Evaluation of public hospital performance in Khanh Hoa Province : Vietnam in connection with patient and staff satisfaction surveys

This research aimed to develop a framework for performance evaluation of public hospitals in Vietnam that is culturally, socially, and politically appropriate. The research included both qualitative and quantitative methods and identified and validated novel instruments to measure patient satisfaction and job satisfaction of hospital staff and to determine a set of hospital indicators that reflect the quality of hospital performance. New models for understanding the determinants of patient and staff satisfaction were developed along with a new performance indicator framework for hospital performance. These instruments will now be applied to the evaluation of hospital services in Khanh Hoa Province, permitting longer term evaluation of their effectiveness in changing system wide performance and satisfaction.

Reactive plasma-aided RF sputtering deposition of hydroxyapatite bio-implant coatings

The plasma-assisted RF sputtering deposition of a biocompatible, functionally graded calcium phosphate bioceramic on a Ti6A14 V orthopedic alloy is reported. The chemical composition and presence of hydroxyapatite (HA), CaTiO3, and CaO mineral phases can be effectively controlled by the process parameters. At higher DC biases, the ratio [Ca]/[P] and the amount of CaO increase, whereas the HA content decreases. Optical emission spectroscopy suggests that CaO+ is the dominant species that responds to negative DC bias and controls calcium content. Biocompatibility tests in simulated body fluid confirm a positive biomimetic response evidenced by in-growth of an apatite layer after 24 h of immersion.

Role of microRNAs in improved osteogenicity of topographically modified titanium implant surfaces

This project aimed at understanding the molecular mechanisms involved in the superior integration of micro-roughened titanium implant surfaces with the surrounding bone, when compared with their smooth surfaces. It involved studying the role of microRNAs and cell signaling pathways in the molecular regulation of bone cells on topographically modified titanium dental implants. The findings suggest a highly regulated microRNA-mediated control of molecular mechanisms during the process of bone formation that may be responsible for the superior osseointegration properties on micro-roughened titanium implant surfaces and indicate the possibility of using microRNA modulators to enhance osseointegration in clinically demanding circumstances.

Clinically-based automatic implant fitting for shape optimization of fracture fixation plates

Complex bone contour and anatomical variations between individual bones complicate the process of deriving an implant shape that fits majority of the population. This thesis proposes an automatic fitting method for anatomically-precontoured plates based on clinical requirements, and investigated if 100% anatomical fit for a group of bone is achievable through manual bending of one plate shape. It was found that, for the plate used, 100% fit is impossible to achieve through manual bending alone. Rather, newly-developed shapes are also required to obtain anatomical fit in areas with more complex bone contour.

Mining, sex work and STIs: why force a connection?

Can the mining boom be blamed for the rising rates of sexually transmitted infections (STIs) in some states? The Australian Medical Association thinks so, with its Queensland president Dr Richard Kidd attributing rising rates of gonorrhoea, syphilis and chlamydia in Queensland and Western Australia to bored and cashed-up miners.

Repeatability of static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with osseointegrated implant

Bone-anchored prostheses, relying on implants to attach the prosthesis directly to the residual skeleton, are the ultimate resort for patients with transfemoral amputations (TFA) experiencing severe socket discomfort. The first patient receiving a bone-anchored prosthesis underwent the surgery in 1990 in the Sahlgrenska University Hospital (Sweden). To date, there are two commercially available implants: OPRA (Integrum, Sweden) and ILP (Orthodynamics, Germany). The key to success to this technique is a firm bone-implant bonding, depending on increasing mechanical stress applied daily during load bearing exercises (LBE). The loading data could be analysed through different biomechanical variables. The intra-tester reliability of these exercises will be presented here. Moreover the effect of increase of loading, axes of application of the load and body weight as well as the difference between force and moment variables will be discussed.

Static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with osseointegrated implant: Load compliance

Osseointegration has been introduced in the orthopaedic surgery in the 1990’s in Gothenburg (Sweden). To date, there are two frequently used commercially available human implants: the OPRA (Integrum, Sweden) and ILP (Orthodynamics, Germany) systems. The rehabilitation program with both systems include some form of static load bearing exercises. These latter involved following a load progression that is monitored by the bathroom scale, providing only the load applied on the vertical axis. The loading data could be analysed through different biomechanical variables. For instance, the load compliance, corresponding to the difference between the load recommended (LR) and the load actually applied on the implant, will be presented here.

Static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with osseointegrated implant: Kinetic analysis

The desire to solve problems caused by socket prostheses in transfemoral amputees and the acquired success of osseointegration in the dental application has led to the introduction of osseointegration in the orthopedic surgery. Since its first introduction in 1990 in Gothenburg Sweden the osseointegrated (OI) orthopedic fixation has proven several benefits[1]. The surgery consists of two surgical procedures followed by a lengthy rehabilitation program. The rehabilitation program after an OI implant includes a specific training period with a short training prosthesis. Since mechanical loading is considered to be one of the key factors that influence bone mass and the osseointegration of bone-anchored implants, the rehabilitation program will also need to include some form of load bearing exercises (LBE). To date there are two frequently used commercially available human implants. We can find proof in the literature that load bearing exercises are performed by patients with both types of OI implants. We refer to two articles, a first one written by Dr. Aschoff and all and published in 2010 in the Journal of Bone and Joint Surgery.[2] The second one presented by Hagberg et al in 2009 gives a very thorough description of the rehabilitation program of TFA fitted with an OPRA implant. The progression of the load however is determined individually according to the residual skeleton’s quality, pain level and body weight of the participant.[1] Patients are using a classical bathroom weighing scale to control the load on the implant during the course of their rehabilitation. The bathroom scale is an affordable and easy-to-use device but it has some important shortcomings. The scale provides instantaneous feedback to the patient only on the magnitude of the vertical component of the applied force. The forces and moments applied along and around the three axes of the implant are unknown. Although there are different ways to assess the load on the implant for instance through inverse dynamics in a motion analysis laboratory [3-6] this assessment is challenging. A recent proof- of-concept study by Frossard et al (2009) showed that the shortcomings of the weighing scale can be overcome by a portable kinetic system based on a commercial transducer[7].

Walking ability of individuals with transfemoral amputation fitted with osseointegrated implant

The prosthetic benefits of osseointegrated fixation for individuals with limb loss, particularly those with transfemoral amputation (TFA), have been clearly demonstrated in the literature. However, very little information is currently available to established how this prosthetic benefits are translated into functional outcomes and, more precisely, walking abilities [1-3]. The ultimate aim of this presentation was to explore how walking abilities of a TFA fitted with an OPRA fixation could be assess through typical temporal and spatial gait characteristics[2].

Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: Reliability of kinetic data

This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an osseointegrated implant to stimulate the bone remodelling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalisation. Eleven unilateral TFAs fitted with an OPRA implant performed five trials in four loading conditions. The forces and moments on the three axes of the implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values (%SEMs). The ICCs of all variables were above 0.9 and the %SEM values ranged between 0 and 87%. This study showed a high between-participants’ variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.

The messaging kettle: Prototyping connection over a distance between adult children and older parents

A prototype "messaging kettle" is described. The connected kettle aims to foster communication and engagement with an older friend or relative who lives remotely, during the routine of boiling the kettle. We describe preliminary encounters and findings from demonstrating a working prototype in morning tea gatherings of people in their 50s-late 70s and from introducing it into the homes of two people in their 80s who live on another continent. Key findings are that: The concept of keeping in touch around a "habituated object" such as a kettle was well received; Simple and varied interaction modalities that allow asymmetric forms of communication are needed; Designing for use across different time zones requires attention; And, that even when augmenting a habituated object, the process of introduction, appropriation and habituation still needs significant attention and investigation.

Loading compliance of static load bearing exercises performed by transfemoral amputees fitted with an osseointegrated implant

Background To date bone-anchored prostheses are used to alleviate the concerns caused by socket suspended prostheses and to improve the quality of life of transfemoral amputees (TFA). Currently, two implants are commercially available (i.e., OPRA (Integrum AB, Sweden), ILP (Orthodynamics GmbH, Germany)). [1-17]The success of the OPRA technique is codetermined by the rehabilitation program. TFA fitted with an osseointegrated implant perform progressive mechanical loading (i.e. static load bearing exercises (LBE)) to facilitate bone remodelling around the implant.[18, 19] Aim This study investigated the trustworthiness of monitoring the load prescribed (LP) during experimental static LBEs using the vertical force provided by a mechanical bathroom scale that is considered a surrogate of the actual load applied. Method Eleven unilateral TFAs fitted with an OPRA implant performed five trials in four loading conditions. The forces and moments on the three axes of the implant were measured directly with an instrumented pylon including a six-channel transducer. The “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the fixation and LP as well as the resultant of the three components of the load applied and LP, respectively were analysed Results For each loading condition, Wilcoxon One-Sample Signed Rank Tests were used to investigate if significant differences (p<0.05) could be demonstrated between the force applied on the long axis and LP, and between the resultant of the force and LP. The results demonstrated that the raw axial and vectorial differences were significantly different from zero in all conditions (p<0.05), except for the vectorial difference for the 40 kg loading condition (p=0.182). The raw axial difference was negative for all the participants in every loading condition, except for TFA03 in the 10 kg condition (11.17 N). Discussion & Conclusion This study showed a significant lack of axial compliance. The load applied on the long axis was significantly smaller than LP in every loading condition. This led to a systematic underloading of the long axis of the implant during the proposed experimental LBE. Monitoring the vertical force might be only partially reflective of the actual load applied, particularly on the long axis of the implant.

The physics of ENSO-monsoon connection

The physical mechanism through which Ei-Nino and Southern Oscillation (ENSO) tends to produce deficient precipitation over Indian continent is investigated using both observations as well as a general circulation model. Both analysis of observations and atmospheric general circulation model (AGCM) study show that the planetary scale response associated with ENSO primarily influences the equatorial Indian Ocean region. Through this interaction it tends to favour the equatorial heat source, enhance precipitation over the equatorial Indian Ocean and indirectly cause a decrease in continental precipitation through induced subsidence. This situation is further complicated by the fact the regional tropospheric quasi biennial oscillation (QBO) has a bimodal structure over this region with large amplitude over the Indian continent. While the ENSO response has a quasi-four year periodicity and tends peak during beginning of the calendar year, the QBO mode tends to peak during northern summer. Thus, the QBO mode exerts a stronger influence on the interannual variability of the monsoon. The strength of the Indian monsoon in a given year depends on the combined effect of the ENSO and the QBO mode. Sines the two oscillations have disparate time scales, exact phase information of the two modes during northern summer is important in determining the Indian summer monsoon. The physical mechanism of the interannual variations of the Indian monsoon precipitation associated with ENSO presented here is similar to the physical process that cause intraseasonal 'active', 'break' oscillations of the monsoon.

The connection between Mueller and Jones matrices of polarization optics

A necessary and sufficient condition for the 4 × 4 Mueller matrix to be derivable from the 2 × 2 Jones matrix is obtained. This condition allows one to determine if a given Mueller matrix describes a totally polarized system or a partially polarized (depolarizing) system. The result of Barakat is analysed in the light of this condition. A recently reported experimentally measured Mueller matrix is examined using this condition and is shown to represent a partially polarized system.