Mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur

Recently the National Patient Safety Agency in the United Kingdom published a report entitled "Mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur". A total of 26 deaths had been reported to them when cement was used at hemiarthroplasty between October 2003 and October 2008. This paper considers the evidence for using cement fixation of a hemiarthroplasty in the treatment of hip fractures.

Identifying and implementing adaptive strategy in the U.S. military

Changes in the environment, including increased environmental complexity, require military supply units to employ a more adaptive strategy in order to enhance military agility. We extend the Lumpkin and Dess (1996) model and develop propositions that explore the interrelationships between/amongst entrepreneurial orientation (EO); opportunity recognition, evaluation and exploitation; environmental and organizational factors; and organizational performance. We propose that the innovativeness, proactiveness, and risk-taking dimensions of EO are of primary importance in identifying adaptive solutions and that these relationships are moderated by environmental factors. The autonomy and competitive aggressiveness dimensions of EO are important in implementing solutions as adaptive strategies, especially in a military context, and these relationships are moderated by organizational factors. This chapter extends existing theory developed primarily for the civilian sector to the military. Military organizations are more rigid hierarchical structures, and have different measures of performance. At an applied level, this research provides insights for military commanders that can potentially enhance agility and adaptability.

The effect of insertion time on the axial pullout strength of anterior vertebral body screws

Top screw pullout occurs when the screw is under too much axial force to remain secure in the vertebral body. In vitro biomechanical pullout tests are commonly done to find the maximum fixation strength of anterior vertebral body screws. Typically, pullout tests are done instantaneously where the screw is inserted and then pulled out immediately after insertion. However, bone is a viscoelastic material so it shows a time dependent stress and strain response. Because of this property, it was hypothesised that creep occurs in the vertebral trabecular bone due to the stress caused by the screw. The objective of this study was therefore to determine whether the axial pullout strength of anterior vertebral body screws used for scoliosis correction surgery changes with time after insertion. This study found that there is a possible relationship between pullout strength and time; however more testing is required as the sample numbers were quite small. The design of the screw is made with the knowledge of the strength it must obtain. This is important to prevent such occurrences as top screw pullout. If the pullout strength is indeed decreased due to creep, the design of the screw may need to be changed to withstand greater forces.

Simulation of the nutrient supply in fracture healing

The healing process for bone fractures is sensitive to mechanical stability and blood supply at the fracture site. Most currently available mechanobiological algorithms of bone healing are based solely on mechanical stimuli, while the explicit analysis of revascularization and its influences on the healing process have not been thoroughly investigated in the literature. In this paper, revascularization was described by two separate processes: angiogenesis and nutrition supply. The mathematical models for angiogenesis and nutrition supply have been proposed and integrated into an existing fuzzy algorithm of fracture healing. The computational algorithm of fracture healing, consisting of stress analysis, analyses of angiogenesis and nutrient supply, and tissue differentiation, has been tested on and compared with animal experimental results published previously. The simulation results showed that, for a small and medium-sized fracture gap, the nutrient supply is sufficient for bone healing, for a large fracture gap, non-union may be induced either by deficient nutrient supply or inadequate mechanical conditions. The comparisons with experimental results demonstrated that the improved computational algorithm is able to simulate a broad spectrum of fracture healing cases and to predict and explain delayed unions and non-union induced by large gap sizes and different mechanical conditions. The new algorithm will allow the simulation of more realistic clinical fracture healing cases with various fracture gaps and geometries and may be helpful to optimise implants and methods for fracture fixation.

Loading applied on prosthetic knee of transfemoral amputee: comparison of inverse dynamics and direct measurements

Inverse dynamics is the most comprehensive method that gives access to the net joint forces and moments during walking. However it is based on assumptions (i.e., rigid segments linked by ideal joints) and it is known to be sensitive to the input data (e.g., kinematic derivatives, positions of joint centres and centre of pressure, inertial parameters). Alternatively, transducers can be used to measure directly the load applied on the residuum of transfemoral amputees. So, the purpose of this study was to compare the forces and moments applied on a prosthetic knee measured directly with the ones calculated by three inverse dynamics computations - corresponding to 3 and 2 segments, and « ground reaction vector technique » - during the gait of one patient. The maximum RMSEs between the estimated and directly measured forces (i.e., 56 N) and moment (i.e., 5 N.m) were relatively small. However the dynamic outcomes of the prosthetic components (i.e., absorption of the foot, friction and limit stop of the knee) were only partially assessed with inverse dynamic methods.

Compliance in peritoneal dialysis : a qualitative study of renal nurses

End-stage renal failure is a life-threatening condition, often treated with home-based peritoneal dialysis (PD). PD is a demanding regimen, and the patients who practise it must make numerous lifestyle changes and learn complicated biomedical techniques. In our experience, the renal nurses who provide mostPDeducation frequently express concerns that patient compliance with their teaching is poor. These concerns are mirrored in the renal literature. It has been argued that the perceived failure of health professionals to improve compliance rates with PD regimens is because ‘compliance’ itself has never been adequately conceptualized or defined; thus, it is difficult to operationalize and quantify. This paper examines how a group of Australian renal nurses construct patient compliance with PD therapy. These empirical data illuminate how PD compliance operates in one practice setting; how it is characterized by multiple and often competing energies; and how ultimately it might be pointless to try to tame ‘compliance’ through rigid definitions and measurement, or to rigidly enforce it in PD patients. The energies involved are too fractious and might be better spent, as many of the more experienced nurses in this study argue, in augmenting the energies that do work well together to improve patient outcomes.

Site survey and analysis of highway trucks overloading status quo in Anhui

In 2004, with the increasing overloading restriction requirements of society in Anhui, a provincial comprehensive overloading transportation survey has been developed to take evaluations on overloading actuality and enforcement efficiency with the support of the World Bank. A total of six site surveys were conducted at Hefei, Fuyang, Luan, Wuhu, Huainan and Huangshan Areas with four main contents respectively: traffic volume, axle load, freight information and registration information. Via statistical analysis on the survey data, conclusions were gained that: vehicle overloading are very universal and serious problems at arterial highways in Anhui now. The traffic loads have far exceeded the designed endure capacity of highways and have caused prevalent premature pavement damage, especially for rigid pavement. The overloading trucks are unimpeded engaged in highway freight transportation actually due to the disordered overloading enforcement strategies and the deficient inspecting technologies.

Application of system dynamics for evaluating truck load regulations in Anhui, China

In the critical situation of prevailing overweight transportation and crag-fast enforcement in Chinese highway networks, this paper develops a methodological framework for truck weight regulation (TWR) evaluation using System Dynamics (SD). Composed of five interrelated subsystems, the framework is able to capture the highway, vehicle and freight variables that influence the effect of TWR and transportation efficiency over time. It specifically describes the development and use of the Truck Weight Regulation Evaluating Model (TWREM) for the highway freight system in Anhui province, China. Three policy alternatives are analyzed: 1) tolerant policy approach, which allows heavy-duty freight activity to continue in its current state, and is shown to lead to nearly catastrophic results; 2) rigid policy approach, which would terminate all heavy-duty freight activities immediately, and is shown to be economically infeasible; and 3) moderate policy approach, which advocates a gradual reduction of heavy-duty freight activities to a moderate state. The simulation results shows that the moderate policy approach is the most appropriate option to solve the social and economic problems arising from the activities of the heavy-duty freight transportation in Anhui. In addition, some suggestions of TWR policy in China are also made in this paper.

The influence of oblique viewing on axial and peripheral refraction for emmetropes and myopes

Refraction may be affected by the forces of lids and extraocular muscles when eye direction and head direction are not aligned (oblique viewing) which might potentially influence past findings on peripheral refraction of the eye. We investigated the effect of oblique viewing on axial and peripheral refraction. In a first experiment, cycloplegic axial refractions were determined when subjects' heads were positioned to look straight-ahead through an open-view autorefractor and when the heads were rotated to the right or left by 30° with compensatory eye rotation (oblique viewing). Subjects were 16 young emmetropes (18–35 years), 22 young myopes (19–36 years) and 15 old emmetropes (45–60 years). In a second experiment, cycloplegic peripheral refraction measurements were taken out to ±34° horizontally from fixation while the subjects rotated their heads to match the peripheral refraction angles (eye in primary position with respect to the head) or the eyes were rotated with respect to the head (oblique viewing). Subjects were 10 emmetropes and 10 myopes. We did not find any significant changes in axial or peripheral refraction upon oblique viewing for any of the subject groups. In general for the range of horizontal angles used, it is not critical whether or not the eye is rotated with respect to the head during axial or peripheral refraction.

Flexural behaviour and design of cold-formed steel beams with rectangular hollow flanges

Until recently, the hot-rolled steel members have been recognized as the most popular and widely used steel group, but in recent times, the use of cold-formed high strength steel members has rapidly increased. However, the structural behavior of light gauge high strength cold-formed steel members characterized by various buckling modes is not yet fully understood. The current cold-formed steel sections such as C- and Z-sections are commonly used because of their simple forming procedures and easy connections, but they suffer from certain buckling modes. It is therefore important that these buckling modes are either delayed or eliminated to increase the ultimate capacity of these members. This research is therefore aimed at developing a new cold-formed steel beam with two torsionally rigid rectangular hollow flanges and a slender web formed using intermittent screw fastening to enhance the flexural capacity while maintaining a minimum fabrication cost. This thesis describes a detailed investigation into the structural behavior of this new Rectangular Hollow Flange Beam (RHFB), subjected to flexural action The first phase of this research included experimental investigations using thirty full scale lateral buckling tests and twenty two section moment capacity tests using specially designed test rigs to simulate the required loading and support conditions. A detailed description of the experimental methods, RHFB failure modes including local, lateral distortional and lateral torsional buckling modes, and moment capacity results is presented. A comparison of experimental results with the predictions from the current design rules and other design methods is also given. The second phase of this research involved a methodical and comprehensive investigation aimed at widening the scope of finite element analysis to investigate the buckling and ultimate failure behaviours of RHFBs subjected to flexural actions. Accurate finite element models simulating the physical conditions of both lateral buckling and section moment capacity tests were developed. Comparison of experimental and finite element analysis results showed that the buckling and ultimate failure behaviour of RHFBs can be simulated well using appropriate finite element models. Finite element models simulating ideal simply supported boundary conditions and a uniform moment loading were also developed in order to use in a detailed parametric study. The parametric study results were used to review the current design rules and to develop new design formulae for RHFBs subjected to local, lateral distortional and lateral torsional buckling effects. Finite element analysis results indicate that the discontinuity due to screw fastening has a noticeable influence only for members in the intermediate slenderness region. Investigations into different combinations of thicknesses in the flange and web indicate that increasing the flange thickness is more effective than web thickness in enhancing the flexural capacity of RHFBs. The current steel design standards, AS 4100 (1998) and AS/NZS 4600 (1996) are found sufficient to predict the section moment capacity of RHFBs. However, the results indicate that the AS/NZS 4600 is more accurate for slender sections whereas AS 4100 is more accurate for compact sections. The finite element analysis results further indicate that the current design rules given in AS/NZS 4600 is adequate in predicting the member moment capacity of RHFBs subject to lateral torsional buckling effects. However, they were inadequate in predicting the capacities of RHFBs subject to lateral distortional buckling effects. This thesis has therefore developed a new design formula to predict the lateral distortional buckling strength of RHFBs. Overall, this thesis has demonstrated that the innovative RHFB sections can perform well as economically and structurally efficient flexural members. Structural engineers and designers should make use of the new design rules and the validated existing design rules to design the most optimum RHFB sections depending on the type of applications. Intermittent screw fastening method has also been shown to be structurally adequate that also minimises the fabrication cost. Product manufacturers and builders should be able to make use of this in their applications.

Application of a continuum theory to vertical vibrations of a layer of granular material

Many interesting phenomena have been observed in layers of granular materials subjected to vertical oscillations; these include the formation of a variety of standing wave patterns, and the occurrence of isolated features called oscillons, which alternately form conical heaps and craters oscillating at one-half of the forcing frequency. No continuum-based explanation of these phenomena has previously been proposed. We apply a continuum theory, termed the double-shearing theory, which has had success in analyzing various problems in the flow of granular materials, to the problem of a layer of granular material on a vertically vibrating rigid base undergoing vertical oscillations in plane strain. There exists a trivial solution in which the layer moves as a rigid body. By investigating linear perturbations of this solution, we find that at certain amplitudes and frequencies this trivial solution can bifurcate. The time dependence of the perturbed solution is governed by Mathieu’s equation, which allows stable, unstable and periodic solutions, and the observed period-doubling behaviour. Several solutions for the spatial velocity distribution are obtained; these include one in which the surface undergoes vertical velocities that have sinusoidal dependence on the horizontal space dimension, which corresponds to the formation of striped standing waves, and is one of the observed patterns. An alternative continuum theory of granular material mechanics, in which the principal axes of stress and rate-of-deformation are coincident, is shown to be incapable of giving rise to similar instabilities.

Damage assessment of 3D reinforced concrete frame under external explosion loading

Multi-storey buildings are highly vulnerable to terrorist bombing attacks in various parts of the world. Large numbers of casualties and extensive property damage result not only from blast overpressure, but also from the failing of structural components. Understanding the blast response and damage consequences of reinforced concrete (RC) building frames is therefore important when assessing multi-storey buildings designed to resist normal gravity loads. However, limited research has been conducted to identify the blast response and damage of RC frames in order to assess the vulnerability of entire buildings. This paper discusses the blast response and evaluation of damage of three-dimension (3D) RC rigid frame under potential blast loads scenarios. The explicit finite element modelling and analysis under time history blast pressure loads were carried out by LS DYNA code. Complete 3D RC frame was developed with relevant reinforcement details and material models with strain rate effect. Idealised triangular blast pressures calculated from standard manuals are applied on the front face of the model in the present investigation. The analysis results show the blast response, as displacements and material yielding of the structural elements in the RC frame. The level of damage is evaluated and classified according to the selected load case scenarios. Residual load carrying capacities are evaluated and level of damage was presented by the defined damage indices. This information is necessary to determine the vulnerability of existing multi-storey buildings with RC frames and to identify the level of damage under typical external explosion environments. It also provides basic guidance to the design of new buildings to resist blast loads.

Experimental studies of the shear behavior of LiteSteel Beams

This paper presents the details of experimental studies on the shear behaviour of a recently developed, cold-formed steel beam known as LiteSteel Beam (LSB). The LSB section has a unique shape of a channel beam with two rectangular hollow flanges and is produced by a patented manufacturing process involving simultaneous cold-forming and dual electric resistance welding. To date, no research has been undertaken on the shear behaviour of LiteSteel beams with torsionally rigid, rectangular hollow flanges. In the present investigation, experimental studies involving more than 30 shear tests were carried out to investigate the shear behaviour of 13 different LSB sections. It was found that the current design rules in cold-formed steel structures design codes are very conservative for the shear design of LiteSteel beams. Significant improvements to web shear buckling occurred due to the presence of rectangular hollow flanges while considerable post-buckling strength was also observed. Experimental results are presented and compared with corresponding predictions from the current design codes in this paper. Appropriate improvements have been proposed for the shear strength of LSBs based on AS/NZS 4600 design equations.

Design of Mono-symmetric LiteSteel Beam Floor Joists with Web Openings

The new cold-formed LiteSteel beam (LSB) sections have found increasing popularity in residential, industrial and commercial buildings due to their lightweight and cost-effectiveness. They have the beneficial characteristics of including torsionally rigid rectangular flanges combined with economical fabrication processes. Currently there is significant interest in using LSB sections as flexural members in floor joist systems. When used as floor joists, the LSB sections require holes in the web to provide access for inspection and various services. But there are no design methods that provide accurate predictions of the moment capacities of LSBs with web holes. In this study, the buckling and ultimate strength behaviour of LSB flexural members with web holes was investigated in detail by using a detailed parametric study based on finite element analyses with an aim to develop appropriate design rules and recommendations for the safe design of LSB floor joists. Moment capacity curves were obtained using finite element analyses including all the significant behavioural effects affecting their ultimate member capacity. The parametric study produced the required moment capacity curves of LSB section with a range of web hole combinations and spans. A suitable design method for predicting the ultimate moment capacity of LSB with web holes was finally developed. This paper presents the details of this investigation and the results