Surveillance of Surgical Site Infections following Major Hip and Knee Surgery in Finland

Background and aims. Since 1999, hospitals in the Finnish Hospital Infection Program (SIRO) have reported data on surgical site infections (SSI) following major hip and knee surgery. The purpose of this study was to obtain detailed information to support prevention efforts by analyzing SIRO data on SSIs, to evaluate possible factors affecting the surveillance results, and to assess the disease burden of postoperative prosthetic joint infections in Finland. Methods. Procedures under surveillance included total hip (THA) and total knee arthroplasties (TKA), and the open reduction and internal fixation (ORIF) of femur fractures. Hospitals prospectively collected data using common definitions and written protocol, and also performed postdischarge surveillance. In the validation study, a blinded retrospective chart review was performed and infection control nurses were interviewed. Patient charts of deep incisional and organ/space SSIs were reviewed, and data from three sources (SIRO, the Finnish Arthroplasty Register, and the Finnish Patient Insurance Centre) were linked for capture-recapture analyses. Results. During 1999-2002, the overall SSI rate was 3.3% after 11,812 orthopedic procedures (median length of stay, eight days). Of all SSIs, 56% were detected after discharge. The majority of deep incisional and organ/space SSIs (65/108, 60%) were detected on readmission. Positive and negative predictive values, sensitivity, and specificity for SIRO surveillance were 94% (95% CI, 89-99%), 99% (99-100%), 75% (56-93%), and 100% (97-100%), respectively. Of the 9,831 total joint replacements performed during 2001-2004, 7.2% (THA 5.2% and TKA 9.9%) of the implants were inserted in a simultaneous bilateral operation. Patients who underwent bilateral operations were younger, healthier, and more often males than those who underwent unilateral procedures. The rates of deep SSIs or mortality did not differ between bi- and uni-lateral THAs or TKAs. Four deep SSIs were reported following bilateral operations (antimicrobial prophylaxis administered 48-218 minutes before incision). In the three registers, altogether 129 prosthetic joint infections were identified after 13,482 THA and TKA during 1999-2004. After correction with the positive predictive value of SIRO (91%), a log-linear model provided an estimated overall prosthetic joint infection rate of 1.6% after THA and 1.3% after TKA. The sensitivity of the SIRO surveillance ranged from 36% to 57%. According to the estimation, nearly 200 prosthetic joint infections could occur in Finland each year (the average from 1999 to 2004) after THA and TKA. Conclusions. Postdischarge surveillance had a major impact on SSI rates after major hip and knee surgery. A minority of deep incisional and organ/space SSIs would be missed, however, if postdischarge surveillance by questionnaire was not performed. According to the validation study, most SSIs reported to SIRO were true infections. Some SSIs were missed, revealing some weakness in case finding. Variation in diagnostic practices may also affect SSI rates. No differences were found in deep SSI rates or mortality between bi- and unilateral THA and TKA. However, patient materials between these two groups differed. Bilateral operations require specific attention paid to their antimicrobial prophylaxis as well as to data management in the surveillance database. The true disease burden of prosthetic joint infections may be heavier than the rates from national nosocomial surveillance systems usually suggest.

A multistep transversal linearization (MTL) method in non-linear dynamics through a Magnus characterization

A new form of a multi-step transversal linearization (MTL) method is developed and numerically explored in this study for a numeric-analytical integration of non-linear dynamical systems under deterministic excitations. As with other transversal linearization methods, the present version also requires that the linearized solution manifold transversally intersects the non-linear solution manifold at a chosen set of points or cross-section in the state space. However, a major point of departure of the present method is that it has the flexibility of treating non-linear damping and stiffness terms of the original system as damping and stiffness terms in the transversally linearized system, even though these linearized terms become explicit functions of time. From this perspective, the present development is closely related to the popular practice of tangent-space linearization adopted in finite element (FE) based solutions of non-linear problems in structural dynamics. The only difference is that the MTL method would require construction of transversal system matrices in lieu of the tangent system matrices needed within an FE framework. The resulting time-varying linearized system matrix is then treated as a Lie element using Magnus’ characterization [W. Magnus, On the exponential solution of differential equations for a linear operator, Commun. Pure Appl. Math., VII (1954) 649–673] and the associated fundamental solution matrix (FSM) is obtained through repeated Lie-bracket operations (or nested commutators). An advantage of this approach is that the underlying exponential transformation could preserve certain intrinsic structural properties of the solution of the non-linear problem. Yet another advantage of the transversal linearization lies in the non-unique representation of the linearized vector field – an aspect that has been specifically exploited in this study to enhance the spectral stability of the proposed family of methods and thus contain the temporal propagation of local errors. A simple analysis of the formal orders of accuracy is provided within a finite dimensional framework. Only a limited numerical exploration of the method is presently provided for a couple of popularly known non-linear oscillators, viz. a hardening Duffing oscillator, which has a non-linear stiffness term, and the van der Pol oscillator, which is self-excited and has a non-linear damping term.

Algebraic distributed space-time codes with low ML decoding complexity

"Extended Clifford algebras" are introduced as a means to obtain low ML decoding complexity space-time block codes. Using left regular matrix representations of two specific classes of extended Clifford algebras, two systematic algebraic constructions of full diversity Distributed Space-Time Codes (DSTCs) are provided for any power of two number of relays. The left regular matrix representation has been shown to naturally result in space-time codes meeting the additional constraints required for DSTCs. The DSTCs so constructed have the salient feature of reduced Maximum Likelihood (ML) decoding complexity. In particular, the ML decoding of these codes can be performed by applying the lattice decoder algorithm on a lattice of four times lesser dimension than what is required in general. Moreover these codes have a uniform distribution of power among the relays and in time, thus leading to a low Peak to Average Power Ratio at the relays.

A geometric approach to stationary defect solutions in one space dimension

In this manuscript, we consider the impact of a small jump-type spatial heterogeneity on the existence of stationary localized patterns in a system of partial dierential equations in one spatial dimension...

Conservation law with the flux function discontinuous in the space variable- II - Convex-concave type fluxes and generalized entropy solutions

We deal with a single conservation law with discontinuous convex-concave type fluxes which arise while considering sign changing flux coefficients. The main difficulty is that a weak solution may not exist as the Rankine-Hugoniot condition at the interface may not be satisfied for certain choice of the initial data. We develop the concept of generalized entropy solutions for such equations by replacing the Rankine-Hugoniot condition by a generalized Rankine-Hugoniot condition. The uniqueness of solutions is shown by proving that the generalized entropy solutions form a contractive semi-group in L-1. Existence follows by showing that a Godunov type finite difference scheme converges to the generalized entropy solution. The scheme is based on solutions of the associated Riemann problem and is neither consistent nor conservative. The analysis developed here enables to treat the cases of fluxes having at most one extrema in the domain of definition completely. Numerical results reporting the performance of the scheme are presented. (C) 2006 Elsevier B.V. All rights reserved.

Distributed space-time codes for cooperative networks with partial CSI

Design criteria and full-diversity Distributed Space Time Codes (DSTCs) for the two phase transmission based cooperative diversity protocol of Jing-Hassibi and the Generalized Nonorthogonal Amplify and Forward (GNAF) protocol are reported, when the relay nodes are assumed to have knowledge of the phase component of the source to relay channel gains. It is shown that this under this partial channel state information (CSI), several well known space time codes for the colocated MIMO (Multiple Input Multiple Output) channel become amenable for use as DSTCs. In particular, the well known complex orthogonal designs, generalized coordinate interleaved orthogonal designs (GCIODs) and unitary weight single symbol decodable (UW-SSD) codes are shown to satisfy the required design constraints for DSTCs. Exploiting the relaxed code design constraints, we propose DSTCs obtained from Clifford Algebras which have low ML decoding complexity.

Edge of Danger: electric light and the negotiation of public and private domestic space in Philip Johnson's Glass and Guest House

In the first half of the twentieth century the dematerializing of boundaries between enclosure and exposure problematized traditional expectations of the domestic environment. At the same time, as a space of escalating technological control, the modern domestic interior also offered new potential to redefine the meaning and means of habitation. The inherent tension between these opposing forces is particularly evident in the introduction of new electric lighting technology and applications into the modern domestic interior in the mid-twentieth century. Addressing this nexus of technology and domestic psychology, this article examines the critical role of electric lighting in regulating and framing both the public and private occupation of Philip Johnson's New Canaan estate. Exploring the dialectically paired transparent Glass House and opaque Guest House, this study illustrates how Johnson employed electric light to negotiate the visual environment of the estate as well as to help sustain a highly aestheticized domestic lifestyle. Contextualized within the existing literature, this analysis provides a more nuanced understanding of the New Canaan estate as an expression of Johnson's interests as a designer as well as a subversion of traditional suburban conventions.

Human rights performance disclosure by companies having operations in high risk countries: Evidence from Australian mineral sector

The aim of this study is to explore whether Australian mineral companies operating in high human rights risk countries provide more human rights disclosures than companies operating in low risk countries. A content analysis instrument containing 88 specific human rights performance items derived from a number of international human rights guidelines has been developed to investigate the annual reports, social responsibility reports and corporate websites of the top 50 Australian mineral companies (2010/2011). The findings show that human rights performance disclosures by companies with operations in high human rights risk countries are significantly higher than companies with operations in the low risk countries. By disclosing extended human rights performance information, companies operating in high risk countries appear to ease community concerns about human rights violations. The finding is consistent with legitimacy theory which posits that organisations respond to community concerns in relation to particular social issues.

Capturability analysis of a geometric guidance law in relative velocity space

In this paper, a relative velocity approach is used to analyze the capturability of a geometric guidance law. Point mass models are assumed for both the missile and the target. The speeds of the missile and target are assumed to remain constant throughout the engagement. Lateral acceleration, obtained from the guidance law, is applied to change the path of the missile. The kinematic equations for engagements in the horizontal plane are derived in the relative velocity space. Some analytical results for the capture region are obtained for non-maneuvering and maneuvering targets. For non-maneuvering targets it is enough for the navigation gain to be a constant to intercept the target, while for maneuvering targets a time varying navigation gain is needed for interception. These results are then verified through numerical simulations.

Four group decodable differential scaled unitary linear space-time codes

Differential Unitary Space-Time Block codes (STBCs) offer a means to communicate on the Multiple Input Multiple Output (MIMO) channel without the need for channel knowledge at both the transmitter and the receiver. Recently Yuen-Guan-Tjhung have proposed Single-Symbol-Decodable Differential Space-Time Modulation based on Quasi-Orthogonal Designs (QODs) by replacing the original unitary criterion by a scaled unitary criterion. These codes were also shown to perform better than differential unitary STBCs from Orthogonal Designs (ODs). However the rate (as measured in complex symbols per channel use) of the codes of Yuen-Guan-Tjhung decay as the number of transmit antennas increase. In this paper, a new class of differential scaled unitary STBCs for all even number of transmit antennas is proposed. These codes have a rate of 1 complex symbols per channel use, achieve full diversity and moreover they are four-group decodable, i.e., the set of real symbols can be partitioned into four groups and decoding can be done for the symbols in each group separately. Explicit construction of multidimensional signal sets that yield full diversity for this new class of codes is also given.

OFDM Based Distributed Space Time Coding for Asynchronous Relay Networks

Recently Li and Xia have proposed a transmission scheme for wireless relay networks based on the Alamouti space time code and orthogonal frequency division multiplexing to combat the effect of timing errors at the relay nodes. This transmission scheme is amazingly simple and achieves a diversity order of two for any number of relays. Motivated by its simplicity, this scheme is extended to a more general transmission scheme that can achieve full cooperative diversity for any number of relays. The conditions on the distributed space time block code (DSTBC) structure that admit its application in the proposed transmission scheme are identified and it is pointed out that the recently proposed full diversity four group decodable DST-BCs from precoded co-ordinate interleaved orthogonal designs and extended Clifford algebras satisfy these conditions. It is then shown how differential encoding at the source can be combined with the proposed transmission scheme to arrive at a new transmission scheme that can achieve full cooperative diversity in asynchronous wireless relay networks with no channel information and also no timing error knowledge at the destination node. Finally, four group decodable distributed differential space time block codes applicable in this new transmission scheme for power of two number of relays are also provided.

Noncoherent low-decoding-complexity space-time codes for wireless relay networks

The differential encoding/decoding setup introduced by Kiran et at, Oggier et al and Jing et al for wireless relay networks that use codebooks consisting of unitary matrices is extended to allow codebooks consisting of scaled unitary matrices. For such codebooks to be used in the Jing-Hassibi protocol for cooperative diversity, the conditions that need to be satisfied by the relay matrices and the codebook are identified. A class of previously known rate one, full diversity, four-group encodable and four-group decodable Differential Space-Time Codes (DSTCs) is proposed for use as Distributed DSTCs (DDSTCs) in the proposed set up. To the best of our knowledge, this is the first known low decoding complexity DDSTC scheme for cooperative wireless networks.

Reengaging, reenacting and reenvisaging discourses of disaster through public space performance: Austerity, art, and the art of protest

This paper offers a mediation on disaster, recovery, resilience, and restoration of balance, in both a material and a metaphorical sense, when ‘disaster’ befalls not the body politic of the nation but the body personal. In the past few decades, of course, artists, activists and scholars have deliberately tried to avoid describing personal, physical and phenomenological experiences of the disabled body in terms of difficulty and disaster. This has been part of a political move, from a medical model, in which disability, disease and illness are positioned as personal catastrophes, to a social model, in which disability is positioned as a social construct that comes from systems, institutions and infrastructure designed to exclude different bodies. It is a move that is responsible for a certain discomfort people with disabilities, and artists with disabilities, today feel towards performances that deploy disability as a metaphor for disaster, from Hijikata, to Theatre Hora. In the past five years, though, this particular discourse has begun rising again, particularly as people with disabilities fact their own anything but natural disasters as a result of the austerity measures now widespread across the US, UK, Europe and elsewhere. Measures that threaten people’s ability to live, and take part in social and institutional life, in any meaningful way. Measures that, as artist Katherine Araniello notes, also bring additional difficulty, danger, and potential for disaster as they ripple outwards across the tides of familial ties, threatening family, friends, and careers who become bound up in the struggle to do more with less. In this paper, I consider how people with disabilities use performance, particularly public space interventionalist performance, to reengage, renact and reenvisage the discourse of national, economic, environmental or other forms of disaster, the need for austerity, the need to avoid providing people with support for desires and interests as well as basic daily needs, particularly when fraud and corruption is so right, and other such ideas that have become an all too unpleasant reality for many people. Performances, for instance, like Liz Crow’s Bedding Out, where she invited people into her bed – for people with disabilities a symbolic space, which necessarily becomes more a public living room restaurant, office and so forth than a private space when poor mobility means they spend much time it in – to talk about their lives, their difficulties, and dealing with austerity. Or, for instance, like the Bolshy Divas, who mimic public and political policy, reports and advertising paranoia to undermine their discourses about austerity. I examine the effects, politics and ethics of such interventions, including examination of the comparative effect of highly bodied interventions (like Crow’s) and highly disembodied interventions (like the Bolshy Diva’s) in discourses of difficulty, disaster and austerity on a range of target spectator communities.

Performing immobility / protesting immobility: The risks & rewards of public space protest performances

Though there is much interest in mobilities and performing mobilities as a characteristic of modern, urban, social life today, this is not always matched by attention to immobilities, as the flipside of mobility in modern life. In this paper, I investigate public space performances designed to draw attention to precisely this counterpoint to current discourses of mobilities – performances about the socially produced immobilities many people with disabilities find a more fundamental feature of day-to-day life, the fight for mobility, and the freedom found when accommodations for alternative mobilities are made available. Although public policy is increasingly aligned with a social model of disability, which sees disability as socially constructed through systems, institutions and infrastructure deliberately designed to exclude specific bodies – stairs, curbs, queues and so forth – and although governments in the US, UK, and to a lesser degree Australia, New Zealand and other Commonwealth nations aim to address these inequalities, the experience of immobility is still every-present for many people. This often comes not just from pain, or from impairment, or event from lack of accommodations for alternative mobilities, but from fellow social performers’ antipathy to, appropriation of, or destruction of accommodations designed to facilitate access for a range of different bodies in public space, and thus the public sphere. The archetypal instance of this tension between the mobile, and those needing accommodations to allow mobility, is, of course, the antipathy many able bodied people feel towards the provision of disabled parking spaces. A cursory search online shows thousands of accounts of antagonism, vitriol, and even violence prompted by disputes which began when a disabled person asked an able person to exit a designated disabled parking space. For many, it seems, expecting them to pass by such parks so others can experience the mobility they take for granted is too much. In this paper, I examine a number of protest performances in public space in which activist present actions – for example, placing wheelchairs in every regular parking space in a precinct – to give bystanders, passersby and spectators, as well as antagonistic fellow social performers, a sense of what socially produced immobility feels like. I examine responses to such protest performances, and what they say about the potential social, political and ethical impacts of such protests, in terms of their potential to produce new attitudes to mobility, alternative mobility, and access to alternative modes of mobility.