Major Home Appliances, 2011

If you haven’t been in the market for new appliances during the past several years, you’re going to be surprised at how innovative and energy-efficient appliances have become. You’ll find energy-smart appliance choices in almost all price ranges. Before heading to the local appliance retailer or “big-box” store, measure the space the new appliance will occupy to make sure it will fit—and that there’s enough room to fully open the door (or lid), as well as adequate clearances for ventilation, plumbing connections and other hookups. Then go to the appliance manufacturers’ Web sites to look at product information, and make a list of questions and “must-have” and “nice-to-have-but-not-essential” features.

Traumatologie de la personne âgée : une urgence nutritionnelle ? [Elderly orthopedic patients: Is nutritional support needed?]

La fracture de hanche chez la personne âgée reste un problème de santé publique. Elle est la conséquence d'une chute neuf fois sur dix et survient chez des personnes fragilisées par une ostéoporose, une sarcopénie, une dénutrition. Dans un service de traumatologie, la dénutrition protéino-énergétique est fréquente. Présente dès l'admission chez environ un patient sur deux, elle va souvent s'aggraver pendant le séjour hospitalier et favoriser la survenue de complications. Une prise en charge nutritionnelle doit impliquer une équipe multidisciplinaire qu'il faut coordonner. Elle doit être envisagée précocement pendant le séjour hospitalier et privilégier la voie orale. L'assistance nutritionnelle sous forme de CNO a prouvé son efficacité dans la réduction de la morbidité postopératoire. Son impact sur la mortalité, sur le pronostic fonctionnel et social reste discuté. Il faudra attendre l'étude de nouvelles cohortes dans lesquelles la compliance au traitement est nettement améliorée avant de conclure de manière définitive.

Optimal culture incubation time in orthopedic device-associated infections: a retrospective analysis of prolonged 14-day incubation.

Accurate diagnosis of orthopedic device-associated infections can be challenging. Culture of tissue biopsy specimens is often considered the gold standard; however, there is currently no consensus on the ideal incubation time for specimens. The aim of our study was to assess the yield of a 14-day incubation protocol for tissue biopsy specimens from revision surgery (joint replacements and internal fixation devices) in a general orthopedic and trauma surgery setting. Medical records were reviewed retrospectively in order to identify cases of infection according to predefined diagnostic criteria. From August 2009 to March 2012, 499 tissue biopsy specimens were sampled from 117 cases. In 70 cases (59.8%), at least one sample showed microbiological growth. Among them, 58 cases (82.9%) were considered infections and 12 cases (17.1%) were classified as contaminations. The median time to positivity in the cases of infection was 1 day (range, 1 to 10 days), compared to 6 days (range, 1 to 11 days) in the cases of contamination (P < 0.001). Fifty-six (96.6%) of the infection cases were diagnosed within 7 days of incubation. In conclusion, the results of our study show that the incubation of tissue biopsy specimens beyond 7 days is not productive in a general orthopedic and trauma surgery setting. Prolonged 14-day incubation might be of interest in particular situations, however, in which the prevalence of slow-growing microorganisms and anaerobes is higher.

Accurate and early diagnosis of orthopedic device-related infection by microbial heat production and sonication.

Proper and rapid diagnosis of orthopedic device-related infection is important for successful treatment. Sonication has been shown to improve the diagnostic performance. We hypothesized that the combination of sonication with a novel method called microcalorimetry will further improve and accelerate the diagnosis of implant infection. We prospectively included 39 consecutive patients (mean age 59 years, 62% males) at our institution from whom 29 orthopedic prostheses and 10 osteosynthesis material were explanted. The explanted device was sonicated. The resulting sonication fluid was analyzed using microcalorimetry. Using standardized criteria to define orthopedic device-related infection, 12 cases (31%) were defined as infected. In all, positive periprosthetic tissue cultures were found. The sensitivity and specificity of microcalorimetry of sonication fluid were 100% and 97%, respectively. Mean time to detection, defined as time to reach a rising heat flow signal of 20 µW measured after equilibiration needed to get accurate measurement, was 10.9 h. In summary, microcalorimetry of sonication fluid is a reliable and a fast method in detecting the presence of microorganisms in orthopedic device-related infection. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1700-1703, 2013.

Care related pain in rehabilitation after orthopedic trauma: An exploratory study with qualitative data.

OBJECTIVE: Care related pain (CRP) is generally under-estimated and rarely studied in rehabilitation as well as in general medecine. Beliefs about pain influence psychological distress, adjustment to pain and physical disability. In this sense, perceptions of CRP could limit recovery. This exploratory study aims to understand patients' and caregivers' subjective perceptions and beliefs about CRP. PATIENTS AND METHODS: Questionnaires about CRP were submitted to members of the interdisciplinary team of a rehabilitation hospital and to patients with musculoskeletal complaints (cross-sectional design). Twenty patients were also individually interviewed (qualitative data). Four topics were addressed: frequency of CRP, situations and procedures causing CRP, beliefs about CRP and means used to deal with CRP. RESULTS: Seventy-five caregivers and 50 patients replied to the questionnaire. CRP is a very common experience in rehabilitation and it is recognized by both groups. Generally, the situations causing CRP reflect the specificity of rehabilitation (mobilization...) and are similarly perceived by patients and caregivers, with patients considering them as more painful. Beliefs about CRP are clearly different from those usually associated with pain. Both groups point out the utilitarian and the inevitable character of CRP. They differ on that, that patients had a more positive view about CRP. They associate it more often with progress and see it as acceptable at least until a certain limit. They are also able to perceive the richness of means used by physiotherapists to help them coping with CRP. CONCLUSION: Our data may suggest new keys to motivate patient to be active in rehabilitation for example in choosing carefully arguments or words which may fit theirs' beliefs about CRP, or in using various means to manage CRP. Promoting the use of relational competences with chronic pain patients and of a patient-centred approach may also be a concern in training caregivers.

Implementation of a perioperative management protocol for patients undergoing orthopedic surgery

OBJECTIVE: To evaluate the initial results after the implementation of perioperative protocol in patients over 60 years of age undergoing surgical treatment for femur fractures.METHODS: We conducted a prospective study of patients older than 60 years who were hospitalized with femur fracture. They were operated under spinal anesthesia and analgesia by lumbar plexus blockade. Data evaluation was performed before arrival in the operating room during surgery, in the post-anesthesia recovery room and in the ward the next morning of the operation.RESULTS: 105 patients underwent various types of surgical corrections of the femur. The hospital stay ranged from three to 86 days. Fasting ranged from 9h15min to 19h30mn. Hypotension occurred in 5.7%. The duration of motor blockade ranged from 1h45min to 5h30imn. Maltodextrin feeding ranged from 50min to 3h45min and the time spent in the post-anesthetic care unit ranged from 50 minutes to 4 hours. Onset of oral intake in the ward ranged from 4hto 8h15min. The duration of anesthesia ranged from 14 to 33 hours. No patient required a urinary catheter, nor was transferred to the ICU. All patients were able to be discharged on the first postoperative day.CONCLUSION: The use of a protocol to accelerate the postoperative period may reduce the fasting time, length of hospital stay and provide faster i discharge n elderly patients with femur fractures.

Study of Control Methods of a High-Frequency Cycloconverter for Domestic Induction Heating Appliances

A high-frequency cyclonverter acts as a direct ac-to-ac power converter circuit that does not require a diode bidge rectifier. Bridgeless topology makes it possible to remove forward voltage drop losses that are present in a diode bridge. In addition, the on-state losses can be reduced to 1.5 times the on-state resistance of switches in half-bridge operation of the cycloconverter. A high-frequency cycloconverter is reviewed and the charging effect of the dc-capacitors in ``back-to-back'' or synchronous mode operation operation is analyzed. In addition, a control method is introduced for regulating dc-voltage of the ac-side capacitors in synchronous operation mode. The controller regulates the dc-capacitors and prevents switches from reaching overvoltage level. This can be accomplished by variating phase-shift between the upper and the lower gate signals. By adding phase-shift between the gate signal pairs, the charge stored in the energy storage capacitors can be discharged through the resonant load and substantially, the output resonant current amplitude can be improved. The above goals are analyzed and illustrated with simulation. Theory is supported with practical measurements where the proposed control method is implemented in an FPGA device and tested with a high-frequency cycloconverter using super-junction power MOSFETs as switching devices.

Evaluation of hemostatic changes using thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgery

The effects of Ringer lactate, 6% hydroxyethyl starch (HES) (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% HES 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (α), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the α angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the α angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, α angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.

Post orthodontic effects of SARPE on sleep-disordered breathing in young adults as observed in a sleep laboratory

Introduction: L’expansion palatine du maxillaire a beaucoup d’effets positifs sur la respiration et la qualité du sommeil, mais peu d'études ont examiné ces données sur des adultes ayant dépassé l’âge permettant de bénéficier d'une expansion palatine conventionnelle. Le but de cette recherche est d’évaluer la stabilité de l’EPRAC (expansion palatine rapide assistée chirurgicalement) et son effet sur les troubles respiratoires après l’ablation des appareils orthodontiques. Méthodes: Neuf patients (Âge moyen 21, entre 16-39 ans) nécessitant une EPRAC ont passé des nuits dans un laboratoire de sommeil, et ce avant l’EPRAC, après l’EPRAC, et après l’ablation des appareils fixes. Les radiographies céphalométriques postéroantérieures ainsi que les modèles d’étude ont été pris pendant ces trois périodes de temps. Résultats: L’analyse des modèles d’étude a démontré une récidive significative au niveau des distances inter-molaires et inter-canines au niveau du maxillaire seulement. Les analyses céphalométriques ont démontré une récidive au niveau de la largeur maxillaire. Aucun changement important n'a été observé dans les stades de sommeil, mais une réduction importante dans l’index de ronflement a été notée. De plus, il y avait moins de changements entre les stades de sommeil. Conclusions: La récidive squelettique est minime et cliniquement non significative. Par contre, les changements dans les distances intermolaires et intercanines sont cliniquement importants. Il semble également qu'une EPRAC ait un effet positif sur la qualité de sommeil par la réduction de l’indice de ronflement ainsi que sur la diminution des changements entre les stades de sommeil.

Effets sur l'articulation temporo-mandibulaire du Twin-Block et d'un appareil myofonctionnel de classe II.

Introduction. Ce projet de recherche consiste en une étude cohorte prospective randomisée visant à évaluer les douleurs ressenties au niveau de l’articulation temporo-mandibulaire (ATM) lors d’une thérapie d’avancement mandibulaire grâce à un appareil fixe, le correcteur de classe II (CC) et d’un appareil amovible, le Twin-Block (TB). Matériels et méthodes. Cette étude comptait 26 patients (11 hommes et 15 femmes), âge moyen de 12ans 10mois (10ans 4mois à 15ans 10mois). Les sujets devaient avoir une malocclusion de classe II et être en croissance, CVM 2 ou 3 (Cervical Vertebral Maturation). Les patients étaient divisés en deux groupes : TB et CC. La douleur était évaluée selon l’axe I de l’examen du RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders) à 7 reprises (T0 à T6). De plus, le patient devait remplir un questionnaire, à la maison, sur la douleur ressentie et la médication prise lors des 30 premiers jours. La douleur était évaluée avant l’insertion des appareils (T0), à 1 semaine (T1) post-insertion, 4 semaines plus tard (T2), 8 semaines (T3) où une expansion de 20 tours (environs 5 mm) était débutée, ensuite (T4) (T5) et (T6) chacun à 8 semaines d’intervalles. Les tests statistiques utilisés dans cette étude : le test «Wilcoxon à un échantillon» ainsi que le test «Mann-Whitney à échantillons indépendants ». Résultats et Discussion. La douleur à l’examen clinique est variable mais tend à diminuer avec le temps. Aucune différence, statistiquement significative, ne fut observée entre les 2 groupes en ce qui à trait aux diverses palpations effectuées. Parmi les patients ayant rapporté de la douleur, 40% l’ont ressentie surtout le matin et 63,3% ont dit qu’elle durait de moins d’une heure jusqu’à quelques heures. Conclusion. D’après nos résultats, lors d’une thérapie myofonctionnnelle, il n’y a pas de différence statistiquement significative entre la douleur occasionnée par un Twin-Block et celle produite par un correcteur de classe II fixe au niveau de l’ATM et des muscles du complexe facial.

Assessing the benefits of domestic hot fill washing appliances

Washing machine and dishwasher appliance use accounts for approximately 10% of electricity demand in EU households. The majority of this demand is due to the operation of electric heating elements inside appliances. This paper investigates the potential benefits that can be realised by adding a hot fill connection to washing appliances, with respect to carbon emissions, demand side management and renewable energy integration. Initial laboratory testing of new hot and cold fill appliances has resulted in modifications to optimise hot fill intake, and a novel numerical model presents a method of characterising appliance electricity use in different configurations. In order to validate model findings and test the use of new hot fill appliances in situ, a pilot study has recorded appliances’ resource consumption at one-minute resolution in fourteen households. The addition of hot fill reduced the total dishwasher and washing machine electricity consumption by 38% and 67% respectively. Depending on how hot water is supplied to appliances it is estimated that hot fill use results in an annual household carbon saving of up to 147 kgCO2. Further to direct electricity reduction, hot fill appliances can offer a method of time shifting demand away from peak periods without inconveniencing occupants’ lifestyles.

New material for orthopedic implants: Electrochemical study of nickel free P558 stainless steel in minimum essential medium

Nickel, a component of stainless steels (SS) applied in orthopedic implants may cause allergic processes in human tissues P558 nickel free SS was studied to verify its viability as a substitute for stainless steel containing nickel Its performance is compared to ISO 5832-9 and F138 most used nowadays grades in implants fabrications, in minimum essential medium. MEM, at 37 degrees C. Potentiodynamic polarization curves, electrochemical impedance spectroscopy (EIS), scanning electron microscopy (SEM) and ""in vitro"" cytotoxicity were used as techniques. From the electrochemical point of view P558 SS is comparable to ISO 5832-9 SS in MEM It remains passivated until the transpassivation potential, above which generalized corrosion occurs F138 presents pitting corrosion at 370 mV/SCE. The cytotoxicity results showed that P558. ISO 5832-9 and F138 do not present cytotoxic character Therefore, these results suggest that P558 SS can be applied in orthopedic implants (C) 2010 Elsevier BV All rights reserved

Acumulação de competências tecnológicas e os processos subjacentes de apredizagem: o caso da Invensis Appliances Controls Unidade Vacaria - RS

Esta dissertação enfoca o relacionamento entre acumulação de competências tecnológicas e os processos subjacentes de aprendizagem. Este relacionamento é examinado na empresa Invensys Appliance Controls Ltda. - Unidade de Vacaria/RS, durante o período de 1981 a 2000. Trata-se de uma empresa metal-mecânica, fornecedora da indústria de linha branca. Em outras palavras, a dissertação examina as implicações dos processos subjacentes de aprendizagem tecnológica para a acumulação de competências para três funções tecnológicas: processo e organização da produção, produtos e equipamentos. Os processos de aprendizagem são examinados à luz de quatro características: variedade, intensidade, funcionamento e interação, a partir do uso de estruturas de análise existente na literatura. Baseado em estudo de caso individual, este estudo encontrou que a maneira e a velocidade de acumulação de competências tecnológicas na empresa estudada estão associadas aos diversos processos usados para adquirir conhecimento tecnológico e convertê-lo em organizacional. Ademais, a simples incidência desses processos na empresa não garantiu na empresa uma implicação positiva para a acumulação de competências tecnológicas. Através do uso de estrutura existente na literatura, porém aplicada a uma indústria diferente de estudos anteriores, esta dissertação sugere que deve existir um esforço organizado, contínuo e integrado para geração e disseminação de conhecimento em toda a empresa a fim de que a acumulação de capacitação tecnológica seja acelerada na empresa.