Hip Arthroscopic Surgery for Femoroacetabular Impingement: A Prospective Analysis of the Relationship Between Surgeon Experience and Patient Outcomes.

Background:Hip arthroscopic surgery is a rapidly growing procedure, but it may be associated with a steep learning curve. Few studies have used patient-reported outcome (PRO) surveys to investigate the relationship between surgeon experience and patient outcomes after the arthroscopic treatment of femoroacetabular impingement (FAI). Hypothesis:Patients undergoing hip arthroscopic surgery for the treatment of FAI in the early stages of a surgeon's career will have significantly worse outcomes and longer procedure times compared with patients treated after the surgeon has gained experience. Study Design:Cohort study; Level of evidence, 2. Methods:Patients undergoing hip arthroscopic surgery for FAI and labral injuries were prospectively enrolled during a sports medicine fellowship-trained surgeon's first 15 months of practice. Patients were stratified into an early group, consisting of the first 30 consecutive cases performed by the surgeon, and a late group, consisting of the second 30 consecutive cases. Radiographic and physical examinations were performed preoperatively and postoperatively. PRO surveys, including the 12-item Short Form Health Survey (SF-12), the modified Harris Hip Score (mHHS), and the Hip disability and Osteoarthritis Outcome Score (HOOS), were administered preoperatively and at a minimum of 1 year postoperatively. Results:There was no difference between the early and late groups for patient age (37.2 ± 11.5 vs 35.3 ± 10.8 years, respectively; P = .489), body mass index (25.6 ± 4.0 vs 25.1 ± 4.5 kg/m2, respectively; P = .615), or sex (P = .465). There was a significantly increased procedure time (119.3 ± 21.0 vs 99.0 ± 28.6 minutes, respectively; P = .002) and traction time (72.7 ± 21.4 vs 59.0 ± 16.7 minutes, respectively; P = .007) in the early group compared with the late group. Mean postoperative PRO scores significantly improved in both groups compared with preoperative values for all surveys except for the SF-12 mental component summary. No differences were found in PRO score improvements or complication rates between the early and late groups. Conclusion:The total procedure time and traction time decrease after a surgeon's first 30 hip arthroscopic surgery cases for FAI and labral tears, but patient outcomes can similarly improve regardless of surgeon experience in the early part of his or her career

Energy-efficient through-life smart design, manufacturing and operation of ships in an industry 4.0 environment

Energy efficiency is an important factor in the marine industry to help reduce manufacturing and operational costs as well as the impact on the environment. In the face of global competition and cost-effectiveness, ship builders and operators today require a major overhaul in the entire ship design, manufacturing and operation process to achieve these goals. This paper highlights smart design, manufacturing and operation as the way forward in an industry 4.0 (i4) era from designing for better energy efficiency to more intelligent ships and smart operation through-life. The paper (i) draws parallels between ship design, manufacturing and operation processes, (ii) identifies key challenges facing such a temporal (lifecycle) as opposed to spatial (mass) products, (iii) proposes a closed-loop ship lifecycle framework and (iv) outlines potential future directions in smart design, manufacturing and operation of ships in an industry 4.0 value chain so as to achieve more energy-efficient vessels. Through computational intelligence and cyber-physical integration, we envision that industry 4.0 can revolutionise ship design, manufacturing and operations in a smart product through-life process in the near future

Attribute Identification and Predictive Customisation Using Fuzzy Clustering and Genetic Search for Industry 4.0 Environments

Today´s factory involves more services and customisation. A paradigm shift is towards “Industry 4.0” (i4) aiming at realising mass customisation at a mass production cost. However, there is a lack of tools for customer informatics. This paper addresses this issue and develops a predictive analytics framework integrating big data analysis and business informatics, using Computational Intelligence (CI). In particular, a fuzzy c-means is used for pattern recognition, as well as managing relevant big data for feeding potential customer needs and wants for improved productivity at the design stage for customised mass production. The selection of patterns from big data is performed using a genetic algorithm with fuzzy c-means, which helps with clustering and selection of optimal attributes. The case study shows that fuzzy c-means are able to assign new clusters with growing knowledge of customer needs and wants. The dataset has three types of entities: specification of various characteristics, assigned insurance risk rating, and normalised losses in use compared with other cars. The fuzzy c-means tool offers a number of features suitable for smart designs for an i4 environment

Use of Air Arthrograms to Aid in Joint Distraction During Hip Arthroscopic Surgery Decreases Postoperative Pain and Opioid Requirements.

BackgroundPositive-pressure air arthrography and venting of the hip capsule are techniques used to decrease the traction forces needed for joint distraction during hip arthroscopic surgery. Little is known about the effects that these techniques have on postoperative pain.HypothesisPositive-pressure air arthrography and venting during hip arthroscopic surgery will decrease patient-reported pain and narcotic requirements in the acute postoperative setting.Study designCohort study; Level of evidence, 3.MethodsA retrospective cohort analysis was conducted to analyze 35 patients who underwent positive-pressure air arthrography and venting to aid joint distraction during hip arthroscopic surgery versus a group with similar demographics, pathologies, and treatments who did not undergo air arthrography. Numeric pain rating scale (NPRS) scores and medication administration including narcotic and nonnarcotic analgesia in the postanesthesia care unit (PACU) were tracked and compared.ResultsThe maximum (7.17 vs 4.97, respectively), minimum (2.43 vs 1.09, respectively), and mean (5.15 vs 3.11, respectively) NPRS scores were all higher in the control group compared with the air arthrogram group (P < .001, P = .007, and P < .001, respectively). The administration of oral morphine equivalents (OMEs) during the PACU stay was significantly lower in the air arthrogram group, with a mean of 36.75 ± 11.37 OMEs, compared with 44.53 ± 16.06 OMEs in the control group (P = .023). There was no difference in postoperative nonopioid medications, such as ketorolac or acetaminophen, given between groups.ConclusionPatients undergoing hip arthroscopic surgery with air arthrography and venting used to aid distraction had significantly less postoperative pain and required a lower total dosage of opioids during their PACU stay when compared with patients who underwent hip arthroscopic surgery without air arthrography

Erosion resistance of surface engineered 6000 series aluminium alloy

Aluminium and its alloys are widely used in a wide variety of applications. Aluminium’s main advantages include: lightness, high specific strength, high thermal and electrical conductivities, good formability, excellent machinability, diversity of aluminium alloys, extensive range of forming and processing options (e.g. rolling, extrusions, stampings, forgings and castings) and suitability for a diverse range of joining techniques, surface treatments and recyclability. A number of surface treatment technologies are available which produce thicker oxide coating layers that can be used to combat corrosion and wear of aluminium alloys under aggressive environments, such as in petroleum extraction environments. Coating processes for surface modification of aluminium alloys include plasma electrolytic oxidation, plasma-sprayed ceramic and hard anodising. In this article, erosive wear characteristics of coatings produced using the aforesaid three processes are compared with each other and benchmarked against the uncoated aluminium substrate. This article investigates the extent of erosion resistance, in particular impingement due to sand loading, of these coatings taking into consideration the effect of material properties such as adhesion, ductility and roughness

An analysis of methods to achieve robustness towards a lean product development process

Since Taguchi’s introduction to robustness much has been researched about it, particularly into the field of new product development. Despite the attention given to the subject by academia, recent research has found that industry has yet to fully grasp its benefits. Among the main attributed factors, lie the complexity of the proposed statistical tools and a general misconception of the concept and its implementation. Based on Toyota’s Product Development System, the term Conceptual Robustness is broadly defined based on three forms of variation: physical, design and market. Parting from the this definition and as part of the LeanPPD Project, the objective of this paper’s contribution is threefold: 1), to present the state of the art on research in the area of robustness, 2) propose a taxonomy in order to understand the different scopes of available resources and 3) finally identifying the possibilities to achieve conceptual robustness (that of Sobek et al., 1999) with the available resources presented to the industry by academic research

George Berkeley en la obra de Jorge Luis Borges: lecturas filosóficas y aplicación del inmaterialismo a la literatura.

Los estudios de la cultura tienen por objeto “la investigación de carácter interdisciplinario que explora las formas de producción o creación de significados y de difusión de los mismos en las sociedades” (Facé, 2000) y uno de los productos más refinados de nuestra cultura es la literatura. De ese vasto hecho cultural que es la literatura, Jorge Luis Borges desarrolla una obra que influyó de manera directa en otros escritores e indirectamente en nosotros. Estudiar su obra a profundidad constituye una empresa valiosa en el marco de los estudios de la cultura. Esta investigación busca indagar un aspecto muy específico en la conformación de la obra del argentino. La lectura e incorporación que Borges realiza de las ideas filosóficas de George Berkeley, filósofo irlandés del siglo XVII-XVIII. Para contestar a la pregunta ¿Qué tanto influyó Berkeley en Borges?, y ¿de qué manera se encuentra presente en el corpus borgeano? Es necesario plantear primero la pregunta por las lecturas filosóficas del argentino y su diálogo con otros filósofos. Jorge Luis Borges es uno de los escritores más importantes que ha dado nuestra lengua. Su obra comprende los géneros del ensayo, el cuento y la poesía. Su complejidad es sabida y reconocida. Su influencia en la literatura posterior es amplia y contundente. Le interesaron dos grandes temas: la ficción especulativa y los márgenes de la cultura. Para Piglia (2013) estos dos temas corresponden a sus dos linajes, el de los Haslam cuyo canon es la biblioteca que desemboca en los grandes temas de la cultura que nutrirán sus ficciones. En el linaje de los Acevedo encontramos el otro tema fundamental en Borges: los márgenes de la cultura y la lucha heroica. Siguiendo a Piglia la grandeza literaria de Borges reside en la permanente tensión entre sus dos linajes

Do Outcomes of Arthroscopic Subscapularis Tendon Repairs Depend on Rotator Cuff Fatty Infiltration?

Background:Rotator cuff fatty infiltration has been correlated with poorer radiographic and clinical outcomes in supraspinatus and infraspinatus tendon repairs, but this has not been well-studied in subscapularis tendon repairs. Purpose:To evaluate the influence of preoperative rotator cuff fatty infiltration on postoperative outcomes for patients undergoing arthroscopic subscapularis tendon repair. Study Design:Cohort study; Level of evidence, 3. Methods:Patients who underwent arthroscopic subscapularis repair between 2010 and 2016 were retrospectively identified, and demographic data and surgical findings were recorded. The extent of fatty infiltration was determined on preoperative magnetic resonance imaging by the Fuchs modification of the Goutallier classification. At the most recent follow-up, patients completed the Patient-Reported Outcomes Measurement Information System for Upper Extremity (PROMIS-UE) computer adaptive test and a postoperative visual analog scale for pain. The distribution of fatty infiltration was compared between patients undergoing subscapularis tendon repair versus subscapularis tendon repair combined with a posterior cuff repair. Outcomes were compared for patients using Goutallier grade 0-1 versus grade ≥2 changes in each rotator cuff muscle. Multivariate linear regression analysis was performed to evaluate the influence of muscle quality, as well as demographic factors, on PROMIS-UE scores. Significance was defined as P < .05. Results:There were 140 shoulders included (mean age, 61.8 years; 42.1% female; mean follow-up, 51.7 months). The prevalence of Goutallier grade 2 changes or higher was significantly greater in patients with multitendon repair relative to isolated subscapularis tendon repair. For the overall group of all patients undergoing subscapularis tendon repair, whether in isolation or as part of a multitendon repair, PROMIS-UE scores were significantly lower for patients with infraspinatus muscle grade 2 or higher Goutallier changes relative to grade 0 or 1. After adjustment for age, body mass index, patient sex, and fatty infiltration in other rotator cuff muscles, poor infraspinatus muscle quality remained the only significant predictor for lower PROMIS-UE scores. Conclusion:Patients undergoing arthroscopic subscapularis tendon repair with poor infraspinatus muscle quality had worse patient-reported outcomes. This was true whether subscapularis tendon repair was isolated or was performed in conjunction with supraspinatus and infraspinatus tendon repairs

Estudio de innovacion en empresas fruticolas curicanas asociadas a Fruseptima

195 p.El Manual de Oslo (OECD 2005) define a la Innovación como la introducción de un nuevo o mejorado producto, de un nuevo o mejorado proceso, de un nuevo método organizativo o de una nueva tecnica de mercadotecnia en las actividades de la empresa.Para que sea reconocida como tal, el requisito mínimo que debe cumplir es que la innovación sea nueva para la empresa. Es decir, algo que por primera vez se experimenta en las prácticas de un establecimiento en pos mejorar o implementar un nuevo producto o proceso o nuevos métodos de trabajo o nuevas formas de diseño y comercialización que deriven en la puesta en el mercado de un bien o servicio. En la economía de la Región del Maule, el rubro frutícola es uno de los que hace el mayor aporte al Producto Interno Bruto Regional, es una de las plazas que genera mayor cantidad de puestos de trabajo en el año y es un rubro que todavía está en crecimiento. El Consejo Nacional de la Innovación para la Competitividad (CNIC), publicó en el año 2007 el primer volumen de su Estrategia Nacional de Innovación para la Competitividad. En ella se expuso que Chile contaba con 11 potenciales focos de desarrollo, que sirven para la generación de conocimiento, puestos de trabajo y un mejor nivel de vida para las personas. Uno de estos sectores o posibles clusters de desarrollo es el que tiene relación con el área frutícola, ratificándose por parte del CNIC como sector económico fundamental en la publicación de su segundo volumen de la Estrategia de Innovación. En ella, propone una serie de pasos a seguir para lograr un desarrollo gradual del sector de aquí al año 2020. Viendo que la región es una zona frutícola por excelencia, sobre todo en la zona de Curicó, se llevó a cabo un estudio de innovación en empresas frutícolas curicanas pertenecientes a la Asociación de Productores Frutícolas de la Séptima Región FRUSÉPTIMA, que forma parte del Nodo Tecnológico Frutícola del Maule junto con la Asociación de Exportadores de Chile (ASOEX) y el Centro de Pomáceas de la Universidad de Talca. Este estudio se aplicó a 23 empresas de la ciudad de Curicó con el fin de identificar las actividades de innovación realizadas por éstas y evaluar el impacto que ha tenido para las empresas en los últimos tres años. La herramienta que se diseñó para el estudio fue un cuestionario de 20 preguntas separadas en 8 temas relacionados con la innovación. El análisis se hizo para la pequeña, mediana y gran empresa Se desprenden hechos generales como el que la mayor actividad innovadora que hacen las empresas es la capacitación para poder innovar, o también que en los últimos años las innovaciones que más se han introducido en las empresas han sido las relacionadas con la mejora de los procesos productivos, o que el departamento de control de calidad es el que más presencia tiene dentro de las empresas, o que pocas empresas practican I+D dentro de sus establecimientos lo que concuerda con el análisis FODA hecho por el Consejo Nacional de Innovación sobre el sistema de innovación en Chile, o que la modernización y gestión de la producción es una de las actividades organizativas importantes en los tres tipos de empresas, o que gran parte de las empresas que participaron en este estudio tiene sus procesos certificados, etc