bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross-programming to reuse old buildings for new functions: The case of Omah Lawa in Surakarta
Authors: Mutiari D , Novianty R
Published: March 2020

Old buildings are a living testament of the past. Although reminiscent of colonial times, buildings from the Dutch colonial era in Indonesia contain a lot of knowledge of building art. One building in the city of Surakarta that is still considered beautiful is Omah Lawa. Unfortunately, the building has not been used for a long time, so it is inhabited by bats. This paper addresses the problem of finding a new function so that this building can be used optimally. First, the paper addresses the concept of conservation of buildings. Adaptive reuse is a conservation theory that allows changes in function in old buildings to adapt to current conditions. This case uses the design method of cross-programming which was introduced by Bernhard Tsumi. Old buildings used to have simple functions such as residences. Now, these buildings are no longer in the residential zone but in the zone of public buildings. As such, its former utilization is no longer permitted. This study used cross-programming to change the function of Omah Lawa in Surakarta into a gallery and a location to market art products. The internal layout was changed to host the new functions while making as few changes as possible to the building.
Sick building syndrome and its effect on health of students and teachers in selected educational buildings in Bandung
Authors: Surahman U , Ray H R D
Published: March 2020

This study investigates the current conditions of indoor air quality, focusing especially on formaldehyde and TVOC, and their effects on health among occupants in the educational buildings located in the city of Bandung. A total of 120 respondents were interviewed and 40 rooms were measured from September to November 2018. The results indicated that around 50% of the respondents in the buildings showed some degrees of chemical sensitivity risk. More than 60% of the measured formaldehyde levels in the buildings exceeded the WHO standard, 0.08 ppm. The respondents studying in rooms with higher mean formaldehyde values tended to have higher multiple chemical sensitivity risk scores.
Sustainable river management: Land use, building coverage, and infrastructure typology of the riverbanks
Authors: Rini E F , Rahayu P , Sinniah G K
Published: March 2020

Surakarta City is intersected by three major rivers which could become the city’s source of clean water. However, pollution of the rivers makes processing this surface water a necessity to create clean water for domestic uses. This study aims to establish a river typology based on the riverbank characteristics and the potential of the surface water to be discharge into clean water. This paper uses spatial analysis to develop typologies and describe the riverbanks characteristics by using the Pepe River in Surakarta as a case study. This is one of the polluted major rivers that flow through Surakarta City. The study found that the Pepe’s riverbanks are dominated by residential and commercial areas. Due to the lack of waste infrastructure, the community (household and small-scale industries) disposes its untreated wastewater directly into the drainage channel. With regard to this problem, five river typologies were established to function as the basis of recommendations to improve the water quality of the river so that it can be used as an urban clean water source. The result shows that all typologies major problems are the lack of wastewater management. The study proposes interventions in waste management, wastewater treatment system, and land use control.
Design visioning in a slum upgrading program: Case study of Ambulu Village, Cirebon Regency, Indonesia
Authors: Pradifta F S , Purnama I , Aji R R , Sulistyo G
Published: March 2020

Design visioning is an approach to formulating the development objective for a planned area. It is based on the input from multiple analyses which results in a clear vision statement. This vision acts as a framework for planning and designing physical interventions. To accomplish the Ministry of Public Works and Public Housing’s directive of “transforming the kampongs’ face” in its slum upgrading program, visionary goal-setting is needed to look beyond physical interventions in infrastructure planning. In fact, the eradication of all slum indicators should not be viewed as an end goal but as a way to improve kampongs’ socioeconomic conditions by creating more liveable and sustainable settlements. Using contextual analysis, followed by SWOT analysis and site analysis, this paper generates general development strategies. The study found that the economic and ecological setting of Ambulu Village in Cirebon Regency has the potential to be promoted into a new maritime-themed tourism destination. The paper presents a vision statement for “Ambulu Eco Fishing Village” as the basis for a set of design principles for developing a slum upgrading masterplan.
A strategy for the sustainable development of the karst area in Wonogiri
Authors: Soedwiwahjono  , Pamardhi-Utomo R
Published: March 2020

The karst area is a strategic area with economic, scientific, and humanitarian values related to livelihood. The karst area of Wonogiri is part of the Gunung Sewu Area, a Global Geopark established by the UNESCO Global Geopark Network. The local inhabitants have not gained any benefit from the potential natural resources. Meanwhile, they are constrained by the harsh nature and the obligation to preserve the karst area. This leads to the question of how spatial planning could intervene inthe socio-economic conditions of the inhabitant by utilizing the natural resources of the karst. The study first describes the characteristics of karst areas from their potentials, problems, opportunities, challenges, and trends. The result of the study is the spatial arrangement of the karst area in Wonogiri based on karst classification and its nature. The karst area can be developed based on its natural resources, such as for agriculture, livestock, special tourism attractions utilizing the landscape and natural formations, including the sustainable exploitation of mineral resources. It can also be used and a source of knowledge. The challenge faced is the obligation to protect its uniqueness related to its geology, geomorphology, paleontology, hydrology, flora and fauna, and the development of knowledge repertoire.
Rural poverty characteristics in Kokap Sub-District, Special Region of Yogyakarta Province
Authors: Isworo E J , Mardiansjah F H
Published: March 2020

Rural poverty is still a major problem for regional development in Indonesia. Kecamatan Kokap (district) in Kabupaten Kulon Progo, which is part of the Strategic Region for the New Yogyakarta International Airport (NYIA), is a rural area that has the highest rate of poverty inKulon Progo. In fact, the development of NYIA and its strategic regional development plan will transform conditions and the main activities from a rural setting to more urban and agricultural activities into non-agricultural activities. This study aims to investigate the characteristics of rural poverty in Kokap using the deprivation trap of poverty, a framework that describes rural poverty as a multi dimensional condition. The study uses a quantitative approach and employs interviews directed via questionnaires with poor households in Kokap as the respondents. The sampling technique used is probability sampling with incidental sampling, in addition to descriptive statistical analysis techniques. The results show that rural poverty in Kokap Sub-district is a complex phenomenon that is strongly influenced by the regional conditions where the poor families live. This is a key finding in formulating strategies to prevent poor rural communities to be caught in a poverty trap amid significant changes that will occur in thearea.
Inquiries into critical success factors in governing small tourism firm in sustainable rural economics
Authors: Mohd Hussain M H , Ismail H N , Samsudin N A , Jaafar S M R S
Published: March 2020

Small Tourism Firms (STFs) has been acknowledged by scholars as one of the main features for tourism development especially in the area that received rapid urbanization. Knowledge on the influences of urban morphology with the specific references on tourism entrepreneurship had already started on the early 1980s. However, previous effort were only considering on the theoretical and empirical point of view and focusing on the classification of characters in comparison to other form of small and medium enterprises. The existing literature does not literally cover the understanding of growth and failure of STFs especially in the perspective of financial aspects. Thus, this paper examines the financial factor related to growth and failure of STFs that emphasis on the factors affecting the growth of STFs in the accommodation sector. Langkawi has been selected as the study area due to its superiority as one of the best tourism destinations in Malaysia. An in-depth interview method has been conducted with 10 potential respondents in representing the small firms. The result from the thematic analysis shows that aspects such as access to the loans, financial constraint and finance tendency were established in understanding the financial influence towards the growth of STFs. The critical success factor, from the perspective of financial is critical especially for the governance and coordination urban-rural towards balance development.
Identification of transportation movement patterns based on the home base approach: A case study of Lembang District, West Bandung Regency
Authors: Judiantono T , Susanto M I P
Published: March 2020

Transportation planning generally uses a traffic model approach. The disadvantage of the traffic model is that it does not consider the movements to and from an area by the community. Therefore, this study uses a home base approach to study the real movement patterns in Lembang District, West Bandung Regency, West Java Province. Lembang District is a geographically strategic region and a center of agriculture and tourism in West Java Province. It is also located adjacent to Bandung City. These characteristics potentially cause a high frequency of transportation movements in the district of Lembang. The study found that the home base approach can accurately show the real movement patterns that the traffic model approach might not uncover. Moreover, the transportation movements of the community of Lembang District are mostly directed to Lembang Village and Bandung City. Furthermore, the findings of this study might differ if the home base approach would use proportional sampling.
Road orientation of housing subdivision in Majlis Bandaraya Iskandar Puteri, Malaysia
Authors: Ling J L S , b Che’Man N , b Majid M R
Published: March 2020

Street network is a city crucial element. The current guidelines of road design generally include road width, cross-sections and street hierarchy which are to be taken into consideration during the design phase of the network. Research have shown that road orientation affects the quality of a housing subdivision. However, there are limited studies on street orientation with most of them concentrating on the effects of the orientation on housing subdivision rather than the factors which give rise to its orientation. This research aims to analyse the street network of housing subdivisions located within Majlis Bandaraya Iskandar Puteri (MBIP) to identify the aspects which influence its orientation. Street networks of 71 housing subdivisions under the administration of MBIP were extracted using the OS Mnx Python programming tool to visualize the street networks in terms of polar charts. The findings of the study imply that the size of a housing subdivision does not affect the manner of streets within it are designed. Street pattern is associated with the time of development and the socioeconomic status of the community within the housing subdivision. Such findings contribute to better understanding of street orientation and can assist urban planners to create a better living environment.
Enhancing reliability of InGaN/GaN light-emitting diodes by controlling the etching profile of the current blocking layer
Authors: Su Shui-Hsiang , Tseng Chun-Lung , Shen Ching-Hsing , Hsieh I-Jou , Lin Yen-Sheng
Published: March 2020

SiO2 was used as the current blocking layer (CBL) during fabricating the InGaN/GaN-based light-emitting diodes (LEDs). The SiO2 film was prepared by plasma enhanced chemical vapor deposition (PECVD) at a lower temperature (LT) of 180 °C and a higher temperature (HT) of 280 °C for characterizing the reliability of LEDs. The degradation of output power in LT-CBL LED is as high as 6.8% during 1000 h in the high-temperature and humidity (85 °C/85 RH) condition. Experimental results demonstrate the low temperature grown CBL forms a larger side-wall angle via wet etching. The thinner side-wall ITO film cracks and the current spreading effect is suppressed, causing drastic power degradation. On the contrary, the HT-CBL SiO2 demonstrates optimal step coverage of ITO film for current spreading and then the HT-CBL LEDs slightly degrade as low as 5% in the accelerated reliability test. A dense quality of HT-CBL SiO2 as well as a good CBL decreased parasitic optical absorption in the p-pad electrode and p-finger. Besides, the HT-CBL SiO2 showed a small side-wall angle of 40˚ which increased the step coverage and current spreading of ITO. An approach is conducted to confirm the side-wall profile of CBL for each process.
Inhomogeneous superconductivity in thin crystals of FeSe1−xTex (x = 1.0, 0.95, and 0.9)
Authors: Eguchi Ritsuko , Senda Megumi , Uesugi Eri , Goto Hidenori , Fujiwara Akihiko , Imai Yasuhiko , Kimura Shigeru , Noji Takashi , Koike Yoji , Kubozono Yoshihiro
Published: March 2020

We investigated the temperature dependence of resistivity in thin crystals of FeSe1−xTex (x = 1.0, 0.95, and 0.9), though bulk crystals with 1.0 ≧ × ≧ 0.9 are known to be non-superconducting. With decreasing thickness of the crystals, the resistivity of x = 0.95 and 0.9 decreases and reaches zero at a low temperature, which indicates a clear superconducting transition. The anomaly of resistivity related to the structural and magnetic transitions completely disappears in 55- to 155-nm-thick crystals of x = 0.9, resulting in metallic behavior in the normal state. Microbeam x-ray diffraction measurements were performed on bulk single crystals and thin crystals of FeSe1−xTex. A significant difference of the lattice constant, c, was observed in FeSe1−xTex, which varied with differing Te content (x), and even in crystals with the same x, which was mainly caused by inhomogeneity of the Se/Te distribution. It has been found that the characteristic temperatures causing the structural and magnetic transition (T
t), the superconducting transition (T
c), and the zero resistivity (T
c
zero) are closely related to the value of c in thin crystals of FeSe1−xTex.
Carbide transformation behaviors of a Cr–Mo–V secondary hardening steel during over-ageing
Authors: He Xing , Hu Chundong , Wang Zimeng , Zhao Hongshan , Wei Xicheng , Dong Han
Published: March 2020

The transformation of carbides in a 1.9Cr-1.4Mo-0.3 V secondary hardening steel that was subjected to over-ageing at 600 °C–700 °C has been investigated. The carbides were characterized using scanning electron microscope (SEM), x-ray diffraction (XRD), inductively coupled plasma-atomic emission spectrometry (ICP-AES), and transmission electron microscopy (TEM) preformed on carbon replicas. The results indicate that MC, M2C, and M3C were formed during over-ageing from 600 to 700 °C, whereas M7C3, and M23C6 started to be formed at 650 and 700 °C, respectively. In addition, the co-existence of hexagonal and orthorhombic M7C3 structures in a carbide particle was firstly observed. M3C was transformed to other carbides, and the formation of both M2C and M23C6 may follow the ‘separate nucleation’ mechanism, whereas M7C3 was transformed from M3C via the ‘in situ nucleation’ mechanism. The crystallographic orientation relationships between the in situ transformed M7C3 and M3C are

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312
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Janus transition metal dichalcogenides: a superior platform for photocatalytic water splitting
Authors: Ju Lin , Bie Mei , Shang Jing , Tang Xiao , Kou Liangzhi
Published: March 2020

Janus two-dimensional (2D) materials, referring to the layers with different surfaces, have attracted intensive research interest due to the unique properties induced by symmetry breaking, and promising applications in energy conversion. Based on the successful experimental synthesis of Janus transition metal dichalcogenides (TMDC), here we present a review on their potential application in photocatalytic overall water splitting, from the perspectives of the latest theoretical and experimental progress. Four aspects which are related to photocatalytic reaction, including the adsorption of water molecules, utilization of sunlight, charge separation and transport, and surface chemical reactions have been discussed, and it is concluded that the Janus structures have better performances than symmetric TMDCs. At the end of this review, we raise further challenges and possible future research directions for Janus 2D materials as water-splitting photocatalysts.
Sr1-xCaxFe1-yCoyO3-δ as facile and tunable oxygen sorbents for chemical looping air separation
Authors: Dou Jian , Krzystowczyk Emily , Wang Xijun , Richard Anthony R , Robbins Thomas , Li Fanxing
Published: March 2020

Chemical looping air separation (CLAS) is a promising technology for oxygen generation with high efficiency. The key challenge for CLAS is to design robust oxygen sorbents with suitable redox properties and fast redox kinetics. In this work, perovskite-structured Sr1-xCaxFe1-yCoyO3 oxygen sorbents were investigated and demonstrated for oxygen production with tunable redox properties, high redox rate, and excellent thermal/steam stability. Cobalt doping at B site was found to be highly effective, 33% improvement in oxygen productivity was observed at 500 °C. Moreover, it stabilizes the perovskite structure and prevents phase segregation under pressure swing conditions in the presence of steam. Scalable synthesis of Sr0.8Ca0.2Fe0.4Co0.6O3 oxygen sorbents was carried out through solid state reaction, co-precipitation, and sol-gel methods. Both co-precipitation and sol-gel methods are capable of producing Sr0.8Ca0.2Fe0.4Co0.6O3 sorbents with satisfactory phase purity, high oxygen capacity, and fast redox kinetics. Large scale evaluation of Sr0.8Ca0.2Fe0.4Co0.6O3, using an automated CLAS testbed with over 300 g sorbent loading, further demonstrated the effectiveness of the oxygen sorbent to produce 95% pure O2 with a satisfactory productivity of 0.04 gO2 gsorbent
−1 h−1 at 600 °C.
Mining citizen science data to explore stopover sites and spatiotemporal variation in migration patterns of the red-footed falcon
Authors: Bounas Anastasios , Solanou Maria , Panuccio Michele , Barišić Sanja , Bino Taulant , Erciyas-Yavuz Kiraz , Iankov Petar , Ieronymidou Christina , Barboutis Christos
Published: March 2020

Citizen science data have already been used to effectively address questions regarding migration, a fundamental stage in the life history of birds. In this study, we use data from eBird and from 3 additional regional citizen science databases to describe the migration routes and timing of the red-footed falcon Falco vespertinus in the Mediterranean region across 8 years (2010–2017). We further examine the seasonal and yearly variation in migration patterns and explore sites used during the species migration. Our results suggest that the autumn passage is spatially less variable and temporally more consistent among years than in spring and that birds migrate faster in spring than in autumn. The species seems to be more prevalent along the Central Mediterranean during spring migration, probably as a result of the clockwise loop migration that red-footed falcons perform. There was a high variation in annual median migration dates for both seasons as well as in migration routes across years and seasons. Higher variation was exhibited in the longitudinal component thus indicating flexibility in migration routes. In addition, our results showed the species’ preference for lowlands covered with cropland and mosaics of cropland and natural vegetation as stopover sites during migration. Stopover areas predicted from our distribution modeling highlight the importance of the Mediterranean islands as stopover sites for sea-crossing raptors, such as the red-footed falcon. This study is the first to provide a broad-scale spatiotemporal perspective on the species migration across seasons, years and flyways and demonstrates how citizen science data can inform future monitoring and conservation strategies.
Laparoscopic-assisted left thoracoabdominal esophagectomy (LLTA): an innovative approach for locally advanced tumors of the gastroesophageal junction
Authors: Reyhani A , Zylstra J , Davies A R , Gossage J A
Published: March 2020

Purpose

To report a novel approach for locally advanced tumors located at the gastroesophageal junction (GEJ) using a laparoscopic abdominal phase and open left thoracotomy with the patient in a single right lateral decubitus position.

Background

The standard open left thoracoabdominal approach offers excellent exposure and access to the GEJ and lower esophagus. It also involves a single position for the procedure, shortening the operation time. The disadvantages are a large incision, division of the costochondral junction, and a low-level thoracotomy. The laparoscopic-assisted left thoracoabdominal esophagectomy (LLTA) is performed with the patient in the same right lateral decubitus position, but initially rolled away from the operator at 45° allowing laparoscopic gastric mobilization and lymphadenectomy. The patient is then tilted back to the lateral position for the thoracic phase. An anterolateral left thoracotomy is performed through the higher fifth intercostal space allowing a high intrathoracic anastomosis, just below the aortic arch. No disruption of the costochondral junction is made.

Methods

Consecutive patients selectively treated for locally advanced GEJ tumors with an LLTA approach between 2013 and 2019 were analyzed and compared to national standards (NOGCA).

Results

This series of 74 consecutive patients had a mean age of 63 years. The median operation time was 235 minutes. The median inpatient stay was 10 days (NOGCA 9 [11–17]). The tumors were predominantly adenocarcinoma (95%) and located at the GEJ (92%). The majority were locally advanced T3 or T4 tumors. Postoperative morbidity was low, Clavien–Dindo (C–D) 0 in 52.7% patients, C–D1 (1.4%), C–D2 (31.1%), C–D3a (5.4%), C–D4a (9.5%), and C–D5 (1.4%). The median number of total lymph nodes (LN) excised was 28 (NOGCA >15); LN % yield ≥18 was 90% (NOGCA 82.5%). Positive nodes were located at the lesser-curve (40%), paraesophageal (32.4%), and subcarinal regions (2.7%). Positive circumferential resection margins (<1 mm) were present in 28.4% of resected specimens (NOGCA 25.1%). This is reflective of the high proportion T3/T4 tumors selected for this approach. Hospital and 30-day mortality was 1.4% (NOGCA 2.7%). Recurrence after LLTA was 25.7% (local 5.4%, systemic 17.6%, mixed 2.7%) at a median of 311 days (62–1,158).

Conclusion

This series demonstrates a novel, safe, and reproducible approach for locally advanced cancer of the GEJ. It offers a better exposure of the hiatus than the right-sided approach and avoids division of the costochondral junction and low thoracotomy seen with the open left thoracoabdominal approach.
Non-CpG methylation biases bisulphite PCR towards low or unmethylated mitochondrial DNA: recommendations for the field
Authors: Morris Margaret J , Hesson Luke B , Youngson Neil A
Published: March 2020

Mitochondrial DNA (mtDNA) is a circular genome of 16 kb that is present in multiple copies in mitochondria. mtDNA codes for genes that contribute to mitochondrial structure and function. A long-standing question has asked whether mtDNA is epigenetically regulated similarly to the nuclear genome. Recently published data suggest that unlike the nuclear genome where CpG methylation is the norm, mtDNA is methylated predominantly at non-CpG cytosines. This raises important methodological considerations for future investigations. In particular, existing bisulphite PCR techniques may be unsuitable due to primers being biased towards amplification from unmethylated mtDNA. Here, we describe how this may have led to previous studies underestimating the level of mtDNA methylation and reiterate methodological strategies for its accurate assessment.
DeepPod: a convolutional neural network based quantification of fruit number in Arabidopsis
Authors: Hamidinekoo Azam , Garzón-Martínez Gina A , Ghahremani Morteza , Corke Fiona M K , Zwiggelaar Reyer , Doonan John H , Lu Chuan
Published: March 2020

Background

High-throughput phenotyping based on non-destructive imaging has great potential in plant biology and breeding programs. However, efficient feature extraction and quantification from image data remains a bottleneck that needs to be addressed. Advances in sensor technology have led to the increasing use of imaging to monitor and measure a range of plants including the model Arabidopsis thaliana. These extensive datasets contain diverse trait information, but feature extraction is often still implemented using approaches requiring substantial manual input.

Results

The computational detection and segmentation of individual fruits from images is a challenging task, for which we have developed DeepPod, a patch-based 2-phase deep learning framework. The associated manual annotation task is simple and cost-effective without the need for detailed segmentation or bounding boxes. Convolutional neural networks (CNNs) are used for classifying different parts of the plant inflorescence, including the tip, base, and body of the siliques and the stem inflorescence. In a post-processing step, different parts of the same silique are joined together for silique detection and localization, whilst taking into account possible overlapping among the siliques. The proposed framework is further validated on a separate test dataset of 2,408 images. Comparisons of the CNN-based prediction with manual counting (R2 = 0.90) showed the desired capability of methods for estimating silique number.

Conclusions

The DeepPod framework provides a rapid and accurate estimate of fruit number in a model system widely used by biologists to investigate many fundemental processes underlying growth and reproduction
A novel method for detecting morphologically similar crops and weeds based on the combination of contour masks and filtered Local Binary Pattern operators
Authors: Le Vi Nguyen Thanh , Ahderom Selam , Apopei Beniamin , Alameh Kamal
Published: March 2020

Background

Weeds are a major cause of low agricultural productivity. Some weeds have morphological features similar to crops, making them difficult to discriminate.

Results

We propose a novel method using a combination of filtered features extracted by combined Local Binary Pattern operators and features extracted by plant-leaf contour masks to improve the discrimination rate between broadleaf plants. Opening and closing morphological operators were applied to filter noise in plant images. The images at 4 stages of growth were collected using a testbed system. Mask-based local binary pattern features were combined with filtered features and a coefficient k. The classification of crops and weeds was achieved using support vector machine with radial basis function kernel. By investigating optimal parameters, this method reached a classification accuracy of 98.63% with 4 classes in the “bccr-segset” dataset published online in comparison with an accuracy of 91.85% attained by a previously reported method.

Conclusions

The proposed method enhances the identification of crops and weeds with similar appearance and demonstrates its capabilities in real-time weed detection.
T4 Nursing Matters! Better Nurse Staffing and Work Environments Associated with Lower Burn Patient Mortality
Authors: Bettencourt Amanda P , Aiken Linda H , Sloane Douglas , McHugh Matthew
Published: March 2020

Introduction

The complexity of modern burn care requires an integrated team of clinicians working together to achieve the best possible outcome for each survivor. Nurses are central to many aspects of a burn survivor’s care including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabilitation. Previous research suggests that hospital nursing resources such as staffing, education, and the quality of the work environment relate to overall patient mortality, but the relationship between those resources and burn mortality has not been previously examined. Due to their unique and complex care needs, burn patients are likely highly sensitive to nursing resources.

Methods

This study examined whether patient-to-nurse ratios, nurse education, and features of the clinical work environment are associated with burn patient in-hospital mortality. A multivariable regression model using a linked, cross-sectional claims database of 14,064 adult (>18 yrs.) burn patients admitted to 653 hospitals was employed. Mortality was risk-adjusted for age, burn size, the presence of mechanical ventilation, co-morbidities, and hospital characteristics such as burn patient volume, technological capabilities, and teaching status. Nursing resources were independently reported by 29,586 bedside nurses working in the study hospitals. The work environment was assessed using the National Quality Forum-endorsed Practice Environment Scale. Nursing resources differ in the high vs. low-volume hospitals, so the final model includes an interaction term for each nursing resource and hospital burn patient volume.

Results

In the risk-adjusted main-effects model, the patient’s age, burn size, presence of mechanical ventilation, comorbidities, and hospital burn patient volume were all significantly associated with in-hospital mortality. The full model including interaction terms suggests that in high burn patient volume hospitals (>100 patients / yr.) each additional patient added to a nurse’s workload is associated with 30% higher odds of mortality (p< 0.05, 95% CI [1.02, 1.94]), and improvements in the nurse work environment are associated with 28% lower odds of mortality (p< 0.05, 95%CI [0.07, 0.99]).

Conclusions

Nurse staffing and the nurse work environment significantly relate to burn patient mortality in high-volume burn hospitals where the most complex burn patients often receive care.

Applicability of Research to Practice

Nursing resources are critical to the survival of the most complex burn patients, and are a significant, yet previously unmeasured variable in the evaluation of burn outcomes. To promote optimal recovery for burn survivors, attention to nurse staffing and the work environment is warranted. Future evaluations of burn patient outcomes should account for hospital nursing resources.
6 Complete Blood Count and Derived Indices: Evolution Pattern and Prognostic Value in Adult Burned Patients
Authors: Aramendi Ignacio , Moreno Laura , Cabrera Julio R , Angulo Martin , dos Santos Gimena , Gastón Burghi
Published: March 2020

Introduction

Thermal injuries represent a major health problem. Biomarkers capable of predicting burned patients outcomes are missing. Certain parameters of complete blood count (CBC) such as red cell distribution width (RDW) and mean platelet volume (MPV), as well as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and RDW-to-platelet ratio (RPR) have been associated with inflammatory status and outcome in diverse medical conditions. The aim of this study was to describe the evolution pattern of these parameters in adult burned patients.

Methods

Adult burned patients admitted to the National Burn Center of a University Hospital between May 2017 and March 2018 were included. Patients characteristics and outcomes were recorded, as well as CBC parameters on days 1, 3, 5 and 7 after thermal injury.

Results

Eighty-eight patients were included. Total body surface area burned was 14 [7–23] %, and mortality was 15%. Non-survivors presented higher RDW (days 3, 5 and 7; P < 0.01) and MPV (days 3 and 7; P < 0.01). NLR decreased after admission in all patients (P < 0.01), but was higher in non-survivors compared to survivors on days 1 and 7 (P < 0.01). On day 3, PLR was higher in survivors than in non-survivors (P < 0.05). In deceased patients, RPR was significantly higher on days 3, 5 and 7 (P < 0.01). There was a significant correlation between NLR on admission and burn extension and severity. Kaplan-Meier analysis revealed that NLR, PLR and RPR could identify patients with increased mortality.

Conclusions

Basic CBC parameters and derived indices could be useful as biomarkers to determine prognosis in adults with thermal injuries.

Applicability of Research to Practice

The study allowed us to identify basic CBC parameters and indices that behave differently in survivors and non-survivors. Interestingly, the CBC profile that differentiates survivors and non-survivors varies at each time point. A particular combination of CBC parameters might be used as a prognostic indicator depending on evolution time since thermal injury.
23 Triage and Transfer to a Regional Burn Center - Impact of a Mobile Phone App
Authors: Carmichael Heather , Dyamenahalli Kiran U , Duffy Patrick , Wagner Anne L Lambert , Wiktor Arek J
Published: March 2020

Introduction

The ABA designs referral criteria to guide providers in recommending appropriate patients for treatment at specialized burn centers. However, patients are typically triaged at local facilities where providers may not have expertise to assess burn injuries properly. Addition of a visual component to a consultation call can improve local triage decisions, including estimations of total burn surface area (TBSA). In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic data to the burn specialist in a HIPPA-compliant manner, facilitating the consultation. Our hypothesis is that use of the burn app can improve triage decisions, particularly in cases of intermediate TBSA (1–10%).

Methods

This is a retrospective review of all consults to our ABA-verified burn center from a single Level II trauma center (TC) approximately 70 miles from our institution. Data were integrated from our call center, burn registry, electronic medical record and the mobile app. Burns were classified as large (>10% TBSA), intermediate (1–10% TBSA), or small (< 1%). Patients were triaged to either a) immediate transfer via ground ambulance or helicopter, b) transfer via private vehicle, c) outpatient follow up at the burn center, or d) local facility/primary care management. Patients were considered to be “down-triaged” if they required transfer but could transfer via private vehicle, or if they could be managed locally.

Results

During the study period, 135 patient consultations were made by the TC for thermal or cold injuries. 82 patients (61%) were referred using the app. Most patients (n=56, 41%) presented with small burns of the hands, feet or face. Overall, 53 patients (39%) were transferred to the burn center. The majority required ambulance transfer (n=44). 60 patients (44%) were recommended for outpatient follow up, but only 43% (n=26) followed up. When the subset of intermediate burns was considered (n=54), the mobile app allowed for successful “down-triage” of 12 patients (30%) referred through the app. No patient referred without the app could be “down-triaged” (p=0.02).

Conclusions

A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow up and transfer mode. However, less than half of patients triaged to outpatient follow up were actually seen at the burn center.

Applicability of Research to Practice

Telemedicine can be used to assist in triage decisions and appropriate referral to a regional burn center. This technology could be optimized to assist in outpatient follow up.
53 Regulation of Glycolysis and the Warburg Effect in Keloids
Authors: Vinaik Roohi , Barayan Dalia , Jeschke Marc G
Published: March 2020

Introduction

Hypertrophic and keloid scarring are considered as major determinants for long-term outcomes and quality of life for burn survivors. Keloid development is predicated on prolonged local inflammation and altered glucose metabolism. Owing to its tumor-like dependence on glucose, we hypothesized that keloids would display the bioenergetics of cancer cells; namely, increased glucose uptake via Glut1 and upregulation of key glycolytic enzymes. Furthermore, burn patients who develop keloids potentially demonstrate early evidence of the aforementioned features compared to non-keloid patients. Therefore, elevated Glut1 expression could serve as a marker for keloid development in burn patients.

Methods

We enrolled 27 control burn patients with 39% ± 4% total body surface area (TBSA) burns. The keloid burn group included 9 burn patients with 47% ± 9% TBSA burns. Skin was obtained for histology, gene and protein expression at 0–17 days post-burn.

Results

Keloids have higher Glut1 expression compared to normal and burn skin (7.72 vs. 0.15, p< 0.001; 7.72 vs. 2.35, p< 0.05). Keloids also exhibit enhanced expression of critical glycolytic enzymes compared to burn skin at 7–10 days post-burn (HK2: 4.14 vs. 2.36, p< 0.001; PFK1: 6.51 vs. 3.83, p< 0.001; PFK2: 5.35 vs. 1.27, p< 0.001; PDK1: 5.50 vs. 4.31, p< 0.05; PKM2: 7.58 vs. 2.98, p< 0.001). A Glut1 time-course analysis in burn skin from non-keloid patients indicated a significant elevation at 7–10 days post-burn compared to normal skin (3.22 vs. 0.20, p< 0.01). Skin from keloid burn patients prior to development of keloids demonstrate higher Glut1 expression compared to skin from non-keloid controls when matched by days post-burn (40.5 vs. 0.58 at 0–2 days, p< 0.05).

Conclusions

Patients who develop post-burn keloids exhibit early risk factors prior to the development of keloids (e.g. elevated skin Glut1). Keloids have an augmented reliance on glycolysis compared to burn skin. Therefore, early identification and targeting glycolysis in susceptible patients is key.

Applicability of Research to Practice

Upregulation of glycolytic enzymes and transporters such as Glut1 may serve as keloid predictive markers. Identification of at-risk patients allows for a tailored treatment regimen that targets dysregulated glycolysis in these patients. Pharmaceutical agents like shikonin suppress multiple glycolytic steps, serving as an effective means to interfere with the proliferative capacity of keloids. Potentially, local shikonin administration could serve as a therapy in select patients exhibiting keloid risk factors.
65 Fourteen Years of Worldwide Teleconsultation Support for Burn Patient Care
Authors: Cancio Leopoldo C
Published: March 2020

Introduction

The onset of hostilities in 2003 in Iraq generated large numbers of burned combat casualties and civilians, but most U.S. deployed providers are inexperienced in burn care. To help address this gap, the U.S. military established a Burn Teleconsultation (BTC) program in 2005. The BTC was one of 21 specialty TC programs. We reviewed this experience.

Methods

TC was a store-and-forward system based on e mail. BTC was one of the earliest TC programs established (Jan 2005). Users accessed BTC by sending an e mail (often with photos) to burntrauma.consult.army@mail.mil. This reached a group of Burn Center providers, as well as the overall TC program manager (PM). The PM ensured a timely response and documented resolution. BTC was publicized in numerous educational and other materials. Other TCs included Dermatology (Derm, Apr 2004), Ophthalmology (Jul 2004), and Infectious Diseases (ID, Jan 2005).

Results

TC program as a whole. The TC program was active for 176 months. 3766 providers requested TCs; 14763 TCs were completed; and at least 333 patient evacuations were prevented and 775 were facilitated. The median response time (RT) was 2 hours, 57 min. RT was < = 1 hour in 26.3% of cases, and < = 24 hours in 96.4%. Leading programs were Derm (5616 patients, 38.0%), Orthopedics (1428, 9.7%), and ID (1103, 7.5%). TC was transitioned to another platform in Jan 2019.

BTC program. BTC provided 197 (1.3%) TCs. Peak years were among the peak war years: fiscal years 2006 (24 patients), 2008 (32), and 2009 (34). Location of the requesting provider included Iraq (95 consultations, 48.2%), Afghanistan (56, 28.4%), and the continental US (20, 10.2%). The affiliation of the patient was predominantly non-combatant (76 patients, 38.6%), U.S. Army (37, 18.7%), and U.S. Marine Corps (12, 6.1%). The median RT was faster than for the overall TC program at 1 hour, 25 min. RT was < = 1 hour in 45.4% of cases, and < =24 hours in 98.3%.

Conclusions

TC took advantage of the availability of e mail to most deployed providers; it did not depend on wide-band video-teleconferencing, which was not available. Like the leading TC program (Derm), BTC relied on digital photos to enhance communication. BTC achieved a faster RT than the TC as a whole, making it appropriate for rapid, if non-immediate, consultation. The fact that non-combatants constituted the largest group of BTC patients represents the role of civilians with burns on the battlefield. It argues for more training in burn care, to include care well past initial resuscitation, for those who deploy.

Applicability of Research to Practice

Asynchronous teleconsultation should be considered for non-emergent burn care support.
98 A 10-year Retrospective Review of Older Adult Admissions at a Regional Burn Center
Authors: Campbell Stephanie , Andres Trina
Published: March 2020

Introduction

A verified regional burn center conducted a 10-year retrospective review of older adult patients admitted to the burn service. The primary goal of the review was to examine trends in mechanisms of injury, demographics, and outcomes to inform burn prevention programming.

Methods

Admission data from 2009–2018 was retrieved from burn center databases and combined into a Microsoft Excel spreadsheet. Older adults were defined as age 65 years and older. Patients admitted to the burn service for skin disorders or soft tissue infections were excluded. Patients with cutaneous burn injuries or inhalation only injuries were included.

Results

The total number of patients included was 697. Nearly a third of the patients were 65 to 69 years old, with incidence declining with each subsequent 5-year age group. Males accounted for 61.3% of admissions. Two thirds of the patients were White (67.6%). The other third consisted of Black (18.4%) and Hispanic (9.8%), Asian (1.9%) and Native American (0.14%) patients. Overall mortality was 14%. Mortality generally increased per 5-year age group: 65–69 (7.8%), 70–74 (10.6%), 75–79 (13.7%), 80–84 (20.6%), 85–89 (29.8%), 90–94 (24.2%), and 95–99 (42.9%). Baux scores ranged from 65 to 180. The highest Baux score that lived to discharge was 119. The average Baux score of the mortality group was 114 and the average of the lived group was 82. No patients with a Total Body Surface Area (TBSA) above 43% lived. Fire/flame burns accounted for 72.7%. Scald burns made up 19.9%, contact burns 3%, chemical burns 2.3% and electrical burns < 1%. Nearly a quarter (24.6%) of fire/flame burns were related to smoking on home oxygen therapy (HOT), which was also the overall most common mechanism at 17.8%. Other fire/flame mechanisms included housefires (21.2%), clothing catching on fire (16.9%), and gasoline-related injuries (11.7%). More than 70% of scald burns came from the three mechanisms: hot tap water, boiling water, and hot grease. For the mortality group, a third of patients had been injured in housefires (32.7%), followed by clothing catching on fire (17.4%) and HOT burns (12.2%).

Conclusions

Incidence rates decline with increasing age but mortality rates climb. Burn injuries with a TBSA greater than 40% are generally fatal in the older adult. Flame burns account for the majority of injuries with HOT and house fire injuries as the leading mechanisms. Scald burns were most often caused by hot tap water or boiling water. White older adults accounted for more than double the number of patients identified in all other races combined.

Applicability of Research to Practice

The demographics and mechanism of injury insight gained from this review can be utilized to inform prevention programming design in this region. Trends in mortality can help emphasize the seriousness of preventing older adult burn injuries and anticipate the mortality risk for older adults admitted to the burn center.
102 Wildfire Burns: Implications for Burn Care
Authors: Palmieri Tina L , Romanowski Kathleen S , Sen Soman , Greenhalgh David G
Published: March 2020

Introduction

Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries.

Methods

Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups.

Results

A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group).

Conclusions

Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries.

Applicability of Research to Practice

All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.