Blood cultures for evaluation of early postoperative fever after femoral neck fracture surgery

PURPOSE. To evaluate the utility of blood cultures in the assessment of early postoperative fever in hip fracture patients with no other indicators of sepsis. METHODS. 101 blood cultures were drawn on postoperative days 0 to 5 to investigate 84 febrile episodes in 31 women and 30 men (mean age, 80 years) whose body temperature measured via the tympanic route was ≥38ºC. Culture results of these 61 patients were divided into culture-positive and culture-negative groups for comparison. RESULTS. Of the 101 blood cultures, only 2 were positive: one was obtained 5 days after dynamic hip screw fixation, and the other 4 days after hemiarthroplasty. Both blood cultures grew coagulase-negative staphylococcal species, which were deemed to be skin contaminants not requiring change of patient management. 44 of these patients were treated with oral or intravenous antibiotics for a period of time. CONCLUSION. The risk of bacteraemia in patients with postoperative fever but no other symptoms of infection is low. Routine procurement of blood cultures in such patients is ineffective and of limited utility.

From simulation to emulation : an integrated approach for network security evaluation

We present a virtual test bed for network security evaluation in mid-scale telecommunication networks. Migration from simulation scenarios towards the test bed is supported and enables researchers to evaluate experiments in a more realistic environment. We provide a comprehensive interface to manage, run and evaluate experiments. On basis of a concrete example we show how the proposed test bed can be utilized.

Investigation into the noise map based on traffic flow prediction in the citywide road network

As one of the measures for decreasing road traffic noise in a city, the control of the traffic flow and the physical distribution is considered. To conduct the measure effectively, the model for predicting the traffic flow in the citywide road network is necessary. In this study, the existing model named AVENUE was used as a traffic flow prediction model. The traffic flow model was integrated with the road vehicles' sound power model and the sound propagation model, and the new road traffic noise prediction model was established. As a case study, the prediction model was applied to the road network of Tsukuba city in Japan and the noise map of the city was made. To examine the calculation accuracy of the noise map, the calculated values of the noise at the main roads were compared with the measured values. As a result, it was found that there was a possibility that the high accuracy noise map of the city could be made by using the noise prediction model developed in this study.

Information provision and network performance represented by Macroscopic Fundamental Diagram

The existence of the Macroscopic Fundamental Diagram (MFD), which relates network space-mean density and flow, has been shown in urban networks under homogeneous traffic conditions. Since the MFD represents the area-wide network traffic performances, studies on perimeter control strategies and an area traffic state estimation utilizing the MFD concept has been reported. The key requirements for the well-defined MFD is the homogeneity of the area wide traffic condition, which is not universally expected in real world. For the practical application of the MFD concept, several researchers have identified the influencing factors for network homogeneity. However, they did not explicitly take drivers’ behaviour under real time information provision into account, which has a significant impact on the shape of the MFD. This research aims to demonstrate the impact of drivers’ route choice behaviour on network performance by employing the MFD as a measurement. A microscopic simulation is chosen as an experimental platform. By changing the ratio of en-route informed drivers and pre-trip informed drivers as well as by taking different route choice parameters, various scenarios are simulated in order to investigate how drivers’ adaptation to the traffic congestion influences the network performance and the MFD shape. This study confirmed and addressed the impact of information provision on the MFD shape and highlighted the significance of the route choice parameter setting as an influencing factor in the MFD analysis.

Effects of wireless sensor network uncertainties on output-only modal analysis employing merged data of multiple tests

The use of Wireless Sensor Networks (WSNs) for Structural Health Monitoring (SHM) has become a promising approach due to many advantages such as low cost, fast and flexible deployment. However, inherent technical issues such as data synchronization error and data loss have prevented these distinct systems from being extensively used. Recently, several SHM-oriented WSNs have been proposed and believed to be able to overcome a large number of technical uncertainties. Nevertheless, there is limited research verifying the applicability of those WSNs with respect to demanding SHM applications like modal analysis and damage identification. This paper first presents a brief review of the most inherent uncertainties of the SHM-oriented WSN platforms and then investigates their effects on outcomes and performance of the most robust Output-only Modal Analysis (OMA) techniques when employing merged data from multiple tests. The two OMA families selected for this investigation are Frequency Domain Decomposition (FDD) and Data-driven Stochastic Subspace Identification (SSI-data) due to the fact that they both have been widely applied in the past decade. Experimental accelerations collected by a wired sensory system on a large-scale laboratory bridge model are initially used as clean data before being contaminated by different data pollutants in sequential manner to simulate practical SHM-oriented WSN uncertainties. The results of this study show the robustness of FDD and the precautions needed for SSI-data family when dealing with SHM-WSN uncertainties. Finally, the use of the measurement channel projection for the time-domain OMA techniques and the preferred combination of the OMA techniques to cope with the SHM-WSN uncertainties is recommended.

Investigating effective wayfinding in airports : a Bayesian network approach

Effective Wayfinding is the successful interplay of human and environmental factors resulting in a person successfully moving from their current position to a desired location in a timely manner. To date this process has not been modelled to reflect this interplay. This paper proposes a complex modelling system approach of wayfinding by using Bayesian Networks to model this process, and applies the model to airports. The model suggests that human factors have a greater impact on effective wayfinding in airports than environmental factors. The greatest influences on human factors are found to be the level of spatial anxiety experienced by travellers and their cognitive and spatial skills. The model also predicted that the navigation pathway that a traveller must traverse has a larger impact on the effectiveness of an airport’s environment in promoting effective wayfinding than the terminal design.

Molecular dynamics simulation of fracture strength and morphology of defective graphene

Different types of defects can be introduced into graphene during material synthesis, and significantly influence the properties of graphene. In this work, we investigated the effects of structural defects, edge functionalisation and reconstruction on the fracture strength and morphology of graphene by molecular dynamics simulations. The minimum energy path analysis was conducted to investigate the formation of Stone-Wales defects. We also employed out-of-plane perturbation and energy minimization principle to study the possi-ble morphology of graphene nanoribbons with edge-termination. Our numerical results show that the fracture strength of graphene is dependent on defects and environmental temperature. However, pre-existing defects may be healed, resulting in strength recovery. Edge functionalization can induce compressive stress and ripples in the edge areas of gra-phene nanoribbons. On the other hand, edge reconstruction contributed to the tensile stress and curved shape in the graphene nanoribbons.

A case for optimising fracture healing through inverse dynamization

The mechanical conditions in the repair tissues are known to influence the outcome of fracture healing. These mechanical conditions are determined by the stiffness of fixation and limb loading. Experimental studies have shown that there is a range of beneficial fixation stiffness for timely healing and that fixation stiffness that is either too flexible or too stiff impairs callus healing. However, much less is known about how mechanical conditions influence the biological processes that make up the sequence of bone repair and if indeed mechanical stimulation is required at all stages of repair. Secondary bone healing occurs through a sequence of events broadly characterised by inflammation, proliferation, consolidation and remodelling. It is our hypothesis that a change in fixation stiffness from very flexible to stiff can shorten the time to healing relative to constant fixation stiffness. Flexible fixation has the benefit of promoting greater callus formation and needs to be applied during the proliferative stage of repair. The greater callus size helps to stabilize the fragments earlier allowing mineralization to occur faster. Together with stable/rigid fixation applied during the latter stage of repair to ensure mineralization of the callus. The predicted benefits of inverse dynamization are shortened healing in comparison to very flexible fixation and healing time comparable or faster than stable fixation with greater callus stiffness.

A new model to study healing of a complex femur fracture with concurrent soft tissue injury in sheep

High energy bone fractures resulting from impact trauma are often accompanied by subcutaneous soft tissue injuries, even if the skin remains intact. There is evidence that such closed soft tissue injuries affect the healing of bone fractures, and vice versa. Despite this knowledge, most impact trauma studies in animals have focussed on bone fractures or soft tissue trauma in isolation. However, given the simultaneous impact on both tissues a better understanding of the interaction between these two injuries is necessary to optimise clinical treatment. The aim of this study was therefore to develop a new experimental model and characterise, for the first time, the healing of a complex fracture with concurrent closed soft tissue trauma in sheep. A pendulum impact device was designed to deliver a defined and standardised impact to the distal thigh of sheep, causing a reproducible contusion injury to the subcutaneous soft tissues. In a subsequent procedure, a reproducible femoral butterfly fracture (AO C3-type) was created at the sheep’s femur, which was initially stabilised for 5 days by an external fixator construct to allow for soft tissue swelling to recede, and ultimately in a bridging construct using locking plates. The combined injuries were applied to twelve sheep and the healing observed for four or eight weeks (six animals per group) until sacrifice. The pendulum impact led to a moderate to severe circumferential soft tissue injury with significant bruising, haematomas and partial muscle disruptions. Posttraumatic measurements showed elevated intra-compartmental pressure and circulatory tissue breakdown markers, with recovery to normal, pre-injury values within four days. Clinically, no neurovascular deficiencies were observed. Bi-weekly radiological analysis of the healing fractures showed progressive callus healing over time, with the average number of callus bridges increasing from 0.4 at two weeks to 4.2 at eight weeks. Biomechanical testing after sacrifice showed increasing torsional stiffness between four and eight weeks healing time from 10% to 100%, and increasing ultimate torsional strength from 10% to 64% (relative to the contralateral control limb). Our results demonstrate the robust healing of a complex femur fracture in the presence of a severe soft tissue contusion injury in sheep and demonstrate the establishment of a clinically relevant experimental model, for research aimed at improving the treatment of bone fractures accompanied by closed soft tissue injuries.

Oropharyngeal dysphagia in an elderly post-operative hip fracture population : a prospective cohort study

Background: normal ageing processes impact on oropharyngeal swallowing function placing older adults at risk of developing oropharyngeal dysphagia (OD). Anecdotal clinical experience has observed that older patients recovering from hip fracture surgery commonly develop OD post-operatively. Objective: to document the presence of OD following hip fracture surgery, and the factors associated with OD. Methods: one hundred and eighty-one patients with a mean age of 83 years (range: 65–103) admitted to a specialised orthogeriatric unit were assessed for OD post-surgery for hip fracture. Pre-admission, intra-operative and post-operative factors were examined to determine their relationship with the presence of OD. Results: OD was found to be present post-operatively in 34% (n = 61) of the current population. Multivariate logistic regression analyses revealed the presence of pre-existing neurological and respiratory medical co-morbidities, presence of post-operative delirium, age and living in a residential aged care facility prior to hospital admission to be associated with the post-operative OD. Conclusion: these results highlight that OD is present in a large number of the older hip fracture population. Early identification of OD has important implications for the provision of timely dysphagia management that may prevent secondary complications and potentially reduce the hospital length of stay.

Compaction control of topography and fault network structure along strike-slip faults in sedimentary basins

Strike-slip faults commonly display structurally complex areas of positive or negative topography. Understanding the development of such areas has important implications for earthquake studies and hydrocarbon exploration. Previous workers identified the key factors controlling the occurrence of both topographic modes and the related structural styles. Kinematic and stress boundary conditions are of first-order relevance. Surface mass transport and material properties affect fault network structure. Experiments demonstrate that dilatancy can generate positive topography even under simple-shear boundary conditions. Here, we use physical models with sand to show that the degree of compaction of the deformed rocks alone can determine the type of topography and related surface fault network structure in simple-shear settings. In our experiments, volume changes of ∼5% are sufficient to generate localized uplift or subsidence. We discuss scalability of model volume changes and fault network structure and show that our model fault zones satisfy geometrical similarity with natural flower structures. Our results imply that compaction may be an important factor in the development of topography and fault network structure along strike-slip faults in sedimentary basins.

Constructing a research network : accounting knowledge in production

Purpose – The purpose of this paper is to contribute to the sociology-of-science type of accounting literature, addressing how accounting knowledge is established, advanced and extended. Design/methodology/approach – The research question is answered through the example of research into linkages between accounting and religion. Adopting an actor-network theory (ANT) approach, the paper follows the actors involved in the construction of accounting as an academic discipline through the controversies in which they engage to develop knowledge. Findings – The paper reveals that accounting knowledge is established, advanced and developed through the ongoing mobilisation of nonhumans (journals) who can enrol other humans and nonhumans. It shows that knowledge advancement, establishment and development is more contingent on network breadth than on research paradigms, which appear as side-effects of positioning vis-a-vis a community. Originality/value – The originality of this paper is twofold. First, ANT is applied to accounting knowledge, whereas the accounting literature applies it to the spread of management accounting ideas, methods and practices. Second, an original methodology for data collection is developed by inviting authors from the network to give a reflexive account of their writings at the time they joined the network. Well diffused in sociology and philosophy, such an approach is, albeit, original in accounting research.

A hybrid association rule mining approach for characterizing network traffic behaviour

Understanding network traffic behaviour is crucial for managing and securing computer networks. One important technique is to mine frequent patterns or association rules from analysed traffic data. On the one hand, association rule mining usually generates a huge number of patterns and rules, many of them meaningless or user-unwanted; on the other hand, association rule mining can miss some necessary knowledge if it does not consider the hierarchy relationships in the network traffic data. Aiming to address such issues, this paper proposes a hybrid association rule mining method for characterizing network traffic behaviour. Rather than frequent patterns, the proposed method generates non-similar closed frequent patterns from network traffic data, which can significantly reduce the number of patterns. This method also proposes to derive new attributes from the original data to discover novel knowledge according to hierarchy relationships in network traffic data and user interests. Experiments performed on real network traffic data show that the proposed method is promising and can be used in real applications. Copyright2013 John Wiley & Sons, Ltd.

Stakeholder engagement by governance networks : a study of stakeholder engagement by road delivery network in Queensland

This thesis explores how governance networks prioritise and engage with their stakeholders, by studying three exemplars of “Regional Road Group” governance networks in Queensland, Australia. In the context of managing regionally significant road works programs, stakeholder prioritisation is a complex activity which is unlikely to influence interactions with stakeholders outside of the network. However, stakeholder priority is more likely to influence stakeholder interactions within the networks themselves. Both stakeholder prioritisation and engagement are strongly influenced by the way that the networks are managed, and in particular network operating rules and continuing access to resources.

Using a Bayesian network to model colonisation with Vancomycin Resistant Enterococcus (VRE)

Objective: Effective management of multi-resistant organisms is an important issue for hospitals both in Australia and overseas. This study investigates the utility of using Bayesian Network (BN) analysis to examine relationships between risk factors and colonization with Vancomycin Resistant Enterococcus (VRE). Design: Bayesian Network Analysis was performed using infection control data collected over a period of 36 months (2008-2010). Setting: Princess Alexandra Hospital (PAH), Brisbane. Outcome of interest: Number of new VRE Isolates Methods: A BN is a probabilistic graphical model that represents a set of random variables and their conditional dependencies via a directed acyclic graph (DAG). BN enables multiple interacting agents to be studied simultaneously. The initial BN model was constructed based on the infectious disease physician‟s expert knowledge and current literature. Continuous variables were dichotomised by using third quartile values of year 2008 data. BN was used to examine the probabilistic relationships between VRE isolates and risk factors; and to establish which factors were associated with an increased probability of a high number of VRE isolates. Software: Netica (version 4.16). Results: Preliminary analysis revealed that VRE transmission and VRE prevalence were the most influential factors in predicting a high number of VRE isolates. Interestingly, several factors (hand hygiene and cleaning) known through literature to be associated with VRE prevalence, did not appear to be as influential as expected in this BN model. Conclusions: This preliminary work has shown that Bayesian Network Analysis is a useful tool in examining clinical infection prevention issues, where there is often a web of factors that influence outcomes. This BN model can be restructured easily enabling various combinations of agents to be studied.