Patient-specific instrumentation does not improve radiographic alignment or clinical outcomes after total knee arthroplasty: A meta-analysis

Background and purpose: Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) has been introduced to improve alignment and reduce outliers, increase efficiency, and reduce operation time. In order to improve our understanding of the outcomes of patient-specific instrumentation, we conducted a meta-analysis. Patients and methods: We identified randomized and quasi-randomized controlled trials (RCTs) comparing patient-specific and conventional instrumentation in TKA. Weighted mean differences and risk ratios were determined for radiographic accuracy, operation time, hospital stay, blood loss, number of surgical trays required, and patient-reported outcome measures. Results: 21 RCTs involving 1,587 TKAs were included. Patient-specific instrumentation resulted in slightly more accurate hip-knee-ankle axis (0.3°), coronal femoral alignment (0.3°, femoral flexion (0.9°), tibial slope (0.7°), and femoral component rotation (0.5°). The risk ratio of a coronal plane outlier (\u3e 3° deviation of chosen target) for the tibial component was statistically significantly increased in the PSI group (RR = 1.64). No significance was found for other radiographic measures. Operation time, blood loss, and transfusion rate were similar. Hospital stay was significantly shortened, by approximately 8 h, and the number of surgical trays used decreased by 4 in the PSI group. Knee Society scores and Oxford knee scores were similar. Interpretation: Patient-specific instrumentation does not result in clinically meaningful improvement in alignment, fewer outliers, or better early patient-reported outcome measures. Efficiency is improved by reducing the number of trays used, but PSI does not reduce operation time

Aboriginal and Torres Strait Islander Suicide in Context

Aboriginal and Torres Strait Islander suicide has been an issue of national public health and mental health concern for only one decade, having increased dramatically from levels that were very low in the late 1980s to levels of young adult male suicide that are now substantially higher than for the non-indigenous population. In this review the authors socially and historically contextualize these changes, identifying the causal frameworks adopted in developing interventions, and present an explanation in narrative and pictorial form that draws on critical family-centered trauma

Fever in the archive

© Thesis Eleven Pty, Ltd., SAGE Publications. Biography is a metaphor for this critical study of a major Australian archive that holds the records of government departments responsible for the administration of Aboriginal affairs in Western Australian from 1897 to 1972. This artefact of totalitarian state control is structured by western colonial ontologies of bureaucracy and legislative control of subject people. The project of decolonizing this archive was begun in the 1970s by Indigenous writers negotiating between the archives and their own cultural knowledge to produce major creative works combining both. These works show the passionate, rich storytelling that emerges when indigenous people release the stories captured in the archives and restore them as living cultural heritage

Aboriginal world views and colonisation: implications for coastal sustainability

In this paper, we show how the Aboriginal people in the south-west of Australia (the Nyungar) developed systems of knowledge, of caring for country and of family relations that enabled them to survive for tens of thousands of years and continue to have importance today. The impacts of British colonisation on cultural continuity and knowledge in the south-west have been significant and include loss of land, break-up of families and massacre. These practices led to a loss of knowledge of language and culture in some cases. However, Nyungar culture is alive and dynamic, constantly being reclaimed, re-energised and rebuilt through the interaction of contemporary and traditional research praxis. Focusing on Derbal Nara (Cockburn Sound) on the coast in the southern metropolitan area of Perth, we provide case examples of the action-research-learning methodologies used by Whadjuk Nyungar Traditional Owners. We also provide examples of stories about Derbal Nara that are still alive and being recounted up to the present day, including those that account for the recent ice age and the end of the ice age 8000 years BC when sea levels rose, drowning land in the area of Derbal Nara. Finally, we argue that Whadjuk Nyungar experiences and world views based on relationality and reflexivity are central to sustainable coastal management and that in some respects there has already been a convergence of Indigenous and Western coastal management. We present a set of principles that support the development of this “third space” for coastal sustainability

Ugly town: Race, policy and people in Perth in the 1920's

In considering the historical treatment of Aboriginal Australians this paper will discuss the different spaces operating in Western Australia's South West in the late 1920s and the government policies that fed into them. These are the Moore River Native Settlement that is located some 100 km north of Perth and White City, a carnival sideshow located at the bottom of William Street on the banks of the Swan River in Perth. The 1905 Aborigines Act and a provision within that act known as the Proclamation of the Prohibited Area of Perth will be discussed. This will be done by comparing the ways that White City was seen by the government in the 1920s and how in recent years Northbridge has been regulated and discursively constructed. The intent is to look at how Aboriginal people have been treated over time and consider the social, historical and political forces that have shaped that construction

Climate change and Australia

Australia has had a variable and mostly arid climate as long as humans have been on the continent. Historically observed trends toward increased warming, with rainfall increases in many tropical areas and rainfall decreases in many temperate areas, are projected to continue. Impacts will be geographically variable but mostly negative for biodiversity, agriculture, and infrastructure. Extreme events such as bushfires and floods will increase in frequency and intensity, concentrated in summer. With an economy heavily dependent on coal for domestic electricity generation and as an export commodity, Australians are high per capita contributors to anthropogenic climate change. A quarter-century of steps to mitigation led in 2012 to a carbon price that has the long-term potential to shift the economy toward more renewable energy sources. However as in other parts of the world this change has come too late, and is proceeding too slowly, to avoid significant climate change. A heritage of indigenous adaptation, strong volunteer cultures, and contemporary cultural diversity provide Australia with considerable adaptive capacity for gradual changes, but the nation is underprepared for sudden or step changes. We identify four pressing research and policy needs focused on such changes: (1) systematic attention to processes and impacts of negative transformative change, or worst-case scenarios, (2) improve forecasts of year-to-year rainfall and climate variability, focusing on processes and climate drivers that may change in response to higher greenhouse gases, (3) identification and engagement of diverse cross-cultural resources, and (4) articulation of alternative governance mechanisms that can interact dynamically with strong government