Management of periprosthetic joint infection after total hip arthroplasty using a Custom Made Articulating Spacer (CUMARS); the exeter experience

Periprosthetic joint infection (PJI) after THA is a major complication with an incidence of 1-3%. We report our experiences with a technique using a custom-made articulating spacer (CUMARS) at the first of two-stage treatment for PJI. This technique uses widely available all-polyethylene acetabular components and the Exeter Universal stem, fixed using antibiotic loaded acrylic cement. Seventy-six hips were treated for PJI using this technique. Performed as the first of a two-stage procedure, good functional results were commonly seen, leading to postponing second stage indefinitely with retention of the CUMARS prosthesis in 34 patients. The CUMARS technique presents an alternative to conventional spacers, using readily available components that are well tolerated, allowing weight bearing and mobility, and achieving comparable eradication rates.

The effectiveness of information-sharing interventions as a means to reduce anxiety in families waiting for surgical patients undergoing an elective surgical procedure : a systematic review protocol

Review question/objective What are the most effective information sharing strategies used to reduce anxiety in families of patients undergoing elective surgery? This review seeks to synthesize the best available evidence in relation to the most effective information-sharing intervention to reduce anxiety for families waiting for patients undergoing an elective surgical procedure. The specific objectives are to review the effectiveness of evidence of interventions designed to reduce the anxiety of families waiting whilst their loved one undergoes a surgical intervention. A variety of interventions exist and include surgical nurse liaison services, intraoperative reporting either by face-to-face or telephone delivery, informational cards, visual information screens, and intraoperative paging devices for families. Inclusion criteria Types of participants All studies of family members over 18 years of age waiting for patients undergoing an elective surgical procedure will be included, including those waiting for both adult and paediatric patients. Studies of families waiting for other patient populations, eg emergency surgery, chemotherapy or intensive care patients will be excluded. Types of intervention(s)/phenomena of interest All information-sharing Interventions for families of patients undergoing an elective surgical procedure will be included, including but not limited to: surgical nurse liaison services, in-person intraoperative reporting, visual information screens, paging devices, informational cards and telephone delivery of intraoperative progress reports. Interventions that take place during the intraoperative phase of care only will be included in the review. Preadmission information sharing interventions will be excluded. Types of outcomes The outcomes of interest include: Primary outcome: the level of anxiety amongst family members or close relatives whilst waiting for patients undergoing surgery, as measured by a validated instrument (such as the S-Anxiety portion of the State-Trait Anxiety Inventory).4 Secondary outcomes: family satisfaction and other measurements that may be considered indicators of stress and anxiety, such as mean arterial pressure (MAP) and heart rate.

A design approach to the study of people's experiences with technologies in the context of public transport

Relevant to the study of people’s attitudes towards public transport use is the consideration to the role of technology as part of the travel experience. Technologies aim to enhance daily tasks but tend to change the way people interact with products and can be perceived as difficult to use. This is critical in the context of “public use” where products and services are to be used by the population at large: adults, children, elderly, people with disabilities, and tourists. From different perspectives, the topic of users and the use of technologies have been studied in the social sciences and human computer interaction fields; however, earlier approaches fail to address the ways in which experiential knowledge informs people’s interactions with products and technologies, and how such information could guide the design of future technologies. This paper describes a pilot study, part of a larger ongoing exploratory research that investigates people’s experiences with infrastructure, systems, and technologies in the context of public transport. The methodological approach included focus groups, field observations, and retrospective verbal reports. At this stage, the study found that four context led factors were the primary source of reference informing participants’ actions and interactions; they are: (i) context >> experience, (ii) context >> interface, (iii) context >> knowledge, (iv) context >> emotion.

The experiences of teachers teaching children with Down syndrome in the early years of schooling

This innovative collective case study research documented teachers' experiences of teaching children with Down syndrome in the early years of schooling in Australia. Results indicated differences in teachers' conceptualisation of children with Down syndrome as learners and how these variations impacted the way the child was included within the class. Unique to this research was the utilisation of a mind-mapping technique of data collection which effectively captured the individual nature of teachers' experiences, making implicit knowledge explicit through description and interpretation of these experiences. Overall findings indicated that teachers were more likely to include children with Down syndrome into general education classrooms if they operated within a contemporary understanding of disability, had positive support from key stakeholders such as school principals and parents/caregivers, and had access to current information on Down syndrome from professional bodies.

A natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer : a phase III double-blind randomised controlled trial

Purpose To investigate the effects of a natural oil-based emulsion containing allantoin versus aqueous cream for preventing and managing radiation induced skin reactions (RISR). Methods and Materials A total of 174 patients were randomised and participated in the study. Patients either received Cream 1 (the natural oil-based emulsion containing allantoin) or Cream 2 (aqueous cream). Skin toxicity, pain, itching and skin-related quality of life scores were collected for up to four weeks after radiation treatment. Results Patients who received Cream 1 had a significantly lower average level of Common Toxicity Criteria at week 3 (p<0.05), but had statistically higher average levels of skin toxicity at weeks 7, 8 and 9 (all p<0.001). Similar results were observed when skin toxicity was analysed by grades. With regards to pain, patients in the Cream 2 group had a significantly higher average level of worst pain (p<0.05) and itching (p=0.046) compared to the Cream 1 group at week 3, however these differences were not observed at other weeks. In addition, there was a strong trend for Cream 2 to reduce the incidence of grade 2 or more skin toxicity in comparison to Cream 1 (p=0.056). Overall, more participants in the Cream 1 group were required to use another topical treatment at weeks 8 (p=0.049) and 9 (p=0.01). Conclusion The natural oil-based emulsion containing allantoin appears to have similar effects for managing skin toxicity compared to aqueous cream up to week 5, however, it becomes significantly less effective at later weeks into the radiation treatment and beyond treatment completion (week 6 and beyond). There were no major differences in pain, itching and skin-related quality of life. In light of these results, clinicians and patients can base their decision on costs and preferences. Overall, aqueous cream appears to be a more preferred option.

Satisfaction with emergency department service among non-English-speaking background patients

Objective: The present study aims to investigate non-English-speaking background (NESB) patients’ satisfaction with hospital ED service and compare it with that of English-speaking background (ESB) patients. Methods: A cross-sectional survey was conducted at the ED of an adult tertiary referral hospital in Queensland, Australia. Patients assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed in the ED, before and after their ED service. Pearson χ2- test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB groups in terms of patient-reported satisfaction. Results: In total, 828 patients participated in the present study. Although the overall satisfaction with the service was high – 95.1% (ESB) and 90.5% (NESB) – the NESB patients who did not use an interpreter were less satisfied with their ED service than the ESB patients (odds ratio 0.5, 95% confidence interval 0.3–0.8, P = 0.013). The promptness of service received the lowest satisfaction rates (ESB 85.4% [82.4–88.0], NESB 74.5% [68.5– 79.7], P < 0.001), whereas courtesy and friendliness received the highest satisfaction rates (ESB 98.8 [97.6–99.4], NESB 97.0 [93.9–98.5], P = 0.063). All participants reported the promptness of service (33.5%), quality and professional care (18.5%) and communication (17.6%) as the most important elements of ED service. Conclusion: The NESB patients were significantly less satisfied than the ESB patients with the ED service. Use of an interpreter improved the NESB patients’ level of satisfaction. Further research is required to examine what NESB patients’ expectations of ED service are.

From prototype to exploitation : mobile services for patients with chronic lower back pain

Many research and development projects that are carried out by firms and research institutes are technology-oriented. There is a large gap between research results, for instance in the form of prototypes, and the actual service offerings to customers. This becomes problematic when an organization wants to bring the results from such a project to the market, which will be particularly troublesome when the research results do not readily fit traditional offerings, roles and capabilities in the industry, nor the financial arrangements. In this chapter, we discuss the design of a business model for a mobile health service, starting with a research prototype that was developed for patients with chronic lower back pain, using the STOF model and method. In a number of design sessions, an initial business model was developed that identifies critical design issues that play a role in moving from prototype toward market deployment. The business model serves as a starting-point to identify and commit relevant stakeholders, and to draw up a business plan and case. This chapter is structured as follows. We begin by discussing the need for mobile health business models. Next, the research and development project on mobile health and the prototype for chronic lower back pain patients are introduced, after which the approach used to develop the business model is described, followed by a discussion of the developed mobile health business model for each of the STOF domains. We conclude with a discussion regarding the lessons that were learned with respect to the development of a business model on the basis of a prototype.

Institutional response and Indigenous experiences of Cyclone Tracy

Early on Christmas morning 1974 Tropical Cyclone Tracy, a Category 4 storm, devastated the Northern Territory city of Darwin leaving only 6% of the city’s housing habitable. The extent of the disaster was largely the result of unregulated and poorly constructed buildings, predominantly housing. While the engineering and reconstruction process demonstrated a very successful response and adaptation to an existing and future risk, the impact of the cyclone of the local community and its Indigenous population in particular, had not been well recorded. NCCARF therefore commissioned a report on the Indigenous experience of Cyclone Tracy to document how Indigenous people were impacted by, responded to, and recovered from Cyclone Tracy in comparison to non-Indigenous groups. The report also considers the research literature on disasters and Indigenous people in the Northern Territory, with a specific focus on cyclones, and considers the socio-political context of Indigenous communities in Darwin prior to Cyclone Tracy.

Experiences with control of evaporators using extensive vapour bleeding

FOR SUGAR factories with cogeneration plants major changes to the process stations have been undertaken to reduce the consumption of exhaust steam from the turbines and maximise the generated power. In many cases the process steam consumption has been reduced from greater than 52% on cane to ~40% on cane. The main changes have been to install additional evaporation area at the front of the set, operate the pan stages on vapour from No 1 or No 2 effects and undertake juice heating using vapour bleed from evaporators as far down the set as the penultimate stage. Operationally, one of the main challenges has been to develop a control system for the evaporators that addresses the objectives of juice processing rate (throughput) and steam economy, while producing syrup consistently at the required brix and providing an adequate and consistent vapour pressure for the pan stage operations. The cyclic demand for vapour by batch pans causes process disturbances through the evaporator set and these must be regulated in an effective manner to satisfy the above list of objectives for the evaporator station. The impact of the cyclic pan stage vapour demand has been modelled to define the impact on juice rate, steam economy, syrup brix and head space pressures in the evaporators. Experiences with the control schemes used at Pioneer and Rocky Point Mills are discussed. For each factory the paper provides information on (a) the control system used, the philosophy behind the control system and experiences in reaching the current system for control (b) the performance of the control system to handle the disturbances imposed by the pan stage and operate within other constraints of the factory (c) deficiencies in the current system and plans for further improvements. Other processing changes to boost the performance of the evaporators are also discussed.

Analysis of albumin-associated peptides and proteins from ovarian cancer patients

Albumin binds low–molecular-weight molecules, including proteins and peptides, which then acquire its longer half-life, thereby protecting the bound species from kidney clearance. We developed an experimental method to isolate albumin in its native state and to then identify [mass spectrometry (MS) sequencing] the corresponding bound low–molecular-weight molecules. We used this method to analyze pooled sera from a human disease study set (high-risk persons without cancer, n= 40; stage I ovarian cancer, n = 30; stage III ovarian cancer, n = 40) to demonstrate the feasibility of this approach as a discovery method. Methods Albumin was isolated by solid-phase affinity capture under native binding and washing conditions. Captured albumin-associated proteins and peptides were separated by gel electrophoresis and subjected to iterative MS sequencing by microcapillary reversed-phase tandem MS. Selected albumin-bound protein fragments were confirmed in human sera by Western blotting and immunocompetition. Results In total, 1208 individual protein sequences were predicted from all 3 pools. The predicted sequences were largely fragments derived from proteins with diverse biological functions. More than one third of these fragments were identified by multiple peptide sequences, and more than one half of the identified species were in vivo cleavage products of parent proteins. An estimated 700 serum peptides or proteins were predicted that had not been reported in previous serum databases. Several proteolytic fragments of larger molecules that may be cancer-related were confirmed immunologically in blood by Western blotting and peptide immunocompetition. BRCA2, a 390-kDa low-abundance nuclear protein linked to cancer susceptibility, was represented in sera as a series of specific fragments bound to albumin. Conclusion Carrier-protein harvesting provides a rich source of candidate peptides and proteins with potential diverse tissue and cellular origins that may reflect important disease-related information.

Emotional climate and high quality learning experiences in science teacher education

The role of emotion during learning encounters in science teacher education is under-researched and under-theorized. In this case study we explore the emotional climates, that is, the collective states of emotional arousal, of a preservice secondary science education class to illuminate practice for producing and reproducing high quality learning experiences for preservice science teachers. Theories related to the sociology of emotions informed our analyses from data sources such as preservice teachers’ perceptions of the emotional climate of their class, emotional facial expressions, classroom conversations, and cogenerative dialogue. The major outcome from our analyses was that even though preservice teachers reported high positive emotional climate during the professor’s science demonstrations, they also valued the professor’s in the moment reflections on her teaching that were associated with low emotional climate ratings. We co-relate emotional climate data and preservice teachers’ comments during cogenerative dialogue to expand our understanding of high quality experiences and emotional climate in science teacher education. Our study also contributes refinements to research perspectives on emotional climate.

Course experiences, satisfaction and career intent of final year pre-registration Australian pharmacy students

Background In Australia, the profession of pharmacy has undergone many changes to adapt to the needs of the community. In recent years, concerns have been raised with evidence emerging of workforce saturation in traditional pharmacy practice sectors. It is not known how current final year pharmacy students’ perceive the different pharmacy career paths in this changing environment. Hence investigating students’ current experiences with their pharmacy course, interaction with the profession and developing an understanding of their career intentions would be an important step, as these students would make up a large proportion of future pharmacy workforce Objective The objective of this study was thus to investigate final year students’ career perspectives and the reasons for choosing pharmacy, satisfaction with this choice of pharmacy as a tertiary course and a possible future career, factors affecting satisfaction and intention of future career paths. Methods A quantitative cross sectional survey of final year students from 3 Australian universities followed by a qualitative semi-structured interview of a convenience sample of final year students from the University of Sydney. Results ‘Interest in health and medicine’ was the most important reason for choosing pharmacy (n=238). The majority of students were ‘somewhat satisfied’ with the choice of pharmacy (35.7%) as a course and possible future career. Positive associations were found between satisfaction and reasons for joining pharmacy such as ‘felt pharmacy is a good profession’ (p=0.003) while negative associations included ‘joined pharmacy as a gateway to medicine or dentistry’ (p=0.001). Quantitate and qualitative results showed the most frequent perception of community pharmacy was ‘changing’ while hospital and pharmaceutical industry was described as ‘competitive’ and ‘research’ respectively. The highest career intention was community followed by hospital pharmacy. Conclusion Complex factors including university experiences are involved in shaping students’ satisfaction and perception of career. This may relate to challenges in the community pharmacy sector, job opportunities in hospital and limited understanding of the pharmaceutical industry. The results offer insight for the profession in terms of entry into various roles and also to pharmacy educators for their roles in shaping curricula and placement experiences that attract future graduates to defined career pathways in pharmacy.

She'll be right mate : inclusivity experiences of men and women working in projects

Occupational segregation is a major source of labour market rigidity and economic inefficiency due to a waste of human resources. Organisations are repeatedly recognised as gendered constructs exhibiting sustained work segregation, income and status inequality, as well as cultural and individual images of gender, and these are perpetuated through their processes, practices and pressures (Acker, 1990). A large percentage of Australia’s workforce is now employed in project-based or project-oriented organisations, leading to the claim that Australia is a project-based economy. For a continued strong performance in this economy, organisations that employ project personnel will need to consider how they address inclusivity and equality in diversity in project based temporary organisations to ensure the supply of high quality project professionals into the future. This paper investigates the inclusion processes experienced and exercised by men and women working in temporary organisations in project situations through a review of reports on the inclusion processes experienced by 60 project managers and project workers in three project based industries in Australia. Results indicate that temporary organisations are not implementing equality and diversity management strategies at the macro level and project workers are accepting this lack of recognition. However inclusivity and equality at the micro level of the team is seen as vital.

The Habitual Rhythms of Becoming-Involved: Insights into Participation Experiences in Urban Spaces by Children with Diverse Mobility

This chapter reports on a study that reveals the essence of participation in urban spaces by ten children who live with various physical conditions: Muscular Dystrophy, Cerebral Palsy, and Autoimmune Rheumatic Diseases. These conditions affect muscle and movement differently resulting in diverse ways in which children move through space (personal mobility). The children at the time of the research were 9-12 years of age residing in South-east Queensland, Australia. The approach and methods selected for this study, interpretive phenomenological inquiry and grounded theory, were chosen for their capacity to capture the complexity and multiple interactions of the child’s urban living. The confronting and poignant accounts by children and their families of their experiences produced a new way of understanding the concept of participation, as a ‘journey of becoming involved.’ Their accounts of performing everyday routines (e.g. leaving home, getting in and out of the car, and entering places) in urban spaces (neighbourhood streets, schools, open spaces, shopping centres, and hospitals) revealed differences in the way settings were experienced. These differences were associated with the interplay between the body, space and context. Where interplays were problematic, explicit decisions about children’s involvement were made. These decisions were described in terms of ‘avoid going’, ‘pick and choose’, ‘discontinue’, ‘accept’, or ‘contest.’ What these decisions mean is some spaces are avoided, some journeys are discontinued, and some barriers encountered in journeys are normalised as everyday experiences, i.e. ‘tolerable discrimination’. These actions resulted in experiences of non-participation or partial–tokenistic participation. The key substantive contribution of the research lies in the identification of points in children’s journeys that shape participation experience. These points identify where future interventions in policy, programming and design can be made to make real and sustaining changes to lives of children and their families in geographies crucial to urban living.

Understanding the information literacy experiences of EFL (English as a Foreign Language) students

Purpose – This paper outlines research that explores the information literacy experiences of EFL (English as a Foreign Language) students. The question explored in this research was: how do EFL students experience information literacy. Design/Methodology/Approach – This study used phenomenography, a relational approach to explore the information literacy experiences of EFL students. Phenomenography studies the qualitatively different ways a phenomenon is experienced in the world around us. Findings – This research revealed that EFL students experienced information literacy in four qualitatively different ways. The four categories revealed through the data were: process, quality, language and knowledge. This research found that language impacted on EFL students’ experiences of information literacy and revealed that EFL students applied various techniques and strategies when they read, understood, organised and translated information. Research limitations/implications – This research was conducted in a specific cultural and educational context, therefore the results might not reflect the experiences of EFL students in other cultural or educational contexts. Practical implications – The findings from this research offer an important contribution to information literacy practice by providing important insights about EFL students’ experiences and perceptions of information and learning that can be used to inform curriculum development in second language learning contexts. Originality/Value - There is currently a lack of research using a relational approach to investigate EFL students’ experiences of information literacy. There is also limited research that explores the impact language has on information literary and learning in English as a foreign or second language contexts.