Monitoring osteoarthritis: a cross-sectional survey in general practice

<b>Background</b> Despite being a highly prevalent chronic condition managed predominantly in primary care and unlike other chronic conditions, osteoarthritis (OA) care is delivered on an ad hoc basis rather than through routine structured review. Evidence suggests current levels of OA care are suboptimal, but little is known about what general practitioners' (GPs) consider important in OA care, and, thus, the scope to improve inconsistency or poor practice is, at present, limited.<p></p> <b>Objectives</b> We investigated GPs' views on and practice of monitoring OA. <p></p> <b>Methods</b> This was a cross-sectional postal survey of 2500 practicing UK GPs randomly selected from the Binley's database. Respondents were asked if monitoring OA patients was important and how monitoring should be undertaken.<p></p> <b>Results</b> Responses were received from 768 GPs of whom 70.8% were male and 89.5% were principals within their practices. Despite 55.4% (n = 405) indicating monitoring patients with OA was important and 78.3% (n = 596) considering GPs the appropriate professionals to monitor OA, only 15.2% (n = 114) did so routinely, and 45% (n = 337) did not monitor any OA patients at all. In total, 61.4% (n = 463) reported that patients should self-monitor. Respondents favored monitoring physical function, pain, and analgesia use over monitoring measures of BMI, self management plans, and exercise advice.<p></p> <b>Conclusions</b> The majority of respondents felt that monitoring OA was important, but this was not reflected in their reported current practice. Much of what they favored for monitoring was in line with published guidance, suggesting provision of suboptimal care does not result from lack of knowledge and interventions to improve OA care must address barriers to GPs engaging in optimal care provision

Swelling of PDMS Networks in Solvent Vapours; Applications for Passive RFID Wireless Sensors

The relative degree of swelling of a poly(dimethylsiloxane) (PDMS) network in organic vapours is demonstrated to be related to the chemical and physical properties of the organic compounds. The swelling ratio, based on volume change, QV, is directly correlated with the Hansen solubility parameters, dd, dp and dh and the vapour pressures of the organic vapours employed. A practical use for such PDMS networks in combination with an understanding of the relationship is demonstrated by the use of PDMS as a mechanical actuator in a prototype wireless RFID passive sensor. The swelling of the PDMS displaces a feed loop resulting in an increase in transmitted power, at a fixed distance

Visualizing arteriosclerosis in dental radiographic shots: case report and literature review.

Dentists are trained to identify atheromatous plaques of the intimal layer of the common carotid artery on panoramic radiographs, but are less familiar with medial layer arteriosclerosis, which results in “pipe-stem” calcifications that may present on intraoral as well as extraoral dental radiographs. Medial arteriosclerosis is often found in diabetics and patients with chronic kidney disease, and is a strong predictor of stroke and cardiovascular events. Two case reports are presented that illustrate the presentation of medial arteriosclerosis in facial and maxillary arteries on dental radiographs. Dentists can play an important role in identifying patients at risk for stroke and cardiovascular events

Geolocation of a Node on a Local Area Network

Geolocation is the process of identifying a node using only its Internet Protocol (IP) address. Locating a node on a LAN poses particular challenges due to the small scale of the problem and the increased significance of queuing delay. This study builds upon existing research in the area of geolocation and develops a heuristic tailored to the difficulties inherent in LANs called the LAN Time to Location Heuristic (LTTLH). LTTLH uses several polling nodes to measure latencies to end nodes, known locations within the LAN. The Euclidean distance algorithm is used to compare the results with the latency of a target in order to determine the target’s approximate location. Using only these latency measurements, LTTLH is able to determine which switch a target is connected to 95% of the time. Within certain constraints, this method is able to identify the target location 78% of the time. However, LANs are not always configured within the constraints necessary to geolocate a node. In order for LTTLH to be effective, a network must be configured consistently, with similar length cable runs available to nodes located in the same area. For best results, the network should also be partitioned, grouping nodes of similar proximity behind one switch

Letter From Marjorie Clarson Grauch to Eleanor Snell, May 22, 1970

This letter from Marjorie Clarson, Ursinus College Class of 1950, congratulates Eleanor Snell on the occasion of her retirement from Ursinus College.https://digitalcommons.ursinus.edu/snell_docs/1058/thumbnail.jp

A METHOD TO ESTIMATE TEMPERATURE OF UNPROTECTED STEEL STRUCTURES IN A FIRE ROOM FOR PERFORMANCE BASED FIRE-PROOF DESIGN

To realize low-voltage dielectric elastomer actuators (DEAs) for artificial muscles, a high-permittivity elastomer and a related thin-film deposition technique must be selected. For polydimethylsiloxane, fillers or functionalized crosslinkers have been incorporated into the elastomer to improve dielectric properties. To produce elastomer layers nanometers thin, molecular beam deposition was introduced. We pursue the synthesis of a high-permittivity oligomer, namely a chloropropyl-functional, vinyl-terminated siloxane to be thermally evaporated and subsequent UV curing to form an elastomer. The synthesized oligomer exhibits dielectric permittivity enhanced by 33% and a breakdown increase of 26% with respect to the commercially available oligomer DMS-V05. Films 160 nm thin were fabricated after being evaporated under ultra-high vacuum conditions. Spectroscopic ellipsometery served for film growth monitoring. Using atomic force microscopy, the film surface morphology and mechanics were characterized after growth termination and subsequent curing. The Young's modulus of the elastomer corresponded to (1.8 ± 0.2) MPa and is thus a factor of two lower than that of DMS-V05. Consequently, the properties of the films prepared by the new elastomer can be quantified by the normalized figure of merit, which estimates to 4.6. The presented approach is an essential step toward the realization of low-voltage DEA for medical applications and beyond

Discussing prognosis with patients with osteoarthritis: a cross-sectional survey in general practice

Osteoarthritis is a leading cause of chronic pain and disability and one of the most common conditions diagnosed and managed in primary care. Despite the evidence that patients would value discussions about the course of osteoarthritis to help them make informed treatment decisions and plan for the future, little is known of GPs’ practice of, or views regarding, discussing prognosis with these patients. A cross-sectional postal survey asked 2500 randomly selected UK GPs their views on discussing prognosis with patients with osteoarthritis and potential barriers or facilitators to such discussions. They were also asked if prognostic discussions were part of their current practice and what indicators they considered important in assessing the prognosis associated with osteoarthritis. Of 768 respondents (response rate 30.7 %), the majority felt it necessary to discuss prognosis with osteoarthritis patients (n = 738, 96.1 %), but only two thirds reported that it was part of their routine practice (n = 498, 64.8 %). Most respondents found predicting the course of osteoarthritis (n = 703, 91.8 %) and determining the prognosis of patients difficult (n = 589, 76.7 %). Obesity, level of physical disability and pain severity were considered the most important prognostic indicators in osteoarthritis. Although GPs consider prognostic discussions necessary for patients with osteoarthritis, few prioritise these discussions. Lack of time and perceived difficulties in predicting the disease course and determining prognosis for patients with osteoarthritis may be barriers to engaging in prognostic discussions. Further research is required to identify ways to assist GPs making prognostic predictions for patients with osteoarthritis and facilitate engagement in these discussions

Comorbidities in patients with gout prior to and following diagnosis: case-control study

OBJECTIVES: To determine the burden of comorbidities in patients with gout at diagnosis and the risk of developing new comorbidities post diagnosis. METHODS: There were 39 111 patients with incident gout and 39 111 matched controls identified from the UK Clinical Practice Research Data-link. The risk of comorbidity before (ORs) and after the diagnosis of gout (HRs) were estimated, adjusted for age, sex, diagnosis year, body mass index, smoking and alcohol consumption. RESULTS: Gout was associated with adjusted ORs (95% CIs) of 1.39 (1.34 to 1.45), 1.89 (1.76 to 2.03) and 2.51 (2.19 to 2.86) for the Charlson index of 1-2, 3-4 and >/=5, respectively. Cardiovascular and genitourinary diseases, in addition to hyperlipidaemia, hypothyroidism, anaemia, psoriasis, chronic pulmonary diseases, osteoarthritis and depression, were associated with a higher risk for gout. Gout was also associated with an adjusted HR (95% CI) of 1.41 (1.34 to 1.48) for having a Charlson index >/=1. Median time to first comorbidity was 43 months in cases and 111 months in controls. Risks for incident comorbidity were higher in cardiovascular, genitourinary, metabolic/endocrine and musculoskeletal diseases, in addition to liver diseases, hemiplegia, depression, anaemia and psoriasis in patients with gout. After additionally adjusting for all comorbidities at diagnosis, gout was associated with a HR (95% CI) for all-cause mortality of 1.13 (1.08 to 1.18; p<0.001). CONCLUSIONS: The majority of patients with gout have worse pre-existing health status at diagnosis and the risk of incident comorbidity continues to rise following diagnosis. The range of associated comorbidities is broader than previously recognised and merits further evaluation

Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis

BACKGROUND: Hyperuricaemia, the biochemical precursor to gout, has been shown to be an independent risk factor for mortality from cardiovascular disease (CVD), although studies examining the clinical phenomenon of gout and risk of CVD mortality report conflicting results. This study aimed to produce a pooled estimate of risk of mortality from cardiovascular disease in patients with gout. DESIGN: Systematic review and meta-analysis. METHODS: Electronic bibliographic databases were searched from inception to November 2012, with results reviewed by two independent reviewers. Studies were included if they reported data on CVD mortality in adults with gout who were free of CVD at time of entry into the study. Pooled hazard ratios (HRs) for this association were calculated both unadjusted and adjusted for traditional vascular risk factors. RESULTS: Six papers, including 223,448 patients, were eligible for inclusion (all (CVD) mortality n?=?4, coronary heart disease (CHD) mortality n?=?3, and myocardial infarction mortality n?=?3). Gout was associated with an excess risk of CVD mortality (unadjusted HR 1.51 (95% confidence interval, CI, 1.17-1.84)) and CHD mortality (unadjusted HR 1.59, 95% CI 1.25-1.94)). After adjusting for traditional vascular risk factors, the pooled HR for both CVD mortality (HR 1.29, 95% CI 1.14-1.44) and CHD mortality (HR 1.42, 95% CI 1.22-1.63) remained statistically significant, but none of the studies reported a significant association with myocardial infarction. CONCLUSIONS: Gout increases the risk of mortality from CVD and CHD, but not myocardial infarction, independently of vascular risk factors