bluuebunny/crossref_metadata_2025 huggingface dataset:
Gangliosides modulate insulin secretion by pancreatic beta cells under glucose stress
Authors: Jennemann Richard , Kaden Sylvia , Volz Martina , Nordström Viola , Herzer Silke , Sandhoff Roger , Gröne Hermann-Josef
Published: March 2020

In pancreatic beta cells, the entry of glucose and downstream signaling for insulin release is regulated by the glucose transporter 2 (Glut2) in rodents. Dysfunction of the insulin-signaling cascade may lead to diabetes mellitus. Gangliosides, sialic acid-containing glycosphingolipids (GSLs), have been reported to modulate the function of several membrane proteins.Murine islets express predominantly sialylated GSLs, particularly the simple gangliosides GM3 and GD3 having a potential modulatory role in Glut2 activity. Conditional, tamoxifen-inducible gene targeting in pancreatic islets has now shown that mice lacking the glucosylceramide synthase (Ugcg), which represents the rate-limiting enzyme in GSL biosynthesis, displayed impaired glucose uptake and showed reduced insulin secretion. Consequently, mice with pancreatic GSL deficiency had higher blood glucose levels than respective controls after intraperitoneal glucose application. High-fat diet feeding enhanced this effect. GSL-deficient islets did not show apoptosis or ER stress and displayed a normal ultrastructure. Their insulin content, size and number were similar as in control islets. Isolated beta cells from GM3 synthase null mice unable to synthesize GM3 and GD3 also showed lower glucose uptake than respective control cells, corroborating the results obtained from the cell-specific model. We conclude that in particular the negatively charged gangliosides GM3 and GD3 of beta cells positively influence Glut2 function to adequately respond to high glucose loads.
The impact of broad-based vs targeted taxation on youth alcohol consumption in Lebanon
Authors: Chalak Ali , Ghandour Lilian , Anouti Sirine , Nakkash Rima , Yassin Nasser , Afifi Rima
Published: March 2020

This study aims to model youth’s off-premise alcohol demand and forecasts ethanol intake responsiveness to alcohol taxes. Using stated preference alcohol purchase data from a survey of 1024 university students in Lebanon, we derive price elasticities that we use to forecast the effects of two excise tax scenarios on overall ethanol intake. The first scenario imposes a broad-based 20% tax on all types of alcoholic beverages, and the second scenario imposes a targeted 20% tax only on the high ethanol content, while exempting the lower ethanol beverages. Overall, targeted taxes are found to achieve a reduction in ethanol intake that is nearly three times that achieved by broad taxes (15.7% vs 5.3%). For ‘past-month binge drinkers’, targeted taxes would decrease alcohol intake by 16.3%, while broad taxes increase it by 3.3%. Finally, ethanol intake among participants who prefer low ethanol content would decrease under targeted taxes by more than five times as much as under broad taxes. For ‘high-ethanol drinkers’, targeted taxes decrease alcohol intake by an even larger proportion than for ‘low-ethanol drinkers’ (19.0% vs 15.6%), while broad taxes increase their ethanol intake by ∼16.0%. This study contributes evidence that taxation policy substantially reduces alcohol consumption and that alcohol consumption patterns should be accounted for when designing taxes.
E-healthy diet literacy scale and its relationship with behaviors and health outcomes in Taiwan
Authors: Van Duong Tuyen , Chiu Chia-Hui , Lin Cheng-Yu , Chen Yi-Chun , Wong Te-Chih , Chang Peter W S , Yang Shwu-Huey
Published: March 2020

The study was to develop the e-healthy diet literacy (e-HDL) questionnaire based on the comprehensive health literacy (HL) conceptual framework, to examine the association among HL, e-HDL, health behaviors and outcomes. A nationwide study was conducted on 1342 adults aged 18 years and above, between April and September 2017. Multi-stage random sampling was used to recruit the participants from four regions and 19 cities and counties in Taiwan. HL and e-HDL were measured by HLS-SF12 and the e-healthy diet literacy questionnaire (e-HDLQ), respectively. Socio-demographics, behaviors (e.g. smoking, drinking and exercising) and health outcomes were also measured. Principal component analysis (PCA), linear regression models and logistic regression models were used. The mean age was 33.9 ± 11.4 years. The e-HDLQ was constructed with 11 items. A positive association between HL and e-HDL was found. In the multivariate analysis, HL and e-HDL were significantly lower in men and higher in those who used Facebook for searching information. HL was positively associated with the ability to pay for medication, and social status. The e-HDL was lower in older participants, and people who searched for healthy cooking, healthy food places or weight control, as compared with ones searched for nutritional therapies, while positively associated with education. Both HL and e-HDL were positively associated with health status and physical activities. In conclusion, the valid e-HDL survey tool was developed for general public use. The e-HDL strongly associated with HL, while both were determined by gender, online searching means and linked to health behaviors and outcomes.
Effects of a geriatric education program for emergency physicians: a mixed-methods study
Authors: Hesselink Gijs , Sir Özcan , Öztürk Ekin , Heiwegen Nikki , Olde Rikkert Marcel , Schoon Yvonne
Published: March 2020

Emergency physicians (EPs) often regard care for older adults as complex, while they lack sufficient geriatric skills. This study evaluates the effect of a geriatric education program on EPs’ geriatric knowledge, attitude and medical practice when treating older adults. A mixed-methods study was performed on EPs from two Dutch hospitals. Effects were measured by pre–post tests of EPs’ (n = 21) knowledge of geriatric syndromes and attitudes toward older adults, and by a retrospective pre–post analysis of 100 records of patients aged 70 years or more. Six EPs were purposively sampled and interviewed after completion of the education program. The program significantly improved EPs’ geriatric knowledge. EPs indicated that the program improved their ability and attentiveness to recognize frailty and geriatric syndromes. The program also significantly improved EPs’ attention for the older patient’s social history and circumstances (P = 0.04) but did not have a significant effect on medical decision making. EPs valued especially the case-based teaching and indicated that the interactive setting helped them to better understand and retain knowledge. Combined quantitative and qualitative data suggest that EPs benefit from geriatric emergency teaching. Future enhancement and evaluation of the geriatric education program is needed to confirm benefits to clinical practice and patient outcomes.
Research of cooling load & chiller selection in metro station
Authors: Wang Zhiyi , Zhong Jiachen , Pan Zudong
Published: March 2020

Air conditioning is of the most energy saving potential system in the metro station. This study analyzes the composition and characteristics of air conditioning cooling load in a metro station. The hourly distribution and the proportion of each cooling load are calculated. The results show that cooling load fluctuation of metro air conditioning is large, and the operating time of different load varies greatly. According to the air conditioning cooling load, the coefficient of performance of the fixed frequency screw, variable frequency screw, series countercurrent screw and magnetic bearing centrifugal chiller under the load of 20–100% are tested. The annual operating cost of four chillers is compared. Test results show that the magnetic bearing centrifugal chiller has a much higher coefficient of performance at part load and lower annual operating cost. Increased initial investment can be recovered in less than 2 years. The magnetic bearing centrifugal chiller is suitable as a cold source of air conditioning system in the metro station.
Maternal Secretor Status Affects Oral Rotavirus Vaccine Response in Breastfed Infants in Bangladesh
Authors: Williams Frank B , Kader Abdul , Colgate E Ross , Dickson Dorothy M , Carmolli Marya , Uddin Muhammad Ikhtear , Sharmin Salma , Islam Shahidul , Bhuiyan Taufiqur Rahman , Alam Masud , Nayak Uma , Mychaleckyj Josyf C , Petri William A , Haque Rashidul , Qadri Firdausi , Kirkpatrick Beth D , Lee Benjamin
Published: March 2020

Secretor status controls mucosal histo–blood group antigen expression and is associated with susceptibility to rotavirus (RV) diarrhea, with nonsecretors less susceptible to symptomatic infection. The role of breast milk secretor status on oral live-attenuated RV vaccine response in breastfed infants has not been explored. In a monovalent G1P[8] RV vaccine (Rotarix) trial in Bangladesh, RV-specific plasma immunoglobulin A antibody seroconversion rates were higher among infants of maternal nonsecretors (39%) than infants of maternal secretors (23%; P = .001). Maternal status remained a significant predictor when correcting for infant status (P = .002). Maternal secretor status should be considered when interpreting oral RV vaccine responses in low- and middle-income settings.

Clinical Trials Registration. NCT01375647.
Developing Quality Programs for Cell-Free DNA (cfDNA) Extraction from Peripheral Blood
Authors: Samoila Aliaksandra , Sosa Jose , Padilla Jessica , Wutkowski Michael , Vanness Katelynd , Viale Agnes , Berger Michael , Houck-Loomis Brian , Pessin Melissa , Peerschke Ellinor I
Published: March 2020

Background

Cell-free DNA (cfDNA) analysis using peripheral blood represents an exciting, minimally invasive technology for cancer diagnosis and monitoring. The reliability of testing is dependent on the accuracy and sensitivity of specific molecular analyses to detect tumor-associated genomic variants and on the quantity and quality of cfDNA available for testing. Specific guidelines for standardization and design of appropriate quality programs focused specifically on cfDNA isolation are lacking, as are standardized quality control reagents.

Content

This report describes and illustrates quality control and quality assurance processes, supported by generation of in-house quality control material, to ensure the reliability of the preanalytical phase of cfDNA analysis.

We have developed a robust quality program to support high-volume automated cfDNA extraction from peripheral blood by implementing processes and procedures designed to monitor the adequacy of specimen collection, specimen stability, efficiency of cfDNA extraction, and cfDNA quality.
Classifying non-small cell lung cancer types and transcriptomic subtypes using convolutional neural networks
Authors: Yu Kun-Hsing , Wang Feiran , Berry Gerald J , Ré Christopher , Altman Russ B , Snyder Michael , Kohane Isaac S
Published: March 2020

Objective

Non-small cell lung cancer is a leading cause of cancer death worldwide, and histopathological evaluation plays the primary role in its diagnosis. However, the morphological patterns associated with the molecular subtypes have not been systematically studied. To bridge this gap, we developed a quantitative histopathology analytic framework to identify the types and gene expression subtypes of non-small cell lung cancer objectively.

Materials and Methods

We processed whole-slide histopathology images of lung adenocarcinoma (n = 427) and lung squamous cell carcinoma patients (n = 457) in the Cancer Genome Atlas. We built convolutional neural networks to classify histopathology images, evaluated their performance by the areas under the receiver-operating characteristic curves (AUCs), and validated the results in an independent cohort (n = 125).

Results

To establish neural networks for quantitative image analyses, we first built convolutional neural network models to identify tumor regions from adjacent dense benign tissues (AUCs > 0.935) and recapitulated expert pathologists’ diagnosis (AUCs > 0.877), with the results validated in an independent cohort (AUCs = 0.726-0.864). We further demonstrated that quantitative histopathology morphology features identified the major transcriptomic subtypes of both adenocarcinoma and squamous cell carcinoma (P < .01).

Discussion

Our study is the first to classify the transcriptomic subtypes of non-small cell lung cancer using fully automated machine learning methods. Our approach does not rely on prior pathology knowledge and can discover novel clinically relevant histopathology patterns objectively. The developed procedure is generalizable to other tumor types or diseases.
7 Artificial Intelligence and Machine Learning as a Predictive Tool for Acute Kidney Injury in Trauma and Severely Burned Patients
Authors: Falwell Stephanie M , Tran Nam K , Sen Soman , Palmieri Tina L , Greenhalgh David G , Rashidi Hooman
Published: March 2020

Introduction

Kidney injury doubles burn mortality—thus, early prediction of acute kidney injury (AKI) in the burn population could benefit from artificial intelligence (AI) and machine learning (ML). Our objective in this study was to build and assess the theoretical performances of such AI/ML algorithms and to develop generalizable models that could augment AKI recognition.

Methods

Two databases containing patients that received neutrophil gelatinase associated lipocalin (NGAL), creatinine, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and urine output (UOP) measurements at admission were used to train, test, and generalize the AI/ML models. Models were first optimized in Cohort A for predicting AKI in Cohort B. Cohort A (n = 50) was based on a retrospective dataset of adult (age³18 years) burn patients, while Cohort B (n = 51) consisted of prospectively enrolled adult burned or non-burned trauma patients at risk for AKI. We employed a grid search and cross validation approach in building 68,100 unique ML models from five distinct ML approaches: logistic regression (LR), k-nearest neighbor (k-NN), support vector machine (SVM), random forest (RF), and deep neural networks (DNN) which enabled us to find the most accurate ML models.

Results

The best generalization accuracy (86%), sensitivity (91%), and specificity (85%) with NGAL alone was noted with LR, SVM and RF models. Generalizability prediction accuracy, sensitivity and specificity were respectively highest with the optimized DNN model (92%, 100%, and 90%) and the k-NN model (92%, 91%, and 93%) when tested with Cohort B using all four biomarkers. k-NN provided best generalization accuracy (84%) without NGAL using only NT-proBNP and creatinine, followed by DNN using creatinine only with an accuracy of 82%. AI/ML algorithms using results obtained at admission accelerated the average (SD) time to AKI prediction by 61.8 (32.5) hours.

Conclusions

NGAL is analytically superior to traditional AKI biomarkers such as creatinine and UOP. With machine learning, the AKI predictive capability of NGAL can be further enhanced and accelerated when combined with NT-proBNP, UOP, and creatinine.

Applicability of Research to Practice

Without NGAL, machine learning models continue to provide robust means in accelerating the prediction of AKI using both common and biomarkers of cardiorenal dysfunction.
42 CFTR Mediates Enteric Bacterial Translocation Post Severe Burn via ERK and Inflammatory Signaling
Authors: Liu Xinzhu , Shen Chuanan
Published: March 2020

Introduction

This research was to investigate the role of cystic fibrosis transmembrane conductance regulator (CFTR) in mediating enteric bacterial translocation (EBT) post severe burn as well as the signaling pathways involved.

Methods

A hypoxia treatment model of Caco-2 in vitro and a 30% TBSA full-thickness dermal burn mice model in vivo were established to explore the effect of major burn injury on intestinal epithelial barrier and the expression of CFTR and tight junction proteins. In addition, the DF508 mice (mice with F508del CFTR gene mutation) were used to analyze bacterial counts in extraintestinal organs and the expression of ZO-1, OCLN and E-cadherin. And CFTR specific inhibitor or down-regulation of CFTR in Caco-2 cells were used to explore the effect of CFTR on tight junction of intestinal cells. Furthermore, in the models above, MAPK pathway and inflammatory factors were detected to explore the mechanism. Finally, Vitamin D3 was used to pretreat mice before severe burn or Caco-2 cells before hypoxia. Bacterial counts in extraintestinal organs and the expression of CFTR, ZO-1, OCLN and P-ERK as well as the concentrations of inflammatory factors were detected.

Results

Our data showed a decrease of CFTR, concomitant with activation of ERK signaling, elevation of inflammatory factors (TNF-α, IL-1β and IL-8) and declined expression of ZO-1, occludin and E-cadherin, and a cellular mislocation of ZO-1 and OCLN post hypoxia. Furthermore, either administration of CFTR specific inhibitor or down-regulation of CFTR caused similar alterations as hypoxia did. Ileum of DF508 -/- and +/- mice exhibited increased inflammation, declined ZO-1, occludin and E-cadherin and EBT compared to +/+ mice. Moreover, vitamin D3 could reverse the junctional damage induced by hypoxia, thus preventing occurrence of EBT, possibly via up-regulating CFTR.

Conclusions

CFTR/ERK/inflammatory factors signaling was critical in modulating intestinal epithelial junction, accordingly regulating EBT. Vitamin D3 can protect intestinal epithelial barrier after severe burn, which may be associated with the up-regulation of CFTR, the inhibition of ERK pathway and decreased pro-inflammatory cytokine.

Applicability of Research to Practice

This research may be used in practice in the future to regulate the metabolism after severe burns.
47 Burn-induced Ileal Extracellular Matrix Upregulation Associated with Epithelial to Mesenchymal Transition
Authors: Cummins Claire B , Wang Xiaofu , Gu Yanping , Song Jusong , Radhakrishnan Ravi S
Published: March 2020

Introduction

Severe burns have long been associated with systemic inflammation and intestinal dysfunction. Recent evidence suggests that intestinal fibrosis may be responsible for intestinal dysfunction after burns. In response to inflammatory stimuli, intestinal epithelial cells may undergo epithelial-mesenchymal transition (EMT). EMT is a process by which epithelial cells acquire a mesenchymal-like phenotype, thereby compromising epithelial barrier function. EMT has been implicated in the pathogenesis of intestinal fibrosis. In the present study, we examined the cellular mechanism of burn-induced intestinal dysfunction.

Methods

Male BALA/c mice (8–12 weeks) received 30% total body surface area full-thickness scald burns or sham procedure. Ileal tissue was collected 5 days after burn for immunofluorescence (IF) and Western blot. Rat intestinal epithelial cell line IEC-6 was treated with cytokines and EMT marker proteins were analyzed by Western blot.

Results

IF data demonstrated that burn significantly increased extracellular matrix (ECM) protein laminin in ileal tissues, suggesting that burn injury induces ileal fibrogenesis. In IEC-6 cells treated with Tumor necrosis factor (TNF) α, IL-1β dose-dependently upregulated α-smooth muscle actin (α-SMA), a well known marker for myofibroblasts. ECM proteins fibronectin and laminin were found to be significantly increased after TNFα treatment. Tight junction protein E-cadherin was decreased after TNFα treatment. Futhermore, TNF receptor signaling antagonist R-7050 and SM7368 blocked TNFα-induced α-SMA upregulation.

Conclusions

Burn-induced mouse ileum ECM upregulation may be through TNFα-mediated EMT.

Applicability of Research to Practice

TNFα receptor antagonism could represent a potential pathway for drug development for treatment of burn-induced intestinal dysfunction.
59 Annual Incidence of Childhood Burn Injuries and Prevalence of Household Risk Factors in Rural Ghana: A Population-based Cluster-randomized Survey
Authors: Mehta Kajal , Gyedu Adam , Mock Charles , Stewart Barclay T
Published: March 2020

Introduction

Childhood burns are a leading cause of injury in low- and middle-income countries. Many childhood burns can be prevented by modifications in the household environment and targeted education. Therefore, we aimed to determine the incidence of childhood burn injuries and describe the prevalence of potentially modifiable household risk factors.

Methods

We performed a population-based, cluster-randomized, household survey of 358 households in a rural district in Ghana. From the district, 6 of 11 community clusters were randomly selected. Within these clusters, a census of all households with a caregiver of at least one child < 5 years of age was conducted. Caregivers were interviewed regarding childhood burn injury (CBI) within the past 6 months and potentially modifiable household risk factors.

Results

Of the 358 households sampled, most households lived in completed structures they owned (67%, 95% CI 61.9–71.6%). The adjusted annual incidence of childhood burn injury was 7.9%. The median age of burn injury was 3 years. The most common etiology of CBI was flame burn (53%, 95% CI 36.8–67.7%). Increasing year of age (AOR 0.92, 95% CI 0.84–1.01) and households with an older sibling ³12 years (AOR 0.53, 95% CI 0.24–1.17) were weakly associated with lower odds of CBI. The majority of households (84%, 95% CI 80.5–88%) used an open fire with firewood as fuel arrangement for cooking. In most households there was not a separate room used as a kitchen (90%, 95% CI 86–92.4%) and the stove/cooking arrangement height was within reach of children under five (< 1 meter; 96%, 95% CI 94.6–97%). Female gender (AOR 1.37, 95% CI 0.71–2.64), outdoor cooking arrangement (AOR 1.05, 95% CI 0.42–2.62) and an increased number of children under caregiver supervision (≥5 children; AOR 1.32, 95%CI 0.42–2.62) were not predictive of CBI.

Conclusions

Burns are a common cause of childhood injury in rural Ghana. There may be opportunities to reduce the risk of burn injuries in rural settings by supporting the transition to safer cooking arrangements, child barrier apparatuses (e.g. playpens that separate children from cooking arrangements), and/or health promotion initiatives. Given the high incidence of childhood burn injuries, strategic burn-related healthcare capacity development is also required to limit preventable death and disability.

Applicability of Research to Practice

These findings, which differ somewhat from similar studies in other LMIC communities, suggest that there is not a one-size-fits-all solution for the prevention of childhood burn injuries. Community-specific and contextually relevant interventions that aim to prevent childhood burn injuries can be identified by results from population-based surveys of injury epidemiology and potentially modifiable risk factors.
79 Maximizing Safe Positioning of Upper Extremities After Axillary Burn Injuries to Prevent Contractures and Maintain Function
Authors: Greiser Connie , Lorello David , Barto Eric , Gartner S V , Lyons Dan , Stutesman Derek , Richey Karen J , Murray Derek O , Foster Kevin N
Published: March 2020

Introduction

Burns crossing over a joint can result in a contracture of that joint. Axillary burns and subsequent contractures are common and may impact negatively on burn survivor rehabilitation. Positioning of burned extremities at the most lengthened position is ideal for maintenance of function and contracture prevention, 90 degrees of abduction is the most accepted position for axillary burn injuries. However, many activities of daily living require shoulder range of motion (ROM) greater than 90 degrees. The primary objective of this study was to describe and examine the incidence of paresthesia, pain, and intolerance in healthy subjects when the shoulder was placed in a position of 90 degrees or greater of shoulder abduction.

Methods

The subject’s nondominant upper extremity (NDE) was randomly placed in a series three of positions, including: (1) 90 degrees shoulder abduction, 30 degrees horizontal adduction with elbow extension, forearm neutral; (2) 130 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral; (3) 150 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral. Each position was maintained for a maximum of 2 hours. Subjects experiencing subjective symptoms including paresthesia lasting longer than 1 minute, pain rated greater than 3/10, and/or intolerance 2/5 was removed from the position. All subjects received at least 30 minutes of rest between positions.

Results

A total of 25 subjects were enrolled, mean age was 25.8 years, the majority were female (60%) and 20% had a history of NDE shoulder injury. The right arm was the dominant extremity (DE) in 88% of subjects. There were no significant differences in ROM between the DE and NDE extremity with the exception of external shoulder rotation, 94.96⁰ vs 84.8⁰ (p=.0142). Average total splint time was 136 minutes with a range of 40 – 360 minutes. Only 1 subject successfully completed all 3 splinting periods. There were 75 individual splinting events over the 3 splinting periods, and 90% of the time the splinting was stopped early. The most common reason for stopping early was paresthesia (88%) followed by pain (7%).

Conclusions

The positions selected represent the routine and usual care at our burn center. Patients are routinely positioned from hours to days depending on patient need. This study demonstrated that healthy subjects were unable to tolerate positioning for even two hours.

Applicability of Research to Practice

Additional research is needed to determine optimal positioning for the shoulder joint.
80 Burn Rehabilitation: How Do You Minimize Delays?
Authors: Barba Michael G
Published: March 2020

Introduction

Timely rehabilitation is vital to the functional outcomes of burn patients. The rehabilitation department at our ABA certified Burn Center determined there was a need for a more effective method to coordinate daily care in the Burn Progressive Care Unit (BPCU). The purpose of this performance improvement project was to evaluate whether our Burn Center had a problem with delays in rehabilitation and if so, develop a plan to reduce disruptions.

Methods

Lean Six Sigma Process Improvement Methodology guided the team in this project. A 5-question needs assessment Pre-Rehabilitation Worksheet (Pre-RW) was used to evaluate the problem. The Pre-RW asked if there was a delay; reason for delay; length of delay; communication between services; body region, and the number of cutaneous functional units (CFUs) involved. The team then analyzed data from the Pre-RWs using descriptive statistics and a Pareto chart. Results from the Pre-RWs were used to prioritize changes that would mitigate delays. Rehabilitation staff then completed Post-RWs. Pre- and Post-RW results were compared to determine if the changes decreased delays in rehabilitative care.

Results

From April 24 to August 5, 2018, 140 Pre-RWs were completed in the BPCU; 24 were incomplete/omitted. Rehabilitation encounters that were delayed or canceled were 37.9% (n=53). Of these, 64% were delayed but eventually completed. The top 3 reasons for delay were: dressings down for morning rounds (DFR, 26%); wound care in progress (19%); patient refusal (16%). In 47% of the encounter delays the patients had over 15 CFUs involved. Improvements were made as follows: DFR assessment became part of the bedside rounds process; wound care orders were placed prior to 9 a.m.; patients were offered evening wound care. Communication improved through the use of a whiteboard, hands-free voice-call badges, and a time frame for coordinating the plan of the day. Following the improvements, Post-RWs (n=131) were collected from May 1 to July 30, 2019. 23.8% of all encounters were delayed or canceled. Of these, 51% were delayed but performed. The 3 chief reasons for delay were patient refusal, 38%; untimely dressing changes, 19%; and medical issues, 13%. In 84% of the deficit encounters 0–15 CFUs were involved.

Conclusions

Our burn center was able to define a problem with delays in rehabilitation and mitigate delays. This project demonstrates that deliberate changes decrease delays in rehabilitation.

Applicability of Research to Practice

Care of the burn patient requires a structured interdisciplinary, systems approach. Burn centers can improve outcomes by adopting a plan to improve coordination of services.
554 Severity of Gasoline Burns: A Retrospective Review
Authors: Smith Hannah , Echternacht Scott R , Bell Derek
Published: March 2020

Introduction

Gasoline burns represent a significant source of preventable morbidity each year. Often used inappropriately as an accelerant, gasoline is substantially more volatile than other commonly used accelerants due to its low flash point and vapor pressure. We sought to review the clinical outcomes for patients presenting with burns caused by gasoline accelerated flame.

Methods

An IRB exempt retrospective study of consecutive patients presenting from 2010–2017 to a single ABA verified institution was performed. Exclusion criteria included ultraviolet burns, allergic reactions and Stevens-Johnson Syndrome. Collected patient demographics included age and gender. The primary clinical endpoint was percent total body surface area (%TBSA) burned, delineated into second or third degree burn. Secondary endpoints included length of stay (LOS), days admitted to the intensive care unit (ICU), and mortality. Kruskal-Wallis Test and Wilcoxon Rank Sum Test were used for statistical comparison between the etiologies of burns. Fisher’s Exact test was used for comparison of mortality rates using a Bonferroni correction accounting for nine pairwise comparisons.

Results

A total of 5,994 patients were included; 256 with burns from gasoline fueled flame and 5,738 from other etiologies including flame with other accelerants, flame, scald, contact, electrical, chemical, friction, radiation, and frostbite. Gasoline burns resulted in a higher %TBSA of second degree burns (x̅=4.37%: 95% CI 3.62–5.12; p < 0.001; Table 1) and higher overall %TBSA (x̅=4.94%: 95% CI 3.99–5.88; p < 0.001; Table 2) than burns of all other etiologies except radiation burns where no statistically significant difference was found. Gasoline burns had a lower percent mortality (0.39%) than flame burns (4.98%; p< 0.05) and showed no statistically significant difference in mortality rate compared to other etiologies of burns. Comparison of second degree measures of LOS and number of ICU days yielded mixed results and lacked statistical significance.

Conclusions

Patients with burns caused by gasoline accelerated flame sustain a higher %TBSA of second degree burns and overall %TBSA than all other etiologies of burns except radiation burns.

Applicability of Research to Practice

Our results highlight the extent of burns caused by gasoline accelerated flame and underscore the importance of public education to reduce the inappropriate use of gasoline as an accelerant with the ultimate goal of reducing the significant morbidity associated with these burns.
578 Childhood Burn Injuries: The Parent Perspective
Authors: Dillard Dana R , Kolomer Stacey R
Published: March 2020

Introduction

Interventions for burn-injured children (BIC) largely focus on the child with the physical injury while consideration for family systems appears incidental. This study aimed to gain insight into the perspectives and needs of parents/caregivers of pediatric burn patients (PPBP). When considering BIC within the context of a family system, it is reasonable to expect the injury to engulf everyone. The literature emphasizes the acute and lasting physical and emotional impact of burns. Moreover, research suggests PPBP experience an emotional response to the incident that is often complicated by physical absence from their other uninjured children. Thus, this exploratory study fills a gap by engaging the unique perspective of the PPBP and posits direct implications for essential program enhancement/development.

Methods

PPBP attending a family program participated in semi-structured interviews (N=11) guided by the research question: What are the experiences of PPBP? Participants’ self-identified as African American (n=4), Caucasian (n=5), and Latino (n=2). Age ranged from 29 to 48 (M=38.36, SD=6.14). Interviews involved queries regarding the burn incident, from injury to present (M=7.12 years, SD=4.61), including support received, what they wish people understood about the experience, and ideas for programming. Interviews were recorded and transcribed. Data were analyzed using van Manen’s hermeneutic phenomenological approach.

Results

Findings supported PPBP’s unique experience coalescing into one theme—the never-ending trip from hell—conceptualized as, “I didn’t mean to get here—none of this is familiar and I can’t find anyone I know. What’s going on and when will it be over?” Mutual painful insights were parental guilt, sensory experiences related to the acute incident and aftercare, unknown prognosis and medical treatment expectations, physical/emotional health problems, family members insensitivity, managing the cruelty of others, isolation, marital strains, and sibling tensions. Families also reported positive outcomes: strength of informal support networks, empowerment through educating others, and creating new allies. PPBP emphasized the benefits associated with meeting other families who also endured a burn injury and the importance of mutual support.

Conclusions

Programs should address the needs of all family members, not just BIC. In order to mitigate the impact of burn trauma, the family system impact remains a critical primary consideration for research and interventions.

Applicability of Research to Practice

Findings can contribute to program planning with increased consideration of the family system. As a result of findings from this study, siblings are now included in a summer camp program historically serving only BIC.
733 From the Trenches of War to the Bedside of Civilians: Joseph E. Murray MD FACS and the Contributions of Military Surgeons to Advances in Burn Care
Authors: Paletta Christian
Published: March 2020

Introduction

Significant advances in medical and surgical care have often originated from our experience caring for those wounded on the battlefield. The year of the ABA’s 52nd annual meeting marks the 30th anniversary of the selection of Joseph E. Murray MD FACS as recipient of the 1990 Nobel Prize in Medicine.

Methods

In his autobiography Surgery of the Soul: Reflections on a Curious Career, Dr. Murray credits a 22 year old US Army aviator named Charles Woods with guiding him into an emerging field of transplantation surgery. On December 23, 1944, Woods sustained burns over 70% of his body in an accident during takeoff while teaching another pilot at his Army Air Corps base in India. Woods survived and eventually was transferred back to the US where came under of the care of a young 25 year old surgeon named Joseph Murray.

Results

Like many young surgeons of his era, Dr. Murray joined the military service during WWII. Dr. Murray had just completed his internship at Peter Bent Brigham in Boston in September 1944 when he was assigned to Valley Forge General Hospital in Phoenixville, PA. Valley Forge was one of eight regional US Army hospitals created during WWII dedicated to plastic surgery and burn care. It was during his care for soldiers wounded in battle at this time in his early formative years that Dr. Murray developed his curiosity regarding tissue transplantation. Following military service, he completed his surgical training in Boston and New York City, and returned to the Brigham in July 1951. His military service caring for burn victims instilled a passion and curiosity regarding transplantation of human tissue. This culminated in his leading a team to perform the first human kidney transplantation on December 23, 1954...exactly 10 years to the day after the airplane crash that injured Charlie Woods.

Conclusions

Recognizing his dedication and accomplishments in the field of transplantation surgery, the Nobel selection committee awarded Dr. Murray thirty-six years later it’s Prize in Medicine.

Applicability of Research to Practice

Dr. Murray’s legacy which began during his care of soldiers during WWII offers an inspiration to all those caring for patients who have sustained burn injuries.
736 Autologous Skin Cell Suspension in Combination with Meshed Autograft: A Case Report Demonstrating the Efficacy in NSTI
Authors: Kopari Nicole M
Published: March 2020

Introduction

Necrotizing soft tissue infections (NSTIs) are some of the more difficult disease processes encountered by physicians. Most patients require multiple surgical debridements, and survivors often have complex wounds requiring soft tissue coverage and prolonged hospitalizations. The goal of this report is to describe the use of autologous skin cell suspension over widely meshed skin graft in a patient with large wound secondary to a NSTI.

Methods

A retrospective chart review was performed of a patient with NSTI of the abdomen.The patient received autologous skin cell suspension as an epidermal graft in combination with widely meshed skin grafting.

Results

A 41 year-old female had an abdominal wound infection resulting in a NSTI. The patients had poorly controlled diabetes, congestive heart failure, and coronary heart disease with a drug eluting stent on dual antiplatelet therapy. She presented septic to an outside facility where she underwent multiple abdominal wound debridements. She was transferred to our institution with concerns for ongoing infection. Upon arrival, the wounds appeared stable with granulation tissue present over the wound bed with small areas of necrotic fat. She underwent debridement and autologous skin cell suspension in combination with a widely (3:1) meshed skin graft. The donor site also received treatment with the cell suspension. The wounds were covered with a non-adherent dressing along with bismuth-impregnated, petroleum-based gauze. Additional padding was secured with sutures to prevent post-operative shearing. On post-operative day (POD) 2 the outer dressings were changed with excellent adherence of the graft. On POD 4 her dressings were taken down completely, staples were removed, and she was transitioned to daily topical antimicrobial ointment and a non-adherent dress to her torso. She had >95% closure on POD 7 on both her graft and donor site.

Conclusions

Similar to severe burn injuries, the magnitude and scope of NSTI necessitates radical debridement often creating challenges in wound care, preservation of function, and cosmesis. Autologous skin cell suspension in combination with widely meshed skin grafts appear to be well-suited for treatment of large wounds resulting from NSTI. Treatment of this patient demonstrated decreased healing times, decreased donor sites, and an acceptable cosmetic outcome.

Applicability of Research to Practice

Autologous skin cell suspension has been approved for the use in partial and full thickness burn either as an epidermal graft alone or in combination with widely meshed grafts. This case report represents an example of its use in large complex wounds secondary to NSTI with acceptable outcomes.
738 Post-operative Wound Care Using Silver-based Dressing with Autologous Skin Cell Suspension
Authors: Carter Jeffrey E , Mai Kathryn , Lennard Shana , Landry Jeremy , G’sell David , Tuggle Charles T
Published: March 2020

Introduction

Postoperative dressing and wound care are essential to optimize graft survival through imbibition, inosculation, and neovascularization. Autologous skin cell suspension (ASCS) using extended-wear dressings (EWD) as a primary or secondary has not been previously described in the literature. The goal of our study was to assess the feasibility of new dressing protocol for ASCS at reducing dressing changes without increasing reoperation rates for failure to close or mortality.

Methods

The study was an IRB approved, single-center, retrospective review of admissions between April 2018 to August 2019. Patients included in the study were >14 years of age with >3%TBSA partial-thickness and full-thickness burns undergoing excision and ASCS. EWD included a controlled-release silver antimicrobial dressing with active fluid management. Standard of Care (SoC) primary dressing with fine-pore, non-adherent polyethylene film followed by petroleum gauze, layered gauze, and compressive dressings. Data included age, gender, %TBSA, mortality, primary and secondary dressing, dressings changes prior to primary dressing change (DC), and failure to close (FTC) requiring reoperation. Fisher’s exact test was used to compare the two populations.

Results

A total of 53 ASCS cases were performed with 33 receiving standard of care (SOC) and 20 EWD post-operatively. The median age was 48 (range 14–85) with 26% of the patients being female. The median TBSA was 17% (range 3–72%). Median age for SoC was 57 and for EWD was 33 (p-value= 0.0289). Median %TBSA for SoC was 20% and for EWD was 15% (p-value= 0.0182). 1 SoC patient required reoperation from both groups (p-value= 0.5210). No EWD patients required reoperation. 1 patient expired (SoC) in the study secondary to decompensated cirrhosis. EWD required median 1 DC versus 3 in the SoC group (p-value= 0.0164).

Conclusions

EWD with ASCS reduced the total number of dressing changes and did not result in increased mortality or reoperation for FTC in our feasibility trial with partial-thickness and full-thickness burn injuries. Optimizing postoperative care with EWD in ASCS may serve to reduce dressing change costs and patient discomfort as well as to shorten hospital length of stay.

Applicability of Research to Practice

Reduced wound care following autologous skin cell suspension.
748 The Calm After the Storm? Burn Injury Incidence Following Hurricanes and Tropical Storms
Authors: Zirulnik Alexander , Neal Dan , Carson Joshua S
Published: March 2020

Introduction

In recent years, we have noted a pattern of a surges in burn admissions occurring in the wake of some of the larger storm events occurring in our region. Many injuries incurred in the activities related to the storms’ aftermath— accelerate related burns from burning debris, generator explosions, and electrical repair burns. It is suspected that conditions created by larger storms may increase the population-wide risk for burn injuries for some time after the storm itself. If trues, this would suggest a need for more concerted burn prevention efforts in the wake of major natural disasters. The purpose of this study was to identify whether there is indeed a predictable surge in burn injuries relationships between seasonal variation and burn injuries in one catchment area of a regional center. We hypothesize that there is an underlying association between significant storms and an increased number of burn-related injuries before and after storms.

Methods

Using a retrospective approach, we examined burn center admission data from 2007–2018 (N=4,637) to include burns in the week prior to and three weeks after hurricane or tropical storm events (a storm window) in our state. This dataset only examined burns in which patients were admitted greater than 20 hours to exclude any confounding follow-up visits.

Results

Using Poisson regression to evaluate the effect of the storm window has on the number of daily admissions, there was found to be no significant association in respect to daily case totals (p=.165) when comparing across all years in respect to storm windows. When examining data from 2017 and 2018; years in which severe storms (category 4+) hit the state of Florida, there was found to be a significant increase in the number of daily burn admissions during the storm window by about 39% (p=0.039) as compared to 2015 when no storms hit the state.

Conclusions

It is hypothesized that a significant association of injuries were found in later years due to the ever-increasing intensity of storms hitting the state. Public awareness should be directed to the dangers of burns and related injuries in the wake of major weather events, i.e. before and after storms. In addition, further studies should examine the relationships between injuries and weather-related events.

Applicability of Research to Practice

Awareness of a tendency for burn injuries and admissions to surge after major storms could be used to improve the timing and content of burn prevention response to these incidents.
750 Burn Injury in Our Region’s Indigenous Population
Authors: Wainwright Lindsay , Quaife Tanis , Magnusson Saul , Logsetty Sarvesh
Published: March 2020

Introduction

Our Indigenous population is disproportionately affected by injury resulting in significant morbidity and mortality. Burn injuries in this population have not yet been explored.

Barriers to healthcare faced by Indigenous people differ from non-Indigenous people and understanding these differences is essential to providing culturally safe care.

Our research seeks to understand the characteristics of burns in our Indigenous population and the personal experiences of Indigenous burn survivors. Our aim is to raise awareness about the specialized needs of this population and provide cultural understanding to inform in-hospital care and repatriation to home communities.

Methods

Data was collected from our regional burn unit to examine burn characteristics between Indigenous and non-Indigenous burn survivors. The combined adult and pediatric burn registries were examined. Between 2008–2018 there were 615 complete observation data sets. Observations were grouped by Indigenous status, age, and urban/rural.

Summary tables were constructed and t-tests performed to examine differences in burn severity and length of stay between the groups of interest.

Results

Indigenous burn patients in our region are younger at the time of injury and while they have a similar TBSA, their length of stay is considerably longer.

Conclusions

Burn injuries in the Indigenous population account for 25% of all admissions. Despite a similar burn size their injuries result in significantly longer stays in hospital. This may be because Indigenous burn patients are more likely to live in rural/remote settings far from specialized burn care compared to non-Indigenous patients. The distance from definitive care may the reason for the longer length of stay. Being far from their home community while in hospital is a unique challenge in this population.

Future plans are to gain a better understanding of Indigenous burn patients and their barriers to care by completing a qualitative narrative analysis on Indigenous burn survivor healthcare experiences. This information will inform burn patient care in hospital and repatriation to home communities.

Applicability of Research to Practice

Burns are prevalent in Indigenous populations and understanding their experiences supports culturally competent care. The distance from definitive care seems to increase length of stay independent of the size of burn. This research aims to better understand this population so that we may better serve Indigenous burn patients.