Search

The occurrence of record‐breaking flood events continues to cause damage and disruption despite significant investments in flood defences, suggesting that these events are in some sense surprising. This study develops a new statistical test to help assess if a flood event can be considered surprising or not. The test statistic is derived from annual maximum series (AMS) of extreme events, and Monte Carlo simulations were used to derive critical values for a range of significance levels based on a Generalised Logistic distribution. The method is tested on a national data set of AMS of peak flow from the United Kingdom, and is found to correctly identify recent large events that have been identified elsewhere as causing a significant change in UK flood management policy. No temporal trend in the frequency or magnitude of surprising events was identified, and no link could be established between the occurrences of surprising events and large‐scale drivers. Finally, the implications of the findings for future research examining the most extreme flood events are discussed. [ABSTRACT FROM AUTHOR]

This study presents a bivariate extension of the goodness-of-fit measure for regional frequency distributions developed by Hosking and Wallis (1993) for use with the method of L-moments. Utilizing the approximate joint normal distribution of the regional L-skewness and L-kurtosis, a graphical representation of the confidence region on the L-moment diagram can be constructed as an ellipsoid. Candidate distributions can then be accepted where the corresponding theoretical relationship between the L-skewness and L-kurtosis intersects the confidence region, and the chosen distribution would be the one that minimizes the Mahalanobis distance measure. Based on a set of Monte Carlo simulations, it is demonstrated that the new bivariate measure generally selects the true population distribution more frequently than the original method. Results are presented to show that the new measure remains robust when applied to regions where the level of intersite correlation is at a level found in real world regions. Finally the method is applied to two different case studies involving annual maximum peak flow data from Italian and British catchments to identify suitable regional frequency distributions. [ABSTRACT FROM AUTHOR]

The application of historical flood information as a tool for augmenting instrumental flood data is increasingly recognised as a valuable tool. Most previous studies have focused on large catchments with historic settlements, this paper applies the approach to the smaller lowland system of the Sussex Ouse in southeast England. The reassessment of flood risk on the Sussex Ouse is pertinent in light of the severe flooding in October 2000 and heightened concerns of a perceived increase in flooding nationally. Systematic flood level readings from 1960 and accounts detailing past flood events within the catchment are compiled back to ca. 1750. This extended flood record provides an opportunity to reassess estimates of flood frequency over a timescale not normally possible within flood frequency analysis. This paper re-evaluates flood frequency at Lewes on the Sussex Ouse downstream of the confluence of the Sussex Ouse and River Uck. The paper considers the strengths and weaknesses in estimates resulting from contrasting methods of analysis and their corresponding data: (i) single site analysis of gauged annual maxima; (ii) combined analysis of systematic annual maxima augmented with historical peaks of estimated magnitude; (iii) combined analysis of systematic annual maxima augmented with historical peaks of estimated magnitude exceeding a known threshold, and (iv) sensitivity analysis including only the very largest historical flood events. Use of the historical information was found to yield much tighter confidence intervals of risk estimates, with uncertainty reduced by up to 40% for the 100-year return frequency event when historical information was added to the gauged data. [ABSTRACT FROM AUTHOR]

A new generalized method is presented enabling the use of multiple donor sites when predicting an index flood variable in an ungauged catchment using a hydrological regression model. The method is developed from the premise of having an index flood prediction with minimum variance, which results in a set of optimal weights assigned to each donor site. In the model framework presented here, the weights are determined by the geographical distance between the centroids of the catchments draining to the subject site and the donor sites. The new method was applied to a case study in the United Kingdom using annual maximum series of peak flow from 602 catchments. Results show that the prediction error of the index flood is reduced by using donor sites until a minimum of six donors have been included, after which no or marginal improvements in prediction accuracy are observed. A comparison of these results is made with a variant of the method where donor sites are selected based on connectivity with the subject site through the river network. The results show that only a marginal improvement is obtained by explicitly considering the network structure over spatial proximity. The evaluation is carried out based on a new performance measure that accounts for the sampling variability of the index flood estimates at each site. Other results compare the benefits obtained by adding relevant catchment descriptors to a simple regression model with those obtained by transferring information from local donor sites. [ABSTRACT FROM AUTHOR]

The effect of urban land cover on catchment flood response is evaluated using a lumped rainfall-runoff model to analyse flood events from selected UK catchments with mixed urban and rural land use. The present study proposes and evaluates a series of three extensions to an existing model to enable a better representation of urban effects, namely: an increase in runoff volume, reduced response time and a decrease in baseflow (resulting from decreased infiltration). Based on observed flood events from seven catchments, cross-validation methods are used to compare the predictive ability of the model variants with that of the original unmodified model. The results show that inclusion of urban effects increases the predictive ability of the model across catchments, despite large between-event variability of model performance. More detailed investigations into the relationship between model performance and individual event characteristics (antecedent soil moisture, rainfall duration, depth and intensity) did not reveal systematic inabilities of the model to reproduce certain types of events. Finally, it is demonstrated that the new extended model has the ability to simulate urban effects in accordance with the expected changes in storm runoff patterns. [ABSTRACT FROM AUTHOR]

In November 2009, record-breaking rainfall resulted in severe, damaging flooding in Cumbria, in the north-west of England. This paper presents an analysis of the river flows and lake levels experienced during the event. Comparison with previous maxima shows the exceptional nature of this event, with new maximum flows being established at 17 river flow gauging stations, particularly on catchments influenced by lakes. The return periods of the flood peaks are estimated using the latest Flood Estimation Handbook statistical procedures. Results demonstrate that the event has had a considerable impact on estimates of flood frequency and associated uncertainty. Analysis of lake levels suggests that their record high levels reduced their attenuating effect, significantly affecting the timing and magnitude of downstream peaks. The peak flow estimate of 700 m3 s"1 at Workington, the lowest station on the Derwent, was examined in the context of upstream inputs and was found to be plausible. The results of this study have important implications for the future development of flood frequency estimation methods for the UK. It is recommended that further research is undertaken on the role of abnormally elevated lake levels and that flood frequency estimation procedures in lake-influenced catchments are reviewed. [ABSTRACT FROM AUTHOR]

The paper uses a simple water balance model that partitions the precipitation between actual evapotranspiration, quick flow and delayed flow, and has sufficient complexity to capture the essence of climate and vegetation controls on this partitioning. Using this model, monthly flow duration curves have been constructed from climate data across Europe to address the relative frequency of ecologically critical low flow stages in semi-arid rivers, when flow commonly persists only in disconnected pools in the river bed. The hydrological model is based on a dynamic partitioning of precipitation to estimate water available for evapotranspiration and plant growth and for residual runoff. The duration curve for monthly flows has then been analysed to give an estimate of bankfull flow based on recurrence interval. Arguing from observed ratios of cross-sectional areas at flood and low flows, hydraulic geometry suggests that disconnected flow under "pool" conditions is approximately 0.1% of bankfull flow. Flow duration curves define a measure of bankfull discharge on the basis of frequency. The corresponding frequency for pools is then read from the duration curve, using this (0.1 %) ratio to estimate pool discharge from bank full discharge. The flow duration curve then provides an estimate of the frequency of poorly connected pool conditions, corresponding to this discharge, that constrain survival of river-dwelling arthropods and fish. The methodology has here been applied across Europe at 15 km resolution, and the potential is demonstrated for applying the methodology under alternative climatic scenarios. [ABSTRACT FROM AUTHOR]

Monthly duration curves have been constructed from climate data across Europe to help address the relative frequency of ecologically critical low flow stages in temporary rivers, when flow persists only in disconnected pools in the river bed. The hydrological model is based on a partitioning of precipitation to estimate water available for evapo-transpiration and plant growth and for residual runoff. The duration curve for monthly flows has then been analysed to give an estimate of bankfull flow based on recurrence interval. The corresponding frequency for pools is then based on the ratio of bank full discharge to pool flow, arguing from observed ratios of cross-sectional areas at flood and low flows to estimate pool flow as 0.1% of bankfull flow, and so estimate the frequency of the pool conditions that constrain survival of river-dwelling arthropods and fish. The methodology has been applied across Europe at 15 km resolution, and can equally be applied under future climatic scenarios. [ABSTRACT FROM AUTHOR]

This paper investigates a new approach to spatial generalisation of rainfall-runoff model parameters -- site-similarity with pooling groups -- for use in flood frequency estimation at ungauged sites using continuous simulation. The method is developed for the generalisation of a simple conceptual model, the Probability Distributed Model, with four parameters which require specific estimation. The study is based on a relatively large sample of catchments in Great Britain. Various options are investigated within the approach. In the final version, the pooling group comprises the 10 calibrated catchments closest, in catchment property space, to the target site, where the catchment properties used to define the space differ for each parameter of the model. An analysis that, explicitly, takes account of calibration uncertainty as a source of error enables the uncertainty associated with generalised parameter values to be reduced, justifiably. The approach uses calibration uncertainty estimated through jack-knifing and employs a weighting scheme within pooling groups that uses weights which vary both with distance in the catchment property space and with the calibration uncertainty. Models using generalised values from this approach perform relatively well compared with direct calibration. Although performance appears to be better in some areas of the country than others, there are no obvious relationships between catchment properties and performance. [ABSTRACT FROM AUTHOR]

The depth–duration–frequency (DDF) model developed as part of the Flood Estimation Handbook (FEH) enables estimates of design rainfall to be made at any location in the UK. This study presents a shortcut method for estimating seasonal design rainfall for a summer and winter season, respectively, using a simple seasonal correction factor in combination with the FEH DDF estimate of design rainfall. The seasonal correction factors were derived for the summer and winter season for a range of durations. The observed correction factors were linked to standard average annual rainfall available from the FEH CD-ROM, thereby enabling the use of this method at any location in the UK. The results obtained in this study are shown to correspond well to the summary statistics on seasonal rainfall presented in the Flood Studies Report. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Objective: To investigate associations between changes in leg extensor muscle power of the affected limb (ΔLEP) and changes in physical function after 12 weeks of progressive resistance training (PRT) or neuromuscular exercise (NEMEX) in patients with hip osteoarthritis., Design: Secondary analyses of a randomized controlled trial. From 160 participants enrolled in the clinical trial and cluster randomized to PRT (n ​= ​82) or NEMEX (n ​= ​78), a total of 147 (92%) had complete follow-up data and were included in the analyses. Simple linear and multivariate linear regression models estimated the crude and adjusted associations between ΔLEP normalized to body weight (watt/kg) and changes in performance-based and patient-reported measures of physical function., Results: Adjusted estimates [95% confidence intervals] showed associations between ΔLEP (watt/kg) and changes in 30-s chair stand test (β: 2.34 [1.33; 3.35], R 2 : 0.13), 9-step timed stair climb test (β: -1.47 [-2.09; -0.85], R 2 : 0.38), 40-m fast paced walking test (β: -2.20 [-3.30; -1.11], R 2 : 0.09), Activities of Daily Life function (β: 8.63 [3.16; 14.10], R 2 : 0.23) and Sport and Recreation function (β: 10.57 [2.32; 18.82], R 2 : 0.21) subscales from the Hip disability and Osteoarthritis Outcomes Score. Group allocation to PRT did not lead to greater regression coefficients than in NEMEX., Conclusions: Changes in leg extensor muscle power after supervised exercise are consistently associated with changes in physical function across performance-based and patient-reported measures in patients with hip osteoarthritis. These associations seem to be independent of allocation to PRT or NEMEX., Competing Interests: TK, UD and IM have worked extensively with PRT. STS is co-lead of the Danish initiative, Good Life with osteoArthritis in Danmark (GLA:D), which entails NEMEX and has received personal fees from Munksgaard, TrustMe-Ed, and Nestlé Health Science, outside the submitted work., (© 2024 The Authors.)

Background: Restoring maximal muscle strength of the knee extensors (KE) and knee flexors (KF) following anterior cruciate ligament (ACL) injury and ACL reconstruction is of great importance to reduce the re-injury rate after ACL reconstruction and to reduce the risk of knee osteoarthritis. Therefore, it is essential that clinicians and healthcare providers use valid and reliable measures to assess knee muscle strength to ensure a safe return to sport., Purpose: To evaluate the reliability (test-retest reliability, inter-tester reliability and test-retest agreement) and validity (concurrent validity, convergent validity and ForceFrame (FF) vs. isokinetic dynamometer (ID) agreement) of the ForceFrame (FF) dynamometer during isometric testing of the knee extensors and flexors., Study Design: Cross-sectional study., Material and Methods: Twenty-seven participants with ACL injury or reconstruction were recruited for participation in this study. maximal voluntary isometric contration (MVIC) of the knee extensors and flexors was tested on two separate days. Day one included validity assessments with FF, a gold-standard ID and a handheld dynamometer (HHD). Day two included reliability assessments with FF performed by two assessors. Main outcome measures were day-to-day test-retest reliability and agreement and inter-tester reliability of FF, and concurrent validity (FF vs. an ID and a HHD). Reliability was tested as test-retest and inter-tester reliability using interclass correlation coefficient (ICC), while agreement was tested using Bland & Altman plots with limits of agreement (LOA), standard error of measurement (SEM) and smallest detectable change (SDC). Concurrent validity between FF, ID, and HHD was assessed using Pearson's correlations and mean difference was evaluated by Bland & Altman plots., Results: Twenty-seven participants (10 females, 17 males) with a median age of 25 years (range 19-60) were included in this study. There was a good day-to-day test-retest reliability for MVIC of KE (ICC=0.77, CI95:0.48-0.90) and KF (ICC=0.83, CI95:0.61-0.92) and excellent inter-tester reliability for MVIC of KE (ICC=0.97, CI95:0.94-0.98) and KF (ICC=0.93, 95CI:0.85-0.97). Standard error of measurement (SEM) was 8% and 9%, while the smallest detectable change (SDC) was 22% and 27% for KE and KF, respectively. FF showed fair concurrent validity compared to ID for KE (r=0.56), poor concurrent validity for knee flexors (KF (r=0.24) and compared to HHD a moderate correlation for KE (r=0.74) and poor correlation for KF (r=0.12). Bland & Altman plots between FF and the ID showed a mean difference of -0.51 Nm/kg for KE and -0.32Nm/kg for KF., Conclusions: FF can be used to obtain reliable and valid results to assess MVIC of the KE, but not the KF. It should be noted that absolute results produced by the FF may be considered an underestimation of actual MVIC. The test position to assess KF in FF does not appear to be optimal, and different test-positions may be considered., Level of Evidence: Level 3., Competing Interests: The study was supported with funding (to purchase of a test device, the ForceFrame and covering transportations costs for participants) by the Research Council at Lillebaelt Hospital, Denmark. The authors report no conflicts of interest associated with the creation of this manuscipt., (© The Author(s).)

Background: Limited evidence exists regarding the effectiveness of pain relief and functional improvement in patients undergoing revision total hip replacement (THR). Furthermore, there are no clinical guidelines or consensus on optimal rehabilitation after revision THR., Purpose: The primary aim of this study was to compare the effectiveness of an exercise intervention targeting hip strengthening with standard community-based rehabilitation in patients undergoing revision THR., Methods: This multicenter randomized controlled assessor-blinded trial will be conducted at eight hospitals and multiple municipality rehabilitation centers in Denmark. A total of 84 patients undergoing revision THR are estimated to be allocated to either an exercise intervention targeting hip strengthening (NEMEX-STR) or standard community-based rehabilitation (Usual care). Recruitment was initiated in November 2022 and is expected to be completed by June 2024. The primary outcome is change in functional performance measured by the 30 s chair stand test, from baseline to 4 months after the start of intervention. Secondary outcomes include hip disability and osteoarthritis outcome score; 40 m fast-paced walk test; 9-step timed stair climb test; leg extensor muscle power; global perceived effect; and adverse events. Other outcomes include The International Physical Activity Questionnaires, pain intensity, and European quality of life-5 dimensions. An intention-to-treat approach will be used for analyzing changes in primary and secondary outcome measures. The trial was approved by the Central Denmark Region Committees on Health Research Ethics (Journal No 1-10-72-134-22) and registered on the Central Denmark Regions' internal list of research projects (Journal No 1-16-02-285-22)., Discussion: To our knowledge, this study is the first to explore different rehabilitation programs after revision THR through a randomized controlled trial. The results will provide clinically relevant evidence for optimal rehabilitation after revision THR for improving functional performance, physical function, and quality of life, with great importance for patients, relatives, physiotherapists, and decision-makers., Clinicaltrial: GOV: NCT05657054., (© 2024 The Author(s). Physiotherapy Research International published by John Wiley & Sons Ltd.)

Objectives: To estimate the effectiveness of exercise at end of treatment and long-term follow-up compared to a control condition or other conservative treatments in patients with Greater Trochanteric Pain Syndrome (GTPS)., Methods: Databases were searched September 2021 and updated September 2023. Randomized controlled trials (RCT) comparing exercise interventions for patients with GTPS, to a control condition; corticosteroid injection; shock wave therapy; or other types of exercise programs were included. Risk of bias was assessed using the ROB2 tool. Meta-analyses were performed using a random-effects model. The certainty of the evidence was rated by the GRADE approach., Results: Six RCTs including a total of 733 patients with GTPS were included. Three trials compared exercise to sham exercise or wait-and-see control groups, two trials compared exercise to corticosteroid injection, two trials compared exercise to shockwave therapy, and one trial compared exercise to another type of exercise. Meta-analyses showed that in the long term, exercise slightly reduces hip pain and disease severity, while slightly improving patient-reported physical function and global rating of change compared to a control condition. No serious adverse events were reported. Compared to corticosteroid injection, exercise improves long-term global rating of change., Conclusion: The current evidence supports a strong recommendation for exercise as first line treatment in patients clinically diagnosed with GTPS. Compared to corticosteroid injection, exercise is superior in increasing the likelihood that a patient experiences a meaningful global improvement. These results are based on few trials and a moderate number of patients., Registration: This review was prospectively registered in the PROSPERO database of systematic reviews (ID: CRD42021261380). CONTRIBUTION OF PAPER., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Exercise is recommended as first-line treatment for patients with hip osteoarthritis (OA). However, randomized controlled trials providing evidence for the optimal exercise type are lacking., Objective: To investigate whether progressive resistance training (PRT) is superior to neuromuscular exercise (NEMEX) for improving functional performance in patients with hip OA., Design: Multicenter, cluster-randomized, controlled, parallel-group, assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT04714047)., Setting: Hospitals and physiotherapy clinics., Participants: 160 participants with clinically diagnosed hip OA were enrolled from 18 January 2021 to 28 April 2023 and randomly assigned to PRT ( n = 82) or NEMEX ( n = 78)., Intervention: Twelve weeks of PRT or NEMEX with 2 supervised 60-minute group sessions each week. The PRT intervention consisted of 5 high-intensity resistance training exercises targeting muscles at the hip and knee joints. The NEMEX intervention included 10 exercises and emphasized sensorimotor control and functional stability., Measurements: The primary outcome was change in the 30-second chair stand test (30s-CST). Key secondary outcomes were changes in scores on the pain and hip-related quality of life (QoL) subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS)., Results: The mean changes from baseline to 12-week follow-up in the 30s-CST were 1.5 (95% CI, 0.9 to 2.1) chair stands with PRT and 1.5 (CI, 0.9 to 2.1) chair stands with NEMEX (difference, 0.0 [CI, -0.8 to 0.8] chair stands). For the HOOS pain subscale, mean changes were 8.6 (CI, 5.3 to 11.8) points with PRT and 9.3 (CI, 5.9 to 12.6) points with NEMEX (difference, -0.7 [CI, -5.3 to 4.0] points). For the HOOS QoL subscale, mean changes were 8.0 (CI, 4.3 to 11.7) points with PRT and 5.7 (CI, 1.9 to 9.5) points with NEMEX (difference, 2.3 [CI, -3.0 to 7.6] points)., Limitation: Participants and physiotherapists were not blinded., Conclusion: In patients with hip OA, PRT is not superior to NEMEX for improving functional performance, hip pain, or hip-related QoL., Primary Funding Source: Independent Research Fund Denmark., Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3225.

Since the first administration of insulin to a person with diabetes in 1922, scientific contributions from academia and industry have improved insulin therapy and access. The pharmaceutical need for insulin is now more than 40 tons annually, half of which is produced by recombinant secretory expression in Saccharomyces cerevisiae. We discuss how, in this yeast species, adaptation of insulin precursors by removable structural elements is pivotal for efficient secretory expression. The technologies reviewed have been implemented at industrial scale and are seminal for the supply of human insulin and insulin analogues to people with diabetes now and in the future. Engineering of a target protein with removable structural elements may provide a general approach to yield optimisation., Competing Interests: Declaration of interests All authors are employees and shareholders of Novo Nordisk A/S., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)