Wound problems following hip arthroplasty before and after the introduction of a direct thrombin inhibitor for thromboprophylaxis

NICE guidelines have stated that patients undergoing elective hip surgery are at increased risk for venous thromboembolic events (VTE) following surgery and have recommended thromboprophylaxis for 28-35 days1, 2. However the studies looking at the new direct thrombin inhibitors have only looked at major bleeding. We prospectively looked at wound discharge in patients who underwent hip arthroplasty and were given dabigatran postoperatively between March 2010 and April 2010 (n=56). We retrospectively compared these results to a matched group of patients who underwent similar operations six months earlier when all patients were given dalteparin routinely postoperatively until discharge, and discharged home on 150mg aspirin daily for 6 weeks (n=67). Wound discharge after 5 days was significantly higher in the patients taking dabigatran (32% dabigatran n=18, 10% dalteparin n=17, p=0.003) and our rate of delayed discharges due to wound discharge significantly increased from 7% in the dalteparin group (n=5) to 27% for dabigatran (n=15, p=0.004). Patients who received dabigatran were more than five times as likely to return to theatre with a wound complication as those who received dalteparin (7% dabigatran n=4, vs. 1% dalteparin n=1), however, this was not statistically significant (p=0.18). The significantly higher wound discharge and return to theatre rates demonstrated in this study have meant that we have changed our practice to administering dalteparin until the wound is dry and then starting dabigatran. Our study demonstrates the need for further clinical studies regarding wound discharge and dabigatran.

Direct evaluation of IEC 61850-9-2 process bus network performance

This letter presents a technique to assess the overall network performance of sampled value process buses based on IEC 61850-9-2 using measurements from a single location in the network. The method is based upon the use of Ethernet cards with externally synchronized time stamping, and characteristics of the process bus protocol. The application and utility of the method is demonstrated by measuring latency introduced by Ethernet switches. Network latency can be measured from a single set of captures, rather than comparing source and destination captures. Absolute latency measures will greatly assist the design testing, commissioning and maintenance of these critical data networks.

GABAergic modification of myopic and hyperopic ocular tissue effects on scleral fibroblast growth

Purpose: Myopia is a common eye disorder affecting up to 90% of children in South East Asia and 30% of the population worldwide. Myopia of high severity is a leading cause of blindness around the world (4th to 5th most common). Changes and remodelling of the sclera i.e. increase cellular proliferation & increase protein synthesis within scleral cells (↑ scleral DNA) and thinning and lose of extracellular matrix of sclera (↓ scleral GAG synthesis) have been linked to myopic eye growth in animal models. Signals acting on the sclera are thought to originate in the retina, and are modulated by the retinal pigment epithelium (RPE) with limited evidence suggesting that the RPE can modify scleral cell growth in culture. However, the mechanism of retinal signal transmission and the role of posterior eye cup tissue, including the RPE, in mediating changes in scleral fibroblast growth during myopia development are unclear. Retinal transmitter systems are critically involved in pathways regulating eye growth, which ultimately lead to alterations in the sclera if eye size is to change. A dopaminergic agonist and muscarinic antagonists decrease the proliferation of scleral chondrocytes when co-cultured with chick’s retinal pigment epithelium (RPE). GABA receptors have recently been localised to chick sclera. We therefore hypothesised that posterior eye cup tissue from myopic eyes would stimulate and from hyperopic eyes would inhibit growth of scleral fibroblasts in vitro and that GABAergic agents could directly interact with scleral cells or indirectly modify the effects of myopic and hyperopic posterior eye cup tissue on scleral fibroblast growth. Method: Fibroblastic cells obtained from 8-day-old chick sclera were used to establish cell banks. Two major experiments were performed. Experiment 1: To determine if posterior eye cup tissues from myopic eye stimulates and hyperopic eye inhibits scleral cell proliferation, when co-cultured with scleral cells in vitro. This study comprised two linked experiments, i) monocular visual treatments of FDM (form-deprivation myopia), LIM (lens-induced myopia) and LIH (lens-induced hyperopia) with assessment of the effect of full punch eye cup tissue on DNA and GAG synthesis by cultured chick scleral fibroblasts, and ii) binocular visual treatments comprising LIM and LIH with assessment of the effect of individual layers of eye cup tissues (neural retina, RPE and choroid) on cultured chick scleral fibroblasts. Visual treatment was applied for 3 days. Experiment 2: To determine the direct interaction of GABA agents on scleral cell growth and to establish whether GABA agents modify the stimulatory/inhibitory effect of myopic and hyperopic posterior eye cup tissues on cultured scleral cell growth in vitro. Two linked experiments were performed. i) GABA agonists (muscimol and baclofen) and GABA antagonists (bicuculine (-), CGP46381 and TPMPA) were added to scleral cell culture medium to determine their direct effect on scleral cells. ii) GABAergic agents (agonists and antagonists) were administered to scleral fibroblasts co-cultured with posterior eye cup tissue (retina, RPE, retina/RPE, RPE/choroid). Ocular tissues were obtained from chick eyes wearing +15D (LIH) or -15D lenses (LIM) for 3 days. In both experiments, tissues were added to hanging cell culture insert (pore size 1.0ìm) placed over each well of 24 well plates while scleral cells were cultured in DMEM/F12, Glutamax (Gibco) plus 10% FBS and penicillin/streptomycin (50U/ml)) and fungizone (1.25ug/ml) (Gibco), at seeding density of 30,000 cells/well at the bottom of the well and allowed to grow for 3 days. Scleral cells proliferation rate throughout the study was evaluated by determining GAG and DNA content of scleral cells using Dimethylmethylene blue (DMMB) dye and Quant-iTTm Pico Green® dsDNA reagent respectively. Results and analysis: Based on DNA and GAG content, there was no significant difference in tissue effect of LIM and LIH eyes on scleral fibroblast growth (DNA: 8.4 ± 1.1μg versus 9.3 ± 2.3 μg, p=0.23; GAG: 10.13 ± 1.4 μg versus 12.67 ± 1.2 μg, F2,23=6.16, p=0.0005) when tissues were obtained from monocularly treated chick eyes (FDM or +15D lens or -15D lens over right eyes with left eyes untreated) and co-cultured as full punch. When chick eyes were treated binocularly with -15D lens (LIM) right eye and +15D lens (LIH) left eyes and tissue layers were separated, the retina from LIM eyes did not stimulate scleral cell proliferation compared to LIH eyes (DNA: 27.2 ± 6.7 μg versus 23.2 ± 1.5 μg, p=0.23; GAG: 28.1 ±3.7 μg versus 28.7 ± 4.2 μg, p=0.21). Similarly, the LIH and LIM choroid did not produce a differential effect based on DNA (LIM 46.9 ± 6.4 μg versus LIH 53.5 ± 4.7 μg, p=0.18), however the choroid from LIH eyes induced higher scleral GAG content than from LIM eyes (32.5 ± 6.7 μg versus 18.9 ± 1.2 μg, p=0.023). In contrast, the RPE from LIM eyes caused a significant increase in fibroblast proliferation whereas the RPE from LIH eyes was relatively inhibitory (72.4 ± 6.3 μg versus 27.9 ± 2.3 μg, F1, 6=69.99, p=0.0005). GAG data were opposite to DNA data e.g. the RPE from LIH eyes increased (33.7 ± 7.9 μg) while the RPE from LIM eyes decreased (28.2 ± 3.0 μg) scleral cell growth (F1, 6=13.99, p=0.010). Based on DNA content, GABA agents had a small direct effect on scleral cell growth; GABA agonists increased (21.4 ± 1.0% and 18.3 ± 1.0% with muscimol and baclofen, p=0.0021), whereas GABA antagonists decreased fibroblast proliferation (-23.7 ± 0.9% with bicuculine & CGP46381 and -28.1 ± 0.5% with TPMPA, p=0.0004). GABA agents also modified the effect of LIM and LIH tissues (p=0.0005).The increase in proliferation rate of scleral fibroblasts co-cultured with tissues (RPE, retina, RPE/retina and RPE/choroid) from LIM treated eyes was enhanced by GABA agonists (muscimol: 27.4 ± 1.2%, 35.8 ± 1.6%, 8.4 ± 0.3% and 11.9 ± 0.6%; baclofen: 27.0 ± 1.0%, 15.8 ± 1.5%, 16.8 ± 1.2% and 15.4 ± 0.4%, p=0.014) whereas GABA antagonists further reduced scleral fibroblasts growth (bicuculine: -52.5 ± 2.5%, -36.9 ± 1.4%, -37.5 ± 0.6% and -53.7 ± 0.9%; TPMPA: 57.3 ± 1.3%, -15.7 ± 1.2%, -33.5 ± 0.4% and -45.9 ± 1.5%; CGP46381: -51.9 ± 1.6%, -28.5 ± 1.5%, -25.4 ± 2.0% and -45.5 ± 1.9% respectively, p=0.0034). GAG data were opposite to DNA data throughout the experiment e.g. GABA agonists further inhibited while antagonists relatively enhanced scleral fibroblasts growth for both LIM and LIH tissue co-culture. The effect of GABA agents was relatively lower (p=0.0004) for tissue from LIH versus LIM eyes but was in a similar direction. There was a significant drug effect on all four tissue types e.g. RPE, retina, RPE/retina and RPE/choroid for both LIM and LIH tissue co-culture (F20,92=3.928, p=0.0005). However, the effect of GABA agents was greatest in co-culture with RPE tissue (F18,36=4.865, p=0.0005). Summary and Conclusion: 1) Retinal defocus signals are transferred to RPE and choroid which then exert their modifying effect on scleral GAG and DNA synthesis either through growth stimulating factors or directly interacting with scleral cells in process of scleral remodeling during LIM and LIH visual conditions. 2) GABAergic agents affect the proliferation of scleral fibroblasts both directly and when co-cultured with ocular tissues in vitro.

Dermal fibroblast infiltration of poly(ε-caprolactone) scaffolds fabricated by melt electrospinning in a direct writing mode

Melt electrospinning in a direct writing mode is a recent additive manufacturing approach to fabricate porous scaffolds for tissue engineering applications. In this study, we describe porous and cell-invasive poly (ε-caprolactone) scaffolds fabricated by combining melt electrospinning and a programmable x–y stage. Fibers were 7.5 ± 1.6 µm in diameter and separated by interfiber distances ranging from 8 to 133 µm, with an average of 46 ± 22 µm. Micro-computed tomography revealed that the resulting scaffolds had a highly porous (87%), three-dimensional structure. Due to the high porosity and interconnectivity of the scaffolds, a top-seeding method was adequate to achieve fibroblast penetration, with cells present throughout and underneath the scaffold. This was confirmed histologically, whereby a 3D fibroblast-scaffold construct with full cellular penetration was produced after 14 days in vitro. Immunohistochemistry was used to confirm the presence and even distribution of the key dermal extracellular matrix proteins, collagen type I and fibronectin. These results show that melt electrospinning in a direct writing mode can produce cell invasive scaffolds, using simple top-seeding approaches.

Understanding requirements of novel healthcare information systems for management of advanced prostate cancer

Effective management of chronic diseases is a global health priority. A healthcare information system offers opportunities to address challenges of chronic disease management. However, the requirements of health information systems are often not well understood. The accuracy of requirements has a direct impact on the successful design and implementation of a health information system. Our research describes methods used to understand the requirements of health information systems for advanced prostate cancer management. The research conducted a survey to identify heterogeneous sources of clinical records. Our research showed that the General Practitioner was the common source of patient's clinical records (41%) followed by the Urologist (14%) and other clinicians (14%). Our research describes a method to identify diverse data sources and proposes a novel patient journey browser prototype that integrates disparate data sources.

Designing mobile systems for social navigation in urban public places

This thesis presents social requirements and design considerations from a study evaluating interactive approaches to social navigation and user-generated information sharing in urban environments using mobile devices. It investigates innovative ways to leverage mobile information and communication technology in order to provide a social navigation platform for residents and visitors in and for public urban places. Through a design case study this work presents CityFlocks, a mobile information system that offers an easy way for information-seeking new residents or visitors to access tacit knowledge from local people about their new community. It is intended to enable visitors and new residents in a city to tap into the knowledge and experiences of local residents in order to gather information about their new environment. Its design specifically aims to lower existing barriers of access and facilitate social navigation in urban places. In various user tests it evaluates two general user interaction alternatives – direct and indirect social navigation – and analyses which interaction method works better for people using a mobile device to socially navigate urban environments. The outcomes are relevant for the user interaction design of future mobile information systems that leverage the social navigation approach.

Active awareness : supporting the intentional disclosure of awareness information in collaborative systems

This thesis opens up the design space for awareness research in CSCW and HCI. By challenging the prevalent understanding of roles in awareness processes and exploring different mechanisms for actively engaging users in the awareness process, this thesis provides a better understanding of the complexity of these processes and suggests practical solutions for designing and implementing systems that support active awareness. Mutual awareness, a prominent research topic in the fields of Computer-Supported Cooperative Work (CSCW) and Human-Computer Interaction (HCI) refers to a fundamental aspect of a person’s work: their ability to gain a better understanding of a situation by perceiving and interpreting their co-workers actions. Technologically-mediated awareness, used to support co-workers across distributed settings, distinguishes between the roles of the actor, whose actions are often limited to being the target of an automated data gathering processes, and the receiver, who wants to be made aware of the actors’ actions. This receiver-centric view of awareness, focusing on helping receivers to deal with complex sets of awareness information, stands in stark contrast to our understanding of awareness as social process involving complex interactions between both actors and receivers. It fails to take into account an actors’ intimate understanding of their own activities and the contribution that this subjective understanding could make in providing richer awareness information. In this thesis I challenge the prevalent receiver-centric notion of awareness, and explore the conceptual foundations, design, implementation and evaluation of an alternative active awareness approach by making the following five contributions. Firstly, I identify the limitations of existing awareness research and solicit further evidence to support the notion of active awareness. I analyse ethnographic workplace studies that demonstrate how actors engage in an intricate interplay involving the monitoring of their co-workers progress and displaying aspects of their activities that may be of relevance to others. The examination of a large body of awareness research reveals that while disclosing information is a common practice in face-to-face collaborative settings it has been neglected in implementations of technically mediated awareness. Based on these considerations, I introduce the notion of intentional disclosure to describe the action of users actively and deliberately contributing awareness information. I consider challenges and potential solutions for the design of active awareness. I compare a range of systems, each allowing users to share information about their activities at various levels of detail. I discuss one of the main challenges to active awareness: that disclosing information about activities requires some degree of effort. I discuss various representations of effort in collaborative work. These considerations reveal that there is a trade-off between the richness of awareness information and the effort required to provide this information. I propose a framework for active awareness, aimed to help designers to understand the scope and limitations of different types of intentional disclosure. I draw on the identified richness/effort trade-off to develop two types of intentional disclosure, both of which aim to facilitate the disclosure of information while reducing the effort required to do so. For both of these approaches, direct and indirect disclosure, I delineate how they differ from related approaches and define a set of design criteria that is intended to guide their implementation. I demonstrate how the framework of active awareness can be practically applied by building two proof-of-concept prototypes that implement direct and indirect disclosure respectively. AnyBiff, implementing direct disclosure, allows users to create, share and use shared representations of activities in order to express their current actions and intentions. SphereX, implementing indirect disclosure, represents shared areas of interests or working context, and links sets of activities to these representations. Lastly, I present the results of the qualitative evaluation of the two prototypes and analyse the results with regard to the extent to which they implemented their respective disclosure mechanisms and supported active awareness. Both systems were deployed and tested in real world environments. The results for AnyBiff showed that users developed a wide range of activity representations, some unanticipated, and actively used the system to disclose information. The results further highlighted a number of design considerations relating to the relationship between awareness and communication, and the role of ambiguity. The evaluation of SphereX validated the feasibility of the indirect disclosure approach. However, the study highlighted the challenges of implementing cross-application awareness support and translating the concept to users. The study resulted in design recommendations aimed to improve the implementation of future systems.

Direct detection of additives and degradation products from polymers by liquid extraction surface analysis employing chip-based nanospray mass spectrometry

RATIONALE: Polymer-based surface coatings in outdoor applications experience accelerated degradation due to exposure to solar radiation, oxygen and atmospheric pollutants. These deleterious agents cause undesirable changes to the aesthetic and mechanical properties of the polymer, reducing its lifetime. The use of antioxidants such as hindered amine light stabilisers (HALS) retards these degradative processes; however, mechanisms for HALS action and polymer degradation are poorly understood. METHODS: Detection of the HALS TINUVINW123 (bis(1-octyloxy-2,2,6,6-tetramethyl-4-piperidyl) sebacate) and the polymer degradation products directly from a polyester-based coil coating was achieved by liquid extraction surface analysis (LESA) coupled to a triple quadrupole QTRAPW 5500 mass spectrometer. The detection of TINUVINW123 and melamine was confirmed by the characteristic fragmentation pattern observed in LESA-MS/MS spectra that was identical to that reported for authentic samples. RESULTS: Analysis of an unstabilised coil coating by LESA-MS after exposure to 4 years of outdoor field testing revealed the presence of melamine (1,3,5-triazine-2,4,6-triamine) as a polymer degradation product at elevated levels. Changes to the physical appearance of the coil coating, including powder-like deposits on the coating's surface, were observed to coincide with melamine deposits and are indicative of the phenomenon known as polymer ' blooming'. CONCLUSIONS: For the first time, in situ detection of analytes from a thermoset polymer coating was accomplished without any sample preparation, providing advantages over traditional extraction-analysis approaches and some contemporary ambient MS methods. Detection of HALS and polymer degradation products such as melamine provides insight into the mechanisms by which degradation occurs and suggests LESA-MS is a powerful new tool for polymer analysis. Copyright (C) 2012 John Wiley & Sons, Ltd.

Effect of joint mechanism on vehicle redirectional capability of water-filled road safety barrier systems

Portable water-filled barriers (PWFBs) are roadside appurtenances that prevent vehicles from penetrating into temporary construction zones on roadways. PWFBs are required to satisfy the strict regulations for vehicle re-direction in tests. However, many of the current PWFBs fail to re-direct the vehicle at high speeds due to the inability of the joints to provide appropriate stiffness. The joint mechanism hence plays a crucial role in the performance of a PWFB system at high speed impacts. This paper investigates the desired features of the joint mechanism in a PWFB system that can re-direct vehicles at high speeds, while limiting the lateral displacement to acceptable limits. A rectangular “wall” representative of a 30 m long barrier system was modeled and a novel method of joining adjacent road barriers was introduced through appropriate pin-joint connections. The impact response of the barrier “wall” and the vehicle was obtained and the results show that a rotational stiffness of 3000 kNm/rad at the joints seems to provide the desired features of the PWFB system to re-direct impacting vehicles and restrict the lateral deflection. These research findings will be useful to safety engineers and road barrier designers in developing a new generation of PWFBs for increased road safety.

A unique battery/supercapacitor direct integration scheme for hybrid electric vehicles

Battery/supercapacitor hybrid energy storage systems have been gaining popularity in electric vehicles due to their excellent power and energy performances. Conventional designs of such systems require interfacing dc-dc converters. These additional dc-dc converters increase power loss, complexity, weight and cost. Therefore, this paper proposes a new direct integration scheme for battery/supercapacitor hybrid energy storage systems using a double ended inverter system. This unique approach eliminates the need for interfacing converters and thus it is free from aforementioned drawbacks. Furthermore, the proposed system offers seven operating modes to improve the effective use of available energy in a typical drive cycle of a hybrid electric vehicle. Simulation results are presented to verify the efficacy of the proposed system and control techniques.

Battery clamped three-level inverter for renewable energy systems

This paper presents a novel battery direct integration scheme for renewable energy systems. The idea is to replace ordinary capacitors of a three-level flying-capacitor inverter by three battery banks to alleviate power fluctuations in renewable generation. This approach eliminates the need for interfacing dc-dc converters and thus considerably improves the overall efficiency. However, the major problem with this approach is the uneven distribution of space vectors which is due to unavoidable unbalance in clamping voltages. A detailed analysis on the effects of this issue and a novel carrier based pulse width modulation method, which can generate undistorted currents even in the presence of unevenly distributed space vectors, are presented in this paper. A charge/discharge controller is also proposed for power sharing and state of charge balancing of battery banks. Simulation results are presented to verify the efficacy of the proposed system, modulation method and power sharing controller.

An analysis on the possibility of using capacitors of a three-level capacitor clamped inverter as power smoothing elements for wind power systems

This paper presents a new direct integration scheme for supercapacitors that are used to mitigate short term power fluctuations in wind power systems. The idea is to replace ordinary capacitors of a 3-level flying capacitor inverter by supercapacitors and operate them under variable voltage conditions. This approach eliminates the need of interfacing dc-dc converters for supercapacitor integration and thus considerably improves the overall efficiency. However, the major problem of this unique system is the change of supercapacitor voltages. An analysis on the effects of these voltage variations are presented. A space vector modulation method, built from the scratch, is proposed to generate undistorted current even in the presence of dynamic changes in supercapacitor voltages. A supercapacitor voltage equalisation algorithm is also proposed. Furthermore, resistive behavior of supercapacitors at high frequencies and the need for a low pass filter are highlighted. Simulation results are presented to verify the efficacy of the proposed system in suppressing short term wind power fluctuations.

A new method of interfacing battery/supercapacitor energy storage systems for distributed energy sources

Battery-supercapacitor hybrid energy storage systems can achieve better power and energy performances compared to their individual use. These hybrid systems require separate dc-dc converters, or at least one dc-dc converter for the supercapacitor bank, to connect them to the dc-link of the grid connecting inverter. However, the use of such dc-dc converters introduces additional cost and power losses. Therefore, the possibility of direct connection of energy storage systems, to the dc-link of a diode clamped 3-level inverter is investigated in this paper. Even though the proposed topology does not use dc-dc converters, a vector selection method is proposed to produce a similar control flexibility that is found in the separate dc-dc converter topology. The major issue with the proposed system is the imminent imbalance of the neutral point potential. A PWM technique with modified carriers is used to solve this problem. Simulations are carried out using MATLAB/SIMULINK to verify the efficacy of the proposed system.

Acoustic emission activity from the two main types of small multi-cylinder diesel engine fuel injection systems

Effective fuel injector operation and efficient combustion are two of the most critical aspects when Diesel engine performance, efficiency and reliability are considered. Indeed, it is widely acknowledged that fuel injection equipment faults lead to increased fuel consumption, reduced power, greater levels of exhaust emissions and even unexpected engine failure. Previous investigations have identified fuel injector related acoustic emission activity as being caused by mechanisms such as fuel line pressure build-up; fuel flow through injector nozzles, injector needle opening and closing impacts and premixed combustion related pulses. Few of these investigations however, have attempted to categorise the close association and interrelation that exists between fuel injection equipment function and the acoustic emission generating mechanisms. Consequently, a significant amount of ambiguity remains in the interpretation and categorisation of injector related AE activity with respect to the functional characteristics of specific fuel injection equipment. The investigation presented addresses this ambiguity by detailing a study in which AE signals were recorded and analysed from two different Diesel engines employing the two commonly encountered yet fundamentally different types of fuel injection equipment. Results from tests in which faults were induced into fuel injector nozzles from both indirect-injection and direct-injection engines show that functional differences between the main types of fuel injection equipment results in acoustic emission activity which can be specifically related to the type of fuel injection equipment used.