Static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with osseointegrated implant: Kinetic analysis

The desire to solve problems caused by socket prostheses in transfemoral amputees and the acquired success of osseointegration in the dental application has led to the introduction of osseointegration in the orthopedic surgery. Since its first introduction in 1990 in Gothenburg Sweden the osseointegrated (OI) orthopedic fixation has proven several benefits[1]. The surgery consists of two surgical procedures followed by a lengthy rehabilitation program. The rehabilitation program after an OI implant includes a specific training period with a short training prosthesis. Since mechanical loading is considered to be one of the key factors that influence bone mass and the osseointegration of bone-anchored implants, the rehabilitation program will also need to include some form of load bearing exercises (LBE). To date there are two frequently used commercially available human implants. We can find proof in the literature that load bearing exercises are performed by patients with both types of OI implants. We refer to two articles, a first one written by Dr. Aschoff and all and published in 2010 in the Journal of Bone and Joint Surgery.[2] The second one presented by Hagberg et al in 2009 gives a very thorough description of the rehabilitation program of TFA fitted with an OPRA implant. The progression of the load however is determined individually according to the residual skeleton’s quality, pain level and body weight of the participant.[1] Patients are using a classical bathroom weighing scale to control the load on the implant during the course of their rehabilitation. The bathroom scale is an affordable and easy-to-use device but it has some important shortcomings. The scale provides instantaneous feedback to the patient only on the magnitude of the vertical component of the applied force. The forces and moments applied along and around the three axes of the implant are unknown. Although there are different ways to assess the load on the implant for instance through inverse dynamics in a motion analysis laboratory [3-6] this assessment is challenging. A recent proof- of-concept study by Frossard et al (2009) showed that the shortcomings of the weighing scale can be overcome by a portable kinetic system based on a commercial transducer[7].

Analysing student programs in the PHP intelligent tutoring system

Programming is a subject that many beginning students find difficult. The PHP Intelligent Tutoring System (PHP ITS) has been designed with the aim of making it easier for novices to learn the PHP language in order to develop dynamic web pages. Programming requires practice. This makes it necessary to include practical exercises in any ITS that supports students learning to program. The PHP ITS works by providing exercises for students to solve and then providing feedback based on their solutions. The major challenge here is to be able to identify many semantically equivalent solutions to a single exercise. The PHP ITS achieves this by using theories of Artificial Intelligence (AI) including first-order predicate logic and classical and hierarchical planning to model the subject matter taught by the system. This paper highlights the approach taken by the PHP ITS to analyse students’ programs that include a number of program constructs that are used by beginners of web development. The PHP ITS was built using this model and evaluated in a unit at the Queensland University of Technology. The results showed that it was capable of correctly analysing over 96 % of the solutions to exercises supplied by students.

Pre-packaging preschool literacy: What drives early childhood teachers to use commercially produced phonics programs in prior to school settings

Language-rich environments are key to overall quality in early childhood settings, including frequent child–staff interactions around picture books and dramatic play. In a language-rich environment, explicit teaching of literacy concepts, such as phonics, is embedded in authentic and meaningful situations where alphabet letters and sounds are taught in a context meaningful to the child. Recent research, however, suggests that the use of commercial pre-packaged phonics programs (such as Letterland and Jolly Phonics) is widespread in prior to school settings in Sydney, Australia. Little is known about why early childhood teachers choose to use such programs with children aged five and under. In the present study, thematic analysis of data from interviews with five early childhood teachers using commercial phonics programs found that their reasons were pragmatic rather than pedagogical. Motivations included the idea that the programs reduced their workload, provided tangible evidence to parents of their child’s ‘school readiness’, and served as a marketing tool to attract parents. Further analysis found that the teachers were unable to articulate what phonics and phonological awareness are and how they are learnt in early childhood.

Bone-anchored prosthesis: Update in international developments

This symposium will provide hand-on update on the current development of the load sensors measuring the inner prosthetic loading that can strongly contribute the ever increasing demand for evidence-based clinical practice. Surgical implantations of osseointegrated fixations for bone-anchored prosthesis are developing at an unprecedented pace worldwide (e.g., Australia, UK, Sweden, US). This option is becoming accessible to a wide range of individuals with limb loss. With these new developments come new potential challenges and opportunities for all the stakeholders involved in the prosthetic care of these patients. Clearly, there is a need for those stakeholders, particularly those attending the ISPO, to be informed of the current and upcoming international developments in bone-anchored prostheses. The objectives of this symposium will be: • To present an overview of the current growth of the procedures worldwide (e.g., identification of key players, centers of activities, growth trend) with a strong focus on the introduction of the framework to evaluate the availability of the procedure at national level (e.g., number of patients treated, range of the levels of implantation, number of commercial fixations accessible), • To provide first-hand updates on the latest cutting-edge scientific and clinical developments of fixations and rehabilitations programs (e.g., Innovative design of implant, cost-effectiveness, long-terms rehabilitation outcomes for screw-type fixation, current developments in US, comparative analysis for press-fit type of implant, potential moves toward single-stage surgeries).

The Steering Clear First Offender Drink Driving Program

This program is a research based, guided intervention program, designed for first time drink driving offenders which provides them with information and strategies to avoid drink driving in the future. It is an innovative program with the ability to tailor specific information to different individuals based on their level of risk of reoffending and help them develop their own plan to prevent them from drink driving. It aims to teach offenders the skills to implement their own plan when they determine they are at risk of future drink driving. The program provides information about: What a standard drink is and how blood alcohol content (BAC) is determined; How alcohol affects the body, reaction time, and decision making; The consequences of drink driving and what happens after a second offence; How to deal with risky drink driving situations in the future; How to build a personalised plan to avoid drink driving in the future, and; Levels of alcohol consumption and its impact on daily life. It also includes access to a mobile friendly web app that can be used anytime after completing the program. This is tool that will aid offenders in tracking their drinks and build on plans to prevent future drink driving.

Incentivizing innovation: A review of the Brazilian federal innovation support programs

Innovation is the transformation of knowledge of any kind into new products or services in the market. Its importance as a production factor is widely acknowledged. In the age of the knowledge-based economy innovation became critical for any company or even country to compete globally. Many countries are encouraging innovation through various mechanisms, and one of the most widely used is the provision of special incentives for innovation. This paper investigates incentive systems for the growth of technology companies as a strategy to promote knowledge-based economic development. As for the case investigations the study focuses on an emerging economy, Brazil. The research is based upon the available literature, best practices, government policy and review of incentive systems. The findings provide insights from the case study in a country context and some lessons learned for other countries using incentive systems to boost the innovation capabilities of their technology companies.

Towards sustainable poverty alleviation: Building NGO accountability to beneficiaries in microenterprise development programs

This thesis investigates the operations of non-government organisations (NGOs) engaging in microenterprise development programs in Bangladesh and Indonesia, to understand the nature and mechanisms of NGO accountability to the poor. Findings reveal both barriers and mechanisms contributing to success within these programs. A range of mechanisms enhance both accountability of NGOs and the poor, facilitating more effective programs and sustainable poverty alleviation.

The rise and fall of Rentboy.com

Earlier this week, the New York Police Department in partnership with Homeland Security arrested seven people and seized a number of documents pertaining to the website Rentboy.com. Although the website purports to help men connect for companionship only, authorities allege that it has been used to “facilitate the promotion, management, establishment, and carrying on of an unlawful activity, namely an enterprise involving prostitution”. Unlike Australia, which started the decriminalisation of sex work as early as 1979, sex work is illegal across all of the USA, save a few counties in Nevada where it is subject to heavy regulation. The raid on Rentboy.com raises important questions about sex work, including its visibility, consumer demand for such services, and the ongoing marginalisation of those who buy and sell sexual services...

The discursive positioning of graduating teachers in accreditation of teacher education programs

This paper uses discourse analysis techniques associated with Foucauldian archaeology to examine a teacher education accreditation document from Australia to reveal how graduating teachers are constructed through the discourses presented. The findings reveal a discursive site of contestation within the document itself and a mismatch between the identified policy discourses and those from the academic archive. The authors suggest that rather than contradictory representations of what constitutes graduating teacher quality and professionalism, what is needed is an accreditation process that agrees on constructions of graduate identity and professional practice that enact an intellectual and reflexive form of professionalism.

Rehabilitation of individuals with bone-anchored prosthesis: State-of-the-art and challenges

Individuals with limb amputation fitted with conventional socket-suspended prostheses often experience socket-related discomfort leading to a significant decrease in quality of life. Bone-anchored prostheses are increasingly acknowledged as viable alternative method of attachment of artificial limb. In this case, the prosthesis is attached directly to the residual skeleton through a percutaneous fixation. To date, a few osseointegration fixations are commercially available. Several devices are at different stages of development particularly in Europe and the US.[1-15] Clearly, surgical procedures are currently blooming worldwide. Indeed, Australia and Queensland in particular have one of the fastest growing populations. Previous studies involving either screw-type implants or press-fit fixations for bone-anchorage have focused on fragmented biomechanics aspects as well as the clinical benefits and safety of the procedure. However, very few publications have synthetized this information and provided an overview of the current developments in bone-anchored prostheses worldwide, let alone in Australia. The purposes of the presentation will be: 1. To provide an overview of the state-of-art developments in bone-anchored prostheses with as strong emphasis on the design of fixations, treatment, benefits, risks as well as future opportunities and challenges, 2. To present the current international developments of procedures for bone-anchored prostheses in terms of numbers of centers, number of cases and typical case-mix, 3. To highlight the current role Australia is playing as a leader worldwide in terms of growing population, broadest range of case-mix, choices of fixations, development of reimbursement schemes, unique clinical outcome registry for evidence-based practice, cutting-edge research, consumer demand and general public interest.

Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: A pragmatic, stepped-wedge, cluster-randomised controlled trial

- Background Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme. - Methods Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886). - Findings Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42–0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42–0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7–19], control 10 days [6–18]). - Interpretation Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units.

Learner driver mentor programs: Stakeholder perspectives on an ideal program

This study investigated the development and operation of Learner Driver Mentor Programs (LDMPs). LDMPs are used throughout Australia to assist young learner drivers to gain supervised on-road driving experience through coordinated access to vehicles and supervisors. There is a significant lack of research regarding these programs. In this study, 41 stakeholders including representatives from existing or ceased LDMPs as well as representatives of other groups completed a questionnaire in either survey or interview format. The questionnaire sought information about the objectives of LDMPs, any social problems that were targeted as well as the characteristics of an ideal program and what could be done to improve them. Stakeholders indicated that LDMPs were targeted at local communities and, therefore, there should be a clear local need for the program as well as community ownership and involvement in the program. Additionally, the program needed to be accessible and provide clear positive outcomes for mentees. The most common suggestion to improve LDMPs related to the provision of greater funding and sponsorship, particularly in relation to the vehicles used within the programs. LDMPs appear to have an important role in facilitating young learner drivers to acquire the appropriate number of supervised hours of driving practice. However, while a number of factors appear related to a successful program, the program must remain flexible and suitable for its local community. There is a clear need to complete evaluations of existing programs to ensure that future LDMPs and modifications to existing programs are evidence-based.

Nutritional rehabilitation in cystic fibrosis: A 5 year follow-up study

Previously, we reported catch-up weight gain, growth, and improved lung function in a group of malnourished cystic fibrosis (CF) children receiving aggressive nutritional supplementation for 1 year compared with a forced expiratory volume in 1 s (FEV1)-, height-, and sex-matched comparison group receiving standard therapy. To evaluate long-term effects, the clinical progress of both groups has been studied over a 5 year period. The supplemented group (n = 10) received supplements for a median of 1.35 years to achieve nutritional rehabilitation. Compared with the nonsupplemented group (n = 14), the previously supplemented group had lower mortality (2 vs. 4, N.S.) and significantly greater weight and height z scores at 4 and 5 years. The progression of pulmonary function abnormalities as measured by FEV, and forced vital capacity (FVC) slopes was greater at 3 years in the nonsupplemented group (FEV1, p < 0.05) but no significant differences in rates of deterioration of pulmonary function were seen after 5 years in the two groups of survivors. We conclude that intensive nutritional support for 1 year has both short-and long-term effects on nutrition and growth, still evident some years after the cessation of this therapeutic modality. Supplementation for periods of longer than 1 year may produce greater gains and possibly prolong the improvement in pulmonary function observed in the earlier study. © 1992 Raven Press, Ltd., New York.