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Purpose This study aimed to establish the functional impact of displacement of urogenital organs after abdominoperineal resection (APR) using validated questionnaires. Methods Patients who underwent APR for primary or recurrent rectal cancer (2001–2018) with evaluable pre- and postoperative radiological imaging and completed urinary (UDI-6, IIQ-7) and sexual questionnaires (male, IIEF; female, FSFI, FSDS-R) were included from 16 centers. Absolute displacement of the internal urethral orifice, posterior bladder wall, distal end of the prostatic urethra, and cervix were correlated to urogenital function by calculating Spearman’s Rho (ρ). Median function scores were compared between minimal or substantial displacement using median split. Results There were 89 male and 36 female patients included, of whom 45 and 19 were sexually active after surgery. Absolute displacement of the internal urethral orifice and posterior bladder wall was not correlated with UDI-6 in men (ρ = 0.119 and ρ = 0.022) nor in women (ρ = − 0.098 and ρ = − 0.154). In men with minimal and substantial displacement of the internal urethral orifice, median UDI-6 scores were 10 (IQR 0–22) and 17 (IQR 5–21), respectively, with corresponding scores of 25 (IQR 10–46) and 21 (IQR 16–36) in women. Displacement of the cervix and FSDS-R were correlated (ρ = 0.433) in sexually active patients. Conclusion This first analysis on functional impact of urogenital organ displacement after APR suggests that more displacement of the cervix might be associated with worse sexual function, while the data does not indicate any potential functional impact of bladder displacement. Studies are needed to further explore this underexposed topic.

This study aimed to establish the functional impact of displacement of urogenital organs after abdominoperineal resection (APR) using validated questionnaires.Patients who underwent APR for primary or recurrent rectal cancer (2001-2018) with evaluable pre- and postoperative radiological imaging and completed urinary (UDI-6, IIQ-7) and sexual questionnaires (male, IIEF; female, FSFI, FSDS-R) were included from 16 centers. Absolute displacement of the internal urethral orifice, posterior bladder wall, distal end of the prostatic urethra, and cervix were correlated to urogenital function by calculating Spearman's Rho (ρ). Median function scores were compared between minimal or substantial displacement using median split.There were 89 male and 36 female patients included, of whom 45 and 19 were sexually active after surgery. Absolute displacement of the internal urethral orifice and posterior bladder wall was not correlated with UDI-6 in men (ρ = 0.119 and ρ = 0.022) nor in women (ρ = - 0.098 and ρ = - 0.154). In men with minimal and substantial displacement of the internal urethral orifice, median UDI-6 scores were 10 (IQR 0-22) and 17 (IQR 5-21), respectively, with corresponding scores of 25 (IQR 10-46) and 21 (IQR 16-36) in women. Displacement of the cervix and FSDS-R were correlated (ρ = 0.433) in sexually active patients.This first analysis on functional impact of urogenital organ displacement after APR suggests that more displacement of the cervix might be associated with worse sexual function, while the data does not indicate any potential functional impact of bladder displacement. Studies are needed to further explore this underexposed topic.

Additional file 2. An exemplary mockup of conversations with the Exemplary Virtual assistant.

Additional file 1. Interview Guideline.

Aim: This study aimed to quantify displacement of urogenital organs after abdominoperineal resection (APR), and to explore patient and treatment characteristics associated with displacement. Method: Patients from 16 centres who underwent APR for primary or recurrent rectal cancer (2001–2018) with evaluable preoperative and 6–18 months postoperative radiological imaging were included in the study. Anatomical landmarks on sagittal images were related to a coordinate system based on reference lines between fixed bony structures and absolute displacements were calculated using the Pythagorean theorem. Rotation of landmarks was measured relative to a pubic-S5 reference line. Results: There were 248 patients included of which 171 were men and 77 women. The median displacement of the internal urethral orifice was 25 mm in men (maximum 65), and 17 mm in women (maximum 50). Rotation of the internal urethral orifice was in a caudal direction in 160/170 (94%) of men and 65/73 (89%) of women, with a median of 32 degrees (maximum 85) and 33 degrees (maximum 83), respectively. Displacements of the posterior bladder wall, distal end of prostatic urethra and cervix were significantly correlated with the internal urethral orifice. In linear regression analysis, biological mesh reconstruction of the pelvic floor and visceral interposition were significantly associated with increased displacement of the internal urethral orifice, and female gender and any filling of the presacral space with decreased displacement. Conclusions: Substantial absolute displacement and rotation of urogenital organs after APR for rectal cancer were observed, but with high variability among both men and women, and being significantly associated with reconstructive interventions.

Africa is severely affected by floods, with an increasing vulnerability to these events in the most recent decades. Our improved preparation against and response to this hazard would benefit from an enhanced understanding of the physical processes at play. Here, a database of 399 African stream gauges is used to analyze the seasonality of observed annual maximum flood, precipitation and soil moisture between 1981 and 2018. The database includes a total of 11,302 flood events, covering most African regions. The analysis is based on directional statistics to compare the annual maximum river flood with annual maximum rainfall and soil moisture. The results show that the annual maximum flood in most areas is more strongly linked to the annual peak of soil moisture than of annual maximum precipitation. In addition, the interannual variability of flood magnitudes is better explained by the variability of annual maximum soil moisture than by the variability in the annual maximum precipitation. These results have important implications for flood forecasting and the analysis of the long-term evolution of these hydrological hazards in relation with their drivers.

Psychiatric symptoms in children with Fetal Alcohol Spectrum Disorders (FASD) present with high prevalence and morbidity, often across symptom domains, e.g. ADHD-like symptoms, emotional dysregulation and sleep problems. Polypharmacy is often used, but no empirically-based guidelines exist regarding optimal treatment for these children. Moreover, stimulant use in these children is controversial as their responsiveness may be different due to altered neural circuitry associated with prenatal alcohol exposure. The objective of this review is to give an overview of existing data on pharmacological treatments of neurobehavioral symptoms in FASD. Our literature review yielded limited and conflicting clinical data on the effectiveness of pharmacological treatments for psychiatric symptoms in children with FASD, with some symptom domains lacking data altogether. We emphasize the need for clinical trials to guide pharmacological treatments in this complex population.

Quantifying the magnitude and frequency of extreme precipitation events is key in translating climate observations to planning and engineering design. Past efforts have mostly focused on the estimation of daily extremes using gauge observations. Recent development of high-resolution global precipitation products, now allow estimation of global extremes. This research aims to quantitatively characterize the spatiotemporal behavior of precipitation extremes, by calculating extreme precipitation return levels for multiple durations on the global domain using the Multi-Source Weighted-Ensemble Precipitation (MSWEP) dataset. Both classical and novel extreme value distributions are used to provide insight into the spatial patterns of precipitation extremes. Our results show that the traditional Generalized Extreme Value (GEV) distribution and Peak-Over-Threshold (POT) methods, which only use the largest events to estimate precipitation extremes, are not spatially coherent. The recently developed Metastatistical Extreme Value (MEV) distribution, that includes all precipitation events, leads to smoother spatial patterns of local extremes. For durations of 5 and 10 days, however, there are less events per year to fit the distribution (37 and 22 on average, respectively), leading to larger inter-annual variability and possible overestimation of the extremes. While the GEV and POT methods predict a consistent shift from heavy to thin tails with increasing duration, the MEV method predicts a relatively constant heaviness of the tail for any precipitation duration, opening up an important research question on what is the ‘correct’ tail behavior of extreme precipitation for different durations. The generated extreme precipitation return levels and corresponding parameters are provided as the Global Precipitation EXtremes (GPEX) dataset. These data can be useful for studying the underlying physical processes causing the spatiotemporal variations of the heaviness of extreme precipitation distributions.

Understanding the magnitude and frequency of extreme precipitation events is a core component of translating climate observations to planning and engineering design. This research aims to capture extreme precipitation return levels at the global scale. A benchmark of the current climate is created using the global Multi-Source Weighted-Ensemble Precipitation (MSWEP-V2, coverage 1979-2017 at 0.1 arc degree resolution) data, by using both classical and novel extreme value distributions. Traditional extreme value distributions, such as the Generalized Extreme Value (GEV) distribution use annual maxima to estimate precipitation extremes, whereas the novel Metastatistical Extreme Value (MEV) distribution also includes the ordinary precipitation events. Due to this inclusion the MEV is less sensitive to local extremes and thus provides a more reliable and smoothened spatial pattern. The global scale application of methods allows analysis of the complete spatial patterns of the extremes. The generated database of precipitation extremes for high return periods is particularly relevant in otherwise data-sparse regions to provide a benchmark for local engineers and planners.

We introduce the Precipitation Probability DISTribution (PPDIST) dataset, a collection of global high-resolution (0.1°) observation-based climatologies (1979–2018) of the occurrence and peak intensity of precipitation (P) at daily and 3-hourly time-scales. The climatologies were produced using neural networks trained with daily P observations from 93,138 gauges and hourly P observations (resampled to 3-hourly) from 11,881 gauges worldwide. Mean validation coefficient of determination (R2) values ranged from 0.76 to 0.80 for the daily P occurrence indices, and from 0.44 to 0.84 for the daily peak P intensity indices. The neural networks performed significantly better than current state-of-the-art reanalysis (ERA5) and satellite (IMERG) products for all P indices. Using a 0.1 mm 3 h−1 threshold, P was estimated to occur 12.2%, 7.4%, and 14.3% of the time, on average, over the global, land, and ocean domains, respectively. The highest P intensities were found over parts of Central America, India, and Southeast Asia, along the western equatorial coast of Africa, and in the intertropical convergence zone. The PPDIST dataset is available via www.gloh2o.org/ppdist., Measurement(s) hydrological precipitation process • precipitation occurrence • precipitation intensity Technology Type(s) Neural networks models • Gauge or Meter Device • satellite imaging of a planet • reanalyses Factor Type(s) daily and 3-hourly time-scales • year of data collection Sample Characteristic - Environment climate system Sample Characteristic - Location Earth (planet) Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.12815585