In vivo assessment of the biomechanical properties of the uterine cervix in pregnancy

Measuring the stiffness of the cervix might be useful in the prediction of preterm delivery or successful induction of labor. For that purpose, a variety of methods for quantitative determination of physical properties of the pregnant cervix have been developed. Herein, we review studies on the clinical application of these new techniques. They are based on the quantification of mechanical, optical, or electrical properties associated with increased hydration and loss of organization in collagen structure. Quasi-static elastography determines relative values of stiffness; hence, it can identify differences in deformability. Quasi-static elastography unfortunately cannot quantify in absolute terms the stiffness of the cervix. Also, the current clinical studies did not demonstrate the ability to predict the time point of delivery. In contrast, measurement of maximum deformability of the cervix (e.g. quantified with the cervical consistency index) provided meaningful results, showing an increase in compliance with gestational age. These findings are consistent with aspiration measurements on the pregnant ectocervix, indicating a progressive decrease of stiffness along gestation. Cervical consistency index and aspiration measurements therefore represent promising techniques for quantitative assessment of the biomechanical properties of the cervix. © 2013 John Wiley & Sons, Ltd.     

Community-based adaptation in low-lying islands in the Philippines: challenges and lessons learned

Community-based adaptation (CBA) seeks to address climate risks and socio-economic drivers of vulnerability simultaneously. However, as CBA activities appear very similar to standard development work, difficulties in identifying good practices arise. To clarify the role of CBA, this study elucidated how climate change can impact pre-existing development problems by investigating the experiences of four low-lying island communities in central Philippines. The islands currently suffer from frequent and extreme tidal flooding (following an earthquake-induced land subsidence in 2013, with a magnitude that is broadly similar to sea-level rise projections under a 1.5 to 2 °C global warming scenario), and endured a dry spell in 2016. The study also identified various publicly and privately initiated adaptation strategies, and evaluated their resilience against actual biophysical events. The study conducted focus group discussions with local leaders and in-depth interviews with government officials and residents in March 2016. Results show that tidal flooding impacted almost all aspects of daily life on the islands, while the dry spell completely depleted their limited water supplies. The strategies implemented by governments and NGOs (e.g., seawalls, rainwater collectors) were found to be inadequate in preventing tidal flooding and compensating for the dry spell. Also, communities used coral stones and plastic waste for raising the floors of their homes, which have an erosive effect on their capacity to adapt in the long term. Lack of community participation in publicly initiated projects and lack of adaptation funding for community-based strategies were the greatest obstacles to implementing climate-resilient solutions.