Background: Cryotherapy is commonly used during physiotherapeutic rehabilitation of patients following total knee replacement (TKR). Evidence for treatment effectiveness within the current literature is contradictory and there are no clinical guidelines to inform cryotherapy treatment within this particular patient group. This study surveys current cryotherapy treatment efficacy in the acute post-operative management of TKR patients. Methods: In total 263 senior physiotherapists completed and returned a postal questionnaire, which, using open and closed questions investigated the use of cryotherapy following TKR. Survey results were used to inform a pragmatic randomized clinical trial (RCT) involving 133 consecutive TKR patients. The RCT investigated cryotherapy treatment efficacy in the acute post-operative management of TKR patients. Patients were randomized into three groups; no cryotherapy (NC), delayed cryotherapy (DC) and immediate cryotherapy (IC). The primary outcome measure was post-operative pain with knee swelling, active range of motion (AROM), function and levels of physiotherapy input assessed as secondary outcome measures. Observations were taken pre-operatively and at 3, 7 and 42 days post-operatively. Results: The survey reported that 33% of respondents used some form of cryotherapy routinely following TKR surgery. The two main methods of cryotherapy application were Cryocuff (59%) and crushed ice (30%). Treatments were most frequently applied between 24 hrs and 48 hrs post-surgery for 20 minutes, twice a day. Chi square analysis indicated significant differences (p<0.01) in between NHS and private sites relating to a lack of cryotherapy resources and treatment time for cryotherapy in the NHS. A lack of proven efficacy was the most cited reason for not applying cryotherapy treatment, and swelling the most common treatment indicator. There was particular uncertainty regarding the cleaning and sterilization of the Cryocuff device. The RCT indicated that patients in IC group had significantly less post-operative pain than the NC and DC groups at 3 days. Mean difference (p <0.05, 95% CI) in post-operative analogue scores (VAS, scale 0-10) was -1.6 (p <0.01, CI -2.49- to -0.707) for IC and NC; and -0.922 (p= 0.044, CI -0.183 to -0.009) for IC and DC groups. At 7 and 42 days there were significant reductions in VAS scores for both cryotherapy groups compared to the NC group. There was significant improvement in knee swelling, AROM, ability to transfer and need for additional physiotherapy in both cryotherapy treatment groups although no significant reduction in opiate requirement was found. Conclusions: In current clinical practice there was little consensus regarding treatment indicators, method of application and management of cryotherapy following TKR. However, in a RCT the use of cryotherapy combined with compression, as compared to a no cryotherapy control, led to significant reductions in patient reported pain, less post-operative swelling, greater recovery of AROM, faster return of function and less reliance on OPD physiotherapy treatment. It is concluded that cryotherapy combined with compression has an important role to play in the acute rehabilitation of TKR and should be considered as part of routine management.

With technology changing at a dramatic pace, entrepreneurs may assume that acquiring the newest production equipment available is the best option. But that is not always the case. It is important to first assess the needs in order to decide whether new or remanufactured production equipment is the best alternative. Investment on production equipment can be initiated due to existing equipment cannot handle capacity; products evolve and changes needed to meet market requirement; to continuously improve production system; or the general requirements for quality, environment, economy and safety. However, the study reveals that it has received only limited attention from academics and practitioners regarding to whether decide to remanufacture or new acquire production equipment. Further, the framework visualizes the complexity of managing decision-making between production equipment remanufacturing and new acquisition. The study employs qualitative method by conducting literature review, interviews, brainstorming sessions, benchmarking, and observation to build the theoretical framework and collect empirical data. The thesis identifies the differences between production equipment remanufacturing and new acquisition; distinguishes the different levels of production equipment, proposes a new definition of production equipment remanufacturing; and analyses factors should be considered for the decision-making process. Altogether, the findings provide strong evidence to propose a decision-making checklist in decisions between production equipment remanufacturing and new acquisition.

Tikslas: įvertinti fizinių pratimų poveikį, vyrams sergantiems hipogonadizmu, kuriems taikoma pakaitinė testosterono terapija. Uždaviniai: 1. Nustatyti vyrų sergančių hipogonadizmu kūno masės komponentų pokyčius atsiradusius dėl 6 mėnesių trukmės kineziterapijos programos taikymo. 2. Palyginti kūno masės komponentus vyrų sergančių hipogonadizmu ir sveikų vyrų prieš ir po kinezirerapijos taikymo. 3. Nustatyti vyrų sergančių hipogonadizmu fizinių ypatybių (šuolio metu išvystomų rodiklių: jėgos, galingumo, greičio, aukščio, santykinio galingumo bei kūno slėgio centro svyravimų elipsės ploto) pokyčius atsiradusius dėl 6 mėnesių kineziterapijos programos taikymo 4. Palyginti fizinių ypatybių pokyčius (šuolio metu išvystomų rodiklių: jėgos, galingumo, greičio, aukščio, santykinio galingumo bei kūno slėgio centro svyravimų elipsės ploto) vyrų sergančių hipogonadizmu ir sveikų vyrų prieš ir po kineziterapijos taikymo. Tiriamieji: 38 vyrai: 18 – sergantys hipogonadizmu ir 20 sveikų vyrų. Tyrimo organizavimas: vyrai sergantys hipogonadizmu padalinti į du pogrupius: 8 vyrams 6 mėn. buvo taikyta pakaitinė testosterono terapija ir kineziterapija (2 k/sav. po 60 min), 10 vyrų taikyta tik pakaitinė testosterono terapija 3 k/6 mėn. kas 8 savaitės buvo švirkščiama Nebido 1000 mg/4 ml injekcinis tirpalas. Tyrimo metodai: 1. Tiriamųjų fizinis aktyvumas, naudojant Tarptautinį fizinio aktyvumo klausimyną (IPAQ). 2. Kūno sudėties analizė X – SCAN įranga – ūgį, kūno svorį, kūno masės indeksą... [toliau žr. visą tekstą] / The aim of the research is to assess the effect of exercise therapy on males with hypogonadism treated with testosterone replacement therapy. Objectives: 1. To determine changes in body weight components resulting from a six-month programme of exercise therapy. 2. To compare the body weight components in males with hypogonadism and healthy males before and after exercise therapy. 3. To determine changes in physical parameters (parameters achieved during jumping tasks: strength, power, speed, altitude, relative power, and the ellipse area of body centre pressure) in males with hypogonadism resulting from a six-month programme of exercise therapy programme. 4. To compare the changes in physical parameters (indicators achieved during jumping tasks: strength, power, speed, altitude, relative power, and the ellipse area of body centre pressure) in males with hypogonadism and healthy males before and after exercise therapy. Subjects: 38 males including 18 males with hypogonadism and 20 healthy males. Research design: males with hypogonadism were arranged into two subgroups: 8 men were treated with testosterone replacement therapy combined with exercise therapy for 6 months (2/60-minute sessions per week), 10 men were given testosterone replacement therapy only: 3 times per 6 months, i.e. every 8 weeks they received Nebido 1000 mg/4 ml injections. Research methods: 1. International Physical Activity Questionnaire to obtain estimates of physical activity. 2. X – SCAN for body... [to full text]

Background and Objectives: Little is known about the impact of nicotine replacement therapy (NRT) use duration on smoking cessation in the general population. This study determines whether duration of NRT use is associated with smoking cessation. Methods: Data were from the Ontario Tobacco Survey longitudinal study of a population-based cohort of baseline smokers who made serious quit attempts during 18 months of follow-up. The association between NRT (any NRT, patches, or gum) use duration and smoking cessation outcomes (short-term abstinence ≥1 month and long-term abstinence ≥12 months) was estimated by Poisson regression, adjusting for all confounding variables. Results: Among the 1,590 eligible smokers, 933 (59%) did not use any NRT, 535 (34%) used NRT <8 weeks, and 112 (8%) used NRT ≥8 weeks at follow-up. The median duration of NRT use was 14 days. A consistent “J” shape of associations between quit aid use duration and smoking cessation outcomes (quit rates) was found. Using any NRT, patches, or gum <8 weeks was generally associated with a lower likelihood of quitting, but using them ≥8 weeks was generally associated with a higher likelihood of quitting, compared to not using them. Only using patches for the recommended duration (≥8 weeks) was associated with a higher likelihood of short-term (relative risk, RR 1.74, 95% confidence interval, CI 1.21-2.50) and long-term (RR 2.62, 95% CI 1.25-5.50) abstinence at the end of 18 months of follow-up, compared to not using patches. Using gum ≥8 weeks was not associated with short- or long-term abstinence at the end of 18 months of follow-up. Conclusions: Using nicotine patches for the recommended duration is associated with successful short- and long-term abstinence in the general population. More efforts are needed to encourage smokers to use nicotine patches for eight or more weeks when attempting to quit.

Background and Objectives: Little is known about the impact of nicotine replacement therapy (NRT) use duration on smoking cessation in the general population. This study determines whether duration of NRT use is associated with smoking cessation. Methods: Data were from the Ontario Tobacco Survey longitudinal study of a population-based cohort of baseline smokers who made serious quit attempts during 18 months of follow-up. The association between NRT (any NRT, patches, or gum) use duration and smoking cessation outcomes (short-term abstinence ≥1 month and long-term abstinence ≥12 months) was estimated by Poisson regression, adjusting for all confounding variables. Results: Among the 1,590 eligible smokers, 933 (59%) did not use any NRT, 535 (34%) used NRT <8 weeks, and 112 (8%) used NRT ≥8 weeks at follow-up. The median duration of NRT use was 14 days. A consistent “J” shape of associations between quit aid use duration and smoking cessation outcomes (quit rates) was found. Using any NRT, patches, or gum <8 weeks was generally associated with a lower likelihood of quitting, but using them ≥8 weeks was generally associated with a higher likelihood of quitting, compared to not using them. Only using patches for the recommended duration (≥8 weeks) was associated with a higher likelihood of short-term (relative risk, RR 1.74, 95% confidence interval, CI 1.21-2.50) and long-term (RR 2.62, 95% CI 1.25-5.50) abstinence at the end of 18 months of follow-up, compared to not using patches. Using gum ≥8 weeks was not associated with short- or long-term abstinence at the end of 18 months of follow-up. Conclusions: Using nicotine patches for the recommended duration is associated with successful short- and long-term abstinence in the general population. More efforts are needed to encourage smokers to use nicotine patches for eight or more weeks when attempting to quit.

As aquaculture continues to expand, protein sources have become more costly and less available. Simultaneously, lipid-extracted algal meals (LEA) (co-products of bio-diesel production) are becoming increasingly available as alternative sources of energy are investigated. By integrating LEA into aquaculture diets, feed prices could be lowered and bio-diesel production would have an additional revenue stream. Three feeding trials each of 7 weeks duration were conducted to evaluate five different algal meals as partial replacements for fishmeal and soy protein concentrate in diets for juvenile red drum (Sciaenops ocellatus). Apparent digestibility coefficients (ADCs) for CP and energy in various LEAs also were determined with red drum and hybrid striped bass (HSB). In the first trial, whole algae meal and LEA derived from Navicula sp. replaced 5 or 10% of the crude protein (CP) in the reference diet. Weight gain, feed efficiency (FE), hepatosomatic index (HSI), as well as protein and energy retention were not significantly (P>0.05) affected by the dietary treatments. Algal inclusion significantly affected the ADCs of the various dietary treatments for dry matter, CP, and energy. The inclusion of ash in the form of diatomaceous earth improved digestibility of protein as well as weight gain, survival and FE. A second feeding trial evaluated LEA derived from Chlorella sp. processed at high temperatures, replacing 5, 10, 20, and 25% of the CP in the reference diet. Weight gain, FE, survival, and protein efficiency ratio (PER) were significantly reduced at substitution levels of 20 and 25%. The third feeding trial evaluated LEA derived from Nanochloropsis salina, replacing 5, 7.5, 10, and 15% of the CP in the reference diet. Weight gain, FE, survival, and PER were significantly affected by some dietary treatments, with the 15% substitution levels causing significant reductions in performance. Intraperitoneal fat ratio and whole-body lipids were significantly lower in the fish fed the 15% substitution diet. Based on the results of these experiments, replacement of up to 10% of CP from fishmeal and soy protein concentrate with LEA was possible without causing substantial reductions in fish performance, and the whole algae product provided a more nutritious product. Red drum and HSB showed similar responses in their ability to digest CP and energy from the various algal products, although ADCs varied greatly among the different products and processing methods.

The cervical spine must provide structural support for the head, allow large range of motion and protect both the spinal cord and branching nerves. There are two types of spinal joints: the intervertebral discs which are flexible connections and the facets, which are articulating synovial joints. Both types degenerate with age. Current surgical treatments include spinal fusion and articulating disc replacement implants. If both disc and facet joints are degenerated, fusion is the only option. In spinal fusion, the disc is removed and the adjacent vertebrae are fused which causes abnormally high stress levels in adjacent discs. In disc replacement, an articulating device is inserted to restore intervertebral motion and mimic healthy spinal kinematics. Disc arthroplasty does not significantly increase adjacent level stress but the lack of rotational constraint causes increased facet contact pressures. Thus, there is a need for a cervical total level arthroplasty system (CTLAS) that has a disc implant specifically designed to preserve the facet joints and implants for facet arthroplasty that can act independently or in-unison with the disc replacement. The conceptual design of a CTLAS implant system was proposed that would replace the disc and the facet joints. To facilitate medical imaging, PEEK (polyetheretherkeytone) was selected as the structural and bearing material. In the present thesis, multi-station pin-on-plate wear testing was initiated for pairs of unfilled (OPT) and carbon-fiber-reinforced (CFR) PEEK. Wear is important in arthroplasty implant design because wear particles can cause osteolysis leading to loosening. A variety of experiments were performed to investigate the effects of load, contact geometry and lubricant composition on wear. CFR PEEK was found to have much lower and more predictable wear than OPT PEEK in the present experiments. The wear of OPT PEEK pairs showed sensitivity to lubricant protein concentration. The coefficient of friction during testing was found to be quite high (up to 0.5), which might have clinical implications. Also, some subsurface fatigue was found, exposing carbon fibers of CFR PEEK. This remains a concern for its long-term application. Further wear testing is recommended using actual implants in a spine wear simulator.

Research to improve artificial renal replacement therapies is varied across the many different parts of a hemodialysis system. Work largely focuses on developing a better dialyzer - the component that is directly responsible for removing wastes from the blood - but less study is devoted to the entire hemodialysis system. This work seeks to improve hemodialysis in two ways: by proposing a new renal replacement therapy that does not rely on traditional hemodialysis components, and by investigating the feasibility of adapting current hemodialysis practices to a portable format. While an alternative renal replacement therapy may be the best solution to today's dialysis problems, this work further focuses on reducing hemodialysis to a portable format through systematic engineering design. In that process, a detailed system model is made in Simulink that can account for the large number of inputs of such a system - the blood flow rate, dialyzer size, treatment time, etc. - allowing for detailed exploration of the design space. Once the model is completed, it is verified through in vitro experiments carried out with porcine blood. Additionally, the model is verified against published human hemodialysis data. After model verification, hemodialysis concepts are generated that allow for maximum portability under different patient conditions.

Global concern about the environmental impacts of waste disposal and stringent implementation of environmental laws lead to numerous research on recycled materials. Increased awareness about the inherent engineering values of waste materials, lack of landfill sites and strong demand for construction materials have encouraged research on composite materials, which are either fully or partly made of recycled materials. This trend is particularly strong in transportation and geotechnical projects, where huge quantities of raw materials are normally consumed. Owing to the low mass-to-volume ratio, disposal of Expanded Polystyrene (EPS) is a major problem. In addition, EPS recycling methods are expensive, labour intensive and energy demanding. Hence, this thesis is focused on the development of a new soil composite made by mixing recycled EPS with expansive clays. Given the high cost of damage to various buildings, structures and pavements caused by the unpredictable ground movements associated with expansive soils, it has been considered prudent to try and develop a new method of soil modification using recycled EPS beads as a swell-shrink modifier and desiccation crack controller. The innovative application of recycled EPS as a soil modifier will minimise the quantity of waste EPS destined to the landfill considerably. An extensive experimental investigation has been carried out using laboratory reconstituted expansive soils - to represent varied plasticity indices - consisting of fine sand and sodium bentonite. Three soils notated as SB16, SB24 and SB32 representing 16%, 24% and 32% of bentonite contents respectively were tested with four EPS contents of 0.0%, 0.3%, 0.6% and 0.9%. The tests performed include compaction, free swell, swell pressure, shrinkage, desiccation, shear strength and hydraulic conductivity. All the tests have been performed at the respective maximum dry unit weight and optimum moisture content of the mixes. It has been observed that by mixing of recycled EPS beads with the reconstituted soil, a lightweight geomaterial is produced with improved engineering properties in terms of dry unit weight, swelling, shrinkage and desiccation. The EPS addition depends on the moulding moisture content of the soil. With increasing moisture content, additional EPS can be added. Also, there is a reduction in dry unit weight with the addition of EPS. Furthermore, the reduction of swell-shrink potential and desiccation cracking in soils, for example, is related to the partial replacement of soil particles as well as the elasticity of the EPS beads. There is a reduction in shear strength with the addition of EPS to soils. However, mixing of chemical stabilisers along with EPS can enhance the strength in addition to improved overall properties.

Bridges form a vital link in the physical infrastructure and must be maintained in a "safe working order" at all times. It is estimated that there are currently 20,000 timber road bridges in service throughout Australia. Increasing demands on these bridges due to heavier and faster moving loads, together with deterioration are placing these aging structures at a higher risk of collapse. Unfortunately, many local governments and government departments have neglected the benefits of preventative maintenance and have opted for "just in time" repairs. This is especially true for timber bridges. This past neglect has placed bridge stock in a poor state that is only now being recognised as a significant problem. A key component of this research is to develop improvements to this current situation. This research thesis generates detailed knowledge on the load carrying capacities of timber bridges and new non destructive testing techniques that can be substituted for conventional testing procedures. For the first time guidelines have been developed for undertaking capacity assessment on timber bridges by specifying intervention levels for notched timber and limiting maximum allowable strains in timber members. This newly acquired knowledge will enable Asset Managers to more accurately determine the capacity of sniped timber bridge girders to enable appropriate retrofitting and maintenance while also allowing the safe movement of heavy vehicles. The knowledge generated through destructive testing of timber girders and the analysis of the vast amount of experimental data has enabled the first instance of developing specifications for replacement girders. These specifications detail both functional and performance related targets for three different types of replacement girders. Testing of these replacement girders also demonstrates that through some minor modifications that the specification targets can be met. The outcomes of this thesis provide an innovative approach to accessing the condition and capacity of timber girders and to increasing the safety and life of timber bridges in Queensland. By using new techniques such as Non-destructive testing, species identification and limiting maximum allowable strains, as described in this thesis, the road transport network can be safety used by heavy and permit vehicles. It is only through the effective management of timber bridge maintenance and rehabilitation that Australia can have an efficiently running road transportation network.