The Use and Efficiency of Public Transport : The Effects of Price and Service Measures

Like in many other countries in the Netherlands, , the government of the Nethertlands assigns public transport an important role in its transport policy. However, the costs of public transport do exceed the revenues of it. Price may be an important variable to both increase the use of public transport and to improve the costs/benefits ratio. Unfortunately, little knowledge is available with regard to the effects of price measures. In the paper two questions are answered. First, the influence of price measures on the use of public transport, the costs/benefits ration and the modal split is discussed. Then, the change of structure in the Netherlands and its implications on the probability that price measures will be taken is described and discussed. It is concluded, that price does influence the demand for public transport. Besides, because of the financing system it seems less unlikely than desirable that regional/local authorities will implement price measures

The Use and Efficiency of Public Transport : The Effects of Price and Service Measures

Like in many other countries in the Netherlands, , the government of the Nethertlands assigns public transport an important role in its transport policy. However, the costs of public transport do exceed the revenues of it. Price may be an important variable to both increase the use of public transport and to improve the costs/benefits ratio. Unfortunately, little knowledge is available with regard to the effects of price measures. In the paper two questions are answered. First, the influence of price measures on the use of public transport, the costs/benefits ration and the modal split is discussed. Then, the change of structure in the Netherlands and its implications on the probability that price measures will be taken is described and discussed. It is concluded, that price does influence the demand for public transport. Besides, because of the financing system it seems less unlikely than desirable that regional/local authorities will implement price measures

Progressive slip after removal of screw fixation in slipped capital femoral epiphysis: two case reports

<p>Abstract</p> <p>Introduction</p> <p>In slipped capital femoral epiphysis the femoral neck displaces relative to the head due to weakening of the epiphysis. Early recognition and adequate surgical fixation is essential for a good functional outcome. The fixation should be secured until the closure of the epiphysis to prevent further slippage. A slipped capital femoral epiphysis should not be confused with a femoral neck fracture.</p> <p>Case presentation</p> <p>Case 1 concerns a 15-year-old boy with an adequate initial screw fixation of his slipped capital femoral epiphysis. Unfortunately, it was thought that the epiphysis had healed and the screw was removed after 11 weeks. This caused new instability with a progressive slip of the femoral epiphysis and subsequently re-fixation and a subtrochanteric correction osteotomy was obligatory. Case 2 concerns a 13-year-old girl with persistent hip pain after screw fixation for slipped capital femoral epiphysis. The screw was removed as lysis was seen around the screw on the hip X-ray. This operation created a new unstable situation and the slip progressed resulting in poor hip function. A correction osteotomy with re-screw fixation was performed with a good functional result.</p> <p>Conclusion</p> <p>A slipped epiphysis of the hip is not considered ‘healed’ after a few months. Given the risk of progression of the slip the fixation material cannot be removed before closure of the growth plate.</p

The results of downgrading moderate and severe slipped capital femoral epiphysis by an early Imhauser femur osteotomy

Purpose: Patients with moderate and severe slipped capital femoral epiphysis (SCFE) develop osteoarthritis earlier in life in association with mechanical impingement. Methods: To correct deformity and diminishim pingement, we performed epiphysiodesis combined with an Imhauser intertrochanteric osteotomy (ITO) in moderate and severe slipped capital femoral epiphysis. We downgraded the angle of the head relative to the acetabulum into an angle corresponding to a mild slip or even an anatomical position. Our hypothesis is that the avoidance of anterior impingement at an early stage can prevent the development of osteoarthritis. Results: The results of 28 patients (32 hips) were evaluated. Outcome parameters were SF-36, Harris Hip Score, range of motion, Kellgren-Lawrence score, chondrolysis and avascular necrosis. After a median follow-up of 8 (range 2-25) years, the group was clinically, functionally and socially performing well. Radiologically, there was no sign of chondrolysis or avascular necrosis, and more than 80% of the patients did not show any signs of osteoarthritis. Conclusions: Based on these results, we conclude that a one-stage Imhauser ITO combined with epiphysiodesis performed on patients with moderate and severe SFCE gives satisfactory results

Active monitoring versus an abduction device for treatment of infants with centered dysplastic hips: study protocol for a randomized controlled trial (TReatment with Active Monitoring (TRAM)-Trial)

Background: Developmental Dysplasia of the Hip (DDH) is one of the most common pediatric orthopedic disorders, affecting 1-3% of all newborns. The optimal treatment of centered DDH is currently under debate. This randomized controlled trial aims to study the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH. Methods: This is a multicenter, parallel-group, open-label, non-inferiority randomized controlled trial studying the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH in fourteen hospitals in the Netherlands. In total, 800 infants with centered DDH (Graf IIa-/IIb/IIc), aged 10-16 weeks, will be randomly allocated to the active monitoring or abduction treatment group. Infants will be followed up until the age of 24 months. The primary outcome is the rate of normal hips, defined as an acetabular index lower than 25 degrees on an antero-posterior radiograph, at the age of 12 months. Secondary outcomes are the rate of normal hips at the age of 24 months, complications, time to hip normalization, the relation between baseline patient characteristics and the rate of normal hips, compliance, costs, cost-effectiveness, budget impact, health-related quality of life (HRQoL) of the infant, HRQoL of the parents/caregivers, and parent/caregiver satisfaction with the treatment protocol.Discussion: The outcomes of this randomized controlled trial will contribute to improving current care-as-usual for infants with centered DDH.Orthopaedics, Trauma Surgery and Rehabilitatio

The genetic epidemiology of joint shape and the development of osteoarthritis

Congruent, low-friction relative movement between the articulating elements of a synovial joint is an essential pre-requisite for sustained, efficient, function. Where disorders of joint formation or maintenance exist, mechanical overloading and osteoarthritis (OA) follow. The heritable component of OA accounts for ~ 50% of susceptible risk. Although almost 100 genetic risk loci for OA have now been identified, and the epidemiological relationship between joint development, joint shape and osteoarthritis is well established, we still have only a limited understanding of the contribution that genetic variation makes to joint shape and how this modulates OA risk. In this article, a brief overview of synovial joint development and its genetic regulation is followed by a review of current knowledge on the genetic epidemiology of established joint shape disorders and common shape variation. A summary of current genetic epidemiology of OA is also given, together with current evidence on the genetic overlap between shape variation and OA. Finally, the established genetic risk loci for both joint shape and osteoarthritis are discussed

Collectieve actie en regionaal verkeers- en vervoersbeleid

De bestuurlijke structuur van Nederland is de laatste jaren een belangrijk onderwerp van discussie. In de paper wordt de theorie van het fiscal federalism gebruikt om de bestuurlijke ontwikkelingen op het gebied van het verkeers- en vervoersbeleid te beschrijven cq. verklaren. Volgens deze theorie, die impliceert, dat de vormgeving van de overheidsstructuur een afgeleide is van haar functie, het verschaffen van publieke voorzieningen, kunnen veranderende omstandigheden tot een verandering van de organisatie leiden. Op het gebied van het verkeer en vervoer is sprake van veranderende omstandigheden. (Vrij willige) samenwerking kan een oplossing bieden voor de druk op de bestaande bestuurlijke structuur. In de paper wordt inzicht gegeven in de variabelen die de kans op totstandkoming en continuering van (vrijwillige) samenwerking beïnvloeden. Deze inzichten kunnen worden gebruikt om de kans op (vrijwillige) samenwerking en daarmee een efficiënte verschaffing en beheer van het verkeersnetwerk te optimaliseren