A DELPHI STUDY TO DETERMINE OSTEOARTHRITIS MANAGEMENT LEARNING NEEDS OF PRIMARY CARE PHYSICIANS IN THE SOUTH WEST LHIN

ABSTRACT Objective(s)-. To determine the learning needs of primary care physicians (PCPs) in the South West Local Health Integration Network planning area regarding hip and knee osteoarthritis (OA) management. Methods-. A Delphi process was administered to a group of experts (n=40) in OA management to achieve consensus on the perceived knowledge level of specific OA management topics possessed by PCPs and the relevance of these topics to PCPs ability to manage an OA population. Results: Three rounds were needed to reach consensus. There was a statistically significant difference between the perceived knowledge and relevance ratings for the following topics: appropriate x-ray views for hip and knee OA, knee OA prevention strategies, assessing knee deformity, pain assessment, pain management, non-surgical treatment options, criteria for appropriate referral and knee arthroscopy (p\u3c 0.05). Conclusions: According to expert opinion, there is a difference between PCPs’ knowledge of various topics in OA management and the relevance of these topics to their ability to manage an OA population

Expression kinetics and innate immune response after electroporation and LNP-mediated delivery of a self-amplifying mRNA in the skin

In this work, we studied the expression kinetics and innate immune response of a self-amplifying mRNA (sa-RNA) after electroporation and lipid-nanoparticle (LNP)-mediated delivery in the skin of mice. Intradermal electroporation of the sa-RNA resulted in a plateau-shaped expression, with the plateau between day 3 and day 10. The overall protein expression of sa-RNA was significantly higher than that obtained after electroporation of plasmid DNA (pDNA) or non-replication mRNAs. Moreover, using IFN-beta reporter mice, we elucidated that intradermal electroporation of sa-RNA induced a short-lived moderate innate immune response, which did not affect the expression of the sa-RNA. A completely different expression profile and innate immune response were observed when LNPs were used. The expression peaked 24 h after intradermal injection of sa-RNA-LNPs and subsequently showed a sharp drop. This drop might be explained by a translational blockage caused by the strong innate immune response that we observed in IFN-beta reporter mice shortly (4 h) after intradermal injection of sa-RNA-LNPs. A final interesting observation was the capacity of sa-RNA-LNPs to transfect the draining lymph nodes after intradermal injection

MHD stability of fully non inductive discharges in Tore Supra

12th International Congress on Plasma Physics, 25-29 October 2004, Nice (France)During the 2003 experimental campaign, the aim of realizing reliable fully non inductive discharges has been successfully completed in Tore Supra. One the major difficulties in optimizing this scenario comes from MHD stability issues. Indeed, the current profile obtained with LH antennas in these experiments is prone to the triggering of single or double tearing modes. Under certain conditions, the discharges enters in a regime of permanent MHD activity. The present work investigates the MHD properties of these fully non-inductive discharges in the operational space defined by the toroidal magnetic field B, the total plasma current Ip, and the mean parallel index of LH waves . Linear MHD stability properties divide the operational space in regions separated by rational values of the minimum of the safety factor. We discuss in our work the localisation of the transition between benign MHD activity and the MHD regime

An in vitro comparison between two methods of electrical resistance measurement for occlusal caries detection

Because of different measurement techniques and the easier design of the CRM prototype, this in vitro study aimed to compare the diagnostic performance and reproducibility of two electrical methods (Electronic Caries Monitor III, ECM and Cariometer 800, CRM) for occlusal caries detection, and to evaluate the effect of staining/ discoloration of fissures on diagnostic performance. Hundred and seventeen third molars with no apparent occlusal cavitation were selected. Six examiners inspected all specimens independently, using the CRM, and a subgroup of 4 using the ECM. Histological validation using a stereomicroscope was performed after hemisectioning. Intra- and interexaminer reproducibility was assessed by Lin's concordance correlation coefficient (CCC) and Bland and Altman analysis. Diagnostic performance parameters included sensitivity (SE), specificity (SP) and area under the ROC curve (A(z)). The CCC yielded an intra- and interexaminer reproducibility of 0.69/0.62 (ECM) and of 0.79/0.74 (CRM). The mean intra- and interexaminer 95% range of measurements (range between Bland and Altman limits of agreement) given in percentages of the instrument reading were 67%/65% for the ECM and 28%/33% for the CRM. A(z) at the D3-4 level was 0.74 (ECM) and 0.78 (CRM). The CRM showed at least equivalent diagnostic performance to the ECM. However, improvement is still desirable. Diagnostic performance appeared to be enhanced in discolored lesions; however, this may be related to sample lesion distribution characteristics. Copyright (C) 2006 S. Karger AG, Basel

The healing pattern of osteoid osteomas on computed tomography and magnetic resonance imaging after thermocoagulation

Objective To compare the healing pattern of osteoid osteomas on computed tomography (CT) and magnetic resonance imaging (MRI) after successful and unsuccessful thermocoagulation. Materials and methods Eighty-six patients were examined by CT and 18 patients by dynamic gadolinium-enhanced MRI before and after thermocoagulation for osteoid osteoma. Thermocoagulation was successful in 73% (63/86) and unsuccessful in 27% (23/86) of patients followed by CT. Thermocoagulation was successful in 72% (13/18) of patients followed by MRI. After treatment, the healing of the nidus on CT was evaluated using different healing patterns (complete ossification, minimal nidus rest, decreased size, unchanged size or thermonecrosis). On MRI the presence of reactive changes (joint effusion, "oedema-like" changes of bone marrow and soft tissue oedema) and the delay time (between arterial and nidus enhancement) were assessed and compared before and after thermocoagulation. Results Complete ossification or a minimal nidus rest was observed on CT in 58% (16/28) of treatment successes (with > 12 months follow-up), but not in treatment failures. "Oedema-like" changes of bone marrow and/or soft tissue oedema were seen on MR in all patients before thermocoagulation and in all treatment failures. However, residual "oedema-like" changes of bone marrow were also found in 69% (9/13) of treatment successes. An increased delay time was observed in 62% (8/13) of treatment successes and in 1/5 of treatment failures. Conclusion Complete, or almost complete, ossification of the treated nidus on CT correlated with successful treatment. Absence of this ossification pattern, however, did not correlate with treatment failure. CT could not be used to identify the activity of the nidus following treatment. The value of MR parameters to assess residual activity of the nidus was limited in this study

Software-recorded and self-reported duration of computer use in relation to the onset of severe arm–wrist–hand pain and neck–shoulder pain

Objectives: In both science and media, the adverse effects of a long duration of computer use at work on musculoskeletal health have long been debated. Until recently, the duration of computer use was mainly measured by self-reports, and studies using more objective measures, such as software-recorded computer duration, were lacking. The objective of this study was to examine the association between duration of computer use at work, measured with software and self-reports, and the onset of severe arm-wrist-hand and neck-shoulder symptoms. Methods: A 2-year follow-up study was conducted between 2004 and 2006 among 1951 office workers in The Netherlands. Self-reported computer duration and other risk factors were collected at baseline and at 1-year follow-up. Computer use at work was recorded continuously with computer software for 1009 participants. Outcome questionnaires were obtained at baseline and every 3 months during follow-up. Cases were identified based on the transition within 3 months of no or minor symptoms to severe symptoms. Results: Self-reported duration of computer use was positively associated with the onset of both arm-wrist-hand (RR 1.9, 95% CI 1.1 to 3.1 for more than 4 h/day of total computer use at work) and neck-shoulder symptoms (RR 1.5, 95% CI 1.1 to 2.0 for more than 4 h/day of mouse use at work). The recorded duration of computer use did not show any statistically significant association with the outcomes. Conclusions: In the present study, no association was found between the software-recorded duration of computer use at work and the onset of severe arm-wrist-hand and neck-shoulder symptoms using an exposure window of 3 months. In contrast, a positive association was found between the self-reported duration of computer use at work and the onset of severe arm-wrist-hand and neck-shoulder symptoms. The different findings for recorded and self-reported computer duration could not be explained satisfactorily

Nonlinear interaction of fast particles with Alfven waves in toroidal plasmas

A numerical algorithm to study the nonlinear, resonant interaction of fast particles with Alfven waves in tokamak geometry has been developed. The scope of the formalism is wide enough to describe the nonlinear evolution of fishbone modes, toroidicity-induced Alfven eigenmodes and ellipticity-induced Alfven eigenmodes, driven by both passing and trapped fast ions. When the instability is sufficiently weak, it is known that the wave-particle trapping nonlinearity will lead to mode saturation before wave-wave nonlinearities are appreciable. The spectrum of linear modes can thus be calculated using a magnetohydrodynamic normal-mode code, then nonlinearly evolved in time in an efficient way according to a two-time-scale Lagrangian dynamical wave model. The fast particle kinetic equation, including the effect of orbit nonlinearity arising from the mode perturbation, is simultaneously solved of the deviation, {delta}f = f {minus} f{sub 0}, from an initial analytic distribution f{sub 0}. High statistical resolution allows linear growth rates, frequency shifts, resonance broadening effects, and nonlinear saturation to be calculated quickly and precisely. The results have been applied to an ITER instability scenario. Results show that weakly-damped core-localized modes alone cause negligible alpha transport in ITER-like plasmas--even with growth rates one order of magnitude higher than expected values. However, the possibility of significant transport in reactor-type plasmas due to weakly unstable global modes remains an open question