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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-oÂf-dÂelay (CoD) framework to prioritize projects toward optimizing readiness. Cost-Âof-dÂelay 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
Analyzing Operating and Support Costs for Air Force Aircraft
Purpose: Recent legislation resulted in an elevation of operating and support (O&S) costs’ relative importance for decision-making in Department of Defense programs. However, a lack of research in O&S hinders a cost analyst’s abilities to provide accurate sustainment estimates. Thus, the purpose of this paper is to investigate when Air Force aircraft O&S costs stabilize and to what degree. Next, a parametric O&S model is developed to predict median O&S costs for use as a new tool for cost analyst practitioners.Design/Methodology/Approach: Utilizing the Air Force total ownership cost database, 44 programs consisting of 765 observations from 1996 to 2016 are analyzed. First, stability is examined in three areas: total O&S costs, the six O&S cost element structures and by aircraft type. Next, stepwise regression is used to predict median O&S costs per total active inventory (CPTAI) and identify influential variables.Findings: Stability results vary by category but generally are found to occur approximately five years from initial operating capability. The regression model explains 89.01 per cent of the variance in the data set when predicting median O&S CPTAI. Aircraft type, location of lead logistics center and unit cost are the three largest contributing factors
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