bluuebunny/crossref_metadata_2025 huggingface dataset:
Sympatric speciation of wild emmer wheat driven by ecology and chromosomal rearrangements
Authors: Wang Hongwei , Yin Huayan , Jiao Chengzhi , Fang Xiaojian , Wang Guiping , Li Guangrong , Ni Fei , Li Penghuan , Su Peisen , Ge Wenyang , Lyu Zhongfan , Xu Shoushen , Yang Yanhong , Hao Yongchao , Cheng Xinxin , Zhao Jinxiao , Liu Cheng , Xu Fengfeng , Ma Xin , Sun Silong , Zhao Yan , Bao Yinguang , Liu Cheng , Zhang Jingjing , Pavlicek Tomas , Li Anfei , Yang Zujun , Nevo Eviatar , Kong Lingrang
Published: March 2020

In plants, the mechanism for ecological sympatric speciation (SS) is little known. Here, after ruling out the possibility of secondary contact, we show that wild emmer wheat, at the microclimatically divergent microsite of “Evolution Canyon” (EC), Mt. Carmel, Israel, underwent triple SS. Initially, it split following a bottleneck of an ancestral population, and further diversified to three isolated populations driven by disruptive ecological selection. Remarkably, two postzygotically isolated populations (SFS1 and SFS2) sympatrically branched within an area less than 30 m at the tropical hot and dry savannoid south-facing slope (SFS). A series of homozygous chromosomal rearrangements in the SFS1 population caused hybrid sterility with the SFS2 population. We demonstrate that these two populations developed divergent adaptive mechanisms against severe abiotic stresses on the tropical SFS. The SFS2 population evolved very early flowering, while the SFS1 population alternatively evolved a direct tolerance to irradiance by improved ROS scavenging activity that potentially accounts for its evolutionary fate with unstable chromosome status. Moreover, a third prezygotically isolated sympatric population adapted on the abutting temperate, humid, cool, and forested north-facing slope (NFS), separated by 250 m from the SFS wild emmer wheat populations. The NFS population evolved multiple resistant loci to fungal diseases, including powdery mildew and stripe rust. Our study illustrates how plants sympatrically adapt and speciate under disruptive ecological selection of abiotic and biotic stresses.
Structural elucidation of the
Clostridioides difficile
transferase toxin reveals a single-site binding mode for the enzyme
Authors: Sheedlo Michael J. , Anderson David M. , Thomas Audrey K. , Lacy D. Borden
Published: March 2020

Clostridioides difficile
is a Gram-positive, pathogenic bacterium and a prominent cause of hospital-acquired diarrhea in the United States. The symptoms of
C. difficile
infection are caused by the activity of three large toxins known as toxin A (TcdA), toxin B (TcdB), and the
C. difficile
transferase toxin (CDT). Reported here is a 3.8-Å cryo–electron microscopy (cryo-EM) structure of CDT, a bipartite toxin comprised of the proteins CDTa and CDTb. We observe a single molecule of CDTa bound to a CDTb heptamer. The formation of the CDT complex relies on the interaction of an N-terminal adaptor and pseudoenzyme domain of CDTa with six subunits of the CDTb heptamer. CDTb is observed in a preinsertion state, a conformation observed in the transition of prepore to β-barrel pore, although we also observe a single bound CDTa in the prepore and β-barrel conformations of CDTb. The binding interaction appears to prime CDTa for translocation as the adaptor subdomain enters the lumen of the preinsertion state channel. These structural observations advance the understanding of how a single protein, CDTb, can mediate the delivery of a large enzyme, CDTa, into the cytosol of mammalian cells.
Regulation of B cell receptor-dependent NF-κB signaling by the tumor suppressor KLHL14
Authors: Choi Jaewoo , Phelan James D. , Wright George W. , Häupl Björn , Huang Da Wei , Shaffer Arthur L. , Young Ryan M. , Wang Zhuo , Zhao Hong , Yu Xin , Oellerich Thomas , Staudt Louis M.
Published: March 2020

TheKLHL14gene acquires frequent inactivating mutations in mature B cell malignancies, especially in the MYD88L265P, CD79B mutant (MCD) genetic subtype of diffuse large B cell lymphoma (DLBCL), which relies on B cell receptor (BCR) signaling for survival. However, the pathogenic role of KLHL14 in DLBCL and its molecular function are largely unknown. Here, we report that KLHL14 is in close proximity to the BCR in the endoplasmic reticulum of MCD cell line models and promotes the turnover of immature glycoforms of BCR subunits, reducing total cellular BCR levels. Loss of KLHL14 confers relative resistance to the Bruton tyrosine kinase (BTK) inhibitor ibrutinib and promotes assembly of the MYD88-TLR9-BCR (My-T-BCR) supercomplex, which initiates prosurvival NF-κB activation. Consequently, KLHL14 inactivation allows MCD cells to maintain NF-κB signaling in the presence of ibrutinib. These findings reinforce the central role of My-T-BCR–dependent NF-κB signaling in MCD DLBCL and suggest that the genetic status of KLHL14 should be considered in clinical trials testing inhibitors of BTK and BCR signaling mediators in DLBCL.
An allosteric switch regulates
Mycobacterium tuberculosis
ClpP1P2 protease function as established by cryo-EM and methyl-TROSY NMR
Authors: Vahidi Siavash , Ripstein Zev A. , Juravsky Jordan B. , Rennella Enrico , Goldberg Alfred L. , Mittermaier Anthony K. , Rubinstein John L. , Kay Lewis E.
Published: March 2020

The 300-kDa ClpP1P2 protease from
Mycobacterium tuberculosis
collaborates with the AAA+ (ATPases associated with a variety of cellular activities) unfoldases, ClpC1 and ClpX, to degrade substrate proteins. Unlike in other bacteria, all of the components of the Clp system are essential for growth and virulence of mycobacteria, and their inhibitors show promise as antibiotics. MtClpP1P2 is unique in that it contains a pair of distinct ClpP1 and ClpP2 rings and also requires the presence of activator peptides, such as benzoyl-leucyl-leucine (Bz-LL), for function. Understanding the structural basis for this requirement has been elusive but is critical for the rational design and improvement of antituberculosis (anti-TB) therapeutics that target the Clp system. Here, we present a combined biophysical and biochemical study to explore the structure–dynamics–function relationship in MtClpP1P2. Electron cryomicroscopy (cryo-EM) structures of apo and acyldepsipeptide-bound MtClpP1P2 explain their lack of activity by showing loss of a key β-sheet in a sequence known as the handle region that is critical for the proper formation of the catalytic triad. Methyl transverse relaxation-optimized spectroscopy (TROSY)-based NMR, cryo-EM, and biochemical assays show that, on binding Bz-LL or covalent inhibitors, MtClpP1P2 undergoes a conformational change from an inactive compact state to an active extended structure that can be explained by a modified Monod–Wyman–Changeux model. Our study establishes a critical role for the handle region as an on/off switch for function and shows extensive allosteric interactions involving both intra- and interring communication that regulate MtClpP1P2 activity and that can potentially be exploited by small molecules to target
M. tuberculosis
.
Big-Bang Nucleosynthesis after Planck
Authors: Fields Brian D. , Olive Keith A. , Yeh Tsung-Han , Young Charles
Published: March 2020

We assess the status of big-bang nucleosynthesis (BBN) in light of the finalPlanckdata release and other recent developments, and in anticipation of future measurements.Planckdata from the recombination era fix the cosmic baryon density to 0.9% precision, and now damping tail measurements determine the helium abundance and effective number of neutrinos with precision approaching that of astronomical and BBN determinations respectively. All three parameters are related by BBN . In addition, new high-redshift measurements give D/H to better precision than theoretical predictions, and new Li/H data reconfirm the lithium problem. We present new7Be(n,p)7Li rates using new neutron capture measurements; we have also examined the effect of proposed changes in thed(p,γ)3He rates. Using these results we perform a series of likelihood analyses. We assess BBN/CMB consistency, with attention to how our results depend on the choice ofPlanckdata, as well as how the results depend on the choice of non-BBN, non-Planckdata sets. Most importantly the lithium problem remains, and indeed is more acute given the very tight D/H observational constraints; new neutron capture data reveals systematics that somewhat increases uncertainty and thus slightly reduces but does not essentially change the problem. We confirm thatd(p,γ)3He theoretical rates brings D/H out of agreement and slightly increases7Li new experimental data are needed at BBN energies. Setting the lithium problem aside, we find the effective number of neutrino species at BBN isNν = 2.86 ± 0.15. Future CMB Stage\nobreakdash-4 measurements promise substantial improvements in BBN parameters: helium abundance determinations will be competitive with the best astronomical determinations, andNeffwill approach sensitivities capable of detecting the effects of Standard Model neutrino heating of the primordial plasma.
Stochastic entropy production in diffusive systems
Authors: Martin R J , Ford I J
Published: March 2020

Computing the stochastic entropy production associated with the evolution of a stochastic dynamical system is a well-established problem. In a small number of cases such as the Ornstein–Uhlenbeck process, of which we give a complete exposition, the distribution of entropy production can be obtained analytically. For a general potential it is much harder. A recent development in solving the Fokker–Planck equation, in which the solution is written as a product of positive functions, addresses any system governed by the condition of detailed balance, thereby permitting nonlinear potentials. Using examples in one and higher dimension, we demonstrate how such a framework is very convenient for the computation of stochastic entropy production in diffusion processes.
Investigation of spectroscopic and thermo-mechanical behaviors of different phenanthroimidazole-azo dyes in solvent and polymer medium
Authors: Erbaş Seçil Çelik , Uregil Umut , Gülle Sibel , Baştürk S Bahar
Published: March 2020

The aim of this study is the investigation of the interaction between dyes and polymers which have different polarities. Dye doped polymer films have larger application areas because of the fact that dye is more stable when doped in polymer compared to solvent medium. However, dye dispersion in the polymer medium affects both the spectroscopic and mechanical properties of the polymer. The polymer-dye interaction must be high for a good dispersion,. In this study, polypropylene with apolar character and polymethylmethacrylate with polar groups were chosen as a solid phase to examine polymer-dye interactions. The photophysical properties of phenanthroimidazole-azo compounds synthesized previously were examined with UV–visible and fluorescence spectroscopy techniques in tetrahydrofuran and two polymer media. Also, photostability tests of azo dyes in THF and polymer films were performed. Surface roughness characterizations of polymer films were carried out with AFM. Additionally, the viscoelastic behaviors of the polymethylmethacrylate and polypropylene films under sinusoidal vibrations at different temperatures were studied by dynamic mechanical analysis technique.
Medications requiring prior authorization across health insurance plans
Authors: Jones Laney K , Ladd Ilene G , Gionfriddo Michael R , Gregor Christina , Evans Michael A , Graham Jove
Published: March 2020

Objective

To determine the amount of variation in numbers and types of medications requiring prior authorization (PA) by insurance plan and type.

Methods

Most health insurance companies require PA for medications to ensure safe and effective use and contain costs. We generated 4 lists of medications that required PA during 2017 for commercial, marketplace, Medicaid, and Medicare plans. We aggregated medications according to the generic medication name equivalent using codes and medication names. We compared these medications to assess how many of the medications required PA by 1, 2, 3, or all 4 of the insurance plans. We counted all prescription orders written for a patient age 18 years or older with health plan insurance during 2017 for any of the medications that appeared on the health plan’s PA lists by querying the electronic health record.

Results

PA was required for 600 unique medications in 2017 across the 4 plans. Of 691,457 prescription orders written for 114,159 members, 31,631 (5%) were written for 1 of the 600 medications that required PA by at least 1 insurance plan. There were 12,540 medication orders (written for 6,642 members) that potentially required PA. The marketplace plan required PA for the greatest number of medications (440), followed by the Medicare (272), commercial (271), and Medicaid (72) plans. The most commonly prescribed classes of medications for which PA was required by at least 1 plan were antihyperlipidemics (22% of orders potentially requiring PA), narcotic analgesics (13%), hypnotics (12%), antidiabetic medications (9%), and antidepressants (9%). For only 25% of medications (151 of 600) was PA required by at least 3 plans, and for only 5% (32 of 600) was PA required by all 4 insurance types.

Conclusion

Medications requiring PA can differ within a single health insurance company, but this variation may be unavoidable due to external factors.
Transmission of Cryptosporidium Species Among Human and Animal Local Contact Networks in Sub-Saharan Africa: A Multicountry Study
Authors: Krumkamp Ralf , Aldrich Cassandra , Maiga-Ascofare Oumou , Mbwana Joyce , Rakotozandrindrainy Njari , Borrmann Steffen , Caccio Simone M , Rakotozandrindrainy Raphael , Adegnika Ayola Akim , Lusingu John P A , Amuasi John , May Jürgen , Eibach Daniel ,   CRYPTO Study Group, Stark Tony , Dekker Denise , Jaeger Anna , Hogan Benedikt , Lamshöft Maike , Thye Thorsten , Schuldt Kathrin , Winter Doris , Tannich Egbert , Rohmann Christina , Melhem Sophia , Boahen Kennedy Gyau , Akenten Charity Wiafe , Sarpong Nimako , Oppong Kwabena , Schares Gereon , Conraths Franz , Kremsner Peter G , Manouana Prince , Mbong Mirabeau , Byrne Natalie , Gesase Samwel , Minja Daniel T R , Sannella Anna Rosa
Published: March 2020

Background

Cryptosporidiosis has been identified as one of the major causes of diarrhea and diarrhea-associated deaths in young children in sub-Saharan Africa. This study traces back Cryptosporidium-positive children to their human and animal contacts to identify transmission networks.

Methods

Stool samples were collected from children < 5 years of age with diarrhea in Gabon, Ghana, Madagascar, and Tanzania. Cryptosporidium-positive and -negative initial cases (ICs) were followed to the community, where stool samples from households, neighbors, and animal contacts were obtained. Samples were screened for Cryptosporidium species by immunochromatographic tests and by sequencing the 18S ribosomal RNA gene and further subtyped at the 60 kDa glycoprotein gene (gp60). Transmission clusters were identified and risk ratios (RRs) calculated.

Results

Among 1363 pediatric ICs, 184 (13%) were diagnosed with Cryptosporidium species. One hundred eight contact networks were sampled from Cryptosporidium-positive and 68 from negative ICs. Identical gp60 subtypes were detected among 2 or more contacts in 39 (36%) of the networks from positive ICs and in 1 contact (1%) from negative ICs. In comparison to Cryptosporidium-negative ICs, positive ICs had an increased risk of having Cryptosporidium-positive household members (RR, 3.6 [95% confidence interval {CI}, 1.7–7.5]) or positive neighboring children (RR, 2.9 [95% CI, 1.6–5.1]), but no increased risk of having positive animals (RR, 1.2 [95% CI, .8–1.9]) in their contact network.

Conclusions

Cryptosporidiosis in rural sub-Saharan Africa is characterized by infection clusters among human contacts, to which zoonotic transmission appears to contribute only marginally.
Reappraising Risk Factors for Inflammatory Bowel Disease-associated Neoplasia: Implications for Colonoscopic Surveillance in IBD
Authors: Shah Shailja C , Itzkowitz Steven H
Published: March 2020

One of the most feared complications of inflammatory bowel disease [IBD]-associated colitis is colorectal cancer. When considering the substantial increase in the prevalence of IBD, without any anticipated decline, coupled with decreasing colectomy rates for dysplasia and expanding medical options for effectively controlling inflammation, it is predicted that the pool of people living with—and ageing with—colonic IBD, who are recommended to undergo lifelong colonoscopic surveillance for colorectal neoplasia, will strain existing resources and challenge the sustainability of current guideline-based surveillance recommendations. At the same time, we are missing the opportunity for early detection in a group that is overlooked as high-risk, as a substantial proportion of colorectal cancers are being diagnosed in individuals with colonic IBD who have disease duration shorter than when guidelines recommend surveillance initiation. Here, we reappraise: 1] inflammation as a dynamic risk factor that considers patients’ cumulative course; 2] time of screening initiation that is not based primarily on absolute disease duration; and 3] surveillance intervals as an iterative determination based on individual patient factors and consecutive colonoscopic findings. This Viewpoint supports a paradigm shift that will ideally result in a more effective and higher-value colorectal cancer prevention approach in IBD.
Whole genome sequencing provides genomic insights into three Morganella morganii strains isolated from bovine rectal swabs in Dhaka, Bangladesh
Authors: Rahman Aura , Bhuiyan Omar Faruk , Sadique Abdus , Afroze Tamanna , Sarker Mrinmoy , Momen Abdul Mueed Ibne , Alam Jahidul , Hossain Arman , Khan Imran , Rahman Kazi Fahmida , Kamruzzaman Mohammad , Shams Fariza , Ahsan Gias U , Hossain Maqsud
Published: March 2020

Morganella morganii, a gram negative, facultative anaerobic bacterium belonging to the Proteeae tribe of the Morganellaceae family, is an unusual opportunistic pathogen mainly responsible for nosocomial and urinary tract infections. While cattle have long been established as a source of a few zoonotic pathogens, no such data has been recorded for M. morganii despite its ubiquitous presence in nature and a number of animal hosts. In this study, draft genomes were produced of three M. morganii isolates from Bangladeshi cattle. The three isolates, named B2, B3 and B5, possessed an average genome size of 3.9 Mp, a GC% of ∼51% and pan and core genomes of 4637 and 3812 genes, respectively. All strains were bearers of the qnrD1 carrying plasmid Col3M and possessed roughly similar virulence profiles and prophage regions. The strains also carried genes that were unique when compared with other publicly available M. morganii genomes. Many of these genes belonged to metabolic pathways associated with adaptation to environmental stresses and were predicted in silico to be borne in genomic islands. The findings of this study expand on the current understanding of M. morganii’'s genomic nature and its adaptation in cattle.
Carbon metabolism snapshot by ddPCR during the early step of Candida albicans phagocytosis by macrophages
Authors: Laurian Romain , Jacot-des-Combes Cécile , Bastian Fabiola , Dementhon Karine , Cotton Pascale
Published: March 2020

During Candida macrophage interactions, phagocytosed yeast cells feed in order to grow, develop hyphae and escape. Through numerous proteomic and transcriptomic studies, two metabolic phases have been described. A shift to a starvation mode is generally identified as early as one-hour post phagocytosis, followed by a glycolytic growth mode after C. albicans escaped from the macrophage. Healthy macrophages contain low amounts of glucose. To determine if this carbon source was sensed and metabolized by the pathogen, we explored the transcription level of a delimited set of key genes expressed in C. albicans cells during phagocytosis by macrophages, at an early stage of the interaction. This analysis was performed using a technical digital droplet PCR approach to quantify reliably the expression of carbon metabolic genes after 30 min of phagocytosis. Our data confirm the technique of digital droplet PCR for the detection of C. albicans transcripts using cells recovered after a short period of phagocytosis. At this stage, carbon metabolism is clearly oriented towards the use of alternative sources. However, the activation of high-affinity glucose transport system suggests that the low amount of glucose initially present in the macrophages is detected by the pathogen.
Low Neuroactive Steroids Identifies a Biological Subtype of Depression in Adults with Human Immunodeficiency Virus on Suppressive Antiretroviral Therapy
Authors: Mukerji Shibani S , Misra Vikas , Lorenz David R , Chettimada Sukrutha , Keller Kiana , Letendre Scott , Ellis Ronald J , Morgello Susan , Parker Robert A , Gabuzda Dana
Published: March 2020

Background

The prevalence and mortality risk of depression in people with human immunodeficiency virus (HIV) infection receiving antiretroviral therapy (ART) is higher than in the general population, yet biomarkers for therapeutic targeting are unknown. In the current study, we aimed to identify plasma metabolites associated with depressive symptoms in people with HIV receiving ART.

Methods

This is a prospective study of ART-treated HIV-infected adults with or without depressive symptoms assessed using longitudinal Beck Depression Inventory scores. Plasma metabolite profiling was performed in 2 independent cohorts (total n = 99) using liquid and gas chromatography and tandem mass spectrometry.

Results

Participants with depressive symptoms had lower neuroactive steroids (dehydroepiandrosterone sulfate [DHEA-S], androstenediols, and pregnenolone sulfate) compared with those without depressive symptoms. The cortisol/DHEA-S ratio, an indicator of hypothalamic-pituitary-adrenal axis imbalance, was associated with depressive symptoms (P < .01) because of low DHEA-S levels, whereas cortisol was similar between groups. The odds of having depressive symptoms increased with higher cortisol/DHEA-S ratios (adjusted odds ratio, 2.5 per 1-unit increase in z score; 95% confidence interval, 1.3–4.7), independent of age and sex. The kynurenine-to-tryptophan ratio showed no significant associations.

Conclusions

These findings suggest that altered neuroactive steroid metabolism may contribute to the pathophysiological mechanisms of depression in ART-treated HIV-infected adults, representing a potential biological pathway for therapeutic targeting.
26 Brief Psychological Intervention for Distress Reduction in Inpatient Burn Survivors: A Pilot Study
Authors: Stoycos Sarah A , Semple Randye J , Garner Warren L , Tankersley Amelia P , Yenikomshian Haig A , Briere John
Published: March 2020

Introduction

It is estimated that 19–45% of hospitalized burns patients exhibit symptoms of posttraumatic stress (PTS) during hospitalization, and inpatient distress is linked with poorer functional, psychosocial, and medical prognosis. Despite this, research on psychological intervention for PTS during inpatient treatment for burns remains nascent. The current study developed and pilot-tested a six-session cognitive-behavioral therapy (CBT) for adult inpatients with acute burns.

Methods

After IRB approval, patients were enrolled in a single verified ABA burn center. Interventions consisted of 6, 50-minute CBT sessions over two weeks. Therapeutic techniques included mindfulness-focused relaxation training, titrated exposure, psychoeducation, and cognitive restructuring. Depression (Beck Depression Inventory II; [BDI]), anxiety (Beck Anxiety Inventory [BAI]), and PTS (Detailed Assessment of Posttraumatic Stress- PTS-T subscale) were assessed at baseline, 2 weeks, and 6 weeks post-intervention. All data were analyzed in SPSS using Student’s univariate t-tests and Last Observation Carried Forward analysis for missing data at T1. No missing data were imputed for T2 given the high drop-out rate.

Results

Seventeen adult participants were enrolled (13 female; Mage = 31.7 years, SD = 8.7, range 21–53 years; 35% Hispanic/Latinx; MTBSA = 21.6%, SD = 20.2). Analyses indicated no relation between demographic or study variables and drop-out. Average number of sessions was 4.8 (SD = 1.4). At baseline, participants reported moderate anxiety (M = 23, SD = 12.32), mild depression (M = 14.18, SD = 8.46), and clinically significant posttraumatic stress (M = 72.18, T score = 75, 99th percentile).

Comparing baseline to post-intervention, BAI scores decreased, t(16) = 3.76, p = .002, Cohen’s d = .61, whereas BDI scores, t(16) = 1.06, ns, Cohen’s d = .19, and PTS scores, t(16) = 1.03, ns, Cohen’s d = .12, did not change. There were no changes from post-intervention to follow-up in BAI, t(5) = 1.48, ns, Cohen’s d = .43, BDI, t(5) = 1.06, ns, Cohen’s d = .54, or PTS scores (t(5) = .55, ns, Cohen’s d = .12) for the six participants who completed follow-up assessment. TBSA burn was not associated with anxiety, depression, or PTS symptoms at any timepoint.

Conclusions

Participants reported significant reductions in anxiety, but not PTS or depression symptoms, following a CBT distress-reduction intervention. More generally, the findings of this study point to the potential utility of implementing an early intervention of empirically-based treatment components to help burn survivors manage emotional symptoms following trauma.

Applicability of Research to Practice

Patients experiencing anxiety may benefit from short-term mindfulness or exposure interventions and more research is needed to understand the trajectory and heterogeneity of PTS symptom relief following acute burns.
58 The Homelessness Crisis and Burn Injuries: A Cohort Study
Authors: Vrouwe Sebastian Q , Johnson Maxwell B , Pham Christopher H , Lane Christianne J , Garner Warren L , Gillenwater Justin , Yenikomshian Haig A
Published: March 2020

Introduction

Many metropolitan areas face a growing homelessness crisis. Lower socioeconomic status has been shown to be a consistent risk factor for burn injury; however, only a limited number of studies have specifically examined homeless burn patients. The purpose of this study is to characterize the demographics and outcomes of homeless patients who sustain burn injuries and compare them to a cohort of domiciled patients in a large, metropolitan city.

Methods

A retrospective cohort study was performed at an ABA-verified center located in a major metropolitan area. Consecutive acute burn admissions in adults from June 1, 2015 to December 31, 2018 were included. Prevalence was estimated using data from the regional homeless count. Comparisons of demographics, burn characteristics, clinical outcomes, and disposition were made between patients categorized homeless or domiciled at the time of their injury.

Results

Of 881 admissions, 751 (85%) had stable housing, and 130 (15%) were homeless. The mean prevalence rate of burn injury requiring hospitalization for homeless adults was estimated at 88 per 100,000 persons. Homeless patients had a significantly larger median burn size (7% vs 5%, p< 0.05), characterized by a greater rate of flame burns (68% vs 42%, p< 0.001). For the homeless, rates of assault and self-inflicted injury were four- (18% vs 4%, p< 0.001) and two-fold higher (9% vs 4%, p< 0.001), respectively. Homeless patients had higher rates of mental illness (32% vs 12%, p< 0.001) and substance abuse (88% vs 22%, p< 0.001), and were less likely to follow-up as outpatients (54% vs 87%, p< 0.001). There were no significant differences in mortality. Homeless patients had a longer median length of stay (LOS, 11 days vs 7 days, p< 0.001), but there were no significant differences in LOS per %TBSA. Homeless patients had more complex discharge dispositions and were more frequently discharged to a recuperative care facility than domiciled patients (27% vs. 1%, p< 0.001).

Conclusions

Homeless patients comprised a significant subset of our adult inpatient population, with an estimated five-fold greater rate of burn injury requiring hospitalization compared to the national average. These patients sustained larger burn injuries with greater rates of assault or self-inflicted injury.

Applicability of Research to Practice

Homeless individuals should be considered a high-risk population for burn injury. This distinction serves as a call to action for the development of burn prevention strategies.
509 Fungal Infections After Blast and Thermal Injury
Authors: Pruskowski Kaitlin A , Rizzo Julie A , Cancio Leopoldo C
Published: March 2020

Introduction

Invasive fungal wound infections have been reported after combat-related blast injury sustained in recent conflicts. Systemic antifungal agents are commonly used as an adjunct to urgent surgical debridement. There is currently controversy in defining the depth of fungal invasion, which is the most critical factor that determines the treatment strategy. The objective of this study was to describe fungal infections in blast injury patients admitted to our burn center.

Methods

This was a retrospective chart review. Subjects who were admitted between January 2004 and February 2019, received a systemic antifungal agent, and experienced a blast injury were included. Culture and histopathology results were recorded.

Results

Eighty one patients were included. Seventy five subjects (92.6%) were active-duty service members at the time of injury and 79 (97.5%) subjects were male. On average, subjects were 27.4±7.8 years old with a burn size of 51.4±25.3% TBSA. Twenty seven subjects (33.3%) died during their hospital stay.

The 75 subjects had 157 cultures positive for fungi, including 130 tissue cultures. The most common genera isolated was Aspergillus (n=148), Candida (n=106), Fusarium (n=16), and Mucor (n=12). Fifty seven percent of subjects who grew Mucor died, as compared to 52% who grew Aspergillus, 50% who grew Fusarium, and 32.3% who grew Candida.

For histopathology, 33 subjects (40.7%) had results with fungus in non-viable tissue, 27 subjects (25.9%) had results with fungus in viable tissue, and 14 (17.3%) had results with angioinvasion. Subjects who had fungus in viable tissue had the highest mortality rate (71.4%), followed by angioinvasion (64.3%), and fungus in non-viable tissue (33.3%).

The 75 subjects received 121 courses of systemic antifungals. The average duration of therapy was 12.3±13.6 days. The most common antifungals ordered were voriconazole (n=58), fluconazole (n=53), and liposomal amphotericin B (n=42).

Conclusions

Invasive fungal infection after blast injury had a high mortality rate. Early recognition and management of fungal infections is paramount to patient survival. A consensus is needed on how to best define the depth and level of invasion of fungal wound infections, and to determine the optimal treatment duration of systemic antifungal agents for these patients.

Applicability of Research to Practice

Invasive fungal wound infections carry a high mortality rate. A consensus is needed on the optimal systemic therapy.
532 Early Debridement and Cultured Allogenic Keratinocyte Dressing Prevent Hypertrophic Scarring in Infants with Deep Dermal Burns
Authors: Lee SeungJe
Published: March 2020

Introduction

Deep dermal burns are frequently treated with excision and skin grafting. Otherwise, wound healing may take up to 4 to 6 weeks, with serious scarring. Especially in pediatric patients, post-burn scarring could result in psychologic trauma and functional disability. We aimed to investigate the efficacy of early debridement and dressing using cultured allogenic keratinocytes in infants with deep dermal burns to prevent hypertrophic scarring.

Methods

From April 2016 to April 2018, 18 infants were treated for deep dermal burns. Except for 5 infants who underwent skin grafting or excision, 13 infants were included in this study. We performed early debridement in these patients using Hydrosurgery device and serial dressings using cultured allogenic keratinocytes.

Results

The average operative date was 8.3 days after the accident. The mean healing time was 18.3 days after the accident. The patients did not experience any contraction, but 3 patients had hyperpigmentation, 2 patients had mild hypertrophic scarring, and 1 patient had mixed pigmentation (hyperpigmentation and hypopigmentation).

Conclusions

Our prophylactic scar therapy, using early debridement with VersajetTM and dressings with Kaloderm®, may be beneficial for infants with dermal burns. This method was able to shorten the healing time, resulting in better scar outcomes. Our follow-up findings revealed that the scars had an aesthetically pleasing appearance and patients were able to perform normal activities without restrictions.

Applicability of Research to Practice

Burn scars are painful regardless of their seriousness. They restrict the function of the body, are aesthetically unappealing, and may feel unpleasant. Patients with a post-burn scar may have aesthetic, functional, and psychological problems. In particular, infant patients experience difficulties due to scarring as they grow up.
534 Management of Burn Scar with Dermabrasion and Non-cultured Regenerative Epithelial Suspension
Authors: Qiao Liang
Published: March 2020

Introduction

Challenging scars are detrimental for the health-related quality of life of the burn patients, increases financial burdens and, moreover, tests the clinician’s ability to treat these scars. Regenerative epithelial suspension can lead to the restoration of wound and repigmentation, which can treat scar and depigmentation diseases.The application of evidence-based practice has been shown to have the potential to improve health outcomes and strengthen health systems by providing more efficient and cost-effective care.

We challenged the noncultured regenerative epithelial suspension in 3 burn scars with hyper- or hypo-pigmentation.

Methods

The cases presented comprise of a superficial burn scar with hyperpigmentation on face of an 18 year old male, a superficial burn scar with hypopigmentation on the thoracic region of 12 year old girl and a challenging to heel burn scar with hyperpigmentation on the right leg of a 20 year old gentleman. The scars were treated with microdermabrasion, then the ratio of about 1:60–1:150 autologous noncultured regenerative epithelial suspension were obtained and sprayed to the wound. The care givers regularly assessed these wounds till healing, including a clinical, a planimetric and photographic records to 3 months.

Results

A total of 3 patients with superficial scars treated by non-cultured regenerative epithelial suspension technology combined with microdermabrasion showed significant improvement in skin texture and color.

Conclusions

Our study showed that regenerative epithelial suspension technology combined with microdermabrasion may improve scar.

Applicability of Research to Practice

The good clinical outcomes documented through these three selected cases support the use of this new promising treatment in our daily practice of superficial scar management.
563 Therapy Dog Visits in a Burn Unit: The Positive Effects on Patients and Staff
Authors: Quinn Megan , Castro Alexis , Kopari Nicole M
Published: March 2020

Introduction

Hospitalized burn patients encounter multiple stressors including pain, lack of sleep, concerns about outcomes, and unfamiliar environment that can impact their experience, well-being, and recovery. To help reduce these stressors, complementary therapies have been incorporated in their care. Burn Unit staff also carry emotional burdens from caring for patients and experience a high rate of “burnout.” A dog therapy program is one example of complementary interventions to help hospitalized burn patients cope, while helping nurses to focus on their patients in a unique and interactive way.

Methods

A therapy dog visitation protocol was developed which included recent literature supporting these visits and patient exclusion criteria. Exclusion criteria included: patients with burns >20% TBSA for adults and >15% for children, patients immediately recovering from conscious sedation/anesthesia, patients with Integra, and patients with allergies or fear of dogs. Post-visit surveys were recorded for patients and staff members. The surveys rated overall mood, enjoyment related to the visit, improvement in mood following the visit, importance of having activities such as dog therapy visits during the hospitalization, and recommendations for continued opportunities for other patients and staff to have dog therapy visits. A scaling system from 0–10 was utilized with 10 being the highest score.

Results

There were 15 patients and 24 staff members who completed the survey. All staff reported positive interactions with the dog therapy and responded that the therapy improved their mood. All patients answered that they enjoyed the therapy dog visit and 13/15 indicated improvement in their overall mood following a visit with the dog. All participants believed it is important to have activities such as dog therapy during hospitalization, with 32/39 rating the importance at 10/10. All participants recommended other patients and staff have the opportunity to have a therapy dog visit.

Conclusions

The dog therapy program allowed for positive interactions for both nurses and patients and improved patients’ moods. It also provided patients with an activity to look forward to during their hospitalization. Through this connection, nurses are able to help patients recover in a way that is different from the more traditional biomedical approach, which may also improve staff morale.

Applicability of Research to Practice

Complementary interventions such as therapy dogs may be utilized to improve morale within the Burn Unit.
586 Scalp Burn Injury Associated with Hair Highlight Treatment
Authors: Uberti Eileen , Prelack Kathrina
Published: March 2020

Introduction

Hair highlighting treatment has become popular at salons across the country. The ubiquity of this beauty treatment gives many people the impression that it is safe. The process of changing hair color differs between hair salons and hair stylists. We describe the cases of two teenage patients who received third degree burns from hair highlighting treatments. Differences in highlighting technique and treatment modality will be compared and contrasted.

Methods

As part of a quality assurance project looking at variation in scalp burn treatment and outcome, two patients were identified who experienced scalp burn injury due to hair highlighting. Patient 1 received a hot foil hair lighting application. After 5 minutes, the patient experienced tingling in the scalp and removed heat lamp and foils from hair. The first two weeks of treatment were administered by her primary care provider before the patient admitted to our burn facility, where topical collagenase was initiated. Forty two days after initial injury the patient underwent first surgery for debridement, followed by subsequent excision and grafting of scalp. Patient returned for tissue expansion nine months later. Patient 2 received a hair highlighting treatment of bleach and water. Patient 2 complained of burning and immediately her hair was washed out by the hairdresser. The patient was seen two weeks later in our clinic, and treated conservatively with mineral oil and antibacterial topical application. Patient was offered tissue expansion surgery but declined.

Results

Table 1. compares injury type, treatment and outcome in these two patients. Both injuries required significant time to heal, ranging between 56–70 days. Although similar injuries, mode of treatment differed at this same institution. Both patients made decisions based on school activities and fear or surgery, which prolonged time of conservative treatment. Patient 1 received psychological support and anti-anxiety medication prior to all treatments. After tissue expansion Patient 1 no longer required medication and had no sign of alopecia. Patient 2 has area of alopecia 2x2 cm. Neither patient requires further follow up, however Patient 2 could return for tissue expansion if desired.

Conclusions

Hair highlighting is a risk for serious scalp burn injury. Conservative treatment (often per patient preference) is associated with prolonged days to healing. Surgical intervention which includes subsequent tissue expansion, combined with psychological support and anxiety management results in good outcome.

Applicability of Research to Practice

Results from this analysis will be used to develop treatment protocols and staff education on scalp burn injury.
591 Cost Savings in Operative Burn Care
Authors: Williams Tracy L , Voycik Meaghan , Ziembicki Jenny A
Published: March 2020

Introduction

“Over the past 30 years, techniques of early excision and grafting along with enhancement of critical care have significantly improved survival following severe burn. Despite these advancements, large volume blood loss associated with surgical intervention continues to be a challenging aspect of burn surgery.” (Sterling, 2011)

“Estimates of blood loss in adults during burn surgery range from 196 to 269 ml for each percent of the body surface area excised and grafted.” (Cartotto, 2000)

A gold standard to achieve hemostasis does not exist. Therefore, institutions rely on their habit, practices, and FDA guidelines to formulate a standard of care. (Groenewold et al, 2011) In multiple comparison studies, “telfa pads soaked in epinephrine solution are a mainstay of hemostasis.” (Sterling, 2010)

In 2018, an epinephrine shortage led to an increase cost to the operating room (OR) during the surgical treatment of burn wounds.

This prompted the pharmacy and OR to collaborate on a more cost-effective measure without compromising patient care.

Methods

In November 2018, the epinephrine dosages were modified. Dosages were changed from Epinephrine 1;1000, 1mg/ml, 60mg/L for adults and 30mg/L for pediatrics to Epinephrine 1:1000, 1mg/ml, 30mg/L for adults and 15mg/L for pediatric patient’s.

Parameters were set as to the amount of product that would be preordered from the pharmacy for each patient based on the total body surface area to be excised and or grafted:

Should additional quantities be needed, an arrangement was made that the pharmacy would prepare and deliver the solution to the OR within 15 minutes of order to avoid delays in treatment. The time periods examined were: June 1, 2018 though November 7, 2018 and November 8, 2018 through June 20, 2019. Total burn patients requiring surgical intervention admitted during this time frame were 180 and 184 patients. June 2018-November 2018 represents previous practice. November 2018-June 2019 represents the implementation of changes in epinephrine dosage and establishing parameters for ordering.

Results

The overall Cost Savings In Operative Burn Care in relation to decreasing the dosage of Epinephrine from November 2018 to June 2019 was $100,952.25.

Setting parameters provided better estimation of need and resulted in a 26% decrease in ordered product.

Better estimation of product led to a 9.3% decrease in waste.

Decreasing waste led to a savings of $28,463.61.

Monthly cost to the OR for Epinephrine solution decreased to $9708.30 per month indicating a savings of $26,291.70 per month.

Conclusions

Operative costs decreased therefore leading to departmental savings.

Applicability of Research to Practice

Burn wound hemostasis was accomplished using reduced doses of Epinephrine solution.

Nurses have a clearer picture on the amount of Epinephrine solution to order for each patient.

The amount of product waste was reduced.
615 Bacterial Nanocellulose as Cooling Agent
Authors: Luze Hanna , Holzer Judith , Tiffner Katrin , Kainz Sonja , Reisenegger Peter , Nischwitz Sebastian P , Funk Martin , Birngruber Thomas , Mautner Selma , Kamolz Lars-Peter
Published: March 2020

Introduction

Cooling of burn injuries is most important, not only to reduce pain but also to reduce the intradermal damage as well as the burn wound conversion. Studies have shown that cooling for about 20 to 30 minutes using only plain tap water at moderate temperature is most efficient resulting in least intradermal damage. However, many burn injuries reach the hospital without any pre-clinical cooling, possibly due to the lack of a cooling agent. After a pilot study, we investigated if a bacterial nanocellulose (BNC)-based wound dressing containing about 95% water can cool a burn injury and if so the effect suffices to reduce the damage in the skin.

Methods

Skin explants from human donors were burned with inflicted a contact burn injury, of which half were treated with a BNC-based wound dressing and a paraffin gauze dressing. Intradermal temperature sensors measured the temperature changes in the dermis over the course of 24 hours. Biopsies were taken for histological evaluation at different time points.

Results

The intradermal measurements show high temperature spikes at the moment of the burn injuries. After the application of a BNC-based wound dressing the intradermal skin temperature was significantly reduced. The area under the curve in the treated group was significantly less than the untreated. The histological assessment showed according results with less damage in the treated group in comparison to the untreated.

Conclusions

Bacterial nanocellulose-based wound dressings with high water content significantly lower the intradermal temperature after a contact burn and reduce the thermal damage inflicted to the skin. A secondary dressing that permits the water to evaporate slower additionally prolongs the cooling effect. The use of such a wound dressing could find use in a preclinical setting where other cooling options are not available.

Applicability of Research to Practice

The findings of this experiment should be tested in an in-vivo setting prior to clinical use to investigate the possibility of inducing hypothermia with this treatment.