Order: panning North to South through the Western Netherlands:
Vecht (Utrecht) (minor channel in Roman times, flowing into former Zuider Zee lagoon)
Kromme Rijn Oude Rijn (Utrecht and South Holland) (main channel in Roman times, dammed in the 12th century)
Hollandse IJssel (formed after Roman times, dammed in the 13th century AD)
Linge (big channel in Roman times, dammed in the 14th century AD)
De Biesbosch-area (initiated by AD 14211424 storm surges and river floods, by-passed since the digging of Nieuwe Merwede canal in AD 1904)
This model organizes data into one or more tables (or "relations") of columns and rows, with a unique key identifying each row. Rows are also called records or tuples. Columns are also called attributes. Generally, each table/relation represents one "entity type" (such as customer or product). The rows represent instances of that type of entity (such as "Lee" or "chair") and the columns representing values attributed to that instance (such as address or price).
A foreign key is a field in a relational table that matches the primary key column of another table. The foreign key can be used to cross-reference tables. Foreign keys do not need to have unique values in the referencing relation. Foreign keys effectively use the values of attributes in the referenced relation to restrict the domain of one or more attributes in the referencing relation. A foreign key could be described formally as: "For all tuples in the referencing relation projected over the referencing attributes, there must exist a tuple in the referenced relation projected over those same attributes such that the values in each of the referencing attributes match the corresponding values in the referenced attributes."
Arthritis of joints involves inflammation of the synovial membrane. Joints become swollen, tender and warm, and stiffness limits their movement. With time, multiple joints are affected (polyarthritis). Most commonly involved are the small joints of the hands, feet and cervical spine, but larger joints like the shoulder and knee can also be involved. Synovitis can lead to tethering of tissue with loss of movement and erosion of the joint surface causing deformity and loss of function.
RA typically manifests with signs of inflammation, with the affected joints being swollen, warm, painful and stiff, particularly early in the morning on waking or following prolonged inactivity. Increased stiffness early in the morning is often a prominent feature of the disease and typically lasts for more than an hour. Gentle movements may relieve symptoms in early stages of the disease. These signs help distinguish rheumatoid from non-inflammatory problems of the joints, such as osteoarthritis. In arthritis of non-inflammatory causes, signs of inflammation and early morning stiffness are less prominent with stiffness typically less than one hour, and movements induce pain caused by mechanical arthritis. The pain associated with RA is induced at the site of inflammation and classified as nociceptive as opposed to neuropathic. The joints are often affected in a fairly symmetrical fashion, although this is not specific, and the initial presentation may be asymmetrical.
As the pathology progresses the inflammatory activity leads to tendon tethering and erosion and destruction of the joint surface, which impairs range of movement and leads to deformity. The fingers may suffer from almost any deformity depending on which joints are most involved. Specific deformities, which also occur in osteoarthritis, include ulnar deviation, boutonniere deformity (also "buttonhole deformity", flexion of proximal interphalangeal joint and extension of distal interphalangeal joint of the hand), swan neck deformity (hyperextension at proximal interphalangeal joint and flexion at distal interphalangeal joint) and "Z-thumb." "Z-thumb" or "Z-deformity" consists of hyperextension of the interphalangeal joint, fixed flexion and subluxation of the metacarpophalangeal joint and gives a "Z" appearance to the thumb. The hammer toe deformity may be seen. In the worst case, joints are known as arthritis mutilans due to the mutilating nature of the deformities.