Armpje drukken: aanval de beste verdediging?

Inleiding Humerusschachtfracturen kunnen veroorzaakt worden door een direct trauma, een val op de gebogen elleboog of hand met uitgestrekte arm of door een plotselinge rotatiebeweging. Een direct trauma resulteert meestal in een dwarse fractuur. Een plotselinge rotatiebeweging resulteert vaak in een spiraalfractuur in het bijzonder in het distale deel van de humerus. ‘Armpje drukken’ of ‘arm worstelen’ is een bezigheid die door jong volwassen mannen veelvuldig op recreatief, maar ook op competitief niveau wordt beoefend. Toch is deze activiteit minder onschuldig dan het in eerste instantie lijkt

Spatial and Dynamic Modeling of Flood Management Policies in the Upper Tisza

Flood management policy has been the subject of an international joint research project with the Upper Tisza in Hungary as its pilot study area. Design specifications for a geographically explicit simulation are presented. Potential flood management policies, based on surveys and interviews with stakeholders, are presented. Some experiments on an executable prototype of the simulation model are also reported on, where the consequences of flood management policies are investigated. Focus has been on financial policy measures, mainly insurance. Besides more traditional evaluation of policy scenarios, the model incorporates adaptive optimization functionality. The report incorporates three contributions: (1) the insurance policy issue in Hungary is framed in the broader context of flood management; (2) the structuring of a flood risk policy model, capable of simulating flood failures and estimating the economic consequences; (3) reports from policy experiments performed on the implemented prototype flood risk policy model

Flood Risk Management Policy in the Upper Tisza Basin: A System Analytical Approach. Simulation and Analysis of Three Flood Management Strategies

This report describes an integrated flood catastrophe model as well as some results of a case study made in the upper Tisza region in northeastern Hungary: the Palad-Csecsei basin (the pilot basin). The background data was provided through the Hungarian Academy of Sciences and complemented by interviews with different stakeholders in the region. Based upon these data, where a large degree of uncertainty is prevailing, we demonstrate how an implementation of a simulation and decision analytical model can provide insights into the effects of imposing different policy options for a flood risk management program in the region. We focus herein primarily on general options for designing a public-private insurance and reinsurance system for Hungary. Obviously, this is a multi-criteria and multi-stakeholder problem and cannot be solved using standard approaches. It should however be emphasized that the main purpose of this report is not to provide any definite recommendations, but rather to explore a set of policy packages that could gain a consensus among the stakeholders

Determination of rat vertebral bone compressive fatigue properties in untreated intact rats and zoledronic-acid-treated, ovariectomized rats

Summary: Compressive fatigue properties of whole vertebrae, which may be clinically relevant for osteoporotic vertebral fractures, were determined in untreated, intact rats and zoledronic-acid-treated, ovariectomized rats. Typical fatigue behavior was found and was similar to that seen in other species. Fatigue properties were comparable between both groups. Introduction: Osteoporosis is often treated with bisphosphonates, which reduce fracture risk. Effects of bisphosphonates on fatigue strength, which may be clinically relevant for vertebral fractures, are unknown. We determined vertebral, compressive fatigue properties in normal and zoledronic acid (ZOL)-treated, OVX rats. Methods: Thirty-five-week old Wistar rats were divided into SHAM-OVX (n = 7) and OVX with ZOL treatment (n = 5; single injection, 20 μg/kg b.w. s.c.). After 16 weeks, vertebral trabecular microarchitecture and cortical thickness were determined using micro-CT. Vertebrae were cyclically compressed in load-control at 2 Hz starting at 0.75% apparent strain. A line parallel to the apparent strain curve was drawn at 0.5% higher offset, after which the intersection was defined as the time to failure and the apparent strain at failure. Data were compared using Student’s t test.Results Morphology and fatigue properties were the same in both groups. Samples failed between 10 min and 15 h. Force–displacement curves displayed typical fatigue behavior. Displacement increased over time due to mostly creep and to decreasing secant stiffness. Conclusions: We established a technique to determine compressive fatigue properties in the rat vertebral body. Our initial results indicate that ZOL-treated OVX rats have similar vertebral fatigue properties as SHAM-OVX controls

Clinical practice guidelines for the foot and ankle in rheumatoid arthritis: a critical appraisal

Background: Clinical practice guidelines are recommendations systematically developed to assist clinical decision-making and inform healthcare. In current rheumatoid arthritis (RA) guidelines, management of the foot and ankle is under-represented and the quality of recommendation is uncertain. This study aimed to identify and critically appraise clinical practice guidelines for foot and ankle management in RA. Methods: Guidelines were identified electronically and through hand searching. Search terms 'rheumatoid arthritis', 'clinical practice guidelines' and related synonyms were used. Critical appraisal and quality rating were conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: Twenty-four guidelines were included. Five guidelines were high quality and recommended for use. Five high quality and seven low quality guidelines were recommended for use with modifications. Seven guidelines were low quality and not recommended for use. Five early and twelve established RA guidelines were recommended for use. Only two guidelines were foot and ankle specific. Five recommendation domains were identified in both early and established RA guidelines. These were multidisciplinary team care, foot healthcare access, foot health assessment/review, orthoses/insoles/splints, and therapeutic footwear. Established RA guidelines also had an 'other foot care treatments' domain. Conclusions: Foot and ankle management for RA features in many clinical practice guidelines recommended for use. Unfortunately, supporting evidence in the guidelines is low quality. Agreement levels are predominantly 'expert opinion' or 'good clinical practice'. More research investigating foot and ankle management for RA is needed prior to inclusion in clinical practice guidelines