Maximum recovery after knee replacement - the MARKER study rationale and protocol

Background There is little scientific evidence to support the usual practice of providing outpatient rehabilitation to patients undergoing total knee replacement surgery (TKR) immediately after discharge from the orthopaedic ward. It is hypothesised that the lack of clinical benefit is due to the low exercise intensity tolerated at this time, with patients still recovering from the effects of major orthopaedic surgery. The aim of the proposed clinical trial is to investigate the clinical and cost effectiveness of a novel rehabilitation strategy, consisting of an initial home exercise programme followed, approximately six weeks later, by higher intensity outpatient exercise classes. Methods/Design In this multicentre randomised controlled trial, 600 patients undergoing primary TKR will be recruited at the orthopaedic pre-admission clinic of 10 large public and private hospitals in Australia. There will be no change to the medical or rehabilitative care usually provided while the participant is admitted to the orthopaedic ward. After TKR, but prior to discharge from the orthopaedic ward, participants will be randomised to either the novel rehabilitation strategy or usual rehabilitative care as provided by the hospital or recommended by the orthopaedic surgeon. Outcomes assessments will be conducted at baseline (pre-admission clinic) and at 6 weeks, 6 months and 12 months following randomisation. The primary outcomes will be self-reported knee pain and physical function. Secondary outcomes include quality of life and objective measures of physical performance. Health economic data (health sector and community service utilisation, loss of productivity) will be recorded prospectively by participants in a patient diary. This patient cohort will also be followed-up annually for five years for knee pain, physical function and the need or actual incidence of further joint replacement surgery. Discussion The results of this pragmatic clinical trial can be directly implemented into clinical practice. If beneficial, the novel rehabilitation strategy of utilising outpatient exercise classes during a later rehabilitation phase would provide a feasible and potentially cost-effective intervention to optimise the physical well-being of the large number of people undergoing TKR.

Collaborative destination branding : planning for tourism development through design in the Waterfall Way, NSW, Australia

This thesis develops, applies and analyses a collaborative design methodology for branding a tourism destination. The area between the Northern Tablelands and the Mid-North Coast of New South Wales, Australia, was used as a case study for this research. The study applies theoretical concepts of systems thinking and complexity to the real world, and tests the use of design as a social tool to engage multiple stakeholders in planning. In this research I acknowledge that places (and destinations) are socially constructed through people's interactions with their physical and social environments. This study explores a methodology that is explicit about the uncertainties of the destination’s system, and that helps to elicit knowledge and system trends. The collective design process used the creation of brand concepts, elements and strategies as instruments to directly engage stakeholders in the process of reflecting about their places and the issues related to tourism activity in the region. The methods applied included individual conversations and collaborative design sessions to elicit knowledge from local stakeholders. Concept maps were used to register and interpret information released throughout the process. An important aspect of the methodology was to bring together different stakeholder groups and translate the information into a common language that was understandable by all participants. This work helped release significant information as to what kind of tourism activity local stakeholders are prepared to receive and support. It also helped the emergence of a more unified regional identity. The outcomes delivered by the project (brand, communication material and strategies) were of high quality and in line with the desires and expectation of the local hosts. The process also reinforced local sense of pride, belonging and conservation. Furthermore, interaction between participants from different parts of the region triggered some self organising activity around the brand they created together. A major contribution of the present work is the articulation of an inclusive methodology to facilitate the involvement of locals into the decision-making process related to tourism planning. Of particular significance is the focus on the social construction of meaning in and through design, showing that design exercises can have significant social impact – not only on the final product, but also on the realities of the people involved in the creative process.

Design, fabrication and characterization of PCL electrospun scaffolds—a review

The expanding interest in electrospinning fibers for bioengineering includes a significant use of polyesters, including poly(3-caprolactone) (PCL). This review summarizes literature on PCL and selected blends, and provides extensive descriptions of the broad range of parameters used in manufacturing such electrospun fibers. Furthermore the chemical, physical and biological approaches for characterizing the electrospun material are described and opinions offered on important information to include in future publications with this electrospun material.

Dangers of the after-dark wonderlands : Part A - A review of the impact of physical environment design on nightclub violence

Nightclubs are businesses. Their business is pleasure; however pleasure has its price. People have become increasingly concerned about the problems of violence in society but why do higher levels of violence occur in nightclubs despite the established patterns of behaviour that dictates how we socialise and act? In response, researchers have focused on identifying social and situational factors that may contribute to violence from a government perspective, focusing on a variety of specific issues ranging from financial standpoints with effective target marketing strategies to legal obligations of supplying alcohol and abiding regulatory conditions. There is little research into specific design properties that can determine design standards to ensure/improve the physical design of nightclub environments to reduce patron violence. To address this gap, this current article aims to understand how people experience and respond to the physical environment of nightclubs and how these spaces influence their behaviour. The first section of this paper examines the background on nightclubs and theories concerning the influence of pleasure. The second section of this paper details the findings of existing studies that have examined the nightlife context and the various factors that influence patron violence. The main finding of this paper is that although alcohol likely plays a contributing role in aggressive patron behaviour, there is evidence that the relationship is moderated by a number of significant factors relating to the characteristics of the drinking environment such as: physical comfort; the degree of overall 'permissiveness‘ in the establishment; crowding; and physical environmental elements most influenced by day to-day management practices such as lighting, ventilation, cleanliness and seating arrangements. The findings from this paper have been used to develop a framework to guide exploratory research on how specific elements of the physical environment of nightclubs have an impact on elevated patron aggression and assault (Koleczko & Garcia Hansen, 2011).

Dangers of the after-dark wonderlands : Part B - A review of the impact of the physical environment design on nightclub violence

Violence in nightclubs is a serious problem that has the Australian government launching multimillion dollar drinking campaigns. Research on nightclub violence has focused on identifying contributing social and environmental factors, with many concentrating on a variety of specific issues ranging from financial standpoints with effective target marketing strategies to legal obligations of supplying alcohol and abiding regulatory conditions. Moreover, existing research suggests that there is no single factor that directly affects the rate violence in licensed venues. As detailed in the review paper of Koleczko and Garcia Hansen (2011), there is little research about the physical environment of nightclubs and which specific design properties can be used to determine design standards to ensure/improve the physical design of nightclub environments to reduce patron violence. This current study seeks to address this omission by reporting on a series of interviews with participants from management and design domains. Featured case studies are both located in Fortitude Valley, a Mecca for party-goers and the busiest nightclub district in Queensland. The results and analysis support the conclusions that a number of elements of the physical environment influence elevated patron aggression and assault.

Assessment of pre- and post-flood groundwater recharge via 3D visualisation, Lockyer Valley, southeast Queensland

The Lockyer Valley in southeast Queensland supports important and intensive irrigation which is dependant on the quality and availability of groundwater. Prolonged drought conditions from ~1997 resulted in a depletion of the alluvial aquifers, and concern for the long-term sustainability of this resource. By 2008, many areas of the valley were at < 20% of storage. Some relief occurred with rain events in early 2009, then in December 2010 - January 2011, most of southeast Queensland experienced unprecedented flooding. These storm-based events have caused a shift in research focus from investigations of drought conditions and mitigation to flood response analysis. For the alluvial aquifer system of the valley, a preliminary assessment of groundwater observation bore data, prior to and during the flood, indicates that there is a spatially variable aquifer response. While water levels in some bores screened in unconfined shallow aquifers have recovered by more than 10 m within a short period of time (months), others show only a small or moderate response. Measurements of pre- and post-flood groundwater levels and high-resolution time-series records from data loggers are considered within the framework of a 3D geological model of the Lockyer Valley using Groundwater Visualisation System(GVS). Groundwater level fluctuations covering both drought and flood periods are used to estimate groundwater recharge using the water table fluctuation method (WTF), supplemented by estimates derived using chloride mass balance. The presentation of hydraulic and recharge information in a 3D format has considerable advantages over the traditional 2D presentation of data. The 3D approach allows the distillation of multiple types of information(topography, geological, hydraulic and spatial) into one representation that provides valuable insights into the major controls of groundwater flow and recharge. The influence of aquifer lithology on the spatial variability of groundwater recharge is also demonstrated.

Design of compact coupled-line couplers

The size of rat-race and branch-line couplers can be reduced by using periodic loading or artificial transmission lines. The objective of this work is to extend the idea of size reduction through periodic loading to coupled-line 90° hybrids. A procedure for the extraction of the characteristic parameters of a coupled-line 4-port from a single set of S-parameters is described. This method can be employed to design of coupled artificial transmission line couplers of arbitrary geometry. The procedure is illustrated through the design a broadside-coupled stripline hybrid, periodically loaded with stubs. Measured results for a prototype coupler confirm the validity of the theory.

The first global entertainment company : explaining Pathe's global dominance in the pre-Hollywood film industry

For almost a decade before Hollywood existed, French firm Pathe towered over the early film industry with estimates of its share of all films sold around the world varying between 50-70%. Pathe was the first global entertainment company. This paper analyses its rise to market leadership by applying a theoretical framework drawn from the business literature on causes of industry dominance, which provides insights into how firms acquire and maintain market dominance, and in this case the film industry. This paper uses evidence presented by film historians to argue that Pathe “fits” the expected theoretical model of a dominant firm because it had a marketing orientation, used an effective quality-based competitive strategy and possessed the six critical strategic marketing capabilities that business research shows enable the best performing firms to consistently outperform rivals

From allure to ethics : design as a ‘creative industry'

In this chapter I look at the question of design and ethics in a situation where design as a set of related economic practices has been re-positioned as a key identifier for a new kind of ideas-driven industry - the creative industries. Previously marginal to cultural policy in the form of applied arts, in the creative industries agenda design became a privileged meeting place, or indeed broker, for art and industry, economy and commerce. I explore the new kinds of ethical challenges this brings.

Urban maze : A typological investigation in porous morphology and dynamic pedestrian networks

Mixed use typologies and pedestrian networks are two strategies commonly applied in design of the contemporary city. These approaches, aimed towards the creation of a more sustainalble urban environment, have their roots in the traditional, pre-industrial towns; they characterize urban form, articulating the tension between privaate and public realms through a series of typological variations as well as stimulating commercial activity in the city centre. Arcades, loggias and verandas are just some of the elements which can mediate this tension. Historically they have defined physical and social spaces with particular character; in the contemporary city these features are applied to deform the urban form and create a porous, dynamic morphology. This paper, comparing case studies from Italy, Japan and Australia, investigates how the design of the transition zone can define hybrid pedestrian networks, where a clear distinction between the public and private realms is no longer applicable. Pedestrians use the city in a dynamic way, combining trajectories on the public street with ones on the fringe or inside of the private built environment. In some cases, cities offer different pedestrian network possibilities at different times, as the commercial precints are subject to variations in accessibility across various timeframes. These walkable systems have an impact on the urban form and identity of places, redefining typologies and requiring an in depth analysis through plan, section and elevation diagrams.

Israel's airstrike on Syria's Al-Kibar facility : a test case for the doctrine of pre-emptive self-defence?

This article analyses the legality of Israel’s 2007 airstrike on an alleged Syrian nuclear facility at Al-Kibar—an incident that has been largely overlooked by international lawyers to date. The absence of a threat of imminent attack from Syria means Israel’s military action was not a lawful exercise of anticipatory self-defence. Yet, despite Israel’s clear violation of the prohibition on the use of force there was remarkably little condemnation from other states, suggesting the possibility of growing international support for the doctrine of pre-emptive self-defence. This article argues that the muted international reaction to Israel’s pre-emptive action was the result of political factors, and should not be seen as endorsement of the legality of the airstrike. As such, a lack of opinio juris means the Al-Kibar episode cannot be viewed as extending the scope of the customary international law right of self-defence so as to permit the use of force against non-imminent threats. However, two features of this incident—namely, Israel’s failure to offer any legal justification for its airstrike, and the international community’s apparent lack of concern over legality—are also evident in other recent uses of force in the ‘war on terror’ context. These developments may indicate a shift in state practice involving a downgrading of the role of international law in discussions of the use of force. This may signal a declining perception of the legitimacy of the jus ad bellum, at least in cases involving minor uses of force.