Implementation of the blunt tip cannula for dermal fillers to decrease adverse events intra and post treatment

Abstract Title: Decreasing Adverse Events by Implementing Blunt Tip Cannula in the Administration of Dermal Fillers Intra and Post Treatment Background: Dermal filler administration has become one of the most popular cosmetic procedures since dermal fillers were FDA approved in 1981. Although decreasing adverse events in dermal filler administration is a primary concern, aesthetic providers strive to provide patients with the most comfortable treatment experience possible without compromising aesthetic outcomes. Evidence has suggested that blunt tip cannulas provide a more comfortable delivery of dermal fillers and a lower risk of adverse events when compared with the standard practice of using a hypodermic needle. However, there is little clinical data comparing intra-procedure and post-procedure adverse events of the two techniques. Purpose: The primary purpose of this evidence-based project is to compare adverse events when using either a blunt tip cannula, or the standard procedure of a hypodermic needle for the administration of dermal filler. Facial injections of dermal filler using a blunt tip cannula were compared to patients that were previously injected using a hypodermic needle. Pain/discomfort and the overall desired aesthetic effect of the two techniques were evaluated for statistical significance and best practice application. Methods: 73 total patients, including both male and female adults, ages 24-77 years old, seeking facial augmentation using hyaluronic acid dermal fillers were included in the evidence-based project. Individuals who were pregnant, lactating or had received dermal fillers within the past 24 months were excluded. Once the participants were consented for the treatment and a photo release was obtained, participants were prepared for administration of dermal fillers via a blunt tip cannula. Each injection site was cleaned using Isopropyl Alcohol and 4% Chlorhexidine Gluconate. Topical anesthesia was provided by applying a topical cream consisting of Benzocaine, Tetracaine and Lidocaine, 15 minutes prior to beginning the procedure. As part of the standard procedure for cannula insertion, a 20-gauge hypodermic needle was used to make an entry point for insertion of the cannula into the correct dermal plane. Administration of hyaluronic acid into the anterior and lateral mid-face was then performed using a retrograde injection technique. The treatment area was then compared to the data sets of patients previously injected with the standard practice hypodermic needle for pain, and aesthetic outcome. Patients were evaluated intra-procedure, immediately post-procedure procedure and then again 14 days after the treatment. Pain was assessed and recorded using the Wong Baker FACES pain scale whereas 0 is no pain, 1 is the least amount of pain and then increases to 10, with 10 as the most pain possible. Aesthetic outcome was measured by utilization of the Global Aesthetic Improvement Scale (GAIN). The GAIN measuring tool is a 5-point scale rating and measuring the aesthetic improvement in appearance. The degree and description are as follows; 5 is very much improved with an excellent corrective result, 4 is much improved with a marked improvement of the overall appearance but not completely optimal, 3 is an improvement compared to the initial condition, but an additional treatment may be needed, 2 is unchanged and the appearance remains the same compared with the original condition and 1 is a worsened where the appearance has worsened compared to the original condition. Results: 14 days post treatment, all patients who were injected with dermal fillers by the blunt tip cannula overall had less pain and discomfort compared to the data set of patients that were treated by the hypodermic needle. In addition, all 73 patients scored a 5 on the GAIN improvement scale reporting a significant increase in overall aesthetic effect and outcome. Conclusion: When compared to the standard procedure of dermal filler administration by hypodermic needle, blunt tip cannula administration results in less pain and bruising with no decrease in aesthetic outcome. The addition of the blunt tip cannula to the clinical setting should be considered by providers who seek to provide their patients with techniques that offer less pain and bruising without compromising aesthetic outcome

Regulation of Pituitary Thyrotropin Production in Red Drum

Thyroid stimulating hormone (TSH), also known as thyrotropin, is a pituitary hormone which stimulates the thyroid gland to synthesize and secrete the thyroid hormones, thyroxine (T4) and triiodothyronine (T3). In tetrapod vertebrates, the regulation of pituitary hormone production and secretion is accomplished by a portal system which delivers thyrotropin-releasing hormone to positively stimulate the pituitary to release more TSH. However, in teleost fish such as the red drum (Sciaenops ocellatus), TSH production appears to be negatively controlled through direct neurosecretory innervations of the pituitary by the hypothalamus. Further research has yet to establish the importance of precise regulation of TSH expression in the red drum pituitary gland via hypothalamic TSH inhibitory factors (TIFs). Examining pituitary glands in in vitro incubations should provide a direct method for testing possible TIFs while controlling for other factors. Unfortunately, the pituitary gland of the red drum provides a very small amount of tissue, and it can be difficult to extract enough RNA from single pituitary glands to use in common mRNA expression analysis techniques such as Northern blotting. My objective is to determine if more sensitive techniques, dot blot and real-time PCR, are suitable for analyzing mRNA expression of red drum TSH. Dot blot was found to be successful in determining relative quantification of TSH mRNA in samples of at least two pooled pituitary glands following in vitro incubation. Real-time PCR with TaqMan probes was also successful at amplifying a TSH mRNA signal from 50ng of red drum pituitary mRNA. Thus, real-time PCR should provide a sensitive technique to measure mRNA expression of TSH in single pituitary glands and allow further investigation of the existence of hypothalamic TSH inhibitory control factors

Diversity in case management modalities: the Summit model

Though ubiquitous in community mental health agencies, case management suffers from a lack of consensus regarding its definition, essential components, and appropriate application. Meaningful comparisons of various case management models await such a consensus. Global assessments of case management must be replaced by empirical studies of specific interventions with respect to the needs of specific populations. The authors describe a highly differentiated and prescriptive system of case management involving the application of more than one model of service delivery. Such a diversified and targeted system offers an opportunity to study the technology of case management in a more meaningful manner

Building a COVID-19 Web Archive with Grant Funding

Recording available at: [LINK]https://www.youtube.com/watch?v=mk3HM8lteGc[/LINK]Grant funding can be a mixed blessing for archivists, and as the economic effects of COVID-19 reduce budgets for libraries and archives nationwide, our profession will see even greater reliance on “soft” money. While there are issues with the damaging effect of grants on the future of the profession, a more pressing concern is the burden that ongoing maintenance costs from former grant projects place upon archival budgets. However, due to the Internet Archive’s forward-thinking subscription model, web archiving is one project that can be completed with a one-time grant, even a small one, with little ongoing cost to the hosting archives. This makes creating a web archive around a current event an attractive and practical project within the limitations of grant funding. This poster will show how we created a web archive documenting COVID-19 in Central Indiana, covering how to pitch web archiving to a grantmaker, how to make appraisal decisions when gathering URL seeds, how to manage crawling within a limited data budget, and tools and techniques for managing this work between several people working remotely. We will also discuss certain pitfalls that we encountered and what other archivists can do to avoid them in the future

Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department

Objective We aimed to assess physicians\u27 perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. Methods This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs\u27 listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. Results There were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). Conclusion Barriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings

Possible Changes to U.S. Policies on the Use of Force in Counterterrorism Operations

We write today to express our deep concern regarding reports that the administration is considering weakening current policy standards for the use of force in counterterrorism operations

NGO Statement on Reported Changes to U.S. Policy on Use of Armed Drones and Other Lethal Force

The Trump administration’s failure thus far to release and explain the changes it has made to a previously public policy is a dangerous step backwards. Transparency around the use of lethal 2 force is critical to allowing independent scrutiny of the lawfulness of operations and to providing accountability and redress for victims of violations of international law. Transparency also helps governments identify and address civilian harm. It enables the public to be informed about some of the most important policy choices the government makes in its name – ones that involve life and death decisions. While transparency can enhance the legitimacy of government actions, secrecy, by contrast, heightens existing concerns and creates new ones

Using remote sensing to quantify fishing effort and predict shorebird conflicts in an intertidal fishery.

Accurate estimates of fishing effort are necessary in order to assess interactions with the wider ecosystem and for defining and implementing appropriate management. In intertidal and inshore fisheries in which vessel monitoring systems (VMS) or logbook programmes may not be implemented, quantifying the distribution and intensity of fishing can be difficult. The most obvious effects of bottom-contact fishing are often physical changes to the habitat, such as scarring of the sediment following dredging or trawling. We explored the potential of applying remote sensing techniques to aerial imagery collected by an unmanned aerial vehicle, or drone, in an area of intertidal mud flat (0.52 km2) in Poole Harbour, UK, where shellfish dredging is widely carried out and conflicts between commercial fishing interests and the conservation of internationally important shorebird populations are a concern. Image classification and image texture analysis were performed on imagery collected during the open dredge season in November 2015, in order to calculate measures of fishing intensity across three areas of the harbour subject to different management measures. We found a significant correlation between results of the image texture analysis and official sightings records collected during the dredging season, indicating that this method most accurately quantified dredging disturbance. The relationship between shorebird densities and food intake rates and the results of this analysis method were then investigated to assess the potential for using remotely sensed measures of fishing effort to assess responses of overwintering shorebird populations to intertidal shellfish dredging. Our work highlights the application of such methods, providing a low-cost tool for quantifying fishing effort and predicting wildlife conflicts