Multimodel inference to quantify the relative importance of abiotic factors in the population dynamics of marine zooplankton

The effect of multiple stressors on marine ecosystems remains poorly understood and most of the knowledge available is related to phytoplankton. To partly address this knowledge gap, we tested if combining multimodel inference with generalized additive modelling could quantify the relative contribution of environmental variables on the population dynamics of a zooplankton species in the Belgian part of the North Sea. Hence, we have quantified the relative contribution of oceanographic variables (e.g. water temperature, salinity, nutrient concentrations, and chlorophyll a concentrations) and anthropogenic chemicals (i.e. polychlorinated biphenyls) to the density of Acartia clausi. We found that models with water temperature and chlorophyll a concentration explained ca. 73% of the population density of the marine copepod. Multimodel inference in combination with regression-based models are a generic way to disentangle and quantify multiple stressor-induced changes in marine ecosystems. Future-oriented simulations of copepod densities suggested increased copepod densities under predicted environmental changes

Circadian patterns in postvoid residual and voided percentage among older women with urinary incontinence

Background: Women with urinary incontinence incur an increased risk of elevated postvoid residual (PVR) volume and impaired voiding efficiency (i.e., voided percentage (Void%)), but the clinical significance of these parameters remains poorly described. Further characterization of PVR and voiding efficiency may thus be useful in refining the evaluation and management of urinary incontinence. This study aims to explore possible circadian variations in PVR and Void% in older women with stress (SUI), urge (UUI) and mixed urinary incontinence (MUI). Methods: A single center prospective study which enrolled a convenience sample of 90 older women who consulted a tertiary referral hospital for urinary incontinence. Participants underwent an extensive medical interview and were hospitalized to complete a 24-h frequency-volume chart (FVC) with PVR measurement after each void (FVCPVR). Results: FVCPVR analysis demonstrated no differences in mean PVR and Void% between patients with SUI, UUI and MUI. Likewise, no daytime or nighttime differences were observed in mean PVR or Void% within or between groups. Conclusions: No evidence of circadian variation in PVR or Void% was observed in older women with SUI, UUI or MUI

Clean intermittent self-catheterization as a treatment modality for urinary retention : perceptions of urologists

Purpose: Clean intermittent self-catheterization (CISC) is now considered the gold standard for the management of urinary retention. In the literature, several articles on patients' perspectives on CISC and adherence to this technique have been published. No studies have yet explored the points of view of professional caregivers, such as nurses and doctors. The aim of this study was to explore the opinions of urologists about CISC and to evaluate the need for dedicated nurses specialized in CISC through a self-administered questionnaire. Methods: A questionnaire was developed to explore the opinions of professional caregivers about self-catheterization and to evaluate the need to provide nurses with specialized education in CISC. Questionnaires were sent to 244 urologists through email. We received 101 completed questionnaires. The response rate was 41.4%. Results: Hand function, the presence or absence of tremor, and visual acuity were rated as the most important determinants for proposing CISC to a patient. Twenty-five percent of the urologists reported that financial remuneration would give them a greater incentive to propose CISC. The lack of dedicated nurses was reported by half of the urologists as a factor preventing them from proposing CISC. A meaningful number of urologists thought that patients perceive CISC as invasive and unpleasant. Although most urologists would choose CISC as a treatment option for themselves, almost 1 urologist out of 5 would prefer a permanent catheter. Conclusions: This questionnaire gave valuable insights into urologists' perceptions of CISC, and could serve as the basis for a subsequent broader international study. Further research should also focus on the opinions of nurses and other caregivers involved in incontinence management. Apart from financial remuneration, it is also clear that ensuring sufficient expertise and time for high-quality CISC care is important. This could be a potential role for dedicated nurses

Impact of onabotulinumtoxinA on quality of life and practical aspects of daily living : a pooled analysis of two randomized controlled trials

Objective: To evaluate the impact of onabotulinumtoxinA on individual domains of the quality of life questionnaires in a pooled analysis of two phase 3 trials in overactive bladder patients with urinary incontinence who were inadequately managed by >= 1 anticholinergic. Methods: Patients received intradetrusor injections of onabotulinumtoxinA 100U (n = 557) or placebo (n = 548). The proportions of patients with a positive response (condition "greatly improved" or "improved") on the Treatment Benefit Scale, and changes in Incontinence Quality of Life scores and King's Health Questionnaire domain scores were analyzed in the overall population and subgroups with clean intermittent catheterization use and urinary tract infection status during the first 12 weeks of treatment. Responses to individual King's Health Questionnaire items were also assessed. Results: Significantly greater proportions of onabotulinumtoxinA-treated patients achieved positive Treatment Benefit Scale response versus placebo (61.8% vs 28.0%; P < 0.001). OnabotulinumtoxinA showed significantly greater improvements versus placebo in Incontinence Quality of Life total (22.5 vs 6.6), Incontinence Quality of Life subscale scores and all domains of the King's Health Questionnaire. Notably, a similar trend was observed regardless of clean intermittent catheterization/urinary tract infection status. Additionally, onabotulinumtoxinA resulted in significantly greater improvements than the placebo in practical aspects of patients daily lives, including pad use, need to change undergarments, sleep, relationship with partner and work life/daily activities. Conclusion: In overactive bladder patients with urinary incontinence, onabotulinumtoxinA 100U demonstrated significant improvements across the individual domains of the quality of life questionnaires, regardless of clean intermittent catheterization or urinary tract infection status, and provided a positive impact on practical aspects of patients' daily lives

Outcome of anterior lumbar interbody fusion : a retrospective study of clinical and radiologic parameters

Objective. This study aims to critically evaluate the long-term results of stand-alone anterior lumbar interbody fusion (ALIF), without use of rhBMP-2, as a therapeutic option for symptomatic patients with degenerative disc disease (DDD). Furthermore this study intends to identify predictive parameters for anterior lumbar interbody fusion outcome. Methods. A retrospective cohort study with additional telephone interview to obtain missing data was performed. All patients who underwent a L4-L5 and/or L5-S1 ALIF-procedure in the period between 2006 and 2011 were identified. The medical files of 123 patients with 154 fusion levels were reviewed. All patients were contacted by phone to gather supplementary and missing information. Pain and functionality scores (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), radiological (intervertebral disc height, Modic and Pfirrmann classifications) and different clinical parameters were gathered. Results. The mean age at surgery of the population was 46.2 years. Overall, 59 female and 64 male patients were included in the study. The mean visual analogue scales (VAS) for back and leg pain improved significantly (P<0.001) with 5 and 4.4 points respectively at 3 years follow-up. Modic-type I changes are associated with a better improvement in VAS-score for back pain (P=0.026), Pfirrmann-grades IV and V and an intervertebral disc height of less than 5 mm are associated with a better improvement in leg pain (respective P-values: 0.045 and 0.033). Overall, 89% of patients would reconsider the surgical intervention. Conclusions. The ALIF-technique is a durable treatment option for patients with DDD. This study suggests different predictive parameters for treatment outcome