Evaluation of patient related factors influencing outcomes after total hip replacement

Background: Basic patient factors such as age, sex, and comorbidities are poorly understood in the context of re-operation rates and patient-reported outcome measures after total hip replacement (THR) surgery. Aims: The aims of this thesis were to investigate: 1. If comorbidity measures developed for mortality outcomes also are applicable for re-operations. 2. How age influences health-related quality of life (HRQoL). 3. If sex/age interacts with self-administered Charnley classification in regards to HRQoL. 4. The generalizability of HRQOL estimates. 5. If antidepressant use impacts patient-reported outcomes. Methods: All studies were based upon the Swedish Hip Arthroplasty Register (SHAR) database. For study I, data from SHAR was cross-matched with the National Patient Register through which 3 different comorbidity measures were calculated: the Charlson score, the Elixhauser score, and the Royal College of Surgeons (RCS) Charlson’s score. The three scores were then compared using survival analysis with implant re-operation performed between 0 to 2 years and 2 to 12 years. In study II and III we used the SHAR’s PROM database with HRQoL outcomes as measured by EQ-5D and EQ-VAS. In study II we modeled age using linear regression in combination with restricted cubic splines in order to study the relationship between age and HRQoL. In study III we used linear regression with interaction terms evaluated by ANOVA-tests, subset, and EQ-5D dimension specific analyses. In study IV we linked the SHAR’s PROM database to the National Patient Register and a Danish cross-sectional sample. The Charlson comorbidity measure was calculated as in study I, and effect modification by country was investigated through terms of interaction, evaluated as in study III. In study V, we cross-matched the SHAR’s PROM database with the Prescribed Drug Register. We calculated the usage of antidepressants using regular expressions. Measures for compliance, treatment change, and indication were retrieved from the prescription text. Results Study I: 0-2 years, only the Elixhauser score showed significant risk increase with increased score for both 1-2 and ≥ 3 comorbidities. The predictive C-statistic in this period for the Elixhauser score was poor, 0.52. None of the measures proved to be of any value between 2-12 years. Study II: Both the EQ-5D index and EQ VAS exhibited a non-linear relationship with age, they were fairly unaffected by age until the patient’s late sixties, after which it had a negative impact. Study III: We found that women in category C had a poorer EQ-5D outcome compared to men. This effect was mostly due to the fact that women failed to improve in the mobility dimension, only 40% improved, while 50% of men improved. Age did not interact with Charnley class. We also found that the classification performed best without splitting or aggregating classes. Study IV: Danish patients had an overall higher EQ-5D index and EQ VAS than Swedish patients (p-value < 0.001). After regression analysis, the estimated coefficients for sex, age, or the Charlson score did not differ between countries for either the EQ-5D index (p-value = 0.83) or EQ VAS (p-value = 0.41) one year after THR. Study V:Antidepressants were used by 9% of the cases (n = 954). Patients using antidepressants had poorer HRQoL, more pain, and experienced less satisfaction. Preoperative antidepressant use was independent of patient-reported anxiety/depression in predicting PROs one year after THR. Discontinuation of treatment was negatively associated with pain and satisfaction at one year. Conclusions Study I: We failed to validate any of the scores for re-operations after total hip arthroplasties, although the Elixhauser score may be useful for estimating the comorbidities relevant to the risk of re-operation within 2 years. The comorbidity associated risk increase was small, and is undoubtedly best suited to the study of large samples and not individual patients. Study II: There is a non-linear relationship for age and HRQoL in patients receiving THR; resulting in residual confounding if treated as a simple linear term or categorically in the regression. The implication of this is important, as age is a common confounder. The same applies to the preoperative EQ-5D index and EQ VAS. Study III: The self-administered Charnley classification is a reliable instrument with interesting properties easy to utilize in everyday clinical practice. There is also strong evidence that women in Charnley class C fail to improve their mobility as much as men. Study IV: There are clear similarities in how basic predictors influence patient-reported outcomes in patients with THR in Sweden and Denmark. Apparent cultural, social, and other such differences among these countries are not reflected in these predictors. Study V: Antidepressants have a negative influence on patient-reported outcomes 1 year after THR, independent of the pre-operative EQ-5D anxiety/depression dimension. We also found that discontinuation of treatment prior to surgery is associated with poorer outcomes in the dimensions of pain and satisfaction

How can Cape Flats youth overcome Environmental circumstance by using their Personal potential?

This study focuses on identity and (un)employment among Coloured born-frees from the Cape Flats in Cape Town. Coloured adolescents could be classified as vulnerable because their living conditions are characterized by unemployment, crime, gangsterism and a lack of positive role models. In conjunction with digital exclusion and poor quality education; these circumstances restrict youth from participating fairly in socio-economic activities – effectively limiting their growth potential. Personalization theory states that growth is not solely dictated by environmental conditions but in part dependent on how an individual respond to these external experiences. Most members of the Cape Flats are not criminals or gangsters. However, most research utilizes a deficit paradigm; exclusively emphasizing the negative conditions in these disadvantaged districts. A qualitative Grounded Theory methodology was employed to address this gap by incorporating corporate and creatively employed youth as research participants. Moreover, male and female born-frees, aged 18-28, were interviewed. 10 individuals from each employment sector (corporate, creative and criminal) were given the same set of questions in order to establish reasons why certain careers were chosen. Cognitive and behavioural characteristics, both distinct and shared, across the 3 groups were identified. Personal Potential is derived from Self-actualization and Self-efficacy – this contributes to new knowledge as these theories have not previously been applied to the Cape Flats context. The most destructive influence limiting potential was found to be the behaviour witnessed by others in their neighbourhoods. The findings indicate that communication is the most practical learning tool among youth. However, youth do not want to be told what to do, rather, they want to be like those they see. The innovative praxis model aiding this connection is the digital network Question Mark Kaffy. This platform broadens the outlook of youth beyond what is merely observed in their physical setting, displaying the diversity of South Africa's creatives. This research project sheds light on youth who have maximized their Personal Potential and shares insights as to how others may do the same. Thus, it empowers Cape Flat's creatives to become constructive citizens by serving as new role models to aspiring artists, which contributes to the creation of a Collective Creative Cultural identity amongst Capetonians

ADAPTIVE USER INTERFACE BASED ON EYE TRACKING

An adaptive user interface system can be used to dynamically adapt a graphical user interface (GUI) for a user. The system is based on the observed ability of the user to focus on various GUI elements presented on the interface. The system is comprised of two subsystems, an eye tracking module and an interface adapter. The eye tracking module captures successive images of user’s eye focus locations on the interface over a predefined time period. The module then determines a set of interface locations most focussed on by the user and transmits them to the interface adapter. The interface adapter adapts or realigns the graphical user interface according to the received focussed locations

Tilt-Table Alignment For Inertial-Platform Maintenance Without A Surveyed Site

A method for aligning the rotary tilt table for an inertial-platform maintenance facility without surveying the site is analyzed and evaluated. The method utilizes multiple measurements of the tilt-table azimuth alignment error with different inertial platforms to determine a best estimate of the alignment error. Error analysis indicates that useful facility performance can be obtained with only a small number of measurements. The tilt-table alignment accuracy can be improved as more measurements of the alignment error are made during normal facility operation. © 1973, IEEE. All rights reserved

Unsupervised Contact Learning for Humanoid Estimation and Control

This work presents a method for contact state estimation using fuzzy clustering to learn contact probability for full, six-dimensional humanoid contacts. The data required for training is solely from proprioceptive sensors - endeffector contact wrench sensors and inertial measurement units (IMUs) - and the method is completely unsupervised. The resulting cluster means are used to efficiently compute the probability of contact in each of the six endeffector degrees of freedom (DoFs) independently. This clustering-based contact probability estimator is validated in a kinematics-based base state estimator in a simulation environment with realistic added sensor noise for locomotion over rough, low-friction terrain on which the robot is subject to foot slip and rotation. The proposed base state estimator which utilizes these six DoF contact probability estimates is shown to perform considerably better than that which determines kinematic contact constraints purely based on measured normal force.Comment: Submitted to the IEEE International Conference on Robotics and Automation (ICRA) 201

MEMS 411: Group B Prosthetic Arm Design

Design a custom prosthetic arm for a customer who is missing her arm two inches past her elbow. Introduce mobility so that she can utilize the arm to perform more everyday tasks than she was able to before with her immobile arm

Between Patron and Priest: Amdo Tibet Under Qing Rule, 1792-1911

In the late eighteenth century, a Qing-centered, pluralistic legal order emerged in the Tibetan regions of the Qing empire. In the Gansu borderlands known to Tibetans as "Amdo," the Qing state established subprefectures to administer indigenous populations and prepare them for integration into the empire. In the 1790s, the Qianlong emperor asserted the dynasty's sovereignty in central Tibet and embarked on a program to reform the Tibetan government. This dissertation examines the nineteenth-century legacy of these policies from the twin perspectives of the indigenous people of the region and the officials dispatched to manage them. On the basis of Manchu and Tibetan-language sources, Part One argues that the exercise of Qing sovereignty in central Tibet was connected to the Qianlong court's desire to monopolize indigenous arts of divination, especially as they related to the identification of prominent reincarnations. The Qing court exported a Ming-era bureaucratic technology--a lottery, and repurposed it as a divination technology--the Golden Urn. The successful implementation of this new ritual, however, hinged on the astute use of legal cases and the intervention of Tibetan Buddhist elites, who found a home for the Urn within indigenous traditions.East Asian Languages and Civilization

Prediction of chronic alcoholism from the Minnesota multiphasic personality inventory

Call number: LD2668 .T4 1955 S44Master of Scienc