Management of periprosthetic joint infection after total hip arthroplasty using a Custom Made Articulating Spacer (CUMARS); the exeter experience

Periprosthetic joint infection (PJI) after THA is a major complication with an incidence of 1-3%. We report our experiences with a technique using a custom-made articulating spacer (CUMARS) at the first of two-stage treatment for PJI. This technique uses widely available all-polyethylene acetabular components and the Exeter Universal stem, fixed using antibiotic loaded acrylic cement. Seventy-six hips were treated for PJI using this technique. Performed as the first of a two-stage procedure, good functional results were commonly seen, leading to postponing second stage indefinitely with retention of the CUMARS prosthesis in 34 patients. The CUMARS technique presents an alternative to conventional spacers, using readily available components that are well tolerated, allowing weight bearing and mobility, and achieving comparable eradication rates.

Biological performance of a polycaprolactone-based scaffold plus recombinant human morphogenetic protein-2 (rhBMP-2) in an ovine thoracic interbody fusion model

PURPOSE. We develop a sheep thoracic spine interbody fusion model to study the suitability of polycaprolactone-based scaffold and recombinant human bone morphogenetic protein-2 (rhBMP-2) as a bone graft substitute within the thoracic spine. The surgical approach is a mini- open thoracotomy with relevance to minimally invasive deformity correction surgery for adolescent idiopathic scoliosis. To date there are no studies examining the use of this biodegradable implant in combination with biologics in a sheep thoracic spine model. METHODS. In the present study, six sheep underwent a 3-level (T6/7, T8/9 and T10/11) discectomy with randomly allocated implantation of a different graft substitute at each of the three levels; (i) calcium phosphate (CaP) coated polycaprolactone-based scaffold plus 0.54μg rhBMP-2, (ii) CaP coated PCL- based scaffold alone or (iii) autograft (mulched rib head). Fusion was assessed at six months post-surgery. RESULTS. Computed Tomographic scanning demonstrated higher fusion grades in the rhBMP-2 plus PCL- based scaffold group in comparison to either PCL-based scaffold alone or autograft. These results were supported by histological evaluations of the respective groups. Biomechanical testing revealed significantly higher stiffness for the rhBMP-2 plus PCL- based scaffold group in all loading directions in comparison to the other two groups. CONCLUSION. The results of this study demonstrate that rhBMP-2 plus PCL- based scaffold is a viable bone graft substitute, providing an optimal environment for thoracic interbody spinal fusion in a large animal model.

Segmental torso masses and joint torques produced by gravity in the adolescent scoliotic spine

Introduction Calculating segmental torso masses in Adolescent Idiopathic Scoliosis (AIS) patients allows the gravitational loading on the scoliotic spine during relaxed standing to be estimated. Methods Low dose CT data was used to calculate vertebral level-by-level torso masses and spinal joint torques for 20 female AIS patients (mean age 15.0 ± 2.7 years, mean Cobb angle 53 ± 7.1°). ImageJ software (v1.45 NIH USA) was used to threshold the T1 to L5 CT images and calculate the segmental torso volume and mass for each vertebral level. Masses for the head, neck and arms were taken from published data. Intervertebral joint torques in the coronal and sagittal planes at each vertebral level were found from the position of the centroid of the segment masses relative to the joint centres (assumed to be at the centre of the intervertebral disc. The joint torque at each level was found by summing torque contributions for all segments above that joint. Results Segmental torso mass increased from 0.6kg at T1 to 1.5kg at L5. The coronal plane joint torques due to gravity were 5-7Nm at the apex of the curve; sagittal torques were 3-5.4Nm. Conclusion CT scans were in the supine position and curve magnitudes are known to be smaller than those in standing. Hence, this study has shown that gravity produces joint torques potentially of higher than 7Nm in the coronal plane and 5Nm in the sagittal plane during relaxed standing in scoliosis patients. The magnitude of these torques may help to explain the mechanics of AIS progression and the mechanics of bracing. This new data on torso segmental mass in AIS patients will assist biomechanical models of scoliosis.

6 versus 12 month performance of polycaprolactone-based scaffold plus recombinant human morphogenetic protein-2 (rhBMP-2) in an ovine thoracic interbody fusion model

Introduction Well-designed biodegradable scaffolds in combination with bone growth factors offer a valuable alternative to the current gold standard autograft in spinal fusion surgery Yong et al. (2013). Here we report on 6- vs 12- month data set evaluating the longitudinal performance of a CaP coated polycaprolactone (PCL) scaffold loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2) as a bone graft substitute within a large preclinical animal model. Methods Twelve sheep underwent a 3-level (T6/7, T8/9 and T10/11) discectomy with randomly allocated implantation of a different graft substitute at each of the three levels; (i) calcium phosphate (CaP) coated polycaprolactone based scaffold plus 0.54µg rhBMP-2, (ii) CaP coated PCL- based scaffold alone or (iii) autograft (mulched rib head). Fusion assessments were performed via high resolution clinical computed tomography and histological evaluation were undertaken at six (n=6) and twelve (n=6) months post-surgery using the Sucato grading system (Sucato et al. 2004). Results The computed tomography fusion grades of the 6- and 12- months in the rhBMP-2 plus PCL- based scaffold group were 1.9 and 2.1 respectively, in the autograft group 1.9 and 1.3 respectively, and in the scaffold alone group 0.9 and 1.17 respectively. There were no statistically significant differences in the fusion scores between 6- and 12- month for the rhBMP plus PCL- based scaffold or PCL – based scaffold alone group however there was a significant reduction in scores in the autograft group. These scores were seen to correlate with histological evaluations of the respective groups. Conclusions The results of this study demonstrate the efficacy of scaffold-based delivery of rhBMP-2 in promoting higher fusion grades at 6- and 12- months in comparison to the scaffold alone or autograft group within the same time frame. Fusion grades achieved at six months using PCL+rhBMP-2 are not significantly increased at twelve months post-surgery.

Gravity-induced coronal plane joint moments in the adolescent scoliotic spine

INTRODUCTION Calculating segmental (vertebral level-by-level) torso masses in Adolescent Idiopathic Scoliosis (AIS) patients allows the gravitational loading on the scoliotic spine during relaxed standing to be estimated. METHODS Existing low dose CT scans were used to calculate vertebral level-by-level torso masses and joint moments occurring in the spine for a group of female AIS patients with right-sided thoracic curves. Image processing software, ImageJ (v1.45 NIH USA) was used to reconstruct the torso segments and subsequently measure the torso volume and mass corresponding to each vertebral level. Body segment masses for the head, neck and arms were taken from published anthropometric data. Intervertebral joint moments at each vertebral level were found by summing each of the torso segment masses above the required joint and multiplying it by the perpendicular distance to the centre of the disc. RESULTS AND DISCUSSION Twenty patients were included in this study with a mean age of 15.0±2.7 years and a mean Cobb angle 52±5.9°. The mean total trunk mass, as a percentage of total body mass, was 27.8 (SD 0.5) %. Mean segmental torso mass increased inferiorly from 0.6kg at T1 to 1.5kg at L5. The coronal plane joint moments during relaxed standing were typically 5-7Nm at the apex of the curve (Figure 1), with the highest apex joint of 7Nm. CT scans were performed in the supine position and curve magnitudes are known to be 7-10° smaller than those measured in standing [1]. Therefore joint moments produced by gravity will be greater than those calculated here. CONCLUSIONS Coronal plane joint moments as high as 7Nm can occur during relaxed standing in scoliosis patients, which may help to explain the mechanics of AIS progression. The body mass distributions calculated in this study can be used to estimate joint moments derived using other imaging modalities such as MRI and subsequently determine if a relationship exists between joint moments and progressive vertebral deformity.

Robust multiple-sensing-modality data fusion using Gaussian Process Implicit Surfaces

The ability to build high-fidelity 3D representations of the environment from sensor data is critical for autonomous robots. Multi-sensor data fusion allows for more complete and accurate representations. Furthermore, using distinct sensing modalities (i.e. sensors using a different physical process and/or operating at different electromagnetic frequencies) usually leads to more reliable perception, especially in challenging environments, as modalities may complement each other. However, they may react differently to certain materials or environmental conditions, leading to catastrophic fusion. In this paper, we propose a new method to reliably fuse data from multiple sensing modalities, including in situations where they detect different targets. We first compute distinct continuous surface representations for each sensing modality, with uncertainty, using Gaussian Process Implicit Surfaces (GPIS). Second, we perform a local consistency test between these representations, to separate consistent data (i.e. data corresponding to the detection of the same target by the sensors) from inconsistent data. The consistent data can then be fused together, using another GPIS process, and the rest of the data can be combined as appropriate. The approach is first validated using synthetic data. We then demonstrate its benefit using a mobile robot, equipped with a laser scanner and a radar, which operates in an outdoor environment in the presence of large clouds of airborne dust and smoke.

Data fusion and tracking with multiple UAVs

This chapter describes decentralized data fusion algorithms for a team of multiple autonomous platforms. Decentralized data fusion (DDF) provides a useful basis with which to build upon for cooperative information gathering tasks for robotic teams operating in outdoor environments. Through the DDF algorithms, each platform can maintain a consistent global solution from which decisions may then be made. Comparisons will be made between the implementation of DDF using two probabilistic representations. The first, Gaussian estimates and the second Gaussian mixtures are compared using a common data set. The overall system design is detailed, providing insight into the overall complexity of implementing a robust DDF system for use in information gathering tasks in outdoor UAV applications.

Score-level multibiometric fusion based on Dempster-Shafer theory incorporating uncertainty factors

While existing multi-biometic Dempster-Shafer the- ory fusion approaches have demonstrated promising perfor- mance, they do not model the uncertainty appropriately, sug- gesting that further improvement can be achieved. This research seeks to develop a unified framework for multimodal biometric fusion to take advantage of the uncertainty concept of Dempster- Shafer theory, improving the performance of multi-biometric authentication systems. Modeling uncertainty as a function of uncertainty factors affecting the recognition performance of the biometric systems helps to address the uncertainty of the data and the confidence of the fusion outcome. A weighted combination of quality measures and classifiers performance (Equal Error Rate) are proposed to encode the uncertainty concept to improve the fusion. We also found that quality measures contribute unequally to the recognition performance, thus selecting only significant factors and fusing them with a Dempster-Shafer approach to generate an overall quality score play an important role in the success of uncertainty modeling. The proposed approach achieved a competitive performance (approximate 1% EER) in comparison with other Dempster-Shafer based approaches and other conventional fusion approaches.

Fusion of worlds : consumers’ self-narrative in a hybrid physical/digital world

As the Internet becomes deeply embedded into consumers’ daily life, the digital virtual world brings significant influence to consumers’ self and narrative. Prior studies look at consumer self from either from a certain online space or comparing consumers’ physical and digital virtual selves but not the integration of the physical/digital world. This paper aims to explore the meanings of the digital virtual space on consumers’ narrative as a whole (their interests, dreams, or subjectivity). We utilise a postmodern concept of the cyborg to understand the cultural complexity, subjective meanings of, and the extent to which the digital virtual space plays a role in consumers’ self-narrative. We conducted in-depth interviews and gathered three consumer narratives. Our findings indicate that consumers’ narrative contains important fragments from both physical and digital virtual worlds and their physical and digital virtual selves form a feedback loop that strengthen their overall narrative.

Preparation, Analysis and Use of an Affinity Adsorbent for the Purification of GST Fusion Protein

Methods are presented for the preparation, ligand density analysis and use of an affinity adsorbent for the purification of a glutathione S-transferase (GST) fusion protein in packed and expanded bed chromatographic processes. The protein is composed of GST fused to a zinc finger transcription factor (ZnF). Glutathione, the affinity ligand for GST purification, is covalently immobilized to a solid-phase adsorbent (Streamline™). The GST–ZnF fusion protein displays a dissociation constant of 0.6 x10-6 M to glutathione immobilized to Streamline™. Ligand density optimization, fusion protein elution conditions (pH and glutathione concentration) and ligand orientation are briefly discussed.

A multidimensional collaborative filtering fusion approach with dimensionality reduction

Multidimensional data are getting increasing attention from researchers for creating better recommender systems in recent years. Additional metadata provides algorithms with more details for better understanding the interaction between users and items. While neighbourhood-based Collaborative Filtering (CF) approaches and latent factor models tackle this task in various ways effectively, they only utilize different partial structures of data. In this paper, we seek to delve into different types of relations in data and to understand the interaction between users and items more holistically. We propose a generic multidimensional CF fusion approach for top-N item recommendations. The proposed approach is capable of incorporating not only localized relations of user-user and item-item but also latent interaction between all dimensions of the data. Experimental results show significant improvements by the proposed approach in terms of recommendation accuracy.

Career counseling : joint contributions of contextual action theory and the systems theory framework

The influence of constructivism and the ongoing drive for convergence, both of career theories and between theory and practice, have been key drivers in the career development literature for two decades (Patton, International Handbook of Career Guidance, 2008). Both contextual action theory and systems theory are derived from the root metaphor of contextualism, which has been proffered as a worldview to assist scientists and practitioners in organizing day-to-day experiential data. This chapter identifies the theoretical contributions of the Systems Theory Framework (STF) (Patton and McMahon, Career development and systems theory: A new development, 1999, Career psychology in South Africa, 2006) and Contextual Action Theory (Young and Valach, The future of career, 2000, Journal of Vocational Behavior 64:499–514, 2004; Young et al., Career choice and development, 1996, Career choice and development, 2002), each of which has advanced thinking in theory integration and in the integration between theory and practice in the career development and counseling field. Young et al. (Career development in childhood and adolescence, 2007) noted the connections between the Patton and McMahon systems theory approach and the contextual action theory approach and these connections will be highlighted in terms of the application of these theoretical developments to practice in career counseling, with a particular focus on the commonalities between the two approaches and what counselors can learn from each of them. In particular, this chapter will discuss common conceptual understandings and practice dimensions.

Hip joint stabilization vs. propulsion and resistance in individuals with transfemoral amputation

Joint moments and joint powers are widely used to determine the effects of rehabilitation programs and prosthetic components (e.g., alignments). A complementary analysis of the 3D angle between joint moment and joint angular velocity has been proposed to assess whether the joints are predominantly driven or stabilized.

Dynamic input to determine hip joint moments, power and work on the prosthetic limb of transfemoral amputees: ground reactions vs knee reactions

Study Design: Comparative analysis Background: Calculations of lower limbs kinetics are limited by floor-mounted force-plates. Objectives: Comparison of hip joint moments, power and mechanical work on the prosthetic limb of a transfemoral amputee calculated by inverse dynamics using either the ground reactions (force-plates) or knee reactions (transducer). Methods: Kinematics, ground reactions and knee reactions were collected using a motion analysis system, two force-plates and a multi-axial transducer mounted below the socket, respectively. Results: The inverse dynamics using ground reactions under-estimated the peaks of hip energy generation and absorption occurring at 63 % and 76 % of the gait cycle (GC) by 28 % and 54 %, respectively. This method over-estimated a phase of negative work at the hip (from 37 %GC to 56 %GC) by 24%. It under-estimated the phases of positive (from 57 %GC to 72 %GC) and negative (from 73 %GC to 98 %GC) work at the hip by 11 % and 58%, respectively. Conclusions: A transducer mounted within the prosthesis has the capacity to provide more realistic kinetics of the prosthetic limb because it enables assessment of multiple consecutive steps and a wide range of activities without issues of foot placement on force-plates. CLINICAL RELEVANCE The hip is the only joint that an amputee controls directly to set in motion the prosthesis. Hip joint kinetics are associated with joint degeneration, low back pain, risks of fall, etc. Therefore, realistic assessment of hip kinetics over multiple gait cycles and a wide range of activities is essential.