Assessing the Impact of Surgical Technique on Implant Migration, Tibiofemoral Contact Kinematics, and Functional Recovery Following Uncemented Total Knee Arthroplasty

The standard of care treatment for end-stage osteoarthritis of the knee joint is a total knee arthroplasty (TKA). As we move towards a younger TKA patient cohort, implant longevity is of increasing concern. Porous hydroxyapatite coated uncemented implants provide a promising alternative to cemented fixation methods. Currently, a lack of consensus exists regarding which surgical technique is best suited to the uncemented TKA procedure. This thesis sought to examine the impact of surgical technique on tibial and femoral component migration. Additionally, we investigated the impact of technique on post-operative kinematics and functional recovery. The results of this thesis indicate no significant effect of surgical technique on one year migration of the tibial and femoral components or on post-operative kinematics, condylar liftoff, and function. In conclusion, this thesis provides support for the use of a single-radius cruciate-retaining porous hydroxyapatite coated uncemented implant as a viable alternative to cemented TKA

Bionomic response of Aedes aegypti to two future climate change scenarios in far north Queensland, Australia: implications for dengue outbreaks

BACKGROUND: Dengue viruses are transmitted by anthropophilic mosquitoes and infect approximately 50 million humans annually. To investigate impacts of future climate change on dengue virus transmission, we investigated bionomics of the mosquito vector, Aedes aegypti. METHODS: Using a dynamic life table simulation model (the Container inhabiting mosquito simulation CIMSiM) and statistically downscaled daily values for future climate, we assessed climate change induced changes to mosquito bionomics. Simulations of Ae. aegypti populations for current (1991-2011) and future climate (2046-2065) were conducted for the city of Cairns, Queensland, the population centre with most dengue virus transmission in Australia. Female mosquito abundance, wet weight, and the extrinsic incubation period for dengue virus in these mosquitoes were estimated for current and future climate (MPI ECHAM 5 model, B1 and A2 emission scenarios). RESULTS: Overall mosquito abundance is predicted to change, but results were equivocal for different climate change scenarios. Aedes aegypti abundance is predicted to increase under the B1, but decrease under the A2 scenario. Mosquitoes are predicted to have a smaller body mass in a future climate. Shorter extrinsic incubation periods are projected. CONCLUSIONS: It is therefore unclear whether dengue risk would increase or decrease in tropical Australia with climate change. Our findings challenge the prevailing view that a future, warmer climate will lead to larger mosquito populations and a definite increase in dengue transmission. Whilst general predictions can be made about future mosquito borne disease incidence, cautious interpretation is necessary due to interaction between local environment, human behaviour and built environment, dengue virus, and vectors.This project was funded by the Commonwealth Department for Climate Change, via the NH&MRC (project 1003371)

Bionomic response of Aedes aegypti to two future climate change scenarios in far north Queensland, Australia: implications for dengue outbreaks

Background: Dengue viruses are transmitted by anthropophilic mosquitoes and infect approximately 50 million humans annually. To investigate impacts of future climate change on dengue virus transmission, we investigated bionomics of the mosquito vector, Aedes aegypti. Methods: Using a dynamic life table simulation model (the Container inhabiting mosquito simulation CIMSiM) and statistically downscaled daily values for future climate, we assessed climate change induced changes to mosquito bionomics. Simulations of Ae. aegypti populations for current (1991-2011) and future climate (2046-2065) were conducted for the city of Cairns, Queensland, the population centre with most dengue virus transmission in Australia. Female mosquito abundance, wet weight, and the extrinsic incubation period for dengue virus in these mosquitoes were estimated for current and future climate (MPI ECHAM 5 model, B1 and A2 emission scenarios). Results: Overall mosquito abundance is predicted to change, but results were equivocal for different climate change scenarios. Aedes aegypti abundance is predicted to increase under the B1, but decrease under the A2 scenario. Mosquitoes are predicted to have a smaller body mass in a future climate. Shorter extrinsic incubation periods are projected. Conclusions: It is therefore unclear whether dengue risk would increase or decrease in tropical Australia with climate change. Our findings challenge the prevailing view that a future, warmer climate will lead to larger mosquito populations and a definite increase in dengue transmission. Whilst general predictions can be made about future mosquito borne disease incidence, cautious interpretation is necessary due to interaction between local environment, human behaviour and built environment, dengue virus, and vectors

A biologically relevant rapid quantification of physical and biological stress profiles on rocky shores.

Different combinations and intensities of physical (e.g. thermal) and biological (e.g.competition or predation) stress operate on organisms in different locations. Variation in these stresses can occur over small to medium spatial scales (cm to 10s m) in heterogeneous environments such as rocky shores, due to differences in sun and wave exposure, shore topography and/or recruitment. In this study we demonstrate how simple measurements can be taken that represent physical and biological stresses (stress profiles)in a given location. Using a bootstrapped principal component analysis, we identified significantly different stress profiles at four sites separated by only 10s to 100s of metres on the Shek O peninsula in Hong Kong. We then measured response to thermal stress, as determined by detachment temperature, in the limpet Cellana grata (which is known to be a sensitive indicator species to thermal stress) from each location. Significant differences in stress profile between locations were also seen in thermal stress tolerance of limpets from those locations. At locations where the major stresses are likely to be more physical or less biological in nature (e.g. southerly facing aspect or lower density of grazers), the mean detachment temperature was higher, whereas detachment temperature was lower at sites with more biological or less physical stress. This method is, therefore, able to determine biologically meaningful differences in stress profiles over small to medium spatial scales, and demonstrates that localised adaptation (i.e. post planktonic settlement) or acclimation of species may occur in response to these different stress profiles. The technique can be adapted to different environments and smaller or larger spatial scales as long as the stress experienced by the study species is relevant to these scales

Epidemiology of dengue in a high-income country: a case study in Queensland, Australia

Background: Australia is one of the few high-income countries where dengue transmission regularly occurs. Dengue is a major health threat in North Queensland (NQ), where the vector Aedes aegypti is present. Whether NQ should be considered as a dengue endemic or epidemic region is an ongoing debate. To help address this issue, we analysed the characteristics of locally-acquired (LA) and imported dengue cases in NQ through time and space. We describe the epidemiology of dengue in NQ from 1995 to 2011, to identify areas to target interventions. We also investigated the timeliness of notification and identified high-risk areas. Methods: Data sets of notified cases and viraemic arrivals from overseas were analysed. We developed a time series based on the LA cases and performed an analysis to capture the relationship between incidence rate and demographic factors. Spatial analysis was used to visualise incidence rates through space and time. Results: Between 1995 and 2011, 93.9% of reported dengue cases were LA, mainly in the 'Cairns and Hinterland' district; 49.7% were males, and the mean age was 38.0 years old. The sources of imported cases (6.1%) were Indonesia (24.6%), Papua New Guinea (23.2%), Thailand (13.4%), East Timor (8.9%) and the Philippines (6.7%), consistent with national data. Travellers importing dengue were predominantly in the age groups 30-34 and 45-49 years old, whereas the age range of patients who acquired dengue locally was larger. The number of LA cases correlated with the number of viraemic importations. Duration of viraemia of public health importance was positively correlated with the delay in notification. Dengue incidence varied over the year and was typically highest in summer and autumn. However, dengue activity has been reported in winter, and a number of outbreaks resulted in transmission year-round. Conclusions: This study emphasizes the importance of delay in notification and consequent duration of viraemia of public health importance for dengue outbreak duration. It also highlights the need for targeted vector control programmes and surveillance of travellers at airports as well as regularly affected local areas. Given the likely increase in dengue transmission with climate change, endemicity in NQ may become a very real possibility

Machine Learning Groups Patients by Early Functional Improvement Likelihood Based on Wearable Sensor Instrumented Preoperative Timed-Up-and-Go Tests

© 2019 The Author(s) Background: Wearable sensors permit efficient data collection and unobtrusive systems can be used for instrumenting knee patients for objective assessment. Machine learning can be leveraged to parse the abundant information these systems provide and segment patients into relevant groups without specifying group membership criteria. The objective of this study is to examine functional parameters influencing favorable recovery outcomes by separating patients into functional groups and tracking them through clinical follow-ups. Methods: Patients undergoing primary unilateral total knee arthroplasty (n = 68) completed instrumented timed-up-and-go tests preoperatively and at their 2-, 6-, and 12-week follow-up appointments. A custom wearable system extracted 55 metrics for analysis and a K-means algorithm separated patients into functionally distinguished groups based on the derived features. These groups were analyzed to determine which metrics differentiated most and how each cluster improved during early recovery. Results: Patients separated into 2 clusters (n = 46 and n = 22) with significantly different test completion times (12.6 s vs 21.6 s, P \u3c .001). Tracking the recovery of both groups to their 12-week follow-ups revealed 64% of one group improved their function while 63% of the other maintained preoperative function. The higher improvement group shortened their test times by 4.94 s, (P = .005) showing faster recovery while the other group did not improve above a minimally important clinical difference (0.87 s, P = .07). Features with the largest effect size between groups were distinguished as important functional parameters. Conclusion: This work supports using wearable sensors to instrument functional tests during clinical visits and using machine learning to parse complex patterns to reveal clinically relevant parameters

The Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis, a multicentre observational study (ARISE FLUIDS observational study): Rationale, methods and analysis plan

There is uncertainty about the optimal i.v. fluid volume and timing of vasopressor commencement in the resuscitation of patients with sepsis and hypotension. We aim to study current resuscitation practices in EDs in Australia and New Zealand (the Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis [ARISE FLUIDS] observational study).ARISE FLUIDS is a prospective, multicentre observational study in 71 hospitals in Australia and New Zealand. It will include adult patients presenting to the ED during a 30 day period with suspected sepsis and hypotension (systolic blood pressur

Simulation of the ozone formation in the northern part of the Po Valley

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95424/1/jgrd8866.pd

Cytogerontology since 1881: A reappraisal of August Weismann and a review of modern progress

Cytogerontology, the science of cellular ageing, originated in 1881 with the prediction by August Weismann that the somatic cells of higher animals have limited division potential. Weismann's prediction was derived by considering the role of natural selection in regulating the duration of an organism's life. For various reasons, Weismann's ideas on ageing fell into neglect following his death in 1914, and cytogerontology has only reappeared as a major research area following the demonstration by Hayflick and Moorhead in the early 1960s that diploid human fibroblasts are restricted to a finite number of divisions in vitro. In this review we give a detailed account of Weismann's theory, and we reveal that his ideas were both more extensive in their scope and more pertinent to current research than is generally recognised. We also appraise the progress which has been made over the past hundred years in investigating the causes of ageing, with particular emphasis being given to (i) the evolution of ageing, and (ii) ageing at the cellular level. We critically assess the current state of knowledge in these areas and recommend a series of points as primary targets for future research