Using the Herschel-Bulkley Consistency Index to Characterise Complex Biopolymer Systems-The Effect of Screening.

The use of the consistency index, as determined from fitting rheological data to the Herschel-Bulkley model, is described such that it may yield systematic trends that allow a very convenient description of the dissipative flow properties of linear and branched (bio)polymers in general, both in molecular and weakly associated supramolecular solutions. The effects of charge-mediated interactions by the systematic variation of the ionic strength and hydrogen bonding by a systematic variation in pH, using levels that are frequently encountered in systems used in practice, is investigated. These effects are then captured using the associated changes in the intrinsic viscosity to highlight the above-mentioned trends, while it also acts as an internal standard to describe the data in a concise form. The trends are successfully captured up to 100 times the polymer coil overlap and 100,000 times the solvent viscosity (or consistency index). These results therefore enable the rapid characterization of biopolymer systems of which the morphology remains unknown and may continue to remain unknown due to the wide-ranging monomer diversity and a lack of regularity in the structure, while the macromolecular coil size may be determined readily.

Performance of the First-Trimester Cervical Consistency Index to Predict Preterm Birth.

Background/Objectives: Preterm birth (PTB) remains a significant global health challenge. Previous attempts to predict preterm birth in the first trimester using cervical length have been contradictory. The cervical consistency index (CCI) was introduced to quantify early cervical changes and has shown promise across various clinical scenarios in the mid-trimester, though testing in the first trimester is lacking. This study aims to assess the cervical consistency index performance in predicting preterm birth during the first trimester of pregnancy. Methods: In this prospective cohort study, focused exclusively on research, women with singleton pregnancies, both with and without a history of spontaneous preterm birth (sPTB), were included. The primary outcome was sPTB before 37 weeks, with a secondary outcome of sPTB before 34 weeks. CCI measurements were taken between 11+0 to 13+6 weeks of gestation. Receiver operating characteristic (ROC) curves were generated, and sensitivity and specificity were calculated for the optimal cut-off and for the 5th, 10th, and 15th percentile. Intraobserver and interobserver agreements were assessed using the intraclass correlation coefficient (ICC). Results: Among the 667 patients analyzed, the rates of sPTB before 37 and 34 weeks were 9.2% (61/667) and 1.8% (12/667), respectively. The detection rates (DRs) for CCI predicting PTB before 37 and 34 weeks were 19.7% (12/61) and 33.3% (4/12). Negative predictive values were 91.8% (546/595) and 98.7% (588/596), while the areas under the curve (AUC) for sPTB before 37 and 34 weeks were 0.62 (95% CI: 0.54-0.69) and 0.80 (95% CI: 0.71-0.89), respectively. Of the 61 patients with preterm birth, 13 (21.3%) had a preterm birth history; in this group, the CCI percentile 10th identified 39% (5/13). Intraobserver ICC was 0.862 (95% CI: 0.769-0.920), and interobserver ICC was 0.833 (95% CI: 0.722-0.902). Conclusions: This study suggests that utilizing CCI in the first trimester of pregnancy could serve as a valuable tool for predicting preterm birth before 34 weeks of gestation, demonstrating robust intraobserver and interobserver reliability.

Prediction of Preterm Birth with Serial Measurements of Ultrasound Markers.

To compare the ability of cervical length (CL), anterior cervical angle (ACA), and cervical consistency index (CCI) to predict premature birth. METHODS: This prospective study involved 85 pregnant women who gave birth prematurely and a control group of 31 pregnant women who gave birth at term. The study was performed in the Obstetrics and Gynecology Clinic of the Municipal Clinical Hospital Filanthropia Craiova between January 1, 2019, and January 1, 2022. Cases were examined using transvaginal ultrasonography (TVU) in the second and third trimesters of pregnancy, and cervical length (CL), Anterior Cervical Angle (ACA), and Cervical Consistency Index (CCI) were measured. RESULTS: The mean value from the three measurements at all three parameters was statistically significant with preterm birth (p<0.05). Cervical length <25mm, was highly significant in the prediction of preterm labor with a sensitivity of 99%, specificity of 61%, positive predictive value (PPV) of 78%, negative predictive value (NPV) of 97 %, and a positive likelihood ratio (LR+) of 2.54 and negative likelihood ratio (LR-) of 0.02. CCI also remains, despite low specificity and PPV values, a potential predictive parameter in the prediction of preterm birth, with a sensitivity of 73%, NPV of 92% and a LR+of 1.32 and LR- of 0.6 also correlated with CL, CCI being more difficult to interpret as an independent predictive parameter. CONCLUSIONS: CL remains the standard parameter for predicting the preterm birth, but in combination with other parameters, the prediction rate can increase significantly.

Rheological and Viscoelastic Properties of Chitosan Solutions Prepared with Different Chitosan or Acetic Acid Concentrations.

Chitosan (Ch) is a partially crystalline biopolymer, insoluble in pure water but soluble in acid solutions. It has attracted interest from researchers to prepare solutions using different acid types and concentrations. This research aims to study both the effect of chitosan (Ch) or acetic acid (Ac) concentrations, at different temperatures, on rheological and viscoelastic properties of Ch solutions. To study the effect of Ch, solutions were prepared with 0.5−2.5 g Ch/100 g of solution and Ac = 1%, whereas to study the effect of Ac, the solutions were prepared with 2.0 g of Ch/100 g of solution and Ac = 0.2−1.0%. Overall, all analyzed solutions behaved as pseudoplastic fluid. The Ch strongly affected rheological properties, the consistency index (K) increased and the index flow behavior (n) decreased as a function of Ch. The activation energy, defined as the energy required for the molecule of a fluid to move freely, was low for Ch = 0.5%. The effect of Ac was less evident. Both K and n varied according to a positive and negative, respectively, parabolic model as a function of Ac. Moreover, all solutions, irrespective of Ch and Ac, behaved as diluted solutions, with G" > G'. The relaxation exponent (n") was always higher than 0.5, confirming that these systems behaved as a viscoelastic liquid. This n" increased with Ch, but it was insensitive to Ac, being slightly higher at 45 °C.

Polymer-Solvent Interactions in Modified Starches Pastes-Electrokinetic, Dynamic Light Scattering, Rheological and Low Field Nuclear Magnetic Resonance Approach.

Starch paste is a very complex dispersion that cannot be clearly classified as a solution, colloid or suspension and many factors affects its properties. As these ambiguities constitute a barrier to technological development, the aim of this study was to investigate the interaction of starch macromolecules with water by analysing the results of rheological properties, low field nuclear magnetic resonance (LF NMR), dynamic light scattering (DLS) and ζ potential analyses. Starch pastes with a concentration of 1%, prepared with distilled water and buffered to pH values of 2.5, 7.0 and 9.5 were analysed. It was proved that the pH buffering substantially decreased the values of consistency index but the pH value itself was not significant. LF NMR studies indicated that the dissolution of starch in water resulted in a reduction in spin-lattice as well as spin-spin relaxation times. Moreover, changes in relaxation times followed the patterns observed in rheological studies. Electrokinetic and DLS analyses showed that potential values are primarily influenced by the properties of the starches themselves and, to a lesser extent, by the environmental conditions. The conducted research also showed complementarity and, to some extent, substitutability of the applied research methods as well as exclusion chromatography (a method not used in this work).

Prioritizing intervention measures to prevent inappropriate self-medication practices using the Analytical Hierarchy Process.

Background: United Nations Sustainable Development Goal 3 outlines the target of reducing premature mortality from non-communicable diseases by one third through prevention and treatment by 2030. In low and middle-income countries (LMICs) like Nepal, a significant number of people do not have accessible and affordable healthcare services available to them, leading to self-medication practices (SMP). Limited numbers of health professionals, ineffective regulation and easy availability of prescription medicines encourage the use of inappropriate SMP, which could result in health risks. Objectives: The objection of the study is to test the application of Analytical Hierarchy Process (AHP) for prioritizing the intervention measures for preventing inappropriate SMP. Methods: The 25 experts were included in the study, out of which only 16 experts passed the consistency test. Data were collected using a structured questionnaire by the application of AHP model for ranking the intervention measures for preventing inappropriate SMP from March 2020 to May 2020. During this process, the purposively selected experts compared seven intervention measures based on three criteria: control use of prescription and non-prescription medicine, knowledge regarding the medicine and its use, and minimizing healthcare cost. Result: The criteria, "control use of prescription and non-prescription medicine" was judged 3.58 times and 1.53 times more important than to "minimize the healthcare cost" and "knowledge regarding the medicine and its use" respectively. "Regulation of prescription and non-prescription dispensing practice" was the most prioritized intervention measure to prevent inappropriate SMP with a priority score of 20.68% followed by the "accessibility of healthcare system" (19.27%) and "awareness program for the consumers" (17.13%). Conclusion: The AHP method can be used in decision-making related to prioritizing the intervention measures to prevent inappropriate SMP. Among the seven intervention measures considered, "regulation of prescription and non-prescription dispensing practice" was the most preferred intervention measure to improve SMP followed by "access to healthcare" and an "awareness program".

Incorporating Glucose Variability into Glucose Forecasting Accuracy Assessment Using the New Glucose Variability Impact Index and the Prediction Consistency Index: An LSTM Case Example.

BACKGROUND: In this work, we developed glucose forecasting algorithms trained and evaluated on a large dataset of free-living people with type 1 diabetes (T1D) using closed-loop (CL) and sensor-augmented pump (SAP) therapies; and we demonstrate how glucose variability impacts accuracy. We introduce the glucose variability impact index (GVII) and the glucose prediction consistency index (GPCI) to assess the accuracy of prediction algorithms. METHODS: A long-short-term-memory (LSTM) neural network was designed to predict glucose up to 60 minutes in the future using continuous glucose measurements and insulin data collected from 175 people with T1D (41,318 days) and evaluated on 75 people (11,333 days) from the Tidepool Big Data Donation Dataset. LSTM was compared with two naïve forecasting algorithms as well as Ridge linear regression and a random forest using root-mean-square error (RMSE). Parkes error grid quantified clinical accuracy. Regression analysis was used to derive the GVII and GPCI. RESULTS: The LSTM had highest accuracy and best GVII and GPCI. RMSE for CL was 19.8 ± 3.2 and 33.2 ± 5.4 mg/dL for 30- and 60-minute prediction horizons, respectively. RMSE for SAP was 19.6 ± 3.8 and 33.1 ± 7.3 mg/dL for 30- and 60-minute prediction horizons, respectively; 99.6% and 97.6% of predictions were within zones A+B of the Parkes error grid at 30- and 60-minute prediction horizons, respectively. Glucose variability was strongly correlated with RMSE (R≥0.64, P < 0.001); GVII and GPCI demonstrated a means to compare algorithms across datasets with different glucose variability. CONCLUSIONS: The LSTM model was accurate on a large real-world free-living dataset. Glucose variability should be considered when assessing prediction accuracy using indices such as GVII and GPCI.

Índice de consistencia cervical o longitud cervical en la predicción de parto pretérmino inminente en pacientes sintomáticas / Cervical consistency index or cervical length in predicting imminent preterm delivery in symptomatic patients

OBJETIVO: Comparar el índice de consistencia cervical con la longitud cervical en la predicción de parto pretérmino inminente en pacientes sintomáticas. MÉTODO: Estudio prospectivo realizado en mujeres con embarazos únicos entre 24 y 35 semanas, con diagnóstico clínico de amenaza de parto pretérmino, que asistieron al Hospital Central Dr. Urquinaona en Maracaibo, Venezuela. Al momento del diagnóstico, las pacientes fueron evaluadas con ecografía transvaginal para establecer los valores del índice de consistencia cervical y la longitud cervical. La resultante principal fue parto inminente (en los 7 días siguientes a la evaluación). RESULTADOS: Se incluyeron 657 pacientes, de las que 152 presentaron parto pretérmino inminente (grupo A) y 505 fueron consideradas como controles (grupo B). No se encontraron diferencias entre los grupos en cuanto a edad materna, nuliparidad, antecedente de parto pretérmino, antecedente de hábito tabáquico e índice de masa corporal. Las pacientes del grupo A presentaron valores significativamente más bajos del índice de consistencia cervical y de longitud cervical que las del grupo B (p < 0,0001). El índice de consistencia cervical mostró un valor de área bajo la curva de 0,857, mientras que para la longitud cervical este fue de 0,977. La diferencia de la capacidad de discriminación entre las áreas bajo la curva de cada prueba fue significativa (p < 0,0001). CONCLUSIÓN: El índice de consistencia cervical no es superior a la longitud cervical en la predicción de parto pretérmino inminente en pacientes sintomáticas.

OBJECTIVE: To compare the cervical consistency index with the cervical length in predicting imminent preterm delivery in symptomatic patients. METHOD: This prospective study was conducted in women with single pregnancies between 24 and 35 weeks, with a clinical diagnosis of threatened preterm delivery who attended the Central Hospital Dr. Urquinaona, in Maracaibo, Venezuela. At the time of diagnosis, the patients were evaluated using transvaginal ultrasound to establish the values of the cervical consistency index and cervical length. The main result was imminent delivery (in the 7 days following the evaluation). RESULTS: 657 patients were included, 152 women presented imminent preterm delivery (group A) and 505 were considered as controls (group B). No differences were found between the groups concerning maternal age, nulliparity, history of preterm delivery, history of smoking, and body mass index. Group A patients presented significantly lower values of cervical consistency index and cervical length compared to group B patients (p < 0.0001). The cervical consistency index and cervical length showed an area value under the curve of 0.857 and 0.977, respectively. The difference in the ability to discriminate between the areas under the curve of each test was significant (p < 0.0001). CONCLUSIONS: The cervical consistency index is not superior to the cervical length in the prediction of imminent preterm delivery in symptomatic patients.

Prediction of preterm birth and adverse perinatal outcomes after cervical pessary placement in singleton pregnancies with short cervical length.

OBJECTIVES: To identify ultrasound-assessed cervical characteristics, modified after pessary placement, which could be predictive of spontaneous preterm birth (sPTB) at < 34 weeks of gestation (WG) or severe adverse perinatal outcomes (APO). STUDY DESIGN: This prospective observational study conducted at Vall d'Hebron Universitary Hospital assessed multiple cervical characteristics in women with short cervical length (CL). All participants were examined by transvaginal ultrasound before and immediately after a cervical pessary was placed. Cervical assessment included CL, uterocervical angles (UCA), and cervical consistency indexes (cervical consistency index (CCI) and cervical length consistency index (CLCI)). Pregnancy outcomes were recorded to determine the capacity of these variables for predicting sPTB at < 34 WG and severe APO. RESULTS: Thirty-one women with short CL, 17 (54.8%) with asymptomatic midtrimester short CL, and 14 (45.2%) after arrested threatened preterm labor were enrolled. After pessary placement, transvaginal ultrasound detected four participants in whom the pessary was not correctly placed around the cervix (12.9%); additionally, significant changes were observed in most cervical baseline characteristics, with CL, anterior UCA (A-UCA), CLCI, and intersegmentary angle (ISA) being predictive of sPTB at <34 WG and severe APO. Receiver operator curves were calculated to compare the predictive capacity of these variables, with CL and A-UCA after pessary placement being the best predictive parameters with an area under the curve of 0.88 and 0.87, respectively. CONCLUSIONS: Transvaginal ultrasound after pessary placement detects incorrect pessary placement after pessary insertion and during follow-up. APO and sPTB can be predicted by measuring CL, A-UCA, CLCI, and ISA immediately after pessary placement, being CL and A-UCA more accurate and easier to be measured. Our results help to better identify women in whom the pessary is more likely to fail. Further research is required to assess the effectiveness of applying alternative, sequential or additional treatments to reduce prematurity and our results could be considered when designing such studies.

Effect of particle size, concentration, temperature and pH on rheological properties of shallots flour.

Shallot flour was prepared and sieved into three different particle sizes of < 180 µm (sample A), 180 µm (sample B) and 250 µm (sample C). Effect of concentration [0.5%, 1.0%, 1.5% and 2.0% (w/w)], temperature (20, 30, 40, 60 and 80 °C), pH (4, 7 and 10) and freezing (- 20 °C) on rheological properties of shallot flour were studied at increasing shear of 0.1-100 s-1. Effect of dynamic change in temperature (15-95 °C) was also measured at constant shear rate of 50 s-1. Power law (Eq. 2) model with coefficient of determination (R2) above 0.90, well described the rheological behavior of the shallot flour as a shear thinning, non-Newtonian fluid at different concentration, temperature and pH. All the samples had n values below 1 and increase in viscosity or consistency index (k) value with increase in concentration of the sample was observed, while inverse relation was observed when temperature was increased. All samples showed increase in k value when the pH of the dispersion was varied from acidic to alkaline condition. Viscosity of samples were found unaffected even after freezing in freeze-thaw cycle. These data show sample A to be most suitable for their application as thickener, having highest k value. The obtained research provides information for utilization of shallot as a thickener in various food industries.

Characterization of insect chitosan films from Tenebrio molitor and Brachystola magna and its comparison with commercial chitosan of different molecular weights.

Insects are considered as alternative sources of chitosan; however, studies about the functional film-forming properties of insect chitosan are scarce. Insect chitosan films were made from Tenebrio molitor and Brachystola magna and were compared with commercial chitosan of different molecular weights (Mw). Mechanical properties (tensile strength, TS; elastic modulus, EM; elongation at break, %E), water vapor permeability (WVP) and physicochemical properties were characterized. The film properties of both commercial and insect chitosan were affected by Mw. Commercial chitosan films showed that at lower Mw, the TS (from 59 to 48 MPa) and EM (from 1471 to 1286 MPa) decreased; whereas WVP (from 2.9 × 10-11 to 3.4 × 10-11 g m-1s-1Pa-1), % E (from 38 to 41%) and solubility (from 30 to 33%) increased. Chitosan insect films showed lower TS and EM, and higher WPV, %E and solubility than commercial films. SEM revealed that chitosan insect films had lower porosity than commercial films. FTIR and X-ray diffraction showed not difference between insect and commercial chitosan films. These results showed that T. molitor and B. magna chitosan films could be used as a packaging material in several food products.

The Predictive Value of the Cervical Consistency Index to Predict Spontaneous Preterm Birth in Asymptomatic Twin Pregnancies at the Second-Trimester Ultrasound Scan: A Prospective Cohort Study.

Novel transvaginal ultrasound (TVU) markers have been proposed to improve spontaneous preterm birth (sPTB) prediction. Preliminary results of the cervical consistency index (CCI), uterocervical angle (UCA), and cervical texture (CTx) have been promising in singletons. However, in twin pregnancies, the results have been inconsistent. In this prospective cohort study of asymptomatic twin pregnancies assessed between 18+0-22+0 weeks, we evaluated TVU derived cervical length (CL), CCI, UCA, and the CTx to predict sPTB < 34+0 weeks. All iatrogenic PTB were excluded. In the final cohort of 63 pregnancies, the sPTB rate < 34+0 was 16.3%. The CCI, UCA, and CTx, including the CL was significantly different in the sPTB < 34+0 weeks group. The best area under the receiver operating characteristic curve (AUC) for sPTB < 34+0 weeks was achieved by the CCI 0.82 (95%CI, 0.72-0.93), followed by the UCA with AUC 0.72 (95%CI, 0.57-0.87). A logistic regression model incorporating parity, chorionicity, CCI, and UCA resulted in an AUC of 0.91 with a sensitivity of 55.3% and specificity of 88.1% for predicting sPTB < 34+0. The CCI performed better than other TVU markers to predict sPTB < 34+0 in twin gestations, and the best diagnostic accuracy was achieved by a combination of parity, chorionicity, CCI, and UCA.

Anaerobic co-digestion of sewage sludge with cellulose, protein, and lipids: Role of rheology and digestibility.

Rheology is known to have an impact on the performance of digesters, but the effect of additional substrates (co-digestion) is poorly understood. The main objective of this study was to investigate the effects of the addition of cellulose, protein and lipids to substrates on the rheological behaviour and biogas production of the mixture of primary sludge (PS) and waste-activated sludge (WAS) in a batch system. A mixture of PS and WAS to form the main substrate was anaerobically co-digested with different types of organic matter (cellulose, protein and lipids) as co-substrates at different co-substrate to main substrate ratios of 2-8 (wt%) under mesophilic conditions and below ammonia inhibition levels. Yield stress (τy) and the flow consistency index (k) of the combined feed in the case of cellulose and protein were significantly dependent on the amount of co-substrate added, while there was an insignificant impact on these properties when lipids were added. Cellulose significantly increased τy and k in the feed, which resulted in poor fluidity and the improper homogenisation of the digester content, and consequently decreased the biogas yield. In contrast, the biogas yield was improved through the addition of 2% to 6% protein despite an increase in τy and k of the feed, but the methane yield decreased at 7% and 8% levels of protein concentration. This observation indicates that the threshold for τy and k of the digester media depends on the organic nature and digestibility of the substrate. There was no significant impact on the flow properties of the initial mixture when lipids were added, and their addition increased the biogas yield. A first-order kinetic reaction model was used for predicting the yield of methane from these digesters. The rate constant values revealed an increasing trend, with the highest for protein then lipids then cellulose.

Consistency Index-Based Sensor Fault Detection System for Nuclear Power Plant Emergency Situations Using an LSTM Network.

A nuclear power plant (NPP) consists of an enormous number of components with complex interconnections. Various techniques to detect sensor errors have been developed to monitor the state of the sensors during normal NPP operation, but not for emergency situations. In an emergency situation with a reactor trip, all the plant parameters undergo drastic changes following the sudden decrease in core reactivity. In this paper, a machine learning model adopting a consistency index is suggested for sensor error detection during NPP emergency situations. The proposed consistency index refers to the soundness of the sensors based on their measurement accuracy. The application of consistency index labeling makes it possible to detect sensor error immediately and specify the particular sensor where the error occurred. From a compact nuclear simulator, selected plant parameters were extracted during typical emergency situations, and artificial sensor errors were injected into the raw data. The trained system successfully generated output that gave both sensor error states and error-free states.

Prediction of duration of labor based on biomechanical measurements of the cervix: A preliminary study.

OBJECTIVE: Induction of labor is a common procedure in obstetrics. Predictability of duration of labor could facilitate planning as well as patient's satisfaction. The primary purpose of this study was to evaluate the usefulness of a new biomechanical measurement of the cervix based on the aspiration technique for predicting the duration of labor after induction. STUDY DESIGN: This was a prospective single centre study. Inclusion criteria were term nulliparous pregnant women with an unfavourable cervix who needed an induction of labor. Digital (Bishop score), sonographic (cervical length and cervical consistency index (CCI)) as well as aspiration measurements (closure pressure) of the cervix were performed and compared to duration of labor. The technical feasibility and the acceptability of the measurements were explored. RESULTS: There were no technical complications of the sonographic or aspiration measurements. Measuring the Bishop score was reported as most painful examination. Both the time to active phase of labor and the time to delivery is significantly correlated with the Bishop score, but not with the cervical length, CCI or closure pressure. CONCLUSION: The new biomechanical measurement of the cervix, based on the aspiration technique, is technically feasible and acceptable. In our small cohort no correlation was found between the closure pressure and the duration of labor.

Cervical modifications after pessary placement in singleton pregnancies with maternal short cervical length: 2D and 3D ultrasound evaluation.

INTRODUCTION: The use of a pessary proved to prevent preterm birth in asymptomatic women with mid-trimester short cervical length (CL); however, the precise mechanisms by which the pessary confers its benefit remain unclear. The aim of this study was to evaluate multiple cervical characteristics assessed by 2-dimensional and 3-dimensional ultrasound before and after placement of a cervical pessary to ascertain its mechanism of action. MATERIAL AND METHODS: In this prospective cohort study, we assessed the cervical characteristics in singleton pregnancies with maternal short CL and compared them with matched reference women with normal CL. The variables evaluated were: CL, uterocervical angles, cervical consistency indices (cervical consistency index and CL consistency index), cervical volume and vascular indices. All variables were re-assessed immediately after pessary placement and 4-6 weeks later in all participants. Mann-Whitney U test was used to assess differences between groups and paired samples t test for comparisons in two different examinations in the same women. The aim of this study was to evaluate multiple cervical ultrasound variables before and after the placement of a cervical pessary and compare the evolution of these variables with a reference group with normal CL to better understand the device's mechanism of action. RESULTS: Thirty-three women with short CL and 24 reference women with normal CL were enrolled. At the time of enrollment, gestational age and maternal baseline characteristics did not differ between groups. Immediately after pessary placement, CL increased, uterocervical angles were narrower and cervical consistency increased significantly. When the magnitude of change in cervical variables was compared over time between the reference group and the study group, median CL had increased in the study group (1.47 mm) but it had shortened in the reference group (-2.56 mm). These inverse trends were statistically significant (P = 0.006). CONCLUSIONS: Cervical pessary reduces both uterocervical angles and corrects cervical angulation by pushing the cervix up toward the uterus. Maintaining the cervix aligned to the uterine axis leads to reduced cervical tissue stretch, so avoiding further cervical shortening. All these changes were present after pessary placement; however, the clinical implications of these findings remain unknown.

Cervical consistency index and risk of Cesarean delivery after induction of labor at term.

OBJECTIVE: To evaluate the association between the cervical consistency index (CCI) and the risk of Cesarean delivery after planned induction of labor (IOL) at term. METHODS: This was a prospective observational study of women with a term singleton pregnancy admitted for IOL due to maternal or fetal indication. Ultrasonographic images were obtained before IOL and CCI was calculated offline once recruitment was completed. The main outcome was defined as Cesarean delivery due to failed IOL or arrest of labor. Cesarean deliveries indicated due to maternal or fetal compromise (Van Dillen's grade 1 or 2) were excluded from analysis. Univariate statistical analysis was performed using Fisher's exact test and Student's t-test for categorical and continuous variables, respectively. Multivariate analysis was performed using logistic regression, including CCI and other variables related to the main outcome. Intraclass correlation coefficients were used to estimate intra- and interobserver agreement. RESULTS: Of 510 women admitted for IOL during the study period and for whom image quality was adequate, 46 were excluded due to emergency Cesarean delivery leaving 464 pregnancies for analysis. Cesarean section due to failed IOL or arrest of labor was performed in 100/464 (21.6%) pregnancies. The mean CCI of women who underwent Cesarean delivery was not significantly different from that in those who had vaginal delivery after IOL (70.1 ± 12.3% vs 70.0 ± 13.1%; P = 0.94). Multivariate analysis also showed absence of statistical association between CCI and Cesarean delivery for failed IOL or arrest of labor. Intraclass correlation coefficients for intra- and interobserver agreement were 0.81 (95% CI, 0.66-0.89) and 0.86 (95% CI, 0.75-0.92), respectively. CONCLUSION: CCI does not seem to be associated with the risk of Cesarean delivery after IOL. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Fuzzy Group Consensus Decision Making and Its Use in Selecting Energy-Saving and Low-carbon Technology Schemes in Star Hotels.

Energy-saving and low-carbon technologies play important roles in reducing environmental risk and developing green tourism. An energy-saving and low-carbon technology scheme selection may often involve multiple criteria and sub-criteria as well as multiple stakeholders or decision makers, and thus can be structured as a hierarchical multi-criteria group decision making problem. This paper proposes a framework to solve group consensus decision making problems, where decision makers' preferences between the alternatives considered with respective to each criterion are elicited by the paired comparison method, and expressed as triangular fuzzy preference relations (TFPRs). The paper first simplifies the existing computation formulas used to determine triangular fuzzy weights of TFPRs. A consistency index is then devised to measure the inconsistency degree of a TFPR and is used to check acceptable consistency of TFPRs. By introducing a possibility degree formula of comparing any two triangular fuzzy weights, an index is defined to measure the consensus level between an individual ranking order and the group ranking order for all alternatives. A consensus model is developed in detail for solving group decision making problems with TFPRs. A case study of selecting energy-saving and low-carbon technology schemes in star hotels is provided to illustrate how to apply the proposed group decision making consensus model in practice.

Development of gluten free eggless cake using gluten free composite flours made from sprouted and malted ingredients and its physical, nutritional, textural, rheological and sensory properties evaluation.

The aim of the study was to develop gluten free eggless cake using gluten free composite flour made of finger millet, sprouted soy and amaranth, for patients with celiac disease. Gluten free eggless cake prepared (T2), were analyzed for physical, textural, rheological and nutritional properties and compared with control cake (C) made using refined wheat flour and eggs and eggless composite flour cake made using whole wheat flour, malted finger millet, sprouted soy flour and amaranth (T1). There was no significant difference between T2 and C batter in terms of textural properties, flow behaviour index and consistency index. T2 had higher volume (454.4 cm3) as compared to T1 (437.1 cm3) cake. No significant differences in textural analysis were observed between cakes in terms of springiness, resilience and cohesiveness. The nutritional quality of T2 cake was significantly (p < 0.05) higher in case of phosphorous (224.0 mg/100 g) and iron content (7.39 mg/100 g). Therefore, gluten free eggless cake of high nutritional composition with good quality characteristics is a good substitute for refined flour egg and composite flour eggless cake. Higher mineral content due to germinated ingredients also made it a nutritious and palatable naturally gluten free food option for the people with celiac disease.

Mid-Trimester Cervical Consistency Index and Cervical Length to Predict Spontaneous Preterm Birth in a High-Risk Population.

Background Short cervical length (CL) has not been shown to be adequate as a single predictor of spontaneous preterm birth (sPTB) in high-risk pregnancies. Objective The objective of this study was to evaluate the performance of the mid-trimester cervical consistency index (CCI) to predict sPTB in a cohort of high-risk pregnancies and to compare the results with those obtained with the CL. Study Design Prospective cohort study including high-risk singleton pregnancies between 19 +0 and 24 +6 weeks. The ratio between the anteroposterior diameter of the uterine cervix at maximum compression and at rest was calculated offline to obtain the CCI. Results Eighty-two high sPTB risk women were included. CCI (%) was significantly reduced in women who delivered <37 +0 weeks compared with those who delivered at term, while CL was not. The area under the curve (AUC) of the CCI to predict sPTB <37 +0 weeks was 0.73 (95% confidence interval [CI], 0.61-0.85), being 0.51 (95% CI, 0.35-0.67), p = 0.03 for CL. The AUC of the CCI to predict sPTB <34 +0 weeks was 0.68 (95% CI, 0.54-0.82), being 0.49 (95% CI, 0.29-0.69), p = 0.06 for CL. Conclusion CCI performed better than sonographic CL to predict sPTB. Due to the limited predictive capacity of these two measurements, other tools are still needed to better identify women at increased risk.