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The gap detection test: can it be used to diagnose tinnitus?

Objectives: Animals with induced tinnitus showed difficulties in detecting silent gaps in sounds, suggesting that the tinnitus percept may be filling the gap. The main purpose of this study was to evaluate the applicability of this approach to detect tinnitus in human patients. The authors first hypothesized that gap detection would be impaired in patients with tinnitus, and second, that gap detection would be more impaired at frequencies close to the tinnitus frequency of the patient. Design: Twenty-two adults with bilateral tinnitus, 20 age-matched and hearing loss–matched subjects without tinnitus, and 10 young normal-hearing subjects participated in the study. To determine the characteristics of the tinnitus, subjects matched an external sound to their perceived tinnitus in pitch and loudness. To determine the minimum detectable gap, the gap threshold, an adaptive psychoacoustic test was performed three times by each subject. In this gap detection test, four different stimuli, with various frequencies and bandwidths, were presented at three intensity levels each. Results: Similar to previous reports of gap detection, increasing sensation level yielded shorter gap thresholds for all stimuli in all groups. Interestingly, the tinnitus group did not display elevated gap thresholds in any of the four stimuli. Moreover, visual inspection of the data revealed no relation between gap detection performance and perceived tinnitus pitch. Conclusions: These findings show that tinnitus in humans has no effect on the ability to detect gaps in auditory stimuli. Thus, the testing procedure in its present form is not suitable for clinical detection of tinnitus in humans.

Consensus over de criteria voor diagnose van ondervoeding en sarcopenie

Dit najaar zijn de langverwachte nieuwe consensuscriteria voor hetvaststellen van ondervoeding en sarcopenie gepresenteerd. Het gaatom de internationale criteria voor de diagnose van ondervoeding ende herziene Europese consensus over de sarcopenie-definitie en decriteria voor diagnose. Beide worden internationaal gedragen en zullen wereldwijd worden aanbevolen als de nieuwe standaard

Non-specific neck pain: to match or not to match?

The general aim of this dissertation is to gain insight into the physiotherapeutic validity of physiotherapy research in subjects with non-specific neck pain. Chapter 1 describes the background of the research and the research questions and gives an overview of the studies performed. Chapter 2 presents the results of a systematic review (SR) of the completeness of the clinical reasoning process within the methodology of the RCT in patients with non-specific neck pain. For the SR analysis 122 studies were included. In the majority of studies (70%) the described clinical reasoning process was incomplete. There was scarcely any association between the degree of risk of bias and the completeness of the clinical reasoning process, indicating that better methodological quality does not necessarily imply a better description of clinical reasoning process. Chapter 3 presents the results of a SR in which we sought to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain. Thirteen TBCSs were identified. In conclusion, existing treatment-based classification systems are of moderate quality at best. Moreover, these systems were not more effective than alternative treatments. Therefore, we do not recommend the use of these systems in daily physiotherapy practice. Chapter 4 describes a Delphi study of the clinical reasoning process of physiotherapy experts in unimodal interventions in patients with non-specific neck pain. This study had three goals. First, we aimed explore the expert opinions on the indication for physiotherapy when, other than neck pain, there are no positive signs and symptoms, no positive diagnostic tests or complaints of limitations in functioning or restrictions in participation. Second, we focused on the experts' use of measurement tools and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to reach consensus among experts on the use of unimodal interventions in patients with non-specific neck pain. According to all experts, pain alone was not considered to be an indication for physiotherapy. Patient reported outcome measures were mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Only 6 of the 18 variants of sequential linear clinical reasoning reached a consensus of more than 50%. Chapter 5 describes a review that examined the completeness of the description of manipulation and mobilization interventions in randomized controlled trials of subjects with non-specific neck pain. In conclusion, mobilization or manipulation interventions are poorly reported in RCTs, compromising the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions. Chapter 6 investigated the diagnostic physiotherapeutic process regarding limited ROM of the neck. It can be concluded that the overall diagnostic accuracy of physical examination is limited (compared to the CROM measurement). Therefore, a measurement device should be used in daily physical therapy practice to assess if a movement direction is restricted. Chapter 7 describes an exploratory, practice-oriented study into matched treatments in patients with non-specific neck pain. The objective of this study was 1) to establish the measurement error of the used accelerometer; 2) To determine which different treatments are used; 3) To explore if the cervical ROM, pain, (perceived) disability and motor control improved after one treatment. The SCT is a reliable accelerometer for measuring neck ROM, with a small measurement error. Eight different treatments were carried out. Pain, disability and left and right rotation showed a clinically relevant improvements (exceeded the measurement error). Chapter 8 comprises the general discussion. The general discussion presents an overview of this dissertation and discusses the strengths and limitations of the studies and possible implications of the results and recommendations for future research.

Dementie bij mensen met (zeer) ernstige verstandelijke (en meervoudige) beperkingen

Substantial CT radiation dose reduction does not affect the preference for CT over direct digital radiography to diagnose isolated zygomatic fractures

Introduction: Zygomatic fractures can be diagnosed with either computed tomography (CT) or direct digital radiography (DR). The aim of the present study was to assess the effect of CT dose reduction on the preference for facial CT versus DR for accurate diagnosis of isolated zygomatic fractures. Materials and methods: Eight zygomatic fractures were inflicted on four human cadavers with a free fall impactor technique. The cadavers were scanned using eight CT protocols, which were identical except for a systematic decrease in radiation dose per protocol, and one DR protocol. Single axial CT images were displayed alongside a DR image of the same fracture creating a total of 64 dual images for comparison. A total of 54 observers, including radiologists, radiographers and oral and maxillofacial surgeons, made a forced choice for either CT or DR. Results: Forty out of 54 observers (74%) preferred CT over DR (all with P < 0.05). Preference for CT was maintained even when radiation dose reduced from 147.4 mSv to 46.4 mSv (DR dose was 6.9 mSv). Only a single out of all raters preferred DR (P ¼ 0.0003). The remaining 13 observers had no significant preference. Conclusion: This study demonstrates that preference for axial CT over DR is not affected by substantial (~70%) CT dose reduction for the assessment of zygomatico-orbital fractures.

Automated energy performance diagnosis of HVAC systems by the 4S3F method

In practice, faults in building installations are seldom noticed because automated systems to diagnose such faults are not common use, despite many proposed methods: they are cumbersome to apply and not matching the way of thinking of HVAC engineers. Additionally, fault diagnosis and energy performance diagnosis are seldom combined, while energy wastage is mostly a consequence of component, sensors or control faults. In this paper new advances on the 4S3F diagnose framework for automated diagnostic of energy waste in HVAC systems are presented. The architecture of HVAC systems can be derived from a process and instrumentation diagram (P&ID) usually set up by HVAC designers. The paper demonstrates how all possible faults and symptoms can be extracted on a very structured way from the P&ID, and classified in 4 types of symptoms (deviations from balance equations, operational states, energy performances or additional information) and 3 types of faults (component, control and model faults). Symptoms and faults are related to each other through Diagnostic Bayesian Networks (DBNs) which work as an expert system. During operation of the HVAC system the data from the BMS is converted to symptoms, which are fed to the DBN. The DBN analyses the symptoms and determines the probability of faults. Generic indicators are proposed for the 4 types of symptoms. Standard DBN models for common components, controls and models are developed and it is demonstrated how to combine them in order to represent the complete HVAC system. Both the symptom and the fault identification parts are tested on historical BMS data of an ATES system including heat pump, boiler, solar panels, and hydronic systems. The energy savings resulting from fault corrections are estimated and amount 25%. Finally, the 4S3F method is extended to hard and soft sensor faults. Sensors are the core of any FDD system and any control system. Automated diagnostic of sensor faults is therefore essential. By considering hard sensors as components and soft sensors as models, they can be integrated into the 4S3F method.