The Impact of Retention Polders, Dyke-Shifts and Reservoirs on Discharge in the Elbe River - Hydrological Modelling Study in the Framework of the Action Plan for the Flood Protection in the Elbe River Basin of the International Commission for the Protection of the Elbe River (ICPER/IKSE/MKOL)

A hydrological model simulation study has been carried out in the Elbe basin using detailed data obtained from the relevant Czech and German institutes. The LISFLOOD model has been calibrated for the Elbe river basin using these data. Using this calibrated model setup, two studies have been carried out in the framework of the Action Plan for Flood Protection of the International Commission for the Protection of the Elbe River (ICPER/IKSE/MKOL). The 2002 flood without dyke-breaks: The first part of the simulation study was a simulation of the 2002 summer flood without dyke-breaks. It has been estimated here that without dyke-breaks, the discharge in the lower part of the Elbe river would have been 2.6 ¿ 9.1 % higher (117-384 m3/s). Waterlevels would have between 18 and 54 cm higher. Reservoir Study: The planned scenario for Saale reservoir steering investigated here does not have any significant influence on the discharge of the Elbe. The influence of changing the flood storage in the Bleiloch and Hohenwarte reservoirs in winter from 40 to 55 Mm3 and in summer from 25 to 35 Mm3 on river discharge has been assessed. The scenario results have shown that this planned scenario for reservoir steering in the Saale cascade does not have a significant influence on the discharge of the river Elbe, for the investigated flood events in 1994, 2002 und 2003 at gauging station Calbe-Griezehne (lower Saale). Also the influence on the discharge in the river Elbe is marginal: changes in peak discharge downstream the Saale-confluence are in the order of 0.2% (difference in discharge 4-8 m3/s). Furthermore, the influence of the Vltava reservoir cascade was investigated using two datasets provided by the Czech Hydro-Meteorological Institute (CHMI): one dataset with the actual situation and steering of the Vltava cascade, and a scenario without the Vltava cascade. For floods with a magnitude such as in August 2002, the difference between the scenario with and without the Vltava cascade is between 1.6 and 3.7% (84-171 m3/s) in the German part of the Elbe river. Polder and Dyke-shift Study: The potential effects of 5 polders and 20 dyke-shifts on discharge in the river Elbe have been estimated. The main outcomes are the following: The 20 planned dyke-shifts reduce the peak discharge of the 2002 summer flood with 1.3-4.6% (58-202 m3/s). Waterlevels would have been 10-31cm lower. For the 2006 flood the results are similar in character, but lower in magnitude. The measures reduce the peak discharge of the 2006 spring flood with 0.4-1.3% (10-48 m3/s). Waterlevels would have been 3-10cm lower. The 5 planned polders and 20 planned dyke-shifts simulated here, reduce the peak discharge of the 2002 summer flood with 3.9-10.8% (178-469 m3/s). Waterlevels would have been 23-74cm lower. For the 2006 flood, the results are again lower: the measures reduce the peak discharge of the 2006 spring flood with 1.2-3.3% (31-121 m3/s). Waterlevels would have been 8-21cm lower.JRC.H.7-Land management and natural hazard

Overcoming the barriers of teaching physical examination at the bedside: More than just curriculum design

Background: Physicians in training must achieve a high degree of proficiency in performing physical examinations and must strive to become experts in the field. Concerns are emerging about physicians' abilities to perform these basic skills, essential for clinical decision making. Learning at the bedside has the potential to support skill acquisition through deliberate practice. Previous skills improvement programs, targeted at teaching physical examinations, have been successful at increasing the frequency of performing and teaching physical examinations. It remains unclear what barriers might persist after such program implementation. This study explores residents' and physicians' perceptions of physical examinations teaching at the bedside following the implementation of a new structured bedside curriculum: What are the potentially persisting barriers and proposed solutions for improvement? Methods: The study used a constructivist approach using a qualitative inductive thematic analysis that was oriented to construct an understanding of the barriers and facilitators of physical examination teaching in the context of a new bedside curriculum. Participants took part in individual interviews and subsequently focus groups. Transcripts were coded and themes were identified. Results: Data analyses yielded three main themes: (1) the culture of teaching physical examination at the bedside is shaped and threatened by the lack of hospital support, physicians' motivation and expertise, residents' attitudes and dependence on technology, (2) the hospital environment makes bedside teaching difficult because of its chaotic nature, time constraints and conflicting responsibilities, and finally (3) structured physical examination curricula create missed opportunities in being restrictive and pose difficulties in identifying patients with findings. Conclusions: Despite the implementation of a structured bedside curriculum for physical examination teaching, our study suggests that cultural, environmental and curriculum-related barriers remain important issues to be addressed. Institutions wishing to develop and implement similar bedside curricula should prioritize recruitment of expert clinical teachers, recognizing their time and efforts. Teaching should be delivered in a protected environment, away from clinical duties, and with patients with real findings. Physicians must value teaching and learning of physical examination skills, with multiple hands-on opportunities for direct role modeling, coaching, observation and deliberate practice. Ideally, clinical teachers should master the art of combining both patient care and educational activities

Systematic review of measurement properties of questionnaires measuring somatization in primary care patients

Objective The aim of this review is to critically appraise the evidence on measurement properties of self-report questionnaires measuring somatization in adult primary care patients and to provide recommendations about which questionnaires are most useful for this purpose. Methods We assessed the methodological quality of included studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. To draw overall conclusions about the quality of the questionnaires, we conducted an evidence synthesis using predefined criteria for judging the measurement properties. Results We found 24 articles on 9 questionnaires. Studies on the Patient Health Questionnaire-15 (PHQ-15) and the Four-Dimensional Symptom Questionnaire (4DSQ) somatization subscale prevailed and covered the broadest range of measurement properties. These questionnaires had the best internal consistency, test-retest reliability, structural validity, and construct validity. The PHQ-15 also had good criterion validity, whereas the 4DSQ somatization subscale was validated in several languages. The Bodily Distress Syndrome (BDS) checklist had good internal consistency and structural validity. Some evidence was found for good construct validity and criterion validity of the Physical Symptom Checklist (PSC-51) and good construct validity of the Symptom Check-List (SCL-90-R) somatization subscale. However, these three questionnaires were only studied in a small number of primary care studies. Conclusion Based on our findings, we recommend the use of either the PHQ-15 or 4DSQ somatization subscale for somatization in primary care. Other questionnaires, such as the BDS checklist, PSC-51 and the SCL-90-R somatization subscale show promising results but have not been studied extensively in primary care. © 2017 Elsevier Inc

Targeted workplace incivility: the roles of belongingness, embarrassment, and power

The research to date has largely been unclear about whether a single perpetrator is sufficient to instigate the well-documented negative consequences of workplace incivility. In the current research, we examine the extent to which perceived belongingness and embarrassment mediate the relationship between incivility from a single perpetrator and two important outcomes (job insecurity and somatic symptoms), and the extent to which the perpetrator’s power moderates these relationships. Across two studies using different methods, we find that incidents of single perpetrator incivility are associated with target feelings of isolation and embarrassment, which in turn relate to targets’ perceived job insecurity and somatic symptoms (Studies 1 and 2) both the same day and three days later (Study 2). Moreover, we find that perpetrator power moderates the relationship between incivility and embarrassment, such that targets are more embarrassed when the perpetrator is powerful. Implications for theory and practice are discussed

Descriptive epidemiology of somatising tendency: findings from the CUPID study.

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait

Comparison of the Factor Structure of the Patient Health Questionnaire for somatic symptoms (PHQ-15) in Germany, the Netherlands, and China : A Transcultural Structural Equation Modeling (SEM) Study

BackgroundPersistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China.MethodCross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed.ResultsThe general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples.ConclusionThe PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted toa bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China