bluuebunny/crossref_metadata_2025 huggingface dataset:
Incorporation of rapid diagnostic tests to improve time to antimicrobial therapy for gram-positive bacteremia and candidemia
Authors: Koh Leroy , Shah Punit J , Korulla Aileen , Jasmak Gordana , Fasoranti Oyejoke , Janak Charles , Perez Katherine
Published: March 2020

Purpose

Even with rapid diagnostic technology to swiftly identify infectious organisms, prompt response is needed to translate results into appropriate actions. The purpose of this study was to determine if the introduction of real-time pharmacist response to positive rapid diagnostic test results would decrease time to antimicrobial therapy for gram-positive bacteremia and candidemia in a community hospital setting.

Methods

A quasi-experimental study was conducted in 2 community hospitals. The study comprised 2 cohorts of adult patients who tested positive for gram-positive bacteremia involving Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, or Candida species. The preintervention cohort consisted of patients admitted from November 2017 through May 2018. The intervention cohort consisted of patients admitted from July 2018 through January 2019, after the intervention went live. The primary outcomes were time to optimal antimicrobial therapy and time to effective antimicrobial therapy.

Results

A total of 140 patients were included in the preintervention group, with 124 patients included in the intervention group. The mean (SD) time to effective therapy decreased from 13.9 (21.6) hours in the preintervention group to 8.6 (12.5) hours in the intervention group (hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.89-1.48; P = 0.29). The mean (SD) time to optimal therapy significantly decreased from 53.7 (57.7) hours in the preintervention group to 38.4 (31.5) hours in the intervention group (HR, 1.73; 95% CI, 1.33-2.26; P < 0.001).

Conclusion

The introduction of real-time pharmacist response to positive rapid diagnostic test results led to a significant decrease in time to optimal antimicrobial therapy but did not significantly affect time to effective therapy. The results showed that the allocation of limited resources of a community hospital to such a stewardship program is justifiable.
The Association of Occupational Noises and the Prevalence of Metabolic Syndrome
Authors: Khosravipour Masoud , Abdollahzad Hadi , Khosravi Farid , Rezaei Mansour , Mohammadi Sarableh Hadis , Moradi Zahra
Published: March 2020

Objectives

Previous studies have shown the association of exposure to noise with cardiovascular diseases such as hypertension, however, it is not well known whether the exposure has any effect on metabolic syndrome (MetS). This study aimed to quantify and clarify the association between noise exposure and the prevalence of MetS.

Methods

This cross-sectional study was conducted in 2017 among 518 workers in a thermal power plant industry. According to types of work and 8-h equivalent A-weighted sound pressure level (8-h LAeq), the participants were divided into the following groups: office workers and line-production workers exposed to < 85, 90 to <95, 95 to <100, and ≥100 dBA. We used the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria to identify subjects with MetS. The logistic regression was used to determine the odds of MetS among study groups.

Results

We observed the significant differences in the number (%) of subjects with high blood pressure in line-production workers who exposed to noise ≥100 (12 [19.7%]) versus <85 dBA (7 [7.1%]) and office (10 [4.7%]) groups. For the waist circumference (>102 cm), there was a significant difference in the ≥100 dBA group (12 [19.7%]) compared with office group (21 [9.8%]). Obtained results indicated only the significant difference in the prevalence of MetS in ≥100 versus <85 dBA groups (10 [16.4%] versus 6 [6.1%]). The unadjusted and adjusted odds ratios and 95% confidence intervals of MetS in ≥100 versus <85 dBA groups were estimated 3.01 (1.03, 8.75) and 3.24 (1.01, 10.42), respectively.

Conclusions

This study indicated the significant association between noise exposure and MetS in line-production workers. However, more studies are needed to confirm our results.
Defining an intrasexual male weapon polymorphism in a New Zealand harvestman (Opiliones: Neopilionidae) using traditional and geometric morphometrics
Authors: Powell Erin C , Painting Christina J , Hickey Anthony J , Holwell Gregory I
Published: March 2020

In many species, competition for mates has led to exaggerated male sexually-selected traits. Sexually-selected male weapons are used in male-male combat and include structures like horns, antlers and enlarged teeth. Weapons often vary intraspecifically in size, resulting in either a continuum of weapon sizes or in discrete male polymorphisms. More rarely, complex weapon polymorphisms can also include variation in weapon shape; however, these are difficult to quantify. Here we first use traditional linear morphometrics to describe a weapon trimorphism in the endemic New Zealand harvestman, Forsteropsalis pureoraTaylor, 2013. We identified three male morphs: a small-bodied gamma male with reduced chelicera, a large-bodied beta male with long, slender chelicerae, and a large-bodied alpha male with shorter, but very broad, robust chelicerae. Chelicera length alone failed to fully capture the variation in weapon investment. Using geometric morphometrics, we show that alpha males are different in weapon shape, whereas beta and gamma males have similar weapon shape, but vary in their body size and chelicera length. Additionally, we describe how the chelicerae function during male-male combat from observations of contests. This work demonstrates how combining linear and geometric morphometrics can help to elucidate complex polymorphism.
Determining the dependence structure of multivariate extremes
Authors: Simpson E S , Wadsworth J L , Tawn J A
Published: March 2020

In multivariate extreme value analysis, the nature of the extremal dependence between variables should be considered when selecting appropriate statistical models. Interest often lies in determining which subsets of variables can take their largest values simultaneously while the others are of smaller order. Our approach to this problem exploits hidden regular variation properties on a collection of nonstandard cones, and provides a new set of indices that reveal aspects of the extremal dependence structure not available through existing measures of dependence. We derive theoretical properties of these indices, demonstrate their utility through a series of examples, and develop methods of inference that also estimate the proportion of extremal mass associated with each cone. We apply the methods to river flows in the U.K., estimating the probabilities of different subsets of sites being large simultaneously.
Rethinking the nature of inhibitory control deficits in Tourette syndrome
Authors: Jackson Georgina M , Jackson Stephen R
Published: March 2020

This scientific commentary refers to ‘Impaired automatic but intact volitional inhibition in primary tic disorders’, by Rawji etal. (doi:10.1093/brain/awaa024).
High Incidence of Herpes Zoster After Cord Blood Hematopoietic Cell Transplant Despite Longer Duration of Antiviral Prophylaxis
Authors: Xue Elisabetta , Xie Hu , Leisenring Wendy M , Kimball Louise E , Goyal Sonia , Chung Lisa , Blazevic Rachel , Maltez Byron , Edwards Anna , Dahlberg Ann E , Salit Rachel B , Delaney Colleen , Pergam Steven A , Boeckh Michael , Milano Filippo , Hill Joshua A
Published: March 2020

Background

Cord blood transplant (CBT) recipients have a high incidence of herpes zoster (HZ) in the context of short-term peritransplant antiviral prophylaxis. In 2009, international guidelines recommended HZ prophylaxis for at least 1 year after hematopoietic cell transplant. The impact of longer-term antiviral prophylaxis on HZ incidence after CBT is unknown.

Methods

We retrospectively analyzed varicella zoster virus (VZV)–seropositive CBT recipients who were transplanted between 2006 and 2016. We abstracted HZ events and other variables for up to 5 years post-CBT. We calculated the cumulative incidence of HZ and used Cox proportional hazards regression to identify variables associated with HZ.

Results

The study cohort consisted of 227 patients. Among 1-year survivors, 91% were still receiving prophylaxis, for a median duration of 20.6 months. HZ occurred in 44 patients (19%) at a median of 23.6 months. The cumulative incidence of HZ by 1 year after CBT was 1.8% (95% confidence interval [CI], .1%–4%), but increased to 26% (95% CI, 19%–33%) by 5 years. In a multivariable analysis, acute graft-vs-host disease was associated with increased risk, whereas antiviral prophylaxis was associated with reduced risk for HZ (adjusted hazard ratio, 0.19 [95% CI, .09–.4]). There was no association between CD4+ T-cell counts at 1 year post-CBT and subsequent risk for HZ.

Conclusions

We found a high incidence of HZ after CBT despite antiviral prophylaxis for > 1 year. Based on these findings, we suggest longer duration of prophylaxis for HZ after CBT. Compliance with antiviral prophylaxis, VZV-specific immune monitoring, and vaccination to mitigate HZ after CBT also require further study.
Who is afraid of machines?
Authors: Blanas Sotiris , Gancia Gino , Lee Sang Yoon (Tim)
Published: March 2020

We study how various types of machines, namely, information and communication technologies, software and especially industrial robots, affect the demand for workers of different education, age and gender. We do so by exploiting differences in the composition of workers across countries, industries and time. Our data set comprises 10 high-income countries and 30 industries, which span roughly their entire economies, with annual observations over the period 1982–2005. The results suggest that software and robots reduced the demand for low- and medium-skill workers, the young and women – especially in manufacturing industries; but raised the demand for high-skill workers, older workers and men – especially in service industries. These findings are consistent with the hypothesis that automation technologies, contrary to other types of capital, replace humans performing routine tasks. We also find evidence for some types of workers, especially women, having shifted away from such tasks.
Shifts in short-chain fatty acid profile, Fe(III) reduction and bacterial community with biochar amendment in rice paddy soil
Authors: Lu Yue , Fu Leiling , Tang Lin , Zhang Jing , Zhang Yanru , Wang Jingjing , Xie Qingqing , Yang Zhaohui , Fan Changzheng , Zhang Shoujuan
Published: March 2020

Biochar, a valuable product from the pyrolysis of agricultural and forestry residues, has been widely applied as soil amendment. However, the effect of different types of biochar on soil microorganisms and associated biochemical processes in paddy soil remains ambiguous. In this study, we investigated the impact of biochars derived from different feedstocks (rice straw, orange peel and bamboo powder) on the dynamics of short-chain fatty acids (SCFAs), iron concentration and bacterial community in paddy soil within 90 days of anaerobic incubation. Results showed that biochar amendment overall inhibited the accumulation of SCFAs while accelerating the Fe(III) reduction process in paddy soil. In addition, 16S rRNA gene sequencing results demonstrated that the α-diversity of the bacterial community significantly decreased in response to biochar amendments at day 1 but was relatively unaffected at the end of incubation, and incubation time was the major driver for the succession of the bacterial community. Furthermore, significant correlations between parameters (e.g. SCFAs and iron concentration) and bacterial taxa (e.g. Clostridia, Syntrophus, Syntrophobacter and Desulfatiglans) were observed. Overall, our findings demonstrated amendment with different types of biochar altered SCFA profile, Fe(III) reduction and bacterial biodiversity in rice paddy soil.
Minor Representations: From Anne Frank to Bana Alabed – The Radically Performative Literacies of a Viral Child
Authors: Trezise Bryoni
Published: March 2020

In this article, I construct a comparative analysis of two forms of child-authored life-narrative: the famous Diary of a Young Girl written by Anne Frank and the contemporary Twitter stream authored by the Syrian child-writer Bana Alabed. My interest in these two textual practices is focused on how they each formulate notions and experiences of temporality that are central to how conceptions of the modern, innocent child and its most recent counterpart – a figure whom I term the viral child – function. Across this analysis, I observe how the textual utterances performed by each child-author make specific claims about the autobiographical ‘I’ as it enacts a literary relationship to the temporality of its ongoing construction. I argue that the radical shift in relations between the child-figure and the future cast by Alabed’s tweets positions the viral child as not only a voice, but also a medium, of the cultural present.
A-to-I RNA Editing Uncovers Hidden Signals of Adaptive Genome Evolution in Animals
Authors: Popitsch Niko , Huber Christian D , Buchumenski Ilana , Eisenberg Eli , Jantsch Michael , von Haeseler Arndt , Gallach Miguel
Published: March 2020

In animals, the most common type of RNA editing is the deamination of adenosines (A) into inosines (I). Because inosines basepair with cytosines (C), they are interpreted as guanosines (G) by the cellular machinery and genomically encoded G alleles at edited sites mimic the function of edited RNAs. The contribution of this hardwiring effect on genome evolution remains obscure. We looked for population genomics signatures of adaptive evolution associated with A-to-I RNA edited sites in humans and Drosophila melanogaster. We found that single nucleotide polymorphisms at edited sites occur 3 (humans) to 15 times (Drosophila) more often than at unedited sites, the nucleotide G is virtually the unique alternative allele at edited sites and G alleles segregate at higher frequency at edited sites than at unedited sites. Our study reveals that a significant fraction of coding synonymous and nonsynonymous as well as silent and intergenic A-to-I RNA editing sites are likely adaptive in the distantly related human and Drosophila lineages.
A combination of genetic and phenotypic characterization of spring- and autumn-spawning herring suggests gene flow between populations
Authors: Berg Florian , Østgaard Hedda D , Slotte Aril , Andersson Leif , Folkvord Arild
Published: March 2020

Atlantic herring (Clupea harengus) has complex population structure and dynamics including diverse life histories and spawning times with spring and autumn spawning as the most common modes. Originally, spawning herring were phenotypically identified based on their maturity development or otolith microstructure by determining seasonal specific larval growth patterns. Recently, genetic markers have revealed clear genetic differentiation between spring- and autumn-spawning populations. All three methods were applied to herring caught at the same locations during spring and autumn to determine the coherence of methods. In a selected subset, most herring (∼77%) had an otolith microstructure and genetic assignment coinciding with the phenotypically assigned spawning season. Non-spawning herring (<5%) that were classified as belonging to the current spawning season using genotyping and otolith-typing were assigned as skipped spawners. For ∼8% of spawning herring, the genetic and otolith assignment contradicted the phenotypically assigned spawning season, characteristic of straying individuals. Otolith-typing contradicted the genetic and phenotypical assignment in ∼7% of the cases, potentially representing individuals reuniting back to the spawning season favoured by their genotype. Although the viability of offspring from these individuals remains undocumented, it is suggested that the observed switching of spawning season may contribute to gene flow between herring populations.
Sound absorption characteristics of KGM-based aerogel
Authors: Wang Yixin , Xiang Fei , Wang Wei , Wang Weiling , Su Yuehong , Jiang Fatang , Chen Sheng , Riffat Saffa
Published: March 2020

This study presents the preparation and property characterization of biomass aerogels as sound absorption materials. Biomasses were chosen to prepare aerogels through the freeze-drying method. Results indicated that four components may have different effects on the aerogel pore structure, and the aerogel formula was thus optimized to reach the best sound absorption. Within the experimental range, biomass aerogel with the optimized formula had an average sound efficiency 0.352, density 0.047 g/cm3 and porosity 94.46 ± 0.04%. It shows better sound absorption performance than traditional sound absorption cotton. These results demonstrate the high sound absorption potential of biomass aerogels for building applications.
Heronian Friezes
Authors: Fomin Sergey , Setiabrata Linus
Published: March 2020

Motivated by computational geometry of point configurations on the Euclidean plane, and by the theory of cluster algebras of type $A$, we introduce and study Heronian friezes, the Euclidean analogues of Coxeter’s frieze patterns. We prove that a generic Heronian frieze possesses the glide symmetry (hence is periodic) and establish the appropriate version of the Laurent phenomenon. For a closely related family of Cayley–Menger friezes, we identify an algebraic condition of coherence, which all friezes of geometric origin satisfy. This yields an unambiguous propagation rule for coherent Cayley–Menger friezes, as well as the corresponding periodicity results.
L
p
Estimates for Joint Quasimodes of Semiclassical Pseudodifferential Operators Whose Characteristic Sets Have kth Order Contact
Authors: Tacy Melissa
Published: March 2020

In this paper we develop $L^{p}$ estimates for functions $u$, which are joint quasimodes of semiclassical pseudodifferential operators $p_{1}(x,hD)$ and $p_{2}(x,hD)$ whose characteristic sets meet with $k$th order contact, $k\geq{}1$. As part of the technical development we use Fourier integral operators to adapt a flat wavelet analysis to the curved level sets of $p_{1}(x,\xi )$.
Communication Inefficiencies and Research Validity in International Studies
Authors: Walker Lee Demetrius
Published: March 2020

In this essay, I propose that a focus on research validity can improve communications among scholars of international studies who use a variety of methodological approaches because validity as a unifying standard allows for greater flexibility of methodological and empirical approaches to theoretical concepts. Social science disciplines have recently been more concerned with replication and transparency as the standards by which social science research is measured and valued. I apply transparency, replication, and validity to five identified inefficiencies in international studies communication and an examination of judicial independence/international studies research. This application indicates that validity is the more useful standard in that it addresses four of the five communication inefficiencies. Linking validity to advancing causal inference research, creating incentives for multimethod research teams, and improving social science communication to the lay public can also facilitate communication among international studies scholars.
12 Effective Treatment of Malnourished Pediatric Burn Patients
Authors: Hall Jennifer , Abbott Laura , Prelack Kathrina , Friedstat Jonathan
Published: March 2020

Introduction

Pediatric burn patients are at high nutritional risk given disease burden and its impact on body reserves. As part of our global mission, we care for children who arrive late after their injury, often with malnutrition. In our experience, these patients have greater susceptibility to infection, poor wound healing, and longer lengths of stay. In accordance, we implemented strategies to improve outcomes in this population including a sustained period of nutritional optimization prior to surgery. The purpose of this study was to describe the frequency of malnutrition in our hospital and to compare clinical outcomes between malnourished (MN) and well-nourished patients (WN) using this approach.

Methods

An IRB approved retrospective review of pediatric burn patients at our institution from 2010–2018 who received nutritional support (enteral and/or parenteral nutrition) for at least five days was conducted. Data collection included general demographics, anthropometrics, nutritional intake, nutrition related labs, and clinical outcome variables such as length of stay (LOS), and days to wound closure. Using a case-control design, malnourished patients were matched (by age and burn size) to their well-nourished counterparts. Differences in nutritional status and clinical outcome were compared by student’s t test.

Results

A total of 174 patients, 7.02 ± 5.19 years of age with 39.18 ± 18.31% total body surface area (TBSA) burns were included in the study. Thirty percent of all patients classified as malnourished based upon body mass index (BMI) or weight/length z-scores, visual assessment and/or reported weight loss. On admission, malnourished patients had significantly lower BMI z scores (MN -2.5 vs. WN 0.8, p< 0.0001). Despite significant differences in days post burn admission (MN 97.9 days, WN 17.7 days, p=0.028); there was no statistical difference in days to 95% wound closure (MN 39.4, WN 38.2 days, p=0.85) or LOS (MN 56.5, WN 52.5 days p=0.63) between the two groups. Average intake of malnourished patients over the first four weeks of admission ranged between 92–116% of calorie goal and 96–109% protein goal.Nutrition related lab value averages for MN patients improved over the four week time frame, Prealbumin (mg/dl) (week one 9.6, week four 17.75), C-reactive protein (mg/L) (week one 92.3, week four 71.91), and Albumin (g/dl) (week one 2.64, week four 3.32).

Conclusions

Despite arriving significantly malnourished, our pediatric burn patients had similar outcomes to their well-nourished counterparts in terms of LOS and 95% wound closure. This can be attributed to prompt identification of those patients at risk, and use of refeeding and nutritional rehabilitation protocols prior to surgical intervention.

Applicability of Research to Practice

Effective protocols for the management of malnourished pediatric burn patients can negate the impact of malnutrition on clinical outcomes.
31 Patients in Need: Are We Identifying and Helping Them?
Authors: Fassel Mikenzy , Galet Colette , Wibbenmeyer Lucy
Published: March 2020

Introduction

Healing from a burn injury is a complex process that takes months to years. Survivors and families with basic needs or mental health issues may experience additional challenges during recovery. We previously showed a significant and positive correlation between adverse childhood events (ACEs) and number of needs (r = 0.5), housing insecurity (r = 0.23), food insecurity (r = 0.34), stress (r = 0.39), and symptoms of depression (r = 0.44). Herein, we assessed whether these needs were identified and addressed prior to discharge.

Methods

Medical charts of the 175 burn patients enrolled in our ACEs study were reviewed to assess if a social worker assessment (SWA) was done. SWA is primarily performed for discharge planning. We collected patient/family identified needs, resources provided, mental health consultation (adults only), and whether patients received additional information (burn bag) on support programs, burn/wound care guide, alternative dressings, post-traumatic stress disorder, and intimacy; the latter being only distributed to adult patients. Collected data were compared to the Family Strengths and Needs Assessment Survey (Strengths and Needs Survey) completed at the time of consent and analyzed using SPSS.

Results

SWA was completed on 50 inpatients (63.3%) and one outpatient. Based on the Strengths and Needs Survey, patients receiving SWA were more likely to rent (45.2% vs. 30%) or live in shared/temporary housing or be homeless (9.4% vs. 5.7%; p = 0.035) and report police interaction (15.1% vs. 4.1%; p = 0.023). Housing was addressed in only three SWA (5.7%). A higher number of patients with SWA reported food insecurity (22.6% vs. 12.3%; p = 0.082). Five SWA included food stamp status, with only one patient being provided information on food stamps. No difference was observed regarding stress and symptoms of depression between those who received a SWA and those who did not (45.3% vs. 39.3%; p = 0.36 and 39.6% vs 29.5%; p = 0.5, respectively). Psychosocial assessment need was noted in 46 SWA (90.6%). Only 12 adult inpatients (15%) were seen by mental health providers; 10 had a SWA. Burn bags were provided to 30 patients (58.8%), more often to adult than to pediatric patients (73.3% vs. 40%; p = 0.04).

Conclusions

Our study shows that many of our patients’ needs are not adequately assessed with the current social work and mental health capabilities. While SWA is performed on many of our patients with basic needs, many are not addressed, and individualized resources are often not provided. Moreover, only a third of our patients with identified psychosocial needs received consultation. Further study is warranted to develop a targeted approach to better meet the needs of our burn patients and their families.

Applicability of Research to Practice

By further assessing our patients’ needs, we will be able to better connect them with relevant resources to lighten the burden they face during their recovery.
41 Changes of Mitochondria-related Gene Expression Profile Associated with Burn-induced Cardiomyopathy
Authors: Wen Jake J , Radhakrishnan Ravi S
Published: March 2020

Introduction

Burn-related cardiac mitochondria dysfunction (BRMD) is associated with negative health outcomes and decreased health-related quality of life; however, few studies of the molecular-genetic mechanisms of BRMD exist.

Methods

60% of total body surface area (TBSA) burned rats was employed. O2K Respirometer system (Innsbruck, Austria) was utilized to measure cardiac mitochondrial function. OXPHOS complex activities were determined by using OXPHOS enzyme complex activity assays (Cayman Chemical, Ann Arbor, Michigan). The Rat Mitochondria RT2 Profiler PCR Array was used to identify differential regulation of genes involved in mitochondrial biogenesis and metabolism function.

Results

Burn injury induced cardiac mit dysfunction by decreasingOXPHOS oxygen consumption at State 3 energized by malate/pyruvate and succinate and declining mit ETC activity in complex I, III, IV and V. 84 rat mit-related gene profiles were measured. The mitochondrial gene profile showed that 30/84 genes related to mitochondrial function and structure were differentially expressed. Of these 30 genes, 17 (ATP12a, ATP4a, ATP6v0a2, ATP6v1e2, ATP6v1g3, COX8c, LHPP, NDUFA5, SLC25a10, SLC25a15, UCP1, UCP2, UCP3, UQCRFS1, LDHA and RGDC) were more than 2 fold up-regulated, and 13 (ATP5c1, ATP5i, ATP5L, COX17, COX6c, COX7a2, NDUFA8, NDUFB3, NDUFB7, NDUFB9, NDUFS4, NDUFS8, and UQCRB) were greater than 2-fold down-regulated. Furthermore, 8 genes (AIFM2, BCL2, FIS1, IMMP2L, MSTO1, SLC25A23, SLC25A37, SLC25A4) that had significant differentially expression were associated with heart dysfunction.

Conclusions

This study provides preliminary evidence that 30 mitochondrial function genes were significantly associated with burn-induced heart dysfunction in 24 hpb rats.

Applicability of Research to Practice

These findings elucidate possible pathways and early biomarkers for targeting novel interventions for burn-induced heart dysfunction.
57 Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of 2495 Children
Authors: Griffin Bronwyn R , Frear Cody , Oakley Ed , Kimble Roy M
Published: March 2020

Introduction

First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective was to analyze the associations between first aid and skin grafting requirements in children with burns.

Methods

This cohort study utilized a prospectively collected registry of patients managed at a tertiary children’s hospital. Multivariate logistic regression models were used to evaluate the relation ship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and theater interventions. Adequate first aid was defined as 20 minutes of cool running water within three hours of injury.

Results

In our cohort of 2495 children, 2259 (90.6%) received first aid involving running water, but only 1780 (71.3%) were given the adequate duration. A total of 236 (9.5%) children required grafting. The odds of grafting were decreased in the adequate first aid group (OR 0.6, 95% CI 0.4 to 0.8). The provision of adequate running water was further associated with reductions in the full-thickness depth (OR 0.4, 95% CI 0.2 to 0.6), hospital admission (OR 0.7, 95% CI 0.5 to 0.9) and theater operations (OR 0.7, 95% CI 0.5 to 0.9), but not hospital length of stay (HR=0.9, 95% CI 0.7 to 1.2, p=0.48).

Conclusions

Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by pre-hospital and emergency services in the preliminary management of pediatric burns.

Applicability of Research to Practice

Although children are at particularly high risk of burn injuries there was a paucity of literature addressing the relationship between burn first aid and clinical outcomes in pediatric populations. Due to differences in volume, surface area and skin thickness it was unknown whether benefits in adults applied to children. This study supports the prioritization of the administration of cool running water for 20 minutes to be adhered to immediately after a pediatric burn to decrease the severity and improve patient outcomes.
90 Efficacy of Topical Antimicrobial Agents Against Bacterial Isolates from Burn Wounds
Authors: Nethery William A , Warner Petra , Durkee Paula J , Zembrodt Jacquelyn , Dwyer Angela , Fowler Laura
Published: March 2020

Introduction

Topical antimicrobials are key to prevention of infection and mortality in the acute burn patient population. The purpose of this study was to determine the effectiveness of commercially available and in-house compounded topical preparations.

Methods

One hundred isolates from 15 different microorganisms were used to evaluate topical antimicrobial effectiveness. The isolates included 40 Gram-positive and 60 Gram-negative microorganisms. Sixteen multidrug-resistant organisms were included in the study. The study was conducted using the Nathan Topical Well Assay method to assess in-vitro activity. Twenty-two various irrigation solutions and ointments were tested. Since there are no standardized zones to determine susceptibility for topical antimicrobials, any zone of inhibition (>8 mm) was considered to show effectiveness.

Results

The compounds 1:1:1 + DAB (1 part bacitracin: 1 part silver sulfadiazine: 100,000 units per gram nystatin + 5mg/gram neomycin sulfate + 500 units/gram polymyxin B) and 3:1 + DAB (3 part bacitracin: 1 part silver sulfadiazine + 5mg/gram neomycin sulfate + 500 units/gram polymyxin B) in both irrigation and ointment dosage form demonstrated 100% effectiveness against all isolates. Sodium hypochlorite 0.5% solution appeared to be very effective against gram-negative organisms, but moderately effective against gram-positive organisms. Double antibiotic solution was highly effective against all gram-negative bacteria. 3:1 ointment and 1:1:1 ointment were highly effective against gram-positive organisms and moderately effective against gram-negative organisms.

The data indicates that many of the topical antimicrobials target certain bacteria more readily than others. Besides 1:1:1 + DAB and 3:1 + DAB, it shows that more than one drug product is necessary to demonstrate adequate killing ability of a broad spectrum of organisms. Multidrug resistant organisms also indicate more resistance against topical antimicrobials. The only compounds that showed a high degree of effectiveness against MDROs were sodium hypochlorite 0.5% solution, 1:1:1 + DAB ointment and solution, and 3:1 + DAB ointment and solution.

Conclusions

The bacitracin and silver sulfadiazine component of 3:1 and 1:1:1 has a high degree of effectiveness against Gram-positive organisms. Double antibiotic ointment was moderately effective against Gram-negative organisms. However, when the two were combined into one ointment it created a synergistic effect, which killed all the organisms tested.

Applicability of Research to Practice

Antimicrobial effectiveness and adverse effects must be considered when selecting the appropriate topical agent to be used on wounds. Further research is needed to determine the production of resistant bacteria and topical antimicrobials and the clinical usefulness of topical antimicrobial susceptibilities.
103 Screening for Alcohol and Drugs: Are We Under-testing Older Patients?
Authors: Savetamal Alisa , Burton Timothy , Davis Brittany , Wenta Samantha
Published: March 2020

Introduction

Only a fraction of trauma patients are being tested for drugs of abuse, despite the evidence that abuse of these substances contributes to traumatic injuries. In the specific trauma patient population of burn victims, drug and alcohol intoxication at the time of the burn may alter prognosis for both morbidity and mortality. Younger populations tend to be thought of at higher risk for drug and alcohol intoxication, and this may bias testing in other age groups. This study examined drug and alcohol testing in burn patients presenting to an ABA-verified burn center to determine if testing biases existed based on age, sex, or burn severity, and what populations were high risk for abuse in order to optimize testing in the high risk populations.

Methods

The burn center’s inpatient database was queried for all admitted patients from January 2013 to December 2017. Patients whose charts lacked description of the burns or where no burn information could be found were excluded from the study. Age, sex, length of stay (LOS), and total body surface area (TBSA) burned were examined. Statistical analysis was then performed with t-tests and Fisher’s test.

Results

A total of 1032 patients were included in the study. 159 (15.4%) patients were tested for alcohol use and 146 (14.1%) were tested for drugs. Significant predictors of whether patients were tested or not were TBSA and LOS (P< 0.001 for both). There were no significant differences between sexes in testing positive for drugs or alcohol, although there was a trend for more aggressive screening in males than females. The age group most likely to test positive for drugs and/or alcohol was 51–60 year olds. This age group accounted for 25% and 20% of all burn patients tested for alcohol and substances of abuse, respectively; yet this group accounted for 53% and 23% of all positive alcohol and drug tests. Perhaps surprisingly, individuals in age groups up to 90s tested positive for both alcohol and drugs.

Conclusions

As expected, age extremes were not tested for drugs or alcohol. Only 15% of patients were screened on arrival. Of these and contrary to expectations, 51–60 year olds were the most likely group of burn patients to test positive for drugs and/or alcohol, and patients up to their 90s were testing positive for substances of abuse. However, these populations are not as rigorously screened as younger populations and the use of these substances may be missed, thus affecting patient outcomes. Age bias may be limiting screening and affecting care in older burn patient populations.

Applicability of Research to Practice

Older patients (51–60 year olds) when tested are more likely to test positive particularly for alcohol upon presentation. More rigorous testing of older patients for alcohol and drugs of abuse may capture more patients who are using these substances and help to guide early care in these populations.
105 The Impact of Flap Timing and Mechanism of Injury on Flap Complications in Acute Burn Patients
Authors: Sheckter Clifford C , Perrault David , Rochlin Danielle H , Pham Christopher H , Karanas Yvonne L
Published: March 2020

Introduction

Burn wounds are often amenable to excision and grafting, but pedicled and free flaps are sometimes necessary to achieve closure of complex wounds. Flap coverage of exposed bone, tendons and cartilage has classicaly been delayed in acute burn patients due to concern of progressive tissue necrosis, microvascular thrombosis and percieved high failure rates. More recently, a number of reports have demonstrated that the use of flaps is safe earlier in acute burn care. We aim to elucidate the role of flaps in primary burn woud coverage leveraging national US data.

Methods

Acute burn patients with known % total body surface area were extracted from the Nationwide/National Inpatient Sample from 2002–2014 based on International Classification of Disease (ICD) Codes 9th edition. Flap procedures were identified based on ICD-9 procedure codes. Flap and non-flapped patients were compared using multivariable analysis. Variables included age, gender, race, Elixhauser comorbidity index, %TBSA, burn mechanism, inhalation injury, and location of burn. Flap complication was defined by ICD-9 procedure code 8675, return to OR for revision of flap. Multivariable analysis evaluated predictors of flap compromise based on stepwise logistic regression with backwards elimination.

Results

The weighted sample included 306,924 encounters of which 526 received a flap (0.17%). The mean age of encounters receiving a flap was 45.0 (SD 21.2) years versus 35.5 (SD 24.2) years in the non flap group (p=0.023). 7.8% of patients who received a flap suffered electric injury compared to 2.7% of non-free flap encounters (OR 3.76, 95% CI 1.95–7.24, p< 0.001). Patients who underwent flap wound coverage were more likely to have a lower extremity burn; 55.3% of encounters versus 43.1% in non- flap patients (OR 2.26, 95% CI 1.05–2.15, p=0.024). There were no significant differences in gender, race, Elixhauser comorbidity index, %TBSA, or inhalation injury. The mean hospital day of the flap procedure was 10.1 (SD 10.7) days. Flap complications occurred in 6.4% of flap encounters. The only independent predictor of flap complication was electrical injury (OR 40.49, 95% OR 2.98–550.64, p=0.005). The time to flap coverage and location were not associated with complications.

Conclusions

Electrical injury was an independent predictor of flap complications compared to other mechanisms. Flap timing was not associated with return to surgery for complications. This suggests that the use of flaps is safe in acute burn care to achieve burn wound closure with an understanding that electrical injuries may deserve particular consideration to avoid failure.

Applicability of Research to Practice

Inform surgeon decision making when deciding candidacy for flap surgery in acute burn patients.
114 Galectin-1 Is Overexpressed in Post-Burn Hypertrophic Scar
Authors: Kirkpatrick Liam D , Carney Bonnie C , Smith Robert D , Moffatt Lauren T , Shupp Jeffrey W
Published: March 2020

Introduction

Upon healing, burn wounds often leave hypertrophic scars (HTS), a significant morbidity for patients that can have lasting psychosocial impacts. HTS is marked by excess collagen deposition, dermal and epidermal thickening, and an increased concentration of fibroblasts. The Galectins, a family of lectins with a conserved carbohydrate-recognition-domain, function intracellularly and extracellularly as mediators of a multitude of biological processes including inflammatory responses, cell migration and differentiation, and cell-ECM adhesion. Galectin-1 (Gal-1) has been associated with several fibrotic diseases and can induce keratinocyte and fibroblast proliferation and migration as well as differentiation into fibroproliferative myofibroblasts. Gal-1 transcription is driven by the PI3K/AKT pathway, and AKT activation is increased in HTS compared to normal skin (NS). In this study, Gal-1 expression was assessed in human and porcine HTS and NS tissues.

Methods

mRNA was isolated from biopsies of human or porcine HTS and NS tissue. Total transcriptome microarray analysis was performed in porcine HTS vs. NS. Transcription of the Galectin-1 gene (LGALS1) was assessed by qRT-PCR using primers specific to human or porcine LGALS1 and GAPDH genes. A Gal-1 antibody was used for immunofluorescent (IF) staining to corroborate gene expression data.

Results

LGALS1, 4, 8, and 12 were differentially regulated genes in pig HTS vs. NS by microarray analysis (fold change= 3.58, 6.11, 1.89, and 3.03, p< 0.01). Confirmatory qRT-PCR results showed significant upregulation of LGALS1 transcription in HTS compared to NS of both human and porcine tissues (Fold change= 6.11 and 7.70, n=15 and n=3 scars respectively, p< .001). In pig HTS, this upregulation was maintained throughout scar development and remodeling (days 49, 56, 77, 99, and 112 post-wounding). IF Gal-1 in human HTS showed significantly increased fluorescence (503±58 vs 346±23, p< .001, n=5 scars) compared to NS, and Gal-1 was visualized in both intracellular and extracellular areas of the dermis.

Conclusions

Galectin-1 is overexpressed in HTS at the mRNA and protein levels and may have a role in the development of scar phenotypes due to fibroblast over-proliferation, collagen secretion, and dermal thickening. The role of galectins shows promise for future study and may lead to development of new pharmacotherapies.

Applicability of Research to Practice

A better understanding of galectin signaling and its effects on the ECM and cell growth may lead to new treatments aimed at reducing scar formation. Changes in galectin expression could be induced as possible downstream effects of anti-scarring gene therapies aimed at AKT-inactivation.
121 The Opioid Dependence Paradox in Among Patients with Burn Injury
Authors: Peluso Heather , Georgi Marc S , Caffrey Julie
Published: March 2020

Introduction

The opioid epidemic has contributed significantly to the healthcare economic burden nationwide.

Methods

Using the 2016 National Readmission Database, patients were included if they had a principal diagnosis of burn injury. Opioid dependence was identified using appropriate ICD-10 CM codes. The primary outcome was 30-day all-cause readmission. Secondary outcomes were in-hospital and calendar-year mortality, resource utilization, and most common reasons for admission and readmission. Confounders were adjusted for using multivariate regression analysis.

Results

22,348 patients were included, 597 of whom were opioid dependent. Opioid dependent patients were more likely to be older (43 years, range: 38.6–47.2 years) and male (70.8%) compared with patients without opioid dependence. Opioid dependence was associated with higher 30-day readmission rates (adjusted odds ratio (aOR): 1.93, 95% confidence interval (CI):1.39–2.68, p-value: < 0.01), longer mean length of stay (adjusted mean difference (aMD): 5.46 days, CI:2.63–8.29, p-value: < 0.01). and higher total hospitalization charges (aMD: $50,050, CI:$5,941-$94,960, p-value: 0.03) and costs (aMD: $14,889, CI:$3,658-$26,119, p-value: 0.01). However, opioid dependence was associated with lower in-hospital (aOR: 0.23, CI:0.06–0.85, p-value: 0.03) and calendar-year (aOR: 0.47, CI:0.22–0.99, p-value: 0.04) mortality. The most common reasons for both initial admission and readmission are presented in Table 1.

Conclusions

Opioid dependence is associated with lower in-hospital and calendar-year mortality, but higher rates of readmission, longer mean length of stay and higher hospital charges among patients with burn injuries.

Applicability of Research to Practice

Despite increased resource utilization for patients with opioid dependence, mortality was decreased in this population. Further research is needed to elucidate this paradox.
125 Management of Acute Pain in the Burn Patient: Reaching a New Guideline
Authors: Romanowski Kathleen S , Carson Joshua S , Pape Kate , Bernal Eileen , Wiechman Shelley A , Carter Damien W , Nitzschke Stephanie , Bhalla Paul I , Litt Jeffrey , Friedman Bruce , Jeng James C , Sharar Sam , Liu Yuk , Ryan Colleen M , Joe Victor C
Published: March 2020

Introduction

The most recent ABA pain guidelines were developed over 13 years ago and have not been revised despite the changing practice of burn care. Coupled with the nationwide opioid epidemic there is a need to examine the available literature and revise the ABA practice guidelines for pain management.

Methods

A committee of a professional association was created to revise the previously published pain guidelines and consisted of a wide range of burn care providers including burn surgeons, burn nurses, anesthesiologists, a pharmacist, and a psychologist. A MEDLINE search of English-language publications from 1968 to 2018 was conducted using the keywords “burn pain,” “treatment,” and “assessment”. Selected other references were also used based on our evaluation of the greater pain literature. Studies were graded by 2 members of the committee using Oxford Centre for Evidence-based Medicine – Levels of Evidence (level 1 being the highest and level 5 the lowest). When there was a disagreement, a third member of the committee was used to resolve the disagreement. Our next step was to meet as a group and determine what our expert consensus was on a variety of topics related to treating pain in burn-injured patients. Finally, we assessed gaps in the knowledge that was available and determined research questions that would aid us in providing better recommendations for the care of the burn-injured patient.

Results

The literature search produced 189 papers, of which 95 were found to be relevant to the assessment and treatment of burn pain. From the greater pain literature, 115 references were included so a total of 210 papers were analyzed. The greatest number of papers were level 5 evidence (62, 29.5%) while only 30 (14.3%) were level 1. Following the review of the literature and meeting to establish consensus, 18 guidelines were established in the areas of pain assessment, opioid pain medications, non-opioid pain medications, regional anesthesia, and non-pharmacologic treatments.

Conclusions

While there is increasing research on various pain management modalities, the available studies are inadequate to create a true standard of care. Despite this, our committee reached a consensus using available literature from burn or other areas, expert experience and knowledge of pain physiology. Moving forward we call for more burn specific research into all modalities for burn pain control as well as research on multimodal pain control.

Applicability of Research to Practice

Burn pain is particularly difficult to manage and further study is needed to develop a standard of care for burn pain management.