Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery

Objective
To determine health-related quality of life (HRQOL), psychological distress, physical function, and self efficacy in persons waiting for lower-limb joint replacement surgery.

Methods
A total of 214 patients on a waiting list for unilateral primary total knee or hip replacement at a large Australian public teaching hospital completed questionnaires after entry to the list. HRQOL and psychological distress were compared with available population norms.

Results
Average HRQOL was extremely poor (mean ± SD 0.39 ± 0.24) and much lower (>2 SD) than the population norm. Near death-equivalent HRQOL or worse than death-equivalent HRQOL were reported by 15% of participants. High or very high psychological distress was up to 5 times more prevalent in the waiting list sample (relative risk 5.4 for participants ages 75 years and older; 95% confidence interval 3.3, 9.0). Women had significantly lower HRQOL, self efficacy, and physical function scores than men. After adjusting for age and sex, significant socioeconomic disparities were also found. Participants who received the lowest income had the poorest HRQOL; those with the least education or the lowest income had the highest psychological distress. Low self efficacy was moderately associated with poor HRQOL (r = 0.49, P < 0.001) and more strongly associated with high psychological distress (r = -0.55, P < 0.001).

Conclusion
Patients waiting for joint replacement have very poor HRQOL and high psychological distress, especially women and those from lower socioeconomic backgrounds. Lengthy waiting lists mean patients can experience extended and potentially avoidable morbidity. Interventions to address psychological distress and self efficacy could reduce this burden and should target women and lower socioeconomic groups.

Quality of life and depression among older patients waiting for joint replacement surgery

Purpose: Older patients waiting for joint replacement surgery in many western countries experience lengthy waits for their surgery. Although these patients suffer with mobility problems the nature of the disability associated with waiting for surgery is unclear. The purpose of this study was to determine health-related quality of life and symptoms of depression in persons waiting for their initial orthopaedic consultation following referral for total knee or total hip replacement surgery.

Methods: All patients who were waiting for an initial orthopaedic consultation for lower-limb joint replacement as at 25 August 2005 were surveyed. Participants were mailed questionnaires concerning demographic information, medical history, health-related quality of life (the Assessment of Quality of Life (AQoL) instrument), and symptoms of depression (Center for Epidemiologic Studies – Depression (CES-D) Scale).

Results: The 84 respondents (response rate 64%) had a mean age of 68.3 (SD 11.5 years), and 60% or respondents were women. Respondents reported an average of 1.6 (SD 0.9) medical conditions, and 85% reported osteoarthritis.} The average health-related quality of life was low (mean AQoL 0.38; SD 0.27), and near death-equivalent or worse than death-equivalent health-related quality of life (AQoL<0.1 of a maximum possible 1.0) was reported by 23% of the participants.The mean depression scale score was 16.5 (SD 11.1), and symptoms of depression (CES-D>16 of a maximum possible 60) were reported by 35% of the sample. There was a strong correlation between health-related quality of life and depression (r=–0.6).

Conclusions: Almost a third of patients waiting to see an orthopaedic surgeon about joint replacement surgery for their hip or knee had symptoms of depression. Geriatric rehabilitation services often provide interventions to these patients. The very poor quality of life reported suggests that more than exercise and strengthening will be needed to reduce disability.

Human resource management and performance : a study of Australian joint-ventures in Malaysia

Examines human resource management and performance of successful Australian-Malaysian joint ventures. The findings suggest that each phase of joint venture development has its own pattern of human resource practices. Also discussed are human resource problems in joint ventures, strategies to overcome them and factors associated with success.

Developing reflexive capability for successful joint ventures between Australian and Malaysian property and construction professionals

Increasingly Malaysian property and construction firms are seeking to work internationally. Firms enter international markets through various strategies and typically property and construction professionals rely on developing various forms of cooperative and collaborative arrangements. The common modes of entry include international alliances, project joint ventures, partnerships, company joint ventures and large consortiums; which arise as a response to clients seeking expressions of interests from the international community or the firms seeking to internationalise approaching clients and/or potential host country partners. Increasingly project teams on international mega projects are composed of multiple key partners from different countries coming together to achieve a higher level of strategic flexibility. Establishing and maintaining local connections and business networks are therefore critical to ensure the success of exporting firms. This paper reports the findings of a project which explores factors affecting the performance of Malaysian property and construction professionals working internationally through effective joint ventures. The project seeks to develop a performance measurement framework to examine the extent to which Malaysian firms are developing sustainable business models internationally which adapt and respond to changing conditions. A generic framework was initially developed prior to this study through a grounded theory approach merging theory from internationalisation, design management and market knowledge literature followed by a case study empirical investigation and then further literature review based upon the themes which emerged from the case study analysis. A reflexive capability model for firms in managing both economic and non-economic capital; including social, cultural and intellectual capital was developed. This project seeks to build upon the reflexive model by adapting it to the unique contexts related to the specific geographic localities of exporting Malaysian firms. Specifically, the project explores the extent to which the performance measurement framework can be used to map capabilities Malaysian construction firms have and Which they need to develop in relation to developing and maintaining international collaborative partnerships. The preliminary results of one case study Malaysian architectural firm are discussed.

Joint velocity redistribution for fault tolerant manipulators

If the end-effector of a robotic manipulator moves on a specified trajectory, then for the fault tolerant operation, it is required that the end-effector continues the trajectory with a minimum velocity jump when a fault occurs within a joint. This problem is addressed in the paper. A way to tolerate the fault is to find new joint velocities for the faulty manipulator in which results into the same end-effector velocity provided by the healthy manipulator. The aim of this study is to find a strategy which optimally redistributes the joint velocities for the remained healthy joints of the manipulators. The optimality is defined by the minimum end-effector velocity jump. A solution of the problem is presented and it is applied to a robotics manipulator. Then through a case study and a simulation study it is validated. The paper shows that if would be possible the joint velocity redistribution results into a zero velocity jump.

Joint learning and dictionary construction for pattern recognition

We propose a joint representation and classification framework that achieves the dual goal of finding the most discriminative sparse overcomplete encoding and optimal classifier parameters. Formulating an optimization problem that combines the objective function of the classification with the representation error of both labeled and unlabeled data, constrained by sparsity, we propose an algorithm that alternates between solving for subsets of parameters, whilst preserving the sparsity. The method is then evaluated over two important classification problems in computer vision: object categorization of natural images using the Caltech 101 database and face recognition using the Extended Yale B face database. The results show that the proposed method is competitive against other recently proposed sparse overcomplete counterparts and considerably outperforms many recently proposed face recognition techniques when the number training samples is small.

Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7 : Australian orthopaedic association national joint replacement registry

Background The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia.

Methods Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk.

Results Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups.

Conclusions Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.