Walgett's Drinking Water: Yuwaya Ngarra-li Briefing Paper

This Briefing Paper documents a timeline of events in Walgett's recent history of drinking water management. It sets out the context in which drinking water is accessed, the associated risks, and the story of community advocacy pivotal to change. Its purpose is to inform efforts to improve water security and quality for residents in Walgett and the nearby Namoi and Gingie Villages, including urgent actions called for by the Dharriwaa Eldergs Group and Walgett Aboriginal Medical Service

Outcomes of unilateral and bilateral total knee arthroplasty in 238,373 patients

© 2016 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation. Background and purpose — There is no consensus about the outcome of simultaneous vs. staged bilateral total knee arthroplasty (TKA). We examined this issue by analyzing 238,373 patients. Patients and methods — Demographic, clinical, and outcome data were evaluated for TKA patients (unilateral: 206,771; simultaneous bilateral: 6,349; staged bilateral: 25,253) from the Canadian Hospital Morbidity Database for fiscal years 2006–2007 to 2012–2013. Outcomes were adjusted for age, sex, comorbidities, and hospital TKA volume. Results — Simultaneous bilateral TKA patients were younger than staged bilateral TKA patients (median 64 years vs. 66 years), were more likely to be male (41% vs. 39%), and had a lower frequency of having ≥1 comorbid condition (2.9% vs. 4.2%). They also had a higher frequency of blood transfusions (41% vs. 19%), a shorter median length of stay (6 days vs. 8 days), a higher frequency of transfer to a rehabilitation facility (46% vs. 9%), and a lower frequency of knee infection (0.5% vs. 0.9%) than staged bilateral TKA patients, but they had higher rate of cardiac complications within 90 days (2.0% vs. 1.7%). Simultaneous patients had higher in-hospital mortality compared to the second TKA in staged patients (0.16% vs. 0.06%), but they had similar rates of in-hospital mortality compared to unilateral patients (0.16% vs. 0.14%). The cumulative 3-year revision rate was highest in the unilateral group (2.3%), but it was similar in the staged and simultaneous bilateral groups (1.4%). Interpretation — We found important differences between the outcomes of simultaneous and staged bilateral TKA. Further clarification of outcomes would be best determined in an adequately powered randomized trial, which would remove the selection bias inherent in this retrospective study design

Fatigue Life of Haynes 188 Superalloy in Direct Connect Combustor Durability Rig

The Direct Connect Combustor Durability Rig (DCR) will provide NASA a flexible and efficient test bed to demonstrate the durability of actively cooled scramjet engine structure, static and dynamic sealing technologies, and thermal management techniques. The DCR shall be hydrogen fueled and cooled, and test hydrogen coolded structural panels at Mach 5 and 7. Actively cooled Haynes 188 superalloy DCR structural panels exposed to the combustion environment shall have electrodischarge machined (EDM) internal cooling holes with flowing liquid hydrogen. Hydrogen combustion could therefore produce severe thermal conditions that could challenge low cycle fatigue durability of this material. The objective of this study was to assess low cycle fatigue capability of Haynes 188 for DCR application. Tests were performed at 25 and 650 C, in hydrogen and helium environments, using specimens with low stress ground (LSG) and electro-discharge machined (EDM) surface finish. Initial fatigue tests in helium and hydrogen indicate the low cycle fatigue life capability of Haynes 188 in hydrogen appears quite satisfactory for the DCR application. Fatigue capability did not decrease with increasing test temperature. Fatigue capability also did not decrease with EDM surface finish. Failure evaluations indicate retention of ductility in all conditions. Additional tests are planned to reconfirm these positive trends

Predicting optical coherence tomography-derived diabetic macular edema grades from fundus photographs using deep learning

Diabetic eye disease is one of the fastest growing causes of preventable blindness. With the advent of anti-VEGF (vascular endothelial growth factor) therapies, it has become increasingly important to detect center-involved diabetic macular edema (ci-DME). However, center-involved diabetic macular edema is diagnosed using optical coherence tomography (OCT), which is not generally available at screening sites because of cost and workflow constraints. Instead, screening programs rely on the detection of hard exudates in color fundus photographs as a proxy for DME, often resulting in high false positive or false negative calls. To improve the accuracy of DME screening, we trained a deep learning model to use color fundus photographs to predict ci-DME. Our model had an ROC-AUC of 0.89 (95% CI: 0.87-0.91), which corresponds to a sensitivity of 85% at a specificity of 80%. In comparison, three retinal specialists had similar sensitivities (82-85%), but only half the specificity (45-50%, p<0.001 for each comparison with model). The positive predictive value (PPV) of the model was 61% (95% CI: 56-66%), approximately double the 36-38% by the retinal specialists. In addition to predicting ci-DME, our model was able to detect the presence of intraretinal fluid with an AUC of 0.81 (95% CI: 0.81-0.86) and subretinal fluid with an AUC of 0.88 (95% CI: 0.85-0.91). The ability of deep learning algorithms to make clinically relevant predictions that generally require sophisticated 3D-imaging equipment from simple 2D images has broad relevance to many other applications in medical imaging