The need of data harmonization to derive robust empirical relationships between soil conditions and vegetation.

Question: Is it possible to improve the general applicability and significance of empirical relationships between abiotic conditions and vegetation by harmonization of temporal data? Location: The Netherlands. Methods: Three datasets of vegetation, recorded after periods with different meteorological conditions, were used to analyze relationships between soil moisture regime (expressed by the mean spring groundwater level - MSLt calculated for different periods) and vegetation (expressed by the mean indicator value for moisture regime Fm). For each releve, measured groundwater levels were interpolated and extrapolated to daily values for the period 1970-2000 by means of an impulse-response model. Sigmoid regression lines between MSLt and Fm were determined for each of the three datasets and for the combined dataset. Results: A measurement period of three years resulted in significantly different relationships between Fm and MSLt for the three datasets (F-test,/? <0.05>. The three regression lines only coincided for the mean spring groundwater level computed over the period 1970-2000 (AfSLclimate) and thus provided a general applicable relationship. Precipitation surplus prior to vegetation recordings strongly affected the relationships. Conclusions: Harmonization of time series data (1) eliminates biased measurements, (2) results in generally applicable relationships between abiotic and vegetation characteristics and (3) increases the goodness of fit of these relationships. The presented harmonization procedure can be used to optimize many relationships between soil and vegetation characteristics. © IAVS; Opulus Press Uppsala

Baseline meniscal extrusion associated with incident knee osteoarthritis after 30 months in overweight and obese women

Objective: To investigate the association between baseline meniscal extrusion and the incidence of knee osteoarthritis (KOA) after 30 months in a high-risk population of overweight and obese women, free of clinical and radiological KOA at baseline. Methods: 407 middle-aged overweight women (body mass index - BMI ≥ 27 kg/m2) were evaluated at baseline and after 30 months of follow-up. Meniscal extrusion was defined as grade ≥2 on MRI according to MRI Osteoarthritis Knee Score (MOAKS). The primary outcome measure was KOA after 30 months follow-up, defined using the following criteria: either incidence of radiographic KOA (Kellgren & Lawrence grade 2 or higher), or clinical osteoarthritis (OA) according to the American College of Radiology (ACR) criteria, or medial or lateral joint space narrowing (JSN) of ≥1.0 mm. Using generalized estimating equations (GEE), we determined the association between knees with and without meniscal extrusion and both outcomes, corrected for the baseline differences. Results: 640 knees were available at baseline of which 24% (153) had meniscal extrusion. There was a significantly higher incidence of KOA according to the primary outcome measure in women with meniscal extrusion compared to those without extrusion (28.8%, odds ratio - OR 2.39, 95% CI 1.53, 3.73). A significantly higher incidence was found for the development of radiographic KOA (12.4%, OR 2.61, 95% CI 1.11, 6.13) and medial JSN (11.8%, OR 3.19, 95% CI 1.59, 6.41). Meniscal extrusion was not significantly associated with clinical KOA and lateral JSN. Conclusion: Meniscal extrusion was associated with a significantly higher incidence of KOA, providing an interesting target for early detection of individuals at risk for developing KOA

Mogelijkheden en beperkingen van een gebiedsgerichte uitwerking van de Nitraatrichtlijn

Wordt de landbouw onevenredig hard getroffen in die gebieden in Nederland waar aan de nitraatconcentratie in het grondwater wordt voldaan? Die vraag probeerden Alterra en de Universiteit Utrecht te beantwoorden in een studie naar de mogelijkheden die de Nitraatrichtlijn biedt om de aanwijzing van nitraatuitspoelingsgevoelige gebieden (kwetsbare zones) en bijbehorende nitraatactieprogramma's te differentiëren naar de landbouw- en milieukundige omstandigheden in de verschillende regio's. Het doel hierachter is een betere aansluiting te krijgen bij de gebiedsgerichte uitwerking van de Kaderrichtlijn Water. De resultaten zijn gebaseerd op literatuurstudie, brainstormsessies, interviews en een bijeenkomst met actoren uit het veld. Een verdere differentiatie is technisch mogelijk via aanwijzing van specifieke kwetsbare zones en het uitzonderen van andere gebieden. Verwacht wordt echter dat het uit te zonderen areaal beperkt zal zijn. Meer perspectief bied een verdergaande (gebiedsgerichte) differentiatie van gebruiksnormen die van toepassing zijn op de aangewezen kwetsbare zones. Nitraatactieprogramma's zijn verder te 'harmoniseren' met stroomgebiedsplannen van de Kaderrichtlijn Water, maar dienen wel als zodanig herkenbaar in stand te blijven

Beter werken met "Waternood"; een proeftoepassing in het herinrichtingsgebied "De Leijen"

Waternood is een methodiek voor het ontwerpen, inrichten en beheren van waterbeheerssystemen. Deze methode is toegepast in het herinrichtingsgebied De Leijen in Noord-Brabant. Belangrijke onderdelen van de methodiek zijn het vaststellen van het actuele en het optimale grondwaterregime, en het vaststellen van de bereikte doelrealisatie. In deze studie zijn daarvoor methoden ontwikkeld en in de praktijk getoetst, in het bijzonder voor de functies landbouw en natuur. De doelrealisatie is vastgesteld door het actuele en het optimale grondwaterregime met elkaar te vergelijken, door gewasopbrengsten te berekenen op basis van nat- en droogteschade (voor gras en maos), en door te berekenen in welke grondwaterregimes zich natuurlijke vegetaties ontwikkelen (voor een groot aantal natuurdoeltypen). De doelrealisatie voor landbouw was bevredigend (86Œ die voor natuur scoorde relatief laag (41Ž De lage score voor natuur verbeterde nauwelijks na vernattingsmaatregelen. Een van de conclusies is dat de natuurdoelen beter moeten worden afgestemd op de mogelijkheden die het regionale watersysteem biedt

Reducing progression of knee OA features assessed by MRI in overweight and obese women: Secondary outcomes of a preventive RCT

Objective: To evaluate the preventive effects of a randomized controlled trial on progression of Magnetic Resonance Imaging (MRI) features of knee osteoarthritis (OA) in overweight and obese women. Design: In a 2 × 2 factorial design, 2.5 years effects of a diet and exercise program and of glucosamine sulphate (double-blind, placebo-controlled) were evaluated in 407 middle-aged women with body mass index (BMI) ≥ 27 kg/m2 without clinical signs of knee OA at baseline (ISRCTN 42823086). MRIs were scored with the MRI Osteoarthritis Knee Score (MOAKS). Progression was defined for bone marrow lesions (BMLs), cartilage defects, osteophytes, meniscal abnormalities and meniscal extrusion. Analyses on knee level were performed over the four intervention groups using adjusted Generalized Estimating Equations (GEE). Results: 687 knees of 347 women with mean age 55.7 years (±3.2 SD) and mean BMI 32.3 kg/m2 (±4.2 SD) were analyzed. Baseline prevalence was 64% for BMLs, 70% for cartilage defects, 24% for osteophytes, 66% for meniscal abnormalities and 52% for meniscal extrusions. The diet and exercise program + placebo intervention showed significantly less progression of meniscal extrusion compared to placebo only (12% vs 22%, OR 0.50, 95% CI [0.27-0.92]). The interventions did not result in significant differences on other OA MRI features. Conclusions: In subjects at high risk for future knee OA development, a diet and exercise program, glucosamine sulphate and their combination showed small and mainly non-significant effects on the progression of OA MRI features. Only progression of meniscal extrusion was significantly diminished by the diet and exercise program

Governance Conditions for Improving Quality Drinking Water Resources: the Need for Enhancing Connectivity

Realising the water quality objectives of the European Water Framework Directive have appeared to stagnate over the last decade all across Europe because of their highly complex nature. In the literature, interactive governance approaches tend to be regarded as the best way of dealing with complex water issues, but so far little empirical evidence has been reported on this perspective in regard to water quality issues. In this paper we have analysed how conditions of governance contribute to the realisation of water quality objectives at different types of drinking water resources in the Netherlands. The analysis demonstrates the importance of addressing different hydrological scales, institutional levels and sectors and thus enhance connectivity in order to improve water quality. The two other important conditions of governance approaches for water quality improvement which were identified are the use of joint fact-finding to gain a shared perception of risks, and the use of explicit decision-making and close monitoring of outcomes (re. water quality improvement), both of which contribute to this enhanced connectivity

Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update.

BACKGROUND: The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. METHODS: A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. RESULTS: Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively. CONCLUSIONS: Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures

Thriving on strengths:Effects of a strengths intervention for younger and older teachers

The teaching profession is characterized by high demands and teachers who thrive are better able to navigate their demanding context than teachers who survive. Based on theories on strengths use we propose that strengths interventions which help teachers to identify, use, and develop their strengths can enhance their thriving (vitality and learning) which enables them to perform better. In addition, based on the socioemotional selective theory we propose that strengths interventions are especially beneficial for older teachers because it fits their goals and skills. We conducted a quasi-experimental study, in which 152 teachers and their team leaders participated in a strengths intervention. Longitudinal survey data indicated that the strengths intervention contributed to older teachers’ (≥ 46 years old) vitality, which in turn, contributed to their performance. No significant effects were found for younger teachers. We discuss the implications of our study for older teachers.</p

Evaluating strategic environmental assessment in the Netherlands: Content, process and procedure as indissoluble criteria for effectiveness

To assess the effectiveness of strategic environmental assessment (SEA) we distinguish between its contribution to the quality of the ultimate policy choice (usefulness, applicability), the procedural quality of the planning process (transparency, timeliness) and the quality of stakeholder participation in the planning process (openness, equity, dialogue). In the context of two case studies involving Dutch planning practice, we argue that when and how an SEA is applied is crucial to understanding its e

Self-Assessment of Competence and Referral Behavior for Musculoskeletal Injections among Dutch General Practitioners.

General practitioners (GPs) are qualified and trained to administer therapeutic musculoskeletal injections when indicated. However, it is unknown to what extend Dutch GPs feel competent to administer these injections in clinical practice. Reluctance among GPs to inject might lead to unnecessary and costly referral to secondary care. An online and offline questionnaire was spread among Dutch GPs, querying demographics, GPs' self-assessment of injection competence, the number of administered/referred injections and management strategy for musculoskeletal injections. A total of 355 GPs responded. In total, 81% of the GPs considered themselves competent in administering musculoskeletal injections. Self-assessed incompetent GPs performed less injections the last month than self-assessed competent GPs (1.2 ± 1.4 vs 4.8 ± 4.6 injections, P < 0.001). Additionally, they referred four times more often to a colleague GP (0.4 ± 1.0 vs 0.1 ± 0.6 injections per month, P < 0.001) and twice as often to secondary care (1.0 ± 1.3 vs 0.5 ± 0.9 injections per month, P = 0.001). Self-assessed incompetence was associated with female sex (OR [95% CI] = 4.94 [2.39, 10.21]) and part-time work (OR [95% CI] = 2.58 [1.43, 4.66]). The most frequently addressed barriers were a lack of confidence in injection skills, lack of practical training, and uncertainty about the effectiveness and diagnosis of musculoskeletal injections. Although most GPs considered themselves competent to administer musculoskeletal injections, the referral rate to secondary care for several injections was strikingly high. To decrease secondary care referrals, addressing some of the most frequently indicated barriers is highly recommended