Hip Osteoarthritis in General Practice: Course and Therapies

Osteoarthritis of the hip is a common problem in todayâ?Ts aging society. The disease is characterised by joint pain and functional limitations. The treatment of osteoarthritis has been focused on relief of symptoms, since there are as yet no therapies available that can alter progression of the disease. In the last decade the search for a disease modifying treatment has been intensified. One of the most promising agents is glucosamine sulphate. Results on pain were conflicting, when tested in patients with knee osteoarthritis. Our randomised controlled trial (GOAL) was the first trial to assess the effect of glucosamine on symptoms and structural progression of primary care patients with hip osteoarthritis. We found that there was no difference in effect between glucosamine and placebo on pain (-1.54 [-5.43, 2.36]), function (-2.01[-5.38, 1.36]), or joint space narrowing (-0.029 [-0.122, 0.064]). Also, no significant differences were found in any of the predefined subgroups based on radiographic severity or type of osteoarthritis. We also looked at the course of complaints of patients with hip osteoarthritis over two years. We assessed pain and function every three months and found that while complaints on average stayed relatively stable over 2 years, the intraindividual pain level was highly fluctuating. Seventy percent of all patients with hip osteoarthritis had consulted one or more care givers for their complaints. The costs for medical consumption is estimated to be â,¬639 per patient per year, which is comparable to costs for knee osteoarthritis. The majority of these costs were attributable to total hip replacement by an orthopedist

Design of a Secure and Decentralized Location Service for Agent Platforms

Abstract. Agent platforms designed for Internet-scale, open networks need scalable and secure location services for agents and services. The location service based on the Fonkey public key distribution infrastructure presented in this paper has been designed and implemented for this purpose. It is scalable in the total number of published identifier–contact address pairs, the number of updates/changes, and the number of agent platforms publishing and requesting contact addresses. This system also supports a signing mechanism to authenticate the publisher of an identifier–contact address pair. Experimental results show that the current implementation based on the Bunshin/Free Pastry overlay network exhibits good scaling behavior.

Densidade, tamanho e distribuição estomática em 35 espécies de árvores na Amazônia Central

Stomata are turgor-operated valves that control water loss and CO2 uptake during photosynthesis, and thereby water relation and plant biomass accumulation is closely related to stomatal functioning. The aims of this work were to document how stomata are distributed on the leaf surface and to determine if there is any significant variation in stomatal characteristics among Amazonian tree species, and finally to study the relationship between stomatal density (S D) and tree height. Thirty five trees (>17 m tall) of different species were selected. Stomatal type, density (S D), size (S S) and stomatal distribution on the leaf surface were determined using nail polish imprints taken from both leaf surfaces. Irrespective of tree species, stomata were located only on the abaxial surface (hypostomaty), with large variation in both S D and S S among species. S D ranged from 110 mm-2 in Neea altissima to 846 mm-2 in Qualea acuminata. However, in most species S D ranges between 271 and 543 mm-2, with a negative relationship between S D and S S. We also found a positive relationship between S D and tree height (r² = 0.14, p 17 m de altura) de diferentes espécies foram selecionadas. Tipo de complexo estomático, S D, tamanho (S S) e distribuição na superfície foliar foram determinados utilizando impressões de ambas as superfícies foliares com esmalte incolor. Independente da espécie, os estômatos foram encontrados apenas na superfície abaxial (hipoestomatia) com ampla variação na S D e no S S entre espécies. A densidade estomática variou de 110 mm-2 em Neea altissima a 846 mm-2 em Qualea acuminata. Entretanto, a maioria das espécies apresentou S D entre 271 e 543 mm-2, com uma relação negativa entre S D e S S. Observou-se uma relação positiva entre S D e altura arbórea (r² = 0.14, p < 0.01), não havendo relação entre S D e espessura foliar. Os tipos estomáticos mais comuns foram: anomocíticos (37%), seguidos de paracíticos (26%) e anisocíticos (11%). Concluiu-se que em espécies da Amazônia, a distribuição de estômatos na superfície foliar está mais relacionada a fatores genéticos de cada espécie do que a variações ambientais. Entretanto, S D é fortemente influenciada por fatores ambientais concernentes à altura da árvore

Comparison of outcome and characteristics between 6343 COVID-19 patients and 2256 other community-acquired viral pneumonia patients admitted to Dutch ICUs

Purpose: Describe the differences in characteristics and outcomes between COVID-19 and other viral pneumonia patients admitted to Dutch ICUs. Materials and methods: Data from the National-Intensive-Care-Evaluation-registry of COVID-19 patients admitted between February 15th and January 1th 2021 and other viral pneumonia patients admitted between January 1st 2017 and January 1st 2020 were used. Patients' characteristics, the unadjusted, and adjusted in-hospital mortality were compared. Results: 6343 COVID-19 and 2256 other viral pneumonia patients from 79 ICUs were included. The COVID-19 patients included more male (71.3 vs 49.8%), had a higher Body-Mass-Index (28.1 vs 25.5), less comorbidities (42.2 vs 72.7%), and a prolonged hospital length of stay (19 vs 9 days). The COVID-19 patients had a significantly higher crude in-hospital mortality rate (Odds ratio (OR) = 1.80), after adjustment for patient characteristics and ICU occupancy rate the OR was respectively 3.62 and 3.58. Conclusion: Higher mortality among COVID-19 patients could not be explained by patient characteristics and higher ICU occupancy rates, indicating that COVID-19 is more severe compared to other viral pneumonia. Our findings confirm earlier warnings of a high need of ICU capacity and high mortality rates among relatively healthy COVID-19 patients as this may lead to a higher mental workload for the staff. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)

Drie-dimensionale modellering van het transport van zwevend stof in de Nederlandse kustwateren

In dit rapport wordt een drie-dimensionaal numeriek-wiskundig model ter berekening van het transport van zwevende en opgeloste stoffen in de Nederlandse kustwateren beschreven. Het belang van de modellering van zwevend stof en slib in drie dimensies wordt uiteengezet. Het model is een belangrijke schakel in een meer omvattende waterkwaliteitsmodellering, te gebruiken voor beleidsontwikkeling, beleidsevaluatie, ontwerp van een monitoringsstrategie, effectstudies, etc. Een koppeling met het MANS instrumentarium is operationeel. Tevens wordt het model gebruikt in het onderzoek naar de aanslibbing van scheepvaartgeulen. Fysische effecten m.b.t. transport van zwevend stof en slib worden aan de hand van modelresultaten beschreven. Mesoschaal effecten in de omgeving van de Vlaamse Banken, de Zuidhollandse kust en het Marsdiep worden berekend. Als voorbeeld van prognostisch modelgebruik wordt het effect van een zeewaartse uitbreiding van de Maasvlakte berekend. Als belangrijkste resultaat hiervan komt naar voren een versterking van het slibtransport richting Maasmond vanaf de huidige stortlokatie Loswal Noord, en een versterking van het kustwaartse transport voor de kust van Zuid-Holland