Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

PURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.

Anatomical and functional characteristics of the pelvic floor in nulliparous women submitted to three-dimensional endovaginal ultrasonography: case control study and evaluation of interobserver agreement

PURPOSE: To determine anatomical and functional pelvic floor measurements performed with three-dimensional (3-D) endovaginal ultrasonography in asymptomatic nulliparous women without dysfunctions detected in previous dynamic 3-D anorectal ultrasonography (echo defecography) and to demonstrate the interobserver reliability of these measurements. METHODS: Asymptomatic nulliparous volunteers were submitted to echo defecography to identify dynamic dysfunctions, including anatomical (rectocele, intussusceptions, entero/sigmoidocele and perineal descent) and functional changes (non-relaxation or paradoxical contraction of the puborectalis muscle) in the posterior compartment and assessed with regard to the biometric index of levator hiatus, pubovisceral muscle thickness, urethral length, anorectal angle, anorectal junction position and bladder neck position with the 3-D endovaginal ultrasonography. All measurements were compared at rest and during the Valsalva maneuver, and perineal and bladder neck descent was determined. The level of interobserver agreement was evaluated for all measurements. RESULTS: A total of 34 volunteers were assessed by echo defecography and by 3-D endovaginal ultrasonography. Out of these, 20 subjects met the inclusion criteria. The 14 excluded subjects were found to have posterior dynamic dysfunctions. During the Valsalva maneuver, the hiatal area was significantly larger, the urethra was significantly shorter and the anorectal angle was greater. Measurements at rest and during the Valsalva maneuver differed significantly with regard to anorectal junction and bladder neck position. The mean values for normal perineal descent and bladder neck descent were 0.6 cm and 0.5 cm above the symphysis pubis, respectively. The intraclass correlation coefficient ranged from 0.62-0.93. CONCLUSIONS: Functional biometric indexes, normal perineal descent and bladder neck descent values were determined for young asymptomatic nulliparous women with the 3-D endovaginal ultrasonography. The method was found to be reliable to measure pelvic floor structures at rest and during Valsalva, and might therefore be suitable for identifying dysfunctions in symptomatic patients.

Impact of reliability of supply on long-term development approaches to electricity distribution networks

The Finnish electricity distribution sector, rural areas in particular, is facing major challenges because of the economic regulation, tightening supply security requirements and the ageing network asset. Therefore, the target in the distribution network planning and asset management is to develop and renovate the networks to meet these challenges in compliance with the regulations in an economically feasible way. Concerning supply security, the new Finnish Electricity Market Act limits the maximum duration of electricity supply interruptions to six hours in urban areas and 36 hours in rural areas. This has a significant impact on distribution network planning, especially in rural areas where the distribution networks typically require extensive modifications and renovations to meet the supply security requirements. This doctoral thesis introduces a methodology to analyse electricity distribution system development. The methodology is based on and combines elements of reliability analysis, asset management and economic regulation. The analysis results can be applied, for instance, to evaluate the development of distribution reliability and to consider actions to meet the tightening regulatory requirements. Thus, the methodology produces information for strategic decision-making so that DSOs can respond to challenges arising in the electricity distribution sector. The key contributions of the thesis are a network renovation concept for rural areas, an analysis to assess supply security, and an evaluation of the effects of economic regulation on the strategic network planning. In addition, the thesis demonstrates how the reliability aspect affects the placement of automation devices and how the reserve power can be arranged in a rural area network.

Biovoimalaitoksen energiatehokkuuden parantaminen ja osakuorma-ajon optimointi

Energiatehokkuus on nykyaikana yksi tärkeimmistä energiataloudellisista tekijöistä voimalaitosten sähköntuotannossa. Varsinkin yhteistuotantolaitoksissa joissa sähkö on lämpöenergian lisänä saatava sivutuote, sähkön tuotannon optimointi voi merkitä laitostalouden ja yrityksen kannalta huomattavia lisätuloja tai -säästöjä. Kaukaan Voima Oy:n biovoimalaitos on vuonna 2009 kaupalliseen käyttöön valmistunut moderni yhteistuotantolaitos, joka sijaitsee Lappeenrannassa UPM Kaukas sellutehtaan tehdasalueella. Voimalaitos tuottaa kaukolämpöä ja sähköä Lappeenrannan kaupungille sekä prosessihöyryä ja sähköä UPM Kaukaan tehtaille. Tämän työn tavoitteena on tarkastella biovoimalaitoksen omakäyttösähkön kulutusta kuukausitasolla verrattuna laitoksella tuotettavan höyryn määrään sekä etsiä voimalaitokselta kohteita, joiden omakäyttösähkön kulutusta voidaan vähentää vaikuttamatta höyryntuotantoon ja näin parantaa laitoksen energiatehokkuutta ja hyötysuhdetta. Työ rajataan käsittelemään voimalaitoksen apulaitteiden ja -järjestelmien omakäyttösähkön kulutusta. Työssä tarkastellaan vuodenaikojen vaihtelun ja kaukolämmön sekä prosessihöyryn tarpeen muutoksen vaikutusta voimalaitoksen ajomalliin sekä höyryntuotannon ja omakäyttösähkön kulutuksen suhteisiin. Työssä esiin nousseiden kohteiden potentiaaliset sähköenergian säästöt ovat noin 2500 MWh vuodessa joka tarkoittaa keskimäärin 3,7 % vähennystä voimalaitoksen kuukausittaiseen omakäyttösähkön kulutukseen. Kohteet eivät käytännössä vaadi minkaanlaista investointirahaa, vaan uusia ajojärjestelyitä. Keskeisimmiksi säästökohteiksi valikoitui laitoksen pumppausjärjestelmien paineenalennukset.

Comparison of sustainability of technologies for water desalination

The aim of this work is to perform an in-depth overview on the sustainability of several major commercialized technologies for water desalination and to identify the challenges and propose suggestions for the development of water desalination technologies. The overview of those technologies mainly focuses on the sustainability from the viewpoint of total capital investment, total product cost, energy consumption and global warming index. Additionally, a systematic sustainability assessment methodology has been introduced to validate the assessment process. Conclusions are:1) Reverse osmosis desalination (RO) plants are better than multi-stage flash distillation (MSF) desalination plants and multiple-effect distillation (MED) desalination plants from the viewpoint of energy consumption, global warming index and total production cost; 2)Though energy intensive, MSF plants and MED plants secure their advantages over RO plants by lower total capital investment, wider applicability and purer water desalted and they are still likely to flourish in energy-rich area;3) Water production stage and wastewater disposal stage are the two stages during which most pollutant gases are emitted. The water production stage alone contributes approximately 80~90% of the total pollutant gases emission during its life cycle; 4)The total capital cost per m3 desalted water decreases remarkably with the increasing of plant capacity. The differences between the capital cost per m3 desalted water of RO and other desalination plants will decrease as the capacity increases; 5) It is found that utilities costs serve as the major part of the total product cost, and they account for 91.16%, 85.55% and 71.26% of the total product cost for MSF, MED and RO plants, respectively; 6) The absolute superiority of given technology depends on the actual social-economic situation (energy prices, social policies, technology advancements).

Polysulfidiprosessi sulfaattisellutehtaassa

Kandidaatintyön tavoitteena on kartoittaa merkittävimmät muutokset sellutehtaalla siirryttäessä sulfaattimassan valmistuksesta polysulfidiselluprosessiin. Työssä esitellään sulfaattisellun valmistusprosessi ja polysulfidin vaatimat muutokset selluprosessissa erityisesti höyrynkulutuksen kannalta. Sellutehtaan höyrynkulutusta ja sen mahdollisia muutoksia tarkastellaan suhteessa tehtaan selluntuotantoon. Tutkimus tehdään tutustuen dokumenttilähteisiin sekä erityisesti hankkimalla lisätietoa ja käytännön näkemystä asiantuntijahaastatteluista. Työssä käytetään esimerkkinä tyypillistä modernia sellutehdasta, jonka perusteella tarkasteltavat osaprosessit ovat valikoituneet. Sulfaattiprosessiin tehtävät muutokset käsittävät keittolipeän muuttamisen polysulfidipitoiseksi, polysulfidin valmistusprosessin (MOXY) sekä keiton muuttamisen siten, että polysulfidin vaikutus voidaan maksimoida. Polysulfidiprosessi vaikuttaa merkittävästi lipeäkiertoon, keittämöön sekä kuivauskoneeseen. Muilla osastoilla ominaishöyrynkulutuksen odotetaan pysyvän tavanomaista sulfaattiprosessia vastaavalla tasolla. Höyrynkulutuksella on huomattava merkitys modernin sellutehtaan tuotanto- ja kustannustehokkuuteen, sillä säästetyllä ylijäämähöyryllä voidaan tuottaa myyntisähköä. Uusiutuvan energian tuottajana ja ympäristövastuullisena toimijana sellutehtaiden on järkevää pyrkiä vähentämään omaa höyrynkulutustaan ja lisäämään sitä kautta sähköntuotantoaan.

Polysulfidiprosessin vaikutukset höyrynkulutukseen sulfaattisellutehtaassa

Diplomityön tavoitteena on kartoittaa höyrynkulutuksen merkittävimmät muutokset sellutehtaalla siirryttäessä sulfaattimassan valmistuksesta polysulfidiselluprosessiin. Työssä esitellään sulfaattisellun valmistusprosessi ja polysulfidin vaatimat muutokset selluprosessissa erityisesti höyrynkulutuksen kannalta. Sellutehtaan höyrynkulutusta ja sen mahdollisia sekä todennettuja muutoksia tarkastellaan suhteessa tehtaan selluntuotantoon. Diplomityössä analysoidaan muutoksiin johtaneita syitä ja erityisesti peilataan niitä ennalta odotettuihin muutoksiin, joita kandidaatintyö ”Polysulfidiprosessi sulfaattisellutehtaassa” (Szepaniak 2014) esitti kirjallisuuden pohjalta. Tutkimus tehdään tutustuen dokumenttilähteisiin sekä erityisesti hankkimalla lisätietoa ja käytännön näkemystä asiantuntijahaastatteluista. Työssä käytetään esimerkkinä tyypillistä modernia sellutehdasta, jonka perusteella tarkasteltavat osaprosessit ovat valikoituneet. Tutkimustulosten perusteella esitetään jatkotutkimus- ja kehityskohteita. Sulfaattiprosessiin tehtävät muutokset käsittävät keittolipeän muuttamisen polysulfidipitoiseksi, polysulfidin valmistusprosessin (MOXY) sekä keiton muuttamisen siten, että polysulfidin vaikutus voidaan maksimoida. Polysulfidiprosessi vaikuttaa merkittävästi lipeäkiertoon ja keittämöön. Keittämön höyrynkulutus kasvaa, haihduttamon kuorma vähenee ja soodakattilan lämmöntuotanto heikkenee. Muilla osastoilla ominaishöyrynkulutuksen muutokset ovat tilastollisesti merkityksettömiä. Höyrynkulutuksella on huomattava merkitys modernin sellutehtaan tuotanto- ja kustannustehokkuuteen, sillä säästetyllä ylijäämähöyryllä voidaan tuottaa myyntisähköä. Uusiutuvan energian tuottajana ja ympäristövastuullisena toimijana sellutehtaiden on järkevää pyrkiä vähentämään omaa höyrynkulutustaan ja lisäämään sitä kautta sähköntuotantoaan.

Effect of the consumption of tomato paste on plasma prostate-specific antigen levels in patients with benign prostate hyperplasia

The consumption of tomatoes and tomato products has been associated with a reduced risk of prostate cancer. We observed a decrease of 10.77% in prostate-specific antigen (PSA) levels in patients with benign prostate hyperplasia who were submitted to daily ingestion of tomato paste. This was an experimental rather than a controlled study with a sample of 43 men ranging in age from 45 to 75 years, all with histological diagnoses of benign prostate hyperplasia and plasma PSA levels of 4-10 ng/mL. All patients received 50 g of tomato paste once a day for 10 consecutive weeks and PSA levels were analyzed before, during and after the consumption of tomato paste. ANOVA for repeated measures was used to compare PSA levels before, during and after the consumption of tomato paste. The mean ± SD PSA level was 6.51 ± 1.48 ng/mL at baseline and 5.81 ± 1.58 ng/mL (P = 0.005) after 10 weeks. Acceptance was good in 88.3, regular in 9.3, and poor in 2.3% of the patients. Dietary ingestion of 50 g of tomato paste per day for 10 weeks significantly reduced mean plasma PSA levels in patients with benign prostate hyperplasia, probably as a result of the high amount of lycopene in tomato paste. This was not a prostate cancer prevention study, but showed some action of tomato paste in prostate biology. The development of prostate cancer is typically accompanied by an increase in plasma PSA levels, thus any intervention that affects plasma PSA levels can suggest an impact in the progression of disease.

Relationship between pulmonary function and indoor air pollution from coal combustion among adult residents in an inner-city area of southwest China

Few studies evaluate the amount of particulate matter less than 2.5 mm in diameter (PM2.5) in relation to a change in lung function among adults in a population. The aim of this study was to assess the association of coal as a domestic energy source to pulmonary function in an adult population in inner-city areas of Zunyi city in China where coal use is common. In a cross-sectional study of 104 households, pulmonary function measurements were assessed and compared in 110 coal users and 121 non-coal users (≥18 years old) who were all nonsmokers. Several sociodemographic factors were assessed by questionnaire, and ventilatory function measurements including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the FEV1/FVC ratio, and peak expiratory flow rate (PEFR) were compared between the 2 groups. The amount of PM2.5 was also measured in all residences. There was a significant increase in the relative concentration of PM2.5 in the indoor kitchens and living rooms of the coal-exposed group compared to the non-coal-exposed group. In multivariate analysis, current exposure to coal smoke was associated with a 31.7% decrease in FVC, a 42.0% decrease in FEV1, a 7.46% decrease in the FEV1/FVC ratio, and a 23.1% decrease in PEFR in adult residents. The slope of lung function decrease for Chinese adults is approximately a 2-L decrease in FVC, a 3-L decrease in FEV1, and an 8 L/s decrease in PEFR per count per minute of PM2.5 exposure. These results demonstrate the harmful effects of indoor air pollution from coal smoke on the lung function of adult residents and emphasize the need for public health efforts to decrease exposure to coal smoke.

Concomitant stress potentiates the preference for, and consumption of, ethanol induced by chronic pre-exposure to ethanol

Ethanol abuse is linked to several acute and chronic injuries that can lead to health problems. Ethanol addiction is one of the most severe diseases linked to the abuse of this drug. Symptoms of ethanol addiction include compulsive substance intake and withdrawal syndrome. Stress exposure has an important role in addictive behavior for many drugs of abuse (including ethanol), but the consequences of stress and ethanol in the organism when these factors are concomitant results in a complex interaction. We investigated the effects of concomitant, chronic administration of ethanol and stress exposure on the withdrawal and consumption of, as well as the preference for, ethanol in mice. Male Swiss mice (30–35 g, 8-10 per group) were exposed to an ethanol liquid diet as the only source of food for 15 days. In the final 5 days, they were exposed to forced swimming stress. Twelve hours after removal of the ethanol liquid diet, animals were evaluated for ethanol withdrawal by measuring anxiety-related behaviors and locomotor activity. Twenty-four hours after evaluation of ethanol withdrawal, they were evaluated for voluntary consumption of ethanol in a “three-bottle choice” paradigm. Mice exposed to chronic consumption of ethanol had decreased locomotor activity during withdrawal. Contrary to our expectations, a concomitant forced swimming stress did not aggravate ethanol withdrawal. Nevertheless, simultaneous ethanol administration and stress exposure increased voluntary consumption of ethanol, mainly solutions containing high concentrations of ethanol. These results showed that stressful situations during ethanol intake may aggravate specific addiction-related behaviors.

Impact of socio-cultural and economic factors on vegetable consumption behaviours: case of Giresun province, Turkey

Many factors impact on food consumption behaviours. The aim of the study is to determine the impact of socio-demographic and ecological factors on vegetable consumption. A 14-question questionnaire was applied on a voluntary basis to 200 individuals who accepted to participate in the study. Their socio-demographic attributes and the vegetable consumption habits of their families were determined. Their average monthly budget for vegetables is € 31.82±12.72. The two attributes of purchased vegetables with most demand are cleanliness (61.5%) and freshness (22%). The maximum price per 1 kg of vegetables, which individuals with an income of € 301-450 can afford, is € 0.96, but for individuals with an income of > € 450, it is € 1.25. It was observed that the amount of purchased vegetables increased with the increase in the budget allocated for vegetables.

Climate change and global responsibility - the role of energy consumption, GDP and CO2 emissions

Climate change is one of the biggest challenges faced by this generation. Despite being the single most important environmental challenge facing the planet and despite over two decades of international climate negotiations, global greenhouse gas (GHG) emissions continue to rise. By the middle of this century, GHGs must be reduced by as much as 40-70% if dangerous climate change is to be avoided. In the Kyoto Protocol no quantitative emission limitation and reduction commitments were placed on the developing countries. For the planning of the future commitments period and possible participation of developing countries, information of the functioning of the energy systems, CO2 emissions development in different sectors, energy use and technological development in developing countries is essential. In addition to the per capita emissions, the efficiency of the energy system in relation to GHG emissions is crucial for the decision of future long-term burden sharing between countries. Country’s future development of CO2 emissions can be defined by the estimated CO2 intensity of the future and the estimated GDP growth. The changes in CO2 intensity depend on several factors, but generally developed countries’ intensity has been increasing in the industrialization phase and decreasing when their economy shifts more towards the system dominated by the service sector. The level of the CO2 intensity depends by a large extent on the production structure and the energy sources that are used. Currently one of the most urgent issues regarding global climate change is to decide the future of the Kyoto Protocol. Negotiations on this topic have already been initiated, with the aim of being finalised by the 2015. This thesis provides insights into the various approaches that can be used to characterise the concept of comparable efforts for developing countries in a future international climate agreement. The thesis examines the post-Kyoto burden sharing questions for developing countries using the contraction and convergence model, which is one approach that has been proposed to allocate commitments regarding future GHG emissions mitigation. This new approach is a practical tool for the evaluation of the Kyoto climate policy process and global climate change negotiations from the perspective of the developing countries.

Evolution of architectural floor plans

Layout planning is a process of sizing and placing rooms (e.g. in a house) while a t t empt ing to optimize various criteria. Often the r e are conflicting c r i t e r i a such as construction cost, minimizing the distance between r e l a t ed activities, and meeting the area requirements for these activities. The process of layout planning ha s mostly been done by hand, wi th a handful of a t t empt s to automa t e the process. Thi s thesis explores some of these pa s t a t t empt s and describes several new techniques for automa t ing the layout planning process using evolutionary computation. These techniques a r e inspired by the existing methods, while adding some of the i r own innovations. Additional experimenLs are done to t e s t the possibility of allowing polygonal exteriors wi th rectilinear interior walls. Several multi-objective approaches are used to evaluate and compare fitness. The evolutionary r epr e s ent a t ion and requirements specification used provide great flexibility in problem scope and depth and is worthy of considering in future layout and design a t t empt s . The system outlined in thi s thesis is capable of evolving a variety of floor plans conforming to functional and geometric specifications. Many of the resulting plans look reasonable even when compared to a professional floor plan. Additionally polygonal and multi-floor buildings were also generated.

The relationship between fructose consumption and risk of obesity in two Aboriginal populations

Résumé La prédominance de l'obésité qui touche les enfants et les adultes a augmenté dans le monde entier ces dernières décennies. Les différentes études épidémiologiques ont prouvé que l'obésité est devenue une préoccupation profonde de santé aux États-Unis et au Canada. Il a été montré que l'obésité a beaucoup d’effets sur la santé ainsi il serait important de trouver différentes causes pour le gain de poids. Il est clair que l'obésité soit la condition de multiples facteurs et implique des éléments génétiques et environnementaux. Nous nous concentrons sur les facteurs diététiques et particulièrement le fructose où sa consommation a parallèlement augmenté avec l'augmentation du taux d'obésité. La forme principale du fructose est le sirop de maïs à haute teneur en fructose (HFCS) qui est employé en tant qu'édulcorant primordial dans la plupart des boissons et nourritures en Amérique du Nord. Il a été suggéré que la prise du fructose serait probablement un facteur qui contribue à l’augmentation de la prédominance de l'obésité. L'objectif de cette étude était d'évaluer s'il y a un rapport entre la consommation du fructose et le risque d'obésité. Nous avons travaillé sur deux bases de données des nations Cree et Inuit. Nous avons eu un groupe de 522 adultes Cree, (263 femmes et 259 hommes) dans deux groupes d'âge : les personnes entre 20 et 40 ans, et les personnes de 40 à 60 ans. Nous les avons classés par catégorie en quatre groupes d'indice de masse corporelle (IMC). L'outil de collecte de données était un rappel de 24 heures. En revanche, pour la base de données d'Inuit nous avons eu 550 adultes (301 femmes et 249 hommes) dans deux groupes d'âge semblables à ceux du Cree et avec 3 catégories d’indice de masse corporelle. Les données dans la base d'Inuit ont été recueillies au moyen de deux rappels de 24 heures. Nous avons extrait la quantité de fructose par 100 grammes de nourriture consommés par ces deux populations et nous avons créé des données de composition en nourriture pour les deux. Nous avons pu également déterminer les sources principales du fructose pour ces populations. Aucun rapport entre la consommation du fructose et l’augmentation de l’indice de masse corporelle parmi les adultes de Cree et d'Inuit n’a été détecté. Nous avons considéré l’apport énergétique comme facteur confondant potentiel et après ajustement, nous avons constaté que l'indice de masse corporelle a été associé à l’apport énergétique total et non pas à la consommation du fructose. Puisque dans les études qui ont trouvé une association entre la consommation de fructose et l’obésité, le niveau de la consommation de fructose était supérieure à 50 grammes par jour et comme dans cette étude ce niveau était inférieur à cette limite (entre 20.6 et 45.4 g/jour), nous proposons que des effets negatifs du fructose sur la masse corporelle pourraient être testés dans des populations à plus haute consommation. Les essais cliniques randomisés et éventuelles études cohortes avec différents niveaux de consommation de fructose suivis à long terme pourraient aussi être utiles. Mots clés : fructose, sirop de maïs à haute teneur en fructose (HFCS), obésité et poids excessif