No description available.

No description available.

<p><strong>Objective: </strong>The objective of this thesis is to identify the approaches to patient-centered care provision currently employed by clinicians and to identify patient perspectives of patient-centeredness in relation to pain and disability following distal radius fracture. This thesis includes a scoping review of patient-centered care frameworks and models, as well as a prospective cohort study.</p> <p><strong>Rationale: </strong>Patient-centered care provision has been linked with positive health outcomes, improved patient satisfaction, and reduced health costs. A uniform approach to patient-centered care in rehabilitation has yet to be developed primarily due to the breadth and scope of practice. Understanding current approaches to patient-centered care and patient perspectives on this care can serve as a foundation to future discussions on the development of a rehabilitation-specific approach to patient-centered care provision.</p> <p><strong>Data sources: </strong>Frameworks and models of patient-centered care provision were located via electronic database searches. The extracted frameworks and models were compared based on how they described strategies on achieving the three tenets of patient-centered care: communication, partnership, and health promotion. A prospective cohort study provided patient perspectives on patient-centeredness, pain, and disability following distal radius fracture at baseline and at three months post distal radius fracture in 129 patients.</p> <p><strong>Methods: </strong>Frameworks and models on patient-centered care provision were extracted from articles and placed in data summary tables for comparison and review. Information on how these frameworks and models described strategies for communication, partnership, and health promotion was collated and reviewed. The patients’ perceptions of patient-centeredness, pain, and disability were determined from responses to the Patient Perceptions of Patient-Centeredness Questionnaire and the Patient Rated Wrist Evaluation. Outcome measure responses were analyzed to measure change over time (Wilcoxon Rank Sum and T-Test analyses) and to identify relationships (Pearson correlations).</p> <p><strong>Results: </strong>The scoping review found 19 articles, from which 25 patient-centered care frameworks or models were identified. All frameworks and models reported strategies on achieving effective communication, partnership, and health promotion. The prospective cohort study revealed significant correlations between patient perspectives of patient-centeredness and pain and disability following distal radius fracture. This suggests that positive experiences with patient-centered care provision are correlated with reduction in pain and improvement in function following an acute orthopaedic injury.</p> <p><strong>Implications: </strong>Until a rehabilitation-specific approach to patient-centered care provision is developed, rehabilitation clinicians can be confident that selection of one of the currently employed frameworks or models of patient-centered care will reflect the three tenets of patient-centered care provision. Adopting one of these patient-centered approaches to care provision likely will result in positive health outcomes.</p> / Master of Science Rehabilitation Science (MSc)

Yes / Corsets have been used both to create a fashionable silhouette and as an orthopaedic treatment for spinal conditions, but skeletal changes associated with the use of corsetry are rarely reported on in the palaeopathological literature. Here, we report on a 19th-century adult male with Pott’s disease of the vertebral column and related vertebral compression deformities, which probably result from the use of a corset. Wolverhampton HB40 presented destruction of the vertebral bodies of T6 to L4, ankylosis of the apophyseal joints of L1 and L2 and an angular kyphosis of the lumbar region, the result of tuberculosis. The presence of flattened spinous processes and bilateral acute angulation of multiple ribs in the lower thoracic region is indicative of plastic deformation caused by the use of the corset. The presence of both of these changes in an adult male, at a time when the use of cosmetic corsets by men was in decline, suggests that the compression trauma was the result of an orthopaedic corset used to correct the defective posture resulting from tubercular kyphosis, although corset use to obtain a fashionable silhouette cannot be ruled out.

Total Hip Arthroplasty (THA) is an orthopaedic procedure that is performed to reduce pain and restore the functionality of hip joints that are affected by degenerative diseases. The outcomes of THA are generally good. However, the stress shielding of the periprosthetic femur is a factor that can contribute towards the premature loosening of the femoral stem. In order to improve the stress shielding characteristics of metallic femoral stems, stiffness configurations that offer more flexibility should be considered. This research has investigated the potential of more flexible and lightweight cobalt chromium molybdenum (CoCrMo) femoral stems that can be manufactured using Selective Laser Melting (SLM). Square pore cellular structures with compressive properties that are similar to human bone have been presented and incorporated into femoral stems by utilising fully porous and functionally graded designs. A three dimensional finite element model has been developed to investigate and compare the load transfer to the periprosthetic femur when implanted with femoral stems offering different stiffness configurations. It was shown that the load transfer was improved when the properties of the square pore cellular structures were incorporated into the femoral stem designs. Factors affecting the manufacturability and production of laser melted femoral stems have been investigated. A femoral stem design has been proposed for cemented or cementless fixation. Physical testing has shown that a functionally graded stem can be repeatedly manufactured using SLM, which was 48% lighter and 60% more flexible than a traditional CoCrMo prosthesis. The research presented in this thesis has provided an early indication of utilising SLM to manufacture lightweight CoCrMo femoral stems with levels of flexibility that have the potential to reduce stress shielding in the periprosthetic femur.

O presente estudo visa comparar biomecanicamente, por meio do ensaio de flexão em quatro pontos, a resistência de segmentos de rádios de cães autoclavados e desvitalizados em nitrogênio líquido. Foram utilizados 20 cadáveres de cães de mais de dois anos de idade e massa corporal superior a 20 kg, portanto 40 rádios, que foram divididos em quatro grupos: grupo autoclave (GA), grupo controle autoclave (GCA), grupo nitrogênio (GN) e grupo controle nitrogênio (GCN). Os corpos de prova dos grupos GCA e GCN pertenciam ao lado contralateral dos grupos GA e GN, respectivamente. Os ossos foram autoclavados a 121&ordm;C, por 20 min a 2 atm. A desvitalização em nitrogênio foi realizada por meio da imersão em nitrogênio líquido, por 20 min, seguida de descongelamento à temperatura ambiente, sendo finalizada por imersão em solução de NaCL a 0,9%, por mais 15 min. A avaliação da resistência biomecânica foi realizada pelo ensaio de flexão em quatro pontos. Foi utilizado o programa de computador PMI para calcular o momento de inércia após o ensaio biomecânico destrutivo. Foram comparadas as variáveis força máxima, rigidez, altura máxima à secção transversa do corpo de prova, deslocamento do baricentro em relação ao eixo x, flecha, tensão-tração, tensão compressão e tensão máxima. Não foram encontradas diferenças estatisticamente significantes entre os grupos GN e GCN. Foram encontradas diferenças estatisticamente significantes entre os grupos GA e GCA somente na comparação da variável força máxima. A análise das variáveis tensão-tração, tensão-compressão e tensão máxima evidenciou diferenças estatisticamente significantes entre os grupos GA e GN, sendo os valores maiores para o grupo GA. Também foi realizada comparação entre os deltas (GN menos GCN e GA menos GCA) em que não foram observadas diferenças estatísticas. / The present study aim to, biomechanically compare through the four points bending test, the strenght of autoclaved and devitalized in liquid nitrogen radius segments. 20 corpses of dogs (>2 years of age and >20 kg of weight) were used. 40 radius were collected and divided into 4 groups, Autoclave Group (GA), Control Autoclave Group (GCA), Nitrogen Group (NG) and Control Nitrogen Group (GCN). Bone segments from groups GCA and GCN were contralateral to GA and NG. The segments were autoclaved at 121&ordm;C and 2 atm for 20 minutes. Nitrogen devitalization of the bone segments was obtained by 20 minutes immersion, followed by thawing at room temperature and 15 minutes immersion in 0,9% NaCL solution. The biomechanical strenght evaluation was performed in the four points bending test; afterwards, PMI computer program calculated the moment of inertia after the destructive biomechanical assay. Variables compared were maximum strength, stiffness, maximum high trough the transverse section of the bone segment, centers of mass dislocation in relation to x axe, arrow, stress-tension, stress-compression and maximum stress. No statistically significant differences between the GN and GCN groups were found. Statistically significant differences were found between groups GA and GCA only in the comparison of the maximum force variable. The analysis of variable stress-tension, stress-compression and maximum stress showed statistically significant differences between the GA and GN groups, with higher values for the GA group. Comparison of the deltas (GN least GCN and GA least GCA) that no statistical differences were observed was also performed.

Medical imaging technologies have allowed for in vivo evaluation of the human musculoskeletal system. With advances in both medical imaging and computing, patient-specific model development of anatomic structures is becoming a reality. Three-dimensional surface models are useful for patient-specific measurements and finite element studies. Orthopaedics is closely tied to engineering in the analysis of injury mechanisms, design of implantable medical devices, and potentially in the prediction of injury. However, a disconnection exists between medical imaging and orthopaedic analysis; whereby, the ability to generate three-dimensional models from an imaging dataset is difficult, which has restricted its application to large patient populations. We have compiled image processing, image segmentation, and surface generation tools in a single software package catered specifically to image-based orthopaedic analysis. We have also optimized an automated segmentation technique to allow for high-throughput bone segmentation and developed algorithms that help to automate the cumbersome process of mesh generation in finite element analysis. We apply these tools to evaluate graft placement in anterior cruciate ligament reconstruction in a multicenter study that aims to improve the patient outcomes of those that undergo this procedure.

Det övergripande syftet med avhandlingsarbetet är att illustrera och belysa upplevelsen av att vara patient med behov av ledprotes, avseende aspekterna kommunikation, smärtupplevelse, lidande och tillfredsställelse med vård och behandling. Under väntetiden för ledprotesoperation upplever deltagarna i studierna lidande i olika former, tillika att vården är otillgänglig och onåbar i ett ansiktslöst system (I). Att få information om sin sjukdom vad man kan/får/ska göra är nästan omöjligt. Kontakten med sjukvården är svår att upprätta och det är mestadels patientens ansvar att söka information om vad som händer (II). Den bristfälliga kommunikationen som deltagarna i delstudie I upplever, leder till att de känner sig missförstådda och nedvärderade av sjukvårdssystemet, och därmed befinner sig i en ständig kamp för att få sitt vårdbehov bekräftat. Under deltagarnas vandring i sjukvårdssystemet förändras deras negativa uppfattning om vården till att bli mer positiv när en reell kommunikation och personlig kontakt etablerats (IIV). Fynden i arbetena (I-IV) tolkas inom ramen för Katie Erikssons och Lennart Fredrikssons beskrivningar av lidande och det vårdande samtalet. En del deltagare i studierna har av egen kraft, eller till följd av personliga egenskaper uppnått insikter om sig själva och försonats med sitt lidande, på så sätt har de kunnat bibehålla eller uppnå mening i sin tillvaro. Av egen kraft, eller med hjälp av anhöriga kan individerna få sitt lidande bekräftat och därmed möjligheten att kunna lida ut och försonas med sig själv och den förändrade tillvaron. Så länge som sjukvården upplevs som ett ansiktslöst system finns det deltagare i avhandlingen som inte klarar av att ta itu med sitt lidande. Under patientens vandring i sjukvårdssystemet blir det uppenbart att systemet får ett ansikte först när deltagarna kan relatera till vården i form av en reell person. Vården får inte ett ansikte så länge som patienten upplever sig dåligt bemött utan detta sker när det med Fredrikssons termer uppstår ett vårdande samtal. Under väntetiden för operation finns det relativt få tillfällen där ett vårdande samtal har möjlighet att uppstå. Möjligheten för detta är dock större när patienten väl är inlagd på sjukhuset för att bli opererad, vilket återspeglas i den höga grad av tillfredsställelse med vården som uttrycks i delstudie II-IV. Patienterna är tillfredsställda med vård och behandling, trots att de har upplevt postoperativ smärta i en hög grad. I delstudie III var det 68% (n=40) och i delstudie IV 83.5% (n=50) som hade upplevt smärtor motsvarande ≥ 4 på Visuell Analog Skala (VAS). Under sjukhusvistelsen upplever sig patienten bekräftad och synlig i systemet. Synligheten är ömsesidig då även vården (systemet) får ett ansikte på patienten. I ett vårdande samtal uppstår en känsla av tillit och när detta sker vågar patienten och vårdaren kommunicera på ett öppet sätt där de båda är närvarande i situationen / The overall objective of the thesis is to describe and illustrate the experience of being an arthroplastic surgery patient during the perioperative period with regard to the issues of communication, pain,suffering and satisfaction with care. While waiting for surgery, the participants in this thesis experience suffering in different ways and mainly experience health care as being unavailable and negative in a faceless system (I). Obtaining information related to their illness is difficult, as it is hard to establish contact with health care providers. The responsibility for establishing contact and obtaining information rests solely with the patients (II). In Paper I, due to poor communication, the respondents express feelings of abandonment, anonymity and being disparaged by the health care system. During the participants' journey through the health care system, the negative experience acquires a more positive nature, as personal contacts are established with health care representatives (I-IV). The findings in the different papers (I-IV) are interpreted in the light of Katie Eriksson and Lennart Fredriksson’s descriptions of suffering and the caring conversation. There are participants in this thesis who have been able to reach a personal understanding of themselves and have found reconciliation in suffering. In this way, they have been able to maintain or obtain meaning in their lifeworld. Through their own power, or with the help of family and friends, individuals may be able to attain confirmation of their suffering, have the time and space to suffer and find reconciliation. However, as long as health care is experienced as a faceless system, there are individuals in this study who are unable to face their suffering. During the patients’ journey through the system, it becomes obvious that the system obtains a face when the individuals are able to establish trustful contact with an actual person within the system. The system does not obtain a face as long as the individuals perceive themselves as being poorly treated by health care representatives. In these cases, the system is actually the cause of additional suffering. In the terms defined by Fredriksson, the system obtains a face when a turning point occurs in the form of a caring conversation. During the waiting time, there are few opportunities for a caring conversation. An opportunity is more likely to occur when the individual is admitted to hospital. This is reflected in the extensive degree of satisfaction with care as expressed in Papers II-IV. High levels of satisfaction are reported, although the participants report having experienced high levels of postoperative pain. In Paper III, 68% (n=40) and, in Paper IV, 83.5% (n=50) of the patients experienced pain of ≥ 4 on the Visual Analogue Scale (VAS). When they have been admitted to hospital, the individuals sense that they are confirmed by and visible in the system. This visibility is mutual, as the individual becomes an actual person to health care representatives. In a caring conversation, a sense of trust is established and, as this occurs, the individual and the care provider dare to communicate in an open way, where both are present in the situation.

The number of patients who have undergone some kind of internal fixation or joint replacement is increasing thanks to the development of technology and orthopaedics. All these patients carry metal implants. Magnetic resonance imaging has an advantage over other imaging methods, due to its superior soft tissue contrast and to its sensitivity in detecting the inflammation which is present at infections and malignancies. However metal implants usually deteriorate the image quality and as a result affect the accuracy of the diagnostic procedure. This is the case when the region of interest is in the proximal vicinity of the implant, or the implant is large enough. A number of MRI sequences have been proposed in order to overcome the artifact that comes from metal implants, more formally known as susceptibility artifact. However the most effective of them, are not widely available. The need for optimization of MR imaging at the presence of metal implants presupposes the development of methods capable of quantifying the artifact under various imaging sequences and conditions. Most artifact quantification techniques proposed until now, are usually based on the visual observation (experienced radiologists) or at image segmentation methods. These segmentation methods, segment the image based on arbitrary selected gray values (thresholds). A more objective and precise quantification method relies on the subtraction of images of a zero artifact replica (test object) from those of the real metal implant. The copy is constructed from material with similar values of magnetic susceptibility with its environment (usually water). The images deriving from the copy if we take in consideration the noise differences, have no susceptibility artifact. In this method artifact is quantified as energy differences between the two images [Kolind S et al, 2004]. Since the acquisition conditions are identical except the presence of susceptibility artifact in the image depicting the real metal object, the energy difference is used to quantify the artifact. While the method quantifies the artifact, giving precise values, it does not inform us for its position in space At this thesis we proposed a new, to our knowledge, method of artifact quantification. It is based in the physical cause of the artifact, which are the gradients of the magnetic field, which derive from the presence of the metal implant. The gradients of the magnetic field create corresponding gradients at the gray scale values of the image. These gradients may be detected if we apply suitable filter which detects the amplitude of the gradient. In this way we detect both regions with signal void (low signal intensity) and signal pill ups (high signal intensity). That means that we do not have to apply two different operators to segment two regions of the artifact with so different signal intensity values. Then the image is thresholded using a fully automated algorithm, proposed by [Li & Lee 1993]. This algorithm is available in image analysis environment ImageJ. At the first part of this thesis there are presented the basic principles of nuclear magnetic imaging image formation. The interaction of the most common materials with the magnetic field is also presented. All these are considered necessary to explain the generation of magnetic susceptibility artifact at the image acquired. The theory beyond the magnetic susceptibility artifact generation is then explained in detail. At the experimental part of this thesis, the proposed algorithm is applied to the imaging of two implants (made of titanium and antimagnetic stainless steel) at the sequences which are most commonly used to musculoskeletal MRI. The proposed algorithm is compared with a variation of the method of the image energy differences proposed by [Kolind Sh, 2004]. This method quantifies the artifact as energy difference of image of the real implant from the image of a replica with zero susceptibility artifact (reference image). In the present thesis the image of lower susceptibility artifact (obtained at higher bandwidth) is considered as reference image. In our case it is assumed that the energy difference among different bandwidth acquisitions is negligible in relation to the susceptibility artifact amplitude. This assumption allows as to use instead of energy differences, the differences in the gray scale values of the image instead. Statistical analysis showed moderate to strong positive correlation between the two methods. Possible reasons of not obtaining strong correlation at all measurements is due to the regions of the image that the proposed algorithm quantifies. By segmenting regions of high gradient, we focus mainly at regions where there is high variation at the gray scale values. However, in many cases nearly homogeneous regions of an image, with little or no alteration in gray scale values, may also be considered as artifact. These areas are not segmented as artifact when the proposed algorithm is applied. More over the assumption of considering negligible the noise contribution between the different acquisitions may be an oversimplification. Nevertheless, the proposed algorithm, is an objective repeatable and observer independent method. Moreover it is capable of determining the boundaries of the artifact in image space. It is not intended to be used as a method of absolute quantification of the susceptibility artifact. It should be used as means of comparison of acquisitions concerning the same sequence. Its combination with an additional algorithmic step, such as one which detects image features may result in a powerful tool of image artifact quantification. This more sophisticated version of this proposed algorithm should be adequate enough to quantify the artifact not only at phantom models but even at the everyday clinical practice. / H εξέλιξη της ιατρικής και ειδικότερα της ορθοπαιδικής έχει κάνει ολοένα και περισσότερο συχνή την ύπαρξη ασθενών που φέρουν μεταλλικά εμφυτεύματα. Η απεικόνιση με μαγνητικό συντονισμό πλεονεκτεί σε σχέση με άλλες απεικονιστικές μεθόδους εξαιτίας της καλύτερης αντίθεσης που προσφέρει στους μαλακούς ιστούς και στην ευαισθησία στην ανάδειξη της φλεγμονής που συνοδεύει τις μολύνσεις και τις κακοήθειες. Η ύπαρξη μεταλλικών εμφυτευμάτων συνήθως υποβαθμίζει την ποιότητα της εικόνας και την καθιστά πολλές φορές μη διαγνωστική, ειδικά αν η περιοχή ενδιαφέροντος είναι κοντά στο μεταλλικό εμφύτευμα ή στην περίπτωση που αυτό είναι αρκετά μεγάλο. Μια σειρά από μεθόδους ή ακόμη και ειδικές ακολουθίες έχει προταθεί κατά καιρούς για να αντιμετωπιστεί η ύπαρξη των τεχνημάτων επιδεκτικότητας, όπως ονομάζονται τα artifact που έχουν σαν αιτία τους τις τοπικές στρεβλώσεις στο μαγνητικό πεδίο εξαιτίας μεταλλικών προθέσεων. Οι πιο αποτελεσματικές από αυτές παραμένουν μη διαθέσιμες για το ευρύ κοινό. Η ανάγκη για βελτιστοποίηση των συνθηκών απεικόνισης κάνει επιτακτική την ανάγκη για ποσοτικοποίηση του artifact στις διαφορετικές συνθήκες λήψεις. Οι τεχνικές ποσοτικοποίησης του artifact που έχουν προταθεί μέχρι σήμερα βασίζονται στην ποιοτική ακτινολογική εκτίμηση (οπτική παρατήρηση) είτε σε μεθόδους τμηματοποίησης της περιοχής εικόνας του artifact που συνήθως στηρίζονται στην επιλογή αυθαίρετων τιμών κατωφλίου τόνων του γκρι. Μια πιο αντικειμενική και ακριβής μέθοδος αφορά στην αφαίρεση εικόνων γεωμετρικού αναλόγου (αντικείμενο ελέγχου- ομοίωμα) του εμφυτεύματος από την εικόνα που απεικονίζει το ίδιο το εμφύτευμα. Το ανάλογο είναι κατασκευασμένο από υλικό με παρόμοια μαγνητική επιδεκτικότητα προς το περιβάλλον του εμφυτεύματος. Η απεικόνιση ενός τέτοιου ομοιώματος, λαμβανομένης υπόψη και της συνεισφοράς του θορύβου, παρουσιάζει μηδενικό artifact επιδεκτικότητας σε σχέση με το πραγματικό εμφύτευμα. Το artifact στην περίπτωση αυτή ποσοτικοποιείται ως διαφορά ενέργειας εικόνας στην περιοχή του περιβάλλοντος υλικού [Kolind S et al,2004]. Η τελευταία αυτή μέθοδος ενώ ποσοτικοποιεί με ακρίβεια το artifact δεν παρέχει πληροφορίες για τη θέση του στο χώρο. Στην παρούσα μεταπτυχιακή εργασία, προτείνεται μία νέα, με βάση τα όσα γνωρίζουμε, μέθοδος ποσοτικοποίησης του artifact. Η μέθοδος αυτή βασίζεται στη γενεσιουργό αιτία του artifact, που είναι οι στρεβλώσεις του μαγνητικού πεδίου από την παρουσία του μεταλλικού αντικειμένου. Οι στρεβλώσεις αυτές εκφράζονται ως βαθμιδώσεις του μαγνητικού πεδίου. Οι βαθμιδώσεις του Μ.Π προκαλούν αντίστοιχες βαθμιδώσεις στην ένταση των τόνων του γκρι στην εικόνα. Αυτές οι βαθμιδώσεις μπορούν να αναδειχθούν αν εφαρμόσουμε κατάλληλο φίλτρο στην εικόνα που ανιχνεύει το μέγεθος/ πλάτος της βαθμίδωσης. Με αυτό τον τρόπο θα ανιχνευτούν τόσο περιοχές με υψηλό όσο και περιοχές με χαμηλό σήμα, απλοποιώντας έτσι τη διαδικασία, αφού δε χρειάζεται να ανιχνευτούν με ξεχωριστό αλγόριθμο περιοχές του artifact με πολύ διαφορετικές τιμές τόνων του γκρι. Στη συνέχεια η εικόνα που προκύπτει κατωφλιώνεται με αυτόματή μέθοδο που έχει προταθεί [Li & Lee 1993] και είναι διαθέσιμη στο περιβάλλον ανάλυσης εικόνας Image J. Στο πρώτο τμήμα της παρούσας εργασίας αναπτύσσονται, συνοπτικά βασικές αρχές του πυρηνικού μαγνητικού συντονισμού και του τρόπου με τον οποίο δημιουργείται η δισδιάστατη εικόνα στο MRI. Ακολουθεί επίσης μια σύντομη περιγραφή του τρόπου με τον οποίο συμπεριφέρονται τα πιο κοινά υλικά όταν βρεθούν εντός του μαγνητικού πεδίου. Όλα αυτά είναι αναγκαία για γίνει κατανοητός ο τρόπος που δημιουργείται το artifact μαγνητικής επιδεκτικότητας στην εικόνα που λαμβάνουμε. Στη συνέχεια αναπτύσσεται με λεπτομέρεια ο μηχανισμός και η φυσική που εμπλέκεται στη δημιουργία των artifact μαγνητικής επιδεκτικότητας. Στο πειραματικό μέρος, εφαρμόζεται ο προτεινόμενος αλγόριθμος σε απεικονίσεις δύο εμφυτευμάτων (τιτανίου και αντιμαγνητικού χάλυβα) στις πιο κοινά χρησιμοποιούμενες ακολουθίες του μυοσκελετικού. Ο προτεινόμενος αλγόριθμος ελέγχεται ως προς την ικανότητα του να ποσοτικοποιεί το artifact με μία παραλλαγή της μεθόδου διαφοράς ενεργειών εικόνων [Kolind Sh,2004]. H μέθοδος αυτή ποσοτικοποιεί το artifact ως διαφορά ενέργειας της εικόνας του πραγματικού εμφυτεύματος από εικόνα γεωμετρικού αναλόγου με μηδενικό artifact (εικόνα αναφοράς). Στην περίπτωση μας χρησιμοποιήσαμε ως εικόνα αναφοράς την εικόνα με το ελάχιστο artifact (η οποία βάσει θεωρίας αντιστοιχεί στη λήψη με το υψηλότερο bandwindth). Επίσης θεωρήσαμε τη διαφορά θορύβου των διαφορετικών λήψεων αμελητέα ως προς τις τιμές έντασης (τόνοι του γκρι) του artifact, ώστε να μπορούμε να αξιοποιήσουμε το πεδίο των τιμών των τόνων του γκρι και όχι αυτό της ενέργειας της εικόνας. Η στατιστική επεξεργασία αναδεικνύει μέτρια ως ισχυρή θετική συσχέτιση των 2 αλγορίθμων. Πιθανοί λόγοι που δεν έχουμε σε όλες τις μετρήσεις ισχυρή ή πολύ ισχυρή συσχέτιση αποδίδονται πρωτίστως στην περιοχή της εικόνας που ποσοτικοποιεί η προτεινόμενη μέθοδος. Τμηματοποιώντας τις βαθμιδώσεις της εικόνας εστιάζουμε σε περιοχές που υπάρχει έντονη μεταβολή των τιμών του γκρι. Παρόλα αυτά το artifact μπορεί κατά περιπτώσεις να περιλαμβάνει και ομοιογενείς περιοχές εικόνας με παραπλήσιες τιμές του γκρι. Αυτές είναι περιοχές που δεν τμηματοποιεί (ανιχνεύει) η προτεινόμενη προσέγγιση. Μια ακόμη αιτία θα μπορούσε να είναι η μη αξιολογήση της συνεισφοράς του θορύβου στις διαφορετικές λήψεις (bandwidths). Η απώλεια τέτοιων περιοχών δεν μειώνει την αξία του αλγορίθμου, αφού αποτελεί μια αντικειμενική μέθοδο, ανεξάρτητη από τον παρατηρητή, επαναλήψιμη και ικανή να οριοθετήσει το artifact στο χώρο. Δεν της επιτρέπει παρόλα αυτά να χρησιμοποιηθεί σαν μέθοδος απόλυτης ποσοτικοποίησης του artifact. Μπορεί να χρησιμοποιηθεί για την πραγματοποίηση συγκρίσεων ιδανικά σε συνθήκες λήψεις που αφορούν την ίδια ακολουθία. Ο συνδυασμός της με ένα επιπλέον αλγοριθμικό βήμα, όπως ένα βήμα που θα ανιχνεύονται χαρακτηριστικά της εικόνας σε συνδυασμό με την οριοθέτηση του artifact που έχει προηγηθεί, μπορεί να δώσει ένα ισχυρό εργαλείο τμηματοποίησης της εικόνας με εφαρμογές που θα μπορούν να επεκταθούν από τη χρήση σε ομοιωμάτων ως εργαλείων για την ποσοτικοποίηση του artifact και στην καθημερινή κλινική πρακτική.

Multiwall carbon nanotubes (MWNTs) have extraordinary mechanical and thermal transport properties. They significantly improve the static and dynamic mechanical properties of acrylic orthopaedic bone cement when added to the dry cement polymer powder. Understanding the role MWNTs play on bone cement polymerization temperatures will lead to improved mechanical integrity of the cement-bone interface in joint arthroplasties. It was determined through thermal testing that MWNTs increased the polymerization time of the methylmethacrylate by 45-460% and decreased the peak exothermic temperature of bone cement with and without antibiotics. The flow of heat produced during polymerizing cement was reduced 25-85% with the addition of MWNTs to the cement powder. This decreases the probability of thermal necrosis and “hot” spots caused by high exothermic polymerization temperatures that can destroy the bone adjacent to the cement. These high temperatures also affect the potency and range of antibiotics used in arthroplasty. Isothermal and elution studies determined that MWNTs altered the heat flow and amount of antibiotic release from bone cement during polymerization. Antibiotic elution from bone cement containing MWNTs could match the elution seen in pure cement. The alteration of the flow of heat from bone cement leads to new options for heat-labile antibiotics in total joint arthroplasty.