Invited Discussion on: The Impact of Isotretinoin Therapy on the Nasal Skin Thickness and Elasticity: An Ultrasonography and Elastography Based Assessment in Relation to Dose and Duration of Therapy

2022 ◽  
Author(s):  
Roxana Cobo
Keyword(s):  
Skin Thickness ◽  
Duration Of Therapy ◽  
The Impact ◽  
Isotretinoin Therapy

A Sensitivity Study of the Porcine Head Subjected to Bump Impact

2016 ◽  
Author(s):  
Kimberly A. Thompson ◽  
Adam C. Sokolow ◽  
Juliana Ivancik ◽  
Timothy G. Zhang ◽  
William H. Mermagen ◽  
...  
Keyword(s):  
Human Brain ◽  
3D Model ◽  
Porcine Model ◽  
Load Transfer ◽  
Numerical Study ◽  
Sensitivity Study ◽  
Complex Problem ◽  
Model Parameters ◽  
Skin Thickness ◽  
The Impact

Understanding load transfer to the human brain is a complex problem that has been a key subject of recent investigations [4–6]. Because the porcine is a gyrencephalic species, having greater structural and functional similarities to the human brain than other lower species outlined in the literature, it is commonly chosen as a surrogate for human brain studies [7]. Consequently, we have chosen to use a porcine model in this work. To understand stress wave transfer to and through the brain, it is important to fully characterize the nature of the impact (i.e. source, location, and speed) as well as the response of the constituent tissues under such impact. We suspect the material and topology of these tissues play an important role in their response. In this paper, we report on a numerical study assessing the sensitivity of model parameters for a 6-month old Gottingen mini-pig model, under bump loading. In this study, 2D models are used for computational simplicity. While a 3D model is more realistic in nature, a 2D representation is still valuable in that it can provide trends on parameter sensitivity that can help steer the development of the 3D model. In this work, we investigate the variation of skull and skin thickness, evaluate material variability of the skull, and consider the effects of nasal cavities on load transfer. Eighty simulations are computed in LS-DYNA and analyzed in MATLAB. The results of this study will provide useful knowledge on the necessary components and parameters of the porcine model and therefore provide more confidence in the analysis. This is an essential first step as we look toward bridging the gap between correlates of injury in animal and human models.

scholarly journals A Multicenter Stewardship Initiative to Decrease Excessive Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S63-S64
Author(s):  
Farnaz Foolad ◽  
Angela Huang ◽  
Cynthia Nguyen ◽  
Lindsay Colyer ◽  
Megan Lim ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Total Duration ◽  
Audit And Feedback ◽  
Patient Specific ◽  
Control Group ◽  
Duration Of Therapy ◽  
The Impact ◽  
Research Grant

Abstract Background Hospitals have implemented multifaceted approaches to quickly identify CAP, start timely therapy, and reduce hospital readmission, yet there has been minimal focus on providing appropriate duration of therapy. The IDSA CAP guidelines recommend 5 days of antibiotic therapy for patients that are clinically stable and quickly defervesce. However, previous publications suggest duration of therapy for CAP may be unnecessarily prolonged. Methods The objective of this multicenter, quasi-experimental study of hospitalized patients with CAP was to assess the impact of a prospective 6-month stewardship intervention on total duration of antibiotic therapy and associated clinical outcomes. All centers updated institutional CAP guidelines to promote IDSA-concordant durations of therapy and provided education to pharmacists and prescribers. Daily patient-specific prospective audit and feedback was provided by infectious diseases stewardship pharmacists to optimize compliance with guideline recommendations. Results A total of 600 patients were included (307 in the historic control group and 293 in the stewardship intervention group). The stewardship intervention led to significantly increased rates of compliance with IDSA duration of therapy recommendations (5.6% vs. 41.4%, P< < 0.01) and significantly reduced the duration of therapy for CAP (9 vs. 6 days, P < 0.01). Inappropriate days of antibiotic therapy was reduced in the intervention group (4 vs. 1.6 days, P < 0.01), and total avoidance of 720 excessive days of antibiotic therapy. Clinical outcomes, including mortality, length of hospitalization, readmission to hospital with pneumonia, presentation to the ER/clinic with pneumonia within 30 days of discharge, and incidence of C. difficilecolitis, were not different between groups. Conclusion This multicenter evaluation of a prospective stewardship intervention in hospitalized CAP patients reduced the total duration of antibiotic therapy and increased compliance with guideline-concordant duration of therapy without adversely affecting patient outcomes. This project was funded through a competitive stewardship grant provided by Merck & Co. Disclosures A. Huang, Merck: Grant Investigator, Research grant; C. Nguyen, Merck: Grant Investigator, Research grant; J. Grieger, Merck: Grant Investigator, Research grant; S. Revolinski, Merck: Grant Investigator, Research grant; J. Li, Merck: Grant Investigator, Research grant; M. Mack, Merck: Grant Investigator, Research grant; J. N. Wainaina, Merck: Grant Investigator, Research grant; G. Eschenauer, Merck: Grant Investigator, Research grant; T. Patel, Merck: Grant Investigator, Research grant; V. Marshall, Merck: Grant Investigator, Research grant; J. Nagel, Merck: Grant Investigator, Research grant

scholarly journals 52. Development and Implementation of a Short Duration of Antibiotic Therapy Algorithm for Uncomplicated Gram-Negative Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S48-S48
Author(s):  
Esther Y Bae ◽  
Fidelia Bernice ◽  
Kathryn Dzintars ◽  
Sara E Cosgrove ◽  
Pranita D Tamma ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Median Duration ◽  
Intervention Period ◽  
Therapy Algorithm ◽  
Gram Negative ◽  
Duration Of Therapy ◽  
Number Of Patients ◽  
Gram Negative Bacteremia ◽  
The Impact

Abstract Background Recent literature suggests no difference in clinical outcomes between short (7 days) and prolonged course (14 days) antibiotic therapy for the treatment of uncomplicated Gram-negative bacteremia (GNB). Methods The objectives of the study were to develop and implement a treatment algorithm that identifies patients who are eligible for 7-day therapy for uncomplicated GNB and evaluate its impact on patient outcomes at The Johns Hopkins Hospital (JHH) in Baltimore. The algorithm was developed and implemented at JHH on 11/11/2019. From 11/11/2019 to 3/31/2020, the Infectious Diseases (ID) Pharmacy Resident and ID pharmacists reviewed cases of GNB on weekdays and contacted teams to provide algorithm-compliant treatment recommendations. To quantify the impact of the intervention on clinical outcomes, data from the same time period during the previous year (baseline) were collected and compared to those collected during the intervention. The primary outcome was duration of antibiotic therapy for GNB. Secondary outcomes included: duration of intravenous (IV) antibiotics, length of hospital stay (LOS), and recurrent bacteremia. Results A total of 345 patients with GNB were identified (142 baseline; 203 intervention) of which 59 and 55 patients met criteria for 7-day therapy, respectively. The Pitt bacteremia score (median 1), bacteremia source [urinary (43%), abdominal (23%)], and organisms [E. coli (48%) and Klebsiella spp. (33%)] were similar between the periods. More patients in the intervention period were treated for ≤8 days (60.0% vs. 37.3%; p=0.015), and the median duration of therapy was 2 days shorter (8 vs. 10 days; p=0.04). Median duration of IV antibiotic therapy (4 vs. 7 days; p=0.004) and median LOS (4 vs. 7 days; p=0.029) were also shorter in the intervention period. There were no differences in the rate of 30-day recurrent bacteremia between the periods (3.4% baseline vs. 1.8% intervention; p=0.60). Conclusion Our pharmacist-led intervention successfully shortened the duration of therapy, increased conversion from IV to PO therapy, and reduced LOS, without negatively impacting the number of patients with recurrent GNB. Disclosures All Authors: No reported disclosures

scholarly journals Optimization of Novel Sphere Sandwich Structure for Impact Requirements

2020 ◽  
Vol 44 (4) ◽  
pp. 251-256
Author(s):  
Meethaq M. Abed ◽  
Mohammed H. Al-maammori
Keyword(s):  
Fracture Toughness ◽  
Sandwich Structure ◽  
Impact Test ◽  
Skin Thickness ◽  
Sphere Diameter ◽  
Anova Analysis ◽  
Specimen Material ◽  
Optimal Value ◽  
The Impact ◽  
Specific Fracture

Sphere Sandwich Structures (SSS) are a new structure which may have the potentials to provide the energy absorption as compared with monolithic specimen material. By using innovation carving wax method, fifteen specimens have been prepared according to RSM optimize method and it machined by CNC-3axis machine with sphere end screw. Three factors sphere diameter(D), distance between spheres(X) and skin thickness(K) have been studied. The impact test has been achieved by Izod test to calculate specific fracture toughness. The results show the sample 642 has the highest specific fracture toughness value with an improvement of 300% compared with the monolithic sample. The optimal value of this test is 35.37 MPa m0.5 g-1 of the sample 682 (diameter = 6, distance between spheres = 8, skin thickness = 2 mm) with 10% error when compared with practice result at the same geometry. According to ANOVA analysis, the diameter of sphere(D) has greatest effect than other factors and then skin thickness(K).

scholarly journals ВИЗНАЧЕННЯ ВПЛИВУ ЛАЗЕРНОГО ГРАВІРУВАННЯ НА ГІГІЄНІЧНІ ВЛАСТИВОСТІ НАТУРАЛЬНИХ ШКІР ДЛЯ ВЕРХУ ВЗУТТЯ ТА ШКІРГАЛАНТЕРЕЙНИХ ВИРОБІВ

2021 ◽  
Vol 152 (6) ◽  
pp. 29-39
Author(s):  
Н. М. Борщевська ◽  
Н. В. Первая
Keyword(s):  
Laser Radiation ◽  
Laser Ablation ◽  
Direct Action ◽  
Morphological Structure ◽  
Front Surface ◽  
Collagen Fibers ◽  
Vapor Permeability ◽  
Skin Thickness ◽  
Laser Engraving ◽  
The Impact

Purpose. Investigation of the effect of laser engraving on the hygienic properties of nature leather for uppers and leather goods, namely leather Krast, Flotar and Nappa. Methodology. To achieve this goal, the method of scanning electron microscopy (SEM) was used. Hygienic properties of Krast, Flotar and Nappa hides was studied in accordance with ISO 14268: 2008 by determining vapor permeability. Findings. According to the results of the study of the effect of laser radiation on the hygienic properties of nature leather for uppers and leather goods, the nature of changes in the micro- and macrostructure of the dermis under laser engraving and allowable depth and area of laser ablation that do not impair the hygienic properties of these skins and products. With increasing ablation depth to 0,7 mm (50% of the total thickness of the sample), the relative vapor permeability increases in all samples of the studied skins, while the relative vapor permeability for the skin of Krast increased by 5%, Flotar by 13,5% and 9,5% for Nappa. The optimal value of the depth of laser ablation, which does not impair the operational and hygienic characteristics of the products is 25–30% of the skin thickness. On the front surface revealed features of the structure, which are characteristic only for the area of direct action of the laser beam, namely the skin samples Flotar and Nappa have obvious signs of welding collagen fibers. In the area of laser ablation, an increase in the interstructural distances between the bundles of collagen fibers was also detected, which was the result of thermophysical processes of laser radiation. Originality. The determined effect affects the depths and flat laser ablations on the morphological structure of the dermis and the hygienic properties of natural leather for shoe uppers and leather goods. Practical value. The vapor permeability of genuine leather for the uppers of shoes and leather goods under the action of laser radiation was determined. The value of the depth and area of laser ablation for finishing leather products, taking into account the impact on the hygienic properties of products in general.

Ballistic Performance of Sandwich Composite Armor System

2020 ◽  
Author(s):  
Shah Alam ◽  
Samhith Shakar
Keyword(s):  
Impact Resistance ◽  
Absorption Capacity ◽  
Sandwich Composite ◽  
Skin Thickness ◽  
Ballistic Performance ◽  
Backing Plate ◽  
Composite Armor ◽  
Corrugated Structure ◽  
The Impact ◽  
Armor System

Abstract This study focused on the design, modelling and the analysis of the dynamic response of composite armor system, constructed with Kevlar 29 as front skin, Alumina-ceramic filled in x shaped corrugated structure as core and bottom skin Kevlar 29 and T800S, in terms of residual velocity, energy absorption capacity and limiting velocity. The core cell size, height, thickness, skin thickness, etc., will be varied to get their influence on the impact resistance. The design parameter will be investigated for the sandwich composite armor with various configurations and stacking sequence of Alumina Ceramics, Kevlar 29 and T800S. The sandwich typically consists of front plate, core and backing plate, which will be impacted at different velocities starting at 100m/s till significant armor penetration. The ballistic limit velocity (V50) will be determined from the analysis. The non-linear explicit dynamic analysis and simulation results computed using the software ABAQUS will be validated by experiment. From the data obtained it can be suggested which composite armor has improved impact resistance and performance.

scholarly journals 151. An Electronic Algorithm to Better Target Antimicrobial Stewardship Program (ASP) Efforts for Children Hospitalized with Community-Acquired Pneumonia (CAP)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S85-S86
Author(s):  
Jeffrey Gerber ◽  
Robert Grundmeier ◽  
Keith W Hamilton ◽  
Lauri Hicks ◽  
Melinda M Neuhauser ◽  
...  
Keyword(s):  
Chart Review ◽  
Inappropriate Prescribing ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Duration Of Therapy ◽  
Test Characteristics ◽  
Diagnostic Codes ◽  
Stewardship Program ◽  
Icd 10 ◽  
The Impact

Abstract Background Pediatric antibiotic stewardship programs (ASPs) have been successful in decreasing inappropriate antibiotic use. However, they require considerable time and effort. Approaches to increase ASP efficiency are urgently needed. We developed and validated an electronic algorithm to identify inappropriate antibiotic use in children hospitalized with community-acquired pneumonia (CAP). Methods At Children’s Hospital of Philadelphia (CHOP), we used ICD-10 diagnostic codes to identify inpatient patient encounters for pneumonia between 3/15/17 – 3/14/18 for which patients received a systemic antibiotic in the first 48 hours of hospitalization. Exclusion criteria included transfer from another facility, intensive care unit admission or death in first 48 hours, immunocompromising condition, or specific comorbidities. We randomly selected 150 subjects. Inappropriate antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration of therapy were based on established CHOP and IDSA/PIDS guidelines. Results Of 148 eligible subjects, median age was 3.8, 48% were female, and 129 (86%) were admitted to a general pediatrics service. On chart review, 147 (99%) subjects were correctly diagnosed with CAP. Of these subjects, the choice of initial antibiotic(s) was appropriate in 133 (90%). Of the 147 subjects, 137 (93%) had an appropriate duration of therapy. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table. Conclusion In pediatric patients hospitalized with CAP, the electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration was highly accurate. This algorithm could have considerable utility in targeting ASP initiatives. The impact of interventions based on this algorithm should be tested in the future Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration Disclosures All Authors: No reported disclosures

An analysis of adjuvant temozolomide plus radiotherapy vs radiotherapy alone in a single academic institution

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1575-1575
Author(s):  
S. Hopkins ◽  
S. Gertler ◽  
G. Nicholas
Keyword(s):  
Recursive Partitioning ◽  
Standard Of Care ◽  
Risk Of Death ◽  
Duration Of Therapy ◽  
Post Surgery ◽  
Adjuvant Temozolomide ◽  
Time Period ◽  
Radiotherapy Alone ◽  
The Impact

1575 Background: The NCIC CE.3/EORTC 22981/26981 was open during the time period of August 2000 to March 2002. When the study closed, there existed a gap in care that did not address the ongoing management of patients (pts) with glioblastoma multiforme (GBM) that had been surgically excised. As a result of this gap, it was decided that the adjuvant use of temozolomide (TMZ) was to become the standard of care at our centre due to its lack of perceived toxicities and early evidence for its activity. Methods: An analysis was performed of all pts with GBM that were seen at the centre from 1998 to the summer of 2005. In total, 240 pts were identified across multiple medical and radiation oncologists. 75 pts were treated with radiotherapy (RAD) alone post surgery, 86 pts were treated with RAD + TMZ post surgery, 18 pts only had surgery and the remaining pts were unresectable. Average age was 59.7 years for pts treated only with RAD, and 54.6 years for those treated with TMZ + RAD (p = 0.028). 59% of pts treated with RAD were male, while 62% treated with RAD + TMZ were male. Median follow-up was 11.3 months for RAD and 15.7 months for TMZ + RAD (p = 0.0001816). Preliminary survival analysis demonstrates a 56% reduction in the risk of death for pts treated with TMZ + RAD when compared to RAD (log rank p = 9.6 × 10−6). Median survival was 12.7 months for pts treated with RAD and 27 months for pts treated with TMZ + RAD (see table ). A further analysis including recursive partitioning analysis (RPA) and duration of therapy post RAD will be attempted to confirm the similarities between the two groups. Conclusion: Adjuvant TMZ + RAD has increased overall survival by 14.3 months in our institution. Further analysis is necessary to determine the impact on duration of therapy of TMZ. [Table: see text] [Table: see text]

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