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

Use of Factors in Development Estimates: Improving the Cost Analysis Toolkit

Factor Estimating is a technique commonly used by defense acquisition analysts to develop cost estimations. However, previous studies developing factors for the Engineering and Manufacturing Development (EMD) phase of the life cycle are limited. This research expands the current toolkit for cost analysts by developing cost factors in previously unexplored areas. More specifically, over 400 cost reports are utilized to create new standard cost factors that are delineated by five categories: commodity type, contract type, contractor type, development type, and Service. The factors are developed for those elements that are common in a wide array of projects such as program management, systems engineering, data, or training. This new factor dataset provides cost analysts with the information necessary to appropriately identify and select the most relevant factors to use when developing future cost estimates. Through statistical analysis, the research also helps identify those elements in which more analysts’ time and energy should be allocated when developing their estimates

Nature-based solutions forming urban intervention approaches to anthropogenic climate change:a quantitative literature review

Discussion around anthropogenic climate change has occurred for over 100 years. However, in recent decades, these discussions have intensified due to increased confidence in scientific research highlighting adverse effects, increased knowledge breadth in climate science, and heightened public and political awareness and engagement on the topic. Climate change is now acknowledged as one of the biggest challenges and threats to modern lifestyles. Nature-based solutions (NBS), as a mediator and mitigator to adverse climate change effects, is an emerging area of expanding research collateral and practitioner literacy. To highlight current NBS knowledge, existing knowledge gaps, and research trends, a Quantitative Systematic Literature Review (QSLR) was undertaken (n = 54). This QSLR reveals the short temporal span of articles relating to NBS as a response to climate change, with most articles being of a research style format. NBS research focus areas were found to be dominated by ecological and infrastructure approaches to climate change mitigation, and ecological and technical positions were found to be most topical across the current climate change literature. Multiple knowledge gaps were identified by the review, namely the lack of broader conceptual approaches and knowledge acquisition regarding climate change responses via NBS, as well as the psychological relationship humans share with NBS and climate change, adverse or otherwise. These knowledge gaps highlight where future research inquiry may be directed to increase the value and completion of this research area. It is hoped that this QSLR will assist in increasing the profile of NBS in the multidisciplinary and complex response to anthropogenic climate change, as well as contribute to the growth in investment and implementation of NBS assets for a rigid and resilient global future

Agile Software Development: Creating a Cost of Delay Framework for Air Force Software Factories

The Air Force software development environment is experiencing a paradigm shift. The 2019 Defense Innovation Board concluded that speed and cycle time must become the most important software metrics if the US military is to maintain its advantage over adversaries.1 This article proposes utilizing a cost-o­f-d­elay (CoD) framework to prioritize projects toward optimizing readiness. Cost-­of-d­elay is defined as the economic impact resulting from a delaying product delivery or, said another way, opportunity cost. In principle, CoD assesses the negative impacts resulting from changes to the priority of a project

Discussion of the selection and use of teaching aids and standard materials in the lower school at Perkins School for the Blind

Thesis (Ed.M.)--Boston Universit

Simultaneous evaluation of abstinence and relapse using a Markov chain model in smokers enrolled in a two-year randomized trial

Abstract Background GEE and mixed models are powerful tools to compare treatment effects in longitudinal smoking cessation trials. However, they are not capable of assessing the relapse (from abstinent back to smoking) simultaneously with cessation, which can be studied by transition models. Methods We apply a first-order Markov chain model to analyze the transition of smoking status measured every 6 months in a 2-year randomized smoking cessation trial, and to identify what factors are associated with the transition from smoking to abstinent and from abstinent to smoking. Missing values due to non-response are assumed non-ignorable and handled by the selection modeling approach. Results Smokers receiving high-intensity disease management (HDM), of male gender, lower daily cigarette consumption, higher motivation and confidence to quit, and having serious attempts to quit were more likely to become abstinent (OR = 1.48, 1.66, 1.03, 1.15, 1.09 and 1.34, respectively) in the next 6 months. Among those who were abstinent, lower income and stronger nicotine dependence (OR = 1.72 for ≤ vs. > 40 K and OR = 1.75 for first cigarette ≤ vs. > 5 min) were more likely to have relapse in the next 6 months. Conclusions Markov chain models allow investigation of dynamic smoking-abstinence behavior and suggest that relapse is influenced by different factors than cessation. The knowledge of treatments and covariates in transitions in both directions may provide guidance for designing more effective interventions on smoking cessation and relapse prevention. Trial Registration clinicaltrials.gov identifier: NCT00440115Peer Reviewe

Redisgn of a Medical Courier Robot

The primary goal was to evaluate robotic couriers for design and operation in hospital environment and to create a robot drivetrain that is more robust and maneuverable than current robotic couriers. These drivetrain improvements allow couriers to efficiently complete functions they were designed to accomplish. Existing drivetrain systems were evaluated through decision and design matrices to choose a drivetrain which could most benefit this application. A mecanum drive was chosen due to several factors including mobility, reliability, and maintenance among others