Exploring the link between the corporate governance and efficiency of Italian water utilities

The present paper analyzes the linkage between the corporate governance of Italian water utilities (ownership, board size and board composition) and their ef fi ciency measured through data envelopment analysis (DEA). Using a general panel data regression model, we found that board size negatively affects the ef fi ciency of water utilities. Moreover, the presence of directors with political af fi liations or who are/were members of local or national go- vernment negatively affects ef fi ciency, and the presence of directors with a degree on the board has a slight negative effect on productivity. Conversely, other variables (ownership, gender diversity and average age of board members) were found not to affect the ef fi ciency of Italian water utilities. The existence of economies of scale was also confirmed .Este artículo analiza la relación entre el gobierno corporativo de los servicios del agua italianos (propiedad, tamaño y composición del consejo) y su e fi ciencia medida a través del análisis envolvente de datos (AED). Usando un modelo general de regresión de datos de panel averiguamos que el tamaño del consejo afecta negativamente la e fi ciencia de los servicios del agua. Además, la presencia de directores con a fi liaciones políticas o que son o fueron miembros del gobierno local o nacional afecta negativamente a la e fi ciencia, y la presencia de directores con una carrera universitaria en el consejo tiene un efecto ligeramente negativo sobre la productividad. Inversamente, otras variables (propiedad, diversidad de género y edad media de los miembros del consejo) no afectan a la e fi ciencia de los servicios del agua italianos. La existencia de economías de escala también fue con fi rmada

Effects of hip abductor strengthening on musculoskeletal loading in hip dysplasia patients after total hip replacement

Hip dysplasia patients after total hip replacement show worse functional performance compared to primary osteoarthritis patients, and unfortunately there is no research on muscle and joint loads that would help understand rehabilitation effects, motor dysfunctions and failure events. We tested the hypothesis that a higher functional improvement in hip dysplasia patients who received hip abductor strengthening after hip replacement, would result in different gait function and musculoskeletal loads during walking compared to patients who performed standard rehabilitation only. In vivo gait analysis and musculoskeletal modeling were used to analyze the differences in gait parameters and hip and muscle forces during walking between the two groups of patients. We found that, in a functional scenario of very mild abnormalities, the patients who performed muscle strengthening expressed a more physiological force pattern and a generally greater force in the operated limb, although statistically significant in limited portions of the gait cycle, and likely related to a higher gait speed. We conclude that in a low-demand task, the abductor strengthening program does not have a marked effect on hip loads, and further studies on hip dysplasia patients would help clarify the effect of muscle strengthening on loads

New spatial mechanisms for the kinematic analysis of the tibiotalar joint

In virtually unloaded conditions, the tibiotalar (ankle) joint behaves as a single degree-of-freedom system, and two fibres within the calcaneal-fibular and tibio-calcaneal ligaments remain nearly isometric throughout the flexion arc. A relevant theoretical model also showed that three articular surfaces and two ligaments act together as a mechanism to control the passive kinematics. Two equivalent spatial parallel mechanisms were formulated, with ligament fibres assumed isometric and articulating surfaces assumed rigid, either as three sphere-plane contacts, or as a single spherical pair. Predicted and measured motion in three specimens compared fairly well. Important enhancement of this previous work is here presented, with more accurate experimental data, more anatomical model surfaces, and a more robust mathematical model

Functional Evaluation of a Shock Absorbing Insole During Military Training in a Group of Soldiers: A Pilot Study

Abstract Objective Soldiers' lower limbs and feet are frequently affected by overload- and overuse-related injuries. In order to prevent or limit the incidence of these injuries, the use of foot orthoses is often recommended. The aim of this study is to assess the effects of shock-absorbing insoles on in-shoe plantar pressure magnitude and distribution in a group of professional infantry soldiers wearing military boots during standard indoor military training. Methods Twenty male professional soldiers of the Italian Army (age 35.1 ± 6.1 years; BMI 25.2 ± 2.3 kg/m2) were recruited for this study. Each subject underwent clinical examination to assess possible overuse-related diseases of the lower limb and trunk. Subjects with altered foot morphology according to the Foot Posture Index (FPI) were excluded from this study. Twelve subjects were considered eligible and therefore underwent an indoor training routine comprised of marching, running, jumping inside parallel bars and jumping from different heights. Soldiers repeated the training session twice wearing standard military boots along with two types of insoles: the standard prefabricated insole within the boots (STI), and a special shock-absorbing insole (SAI) featuring an elastic medial arch support. A 99-capacitive sensor insole system was used to record plantar pressure distribution in both feet. Analysis of in-shoe pressure parameters at rearfoot, midfoot and forefoot and in the total foot was performed via a custom-software application developed in MATLAB. Perceived foot comfort (VAS 0–15) was also assessed. Results Pressure parameters recorded during walking and running were considered suitable for statistical analysis. In the whole foot region, pressure parameters were 18–22% lower in military boots fitted with the SAI during walking and 14–18% lower during running. SAI resulted in better comfort (+25%) with respect to the prefabricated boot orthotics (median comfort: SAI = 15/15; STI = 12/15; p = 0.0039) both during walking and running. Conclusions Shock-absorbing insoles can be an effective solution when fitted inside military boots. The present functional evaluation shows that wearing a prefabricated shock-absorbing insole can provide a significant amelioration of perceived foot comfort and plantar pressure parameters. Further studies are now needed with a larger population and more demanding exercises

A new ligament-compatible patient-specific 3D-printed implant and instrumentation for total ankle arthroplasty: from biomechanical studies to clinical cases

Background: Computer navigation and patient-specific instrumentation for total ankle arthroplasty have still to demonstrate their theoretical ability to improve implant positioning and functional outcomes. The purpose of this paper is to present a new and complete total ankle arthroplasty customization process for severe posttraumatic ankle joint arthritis, consisting of patient-specific 3D-printed implant and instrumentation, starting from a ligament-compatible design. Case presentation: The new customization process was proposed in a 57-year-old male patient and involved image analysis, joint modeling, prosthesis design, patient-specific implant and instrumentation development, relevant prototyping, manufacturing, and implantation. Images obtained from a CT scan were processed for a 3D model of the ankle, and the BOX ankle prosthesis (MatOrtho, UK) geometries were customized to best fit the model. Virtual in silico, i.e., at the computer, implantation was performed to optimize positioning of these components. Corresponding patient-specific cutting guides for bone preparation were designed. The obtained models were printed in ABS by additive manufacturing for a final check. Once the planning procedure was approved, the models were sent to final state-of-the-art additive manufacturing (the metal components using cobalt-chromium-molybdenum powders, and the guides using polyamide). The custom-made prosthesis was then implanted using the cutting guides. The design, manufacturing, and implantation procedures were completed successfully and consistently, and final dimensions and location for the implant corresponded with the preoperative plan. Immediate post-op X-rays showed good implant positioning and alignment. After 4 months, clinical scores and functional abilities were excellent. Gait analysis showed satisfactory joint moment at the ankle complex and muscle activation timing within normality. Conclusions: The complete customization process for total ankle arthroplasty provided accurate and reliable implant positioning, with satisfactory short-term clinical outcomes. However, further studies are needed to confirm the potential benefits of this complete customization process. Level of evidence: 5. Case report