Inter-physician agreement on the readiness of sick-listed employees to return to work

Purpose: To determine the agreement between occupational physician (OP) ratings of an employee's readiness to return to work (RRTW). Method: Anonymized written vignettes of 132 employees, sick-listed for at least 3 weeks, were reviewed by 5 OPs. The OPs intuitively rated RRTW as the ability (knowledge and skills) and willingness (motivation and confidence) of sick-listed employees to resume work. Inter-OP percentages of agreement were calculated and Cohen's kappas (kappa) were determined to correct for agreement by chance. Results: The percentage of agreement between OPs was 57% (range 39-89%) on the ability and 63% (range 48-87%) on the willingness of sick-listed employees to resume work. The mean. was 0.14 (range from -0.21 to 0.79) for ability and 0.25 (range from -0.11 to 0.74) for willingness. The OP-rating of RRTW of employees sick-listed with mental disorders did not differ from the OP-rating of RRTW of employees with musculoskeletal disorders. Conclusion: The inter-OP agreement on intuitively rated RRTW showed a wide variability, which accentuates the need for instruments to establish an employee's RRTW and for training in giving well founded return to work recommendations

Design and fabrication of a planar three-DOFs MEMS-based manipulator

This paper presents the design, modeling, and fabrication of a planar three-degrees-of-freedom parallel kinematic manipulator, fabricated with a simple two-mask process in conventional highly doped single-crystalline silicon (SCS) wafers (100). The manipulator’s purpose is to provide accurate and stable positioning of a small sample (10 × 20 × 0.2 μm3), e.g., within a transmission electron microscope. The manipulator design is based on the principles of exact constraint design, resulting in a high actuation-compliance combined with a relatively high suspension stiffness. A modal analysis shows that the fourth vibration mode frequency is at least a factor 11 higher than the first three actuation-related mode frequencies. The comb-drive actuators are modeled in combination with the shuttle suspensions gaining insight into the side and rotational pull-in stability conditions. The two-mask fabrication process enables high-aspect-ratio structures, combined with electrical trench insulation. Trench insulation allows structures in conventional wafers to be mechanically connected while being electrically insulated from each other. Device characterization shows high linearity of displacement wrt voltage squared over ±10 μm stroke in the x- and y-directions and ±2◦ rotation at a maximum of 50 V driving voltage. Out-of-plane displacement crosstalk due to in-plane actuation in resonance is measured to be less than 20 pm. The hysteresis in SCS, measured using white light interferometry, is shown to be extremely small

Oncostatin-M inhibits luteinizing hormone stimulated Leydig cell progenitor formation in vitro

Background: The initial steps of stem Leydig cell differentiation into steroid producing progenitor cells are thought to take place independent of luteinizing hormone (LH), under the influence of locally produced factors such as leukaemia inhibitory factor (LIF), platelet derived growth factor A and stem cell factor. For the formation of a normal sized Leydig cell population in the adult testis, the presence of LH appears to be essential. Oncostatin M (OSM) is a multifunctional cytokine and member of the interleukin (IL)-6 family that also includes other cytokines such as LIF. In the rat OSM is highly expressed in the late fetal and neonatal testis, and may thus be a candidate factor involved in Leydig cell progenitor formation. Methods: Interstitial cells were isolated from 13-day-old rat testes and cultured for 1, 3 or 8 days in the presence of different doses of OSM ( range: 0.01 to 10 ng/ml) alone or in combination with LH ( 1 ng/ml). The effects of OSM and LH on cell proliferation were determined by incubating the cultures with [3H] thymidine or bromodeoxyuridine ( BrdU). Developing progenitor cells were identified histochemically by the presence of the marker enzyme 3beta-hydroxysteroid dehydrogenase (3beta-HSD). Results: OSM, when added at a dose of 10 ng/ml, caused a nearly 2-fold increase in the percentage of Leydig cell progenitors after 8 days of culture. Immunohistochemical double labelling experiments with 3beta-HSD and BrdU antibodies showed that this increase was the result of differentiation of stem Leydig cells/precursor cells and not caused by proliferation of progenitor cells themselves. The addition of LH to the cultures consistently resulted in an increase in progenitor formation throughout the culture period. Surprisingly, when OSM and LH were added together, the LH induced rise in progenitor cells was significantly inhibited after 3 and 8 days of culture. Conclusion: Taken together, the results of the present study suggest that locally produced OSM may not only play a role in the regulation of Sertoli cell proliferation and the initiation of spermatogenesis but may also play a role in the regulation of Leydig cell progenitor formation by keeping the augmenting effects of LH on this process in abeyance

The value of genetic testing in the diagnosis and risk stratification of arrhythmogenic right ventricular cardiomyopathy

BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by risk of malignant ventricular arrhythmias (VA). ARVC is diagnosed using an array of clinical tests in the consensus-based task force criteria (TFC), one of which is genetic testing. OBJECTIVE: To investigate the value of genetic testing in diagnosing ARVC and its relation to the occurrence of first malignant VA. METHODS: A multicenter cohort of ARVC patients was scored using the revised 2010 TFC with and without genetic criterion, analyzing any resulting loss or delay of diagnosis. Malignant VA was defined as sustained ventricular arrhythmia (≥30s duration at ≥100 bpm or requiring intervention). RESULTS: We included 402 subjects (55% male, 54% proband, 40 [27-51] years old at presentation) who were diagnosed with definite ARVC. A total of 232 (58%) subjects fulfilled genetic testing criteria. Removing the genetic criterion caused loss of diagnosis in 18 (4%) patients (11/216 [5%] probands, 7/186 [4%] relatives), and delay of diagnosis ≥30 days in 22 (5%) patients (21/216 [10%] probands, 1/186 [0.5%] relative). A first malignant VA occurred in no patients who lost diagnosis and in 3 patients (3/216 [1%] probands and no relatives) during their diagnosis delay, none fatal. Time to event analysis showed no significant difference in time from diagnosis to malignant VA between pathogenic variant carriers and non-carriers. CONCLUSION: Disregarding the genetic criterion of the TFC caused loss or delay of diagnosis in 10% (n=40/402) of ARVC patients. Malignant VA occurred in 1% (n=3/402) of cases with lost or delayed diagnosis, none fatal