Replacing temporomandibular joints

The masticatory system plays an important role during biting, chewing, swallowing, speech, singing and other functions, all directly affecting quality of life. For proper functioning, both temporomandibular joints and the connecting mandible, together with the masticatory muscles and contiguous tissue components, play a major role. In a healthy situation, the masticatory muscles supply the mandible with the required movements and biting and chewing forces, while the left and right mandibular condyles slide smoothly along their articular eminences. Disturbances of the masticatory system can lead to a wide range of both muscular and Temporomandibular Joint (TMJ) conditions and pathology, resulting in pain, limited mouth opening, headaches, clicking or popping sounds in the TMJ and impaired masticatory functioning. TMJ disturbances and muscle problems influence each other and may lead to chronic pain and functional impairment. The TMJ prosthesis design is a mixture of well-known and accepted techniques, and new inventions. Among the well-known techniques are screw fixation and the use of proven biocompatible materials. The main new developments are a double articulation, including an inferiorly located centre of rotation, a self-adjusting skull part that is built from stock parts and a rigid screw-prosthesis connection

Preferred Islet Delivery Device Characteristics and Implantation Strategies of Patients With Type 1 Diabetes

Islet delivery devices (IDDs) offer potential benefits for islet transplantation and stem cell-based replacement in type 1 diabetes. Little is known about patient preferences regarding islet delivery device characteristics and implantation strategies. Patient preferences for IDDs and implantation strategies remain understudied. We invited patients, parents and caregivers to fill in an online questionnaire regarding IDDs. An online survey gathered responses from 809 type 1 diabetes patients and 47 caregivers. We also assessed diabetes distress in a subgroup of 412 patients. A significant majority (97%) expressed willingness to receive an IDD. Preferred IDD attributes included a 3.5 cm diameter for 37.7% of respondents, while when provided with all options, 30.4% found dimensions unimportant. Respondents were open to approximately 4 implants, each with a 5 cm incision. Many favored a device functioning for 12 months (33.4%) or 24 months (24.8%). Younger participants (16-30) were more inclined to accept a 6 months functional duration ( p < 0.001). Functional duration outweighed implant quantity and size ( p < 0.001) in device importance. This emphasizes patients' willingness to accommodate burdens related to IDD features and implantation methods, crucial for designing future beta cell replacement strategies

Agrarische structuur, trends en beleid: ontwikkelingen in Nederland vanaf 1950

In en rond de agrarische sector in Nederland hebben zich de afgelopen decennia ingrijpende veranderingen voorgedaan. Zo is het aandeel van de agrarische sector in de nationale economie stelselmatig teruggelopen. Dit rapport brengt de structurele veranderingen in kaart en analyseert de invloed van beleidsmaatregelen. Geconcludeerd wordt dat de processen van bedrijfsbeëindiging en schaalvergroting die zich in de land/ en tuinbouw voordoen, vooral bepaald zijn door het duurder worden van arbeid, in combinatie met het beschikbaar komenvan arbeidsbesparende technische mogelijkheden.Fundamental changes have taken place in and around the Dutch agricultural sector during the past decades, and the agriculture sector¿s share in the national economy has exhibited a consistent decline. This report maps the structural changes in the sector and analyses the influence of policy measures. The report concludes that the processes resulting in the closure of farms and increases in scale are primarily determined by the increasing cost of labour incombination with the availability of labour/saving technology

Automated Whole Animal Bio-Imaging Assay for Human Cancer Dissemination

A quantitative bio-imaging platform is developed for analysis of human cancer dissemination in a short-term vertebrate xenotransplantation assay. Six days after implantation of cancer cells in zebrafish embryos, automated imaging in 96 well plates coupled to image analysis algorithms quantifies spreading throughout the host. Findings in this model correlate with behavior in long-term rodent xenograft models for panels of poorly- versus highly malignant cell lines derived from breast, colorectal, and prostate cancer. In addition, cancer cells with scattered mesenchymal characteristics show higher dissemination capacity than cell types with epithelial appearance. Moreover, RNA interference establishes the metastasis-suppressor role for E-cadherin in this model. This automated quantitative whole animal bio-imaging assay can serve as a first-line in vivo screening step in the anti-cancer drug target discovery pipeline

An illness-focused interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours primary care: study protocol for a cluster randomised trial

Background Fever is the most common reason for a child to be taken to a general practitioner (GP), especially during out-of-hours care. It is mostly caused by self-limiting infections. However, antibiotic prescription rates remain high, especially during out-of-hours care. Anxiety and lack of knowledge among parents, and perceived pressure to prescribe antibiotics amongst GPs, are important determinants of excessive antibiotic prescriptions. An illness-focused interactive booklet has the potential to improve this by providing parents with information about fever self-management strategies. The aim of this study is to develop and determine the effectiveness of an interactive booklet on management of children presenting with fever at Dutch GP out-of-hours cooperatives. Methods/design We are conducting a cluster randomised controlled trial (RCT) with 20 GP out-of-hours cooperatives randomised to 1 of 2 arms: GP access to the illness-focused interactive booklet or care as usual. GPs working at intervention sites will have access to the booklet, which was developed in a multistage process. It consists of a traffic light system for parents on how to respond to fever-related symptoms, as well as information on natural course of infections, benefits and harms of (antibiotic) medications, self-management strategies and ‘safety net’ instructions. Children < 12 years of age with parent-reported or physician-measured fever are eligible for inclusion. The primary outcome is antibiotic prescribing during the initial consultation. Secondary outcomes are (intention to) (re)consult, antibiotic prescriptions during re-consultations, referrals, parental satisfaction and reassurance. In 6 months, 20,000 children will be recruited to find a difference in antibiotic prescribing rates of 25% in the control group and 19% in the intervention group. Statistical analysis will be performed using descriptive statistics and by fitting two-level (GP out-of-hours cooperative and patient) random intercept logistic regression models. Discussion This will be the first and largest cluster RCT evaluating the effectiveness of an illness-focused interactive booklet during GP out-of-hours consultations with febrile children receiving antibiotic prescriptions. It is hypothesised that use of the booklet will result in a reduced number of antibiotic prescriptions, improved parental satisfaction and reduced intention to re-consult

Zetmeelaardappelen en herziening van het EU-beleid

Dit rapport analyseert de gevolgen van een volledige ontkoppeling van de Europese premie voor zetmeelaardappelen en van de afbouw van het EU-zetmeelbeleid voor de betreffende sector in Nederland. Deze gevolgen kunnen, afhankelijk van de omstandigheden en de reacties van de telers, uiteenlopen. Naast voorzetting van de productie in de huidige omvang is een daling met ongeveer 30% mogelijk. Ook een volledige afbouw van de teelt en verwerking kan niet worden uitgesloten. Gezien de gevoeligheid van de sector voor de beleidsveranderingen wordt een fasegewijze introductie met toepassing van flankerende maatregelen aanbevolen