BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve se...BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed,for the duration of the operation,the minimum inhibitory concentration of the likely organisms that are encountered.Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4%and 8%to between 1%and 3%.Controversy,however,still surrounds the optimal frequency and dosing of antibiotic administration.AIM To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime,combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty METHODS Following ethical approval,patients undergoing primary total hip arthroplasty(THA)/total knee arthroplasty(TKA)with the old regime(OR)of a preoperative dose[cefazolin 2 g intravenously(IV)],and two subsequent doses(2 h and 8 h),were compared to those after a change to a new regime(NR)of a weight-adjusted preoperative dose(cefazolin 2 g IV for patients<120 kg;cefazolin 3g IV for patients>120 kg)and a post-operative dose at 2 h.The primary outcome in both groups was SSI rates during the 2 years post-operatively.RESULTS A total of n=1273 operations(THA n=534,TKA n=739)were performed in n=1264 patients.There was no statistically significant difference in the rate of deep(OR 0.74%(5/675)vs NR 0.50%(3/598);fishers exact test P=0.72),nor superficial SSIs(OR 2.07%(14/675)vs NR 1.50%(9/598);chi-squared test P=0.44)at 2 years postoperatively.With propensity score weighting and an interrupted time series analysis,there was also no difference in SSI rates between both groups[RR 0.88(95%CI 0.61 to 1.30)P=0.46].CONCLUSION A weight-adjusted regime,with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population.展开更多
Estimating 3D human pose from 2D images in real world contexts remains a challenge,characterized by unique data constraints.Large general datasets of motion-captured 3D adult human poses paired with 2D images exist,bu...Estimating 3D human pose from 2D images in real world contexts remains a challenge,characterized by unique data constraints.Large general datasets of motion-captured 3D adult human poses paired with 2D images exist,but in many application settings,collection of further motion-captured data is impossible,precluding a straightforward fine-tuning approach to adaptation.We present a method for improving 3D pose estimation transfer learning to domains where there are only depth camera images available as supervision.Our heuristic weakly supervised 3D human pose(HW-HuP)estimation method learns partial pose priors from general 3D human pose datasets and employs weak supervision with depth data to guide learning in an optimization and regression cycle.We show that HW-HuP meaningfully improves upon state-of-the-art models in the adult in-bed setting,as well as on large scale public 3D human pose datasets,under comparable supervision conditions.Our model code and data are publicly available at https://github.com/ostadabbas/hw-hup.A significantly expanded version of this paper,with supplementary material,is available as a preprint on arXiv at https://arxiv.org/abs/2105.10996.展开更多
Background:Studies have demonstrated improved clinical outcomes with extended infusion(EI)piperacillin/tazobactam(TZP)compared to standard infusion(SI).However,there is less evidence on its benefits in noncritically-i...Background:Studies have demonstrated improved clinical outcomes with extended infusion(EI)piperacillin/tazobactam(TZP)compared to standard infusion(SI).However,there is less evidence on its benefits in noncritically-ill patients.Hospital-wide EI TZP was implemented at our site on February 21,2012.Our objectives were to compare clinical,safety and economic outcomes between EI and SI TZP.Methods:A retrospective cohort study of all adult patients who received EI TZP(3.375 g IV q8h infused over 4 hours and SI TZP for≥48 hours during 3 years pre-and postimplementation was conducted.The primary study outcome was 14-day mortality while secondary outcomes included length of hospital stay(LOS),nursing plus pharmacy cost,occurrence of Clostridioides difficile infection,readmission within 30 days and change in Pseudomonas aeruginosa minimum inhibitory concentration(MIC)distribution for TZP.The primary outcome and binary secondary outcomes were analyzed using a logistic regression model.LOS was examined using time to event analysis.Cost was examined using linear regression modelling.Results:Overall,2034 patients received EI TZP and 1364 patients received SI TZP.EI TZP was associated with lower odds of mortality(OR 0.76,95%CI 0.63-0.91),lower odds of C.difficile infection(OR 0.59,95%CI 0.41-0.84)and 8%lower cost(estimate 0.92,95%CI 0.87-0.98)compared to SI TZP.Conclusions:Hospital-wide implementation of EI TZP was associated with lower odds of 14-day mortality and incidence of C.difficile infection with cost savings at our institution.展开更多
文摘BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed,for the duration of the operation,the minimum inhibitory concentration of the likely organisms that are encountered.Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4%and 8%to between 1%and 3%.Controversy,however,still surrounds the optimal frequency and dosing of antibiotic administration.AIM To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime,combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty METHODS Following ethical approval,patients undergoing primary total hip arthroplasty(THA)/total knee arthroplasty(TKA)with the old regime(OR)of a preoperative dose[cefazolin 2 g intravenously(IV)],and two subsequent doses(2 h and 8 h),were compared to those after a change to a new regime(NR)of a weight-adjusted preoperative dose(cefazolin 2 g IV for patients<120 kg;cefazolin 3g IV for patients>120 kg)and a post-operative dose at 2 h.The primary outcome in both groups was SSI rates during the 2 years post-operatively.RESULTS A total of n=1273 operations(THA n=534,TKA n=739)were performed in n=1264 patients.There was no statistically significant difference in the rate of deep(OR 0.74%(5/675)vs NR 0.50%(3/598);fishers exact test P=0.72),nor superficial SSIs(OR 2.07%(14/675)vs NR 1.50%(9/598);chi-squared test P=0.44)at 2 years postoperatively.With propensity score weighting and an interrupted time series analysis,there was also no difference in SSI rates between both groups[RR 0.88(95%CI 0.61 to 1.30)P=0.46].CONCLUSION A weight-adjusted regime,with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population.
基金supported by the National Science Foundation under Grant No.1755695.
文摘Estimating 3D human pose from 2D images in real world contexts remains a challenge,characterized by unique data constraints.Large general datasets of motion-captured 3D adult human poses paired with 2D images exist,but in many application settings,collection of further motion-captured data is impossible,precluding a straightforward fine-tuning approach to adaptation.We present a method for improving 3D pose estimation transfer learning to domains where there are only depth camera images available as supervision.Our heuristic weakly supervised 3D human pose(HW-HuP)estimation method learns partial pose priors from general 3D human pose datasets and employs weak supervision with depth data to guide learning in an optimization and regression cycle.We show that HW-HuP meaningfully improves upon state-of-the-art models in the adult in-bed setting,as well as on large scale public 3D human pose datasets,under comparable supervision conditions.Our model code and data are publicly available at https://github.com/ostadabbas/hw-hup.A significantly expanded version of this paper,with supplementary material,is available as a preprint on arXiv at https://arxiv.org/abs/2105.10996.
文摘Background:Studies have demonstrated improved clinical outcomes with extended infusion(EI)piperacillin/tazobactam(TZP)compared to standard infusion(SI).However,there is less evidence on its benefits in noncritically-ill patients.Hospital-wide EI TZP was implemented at our site on February 21,2012.Our objectives were to compare clinical,safety and economic outcomes between EI and SI TZP.Methods:A retrospective cohort study of all adult patients who received EI TZP(3.375 g IV q8h infused over 4 hours and SI TZP for≥48 hours during 3 years pre-and postimplementation was conducted.The primary study outcome was 14-day mortality while secondary outcomes included length of hospital stay(LOS),nursing plus pharmacy cost,occurrence of Clostridioides difficile infection,readmission within 30 days and change in Pseudomonas aeruginosa minimum inhibitory concentration(MIC)distribution for TZP.The primary outcome and binary secondary outcomes were analyzed using a logistic regression model.LOS was examined using time to event analysis.Cost was examined using linear regression modelling.Results:Overall,2034 patients received EI TZP and 1364 patients received SI TZP.EI TZP was associated with lower odds of mortality(OR 0.76,95%CI 0.63-0.91),lower odds of C.difficile infection(OR 0.59,95%CI 0.41-0.84)and 8%lower cost(estimate 0.92,95%CI 0.87-0.98)compared to SI TZP.Conclusions:Hospital-wide implementation of EI TZP was associated with lower odds of 14-day mortality and incidence of C.difficile infection with cost savings at our institution.
