Sarcoidosis and Work Participation: The Need to Develop a Disease-Specific Core Set for Assessment of Work Ability.

OBJECTIVE: Sarcoidosis, an inflammatory multi-organ disease with a wide variety of clinical manifestations, affecting people of working age. Patients suffer from a broad spectrum of physical symptoms of varying severity that impact function including cognitive impairment and disabling fatigue. The Dutch Sarcoidosis Society identified a knowledge gap in various facets related to work ability. The aim of this study was to assess sarcoidosis patients' perceived problems related to work performance, employer, and disability evaluations. METHODS: A cross-sectional web-based anonymous survey was conducted among Dutch sarcoidosis patients recruited through sarcoidosis patient societies and outpatient sarcoidosis clinics. This investigation queried work performance, employer support, and disability evaluations. RESULTS: The study sample included 755 patients of whom 43% (n = 328) had undergone disability evaluation and were significantly more likely to experience extrapulmonary symptoms, severe fatigue, reduced exercise capacity along with memory problems and concentration problems with higher mean FAS and SFNSL-scores. Of these 328, 37% (n = 121) perceived they had not been listened to or taken seriously at assessments, and 38% (n = 124) disagreed with the outcome of disability assessments by benefits authorities; 75% (n = 93) appealed or requested re-assessment. DISCUSSION: A better understanding of sarcoidosis-related impact on work ability and quantification of disease burden is needed. Education for medical examiners and employers on sarcoidosis may improve quality of assessments and work accommodations. Development of guidelines for benefit authorities, which consider the broad impact of sarcoidosis beyond that of reduced pulmonary function, including extra-pulmonary assessment like fatigue, cognitive difficulties, as well as other organ involvement are needed.

Correction to: The Burden of Sarcoidosis Symptoms from a Patient Perspective.

The original version of this article unfortunately contained a mistake in coauthor's given name. The abbreviated given name "M.D." for coauthor M.D.P. Elfferich's name has been inadvertently deleted during the production process.

The Burden of Sarcoidosis Symptoms from a Patient Perspective.

PURPOSE: The clinical manifestations of sarcoidosis vary widely, depending on the intensity of the inflammation and the organ systems affected. Hence, sarcoidosis patients may suffer from a great variety of symptoms. The aim of this study was to compare the self-reported burden of sarcoidosis patients in Denmark, Germany and the Netherlands, especially the prevalence of fatigue and small fiber neuropathy (SFN)-related symptoms, as well as differences in treatment strategies. METHODS: A cross-sectional web-based anonymous survey about complaints was conducted among sarcoidosis patients. Patients were invited to take part through the sarcoidosis patient societies as well as through outpatient sarcoidosis clinics in these countries. RESULTS: The questionnaire was completed by 1072 sarcoidosis patients (152 Danish, 532 German and 388 Dutch). Almost all patients reported having sarcoidosis-associated symptoms (organ-related as well as non-specific, non-organ related). Fatigue was reported by almost all respondents (90%), followed by pulmonary symptoms (72.4%). More than 50% of the respondents were being treated with prednisone, which was comparable in all three countries. In contrast, second- and third-line treatment differed substantially between Denmark, Germany and the Netherlands. CONCLUSION: Sarcoidosis patients in Denmark, Germany and the Netherlands present with similar self-reported symptoms, organ-related as well as non-specific, non-organ related. Fatigue (90%) and symptoms associated with SFN (86%) were highly prevalent in all three countries.

Effectiveness of septoplasty versus non-surgical management for nasal obstruction due to a deviated nasal septum in adults: study protocol for a randomized controlled trial.

BACKGROUND: Septoplasty, i.e., surgical correction of the deviated nasal septum, is the most common ear, nose and throat (ENT) operation in adults. Currently the main indication to perform septoplasty is nasal obstruction. However, the effectiveness of septoplasty for nasal obstruction in adults with a deviated nasal septum remains uncertain. Scientific evidence is scarce and inconclusive, and internationally accepted guidelines are lacking. Moreover, there is no consensus on whether or not septoplasty should be combined with concurrent turbinate surgery. The objective of the current ongoing trial is to study the effectiveness of septoplasty (with or without concurrent turbinate surgery) as compared to non-surgical management for nasal obstruction in adults with a deviated nasal septum, both in terms of subjective (health-related quality of life) as well as objective (nasal patency) outcome measures. METHODS/DESIGN: The study is designed as a pragmatic, multicenter, parallel-group, randomized controlled trial. A total of 200 adults will be enrolled with nasal obstruction based on a deviated nasal septum and an indication for septoplasty according to current medical practice in the Netherlands. Participants will be randomized to either septoplasty (with or without concurrent turbinate surgery as originally indicated by the otorhinolaryngologist) or a non-surgical watchful waiting strategy. Follow-up visits will be scheduled at 0, 3, 6, 12, and 24 months. During each follow-up visit, health-related quality of life questionnaires will be administered and measurements of four-phase rhinomanometry and peak nasal inspiratory flow will be performed. Costs will be studied using a patient-based diary. Effects of septoplasty on health-related quality of life (primary outcome) and nasal patency will be calculated as mean differences with 95 % confidence intervals. Subgroup analyses according to gender, age, and severity of the septal deviation will be performed. All analyses will be performed on an intention-to-treat basis. DISCUSSION: With the results of this study we aim to contribute to the development of evidence-based guidelines regarding indications for septoplasty. TRIAL REGISTRATION: Nederlands Trial Register/Dutch Trial Registry ( www.trialregister.nl ), trial identifying number: NTR3868 . Registered on 21 February 2013.

A real-time intercepting beam-profile monitor for a medical cyclotron.

There is a lack of real-time continuous beam-diagnostic tools for medical cyclotrons due to high power deposition during proton irradiation. To overcome this limitation, we have developed a profile monitor that is capable of providing continuous feedback about beam shape and current in real time while it is inserted in the beam path. This enables users to optimize the beam profile and observe fluctuations in the beam over time with periodic insertion of the monitor.

Automatic measurement of compression wood cell attributes in fluorescence microscopy images.

This paper presents a new automated method for analyzing compression wood fibers in fluorescence microscopy. Abnormal wood known as compression wood is present in almost every softwood tree harvested. Compression wood fibers show a different cell wall morphology and chemistry compared to normal wood fibers, and their mechanical and physical characteristics are considered detrimental for both construction wood and pulp and paper purposes. Currently there is the need for improved methodologies for characterization of lignin distribution in wood cell walls, such as from compression wood fibers, that will allow for a better understanding of fiber mechanical properties. Traditionally, analysis of fluorescence microscopy images of fiber cross-sections has been done manually, which is time consuming and subjective. Here, we present an automatic method, using digital image analysis, that detects and delineates softwood fibers in fluorescence microscopy images, dividing them into cell lumen, normal and highly lignified areas. It also quantifies the different areas, as well as measures cell wall thickness. The method is evaluated by comparing the automatic with a manual delineation. While the boundaries between the various fiber wall regions are detected using the automatic method with precision similar to inter and intra expert variability, the position of the boundary between lumen and the cell wall has a systematic shift that can be corrected. Our method allows for transverse structural characterization of compression wood fibers, which may allow for improved understanding of the micro-mechanical modeling of wood and pulp fibers.

In-hospital rehabilitation after multiple joint procedures of the lower extremities in haemophilia patients: clinical guidelines for physical therapists.

This project aimed to develop guidelines for use during in-hospital rehabilitation after combinations of multiple joint procedures (MJP) of the lower extremities in persons with haemophilia (PWH). MJP are defined as surgical procedures on the ankles, knees and hips, performed in any combination, staged, or during a single session. MJP that we studied included total knee arthroplasty, total hip arthroplasty and ankle arthrodesis. Literature on rheumatoid arthritis demonstrated promising functional results, fewer hospitalization days and days lost from work. However, the complication rate is higher and rehabilitation needs optimal conditions. Since 1995, at the Van Creveldkliniek, 54 PWH have undergone MJP. During the rehabilitation in our hospital performed by experienced physical therapists, regular guidelines seemed useless. Guidelines will guarantee an optimal physical recovery and maximum benefit from this enormous investment. This will lead to an optimal functional capability and optimal quality of life for this elderly group of PWH. There are no existing guidelines for MJP, in haemophilia, revealed through a review of the literature. Therefore, a working group was formed to develop and implement such guidelines and the procedure is explained. The total group of PWH who underwent MJP is described, subdivided into combinations of joints. For these subgroups, the number of days in hospital, complications and profile at discharge, as well as a guideline on the clinical rehabilitation, are given. It contains a general part and a part for each specific subgroup.

Comments on the paper 'A novel 3D wavelet-based filter for visualizing features in noisy biological data', by Moss et al.

Moss et al. (2005) describe, in a recent paper, a filter that they use to detect lines. We noticed that the wavelet on which this filter is based is a difference of uniform filters. This filter is an approximation to the second-derivative operator, which is commonly implemented as the Laplace of Gaussian (or Marr-Hildreth) operator. We have compared Moss' filter with (1) the Laplace of Gaussian operator, (2) an approximation of the Laplace of Gaussian using uniform filters and (3) a few common noise reduction filters. The Laplace-like operators detect lines by suppressing image features both larger and smaller than the filter size. The noise reduction filters only suppress image features smaller than the filter size. By estimating the signal-to-noise ratio and mean square difference of the filtered results, we found that the filter proposed by Moss et al. does not outperform the Laplace of Gaussian operator. We also found that for images with extreme noise content, line detection filters perform better than the noise reduction filters when trying to enhance line structures. In less extreme cases of noise, the standard noise reduction filters perform significantly better than both the Laplace of Gaussian and Moss' filter.

Using line segments as structuring elements for sampling-invariant measurements.

When performing measurements in digitized images, the pixel pitch does not necessarily limit the attainable accuracy. Proper sampling of a band-limited continuous-domain image preserves all information present in the image prior to digitization. It is therefore (theoretically) possible to obtain measurements from the digitized image that are identical to measurements made in the continuous domain. Such measurements are sampling invariant, since they are independent of the chosen sampling grid. It is impossible to attain strict sampling invariance for filters in mathematical morphology due to their nonlinearity, but it is possible to approximate sampling invariance with arbitrary accuracy at the expense of additional computational cost. In this paper, we study morphological filters with line segments as structuring elements. We present a comparison of three known and three new methods to implement these filters. The method that yields a good compromise between accuracy and computational cost employs a (subpixel) skew to the image, followed by filtering along the grid axes using a discrete line segment, followed by an inverse skew. The staircase approximations to line segments under random orientations can be modeled by skewing a horizontal or vertical line segment. Rather than skewing the binary line segment we skew the image data, which substantially reduces quantization error. We proceed to determine the optimal number of orientations to use when measuring the length of line segments with unknown orientation.

Sliding friction dynamics of hard single asperities on soft substrates.

The sliding friction of hard, micron-sized single asperities sliding on soft polyester films was studied. Transitions from steady sliding to so-called "stick-slip" or nonstationary motion occur for decreasing driving speed, decreasing driving spring stiffness, increasing normal load, decreasing tip radius, and decreasing crosslink density. Normal displacements of the tip during sliding were studied in some detail. It is argued these play an important role in the dynamics of the system, being the dominant factor in determining the contact area between asperity and substrate. A rather simple model is proposed that is related to rate-and-state descriptions of stick-slip phenomena. In this particular description the normal displacement plays a part analogous to that of the state parameter. In a limited comparison of experiment and numerical results we find qualitative agreement on all measured trends.

Usefulness of the retrospective Life-Chart method manual in outpatients with a mood disorder: a feasibility study.

The aim of this project was to evaluate whether the Life-Chart Manual (LCM) can help patients to complete their own Life-Chart (LC). All patients were recruited via the outpatient department for affective disorders of the Academic Hospital Maastricht. They were diagnosed as having a unipolar or bipolar disorder according to DSM-IV criteria. Following a short briefing interview, these patients were asked to complete their own LC for the last 6 years, using the manual. Seventy-four patients were selected, of whom 44 were willing to participate in the study. About half of these patients (n=20) completed the LC adequately (60-80% of the items completed) with only minimal professional help. Although patients found it difficult to complete the LC, most considered it worthwhile. The LCM is an adequate tool to help patients with a major affective disorder to complete their own LC with minimal professional assistance.