Failure characteristics of all polyethylene cemented glenoid implants in total shoulder arthroplasty

Total shoulder arthroplasty (TSA) still suffers today from mid-term and long-term complications such as glenoid implant loosening, wear, humeral head subluxation/dislocation and implant fracture. Unlike the hip and knee joint replacements, the artificial shoulder joint has yet to offer a long-term satisfactory solution to shoulder replacement. With loosening being the number one reason for TSA revision, investigating methods of monitoring the glenoid implant loosening and investigate the effects of various design parameters on the loosening behaviour of the glenoid fixation is necessary to explore the problem. Several studies were carried out using in-vitro cyclic testing and FEA to; investigate failure progression and its correlation to quantitative measures in a 2D study (n = 60), investigating key glenoid design features in a 2D (n = 60) and 3D study (n = 20), investigating the validity of using bone substitute foam for studying glenoid fixation in a cadaveric study and investigating any correlation between failure and CT or in-vitro quantitative measures (n = 10). Visible failure was observed, for the first time, correlating to inferior rim displacement and vertical head displacement measures. CT failure was detected in 70% of specimens before visible failure was observed. Out of the design pairs tested; smooth-back/rough-back (range of roughnesses), peg/keel, curved-back/flat-back and conforming/non-conforming, roughening the back-surface to 3.4 μm or more improved fixation performance (p < 0.05). Roughening the back-surface changed the mode of failure from implant/cement failure inferiorly due to tensile/shear stresses, to cement/bone failure superiorly due to compressive/shear loading. Differences in the other design pairs were marked showing peg to perform better than keel, conforming over non-conforming and no difference in curved-back over flat-back, although these differences are marginal. Improvements in the standard testing method have also been suggested

Practical Toolkit For Embedding Ethics In The Engineering Curriculum

The need to embed ethics into the engineering curriculum is a collective imperative if we are to successfully navigate complexity, uncertainty and challenging ethical issues to build a sustainable society that works for everyone. To maximise positive impact, behaviours such as inclusivity and sustainability must become instinctive – golden threads running through everything that engineers think and do. Proactively, bringing engineering ethics to the fore in engineering programmes is one way UK higher education equips future engineers with the skills and mindset they need to succeed. This workshop brings together best practice from expert practitioners across the UK, introducing a nationally curated ‘Engineering Ethics Toolkit’. To help educators to know and use the toolkit the workshop offered an attractive translation of engineering ethics teaching theory to the practice of engineering education. In this workshop, participants were introduced to a pragmatic approach to integrating ethics content into their teaching, using examples and a detailed and interactive curriculum map, which connects the elements of the toolkit. Our aim is to ensure the toolkit becomes an ongoing, regular component of engineering teaching and highlighting excellence in integrating ethics. The workshop was as a seed to encourage further case studies to be developed and to also explore what can yet be done in this space to ensure the next generation of engineers are well-equipped to address the ethical issues they face

Deliberate Practice Makes Perfect! Developing Logbook Keeping as a Professional Skill through CDIO

Deliberate practice, including focused practice time by students, feedback from experts, mentors, educators or peers, and student reflection[1] is needed in order to develop and excel in any skill. This study looks at whether deliberate and directed practice can be used to develop professional engineering skills in a CDIO teaching setting, using logbook keeping as a key example

Effect of Baseplate Positioning on Fixation of Reverse Total Shoulder Arthroplasty

Background: The glenoid component in reverse total shoulder arthroplasty is recommended to be positioned inferiorly or with a downward tilt with the intention of reducing scapular notching. However, it is still unclear whether modifying the position of the glenoid prosthesis affects implant stability. The aim of this study was to determine the association between implant positioning and glenoid prosthesis fixation using Grammont reverse total shoulder arthroplasty. Methods: Four positions for the glenoid prosthesis were studied using the finite element method. The glenosphere was positioned as follows: 1) in the middle of the glenoid fossa, 2) flush with the inferior glenoid rim, 3) with an inferior overhang, 4) with a 15° inferior inclination. Bone-prosthesis micromotions and strain-induced bone adaptations were quantified during five daily activities. Findings: When the glenoid component was tilted inferiorly, the activities producing anterior-posterior shear forces (e.g. standing up from an armchair) caused an increase in peak micromotions. In the lateral-middle glenoid, inferior positioning caused a 64.6% reduction in bone apparent density. In the lateral-inferior glenoid, central positioning led to the most severe bone resorption, reaching 43.9%. Interpretation: Reducing activities which generate anterior-posterior shear forces on the shoulder joint will increase bone formation and may improve the primary stability of the implant when fixed in the position with an inferior tilt. Postoperative bone resorption is highly dependent on implant positioning. Understanding the relationship between bone resorption and implant positioning will help surgeons improve the long-term stability of reverse total shoulder arthroplasty

The Immersive Placement Experience: Sink Or Swim?

To excel in their respective engineering fields, engineering students need to be equipped with a combination of technical and interpersonal skills. Central to excellent interpersonal skills is good communication. The aim of the study is to evaluate how well-prepared mechanical and design engineering students felt entering into their industrial placements, using a UK university as a pilot case study. For the study interviews were carried out with final year students who had previously completed an industrial placement year, focussing on communication, workplace diversity, technical working methods and university teaching styles. Reponses were anonymised, coded and analysed using quantitative and qualitative methods. Nine engineering students were interviewed regarding their placement experience and were asked to rate how well they thought their engineering programmes helped in developing these skills. Two key findings were: 1) students on average spent 60 % or more of their placement work using their communication skills and 2) students felt more could be done to prepare them for individual presentations and individual projects before placement. On average the students felt marginally more prepared with the interpersonal skills element compared to the technical skills element. The survey also highlighted that the students' understanding of what falls under the umbrella of workplace diversity was narrow, and they did not classify skill differences as a component of diversity. The student's honest feedback allowed a collation of proposed recommendations for both the mechanical and design engineering courses

Development and pilot implementation of a locally developed Trauma Registry: lessons learnt in a low-income country

Background Trauma registries (TRs) play an integral role in the assessment of trauma care quality. TRs are still uncommon in developing countries owing to awareness and cost. We present a case study of development and pilot implementation of “Karachi Trauma Registry” (KITR), using existing medical records at a tertiary-care hospital of Karachi, Pakistan to present results of initial data and describe its process of implementation. Methods KITR is a locally developed, customized, electronic trauma registry based on open source software designed by local software developers in Karachi. Data for KITR was collected from November 2010 to January 2011. All patients presenting to the Emergency Department (ED) of the Aga Khan University Hospital (AKUH) with a diagnosis of injury as defined in ICD-9 CM were included. There was no direct contact with patients or health care providers for data collection. Basic demographics, injury details, event detail, injury severity and outcome were recorded. Data was entered in the KITR and reports were generated. Results Complete data of 542 patients were entered and analysed. The mean age of patients was 27 years, and 72.5% were males. About 87% of patients had sustained blunt injury. Falls and motor vehicle crashes were the most common mechanisms of injury. Head and face, followed by the extremities, were the most frequently injured anatomical regions. The mean Injury Severity Score (ISS) was 4.99 and there were 8 deaths. The most common missing variables in the medical records were ethnicity, ED notification prior to transfer, and pre-hospital IV fluids. Average time to review each chart was 14.5 minutes and entry into the electronic registry required 15 minutes. Conclusion Using existing medical records, we were able to enter data on most variables including mechanism of injuries, burden of severe injuries and quality indicators such as length of stay in ED, injury to arrival delay, as well as generate injury severity and survival probability but missed information such as ethnicity, ED notification. To make the data collection process more effective, we propose provider based data collection or making a standardized data collection tool a part of medical records

In-vitro External Fixation Pin-Site Model Proof of Concept: A Novel Approach to Studying Wound healing in Transcutaneous Implants

External fixation is an essential surgical technique for treating trauma, limb lengthening and deformity correction, however infection is common, with infection rates ranging from 4.5 to 100% of cases. Throughout the literature researchers and clinicians have highlighted a relationship between excessive movement of the pin and skin and an increase in the patient’s risk of infection, however, currently no studies have addressed this role of pin-movement on pin-site wounds. This preliminary study describes a novel in vitro pin-site model, developed using a full-thickness human skin equivalent (HSE) model in conjunction with a bespoke mechanical system which simulates pin-movement. The effect of pin-movement on the wound healing response of the skin equivalents was assessed by measuring the expression of pro-inflammatory cytokines. Six human skin equivalent models were divided into three test groups: no pin as the control, static pin-site wound and dynamic pin-site wound (n = 3). On day 3 concentrations of IL-1α and IL-8 showed a significant increase compared to the control when a static fixation pin was implanted into the skin equivalent (p < 0.05) and (p < 0.005) respectively. Levels of IL-1α and IL-8 increased further in the dynamic sample compared to the static sample (p < 0.05) and (p < 0.0005). This study demonstrates for the first time the application of HSE model to study external-fixation pin-movement in vitro. The results of this study demonstrated pin-movement has a negative effect on soft-tissue wound-healing, supporting the anecdotal evidence reported in the literature, however further analysis of wound heading would be required to verify this hypothesis

Childhood Unintentional Injuries: Need for a Community-Based Home Injury Risk Assessments in Pakistan

Background. A substantial proportion of the annual 875,000 childhood unintentional injury deaths occur in the home. Very few printed tools are available in South Asia for disseminating home injury prevention information. Methods. Three tools were planned: an injury hazard assessment tool appropriate for a developing country setting, an educational pamphlet highlighting strategies for reducing home injury hazards, and an in-home safety tutorial program to be delivered by a trained community health worker. Results. The three tools were successfully developed. Two intervention neighborhoods in Karachi, Pakistan, were mapped. The tools were pretested in this local setting and are now ready for pilot testing in an intervention study. Conclusion. Planning for an innovative, community-based pilot study takes considerable time and effort in a low-income setting like Pakistan. The primary outcome of the pre-testing phase of the study was the development of three important tools geared for low-income housing communities in Pakistan

Disseminating childhood home injury risk reduction information in Pakistan: results from a community-based pilot study

Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools. Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. A follow up assessment was conducted 4–5 months later. Results: 503 households were enrolled; 256 received a tutorial and 247 a pamphlet. The two groups differed significantly (p \u3c 0.01) in level of maternal education and relationship of the child to the primary caregiver. However, when controlling for these variables, those receiving an in-home tutorial had a higher odds of hazard reduction than the pamphlet group for uncovered vats of water (OR 2.14, 95% CI: 1.28, 3.58), an open fire within reach of the child (OR 3.55, 95% CI: 1.80, 7.00), and inappropriately labeled cooking fuel containers (OR 1.86, 95% CI: 1.07, 3.25). Conclusions: This pilot project demonstrates the potential utility of using home-visit tutorials to decrease home hazards in a low-income neighborhood in Pakistan. A longer-term randomized study is needed to assess actual effectiveness of the use of allied health workers for home-based injury education and whether this results in decreased home injuries

What is the role of ethics in accreditation documentation from a global view?

Ethics in engineering has long been an important element in engineering programmes, however these subjects are often taught at a basic learning level with little attempt to connect to demonstrative learning outcomes. In recent years there has been a step change in the importance of ethics as an integral part of engineering programmes and is reflected in the text of accreditation documents. In this paper we expand our analysis from an earlier study, which focused on four European countries, to understand the role of ethics on a more global scale. We conducted a multi-country analysis on how and where ethics features in accreditation documents in twelve countries across five continents (Belgium, Canada, Colombia, France/Switzerland, Ireland, Japan, Romania, South Africa, Sweden, UK and USA). We identified explicit or implicit references to ethics education, extracted verbs relating to learning outcomes, and compared definitions of key terms. A comparison to Bloom’s taxonomy showed considerably higher frequency of verbs linked to ethics teaching associated to lower levels of cognitive learning. Definitions of terms relating to the process of accreditation were often lacking in documents, highlighting a need for setting terms of reference. This study highlights differences in how ethics is described in accreditation documents. However, more needs to be done to explicitly highlight ethics as an integral part of engineering education. Relying on implicit links to ethics leaves the role of ethics open to interpretation, resulting in uneven emphasis in the translation of ethics within programme designs