bluuebunny/crossref_metadata_2025 huggingface dataset:
Design of an actuator with bionic claw hook–suction cup hybrid structure for soft robot
Authors: Wang Xingxiang , Lin Aomin , Yuan Wenqing , Hu Hongwei , Cheng Guanggui , Ding Jianning
Published: April 2024

To improve the adaptability of soft robots to the environment and achieve reliable attachment on various surfaces such as smooth and rough, this study draws inspiration from the collaborative attachment strategy of insects, cats, and other biological claw hooks and foot pads, and designs an actuator with a bionic claw hook–suction cup hybrid structure. The rigid biomimetic pop-up claw hook linkage mechanism is combined with a flexible suction cup of a ‘foot pad’ to achieve a synergistic adhesion effect between claw hook locking and suction cup adhesion through the deformation control of a soft pneumatic actuator. A pop-up claw hook linkage mechanism based on the principle of cat claw movement was designed, and the attachment mechanism of the biological claw hooks and footpads was analysed. An artificial muscle-spring-reinforced flexible pneumatic actuator (SRFPA) was developed and a kinematic model of the SRFPA was established and analysed using Abaqus. Finally, a prototype of the hybrid actuator was fabricated. The kinematic and mechanical performances of the SRFPA and entire actuator were characterised, and the attachment performance of the hybrid actuator to smooth and rough surfaces was tested. The results indicate that the proposed biomimetic claw hook–suction cup hybrid structure actuator is effective for various types of surface adhesion, object grasping, and robot walking. This study provides new insights for the design of highly adaptable robots and biomimetic attachment devices.
Simulation and experimental study of notched cantilever beam for improved vibration energy harvesting
Authors: Tamrakar Rohit , Nannaware Pushparaj
Published: April 2024

This research paper addresses the design and analysis of a Notched Cantilever Beam Energy Harvester (NCBEH) aimed at enhancing vibration energy harvesting. The voltage output from Lead Zirconate Titanate (PZT) piezoelectric material is directly related to the strain it experiences. Therefore, numerical simulations using ANSYS were conducted to investigate the variations in natural frequency and stress–strain distribution with respect to slot length in a slotted cantilever beam. Additionally, a notch was introduced into the beam to further enhance strain distribution. The study found that, with precise PZT placement, an NCBEH with a 55 mm slot length can generate 15% more voltage output at lower natural frequencies compared to existing Piezoelectric Cantilever Beam Energy Harvesters (PCEH) [1]. Experimental tests were also conducted to compare the voltage output response of the NCBEH and the PCEH, with the results showing good agreement with the numerical simulation findings.
Private list sharing leads to cooperation and central hubs emergence in ABM
Authors: Vasellini Riccardo , Cecconi Federico , Mocenni Chiara
Published: April 2024

We introduce an agent based model framework to investigate how an alternative to classic image score and gossip can support the emergence of cooperation in a repeated prisoner dilemma game with agents employing mixed strategies. We debate the universality of image scores, arguing that they cannot be considered an objective property of the agents observed but rather a subjective property of each observer. From this assumption, we develop a private list mechanism for opponent selection and gossip sharing among the population of the simulation. The results show that the private list mechanism is able to foster the emergence of cooperation, and that for various levels of list usage different levels of cooperation correspond in the system. Finally, we observe interesting topological properties emerging, with networks characterised by one ‘super-hub’ connected to every other node, suggesting the emergence of centralized entities to support cooperation.
Women’s leadership in climate-resilient agrifood systems: defining a future research agenda
Authors: Morgan Miranda Yeen , Bryan Elizabeth , Elias Marlène
Published: April 2024

Women’s leadership is increasingly considered critical for achieving climate-resilient agrifood systems. Numerous initiatives and policies highlight the business case for women’s leadership to deliver a range of positive social, economic and environmental outcomes. In this Perspective, we examine the business case, finding uneven evidence linking women’s leadership to increased resilience to climate change. We problematize the ways women’s leadership is typically understood in this area and argue that, despite the value and utility of understanding the pathways through which women’s leadership can strengthen climate-resilient agrifood systems, support for increasing women’s leadership should not be contingent on proving the business case or its instrumental value. Rather, increasing the leadership of women in all their diversity in climate action is a moral imperative and non-negotiable due to women’s human right to have meaningful influence in the decisions that affect their lives. Finally, we propose ways to reframe the debate on women’s leadership in climate and agrifood systems and suggest priorities for future research in this area.
Geothermal power generation potential in the United States by 2050
Authors: Chen Chen , Merino-Garcia Daniel , Lines Timothy D G H , Cohan Daniel S
Published: April 2024

Geothermal energy provides a dispatchable source of carbon-free electricity that can balance the output of variable resources. However, geothermal provides just 3.7 gigawatts (GW
e
) (

<

1%) of electricity in the United States today, mostly from hydrothermal resources that are geographically constrained. Enhanced geothermal systems (EGS), which extract heat from deep rock, could be applicable in more locations. However, baseline levels and potential trends in EGS costs have been insufficiently characterized by previous studies. Here, we assess geothermal penetration potential by using as baseline the latest available data on drilling costs from three costing models to create updated estimates of costs and performance. We input those estimates along with various scenarios of cost trends, emissions policies, and electricity demand into the regional energy deployment system (ReEDS) capacity expansion model to simulate electricity generation in the United States through 2050. The scarcity of hydrothermal resources limits deployments to no more than 18 GW
e
across our scenarios. EGS is more costly than hydrothermal for now, but it has greater potential to scale nationwide. Thus, future deployments of EGS depend strongly on projected cost reductions and emissions policies. In scenarios with moderate (

<

50%) reductions in costs by 2050, very little EGS is likely to be built, since wind and solar with storage provide lower-cost electricity. However, over 70% cost reductions from our updated baseline would make geothermal the least-cost carbon-free dispatchable resource. Under those cost trends, we project that 3 GW
e
of EGS would be built by 2050 under existing policies, 11 GW
e
with a 95% decarbonization policy, and 152 GW
e
if full decarbonization of electricity is mandated. Most geothermal would likely first be built in western states with the steepest subsurface temperature gradients, although mandates for full decarbonization could drive it to be deployed in other states.
STMND1 is a phylogenetically ancient stathmin which localizes to motile cilia and exhibits nuclear translocation that is inhibited when soluble tubulin concentration increases
Authors: Deng Xiang , Seguinot Bryan O. , Bradshaw Gary , Lee Jong Suk , Coy Shannon , Kalocsay Marian , Santagata Sandro , Mitchison Timothy
Published: April 2024

Stathmins are small, unstructured proteins that bind tubulin dimers and are implicated in several human diseases, but whose function remains unknown. We characterized a new stathmin, STMND1 (Stathmin Domain Containing 1) as the human representative of an ancient subfamily. STMND1 features a N-terminal myristoylated and palmitoylated motif which directs it to membranes and a tubulin-binding stathmin-like domain (SLD) that contains an internal nuclear localization signal. Biochemistry and proximity labeling showed that STMND1 binds tubulin, and live imaging showed that tubulin binding inhibits translocation from cellular membranes to the nucleus. STMND1 is highly expressed in multiciliated epithelial cells, where it localizes to motile cilia. Overexpression in a model system increased the length of primary cilia. Our study suggests that the most ancient stathmins have cilium-related functions that involve sensing soluble tubulin.
Even worse for Black girls: the longitudinal association of racial bullying with the initiation of alcohol and tobacco use
Authors: Menezes Alessandra A S , Sanchez Zila M , Demarzo Marcelo , Rezende Leandro F M , Miskolci Richard
Published: April 2024

We used Poisson’s linear regression to examine the association between racial bullying (RB) and the initiation of alcohol and tobacco uses after 9 months. Two cluster-randomized controlled trials were conducted in 2019 with children in grades five (girls: 50.0%; 10 years old: 82.0%; White: 36.8%; Black: 58.7%; others: 4.5%) and seven (girls: 49.5%; 12 years old: 78.1%; White: 33.2%; Black: 60.4%; others: 6.4%) from 30 public schools in the municipality of São Paulo, Brazil. We restricted our analyses to 2 subsets of students in each grade: those who reported no lifetime alcohol use at baseline and those who reported no lifetime baseline tobacco use. At baseline, 16.2% of fifth and 10.7% of seventh graders reported suffering from RB in the 30 days before data collection. After 9 months, 14.9% of fifth graders started using alcohol and 2.5%, tobacco. Among seventh graders, the figures were 31.2% and 7.7%, respectively. RB predicted the initiation of use of alcohol (risk ratio [RR] = 1.36; 95% CI, 1.07-1.70) and tobacco (RR = 1.81; 95% CI, 1.14-2.76) among seventh graders, with race-gender differences, particularly in Black girls (alcohol: RR = 1.45; 95% CI, 1.07-1.93; tobacco: RR = 2.34; 95% CI, 1.31-3.99). School-based programs and policies must explicitly address issues related to racism and gender in alcohol and tobacco prevention strategies.
Catalytic dehydration of 1,2-butanediol to 1,3-butadiene over CsH2PO4/SiO2
Authors: Inaba Takami , Kurniawan Enggah , Hara Takayoshi , Yamada Yasuhiro , Sato Satoshi
Published: April 2024

Silica-supported alkali metal phosphate catalysts were investigated for the vapor-phase dehydration of 1,2-butanediol (1,2-BDO) to produce 1,3-butadiene (BD). Among the alkali metal phosphates explored, a silica-supported CsH2PO4 (CsH2PO4/SiO2) was found to be the most efficient catalyst. Several parameters, such as the Cs/P ratio, reaction temperature, and contact time, significantly affected the BD formation. The highest BD yield of 59.6% was achieved over 10CsH2PO4/SiO2 at 411 °C, with butanal and butanone as the main side products. Based on the conversion-selectivity plots at 411 °C, a possible reaction pathway for BD formation was proposed. In addition, the dehydrations of 1,2-epoxybutane and 2-buten-1-ol were also performed to verify the reaction sequence. The epoxidation of 1,2-BDO to 1,2-epoxybutane, which is one of the initial steps of the stepwise formation of BD, proceeded via an acid-base concerted mechanism. This work is the first report on the dehydration of 1,2-BDO to produce BD efficiently.
Olfactory function after mild traumatic brain injury in children—a longitudinal case control study
Authors: Gellrich Janine , Zickmüller Claudia , Thieme Theresa , Karpinski Christian , Fitze Guido , Smitka Martin , von der Hagen Maja , Schriever Valentin A
Published: April 2024

The prevalence of posttraumatic olfactory dysfunction in children after mild traumatic brain injury ranges from 3 to 58%, with potential factors influencing this variation, including traumatic brain injury severity and assessment methods. This prospective longitudinal study examines the association between mild traumatic brain injury and olfactory dysfunction in children. Seventy-five pediatric patients with mild traumatic brain injury and an age-matched healthy control group were enrolled. Olfactory function was assessed using the Sniffin’ Sticks battery, which focuses on olfactory threshold and odor identification. The study found that children with mild traumatic brain injury had impaired olfactory function compared with healthy controls, particularly in olfactory threshold scores. The prevalence of olfactory dysfunction in the patient group was 33% and persisted for 1 yr. No significant association was found between traumatic brain injury symptoms (e.g. amnesia, loss of consciousness) and olfactory dysfunction. The study highlights the importance of assessing olfactory function in children after mild traumatic brain injury, given its potential impact on daily life. Although most olfactory dysfunction appears transient, long-term follow-up is essential to fully understand the recovery process. The findings add valuable insights to the limited literature on this topic and urge the inclusion of olfactory assessments in the management of pediatric mild traumatic brain injury.
Distinct neural mechanisms for action access and execution in the human brain: insights from an fMRI study
Authors: Papitto Giorgio , Friederici Angela D , Zaccarella Emiliano
Published: April 2024

Goal-directed actions are fundamental to human behavior, whereby inner goals are achieved through mapping action representations to motor outputs. The left premotor cortex (BA6) and the posterior portion of Broca’s area (BA44) are two modulatory poles of the action system. However, how these regions support the representation-output mapping within the system is not yet understood. To address this, we conducted a finger-tapping functional magnetic resonance imaging experiment using action categories ranging from specific to general. Our study found distinct neural behaviors in BA44 and BA6 during action category processing and motor execution. During access of action categories, activity in a posterior portion of BA44 (pBA44) decreased linearly as action categories became less specific. Conversely, during motor execution, activity in BA6 increased linearly with less specific categories. These findings highlight the differential roles of pBA44 and BA6 in action processing. We suggest that pBA44 facilitates access to action categories by utilizing motor information from the behavioral context while the premotor cortex integrates motor information to execute the selected action. This finding enhances our understanding of the interplay between prefrontal cortical regions and premotor cortex in mapping action representation to motor execution and, more in general, of the cortical mechanisms underlying human behavior.
Acute myocardial infarction following radiofrequency catheter ablation in a child: a case report on the mechanism of coronary artery occlusion assessed by cardiovascular imaging
Authors: Nishio Ryota , Doi Shinichiro , Fukunaga Hideo , Dohi Tomotaka
Published: April 2024

Background

Radiofrequency ablation is a common treatment for atrioventricular nodal re-entrant tachycardia, even in paediatric patients weighing ≥15 kg, where outcomes are similar to those in adults. However, reports of acute coronary artery occlusion after radiofrequency ablation for atrioventricular nodal re-entrant tachycardia are rare.

Case summary

An 11-year-old girl with symptomatic atrioventricular nodal re-entrant tachycardia refractory to drug treatment underwent radiofrequency ablation. During the procedure, ST elevation was observed, and coronary angiography revealed occlusion of the right coronary artery at the segment 4 atrioventricular branch. Intravascular ultrasonography showed a narrowed lumen and an abnormal area of low echogenicity in the adjacent myocardium. After dilation with a 1.5 mm diameter balloon, blood flow was successfully restored. Follow-up coronary computed tomography angiography revealed residual stenosis in the right coronary artery at the segment 4 atrioventricular branch; however, blood flow to the distal occlusion was preserved. The patient was discharged without further complications.

Discussion

To the best of our knowledge, this is the first report of coronary artery occlusion following radiofrequency ablation for atrioventricular nodal re-entrant tachycardia, evaluated using intravascular ultrasonography and coronary computed tomography angiography. Based on the imaging findings, direct thermal injury was considered the cause of occlusion.
Two ‘firsts’ in a patient with tricuspid valve infective endocarditis following edge-to-edge repair: a case report
Authors: Patrascu Alexandru , Binder Donat , Al Farwan Feraas , Weinmann Kai , Ott Ilka
Published: April 2024

Background

Tricuspid regurgitation (TR) is associated with increased morbidity and mortality. As many elderly TR patients are deemed inoperable, transcatheter edge-to-edge repair (T-TEER) is arising as a viable treatment option. Though procedural safety aspects seem excellent, long-term risks cannot be ignored, including the feasibility of cardiac pacing by endovascular lead implantation at a later time, as well as T-TEER device-related infective endocarditis (IE), in the context of systemic infection.

Case summary

We present the case of an 80-year-old man with recurrent admissions for right heart failure due to massive TR, despite successful percutaneous mitral valve repair. The patient was turned down for surgery and eventually underwent T-TEER, with successful TR reduction to mild-to-moderate and improvement in quality of life. Five months later, the patient was admitted for symptomatic bradycardia and the first reported pacemaker implantation after T-TEER with a specific tricuspid valve device was performed. Lead implantation was guided by transoesophageal echocardiography, and did not worsen residual TR. Two years later, the patient presented with device-related tricuspid valve IE, again a ‘first’ following T-TEER. Despite antimicrobial therapy, the vegetation embolized through the atrial septal defect caused by prior mitral-TEER and triggered an ischaemic stroke. Furthermore, sepsis led to multiorgan failure and eventually death.

Discussion

Tricuspid regurgitation is an individual predictor of morbidity and mortality, frequently found in elderly, and should be addressed in symptomatic inoperable patients. With the rise of interventional treatment, new challenges face long-term follow-up and treatment after percutaneous repair. This case report underscores the feasibility of endovascular pacemaker lead implantation after T-TEER, while it points to the risk of device-related tricuspid valve IE.
Evolving consequences of right coronary artery to right atrium: coronary cameral fistula—a case report
Authors: How Wei Jun , Luckie Matthew , Bratis Konstantinos , Hasan Ragheb , Malik Nadim
Published: April 2024

Background

Coronary cameral fistula is a rare diagnosis, which may be picked up incidentally on cardiac imaging. While majority of cases is asymptomatic, they can be complicated by myocardial ischaemia, arrhythmias, heart failure, infective endocarditis, and rarely rupture or thrombosis of the fistula leading to sudden death.

Case summary

A 73-year-old female presents with fever, lethargy, and examination finding of a continuous cardiac murmur. CT coronary angiogram confirmed the presence of a coronary cameral fistula, with an aneurysmal RCA seen arising from the right coronary sinus, following an extensive tortuous course wrapping around the heart, and terminating at the right atrium. While there was initial streptococcus bacteraemia identified on blood culture sampling, no obvious masses were detected on the valves, chambers, or along the course of the fistula. Over time, she develops anginal chest pain and heart failure symptoms, with progressive dilatation of the right ventricle and functional tricuspid regurgitation secondary to shunting of the fistula into the right chambers. Surgical intervention was then pursued and successfully addressed these complications.

Discussion

This case report highlights the importance of advanced imaging modalities for accurate diagnosis of coronary cameral fistulae, addressing late manifestations of the disease and the necessity for a collaborative, multidisciplinary approach in managing complex cardiac anomalies.
In-depth analysis of pre- and postoperative functional outcome parameters in patients receiving laryngotracheal surgery
Authors: Evermann Matthias , Roesner Imme , Denk-Linnert Doris-Maria , Klepetko Walter , Schweiger Thomas , Hoetzenecker Konrad
Published: April 2024

OBJECTIVES

Surgical treatment for airway stenosis necessitates personalized techniques based on the stenosis location and length, leading to favourable surgical outcomes. However, there is limited literature on functional outcomes following laryngotracheal surgery with an adequate number of patients.

Methods

We conducted a retrospective analysis of patients who underwent laryngotracheal surgery at the Department of Thoracic Surgery, Medical University of Vienna, from January 2017 to June 2021. The study included standardized functional assessments before and after surgery, encompassing spirometry, voice measurements, swallowing evaluation and subjective patient perception.

RESULTS

The study comprised 45 patients with an average age of 51.9 ± 15.9 years, of whom 89% were female, with idiopathic being the most common aetiology (67%). Procedures included standard cricotracheal resection in 11%, cricotracheal resection with dorsal mucosal flap in 49%, cricotracheal resection with dorsal mucosal flap and lateral cricoplasty in 24% and single-stage laryngotracheal reconstruction in 16%. There were no in-hospital mortalities or restenosis cases during the mean follow-up period of 20.8 ± 13.2 months. Swallowing function remained intact in all patients. Voice evaluations showed a decrease in fundamental vocal pitch [203 (81–290) Hz vs 150 (73–364) Hz, P < 0.001] and dynamic voice range (23.5 ± 5.8 semitones vs 17.8 ± 6.7 semitones, P < 0.001). However, no differences in voice volume were observed (60.0 ± 4.1 dB vs 60.2 ± 4.8 dB, P = 0.788). The overall predicted voice profile changed from R0B0H0 to R1B0H1.

CONCLUSIONS

Laryngotracheal surgery proves effective in fully restoring breathing capacity while preserving vocal function. Even in cases of high-grade and complex airway stenosis necessitating laryngotracheal reconstruction, favourable functional outcomes can be achieved.
Eliminate LDL cholesterol after heart attack … but only for a while
Authors: Prati Francesco , Biccirè Flavio Giuseppe , Sammartini Emanuele , Gatto Laura
Published: April 2024

There is a clear demonstration of the inverse linear correlation between LDL cholesterol levels and clinical benefit. However, the timing of the action of lipid-lowering drugs is not clear. According to animal studies with recombinant lipoprotein A-1, the composition of atherosclerosis changes within 40 h (with variations in lipid and inflammatory contents). Progression–regression studies of atherosclerosis in humans confirm the data, highlighting a rapid change in the plaque over 5 weeks. The data are also in line with what emerges from the survival curves of the old study comparing atorvastatin 80 mg vs. placebo (Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering). The spacing of the curves occurs after only 4 weeks, indicating the precociousness of the favourable effects of powerful statins. Finally, a recent Odyssey post hoc analysis compared the risk of cardiac death and coronary revascularization between a group in which alirocumab lowered LDL cholesterol to below 15 mg (Group 1 and in which the drug was therefore stopped) against the subjects in the placebo group (Group 2), applying a propensity score matching. The primary endpoint occurred in a lower percentage of patients in Group 1 (6.4 vs. 8.4%). Furthermore, patients in Group 1 had a significantly lower hazard ratio (HR) for major adverse cardiovascular events [0.72; 95% confidence interval (CI) 0.51–0.997; P = 0.047] compared with the entire alirocumab group vs. placebo (HR 0.85; 95% CI 0.78–0.93; P < 0.001). According to these preliminary observations, aggressive and early treatment of hypercholesterolaemia in subjects with acute coronary syndrome translates into improved clinical results compared with a strategy that provides for more gradual control. These data will need to be confirmed through further prospective clinical studies and ideally with early conducted atherosclerosis regression studies.
There are those who would like zero LDL cholesterol
Authors: Borghi Claudio , Bragagni Alessio
Published: April 2024

The overwhelming evidence that the reduction of LDL cholesterol (LDLc) levels is associated with a parallel reduction in cardiovascular (CV) risk has led the scientific community to progressively and constantly reduce the optimal therapeutic targets of LDLc, both in patients with known CV disease and in patients undergoing primary prevention. The recent introduction of proprotein convertase subtilisin/kexin type 9 inhibitors has allowed clinicians to observe reductions in LDLc levels that go well beyond the limits set by the main international guidelines; following the ‘the lower the better’ paradigm, it is natural to ask how low LDLc can be reduced, whether this intervention is associated with a further reduction in CV risk and, above all, whether there are no issues related to safety in the use of polypharmacotherapies that determine an extreme reduction in LDLc levels. The purpose of this article is to summarize the main scientific evidence on the topic, trying to provide an answer to all clinicians who ‘would like their LDLc to be—almost—zero’.
Remote monitoring of severe heart failure
Authors: Scardovi Angela Beatrice , Boccanelli Alessandro
Published: April 2024

Patients with advanced heart failure, due to the instability of their clinical conditions, need close surveillance to avoid dangerous exacerbations or sudden events. Digital technology can be of great help in this contest, thanks to remote monitoring, made possible with the use of wearable or implantable instruments. The latter are currently generally inserted inside defibrillators or resynchronization systems, or inserted inside the pulmonary circulation for monitoring pulmonary pressure. Parameters such as thoracic impedance, physical activity, heart rate variability, atrial and ventricular arrhythmias, blood pressure, and O2 saturation can be controlled remotely. The data relating to the actual benefit in terms of avoidable events (death and hospitalizations) are not definitive, but certainly from an organizational point of view, the benefit is evident, both on the part of the patient and of the organization of care. The latter, provided in the form of televisits, requires a re-modulation of the system, making use of trained personnel, a well-structured network, and digital technologies (platforms, electronic health records) that are not yet perfectly developed. The evolution of the solutions offered by artificial intelligence guarantees a rapid and progressive refinement of telemedicine in this sector.
Places to go, people to know, things to learn
Authors: Smith Abigail M
Published: April 2024

Professor Abby Smith grew up in New England loving the ocean, and in due course became a marine scientist. From the vantage point of nearing retirement after over 30 years in the game, she reflects here on where she came from, people who helped along the journey, and what she learned.
Subcostal bilateral internal thoracic artery harvesting with the da Vinci Single Port system: an experimental feasibility study
Authors: Stein Hubert , Falk Volkmar , Zacharias Joseph , Ikeda Michael , Smith John Michael , Crichton Georgia , Ryckembusch Louis , Kempfert Jörg
Published: April 2024

We evaluated the feasibility of harvesting bilateral internal thoracic arteries with the da Vinci Single Port system (SP) through a single left-sided subcostal incision. Complete bilateral mobilization with sufficiently long conduits for multivessel grafting was possible in 2 human cadavers and 2 live porcine. Creating the subcostal access and docking the SP system took between 14 and 21 min and the total harvest time ranged from 65 to 125 min in all models. No major bleeding was observed in the live porcine and hemostasis was managed with the available instrumentation. One porcine deceased during surgery due to ventricular fibrillation followed by cardiac arrest. The robotic harvesting was technically easily reproduced by the surgeons and required no additional rib-spreading. Further studies will be required to assess if this subcostal approach with the da Vinci SP system yields true clinical benefits in patients.
Antibiotic prescribing practices of medical doctors in a resource-limited setting and the influence of individual perceptions and stewardship support: a survey in three tertiary hospitals in Vietnam
Authors: Vu Huong Thi Lan , Pham Thuy Thi Thanh , Duong Yen Hai , Truong Quan Anh , Nguyen Hong Khanh , Nguyen Tu Thi Cam , Trinh Long Xuan , Nguyen Ha Thi Hong , Le Minh Quang , Vu Vinh Hai , Chau Duc Minh , Huynh Nguyet Thi , Vo Em Thi Hoang Dung , Le Hoa Nguyen Minh , Pham Thach Ngoc , Pollack Todd M , Van Doorn H Rogier
Published: April 2024

Objectives

To understand antibiotic prescribing and influencing factors to inform antimicrobial stewardship (AMS) interventions to reduce unwanted consequences of antibiotic use in hospitals in Vietnam, a lower-middle-income country in Asia.

Methods

We conducted a cross-sectional study of doctors at three tertiary hospitals using non-probability convenience sampling, through a paper-based (Hospitals 1 and 2) or electronic (Hospital 3) survey. Questions included items on perceptions regarding antibiotic resistance and AMS, prescribing practices, knowledge, demographics and training. We used principal components analysis and mixed-effects models to examine practices and identify influencing factors.

Results

Among 314 surveyed participants, 61%, 57% and 59% in Hospitals 1, 2 and 3, respectively, felt certain about the appropriateness of their antibiotic prescriptions. In total, 9% reported sometimes prescribing antibiotics when not needed to meet patients’ expectations, and 13% reported doing so to avoid perceived complications. Higher prescribing confidence was found among those with positive perceptions about AMS (P < 0.0001), whereas negative perceptions about colleagues’ practices reduced this confidence (P < 0.0001). Individual preference for branded antibiotics was associated with more unnecessary prescribing whereas having higher prescribing confidence decreased the habits of prescribing when not needed.

Conclusions

This study provides important implications for design of hospital interventions to address influencing factors on antibiotic prescribing in Vietnam and similar resource-limited settings. Specific interventions should target improving knowledge through education and training for doctors, enhancing the support from the AMS team, and promoting guidelines and policies for appropriate antibiotic use in hospital.
Dihydrophenazine: a multifunctional new weapon that kills multidrug-resistant Acinetobacter baumannii and restores carbapenem and oxidative stress susceptibilities
Authors: Mahdally Norhan H , ElShiekh Riham A , Thissera Bathini , Eltaher Ashraf , Osama Aya , Mokhtar Maha , Elhosseiny Noha M , Kashef Mona T , Magdeldin Sameh , El Halawany Ali M , Rateb Mostafa E , Attia Ahmed S
Published: April 2024

Aims

The current work aims to fully characterize a new antimicrobial agent against Acinetobacter baumannii, which continues to represent a growing threat to healthcare settings worldwide. With minimal treatment options due to the extensive spread of resistance to almost all the available antimicrobials, the hunt for new antimicrobial agents is a high priority.

Methods and results

An Egyptian soil-derived bacterium strain NHM-077B proved to be a promising source for a new antimicrobial agent. Bio-guided fractionation of the culture supernatants of NHM-077B followed by chemical structure elucidation identified the active antimicrobial agent as 1-hydroxy phenazine. Chemical synthesis yielded more derivatives, including dihydrophenazine (DHP), which proved to be the most potent against A. baumannii, yet it exhibited a marginally safe cytotoxicity profile against human skin fibroblasts. Proteomics analysis of the cells treated with DHP revealed multiple proteins with altered expression that could be correlated to the observed phenotypes and potential mechanism of the antimicrobial action of DHP. DHP is a multipronged agent that affects membrane integrity, increases susceptibility to oxidative stress, interferes with amino acids/protein synthesis, and modulates virulence-related proteins. Interestingly, DHP in subinhibitory concentrations re-sensitizes the highly virulent carbapenem-resistant A. baumannii strain AB5075 to carbapenems providing great hope in regaining some of the benefits of this important class of antibiotics.

Conclusions

This work underscores the potential of DHP as a promising new agent with multifunctional roles as both a classical and nonconventional antimicrobial agent that is urgently needed.
19 Influence of Co-morbid Modifiable Risk Factors on Adipose-Derived Stem Cell Paracrine Factors in Burn Patients
Authors: Robinson Jared M , Dennis Jenna , Trinh Sophia , Fontenot Cameron , Phelan, III Herb A , Carter Jeffrey E , Schoen Jonathan E , Smith Alison A
Published: April 2024

Introduction

Delayed post-operative wound healing contributes to complications resulting in significant morbidity, mortality and healthcare costs. Co-morbid conditions can act as modifiable risk factors (MRFs) in post-operative wound healing, and their influence has previously been described. However, comparisons of subcellular impacts are less well understood. Adipose-derived stem cells (ADSCs) stimulate a repair response in burned tissue using paracrine signaling factors to alter the surrounding cellular environment. In this pilot study, we tested the hypothesis that the paracrine factor profiles secreted by ADSCs isolated from damaged adipose tissue at the time of burn injury would be altered with differing combinations of MRFs.

Methods

Adipose tissue was collected from adult patients (N=15) with severe burn injuries (>20% total body surface area) and non-severe burn injuries (N=2) at the index operation. ADSCs were extracted and cultured in vitro. Supernatants were harvested 30 hours after plating and used for cytokine determinations by Multiplex assay. Fluorescence activated single cell sorting () confirmed their phenotype with markers CD 90, CD 166, and CD 73. Analysis of variance (ANOVA) and Tukey’s postestimation were performed to compare cohorts with and without comorbid substance use disorder (S-MRF), cardiovascular disease (V-MRF), nutritional deficiency (N-MRF), or a combination of concurrent MRFs (SVN-, SV-, SN-, and VN-MRF).

Results

Profiles from the VN-MRF cohort showed a significant difference (p < 0.05) in IL-6 concentrations from V-, N-, SVN-, and SV-MRF cohorts and IL-8 from S-, V-, N-, SV-, and SVN-MRF cohorts. Profiles from the SV-MRF cohort showed a significant difference (p < 0.05) in IFN-y concentrations from S-, V-, and N-MRF cohorts and IL-17 from V-MRF cohorts. No significant differences in supernatant concentrations of IL-1 beta, IL-4, IL-10, IL-13, TGF-a, TNF-a, FGF-2, MCP-1, VEGF, or MRF were observed (p>0.05).

Conclusions

This study suggests ADSC paracrine factor expression at the time of a burn injury may vary with different combinations of comorbidities and potentially in demographics with a higher burden of chronic illness.

Applicability of Research to Practice

Future studies are needed to examine how modifiable risk factors impact wound healing and post-operative outcomes in burn patients.
27 Streamlining the Discharge Process
Authors: Coffey Rebecca , Salazar Elizabeth , Ewing Amber , Faris Janie J , Ruiz Alina , Terry Michelle
Published: April 2024

Introduction

Survival rates of burn patients are increasing but the challenges for hospital discharge are numerous and require a comprehensive approach for a successful discharge. The unit-based council of a regional burn center identified two reasons for readmissions; inadequate education and preparation prior to discharge. The purpose of this quality project was to evaluate the discharge processes, identify opportunities and improve patient outcomes.

Methods

Data was collected on readmission rates and discharge instruction accuracy prior to implantation of the new discharge process (NDP). After development of the NDP education was provided to all burn team members. All discharged patients during the evaluation period from 6/1 to 8/31/2023 were reviewed. Data collection included: readmission rates, number of patients receiving discharge phone calls (9/1/2023 – 9/28/202), and the use of the new discharge instructions.

Results

A total of 478 discharges occurred during the evaluation period. New discharge instructions were used 38.5% versus old instructions 61.5%. Twenty-eight patients (100%) received discharge phone calls; all patients understood wound care instructions. One patient had difficulty completing wound care, 2 patients did not receive supplies, and 3 patients did not pick up the prescription medications. Readmission rates improved to 7% with, wound care (30.7%), cellulitis (30.7%) and uncontrolled pain (7%) as the most common reasons for readmission. All burn patients received the new discharge education folders with references to the newly completed wound care videos.

Conclusions

A systematic multidisciplinary approach to the discharge process will provide safe and effective discharge for the burn patient. Education of all team members is imperative for successful change.

Applicability of Research to Practice

Identifying gaps in the discharge process will improve long term outcomes for patients.
28 Substance Use Disorder: A National Survey
Authors: Van Dobbe  , Bay Curt C , Richey Karen J , Foster Kevin N
Published: April 2024

Introduction

Substance use disorder (SUD) involves an individual’s inability to control their use of drugs, alcohol and/or medications. Our burn center provides care to over 1,400 inpatients and 5,000 outpatients a year, and we see numerous patients with this disorder who have complex and challenging needs that can affect staff member perspectives on providing care. To establish a broader outlook on the relationship between burn center staff and patients with SUD, a survey was conducted within our center in 2022 and the same survey was sent to burn centers nationwide in 2023.

Methods

A modified version of the 11-item Medical Condition Regard Scale was distributed via SurveyMonkey to burn professionals across the country. It was requested that they distribute to team members as appropriate. An additional 6 burn specific questions were asked. Participants were asked to respond on a 6-point Likert scale. There were both positively (POS) and negatively (NEG) phrased questions. No personal or professional demographic data was collected to ensure anonymity. Binary frequencies were calculated.

Results

A total of 60 individuals responded. When responding to POS questions, the majority agreed that insurance coverage should be equal to other conditions (88%), would not mind being called in to care for this population (53%), felt they could find something to help the patient feel better (67%), and found working with SUD patients satisfying (50%). The majority did not enjoy giving extra time to burn patients with substance use disorder (60%). When asked NEG questions, 38% responded it was difficult to work with these patients, 25% reported irritation, 23% preferred not to work with SUD patients, 20% felt there was little they could do to help, and 7% felt it was a waste of medical dollars. When asked POS burn specific questions, 68.3% felt current practice to manage withdrawal symptoms was effective, 65% felt that these patients experienced more anxiety, had other mental health disorders (86%) and that pain management was particularly difficult (90%). When asked NEG burn specific questions 48% felt the care they provided was appreciated, and only 58% felt safe when providing care.

Conclusions

Overall response rate was low. Similar to the 2022 survey, the national survey indicated that staff were willing to help these patients yet reported difficulty in working with this population. Likewise, nationwide survey responses identified management of pain and withdrawal symptoms as areas of care requiring improvement. Of interest in our original survey 65% of staff feel compassionate toward burn patients with substance use disorders while 2023 survey results indicate 43% of staff feeling compassionate toward burn patients with SUD.

Applicability of Research to Practice

Survey results can be used to develop protocols and improve patient outcomes as well as patient and staff satisfaction.
71 Burn Camp Outcomes: Capturing Changes in Pediatric Quality of Life
Authors: Mikolaj Kerry , Jackson Brad , Schiffer Nichole , Boulter Trudy J , Kierulf Genevieve
Published: April 2024

Introduction

The Pediatric Quality of Life Inventory (PedsQL) is an outcome measure used to assess health related quality of life in children and adolescents. This tool is used in healthy, acute, and chronic health conditions to assess physical and psychosocial functioning. We applied this measure with our pediatric burn survivors and their caregivers. Within a burn camp setting, we evaluate progress towards programming goals relating to physical functioning, emotion regulation, social skill challenges, and academic participation. In order to further assess the impact of burn camp experiences on quality of life, we are in the process of collecting PedsQL data from patients in the burn clinic who have not attended burn camp.

Methods

PedsQL surveys were sent to campers ages 8-18 years old and their caregivers prior to burn camp and again 3 months post-camp from 2018-2023. Surveys consisted of questions relating to physical, emotional, social, and school functioning. Survey data were coded and average scores for each functioning scale were used to generate a total score, psychosocial health score, and physical health score for each subset of surveys.

Results

PedsQL scores increased following burn camp among both camper and caregiver reports for all outcomes measured. High scores are indicative of a better quality of life rating (see Tables 1 & 2).

Conclusions

PedsQL surveys were trialed as a measure of burn camp outcomes from 2018-2019, showing positive changes among quality of life measures post-camp for both campers and caregivers. Since 2019 we have significantly expanded our data set, showing similar trends, and now plan to compare PedsQL scores of campers with those of burn injured children seen in our burn clinic, who did not attend camp.

Applicability of Research to Practice

The PedsQL is a validated outcome measure used to assess quality of life in children with a wide range of medical conditions. Our research supports the use of this tool in evaluating the success of medical specialty camps.
79 Diagnosis and Management of Orbital Compartment Syndrome in Burn Patients —a Systematic Review
Authors: Makarewicz Nathan , Perrault David , Sheckter Clifford C
Published: April 2024

Introduction

Orbital compartment syndrome (OCS) is a recognized yet poorly understood problem in the acute management of major burns. Proposed risk factors including large volume resuscitation and deep burns to the orbital region, though OCS has been described in less severe burns. Diagnosis remains inconsistent in terms of pressure thresholds, and management is controversial regarding indications for surgical decompression. A systematic review is necessary to understand OCS in greater detail and guide management.

Methods

A systematic review of the literature discussing OCS in burn patients was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, and Embase were searched from inception of literature until June 2023. All primary literature publications were considered. Animal studies were excluded. Study quality was assessed using two validated scoring systems.

Results

303 unique articles were identified of which 8 met inclusion criteria. All studies were retrospective. 5/8 studies measured intraocular pressure. 2 studies defined OCS at IOP>40mmHg, 2 studies defined OCS at IOP>30mmHg, and one defined OCS at IOP>30-40mmHg. A total of 60 unique cases with OCS were reported. The weighted mean total body surface area (TBSA) of burn was 58%. The weighted mean percentage of patients with orbital burns was 85%. The mean weighted 24-hour resuscitation volume was 6.64cc/kg/TBSA. Surgical treatment was always a lateral canthotomy, and some authors added cantholysis. When post-canthotomy pressures were taken, they normalized in every case. Long-term outcomes such as vision were not consistently reported. Further, reconstructive management was not described. Mortality ranged in the studies between 8-67%. The methodological index for non-randomized studies (MINORS) rated three studies as good, one as fair, and four as poor.

Conclusions

The most common patient with OCS is a large surface area (>55% TBSA) burn with facial involvement undergoing resuscitation that exceeds 6cc/kg/TBSA. A precise decompressive threshold remains conflicted though all studies agree on a 30-40mmHg. Surgical decompression consisted of lateral canthotomy with the addition of cantholysis if pressures did not normalize.

Applicability of Research to Practice

Burn practitioners should be aware of risk factors for OCS and measure IOP in any large TBSA burn (i.e. >40% TBSA) with facial involvement undergoing resuscitation exceeding 4cc/kg/TBSA. Lateral canthotomy should be performed in timely fashion with confirmation of normalization of IOP. Persistently elevated IOP should be treated with cantholysis.