Conclusions

Is it possible to define an integrated method for strategic flood risk management and spatial quality enhancement, in which spatial quality is a decisive ex-ante criterion, and what would be the key elements and steps in such a method? This constitutes the primary research question. The publications that together form this dissertation describe such a method and thus provide a positive answer to the primary research question. A key principle in the approach is the inclusion of multiple interchangeable (effective) flood risk reduction interventions at varying locations, so that the criteria of spatial quality can become decisive in flood risk management strategy development. The ability to assess the impact of different interventions on spatial quality is essential. In order to do so, an assessment framework was developed; it combines the approach of a spatial quality criteria checklist with expert judgement. The checklist supports expert judgement in that it keeps a wide, open perspective while assessing the spatial quality of a conceptual intervention, and thus allows verifiable and reproducible assessments. The method developed employs research-by-design to systematically test different interventions at different locations. It includes the following steps: An inventory of current and potential flood risk protection strategies An inventory of a region’s spatial characteristics, challenges, and potentials A qualitative assessment of existing situations and a spatial impact assessment of reference flood risk strategies, if any exist Systematic research on how flood risk management interventions at different scales can shift the location of a flood risk intervention; this includes qualitative assessments of interventions at various locations Systematic research on how flood risk management interventions in different flood risk layers can shift the location of a flood risk assignment; this includes qualitative assessments of interventions at various locations Selection of a combination of interventions that are preferred from a spatial quality objectiv

Are the therapeutic strategies in anorexia of ageing effective on nutritional status? A systematic review with meta-analysis

BACKGROUND: Anorexia of ageing (AA) may be considered as a risk factor for frailty and has an important impact on quality of life, morbidity and mortality. METHODS: A systematic review and a meta-analysis were performed to summarise the results from several trials on the effectiveness of treatments in AA, as associated with depression, sensory impairment of taste and smell, decreased appetite or early satiety, and disability. Eligible studies were required to report baseline and follow-up values, the mean change (∆-change) from baseline, and/or the mean difference among intervention groups versus control group, concerning food intake (kcal/daily) and/or nutritional outcomes, such as body weight, body mass index, albumin and Mini Nutritional Assessment. RESULTS: The systematic review included 20 papers based on different therapeutic approaches concerning food intake and/or nutritional outcomes. The results of the meta-analysis indicate that the interventions for AA have an important impact on body weight [+1.59 kg; 95% confidence interval (CI) = 1.48-+1.71 kg; P < 0.001) and on energy intake (+56.09 kcal; 95% CI = -54.05 to +166.25 kcal; P = 0.32). Regarding secondary outcomes, it was not possible to meta-analyse the limited amount of data availab le. CONCLUSIONS: The different variants of AA need to be defined because diverse therapeutic approaches are available. A more precise definition of the functional impairments associated with AA may allow a more correct decision about the most appropriate therapy to be prescribed. Moreover, this may allow for a more effective performance of the different therapeutic approaches once they are better targeted to the different scenarios of AA

Decision support system for the long-term city metabolism planning problem

A Decision Support System (DSS) tool for the assessment of intervention strategies (Alternatives) in an Urban Water System (UWS) with an integral simulation model called “WaterMet²” is presented. The DSS permits the user to identify one or more optimal Alternatives over a fixed long-term planning horizon using performance metrics mapped to the TRUST sustainability criteria (Alegre et al., 2012). The DSS exposes lists of in-built intervention options and system performance metrics for the user to compose new Alternatives. The quantitative metrics are calculated by the WaterMet² model and further qualitative or user-defined metrics may be specified by the user or by external tools feeding into the DSS. A Multi-Criteria Decision Analysis (MCDA) approach is employed within the DSS to compare the defined Alternatives and to rank them with respect to a pre-specified weighting scheme for different Scenarios. Two rich, interactive Graphical User Interfaces, one desktop and one web-based, are employed to assist with guiding the end user through the stages of defining the problem, evaluating and ranking Alternatives. This mechanism provides a useful tool for decision makers to compare different strategies for the planning of UWS with respect to multiple Scenarios. The efficacy of the DSS is demonstrated on a northern European case study inspired by a real-life urban water system for a mixture of quantitative and qualitative criteria. The results demonstrate how the DSS, integrated with an UWS modelling approach, can be used to assist planners in meeting their long-term, strategic level sustainability objectives

Exercise for falls prevention in community-dwelling older adults: Trial and participant characteristics, interventions and bias in clinical trials from a systematic review

IntroductionThere is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults.MethodsMEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018.Results108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16–52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15–43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12–52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias.ConclusionsThe characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines

Evaluation of the risks of contaminating low erucic acid rapeseed with high erucic rapeseed and identification of mitigation strategies

High erucic acid rapeseed (HEAR) oil is under increasing demand for various industrial applications. However, many growers are concerned that if they grow the crop, they will not be able to revert to other rapeseed varieties in the future due to the risk of erucic acid (EA) contamination of the harvested seed and inability to maintain acceptable erucic acid thresholds. This review considered published literature and, using the same criteria as that used to contain transgenic crops, aimed to identify the key risks of erucic acid contamination, broadly prioritise them and identify pragmatic mitigation options. Oilseed rape has a number of traits that increase the risk of low erucic acid rapeseed (LEAR) crops being contaminated with EA from HEAR varieties. The quantity of seed produced and the potential for seed dormancy coupled with partial autogamy (self-fertilisation) facilitate the establishment and persistence of volunteer and feral populations. The large quantities of pollen produced when the crop is in flower mean there is also a high potential for cross-pollination. Self-sown volunteer plants represent the highest potential contamination risk, followed by the presence of arable weeds (e.g., wild mustard) whose seeds are also high in EA. Other risks arise from the cross-pollination of compatible wild relatives and the mixing of seed prior to sowing. It is important that both HEAR and LEAR varieties are appropriately managed since risks and their potential for mitigation arise throughout the entire LEAR crop production process. The length of rotation, type of tillage, cultivar choice, buffer zones, effective weed management and basic machinery hygiene are all factors that can reduce the risk of erucic acid contamination of LEAR crops and maintain the required thresholds.Peer reviewedFinal Published versio

Radiomics strategies for risk assessment of tumour failure in head-and-neck cancer

Quantitative extraction of high-dimensional mineable data from medical images is a process known as radiomics. Radiomics is foreseen as an essential prognostic tool for cancer risk assessment and the quantification of intratumoural heterogeneity. In this work, 1615 radiomic features (quantifying tumour image intensity, shape, texture) extracted from pre-treatment FDG-PET and CT images of 300 patients from four different cohorts were analyzed for the risk assessment of locoregional recurrences (LR) and distant metastases (DM) in head-and-neck cancer. Prediction models combining radiomic and clinical variables were constructed via random forests and imbalance-adjustment strategies using two of the four cohorts. Independent validation of the prediction and prognostic performance of the models was carried out on the other two cohorts (LR: AUC = 0.69 and CI = 0.67; DM: AUC = 0.86 and CI = 0.88). Furthermore, the results obtained via Kaplan-Meier analysis demonstrated the potential of radiomics for assessing the risk of specific tumour outcomes using multiple stratification groups. This could have important clinical impact, notably by allowing for a better personalization of chemo-radiation treatments for head-and-neck cancer patients from different risk groups.Comment: (1) Paper: 33 pages, 4 figures, 1 table; (2) SUPP info: 41 pages, 7 figures, 8 table

Tests for predicting complications of pre-eclampsia: A protocol for systematic reviews

Background Pre-eclampsia is associated with several complications. Early prediction of complications and timely management is needed for clinical care of these patients to avert fetal and maternal mortality and morbidity. There is a need to identify best testing strategies in pre eclampsia to identify the women at increased risk of complications. We aim to determine the accuracy of various tests to predict complications of pre-eclampsia by systematic quantitative reviews. Method We performed extensive search in MEDLINE (1951–2004), EMBASE (1974–2004) and also will also include manual searches of bibliographies of primary and review articles. An initial search has revealed 19500 citations. Two reviewers will independently select studies and extract data on study characteristics, quality and accuracy. Accuracy data will be used to construct 2 × 2 tables. Data synthesis will involve assessment for heterogeneity and appropriately pooling of results to produce summary Receiver Operating Characteristics (ROC) curve and summary likelihood ratios. Discussion This review will generate predictive information and integrate that with therapeutic effectiveness to determine the absolute benefit and harm of available therapy in reducing complications in women with pre-eclampsia

Generative Adversarial Networks for Financial Trading Strategies Fine-Tuning and Combination

Systematic trading strategies are algorithmic procedures that allocate assets aiming to optimize a certain performance criterion. To obtain an edge in a highly competitive environment, the analyst needs to proper fine-tune its strategy, or discover how to combine weak signals in novel alpha creating manners. Both aspects, namely fine-tuning and combination, have been extensively researched using several methods, but emerging techniques such as Generative Adversarial Networks can have an impact into such aspects. Therefore, our work proposes the use of Conditional Generative Adversarial Networks (cGANs) for trading strategies calibration and aggregation. To this purpose, we provide a full methodology on: (i) the training and selection of a cGAN for time series data; (ii) how each sample is used for strategies calibration; and (iii) how all generated samples can be used for ensemble modelling. To provide evidence that our approach is well grounded, we have designed an experiment with multiple trading strategies, encompassing 579 assets. We compared cGAN with an ensemble scheme and model validation methods, both suited for time series. Our results suggest that cGANs are a suitable alternative for strategies calibration and combination, providing outperformance when the traditional techniques fail to generate any alpha