Greater Risk Of Failure Research Articles

Experimental Investigation of Bridge Scour under Pressure Flow Conditions

Recent studies have revealed that the frequency and magnitude of floods tend to increase due to climate change. Hence, excessive scouring due to flood events puts river bridges at greater risk of failure. This paper presents the initial findings of an experimental study to improve the understanding of the main characteristics of bridge pier scour under pressurized flow encountered during flooding. The experiments were carried out in four main groups according to two deck alignments with circular and oblong pier shapes. For each group of experiments, thirty-six tests were conducted under partially and fully pressurized flow conditions using four approach flow depths and three discharge values. The validity of the structured design approach for pier scour estimation implemented in the guidelines was investigated. The results showed that the bridge pier scour depths were up to 29.4% and 49.4% greater than the sum of the vertical contraction and local scour depths for 100 L/s for partially and fully pressurized flow conditions, respectively. However, as the discharge increased to 120 L/s, the bridge pier scour depth became 38.3% and 17.8% smaller than the sum of the vertical contraction and local scour depths for partially and fully pressurized flow, respectively. So, the structured design approach was determined to be safe for high discharge values. Furthermore, it was found that tests with a circular pier resulted in higher bridge pier scour depths than the sum of the vertical contraction and local scour depths up to 19.3% even for 120 L/s. Conversely, smaller bridge pier scour depths than the sum of the vertical contraction and local scour depths were observed up to 17.8% for tests with oblong piers. Thus, it can be concluded that the pier shape has a profound effect on scour holes and oblong piers cause smaller scour depths than circular piers in pressurized flow conditions. This study showed that the flow–pier–deck interaction significantly affects the depth and width of the scour hole, especially for small discharges and fully pressurized flow conditions.

Hygrothermal response of a wood-frame thick-wall assembly to rainwater wetting under future climate scenarios in Canada

Current exterior wall assembly designs for new low-rise residential buildings targeting low-energy demand in heating dominated countries include split-insulation wall and thick-wall assembly designs. Both have been shown to result in thermal efficiency gains compared to building-code minimum assemblies, however long-term hygrothermal performance can vary depending on boundary conditions and the presence of construction deficiencies. Future climate scenarios estimate many heating-dominated climates will experience a reduction in heating-degree day hours and an increase in annual rainfall. Using validated assembly performance data from a Passive House certified facility, a sensitivity analysis is performed to determine the impact of rainwater wetting, air exfiltration and insulation material properties on the hygrothermal response of a thick-wall assembly. Results show that rainwater leakage values of 0.50% and greater of the adhering rainfall on the exterior surface of the assembly results in the greatest risk for failure. The hygrothermal response of the assembly is then examined under a global temperature rise scenario of 3.5°C for five geographic locations across Canada. Results show that an increase in average annual total rainfall does not directly result in an increase in the failure rate of the assembly when a rainwater leak is present. Additional climatic factors, including outdoor air temperature, driving rain and solar radiation received will influence the hygrothermal response of the assembly and need to be considered when modelling the performance under future climate change scenarios.

To Remplissage or not to Remplissage Part 2: Recurrent Instability After Primary Stabilization Surgery (RIPSS) Risk Tool Assesses Preoperative Failure Rates in On-track Shoulders Undergoing Primary Arthroscopic Anterior Stabilization with or without Remplissage Augmentation

Objectives: Given the high rates of recurrent instability following the initial arthroscopic Bankart repair (ABR), it is crucial to provide recommendations for appropriate surgical interventions for patients at a higher risk of experiencing recurring instability. In Part 1 of the study, it was discovered that on-track Hill-Sachs lesions (HSL) with specific prognostic factors (i.e., younger age, increased shoulder laxity, lower DTD, and 2+ preoperative instability events) were associated with a greater risk of failure. Therefore, the objective of Part 2 was to develop a risk assessment tool that takes into account significant prognostic factors for recurrent shoulder instability following primary ABR and evaluate the role of remplissage augmentation given a patient’s risk profile. Methods: We retrospectively reviewed prospectively collected data of consecutive patients aged 14-40 who underwent either ABR (arthroscopic Bankart repair) or ABR+R (ABR with remplissage) procedures between 2013 and 2021 for anterior glenohumeral instability. Preoperative magnetic resonance imaging was used to determine the values of glenoid bone loss, Hills-Sachs Interval (HSI), glenoid track (GT), and distance-to-dislocation (DTD). On-track lesions have a distance-to-dislocation (DTD) value greater than zero. In addition, within the category of on-track lesions, there is a subset known as “near-track” lesions, with a DTD ranging from 0 to 10 mm. Capsuloligamentous laxity scores were categorized according to hyperlaxity status, defined as external rotation greater than 85 degrees and/or grade 2+ posterior and inferior load-and-shift on examination under anesthesia. Recurrent shoulder instability was defined as recurrent dislocation and/or subjective subluxation postoperatively. Patients were excluded if the indexed surgery was a revision procedure, < 2-year follow-up, or glenoid bone loss (GBL) >20%. A final multivariate survival analysis was constructed using categorical prognostic factors (i.e., patient age, “near-track” status, hyperlaxity, and 2+ preoperative instability episodes) identified in Part 1, while adjusting for GBL. Although contact athlete status was not identified as a significant predictor of recurrent shoulder instability in Part 1, the final model stratified by contact athlete status given its established importance in prior literature. Multivariate hazard ratio estimates were utilized to create a risk assessment tool and correlated with patient-specific risk estimates via post-estimation analysis. Results: One-hundred-and-fifty-five patients were included for analysis (ABR: 116 | ABR+R: 39) with an average age of 21.6 ± 6.2 years and an average follow-up of 5.1 ± 2.0 years (range: 2.0 – 8.7 yrs). Patients with near-track lesions had a three-fold higher risk of recurrent instability (Hazard Ratio [HR]: 2.5, p = 0.03) compared to on-track HSL with DTD > 10mm. Individuals with evidence of hyperlaxity exhibited a five-fold increased risk (HR: 5.4, p=0.03) relative to patients without hyperlaxity. Younger patient groups had twice the risk of recurrent shoulder instability (HR: 2.2, p=0.003) compared to older adjacent groups. Patients with two or more preoperative recurrent instability episodes faced a four-times greater risk (HR: 4.2, p=0.004) for recurrent shoulder instability compared to patients who experienced a single instability event preoperatively. Lastly, patients who underwent primary ABR only had almost 10-times greater risk of recurrent shoulder instability (HR: 9.5, p=0.002) than those who underwent primary ABR+R. The Recurrent Instability after Primary Shoulder Stabilization (RIPSS) risk assessment score considers patient age, near-track status, hyperlaxity, preoperative instability episodes, and surgical technique (ABR vs. ABR+R) as important prognostic indicators, Table 2. The RIPSS score was created with risk stratifying subgroups: Low-risk (0 – 2), Moderate-risk (3 – 6), High-risk (7 – 9), and Extreme-risk (10+). Figure 1 illustrates a strong correlation between patient RIPSS scores with patient-specific hazard ratio estimates derived from the multivariate Cox regression modeling computed in “To Remplissage or not to Remplissage Part 1”. According to RIPSS score subgroups, recurrent shoulder instability rates range from 4.3% among low-risk groups to 54.6% among extreme-risk groups, Figure 1. Conclusions: Patients with a low-risk RIPSS score without ABR+R may not benefit from remplissage augmentation. Their risk for recurrent instability would remain low despite the addition of remplissage. However, patients with a high- or extreme-risk RIPSS score prior to considering ARB+R would likely benefit from remplissage supplementation. The RIPSS score may be an effective risk assessment tool that may help identify patients who may benefit from a primary Bankart repair with remplissage augmentation. The risk assessment tool developed may optimize surgical treatment and allow physicians to determine patient risk scores with and without remplissage augmentation.

Success rate and predictors of failure of enema reduction of intussusception in children with a water-soluble contrast medium at a height of 120 cm or less.

This study investigates the reduction rate and failure predictors of hydrostatic enema reduction for intussusception. The procedure typically begins with a water-soluble contrast medium at 90 cm above the patient, subsequently elevated to 120 cm. Our focus is on the reduction rate during initial attempts when the contrast medium is positioned at or below 120 cm from the patient. Hydrostatic enema reductions for intussusception, performed between March 2010 and May 2022 at Tokyo Metropolitan Children's Medical Center, were investigated retrospectively. The initial attempts involved one or more trials. The clinical characteristics, treatment modalities, and outcomes were analyzed. Logistic regression was used to identify the predictors of failure when the reduction was performed with the water-soluble contrast medium at a height of 120 cm or less. Reduction was achieved successfully with the water-soluble contrast medium at a height at or below 120 cm in 77.5% of 351 patients. When reductions performed at heights greater than 120 cm were included, 333 (94.9%) were successful during the initial attempts and were unaccompanied by complications. Predictors of failure of reductions performed at or below 120 cm were age less than 12 months and the presence of trapped fluid. The present study found a successful reduction rate of 77.5% during the initial attempts, suggesting that a height greater than 120 cm may yield an even greater success rate. Children aged below 12 months and those with trapped fluid may have a greater failure risk during the initial attempts.

Humerus fractures: selecting fixation for a successful outcome.

Current evidence suggests at least one-third of humeral shaft fractures initially managed nonoperatively will fail closed treatment, and this review highlights surgical considerations in those circumstances. Although operative indications are well-defined, certain fracture patterns and patient cohorts are at greater risk of failure. When operative intervention is necessary, internal fixation through an anterolateral approach is a safe and sensible alternative. Determining which patients will benefit most involves shared decision-making and careful patient selection. The fracture characteristics, bone quality, and adequacy of the reduction need to be carefully evaluated for the specific operative risks for individuals with certain comorbid conditions, inevitably balancing the patient's expectations and demands against the probability of infection, nerve injury, or nonunion. As our understanding of the etiology and risk of nonunion and symptomatic malunion of the humeral diaphysis matures, adhering to the principles of diagnosis and treatment becomes increasingly important. In the event of nonunion, respect for the various contributing biological and mechanical factors enhances the likelihood that all aspects will be addressed successfully through a comprehensive solution. This review further explores specific strategies to definitively restore function of the upper extremity with the ultimate objective of an uninfected, stable union.

Cheilectomy Alone in Patients With Elevatus Yields Poor 5-Year Survival Rate

This study was performed to evaluate the efficacy of the cheilectomy procedure for different degrees of elevatus. The study was Institutional Review Board approved and patients were evaluated retrospectively at Ascension St. John Hospital, St. John Surgery Center and St. John Macomb Township Surgery Center between 9/8/2012 and 1/8/2016. These were all performed by the same surgeon. The pre- and postoperative radiographs were analyzed and Seiberg's index was calculated. Charts were also reviewed, and demographic information was obtained. A telephone survey was performed, and Visual Analog Pain score and Foot and Ankle Ability Measure was obtained. Body mass index, age, calcaneal inclination angle, Seiberg's index, Foot and Ankle Ability Measure, and visual analog score were analyzed using chi-square test, bivariate regression analysis and independent t test. Seiberg's index had a statistically significant influence on 5-year survival rate for the cheilectomy procedure (p ≤ .05). For patients with Seiberg's index less than 0.20 cm demonstrated FAAM, and VAS p values .18 and .37 with 87.0% 5-year survival. Seiberg's index between 0.20 and 0.40 cm had FAAM and VAS scores with p values <.01 and .02 with 62.0% 5-year survival. Seiberg's index ≤0.40 cm p values <.01 and .55 with 5-year survival rate of 0.0%. Therefore, if Seiberg's index is greater than 0.20 cm based on this research a cheilectomy alone as a sole treatment is at greater risk of failure.

Using in-class group assignments to improve low-achieving students’ performance in an introductory accounting course

ABSTRACT In the United States, a high portion of students do not pass their introductory accounting courses. In this study, In-class Group Assignments (IGAs) that require students to work in small groups are used to supplement traditional lectures in Introductory Managerial Accounting. In two groups of students attending this course, four experimental IGAs are given to one group (treatment group) but not the other (control group) to assess the pedagogy’s effectiveness, especially for low-achieving students at greater risk of failure. Results on student performance for exam questions related to topics of these IGAs are consistent with improved performance among low-achieving students. Additional evidence suggests that students view IGAs favorably and use them to study for exams. IGAs could be a solution for improving performance among low-achieving, less motivated students who enroll in introductory accounting across countries.

Treating Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries Operatively in the Acute Setting Is Potentially Advantageous

Combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) remains among the most common knee injury patterns in orthopaedics. Optimal treatment of grade III MCL injuries is still debated, especially when combined with ACL injury. Most patients with these severe injuries are treated conservatively for at least 6 weeks to allow for MCL healing, followed by delayed ACL reconstruction. Although acute treatment of the MCL was common in the 1970s, postoperative stiffness was frequently reported. Moreover, studies of such treatment failed to show clinical benefits of surgical over conservative treatment, and the MCL exhibited intrinsic healing capacity, leading to the consensus that all MCL injuries are treated conservatively. The current delayed treatment algorithm for ACL-MCL injuries has several disadvantages. First, MCL healing may be incomplete, resulting in residual valgus laxity that places the ACL graft at greater risk of failure. Second, delayed treatment lengthens the overall rehabilitation period, thereby prolonging the presence of atrophy and delaying return to preinjury activity levels. Third, the initial healing period leaves the knee unstable for longer and risks further intra-articular damage. Acute simultaneous surgical treatment of both ligaments has the potential to avoid these shortcomings. This article will review the evolution of treatment of ACL-MCL injuries and explain how it shifted toward the current treatment algorithm. We will (1) discuss why the consensus shifted, (2) discuss the shortcomings of the current treatment plan, (3) discuss the potential advantages of acute simultaneous treatment, and (4) present an overview of the available literature.

Novel biomarkers predict ablation outcomes in long stranding persistent atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Background Ablation of long-standing persistent atrial fibrillation (LSPAF) is not always successful. The arrhythmia burden was reduced by 75% by 12 months in majority (72%) of patients with LSPAF who underwent surgical or percutaneous ablation in the CASA-AF trial. We hypothesised that biomarker(s) improve prediction of clinical success and offer insights into mechanisms. Objective To identify biomarkers that predict success (75% arrhythmia burden reduction) after ablation for LSPAF at 12-months. Methods Amongst patients participating in the CASA-AF RCT (ISRCTN18250790), pre-ablation serum samples were selected for 20 patients who met criteria for ablation-success at 12 months, and 20 who did not. Olink ProteomicsTM (Sweden) provided analyses using three biomarker panels [inflammation (INFL), cardiovascular III (CVD III), and cell cytology (CELL)] each containing 92 biomarkers. Univariate and multivariable analyses were adjusted for age, sex, BMI, LA diameter and CRP. ROC analysis was undertaken to assess the diagnostic accuracy of the biomarkers. To counter the false discovery rate, Benjamini-Hochberg correction was utilised. Results When patients with ablation-success and -failure were compared, no differences in demographics or cardiac function were found. On univariate analysis, several biomarkers in each panel were associated with ablation-success. Multivariable analysis narrowed the range of biomarkers and identified those that were jointly predictive of outcome: INFL (MCP1 + CD8A + CD40, Figure 1), CVD III (FAS + CPB1) and CELL (GCG + ENTPD6 + IL17RB). These joint biomarkers were analysed using ROC (Figure 2), which showed that increases of biomarkers on the INFL panel (MCP1 + CD8A + CD40) were associated with a greater risk of failure and achieved the highest AUC for prediction of outcome [0.82 (0.75-0.87)]. Conclusion The increase in the serum concentration of markers of inflammation (MCP1 + CD8A + CD40) might be used to identify patients less likely to have sustained benefit from LSPAF ablation. Further studies are required to confirm their prognostic value as pre-procedural biomarkers.

C84 PERCUTANEOUS TREATMENT OF INTERATRIAL MULTIFENESTRATE ANEURYSM IN PAEDIATRIC POPULATION: INFLUENCE OF THE LAYOUT DURING MID–TERM AND LONG–TERM FOLLOW–UP

Abstract Background Multifenestrate aneurysms of interatrial septum (ISA) are a challenge in paediatric age, not only for the complex anathomy, but also for small body surface and small dimensions of cardiac chambers of the patients, that may limit the use of large and multiple devices. Aim of the study: to evaluate the efficacy of percutaneous closure of multifenestrate aneurysms during mid–term and long–term follow–up; to evaluate if the morphological characteristics of interatrial septum may influence the success of the procedure. Materials and Methods We retrospectively analyzed 63 patients (mean–age 9,12±3,12 years) undergone to cardiac catheterism from 2000 to 2021, for percutaneous closure of interatrial aneurysm in our division of Cardiology, subdivided into 3 groups on the basis of side and morphological characteristics of the interatrial aneurysm: Group I (2 o more defects DIA&amp;gt;5 mm); Group II (one defect &amp;gt;5 mm and more than one further fenestrations); Group III (multiple fenestrations). Results Percutaneous closure was efficacy in 60 patients (95%), while in 3 patients (5%) surgery closure was necessary. In half of the treated patients (30) we used 2 devices. Complications occurred in 4 patients (6%). Only in 2 patients occurred major complications (Atrio–Ventricular Block that needed PMK implantation and partial displacement of device, treated by removal and percutaneous replanting). Residual shunts, not emodynamically significant appear in the immediate post–operative period in 26% and during the follow–up in 18%. The group I was associated with greater risk of failure of the procedure (P &amp;lt; 0.01) and need of implantations of more than one devices (P &amp;lt; 0.01). Conclusions Percutaneous closure of multifenestrate aneurysm of interatrial septum in paediatric age are effective and shows low incidence of failure and complications. If is present residual shunt is not significant. The anathomy of interatrial septum influences procedural outcome.

Impact of hybrid layer formation on the 15-year survival, complications, and failures of full-coverage retainers

To compare the effect of 4-META/MMA-TBB resin, which can provide hybrid layer formation, and acid-base cements on survival, complications, and failure risks of full-coverage retainers evaluated for 15 years. A total of 1,161 abutment teeth in 260 patients treated with at least one single crown or fixed partial denture were recalled for clinical examination. Survival was defined as not having undergone extraction of abutments or renewal of prostheses. Secondary caries, pulp necrosis, or prosthesis detachment were recorded as complications. Survival and complications rates were analyzed using the Kaplan-Meier method and log-rank test. Multivariable analysis of factors associated with failure or complications using Cox's proportional hazard regression model was performed (α = 0.05). Significant differences were observed in survival (p = 0.007), secondary caries (p = 0.000), and prosthesis detachment (p = 0.025) complications between luting agents. The 5-, 10-, and 15-year survival rates for 4-META/MMA-TBB resin were 95.2%, 90.5%, and 90.5%, while those of acid-base cements were 93.2%, 80.6, and 67.4%, respectively. Secondary caries and prosthesis detachment complications for 4-META/MMA-TBB resin were 1.9% and 0.5%, whereas those for acid-base cements were 15.2% and 4.3% respectively. Acid-base cements were associated with a 1.664-, 2.950-, 3.333-, and 4.444-times greater risk of failure, prosthesis renewal, secondary caries, and prosthesis detachment, respectively. 4-META/MMA-TBB resin has higher long-term survival rate with lesser caries, and prosthesis detachment than acid-base cements. The ability of this resin to create an acid-base resistant hybrid layer may contribute to a life-long function of tooth abutment.

E-Government, Governance and Corruption in Asian countries

In developing countries, the implementation of e-government is at greater risk of failure when the corruption is still high. This paper examines the effect of e-government on the level of corruption in 47 developing countries in Asia using E-Government Development Index which is divided into components of online service, human capital, telecommunication infrastructure and e-participation. This paper also places the role of governance in government to moderate the relationship between e-government and perceptions of corruption. The result shows that implementation of e-government and governance has increased the perception of corruption with telecommunications infrastructure has the most significant effect.

Understanding the limits to forming policy-driven markets in the electricity sector

The formation of policy-pushed markets has been underexamined in the transition literature, despite their importance for achieving sustainability policy objectives and their greater risk of failure. This study draws from service-dominant logic, i.e., a marketing-originated meta-theory of markets, to explain why one of these policy-pushed markets—local energy flexibility markets—may not develop. In particular, we show that to decide whether to participate in these policy-pushed markets, market actors assess the resources available to them, anticipate the required interactions to integrate resources, and forecast potential value formation. Actors’ limited ability to identify or access resources, and/or their unwillingness or inability to interact with other actors to integrate resources explain why value processes do not unfold so that the market does not develop. We also demonstrate that existing institutional arrangements may limit actors’ agency to access to resources or coordinate value flows, which prevents the policy-pushed market from self-adjustment.

Medium, Small and Medium Enterprises and Digital Platforms

A new business platform is a must for companies that are disrupting new media technology, especially during the Covid 19 era. However, many incumbent companies are less able to keep up with changing business trends. Anticipate all changes in the competitive climate in the digital era in carrying out the company transformation program along with the implementation of good corporate governance values to avoid oral hazards and a greater risk of failure. The qualitative method used in this research is a case study approach. The analysis focuses on efforts to raise Medium, Small and Medium Enterprises (MSMEs) that contribute to improving the Indonesian economy. The findings show that credit, training, and mentoring programs have not been able to strengthen their position in small and medium enterprises but they are still working to increase the literacy index and financial inclusion to accelerate income distribution in Indonesia.

Perceived Stress, Personality Traits, and State of Victim's Consciousness: Impact on Tourniquet Application Time and Effectiveness.

One of the main avoidable causes of combat-related injury death is extremity hemorrhage. Even with regular training, failure to properly apply a tourniquet is common. In this study, we sought to assess if rescuer's stress and personality traits, along with victim's state of consciousness, had a role to explain tourniquet application failure. Eighty-seven soldiers completed a sociodemographic and personality questionnaire (perceived stress, active altruism, mindfulness, and empathy) during a forward combat casualty care course. Then, they underwent a leg hemorrhage simulation on a randomly conscious or unconscious victim. Tourniquet application time and effectiveness (using popliteal artery Doppler) were recorded. Tourniquet application effective rate was 37% and soldiers with higher levels of perceived stress were at greater risk of failure, especially on a conscious victim. Participants who deployed overseas and those who have undergone combat rescue training were significantly quicker to apply a tourniquet. Altruist and empathetic caregivers were slower to apply the tourniquet while mindful ones were faster. Combat-related injuries, even simulated, not only involve the rescuer's technical skills but also their ability to deal with stressful external stimuli. Tourniquet application speed seems to be influenced by perceived stress and personality traits of the rescuers. Frequent failures justify repeated training, and one way to pursue improvement could be to develop a personalized pedagogy adapting to the needs of the students according to their current skillset but also their perceived stress and personality determinants. In the pedagogical process (planning, goal setting, teaching, and evaluating), the state of consciousness of the victim seems to be a parameter that needs to be accounted for, but further studies are required to accurately describe its influence.

Risk of Conversion to Arthroplasty After Hip Arthroscopy: Validation of a Published Risk Score Using an Independent, Prospectively Collected Database

Background: Hip arthroscopy is rapidly advancing and increasingly commonly performed. The most common surgery after arthroscopy is total hip arthroplasty (THA), which unfortunately occurs within 2 years of arthroscopy in up to 10% of patients. Predictive models for conversion to THA, such as that proposed by Redmond et al, have potentially substantial value in perioperative counseling and decreasing early arthroscopy failures; however, these models need to be externally validated to demonstrate broad applicability. Purpose: To utilize an independent, prospectively collected database to externally validate a previously published risk calculator by determining its accuracy in predicting conversion of hip arthroscopy to THA at a minimum 2-year follow-up. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: Hip arthroscopies performed at a single center between November 2015 and March 2017 were reviewed. Patients were assessed pre- and intraoperatively for components of the THA risk score studied—namely, age, modified Harris Hip Score, lateral center-edge angle, revision procedure, femoral version, and femoral and acetabular Outerbridge scores—and followed for a minimum of 2 years. Conversion to THA was determined along with the risk score’s receiver operating characteristic (ROC) curve and Brier score calibration characteristics. Results: A total of 187 patients (43 men, 144 women, mean age, 36.0 ± 12.4 years) underwent hip arthroscopy and were followed for a mean of 2.9 ± 0.85 years (range, 2.0-5.5 years), with 13 patients (7%) converting to THA at a mean of 1.6 ± 0.9 years. Patients who converted to THA had a mean predicted arthroplasty risk of 22.6% ± 12.0%, compared with patients who remained arthroplasty-free with a predicted risk of 4.6% ± 5.3% (P < .01). The Brier score for the calculator was 0.04 (P = .53), which was not statistically different from ideal calibration, and the calculator demonstrated a satisfactory area under the curve of 0.894 (P < .001). Conclusion: This external validation study supported our hypothesis in that the THA risk score described by Redmond et al was found to accurately predict which patients undergoing hip arthroscopy were at risk for converting to subsequent arthroplasty, with satisfactory discriminatory, ROC curve, and Brier score calibration characteristics. These findings are important in that they provide surgeons with validated tools to identify the patients at greatest risk for failure after hip arthroscopy and assist in perioperative counseling and decision making.

Damage Detection in Composite Materials Using Tap Test Technique and Neural Networks

The wind energy sources promote the generation of electricity, being environmentally safe, clean and its use has been growing in Brazil, especially in the northeastern states with the implementation of new wind farms. Wind turbines, however, are subject to weather, risk of animal shocks, materials carried by the wind, and the vibrations of the system itself. The blade is the most important component of a wind turbine and is the one with the greatest risk of failure. They are usually made of a composite fiber-reinforced polymer matrix and balsa wood as structural reinforcement. As the material composing this blade has heterogeneous and anisotropic characteristics, conventional inspection techniques are not considered effective. The non-destructive Tap Test technique can be a safe option in composite materials because it does not suffer from these limitations. The objective of this work is to inspect composite plates of polymeric resin used in wind turbines with discontinuities using the non-destructive Tap Test technique, where regions with and without defect were analyzed. The collected signals from an accelerometer and a microphone were processed, to allow the extraction of features and the recognition of discontinuities with the aid of a neural network.

Slope Stability Analysis for Mine Hazard Assessment Using UAV

Slopes in open-pit mines are excavated to the steepest feasible angle for maximum profits, which involves a great risk of failure. Unmanned Air Vehicles (UAV) are emerging as new technology to provide information at a high spatial resolution which leads to fast and accurate qualitative results that can be used for stability analysis. The acquired images from the UAV flight plan are processed to produce Digital Elevation Model (DEM). Parameters of slope instability derived from DEM, namely slope, aspect along with inventory maps are fed as an input to Artificial Neural Network (ANN) models. ANNs have the ability to learn and generalize the knowledge on unseen data. Opencast mines in different areas are selected as training sites using random sampling. A feedforward back-propagation algorithm is implemented to analyze slope susceptibility, and the area is classified into four hazard-prone zones. Four input parameters, namely slope, aspect, drainage density and geological structures, are trained using the algorithm. The factors are rated based on the role played by each of them in causing slope failure. 20% of the training sites are selected for testing and 20% for validation purpose. Hazard-prone zones provide useful information regarding possible future which helps in drawing up measures for mitigation.

Real-world effectiveness of tofacitinib in patients with rheumatoid arthritis: a prospective observational study.

Tofacitinib is an approved treatment for rheumatoid arthritis (RA), but data on its use in the "real-world" are limited. We sought to analyse tofacitinib drug survival in the Israeli registry and compare it to other biologic agents. We included RA patients treated with tofacitinib, etanercept, golimumab, tocilizumab, or abatacept between 2010-2019. The primary endpoint was event-free survival (EFS), defined as the time from treatment initiation to a treatment failure event from any cause (i.e., inefficacy or intolerability). EFS was compared between agents using Cox regression and Kaplan-Meier analysis, stratifying patients by treatment line. A total of 964 eligible treatment courses were included (tocilizumab [325], etanercept [284], abatacept [127], tofacitinib [139], and golimumab [109]). In a univariate analysis, EFS with tofacitinib in the complete cohort was similar to etanercept, golimumab, and abatacept but was lower than tocilizumab) 3-year EFS 43% vs. 53%, HR 0.65). In a multivariable analysis, tofacitinib was similar to all other drugs, except for etanercept, which was inferior (HR 1.70); advanced treatment line was also associated with greater risk for failure (HR 1.64). In a univariable analysis stratified by the treatment line, tofacitinib had similar or better drug survival than other agents in the first and second lines. In the third line and beyond, tocilizumab had a higher EFS compared to tofacitinib (HR 0.57). Drug survival with tofacitinib is related to treatment line. Early introduction is associated with similar or better survival than other agents, whereas tocilizumab was superior in the third line or later.

The survival of the fittest in the global markets: multinational corporation challenge, evolution and decline

PurposeThe purpose of this perspective paper is to answer the question of why some multinational corporations (MNCs) do not evolve and fail to avoid retrogression by natural selection in international business (IB) and to introduce eight papers selected for this special issue.Design/methodology/approachThe authors conceptually discuss the reasons for MNC failure by illustrating key motivations behind foreign direct investment (FDI) undertaken by MNCs based on internalization theory, the OLI paradigm and the OILL (i.e. OLI plus the learning motivation) paradigm. Then, the authors develop an evolutionary perspective to explore the survival of the fittest in the global markets and the natural selection of MNCs.FindingsThe eight papers selected for this special issue expand the authors’ understanding of globalized organizations' challenges, evolution and decline as well as offering a distinct opportunity to reconsider diverse extant theories about MNCs by suggesting an extension that accounts for the rise of various globalized organizations particularly in and from emerging markets.Originality/valueDespite increased numbers of MNCs, which struggle to survive and are faced with great risk of failure, the authors’ understanding of them still remains in infancy. While scholars have investigated diverse topics related to MNCs, existing studies have developed theories predominantly emphasizing MNC success. Thus, conventional theories in IB such as internalization theory and the OLI paradigm may not be sufficiently applicable to explain the phenomenon of MNC failure (i.e. MNC decline). Based on authors’ discussions, the authors believe this is an appropriate time to refine mainstream IB theories by concurrently considering both evolution and retrogression.