Mobile-bearing total ankle arthroplasty: A fundamental assessment of the clinical, radiographic and functional outcomes

Ankle arthritis often leads to significant impairments for the patient. As total ankle arthroplasty (TAA) with use of fixed-bearing (2-component) total ankle prostheses has a high rate of early failures, fusion of the ankle joint is, until today, considered to be the standard surgical treatment for end-stage ankle arthritis. TAA with use of a mobile-bearing design became available in 1981 with the development of the New Jersey Low Contact Stress (LCS®, DePuy, Warsaw, Indiana) ankle prosthesis in the USA and in 1986 with the development of the Scandinavian Total Ankle Replacement (STAR, Waldemar Link, Hamburg, Germany) prosthesis in Denmark. The LCS ankle prosthesis was introduced in 1988 at the Slotervaartziekenhuis, Amsterdam, this hospital thus becoming the first non-designer hospital in Europe to use a mobile-bearing ankle prosthesis. With growing experience, this method became our preferred surgical treatment for the arthritic ankle with end-stage disease, at first in patients with inflammatory arthritis, later also in patients with osteoarthritis (mostly of posttraumatic origin). Since TAA as a reliable treatment option is, until today, still subject of debate, an in-depth evaluation of its clinical, radiographic and functional outcomes was performed in order to properly assess its current position in the armamentarium of the modern foot and ankle surgeonUBL - phd migration 201

Approaches for setting micronutrient recommendations : a case study of vitamin B12 for adults and elderly people

Background: Most countries in Europe provide recommendations on the micronutrient composition of diets to fulfil requirements of nearly all individuals in the general apparently healthy population. However as each country uses its own methods for deriving such recommendations, there is large variation between countries in the recommended micronutrient intakes. The objectives of this thesis are to signal key issues for harmonizing approaches for establishing micronutrient recommendations for adults and elderly across Europe and to illustrate standardized and transparent review methods that can be used to summarize and evaluate the evidence-base for setting recommendations, using vitamin B12 as a case micronutrient. Methods: First the need for harmonization is substantiated by a descriptive study on the variation in published micronutrient recommendations across Europe. In addition methodological factors were identified that should be considered for alignment of recommended intakes across Europe. Secondly, the evidence-base for establishing recommended vitamin B12 intakes was summarized in two systematic reviews. One review focused on requirements for the compensation of daily obligatory losses (factorial approach) and the other review evaluated the relation of vitamin B12 intake and status with cognitive performance (dose-response approach). Whether interactions between folate and vitamin B12 on cognitive performance should be considered for establishing recommended vitamin B12 intakes was evaluated using data from 2203 Norwegian elderly from the Hordaland Homocysteine Study. Results: For harmonizing approaches for establishing micronutrient recommendations, standard methods are needed to a)-select health indicators and define adequate biomarker concentrations, b)-make assumptions about inter-individual variation in requirements, c)-derive bioavailability factors, and d)-select and interpret evidence on requirements. The first systematic review showed that daily vitamin B12 losses in apparently healthy adults and elderly probably range between 2.6-3.9 µg and bioavailability from the usual diet may range between 29 and 37% rather than the generally assumed 50%. Dose-response evidence from 2 randomized controlled trials and 19 prospective cohort studies showed no or inconsistent associations between vitamin B12 intake or status and dementia, Alzheimer’s Disease, global cognitive function or domain-specific cognitive function in adults and elderly people. Cross-sectional analyses in the Norwegian cohort study showed that low plasma vitamin B12 in combination with high folate was associated with better cognitive performance. However, these associations were not observed for sensitive markers of vitamin B12 status. Conclusion: The main conclusion of this thesis is that evidence underlying current recommended vitamin B12 intakes is old and has large uncertainties, whereas the available evidence on the relation between vitamin B12 and cognitive performance is yet not convincing and thereby limits its use as an outcome for estimating vitamin B12 requirements. The relation between vitamin B12 intake and markers of vitamin B12 status seems the best alternative, but sound statistical methods to define recommendations based on these dose-response data should be further developed. </p

Restarting from scratch: humanist initiatives as an option for strengthening civil society in the new member states of the European Union

Topic: Inclusion and exclusion are direct results of how the concepts of human dignity, equality and justice are valued. This always held true for the European Union (EU) since it was formed, but is even more topical now that recently twelve new countries of Central- and Eastern Europe have joined. Therefore at the moment, a major process of reorientation on the question how to construct stable societies is going on. Research question: In this essay research is done on the question whether - and if so how - humanist initiatives might be an option for strengthening civil society in the new member states. Conclusion: All together one can say that in the effort to integrate - and therewith include - the new European member states as well as possible into the new European Union, the rebuilding of civil society is crucial. Humanism seems to be able to attribute to that, by the fact that some core values of this philosophy of life, of this movement that started in the Renaissance and goes back to the ancient times, are similar to the ones needed for the development of civil society. Those key-notes being: autonomy, solidarity, and responsibility. Another explanation for the fact that humanism seems to successfully function as a source of inspiration for the development of common European ideas how to organize society, is because of the common history Western, Northern, Middle and Eastern Europe share in this tradition. It reaffirms the common roots all those parts of Europe share as part of their cultural and historical background

A note on the expressive power of linear orders

This article shows that there exist two particular linear orders such that first-order logic with these two linear orders has the same expressive power as first-order logic with the Bit-predicate FO(Bit). As a corollary we obtain that there also exists a built-in permutation such that first-order logic with a linear order and this permutation is as expressive as FO(Bit)

Early Recognition and Management of Side Effects Related to Systemic Anticancer Therapy for Advanced Breast Cancer

Objectives: Advances in science and technology have meant there are numerous treatment options available for people with advanced breast cancer (ABC). However, each therapeutic approach can cause side effects or adverse events, which can significantly affect the person's quality of life, overall well-being, and, in some instances, safety. This report presents an overview of the common side effects of systemic anticancer therapy and ways to manage them. Data Sources: Data sources include peer-reviewed articles sourced in electronic databases and national and international best practice guidelines (ESMO, ASCO, and MASCC guidelines). Conclusion: Systemic anticancer therapies have side effects that healthcare professionals need to know about to monitor and manage them in early stages. Nurses play an important role in patient education, early identification, monitoring, and management of treatment side effects. Implications for Nursing Practice: People with ABC face many challenges during their treatment journey. Oncology nurses, specialist nurses, and nurse practitioners can be of support by providing preventive measures and side effects management at an early stage. Nurses need to have a good understanding of toxicity management but also advanced tumor-specific cancer knowledge of the different subtypes of ABC and holistic assessment skills. They are also key to providing support and enhancing self-management and early recognition of side effects. (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/

Nutri-RecQuest: a web-based search engine on current micronutrient recommendations

Background: The EURRECA (EURopean micronutrient RECommendations Aligned) Network of Excellence collated current micronutrient recommendations. A user-friendly tool, Nutri-RecQuest, was developed to allow access to the collated data and to create a database source for use in other nutritional software tools. Methods: Recommendations, that is, intakes of micronutrients sufficient to meet the requirements of the majority of healthy individuals of that population, from 37 European countries/organizations and eight key non-European countries/regions comprising 29 micronutrients were entered into a database. General information on the source of the recommendations, as well scientific background information, was added. Results: A user-friendly web-based interface was developed to provide efficient search, comparison, display, print and export functions. Conclusion: Easy access to existing recommendations through the web-based tool may be valuable for bodies responsible for setting recommendations, as well as for users of recommendations including scientists, policy makers, health professionals and industry. Adding related dietary reference values such as average nutrient requirements and upper limits may extend the utility of the tool. European Journal of Clinical Nutrition (2010) 64, S43-S47; doi:10.1038/ejcn.2010.6