Thoracoscopic scoliosis surgery – a cheaper option? A cost analysis of 189 consecutive cases

INTRODUCTION: Increasing health care costs, limited resources and increased demand makes cost effective and cost-efficient delivery of Adolescent Idiopathic Scoliosis (AIS) management paramount. Rising implant costs in deformity correction surgery have prompted analysis of whether high implant densities are justified. The objective of this study was to analyse the costs of thoracoscopic scoliosis surgery, comparing initial learning curve costs with those of the established technique and to the costs involved in posterior instrumented fusion from the literature. METHODS: 189 consecutive cases from April 2000 to July 2011 were assessed with a minimum of 2 years follow-up. Information was gathered from a prospective database covering perioperative factors, clinical and radiological outcomes, complications and patient reported outcomes. The patients were divided into three groups to allow comparison; 1. A learning curve cohort, 2. An intermediate cohort and 3. A third cohort of patients, using our established technique. Hospital finance records and implant manufacturer figures were corrected to 2013 costs. A literature review of AIS management costs and implant density in similar curve types was performed. RESULTS: The mean pre-op Cobb angle was 53°(95%CI 0.4) and was corrected postop to mean 22.9°(CI 0.4). The overall complication rate was 20.6%, primarily in the first cohort, with a rate of 5.6% in the third cohort. The average total costs were $46,732, operating room costs of $10,301 (22.0%) and ICU costs of $4620 (9.8%). The mean number of screws placed was 7.1 (CI 0.04) with a single rod used for each case giving average implant costs of $14,004 (29.9%). Comparison of the three groups revealed higher implant costs as the technique evolved to that in use today, from $13,049 in Group 1 to $14577 in Group 3 (P<0.001). Conversely operating room costs reduced from $10,621 in Group 1 to $7573 (P<0.001) in Group 3. ICU stay was reduced from an average of 1.2 to 0 days. In-patient stay was significantly (P=0.006) lower in Groups 2 and 3 (5.4 days) than Group 1 (5.9 days) (i.e. a reduction in cost of approximately $6,140). CONCLUSIONS: The evolution of our thoracoscopic anterior scoliosis correction has resulted in an increase in the number of levels fused and reduction in complication rate. Implant costs have risen as a result, however, there has been a concurrent decrease in those costs generated by operating room use, ICU and in-patient stay with increasing experience. Literature review of equivalent curve types treated posteriorly shows similar perioperative factors but higher implant density, 69-83% compared to the 50% in this study. Thoracoscopic Scoliosis surgery presents a low density, reliable, efficient and effective option for selected curves. A cost analysis of Thoracoscopic Scoliosis Surgery using financial records and a prospectively collected database of all patients since 2000, demonstrating a clear cost advantage compared to equivalent posterior instrumentation and fusion.

Audiencing through social media : a brief overview

Notwithstanding the problems with identifying audiences (c.f. Hartley, 1987), nor with sampling them (c.f. Turner, 2005), we contend that by using social media, it is at least possible to gain an understanding of the habits of those who chose to engage with content through social media. In this chapter, we will broadly outline the ways in which networks such as Twitter and Facebook can stand as proxies for audiences in a number of scenarios, and enable content creators, networks and researchers to understand the ways in which audiences come into existence, change over time, and engage with content. Beginning with the classic audience – television – we will consider the evolution of metrics from baseline volume metrics to the more sophisticated ‘telemetrics’ that are the focus of our current work. We discuss the evolution of these metrics, from principles developed in the field of ‘sabermetrics’, and highlight their effectiveness as both a predictor and a baseline for producers and networks to measure the success of their social media campaigns. Moving beyond the evaluation of the audiences engagement, we then move to consider the ‘audiences’ themselves. Building on Hartley’s argument that audiences are “imagined” constructs (1987, p. 125), we demonstrate the continual shift of Australian television audiences, from episode to episode and series to series, demonstrating through our map of the Australian Twittersphere (Bruns, Burgess & Highfield, 2014) both the variation amongst those who directly engage with television content, and those who are exposed to it through their social media networks. Finally, by exploring overlaps between sporting events (such as the NRL and AFL Grand Finals), reality TV (such as Big Brother, My Kitchen Rules & Biggest Loser), soaps (e.g. Bold & The Beautiful, Home & Away), and current affairs programming (e.g. Morning Television & A Current Affair), we discuss to what extent it is possible to profile and categorize Australian television audiences. Finally, we move beyond television audiences to consider audiences around social media platforms themselves. Building on our map of the Australian Twittersphere (Bruns, Burgess & Highfield, 2014), and a pool of 5000 active Australian accounts, we discuss the interconnectedness of audiences around particular subjects, and how specific topics spread throughout the Twitter Userbase. Also, by using Twitter as a proxy, we consider the career of a number of popular YouTuber’s, utilizing a method we refer to as Twitter Accession charts (Bruns & Woodford, 2014) to identify the growth curves, and relate them to specific events in the YouTubers career, be that ‘viral’ videos or collaborations, to discuss how audiences form around specific content creators.

Extreme water level exceedance probabilities around Australia

The potential impacts of extreme water level events on our coasts are increasing as populations grow and sea levels rise. To better prepare for the future, coastal engineers and managers need accurate estimates of average exceedance probabilities for extreme water levels. In this paper, we estimate present day probabilities of extreme water levels around the entire coastline of Australia. Tides and storm surges generated by extra-tropical storms were included by creating a 61-year (1949-2009) hindcast of water levels using a high resolution depth averaged hydrodynamic model driven with meteorological data from a global reanalysis. Tropical cyclone-induced surges were included through numerical modelling of a database of synthetic tropical cyclones equivalent to 10,000 years of cyclone activity around Australia. Predicted water level data was analysed using extreme value theory to construct return period curves for both the water level hindcast and synthetic tropical cyclone modelling. These return period curves were then combined by taking the highest water level at each return period.

Fire performance and design of load bearing light gauge steel frame wall systems exposed to realistic design fires

This paper presents the fire performance results of light gauge steel frame (LSF) walls lined with single and double plasterboards, and externally insulated with rock fibre insulation as obtained using a finite element analysis based parametric study. A validated numerical model was used to study the influence of various fire curves developed for a range of compartment characteristics. Data from the parametric study was utilized to develop a simplified method to predict the fire resistance ratings of LSF walls exposed to realistic design fire curves. Further, this paper also presents the details of suitable fire design rules based on current cold-formed steel standards and the modifications proposed by previous researchers. Of these the recently developed design rules by Gunalan and Mahendran [1] were investigated to determine their applicability to predict the axial compression strengths and fire resistance ratings (FRR) of LSF walls exposed to realistic design fires. Finally, the stud failure times obtained from fire design rules and finite element studies were compared for LSF walls lined with single and double plasterboards, and externally insulated with rock fibres under realistic design fire curves.

Fire resistance rating of light gauge steel frame walls exposed to realistic design fires : a review and development of time equivalent approach

This paper presents the details of research undertaken on the development of an energy based time equivalent approach for light gauge steel frame (LSF) walls. This research utilized an energy based time equivalent approach to obtain the fire resistance ratings (FRR) of LSF walls exposed to realistic design fires with respect to standard fire exposure [1]. It is based on the equal area concept of fire severity and relates to the amount of energy transferred to the member. The proposed method was used to predict the fire resistance of single and double plasterboard lined and externally insulated LSF walls. The predicted fire resistance ratings were compared with the results from finite element analyses and fire design rules for three different wall configurations. This paper presents the review of the available time equivalent approaches and the development of energy based time equivalent approach for the prediction of fire resistance ratings of LSF walls exposed to realistic design fires.

Electrowetting control of Cassie-to-Wenzel Transitions in superhydrophobic carbon nanotube-based nanocomposites

The possibility of effective control of the wetting properties of a nanostructured surface consisting of arrays of amorphous carbon nanoparticles capped on carbon nanotubes using the electrowetting technique is demonstrated. By analyzing the electrowetting curves with an equivalent circuit model of the solid/liquid interface, the long-standing problem of control and monitoring of the transition between the "slippy" Cassie state and the "sticky" Wenzel states is resolved. The unique structural properties of the custom-designed nanocomposites with precisely tailored surface energy without using any commonly utilized low-surface-energy (e.g., polymer) conformal coatings enable easy identification of the occurrence of such transition from the optical contrast on the nanostructured surfaces. This approach to precise control of the wetting mode transitions is generic and has an outstanding potential to enable the stable superhydrophobic capability of nanostructured surfaces for numerous applications, such as low-friction microfluidics and self-cleaning.

Electron-conduction mechanism and specific heat above transition temperature in LaFeAsO and BaFe2As2 superconductors

The ionization energy theory is used to calculate the evolution of the resistivity and specific heat curves with respect to different doping elements in the recently discovered superconducting pnictide materials. Electron-conduction mechanism in the pnictides above the structural transition temperature is explained unambiguously, which is also consistent with other strongly correlated materials, such as cuprates, manganites, titanates and magnetic semiconductors.

Gravity-induced coronal plane joint moments in the adolescent scoliotic spine

INTRODUCTION Calculating segmental (vertebral level-by-level) torso masses in Adolescent Idiopathic Scoliosis (AIS) patients allows the gravitational loading on the scoliotic spine during relaxed standing to be estimated. METHODS Existing low dose CT scans were used to calculate vertebral level-by-level torso masses and joint moments occurring in the spine for a group of female AIS patients with right-sided thoracic curves. Image processing software, ImageJ (v1.45 NIH USA) was used to reconstruct the torso segments and subsequently measure the torso volume and mass corresponding to each vertebral level. Body segment masses for the head, neck and arms were taken from published anthropometric data. Intervertebral joint moments at each vertebral level were found by summing each of the torso segment masses above the required joint and multiplying it by the perpendicular distance to the centre of the disc. RESULTS AND DISCUSSION Twenty patients were included in this study with a mean age of 15.0±2.7 years and a mean Cobb angle 52±5.9°. The mean total trunk mass, as a percentage of total body mass, was 27.8 (SD 0.5) %. Mean segmental torso mass increased inferiorly from 0.6kg at T1 to 1.5kg at L5. The coronal plane joint moments during relaxed standing were typically 5-7Nm at the apex of the curve (Figure 1), with the highest apex joint of 7Nm. CT scans were performed in the supine position and curve magnitudes are known to be 7-10° smaller than those measured in standing [1]. Therefore joint moments produced by gravity will be greater than those calculated here. CONCLUSIONS Coronal plane joint moments as high as 7Nm can occur during relaxed standing in scoliosis patients, which may help to explain the mechanics of AIS progression. The body mass distributions calculated in this study can be used to estimate joint moments derived using other imaging modalities such as MRI and subsequently determine if a relationship exists between joint moments and progressive vertebral deformity.

A biomechanical analysis of growing rods used in the management of early onset scoliosis

INTRODUCTION Managing spinal deformities in young children is challenging, particularly early-onset scoliosis (EOS). Any progressive spinal deformity particularly in early life presents significant health risks for the child and a challenge for the treating surgeon. Surgical intervention is often required if EOS has been unresponsive to conservative treatment particularly with rapidly progressive curves. An emerging treatment option particularly for EOS is fusionless scoliosis surgery. Similar to bracing this surgical option potentially harnesses growth, motion and function of the spine along with correcting spinal deformity. Dual growing rods is one such fusionless treatment, which aims to modulate growth of the vertebrae. The aim of this study was to ascertain the extent to which semi-constrained growing rods (Medtronic, Memphis, TN) with a telescopic sleeve component, reduce rotational constraint on the spine compared with standard rigid rods and hence potentially provide a more physiological mechanical environment for the growing spine. METHODS Six 40-60kg English Large White porcine spines served as a model for the paediatric human spine. Each spine was dissected into 7 level thoracolumbar multi-segment unit (MSU) spines, removing all non-ligamentous soft tissues. Appropriately sized semi-constrained growing rods and rigid rods were secured by multi-axial screws (Medtronic) prior to testing in alternating sequences for each spine. Pure nondestructive moments of +/4Nm at a constant rotation rate of 8deg/s was applied to the mounted MSU spines. Displacement of each level was captured using an Optotrak (Northern Digital Inc, Waterloo, ON). The range of motion (ROM), neutral zone (NZ) size and stiffness (Nm/deg) were calculated from the Instron load-displacement data and intervertebral ROM was calculated through a MATLAB algorithm from Optotrak data. RESULTS Irrespective of sequence order rigid rods significantly reduced the total ROM (deg) than compared to semi-constrained rods (p<0.05) and resulted in a significantly stiffer (Nm/deg) spine for both left and right axial rotation testing (p<0.05). Analysing the intervertebral motion within the instrumented levels, rigid rods showed reduced ROM (Deg) than compared to semi-constrained growing rods and the un-instrumented (UN-IN) test sequences. CONCLUSION The semi-constrained growing rods maintained rotation similar to UN-IN spines while the rigid rods showed significantly reduced axial rotation across all instrumented levels. Clinically the effect of semi-constrained growing rods evaluated in this study is that they will allow growth via the telescopic rod components while maintaining the axial rotation ability of the spine, which may also reduce the occurrence of the crankshaft phenomenon.

Determination of strain-rate-dependent mechanical behavior of living and fixed osteocytes and chondrocytes using atomic force microscopy and inverse finite element analysis

The aim of this paper is to determine the strain-rate-dependent mechanical behavior of living and fixed osteocytes and chondrocytes, in vitro. Firstly, Atomic Force Microscopy (AFM) was used to obtain the force-indentation curves of these single cells at four different strain-rates. These results were then employed in inverse finite element analysis (FEA) using Modified Standard neo-Hookean Solid (MSnHS) idealization of these cells to determine their mechanical properties. In addition, a FEA model with a newly developed spring element was employed to accurately simulate AFM evaluation in this study. We report that both cytoskeleton (CSK) and intracellular fluid govern the strain-rate-dependent mechanical property of living cells whereas intracellular fluid plays a predominant role on fixed cells’ behavior. In addition, through the comparisons, it can be concluded that osteocytes are stiffer than chondrocytes at all strain-rates tested indicating that the cells could be the biomarker of their tissue origin. Finally, we report that MSnHS is able to capture the strain-rate-dependent mechanical behavior of osteocyte and chondrocyte for both living and fixed cells. Therefore, we concluded that the MSnHS is a good model for exploration of mechanical deformation responses of single osteocytes and chondrocytes. This study could open a new avenue for analysis of mechanical behavior of osteocytes and chondrocytes as well as other similar types of cells.

Evaluation of emerging intelligent transport systems to improve safety on level crossings : an overview

Safety at railway level crossings (RLX) is one part of a wider picture of safety within the whole transport system. Governments, the rail industry and road organisations have used a variety of countermeasures for many years to improve RLX safety. New types of interventions are required in order to reduce the number of crashes and associated social costs at railway crossings. This paper presents the results of a large research program which aimed to assess the effectiveness of emerging Intelligent Transport Systems (ITS) interventions, both on-road and in-vehicle based, to improve the safety of car drivers at RLXs in Australia. The three most promising technologies selected from the literature review and focus groups were tested in an advanced driving simulator to provide a detailed assessment of their effects on driver behaviour. The three interventions were: (i) in-vehicle visual warning using a GPS/smartphone navigation-like system, (ii) in-vehicle audio warning and; (iii) on-road intervention known as valet system (warning lights on the road surface activated as a train approaches). The effects of these technologies on 57 participants were assessed in a systematic approach focusing on the safety of the intervention, effects on the road traffic around the crossings and driver’s acceptance of the technology. Given that the ITS interventions were likely to provide a benefit by improving the driver’s awareness of the crossing status in low visibility conditions, such conditions were investigated through curves in the track before arriving at the crossing. ITS interventions were also expected to improve driver behaviour at crossings with high traffic (blocking back issue), which were also investigated at active crossings. The key findings are: (i) interventions at passive crossings are likely to provide safety benefits; (ii) the benefits of ITS interventions on driver behaviour at active crossings are limited; (iii) the trialled ITS interventions did not show any issues in terms of driver distraction, driver acceptance or traffic delays; (iv) these interventions are easy to use, do not increase driver workload substantially; (v) participants’ intention to use the technology is high and; (vi) participants saw most value in succinct messages about approaching trains as opposed to knowing the RLX locations or the imminence of a collision with a train.

Experimental investigation of post-fire mechanical properties of cold-formed steels

Cold-formed steel members are widely used in residential, industrial and commercial buildings as primary load-bearing elements. During fire events, they will be exposed to elevated temperatures. If the general appearance of the structure is satisfactory after a fire event then the question that has to be answered is how the load bearing capacity of cold-formed steel members in these buildings has been affected. Hence after such fire events there is a need to evaluate the residual strength of these members. However, the post-fire behaviour of cold-formed steel members has not been investigated in the past. This means conservative decisions are likely to be made in relation to fire exposed cold-formed steel buildings. Therefore an experimental study was undertaken to investigate the post-fire mechanical properties of cold-formed steels. Tensile coupons taken from cold-formed steel sheets of three different steel grades and thicknesses were exposed to different elevated temperatures up to 800 oC, and were then allowed to cool down to ambient temperature before they were tested to failure. Tensile coupon tests were conducted to obtain their post-fire stress-strain curves and associated mechanical properties (yield stress, Young’s modulus, ultimate strength and ductility). It was found that the post-fire mechanical properties of cold-formed steels are reduced below the original ambient temperature mechanical properties if they had been exposed to temperatures exceeding 300 oC. Hence a new set of equations is proposed to predict the post-fire mechanical properties of cold-formed steels. Such post-fire mechanical property assessments allow structural and fire engineers to make an accurate prediction of the safety of fire exposed cold-formed steel buildings. This paper presents the details of this experimental study and the results of post-fire mechanical properties of cold-formed steels. It also includes the results of a post-fire evaluation of cold-formed steel walls.

Regional trade-offs between mine water and energy use : a water treatment case study

The mining industry faces concurrent pressures of reducing water use, energy consumption and greenhouse gas (GHG) emissions in coming years. However, the interactions between water and energy use, as well as GHG e missions have largely been neglected in modelling studies to date. In addition, investigations tend to focus on the unit operation scale, with little consideration of whole-of-site or regional scale effects. This paper presents an application of a hierarchical systems model (HSM) developed to represent water, energy and GHG emissions fluxes at scales ranging from the unit operation, to the site level, to the regional level. The model allows for the linkages between water use, energy use and GHG emissions to be examined in a fl exible and intuitive way, so that mine sites can predict energy and emissions impacts of water use reduction schemes and vice versa. This paper examines whether this approach can also be applied to the regional scale with multiple mine sites. The model is used to conduct a case study of several coal mines in the Bowen Basin, Australia, to compare the utility of centralised and decentralised mine water treatment schemes. The case study takes into account geographical factors (such as water pumping distances and elevations), economic factors (such as capital and operating cost curves for desalination treatment plants) and regional factors (such as regionally varying climates and associated variance in mine water volumes and quality). The case study results indicate that treatment of saline mine water incurs a trade-off between water and energy use in all cases. However, significant cost differences between centralised and decentralised schemes can be observed in a simple economic analysis. Further research will examine the possibility for deriving model up-scaling algorithms to reduce computational requirements.

Automated diagnosis of Age-related Macular Degeneration using greyscale features from digital fundus images

Age-related Macular Degeneration (AMD) is one of the major causes of vision loss and blindness in ageing population. Currently, there is no cure for AMD, however early detection and subsequent treatment may prevent the severe vision loss or slow the progression of the disease. AMD can be classified into two types: dry and wet AMDs. The people with macular degeneration are mostly affected by dry AMD. Early symptoms of AMD are formation of drusen and yellow pigmentation. These lesions are identified by manual inspection of fundus images by the ophthalmologists. It is a time consuming, tiresome process, and hence an automated diagnosis of AMD screening tool can aid clinicians in their diagnosis significantly. This study proposes an automated dry AMD detection system using various entropies (Shannon, Kapur, Renyi and Yager), Higher Order Spectra (HOS) bispectra features, Fractional Dimension (FD), and Gabor wavelet features extracted from greyscale fundus images. The features are ranked using t-test, Kullback–Lieber Divergence (KLD), Chernoff Bound and Bhattacharyya Distance (CBBD), Receiver Operating Characteristics (ROC) curve-based and Wilcoxon ranking methods in order to select optimum features and classified into normal and AMD classes using Naive Bayes (NB), k-Nearest Neighbour (k-NN), Probabilistic Neural Network (PNN), Decision Tree (DT) and Support Vector Machine (SVM) classifiers. The performance of the proposed system is evaluated using private (Kasturba Medical Hospital, Manipal, India), Automated Retinal Image Analysis (ARIA) and STructured Analysis of the Retina (STARE) datasets. The proposed system yielded the highest average classification accuracies of 90.19%, 95.07% and 95% with 42, 54 and 38 optimal ranked features using SVM classifier for private, ARIA and STARE datasets respectively. This automated AMD detection system can be used for mass fundus image screening and aid clinicians by making better use of their expertise on selected images that require further examination.

Flexural–torsional buckling behaviour and design of cold-formed steel compression members at elevated temperatures

Current design rules for the member capacities of cold-formed steel columns are based on the same non-dimensional strength curve for both fixed and pinned-ended columns at ambient temperature. This research has investigated the accuracy of using current ambient temperature design rules in Australia/New Zealand (AS/NZS 4600), American (AISI S100) and European (Eurocode 3 Part 1.3) standards in determining the flexural–torsional buckling capacities of cold-formed steel columns at uniform elevated temperatures using appropriately reduced mechanical properties. It was found that these design rules accurately predicted the member capacities of pin ended lipped channel columns undergoing flexural torsional buckling at elevated temperatures. However, for fixed ended columns with warping fixity undergoing flexural–torsional buckling, the current design rules significantly underestimated the column capacities as they disregard the beneficial effect of warping fixity. This paper has therefore recommended the use of improved design rules developed for ambient temperature conditions to predict the axial compression capacities of fixed ended columns subject to flexural–torsional buckling at elevated temperatures within AS/NZS 4600 and AISI S100 design provisions. The accuracy of the proposed fire design rules was verified using finite element analysis and test results of cold-formed lipped channel columns at elevated temperatures except for low strength steel columns with intermediate slenderness whose behaviour was influenced by the increased nonlinearity in the stress–strain curves at elevated temperatures. Further research is required to include these effects within AS/NZS 4600 and AISI S100 design rules. However, Eurocode 3 Part 1.3 design rules can be used for this purpose by using suitable buckling curves as recommended in this paper.