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A rise in the number of flood-affected people and areas has increased the interest in new methods and concepts that account for this change. Citizens are integrated into disaster risk reduction processes through participatory approaches and can provide valuable up-to-date local knowledge. During a field study in Eberbach (Baden–Wuerttemberg, Germany) sketch maps and questionnaires were used to capture local knowledge about flooding. Based on a previous study on urban flooding in Santiago de Chile, the tools were adapted and applied to river flooding in the city of Eberbach, which is regularly flooded by the Neckar River, a major river in southwest Germany. The empirical database of the study comprises 40 participants in the study area and 40 in a control area. Half of the participants in each group are residents and half are pedestrians. Purposive sampling was used, and the questionnaires aimed to gather demographic information and explore what factors, such as property, influence the risk perception of the study participants. The results show that residents identify a larger spatial area as at risk than pedestrians, and owning property leads to higher risk awareness. The flood type influenced the choice of the base maps for the sketch maps. For river flooding, one map with an overview of the area was sufficient, while for urban flooding a second map with more details of the area also enables the marking of small streets. The information gathered can complement authoritative data such as from flood models. This participatory approach also increases the communication and trust between local governments, researchers, and citizens.

Objectives:To develop an ultrasound enthesis score and to assess its validity in the diagnostic classification of the spondyloarthropathies (SpAs).Methods:Twenty-five patients with SpA and 29 healthy controls participated in a blinded, gender-matched, cross-sectional study involving ultrasound assessment. The following entheses were explored bilaterally: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar ligament, distal quadriceps and brachial triceps tendons. The ultrasound score evaluated enthesis thickness, structure, calcifications, erosions, bursae and power Doppler signal. The value of each elemental lesion was calculated using a three-model analysis. Validity was analysed by receiver operating characteristic (ROC) curves. Inter-reader and interexplorer intraclass correlation coefficients (ICCs) were calculated.Results:The logistic regression model overestimated the score of three elemental lesions: calcification (0–3), Doppler (0 or 3) and erosion (0 or 3), while scoring tendon structure, tendon thickness and bursa as 0 or 1. ROC curves established an ultrasound score of ⩾18 as the best cut-off point for differentiation between cases and controls. This cut-off point was exceeded by 5/29 controls (17%) and by 21/25 patients with SpA (84%). The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR−) were 83.3%, 82.8%, 4.8% and 0.2%, respectively. The inter-reader and interexplorer ICCs were 0.60 and 0.86, respectively.Conclusion:The findings suggest that the ultrasound enthesis score could be a valid tool in the diagnosis of SpA.

The fact that an increasing number of people and local authorities are affected by natural hazards, especially floods, highlights the necessity of adequate mitigation and preparedness within disaster management. Many governments, though, have only insufficient monetary or technological capacities. One possible approach to tackle these issues is the acquisition of information by sketch maps complemented by questionnaires, which allows to digitally capture flood risk perception. We investigate which factors influence information collected by sketch maps and questionnaires in case studies in an area prone to pluvial flooding in Santiago de Chile. Our aim is to gain more information about the methods applied. Hereby, we focus on the spatial acquisition scale of sketch maps and personal characteristics of the participants, for example, whether they live at this very location of the survey (residents) or are pedestrians passing by. Our results show that the choice of the acquisition scale of the base map influences the amount and level of detail of information captured via sketch maps. Thus, detail base maps lead to more precise results when compared to reference data, especially in the case of residents. The results also reveal that the place of living of the respondents has an effect on the resulting information because on the neighborhood level the risk perception of residents is more detailed than the one of pedestrians. The study suggests that the integration of citizens via sketch maps can provide information about flood risk perception, and thus can influence the flood mitigation in the area.

PurposeThe laparoscopic suturing task is a complex procedure that requires objective assessment of surgical skills. Analysis of laparoscopic suturing task components was performed to improve current objective assessment tools.MethodsTwelve subjects participated in this study as three groups of four surgeons (novices, intermediates and experts). A box-trainer and organic tissue were used to perform the experiment while tool movements were recorded with the augmented reality haptic system. All subjects were right-handed and developed a surgeon’s knot. The laparoscopic suturing procedure was decomposed into four subtasks. Different objective metrics were applied during tool-motion analysis (TMA). Statistical analysis was performed, and results from three groups were compared using the Jonckheere–Terpstra test, considering significant differences when P ≤ 0.05.ResultsSeveral first, second and fourth subtask metrics had significant differences between the three groups. Subtasks 1 and 2 had more significant differences in metrics than subtask 4. Almost all metrics showed superior task executions accomplished by experts (lower time, total path length and number of movements) compared with intermediates and novices.ConclusionThe most important subtasks during suture learning process are needle puncture and first knot. The TMA could be a useful objective assessment tool to discriminate surgical experience and could be used in the future to measure and certify surgical proficiency.

Purpose This forum article discusses the concept of slow disasters from Latin America, presenting different perspectives and experiences of practical research using this notion. It discusses the extent to which a focus on the “slow” temporality of disasters advances our understanding of socio-environmental processes in the region.Design/methodology/approach The article emerges from a pilot project to explore the relevance of temporality to analyse socio-environmental injustices in Latin America, which was followed by a panel organised at the 2023 NEEDS Conference in Enschede, The Netherlands, where four panellists presented first hand research experiences with the concept of slow disasters.Findings The article presents myriad usages of slow disasters and related concepts in Latin America and includes empirical cases from Peru, Chile and Argentina, highlighting different critical dimensions of their temporalities. It shows the analytical power of slow disaster to help understand disasters as gradual processes of normalisation of environmental injustices and vulnerabilities due to the slower pace of visible material impact to affected groups and their continuous adaptation to their exposure to it. The article reflects on the potential use of this concept by Latin American scholars and contributes to applications in other regional contexts.Originality/value The paper adds a conceptual discussion on the notion of slow disasters as reflected from different Latin American geographies. The paper contributes to ongoing strands of postcolonial disaster studies, departing from empirically grounded conceptualisations of disaster by Latin American scholars and promoting a constructive dialogue with academic debates dominated by the Anglophone scholarly literature.

Purpose Different effects on cardiovascular and respiratory systems and liver are associated with pneumoperitoneum. This study aimed to determine the morphological changes in the abdominal anatomy as a result of increased intra-abdominal pressure due to pneumoperitoneum using MRI. Methods Ten healthy female pigs were used in this study. MRI studies of the abdomen in supine position were made before the creation of pneumoperitoneum and 1 h after increasing the pressure to 14 mmHg. Changes in area, volume, and longitudinal and transverse length of the liver were measured. The diameters of the lumen of the abdominal aorta, the inferior vena cava and portal vein were observed in three positions along the abdominal cavity. The position of the diaphragm after the induction of pneumoperitoneum was also analyzed. Results After induction of pneumoperitoneum, volume and transverse length of the liver was significantly increased, while peak area was decreased. Stenosis in the aortic lumen was observed ( P  < 0.05). Longitudinal and transverse diameters of the portal lumen were reduced, but significant differences were only found in the longitudinal diameter. Alterations in the diameter of the inferior vena cava lumen were obtained in three analyzed positions, but differences were significant only in two of them. A mean cranial displacement of the diaphragm equal to 25 mm was also observed. Conclusion Increasing abdominal pressure up to laparoscopic pressure (14 mmHg) provokes morphological changes in the liver, vascular structures and diaphragm. These changes could be related to functional alterations that different organs experience after the induction of pneumoperitoneum.

Objective:To assess the multiexaminer reproducibility and the accuracy comparing with cadaver anatomic specimens of ultrasound (US) measurement of femoral articular cartilage (FAC) thickness.Methods:In 8 flexed cadaver knees, FAC thickness was blindly, independently and consecutively measured twice by 10 rheumatologists at the lateral condyle (LC), medial condyle (MC) and intercondylar notch (IN) with US. After the US measurements, the knees were dissected. Articular cartilage integrity was evaluated macroscopically in the femoral condyles. FAC thickness was blindly measured in the specimens using a stereoscopic magnifying loupe and a digitised image software. Interexaminer and intraexaminer reliability of US FAC thickness measurement and agreement between US and anatomic measurements were assessed by estimating the intraclass correlation coefficient (ICC).Results:Interexaminer ICCs were higher than 0.90 for MC (p<0.001) and IN (p<0.001) and higher than 0.75 for LC (p<0.01). Mean intraexaminer ICCs were 0.832 for MC (p<0.001), 0.696 for LC (p<0.001) and, 0.701 for IN (p<0.001). Agreement between US and anatomic FAC thickness measurements was good for MC (ICC 0.719; p = 0.020) and poor for LC (p = 0.285) and IN (p = 0.332). Bland–Altman analysis showed that the difference between US and anatomic values was considerably high in the one knee with severely damaged FAC. After eliminating this knee from the analysis, ICCs were 0.883 (p<0.001) for MC, 0.795 (p = 0.016) for LC and 0.732 for IN (p = 0.071).Conclusion:US demonstrated a good reproducibility in FAC thickness measurement by multiple examiners. In addition, US FAC thickness measurement was accurate in normal to moderately damaged cartilage.

Objective: To compare the clinical assessment of overall inflammatory activity in patients with rheumatoid arthritis (RA) with grey scale and power Doppler (PD) ultrasonography (US). Methods: Ninety four consecutive patients with RA were included. Demographic and clinical data, C reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) were recorded for each patient. The presence of tenderness, swelling, and a subjective swelling score from 1 to 3 were independently assessed by two rheumatologists, who reached a consensus in 60 joints examined in each patient. All patients underwent a US examination by a third blinded rheumatologist, using PD. US joint effusion, synovitis, and PD signal were graded from 1 to 3 in the 60 joints. Joint count and joint index for effusion, synovitis, and PD signal were recorded. A 28 joint count for clinical and US variables was calculated. Interobserver reliability of the US examination was evaluated by a fourth blinded rheumatologist. Results: US showed significantly more joints with effusion (mean 15.2) and synovitis (mean 14.6) than clinical examination (mean 11.5, p<0.05). A significant correlation was found between joint count and joint index for swelling, US effusion, synovitis, and PD signal. The 28 joint count for effusion, synovitis, and PD signal correlated highly with the corresponding 60 joint counts. US findings correlated better with CRP and ESR than clinical measures. Interobserver reliability was better for US findings than for clinical assessment. Conclusion: US is a sensitive method for assessing joint inflammatory activity in RA, complementary to clinical evaluation.

PurposeSurgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to five tasks included in SINERGIA laparoscopic virtual reality simulator.MethodsThirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1–R8) of the five mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of R1, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value <0.005.ResultsIn total, 84.38% of the metrics provided by SINERGIA and included in this study show significant differences when comparing R1 and R8. Metrics are mostly improved in the first session of training (75.00% when R1 and R4 are compared vs. 37.50% when R4 and R8 are compared). In tasks Coordination and Navigation and touch, all metrics are improved. On the other hand, Navigation just improves 60% of the analyzed metrics. Most learning curves show an improvement with better results in the fulfillment of the different tasks.ConclusionsLearning curves of metrics that assess the basic psychomotor laparoscopic skills acquired in SINERGIA virtual reality simulator show a faster learning rate during the first part of the training. Nevertheless, eight repetitions of the tasks are not enough to acquire all psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program.