Hybrid multi-criteria decision making approach proposal for evaluating workloads of aircraft maintenance technicians.

BACKGROUND: Aircraft maintenance technicians (AMTs) have the most difficulty in terms of total workload criteria working in line maintenance. This is a very important problem for the Aircraft Maintenance Organization. A systematic and scientific approach is required for its solution. OBJECTIVE: This study proposes a new Multi-Criteria Decision Making (MCDM) based approach to evaluating the total workloads of AMTs to identify the most challenging AMT tasks in the aircraft maintenance organization. METHODS: A new hybrid MCDM approach is proposed by integrating the Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Technique for Order Preference by Similarity (TOPSIS) methods to compare AMTs on the basis of workloads according to license categories. The hybrid method proposed in this study evaluates the total workload under three main titles: mental, physical, and environmental workload. RESULTS: Focusing on AMTs working in line maintenance of an aircraft maintenance organization, this study revealed that the most important workload criteria determined by the DEMATEL method are lower back strain, upper back strain, time pressure, and air temperature criteria. The results of the TOPSIS method showed that the license categories of AMTs are sorted according to the workloads as follows: A, B2, B1, and B1 + B2. The AMTs holding a "Category A" license have fewer workloads than the other categories. CONCLUSION: The findings of the study reveal some measures that might allow authorities to minimize the workload of AMTs. In addition, the study contributes to the literature because there are few studies that systematically analyze total workloads by using MCDM methods.

Modafinil attenuates the neuroinflammatory response after experimental traumatic brain injury.

BACKGROUND: Modafinil has been proven to exert anti-inflammatory, anti-oxidative and neuroprotective effects on numerous neurological disorders. However, its effects after traumatic brain injury (TBI) have not been yet explored. The aim of this study was to explore if Modafinil can attenuate the neuroinflammatory phase of TBI and clarify the possible underlying mechanisms. METHODS: A weight drop model was used to induce experimental TBI on 30 Wistar albino rats. The treatment group received Modafinil on the day of the trauma and the following 5 days. Garcia Test was used to assess for neurological status and histopathological examination along with biochemical analysis of NSE, S-100B, CASP3, and TBARS levels were performed. RESULTS: Rats treated with Modafinil after the trauma had a statistically significant higher Garcia Test Score (P<0.001) and presented with increased evidence of anti-inflammatory and neuroprotective effect (P<0.05, P=0.005). Decreased levels of all biochemical parameters with NSE, CASP3, and TBARS having statistical significance was observed (P<0.05). CONCLUSIONS: The findings of this paper support the notion that a psychoactive drug Modafinil, traditionally used for sleep disorders and also known as a cognitive enhancer may prove beneficial in decreasing mortality and morbidity after TBI through anti-inflammatory, anti-oxidative and neuroprotective effects.

Evaluation of associations between condylar morphology, ramus height, and mandibular plane angle in various vertical skeletal patterns: a digital radiographic study.

BACKGROUND: To evaluate condylar morphology, ramus height, and asymmetry indexes in patients with different vertical skeletal patterns and to determine the association between condylar and ramal measurements with the mandibular plane angle. METHODS: Dental panoramic radiographs of 60 patients with different skeletal patterns were evaluated. According to the cranial base (Sella-Nasion)-mandibular plane (SN-MP) angle, the patients were divided into three groups: normal angle (NA), low angle (LA), and high angle (HA). The condylar area, condylar perimeter, condylar heights, and ramus height were measured, and the asymmetry index value of each measurement was calculated. A one-way analysis of variance as well as a post hoc Tukey and Kruskall-Wallis tests were used to determine intergroup differences. Pearson's correlation coefficient was used to determine the relationship between all measurements and SN-MP. RESULTS: The intergroup comparison of condylar area, condylar perimeter, condylar heights, and ramus height measurements showed that the patients in the LA group have statistically significantly greater values compared to those in the HA group. A statistically significant difference was detected between the NA and LA groups only in the condylar area measurements. There was no statistical difference only in the ramus height measurements between the NA and HA groups. Asymmetry index values of the groups were similar. The negative correlations were found between all measurements and the SN-MP angle. CONCLUSION: HA individuals have lower ramus heights and smaller condylar morphologies than NA and LA individuals. In addition, as the SN-MP angle increases, the condyle dimensions and ramus height decrease, and this is a clinically important finding.

Effects of pirfenidone on experimental head injury in rats.

Traumatic brain injury (TBI) continues to be a significant public healthcare concern. Neuroinflammation that occurs in the secondary phase of TBI leads to cognitive and physical dysfunction. A number of therapeutic modalities have been evaluated in an attempt to find a suitable treatment. The only drug approved for the treatment of idiopathic pulmonary fibrosis, pirfenidone, has been evaluated for its antifibrotic, anti-inflammatory, and anti-oxidant properties for various disorders, but this is the first study to examine its effects in an experimental TBI model. Twenty-four Wistar rats were randomly divided into three groups: control, trauma, and pirfenidone. The two latter groups underwent experimental diffuse cortical injury mimicking TBI. Neurological assessment was performed using the Garcia test, histological analysis was performed to examine neuroprotective and anti-inflammatory effects, and biochemical analyses of neuron-specific enolase (NSE), S-100B, caspase-3, and thiobarbituric acid reactive substances were performed. The pirfenidone group had a better Garcia test score (P=0.001), an increased anti-inflammatory effect (P<0.001), and an enhanced neuroprotective effect (P=0.007) along with decreased NSE, S100B, and TBARS levels compared to the trauma group. However, pirfenidone did not show a beneficial effect on caspase-3 levels. Pirfenidone may help decrease mortality and morbidity rates after TBI through its anti-inflammatory and antioxidant effects.

Histopathologic Analysis of Tamoxifen on Epidural Fibrosis.

BACKGROUND: Epidural fibrosis is a challenging topic in spinal surgery. This phenomenon constitutes one of the main reasons behind postlaminectomy syndrome or failed back surgery syndrome, which leads to persistent back and leg pain in association with compression and/or stretching the nerve root or the dura. The exact mechanism of action in epidural fibrosis is complex and remains uncertain. Excessive deposition of collagen, fibronectin, and dermatan sulfate, known as the "extracellular matrix," and decrease of tissue cellularity results in epidural fibrosis. The most investigated and important actor in epidural fibrosis as well as in other forms of aberrant wound healing is presumed to be transforming growth factor-1ß formation. Tamoxifen (TAM), a synthetic nonsteroidal antiestrogen used in breast cancer, is also effective in inhibiting fibroblast proliferation via downregulation of transforming growth factor-1ß. METHODS: Twenty-four adult male rats were randomly divided into 3 groups. Laminectomy was the sole intervention in the control group. Spongostan was placed in the operation lodge after laminectomy in the second group. In the treatment group, TAM was administrated orally after laminectomy. Epidural fibrosis, dural thickness, inflammatory response, and arachnoidal involvement were evaluated and graded histopathologically. RESULTS: Epidural fibrosis, dural thickness, and inflammatory response in the subjects treated with TAM were significantly less than in the control and Spongostan group and the differences were statistically significant. Although arachnoidal involvement was observed in a subject in the TAM group, the differences between all groups weren't statistically significant. CONCLUSIONS: Tamoxifen reduced epidural fibrosis, dural thickness, and inflammatory response after laminectomy in rats.

The First Case of Kernohan-Woltman Notch Phenomenon Caused by Epidural Hematoma in a Pediatric Patient.

Kernohan-Woltman notch phenomenon (KWNP) is an ipsilateral motor weakness due to compression of the contralateral cerebral peduncle. Most of the KWNP cases reported have been due to subdural hematomas, intracranial space-occupying lesions, and spontaneous bleeding of vascular malformations. In this study, we present the first pediatric case of KWNP caused by a traumatic epidural hematoma. Although subdural hematomas are the most frequent reason for KWNP, epidural hematomas may cause paradoxical ipsilateral signs not only in adults but also in pediatric patients.

A critical appraisal of the North American Spine Society guidelines with the Appraisal of Guidelines for Research and Evaluation II instrument.

BACKGROUND CONTEXT: The North American Spine Society (NASS) publishes clinical guidelines that are taken into consideration worldwide by clinicians who have a special interest in spinal surgery. The Appraisal of Guidelines for Research and Evaluation (AGREE) II is the second version of the original AGREE instrument to assess the quality of guidelines in terms of development process. This appraisal aims to evaluate each individual NASS guideline using AGREE II tool to demonstrate its methodologic robust and weakness. PURPOSE: To evaluate the quality of the clinical practice guidelines published by the NASS. STUDY DESIGN: Four appraisers used the AGREE II guideline evaluation instrument to evaluate the NASS guidelines. METHODS: All six guidelines available on the NASS web site as of July 1, 2014 were evaluated. Four reviewers independently assessed these guidelines using the AGREE II instrument. The instrument standardizes the quantitative assessment of quality for a guideline's development process across six domains that include: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Additionally, each reviewer rated the overall quality of the guidelines. RESULTS: Overall results for the AGREE II domains across all six guidelines were: scope and purpose (median score, 94.4%), stakeholder involvement (median score, 56.9%), rigor of development (median score, 91.7%), clarity of presentation (median score, 94.4%), applicability (median score, 60.9%), and editorial independence (median score, 71.9%). CONCLUSIONS: Our study showed that the quality of the NASS guidelines needs some improvement. There is a critical need for broader stakeholder involvement including patient representatives and health economists. Consideration of resource implications and monitoring process and standardization of how recommendations are implemented need to be improved. Studies analyzing facilitators and barriers would be helpful for future NASS guidelines.