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Background: Long‐term use of antiseizure drugs is associated with a low bone mineral density (BMD) and an increased fracture risk. The literature regarding institutionalised children on chronic antiseizure drugs is limited. Therefore, the aim of this cross‐sectional study is to evaluate the prevalence of low BMD and the history of fractures in institutionalised children with epilepsy and intellectual disability (ID). Methods: A dual‐energy X‐ray absorptiometry of lumbar spine (L1–L4) and hip was performed in 24 children, residing in a long‐stay care facility in the Netherlands. Additionally, serum concentrations of albumin, calcium and 25‐hydroxyvitamin D were determined. Data on fractures were retrospectively extracted from the medical files. Results: Ages of the children (14 male and 10 female) ranged from 5 to 17 years with a mean age of 13.0 (±3.2). The criteria of the International Society for Clinical Densitometry (ISCD) were used for classification of bone mineral disorders. Eight (33.3%) children had a normal BMD (Z‐score > − 2.0). Of the 16 children with a low BMD (Z‐score ≤ − 2.0), three were diagnosed as osteoporotic, based on their fracture history. Ten children (41.7%) were reported to have at least one fracture in their medical history. Serum concentrations of albumin‐corrected calcium (2.28–2.50 mmol/L) and (supplemented) vitamin D (16–137 nmol/L) were within the normal range. Conclusions: This study demonstrated that 67% of institutionalised children with epilepsy and ID had low BMD and 42% had a history of at least one fracture, despite supplementation of calcium and vitamin D in accordance with the Dutch guidelines. [ABSTRACT FROM AUTHOR]

The article offers information regarding role played by randomized controlled trials (RCTs) in advancing medical science and evidence-based medicine (EBM) and mentions information on factors to be considered in RCTs including patient selection, immortal time bias, and healthy complier bias.

This article addresses the role of the tuning of the parameters of the subgrid parametrizations of diffusive processes in numerical models. To this end, it examines the stability and accuracy of a set of fractional time-split integration schemes for the nonlinear diffusion equation. The best values of the time-decentring parameters are established. The dependency of the diffusion on the exchange coefficient is tuned to get the most accurate simulation of the steady-state solution and this is then tested in a non-steady-state model integration. The following questions are then addressed: (i) what is the relative role of parameter 'tuning' compared to the choice of the numerical scheme? and (ii) what is the effect of using a parametrization in one model that has been tuned in another model? The presented tests suggest that the best results are obtained by controlling the details of the numerics while taking the physical value of the exchange coefficient, instead of tuning the physics parametrization. This suggests that it is beneficial to consider 'tuning' the physics parametrization schemes via the freedom in the numerics as an alternative to tuning the parameters of the physical processes. Copyright © 2012 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

This study examines flood risk perceptions of individuals in the Netherlands using a survey of approximately 1000 homeowners. Perceptions of a range of aspects of flood risk are elicited. Various statistical models are used to estimate the influence of socioeconomic and geographical characteristics, personal experience with flooding, knowledge of flood threats, and individual risk attitudes on shaping risk belief. The study shows that in general, perceptions of flood risk are low. An analysis of the factors determining risk perceptions provides four main insights relevant for policy makers and insurers. First, differences in expected risk are consistently related to actual risk levels, since individuals in the vicinity of a main river and low-lying areas generally have elevated risk perceptions. Second, individuals in areas unprotected by dikes tend to underestimate their risk of flooding. Third, individuals with little knowledge of the causes of flood events have lower perceptions of flood risk. Fourth, there is some evidence that older and more highly educated individuals have a lower flood risk perception. The findings indicate that increasing knowledge of citizens about the causes of flooding may increase flood risk awareness. It is especially important to target individuals who live in areas unprotected by dike infrastructure, since they tend to be unaware of or ignore the high risk exposure faced. [ABSTRACT FROM AUTHOR]

Climate change is projected to cause severe economic losses, which has the potential to affect the insurance sector and public compensation schemes considerably. This article discusses the role insurance can play in adapting to climate change impacts. The particular focus is on the Dutch insurance sector, in view of the Netherlands being extremely vulnerable to climate change impacts. The usefulness of private insurance as an adaptation instrument to increased flood risks is examined, which is currently unavailable in the Netherlands. It is questioned whether the currently dominant role of the Dutch government in providing damage relief is justified from an economic efficiency perspective. Characteristics of flood insurance arrangements in the Netherlands, the United Kingdom, Germany, and France are compared in order to identify possible future directions for arrangements in the Netherlands. It is argued that social welfare improves when insurance companies take responsibility for part of the risks associated with climate change. [ABSTRACT FROM AUTHOR]

The article presents an experiment which examines the competition phenomena between two grass species, the Lolium perenne and Anthoxanthum odoratum. In a pot experiment, both grass species were placed in a low and high fertility soils with phosphate and potash compounds. Findings reveal that the nutrients competition of the species resulted to low nourishment and disease of one of the plants. In the experiment, the number of tillers in the turf of each plant has been the indicator of health status of the grass.

Aim: To study the association between femoral neck (FN) bone mineral density (BMD) T-score and fracture risk in individuals with and without type 2 diabetes (T2D)., Materials and Methods: We performed a single-centre retrospective cohort study using the Danish National Health Service. BMD of the FN was measured by dual-energy X-ray absorptiometry. Cox proportional hazards regression models were used to study the association between FN BMD T-score and fractures in individuals with and without T2D separately, adjusted for age, comorbidities and comedication. The results from this analysis were used to estimate the 10-year absolute fracture risk., Results: In total, there were 35,129 women (2362 with T2D) and 7069 men (758 with T2D). The FN BMD T-score was significantly associated with risk of any, hip and major osteoporotic fracture in men and women with [adjusted hazard risk ratios (aHR) women, hip: 1.57; 95% confidence interval (CI) 1.24-2.00, incidence rate (IR) 8.7; aHR men, hip: 1.55; 95% CI 1.01-2.36, IR 4.6] and without T2D (aHR women, hip: 1.75; 95% CI 1.64-1.87, IR 7.0; aHR men, hip: 1.97, 95% CI 1.73-2.25, IR 6.3), and its ability to predict fracture risk was similar. Fracture IRs were not significantly different for individuals with or without T2D, nor was the estimated cumulative 10-year fracture risk., Conclusions: The FN BMD T-score was significantly associated with hip, non-spine and major osteoporotic fracture risk in men and women with and without T2D. Fracture risk for a given T-score and age was equal in individuals with and without T2D, as was the ability of the FN BMD T-score to predict fracture risk., (© 2024 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Background/aims: This pilot study was designed to determine the clinical bone formation ability of a human recombinant DNA bone morphogenetic protein-7, also referred to as Osteogenic Protein-1 [OP-1] combined with a collagen carrier, implanted in the maxillary sinus of 3 patients. The results were compared with a group of 3 patients treated with sinus floor elevation and autogenous bone grafts., Methods: 6 consecutive patients, 4 female and 2 male, between 48 and 57 years of age were treated by means of sinus floor elevation for insufficient bone height in the posterior maxilla for implant surgery. 3 patients, 2 female and 1 male, were treated with OP-1 attached to a collagen device. In these patients, 4 maxillary sinus grafting procedures according to Tatum's method were carried out. 1 g of collagen carrier containing 2.5 mg rhOP-1 mixed with 3 ml of saline was placed between the bony floor and the elevated mucosal lining of the most caudal part of the maxillary sinus, in order to increase the vertical bone dimension to place dental implants of a sufficient length. The 3 other patients, also 2 female and 1 male, with a total of 5 sinus sites, were treated with sinus floor elevation and autogenous iliac crest bone grafts. After 6 months, during dental implant preparation, bone cores were taken for histology. Thus, clinical, radiological and histological results of the 2 groups of 3 patients were compared., Results: 6 months after sinus grafting with OP-1, in 1 male, well-vascularized bone-like tissue of good quality was observed clinically. This could be confirmed by histology. In the second, female, patient no bone formation was observed at all. A cyst-like granular tissue mass, without purulent content, was removed. In the 3rd, female, patient, who received bilateral sinus grafts, some bone-like formation was seen, however it showed flexible tissue which led to the decision that at 6 months after the sinus grafting, the implant placement had to be postponed. In all 5 autogenous grafted sinuses a bone appearance similar to normal maxillary bone was observed clinically as well as histologically and dental implants could be placed six months after sinus floor elevation surgery., Conclusions: These findings indicate that the OP-1 device has the potential for initiating bone formation in the human maxillary sinus within 6 months after a sinus floor elevation operation. However, the various findings in these 3 patients indicate that the behaviour of the material is at this moment insufficiently predictable, in this indication area. Further investigation is indicated before OP-1 can be successfully used instead of the "gold standard" autogenous bone graft.

Objective: The purpose of this case study was to analyze the tissue formed in a maxillary sinus, 6 and 12 months after grafting with recombinant human osteogenic protein-1 (OP-1) linked to a collagen carrier of bovine origin., Patient and Methods: A 49-year-old woman referred for bilateral sinus floor elevation, was grafted with an OP-1 device. After 6 months, a biopsy was taken from one of the grafted areas. After 12 months, during implant placement, 5 biopsies were taken from the grafted area and the maxillary host bone. Biopsies were processed without decalcification for histological analyses., Results: The biopsy taken after 6 months contained newly formed bone, fibrotic tissue and device remnants. After 12 months, however, bone was absent from all biopsies which were taken from the grafted area, while particles of the collagen carrier were still abundant. Inflammatory cells were observed between remnants of the collagen carrier in the grafted area., Conclusion: This study indicates that an onset of new bone formation, which was observed after 6 months, did not persist. 12 months after grafting no bone was present in the biopsies from the grafted area, while the collagen carrier had remained. Lack of mechanical loading, as a result of postponing implant placement from 6 to 12 months, may have resulted in resorption of the emerging bone which was present 6 months after grafting.