Prevention of surgical site infection in total joint arthroplasty : an international tertiary care center survery

Background Prevention strategies are critical to reduce infection rates in total joint arthroplasty (TJA), but evidence-based consensus guidelines on prevention of surgical site infection (SSI) remain heterogeneous and do not necessarily represent this particular patient population. Questions/Purposes What infection prevention measures are recommended by consensus evidence-based guidelines for prevention of periprosthetic joint infection? How do these recommendations compare to expert consensus on infection prevention strategies from orthopedic surgeons from the largest international tertiary referral centers for TJA? Patients and Methods A review of consensus guidelines was undertaken as described by Merollini et al. Four clinical guidelines met inclusion criteria: Centers for Disease Control and Prevention's, British Orthopedic Association, National Institute of Clinical Excellence's, and National Health and Medical Research Council's (NHMRC). Twenty-eight recommendations from these guidelines were used to create an evidence-based survey of infection prevention strategies that was administered to 28 orthopedic surgeons from members of the International Society of Orthopedic Centers. The results between existing consensus guidelines and expert opinion were then compared. Results Recommended strategies in the guidelines such as prophylactic antibiotics, preoperative skin preparation of patients and staff, and sterile surgical attire were considered critically or significantly important by the surveyed surgeons. Additional strategies such as ultraclean air/laminar flow, antibiotic cement, wound irrigation, and preoperative blood glucose control were also considered highly important by surveyed surgeons, but were not recommended or not uniformly addressed in existing guidelines on SSI prevention. Conclusion Current evidence-based guidelines are incomplete and evidence should be updated specifically to address patient needs undergoing TJA.

Academics in the policy process : engagement with Australian media policy inquiries 2011-2013

This paper critically evaluates the series of inquires that the Australian Labor government undertook during 2011-2013 into reform of Australian media, communications and copyright laws. One important driver of policy reform was the government’s commitment to building a National Broadband Network (NBN), and the implications this had for existing broadcasting and telecommunications policy, as it would constitute a major driver of convergence of media and communications access devices and content platforms. These inquiries included: the Convergence Review of media and communications legislation; the Australian Law Reform Commission (ALRC) review of the National Classification Scheme; and the Independent Media Inquiry (Finkelstein Review) into Media and Media Regulation. One unusual feature of this review process was the degree to which academics were involved in the process, not simply as providers of expert opinion, but as review chairs seconded from their universities. This paper considers the role played by activist groups in all of these inquiries and their relationship to the various participants in the inquiries, as well as the implications of academics being engaged in such inquiries, not simply as activist-scholars, but as those primarily responsible for delivering policy review outcomes. The paper draws upon the concept of "policy windows" in order to better understand the context in which the inquiries took place, and their relative lack of legislative impact.

Archbishops’ chaplain behind bars at last

The sentencing of a self-confessed child sex offender and senior Brisbane Anglican priest Canon Barry Greaves in Brisbane District Court last Friday (April 24, 2009) is a significant event for many reasons and for many people. It is a significant event because Greaves was a priest at Boonah in the early 1980s when he committed the offences and because knowledge of his own sex offending against children failed to deter him from seeking and gaining high office in the Anglican Church. He accepted the position of being an Archbishop’s chaplain to Brisbane Archbishop Dr Peter Hollingworth in 1999. He stayed on as an Archbishop’s chaplain to the incoming Archbishop Dr Phillip Aspinall in 2002 and not even the disgrace of the sex scandal in the Brisbane Diocese resulted in a glimmer of guilt that maybe he was not an appropriate person to be providing pastoral care to other victims of sexual assault. Families of victims who were referred to Greaves for pastoral care are now flabbergasted by the double betrayal. “I went looking for comfort and now I discover I was confiding in a f***ing pedophile,” one woman said.

Exploring sustainability themes in engineering accreditation and curricula

Purpose This paper aims to present key findings from an inquiry into engineering accreditation and curricula renewal. The research attempted to ascertain conceptions of requisite sustainability themes among engineering academics and professionals. The paper also reflects on the potential role of professional engineering institutions (PEIs) in embedding sustainability through their programme accreditation guidelines and wider implications in terms of rapid curricula renewal. Design/methodology/approach This research comprised an International Engineering Academic Workshop held during the 2010 International Symposium on Engineering Education in Ireland, on “accreditation and sustainable engineering”. This built on the findings of a literature review that was distributed prior to the workshop. Data collection included individual questionnaires administered during the workshop, and notes scribed by workshop participants. Findings The literature review highlighted a wide range of perspectives across and within engineering disciplines, regarding what sustainability/sustainable development (SD) themes should be incorporated into engineering curricula, and regarding language and terminology. This was also reflected in the workshop discussions. Notwithstanding this diversity, clusters of sustainability themes and priority considerations were distilled from the literature review and workshop. These related to resources, technology, values, ethics, inter- and intra-generational equity, transdisciplinarity, and systems and complex thinking. Themes related to environmental and economic knowledge and skills received less attention by workshop participants than represented in the literature. Originality/value This paper provides an appreciation of the diversity of opinion regarding priority sustainability themes for engineering curricula, among a group of self-selected engineering academics who have a common interest in education for SD. It also provides some insights and caveats on how these themes might be rapidly integrated into engineering curricula.

Sustaining social innovation enterprises through a design led innovation framework

Constant changes in the global economic environment require companies to revisit traditional assumptions about how businesses create and capture value (Teece, 2010). In recent years, management practice literature has focused largely on better understanding business models and business model innovation (Amit, Zott and Massa, 2010; Johnson, Christensen and Kagermann, 2008). Much has been written on the benefits of linking design and design thinking to organisational strategies and business transformation. However, very little has been researched and reported on regarding the impact of design led approaches to triple bottom-line opportunities such as, social innovation enterprise. In the context of this paper Design Led Innovation is defined as the tools and approaches which enable design thinking to be embedded as an element of cultural transformation within a business. Being Design Led requires a company to have a vision for top line growth founded on deep customer insights and expanded through customer and stakeholder engagements. The outcomes of this are then mapped to all aspects of the business, enabling the vision to be successfully implemented and achieved. It is the latter part of this definition where we believe Design Led Innovation has the greatest value in transforming social innovation enterprise into a sustainable business venture. However, we also acknowledge that enabling these firms to think strategically about their business model is difficult given the unique operational and funding challenges that often characterize many social enterprises. The purpose of this paper, therefore, is to pose the question, do sustainable innovation enterprise innovate their business model? And if so, how? It is the authors’ opinion that such enterprises only innovate at the product or system level without a complete understanding of the business model structure, which underpins the long term viability. However, in this paper we challenge this notion and explore if such firms can overcome their size and operational constraints to become sustainable enterprises using a design led approach. This is achieved through contextualizing business model innovation, briefly defining social innovation enterprise and profiling a new and emerging industry in Australia – Clean Technology. Future research challenges and opportunities are also presented.

Biotechnology :paper alert

A selection of interesting papers that were published in the two months before our press date in major journals most likely to report significant results in biotechnology.

Assessing capacity in the context of testamentary, enduring power of attorney, and advance care directive documents in Australia

Balancing the competing interests of autonomy and protection of individuals is an escalating challenge confronting an ageing Australian population. Legal and medical professionals are increasingly being asked to determine whether individuals are legally capable to make their own testamentary, financial and/or personal/health care decisions. Diseases such as dementia impact upon cognition which necessitates collaboration between the legal and medical professions to satisfactorily assess the effect of such mentally disabling conditions upon legal competency. Terminological and methodological differences exist between the two professions when assessing capacity in this context which subsequently create miscommunication and misunderstanding. Consequently, it is not necessarily a simple solution for a legal professional to seek the opinion of a medical practitioner. Exacerbating the situation is the fact that no consistent and transparent capacity assessment paradigm currently exists in Australia. Assessments are instead being undertaken on an ad hoc basis dependent upon the skill set of the legal and/or medical professionals involved. A qualitative study seeking the views of legal and medical professionals who practise in this area has been conducted. This incorporated a review of the relevant literature and surveys which informed the semi-structured interviews conducted with 10 legal and 20 medical practitioners. Practitioners were asked whether there is a standard approach to assessment and whether national guidelines would assist. The general consensus was that uniform guidelines would be advantageous. The research also canvassed practitioner views as to the state of the relationship between the professions when assessing capacity. Three promising practices have emerged from this research: first, is the need for the development of national guidelines and supporting principles to satisfactorily assess capacity; second, is the possibility of strengthening the relationship between legal and medical professionals to assist in the satisfactory assessment of legal capacity; and third, the need for increased community education.

Mechanisms of tumour invasion and metastasis : emerging targets for therapy

The progression of a tumour from one of benign and delimited growth to one that is invasive and metastatic is the major cause of poor clinical outcome in cancer patients. The invasion and metastasis of tumours is a highly complex and multistep process that requires a tumour cell to modulate its ability to adhere, degrade the surrounding extracellular matrix, migrate, proliferate at a secondary site and stimulate angiogenesis. Knowledge of the process has greatly increased and this has resulted in the identification of a number of molecules that are fundamental to the process. The involvement of these molecules has been shown to relate not only to the survival and proliferation of the tumour cell but, also to the processes of tumour cell adhesion, migration, and the tumour cells ability to degrade and escape the primary site as well as play a role in angiogenesis. These molecules may provide important therapeutic targets that represent the ability to target specific steps in the process of invasion and metastasis and provide additional therapies. The review focuses on representative key targets in each of these processes and summarises the state of play in each case.

A control theoretic paradigm for cell signaling networks : a simple complexity for a sensitive robustness

The fields of molecular biology and cell biology are being flooded with complex genomic and proteomic datasets of large dimensions. We now recognize that each molecule in the cell and tissue can no longer be viewed as an isolated entity. Instead, each molecule must be considered as one member of an interacting network. Consequently, there is an urgent need for mathematical models to understand the behavior of cell signaling networks in health and in disease.

The amplified peptidome : the new treasure chest of candidate biomarkers

Mass spectrometric analysis of the low-molecular weight (LMW) range of the serum/plasma proteome is revealing the existence of large numbers of previously unknown peptides and protein fragments predicted to be derived from low- abundance proteins. This raises the question of why such low abundance molecules would be retained at detectable levels in the circulation, instead of being rapidly cleared and excreted. Theoretical models of biomarker production and association with serum carrier proteins have been developed to elucidate the mechanisms governing biomarker half-life in the bloodstream. These models predict that the vast majority of LMW biomarkers exist in association with circulating high molecular mass carrier proteins. Moreover, the total serum/ plasma concentration of the biomarker is largely determined by the clearance rate of the carrier protein, not the free-phase biomarker clearance itself. These predictions have been verified experimentally using molecular mass fractionation of human serum before mass spectrometry sequence analysis. These principles have profound implications for biomarker discovery and measurement.

Rapid on-site evaluation of fine needle aspiration specimens by cytology scientists : a review of 3032 specimens

Objectives To determine: (1) the accuracy of cytology scientists at assessing specimen adequacy by rapid on-site evaluation (ROSE) at fine needle aspiration (FNA) cytology collections; and (2) whether thyroid FNA with ROSE has lower inadequacy rates than non-attended FNAs. Methods The ROSE of adequacy for 3032 specimens from 17 anatomical sites collected over a 20-month period was compared with the final report assessment of adequacy. ROSE was performed by 19 cytology scientists. The report profile for 1545 thyroid nodules with ROSE was compared with that for 1536 consecutive non-ROSE thyroid FNAs reported by the same cytopathologists during the study period. Results ROSE was adequate in 75% (2276/3032), inadequate in 12% (366/3032) and in 13% (390/3032) no opinion was rendered. Of the 2276 cases assessed as adequate by ROSE, 2268 (99.6%) were finally reported as adequate for assessment; eight specimens had adequacy downgraded on the final report. Fifty eight per cent of cases with a ROSE assessment of inadequate were reported as adequate (212/366), whereas 93% (363/390) with no opinion rendered were reported as adequate. The overall final report adequacy rate for the 3032 specimens was 94% (2843/3032). Confirmation of a ROSE of adequacy at reporting was uniformly high amongst the 19 scientists, ranging from 98% to 100%. The inadequacy rate for thyroid FNAs with ROSE (6%) was significantly (P < 0.0001) lower than for non-ROSE thyroid FNAs (17%). A significantly (P = 0.02) higher proportion of adequate ROSE thyroid specimens was reported with abnormalities, compared with non-ROSE thyroid collections. Conclusions Cytology scientists are highly accurate at determining specimen adequacy at ROSE for a wide range of body sites. ROSE of thyroid FNAs can significantly reduce inadequate reports.

Stress and burnout amongst professional carers of people with intellectual disability : another health inequity

Purpose of review This paper summarizes trends in the research literature about stress and burnout in the lives of people who are the professional carers of people with intellectual disability. The principal time period considered was from 2004 to 2006. Recent findings Studies reviewed here focus on several themes including inequities affecting professional carers of people with intellectual disability and the possible effects of some models of care on inequities. Implications for people with intellectual disability are also considered. Summary The diaspora of people with intellectual disability into the community and their accompanying services found a whole new set of unpredicted and unprecedented challenges. Life in the community has rendered professional carers of people with intellectual disability more clearly vulnerable to stress and burnout for a variety of complex reasons, some identified and others as yet unrecognized. Lack of support and lack of role definition are particular problems. Presence of physical and mental health inequities result in major disparities in community care for people with intellectual disability.

Sewer performance reporting : factors that influence blockages

Managing sewer blockages represents a significant operational challenge for water utilities. In Australia, company-level blockage rates are used to compare the effectiveness of the management strategies of different utilities. Anecdotal evidence suggests this may not be a fair basis for comparison because blockages are influenced by a range of factors beyond management control and that vary from company to company. This issue was investigated as part of a broader research effort on sewer blockage management undertaken in conjunction with the Water Services Association of Australia (WSAA) and its members. A Web-based survey was used to collate expert opinion on factors that influence blockage rate. The identified factors were then investigated in an exploratory analysis of blockage-related data provided by two participating utilities, supported by literature reviews. The results indicate that blockage rate is influenced by a range of factors, including asset attributes, climatic conditions, water consumption, and soil type. Since these factors vary from utility to utility, this research supports the assertion that company-level blockage rate is not in itself an appropriate metric for comparing management effectiveness.

My System of Career Influences MSCI (Adult) Workbook

NOTE: This client booklet is to be used in conjunction with the MSCI (Adult) Facilitators Guide. Career development in the 21st century presents many challenges and opportunities. Throughout your life you will make countless decisions and experience numerous transitions. Each decision may be subject to a range of influences, for example people we know may give us an opinion, we may be attracted to a particular place or a particular salary, or we may simply want a change. No two people will have the same pattern of influences. The My System of Career Influences MSCI (Adult) is a qualitative career assessment reflection process based on recent developments in theory and practice. It uses a constructivist view and encourages a narrative and story-based approach to your career development. It has been used successfully with employees by career development practitioners working in a range of businesses and organisations from large to small and in one-on-one career counselling sessions as well as in a group setting.

Abandoning the Magic Circle

As a concept, the magic circle is in reality just 4 years old. Whilst often accredited to Johan Huizinga (1955), the modern usage of term in truth belongs to Katie Salen and Eric Zimmerman. It became in academia following the publication of “Rules of Play” in 2003. Because of the terminologyused, it carries with it unhelpful preconceptions that the game world, or play-space, excludes reality. In this paper, I argue that Salen and Zimmerman (2003) have taken a term used as an example, and applied a meaning to it that was never intended, based primarily upon definitions given by other authors, namely Apter (1991) and Sniderman (n.d.). I further argue that the definition itself contains a logical fallacy, which has prevented the full understanding of the definition in later work. Through a study of the literature in Game Theory, and examples of possible issues which could arise in contemporary games, I suggest that the emotions of the play experience continue beyond the play space, and that emotions from the “real world” enter it with the participants. I consider a reprise of the Stanley Milgram Obedience Experiment (2006), and what that tells us about human emotions and the effect that events taking place in a virtual environment can have upon them. I evaluate the opinion espoused by some authors of there being different magic circles for different players, and assert that this is not a useful approach to take when studying games, because it prevents the analysis of a game as a single entity. Furthermore I consider the reasons given by other authors for the existence of the Magic Circle, and I assert that the term “Magic Circle” should be discarded, that it has no relevance to contemporary games, and indeed it acts as a hindrance to the design and study of games. I conclude that the play space which it claims to protect from the courts and other governmental authorities would be better served by the existing concepts of intent, consent, and commonly accepted principles associated with international travel.