Dying feet in ICU : why might extracorporeal membrane oxygenation machines cause necrotic feet?

Background Extracorporeal membrane oxygenation (ECMO) is used for severe lung and/or heart failure in intensive care units (ICU). The Prince Charles Hospital (TPCH) has one of the largest ECMO units in Australia. Its use rapidly increased during the H1N1 (“swine flu”) pandemic and an increase in pedal complications resulted. The relationship between ECMO and pedal complications has been described, particularly in children, though no strong data exists. This paper presents a case series of foot complications in patients having received ECMO treatment. Methods We present nine cases of severe foot complications resulting from patients receiving ECMO treatment at TPCH in 2009–2012. Results Case ages ranged from 16 - 58 years and three were male. Six cases had an unremarkable medical history prior to H1N1 or H1N2 infection, one had Cardiomyopathy, one had received a lung transplant, and one had multi-organ failure post-sepsis. Common medications prescribed included vasopressors, antibiotics, and sedatives. All cases showed signs of markedly impaired peripheral perfusion whilst on ECMO and seven developed increasing areas of foot necrosis. Outcomes include two bilateral below knee amputations, two multiple digital amputations, one Reflex Sympathetic Dystrophy Syndrome, three pressure injuries, and three deaths. Conclusion Necrosis of the feet appears to occur more readily in younger people requiring ECMO treatment than others in ICU. The authors are conducting further studies to investigate associations between particular infections, medical history, medications, or machine techniques and severe foot complications. Some of these early results will also be presented at this conference.

The local library across the digital and physical city : opportunities for economic development

This paper considers the role of the public library as a community hub, engagement space, and entrepreneurial incubator in the context of the city, city governance, and local government planning. It considers this role from the perspective of library experts and their future visions for libraries in a networked knowledge economy. Public libraries (often operated by or on behalf of local governments) potentially play a pivotal role for local governments in positioning communities within the global digital network. Fourteen qualitative interviews with library experts informed the study which investigates how the relationship between digital technology and the physical library space can potentially support the community to develop innovative, collaborative environments for transitioning to a digital future. The study found that libraries can capitalise on their position as community hubs for two purposes: first, to build vibrant community networks and forge economic links across urban localities; and second, to cross the digital divide and act as places of innovation and lifelong learning. Libraries provide a specific combination of community and technology spaces and have significant tangible connection points in the digital age. The paper further discusses the potential benefits for libraries in using ICT networks and infrastructure, such as the National Broadband Network in Australia. These networks could facilitate greater use of library assets and community knowledge, which, in turn, could assist knowledge economies and regional prosperity.

Local stress-strain distribution and load transfer across cartilage matrix at micro-scale using combined microscopy-based finite element method

Articular cartilage is the load-bearing tissue that consists of proteoglycan macromolecules entrapped between collagen fibrils in a three-dimensional architecture. To date, the drudgery of searching for mathematical models to represent the biomechanics of such a system continues without providing a fitting description of its functional response to load at micro-scale level. We believe that the major complication arose when cartilage was first envisaged as a multiphasic model with distinguishable components and that quantifying those and searching for the laws that govern their interaction is inadequate. To the thesis of this paper, cartilage as a bulk is as much continuum as is the response of its components to the external stimuli. For this reason, we framed the fundamental question as to what would be the mechano-structural functionality of such a system in the total absence of one of its key constituents-proteoglycans. To answer this, hydrated normal and proteoglycan depleted samples were tested under confined compression while finite element models were reproduced, for the first time, based on the structural microarchitecture of the cross-sectional profile of the matrices. These micro-porous in silico models served as virtual transducers to produce an internal noninvasive probing mechanism beyond experimental capabilities to render the matrices micromechanics and several others properties like permeability, orientation etc. The results demonstrated that load transfer was closely related to the microarchitecture of the hyperelastic models that represent solid skeleton stress and fluid response based on the state of the collagen network with and without the swollen proteoglycans. In other words, the stress gradient during deformation was a function of the structural pattern of the network and acted in concert with the position-dependent compositional state of the matrix. This reveals that the interaction between indistinguishable components in real cartilage is superimposed by its microarchitectural state which directly influences macromechanical behavior.

Facilitating local stories in post-disaster regional communities : evaluation in narrative-driven oral history projects

Cyclone Yasi struck the Cassowary Coast of Northern Queensland, Australia, in the early hours of February 3, 2011, destroying many homes and property, including the destruction of the Cardwell and district historical society’s premises. With their own homes flattened, many residents were forced to live in mobile accommodation, with extended family, or leave the area altogether. The historical society members seemed, however, particularly devastated by their flattened foreshore museum and loss of their precious collection of material. A call for assistance was made through the Oral History Association of Australia’s Queensland branch (OHAA Qld), which along with a Queensland University of Technology (QUT) research team sponsored a trip to best plan how they could start to pick up the pieces to rebuild the museum. This chapter highlights the need for communities to gather, preserve and present their own stories, in a way that is sustainable and meaningful to them – whether that be because of a disaster, or as they go about life in their contemporary communities – the key being that good advice, professional support and embedded evaluation practices at crucial moments along the way can be critically important.

Local Commons : communicating local issues through place-based interventions

Due to the numerous possibilities of voicing concerns and the flood of data we are exposed to, local issues are at a risk of being overlooked. Following a research agenda proposed by Foth et al. (2013), this thesis explored the possible contributions of situated digital and tangible media for communicating local issues. Making use of the location of an issue could thereby not only allow to reach the targeted audience but also for a deeper involvement of citizens. Through the development of a design intervention in public space, called Local Commons, the benefits of this approach were investigated. Therefore, the intervention combined digital and tangible media in order to engage the public to contribute and debate different perspectives on a given local issue. The interaction with the intervention was thereby twofold. First, the intervention invited the audience to submit images of their perspectives on the issue, which were displayed on a public screen. Via tangible buttons in front of the screen, the audience then had the possibility to agree or disagree to the displayed perspectives, creating a space for deliberation. In a field study, the concept was subsequently tested and evaluated. The results of this study, although not generalisable, supported the chosen approach of this thesis.

The development of shared understandings of assessment policy : travelling between global and local contexts

In this paper, teachers’ enactment of assessment policy within demands for accountability and consistency of teacher judgements is considered. Evidence is drawn from a qualitative study involving 50 middle school teachers from Queensland, Australia, who participated in online social moderation meetings with teachers located in dispersed areas around the state. The study presents how travelling policy is embedded in local histories and cultures, in particular within systems of accountability; and the different layers of what may be considered ‘local’. The paper examines the intersections of travelling and embedded policy, and global and local contexts as these are enacted through online moderation meetings.

On the advanced analysis of steel frames allowing for flexural, local and lateral-torsional buckling

Detailed procedure for second-order analysis has been coded in the newest Eurocode 3 and the Hong Kong steel code (2005). The effective length method has been noted to be inapplicable to analysis of shallow domes of imperfect members exhibiting snap-through buckling, to portals with leaning columns and others. On the other hand, the advanced analysis is not limited to buckling design of these structures. This paper demonstrates its application to the design of a simple plane sway portal and a three diminsional non-sway steel building. The results by the advanced analysis and the first-order linear analysis are compared and the technique for practical second-order analysis steel structures is described. It is observed that the use of a straight element by itself cannot model the buckling resistance of columns governed by different buckling curves for hot-rolled and cold-formed sections of various shapes like I, H, hollow etc. Also the curvature of the conventional cubic Hermite element is not varied by the external axial force and thus it cannot simulate the response of a buckling column. Thus its use for second-order analysis is basically unacceptable. A technique for additional checking of beams undergoing lateral-torsional buckling is also suggested making the advanced analysis a complete design tool for conventional steel frames.

A randomised controlled trial of amniotic membrane in the treatment of a standardised burn injury in the merino lamb

Burn injury is associated with disabling scar formation which impacts on many aspects of the patient's life. Previously we have shown that the fetus heals a deep dermal burn in a scarless fashion. Amniotic membrane (AM) is the outermost fetal tisue and has beeen used as a dressing in thermal injuries, though there is little data to support this use. To assess the efficacy of AM in scar minimisation after deep dermal burn wound, we conducted a randomised controlled study in the 1-month lamb. Lambs were delivered by caesarian section and the amniotic membranes stored after which lambs were returned to their mothers post-operatively. At 1 month, a standardised deep dermal burn was created under general anaesthesia on both flanks of the lamb. One flank was covered with unmatched AM, the other with paraffin gauze. Animals were sequentially euthanased from Day 3-60 after injury and tissue analysed for histopathology and immunohistochemically for alpha-smooth muscle actin (alphaSMA) content. AM resulted in reduced scar tissue as assessed histopathologically and reduced alphaSMA content. This study provides the first laboratory evidence that AM may reduce scar formation after burn injury.

Model-predictive control and closed-loop stability considerations for nonlinear plants described by local ARX-type models

In this paper, a model-predictive control (MPC) method is detailed for the control of nonlinear systems with stability considerations. It will be assumed that the plant is described by a local input/output ARX-type model, with the control potentially included in the premise variables, which enables the control of systems that are nonlinear in both the state and control input. Additionally, for the case of set point regulation, a suboptimal controller is derived which has the dual purpose of ensuring stability and enabling finite-iteration termination of the iterative procedure used to solve the nonlinear optimization problem that is used to determine the control signal.

Local inter-session variability modelling for object classification

Object classification is plagued by the issue of session variation. Session variation describes any variation that makes one instance of an object look different to another, for instance due to pose or illumination variation. Recent work in the challenging task of face verification has shown that session variability modelling provides a mechanism to overcome some of these limitations. However, for computer vision purposes, it has only been applied in the limited setting of face verification. In this paper we propose a local region based intersession variability (ISV) modelling approach, and apply it to challenging real-world data. We propose a region based session variability modelling approach so that local session variations can be modelled, termed Local ISV. We then demonstrate the efficacy of this technique on a challenging real-world fish image database which includes images taken underwater, providing significant real-world session variations. This Local ISV approach provides a relative performance improvement of, on average, 23% on the challenging MOBIO, Multi-PIE and SCface face databases. It also provides a relative performance improvement of 35% on our challenging fish image dataset.

Vaccination of koalas with a recombinant Chlamydia pecorum major outer membrane protein induces antibodies of different specificity compared to those following a natural live infection

Chlamydial infection in koalas is common across the east coast of Australia and causes significant morbidity, infertility and mortality. An effective vaccine to prevent the adverse consequences of chlamydial infections in koalas (particularly blindness and infertility in females) would provide an important management tool to prevent further population decline of this species. An important step towards developing a vaccine in koalas is to understand the host immune response to chlamydial infection. In this study, we used the Pepscan methodology to identify B cell epitopes across the Major Outer Membrane Protein (MOMP) of four C. pecorum strains/genotypes that are recognized, either following (a) natural live infection or (b) administration of a recombinant MOMP vaccine. Plasma antibodies from the koalas naturally infected with a C. pecorum G genotype strain recognised the epitopes located in the variable domain (VD) four of MOMP G and also VD4 of MOMP H. By comparison, plasma antibodies from an animal infected with a C. pecorum F genotype strain recognised epitopes in VD1, 2 and 4 of MOMP F, but not from other genotype MOMPs. When Chlamydia-free koalas were immunised with recombinant MOMP protein they produced antibodies not only against epitopes in the VDs but also in conserved domains of MOMP. Naturally infected koalas immunised with recombinant MOMP protein also produced antibodies against epitopes in the conserved domains. This work paves the way for further refinement of a MOMP-based Chlamydia vaccine that will offer wide cross-protection against the variety of chlamydial infections circulating in wild koala populations.

Binding of small mono- and oligomeric integrin ligands to membrane-embedded integrins monitored by surface plasmon-enhanced fluorescence spectroscopy

We recently developed a binding assay format by incorporating native transmembrane receptors into artificial phospholipid bilayers on biosensor devices for surface plasmon resonance spectroscopy. By extending the method to surface plasmon-enhanced fluorescence spectroscopy (SPFS), sensitive recording of the association of even very small ligands is enabled. Herewith, we monitored binding of synthetic mono- and oligomeric RGD-based peptides and peptidomimetics to integrins alphavbeta3 and alphavbeta5, after having confirmed correct orientation and functionality of membrane-embedded integrins. We evaluated integrin binding of RGD multimers linked together via aminohexanoic acid (Ahx) spacers and showed that the dimer revealed higher binding activity than the tetramer, followed by the RGD monomers. The peptidomimetic was also found to be highly active with a slightly higher selectivity toward alphavbeta3. The different compounds were also evaluated in in vitro cell adhesion tests for their capacity to interfere with alphavbeta3-mediated cell attachment to vitronectin. We hereby demonstrated that the different RGD monomers were similarly effective; the RGD dimer and tetramer showed comparable IC50 values, which were, however, significantly higher than those of the monomers. Best cell detachment from vitronectin was achieved by the peptidomimetic. The novel SPFS-binding assay platform proves to be a suitable, reliable, and sensitive method to monitor the binding capacity of small ligands to native transmembrane receptors, here demonstrated for integrins.

Entrenchment of GIS technology for enterprise solutions in Maryland's state and local government

Beginning in 1974, the State of Maryland created spatial databases under the MAGI (Maryland's Automated Geographic Information) system. Since that early GIS, other state and local agencies have begun GISs covering a range of applications from critical lands inventories to cadastral mapping. In 1992, state agencies, local agencies, universities, and businesses began a series of GIS coordination activities, resulting in the formation of the Maryland Local Geographic Information Committee and the Maryland State Government Geographic Information Coordinating Committee. GIS activities and system installations can be found in 22 counties plus Baltimore City, and most state agencies. Maryland's decision makers rely on a variety of GIS reports and products to conduct business and to communicate complex issues more effectively. This paper presents the status of Maryland's GIS applications for local and state decision making.

Metacognitive instruction : global and local shifts in considering listening input

A key shift of thinking for effective learning and teaching of listening input has been seen and organized in education locally and globally. This study has probed whether metacognitive instruction through a pedagogical cycle shifts high-intermediate students' English language learning and English as a second language (ESL) teacher's teaching focus on listening input. Twenty male Iranian students with an age range of 18 to 24 received a guided methodology including metacognitive strategies (planning, monitoring, and evaluation) for a period of three months. This study has used the strategies and probed the importance of metacognitive instruction through interviewing both the teacher and the students. The results have shown that metacognitive instruction helped both the ESL teacher's and the students' shift of thinking about teaching and learning listening input. This key shift of thinking has implications globally and locally for classroom practices of listening input.