Modelling damage due to low flows in the Meuse. Poster.

In this research the damage due to low discharges on the Meuse has been analysed to get a better view on the scope of the low flow problem. The research area consists of the Dutch and the Flemish part of the Meuse upstream of Roermond and the canals fed by it. A model has been developed to assess the total damage and the distribution over different regions and economic sectors in a number of situations. Total damage varies from a few million Euros in a medium dry year to ten times that much in an extreme dry year. Most of the damage occurs in the navigation sector and the power generation sector. Climatological and economical development will increase future damage substantially. On the other hand, much can be gained by applying appropriate management strategies

Improving mesh set-up to increase cross-sectional-area accuracy for water-level prediction

An accurate prediction of river water levels using hydraulic modelling is essential for adequate rivermanagement. 2D models are one of the best choices for simulating river hydraulics as they enable moredetailed and accurate simulations of water levels and flood patterns. The bathymetry in 2D models generallyis described with a continuous mesh covering the main channel and floodplain. The mesh set-upcan affect the simulation results significantly, and selecting a suitable mesh is as crucial as applying anappropriate calibration method. The mesh resolution affects bathymetry discretization, discharge capacity,and, consequently, simulated water levels. A higher resolution leads to more precise results, but onthe other hand high resolution models are time consuming. This study aims to develop a modified meshset-up with the same cross-sectional flow area as the measured cross-section at the highest resolution.The modified mesh is developed using an algorithm which changes the nodes of the mesh vertically fora limited range to determine the mesh with the same flow area as observed, but at a lower resolution.Then, D-Flow-FM software is used to model a hypothetical river for 100 kilometers with one uniformcross-section to exclude the effect of longitudinal variability in cross sections on the results. A constantroughness is considered to exclude the effect of roughness on the results and evaluate the effectof mesh set-up on the discharge capacity and predicted water levels. Moreover, a steady inflow of low,intermediate and high flows is used as upstream boundary condition. For comparison, simulated waterlevels for the high-resolution mesh, the current mesh in the D-Flow-FM model and the modified meshare compared. Differences between water levels simulated with the current mesh and the modified meshare around 3 to 10 centimeters, but the modified mesh and the high-resolution mesh simulate the samewater levels for different types of cross sections and discharge levels

Quantification of uncertainties in a 2D hydraulic model for the Dutch river Rhine using expert opinions

Hydraulic–morphological river models are applied to design and evaluate measures for purposes such as safety against flooding. These numerical models are all based on a deterministic approach. However, the modeling of river processes involves numerous uncertainties. The aim of this study is to identify the sources of uncertainty that induce the largest uncertainties in the model outcomes and quantify this uncertainty using expert opinions. Experts have been selected based on a Pedigree matrix. The selected experts are asked to list and quantify the most important uncertainty sources for two situations: (1) the computation of design water levels (DWL) and (2) the computation of the hydraulic effect of a change in the river bed. The experts stated that the sources of uncertainty are different for the computation of the DWL and effect studies. The experts agreed that for DWL, the upstream discharge and the roughness predictor for the main channel have the largest uncertainty. For effect studies, no clear dominant source could be identified. The quantification of the uncertainty sources showed a significant effect on the predicted water levels under design discharge conditions

Outcome Measures in Adult Vulvar Lichen Sclerosus:A Systematic Review

Objectives:Core outcome domains (CODs) for treatment of adult vulvar lichen sclerosus (VLS) have recently been established through a Delphi study. A number of measuring tools are available for evaluating VLS. The aim of this study is to identify available standardized measurement tools for the major CODs for VLS that have recently been defined, namely, physical findings and quality of life (QoL) specific to VLS. Materials and Methods: A systematic search through September 8, 2023, for measuring tools applicable to VLS regarding physical findings and QoL including sexual function or sexual well-being and self-image was performed. Results: Thirty-five studies were included in the systematic review describing 26 tools covering the following 6 outcome domains: QoL-general health, QoL-lichen sclerosus specific, symptoms, clinical signs, emotional impact, and sexual functioning. Conclusions: In current research, there is no uniformity in use of measurement tools for evaluating VLS. The established CODs to evaluate treatment of VLS are applicable for evaluating disease course as well. A comprehensive study to reach consensus regarding measurement of physical findings, QoL-lichen sclerosus specific, sexuality, and self-image taking the predetermined CODs and other factors such as age into account is needed.</p

Outcome Measures in Adult Vulvar Lichen Sclerosus:A Case Series of Women Diagnosed as Juveniles

OBJECTIVES: Studies on the consequences of juvenile vulvar lichen sclerosus (JVLS) in adulthood are limited. A number of measuring tools are available for analyzing adult vulvar lichen sclerosus (VLS), but these have not been applied in studies on JVLS. The aim is to study physical findings, quality of life, sexual well-being, and self-image in adult women with a history of juvenile VLS. MATERIALS AND METHODS: Adult women with a biopsy proven history of JVLS were recruited to be examined and surveyed using available standardized measurement tools. This took place in an outpatient setting by physicians who were not involved in the treatment of participants. RESULTS: Twenty-seven women (median age 29 years) with a history of JVLS and median time since biopsy of 19.5 years were recruited. Of these women, 59% currently had symptoms, 63% had signs of active disease, and 85% had moderate to severe architectural changes. Despite these residual signs, vulvar specific-quality of life and vulvar self-image scored favorably while generic health-related quality of life was somewhat effected. CONCLUSIONS: JVLS has consequences in adulthood involving physical findings and vulvar quality of life. The use of standardized outcome measures for clinical practice and research purposes facilitates a better understanding of the sequelae to JVLS.</p

Growing up with juvenile vulvar lichen sclerosus, the experiences and care needs of adult women with lichen sclerosus since childhood:a qualitative exploration

BACKGROUND: Vulvar Lichen Sclerosus (VLS) is a chronic remitting condition affecting the genital skin of females of all ages. Although qualitative studies have been conducted focusing on women with VLS in mid-life or older, less is known about the experiences of individuals with VLS from childhood or adolescence onward.OBJECTIVE: To gain understanding of the experiences of women with a history of juvenile VLS (JVLS) regarding the impact of the disease on their personal lives, and their experiences and needs regarding care and guidance.METHODS: A qualitative study was conducted consisting of 27 in-depth face-to-face interviews with adult women with a histologically confirmed history of JVLS, striving for maximum variation and saturation. Interviews were audio-taped and transcribed verbatim. A thorough thematic content analysis was performed.RESULTS: Three main themes were identified. I. Varying impact of living with JVLS: Women experienced diverse emotional and physical impact, from shame and denial to complete acceptance, from restrictions in daily functioning to no limitations. They felt hindered by their own lack of knowledge about JVLS, and generally expressed a positive influence of sharing their experiences with people close to them. II. Finding one's way in care and guidance: While navigating care and guidance, women often felt hindered by knowledge gaps among health care professionals (HCPs), lack of continuity in care and guidance, lack of life-stage adjusted and future-oriented information provision, inadequate guidance around life events, and insufficient monitoring of determinants of therapy adherence. III. Need for patient-tailored care: Patients stressed the need for age-appropriate and life-phase adjusted information, guidance around life-events and compassionate contact with knowledgeable HCPs, aware of the determinants of therapy adherence and influencing factors.CONCLUSIONS: Age-appropriate life-phase adjusted individually tailored care for women diagnosed with VLS in childhood or adolescence is needed. Care and guidance from childhood onward should encompass a standard of care adapted to the individual as needs change over time. This involves taking interpersonal differences into account, including differences in support network and coping strategies. These findings demonstrate the need for improving awareness and knowledge about (J)VLS among HCPs, especially primary care providers, and among the general public.</p

Growing up with juvenile vulvar lichen sclerosus, the experiences and care needs of adult women with lichen sclerosus since childhood:a qualitative exploration

BACKGROUND: Vulvar Lichen Sclerosus (VLS) is a chronic remitting condition affecting the genital skin of females of all ages. Although qualitative studies have been conducted focusing on women with VLS in mid-life or older, less is known about the experiences of individuals with VLS from childhood or adolescence onward.OBJECTIVE: To gain understanding of the experiences of women with a history of juvenile VLS (JVLS) regarding the impact of the disease on their personal lives, and their experiences and needs regarding care and guidance.METHODS: A qualitative study was conducted consisting of 27 in-depth face-to-face interviews with adult women with a histologically confirmed history of JVLS, striving for maximum variation and saturation. Interviews were audio-taped and transcribed verbatim. A thorough thematic content analysis was performed.RESULTS: Three main themes were identified. I. Varying impact of living with JVLS: Women experienced diverse emotional and physical impact, from shame and denial to complete acceptance, from restrictions in daily functioning to no limitations. They felt hindered by their own lack of knowledge about JVLS, and generally expressed a positive influence of sharing their experiences with people close to them. II. Finding one's way in care and guidance: While navigating care and guidance, women often felt hindered by knowledge gaps among health care professionals (HCPs), lack of continuity in care and guidance, lack of life-stage adjusted and future-oriented information provision, inadequate guidance around life events, and insufficient monitoring of determinants of therapy adherence. III. Need for patient-tailored care: Patients stressed the need for age-appropriate and life-phase adjusted information, guidance around life-events and compassionate contact with knowledgeable HCPs, aware of the determinants of therapy adherence and influencing factors.CONCLUSIONS: Age-appropriate life-phase adjusted individually tailored care for women diagnosed with VLS in childhood or adolescence is needed. Care and guidance from childhood onward should encompass a standard of care adapted to the individual as needs change over time. This involves taking interpersonal differences into account, including differences in support network and coping strategies. These findings demonstrate the need for improving awareness and knowledge about (J)VLS among HCPs, especially primary care providers, and among the general public.</p

Long-term consequences of juvenile vulvar lichen sclerosus:A cohort study of adults with a histologically confirmed diagnosis in childhood or adolescence

INTRODUCTION: Vulvar lichen sclerosus (VLS) occurs in at least one in 900 girls. There is limited knowledge as to what extent the disease persists in adulthood and what the repercussions in adulthood may be. The aim of this study is to evaluate the long-term consequences of VLS diagnosed in childhood or adolescence. MATERIAL AND METHODS: The population of females histologically diagnosed with VLS in childhood or adolescence in the Netherlands between 1991 and 2015 was identified through the national pathology database. Histological specimens were retrieved and re-evaluated. Potential participants for whom the diagnosis was reconfirmed and who are now adults, were then traced and surveyed. Descriptive statistics were calculated and compared with the literature. Main outcome measures are the demographics of the cohort, their scores on standardized quality of life (QoL) and sexuality questionnaires and answers to additional questions regarding patients' experience with the disease. The questionnaires used were the Dermatology Life Quality Index (DLQI), the Skindex-29, the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). Secondary outcome measures include obstetric history and histological features found in the original tissue specimens. RESULTS: A total of 81 women participated, median age 29.0 years, median follow-up from childhood diagnosis 19.5 years. Both QoL and sexuality were somewhat affected in 51.9% of cases. Less than half (45%) reported having regular check-ups. Forty-five (56%) reported symptoms within the past year; of those with symptoms, 14 (31%) were not under surveillance. Cesarean section rate (14.5%) was comparable to the general population, and there were more high-grade obstetric anal sphincter injuries with vaginal deliveries than expected. Sixteen respondents (20%) were not aware of the childhood diagnosis prior to this study. CONCLUSIONS: Symptoms due to VLS are reported by most adults diagnosed as juveniles. QoL and sexuality are affected and correlate to recent symptoms. VLS as a juvenile does not preclude a vaginal delivery. Women diagnosed with VLS in childhood or adolescence are often lost to follow-up.</p