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No / The marginal cost approach for the analysis of repair/replacement models was introduced by Berg in 1980 and has since been applied to many maintenance policies of various complexity. All models hitherto analysed in the literature by the marginal cost approach have one single decision variable only, this being, typically, the age of the current item at the time of ordering or replacement. This paper is concerned with the extension of the marginal cost technique to maintenance policies with several decision variables. After addressing the general framework appropriate for the multi-parameter case, we exemplify the workings of the technique by analysing a two-variable maintenance model involving replacement and minimal repair. We demonstrate that the marginal cost approach is an attractive and intuitively appealing technique also for models with several decision variables. Just as in the single-parameter situation, the approach is amenable to economic interpretation, a welcome feature for users of maintenance models with a prime interest in its economic (rather than its mathematical) aspects. As an added bonus of the marginal cost approach, in our example, some otherwise necessary tools from the theory of stochastic processes are dispensable.

In a production environment, physical and cyber-related failures become unavoidable because of the complexity of highly connected manufacturing systems and a finite equipment life cycle. The main purpose of this thesis is to investigate optimal maintenance outsourcing and replacement policies in the presence of cyber-threats, as well as policies to achieve channel coordination via cost subsidization. Although well-developed maintenance outsourcing literature has addressed many advanced and trending issues such as the costs and benefits of new technology adoptions, learning effects, forgetting effects, and systems with back-up machines, no study has looked at the effect of cyber threats on connected production systems. Besides filling this gap, this thesis addresses the most common replacement policies including preventive maintenance with minimal repairs and age replacement. The advent of the Internet of Things (IoT) has enabled the creation of "smart" manufacturing systems, However the resulting connected format makes these systems potential targets for cyber-attacks. Manufacturers have to face a difficult decision as to whether they should adopt costly security technologies or let the manufacturing systems be vulnerable to cyber-threats. This study develops a model addressing this dilemma by providing some insights into the effects of cost subsidization and installation of security systems on the system profit. Our findings suggest that a manufacturer can trade off cost subsidization to gain flexibility in the maintenance decision-making process. The study also provides evidence that, for a "smart" manufacturing system, the existence of a security system guarantees at least a marginal increase in system profit. With the help of an extensive numerical study, we provide guidelines for optimizing system profit and addressing the effect of various model parameters (such as a monetary parameter, failure rate and a cyber-attack related parameter) on the value of a security system.In the second part of this thesis, we build analytical models to deal with cyber-threats in the context of a production system that utilizes the age replacement policy. We propose two different scenarios involving cyber-threats. First, cyber-attacks do not disrupt the physical production system. In this case, we replace the broken components either when the system has a physical breakdown or when a predetermined amount of time (T) elapses. Second, we need to replace the system right after it suffers from a successful cyber-attack. Thus, we replace the system components if one of three following events happen, whichever comes first: (1) a successful cyber-attack, (2) a physical breakdown, or (3) a predetermined time (T) elapses. We analytically provide optimal policies to minimize the expected cost for these scenarios. Finally, we carry out sensitivity analyses to show the effect of different model parameters on the value of a cyber security system.

Unicompartmental knee replacement (UKR) is the principal alternative to total knee replacement (TKR) in the treatment of end-stage knee osteoarthritis. It involves less tissue resection, resulting in lower rates of morbidity and faster recoveries compared to TKR. However, UKR has a significantly higher revision rate compared to TKR. As a result, whilst over a third of patients are eligible for UKR, only around 8% receive it. A comprehensive comparison of matched patients undergoing TKR and UKR was undertaken using a large dataset from the National Joint Registry for England and Wales (NJR). Failure rates (revision, reoperation, complications and mortality), length of stay and patient-reported outcomes (PROMs) were studied. Whilst patients undergoing TKR had lower reoperation and revision rates, they had higher rates of morbidity and mortality, longer hospital stays, and inferior PROMs compared to UKR. The main reason for revision in UKR was loosening. In view of the high revision rate in UKR, NJR data was studied to identify modifiable risk factors for failure in UKR. Important patient factors were identified including age, gender and pre-operative function. Surgeons with a higher UKR caseload had significantly lower revision rates and superior patient-reported outcomes. Increasing usage (offering UKR to a greater proportion of knee replacement patients) appears to be a viable method of increasing caseload and therefore of improving results. Surgeons with optimal usage (around 50% of patients, using appropriate implants) achieved revision/reoperation rates similar to matched patients undergoing TKR. Two clinical studies were conducted to establish whether the use of cementless fixation would improve fixation and reduce the revision rate of UKR. Cementless UKR was demonstrated to be safe and reliable, with PROMs similar or superior to those demonstrated in cemented UKR. Patients with suboptimal cementless fixation were examined and pre-disposing technical factors were identified. Finally, using NJR data, the effect of the introduction of cementless UKR on overall outcomes was examined. The number of cementless cases was small, and no significant effect on implant survival was demonstrated. However, patients undergoing cementless UKR demonstrated superior PROMs. These studies demonstrate that UKR has numerous advantages over TKR in terms of morbidity, mortality and PROMs. If surgeons perform high volumes of UKR (achievable by increasing their UKR usage), these advantages can be attained without the large difference in revision rates previously demonstrated. Cementless UKR is safe and provides superior fixation and outcomes in the hands of high-volume surgeons. Further work is needed to quantify the revision rate of cementless UKR, and to assess its results in the hands of less experienced surgeons.

Decreased testosterone levels (hypogonadism) in middle-aged men (aged 45-64) has been associated with increased levels of depression. Studies have suggested that increases in anxiety and/or attention problems may also be associated with hypogonadism but have not provided empirical evidence to support these suggestions. The purpose of this quantitative study was to examine depression, anxiety, and attention problems in middle-aged men using a psychological self-report inventory. The theoretical model used in this study was the biomedical model, which combined pharmacological treatment with psychological self-report inventories to determine if there was an association or relationship between the testosterone levels in men and the psychological distress experienced by men who have become hypogonadal. A total of 179 males were recruited through local physicians. There was a statistically significant difference and a small size effect in the level of depression, anxiety, and/or attention issues experienced by those who were receiving TRT versus those who were not. This study may provide some guidance to medical clinicians, such as psychiatrists, primary-care physicians, and endocrinologists, as well as clinical psychologists who see middle-aged men in their practice settings.

Ultra-high molecular weight polyethylene (UHMWPE) is used worldwide as a bearing material in total joint replacement prostheses. Despite its excellent biocompatibility and high wear resistance, wear of UHMWPE components continues to be a major problem limiting the clinical lifespan of UHMWPE-containing orthopaedic implant devices. Multi-directional motion or cross-path motion is known to affect wear rates of UHMWPE in total knee and hip replacement prostheses. The purpose of this study was to quantify the effect of counterface roughness on the cross-path wear of UHMWPE and to determine if the previously established unified theory of wear model could accurately predict wear rates in an abrasive wear environment. UHMWPE pins were articulated against both smooth (centerline roughness, Ra, of 0.015 µm) and rough (Ra = 0.450µm) cobalt-chromium counterfaces in a series of six rectangular wear paths (width = A, length = B) with systematically increasing aspect ratios (B/A) and linear tracking (A = 0), all with identical path lengths (20mm) per cycle. Gravimetric weight loss was converted into volumetric wear rates and wear factors, k. The results showed that for both smooth and rough-counterface tests, wear reached a maximum when a 3mmx7mm wear path was employed. The unified theory of wear was generally accurate in predicting wear rates; however, for rough-counterface tests there was a larger increase in the wear factor for higher aspect ratio rectangular wear paths. The ratio [k rough/ k smooth] decreased monotonically as a function of increasing width of rectangles, normalized by total path length, or A/(A +B). This study showed that wear of UHMWPE articulating in a rectangular motion path likely occurs via a two-step mechanism beginning with molecular orientation followed by material fracture from the UHMWPE surface. The models inability to accurately predict UHMWPE wear for rectangular paths with lower aspect ratios suggests that there may be other operative wear mechanisms including significant re-orientation in the perpendicular sliding direction. In conclusion, it is possible to predict the wear behavior of UHMWPE using mathematical models. A robust model would have an important role in characterizing and predicting performance of currently used and potential future orthopaedic implant materials.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.

Source: Masters Abstracts International, Volume: 47-06, page: 3565. Adviser: Benjamin Amick. Includes bibliographical references.

published_or_final_version / Orthopaedic Surgery / Master / Master of Philosophy