Background: Antibiotic-laden bone cement is used commonly for fixation of primary hip arthroplasty and in the creation of spacers for treatment of orthopedic infections. We report an adverse event associated with the use of a vancomycin-laden bone cement spacer for treatment of a total knee arthroplasty infection. Case Presentation: A 60-year old Hispanic male developed chronic total knee arthroplasty infection caused by coagulase-negative staphylococci and anaerobic bacteria. He received systemic vancomycin and a vancomycinladen cement spacer. During treatment, the patient developed a macular rash that resolved with discontinuation of intravenous vancomycin. He completed a six-week course of antibiotics uneventfully. When the patient returned to the operating room for revision arthroplasty, substantial local inflammation was found in the frozen sections. The vancomycin-laden cement spacer was removed and replaced with a spacer that did not contain vancomycin. No organisms were found on either routine microbiologic culture or broad-range polymerasechain reaction studies. The Naranjo nomogram showed a ''probable'' adverse drug reaction to vancomycin cement. The patient received six more weeks of broad-spectrum antibiotics and eventually underwent successful revision arthroplasty. Conclusion: We believe that this patient had systemic and local allergic reactions to vancomycin. Because antibiotic-laden bone cement and other topical antibiotic preparations are used commonly in the treatment of surgical infections, we encourage providers to be aware of the possible adverse effects.
Constructs from theoretical psychology can be used to decompose the representational and processing resources of cognition. The decomposition supports “cognitive task analysis” through which user performance can be related to the functioning of resources. Such functional relationships have been formalised and embodied in an expert system. This builds approximate models which describe cognitive activity associated with the execution of dialogue tasks. Attributes of these “cognitive task models” can be used to predict likely properties of user performance.
The use of micro-processors and commercial operating systems in real-time applications demands a good understanding of factors which influence software performance. Advances in micro-processor design (e.g. pipelining) make performance prediction based on instruction cycle counts difficult. In addition, the increasing complexity of operating systems raises doubts about our ability to ensure that their performance will meet system requirements. Performance measurement is more important than ever. This paper describes an ongoing project intended to use performance measurements to characterize the performance of real-time systems software. To date the project has conducted extensive experiments on an in-house operating system running on Intel's 286/10 micro-computer in order to test the feasibility of accurate and repeatable measurement of O/S performance. The measurement approach, which views the software from a resource-consumption standpoint, can be applied to both O/S and application level software. Some of the measurement results are presented here and are used to test the manufacturer's assumptions about the hardware's performance.
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