Re-cementing in revision total hip replacement

Removal of well-fixed cement at revision surgery risks bone loss, cortical perforation and fracture, is time-consuming, technically demanding and carries increased risks for the patient. The cement-in-cement technique avoids these problems and when used appropriately has given favourable results at our centre when used on both the femoral and acetabular sides of the articulation. A modified technique has also been used in selected cases of infection and peri-prosthetic fracture. This chapter highlights the results to date and the operative techniques employed. It is essential to recognise that this technique relies fundamentally on the presence of a well-fixed cement mantle, and it is imperative that the criteria laid out are adhered to in order to achieve success. If there is loosening or lysis on the femoral side extending distal to the lesser trochanter or around more than just the periphery of the acetabular cement mantle, then alternative revision techniques should be employed.

Airborne particle concentrations at schools measured at different spatial scales

Potential adverse effects on children health may result from school exposure to airborne particles. To address this issue, measurements in terms of particle number concentration, particle size distribution and black carbon (BC) concentrations were performed in three school buildings in Cassino (Italy) and its suburbs, outside and inside of the classrooms during normal occupancy and use. Additional time resolved information was gathered on ventilation condition, classroom activity, and traffic count data around the schools were obtained using a video camera. Across the three investigated school buildings, the outdoor and indoor particle number concentration monitored down to 4 nm and up to 3 m ranged from 2.8×104 part cm-3 to 4.7×104 part cm-3 and from 2.0×104 part cm-3 to 3.5×104 part cm-3, respectively. The total particle concentrations were usually higher outdoors than indoors, because no indoor sources were detected. I/O measured was less than 1 (varying in a relatively narrow range from 0.63 to 0.74), however one school exhibited indoor concentrations higher than outdoor during the morning rush hours. Particle size distribution at the outdoor site showed high particle concentrations in different size ranges, varying during the day; in relation to the starting and finishing of school time two modes were found. BC concentrations were 5 times higher at the urban school compared with the suburban and suburban-to-urban differences were larger than the relative differences of ultrafine particle concentrations.

Inhaled particle counts on bicycle commute routes of low and high proximity to motorised traffic

Frequent exposure to ultrafine particles (UFP) is associated with detrimental effects on cardiopulmonary function and health. UFP dose and therefore the associated health risk are a factor of exposure frequency, duration, and magnitude of (therefore also proximity to) a UFP emission source. Bicycle commuters using on-road routes during peak traffic times are sharing a microenvironment with high levels of motorised traffic, a major UFP emission source. Inhaled particle counts were measured along popular pre-identified bicycle commute route alterations of low (LOW) and high (HIGH) motorised traffic to the same inner-city destination at peak commute traffic times. During commute, real-time particle number concentration (PNC; mostly in the UFP range) and particle diameter (PD), heart and respiratory rate, geographical location, and meteorological variables were measured. To determine inhaled particle counts, ventilation rate was calculated from heart-rate-ventilation associations, produced from periodic exercise testing. Total mean PNC of LOW (compared to HIGH) was reduced (1.56 x e4 ± 0.38 x e4 versus 3.06 x e4 ± 0.53 x e4 ppcc; p = 0.012). Total estimated ventilation rate did not vary significantly between LOW and HIGH (43 ± 5 versus 46 ± 9 L•min; p = 0.136); however, due to total mean PNC, accumulated inhaled particle counts were 48% lower in LOW, compared to HIGH (7.6 x e8 ± 1.5 x e8 versus 14.6 x e8 ± 1.8 x e8; p = 0.003). For bicycle commuting at peak morning commute times, inhaled particle counts and therefore cardiopulmonary health risk may be substantially reduced by decreasing exposure to motorised traffic, which should be considered by both bicycle commuters and urban planners.

Revision total hip replacement using the cement-in-cement technique for the acetabular component : technique and results for 60 hips

The technique of femoral cement-in-cement revision is well established, but there are no previous series reporting its use on the acetabular side at the time of revision total hip arthroplasty. We describe the surgical technique and report the outcome of 60 consecutive cement-in-cement revisions of the acetabular component at a mean follow-up of 8.5 years (range 5-12 years). All had a radiologically and clinically well fixed acetabular cement mantle at the time of revision. 29 patients died. No case was lost to follow-up. The 2 most common indications for acetabular revision were recurrent dislocation (77%) and to compliment a femoral revision (20%). There were 2 cases of aseptic cup loosening (3.3%) requiring re-revision. No other hip was clinically or radiologically loose (96.7%) at latest follow-up. One case was re-revised for infection, 4 for recurrent dislocation and 1 for disarticulation of a constrained component. At 5 years, the Kaplan-Meier survival rate was 100% for aseptic loosening and 92.2% (95% CI; 84.8-99.6%) with revision for all causes as the endpoint. These results support the use of the cement-in-cement revision technique in appropriate cases on the acetabular side. Theoretical advantages include preservation of bone stock, reduced operating time, reduced risk of complications and durable fixation.

Evaluation of the cost-effectiveness of strategies claiming to reduce the risk of surgical site infections following primary total hip arthroplasty

Background Total hip arthroplasty (THA) is a commonly performed procedure and numbers are increasing with ageing populations. One of the most serious complications in THA are surgical site infections (SSIs), caused by pathogens entering the wound during the procedure. SSIs are associated with a substantial burden for health services, increased mortality and reduced functional outcomes in patients. Numerous approaches to preventing these infections exist but there is no gold standard in practice and the cost-effectiveness of alternate strategies is largely unknown. Objectives The aim of this project was to evaluate the cost-effectiveness of strategies claiming to reduce deep surgical site infections following total hip arthroplasty in Australia. The objectives were: 1. Identification of competing strategies or combinations of strategies that are clinically relevant to the control of SSI related to hip arthroplasty 2. Evidence synthesis and pooling of results to assess the volume and quality of evidence claiming to reduce the risk of SSI following total hip arthroplasty 3. Construction of an economic decision model incorporating cost and health outcomes for each of the identified strategies 4. Quantification of the effect of uncertainty in the model 5. Assessment of the value of perfect information among model parameters to inform future data collection Methods The literature relating to SSI in THA was reviewed, in particular to establish definitions of these concepts, understand mechanisms of aetiology and microbiology, risk factors, diagnosis and consequences as well as to give an overview of existing infection prevention measures. Published economic evaluations on this topic were also reviewed and limitations for Australian decision-makers identified. A Markov state-transition model was developed for the Australian context and subsequently validated by clinicians. The model was designed to capture key events related to deep SSI occurring within the first 12 months following primary THA. Relevant infection prevention measures were selected by reviewing clinical guideline recommendations combined with expert elicitation. Strategies selected for evaluation were the routine use of pre-operative antibiotic prophylaxis (AP) versus no use of antibiotic prophylaxis (No AP) or in combination with antibiotic-impregnated cement (AP & ABC) or laminar air operating rooms (AP & LOR). The best available evidence for clinical effect size and utility parameters was harvested from the medical literature using reproducible methods. Queensland hospital data were extracted to inform patients’ transitions between model health states and related costs captured in assigned treatment codes. Costs related to infection prevention were derived from reliable hospital records and expert opinion. Uncertainty of model input parameters was explored in probabilistic sensitivity analyses and scenario analyses and the value of perfect information was estimated. Results The cost-effectiveness analysis was performed from a health services perspective using a hypothetical cohort of 30,000 THA patients aged 65 years. The baseline rate of deep SSI was 0.96% within one year of a primary THA. The routine use of antibiotic prophylaxis (AP) was highly cost-effective and resulted in cost savings of over $1.6m whilst generating an extra 163 QALYs (without consideration of uncertainty). Deterministic and probabilistic analysis (considering uncertainty) identified antibiotic prophylaxis combined with antibiotic-impregnated cement (AP & ABC) to be the most cost-effective strategy. Using AP & ABC generated the highest net monetary benefit (NMB) and an incremental $3.1m NMB compared to only using antibiotic prophylaxis. There was a very low error probability that this strategy might not have the largest NMB (<5%). Not using antibiotic prophylaxis (No AP) or using both antibiotic prophylaxis combined with laminar air operating rooms (AP & LOR) resulted in worse health outcomes and higher costs. Sensitivity analyses showed that the model was sensitive to the initial cohort starting age and the additional costs of ABC but the best strategy did not change, even for extreme values. The cost-effectiveness improved for a higher proportion of cemented primary THAs and higher baseline rates of deep SSI. The value of perfect information indicated that no additional research is required to support the model conclusions. Conclusions Preventing deep SSI with antibiotic prophylaxis and antibiotic-impregnated cement has shown to improve health outcomes among hospitalised patients, save lives and enhance resource allocation. By implementing a more beneficial infection control strategy, scarce health care resources can be used more efficiently to the benefit of all members of society. The results of this project provide Australian policy makers with key information about how to efficiently manage risks of infection in THA.

Total Solar Eclipse in North Queensland 14 Nov 2012

This article is a brief introduction to the total solar eclipse Wed 14 November 2012 in north Queensland that will be seen in a narrow strip of land just 140 km wide in the vicinity of Cairns.

Radiotherapy Monte Carlo simulation using cloud computing technology

Cloud computing allows for vast computational resources to be leveraged quickly and easily in bursts as and when required. Here we describe a technique that allows for Monte Carlo radiotherapy dose calculations to be performed using GEANT4 and executed in the cloud, with relative simulation cost and completion time evaluated as a function of machine count. As expected, simulation completion time decreases as 1=n for n parallel machines, and relative simulation cost is found to be optimal where n is a factor of the total simulation time in hours. Using the technique, we demonstrate the potential usefulness of cloud computing as a solution for rapid Monte Carlo simulation for radiotherapy dose calculation without the need for dedicated local computer hardware as a proof of principal. Funding source Cancer Australia (Department of Health and Ageing) Research Grant 614217

When the right to be counted doesn’t count : the politics and challenges of researching the health of asylum seekers

A fundamental prerequisite of population health research is the ability to establish an accurate denominator. This in turn requires that every individual in the study population is counted. However, this seemingly simple principle has become a point of conflict between researchers whose aim is to produce evidence of disparities in population health outcomes and governments whose policies promote(intentionally or not) inequalities that are the underlying causes of health disparities. Research into the health of asylum seekers is a case in point. There is a growing body of evidence documenting the adverse affects of recent changes in asylum-seeking legislation, including mandatory detention. However, much of this evidence has been dismissed by some governments as being unsound, biased and unscientific because, it is argued, evidence is derived from small samples or from case studies. Yet, it is the policies of governments that are the key barrier to the conduct of rigorous population health research on asylum seekers. In this paper, the authors discuss the challenges of counting asylum seekers and the limitations of data reported in some industrialized countries. They argue that the lack of accurate statistical data on asylum seekers has been an effective neo-conservative strategy for erasing the health inequalities in this vulnerable population, indeed a strategy that renders invisible this population. They describe some alternative strategies that may be used by researchers to obtain denominator data on hard-to-reach populations such as asylum seekers.

Physiological, perceptual and technical responses to on-court tennis training on hard and clay courts

The aim of this study was to investigate the effect of court surface (clay v hard-court) on technical, physiological and perceptual responses to on-court training. Four high-performance junior male players performed two identical training sessions on hard and clay courts, respectively. Sessions included both physical conditioning and technical elements as led by the coach. Each session was filmed for later notational analysis of stroke count and error rates. Further, players wore a global positioning satellite device to measure distance covered during each session; whilst heart rate, countermovement jump distance and capillary blood measures of metabolites were measured before, during and following each session. Additionally a respective coach and athlete rating of perceived exertion (RPE) were measured following each session. Total duration and distance covered during of each session were comparable (P>0.05; d<0.20). While forehand and backhands stroke volume did not differ between sessions (P>0.05; d<0.30); large effects for increased unforced and forced errors were present on the hard court (P>0.05; d>0.90). Furthermore, large effects for increased heart rate, blood lactate and RPE values were evident on clay compared to hard courts (P>0.05; d>0.90). Additionally, while player and coach RPE on hard courts were similar, there were large effects for coaches to underrate the RPE of players on clay courts (P>0.05; d>0.90). In conclusion, training on clay courts results in trends for increased heart rate, lactate and RPE values, suggesting sessions on clay tend towards higher physiological and perceptual loads than hard courts. Further, coaches appear effective at rating player RPE on hard courts, but may underrate the perceived exertion of sessions on clay courts.

Complications related to therapeutic anticoagulation in total hip arthroplasty

Bleeding related wound complications cause significant morbidity in lower limb arthroplasty surgery. Patients who require therapeutic anticoagulation in the peri operative period are potentially at higher risk of these complications. This is a retrospective case control study reviewing all primary total hip replacements performed in a single center over a five year period and comparing outcomes of the patients on warfarin with a double-matched control group of patients not on warfarin. The warfarin group had significantly higher risk of deep joint infection (9% vs 2.2%), haematoma/ wound ooze (28% vs 4%) and superficial infection (13.5% vs 2.2%). Managing the total hip arthroplasty patient with therapeutic anticoagulation is a balance between the risk of thromboembolic disease and bleeding related complications. Improved understanding of this risk will better allow the patient to make an informed decision regarding their elective arthroplasty surgery.

Does 'habitus' count in Chinese Australians' mathematics achievement?

Large-scale international comparative studies and cross-ethnic studies have revealed that Chinese students, whether living in China or overseas, consistently outperform their counterparts in mathematics achievement. These studies tended to explain this result from psychological, educational, or cultural perspectives. However, there is scant sociological investigation addressing Chinese students’ better mathematics achievement. Drawing on Bourdieu’s sociological theory, this study conceptualises Chinese Australians’ “Chineseness” by the notion of ‘habitus’ and considers this “Chineseness” generating but not determinating mechanism that underpins Chinese Australians’ mathematics learning. Two hundred and thirty complete responses from Chinese Australian participants were collected by an online questionnaire. Simple regression model statistically significantly well predicted mathematics achievement by “Chineseness” (F = 141.90, R = .62, t = 11.91, p < .001). Taking account of “Chineseness” as a sociological mechanism for Chinese Australians’ mathematics learning, this study complements psychological and educational impacts on better mathematics achievement of Chinese students revealed by previous studies. This study also challenges the cultural superiority discourse that attributes better mathematics achievement of Chinese students to cultural factors.

A snapshot of radiation therapy techniques and technology in Queensland : an aid to mapping undergraduate curriculum

Introduction: Undergraduate students studying the Bachelor of Radiation Therapy at Queensland University of Technology (QUT) attend clinical placements in a number of department sites across Queensland. To ensure that the curriculum prepares students for the most common treatments and current techniques in use in these departments, a curriculum matching exercise was performed. Methods: A cross-sectional census was performed on a pre-determined “Snapshot” date in 2012. This was undertaken by the clinical education staff in each department who used a standardized proforma to count the number of patients as well as prescription, equipment, and technique data for a list of tumour site categories. This information was combined into aggregate anonymized data. Results: All 12 Queensland radiation therapy clinical sites participated in the Snapshot data collection exercise to produce a comprehensive overview of clinical practice on the chosen day. A total of 59 different tumour sites were treated on the chosen day and as expected the most common treatment sites were prostate and breast, comprising 46% of patients treated. Data analysis also indicated that intensity-modulated radiotherapy (IMRT) use is relatively high with 19.6% of patients receiving IMRT treatment on the chosen day. Both IMRT and image-guided radiotherapy (IGRT) indications matched recommendations from the evidence. Conclusion: The Snapshot method proved to be a feasible and efficient method of gathering useful

Shahejie−Shahejie/Guantao/Wumishan and Carboniferous/Permian Coal−Paleozoic Total Petroleum Systems in the Bohaiwan Basin, China (based on geologic studies for the 2000 World Energy Assessment Project of the U.S. Geological Survey)

This report discusses the geologic framework and petroleum geology used to assess undiscovered petroleum resources in the Bohaiwan basin province for the 2000 World Energy Assessment Project of the U.S. Geological Survey. The Bohaiwan basin in northeastern China is the largest petroleum-producing region in China. Two total petroleum systems have been identified in the basin. The first, the Shahejie–Shahejie/Guantao/Wumishan Total Petroleum System, involves oil and gas generated from mature pods of lacustrine source rock that are associated with six major rift-controlled subbasins. Two assessment units are defined in this total petroleum system: (1) a Tertiary lacustrine assessment unit consisting of sandstone reservoirs interbedded with lacustrine shale source rocks, and (2) a pre-Tertiary buried hills assessment unit consisting of carbonate reservoirs that are overlain unconformably by Tertiary lacustrine shale source rocks. The second total petroleum system identified in the Bohaiwan basin is the Carboniferous/Permian Coal–Paleozoic Total Petroleum System, a hypothetical total petroleum system involving natural gas generated from multiple pods of thermally mature coal beds. Low-permeability Permian sandstones and possibly Carboniferous coal beds are the reservoir rocks. Most of the natural gas is inferred to be trapped in continuous accumulations near the center of the subbasins. This total petroleum system is largely unexplored and has good potential for undiscovered gas accumulations. One assessment unit, coal-sourced gas, is defined in this total petroleum system.

Total Dik - Transmedia Concept development

Total Dik! is a collaborative project between the Queensland University of Technology (QUT) and Queensland Theatre Company (QTC). Total Dik! explores transmedia storytelling in live performance from concept development to delivery and builds on works, By the Way, Meet Vera Stark, (Forrester2012), Hotel Modern’s Kamp (2005) and God’s Beard (2012) that use visual art, puppetry, music and film. The project’s first iteration enabled an interrogation of the integration of media-rich elements with live performers in a theatrical environment. Performative transmedia storytelling draws on the tenets of convergent media theory developed by Jenkins (2007, 2012), Dena (2010) and Philips (2012). This exploratory work, juxtaposing transmedia storytelling techniques with live performance, draws on Samuel Becket’s challenges to theatre orthodoxy, and touches on Brechtian notions of alienation through ‘sleight-of-hand’ or processual unpacking and deconstruction during performance. Total Dik! blends a convergence of technologies, models, green screen capture, and live dimensions of performance in one narrative allowing the work’s creators to test new combinations of transmedia storytelling techniques on a traditional performance platform.