Het soort functionarissen dat in de huisartsenpraktijk emplooi vindt neemt nog steeds toe. Dat is het gevolg van nieuwe zorgvisies -en modellen, veranderende zorgbehoeften en aanpassingen op de ideeën en verwachtingen die de burger, en daarmee de politiek, heeft van wat de eerstelijnszorg zou moeten bieden. Enerzijds betreft dat de toename van complexere medische behandelopties en anderzijds de groei van preventieve mogelijkheden en de begeleiding bij bijvoorbeeld dementie, diabetes, astma, hypertensie en kwetsbaarheid in het algemeen. Diagnostiek wordt in de meer protocollaire gevallen door bijvoorbeeld de POH, de verpleegkundig specialist of de physician assistant gedaan. Echter, min of meer protocollaire handelingen zijn in toenemende mate ingebed in complexe zorgsituaties, waarbij sociale, psychische en fysieke kwetsbaarheid in elkaars verlengde liggen. Dat maakt ook dat de diagnostiek en daarmee de organisatie van de zorg complexer wordt.
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Rationale: Diagnosis of sarcopenia in older adults is essential for early treatment in clinical practice. Bio-electrical impedanceanalysis (BIA) may be a valid means to assess appendicular lean mass (ALM) in older adults, but limited evidence is available.Therefore, we aim to evaluate the validity of BIA to assess ALM in older adults.Methods: In 215 community dwelling older adults (age ≥ 55 years), ALM was measured by BIA (Tanita MC-780; 8-points) andcompared with dual-energy X-ray absorptiometry (DXA, Hologic Discovery A) as reference. Validity for assessing absolute values ofALM was evaluated by: 1) bias (mean difference), 2) percentage of accurate predictions (within 5% of DXA values), 3) individualerror (root mean squared error (RMSE), mean absolute deviation), 4) limits of agreement (Bland-Altman analysis). For diagnosis oflow ALM, the lowest quintile of ALM by DXA was used (below 21.4 kg for males and 15.4 for females). Sensitivity and specificityof detecting low ALM by BIA were assessed.Results: Mean age of the subjects was 71.9 ± 6.4, with a BMI of 25.8 ± 4.2 kg/m2, and 70% were females. BIA slightlyunderestimated ALM compared to DXA with a mean bias of -0.6 ± 0.2 kg. The percentage accurate predictions was 54% withRMSE 1.6 kg and limits of agreements -3.0 – +1.8 kg. Sensitivity was 79%, indicating that 79% of subjects with low ALMaccording to DXA also had low ALM with the BIA. Specificity was 90%, indicating that 90% of subjects with ‘no low’ ALMaccording to DXA also had ‘no low’ ALM with the BIA.Conclusions: This comparison showed a poor validity of BIA to assess absolute values of ALM, but a reasonable sensitivity andspecificity to diagnose a low level of ALM in community-dwelling older adults in clinical practice.
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This study explores how a pre-service mathematics teacher interprets eye-tracking data to diagnose students’ reasoning when working with histograms. Using a qualitative case study design, the participant engaged with an eye-tracking vignette, featuring a student’s gaze plot, answer, and cued recall explanation. The targeted error was frequency–value confusion, a common systematic error where students treat bar heights as measured values. Findings show that the participant initially relied on assumptions rather than the gaze data itself. Over time, her reasoning shifted to a more reflective analysis, integrating multiple data sources to better understand the student’s thought process. She also identified the limitations of interpreting gaze data in isolation, especially when no clear pattern was evident. This study suggests that the use of eye-tracking data, when scaffolded through structured tasks, can enhance pre-service teachers’ diagnostic skills in the interpretation of statistical graphs.
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Sarcopenie gaat gepaard met een verhoogd risico op vallen en fracturen, kwetsbaarheid, functionele beperkingen, verlies van zelfstandigheid, langdurige opname in een zorginstelling en vroegtijdig sterfte. Het leidt daardoor tot hogere zorgkosten. Sarcopenie – afkomstig van de Griekse woorden sarx (‘vlees’) en penia (‘tekort’, ‘gebrek’) – ontstaat door veroudering (primaire sarcopenie) of door, met name inflammatoire, aandoeningen (secundaire sarcopenie). Daarnaast dragen lichamelijke inactiviteit, sedentair gedrag en onvoldoende inname van energie en eiwit bij aan het ontstaan.In deze klinische les zetten we de screening op en diagnose van sarcopenie uiteen volgens de nieuwste Europese definitie van de European Working Group on Sarcopenia in Older Persons 2 (EWGSOP2).1 Wij hopen hiermee de actieve opsporing en behandeling van sarcopenie in de klinische praktijk te bevorderen.
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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
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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.
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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.
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