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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.
We present and discuss an exploration of the possibilities and properties of 3D printing with a printing space of 1 cubic meter, and how those can be integrated into architectural education through an experimental design and research course with students of architecture.We expand on issues presented at the eCAADe conference 2017 in Rome [Ref 6] by increasing the complexity and size of our prints, printing not a model to scale, but a full scale funtional prototype of a usable architectural object: A coffee bar.
Manufacturing process simulation (MPS) has become more and more important for aviation and the automobile industry. A highly competitive market requires the use of high performance metals and composite materials in combination with reduced manufacturing cost and time as well as a minimization of the time to market for a new product. However, the use of such materials is expensive and requires sophisticated manufacturing processes. An experience based process and tooling design followed by a lengthy trial-and-error optimization is just not contemporary anymore. Instead, a tooling design process aided by simulation is used more often. This paper provides an overview of the capabilities of MPS in the fields of sheet metal forming and prepreg autoclave manufacturing of composite parts summarizing the resulting benefits for tooling design and manufacturing engineering. The simulation technology is explained briefly in order to show several simplification and optimization techniques for developing industrialized simulation approaches. Small case studies provide examples of an efficient application on an industrial scale.
The Kremer-Grest (KG) bead-spring model is a near standard in Molecular Dynamic simulations of generic polymer properties. It owes its popularity to its computational efficiency, rather than its ability to represent specific polymer species and conditions. Here we investigate how to adapt the model to match the universal properties of a wide range of chemical polymers species. For this purpose we vary a single parameter originally introduced by Faller and Müller-Plathe, the chain stiffness. Examples include polystyrene, polyethylene, polypropylene, cis-polyisoprene, polydimethylsiloxane, polyethyleneoxide and styrene-butadiene rubber. We do this by matching the number of Kuhn segments per chain and the number of Kuhn segments per cubic Kuhn volume for the polymer species and for the Kremer-Grest model. We also derive mapping relations for converting KG model units back to physical units, in particular we obtain the entanglement time for the KG model as function of stiffness allowing for a time mapping. To test these relations, we generate large equilibrated well entangled polymer melts, and measure the entanglement moduli using a static primitive-path analysis of the entangled melt structure as well as by simulations of step-strain deformation of the model melts. The obtained moduli for our model polymer melts are in good agreement with the experimentally expected moduli.
Algorithmic design and resilience assessment of energy efficient high-rise water supply systems
(2018)
High-rise water supply systems provide water flow and suitable pressure in all levels of tall buildings. To design such state-of-the-art systems, the consideration of energy efficiency and the anticipation of component failures are mandatory. In this paper, we use Mixed-Integer Nonlinear Programming to compute an optimal placement of pipes and pumps, as well as an optimal control strategy.Moreover, we consider the resilience of the system to pump failures. A resilient system is able to fulfill a predefined minimum functionality even though components fail or are restricted in their normal usage. We present models to measure and optimize the resilience. To demonstrate our approach, we design and analyze an optimal resilient decentralized water supply system inspired by a real-life hotel building.
68Ga-radiopharmaceuticals are common in the field of Nuclear Medicine to visualize receptor-mediated processes. In contrast to straightforward labeling procedures for clinical applications, preclinical in vitro and in vivo applications are hampered for reasons like e.g. volume
restriction, activity concentration, molar activity and osmolality. Therefore, we developed a semiautomatic system specifically to overcome these problems. A difficulty appeared unexpectedly, as intrinsic trace metals derived from eluate (Zn, Fe and Cu) are concentrated as well in amounts that influence radiochemical yield and thus lower molar activity.
Often, research results from collaboration projects are not transferred into productive environments even though approaches are proven to work in demonstration prototypes. These demonstration prototypes are usually too fragile and error-prone to be transferred
easily into productive environments. A lot of additional work is required.
Inspired by the idea of an incremental delivery process, we introduce an architecture pattern, which combines the approach of Metrics Driven Research Collaboration with microservices for the ease of integration. It enables keeping track of project goals over the course of the collaboration while every party may focus on their expert skills: researchers may focus on complex algorithms,
practitioners may focus on their business goals.
Through the simplified integration (intermediate) research results can be introduced into a productive environment which enables
getting an early user feedback and allows for the early evaluation of different approaches. The practitioners’ business model benefits throughout the full project duration.
Comparison of different training algorithms for the leg extension training with an industrial robot
(2018)
In the past, different training scenarios have been developed and implemented on robotic research platforms, but no systematic analysis and comparison have been done so far. This paper deals with the comparison of an isokinematic (motion with constant velocity) and an isotonic (motion against constant weight) training algorithm. Both algorithms are designed for a robotic research platform consisting of a 3D force plate and a high payload industrial robot, which allows leg extension training with arbitrary six-dimensional motion trajectories. In the isokinematic as well as the isotonic training algorithm, individual paths are defined i n C artesian s pace by sufficient s upport p oses. I n t he i sotonic t raining s cenario, the trajectory is adapted to the measured force as the robot should only move along the trajectory as long as the force applied by the user exceeds a minimum threshold. In the isotonic training scenario however, the robot’s acceleration is a function of the force applied by the user. To validate these findings, a simulative experiment with a simple linear trajectory is performed. For this purpose, the same force path is applied in both training scenarios. The results illustrate that the algorithms differ in the force dependent trajectory adaption.
During rapid deceleration of the body, tendons buffer part of the elongation of the muscle-tendon unit (MTU), enabling safe energy dissipation via eccentric muscle contraction. Yet, the influence of changes in tendon stiffness within the physiological range upon these lengthening contractions is unknown. This study aimed to examine the effect of training-induced stiffening of the Achilles tendon on triceps surae muscle-tendon behavior during a landing task. Twenty-one male subjects were assigned to either a 10-week resistance-training program consisting of single-leg isometric plantarflexion (n = 11) or to a non-training control group (n = 10). Before and after the training period, plantarflexion force, peak Achilles tendon strain and stiffness were measured during isometric contractions, using a combination of dynamometry, ultrasound and kinematics data. Additionally, testing included a step-landing task, during which joint mechanics and lengths of gastrocnemius and soleus fascicles, Achilles tendon, and MTU were determined using synchronized ultrasound, kinematics and kinetics data collection. After training, plantarflexion strength and Achilles tendon stiffness increased (15 and 18%, respectively), and tendon strain during landing remained similar. Likewise, lengthening and negative work produced by the gastrocnemius MTU did not change detectably. However, in the training group, gastrocnemius fascicle length was offset (8%) to a longer length at touch down and, surprisingly, fascicle lengthening and velocity were reduced by 27 and 21%, respectively. These changes were not observed for soleus fascicles when accounting for variation in task execution between tests. These results indicate that a training-induced increase in tendon stiffness does not noticeably affect the buffering action of the tendon when the MTU is rapidly stretched. Reductions in gastrocnemius fascicle lengthening and lengthening velocity during landing occurred independently from tendon strain. Future studies are required to provide insight into the mechanisms underpinning these observations and their influence on energy dissipation.
The Dry-Low-NOx (DLN) Micromix combustion technology has been developed as low emission combustion principle for industrial gas turbines fueled with hydrogen or syngas. The combustion process is based on the phenomenon of jet-in-crossflow-mixing (JICF). Fuel is injected perpendicular into the air-cross-flow and burned in a multitude of miniaturized, diffusion-like flames. The miniaturization of the flames leads to a significant reduction of NOx emissions due to the very short residence time of reactants in the flame. In the Micromix research approach, computational fluid dynamics (CFD) analyses are validated toward experimental results. The combination of numerical and experimental methods allows an efficient design and optimization of DLN Micromix combustors concerning combustion stability and low NOx emissions. The paper presents a comparison of several numerical combustion models for hydrogen and hydrogen-rich syngas. They differ in the complexity of the underlying reaction mechanism and the associated computational effort. The performance of a hybrid eddy-break-up (EBU) model with a one-step global reaction is compared to a complex chemistry model and a flamelet generated manifolds (FGM) model, both using detailed reaction schemes for hydrogen or syngas combustion. Validation of numerical results is based on exhaust gas compositions available from experimental investigation on DLN Micromix combustors. The conducted evaluation confirms that the applied detailed combustion mechanisms are able to predict the general physics of the DLN-Micromix combustion process accurately. The FGM method proved to be generally suitable to reduce the computational effort while maintaining the accuracy of detailed chemistry.
Seismic design of buried pipeline systems for energy and water supply is not only important for plant and operational safety but also for the maintenance of the supply infrastructure after an earthquake. The present paper shows special issues of the seismic wave impacts on buried pipelines, describes calculation methods, proposes approaches and gives calculation examples. This paper regards the effects of transient displacement differences and resulting tensions within the pipeline due to the wave propagation of the earthquake. However, the presented model can also be used to calculate fault rupture induced displacements. Based on a three-dimensional Finite Element Model parameter studies are performed to show the influence of several parameters such as incoming wave angle, wave velocity, backfill height and synthetic displacement time histories. The interaction between the pipeline and the surrounding soil is modeled with non-linear soil springs and the propagating wave is simulated affecting the pipeline punctually, independently in time and space. Special attention is given to long-distance heat pipeline systems. Here, in regular distances expansion bends are arranged to ensure movements of the pipeline due to high temperature. Such expansion bends are usually designed with small bending radii, which during the earthquake lead to high bending stresses in the cross-section of the pipeline. Finally, an interpretation of the results and recommendations are given for the most critical parameters.