Integrating mangrove growth and failure in coastal flood protection designs.

Mangrove forests reduce wave attack along tropical and sub-tropical coastlines, decreasing the wave loads acting on coastal protection structures. Mangrove belts seaward of embankments can therefore lower their required height and decrease their slope protection thickness. Wave reduction by mangroves depends on tree frontal surface area and stability against storms, but both aspects are often oversimplified or neglected in coastal protection designs. Here we present a framework to evaluate how mangrove belts influence embankment designs, including mangrove growth over time and failure by overturning and trunk breakage. This methodology is applied to Sonneratia apetala mangroves seaward of embankments in Bangladesh, considering forest widths between 10 and 1000 m (cross-shore). For water depths of 5 m, wave reduction by mangrove forests narrower than 1 km mostly affects the slope protection and the bank erodibility, whereas the required embankment height is less influenced by mangroves. Sonneratia apetala trees experience a relative maximum in wave attenuation capacity at 10 years age, due to their large submerged canopy area. Once trees are more than 20 years old, their canopy is emergent, and most wave attenuation is caused by trunk and roots. Canopy emergence exposes mangroves to wind loads, which are much larger than wave loads, and can cause tree failure during cyclones. These results stress the importance of including tree surface area and stability models when predicting coastal protection by mangroves.

Analysis of radiation exposure data from common radiological procedures in Dutch hospitals.

INTRODUCTION: In the Netherlands, Diagnostic Reference Levels (DRLs) have not been based on a national survey as proposed by ICRP. Instead, local exposure data, expert judgment and the international scientific literature were used as sources. This study investigated whether the current DRLs are reasonable for Dutch radiological practice. METHODS: A national project was set up, in which radiography students carried out dose measurements in hospitals supervised by medical physicists. The project ran from 2014 to 2017 and dose values were analysed for a trend over time. In the absence of such a trend, the joint yearly data sets were considered a single data set and were analysed together. In this way the national project mimicked a national survey. RESULTS: For six out of eleven radiological procedures enough data was collected for further analysis. In the first step of the analysis no trend was found over time for any of these procedures. In the second step the joint analysis lead to suggestions for five new DRL values that are far below the current ones. The new DRLs are based on the 75 percentile values of the distributions of all dose data per procedure. CONCLUSION: The results show that the current DRLs are too high for five of the six procedures that have been analysed. For the other five procedures more data needs to be collected. Moreover, the mean weights of the patients are higher than expected. This introduces bias when these are not recorded and the mean weight is assumed to be 77 kg. IMPLICATIONS FOR PRACTICE: The current checking of doses for compliance with the DRLs needs to be changed. Both the procedure (regarding weights) and the values of the DRLs should be updated.

Compliance to Diagnostic Reference Levels for radiation exposure in common radiological procedures in Dutch hospitals: A nation-wide survey carried out by medical imaging students.

INTRODUCTION: In the Netherlands, hospitals have difficulty in implementing the formal procedure of comparing radiation dose values to Diagnostic Reference Levels (DRLs). METHODS: To support the hospitals, train radiography students, and carry out a nationwide dose survey, diagnostic radiography students performed 125 DRL comparisons for nine different procedures in 29 radiology departments. Students were instructed at three Dutch Universities of Applied Sciences with a radiography programme and supervised by medical physicists from the participating hospitals. RESULTS: After a pilot study in the western part of the country in eight hospitals, this study was enlarged to involve 21 hospitals from all over the Netherlands. The 86 obtained dose comparisons fall below the DRLs in 97% of all cases. This very high compliance may have been enhanced by the voluntary participation of hospitals that are confident about their performance. CONCLUSION: The results indicate that the current DRLs that were not based on a national survey, may need to be updated, sometimes to half their current value. For chest and pelvis examinations the DRLs could be lowered from 12 and 300 µGy·m2 to the 75-percentile values found in this study of 5,9 and 188 µGy·m2, respectively.

Combined vertebral fracture assessment and bone mineral density measurement: a new standard in the diagnosis of osteoporosis in academic populations.

UNLABELLED: Vertebral Fracture Analysis enables the detection of vertebral fractures in the same session as bone mineral density testing. Using this method in 2,424 patients, we found unknown vertebral fractures in approximately one out of each six patients with significant impact on management. INTRODUCTION: The presence of osteoporotic vertebral fractures (VF) is an important risk factor for all future fractures independent of BMD. Yet, determination of the VF status has not become standard practice. Vertebral Fracture Assessment (VFA) is a new feature available on modern densitometers. In this study we aimed to determine the prevalence of VF using VFA in all patients referred for BMD testing in a university medical center and to evaluate its added clinical value. METHODS: Prospective diagnostic evaluation study in 2,500 consecutive patients referred for BMD. Patients underwent VFA in supine position after BMD testing. Questionnaires were used to assess perceived added value of VFA. RESULTS: In 2,424 patients (1,573 women), results were evaluable. In 541 patients (22%), VFA detected a prevalent VF that was unknown in 69%. In women, the prevalence was 20% versus 27% found in men (p < 0.0001). The prevalence of VF was 14% in patients with normal BMD (97/678), increased to 21% (229/1,100) in osteopenia and to 26% in those with osteoporosis (215/646) by WHO criteria. After excluding mild fractures VF prevalence was 13% (322/2,424). In 468 of 942 questionnaires (50% response rate), 27% of the referring physicians reported VFA results to impact on patient management. CONCLUSIONS: VFA is a patient friendly new tool with a high diagnostic yield, as it detected unknown VF in one out of each six patients, with significant impact on management. We believe these findings justify considering VFA in all new patients referred for osteoporosis assessment in similar populations.

Direct comparison of FP-CIT SPECT and F-DOPA PET in patients with Parkinson's disease and healthy controls.

PURPOSE: Diagnosing Parkinson's disease (PD) on clinical grounds may be difficult, especially in the early stages of the disease. F-DOPA PET and FP-CIT SPECT scans are able to determine presynaptic dopaminergic activity in different ways. The aim of this study was to determine and compare the sensitivity and specificity of the two methods in the detection of striatal dopaminergic deficits in the same cohort of PD patients and healthy controls. METHODS: Movement disorder specialists recruited 11 patients with early-stage PD and 17 patients with advanced PD. The patients underwent both an FP-CIT SPECT scan and an F-DOPA PET scan. In addition, 10 FP-CIT SPECT scans or 10 F-DOPA PET scans were performed in 20 healthy controls. A template with regions of interest was used to sample tracer activity of the caudate, putamen and a reference region in the brain. The outcome parameter was the striatooccipital ratio (SOR). Normal SOR values were determined in the controls. The sensitivity and specificity of both scanning methods were calculated. RESULTS: FP-CIT SPECT and F-DOPA PET scans were both able to discriminate PD patients from healthy controls. For the early phases of the disease, sensitivity and specificity of the contralateral striatal and putaminal uptake of FP-CIT and F-DOPA was 100%. When only caudate uptake was considered, the specificities were 100% and 90% for FP-CIT and F-DOPA, respectively, while the sensitivity was 91% for both scanning techniques. CONCLUSION: FP-CIT SPECT and F-DOPA PET scans are both able to diagnose presynaptic dopaminergic deficits in early phases of PD with excellent sensitivity and specificity.

Comparison of FP-CIT SPECT with F-DOPA PET in patients with de novo and advanced Parkinson's disease.

PURPOSE: Diagnosis of Parkinson's disease (PD) can be difficult. F-DOPA PET is able to quantify striatal dopa decarboxylase activity and storage capacity of F-dopamine, but is expensive and not generally available. FP-CIT binds to the dopamine transporter, and FP-CIT SPECT is cheaper and more widely available, but has a lower resolution. The aim of this study was to compare these two methods in the same patients with different stages of PD to assess their power in demonstrating deficits of the striatal dopaminergic system. METHODS: Thirteen patients with de novo PD and 17 patients with advanced PD underwent FP-CIT SPECT and static F-DOPA PET. After data transfer to standard stereotactic space, a template with regions of interest was used to sample values of the caudate, putamen and an occipital reference region. The outcome value was striato-occipital ratios. Patients were clinically examined in the "off state" (UPDRS-III and H&Y stage). RESULTS: Good correlations were found between striatal F-DOPA uptake and striatal FP-CIT uptake (r = 0.78) and between putaminal F-DOPA uptake and putaminal FP-CIT uptake (r = 0.84, both p < 0.0001). Both striatal uptake of FP-CIT and that of F-DOPA correlated moderately with H&Y stage (rho = -0.52 for both techniques), UPDRS-III (rho = -0.38 for F-DOPA; rho = -0.45 for FP-CIT) and disease duration (rho = -0.59 for F-DOPA; rho = -0.49 for FP-CIT, all p < 0.05). CONCLUSION: FP-CIT values correlate well with F-DOPA values. Both methods correlate moderately with motor scores and are equally able to distinguish patients with advanced PD from patients with de novo PD.

An overview of quantitative risk measures for loss of life and economic damage.

A comprehensive overview of methods to quantify and limit risks arising from different sources is still missing in literature. Therefore, a study of risk literature was carried out by the authors. This article summarises about 25 quantitative risk measures. A risk measure is defined as a mathematical function of the probability of an event and the consequences of that event. The article focuses mainly on risk measures for loss of life (individual and societal risk) and economic risk, concentrating on risk measurement experiences in The Netherlands. Other types of consequences and some international practices are also considered. For every risk measure the most important characteristics are given: the mathematical formulation, the field of application and the standard set in this field. Some of the measures have been used in a case study to calculate the flood risks for an area in The Netherlands.