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.

Social enterprises and the performance advantages of a Vincentian marketing orientation

This study focuses on the managerial issue of should social enterprises (SEs) become more marketing oriented. It adapts the Kohli et al. (J Mark Res 30:467–477,1993) MARKOR marketing orientation scale to measure the adoption of marketing by SEs. The items capture Vincentian-based values to leverage business in service to the poor as a measure of a Vincentian marketing orientation (VMO). A VMO is an organisational wide value-driven philosophy of management that focuses a SE on meeting its objectives by adopting a more marketing orientated approach to serve the needy and poor in a just and sustainable manner. SEs that exhibit a VMO seek to understand and respond to both the needs of their beneficiaries and stakeholders. They are constantly generating,disseminating, and responding to environmental, beneficiary, and stakeholder information and develop their business propositions to more effectively and efficiently meet the needs of the poor, while guided by a philosophy of leveraging business for social good. This study of SEs in Australia found that a VMO is strongly and positively correlated with social, economic, and environmental performance. These findings suggest that SEs may benefit by leveraging marketing capabilities to better serve their beneificiaries and stakeholders.

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.

Satisfaction with emergency department service among non-English-speaking background patients

Objective: The present study aims to investigate non-English-speaking background (NESB) patients’ satisfaction with hospital ED service and compare it with that of English-speaking background (ESB) patients. Methods: A cross-sectional survey was conducted at the ED of an adult tertiary referral hospital in Queensland, Australia. Patients assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed in the ED, before and after their ED service. Pearson χ2- test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB groups in terms of patient-reported satisfaction. Results: In total, 828 patients participated in the present study. Although the overall satisfaction with the service was high – 95.1% (ESB) and 90.5% (NESB) – the NESB patients who did not use an interpreter were less satisfied with their ED service than the ESB patients (odds ratio 0.5, 95% confidence interval 0.3–0.8, P = 0.013). The promptness of service received the lowest satisfaction rates (ESB 85.4% [82.4–88.0], NESB 74.5% [68.5– 79.7], P < 0.001), whereas courtesy and friendliness received the highest satisfaction rates (ESB 98.8 [97.6–99.4], NESB 97.0 [93.9–98.5], P = 0.063). All participants reported the promptness of service (33.5%), quality and professional care (18.5%) and communication (17.6%) as the most important elements of ED service. Conclusion: The NESB patients were significantly less satisfied than the ESB patients with the ED service. Use of an interpreter improved the NESB patients’ level of satisfaction. Further research is required to examine what NESB patients’ expectations of ED service are.

Ultrafine particles in cities

Ultrafine particles (UFP; diameter less than 100 nm) are ubiquitous in urban air, and an acknowledged risk to human health. Globally, the major source for urban outdoor UFP concentrations is motor traffic. Ongoing trends towards urbanisation and expansion of road traffic are anticipated to further increase population exposure to UFPs. Numerous experimental studies have characterised UFPs in individual cities, but an integrated evaluation of emissions and population exposure is still lacking. Our analysis suggest that average exposure to outdoor UFPs in Asian cities is about four-times larger than those in European cities but impacts on human health are largely unknown. This article reviews some fundamental drivers of UFP emissions and dispersion, and highlights unresolved challenges, as well as recommendations to ensure sustainable urban development whilst minimising any possible adverse health impacts.

Characteristics of ultrafine particle sources and deposition rates in primary school classrooms

The aim of this work was to investigate changes in particle number concentration (PNC) within naturally ventilated primary school classrooms arising from local sources either within or adjacent to the classrooms. We quantify the rate at which ultrafine particles were emitted either from printing, grilling, heating or cleaning activities and the rate at which the particles were removed by both deposition and air exchange processes. At each of 25 schools in Brisbane, Australia, two weeks of measurements of PNC and CO2 were taken both outdoors and in the two classrooms. Bayesian regression modelling was employed in order to estimate the relevant rates and analyse the relationship between air exchange rate (AER), particle infiltration and the deposition rates of particle generated from indoor activities in the classrooms. During schooling hours, grilling events at the school tuckshop as well as heating and printing in the classrooms led to indoor PNCs being elevated by a factor of more than four, with emission rates of (2.51 ± 0.25) x 1011 p min-1, (8.99 ± 6.70) x 1011 p min-1 and (5.17 ± 2.00) x 1011 p min-1, respectively. During non-school hours, cleaning events elevated indoor PNC by a factor of above five, with an average emission rate of (2.09 ± 6.30) x 1011 p min-1. Particles were removed by both air exchange and deposition; chiefly by ventilation when AER > 0.7 h-1 and by deposition when AER < 0.7 h-1.

Dynamic modelling of long-term care decisions

This paper describes and analyzes research on the dynamics of long-term care and the policy relevance of identifying the sources of persistence in caregiving arrangements (including the effect of dynamics on parameter estimates, implications for family welfare, parent welfare, child welfare, and cost of government programs). We discuss sources and causes of observed persistence in caregiving arrangements including inertia/state dependence (confounded by unobserved heterogeneity) and costs of changing caregivers. We comment on causes of dynamics including learning/human capital accumulation; burnout; and game-playing. We suggest how to deal with endogenous geography; dynamics in discrete and continuous choices; and equilibrium issues (multiple equilibria, dynamic equilibria). We also present an overview of commonly used longitudinal data sets and evaluate their relative advantages/disadvantages. We also discuss other data issues related to noisy measures of wealth and family structure. Finally, we suggest some methods to handle econometric problems such as endogeneous geography. © 2014 Springer Science+Business Media New York.

Bike share's impact on car use : evidence from the United States, Great Britain, and Australia

There are currently more than 700 cities operating bike share programs. Purported benefits of bike share include flexible mobility, physical activity, reduced congestion, emissions and fuel use. Implicit or explicit in the calculation of program benefits are assumptions regarding the modes of travel replaced by bike share journeys. This paper examines the degree to which car trips are replaced by bike share, through an examination of survey and trip data from bike share programs in Melbourne, Brisbane, Washington, D.C., London, and Minneapolis/St. Paul. A secondary and unique component of this analysis examines motor vehicle support services required for bike share fleet rebalancing and maintenance. These two components are then combined to estimate bike share’s overall contribution to changes in vehicle kilometers traveled. The results indicate an estimated reduction in motor vehicle use due to bike share of approx. 90,000 km per annum in Melbourne and Minneapolis/St. Paul and 243,291 km for Washington, D.C. London’s bike share program however recorded an additional 766,341 km in motor vehicle use. This was largely due to a low car mode substitution rate and substantial truck use for rebalancing of bicycles. As bike share programs mature, evaluation of their effectiveness in reducing car use may become increasingly important. Researchers can adapt the analytical approach proposed in this paper to assist in the evaluation of current and future bike share programs.

Precise relative clock synchronization for distributed control using TSC registers

Precise clock synchronization is essential in emerging time-critical distributed control systems operating over computer networks where the clock synchronization requirements are mostly focused on relative clock synchronization and high synchronization precision. Existing clock synchronization techniques such as the Network Time Protocol (NTP) and the IEEE 1588 standard can be difficult to apply to such systems because of the highly precise hardware clocks required, due to network congestion caused by a high frequency of synchronization message transmissions, and high overheads. In response, we present a Time Stamp Counter based precise Relative Clock Synchronization Protocol (TSC-RCSP) for distributed control applications operating over local-area networks (LANs). In our protocol a software clock based on the TSC register, counting CPU cycles, is adopted in the time clients and server. TSC-based clocks offer clients a precise, stable and low-cost clock synchronization solution. Experimental results show that clock precision in the order of 10~microseconds can be achieved in small-scale LAN systems. Such clock precision is much higher than that of a processor's Time-Of-Day clock, and is easily sufficient for most distributed real-time control applications over LANs.

Formation and electron field emission of graphene films grown by hot filament chemical vapor deposition

Graphene films with different structures were catalytically grown on the silicon substrate pre-deposited with a gold film by hot filament chemical vapor deposition under different conditions, where methane, hydrogen and nitrogen were used as the reactive gases. The morphological and compositional properties of graphene films were studied using advanced instruments including field emission scanning electron microscopy, micro-Raman spectroscopy and X-ray photoelectron spectroscopy. The results indicate that the structure and composition of graphene films are changed with the variation of the growth conditions. According to the theory related to thermodynamics, the formation of graphene films was theoretically analyzed and the results indicate that the formation of graphene films is related to the fast incorporation and precipitation of carbon. The electron field emission (EFE) properties of graphene films were studied in a high vacuum system of ∼10-6 Pa and the EFE results show that the turn-on field is in a range of 5.2-5.64 V μm-1 and the maximum current density is about 63 μ A cm-2 at the field of 7.7 V μm-1. These results are important to control the structure of graphene films and have the potential applications of graphene in various nanodevices.

Lanthanum oxide nanostructured films synthesized using hot dense and extremely non-equilibrium plasma for nanoelectronic device applications

Lanthanum oxide (La2O3) nanostructured films are synthesized on a p-type silicon wafer by ablation of La2O3 pellet due to interaction with hot dense argon plasmas in a modified dense plasma focus (DPF) device. The nanostructured films are investigated using scanning electron microscopy (SEM), atomic force microscopy (AFM), and X-ray diffraction (XRD) spectra. SEM study shows the formation of nano-films having nano-size structures with the average nanostructures size ~25, ~53, and ~45 nm for one, two, and three DPF shots, respectively. The nanostructures sizes and morphology of nano-films are consistent between the AFM and SEM analyses. XRD spectra confirms nano-sized La2O3 with an average grain size ~34, ~51, and ~42 nm for one, two, and three DPF shots, respectively. The electrical properties such as current-voltage and capacitance-voltage (C-V) characteristics of the Al-La2O3-Si metal-oxide- semiconductor (MOS) capacitor structure are measured. The current conduction mechanism of the MOS capacitors is also demonstrated. The C-V characteristics are further used to obtain the electrical parameters such as the dielectric constant, oxide thickness, flat-band capacitance, and flat-band voltage of the MOS capacitors. These measurements demonstrate significantly lower leakage currents without any commonly used annealing or doping, thereby revealing a significant improvement of the MOS nanoelectronic device performance due to the incorporation of the DPF-produced La2O3 nano-films.

Multivariate statistical analysis of hydrochemical data to assess alluvial aquifer–stream connectivity during drought and flood : Cressbrook Creek, southeast Queensland, Australia

A catchment-scale multivariate statistical analysis of hydrochemistry enabled assessment of interactions between alluvial groundwater and Cressbrook Creek, an intermittent drainage system in southeast Queensland, Australia. Hierarchical cluster analyses and principal component analysis were applied to time-series data to evaluate the hydrochemical evolution of groundwater during periods of extreme drought and severe flooding. A simple three-dimensional geological model was developed to conceptualise the catchment morphology and the stratigraphic framework of the alluvium. The alluvium forms a two-layer system with a basal coarse-grained layer overlain by a clay-rich low-permeability unit. In the upper and middle catchment, alluvial groundwater is chemically similar to streamwater, particularly near the creek (reflected by high HCO3/Cl and K/Na ratios and low salinities), indicating a high degree of connectivity. In the lower catchment, groundwater is more saline with lower HCO3/Cl and K/Na ratios, notably during dry periods. Groundwater salinity substantially decreased following severe flooding in 2011, notably in the lower catchment, confirming that flooding is an important mechanism for both recharge and maintaining groundwater quality. The integrated approach used in this study enabled effective interpretation of hydrological processes and can be applied to a variety of hydrological settings to synthesise and evaluate large hydrochemical datasets.

Designing atmospheric-pressure plasma sources for surface engineering of nanomaterials

Atmospheric-pressure plasma processing techniques emerge as efficient and convenient tools to engineer a variety of nanomaterials for advanced applications in nanoscience and nanotechnology. This work presents different methods, including using a quasi-sinusoidal high-voltage generator, a radio-frequency power supply, and a uni-polar pulse generator, to generate atmospheric-pressure plasmas in the jet or dielectric barrier discharge configurations. The applicability of the atmospheric-pressure plasma is exemplified by the surface modification of nanoparticles for polymeric nanocomposites. Dielectric measurements reveal that representative nanocomposites with plasma modified nanoparticles exhibit notably higher dielectric breakdown strength and a significantly extended lifetime.

Enriching the "I" in Bim : a BIM-Specifications (Bimspecs) approach

This paper conceptualizes a framework for bridging the BIM-Specifications divide by embedding project-specific information in BIM objects by means of a product library. We demonstrate how model information, enriched with data at various levels of development (LODs), can evolve simultaneously with design and construction using a window object embedded in a wall as life-cycle phase exemplars at different levels of granularity. The conceptual approach is informed by the need for exploring an approach that takes cognizance of the limitations of current modelling tools in enhancing the information content of BIM models. Therefore, this work attempts to answer the question, “How can the modelling of building information be enhanced throughout the life-cycle phases of buildings utilizing building specification information?”

Numerical modelling and analysis of the blast performance of laminated glass panels and the influence of material parameters

This paper presents a comprehensive numerical procedure to treat the blast response of laminated glass (LG) panels and studies the influence of important material parameters. Post-crack behaviour of the LG panel and the contribution of the interlayer towards blast resistance are treated. Modelling techniques are validated by comparing with existing experimental results. Findings indicate that the tensile strength of glass considerably influences the blast response of LG panels while the interlayer material properties have a major impact on the response under higher blast loads. Initially, glass panes absorb most of the blast energy, but after the glass breaks, interlayer deforms further and absorbs most of the blast energy. LG panels should be designed to fail by tearing of the interlayer rather than failure at the supports to achieve a desired level of protection. From this aspect, material properties of glass, interlayer and sealant joints play important roles, but unfortunately they are not accounted for in the current design standards. The new information generated in this paper will enhance the capabilities of engineers to better design LG panels under blast loads and use better materials to improve the blast response of LG panels.