bluuebunny/crossref_metadata_2025 huggingface dataset:
A review on optical bandgap engineering in TiO2nanostructures via doping and intrinsic vacancy modulation towards visible light applications
Authors: Nair Radhika V , Gummaluri Venkata Siva , Matham Murukeshan Vadakke , C Vijayan
Published: March 2022

The prospect of engineering the bandgap in semiconductor nanostructures all the way from ultraviolet to visible is highly significant in various applications such as photocatalysis, sensing, optoelectronics and biomedical applications. Since many semiconductors have their bandgaps in the UV region, various techniques are used to tune their bandgaps to the visible region. Doping and co-doping with metals and non-metals have been found to be highly effective in bandgap narrowing as doping creates a continuum of mid-bandgap states which effectively reduces the bandgap. Other than these techniques, the modulation of intrinsic vacancies is an effective way to control the bandgap. Among all semiconductors, titanium dioxide (TiO2) is a well-studied material for UV photocatalytic applications. TiO2has oxygen and titanium vacancies as intrinsic defects which influence the bandgap based on its phase of existence. The oxygen vacancies generate unpaired electrons associated with Ti3+species, resulting in the creation of donor levels within the bandgap. Trivacancies give a p-type nature to TiO2due to excess holes and generate acceptor levels in the bandgap. The existence of a continuum of such intrinsic defect states within the bandgap appears to narrow the bandgap and enhances the visible light absorption in TiO2, although the effect is an apparent narrowing. Doping and co-doping of TiO2with metals such as Au, Ag, Fe, Co, Ni, Pt and Pd and non-metals such as B, C, N, Br and Cl, doping with Ti3+ions and hydrogenation have all been found to narrow the bandgap of TiO2. In this review, we focus on such intrinsic vacancy-modulated bandgap narrowing in TiO2. This review covers significant recent advancements in bandgap engineering of TiO2.
Tuning the adiabaticity of spin dynamics in diamond nitrogen vacancy centers
Authors: Band Y B , Japha Y
Published: March 2022

We study the spin dynamics of diamond nitrogen vacancy (NV) centers in an oscillating magnetic field along the symmetry axis of the NV in the presence of transverse magnetic fields. It is well-known that the coupling between the otherwise degenerate Zeeman levels |M

S
= ±1⟩ due to strain and electric fields is responsible for a Landau–Zener process near the pseudo-crossing of the adiabatic energy levels when the axial component of the oscillating magnetic field changes sign. We derive an effective two-level Hamiltonian for the NV system that includes coupling between the two levels via virtual transitions into the third far-detuned level |M

S
= 0⟩ induced by transverse magnetic fields. This coupling adds to the coupling due to strain and electric fields, with a phase that depends on the direction of the transverse field in the plane perpendicular to the NV axis. Hence, the total coupling of the Zeeman levels can be tuned to control the adiabaticity of spin dynamics by fully or partially compensating the effect of the strain and electric fields, or by enhancing it. Moreover, by varying the strength and direction of the transverse magnetic fields, one can determine the strength and direction of the local strain and electric fields at the position of the NV center, and even the external stress and electric field. The nuclear spin hyperfine interaction is shown to introduce a nuclear spin dependent offset of the axial magnetic field for which the pseudo-crossing occurs, while the adiabaticity remains unaffected by the nuclear spin. If the NV center is coupled to the environment, modeled by a bath with a Gaussian white noise spectrum, as appropriate for NVs near the diamond surface, then the spin dynamics is accompanied by relaxation of the Zeeman level populations and decoherence with a non-monotonic decrease of the purity of the system. The results presented here have important impact for metrology with NV centers, quantum control of spin systems in solids and coupled dynamics of spin and rotations in levitated nano-objects in the presence of magnetic fields.
On the length used for CT ionization chambers to determine CTDI
Authors: DeWerd Larry A , Khan Ahtesham Ullah , Jensen Andrew R
Published: March 2022

Objective. Computed tomography dose index (CTDI) calculations based on measurements made with CT ionization chambers require characterization of two chamber properties: radiation sensitivity and effective length. The sensitivity of a CT ionization chamber is currently determined in some countries by calibration in an x-ray field that irradiates the entire chamber. Determination of the effective length is left to the user, and this value is frequently assumed to be equivalent to the nominal length—typically 100 mm—stated by the manufacturer. This assumption undermines the intention and usefulness of CTDI calculation. Thus, a slit-based calibration, N
KL, of the CT ionization chambers was proposed by collimating the x-ray beam to a well-defined aperture width. The aim of this work is to compare the two methods. Approach. Four different CT ionization chambers (Standard Imaging Exradin A101, Radcal 10x5-3CT, Victoreen 500-100, and Capintec PC-4P) are investigated in this work. Sensitivity profiles were measured for all four chambers and effective/rated chamber lengths were calculated. A novel Monte-Carlo based correction was proposed to account for the presence of the aperture. CTDI was calculated and compared for two calibration beams as well as for a commercial CT scanner using Exradin A101 and Radcal 10x5-3CT chambers. Main results. The nominal chamber length was found to deviate up to 21% compared to the effective length. Correction for the aperture depended on the aperture opening size. CTDI calculation results illustrate the potential 17% error in CTDI calculation that can be caused by assuming the effective chamber length is equivalent to the manufacturer’s stated nominal length. CTDI calculations with CT ionization chambers calibrated with an air-kerma length calibration method yield the smallest variation in the CTDI regardless of the chamber model. Significance. To avoid an erroneous CTDI, information regarding the chamber’s effective length must be included in the calibration or stated by the manufacturer. Alternatively, a slit-based calibration can be performed.
Schottky contact diameter effect on the electrical properties and interface states of Ti/Au/p-AlGaAs/GaAs/Au/Ni/Au Be-doped p-type MBE Schottky diodes
Authors: Lakhdari Issam , Sengouga Nouredine , Labed Madani , Tibermacine Toufik , Mari Riaz , Henini Mohamed
Published: March 2022

Schottky diodes based on Be-doped p-type AlGaAs were grown by molecular beam epitaxy and their current–voltage (I–V) and capacitance–voltage (C–V) characteristics measured. The Schottky and Ohmic contacts are Ti/Au and Au/Ni/Au, respectively. The effect of the Schottky contact diameter on I–V and C–V characteristics was studied. To elucidate this effect, the Schottky diode figures of merits and interface states are extracted from I–V and C–V characteristics, respectively. It was found that interface states density increases with increasing Schottky contact diameter then saturates beyond 400 µm. The frequency dependence of the C–V characteristics was also related to these interface states. The results of this present study can help choosing the right Schottky contact dimensions.
4D printed shape memory sandwich structures: experimental analysis and numerical modeling
Authors: Serjouei A , Yousefi A , Jenaki A , Bodaghi M , Mehrpouya M
Published: March 2022

Additive manufacturing has provided a unique opportunity to fabricate highly complex structures as well as sandwich structures with various out-of-plane cores. The application of intelligent materials, such as shape memory polymers, gives an additional dimension to the three-dimensional (3D) printing process, known as four-dimensional (4D) printing, so that the deformed structures can return to their initial shape by the influence of an external stimulus like temperature. In this study, 4D printing of smart sandwich structures with the potential of energy absorption is investigated. The samples were fabricated considering various process parameters (i.e. layer height, nozzle temperature, printing velocity, and wall thickness) and tested mechanically. The experimental work reveals that the deformed sandwiches can fully recover their initial form by applying simple heating. Besides, a reliable finite element model (FEM) was developed to predict the functional behavior of the horseshoe sandwich structures in compression analysis. The experimental and simulation results show that among process parameters, wall thickness, layer height, and nozzle temperature are the most significant parameters to increase the compressive load and, consequently, the energy absorption rate. The concept, results, and modeling provided in this study are expected to be used in the design and fabrication of 4D printed sandwich structures for energy absorption applications.
Resonance-like enhancement of forced nonlinear diffusion as a nonequilibrium phase transition
Authors: Goychuk Igor
Published: March 2022

We describe the phenomenon of a resonance-like, giant enhancement of diffusion in a basic model of nonlinear diffusion featured by a nonlinear in velocity friction and the corresponding multiplicative thermal noise. The model is consistent with thermal equilibrium in the absence of driving. Different from previous studies of this phenomenon, where the crucial nonlinearity originates from a periodic external potential while friction is linear, we focus on the case of a constant force driving, whereas the crucial nonlinearity stems from the friction. The basic model of such friction considered interpolates between linear viscous Stokes friction at small velocities and dry Coulomb-like friction at large velocities corresponding to a stress plateau in some nonlinear viscoelastic materials. Recently, a nonequilibrium phase transition to super-diffusion and super-transport was discovered within this basic model. We show that adding a tiny viscous friction part to major nonlinear friction regularizes in part this behavior. Diffusion becomes asymptotically normal. However, the phase transition translates into a giant enhancement of normal diffusion and mobility of particles at the transition point over the intuitively expected large force limit, where the linearization of friction occurs. Such a giant enhancement of diffusion is closely related to the largely enhanced kinetic temperature of the particles at and beyond the critical point. We provide analytical results obtained within an effective mass approximation which nicely agree with stochastic numerics.
Jackiw-Teitelboim and Kantowski-Sachs quantum cosmology
Authors: Fanaras Georgios , Vilenkin Alexander
Published: March 2022

We study quantum cosmology of the 2D Jackiw-Teitelboim (JT) gravity with Λ > 0 and calculate the Hartle-Hawking (HH) wave function for this model in the minisuperspace framework. Our approach is guided by the observation that the JT dynamics can be mapped exactly onto that of the Kantowski-Sachs (KS) model describing a homogeneous universe with spatial sections of S
1 × S
2 topology. This allows us to establish a JT-KS correspondence between the wave functions of the models.
We obtain the semiclassical Hartle-Hawking wave function by evaluating the path integral with appropriate boundary conditions and employing the methods of Picard-Lefschetz theory. The JT-KS connection formulas allow us to translate this result to JT gravity, define the HH wave function and obtain a probability distribution for the dilaton field.
Model for access and stability of the X-point radiator and the threshold for marfes in tokamak plasmas
Authors: Stroth U. , Bernert M. , Brida D. , Cavedon M. , Dux R. , Huett E. , Lunt T. , Pan O. , Wischmeier M. , ASDEX Upgrade Team the
Published: March 2022

Based on particle and energy balances, a reduced model is derived for the physical mechanisms leading to the occurrence of stable and unstable X-point radiators (XPRs), the latter also known as marfes. The leading roles of the neutral deuterium density in the divertor region for initiating XPRs is highlighted. An access condition is formulated whose parameter dependencies are consistent with experimental observations and which could also apply to the process of divertor detachment. With an exponential increase of the recombination rate at low temperature, the XPR becomes magnetohydrodynamically unstable, leading to a marfe and, possibly, to a disruption. A critical density for marfe occurrence is formulated with the upstream density and safety factor as leading parameters, as in the experiment. Marfes are predicted to be more likely in carbon devices than in impurity-seeded plasmas in tungsten devices. The edge plasma parameter domain where marfes occur resembles that used for active marfe avoidance schemes. Both the XPR and marfe occurrence parameter can be used to guide active discharge control.
Thin film sensing in a planar terahertz meta-waveguide
Authors: Islam Maidul , Kumar Bhowmik Bhairov , Dhriti K M , Minakshi  , Mohan Devendra , Ahmad Amir , Kumar Gagan
Published: March 2022

In this paper, we explore the sensing characteristics of a terahertz meta-waveguide consisting of a one-dimensional array of periodically arranged sub-wavelength scale split-ring resonators (SRRs). The substrate of the meta-waveguide structure has two layers. The lower one is made of metal, whereas the upper layer is made of a dielectric. On top of it, metallic SRRs are placed. The meta-waveguide is capable of guiding the fundamental as well as the higher-order terahertz modes along the designed structures. We analyze the sensing capability of the meta-waveguide by covering it with a thin film analyte. The waveguide transmission properties are observed for varying refractive indices of the analyte. Different sensing parameters such as frequency shift, sensitivity, and figure of merit (FoM) of resonance modes supported by the meta-waveguide have been studied. The obtained values of sensitivity and FoM indicate a better sensing capability of the meta-waveguide rather than metamaterial-based structures in the transmission approach. We also employ a coupled harmonic oscillator model in order to interpret and validate the numerical observations. The meta-waveguide design can open alternate avenues for sensing thin film analytes with greater sensitivity.
Improving surface characteristics and corrosion resistance of medical grade 316L by titanium powder mixed electro-discharge treatment
Authors: Singh Gurpreet , Singh Malkeet , Singh Sidhu Sarabjeet , Ablyaz Timur Rizovich
Published: March 2022

The article focuses on the corrosion behavior of medical grade 316L stainless steel used in cardiac stents, orthopaedic, and dental implants. In this research work, electro-discharge treatment (EDT) was used for the deposition of titanium dioxide (TiO2) particles on 316L stainless steel to improve its corrosion-resistant property. The samples were characterized using scanning electron microscopy and x-ray diffraction techniques to correlate the modified surface with the EDT process parameters. The electrochemical corrosion analysis shows a lower corrosion rate for the TiO2 coated specimen (1.883 mpy) compared to the untreated surface (13.729 mpy). This improved corrosion resistance of TiO2 coated substrate was attributed to the formation of various silicides, carbides, and bioactive compounds.
Research on prediction of WMA mixing temperature or additive dosage using digital image recognition of coating rate
Authors: Wang Liming , Kang Jinling , Fan Yibing , Ma Kun , Gong Chun
Published: March 2022

It is difficult to determine a reasonable mixing temperature for WMA based solely on the viscosity-temperature relationship of the binder, as is the case for HMA, and it is a more reasonable solution to determine the mixing temperature of WMA by the state of the mix. This paper proposes to use the coating rate as an index for determining the mixing temperature of WMA, to analyze the reliability and sensitivity of this index using a digital image recognition method, and to analyze the influence law of this method based on the coating rate recognition test. The study shows that: The precision of the digital image coating rate recognition test can meet the requirements of calculating the mixing temperature; in a certain range, the coating rate of WMA is positively correlated with the mixing temperature or additive dosage; the sensitive variation of the coating rate with mixing temperature and additive dosage can be used to predict the engineering mixing temperature or additive dosage for WMA; the slope of the coating rate contour also has some common trends and can be used to illustrate the effect of warm mix additives (or warm mix technology) on the effectiveness or efficiency of warm mix.
Soft memtransistor with ion transfer interface
Authors: Zhang Zhong-Da , Zhong Ya-Nan , Xu Jian-Long , Gao Xu , Wang Sui-Dong
Published: March 2022

A paradigm for soft memtransistor is demonstrated based on the ion transfer interface, consisting of an ion-rich semiconducting polymer layer on the top and a gelatin dielectric for receiving ions on the bottom. The flexible polymer memtransistor acted as an analog-type memristor without gating, and its memristive strength could be largely modulated by applying gate voltage. It is proposed that the ion redistribution across the ion transfer interface can modify the hole doping level in the polymer layer, which is responsible for the tunable memristive characteristics. Different levels of synaptic potentiation and depression were successfully emulated using the polymer memtransistor, and it is promising to extend the emulation to multi-terminal heterosynaptic plasticity.
Quantitative maximal volume entropy rigidity on Alexandrov spaces
Authors: Chen Lina
Published: March 2022

We will show that the quantitative maximal volume entropy rigidity holds on Alexandrov spaces. More precisely, given

N
,
D

N, D

, there exists

ϵ
(
N
,
D
)
>
0

\epsilon (N, D)>0

, such that for

ϵ
>
ϵ
(
N
,
D
)

\epsilon >\epsilon (N, D)

, if

X
X

is an

N
N

-dimensional Alexandrov space with curvature

≥
−
1

\geq -1

,

diam
⁡
(
X
)
≤
D
,
h
(
X
)
≥
N
−
1
−
ϵ

\operatorname {diam}(X)\leq D, h(X)\geq N-1-\epsilon

, then

X
X

is Gromov-Hausdorff close to a hyperbolic manifold. This result extends the quantitive maximal volume entropy rigidity provided by Chen, Rong, and Xu [J. Differential Geom. 113 (2019), pp. 227–272] to Alexandrov spaces. And we will also give a quantitative maximal volume entropy rigidity for

RCD
∗

\operatorname {RCD}^*

-spaces in the non-collapsing case.
TAK1 is essential for endothelial barrier maintenance and repair after lung vascular injury
Authors: Wang Dong-Mei , Soni Dheeraj , Regmi Sushil C. , Vogel Stephen M. , Tiruppathi Chinnaswamy
Published: March 2022

TGF-β-activated kinase 1 (TAK1) inhibition or ablation of TAK1 expression in adult mice endothelial cells caused endothelial barrier breakdown due to loss of β-catenin expression. Mechanistically, TAK1 inactivates GSK3β through AKT activation which in turn stabilizes the endothelial barrier.
Preprint Highlight: ER-lysosome lipid transfer protein VPS13C/PARK23 prevents aberrant mtDNA- dependent STING signaling
Authors: Bonet-Ponce Luis
Published: March 2022

Loss-of-function mutations in VPS13C cause familial Parkinson’s disease (PD) and increase the risk to develop the sporadic form of the disease. However, the underlying disease mechanisms remain unclear. It has been previously established that VPS13C tethers lysosomes with the endoplasmic reticulum (ER) and promotes lipid interchange between both organelles. This study provides a cellular role of VPS13C, specifically regulating the cGAS/STING pathway and contributing to the innate immune response. The authors generate VPS13C knockout HeLa cells and use confocal microscopy and biochemical approaches to show loss of VPS13C leads to altered lysosome lipid composition and mitochondrial DNA leakage. Understanding how VPS13C preserves cellular homeostasis is an exciting discovery for scientists working on neurodegeneration and for cell biologists interested in lysosome-to-mitochondria cross-talk.
Preprint Highlight: Pathogenic Neutrophilia Drives Acute Respiratory Distress Syndrome in Severe COVID-19 Patients
Authors: Coleman Fadie
Published: March 2022

SARS-CoV-2 disproportionately affects African Americans in the U.S., but research that evaluates causes of disease severity among this population are lacking. Diverse clinical outcomes present challenges in identifying processes that dictate severe disease. Although the presence of higher-than-normal blood neutrophil levels has been found to be associated with problems in severe cases, specific studies of neutrophil activity in the lungs are inconclusive. Single cell sequencing of samples in African-American patients identified exacerbated neutrophilia in the lungs as a key immunological feature of disease severity. This paper has great potential to inspire future therapeutic approaches for severe COVID-19 cases and can help to explain why current mainstream treatments are not highly successful in preventing death in the critically ill.
Saying goodbye? Downsizing—are human resources assets or liabilities?
Authors: Wilkinson Adrian
Published: March 2022

‘Saying goodbye? Downsizing—are human resources assets or liabilities?’ addresses the topic of downsizing, which is a fact of business life and of Human Resource Management (HRM). There are three main approaches to downsizing: workforce reduction, work redesign, and systemic. Many organizations—whether in the public or private sectors across the European, Australasian, and US economies—have a preoccupation with cost-cutting, so seek to reduce staff numbers on a yearly basis. However, there is a concern that the cost-cutting regime associated with many organizational change strategies has fractured the traditional employment relationships. Ultimately, the impact of downsizing on the organization and staff is very much affected by the way it is implemented.
2. The employment relationship and the employment contract
Authors: Cabrelli David
Published: March 2022

‘The employment relationship and the employment contract’ examines the employment relationship and the employment contract, which is central to labour law. The three key features in classifying any contract as one of employment include control, subordination, and dependence. Employment law is attached in all legal systems to the ‘binary’ divide. A central question is whether and how the rules of employment law and, in particular, the criteria for the establishment of an employment contract ought to react to changing patterns of work, known as ‘atypical work contracts’. There is also the ‘unitary’
concept of the ‘employee’ and ‘employer’ to be considered, and the ‘content’ and ‘performance’ of the employment relationship.
3. Statutory employment rights
Authors: Cabrelli David
Published: March 2022

‘Statutory employment rights’ evaluates statutory employment rights. In many countries, it is statutory measures passed by politicians in Congress or parliaments, rather than the common law or a section of the Civil Code or Labour Code, that are the primary source of employment protection. The principal employment rights set out in legislation include minimum wage regulations, wage security protections, paid sick leave entitlements, family-friendly and work‒life balance rights, and laws regulating the working hours and conditions of employees. There is a distinction between legislative measures that seeks to achieve the policy of distributive justice and employment laws that aims to secure corrective justice. We mustn't forget the economics of statutory employment rights.
5. Dismissals/discharges
Authors: Cabrelli David
Published: March 2022

‘Dismissals/discharges’ assesses the ‘just cause’ and ‘employment-at-will’ approaches to the regulation of workplace dismissals and considers the economics of unfair dismissal laws before identifying who should be covered by them. Systems that apply a ‘just cause’ requirement will set out a series of reasons for the discharge of an employee that are deemed legally acceptable. The nature and number of those reasons is a matter of choice for that jurisdiction. Some countries that adopt a ‘just cause’
regime also impose additional legal requirements, including the testing of the substantive and procedural fairness of the employer’s decision to dismiss.
There are a number of legal remedies for unfair dismissal.
3. Interpersonal violence
Authors: Dwyer Philip
Published: March 2022

‘Interpersonal violence’ discusses the act of male-on-male violence throughout history, which was more about proving oneself in front of one’s peers and belonging to a group. Why do men fight and kill and why are the different kinds of violence used? Violence is bound up with ‘honour societies’. There has been a steady decline and transformation of interpersonal violence over the centuries, particularly in the western world. There are some interesting arguments being used to explain the decline of homicide rates in Europe, but not in the United States. Why are some societies more violent than others?
5. Love known
Authors: Post Jonathan F. S.
Published: March 2022

‘Love known’ explores the question of love in Bishop’s poetry. As a point of departure, we can look at the title of Thomas Travisano’s recent biography, Love Unknown. Can love really be unknown to Bishop? Bishop experienced a gradual emergence as a love poet over the course of her career, from a deep reluctance to delve into the private topic of love to a more explicit recognition of its place in her life and poetry, culminating ultimately in her villanelle ‘One Art’. We can see elements of lesbian flirtation encoded in modes of dress and address, paying special attention to the function of pronouns, and to the unfolding world of private eros that she shared with her Brazilian partner, Lota de Machedo Soares.
Epilogue
Authors: Post Jonathan F. S.
Published: March 2022

‘Epilogue’ describes the place of Bishop’s poetry in the classroom setting that underlies the writing of this book. Reading poetry often presents challenges and but Bishop’s poetry rises to meet those challenges. As can be seen in ‘The Fish’, her poems are always about surfaces getting deeper, about knowledge as process, a richly varied pattern of thinking the reader can follow by attending carefully to a poem’s diction, syntax, grammar, and punctuation. Bishop’s work helps readers discover how to speak and write about what the eye sees and the ear hears when reading a poem. Bishop brings out the inner poet in us all, making her readers feel that they are part of the poem’s creative energy.
1. Legacies
Authors: Gordon Charlotte
Published: March 2022

‘Legacies’ talks about Mary Shelley, who ran away with the poet Percy Shelley and became the author of Frankenstein. Although Mary published eight more books after Frankenstein and more than 50 short stories and essays, most people only know her for her first book. We can see that her writing represents a commitment to social reform and women’s independence. She advocated for the rights of women, like her famous mother, Mary Wollstonecraft. Mary Shelley broke conventions and stretched literary genres to express her radical ideas. She lived as an independent woman during a time when middle-class women were supposed to be wives and mothers, not famous authors.
Sensitivity analysis and methodological choices on health-related impoverishment estimates in Cambodia, 2009–17
Authors: Fernandes Antunes Adélio , Jacobs Bart , Jithitikulchai Theepakorn , Nagpal Somil , Tong Kimsun , Flessa Steffen
Published: March 2022

The measurement of health expenditure–related impoverishment as a proxy of financial risk protection is regularly used as an indicator of progress towards universal health coverage. However, the use of this indicator is greatly sensitive to analysts’ choices and data sources, making comparisons across time and countries challenging. We report the results of a sensitivity analysis of critical methodological choices in estimating health-related financial impoverishment in Cambodia from 2009 to 2017. We include the following in our analysis: the construction and data sources for consumption aggregates and out-of-pocket health estimates; the use of international and national absolute and relative poverty thresholds (defined by the share of household food consumption); time and regional price adjustment methods and index sources. Marginal changes substantially affected estimates at the national and regional levels among households. In most cases, the choice of poverty thresholds and temporal and regional deflators had a significant effect. An increase of 0.01 USD in the average daily per capita poverty line resulted in relative increases in impoverished incidences of 2.90–2.62% for 2009 and 3.06–2.95% for 2014. From 2013 onwards, estimates for impoverishment in rural areas based on median food consumption were often significantly higher than estimates using official poverty lines. The high sensitivity of the impoverishment indicator cautions against its use in assessing health-related financial hardship and protection, especially with low and absolute poverty lines. In the context of low- and middle-income countries, assessing financial hardship in relative terms by using measures such as catastrophic health expenditure, complemented with research on coping strategies and their socio-economic effects on households, may be more conducive to policymaking goals and progress towards achieving universal health coverage.
Psychological Factors Associated With Adherence to Oral Treatment in Ulcerative Colitis
Authors: Dasharathy Sonya S , Long Millie D , Lackner Jeffrey M , Ben-Ami Shor Dana , Yang Liu , Bar Nir , Ha Christina , Weiss Guy A
Published: March 2022

Introduction

Medication nonadherence in patients with ulcerative colitis (UC) can result in frequent relapses, severe disease, and higher risk of colorectal cancer. Behavioral models relying on motivation and perceived competence, like the self-determination theory (SDT), have been implicated in nonadherence; however, the SDT has not been evaluated in the adult UC population. We sought to examine the association between adherence to oral medications in patients with UC and psychological distress, relationship with health care providers, motivation, and competence.

Methods

We performed a cross-sectional study within the Inflammatory Bowel Disease (IBD) Partners online registry in which participants completed a baseline survey including demographic information, IBD history, symptoms, medication adherence, and psychosocial factors. Members of the registry with a diagnosis of UC received an online follow-up survey that included baseline questionnaires and assessment of competence, motivation, and patient-physician relationship. Logistic regression models were performed to determine the relationship between psychosocial factors, adherence modifiers, and medication adherence.

Results

Of the 410 UC patients included, 29% had low adherence to their medications, 36% had medium adherence, and 34% had high adherence. In the multivariable analysis, younger patients, those with a lower perceived competence, and those with worse relationship with their providers were more likely to have lower adherence to their medications.

Conclusions

Poor adherence to oral medications in UC was associated with lower perceived competence and worse relationship with providers. Further interventions based on the SDT can potentially improve adherence and optimize patient care.
2 Examination of Burn Resuscitation Complications from the Burn Navigator Observational Trial
Authors: Rizzo Julie A , Coates Elsa , Salinas Jose , Serio-Melvin Maria , Pham Tam N , Abdelfattah Kareem R , Foster Kevin N , Liu Nehemiah T
Published: March 2022

Introduction

Burn care continues to focus on providing enough fluid resuscitation to perfuse end organs with the least amount of fluid necessary in order to prevent complications related to excess fluid. In this observational trial of 5 ABA-verified burn centers that utilized the Burn Navigator (BN), a clinical decision support tool, we sought to examine resuscitation-related complications that occurred in the first 48 hours after burn injury. Since minimal literature exists regarding the incidence of resuscitation-related complications in the acute phase after burn injury, we aimed to present our data for future comparison.

Methods

An observational study of adult patients undergoing burn resuscitation utilizing the BN was conducted. Data were gathered hourly for the first 48 hours for patients on fluid infusion rates, laboratory data, critical care elements to include ventilator settings and clinically relevant outcomes. Morbidities were classified based on each burn center’s definition as related to over or under-resuscitation and variables associated with these outcomes were extracted from the data set.

Results

Three hundred patients were enrolled into the study, and 156 resuscitation-related complications were documented in 92 patients in the first 48 hours after admission. Compartment syndromes (abdominal, extremity, ocular) accounted for 62 (40%) of the complications. ARDS occurred in 9 patients. ARDS patients were the most severely injured, reflected by highest Baux score. None of the ARDS patients had an inhalation injury. The under-resuscitation morbidities of shock and acute kidney injury accounted for 81 (52%) of the complications. Patients experiencing shock received greater than the Parkland formula in the first 24 hours after injury. Most patients with AKI continued to make adequate urine during their resuscitation period, with 59% making an average of >30 ml/hr over the first 24 hours. Nearly half of patients with AKI were placed on renal replacement therapy in the first 48 hours. Seventeen patients (18.5%) experienced both a compartment syndrome and either AKI or shock.

Conclusions

This large observational study demonstrates variables associated with different complications across 5 major burn centers and shows that complications associated with over- and under-resuscitation can occur within the same patient during resuscitation after burn injury. Additional comparative studies are needed to better understand the cause of these complications, to determine the incidence of these complications in a larger population and criteria used to define each complication.
6 Risk Factors and Comorbidities Associated with Post-burn Hypertension
Authors: Efejuku Tsola A , Joglar Alejandro A , Chokshi Shivan N , Corona Kassandra K , Wermine Kendall , Gotewal Sunny , De La Tejera Giovanna , Golovko George , Haseem Maria , Keys Phillip H , Song Juquan , Wolf Steven E , El Ayadi Amina
Published: March 2022

Introduction

Hypertension (HTN) is a prevalent condition in the United States and leads to an increased risk of developing other comorbidities. However, the impact of hypertension following severe burns on patient outcomes is not known. We hypothesize that post-burn hypertension is associated with an increased risk of other comorbidities and mortality.

Methods

This study used data from TriNetX, a global federated health research network. Burned patients who were diagnosed with essential hypertension at least 1 day after injury were identified in the TriNetX database using specific ICD codes and were compared to those who did not develop essential hypertension; neither cohort was diagnosed with hypertension prior to injury. Each cohort was balanced for age, gender, race, and ethnicity. Occurrence of the following within 3 days of burn was compared between the two cohorts: acute kidney injury (AKI), hyperglycemia, heart failure, coronary artery disease, and death. These patient cohorts were then stratified by gender, percent total body surface area (TBSA) burned, and age. Statistical analysis for the measures of association used an odds ratio with a 95% confidence interval and a risk ratio with a z-test. Significance for the z-test was set at a p-value of < 0.05.

Results

The search identified 460,977 burn patients of whom 87,808 were diagnosed with hypertension at least 1 day after burn injury. Those diagnosed with hypertension were 7.25 times as likely to develop AKI, 5.45 times as likely to develop hyperglycemia, 7 times as likely to develop heart failure, 7.17 times as likely to develop coronary artery disease, and 1.78 times as likely to die. Men were at greater risk of experiencing AKI, heart failure, coronary artery disease, and death, however, women were 1.51 times as likely to develop hyperglycemia. Stratification based on % TBSA burned indicated an increased risk for all outcomes for patients with a high percentage of total body surface area burned (60% to > 90% TBSA burned was higher than < 10% to 50-59% groups). Subgroup analysis based on age indicated elevated risk of developing AKI, heart failure, coronary artery disease, or death with age. However, we found a spike in risk for all outcomes in the 0-9 age group. All data was significant at p < .0001.

Conclusions

A new hypertension diagnosis in severely burned patients is highly associated with other comorbidities including acute kidney injury, heart failure, coronary artery disease, and death. Overall, males, older patients, and those with a higher percent TBSA burned are at a higher risk of developing these comorbidities.
40 Evaluation of a Multidisciplinary Approach to Pressure Injury Prevention Among Patients in a Burn Center
Authors: Richerbach Stacey , Hockenberry Tiffany , Richey Karen , Foster Kevin N
Published: March 2022

Introduction

Compromised skin integrity in tandem with the prolonged length of stay necessitated by patients in a burn center has the capacity to result in an increased incidence of hospital acquired pressure ulcers (HAPUs). A HAPU increases the cost of a hospital stay by approximately $43,000. Many interventions exist to reduce their occurrence; however, interventions have been largely compartmentalized by discipline. One burn center’s dramatic increase in HAPUs from 2018 to 2019 led to further evaluation of prevention efforts. Upon detecting a 117% increase of HAPUs and a threefold increase in cost for specialty bed rental, a multidisciplinary approach to pressure injury prevention was employed. The frequency of multidisciplinary patient rounds was increased from once to twice daily, and involved discussions regarding functional status, mobility, and nutrition. The practice of ordering specialty beds was modified to require three-part approval by the Medical Director of Burn Services, Nursing Director, and a burn therapy supervisor. The purpose of this QI project was to examine the implementation of the multidisciplinary approach to pressure injury prevention among patients in a burn center and to identify trends in HAPUs and specialty bed expenses.

Methods

This was a retrospective review of patients admitted to a Burn Center between January 1, 2018 and June 30, 2021. Preexisting pressure ulcers were identified upon admission and were not regarded as HAPUs. Patients were grouped by year of their admission date.

Results

A total of 941 patients were admitted for inpatient care in 2020, six HAPUs (1.35%) were identified for this population. As compared to the prior year, this revealed a 53% decrease in incidence of HAPUs. The specialty bed rental cost from 2019 to 2020 was reduced by $110,181.76 (68%).

*Data provided for 2021 is from 01/01/2021 to 06/30/2021

Conclusions

Following implementation of a multidisciplinary approach to pressure injury prevention, we were able to reduce the incidence of HAPUs and dramatically reduce the expense associated with specialty bed rental. This supports an effort to identify additional practices which may increase quality while decreasing cost.
65 Therapist Confidence Utilizing Virtual Range of Motion Methods
Authors: Yelvington Miranda L , Parry Ingrid , James Michelle , Bettencourt Kory , Taylor Sandra , Greenhalgh David
Published: March 2022

Introduction

Since the SARS-CoV-2 virus (COVID-19) was officially declared a pandemic, there has been a marked increase in virtual clinical care. Between 2019 and 2020, telehealth (TH) visits, including tele-rehabilitation (TR), increased from 11% to 46%. While many therapy interventions can be performed with verbal guidance or demonstration, objective tool-based outcomes such as goniometrics , a valuable tool to determine burn survivor progress, have proved more challenging. The purpose of this study was to evaluate the level of confidence of therapists using three different remote methods of measuring finger range of motion (ROM).

Methods

Therapists evaluated finger ROM position of a mannequin model via a simulated TH visit using three different methods: Goniometry (GON), Visual Estimation (VE), and Electronic Protractor (EP). Pre and post-questionnaires were used to assess the participant’s experiences and comfort with each method of measurement. Descriptive statistics are used to report clinician opinions. A linear mixed effect model was used to determine the interaction of bias as a function of clinician characteristics (i.e., experience, familiarity, etc.).

Results

A total of 30 therapists and one hand surgeon participated. All reported some (30%) or a lot (70%) of familiarity with standard GON, and most reported some (30%)or a lot (40%) of familiarity with finger-specific goniometry. Post-testing, clinicians reported VE (80%) as the most difficult method and EP (73%) as the easiest. Only 7% reported feeling more confident with TR compared to in-person measurements, 27% felt equally confident, and 67% felt less confident. The average time to conduct the remote assessment measurement was 11:45 minutes using GON, 4:27 minutes using VE and 9:47 minutes using EP. There was not a significant relationship between performance bias and years of experience (p=0.587), familiarity with GON (p=0.406), familiarity with finger GON (p=0.709) or profession (p=0.281).

Conclusions

Despite the transition to virtual care, the mandate for valid and accurate documentation of functional outcome measures, including ROM, remains. Our study showed that the tools used for TR may not be the same as for in-person and clinicians need to adapt their approaches and skillsets. In addition, training with these new tools is essential for clinician confidence. In addition, there was not a relationship between experience and performance, suggesting that TR joint measurement is accessible to clinicians of all experience levels with proper training.
70 Effect of of Virtual Reality on Pain Reduction in Robot Training in Burn Patients
Authors: Joo So Young , Seo Cheong Hoon
Published: March 2022

Introduction

Burn injuries and their treatment are extremely painful. This study aimed to determine whether virtual reality (VR) can reduce pain during robot-assisted gait training (RAGT) in burn patients, by analyzing the cerebral blood flow (CBF) in the prefrontal cortex over time, using functional near-infrared spectroscopy (fNIRS).

Methods

The patients included in this study complained of a pain score≥5 on a visual analog scale (VAS) during RAGT, which was performed 10 times for 2 weeks. Each session consisted of 15 min of VR application, a 2 min break, and 15 min without VR. The average values of oxy-hemoglobin and deoxy-hemoglobin in the prefrontal cortex using fNIRS were calculated at four stages: temporal delay time with only RAGT, RAGT without VR, temporal delay time with RAGT and VR, and RAGT with VR. The pain scores and CBF were evaluated in sessions 1, 5, and 10 of the RAGT.

Results

The mean VAS pain scores were significantly lower (P< 0.05) in the experimental condition than in the control condition. Oxy-hemoglobin in the prefrontal lobe increased significantly when RAGT was performed with VR.

Conclusions

Therefore, VR may be a strong non-pharmacological pain reduction technique for burn patients during physical therapy.
81 Post-operative Self-adherent Compression Wrapping of the Hand and Its Impact on Skin-graft Viability
Authors: Vocke Scott F , Puthumana Joseph S , Dean Brooke , Andre Gregory , Rodriguez Joshua , Mercadante Misao , Hultman Charles S , Lifchez Scott , Kawaji Qingwen , Rostami Sohayla , Martinez Stephanie L , Caffrey Julie
Published: March 2022

Introduction

Potential complications of autografting for burn wound coverage of the hand include edema, hematoma formation, and bleeding; all of which can lead to graft failure. Self-adherent elastic wraps are commonly used by burn rehabilitation clinicians to minimize complications by providing graft protection and decreasing edema post-operatively; however, there is a lack of evidence on its impact on graft healing. The purpose of this study was to determine if the application of self-adherent elastic wraps to the hand in the operating room after autografting improves the percentage of graft viability.

Methods

A retrospective chart review was performed for 37 patients with burned hands who underwent autografting from January 2017 to July 2021. Grafted hands were categorized into 2 groups: post-operative dressings with and without self-adherent elastic wraps. Post-operative day 4 pictures for both groups were collected from the medical record and a blinded digital photograph analysis of graft viability was performed by 5 expert raters including 3 Burn Surgery Fellows,1 Burn Attending Surgeon and 1 Hand Attending Surgeon. A rating system was developed based on percentage of graft take as seen in Table 1 and presence of hematomas were assessed.

Results

Patients who received self-adherent elastic wraps suffered burns with significantly larger TBSA (p=0.007) and were admitted for a longer duration (p=0.009) than patients who did not. Patients with elastic wrap had a higher percentage of grafts with >95% take (64.0% vs 41.7%, p=0.227) and a lower rate of hematoma formation (24.0% vs. 41.7%, p=0.443). Intra-class correlation coefficient across raters was 0.90 for graft take and 0.87 for determining presence of hematomas, indicating excellent interrater reliability.

Conclusions

Despite suffering larger burns requiring longer hospitalizations, patients who received elastic wrap had a higher rate of >95% graft take than those without. This study is limited by a relatively small sample size, however these findings warrant continued research in the use of self-adherent elastic wrap to maximize graft take in hand burns.