bluuebunny/crossref_metadata_2025 huggingface dataset:
635 Free Versus Pedicled Flaps for Primary Reconstruction of Electrical Injuries: A Systematic Review and Observational Meta-Analysis
Authors: Khoo Kimberly , Bashour Laura , Peterson Joshua M , Padilla Pablo L , Mulay Sagar R , Dziewulski Peter
Published: April 2021

Introduction

Both high-voltage (>1000 V) and low-voltage (< 1000 V) electrical burns can cause serious injuries due to dissipation of heat as electric current passes through deep tissues. Because of tissue loss and vital structure exposure, flap-based reconstruction is frequently performed in patients with these injuries. Depending on clinical presentation, both free and pedicled flaps may be indicated. We wondered if reported reconstructive outcomes after electrical injury differ between free and pedicled flaps when implemented in the immediate post-injury period.

Methods

A systematic literature review following PRISMA guidelines was conducted using PubMed and Ovid MEDLINE databases. Articles that were included described patients with electrical burn injuries who underwent reconstruction with either free or pedicled flaps within 90 days of injury. Technique articles or articles lacking outcomes analysis were excluded. Data was extracted from articles that met inclusion and exclusion criteria, including flap type, timing of reconstruction, complications, and patient demographics. Statistical analysis was performed with chi-square tests.

Results

Of 536 articles obtained from the literature search, 37 met criteria. To date, no randomized control trials comparing these modalities have been performed. In total, these studies reported on 364 total patients who experienced high- and low-voltage electrical burn injuries. Pooled reported outcomes of 374 flap reconstructions were analyzed, including 145 free flaps and 229 pedicled flaps. Reported complication rates did not differ significantly between free flaps (30/145, 20.7%) and pedicled flaps (46/229, 20.1%; p = .89). However, free flaps experienced significantly higher failure rates than pedicled flaps (13/145, 9.0% vs. 0/229, 0%; p = < .05).

Conclusions

Electrical burn injuries present a unique indication for flap-based reconstruction in the immediate post-burn phase of care. However, substantial variation exists amongst physicians regarding whether to proceed with a free flap or pedicled flap surgery when indicated. Our data identified an overall significant difference between free versus pedicled flap failure rate but did not identify a significant difference between overall complication rates.
638 Biodegradable Temporizing Matrix in Combination with Wide Meshed Graft and Autologous Spray Cell Suspension (ASCS) Graft Can be Used for Reconstruction of Extensive Necrotizing Infections: A Case Report
Authors: Olivi Joe A , Rodgers Megan D
Published: April 2021

Introduction

Background: A necrotizing infection of the left upper extremity underwent extensive debridement with remaining exposed muscle, tendon, and bone. BTM was used to provide an acceptable temporizing matrix in conjunction with wide meshed split thickness skin graft (STSG) 3:1 ratio and ASCS graft for successful reconstruction. This left a functional limb and avoided arm forequarter amputation.

Methods

Case Presentation: We present a 67 y/o male with necrotizing infection who underwent extensive surgical debridement of skin and subcutaneous tissues of the left hand, forearm, and upper arm. BTM was applied for coverage over muscle, tendon, and bone to salvage his arm and avoid forequarter amputation. Following maturation of the BTM a 3:1 ratio STSG was placed along with application of an ASCS graft. A vacuum assisted closure (VAC) dressing was successfully used to stabilize the grafts. One month post grafting the wound was approximately 94% healed, with good range of motion, and limited but improving function of his arm.

Results

Conclusion: Necrotizing infection extremity reconstruction can be achieved with BTM, wide meshed STSG, and autologous ASCS grafting. A wound VAC provided a safe and effective dressing over these grafted mediums.

Conclusions

Conclusion: Necrotizing infection extremity reconstruction can be achieved with BTM, wide meshed STSG, and ASCS epidermal autograft. A wound VAC provided a safe and effective dressing over these grafted mediums.
641 North American Practices for Facial Massage and Stretching Post Facial Burns
Authors: Barwick Alexa , Nakamura Dana Y , Holmes James H , Molnar Joseph
Published: April 2021

Introduction

Facial burns can be complicated by the development of scar tissue and contractures, resulting in decreased flexibility of the tissue involved in swallowing, facial expression, and verbal communication. Maximizing functional range of motion is an important preventative measure for improving functional outcomes for swallowing, communication, and for the prevention of microstomia. A range of therapy interventions including stretching, massage, compression, and use of appliances has been reported in the literature; however, there is limited to no information on current practice patterns amongst North American providers (MD, DO, PA, NP, etc.) or therapists (PT, OT, and SLP).

Methods

A RedCap survey was developed by a Speech-Language Pathologist and Occupational Therapist involved in burn care. The survey consisted of 18 total questions, with participants responding to between 12–13 questions due to branching logic. Questions were related to demographic and service provision related to facial massage and stretching. Survey questions were multiple choice, multiple answer multiple choice, or contained text boxes. The survey was distributed to Providers and Therapists from the United Stated of America and Canada who were members of the American Burn Association (ABA).

Results

A total of 69 surveys were collected, with 57 surveys meeting criteria for inclusion. Respondents consisted of therapists 68%, providers 23%, and other health professionals 9%. Forty-six ABA burn centers from across the United States and Canada were represented. The majority of respondents had over 10 years of experience working with burn patients. 91% of respondents reported that facial massage and stretching was used as a tool at their facility. Respondents, who report facial massage is utilized at their facility, report OT as being the primary discipline responsible for assessing (67%) and completing (65%) facial massage, with 85% reporting additional discipline(s) also participating in facial massage. 9% of respondents report that facial massage and stretching is not utilized at their facility following facial burns. Of those who responded that facial massage and stretching is not utilized following facial burns, 40% felt this would be beneficial to patients, while 60% were unsure.

Conclusions

Facial scar management is an important part of burn care, with the majority of respondents reporting completion of facial massage and stretching as part of the services provided to patients who have suffered facial burns. OTs are the primary service providers for facial massage and stretching post facial burn. Practices for facial massage varies greatly, with the majority of respondents reporting no specific protocol for facial massage and stretching is followed.
646 Telehealth in Burn Rehabilitation: Virtual Objective Measures
Authors: Siwy Katherine G
Published: April 2021

Introduction

The COVID-19 pandemic thrusted many burn therapists into the world of telehealth overnight. While telehealth has been widely utilized since and has played a vital role in burn care overall, adaptation of platform has been minimal amongst burn therapists. As more hospital systems integrate telehealth as a service delivery mode, there is a need for guidelines on how to capture data collection and recommended documentation language which indicates progress and justifies therapy.

Methods

The following virtual visit documentation and objective data collection guidance form was created in an effort to capture ability, disabilities, limitations and barriers of the burn survivor participating in the burn rehabilitative virtual visits. The guidance form is intended to demonstrate examples of data collection can be captured in the virtual environment along with pointers to enhance the experience and recommended documentation language. It is not all inclusive, nor are all the tests listed necessarily required for a successful virtual interaction. (Attachment A)

Results

Despite the inability to perform formal standardized objective measurements, a burn therapist is still able to measure and document gains and losses. Posture, gait, range of motion, skin integrity, strength, motor control, body mechanics, coordination, adl’s, functional mobility, transfers are a few of the many categories which a burn therapist can focus their documentation.

Conclusions

When appropriately administered and thoroughly documented telehealth can not only provide quality care to burn survivors but also demonstrate gains to optimal outcome goals and return to baseline levels of independence with ADLs, IADL’s, mobility, transfers, range of motion, strength and sensation.
652 Burns and Incidence of Operative Treatment
Authors: Schober Marc , Hallman Taylor , Africa Robert , Wermine Kendall , Gotewal Sunny , Cuartas-Olarte Andres , Torres Mark Jason , Peterson Joshua M , Golovko George , Song Juquan , El Ayadi Amina , Wolf Steven E
Published: April 2021

Introduction

Over the past three decades, it has been repeatedly demonstrated that early surgical intervention is associated with improved outcomes in burns, however, large-scale studies regarding the incidence of operative treatment in burn patients are lacking. We conducted a retrospective study using the TriNetX database, a global, real-time electronic medical record driven index of patient populations, analyzing the incidence of grafting procedures in burned patients related to age and % total body surface area (TBSA) burned.

Methods

The population of burn patients and operative treatments were indexed using ICD-10 codes T31.0-T31.9 and 1013913, respectively. Queries were structured as sequential events allowing analysis of burn diagnosis to be followed by a subsequent operation. The patient population was partitioned by TBSA burned, and the number of grafting procedures were assessed. All patients were included and stratified by ages of 0–17, 18–34, 35–64, and 65–89. The data includes information collected between 2000–2020 from over 35 healthcare organizations comprising the Research network in TriNetX. Extracted data were analyzed using chi-square statistical analysis with p< 0.05 considered significant.

Results

Of 116,325 burn patients identified, 11.14% underwent at least one grafting procedure. Of surgeries performed, the majority occurred in the 35–64 years age group (45.3% p = < 0.001). Additionally, the incidence of grafting procedures was directly proportional to patient age: age groups of 0–17, 18–34, 35–64, and 65–89 years received grafting procedures in 6.5% (p = < 0.001), 9.8% (p = < 0.001), 12.9% (p = < 0.001), and 15.9% (p = < 0.001) of cases, respectively. When stratified by TBSA burned, those with 40–49% TBSA burns had the highest incidence of operations (50.7% p = < 0.001). Large TBSA burns correlated with increasing incidence of grafting procedures until 50–59% TBSA burned, where incidence begins to decrease, likely related to referral patterns which did not capture grafting procedures performed at specialized burn treatment centers or institution of palliative care.

Conclusions

This study reveals that the incidence of operational treatment increases with both age and percent TBSA burned. The data corroborate a referral pattern for burns that demonstrates a decline in operative treatments beginning with 50–59% TBSA, inconsistent with referral guidelines to specialized burn care centers published by the ABA.
653 Resourceful Surgical Planning for Coverage of Large Burns: Optimizing Cultured Epithelial Autografts (CEAs) Outcomes by Combining with a Modified MEEK Procedure
Authors: Coffman Beretta C , Fagan Shawn P , Homsombath Bounthavy , Lack Kevin , Hassan Zaheed
Published: April 2021

Introduction

We previously reported a modified MEEK technique providing reliable skin transfer using a specific adhesive called, “The Rule of Sevens”.¹ This innovative approach is now part of our practice and we have experienced good outcomes as a result. With that technique perfected, we have also begun incorporating this method as part of the surgical plan for coverage of large TBSA burns with CEAs. This study is a report of our initial experiences utilizing a combination of our modified MEEK procedure and CEA grafting for larger TBSA burns.

Methods

This retrospective study was granted exemption by IntegReview IRB. Demographic data was reviewed. In some cases, incomplete documentation related to percentage take was noted. To account for this limitation, we agreed with other investigators in the literature and applied the “clinically relevant” assessment to this study analysis. This approach assumed that take and final coverage were successful when re-grafting was not required by the time of discharge or death.²

Results

Nineteen (19) patients total were treated with MEEK/CEA from April 2016 – February 2020. One patient was an outlier, acquiring infection, requiring additional surgery to close the wound, and did not meet criteria to evaluate. There were 4 females (25%) and 14 males (74%), age range 9–71, Mean 37, Median 34, Mode N/A. TBSA was 30–92%, Mean 62 Median 60, Mode 55. Length of stay was 20–188 days, Mean 89, Mode 136. This is approximately 1.5 days’ stay, per percent of burn in this group of patients with larger burns. MEEK meshing ratio was documented on 16 patients, range from 6:1 - 9:1 ratio. Five patients had a 6:1 ratio, 11 patients had 9:1 meshing ratio used.

There were 6 deaths in the total group of 18 evaluable patients (33%). Of these, all had MEEK performed initially, however; 3 did not live long enough to have CEA placed. One patient died before initial takedown of CEA could be performed. The other two died during treatment, both had documentation supporting 70% and 90% take, respectively.

To determine overall take, we determined whether any of the surviving patients treated needed further grafting. None of the 12 remaining patients required further grafting. This met our criteria of successful take and gave us a 100% success rate. There were 9 patients with documentation clearly stating a percent take rate. In this group, the documented percent take range was 60–97%, Mean 84%, Median 85% and Mode 96%,80%. Again, none of these patients required additional surgery.

Conclusions

A modified MEEK technique in providing coverage of larger burns with CEA has offered our center better options of expansion thus perfecting the technique of transfer. Most importantly, the MEEK/CEA has resulted in excellent outcomes with a documented mean take rate of 84%.
660 Decreasing Burn Excision Time by Using a Circular Dermatome
Authors: Savetamal Alisa , Wenta Samantha
Published: April 2021

Introduction

Excision of burn-injured tissue can be accomplished by a variety of means. The most commonly used tools in the burn community are straight blades of varying lengths fitted to guards of different depths. A traditional straight dermatome can also be used for excision. We describe here the use of a circular dermatome, which in addition to allowing curvilinear excision holds the promise of expediting burn excision as well.

Methods

IRB approval was obtained for a prospective study of the use of a circular dermatome device for the excision of burns. Patients with deep partial- and full-thickness burns were eligible for inclusion in the study. Eight patients undergoing nine procedures were included. The excisions were performed exclusively with the dermatome, with use of standard equipment only for smaller areas (hands/feet). The size of the dermatome, depth of excision, and time of excision with the dermatome were noted. Total operative time (recorded as “procedure start” to “procedure end”) was also recorded, as was the subsequent wound coverage material.

Results

A total of nine cases were included. The four-inch diameter blade was most commonly used, typically at depths of 25 or 30/1000thinch. The sizes of the areas excised ranged from 392cm2 to 4694 cm2. The total time of excision was short (2 to 10 minutes), and total case times varied greatly (31 to 262 minutes) due to differences in wound coverage. Excision time per cm2 was calculated in seconds due to the brevity of the excision and typically fell between 0.1 to 0.3 seconds per centimeter squared. The outlier (0.7s/cm2) was encountered early in the study and represented a challenge of technique. Cases where wound coverage was achieved with allograft or with standard split-thickness skin graft had case times of 2 to 5 seconds per square centimeter; the outlier (11s/cm2) was the result of a use of an unrelated new technology.

Conclusions

Rapid excision of a large area of burn can be accomplished with the circular dermatome. The device can also be used of course to take autograft. When the case consists completely of excision and allografting or conventional split-thickness skin grafting, the total operative time can be very short indeed. The dermatome may be beneficial additionally for longer cases where operating room time saved in excision may be used for other purposes.
663 Application and Management of Cultured Epithelial Autografts (CEAs) on Posterior Burns – A 5-year, Multi-center, Retrospective Review of Outcomes
Authors: Homsombath Bounthavy , Hassan Zaheed , Fagan Shawn P , Coffman Beretta C
Published: April 2021

Introduction

In patients with larger burns, treatment with CEAs have proven to increase survival.1 CEAs, while useful, are not without some disadvantages. For instance, if the injury involves burns to posterior surfaces, the challenge is inherent in that these fragile sheets are easily sheared, and pressure can cause disruption and graft loss. CEA grafting must be managed with specific care and with specialized protocols that help address these challenges. Graft loss due to these and other factors can delay healing, increase hospital length of stay, and increase the cost of care. The purpose of this study is to evaluate the success for graft take in patients with posterior burns treated with CEA and to discuss the techniques, protocols and approaches to managing these patients within our burn network.

Methods

This retrospective study was granted exemption by IntegReview IRB. Take rate for each application of CEA was not always found for some cases. For purposes of this study, we agreed with methods of other researchers in the literature and adapted the “clinically relevant” assessment that take and final coverage was successful when re-grafting was not required by the time of discharge or death.2

Results

Study dates was March 2016 - December 2019 and at this time, is being reported from among 3 of 6 participating centers. Our approach is to provide CEA prep the day before initial placement and then to ensure strict protocols are followed at the bedside post-op and thereafter. Total number of patients considered was 68, 41 were deemed evaluable. See tables for other demographics and results. 31 patients were discharged to rehab (75%), 6 were discharged home (15%) and 4 died (10%).

Conclusions

Meticulous attention to wound bed preparation and ensuring that post-op care is clearly stated and understood by all clinicians involved in the care of patients with larger burns with posterior trunk involvement is the key to successful coverage with CEA to this challenging anatomical location.
665 Blood Loss in Burn Surgeries: Prediction and Its Related Factors
Authors: Aurino Leorca , Menna Clara , Wardhana Aditya
Published: April 2021

Introduction

Blood loss is a common and important problem in burn surgery, and patients often require blood transfusions. Preparation of estimated blood transfusions needed prior to surgery is essential. Some studies have devised formulas that can predict blood loss during burn surgery. However, there were many different factors in each study that may influence the amount of blood loss, which were not included in the formulas. Until today, there is no standardized formula that is widely used.

Methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE database for cohort and trial studies that investigate blood loss in burn surgeries. Studies should have clear quantitative blood loss outcome.

Results

We included 15 studies from 1982 to 2018, 13 of which are cohort studies and 2 RCTs, with a total of 1613 subjects; all studies calculated blood loss and assessed possible relating factors, four of them proposed formulas to predict the volume of blood loss, 13 studies mentioned efforts used to reduce blood loss, and 6 studies assessed the timing of surgery. We found trends of blood loss within each variable and summarized them in tables.

Conclusions

From the studies included, there were a variety of results in the amount of blood loss and its related factors. This was due to confounding factors and dissimilarities between studies. However, several studies proposed blood loss prediction formulas, which pose promising benefits to betterment in burn surgeries.
668 Fixation of Split-Thickness Skin Grafts with Liquid Adhesive and Fibrin Glue in Place of Staples
Authors: Frost Joshua , Hallier Nathan , Moreno Tanir , Covell Jared , Keck Ryan , Griswold John A
Published: April 2021

Introduction

A critical component of split-thickness skin grafting is the fixation of the skin graft to the wound site. Graft displacement can result in graft failure, especially during the initial 48–72 hours following application. The most common method of securing grafts is with the use of staples, sometimes with the addition of fibrin glue in order to aid both graft adhesion and homeostasis. The use of staples, however, is associated with significant levels of patient discomfort, especially during staple removal. A possible alternative to staples is the use of liquid adhesives, in combination with steri-strips, to anchor the edges of skin grafts to intact skin. Certain liquid adhesives, such as gum-based resins, are cheaper to use than staples and offer the potential to secure small split-thickness skin grafts without the associated pain of staples. In this pilot study, we examined the effectiveness of using a combination of gum-based resin (Gum Mastic-Storax-Msal-Alcohol), fibrin glue, and steri-strips to secure partial-thickness grafts in 8 patients without the use of staples or sutures.

Methods

Patients were included in the study who required split-thickness skin grafts to treat wounds involving less than or equal to 15% total surface body area and whose wounds were not located in areas prone to graft displacement, such as the axilla and groin. For each patient, skin grafts were secured using fibrin glue (sprayed over the entire wound), and a combination of liquid adhesive and steri-strips applied around the wound perimeter. The success of each graft was determined by the percentage of graft take.

Results

From January 1st, 2020 to April 30th, 2020, 8 patients were identified who fit the inclusion criteria. Five of the patients received grafts to their lower extremities, two patients received grafts to their upper extremities, and one of the patients received a graft to the torso. The average wound site that was grafted was 116.7 cm2. Average graft take among the 8 patients was 96.9%, with a range of 90%-100%. No complications at the graft site were noted, such as hematomas or any other event that resulted in graft displacement or failure.

Conclusions

The results of the study demonstrate that a combination of liquid adhesive, fibrin glue, and steri-strips, can be used as an effective alternative to staples in small split-thickness skin grafts. The use of liquid adhesive in place of staples was advantageous because it eliminated to need for staple removal, which resulted in less discomfort for the patient and less work for the nursing staff.
669 Application of In-cell Western Blot to Study Burn-induced Cardiac Dysfunction
Authors: Wen Jake J
Published: April 2021

Introduction

Traditional Western blotting (WB) may not reflect true target protein amount due to interference from enzymic activity during sample preparation. In-Cell Western (ICW) blotting has proved to have advantages over the traditional WB. However, ICW has not been used to study burn-induced cardiac dysfunction. This study will explore the efficacy of ICW in the study of burn-induced cardiac dysfunction.

Methods

Human cardiomyocytes (Ac16) were cultured in serum from rats with/without 60% of total body surface area (TBSA) burn injury. Cultured cells were permeabilized by Tritons-100 X, 1st anti-targeted protein antibodies were added and incubated, and, finally, two fluorescence-conjugated 2nd antibodies (one red and one blue) were added and incubated. LI-COR Odyssey CLx scanner was employed to obtain images and LI-COR Image Studio 4.0 software was used to analyze image and GraphPad Prism 8.0 software was used to determine image density.

Results

ICW proved to be a good tool to study burn injury. Our ICW data showed that burn serum resulted in 1) increased cardiomyocyte PARP1 (leading to increased protein acetylation); 2) increased damage of cardiomyocyte mitochondrial DNA replication (via increase in mitochondrial Fis1and BCBN proteins and decrease in parkin and POLG proteins); and 3) a decrease of cardiomyocyte mitochondrial biogenesis (with increase in inflammation-related proteins, apoptosis-related proteins, and decrease Brf2-ARE-related proteins).

Conclusions

This study provides preliminary evidence that ICW may be a novel tool to study burn injury and confirms that burn-injury induced cardiomyocyte mitochondrial dysfunction occurs via damage of mitDNA replication, involving inflammation, apoptosis, and mitochondrial biogenesis pathways.
672 An Investigation of Antibiotic Loading and Release in Acid-precipitated Keratin Proteins to Treat Topical Burn Infections
Authors: Thompson Marc A , Christy Robert J
Published: April 2021

Introduction

Human-hair derived keratin (KOS) protein has been selected in this investigation for its ability to bind antibiotic compounds and provide sustained release while withstanding harsh proteolytic environments such as inflamed, damaged tissue. The need to control local flora has been recognized as an imperative for wound healing, as recovery is significantly hampered by infection. This study investigates the synthesis of KOS-based particulate matter, developed using acid-precipitation, to load and release the water-soluble antibiotic ciprofloxacin (CIP). We hypothesize that ionically bound CIP release is tied to the degradation of KOS, therefore, bacterial metabolism, which produces proteolytic enzymes, will trigger CIP release thereby creating a novel self-extinguishing delivery system for contaminated skin wounds.

Methods

Ciprofloxacin hydrochloride was solubilized in deionized water (pH 5.3) under constant stirring. Freeze-dried KOS powder was added for an ultimately 5% w/v and 0.8% w/v solution of KOS and CIP, respectively. To improve the stability of KOS a water-soluble diglycidyl ether crosslinker was added to solutions and stirred for 24 hours. CIP-loaded protein was precipitated out by a hydrochloric acid induced pH reduction. Samples were collected and frozen at -20 °C prior to lyophilization, thus forming the stable product. Degradation of KOS and commensurate release of CIP were measured using a bicinchoninic acid (BCA) assay and fluorescent measurements of hydrated material supernatant. The reduction of bacterial colonies was validated by a broth inhibition assay whereby CIP-loaded KOS or unloaded KOS controls where hydrated in bacterial-laden broth cultures of Pseudomonas aeruginosa or Methicillin-resistant Staphylococcus aureus. Cultures were sampled at 24, 48, or 72 hours and plated to quantify colony-forming units.

Results

The presence of CIP in the KOS protein was confirmed and release rates follow similar patterns to that of KOS degradation. CIP-loaded proteins significantly reduce bacterial colony presence in concentrated inoculant solutions up to 72 hours.

Conclusions

CIP release does appear to coincide with KOS degradation, which is bolstered in the presence of infectious levels of bacteria. Ongoing studies aim to observe more robust models of infection and more controlled antibiotic release.
Measuring the Value of Softwood Log Exports: Evidence from Oregon
Authors: Rossi David , Zhai Jun , Kuusela Olli-Pekka
Published: April 2021

Oregon softwood log exports experienced a resurgence during years after the Great Recession. Using an empirically grounded partial equilibrium model, the purpose of this study is to assess the net effects of log exports on total economic surplus by measuring the effects of a hypothetical absence of export markets from 2010:Q1 to 2015:Q4. Based on our modeling results, the net economic losses would have amounted to $248 million during the study period in total. Oregon mills would have gained $1.66 billion in total, whereas landowners would have lost $1.91 billion in total had there not been export markets. Furthermore, additional losses would have occurred from the forgone export premium. Our modeling results suggest that harvests would have been 1.97 billion board feet lower in the absence of export markets. However, Oregon mills would have used an additional 3.0 billion board feet. We also provide estimates for potential employment effects.
Planet-induced radio emission from the coronae of M dwarfs: the case of Prox Cen and AU Mic
Authors: Kavanagh Robert D , Vidotto Aline A , Klein Baptiste , Jardine Moira M , Donati Jean-François , Ó Fionnagáin Dúalta
Published: April 2021

There have recently been detections of radio emission from low-mass stars, some of which are indicative of star–planet interactions. Motivated by these exciting new results, in this paper we present Alfvén wave-driven stellar wind models of the two active planet-hosting M dwarfs Prox Cen and AU Mic. Our models incorporate large-scale photospheric magnetic field maps reconstructed using the Zeeman–Doppler imaging method. We obtain a mass-loss rate of $0.25~\dot{\mathrm{ M}}_{\odot }$ for the wind of Prox Cen. For the young dwarf AU Mic, we explore two cases: a low and a high mass-loss rate. Depending on the properties of the Alfvén waves that heat the corona in our wind models, we obtain mass-loss rates of 27 and $590~\dot{\mathrm{ M}}_{\odot }$ for AU Mic. We use our stellar wind models to assess the generation of electron cyclotron maser instability emission in both systems, through a mechanism analogous to the sub-Alfvénic Jupiter–Io interaction. For Prox Cen, we do not find any feasible scenario where the planet can induce radio emission in the star’s corona, as the planet orbits too far from the star in the super-Alfvénic regime. However, in the case that AU Mic has a stellar wind mass-loss rate of $27~\dot{\mathrm{ M}}_{\odot }$, we find that both planets b and c in the system can induce radio emission from ∼10 MHz to 3 GHz in the corona of the host star for the majority of their orbits, with peak flux densities of ∼10 mJy. Detection of such radio emission would allow us to place an upper limit on the mass-loss rate of the star.
Expasy, the Swiss Bioinformatics Resource Portal, as designed by its users
Authors: Duvaud Séverine , Gabella Chiara , Lisacek Frédérique , Stockinger Heinz , Ioannidis Vassilios , Durinx Christine
Published: April 2021

The SIB Swiss Institute of Bioinformatics (https://www.sib.swiss) creates, maintains and disseminates a portfolio of reliable and state-of-the-art bioinformatics services and resources for the storage, analysis and interpretation of biological data. Through Expasy (https://www.expasy.org), the Swiss Bioinformatics Resource Portal, the scientific community worldwide, freely accesses more than 160 SIB resources supporting a wide range of life science and biomedical research areas. In 2020, Expasy was redesigned through a user-centric approach, known as User-Centred Design (UCD), whose aim is to create user interfaces that are easy-to-use, efficient and targeting the intended community. This approach, widely used in other fields such as marketing, e-commerce, and design of mobile applications, is still scarcely explored in bioinformatics. In total, around 50 people were actively involved, including internal stakeholders and end-users. In addition to an optimised interface that meets users' needs and expectations, the new version of Expasy provides an up-to-date and accurate description of high-quality resources based on a standardised ontology, allowing to connect functionally-related resources.
The Great Trade-off in Workers’ Compensation: Perceptions of Injustice by Those Experiencing Persistent Pain
Authors: Quintner John , Galbraith Melanie
Published: April 2021

Introduction

Some claimants harbor perceptions of injustice about the way they have been treated. In particular, those with ongoing and disabling pain have been generally dissatisfied by the way they have been managed by the systems designed to offer them financial compensation.

Aim

In this paper we aim to explore possible factors that may contribute to their dissatisfaction.

Method

We review the historical development of the various systems in which monetary compensation was awarded for personal injury.

Findings

In the latter years of the 19th century, a significant trade-off occurred in the German workers’ compensation systems. On the one hand, employers accepted the principle of no-fault insurance and agreed to provide injured workers with monetary compensation and medical treatment. On the other hand, employees agreed to relinquish the right to sue their employer for negligence. However, awards under this legal system did not include assessments for ongoing pain, humiliation, or loss of social status as were incorporated in previous systems.

Conclusion

Although the Prussian and German approach provided a utilitarian model for similar systems around the world, its failure to include some long-established benefits of a moral nature may have contributed to the current perceptions of injustice expressed by many injured workers experiencing persistent pain.
Rapid Mobilization of Medical Students to Provide Health Care Workers With Emergency Childcare During the COVID-19 Pandemic
Authors: Lane Emily C.A. , Tran Audrey A. , Graulty Christian J. , Bumsted Tracy
Published: April 2021

Problem

In March 2020, the novel coronavirus 2019 (COVID-19) pandemic spread rapidly within the United States and began overwhelming the health care system. To conserve personal protective equipment, reduce the spread of the virus, and keep student learners safe, leaders of medical schools across the country made the difficult decision to suspend in-person clinical experiences. As medical students were sent home and hospital systems ramped up their response to the virus, many essential health care workers (HCWs) faced an immediate challenge. As “nonessential” services such as schools and daycare centers abruptly closed, HCWs serving on the frontlines in inpatient settings needed a way to both fight the pandemic and care for their children.

Approach

Medical students at Oregon Health & Science University were able to rapidly OR organize to provide childcare for essential HCWs. For roughly 8 weeks following the state of emergency (March 13 through May 15, 2020), students used Twitter and emerging technology to match families in need of childcare with a trainee volunteer.

Outcomes

By May 15th, the service had successfully fulfilled 181 of the 202 requests for childcare (90%) over the course of 8 weeks. Of the 181 completed childcare requests, 172 (95%) were fulfilled by an individual (1:1 volunteer-to-household pairing), and 9 (5%) were fulfilled by 2 or more volunteers.

Next Steps

The trainees who provided childcare will apply the skills learned (e.g., clear communication, grassroots organizing, triaging, leveraging new technology) to patient care. Broader applications for this system include organizing volunteers to conduct contract tracing or to provide public health information in languages other than English. Future research includes examining the effect of the service on the productivity, morale, and mental health of both those who provided and received childcare.
Adaptive Behavior Profiles of Intellectually Gifted Children with Autism Spectrum Disorder
Authors: Dempsey Jack , Ahmed Kelli , Simon Andrea R. , Hayutin Lisa G. , Monteiro Sonia , Dempsey Allison G.
Published: April 2021

Objective:

The purpose of this study is to identify whether the well-described pattern of declining adaptive functioning across age among children with autism spectrum disorder (ASD) also exists among intellectually gifted children with ASD because their cognitive abilities might serve as a protective factor.

Methods:

Data from the Simons Simplex Collection were used to identify 51 participants with full-scale intelligence (IQ) scores of 130 or above with this group labeled as the intellectually gifted range (IGR). Two comparison samples of children with IQs in the intellectual disability range (IDR; < 70 Standard Score [SS]) and average range (AR; 85–115 SS) were created based on matching of age (±2 years), maternal education level, and sex.

Results:

Multivariate analysis of variance indicated a main overall effect for the IQ group on a measure of adaptive skills (Λ = 0.61, F(6, 296), p < 0.001). Post hoc comparisons revealed that the IDR group scored lower on all subscales than the AR and IGR groups, but the scores between the latter groups did not differ from one another in socialization and daily living skills (DLS) domains. Age was negatively correlated with adaptive communication scores in all groups but only associated with socialization and DLS domain scores in the IGR group (r = −0.51 and −0.48, respectively).

Conclusion:

The findings suggest that intellectual giftedness does not serve as a protective factor against age-related declines in adaptive functioning among individuals with ASD.
Longitudinal Psychiatric and Developmental Outcomes in 22q11.2 Deletion Syndrome: A Systematic Review
Authors: Jhawar Nandini , Brown Marissa J. , Cutler-Landsman Donna , Kates Wendy R. , Angkustsiri Kathleen , Antshel Kevin M.
Published: April 2021

Objective:

22q11.2 deletion syndrome (22q11DS) is a common genetic deletion syndrome associated with psychiatric disorders and developmental delays. A significant amount of 22q11DS research literature is published annually; here, we focus exclusively on longitudinal data that have been published in the past 5 years regarding psychiatric disorders and/or cognitive and social development. After a review, areas for future research consideration and clinical recommendations are presented.

Methods:

Articles were reviewed and organized in adherence with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for conducting systematic reviews. The literature search identified 852 studies, and 22 studies met inclusion criteria.

Results:

Longitudinal study findings indicate that developmental considerations for youth with 22q11DS should focus on the primacy and enduring nature of social and executive functioning deficits, attention-deficit/hyperactivity disorder, anxiety, and negative symptoms of psychosis.

Conclusion:

From the diathesis of physiological conditions and genetic variance, 22q11DS and its associated phenotype of persistent cognitive deficits, comorbid psychiatric disorders, and social impairments likely conspire to increase the risk for stress in adolescence. The diathesis-stress framework, along with chronic stress, increases psychosis risk in individuals with 22q11DS. The existing literature has a heavy focus on the impact of the deletion on individual skills and attributes, such as cognition, but lacks information on the impact of the environment. Future 22q11DS research should consider specific aspects of social functioning, including interactions with parenting styles and family communication, as well as high demands in educational settings, as possible risk factors for psychosis.
Ear Infection Trajectories and Academic, Behavioral, and Quality-of-Life Outcomes: A Population-Based Longitudinal Study
Authors: Wang Jing , Quach Jon , Sung Valerie , Carew Peter , Wake Melissa
Published: April 2021

Objective:

The purpose of this study was to investigate (1) typical trajectories of parent-reported ear infections throughout childhood and (2) their associations with child outcomes.

Method:

Design and participants: Two parallel cohorts assessed biennially from 2004 to 2014 spanning ages 0–1 to 10–11 years (B cohort, n = 3721) and ages 4–5 to 14–15 years (K cohort, n = 3489) in the Longitudinal Study of Australian Children. Ear infection: Parent-reported ongoing ear infections (B: waves 1–6; K: waves 1, 2, 4, and 5). Outcomes (wave 6): National academic standardized test, teacher-reported learning, parent- and teacher-reported behavior, and self-reported quality of life. Analysis: Latent class models identified ear infection trajectories. Linear regression quantified associations between trajectories and outcomes.

Results:

Four probability trajectories of ear infections emerged in both cohorts: “consistently low” (B 86.2%, K 87.0%), “moderate to low” (5.5%, 9.7%), “low to moderate” (7.0%, 1.5%), and “consistently high” (1.4%, 1.8%). In K cohort, the “consistently high” group had the worst outcomes (effect sizes 0.2–0.8 SDs), with effect sizes largest for psychosocial and language outcomes. “Moderate to low” and “low to moderate” groups showed marginal to no academic associations, although behavior and quality-of-life scores were 0.2 to 0.3 SDs poorer than the “consistently low” group. Similar but attenuated associations were seen in B cohort.

Conclusion:

Sizable adverse adolescent outcomes follow parent reports of persistent ongoing ear infections throughout childhood. Despite a possibility of reverse causation, this suggests that cumulative rather than age-specific ear infections are most important to outcomes. Clinicians may generally be reassuring about ongoing ear infections limited to either early or middle childhood but should proactively identify and manage the small subgroup whose early infections persist throughout the elementary school years.
Remdesivir-Associated Pancreatitis
Authors: Khadka Sushmita , Williams Karen , Solanki Shantanu
Published: April 2021

We report a case of acute pancreatitis that developed after four days of remdesivir therapy in a patient being treated for COVID-19. Despite improvement in patient's respiratory status, abdominal pain worsened and clinical signs and symptoms progressed to a diagnosis of acute pancreatitis 4 days after initiation of remdesivir therapy. Withdrawal of remdesivir paired with medical management of acute pancreatitis led to the resolution of pancreatitis within three days. To our knowledge, this is the first case report depicting remdesivir as a possible cause of acute pancreatitis.
Effects of Laparoscopic Radical Gastrectomy on Peritoneal Micrometastases of Gastric Cancer
Authors: Wei Chengzhi , Yu Zhu , Wang Gonghe , Zhou Yiming , Tian Lei
Published: April 2021

Background:

Some reports asserted that the stimulation of ultrasonic scalpel and the persistent state of carbon dioxide (CO2) pneumoperitoneum in laparoscopic surgery may affect the adhesion and invasion of gastric cancer (GC) cells. This study aimed to reveal the effects of laparoscopic radical gastrectomy on peritoneal micrometastases (PM) of GC.

Materials and Methods:

Fifty-three patients who underwent laparoscopic radical gastrectomy for GC were enrolled in the study. The expressions of carcinoembryonic antigen (CEA) mRNA and dopa decarboxylase (DDC) mRNA in peritoneal lavage fluid were detected by reverse transcription-polymerase chain reaction. The positive rates of CEA mRNA and DDC mRNA in preoperative peritoneal lavage fluid (pre-CEA, pre-DDC) were compared with those in postoperative lavage fluid (post-CEA, post-DDC). The correlation between the expressions of pre-CEA and pre-DDC and clinicopathologic factors and disease-free survival was analyzed.

Results:

There was no significant difference in the positive rates of pre-CEA and pre-DDC compared with those of post-CEA and post-DDC (all P>0.05). The positive rates of pre-CEA and pre-DDC increased with the increase of TNM stage, deepening of invasion, lymph node metastasis, and serosal invasion (all P<0.05), but had no correlation with tumor location, size, degree of differentiation, nerve invasion, and vascular invasion (all P>0.05). The disease-free survival in the combined positive patients was lower than that in the negative patients.

Conclusions:

Laparoscopic radical gastrectomy for GC is safe and feasible, without increasing the risk of PM. The PM of GC may be associated with late tumor stage, deep infiltration, lymph node metastasis, and serosal invasion.
Emerging SARS-CoV-2 mutation hotspots associated with clinical outcomes
Authors: Pang Xianwu , Li Pu , Zhang Lifeng , Que Lusheng , Dong Min , Wang Qihui , Wei Yinfeng , Xie Bo , Xie Xing , Li Lanxiang , Yin Chunyue , Wei Liuchun , Zhou Qingniao , Li Yingfang , Yu Lei , Li Weidong , Mo Zengnan , Leng Jing , Hu Yanling
Published: April 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Understanding the influence of mutations in the SARS-CoV-2 gene on clinical outcomes and related factors is critical for treatment and prevention. Here, we analyzed 209,551 high-coverage complete virus sequences and 321 RNA-seq samples to mine the mutations associated with clinical outcome in the SARS-CoV-2 genome. Several important hotspot variants were found to be associated with severe clinical outcomes. Q57H variant in ORF3a protein were found to be associated with higher mortality rate, and was high proportion in severe cases (39.36%) and 501Y.V2 strains (100%) but poorly proportional to asymptomatic cases (10.04%). T265I could change nsp2 structure and mitochondrial permeability, and evidently higher in severe cases (20.12%) and 501Y.V2 strains (100%) but lower in asymptomatic cases (1.43%). Additionally, R203K and G204R could decrease the flexibility and immunogenic property of N protein with high frequency among severe cases, VUI 202012/01 and 484K.V2 strains. Interestingly, the SARS-CoV-2 genome was more susceptible to mutation because of the high frequency of nt14408 mutation (which located in RNA polymerase) and the high expression levels of ADAR and APOBEC in severe clinical outcomes. In conclusion, several important mutation hotspots in the SARS-CoV-2 genome associated with clinical outcomes was found in our study, and that might correlate with different SARS-CoV-2 mortality rates.
Temporal perturbations cause movement-context independent but modality specific sensorimotor adaptation
Authors: Schlichting Nadine , Kartashova Tatiana , Wiesing Michael , Zimmermann Eckart
Published: April 2021

Complex, goal-directed and time-critical movements require the processing of temporal features in sensory information as well as the fine-tuned temporal interplay of several effectors. Temporal estimates used to produce such behavior may thus be obtained through perceptual or motor processes. To disentangle the two options, we tested whether adaptation to a temporal perturbation in an interval reproduction task transfers to interval reproduction tasks with varying sensory information (visual appearance of targets, modality, virtual reality (VR) environment or real-world) or varying movement types (continuous arm movements or brief clicking movements). Halfway through the experiments we introduced a temporal perturbation, such that continuous pointing movements were artificially slowed down in VR, causing participants to adapt their behavior to sustain performance. In four experiments, we found that sensorimotor adaptation to temporal perturbations is independent of environment context and movement type, but modality specific. Our findings suggest that motor errors induced by temporal sensorimotor adaptation affect the modality specific perceptual processing of temporal estimates.