The Value of Empirical Data for Estimating the Parameters of a Sociohydrological Flood Risk Model.

In this paper, empirical data are used to estimate the parameters of a sociohydrological flood risk model. The proposed model, which describes the interactions between floods, settlement density, awareness, preparedness, and flood loss, is based on the literature. Data for the case study of Dresden, Germany, over a period of 200 years, are used to estimate the model parameters through Bayesian inference. The credibility bounds of their estimates are small, even though the data are rather uncertain. A sensitivity analysis is performed to examine the value of the different data sources in estimating the model parameters. In general, the estimated parameters are less biased when using data at the end of the modeled period. Data about flood awareness are the most important to correctly estimate the parameters of this model and to correctly model the system dynamics. Using more data for other variables cannot compensate for the absence of awareness data. More generally, the absence of data mostly affects the estimation of the parameters that are directly related to the variable for which data are missing. This paper demonstrates that combining sociohydrological modeling and empirical data gives additional insights into the sociohydrological system, such as quantifying the forgetfulness of the society, which would otherwise not be easily achieved by sociohydrological models without data or by standard statistical analysis of empirical data.

Judokas with low back pain have lower flexibility of the hip-spine complex: A case-control study.

OBJECTIVE: Study whether male adult judokas with and without low back pain (LBP) have different hip-spine flexibility. DESIGN: Cross-sectional. SETTING: Judo training centres. PARTICIPANTS: Judokas with (n = 29) and without (n = 33) LBP. MAIN OUTCOME MEASURES: Range of motion (ROM) (passive and active rotations) of hips, lumbar spine (flexion-extension) and fingertip-to-floor distance (FTFD). RESULTS: The non-dominant hips of judokas with LBP had 6.8 ± 1.2° (ES:1.45, p < 0.001) lower passive and 8.0 ± 1.3° (ES:1.55, p < 0.001) lower active internal rotation. Dominant hips of judokas with LBP had 5.1 ± 1.6° (ES: 0.81, p = 0.002) lower active internal rotation and 8.8 ± 2.9° (ES:0.79, p = 0.003) lower active total rotation. The LBP group showed 8.0 ± 2.8° (ES: 0.73, p = 0.006) lower flexion and 6.0 ± 2.2° (ES: 0.69, p = 0.009) lower extension of the lumbar spine. The FTFD in the LBP group was 7.3 ± 2.6 cm (ES: 0.72, p = 0.007) lower. The multi-level regression analyses showed passive (OR 1.54, 95%CI 1.18-2.00, p = 0.001) and active (OR 1.47, 95%CI 1.16-1.87, p = 0.001) hip internal rotation of the non-dominant leg and lumbar spinal flexion (OR 1.11, 95%CI 1.03-1.20, p = 0.006) and extension (OR 1.16, 95%CI 1.01-1.33, p = 0.035) were related to LBP. CONCLUSION: Lower hip internal rotation of the non-dominant leg (passive and active) and lower lumbar flexibility are significantly related to LBP in male adult judokas.

Active pelvic tilt is reduced in athletes with groin injury; a case-controlled study.

OBJECTIVE: To study if athletes with groin injury had less active pelvic tilt (APT) than non-injured controls. DESIGN: Case-control. SETTING: Sports physiotherapy clinics and sports clubs. PARTICIPANTS: 17 athletes (Tegner>5, age 25.1(5.2) with groin injury and 27 healthy controls (Tenger>5, age 24.4(3.6)). MAIN OUTCOME MEASURES: Active pelvic tilt, defining the ability of an individual to actively tilt the pelvis anteriorly and posteriorly over a frontal axis, and hip range of motion (HROM) parameters. RESULTS: Linear regression model associations with generalized estimated equations revealed that APT was lower on injured sides compared to non-injured for total (21.1(7.1) vs. 27.2(8.0), P = .003, effect size (ES) = 0.8) and anterior (10.2(5.9) vs. 13.7(4.8), P = .004, ES = 0.65) APT. Posterior APT (-10.9(3.6) vs. -13.4(5.2), P = .06, ES = 0.56) showed a trend towards being lower in those with groin injury. HROM parameters were not found associated. CONCLUSIONS: Total active and anterior pelvic tilt were lower on the injured side in athletes with groin injury when compared to non-injured sides and healthy controls. This may be a relevant factor to consider in rehabilitation. Whether this is a cause or effect cannot be ascertained due to the cross sectional study design.

Extracorporeal shock wave lithotripsy under intravenous sedation for treatment of urolithiasis.

BACKGROUND: In contrast to treatment with oral or intramuscular analgesics, extracorporeal shock wave lithotripsy (E.S.W.L.) can be performed with patients under sedation too. Besides the advantage of increased shock energy, patients tend to have more constant breathing excursions and are more idle during treatment, potentially increasing the stone-free ratio (S.F.R.) after treatment. METHODS: This study presents the results of 310 patients who underwent 400 E.S.W.L. procedures under sedation, with a stationary lithotripter. RESULTS: After one procedure, the S.F.R. was 54.8% (170/310). A second treatment was successful in 42.1% (32/76), a third treatment in 21.4% (3/14). Therefore, 66.1% (205/310) of patients eventually became stone-free. Kidney stones were successfully treated in 65.4% (161/246), ureteral stones in 68.8% (44/64) of cases. Patients with stones ≤15 mm were successfully treated in 67.4% (194/288), patients with stones >15 mm in 50% (11/22) of cases. Considering each procedure individually, 45.3% (181/400) of procedures were successful after 3 weeks. Extending follow-up to 3 months is important, since 26.7% of stones (24/90) eventually still disappeared, increasing S.F.R. to 51.3% after one procedure. Complications occurred after 5.5% E.S.W.L.-procedures. CONCLUSIONS: E.S.W.L. is a well-tolerated, non-invasive procedure that produces reasonable stone clearance of both upper and lower urinary tract calculi. Performing the procedure whilst patients are intravenously sedated results in an acceptable S.F.R. Strong selection based on unfavourable factors could increase the chance on successful treatment and spare patients a pointless procedure. However, considering E.S.W.L.'s elegant nature, sometimes a more tolerant approach seems justifiable.

Reduce bladder cancer recurrence in patients treated for upper urinary tract urothelial carcinoma: The REBACARE-trial.

BACKGROUND: Following radical nephro-ureterectomy for urothelial carcinoma of the upper urinary tract (UUT), the reported bladder recurrence rate of urothelial carcinoma is 22-47%. A single intravesical instillation of chemotherapy within 10 days following nephro-ureterectomy has the potential to decrease the risk of a bladder recurrence significantly. Despite recommendation by the European Association of Urology guideline to administer a single instillation postoperatively, the compliance rate is low because the risk of extravasation of chemotherapy. AIM: To reduce the risk of bladder cancer recurrence by a single intravesical instillation of Mitomycin immediately (within 3 h) before radical nephro-ureterectomy or partial ureterectomy. METHODS: Adult patients (age ≥ 18 years) with a (suspicion of a) urothelial carcinoma of the UUT undergoing radical nephro-ureterectomy or partial ureterectomy will be eligible and will receive a single intravesical instillation of Mitomycin within 3 h before surgery. In total, 170 patients will be included in this prospective, observational study. Follow-up will be according to current guidelines. RESULTS: The primary endpoint is the bladder cancer recurrence rate up to two years after surgery. Secondary endpoints are: a) the compliance rate; b) oncological outcome; c) possible side-effects; d) the quality of life; e) the calculation of costs of a single neoadjuvant instillation with Mitomycin and f) molecular characterization of UUT tumors and intravesical recurrences. CONCLUSIONS: A single intravesical instillation of Mitomycin before radical nephro-ureterectomy or partial ureterectomy may reduce the risk of a bladder recurrence in patients treated for UUT urothelial carcinoma and will circumvent the disadvantages of current therapy.

Effect of short-term outlet obstruction on rat bladder nerve density and contractility.

1 The present study was designed to investigate the relationship between innervation density and contractile responses to field stimulation and exogenous agonists at early time points after induction of bladder outlet obstruction (BOO) in rats. 2 When compared with sham-operated animals, 1, 3 and 7 days of BOO were associated with a 75%, 80% and 90% increase of bladder weight. Field stimulation caused a frequency-dependent increase in force of contraction. The force of contraction was reduced at each frequency in BOO rats with the greatest decrease after 1 day and a gradual but incomplete recovery thereafter. In contrast, contractile responses to ATP, carbachol and KCl were markedly reduced after 1 day of BOO and fully recovered after 7 days. The neurofilament staining was not altered by 1 day of BOO, but gradually decreased with increasing duration of BOO reaching the lowest levels after 7 days. 3 We conclude that impaired cellular contractility seems to underlie the early reductions of field stimulation-induced contraction, possibly reflecting surgical trauma of the tissue. However, at later time points a reduced nerve density, possibly reflecting a partial denervation, appears to be the main reason for impaired contractile response to field stimulation.

Reliability of the Dutch translation of the Kujala Patellofemoral Score Questionnaire.

OBJECTIVE: There are no Dutch language disease-specific questionnaires for patients with patellofemoral pain syndrome available that could help Dutch physiotherapists to assess and monitor these symptoms and functional limitations. The aim of this study was to translate the original disease-specific Kujala Patellofemoral Score into Dutch and evaluate its reliability. METHODS: The questionnaire was translated from English into Dutch in accordance with internationally recommended guidelines. Reliability was determined in 50 stable subjects with an interval of 1 week. The patient inclusion criteria were age between 14 and 60 years; knowledge of the Dutch language; and the presence of at least three of the following symptoms: pain while taking the stairs, pain when squatting, pain when running, pain when cycling, pain when sitting with knees flexed for a prolonged period, grinding of the patella and a positive clinical patella test. The internal consistency, test-retest reliability, measurement error and limits of agreement were calculated. RESULTS: Internal consistency was 0.78 for the first assessment and 0.80 for the second assessment. The intraclass correlation coefficient (ICCagreement ) between the first and second assessments was 0.98. The mean difference between the first and second measurements was 0.64, and standard deviation was 5.51. The standard error measurement was 3.9, and the smallest detectable change was 11. The Bland and Altman plot shows that the limits of agreement are -10.37 and 11.65. CONCLUSIONS: The results of the present study indicated that the test-retest reliability translated Dutch version of the Kujala Patellofemoral Score questionnaire is equivalent of the test-retest original English language version and has good internal consistency. Trial registration NTR (TC = 3258). Copyright © 2015 John Wiley & Sons, Ltd.

[Anticholinergics for overactive bladder: does subtype selectivity play a role?]. / Anticholinergika bei überaktiver Blase: Spielt Subtypselektivität eine Rolle?

Anticholinergics act in the treatment of overactive bladder by blocking muscarinic receptors of which five subtypes exist. Their desired effects occur via M(3) receptors, but a role for M(2) receptors is being discussed. Adverse effects such as dry mouth and constipation occur also via M(3) receptors, but M(2) and M(1) receptors can mediate side effects in the heart or on cognitive function, respectively. Therefore, an M(3)-selective drug such as darifenacin could theoretically be less effective but also have fewer cardiac or central nervous side effects. However, the limited available clinical data do not support a smaller efficacy or better general tolerability. The lack of adverse effects on cognitive function is well documented for darifenacin, but it cannot yet be determined definitively whether this discriminates it from other modern anticholinergics.