A Sustainable Water Resources Management Assessment Framework (SWRM-AF) for Arid and Semi-Arid Regions:Part 1: Developing the Conceptual Framework

The evaluation of water resources management practices is essential for water usage decisions in regions with limited water resources. The literature provides numerous assessment frameworks, but many ignore the unique characteristics and conditions of some special arid and semi-arid regions, such as the Gulf Cooperation Council (GCC) countries, which lack any permanent rivers or lakes. Thus, this study, the first in a two-part series, seeks to develop a conceptual Sustainable Water Resources Management Assessment Framework (SWRM-AF). General and particular criteria explain how components and indicators were identified. The conceptual SWRM-AF provided here has four components (environment, economy, society, and infrastructure) and 24 indicators. Almost every indicator has been selected from the literature and is briefly explained and justified. This research presents, possibly for the first time, clear and straightforward directions for evaluating each indicator in colour-coded tables. To create a more holistic framework for arid and semi-arid regions, social indicators like “intervention acceptability” and environmental indicators for assessing the impacts of desalination treatment plants have been added to form a unique framework applicable to such regions. Therefore, the components and indicators of conceptual SWRM-AF could work collectively to aid the process of decision-making. The next phase is validating this framework using a participatory approach

In Vivo Evaluation of Cervical Stiffness Evolution during Induced Ripening Using Shear Wave Elastography, Histology and 2 Photon Excitation Microscopy: Insight from an Animal Model

Prematurity affects 11% of the births and is the main cause of infant mortality. On the opposite case, the failure of induction of parturition in the case of delayed spontaneous birth is associated with fetal suffering. Both conditions are associated with precocious and/or delayed cervical ripening. Quantitative and objective information about the temporal evolution of the cervical ripening may provide a complementary method to identify cases at risk of preterm delivery and to assess the likelihood of successful induction of labour. In this study, the cervical stiffness was measured in vivo in pregnant sheep by using Shear Wave Elastography (SWE). This technique assesses the stiffness of tissue through the measurement of shear waves speed (SWS). In the present study, 9 pregnant ewes were used. Cervical ripening was induced at 127 days of pregnancy (term: 145 days) by dexamethasone injection in 5 animals, while 4 animals were used as control. Elastographic images of the cervix were obtained by two independent operators every 4 hours during 24 hours after injection to monitor the cervical maturation induced by the dexamethasone. Based on the measurements of SWS during vaginal ultrasound examination, the stiffness in the second ring of the cervix was quantified over a circular region of interest of 5 mm diameter. SWS was found to decrease significantly in the first 4–8 hours after dexamethasone compared to controls, which was associated with cervical ripening induced by dexamethasone (from 1.779 m/s ± 0.548 m/s, p < 0.0005, to 1.291 m/s ± 0.516 m/s, p < 0.000). Consequently a drop in the cervical elasticity was quantified too (from 9.5 kPa ± 0.9 kPa, p < 0.0005, to 5.0 kPa ± 0.8 kPa, p < 0.000). Moreover, SWE measurements were highly reproducible between both operators at all times. Cervical ripening induced by dexamethasone was confirmed by the significant increase in maternal plasma Prostaglandin E2 (PGE2), as evidenced by the assay of its metabolite PGEM. Histological analyses and two-photon excitation microscopy, combining both Second Harmonic Generation (SHG) and Two-photon Fluorescence microscopy (2PF) contrasts, were used to investigate, at the microscopic scale, the structure of cervical tissue. Results show that both collagen and 2PF-active fibrillar structures could be closely related to the mechanical properties of cervical tissue that are perceptible in elastography. In conclusion, SWE may be a valuable method to objectively quantify the cervical stiffness and as a complementary diagnostic tool for preterm birth and for labour induction success

Objective assessment of cervical stiffness after administration of misoprostol for intrauterine contraceptive insertion

PURPOSE The goal of this study was to objectively quantify cervical stiffness in misoprostol users prior to IUC insertion and at follow-up consultation to evaluate the feasibility of assessing cervical stiffness and to study the influence of misoprostol on cervical softening. MATERIALS AND METHODS This was a cross-sectional study that evaluated 40 women who wished to use the LNG IUS. These women were evaluated immediately before LNG IUS insertion and 6 weeks later at follow-up consultation. Participants received 200 μg of misoprostol combined with 75 mg of diclofenac in a single tablet orally (Arthrotec forte 75/200(®), Pfizer, USA) 6-12 h prior to insertion in "off label" use. On both occasions, cervical stiffness was determined using a novel medical device based on the aspiration technique. The Wilcoxon rank-sum and the Wilcoxon signed-rank test were applied to compare cervical stiffness assessments at insertion of the IUD and at follow-up. RESULTS For the first time, cervical stiffness was quantitatively assessed in misoprostol users prior to IUD insertion, proving that the aspiration technique enables detection of pharmacologically induced cervical changes, and also that misoprostol has a detectable softening effect on cervical tissue. CONCLUSION The clinical value of the detected cervical softening after misoprostol administration remains unclear. Aspiration measurements could be helpful in searching for the ideal candidate, the appropriate route, dosage and interval of misoprostol intake prior to IUC insertion

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Fundus thickness assessment by 3D transvaginal ultrasound allows metrics-based diagnosis and treatment of congenital uterine anomalies

Purpose: The development of a metric fundus assessment and definition of the uterine fundus thickness (FTH) for supporting objective diagnosis and treatment of congenital uterine anomalies (CUAs). Materials and Methods: A) In a prospective cohort study, FTH was systematically assessed by 3 D transvaginal ultrasound (TVS) in patients, who presented a normal uterus. B) The mean normal FTH recorded was applied to uteri with fundal protrusions and septations, and compared to two CUA classification systems (ASF and ESHRE/ESGE). C) FTH was studied for preoperative metric planning and evaluation of the postoperative outcome. Results: A) From August 2013 to January 2014, FTH was assessed in 100 normal uteri. An FTH of 12.02 +/- 2.03 mm (mean +/- SD) was recorded. B) Evaluating the 8 detected abnormal uteri, excellent correlation with the new ESHRE/ESGE classification system was observed, taking an FTH of 12 mm as the overall normal FTH equivalent to the individual normal wall thickness (WTH) stipulated in the classification and an FTH of 18 mm as the WTH + 50 %, serving as a cut-off value of (abnormal) septation. C) Metric fundus assessment was initially applied before and after septum resection and the following pregnancy could be monitored. Conclusion: An FTH measurement in 3 D TVS paves the way for metric fundus diagnostics. This objectively distinguishes normal from abnormal fundi. It also has the potential to support accurate septum resection planning and objective postoperative evaluation. The value of the fundus assessment and metrics proposed in this study is not known. It should be investigated in prospective randomized controlled trials

Sustainable water resources management assessment frameworks (SWRM-AF) for arid and semi-arid regions:a systematic review

Sustainable water resources management assessment frameworks (SWRM-AF) with associated indicators and benchmarks have appeared widely during the last decades to improve or maintain water resources. Examination or evaluation of their appropriateness and refinement for particular arid and semi-arid regions is a relatively unexplored area. To fill this gap in knowledge, a systematic review of relevant 21st century studies identified within two extensive databases, Scopus and Engineering Village, and in grey literature, is undertaken in this study. Therein, 17 studies are identified and thoroughly explored to identify their focus, application, and framework construction. The results of the comparative analysis among these frameworks show that the average numbers of components and indicators are 4.5 and 17.6, respectively. Meanwhile, categorical rescaling (47.1%), equal weighting (47.1%), arithmetic technique (82.35%), local scale (52.8%), and interval of the final index value of [0&ndash;100] (41.2%) are the most commonly used normalization methods and elements. The paper concludes that none of the existing tools reviewed is 100% applicable for arid and semi-arid regions, and therefore the case is made for developing a new bespoke SWRM-AF. The outcomes of this paper provide some useful insights into what should be included therein (e.g., stakeholder engagement and specific indicators to fit the context)

Measuring the in vivo behavior of soft tissue and organs using the aspiration device

The aspiration technique is used to characterize the mechanical behavior of soft human tissues. This method has been applied intra-operatively on human liver as well as on the uterine cervix during gestation. Further applications are on other abdominal organs as well as on the vaginal wall. The experimental set-up, the measurement protocol and the procedure for data analysis are described in this paper. Application on human organs aimed at (i) tissue classification towards development of novel diagnostic procedures, and (ii) determining constitutive models of soft biological tissue. The first goal is achieved using scalar parameters extracted from pressure and deformation profile histories. Determination of parameters for non-linear time dependent constitutive model formulations requires solving the inverse problem. Observations from on-going and recently completed clinical studies on liver, uterine cervix and vaginal wall are summarized in order to illustrate advantages and limitations of the aspiration technique

Attitudes of Turkish nursing students toward elderly people

WOS: 000355558900013Purpose: This study was conducted to determine the attitudes of nursing students towards elderly people. Methods: The study was carried out in a cross-sectional and descriptive design. The Turkish version of UCLA-GA Scale was used to evaluate attitudes towards older people among 931 students attending four schools of nursing located in Aegean, Mediterranean, Marmara regions and Istanbul in Turkey. Results: Mean score of UCLA-GA scale was 48.64 +/- 5.51 (min: 22, max: 64). Female students were found to have more positive attitudes than male students (t = 2.709, P < 0.05), those who have an elderly relative than those who do not (t = 2.671, P < 0.05), those who want to live with an elderly family member than those who do not (t = 6.374, P < 0.05), and those who want to work at a unit offering care to the elderly after graduation than those who do not (t = 5.259, P < 0.05). Conclusion: Positive attitudes towards ageism were affected by variables such as: sex, willingness to live with aged parents after starting a family, work with older people after graduation and whether they had previously or currently lived with an aged relative. (C) 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved