Demographic and clinical characteristics of primary and secondary care patients with osteoarthritis of hip and knee are quite similar

Purpose: As is stated in many guidelines for patients with osteoarthritis, it is advised to treat patients conservatively before patients are referred to secondary care. Therefore, it can be expected that secondary care patietns with osteoarthritis differ from primary care patients. The purpose of the current study is to compare demographic and clinical characteristics of patients with osteoarthritis who are referred to primary care physiotherapists and patients who are referred to secondary care. Methods: In a cross-sectional study secondary analyses were performed on two cohorts of patients with knee or hip osteoarthritis: one primary care dataset (n=200) and one secondary care dataset (n=279). In both studies comparable measurements were performed at baseline in the same time period. Measurements included, among others, gender, age, location and duration of osteoarthritis, number of comorbidities, pain (VAS), physical function (WOMAC), muscle strength, range of motion, social support and quality of life. Results: Both groups were similar in most characteristics, with some exceptions. The primary care group consisted of less patients with both hip and knee osteoarthritis and of younger patients compared to the secondary care group. Furthermore, secondary care patients reported more pain (4.0 versus 4.8), less muscle strength and more falls in the last six months. Conclusions: There are differences between primary and secondary care populations of patients with osteoarthritis, but these differences are minimal. Looking at the results of this research, the question arises whether the health care of patients with osteoarthritis can be organised more efficient and less expensive. However, long-term prospective studies are needed to evaluate the cost effectiveness of both primary and secondary care of patients with osteoarthritis. (aut. ref.

Performance of a large limited streamer tube cell in drift mode

The performance of a large (3x3 $cm^2$) streamer tube cell in drift mode is shown. The detector space resolution has been studied using cosmic muons crossing an high precision silicon telescope. The experimental results are compared with a GARFIELD simulation.Comment: 18 pages, 7 figures. Accepted by Nucl. Instr. and Methods

A dynamic method for charging-up calculations: the case of GEM

The simulation of Micro Pattern Gaseous Detectors (MPGDs) signal response is an important and powerful tool for the design and optimization of such detectors. However, several attempts to simulate exactly the effective charge gain have not been completely successful. Namely, the gain stability over time has not been fully understood. Charging-up of the insulator surfaces have been pointed as one of the responsible for the difference between experimental and Monte Carlo results. This work describes two iterative methods to simulate the charging-up in one MPGD device, the Gas Electron Multiplier (GEM). The first method uses a constant step for avalanches time evolution, very detailed, but slower to compute. The second method uses a dynamic step that improves the computing time. Good agreement between both methods was reached. Despite of comparison with experimental results shows that charging-up plays an important role in detectors operation, should not be the only responsible for the difference between simulated and measured effective gain, but explains the time evolution in the effective gain.Comment: Minor changes in grammatical statements and inclusion of some important information about experimental setup at section "Comparison with experimental results

Patients with shoulder syndromes in general and physiotherapy practice:An observational study

BACKGROUND: Shoulder complaints are commonly seen in general practice and physiotherapy practice. The only complaints for which general practitioners (GPs) refer more patients to the physiotherapist are back and neck pain. However, a substantial group have persistent symptoms. The first goal of this study is to document current health care use and the treatment process for patients with shoulder syndromes in both general practice and physiotherapy practice. The second goal is to detect whether there are differences between patients with shoulder syndromes who are treated by their GP, those who are treated by both GP and physiotherapist and those who access physiotherapy directly. METHODS: Observational study using data from the Netherlands Information Network of General Practice and the National Information Service for Allied Health Care. These registration networks collect healthcare-related information on patient contacts including diagnoses, prescriptions, referrals, treatment and evaluation on an ongoing basis. RESULTS: Many patients develop symptoms gradually and 35% of patients with shoulder syndromes waited more than three months before visiting a physiotherapist. In 64% of all patients, treatment goals are fully reached at the end of physiotherapy treatment. In general practice, around one third of the patients return after the referral for physiotherapy. Patients with shoulder syndromes who are referred for physiotherapy have more consultations with their GP and are prescribed less medication than patients without a referral. Often, this referral is made at the first consultation. In physiotherapy practice, referred patients differ from self-referrals. Self-referrals are younger, they more often have recurrent complaints and their complaints are more often related to sports and leisure activities. CONCLUSIONS: There is a fairly large group of patients with persistent symptoms. Early referral by a GP is not advised under current guidelines. However, in many patients, symptoms develop gradually and a wait-and-see policy means more valuable time may pass before physiotherapy intervention takes place. Meanwhile a long duration of complaints is a predictor for poor outcome. Therefore, future research into early referral is required. As physiotherapists, we should develop a way of educating patients to avoid lengthy waiting periods before seeking help. To prevent high costs, physiotherapists could consider a classification of pain and limitations and wait-and-see policy as used by GPs. With early detection, a once-off consultation might be sufficient

Simulation of gain stability of THGEM gas-avalanche particle detectors

Charging-up processes affecting gain stability in Thick Gas Electron Multipliers (THGEM) were studied with a dedicated simulation toolkit. Integrated with Garfield++, it provides an effective platform for systematic phenomenological studies of charging-up processes in MPGD detectors. We describe the simulation tool and the fine-tuning of the step-size required for the algorithm convergence, in relation to physical parameters. Simulation results of gain stability over time in THGEM detectors are presented, exploring the role of electrode-thickness and applied voltage on its evolution. The results show that the total amount of irradiated charge through electrode's hole needed for reaching gain stabilization is in the range of tens to hundreds of pC, depending on the detector geometry and operational voltage. These results are in agreement with experimental observations presented previously

Simulation of VUV electroluminescence in micropattern gaseous detectors: the case of GEM and MHSP

Electroluminescence produced during avalanche development in gaseous avalanche detectors is an useful information for triggering, calorimetry and tracking in gaseous detectors. Noble gases present high electroluminescence yields, emitting mainly in the VUV region. The photons can provide signal readout if appropriate photosensors are used. Micropattern gaseous detectors are good candidates for signal amplification in high background and/or low rate experiments due to their high electroluminescence yields and radiopurity. In this work, the VUV light responses of the Gas Electron Multiplier and of the Micro-Hole Strip Plate, working with pure xenon, are simulated and studied in detail using a new and versatile C++ toolkit. It is shown that the solid angle subtended by a photosensor placed below the microstructures depends on the operating conditions. The obtained absolute EL yields, determined for different gas pressures and as functions of the applied voltage, are compared with those determined experimentally.Comment: Accepted for publication in Journal of Instrumentatio

Overweight and obese adults have low intentions of seeking weight-related care:A cross-sectional survey

Background The prevalence of obesity is growing worldwide. Obesity guidelines recommend increasing the level of weight-related care for persons with elevated levels of weight-related health risk (WRHR). However, there seems to be a discrepancy between need for and use of weight-related care. The primary aim of this study is to examine predisposing factors that may influence readiness to lose weight and intention to use weight-related care in an overweight population. Methods A population-based, cross-sectional survey was conducted. Data were collected using an online self-administered questionnaire sent to a population-representative sample of 1,500 Dutch adults on the Health Care Consumer Panel (n = 861 responded). Data were used from individuals (n = 445) with a mildly, moderately or severely elevated level of WRHR. WRHR status was based on self-reported data on Body Mass Index, risk assessment for diabetes mellitus type 2 (DM2) and cardiovascular disease (CVD), or co-morbidities. Results 55.1% of persons with increased WRHR were ready to lose weight (n = 245). Depending on level of WRHR; educational level, marital status, individuals with an accurate perception of their weight and better perceptions and expectations of dietitians were significantly related to readiness to lose weight. Most of them preferred individual weight-loss methods (82.0% of n = 245). 11% (n = 26 of n = 245) intended to use weight-related care. Weight-related care seeking was higher for those with moderate or severe WRHR. Expectations and trust in dietitians did not seem to influence care seeking. Conclusions Many Dutch adults who are medically in need of weight-related care are ready to lose weight. Most intend to lose weight individually, and only a few intend to use weight-related care. Therefore, obesity prevention initiatives should focus on monitoring weight change and weight-loss plans, and timely referral to obesity management. However, many people are not ready to lose weight. For this group, strategies for behaviour change may depend on WRHR, perceptions of weight and dietitians, educational level and marital status. Obesity prevention initiatives should focus on increasing the awareness of the seriousness of their condition and offering individually appropriate weight management programmes. Keywords: Overweight, Obesity, Weight change, Patient’s acceptance of health care, Perception, Dietary service

Effects of High Charge Densities in Multi-GEM Detectors

A comprehensive study, supported by systematic measurements and numerical computations, of the intrinsic limits of multi-GEM detectors when exposed to very high particle fluxes or operated at very large gains is presented. The observed variations of the gain, of the ion back-flow, and of the pulse height spectra are explained in terms of the effects of the spatial distribution of positive ions and their movement throughout the amplification structure. The intrinsic dynamic character of the processes involved imposes the use of a non-standard simulation tool for the interpretation of the measurements. Computations done with a Finite Element Analysis software reproduce the observed behaviour of the detector. The impact of this detailed description of the detector in extreme conditions is multiple: it clarifies some detector behaviours already observed, it helps in defining intrinsic limits of the GEM technology, and it suggests ways to extend them.Comment: 5 pages, 6 figures, 2015 IEEE Nuclear Science Symposiu