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Improved energy efficiency can help reduce pollution, contribute to energy security, and help consumers save money. This paper explores energy labelling schemes as a policy instrument for promoting energy-efficient cars in Spain. Specifically, it explores consumer responses to changes in vehicle prices. We derive the demand responses for two different efficiency labelling schemes: absolute and relative. To that end, we calculate own- and cross-price elasticities of demand for cars with efficiency labels on the Spanish car market. The results show that the elasticities for more efficient cars are in general higher. However, in the specific case of sedans, the elasticities depend on assumptions about how consumers decide which car to purchase. If consumers are concerned about the absolute energy performance of cars independently of other attributes, and thus pay attention to absolute labelling, demand for more efficient cars is more elastic than demand for less efficient cars. If consumers choose the car segment first and then the energy performance, using the relative label, the opposite result is found. The results suggest that both relative and absolute labelling schemes can be useful, depending on how consumers make their decisions. It might also be possible to design a mixed system.

The success parameters for any company are on time completion, within specific budget and with requisite performance. In particular an efficient and effective inventory management helps a firm maintaining competitive advantage, especially in a time of accelerating globalization. From this point of view several organizations employ the ABC analysis to have an efficient control on a large number of inventory items. With the increasing levels of integration in manufacturing and service systems conventional ABC analysis is limited because it accounts for only one criterion, mostly “annual dollar usage”, for classifying inventory items. To alleviate this shortcoming, this paper proposes a modified version of ABC analysis and Cross Analysis based on Analytic Network Process, a multicriteria approach, that allows to consider several criteria all at once for the optimal choice of materials management.

Star-shaped gold nanoparticles (StarAuNPs) are extremely attractive nanomaterials, characterized by localized surface plasmon resonance which could be potentially employed in a large number of applications. However, the lack of a reliable and reproducible synthetic protocols for the production of StarAuNPs is the major limitation to their spreading. For the first time, here we present a robust protocol to manufacture reproducible StarAuNPs by exploiting a fluidic approach. Star-shaped AuNPs have been synthesized by means of a seed-less protocol, employing ascorbic acid as reducing agent at room temperature. Moreover, the versatility of the bench-top microfluidic protocol has been exploited to afford hydrophilic, hydrophobic and solid-supported engineered StarAuNPs, by avoiding intermediate NP purifications.

The first page of this article is displayed as the abstract., Rohit Chikkaraddy opened the discussion of the Introductory Lecture: Regarding quantifying the chemical enhancement, you showed a systematic change in the SERS enhancement for halide substituted molecules due to charge transfer from the metal. Is the extra enhancement due to an inherent increase in the Raman cross-section of the molecule? How do you go about referencing, as the charge transfer changes the vibrational frequency? Richard Van Duyne answered: The extra enhancement is not due to an increase in the Raman cross section, as that is ratioed out in the calculation of the enhancement factor. The charge transfer (CT) process does not transfer a complete electron, it is a fractional degree of CT. Thus the change in vibrational frequency is small. DFT calculations that provide eigenvectors allow one to reference the vibrational modes of the free molecule with those of the adsorbed molecule. Sylwester Gawinkowski asked: You have shown that the enhancement factor curve is redshifted relative to the plasmon resonance band and has a maximum at about 800 nm. This means that the SERS signal should be strongest for excitations in the near infrared spectral region. Why do most SERS reports, particularly related to single molecule SERS, have the excitation in the green or red spectral range and not in the near infrared?

In industrial plants, line balancing problems do not often find an objective solution and production managers often allocate tasks to operators without following a real methodology, but basing on personal experience; therefore, there are many problems when quick changes of capacity or constraints occur. The starting point of this study is the investigation of the main balancing methodologies, understanding their advantages and disadvantages in assigning homogenously tasks to workers. We propose new assembly lines balancing technique simple, general and effective, able to solve some ambiguity in balancing. Thanks to the proposed research, integration and a progress of classic methodologies have been realised. The method proposed, called IBM - integrated balancing method, has been applied to a real case study (the assembly line of a multinational company), in order to show its capacity of supporting production managers in designing and optimising assembly lines (ALBPs).

Over the years, many techniques have been developed for human reliability analysis (HRA). The main weakness of traditional HRA approaches is the use of a simple classification scheme without a link to a model of cognition in terms of mental processes. The present work is an attempt in this direction through a particular hybrid probabilistic model. The human error in industrial emergency model aims to develop an integrated methodological approach useful in critical infrastructures during an emergency condition. The proposed method, starting from the integration of existing techniques, develops a very flexible tool, able to take into account the main external and internal factors responsible of human error in emergency conditions. The model is able to estimate the evolution of human behavior and error following the evolution of the emergency scenario. The final result is a simulation model that calculates the contextualized human error probability, through which it is possible to estimate a realistic and detailed scenario of the conditions during the emergency management.

Jurgen Popp opened a general discussion of the paper by Roy Goodacre: What is the advantage of using SERS instead of ordinary Raman spectroscopy?

Serious incidents that occur inside or caused by industrial plants represent a very critical issue. In this context, the human reliability analysis (HRA) is an important tool to assess human factors that influence human behaviour in disasters scenario. In fact, the reliability assessment of interaction between human-machine systems is an important factor that affects the overall performance and safety in industrial plants. However, even though HRA techniques have been available for decades, there is not a universal method/procedure to reduce human errors that affect human performance. This study aims to design a novel approach to investigate the relationship between human reliability and operator performance considering the dependence on the available time to make decisions.

Capsular contracture, implant malposition and displacement, breast asymmetry, improper contour, and symmastia may compromise the aesthetic outcome of breast augmentation and usually require surgical correction. Correction of these deformities may be achieved by accommodating a new implant in a novel pocket created in the precapsular space in either the subpectoral or subglandular plane. This article describes a modality to correct adverse results of augmentation mammaplasty and evaluates patient satisfaction. Precapsular reaugmentation was performed in 49 patients who underwent cosmetic breast surgery revisions from 2004 to 2009. All patients had previously received breast implants but complained of implant malposition and dislocation, implant size change, capsular contracture, and symmastia. A precise neoprecapsular pocket was developed above the old anterior implant capsule wall, with dissection limited to create only the space necessary for proper placement of the implant. Patients were evaluated for resolution of symptoms, satisfaction, and complications. Implant malposition and rippling, capsular contracture, breast asymmetry, and symmastia were the most common complaints from the first augmentation. Nineteen women had subpectoral implant placement, 12 had subglandular, and the rest (n = 18) had “dual-plane” location of their implants. We used textured silicone implants in 17 cases and polyurethane-coated prostheses in the remaining 32 cases. The average follow-up time was 24.1 months. Breast augmentation-related complications had resolved in all patients without any recurrence to date. The overall complication rate was very low and patient satisfaction with this procedure was extremely high. The creation of a neoprecapsular pocket combined in peculiar cases with the placement of polyurethane-coated implants is a versatile option that offers an effective one-stage solution for the correction of cosmetic mammaplasty-induced deformities.

A conventional superficial musculoaponeurotic system (SMAS) face-lift is well established because it allows the skin envelope to be rotated in a bit more lateral direction than the cephalad redirection of the SMAS flap. This ensures an individualization of the treatment plan according to the needs of the patient and avoids a postoperative stretched look. However, this technique has some limitations with respect to its long-term effects on the sagging tissue, inadequate lifting of the malar fat pad, and flattening of the nasolabial fold. The procedure described by the authors consisted of a modified approach to conventional SMAS flap dissection for 327 patients with facial aging signs undergoing a face-lift. A pointing tongue-shaped flap of zygomaticotemporal fascia was dissected and preserved in the posterior half of the upper edge of the SMAS flap and anchored to the deep temporal fascia, enhancing the vertical support of the facial soft tissues. Outcomes were determined by case notes, clinical review, and a questionnaire. The study investigated 327 consecutive modified SMAS face-lifting procedures. Few complications were observed. Only two patients experienced small hematomas needing evacuation. Some patients reported bearable pain in the temporal region and tension during mouth opening. Temporary weakness in the branches of the facial nerve experienced by two patients resolved completely within some months. Two patients presented with dehiscence of the scar, and one patient experienced punctual retroauricular skin necrosis, which healed uneventfully with conservative treatment. Two patients reported that the knot in the temporal region was palpable through the skin. One patient experienced retroauricular infection. Only two patients required additional procedures. One mild hypertrophic scar responding to steroid injection over the mastoid area was observed in the entire series. With the reported technique, the authors achieved pleasing, natural, durable results with minimal morbidity and an overall complication rate of 3.9%. All the patients were sent a satisfaction questionnaire or contacted for a telephone interview. A total of 235 patients replied. The patients reported high levels of satisfaction after treatment. The authors believe that the rhytidectomy technique described in this report has several beneficial attributes. High vertical elevation of the SMAS flap delivers a long-lasting benefit and addresses the problem of neck laxity and platysma redundancy, leading to a correction of the neck contouring and jowls. Nasolabial folds appear to be smoothed, and malar flattening is restored by imbrications of the SMAS flap over the cut edge in the malar prominence. This investigation demonstrates that the rhytidectomy technique is safe and produces highly predictable results.

Purpose The paper aims to evaluate reliability allocation using an aerospace system prototype. The proposed approach has been applied and compared with other traditional methods on an aerospace system prototype, where the reliability allocation process is rigorous. Design/methodology/approach The new approach is based on Integrated factors Method (IFM), whose values are adjusted trough a multicriteria method, the Analytic Hierarchy Process, depending on the importance of each factor and each unit of the system. The result is a dynamic model, that combines the advantages of the allocation method and the multicriteria decision-making technique. Findings The reasons that led to the development of the IFM based AHP are the outcome of a careful analysis of the current military and commercial approaches. In particular most of analyzed methods use constant weights for the factors involved in the reliability allocation; different weights are rarely assigned to these factors. Research limitations/implications There is no limitation for implementation of A-IFM reliability allocation model in very large and complex systems, and it can therefore provide an improved structured arrangement for reliability allocation. Therefore, researchers are encouraged to test the proposed propositions further. Practical implications The proposed method offers several benefits compared with current military and commercial approaches. Originality/value The computational results clearly demonstrate the effectiveness of the new approach and its ability to overcome the criticalities highlighted in literature.

The ever-increasing complexity of production systems, together with the need to obtain efficient processes with limited costs, has led companies to develop custom tools for process control and management. Even for risk assessment, the traditional models often are overcome by methods that are best suited to specific needs. In this context, the aim of this paper was to propose a new model, which we call the global safety improve risk assessment (G-SIRA). This model can classify risks and identify corrective actions that allow the best risk reduction at the lowest cost. The proposed model, which is based on improvements to previous research, uses the analytic hierarchy process approach to develop a valid and simple tool for risk management. The G-SIRA method has been tested in a real-world application, i.e., it was applied to all of the processes of a textile company, and the results were compared with those obtained from the classical approach failure mode, effects, and criticality analysis. The comparison clearly showed the effectiveness of the proposed model.

Temporomandibular joint (TMJ) ankylosis is a pathological condition characterized by articular bony or fibrous tissue fusion. TMJ ankylosis developing during childhood can lead to growth complications because of the loss of mandibular function. Hard and soft autogenous tissue grafting has been used for TMJ reconstruction in the growing patient. However, in cases where autogenous tissue grafts fail either due to unpredictable growth or ankylosis, total alloplastic temporomandibular joint replacement (TMJ TJR) can provide a viable option. The case of a 7-year old female suffering from recurrent bilateral TMJ ankylosis resulting from birth trauma, and with concomitant obstructive sleep apnea syndrome (OSAS) is presented. Due to prior surgical and autogenous graft failures, the decision was made to complete her joint reconstructions utilizing patient-fitted TMJ prostheses. Questions have been raised about the longevity of TMJ TJR devices as well as their lack of growth potential, but children with TMJ ankylosis do not have condyle-related growth potential and that replacing failed autogenous tissue graft material with more autogenous tissue will result in the same adverse outcomes. Therefore, in growing patients with recurrent TMJ ankylosis and/or failed autogenous tissue grafts, there may be a role for TMJ TJR.

The success of a company depends on customer’s satisfaction: quality, price, and service. These three goals depend in particular on R.A.M.S. characteristics: reliability, availability, maintainability, and safety. In the last few years, in order to guarantee high standards of reliability and maintainability, new methodologies and techniques have been developed to estimate the R.A.M.S. targets. In particular, the reliability target represents both the starting and the ending point of R.A.M.S. analysis. The design of the reliability target of a system is a crucial aspect of reliability analysis, as it affects the performance of the system and components. This paper aims to develop a new approach called “IFM Target,” to define the reliability target for complex systems through the integrated factors method, to combine the advantages of usually used approaches, and to overcome some criticalities highlighted in a careful literature analysis. The proposed method has been applied on a sintering system. The results show the effectiveness of the proposed approach.

This special issue addresses a double transformation. The first is the historical process that saw a dramatic increase in the production of documents and a substantial improvement in their management and preservation throughout Europe between the fifteenth and the eighteenth centuries. The early modern period, broadly conceived, is often described as the age of print, but it was also the great time of archives, understood as both the physical repositories and organized offices established by institutions or collectivities to store handwritten documents produced in the course of continuous functions with a view to long-term use. For many European historians, the process of centralization, expansion and (more or less successful) rearrangement of archives is symbolized by the establishment of the great Simancas and Vatican archives in 1540 and 1612 respectively. But, as the articles collected here demonstrate, smaller states also enacted reforms in record-keeping, and these changes were more concerned with archives than with central institutions. The second transformation is interpretive and methodological. Archives have long been at the centre of historians’ research, but over the last ten to fifteen years, an ‘archival turn’ in disciplines ranging from history, literature, anthropology and the social sciences has transformed archives from sites of research into objects of enquiry in their own right. These works study the evolving processes of selection, ordering and usage that produced archives not as neutral repositories of sources but as historically constructed tools of power relations, deeply embedded in changing social and cultural contexts. The history of archives has been long practised by archivists, who are professionally aware that documents were neither produced nor arranged as

No complete scientific study has yet investigated the incidence of surgical-site infections in plastic surgery operations. However, it has been noted that in the case of wound infection, the aesthetic and sometimes the functional results become invalidated by delay and an alteration of the healing processes, thus necessitating surgical correction. This study aimed to evaluate the effectiveness of applying tissue adhesive on surgical wounds in plastic surgery as a protection capable of reducing the onset of infection, and to verify the existence of a statistically significant difference between treated and untreated wounds, and to determine patients' satisfaction with their cicatricial results.

In industrial plants, it is important to ensure a balanced allocation of the operations among workstations. Overloaded workstations (bottlenecks) rather than shortly saturated ones can affect the performance of the whole line in terms of production, whose speed often depends on the slowest station. The devolvement of the proposed method comes from a careful study and analysis of several line balancing techniques, in order to highline their strengths and weaknesses in providing unique and effective solutions. Based on the analysis carried out, a new approach for assembly lines balancing is proposed, able to integrate the main advantages of classic methodologies. Finally the proposed approach has been applied to a simulation experiment in order to show its effectiveness and ability to fill the gap found in literature.

Lateral cephalometric radiograph produces a two-dimensional image with several drawbacks. Cone beam computed tomography (CBCT) allows obtaining a three-dimensional representation of the craniofacial structures and seems to overcome the problems of superimposition and magnification, providing more precision than two-dimensional methods. The aim of the current study was to test the intraobserver and interobserver reliability of linear and angular measurements performed on two-dimensional conventional cephalometric images and CBCT-generated cephalograms, and to evaluate if there is a statistically significant difference between the 2 methods of measurements. The sample group consisted of 24 adolescents with a pretreatment digital lateral radiograph and a corresponding CBCT image. A total of 16 cephalometric landmarks were identified and 17 widely used measurements (9 angular and 8 linear) were recorded by 2 independent observers. Intraobserver and interobserver reliability were assessed by calculating Pearson correlation coefficient. Student t-test was used to compare the 2 methods. The threshold for significance was set at P ≤ 0.05.Concerning the intraobserver and interobserver reliability, data showed a statistically significant correlation between all two-dimensional and three-dimensional measurements. The linear and angular measurements of two-dimensional and three-dimensional cephalometry were not statistically different. The results of the current study showed the reliability of both conventional two-dimensional and three-dimensional cephalometry. Linear and angular measurements from CBCT were found also to be similar to conventional measurements. Considering that conventional images deliver the lowest radiation doses to patients, the use of CBCT for orthodontic purposes should be limited.

A complex system consists of many subsystems, which are developed concurrently and sometimes independently. It would be too late to validate the system reliability until the final system prototype is ready after months or years of development. From a project management point of view, the reliability of each subsystem or sub-function should be examined as early as possible. Therefore, the allocation of a reasonable reliability requirement to each subsystem and sub-function based on the system reliability target is very important. The present work analyses, in literature, the main reliability allocation techniques. Starting from the known methodologies, a new critical flow method for reliability allocation method has been developed. The proposed method can be used for complex system with serial and parallel configurations.

Piezosurgery is an alternative surgical technique, now widely tested, that uses ultrasounds for bone cutting. This device uses ultrasounds to section hard tissues without harming surrounding soft tissues. The authors analyzed their experience in craniomaxillofacial procedures with piezosurgery. A comparison between operation timing and complication rates between piezosurgery and traditional cutting instruments has been performed. A total of 27 patients were examined (15 females and 12 males; average age, of 5.5 months) affected by craniosynostosis. The aim of this study was to analyze the advantages and disadvantages of piezosurgery in pediatric craniofacial procedures. Piezoelectric device in this study has shown being a valid instrument for bone cutting in accurate procedures, because it allows performing a more precise and safer cutting, without the risk of harming surrounding tissues.

In the paper, the authors present a new methodology aimed to reduce, as possible, the subjectivity of the choices in applying spending review policies linked to costs/benefits to the community, thanks to the definition of objective criteria and a specific mathematical function, applied to the case study of Optimal Territorial Areas of the Lazio region. The main aspects driving these choices and underlying the mathematical formulation of the problem, are basically three: - the number of service users; - the social-economic impact on the community; - the service effectiveness/efficiency. The more critical aspect in defining the Objective Function is the evaluation of the service quality, unavoidably characterized by Intangibility (immaterial performance), Contextuality (simultaneity of service production and usage) and Heterogeneity (strong influence of conditions and context).

Purpose– Nowadays, especially after the recent financial downturn, companies are looking for much more efficient and creative business processes management. They need to place better solutions on the market in less time and with lower costs. Companies are achieving these goals of efficiency always more by using the offshoring strategy. It commonly describes a company’s relocation of a business process from one country to another, typically manufacturing processes towards low-cost countries (Brazil, Russia, India, China and South Africa – BRICS area). The purpose of this paper is to propose a methodological approach based on project management tools that supports the decision-making process in order to help companies in optimizing the re-engineering production processes and improve management costs. The framework provided in this paper is grounded on available literature and from the authors’ personal experiences in managing several projects.Design/methodology/approach– This paper seeks to propose a Project Management Process Reengineering performance model (PMPR) for managing projects of reengineering of processes and applies it in a real case study concerning the relocation of an automotive glass production line.Findings– The model proposed in this paper should serve as a valuable tool to facilitate a successful BPR design in the project management and intends to assist companies as they operate projects of transferring and optimizing production lines.Originality/value– This paper proposes a PMPR model with a methodological approach which integrates efficiency and effectiveness estimators applicable to company needs. Thus, the aim of the paper is to develop a methodology and technical approach for the redesign and realization of a production line in consequence of its relocation.

Background: In the last 3 decades, liposuction has become a mainstay of the plastic surgeon’s armamentarium, and the technique has evolved considerably. We retrospectively review all of the liposuction procedures that we performed over the past 20 years. Methods: The principles of superficial 3-dimensional liposuction with respect to preoperative, intraoperative, and postoperative management of patients scheduled to undergo liposuction of the hips, flanks, and thighs were described. Results: A total of 4000 patient charts were reviewed. The results indicated that 50 patients experienced a postsurgical seroma that was resolved after syringe aspirations. One patient developed a major mycobacterial infection that was resolved after antibiotic therapy. Twenty patients complained of minor asymmetries that were corrected 6 months later under local anesthesia; 18 patients suffered from minor skin irregularities, which improved after lipofilling. In 6 cases, transient hyperpigmentation (6–12 months) of the skin before the use of suction drainages in the removal of large adiposities in patients with light skin was experienced, and in 2 cases, transient paresthesia (8 and 10 months) was experienced. No skin necrosis, deep vein thrombosis, or death occurred. Conclusions: If performed correctly, 3-dimensional superficial liposuction of the trunk, hips, and thighs can yield very satisfying outcomes because of the excellent contour and the enhanced skin retraction provided by the thin cutaneous adipose flap. Three-dimensional liposuction is a reliable method with proven results. A careful application of the technique combined with accurate surgical planning, a thorough preoperative explanation of real expectations, and postoperative care is crucial.

Various interpretations of clinical and cephalometric data lead to different diagnostic and surgical planning in the study of dentoskeletal malformations. Many authors have identified this discrepancy as an incorrect positioning between the skeletal structures and the Frankfurt plane (PFH)--a plane that is used routinely for the sagittal measurement of the upper and lower jaw. The aim of this study was to establish a control method to verify the correct positioning of the sella-nasion point plane (SN) and the PFH. To find a reference plane, the authors concentrated their attention on measuring the intersecting angles between these two planes and the vertical posterior maxillary (PM) plane. Fifty patients (33 women and 17 men), all of whom were aesthetically and structurally harmonious class I dentoskeletal types, were analyzed using this method. Student's t-test, the Kolmogorov-Smirnov test, and Fisher's F-test were used for statistical analysis. The results were compared with those proposed by the University of Michigan. To achieve a correct diagnosis and to obtain good functional and cosmetic results in the treatment of these kinds of malformations, it is necessary to make use of the PM vertical plane during cephalometric analysis.

One-stage augmentation/mastopexy entails the challenge of augmenting breast volume with an implant while resecting excess skin. Although both augmenting and lifting the breast in a one-stage operation is gaining in popularity, its safety and its efficacy are still under debate and merit deeper evaluation. We retrospectively reviewed our experience over a 5-years period with patients who underwent augmentation mammoplasty/mastopexy with the specific objectives of documenting their outcomes and formulating algorithms for safe, simple, and effective operative strategies to manage such patients. Our surgical approach to augmentation/mastopexy breast ptosis was described step by step. Patient satisfaction with the results was also evaluated. One hundred seven patients underwent successful simultaneous augmentation/mastopexy surgery. Sixty-nine underwent primary breast surgery and 38 underwent secondary breast surgery. In 12 cases a periareolar mastopexy scar was used, while in 51 patients a vertical approach was preferred; in 11 and 33 patients a short “T” and an inverted “T” scar mastopexy was necessary, respectively. Few complications were observed, with a very low overall complication rate (14 %) and a reoperation rate of 12.1 % at 14.7 months. Patient satisfaction with the results of this procedure was extremely high. Simultaneous augmentation/mastopexy is an effective and versatile way to lift the NAC, tighten the breast skin, increase breast projection, and fill in the upper pole. Our technique of simultaneous breast mastopexy after augmentation through a lower periareolar approach showed excellent correction of pre-existing ptosis, making this method highly reliable because the intraoperative tailor-tacking was customized to the patient, implant size, and projection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

To meet the requirements and specifications coming from the surrounding society, the socio-economic progress involves the development of new products, new technologies, new organizational forms etc. Companies are constantly looking for methods or procedures to improve production and income; but, the enterprise growth is strictly linked to the reliability of its internal processes. Internal failures can often cause loss of image. The goal of the present work is the development of an algorithm able to optimize the production line of a pharmaceutical firm. In particular, the proposed weighing procedure allows both checking missing components in packaging and minimizing false rejects of packages by dynamic scales. The main problem is the presence at the same time, in the same package, of different components with different variable weights. The consequence is uncertainty in recognizing the absence of one or more components.

The proposed work analyses and applies a new reliability and redundancy allocation procedure. Starting from a similar methodology previously developed by the authors, Integrated Factors Method (IFM), a new reliability allocation and optimization method is developed: Advanced Integrated Factors Method (AIFM). The new technique has been proposed to analyze complex systems in the pre-design phase, even if its general characteristics allow extending the method to different design and production phases. The previous method has been improved through the introduction of new indexes that help improve underperforming components in order to achieve the allocated reliability values. The method introduces a big number of factors, so it can be applied to a wide range of systems. It is characterized by a very simple mathematical formulation, that can be made more complicated for a more detailed analysis.

Pierre Robin Sequence (PRS) is a congenital abnormality characterized by mandibular hypoplasia, glossoptosis and often secondary palate cleft. It may be an isolated or part of a most complicated syndrome. The genetic syndrome that most frequently co-occurs is Stickler syndrome characterized by skeletal abnormalities, joint pain, congenital myopia and retinal detachment. The authors describe their fast and early mandibular osteodistraction (FEMOD) protocol in severe cases of PRS airway obstruction.

Polyurethane-covered breast implants have been used increasingly for cosmetic and revision breast surgery. The incision for insertion should be of minimal length and the placement of these implants in the pocket can be more difficult than that of conventional implants because of the highly adherent textured surface of the polyurethane external layer that grasps the surrounding tissues. The use of a sterile plastic insertion sleeve that is open on both sides is suggested by the manufacturer to overcome the friction between the polyurethane implant and the skin and surrounding tissues. A new method to facilitate polyurethane implant insertion and adjustment in all cases of primary breast augmentation and revision surgery is presented. After the implant, which is in the sleeve, is located in the pocket, the plastic sleeve is filled with saline and antibiotics so the solution lubricates the surface around the implant. The sleeve is then twisted so that the solution is squeezed inside the pocket while the sleeve itself is pulled back and removed. Between 2010 and 2013, this method was used in 73 cases of primary augmentation and revision breast surgery without any complications. The method described here allows for easier removal of the plastic sleeve during polyurethane implant insertion without any complications or evidence of implant migration or rotation at follow-up. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

In the age of competition, no industry can survive without pondering much about reducing expenditures wherever possible. Management of inventories represents one of the most important areas in business, trade and industry. The scheduling of production lots, as well as their sizing, is an area of increasing research attention within the wider field of production planning and scheduling. In the present paper a new mathematical model to find the target stocking level which minimises the total cost of the system while satisfying the service level constraint is presented. Starting from the analysis of inventory management models in literature, a completely original model has been developed and applied to a real case in healthcare sector. The analysis of the results, arising from the case study, allowed to evaluate the effectiveness of the proposed models and to highlight the differences. Nevertheless the proposed model has characteristics of generality that allow the application in other areas.

The drive to lower operating costs and improve manufacturing efficiency has led many manufacturing companies to implement different methodologies in order to identify a suitable risk assessment model. So, the concern for safety in industrial activities, both inside the establishments and in their surroundings, has a crucial role. As a result, many laws, regulations and risk analysis techniques are well adapted to industry needs since they were developed for its purpose. However increasing safety is often difficult, especially when you have already obtained good results, so the aim of our paper is the proposal of a new methodological approach called the safety improve risk assessment (SIRA) by integrating the conventional aspects of the popular failure mode, effects, and criticality analysis (FMECA) procedure with economic considerations in order to take into account the risk and to minimise the total safety costs by defining a specific index called total risk priority number (TRPN) index. The index propos...

Objectives The lingual dysfunctions play a considerable role in the pathogenesis of dentoskeletal dysmorphisms. The treatment of dento-maxillofacial dysgnathia implies a functional rehabilitation to re-harmonize the stomatognathic system. This study aims to demonstrate the importance of a rehabilitation protocol of functional orofacial parameters at the end of a surgical-orthodontic treatment in order to achieve long-term success. Materials and methods After orthognathic surgery, facial expression exercises and jaw exercises are prescribed to promote the recovery of neuromuscular function. At the end of treatment, a sample of 30 dysgnathic patients underwent a functional evaluation of the orofacial district to identify any lingual or articulatory dysfunctions. The information gathered led to an individual re-education program that consisted of an active myofunctional-logopedic approach integrated with appliances used as retention. Results 19 patients needed myofunctional therapy to re-educate deglutition and tongue posture. Articulatory disorders were found in 7 patients originally suffering from Class III and/or open-bite skeletal disharmony; 5 of these completed rehabilitation with speech therapy. After rehabilitation the functional parameters were completely normalized in 12 patients; in 5 cases, partial improvements were obtained, while in 2 cases the therapy was ineffective. Conclusions In a patient undergoing post-surgical reconsolidation of his/her functional equilibrium even an uncontrolled speech defect may lead to an instable result. Only through an interdisciplinary approach it is possible to intercept and re-educate all the functions that are not compliant with the structural changes and to eliminate a tendency to relapse of the dysgnathia.

The study analyzed two samples of 10 patients with Class lIl dentoskeletal deformities and maxillary and mandibular involvement. Surgery was performed on both jaws at the same time, using different techniques for the stabilization of bone. In one group, osteosynthesis by wire fixation was performed (WF); and in the other group, bicortical screws were used for the mandible (RIF) and plates for the maxilla. At 20 and 40 days after the operation, radiocephalometric examinations were performed, and the differences in structural stability verified, by comparing the efficiency of the two methods of bone stabilization. Results indicate that in the postoperative period analyzed, dentoskeletal movements in the RIF group were inferior compared with the WF group. On the basis of these results, the advantages and the disadvantages offered by these two techniques of bone stabilization are analyzed. (A M J O RTHOD D ENTOFAC O RTHOP 1994;105:477-82.)

The present paper proposes the development of a virtual model simulating an assembly line. Starting from the analysis of the real line, through an incremental approach, a simulation model is created, verified and validated, in order to obtain useful information about:• productive capacity;• partial and total lead time;• Percentage of saturation, Value Added (VA) and Non-Value Added (NVA), for each worker and station.During the development phase, an important goal has been pursued: the possibility to use and change the model without knowing the creation logic. It is possible to change input parameters through simple tables, which contain times of man-machine operations. You can easily set times in order to move an operation from one station to another or to add/delete a job in a station, according to the technological and ergonomic constraints of the process.Moreover, the acquisition of scheduling data is extremely easy and starts from the generation of a list of production codes related to different work-cycles.