To develop evidence-based recommendations on the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA).
The task force comprised an expert group of rheumatologists, ...radiologists, methodologists and experienced rheumatology practitioners from 13 countries. Thirteen key questions on the role of imaging in RA were generated using a process of discussion and consensus. Imaging modalities included were conventional radiography, ultrasound, MRI, CT, dual-emission x-ray absorptiometry, digital x-ray radiogrammetry, scintigraphy and positron emission tomography. Research evidence was searched systematically for each question using MEDLINE, EMBASE and Cochrane CENTRAL. The experts used the evidence obtained from the relevant studies to develop a set of 10 recommendations. The strength of recommendation was assessed using a visual analogue scale.
A total of 6888 references was identified from the search process, from which 199 studies were included in the systematic review. Ten recommendations were produced encompassing the role of imaging in making a diagnosis of RA, detecting inflammation and damage, predicting outcome and response to treatment, monitoring disease activity, progression and remission. The strength of recommendation for each proposition varied according to both the research evidence and expert opinion.
Ten key recommendations for the role of imaging in the management of RA were developed using research-based evidence and expert opinion.
The major event that hit Europe in summer 2021 reminds society that floods are recurrent and among the costliest and deadliest natural hazards. The long-term flood risk management (FRM) efforts ...preferring sole technical measures to prevent and mitigate floods have shown to be not sufficiently effective and sensitive to the environment. Nature-Based Solutions (NBS) mark a recent paradigm shift of FRM towards solutions that use nature-derived features, processes and management options to improve water retention and mitigate floods. Yet, the empirical evidence on the effects of NBS across various settings remains fragmented and their implementation faces a series of institutional barriers. In this paper, we adopt a community expert perspective drawing upon LAND4FLOOD Natural flood retention on private land network (https://www.land4flood.eu) in order to identify a set of barriers and their cascading and compound interactions relevant to individual NBS. The experts identified a comprehensive set of 17 barriers affecting the implementation of 12 groups of NBS in both urban and rural settings in five European regional environmental domains (i.e., Boreal, Atlantic, Continental, Alpine-Carpathian, and Mediterranean). Based on the results, we define avenues for further research, connecting hydrology and soil science, on the one hand, and land use planning, social geography and economics, on the other. Our suggestions ultimately call for a transdisciplinary turn in the research of NBS in FRM.
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•The European expert community perspective on nature-based solutions is presented.•12 groups of nature-based solutions relevant to flood risk management are defined.•17 implementation barriers for the 12 nature-based-solution groups are identified.•Cascading and compound barriers call for a transdisciplinary approach to floods.
Introduction/objectives
Magnetic resonance imaging (MRI) is recommended for evaluation of changes in juvenile spondyloarthropathies (JSpA). To our knowledge, there is no previous prospective study ...analysing early changes on axial MRI. The objective is to investigate incidence of reparable changes on axial MRI in patients with established JSpA, lasting for less than 6 months.
Materials and methods
The pilot study included 27 patients with confirmed diagnosis of JSpA examined within 2 years. Prior to imaging, basic demographic and laboratory data and HLA-B27 were collected. Patients filled out a visual analogue scale for pain and a childhood health assessment questionnaire. A paediatric rheumatologist and a paediatric physiatrist examined patients and measured indices of flexion, extension and sagittal flexibility. Contrast-enhanced axial MRI examination and cervical x-ray were performed. Three experienced paediatric radiologists independently reviewed x-ray and MRI images of all patients.
Results
There was no significant correlation between early changes detected on MRI and other parameters. The study revealed early changes of the cervical spine to be the most common finding. More patients had positive cervical MRI than positive sacroiliac joint (SIJ) MRI. Cervical x-ray and MRI were equally useful for diagnosis regardless of other parameters.
Conclusion
Study showed new information on axial involvement, striking cervical spine as the most involved part. The biggest study limitation is the small number of patients. Establishing early JSpA diagnosis is of utmost importance, especially in the light of novel therapy introduced in every day practice. It seems that cervical spine involvement is more represented than previously described in literature, especially in comparison with SIJ.
Key Points
• Contrast-enhanced MRI is considered the gold standard for detection early changes in JSpA.
• Standardization of diagnostic criteria and better classification of changes using the unique scoring system for children are necessary.
• It seems that cervical spine involvement is more represented than previously described in the literature, especially in comparison with SIJ involvement.
Climate change has increasing impacts of hydro-meteorological extremes on water resources. Projections indicate a similar trend and challenge in the effectiveness of conventional engineering ...solutions in climate change adaptation (CCA) and disaster risk reduction (DRR) strategies. Nature-based solutions (NbSs) have been promoted as viable approaches and measures that complement engineering solutions. While the effects of NbSs have been increasingly demonstrated, their broader implementation can be favoured by NbSs knowledge integration in higher education curricula. Knowledge on how the research practice is translated into the educational landscape is missing. This paper adopts the concept of knowledge translation and analyses the integration of NbSs in the study programs of higher education institutions in three European countries (Croatia, Czechia, and Slovenia). Specifically, it explores the extent, thematic areas, and curricular settings of NbSs related to water resources management in implemented curricula at public universities. The results show that NbSs are integrated in a limited number of courses within the relevant study programs (in the fields of, e.g., natural sciences, geography, and engineering and technology) and represent rather an extension of compulsory curricula. Bibliometric analysis revealed that most courses involving the NbSs approach still represent a personalized knowledge, i.e., developed by professors during their research activities. The barriers impairing a broader integration of NbSs in the studied programs are then discussed. Our results therefore indicate that NbSs do not represent a mainstream knowledge that would proliferate into higher education curricula through accreditations procedures, but that the knowledge that is mostly integrated through direct incremental implementation of NbSs in the individual compulsory lessons or facultative courses. We assert that without broader and systematic NbSs knowledge translation to study programs, the effectiveness of climate change adaptation and disaster risk reduction strategies cannot be fully achieved.
This paper examines the level of payment for ecosystem services (PES) concept implementation in the financing of water-related forest ecosystem services (ES) in the Republic of Croatia, the ...Federation of Bosnia and Herzegovina (FB&H), the Republic of Slovenia, and the Republic of Serbia. The focus is on water-related forest ES recognised by the millennium ecosystem assessment (MEA). For the purpose of this paper, the term pure PES describes schemes that comply to all five conditions set by Wunder definition and term PES like for those schemes that miss some of those conditions. In the first step, the most important legislative documents related to forests, water, and environmental protection were selected. The second consists of a content analysis; focusing on the definition of ES; the definition of fees or payments; the establishment of ‘forest funds’, ‘water funds’, or ‘environmental funds’; and the way these funds were spent. Here we looked at the flow of funding into the forestry sector recognising forest management as the main water-related forest ES provider. Research revealed existence of well-established payments schemes in forestry in Croatia for almost 30 years and in FB&H for some 20 years which were assessed as closest to pure PES. In Serbia and Slovenia, there were no PES or PES like schemes in the forestry sector. In the water sector the well-established PES like payments schemes existing in all four countries. The environmental protection sector, however, rely more on the tax like rather than on the PES like schemes. Legislation in general recognised the link between forests and water, but this was much more evident in the forestry than in the water or environment sector. The role of the state is strongly pronounced in all countries studied, and was the main driving force behind all payments. However, this position of the state represents also the main obstacle for the development of pure PES schemes, together with underdeveloped private forestry and complex socio-economic conditions. Nevertheless, there is room for further development of pure PES and PES like schemes based on EU or global experiences.
Bridge piers on large rivers are often protected from scouring using launchable stone, such as a riprap sloping structure. While such scour countermeasures are effective for pier protection, they ...significantly alter flow conditions in the bridge opening by overtopping flow and flow contraction, deflecting the formation of the scour hole downstream and exposing the downstream riverbed to additional scour. This paper provides a comprehensive and relevant review of bridge scour estimation methods for piers with a riprap sloping structure installed as a scour countermeasure. Research on empirical methods for bridge scour estimation is reviewed and analyzed with formulae used for comparable structures—complex pier formulae and formulae for river training structures. A summary of relevant formulae applicable to piers with installed scour countermeasures is provided, as well as a discussion on the possible future research directions that could contribute to the field.
Nowadays, great emphasis is placed on the relationship between forest and water because forests are considered as substantial sources of many water ecosystem services. The aim of this paper is to ...analyze the stakeholder opinions towards the relationship between forests and water and the potential development of water-related payments for ecosystem services (PES) schemes. The study is developed in the context of COST Action CA15206–PESFOR-W (Forests for Water) aimed at synthesizing current knowledge about the PES schemes across Europe. The stakeholder opinions were mapped out using a structured questionnaire consisting of 20 questions divided into four thematic sections. The data were collected through an online survey. The results showed opinions of 142 stakeholders from 23 countries, mainly from Eastern Europe and the Mediterranean Basin. In order to analyze the collected data, the stakeholders were grouped in buyers, sellers, intermediaries, and knowledge providers. The survey results indicated that the most important category of water ecosystem services according to our sample of stakeholders is regulating services followed by provisioning services. Further findings pointed out the highest importance that shared values and direct changes in land management can have when designing water-related PES schemes. The role of public authorities and collective collaboration of different stakeholders, with emphasis on local and expert knowledge, are also identified as of crucial importance. The results show that stakeholder opinions can serve as a starting point when designing PES schemes.
Morphodynamic changes in the riverbed may be accelerated by the climate change-induced effects, mostly through the increase of the frequency of extreme climatic events such as floods. This can lead ...to scouring of the riverbed around the bridge substructure and consequently reduces its overall stability. In order to better understand hydromorphological processes at the local scale, the influence of floods on bridge scour requires a detailed analysis of several interacting flood hydrograph characteristics. This paper presents a multivariate analysis of the annual maximum (AM) flood discharge data at four gauging stations on the Drava and Sava Rivers in Croatia (Europe). As part of the hydrograph analysis, multiple baseflow separation methods were tested. Flood volumes and durations were derived after extracting the baseflow from measured discharge data. Suitable marginal distribution functions were fitted to the peak discharge (Q), flood volume (V) and duration (D) data. Bivariate copula analyses were conducted for the next pairs: peak discharge and volume (Q–V), hydrograph volume and duration (V–D) and peak discharge and hydrograph duration (Q–D). The results of the bivariate copula analyses were used to derive joint return periods for different flood variable combinations, which may serve as a preliminary analysis for the pilot bridges of the R3PEAT project where the aim is to investigate the influences on the riverbed erosion around bridges with installed scour countermeasures. Hence, a design hydrograph was derived that could be used as input data in the hydraulic model for the investigation of the bridge scour dynamics within the project and a preliminary methodology is proposed to be applied. The results indicate that bivariate frequency analysis can be very sensitive to the selected baseflow separation methodology. Therefore, future studies should test multiple baseflow separation methods and visually inspect the performance.
Background Infantile free sialic acid storage disease (ISSD) is a severe multisystemic disorder characterized by the accumulation of free sialic acid in lysosomes. Case presentation The patient ...presented prenatally with fetal ascites and large scrotal hernias, without pleural or pericardial effusion. During the infantile period, he was diagnosed with permanent isolated immunoglobulin G (IgG) hypogammaglobulinemia, which thus far has rarely been associated with ISSD. The analysis of the SLC17A5 gene revealed a novel homozygous 94 bp gene deletion. We further provide a detailed description of pre- and postnatal clinical and radiographic findings. Conclusions Fetal ascites could be the first sign of several lysosomal storage diseases (LSDs), including ISSD. The analysis of LSD gene panels is an effective approach to diagnosis in the case of non-specific symptoms and when specific biochemical tests are not easily available.
Analysis and modelling of discharge and suspended sediment time series is of great importance in hydrology and water management. Discharge and suspended sediment time series are the result of complex ...physical processes and characterized by non-stationarity. Wavelet transform enables representation of non-stationarities in time-frequency domain, decomposition and reconstruction of series and de-noising of series, and therefore represents powerful tool for analysis of hydrological time series. Overview of mentioned wavelet transform advantages is given in this paper with focus on discharge and suspended sediment time series, presented through: (i) multi-temporal scale analysis of series variability; (ii) multi-scale trend analysis; (iii) prediction and forecasting of series with wavelet based hybrid black-box models, and (iv) wavelet-aided simulation of synthetic series.
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