bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiation Therapy for Cholangiocarcinoma
Authors: Sittenfeld Sarah M.C. , Broughman James R. , Campbell Shauna R. , Stephans Kevin L.
Published: March 2020

Cholangiocarcinoma (CC) is a rare disease representing only 3% of the primary gastrointestinal malignancies. CC is classified based on anatomical location (intrahepatic, perihilar, and extrahepatic) and surgery is the preferred definitive treatment, regardless of location. However, a minority of patients is able to undergo complete surgical resection, and thus, nonsurgical locoregional therapy is imperative for tumor control. With the significant evolution of external beam radiation therapy, higher doses can be more precisely delivered, with adequate sparing of surrounding normal tissues, which appear to be associated with improved outcomes. In this review, we discuss the role of radiation therapy for each anatomical subsite of CC including the postoperative setting, neoadjuvant setting prior to liver transplantation, as well as definitive treatment with dose-escalated radiation and stereotactic body radiation therapy. Although there has been substantial improvement in radiation therapy techniques, randomized data are limited given CC remains both a rare and heterogenous disease. A multidisciplinary approach to treatment is essential in order to achieve optimal outcomes, and further investigation into novel therapies remains ongoing.
The Role of Liver Transplantation for Liver Metastasis from Colorectal Cancer
Authors: Tomiyama Koji , Dokus M. Katherine , Errigo Jennie , Laryea Marie , Hernandez-Alejandro Roberto
Published: March 2020

As chemotherapy for colorectal cancer becomes effective for extending long-term survival, its liver metastases (colorectal cancer liver metastases [CRCLM]) are considered as the progression that best defines patient survival. Surgical resection is the most effective and only curative treatment for CRCLM. Although advancement in liver surgery to increase resectability of CRCLM has borne fruit, there are still limitations, namely tumor burden, remnant liver volume, and chemotherapy-related liver damage. CRCLM used to be considered a contraindication for liver transplantation (LTx) based on preliminary experience in the early era of LTx. Recent advancement in chemotherapy and surgical resection for CRCLM as well as improved outcome of LTx have attracted interest in revisiting this old dogma of LTx for CRCLM. Preliminary experience from Norway has shown promising results and potential for long-term survival with LTx. In this article, we review the history of LTx for CRCLM, rationale for revisiting the concept, early experience from Norway and discuss the issues around and future perspectives on LTx for CRCLM.
Monsters and the pantomime
Authors: Marsden Robert
Published: March 2020

Monsters within British pantomime are ubiquitous creatures, from the ogre in the castle ofPuss in Bootsto the Giant at the top of the beanstalk, and as personified in the monstrous acts of Wicked Stepmothers, frightening Barons and diabolical henchmen. The popularity of pantomime means that it is often the first encounter that a child has with a monster in material form, sharing the same physical space: a theatre. Bruno Bettelheim (1991) argues that fairytales, from where many pantomimes are drawn, are our first negotiations with the monstrous. In pantomime, the audience are complicit in the act of finding, chasing and dealing with the monster, and the ethical positioning of this by writers and directors is paramount in guiding us to understand how we may deal with the ‘other’ in our own lives. This paper critically interrogates the threat posed by these monsters when invested with a materiality in performance. In the first instance, I explore the interplay between stage space and the representation of the monster and how this relates to my professional experience of directing over twenty-five professional pantomimes in the United Kingdom since 1999. Tracing this spatial dynamic between monster and audience to the medieval stage and the ludic dimension to the staging of the devils in the mystery play, the paper argues that there is a long-reaching historical antecedent to the staging of evil that informs and inspires spatial practices in modern-day pantomime. Key questions are: to what extent have pantomimes historically presented and rehearsed the threat posed by the monster in order to contain that threat?; What ethical considerations do producers, writers and directors now face in the contemporary pantomime? Finally, to what extent does the popular form of pantomime itself matter as a vehicle for enabling audiences both young and old to confront the monstrous Other?
Review of developments on polymers’ breakdown characteristics and mechanisms on a nanosecond time scale
Authors: Zhao Liang , Su Jian Cang , Liu Chun Liang
Published: March 2020

The breakdown of polymer insulators at a nanosecond scale is a serious problem for high-voltage devices and pulsed power systems. This paper reviews recent developments in research on the mechanisms and characteristics of the breakdown of polymers at a nanosecond scale at the Northwest Institute of Nuclear Technology. An improved avalanche breakdown model is proposed, and a formula for the strength of the electric breakdown (EBD) is formulated based on it. The formative time lag of the avalanche breakdown model is then developed to verify it. Two research groups were formed to study the characteristics of the breakdown. One focused on the characteristics of single-pulse breakdown, such as the effects of size, polymer type, electrode, pulse width, and pulse polarity on EBD, with the aim of deriving expressions for EBD. The other research group examined cumulative (multi-pulse) characteristics of the breakdown with the aim of deriving a formula for the lifetime of the polymer. A method to design solid insulation structures is finally proposed.
Driven electrostatic phase space vortices in a 1D weakly dissipative Vlasov–Poisson system
Authors: Trivedi Pallavi , Ganesh Rajaraman
Published: March 2020

The effect of collisions on driven electrostatic phase space vortices is analyzed by means of Eulerian simulation for two different collision models. It was demonstrated recently [P. Trivedi and R. Ganesh, Phys. Plasmas 23, 062112 (2016)] that in the absence of collisions, at late times, steady state phase space vortices manifest to form a plateau in the resonant region of the particle velocity distribution function, due to trapping of particles supporting multiextrema giant phase space vortices (PSVs). In the presence of collisions, over long time, this multiextrema plateau are found to smooth out, since collisions drive the velocity distribution toward Maxwellian, irrespective of how weak the collisions are as long as they are non-zero. In these conditions, kinetic processes and collisionality are found to be in competition, and the evolution of the plasma is found, therefore, to be a result of nontrivial combination of these two effects. An attempt has been made by means of numerical simulations to study the effect of weak collisionality on the electrostatic driven phase space vortices with two types of collision operators: (1) Bhatnagar–Gross–Krook (Krook) collision operator, where the colliding particles can be treated as isolated pairs and, (2) Fokker–Planck (FP) type collision operator (Zakharov–Karpman) in one dimension, where many weak collisions lead to particle diffusion in velocity space. It is shown that depending on the collision model used, the nature of smoothing in velocity space of giant PSVs results in qualitatively very different phase space structures. However, irrespective of the collision model used, excess density fractions over 10% are retained.
Complex impedance of a transition-edge sensor with sub-μs time constant
Authors: Hattori K. , Kobayashi R. , Takasu S. , Fukuda D.
Published: March 2020

Optical transition edge sensor (TES) detectors that can resolve the energy of a single optical photon have proven to be desirable in multicolor fluorescence microscopy. Here, detectors with a higher energy resolution can distinguish dyes having similar or closer emission wavelengths, thus enabling the observation of multiple kinds of dyes simultaneously. To improve energy resolution, it is necessary to know how different the measured energy resolution is from the limit determined by the temperature sensitivity αI and current sensitivity βI, as extracted from the complex impedance. Due to the very fast response of an optical TES (the time constant is shorter than 1 µs), the complex impedance must be measured up to frequencies larger than 10 MHz. However, at high frequencies, the parasitic impedance in the circuit and reflections of electrical signals caused by discontinuities in the characteristic impedance of the readout circuits become significant. To reduce these effects, twisted pair cables are replaced with coaxial ones in this work; thus, a cleaner transfer function of the readout at high frequencies is obtained. The measured impedance of the studied TES is consistent with that given by the single-block model.
Evaluating carbon dots as electron mediators in photochemical and photocatalytic processes of NiFe2O4
Authors: Ombaka Lucy M. , Dillert Ralf , Robben Lars , Bahnemann Detlef W.
Published: March 2020

Spinel ferrites such as nickel ferrite are promising energy conversion photocatalysts as they are visible-light absorbers, chemically stable, earth abundant, and inexpensive. Nickel ferrite shows poor photocatalytic activity due to fast electron–hole recombination upon illumination. This study evaluates the capability of carbon dots (CDs) to improve charge-carrier separation in NiFe2O4. We report a facile solvothermal approach for synthesizing NiFe2O4 and CDs/NiFe2O4 nanoparticles at 200–215 °C. The photocatalysts were characterized using transmission and scanning electron microscopy, x-ray diffraction, Raman spectroscopy, Fourier transform infrared spectroscopy, UV-VIS-NIR spectroscopy, photoelectrochemical analysis, and laser flash photolysis. Photocatalytic oxidation of methanol to formaldehyde under visible light was employed to test the effect of CDs on the photocatalytic efficacy of NiFe2O4. UV-VIS-NIR spectroscopy depicted a total quenching of NIR absorption and a diminished absorption of a peak at ∼745 nm in CDs/NiFe2O4 compared with NiFe2O4, indicating a transfer of electrons from NiFe2O4 to CDs. A 12-fold increment in the incident-photon-to-charge-efficiency was achievable with CDs/NiFe2O4 (0.36%) compared with NiFe2O4 (0.03%). Impedance spectroscopy exhibited a more efficient charge separation and faster interfacial charge transfer in CDs/NiFe2O4 compared with pure NiFe2O4. This was accounted for by the lower initial quantity of charge carrier upon irradiation in CDs/NiFe2O4 compared with NiFe2O4 as detected from laser flash photolysis, indicating that CDs acted as electron acceptors and reservoirs in CDs/NiFe2O4. Compared with NiFe2O4, CDs/NiFe2O4 showed an enhanced photocatalytic activity toward formaldehyde formation. Consequently, CDs are good electron mediators for NiFe2O4, capable of improving charge-carrier separation and the photocatalytic activity of NiFe2O4.
Proton-conducting oxides for energy conversion and storage
Authors: Duan Chuancheng , Huang Jake , Sullivan Neal , O'Hayre Ryan
Published: March 2020

Proton-conducting oxides are a class of solid-state ion-conducting ceramic materials that demonstrate significant hydrogen ion (proton) conductivity at intermediate temperatures (e.g., 300–700 °C). They are garnering significant attention due to several unique characteristics that distinguish them from both higher temperature oxygen ion conducting oxides and lower temperature proton-conducting polymers. By enabling proton-mediated electrochemistry under both dry and wet environments at moderate temperatures, protonic ceramics provide unique opportunities to enhance or synergize a diverse range of complementary electrochemical and thermochemical processes. Because of this potential, significant efforts have been devoted to advancing numerous energy-related applications using these materials. This review aims to comprehensively summarize these applications and analyze the most up-to-date and future developments of proton-conducting oxides. We aim to bring together this diverse subject matter by integrating the fundamentals of proton-conducting oxides with application-oriented insights. We begin with a historical roadmap, followed by a basic overview of the materials, theories and fundamentals, and fabrication and processing technologies underlying the field. The central section of our review summarizes major applications and developments of proton-conducting ceramics, ranging from maturing applications approaching commercialization to embryonic technologies just now emerging from the lab. These include protonic ceramic fuel cells, protonic ceramic electrolysis cells, reversible protonic ceramic electrochemical cells, protonic ceramic membrane reactors, and protonic ceramic electrochemical reactors. For each application, we analyze both the prospects and challenges and offer recommendations for future research directions so that tomorrow's researchers can continue to advance the development and commercialization of these fascinating materials.
Relations between angular and Cartesian orientational expansions
Authors: te Vrugt Michael , Wittkowski Raphael
Published: March 2020

Orientational expansions, which are widely used in natural sciences, exist in angular and Cartesian forms. Although these expansions are orderwise equivalent, it is difficult to relate them in practice. In this article, both types of expansions and their relations are explained in detail. We give explicit formulas for the conversion between angular and Cartesian expansion coefficients for functions depending on one, two, and three angles in two and three spatial dimensions. These formulas are useful, e.g., for comparing theoretical and experimental results in liquid crystal physics. The application of the expansions in the definition of orientational order parameters is also discussed.
Possibility for inhibited spontaneous emission in electromagnetically open parity–time-symmetric guiding structures
Authors: Hadad Yakir , Engheta Nader
Published: March 2020

Significance

Energy conservation implies that in lossless systems with prohibited radiation, spontaneous emission (the process in which an excited atom returns to its ground state while emitting a photon) is inhibited. However, since radiation is forbidden, electromagnetic sensing and far-field manipulation of the quantum emitter are challenging tasks. We suggest to resolve this issue by using a parity–time-symmetric waveguide system with balanced gain and loss. We theoretically show that the power emitted by a classical dipole in this system may be nullified while dipole excitation frequency is well inside the structure’s passband. In light of known relations connecting spontaneous emission of quantum emitters and classical dipole radiation, our results establish a possibility for inhibited spontaneous emission in electromagnetically open systems.
Study on substitution of Ni with Ni3Al on structure and properties of W–6Ni3Al–4Co alloys by two-step sintering process
Authors: Dong Hongfeng , Li Peiyou , Ai Taotao , Li Wenhu
Published: March 2020

Herein, the effect of substitution of Ni with Ni3Al and two-step sintering on the phase transformation, microstructure evolution, and properties of W–6Ni–4Co alloys were evaluated. The results show that the reaction products of Ni3Al and Co include (Ni, Co)3Al4 to Co2Al9 during the two-step sintering process. When Ni was substituted by Ni3Al, the densification temperature was reduced. The distribution of W phase turned from stripes to network, and the grain size increased with an increase in the sintering temperature. The Ni3Al substituted sample sintered at 1500 °C for 20 min displayed a combination of high densification parameter, microhardness, and strength because of denser microstructure of the alloy.
HLPpred-Fuse: improved and robust prediction of hemolytic peptide and its activity by fusing multiple feature representation
Authors: Hasan Md Mehedi , Schaduangrat Nalini , Basith Shaherin , Lee Gwang , Shoombuatong Watshara , Manavalan Balachandran
Published: March 2020

Motivation

Therapeutic peptides failing at clinical trials could be attributed to their toxicity profiles like hemolytic activity, which hamper further progress of peptides as drug candidates. The accurate prediction of hemolytic peptides (HLPs) and its activity from the given peptides is one of the challenging tasks in immunoinformatics, which is essential for drug development and basic research. Although there are a few computational methods that have been proposed for this aspect, none of them are able to identify HLPs and their activities simultaneously.

Results

In this study, we proposed a two-layer prediction framework, called HLPpred-Fuse, that can accurately and automatically predict both hemolytic peptides (HLPs or non-HLPs) as well as HLPs activity (high and low). More specifically, feature representation learning scheme was utilized to generate 54 probabilistic features by integrating six different machine learning classifiers and nine different sequence-based encodings. Consequently, the 54 probabilistic features were fused to provide sufficiently converged sequence information which was used as an input to extremely randomized tree for the development of two final prediction models which independently identify HLP and its activity. Performance comparisons over empirical cross-validation analysis, independent test and case study against state-of-the-art methods demonstrate that HLPpred-Fuse consistently outperformed these methods in the identification of hemolytic activity.

Availability and implementation

For the convenience of experimental scientists, a web-based tool has been established at http://thegleelab.org/HLPpred-Fuse.

Contact

glee@ajou.ac.kr or watshara.sho@mahidol.ac.th or bala@ajou.ac.kr

Supplementary information

Supplementary data are available at Bioinformatics online.
Simultaneous Determination of Eight Components in Leonuri Herba from Different Habitats by HPLC-DAD
Authors: Xu Yang , Yang Huailei , Chi Jihong , Wang Fang , Bao Huiwei
Published: March 2020

A HPLC-DAD method was established for the simultaneous determination of eight components in Leonuri Herba from different habitats, as well as providing methodological reference for quality control of Leonuri Herba. In this study, absolute ethanol extracts of the medicinal material were considered as the sample solutions to be analyzed. Agilent ZORBAX SB-C18 column (250 mm × 4.6 mm, 5 μm) was used for determination maintained at the temperature of 30°C. Gradient elution was performed with a mobile phase of methanol (B)-0.1% phosphoric acid solution (A) at the flow rate of 1.0 mL·min−1. The analysis was carried out at the wavelength of 225, 280 and 320 nm. The measured eight components showed good linear relationships within their own concentration range. Average recoveries ranged from 98.83 to 100.36% with RSDs of 1.14~1.97%. The proposed method was found to be simple, accurate and reproducible, which provided an effective quantitative analytical method for quality control of Leonuri Herba from different habitats.
Perinatal Transmission of 2019 Coronavirus Disease–Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry?
Authors: Fan Cuifang , Lei Di , Fang Congcong , Li Chunyan , Wang Ming , Liu Yuling , Bao Yan , Sun Yanmei , Huang Jinfa , Guo Yuping , Yu Ying , Wang Suqing
Published: March 2020

We present 2 cases of coronavirus disease 2019 (COVID-19)–associated severe respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the third trimester of pregnancy. Both mothers and newborns had excellent outcomes. We failed to identify SARS-CoV-2 in all of the products of conception and the newborns. This report provided evidence of low risk of intrauterine infection by vertical transmission of SARS-CoV-2.
Echocardiographic reference ranges for normal left ventricular layer-specific strain: results from the EACVI NORRE study
Authors: Tsugu Toshimitsu , Postolache Adriana , Dulgheru Raluca , Sugimoto Tadafumi , Tridetti Julien , Nguyen Trung Mai-Linh , Piette Caroline , Moonen Marie , Manganaro Roberta , Ilardi Federica , Chitroceanu Alexandra Maria , Sperlongano Simona , Go Yun Yun , Kacharava George , Athanassopoulos George D , Barone Daniele , Baroni Monica , Cardim Nuno , Hagendorff Andreas , Hristova Krasimira , Lopez Teresa , de la Morena Gonzalo , Popescu Bogdan A , Penicka Martin , Ozyigit Tolga , Rodrigo Carbonero Jose David , van de Veire Nico , Von Bardeleben Ralph Stephan , Vinereanu Dragos , Zamorano Jose Luis , Rosca Monica , Calin Andreea , Magne Julien , Cosyns Bernard , Galli Elena , Donal Erwan , Santoro Ciro , Galderisi Maurizio , Badano Luigi P , Lang Roberto M , Lancellotti Patrizio
Published: March 2020

Aims 

To obtain the normal range for 2D echocardiographic (2DE) measurements of left ventricular (LV) layer-specific strain from a large group of healthy volunteers of both genders over a wide range of ages.

Methods and results 

A total of 287 (109 men, mean age: 46 ± 14 years) healthy subjects were enrolled at 22 collaborating institutions of the EACVI Normal Reference Ranges for Echocardiography (NORRE) study. Layer-specific strain was analysed from the apical two-, three-, and four-chamber views using 2DE software. The lowest values of layer-specific strain calculated as ±1.96 standard deviations from the mean were −15.0% in men and −15.6% in women for epicardial strain, −16.8% and −17.7% for mid-myocardial strain, and −18.7% and −19.9% for endocardial strain, respectively. Basal-epicardial and mid-myocardial strain decreased with age in women (epicardial; P = 0.008, mid-myocardial; P = 0.003) and correlated with age (epicardial; r = −0.20, P = 0.007, mid-myocardial; r = −0.21, P = 0.006, endocardial; r = −0.23, P = 0.002), whereas apical-epicardial, mid-myocardial strain increased with the age in women (epicardial; P = 0.006, mid-myocardial; P = 0.03) and correlated with age (epicardial; r = 0.16, P = 0.04). End/Epi ratio at the apex was higher than at the middle and basal levels of LV in men (apex; 1.6 ± 0.2, middle; 1.2 ± 0.1, base 1.1 ± 0.1) and women (apex; 1.6 ± 0.1, middle; 1.1 ± 0.1, base 1.2 ± 0.1).

Conclusion 

The NORRE study provides useful 2DE reference ranges for novel indices of layer-specific strain.
Ice(berg) Transport Costs
Authors: Bosker Maarten , Buringh Eltjo
Published: March 2020

Iceberg transport costs are a key ingredient of modern trade and economic geography models. Using detailed information on Boston’s nineteenth-century global ice trade, we show that the cost of shipping the only good that truly melts in transit is not well-proxied by this assumption. Additive cost components account for the largest part of per unit ice(berg) transport costs in practice. Moreover, the physics of the melt process and the practice of insulating the ice in transit meant that shipping ice is subject to economies of scale. This finding supports, from an unexpected historical angle, recent efforts to incorporate more realistic features of the transportation sector in trade and economic geography models.
Honesty and Self-Selection into Cheap Talk
Authors: Fehrler Sebastian , Fischbacher Urs , Schneider Maik T
Published: March 2020

In many situations, people can lie strategically, for their own benefit. Since individuals differ with respect to their willingness to lie, the credibility of statements will crucially depend on who self-selects into such cheap-talk situations. We study this process in a two-stage political competition setting. At the entry stage, potential candidates compete in a contest to become their party’s candidate in an election. At the election stage, the nominated candidates campaign by making promises to voters. Confirming the model’s key prediction, we find in our experiment that dishonest people over-proportionally self-select into the political race and thereby lower voters’ welfare.
The Struggle between Nationalist and Jihadist Narratives of Gallipoli, 1915–2015
Authors: Aktar Ayhan
Published: March 2020

There have been a number of milestones in the (re-)writing of the history of the Gallipoli campaign (1915). First, the dominant Turkish nationalist historiography ‘Turkified’ the victory of the Ottoman Imperial Army. Narratives of the 1930s were also constructed in such a way that the presence of Mustafa Kemal (later Atatürk) was used as a bridge to attach the Gallipoli campaign of 1915 to the Turkish War of Independence (1919–1922). In later years, Islamist poets such as Mehmet Akif wrote poems presenting the campaign as a kind of ‘Resistance of Islam against the Infidel’. However, it was not until the mid-1990s that the Gallipoli campaign came to be framed as an ‘Invasion of Crusaders into the House of Islam’. This new narrative reflects a jihadist revision. In this article, these trends will be analysed within the framework of operations of political power in both civil society and the state.
Comparative proteomics analysis of Tibetan hull-less barley under osmotic stress via data-independent acquisition mass spectrometry
Authors: Wang Yulin , Sang Zha , Xu Shaohang , Xu Qijun , Zeng Xingquan , Jabu Dunzhu , Yuan Hongjun
Published: March 2020

Background

Tibetan hull-less barley (Hordeum vulgare L. var. nudum) is one of the primary crops cultivated in the mountains of Tibet and encounters low temperature, high salinity, and drought. Specifically, drought is one of the major abiotic stresses that affect and limit Tibetan barley growth. Osmotic stress is often simultaneously accompanied by drought conditions. Thus, to improve crop yield, it is critical to explore the molecular mechanism governing the responses of hull-less barley to osmotic/drought stress conditions.

Findings

In this study, we used quantitative proteomics by data-independent acquisition mass spectrometry to investigate protein abundance changes in tolerant (XL) and sensitive (DQ) cultivars. A total of 6,921 proteins were identified and quantified in all samples. Two distinct strategies based on pairwise and time-course comparisons were utilized in the comprehensive analysis of differentially abundant proteins. Further functional analysis of differentially abundant proteins revealed that some hormone metabolism–associated and phytohormone abscisic acid–induced genes are primarily affected by osmotic stress. Enhanced regulation of reactive oxygen species (may promote the tolerance of hull-less barley under osmotic stress. Moreover, we found that some regulators, such as GRF, PR10, MAPK, and AMPK, were centrally positioned in the gene regulatory network, suggesting that they may have a dominant role in the osmotic stress response of Tibetan barley.

Conclusions

Our findings highlight a subset of proteins and processes that are involved in the alleviation of osmotic stress. In addition, this study provides a large-scale and multidimensional proteomic data resource for the further investigation and improvement of osmotic/drought stress tolerance in hull-less barley or other plant species.
18 Stop the Burn: A Smoking and Home Oxygen Safety Initiative with Use of Firebreaks
Authors: Mastropieri Cynthia J , Leonard Ginger , Holmes James H
Published: March 2020

Introduction

COPD is a chronic pulmonary disease treated with home oxygen. The single most common cause of COPD is cigarette smoking. Approximately 1.4 million people in the US use long-term oxygen therapy for treatment of hypoxic COPD. Smoking is an addictive risky behavior and smoking on oxygen therapy is responsible for the majority of home oxygen fires and deaths. Up to 52% of patients who use oxygen therapy continue to smoke in spite of these risks. At least 1,000 burn injuries per year occur when oxygen cannula tips ignite after coming in close contact with cigarettes, lighters, or matches. Flames travel externally and internally along the tubing toward the oxygen concentrator, which can explode. Previous prevention efforts have focused on counseling and education of patients and their caregivers; however, the habit continues, causing burn injury admissions and increasing health care costs.

Methods

Our ABA verified burn center admitted 90 burn injuries during July 2015 to September 2019 related to smoking on oxygen. Given the mechanism of injury, further preventive efforts were researched, and firebreak devices were identified as a secondary preventive measure to attempt to reduce negative consequences of smoking on oxygen. A firebreak device is fitted in the oxygen tubing near the patient and also near the oxygen concentrator. The firebreak acts as a thermal fuse by stopping the oxygen supply when triggered, preventing the flames from burning to the oxygen concentrator. Our program goal was to develop a safety initiative using educational information and firebreak devices. Information was shared at the regional Trauma committee and with local EMS, Fire and on Facebook. The program was initiated in 2018. We worked with local EMS and Fire agencies to install the firebreak devices in nursing homes, assisted living facilities and in patients’ homes who use oxygen.

Results

Our program distributed 225 firebreak kits, which included no smoking signs, a home oxygen safety checklist, an educational video link, nasal cannula tubing and 2 firebreak devices. Since the initiation of the program, the number of burn injury admissions from smoking on oxygen decreased from an average of 24/year to an average of 9/year.

Conclusions

Standardizing the use of firebreak kits in the community for those smoking on oxygen or using oxygen stops a fire by halting the oxygen supply thereby potentially decreasing burn admissions. Therefore, we recommend the consideration of firebreak kits for patients who continue to smoke while using oxygen to Stop the Burn.

Applicability of Research to Practice

Future research is recommended to determine the effectiveness of firebreak kits as a safety measure for all individuals who use oxygen.
24 Geospatial Localization of Adult Burn Injuries and Associated Housing Factors in a Major Urban Metropolis
Authors: Chandramouli Mathangi A , Mount Lauren , Winchell Robert , Chang Philip
Published: March 2020

Introduction

According to the National Burn Repository, almost 75% of all burns occur at the burn victim’s home. The modern urban metroplex is a diverse ecosystem made up of varied socioeconomic backgrounds often housed under heterogenous living conditions. We sought to better understand the relationship between location of injury and socioeconomic factors using geospatial mapping for this patient population.

Methods

Injury Zip Code Data was obtained from the electronic medical record of an ABA verified Burn Center serving a major urban metropolis from 2016–2018. Data was also obtained from this city’s OpenData database and included housing vacate list data from the fire department of this city, fire department dispatch data, fire department firehouse listing, fire department active order violation, and housing maintenance code complaints. ArcGIS software was used to create and analyze hotspot maps (p< 0.05).

Results

GIS analysis revealed a statistically significant relationship between number of burns (NB) and firehouse density per zip code in sparsely distributed patches around NYC (Fig. 1) (p< 0.05). Notably, there is a statistically significant relationship between NB and fire dispatch volume as well as a large cluster of statistically significant area with respect to NB and housing active code violations in the two most populous districts (Fig 2 and 3) (p< 0.01).

Conclusions

Certain housing factors such as building code violations relate to burn volume in certain areas. It is also noted that increased firehouse density and fire dispatch volume are associated a larger volume of burn occurrences. Further analysis of different housing and social factors are is anticipated.

Applicability of Research to Practice

Burn outreach efforts are tailored towards our unique population. Having a better understanding of the population and localizing areas with increased burn injuries along with the potential social factors can help direct future outreach and prevention efforts.
62 Impact of the Affordable Care Act on Post-discharge Services After Burn Injury
Authors: Godat Laura N , Higginson Sara , Lee Jeanne , Doucet Jay , Costantini Todd W
Published: March 2020

Introduction

Recovery from burn injury is a prolonged process often requiring post-discharge services such as rehabilitation or skilled nursing care. Affordable Care Act Open Enrollment (ACA-OE) began in January 2014 providing access to medical insurance for millions of previously uninsured Americans. Whether improved insurance coverage has improved access to post-discharge care for patients admitted with burn injury is unknown. We hypothesized that the ACA would improve insurance coverage for patients admitted with burn injury and that medical insurance would be associated with increased access to post-discharge care services.

Methods

The Nationwide Readmission Database was queried to identify patients ages 18–65 with an index admission for cutaneous burn injury using ICD-9 & ICD-10 codes. Patients with Medicare or those that died during the index admission were excluded. Pre-ACA-OE admissions (2013, Q1-Q3) were compared with post-ACA admissions (2016, Q1-Q3) to evaluate the effects the ACA-OE of insurance status, length of stay, discharge disposition, 30- and 90-day readmission rates.

Results

There were 12,932 burn-injured patients included with 5,389 patients in 2013 and 7,543 patients in 2016. Post-ACA, Medicaid insurance increased from 33.0% to 43.9% (p< 0.001) while self-pay decreased from 25.8% to 13.7% (p< 0.001). Private insurance status did not change after implementation of the ACA (41.2% vs. 42.4%). Post-ACA-OE, overall routine discharge home decreased from 79.4% to 77.7% (p=0.02) while discharge to a care facility increased from 7.2% to 8.7% (p=0.002). Length of stay was not different between groups (8.9 ± 15.9 days vs. 9.0 ± 15.5 days). Medicaid patients had the highest readmission rates at 30- and 90-days (see Figure). Medicaid patients had decreased 90-day non-elective readmission rates post-ACA-OE (22.4% to 20.0%, p=0.041). Predictors of non-elective 90-day readmission were Medicaid insurance (OR 2.06, CI 1.76–2.40, p< 0.001) and older age (OR 1.03, CI 1.02–1.03, p< 0.001).

Conclusions

The ACA-OE increased access to insurance for burn patients. Discharges to care facilities after burn injury increased post-ACA-OE and was associated with decreased 90-day readmission. Ongoing advocacy efforts are need to improve access to post-burn care resources to optimize recovery from injury.

Applicability of Research to Practice

Awareness of the impacts of health policy and insurance coverage on access to post-discharge resources and readmission rates after burn injury.
113 Successful Treatment of Sulfur Mustard Burns with Silver-Nylon Dressings
Authors: Barillo David J , Croutch Claire R , Barillo Anthony R , Reid Frances M
Published: March 2020

Introduction

Sulfur mustard (SM) is a chemical weapon first used in 1917 and in 11 subsequent regional conflicts including use by ISIS in Syria in 2016. SM skin exposure results in burns that are indolent, recurrent and hard to treat. Despite 100 years of experience, there is no standard of care for SM burns. We tested silver-nylon dressings in a porcine model of partial thickness SM injury.

Methods

The study was performed in an AAALAC-approved facility under Good Laboratory Practices (GLP) standards. A total of 1320 superficial or deep partial thickness burns were produced in 165 Gottingen minipigs by vapor cap exposure. The wounds were then debrided with 7 days of saline wet/wet dressings. Silver-nylon dressings were applied and changed daily, every 4 days or every 7 days. Control dressings were silver sulfadiazine changed daily. Dressings were left intact for 30 days followed by 7 days of no treatment. Animals were euthanized and wounds assessed by histopathology (primary endpoint). The non-inferiority margin for histopathology score was 1.5 (10% of maximum possible score).

Results

There was no mortality or wound infection seen. Silver-nylon when applied once every 7 days to superficial or deep wounds was not inferior to the comparator treatment, SSD on gauze, as evaluated by histopathology (Δ =0.38 95% CI = 0.15, p = 0.0001). There was no statistical difference when comparing silver nylon applied daily, every 4 days or every 7 days in either superficial or deep wounds Chart # 1). Blood silver levels were drawn pre-study, mid study and at autopsy. Blood silver levels were negative in all cases (n= 480). At study end, silver ion was detected in virtually all wounds. Mean skin silver ion levels in wounds treated with daily SSD on gauze or BCD bandage every 1, 4, or 7-days were 3.74, 3.61, 5.43, and 4.40 μg/g, respectively for deep dermal wounds and 2.41, 1.91, 3.75, and 2.73 μg/g,respectively for superficial dermal wounds.There was no statistically significant difference between any of the bandage treatments with regard to silver ion levels in skin punch biopsies collected on Study Day 46.

Conclusions

Silver nylon dressings provide effective treatment for sulfur mustard burns. As in prior studies, silver-nylon provides high wound silver levels without systemic absorption. The data from this study was submitted to the US Food and Drug Administration, resulting in the first-ever FDA clearance for a product indicated to treat sulfur-mustard skin burns.

Applicability of Research to Practice

Silver-nylon dressings can be successfully used to treat cutaneous partial-thickness sulfur mustard skin burns.
524 The Use of Enzymatic Debridement in Large Burns Two Years of Experience
Authors: Minic Jasminka , Governa Maurizio
Published: March 2020

Introduction

Modern era of treatment of burn injury stated with revolutionary approach of early surgical debridement followed by autologous skin grafting since early sixties of the last century. For many decades it’s been a gold standard treatment. It’ s considered effective although not selective approach in terms of blood loss and vital tissue preservation.

We hypothesized that selective enzymatic debridement could have the positive outcome in terms of local control of wound healing and could decrease systemic inflammatory response.

Methods

Since February 2017 till February 2019 in our Burn Unit, we treated over 50 cases of partially deep and deep burns. Thirty nine out of 50 was >15% TBSA (15 - 85%). Most of the patients (34 out of 39) was treated in BU or ICU. According to our protocol allograft skin grafting followed enzymatic debridement. Skin biopsy was performed before and after treatment. Three cases died for other complications and comorbidity.

Results

We respected the gold standard performing complete selective debridement within 1,4 days. Mean age was 54,1ys (1.1–96 ys). No blood transfusion was necessary after enzymatic debridement. Only one procedure was necessary for the majority patients (32 out of 39 pt). Twenty eight out of 39 patients went to OR for skin grafting. For the burn wound completion there was a necessity of average 5,8% autografts. Infection was well controlled with antibiotics therapy. Five cases of sepsis and one case of bacteremia was registered.

Conclusions

Regardless it a limited number of patient and only one year of experience, obtained results are encouraging. Rapid enzymatic debridement as a minimally invasive tool permitted to control burn wound not only on the local level but it seam like that has improved pro and anti-inflammatory response in terms of better control of the SIRS. Further investigations will be necessary to confirm it.

Applicability of Research to Practice

This study is applicable inner practice. All the following data were took from our data base system.
565 Suicidality After Burn Injuries: A Systematic Review
Authors: Lerman Sheera F , Hultman C Scott , Cox Carrie A , Caffrey Julie
Published: March 2020

Introduction

Burn injuries are associated with substantial pain and disability and may lead to significant long term psychological distress including suicidality. Suicide is among the leading causes of death in the United States and burn survivors may be at increased risk due to the nature of their injury and psychiatric comorbidities. The purpose of this review is to assess the evidence as to the prevalence of suicidal ideations and behaviors (attempts and completed suicides) in burn survivors as well as assessment of risk and protective factors for these behaviors.

Methods

MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched using search terms regarding suicide, suicidality and burn. Studies evaluating self-immolation were excluded unless they also measured suicidality after the injury. Fourteen observational and population-based studies which measured any type of suicidality (ideation, attempts or completed suicide) post-burn injuries underwent critical appraisal.

Results

Few studies directly measure suicidality after burn injuries, and even fewer measure changes in suicidality over time. Overall, burn survivors demonstrate elevated suicidal ideations with rates as high as 32%. Pain at discharge, perceived level of disfigurement and premorbid psychiatric comorbidities are among the significant risk factors for suicidal ideations. There is mixed evidence as to rates of completed suicide post-burn injury, though rates appear to be relatively low.

Conclusions

Results of this systematic review shed light on the scarcity of data on rates of suicidality among burn survivors. This is surprising given the multiple risk factors burn survivors possess including chronic pain, sleep disturbances, history of substance abuse, post-traumatic stress disorder, social isolation and depression which are linked to suicidality in the general population. In addition, individuals with self-inflicted burns may be at even higher risk given that previous suicide attempts are of the strongest predictor of future suicidality. More research is needed to better understand the impact of these risk factors in burn survivors and inform their care.

Applicability of Research to Practice

There is high importance in screening burn survivors for suicidal ideations at discharge from the hospital and following them over time in order to understand the magnitude of this phenomena and offer targeted interventions to vulnerable individuals.
599 Critical Burn Injury in Young Children: A New Challenge of Success
Authors: Lodescar Rachelle J , Bessey Palmer Q , Rabbitts Angela , Greenwald Bruce M , Gallagher James
Published: March 2020

Introduction

Critical burn injury in young children now happens rarely, thanks to many prevention efforts. The challenge that presents is that neither most burn center teams (BC) or pediatric critical care teams (PICU) have sufficient experience to maintain broad expertise in the care of these uncommon but vulnerable patients. Several years ago our BC team and PICU team agreed to co-manage these patients no matter where they were admitted in the hospital. The purpose of this report is to review the results of this cooperative approach.

Methods

We reviewed all pediatric admissions (age 0 to 15) admitted with acute burn injury from October 2015 – September 2019. We further identified those who were co-directed with the PICU. In those cases, senior members of both teams consulted either on the referral call or before the patient’s arrival, both teams rounded together on the patients, and most clinical decisions were made jointly. The burn team performed wound care with bedside caregivers from the PICU as needed. Where the patient was housed in the hospital (BC or PICU) was a secondary but joint decision, guided by the clinical needs of the patient and not by the preference of the team ‘in charge’ of the unit. Data were analyzed with SAS 9.4 and are expressed as Mean ± SEM. Differences in means were tested for significance with TTest and Chi Square.

Results

There were 799 patients admitted with burn injuries over the four-year period. Twenty-seven of them (3.4 ± 0.6 %) had a portion of their care co-directed. These were older than all other pediatric cases (4.9 ± 0.7 years vs 3.2 ± 1.5, p=0.03), and they had larger mean burn size (20 ± 7 % TBSA vs 4 ± 0.2, p=0.03). They more often had inhalation injury (40.7 ± 9.6 % vs 0.9 ± 0.3, p< 0.01). The length of stay of the co-directed patients was longer than the other cases (14 ± 3 days vs 5 ± 1, p< 0.01). Only two patients died: a four-year old with cardiac arrest at the scene from inhalation injury and a three-year old with inhalation injury and a deep burn > 80% TBSA.

Conclusions

Critical burn injuries happen uncommonly in young children. They challenge burn centers, because they are unusual, and it is difficult for the burn team or the PICU team to maintain expertise in all aspects of their care. A cooperative, co-directed patient care model with both the BC and PICU teams may serve to provide optimal care to these infrequent but vulnerable patients.

Applicability of Research to Practice

Directly Applicable.
650 Exploring the Mechanism of Wound Healing in Rats of Different Ages Using a Burn Model
Authors: Shen Chuanan
Published: March 2020

Introduction

This study attempted to explore the mechanism of wound healing in rats of different ages using an reliable and reproducible burn model.

Methods

A self-made metal column, heated in a boiling water bath, was applied for different time periods to the lower back of rats of different ages in burn creation. Wounds were observed visibly at different time points post burning. Biopsies were obtained and examined at 72 h post burn to determine the depth of burns. In exploring the mechanism of wound healing in rats of different ages, we used primary antibodies including Anti-EGFR [EP38Y] (ab52894) and p75NTR (D4B3) for immunofluorescence of the skin paraffin sections (5μm) obtained from normal rats and on day 3 post burn creation. And we measured the expression of CD271 and EGFR.

Results

The contact durations producing the desired depth of injury in the rat model under constant temperature and pressure were: 3 seconds (deep second degree) and 5 seconds (third degree) in 1-month-old rats; 3 seconds (superficial second degree), 5 seconds (deep second degree), and 7–9 seconds (third degree) in 2-month-old rats; 3–5 seconds (superficial second degree), 7–9 seconds (deep second degree), and 11–13 seconds (third degree) in 12- and 18-month-old rats. The distribution of CD271 and epidermal stem cells showed no age-related changes (P＞0.05), and the expression of EGFR decreased with age in normal rats (P＜0.001). Compared with normal rats, the content of CD271 and epidermal stem cells and the expression of EGFR increased in burned rats.

Conclusions

The reliable and reproducible experimental model produces consistent burn injuries in rats of different ages. The number of CD271 and epidermal cells and the expression of EGFR increase during wound healing in rats, suggesting that CD271, epidermal cells and EGFR in epidermal stem cell membranes are associated with burn wound healing.

Applicability of Research to Practice

This research may be used in clinical practice in the future for better wound care.