Comparison of single-incision mini-slings (Ajust) and standard transobturator midurethral slings (Align) in the management of female stress urinary incontinence: A 1-year follow-up

AbstractObjectiveTo investigate the effectiveness and safety of a new single-incision mini-sling (SIMS)—Ajust—compared with the standard transobturator midurethral sling (SMUS)—Align—for the treatment of female stress urinary incontinence (SUI).Materials and MethodsA retrospective cohort study was conducted between January 1, 2010 and August 31, 2012. Women with SUI who underwent either SMUS-Align or SIMS-Ajust were recruited. The primary outcomes included operation time, estimated operative blood loss, postoperative pain, and complications. The secondary outcomes included subjective and objective success, defined as an International Consultation on Incontinence Questionnaire (ICIQ) score of 0 or improvement as felt by the patient and a long-term complication, such as dyspareunia and mesh erosion after 6 months and 12 months of follow-up.ResultsA total of 136 patients were enrolled, including 76 receiving SMUS-Align and 60 receiving SIMS-Ajust. Baseline characteristics of the patients in both groups were similar, without a statistically significant difference. Primary outcomes between both groups were similar, except that women treated with SIMS-Ajust had statistically significantly shorter operation time (p = 0.003), less intent to treat (p < 0.05), and earlier postoperative discharge (p = 0.001) than women treated with SMUS-Align. Secondary outcomes were similar without a significant difference between the two groups (93% vs. 88% success rate in each group).ConclusionOur results showed that SIMS-Ajust was not inferior to SMUS-Align with respect to success rate, and might have a slight advantage in early discharge. A long-term follow-up or prospective study is needed to confirm the above findings

The resource demands and water stress of cities: A study of the U.S. urban food-energy-water nexus

Urbanization and population growth increase demands for commodities such as food, energy, and water in cities. Energy and food production depend on water resources, and piped treated water and wastewater systems depend on energy resources, representing aspects of the food-energy-water nexus. Because water resources are used outside of cities to produce the goods that are eventually consumed in cities, the water stress of cities is impacted by local water shortages and indirectly by physical water stress in locations in the supply chain. As a result, determining cities' consumption of resources and their implications can act as a powerful tool in informing resource managers and policy makers. The main research question in this work is: How can the resource usage of cities be quantified, and what are the implications associated with these urban resource flows? In this work, the local and indirect water stress of 69 metropolitan statistical areas (MSAs) within the contiguous United States is determined and compared. In addition, electricity-water interdependencies are further broken down at an urban scale by spatially and temporally quantifying direct and indirect water and electricity consumption for households in the urban area of Chicago, Illinois, USA. This analysis synthesizes data of various sources and resolutions and can act as a decision-support tool in advancing food-energy-water nexus literature and informing nexus-related policy. The urban direct and indirect water stress quantification results show that cities typically import commodities from nearby locations with similar water resource constraints, and generally have similar local and indirect water stress. In particular, cities in the Western United States have stressed local water resources and also import commodities from water-stressed locations. Individual contributions of food, fuel, and electricity imports to urban water stress vary from city to city, and do not necessarily reflect their geographical locations. The quantification of Chicago's electricity-water nexus highlights that the direct consumption of water and electricity greatly exceed their respective indirect consumption when considering the urban electricity-water nexus. In addition, while direct electricity consumption and drinking water consumption are largest in the summer (June-August), wastewater treated and its associated indirect electricity peak during the spring (March-May). While the area's electricity provider has installed smart electricity meters, Chicago's water sector has comparatively lagged in advances, struggling with challenges of limited drinking water withdrawals from Lake Michigan and massive gray infrastructure investment and overflow restrictions with a combined sewer system. This work quantifies resource flows and their interdependencies in the urban environment, and can be used as a decision-making basis in future resource management initiatives and policy making

The resource demands and water stress of cities: A study of the U.S. urban food-energy-water nexus

Urbanization and population growth increase demands for commodities such as food, energy, and water in cities. Energy and food production depend on water resources, and piped treated water and wastewater systems depend on energy resources, representing aspects of the food-energy-water nexus. Because water resources are used outside of cities to produce the goods that are eventually consumed in cities, the water stress of cities is impacted by local water shortages and indirectly by physical water stress in locations in the supply chain. As a result, determining cities' consumption of resources and their implications can act as a powerful tool in informing resource managers and policy makers. The main research question in this work is: How can the resource usage of cities be quantified, and what are the implications associated with these urban resource flows? In this work, the local and indirect water stress of 69 metropolitan statistical areas (MSAs) within the contiguous United States is determined and compared. In addition, electricity-water interdependencies are further broken down at an urban scale by spatially and temporally quantifying direct and indirect water and electricity consumption for households in the urban area of Chicago, Illinois, USA. This analysis synthesizes data of various sources and resolutions and can act as a decision-support tool in advancing food-energy-water nexus literature and informing nexus-related policy. The urban direct and indirect water stress quantification results show that cities typically import commodities from nearby locations with similar water resource constraints, and generally have similar local and indirect water stress. In particular, cities in the Western United States have stressed local water resources and also import commodities from water-stressed locations. Individual contributions of food, fuel, and electricity imports to urban water stress vary from city to city, and do not necessarily reflect their geographical locations. The quantification of Chicago's electricity-water nexus highlights that the direct consumption of water and electricity greatly exceed their respective indirect consumption when considering the urban electricity-water nexus. In addition, while direct electricity consumption and drinking water consumption are largest in the summer (June-August), wastewater treated and its associated indirect electricity peak during the spring (March-May). While the area's electricity provider has installed smart electricity meters, Chicago's water sector has comparatively lagged in advances, struggling with challenges of limited drinking water withdrawals from Lake Michigan and massive gray infrastructure investment and overflow restrictions with a combined sewer system. This work quantifies resource flows and their interdependencies in the urban environment, and can be used as a decision-making basis in future resource management initiatives and policy making.U of I OnlyAuthor requested U of Illinois access only (OA after 2yrs) in Vireo ETD syste

Unveiling the dynamic of water-electricity conflict within and beyond megacity boundary

Electricity demand in megacities may exert substantial stress on water resources, which is often expressed through the water scarcity footprint for electricity consumption (WSFE). Conversely, water scarcity may constrain electricity production, leading to increased vulnerability for megacities electricity production. The WSFE and the water related vulnerability of electricity production reflect two aspects of water-electricity conflict. This varies over time by both the amount and location of electricity production. However, no studies have conducted time-series analysis to evaluate the trends of these two indicators, both in terms of severity and spatial characteristics. Our study focused on evaluating trends in water-electricity conflict both within and beyond megacity administrative boundaries. China's four provincial-level megacities, i.e. Beijing, Tianjin, Shanghai and Chongqing, were chosen as case studies. The results show that water related vulnerability of electricity production in Tianjin, Beijing, Shanghai and Chongqing was diverse and can be classified as extreme, severe, moderate and minor, respectively. Between 2006 and 2016, the WSFE of Tianjin experienced an increasing trend, and its water related vulnerability of electricity production remained at the highest level. Beijing's WSFE has decreased, but its water related vulnerability of electricity production has increased. These differing trends highlight the need for joint reductions to both WSFE and water related vulnerability of electricity production in mitigating water-electricity conflict

Evaluating the vulnerability of physical and virtual water resource networks in China's megacities

The water resource networks that provide water for urban consumption consists not only of physical water supply, but also water embodied in imported goods and services i.e. virtual water supply or external water footprint. However, it remains unknown that if relying on external water footprint will increase or decrease the vulnerability of cities’ water resource networks. Here, we evaluate the vulnerability of urban water resource networks for China's six megacities i.e. Beijing, Tianjin, Shanghai, Chongqing, Guangzhou, and Shenzhen. The vulnerability index was developed through combining a refined multi-region input-output table with both water footprint and water scarcity footprint analysis. The results showed that megacities need to import large volumes of virtual water embodied in food related sectors to balance their physical water shortages. The external blue water footprint (BWF) of the six megacities accounted for 80.7% of their total BWF, and was almost twice their physical water supply. The large share of external BWF helped Beijing, Tianjin, and Shanghai, which suffer extreme water stress in their urban areas, to decrease their total vulnerability by 39%, 33%, and 28% respectively, but conversely increase their vulnerability to external water shortages i.e. indirect vulnerability. Establishing megacity physical and virtual water resource networks based on input-output analysis provides an opportunity for urban water planners to internalize the risk of their external water footprint. Avoiding import water-intensive products from regions suffering extreme water stress, or managing indirect vulnerability through cooperation with those regions are suggested as viable water management approaches