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BACKGROUND
Immunosuppression is often considered as an indication for antibiotic prophylaxis to prevent surgical site infections (SSI) while performing skin surgery. However, the data on the risk of developing SSI after dermatologic surgery in immunosuppressed patients are limited.
PATIENTS AND METHODS
All patients of the Department of Dermatology and Allergology at the University Hospital of RWTH Aachen in Aachen, Germany, who underwent hospitalization for a dermatologic surgery between June 2016 and January 2017 (6 months), were followed up after surgery until completion of the wound healing process. The follow-up addressed the occurrence of SSI and the need for systemic antibiotics after the operative procedure. Immunocompromised patients were compared with immunocompetent patients. The investigation was conducted as a retrospective analysis of patient records.
RESULTS
The authors performed 284 dermatologic surgeries in 177 patients. Nineteen percent (54/284) of the skin surgery was performed on immunocompromised patients. The most common indications for surgical treatment were nonmelanoma skin cancer and malignant melanomas. Surgical site infections occurred in 6.7% (19/284) of the cases. In 95% (18/19), systemic antibiotic treatment was needed. Twenty-one percent of all SSI (4/19) were seen in immunosuppressed patients.
CONCLUSION
According to the authors' data, immunosuppression does not represent a significant risk factor for SSI after dermatologic surgery. However, larger prospective studies are needed to make specific recommendations on the use of antibiotic prophylaxis while performing skin surgery in these patients.
The available data on complications after dermatologic surgery have improved over the past years. Particularly, additional risk factors have been identified for surgical site infections (SSI). Purulent surgical sites, older age, involvement of head, neck, and acral regions, and also the involvement of less experienced surgeons have been reported to increase the risk of the SSI after dermatologic surgeries.1 In general, the incidence of SSI after skin surgery is considered to be low.1,2 However, antibiotics in dermatologic surgeries, especially in the perioperative setting, seem to be overused,3,4 particularly regarding developing antibiotic resistances and side effects.
Immunosuppression has been recommended to be taken into consideration as an additional indication for antibiotic prophylaxis to prevent SSI after skin surgery in special cases.5,6 However, these recommendations do not specify the exact dermatologic surgeries, and were not specifically developed for dermatologic surgery patients and treatments, but adopted from other surgical fields.6 According to the survey conducted on American College of Mohs Surgery members in 2012, 13% to 29% of the surgeons administered antibiotic prophylaxis to immunocompromised patients to prevent SSI while performing dermatologic surgery on noninfected skin,3 although this was not recommended by Journal of the American Academy of Dermatology Advisory Statement. Indeed, the data on the risk of developing SSI after dermatologic surgery in immunosuppressed patients are limited. However, it is possible that due to the insufficient evidence on the risk of SSI occurrence in this patient group, dermatologic surgeons tend to overuse perioperative antibiotic prophylaxis.
To make specific recommendations on the use of antibiotic prophylaxis in immunosuppressed patients in the field of skin surgery, more information about the incidence of SSI after dermatologic surgery in these patients is needed. The aim of this study was to fill this data gap by investigating whether there is an increased risk of SSI after skin surgery in immunocompromised patients compared with immunocompetent patients.
Like all preceding transformations of the manufacturing industry, the large-scale usage of production data will reshape the role of humans within the sociotechnical production ecosystem. To ensure that this transformation creates work systems in which employees are empowered, productive, healthy, and motivated, the transformation must be guided by principles of and research on human-centered work design. Specifically, measures must be taken at all levels of work design, ranging from (1) the work tasks to (2) the working conditions to (3) the organizational level and (4) the supra-organizational level. We present selected research across all four levels that showcase the opportunities and requirements that surface when striving for human-centered work design for the Internet of Production (IoP). (1) On the work task level, we illustrate the user-centered design of human-robot collaboration (HRC) and process planning in the composite industry as well as user-centered design factors for cognitive assistance systems. (2) On the working conditions level, we present a newly developed framework for the classification of HRC workplaces. (3) Moving to the organizational level, we show how corporate data can be used to facilitate best practice sharing in production networks, and we discuss the implications of the IoP for new leadership models. Finally, (4) on the supra-organizational level, we examine overarching ethical dimensions, investigating, e.g., how the new work contexts affect our understanding of responsibility and normative values such as autonomy and privacy. Overall, these interdisciplinary research perspectives highlight the importance and necessary scope of considering the human factor in the IoP.
Melting probes are a proven tool for the exploration of thick ice layers and clean sampling of subglacial water on Earth. Their compact size and ease of operation also make them a key technology for the future exploration of icy moons in our Solar System, most prominently Europa and Enceladus. For both mission planning and hardware engineering, metrics such as efficiency and expected performance in terms of achievable speed, power requirements, and necessary heating power have to be known.
Theoretical studies aim at describing thermal losses on the one hand, while laboratory experiments and field tests allow an empirical investigation of the true performance on the other hand. To investigate the practical value of a performance model for the operational performance in extraterrestrial environments, we first contrast measured data from terrestrial field tests on temperate and polythermal glaciers with results from basic heat loss models and a melt trajectory model. For this purpose, we propose conventions for the determination of two different efficiencies that can be applied to both measured data and models. One definition of efficiency is related to the melting head only, while the other definition considers the melting probe as a whole. We also present methods to combine several sources of heat loss for probes with a circular cross-section, and to translate the geometry of probes with a non-circular cross-section to analyse them in the same way. The models were selected in a way that minimizes the need to make assumptions about unknown parameters of the probe or the ice environment.
The results indicate that currently used models do not yet reliably reproduce the performance of a probe under realistic conditions. Melting velocities and efficiencies are constantly overestimated by 15 to 50 % in the models, but qualitatively agree with the field test data. Hence, losses are observed, that are not yet covered and quantified by the available loss models. We find that the deviation increases with decreasing ice temperature. We suspect that this mismatch is mainly due to the too restrictive idealization of the probe model and the fact that the probe was not operated in an efficiency-optimized manner during the field tests. With respect to space mission engineering, we find that performance and efficiency models must be used with caution in unknown ice environments, as various ice parameters have a significant effect on the melting process. Some of these are difficult to estimate from afar.
The problem of creation and use of sorption materials is of current interest for the practice of the modern medicine and agriculture. Practical importance is production of a biostimulant using a carbon sorbent for a significant increase in productivity, which is very relevant for the regions of Kazakhstan. It is known that a plant phytohormone—fusicoccin—in nanogram concentrations transforms cancer cells to the state of apoptosis. In this regard, there is a scientific practical interest in the development of a highly efficient method for producing fusicoccin from extract of germinated wheat seeds. According to the results of computer modeling, cleaning composite components of fusicoccin using microporous carbon adsorbents not suitable as the size of the molecule of fusicoccin more than micropores and the optimum pore size for purification of constituents of fusicoccin was determined by computer simulation.
Combined with the use of renewable energy sources for
its production, Hydrogen represents a possible alternative gas
turbine fuel for future low emission power generation. Due to
its different physical properties compared to other fuels such
as natural gas, well established gas turbine combustion
systems cannot be directly applied for Dry Low NOx (DLN)
Hydrogen combustion. This makes the development of new
combustion technologies an essential and challenging task
for the future of hydrogen fueled gas turbines.
The newly developed and successfully tested “DLN
Micromix” combustion technology offers a great potential to
burn hydrogen in gas turbines at very low NOx emissions.
Aiming to further develop an existing burner design in terms
of increased energy density, a redesign is required in order to
stabilise the flames at higher mass flows and to maintain low
emission levels.
For this purpose, a systematic design exploration has
been carried out with the support of CFD and optimisation
tools to identify the interactions of geometrical and design
parameters on the combustor performance. Aerodynamic
effects as well as flame and emission formation are observed
and understood time- and cost-efficiently. Correlations
between single geometric values, the pressure drop of the
burner and NOx production have been identified as a result.
This numeric methodology helps to reduce the effort of
manufacturing and testing to few designs for single
validation campaigns, in order to confirm the flame stability
and NOx emissions in a wider operating condition field.
Combined with the use of renewable energy sources for its production, Hydrogen represents a possible alternative gas turbine fuel within future low emission power generation. Due to the large difference in the physical properties of Hydrogen compared to other fuels such as natural gas, well established gas turbine combustion systems cannot be directly applied for Dry Low NOx (DLN) Hydrogen combustion. Thus, the development of DLN combustion technologies is an essential and challenging task for the future of Hydrogen fuelled gas turbines. The DLN Micromix combustion principle for hydrogen fuel has been developed to significantly reduce NOx-emissions. This combustion principle is based on cross-flow mixing of air and gaseous hydrogen which reacts in multiple miniaturized diffusion-type flames. The major advantages of this combustion principle are the inherent safety against flash-back and the low NOx-emissions due to a very short residence time of reactants in the flame region of the micro-flames. The Micromix Combustion technology has been already proven experimentally and numerically for pure Hydrogen fuel operation at different energy density levels. The aim of the present study is to analyze the influence of different geometry parameter variations on the flame structure and the NOx emission and to identify the most relevant design parameters, aiming to provide a physical understanding of the Micromix flame sensitivity to the burner design and identify further optimization potential of this innovative combustion technology while increasing its energy density and making it mature enough for real gas turbine application. The study reveals great optimization potential of the Micromix Combustion technology with respect to the DLN characteristics and gives insight into the impact of geometry modifications on flame structure and NOx emission. This allows to further increase the energy density of the Micromix burners and to integrate this technology in industrial gas turbines.
In this paper, we provide an analytical study of the transmission eigenvalue problem with two conductivity parameters. We will assume that the underlying physical model is given by the scattering of a plane wave for an isotropic scatterer. In previous studies, this eigenvalue problem was analyzed with one conductive boundary parameter whereas we will consider the case of two parameters. We prove the existence and discreteness of the transmission eigenvalues as well as study the dependence on the physical parameters. We are able to prove monotonicity of the first transmission eigenvalue with respect to the parameters and consider the limiting procedure as the second boundary parameter vanishes. Lastly, we provide extensive numerical experiments to validate the theoretical work.