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Sample records for scar assessment scale

  1. A Clinimetric Overview of Scar Assessment Scales

    NARCIS (Netherlands)

    van der Wal, M.B.A.; Verhaegen, P.D.H.M.; Middelkoop, E.; van Zuijlen, P.P.M.

    2012-01-01

    Standardized validated evaluation instruments are mandatory to increase the level of evidence in scar management. Scar assessment scales are potentially suitable for this purpose, but the most appropriate scale still needs to be determined. This review will elaborate on several clinically relevant

  2. Reliability and Photographic Equivalency of the Scar Cosmesis Assessment and Rating (SCAR) Scale, an Outcome Measure for Postoperative Scars.

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    Kantor, Jonathan

    2017-01-01

    Until recently, no ideal valid, feasible, and reliable scar scale existed to effectively assess the quality of postoperative linear scars. The Scar Cosmesis Assessment and Rating (SCAR) scale was developed and validated as a tool to assess the quality of postoperative scars in clinical and research settings. To assess the reliability of using photographs in lieu of live patient scar rating assessments, and to determine the interrater and intrarater reliability of the SCAR scale. This was a reliability study to assess clinicians' interrater and intrarater reliability, as well as the reliability of using high-quality macrophotographs of postoperative scars. Patients were from a private practice dermatology clinic, with assessed scars representing a range of surgical procedures including those performed by dermatologists, plastic surgeons, and general surgeons. Assessments were performed by an international multidisciplinary team from dermatology, plastic surgery, surgical oncology, emergency medicine, and physiatry, using photographs and live patient assessments. A single photograph was assessed for each patient's scar. Data were obtained between August 3, 2015, and January 18, 2016. Data analysis occurred between January 18, 2016, and July 29, 2016. Using the intraclass correlation coefficient (ICC), the scale was tested for photographic equivalency as well as interrater reliability and intrarater reliability by 5 raters on a set of 80 total patient scars, 20 of which were analyzed for photographic equivalency and the remaining 60 of which were analyzed for interrater and intrarater reliability. The SCAR scale that measures postoperative scar cosmesis, with scores ranging from 0 (best possible scar) to 15 (worst possible scar), based on 6 clinician and 2 patient items was used. Of those 60 in the photographic subgroup, 10 were rated using not only the SCAR scale but also the Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale, and 10 were

  3. Analysis of Frequency of Use of Different Scar Assessment Scales Based on the Scar Condition and Treatment Method

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    Seong Hwan Bae; Yong Chan Bae

    2014-01-01

    Analysis of scars in various conditions is essential, but no consensus had been reached on the scar assessment scale to select for a given condition. We reviewed papers to determine the scar assessment scale selected depending on the scar condition and treatment method. We searched PubMed for articles published since 2000 with the contents of the scar evaluation using a scar assessment scale with a Journal Citation Report impact factor >0.5. Among them, 96 articles that conducted a scar evalu...

  4. Interpretation and precision of the Observer Scar Assessment Scale improved by a revised scoring

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    Lindeboom, J.A.; Bruijnesteijn van Coppenraet, E.S.; Kuijper, E.J.; Polsbroek, R.M.; Horsthuis, R.B.G.; Prins, J.M.; Lindeboom, R.

    2008-01-01

    Objective To apply Rasch measurement to develop a rule for clinical interpretation of the Observer Scar Assessment Scale (OSAS) to help surgeons judge reported sum scores clinically. Study Design and Setting We used cross-sectional data of a multicenter randomized clinical trial for the treatment of

  5. Assessment of scar quality after cleft lip closure

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    Frans, F.A.; van Zuijlen, P.P.M.; Griot, J.P.W.D.; van der Horst, C.M.A.M.

    2012-01-01

    Objective: To assess scar quality after cleft lip repair. Design: The linear scars of patients with cleft lip with or without cleft palate were evaluated in a prospective study using the Patient and Observer Scar Assessment Scale. Linear regression was performed to identify which scar

  6. Assessment of scar quality after cleft lip closure

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    Frans, Franceline A.; van Zuijlen, Paul P. M.; Griot, J. P. W. Don; van der Horst, Chantal M. A. M.

    2012-01-01

    To assess scar quality after cleft lip repair. The linear scars of patients with cleft lip with or without cleft palate were evaluated in a prospective study using the Patient and Observer Scar Assessment Scale. Linear regression was performed to identify which scar characteristics were important

  7. Reliable scar scoring system to assess photographs of burn patients.

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    Mecott, Gabriel A; Finnerty, Celeste C; Herndon, David N; Al-Mousawi, Ahmed M; Branski, Ludwik K; Hegde, Sachin; Kraft, Robert; Williams, Felicia N; Maldonado, Susana A; Rivero, Haidy G; Rodriguez-Escobar, Noe; Jeschke, Marc G

    2015-12-01

    Several scar-scoring scales exist to clinically monitor burn scar development and maturation. Although scoring scars through direct clinical examination is ideal, scars must sometimes be scored from photographs. No scar scale currently exists for the latter purpose. We modified a previously described scar scale (Yeong et al., J Burn Care Rehabil 1997) and tested the reliability of this new scale in assessing burn scars from photographs. The new scale consisted of three parameters as follows: scar height, surface appearance, and color mismatch. Each parameter was assigned a score of 1 (best) to 4 (worst), generating a total score of 3-12. Five physicians with burns training scored 120 representative photographs using the original and modified scales. Reliability was analyzed using coefficient of agreement, Cronbach alpha, intraclass correlation coefficient, variance, and coefficient of variance. Analysis of variance was performed using the Kruskal-Wallis test. Color mismatch and scar height scores were validated by analyzing actual height and color differences. The intraclass correlation coefficient, the coefficient of agreement, and Cronbach alpha were higher for the modified scale than those of the original scale. The original scale produced more variance than that in the modified scale. Subanalysis demonstrated that, for all categories, the modified scale had greater correlation and reliability than the original scale. The correlation between color mismatch scores and actual color differences was 0.84 and between scar height scores and actual height was 0.81. The modified scar scale is a simple, reliable, and useful scale for evaluating photographs of burn patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Microneedling therapy in atrophic facial scars: An objective assessment

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    Majid Imran

    2009-01-01

    Full Text Available Background: Atrophic facial scars are always a challenge to treat, especially the ones that are deep-seated and/or involve much of the face. Microneedling or dermaroller therapy is a new addition to the treatment armamentarium for such scars that offers a simple and reportedly effective management of these scars. Aims: The aim of the present study was to perform an objective evaluation of the efficacy of dermaroller treatment in atrophic facial scars of varying etiology. Materials and Methods: Thirty-seven patients of atrophic facial scarring were offered multiple sittings of microneedling (dermaroller treatment and their scars were evaluated and graded clinically and by serial photography at the start as well as at two months after the conclusion of the treatment protocol. Any change in the grading of scars after the end of treatment and follow-up period was noted down. The patients were also asked to evaluate the effectiveness of the treatment received on a 1-10 point scale. The efficacy of dermaroller treatment was thus assessed both subjectively by the patients as well as objectively by a single observer. Results: Overall 36 out of the total of 37 patients completed the treatment schedule and were evaluated for its efficacy. Out of these 36 patients, 34 achieved a reduction in the severity of their scarring by one or two grades. More than 80% of patients assessed their treatment as ′excellent′ on a 10-point scale. No significant adverse effects were noted in any patient. Conclusions: Microneedling therapy seems to be a simple and effective treatment option for the management of atrophic facial scars.

  9. Objective Scar Assessment Tools: A Clinimetric Appraisal

    NARCIS (Netherlands)

    Verhaegen, P.D.H.M.; van der Wal, M.B.A.; Middelkoop, E.; van Zuijlen, P.P.M.

    2011-01-01

    Background: Scars may lead to an array of cosmetic, psychological, and functional problems. Different scar features can be distinguished (i.e., color, thickness, relief, pliability, and surface area) that are clinically relevant and contribute to the quality and judgment of a scar. Today, objective

  10. Scars

    Science.gov (United States)

    ... never go away completely. If the way a scar looks bothers you, various treatments might minimize it. These include surgical revision, dermabrasion, laser treatments, injections, chemical peels, and creams.

  11. Patient reported facial scar assessment : directions for the professional

    NARCIS (Netherlands)

    Hoogewerf, Cornelis J; van Baar, Margriet E; Middelkoop, Esther; Van Loey, N.E.E.

    BACKGROUND: The face is central to our identity and provides our most expressive means of communication. Currently, the role of facial scarring in relation to self-esteem is unclear and the value of self-reported scar assessment is insufficiently understood. The aim of this study was twofold: (1) to

  12. Clinimetrics of tristimulus colourimeters in scar assessment: a review of evidence.

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    Jones, H G

    2012-01-01

    To review the evidence regarding the use of tristimulus colourimeters (TC) in scar assessment. A literature search was performed using Ovid and the Cochrane database with the search terms 'scar assessment', 'clinimetrics', 'tristimulus colourimeter', 'microcolour', 'chromameter' and 'colour spectrometer'. Wound colour is usually assessed with a visual analogue scale, such as VSS or POSAS. Research on objectifying the assessment by using an assessment tool has so far been encouraging, but has failed to show a benefit over the visual analogue scales in terms of validity, accuracy and reproducibility. Studies vary in methodological quality. Research on TC clinimetrics has shown moderate to high concurrent validity, reliability and reproducibility of these products in terms of assessing vascularity, but less correlation in terms of pigmentation, when compared with the visual scoring systems. The evidence for using TC is based on a relatively small number of studies, and more research is needed before widespread implementation of TC for assessing scar maturation is recommended.

  13. A Modeling Approach for Burn Scar Assessment Using Natural Features and Elastic Property

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    Tsap, L V; Zhang, Y; Goldgof, D B; Sarkar, S

    2004-04-02

    A modeling approach is presented for quantitative burn scar assessment. Emphases are given to: (1) constructing a finite element model from natural image features with an adaptive mesh, and (2) quantifying the Young's modulus of scars using the finite element model and the regularization method. A set of natural point features is extracted from the images of burn patients. A Delaunay triangle mesh is then generated that adapts to the point features. A 3D finite element model is built on top of the mesh with the aid of range images providing the depth information. The Young's modulus of scars is quantified with a simplified regularization functional, assuming that the knowledge of scar's geometry is available. The consistency between the Relative Elasticity Index and the physician's rating based on the Vancouver Scale (a relative scale used to rate burn scars) indicates that the proposed modeling approach has high potentials for image-based quantitative burn scar assessment.

  14. The Stanford-ReSurge Burn Scar Contracture Scale for Neck: Development and Initial Validation for Burn Scar Contracture.

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    Cai, Lawrence; Puri, Vinita; Dangol, Mohan Krishna; Mannan, Iftekhar Ibne; Khundkar, Shafquat Hussain; Le Thua, Trung-Hau; Muguti, Godfrey; Rai, Shankar Man; Karanas, Yvonne; Chang, James

    2016-11-01

    Burn contractures can cause significant disability, particularly in patients in resource-limited settings. However, a gap exists in our ability to measure outcomes in patients with burn contractures of the neck. The objective of this study was to develop and validate the Stanford-ReSurge Burn Scar Contracture Scale-Neck to longitudinally assess functional status and measure functional improvement following contracture release of the neck. A literature review was performed to identify scales used in neck assessment and burn assessment. Items were then removed from the pool based on redundancy, feasibility, cultural appropriateness, and applicability to patients in international resource-limited environments. Remaining items were administered to patients with burn contracture of the neck. The initial literature review found 33 scales that were combined to create an initial pool of 714 items, which was first reduced to 40 items. Feedback from field testing then yielded a 20-item outcome tool to assess appearance, activities of daily living, somatosensation, satisfaction, and range of motion, with a floor of 20 and a ceiling score of 100 points. Preliminary testing with 10 patients showed an average preoperative score of 58 points and an average 1-month postoperative score of 42 points. The authors have created an outcome tool for measuring functional status following burn contracture release of the neck, which can easily be implemented in resource-limited settings where the burden of burn injuries and morbidities is disproportionately high. Ongoing work includes a multicountry study to evaluate validity and reliability.

  15. Evaluation of Acne Scars: How to Assess Them and What to Tell the Patient.

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    Fife, Douglas

    2016-04-01

    The prevalence and emotional impact of acne scarring are underestimated by the medical community. Dermatology providers should be able to evaluate the acne scar patient and discuss treatment options. Important aspects of the patient history include current treatments, prior acne scar procedures, and the patient's goals for treatment. During the physical examination, the scars are assessed and classified by scar morphology and overall severity of scarring. Finally, a treatment plan is developed in which the most appropriate procedures are matched with the scars that will work the best. Helping the patient understand likely expectations for improvement will increase overall satisfaction. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Comparison between high-frequency ultrasonography and histological assessment reveals weak correlation for measurements of scar tissue thickness.

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    Agabalyan, Natacha A; Su, Samuel; Sinha, Sarthak; Gabriel, Vincent

    2017-05-01

    Current methods for evaluating scar tissue volume following burns have shortcomings. The Vancouver Burn Scar scale is subjective, leading to a high variability in assessment. Although histological assessment via punch biopsy can discriminate between the different layers of skin, such an approach is invasive, inefficient, and detrimental to patient experience and wound healing. This study investigates the accuracy of high-frequency ultrasonography, a non-invasive alternative to histology, for measuring dermal and epidermal thickness in scar tissue. Scar thicknesses of 10 patients following burns were assessed using a 2-D high-frequency ultrasound probe. The scars were then biopsied using a circular 4mm punch biopsy for histological assessment. Dermal, epidermal, and total thickness of the scar tissue was measured using ultrasound and histology, and correlations between the two measurements were calculated. There was not a strong correlation between ultrasound measurement and histological analysis for epidermal, dermal, and total thickness (Spearman's rank correlation of -0.1223, -0.6242, and -0.6242) of scar tissue. Measurements of scar thickness using high-frequency ultrasonography did not recapitulate the in vivo dermal, epidermal and total thickness. Based on these findings, strategies for further optimization of 2-D ultrasonography is discussed before clinical and research use. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  17. In vivo assessment of human burn scars through automated quantification of vascularity using optical coherence tomography

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    Liew, Yih Miin; McLaughlin, Robert A.; Gong, Peijun; Wood, Fiona M.; Sampson, David D.

    2013-06-01

    In scars arising from burns, objective assessment of vascularity is important in the early identification of pathological scarring, and in the assessment of progression and treatment response. We demonstrate the first clinical assessment and automated quantification of vascularity in cutaneous burn scars of human patients in vivo that uses optical coherence tomography (OCT). Scar microvasculature was delineated in three-dimensional OCT images using speckle decorrelation. The diameter and area density of blood vessels were automatically quantified. A substantial increase was observed in the measured density of vasculature in hypertrophic scar tissues (38%) when compared against normal, unscarred skin (22%). A proliferation of larger vessels (diameter≥100 μm) was revealed in hypertrophic scarring, which was absent from normal scars and normal skin over the investigated physical depth range of 600 μm. This study establishes the feasibility of this methodology as a means of clinical monitoring of scar progression.

  18. Scar massage for hypertrophic burns scarring-A systematic review.

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    Ault, P; Plaza, A; Paratz, J

    2017-06-29

    Scar massage is used in burn units globally to improve functional and cosmetic outcomes of hypertrophic scarring following a burn, however, the evidence to support this therapy is unknown. To review the literature and assess the efficacy of scar massage in hypertrophic burn scars. MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library were searched using the key words "burn", "burn injury", "thermal injury" and "scar", "hypertrophic scar" and "massage", "manipulation", "soft tissue mobilisation", "soft tissue manipulation". The articles were scored by the assessors using the Physiotherapy Evidence Database (PEDro) scale and outcome measures on range of motion (ROM), cosmesis (vascularity, pliability, height), pain scores, pruritus, and psychological measures of depression and anxiety were extracted. Eight publications were included in the review with 258 human participants and 15 animal subjects who received scar massage following a thermal injury resulting in hypertrophic scarring. Outcome measures that demonstrated that scar massage was effective included scar thickness as measured with ultrasonography (p=0.001; g=-0.512); depression (Centre for Epidemiologic Studies - Depression [CES-D]) (p=0.031; g=-0.555); pain as measured with Visual Analogue Scale (VAS) (p=0.000; g=-1.133) and scar characteristics including vascularity (p=0.000; g=-1.837), pliability (p=0.000; g=-1.270) and scar height (p=0.000; g=-2.054). Outcome measures that trended towards significance included a decrease in pruritus (p=0.095; g=-1.157). It appears that there is preliminary evidence to suggest that scar massage may be effective to decrease scar height, vascularity, pliability, pain, pruritus and depression in hypertrophic burns scaring. This review reflects the poor quality of evidence and lack of consistent and valid scar assessment tools. Controlled, clinical trials are needed to develop evidence-based guidelines for scar massage in hypertrophic burns scarring. Copyright © 2017

  19. The challenge of objective scar colour assessment in a clinical setting: using digital photography.

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    Anderson, J C; Hallam, M-J; Nduka, C; Osorio, D

    2015-08-01

    Scar assessment in the clinical setting is typically impeded by a lack of quantitative data and most systems rely on subjective rating scales which are user dependant and show considerable variability between raters. The growing use of digital photography in medicine suggests a more objective approach to scar evaluation. Our objective was to determine if cameras could be of practical use for measuring colour in a clinical setting. The measurement of colour and reflectance spectra in photographs faces two difficulties: firstly the effects of variable illumination spectra, and secondly to recover accurate colour and spectral information from the sparse red, green and blue (RGB) camera signals. As a result the colour rendition is often inaccurate, and spectral information is lost. To deal with variable illumination and other factors that systematically affect all reflectance spectra ColourWorker (a method for image-based colour measurement implemented in software) calibrates the spectral responses of the camera's RGB sensors using a colour standard in the image. To make best use of the calibrated signals, it takes advantage of the fact that although a given RGB signal can be caused by an infinite number of spectra, most natural reflectance spectra vary smoothly and have predictable forms. This means given a set of examples of spectra produced by the materials of interest, it is possible to estimate the specific spectrum that produced a given RGB signal once corrected for the illumination. We describe a method for recovering spectral and chromatic information relating to surface reflectance from ordinary digital images and apply this to analyse photographs of surgical scars, taken as part of a clinical trial, in an attempt to better quantify clinical scar assessment. It should be noted the pre-existing trial protocol did not allow for a comprehensive evaluation of the accuracy of the method which would require the spectrophotometric measurement of skin regions

  20. Non-ablative fractional laser provides long-term improvement of mature burn scars--a randomized controlled trial with histological assessment.

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    Taudorf, Elisabeth H; Danielsen, Patricia L; Paulsen, Ida F; Togsverd-Bo, Katrine; Dierickx, Christine; Paasch, Uwe; Haedersdal, Merete

    2015-02-01

    Non-ablative fractional laser-treatment is evolving for burn scars. The objective of this study was to evaluate clinical and histological long-term outcome of 1,540 nm fractional Erbium: Glass laser, targeting superficial, and deep components of mature burn scars. Side-by-side scar-areas were randomized to untreated control or three monthly non-ablative fractional laser-treatments using superficial and extra-deep handpieces. Patient follow-up were at 1, 3, and 6 months. Primary outcome was improvement in overall scar-appearance on a modified-Patient-and-Observer-Scar-Assessment-Scale (mPOSAS, 1 = "normal skin", 10 = "worst imaginable scar"). Secondary outcomes included histology, patient satisfaction (0-10), patient-assessed improvement, and safety. Study was completed by 17 of 20 randomized patients with normotrophic (n = 11), hypertrophic (n = 5) or atrophic (n = 1) scars. Scar-appearance improved from laser-treatments (P ablative fractional laser-treatments induce long-term clinical and histological improvement of mature burn scars. © 2014 Wiley Periodicals, Inc.

  1. New Atrophic Acne Scar Classification: Reliability of Assessments Based on Size, Shape, and Number.

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    Kang, Sewon; Lozada, Vicente Torres; Bettoli, Vincenzo; Tan, Jerry; Rueda, Maria Jose; Layton, Alison; Petit, Lauren; Dréno, Brigitte

    2016-06-01

    Post-acne atrophic scarring is a major concern for which standardized outcome measures are needed. Traditionally, this type of scar has been classified based on shape; but survey of practicing dermatologists has shown that atrophic scar morphology has not been well enough defined to allow good agreement in clinical classification. Reliance on clinical assessment is still needed at the current time, since objective tools are not yet available in routine practice. Evaluate classification for atrophic acne scars by shape, size, and facial location and establish reliability in assessments. We conducted a non-interventional study with dermatologists performing live clinical assessments of atrophic acne scars. To objectively compare identification of lesions, individual lesions were marked on a high-resolution photo of the patient that was displayed on a computer during the clinical evaluation. The Jacob clinical classification system was used to define three primary shapes of scars 1) icepick, 2) boxcar, and 3) rolling. To determine agreement for classification by size, independent technicians assessed the investigators' markings on digital images. Identical localization of scars was denoted if the maximal distance between their centers was ≤ 60 pixels (approximately 3 mm). Raters assessed scars on the same patients twice (morning/afternoon). Aggregate models of rater assessments were created and analyzed for agreement. Raters counted a mean scar count per subject ranging from 15.75 to 40.25 scars. Approximately 50% of scars were identified by all raters and ~75% of scars were identified by at least 2 of 3 raters (weak agreement, Kappa pairwise agreement 0.30). Agreement between consecutive counts was moderate, with Kappa index ranging from 0.26 to 0.47 (after exclusion of one outlier investigator who had significantly higher counts than all others). Shape classifications of icepick, boxcar, and rolling differed significantly between raters and even for same raters at

  2. ASSESSMENT OF MICRONEEDLING THERAPY IN THE MANAGEMENT OF ATROPHIC FACIAL ACNE SCARS

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    Ajay

    2015-12-01

    Full Text Available STUDY BACKGROUND Post acne scars are always a challenge to treat, especially the ones which are deep seated. There are many treatment options like laser resurfacing, dermabrasion, microdermabrasion and non-ablative laser resurfacing but with considerable morbidity and interference with the daily activities of the patient in the post-treatment period. Microneedling or dermaroller therapy is one of the new treatment options in the management of acne scars with satisfactory improvement and no significant side effect. The aim of the present study is to perform an objective evaluation the efficacy of microneedling in the treatment of atrophic acne scars. MATERIALS AND METHODS Thirty patients of skin type III-V having atrophic facial acne scars presenting to our dermatology OPD. were received multiple sittings of microneedling (dermaroller treatment with an interval of 6 weeks between each session. Goodman & Baron’s acne scar grading system was used for assessment of their scars and was evaluated clinically by serial photography at the start as well as at two months after the conclusion of the treatment. Patients on anticoagulant therapy, of keloidal tendency, with bleeding disorders, vitiligo patients, pregnant and lactating mothers and patients with active acne lesions were excluded from the study. The duration of this study was for ten months-from January 2014 to October 2014. RESULTS Any change in the grading of scars after the end of treatment and follow-up period was noted down. The efficacy and improvement of dermaroller treatment was assessed by Goodman and Baron’s Global Acne Scarring System. Out of 30 patients, 26(80.64% patients achieved a reduction in the severity of their scarring by one or two grades. Quantitative assessment showed that 13.3% of patients had minimal, 16.6% had good and 70% showed very good improvement. Adverse effects were limited to transient pain, erythema and edema. CONCLUSION Microneedling therapy seems to be

  3. Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients.

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    Wang, Xue-Qing; Mill, Julie; Kravchuk, Olena; Kimble, Roy M

    2010-12-01

    This study describes the ultrasound assessment of burn scars in paediatric patients and the association of these scar thickness with laser Doppler imaging (LDI) determined burn depth. A total of 60 ultrasound scar assessments were conducted on 33 scars from 21 paediatric burn patients at 3, 6 and 9 months after-burn. The mean of peak scar thickness was 0.39±0.032 cm, with the thickest at 6 months (0.40±0.036 cm). There were 17 scald burn scars (0.34±0.045 cm), 4 contact burn scars (0.61±0.092 cm), and 10 flame burn scars (0.42±0.058 cm). Each group of scars followed normal distributions. Twenty-three scars had original burns successfully scanned by LDI and various depths of burns were presented by different colours according to blood perfusion units (PU), with dark blue burns, with the thinnest scars for green coloured burns and the thickest for dark blue coloured burns. Within light blue burns, grafted burns healed with significantly thinner scars than non-grafted burns. This study indicates that LDI can be used for predicting the risk of hypertrophic scarring and for guiding burn care. To our knowledge, this is the first study to correlate the thickness of burns scars by ultrasound scan with burn depth determined by LDI. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

  4. The dermatology life quality index as a means to assess life quality in patients with different scar types.

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    Reinholz, M; Poetschke, J; Schwaiger, H; Epple, A; Ruzicka, T; Gauglitz, G G

    2015-11-01

    Measuring quality of life through questionnaires is a common method to evaluate the impact of different afflictions on the patient's well-being, especially in the field of dermatology where appearance changing afflictions are common. A variety of questionnaires has been used to distinguish different skin conditions like psoriasis, atopic dermatitis and scars. Using the Dermatology Life Quality Index (DLQI), we investigated different scar types regarding their impact on quality of life. We assessed the quality of life in 130 patients presenting to our outpatient scar clinic for the first time using the DLQI. Scars were analysed according to their clinical appearance (physiological scars, keloids, hypertrophic scars, atrophic scars, self-harm scars). Physiological scars were established as a baseline for further comparison between groups. Patients in the physiological scar group scored a mean DLQI score of 2.07 ± 3.56, patients in the keloid-, hypertrophic scar-, atrophic scar- and self-harm scar group scored values of 6.06 ± 4.00, 2.53 ± 2.48, 7.26 ± 6.72 and 12.00 ± 3.85 respectively. When compared to the baseline group the difference in the overall score for keloids was +3.99 (P scars scored +0.45 (ns), atrophic scars +5.19 (P scars +9.93 (P scars do affect patients in a different magnitude. The DLQI provides a promising adjunct for quantifying the quality of life in patients suffering from keloids, atrophic- and self-harm scars and may constitute an interesting additional tool for monitoring the progress of scar treatments. © 2015 European Academy of Dermatology and Venereology.

  5. Quality of life and mediating role of patient scar assessment in burn patients.

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    Oh, Hyunjin; Boo, Sunjoo

    2017-09-01

    In this study, we examined the plausibility of the mediating effect of the levels of patient scar assessment on the relationship between burn severity measured with total body surface area and burn-specific health-related quality of life (HRQL) among patients with burns in South Korea. In this cross sectional descriptive study, we collected data from 100 burn patients in three burn centers specializing in burn care in South Korea. Patient scar assessment, burn specific HRQL, and burn-related characteristics were self-reported with anonymous, paper-based surveys. The findings showed a positive correlation between burn severity, patient scar assessment, and HRQL in burn patients. The evidence of this paper is that quality of life after burns more determined by scar characteristics than burn severity. In the light of the poor HRQL in burn patients, the results of this study support that improving scar status could improve patients' HRQL. Health care providers should keep in mind that patients' perspectives of their scars would be a great indicator of their HRQL, so the providers' focus should be on intensive scar management intervention in their care. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  6. Efficacy and Safety of a Novel 100% Silicone Scar Gel Treatment for Early Intervention in Scar Management.

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    Goldberg, David J

    2016-12-01

    Objective: To evaluate the efficacy and safety of a new topical silicone gel for the early intervention in the management of scars. Design: In this 12-week, observational study, healthy subjects (n=15) with an accessible linear or hypertrophic scar were given the test product and instructed to apply twice daily. Subjects returned 14, 28, 56, and 84 days later for evaluation and recording of adverse events. Setting: Private practice of the author. Participants: Eligible subjects had a scar with a Vancouver Scar Scale total score ≥3 at baseline. Measurements: Improvement was evaluated by the Vancouver Scar Scale and Observer Scar Assessment Scale at baseline and at four follow-up visits. Results: The median total Vancouver Scar Scale score and median total Observer Scar Assessment Scale score decreased significantly from baseline at each visit, showing rapid and continuing improvement in the appearance of the scars. For Vancouver Scar Scale, significant differences of individual parameters from baseline began at 28 days for pliability and height, 56 days for vascularity, and 84 days for pigmentation. For Observer Scar Assessment Scale parameters, significant differences from baseline began at 14 days and continued until 84 days for vascularization, thickness, and pigmentation. Pain and pruritis scores were low at each visit. Overall, 84.6 percent of subjects rated the treatment as excellent, very good, or good after three months of treatment. No adverse events were reported. Conclusion: The test product improved the appearance of scars after three months of twice-daily treatment and without adverse events.

  7. Effectiveness of Autologous Fat Grafting in Adherent Scars: Results Obtained by a Comprehensive Scar Evaluation Protocol.

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    Jaspers, Mariëlle E H; Brouwer, Katrien M; van Trier, Antoine J M; Groot, Marloes L; Middelkoop, Esther; van Zuijlen, Paul P M

    2017-01-01

    Nowadays, patients normally survive severe traumas such as burn injuries and necrotizing fasciitis. Large skin defects can be closed but the scars remain. Scars may become adherent to underlying structures when the subcutical fat layer is damaged. Autologous fat grafting provides the possibility of reconstructing a functional sliding layer underneath the scar. Autologous fat grafting is becoming increasingly popular for scar treatment, although large studies using validated evaluation tools are lacking. The authors therefore objectified the effectiveness of single-treatment autologous fat grafting on scar pliability using validated scar measurement tools. Forty patients with adherent scars receiving single-treatment autologous fat grafting were measured preoperatively and at 3-month follow-up. The primary outcome parameter was scar pliability, measured using the Cutometer. Scar quality was also evaluated by the Patient and Observer Scar Assessment Scale and the DSM II ColorMeter. To prevent selection bias, measurements were performed following a standardized algorithm. The Cutometer parameters elasticity and maximal extension improved 22.5 percent (p Scar Assessment Scale scores improved from 3.6 to 2.9 on the observer scale, and from 5.1 to 3.8 on the patient scale (both p scar and normal skin remained unaltered. For the first time, the effect of autologous fat grafting on functional scar parameters was ascertained using a comprehensive scar evaluation protocol. The improved scar pliability supports the authors' hypothesis that the function of the subcutis can be restored to a certain extent by single-treatment autologous fat grafting. Therapeutic, IV.

  8. Modified Vancouver Scar Scale score is linked with quality of life after burn.

    Science.gov (United States)

    Finlay, Vidya; Burrows, Sally; Kendell, Rosemary; Berghuber, Aaron; Chong, Vincent; Tan, Jason; Edgar, Dale W; Wood, Fiona

    2017-06-01

    This study aimed to determine if a scar quality is associated with quality of life (QoL) at six months post-burn and beyond. Quantile regression models adjusted for covariates were used to demonstrate the relationship of modified Vancouver Scar Scale (mVSS) total (with and without pigmentation) and the mVSS components, to the Burn Specific Health Scale-Brief (BSHS-B) scores (full scale, Affect and Relations domain, Skin Sensitivity domain). The sample (n=341) comprised 67% males, 83% with skin grafts with a median age 38 years, total body surface area (TBSA) 4%, length of stay seven days, mVSS total score of five and BSHS-B total score of 153. Between six and 12 months of injury, mVSS total, TBSA and female gender were significantly associated with the BSHS-B, a situation that was not affected by the presence or absence of pigmentation scores. The mVSS components did not individually influence QoL. mVSS total score, gender and burn size data may be a useful adjunct to experienced clinical judgment for identifying at risk patients and directing appropriate, timely resource allocation. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  9. What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers.

    Science.gov (United States)

    Thompson, Callie M; Sood, Ravi F; Honari, Shari; Carrougher, Gretchen J; Gibran, Nicole S

    2015-11-01

    Reliable characterization of a hypertrophic scar (HTS) is integral to epidemiologic studies designed to identify clinical and genetic risk factors for HTS. The Vancouver Scar Scale (VSS) has been widely used for this purpose; however, no publication has defined what score on this scale corresponds to a clinical diagnosis of HTS. In a survey of 1000 burn care providers, we asked respondents what VSS score indicates a HTS and asked them to score scar photos using the VSS. We used receiver-operating-characteristic (ROC) curves to evaluate VSS sub-scores and their combinations in diagnosis of HTS. Of 130 responses (13.5%), most were physicians (43.9%) who had worked in burn care for over 10 years (63.1%) and did not use the VSS in clinical practice (58.5%). There was no consensus as to what VSS score indicates a diagnosis of HTS. VSS height score (0-3) performed best for diagnosis of HTS; using a cut-off of ≥1, height score was 99.5% sensitive and 85.9% specific for HTS. Burn clinicians do not routinely use the VSS and perceptions vary widely regarding what constitutes a HTS. When a dichotomous variable is needed, the VSS height score with a cut-off of ≥1 may be optimal. Our findings underscore the need for an objective tool to reproducibly characterize HTS across burn centers. Published by Elsevier Ltd.

  10. Scar Assessment After Breast Augmentation Surgery with Axillary Incision versus Inframammary Fold Incision: Long-Term Follow-Up in Chinese Patients.

    Science.gov (United States)

    Sun, Jingjing; Mu, Dali; Liu, Chunjun; Ji, Kai; Chen, Lin; Liu, Wenyue; Luan, Jie

    2016-10-01

    The inframammary fold (IMF) incision is widely used in Western countries for breast augmentation surgery, whereas the axillary incision is the dominant approach used in China, because many Chinese surgeons believe that the Asian population has a higher risk of developing hypertrophic scars. However, comparative data of scar assessment through different incisions in Chinese patients are scarce. The aims of the study were as follows: (1) to evaluate the outcomes of scar assessment using the Vancouver scar scale (VSS), combined with patient satisfaction scoring, in the scar assessment after breast augmentation surgery; (2) to compare the long-term cosmetic effects of surgical scars between axillary and IMF incisions. Consecutive patients coming to our department for follow-up care at least 1 year after primary breast augmentation surgeries with axillary and IMF incisions between January 1, 2014 and December 31, 2014 were included in the research. Internal consistency, inter-rater reliability, and convergent validity were examined for the VSS and patient satisfaction scoring. The baseline characteristics and scar scores were tested using the Mann-Whitney U-test and Student's t test between the two groups. Sixty-one patients underwent implantation surgeries through the axillary incisions, and 17 patients through the IMF incisions. There were no significant differences in age, follow-up time, body mass index, implant volume, or implant projection between groups. Reliability and validity of the VSS and patient satisfaction scoring were satisfactory. The scores of pigmentation were higher in the IMF group than those in the axilla group with statistical significance (P scars were significantly longer in the axilla group compared with the IMF group (P scars after augmentation mammaplasty. Scars in the axilla and IMF can achieve comparable cosmetic effects and patient satisfaction in Chinese women. Chinese patients with proper indications can receive breast augmentation

  11. Assessment of burn-specific health-related quality of life and patient scar status following burn.

    Science.gov (United States)

    Oh, Hyunjin; Boo, Sunjoo

    2017-11-01

    This study assessed patient-perceived levels of scar assessment and burn-specific quality of life (QOL) in Korean burn patients admitted to burn care centers and identified differences in scar assessment and QOL based on various patient characteristics. A cross-sectional descriptive study using anonymous paper-based survey methods was conducted with 100 burn patients from three burn centers specializing in burn care in South Korea. Mean subject age was 44.5 years old, and 69% of the subjects were men. The overall mean QOL was 2.91 out of 5. QOL was lowest for the work subdomain (2.25±1.45) followed by the treatment regimen subdomain (2.32±1.16). The subjects' mean total scar assessment score was 35.51 out of 60, and subjects were most unsatisfied with scar color. Subjects with low income, flame-source burns, severe burns, visible scars, and scars on face or hand reported significantly lower QOL. Subjects with severe burn degree and burn range perceived their burn scar condition to be worse than that of others. The results show that burn subjects experience the most difficulties with their work and the treatment regimen. Subjects with severe burn and visible scarring have a reduced QOL and a poor scar status. Scar management intervention may improve QOL of burn patients especially those with severe burn and visible scars. Further studies are warranted to evaluate the relationship between scar assessment and QOL. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  12. Assessment of left ventricular myocardial scar in coronary artery disease by a three-dimensional MR imaging technique.

    Science.gov (United States)

    Yin, Gang; Zhao, Shihua; Lu, Minjie; Ma, Ning; Zuehlsdorff, Sven; Cheng, Huaibing; Jiang, Shiliang; Zhao, Tao; Zhang, Yan; An, Jing; Lv, Chuanjian; He, Zuoxiang

    2013-07-01

    To evaluate the feasibility of free-breathing three-dimensional (3D) phase sensitive inversion recovery (PSIR) Turbo FLASH late gadolinium enhancement (LGE) magnetic resonance images (MRI) on left ventricular scar in patients with coronary artery disease (CAD) compared with clinically established breathhold two-dimensional (2D) PSIR Turbo FLASH images. In 58 consecutive patients with confirmed CAD, LGE MRI using the two sequences have been acquired. Image quality was graded on a four-point scale according to the image appearance. Qualitative evaluation including the distribution area and the transmural extent of the scar based on the American Heart Association's (AHA's) 17-segment model was performed in both of 2D and 3D images. The scar volumes were compared quantitatively between 2D and 3D images. A total of 51 individuals were used for final statistical analysis. No differences were noted in image quality (P = 0.80), scar distribution area (P = 0.17), and scar transmural extent (P = 0.20) between 3D and 2D images. There was strong correlation in scar volume between the 3D and 2D results (r = 0.940; P trend toward a larger scar volume identified by 3D method was indicated through Bland-Altman analysis. Free-breathing 3D PSIR Turbo FLASH imaging is another feasible method to identify left ventricular myocardial scar in patients with CAD and detects more scar volume compared with breathhold 2D PSIR Turbo FLASH imaging. Copyright © 2012 Wiley Periodicals, Inc.

  13. Outcomes of ablative fractional laser scar treatment.

    Science.gov (United States)

    Kim, Deok-Woo; Hwang, Na-Hyun; Yoon, Eul-Sik; Dhong, Eun-Sang; Park, Seung-Ha

    2015-04-01

    Ablative fractional laser (AFL) systems are commonly used to treat various scars, and recent reports have indicated that early scar treatment with fractional lasers has good aesthetic results. Some scars respond dramatically to AFL treatment, incurring high levels of patient satisfaction; however, other scars respond poorly or became worse after treatment. This study was designed to clarify prognostic factors that predict AFL scar treatment outcomes. A total of 108 patients were included in this study. The fractional laser treatments were repeated every 4 weeks until the scar site was acceptable and no additional improvement was expected or the patient discontinued the treatment. The scar improvements were defined as changes in the Manchester scar scale (MSS) from before to after laser treatment. A digital camera was used to acquire digital photographs of the scars under the same light source, the same background, exposure, and white balance. This study developed a modification of the MSS for image analysis in which colour assessment was based on L*a*b* colour co-ordinates of the digital images. The mean MSS values prior to and after laser treatments were 11.6 ± 3.6 and 9.5 ± 2.9, respectively (p treatment improved the qualities of each scar, and the improvements were evident in colour and contour. Scar elevation, pigmentation, high vascularity, early onset of treatment, and the number of treatment sessions were directly related to scar improvement after AFL therapy (p treatments were effective methods for scar treatment. Clinicians can use these prognostic factors to determine treatment plans and to estimate scar improvement after AFL treatment.

  14. Evaluation of the use of unipolar voltage amplitudes for detection of myocardial scar assessed by cardiac magnetic resonance imaging in heart failure patients.

    Science.gov (United States)

    Nguyên, Uyên Châu; Maffessanti, Francesco; Mafi-Rad, Masih; Conte, Giulio; Zeemering, Stef; Regoli, François; Caputo, Maria Luce; van Stipdonk, Antonius M W; Bekkers, Sebastiaan C A M; Suerder, Daniel; Moccetti, Tiziano; Krause, Rolf; Prinzen, Frits W; Vernooy, Kevin; Auricchio, Angelo

    2017-01-01

    Validation of voltage-based scar delineation has been limited to small populations using mainly endocardial measurements. The aim of this study is to compare unipolar voltage amplitudes (UnipV) with scar on delayed enhancement cardiac magnetic resonance imaging (DE-CMR). Heart failure patients who underwent DE-CMR and electro-anatomic mapping were included. Thirty-three endocardial mapped patients and 27 epicardial mapped patients were investigated. UnipV were computed peak-to-peak. Electrograms were matched with scar extent of the corresponding DE-CMR segment using a 16-segment/slice model. Non-scar was defined as 0% scar, while scar was defined as 1-100% scar extent. UnipVs were moderately lower in scar than in non-scar (endocardial 7.1 [4.6-10.6] vs. 10.3 [7.4-14.2] mV; epicardial 6.7 [3.6-10.5] vs. 7.8 [4.2-12.3] mV; both pscar extent was moderate for endocardial (R = -0.33, p25%, >50% and >75% scar extent with AUCs of 0.72, 0.73 and 0.76, respectively, while epicardial UnipV were poor scar predictors, independent of scar burden (AUC = 0.47-0.56). UnipV in non-scar varied widely between patients (pscar compared to non-scar in only 9/22 (41%) endocardial mapped patients and 4/19 (21%) epicardial mapped patients with scar. UnipV are slightly lower in scar compared to non-scar. However, significant UnipV differences between and within patients and large overlap between non-scar and scar limits the reliability of accurate scar assessment, especially in epicardial measurements and in segments with less than 75% scar extent.

  15. The effect of topical scar treatment on postoperative scar pain and pruritus after total knee arthroplasty.

    Science.gov (United States)

    Kong, Chae-Gwan; Kim, Geon-Hyeong; Kim, Dong-Wook; In, Yong

    2014-04-01

    The surgical wound of total knee arthroplasty (TKA) needs continuous flexion and extension movement. Silicone gel treatment is widely used to treat hypertrophic scars and keloids since it is easily applied and prevents scar pain and itching. The aim of this study was to evaluate the clinical efficacy and safety of silicone gel applied to surgical scars of TKA on postoperative scar pain and pruritus. One hundred TKAs were randomized into a silicone gel group (silicone gel was applied to the wound after stitch-out for 1 month) or a placebo group. The postoperative scar pain and pruritus were evaluated with the use of a visual analog scale (VAS) at postoperative 3 months, 6 months and 1 year. Scar assessment was done using the Vancouver scar scale by evaluating scar pigmentation, vascularity, pliability, and height. Although silicone gel group showed better pigmentation and height scales than placebo group (P scar pain and pruritus VAS scores between the groups (P > 0.05). Application of silicone gel had no beneficial effects on scar pain and itching relief during the early postoperative period of TKA. I-Randomized Controlled Trial.

  16. Changes in burn scar contracture: utilization of a severity scale and predictor of return to duty for service members.

    Science.gov (United States)

    Niedzielski, Lt Stephanie; Chapman, Maj Ted

    2015-01-01

    A medical records review of Operation Iraqi Freedom and Operation Enduring Freedom burn injury survivors admitted to the U.S. Army Institute of Surgical Research Burn Center from April 2003 to August 2005 was conducted. The study proposed the use of a newly developed scale, the Burn Scar Contracture Severity Scale, to potentially provide standardization in quantifying burn scar contracture severity. Changes in the active range of motion from in-patient discharge to out-patient follow-up of individuals with upper extremity burn injuries were compared. Changes in the impairment via American Medical Association impairment scores and perceived disability using the disabilities of the arm, shoulder, and hand questionnaire scores from the in-patient discharge to the out-patient follow-up were also compared. A weak, yet positive correlation (r = .417, .451, P ≤ .001) between the proposed scale and the disabilities of the arm, shoulder, and hand questionnaire and the American Medical Association impairment scores was found, respectively. A receiver operating characteristic curve analysis revealed a cut-off score of 6.5 for the burn scar contracture severity scale, indicating that individuals scoring below a 6.5 returned to duty and those scoring above 6.5 did not return to duty. Results suggest that the burn scar contracture severity scale is able to discriminate between the individuals who returned to duty and those who did not return to duty.

  17. Efficacy of intense pulsed light for the treatment of burn scar dyschromias: a pilot study to assess patient satisfaction, safety, and willingness to pay.

    Science.gov (United States)

    Hultman, Charles Scott; Friedstat, Jonathan S; Edkins, Renee E

    2015-06-01

    No treatment algorithms exist to reliably treat burn scar dyschromias. Intense pulsed light (IPL) has been used successfully to treat hyperpigmentation disorders, but has not been studied extensively in the treatment of burn scars. The purpose of this investigation was to assess clinical efficacy and patient satisfaction with IPL for the treatment of burn scar dyschromia. Patients with burn scar dyschromias were treated using the Lume 1 platform (Lumenis) to target pigmented lesions, using fluences between 10 and 22 joules/cm and filters ranging from 560 to 650 nm. At the conclusion of the study, providers assessed changes in burn scar dyschromia, whereas patients were queried regarding satisfaction and perceived efficacy, using a 1 to 5 Likert scale. The patients, who were not charged for the IPL treatment, were queried regarding willingness to pay. Twenty patients (mean age, 35.4 years; mean total body surface area, 27.6%; mean composite Fitzpatrick score, 3.9) underwent IPL treatment of burn scar dyschromias, an average of 3.2 years after injury. Mean fluence was 15.4 J/cm (range, 10-22 J/cm), and the most common filter used was 590 nm (range, 560-650 nm). Mean area treated was 90.7 cm, with a range of 4 to 448 cm. Complications included pain (4), hyperpigmentation (1), and blistering (2). Sixteen patients noted mild to moderate improvement, reporting a 4.5 for efficacy and a 4.4 for satisfaction. Regarding willingness to pay, patients would spend a mean of U.S. $7429 to completely remove their scars, but only a median of U.S. $350 to get the actual results that they received. Mean length of follow-up was 3.8 months, with a standard deviation of 2.2 months. Patients perceived IPL as an efficacious modality in the treatment of burn scar dyschromia, with a high level of satisfaction, despite the potential for morbidity. However, we are reluctant to recommend IPL for routine treatment of burn scar dyschromias, given only minimal improvement observed, potential for

  18. Automated left ventricle segmentation in late gadolinium-enhanced MRI for objective myocardial scar assessment.

    Science.gov (United States)

    Tao, Qian; Piers, Sebastiaan R D; Lamb, Hildo J; van der Geest, Rob J

    2015-08-01

    To develop and validate an objective and reproducible left ventricle (LV) segmentation method for late gadolinium enhanced (LGE) magnetic resonance imaging (MRI), which can facilitate accurate myocardial scar assessment. A cohort of 25 ischemic patients and 25 nonischemic patients were included. A four-step algorithm was proposed: first, the Cine-MRI and LGE-MRI volume were globally registered; second, the registered Cine-MRI contours were fitted to each LGE-MRI slice via the constructed contour image; third, the fitting was optimized in full LGE-MRI stack; finally, the contours were refined by taking into account patient-specific scar patterns. The automated LV segmentation results were compared with that of manual segmentation from two experienced observers. The accuracy of automated segmentation, expressed as the average contour distances to manual segmentation, was 0.82 ± 0.19 pixels, in the same order as interobserver difference between manual results (0.90 ± 0.26 pixels), but with lower variability (0.60 ± 0.37 pixels, P segmentation further demonstrated higher consistency than that of manual segmentation (Pearson correlation 0.97 vs. 0.84). An automated LV segmentation method for LGE-MRI was developed, providing high segmentation accuracy and lower interobserver variability compared to fully manual image analysis. The method facilitates objective assessment of myocardial scar. © 2014 Wiley Periodicals, Inc.

  19. Fractional CO2 laser treatment of caesarean section scars-A randomized controlled split-scar trial with long term follow-up assessment

    DEFF Research Database (Denmark)

    Karmisholt, Katrine E; Taudorf, Elisabeth H; Wulff, Camilla B

    2017-01-01

    BACKGROUND AND OBJECTIVES: Caesarean section (c-section) scars can be pose functional and cosmetic challenges and ablative fractional laser (AFXL) treatment may offer benefit to patients. We evaluated textural and color changes over time in AFXL-treated versus untreated control scars. MATERIALS......-treated scars. At 6 months follow-up, a majority of patients (64%) favored subsequent AFXL-treatment of their untreated control scar tissue. CONCLUSIONS: Scar remodeling is initiated 1 month after AFXL treatment, but overall scar improvement is concealed until laser-induced color changes resolve. At 6 months...

  20. Assessment of propeller and off-road vehicle scarring in seagrass beds and wind-tidal flats of the southwestern Gulf of Mexico

    Science.gov (United States)

    Martin, S.R.; Onuf, C.P.; Dunton, K.H.

    2008-01-01

    We used aerial photography and GIS to establish a quantitative baseline of propeller and off-road vehicle (ORV) scarring in seagrass and wind-tidal flats of the upper Laguna Madre in the Padre Island National Seashore (Texas, USA). We also examined scar recovery through comparison of recent (2002, 2005) and historical (1967) aerial photographs of the study area. Scarring intensity was calculated using two different methods. In the first, polygons were visually drawn around groups of scars on digital images. Scarring intensity was estimated as light (20%), based on the total coverage of scars within each polygon (taking into account the length, width, and density of scars). We developed a more objective method that employed creation of vector grid cells and buffers that incorporated the localized ecological impact of scars. Results of spatial and temporal analysis revealed that the polygon approach greatly underestimated the magnitude of scarring. For example, in a single photograph, 7% of seagrass area was lightly scarred according to the polygon method; but light scarring increased to 51% according to grid analysis of the same image. Our results also indicated that propeller scars in Halodule wrightii beds appear to recover in less than three years and ORV tracks have persisted in the wind-tidal flats for at least 38 years. Our approach provides resource managers with procedures for a more objective and efficient assessment of physical disturbances to seagrass and wind-tidal flats caused by boats and ORVs. ?? 2008 by Walter de Gruyter.

  1. Acne Scars

    Science.gov (United States)

    ... Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids Excess Fat Excessive Sweating ... Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids Excess Fat Excessive Sweating ...

  2. Outcome measures and scar aesthetics in minimally invasive video-assisted parathyroidectomy.

    LENUS (Irish Health Repository)

    Casserly, Paula

    2012-02-01

    OBJECTIVES: To compare the scar outcome of video-assisted parathyroidectomy (VAP) with traditional bilateral cervical exploration (BCE) using previously validated scar assessment scales, and to examine the feasibility of introducing VAP into a general otolaryngology-head and neck practice. DESIGN: A retrospective review of medical records from a prospectively obtained database of patients and long-term follow-up of scar analysis. PATIENTS: The records of 60 patients undergoing parathyroidectomy were reviewed: 29 patients underwent VAP and 31 patients underwent an open procedure with BCE. The groups were matched for age and sex. A total of 46 patients were followed up to assess scar outcome. MAIN OUTCOME MEASURES: The primary outcome was a comparison of patient and observer scar satisfaction between VAP and traditional BCE using validated scar assessment tools: the Patient Scar Assessment Scale and the Manchester Scar Scale. The secondary outcomes were to retrospectively evaluate our results with VAP and to assess the suitability of introducing this technique into a general otolaryngology-head and neck practice. RESULTS: The average scar length in the VAP group was 1.7 cm, and the average scar length in the BCE group was 4.3 cm. The patients in the BCE group scored higher than the patients in the VAP group on the Manchester Scar Scale (P < .01) and on the Patient and Observer Scar Scales (P = .02), indicating a worse scar outcome. The mean operative time in the VAP group was 41 minutes compared with 115 minutes in the open procedure BCE group. There was no difference between the 2 groups in terms of postoperative complications. CONCLUSIONS: Video-assisted parathyroidectomy is a safe and feasible procedure in the setting of a general otolaryngology-head and neck practice, with outcomes and complication rates that are comparable to those of traditional bilateral neck exploration. Both patient and observer analysis demonstrated that VAP was associated with a more

  3. Quality of life and psychosocial impact of scarring and non-scarring alopecia in women.

    Science.gov (United States)

    Katoulis, Alexandros C; Christodoulou, Christos; Liakou, Aikaterini I; Kouris, Anargyros; Korkoliakou, Panagiota; Kaloudi, Eythymia; Kanelleas, Antonios; Papageorgiou, Charalabos; Rigopoulos, Dimitrios

    2015-02-01

    Alopecia is a common dermatological condition with mostly cosmetic consequences that, nevertheless, has significant psychological and psychosocial impact. To assess the impact of alopecia on quality of life and certain psychological domains and to compare it between scarring and non-scarring alopecia in Greek adult women. Forty-four women, aged 18-70 years, with scarring (n = 19) or non-scarring alopecia (n = 25) were recruited. All patients were evaluated by Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-esteem Scale (RSES) and UCLA Loneliness Scale (UCLA-LS). Women with scarring alopecia had higher scores in DLQI, HADS and UCLA- LS and lower scores in RSES, compared to women with non-scarring alopecia. A statistically significant difference between the two groups was documented for DLQI (p = 0.0067), HADS (p = 0.0008), and HADS-Anxiety (HADS-A) (p alopecia compared with non-scarring alopecia, probably depicting the poorer prognosis of the former. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  4. Quantitative analysis of a scar's pliability, perfusion and metrology

    Science.gov (United States)

    Gonzalez, Mariacarla; Sevilla, Nicole; Chue-Sang, Joseph; Ramella-Roman, Jessica C.

    2017-02-01

    The primary effect of scarring is the loss of function in the affected area. Scarring also leads to physical and psychological problems that could be devastating to the patient's life. Currently, scar assessment is highly subjective and physician dependent. The examination relies on the expertise of the physician to determine the characteristics of the scar by touch and visual examination using the Vancouver scar scale (VSS), which categorizes scars depending on pigmentation, pliability, height and vascularity. In order to establish diagnostic guidelines for scar formation, a quantitative, accurate assessment method needs to be developed. An instrument capable of measuring all categories was developed; three of the aforementioned parameters will be explored. In order to look at pliability, a durometer which measures the amount of resistance a surface exerts to prevent the permanent indentation of the surface is used due to its simplicity and quantitative output. To look at height and vascularity, a profilometry system that collects the location of the scar in three-dimensions and laser speckle imaging (LSI), which shows the dynamic changes in perfusion, respectively, are used. Gelatin phantoms were utilized to measure pliability. Finally, dynamic changes in skin perfusion of volunteers' forearms undergoing pressure cuff occlusion were measured, along with incisional scars.

  5. Comparison of Electrocardiography Markers and Speckle Tracking Echocardiography for Assessment of Left Ventricular Myocardial Scar Burden in Patients With Previous Myocardial Infarction.

    Science.gov (United States)

    Nestaas, Eirik; Shih, Jhih-Yuan; Smedsrud, Marit K; Gjesdal, Ola; Hopp, Einar; Haugaa, Kristina H; Edvardsen, Thor

    2017-05-01

    Myocardial scar burden is an important prognostic factor after myocardial infarction. This cohort study compared assessment of left ventricle scar burden between pathological Q waves on electrocardiography (ECG), Selvester multiparametric ECG scoring system for scar burden, and global longitudinal strain (GLS) by speckle-tracking echocardiography 6 months after myocardial infarction. The scar burden was defined by late gadolinium enhancement cardiac magnetic resonance as fraction of total left ventricle tissue. ECG measures were presence of pathologic Q waves and Selvester scores. GLS was the average of peak strain from 16 left ventricle segments. In 34 patients aged 58 ± 10 years (mean ± SD), the scar burden was 19% (9, 26) (median [quartiles]) and 79% had scar burden >5%. Patients with scar burden >5% more frequently had pathologic Q waves (63% vs 14%) and had worse Selvester scores (5 [3, 7] vs 0 [0, 1]) and worse GLS (-16.6 ± 2.4% vs -19.9 ± 1.1%). Pathologic Q waves, Selvester scores, ejection fraction, and GLS related to scar burden in univariable analyses. Sensitivity and specificity for detecting scar burden >5% was 63% and 86% (pathologic Q waves), 89% and 86% (Selvester score), 81% and 86% (ejection fraction), 89% and 86% (GLS), and 96% and 71% (combination of Q waves, Selvester score, and GLS). In conclusion, Selvester score and GLS related to scars 6 months after myocardial infarction, and pathologic Q waves were only weakly associated with scar and GLS was associated with scar independently of ECG markers. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Automatic classification of scar tissue in late gadolinium enhancement cardiac MRI for the assessment of left-atrial wall injury after radiofrequency ablation.

    Science.gov (United States)

    Perry, Daniel; Morris, Alan; Burgon, Nathan; McGann, Christopher; Macleod, Robert; Cates, Joshua

    2012-02-23

    Radiofrequency ablation is a promising procedure for treating atrial fibrillation (AF) that relies on accurate lesion delivery in the left atrial (LA) wall for success. Late Gadolinium Enhancement MRI (LGE MRI) at three months post-ablation has proven effective for noninvasive assessment of the location and extent of scar formation, which are important factors for predicting patient outcome and planning of redo ablation procedures. We have developed an algorithm for automatic classification in LGE MRI of scar tissue in the LA wall and have evaluated accuracy and consistency compared to manual scar classifications by expert observers. Our approach clusters voxels based on normalized intensity and was chosen through a systematic comparison of the performance of multivariate clustering on many combinations of image texture. Algorithm performance was determined by overlap with ground truth, using multiple overlap measures, and the accuracy of the estimation of the total amount of scar in the LA. Ground truth was determined using the STAPLE algorithm, which produces a probabilistic estimate of the true scar classification from multiple expert manual segmentations. Evaluation of the ground truth data set was based on both inter- and intra-observer agreement, with variation among expert classifiers indicating the difficulty of scar classification for a given a dataset. Our proposed automatic scar classification algorithm performs well for both scar localization and estimation of scar volume: for ground truth datasets considered easy, variability from the ground truth was low; for those considered difficult, variability from ground truth was on par with the variability across experts.

  7. The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial.

    Science.gov (United States)

    Cho, Yoon Soo; Jeon, Jong Hyun; Hong, Aram; Yang, Hyeong Tae; Yim, Haejun; Cho, Yong Suk; Kim, Do-Hern; Hur, Jun; Kim, Jong Hyun; Chun, Wook; Lee, Boung Chul; Seo, Cheong Hoon

    2014-12-01

    To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn. One hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter(®), Tewameter(®), Sebumeter(®), and Cutometer(®), respectively. The scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension. Our results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  8. Values of patients and caregivers for donor site scars: An inter-observer analysis between patients and caregivers and prediction of cosmetic satisfaction

    NARCIS (Netherlands)

    Eskes, Anne M.; Brölmann, Fleur E.; van de Kar, Annekatrien L.; Niessen, Frank B.; Lindeboom, Robert; Ubbink, Dirk T.; Vermeulen, Hester

    2012-01-01

    Background: The Patient and Observer Scar Assessment Scale (POSAS) is used to judge scars and involves patients and caregivers. Although the opinions of both are integrated, agreement between them is poorly investigated, especially in donor site scars (DSSs). Furthermore, it is unknown which

  9. A comparison between laser-doppler imaging and colorimetry in the assessment of scarring: "a pilot study".

    Science.gov (United States)

    Peeters, Wouter; Anthonissen, Mieke; Deliaert, An; Van der Hulst, Rene; Van den Kerckhove, Eric

    2012-05-01

    This cross-sectional pilot-study investigated the reproducibility of the LDI (Moor-LDI-B2; Moor Instruments) and the chromameter (Minolta chromameter CR-300) when used in scar assessment. Twenty-seven scars in 14 subjects were included between January and June 2003. One observer performed two times both measurements with 10 min apart. The intra-observer agreement is quantified by means of the intra-class correlations (ICC) and the standard errors of measurement (SEM) for both the LDI and the chromameter. Ignoring one outlier, the ICC of the LDI = 0.856 and the SEM = 34.56. The chromameter shows a better reproducibility with an ICC of 0.93 and a SEM of 0.79. This pilot-study with a limited number of measurements shows a moderate reproducibility of the LDI compared to the chromameter measurements, in the assessment of respectively flux and redness in scars. © 2011 John Wiley & Sons A/S.

  10. Handheld SFDI/polarimetric imaging device for objective evaluation of hypertrophic scars (Conference Presentation)

    Science.gov (United States)

    Ramella-Roman, Jessica C.; Montejo, Karla; Sevilla, Nicole; Stoff, Susan; Gonzalez, Mariacarla; Chue-Sang, Joseph

    2017-02-01

    Scars can be debilitating and cause serious functional limitations, significantly reduced physical function and loss of ability to perform normal daily activities. Scar formation is not fully understood and the treatment options have been hampered by the lack of an objective diagnostic tool to assess scars. Presently, assessment of hypertrophic scars has been based on subjective clinician rankings using a four-parameter scale called the Vancouver Scar Scale (VSS) or the Patient Observer Scar Assessment Scale (POSAS) but no objective, standardized tool for quantifying scar severity is available, despite known inadequacies of the subjective scales. We have developed a hand-held multi modal system consisting of a combined Spatial Frequency Domain Imager (SFDI) used for the assessment of tissue molecular components and a polarimeter for structural measurements. The SFDI capability is provided by an Arduino board controlled spectrally and polarimetric diverse Light Emitting Diodes (LED) ring illuminator. For SFDI imagery, the LEDs are combined with sinusoidal patterns. A single pattern snapshot SFDI approach is used to observe and quantify the biological components in the scar tissue including: oxygenated and de oxygenated hemoglobin, water, and melanin. The SFDI system is integrated with a reduced Mueller Matrix polarimetric system, whose illumination is also included in the LED's ring, and providing for the assessment of collagen orientation through Mueller Matrix decomposition. The design of the system and experimental work on phantoms will be presented.

  11. Vertical scar versus the inverted-T scar reduction mammaplasty: a 10-year follow-up.

    Science.gov (United States)

    Bouwer, Lesley R; van der Biezen, Jan Jaap; Spronk, Cees A; van der Lei, Berend

    2012-10-01

    A retrospective study was undertaken to evaluate whether the initial outcome of two types of reduction mammaplasty techniques (vertical scar reduction mammaplasty vs. the inverted-T scar reduction mammaplasty) remains stable in the long term: Sixty-nine patients who had undergone breast reduction surgery in the period 1997-2000 at the Department of Reconstructive Plastic Surgery at the Medical Center of Leeuwarden were willing and able to participate in this study. A structured questionnaire was used to assess the degree of patient satisfaction. For subjective evaluation, the Strasser Grading System on photographs at the 3 months after surgery and after long-term follow-up (10 years) was used. The median general appreciation mark for the entire surgical procedure given by patients was 8 (1-10) on a scale from 1 to 10. Forty-six of the 69 patients could be scored according to Strasser: at 3 months in 17 patients (37%) the result was 'good', in 21 patients (46%) 'mediocre' and in eight patients (17%) 'poor'. After 10 years, in 37 of the patients (80%) the result was 'good', in six patients (13%) 'mediocre' and in three patients (7%) 'poor'. At 3 months, there was a higher incidence of bottoming out in the vertical scar group (one on two patients) as compared to the inverted-T scar group (one on 10 patients); however, at the 10-years follow-up bottoming out was 50% in the inverted-T scar group and 20% in the vertical scar group. Despite bottoming out, in both the vertical scar reduction mammaplasty technique and the inverted-T scar reduction mammaplasty technique, high patient satisfaction rates are achieved that remains for years. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Acne Scars

    Science.gov (United States)

    ... different skin problem. Image used with permission of Journal of the American Academy of Dermatology. J Am Acad Dermatol 2001;45:116 . References: ... Images of acne scars used with permission of Journal of the American Academy of Dermatology . J Am Acad Dermatol 2001;45:109-17 ...

  13. Prevalence of scars and "mini-scars", and their impact on quality of life in Japanese patients with acne.

    Science.gov (United States)

    Hayashi, Nobukazu; Miyachi, Yoshiki; Kawashima, Makoto

    2015-07-01

    There have been very few studies on the prevalence and severity of acne scars in Japanese patients. The aim of the present study was to investigate the prevalence of acne scars and their impact on the quality of life (QOL) in Japanese acne patients. Acne scars were classified as mini-scars (atrophic scars of ≥0.5 and scars (≥2 mm in diameter), and hypertrophic scars. The severity of acne and acne scars were evaluated. The background of patients and their QOL in relation to acne were assessed. Of 240 subjects, 218 (90.8%) had scars. All patients with scars had mini-scars; 61.2% and 14.2% of 240 had atrophic scars and hypertrophic scars, respectively. Severe scarring was found in patients who had experienced severe acne symptoms, although 15.0% of patients with scars had experienced only mild acne symptoms. The total Dermatology Life Quality Index score was significantly higher in patients with scars than in patients without scars (5.9 ± 4.4 vs 4.2 ± 4.1). Almost all the patients had small atrophic scars with a diameter of 0.5 or more and less than 2 mm, which we have termed "mini-scars". Acne scars had a negative impact on patient QOL. Early initiation of treatment is recommended to avoid acne scars. © 2015 Japanese Dermatological Association.

  14. Scar satisfaction and body image in thyroidectomy patients: prospective study in a tertiary referral centre.

    Science.gov (United States)

    Sethukumar, P; Ly, D; Awad, Z; Tolley, N S

    2018-01-01

    This study is the first to evaluate scar satisfaction and body image in thyroidectomy patients using validated assessment tools. A total of 123 thyroidectomy patients were recruited over 8 months. Both patients and clinicians completed assessment tools that included: the Manchester Scar Scale (to measure scar perception), Dysmorphic Concern Questionnaire (to assess body image), Body Dysmorphic Concern Questionnaire (to screen for body dysmorphic disorder) and EQ-5D (to measure life quality). A separate image panel comprising experts and non-experts assessed 15 scar photographs. The results were analysed using non-parametric descriptive statistics. Poor body image was associated with poor scar perception (ρ = 0.178, p = 0.05). Poor life quality correlated with poor scar perception (ρ = -0.292, p = 0.001). Scar length did not affect scar perception. Prevalence of body dysmorphic disorder among patients was found to be 8.94 per cent, which is higher than general population rates. Negative body image and life quality impact negatively upon scar perception.

  15. The Effect of Tranilast 8% Liposomal Gel Versus Placebo on Post-Cesarean Surgical Scars: A Prospective Double-Blind Split-Scar Study.

    Science.gov (United States)

    Kohavi, Libi; Sprecher, Eli; Zur, Eyal; Artzi, Ofir

    2017-09-01

    Tranilast (N-[3, 4-dimethoxycinnamoyl] anthranilic acid), an antiallergic drug, has been shown to attenuate scar formation possibly through inhibition of transforming growth factor beta 1 activity and consequent suppression of collagen synthesis in fibroblasts. The authors aimed at evaluating the efficacy and safety of tranilast 8% gel in improving the appearance and symptoms of new post-cesarean section surgical wounds. In this prospective double-blind split-scar study, the authors treated each half scar of 26 women with either tranilast 8% liposomal gel or tranilast-free liposomal gel (placebo). Treatment was applied twice daily for 3 months. Twenty women completed the trial. Scar halves were evaluated by 2 investigators and by the patients 9 months after the last application using the Patient and Observer Scar Assessment Scale (POSAS). The participants also rated overall satisfaction and recorded side effects of the treatment. The mean POSAS scores at 9 months post-treatment were significantly lower for tranilast-treated half scars compared with placebo-treated half scars (p scar appearance (p = .002). Three participants reported itching and erythema on the tranilast-treated side. Topical tranilast 8% gel provided significantly better postcaesarian section scar cosmesis and user satisfaction compared with placebo.

  16. Patient opinion of scarring is multidimensional: An investigation of the POSAS with confirmatory factor analysis.

    Science.gov (United States)

    DeJong, Helen M; Phillips, Michael; Edgar, Dale W; Wood, Fiona M

    2017-02-01

    Scarring is a significant consequence for patients following a burn. Understanding how patients perceive the physiological scar and define scar severity may provide valuable information regarding how the scar influences quality of life after burn. The Patient and Observer Scar Assessment Scale was the first scar assessment tool validated to include the patients' evaluation of the scars physical qualities, following a burn. Validation studies of this tool have previously been conducted for a discrete scar-site after burn. The aim of this study was to assess the structural validity of the POSAS to capture the patients' evaluation of the total area of burn scar(s). Statistical analysis was based on 508 completed POSAS forms from 358 patients. Exploratory factor analysis (EFA) was used initially to identify the number of factors within the tool, then confirmatory factor analysis (CFA) using structural equation modelling explored areas of misfit within each factor and whether the model provided a predicable structure to capture patient perception of scar severity. The CFA analysis confirmed that a two dimensional model was superior to a unidimensional model when assessing the patient opinion of their total burn scar. The two dimensions were the physical scar (color, stiffness, thickness and irregularity) and the sensory scar (pain and itch). Further strain analysis of the two factor model identified additional domains. Independent factors influenced the perception of color forming a separate subdomain within the physical domain. Color is a visual characteristic, whereas the other three are predominantly tactile characteristics. A significant relationship between thickness and irregularity suggested they may form another subdomain, however further research is required to confirm this. Both pain and itch were recognized as independent, multidimensional latent variables, which require assessment tools with multidimensional structures. When assessing the entire burn scar

  17. Objective and quantitative evaluation of scar color using the L*a*b* color coordinates.

    Science.gov (United States)

    Cheon, Young Woo; Lee, Won Jai; Rah, Dong Kyun

    2010-05-01

    Scar color evaluation by clinical physicians has been based on subjective judgments. The purpose of this study was to investigate the application of a novel photographic analysis to produce an objective and quantitative measurement of scar color using the L*a*b* color coordinates. Three plastic surgeons evaluated photos of 207 scars using the clinical scar assessment scale developed by Beausang et al. Scar color was subjectively classified as group 1 (perfect match), 2 (slight mismatch), 3 (obvious mismatch), or 4 (gross mismatch). Three general physicians quantified color differences between the scar and the surrounding normal skin using the L*a*b* color coordinates. The total color difference (DeltaT*) and the color differences for each coordinate (DeltaL*, Deltaa*, and Deltab*) were calculated. The measurement was performed 3 times with a 4-week interval. Group 1 contained 51 scars, group 2 had 68, group 3 had 46, and group 4 had 42. The mean (SD) total color difference values (DeltaT*) for each group were 4.4 (1.83), 9.55 (2.18), 17.76 (2.96), and 29.06 (9.45), respectively (P L*a*b* color coordinates is found to be a reliable method to quantify scar color. With further study, this method could be simple and effective to assess the effects of scar management.

  18. Cutaneous Scarring: A Clinical Review

    Directory of Open Access Journals (Sweden)

    Richard Baker

    2009-01-01

    Full Text Available Cutaneous scarring can cause patients symptoms ranging from the psychological to physical pain. Although the process of normal scarring is well described the ultimate cause of pathological scarring remains unknown. Similarly, exactly how early gestation fetuses can heal scarlessly remains unsolved. These questions are crucial in the search for a preventative or curative antiscarring agent. Such a discovery would be of enormous medical and commercial importance, not least because it may have application in other tissues. In the clinical context the assessment of scars is becoming more sophisticated and new physical, medical and surgical therapies are being introduced. This review aims to summarise some of the recent developments in scarring research for non-specialists and specialists alike.

  19. Midcervical scar satisfaction in thyroidectomy patients.

    Science.gov (United States)

    Best, Amy R; Shipchandler, Taha Z; Cordes, Susan R

    2017-05-01

    Assess long-term patient satisfaction with conventional thyroidectomy scars and the impact of thyroidectomy scars on patient quality of life. Validated survey administration and retrospective review of clinical and demographic data. Patients who underwent conventional thyroidectomy through years 2000 to 2010 were identified and administered the validated Patient Scar Assessment Questionnaire. Mean satisfaction, appearance and scar-consciousness scores were determined. Thirty-seven patients also measured the length of their current scar. Patient demographic and operative data were collected retrospectively from the medical record. Data were analyzed with one-way analysis of variance and independent samples t testing. Sixty of 69 patients perceived the appearance of their scar to be "good" or "excellent." Sixty-three patients (91.3%) were satisfied with all scar outcomes; 67 (97.1%) were satisfied with the overall appearance of their scar. Mean total satisfaction score was 17.3 (scar; 65 (94.2%) reported no attempt to hide their scar. Seven patients (10.1%) indicated any likelihood of pursuing scar revision. Females had significantly higher total satisfaction scores, consciousness scores, and satisfaction with appearance scores. The effect of perceived scar length was significant for scar-consciousness, not patient satisfaction. The majority of patients were satisfied with their thyroidectomy scar appearance. Few patients reported a desire to hide the scar or pursue revision. Women were more likely to be dissatisfied than men. Length may play a role in scar consciousness. 4 Laryngoscope, 127:1247-1252, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Multi-scale controls of historical forest-fire regimes: new insights from fire-scar networks

    Science.gov (United States)

    Donald A. Falk; Emily K. Heyerdahl; Peter M. Brown; Calvin Farris; Peter Z. Fule; Donald McKenzie; Thomas W. Swetnam; Alan H. Taylor; Megan L. Van Horne

    2011-01-01

    Anticipating future forest-fire regimes under changing climate requires that scientists and natural resource managers understand the factors that control fire across space and time. Fire scars—proxy records of fires, formed in the growth rings of long-lived trees—provide an annually accurate window into past low-severity fire regimes. In western North America, networks...

  1. An assessment of the efficacy and safety of cross technique with 100% TCA in the management of ice pick acne scars

    Directory of Open Access Journals (Sweden)

    Deepali Bhardwaj

    2010-01-01

    Full Text Available Background : Chemical reconstruction of skin scars (CROSS is a technique using high concentrations of trichloroacetic acid (TCA focally on atrophic acne scars to induce inflammation followed by collagenisation. This can lead to reduction in the appearance of scars and cosmetic improvement. Aims : The aim of this pilot study is to investigate the safety of the CROSS technique, using 100% TCA, for atrophic ice pick acne scars. Settings and Design : Open prospective study. Materials and Methods : Twelve patients with predominant atrophic ice pick post acne scars were treated with the CROSS technique, using 100% TCA, applied with a wooden toothpick, at two weekly intervals for four sittings. Efficacy was assessed on the basis of the physician′s clinical assessment, photographic evaluation at each sitting and patient′s feedback after the fourth treatment, and at the three-month and six-month follow-up period, after the last treatment. Results : More than 70% improvement was seen in eight out of ten patients evaluated and good results (50 - 70% improvement were observed in the remaining two patients. No significant side effects were noted. Transient hypopigmentation and hyperpigmentation was observed in one patient each. Physician′s findings were in conformity with the patient′s assessment. Three months after the last treatment, one patient noted a decrease in improvement with no further improvement even at the six-month follow-up period. Conclusion : The CROSS technique with 100% TCA is a safe, efficacious, cost-effective and minimally invasive technique for the management of ice pick acne scars that are otherwise generally difficult to treat. In few patients the improvement may not be sustained, probably due to inadequate or delayed collagenisation.

  2. Fractional CO2 Laser Resurfacing as Monotherapy in the Treatment of Atrophic Facial Acne Scars.

    Science.gov (United States)

    Majid, Imran; Imran, Saher

    2014-04-01

    While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. The aim of the present study is to assess the efficacy and safety of fractional CO2 laser resurfacing in atrophic facial acne scars. Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as 'excellent' if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and boxcar scars responded the best while pitted scars responded the least to fractional laser monotherapy. The commonest reported adverse effect was transient erythema and crusting lasting for an average of 3-4 and 4-6 days, respectively while three patients developed post-inflammatory pigmentation lasting for 8-12 weeks. Fractional laser resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar scars with minimal adverse effects.

  3. Autologous fat grafting does not improve burn scar appearance: A prospective, randomized, double-blinded, placebo-controlled, pilot study.

    Science.gov (United States)

    Gal, Shaili; Ramirez, Jesus Ignacio; Maguina, Pirko

    2017-05-01

    It has been proposed that fat grafts can improve the appearance of mature burn scars. The pluripotent progenitor cells contained within autologous adipose tissue grafts are believed to induce skin repair and improve scar appearance. We conducted a prospective, randomized, double-blinded, placebo-controlled study to evaluate the effects of fat grafts on the appearance of mature burn scars. Pediatric burn survivors with mature scars were recruited for this study. A homogeneous scar measuring 10×5cm was randomized into two halves: one was injected with autologous fat graft and the other with normal saline. Scar injection was performed using standard Coleman technique. Appearance of the two scar halves was assessed, six to twelve months later by the operating surgeon, by blinded observers and by the blinded patients. Eight patients completed the study pilot with 6-12 month follow-up. Assessment by the patients did not clearly favor fat grafts or saline injections; the operating surgeon did not identify any differences on any of the patients; the blinded observers measured all scars using Vancouver Scar Scale and noticed no differences in pigmentation, vascularity and height; differences in pliability showed similar changes in both the fat grafted and control arms. After the pilot was completed, decision was made to stop enrolling patients for this study since no benefit to fat grafting was observed. Single treatment with autologous fat grafts did not improve mature pediatric burn scars when compared to normal saline injections. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  4. Impact of facial burns: relationship between depressive symptoms, self-esteem and scar severity.

    Science.gov (United States)

    Hoogewerf, Cornelis Johannes; van Baar, Margriet Elisabeth; Middelkoop, Esther; van Loey, Nancy Elisa

    2014-01-01

    This study assessed the role of self-reported facial scar severity as a possible influencing factor on self-esteem and depressive symptoms in patients with facial burns. A prospective multicentre cohort study with a 6 months follow-up was conducted including 132 patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale, the Rosenberg Self-esteem Scale and the Hospital Anxiety and Depression Scale. Structural Equation Modeling was used to assess the relations between depressive symptoms, self-esteem and scar severity. The model showed that patient-rated facial scar severity was not predictive for self-esteem and depressive symptoms six months post-burn. There was, however, a significant relationship between early depressive symptoms and both patient-rated facial scar severity and subsequent self-esteem. The variables in the model accounted for 37% of the variance in depressive symptoms six months post-burn and the model provided a moderately well-fitting representation of the data. The study suggests that self-esteem and depressive symptoms were not affected by self-reported facial scar severity but that earlier depressive symptoms were indicative for a more severe self-reported facial scar rating. Therefore, routine psychological screening during hospitalisation is recommended in order to identify patients at risk and to optimise their treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Effects of the Combined PDL/Nd:YAG Laser on Surgical Scars: Vascularity and Collagen Changes Evaluated by In Vivo Confocal Microscopy

    Directory of Open Access Journals (Sweden)

    Krisztina Vas

    2014-01-01

    Full Text Available The aim of this study was to investigate the efficacy of the sequential combined 585 nm PDL and the 1064 nm neodymium:yttrium-aluminium-garnet laser (PDL/Nd:YAG in the treatment of surgical scars and to evaluate the short-term effects by in vivo confocal microscopy (RCM and the long-term effects by clinical assessment of the scars. Twenty-five patients were enrolled with 39 postoperative linear scars; each scar was divided into two fields. One half was treated with the combined PDL/Nd:YAG laser, whereas the other half remained untreated. Each scar was treated three times at monthly intervals. Scars were evaluated by an independent examiner, using the Vancouver Scar Scale. The combined PDL/Nd:YAG laser significantly improved the appearance of the scars. In order to study the short-term effects of combined laser treatment, six additional patients were enrolled with 7 postoperative linear scars. One half of scars was treated once with the combined PDL/Nd:YAG laser. One week after this laser treatment, both the treated and the nontreated parts of the scars were examined by dermoscopy and RCM. The dermoscopic pictures revealed improvements even in treated areas. In conclusion, the combined PDL/Nd:YAG laser was found to be effective in improving the quality and appearance of the surgical scars.

  6. Facial Scar Revision: Understanding Facial Scar Treatment

    Science.gov (United States)

    ... facial plastic surgeon Facial Scar Revision Understanding Facial Scar Treatment When the skin is injured from a cut ... A facial plastic surgeon has many options for treating and improving facial scars. “After the accident, I thought I would never ...

  7. Laser treatment of scars

    Science.gov (United States)

    Fitzpatrick, Richard E.

    1994-09-01

    Fifteen patients with erythematous/hypertrophic scar/span>s and eleven patients with post- inflammatory brown hyperpigmentation of scars were treated with flashlamp pump pulsed-dye lasers. The red scars were treated with a wavelength of 585 nm and a pulse width of 450 msec. The brown scars were treated with a wavelength of 510 nm and a pulse width of 300 nsec. The erythematous scars improved an average of 77% after 1.8 treatments, and 46% of these scars had complete resolution of the erythema. The hyperpigmented scars had an average improvement of 80% after 1.5 treatments, and 45% of these patients had complete resolution of the hyperpigmentation. An unexpected benefit of treatment of these scars was softening and flattening of the hypertrophic scar tissue and normalization of the surface of the scar. Repeated treatments were noted to result in cumulative and progressive improvement in all aspects of these scars.

  8. Interventions for acne scars.

    Science.gov (United States)

    Abdel Hay, Rania; Shalaby, Khalid; Zaher, Hesham; Hafez, Vanessa; Chi, Ching-Chi; Dimitri, Sandra; Nabhan, Ashraf F; Layton, Alison M

    2016-04-03

    Acne scarring is a frequent complication of acne and resulting scars may negatively impact on an affected person's psychosocial and physical well-being. Although a wide range of interventions have been proposed, there is a lack of high-quality evidence on treatments for acne scars to better inform patients and their healthcare providers about the most effective and safe methods of managing this condition. This review aimed to examine treatments for atrophic and hypertrophic acne scars, but we have concentrated on facial atrophic scarring. To assess the effects of interventions for treating acne scars. We searched the following databases up to November 2015: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2015, Issue 10), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers, and checked the reference lists of included studies and relevant reviews for further references to randomised controlled trials. We include randomised controlled trials (RCTs) which allocated participants (whether split-face or parallel arms) to any active intervention (or a combination) for treating acne scars. We excluded studies dealing only or mostly with keloid scars. Three review authors independently extracted data from each of the studies included in this review and evaluated the risks of bias. We resolved disagreements by discussion and arbitration supported by a method expert as required. Our primary outcomes were participant-reported scar improvement and any adverse effects serious enough to cause participants to withdraw from the study. We included 24 trials with 789 adult participants aged 18 years or older. Twenty trials enrolled men and women, three trials enrolled only women and one trial enrolled only men. We judged eight studies to be at low risk of bias for both sequence generation and allocation concealment. With regard to blinding we judged

  9. Treatment of hypertrophic scars and keloids using intense pulsed light (IPL).

    Science.gov (United States)

    Erol, O Onur; Gurlek, Ali; Agaoglu, Galip; Topcuoglu, Ela; Oz, Hayat

    2008-11-01

    Keloids and hypertrophic scars are extremely disturbing to patients, both physically and psychologically. This study prospectively assessed the safety and efficacy of intense pulsed light (IPL) on scars originating from burns, trauma, surgery, and acne. Hypertrophic scars in 109 patients, originating from surgical incisions (n = 55), traumatic cuts (traffic accidents) (n = 24), acne scars (n = 6), keloids (n = 5), and burns (n = 19), were treated using an IPL Quantum device. Treatment was administered at 2-4-week intervals, and patients received an average of 8 treatments (range = 6-24). Using digital photographs, Changes in scar appearance were assessed by two physicians who were blinded to the study patients and treatments. The photographs were graded on a scale of 0 to 4 (none, minimal, moderate, good, excellent) for improvement in overall clinical appearance and reduction in height, erythema, and hardness. An overall clinical improvement in the appearance of scars and reductions in height, erythema, and hardness were seen in the majority of the patients (92.5%). Improvement was excellent in 31.2% of the patients, good in 25.7%, moderate in 34%, and minimal in 9.1%. Over half the patients had good or excellent improvement. In the preventive IPL treatment group, 65% had good to excellent improvement in clinical appearance. Patient satisfaction was very high. This study suggests that IPL is effective not only in improving the appearance of hypertrophic scars and keloids regardless of their origin, but also in reducing the height, redness, and hardness of scars.

  10. Microneedling for acne scars in Asian skin type: an effective low cost treatment modality.

    Science.gov (United States)

    Dogra, Sunil; Yadav, Savita; Sarangal, Rishu

    2014-09-01

    Postacne scarring is disfiguring, both physically as well as psychologically. Over the past two decades, multiple modalities for treatment of acne scars have emerged and microneedling with dermaroller is one of them. To evaluate the efficacy and safety of microneedling treatment for atrophic facial acne scars. Thirty-six patients (female--26, male--10) of postacne atrophic facial scars underwent five sittings of dermaroller under topical anesthesia at monthly intervals. Objective evaluation of improvement was performed by recording the acne scar assessment score at baseline and thereafter at every visit. Pre- and posttreatment photographs were compared, and improvement was graded on quartile score. Final assessment was performed 1 month after the last sitting. Patients were asked to grade the improvement in acne scars on visual analog scale (VAS, 0-10 point scale) at the end of study. Of 36 patients, 30 completed the study. The age group ranged from 18 to 40 years, and all patients had skin phototype IV or V. There was a statistically significant decrease in mean acne scar assessment score from 11.73 ± 3.12 at baseline to 6.5 ± 2.71 after five sittings of dermaroller. Investigators' assessment based on photographic evaluation showed 50-75% improvement in majority of patients. The results on visual analog scale (VAS) analysis showed "good response" in 22 patients and "excellent response" in four patients, at the end of study. The procedure was well tolerated by most of the patients, and chief complications noted were postinflammatory hyperpigmentation in five patients and tram-trek scarring in two patients. Microneedling with dermaroller is a simple and cheap, means of treatment modality for acne scars remodulation with little downtime, satisfactory results and peculiar side effects in Asian skin type. © 2014 Wiley Periodicals, Inc.

  11. The prophylactic use of a topical scar gel containing extract of Allium cepae, allantoin, and heparin improves symptoms and appearance of cesarean-section scars compared with untreated scars.

    Science.gov (United States)

    Ocampo-Candiani, Jorge; Vázquez-Martínez, Osvaldo T; Iglesias Benavides, José Luis; Buske, Kristin; Lehn, Annette; Acker, Clemens

    2014-02-01

    Abdominal Cesarean sections (C-sections) are frequently associated with an increased risk of excessive or unpleasant scarring. A topical scar gel containing extract of Allium cepae, allantoin and heparin (Contractubex®; Merz Pharmaceuticals GmbH, Germany), has shown efficacy in improving the appearance of various scar types. To investigate the efficacy of the topical scar gel, Contractubex, in the early treatment of C-section scars. A total of 61 females, aged ≥18 years, who had given birth by elective C-section for the first time within the last 5-10 days, were included in this prospective, randomized, single-center study. Patients were advised to apply the topical scar gel twice daily (treatment group), or received no treatment (control group). Efficacy was evaluated at 6 and 12 weeks after a baseline visit using the Patient and Observer Scar Assessment Scale (POSAS), a validated scar assessment tool comprised of a Patient Scale and an Observer Scale. Analysis revealed a significant change in the POSAS Patient Scale total score, with a 14.2% improvement in the treatment group compared with a decline of similar magnitude (-14.8%) in the control group at week 6. Significant improvements were also seen for POSAS Patient Scale sub-items in the treatment group compared with the control group for scar color (13.6% vs -18.5%, respectively, P=0.0284), stiffness (12.5% vs -34.6%, respectively, P=0.0029), and irregularity (29.4% vs -46.2%, respectively, P=0.0140) after 6 weeks of treatment. No significant changes were observed for the POSAS Observer Scale total score or its subitems after treatment with the topical scar gel, although there was a strong overall trend in favor of the treatment group. No significant adverse events were observed during the study. Contractubex represents an efficacious and well-tolerated preventative treatment that rapidly and significantly improves the color, stiffness and irregularity of C-section scars.

  12. Fractional CO 2 laser resurfacing as monotherapy in the treatment of atrophic facial acne scars

    Directory of Open Access Journals (Sweden)

    Imran Majid

    2014-01-01

    Full Text Available Background: While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. Aim: The aim of the present study is to assess the efficacy and safety of fractional CO 2 laser resurfacing in atrophic facial acne scars. Materials and Methods: Sixty patients with moderate to severe atrophic facial acne scars were treated with 3-4 sessions of fractional CO 2 laser resurfacing at 6-week intervals. The therapeutic response to treatment was assessed at each follow up visit and then finally 6 months after the last laser session using a quartile grading scale. Response to treatment was labelled as ′excellent′ if there was >50% improvement in scar appearance and texture of skin on the grading scale while 25-50% response and <25% improvement were labelled as ′good′ and ′poor′ response, respectively. The overall satisfaction of the patients and any adverse reactions to the treatment were also noted. Results: Most of the patients showed a combination of different morphological types of acne scars. At the time of final assessment 6 months after the last laser session, an excellent response was observed in 26 patients (43.3% while 15 (25% and 19 patients (31.7% demonstrated a good and poor response respectively. Rolling and superficial boxcar scars responded the best while pitted scars responded the least to fractional laser monotherapy. The commonest reported adverse effect was transient erythema and crusting lasting for an average of 3-4 and 4-6 days, respectively while three patients developed post-inflammatory pigmentation lasting for 8-12 weeks. Conclusions: Fractional laser resurfacing as monotherapy is effective in treating acne scars especially rolling and superficial boxcar

  13. Psychometric properties of the Brisbane Burn Scar Impact Profile in adults with burn scars.

    Science.gov (United States)

    Tyack, Zephanie; Kimble, Roy; McPhail, Steven; Plaza, Anita; Simons, Megan

    2017-01-01

    The aim of the study was to determine the longitudinal validity, reproducibility, responsiveness and interpretability of the adult version of the Brisbane Burn Scar Impact Profile, a patient-report measure of health-related quality of life. A prospective longitudinal cohort study of patients with or at risk of burn scarring was conducted at three assessment points (at baseline around the time of wound healing, one to two weeks post-baseline and 1-month post-baseline). Participants attending a major metropolitan adult burn centre at baseline were recruited. Participants completed the Brisbane Burn Scar Impact Profile and the 36-item Short Form Health Survey and Patient Observer Scar Assessment Scale. Intraclass Correlation Coefficients (ICCs), smallest detectable change, percentage of those who improved, stayed the same or worsened and Area under the Receiver Operating Characteristic Curve (AUC) were used to test the aim. Data were included for 118 participants at baseline, 68 participants at one to two weeks and 57 participants at 1-month post-baseline. All groups of items had acceptable reproducibility, except for the overall impact of burn scars (ICC = 0.69), the impact of sensations which was not expected to be stable (ICC = 0.63), mobility and daily activities (ICC = 0.63, 0.67 respectively). The responsiveness of six out of seven groups of items able to be tested against external criterion was supported (AUC = 0.72-0.75). Hypothesised correlations of changes in the Brisbane Burn Scar Impact Profile items with changes in criterion measures generally supported longitudinal validity (e.g., nine out of thirteen hypotheses using the SF-36 as an external criterion were supported). Internal consistency estimates, item-total and inter-item correlations indicated there was likely redundancy of some groups of items, particularly in the relationships and social interaction, appearance and emotional reactions items (Chronbach's alpha range = 0.94-0.95). Support was found

  14. Psychometric properties of the Brisbane Burn Scar Impact Profile in adults with burn scars.

    Directory of Open Access Journals (Sweden)

    Zephanie Tyack

    Full Text Available The aim of the study was to determine the longitudinal validity, reproducibility, responsiveness and interpretability of the adult version of the Brisbane Burn Scar Impact Profile, a patient-report measure of health-related quality of life.A prospective longitudinal cohort study of patients with or at risk of burn scarring was conducted at three assessment points (at baseline around the time of wound healing, one to two weeks post-baseline and 1-month post-baseline. Participants attending a major metropolitan adult burn centre at baseline were recruited. Participants completed the Brisbane Burn Scar Impact Profile and the 36-item Short Form Health Survey and Patient Observer Scar Assessment Scale. Intraclass Correlation Coefficients (ICCs, smallest detectable change, percentage of those who improved, stayed the same or worsened and Area under the Receiver Operating Characteristic Curve (AUC were used to test the aim.Data were included for 118 participants at baseline, 68 participants at one to two weeks and 57 participants at 1-month post-baseline. All groups of items had acceptable reproducibility, except for the overall impact of burn scars (ICC = 0.69, the impact of sensations which was not expected to be stable (ICC = 0.63, mobility and daily activities (ICC = 0.63, 0.67 respectively. The responsiveness of six out of seven groups of items able to be tested against external criterion was supported (AUC = 0.72-0.75. Hypothesised correlations of changes in the Brisbane Burn Scar Impact Profile items with changes in criterion measures generally supported longitudinal validity (e.g., nine out of thirteen hypotheses using the SF-36 as an external criterion were supported. Internal consistency estimates, item-total and inter-item correlations indicated there was likely redundancy of some groups of items, particularly in the relationships and social interaction, appearance and emotional reactions items (Chronbach's alpha range = 0.94-0.95.Support

  15. A novel spectral imaging system for quantitative analysis of hypertrophic scar

    Science.gov (United States)

    Ghassemi, Pejhman; Shupp, Jeffrey W.; Moffatt, Lauren T.; Ramella-Roman, Jessica C.

    2013-03-01

    Scarring can lead to significant cosmetic, psychosocial, and functional consequences in patients with hypertrophic scars from burn and trauma injuries. Therefore, quantitative assessment of scar is needed in clinical diagnosis and treatment. The Vancouver Scar Scale (VSS), the accepted clinical scar assessment tool, was introduced in the nineties and relies only on the physician subjective evaluation of skin pliability, height, vascularity, and pigmentation. To date, no entirely objective method has been available for scar assessment. So, there is a continued need for better techniques to monitor patients with scars. We introduce a new spectral imaging system combining out-of-plane Stokes polarimetry, Spatial Frequency Domain Imaging (SFDI), and three-dimensional (3D) reconstruction. The main idea behind this system is to estimate hemoglobin and melanin contents of scar using SFDI technique, roughness and directional anisotropy features with Stokes polarimetry, and height and general shape with 3D reconstruction. Our proposed tool has several advantages compared to current methodologies. First and foremost, it is non-contact and non-invasive and thus can be used at any stage in wound healing without causing harm to the patient. Secondarily, the height, pigmentation, and hemoglobin assessments are co-registered and are based on imaging and not point measurement, allowing for more meaningful interpretation of the data. Finally, the algorithms used in the data analysis are physics based which will be very beneficial in the standardization of the technique. A swine model has also been developed for hypertrophic scarring and an ongoing pre-clinical evaluation of the technique is being conducted.

  16. Scar revision - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100098.htm Scar revision - series—Normal anatomy To use the sharing ... entire body, and acts as a protective barrier. Scar tissue forms as skin heals after an injury ( ...

  17. Acne scar subcision

    Directory of Open Access Journals (Sweden)

    B S Chandrashekar

    2010-01-01

    Full Text Available Subcision is a simple and safe office surgery procedure for treatment of depressed acne scars. It can easily be combined with other treatments such as laser, dermaroller and scar revisions for maximum efficacy.

  18. Nd:YAG Laser Treatment for Keloids and Hypertrophic Scar/span>s: An Analysis of 102 Cases

    Science.gov (United States)

    Koike, Sachiko; Akaishi, Satoshi; Nagashima, Yuki; Dohi, Teruyuki; Hyakusoku, Hiko

    2014-01-01

    Background: The present retrospective cohort study was performed to determine the efficacy of contact-mode 1064 nm neodymium-yttrium-aluminum-garnet (Nd:YAG) laser laser for keloids and hypertrophic scar/span>s. The indication and limitations of this modality are discussed. Methods: The cohort consisted of 102 consecutive Japanese patients (23 males and 79 females) with keloids and hypertrophic scar/span>s for more than 1 year. They were treated every 3–4 weeks for 1 year with a long-pulsed 1064 nm Nd:YAG laser (Cutera, Brisbane, Calif.) in contact mode. Thirty-eight patients had hypertrophic scar/span>s and 64 had keloids. The scars were evaluated before the treatment commenced and 1 month after the last session by using the Japan Scar Workshop Scar Scale 2011. Recurrence was assessed at 6 months after the termination of treatment. Results: The average total Japan Scar Workshop score of the keloid and hypertrophic scar region groups dropped significantly after 1 year of treatment compared with before treatment (all P hypertrophic scar/span>s or keloids deteriorated. However, 3 of the 34 anterior chest keloids (8.8%) did not respond. The following recurrence rates were observed 6 months after stopping laser treatment: 1 of the abdomen hypertrophic scar/span>s (4%), 18 of the anterior chest keloids (52.9%), 5 of the upper arm keloids (35.7%), and 4 of the scapula keloids (25%). Conclusions: Hypertrophic scar/span>s responded significantly better to 1064 nm Nd:YAG laser treatment than keloids. However, keloid recurrence occurred when there was remaining redness and induration, even if only a small part of the scar was affected. PMID:25587506

  19. Adapalene 0.1%/benzoyl peroxide 2.5% gel reduces the risk of atrophic scar formation in moderate inflammatory acne: a split-face randomized controlled trial.

    Science.gov (United States)

    Dreno, B; Tan, J; Rivier, M; Martel, P; Bissonnette, R

    2017-04-01

    The efficacy of current topical acne treatments in mitigating the potential for acne scarring is not known. To evaluate the effect of adapalene 0.1%/benzoyl peroxide 2.5% (A/BPO) gel compared to vehicle in reducing the risk of acne scarring. Multicentre, randomized, investigator-blinded, vehicle-controlled, split-face study conducted over 6 months. Subjects were adults with active moderate facial acne vulgaris and at least 10 atrophic acne scars at baseline. Efficacy evaluations included counts of atrophic acne scars and primary acne lesions as well as a Scar Global Assessment (SGA; 5-point scale). After 6 months treatment, scar counts remained stable with A/BPO while increasing by approximately 25% with vehicle (mean scar count 11.58 vs. 13.55, respectively, at Month 6; P = 0.036). The percentage of subjects with a SGA of 'almost clear' (hardly visible scars) increased from 9.7% to 45.2% with A/BPO, whereas it did not change with vehicle (P = 0.0032). Total acne lesion counts decreased by 65% with A/BPO and 36% with vehicle (mean lesion count 8.5 vs. 16.1, respectively, at Month 6; P scars and improving the global severity of scarring. © 2016 European Academy of Dermatology and Venereology.

  20. Post-burn scars and scar contractures

    Directory of Open Access Journals (Sweden)

    Goel Arun

    2010-10-01

    Full Text Available The mortality and morbidity from burns have diminished tremendously over the last six to seven decades. However, these do not truly reflect whether the victim could go back to society as a useful person or not and lead a normal life because of the inevitable post-burn scars, contractures and other deformities which collectively have aesthetic and functional considerations. This article gives an overview of the post-burn scars and scar contractures, especially their prevention, minimisation and principles of management.

  1. DIEP flap customization using Fluobeam® indocyanine green tissue perfusion assessment with large previous abdominal scar

    Directory of Open Access Journals (Sweden)

    Michael A. Fallucco

    2017-06-01

    Full Text Available The Fluobeam® is a portable, near-infrared camera that is held and controlled by the surgeon to visualize tissue perfusion using indocyanine green (ICG fluorescence imaging. This case report describes how data obtained from ICG imaging allows intraoperative customization in a previously surgically scarred abdomen during autologous Deep Inferior Epigastric Artery Perforator (DIEP flap bilateral breast reconstruction. The outcome was successful breast mound recreation without fat necrosis.

  2. Orthodontic scars

    Directory of Open Access Journals (Sweden)

    Vinay Reddy

    2012-01-01

    Full Text Available Orthodontic therapy apart from its benefits also has potential risks and limitations in terms of tissue damage. Fortunately, in orthodontics, risks are minimal and infrequent However, all potential risks and limitations should be considered and addressed when making the decision to undergo orthodontic treatment. Orthodontic treatment carries with it the risk of various types of soft and hard tissue damages (e.g. decalcification of enamel, lacerations, ulcerations, temporomandibular joint disorders, etc-, apart from treatment failure in itself. If correcting a malocclusion is to be of benefit, the advantages offered should outweigh any possible damage- All preventive procedures should be considered during and after orthodontic treatment to restore the normal health of soft and hard tissues. Hence, the orthodontist should be vigilant and prudent enough in assessing and monitoring every aspect of these tissues at any given stage and time in order to achieve a healthy and successful final result.

  3. Cesarean scar pregnancy

    DEFF Research Database (Denmark)

    Petersen, Kathrine Birch; Hoffmann, Elise; Rifbjerg Larsen, Christian

    2016-01-01

    OBJECTIVE: To study treatment modalities for cesarean scar pregnancies (CSPs), focusing on efficacy and complications in relation to study quality. DESIGN: Systematic review. SETTING: Not applicable. PATIENT(S): A total of 2,037 women with CSP. INTERVENTION(S): Review of MEDLINE, EMBASE, and Coch......OBJECTIVE: To study treatment modalities for cesarean scar pregnancies (CSPs), focusing on efficacy and complications in relation to study quality. DESIGN: Systematic review. SETTING: Not applicable. PATIENT(S): A total of 2,037 women with CSP. INTERVENTION(S): Review of MEDLINE, EMBASE......, and Cochrane Library to find studies including five or more women. Data were extracted on primary treatment modality/efficacy, complications, and future fertility. The level of evidence was categorized according to Oxford Centre for Evidence-based Medicine guidelines. Quality was assessed using The Cochrane...... Collaboration's Risk of Bias Tools for Randomized Controlled Trials and the modified Delphi techniques for case series. Meta-analysis was impossible owing to multifarious treatments. MAIN OUTCOME MEASURE(S): Successful first-line treatment. Complications were hysterectomy, laparotomy, bleeding >1,000 m...

  4. Comparison of non-ablative and ablative fractional laser treatments in a postoperative scar study.

    Science.gov (United States)

    Shin, Jung U; Gantsetseg, Dorjsuren; Jung, Jin Young; Jung, Inhee; Shin, Sungsik; Lee, Ju Hee

    2014-12-01

    Postoperative scarring after thyroidectomy is a problem for both patients and clinicians. Recently, both non-ablative and ablative fractional laser (NFL and AFL) systems have attracted attention as potential therapies for the revision of thyroidectomy scars. The present split-scar study was designed to directly compare the efficacy of these two methods for the treatment of post-thyroidectomy scars. Twenty females (mean age 42.1 years, range 22-55) with scarring 2-3 months post-thyroidectomy were enrolled in the study. One half of the scar (chosen at random) was treated with NFL and the other half was treated with AFL. In each case, two treatments were given at 2-month intervals. Clinical photographs were taken at baseline, before each treatment, and at the final 3-month evaluation. Independent clinician grading of improvement and patient satisfaction were measured on a quartile scale. Color (erythema and melanin indices) and scar hardness were measured at baseline and at three months post-treatment with a dermaspectrometer and durometer, respectively. The mean clinical improvement grades for AFL and NFL were highly similar, 2.45 ± 0.99 and 2.35 ± 0.85, respectively, without statistical significance (P = 0.752). However, NFL treatment resulted in statistically significant changes in erythema and pigmentation (P = 0.035 and P = 0.003, respectively), and skin hardness was significantly reduced after AFL treatment (P = 0.026). Clinical improvement was not significantly different between the two systems; however, AFL was better at reducing scar hardness whereas NFL was superior for lightening color. These data suggest that a study assessing the feasibility of a combined approach for the revision of post-thyroidectomy scarring might be warranted. © 2014 Wiley Periodicals, Inc.

  5. Intraoperative assessment of cerebral aqueduct patency and cisternal scarring: impact on success of endoscopic third ventriculostomy in 403 African children.

    Science.gov (United States)

    Warf, Benjamin C; Kulkarni, Abhaya V

    2010-02-01

    In the setting of a developing country where preoperative imaging may be limited, the authors wished to determine whether cisternal scarring or aqueduct patency at the time of surgery was sufficiently predictive of the failure of endoscopic third ventriculostomy (ETV) to justify shunt placement at the time of the initial operation. The status of the prepontine cistern and aqueduct at the time of ventriculoscopy was prospectively recorded in 403 children in whom an ETV had been completed. Kaplan-Meier methods were used to construct survival curves. A Cox proportional hazards model was used to provide estimates of HRs for the time to ETV failure. Several independent variables were tested in a single multivariable model, including those previously shown to be associated with ETV survival, that is, age, hydrocephalus etiology, and extent of choroid plexus cauterization (CPC). In addition, intraoperative variables of particular interest were included in the analysis: status of the aqueduct at surgery (closed vs open) and status of the prepontine cistern at surgery (scarred vs clean/unscarred). Multicollinearity was not a concern since the variance inflation factors for all variables were aqueduct and an unscarred cistern were each independently associated with significantly better ETV success (HRs of 0.66 and 0.44, respectively). The presence of cisternal scarring more than doubled the risk of ETV failure, and an open aqueduct increased the risk of failure by 50%. Intraoperative observations of the aqueduct and prepontine cistern are independent predictors of the risk of ETV failure and can be used to further refine outcome predictions based on age, hydrocephalus etiology, and extent of CPC. Further studies will test validity in several African centers and determine what threshold of failure risk should prompt shunt placement at the initial operation.

  6. Non-Operative Treatment of Hypertrophic Scar/span>s and Keloids After Burns in Children

    Science.gov (United States)

    Argirova, M.; Hadjiski, O.; Victorova, A.

    2006-01-01

    Summary Scars are a consequence of the natural way of wound healing and replacement of the damaged part of the skin. Hypertrophic scar/span>s and keloids are formed as a result of the process of abnormal wound healing, causing aesthetic and functional deformities, discomfort, and disturbance of children's normal growth. The prophylaxis and treatment of these scars, i.e. burns sequelae, are a significant moment in the treatment of children with burns. The objectives of the present study are methods for the prophylaxis and non-operative treatment of hypertrophic scar/span>s and keloids in children with burns. Altogether, 547 children with 485 burns sequelae - fresh scars in the period of healing and old hypertrophic scar/span>s (377) and keloids (108) - were treated in our Clinic of Children's Burns for a period of five years. The age of the patients varied between 0 and 18 years. Non-operative treatment was applied in 276 children. The patients were divided into two groups according to the treatment applied. Compression, intralesional application of triamcinolone acetonide, and silicone sheets were employed in the first group (84.06%), while only silicone sheets were applied to children in the second group (15.94%). Unaffected areas and areas adjacent to the scar were used as control areas. The sequelae monitored in both groups were assessed using the Vancouver Scar Scale. The children were monitored in an out-patient department. The results obtained are regardless of age, anatomical location, and scar aetiology. In old scars, and especially in keloids, the treatment proved to have variable results, according to the assessment parameters. We were satisfied with the improvement of the parameters during the course of treatment and with the good final results, which we consider a therapeutic success. Analysis of the results shows that the parameters improved slowly during the course of treatment, the process being most active during the first few weeks. The use of

  7. Combination therapy in the management of atrophic acne scars

    Directory of Open Access Journals (Sweden)

    Shilpa Garg

    2014-01-01

    Full Text Available Background: Atrophic acne scars are difficult to treat. The demand for less invasive but highly effective treatment for scars is growing. Objective: To assess the efficacy of combination therapy using subcision, microneedling and 15% trichloroacetic acid (TCA peel in the management of atrophic scars. Materials and Methods: Fifty patients with atrophic acne scars were graded using Goodman and Baron Qualitative grading. After subcision, dermaroller and 15% TCA peel were performed alternatively at 2-weeks interval for a total of 6 sessions of each. Grading of acne scar photographs was done pretreatment and 1 month after last procedure. Patients own evaluation of improvement was assessed. Results: Out of 16 patients with Grade 4 scars, 10 (62.5% patients improved to Grade 2 and 6 (37.5% patients improved to Grade 3 scars. Out of 22 patients with Grade 3 scars, 5 (22.7% patients were left with no scars, 2 (9.1% patients improved to Grade 1and 15 (68.2% patients improved to Grade 2. All 11 (100% patients with Grade 2 scars were left with no scars. There was high level of patient satisfaction. Conclusion: This combination has shown good results in treating not only Grade 2 but also severe Grade 4 and 3 scars.

  8. regional scale assessment of the regional scale assessment

    African Journals Online (AJOL)

    eobe

    head” hydropower which are designed to extract the kinetic energy of rivers, streams, tidal currents or ... is analogous to that of wind turbines, though they capture energy through the process of hydrodynamic, rather than ..... Assessment of Horizontal and Vertical Axis Turbines for River and Tidal Applications: A Technology.

  9. Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach.

    Science.gov (United States)

    Poetschke, Julian; Dornseifer, Ulf; Clementoni, Matteo Tretti; Reinholz, Markus; Schwaiger, Hannah; Steckmeier, Stephanie; Ruzicka, Thomas; Gauglitz, Gerd G

    2017-07-01

    In this study, we aimed to quantify the effects of fractional ablative carbon dioxide laser therapy in the treatment of widespread hypertrophic burn scars. While many different pilot studies have described the potential of the technology and expert groups and current guidelines, alike, recommend its use, the level of evidence for the efficacy of fractional CO 2 -laser treatment for burn scars is currently very low. Ten patients (three male, seven female) with hypertrophic burn scars were treated with a single course of fractional CO 2 -laser therapy in an in-patient controlled setup, using a standardized treatment paradigm. Documentation was based on modern scar scales and questionnaires, like the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), and Dermatology Life Quality Index (DLQI), as well as state of the art clinical measurements (PRIMOS, Cutometer). Over the course of 6 months after treatment, VSS and POSAS scores showed significant improvement in the rating of scar parameters, as did the quality of life rating according to the DLQI. In the treated scars, surface relief improved significantly, as S max decreased by 1893 μm (-36.92%) (p = 0.0273) and S z by 1615 μm (-36.37%) (p = 0.0488). Scar firmness in treated scars could be reduced by 30% after one treatment session, as R 0 improved by 0.0797 mm (+30.38%) (p = 0.0212). Fractional ablative CO 2 -laser treatment is a safe and efficacious option for the treatment of hypertrophic burn scars. While more treatment sessions are required for satisfying results, significant improvement is already apparent after a single course of treatment.

  10. Focal Acne Scar Treatment (FAST), a new approach to atrophic acne scars: a case series.

    Science.gov (United States)

    Schweiger, Eric S; Sundick, Lauren

    2013-10-01

    Acne scars are a common concern in dermatology. Fractional CO2 laser resurfacing is a recent addition in our armamentarium of treatment options for acne scars and has been shown to be an excellent option for patients with atrophic acne scars. Patients with acne scars receiving fractional CO2 resurfacing usually have both the acne scars and surrounding unscarred areas treated in common practice. There has yet to be a study that looked at the implications of only focally treating the acne scars while leaving surrounding normal skin untreated. To evaluate the safety and efficacy of a focal approach to fractional CO2 laser treatment for acne scars, coined "Focal Acne Scar Treatment" or "FAST" This retrospective case series was conducted at Schweiger Dermatology, in New York, NY, with patients treated from November 2011 through May 2012. Overall, six patients (ages 18 to 48) were treated with the fractional CO2 laser resurfacing, using a so called "FAST" technique treating only the acne scars and leaving normal skin untreated. Evaluation was based on physician and patient assessment of improvement at one week and four weeks post-treatment. All six patients treated with the Focal Acne Scar Treatment technique of fractional CO2 laser resurfacing had significant improvement post treatment ranging from 40% to 70% as estimated by the treating dermatologist and patient at four weeks post treatment. Patient satisfaction was high following FAST method. Temporary post-inflammatory hyperpigmentation was seen in two patients but resolved after a single 1550 nm Erbium Glass fractional laser treatment. The Focal Acne Scar Treatment technique is an effective method of improving the appearance of atrophic acne scars. Higher energy and density levels can be used when utilizing this technique, resulting in improved outcomes when compared with whole face fractional CO2 laser resurfacing. Healing is improved and faster with this technique and no increased incidence of permanent adverse

  11. Assessing wildfire risks at multiple spatial scales

    Science.gov (United States)

    Justin Fitch

    2008-01-01

    In continuation of the efforts to advance wildfire science and develop tools for wildland fire managers, a spatial wildfire risk assessment was carried out using Classification and Regression Tree analysis (CART) and Geographic Information Systems (GIS). The analysis was performed at two scales. The small-scale assessment covered the entire state of New Mexico, while...

  12. Numerical study of scars in a chaotic billiard

    CERN Document Server

    Li, B

    1997-01-01

    We study numerically the scaling properties of scars in stadium billiard. Using the semiclassical criterion, we have searched systematically the scars of the same type through a very wide range, from ground state to as high as the 1 millionth state. We have analyzed the integrated probability density along the periodic orbit. The numerical results confirm that the average intensity of certain types of scars is independent of $\\hbar$ rather than scales with (1989).

  13. [Effectiveness of scar split thickness skin graft combined with acellular allogeneic dermis in treatment of large deep II degree burn scar].

    Science.gov (United States)

    Cui, Zelong; Yang, Xiaohui; Shou, Jiabao; Wang, Guangyi

    2014-12-01

    To investigate the feasibility and effectiveness of using scar split thickness skin grafts combined with acellular allogeneic dermis in the treatment of large deep II degree burn scar. Between January 2013 and December 2013, 20 cases of large deep II degree burn scar undergoing plastic operation were enrolled. There were 14 males and 6 females, aged 4 to 60 years (mean, 40 years). Burn reasons included hydrothermal burns in 10 cases, flame burns in 9 cases, and lime burns in 1 case. The burn area accounted for 70% to 96% total body surface area (TBSA) with an average of 79% TBSA. The time from wound healing to scar repair was 3 months to 2 years (mean, 7 months). Based on self-control, 0.7 mm scar split thickness skin graft was used to repair the wound at the right side of joints after scar resection (control group, n=35), 0.5 mm scar split thickness skin graft combined with acellular allogeneic dermis at the left side of joints (trial group, n=30). Difference was not statistically significant in the scar sites between 2 groups (Z=-1.152, P=0.249). After grafting, negative pressure drainage was given for 10 days; plaster was used for immobilization till wound healing; and all patients underwent regular rehabilitation exercises. No significant difference was found in wound healing, infection, and healing time between 2 groups (P > 0.05). All patients were followed up for 6 months. According to the Vancouver Scar Scale (VSS), the score was 5.23 ± 1.41 in trial group and was 10.17 ± 2.26 in control group, showing significant difference (t=8.925, P=0.000). Referring to Activities of Daily Living (ADL) grading standards to assess joint function, the results were excellent in 8 cases, good in 20 cases, fair in 1 case, and poor in 1 case in trial group; the results were excellent in 3 cases, good in 5 cases, fair in 22 cases, and poor in 5 cases in control group; and difference was statistically significant (Z=-4.894, P=0.000). A combination of scar split thickness skin

  14. Story on Scars

    Science.gov (United States)

    ... doesn't and it bothers you, there are treatments that can make a scar less noticeable, such as skin-smoothing medicated creams, ... doctor to find out if any of these treatments would be right for ... bothering you about your scar and how you feel on the inside. Because ...

  15. Laser scar revision.

    Science.gov (United States)

    Lupton, Jason R; Alster, Tina S

    2002-01-01

    A variety of lasers can be used to treat scars and striae effectively. It is of paramount importance that the type of scar be properly classified on initial examination so that the most appropriate method of treatment can be chosen. Classification also allows the laser surgeon to discuss with the patient the anticipated response to treatment. The 585-nm pulsed dye laser (PDL) is the most appropriate system for treating hypertrophic scars, keloids, erythematous scars, and striae. The PDL carries a low risk of side effects and complications when operated at appropriate treatment parameters and time intervals. Atrophic scars are best treated with ablative CO2 and Er:YAG lasers; however, proliferative keloids and hypertrophic scars should not be vaporized because of the high risk of scar recurrence or progression. The appropriate choice and use of lasers can significantly improve most scars. As research in laser-skin interaction continues, further refinements in laser technology coupled with the addition of alternate treatment procedures will allow improved clinical efficacy and predictability.

  16. Novel technology in the treatment of acne scars: The matrix-tunable radiofrequency technology

    Directory of Open Access Journals (Sweden)

    M Ramesh

    2010-01-01

    Full Text Available Background : Despite the many advances, scarring, particularly acne or pimple scarring, does not have a satisfactory treatment. A new armamentarium in this field is this recently devised matrix-tunable radiofrequency technology, which utilizes radiofrequency emission in the treatment of acne scars. Aims : To evaluate the efficiency of the new matrix-tunable radiofrequency technology in patients with acne scars of varying sizes. Settings and Design : A prospective study of 30 randomly selected patients with acne scars was carried out. Materials and Methods : Thirty healthy patients with different types of acne scars - ice pick, box and rolling type - were randomly selected. The scars were either shallow or deep, varied in size from 2 to 20 mm and ranged in number from 10 to 50. These patients were first treated with broad-spectrum antibiotics and local exfoliating agents (topical tretinoin 0.025% and then subjected to matrix-tunable radiofrequency technology. Each scar was treated at intervals of 1 month. A maximum of four such sittings were carried out. Patients were followed-up every 15 days. Results were noted at the end of 2 months and 6 months. Improvement was assessed by using the visual analog scale (VAS at 2 months and 6 months, and results were noted in terms of percentage improvement of the whole face by calculating an average of percentage improvement on the basis of interviews of the patient and his/her accompanying relatives. The visual analog scaling was performed by means of high-resolution digital photographs taken at the baseline and at each subsequent visit. Results : The VAS improvement in scars ranged from 10 to 50% at the end of 2 months to 20 to 70% at the end of 6 months. Of the 30 patients of acne scars, the cosmetic result was excellent (>60% improvement in four, good (35-60% improvement in 18 and moderate to poor (<35% improvement in eight. A few patients reported burning sensation and a mild sunburn-like sensation for

  17. Safety and Efficacy Evaluation of Pulsed Dye Laser Treatment, CO2 Ablative Fractional Resurfacing, and Combined Treatment for Surgical Scar Clearance.

    Science.gov (United States)

    Cohen, Joel L; Geronemus, Roy

    2016-11-01

    Surgical scars are an unwanted sequela following surgical procedures. Several different treatment modalities and approaches are currently being employed to improve the cosmesis of surgical scars with each having varying degrees of success. The objective of this study was to assess the ef cacy and safety pulsed dye laser treatment, CO2 ablative fractional resurfacing, and a combined treatment with these two modalities for the cosmetic improvement of surgical scarring that occurred following the surgical removal of skin cancer from different anatomic areas. Twenty-five patients with surgical scarring most frequently on the face following recent surgical excision of skin cancer with Mohs surgery were included in this multicenter, prospective clinical study. Patients were randomized into 4 treatment arms, namely, pulsed dye laser alone, CO2 laser alone, a combined treatment with these two modalities, and CO2 ablative fractional resurfacing on the same day of surgery to half of the scar, followed by a combined treatment with the two modalities to that half of the scar. Patients in each study arm received a total of 3-4 treatments, while those patients in Arm 4 underwent an additional treatment with CO2 laser immediately after surgery. Patients were followed up at 1 and 3 months after the final treatment session. No adverse events were seen. Significant improvements in the appearance of scars were achieved in all study arms, as as- sessed by the Vancouver Scar Scale and Global Evaluation Response scales, with the best clinical outcomes seen in those scars that underwent a combination treatment. All patients reported very high satisfaction from treatment. Both pulsed dye laser treatment and CO2 ablative fractional resurfacing, when used as a monotherapy, are safe and effective in the treatment and improvement of recent surgical scarring. When both of these modalities are used in combination, however, they appear to potentially have a synergistic effect and an accelerated

  18. Forensic analysis of rockfall scars

    Science.gov (United States)

    de Vilder, Saskia J.; Rosser, Nick J.; Brain, Matthew J.

    2017-10-01

    We characterise and analyse the detachment (scar) surfaces of rockfalls to understand the mechanisms that underpin their failure. Rockfall scars are variously weathered and comprised of both discontinuity release surfaces and surfaces indicative of fracturing through zones of previously intact rock, known as rock bridges. The presence of rock bridges and pre-existing discontinuities is challenging to quantify due to the difficulty in determining discontinuity persistence below the surface of a rock slope. Rock bridges form an important control in holding blocks onto rockslopes, with their frequency, extent and location commonly modelled from the surface exposure of daylighting discontinuities. We explore an alternative approach to assessing their role, by characterising failure scars. We analyse a database of multiple rockfall scar surfaces detailing the areal extent, shape, and location of broken rock bridges and weathered surfaces. Terrestrial laser scanning and gigapixel imagery were combined to record the detailed texture and surface morphology. From this, scar surfaces were mapped via automated classification based on RGB pixel values. Our analysis of the resulting data from scars on the North Yorkshire coast (UK) indicates a wide variation in both weathering and rock bridge properties, controlled by lithology and associated rock mass structure. Importantly, the proportion of rock bridges in a rockfall failure surface does not increase with failure size. Rather larger failures display fracturing through multiple rock bridges, and in contrast smaller failures fracture occurs only through a single critical rock bridge. This holds implications for how failure mechanisms change with rockfall size and shape. Additionally, the location of rock bridges with respect to the geometry of an incipient rockfall is shown to determine failure mode. Weathering can occur both along discontinuity surfaces and previously broken rock bridges, indicating the sequential stages of

  19. Utility of multiparametric MRI in Caesarean section scar characterization and preoperative prediction of scar dehiscence: a prospective study.

    Science.gov (United States)

    Kumar, Ishan; Verma, Ashish; Matah, Manjari; Satpathy, Gayatri

    2017-07-01

    Background Post-Caesarean uterine scar rupture during vaginal birth after Caesarean section (VBAC) is a potentially life-threatening complication. Prediction of scar dehiscence and scar rupture is vital in treatment planning and selecting candidates of trial of labor after a Caesarean section (CS). Purpose To assess the accuracy of magnetic resonance imaging (MRI) for evaluation of post-Caesarean uterine scar and to predict scar dehiscence during repeat CS. Material and Methods Thirty patients with a history of at least one previous CS underwent pelvic MRI for assessment of uterine scar during a subsequent gestation, all of whom underwent lower segment Caesarean section (LSCS) subsequently due to one of the established indications of CSs. Thickness, T1, T2 signal intensity ratio (SER), and apparent diffusion coefficient (ADC) value of scar site were charted. The lower uterine segment was assessed and graded intraoperatively and findings were correlated with MRI findings. Results A total of 30 participants were included in this study, of which nine were classified as having an abnormal scar (of various grades) based on surgical observations. T2 SER with a cutoff value of 0.935 showed the highest sensitivity of 100% and scar thickness value of 3.45 mm showed highest specificity of 91% in prediction of abnormal scar. On drawing a receiver operating characteristic (ROC) curve, T2 signal intensity ratio showed the highest area under the curve (AUC) closely followed by scar thickness values. Conclusion MRI derived parameters may be utilized for differentiation of an abnormal post-Caesarean uterine scar from a normal one. Both scar thickness and T2 SER measured on MRI can be used to predict scar dehiscence. However, T2 SER can serve as a more standardized and objective criterion.

  20. Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers.

    Science.gov (United States)

    Choi, Jae Eun; Oh, Ga Na; Kim, Jong Yeob; Seo, Soo Hong; Ahn, Hyo Hyun; Kye, Young Chul

    2014-08-01

    Nonablative fractional photothermolysis has been reported to show early promise in the treatment of hypertrophic scars, but there are few reports on ablative fractional photothermolysis for the treatment of hypertrophic scars. To evaluate and compare the efficacy and safety of Er:YAG fractional laser (EYFL) and CO2 fractional laser (CO2FL) for treatment of hypertrophic scars. Thirteen patients with hypertrophic scars were treated with 2,940 nm EYFL, and ten were treated with 10,600 nm CO2FL. An independent physician evaluator assessed the treatment outcomes using Vancouver scar scale (VSS) and 5-point grading scale (grade 0, no improvement; grade 1, 1-25%; grade 2, 26-50%; grade 3, 51-75%; grade 4, 76-100% improvement). Patients are queried about their subjective satisfaction with the treatment outcomes. After the final treatment, average percentage changes of VSS were 28.2% for EYFL and 49.8% for CO2FL. Improvement was evident in terms of pliability, while insignificant in terms of vascularity and pigmentation. Based on physician's global assessment, mean grade of 1.8 for EYFL and 2.7 for CO2FL was achieved. Patient's subjective satisfaction scores paralleled the physician's objective evaluation. CO2FL is a potentially effective and safe modality for the treatment of hypertrophic scars, particularly in terms of pliability.

  1. Scar Ectopic Pregnancy

    OpenAIRE

    Patel, Madhuri Arvind

    2015-01-01

    Scar ectopic pregnancy is the rarest form of ectopic pregnancy and has been increasingly diagnosed all over the world. This is a life-threatening form of abnormal implantation of embryo within the myometrium and fibrous tissues in a previous scar on the uterus, especially following caesarean section. With the increasing rate of caesarean section, there is a substantial increase in this condition with better understanding of this disease. The early and accurate diagnosis with timely management...

  2. Laser therapy for prevention and treatment of pathologic excessive scars.

    Science.gov (United States)

    Jin, Rui; Huang, Xiaolu; Li, Hua; Yuan, Yuwen; Li, Bin; Cheng, Chen; Li, Qingfeng

    2013-12-01

    The management of hypertrophic scars and keloids remains a therapeutic challenge. Treatment regimens are currently based on clinical experience rather than substantiated evidence. Laser therapy is an emerging minimally invasive treatment that has recently gained attention. A meta-analysis was conducted to evaluate the effectiveness of various laser therapies. The pooled response rate, pooled standardized mean difference of Vancouver Scar Scale scores, scar height, erythema, and pliability were reported. Twenty-eight well-designed clinical trials with 919 patients were included in the meta-analysis. The overall response rate for laser therapy was 71 percent for scar prevention, 68 percent for hypertrophic scar treatment, and 72 percent for keloid treatment. The 585/595-nm pulsed-dye laser and 532-nm laser subgroups yielded the best responses among all laser systems. The pooled estimates of hypertrophic scar studies also showed that laser therapy reduced total Vancouver Scar Scale scores, scar height, and scar erythema of hypertrophic scars. Regression analyses of pulsed-dye laser therapy suggested that the optimal treatment interval is 5 to 6 weeks. In addition, the therapeutic effect of pulsed-dye laser therapy is better on patients with lower Fitzpatrick skin type scores. This study presents the first meta-analysis to confirm the efficacy and safety of laser therapy in hypertrophic scar management. The level of evidence for laser therapy as a keloid treatment is low. Further research is required to determine the mechanism of action for different laser systems and to examine the efficacy in quantifiable parameters, such as scar erythema, scar texture, degrees of symptom relief, recurrence rates, and adverse effects.

  3. Patient-Reported Outcome Instruments for Surgical and Traumatic Scars: A Systematic Review of their Development, Content, and Psychometric Validation.

    Science.gov (United States)

    Mundy, Lily R; Miller, H Catherine; Klassen, Anne F; Cano, Stefan J; Pusic, Andrea L

    2016-10-01

    Patient-reported outcomes (PROs) are of growing importance in research and clinical care and may be used as primary outcomes or as compliments to traditional surgical outcomes. In assessing the impact of surgical and traumatic scars, PROs are often the most meaningful. To assess outcomes from the patient perspective, rigorously developed and validated PRO instruments are essential. The authors conducted a systematic literature review to identify PRO instruments developed and/or validated for patients with surgical and/or non-burn traumatic scars. Identified instruments were assessed for content, development process, and validation under recommended guidelines for PRO instrument development. The systematic review identified 6534 articles. After review, we identified four PRO instruments meeting inclusion criteria: patient and observer scar assessment scale (POSAS), bock quality of life questionnaire for patients with keloid and hypertrophic scarring (Bock), patient scar assessment questionnaire (PSAQ), and patient-reported impact of scars measure (PRISM). Common concepts measured were symptoms and psychosocial well-being. Only PSAQ had a dedicated appearance domain. Qualitative data were used to inform content for the PSAQ and PRISM, and a modern psychometric approach (Rasch Measurement Theory) was used to develop PRISM and to test POSAS. Overall, PRISM demonstrated the most rigorous design and validation process, however, was limited by the lack of a dedicated appearance domain. PRO instruments to evaluate outcomes in scars exist but vary in terms of concepts measured and psychometric soundness. This review discusses the strengths and weaknesses of existing instruments, highlighting the need for future scar-focused PRO instrument development. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www

  4. Clinical Music Study Quality Assessment Scale (MUSIQUAS)

    NARCIS (Netherlands)

    Jaschke, A.C.; Eggermont, L.H.P.; Scherder, E.J.A.; Shippton, M.; Hiomonides, I.

    2013-01-01

    AIMS Quality assessment of studies is essential for the understanding and application of these in systematic reviews and meta analyses, the two “gold standards” of medical sciences. Publications in scientific journals have extensively used assessment scales to address poor methodological quality,

  5. An enlarging landslide scar and evolution of the surrounding forested hillslope: Results from a dendrogeomorphic and multi-temporal LiDAR DTM survey

    Science.gov (United States)

    Keck, J. W.; Hsiao, C.; Lin, B.; Wright, W. E.; Chi, S.

    2012-12-01

    half of landslide scar development, are used to analyze changes in hillslope topography. Inferences regarding rainfall characteristics and hillslope scale landslide processes that include both the visible scar and landslide features obscured by the forest are presented and implications for landslide sediment hazard assessments discussed.

  6. A paired comparison analysis of third-party rater thyroidectomy scar preference.

    Science.gov (United States)

    Rajakumar, C; Doyle, P C; Brandt, M G; Moore, C C; Nichols, A; Franklin, J H; Yoo, J; Fung, K

    2017-01-01

    To determine the length and position of a thyroidectomy scar that is cosmetically most appealing to naïve raters. Images of thyroidectomy scars were reproduced on male and female necks using digital imaging software. Surgical variables studied were scar position and length. Fifteen raters were presented with 56 scar pairings and asked to identify which was preferred cosmetically. Twenty duplicate pairings were included to assess rater reliability. Analysis of variance was used to determine preference. Raters preferred low, short scars, followed by high, short scars, with long scars in either position being less desirable (p scars over the alternatives. High, short scars were the next most favourably rated. If other factors influencing incision choice are considered equal, surgeons should consider these preferences in scar position and length when planning their thyroidectomy approach.

  7. Burn Scar Biomechanics Following Pressure Garment Therapy

    Science.gov (United States)

    Kim, Jayne Y.; Willard, James J.; Supp, Dorothy M.; Roy, Sashwati; Gordillo, Gayle M.; Sen, Chandan K.; Powell, Heather M.

    2015-01-01

    Background The current standard of care for the prevention and treatment of scarring following burn injury is pressure garment therapy (PGT). Although this therapy has been used clinically for many years, controversy remains regarding its efficacy. The purpose of this study was to evaluate the efficacy of PGT in a female Red Duroc pig (fRDP) burn model where wound depth could be tightly controlled. Methods Full-thickness burn wounds were generated on fRDPs. At day 28 post-burn, PGT was applied to half of the wounds (10 mmHg), with control wounds covered with garments exerting no compression. Scar area, perfusion, hardness, and elasticity were quantified at days 0, 28, 42, 56, and 72 using computerized planimetry, Laser Doppler and torsional ballistometry. Scar morphology was assessed at days 28, 56 and 76 using histology, immunohistochemistry and transmission electron microscopy. Results Pressure garment therapy significantly hindered scar contraction with control scars contracting to 64.6 + 13.9% original area at day 72 while PGT scars contracted to 82.7 + 17.9% original area. PGT significantly reduced skin hardness and increased skin strength by 1.3X. No difference in perfusion or blood vessel density was observed. Average collagen fiber diameter was greater in control burns than PGT. Conclusions PGT was effective at reducing scar contraction and improving biomechanics compared to control scars. These results confirm the efficacy of pressure garments and highlight the need to further investigate the role of pressure magnitude and time of therapy application to enhance their efficacy for optimal biomechanics and patient mobility. PMID:25989300

  8. [Correlations between Beck's suicidal ideation scale, suicidal risk assessment scale RSD and Hamilton's depression rating scale].

    Science.gov (United States)

    Ducher, J-L; Dalery, J

    2008-04-01

    Most of the people who will attempt suicide, talk about it beforehand. Therefore, recognition of suicidal risk is not absolutely impossible. Beck's suicidal ideation scale and Ducher's suicidal risk assessment scale (RSD) are common tools to help practicians in this way. These scales and the Hamilton's depression scale were included in an international multicentric, phase IV, double-blind study, according to two parallel groups who had been administered a fixed dose of fluvoxamin or fluoxetin for six weeks. This allowed examination of the correlations between these scales and the relations, which could possibly exist between suicidal risk, depression and anxiety. (a) Relationships between the Beck's suicidal ideation scale, the suicidal risk assessment scale RSD and Hamilton's depression before treatment. Before treatment, the analysis was conducted with 108 male and female depressive outpatients, aged 18 or over. Results revealed a significant positive correlation (with a Pearson's correlation coefficient r equal to 0.69 and risk pRSD. These scales correlate less consistently with Hamilton's depression (Beck/Hamilton's depression: r=0.34; p=0.0004-RSD/Hamilton's depression: r=0.35; p=0.0002). We observed that the clinical anxiety scale by Snaith is also strongly correlated to these two suicidal risk assessment scales (Beck/CAS: r=0.48; pRSD/CAS: r=0.35; p=0.0005). Besides, the item "suicide" of Hamilton's depression scale accounts for more than a third of the variability of Beck's suicidal ideation scale and the suicidal risk assessment scale RSD. According to these results, the suicidal risk evaluated by these two scales seems to be significantly correlated with anxiety as much as with depression. On the other hand, the Clinical Global Impression is fairly significantly correlated with Beck's suicidal ideation scale (r=0.22; p=0.02), unlike the suicidal risk assessment scale RSD (r=0.42; pRSD and Hamilton's depression under treatment. The follow-up under

  9. A novel instrument aimed at measuring hypertrophic scar formation

    Energy Technology Data Exchange (ETDEWEB)

    Ramella-Roman, J C; Nguyen, T A; Lemaillet, P [Department of Biomedical Engineering, Catholic University of America (United States); Pavlovich, A R; Jordan, M H; Shupp, J W, E-mail: ramella@cua.edu [Burn Center, Department of Surgery, Washington Hospital Center-MedStar Health Research Institute, Washington, DC (United States)

    2011-01-01

    Hypertrophic scaring is a condition that can occur after thermal trauma and can lead to loss of function and psyco-social complications. Assessment of the development of a hypertrophic scar currently relies on visual inspection and grading. In this paper we propose a system based on polarized illumination and collection capable of capturing images of scars and quantify their roughness. Models of rough surface roughness are ultimately used to quantify the level of roughness of scarred skin compared to normal skin.

  10. Chronic caesarian section scar pain treated with fascial scar release techniques: A case series.

    Science.gov (United States)

    Wasserman, Jennifer B; Steele-Thornborrow, Jessica L; Yuen, Jeremy S; Halkiotis, Melissa; Riggins, Elizabeth M

    2016-10-01

    To describe outcomes of two subjects with chronically painful Caesarian section (C-section) scars following an intervention of specific myofascial scar release techniques. Case series. Over 1.3 million C-sections are performed annually in the US. Anywhere from 7 to 18% of those will develop chronic scar pain. Although anecdotal evidence supporting the use of fascial release in reducing surgical scar pain exists, almost no research has been published. Two subjects who both underwent two C-sections resulting in chronic discomfort of 6-9 years duration participated in this study. Both reported premenstrual pain, pain upon pressure to the lower abdomen, and pain during bowel movements. Subject 1 also reported sharp pain with bed mobility. Four, 30-min treatment sessions over a period of two weeks consisted of stretching the scar until a release in tissue tension was felt by the treating therapist. Outcome measures included pain and pressure tolerance using a Pressure Algometer, measurements of scar flexibility using an Adheremeter, and the Numeric Pain Rating Scale (NPRS). These measures were collected at baseline, five days after the final treatment and at four weeks. Both subjects demonstrated improvements in all outcome measures. At four weeks, pressure tolerance at all point improved as much as 79% (p < 0.0001) and scar mobility increased in all directions at all points as much as 200% (p < 0.0001). Following treatment, both subjects rated their premenstrual pain for all previously painful activities at 0/10 for the first time since their surgeries. These results suggest that scar release techniques may help reduce chronic scar pain in women who have had C-section surgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Long-Term Followup of Dermal Substitution with Acellular Dermal Implant in Burns and Postburn Scar Corrections

    Directory of Open Access Journals (Sweden)

    I. Juhasz

    2010-01-01

    Full Text Available Full-thickness burn and other types of deep skin loss will result in scar formation. For at least partial replacement of the lost dermal layer, there are several options to use biotechnologically derived extracellular matrix components or tissue scaffolds of cadaver skin origin. In a survey, we have collected data on 18 pts who have previously received acellular dermal implant Alloderm. The age of these patients at the injury varied between 16 months and 84 years. The average area of the implants was 185 cm2. Among those, 15 implant sites of 14 patients were assessed at an average of 50 months after surgery. The scar function was assessed by using the modified Vancouver Scar Scale. We have found that the overall scar quality and function was significantly better over the implanted areas than over the surrounding skin. Also these areas received a better score for scar height and pliability. Our findings suggest that acellular dermal implants are especially useful tools in the treatment of full-thickness burns as well as postburn scar contractures.

  12. Subcision for treatment of rolling acne scars in Iraqi patients: a clinical study.

    Science.gov (United States)

    Al-Dhalimi, Muhsin A; Arnoos, Ahmad A

    2012-06-01

    Acne scarring is a common dermatologic problem causing a great cosmetic disfigurement. Subcision is one of the effective modalities for treatment of rolling acne scars. To evaluate the efficacy and safety of subcision for rolling acne scars in Iraqi patients. Forty patients (21 males and 19 females) with moderate to severe grades of facial rolling acne scars were enrolled in this study. Subcision was done for all patients. Patients were followed up at 2, 6, 12 weeks, and 6 months after the last session. The response to treatment was evaluated by objective and subjective methods. Thirty-four patients completed the study and follow up period. Eight of them were complaining of severe and 26 of moderate grade of acne scars. At the end of the study, 18 (52.94%) patients had mild grade, 15 (44.11%) patients had moderate grade, and one (2.92%) patient had severe grade. This change was statistically highly significant (P-value = 0.0000001). The average scar score before treatment was 13.264 ± 1.675; and it improved to 9.47 ± 2.71 after 6 months (P-value = 0.0000001). Regarding the photographic assessment, the difference in the visual analogue scale before and after the treatment was statistically highly significant (P-value = 0.0000001). All patients were satisfied regarding the improvement after treatment with varying degrees. All reported side-effects were mild and transient. Subcision is a safe, easy to perform, well-tolerated, and valuable surgical technique for treatment of rolling acne scars. © 2012 Wiley Periodicals, Inc.

  13. Right and left ventricular function and myocardial scarring in adult patients with sickle cell disease: a comprehensive magnetic resonance assessment of hepatic and myocardial iron overload.

    Science.gov (United States)

    Junqueira, Flávia P; Fernandes, Juliano L; Cunha, Guilherme M; T A Kubo, Tadeu; M A O Lima, Claudio; B P Lima, Daniel; Uellendhal, Marly; Sales, Sidney R; A S Cunha, Carolina; L R de Pessoa, Viviani; L C Lobo, Clarisse; Marchiori, Edson

    2013-09-19

    Patients with Sickle cell disease (SCD) who receive regular transfusions are at risk for developing cardiac toxicity from iron overload. The aim of this study was to assess right and left cardiac volumes and function, late gadolinium enhancement (LGE) and iron deposits in patients with SCD using CMR, correlating these values with transfusion burden, ferritin and hemoglobin levels. Thirty patients with SCD older than 20 years of age were studied in a 1.5 T scanner and compared to age- and sex-matched normal controls. Patients underwent analysis of biventricular volumes and function, LGE and T2* assessment of the liver and heart. When compared to controls, patients with SCD presented higher left ventricular (LV) volumes with decreased ejection fraction (EF) with an increase in stroke volume (SV) and LV hypertrophy. The right ventricle (RV) also presented with a decreased EF and hypertrophy, with an increased end-systolic volume. Although twenty-six patients had increased liver iron concentrations (median liver iron concentration value was 11.83 ± 9.66 mg/g), only one patient demonstrated an abnormal heart T2* < 20 msec. Only four patients (13%) LGE, with only one patient with an ischemic pattern. Abnormal heart iron levels and myocardial scars are not a common finding in SCD despite increased liver iron overload. The significantly different ventricular function seen in SCD compared to normal suggests the changes in RV and LV function may not be due to the anemia alone. Future studies are necessary to confirm this association.

  14. Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types.

    Science.gov (United States)

    Khunger, Niti; Bhardwaj, Deepali; Khunger, Monica

    2011-03-01

    Acne scars are difficult to treat. Chemical reconstruction of skin scars (CROSS) is a technique using high strength trichloroacetic acid (TCA) focally on the atrophic acne scars to induce collagenization and cosmetic improvement. The aim of this study was to evaluate the efficacy and safety of CROSS technique using 100% TCA in ice pick scars in dark skin types IV and V. Thirty patients with ice pick acne scars were initially primed for 2 weeks before the procedure. The priming agents used were hydroquinone 4% applied in the morning and tretinoin 0.025% in the night. Sunscreens were advised to prevent postinflammatory hyperpigmentation. Subsequently, they underwent focal application of 100% TCA with a wooden toothpick in each individual scar, at 2 weekly intervals, for four sessions. Improvement was assessed by the physician, photographic assessment by an independent investigator, and patient feedback by visual analogue scale after the fourth treatment. Excellent improvement (more than 70%) was observed in the majority of patients (73.3%), while 20% patients showed good improvement (50-70%) and 6.7% patients had fair results (30-49%) at the end of four sessions. Transient hypopigmentation was observed in one patient and hyperpigmentation in two patients. However, no significant adverse effects such as prolonged pigmentary changes or scarring were noted. Treatment of ice pick acne scars with the CROSS technique using high strength 100% TCA is a safe, minimally invasive, efficacious, and cost-effective technique in darker skin. Adequate priming and continued use of hydroquinone and tretinoin reduces complications and promotes healing. © 2011 Wiley Periodicals, Inc.

  15. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    Shilpa Garg

    2014-01-01

    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  16. Can Acne Scars Be Removed?

    Science.gov (United States)

    ... Arrhythmias Abuse Love and Romance Understanding Other People Can Acne Scars Be Removed? KidsHealth > For Teens > Can Acne Scars Be Removed? Print A A A ... acné? Different Types of Acne Scars from acne can seem like double punishment — first you had to ...

  17. A double-blind, randomized, multicenter, controlled trial of suspended polymethylmethacrylate microspheres for the correction of atrophic facial acne scars.

    Science.gov (United States)

    Karnik, Jwala; Baumann, Leslie; Bruce, Suzanne; Callender, Valerie; Cohen, Steven; Grimes, Pearl; Joseph, John; Shamban, Ava; Spencer, James; Tedaldi, Ruth; Werschler, William Philip; Smith, Stacy R

    2014-07-01

    Acne scarring remains a stubborn clinical problem. Few treatments have been shown to be definitely effective for this problem. Polymethylmethacrylate (PMMA) microspheres in collagen (ArteFill, Suneva Medical Inc, Santa Barbara, CA) have shown long-term benefit for nasolabial fold treatment. A pilot study has shown benefit for PMMA-collagen in atrophic acne scarring. We sought to demonstrate the safety and effectiveness of PMMA-collagen for acne scarring in a controlled, blinded trial. Subjects with at least 4 moderate to severe rolling, atrophic scars randomly received PMMA-collagen or saline injections. Subjects underwent up to 2 injection sessions and were followed up for 6 months. Efficacy was assessed using a validated rating scale for each scar. In all, 147 subjects underwent injections. Success was achieved by 64% of those treated with PMMA-collagen compared with 33% of control subjects (P = .0005). The treatment showed excellent safety with generally mild, reversible adverse events. No significant differences in efficacy or safety were noted between genders, for darker skin types, or in older age groups. Subjects were followed up for only 6 months. PMMA-collagen demonstrates substantial effectiveness in the treatment of atrophic acne scars of the face while maintaining an excellent safety profile. Further follow-up should be undertaken to demonstrate longer-term benefit and safety. Copyright © 2014 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  18. Scale Effects in Moral Relevance Assessment.

    Science.gov (United States)

    Nagel, Jonas; Rybak, Andrej

    2017-03-01

    Research on moral judgment often employs bipolar rating scales to assess whether the difference between two contrasted options is judged to be morally relevant. We give an account of how different numbers of response options provided on such scales (odd vs. even) change the meaning of the test question by communicating different implicit presuppositions. We demonstrate experimentally that these changes can qualitatively affect the moral relevance judgments that subjects express in response to a given judgment problem. Several alternative explanations in terms of trivial measurement distortion are tested and refuted, and we present suggestive evidence as to what kind of factors might be prone to scale effects. The findings underscore that expressed moral judgments are constructed ad hoc and do not necessarily reflect the content of underlying stable moral commitments. We discuss implications for theories and methodology in moral psychology and in judgment and decision-making research more generally.

  19. The effect of moisturizers or creams on scars: a systematic review protocol.

    Science.gov (United States)

    Klotz, Tanja; Munn, Zachary; Aromataris, Edoardo; Greenwood, John

    2017-01-01

    The objectives of the review are to identify the effect of any moisturizers or creams (medicated or unmedicated) on immature scars (linear, keloid or hypertrophic) on any persons of any age. Effects will be assessed by changes in scar activity, changes in the final appearance/cosmesis of the scar, improvements in patient reported features of scars (e.g. itch, tightness, range of movement) and/or by altering measurable features of the scar such as vascularity, color, height, length, pliability and/or transepidermal water loss.Specifically the review question is: are moisturizers or creams effective in modifying immature scars?

  20. Treatment of atrophic facial acne scars with fractional Er:Yag laser.

    Science.gov (United States)

    Al-Dhalimi, Muhsin; Jaber, Akeel

    2015-01-01

    Acne scars are often a permanent disfiguring sequel of acne vulgaris. Although many treatment modalities are available, they are often non satisfactory for all patients. To determine the effectiveness and safety of fractional 1540 nm erbium_glass laser treatment of facial acne scars in Iraqi patients. Twenty one patients were enrolled in this prospective clinical study. Three sessions of the 1540 nm erbium glass laser were applied at 2-week intervals. The patients were assessed at 1, 3, and 6 months after the last session. The effect of treatment was assessed by objective (Sharquie scoring system for grading acne scarring and visual analog scale) and subjective (patient satisfaction) methods. Two patients were defaulted. Eleven patients (57.9%) showed improvement from moderate to mild grade, and no grade changes were detected in eight patients (42.1%). The mean score of the visual analog scale prior to treatment was 8.61 ± 0.86 and decreased to 6.15 ± 1.28 (P = 0.037). Ten patients were satisfied to varying degrees. No significant side effects were noted. Non-ablative fractional 1540 nm erbium glass laser is an effective and safe method to treat acne scars and represent good alternative for patients who cannot use the ablative methods because of its longer downtime.

  1. Scar resurfacing with high-energy, short-pulsed and flashscanning carbon dioxide lasers.

    Science.gov (United States)

    Bernstein, L J; Kauvar, A N; Grossman, M C; Geronemus, R G

    1998-01-01

    Scars have a significant effect on a person's physical and social being. Many treatment modalities for scar improvement such as surgical scar revision, electrosurgical planing, chemical peeling, filler substance implantation, and dermabrasion have been developed. Recently, the resurfacing carbon dioxide (CO2) laser systems have proven to be a useful and safe treatment in the treatment of facial rhytides and acne scarring. The purpose of this study was to evaluate the resurfacing CO2 lasers in the treatment of various surgical, traumatic, acne, and varicella scars. Thirty subjects, aging between 14 and 84 years, with surgical, traumatic, acne, or varicella scars were evaluated. Two types of resurfacing laser systems were utilized in this study, a high-energy, short-pulsed CO2 laser and a continuous wave CO2 laser with an optico-mechanical computer flash-scanner. Post-surgical scars were treated with laser resurfacing between 4 and 6 weeks after scar formation. Traumatic, acne, and varicella scars were treated after scar maturation (range, 1-10 years). Scar improvement was evaluated by photographic analysis of before and after images by four independent health care workers using a quartile scale of improvement ( 75%) as well as optical profilometry using silicone surface impressions in 12 scars. Twenty of 24 surgical scars had greater than 75% improvement, and 24 of 24 had greater than 50% improvement by photographic analysis. All six traumatic, acne and varicella scars had greater than 50% improvement. Optical profilometry and surface topography maps reveal a significant flattening of related and depressed scars. The high-energy, short-pulsed CO2 laser and the continuous wave CO2 laser with flash-scanning attachment are safe and effective as a treatment modality for scar revision. In general, elevated scars improve more dramatically than depressed scars.

  2. Interactive visualization for scar transmurality in cardiac resynchronization therapy

    Science.gov (United States)

    Reiml, Sabrina; Toth, Daniel; Panayiotou, Maria; Fahn, Bernhard; Karim, Rashed; Behar, Jonathan M.; Rinaldi, Christopher A.; Razavi, Reza; Rhode, Kawal S.; Brost, Alexander; Mountney, Peter

    2016-03-01

    Heart failure is a serious disease affecting about 23 million people worldwide. Cardiac resynchronization therapy is used to treat patients suffering from symptomatic heart failure. However, 30% to 50% of patients have limited clinical benefit. One of the main causes is suboptimal placement of the left ventricular lead. Pacing in areas of myocardial scar correlates with poor clinical outcomes. Therefore precise knowledge of the individual patient's scar characteristics is critical for delivering tailored treatments capable of improving response rates. Current research methods for scar assessment either map information to an alternative non-anatomical coordinate system or they use the image coordinate system but lose critical information about scar extent and scar distribution. This paper proposes two interactive methods for visualizing relevant scar information. A 2-D slice based approach with a scar mask overlaid on a 16 segment heart model and a 3-D layered mesh visualization which allows physicians to scroll through layers of scar from endocardium to epicardium. These complementary methods enable physicians to evaluate scar location and transmurality during planning and guidance. Six physicians evaluated the proposed system by identifying target regions for lead placement. With the proposed method more target regions could be identified.

  3. Outcome of dermal grafting in the management of atrophic facial scars

    Directory of Open Access Journals (Sweden)

    Kanathur Shilpa

    2016-01-01

    Full Text Available Background: Scars over the face are cosmetically and psychologically disturbing. Various techniques have been described and are being practiced in the management of these scars. Aims and Objectives: This study was undertaken to study the safety, effectiveness of using dermal grafts as fillers in the management of facial scars due to acne, chickenpox, trauma or any others. Materials and Methods: Fifteen patients with atrophic facial scars of varied aetiology and willing for surgery were considered for dermal graft technique. After pre-operative workup, subcision was done 2 weeks before planned surgery. Depending on the type of scar, grafts were inserted using pocket or road railing techniques. Scar improvement was assessed based on patient satisfaction. Results: Linear scars showed excellent improvement. Acne, varicella and traumatic scars also showed good improvement. However, two patients did not appreciate improvement due to marked surface irregularities as the scars were elevated. They were further subjected to LASER and chemical peel resurfacing. Conclusion: Dermal grafting can be used in the management of any round to oval facial scar which is soft, prominent and at least 4-5 mm across; linear scars at least 2-3 mm across and 3-4 cm in length. However, scars with prominent surface irregularities need further resurfacing techniques along with dermal grafting. Limitations: Limitations of the study include small sample size, and only subjective assessment of the scar has been taken into consideration to assess the outcome.

  4. Measuring Scars of Periodic Orbits

    CERN Document Server

    Kaplan, L

    1999-01-01

    The phenomenon of periodic orbit scarring of eigenstates of classically chaotic systems is attracting increasing attention. Scarring is one of the most important ``corrections'' to the ideal random eigenstates suggested by random matrix theory. This paper discusses measures of scars and in so doing also tries to clarify the concepts and effects of eigenfunction scarring. We propose a new, universal scar measure which takes into account an entire periodic orbit and the linearized dynamics in its vicinity. This measure is tuned to pick out those structures which are induced in quantum eigenstates by unstable periodic orbits and their manifolds. It gives enhanced scarring strength as measured by eigenstate overlaps and inverse participation ratios, especially for longer orbits. We also discuss off-resonance scars which appear naturally on either side of an unstable periodic orbit.

  5. Suppression of scar formation in a murine burn wound model by the application of non-thermal plasma

    Science.gov (United States)

    Hoon Lee, Dae; Lee, Jae-Ok; Jeon, Wonju; Choi, Ihn-Geun; Kim, Jun-Sub; Hoon Jeong, Je; Kang, Tae-Cheon; Hoon Seo, Cheong

    2011-11-01

    Suppression of hypertrophic scar generation in an animal model by treatment with plasma is reported. Contact burn following mechanical stretching was used to induce scar formation in mice. Exposure to the plasma tended to reduce the scar area more rapidly without affecting vitality. The treatment resulted in decreased vascularization in the scar tissue. Plasma-treated scars showed mild decrease in the thickness of hypertrophic tissues as shown by histological assessment. Finally, we showed that plasma treatment induced cell death and reactive oxygen species generation in hypertrophic scar fibroblast. All of the results support that plasma treatment can control scar generation.

  6. Prevalence and Risk Factors of Acne Scarring Among Patients Consulting Dermatologists in the Unites States.

    Science.gov (United States)

    Tan, Jerry; Kang, Sewon; Leyden, James

    2017-02-01

    Although there have been few formal studies, scarring is a known bothersome companion of acne vulgaris. We performed a prospective study of subjects consulting a dermatologist for active acne to assess the frequency of acne scarring. Investigators performed a short questionnaire on all acne patients seen at their office for one consecutive 5-day work week to assess scar frequency. Additionally, the first four subjects with acne scars identified were enrolled for a second phase (scar cohort) of the study during which the investigator collected further medical history and performed a clinical evaluation and the patient completed a self-administered questionnaire about scar perceptions and impact on quality of life. A total of 1,972 subjects were evaluated by 120 investigators. Among these, 43 percent (n=843) had acne scarring. Subjects with acne scars were significantly more likely to have severe or very severe acne (P less than .01); however, 69% of the subjects with acne scars had mild or moderate acne at the time of the study visit. Risk factors correlated with increased likelihood of scarring were acne severity, time between acne onset and first effective treatment, relapsing acne, and male gender. Treatments that can completely resolve acne scars are not yet available - prevention and early treatment remain a primary strategy against scars. It is vital for clinicians who manage individuals with acne to institute effective therapy as early as possible, since treatment delay is a key modifiable risk factor for scarring. J Drugs Dermatol. 2017;16(2):97-102..

  7. Observer-blind randomized controlled study of a cosmetic blend of safflower, olive and other plant oils in the improvement of scar and striae appearance.

    Science.gov (United States)

    Bielfeldt, S; Blaak, J; Staib, P; Simon, I; Wohlfart, R; Manger, C; Wilhelm, K P

    2017-11-02

    The normal process of skin tissue repair following injury invariably results in visual scarring. It is known that topical treatment with hydrophobic cosmetics rich in silicone and mineral oil content can improve the appearance of scars and striae. Given lifestyle preferences of many cosmetic consumers towards so-called natural treatments, the objective of this controlled randomized study was to investigate the efficacy of a plant body oil rich in oleic and linoleic acids (Bio Skin Oil® ) for improving the appearance of scars and striae. A panel of 80 volunteers with non-hypertrophic scars (40) or stretch marks (40) not older than 3 years applied a cosmetic face and body oil for 8 weeks. Compared to an untreated scar/stretch mark region, a blinded investigator as well as volunteer assessments with given observed parameters demonstrated the efficacy of the oil under test. On the Observer Scar Assessment Scale (OSAS), the mean score was reduced on the product-treated area by approximately 5% (P = 0.006). The untreated area remained unchanged. Observed effects by volunteers were more pronounced - Patient Scar Assessment Scale (PSAS) giving a reduction of approximately 20% on the treated area, and on the control untreated area a reduction of approximately 6%. The overall product effect of 14% was shown to be clearly significant (P = 0.001). All statements relating to product traits achieved higher frequencies of agreements than of non-agreements and were therefore assessed positively by the volunteers. Highest frequencies of agreements occurred in statements that the test product provides a long-lasting, soft and supple skin feeling (93%); caring effect (87%); and quick absorbance (84%). Agreement was also found for statements that the product improves the skin appearance (61%) and that scars/striae appear less pronounced (51%). Only 17% of volunteers felt the oil had no benefit to the appearance of their scars/striae. The oil blend under test is effective in improving

  8. Clinical evaluation of the efficacy and safety of fractional bipolar radiofrequency for the treatment of moderate to severe acne scars.

    Science.gov (United States)

    Verner, Ines

    2016-01-01

    Several treatment modalities are used for the treatment of acne scars with variable results. Recent studies showed that fractional radiofrequency may be an effective treatment modality for acne scars. The objective of this study was to assess the efficacy, safety, tolerability and patient satisfaction of fractional bipolar radiofrequency (RF), the eTwo™ system (Syneron Candela Ltd., Yokneam, Israel) for treating acne scars. Twelve patients with moderate to severe acne scars received 3-5 treatments with the Sublative fractionated bipolar RF applicator of the eTwo device at 1-month intervals. Patients were evaluated clinically and photographically at each visit and 3 months after the final treatment. Very good improvement (at least one scale) was seen after completing the five treatments. The patient satisfaction survey (Global Aesthetic Improvement Scale scores) revealed that half (6 out of 12) of the patients reported to be satisfied with treatment results, while the other half reported to be very satisfied. Beyond the expected erythema and minimal scab formation in the treated areas, which was mild and transient, none of the participants reported any adverse events. The data presented here support the high efficacy and safety of fractionated bipolar RF for the aesthetic improvement of moderate to severe acne scars. © 2015 Wiley Periodicals, Inc.

  9. Acne Scar Treatment: A Multimodality Approach Tailored to Scar Type.

    Science.gov (United States)

    Zaleski-Larsen, Lisa A; Fabi, Sabrina G; McGraw, Timothy; Taylor, Mark

    2016-05-01

    Acne scarring can be classified into atrophic icepick, boxcar, and rolling scars in addition to keloidal and hypertrophic scars. Additionally, these scars can be erythematous, hyperpigmented, and/or hypopigmented. Each scar type has a different structural cause warranting a customized approach. Many cosmetic options exist to address these changes individually, but little literature exists about the safety and efficacy of combining such procedures and devices. A Medline search was performed on combination treatments because it relates to facial acne scarring, and results are summarized. Practical applications for these combinations of procedures are also discussed. Studies examining the efficacy and safety of ablative, nonablative, fractionated, and nonfractionated lasers, dermabrasion, chemical peels, needling, subcision, radiofrequency, stem cell therapy, fat transplantation, platelet-rich plasma, and hyaluronic acid dermal fillers for acne scars were found. The authors review their experience in combining these techniques. Review of the literature revealed multiple single options for facial acne scarring treatment with minimal evidence in the literature found on the safety and efficacy of combining such procedures and devices. The authors' experience is that combining acne scar treatment techniques can be performed safely and synergistically with optimal patient outcomes.

  10. Update on Postsurgical Scar Management

    Science.gov (United States)

    Commander, Sarah Jane; Chamata, Edward; Cox, Joshua; Dickey, Ryan M.; Lee, Edward I.

    2016-01-01

    Postoperative scar appearance is often a significant concern among patients, with many seeking advice from their surgeons regarding scar minimization. Numerous products are available that claim to decrease postoperative scar formation and improve wound healing. These products attempt to create an ideal environment for wound healing by targeting the three phases of wound healing: inflammation, proliferation, and remodeling. With that said, preoperative interventions, such as lifestyle modifications and optimization of medical comorbidities, and intraoperative interventions, such as adherence to meticulous operative techniques, are equally important for ideal scarring. In this article, the authors review the available options in postoperative scar management, addressing the benefits of multimodal perioperative intervention. Although numerous treatments exist, no single modality has been proven superior over others. Therefore, each patient should receive a personalized treatment regimen to optimize scar management. PMID:27478420

  11. Ablative fractional CO2laser for burn scar reconstruction: An extensive subjective and objective short-term outcome analysis of a prospective treatment cohort.

    Science.gov (United States)

    Issler-Fisher, Andrea C; Fisher, Oliver M; Smialkowski, Ania O; Li, Frank; van Schalkwyk, Constant P; Haertsch, Peter; Maitz, Peter K M

    2017-05-01

    The introduction of ablative fractional CO 2 lasers (CO 2 -AFL) for burn scar management shows promising results. Whilst recent studies have focused on objective scar outcomes following CO 2 -AFL treatment, to date no data on patient subjective factors such as quality of life are available. A prospective study was initiated to analyze the safety and efficacy of the CO 2 -AFL. Various objective and subjective outcome parameters were prospectively collected from the date of first consultation and follow-up following treatment. Objective factors include the Vancouver Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS), and ultrasound measurements of the thickness of the scar. Subjective parameters included the assessment of neuropathic pain and pruritus, as well as the evaluation of improvement of quality of life following CO 2 -AFL with the Burns Specific Health Scale (BSHS-B). For treatment effect analysis, patients were stratified according to scar maturation status (> or <2 years after injury). 47 patients with 118 burn scars completed at least one treatment cycle. At a median of 55 days (IQR 32-74) after CO 2 -AFL treatment all analyzed objective parameters decreased significantly: intra-patient normalized scar thickness decreased from a median of 2.4mm to 1.9mm (p<0.001) with a concomitant VSS-drop from a median of 7 to 6 (p<0.001). The overall POSAS patient scale decreased from a median of 9 to 5 (p<0.001) with similar effects documented in POSAS observer scales. Both pain and pruritus showed significant reduction. Quality of life increased significantly by 15 points (median 120 to 135; p<0.001). All of the identified changes following CO 2 -AFL were equally significant irrespective of scar maturation status. Our preliminary results confirm significant improvement in thickness, texture, colour, and symptoms following treatment with CO 2 -AFL. Foremost, quality of life of patients with both immature and mature scars (up to 23 years after

  12. Scar outcomes in dermatological surgery.

    Science.gov (United States)

    Kim, Burcu; Sgarioto, Melissa; Hewitt, Daniel; Paver, Robert; Norman, Julia; Fernandez-Penas, Pablo

    2018-02-01

    Significant functional impairment and psychological burden may result from poor scar quality and its impact on patient's quality of life has been well-established. It is important to identify measures to reduce the risk of surgical complications. 212 patients undergoing dermatological surgery were recruited from March 2011 to February 2014. Their age, sex, surgical site, closure type, defect size (length and width), scar length, number of deep sutures, suture type and size were recorded. The patients were followed up at 6 weeks and 6 months for complications including abscess formation, granuloma formation, scar spreading, suture spitting and hypertrophic scar formation. At 6 weeks complications included suture spitting (14%), granuloma (11%), scar spreading (7%), hypertrophic scarring (3%) and abscess formation (1%), and at 6 months; scar spreading (17%), hypertrophic scarring (2%) and suture spitting (1%). In our multivariate analysis there were no predictors for spreading or spitting at 6 weeks, and only the defect size width was a predictor for granulomas in the stepwise analysis. For scar spreading at 6 months, younger age, site (trunk or limbs), higher number of deep sutures and surgeon were independent predictors (P sutures more superficially to the skin surface and was throwing more knots per closure; factors that we did not record in our study and merit further study. © 2017 The Australasian College of Dermatologists.

  13. Periorbital Scar Correction.

    Science.gov (United States)

    Chambers, Christopher B; Moe, Kristen S

    2017-02-01

    Periorbital scarring with eyelid retraction can have serious visual effects and can lead to loss of vision or even loss of the eye. Understanding of eyelid anatomy and the delicate balance of its structural supports is critical for the identification of the eyelid disorder responsible for the cicatrix and helps to guide treatment. The 2-finger test and lateral distraction of the lid can also be of significant help in proper diagnosis of the underlying disorder. Proper reconstruction with respect to the anterior and posterior lamellae helps to ensure a favorable outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Retinoic acid and glycolic acid combination in the treatment of acne scars.

    Science.gov (United States)

    Chandrashekar, B S; Ashwini, K R; Vasanth, Vani; Navale, Shreya

    2015-01-01

    Acne is a prevalent condition in society affecting nearly 80-90% of adolescents often resulting in secondary damage in the form of scarring. Retinoic acid (RA) is said to improve acne scars and reduce postinflammatory hyperpigmentation while glycolic acid (GA) is known for its keratolytic properties and its ability to reduce atrophic acne scars. There are studies exploring the combined effect of retinaldehyde and GA combination with positive results while the efficacy of retinoic acid and GA (RAGA) combination remains unexplored. The aim of this study remains to retrospectively assess the efficacy of RAGA combination on acne scars in patients previously treated for active acne. A retrospective assessment of 35 patients using topical RAGA combination on acne scars was done. The subjects were 17-34 years old and previously treated for active acne. Case records and photographs of each patient were assessed and the acne scars were graded as per Goodman and Baron's global scarring grading system (GSGS), before the start and after 12 weeks of RAGA treatment. The differences in the scar grades were noted to assess the improvement. At the end of 12 weeks, significant improvement in acne scars was noticed in 91.4% of the patients. The RAGA combination shows efficacy in treating acne scars in the majority of patients, minimizing the need of procedural treatment for acne scars.

  15. Retinoic acid and glycolic acid combination in the treatment of acne scars

    Directory of Open Access Journals (Sweden)

    B S Chandrashekar

    2015-01-01

    Full Text Available Introduction: Acne is a prevalent condition in society affecting nearly 80-90% of adolescents often resulting in secondary damage in the form of scarring. Retinoic acid (RA is said to improve acne scars and reduce postinflammatory hyperpigmentation while glycolic acid (GA is known for its keratolytic properties and its ability to reduce atrophic acne scars. There are studies exploring the combined effect of retinaldehyde and GA combination with positive results while the efficacy of retinoic acid and GA (RAGA combination remains unexplored. Aim: The aim of this study remains to retrospectively assess the efficacy of RAGA combination on acne scars in patients previously treated for active acne. Materials and Methods: A retrospective assessment of 35 patients using topical RAGA combination on acne scars was done. The subjects were 17-34 years old and previously treated for active acne. Case records and photographs of each patient were assessed and the acne scars were graded as per Goodman and Baron′s global scarring grading system (GSGS, before the start and after 12 weeks of RAGA treatment. The differences in the scar grades were noted to assess the improvement. Results: At the end of 12 weeks, significant improvement in acne scars was noticed in 91.4% of the patients. Conclusion: The RAGA combination shows efficacy in treating acne scars in the majority of patients, minimizing the need of procedural treatment for acne scars.

  16. Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatment.

    Science.gov (United States)

    Gold, Michael H; McGuire, Michael; Mustoe, Thomas A; Pusic, Andrea; Sachdev, Mukta; Waibel, Jill; Murcia, Crystal

    2014-08-01

    In 2002, an international advisory panel was convened to assess the scientific literature and develop evidence-based guidance for the prevention and treatment of pathologic scarring. Emerging clinical data, new treatment options, and technical advances warranted a renewed literature search and review of the initial advisory panel recommendations. To update the management algorithm for pathologic scarring to reflect best practice standards at present. Management recommendations were derived from clinical evidence amassed during a comprehensive literature search and from the clinical experience and consensus opinion of advisory panel members. A combination approach using multiple modalities provides the maximum potential for successful treatment of hypertrophic scars and keloids. The advisory panel advocates a move toward more aggressive initial management of keloids, including earlier application of 5-fluorouracil. A growing body of clinical research supports a place in therapy for newer agents (e.g., bleomycin, onion extract, imiquimod, mitomycin C) and laser therapy (pulsed-dye, fractional) for scar management. Prevention and treatment of pathologic scarring requires individualized care built upon the principles of evidence-based medicine and continues to evolve in step with technological and scientific advances.

  17. Development of BCG Scar and Subsequent Morbidity and Mortality in Rural Guinea-Bissau.

    Science.gov (United States)

    Storgaard, Line; Rodrigues, Amabelia; Martins, Cesario; Nielsen, Bibi Uhre; Ravn, Henrik; Benn, Christine Stabell; Aaby, Peter; Fisker, Ane Bærent

    2015-09-15

    Previous studies have found that BCG vaccination has nonspecific beneficial effects on child survival, especially among children who developed a BCG scar. These studies have mostly been done in settings with a high scar frequency. In rural Guinea-Bissau, many children do not develop a scar; we tested the hypothesis that among BCG-vaccinated children, a vaccination scar was associated with lower mortality and fewer hospital admissions. During 2009-2011, children scar status assessed at semiannual visits. We compared mortality and hospital admission rates of scar-positive and scar-negative BCG-vaccinated children during 6 months of follow-up in Cox proportional hazards models. Among 15 911 BCG-vaccinated children, only 52% had a scar. There were 106 non-injury-related deaths among scar-positive children and 137 among scar-negative children. The mortality rate ratio (MRR) was 0.74 (95% confidence interval [CI], .56-.96) overall; 0.48 (95% CI, .26-.90) in infancy, 0.69 (95% CI, .45-1.05) in the second year of life, and 0.89 (95% CI, .61-1.31) in the third-fifth year of life. The association between scar positivity and lower mortality differed significantly by cause of death and was strongest for respiratory infections (MRR, 0.20 [95% CI, .07-.55]). There were 99 hospital admissions among scar-positive children and 125 admissions among scar-negative children, resulting in an incidence rate ratio of 0.74 (95% CI, .60-.92). Among BCG-vaccinated children in a setting with low scar prevalence, having a scar is associated with lower mortality and morbidity. BCG scar prevalence may be an important marker of vaccination program quality. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  18. [Perioperative interstitial brachytherapy for recurrent keloid scars].

    Science.gov (United States)

    Rio, E; Bardet, E; Peuvrel, P; Martinet, L; Perrot, P; Baraer, F; Loirat, Y; Sartre, J-Y; Malard, O; Ferron, C; Dreno, B

    2010-01-01

    Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (LDR) Ir-192 in the treatment of keloid scars. We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medicosurgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Median age was 28 years (range 13-71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1-6h). The median dose was 20Gy (range, 15-40Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14-150 months). All relapses occurred early - within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6cm long. The rate was 100% for treated scars below 4.5cm in length, 95% (95% CI: 55-96) for those 4.5-6cm long, and 75% (95% CI: 56-88) beyond 6cm (p=0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16-181 months). Early perioperative LDR brachytherapy delivering 20Gy at 5mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. 2009 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  19. Comparative study on efficacy and safety of 1550 nm Er:Glass fractional laser and fractional radiofrequency microneedle device for facial atrophic acne scar.

    Science.gov (United States)

    Chae, Woong Suk; Seong, Jun Young; Jung, Ha Na; Kong, Sook Hyun; Kim, Min Ho; Suh, Ho Seok; Choi, Yu Sung

    2015-06-01

    The 1550 nm Er:Glass fractional laser is widely used for the treatment of atrophic acne scar. A novel fractional radiofrequency microneedle device has recently emerged as an alternative for treating acne scars. To evaluate the clinical efficacy and safety of a Er:Glass fractional laser and fractional radiofrequency microneedle device in the treatment of facial atrophic acne scars and to assess the difference between the treatment modalities depending on facial compartment. A total of 40 patients were equally randomized into two groups. Each group of 20 patients received three treatments at 4-week interval using Er:Glass fractional laser or fractional radiofrequency microneedle device. Scar severity scores (ECCA grading scale) improved by a mean of 25.0% and 18.6% in groups A and B, respectively (both P acne scars improved in both groups without significant side effects. Additionally, the fractional laser was a more effective treatment option for acne scars, but the fractional radiofrequency microneedle device offered good adherence and short downtime. © 2015 Wiley Periodicals, Inc.

  20. Prevalence of scar contractures after burn: A systematic review.

    Science.gov (United States)

    Oosterwijk, Anouk M; Mouton, Leonora J; Schouten, Hennie; Disseldorp, Laurien M; van der Schans, Cees P; Nieuwenhuis, Marianne K

    2017-02-01

    Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the prevalence, course, and determinants is essential. A literature search was conducted including Pubmed, Cochrane library, CINAHL, and PEDro. Articles were included if they provided burn scar contracture data to calculate the point prevalence. The quality of the articles was scored. Data were extracted regarding study, subject and burn characteristics, method of scar contracture assessment, point prevalence, and possible determinants. Nine articles and one abstract could be included for data extraction. The prevalence at discharge was 38-54%, but with a longer time after burn, the prevalence was lower. Contractures were more likely to occur in more severe burns, flame burns, children, female, the cervical spine, and the upper extremity. The prevalence of burn scar contractures varies considerably between studies. When prevalence is unclear, it is also difficult to investigate potential determinants and evaluate changes in interventions. There is a need for extensive, well-designed longitudinal (inter)national studies that investigate prevalence of scar contractures, their evolvement over time, and risk factors. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  1. Update on hypertrophic scar treatment

    Science.gov (United States)

    Rabello, Felipe Bettini; Souza, Cleyton Dias; Júnior, Jayme Adriano Farina

    2014-01-01

    Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scar/span>s and keloids are pathological scar/span>s resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scar/span>s, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scar/span>s, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin. PMID:25141117

  2. A split-face comparative study to evaluate efficacy of combined subcision and dermaroller against combined subcision and cryoroller in treatment of acne scars.

    Science.gov (United States)

    Gadkari, Reshma; Nayak, Chitra

    2014-03-01

    Acne scars occur consequent to abnormal wound healing following sebaceous follicular inflammation in acne. Various types of acne scars are icepick, rolling, boxcar, hypertrophic, and keloidal. Different modalities of treatment include subcision, dermaroller, cryoroller, punch excision, chemical peeling, and lasers. To compare the efficacy of combined subcision and dermaroller vs. combined subcision and cryoroller in acne scar treatment. Thirty patients (19 males and 11 females) with grade 2, 3, and 4 postacne scarring (Goodman and Baron qualitative grading system) were enrolled in the study. Three sittings each at 1-month interval were carried out of subcision under nerve block on the entire face followed by derma roller (2.5 mm) and cryoroller on one half of the face. Standardized digital photography was performed preprocedure and at 6 months. Grading of acne scar photographs using the Goodman and Baron qualitative and quantitative grading scale was carried out by a blinded observer pre- and postprocedure at 6 months. Patients' own evaluation based on patient scar severity perception scale of 1-10 was also taken into account. Assessment using the quantitative grading scale showed a 57% improvement using combined subcision and cryoroller against 40% improvement with combined subcision and dermaroller. Average improvement perceived by the subjects was 61% with combined subcision and cryoroller against 45% with combined subcision and dermaroller. The data were analyzed using Wilcoxon signed rank test and found statistically significant. Postinflammatory hyperpigmentation on the cryoroller side and erythema, edema, and hematoma formation due to subcision was transient. Combined subcision and cryoroller is more effective than combined subcision and dermaroller for treatment of acne scars. © 2014 Wiley Periodicals, Inc.

  3. Perforator-Based Interposition Flaps Perform Better Than Full-Thickness Grafts for the Release of Burn Scar Contractures: A Multicenter Randomized Controlled Trial.

    Science.gov (United States)

    Stekelenburg, Carlijn M; Jaspers, Mariëlle E H; Jongen, Sandra J M; Baas, Dominique C; Gardien, Kim L M; Hiddingh, Jakob; van Zuijlen, Paul P M

    2017-02-01

    Burn scar contractures remain a significant problem for the severely burned patient. Reconstructive surgery is often indicated to improve function and quality of life. Skin grafts (preferably full-thickness grafts) are frequently used to cover the defect that remains after scar release. Local flaps are also used for this purpose and provide healthy skin subcutaneous tissue. The vascularization and versatility of local flaps can be further improved by enclosing a perforator at the base of the flap. Until now, no randomized controlled trial has been performed to determine which technique has the best effectiveness in burn scar contracture releasing procedures. A multicenter randomized controlled trial was performed to compare the effectiveness of perforator-based interposition flaps to full-thickness skin grafts for the treatment of burn scar contractures. The primary outcome parameter was change in the surface area of the flap or full-thickness skin graft. Secondary outcome parameters were width, elasticity, color, Patient and Observer Scar Assessment Scale score, and range of motion. Measurements were performed after 3 and 12 months. The mean surface area between flaps (n = 16) and full-thickness skin grafts (n = 14) differed statistically significantly at 3 months (123 percent versus 87 percent; p Scar Assessment Scale observer score and color), interposition flaps showed superior results compared with full-thickness skin grafts. Perforator-based interposition flaps result in a more effective scar contracture release than full-thickness skin grafts and should therefore be preferred over full-thickness skin grafts when possible. Therapeutic, I.

  4. Understanding emotion and emotional scarring in recurrent depression.

    Science.gov (United States)

    van Rijsbergen, Gerard D; Hollon, Steven D; Elgersma, Hermien J; Kok, Gemma D; Dekker, Jack; Schene, Aart H; Bockting, Claudi L H

    2015-05-01

    A single-item assessment of sad mood after remission from MDD is predictive of relapse, yet the mechanisms that play a role in depressive relapse remain poorly understood. In 283 patients, remitted from recurrent depression (DSM-IV-TR criteria; HAM-D17 score ≤ 10), we examined emotional scarring, that is, whether the number of previous depressive episodes was associated with higher levels of sad mood as assessed with a 1-item Visual Analogue Mood Scale (VAMS). We then fitted a cross-sectional multivariate regression model to predict sad mood levels, including the Dysfunctional Attitude Scale Version-A, cognitive reactivity (Leiden Index of Depression Sensitivity), Ruminative Response Scale, and Everyday Problem Checklist. Patients with greater numbers of prior episodes experienced higher levels of sad mood after remission. In multivariate regression, intensity of daily stress and dysfunctional beliefs were associated with the VAMS (Adj. R(2)=.091) although not over and above depressive symptomatology (Adj. R(2)=.114). Cognitive reactivity was not associated with sadness. Our finding that patients with more previous MDEs reported higher levels of sad mood while remitted could be indicative of emotional scarring. Dysfunctional beliefs and intensity of daily stress were associated with sad mood but not over and above residual symptoms. Thus, illness related characteristics especially are associated with sad mood after remission. More negative affect after remission could result in lower stress tolerance or more stress intensity could result in negative affect. Future studies should examine premorbid sadness in a longitudinal cohort, and should study the exact pathway from stress, affect, and cognition to relapse. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Compression therapy affects collagen type balance in hypertrophic scar.

    Science.gov (United States)

    Tejiram, Shawn; Zhang, Jenny; Travis, Taryn E; Carney, Bonnie C; Alkhalil, Abdulnaser; Moffatt, Lauren T; Johnson, Laura S; Shupp, Jeffrey W

    2016-04-01

    The effects of pressure on hypertrophic scar are poorly understood. Decreased extracellular matrix deposition is hypothesized to contribute to changes observed after pressure therapy. To examine this further, collagen composition was analyzed in a model of pressure therapy in hypertrophic scar. Hypertrophic scars created on red Duroc swine (n = 8) received pressure treatment (pressure device mounting and delivery at 30 mm Hg), sham treatment (device mounting and no delivery), or no treatment for 2 wk. Scars were assessed weekly and biopsied for histology, hydroxyproline quantification, and gene expression analysis. Transcription levels of collagen precursors COL1A2 and COL3A1 were quantified using reverse transcription-polymerase chain reaction. Masson trichrome was used for general collagen quantification, whereas immunofluorescence was used for collagen types I and III specific quantification. Total collagen quantification using hydroxyproline assay showed a 51.9% decrease after pressure initiation. Masson trichrome staining showed less collagen after 1 (P < 0.03) and 2 wk (P < 0.002) of pressure application compared with sham and untreated scars. Collagen 1A2 and 3A1 transcript decreased by 41.9- and 42.3-fold, respectively, compared with uninjured skin after pressure treatment, whereas a 2.3- and 1.3-fold increase was seen in untreated scars. This decrease was seen in immunofluorescence staining for collagen types I (P < 0.001) and III (P < 0.04) compared with pretreated levels. Pressure-treated scars also had lower levels of collagen I and III after pressure treatment (P < 0.05) compared with sham and untreated scars. These results demonstrate the modulation of collagen after pressure therapy and further characterize its role in scar formation and therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Therapeutic response of 70% trichloroacetic acid CROSS in atrophic acne scars.

    Science.gov (United States)

    Agarwal, Nidheesh; Gupta, Lalit K; Khare, Ashok Kumar; Kuldeep, C M; Mittal, Asit

    2015-05-01

    Acne scarring is a common sequela of acne for which no single treatment method is uniformly effective. The chemical reconstruction of skin scars (CROSS) therapy using high-concentration trichloroacetic acid (TCA) has shown promise as a cheap, safe, and effective modality of treatment in acne scars. To assess the therapeutic response of 70% TCA CROSS on atrophic acne scars and to evaluate the adverse effects of this therapy. Fifty-three patients with postacne atrophic scars were treated with 70% of TCA focal application every 2 weeks by the CROSS technique and results evaluated on 3 parameters: physician assessment, patient assessment, and satisfaction level of patients, after a follow-up of 3 months. Good or excellent improvement (>50%) was seen in 66% of patients on physician and patient assessments. The patients were either very satisfied or satisfied in 81.1% of cases. Patients with predominantly boxcar scars and higher pretreatment scar severity were associated with better treatment outcomes. Age, sex, duration of scars, or type of skin did not significantly influence the treatment outcome and adverse effects. The study showed that 70% of TCA is a safe and effective treatment option in all types of atrophic acne scars, especially in severe boxcar scars.

  7. Comparison of intralesional verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids

    Directory of Open Access Journals (Sweden)

    Margaret Shanthi F

    2008-01-01

    Full Text Available Background : The calcium channel blocker, verapamil stimulates procollagenase synthesis in keloids and hypertrophic scars. Aim : To study the effect of verapamil in the treatment of hypertrophic scars and keloids and to evaluate the effect of verapamil on the rate of reduction of hypertrophic scars and keloids in comparison with triamcinolone. Methods : The study was a randomized, single blind, parallel group study in which 54 patients were allocated to to receive either verapamil or triamcinolone. Drugs were administered intralesionally in both groups. Improvement of the scar was measured using modified Vancouver scale and by using a centimeter scale serially till the scar flattened. Results : There was a reduction in vascularity, pliability, height and width of the scar with both the drugs after 3 weeks of treatment. These changes were present at one year of follow-up after stopping treatment. Scar pigmentation was not changed desirably by either drug. Length of the scars was also not altered significantly by either drug. The rate of reduction in vascularity, pliability, height and width of the scar with triamcinolone was faster than with verapamil. Adverse drug reactions were more with triamcinolone than with verapamil. Conclusion : Intralesional verapamil may be a suitable alternative to triamcinolone in the treatment of hypertrophic scars and keloids.

  8. Comparison of Two Kinds of Lasers in the Treatment of Acne Scars.

    Science.gov (United States)

    Reinholz, Markus; Schwaiger, Hannah; Heppt, Markus V; Poetschke, J; Tietze, J; Epple, Andreas; Ruzicka, T; Kaudewitz, P; Gauglitz, Gerd G

    2015-10-01

    Acne scars are common and stigmatizing for the affected patients. Besides surgery, chemical peels, microdermabrasion, and microneedling, the treatment with fractional laser is a standard therapy. The results of reducing acne scars treated either with a fractional Er:YAG (erbium-doped yttrium-aluminum-garnet [Er:Y3Al5O1]) or a carbon dioxide (CO 2 ) laser at different wavelengths were compared and evaluated in the pilot study presented here. Fourteen patients with severe scars on both cheeks were treated four times in a random split-face approach: on one side with Er:YAG laser and on the contralateral side with CO2 laser following a standardized protocol. Therapeutic success was evaluated through the use of a high-resolution, 3D small-field capture system (PRIMOS), digital photography, and the Patient and Observer Scar Assessment Scale (POSAS) questionnaire. The evaluation was performed by a blinded investigator. Treatment results displayed a higher efficacy of the fractional CO2 laser compared with the Er:YAG laser as displayed by digital photographs. Additionally, objective (high-resolution, 3D small-field capture; PRIMOS) and subjective (POSAS) measuring results correlated positively in certain qualities (color, stiffness, thickness, surface, overall opinion). Using a novel scientific approach, we evaluated the therapeutic efficacy of different fractional lasers on acne scars using a rater-blinded approach. Compared with an Er:YAG laser, better skin smoothening was achieved by fractional CO2 laser treatment. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Comparison of four different lasers for acne scars: Resurfacing and fractional lasers.

    Science.gov (United States)

    You, Hi-Jin; Kim, Deok-Woo; Yoon, Eul-Sik; Park, Seung-Ha

    2016-04-01

    Acne scars are common and cause cosmetic problems. There is a multitude of treatment options for acne scars, including dermabrasion, chemical peeling, and fillers, but the advent of laser technology has greatly improved the treatment of acne scars. Although several laser systems are available, studies comparing their efficacy are limited. This study compares the results of treatments using resurfacing (carbon dioxide, CO2; erbium-doped yttrium aluminum garnet, Er:YAG) versus fractional (nonablative fractional laser, NAFL; ablative fractional laser, AFL) lasers. A retrospective photographic analysis of 58 patients who underwent laser treatment for facial atrophic acne scars was performed. Clinical improvement was assessed by six blinded investigators with a scale graded from 0 to 10. Adverse events were also noted. Mean improvement scores of the CO2, Er:YAG, NAFL, and AFL groups were 6.0, 5.8, 2.2, and 5.2, respectively. The NAFL group showed a significantly lower score than the other groups. The mean number of treatments was significantly greater in the fractional laser groups than in the resurfacing laser groups. The resurfacing laser groups had a prolonged recovery period and high risk of complications. The Er:YAG laser caused less erythema or pigmentation compared to the CO2 laser. Although the CO2 laser, Er:YAG laser, and AFL improved the acne scars, the CO2 laser had a greater downtime. Three consecutive AFL treatments are as effective as a single treatment with resurfacing lasers, with shorter social downtime periods and less adverse effects. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Treatment of acne scars by fractional bipolar radiofrequency energy.

    Science.gov (United States)

    Gold, Michael H; Biron, Julie A

    2012-08-01

    A variety of modalities are available for the treatment of acne scars. This prospective, IRB-approved study evaluates the efficacy and tolerance of fractional bipolar RF energy in the treatment of facial acne scars. Healthy subjects (n = 15, 13 females, aged 35.7 ± 5.6 years [mean ± SD], skin types I-V) with mild to moderate acne scars received three monthly treatments with a fractional bipolar RF device. Improvement and tolerance were evaluated at each visit, including a 1-month and 3-month follow-up visit. Ten subjects completed the study. Physician-assessed acne scar severity was significantly reduced at 1 month and 3 months. Adverse effects were limited to transient erythema. Dryness, bruising and crusting erosion were limited. Subject-assessed stinging/burning, stinging (alone), tingling, itching and burning were also limited and consistent with each treatment. Subject-assessed fine lines and wrinkles, brightness, tightness, acne scar texture, pigmentation were all improved significantly. Satisfaction was high in 67-92% of subjects. Fractional bipolar RF energy is a safe and effective modality for the treatment of acne scars.

  11. Prevalence and distribution of regional scar in dysfunctional myocardial segments in Duchenne muscular dystrophy

    Science.gov (United States)

    2011-01-01

    Background The segmental relationship between cardiovascular magnetic resonance (CMR) peak circumferential strain (Ecc) and myocardial scar has not been well characterized in Duchenne muscular dystrophy (DMD), and it is unknown whether echocardiography accurately measures Ecc in DMD. We assessed segmental Ecc and scar using CMR with myocardial tissue tagging and late gadolinium enhancement (LGE) in patients with DMD, then compared CMR with echocardiographic velocity vector imaging (VVI) for regional Ecc based on independent observer assessments. Results Participants enrolled (n = 16; age 8-23) had median left ventricular (LV) ejection fraction of 0.52 (range 0.28-0.69), and 156 basal and mid-cavity myocardial segments from the 13 patients completing the LGE protocol were analyzed for strain and scar. Segmental CMR Ecc in the most negative quartile (quartile 4) ruled out scar in that segment, but scar was present in 46% of segments in the least negative (most dysfunctional) Ecc quartile 1, 33% of Ecc quartile 2 segments, and 15% of Ecc quartile 3 segments. Overall scar prevalence in inferior, inferolateral, and anterolateral segments was eight times higher than in inferoseptal, anteroseptal, and anterior segments (p scar in lateral versus septal segments was consistent across CMR Ecc quartiles (quartile 1: 76% versus 11%, p = 0.001; quartile 2: 65% versus 9%, p scar by CMR in that segment highly unlikely, but the correlation in segmental Ecc between CMR and echo was limited (r = 0.27; p = 0.02). Conclusions The relationship between scar and Ecc in DMD is complex. Among myocardial segments with depressed Ecc, scar prevalence was much higher in inferior, inferolateral, and anterolateral segments, indicating a regionally dependent association between abnormal Ecc and scar, with free wall segments commonly developing dysfunction with scar and septal segments developing dysfunction without scar. Although normal echocardiographic Ecc predicted absence of scar, regional

  12. Tuberculin reaction and BCG scar

    DEFF Research Database (Denmark)

    Timmermann, Clara Amalie Gade; Biering-Sørensen, Sofie; Aaby, Peter

    2015-01-01

    rate ratio (MRR) comparing children with a BCG scar with those without was 0.42 (95% CI = 0.19; 0.93). There was a similar tendency for TST positivity: MRR = 0.47 (95% CI = 0.14; 1.54). For LBW children who had both a positive TST reaction and a scar, the MRR was 0.22 (95% CI = 0.05; 0.87). For NBW...

  13. Efficacy of IPL device combined with intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with regards to the recovery of skin barrier function: A pilot study.

    Science.gov (United States)

    Kim, Dong Young; Park, Hyun Sun; Yoon, Hyun-Sun; Cho, Soyun

    2015-10-01

    Keloids and hypertrophic scars are prevalent and psychologically distressful dermatologic conditions. Various treatment modalities have been tried but without complete success by any one method. We evaluated the efficacy of a combination of intense pulsed light (IPL) device and intralesional corticosteroid injection for the treatment of keloids and hypertrophic scars with respect to the recovery of skin barrier function. Totally 52 Korean patients were treated by the combined treatment at 4-8-week intervals. Using digital photographs, changes in scar appearance were assessed with modified Vancouver Scar Scale (MVSS), physicians' global assessment (PGA) and patient's satisfaction score. In 12 patients, the stratum corneum (SC) barrier function was assessed by measuring transepidermal water loss (TEWL) and SC capacitance. Most scars demonstrated significant clinical improvement in MVSS, PGA and patient's satisfaction score after the combined therapy. A significant decrease of TEWL and elevation of SC capacitance were also documented after the treatment. The combination therapy (IPL + corticosteroid injection) not only improves the appearance of keloids and hypertrophic scars but also increases the recovery level of skin hydration status in terms of the skin barrier function.

  14. Objective severity does not capture the impact of rosacea, acne scarring and photoaging in patients seeking laser therapy.

    Science.gov (United States)

    Thomas, C L; Kim, B; Lam, J; Richards, S; See, A; Kalouche, S; Paver, R D; Fernández Peñas, P

    2017-02-01

    Measures of quality of life (QOL) and patient satisfaction are of great importance in dermatology, as both impact upon treatment adherence and health outcomes. Patients' assessment of QOL often differs from their doctors' predictions and their assessments of skin disease severity do not correlate with patients' own perceptions. The development of laser technology has facilitated successful treatment of many skin conditions, but studies on patient satisfaction are lacking. Our aim was to determine the extent of discordance between patient and dermatologist-assessed disease severity and assess the impact of acne scarring, rosacea and photoaging on QOL. Our secondary aim was to assess patient satisfaction with laser therapy. A prospective study of patients undergoing laser treatment for acne scarring, rosacea and photoaging was conducted over 1 year at the Skin & Cancer Foundation Australia. Subjective disease severity was determined using a visual analogue scale (VAS). Two dermatologists determined objective severity using validated grading scales to score photographs. QOL impact was measured by Skindex-16, satisfaction was measured using an amended Comprehensive Satisfaction Questionnaire (PSQ-18). A total of 147 individuals sought laser therapy for acne scarring, rosacea and photoaging. Dermatologists' subjective disease severity correlated weakly with patient-reported severity. All conditions negatively impacted upon QOL. Patients with rosacea had the most symptomatic impact; acne scarring was associated with the greatest self-esteem and social functioning issues; photoaging patients were the least affected. There were significant correlations between subjective severity assessment and Skindex-16 scores. There was notable discordance between dermatologist's skin severity assessment and patient's self-reported QOL impact. Skin conditions can have a profound impact on patient QOL, which is affected by patients' perception of disease severity and not fully

  15. Scar Detection by Pulse-Cancellation Echocardiography: Validation by CMR in Patients With Recent STEMI.

    Science.gov (United States)

    Gaibazzi, Nicola; Bianconcini, Michele; Marziliano, Nicola; Parrini, Iris; Conte, Maria Rosa; Siniscalchi, Carmine; Faden, Giacomo; Faggiano, Pompilio; Pigazzani, Filippo; Grassi, Francesca; Albertini, Lisa

    2016-11-01

    This study sought to assess an echocardiographic approach (scar imaging echocardiography with ultrasound multipulse scheme [eSCAR]), based on existing multipulse ultrasound scheme, as a marker of myocardial scar in humans, compared with cardiac magnetic resonance assessing late gadolinium enhancement (CMR-LGE). The detection of myocardial scar impacts patient prognosis and management in coronary artery disease and other types of cardiac disease. The clinical experience with echocardiography suggests that the reflected ultrasound signal is often significantly enhanced in infarcted myocardial segments. Twenty patients with a recent ST-segment elevation myocardial infarction (STEMI) (cases) and 15 patients with absent CMR-LGE (negative controls) were imaged with both the eSCAR pulse-cancellation echocardiography and CMR-LGE to assess their potential association. Scar was detectable at CMR-LGE in 19 of 20 STEMI patients (91%), whereas all (100%) demonstrated eSCAR at echocardiography. In the 19 STEMI patients in whom CMR-LGE was detected, regional matching between eSCAR and CMR-LGE was total, although the segmental extent of detected scar was not always superimposable, particularly in the most apical segments, a region in which eSCAR demonstrated undersensitivity for the true extent of scar. A 2-dimensional multipulse echocardiography allows detection of myocardial scar, reliably matching the presence and site of CMR-LGE at 30 days after STEMI, or its absence in negative controls. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Implementation of functional assessment scales in geriatric practice

    DEFF Research Database (Denmark)

    Poulsen, Ingrid; Hesselbo, Bjørn; Pietersen, Inge

    2005-01-01

    A study was undertaken to evaluate the feasibility of functional assessment scales regarding completion rate and ability to document functional changes in geriatric rehabilitation patients.......A study was undertaken to evaluate the feasibility of functional assessment scales regarding completion rate and ability to document functional changes in geriatric rehabilitation patients....

  17. The successful treatment of pain associated with scar tissue using acupuncture.

    Science.gov (United States)

    Fang, Sheng

    2014-10-01

    In this case report, a 48-year-old female who had suffered severe scar pain for 3 months was treated with acupuncture using the Wei Ci technique (surrounding the dragon). Scar tissue usually forms after deep trauma, such as piercings, burns, and surgery, to the dermis. In Chinese Medicine, scar tissue causes local Qi and blood stagnation which lead to pain. The Wei Ci technique (surrounding the dragon) and distal points Hegu-LI-4, Taichong-LIV-3, Zusanli-ST-36 were used. The patient received a total of eight treatments in 5 weeks. The scar pain decreased from 7 to 1 or 2 on a Likert scale of 0-10, with 0 being no pain and 10 being the worst pain. Acupuncture may have a good short-term pain-relieving effect on scar pain but its long-term scar-pain-relieving effects are still unclear. Copyright © 2014. Published by Elsevier B.V.

  18. Interrupted or continuous-intradermal suturing? Statistical analysis of postoperative scars

    Directory of Open Access Journals (Sweden)

    Elif Sarı

    2014-12-01

    Full Text Available Background and Design: Postoperative scar development is an important problem for patients treated in plastic surgery clinics. Most patients think that continuous intradermal suturing is superior to interrupted suturing because they assume that it creates less scarring. We evaluated scars that form following intradermal and interrupted suturing. This article presents our controlled study that objectively compared the scars on patients' faces using a wound evaluation scale. Materials and Methods: Thirty-five patients, who had undergone operations on the bilateral cheeks, were included in this study. Thirty patients were female; five patients were male. Their mean age was 40.05 years. The average scar evaluation time after surgery was 9.05 months. Elliptical excisions were made on the lesions under local anesthesia. The incisions on the right cheeks were sutured with 6/0 monofilament nonabsorbable sutures using the continuous intradermal suturing technique. The left cheek incisions were sutured with same sutures using the interrupted suturing method. Results: The patients were evaluated 7–11 months after operation (mean: 9.05 months using the Stony Brook Scar Evaluation Scale. A Related Samples T-test was used for statistical evaluation of the differences between the suturing techniques. No significant differences were noted in scar formation between the two suturing methods (p>0.05. Conclusion: We found no differences in scar formation between the two frequently used suturing techniques studied here. We believe that the suturing technique is a less important determinant of scar formation than are other factors.

  19. Chemical reconstruction of skin scars therapy using 100% trichloroacetic acid in the treatment of atrophic facial post varicella scars: A pilot study

    Directory of Open Access Journals (Sweden)

    Nidheesh Agarwal

    2013-01-01

    Full Text Available Context: Chickenpox (varicella is a common viral disease caused by Varicella zoster virus. Facial atrophic scars after varicella infection are not uncommon and pose a cosmetic problem. Like atrophic scars of other aetiologies, they are a difficult condition to treat. There are not enough references in the literature regarding efficient treatment of post varicella scars. High strength Trichloroacetic acid (TCA, which is known to cause dermal collagen remodelling, was used to treat varicella scars in the present study. Aims: The study was undertaken to assess the efficiency of Chemical Reconstruction of Skin Scars (CROSS technique using 100% TCA in the treatment of atrophic facial post varicella scars. Settings and Design: Open label, pilot study. Materials and Methods: A total of 16 patients with atrophic facial post varicella scars were treated by focal application of 100% TCA solution by pressing down upon the scar surface by a toothpick (CROSS technique. Total 4 sittings were given at 2 weekly intervals and the results evaluated after 3 months of follow-up. Statistical analysis was carried out using Fischer′s exact t-test. Results: All of the 13 patients who completed the study showed good clinical improvement, with 69% patients grading the response as excellent (>75% improvement, whereas the rest 31% patients reporting good (51-75% improvement. No significant complications were seen in any patient. Conclusions: CROSS technique using 100% TCA is a safe, cheap and effective therapy for the treatment of post varicella scars.

  20. Fractional ablative CO2 laser treatment versus scar subcision and autologous fat transfer in the treatment of atrophic acne scars: New technique

    Directory of Open Access Journals (Sweden)

    Laila Mohammad

    2016-04-01

    Full Text Available There are different modalities for management of atrophic acne scars which include lasers. Ablative fractional CO2 laser was developed to address the shortcomings of traditional ablative lasers, with superior results to non-ablative fractional lasers. Autologous fat transfer has been utilized for nearly a decade in tissue augmentation and reconstruction.Present studies were designed to compare ablative fractional CO2 laser treatment with scar subcision and autologous fat transfer in the treatment of atrophic acne scars. 20 patients with atrophic acne scars were recruited: 10 patients were treated by three sessions of ablative fractional CO2 laser therapy, and 10 patients treated by subcision and autologous fat transfer. All patients were followed up for three months, and were assessed by digital photograph before and after treatment through the application of Goodman and Baron quantitative and qualitative grading systems, in addition to reports by three physicians committees and reports of patients’ satisfaction. Analysis of both groups showed significant improvements in all types of atrophic acne scars. The mean percentage of total quantitative improvement was more significant in the case of autologous fat transfer with regard to ice-pick and total number of scars. Therefore, scar subcision with autologous fat transfer proved to be as effective as, or even more effective than, ablative fractional CO2 laser in the treatment of atrophic acne scars with regard to the total number of scars as well as ice-pick type.

  1. Flood risk assessments at different spatial scales

    NARCIS (Netherlands)

    de Moel, H.; Jongman, B.; Kreibich, H.; Merz, B.; Penning-Rowsell, E; Ward, P.J.

    2015-01-01

    Managing flood risk, i.e. both the hazard and the potential consequences, is an important aspect of adapting to global change and has gained much traction in recent decades. As a result, a priori flood risk assessments have become an important part of flood management practices. Many methodologies

  2. New diagnostic criteria and operative strategy for cesarean scar syndrome: Endoscopic repair for secondary infertility caused by cesarean scar defect.

    Science.gov (United States)

    Tanimura, Satoshi; Funamoto, Hiroshi; Hosono, Takashi; Shitano, Yasushi; Nakashima, Masao; Ametani, Yuka; Nakano, Takashi

    2015-09-01

    The aim of the present study was to assess the efficacy of endoscopic repair for secondary infertility caused by post-cesarean scar defect (PCSD). Our investigation focused on the validity of new diagnostic criteria and selection methods. The subjects were 22 women with secondary infertility due to PCSD with retention of bloody fluid in the uterine cavity. Women with a residual myometrial thickness of ≥ 2.5 mm and an anteflexed or straight uterus underwent hysteroscopic surgery, while all others underwent laparoscopic repair. Hysteroscopic surgery involved resection and coagulation of scarred areas, whereas laparoscopic surgery involved removal of scarred areas combined with hysteroscopy, followed by resuturing. Fourteen of the 22 women (63.6%) who were followed up for ≥ 1 year after surgery achieved pregnancy. Pregnancies occurred in all four women (100%) who underwent hysteroscopic surgery and in 10 of the 18 women (55.6%) who underwent laparoscopic surgery. Three out of four women who underwent hysteroscopic surgery had term deliveries. Among the women who underwent laparoscopic surgery, five had term deliveries. No cases of uterine rupture were experienced, and the delivery method was cesarean section in all cases. We propose that infertility associated with PCSD, cesarean scar syndrome, is caused by the retention of bloody fluid in the uterine cavity and scarring. Endoscopic treatment, such as hysteroscopy or laparoscopy, was effective for cesarean scar syndrome. © 2015 Japan Society of Obstetrics and Gynecology.

  3. Fillers for the improvement in acne scars

    Directory of Open Access Journals (Sweden)

    Wollina U

    2015-09-01

    Full Text Available Uwe Wollina,1 Alberto Goldman2 1Department of Dermatology and Allergology, Academic Teaching Hospital, Dresden-Friedrichstadt, Dresden, Germany; 2Clinica Goldman, Porto Alegre, Rio Grande do Sul, Brazil Abstract: Acne is a common inflammatory disease. Scarring is an unwanted end point of acne. Both atrophic and hypertrophic scar types occur. Soft-tissue augmentation aims to improve atrophic scars. In this review, we will focus on the use of dermal fillers for acne scar improvement. Therefore, various filler types are characterized, and available data on their use in acne scar improvement are analyzed. Keywords: acne, scars, dermal fillers, injection, extracellular matrix

  4. An empirical assessment of the SERVQUAL scale

    Directory of Open Access Journals (Sweden)

    Mahla Zargar

    2015-11-01

    Full Text Available During the past few years, many people have used point of sales for purchasing goods and services. Point of sales tends to provide a reliable method for making purchases in stores. Implementation of point of sales may reduce depreciation cost of automated telling machines and helps banks increase their productivities. Therefore, for bank managers, it is important to provide high quality services. This paper presents an empirical investigation to measure quality service using SERVQUAL scale. The study first extracts six factors including Trust, Responsiveness, Reliability, Empathy, Tangibles and getting insight for future development through the implementation of structural equation modeling. Next, it has implemented structural equation modeling and realizes that all components had positive impacts on customer satisfaction.

  5. Rare complications of cesarean scar

    Directory of Open Access Journals (Sweden)

    Divyesh Mahajan

    2013-01-01

    Full Text Available Cesarean scar pregnancy (CSP and cesarean scar dehiscence (CSD are the most dreaded complications of cesarean scar (CS. As the incidence of CS is increasing worldwide, so is the incidence of CSP, especially in cases with assisted reproduction techniques. It is of utmost importance to diagnose CSP in the early first trimester, as it can lead to myometrial rupture with fatal outcome. On the other hand, CSD may be encountered during pregnancy or in the postpartum period. CSD in the postpartum period is very rare and can cause secondary postpartum hemorrhage (PPH leading to increased maternal morbidity or even death if not diagnosed and managed promptly. Both complications can be diagnosed on ultrasonography (USG and confirmed on magnetic resonance imaging (MRI. These two conditions carry high morbidity and mortality. In this article, we highlight the role of imaging in the early diagnosis and management of these conditions.

  6. Topical Silicone Sheet Application in the Treatment of Hypertrophic Scar/span>s and Keloids

    Science.gov (United States)

    Westra, Iris; Pham, Hth

    2016-01-01

    Objective: Since the early 1980s, topical silicone sheets have been used in the treatment of hypertrophic scar/span>s and keloids.This study aimed to determine the optimal duration and application of these sheets. Design: multi-centered therapeutic study. Setting and participants: A total of 224 patients were included in this study; 205 patients with hypertrophic scar/span>s and 19 patients with keloids. Patients received treatment with a topical silicone sheet. Treated scars varied in age, ranging from two weeks to 62 years and treatment time ranged from one month to 16 months. Assessment of the scars was performed by the use of standardized study forms and digital photography. Measurements: Skin therapists objectively assessed the scars on its color, thickness, and elasticity. Patients themselves subjectively assessed their perception of their scar and their experience with the usage of the topical silicone sheet. Results: After applying the topical silicone sheet, all scars, regardless of type of scar and maturity, improved significantly in color, thickness, and elasticity. Conclusion: In this study, treatment with the topical silicone sheet showed significant improvement on both hypertrophic scar/span>s and keloids. Best results were reached when the silicone sheet was applied at least four hours per day. PMID:27847546

  7. Integrated Cooling-Vacuum-Assisted Non-Fractional 1540 nm Erbium:Glass Laser is Effective in Treating Acne Scars.

    Science.gov (United States)

    Politi, Yael; Levi, Assi; Lapidoth, Moshe

    2016-11-01

    Acne scars are a common result of in ammatory acne, affecting many patients worldwide. Among which, atrophic scars are the most prevalent form, presenting as dermal depressions caused by inflammatory degeneration of dermal collagen. Mid-infrared laser skin interaction is characterized by its modest absorption in water and nite penetration to the mid-dermis. Since collagen is a desirable laser target, 1540-nm wavelength is amenable for collagen remodeling within the depressed area of atrophic scars. To evaluate the safety and efficacy of acne scars treatment using an integrated cooling-vacuum-assisted 1540 nm Erbium: Glass Laser. This interventional prospective study included 25 volunteers (10 men, 15 women) with post acne atrophic scars. Patients were treated with a mid-infrared non-fractional 1540 nm Er:Glass laser (Alma Lasers Ltd. Caesarea, Israel) with integrat- ed cooling- vacuum assisted technology. Acne scars were exposed to 3 stacked laser pulses (400-600 mJ/pulse, 4 mm spot size, frequency of 3 Hz). Patients underwent 3-6 treatment sessions with a 2-3 week interval and were followed-up 1 month and 3 months after the last treatment. Clinical photographs were taken by high resolution digital camera before and after treatment. Clinical evaluation was performed by two independent dermatologists and results were graded on a scale of 0 (exacerbation) to 4 (76%-100% improvement). Patients' and physicians' satisfaction were also recorded (on a 1-5 scale). Pain perception and adverse effects were evaluated as well. Almost all patients (24/25) demonstrated a moderate to significant improvement. Average improvement was 3.9 and 4.1 points on the quartile scale used for outcome assessment 1 and 3 months following the last session, respectively. Patient satisfaction rate was 4.2. Side effects were minimal and transient: erythema, mild transient vesicles, and mild pain or inconvenience. CONCLUSION Cooling-Vacuum-Assisted mid-infrared non-fractional Er:Glass 1540 nm laser

  8. Ruptured Cesarean Scar Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Sujatha BS

    2017-07-01

    Full Text Available A pregnancy with implantation on the scar of a past cesarean section is uncommon. However such pregnancies are on the rise due to the increasing number of lower segment cesarean section. One of the complications of such a pregnancy is uterine rupture in early pregnancy which can be life threatening to the patient. The following is a report of a patient who presented at 10 weeks of gestational age with features of hypovolemic shock and lower position of the gestational sac in relation to the uterus with normal fetal heart rate. The diagnosis of ruptured cesarean scar pregnancy was made only after laparotomy.

  9. Pulsed dye laser versus long-pulsed Nd:YAG laser in the treatment of hypertrophic scars and keloid: A comparative randomized split-scar trial.

    Science.gov (United States)

    Al-Mohamady, Abd El-Shakour Abd El-Hafiz; Ibrahim, Shady Mahmoud Attia; Muhammad, Muhammad Mohsen

    2016-08-01

    Keloids and hypertrophic scars are benign fibrous growths that occur after trauma or wounding of the skin and present a major therapeutic problem. The purpose of this study is to evaluate and compare the effectiveness of pulsed dye laser (PDL) versus Nd:YAG laser in hypertrophic scar and keloid. Twenty patients with hypertrophic scars and keloid were included in this prospective, randomized, split-scar study. Half of each scar was randomized to treatment with a 595-nm PDL and the contralateral half with the 1064-nm Nd:YAG. Each patient received 6 laser treatment sessions at 1-month intervals. The scars were evaluated at baseline and one month after the last laser session using the Vancouver scar scale (VSS). One month after the last laser treatment, final total VSS analysis of treated sites by PDL and long-pulsed Nd:YAG laser revealed significant improvements (p treatments for keloid and hypertrophic scar provide significant improvement with insignificant difference between both modalities.

  10. Cutaneous leiomyosarcoma arising in a smallpox scar

    National Research Council Canada - National Science Library

    Pol, Robert A; Dannenberg, Hilde; Robertus, Jan-Lukas; van Ginkel, Robert J

    2012-01-01

    ...% of all superficial soft tissue sarcomas. Although the development of various malignancies in scar tissue is well known, we report the first case of a CLM developing in a small pox scar. Case presentation...

  11. Identification of factors predicting scar outcome after burn in adults: A prospective case-control study.

    Science.gov (United States)

    Wallace, Hilary J; Fear, Mark W; Crowe, Margaret M; Martin, Lisa J; Wood, Fiona M

    2017-09-01

    This study examined influences on scarring after burn in a prospective study using a defined outcome measure: scar height measured by a modified Vancouver Scar Scale (mVSS). A prospective case-control study was conducted among 616 adult subjects who sustained a burn in Western Australia. Patient factors influencing scar outcome including gender, Fitzpatrick skin type and selected co-morbidities were explored, as well as injury and clinical factors. A logistic regression model for raised scar after burn was developed which achieved an overall correct prediction rate of 81.1%; 74.8% for those with raised scar and 86.0% for those without raised scar. From this study, injury and clinical predictors for raised scar after adjustment for other variables are: increasing %TBSA, greater burn depth as indicated by level of surgical intervention, wound complications and prolonged hospital stay. Intrinsic patient predictors for raised scar in patients with comparable injuries are: young age (≤30 years), female gender and Fitzpatrick skin types 4-6. The strength of association statistics (odds ratios and 95% confidence intervals) reported will be of practical benefit for clinical decision-making and counselling of patients, and plausible biological explanations for the findings support the validity of the results. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  12. Regional scale ecological risk assessment: using the relative risk model

    National Research Council Canada - National Science Library

    Landis, Wayne G

    2005-01-01

    ...) in the performance of regional-scale ecological risk assessments. The initial chapters present the methodology and the critical nature of the interaction between risk assessors and decision makers...

  13. Reliability of the 7-point subjective global assessment scale in assessing nutritional status of dialysis patients

    NARCIS (Netherlands)

    Visser, R.; Dekker, F. W.; Boeschoten, E. W.; Stevens, P.; Krediet, R. T.

    1999-01-01

    Subjective global assessment (SGA) is a method to score nutritional status in a standardized way. The original 3-point scale has been replaced by a 7-point scale. The reliability of the latter scale has never been tested. We therefore assessed inter-observer and intra-observer reliability.

  14. Acne Scars: Pathogenesis, Classification and Treatment

    OpenAIRE

    Fabbrocini, Gabriella; Annunziata, M. C.; D'Arco, V.; De Vita, V.; Lodi, G.; Mauriello, M. C.; Pastore, F.; Monfrecola, G.

    2010-01-01

    Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%–14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but seve...

  15. Soft tissue trauma and scar revision.

    Science.gov (United States)

    Mobley, Steven R; Sjogren, Phayvanh P

    2014-11-01

    Numerous techniques and treatments have been described for scar revision, with most studies focusing on the adult population. A comprehensive review of the literature reveals a paucity of references related specifically to scar revision in children. This review describes the available modalities in pediatric facial scar revision. The authors have integrated current practices in soft tissue trauma and scar revision, including closure techniques and materials, topical therapy, steroid injection, cutaneous laser therapy, and tissue expanders. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Fillers for the improvement in acne scars

    OpenAIRE

    Wollina U; Goldman A

    2015-01-01

    Uwe Wollina,1 Alberto Goldman2 1Department of Dermatology and Allergology, Academic Teaching Hospital, Dresden-Friedrichstadt, Dresden, Germany; 2Clinica Goldman, Porto Alegre, Rio Grande do Sul, Brazil Abstract: Acne is a common inflammatory disease. Scarring is an unwanted end point of acne. Both atrophic and hypertrophic scar types occur. Soft-tissue augmentation aims to improve atrophic scars. In this review, we will focus on the use of dermal fillers for acne scar improvement. Therefore...

  17. Endometriosis in an episiotomy scar

    Directory of Open Access Journals (Sweden)

    Mine islimye Taskin

    2016-03-01

    Full Text Available Endometriosis that is defined as the presence of functional endometrial tissue outside the uterine cavity is seen 5-10% of reproductive age women. Endometriosis can be seen any other site of the body; but the most frequently affected areas are ovaries, pelvic peritoneum, uterosacral ligament and Douglas pouche. Several teories exist for the development of endometriosis including retrograde menstruation, venous or lymphatic metastasis and immun dysfunction. Endometriosis of the perineum and vulva are extremely rare with the most common sites being episiotomy scars. Scar endometriosis is likely to be caused by mechanical transplantation of endometrium from the uterine cavity into the wound at the time of the surgery. The primary treatment for scar endometriosis is total surgical excision of the lesion. It is important not to leave residual tissue during surgery to prevent the recurrence. Here we present a patient who had her vaginal delivery 5 years ago, have a complaint of painful vulvar lump at the right mediolateral episiotomy scar since 1 year during her every menstruation period and whose final diagnosis was endometriosis after surgical removal and histopathologic examination. Althought vulvar endometrosis is rare, it should be considered in the patients who had a vaginal delivery and complaining painful vulvar lump with swelling in her mestrual cycle. [Cukurova Med J 2016; 41(1.000: 164-166

  18. The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin.

    Science.gov (United States)

    Park, Jae Yang; Lee, Eo Gin; Yoon, Moon Soo; Lee, Hee Jung

    2016-06-01

    Microneedle fractional radiofrequency has been reported to be effective for improving wrinkles, enlarged pores and various scars. Sublative fractional radiofrequency has been shown to induce both fractional ablation of epidermis and upper dermal remodelling, which had rejuvenation effects in photoaged skin. Both modalities may have the potential synergy to improve acne scars. To evaluate the efficacy and safety of combined microneedle and sublative fractional radiofrequency for acne scars in Asian skin. Twenty subjects comprised 11 males and 9 females (mean age 23.65 ± 2.94, skin phototype III-IV) with moderate to severe acne scars. The subjects received three consecutive combined microneedle and sublative fractional radiofrequency at 4-week intervals over 12 weeks. Both blinded dermatologists and subjects assessed the clinical improvement based on the standardized photography and questionnaires, respectively. The quartile grading scale was utilized and defined as follows: grade 1, 0-25% improvement; grade 2, 26-50% improvement; grade 3, 51-75% improvement and grade 4, 76-100% improvement. All 20 subjects were assessed to have grade 2 or more clinical improvement by physicians; four (20%) had grade 4, 10 (50%) had grade 3, and six (30%) had grade 2 improvement. The subjects' grading also showed a good concordance as indicated by Kappa index of 0.695. The mean duration of post-therapy crusting was 5.2 days and post-therapy erythema lasted 2.5 days. Combined microneedle and sublative fractional radiofrequency can have a positive therapeutic effect with no serious complications and may provide a new therapeutic approach on acne scars in Asians. © 2015 Wiley Periodicals, Inc.

  19. [Labour in women with scarred uterus in the Democratic Republic of the Congo: trial of scar and factors influencing the outcome].

    Science.gov (United States)

    Momat, Félix Kitenge Wa; Zalagile, Pierre Akilimali; Mukalenge, Faustin Chenge; Luboya, Oscar Numbi; Kalala, Cléophas Tshibangu; Mashinda, Désiré; Grangé, Gilles; Mukuku, Olivier; Kaj, Fanny Malonga; Lubamba, Chamy Cham; Bwama, Joseph Bagambe; Mukoko, Célestin Kayembe; Kakoma, Jean Baptiste; Kalungwe, Justin Kizonde

    2017-01-01

    Our study aims to identify risks factors associated with failed trial of scar and to set a predictive score of labour in women with scarred uterus in the Democratic Republic of the Congo. We conducted a multicenter cross-sectional analytic study of patients with scarred uterus in four maternity units in the Democratic Republic of the Congo (DRC) from 1 January to 31 December 2013. Logistic regression model was used to identify factors associated with failed trial of scar. We set a predictive score based on this model in order to predict trial of scar failure in maternity units in the DRC. ROC curve was used to assess the ability of the set score to identify patients at risk for trial of scar failure. The cut off point for the predictive score was determined on the basis of the Youden-index-based optimal sensitivity and specificity. All the tests in our study were carried out by using a significance threshold of α=0.05. Two explanatory factors in trial of scar failure were retained. They were the socio-demographic factor (maternal age) and three obstetric factors (fundal height, fetal presentation and premature rupture of membranes). Predictive score was set to predict trial of scar failure. This score was determined based on four elements: maternal age, evaluation of the gestational sac on admission, fundal height and fetal presentation. The minimum score was set at 4 and the maximum score was set at 16. The threshold value was set at 7. A total score greater than or equal to 7 reflects a risk of trial of scar failure. We set a predictive score to predict trial of scar failure. This score was determined based on four elements: maternal age, evaluation of the gestational sac on admission, fundal height and fetal presentation. A total score greater than or equal to 7 reflects a risk of trial of scar failure.

  20. A photonumeric scale for the assessment of atrophic facial photodamage.

    Science.gov (United States)

    Ayer, J; Ahmed, A; Duncan-Parry, E; Beck, P; Griffiths, T W; Watson, R E B; Griffiths, C E M

    2018-01-15

    Photonumeric scales have consistently shown superiority over descriptive equivalents. They have the advantage of providing a consistent visual frame of reference by minimising variability in perception and subjectivity. A photonumeric scale to assess hypertrophic facial photodamage already exists. However, there is currently no objective measure for atrophic facial photodamage. To address this, we have devised a nine-point photonumeric standardised scale. To design, test and validate a photonumeric scale for the assessment of atrophic facial photodamage against a descriptive scale for the same indication. A pool of 393 facial photographs (en face and 45º oblique) from 131 individuals with atrophic facial photodamage was created. Five photographic standards were selected and assigned grades 0 through 8, where 0 is no photodamage and 8 is severe atrophic photodamage, thus making a nine-point scale. Twenty photographs spanning the entire range of values were selected to test the scale. Testing was performed alongside a descriptive equivalent. A panel of 10 dermatologists, 10 non-dermatology clinicians and 14 dermatology scientists marked the two scales; marking was repeated one week later. There was a significantly greater agreement between the graders using the photonumeric scale than the descriptive scale (kappa values 0.71 and 0.37 with standardised errors of 0.57 and 0.17 respectively) with no significant difference in repeatability between the two methods (p copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  1. Descendants of Hardship: Prevalence, Drivers and Scarring Effects of Social Exclusion in Childhood

    Directory of Open Access Journals (Sweden)

    J. Cok Vrooman

    2015-07-01

    Full Text Available The social exclusion of children is problematic for two reasons. Young people typically inherit their marginal position from their family, and therefore cannot be held responsible for their hardship themselves; and social exclusion in childhood may affect their wellbeing and subsequent development, possibly leading to a “scarring effect” in later life. In this contribution we develop an instrument for measuring social exclusion among children. Social exclusion is regarded as a theoretical construct with four sub-dimensions: material deprivation, limited social participation, inadequate access to social rights, and a lack of normative integration. First we analyse data from a survey of 2,200 Dutch children, which contains a large set of social exclusion items. We applied nonlinear principal components analysis in order to construct a multidimensional scale. Measured in this way, the prevalence of social exclusion among children is 4.5%. Boys and children living in large families are more likely to experience social exclusion than girls and children with few siblings. The parental level of education and dependency on social security benefits are also important driving factors of childhood social exclusion. Subsequently we investigate the scarring effect. Longitudinal administrative income and household data covering 25 years were combined with a new survey of just under 1,000 Dutch adults, a third of whom were poor as a child. The survey assessed their past and current degree of social exclusion, and their health and psychosocial development, educational career, past family circumstances, etc. In an absolute sense scarring turns out to have been limited during this period: a very large majority of those who were poor or excluded as a child are above the threshold values in adult life. However, the “descendants of hardship” are still more likely to be socially excluded as adults than people who grew up in more favourable conditions. A

  2. Evaluation of microneedling fractional radiofrequency device for treatment of acne scars

    Directory of Open Access Journals (Sweden)

    Byalekere Shivanna Chandrashekar

    2014-01-01

    Full Text Available Background: Various treatment modalities including non-invasive methods such as chemical peels, topical retinoids, microdermabrasion, minimally invasive techniques such as microneedling, fractional lasers, microneedling radiofrequency devices and invasive procedures such as acne scar surgeries and ablative lasers are used for acne scars, each with its own unique advantages and disadvantages. This study is a retrospective assessment of efficacy and safety of microneedling fractional radiofrequency in the treatment of acne scars. Methods: Thirty one patients of skin types III-V with moderate and severe facial acne scarring received four sequential fractional radiofrequency treatments over a period of 6 months with an interval of 6 weeks between each session. Goodman & Baron′s acne scar grading system was used for assessment by a side by side comparison of preoperative and post- operative photographs taken at their first visit and at the end of 3 months after the last session. Results: Estimation of improvement with Goodman and Baron′s Global Acne Scarring System showed that by qualitative assessment of 31 patients with grade 3 and grade 4 acne scars, 80.64% showed improvement by 2 grades and 19.35% showed improvement by 1 grade. Quantitative assessment showed that 58% of the patients had moderate, 29% had minimal, 9% had good and 3% showed very good improvement. Adverse effects were limited to transient pain, erythema, edema and hyperpigmentation. Conclusion: Microneedling fractional radiofrequency is efficacious for the treatment of moderate and severe acne scars.

  3. The efficacy and safety of subcision using CO2 gas combined with fractional laser for acne scars: Clinical and microscopic evaluation.

    Science.gov (United States)

    Lee, Sang Jun; Suh, Dong Hye; Chang, Ka Yeon; Kim, Hyun Joo; Kim, Tae In; Jeong, Ki-Heon; Shin, Min Kyung; Song, Kye Yong

    2016-11-01

    Various modalities have been used to treat acne scars. CO2 fractional laser is an effective and commonly used treatment. CO2 gas injection into the dermis by needle with high pressure can cause fibrotic collagen breakage, producing the effects of subcision. CO2 also stimulates collagen synthesis by increasing neovascularization and releasing oxygen. This study evaluated the efficacy and the safety of the combined treatment with CO2 gas subcision and CO2 fractional laser for acne scars. Fourteen patients with acne scars were treated with three sessions of CO2 gas subcision at 2-week intervals and two sessions of fractional laser at 4-week interval. The clinical improvement was assessed using a 4-point scale. For histologic analysis, punch biopsy was performed before and after treatment in 10 patients. All patients experienced clinical improvements. Excellent, marked, moderate, and mild response was achieved in 1 (7%), 8 (57%), 4 (29%), and 1 patient (7%), respectively. Histologic evaluation of the biopsy specimens showed increased dermal collagen with dermal thickening and elastic fiber straightening in the reticular dermis after the treatment. The combination therapy with CO2 gas subcision and fractional laser was satisfactory and safe for treating acne scars. Abbreviation and acronym: CO2: Carbon dioxide GAS: Global assessment scale H&E: hematoxylin and eosin; SD: standard deviation.

  4. Effective treatment of acne scars using pneumatic injection of hyaluronic acid.

    Science.gov (United States)

    Patel, Tapan; Tevet, Oren

    2015-01-01

    Acne scars remain a challenging condition to treat despite multiple currently available technologies. This study evaluated the clinical efficacy and safety of pneumatic injections of Hyaluronic Acid in the treatment of acne scars. Two patients (Fitzpatrick skin type IV-V) with acne scars received two sessions of pneumatic, needleless injections of crosslinked hyaluronic acid (HA) at 4-week intervals. The treatment response was assessed by comparing pre- and 3-month posttreatment clinical photography. The patients' acne scar grade improved from 2 to 1 in the first case, and 3 to 2 in the second case, based on independent physician assessment. Patient degree of satisfaction was similar to the physicians' assessment. No significant adverse events were noted. We conclude that pneumatic injection technology to deliver HA to the tissue is an effective and safe method for improving acne scars, even in patients with dark complexion.

  5. Mitigation of abdominal scars during MR-guided focused ultrasound treatment of uterine leiomyomas with the use of an energy-blocking scar patch.

    Science.gov (United States)

    Yoon, Sang-Wook; Seong, Seok Ju; Jung, Sang-Geun; Lee, Sun Young; Jun, Hye Sun; Lee, Jong Tae

    2011-12-01

    To assess the clinical potential of using an energy-blocking scar patch for magnetic resonance-guided focused ultrasound (MRgFUS) treatment of uterine leiomyomas in patients with abdominal scars. A prospective, nonrandomized, single-arm study was conducted in 20 patients (mean age, 41.1 y; range, 33-51 y) with symptomatic leiomyomas (mean volume, 170 cm(3); range, 10-689 cm(3)) and abdominal scars (mean width, 3.3 mm; range, 1.5-8 mm; mean length, 131.6 mm; range, 86-178 mm) who underwent MRgFUS with an isolating patch covering the scar. Scar patches composed of US-blocking material were placed on patients' skin to cover the scar before treatment. Immediately after each treatment, contrast-enhanced T1-weighted MR images were acquired, and the nonperfused volume (NPV) ratio was measured to determine the technical success of the treatment. Patients were followed for 3 months after treatment for any procedure-related adverse events. All treatments were completed with no technical problems. No serious adverse events were reported during treatments and during 3 months of follow-up. The mean NPV ratio was 53.5% ± 21%. The scar patch provides an effective treatment option for patients with uterine leiomyomas and scars in the beam path, who were previously excluded from MRgFUS treatment as a result of an increased risk of skin burns. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  6. Assistance to assessing rating students by language tuple- 4 scale

    Directory of Open Access Journals (Sweden)

    Le Ngoc Hung

    2016-03-01

    Full Text Available In this paper, we introduce an assistance to assessing rating the annual learning and process training of students in the opinion of experts, the approach of hedge algebra. It is advisary to make optimally fuzzy parameters with neural network in order to scale tuple-4 in accordance with current regulations on student assessment annual ranking including 7 levels.

  7. Leaded Paint in Cambodia—Pilot-scale Assessment

    Directory of Open Access Journals (Sweden)

    Sereyrath Lim

    2015-01-01

    Conclusion. Based on our pilot-scale assessment, high levels of lead appear to be common in enamel paints in Cambodia, and a fuller assessment of the situation is warranted. Import and production of such toxic products should be avoided and appropriate labeling and public warnings should be provided.

  8. Relationship Between Scarring and Dog Aggression in Pit Bull-Type Dogs Involved in Organized Dogfighting

    Directory of Open Access Journals (Sweden)

    Katherine A. Miller

    2016-11-01

    Full Text Available When pit bull-type dogs are seized in an investigation of organized dogfighting, heavily scarred dogs are often assumed to be highly dog aggressive due to a history of fighting. These dogs may be deemed dangerous and euthanized based on scarring alone. We analyzed our existing data on dogs seized from four dogfighting investigations, examining the relationship between the dogs’ scars with aggression towards other dogs. Scar and wound data were tallied in three body zones where dogfighting injuries tend to be concentrated. Dog aggression was assessed using a model dog and a friendly stimulus dog in a standardized behavior evaluation. Scarring and dog aggression were significantly related, more strongly among male (Fisher’s Exact p < 0.001 than female dogs (Fisher’s Exact p = 0.05. Ten or more scars in the three body zones was a reasonable threshold with which to classify a dog as high risk for dog aggression: 82% of males and 60% of females with such scarring displayed dog aggression. However, because many unscarred dogs were dog aggressive while some highly scarred dogs were not, we recommend collecting behavioral information to supplement scar counts when making disposition decisions about dogs seized in dogfighting investigations.

  9. Relationship Between Scarring and Dog Aggression in Pit Bull-Type Dogs Involved in Organized Dogfighting.

    Science.gov (United States)

    Miller, Katherine A; Touroo, Rachel; Spain, C Victor; Jones, Kelly; Reid, Pamela; Lockwood, Randall

    2016-11-15

    When pit bull-type dogs are seized in an investigation of organized dogfighting, heavily scarred dogs are often assumed to be highly dog aggressive due to a history of fighting. These dogs may be deemed dangerous and euthanized based on scarring alone. We analyzed our existing data on dogs seized from four dogfighting investigations, examining the relationship between the dogs' scars with aggression towards other dogs. Scar and wound data were tallied in three body zones where dogfighting injuries tend to be concentrated. Dog aggression was assessed using a model dog and a friendly stimulus dog in a standardized behavior evaluation. Scarring and dog aggression were significantly related, more strongly among male (Fisher's Exact p < 0.001) than female dogs (Fisher's Exact p = 0.05). Ten or more scars in the three body zones was a reasonable threshold with which to classify a dog as high risk for dog aggression: 82% of males and 60% of females with such scarring displayed dog aggression. However, because many unscarred dogs were dog aggressive while some highly scarred dogs were not, we recommend collecting behavioral information to supplement scar counts when making disposition decisions about dogs seized in dogfighting investigations.

  10. Autologus bone marrow stem cells in atrophic acne scars: A pilot study.

    Science.gov (United States)

    Ibrahim, Zeinab A; Eltatawy, Rania A; Ghaly, Nahla R; Abd El-Naby, Naeim M; Abou El Fetouh, Heba M; Abd Elateef, Amal E; Abdou, Said; Tahaa, Ateef; El Afandy, Mohamed

    2015-06-01

    Acne scar is a very distressing and difficult problem for physicians and patients. Management of cutaneous scarring from acne can be challenging and confusing. The available modalities may be effective, having considerable morbidity and long downtime. Besides, they may not have the same efficacy in different skin types or acne scar types. To evaluate the short-term safety and efficacy of autologous bone marrow (BM) stem cells (SCs) in treating atrophic acne scars. Fourteen patients with moderate to severe atrophic acne scars were included. All patients were subjected to single session of autologous BMSCs therapy. Each patient received 5 μg/kg/day granulocyte colony-stimulating factor (G-CSF) as a single subcutaneous dose for 2 successive days before BM aspiration. The SC-containing solution was injected under each scar intradermally. The scars of the patients were clinically assessed both qualitatively and quantitatively before and after 6 months. The patients were given a preformed questionnaire Cardiff acne disability index (CADI) before and after treatment. After 6 months of the injection, there was significant improvement in the qualitative grading, quantitative grading and CADI scores. All types of scars showed significant improvement. No significant adverse effects were reported in any patient. Autologous BMSCs seem to be a safe and effective treatment option for the management of all types of atrophic facial acne scars.

  11. Do pressure ulcer risk assessment scales improve clinical practice?

    Directory of Open Access Journals (Sweden)

    Jan Kottner

    2010-07-01

    Full Text Available Jan Kottner1, Katrin Balzer21Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany; 2Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyAbstract: Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed.Keywords: Braden pressure ulcer, prevention, risk assessment, nursing assessment, predictive value, clinical effectiveness, review

  12. [Integrated diagnosis and treatment of scar].

    Science.gov (United States)

    Cen, Y; Chen, J J

    2016-11-20

    Scar is the common disease in the field of burn and plastic surgery, and its diagnosis and treatment should be involved in overwhelming majority hospitals. There are many substandard methods and medical hidden dangers in diagnosis and treatment of scar, due to the unevenness of doctors' clinical experience. According to the classification of integral scar and diabrotic scar, the problems related to diagnosis and treatment of scar are systemically summarized and normalized in this article for decrease in the incidence of adverse events and medical hidden dangers.

  13. Videocapillaroscopy in postburn scars: in vivo analysis of the microcirculation.

    Science.gov (United States)

    Gangemi, Ezio Nicola; Carnino, Riccardo; Stella, Maurizio

    2010-09-01

    The aim of the study was the evaluation in vivo of the differences between the microcirculatory characteristics of the postburn scar and the healthy skin. Twelve patients with postburn scars were included in the study, evaluating fifteen scar areas and twelve healthy skin areas by means of contact optical probe videocapillaroscopy. The examined areas for each patient were the right and the left upper limb. Capillary density, length and diameter, together with capillary distribution pattern (punctiform, reticular, directional) and the presence of microhaemorrhages and neoangiogenesis were studied. The results were obtained by two different researchers using the capillaroscope's software. Capillary loop diameter and length, capillary distribution pattern and presence of neoangiogenesis were found to be significantly increased in postburn scars compared with controls. There were also significant differences between hypertrophic tissue in the active phase and the one in the remission phase for capillary diameter and presence of neoangiogenesis. Videocapillaroscopy showed "in vivo" a change in local microcirculation architecture using a microscope. Patients with hypertrophic burn scars showed a variety of microcirculatory changes, often clustered in a characteristic pattern of abnormally oriented, dilated capillaries and neoangiogenetic phenomena. This methodology is highly likely to be of value in the assessment and prognostication of burn outcome. 2010 Elsevier Ltd and ISBI. All rights reserved.

  14. [Verapamil in conjunction with pressure therapy in the treatment of pathologic scar due burn injury].

    Science.gov (United States)

    Ramos-Gallardo, Guillermo; Miranda-Altamirano, Ariel; Valdes-López, Rebeca; Figueroa-Jiménez, Sandra; García-Benavides, Leonel

    2016-01-01

    Keloids and hypertrophic scars are dermal fibro-proliferative disorders unique to humans. Their treatment is a true challenge with multiple options, but not all the time with good results. Unfortunately this problem is not uncommon in patients with history of burn injury. The aim of this article is to evaluate the use of verapamil and pressure garments in patients with hypertrophic or keloid scar caused by burn injury. We included patients with a hypertrophic or keloid scar caused by burn injury candidate to treatment with pressure garment. The pathologic scars were evaluated by serial photographic records, Vancouver and Posas scales. The scales of Vancouver and Posas were compared with t Student. We included 13 scars in 11 patients. Four scars were located in the legs, 4 in the arms, 4 in the face-neck and 1 in the abdomen. The dose of verapamil was calculated .03mg per kg. Injections were scheduled every 7 to 10 days until complete 6 sessions. Taking in count Posas scale, patients referred improvement in pigmentation (.01), thickness (.005), pliability (.01) and surface area (.004). In the Vancouver scale the observers mentioned improvement in elevation (.008), pigmentation (.014), vascularity (.022), flexibility (.014) and pruritus (.003). No adverse effects were found in verapamil injection. Verapamil was useful in conjunction with pressure garment to improve the condition of the keloid and hypertrophic scar caused by burn.

  15. Early postoperative single treatment ablative fractional lasing of Mohs micrographic surgery facial scars: a split-scar, evaluator-blinded study.

    Science.gov (United States)

    Sobanko, Joseph F; Vachiramon, Vasanop; Rattanaumpawan, Pinyo; Miller, Christopher J

    2015-01-01

    Despite precise surgical technique, some postoperative facial scars will depress and widen over time, likely due to weakened or inadequately replaced collagen fibers in the underlying dermis. The purpose of this study is to evaluate whether a 10,600 nm ablative carbon dioxide (CO2 ) fractional laser used early in the post-surgical setting results in improved postoperative facial scars after a single treatment session. A prospective randomized, comparative split-scar study was conducted on 20 subjects between the ages of 20-90. Subjects underwent Mohs surgery for nonmelanoma skin cancer of the face. Subsequent to tumor removal, subjects with a linear scar of 4 cm or greater were enrolled. On the day of suture removal, all subjects had one-half of their scar randomly selected and treated with a 10,600 nm CO2 fractional laser (energy = 10 mJ; density = 10%; spot size = 7 mm; pulse = 1). The untreated scar half served as a control. Scars were re-evaluated 12 weeks later. An independent blinded observer graded the scar halves with the Vancouver scar scale (VSS) immediately prior to treatment and 12 weeks after treatment. Subjects completed a visual analog scale (VAS) at the same time points. Three months after laser treatment, a significant decrease in VSS and 3 of the 4 of its individual parameters were detected in both control and treated halves of the scar. When comparing the laser group versus the control group, a statistically significant difference was not noted in VSS (P = 0.31) but a statistically significant difference in patient VAS was detected (P = 0.002). No side effects of the laser treatment were noted. Facial wounds sutured in a layered manner heal well. Patients prefer early fractional CO2 lasing of surgical scars, though use of the VSS failed to detect an objective difference between laser and control halves of scars. Conservative laser settings, a single session treatment, and VSS insensitivity for surgical scars may influence these findings. © 2015

  16. National-Scale Wind Resource Assessment for Power Generation (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Baring-Gould, E. I.

    2013-08-01

    This presentation describes the current standards for conducting a national-scale wind resource assessment for power generation, along with the risk/benefit considerations to be considered when beginning a wind resource assessment. The presentation describes changes in turbine technology and viable wind deployment due to more modern turbine technology and taller towers and shows how the Philippines national wind resource assessment evolved over time to reflect changes that arise from updated technologies and taller towers.

  17. [Insight in schizophrenia: assessment of 31 patients with different scales].

    Science.gov (United States)

    Travers, D; Levoyer, D; Millet, B

    2008-01-01

    Insight is more than frequently altered in schizophrenia, rupture of treatment being one the most known consequences of this impairment. Two different types of scales can be used to assess consciousness: self-questionnaires directly filled-in by the patient or questionnaires assessed by a psychiatrist after an interview. AIM OF THE STUDIES: The goal of this study was first to assess insight in schizophrenic patients with these two different types of scales and then try to find a link between insight impairment and schizophrenic symptoms. The self-questionnaire was the Marks et al. Self Appraisal of Illness Questionnaire (SAIQ) [Schizophr Res 45 (2000) 203-11], 17 items finally giving four scores (consciousness of illness, consequences of schizophrenia, need for treatment and worrying about illness) plus a total score of insight. The other questionnaire was the Amador Scale for assessment of Unawareness of Mental Disease [Amador XF, Strauss DH. The scale to assess unawareness of mental disorder (SUMD). Columbia University and New-York State Psychiatric Institute;1990], consisting in an interview with a psychiatrist who finally assesses four dimensions (consciousness of illness, symptoms, need for treatment and consequences of illness) plus a total score. In addition to these scores, Amador's scale gives the opportunity to score attribution a patient gives to illness for his symptoms. Thirty-one patients whose schizophrenia diagnosis had been previously made according to DSM-IV criteria were included. Half were outpatients, half inpatients. Drug prescriptions were controlled; all of the patients being medicated with an antipsychotic, a benzodiazepine and a sleep inducer. They were all assessed by the two scales previously mentioned and the Positive And Negative Syndrome Scale [Kay SR, Opler LA, Fiszbein A. Positive and negative syndrome scale. Traduction de Lepine JL. In: Guelfi JD, éditeur. Evaluation clinique standardisée, tome II. Castres : Editions m

  18. Usefulness of direct W-plasty application to wound debridement for minimizing scar formation in the emergency department.

    Science.gov (United States)

    Min, Jin Hong; Park, Kyung Hye; Choi, Hong Lak; Park, Jung Soo; Lee, Ji Han; Kim, Hoon; Lee, Byung Kook; Lee, Dong Hun; Lee, Taek Gu

    2017-05-29

    A suture line placed with the same direction as the relaxed skin tension line leads to good healing, but a suture line with over 30 degrees of angle from the relaxed skin tension line leads to longer healing time and more prominent scarring. W-plasty is widely used to change the direction of the scar or to divide it into several split scars. In this study, we applied W-plasty to patients with facial lacerations in the emergency room. From June 2012 to December 2014, 35 patients underwent simple repair or W-plasty for facial lacerations. Patients in the simple repair group underwent resection following a thermal margin, and the W-plasty group was resected within a pre-designed margin of W-shaped laceration. We assessed prognosis using the Stony Brook Scar Evaluation Scale (SBSES) after 10 days (short-term) and six months (long-term), respectively, following suture removal. Among 35 patients, 15 (42.9%) underwent simple debridement and 20 (57.1%) underwent W-plasty. In the W-plasty group, there was no difference between short-term and long-term follow-up showing high SBSES, but in the simple debridement group, long-term follow-up SBSES significantly decreased. W-plasty SBSES was higher than simple debridement at short-term as well as long-term follow-up. We experienced good results of direct W-plasty application at six-month long-term follow-up. Therefore, W-plasty application is more effective in reducing scar appearance than a simple debridement method for facial laceration patients with an angle of 30 degrees or more to the relaxed skin tension line. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Nd:YAG Laser Treatment of Keloids and Hypertrophic Scar/span>s

    Science.gov (United States)

    Akaishi, Satoshi; Koike, Sachiko; Dohi, Teruyuki; Kobe, Kyoko; Hyakusoku, Hiko; Ogawa, Rei

    2012-01-01

    Pathological cutaneous scars such as keloids and hypertrophic scar/span>s (HSs) are characterized by a diffuse redness that is caused by the overgrowth of capillary vessels due to chronic inflammation. Our group has been using long-pulsed, 1064-nm Nd:YAG laser in noncontact mode with low fluence and a submillisecond pulse duration to treat keloids and hypertrophic scar/span>s since 2006 with satisfactory results. The present study examined the efficacy of this approach in 22 Japanese patients with keloids (n = 16) or hypertrophic scar/span>s (n = 6) who were treated every 3 to 4 weeks. Treatment settings were as follows: 5 mm spot size diameter; 14 J/cm2 energy density; 300 μs exposure time per pulse; and 10 Hz repetition rate. The responses of the pathological scar/span>s to the treatment were assessed by measuring their erythema, hypertrophy, hardness, itching, and pain or tenderness. Moreover, skin samples from 3 volunteer patients were subjected to histological evaluation and 5 patients underwent thermography during therapy. The average total scar assessment score dropped from 9.86 to 6.34. Hematoxylin and eosin staining and Elastica Masson-Goldner staining showed that laser treatment structurally changed the tissue collagen. This influence reached a depth of 0.5 to 1 mm. Electron microscopy revealed plasma protein leakage, proteoglycan particles, and a change in the collagen fiber fascicles. Further analyses revealed that noncontact mode Nd:YAG laser treatment is highly effective for keloids and hypertrophic scar/span>s regardless of patient age, the origin and multiplicity of scarring, the location of the scar(s), or the tension on the scar. PMID:22259645

  20. FACTORS INFLUENCING THE OCCURRENCE OF HYPERTROPHIC SCARS AMONG POSTOPERATIVE PATIENTS IN GARUT, INDONESIA

    Directory of Open Access Journals (Sweden)

    Andri Nugraha

    2017-02-01

    Full Text Available Background: Hypertrophic scar causes physical and psychological problems. Thus understanding the factors related to the occurrence of hypertrophic scar tissue is needed. Little is known about its influencing factors in Indonesia, especially in Garut. Objective: This study aims to examine the relationships between hypertrophic scar and its influencing factors, and identify the most dominant factor of the occurrence of hypertrophic scars. Methods: This was an observational case control study using retrospective approach in Polyclinic of Surgery of Regional Public Hospital of dr. Slamet of Garut Regency. There were 40 samples recruited in this study by purposive sampling, which was divided to be case group (20 patients and control group (20 patients. Data were collected using Stony Brook Scar Evaluation Scale by observation and documentation of the medical records of patients. Data were analyzed using logistic regression analysis Results: Findings indicated that there were significant relationships between the surgical wound infection (p = 0.02, family history (p = 0.026, and type of suture (p = 0.043 with the occurrence of hypertrophic scars. The most dominant factor on the occurrence of hypertrophic scars was type of suture, acid polyglactin 910. The variables that had no significant relationships with the occurrence of hypertrophic scar tissue were age (p = 0.34, area of surgical wound (p = 0.177, and smoking habit (p = 0.479. Conclusion: There were significant relationships between infection of surgical wound, genetic history, the type of suture, and the occurrence of hypertrophic scar tissue. The most dominant factor that influenced the occurrence of hypertrophic scar tissue was the type of suture. Therefore, it is suggested to health professionals to modify the using of acid polyglactin 910 sutures, and nurses particularly need to provide the information regarding the family history and genetic-related hypertrophic scar, and prevent the

  1. Scar tissue and microvolt T-wave alternans

    NARCIS (Netherlands)

    Kraaier, Karin; Olimulder, Marlon A.G.M.; Olimulder, Marlon; Galjee, Michel A.; van Dessel, Pascal F.H.M.; van der Palen, Jacobus Adrianus Maria; Wilde, Arthur A.M.; Scholten, Marcoen

    2014-01-01

    Microvolt T-wave alternans (MTWA) is an electrocardiographic marker for predicting sudden cardiac death. In this study, we aimed to study the relation between MTWA and scar assessed with cardiac magnetic resonance imaging (CMR) in patients with ischemic cardiomyopathy (ICM) or dilated cardiomyopathy

  2. Functional assessment of mother-child relationships: The EEI Scale

    OpenAIRE

    Panduro Paredes, José Antonio

    2013-01-01

    An infant stimulation in mother-child relationship assessment scale (ISA Scale) was developed, based on a classification of probable effects on child's behavior, such as behavioral promotion stimulation (BPS) and behavioral control stimulation (BCS), refering to mother action level to promote desirable behaviors and to control socially non desirable behaviors in child's behavior repertory. 540 mother-child dyads were evaluated. The construct validity tests showed significant correlations in i...

  3. A Visual Analogue Scale in the Assessment of Dental Anxiety

    OpenAIRE

    Luyk, Neil H.; Beck, Frank M.; Weaver, Joel M.

    1988-01-01

    The purpose of this study is to determine the validity of the visual analogue scale (VAS) in the assessment of changing levels of dental anxiety, through correlation with the dental anxiety scale (DAS) and the state portion (A-state) of the statetrait anxiety inventory (STAI). Forty-five adult patients attending an oral surgery clinic for a routine dental extraction participated. Before any treatment, each patient completed the DAS, the STAI, and a 100mm VAS. The order of administration was r...

  4. [Development of the Heterosexual Love Assessment Scale for Alcoholics].

    Science.gov (United States)

    Sugawarai, Tazuko; Morita, Noriaki; Nakatani, Youji

    2013-10-01

    The purpose of this study was to develop a scale for assessing the attributes of the heterosexual love of alcoholics. Using the characteristics and categories related to the heterosexual love of alcoholics found in previous research, we created a "Heterosexual Love Assessment Scale for Alcoholics" and conducted a survey among 110 alcoholics (80 men and 30 women). The following three factors were extracted from the results: "mutual respect", "superficial intimacy", and "fear of being disliked", A high level of reliability was obtained on the scales indicated below (alpha = 63-82), and concurrent validity was confirmed between these and the Adult Attachment Scale (ECR: Experiences in Close Relationships inventory). Further, correlations were found between "mutual respect" and the benefit of heterosexual love in recovery, and between the other two factors and the impediment of heterosexual love, and between the Denial & Awareness Scale (for alcoholic). As this scale can be used to assess the type of heterosexual love of alcoholics, we predict that it will be useful in examining the effects of heterosexual love on recovery and as a tool for offering advice.

  5. Measurement in Sensory Modulation: The Sensory Processing Scale Assessment

    Science.gov (United States)

    Miller, Lucy J.; Sullivan, Jillian C.

    2014-01-01

    OBJECTIVE. Sensory modulation issues have a significant impact on participation in daily life. Moreover, understanding phenotypic variation in sensory modulation dysfunction is crucial for research related to defining homogeneous groups and for clinical work in guiding treatment planning. We thus evaluated the new Sensory Processing Scale (SPS) Assessment. METHOD. Research included item development, behavioral scoring system development, test administration, and item analyses to evaluate reliability and validity across sensory domains. RESULTS. Items with adequate reliability (internal reliability >.4) and discriminant validity (p sensory modulation (scale reliability >.90; discrimination between group effect sizes >1.00). This scale has the potential to aid in differential diagnosis of sensory modulation issues. PMID:25184464

  6. Correlations between three patient-assessed shoulder instability scales.

    Science.gov (United States)

    Taylor, David; Garewal, Devinder; Evans, Matthew C

    2015-08-01

    To evaluate the correlations between three patient-assessed shoulder instability scales before and after Latarjet stabilisation for traumatic anteroinferior glenohumeral instability. Records of 30 men and 2 women (mean age, 26.7 years) who had not undergone surgery for antero-inferior shoulder instability and records of 31 men and one woman (mean age, 27 years) who had undergone Latarjet stabilisation for anteroinferior shoulder instability and had been followed up for a mean period of 21.3 months were reviewed. Correlations between the Western Ontario Shoulder Instability Index (WOSI), the Melbourne Instability Shoulder Score (MISS), and the L'Insalata Shoulder Questionnaire (L'Insalata) were assessed. The mean score of each scale was significantly greater in the postoperative than preoperative group (p0.01, post-hoc analysis). Correlations of all scale pairs were significant (p<0.001). The WOSIMISS correlations in the pre- and post-operative groups were moderate. The L'Insalata-WOSI correlations in the pre- and post-operative groups were moderate and high, respectively. The L'Insalata-MISS correlations in the pre- and post-operative groups were high and moderate, respectively. The MISS and WOSI scales are moderately correlated. Correlation of the L'Insalata scale with other scales depends on the operative status of the patient. The use of the L'Insalata scale alone is not recommended.

  7. Efficacy and safety of fractional CO 2 laser resurfacing in non-hypertrophic traumatic and burn scars

    Directory of Open Access Journals (Sweden)

    Imran Majid

    2015-01-01

    Full Text Available Background: Fractional photothermolysis is one of the most effective treatment options used to resurface scars of different aetiologies. Aim: To assess the efficacy and safety of fractional CO 2 laser resurfacing treatment in the management of non-hypertrophic traumatic and burn scars. Materials and Methods: Twenty-five patients affected by non-hypertrophic traumatic and burn scars were treated with four sessions of fractional CO 2 laser resurfacing treatment at 6-weekly intervals. Patients were photographed at each visit and finally, 3 months after the end of treatment schedule. Response to treatment was assessed clinically as well as by comparing the initial photograph of the patient with the one taken at the last follow-up visit 3-months after the final treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as ′excellent′ if the mean score achieved was >2. A score of 1-2 was labeled as good response while a score below 1 was labeled as ′poor′ response. The subjective satisfaction of each patient with the treatment offered was also assessed at the last follow-up visit. Results: The commonest site of scarring treated was the face followed by hands. Response to treatment was rated as excellent in 60% (15/25 patients while 24% (6/25 and 16% (4/25 patients were labeled as good and poor responders, respectively. Skin texture showed better response than other variables with average score of 2.44. Linear post-traumatic scars were seen to respond less than other morphological types. Majority of the patients (19 out of 25 were highly satisfied with the treatment offered. No long-term adverse effects were noted in any patient. Conclusions: Fractional photothermolysis with a fractional CO 2 laser gives excellent results in patients with post-burn scars with

  8. Basin-Scale Opportunity Assessment Initiative Background Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Saulsbury, Bo [ORNL; Geerlofs, Simon H. [Pacific Northwest National Laboratory (PNNL); Cada, Glenn F [ORNL; Bevelhimer, Mark S [ORNL

    2010-10-01

    As called for in the March 24, 2010, Memorandum of Understanding (MOU) for Hydropower, the U.S. Department of Energy (DOE), the U.S. Department of the Interior (DOI), the U.S. Army Corps of Engineers (USACE), environmental stakeholders, and the hydropower industry are collaborating to identify opportunities to simultaneously increase electricity generation and improve environmental services in river basins of the United States. New analytical tools provide an improved ability to understand, model, and visualize environmental and hydropower systems. Efficiencies and opportunities that might not be apparent in site-by-site analyses can be revealed through assessments at the river-basin scale. Information from basin-scale assessments could lead to better coordination of existing hydropower projects, or to inform siting decisions (e.g., balancing the removal of some dams with the construction of others), in order to meet renewable energy production and environmental goals. Basin-scale opportunity assessments would inform energy and environmental planning and address the cumulative effects of hydropower development and operations on river basin environmental quality in a way that quantifies energy-environment tradeoffs. Opportunity assessments would create information products, develop scenarios, and identify specific actions that agencies, developers, and stakeholders can take to locate new sustainable hydropower projects, increase the efficiency and environmental performance of existing projects, and restore and protect environmental quality in our nation's river basins. Government agencies and non-governmental organizations (NGO) have done significant work to understand and assess opportunities for both hydropower and environmental protection at the basin scale. Some initiatives have been successful, others less so, and there is a need to better understand the legacy of work on which this current project can build. This background literature review is intended

  9. Evaluation of the effect of fractional CO2 laser on histopathological picture and TGF-β1 expression in hypertrophic scar.

    Science.gov (United States)

    Makboul, Mohamed; Makboul, Rania; Abdelhafez, Assem Hk; Hassan, Safaa Said; Youssif, Sherif M

    2014-09-01

    Hypertrophic scar is a form of abnormal wound healing process in which tissue repair regulating mechanism is disrupted. Transforming growth factor β1 has a particular importance in the fibrotic scarring response. Treatment of hypertrophic scar included many chemical, physical, and surgical options. Fractional CO2 laser devices have gained acceptance as a way for managing hypertrophic scar. Aims of this study are: (a) to determine the clinical and histopathological effects of fractional CO2 laser on hypertrophic scar, (b) to evaluate the expression pattern of transforming growth factor-β1 (TGF-β1) as an important fibrogenic factor before and 6 months after fractional CO2 laser treatment. Forty patients of hypertrophic scar were selected, each patient was treated by four sessions with 1 month apart with fractional CO2 laser. Vancouver Scar Scale (VSS) was used to assess the patients before and after laser treatment. Skin biopsy was taken from eight cases before and 3 months after four fractional CO2 laser sessions and four normal skin control biopsies. All were assessed by hematoxylin-eosin (H&E), Masson's trichrome, Van Gieson and immunohistochemical (IHC) staining with TGF-β1. The epidermal thickness was assessed before and after treatment by image analyzing system software. There was statistically significant difference in VSS before and after fractional CO2 laser (P > 0.001). The epidermal thickness showed significant increase after laser treatment (P > 0.001), and there was also thinning in stratum corneum and replacement of the irregular collagen bands with organized new collagen fibrils as demonstrated by H&E and the other special stains. The study also showed significant decrease in TGF-β1 expression after laser therapy (P = 0.008). Fractional CO2 laser could be considered as a good way for hypertrophic scar management. It normalizes dermal collagen as imaged by histopathological picture and the change in TGF-β1 expression. © 2014 Wiley

  10. Objective estimation of patient age through a new composite scale for facial aging assessment: The face - Objective assessment scale.

    Science.gov (United States)

    La Padula, Simone; Hersant, Barbara; SidAhmed, Mounia; Niddam, Jeremy; Meningaud, Jean Paul

    2016-07-01

    Most patients requesting aesthetic rejuvenation treatment expect to look healthier and younger. Some scales for ageing assessment have been proposed, but none is focused on patient age prediction. The aim of this study was to develop and validate a new facial rating scale assessing facial ageing sign severity. One thousand Caucasian patients were included and assessed. The Rasch model was used as part of the validation process. A score was attributed to each patient, based on the scales we developed. The correlation between the real age and scores obtained, the inter-rater reliability and test-retest reliability were analysed. The objective was to develop a tool enabling the assigning of a patient to a specific age range based on the calculated score. All scales exceeded criteria for acceptability, reliability and validity. The real age strongly correlated with the total facial score in both sex groups. The test-retest reliability confirmed this strong correlation. We developed a facial ageing scale which could be a useful tool to assess patients before and after rejuvenation treatment and an important new metrics to be used in facial rejuvenation and regenerative clinical research. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  11. The efficacy of conditioned media of adipose-derived stem cells combined with ablative carbon dioxide fractional resurfacing for atrophic acne scars and skin rejuvenation.

    Science.gov (United States)

    Zhou, Bing-Rong; Zhang, Ting; Bin Jameel, Afzaal Ahmed; Xu, Yang; Xu, Yan; Guo, Shi-Lei; Wang, Ying; Permatasari, Felicia; Luo, Dan

    2016-06-01

    To evaluate the effects of conditioned medium of adipose-derived stem cells (ADSC-CM) on efficacy and side effects after fractional carbon dioxide laser resurfacing (FxCR) when treating subjects with facial atrophic acne scars or with skin rejuvenation needs. Twenty-two subjects were enrolled in the study and divided into two groups. Nine subjects were included in skin rejuvenation group and thirteen subjects were included in acne scar group, and all subjects underwent three sessions of FxCR. ADSC-CM was applied on FxCR site of one randomly selected face side. Evaluations were done at baseline, 1 week after first treatment, and 1 month after each treatment. The outcome assessments included subjective satisfaction scale; blinded clinical assessment; and the biophysical parameters of roughness, elasticity, skin hydration, transepidermal water loss (TEWL), and the erythema and melanin index. Biopsies taken from one subject in skin rejuvenation group were analyzed using hematoxylin and eosin, Masson's Trichrome, and Gomori's aldehyde fuchsin staining. ADSC-CM combined with FxCR increased subject satisfaction, elasticity, skin hydration, and skin elasticity and decreased TEWL, roughness, and the melanin index in both acne scars and skin rejuvenation groups. Histologic analysis showed that ADSC-CM increased dermal collagen density, elastin density, and arranged them in order. ADSC-CM with FxCR is a good combination therapy for treating atrophic acne scars and skin rejuvenation. JSPH2012-082 - Registered 14 Feb 2012.

  12. ASSESSMENT OF TORNADOS WITH THE ENHANCED FUJITA SCALE IN ROMANIA

    Directory of Open Access Journals (Sweden)

    C. NUCUŢĂ

    2011-03-01

    Full Text Available Assessment of tornadoes with the Enhanced Fujita Scale in Romania. An analysis of the damage caused by a tornado, in order to determine the maximum wind speed that was reached, is important both in terms of documenting the phenomenon and to make improvements to the evaluation method which is used, especially if this method is not specific for the analyzed territory. An overview of the way the tornado from Silivaşu de Câmpie, on the 26th of May 2010, was termed EF2 is done to summarize the difficulties that arise in the assessment of tornadoes occurring in Romania with the Enhanced Fujita scale. The lack of correlation between damage indicators, different construction styles and building materials between those in the United States and those selected in this case study are the main issues addressed. Solutions for these issues are discussed as a starting point for the adjustment of Enhanced Fujita scale for Romania.

  13. Development and external validation of a new PTA assessment scale

    NARCIS (Netherlands)

    Jacobs, B.; Ekert, J. van; Vernooy, L.P.; Dieperink, P.; Andriessen, T.M.J.C.; Hendriks, M.P.; Vugt, A.B. van; Emons, M.A.; Borm, G.F.; Vos, P.E.

    2012-01-01

    BACKGROUND: Post-traumatic amnesia (PTA) is a key symptom of traumatic brain injury (TBI). Accurate assessment of PTA is imperative in guiding clinical decision making. Our aim was to develop and externally validate a short, examiner independent and practical PTA scale, by selecting the most

  14. Regional-scale risk assessment methodology using the Relative ...

    African Journals Online (AJOL)

    2012-04-18

    Apr 18, 2012 ... paper presents an integrated approach to carry out regional-scale ecological risk assessments using a Relative Risk Model. (RRM) adapted ..... Recreational activities. Dams&wiers. Plantations. Gold mine. Habitat alteration. Sugar mill. Sugar. Mixed. Flow alterations. Forestry. 1. Irrigation - dam. Exotic fish.

  15. Large-Scale Assessments and Educational Policies in Italy

    Science.gov (United States)

    Damiani, Valeria

    2016-01-01

    Despite Italy's extensive participation in most large-scale assessments, their actual influence on Italian educational policies is less easy to identify. The present contribution aims at highlighting and explaining reasons for the weak and often inconsistent relationship between international surveys and policy-making processes in Italy.…

  16. A generic scale for assessment of attitudes towards social robots

    DEFF Research Database (Denmark)

    Damholdt, Malene Flensborg; Olesen, Martin Hammershøj; Nørskov, Marco

    2016-01-01

    The research field into social robotics is expanding and with it the need for consistent methods for assessing attitudinal stance towards social robots. In this paper we describe the development and planned validation of the Attitudes towards social robots scale (ASOR-5): a generic questionnaire...

  17. Assessing Laptop Use in Higher Education: The Laptop Use Scale

    Science.gov (United States)

    Kay, Robin; Lauricella, Sharon

    2016-01-01

    The laptop computer is considered one of the most used and important technological devices in higher education, yet limited systematic research has been conducted to develop a measure of laptop use in college and university. The purpose of the following study was to develop a research-based, theoretically grounded scale to assess student use of…

  18. Large-Scale Assessment and English Language Learners with Disabilities

    Science.gov (United States)

    Liu, Kristin K.; Ward, Jenna M.; Thurlow, Martha L.; Christensen, Laurene L.

    2017-01-01

    This article highlights a set of principles and guidelines, developed by a diverse group of specialists in the field, for appropriately including English language learners (ELLs) with disabilities in large-scale assessments. ELLs with disabilities make up roughly 9% of the rapidly increasing ELL population nationwide. In spite of the small overall…

  19. A mechanistic assessment of nutrient flushing at the catchment scale

    Science.gov (United States)

    Willem J. van Verseveld; Jeffrey J. McDonnell; Kate Lajtha

    2008-01-01

    This paper mechanistically assesses the flushing mechanism of DOC, DON, and DIN at the hillslope and catchment scales during two storm events, in a small catchment (WS10), H.J. Andrews Experimental Forest in the western Cascade Mountains of Oregon. Using a combination of natural tracer and hydrometric data, and end-member mixing analysis, we were able to describe the...

  20. Acne Scars: Pathogenesis, Classification and Treatment

    Directory of Open Access Journals (Sweden)

    Gabriella Fabbrocini

    2010-01-01

    Full Text Available Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%–14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options.

  1. A Case of Multiple Spontaneous Keloid Scars

    Directory of Open Access Journals (Sweden)

    Abdulhadi Jfri

    2015-07-01

    Full Text Available Keloid scars result from an abnormal healing response to cutaneous injury or inflammation that extends beyond the borders of the original wound. Spontaneous keloid scars forming in the absence of any previous trauma or surgical procedure are rare. Certain syndromes have been associated with this phenomenon, and few reports have discussed the evidence of single spontaneous keloid scar, which raises the question whether they are really spontaneous. Here, we present a 27-year-old mentally retarded single female with orbital hypertelorism, broad nasal bridge, repaired cleft lip and high-arched palate who presented with progressive multiple spontaneous keloid scars in different parts of her body which were confirmed histologically by the presence of typical keloidal collagen. This report supports the fact that keloid scars can appear spontaneously and are possibly linked to a genetic factor. Furthermore, it describes a new presentation of spontaneous keloid scars in the form of multiple large lesions in different sites of the body.

  2. Digital imaging analysis of scar aesthetics.

    Science.gov (United States)

    Valente, Jonathan H; Jay, Gregory D; Schmidt, Scott T; Oh, Albert K; Reinert, Steven E; Zabbo, Christopher P

    2012-03-01

    Aesthetic outcome is an important end point of wound care. The purpose of this study was to compare a wound aesthetic scoring system by emergency physicians, patients, and digital imaging by blinded plastic surgeons. The goal was to see if digital photography could accurately analyze the aesthetics of closed lacerations for future research. This was a subanalysis of a prospective, randomized trial conducted in an urban, academic emergency department. Patients aged 18 to 100 years were included if they had simple, uncomplicated lacerations 8 hours old or less located on the trunk, head or neck (not scalp), or extremities that required repair by sutures. Exclusion criteria included immunocompromised state of health, a complicated laceration, specialty consultant intervention in management of the wound, or current use of or need for antibiotics for wound prophylaxis. Complicated lacerations were defined in the article. Infection outcomes, demographics, and aesthetic outcomes were assessed. Scar appearance was assessed at 3 to 4 months after closure using a previously validated 0-to 100-mm visual analog scale (VAS) score and 6-point wound evaluation score (WES) done by 2 trained emergency physicians (MD1 and MD2). Patients also performed self-VAS (VAS(Pt)), whereas VAS was done using digital imaging by 2 trained plastic surgeons (VAS(Plast1) and VAS(Plast2)). Data were evaluated when both plastic surgeons independently believed that the digital images were able to be adequately scored. Pearson correlation coefficients were performed using mean values. Three- to 4-month VAS(MD) and WES(MD) follow-up was obtained in 66 of 175 (37.7%), 3- to 4-month VAS(Pt) follow-up was obtained in 70 of 175 (40.0%), and 3- to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VAS(Plast) in 34 of 66 (51.5%). Mean scores for VAS(MD1) and VAS(MD2) were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WES(MD1) and WES(MD2) were

  3. Assessing Vulnerability to Drought on a pan-European scale

    Science.gov (United States)

    Urquijo, Julia; De Stefano, Lucia; González-Tánago, Itziar; Blauhut, Veit; Stahl, Kerstin

    2014-05-01

    During the past decade, a number of theoretical frameworks have been defined within the Disaster Risk Reduction and Climate Change communities to assess drought vulnerability at different scales, sectors, socio-political contexts, and geo-climatic conditions. However, there is still little consensus around the criteria, dimensions and factors used in these assessments; and none of them has been applied at a pan-European scale. This is due to a triple complexity. Firstly, drought as a natural hazard is a complex phenomenon due to the difficulty of determining its onset and its multiscale, multifaceted and dynamic nature. Secondly, there is an on-going debate regarding the concept of vulnerability and its constitutive elements, together with an important diversity of theoretical approaches to assess it. Finally, Europe's diversity in bioclimatic conditions, national water use practice and water use policies adds a challenging characteristic for working on pan-European scale. This work addresses the challenge of defining a methodological approach to the assessment of vulnerability factors to drought at a pan-European scale. For this purpose, we first review existing conceptual frameworks as well as of past initiatives for drought vulnerability assessment. The literature review showed that the high complexity of drought vulnerability assessment requires a clear definition of the concept of vulnerability and the associated terms, and that, before undertaking any assessment, it is necessary to clearly define the "vulnerable unit" i.e. replying to the questions 'whose vulnerability is being assessed?' and 'vulnerability to what type of impact?'. In this context, this work proposes the application of a factor-based approach, consisting in the analysis of significant factors that influence vulnerability in the context of specific situations of potential vulnerability. Those situations are framed within the specific drought characteristics of four different geoclimatic macro

  4. A new modality for fractional CO2 laser resurfacing for acne scars in Asians.

    Science.gov (United States)

    Huang, Luping

    2013-02-01

    Since fractional photothermolysis was first introduced in 2004, it has become a very popular procedure, especially with more and more ablative fractional laser systems and treatments. Fractional ablative laser has been shown to be very effective; however, it does not reach the efficacy of conventional ablative laser treatments in most instances. In an attempt order to make the fractional CO2 laser treatment more efficacious and safe, we combined both the conventional CO2 laser and the fractional CO2 laser to treat acne scars. We report our experience with this new modality. A total of 44 Chinese patients with facial acne scars and skin type IV were included in this study. Each patient received a minimum of two treatment sessions. For each laser session, both the conventional CO2 laser treatment and the DeepFX laser treatment were focused on treating the scar areas only. Following this technique, the more superficialf ActiveFX fractional CO2 laser was performed to the entire face. The efficacy of the procedure was evaluated 3 months after the final laser treatment. The improvement in acne scars and the overall skin texture change were assessed by photographic evaluation using the following scales: ≤25 % (mild), 26-50 % (moderate), 51-75 % (marked), and >75 % (excellent). Side effects from this therapy were mild to moderate. Two cases of HSV outbreak were noted; they were treated and resolved without adverse sequelae. Post-laser erythema was resolved within 1 month in one half of the patients. Prolonged erythema (≤3 months) was noted in 12(27 %) cases. Temporary post-inflammatory hyperpigmentation (PIH; ≤1 month) was seen in approximately 50 % of the patients. PIH (≤3 months) was noted in four cases (9 %). Sixty-four percent of the patients (28/44) had an improvement of between 51 and 75 % after more than two sessions of the combination of laser treatments. The average overall improvement was 52.50 % (±12.25 %). Three patients achieved

  5. Scar Revision Surgery: The Patient's Perspective

    Directory of Open Access Journals (Sweden)

    Benjamin H Miranda

    2015-11-01

    Full Text Available BackgroundInsufficient satisfaction outcome literature exists to assist consultations for scar revision surgery; such outcomes should reflect the patient's perspective. The aim of this study was to prospectively investigate scar revision patient satisfaction outcomes, according to specified patient-selection criteria.MethodsPatients (250 were randomly selected for telephone contacting regarding scar revisions undertaken between 2007-2011. Visual analogue scores were obtained for scars pre- and post-revision surgery. Surgery selection criteria were; 'presence' of sufficient time for scar maturation prior to revision, technical issues during or wound complications from the initial procedure that contributed to poor scarring, and 'absence' of site-specific or patient factors that negatively influence outcomes. Patient demographics, scar pathogenesis (elective vs. trauma, underlying issue (functional/symptomatic vs. cosmetic and revision surgery details were also collected with the added use of a real-time, hospital database.ResultsTelephone contacting was achieved for 211 patients (214 scar revisions. Satisfaction outcomes were '2% worse, 16% no change, and 82% better'; a distribution maintained between body sites and despite whether surgery was functional/symptomatic vs. cosmetic. Better outcomes were reported by patients who sustained traumatic scars vs. those who sustained scars by elective procedures (91.80% vs. 77.78%, P=0.016 and by females vs. males (85.52% vs. 75.36%, P<0.05, particularly in the elective group where males (36.17% were more likely to report no change or worse outcomes versus females (16.04% (P<0.01.ConclusionsSuccessful scar revision outcomes may be achieved using careful patient selection. This study provides useful information for referring general practitioners, and patient-surgeon consultations, when planning scar revision.

  6. Attacker economics for Internet-scale vulnerability risk assessment

    OpenAIRE

    Allodi, L.

    2013-01-01

    Vulnerability risk assessment is a crucial process in security management, and the CVSS score is the standard-de-facto risk metric for software vulnerabilities. In this manuscript I show that current risk assessment methodologies do not fit real “in the wild” attack data. I also present my three-steps plan to identify an Internet-scale risk assessment methodology that accounts for attacker economics and opportunities. Eventually, I want to provide answers like the following: “If we depl...

  7. Efficacy of fractionated microneedle radiofrequency with and without adding subcision for the treatment of atrophic facial acne scars: A randomized split-face clinical study.

    Science.gov (United States)

    Faghihi, Gita; Poostiyan, Nazila; Asilian, Ali; Abtahi-Naeini, Bahareh; Shahbazi, Masoom; Iraji, Fariba; Fatemi Naeini, Farahnaz; Nilforoushzadeh, Mohammad Ali

    2017-06-01

    There is no gold standard treatment for facial acne scars, and overall, little literature exists about the combination therapy for treatment of acne scar. The aim of this study was to evaluate the efficacy of fractionated microneedle radiofrequency (FMR) vs FMR combined with subcision for the treatment of atrophic acne scars. This was a randomized, split-face clinical study of 25 patients with II-IV Fitzpatrick skin types with moderate to severe facial atrophic acne scars. Initially, standard subcision by Nokor needle was performed on one side. Two weeks after subcision, FMR treatment was performed on both cheeks of each participant. Second and third FMR treatment sessions were performed within 4-week intervals. Two-blinded dermatologists performed clinical assessments using a quartile grading scale, and patients were also asked to judge their satisfaction using a visual analog scale (VAS) scoring system. The age of the patients varied from 24 to 40 years (mean: 30.08±4.94 years). Only nine patients (36%) were males. Clinical assessment by two-blinded dermatologists showed statistically significant improvement in the combination (FMR+subcision) group (P=.009). Patient satisfaction was statistically significantly better in the combination group (P=.001). A darkening of skin phototype was associated with a decrease in patient's satisfaction VAS score (P=.07). The combination of subcision and FMR is a safe and effective modality for mixed type acne scars. Additional randomized clinical study with long-term follow-up is necessary for further evaluation of FMR in combination with other procedures. The full trial protocol can be accessed in: http://www.irct.ir/searchresult.php?keyword=%20%20IRCT2016103130597N1&id=30597&number=1&field=a&prt=1&total=1&m=1. The clinical trial registration number is IRCT2016103130597N1. © 2017 Wiley Periodicals, Inc.

  8. The use of botulinum toxin as primary or adjunctive treatment for post acne and traumatic scarring

    Directory of Open Access Journals (Sweden)

    Greg J Goodman

    2010-01-01

    Full Text Available Background : Botulinum toxin has been utilised successfully in many facial and extra facial regions to limit superfluous movement. Scars, whether traumatic or disease-related, are treated with many modalities. Objective: To assess the available literature concerning the prophylactic use of botulinum toxin for the improvement in the cosmetic outcome of scars induced by surgery and to examine its role in the treatment of established scars alone, as also combined with other modalities. Material and Methods : The results of the prophylactic use of botulinum toxin to limit the resultant scarring from surgery are examined by a literature review. The primary and adjunctive use of botulinum toxin in the treatment of post acne and post surgical and traumatic scars is explored by case examples. Results : Literature review and personal experience shows good Improvement in the appearance of scars with the use of botulinum toxin alone or with other adjuvant modalities in the treatment of scars. Conclusion : Botulinum toxin would appear to be useful both in the prophylaxis and treatment of certain types of scars.

  9. Clinical stress assessment using a visual analogue scale.

    Science.gov (United States)

    Lesage, F-X; Berjot, S; Deschamps, F

    2012-12-01

    Clinicians increasingly require short, efficient methods for assessing distress, both in applied research and clinical settings. Most of the available questionnaires are unsuitable for busy clinical settings. The visual analogue scale (VAS) is widely but empirically used to assess perceived stress. To provide evidence on two of the psychometric properties of the VAS: its discriminative sensitivity (capacity to highlight a difference between groups) and its interconcept validity (the relationship between VAS stress assessment and the assessment of different, but similar concepts). Employees attending occupational health centres were randomly selected and completed the VAS and also either the Perceived Stress Scale (PSS) or the Hospital Anxiety and Depression Scale (HADS). Analyses of variance were performed to study group effects (age, sex, marital status, parental status, occupational status) on stress scores (PSS and VAS). In total, 763 employees participated of whom 501 completed the PSS and 262 the HADS. P-values obtained for the effects of sex, age and occupational status were lower with the VAS than with the PSS. Correlations between the VAS and the anxiety subscale, depression subscale and total score of the HADS were 0.66, 0.45 and 0.65, respectively. Other tools used to assess aspects of psychological distress are known to have similar correlations. Our findings provide evidence that the VAS is at least as discriminating as a questionnaire when it comes to highlighting differences in stress levels between two groups, and the observed correlations with related constructs support its construct validity.

  10. Pain Assessment Scale for Patients With Disorders of Consciousness

    DEFF Research Database (Denmark)

    Poulsen, Ingrid; Brix, Pia; Andersen, Sylvia

    2016-01-01

    BACKGROUND: Patients with acquired brain injury undergoing rehabilitation are often unable to verbalize pain because of disorders of consciousness. Hence, observational pain assessment instruments are warranted for these patients. AIM: The aim of this study was to study interrater agreement...... and sensitivity to change over time of an assessment scale developed for the evaluation of pain in severely brain-injured patients with disorders of consciousness. METHODS: We developed a pain assessment scale based on scientific literature and clinical experience with severely brain-injured patients. It consists...... of four domains: physiological/autonomic, body language, verbal communication, and behavior. The domains consist of 27 items. Interrater reliability was tested through three experienced nurses who rated 26 patients with acquired brain injury. The patients were rated in two different situations: before...

  11. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars.

    Science.gov (United States)

    O'Brien, Lisa; Jones, Daniel J

    2013-09-12

    Keloid and hypertrophic scars are common and are caused by a proliferation of dermal tissue following skin injury. They cause functional and psychological problems for patients, and their management can be difficult. The use of silicone gel sheeting to prevent and treat hypertrophic scarring is still relatively new and started in 1981 with treatment of burn scars. To determine the effectiveness of silicone gel sheeting for:(1) prevention of hypertrophic or keloid scarring in people with newly healed wounds (e.g. post surgery);(2) treatment of established scarring in people with existing keloid or hypertrophic scars. In May 2013 we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL for this second update. Any randomised or quasi-randomised controlled trials, or controlled clinical trials, comparing silicone gel sheeting for prevention or treatment of hypertrophic or keloid scars with any other non surgical treatment, no treatment or placebo. We assessed all relevant trials for methodological quality. Three review authors extracted data independently using a standardised form and cross-checked the results. We assessed all trials meeting the selection criteria for methodological quality. We included 20 trials involving 873 people, ranging in age from 1.5 to 81 years. The trials compared adhesive silicone gel sheeting with no treatment; non silicone dressing; other silicone products; laser therapy; triamcinolone acetonide injection; topical onion extract and pressure therapy. In the prevention studies, when compared with a no treatment option, whilst silicone gel sheeting reduced the incidence of hypertrophic scarring in people prone to scarring (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.21 to 0.98) these studies were highly susceptible to bias. In treatment studies, silicone gel sheeting

  12. Refining a self-assessment of informatics competency scale using Mokken scaling analysis.

    Science.gov (United States)

    Yoon, Sunmoo; Shaffer, Jonathan A; Bakken, Suzanne

    2015-01-01

    Healthcare environments are increasingly implementing health information technology (HIT) and those from various professions must be competent to use HIT in meaningful ways. In addition, HIT has been shown to enable interprofessional approaches to health care. The purpose of this article is to describe the refinement of the Self-Assessment of Nursing Informatics Competencies Scale (SANICS) using analytic techniques based upon item response theory (IRT) and discuss its relevance to interprofessional education and practice. In a sample of 604 nursing students, the 93-item version of SANICS was examined using non-parametric IRT. The iterative modeling procedure included 31 steps comprising: (1) assessing scalability, (2) assessing monotonicity, (3) assessing invariant item ordering, and (4) expert input. SANICS was reduced to an 18-item hierarchical scale with excellent reliability. Fundamental skills for team functioning and shared decision making among team members (e.g. "using monitoring systems appropriately," "describing general systems to support clinical care") had the highest level of difficulty, and "demonstrating basic technology skills" had the lowest difficulty level. Most items reflect informatics competencies relevant to all health professionals. Further, the approaches can be applied to construct a new hierarchical scale or refine an existing scale related to informatics attitudes or competencies for various health professions.

  13. Cutaneous osteosarcoma arising from a burn scar

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min A.; Yi, Jaehyuck [Kyungpook National University, Department of Radiology, College of Medicine, Daegu (Korea, Republic of); Kyungpook National University Hospital, Department of Radiology, Daegu (Korea, Republic of); Chae, Jong Min [Kyungpook National University, Department of Pathology, College of Medicine, Daegu (Korea, Republic of)

    2017-04-15

    Tumors that develop in old burn scars are usually squamous cell carcinomas. Sarcomas have also been reported, albeit rarely. To our knowledge, there has been only one case report of an extraskeletal osteosarcoma arising in a prior burn scar reported in the English-language literature, mainly discussing the clinicopathological features. Herein, we present a case of cutaneous osteosarcoma visualized as a mineralized soft-tissue mass arising from the scar associated with a previous skin burn over the back. This seems to be the first report describing the imaging features of a cutaneous osteosarcoma from an old burn scar. (orig.)

  14. Formative Classroom Assessment and Large-Scale Assessment: Toward a More Balanced System

    Directory of Open Access Journals (Sweden)

    Felipe Martínez Rizo

    2009-11-01

    Full Text Available Given the proliferation of large-scale standardized tests that has occurred in Mexico in recent years, this article constitutes a review of the international literature on the subject for the purpose of reflecting on the possible consequences of this phenomenon and exploring the progress of alternative assessment approaches. It also reviews the development of concepts related to formative classroom assessment, and summarizes current thinking on this subject. It emphasizes the importance of such approaches for improving educational quality. In conclusion, it argues that it is necessary to move toward assessment systems that combine large-scale assessment and classroom assessment in a more balanced fashion.

  15. Ruptured Cesarean Scar Ectopic Pregnancy

    OpenAIRE

    Sujatha BS; Sunanda Bharatnur; Samarth Virmani; Shripad Hebbar; Arijit Bishnu

    2017-01-01

    A pregnancy with implantation on the scar of a past cesarean section is uncommon. However such pregnancies are on the rise due to the increasing number of lower segment cesarean section. One of the complications of such a pregnancy is uterine rupture in early pregnancy which can be life threatening to the patient. The following is a report of a patient who presented at 10 weeks of gestational age with features of hypovolemic shock and lower position of the gestational sac in relation to the u...

  16. Papular Acne Scars of the Nose and Chin: An Under-recognised Variant of Acne Scarring

    OpenAIRE

    Ali, Faisal R; Michael Kirk; Vishal Madan

    2016-01-01

    Background: Scarring following acne vulgaris is common and can be of profound psychosocial consequence. Aims and Objectives: We have clinically noted a variant of acne scarring, overlooked by previous categorisation schemes, which we have denominated as papular acne scars of the nose and chin. We sought to characterise these novel entities further. Materials and Methods: Initially, we identified 14 patients with papular acne scars of the nose and chin in a cosmetic dermatology clinic, of whom...

  17. Ecohydrological modeling for large-scale environmental impact assessment.

    Science.gov (United States)

    Woznicki, Sean A; Nejadhashemi, A Pouyan; Abouali, Mohammad; Herman, Matthew R; Esfahanian, Elaheh; Hamaamin, Yaseen A; Zhang, Zhen

    2016-02-01

    Ecohydrological models are frequently used to assess the biological integrity of unsampled streams. These models vary in complexity and scale, and their utility depends on their final application. Tradeoffs are usually made in model scale, where large-scale models are useful for determining broad impacts of human activities on biological conditions, and regional-scale (e.g. watershed or ecoregion) models provide stakeholders greater detail at the individual stream reach level. Given these tradeoffs, the objective of this study was to develop large-scale stream health models with reach level accuracy similar to regional-scale models thereby allowing for impacts assessments and improved decision-making capabilities. To accomplish this, four measures of biological integrity (Ephemeroptera, Plecoptera, and Trichoptera taxa (EPT), Family Index of Biotic Integrity (FIBI), Hilsenhoff Biotic Index (HBI), and fish Index of Biotic Integrity (IBI)) were modeled based on four thermal classes (cold, cold-transitional, cool, and warm) of streams that broadly dictate the distribution of aquatic biota in Michigan. The Soil and Water Assessment Tool (SWAT) was used to simulate streamflow and water quality in seven watersheds and the Hydrologic Index Tool was used to calculate 171 ecologically relevant flow regime variables. Unique variables were selected for each thermal class using a Bayesian variable selection method. The variables were then used in development of adaptive neuro-fuzzy inference systems (ANFIS) models of EPT, FIBI, HBI, and IBI. ANFIS model accuracy improved when accounting for stream thermal class rather than developing a global model. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Suppressed inflammatory gene expression during human hypertrophic scar compared to normotrophic scar formation

    NARCIS (Netherlands)

    van den Broek, L.J.; van der Veer, W.M.; de Jong, E.H.; Gibbs, S.; Niessen, F.B.

    2015-01-01

    Hypertrophic scar formation is a result of adverse cutaneous wound healing. The pathogenesis of hypertrophic scar formation is still poorly understood. A problem next to the lack of suitable animal models is that often normal skin is compared to hypertrophic scar (HTscar) and not to normotrophic

  19. Assessment scale of risk for surgical positioning injuries.

    Science.gov (United States)

    Lopes, Camila Mendonça de Moraes; Haas, Vanderlei José; Dantas, Rosana Aparecida Spadoti; Oliveira, Cheila Gonçalves de; Galvão, Cristina Maria

    2016-08-29

    to build and validate a scale to assess the risk of surgical positioning injuries in adult patients. methodological research, conducted in two phases: construction and face and content validation of the scale and field research, involving 115 patients. the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning contains seven items, each of which presents five subitems. The scale score ranges between seven and 35 points in which, the higher the score, the higher the patient's risk. The Content Validity Index of the scale corresponded to 0.88. The application of Student's t-test for equality of means revealed the concurrent criterion validity between the scores on the Braden scale and the constructed scale. To assess the predictive criterion validity, the association was tested between the presence of pain deriving from surgical positioning and the development of pressure ulcer, using the score on the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (pDesarrollo de Lesiones Debidas al Posicionamiento Quirúrgico contiene siete ítems, siendo que cada uno presenta cinco subítems. La puntuación de esa escala varia de siete a 35 puntos en que, cuanto mayor la puntuación, mayor el riesgo del paciente. El Índice de Validez de Contenido de la escala fue 0,88. Mediante la aplicación de la prueba t de Student, para igualdad de medias, fue constatada validez de criterio concurrente entre los scores de la escala de Braden y de la escala construida. Para evaluar la validez de criterio predictiva, fue testada la asociación de la presencia de dolor debido al posicionamiento quirúrgico y el desarrollo de úlcera por presión con el score de la Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Debidas al Posicionamiento Quirúrgico (p<0,001). La confiabilidad interobservadores fue verificada mediante el coeficiente de correlación intraclase, cuyo valor alcanzado fue 0,99 (p<0,001). la escala es un

  20. Fractional CO(2) laser treatment vs autologous fat transfer in the treatment of acne scars: a comparative study.

    Science.gov (United States)

    Azzam, Omar A; Atta, Ahmed T; Sobhi, Rehab M; Mostafa, Pakinam I N

    2013-01-01

    Acne scars present a highly challenging and frustrating clinical problem. Fractional CO2 laser treatment has led to marked improvement in scars, and fat transfer, or fat grafting, has also recently proven very useful in regenerative medicine. To compare fractional CO2 laser treatment and fat grafting in the treatment of acne scars. Twenty patients were included in this study, 10 received 3 sessions of fractional CO2 laser therapy, and 10 received fat grafting. All patients were then followed up for 3 months, and results were assessed with digital photographs taken by a committee of 3 physicians, by a single-blinded physician, and by reports of patient satisfaction. In the fractional CO2 laser treatment group, under 20% of patients were graded as having excellent scar improvement, 0 as having marked scar improvement, under 10% as having mild scar improvement, and almost 70% as having moderate scar improvement. In the fat-grafting group, the scar and overall improvement were graded as 30% excellent, 30% marked, 20% moderate, and 20% mild. Fat grafting proved to be more effective in the treatment of acne scars than ablative fractional CO2 laser treatment. There were many points in its favor, the most significant being the clinical improvement in scars and texture. This supports the stem cell theory of adipose tissue in regenerative medicine.

  1. Validation of Mini Nutritional Assessment Scale in peritoneal dialysis patients.

    Science.gov (United States)

    Brzosko, Szymon; Hryszko, Tomasz; Kłopotowski, Mariusz; Myśliwiec, Michał

    2013-08-30

    Malnutrition is a negative predictive factor for survival in end stage renal disease (ESRD) patients. Coincidence of malnutrition, inflammation and atherosclerosis (MIA syndrome) in the dialysis population is an exceptionally poor outcome event. Due to flexibility, ease of performance and reproducibility, clinical scales are of particular value in assessment of nutritional status in ESRD patients. The aim of the present study was to evaluate the clinical value of Mini Nutritional Assessment (MNA) in peritoneal dialysis (PD) patients. Nutritional status was assessed in 41 peritoneal dialysis patients by means of the MNA scale and malnutrition inflammation score (MIS). Some other clinical and laboratory parameters associated with nutritional status were analyzed. Patients were followed up for 30 months. In the analyzed group of patients a good nutritional state was diagnosed in 22 patients (54%), risk of malnutrition in 17 (41%) and malnutrition in 2 patients (5%) based on the MNA scale. A strong correlation between MNA based nutritional status and MIS was found (r = -0.85, p assessment of nutritional status in peritoneal dialysis patients. Risk of malnutrition and malnutrition diagnosed by MNA identifies patients at high mortality risk.

  2. Twelve tips for assessing surgical performance and use of technical assessment scales

    DEFF Research Database (Denmark)

    Strandbygaard, Jeanett; Scheele, Fedde; Sørensen, Jette Led

    2017-01-01

    Using validated assessment scales for technical competence can help structure and standardize assessment and feedback for both the trainee and the supervisor and thereby avoid bias and drive learning. Correct assessment of operative skills can establish learning curves and allow adequate monitoring....... However, the assessment of surgical performance is not an easy task, since it includes many proxy parameters, which are hard to measure. Although numerous technical assessment scales exist, both within laparoscopic and open surgery, the validity evidence is often sparse, and this can raise doubts about...... reliability and educational outcome. Furthermore, the implementation of technical assessment scales varies due to several obstacles and doubts about accurate use. In this 12-tips article, we aim to give the readers a critical and useful appraisal of some of the common questions and misunderstandings regarding...

  3. Physiological Implications of Myocardial Scar Structure.

    Science.gov (United States)

    Richardson, William J; Clarke, Samantha A; Quinn, T Alexander; Holmes, Jeffrey W

    2015-09-20

    Once myocardium dies during a heart attack, it is replaced by scar tissue over the course of several weeks. The size, location, composition, structure, and mechanical properties of the healing scar are all critical determinants of the fate of patients who survive the initial infarction. While the central importance of scar structure in determining pump function and remodeling has long been recognized, it has proven remarkably difficult to design therapies that improve heart function or limit remodeling by modifying scar structure. Many exciting new therapies are under development, but predicting their long-term effects requires a detailed understanding of how infarct scar forms, how its properties impact left ventricular function and remodeling, and how changes in scar structure and properties feed back to affect not only heart mechanics but also electrical conduction, reflex hemodynamic compensations, and the ongoing process of scar formation itself. In this article, we outline the scar formation process following a myocardial infarction, discuss interpretation of standard measures of heart function in the setting of a healing infarct, then present implications of infarct scar geometry and structure for both mechanical and electrical function of the heart and summarize experiences to date with therapeutic interventions that aim to modify scar geometry and structure. One important conclusion that emerges from the studies reviewed here is that computational modeling is an essential tool for integrating the wealth of information required to understand this complex system and predict the impact of novel therapies on scar healing, heart function, and remodeling following myocardial infarction. Copyright © 2015 John Wiley & Sons, Inc.

  4. Confirmatory Factor Analysis of the Procrastination Assessment Scale for Students

    Directory of Open Access Journals (Sweden)

    Ronald D. Yockey

    2015-10-01

    Full Text Available The relative fit of one- and two-factor models of the Procrastination Assessment Scale for Students (PASS was investigated using confirmatory factor analysis on an ethnically diverse sample of 345 participants. The results indicated that although the two-factor model provided better fit to the data than the one-factor model, neither model provided optimal fit. However, a two-factor model which accounted for common item theme pairs used by Solomon and Rothblum in the creation of the scale provided good fit to the data. In addition, a significant difference by ethnicity was also found on the fear of failure subscale of the PASS, with Whites having significantly lower scores than Asian Americans or Latino/as. Implications of the results are discussed and recommendations made for future work with the scale.

  5. Developing a scale to assess health regulatory focus.

    Science.gov (United States)

    Ferrer, Rebecca A; Lipkus, Isaac M; Cerully, Jennifer L; McBride, Colleen M; Shepperd, James A; Klein, William M P

    2017-11-13

    Regulatory focus (i.e., focus on motivation to achieve gains or avoid losses and non-gains) is used to tailor health behavior change interventions, improving efficacy, but is currently assessed by scales that are not health-specific and may capture a version of the construct that is not ideally matched to the rationale for tailoring. We developed and validated a Health Regulatory Focus Scale (HRFS), which assesses tendencies to avoid negative health consequences (prevention focus) or achieve positive health outcomes (promotion focus). Across four studies (and a scale development study in supplementary online materials), we established convergent, discriminant, and predictive validity for the HRFS. In studies examining predictive validity, main outcome measures were health behavior intentions, including intentions to reduce alcohol use, quit smoking, eat a healthy diet, exercise, be screened for cancer, and engage in general cancer preventive behaviors. The promotion and prevention sub-scales performed well in confirmatory factor analyses. Single-factor models had significantly poorer fit than models delineating promotion and prevention. The sub-scales were differentially (and only modestly) correlated with related constructs (anxiety, optimism, information avoidance, ambiguity/fatalism). Higher HRFS-Promotion focus generally corresponded with greater health behavior intentions. Conversely, higher HRFS-Prevention focus corresponded with lower health behavior intentions. Associations were largely maintained even when controlling for established regulatory focus measures, supporting the assertion that the HRFS would predict unique variance in health behavior intentions. The HRFS has the potential to improve the precision with which framed health messages change behavior, as it may assess a version of regulatory focus that is more ideally matched to rationale for tailoring interventions. Copyright © 2017. Published by Elsevier Ltd.

  6. Simplifying Fibromyalgia Assessment: The VASFIQ Brief Symptom Scale.

    Science.gov (United States)

    Boomershine, Chad S; Emir, Birol; Wang, Yi; Zlateva, Gergana

    2011-10-01

    We tested the ability of the VASFIQ, a seven-item scale composed of Fibromyalgia Impact Questionnaire (FIQ) visual analog scales (VASs), to quantify fibromyalgia global disease severity and identify fibromyalgia patients with significant symptoms of fatigue, poor sleep, depression or anxiety. Spearman rank correlations were used to compare global VASFIQ, FIQ and Patient Global Impression of Change (PGIC) scores and individual FIQ VAS scores with full-length, validated questionnaire scores for fatigue (Multidimensional Assessment of Fatigue-Global Fatigue Index [MAF-GFI]), poor sleep (Medical Outcomes Study Sleep Problems Index [SPI]) and depression and anxiety (Hospital Anxiety and Depression Scale [HADS]). Patient scores used in the analyses were derived from 2229 patients enrolled in three pregabalin fibromyalgia trials. Receiver operating characteristic analyses determined VASFIQ cutoff scores identifying patients with clinically significant symptom levels using full-length, validated symptom questionnaires to define cases. Global VASFIQ and FIQ scores correlated highly at baseline and study endpoints (ρ = 0.94 and 0.97, respectively; both p7.5, poor sleep by VASsleep >7.9, depression by VASdepression >5.8 and anxiety by VASanxiety >6.0. VASFIQ global scores ≥31.4 and ≥45.0 identified patients with moderate and severe global fibromyalgia symptoms, respectively. The VASFIQ scale accurately quantifies global fibromyalgia severity and identifies patients with significant symptoms of fatigue, poor sleep, depression or anxiety with brevity, enabling rapid patient assessment and informing treatment decisions in busy clinics.

  7. Validity of occupational stress assessment using a visual analogue scale.

    Science.gov (United States)

    Lesage, F X; Berjot, S

    2011-09-01

    The visual analogue scale (VAS) is empirically used by occupational physicians to assess stress but very few studies have been published about its quantitative validation. To assess the external validity of the VAS for the assessment of stress in the clinical occupational health setting by comparing its scores with the Perceived Stress Scale (PSS) of Cohen. An anonymous self-completed questionnaire (PSS14) and the VAS were filled in by a random sample of 360 workers from several occupational health centres. No difference between the mean scores of PSS14 and stress VAS was found. The equation of the linear regression was 'VAS score = -0.18 + 1008 × PSS14 score'. A VAS score of 7.0 was identified as having the best sensitivity/specificity ratio (0.74 and 0.93, respectively) for identifying those with 'high stress' using the PSS cut-off score of 7.2, using a receiver operator curve approach. Our results support an acceptable agreement between the two tests, meaning that the two tools assess the same psychological construct. The good sensitivity/specificity ratio and the area under the curve close to 1 provide evidence that a VAS is suitable to help the occupational physician detect a high level of stress. The use of a VAS for stress assessment seems to be meaningful, suitable and useful for occupational physicians.

  8. An assessment scale for trainee engagement in the Portuguese navy

    OpenAIRE

    Frade, Ana; Veiga, Feliciano

    2014-01-01

    In this study an Assessment Scale for Trainee Engagement in the Portuguese Navy (ASTE-PN) was designed for the Portuguese military context. The sample involved 149 trainees of the Training Course for Petty Officers 1st Class of the Portuguese Navy, ages ranging from 25 to 36, mostly of male gender. The psychometric properties of the study are presented and the results from the factor analysis displayed, which highlighted three factors – cognitive engagement, affective engagement and behavi...

  9. Computing Sampling Weights in Large-scale Assessments in Education

    OpenAIRE

    Meinck, Sabine

    2015-01-01

    Sampling weights are a reflection of sampling design; they allow us to draw valid conclusions about population features from sample data. This paper explains the fundamentals of computing sampling weights for large-scale assessments in educational research. The relationship between the nature of complex samples and best practices in developing a set of weights to enable computation of unbiased population estimates is described. Effects of sampling weights on estimates are shown...

  10. Prevention and curative management of hypertrophic scar formation

    NARCIS (Netherlands)

    Bloemen, M.C.; Veer, van der W.M.; Ulrich, M.; Zuijlen, van P.P.; Niessen, F.B.; Middelkoop, E.

    2009-01-01

    Although hypertrophic scarring commonly occurs following burns, many aspects such as incidence of and optimal treatment for scar hypertrophy remain unclear. This review will focus on hypertrophic scar formation after burn in particular, exploring multiple treatment options and describing their

  11. Cutaneous leiomyosarcoma arising in a smallpox scar

    NARCIS (Netherlands)

    Pol, Robert A.; Dannenberg, Hilde; Robertus, Jan-Lukas; van Ginkel, Robert J.

    2012-01-01

    Background: Cutaneous leiomyosarcoma (CLM) is a very rare smooth muscle tumour that accounts for about 2-3% of all superficial soft tissue sarcomas. Although the development of various malignancies in scar tissue is well known, we report the first case of a CLM developing in a small pox scar. Case

  12. Answers to Common Questions about Scars

    Science.gov (United States)

    ... or more level with the surrounding skin. Another treatment that might be recommended is dermabrasion, a process of sanding down the scar surface, again in an effort to make it more level with the surrounding skin. What is a keloid? A keloid is a tumor of scar tissue ...

  13. Recurrent Carcinoma in Mastectomy Scars | Onuigbo | International ...

    African Journals Online (AJOL)

    Aim: To study the patterns of recurrence of carcinoma in mastectomy scars. Methods: A 30?year retrospective analysis was carried out as regards surgical specimens . of mastectomy scars received by the author from numerous surgeons working in several hospitals with special reference to patients of the Igbo ethnic group.

  14. Effect of intense pulsed light on immature burn scars: A clinical study

    Directory of Open Access Journals (Sweden)

    Arindam Sarkar

    2014-01-01

    Full Text Available Introduction: As intense pulsed light (IPL is widely used to treat cutaneous vascular malformations and also used as non-ablative skin rejunuvation to remodel the skin collagen. A study has been undertaken to gauze the effect of IPL on immature burn scars with regard to vascularity, pliability and height. Materials and Methods: This study was conducted between June 2013 and May 2014, among patients with immature burn scars that healed conservatively within 2 months. Photographic evidence of appearance of scars and grading and rating was done with Vancouver Scar Scale parameters. Ratings were done for both case and control scar after the completion of four IPL treatment sessions and were compared. Results: Out of the 19 cases, vascularity, pliability and height improved significantly (P < 0.05 in 13, 14 and 11 scars respectively following IPL treatment. Conclusions: Intense pulsed light was well-tolerated by patients, caused good improvement in terms of vascularity, pliability, and height of immature burn scar.

  15. Linear and Nonlinear Theory of Eigenfunction Scars

    CERN Document Server

    Kaplan, L

    1998-01-01

    The theory of scarring of eigenfunctions of classically chaotic systems by short periodic orbits is extended in several ways. The influence of short-time linear recurrences on correlations and fluctuations at long times is emphasized. We include the contribution to scarring of nonlinear recurrences associated with homoclinic orbits, and treat the different scenarios of random and nonrandom long-time recurrences. The importance of the local classical structure around the periodic orbit is emphasized, and it is shown for an optimal choice of test basis in phase space, scars must persist in the semiclassical limit. The crucial role of symmetry is also discussed, which together with the nonlinear recurrences gives a much improved account of the actual strength of scars for given classical orbits and in individual wavefunctions. Quantitative measures of scarring are provided and comparisons are made with numerical data.

  16. Treatment of surgical scars using a 595-nm pulsed dye laser using purpuric and nonpurpuric parameters: a comparative study.

    Science.gov (United States)

    Gladsjo, Julie Akiko; Jiang, Shang I Brian

    2014-02-01

    Many studies have examined laser treatment of scars, but cosmetic results have been variable. Although no studies have examined the effect of purpura on scar improvement using the pulsed dye laser (PDL), many clinicians believe inducing purpura results in better and quicker improvement. To determine whether PDL treatment of fresh surgical scars with purpura-inducing settings improves clinical appearance more than non-purpura-inducing settings or no treatment. Twenty-six subjects with surgical scars enrolled in this prospective study. Scars were divided into three equal segments; treatment was randomized: 595-nm PDL with purpuric (1.5 ms) or nonpurpuric (10 ms) settings or no treatment. Fluences were adjusted to Fitzpatrick skin type. Scars were treated three times, 1 month apart, beginning at suture removal. Outcome measures included Vancouver Scar Scale (VSS) and blind clinical ratings. The nonpurpuric condition showed significant improvement on the VSS total score, vascularity, and pliability ratings. The purpuric condition demonstrated a trend for improvement on the VSS total. According to blind observer ratings, all conditions improved, without differences between groups. Nonpurpuric settings on the PDL resulted in significant improvements in the appearance of fresh surgical scars for vascularity, pliability, and VSS total scores, although all scar segments improved over time. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  17. [Is the suicidal risk assessment scale RSD of predictive value?].

    Science.gov (United States)

    Ducher, J L; Terra, J L

    2006-10-01

    A part (60% to 70%) of those who are going to act out their suicide consult a doctor the month before. Studies have shown the need to improve the practitioner's capacity to diagnose depression. The assessment of the suicidal risk is crucial. The search for suicidal risk factors helps to define the populations at risk. However, it doesn't provide information concerning the possibility of acting out in the short term. And how does one react when faced with those who do not present any of the risk factors? Psychometric instruments attempt to help the therapist in his/her reasoning. SUICIDAL RISK ASSESSMENT: Among them, the suicidal risk assessment scale RSD should be mentioned. Its objective is to estimate the seriousness of the suicidal risk, with 11 levels. It is built around a possible will to commit suicide rather than a single assessment of the frequency of suicidal ideas. Its construction in hierarchical order permits the progressive assessment of the suicidal risk, in the form of a semi-structured interview. Hence, the suicidal risk assessment scale RSD looks for the existence of death wishes (levels 1-2), of suicide ideations and its frequency (levels 3-4-5), and of a passive desire to die (level 6). Level 7 shows the onset of a decision making process, except that the patient is still inhibited by various important factors in his/her life. More often, the fear of inflicting immense suffering to his/her loved ones or for religious beliefs, is found. From level 8, determination has made way to hesitation. An active death wish exists, and although the plan remains undefined, the act is decided on. At level 9 the methods of application are developed and a plan is established. The ultimate level exists when there is a start in the preparation of the act of suicide (level 10). This hierarchical order has been confirmed by some epidemiological studies. The inclusion of the suicidal risk assessment scale RSD in a double-blind, placebo-controlled study, which tested

  18. Preferences in Individuals with Angelman Syndrome Assessed by a Modified Choice Assessment Scale

    Science.gov (United States)

    Didden, R.; Korzilius, H.; Kamphuis, A.; Sturmey, P.; Lancioni, G.; Curfs, L. M. G.

    2006-01-01

    Background: Individuals with Angelman syndrome (AS) seem to have a strong preference for water-related items. Until present, preference assessment in AS has not been reported. Methods: An adapted Dutch version of the Choice Assessment Scale (CAS) was administered by parents and other caregivers to 105 individuals with AS. The CAS was adapted by…

  19. A Scale for Assessing the Severity of Arousal Disorders

    Science.gov (United States)

    Arnulf, Isabelle; Zhang, Bin; Uguccioni, Ginevra; Flamand, Mathilde; Noël de Fontréaux, Alix; Leu-Semenescu, Smaranda; Brion, Agnès

    2014-01-01

    Background: Arousal disorders may have serious health consequences. Objective: To develop a scale assessing the severity of arousal disorders (Paris Arousal Disorders Severity Scale, PADSS). Setting: University hospital. Design: Controlled study. Participants: Consecutive patients (older than 15 y), with sleepwalking (SW) and/or sleep terrors (ST), subjects with previous SW/ST, normal controls and patients with rapid eye movement sleep behavior disorder. Intervention: The self-rated scale listed 17 parasomniac behaviors (PADSS-A), assessed their frequency from never to twice or more per night (PADSS-B) and evaluated the consequences (PADSS-C: disturbed sleep, injuries, fatigue, and psychological consequences). The clinimetric properties and face validity of the scale were tested. Results: Half of the 73 patients with SW/ST (more men than women) had injured themselves or others, whereas 15% had concomitant sexsomnia and 23% had amnestic eating behaviors. The total PADSS score (range: 0-50) was 19.4 ± 6.3 (range: 8-36) in this group, 11.7 ± 5.9 in 26 subjects with previous SW/ST, 8.8 ± 3.2 in 26 patients with RBD, and 2.0 ± 3.5 in 53 normal controls (P < 0.05). The PADSS demonstrated high sensitivity (83.6%), specificity (87.8%), internal consistency, and test-retest reliability (0.79). The best cutoff for the total score was at 13/14. Exploratory factor analysis revealed two components: wandering and violence/handling. The complexity of behaviors emerging from N3 sleep (scored on videopolysomnography) positively correlated with scores for the PADSS-total, PADSS-A, PADSS-C, and the “violence/handling” factor. Conclusion: This scale had reasonable psychometric properties and could be used for screening and stratifying patients and for evaluating the effects of treatments. Citation: Arnulf I; Zhang B; Uguccioni G; Flamand M; Noël de Fontréaux A; Leu-Semenescu S; Brion A. A scale for assessing the severity of arousal disorders. SLEEP 2014;37(1):127-136. PMID

  20. Assessing organizational climate: psychometric properties of the CLIOR Scale.

    Science.gov (United States)

    Peña-Suárez, Elsa; Muñiz, José; Campillo-Álvarez, Angela; Fonseca-Pedrero, Eduardo; García-Cueto, Eduardo

    2013-02-01

    Organizational climate is the set of perceptions shared by workers who occupy the same workplace. The main goal of this study is to develop a new organizational climate scale and to determine its psychometric properties. The sample consisted of 3,163 Health Service workers. A total of 88.7% of participants worked in hospitals, and 11.3% in primary care; 80% were women and 20% men, with a mean age of 51.9 years (SD= 6.28). The proposed scale consists of 50 Likert-type items, with an alpha coefficient of 0.97, and an essentially one-dimensional structure. The discrimination indexes of the items are greater than 0.40, and the items show no differential item functioning in relation to participants' sex. A short version of the scale was developed, made up of 15 items, with discrimination indexes higher than 0.40, an alpha coefficient of 0.94, and its structure was clearly one-dimensional. These results indicate that the new scale has adequate psychometric properties, allowing a reliable and valid assessment of organizational climate.

  1. Risk of Scar in the Comparison of Age-related Macular Degeneration Treatments Trials

    Science.gov (United States)

    Daniel, Ebenezer; Toth, Cynthia A.; Grunwald, Juan E.; Jaffe, Glenn J.; Martin, Daniel F.; Fine, Stuart L.; Huang, Jiayan; Ying, Gui-shuang; Hagstrom, Stephanie A.; Winter, Katrina; Maguire, Maureen G.

    2013-01-01

    Objective To describe risk factors for scar in eyes treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD). Design Prospective cohort study within a randomized clinical trial. Participants Patients with no scar on color fundus photography (CFP) or fluorescein angiography (FA) at enrollment in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Methods Eyes were assigned to ranibizumab or bevacizumab treatment and to 1 of 3 dosing regimens for 2 years. Masked readers assessed CFP and FA. Baseline demographic characteristics, visual acuity, morphologic features on photography and optical coherence tomography (OCT), and genotypes associated with AMD risk were evaluated as risk factors using adjusted hazard ratios (aHRs) and associated 95% confidence intervals (CIs). Scars were classified as fibrotic with well-demarcated elevated mounds of yellowish white tissue or nonfibrotic with discrete flat areas of hyperpigmentation with varying amounts of central depigmentation. Main Outcome Measures Scar formation. Results Scar developed in 480 of 1059 eyes (45.3%) by 2 years. Baseline characteristics associated with greater risk of scarring were predominantly classic choroidal neovascularization (CNV) (aHR, 3.1; CI, 2.4–3.9) versus occult CNV, blocked fluorescence (aHR, 1.4; CI, 1.1–1.8), foveal retinal thickness >212 μm (aHR, 2.4; CI, 1.7–3.6) versus 275 μm (aHR, 2.4; CI, 1.7–3.6) versus ≤75 μm, foveal subretinal fluid (aHR, 1.5; CI, 1.1–2.0) versus no subretinal fluid, and subretinal hyperreflective material (SHRM) (aHR, 1.7; CI, 1.3–2.3) versus no SHRM. Eyes with elevation of the retinal pigment epithelium had lower risk (aHR, 0.6; CI, 0.5–0.8) versus no elevation. Drug, dosing regimen, and genotype had no statistically significant association with scarring. Fibrotic scars developed in 24.7% of eyes, and nonfibrotic scars developed in 20.6% of eyes. Baseline risk factors for the scar types

  2. Psychometric assessment of the Correa-Barrick Postpartum Depression Scale.

    Science.gov (United States)

    Barrick, Christina; Kent, Vicky; Crusse, Elizabeth; Taylor, Dianne

    2012-12-10

    Empirical evidence has suggested an association between mood and color sensitivity. The purpose of this study is to report on the psychometric properties of a new postpartum depression rating scale while at the same time showing a correlation between depression severity and impaired color sensitivity. Using a survey design of a sample of 17 postpartum patients, color sensitivity was assessed by the patient's response to a self-report depression scale item, "I notice that everything seems gray/cloudy/drab/lacking color". There was a statistically significant finding between color sensitivity and depression, r=.50, Pdepression for prompt intervention. Referral should be made to mental health providers for follow-up to insure that the mother is not psychotic or so depressed that she cannot care for the baby. Color sensitivity impairment and depression severity has been replicated several times with different samples. It is worthwhile pursuing the pathophysiological basis for this. Copyright © 2012. Published by Elsevier B.V.

  3. Poor scar formation after ablation is associated with atrial fibrillation recurrence.

    Science.gov (United States)

    Parmar, Bhrigu R; Jarrett, Tyler R; Kholmovski, Eugene G; Hu, Nan; Parker, Dennis; MacLeod, Rob S; Marrouche, Nassir F; Ranjan, Ravi

    2015-12-01

    Patients routinely undergo ablation for atrial fibrillation (AF) but the recurrence rate remains high. We explored in this study whether poor scar formation as seen on late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) correlates with AF recurrence following ablation. We retrospectively identified 94 consecutive patients who underwent their initial ablation for AF at our institution and had pre-procedural magnetic resonance angiography (MRA) merged with left atrial (LA) anatomy in an electroanatomic mapping (EAM) system, ablated areas marked intraprocedurally in EAM, 3-month post-ablation LGE-MRI for assessment of scar, and minimum of 3-months of clinical follow-up. Ablated area was quantified retrospectively in EAM and scarred area was quantified in the 3-month post-ablation LGE-MRI. With the mean follow-up of 336 days, 26 out of 94 patients had AF recurrence. Age, hypertension, and heart failure were not associated with AF recurrence, but LA size and difference between EAM ablated area and LGE-MRI scar area was associated with higher AF recurrence. For each percent higher difference between EAM ablated area and LGE-MRI scar area, there was a 7-9% higher AF recurrence (p values 0.001-0.003) depending on the multivariate analysis. In AF ablation, poor scar formation as seen on LGE-MRI was associated with AF recurrence. Improved mapping and ablation techniques are necessary to achieve the desired LA scar and reduce AF recurrence.

  4. Left ventricular scar impact on left ventricular synchronization parameters and outcomes of cardiac resynchronization therapy.

    Science.gov (United States)

    Ahmed, Walid; Samy, Wael; Tayeh, Osama; Behairy, Noha; Abd El Fattah, Alia

    2016-11-01

    Left ventricular scar, including global scar and lateral wall, plays an important role in predicting response to cardiac resynchronization therapy (CRT). Thirty patients underwent CRT implantation. Assessment of left ventricular (LV) dyssynchrony was done through Gated SPECT LV phase analysis. Pre-implantation cardiac magnetic resonance (CMR) with late gadolinium enhancement technique to examine LV scar burden. Echocardiographic examination of LV end-systolic volume (LVES) prior to CRT and 6 months later. Thirty patients received CRT (mean age 58.7±9.0, 24 males). Reverse LV remodeling (decline ≥15% from baseline VES) was documented in 19 patients. Temporal changes in LV dyssynchrony parameters were correlated to LV reverse remodeling. Applying ROC for predicting CRT non-response showed a cutoff 36.5% of global LV scar burden had a sensitivity of 81.8% and specificity of 68.4%. A cutoff for lateral wall scar burden 40.5% of whole lateral wall had a sensitivity of 72.7% and specificity of 68.4%. Reverse LV remodeling is associated with temporal improvements in LV dyssynchrony parameters. LV scar had an unfavorable impact on CRT response. Both global and lateral wall scar burden could predict CRT nonresponse status. Copyright © 2016. Published by Elsevier Ireland Ltd.

  5. Assessment of commonly used pediatric stool scales: a pilot study.

    Science.gov (United States)

    Saps, M; Nichols-Vinueza, D; Dhroove, G; Adams, P; Chogle, A

    2013-01-01

    The Bristol Stool Form Scale (BSFS) and a modified child-friendly version (M-BSFS) are frequently used in clinical practice and research. These scales have not been validated in children. 3-D stool scale models may be better adapted to the child's development. To assess the usefulness of the BSFS, M-BSFS, and a newly developed 3-D stool scale in children. Fifty children were asked to rank the picture cards of the BSFS and 3-D models from hardest to softest and to match the pictures with descriptors for each stool type. Thirty percent of the children appropriately characterized the stools as hard, loose, or normal using the BSFS vs. 36.6% with the 3-D model (p=0.27). Appropriate correlation of stools as hard, loose, or normal consistency using the BSFS vs. the 3-D model by age group was: 6 to 11-year-olds, 27.5% vs. 33.3% (p=0.58) and 12 to 17-year-olds, 32.1% vs. 39.5% (p=0.41). Thirty-three percent correlated the BSFS pictures with the correct BSFS words, 46% appropriately correlated with the M-BSFS words, and 46% correlated the 3-D stool models with the correct wording. The BSFS and M-BSFS that are widely used as stool assessment instruments are not user-friendly for children. The 3-D model was not found to be better than the BSFS and the M-BSFS. Copyright © 2013 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  6. Laser and intense pulsed light therapy for the treatment of hypertrophic scars: a systematic review

    NARCIS (Netherlands)

    Vrijman, C.; van Drooge, A. M.; Limpens, J.; Bos, J. D.; van der Veen, J. P. W.; Spuls, P. I.; Wolkerstorfer, A.

    2011-01-01

    Hypertrophic scars are difficult to improve and remain a therapeutic challenge. Several lasers and light sources have been evaluated in the past decades and have been shown to improve hypertrophic scars. However, a systematic review is not available. To assess current evidence of efficacy of all

  7. Cutaneous leiomyosarcoma arising in a smallpox scar

    Science.gov (United States)

    2012-01-01

    Background Cutaneous leiomyosarcoma (CLM) is a very rare smooth muscle tumour that accounts for about 2–3% of all superficial soft tissue sarcomas. Although the development of various malignancies in scar tissue is well known, we report the first case of a CLM developing in a small pox scar. Case presentation A 66-year-old man presented with a painless, slow-growing lump in a small pox scar on his left shoulder. Histological biopsies showed the lesion to be a primary, well-differentiated cutaneous leiomyosarcoma. A CT scan of the thorax was conducted, which showed no signs of metastases. The complete lesion was then surgically excised, and histopathological examination revealed a radically excised cutaneous type leiomyosarcoma After 13 months’ review the patient was doing well with no evidence of tumour recurrence. Conclusions This is the first report of a CLM arising in a small pox scar. Although the extended time interval between scarring and malignant changes makes it difficult to advise strict follow-up for patients with small pox scars, one should be aware that atypical changes and/or symptoms occurring in a small pox scar could potentially mean malignant transformation. PMID:22799750

  8. Astrocyte scar formation aids CNS axon regeneration

    Science.gov (United States)

    Anderson, Mark A.; Burda, Joshua E.; Ren, Yilong; Ao, Yan; O’Shea, Timothy M.; Kawaguchi, Riki; Coppola, Giovanni; Khakh, Baljit S.; Deming, Timothy J.; Sofroniew, Michael V.

    2017-01-01

    Summary Transected axons fail to regrow in the mature central nervous system (CNS). Astrocyte scars are widely regarded as causal in this failure. Here, using three genetically targeted loss-of-function manipulations in adult mice, we show that preventing astrocyte scar formation, attenuating scar-forming astrocytes, or deleting chronic astrocyte scars all failed to result in spontaneous regrowth of transected corticospinal, sensory or serotonergic axons through severe spinal cord injury (SCI) lesions. In striking contrast, sustained local delivery via hydrogel depots of required axon-specific growth factors not present in SCI lesions, plus growth-activating priming injuries, stimulated robust, laminin-dependent sensory axon regrowth past scar-forming astrocytes and inhibitory molecules in SCI lesions. Preventing astrocyte scar formation significantly reduced this stimulated axon regrowth. RNA sequencing revealed that astrocytes and non-astrocyte cells in SCI lesions express multiple axon-growth supporting molecules. Our findings show that contrary to prevailing dogma, astrocyte scar formation aids rather than prevents CNS axon regeneration. PMID:27027288

  9. Cutaneous leiomyosarcoma arising in a smallpox scar.

    Science.gov (United States)

    Pol, Robert A; Dannenberg, Hilde; Robertus, Jan-Lukas; van Ginkel, Robert J

    2012-07-16

    Cutaneous leiomyosarcoma (CLM) is a very rare smooth muscle tumour that accounts for about 2-3% of all superficial soft tissue sarcomas. Although the development of various malignancies in scar tissue is well known, we report the first case of a CLM developing in a small pox scar. A 66-year-old man presented with a painless, slow-growing lump in a small pox scar on his left shoulder. Histological biopsies showed the lesion to be a primary, well-differentiated cutaneous leiomyosarcoma. A CT scan of the thorax was conducted, which showed no signs of metastases. The complete lesion was then surgically excised, and histopathological examination revealed a radically excised cutaneous type leiomyosarcoma After 13 months' review the patient was doing well with no evidence of tumour recurrence. This is the first report of a CLM arising in a small pox scar. Although the extended time interval between scarring and malignant changes makes it difficult to advise strict follow-up for patients with small pox scars, one should be aware that atypical changes and/or symptoms occurring in a small pox scar could potentially mean malignant transformation.

  10. Cutaneous leiomyosarcoma arising in a smallpox scar

    Directory of Open Access Journals (Sweden)

    Pol Robert A

    2012-07-01

    Full Text Available Abstract Background Cutaneous leiomyosarcoma (CLM is a very rare smooth muscle tumour that accounts for about 2–3% of all superficial soft tissue sarcomas. Although the development of various malignancies in scar tissue is well known, we report the first case of a CLM developing in a small pox scar. Case presentation A 66-year-old man presented with a painless, slow-growing lump in a small pox scar on his left shoulder. Histological biopsies showed the lesion to be a primary, well-differentiated cutaneous leiomyosarcoma. A CT scan of the thorax was conducted, which showed no signs of metastases. The complete lesion was then surgically excised, and histopathological examination revealed a radically excised cutaneous type leiomyosarcoma After 13 months’ review the patient was doing well with no evidence of tumour recurrence. Conclusions This is the first report of a CLM arising in a small pox scar. Although the extended time interval between scarring and malignant changes makes it difficult to advise strict follow-up for patients with small pox scars, one should be aware that atypical changes and/or symptoms occurring in a small pox scar could potentially mean malignant transformation.

  11. The discrete scar in prominent ear correction: a digital 3-dimensional analysis to determine the ideal incision for otoplasty.

    Science.gov (United States)

    Shokrollahi, Kayvan; Au-Yeung, Karen; Javed, Muhammad; Sadri, Amir; Molajo, Adeyinka; Lineaweaver, William

    2015-06-01

    Various postauricular incision sites can be used for prominent ear correction depending on technique and surgeon preference. No study has previously looked at the most aesthetic (least visible) location for the postauricular scar. We investigated the visibility of various scar locations on the posterior ear from a third person perspective through a "Visibility Arc"-a formal assessment of the range of degrees where a particular scar is visible. The objective was to determine the least visible incision-that is, the scar with the shortest visibility arc. Normal ears were marked with 3 different color markers to simulate postoperative scar position, namely, (1) black in auriculocephalic sulcus, (2) blue in the sulcus of the antihelical fold/groove, and (3) green between black and blue. Starting laterally from the right ear toward the left ear, each head was photographed across 180 degrees posteriorly, at 10-degree intervals to determine which colored line (corresponding to a particular scar location) was visible over what "visibility arc." Forty individual ears were analyzed. Scars located in the sulcus of the antihelical fold had the shortest average visible arc, which was a 70-degree arc. The auriculocephalic sulcus had the largest visibility arc, and was most obvious of all of the scar locations-a 100-degree arc. The scar location in between these 2 locations had an 80-degree arc. The least visible scar for pinnaplasty rests in the groove of the antihelix posteriorly, with scars slightly medial to this almost as discrete. The most visible scars when viewed from behind will be those in the "traditional" location of the auriculocephalic sulcus.

  12. A Social Development Assessment Scale for Mexican Children

    Directory of Open Access Journals (Sweden)

    Rocío Aguiar Sierra

    2005-05-01

    Full Text Available This work described the design of an instrument able to measure social development for Mexican children and the process of the establishment of its psychometric properties. Theoretical aspects considered for its construction and the process of validating forms for parents and teachers are described in a three stage processes that resulted in a final version of the Social Development Scale that measures, disruptive behavior, social interaction, cooperation, acceptance and attachment as core dimensions associated with the concept of social competence. The importance of assessing social development and competence for education, children rearing and general well being are analyzed and discussed.

  13. Comparison of high-energy pulsed carbon dioxide laser resurfacing and dermabrasion in the revision of surgical scars.

    Science.gov (United States)

    Nehal, K S; Levine, V J; Ross, B; Ashinoff, R

    1998-06-01

    Both dermabrasion and high-energy pulsed carbon dioxide (CO2) laser resurfacing can improve the appearance of surgical scars. Although the results of these two procedures have been compared using historical data, a prospective evaluation has never been performed in humans. To prospectively compare the clinical effects of dermabrasion and high-energy pulsed CO2 laser resurfacing in the revision of surgical scars. Facial surgical scars in four patients were prospectively revised using a split scar model. One half of the scar was dermabraded and the other half was resurfaced with the high-energy pulsed CO2 laser. Comparisons of the two treatment modalities were performed through clinical assessment, photographic evaluation, and textural analysis of the scars. The high-energy pulsed CO2 laser-resurfaced halves of the scar were bloodless with less postoperative crusting in comparison with the dermabraded halves. Reepithelialization time and degree and duration of postoperative erythema were similar for both treatment halves. Photographic evaluation and textural analysis showed comparable improvement in the clinical appearance and surface texture of the scars with both treatment modalities. Both the high-energy pulsed CO2 laser and dermabrasion can achieve comparable clinical improvement in the revision of surgical scars. The high-energy pulsed CO2 laser offers the advantage of a bloodless field and a more precise method of tissue ablation. Postoperative erythema, however, is an expected finding with both treatment modalities.

  14. A comparative study evaluating the clinical efficacy of skin tapes versus silicone gel for the treatment of posttrauma scar in the rabbit model

    Directory of Open Access Journals (Sweden)

    Chih-Chien Wang

    2014-01-01

    Full Text Available Background: Skin tape and silicone gel are two common over-the-counter preparations used to enhance the cosmesis of keloids and hypertrophic scars of posttrauma wounds. This animal study was performed to determine the clinical efficacy of skin tape versus silicone gel in subjects with scars. Materials and Methods: Three New Zealand rabbits that received total 12 incision wounds which two incision wounds on one ear side and subsequent primary suturing were studied. Stitches were removed after 1 week. Silicone gel was applied right upper side of the rabbit′s ear directly on surgical incision wounds, and skin tapes were also applied left upper side of the rabbit′s ear directly on another surgical incision wounds after 1 week of surgery. The lower incisions in both ears were covered with sterilized gauze and served as controls. We compared two experimental groups at binaural with using Vancouver Scar Scale, Manchester Scar Scale, and The Stony Brook Scar Evaluation Scale. These are widely used in clinical practice and research to document change in scar appearance. Results: We describe a rabbit model for incisional wounds and scarring outcome measures. The results of scar measuring devices demonstrated that skin tape reduced scar formation as well as silicone gel. Conclusions: The results of cosmetic demonstrated that skin tape reduced scar formation as well as silicone gel. However, the economical and effective materials were the important subject that suffices for clinical requirement. The application of these scar prevention devices to reduce scar formation after surgical incision is worthy of future investigation. Moreover, skin tape may represent a low-cost alternative and low scar formation for closure of surgical incisions.

  15. Fractional CO 2 laser resurfacing as monotherapy in the treatment of atrophic facial acne scars

    OpenAIRE

    Imran Majid; Saher Imran

    2014-01-01

    Background: While laser resurfacing remains the most effective treatment option for atrophic acne scars, the high incidence of post-treatment adverse effects limits its use. Fractional laser photothermolysis attempts to overcome these limitations of laser resurfacing by creating microscopic zones of injury to the dermis with skip areas in between. Aim: The aim of the present study is to assess the efficacy and safety of fractional CO 2 laser resurfacing in atrophic facial acne scars. Material...

  16. Relationship Between Scarring and Dog Aggression in Pit Bull-Type Dogs Involved in Organized Dogfighting

    Science.gov (United States)

    Miller, Katherine A.; Touroo, Rachel; Spain, C. Victor; Jones, Kelly; Reid, Pamela; Lockwood, Randall

    2016-01-01

    Simple Summary Organizations responsible for placing dogs seized from dogfighting investigations often must determine if a particular dog should be euthanized because it is too dangerous or if it is safe to place the dog in an adoptive home. In this study, we examine whether the extent of scarring from dog fighting is a reliable predictor of aggression towards other dogs and therefore could be used to help make that decision. We found that dogs with 10 or more scars in the three body zones where dogfighting injuries tend to be concentrated were more likely, on average, to show aggression to other dogs. The relationship is imperfect, however. Many unscarred dogs were dog aggressive while some highly scarred dogs were not. Therefore, we recommend also assessing a dog’s behavior before making decisions about its disposition. Abstract When pit bull-type dogs are seized in an investigation of organized dogfighting, heavily scarred dogs are often assumed to be highly dog aggressive due to a history of fighting. These dogs may be deemed dangerous and euthanized based on scarring alone. We analyzed our existing data on dogs seized from four dogfighting investigations, examining the relationship between the dogs’ scars with aggression towards other dogs. Scar and wound data were tallied in three body zones where dogfighting injuries tend to be concentrated. Dog aggression was assessed using a model dog and a friendly stimulus dog in a standardized behavior evaluation. Scarring and dog aggression were significantly related, more strongly among male (Fisher’s Exact p < 0.001) than female dogs (Fisher’s Exact p = 0.05). Ten or more scars in the three body zones was a reasonable threshold with which to classify a dog as high risk for dog aggression: 82% of males and 60% of females with such scarring displayed dog aggression. However, because many unscarred dogs were dog aggressive while some highly scarred dogs were not, we recommend collecting behavioral information to

  17. The Rendez-vous technique for treatment of caesarean scar defects: a novel combined endoscopic approach.

    Science.gov (United States)

    Nirgianakis, Konstantinos; Oehler, Robert; Mueller, Michael

    2016-02-01

    A caesarean scar defect is a late complication of caesarean birth with a wide range of prevalence between 56 and 84% depending on which diagnostic tool and which definition is used. The referred symptoms which include postmenstrual spotting and infertility are fortunately rare. Moreover, severe complications such as caesarean scar pregnancy and uterine rupture in the following pregnancy may occur. Given the increasing incidence of caesarean births, the potential morbidity associated with caesarean scars is likely to become more important. Recently, a few repair techniques were described in the literature including the hysteroscopic resection of scarred tissue or the laparoscopic repair with or without robotic assistance. Between June 2009 and February 2014, 21 women with caesarean scar defects were operated with the Rendez-vous technique, a minimally invasive surgery combining the laparoscopic and hysteroscopic approach. Data were retrospectively collected. The indications for this surgery included secondary infertility, previous caesarean scar pregnancy, recurrent miscarriage and postmenstrual spotting. Prior to operation, a transvaginal ultrasound was performed to examine the uterine wall defect. The patient characteristics are provided in Table 1. In all cases, the operation was successfully completed laparoscopically. The median operation time was 125 min. One case was complicated by recurrence of the scar defect 6 weeks after the operation. No other intra- or post-operative complications were observed, and the median in-patient stay was 3 days. The benefits of the technique include the feasibility and safety of the procedure, the "Halloween sign" (Fig. 1) which indicates the exact extent and localization of the scar defect and the immediate assessment of repair through the hysteroscopy at the end of the surgery. However, before further studies evaluate the efficacy of this method, the routine repair of caesarean scar defects cannot be recommended. A video of

  18. Resurfacing of pitted facial scars with a pulsed Er:YAG laser.

    Science.gov (United States)

    Kye, Y C

    1997-10-01

    Laser resurfacing has beneficial effects for the treatment of several skin conditions. Recently, the pulsed Er:YAG laser has been shown to be a highly effective treatment for several kinds of pitted facial scars. The purpose of this study was to assess the efficacy and safety of pulsed Er:YAG laser skin resurfacing for pitted facial scars. Four patients with small pox scars, five patients with chicken pox scars, and 21 patients with acne scars were included in this study. All patients were skin type III and IV. All patients were instructed to use tretinoin cream 0.05% nightly for 2-4 weeks prior to the laser treatment. The pulsed Er:YAG laser with 2-mm handpiece at the setting of 500 mJ/pulse, 3.5-4.5 W was used. Two weeks after laser treatment, topical application of hydroquinone 4%, tretinoin 0.05%, and hydrocortisone 1% cream was recommended for 2-4 weeks. Facial photographs were obtained at baseline and 2-week intervals postoperatively with a 35-mm single lense reflex camera equipped with a lense mounted ring flash. The results of treatment were evaluated for the changes of skin texture and color at 2 weeks, 1 month, and 3 months. Three patients with acne scars agreed to skin biopsy. Three months after laser treatment, all patients with small pox and chicken pox scars were improved about 55%, and patients with acne scars were improved about 40% on average. Pulsed Er:YAG laser skin resurfacing is an effective and safe treatment for pitted facial scars.

  19. Clinical efficacy of utilizing Ultrapulse CO2 combined with fractional CO2 laser for the treatment of hypertrophic scars in Asians-A prospective clinical evaluation.

    Science.gov (United States)

    Lei, Ying; Li, Shi Feng; Yu, Yi Ling; Tan, Jun; Gold, Michael H

    2017-06-01

    Hypertrophic scarring is seen regularly. Tissue penetration of laser energy into hypertrophic scars using computer defaults from some lasers may be insufficient and penetration not enough. We have developed a treatment with an interrupted laser "drilling" by the Ultrapulse CO2 (Manual Fractional Technology, MFT) and, a second pass, with fractional CO2 . The MFT with fractional CO2 lasers to treat hypertrophic scars is evaluated. A total of 158 patients with hypertrophic scars had three sessions of MFT with fractional CO2 laser at 3-month intervals. Evaluations made before and 6 months after the 3rd treatment: (1) the Vancouver Scar Scale (VSS), (2) the University of North Carolina (UNC) Scar Scale, and (3) a survey of patient satisfaction. All data were analyzed using a t-test before and after treatment. The VSS score decreased from 9.35 to 3.12 (PCO2 laser had profound effects on the hypertrophic scars treated. It works by increasing the penetration depth of the CO2 laser in the scar tissue, exerting more precise effects on the hypertrophic scars. MFT combined with fractional CO2 laser has the potential to be a major advance in the treatment of hypertrophic scars. © 2017 Wiley Periodicals, Inc.

  20. Flood risk assessment of potential casualties in a global scale

    Science.gov (United States)

    Diaz Loaiza, Andres; Englhardt, Johanna; Boekhorst, Ellen; Ward, Philip; Aerts, Jeroen

    2017-04-01

    Flood risk assessment of potential casualties in a global scale. M. Andres Diaz-Loaiza (1), Johanna Englhardt (1), Ellen de Boekhorst (1), Philip J. Ward (1) and Jeroen Aerts (1) (1) Institute for Environmental Studies, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands. andres.diazloaiza@vu.nl Floods are one of the most dangerous natural disasters for humanity, affecting many people every year. Quantitative risk models on a global scale are nowadays available tools for institutions and actors in charge of risk management in order to plan possible mitigation measures in case of flood risk events. Many of these models have been focus on potential economic damage, population and GDP exposure, but the potential casualties assessment has been left aside. This is partially due to the complexity of the problem itself, in which several variables like the age of a pedestrian (drag/exposed to a flood event), or his weight and swimming experience can be decisive for the complete understanding of the problem. In the present work is presented the advances for the development of a methodology in order to include in the GLOFRIS model a new indicator in case of flood risk events. Preliminary analysis relating the GDP with the potential casualties shows that undeveloped countries have more susceptibility to loss of life in case of flood events. This because the GDP indicator evidences as well the protection measures available in a country.

  1. The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants.

    Science.gov (United States)

    Birk, Nina Marie; Nissen, Thomas Nørrelykke; Ladekarl, Monica; Zingmark, Vera; Kjærgaard, Jesper; Jensen, Trine Mølbæk; Jensen, Signe Kjeldgaard; Thøstesen, Lisbeth Marianne; Kofoed, Poul-Erik; Stensballe, Lone Graff; Andersen, Andreas; Pryds, Ole; Nielsen, Susanne Dam; Benn, Christine Stabell; Jeppesen, Dorthe Lisbeth

    2017-08-03

    The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis is administered intradermally, and vaccination is often followed by a scar at the injection site. Among BCG-vaccinated individuals, having a scar has been associated with lower mortality. We aimed to examine the impact of vaccination technique for scarring in a high income setting, by assessing the associations between the post injection reaction, the wheal size, and the probability of developing a scar, and scar size. This study was nested within a clinical multicenter study randomizing 4262 infants to either BCG vaccination (BCG 1331 SSI) or no intervention. In this substudy, including 492 vaccinated infants, the immediate post BCG vaccination reaction was registered as either wheal (a raised, blanched papule at the injection site), bulge (a palpable element at the injection site), or no reaction. The presence or absence of a BCG scar and the size the scar was measured at 13 months of age. Of 492 infants included, 87% had a wheal after vaccination, 11% had a bulge, and 2% had no reaction. The mean wheal size was 3.8 mm (95% confidence interval 3.7-3.9). Overall, 95% (442/466, 26 lost to follow-up) of BCG-vaccinated infants had a scar at 13 months of age. In infants with a wheal, the probability of developing a scar was 96%, declining to 87% in the case of a bulge, and to 56% in the case of no reaction (p for same probability = 0.03). Wheal size was positively correlated with the probability of getting a scar and scar size. Scarring after BCG vaccination has been associated with lower infant mortality. In a high-income setting, we found that correct injection technique is highly important for the development of a BCG scar and that registration of the category of BCG skin reaction (as wheal, bulge, or no reaction) may be used to identify infants at risk of scar failure. Finally, the wheal size was positively associated with both the probability of getting a scar and scar size. The study was

  2. Identification of factors predicting scar outcome after burn injury in children: a prospective case-control study.

    Science.gov (United States)

    Wallace, Hilary J; Fear, Mark W; Crowe, Margaret M; Martin, Lisa J; Wood, Fiona M

    2017-01-01

    There is a lack of rigorous research investigating the factors that influence scar outcome in children. Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification. This study aimed to examine the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological co-morbidities (asthma, eczema and diabetes type 1 and type 2) and skin pigmentation (Fitzpatrick skin type). A prospective case-control study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure: scar height measured by a modified Vancouver Scar Scale (mVSS). The overall correct prediction rate of the model was 80.6%; 80.9% for children with raised scars (>1 mm) and 80.4% for children without raised scars (≤1 mm). After adjustment for other variables, each 1% increase in % total body surface area (%TBSA) of burn increased the odds of raised scar by 15.8% (95% CI = 4.4-28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR = 11.621; 95% CI = 3.727-36.234) and multiple surgical procedures (OR = 11.521; 1.994-66.566). Greater burn surface area, time to healing of longer than 14 days, and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors.

  3. Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation.

    Science.gov (United States)

    Hedelund, Lene; Haak, Christina S; Togsverd-Bo, Katrine; Bogh, Morten K; Bjerring, Peter; Haedersdal, Merete

    2012-08-01

    The treatment of acne scars with fractional CO(2) lasers is gaining increasing impact, but has so far not been compared side-by-side to untreated control skin. In a randomized controlled study to examine efficacy and adverse effects of fractional CO(2) laser resurfacing for atrophic acne scars compared to no treatment. Patients (n = 13) with atrophic acne scars in two intra-individual areas of similar sizes and appearances were randomized to (i) three monthly fractional CO(2) laser treatments (MedArt 610; 12-14 W, 48-56 mJ/pulse, 13% density) and (ii) no treatment. Blinded on-site evaluations were performed by three physicians on 10-point scales. Endpoints were change in scar texture and atrophy, adverse effects, and patient satisfaction. Preoperatively, acne scars appeared with moderate to severe uneven texture (6.15 ± 1.23) and atrophy (5.72 ± 1.45) in both interventional and non-interventional control sites, P = 1. Postoperatively, lower scores of scar texture and atrophy were obtained at 1 month (scar texture 4.31 ± 1.33, P scar texture 4.26 ± 1.97, P scar texture 3.89 ± 1.7, P scar texture to be mild or moderately improved. Adverse effects were minor. In this single-blinded randomized controlled trial we demonstrated that moderate to severe atrophic acne scars can be safely improved by ablative fractional CO(2) laser resurfacing. The use of higher energy levels might have improved the results and possibly also induced significant adverse effects. Copyright © 2012 Wiley Periodicals, Inc.

  4. The Thriving of Older People Assessment Scale: validity and reliability assessments.

    Science.gov (United States)

    Bergland, Ådel; Kirkevold, Marit; Sandman, Per-Olof; Hofoss, Dag; Edvardsson, David

    2015-04-01

    To explore construct validity and reliability of the Thriving of Older People Assessment Scale. The concept of thriving emphasizes person-environment interaction in relation to well-being. The Thriving of Older People Assessment Scale has been developed and evaluated as a self-report and proxy scale based on the theory of thriving. Cross-sectional survey design. The Thriving of Older People Assessment Scale was completed by a sample of 259 residents, 146 family members and 52 staff from 13 long-term care facilities in Norway and Sweden. Data were collected between April 2010-December 2011. Exploratory factor analysis was applied to explore construct validity in terms of factor structure and dimensionality of the 32-item scale in relation to the thriving theory. Reliability was explored through internal consistency estimation using Cronbach's alpha and through homogeneity evaluation using corrected item-total correlations. Exploratory factor analysis resulted in five factors (subscales) that corresponded meaningfully with the thriving theory and were labelled 1: Resident' attitudes towards being in long-term care; 2: Quality of care and caregivers; 3: Resident engagement and peer relationships; 4: Keeping in touch with people and places; and 5: Quality of the physical environment. The scale had satisfactory internal consistency and homogeneity estimates. The 32-item Thriving of Older People Assessment Scale can be regarded as construct valid and reliable. Its factor structure corresponded logically to the thriving theory and its factors showed satisfactory internal consistency and homogeneity. Nevertheless, the TOPAS would benefit from further testing in other populations and contexts. © 2014 John Wiley & Sons Ltd.

  5. Medical makeup for concealing facial scars.

    Science.gov (United States)

    Mee, Donna; Wong, Brian J F

    2012-10-01

    Surgical, laser, and pharmacological therapies are all used to correct scars and surgical incisions, though have limits with respect to how well facial skin can be restored or enhanced. The use of cosmetics has long been a relevant adjunct to all scar treatment modalities. In recent years, technical advancements in the chemistry and composition of cosmetic products have provided the patient with a broader range of products to employ for concealing scars. This review will provide an overview of contemporary methods for concealing facial scars, birthmarks, and pigmentary changes without the use of traditional/dated, heavy appearing camouflage products. Additionally, general guidelines and information will be provided with respect to identifying competent makeup artists for care of the medical patient. The article by no means is meant to be a tutorial, but rather serves as a starting point in this allied field of medicine. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Cesarean scar endometrioma: Case series

    Science.gov (United States)

    Çöl, Cavit; Yilmaz, Edip Erdal

    2014-01-01

    AIM: To evaluate endometrioma located at cesarean scatrix. METHODS: Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series. The diagnostic approaches and treatment is discussed. RESULTS: All patients had a painful mass located at abdominal scars with history of cesarean section. The ages ranged from 31 to 34 and Doppler ultrasonography (US) detected hypoechoic mass with a mean diameter of 30 mm. Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients. Treatment was achieved with surgical excision in 5 patients, and one is followed by hormone suppression therapy with gonadotropin. CONCLUSION: Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma. Imaging methods like doppler US, computed tomography and magnetic resonance imaging should be used for differential diagnosis. Definitive diagnosis can only be made histopathologically. The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences. PMID:24868512

  7. Measuring the impact of burn scarring on health-related quality of life: Development and preliminary content validation of the Brisbane Burn Scar Impact Profile (BBSIP) for children and adults.

    Science.gov (United States)

    Tyack, Zephanie; Ziviani, Jenny; Kimble, Roy; Plaza, Anita; Jones, Amber; Cuttle, Leila; Simons, Megan

    2015-11-01

    No burn-scar specific, health-related quality of life (HRQOL) measure exists. This study aimed to develop a patient-reported, evaluative HRQOL measure to assess the impact of burn scarring in children and adults. Semi-structured interviews, content validation surveys, and cognitive interviews were used to develop and test content validity of a new measure - the Brisbane Burn Scar Impact Profile (BBSIP). Participants comprised Australian adults (n=23) and children (n=19) with burn scarring; caregivers of children with burn scarring (n=28); and international scar management experts (n=14). Items distinct from other burn scar measures emerged. Four versions of the BBSIP were developed; one for children aged 8-18 years, one for adults, one for caregivers (as proxies for children aged less than 8-years), and one for caregivers of children aged 8-18 years. Preliminary content validity of the BBSIP was supported. Final items covered physical and sensory symptoms; emotional reactions; impact on social functioning and daily activities; impact of treatment; and environmental factors. The BBSIP was developed to assess burn-scar specific HRQOL and will be available at http://www.coolburns.com.au under a creative commons license. Further testing is underway. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  8. Inhibition of prolyl 4-hydroxylase reduces scar hypertrophy in a rabbit model of cutaneous scarring.

    Science.gov (United States)

    Kim, Injoong; Mogford, Jon E; Witschi, Claudia; Nafissi, Mehdi; Mustoe, Thomas A

    2003-01-01

    Hypertrophic scars result from excessive collagen deposition at sights of healing dermal wounds and can be functionally and cosmetically problematic. Pharmacological regulation of collagen synthesis and deposition is a direct approach to the control of scar tissue formation. We tested the ability of the phenanthrolinone derivative FG-1648 (in 0.5% Carbopol 971 PNF gel, pH 6.5), a prolyl 4-hydroxylase inhibitor, to reduce hypertrophic scar formation in a rabbit ear hypertrophic scar model. New Zealand White rabbits were divided into two treatment groups (n = 12 wounds per group with an equal number of controls): low-dose group: 0.5% FG-1648; high-dose group: 1% FG-1648. Left ears were used for treatment and right ear for control. Four 7-mm dermal ulcer wounds were made on each ear. The inhibitor was topically applied to the wound at the time of wounding and once daily up to postoperative day 7. Wounds were harvested at postoperative day 28 and scar hypertrophy quantified by measurement of the scar elevation index. All wounds showed complete healing. Treatment of wounds with 1% prolyl 4-hydroxylase inhibitor decreased the scar elevation index by 26% compared to control wounds (p < 0.01). Wounds treated with 0.5% FG-1648 inhibitor showed no difference in scar elevation compared to control wounds. These results suggest that inhibition of prolyl 4-hydroxylase may be a suitable agent for topical treatment for the prevention of hypertrophic scar tissue.

  9. Pressotherapy of a postoperative scar with the application of non-sterile silicone dressings in a 56-year-old woman treated for breast cancer in the Holycross Cancer Centre in Kielce

    Directory of Open Access Journals (Sweden)

    Paweł Macek

    2016-01-01

    Full Text Available Scarring is a natural process of wound healing. In some cases, however, there is formation of hypertrophic scars and keloids that are the result of collagen decomposition and synthesis. A disturbed scarring process causes functional, aesthetic, and psychological disorders in the patient. Silicone dressings in the form of plasters or gel are used in the treatment of hypertrophic scars and keloids. A case of pressotherapy of a postoperative scar with the use of non-sterile silicone dressings in a 56-year-old patient treated for breast cancer is described herein. The use of a 2-month pressotherapy of the scar resulted in an improvement in all the assessed parameters. Pressotherapy of the postoperative scar in the patient after mastectomy proved to be an effective and promising method. However, the methods of the scar assessment before and after treatment need objectivity.

  10. Cesarean Scar Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    Z Vahedpoor

    2015-07-01

    Conclusion: Previous cesarean scar pregnancy if not detected early can be associated with high morbidity and mortality. Therefore, the possibility of this pregnancy should be considered in pregnant women with uterine bleeding, abdominal pain as well as a history of cesarean section. It should be noted that after previous cesarean scar pregnancy was definitely diagnosed via ultrasound examination, treatment necessitates to be started utilizing methotrexate to ensure the future fertility of the mother.

  11. Effect of hematoporphyrin monomethyl ether-sonodynamic therapy (HMME-SDT on hypertrophic scarring.

    Directory of Open Access Journals (Sweden)

    Hanjun Zhang

    Full Text Available OBJECTIVE: The aim of the present study was to explore the potential for hematoporphyrin monomethyl ether-Sonodynamic Therapy (HMME-SDT treatment of hypertrophic scars within rabbit ears. METHODS: 60 white rabbits were randomly divided into five groups: (1 untreated controls, (2 lesioned, (3 lesioned + HMME, (4 lesioned + US (Ultrasound, and (5 lesioned +HMME-SDT. After induction of a lesion upon the ears of the rabbits, hypertrophic scars were assessed at 14, 28, 42 and 56 days post-lesion +/- treatment. Assessments consisted of visual inspection in the change of the skin, scar formation pathological morphology by hematoxylin and eosin (HE staining technique with optical microscopy, calculation of a hypertrophic index, fibroblastic density measures, and observation of collagen changes in the scar tissue by Van Gieson's (VGStain along with calculation of collagen area density. RESULTS: With continued HMME-SDT treatment there was a gradual improvement in all parameters over the duration of the experiment. The lesion-induced scars of rabbits receiving HMME-SDT treatment were soft, the size was reduced, hyperplasia was flat and the color pale. The fibroblasts and collagens were reduced and the collagens were light red, sparse and orderly. The hypertrophic index was reduced, since the fibroblastic density was lowered and collagen area density was decreased. CONCLUSION: HMME is an effective sonosensitizer and the combination of HMME-SDT treatment can exert significant benefits in reducing the formation of hypertrophic scars.

  12. Treatment of Mesh Skin Grafted Scars Using a Plasma Skin Regeneration System

    Directory of Open Access Journals (Sweden)

    Takamitsu Higashimori

    2010-01-01

    Full Text Available Objectives. Several modalities have been advocated to treat traumatic scars, including surgical techniques and laser resurfacing. Recently, a plasma skin regeneration (PSR system has been investigated. There are no reports on plasma treatment of mesh skin grafted scars. The objective of our study is to evaluate the effectiveness and complications of plasma treatment of mesh skin grafted scars in Asian patients. Materials and Methods. Four Asian patients with mesh skin grafted scars were enrolled in the study. The plasma treatments were performed at monthly intervals with PSR, using energy settings of 3 to 4 J. Improvement was determined by patient questionnaires and physician evaluation of digital photographs taken prior to treatment and at 3 months post treatment. The patients were also evaluated for any side effects from the treatment. Results. All patients showed more than 50% improvement. The average pain score on a 10-point scale was 6.9 +/− 1.2 SD and all patients tolerated the treatments. Temporary, localized hypopigmentation was observed in two patients. Hyperpigmentation and worsening of scarring were not observed. Conclusions. Plasma treatment is clinically effective and is associated with minimal complications when used to treat mesh skin grafted scars in Asian patients.

  13. Fractional Carbon Dioxide Laser in Treatment of Acne Scars

    OpenAIRE

    Petrov, Andrej

    2016-01-01

    BACKGROUND: Scars appear as a result of skin damage during the process of the skin healing. There are two types of acne scars, depending on whether there is a loss or accumulation of collagen: atrophic and hypertrophic. In 80-90% it comes to scars with loss of collagen compared to smaller number of hypertrophic scars and keloids. AIM: The aim of the study was to determine efficiency and safety of fractional carbon dioxide laser in the treatment of acne scars. MATERIAL AN...

  14. [A global scale for assessment of the family environment].

    Science.gov (United States)

    Steinhausen, H C; Wolgensinger, E

    2004-02-01

    Reliability of the Global Family Environment Scale (GFES) which has been developed in Australia and translated into German. Comparison of ratings and reliability of written case vignettes by international raters and clinicians of the own institution. Assessment of interrater-reliability of clinical cases before and after group trainings with introduction of the manual and discussion of written case vignettes. The ratings of seven training case vignettes were rather similar by clinicians from Zurich and in an international study by the Australian authors. In the same way interrater agreements were similar in the two studies and satisfying. In the present study a single training session in comparison to reading the manual did not result in higher interrater agreement. The existing psychometric properties and the availability of a translation represent important prerequisites for the applicability of the GFES in the German-speaking countries.

  15. Extending large-scale forest inventories to assess urban forests.

    Science.gov (United States)

    Corona, Piermaria; Agrimi, Mariagrazia; Baffetta, Federica; Barbati, Anna; Chiriacò, Maria Vincenza; Fattorini, Lorenzo; Pompei, Enrico; Valentini, Riccardo; Mattioli, Walter

    2012-03-01

    Urban areas are continuously expanding today, extending their influence on an increasingly large proportion of woods and trees located in or nearby urban and urbanizing areas, the so-called urban forests. Although these forests have the potential for significantly improving the quality the urban environment and the well-being of the urban population, data to quantify the extent and characteristics of urban forests are still lacking or fragmentary on a large scale. In this regard, an expansion of the domain of multipurpose forest inventories like National Forest Inventories (NFIs) towards urban forests would be required. To this end, it would be convenient to exploit the same sampling scheme applied in NFIs to assess the basic features of urban forests. This paper considers approximately unbiased estimators of abundance and coverage of urban forests, together with estimators of the corresponding variances, which can be achieved from the first phase of most large-scale forest inventories. A simulation study is carried out in order to check the performance of the considered estimators under various situations involving the spatial distribution of the urban forests over the study area. An application is worked out on the data from the Italian NFI.

  16. A scale for assessing Italian schools and classes inclusiveness

    Directory of Open Access Journals (Sweden)

    Lucio Cottini

    2016-07-01

    Full Text Available The paper presents in detail the procedures for developing and validating a tool for assessing the inclusive process pertaining to school contexts called “Inclusive Process Assessment Scale”. The Scale, which is the outcome of the joined work of the authors, sets itself both as an assessing and self-assessing tool, useful for allowing on one hand specific types of evaluation and, on the other, promoting thoughts on inclusive education’s quality indicators, thus contributing to the planning and ongoing adjustment of the educational project of the school and the class. The tool, in its computer version as well, allows for the planning of researches that can collect evidences supporting the full inclusion organization of Italian schools.Una scala per valutare l’inclusività delle scuole e delle classi italianeIl contributo presenta in dettaglio le procedure di costruzione e validazione di uno strumento per valutare i processi inclusivi riferiti ai contesti scolastici, chiamato “Scala di Valutazione dei Processi Inclusivi”. Frutto del lavoro congiunto svolto dagli autori, la Scala si pone come uno strumento valutativo e autovalutativo utile a consentire da un lato, la realizzazione di specifiche forme di misurazione e, dall’altro, la promozione di processi di riflessione sugli indicatori di qualità dell’educazione inclusiva, per contribuire alla progettazione e alla regolazione in itinere del progetto educativo della scuola e della classe. Lo strumento, anche nella sua versione digitale, consente di pianificare ricerche, che possono raccogliere evidenze in grado di avvalorare l’organizzazione scolastica italiana di full inclusion.

  17. Scales for assessment of depression in schizophrenia: Factor analysis of calgary depression rating scale and hamilton depression rating scale.

    Science.gov (United States)

    Grover, Sandeep; Sahoo, Swapnajeet; Dua, Devakshi; Chakrabarti, Subho; Avasthi, Ajit

    2017-06-01

    This study aimed to evaluate the factor structure of Calgary depression rating scale (CDSS) and Hamilton Depression Rating Scale (HDRS) among patients with schizophrenia in acute and remission phase of illness by using exploratory factor analysis. For this, 267 patients with schizophrenia were assessed on CDSS and HDRS. Exploratory factor analysis of CDSS yielded 2 factor models for the whole sample, patients in clinical remission and patients not in clinical remission phase of schizophrenia. Factor analysis of HDRS yielded 3 factor models; however, there was significant difference in the factor structure between those in clinical remission and those not in clinical remission phase of schizophrenia. CDSS total score did not correlate with PANSS positive and negative subscale scores. In contrast, HDRS total score correlated positively with PANSS positive subscale score, PANSS negative subscale score and PANSS general psychopathology subscale score. To conclude, present study suggests while CDSS items separate out into 2 factors, which are stable across different stages of illness, whereas HDRS factor structure appears to be less stable across different stages of illness. Correlation analysis suggests that rating on HDRS may be affected by positive and negative symptoms of schizophrenia, whereas CDSS do not correlate with positive and negative symptoms of schizophrenia. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  18. Ventricular Tachycardia in the Setting of Chagasic Cardiomyopathy: Use of Voltage Mapping to Characterize Endoepicardial Nonischemic Scar Distribution.

    Science.gov (United States)

    Soto-Becerra, Richard; Bazan, Victor; Bautista, William; Malavassi, Federico; Altamar, Jhancarlo; Ramirez, Juan David; Everth, Arlen; Callans, David J; Marchlinski, Francis E; Rodríguez, Diego; García, Fermin C; Sáenz, Luis C

    2017-11-01

    Chagasic cardiomyopathy (CC) is the most frequent nonischemic substrate causing left ventricular (LV) tachycardia in Latin America. Systematic characterization of the LV epicardial/endocardial scar distribution and density in CC has not been performed. Additionally, the usefulness of unipolar endocardial electroanatomic mapping to identify epicardial scar has not been assessed in this setting. Nineteen patients with CC undergoing detailed epicardial and endocardial LV tachycardia mapping and ablation were included. A total of 8494 epicardial and 6331 endocardial voltage signals and 314 epicardial/endocardial matched pairs of points were analyzed. Basal lateral LV scar involvement was observed in 18 of 19 patients. Bipolar voltage mapping demonstrated larger epicardial than endocardial scar and core-dense (≤0.5 mV) scar areas (28 [20-36] versus 19 [15-26] and 21 [2-49] versus 4 [0-7] cm2; P=0.049 and P=0.004, respectively). Bipolar epicardial and endocardial voltages within scar were low (0.4 [0.2-0.55] and 0.54 [0.33-0.87] mV, respectively) and confluent, indicating a dense/transmural scarring process in CC. The endocardial unipolar voltage value (with a newly proposed ≤4-mV cutoff) predicted the presence and extent of epicardial bipolar scar (P<0.001). CC causes a unique ventricular tachycardia substrate concentrated to the basal lateral LV, with marked epicardial predominance. The scar pattern is particularly dense and transmural as compared with the more erratic/patchy scar patterns seen in other nonischemic cardiomyopathies. Endocardial unipolar voltage mapping serves to characterize epicardial scar in this setting. © 2017 American Heart Association, Inc.

  19. No-visible-scar cholecystectomy

    Directory of Open Access Journals (Sweden)

    Tadeusz M. Wróblewski

    2010-12-01

    Full Text Available Introduction: Single incision laparoscopic surgery (SILS is a laparoscopic method providing a good cosmetic effect,but requiring the application of special ports and instruments enabling the surgeon to perform the procedure.We report three-ports cholecystectomy through umbilical and suprapubic incisions performed with typical laparos -copic instruments which calls no-visible-scar cholecystectomy (NVSC.Material and methods: Twenty patients with symptomatic cholelithiasis were qualified for NVSC. Typical CO2 pneumoperitoneumwas done after umbilical skin incision. Two ports of 5 mm were inserted in the maximum externaledges of this incision. After cystic duct and cystic artery dissection the right one was exchanged for a port of 11 mm.The second incision for the 11-mm trocar for the laparoscope was done in the suprapubic median line within the hairarea.Results: Cholecystectomies were performed without any conversion to classical laparoscopic cholecystectomy (LCHor open surgery. They were not technically identical due to the gradual improvement in the access and manipulationof instruments. The time of the intervention ranged from 2 hours during the introduction of the new method to 50 minfor the last procedures. No postoperative complications were observed and all patients were discharged not later thanafter conventional LCH.Conclusions: NVSC is a three-port laparoscopic intervention performed with typical laparoscopic instruments. It ismore convenient for the surgeon than single incision LCH, because the placement of the optic in the suprapubic regiongives more space for the instruments. It also provides a very good cosmetic effect of the intervention. The describedprocedure is easy to learn and in case of technical problems additional ports can be applied (as in typical LCH.

  20. Efficacy of early initiation of a gel containing extractum cepae, heparin, and allantoin for scar treatment: an observational, noninterventional study of daily practice.

    Science.gov (United States)

    Willital, Günter H; Simon, Jeannette

    2013-01-01

    Contractubex® (Merz Pharmaceuticals GmbH, Frankfurt, Germany) is a gel containing extractum cepae, heparin, and allantoin with proven efficacy in the prevention of excessive scarring and promotion of physiological scar formation. To investigate the efficacy of early initiation of Contractubex in the prevention of excessive scarring and promotion of physiological scar formation. In total, 1,268 patients were included in this observational, noninterventional study. Patients were assessed at visit 1 (within 3 weeks of the injury), when treatment was initiated, with subsequent assessments after 2 to 3 months of treatment, and at the end of the study (after 4 to 5 months of treatment). Parameters measured included scar size, color, and pliability (consistency/hardness), as well as patients' and physicians' subjective assessments of treatment efficacy and tolerability. After 2 to 3 months of treatment, there were statistically significant improvements in color and pliability of the scar, sensation of pain, tension, and pruritus compared with visit 1 (Pscars were rated as markedly red or markedly hardened at the final visit. In addition, there was a reduction of 31.5% in mean scar width and of 47.8% in mean scar height at the end of the observation period. A high percentage of patients (85.8%) and physicians (86.6%) rated the treatment as good or very good with respect to prevention of excessive scarring and promotion of physiological scar development. Tolerability was described as good or very good by 92.0% of physicians and 91.5% of patients. The results of this study suggest that the scar gel is effective in preventing excessive scarring and promoting physiological scar formation when treatment is initiated early. In addition, the treatment was well tolerated.

  1. A novel visual facial anxiety scale for assessing preoperative anxiety.

    Directory of Open Access Journals (Sweden)

    Xuezhao Cao

    Full Text Available There is currently no widely accepted instrument for measuring preoperative anxiety. The objective of this study was to develop a simple visual facial anxiety scale (VFAS for assessing acute preoperative anxiety.The initial VFAS was comprised of 11 similarly styled stick-figure reflecting different types of facial expressions (Fig 1. After obtaining IRB approval, a total of 265 participant-healthcare providers (e.g., anesthesiologists, anesthesiology residents, and perioperative nurses were recruited to participate in this study. The participants were asked to: (1 rank the 11 faces from 0-10 (0 = no anxiety, while 10 = highest anxiety and then to (2 match one of the 11 facial expression with a numeric verbal rating scale (NVRS (0 = no anxiety and 10 = highest level of anxiety and a specific categorical level of anxiety, namely no anxiety, mild, mild-moderate, moderate, moderate-high or highest anxiety. Based on these data, the Spearman correlation and frequencies of the 11 faces in relation to the 11-point numerical anxiety scale and 6 categorical anxiety levels were calculated. The highest frequency of a face assigned to a level of the numerical anxiety scale resulted in a finalized order of faces corresponding to the 11-point numeric rating scale.The highest frequency for each of the NVRS anxiety scores were as follow: A0, A1, A2, A3, A4, A5, A7, A6, A8, A9 and A10 (Fig 2. For the six categorical anxiety levels, a total of 260 (98.1% participants chose the face A0 as representing 'no' anxiety, 250 (94.3% participants chose the face A10 as representing 'highest' anxiety and 147 (55.5% participants chose the face A8 as representing 'moderate-high' anxiety. Spearman analysis showed a significant correlation between the faces A3 and A5 assigned to the mild-moderate anxiety category (r = 0.58, but A5 was ultimately chosen due to its higher frequency compared to the frequency of A3 (30.6% vs 24.9%(Fig 3. Similarly, the correlation of the faces A7

  2. Comprehensive large-scale assessment of intrinsic protein disorder.

    Science.gov (United States)

    Walsh, Ian; Giollo, Manuel; Di Domenico, Tomás; Ferrari, Carlo; Zimmermann, Olav; Tosatto, Silvio C E

    2015-01-15

    Intrinsically disordered regions are key for the function of numerous proteins. Due to the difficulties in experimental disorder characterization, many computational predictors have been developed with various disorder flavors. Their performance is generally measured on small sets mainly from experimentally solved structures, e.g. Protein Data Bank (PDB) chains. MobiDB has only recently started to collect disorder annotations from multiple experimental structures. MobiDB annotates disorder for UniProt sequences, allowing us to conduct the first large-scale assessment of fast disorder predictors on 25 833 different sequences with X-ray crystallographic structures. In addition to a comprehensive ranking of predictors, this analysis produced the following interesting observations. (i) The predictors cluster according to their disorder definition, with a consensus giving more confidence. (ii) Previous assessments appear over-reliant on data annotated at the PDB chain level and performance is lower on entire UniProt sequences. (iii) Long disordered regions are harder to predict. (iv) Depending on the structural and functional types of the proteins, differences in prediction performance of up to 10% are observed. The datasets are available from Web site at URL: http://mobidb.bio.unipd.it/lsd. Supplementary data are available at Bioinformatics online. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  3. Assessing sustainable biophysical human-nature connectedness at regional scales

    Science.gov (United States)

    Dorninger, Christian; Abson, David J.; Fischer, Joern; von Wehrden, Henrik

    2017-05-01

    Humans are biophysically connected to the biosphere through the flows of materials and energy appropriated from ecosystems. While this connection is fundamental for human well-being, many modern societies have—for better or worse—disconnected themselves from the natural productivity of their immediate regional environment. In this paper, we conceptualize the biophysical human-nature connectedness of land use systems at regional scales. We distinguish two mechanisms by which primordial connectedness of people to regional ecosystems has been circumvented via the use of external inputs. First, ‘biospheric disconnection’ refers to people drawing on non-renewable minerals from outside the biosphere (e.g. fossils, metals and other minerals). Second, ‘spatial disconnection’ arises from the imports and exports of biomass products and imported mineral resources used to extract and process ecological goods. Both mechanisms allow for greater regional resource use than would be possible otherwise, but both pose challenges for sustainability, for example, through waste generation, depletion of non-renewable resources and environmental burden shifting to distant regions. In contrast, biophysically reconnected land use systems may provide renewed opportunities for inhabitants to develop an awareness of their impacts and fundamental reliance on ecosystems. To better understand the causes, consequences, and possible remedies related to biophysical disconnectedness, new quantitative methods to assess the extent of regional biophysical human-nature connectedness are needed. To this end, we propose a new methodological framework that can be applied to assess biophysical human-nature connectedness in any region of the world.

  4. Fast voltage stability assessment for large-scale power systems

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Y. [Shandong Univ., Jinan (China). School of Electrical Engineering; Wang, L.; Yu, Z. [Shandong Electric Power Co., Jinan (China). Electric Power Control Center

    2007-07-01

    A new method of assessing online voltage stability in large-scale power systems was presented. A local voltage stability index was used to determine weak buses in the system. A case study of the Shandong power system in China was used to demonstrate the accuracy and speed of the method for online applications. The local method was based on the fact that the Thevenin equivalent as determined from the load bus and the apparent load impedance were equal at the point of voltage collapse. Participant buses and key power sources of both reactive and active power transmission paths were determined using electrical distance measurements. Participant buses and key power sources of the reactive and active power transmission paths were also determined. The case study demonstrated that the reactive power reserve of key generators has a significant impact on voltage stability. The study also demonstrated that the voltage stability of the weakest power transmission path can decline or shift when some generators reach their limits. It was concluded that combining voltage stability indices and reactive power reserves increases the accuracy of voltage stability assessments. 11 refs., 3 tabs., 6 figs.

  5. Risk Assessment and Scaling for the SLS LH2 ET

    Science.gov (United States)

    Hafiychuk, Halyna; Ponizovskaya-Devine, Ekaterina; Luchinsky, Dmitry; Khasin, Michael; Osipov, Viatcheslav V.; Smelyanskiy, Vadim N.

    2012-01-01

    In this report the main physics processes in LH2 tank during prepress and rocket flight are studied. The goal of this investigation is to analyze possible hazards and to make risk assessment in proposed LH2 tank designs for SLS with 5 engines (the situation with 4 engines is less critical). For analysis we use the multinode model (MNM) developed by us and presented in a separate report and also 3D ANSYS simulations. We carry out simulation and theoretical analysis the physics processes such as (i) accumulation of bubbles in LH2 during replenish stage and their collapsing in the liquid during the prepress; (ii) condensation-evaporation at the liquid-vapor interface and tank wall, (iv) heating the liquid near the interface and wall due to condensation and environment heat, (v) injection of hot He during prepress and of hot GH2 during flight, (vi) mixing and cooling of the injected gases due to heat transfer between the gases, liquid and the tank wall. We analyze the effects of these physical processes on the thermo- and fluid gas dynamics in the ullage and on the stratification of temperature in the liquid and assess the associated hazards. A special emphasize is put on the scaling predictions for the larger SLS LH2 tank.

  6. [Clinical effects of different modes of ultra pulse carbon dioxide fractional laser used in combination on the treatment of hypertrophic scar on face and neck].

    Science.gov (United States)

    Lei, Y; Li, S F; Yu, Y L; Tan, J

    2016-08-20

    To explore the clinical effects of ultra pulse mode of ultra pulse carbon dioxide fractional laser combined with Deep FX mode or Scaar FX mode on the treatment of patients with hypertrophic scars on face and neck. One hundred and fifty-eight patients with hypertrophic scars on face and neck who met the inclusion criteria were admitted to Hunan Provincial People's Hospital from January 2012 to January 2015. Firstly, the scar areas were cleaned and given compound lidocaine cream for surface anesthesia. Then the scar areas were treated with ultra pulse mode of ultra pulse carbon dioxide fractional laser, with energy from 150 to 175 mJ, frequency of 40 Hz, hole to hole distance of 4 mm or 5 mm, and the treatment time of each hole of 2 s or 3 s. For mild scar, Deep FX mode was added for treatment with energy from 30 to 50 mJ, frequency of 300 Hz, and density of 5%; for moderate and severe scar, Scaar FX mode was additionally used for therapy, with energy from 80 to 150 mJ, frequency of 300 Hz, and density of 3%. The above-mentioned treatments were performed per three months, totally for 3 times, 10-15 min per treatment. After each treatment, wounds were moisturized and given sun protection. Before the first treatment and 6 months after treatment of 3 times, the curative effect was assessed by Vancouver Scar Scale (VSS) and University of North Carolina Scar Scale. Six months after treatment of 3 times, satisfaction degree of patient and loss of working time were recorded. The adverse effects of whole treatment course were recorded. Data were processed with t test. (1) Six months after treatment of 3 times, VSS score of patients was (3.1±1.0) points, which was significantly lower than that before the first treatment [(9.4±1.8) points, t=53.096, PScar Scale score of patients was (1.6±0.7) points, which was significantly lower than that before the first treatment[(8.0±1.4) points, t=63.730, Ptreatment of 3 times, 150 patients were very satisfied with the curative effect

  7. Scaling studies and conceptual experiment designs for NGNP CFD assessment

    Energy Technology Data Exchange (ETDEWEB)

    D. M. McEligot; G. E. McCreery

    2004-11-01

    The objective of this report is to document scaling studies and conceptual designs for flow and heat transfer experiments intended to assess CFD codes and their turbulence models proposed for application to prismatic NGNP concepts. The general approach of the project is to develop new benchmark experiments for assessment in parallel with CFD and coupled CFD/systems code calculations for the same geometry. Two aspects of the complex flow in an NGNP are being addressed: (1) flow and thermal mixing in the lower plenum ("hot streaking" issue) and (2) turbulence and resulting temperature distributions in reactor cooling channels ("hot channel" issue). Current prismatic NGNP concepts are being examined to identify their proposed flow conditions and geometries over the range from normal operation to decay heat removal in a pressurized cooldown. Approximate analyses have been applied to determine key non-dimensional parameters and their magnitudes over this operating range. For normal operation, the flow in the coolant channels can be considered to be dominant turbulent forced convection with slight transverse property variation. In a pressurized cooldown (LOFA) simulation, the flow quickly becomes laminar with some possible buoyancy influences. The flow in the lower plenum can locally be considered to be a situation of multiple hot jets into a confined crossflow -- with obstructions. Flow is expected to be turbulent with momentumdominated turbulent jets entering; buoyancy influences are estimated to be negligible in normal full power operation. Experiments are needed for the combined features of the lower plenum flows. Missing from the typical jet experiments available are interactions with nearby circular posts and with vertical posts in the vicinity of vertical walls - with near stagnant surroundings at one extreme and significant crossflow at the other. Two types of heat transfer experiments are being considered. One addresses the "hot channel" problem, if necessary

  8. Vertical scar versus the inverted-T scar reduction mammaplasty : A 10-year follow-up

    NARCIS (Netherlands)

    Bouwer, Lesley R.; van der Biezen, Jan Jaap; Spronk, Cees A.; van der Lei, Berend

    2012-01-01

    A retrospective study was undertaken to evaluate whether the initial outcome of two types of reduction mammaplasty techniques (vertical scar reduction mammaplasty vs. the inverted-T scar reduction mammaplasty) remains stable in the long term: Sixty-nine patients who had undergone breast reduction

  9. Papular Acne Scars of the Nose and Chin: An Under-recognised Variant of Acne Scarring.

    Science.gov (United States)

    Ali, Faisal R; Kirk, Michael; Madan, Vishal

    2016-01-01

    Scarring following acne vulgaris is common and can be of profound psychosocial consequence. We have clinically noted a variant of acne scarring, overlooked by previous categorisation schemes, which we have denominated as papular acne scars of the nose and chin. We sought to characterise these novel entities further. Initially, we identified 14 patients with papular acne scars of the nose and chin in a cosmetic dermatology clinic, of whom two were female and rest were male. We then prospectively evaluated 100 consecutive patients attending our tertiary referral acne isotretinoin clinic and 49 patients attending a general dermatology clinic. Amongst 149 patients, from a general dermatology and tertiary acne clinic, soft papular scars were noted in four patients, distributed on the nose and chin. Three of the four patients were male, three patients had additional acne scars and the median age was 23.5. We have identified 18 patients with papular acne scars of the nose and chin and propose that this new category should be added to acne scarring classification schemes. Future work should be directed at corroborating the epidemiology of such lesions and describing effective treatment modalities.

  10. Papular acne scars of the nose and chin: An under-recognised variant of acne scarring

    Directory of Open Access Journals (Sweden)

    Faisal R Ali

    2016-01-01

    Full Text Available Background: Scarring following acne vulgaris is common and can be of profound psychosocial consequence. Aims and Objectives: We have clinically noted a variant of acne scarring, overlooked by previous categorisation schemes, which we have denominated as papular acne scars of the nose and chin. We sought to characterise these novel entities further. Materials and Methods: Initially, we identified 14 patients with papular acne scars of the nose and chin in a cosmetic dermatology clinic, of whom two were female and rest were male. We then prospectively evaluated 100 consecutive patients attending our tertiary referral acne isotretinoin clinic and 49 patients attending a general dermatology clinic. Results: Amongst 149 patients, from a general dermatology and tertiary acne clinic, soft papular scars were noted in four patients, distributed on the nose and chin. Three of the four patients were male, three patients had additional acne scars and the median age was 23.5. Conclusions: We have identified 18 patients with papular acne scars of the nose and chin and propose that this new category should be added to acne scarring classification schemes. Future work should be directed at corroborating the epidemiology of such lesions and describing effective treatment modalities.

  11. The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants

    DEFF Research Database (Denmark)

    Birk, Nina Marie; Nissen, Thomas Nørrelykke; Ladekarl, Monica

    2017-01-01

    Background: The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis is administered intradermally, and vaccination is often followed by a scar at the injection site. Among BCG-vaccinated individuals, having a scar has been associated with lower mortality. We aimed to examine the impact...... of vaccination technique for scarring in a high income setting, by assessing the associations between the post injection reaction, the wheal size, and the probability of developing a scar, and scar size. Methods: This study was nested within a clinical multicenter study randomizing 4262 infants to either BCG...... vaccination (BCG 1331 SSI) or no intervention. In this substudy, including 492 vaccinated infants, the immediate post BCG vaccination reaction was registered as either wheal (a raised, blanched papule at the injection site), bulge (a palpable element at the injection site), or no reaction. The presence...

  12. Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy

    Science.gov (United States)

    Kim, Eun Kyoung; Chattranukulchai, Pairoj

    2015-01-01

    In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation. PMID:26175568

  13. The association between Bacillus Calmette-Guérin vaccination (1331 SSI) skin reaction and subsequent scar development in infants

    DEFF Research Database (Denmark)

    Birk, Nina Marie; Nissen, Thomas Nørrelykke; Ladekarl, Monica

    2017-01-01

    BACKGROUND: The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis is administered intradermally, and vaccination is often followed by a scar at the injection site. Among BCG-vaccinated individuals, having a scar has been associated with lower mortality. We aimed to examine the impact...... of vaccination technique for scarring in a high income setting, by assessing the associations between the post injection reaction, the wheal size, and the probability of developing a scar, and scar size. METHODS: This study was nested within a clinical multicenter study randomizing 4262 infants to either BCG...... vaccination (BCG 1331 SSI) or no intervention. In this substudy, including 492 vaccinated infants, the immediate post BCG vaccination reaction was registered as either wheal (a raised, blanched papule at the injection site), bulge (a palpable element at the injection site), or no reaction. The presence...

  14. Reliability and validity of the Acceptance Symptom Assessment Scale in assessing labour pain.

    Science.gov (United States)

    Bergh, Ingrid; Söderlund, Tina; Vinterskog, Linda; Mårtensson, Lena B

    2012-10-01

    to investigate the reliability and validity of the Acceptance Symptom Assessment Scale (ASAS) in assessing labour pain. a test-retest approach was used to assess reliability and validity. labour ward with approximately 2,400 deliveries annually in western part of Sweden. forty-seven pregnant women in the latent or active phase of labour. a total of five pain assessments with both the ASAS and the VAS were conducted in three sessions. correlation between ASAS and VAS. both scales demonstrated high and significant test-retest correlations (r=0.83-0.92; pVAS ratings at all five assessments. Construct validity was established when both the ASAS and the VAS identified a pain reduction (pVAS, mainly (n=30) because the ASAS provided more choices relating to the pain experience, making it possible to label pain acceptable/unacceptable. the ASAS is interchangeable with the VAS for assessing labour pain. Over two-thirds of the women preferred it to the VAS. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Ablative CO2 fractional resurfacing in treatment of thermal burn scars: an open-label controlled clinical and histopathological study.

    Science.gov (United States)

    El-Zawahry, Bakr M; Sobhi, Rehab M; Bassiouny, Dalia A; Tabak, Sahar A

    2015-12-01

    Burn scars can cause permanent disfiguring problems with limited treatments available. To assess and correlate the clinical and histopathological effects of fractional CO2 laser on thermal burns in a controlled study. Fifteen patients 11 with hypertrophic and four with keloidal scars received three CO2 fractional laser sessions every 4-6 weeks. Half of the scar was untreated as a control. Clinical evaluation by Vancouver, PSOAS scores, and photography before, monthly, and 3 months after the last laser session was performed. Ten patients were evaluated histopathologically by standard H&E, Masson trichrome, and Elastica von Gieson special stains. Hypertrophic scars (HTSs) showed textural improvement and a significant decrease of Vancouver, POSAS observer, and patient scores by the end of follow-up period in the laser-treated area (P = 0.011, 0.017 and 0.018, respectively) unlike keloidal scars. Histopathology revealed significant decrease in scar thickness in HTSs only (P < 0.001) as well as a significant decrease in collagen bundle thickness and density in the upper dermis in both types of scars. Fractional CO2 laser is a possible safe and effective modality for the treatment of hypertrophic burn scars with improvement achieved both clinically and histopathologically. © 2015 Wiley Periodicals, Inc.

  16. Clinical studies of the treatment of facial atrophic acne scars and acne with a bipolar fractional radiofrequency system.

    Science.gov (United States)

    Kaminaka, Chikako; Uede, Mikiko; Matsunaka, Hiroshi; Furukawa, Fukumi; Yamamoto, Yuki

    2015-06-01

    Few clinical studies have examined the utility of bipolar fractional radiofrequency (FRF) therapy as a treatment for atrophic acne scars and active acne in people with darker skin. This study was designed to compare the safety and efficacy of bipolar FRF therapy as a treatment for atrophic acne scars and acne vulgaris. Twenty-three Japanese patients with atrophic acne scars and mild to severe acne on both cheeks were treated with a bipolar FRF system (eMatrix; Syneron, Yokneam Illit, Israel). Five treatment sessions were carried out at 1-month intervals, and the patients were followed up for 3 months after the final treatment. Assessments of scar severity and the number of acne lesions and 3-D in vivo imaging analysis were performed. Evaluations of the treatment outcomes and their effects on the patients' quality of life (QOL) were also carried out. We demonstrated that the improvement in scar volume was marked in the patients with mild scars and was at least moderate in 23 (57.5%) of the treated areas. With regard to the number of acne lesions, the treated areas exhibited significantly fewer lesions compared with the baseline at each time point (P scar depth were observed. Bipolar FRF treatment significantly improved the atrophic acne scars and acne of Japanese patients and had minimal side-effects. © 2015 Japanese Dermatological Association.

  17. Laser scar revision: comparison of CO2 laser vaporization with and without simultaneous pulsed dye laser treatment.

    Science.gov (United States)

    Alster, T S; Lewis, A B; Rosenbach, A

    1998-12-01

    Over the past decade, the 585-nm pulsed dye laser (PDL) has been used successfully to treat a variety of cutaneous vascular lesions as well as hypertrophic scars. Laser scar revision has been revolutionized by the recent development of high-energy, pulsed carbon dioxide (CO2) laser systems. These new CO2 lasers allow controlled vaporization of thin layers of skin while minimizing damage to surrounding dermal structures. To determine the effect of a high-energy, pulsed CO2 laser alone and in combination with a 585-nm PDL on nonerythematous hypertrophic scars. Twenty patients with nonerythematous hypertrophic scars were treated with a high-energy, pulsed CO2 laser. One-half of each scar was additionally treated with the 585-nm PDL laser. Sequential clinical and photographic analyses were performed independently by two blinded assessors. In addition, erythema reflectance spectrometry measurements were obtained from the scars before and at regular postoperative intervals. Global assessment scores and erythema spectrometry measurements were significantly improved after laser treatment. Combination CO2 and PDL laser treatment resulted in more significant improvement than CO2 laser irradiation alone. Concomitant use of the high-energy, pulsed CO2 and PDL laser systems was superior to CO2 laser vaporization alone for revision of nonerythematous hypertrophic scars. Once again, the vascular specificity of the 585-nm PDL has been linked to improvement in hypertrophic scar tissue.

  18. Evaluating hypertrophic thyroidectomy scar outcomes after treatment with triamcinolone injections and copper bromide laser therapy.

    Science.gov (United States)

    On, Hye Rang; Lee, Sang Hee; Lee, Yong Sang; Chang, Hang-Seok; Park, CheongSoo; Roh, Mi Ryung

    2015-08-01

    Postoperative hypertrophic scar following thyroidectomy can be a major concern due to its disfiguring appearance. Recently, copper bromide laser (CBL) and intralesional triamcinolone injection (TA ILI) have been used to treat hypertrophic thyroidectomy scars. Data regarding the number of treatment sessions needed to reach a certain endpoint and the prognostic factors that affect treatment duration are unknown. The aim of this study was to evaluate the number of treatment sessions required to reduce VSS score by 50%, which was regarded as the treatment endpoint, and to investigate the factors that influence treatment duration when using CBL and TA ILI. A total of 67 patients were enrolled in this study. Baseline characteristics of the patients including age, sex, body mass index (BMI), distance of the scar from the sternal notch, time of development of the hypertrophic scar, sternocleidomastoid (SCM) muscle prominence, and date of operation were collected on the first visit. They were treated with CBL and TA. The concentration of triamcinolone used was 2.5 mg/ml or 5 mg/ml according to the pliability score of each scar. The mean number of treatment sessions required to achieve the endpoint was 3.85 ± 1.25. Among the variables assessed, location of the scar near the sternal notch (P = 0.020) and patient BMI (P = 0.001) were associated with the increasing number of treatment sessions. In our study cohort, four treatments were required to reduce the VSS of thyroidectomy scars by 50% when using a combination treatment of CBL and low concentration TA ILI. Also, scar location and patient BMI are factors that affect treatment outcome. © 2015 Wiley Periodicals, Inc.

  19. Olfactory ensheathing cell-neurite alignment enhances neurite outgrowth in scar-like cultures

    Science.gov (United States)

    Khankan, Rana R.; Wanner, Ina B.; Phelps, Patricia E.

    2015-01-01

    The regenerative capacity of the adult CNS neurons after injury is strongly inhibited by the spinal cord lesion site environment that is composed primarily of the reactive astroglial scar and invading meningeal fibroblasts. Olfactory ensheathing cell (OEC) transplantation facilitates neuronal survival and functional recovery after a complete spinal cord transection, yet the mechanisms by which this recovery occurs remain unclear. We used a unique multicellular scar-like culture model to test if OECs promote neurite outgrowth in growth inhibitory areas. Astrocytes were mechanically injured and challenged by meningeal fibroblasts to produce key inhibitory elements of a spinal cord lesion. Neurite outgrowth of postnatal cerebral cortical neurons was assessed on three substrates: quiescent astrocyte control cultures, reactive astrocyte scar-like cultures, and scar-like cultures with OECs. Initial results showed that OECs enhanced total neurite outgrowth of cortical neurons in a scar-like environment by 60%. We then asked if the neurite growth-promoting properties of OECs depended on direct alignment between neuronal and OEC processes. Neurites that aligned with OECs were nearly three times longer when they grew on inhibitory meningeal fibroblast areas and twice as long on reactive astrocyte zones compared to neurites not associated with OECs. Our results show that OECs can independently enhance neurite elongation and that direct OEC-neurite cell contact can provide a permissive substrate that overcomes the inhibitory nature of the reactive astrocyte scar border and the fibroblast-rich spinal cord lesion core. PMID:25863021

  20. Risk factors for renal scarring in children with primary vesicoureteral reflux disease

    Directory of Open Access Journals (Sweden)

    Sevgi Mir

    2013-01-01

    Full Text Available To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR and the possible risk factor(s, we studied 90 children (60 girls and 30 boys with VUR followed in the Pediatric Nephrology Unit at the Ege University Hospital from 1998 to 2003. All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m technetium dimercapto-succinic acid scintigraphy. All infants with VUR were given low-dose prophylactic antibiotics and followed-up until resolution of the reflux. Grade of reflux and number of urinary tract infection (UTI episodes (≥3 were found to be statistically significant risk factors for renal scarring (P 0.05. Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05. We conclude that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore, identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure.

  1. Objective and subjective treatment evaluation of scars using optical coherence tomography, sonography, photography, and standardised questionnaires.

    Science.gov (United States)

    Reinholz, Markus; Schwaiger, Hannah; Poetschke, Julian; Epple, Andreas; Ruzicka, Thomas; Von Braunmühl, Tanja; Gauglitz, Gerd G

    2016-12-01

    Currently, different types of treatments for pathological scars are available, however, to date, there is no established method of measurement to objectively assess therapeutic outcome. Treatment success is usually evaluated clinically by the physician and patient. Non-invasive imaging techniques, such as HD-OCT (high-definition optical coherence tomography), may represent a valuable diagnostic tool to objectively measure therapeutic outcome. To compare HD-OCT with ultrasound and subjective evaluation tools, such as questionnaires. In total, eight patients with pathological scars were treated in this pilot study with cryotherapy and intralesional steroid injections, and evaluated pre- and post-treatment using clinical examination, photography, sonography, and HD-OCT. The analysis of objective and subjective measuring methods was used to draw direct comparisons. HD-OCT revealed reduced epidermal and dermal thickness of the scar after four treatments with triamcinolone acetonide and cryotherapy. Based on sonography, a total reduction in scar height and reduction in scar depth was demonstrated. Both methods correlated well with the injected amount of triamcinolone acetonide. In addition, a positive correlation between well-established subjective and objective evaluation methods was found. We demonstrate that HD-OCT may be used as an objective diagnostic instrument to evaluate skin thickness under therapy for pathological scars, and serves as a valuable adjunctive device in combination with ultrasound and subjective evaluation tools. This provides additional information for the therapist concerning the quality and success of the applied treatment.

  2. Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians.

    Science.gov (United States)

    Lee, Sang Ju; Kang, Jin Moon; Chung, Won Soon; Kim, Young Koo; Kim, Hei Sung

    2014-03-01

    Atrophic facial scars which commonly occur after inflammatory acne vulgaris can be extremely disturbing to patients both physically and psychologically. Treatment with fractional laser devices has become increasingly popular, but there has been disappointment in terms of effectiveness. The objective of this study was to assess the safety and efficacy of ablative full-face resurfacing on atrophic acne scars in the Korean population. A total of 22 patients, aged 25-44 years, underwent a new modality of resurfacing combining both short-pulsed and dual-mode erbium:yttrium-aluminum garnet (Er:YAG) laser. The patients had Fitzpatrick skin types ranging from III to V. Photographs were taken before and up to 6 months after treatment. Results were evaluated for the degree of clinical improvement and any adverse events. Degree of improvement was graded using a four-point scale: poor (1) = 75%. Based on the blinded photo assessments by two independent reviewers, clinically and statistically significant mean improvement of 3.41 was observed (one-sample Wilcoxon signed rank test, P acne flare-up occurred in five patients (22.7%). No other adverse effects were observed. A new modality of Er:YAG laser resurfacing combining short-pulsed and dual-mode Er:YAG laser is a safe and very effective treatment modality for atrophic facial acne scars in Asians with darker skin tones.

  3. [Clnical observation, of the effects of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine on the treatment of hyperplastic scar].

    Science.gov (United States)

    Jin, Lei; Zhenming, Hao; Lifeng, Yu; Peng, Duan; Yanbin, Meng

    2015-06-01

    To explore the clinical effects of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine ( Fuchunsan ) on the treatment of postburn hyperplastic scar. Sixty-three patients with hyperplastic scar after burn injury hospitalized from February 2012 to June 2014 in our department were treated with lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan). Patients were divided into early stage group (E, n = 35), middle stage group (M, n = 25), and late stage group ( L, n = 3) according to the formation time of scar, which was respectively 3 weeks to 3 months, longer than 3 months and less than or equal to 6 months, and 3 to 15 years in groups E, M, and L. The number of times of laser treatment of patients in each group was recorded. The degree of scar pain in patients of the three groups was assessed by the Numerical Rating Scale (NRS) before treatment and after treatment for 1, 2, and 3 times. The scar condition of patients in groups E and M was assessed by the Vancouver Scar Scale (VSS) before treatment and after treatment for 1, 3, and 5 times. Patients in group L did not receive VSS assessment but were evaluated by clinical observation only. Photos of scar in treating area were taken before treatment and after treatment for 3 and 5 times to evaluate the clinical effect. Data were processed with t test. Patients in groups E and M were treated with laser for (4.8 ± 1.1) and (7.7 ± 2.1) times respectively. In group L, the treatment was stopped in 2 patients after laser treatment for 5 times, and 1 patient received laser treatment for 12 times. The degree of pain in patients of groups E and M was alleviated significantly after treatment for one time, and the number of patients scoring 1-4 point(s) in NRS increased from 5 cases to 38 cases. After treatment for 2 and 3 times, the increase in the number of patients scoring 1-4 point (s) in NRS was on a small scale. Before treatment and after treatment

  4. The impact of post-acne scars on the quality of life among young adults in Singapore

    Directory of Open Access Journals (Sweden)

    Sai Yee Chuah

    2015-01-01

    Full Text Available Background and Objectives: Post-acne scarring is a common and well-known sequelae of acne vulgaris. We aim to study the impact of post-acne scarring on the quality of life (QOL among young adults in Singapore. Settings and Design: This was a non-interventional prospective study. Materials and Methods: Patients aged 21-40 years with atrophic and hypertrophic acne scars who attended the National Skin Centre, Singapore were recruited in the study. They answered a simple questionnaire and the clinical severity of their acne scars were assessed by the doctor. Statistical Analysis Used: Descriptive analyses using absolute and percentage frequencies were performed on all data. The test of significance was two-sided and was set at 5% (P ≤ 0.05. Differential analyses were conducted using the parametric, independent two-sample t-test and non-parametric Mann-Whitney U-test. The statistical assessments were performed using SPSS version 18.0. Results: A total of 100 patients were studied. The mean patients′ subjective self-scoring on the severity of their post-acne scars was 5.78/10 and the mean Dermatology Life Quality Index (DLQI for post-acne scars was 5.61. Many (36%, n = 36 were self-conscious of their acne scars and 24%, (n = 24 felt that their acne scars was affecting their social activities. Conclusions: Our study showed that post-acne scars have a significant negative effect on the QOL of young adults. It highlights the need to increase public awareness of acne vulgaris and its sequelae through education programs and advocating early treatment to reduce the risk of scarring.

  5. The Impact of Post-Acne Scars on the Quality of Life Among Young Adults in Singapore

    Science.gov (United States)

    Chuah, Sai Yee; Goh, Chee Leok

    2015-01-01

    Background and Objectives: Post-acne scarring is a common and well-known sequelae of acne vulgaris. We aim to study the impact of post-acne scarring on the quality of life (QOL) among young adults in Singapore. Settings and Design: This was a non-interventional prospective study. Materials and Methods: Patients aged 21-40 years with atrophic and hypertrophic acne scars who attended the National Skin Centre, Singapore were recruited in the study. They answered a simple questionnaire and the clinical severity of their acne scars were assessed by the doctor. Statistical Analysis Used: Descriptive analyses using absolute and percentage frequencies were performed on all data. The test of significance was two-sided and was set at 5% (P ≤ 0.05). Differential analyses were conducted using the parametric, independent two-sample t-test and non-parametric Mann–Whitney U-test. The statistical assessments were performed using SPSS version 18.0. Results: A total of 100 patients were studied. The mean patients’ subjective self-scoring on the severity of their post-acne scars was 5.78/10 and the mean Dermatology Life Quality Index (DLQI) for post-acne scars was 5.61. Many (36%, n = 36) were self-conscious of their acne scars and 24%, (n = 24) felt that their acne scars was affecting their social activities. Conclusions: Our study showed that post-acne scars have a significant negative effect on the QOL of young adults. It highlights the need to increase public awareness of acne vulgaris and its sequelae through education programs and advocating early treatment to reduce the risk of scarring. PMID:26644739

  6. Improvement in corneal scarring following bacterial keratitis.

    Science.gov (United States)

    McClintic, S M; Srinivasan, M; Mascarenhas, J; Greninger, D A; Acharya, N R; Lietman, T M; Keenan, J D

    2013-03-01

    Bacterial keratitis results in corneal scarring and subsequent visual impairment. The long-term evolution of corneal scars has not been well described. In this case series, we identified patients who had improvement in corneal scarring and visual acuity from a clinical trial for bacterial keratitis. We searched the records of the Steroids for Corneal Ulcers Trial (SCUT) for patients who had improvement in vision between the 3-month and 12-month visits and reviewed their clinical photographs. Of the 500 patients enrolled in SCUT, five patients with large central corneal scars due to bacterial keratitis are presented. All experienced improvement in rigid contact lens-corrected visual acuity from months 3 to 12. All patients also had marked improvement in corneal opacity during the same time period. None of the patients opted to have penetrating keratoplasty. Corneal scars may continue to improve even many months after a bacterial corneal ulcer has healed. The corneal remodeling can be accompanied by considerable improvement in visual acuity, such that corneal transplantation may not be necessary.

  7. Psychometric Properties of the Persian Version of the Relationship Assessment Scale among Couples

    Directory of Open Access Journals (Sweden)

    غلامرضا دهشیری

    2016-06-01

    Full Text Available This research administrated to evaluate the psychometric properties of the Persian version of Relationship Assessment scale. Therefore, 315 married individuals (199 women and 116 men from Tehran city were volunteered to respond to four scales: the Relationship Assessment, the Kansas Marital Satisfaction, the Oxford Happiness and the Life Satisfaction. Results from exploratory & confirmatory factor analysis showed that factor structure of Relationship Assessment scale was unidimensional. The internal consistency of the scale in the total sample was 0.88. Significant correlations between scores of the Relationship Assessment scale with the scores of the Kansas Marital Satisfaction Scale, the Life Satisfaction Scale and the Oxford Happiness Questionnaire demonstrated good convergent validity of the scale. Also, the results showed that there was no significant gender difference between the mean scores of relationship satisfaction. In conclusion, the Relationship Assessment scale is a valid and reliable tool to measure marital satisfaction in Iran.

  8. The scale for the assessment and rating of ataxia correlates with dysarthria assessment in Friedreich's ataxia.

    Science.gov (United States)

    Eigentler, Andreas; Rhomberg, Johanna; Nachbauer, Wolfgang; Ritzer, Irmgard; Poewe, Werner; Boesch, Sylvia

    2012-03-01

    Dysarthria is an acquired neurogenic sensorimotor speech symptom and an integral part within the clinical spectrum of ataxia syndromes. Ataxia measurements and disability scores generally focus on the assessment of motor functions. Since comprehensive investigations of dysarthria in ataxias are sparse, we assessed dysarthria in ataxia patients using the Frenchay Dysarthria Assessment. The Frenchay Dysarthria Assessment is a ten-item validated test in which eight items focus on the observation of oral structures and speech functions. Fifteen Friedreich's ataxia patients and 15 healthy control individuals were analyzed using clinical and logopedic methodology. All patients underwent neurological assessment applying the Scale for the Assessment and Rating of Ataxia. In Friedreich's ataxia patients, the Frenchay sub-item voice showed to be most affected compared to healthy individuals followed by items such as reflexes, palate, tongue, and intelligibility. Scoring of lips, jaw, and respiration appeared to be mildly affected. Ataxia severity in Friedreich's ataxia patients revealed a significant correlation with the Frenchay dysarthria sum score. The introduction of a binary Adapted Dysarthria Score additionally allowed allocation to distinct dysarthria pattern in ataxias. The Frenchay Dysarthria Assessment proved to be a valid dysarthria measure in Friedreich's ataxia. Its availability in several languages provides a major advantage regarding the applicability in international clinical studies. Shortcomings of the Frenchay test are the multiplicity of items tested and its alphabetic coding. Numerical scoring and condensation of assessments in a modified version may, however, provide an excellent clinical tool for the measurement and scoring of dysarthria in ataxic speech disorders.

  9. The Efficacy and Safety of Ablative Fractional Resurfacing Using a 2,940-Nm Er:YAG Laser for Traumatic Scars in the Early Posttraumatic Period.

    Science.gov (United States)

    Kim, Sun Goo; Kim, Eun Yeon; Kim, Yu Jin; Lee, Se Il

    2012-05-01

    Skin injuries, such as lacerations due to trauma, are relatively common, and patients are very concerned about the resulting scars. Recently, the use of ablative and non-ablative lasers based on the fractional approach has been used to treat scars. In this study, the authors demonstrated the efficacy and safety of ablative fractional resurfacing (AFR) for traumatic scars using a 2,940-nm erbium: yttrium-aluminum-garnet (Er:YAG) laser for traumatic scars after primary repair during the early posttraumatic period. Twelve patients with fifteen scars were enrolled. All had a history of facial laceration and primary repair by suturing on the day of trauma. Laser therapy was initiated at least 4 weeks after the primary repair. Each patient was treated four times at 1-month intervals with a fractional ablative 2,940-nm Er:YAG laser using the same parameters. Post-treatment evaluations were performed 1 month after the fourth treatment session. All 12 patients completed the study. After ablative fractional laser treatment, all treated portions of the scars showed improvements, as demonstrated by the Vancouver Scar Scale and the overall cosmetic scale as evaluated by 10 independent physicians, 10 independent non-physicians, and the patients themselves. This study shows that ablative fractional Er:YAG laser treatment of scars reduces scars fairly according to both objective results and patient satisfaction rates. The authors suggest that early scar treatment using AFR can be one adjuvant scar management method for improving the quality of life of patients with traumatic scars.

  10. The Efficacy and Safety of Ablative Fractional Resurfacing Using a 2,940-Nm Er:YAG Laser for Traumatic Scars in the Early Posttraumatic Period

    Directory of Open Access Journals (Sweden)

    Sun Goo Kim

    2012-05-01

    Full Text Available BackgroundSkin injuries, such as lacerations due to trauma, are relatively common, and patients are very concerned about the resulting scars. Recently, the use of ablative and non-ablative lasers based on the fractional approach has been used to treat scars. In this study, the authors demonstrated the efficacy and safety of ablative fractional resurfacing (AFR for traumatic scars using a 2,940-nm erbium: yttrium-aluminum-garnet (Er:YAG laser for traumatic scars after primary repair during the early posttraumatic period.MethodsTwelve patients with fifteen scars were enrolled. All had a history of facial laceration and primary repair by suturing on the day of trauma. Laser therapy was initiated at least 4 weeks after the primary repair. Each patient was treated four times at 1-month intervals with a fractional ablative 2,940-nm Er:YAG laser using the same parameters. Post-treatment evaluations were performed 1 month after the fourth treatment session.ResultsAll 12 patients completed the study. After ablative fractional laser treatment, all treated portions of the scars showed improvements, as demonstrated by the Vancouver Scar Scale and the overall cosmetic scale as evaluated by 10 independent physicians, 10 independent non-physicians, and the patients themselves.ConclusionsThis study shows that ablative fractional Er:YAG laser treatment of scars reduces scars fairly according to both objective results and patient satisfaction rates. The authors suggest that early scar treatment using AFR can be one adjuvant scar management method for improving the quality of life of patients with traumatic scars.

  11. The Efficacy and Safety of Ablative Fractional Resurfacing Using a 2,940-Nm Er:YAG Laser for Traumatic Scars in the Early Posttraumatic Period

    Science.gov (United States)

    Kim, Sun Goo; Kim, Eun Yeon; Lee, Se Il

    2012-01-01

    Background Skin injuries, such as lacerations due to trauma, are relatively common, and patients are very concerned about the resulting scars. Recently, the use of ablative and non-ablative lasers based on the fractional approach has been used to treat scars. In this study, the authors demonstrated the efficacy and safety of ablative fractional resurfacing (AFR) for traumatic scars using a 2,940-nm erbium: yttrium-aluminum-garnet (Er:YAG) laser for traumatic scars after primary repair during the early posttraumatic period. Methods Twelve patients with fifteen scars were enrolled. All had a history of facial laceration and primary repair by suturing on the day of trauma. Laser therapy was initiated at least 4 weeks after the primary repair. Each patient was treated four times at 1-month intervals with a fractional ablative 2,940-nm Er:YAG laser using the same parameters. Post-treatment evaluations were performed 1 month after the fourth treatment session. Results All 12 patients completed the study. After ablative fractional laser treatment, all treated portions of the scars showed improvements, as demonstrated by the Vancouver Scar Scale and the overall cosmetic scale as evaluated by 10 independent physicians, 10 independent non-physicians, and the patients themselves. Conclusions This study shows that ablative fractional Er:YAG laser treatment of scars reduces scars fairly according to both objective results and patient satisfaction rates. The authors suggest that early scar treatment using AFR can be one adjuvant scar management method for improving the quality of life of patients with traumatic scars. PMID:22783532

  12. Toward Instructional Leadership: Principals' Perceptions of Large-Scale Assessment in Schools

    Science.gov (United States)

    Prytula, Michelle; Noonan, Brian; Hellsten, Laurie

    2013-01-01

    This paper describes a study of the perceptions that Saskatchewan school principals have regarding large-scale assessment reform and their perceptions of how assessment reform has affected their roles as principals. The findings revealed that large-scale assessments, especially provincial assessments, have affected the principal in Saskatchewan…

  13. NASA Standard for Models and Simulations: Credibility Assessment Scale

    Science.gov (United States)

    Babula, Maria; Bertch, William J.; Green, Lawrence L.; Hale, Joseph P.; Mosier, Gary E.; Steele, Martin J.; Woods, Jody

    2009-01-01

    As one of its many responses to the 2003 Space Shuttle Columbia accident, NASA decided to develop a formal standard for models and simulations (M&S). Work commenced in May 2005. An interim version was issued in late 2006. This interim version underwent considerable revision following an extensive Agency-wide review in 2007 along with some additional revisions as a result of the review by the NASA Engineering Management Board (EMB) in the first half of 2008. Issuance of the revised, permanent version, hereafter referred to as the M&S Standard or just the Standard, occurred in July 2008. Bertch, Zang and Steeleiv provided a summary review of the development process of this standard up through the start of the review by the EMB. A thorough recount of the entire development process, major issues, key decisions, and all review processes are available in Ref. v. This is the second of a pair of papers providing a summary of the final version of the Standard. Its focus is the Credibility Assessment Scale, a key feature of the Standard, including an example of its application to a real-world M&S problem for the James Webb Space Telescope. The companion paper summarizes the overall philosophy of the Standard and an overview of the requirements. Verbatim quotes from the Standard are integrated into the text of this paper, and are indicated by quotation marks.

  14. Developing a comprehensive scale to assess college multicultural programming.

    Science.gov (United States)

    Mallinckrodt, Brent; Miles, Joseph R; Bhaskar, Tripti; Chery, Nicole; Choi, Gahee; Sung, Mi-Ra

    2014-01-01

    A barrier to assessing effectiveness of multicultural programming is lack of a relatively brief instrument to measure the wide range of intended outcomes. A frequent goal of programming is to increase cultural empathy, but this is rarely the only intended outcome. We conducted focus groups of campus administrators, student affairs staff, and undergraduate instructors who identified a full range of racial/ethnic multicultural competencies that undergraduates should possess. An 84-item pool generated from these focus groups was combined with the 31-item Scale of Ethnocultural Empathy (SEE; Wang et al., 2003). These 115 items, together with instruments used to gauge concurrent validity, were administered to White undergraduate students in introductory psychology courses at the midpoint (n = 602) and end (n = 676) of fall semester. Exploratory factor analysis suggested 6 subscales for the Everyday Multicultural Competencies/Revised SEE (EMC/RSEE): (a) Cultural Openness and Desire to Learn; (b) Resentment and Cultural Dominance; (c) Anxiety and Lack of Multicultural Self-Efficacy; (d) Empathic Perspective-Taking; (e) Awareness of Contemporary Racism and Privilege; and (f) Empathic Feeling and Acting as an Ally. Item response theory principles guided final selection of subscale items. Analyses suggested good factor stability, reliability, and discriminant validity of the 48-item EMC/RSEE in these undergraduate samples. EMC/RSEE subscales were not strongly correlated with a measure of impression management and were significantly associated with measures of Openness to Diversity Challenge, and Universal-Diverse Orientation. (c) 2014 APA, all rights reserved.

  15. Scar Endometriosis at the Site of Cesarean Section

    OpenAIRE

    Ding, Dah-Ching; Hsu, Senzen

    2006-01-01

    Objective: Scar endometriosis is a rare condition. We report a case of scar endometriosis occurring at the site of an old cesarean section scar. Case Report: A 29-year-old multiparous woman complained of painful sensation during menstruation for 2 years that occurred at the site of her cesarean section surgical scar. On examination, there was a firm nodule measuring 2 × 1.5 cm in size at the mid-point of the scar. In view of the possibility of scar endometriosis, the mass was completely ex...

  16. Watermarking scar as an ultimate copy protection

    Science.gov (United States)

    Braci, Sofiane; Miraoui, Abdelkader; Delpha, Claude; Boyer, Rémy

    2010-02-01

    Strong and powerful attacks are able to make the watermark extraction impossible even if there is some watermarking. In this work, we call this residual information the scar and we use it to prove the existence of an attacked watermark. We evaluate the Scar by the mutual information between the embedded watermark and the attacked copies. It is well known that the mutual information between two random variables gives an evaluation of the shared information between the two variables. Thus, the attack can compromise the correct decoding by removing partialy the watermarking information. However, it is possible to make the watermarking existence proof possible when the mutual information between the embedded message and the attacked copies is above a certain threshold. We propose a practical way to use the scar by measuring the correlation between the attacked watermark and the original one.

  17. Fraxelated radiofrequency device for acne scars

    Science.gov (United States)

    Rao, Babar K.; Khokher, Sairah

    2012-09-01

    Acne scars can be improved with various treatments such as topical creams, chemical peels, dermal fillers, microdermabrasion, laser, and radiofrequency devices. Some of these treatments especially lasers and deep chemical peels can have significant side effects such as post inflammatory hyperpigmentation in darker skin types. Fraxelated RF Laser devices have been reported to have lower incidence of side effects in all skin phototypes. Nine patients between ages 18 and 35 of various skin phototypes were selected from a private practice and treated with a RF fraxelated device (E-matrix) for acne scars. Outcomes were measured by physician observation, subjective feedback received by patients, and comparison of before and after photographs. In this small group of patients with various skin phototypes, fraxelated radiofrequency device improved acne scars with minimal side effects and downtime.

  18. Current Therapeutic Approach to Hypertrophic Scars

    Directory of Open Access Journals (Sweden)

    Zrinka Bukvić Mokos

    2017-06-01

    Full Text Available Abnormal scarring and its accompanying esthetic, functional, and psychological sequelae still pose significant challe nges. To date, there is no satisfactory prevention or treatment option for hypertrophic scars (HSs, which is mostly due to not completely comprehending the mechanisms underlying their formation. That is why the apprehension of regular and controlled physiological processes of scar formation is of utmost importance when facing hypertrophic scarring, its pathophysiology, prevention, and therapeutic approach. When treating HSs and choosing the best treatment and prevention modality, physicians can choose from a plethora of therapeutic options and many commercially available products, among which currently there is no efficient option that can successfully overcome impaired skin healing. This article reviews current therapeutic approach and emerging therapeutic strategies for the management of HSs, which should be individualized, based on an evaluation of the scar itself, patients’ expectations, and practical, evidence-based guidelines. Clinicians are encouraged to combine various prevention and treatment modalities where combination therapy that includes steroid injections, 5-fluorouracil, and pulsed-dye laser seems to be the most effective. On the other hand, the current therapeutic options are usually empirical and their results are unreliable and unpredictable. Therefore, there is an unmet need for an effective, targeted therapy and prevention, which would be based on an action or a modulation of a particular factor with clarified mechanism of action that has a beneficial effect on wound healing. As the extracellular matrix has a crucial role in cellular and extracellular events that lead to pathological scarring, targeting its components mostly by regulating bone morphogenetic proteins may throw up new therapeutic approach for reduction or prevention of HSs with functionally and cosmetically acceptable outcome.

  19. Functional Regeneration Beyond the Glial Scar

    Science.gov (United States)

    Cregg, Jared M.; DePaul, Marc A.; Filous, Angela R.; Lang, Brad T.; Tran, Amanda; Silver, Jerry

    2014-01-01

    Astrocytes react to CNS injury by building a dense wall of filamentous processes around the lesion. Stromal cells quickly take up residence in the lesion core and synthesize connective tissue elements that contribute to fibrosis. Oligodendrocyte precursor cells proliferate within the lesion and help to entrap dystrophic axon tips. Here we review evidence that this aggregate scar acts as the major barrier to regeneration of axons after injury. We also consider several exciting new interventions that allow axons to regenerate beyond the glial scar, and discuss the implications of this work for the future of regeneration biology. PMID:24424280

  20. Scar treatment variations by skin type.

    Science.gov (United States)

    Visscher, Marty O; Bailey, J Kevin; Hom, David B

    2014-08-01

    Patients and clinicians use skin color attributes such as color uniformity, color distribution, and texture to infer physiologic health status. Normalization of skin color, surface texture, and height are important treatment goals in the treatment of scars. Skin color, structure, and response to trauma, vary with ethnicity. The incidence of hypertrophic and keloid scar formation is influenced by these inherent skin attributes. Skin type influences the response to various modalities including laser therapy and surgical intervention, and skin differences must be considered in treatment planning to achieve optimal results. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Transmission and scarring in graphene quantum dots

    Energy Technology Data Exchange (ETDEWEB)

    Huang Liang; Lai Yingcheng; Ferry, David K; Akis, Richard; Goodnick, Stephen M [Department of Electrical Engineering, Arizona State University, Tempe, AZ 85287 (United States)

    2009-08-26

    We study electronic transport in quantum-dot structures made of graphene. Focusing on the rectangular dot geometry and utilizing the non-equilibrium Green's function to calculate the transmission in the tight-binding framework, we find significant fluctuations in the transmission as a function of the electron energy. The fluctuations are correlated with the formation of quantum scarring states, or pointer states in the dot. Both enhancement and suppression of transmission have been observed. As the size of the quantum dot is increased, more scarring states can be formed, leading to stronger transmission or conductance fluctuations.

  2. Do Balanced Scales Assess Bipolar Constructs? The Case of the STAI Scales

    Science.gov (United States)

    Vautier, Stephane; Pohl, Steffi

    2009-01-01

    Balanced scales, that is, scales based on items whose content is either negatively or positively polarized, are often used in the hope of measuring a bipolar construct. Research has shown that usually balanced scales do not yield 1-dimensional measurements. This threatens their construct validity. The authors show how to test bipolarity while…

  3. Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial.

    Science.gov (United States)

    Leheta, Tahra Mohamed; Abdel Hay, Rania Mounir; El Garem, Yehia Farouk

    2014-04-01

    Deep peeling using phenol and percutaneous collagen induction (PCI) are used in treating acne scars. To compare deep peeling using phenol and PCI combined with trichloroacetic acid (TCA) 20% in treating atrophic acne scars. 24 patients with post-acne atrophic scars were randomly divided into two groups; group 1 was subjected to one session of deep peeling using phenol, and group 2 was subjected to four sessions of PCI combined with TCA 20%. As a secondary outcome measure, side effects were recorded and patients were asked to assess their % of improvement by a questionnaire completed 8 months after the procedure. Scar severity scores improved by a mean of 75.12% (p scars, within the same group after treatment, revealed a significant highest degree of improvement in the rolling type (p = 0.005) in group 2. Deep peeling using phenol and PCI with TCA 20% were effective in treating post-acne atrophic scars.

  4. The effect of scale in daily precipitation hazard assessment

    Directory of Open Access Journals (Sweden)

    J. J. Egozcue

    2006-01-01

    Full Text Available Daily precipitation is recorded as the total amount of water collected by a rain-gauge in 24 h. Events are modelled as a Poisson process and the 24 h precipitation by a Generalised Pareto Distribution (GPD of excesses. Hazard assessment is complete when estimates of the Poisson rate and the distribution parameters, together with a measure of their uncertainty, are obtained. The shape parameter of the GPD determines the support of the variable: Weibull domain of attraction (DA corresponds to finite support variables as should be for natural phenomena. However, Fréchet DA has been reported for daily precipitation, which implies an infinite support and a heavy-tailed distribution. Bayesian techniques are used to estimate the parameters. The approach is illustrated with precipitation data from the Eastern coast of the Iberian Peninsula affected by severe convective precipitation. The estimated GPD is mainly in the Fréchet DA, something incompatible with the common sense assumption of that precipitation is a bounded phenomenon. The bounded character of precipitation is then taken as a priori hypothesis. Consistency of this hypothesis with the data is checked in two cases: using the raw-data (in mm and using log-transformed data. As expected, a Bayesian model checking clearly rejects the model in the raw-data case. However, log-transformed data seem to be consistent with the model. This fact may be due to the adequacy of the log-scale to represent positive measurements for which differences are better relative than absolute.

  5. The application of 3D-printed transparent facemask for facial scar management and its biomechanical rationale.

    Science.gov (United States)

    Wei, Yating; Wang, Yan; Zhang, Ming; Yan, Gang; Wu, Shixue; Liu, Wenjun; Ji, Gang; Li-Tsang, Cecilia W P

    2017-10-09

    Deep facial burns leave conspicuous scar to the patients and affect their quality of life. Transparent facemask has been adopted for the prevention and treatment of facial hypertrophic scars for decades. Recently, with the advancement of 3D printing, the transparent facemask could facilitate the fitting of the facial contour. However, the effectiveness of the device and its biomechanical characteristics on pressure management of hypertrophic scar would need more objective evaluation. A biomechanical model of the transparent 3D-printed facemask was established through finite element analysis. Ten patients with extensive deep facial burns within 6 months were recruited for clinical study using 3D-printed facemask designed according to biomechanical model, and the interface pressure was measured on each patient. The patients in the treatment group (n=5) was provided with the 3D-printed transparent face mask soon after initial scar assessment, while the delayed treatment group (n=5) began the treatment one month after the initial scar assessment. The scar assessment was performed one month post intervention for both groups. The biomechanical modeling showed that the 3D, computer-generated facemask resulted in unbalanced pressure if design modifications were not incorporated to address these issues. The interface pressure between the facemask and patient's face was optimized through individualized design adjustments and the addition of silicone lining. After optimization of pressure through additional lining, the mean thickness and hardness of the scars of all 10 patients were decreased significantly after 1-month of intervention. In the delayed treatment group, the mean thickness of the scars was increased within the month without intervention, but it was also decreased after intervention. Facemask design and the silicone lining are important to ensure adequate compression pressure of 3D-printed transparent facemask. The intervention using the 3D-printed facemask

  6. Comparison of Traditional Superficial Cutaneous Sutures Versus Adhesive Strips in Layered Dermatologic Closures on the Back-A Prospective, Randomized, Split-Scar Study.

    Science.gov (United States)

    Yang, Sherry; Ozog, David

    2015-11-01

    Bilayered suture repairs have become the standard of care in dermatologic surgery. However, the benefit of superficial sutures for fine epidermal alignment on high-tension areas remains unclear. To compare the overall cosmetic outcome of traditional epidermal sutures with adhesive strips in layered dermatologic repairs on the back. A total of 10 patients underwent standard elliptical excision on the back followed by subcutaneous closure with 4-0 polyglactin 910 buried sutures. Each half of the wound was then randomized to either 4-0 polypropylene running sutures or 1/4″ Steri-Strip films for epidermal approximation. Postoperative evaluations were completed in person at 2 weeks, 3 months, and 6 months using the Patient and Observer Scar Assessment Scale. The adhesive strip group had superior appearance and greater patient satisfaction at 2 weeks. Evaluation at 3 months and 6 months revealed no statistically significant difference in overall scar cosmesis. Adhesive strips result in equivalent long-term scar outcome when compared with traditional epidermal sutures and should be viewed as a time-saving alternative in layered dermatologic repairs on the back. This finding further corroborates that undermining and placement of deep buried sutures are the primary determinants of wound appearance.

  7. Database of predicted SCAR markers in five fruit and three ...

    Indian Academy of Sciences (India)

    2016-03-04

    ; Paran and Michelmore 1993) markers were introduced to overcome the disadvantages of RAPD. It is easy to design SCAR primers if the target sequence is known. SCAR primers are longer (18–25 bases) than RAPD.

  8. Will stem cells bring hope to pathological skin scar treatment?

    Science.gov (United States)

    Li, Qiankun; Zhang, Cuiping; Fu, Xiaobing

    2016-08-01

    Pathological skin scars, such as keloids, aesthetically and psychosocially affect patients. The quest for scar reduction and the increasing recognition of patient satisfaction has led to the continued exploration of scar treatment. Stem cells are a promising source for tissue repair and regeneration. The multi-potency and secretory functions of these cells could offer possible treatments for pathological scars and have been examined in recent studies. Here, we analyze the factors that influence the formation of pathological skin scars, summarize recent research on pathological scar treatment with stem cells and elaborate on the possible mechanisms of this treatment. Additionally, other effects of stem cell treatments are also presented while evaluating potential side effects of stem cell-based pathological scar treatments. Thus, this review may provide meaningful guidance in the clinic for scar treatments with stem cells. Copyright © 2016. Published by Elsevier Inc.

  9. Before and After Photos: Treatment of Hypertrophic Scars

    Science.gov (United States)

    ... Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids Excess Fat Excessive Sweating ... Hands Age Spots Aging Skin Birthmarks Burn Scars Cellulite Crow's Feet Droopy Eyelids Excess Fat Excessive Sweating ...

  10. Comparison of Three Consciousness Assessment Scales in Poisoned Patients and Recommendation of a New Scale: AVPU Plus

    Directory of Open Access Journals (Sweden)

    Ali Rajabi Kheirabadi

    2015-06-01

    Full Text Available Background: Few methods have been introduced to assess the level of consciousness in critically-ill patients. This study was designed to evaluate how the AlertVerbalPainfulUnresponsive (AVPU responsive scale corresponds with the Glasgow Coma Scale (GCS and Richmond Agitation-Sedation Scale (RASS scores in drug-poisoned patients and to devise an augmented AVPU scale. Methods: In this prospective study, patients with diagnosis of acute drug poisoning were included and their level of consciousness was assessed using GCS, RASS and AVPU scales. Results: Overall, 165 poisoned patients (59% female were studied. According to AVPU scale, 123 patients (74.5% were graded as “alert”, 26 patients (15.8% as “responsive to verbal stimulation”, 10 patients (6.1% as “responsive to painful stimulation”, and 6 patients as “unresponsive” (3.6%. AVPU grades of "alert", "responsive to verbal stimulation", "responsive to painful stimulation" and "unresponsive" corresponded with median [IQR] GCS scores of 15 [15–15], 13 [12–13], 8 [7–10] and 6 [5–6], and median [IQR] RASS scores of -1 [-1 – +1], -2 [-3 – -1], -3 [-4 – -1], -5 [-5 – -5], respectively. By taking the median of RASS scores corresponding with each AVPU grade, an augmented AVPU scale for the assessment of consciousness was devised. The first proposed version of AVPU plus includes 14 qualitative grades of consciousness. By application of this scale, clinicians can evaluate both the alertness/attentiveness and arousal/excitability of poisoned and critical patients. Conclusion: The AVPU plus is a new scale designed for more detailed assessment of neurologic status of poisoned and critical patients. The prognostic-ability, reliability and validity of the scale should be investigated in future studies.

  11. Development of Scales to Assess Homeownership Consumption and Investment Attitudes.

    Science.gov (United States)

    Brandt, Jeanette A.; Olson, Geraldine I.

    1986-01-01

    A method to measure homeowners' housing consumption and investment attitudes was developed. Dimensions in the consumption scale were space, tenure, structure, quality, and neighborhood. The investment scale included tax benefits, equity, rate of return, leverage, and risk. Personal variables were hypothesized to have an effect on overall…

  12. Assessing Africa-wide Pangolin exploitation by scaling local data

    DEFF Research Database (Denmark)

    Ingram, Daniel J.; Coad, Lauren; Abernethy, Katharine A.

    2017-01-01

    Overexploitation is one of the main pressures driving wildlife closer to extinction, yet broad-scale data to evaluate species’ declines are limited. Using African pangolins (Family: Pholidota) as a case study, we demonstrate that collating local-scale data can provide crucial information on regio...

  13. Digital representation of oil and natural gas well pad scars in southwest Wyoming: 2012 update

    Science.gov (United States)

    Garman, Steven L.; McBeth, Jamie L.

    2015-01-01

    The recent proliferation of oil and natural gas energy development in the Greater Green River Basin of southwest Wyoming has accentuated the need to understand wildlife responses to this development. The location and extent of surface disturbance that is created by oil and natural gas well pad scars are key pieces of information used to assess the effects of energy infrastructure on wildlife populations and habitat. A digital database of oil and natural gas pad scars had previously been generated from 1-meter (m) National Agriculture Imagery Program imagery (NAIP) acquired in 2009 for a 7.7-million hectare (ha) (19,026,700 acres) region of southwest Wyoming. Scars included the pad area where wellheads, pumps, and storage facilities reside and the surrounding area that was scraped and denuded of vegetation during the establishment of the pad. Scars containing tanks, compressors, the storage of oil and gas related equipment, and produced-water ponds were also collected on occasion. This report updates the digital database for the five counties of southwest Wyoming (Carbon, Lincoln, Sublette, Sweetwater, Uinta) within the Wyoming Landscape Conservation Initiative (WLCI) study area and for a limited portion of Fremont, Natrona, and Albany Counties using 2012 1-m NAIP imagery and 2012 oil and natural gas well permit information. This report adds pad scars created since 2009, and updates attributes of all pad scars using the 2012 well permit information. These attributes include the origination year of the pad scar, the number of active and inactive wells on or near each pad scar in 2012, and the overall status of the pad scar (active or inactive). The new 2012 database contains 17,404 pad scars of which 15,532 are attributed as oil and natural gas well pads. Digital data are stored as shapefiles projected to the Universal Transverse Mercator (zones 12 and 13) coordinate system. These data are available from the U.S. Geological Survey (USGS) at http://dx.doi.org/10

  14. Medicine in words and numbers: a cross-sectional survey comparing probability assessment scales

    Directory of Open Access Journals (Sweden)

    Koele Pieter

    2007-06-01

    Full Text Available Abstract Background In the complex domain of medical decision making, reasoning under uncertainty can benefit from supporting tools. Automated decision support tools often build upon mathematical models, such as Bayesian networks. These networks require probabilities which often have to be assessed by experts in the domain of application. Probability response scales can be used to support the assessment process. We compare assessments obtained with different types of response scale. Methods General practitioners (GPs gave assessments on and preferences for three different probability response scales: a numerical scale, a scale with only verbal labels, and a combined verbal-numerical scale we had designed ourselves. Standard analyses of variance were performed. Results No differences in assessments over the three response scales were found. Preferences for type of scale differed: the less experienced GPs preferred the verbal scale, the most experienced preferred the numerical scale, with the groups in between having a preference for the combined verbal-numerical scale. Conclusion We conclude that all three response scales are equally suitable for supporting probability assessment. The combined verbal-numerical scale is a good choice for aiding the process, since it offers numerical labels to those who prefer numbers and verbal labels to those who prefer words, and accommodates both more and less experienced professionals.

  15. Short scar correction of the tuberous breast.

    Science.gov (United States)

    Ribeiro, Liacyr; Accorsi, Affonso; Buss, Affonso; Pessĵa, Marcelo Castro Marçal

    2002-07-01

    This article describes the author's technique-an alternative form of short scar correction of tuberous breast. The historical background that suports the technique is described as well as the surgical sequence. Illustrative cases and postoperative results reached by author's technique are shown.

  16. Recombinant human endostatin reduces hypertrophic scar ...

    African Journals Online (AJOL)

    Methods: Sixteen New Zealand white rabbits were used to establish HS models. Then, rabbit ears containing HS were randomly assigned to either the Endostar group or the control group. The changes of appearance and histology were evaluated using the naked eye, hematoxylin eosin staining, and a scar elevation index.

  17. Pulmonary scar carcinoma in South Africa

    African Journals Online (AJOL)

    of both fibrosis and cancer.[2,3]. The Western Cape Province of South Africa (SA) has one of the highest recorded incidences of pulmonary tuberculosis (TB) in the world, and also carries a high burden of smoking-related diseases including lung cancer.[4] However, the potential association between pulmonary scarring and ...

  18. An idiosyncratic history of burn scars.

    Science.gov (United States)

    Petro, Jane A

    2015-03-01

    The history of burn scars can best be found in military medical history. The care of wounded soldiers documented in the Illiad reflected the trauma of the weapons of war, arrow, spear, sword, and ax. The introduction of gunpowder in the 14th century, increasingly sophisticated explosives, and in modern times, petroleum-driven vehicles, including airplanes, created a new subset of wounds requiring attention and post-survival scars challenging the quality of survival. This article selects from among a myriad of examples of modern military treatments as they relate to those survivors. Larrey, with Napolean's Grand Army, Sir Harold Gilles during and following World War I, and the Boston area preparation and response to the Cocoanut Grove Fire in 1942 are the principle topics examined. Recent modern interventions, related to the survival of horrific blast and burn injuries, with modern wound care and scar manipulation techniques provide context to the current ability to modify healing and scars. ©2015 Frontline Medical Communications.

  19. 9 CFR 11.3 - Scar rule.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Scar rule. 11.3 Section 11.3 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL... inflammation, and, other bilateral evidence of abuse indicative of soring including, but not limited to...

  20. "Scars" connect classical and quantum theory

    CERN Multimedia

    Monteiro, T

    1990-01-01

    Chaotic systems are unstable and extremely sensitive to initial condititions. So far, scientists have been unable to demonstrate that the same kind of behaviour exists in quantum or microscopic systems. New connections have been discovered though between classical and quantum theory. One is the phenomena of 'scars' which cut through the wave function of a particle (1 page).

  1. Evaluation of combined fractional radiofrequency and fractional laser treatment for acne scars in Asians.

    Science.gov (United States)

    Yeung, Chi K; Chan, Nicola P Y; Shek, Samantha Y N; Chan, Henry H L

    2012-10-01

    Fractionated radiofrequency (RF) induces deep dermal heating and leaves the epidermis less affected. We studied the efficacy and safety of bipolar RF and fractional diode laser followed by fractional RF in Asians with acne scars. Twenty-four patients (skin types III and IV) with acne scars received up to five treatments of combined fractional 915-nm laser and bipolar RF using a Matrix IR applicator (Syneron Medical Ltd, Yokneam, Israel) with fluence ranging from 50 to 70 J/cm(2) , RF at 70-100 J/cm(3) , double passes followed by full-face bipolar fractional RF treatment using Matrix RF at energy ranging from 50 to 62 mJ/pin, at 4-week intervals. Changes in acne scars, skin texture, pore size, pigmentation irregularity, and complications were assessed up to 3 months post-treatment by standardized photographs obtained with Canfield Visia-CR system®. Subjective improvement and patient satisfaction were assessed by questionnaire. Twenty patients (age 27.7 ± 8.4 years) completed the study. Modest but statistically significant improvement was noted in acne scars, with the mean grade decreased by 29% (P acne scars with modest improvement and low PIH rate comparable to other resurfacing techniques in this Asian case series. Adequate pain control and recduced energy level when treating areas in close proximity to bone are advised. Lasers Surg. Med. 44: 622-630, 2012. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc.

  2. The Psychometric Properties of Scales that Assess Market Orientation and Team Leadership Skills: A Preliminary Study

    Science.gov (United States)

    Kline, Theresa J. B.

    2003-01-01

    This study assessed the psychometric properties of two scales that can be used in predicting team performance: specifically how team members assess the market orientation of their work unit as well the leadership skills present in the team. The first scale is a three-dimensional assessment of the unit's market orientation (innovative, process, or…

  3. The clinical outcome of cesarean scar pregnancies implanted "on the scar" versus "in the niche".

    Science.gov (United States)

    Kaelin Agten, Andrea; Cali, Giuseppe; Monteagudo, Ana; Oviedo, Johana; Ramos, Joanne; Timor-Tritsch, Ilan

    2017-05-01

    The term cesarean scar pregnancy refers to placental implantation within the scar of a previous cesarean delivery. The rising numbers of cesarean deliveries in the last decades have led to an increased incidence of cesarean scar pregnancy. Complications of cesarean scar pregnancy include morbidly adherent placenta, uterine rupture, severe hemorrhage, and preterm labor. It is suspected that cesarean scar pregnancies that are implanted within a dehiscent scar ("niche") behave differently compared with those implanted on top of a well-healed scar. To date there are no studies that have compared pregnancy outcomes between cesarean scar pregnancies implanted either "on the scar" or "in the niche." The purpose of this study was to determine the pregnancy outcome of cesarean scar pregnancy implanted either "on the scar" or "in the niche." This was a retrospective 2-center study of 17 patients with cesarean scar pregnancy that was diagnosed from 5-9 weeks gestation (median, 8 weeks). All cesarean scar pregnancies were categorized as either implanted or "on the scar" (group A) or "in the niche" (group B), based on their first-trimester transvaginal ultrasound examination. Clinical outcomes based on gestational age at delivery, mode of delivery, blood loss at delivery, neonate weight and placental histopathologic condition were compared between the groups with the use of the Mann-Whitney U test. Myometrial thickness overlying the placenta was compared among all the patients who required hysterectomy and those who did not with the use of the Mann-Whitney U test. Myometrial thickness was also correlated with gestational age at delivery with the use of Spearman's correlation. Group A consisted of 6 patients; group B consisted of 11 patients. Gestational age at delivery was lower in group B (median, 34 weeks; range, 20-36 weeks) than in group A (median, 38 weeks; range, 37-39 weeks; P=.001). In group A, 5 patients were delivered via cesarean delivery (with normal placenta), and

  4. SCAR knockouts in Dictyostelium: WASP assumes SCAR's position and upstream regulators in pseudopods

    National Research Council Canada - National Science Library

    Veltman, Douwe M; King, Jason S; Machesky, Laura M; Insall, Robert H

    2012-01-01

    ...) assembles actin at clathrin-coated pits. We show that, unexpectedly, Dictyostelium discoideum SCAR knockouts could still spread, migrate, and chemotax using pseudopods driven by the Arp2/3 complex...

  5. Efficacy and safety of erbium-doped yttrium aluminium garnet fractional resurfacing laser for treatment of facial acne scars.

    Science.gov (United States)

    Nirmal, Balakrishnan; Pai, Sathish B; Sripathi, Handattu; Rao, Raghavendra; Prabhu, Smitha; Kudur, Mohan H; Nayak, Sudhir U K

    2013-01-01

    Treatment of acne scars with ablative fractional laser resurfacing has given good improvement. But, data on Indian skin are limited. A study comparing qualitative, quantitative, and subjective assessments is also lacking. Our aim was to assess the improvement of facial acne scars with Erbium-doped Yttrium Aluminium Garnet (Er:YAG) 2940 nm fractional laser resurfacing and its adverse effects in 25 patients at a tertiary care teaching hospital. All 25 patients received four treatment sessions with Er:YAG fractional laser at 1-month interval. The laser parameters were kept constant for each of the four sittings in all patients. Qualitative and quantitative assessments were done using Goodman and Barron grading. Subjective assessment in percentage of improvement was also documented 1 month after each session. Photographs were taken before each treatment session and 1 month after the final session. Two unbiased dermatologists performed independent clinical assessments by comparing the photographs. The kappa statistics was used to monitor the agreement between the dermatologists and patients. Most patients (96%) showed atleast fair improvement. Rolling and superficial box scars showed higher significant improvement when compared with ice pick and deep box scars. Patient's satisfaction of improvement was higher when compared to physician's observations. No serious adverse effects were noted with exacerbation of acne lesions forming the majority. Ablative fractional photothermolysis is both effective and safe treatment for atrophic acne scars in Indian skin.Precise evaluation of acne scar treatment can be done by taking consistent digital photographs.

  6. The hidden cost of skin scars: quality of life after skin scarring.

    Science.gov (United States)

    Brown, B C; McKenna, S P; Siddhi, K; McGrouther, D A; Bayat, A

    2008-09-01

    Surprisingly little is known about how skin scars affect patients' lives, though specialist clinical impressions suggest their impact is related to both their physical and psychosocial effects. Facial scars have been shown to cause high levels of anxiety and self-consciousness, but further work has been neglected. We aimed to explore the influence of skin scars on patients' quality of life (QoL) and identify potential implications for clinical practice. We adopted a needs-based approach to QoL and conducted semi-structured interviews with scar patients at a specialist clinic. Transcribed data underwent interpretative phenomenological analysis to identify common themes in individuals' personal experiences. Thirty-four scar patients (24 women; aged 14-70 years, mean=35.7 years, SD=17.9 years) with a wide range of scar type, severity and onset were recruited. Five hundred and seventy-three statements were identified from interview transcripts relating to need impairment by skin scars. These were subsequently classified into 44 themes covering five main areas: physical comfort and functioning; acceptability to self and others; social functioning; confidence in the nature and management of the condition; emotional well-being. The majority of respondents were unhappy with their scar's appearance due to their perceived stigma and psychological associations, and thus adopted different coping behaviours to hide or compensate for them. Often this made them unsociable and interfered with their communication skills, personal relationships, work life and leisure activities. Concerns about the diagnosis and persistent nature of scars were common, whilst unempathic management by general physicians and frustrations of current treatment compounded distress. There are five main areas of impact on the needs of scar patients that should be addressed in their management, which are greater and more complex than previously considered. Support services should be made available, along with

  7. Prevalence of scar contractures after burn : A systematic review

    NARCIS (Netherlands)

    Oosterwijk, Anouk M; Mouton, Leonora J; Schouten, Hennie; Disseldorp, Laurien M; van der Schans, Cees P.; Nieuwenhuis, Marianne K

    OBJECTIVE: Burn scar contractures are the pathological outcome of excessive scarring and ongoing scar contraction. Impairment of joint range of motion is a threat to performing activities in daily living. To direct treatment strategies to prevent and/or correct such contractures, insight into the

  8. The Use of Silicone Adhesives for Scar Reduction.

    Science.gov (United States)

    Bleasdale, Benjamin; Finnegan, Simon; Murray, Kathyryn; Kelly, Sean; Percival, Steven L

    2015-07-01

    Significance: This article discusses the history and developments of silicone gel sheeting (SGS) scar therapy. Furthermore, we review a breadth of literature to gain an insight into how and why topical silicone gels remain the favored treatment of medical experts in scar management. We also analyze an ever increasing number of alternative therapies claiming to provide enhanced scar reduction performance. Recent Advances: Topical silicone gel treatments seem to remain the first point of clinical recommendation in scar management. SGS has been used in scar therapy for over 30 years, during which its efficacy has been the subject of numerous clinical evaluations. Critical Issues: While the exact mechanisms by which SGS improves hypertrophic scars, keloid development and recovery are yet to be fully agreed upon, its ability to do so remains largely undisputed at present. However, there still is ongoing deliberation over the exact mechanism of action of silicone in improving a scar. At present it is likely that through occlusion of the scar site and hydration of the wound bed, the overactivity of scar-related cells is suppressed, and their activity normalized. Future Direction: The clinical support of topical silicone gel products, relative to all alternative scar therapies, is considered the internationally recommended first-line form of scar management, and favored by consensus among healthcare professionals. However, there still remains the need for further clinical evidence and a better understanding of the mechanism behind the benefit of silicone gel for use in the prevention of abnormal scarring.

  9. Currently known risk factors for hypertrophic skin scarring : A review

    NARCIS (Netherlands)

    Butzelaar, L.; Ulrich, M. M W; Mink Van Der Molen, A. B.; Niessen, F. B.; Beelen, R. H J

    2016-01-01

    SummaryObjective The study aims to provide an overview of risk factors for hypertrophic scarring. Background Hypertrophic skin scarring remains a major concern in medicine and causes considerable morbidity. Despite extensive research on this topic, the precise mechanism of excessive scarring is

  10. The Use of Silicone Adhesives for Scar Reduction

    Science.gov (United States)

    Bleasdale, Benjamin; Finnegan, Simon; Murray, Kathyryn; Kelly, Sean; Percival, Steven L.

    2015-01-01

    Significance: This article discusses the history and developments of silicone gel sheeting (SGS) scar therapy. Furthermore, we review a breadth of literature to gain an insight into how and why topical silicone gels remain the favored treatment of medical experts in scar management. We also analyze an ever increasing number of alternative therapies claiming to provide enhanced scar reduction performance. Recent Advances: Topical silicone gel treatments seem to remain the first point of clinical recommendation in scar management. SGS has been used in scar therapy for over 30 years, during which its efficacy has been the subject of numerous clinical evaluations. Critical Issues: While the exact mechanisms by which SGS improves hypertrophic scar/span>s, keloid development and recovery are yet to be fully agreed upon, its ability to do so remains largely undisputed at present. However, there still is ongoing deliberation over the exact mechanism of action of silicone in improving a scar. At present it is likely that through occlusion of the scar site and hydration of the wound bed, the overactivity of scar-related cells is suppressed, and their activity normalized. Future Direction: The clinical support of topical silicone gel products, relative to all alternative scar therapies, is considered the internationally recommended first-line form of scar management, and favored by consensus among healthcare professionals. However, there still remains the need for further clinical evidence and a better understanding of the mechanism behind the benefit of silicone gel for use in the prevention of abnormal scarring. PMID:26155385

  11. A Rat Excised Larynx Model of Vocal Fold Scar

    Science.gov (United States)

    Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.

    2009-01-01

    Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…

  12. Therapeutic Improvement of Scarring: Mechanisms of Scarless and Scar-Forming Healing and Approaches to the Discovery of New Treatments

    Directory of Open Access Journals (Sweden)

    Nick L. Occleston

    2010-01-01

    Full Text Available Scarring in the skin after trauma, surgery, burn or sports injury is a major medical problem, often resulting in loss of function, restriction of tissue movement and adverse psychological effects. Whilst various studies have utilised a range of model systems that have increased our understanding of the pathways and processes underlying scar formation, they have typically not translated to the development of effective therapeutic approaches for scar management. Existing treatments are unreliable and unpredictable and there are no prescription drugs for the prevention or treatment of dermal scarring. As a consequence, scar improvement still remains an area of clear medical need. Here we describe the basic science of scar-free and scar-forming healing, the utility of pre-clinical model systems, their translation to humans, and our pioneering approach to the discovery and development of therapeutic approaches for the prophylactic improvement of scarring in man

  13. MicroRNA-21 regulates hTERT via PTEN in hypertrophic scar fibroblasts.

    Directory of Open Access Journals (Sweden)

    Hua-Yu Zhu

    Full Text Available As an important oncogenic miRNA, microRNA-21 (miR-21 is associated with various malignant diseases. However, the precise biological function of miR-21 and its molecular mechanism in hypertrophic scar fibroblast cells has not been fully elucidated.Quantitative Real-Time PCR (qRT-PCR analysis revealed significant upregulation of miR-21 in hypertrophic scar fibroblast cells compared with that in normal skin fibroblast cells. The effects of miR-21 were then assessed in MTT and apoptosis assays through in vitro transfection with a miR-21 mimic or inhibitor. Next, PTEN (phosphatase and tensin homologue deleted on chromosome ten was identified as a target gene of miR-21 in hypertrophic scar fibroblast cells. Furthermore, Western-blot and qRT-PCR analyses revealed that miR-21 increased the expression of human telomerase reverse transcriptase (hTERT via the PTEN/PI3K/AKT pathway. Introduction of PTEN cDNA led to a remarkable depletion of hTERT and PI3K/AKT at the protein level as well as inhibition of miR-21-induced proliferation. In addition, Western-blot and qRT-PCR analyses confirmed that hTERT was the downstream target of PTEN. Finally, miR-21 and PTEN RNA expression levels in hypertrophic scar tissue samples were examined. Immunohistochemistry assays revealed an inverse correlation between PTEN and hTERT levels in high miR-21 RNA expressing-hypertrophic scar tissues.These data indicate that miR-21 regulates hTERT expression via the PTEN/PI3K/AKT signaling pathway by directly targeting PTEN, therefore controlling hypertrophic scar fibroblast cell growth. MiR-21 may be a potential novel molecular target for the treatment of hypertrophic scarring.

  14. Psychometric assessment of the Correa-Barrick Postpartum Depression Scale

    National Research Council Canada - National Science Library

    Barrick, Christina; Kent, Vicky; Crusse, Elizabeth; Taylor, Dianne

    2012-01-01

    .... The purpose of this study is to report on the psychometric properties of a new postpartum depression rating scale while at the same time showing a correlation between depression severity and impaired color sensitivity...

  15. Development of sequence characterized amplified genomic regions (SCAR) for fungal systematics: proof of principle using Alternaria, Ascochyta and Tilletia.

    Science.gov (United States)

    Stewart, Jane E; Andrew, Marion; Bao, Xiaodong; Chilvers, Martin I; Carris, Lori M; Peever, Tobin L

    2013-01-01

    SCARs were developed by cloning RAPD-PCR amplicons into commercially available vectors, sequencing them and designing specific primers for PCR, direct sequencing and phylogenetic analysis. Eighteen to seventy percent of cloned RAPD-PCR amplicons were phylogenetically informative among closely related small-spored Alternaria spp., Ascochyta spp. and Tilletia spp., taxa that have been resistant to phylogenetic analysis with universally primed, protein-coding sequence data. Selected SCARs were sequenced for larger, population-scale samples of each taxon and demonstrated to be useful for phylogenetic inference. Variation observed in the cloned SCARs generally was higher than variation in nuclear ribosomal internal transcribed spacer (ITS) and several protein-coding sequences commonly used in lower level fungal systematics. Sequence data derived from SCARs will provide sufficient resolution to address lower level phylogenetic hypotheses in Alternaria, Ascochyta, Tilletia and possibly many other fungal groups and organisms.

  16. Single Session Treatment of Rolling Acne Scars Using Tumescent Anesthesia, 20% Trichloracetic Acid Extensive Subcision, and Fractional CO2 Laser.

    Science.gov (United States)

    Taylor, Mark B; Zaleski-Larsen, Lisa; McGraw, Timothy A

    2017-01-01

    Successful treatment of acne scars is challenging. Many modalities have been used with marginal success. The authors describe a combination of a superficial chemical peel, subcision, and fractional carbon dioxide (CO2) laser resurfacing in a single-treatment session as a novel treatment approach for rolling acne scars. A total of 114 patients (75 women and 39 men) with predominantly rolling acne scars were treated with a 20% trichloracetic acid chemical peel, subcision with a novel dissecting instrument, and the CO2 laser under tumescent anesthesia. This was a retrospective, uncontrolled, unblinded study. The mean improvement after a single treatment was 2.9 on a scale of 1 to 4 with few complications. Ninety percent of the patients were satisfied with their final result and desired no additional treatment. The combination of a trichloracetic acid 20% chemical peel, subcision, and fractional CO2 laser resurfacing combined with tumescent anesthesia is both safe and effective in the treatment of rolling acne scars.

  17. Coupled agent-based and finite-element models for predicting scar structure following myocardial infarction.

    Science.gov (United States)

    Rouillard, Andrew D; Holmes, Jeffrey W

    2014-08-01

    Following myocardial infarction, damaged muscle is gradually replaced by collagenous scar tissue. The structural and mechanical properties of the scar are critical determinants of heart function, as well as the risk of serious post-infarction complications such as infarct rupture, infarct expansion, and progression to dilated heart failure. A number of therapeutic approaches currently under development aim to alter infarct mechanics in order to reduce complications, such as implantation of mechanical restraint devices, polymer injection, and peri-infarct pacing. Because mechanical stimuli regulate scar remodeling, the long-term consequences of therapies that alter infarct mechanics must be carefully considered. Computational models have the potential to greatly improve our ability to understand and predict how such therapies alter heart structure, mechanics, and function over time. Toward this end, we developed a straightforward method for coupling an agent-based model of scar formation to a finite-element model of tissue mechanics, creating a multi-scale model that captures the dynamic interplay between mechanical loading, scar deformation, and scar material properties. The agent-based component of the coupled model predicts how fibroblasts integrate local chemical, structural, and mechanical cues as they deposit and remodel collagen, while the finite-element component predicts local mechanics at any time point given the current collagen fiber structure and applied loads. We used the coupled model to explore the balance between increasing stiffness due to collagen deposition and increasing wall stress due to infarct thinning and left ventricular dilation during the normal time course of healing in myocardial infarcts, as well as the negative feedback between strain anisotropy and the structural anisotropy it promotes in healing scar. The coupled model reproduced the observed evolution of both collagen fiber structure and regional deformation following coronary

  18. On the surgical treatment of hypertrophic scars: a comprehensive guideline for the surgical treatment of hypertrophic scars

    NARCIS (Netherlands)

    Stekelenburg, C.M.; van der Wal, M.B.A.; Middelkoop, E.; Niessen, F.B.; van Zuijlen, P.P.M.

    2012-01-01

    Background: Treating the hypertrophic scar remains a challenging problem. It often leaves the clinician with the questions whether, when and how to treat a hypertrophic scar. Methods: This review will focus on the surgical treatment of hypertrophic scars considering the latest research in this

  19. Differences in collagen architecture between keloid, hypertrophic scar, normotrophic scar, and normal skin: An objective histopathological analysis

    NARCIS (Netherlands)

    Verhaegen, P.D.; Zuijlen, van P.P.; Pennings, N.M.; Marle, van J.; Niessen, F.B.; Horst, C.; Middelkoop, E.

    2009-01-01

    Normotrophic, hypertrophic, and keloidal scars are different types of scar formation, which all need a different approach in treatment. Therefore, it is important to differentiate between these types of scar, not only clinically but also histopathologically. Differences were explored for collagen

  20. A prospective, randomized, placebo controlled, double blind study of silicone gel in prevention of hypertrophic scar at donor site of skin grafting

    Directory of Open Access Journals (Sweden)

    Ravi Kumar Chittoria

    2013-01-01

    Full Text Available Background: Hypertrophic scarring at donor site of skin grafting is prevalent among Asians. The effectiveness of silicone gel in scar prevention may influence the surgeons and patients regarding its routine use during the postoperative period. Aims and Objectives: To study the efficacy of silicone gel in prevention of hypertrophic scars at donor site of skin grafting. Design: Prospective randomized placebo controlled double blind study. Setting: The study was conducted in the department of Plastic Surgery, Sri Venkateswara Institute of Medical Sciences (SVIMS University, Tirupati, Andhra Pradesh, India from June 2007 to June 2009. Patients were recruited during follow-up in the OPD. Materials and Methods: The susceptibility to scar development varied among patients; therefore, donor site scars were divided into upper half and lower half. Two types of coded gel prepared by an independent pharmacist were used on either half. Thus, selection and assessment biases and confounders were eliminated. Results: 100 scars in 50 patients were randomized into two arms, 50 control and 50 silicone gel. The median age was 25.5 years and there were 30 men (60% and 20 women (40%. Thirty-seven patients (74% had good compliance. The overall incidence of donor site hypertrophic scar was 94% (47 out of 50. At the second month postoperatively, the silicone gel scars were scored lower when compared with the control scars. The differences were statistically significant in all parameters, including pigmentation ( P = 0.001, Vascularity ( P = 0.010, pliability ( P = 0.001, and height ( P = 0.010. Conclusion: The effect of silicone gel in prevention of hypertrophic scar development in donor site scars is promising. Success of silicone gel in its prophylactic role will create its routine use in all types of surgery to minimize the formation of hypertrophic scars in the early postoperative period.

  1. Performance Assessment of a Large Scale Pulsejet- Driven Ejector System

    Science.gov (United States)

    Paxson, Daniel E.; Litke, Paul J.; Schauer, Frederick R.; Bradley, Royce P.; Hoke, John L.

    2006-01-01

    Unsteady thrust augmentation was measured on a large scale driver/ejector system. A 72 in. long, 6.5 in. diameter, 100 lb(sub f) pulsejet was tested with a series of straight, cylindrical ejectors of varying length, and diameter. A tapered ejector configuration of varying length was also tested. The objectives of the testing were to determine the dimensions of the ejectors which maximize thrust augmentation, and to compare the dimensions and augmentation levels so obtained with those of other, similarly maximized, but smaller scale systems on which much of the recent unsteady ejector thrust augmentation studies have been performed. An augmentation level of 1.71 was achieved with the cylindrical ejector configuration and 1.81 with the tapered ejector configuration. These levels are consistent with, but slightly lower than the highest levels achieved with the smaller systems. The ejector diameter yielding maximum augmentation was 2.46 times the diameter of the pulsejet. This ratio closely matches those of the small scale experiments. For the straight ejector, the length yielding maximum augmentation was 10 times the diameter of the pulsejet. This was also nearly the same as the small scale experiments. Testing procedures are described, as are the parametric variations in ejector geometry. Results are discussed in terms of their implications for general scaling of pulsed thrust ejector systems

  2. Reliability and validity of a physical activity social support assessment scale in adolescents - ASAFA Scale

    Directory of Open Access Journals (Sweden)

    José Cazuza de Farias Júnior

    2014-06-01

    Full Text Available Objective: To analyze the reliability and validity of a scale used to measure social support for physical activity in adolescents - ASAFA Scale. Methods: This study included 2,755 adolescents (57.6% girls, 16.5 ± 1.2 years of age, from Joao Pessoa, Paraiba, Brazil. Initially, the scale was consisted of 12 items (6 for social support from parents and 6 from friends. The reliability of the scale was estimated by Cronbach's alpha coefficient (α, by the Composite Reliability (CR, and by the model with two factors and factorial invariance by Confirmatory Factor Analysis (CFA adequacy. Results: The CFA results confirmed that the social support scale contained two factors (factor 1: social support from parents; factor 2: social support from friends with five items each (one item was excluded from each scale, all with high factor loadings (> 0.65 and acceptable adjustment indexes (RMR = 0.050; RMSEA = 0.063; 90%CI: 0.060 - 0.067; AGFI = 0.903; GFI = 0.940; CFI = 0.934, NNFI = 0.932. The internal consistency was satisfactory (parents: α ≥ 0.77 and CR ≥ 0.83; friends: α ≥ 0.87 and CR ≥ 0.91. The scale's factorial invariance was confirmed (p > 0.05; Δχ2 and ΔCFI ≤ 0.01 across all subgroups analyzed (gender, age, economic class. The construct validity was evidenced by the significant association (p < 0.05 between the adolescents physical activity level and the social support score of parents (rho = 0.29 and friends (rho = 0.39. Conclusions: The scale showed reliability, factorial invariance and satisfactory validity, so it can be used in studies with adolescents.

  3. Item reduction and psychometric validation of the Oily Skin Self Assessment Scale (OSSAS) and the Oily Skin Impact Scale (OSIS).

    Science.gov (United States)

    Arbuckle, Robert; Clark, Marci; Harness, Jane; Bonner, Nicola; Scott, Jane; Draelos, Zoe; Rizer, Ronald; Yeh, Yating; Copley-Merriman, Kati

    2009-01-01

    Developed using focus groups, the Oily Skin Self Assessment Scale (OSSAS) and Oily Skin Impact Scale (OSIS) are patient-reported outcome measures of oily facial skin. The aim of this study was to finalize the item-scale structure of the instruments and perform psychometric validation in adults with self-reported oily facial skin. The OSSAS and OSIS were administered to 202 adult subjects with oily facial skin in the United States. A subgroup of 152 subjects returned, 4 to 10 days later, for test–retest reliability evaluation. Of the 202 participants, 72.8% were female; 64.4% had self-reported nonsevere acne. Item reduction resulted in a 14-item OSSAS with Sensation (five items), Tactile (four items) and Visual (four items) domains, a single blotting item, and an overall oiliness item. The OSIS was reduced to two three-item domains assessing Annoyance and Self-Image. Confirmatory factor analysis supported the construct validity of the final item-scale structures. The OSSAS and OSIS scales had acceptable item convergent validity (item-scale correlations >0.40) and floor and ceiling effects (oily skin severity (P oily skin (P oily facial skin), as assessments of self-reported oily facial skin severity and its emotional impact, respectively.

  4. Assessing attention-deficit/hyperactivity disorder in adults: focus on rating scales.

    Science.gov (United States)

    Murphy, Kevin R; Adler, Lenard A

    2004-01-01

    The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults can be a challenging process because it includes making judgments based on clinical interviews, rating scale results, informant ratings, and objective supporting evidence. The patient evaluation should gather information on the severity and frequency of symptoms, the establishment of childhood onset of symptoms, the chronicity and pervasiveness of symptoms, and the impact of symptoms on major life activities. Some of the rating scales being used in the adult population are the Conners' Adult ADHD Rating Scales, the Brown Attention-Deficit Disorder Scale for Adults, the Wender Utah Rating Scale, the ADHD Rating Scale and ADHD Rating Scale-IV, the Current Symptoms Scale, and the recently-developed Adult ADHD Self-Report Scale-v1.1 Symptom Checklist. More research is needed to establish the usefulness of self-administered rating scales compared with investigator-administered scales in the assessment and diagnosis of adult ADHD.

  5. Losartan Attenuates Scar Formation in Filtering Bleb After Trabeculectomy.

    Science.gov (United States)

    Shi, Huimin; Wang, Huiying; Fu, Shuhao; Xu, Kang; Zhang, Xiaoyan; Xiao, Yiqin; Ye, Wen

    2017-03-01

    To examine the effects of losartan on scar formation after trabeculectomy and on fibrotic changes of human Tenon's fibroblasts (HTFs). Trabeculectomy was performed on New Zealand rabbits. They were randomized to receive one of the following treatments: 0.9% normal saline, mitomycin-C, or one of the three doses of losartan. Bleb morphology, IOP, and histopathology examination were performed. Primary cultured HTFs were treated with losartan or vehicle, with or without angiotensin II (Ang II). Cell proliferation was assessed by Cell Counting Kit-8 assay, and cell migration was detected by scratch wound and transwell assay. Transdifferentiation was evaluated through the expression of α-smooth muscle actin (α-SMA) by immunofluorescence, real-time PCR, and Western blot. The expression of fibronectin (FN) was evaluated by real-time PCR and Western blot. An amount of 5 mg/mL of losartan subconjunctival injection significantly decreased IOP postoperatively and attenuated wound healing of the filtering bleb in the rabbit model. Immunostaining results showed less myofibroblast and collagen deposition around the bleb area in the losartan-treated eyes. Losartan (10-5 M) in vitro significantly attenuated Ang II's stimulatory effects on proliferation and migration of HTFs. Expressions of α-SMA and FN in these cells were also decreased by losartan pretreatment. Losartan attenuates scar formation of filtering bleb after trabeculectomy likely via decreasing proliferation, migration, transdifferentiation, and extracellular matrix deposition of Tenon's fibroblasts. These results indicate that losartan may be an effective therapeutic agent in preventing bleb scar formation and in improving surgical outcome after trabeculectomy.

  6. Fractional Carbon Dioxide Laser in Treatment of Acne Scars

    OpenAIRE

    Andrej Petrov; Vesna Pljakovska

    2015-01-01

    BACKGROUND: Scars appear as a result of skin damage during the process of the skin healing. There are two types of acne scars, depending on whether there is a loss or accumulation of collagen: atrophic and hypertrophic. In 80-90% it comes to scars with loss of collagen compared to smaller number of hypertrophic scars and keloids. AIM: The aim of the study was to determine efficiency and safety of fractional carbon dioxide laser in the treatment of acne scars. MATERIAL AND METHODS: The...

  7. Risk assessment of sheep welfare at small-scale slaughter in Nordic countries, comparing with large-scale slaughter.

    Science.gov (United States)

    Hultgren, Jan; Algers, Bo; Atkinson, Sophie; Ellingsen, Kristian; Eriksson, Sofia; Hreinsson, Kjartan; Nordensten, Lotta; Valtari, Heidi; Mejdell, Cecilie Marie

    2016-06-01

    During the pre-slaughter period, animals experience novel environment and procedures which may cause reduced welfare and suffering. Over the last decades, the slaughter industry has restructured into fewer and larger abattoirs, implying potential risks of transport stress, injuries, and impaired animal welfare. Since recently, however, there is growing interest in small-scale slaughter to supply locally or regionally produced meat. Risk managers at all levels thus need to assess animal welfare risks also at small-scale operations. This study aimed to assess risks of poor animal welfare at small-scale lamb slaughter (≤5000 sheep/year and ≤70 sheep/day) in Norway, Iceland, Sweden and Finland, and to compare these risks to large-scale industrial slaughter. Assessment was done applying an individual expert opinion approach during a 2-day workshop. Nine experts in lamb slaughter procedures, behaviour, physiology, health, scoring schemes and/or risk assessment provided estimates of exposure, likelihood of negative consequences following exposure, and intensity and duration of negative consequences for 71 hazards. The methods applied mainly adhered to the risk assessment guidelines of the European Food Safety Authority. The list of hazards was modified from an earlier study and distributed to the experts before the assessment. No other literature was reviewed specifically for the purpose of the assessment. The highest risks to animal welfare identified in both small- and large-scale slaughter were related to inadequate conditions during overnight lairage at the slaughter plant. For most hazards, risk estimates were lower in small-scale slaughter. The reverse was true for splitting of groups and separation of one sheep from the group. Small-scale slaughter has a potential for improved sheep welfare in comparison with large-scale industrial slaughter. Keeping the animals overnight at the slaughterhouse and prolonged fasting before slaughter should be avoided. Solutions

  8. A portable automatic pressure delivery system for scar compression therapy in large animals

    Science.gov (United States)

    Ghassemi, Pejhman; Shupp, Jeffrey W.; Travis, Taryn E.; Gravunder, Andrew J.; Moffatt, Lauren T.; Ramella-Roman, Jessica C.

    2015-01-01

    Compression therapy has long been a standard treatment for hypertrophic scar prevention. However, due to the lack of objective, quantitative assessments, and measurements of scar severity, as well as the lack of a self-operated, controllable, and precise pressure delivery technique, limited concrete evidence exists, demonstrating compression therapy's efficacy. We have designed and built an automatic pressure delivery system to apply and maintain constant pressure on scar tissue in an animal model. A force sensor positioned on a compression plate reads the imposed force in real-time and sends the information to a feedback system controlling two position actuators. The actuators move accordingly to maintain a preset value of pressure onto the skin. The system was used in an in vivo model of compression therapy on hypertrophic scar/span>s. It was shown that the system was capable of delivering a constant pressure of 30 mmHg on scar wounds for a period of two weeks, and that phenotypic changes were seen in the wounds.

  9. Efficacy of fractional CO2 laser in treatment of atrophic scar of cutaneous leishmaniasis.

    Science.gov (United States)

    Banihashemi, Mahnaz; Nahidi, Yalda; Maleki, Masoud; Esmaily, Habibollah; Moghimi, Hamid Reza

    2016-05-01

    Cutaneous leishmaniasis is an endemic disease in Iran. Unfortunately, it can lead to unsightly atrophic scars with limited treatment options. Fractional CO2 laser is accepted for treatment of atrophic acne scars and recently has been used to treat cutaneous leishmaniasis, so we planned to use fractional CO2 laser on leishmaniasis scar. We conducted this study on 60 leishmaniasis scars on the face of 40 patients. The lesions were treated by a fractional CO2 laser with beam size of 120 μm, with energy of 50-90 mJ, and 50-100 spots/cm(2) density with two passes in three monthly sessions. Evaluation was done in the first and second months after the first treatment and 3 and 6 months after the last treatment. Digital photography was performed at each visit. Assessment of improvement rate by patient and physician was rated separately as follows: no improvement (0%), mild (high efficacy of fractional CO2 laser for leishmaniasis scar. No significant adverse effects were noted.

  10. [Surgical strategy for postburn cervical scar contracture].

    Science.gov (United States)

    Feng, Shaoqing; Su, Weijie; Xi, Wenjing; Min, Peiru; Pu, Zheming; Zhang, Yan; Zhang, Yixin

    2015-08-01

    To explore the surgical strategy for postburn cervical scar contracture. Sixty-five patients with scar contracture as a result of burn injury in the neck were hospitalized from July 2013 to July 2014. Release of cervical scar contracture was conducted according to different demands of the 3 anatomic subunits of neck, i.e. lower lip vermilion border-supramaxillary region, submaxillary region, and anterior region of neck. After release of contracture, platysma was released. For some cases with chin retrusion, genioplasty with horizontal osteotomy was performed. The coverage of wound followed the principle of similarity, i.e. the skin tissue covering the wound in the neck should be similar to the characters of skin around the wound in terms of color, texture, and thickness. Based on this principle, except for the preschool children in whom skin grafting was performed, the wounds of the other patients were covered by local skin flaps, adjacent skin flaps, or free skin flaps. All patients underwent release of scar and platysma, while 9 patients underwent genioplasty with horizontal osteotomy. Wounds were covered with local skin flaps in 32 patients, with adjacent skin flaps in 7 patients, with free skin flaps in 11 patients, and with skin grafts in 15 patients. All skin grafts and flaps survived. Good range of motion was achieved in the neck of all patients, with the cervicomental angle after reconstruction ranging from 90 to 120°. All patients were followed up for 6 to 24 months. Six patients who had undergone skin grafting were found to have some degrees of skin contracture, while none of the patients who had undergone flap coverage showed any signs of contracture recurrence. Restoration of the cervicomental angle is critical in the treatment of postburn cervical scar contracture, and the release of scar contracture should conform to the subunit principle. The coverage of wound should be based on the principle of similarity, with repair by skin flaps as the first

  11. The Subjective Experiences of Psychosis Scale (SEPS): psychometric evaluation of a scale to assess outcome in psychosis.

    Science.gov (United States)

    Haddock, Gillian; Wood, Lisa; Watts, Rachel; Dunn, Graham; Morrison, Anthony P; Price, Jason

    2011-12-01

    A range of outcome measures has been developed to assess psychotic symptoms. Many of these are observer based assessments which rate the presence and severity of broad symptom types. There is a need for service-user generated multi-dimensional scales to assess psychosis. To investigate the psychometric properties of a service user generated, self-report scale to assess recovery in relation to psychotic symptoms. The reliability and validity of the Subjective Experiences of Psychosis Scale (SEPS) was investigated with 100 participants experiencing psychosis against observer rated assessments of psychosis and self report measures of affect, esteem, recovery and functioning. Two factors emerged representing positive and negative aspects of psychotic experiences. Test-retest reliability, internal consistency and sensitivity to change were good and the scales correlated with the PANSS, PSYRATS and measures of affect, esteem, recovery and functioning. The SEPS is a reliable and valid tool which can be used to evaluate outcome from treatment and which reflects the multi-dimensional experience of psychosis. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

  12. Using Longitudinal Scales Assessment for Instrumental Music Students

    Science.gov (United States)

    Simon, Samuel H.

    2014-01-01

    In music education, current assessment trends emphasize student reflection, tracking progress over time, and formative as well as summative measures. This view of assessment requires instrumental music educators to modernize their approaches without interfering with methods that have proven to be successful. To this end, the Longitudinal Scales…

  13. Landscape analysis – Assessing countries' readiness to scale up ...

    African Journals Online (AJOL)

    The purpose of this paper is to describe the use of the Landscape Analysis to assess strengths and weaknesses in combating malnutrition in Sub-Saharan Africa. The Landscape Analysis is an inter-agency initiative to assess gaps and constraints and to identify opportunities for effective nutrition actions in order to ...

  14. Connecticut Application of Item Response Theory to Large Scale Assessments.

    Science.gov (United States)

    Pecheone, Raymond; Rindone, Douglas A.

    The Connecticut Assessment of Educational Progress (CAEP) is designed to provide legislators and educators with information on the strengths and weaknesses of students in 11 curricula areas. In addition, the Educational Evaluation and Remedial Assistance (EERA) program was developed to assess student proficiency in the basic skills of reading,…

  15. Fatigue Assessment of Full-Scale Retrofitted Orthotropic Bridge Decks

    NARCIS (Netherlands)

    Teixeira De Freitas, S.; Kolstein, M.H.; Bijlaard, F.S.K.

    2017-01-01

    Full-scale fatigue tests were performed on two retrofitted orthotropic bridge decks (OBDs). The retrofitting systems consist of adding a second steel plate on the top of the existing deck. The aim is to reduce the stresses at the fatigue-sensitive details and therefore extend the fatigue life of

  16. Suppressed inflammatory gene expression during human hypertrophic scar compared to normotrophic scar formation.

    Science.gov (United States)

    van den Broek, Lenie J; van der Veer, Willem M; de Jong, Etty H; Gibbs, Susan; Niessen, Frank B

    2015-08-01

    Hypertrophic scar formation is a result of adverse cutaneous wound healing. The pathogenesis of hypertrophic scar formation is still poorly understood. A problem next to the lack of suitable animal models is that often normal skin is compared to hypertrophic scar (HTscar) and not to normotrophic scar (NTscar) tissue. Another drawback is that often only one time period after wounding is studied, while scar formation is a dynamic process over a period of several months. In this study, we compared the expression of genes involved in inflammation, angiogenesis and extracellular matrix (ECM) formation and also macrophage infiltration in biopsies obtained before and up to 52 weeks after standard surgery in five patients who developed HTscar and six patients who developed NTscar. It was found that HTscar formation coincided with a prolonged decreased expression of inflammatory genes (TNFα, IL-1α, IL-1RN, CCL2, CCL3, CXCL2, CXCR2, C3 and IL-10) and an extended increased expression of ECM-related genes (PLAU, Col3A1, TGFβ3). This coincided with a delayed but prolonged infiltration of macrophages (type 2) in HTscar tissue compared to NTscar tissue. These findings were supported by immunohistochemical localization of proteins coding for select genes named above. Our study emphasizes that human cutaneous wound healing is a dynamic process that is needed to be studied over a period of time rather than a single point of time. Taken together, our results suggest innate immune stimulatory therapies may be a better option for improving scar quality than the currently used anti-inflammatory scar therapies. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Scar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation.

    Science.gov (United States)

    Berruezo, Antonio; Fernández-Armenta, Juan; Andreu, David; Penela, Diego; Herczku, Csaba; Evertz, Reinder; Cipolletta, Laura; Acosta, Juan; Borràs, Roger; Arbelo, Elena; Tolosana, Jose María; Brugada, Josep; Mont, Lluis

    2015-04-01

    Ventricular tachycardia (VT) substrate ablation usually requires extensive ablation. Scar dechanneling technique may limit the extent of ablation needed. The study included 101 consecutive patients with left ventricular scar-related VT (75 ischemic patients; left ventricular ejection fraction, 36 ± 13%). Procedural end point was the elimination of all identified conducting channels (CCs) by ablation at the CC entrance followed by abolition of residual inducible VTs. By itself, scar dechanneling rendered noninducibility in 54.5% of patients; ablation of residual inducible VT increased noninducibility to 78.2%. Patients needing only scar dechanneling had a shorter procedure (213 ± 64 versus 244 ± 71 minutes; P = 0.027), fewer radiofrequency applications (19 ± 11% versus 27 ± 18%; P = 0.01), and external cardioversion/defibrillation shocks (20% versus 65.2%; P scar dechanneling alone had better event-free survival (80% versus 62%) and lower mortality (5% versus 11%). Incomplete CC-electrogram elimination was the only independent predictor (hazard ratio, 2.54 [1.06-6.10]) for the primary end point. Higher end point-free survival rates were observed in patients noninducible after scar dechanneling (log-rank P = 0.013) and those with complete CC-electrogram elimination (log-rank P = 0.013). The complications rate was 6.9%, with no deaths. Scar dechanneling alone results in low recurrence and mortality rates in more than half of patients despite the limited ablation extent required. Residual inducible VT ablation improves acute results, but patients who require it have worse outcomes. Recurrences are mainly related to incomplete CC-electrogram elimination. © 2015 American Heart Association, Inc.

  18. Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up.

    Science.gov (United States)

    Hirche, C; Senghaas, A; Fischer, S; Hollenbeck, S T; Kremer, T; Kneser, U

    2016-02-01

    Long-term function following severe burns to the hand may be poor secondary to scar adhesions to the underlying tendons, webspaces, and joints. In this pilot study, we report the feasibility of applying a pasty dermal matrix combined with percutaneous cannula teno- and adhesiolysis. In this 6 month follow-up pilot study, we included eight hands in five patients with hand burns undergoing minimal-invasive, percutaneous cannula adhesiolysis and injection of INTEGRA™ Flowable Wound Matrix for a pilot study of this new concept. The flowable collagen-glycosaminoglycan wound matrix (FCGWM) was applied with a buttoned 2mm cannula to induce formation of a neo-gliding plane. Post treatment follow-up was performed to assess active range of motion (AROM), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, Vancouver Scar Scale (VSS) and quality of life Short-Form (SF)-36 questionnaire. No complications were detected associated with the treatment of FCGWM injection. The mean improvement (AROM) at 6 months was 30.6° for digits 2-5. The improvement in the DASH score was a mean of 9 points out of 100. The VSS improved by a mean of 2 points out of 14. The study demonstrates the feasibility and safety of percutaneous FCGWM for dermal augmentation after burn. Results from this pilot study show improvements in AROM for digits 2-5, functional scores from the patient's perspective (DASH) and scar quality (VSS). The flowable form of established INTEGRA™ wound matrix offers the advantage of minimal-invasive injection after scar release in the post-burned hand with a reduction in the risk of postsurgical re-scarring. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  19. Nursing-care dependency : Development of an assessment scale for demented and mentally handicapped patients

    NARCIS (Netherlands)

    Dijkstra, Ate; Buist, Girbe; Dassen, T

    1996-01-01

    This article describing the first phase in the development of an assessment scale of nursing-care dependency (NCD) for Dutch demented and mentally handicapped patients focuses on the background to the study and the content validation of the nursing-care dependency scale. The scale aims to

  20. The Combat Exposure Scale: A Systematic Assessment of Trauma in the Vietnam War.

    Science.gov (United States)

    Lund, Mary; And Others

    1984-01-01

    Describes the development of the Combat Exposure Scale, which assessed the combat experiences of 43 help-seeking Vietnam veterans. Scale scores related significantly to current diagnosis of Posttraumatic Stress Disorder and symptom intensity. The Guttman scaling technique resulted in an ordering of events that provided clinically relevant…

  1. Assessing Laptop Use in Higher Education Classrooms: The Laptop Effectiveness Scale (LES)

    Science.gov (United States)

    Lauricella, Sharon; Kay, Robin

    2010-01-01

    Considerable research has been conducted examining the use of laptops in higher education, however, a reliable and valid scale to assess in-class use of laptops has yet to be developed. The purpose of the following study was to develop and evaluate the "Laptop Effectiveness Scale" (LES). The scale consisted of four constructs: academic…

  2. Improvement of Atrophic Acne Scars in Skin of Color Using Topical Synthetic Epidermal Growth Factor (EGF) Serum: A Pilot Study.

    Science.gov (United States)

    Stoddard, Marie Alexia; Herrmann, Jennifer; Moy, Lauren; Moy, Ronald

    2017-04-01

    BACKGROUND: Atrophic scarring in skin of color is a common, permanent, and distressing result of uncontrolled acne vulgaris. Ablative lasers and chemical peels are frequently used to improve the appearance of atrophic scars, primarily through the stimulation of collagen and elastin; however, these treatment modalities are associated with risks, such as dyspigmentation and hypertrophic scarring, especially in patients with darker skin. OBJECTIVE: We evaluated the efficacy of topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars in skin of color. METHODS: A single-center clinical trial was performed on twelve healthy men and women (average age 32.5) with Fitzpatrick Type IV-V skin and evidence of facial grade II-IV atrophic acne scars. Subjects applied topical EGF serum to the full-face twice daily for 12 weeks. Scar improvement was investigated at each visit using an Investigator Global Assessment (IGA), a Goodman grade, clinical photography, and patient self-assessment. RESULTS: Eleven subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 3.36 (SEM = 0.15) to 2.18 (SEM = 0.33). Mean Goodman grade was reduced from 2.73 (SEM = 0.19) to 2.55 (SEM = 0.21). Of the eleven pairs of before and after photographs, nine were correctly chosen as the post-treatment image by a blind investigator. On self-assessment, 81% reported a "good" to "excellent" improvement in their scars compared to baseline (P = 0.004). CONCLUSION: Topical EGF may improve the appearance of atrophic acne scars in skin of color. Additional, larger studies should be conducted to better characterize improvement. J Drugs Dermatol. 2017;16(4):322-326..

  3. Forum: The Rise of International Large-Scale Assessments and Rationales for Participation

    Science.gov (United States)

    Addey, Camilla; Sellar, Sam; Steiner-Khamsi, Gita; Lingard, Bob; Verger, Antoni

    2017-01-01

    This Forum discusses the significant growth of international large-scale assessments (ILSAs) since the mid-1990s. Addey and Sellar's contribution ("A Framework for Analysing the Multiple Rationales for Participating in International Large-Scale Assessments") outlines a framework of rationales for participating in ILSAs and examines the…

  4. Perianal episiotomy scar endometrioma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Wei Chiang; Kim, Kyo Nam; Kim, Soo Ah; Kim, Soon Yong [Sung Ae General Hospital, Seoul (Korea, Republic of)

    2000-09-01

    Endometrioma is a common clinical condition, but cases in which an episiotomy scaris present are, however, rare: only two cases have been reported in obstetric journals, and one other in a radiologic journal. All three were in English. We encountered a case in which a solitary endometrioma was present in the perineal region beneath an episiotomy scar. An irregularly marginated hypoechoic mass was revealed by US, and a discrete homogeneous enhancing mass by CT. (author)

  5. "Marriage" abdominoplasty: a short scar technique.

    Science.gov (United States)

    Shestak, Kenneth C; Walgenbach, Klaus J; Azari, Kodi

    2002-05-01

    Short scar abdominoplasty-that is, a marriage of aggressive superwet lipoplasty, rectus abdominis muscle plication, and excision of lower abdominal skin and excess adipose tissue-can be used as an alternative to conventional abdominoplasty in properly selected patients. According to the authors, this technique offers the advantages of less invasive surgery, decreased pain, and faster return to work. (Aesthetic Surg J 2002;22:294-301.).

  6. Impact assessment of illegal small scale mining on construction of ...

    African Journals Online (AJOL)

    Bogoso-Ayanfuri Highway in Ghana. ... Journal of Applied Science and Technology ... The impact assessment presented in this paper reveals the negative effects of illegal mining on the road constructi-on project; particularly, project delivery ...

  7. Study of fractional ablative laser in surgical and post traumatic scar

    Directory of Open Access Journals (Sweden)

    Nagat Sobhy

    2012-07-01

    Full Text Available Introduction: Ablative, fractional lasers generate microscopic columns of coagulated tissue through the epidermis and dermis to evoke a wound healing response. In this study, we examined the efficacy and safety of fractional ablative 2940nm erbium: YAG laser in the treatment of surgical and post-traumatic scars. Fractional laser photothermolysis is the latest in the broad range of Er: YAG laser technique. This technique promises a novel means of providing treatments that would be as effective as traditional Er: YAG, while further reducing their down time and risk.Aim of the Work: The aim of this work is to assess the efficacy and safety of variable square pulse (VSP fractional Er: YAG laser for the treatment of surgical and post-traumatic scars; both clinically and histopathologically.Methods: Clinical studies were conducted on a range of surgical and post-traumatic scars with a 2940nm erbium: YAG fractional ablative laser varying energy, pulse widths, treatment passes, and number of treatments: twenty subjects, with Fitzpatrick skin types III-IV, received two to five treatments at one month interval and a follow up period for 3 months. Clinical and histopathological evaluation of the results was performed.Results: Almost all patients improved both clinically and histopathologically. Clinical improvement in scars according to investigator assessment: 40% of patients had excellent improvement of 76-100% (grade 3, 50% of patients had good improvement of 50-75% (grade 2, 10% had fair improvement of 26-49% (grade 1 at three month follow up. Histologic findings demonstrated remodeling of scar tissue with renewal and reorganization of collagen fibers in the dermis was noted two weeks post-treatment.Conclusion: These data illustrate the safety and efficacy of the 2940nm erbium:YAG fractional ablative laser in the treatment of surgical and post-traumatic scars with short down time period, and almost no incidence of complication.

  8. Mesenchymal Stem Cell Therapy for the Treatment of Vocal Fold Scarring

    DEFF Research Database (Denmark)

    Wingstrand, Vibe Lindeblad; Larsen, Christian Grønhøj; Jensen, David H

    2016-01-01

    the biomechanical properties of injured vocal folds. This study evaluated the biomechanical effects of mesenchymal stem cell therapy for the treatment of vocal fold scarring. DATA SOURCES: PubMed, Embase, the Cochrane Library and Google Scholar were searched. METHODS: Controlled studies that assessed...

  9. Quantifying Asymmetry and Scar Quality of Children With Repaired Cleft Lip and Palate Using Symnose 2.

    Science.gov (United States)

    Pigott, Ronald W; Pigott, Brian B

    2016-05-01

    The Symnose semiautomated assessment of outcome of the appearance of the repaired cleft lip and nose was developed to measure asymmetry. Symnose 2 has been further developed to include quantification of the extent of scar color, intensity, and contour and midline dehiscence, underexpressed in the measurement of asymmetry.

  10. Impact of facial burns : relationship between depressive symptoms, self-esteem and scar severity

    NARCIS (Netherlands)

    Hoogewerf, Cornelis Johannes; van Baar, Margriet Elisabeth; Middelkoop, Esther; Van Loey, N.E.E.

    2014-01-01

    OBJECTIVE: This study assessed the role of self-reported facial scar severity as a possible influencing factor on self-esteem and depressive symptoms in patients with facial burns. METHOD: A prospective multicentre cohort study with a 6 months follow-up was conducted including 132 patients with

  11. Fire scar mapping for disaster response in KwaZulu-Natal South ...

    African Journals Online (AJOL)

    This study assessed the potential of the new Landsat 8 multispectral imagery in rapidly mapping fire scars to aid disaster management response teams in emergency efforts. Maximum likelihood and iso cluster algorithms where used to classify burnt and unburnt areas in KwaZulu-Natal, South Africa. The Landsat 8 sensor ...

  12. Impact of facial burns: relationship between depressive symptoms, self-esteem and scar severity

    NARCIS (Netherlands)

    Hoogewerf, C.J.; van Baar, M.E.; Middelkoop, E.; van Loey, N.E.

    2014-01-01

    Objective: This study assessed the role of self-reported facial scar severity as a possible influencing factor on self-esteem and depressive symptoms in patients with facial burns. Method: A prospective multicentre cohort study with a 6 months follow-up was conducted including 132 patients with

  13. Estimation of aquifer scale proportion using equal area grids: assessment of regional scale groundwater quality

    Science.gov (United States)

    Belitz, Kenneth; Jurgens, Bryant C.; Landon, Matthew K.; Fram, Miranda S.; Johnson, Tyler D.

    2010-01-01

    The proportion of an aquifer with constituent concentrations above a specified threshold (high concentrations) is taken as a nondimensional measure of regional scale water quality. If computed on the basis of area, it can be referred to as the aquifer scale proportion. A spatially unbiased estimate of aquifer scale proportion and a confidence interval for that estimate are obtained through the use of equal area grids and the binomial distribution. Traditionally, the confidence interval for a binomial proportion is computed using either the standard interval or the exact interval. Research from the statistics literature has shown that the standard interval should not be used and that the exact interval is overly conservative. On the basis of coverage probability and interval width, the Jeffreys interval is preferred. If more than one sample per cell is available, cell declustering is used to estimate the aquifer scale proportion, and Kish's design effect may be useful for estimating an effective number of samples. The binomial distribution is also used to quantify the adequacy of a grid with a given number of cells for identifying a small target, defined as a constituent that is present at high concentrations in a small proportion of the aquifer. Case studies illustrate a consistency between approaches that use one well per grid cell and many wells per cell. The methods presented in this paper provide a quantitative basis for designing a sampling program and for utilizing existing data.

  14. Scar Homogenization Versus Limited-Substrate Ablation in Patients With Nonischemic Cardiomyopathy and Ventricular Tachycardia.

    Science.gov (United States)

    Gökoğlan, Yalçın; Mohanty, Sanghamitra; Gianni, Carola; Santangeli, Pasquale; Trivedi, Chintan; Güneş, Mahmut F; Bai, Rong; Al-Ahmad, Amin; Gallinghouse, G Joseph; Horton, Rodney; Hranitzky, Patrick M; Sanchez, Javier E; Beheiry, Salwa; Hongo, Richard; Lakkireddy, Dhanunjaya; Reddy, Madhu; Schweikert, Robert A; Dello Russo, Antonio; Casella, Michela; Tondo, Claudio; Burkhardt, J David; Themistoclakis, Sakis; Di Biase, Luigi; Natale, Andrea

    2016-11-01

    Scar homogenization improves long-term ventricular arrhythmia-free survival compared with standard limited-substrate ablation in patients with post-infarction ventricular tachycardia (VT). Whether such benefit extends to patients with nonischemic cardiomyopathy and scar-related VT is unclear. The aim of this study was to assess the long-term efficacy of an endoepicardial scar homogenization approach compared with standard ablation in this population. Consecutive patients with dilated nonischemic cardiomyopathy (n = 93), scar-related VTs, and evidence of low-voltage regions on the basis of pre-defined criteria on electroanatomic mapping (i.e., bipolar voltage scar (group 2 [n = 36]). Acute procedural success was defined as noninducibility of any VT at the end of the procedure; long-term success was defined as freedom from any ventricular arrhythmia at follow-up. Acute procedural success rates were 69.4% and 42.1% after scar homogenization and standard ablation, respectively (p = 0.01). During a mean follow-up period of 14 ± 2 months, single-procedure success rates were 63.9% after scar homogenization and 38.6% after standard ablation (p = 0.031). After multivariate analysis, scar homogenization and left ventricular ejection fraction were predictors of long-term success. During follow-up, the rehospitalization rate was significantly lower in the scar homogenization group (p = 0.035). In patients with dilated nonischemic cardiomyopathy, scar-related VT, and evidence of low-voltage regions on electroanatomic mapping, endoepicardial homogenization of the scar significantly increased freedom from any recurrent ventricular arrhythmia compared with a standard limited-substrate ablation. However, the success rate with this approach appeared to be lower than previously reported with ischemic cardiomyopathy, presumably because of the septal and midmyocardial distribution of the scar in some patients. Copyright © 2016 American College of Cardiology Foundation

  15. EI Scale: an environmental impact assessment scale related to the construction materials used in the reinforced concrete

    Directory of Open Access Journals (Sweden)

    Gilson Morales

    2010-12-01

    Full Text Available This study aimed to create EI Scal, an environmental impact assessment scal, related to construction materials used in the reinforced concrete structure production. The main reason for that was based on the need to classify the environmental impact levels through indicators to assess the damage level process. The scale allowed converting information to estimate the environmental impact caused. Indicators were defined trough the requirements and classification criteria of impact aspects considering the eco-design theory. Moreover, the scale allowed classifying the materials and processes environmental impact through four score categories which resulted in a single final impact score. It was concluded that the EI scale could be cheap, accessible, and relevant tool for environmental impact controlling and reduction, allowing the planning and material specification to minimize the construction negative effects caused in the environment.

  16. A critical assessment of validity of scales and stadiometers in a Danish hospital setting

    DEFF Research Database (Denmark)

    Geiker, Nina Rica Wium; Hørup Larsen, Sisse Marie; Stender, Steen

    Objective To critically assess the accuracy of scales and stadiometers at a Danish hospital. Conclusion Less than half the scales and stadiometers detected accurate weight and height. The margin of potential error may lead to suboptimal diagnostics of obesity and assessment of the nutritional sta...... status of both in and out patients. It is necessary at least yearly to calibrate scales and stadiometers, in order to obtain correct assessment of height and weight.......Objective To critically assess the accuracy of scales and stadiometers at a Danish hospital. Conclusion Less than half the scales and stadiometers detected accurate weight and height. The margin of potential error may lead to suboptimal diagnostics of obesity and assessment of the nutritional...

  17. Low scar abdominoplasty with inferior positioning of the umbilicus.

    Science.gov (United States)

    Colwell, Amy S; Kpodzo, Dzifa; Gallico, G Gregory

    2010-05-01

    Miniabdominoplasty with umbilical free float has received little attention in the literature in 15 years and has been criticized for an abnormally low umbilicus. We hypothesized the umbilicus in women presenting for abdominal contouring is positioned higher than ideal and thus may benefit from lowering. In addition, we felt modifications of the original umbilical float technique would improve aesthetic results. A retrospective review identified 60 patients aged 34 to 56 who had abdominoplasty with umbilical fascial transection and inferior positioning. Technical modifications included low placement of a full transverse abdominal scar, abdominal flap undermining to the rib cage, more inferior umbilical repositioning, flank liposuction, and plication of diastasis recti from xiphoid to pubis. Patients did not have enough excess skin to allow traditional abdominoplasty without a high-transverse or vertical midline scar. No umbilical or incisional skin necrosis occurred. To assess optimal umbilical position, plastic surgeons were asked to draw the ideal position on pre- and postoperative photographs from 5 patients. The mean ideal umbilical position was 2.2 cm lower than the actual position (P diastasis recti but a normal body mass index.

  18. Vulnerability of Forests in India: A National Scale Assessment

    Science.gov (United States)

    Sharma, Jagmohan; Upgupta, Sujata; Jayaraman, Mathangi; Chaturvedi, Rajiv Kumar; Bala, Govindswamy; Ravindranath, N. H.

    2017-09-01

    Forests are subjected to stress from climatic and non-climatic sources. In this study, we have reported the results of inherent, as well as climate change driven vulnerability assessments for Indian forests. To assess inherent vulnerability of forests under current climate, we have used four indicators, namely biological richness, disturbance index, canopy cover, and slope. The assessment is presented as spatial profile of inherent vulnerability in low, medium, high and very high vulnerability classes. Fourty percent forest grid points in India show high or very high inherent vulnerability. Plantation forests show higher inherent vulnerability than natural forests. We assess the climate change driven vulnerability by combining the results of inherent vulnerability assessment with the climate change impact projections simulated by the Integrated Biosphere Simulator dynamic global vegetation model. While 46% forest grid points show high, very high, or extremely high vulnerability under future climate in the short term (2030s) under both representative concentration pathways 4.5 and 8.5, such grid points are 49 and 54%, respectively, in the long term (2080s). Generally, forests in the higher rainfall zones show lower vulnerability as compared to drier forests under future climate. Minimizing anthropogenic disturbance and conserving biodiversity can potentially reduce forest vulnerability under climate change. For disturbed forests and plantations, adaptive management aimed at forest restoration is necessary to build long-term resilience.

  19. Vulnerability of Forests in India: A National Scale Assessment.

    Science.gov (United States)

    Sharma, Jagmohan; Upgupta, Sujata; Jayaraman, Mathangi; Chaturvedi, Rajiv Kumar; Bala, Govindswamy; Ravindranath, N H

    2017-09-01

    Forests are subjected to stress from climatic and non-climatic sources. In this study, we have reported the results of inherent, as well as climate change driven vulnerability assessments for Indian forests. To assess inherent vulnerability of forests under current climate, we have used four indicators, namely biological richness, disturbance index, canopy cover, and slope. The assessment is presented as spatial profile of inherent vulnerability in low, medium, high and very high vulnerability classes. Fourty percent forest grid points in India show high or very high inherent vulnerability. Plantation forests show higher inherent vulnerability than natural forests. We assess the climate change driven vulnerability by combining the results of inherent vulnerability assessment with the climate change impact projections simulated by the Integrated Biosphere Simulator dynamic global vegetation model. While 46% forest grid points show high, very high, or extremely high vulnerability under future climate in the short term (2030s) under both representative concentration pathways 4.5 and 8.5, such grid points are 49 and 54%, respectively, in the long term (2080s). Generally, forests in the higher rainfall zones show lower vulnerability as compared to drier forests under future climate. Minimizing anthropogenic disturbance and conserving biodiversity can potentially reduce forest vulnerability under climate change. For disturbed forests and plantations, adaptive management aimed at forest restoration is necessary to build long-term resilience.

  20. Clinical and psychometric validation of the psychotic depression assessment scale

    DEFF Research Database (Denmark)

    Østergaard, Søren D; Pedersen, Christina H; Uggerby, Peter

    2015-01-01

    of the PDAS and its subscales was investigated by Spearman correlation analysis of the global severity ratings and the PDAS, HAM-D6, and BPRS5 total scores. The unidimensionality of the scales was tested by item response theory analysis (Mokken). RESULTS: Ratings from 39 participants with unipolar psychotic...... depression and nine participants with bipolar psychotic depression were included in the analysis. The Spearman correlation analysis indicated that the PDAS, HAM-D6 and BPRS5 were clinically valid (correlation coefficients from 0.78 to 0.85, p

  1. Laparoscopic Resection of Cesarean Scar Ectopic Pregnancy.

    Science.gov (United States)

    Ades, Alex; Parghi, Sneha

    To demonstrate a technique for the laparoscopic surgical management of cesarean section scar ectopic pregnancy. Step-by-step presentation of the procedure using video (Canadian Task Force classification III). Cesarean section scar ectopic pregnancy is a rare form of ectopic pregnancy with an incidence ranging from 1:1800 to 1:2216. Over the last decade, the incidence seems to be on the rise with increasing rates of cesarean deliveries and early use of Doppler ultrasound. These pregnancies can lead to life-threatening hemorrhage, uterine rupture, and hysterectomy if not managed promptly. Local or systemic methotrexate therapy has been used successfully but can result in prolonged hospitalization, requires long-term follow-up, and in some cases treatment can fail. In the hands of a trained operator, laparoscopic resection can be performed to manage this type of pregnancy. Consent was obtained from the patient, and exemption was granted from the local Internal Review Board (The Womens' Hospital, Parkville). In this video we describe our technique for laparoscopic management of a cesarean scar ectopic pregnancy. We present the case of a 34-year-old G4P2T1 with the finding of a live 8-week pregnancy embedded in the cesarean section scar. The patient had undergone 2 previous uncomplicated cesarean sections at term. On presentation her β-human chorionic gonadotropin (β-hCG) level was 52 405 IU/L. She was initially managed with an intragestational sac injection of potassium chloride and methotrexate, followed by 4 doses of intramuscular methotrexate. Despite these conservative measures, the level of β-hCG did not adequately fall and an ultrasound showed a persistent 4-cm mass. A decision was made to proceed with surgical treatment in the form of a laparoscopic resection of the ectopic pregnancy. The surgery was uneventful, and the patient was discharged home within 24 hours of her procedure. Her serial β-hCG levels were followed until complete resolution

  2. Feasibility of prediction of cesarean section scar dehiscence in the third trimester by three-dimensional ultrasound.

    Science.gov (United States)

    Mansour, Ghada M; El-Mekkawi, Sherif F; Khairy, Hassan T; Mossad, Asmaa E M

    2015-05-01

    To assess the role of three-dimensional (3D) ultrasound mutiplanar view in prediction of cesarean section (CS) scars dehiscence. One hundred pregnant women with previous CS scars were investigated by ultrasound to measure the scar thickness by 2D ultrasound and to depict the uterine wall by 3D coronal plane, using 3D multiplanar view. Straight line cut section by 3D multiplanar view was used and prediction of dehiscence was by detecting fenestration of the wall. Operative findings revealed that 95 cases (95%) of the studied group had intact uterine scar, while dehiscence was detected among five ladies (5%). Validity of 3D U/S versus operative findings revealed a sensitivity of 83.3%, specificity 100%, positive predictive value 100%, negative predictive value 99% and accuracy 99%. C technique was superior to straight line technique in multiplanar view for assessment of the scars. Three-dimensional ultrasound is useful in prediction of dehiscent scars during pregnancy with perfect sensitivity. Machines with the availability of C dissection in the multiplanar view are more useful in this field.

  3. Comparative Study of the Use of Trichloroacetic Acid and Phenolic Acid in the Treatment of Atrophic-Type Acne Scars.

    Science.gov (United States)

    Dalpizzol, Mariana; Weber, Magda B; Mattiazzi, Anna Paula F; Manzoni, Ana Paula D

    2016-03-01

    Many therapies involving varying degrees of complexity have been used to treat acne scars, but none is considered the gold standard treatment. A comparative evaluation of 88% phenol and 90% trichloroacetic acid (TCA) applied using the chemical reconstruction of skin scars (CROSS) technique. A nonrandomized, single-blinded self-controlled clinical trial was conducted among patients with ice pick-type and boxcar-type atrophic acne scars. Using 88% phenol on the left hemiface and 90% TCA on the right hemiface was adopted as the standard practice of the CROSS technique. The dermatological quality of life index (DLQI) questionnaire, acne scar grading scale Échelle d´Evaluation Clinique des Cicatrices d'Acne (ECCA), and evaluation of improvement were performed pretreatment and post-treatment. Regarding ECCA, significant differences were found in pretreatment and post-treatment (p scar were only seen after the use of 90% TCA. This study confirmed the efficacy of both TCA and phenol for treating such scars, with less severe complications from the use of phenol.

  4. The Kirby-Desai Scale: A Proposed Scale to Assess Tattoo-removal Treatments

    OpenAIRE

    Kirby, William; Desai, Alpesh; Desai, Tejas; Kartono, Francisca; Geeta, Patel

    2009-01-01

    Background: As tattoos have become increasingly popular in the Western world, tattoo-removal requests have also increased, as patients’ personal identities advance. Laser tattoo removal is the current treatment of choice given its safety and efficacy. However, due to varying types of tattoos, it has been difficult to quantify the number of laser treatments required with certainty when discussing laser tattoo removal with our patients. Objective: To propose a practical numerical scale to asses...

  5. Assessment of the hydrological impacts of green roof: From building scale to basin scale

    Science.gov (United States)

    Versini, P.-A.; Ramier, D.; Berthier, E.; de Gouvello, B.

    2015-05-01

    At the building scale, the use of green roof has shown a positive impact on urban runoff (decrease and slow-down in peak discharge, decrease in runoff volume). The present work aims to study whether similar effects are possible at the basin scale and what is the minimum spreading of green runoff needed to observe significant impacts. It is particularly focused on the circumstances of such impacts and how they can contribute to storm water management in urban environment. Based on observations on experimental green roofs, a conceptual model has been developed and integrated into the SWMM urban rainfall-runoff model to reproduce the hydrological behaviour of two different types of green roof. It has been combined with a method defining green roofing scenarios by estimating the maximum roof area that can be covered. This methodology has been applied on a long time series (18 years) to the Châtillon urban basin (Haut-de-Seine county, France) frequently affected by urban flooding. For comparison, the same methodology has been applied at the building scale and a complementary analysis has been conducted to study which hydrometeorological variables may affect the magnitude of these hydrological impacts at both scales. The results show green roofs, when they are widely implemented, can affect urban runoff in terms of peak discharge and volume, and avoid flooding in several cases. Both precipitation - generally accumulated during the whole event- and the initial substrate saturation are likely to have an impact on green roof effects. In this context, the studied green roofs seem useful to mitigate the effects of usual rainfall events but turn out being less helpful for the more severe ones. We conclude that, combined with other infrastructures, green roofs represent an interesting contribution to urban water management in the future.

  6. Update on scar management: guidelines for treating Asian patients.

    Science.gov (United States)

    Kim, Sukwha; Choi, Tae Hyun; Liu, Wei; Ogawa, Rei; Suh, Jeong Seok; Mustoe, Thomas A

    2013-12-01

    Following injury, Asian skin has a tendency towards hyper-pigmentation and scar formation, and therefore the prevention of scarring is particularly important in Asian patients. Since publication of an International Clinical Recommendation on Scar Management in 2002, there have been numerous publications in the field of scar management. Advances in understanding scar formation have also led to the introduction of new treatments as well as a better understanding of established therapeutic options. A literature search for abstracts, clinical trials and meta-analyses evaluating scar prevention and treatment was performed using PubMed and the Cochrane Database of Systematic Reviews. Based on this data a panel of experts formulated treatment recommendations for Asian patients. Following surgery, scar prevention should be initiated in all Asian patients due to the high risk of poor scars. There is strong evidence for the efficacy of silicone based products, and due to their ease of use, they can be considered first-line therapy. Silicone gel (versus silicone gel sheets) products have demonstrated efficacy. For patients who fail to respond to first-line therapy, intralesional steroid injections, radiation therapy, and intralesional 5-flourouracil injections have achieved widespread acceptance. Laser treatments have been increasingly used, although the evidence remains largely anecdotal without a clear consensus on optimal wavelength, or amount of energy. Surgical approaches have increased in sophistication with recognition of the impact that tension has on scar formation. Updated scar management recommendations will benefit practitioners making decisions regarding optimal, evidence-based treatment strategies for their patients.

  7. Equitable language practices in large-scale assessment ...

    African Journals Online (AJOL)

    This article is based on an HSRC study conducted for the Western Cape Education Department in which 75 000 Grade 8 learners were assessed in mathematics and language in 2006. The country's multilingual education policy is currently misinterpreted to mean that the learning of and use of indigenous African languages ...

  8. Assessment Of Small Scale Farmers\\' Strategies In Alleviating ...

    African Journals Online (AJOL)

    The study assessed the strategies employed by farmers in alleviating poverty in Delta State, Nigeria. An interview schedule was used to collect data from 90 randomly selected farmers. Findings showed that majority of the respondents were males (86.7%) with majority having low education. Majority of respondents were ...

  9. Quality Control Charts in Large-Scale Assessment Programs

    Science.gov (United States)

    Schafer, William D.; Coverdale, Bradley J.; Luxenberg, Harlan; Jin, Ying

    2011-01-01

    There are relatively few examples of quantitative approaches to quality control in educational assessment and accountability contexts. Among the several techniques that are used in other fields, Shewart charts have been found in a few instances to be applicable in educational settings. This paper describes Shewart charts and gives examples of how…

  10. Assessing Agency of University Students: Validation of the AUS Scale

    Science.gov (United States)

    Jääskelä, Päivikki; Poikkeus, Anna-Maija; Vasalampi, Kati; Valleala, Ulla Maija; Rasku-Puttonen, Helena

    2017-01-01

    Fostering agency as a core component of professionalism is seen as a critical task of higher education. However, the tools for assessing university students' agency, and the pedagogical and relational resources needed for its development, are lacking. The present study describes the theoretical foundations and factor structure of the newly…

  11. Is stair negotiation measured appropriately in functional assessment scales?

    NARCIS (Netherlands)

    Iersel, M.B. van; Olde Rikkert, M.G.M.; Mulley, G.P.

    2003-01-01

    BACKGROUND: A decline in mobility may result in problems with the negotiation of stairs, which can potentially be hazardous. In practice, stair negotiation is an important aspect of daily living and therefore needs to be assessed carefully. METHODS: We conducted a systematic literature review to

  12. Development of Self-Efficacy towards Using Alternative Assessment Scale

    Science.gov (United States)

    Buldur, Serkan; Tatar, Nilgun

    2011-01-01

    Determining the candidate teachers' opinions regarding self-efficacy towards alternative assessment will be beneficial in that this will improve their competencies while using these approaches in their applications within the classroom. In this article, the development and validation of the "Self-efficacy towards Using Alternative Assessment…

  13. Assessing severity of delirium by the Delirium Observation Screening Scale

    NARCIS (Netherlands)

    Scheffer, Alice C.; van Munster, Barbara C.; Schuurmans, Marieke J.; de Rooij, Sophia E.

    2011-01-01

    Objective: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. Assessment of the severity of delirium is important for adjusting medication. The minimal dose of medication is preferable to prevent side effects. Only few nurse based severity measures are available.

  14. Assessing severity of delirium by the Delirium Observation Screening Scale

    NARCIS (Netherlands)

    Scheffer, Alice C.; van Munster, Barbara C.; Schuurmans, Marieke J.; de Rooij, Sophia E.

    Objective: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. Assessment of the severity of delirium is important for adjusting medication. The minimal dose of medication is preferable to prevent side effects. Only few nurse based severity measures are available.

  15. Multi-scale landslide risk assessment in Cuba

    NARCIS (Netherlands)

    Castellanos Abella, E.A.

    2008-01-01

    Landslides cause a considerable amount of damage in the mountainous regions of Cuba, which cover about 25% of the territory. Until now, only a limited amount of research has been carried out in the field of landslide risk assessment in the country. This research presents a methodology and its

  16. [Psychometric assessment of a brief Modern Racism Scale].

    Science.gov (United States)

    Campo-Arias, Adalberto; Herazo, Edwin; Oviedo, Heidi C

    2016-06-01

    Objective To find the internal consistency of the Modern Racism Scale (MRS) among medical students in Bucaramanga, Colombia. Methods A total of 352 medical students, mean age=20.0 years (SD=1.9) reported their attitudes towards Afro-Colombians; 59.4 % were women. Students completed the 10-item version of MRS. Cronbach alpha and McDonald omega were calculated. Exploratory factor analyses were done to propose a brief version of the MRS. Results The 10-item version showed a Cronbach alpha of 0.48 and a McDonald omega of 0.15. The short version, the Brief Modern Racism Scale (BMRS) (items 1, 4, 5, 7 and 8) presented a Cronbach alpha of 0.64 and McDonald omega of 0.65. The BMRS showed one salient factor responsible of 41.6 % of the total variance. Conclusions A Spanish-language short version of the MRS shows better psychometric performance than the original version. Further study is needed to corroborate these findings or make adjustments for Colombian cultural regions.

  17. Improvement in Atrophic Acne Scars Using Topical Synthetic Epidermal Growth Factor (EGF) Serum: A Pilot Study.

    Science.gov (United States)

    Seidel, Rachel; Moy, Ronald L

    2015-09-01

    Atrophic acne scars are a common and psychologically devastating sequela of acne vulgaris that are refractory to the vast majority of topical treatments. We evaluated the efficacy of a topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars. A single-center clinical trial was performed on nine self-selected male and female patients with Goodman & Baron grade II-IV atrophic acne scars. Subjects followed a standardized treatment regimen, including twice-daily application of EGF serum to scarred areas over 12 weeks. Subject progress was evaluated at baseline and 4-week intervals by clinical photography, Investigator Global Assessment (IGA), Goodman grade and patient self-assessment. Final patient perceptions were shared by written self-assessment at the end of the study. Before and after photographs were also evaluated by a blind investigator. Eight subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 2.875 (SEM= .327) to 2.38 (SEM = .375). Mean Goodman grade was reduced from 3.00 (SEM = .309) to 2.75 (SEM = .25). Of the eight pairs of before and after photographs given to a blind investigator, five were correctly chosen as the post-treatment image. Two were assessed as "excellent" (76-100%) improvement and three were assessed as "good" (50-75%) improvement. A one-tailed paired student t-test (α = .05) using blind investigator ratings of scar severity for each before and after photograph yielded a P-value of .0019, confirming the difference as statistically significant. On final self-assessment, all but one patient reported "good" to "excellent" improvement in their scars compared to baseline. 75% of patients who received alternative treatments in prior years reported EGF serum to be more efficacious. These results suggest that topical EGF may improve the appearance of atrophic acne scars, though further study and more objective evaluation measures are required

  18. Assessment of Glial Scar, Tissue Sparing, Behavioral Recovery and Axonal Regeneration following Acute Transplantation of Genetically Modified Human Umbilical Cord Blood Cells in a Rat Model of Spinal Cord Contusion.

    Science.gov (United States)

    Mukhamedshina, Yana O; Garanina, Ekaterina E; Masgutova, Galina A; Galieva, Luisa R; Sanatova, Elvira R; Chelyshev, Yurii A; Rizvanov, Albert A

    2016-01-01

    This study investigated the potential for protective effects of human umbilical cord blood mononuclear cells (UCB-MCs) genetically modified with the VEGF and GNDF genes on contusion spinal cord injury (SCI) in rats. An adenoviral vector was constructed for targeted delivery of VEGF and GDNF to UCB-MCs. Using a rat contusion SCI model we examined the efficacy of the construct on tissue sparing, glial scar severity, the extent of axonal regeneration, recovery of motor function, and analyzed the expression of the recombinant genes VEGF and GNDF in vitro and in vivo. Transplantation of UCB-MCs transduced with adenoviral vectors expressing VEGF and GDNF at the site of SCI induced tissue sparing, behavioral recovery and axonal regeneration comparing to the other constructs tested. The adenovirus encoding VEGF and GDNF for transduction of UCB-MCs was shown to be an effective and stable vehicle for these cells in vivo following the transplantation into the contused spinal cord. Our results show that a gene delivery using UCB-MCs-expressing VEGF and GNDF genes improved both structural and functional parameters after SCI. Further histological and behavioral studies, especially at later time points, in animals with SCI after transplantation of genetically modified UCB-MCs (overexpressing VEGF and GDNF genes) will provide additional insight into therapeutic potential of such cells.

  19. Maternal BCG scar is associated with increased infant proinflammatory immune responses.

    Science.gov (United States)

    Mawa, Patrice Akusa; Webb, Emily L; Filali-Mouhim, Abdelali; Nkurunungi, Gyaviira; Sekaly, Rafick-Pierre; Lule, Swaib Abubaker; Prentice, Sarah; Nash, Stephen; Dockrell, Hazel M; Elliott, Alison M; Cose, Stephen

    2017-01-05

    Prenatal exposures such as infections and immunisation may influence infant responses. We had an opportunity to undertake an analysis of innate responses in infants within the context of a study investigating the effects of maternal mycobacterial exposures and infection on BCG vaccine-induced responses in Ugandan infants. Maternal and cord blood samples from 29 mother-infant pairs were stimulated with innate stimuli for 24h and cytokines and chemokines in supernatants were measured using the Luminex® assay. The associations between maternal latent Mycobacterium tuberculosis infection (LTBI), maternal BCG scar (adjusted for each other's effect) and infant responses were examined using linear regression. Principal Component Analysis (PCA) was used to assess patterns of cytokine and chemokine responses. Gene expression profiles for pathways associated with maternal LTBI and with maternal BCG scar were examined using samples collected at one (n=42) and six (n=51) weeks after BCG immunisation using microarray. Maternal LTBI was positively associated with infant IP-10 responses with an adjusted geometric mean ratio (aGMR) [95% confidence interval (CI)] of 5.10 [1.21, 21.48]. Maternal BCG scar showed strong and consistent associations with IFN-γ (aGMR 2.69 [1.15, 6.17]), IL-12p70 (1.95 [1.10, 3.55]), IL-10 (1.82 [1.07, 3.09]), VEGF (3.55 [1.07, 11.48]) and IP-10 (6.76 [1.17, 38.02]). Further assessment of the associations using PCA showed no differences for maternal LTBI, but maternal BCG scar was associated with higher scores for principal component (PC) 1 (median level of scores: 1.44 in scar-positive versus -0.94 in scar-negative, p=0.020) in the infants. PC1 represented a controlled proinflammatory response. Interferon and inflammation response pathways were up-regulated in infants of mothers with LTBI at six weeks, and in infants of mothers with a BCG scar at one and six weeks after BCG immunisation. Maternal BCG scar had a stronger association with infant

  20. RMS Pictorial Scale (RMS-PS: An innovative scale for the assessment of child′s dental anxiety

    Directory of Open Access Journals (Sweden)

    R M Shetty

    2015-01-01

    Full Text Available Background: Dental anxiety assessment for young children is as important as performing their treatment. Appropriate knowledge of patient′s anxiety boosts confidence and will help us to review potential management options specific to every child. Aim: This study aimed to validate (RMS Pictorial Scale (RMS-PS and to compare it with Venham Picture Test (VPT and Facial image scale (FIS in measuring dental anxiety for young children during their first dental visit. Materials and Methods: A total of 102 healthy children aged between 4 and 14 years during their first dental visit were randomly selected for the study. Childs anxiety level was measured using three different scales namely (i RMS-PS (ii VPT, and (iii FIS. Statistical Analysis: Student t test was used to compare the scores obtained from all the three scales. Pearson correlation test was used to obtain correlation among the scales used in the study. Results: A strong correlation (0·76 was found between the VPT and RMS-PS, and a moderate correlation (0.5 was found between RMS-PS and FIS, indicating good validity for the RMS-PS. Conclusions: The findings of this study suggest that the RMS-PS can be a newer and easiest means for the assessment of dental anxiety for young children in a clinical context.

  1. Radial scars without atypia in percutaneous biopsy specimens: can they obviate surgical biopsy?

    Science.gov (United States)

    Mesa-Quesada, J; Romero-Martín, S; Cara-García, M; Martínez-López, A; Medina-Pérez, M; Raya-Povedano, J L

    To evaluate the need for surgical biopsy in patients diagnosed with radial scars without atypia by percutaneous biopsy. In this retrospective observational study, we selected patients with a histological diagnosis of radial scar in specimens obtained by percutaneous biopsy during an 8-year period. The statistical analysis was centered on patients with radial scar without atypia (we assessed the radiologic presentation, the results of the percutaneous biopsy, and their correlation with the results of surgical biopsy and follow-up) and we added the patients with atypia and cancer in the elaboration of the diagnostic indices. We identified 96 patients with radial scar on percutaneous biopsy; 54 had no atypia, 18 had atypia, and 24 had cancer. Among patients with radial scar without atypia, there were no statistically significant differences between patients who underwent imaging follow-up and those who underwent surgical biopsy (p>0.05). The rate of underdiagnosis for percutaneous biopsy in patients without atypia was 1.9%. The rates of diagnosis obtained with percutaneous biopsy in relation to follow-up and surgical biopsy in the 96 cases were sensitivity 92.3%, specificity 100%, positive predictive value 100%, negative predictive value 97.2%, and accuracy 97.9%. The area under the ROC curve was 0.96 (p<0.001), and the kappa concordance index was 0.95 (p<0.001) CONCLUSIONS: We consider that it is not necessary to perform surgical biopsies in patients with radial scars without atypia on percutaneous biopsies because the rate of underestimation is very low and the concordance between the diagnosis reached by percutaneous biopsy and the definitive diagnosis is very high. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Casual and ambulatory blood pressure monitoring in children with renal scarring

    Directory of Open Access Journals (Sweden)

    Miloševski Gordana

    2005-01-01

    Full Text Available INTRODUCTION Renal scarring is the most common cause of arterial hypertension in children. High blood pressure (BP and microalbuminuria contribute to the progression of chronic renal disease. OBJECTIVE The aims of the study were: to assess BP in children with renal scarring by continuous ambulatory blood pressure measurement (ABPM in comparison to the casual method (CBP, and to determine the correlation between ambulatory blood pressure (ABP and/or casual blood pressure (CBP values and proteinuria in children with renal scarring. METHOD This forward-looking study comprised thirty-five children (26 girls and 9 boys, aged between 3-13 years, 10.4±3.9, X+SD. Blood pressure was measured using the casual method (CBP with a mercury manometer; BP was measured three times and the average was taken as a referent value. ABPM was performed using the oscillometric method with the Space Labs device, model 90207. RESULTS 45.71% of patients were classified as hypertensive by ABPM, while only 22.6% of CBP measurements were above the 95th percentile (p<0.01. "White coat hypertension" was present in 40% of the patients. Non-dipping BP alteration was detected in 37.14% of the patients. CONCLUSION Nocturnal systolic hypertension (systolic non-dipping alteration is very frequent in children with renal scarring. Nocturnal diastolic blood pressure, detectable only via ABPM, is positively correlated with proteinuria and may be an initial sign of the progression of renal scarring. ABPM is more sensitive than CBP in the evaluation of BP in children with renal scarring.

  3. Assessing Politicized Sexual Orientation Identity: Validating the Queer Consciousness Scale.

    Science.gov (United States)

    Duncan, Lauren E; Mincer, Elizabeth; Dunn, Sarah R

    2017-01-01

    Building on psychological theories of motivation for collective action, we introduce a new individual difference measure of queer consciousness, defined as a politicized collective identity around sexual orientation. The Queer Consciousness Scale (QCS) consists of 12 items measuring five aspects of a politicized queer identity: sense of common fate, power discontent, system blame, collective orientation, and cognitive centrality. In four samples of adult women and men of varied sexual orientations, the QCS showed good test-retest and Cronbach's reliability and excellent known-groups and predictive validity. Specifically, the QCS was positively correlated with identification as a member of the LGBTQ community, political liberalism, personal political salience, and LGBTQ activism and negatively correlated with right-wing authoritarianism and social dominance orientation. QCS mediated relationships between several individual difference variables and gay rights activism and can be used with both LGBTQ people and allies.

  4. Bench-scale co-processing economic assessment. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Gala, H.B.; Marker, T.L.; Miller, E.N.

    1994-11-01

    The UOP Co-Processing scheme is a single-stage slurry catalyzed process in which petroleum vacuum resid and coal are simultaneously upgraded to a high-quality synthetic oil. A highly active dispersed catalyst has been developed which enables the operation of the co-processing unit at relatively moderate and high temperatures and relatively high pressure. Under the current contract, a multi-year research program was undertaken to study the technical and economic feasibility of this technology. All the contractual tasks were completed. Autoclave experiments were carried out to evaluate dispersed vanadium catalysts, molybdenum catalysts, and a less costly UOP-proprietary catalyst preparation technique. Autoclave experiments were also carried out in support of the continuous pilot plant unit operation and to study the effects of the process variables (pressure, temperature, and metal loading on the catalyst). A total of 24 continuous pilot plant runs were made. Research and development efforts during the pilot plant operations were concentrated on addressing the cost effectiveness of the UOP single-stage slurry catalyzed co-processing concept based on UOP experience gained in the previous DOE contract. To this end, effect of catalyst metal concentration was studied and a highly-active Mo-based catalyst was developed. This catalyst enabled successful long-term operation (924 hours) of the continuous bench-scale plant at highly severe operating conditions of 3,000 psig, 465{degree}C temperature, and 2:1 resid-to-MAF (moisture- and ash-free) coal ratio with 0.1 wt % active metal. The metal loading of the catalyst was low enough to consider the catalyst as a disposable slurry catalyst. Also, liquid recycle was incorporated in the pilot plant design to increase the, reactor back mixing and to increase the flow of liquid through the reactor (to introduce turbulence in the reactor) and to represent the design of a commercial-scale reactor.

  5. Postoperative pain assessment using four behavioral scales in Pakistani children undergoing elective surgery

    Directory of Open Access Journals (Sweden)

    Faisal Shamim

    2015-01-01

    Full Text Available Background: Several measurement tools have been used for assessment of postoperative pain in pediatric patients. Self-report methods have limitations in younger children and parent, nurse or physician assessment can be used as a surrogate measure. These tools should be tested in different cultures as pain can be influenced by sociocultural factors. The objective was to assess the inter-rater agreement on four different behavioral pain assessment scales in our local population. Materials and Methods: This prospective, descriptive, observational study was conducted in Pakistan. American Society of Anesthesiologists I and II children, 3-7 years of age, undergoing elective surgery were enrolled. Four pain assessment scales were used, Children′s Hospital of Eastern Ontario Pain Scale (CHEOPS, Toddler Preschool Postoperative Pain Scale (TPPPS, objective pain scale (OPS, and Face, Legs, Activity, Cry, Consolability (FLACC. After 15 and 60 min of arrival in the postanesthesia care unit (PACU, each child evaluated his/her postoperative pain by self-reporting and was also independently assessed by the PACU nurse, PACU anesthetist and the parent. The sensitivity and specificity of the responses of the four pain assessment scales were compared to the response of the child. Results: At 15 min, sensitivity and specificity were >60% for doctors and nurses on FLACC, OPS, and CHEOPS scales and for FLACC and CHEOPS scale for the parents. Parents showed poor agreement on OPS and TPPS. At 60 min, sensitivity was poor on the OPS scale by all three observers. Nurses showed a lower specificity on FLACC tool. Parents had poor specificity on CHEOPS and rate of false negatives was high with TPPS. Conclusions: We recommend the use of FLACC scale for assessment by parents, nurses, and doctors in Pakistani children aged between 3 and 7.

  6. Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus.

    Science.gov (United States)

    Phan, Ngoc Quan; Blome, Christine; Fritz, Fleur; Gerss, Joachim; Reich, Adam; Ebata, Toshiya; Augustin, Matthias; Szepietowski, Jacek C; Ständer, Sonja

    2012-09-01

    The most commonly used tool for self-report of pruritus intensity is the visual analogue scale (VAS). Similar tools are the numerical rating scale (NRS) and verbal rating scale (VRS). In the present study, initiated by the International Forum for the Study of Itch assessing reliability of these tools, 471 randomly selected patients with chronic itch (200 males, 271 females, mean age 58.44 years) recorded their pruritus intensity on VAS (100-mm line), NRS (0-10) and VRS (four-point) scales. Re-test reliability was analysed in a subgroup of 250 patients after one hour. Statistical analysis showed a high reliability and concurrent validity (r>0.8; pscales showed a high correlation. In conclusion, high reliability and concurrent validity was found for VAS, NRS and VRS. On re-test, higher correlation and less missing values were observed. A training session before starting a clinical trial is recommended.

  7. Cutaneous Scar Prevention and Management; Overview of current therapies

    Directory of Open Access Journals (Sweden)

    Sultan Al-Shaqsi

    2016-02-01

    Full Text Available Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management.

  8. [Mechanism of scar formation and strategy of treatment].

    Science.gov (United States)

    Lu, Shu-liang

    2013-04-01

    So far, studies on the mechanism of scar formation have mainly focused on cells, cytokines and extracellular matrix. Some studies have shown that fibroblast is one of the most important element in the process of scar formation, while epidermal and endothelial cells exert synergistic effects as well. Genetic factor can not be ignored in scar formation, either. Recently, studies have shown decisively the loss or damage of the three-dimensional structure of dermal tissue is the initiator of scar formation. Thus, the defect of epidermis template is proposed as a theory in order to explain the mechanism of scar formation. There are various techniques for scar treatment. The commonly accepted methods are physical therapy, pressure therapy, pharmaceutical therapy, radiotherapy, etc.

  9. Prosthodontist contribution in treating post-burn hypertrophic facial scars

    Directory of Open Access Journals (Sweden)

    Padmanabhan T

    2010-01-01

    Full Text Available The formation of hypertrophic scars is common following healing of the burn wound, particularly in children. The face is one of the areas of the body most frequently affected by burns. Scar formation as a result of burn wounds leads to contraction of the formed granulation tissue, which causes both aesthetic and functional impairment for the patient. Scarring has major psychological and physical repercussions. Scarring on the face and visible regions of the body can be very distressing for the patient. Prevention of scars involves early and continuous use of a compressive orthesis. However, their efficacy is often limited to the facial region because of the contours of this area of body. This paper describes a clinical case of post-burn hypertrophic scars treated with silicone gel sheeting applied with pressure under custom made auto-polymerizing resin stent.

  10. Cesarean scar ectopic pregnancy. Laparoscopic resection and total scar dehiscence repair. A case report.

    Science.gov (United States)

    Mahgoub, Sara; Gabriele, Victor; Faller, Emilie; Langer, Bruno; Wattiez, Arnaud; Lecointre, Lise; Akladios, Cherif

    2017-02-04

    Illustrate laparoscopic technique for resection of cesarean scar ectopic pregnancy, associated with isthmocele repair. Case report SETTING: Tertiary referral centre in Strasbourg, France. The study was approved by the local IRB. Cesarean scar pregnancy is a rare form of ectopic pregnancy. The major risk of this type of pregnancy is the early uterine rupture with massive bleeding and maternal life-threatening. It is therefore crucial to manage actively these pregnancies as soon as they are diagnosed. Therapeutic options can be medical, surgical, or a combination of both. Many case reports or case series are found in the literature, but only few clinical studies, too difficult to carry out because of cases rarity and inconclusiveness. "Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy?" is a meta-analysis that was published in 2016, and includes 194 studies between 1978 and 2014 (126 case reports, 45 cases series and 23 clinical studies). According to this systematic review, hysteroscopy or laparoscopic hysterotomy seems to be the best first-line approach to treat cesarean scar ectopic pregnancy. Uterine artery embolization seems to be reserved for significant bleeding and/or a high suspicion index for arteriovenous malformation. There is however no consensus on treatment of reference. The case concerns a 38-year-old primiparous women with cesarean section in 2010, who was diagnosed by US scan at 7 WG as cesarean scar ectopic pregnancy, confirmed by pelvic MRI. The patient has initially received medical treatment with two intramuscular injections of Methotrexate and one local intra-gestational injection of KCl. Initial rate of HCG was 82000 IU/L. Through a rigorous weekly biological and US scan monitoring, it has been observed an involution of the ectopic pregnancy at ultrasonography associated to HCG decreasing. No bleeding or infectious complications occurred during this period. After 10 weeks of monitoring, because of a

  11. The Development and Validation of the Religious/Spiritually Integrated Practice Assessment Scale

    Science.gov (United States)

    Oxhandler, Holly K.; Parrish, Danielle E.

    2016-01-01

    Objective: This article describes the development and validation of the Religious/Spiritually Integrated Practice Assessment Scale (RSIPAS). The RSIPAS is designed to assess social work practitioners' self-efficacy, attitudes, behaviors, and perceived feasibility concerning the assessment or integration of clients' religious and spiritual beliefs…

  12. Evaluating the Risk of Child Abuse: The Child Abuse Risk Assessment Scale (CARAS)

    Science.gov (United States)

    Chan, Ko Ling

    2012-01-01

    The present study developed the Child Abuse Risk Assessment Scale (CARAS), an actuarial instrument for the assessment of the risk of physical child abuse. Data of 2,363 Chinese parents (47.7% male) living in Hong Kong were used in the analyses. Participants were individually interviewed with a questionnaire assessing their perpetration of child…

  13. Quality Assessment of Physical and Organoleptic Instant Corn Rice on Scale-Up Process

    Science.gov (United States)

    Kumalasari, R.; Ekafitri, R.; Indrianti, N.

    2017-12-01

    Development of instant corn rice product has been successfully conducted on a laboratory scale. Corn has high carbohydrate content but low in fiber. The addition of fiber in instant corn rice, intended to improve the functioning of the product, and replace fiber loss during the process. Scale up process of Instant corn rice required to increase the production capacity. Scale up was the process to get identic output on a larger scale based on predetermined production scale. This study aimed to assess the changes and differences in the quality of instant corn rice during scale up. Instant corn rice scale up was done on production capacity 3 kg, 4 kg and 5 kg. Results showed that scale up of instant corn rice producing products with rehydration ratio ranges between 514% - 570%, the absorption rate ranged between 414% - 470%, swelling rate ranging between 119% - 134%, bulk density ranged from 0.3661 to 0.4745 (g/ml) and porosity ranging between 30-37%. The physical quality of instant corn rice on scale up were stable from the ones at laboratory scale on swelling rate, rehydration ratio, and absorption rate but not stable on bulk density and porosity. Organoleptic qualities were stable at increased scale compared on a laboratory scale. Bulk density was higher than those at laboratory scale, and the porosity was lower than those at laboratory scale.

  14. Small scale water recycling systems--risk assessment and modelling.

    Science.gov (United States)

    Diaper, C; Dixon, A; Bulier, D; Fewkes, A; Parsons, S A; Strathern, M; Stephenson, T; Strutt, J

    2001-01-01

    This paper aims to use quantitative risk analysis, risk modelling and simulation modelling tools to assess the performance of a proprietary single house grey water recycling system. A preliminary Hazard and Operability study (HAZOP) identified the main hazards, both health related and economic, associated with installing the recycling system in a domestic environment. The health related consequences of system failure were associated with the presence of increased concentrations of micro-organisms at the point of use, due to failure of the disinfection system and/or the pump. The risk model was used to assess the increase in the probability of infection for a particular genus of micro-organism, Salmonella spp, during disinfection failure. The increase in the number of cases of infection above a base rate rose from 0.001% during normal operation, to 4% for a recycling system with no disinfection. The simulation model was used to examine the possible effects of pump failure. The model indicated that the anaerobic COD release rate in the system storage tank increases over time and dissolved oxygen decreases during this failure mode. These conditions are likely to result in odour problems.

  15. Assessing motivation orientations in schizophrenia: Scale development and validation

    Science.gov (United States)

    Cooper, Shanna; Lavaysse, Lindsey M.; Gard, David E.

    2014-01-01

    Motivation deficits are common in several disorders including schizophrenia, and are an important factor in both functioning and treatment adherence. Self-Determination Theory (SDT), a leading macro-theory of motivation, has contributed a number of insights into how motivation is impaired in schizophrenia. Nonetheless, self-report measures of motivation appropriate for people with severe mental illness (including those that emphasize SDT) are generally lacking in literature. To fill this gap, we adapted and abbreviated the well-validated General Causality Orientation Scale for use with people with schizophrenia and with other severe mental disorders (GCOS-clinical populations; GCOS-CP). In Study 1, we tested the similarity of our measure to the existing GCOS (using a college sample) and then validated this new measure in a schizophrenia and healthy control sample (Study 2). Results from Study 1 (N=360) indicated that the GCOS-CP was psychometrically similar to the original GCOS and provided good convergent and discriminant validity. In Study 2, the GCOS-CP was given to individuals with (N=44) and without schizophrenia (N=42). In line with both laboratory-based and observer-based research, people with schizophrenia showed lower motivational autonomy and higher impersonal/amotivated orientations. Additional applications of the GCOS-CP are discussed. PMID:25454115

  16. Assessing motivation orientations in schizophrenia: Scale development and validation.

    Science.gov (United States)

    Cooper, Shanna; Lavaysse, Lindsey M; Gard, David E

    2015-01-30

    Motivation deficits are common in several disorders including schizophrenia, and are an important factor in both functioning and treatment adherence. Self-Determination Theory (SDT), a leading macro-theory of motivation, has contributed a number of insights into how motivation is impaired in schizophrenia. Nonetheless, self-report measures of motivation appropriate for people with severe mental illness (including those that emphasize SDT) are generally lacking in the literature. To fill this gap, we adapted and abbreviated the well-validated General Causality Orientation Scale for use with people with schizophrenia and with other severe mental disorders (GCOS-clinical populations; GCOS-CP). In Study 1, we tested the similarity of our measure to the existing GCOS (using a college sample) and then validated this new measure in a schizophrenia and healthy control sample (Study 2). Results from Study 1 (N=360) indicated that the GCOS-CP was psychometrically similar to the original GCOS and provided good convergent and discriminant validity. In Study 2, the GCOS-CP was given to individuals with (N=44) and without schizophrenia (N=42). In line with both laboratory-based and observer-based research, people with schizophrenia showed lower motivational autonomy and higher impersonal/amotivated orientations. Additional applications of the GCOS-CP are discussed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Post herpes-zoster scar sarcoidosis with pulmonary involvement

    Directory of Open Access Journals (Sweden)

    Archana Singal

    2014-01-01

    Full Text Available Cutaneous sarcoidosis presents with a wide range of clinical presentations. An uncommon cutaneous manifestation is infiltration of old cutaneous scars with non-caseating granulomas known as scar sarcoidosis. Most of the patients with this clinical entity have other systemic manifestations, particularly pulmonary changes. We report a case of a 50 years old man, presenting with cutaneous sarcoidosis overlying scars of healed herpes zoster.

  18. The efficacy in treatment of facial atrophic acne scars in Asians with a fractional radiofrequency microneedle system.

    Science.gov (United States)

    Vejjabhinanta, V; Wanitphakdeedecha, R; Limtanyakul, P; Manuskiatti, W

    2014-09-01

    Treatment of acne scars remains a challenge to dermatologists. Multiple modalities have been employed with variable results and adverse effects. To determine the efficacy and adverse effects of a fractional radiofrequency microneedle system (FRMS) on acne scars in Asians at 1-, 3- and 6-month follow-up visits after treatment. Thirty subjects with atrophic acne scars for more than 6 months were enrolled in the study. All volunteers were treated with a FRMS on affected areas. The subjects were treated for a total number of three treatment sessions at 1-month intervals. Subjective assessments were obtained at baseline, 1, 3 and 6 months after the last treatment session by self-evaluation and two blinded dermatologists. Objective evaluation using an ultraviolet A-light video camera was also performed. In addition, pain scores, immediate reactions, healing times and other adverse effects were evaluated. Twenty-six subjects with skin phototypes III-V completed treatment protocol. The average mean scar age was 7 years (range: 0.5-15 years). At 6-month follow-up visit, the majority of the subjects (42.3%) reported a 26-50% improvement on their acne scars. Percent reduction in scar volume corresponded to clinical evaluation. Adverse reactions of the treatment included pain, immediate oedema/erythema, minimal scabbing and transient pigmentary alteration on treated areas. The average pain score was 5.6 of 10. Worsening of skin texture or new scar formation was not observed in any subjects. Fractional radiofrequency microneedle system is a safe and effective device for treating acne scars in Asians with minimal risk of downtime and adverse effects. © 2013 European Academy of Dermatology and Venereology.

  19. Correlation of Scar in Cardiac MRI and High‐Resolution Contact Mapping of Left Ventricle in a Chronic Infarct Model

    Science.gov (United States)

    THAJUDEEN, ANEES; STEWART, BRIAN; COKIC, IVAN; NAKAGAWA, HIROSHI; SHEHATA, MICHAEL; AMORN, ALLEN M.; KALI, AVINASH; LIU, EZH; HARLEV, DORON; BENNETT, NATHAN; DHARMAKUMAR, ROHAN; CHUGH, SUMEET S.; WANG, XUNZHANG

    2015-01-01

    Background Endocardial mapping for scars and abnormal electrograms forms the most essential component of ventricular tachycardia ablation. The utility of ultra‐high resolution mapping of ventricular scar was assessed using a multielectrode contact mapping system in a chronic canine infarct model. Methods Chronic infarcts were created in five anesthetized dogs by ligating the left anterior descending coronary artery. Late gadolinium‐enhanced magnetic resonance imaging (LGE MRI) was obtained 4.9 ± 0.9 months after infarction, with three‐dimensional (3D) gadolinium enhancement signal intensity maps at 1‐mm and 5‐mm depths from the endocardium. Ultra‐high resolution electroanatomical maps were created using a novel mapping system (Rhythmia Mapping System, Rhythmia Medical/Boston Scientific, Marlborough, MA, USA) Rhythmia Medical, Boston Scientific, Marlborough, MA, USA with an 8.5F catheter with mini‐basket electrode array (64 tiny electrodes, 2.5‐mm spacing, center‐to‐center). Results The maps contained 7,754 ± 1,960 electrograms per animal with a mean resolution of 2.8 ± 0.6 mm. Low bipolar voltage (transmural scar, and dense transmural scar) as well as normal tissue, were significantly different. A unipolar voltage of transmural extension of scar in MRI. Electrograms exhibiting isolated late potentials (ILPs) were manually annotated and ILP maps were created showing ILP location and timing. ILPs were identified in 203 ± 159 electrograms per dog (within low‐voltage areas) and ILP maps showed gradation in timing of ILPs at different locations in the scar. Conclusions Ultra‐high resolution contact electroanatomical mapping accurately localizes ventricular scar and abnormal myocardial tissue in this chronic canine infarct model. The high fidelity electrograms provided clear identification of the very low amplitude ILPs within the scar tissue and has the potential to quickly identify targets for ablation. PMID:25656924

  20. Correlation of scar in cardiac MRI and high-resolution contact mapping of left ventricle in a chronic infarct model.

    Science.gov (United States)

    Thajudeen, Anees; Jackman, Warren M; Stewart, Brian; Cokic, Ivan; Nakagawa, Hiroshi; Shehata, Michael; Amorn, Allen M; Kali, Avinash; Liu, Ezh; Harlev, Doron; Bennett, Nathan; Dharmakumar, Rohan; Chugh, Sumeet S; Wang, Xunzhang

    2015-06-01

    Endocardial mapping for scars and abnormal electrograms forms the most essential component of ventricular tachycardia ablation. The utility of ultra-high resolution mapping of ventricular scar was assessed using a multielectrode contact mapping system in a chronic canine infarct model. Chronic infarcts were created in five anesthetized dogs by ligating the left anterior descending coronary artery. Late gadolinium-enhanced magnetic resonance imaging (LGE MRI) was obtained 4.9 ± 0.9 months after infarction, with three-dimensional (3D) gadolinium enhancement signal intensity maps at 1-mm and 5-mm depths from the endocardium. Ultra-high resolution electroanatomical maps were created using a novel mapping system (Rhythmia Mapping System, Rhythmia Medical/Boston Scientific, Marlborough, MA, USA) Rhythmia Medical, Boston Scientific, Marlborough, MA, USA with an 8.5F catheter with mini-basket electrode array (64 tiny electrodes, 2.5-mm spacing, center-to-center). The maps contained 7,754 ± 1,960 electrograms per animal with a mean resolution of 2.8 ± 0.6 mm. Low bipolar voltage (transmural scar, and dense transmural scar) as well as normal tissue, were significantly different. A unipolar voltage of transmural extension of scar in MRI. Electrograms exhibiting isolated late potentials (ILPs) were manually annotated and ILP maps were created showing ILP location and timing. ILPs were identified in 203 ± 159 electrograms per dog (within low-voltage areas) and ILP maps showed gradation in timing of ILPs at different locations in the scar. Ultra-high resolution contact electroanatomical mapping accurately localizes ventricular scar and abnormal myocardial tissue in this chronic canine infarct model. The high fidelity electrograms provided clear identification of the very low amplitude ILPs within the scar tissue and has the potential to quickly identify targets for ablation. ©2015 The Authors. Pacing and Clinical Electrophysiology Published by Wiley Periodicals, Inc.

  1. Elaboration and validation of a diagrammatic scale to assess downy mildew severity in grapevine

    Directory of Open Access Journals (Sweden)

    Cláudia Regina Scapin Buffara

    2014-01-01

    Full Text Available The downy mildew, caused by Plasmopora viticola, is one of the most important grapevine (Vitis vinifera diseases in Southern Brazil, causing defoliation and economic losses. The evaluation of disease severity is an important decision for adoption of strategies and tactics for disease control. Therefore, the objective of this work was to elaborate and to validate a diagrammatic scale to assess downy mildew severity in grapevine, respecting the limitations of visual acuity. The diagrammatic scale with seven levels of disease severity of 1, 3, 6, 12, 25, 50 and 75% was developed in two versions of black-and-white and color scale. The scales were tested and validated by eight raters with and without previous experience with grapevine downy mildew. The raters estimated the severity of 30 grapevine leaves with different downy mildew severity, with and without the use of the scales. Minimum, intermediate and maximum severity levels were collected according to Weber-Fechner's stimulus-response law. The accuracy and precision were analyzed by linear regression between the actual and the estimated severity. Actual severity was assessed with ASSESS(r Program. The scales provided good levels of accuracy (means of 88% and excellent levels of precision (means of 95%. The raters showed great precision and accuracy when used the diagrammatic scale. The color scale provided more precise and accurate estimates than the black-and-white scale. The scale proposed in this work presented appropriate applicability for downy mildew evaluation in grapevine.

  2. JAAD online. Over-the-counter scar products for postsurgical patients: disparities between online advertised benefits and evidence regarding efficacy.

    Science.gov (United States)

    Morganroth, Pamela; Wilmot, Alissa Cowden; Miller, Christopher

    2009-12-01

    Surgical patients frequently read about over-the-counter (OTC) scar products online and ask physicians for advice about product use. We summarized the characteristics of the 20 best-selling scar products on the Web site drugstore.com and reviewed the medical literature for data supporting the efficacy of OTC scar products used on fresh postsurgical wounds. Products had an average price of $16.25 (range $9.49-$59.99) and an average of 9.2 ingredients (range 1-29). Silicone, vitamin E, and onion extract were common ingredients. Although weak evidence indicates that silicone gel dressings may improve postsurgical scar appearance, published evidence does not support postoperative use of most scar products. However, many products have multiple ingredients, and few clinical trials assess the ingredient combinations of specific products. The practical information about OTC scar products and published efficacy data found in this review may help physicians to counsel patients about postsurgical product use and counter unrealistic expectations gained from online advertisements.

  3. A comparative study on the validity of fall risk assessment scales in korean hospitals.

    Science.gov (United States)

    Kim, Keum Soon; Kim, Jin A; Choi, Yun-Kyoung; Kim, Yu Jeong; Park, Mi Hwa; Kim, Hyun-Young; Song, Mal Soon

    2011-03-01

    The purpose of this study was to compare the validity of three fall risk assessment scales including the Morse Fall Scale (MFS), the Bobath Memorial Hospital Fall Risk Assessment Scale (BMFRAS), and the Johns Hopkins Hospital Fall Risk Assessment Tool (JHFRAT). This study was a prospective validation cohort study in five acute care hospitals in Seoul and Gyeonggi-Do, Korea. In total, 356 patients over the age of 18 years admitted from December 2009 to February 2010 participated. The three fall risk assessment scales listed above were tested for sensitivity, specificity, positive predictive and negative predictive values. A receiver-operating characteristic (ROC) curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk. Based on the mean scores of each scale for falls, the MFS at a cut-off score of 50 had a sensitivity of 78.9%, specificity of 55.8%, positive predictive value of 30.8%, and negative predictive value of 91.4%, which were the highest values among the three fall assessment scales. Areas under the curve of the ROC curves were .761 for the MFS, .715 for the BMFRAS, and .708 for the JHFRAT. Accordingly, of the three fall risk assessment scales, the highest predictive validity for identifying patients at high risk for falls was achieved by the MFS. Copyright © 2011 Korean Society of Nursing Science. Published by Elsevier B.V. All rights reserved.

  4. Ozone time scale decomposition and trend assessment from surface observations

    Science.gov (United States)

    Boleti, Eirini; Hueglin, Christoph; Takahama, Satoshi

    2017-04-01

    Emissions of ozone precursors have been regulated in Europe since around 1990 with control measures primarily targeting to industries and traffic. In order to understand how these measures have affected air quality, it is now important to investigate concentrations of tropospheric ozone in different types of environments, based on their NOx burden, and in different geographic regions. In this study, we analyze high quality data sets for Switzerland (NABEL network) and whole Europe (AirBase) for the last 25 years to calculate long-term trends of ozone concentrations. A sophisticated time scale decomposition method, called the Ensemble Empirical Mode Decomposition (EEMD) (Huang,1998;Wu,2009), is used for decomposition of the different time scales of the variation of ozone, namely the long-term trend, seasonal and short-term variability. This allows subtraction of the seasonal pattern of ozone from the observations and estimation of long-term changes of ozone concentrations with lower uncertainty ranges compared to typical methodologies used. We observe that, despite the implementation of regulations, for most of the measurement sites ozone daily mean values have been increasing until around mid-2000s. Afterwards, we observe a decline or a leveling off in the concentrations; certainly a late effect of limitations in ozone precursor emissions. On the other hand, the peak ozone concentrations have been decreasing for almost all regions. The evolution in the trend exhibits some differences between the different types of measurement. In addition, ozone is known to be strongly affected by meteorology. In the applied approach, some of the meteorological effects are already captured by the seasonal signal and already removed in the de-seasonalized ozone time series. For adjustment of the influence of meteorology on the higher frequency ozone variation, a statistical approach based on Generalized Additive Models (GAM) (Hastie,1990;Wood,2006), which corrects for meteorological

  5. National-scale wave energy resource assessment for Australia

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, Michael G.; Heap, Andrew D. [Geoscience Australia, Marine and Coastal Environment Group, GPO Box 378, Canberra, ACT 2601 (Australia)

    2010-08-15

    A nationally consistent wave resource assessment is presented for Australian shelf (<300 m) waters. Wave energy and power were derived from significant wave height and period, and wave direction hindcast using the AusWAM model for the period 1 March 1997 to 29 February 2008 inclusive. The spatial distribution of wave energy and power is available on a 0.1 grid covering 110-156 longitude and 7-46 latitude. Total instantaneous wave energy on the entire Australian shelf is on average 3.47 PJ. Wave power is greatest on the 3000 km-long southern Australian shelf (Tasmania/Victoria, southern Western Australia and South Australia), where it widely attains a time-average value of 25-35 kW m{sup -1} (90th percentile of 60-78 kW m{sup -1}), delivering 800-1100 GJ m{sup -1} of energy in an average year. New South Wales and southern Queensland shelves, with moderate levels of wave power (time-average: 10-20 kW m{sup -1}; 90th percentile: 20-30 kW m{sup -1}), are also potential sites for electricity generation due to them having a similar reliability in resource delivery to the southern margin. Time-average wave power for most of the northern Australian shelf is <10 kW m{sup -1}. Seasonal variations in wave power are consistent with regional weather patterns, which are characterised by winter SE trade winds/summer monsoon in the north and winter temperate storms/summer sea breezes in the south. The nationally consistent wave resource assessment for Australian shelf waters can be used to inform policy development and site-selection decisions by industry. (author)

  6. Management of Keloid and Hypertrophic Scar/span>s

    Science.gov (United States)

    Edriss, A.S.; Mesták, J.

    2005-01-01

    Summary Scar management for the prevention of excessive scar formation has always been important but never so important as it is today. Optimal management continues to be an enigma for surgeons, and the best modality of treatment has been debated for many years. However, most studies have unfortunately been either retrospective or case report descriptions. Advances in scar management have been hampered by confusing or ambiguous terminology. There is no consensus on what amount of post-traumatic skin scar formation is "normal" and what should be considered "hypertrophic". In the World Health Organization's ICD-9, there is no diagnostic code for hypertrophic scar - only keloid is listed. Yet the medical and scientific literature distinguishes them as different conditions. This confusion results in inappropriate management of scar formation, and occasionally contributes to decision making related to elective or cosmetic surgery. Our experience suggests that there is no single treatment for scars that is adequate and that clinical judgement is very important when considering treatment and balancing the potential benefits of the various treatments available. The goal of treating scars is to restore functionality, provide relief of symptoms, enhance cosmetics, and prevent recurrence. This article is based on our scientific and clinical experiences and focuses on over-the-counter options to manage keloid and hypertrophic scar/span>s. PMID:21991008

  7. Abnormal pigmentation within cutaneous scars: A complication of wound healing

    Directory of Open Access Journals (Sweden)

    Sarah Chadwick

    2012-01-01

    Full Text Available Abnormally pigmented scars are an undesirable consequence of cutaneous wound healing and are a complication every single individual worldwide is at risk of. They present a challenge for clinicians, as there are currently no definitive treatment options available, and render scars much more noticeable making them highly distressing for patients. Despite extensive research into both wound healing and the pigment cell, there remains a scarcity of knowledge surrounding the repigmentation of cutaneous scars. Pigment production is complex and under the control of many extrinsic and intrinsic factors and patterns of scar repigmentation are unpredictable. This article gives an overview of human skin pigmentation, repigmentation following wounding and current treatment options.

  8. Ipsilateral Rotational Autokeratoplasty for the Management of Traumatic Corneal Scar

    OpenAIRE

    Alime Günes; Tahir Kansu Bozkurt; Cihan Unlu; Betül Ilkay Sezgin Akcay; Hüseyin Bayramlar

    2012-01-01

    A 40-years-old male patient with a corneal scar secondary to perforating eye injury had undergone ipsilateral rotational autokeratoplasty in our clinics. The corneal scar involved the pupillary area. The patient had a preoperative visual acuity of counting fingers. The patient's cornea was trephined with a 0.5 mm temporal decentration. The 8.0 mm autograft was rotated approximately 180° to relocate the scar to the temporal aspect of the cornea. The final position of the corneal scar was tempo...

  9. Risk assessment of sheep welfare at small-scale slaughter in Nordic countries, comparing with large-scale slaughter

    OpenAIRE

    Hultgren, Jan; Algers, Bo; Atkinson, Sophie; Ellingsen, Kristian; Eriksson, Sofia; Hreinsson, Kjartan; Nordensten, Lotta; Valtari, Heidi; Mejdell, Cecilie Marie

    2016-01-01

    Background During the pre-slaughter period, animals experience novel environment and procedures which may cause reduced welfare and suffering. Over the last decades, the slaughter industry has restructured into fewer and larger abattoirs, implying potential risks of transport stress, injuries, and impaired animal welfare. Since recently, however, there is growing interest in small-scale slaughter to supply locally or regionally produced meat. Risk managers at all levels thus need to assess an...

  10. Treating Scars on the Oral Mucosa.

    Science.gov (United States)

    Evans, Erik William

    2017-02-01

    Mucosal wounds tend to heal more rapidly than skin wounds and with minimal to no scar formation and hence have a minimal impact on function or aesthetics. This is likely due to differences in the magnitude and timing of the various factors that contribute to wound healing. Some examples of these differences are fibroblast proliferation, transforming growth factor-β, macrophages, neutrophils, and T cells. Other factors, such as the moist environment, contribute to the favorable wound-healing characteristics of mucosa. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Development and validation of a scale assessing spiritual needs for Korean patients with cancer.

    Science.gov (United States)

    Yong, Jinsun; Kim, Juhu; Han, Sung-Suk; Puchalski, Christina M

    2008-01-01

    The purpose of this study was to develop a scale assessing the spiritual needs of Korean patients with cancer. For the scale development, qualitative interviews and theoretical analyses were conducted to extract measurable constructs within the Korean culture. As a result, 26 items were developed for the validation of a scale. The scale was administered to 257 cancer patients; the reliability and validity of the scale were examined using Cronbach's alpha and factor analysis, respectively. The reliability was 0.92. The results of factor analysis revealed five subconstructs: love and connection, hope and peace, meaning and purpose, relationship with God, and acceptance of dying. Given these subconstructs, suggestions are provided for future studies. Spirituality has been shown to be important in the lives of patients with chronic disease. Therefore, having a scale which adequately assesses patients' spiritual needs is critical to determining how to address these needs in a clinical setting.

  12. Tools and Techniques for Basin-Scale Climate Change Assessment

    Science.gov (United States)

    Zagona, E.; Rajagopalan, B.; Oakley, W.; Wilson, N.; Weinstein, P.; Verdin, A.; Jerla, C.; Prairie, J. R.

    2012-12-01

    The Department of Interior's WaterSMART Program seeks to secure and stretch water supplies to benefit future generations and identify adaptive measures to address climate change. Under WaterSMART, Basin Studies are comprehensive water studies to explore options for meeting projected imbalances in water supply and demand in specific basins. Such studies could be most beneficial with application of recent scientific advances in climate projections, stochastic simulation, operational modeling and robust decision-making, as well as computational techniques to organize and analyze many alternatives. A new integrated set of tools and techniques to facilitate these studies includes the following components: Future supply scenarios are produced by the Hydrology Simulator, which uses non-parametric K-nearest neighbor resampling techniques to generate ensembles of hydrologic traces based on historical data, optionally conditioned on long paleo reconstructed data using various Markov Chain techniuqes. Resampling can also be conditioned on climate change projections from e.g., downscaled GCM projections to capture increased variability; spatial and temporal disaggregation is also provided. The simulations produced are ensembles of hydrologic inputs to the RiverWare operations/infrastucture decision modeling software. Alternative demand scenarios can be produced with the Demand Input Tool (DIT), an Excel-based tool that allows modifying future demands by groups such as states; sectors, e.g., agriculture, municipal, energy; and hydrologic basins. The demands can be scaled at future dates or changes ramped over specified time periods. Resulting data is imported directly into the decision model. Different model files can represent infrastructure alternatives and different Policy Sets represent alternative operating policies, including options for noticing when conditions point to unacceptable vulnerabilities, which trigger dynamically executing changes in operations or other

  13. Process assessment of small scale low temperature methanol synthesis

    Science.gov (United States)

    Hendriyana, Susanto, Herri; Subagjo

    2015-12-01

    Biomass is a renewable energy resource and has the potential to make a significant impact on domestic fuel supplies. Biomass can be converted to fuel like methanol via several step process. The process can be split into following main steps: biomass preparation, gasification, gas cooling and cleaning, gas shift and methanol synthesis. Untill now these configuration still has a problem like high production cost, catalyst deactivation, economy of scale and a huge energy requirements. These problems become the leading inhibition for biomass conversion to methanol, which should be resolved to move towards the economical. To address these issues, we developed various process and new configurations for methanol synthesis via methyl formate. This configuration combining two reactors: the one reactor for the carbonylation of methanol and CO to form methyl formate, and the second for the hydrogenolysis of methyl formate and H2 to form two molecule of methanol. Four plant process configurations were compared with the biomass basis is 300 ton/day. The first configuration (A) is equipped with a steam reforming process for converting methane to CO and H2 for increasing H2/CO ratio. CO2 removal is necessary to avoid poisoning the catalyst. COSORB process used for the purpose of increasing the partial pressure of CO in the feed gas. The steam reforming process in B configuration is not used with the aim of reducing the number of process equipment, so expect lower investment costs. For C configuration, the steam reforming process and COSORB are not used with the aim of reducing the number of process equipment, so expect lower investment costs. D configuration is almost similar to the configuration A. This configuration difference is in the synthesis of methanol which was held in a single reactor. Carbonylation and hydrogenolysis reactions carried out in the same reactor one. These processes were analyzed in term of technical process, material and energy balance and economic

  14. Human hypertrophic and keloid scar models: principles, limitations and future challenges from a tissue engineering perspective

    NARCIS (Netherlands)

    van den Broek, L.J.; Limandjaja, G.C.; Niessen, F.B.; Gibbs, S.

    2014-01-01

    Most cutaneous wounds heal with scar formation. Ideally, an inconspicuous normotrophic scar is formed, but an abnormal scar (hypertrophic scar or keloid) can also develop. A major challenge to scientists and physicians is to prevent adverse scar formation after severe trauma (e.g. burn injury) and

  15. Cubital tunnel syndrome caused by hypertrophic burn scarring: Sonographic envisage

    Directory of Open Access Journals (Sweden)

    Alparslan Bayram Carli

    2015-08-01

    Full Text Available In nerve entrapment syndromes, an electrodiagnostic study during physical examination would usually suffice to assess localization of injury. However, in daily clinical practice, sometimes it may be necessary to depict the insight; in other words to use an imaging tool. From this point of view, with its manifold advantages, ultrasound (US is superior to other imaging technologies such as magnetic resonance imaging (MRI. According to a study, US increased the sensitivity of electrodiagnostic studies from 78% to 98%. By presenting a patient with cubital tunnel syndrome caused by hypertrophic scarring, we wanted to highlight the complementary role of US in nerve entrapment syndromes in confirming the entrapment, as well as the usefulness of it in the follow-up period of burn patients. [Hand Microsurg 2015; 4(2.000: 44-46

  16. The assessment of disability with the Groningen Activity Restriction Scale. Conceptual framework and psychometric properties

    NARCIS (Netherlands)

    Kempen, G.I J M; Miedema, I; Ormel, J.; Molenaar, W.

    1996-01-01

    The conceptual framework, psychometric properties, descriptive statistics, and the rules for administration and scoring of the Groningen Activity Restriction Scale (CARS) for assessing disability in the area of ADL (Activities of Daily Living including mobility) as well as IADL (Instrumental

  17. Reliability and Validity of a Rating Scale for Assessing Career Choice Appropriateness in Adolescence.

    Science.gov (United States)

    Westbrook, Bert W.; Sanford, Eleanor E.; Waters, Sandy

    1999-01-01

    A rating scale to assess career choices was tested with 143 high school students. Scores correlated with an objective testing method based on the American College Test (ACT) Career Planning Program. (SK)

  18. Chemical concentrations, exposures, health risks by census tract from National Scale Air Toxics Assessment (NATA)

    Data.gov (United States)

    U.S. Environmental Protection Agency — Chemical concentrations, exposures, health risks by census tract for the United States from National Scale Air Toxics Assessment (NATA). This dataset is associated...

  19. A visual scale of loss assessment for dried sweet potato chips due to ...

    African Journals Online (AJOL)

    A visual scale of damage was established on dried sweet potJJto chips infested by Araeceru.s ja)·ciculatus under prevailing ambient conditions in ... Key words: Loss assessment, visual scale, damage, sweet potato, dried chips, Araecerusjasciculatus introauctio!! ..... post-harvest systems in Uganda: Strategies, constraints.

  20. Assessment of renewable energy resources potential for large scale and standalone applications in Ethiopia

    NARCIS (Netherlands)

    Tucho, Gudina Terefe; Weesie, Peter D.M.; Nonhebel, Sanderine

    2014-01-01

    This study aims to determine the contribution of renewable energy to large scale and standalone application in Ethiopia. The assessment starts by determining the present energy system and the available potentials. Subsequently, the contribution of the available potentials for large scale and