User-centred design of a patient portal for persons living with home mechanical ventilation and long-term tracheostomy: a mixed methods study.

Patient portals are secure online platforms that offer patients access to various functions such as personal health information. While patient portals are being increasingly offered by health services, there are limited data on their use for persons living with home mechanical ventilation (HMV) and/or long-term tracheostomy. This study, conducted at an Australian hospital's home mechanical ventilation and long-term tracheostomy services, aimed to explore the perspectives and attitudes of patients and carers regarding the introduction of a patient portal.

A Multidisciplinary Approach to Verbal Communication Interventions for Mechanically Ventilated Adults With a Tracheostomy.

There is developing evidence with regard to the feasibility, utility, and safety of verbal communication interventions with patients with tracheostomy who are invasively ventilated. In the past 2 decades, research efforts have focused on establishing evidence for communication interventions, including introducing an intentional leak into the ventilatory circuit such as with a fenestrated tube, leak speech or ventilator-adjusted leak speech, the use of a one-way valve in-line with the ventilator, and above cuff vocalization. This narrative review describes the benefits of a multi-disciplinary approach, summarizes verbal communication interventions, and provides guidance on the indications, contraindications and considerations for patient selection.

Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection.

Objective: To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic.

Methods: The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed.

Wavelet-based image registration and segmentation framework for the quantitative evaluation of hydrocephalus.

Hydrocephalus, characterized by increased fluid in the cerebral ventricles, is traditionally evaluated by a visual assessment of serial CT scans. The complex shape of the ventricular system makes accurate visual comparison of CT scans difficult. The current research developed a quantitative method to measure the change in cerebral ventricular volume over time.

Is prolonged systemic antibiotic treatment essential in two-stage revision hip replacement for chronic Gram-positive infection?

When using a staged approach to eradicate chronic infection after total hip replacement, systemic delivery of antibiotics after the first stage is often employed for an extended period of typically six weeks together with the use of an in situ antibiotic-eluting polymethylmethacrylate interval spacer. We report our multi-surgeon experience of 43 consecutive patients (44 hips) who received systemic vancomycin for two weeks in combination with a vancomycin- and gentamicin-eluting spacer system in the course of a two-stage revision procedure for deep infection with a median follow-up of 49 months (25 to 83). The antibiotic-eluting articulating spacers fractured in six hips (13.

Selecting and assessing quantitative early ultrasound texture measures for their association with cerebral palsy.

Cerebral palsy (CP) develops as a consequence of white matter damage (WMD) in approximately one out of every 10 very preterm infants. Ultrasound (US) is widely used to screen for a variety of brain injuries in this patient population, but early US often fails to detect WMD. We hypothesized that quantitative texture measures on US images obtained within one week of birth are associated with the subsequent development of CP.

Reconstruction of femoral defects in revision hip surgery: risk of fracture and stem migration after impaction bone grafting.

The use of impaction bone grafting during revision arthroplasty of the hip in the presence of cortical defects has a high risk of post-operative fracture. Our laboratory study addressed the effect of extramedullary augmentation and length of femoral stem on the initial stability of the prosthesis and the risk of fracture. Cortical defects in plastic femora were repaired using either surgical mesh without extramedullary augmentation, mesh with a strut graft or mesh with a plate.

Analysis of push-out test data based on interfacial fracture energy.

Push-out testing is frequently used to assess the interfacial shear strength developed at a bone-biomaterial interface during in vivo experiments. The aim of the present research was to assess the in vivo performance of a novel substrate/coating combination and to introduce a more rigorous fracture mechanics analysis of the push-out test data. An adhesively bonded hydroxyapatite (HA), and a Ti-6Al-4V alloy plasma sprayed with HA, were implanted in female New Zealand white rabbits for up to 6 months in duration.

Application of an interface failure model to predict fatigue crack growth in an implanted metallic femoral stem.

A novel computational modelling technique has been developed for the prediction of crack growth in load bearing orthopaedic alloys subjected to fatigue loading. Elastic-plastic fracture mechanics has been used to define a three-dimensional fracture model, which explicitly models the opening, sliding and tearing process. This model consists of 3D nonlinear spring elements implemented in conjunction with a brittle material failure function, which is defined by the fracture energy for each nonlinear spring element.

Large-scale gene expression analysis of osteoblasts cultured on three different Ti-6Al-4V surface treatments.

To improve implant biocompatibility, we developed a simple cost-effective thermal surface treatment allowing an increase in the oxide layer thickness of a titanium (Ti) alloy used in orthopaedic implants. The goal of this study was to test in vitro the reaction of osteoblasts to the developed surface treatment and to compare it to the osteoblast reaction to two other surface treatments currently used in the practice of implant surgery. Quantification of osteoblast gene expression on a large scale was used in this study.

Meta-analysis: the glass eye of evidence-based practice?

Meta-analysis was developed as a technique for combining the results of many different quantitative studies: it is often used to produce quantitative estimates of causal relations and/or association between variables. Meta-analysis is sometimes regarded as a central component of evidence-based practice. We draw attention to an incompatibility in the epistemology and methods of reasoning in quantitative meta-analysis and the epistemology and reasoning implicit in expert practice.

Effect of different Ti-6Al-4V surface treatments on osteoblasts behaviour.

The purpose of the present work was to examine the effect of different Ti-6Al-4V surface treatments on osteoblasts behaviour. Previous work in this laboratory has demonstrated that an ageing treatment reduces metal ion release from this alloy compared to standard passivation procedures. In this study.

Simulation of a knee joint replacement during a gait cycle using explicit finite element analysis.

The stress distribution within the polyethylene insert of a total knee joint replacement is dependent on the kinematics, which in turn are dependent on the design of the articulating surfaces, the relative position of the components and the tension of the surrounding soft tissues. Implicit finite element analysis techniques have been used previously to examine the polyethylene stresses. However, these have essentially been static analyses and hence ignored the influence of the kinematics.

Organ motion detection in CT images using opposite rays in fan-beam projection systems.

Motion artifacts have been identified as a problem in medical tomography systems. While computed tomography (CT) imaging has been getting faster, there remains a need to detect and compensate for motions in clinical follow-up of neurological patients (multiple sclerosis, tumors, stroke, etc.), in cardiac imaging, and in any area in which failing to detect a motion artifact may lead to misdiagnosis.

A computational model for the prediction of total knee replacement kinematics in the sagittal plane.

A computational model has been developed using a current generation computer-aided engineering (CAE) package to predict total knee replacement (TKR) kinematic in the sagittal plane. The model includes friction and soft tissue restraint varying according to the flexion angle. The model was validated by comparing the outcomes of anterior-posterior (A-P) laxity tests of two contemporary knee replacements against data obtained from a knee simulating machine.

Effect of mechanical surface pretreatment on metal ion release.

The degree of metal ion dissolution from Ti-6Al-4V alloy hip replacement stems subjected to various mechanical and chemical surface pretreatments was analysed in vitro. High-dissolution rates were observed for nitric acid passivated samples that had been mechanically surface treated to increase the implant surface area. Significantly lower ion release levels were observed for mechanically treated samples which had been aged in de-ionised water.

Automated registration of multimodal brain image sets using computer vision methods.

We present a new method of registering three dimensional image volumes of the brain of a given patient acquired at different times or with different imaging modalities, or both. Registration is an essential requirement for fusing the data from the two image sets so as to either increase the available information by exploiting complementary imaging modalities, or to measure small changes over time for prognostication, disease assessment, etc. The new technique exploits an external, removable, remountable reference frame which is attached to the head.

Secondary phase distribution analysis via finite body tessellation.

The concept of a Dirichlet tessellation has been extended to that of a 'finite body' tessellation to provide a more meaningful description of the spatial distribution of non-spherical secondary phase bodies on two-dimensional sections. A finite body tessellation consists of a network of cells constructed from the interfaces of each individual secondary phase body such that every point within a cell is closer to the corresponding body than to any other. Spatial distribution related cell characteristics derived from Dirichlet tessellations have been extended to finite body tessellations.

Reliability theory for load bearing biomedical implants.

At present, load-bearing implants are designed on a deterministic basis in which the structural strength and applied loading are given fixed values, and global safety factors are applied to (i) cover any uncertainties in these quantities, and (ii) to design against failure of the component. This approach will become increasingly inappropriate as younger and more active patient demands become more exacting and as devices become more complex. The present work describes a preliminary investigation in which a scientific and probabilistic technique is applied to assess the structural integrity of the knee tibial tray.

In vivo biocompatibility and mechanical study of novel bone-bioactive materials for prosthetic implantation.

Two epoxy materials with or without adhesively bonded hydroxyapatite (HA) coatings were studied for their biocompatibility and mechanical pushout strength using in vivo implantation in the rabbit lower femur for a duration of 10 days to 6 months. Both were two-part epoxies cured at room temperature for 24 h, with material 1 (Ampreg 26; SP Systems Limited, Cowes, UK) postcured at 110 degrees C (Tg approximately 80 degrees C) and Material 2 (CG5052; Ciba Geigy Limited, Cambridge, UK) at 125 degrees C (Tg approximately 120 degrees C). Implantation in dead rabbit bone was performed to provide mechanical baseline levels.