The Des Moines Lobe (DML)—the largest lobe along the southern margin of the Laurentide ice sheet—deposited low-relief (1–5m) transverse moraine ridges, herein called washboard moraines, that are most ...prominent in central Iowa. Their origin as either subglacial or ice-marginal features bears on the dynamics of the lobe, geomorphic reconstructions of it, and interpretations of similar ridges elsewhere. Data from airborne laser swath mapping provide the first digital elevation models with sufficient spatial resolution to study in detail the geometric attributes of these topographically subtle features. Spectral analysis of profiles perpendicular to ridge crests indicates that most of them are spaced with statistically significant periodicities, with dominant wavelengths of 70–150m. Normalizing and stacking these profiles indicate that, on average, they display no systematic asymmetry. Locally, washboard moraines are intersected by discontinuous longitudinal ridge segments. Trends of the crests of moraines are scalloped, with cusps that point upglacier and are coincident with outwash trains, which were overridden by the lobe. Our interpretation of these data is that the moraines formed subglacially as crevasse-squeeze ridges. Overridden outwash trains likely supported low basal water pressures and resulted in anomalously slow basal slip, causing upglacier deflection of crevasses that extended to the bed. This crevasse-squeeze interpretation reinforces evidence that the DML surged to its maximum position. Bering Glacier, as a temperate, surge-type glacier that deposited crevasse-squeeze ridges similar to the washboard moraines of the DML, may be a good analog for the lobe.
•LiDAR data allow analyses of low-relief, transverse moraines of the Des Moines Lobe.•Spectral analyses indicate that ridges are spaced periodically (70–150m wavelengths).•Along-flow profiles of the moraines display no systematic asymmetry.•Moraine crests form cusps that point upglacier, coincident with outwash trains.•The moraines likely formed as subglacial crevasse-squeeze ridges.•This interpretation reinforces evidence that the lobe was a surge-type glacier.
Four adjacent lakes (Arco, Budd, Deming, and Josephine) within Itasca State Park in Minnesota, USA, are reported to be meromictic in the scientific literature. However, seasonally persistent ...chemoclines have never been documented. We collected seasonal profiles of temperature and specific conductance and placed temperature sensor chains in two lakes for ∼1 year to explore whether these lakes remain stratified through seasonal mixing events and what factors contribute to their stability. The results indicate that all lakes are predominantly thermally stratified and are prone to mixing in isothermal periods during spring and fall. Despite brief, semi-annual erosion of thermal stratification, Deming Lake showed no signs of complete mixing from 2006–2009 and 2019–2022 and is likely meromictic. However, the other lakes are not convincingly meromictic. Geochemical data indicate that water in Budd Lake, which contains the most water, is predominantly sourced from precipitation. The water in the other three lakes is of the calcium–magnesium–bicarbonate type, reflecting a source of water that has interacted with the deglaciated landscape. δ18OH2O and δ2HH2O measurements indicate the lakes are supplied by precipitation modified by evaporation. Josephine, Arco, and Deming lakes sit in a valley with likely permeable sediments and may be hydrologically connected through wetlands and recharged with shallow groundwater, as no streams are present. The water residence time in meromictic Deming Lake is short (100 d), yet it maintains a large reservoir of dissolved iron, indicating that shallow groundwater may be an additional source of water and dissolved ions. All four lakes develop subsurface chlorophyll maxima layers during the summer. All lakes also develop subsurface oxygen maxima that may result from oxygen trapping in the spring by rapidly developed summer thermoclines. Documenting the mixing status and general chemistry of these lakes enhances their utility and accessibility for future biogeochemical studies, which is important as lake stratification and anoxia are becoming more prevalent due to changes in climate and land use.
Aim
The International Continence Society (ICS) has standardized quality control and interpretation of uroflowmetry and urodynamics. We evaluated traces from two large studies of male lower urinary ...tract symptoms (UPSTREAM and UNBLOCS) against ICS standards of urodynamic equipment and practice.
Methods
Ten percent of uroflowmetry and urodynamics traces were selected at random from hospital sites. A data capture template was designed from the ICS Fundamentals of Urodynamic Practice checklist. Two pretrained blinded assessors extracted the data, with a third assessor to arbitrate. Departmental records of calibration checks and equipment maintenance were scrutinized.
Results
Seven out of twenty‐five (28%) departments reported no calibration checks. Four sites (16%) could not provide annual service records. In 32 out of 296 (10.8%) uroflowmetry traces, findings were affected by artifact. One hundred ten urodynamic study traces were reviewed; in 11 records (10%), key pressure traces were incompletely displayed. In 30 (27.2%), reference zero was not set to atmospheric pressure. Resting pressures were outside the expected range for 36 (32.7%). Pressure drift was seen in 18 traces (16.4%). At pressure‐flow study commencement, permission to void was omitted in 15 (13.6%). Cough testing after voiding was done in 71.2%, but the resulting cough spikes were significantly different in 16.5%. Erroneous diagnosis of bladder outlet obstruction (BOO) was identified in six cases (5.5%).
Conclusions
Erroneous diagnosis of BOO is a serious error of interpretation, as it could lead to unnecessary surgery. Other errors of standardization, testing, and interpretation were identified with lower risk of adverse implications. Inconsistent documentation of service records mean equipment accuracy is uncertain.
Urodynamic assessment of urinary incontinence Housley, Sarah L; Harding, Chris; Pickard, Robert
Indian Journal of Urology/Indian journal of urology,
04/2010, Letnik:
26, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Urodynamic evaluation in the assessment of women complaining of urinary incontinence remains controversial with recent UK National Institute of Health and Clinical Excellence guidance maintaining ...that it is unnecessary prior to surgery for women with a primarily stress leakage. Other experts contend it should be part of routine preoperative assessment since it establishes a diagnosis, allows more careful patient counseling and predicts surgical outcome.
To summarize current literature to define the evidence level on which these conflicting opinions are based.
A systematic literature search was performed and retrieved publications summarized in a narrative evidence review using both original papers and previous reviews.
Five hundred and one primary research papers and 65 previous reviews were retrieved. The findings were summarized in a narrative comprising overview, description of methods of bladder and urethral pressure measurement, and a summary of the literature concerning four key questions.
The level of evidence was low regarding answering each of the questions posed, preventing firm conclusions. Urodynamic findings do correlate with relevant symptoms and, to some extent, with symptom severity, giving reasonable diagnostic accuracy. There is no reliable evidence that preoperative urodynamic diagnosis improves outcome from surgery for stress incontinence although it is likely to facilitate preoperative discussion. Tests to differentiate sphincter deficiency and urethral hypermobility are not currently recommended due to poor validity and reproducibility. This along with the current use of mid-urethral tapes as the universal primary surgical procedure means differentiation is not a necessity. Preoperative diagnosis of detrusor overactivity does not appear to worsen surgical outcome in women with a primary symptom of stress leakage. Large, well-designed prospective studies are now underway to provide a definitive answer to these questions.
Abstract
Background
The mainstay treatments for urinary tract infections (UTIs) are nitrofurantoin and trimethoprim. The common route to acquire trimethoprim resistance (TriR) is via horizontal ...transfer of the trimethoprim-insensitive dihydrofolate reductase: dfrA. In contrast, nitrofurantoin resistance (NitR) requires the inactivation of two chromosomally encoded nitroreductases: nfsA and nfsB. The difference in antimicrobial resistance (AMR) evolution is reflected in community surveillance data: NitR incidence = ∼10% and for TriR > 30%. Longitudinal clinical UTI trials provide a unique opportunity to monitor in situ evolution of AMR and correlate its appearance to trial outcomes and the impact on uropathogens.
Objectives
To explore the in situ AMR evolution and its impact in Escherichia coli isolates from patients participating in the clinical trials: AnTIC and ALTAR. AnTIC was an open label randomized trial assessing the efficacy of antibiotic prophylaxis use in clean intermittent self-catheterizing patients. ALTAR compared the efficacy of the non-antibiotic alternative methenamine hippurate to antibiotic prophylaxis to treat recurrent UTIs.
Methods
The investigation of the evolution of nitrofurantoin and trimethoprim resistance in E. coli used general microbiology techniques, bioinformatic genome analysis and genetics to model known AMR mutations in susceptible E. coli strains.
Results
Trimethoprim resistance amongst E. coli trial isolates was driven by 14 out of ∼45 known dfrA allelic variants; the most common being dfrA1 and dfrA17. Growth analysis identified an allelic bias when strains were exposed to sub-MIC concentrations of trimethoprim. Growth rate analysis identified a 2%–10% slower doubling time for nitrofurantoin-resistant strains: NitS: 20.8 ± 0.7 min compared to NitR: 23 ± 0.8 min. Statistically, these data suggested no fitness advantage of evolved strains compared to the sensitive predecessor (P value = 0.13). Genetic manipulation of E. coli to mimic NitR evolution, however, supported a selective advantage.
Conclusions
Longitudinal sampling during antibiotic based clinical trials has provided a new perspective to the response of E. coli to UTI-related antibiotics. Correlation of nitrofurantoin response to pharmacokinetic data suggests that the low incidence of E. coli NitR is driven by selection not fitness. However, fitness correlates to dfrA allele carriage and could potentially be exploited to benefit the use of trimethoprim if other antibiotics are impeded by AMR.
Given the limitations of traditional methods of data collection and the increased use of smartphones, there is growing attention given to using smartphone apps for activity-travel surveys. ...Smartphones, through their location-logging capability, allow for the collection of high-quality data on the travel patterns of individuals over multiple days while minimizing the burden on those being monitored. This paper presents the results of an investigation into the potential and limitations of smartphone apps as passenger travel survey instruments. It evaluates the accuracy and performance of various smartphone apps using properly recorded ‘ground truth’ data. Through an open and global invitation to travel survey app and trace processing suite developers, a total of 17 apps were recruited for testing. A controlled experiment was devised, and the accuracy of the apps evaluated based on their ability to reproduce ground truth trip information. Further, the performance of the apps in terms of battery drain was also quantified and evaluated. Results indicate that while accuracy in terms of the trip ends/starts is reasonably high in most cases, mode inference accuracy varied significantly, with a maximum 65–75% accuracy achieved. As such, until significant improvements in mode inference algorithms arise, purely passive location-logging smartphone apps cannot serve as full-fledged automated travel survey instruments. While this may seem problematic, with minor input from respondents regarding regularly visited locations and modes used, as well as specific test case tuning and use of external data such as General Transit Feed Specification, there is an excellent potential to significantly reduce overall response burden and allow for high quality multi-day travel diary data to be collected. Implications of our findings for app design are discussed.
Lower urinary tract symptoms (LUTS) are common in males aged ≥40 years and have a considerable impact on quality of life. Management can be complex, and although most LUTS could be treated ...effectively in primary care, referrals to urology outpatients are increasing.
To explore GPs' experiences of managing LUTS together with patients' experiences of and preferences for treatment in primary care.
Telephone interviews were conducted with GPs and male patients presenting to primary care with bothersome LUTS.
Eleven GPs and 25 male patients were purposively sampled from 20 GP practices in three UK regions: Newcastle upon Tyne, Bristol, and South Wales. Interviews were conducted between May 2018 and January 2019, and were analysed using a framework approach.
Difficulty establishing causes and differentiating between prostate and bladder symptoms were key challenges to the diagnosis of LUTS in primary care, often making treatment a process of trial and error. Pharmacological treatments were commonly ineffective and often caused side effects. Despite this, patients were generally satisfied with GP consultations and expressed a preference for treatment in primary care.
Managing LUTS in primary care is a more accessible option for patients. Given the challenges of LUTS diagnosis, an effective diagnostic tool for use by GPs would be beneficial. Ensuring bothersome LUTS are not dismissed as a normal part of ageing is essential in improving patients' quality of life. Greater exploration of the role of non-pharmacological treatments is needed.
Evidence-based transportation planning and decision-making relies on accurate data and analysis. In the Toronto context, the main source of data on the movement of individuals within the region is ...the Transportation Tomorrow Survey (TTS). The TTS, conducted every 5 years since 1986, is a large-scale household travel diary survey that relies on self-reporting of travel by telephone and, as of 2011, web. While a high-quality source of data overall, the TTS has well-documented limitations with respect to the incomplete recording of walk and bike trips, or active transportation (AT). The TTS also suffers from other issues related to the reliance on self-reporting travel surveys more broadly, such as systematic under-reporting of discretionary travel, proxy report bias and declining response rates. This thesis explores the significance of not properly recording AT and other travel episodes, and presents solutions to cost-effectively collect multimodal travel data using a variety of methods. The thesis primarily describes a series of data collection projects undertaken from 2014 to 2017, each of which examines possible improvements to travel diary generation. Smartphone location logging apps and trace processing are explored first, where an assessment of the state of the art and 2 public-facing data collection projects were carried out. These led to an app template and app design guidelines being produced. Potential improvements to web survey questionnaire design and open data distribution mechanisms are then looked at, demonstrating potential value in terms of heightened relevance of the collected data and increased use. Finally, an in-person tablet data collection effort was carried out, demonstrating the feasibility of collecting data by combining door-to-door recruitment with internet-enabled tablets and a web survey. Methodological improvements and process-oriented lessons learned throughout are described, as are implications of alternative data collection methods for more accurately representing the demand for travel, active or otherwise.
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