Current challenges and future perspectives for the full circular economy of water in European countries

This paper reviews the current problems and prospects to overcome circular water economy management challenges in European countries. The geopolitical paradigm of water, the water economy, water innovation, water management and regulation in Europe, environmental and safety concerns at water reuse, and technological solutions for water recovery are all covered in this review, which has been prepared in the frame of the COST ACTION (CA, 20133) FULLRECO4US, Working Group (WG) 4. With a Circular Economy approach to water recycling and recovery based on this COST Action, this review paper aims to develop novel, futuristic solutions to overcome the difficulties that the European Union (EU) is currently facing. The detailed review of the current environmental barriers and upcoming difficulties for water reuse in Europe with a Circular Economy vision is another distinctive aspect of this study. It is observed that the biggest challenge in using and recycling water from wastewater treatment plants is dealing with technical, social, political, and economic issues. For instance, geographical differences significantly affect technological problems, and it is effective in terms of social acceptance of the reuse of treated water. Local governmental organizations should support and encourage initiatives to expand water reuse, particularly for agricultural and industrial uses across all of Europe. It should not also be disregarded that the latest hydro politics approach to water management will actively contribute to addressing the issues associated with water scarcity.

Investigation of water and salt flux performances of polyamide coated tubular electrospun nanofiber membrane under pressure

In this study, a novel osmotic membrane was developed by polyamide (PA) coating on the tubular electrospun nanofiber (TuEN) support membrane. Water and reverse salt flux properties of the obtained membrane were investigated by applying pressure in addition to the osmotic forces. Surface characterization of the membrane was carried out by Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscope (SEM) analyses and flux performance tests were performed in both cross flow and submerged membrane setups. Applying pressure from the feed to the concentrate side had significant effects on the water and salt fluxes. Higher pressure differences between the feed and concentrate sides resulted in unexpected high water fluxes up to 500 Lm^-2h^-1 (LMH). Besides, the pressure helps to transfer the salt content of feed water into the concentrate side, differently from the osmotic process preventing the salinity build-up at the feed side. PA coated TuEN membrane operated under pressure will exhibit a favorable solution in water/wastewater treatment applications, especially for membrane bioreactors (MBR) in terms of preventing salt accumulation in the bioreactor, decreasing the membrane fouling, increasing the volume of product water, and enabling the concentrate management.

A comparison of 2 cesarean section methods, modified Misgav-Ladach and Pfannenstiel-Kerr: A randomized controlled study

BACKGROUND

The modified Misgav-Ladach method (MML) is a minimally invasive cesarean section procedure compared with the classic Pfannenstiel-Kerr (PK) method.

OBJECTIVES

The aim of the study was to compare the MML method and the PK method in terms of intraoperative and short-term postoperative outcomes.

MATERIAL AND METHODS

This prospective, randomized controlled trial involved 252 pregnant women scheduled for primary emergency or elective cesarean section between October, 2014 and July, 2015. The primary outcome measures were the duration of surgery, extraction time, Apgar score, blood loss, wound complications, and number of sutures used. Secondary outcome measures were the wound infection, time of bowel restitution, visual analogue scale (VAS) scores at 6 h and 24 h after the operation, limitations in movement, and analgesic requirements. At 6 weeks after surgery, the patients were evaluated regarding late complications.

RESULTS

There was a significant reduction in total operating and extraction time in the MML group (p < 0.001). Limitations in movement were lower at 24 h after the MML operation, and less analgesic was required in the MML group. There was no difference between the 2 groups in terms of febrile morbidity or the duration of hospitalization. At 6 weeks after the operation, no complaints and no additional complications from the surgery were noted.

CONCLUSIONS

The MML method is a minimally invasive cesarean section. In the future, as surgeons' experience increases, MML will likely be chosen more often than the classic PK method.

Investigation of the relationship between salivary cortisol, dehydroepiandrosterone sulfate, anxiety, and depression in patients with hyperemesis gravidarum

BACKGROUND

The aim of this study was to determine the relationship of the salivary levels of dehydroepiandrosterone sulfate (DHEA-S) and cortisol with factors related to depression and anxiety in patients with hyperemesis gravidarum (HG).

METHODS

Forty patients with a diagnosis of HG were selected for the study and matched with 40 control patients according to body mass index, parity, and age. Symptoms of depression and anxiety were investigated using the Beck Depression Inventory and Beck Anxiety Inventory for Adults, respectively. Saliva samples were collected in the morning and at night and subjected to enzyme-linked immunosorbent assay for the determination of DHEA-S and cortisol levels.

RESULTS

We observed a positive correlation between increased levels of depression and anxiety and increased salivary levels of cortisol and DHEA-S in patients with HG.

CONCLUSIONS

Salivary cortisol and DHEA-S levels, as well as mood disorders, should be monitored in patients with HG, although further large, prospective studies are needed to confirm our results.

The effect of place of residence and lifestyle on vitamin D deficiency in pregnancy: Comparison of eastern and western parts of Turkey

OBJECTIVE

The aim of this study was to determine the prevalence and the predictive factors of vitamin D deficiency in pregnancy and the compliance with "The National Vitamin D Support Program" at Turkey's easternmost and westernmost provinces.

MATERIAL AND METHODS

Lifestyles of women at 24-28 weeks of pregnancy were assessed using a questionnaire form, and serum 25-hydroxyvitamin D3 (25(OH)D3) levels were measured.

RESULTS

Vitamin D deficiency (≤20 ng/mL) in pregnant women had a prevalence of 27.8% in İzmir and 76.3% in Erzurum. The compliance of "The National Vitamin D Support Program" was 8% in İzmir and 32.6% in Erzurum. Clothing style, fish consumption, seaside holiday duration, and 1200 IU/day vitamin D replacement had an effect on 25(OH)D3 levels in pregnant subjects in İzmir, whereas only holiday duration and 1200 IU/day vitamin D replacement affected 25(OH)D3 levels in Erzurum. However, when a threshold for 25(OH)D3 level was considered ≥32 ng/mL, lifestyles did not affect 25(OH)D3 level.

CONCLUSION

The effect of lifestyle on 25(OH)D3 level in pregnancy is limited, especially in cold regions. We recommended increasing the compliance with "The National Vitamin D Support Program" at the follow-up of all pregnant women, irrespective of region and season.

The effects of different maternal positions on non-stress test: an experimental study

AIMS AND OBJECTIVES

To determine the effects of different maternal positions on non-stress test results and the preferences of mothers for involving positions.

BACKGROUND

The non-stress test (NST) has become a common tool in diagnosing fetal risks. The major problem encountered in the application of the non-stress test has been obtaining erroneous non-reactive non-stress test results when, indeed, the fetus is healthy and oxygenation is sufficient.

STUDY DESIGN

Experiment design with randomly assigned four positions: supine, left lateral, semi-fowler and sitting up. The sample included 408 women in a university hospital in Turkey. Women were randomly assigned to four groups in equal numbers of 102. Data collection and analysis. Data were collected through two instruments: Demographic and Pregnancy History Form and NST tracing. Main outcome measures were percentage of reactive NST and number of minutes for reactivity in each position.

RESULTS

There were significant (P < 0.05) differences among four groups. Supine position showed the least fetal reactivity. In terms of time to reactivity, there were no statistically significant differences. Qualitative data showed that pregnant women were least comfortable in supine position reporting back pain and shortening of breath.

CONCLUSION

Supine position yields the lowest non-reactivity in tandem with physical discomfort such as back pain and difficulty in breathing.

RELEVANCE TO CLINICAL PRACTICE

Sitting up, semi-fowler and left lateral positions are recommended to be used during the non-stress test. In addition, the preferences of the pregnant women should be determined before the test to minimize discomfort which, when it occurs, may signal physiological alterations experienced during the test.

Risk factors for pelvic surgery

One hundred and eighty four women who had corrective surgery for stress incontinence, genital prolapse or both were compared with two hundred and ninety women who had no surgery for these conditions. Patients and controls did not differ in terms of age, height, weight or body mass index. Younger age at first delivery (20.1+/-4.1 vs 22.8+/-4.9, p<0.000) and a smoking history (33.2% vs 23%, p<0.015) were found as risk factors for the study group. Women who underwent surgery had greater gravidity (4.85+/-2.9 vs 3.87+/-2.5, p<0.001), greater parity (3.03+/-1.9 vs 2.19+/-1.3, p<0.000), were less often nulliparous (2.2% vs 7.9%, p<0.008), less likely to have had a cesarean delivery (1.1% vs 9%, p<0.001) and more likely to have had a vaginal delivery (97.3% vs 85.9%, p<0.000) than the control group. The study group have had larger neonates on average (3800+/-416 vs 3373+/-637 gm's, p<0.000) and had greater use of forceps or vacuum extractor for at least one delivery (17.9% vs 7.6%, p<0.001). Highly significant relationship was found between the risk of having corrective surgery and the number of children born vaginally. Women who had 4 or more vaginal deliveries had 11.7 times more risk of urinary incontinence or genital prolapse.

[A case of upper gastrointestinal system obstruction by duodenal intramural hematoma caused by using an oral anticoagulant drug]

Unwanted haemorrhage can be seen due to long-term oral anticoagulant use. Sometimes these may lead obstructions forming intramural haemotomas. We noticed a case of duodenal obstruction due to an intramural hematoma in a patient who is on chronic oral anticoagulant therapy. In Taksim Hospital 1st General Surgery Department in April 2000, we treated a patient who presented anaemia, jaundice, pyloric obstruction conservatively. As a result we implicated to treat such cases nonoperatively.

Ecophysiological studies in Kalanchoë porphyrocalyx (Baker) and K. miniata (Hils et Bojer), two species performing highly flexible CAM

Preceding results, based on the determination of stable carbon isotope composition (δ13C) of leaf tissues from various Kalanchoë species, suggested a close coincidence between the photosynthetic flexibility of the species and their habitat, life form and taxonomic position within the genus. The ability to shift from C3-to Crassulacean Acid Metabolism (CAM)-type of photosynthesis seemed to concern in particular the more ancestral species in the genus and to be linked to epiphytism and changing climatic situations. For deeper insights into these interrelationships, physiological studies in controlled conditions were carried out on K. miniata and K. porphyrocalyx. These two species differ by their habitat preference and life form. Measurements were conducted on CO2 exchange patterns, day/night fluctuation of malate content in the leaves and 'capacity' of phosphoenolpyruvate carboxylase (PEPC). The results show that the 2 species can be considered as 'facultative' CAM plants, with very high flexibility in their photosynthetic behaviour. The decrease in water availability seems to be a major factor triggering the shift from C3 to the CAM mode. In K. miniata, 21 days of drought depressed CO2 uptake to the level of CAM idling whereas in K. porphyrocalyx, CO2 exchange was considerably more resistant. At least for K. miniata, short-day treatment was found to be a further CAM-inducing factor. The results are discussed in terms of their ecophysiological significance under the environmental conditions of the sites where the investigated species naturally grow.