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Introduction: Dead space management following debridement surgery in chronic osteomyelitis or septic non-unions is one of the most crucial and discussed steps for the success of the surgical treatment of these conditions. In this retrospective clinical study, we described the efficacy and safety profile of surgical debridement and local application of S53P4 bioactive glass (S53P4 BAG) in the treatment of bone infections. Methods: A consecutive single-center series of 38 patients with chronic osteomyelitis (24) and septic non-unions (14), treated with bioactive glass S53P4 as dead space management following surgical debridement between May 2015 and November 2020, were identified and evaluated retrospectively. Results: Infection eradication was reached in 22 out of 24 patients (91.7%) with chronic osteomyelitis. Eleven out of 14 patients (78.6%) with septic non-union achieved both fracture healing and infection healing in 9.1 ± 4.9 months. Three patients (7.9%) developed prolonged serous discharge with wound dehiscence but healed within 2 months with no further surgical intervention. Average patient follow-up time was 19.8 months ± 7.6 months. Conclusion: S53P4 bioactive glass is an effective and safe therapeutic option in the treatment of chronic osteomyelitis and septic non-unions because of its unique antibacterial properties, but also for its ability to generate a growth response in the remaining healthy bone at the bone-glass interface.

Background Context Cervical disc replacement (CDR) aims to restore motion of the treated level to reduce the risk of adjacent segment disease (ASD) compared with spinal fusion. However, first-generation articulating devices are unable to mimic the complex deformation kinematics of a natural disc. Thus, a biomimetic artificial intervertebral CDR (bioAID), containing a hydroxyethylmethacrylate (HEMA)—sodium methacrylate (NaMA) hydrogel core representing the nucleus pulposus, an ultra-high-molecular-weight-polyethylene fiber jacket as annulus fibrosus, and titanium endplates with pins for primary mechanical fixation, was developed. Purpose To assess the initial biomechanical effect of the bioAID on the kinematic behavior of the canine spine, an ex vivo biomechanical study in 6-degrees-of-freedom was performed. Study Design A canine cadaveric biomechanical study. Methods Six cadaveric canine specimens (C3-C6) were tested in flexion-extension (FE), lateral bending (LB) axial rotation (AR) using a spine tester in three conditions: intact, after C4-C5 disc replacement with bioAID, and after C4-C5 interbody fusion. A hybrid protocol was used where first the intact spines were subjected to a pure moment of ±1 Nm, whereafter the treated spines were subjected to the full range of motion (ROM) of the intact condition. 3D segmental motions at all levels were measured while recording the reaction torsion. Biomechanical parameters studied included ROM, neutral zone (NZ), and intradiscal pressure (IDP) at the adjacent cranial level (C3-C4). Results The bioAID retained the sigmoid shape of the moment-rotation curves with a NZ similar to the intact condition in LB and FE. Additionally, the normalized ROMs at the bioAID-treated level were statistically equivalent to intact during FE and AR while slightly decreased in LB. At the two adjacent levels, ROMs showed similar values for the intact compared to the bioAID for FE and AR and

01 februari 2023, Contains fulltext : upload_in_progress_2066_293031.pdf (Publisher’s version ) (Closed access)

De programmadirectie van het Hoogwaterbeschermingsprogramma heeft de ambitie geformuleerd om ruimtelijke kwaliteit te borgen in het planproces van alle HWBP-projecten. Op basis van een grootschalige enquête onder projectmanagers beschrijft dit artikel welke beleidsinstrumenten zij inzetten om ruimtelijke kwaliteit binnen hun projecten te borgen, en wat hiervoor belangrijke drijfveren waren. De enquêteresultaten laten zien dat het realiseren van ruimtelijke kwaliteit sterk afhangt van de geformuleerde projectdoelen. Ook de ervaring van de projectteamleden en de beleidscontext waarin zij opereren spelen een belangrijke rol. Het artikel eindigt met vijf lessen voor het versterken van ruimtelijke kwaliteit in waterveiligheidsprojecten.

Ondanks de toenemende aandacht voor ruimtelijke kwaliteit bestaat er nog geen standaardprocedure voor het integreren van ruimtelijke kwaliteit in het planproces van waterveiligheidsprojecten. In dit artikel wordt een instrumentenpalet geïntroduceerd, bestaande uit vier instrumententypes en bijbehorende instrumenten voor het versterken van ruimtelijke kwaliteit in waterveiligheidsprojecten. Het palet is ontwikkeld met diverse waterschappen, kennis- en adviesbureaus en kan gebruikt worden als handreiking voor projectteams van waterschappen. Naast een toelichting van de instrumenten worden ook praktijkervaringen gedeeld over het gebruik van deze instrumenten. Zo valt bijvoorbeeld de ‘roep om een ruimtelijke integrator’ in het projectteam op.

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Irritable bowel syndrome (IBS) is characterised by recurrent abdominal pain related to defaecation or associated with altered stool frequency or consistency. Despite its prevalence, major uncertainties in the diagnostic and therapeutic management persist in clinical practice. A Delphi consensus was conducted by 20 experts from Belgium, and consisted of literature review and voting process on 78 statements. Grading of recommendations, assessment, development and evaluation criteria were applied to evaluate the quality of evidence. Consensus was defined as > 80 % agreement. Consensus was reached for 50 statements. The Belgian consensus agreed as to the multifactorial aetiology of IBS. According to the consensus abdominal discomfort also represents a cardinal symptom, while bloating and abdominal distension often coexist. IBS needs subtyping based on stool pattern. The importance of a positive diagnosis, relying on history and clinical examination is underlined, while additional testing should remain limited, except when alarm features are present. Explanation of IBS represents a crucial part of patient management. Lifestyle modification, spasmolytics and water-solube fibres are considered first-line agents. The low FODMAP diet, selected probiotics, cognitive behavioural therapy and specific treatments targeting diarrhoea and constipation are considered appropriate. There is a consensus to restrict faecal microbiota transplantation and gluten-free diet, while other treatments are strongly discouraged. A panel of Belgian gastroenterologists summarised the current evidence on the aetiology, symptoms, diagnosis and treatment of IBS with attention for the specificities of the Belgian healthcare system.

Contains fulltext : 247208.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 247208.pdf (Publisher’s version ) (Open Access)

Joosten-ten Brinke, D., Bartman, R. Gulikers, J., Baartman, L., & Silfhout, G. van (2022). Formatief toetsen in de lerarenopleiding: een analyse van de kennisbases. Velon Tijdschift voor Lerarenopleiders, 43(2), 72-95https://velon.nl/formatief-evalueren-in-de-lerarenopleidingen-een-analyse-van-de-kennisbases/(Het Velon tijdschrift is alleen toegankelijk voor leden), Docenten zijn zich steeds meer bewust van het belang van formatief evalueren. Het versterkt het leren van de leerlingen, zorgt voor een grotere betrokkenheid bij het eigen leerproces en bewerkstelligt dat het leren beter beklijft. De verwachting van docenten en schoolleiders is dat net afgestudeerde studenten aan de lerarenopleidingen op de hoogte zijn van formatief evalueren en beschikken over een (vak)didactisch handelingsrepertoire om formatief evalueren in de praktijk te brengen.In dit artikel leest u de resultaten van een onderzoek waarbij de kennisbases van 14 eerstegraads en 18 tweedegraads lerarenopleidingen geanalyseerd zijn op de aandacht voor formatief evalueren om inzicht te krijgen in het beoogde curriculum. Met een kwantitatieve en kwalitatieve analyse van de kennisbases aan de hand van de formatieve evaluatiecyclus wordt duidelijk dat de aandacht voor formatief evalueren verschillend is tussen de kennisbases van de eerstegraads lerarenopleidingen en de kennisbases van de tweedegraads lerarenopleidingen en dat er grote verschillen zijn tussen de verschillende vakspecifieke kennisbases. In het algemeen kan gesteld worden dat er relatief weinig aandacht is voor formatief evalueren. De resultaten van dit onderzoek kunnen gebruikt worden bij de herziening van de kennisbases.

BACKGROUND: Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and subsequent re-operations compared to ankle arthrodesis. The aim of this systematic review and meta-analysis is to generate an overview of complications of TAA surgery.METHODS: PubMed, EMBASE and the Cochrane library were searched between 2000 and 2020 to identify all papers reporting on complications in TAA surgery. Meta-analysis was conducted based on type of complication in TAA surgery. Pooled estimates of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates was rated and described according to the recommendations of the GRADE working group.RESULTS: One hundred twenty-seven studies were included in this systematic review. All combined, they reported on 16.964 TAAs with an average follow-up of 47.99 ± 29.18 months. Complications with highest reported pooled incidence were intra-operative fracture 0.06 (95 %CI 0.04-0.08) (GRADE Very low) and impingement 0.06 (95 %CI 0.04-0.08) (GRADE low) respectively.CONCLUSION: Reported complication incidence of TAA surgery is still high and remains a significant clinical problem that can be severely hampering long-term clinical survival of the prosthesis. The results of this systematic review and meta-analysis can help guide surgeons in informing their patient about complication risks. Implementation of more stringent patient selection criteria might contribute to diminishing TAA complication rates.

Purpose: To identify the life domains that are most frequently reported to be affected in scoliosis patients undergoing brace treatment. Methods: A search within the PubMed database was conducted and a total of 60 publications were selected. We classified the studies based on the methods used to measure patients’ quality of life (QoL) and categorized the life domains reported to be affected. Results: Self-image/body configuration was the most reported affected domain of patients’ QoL, identified in 32 papers, whilst mental health/stress was the second most reported affected domain. Mental health was identified in 11 papers, and 11 papers using the BSSQ questionnaire reported medium stress amongst their participants. Vitality was the third most reported affected domain, identified in 12 papers. Conclusions: Our review indicates that scoliotic adolescents treated with bracing suffer in their quality of life most from psychological burdens. To improve these patients’ life quality, more attention should be focussed on supporting their mental health.

We study a problem where – given a railway network and different fleets – we have to locate maintenance locations and allocate the fleets to these locations. The allocation of fleets to the maintenance locations complicates the maintenance location routing problem. For each candidate location different facility sizes can be chosen and for each size there is an associated annual facility cost that captures the economies of scale in facility size. Because of the strategic nature of facility location, these facilities should be able to handle changes such as adjustments to the line plan and the introduction of new rolling stock types. We capture these changes by discrete scenarios and we formulate this two-stage stochastic problem as a mixed integer problem. Furthermore, we perform a case study with the Netherlands Railways that provides novel managerial insights by showing that the number of opened maintenance facilities highly depends on the allocation restrictions.

We study a problem where – given a railway network and different fleets – we have to locate maintenance locations and allocate the fleets to these locations. The allocation of fleets to the maintenance locations complicates the maintenance location routing problem. For each candidate location different facility sizes can be chosen and for each size there is an associated annual facility cost that captures the economies of scale in facility size. Because of the strategic nature of facility location, these facilities should be able to handle changes such as adjustments to the line plan and the introduction of new rolling stock types. We capture these changes by discrete scenarios and we formulate this two-stage stochastic problem as a mixed integer problem. Furthermore, we perform a case study with the Netherlands Railways that provides novel managerial insights by showing that the number of opened maintenance facilities highly depends on the allocation restrictions.

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Identifying determinants of long-term functional outcome after a distal radius fracture is challenging. Previously, we reported on the association between early HR-pQCT measurements and clinical outcome 12 weeks after a conservatively treated distal radius fracture. We extended the follow-up and assessed functional outcome after two years in relation to early HR-pQCT derived bone parameters.HR-pQCT scans of the fracture region were performed in 15 postmenopausal women with a distal radius fracture at 1-2 (baseline), 3-4 weeks and 26 months post-fracture. Additionally, the contralateral distal radius was scanned at baseline. Bone density, micro-architecture parameters and bone stiffness using micro-finite element analysis (FEA) were evaluated. During all visits, wrist pain and function were assessed using the patient-rated wrist evaluation questionnaire (PRWE), quantifying functional outcome with a score between 0 and 100.Two-year PRWE was associated with torsional and bending stiffness 3-4 weeks post-fracture (R-2: 0.49, p = 0.006 and R-2: 0.54, p = 0.003, respectively). In contrast, early micro-architecture parameters of the fracture region or contralateral bone parameters did not show any association with long-term outcome.This exploratory study indicates that HR-pQCT with mu FEA performed within four weeks after a distal radius fracture captures biomechanical fracture characteristics that are associated with long-term functional outcome and therefore could be a valuable early outcome measure in clinical trials and clinical practice.

Contains fulltext : 214512.pdf (publisher's version ) (Closed access)

Contains fulltext : 214512.pdf (publisher's version ) (Closed access)

Identifying determinants of long-term functional outcome after a distal radius fracture is challenging. Previously, we reported on the association between early HR-pQCT measurements and clinical outcome 12 weeks after a conservatively treated distal radius fracture. We extended the follow-up and assessed functional outcome after two years in relation to early HR-pQCT derived bone parameters.HR-pQCT scans of the fracture region were performed in 15 postmenopausal women with a distal radius fracture at 1-2 (baseline), 3-4 weeks and 26 months post-fracture. Additionally, the contralateral distal radius was scanned at baseline. Bone density, micro-architecture parameters and bone stiffness using micro-finite element analysis (FEA) were evaluated. During all visits, wrist pain and function were assessed using the patient-rated wrist evaluation questionnaire (PRWE), quantifying functional outcome with a score between 0 and 100.Two-year PRWE was associated with torsional and bending stiffness 3-4 weeks post-fracture (R-2: 0.49, p = 0.006 and R-2: 0.54, p = 0.003, respectively). In contrast, early micro-architecture parameters of the fracture region or contralateral bone parameters did not show any association with long-term outcome.This exploratory study indicates that HR-pQCT with mu FEA performed within four weeks after a distal radius fracture captures biomechanical fracture characteristics that are associated with long-term functional outcome and therefore could be a valuable early outcome measure in clinical trials and clinical practice.

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Modern waterway networks are ageing and need to be renewed, yet the institutional context in the waterway sector is averse to change because of path dependencies. Waterway renewal requires actors to navigate between institutional reproduction and change. Applying an innovative framework for analysing institutions in a case study of the Dutch national waterways, we mainly find instances of institutional reproduction, which turns waterway renewal into a technical and financial exercise. However, institutional change becomes increasingly evident through a new functional-relational path, suggesting that planning for waterway renewal also entails reconsidering novel waterway configurations and incorporating neighbouring spatial developments.

In the field of orthopaedic surgery, bacterial invasion of implants and the resulting periprosthetic infections are a common and unresolved problem. Antimicrobial susceptibility testing methods help to define the optimal treatment and identify antimicrobial resistance. This review discusses proven gold-standard techniques and recently developed models for antimicrobial susceptibility testing, while also providing a future outlook. Conventional, gold-standard methods, such as broth microdilution, are still widely applied in clinical settings. Although recently developed methods based on microfluidics and microdroplets have shown advantages over conventional methods in terms of testing speed, safety and the potential to provide a deeper insight into resistance mechanisms, extensive validation is required to translate this research to clinical practice. Recent optical and mechanical methods are complex and expensive and, therefore, not immediately clinically applicable. Novel osteoblast infection and tissue models best resemble infections in vivo. However, the integration of biomaterials into these models remains challenging and they require a long tissue culture, making their rapid clinical implementation unlikely. A method applicable for both clinical and research environments is difficult to realise. With a continuous increase in antimicrobial resistance, there is an urgent need for methods that analyse recurrent infections to identify the optimal treatment approaches.

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Background: Chronic osteomyelitis is caused by bacterial infection of the bone and is a major problem in orthopaedic surgery. Treatment of chronic osteomyelitis requires surgical debridement accompanied by local and systemic administration of antibiotics. A widely established biodegradable local antibiotic carrier is antibiotic-loaded collagen sponges (fleeces). These sponges are commonly used in the treatment of chronic osteomyelitis, but a systematic review of their clinical efficacy and assessment of the quality of evidence have not been conducted, to our knowledge.Methods: This systematic review, performed according to the PRISMA statement, examined the clinical efficacy of and quality of evidence regarding different antibiotic-loaded collagen sponges in the clinical treatment of chronic osteomyelitis. Clinical efficacy was defined as eradication of infection with bone and wound-healing. In addition, the in vivo pharmacokinetics of the various collagen sponges were evaluated. Quality was based on the Level of Evidence, methodological quality, and risks of bias.Results: A total of 813 articles were screened, and 10 were included. Gentamicin-sulfate sponges and gentamic-insulfate/gentamicin-crobefate sponges were studied. A total of 413 patients were treated, with a success rate of 91%. Reported complications were fistulas, prolonged wound drainage, and wound-healing problems. In vivo pharmacokinetic profiles showed an average local antibiotic concentration that was above the minimum inhibitory concentration for only 5 days. The general quality of the included studies was low to moderate, and there was a moderate to high risk of bias.Conclusions: The evidence quality and Level of Evidence of the included studies were low, and the risk of bias in these studies was high. This makes the evidence regarding these sponges inconclusive, and no clinical decision-making can be based on these studies. Utilization of antibiotic-loaded collagen sponges

In the field of orthopaedic surgery, bacterial invasion of implants and the resulting periprosthetic infections are a common and unresolved problem. Antimicrobial susceptibility testing methods help to define the optimal treatment and identify antimicrobial resistance. This review discusses proven gold-standard techniques and recently developed models for antimicrobial susceptibility testing, while also providing a future outlook. Conventional, gold-standard methods, such as broth microdilution, are still widely applied in clinical settings. Although recently developed methods based on microfluidics and microdroplets have shown advantages over conventional methods in terms of testing speed, safety and the potential to provide a deeper insight into resistance mechanisms, extensive validation is required to translate this research to clinical practice. Recent optical and mechanical methods are complex and expensive and, therefore, not immediately clinically applicable. Novel osteoblast infection and tissue models best resemble infections in vivo. However, the integration of biomaterials into these models remains challenging and they require a long tissue culture, making their rapid clinical implementation unlikely. A method applicable for both clinical and research environments is difficult to realise. With a continuous increase in antimicrobial resistance, there is an urgent need for methods that analyse recurrent infections to identify the optimal treatment approaches.

We developed a semi-automated algorithm for the detection of cortical interruptions in finger joints using high-resolution peripheral quantitative computed tomography (HR-pQCT). Here, we tested its reliability compared to microCT (µCT) as gold standard. Nineteen joints of 10 female anatomic index fingers were imaged by HR-pQCT and µCT (82 and 18 µm isotropic voxel sizes, respectively). The algorithm was applied for detection of cortical interruptions of different minimum diameters (range >0.16 to >0.50 mm). Reliability was tested at the joint level with intra-class correlation coefficient (ICC) for the number of interruptions and interruption surface, and at the level of a single interruption for matching between HR-pQCT and µCT with a fixed interruption diameter (>0.10 mm) on µCT. The positive predictive value (PPV0.10mm) and sensitivity0.10mm were evaluated. The mean number of interruptions per joint depended on the diameter cut-off and ranged from 3.4 to 53.5 on HR-pQCT and from 1.8 to 45.1 on µCT for interruptions >0.50 to >0.16 mm, respectively. Reliability at the joint level was almost perfect (ICC ≥0.81) for both the number and surface of interruptions >0.16 and >0.33 mm. As expected, the PPV0.10mm increased with increasing interruption diameter from 84.9 to 100%, for interruptions >0.16 and >0.50 mm, respectively. However, the sensitivity0.10mm decreased with increasing interruption diameter from 62.4 to 4.7%. This semi-automated algorithm for HR-pQCT in finger joints performed best for the detection of cortical interruptions with a minimum diameter of >0.16 or >0.33 mm, showing almost perfect reliability at the joint level and interruptions matched with those on µCT.

We developed a semi-automated algorithm for the detection of cortical interruptions in finger joints using high-resolution peripheral quantitative computed tomography (HR-pQCT). Here, we tested its reliability compared to microCT (µCT) as gold standard. Nineteen joints of 10 female anatomic index fingers were imaged by HR-pQCT and µCT (82 and 18 µm isotropic voxel sizes, respectively). The algorithm was applied for detection of cortical interruptions of different minimum diameters (range >0.16 to >0.50 mm). Reliability was tested at the joint level with intra-class correlation coefficient (ICC) for the number of interruptions and interruption surface, and at the level of a single interruption for matching between HR-pQCT and µCT with a fixed interruption diameter (>0.10 mm) on µCT. The positive predictive value (PPV0.10mm) and sensitivity0.10mm were evaluated. The mean number of interruptions per joint depended on the diameter cut-off and ranged from 3.4 to 53.5 on HR-pQCT and from 1.8 to 45.1 on µCT for interruptions >0.50 to >0.16 mm, respectively. Reliability at the joint level was almost perfect (ICC ≥0.81) for both the number and surface of interruptions >0.16 and >0.33 mm. As expected, the PPV0.10mm increased with increasing interruption diameter from 84.9 to 100%, for interruptions >0.16 and >0.50 mm, respectively. However, the sensitivity0.10mm decreased with increasing interruption diameter from 62.4 to 4.7%. This semi-automated algorithm for HR-pQCT in finger joints performed best for the detection of cortical interruptions with a minimum diameter of >0.16 or >0.33 mm, showing almost perfect reliability at the joint level and interruptions matched with those on µCT.

Contains fulltext : 214500.pdf (publisher's version ) (Closed access)

Contains fulltext : 214500.pdf (publisher's version ) (Closed access)

Contains fulltext : 214500.pdf (publisher's version ) (Closed access)

Proefdierkunde is een multidisciplinaire wetenschap die bijdraagt aan het humane gebruik en verzorging van proefdieren en de kwaliteit van dierexperimenten. Dierverzorgers, bio- technici, onderzoekers en wetgevers streven continu naar het verbeteren van het welzijn van dieren die voor onderzoek gebruikt worden. Transport van kleine knaagdieren voor onderzoek (muizen en ratten) heeft tot dusver beneden de radar van hun kritische blik kunnen blijven. Transport heeft echter niet alleen een direct effect op het welzijn van de dieren, de effecten van transport op onderzoeksresultaten kunnen ook leiden tot verkeerde conclusies.

This paper is a "statement" for the March special issue of JEAPM on "Impact Assessment Research: Achievements, Gaps and Future Directions".

Contains fulltext : 214502.pdf (publisher's version ) (Open Access)

Contains fulltext : 214503.pdf (publisher's version ) (Closed access)

Contains fulltext : 214502.pdf (publisher's version ) (Open Access)

Contains fulltext : 214503.pdf (publisher's version ) (Closed access)

Contains fulltext : 214503.pdf (publisher's version ) (Closed access)

Contains fulltext : 214502.pdf (publisher's version ) (Open Access)

Contains fulltext : 214504.pdf (publisher's version ) (Closed access)