Abstract
Introduction
Scar contracture bands after burns are a persistent problem that cause discomfort and physical and aesthetic limitation. Standard treatment for contracture bands in burn scars ...involves physical therapy, stretching, splinting and laser treatment, as well as surgical releases with local/distant flaps and grafting. A minimally invasive transcutaneous approach for the release of scar bands was initiated in our institution 6 years ago. The method was derived from techniques pioneered by Jose Daher and Raul Gonzalez to interrupt platysma bands in neck rejuvenation.
With IRB approval we evaluated this new approach regarding long term outcomes.
Methods
A retrospective review of 45 patient charts was conducted for those with burn scars who received subcutaneous contracture release from May 1, 2016, through March 31, 2022. The procedure involves introducing a braided suture to loop the contracture band and moving it in a sawing motion until it cuts through the band in multiple sites along the contracture. Demographic data, total burn surface area (TBSA), location, amount of contracture release increments, scar size, and duration of treatment was recorded. Concurrent scar treatments and whether performed under anesthesia was also noted. In follow up visits 3-12 months post release patients were surveyed on satisfaction with the treatment and whether they noticed increased mobility after the procedure. The Vancouver Scar Scale was administered pre- and post-treatment. Patient range of motion was measured pre-and post treatment to assess for change in mobility at treated sites.
Results
Male to female ratio was 51%:49%, average age was 38.8(6 to 68), 58% were white . TBSA ranged from 0.5% to 85%, with an average of 36.1 ± 22.3. The release was applied to 11 different sites spanning the entire body, 39% on the neck . The procedure involved an average of 19.0 ± 8.8 incremental releases, and the average scar size for treatment was 174.4 ± 140.0 cm2. 93% of the procedures involved laser treatment, 76% were done under anesthesia because of the laser, and 84% involved a site that was skin grafted. Only one of the 45 patients reported bleeding post-discharge, and none had an infection at a puncture site. Out of 20 responses, 13 patients reported being “satisfied” and 3 “very satisfied”; none reported being “dissatisfied”. 19 noted an increase in mobility at the contracture site and one did not. On average, patient range of motion increased by 13.6 degrees.
Conclusions
The minimally invasive contracture release described is a versatile, safe, and well-tolerated procedure that can help patients regain form and function after a burn injury. It was successfully applied to a large range of age groups, burn sizes, and scar contracture sites. Encouraging data regarding patient recovery and gain in mobility supports the use of this contracture release technique. Further studies should include prospective multicenter trials.
Applicability of Research to Practice
Immediate
Abstract
Introduction
Laser therapy is a growing intervention in hypertrophic scar treatment. This therapy is associated with minimal risks, however these are poorly studied in the burn population. ...Anecdotal reports of adverse effects such as pain and dyspigmentation exist. As patients, stakeholders, and insurance companies decide on reimbursement for this therapy, a better studied safety profile is necessary. This study is a retrospective review of all laser therapies for adverse events.
Methods
A retrospective review of patients who underwent laser therapy at two centers between May 2019 and June 2022. Patient demographics, details of laser treatments, adverse events, and scar characteristics before and after laser therapy were collected.
Results
A total of 167 patients underwent 533 laser treatments. There were 75 (44.9%) males and 92 (55.1%) females, with an average age of 26 (SD: 20.6) years. In total, 94 patients (56.3%) were Hispanic or Latino, 24 (14.4%) Caucasian, and 49 (29.3%) identified as "Other". All patients were treated for hypertrophic scars after burn injuries. For all patients, average number of laser treatments was 3 (SD: 2.2), with a range of 1 to 17 sessions. There were 9 (1.68%) instances of adverse events out of the total laser encounters. There were 5 (0.93%) reports of increased pain, 1 (0.18%) of an open wound, 2 (0.37%) of increased scar discoloration, and 1 (0.18%) of decreased scar pliability. Of the 5 (2.98%) total patients who encountered adverse events, 3 continued with laser therapy. There was no correlation between number of laser treatments and adverse events.
Conclusions
Patients undergoing laser treatment for burn scar management rarely face adverse events, of which the most common were increased scar pain and dyspigmentation. Even so, most patients experiencing adverse events chose to continue treatments. Laser therapy remains effective in burn scar treatment with minimal risks regarding safety profile.
Applicability of Research to Practice
This review will assist patients in making more informed decisions when considering laser therapy for burn scar management.
Abstract
Introduction
Outside the United States, bromelain-based enzymatic debridement (BBED) has become an effective tool for removal of burn eschar. BBED can be performed at bedside and allows for ...complete eschar removal with maximal dermal preservation and markedly reduced blood loss. It may also decrease the need for autografting or the amount of autograft required. A primary concern with BBED is that it is a painful procedure requiring appropriate analgesia. Experience with BBED in the U.S. has been gained through a multicenter phase 3 clinical trial (DETECT) and an expanded access treatment protocol (NEXT). In this retrospective study, we describe our experience using BBED, with particular focus on pain management.
Methods
A retrospective review was conducted on 29 adult burn patients enrolled in the DETECT or NEXT trials who underwent BBED of acute deep partial- and full-thickness thermal burn wounds at a major burn center between November 2016 and July 2022. Patient demographics and procedural characteristics, including pain management strategies and Numerical Pain Rating Scale (NPRS) scores before, during, and after debridement, were analyzed and described.
Results
Twenty-nine patients with an average age of 41.2 years (SD=17.8, range 18-72) and an average TBSA of 6.3% (SD=5.6, range 1-24.5) underwent a total of 29 BBED. For pain control during debridement, 6 patients required conscious sedation (CS), 7 a regional block (RB), 5 a local block (LB), and 9 only IV and oral (IVPO) medications. Two patients were intubated and sedated prior to the procedure. No patient required additional BBED treatment and all patients achieved >95% eschar removal. The average NPRS pain score 24 hours before treatment, during treatment, and 24 hours after treatment was 4.0, 4.6, & 4.4, respectively (P=0.65). Sixteen patients (55%) healed without the need for autografting. The average number of days from debridement to wound closure for all patients was 34.9 days (SD=11.9) and for patients who underwent autografting was 40.1 days (SD=12.3).
Conclusions
With appropriate analgesia, it is possible to perform BBED of acute deep partial- and full-thickness thermal burns without significant changes in patient-reported pain scores. Prior to debridement, it is critical to establish procedure logistics and reasonable patient expectations.
Applicability of Research to Practice
The authors review their experience controlling pain associated with BBED.
This book looks at the local agency related to peace formation in order to find answers to the pressing question of how large-scale peacebuilding or statebuilding may be significantly improved and ...made more representative of the lives, needs, rights, and ambitions of its subjects.
Compressive Sensing (CS) is a new sensing modality, which compresses the signal being acquired at the time of sensing. Signals can have sparse or compressible representation either in original domain ...or in some transform domain. Relying on the sparsity of the signals, CS allows us to sample the signal at a rate much below the Nyquist sampling rate. Also, the varied reconstruction algorithms of CS can faithfully reconstruct the original signal back from fewer compressive measurements. This fact has stimulated research interest toward the use of CS in several fields, such as magnetic resonance imaging, high-speed video acquisition, and ultrawideband communication. This paper reviews the basic theoretical concepts underlying CS. To bridge the gap between theory and practicality of CS, different CS acquisition strategies and reconstruction approaches are elaborated systematically in this paper. The major application areas where CS is currently being used are reviewed here. This paper also highlights some of the challenges and research directions in this field.
In real-time dynamic reconstruction, geometry and motion are the major focuses while appearance is not fully explored, leading to the low-quality appearance of the reconstructed surfaces. In this ...article, we propose a lightweight lighting model that considers spatially varying lighting conditions caused by self-occlusion. This model estimates per-vertex masks on top of a single Spherical Harmonic (SH) lighting to represent spatially varying lighting conditions without adding too much computation cost. The mask is estimated based on the local geometry of a vertex to model the self-occlusion effect, which is the major reason leading to the spatial variation of lighting. Furthermore, to use this model in dynamic reconstruction, we also improve the motion estimation quality by adding a real-time per-vertex displacement estimation step. Experiments demonstrate that both the reconstructed appearance and the motion are largely improved compared with the current state-of-the-art techniques.
This volume examines and evaluates the impact of international statebuilding interventions on the political economy of conflict-affected countries over the past 20 years. It focuses on countries that ...are emerging, or have recently emerged, from periods of war and protracted conflict. The interventions covered fall into three broad categories:
international administrations and transformative occupations (East Timor, Iraq, and Kosovo);
complex peace operations (Afghanistan, Burundi, Haiti, and Sudan);
governance and statebuilding programmes conducted in the context of economic assistance (Georgia and Macedonia).
This book will be of interest to students of statebuilding, humanitarian intervention, post-conflict reconstruction, political economy, international organisations and IR/Security Studies in general.
Purpose:
To investigate a measurement method for evaluating the resolution properties of CT imaging systems across reconstruction algorithms, dose, and contrast.
Methods:
An algorithm was developed ...to extract the task-based modulation transfer function (MTF) from disk images generated from the rod inserts in the ACR phantom (model 464 Gammex, WI). These inserts are conventionally employed for HU accuracy assessment. The edge of the disk objects was analyzed to determine the edge-spread function, which was differentiated to yield the line-spread function and Fourier-transformed to generate the object-specific MTF for task-based assessment, denoted MTFTask. The proposed MTF measurement method was validated against the conventional wire technique and further applied to measure the MTF of CT images reconstructed with an adaptive statistical iterative algorithm (ASIR) and a model-based iterative (MBIR) algorithm. Results were further compared to the standard filtered back projection (FBP) algorithm. Measurements were performed and compared across different doses and contrast levels to ascertain the MTFTask dependencies on those factors.
Results:
For the FBP reconstructed images, the MTFTask measured with the inserts were the same as the MTF measured from the wire-based method. For the ASIR and MBIR data, the MTFTask using the high contrast insert was similar to the wire-based MTF and equal or superior to that of FBP. However, results for the MTFTask measured using the low-contrast inserts, the MTFTask for ASIR and MBIR data was lower than for the FBP, which was constant throughout all measurements. Similarly, as a function of mA, the MTFTask for ASIR and MBIR varied as a function of noise–-with MTFTask being proportional to mA. Overall greater variability of MTFTask across dose and contrast was observed for MBIR than for ASIR.
Conclusions:
This approach provides a method for assessing the task-based MTF of a CT system using conventional and iterative reconstructions. Results demonstrated that the object-specific MTF can vary as a function of dose and contrast. The analysis highlighted the paradigm shift for iterative reconstructions when compared to FBP, where iterative reconstructions generally offer superior noise performance but with varying resolution as a function of dose and contrast. The MTFTask generated by this method is expected to provide a more comprehensive assessment of image resolution across different reconstruction algorithms and imaging tasks.
You, The People Chesterman, Simon
2005, 2004-03-18, 20040101
eBook
Transitional administrations represent the most complex operations attempted by the United Nations. The missions in Kosovo (1999—) and East Timor (1999–2002) are commonly seen as unique in the ...history of the United Nations. But they may also be seen as the latest in a series of operations that have involved the United Nations in ‘state‐building’ activities, in which it has attempted to develop the institutions of government by assuming some or all of those sovereign powers on a temporary basis. Viewed in light of earlier UN operations, such as those in Namibia (1989–1990), Cambodia (1992–1993), and Eastern Slavonia (1996–1998), the idea that these exceptional circumstances may not recur is somewhat disingenuous. The need for policy research in this area was brought into sharp focus by the weighty but vague responsibilities assigned to the United Nations in Afghanistan (2002—) and its contested role in Iraq (2003—).This book seeks to fill that gap. Aimed at policy‐makers, diplomats, and a wide academic audience (including international relations, political science, international law, war studies, and development studies), the book provides a concise history of transitional administration and a treatment of the five key issues confronting such operations: peace and security, the role of the United Nations as government, establishing the rule of law, economic reconstruction, and exit strategies. Research for the book has been conducted through extensive field research and interviews with key UN staff and local representatives in almost all of the territories under consideration. The unifying theme is that, while the ends of transitional administration may be idealistic, the means cannot be.
In this paper, we propose a novel method, namely GR-PSN, which learns surface normals from photometric stereo images and generates the photometric images under distant illumination from different ...lighting directions and surface materials. The framework is composed of two subnetworks, named GeometryNet and ReconstructNet, which are cascaded to perform shape reconstruction and image rendering in an end-to-end manner. ReconstructNet introduces additional supervision for surface-normal recovery, forming a closed-loop structure with GeometryNet. We also encode lighting and surface reflectance in ReconstructNet, to achieve arbitrary rendering. In training, we set up a parallel framework to simultaneously learn two arbitrary materials for an object, providing an additional transform loss. Therefore, our method is trained based on the supervision by three different loss functions, namely the surface-normal loss, reconstruction loss, and transform loss. We alternately input the predicted surface-normal map and the ground-truth into ReconstructNet, to achieve stable training for ReconstructNet. Experiments show that our method can accurately recover the surface normals of an object with an arbitrary number of inputs, and can re-render images of the object with arbitrary surface materials. Extensive experimental results show that our proposed method outperforms those methods based on a single surface recovery network and shows realistic rendering results on 100 different materials. Our code can be found in https://github.com/Kelvin-Ju/GR-PSN .
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