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.

The committee on public information : a transmedia war propaganda campaign

This thesis develops an understanding of how propaganda entered the realm of journalism and popular culture in the United States during World War I through an examination of materials created by the Committee on Public Information (CPI). The CPI was a US governmental propaganda organisation created during World War I to persuade the nation to mobilise for war. Three of its divisions were chosen for this study: the Division of News (DoN), the Division of Four Minute Men (FMM) and the Division of Pictorial Publicity (DPP). Chapter 1 provides a general context for the thesis, outlines the research questions and details previous research on the CPI. Chapter 2 outlines the methods of analysis for interpreting the case study chapters and provides contextual information. The case studies are presented in Chapters 3, 4 and 5. These chapters are structured in the order of context, medium and content, and contain historical contextual information about each particular division, medialogical aspects of its propagated form and thematic groupings created from close reading of CPI materials. A semiotic analysis in the Peircian tradition is also performed on visual forms of propaganda in Chapter 5. Chapter 6 discusses how the expectations of persuasion, truth and amusement relate to each other when mediated in culture, using Lotman’s concept of the semiosphere. This further develops an understanding of propaganda as a cultural system in relation to other cultural systems – in this case, journalism and popular culture. Chapter 7 provides conclusions about the study, outlines relative strengths and weaknesses regarding the selection and deployment of methods, makes recommendations for future research, and summarises the key contributions of the thesis.

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.

The Committee on Public Information : a transmedia war propaganda campaign

This article summarises a PhD dissertation of the same name. It develops an understanding of how propaganda entered journalism and popular culture in the United States during World War I through an examination of materials created by the Committee on Public Information (CPI). Three CPI divisions were studied: The Division of News, the Four Minute Men, and the Division of Pictorial Publicity. The methodology of archival contextualisation was created, bringing together the methods of close reading, discourse-historical contextualisation, and Piercian semiotics. A summary of relevant literature is interspersed with thematic historical developments that impacted the relationship between propaganda, journalism and popular culture. This review outlines a gap in knowledge about the archival materials as well as the relationship between propaganda, journalism and popular culture from this period. A discussion about how the expectations of persuasion, truth and amusement relate to each other when mediated in culture, using Lotman’s concept of the semiosphere further develops an understanding of propaganda as a cultural system in relation to other cultural systems – in this case, journalism and popular culture. Findings from the study include that the CPI created a transmedia war propaganda campaign, which enabled propaganda to successfully draw entertainment value from popular culture and credibility from journalism in order to influence public opinion.

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.

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.

The empire goes to war : News Corporation and Iraq

The three main contributors to the war on Iraq in March 2003 (the United States, United Kingdom and Australia) are also the three most significant countries in which Rupert Murdoch's News Corporation operates. This article examines the degree of editorial conformity (or otherwise) that existed across the news media of News Corporation in six months leading to the invasion. It compares the framing of the arguments for war and finds significant similarities across the three countries, especially in the output of columnists and commentators employed by News Corporation. While generally pro-war, however, News Corporation outlets also displayed local variations in the caution or stridency of their editorial pitch as well as the degree of toleration for debate. The extent and significance of these variations are used in the article to argue for the development of a more complex political economy model in the study of private news media bias.

Book review : Olivier Corten, The Law Against War

Olivier Corten’s The Law Against War is a comprehensive, meticulously-researched study of contemporary international law governing the use of armed force in international relations. As a translated and updated version of a 2008 book published in French, it offers valuable insights into the positivist methodology that underpins much of the European scholarship of international law. Corten undertakes a rigorous analysis of state practice from 1945 onwards, with a view to clarifying the current meaning and scope of international law’s prohibition on the use of force. His central argument is that the majority of states remain attached to a strict interpretation of this rule. For Corten, state practice indicates that the doctrines of anticipatory self-defence, pre-emptive force and humanitarian intervention have no basis in contemporary international law. His overall position accords with a traditional, restrictive view of the circumstances in which states are permitted to use force...

A review of "The Peace In Between : Post-war violence and peacebuilding", edited by Astri Suhrke and Mats Berdal, Routledge, 2012

The term post-war violence has been with us for much of the twentieth century but the issue itself has existed for centuries. The study of violence in post-war societies has been explored by philosophers (Erasmus), statesmen (Sir Thomas More) and sociologists (Emile Durkheim). In many cases the cessation of war and the signing of peace accords do not always mean an end to the violence. This book examines in considerable detail the causes and purposes of post-conflict violence and argues that features which constrain or encourage violence accumulate in such a manner as to create distinct and different types of post-war environments...

The doctrine of command responsibility in the midst of war : legal fallacy or reflection of reality

The history of war is blighted with astonishing reminders of man’s ability to cast his sense of humanity aside and inflict unspeakable harm upon one another. The ruthless bombing of Dresden, the callousness of the Nazi concentration camps and the massacre of the Tutsis are but a few of the atrocities that have haunted our past. In response to these atrocities, society has imposed an ever-increasing number of laws and rules to regulate warfare. Amongst these is the doctrine of command responsibility. The doctrine of command responsibility states that a commander is criminally liable for the crimes of his subordinates if he knew or should have known of their crimes. This paper will examine whether the doctrine is an appropriate and realistic legal standard to hold commanders accountable to or whether the doctrine is more a reflection of social sentiment and legal rhetoric. If the doctrine, and indeed the law of war in general, is unrealistic then the law cannot fulfil its purpose - that is, the prevention of atrocities. Instead of being solely a reflection of moral authority and social sentiments the law must also be a tool that guides and shapes the decisions and actions of the military through the chaotic and brutal nature of war...

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.