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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.
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.
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.
Direct sampling method via Landweber iteration for an absorbing scatterer with a conductive boundary
(2024)
In this paper, we consider the inverse shape problem of recovering isotropic scatterers with a conductive boundary condition. Here, we assume that the measured far-field data is known at a fixed wave number. Motivated by recent work, we study a new direct sampling indicator based on the Landweber iteration and the factorization method. Therefore, we prove the connection between these reconstruction methods. The method studied here falls under the category of qualitative reconstruction methods where an imaging function is used to recover the absorbing scatterer. We prove stability of our new imaging function as well as derive a discrepancy principle for recovering the regularization parameter. The theoretical results are verified with numerical examples to show how the reconstruction performs by the new Landweber direct sampling method.
The ClearPET project
(2004)
The Crystal Clear Collaboration has designed and is building a high-resolution small animal PET scanner. The design is based on the use of the Hamamatsu R7600-M64 multi-anode photomultiplier tube and a LSO/LuYAP phoswich matrix with one to one coupling between the crystals and the photo-detector. The complete system will have 80 PM tubes in four rings with an inner diameter of 137 mm and an axial field of view of 110 mm. The PM pulses are digitized by free-running ADCs and digital data processing determines the gamma energy, the phoswich layer and even the pulse arrival time. Single gamma interactions are recorded and coincidences are found by software. The gantry allows rotation of the detector modules around the field of view. Simulations, and measurements a 2×4 module test set-up predict a spatial resolution of 1.5 mm in the centre of the field of view and a sensitivity of 5.9% for a point source in the centre of the field of view.
The esophageal Doppler monitor (EDM) is a minimally-invasive hemodynamic device which evaluates both cardiac output (CO), and fluid status, by estimating stroke volume (SV) and calculating heart rate (HR). The measurement of these parameters is based upon a continuous and accurate approximation of distal thoracic aortic blood flow. Furthermore, the peak velocity (PV) and mean acceleration (MA), of aortic blood flow at this anatomic location, are also determined by the EDM. The purpose of this preliminary report is to examine additional clinical hemodynamic calculations of: compliance (C), kinetic energy (KE), force (F), and afterload (TSVRi). These data were derived using both velocity-based measurements, provided by the EDM, as well as other contemporaneous physiologic parameters. Data were obtained from anesthetized patients undergoing surgery or who were in a critical care unit. A graphical inspection of these measurements is presented and discussed with respect to each patient’s clinical situation. When normalized to each of their initial values, F and KE both consistently demonstrated more discriminative power than either PV or MA. The EDM offers additional applications for hemodynamic monitoring. Further research regarding the accuracy, utility, and limitations of these parameters is therefore indicated.
A second-order L-stable exponential time-differencing (ETD) method is developed by combining an ETD scheme with approximating the matrix exponentials by rational functions having real distinct poles (RDP), together with a dimensional splitting integrating factor technique. A variety of non-linear reaction-diffusion equations in two and three dimensions with either Dirichlet, Neumann, or periodic boundary conditions are solved with this scheme and shown to outperform a variety of other second-order implicit-explicit schemes. An additional performance boost is gained through further use of basic parallelization techniques.