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Abstract: The relative impacts of tidal (neap, spring) and river discharge (including a flood event) forcing upon water and sediment circulation have been examined at the rock-bound Guadiana estuary. Near-bed and vertical profiles of current, salinity, turbidity, plus surface suspended sediment concentrations (SSC, at some stations only), were collected at the lower and central/upper estuary during tidal and fortnightly cycles. In addition, vertical salinity and turbidity profiles were collected around high and low water along the estuary. Tidal asymmetry produced faster currents on the ebb than on the flood, especially at the mouth. This pattern of seaward current dominance was enhanced with increasing river flow, due to horizontal advection that was confined within the narrow estuarine channel. The freshwater inputs and, at a degree less, the tidal range controlled the vertical mixing and stratification importance. Well-mixed (spring) and partially stratified (neap) conditions alternated during periods of low river flows, with significant intratidal variations induced by tidal straining (especially at the partially stratified estuary). Highly stratified conditions developed with increasing river discharge. Intratidal variability in the pycnocline depth and thickness resulted from current shear during the ebb. A salt wedge with tidal motion was observed at the lower estuary during the flood event. Depending on the intensity of turbulent mixing, the residual water circulation was dominantly controlled either by tidal asymmetry or gravitational circulation. The SSC was governed by cyclical local processes (resuspension, deposition, mixing, advection) driven by the neap-spring fluctuations in tidal current velocities. More, intratidal variability in stratification indicated the significance of tidal pumping at the partially and highly stratified estuary. The estuary turbidity maximum (ETM) was enhanced with increasing current velocities, and displaced downstream during periods of high river discharge. During the flood event, the ETM was expelled out of the estuary, and the SSC along the estuary was controlled by the sediment load from the drainage basin. Under these highly variable river flow conditions, our observations suggest that sand is exported to the nearshore over the long-term (>years). [Copyright &y& Elsevier]

Background: To compare the patients' and physician's global assessment of disease activity in Behçet's syndrome (BS) and investigate the frequency, magnitude, and determinants of potential discordance., Methods: A total of 226 adult BS patients with a median (IQR) age of 46.9 (35.6-55.2) years were enrolled across Italy, Greece, Portugal, and Spain. Demographic, clinical, and therapeutic variables, as well as the patient reported outcomes, were collected at the recruitment visit. The physical (PCS) and mental (MCS) component summary scores of the Short Form Questionnaire 36 (SF-36) and the Behçet's syndrome Overall Damage Index (BODI) were calculated. Disease activity was assessed by the patients' (PtGA) and physician's global assessment (PGA) in a 10-cm visual analog scale, as well as the Behçet Disease Current Activity Form (BDCAF). Discordance (∆) was calculated by subtracting the PGA from the PtGA and defined as positive (PtGA>PGA) and negative (PtGA 80%) of disagreements were due to patients rating higher their disease activity. Higher values of BDCAF were associated to increased rate of positive discordance. When BDCAF = 0, the median (IQR) values of PtGA and PGA were 0.2 (0-2) and 0 (0-1), respectively. PCS (adjusted odds ratio (adjOR) 0.96 per unit, 95% CI 0.93-0.98, p = 0.006) and MCS (adjOR 0.96 per unit, 95% CI 0.93-0.99, p = 0.003) were independently associated with positive discordance using both cutoffs. Active ocular involvement emerged as a potential determinant of negative discordance (adjOR 5.88, 95% CI 1.48-23.30, p = 0.012)., Conclusions: PtGA and PGA should be considered as complementary measures in BS, as patients and physicians may be influenced by different factors when assessing active disease manifestations. Particularly, PtGA may be a useful tool in the assessment of BS disease activity, as it carries a low risk to misclassify an inactive disease, and may allow to capture aspects of the patient's health that negatively affect his well-being and the treatment.