bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of the sand particle size from natural habitat and the digestive tract, as a basis in determining the grain size of sand suitable for a substrate of sea cucumber (Holothuria scabra) culture semiclosed system
Authors: Sabilu K , Supriyono E , Nirmala K , Jusadi D , Widanarni
Published: April 2021

The decline in production has prompted researchers in various countries to continue to study factors supporting the success of Holothuria scabra culture. This research aims to evaluate the characteristic of nutrients, size of a sand fraction of the sediment from natural habitats, and the digestive tract, as a basis to determine the grain size of sand suitable for substrates of sea cucumbers culture semi-closed system. The result showed that the highest fraction in the digestive tract of sea cucumber with a wet weight of 5-20 g was clay, 50-70 g of sea cucumbers was fine sand, size of 100-120 g was medium and fine sand, size of 200-220 g was the clay fraction, and in natural habitat was fine sand and clay. Medium sand to clay as a dominant fraction to be found was 86.83±1.22-96.74±0.60%. Smaller sea cucumbers tended to absorb a high amount of coarse sand, while larger sea cucumbers tended to absorb a higher amount of fine sand fraction. Meanwhile, protein, fat, and crude fibre content in the natural habitat sediment was low, so that nutrient enrichment and/or artificial feeding on the substrate is important, to provide for the growth of sea cucumbers if its culture efforts use a semiclosed system.
The biological aspect of four shark (Galeocerdo cuvie, Sphyrna lewini, Atelomycterus marmoratus, Carcharhinus melanopterus) of land in Muncar Coastal Fishing Port Banyuwangi East Jawa
Authors: Lelono T D , Bintoro G , Rihmi M K , Pratiwi V D , Wiadnya D G R
Published: April 2021

Sharks are often found in all the waters are scattered in various regions of the world. On the other hand, shark fisheries have declined globally due to shark fishing as well as the demand is very high. Thus, vital information regarding the length-weight relationship is essential in the management and protection of shark fishery resources. Data collection was carried out from December 2019 to March 2020 by way of direct observation, interviews by recording almost all shark catches landed by bottom longlines or drift longlines. Results for the study found 28 species, with four species of sharks that have the highest number that is Galeocerdo Cuvier 17%, Sphyrna lewini 16%, 16% Atelomycterus marmoratus, and Carcharhinus melanopterus 12%. The length-frequency distribution for Galeocerdo cuvier distributed between 148-437 cm in Sphyrna lewini distributed between 109-308 cm, Atelomycterus marmoratus is distributed between 39-68 cm, and Carcharhinus melanopterus is distributed between 49 - 204 cm. The length-weight relationship between Galeocerdo cuvier and Sphyrna lewini is allometric negative, whereas Atelomycterus marmoratus, and Carcharhinus melanopterus are isometric.
Shark fisheries management as a sustainable development implementation in Indonesia fishery sector
Authors: Sulaiman P S , Triharyuni S
Published: April 2021

The challenge of ensuring shark resource preservation is the main issue in fisheries management of Indonesia. Therefore, appropriate fisheries management needs to be developed. This paper aims to explain the shark fisheries condition in Indonesia based on ecological, social, and economic aspects following the sustainable development approach. The research was conducted through academic literature study and fisheries statistic reports. Data were analysed through the graphical approach and tabulation data trends based on the availability of time-series data that have been publish. The result shows that there are about 116 species of sharks in Indonesia ocean waters. One shark species was categorized as critically endangered, 5 species are endangered, 23 species are vulnerable, and 35 species are near-threatened category. Legislation in Indonesia has given enough serious attention to shark protection. To achieve the goal of sustainable shark fisheries management, several strategies can be implemented, namely: (i) preparation of regulations and their implementation to support the management of shark fisheries; (ii) strengthening of scientific database and review of shark fishery in Indonesia as well as at international level; (iii) institutional strengthening, and; (iv) increasing the HR capacity of fisherman and fishery personnel.
Management of small-scale fisheries and their issues: Case study in Sibolga, North Sumatera, Indonesia
Authors: Firdaus M , Huda H M , Mira  , Suryawati S H , Kurniawan T , Sari Y D
Published: April 2021

Small-scale fisheries dominate the fishing industry in Indonesia, and more than 90% of Indonesia’s fishing vessel is estimated to be less than 30 GT. Small-scale fisheries issues could vary by region in Indonesia, based on their characteristics, so the government requires different and effective fisheries development programs and initiatives. Sibolga, North Sumatera, is a fisheries centre in Indonesia where small-scale fishers and industrial fishing vessels co-exist in the same port. For instance, the issues and management strategies addressed have to be approached in several different ways to develop sustainability. The purpose of this research is to examine the management of small-scale fisheries and their issues in the study area. The study was carried out in 2019. Primary and secondary data were used for this analysis. The analysis of data used a qualitative approach. Social and structural aspects should be discussed in the management of small-scale fisheries. Regulations are expected to raise the economic rents of small-scale fishing activities and, on the other hand, to apply a resource tax to small-scale fishermen adapted to current social and institutional conditions.
Characteristics of edible film from chitosan as biodegradable packaging
Authors: Saputra E , Tjahjaningsih W , Abdillah A A
Published: April 2021

This research aimed to study the capability of CMC in improving the characteristics of an edible film made from chitosan, as well as to see the ability of edible film in maintaining the shelf life of fish burger product at room temperature. Three various concentration of CMC was used, namely 0.1%, 0.3% and 0.5%. The results of chitosan edible film characterization from the three concentrations of CMC showed that the concentration of 0.1% was the best as a plasticizer, with thickness 0.19 mm, water vapor transmission rate 50.8 ml/m2/day, the tensile strength 24.2 kgf/cm2, and percentage elongation 18.1%.
From drug center to soka crabs and tilapia salina center: a case study of community economic empowerment at ex-drug base of Ujoeng Pacu Village, Lhokseumawe, Aceh, Indonesia
Authors: Nirzalin  , Prama H , Azhari  , Fakhrurrazi  , Nazaruddin M
Published: April 2021

The social resilience of not being a part of drug dealers in the former drug base is determined by their economic welfare. Growing and sustainable economic prosperity are related to the existence of an economic business that can be run intensively and stable. This article aims to explore the process and success of empowering the ex-drug base community in the village ofUjoeng Pacu, Lhokseumawe City, Aceh. This research was conducted using a qualitative descriptive approach. The use of this ethnographic method is to understand the socio-cultural events under study which then display the data by describing these events. The data were collected using the live-in method, observation, in-depth interviews, and document study. This study found that the economic empowerment of the ex-drug base community ofUjoeng Pacuby implementing the cultivation ofsokacrabs and tilapia salina succeeded in increasing their economic welfare. The success of this empowerment program is passed through the stages of knowledge transfer, stimulus capital, linking marketing networks, and intensive mentoring. Sustainable income and stable welfare have proven to be the main shield for the growth and development of social resilience in the community, and in return, they will not be a part of drug-traffickers.
Isolation and Identification Bacillus Bacteria in Tilapia (Oreochromis niloticus) Using the Vitek-2 Compact
Authors: Mursyidah R M , Zulfa A J , Laith A A , Kismiyati
Published: April 2021

Tilapia, Oreochromis niloticus, is fish commodity that plays an important role in the tropic and subtropics country with their economic value for the community and tolerance for salinity. The high demand for tilapia resulted in the need to increase their production through the stocking density method. The purpose of this research is isolation and identification of pathogenic bacteria in tilapia fish using a Vitek-2 compact. The method used is sampling, perform bacterial isolation using TSB and TSA media using streak plate technique with OSE needle loop and cotton swap, identification of bacteria through gram staining, bacterial pathogenitas test, and using the Vitek-2 compact. The results of this study revealed three species of Bacillus thuringiensis, Bacillus mycoides and Bacillus cereus. All bacteria detected in the tilapia cultures were known as putative pathogens in Fish.
Manipulation the protein concentration in rice bran suspension toward fecundity and production of offspring M. macrocopa.
Authors: Wahyuningtiyas L , Mubarak A S , Sari L A
Published: April 2021

The need of M. macrocopa as a natural food can be fulfilled the quality and feed used optimally to support population growth. Protein is a nutrient that directly influences the fecundity and children of M. macrocopa. This study aims to was the effect of different protein concentrations in the suspension of suspension on the fecundity and production of offspring M. macrocopa. This study complete(CRD) consisting of 5 preparations of 4 replications (P0) protein 16.7% (P1) protein 23.75%, (P2) protein 30.80%, (P3) protein 37.85% (P4) protein 44.9%.The parameters used are the fecundity and production of offspring M. macrocopa.M. macropopa culture was do with density of 20 ind/Lwater andfeed changes are carried out every day. The results of this study showed that the different protein concentrations in rice bran suspension had a significantly different effect (p <0.05) on the fecundity and production of offspring M. macrocopa.that produced the highest fecundity and offspring at a protein concentration of 44.9%, as much as 30.25 ± 0.95 items/parent and child production per parent as much as 28.5 ± 0.57 ind/parent.
Range expansion of Oreochromis niloticus (Linnaeys, 1758) (Perciformes, Chichlidae) in Java Sea and first record for Masalembo Island
Authors: Wijayanti A , Hasan V , Tamam M B
Published: April 2021

Oreochromis niloticus (Linnaeus, 1758) is native to Africa, with introductions reported from Bawean Island and Kangean Island, Java Sea (Indonesia). In 2019, four specimens of O. niloticus were captured from an estuary (conservation area) on Masalembo Island. This record is among the first of this species from the middle of the Java Sea. A description of morphological characters of the specimens are provided.
The effects of various doses of probiotics on growth and survival rates of white shrimp larva (Litopenaeus vannamei)
Authors: Larasati L G , Nimitkul S , Dewi N N
Published: April 2021

The purposes of this research is to know the effective dose of probiotics that can optimize the growth of postlarva (PL15) white shrimp (Litopenaeus vannamei). This research was conducted in January 2020 in Kasetsart University, Bangkok, Thailand for seven days using completely randomized design (CRD) research method with 4 treatments and 6 replications. Commercial probiotic powder application with Bacillus content (108 CFU / g) is given consisting of treatments are C (0 mg/L), P1 (1 mg/L), P2 (3 mg/L) and P3 (5 mg/L). A one way analysis of variance (ANOVA) was applied to compare the control and treated groups at a significanc elevel of P<0.05. Duncan’s New Multiple Range Test (DMRT) was used to identify significant differences of growth, survival, and feed efficiency parameters. The results show that the highest SGR, DGR, absolute weight growth, absolute length growth, SR, FCR, and efficiency of feed utilization average respectively 22.76%, 4.32 mg/day, 11.20 mg, 7,68 mm, 77%, 1.78, 0.56. However, all parameters of shrimp growth, survival, and feed efficiency are not significantly different.
A stretchable superhydrophobic coating with electrothermal ability for anti-icing application
Authors: Peng Yongjing , Hu Jianping , Fan Zhen , Xie Pengkang , Wang Jian , Wang Peng
Published: April 2021

Surface icing in the transmission lines may cause serious accidents. Although the superhydrophobic/electrothermal synergistically anti-icing strategy has been introduced, most coatings tended to lose superhydrophobicity under large deformation. In this research, we prepared a kind of stretchable superhydrophobic coating by partially embedding the modified graphene into the Ecoflex elastomer. The excellent resilience of the Ecoflex elastomer together with the outstanding interficial area of graphene results in the maintainment of superhydrophobicity even under 300% strain. Furthermore, this coating has outstanding superhydrophobic and electrothermal property simutaneously due to the introduction of graphene. After applying 20 V voltage, this coating could melt 2 mm thick ice layer within 115 s. Moreover, this superhydrophobic coating demonstrated excellent mechanical and chemical durability, and outstanding thermostability.
Towards comprehensive understanding of proton-exchange membrane fuel cells using high energy x-rays
Authors: Martens Isaac , Chattot Raphael , Wiegmann Tim , Fuchs Timo , Magnussen Olaf M , Dubau Laetitia , Maillard Frederic , Drnec Jakub
Published: April 2021

For a future hydrogen economy, the development of cost effective energy conversion devices is a key issue. In this perspective, we discuss the use of high energy x-rays for obtaining comprehensive insights into the complex processes which occur inside such devices, focusing on proton exchange membrane fuel cells. This probe enables structural characterisation under operating conditions on all relevant length scales, from the atomic-scale interfaces to complete stacks. This opens up possibilities to go beyond characterisation of the isolated components, towards an understanding of their interactions in the full system which determine the power output, efficiency and degradation pathways in operational devices.
Effect of various synthesis parameters on the stability of size controlled green synthesis of silver nanoparticles
Authors: Kaur Ramanjeet , Avti Pramod , Kumar Vivek , Kumar Rajesh
Published: April 2021

In this study, we have focused on the green method using Litchi Chinensis Leaf Extract (LCLE) for the synthesis of silver nanoparticles (AgNPs). Here, the experimental control parameters (reducing/stabilizing agent quantity, reaction time and temperature, silver ion concentrations) were studied during the size controlled synthesis of silver nanoparticles and their physicochemical properties have been studied. For biological studies, the stability of AgNPs at physiological pH is of vital importance; hence, post-synthesis solution stability of AgNPs was examined at various pH conditions. Stable AgNPs are formed by treating the aqueous solution of AgNO3 with LCLE. Formation of AgNPs was observed visually by the change in the color and further characterized by the surface Plasmon resonance (SPR) peak observed at 436 nm by UV–vis spectroscopy. The synthesized AgNPs were also characterized for their size distribution by Dynamic Light Scattering (DLS), Scanning Electron Microscopy (SEM), Transmission electron microscope (TEM), crystalline nature by X-Ray Diffraction (XRD) and Fourier Transform infrared (FITR) for the functional groups present. The size of AgNPs was in the range of 40–50 nm, spherical in with face centered cubic (FCC) structure. The biomolecules (epicatechin) present in LCLE were responsible for reduction, capping, and stabilizing agent of AgNPs. Post- synthesis, the stability of AgNPs has been studied by changes in the SPR peaks at various pH (2–11) conditions using UV–vis spectroscopy. This size controlled nanoparticles are very stable at physiological pH and retain their intrinsic SPR property.
New horizons in cardiogeriatrics: geriatricians and heart failure care—the custard in the tart, not the icing on the cake
Authors: Levy Shuli , Cole Graham , Pabari Punam , Dani Melanie , Barton Carys , Mayet Jamil , McDonagh Theresa , Baxter John , Plymen Carla
Published: April 2021

Heart failure (HF) can be considered a disease of older people. It is a leading cause of hospitalisation and is associated with high rates of morbidity and mortality in the over-65s. In 2012, an editorial in this journal detailed the latest HF research and guidelines, calling for greater integration of geriatricians in HF care. This current article reflects upon what has been achieved in this field in recent years, highlighting some future challenges and promising areas. It is written from the perspective of one such integrated team and explores the new role of cardiogeriatrician, working in a multidisciplinary team to deliver and improve care to increasingly complex, older, frail patients with multiple comorbidities who present with primary cardiology problems, especially decompensated HF. Geriatric liaison has improved the care of frail patients in orthopaedics, cancer services, stroke, acute medicine and numerous community settings. We propose that this vital role should now be extended to cardiology teams in general and to HF in particular.
Claustral Input to the Macaque Medial Posterior Parietal Cortex (Superior Parietal Lobule and Adjacent Areas)
Authors: Gamberini Michela , Passarelli Lauretta , Impieri Daniele , Montanari Giulia , Diomedi Stefano , Worthy Katrina H , Burman Kathleen J , Reser David H , Fattori Patrizia , Galletti Claudio , Bakola Sophia , Rosa Marcello G P
Published: April 2021

The projections from the claustrum to cortical areas within and adjacent to the superior parietal lobule were studied in 10 macaque monkeys, using retrograde tracers, computerized reconstructions, and quantitative methods. In contrast with the classical view that posterior parietal areas receive afferents primarily from the dorsal and posterior regions of the claustrum, we found that these areas receive more extensive projections, including substantial afferents from the anterior and ventral regions of the claustrum. Moreover, our findings uncover a previously unsuspected variability in the precise regions of the claustrum that originate the projections, according to the target areas. For example, areas dominated by somatosensory inputs for control of body movements tend to receive most afferents from the dorsal-posterior claustrum, whereas those which also receive significant visual inputs tend to receive more afferents from the ventral claustrum. In addition, different areas within these broadly defined groups differ in terms of quantitative emphasis in the origin of projections. Overall, these results argue against a simple model whereby adjacency in the cortex determines adjacency in the sectors of claustral origin of projections and indicate that subnetworks defined by commonality of function may be an important factor in defining claustrocortical topography.
Purification of Four Caffeoylquinic Acid Derivatives from the Flowers of Gynura Procumbens by HSCCC
Authors: Cao Ming-yuan , Hu Ju-wu , Gu Zhen , Xiong Wei , Wu Lei , Xu Jian-guo , Wu Lei-yan
Published: April 2021

Four caffeoylquinic acid derivatives from the Gunura procumbens flowers (GPF) were successfully isolated and purified by high-speed counter-current chromatography (HSCCC). Ethyl acetate–methanol–water (3:1:3, v/v/v) was the optimum biphasic solvent system, which was selected by high-performance liquid chromatography (HPLC) and run on a preparative scale where the lower aqueous phase was used as the mobile phase with a head-to-tail elution mode. Chlorogenic acid (3.83 mg), Isochlorogenic acid A (6.51 mg), Isochlorogenic acid B (4.38 mg) and Isochlorogenic acid C (4.47 mg) were obtained for the first time in an one-step HSCCC separation from 800 mg of the crude extracts. The purities of four compounds were determined to be >95% by HPLC. Chemical structures of each isolated compounds were identified by nuclear magnetic resonance and electrospray ionization mass spectrometry methods. It is worth noting that all the four compounds were isolated here for the first time from GPF and this work confirms the effectiveness of HSCCC for the separation of compounds contained in complex samples, and provides a foundation for further exploitation of G. procumbens.
Efficient Maternofetal Transplacental Transfer of Anti- Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Spike Antibodies After Antenatal SARS-CoV-2 BNT162b2 Messenger RNA Vaccination
Authors: Rottenstreich Amihai , Zarbiv Gila , Oiknine-Djian Esther , Zigron Roy , Wolf Dana G , Porat Shay
Published: April 2021

Maternal and cord blood sera were collected from 20 parturients who received the BNT162b2 vaccine. All women and infants were positive for anti S- and anti-receptor binding domain antibody–specific immunoglobulin G. Cord blood antibody concentrations were correlated to maternal levels and to time since vaccination. Antenatal severe acute respiratory syndrome coronavirus 2 vaccination may provide maternal and neonatal protection.
Pathogens That Cause Acute Febrile Illness Among Children and Adolescents in Burkina Faso, Madagascar, and Sudan
Authors: Marks Florian , Liu Jie , Soura Abdramane Bassiahi , Gasmelseed Nagla , Operario Darwin J , Grundy Brian , Wieser John , Gratz Jean , Meyer Christian G , Im Justin , Lim Jacqueline Kyungah , von Kalckreuth Vera , Cruz Espinoza Ligia Maria , Konings Frank , Jeon Hyon Jin , Rakotozandrindrainy Raphaël , Zhang Jixian , Panzner Ursula , Houpt Eric
Published: April 2021

Background

The etiology and optimal clinical management of acute febrile illness (AFI) is poorly understood.

Methods

Blood samples taken from study participants with acute fever (≥37.5°C) or a history of fever and recruited into the previous Typhoid Fever Surveillance in Africa (TSAP) study were evaluated using a polymerase chain reaction (PCR)-based TaqMan-Array Card designed to detect a panel of bacterial, viral, and parasitic pathogens. Clinical metadata were also assessed.

Results

A total of 615 blood samples available for analysis originated from Burkina Faso (n = 53), Madagascar (n = 364), and Sudan (n = 198) and were taken from participants ranging in age from 0–19 years. Through the TaqMan-Array Card, at least 1 pathogen was detected in 62% (33 of 53), 24% (86 of 364), and 60% (118 of 198) of specimens from Burkina Faso, Madagascar, and Sudan, respectively. The leading identified pathogen overall was Plasmodium spp., accounting for 47% (25 of 53), 2.2% (8 of 364), and 45% (90 of 198) of AFI at the respective sites. In Madagascar, dengue virus was the most prevalent pathogen (10.2%). Overall, 69% (357 of 516) of patients with clinical diagnoses of malaria, respiratory infection, or gastrointestinal infection were prescribed a World Health Organization guideline-recommended empiric antibiotic, whereas only 45% (106 of 237) of patients with pathogens detected were treated with an antibiotic exerting likely activity.

Conclusions

A PCR approach for identifying multiple bacterial, viral, and parasitic pathogens in whole blood unveiled a diversity of previously undetected pathogens in AFI cases and carries implications for the appropriate management of this common syndrome.
Spironolactone effect on the blood pressure of patients at risk of developing heart failure: an analysis from the HOMAGE trial
Authors: Ferreira João Pedro , Collier Timothy , Clark Andrew L , Mamas Mamas A , Rocca Hans-Peter Brunner-La , Heymans Stephane , González Arantxa , Ahmed Fozia Z , Petutschnigg Johannes , Mujaj Blerim , Cuthbert Joe , Rouet Philippe , Pellicori Pierpaolo , Mariottoni Beatrice , Cosmi Franco , Edelmann Frank , Thijs Lutgarde , Staessen Jan A , Hazebroek Mark , Verdonschot Job , Rossignol Patrick , Girerd Nicolas , Cleland John G , Zannad Faiez
Published: April 2021

Aims

Uncontrolled blood pressure (BP) increases the risk of developing heart failure (HF). The effect of spironolactone on BP of patients at risk of developing HF is yet to be determined. To evaluate the effect of spironolactone on the BP of patients at risk for HF and whether renin can predict spironolactone’s effect.

Methods and results

HOMAGE (Heart OMics in Aging) was a prospective multicentre randomized open-label blinded endpoint (PROBE) trial including 527 patients at risk for developing HF randomly assigned to either spironolactone (25–50 mg/day) or usual care alone for a maximum of 9 months. Sitting BP was assessed at baseline, Months 1 and 9 (or last visit). Analysis of covariance (ANCOVA), mixed effects models, and structural modelling equations was used. The median (percentile25–75) age was 73 (69–79) years, 26% were female, and >75% had history of hypertension. Overall, the baseline BP was 142/78 mmHg. Patients with higher BP were older, more likely to have diabetes and less likely to have coronary artery disease, had greater left ventricular mass (LVM), and left atrial volume (LAV). Compared with usual care, by last visit, spironolactone changed SBP by −10.3 (−13.0 to −7.5) mmHg and DBP by −3.2 (−4.8 to −1.7) mmHg (P < 0.001 for both). A higher proportion of patients on spironolactone had controlled BP <130/80 mmHg (36 vs. 26%; P = 0.014). Lower baseline renin levels predicted a greater response to spironolactone (interactionP = 0.041).

Conclusion

Spironolactone had a clinically important BP-lowering effect. Spironolactone should be considered for lowering blood pressure in patients who are at risk of developing HF.
Abundant oleoyl-lysophosphatidylethanolamine in brain stimulates neurite outgrowth and protects against glutamate toxicity in cultured cortical neurons
Authors: Hisano Kazutoshi , Yoshida Hironori , Kawase Shiori , Mimura Tetsuhiko , Haniu Hisao , Tsukahara Tamotsu , Kurihara Taiga , Matsuda Yoshikazu , Saito Naoto , Uemura Takeshi
Published: April 2021

Lysophosphatidylethanolamines (LPEs) are bioactive lysophospholipids that have been suggested to play important roles in several biological processes. We performed a quantitative analysis of LPE species and showed their composition in mouse brain. We examined the roles of oleoyl-LPE (18:1 LPE), which is one of the abundant LPE species in brain. In cultured cortical neurons, application of 18:1 LPE-stimulated neurite outgrowth. The effect of 18:1 LPE on neurite outgrowth was inhibited by Gq/11 inhibitor YM-254890, phospholipase C (PLC) inhibitor U73122, protein kinase C (PKC) inhibitor Go6983 or mitogen-activated protein kinase (MAPK) inhibitor U0126. Additionally, 18:1 LPE increased the phosphorylation of MAPK/extracellular signal-regulated kinase 1/2. These results suggest that the action of 18:1 LPE on neurite outgrowth is mediated by the Gq/11/PLC/PKC/MAPK pathway. Moreover, we found that application of 18:1 LPE protects neurons from glutamate-induced excitotoxicity. This effect of 18:1 LPE was suppressed by PKC inhibitor Go6983. These results suggest that 18:1 LPE protects neurons from glutamate toxicity via PKC inhibitor Go6983-sensitive PKC subtype. Collectively, our results demonstrated that 18:1 LPE stimulates neurite outgrowth and protects against glutamate toxicity in cultured cortical neurons. Our findings provide insights into the physiological or pathological roles of 18:1 LPE in the brain.
6 Burn Patient Insurance Status Influences Hospital Discharge Disposition Locations
Authors: Hulsebos Ian F , Johnson Maxwell B , Spera Leigh J , Hulsebos Elise M , Yenikomshian Haig A , Gillenwater Justin
Published: April 2021

Introduction

Post-discharge services, such as outpatient wound care, may affect long term health outcomes and post-recovery quality of life. Access to these services may vary according to insurance status and ability to withstand out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, or privately insured at the time of their burn unit admissions. We hypothesized that uninsured patients were more likely to be discharged to locations with fewer wound care resources.

Methods

A retrospective review from July 1, 2015 to November 1, 2019 was performed at an ABA-verified burn center. All inpatient burn admission patients were identified and categorized according to insurance payer type. Patient and burn characteristics were recorded. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance.

Results

In total, 284 uninsured, 565 publicly insured and 293 privately insured patients were identified. There were no significant differences in TBSA (P=0.3), presence of full thickness burn (P=0.3), inhalation injury (P=0.3), ICU days (P=0.09), ventilator days (P=0.2), or need for grafting (P=0.1). Uninsured patients were found to be younger (P< 0.0001) and more likely to be male (P=0.03). For primary outcome, uninsured patients were more likely to be discharged without ancillary services (self-care) (80.3% vs. 66.7% vs. 66.9%, P< 0.0001). Publicly insured patients were more likely to receive skilled nursing care (1.1% vs. 6.6% vs. 2.4%, P=0.0007). Privately insured patients were more likely to receive homecare (3.2% vs. 5.8% vs. 10.9%, P=0.0005) or transfer to other institutions for ongoing inpatient care (2.5% vs. 5.1% vs. 11.6%, P< 0.0001). For secondary outcomes, there was no difference in burn unit readmission (P=0.5) while uninsured were more likely to follow up in the same institution’s outpatient burn clinic after discharge (82.4% vs. 72.0% vs. 75.4%, P=0.004).

Conclusions

Despite no differences in burn injury severity, uninsured patients were less likely to receive post-discharge resources. However, these patients were younger, which may partially explain their disproportionate discharge to self-care. Nevertheless, insured patients have greater access to non-emergent medical resources and a broader range of treatment options. Although there were no significant differences in hospital readmission, the long-term implication to differential post-discharge care is unknown. Additional studies are needed to better elucidate if discrepancies in long-term wound healing or perceived quality of life amongst these populations exist.
9 Impact of Methadone Initiation in Intubated Burn Patients: A Retrospective Review
Authors: Zavala Sarah , Wasilewski Gabrielle , Sharma Anisha , Bulakh Olga , Fahmy Joseph , Liu Yuk Ming
Published: April 2021

Introduction

Methadone can be used to wean opiates and reduce length of mechanical ventilation (MV) in critical care and burn patients. The objective of this study was to assess the impact of methadone use on ventilator-free days and clinical outcomes in burned patients requiring MV.

Methods

This was a retrospective study of adult patients admitted to a burn center for initial management of burn injuries who required MV for at least 48 hours between September 2013 and November 2019. Patients were excluded from the study if they had prior methadone use, total body surface area (TBSA) of less than 5%, or expired within the first 28 days of admission. The primary endpoint was the difference in ventilator-free days among those who received methadone compared to those who did not. Secondary endpoints include length of stay, mortality, sedative agent and average daily dose, analgesic agent and average daily dose, and incidence of delirium. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test, as appropriate. Multivariate regression was used to identify variables for possible association with MV duration.

Results

A total of 83 patients were included in the study; 52 received methadone and 31 were controls. Patients were generally well-matched between groups, however patients receiving methadone were younger (45.3 vs 56.2 years, p = 0.002) and had a larger TBSA (30.4 vs 19.1%, p = 0.001). Patients who received methadone had fewer ventilator free days of the first 28 (9.5 vs 15.0 days, p = 0.009) and a longer ICU stay (57.2 vs 35.8 days, p = 0.025). There was no difference between groups in terms of mortality, reintubations, and incidence of delirium. Patients who received methadone had longer duration of analgesia (20.7 vs 12.0 days, p = 0.011) and sedation (19.0 vs 12.4 days, p = 0.026) while on MV.

Conclusions

This study found that methadone use contributed to fewer ventilator-free days and longer ICU stays, which was unexpected but worth discussing. There are several limitations to this study. This study occurred during a time period in which the pain management and sedation strategies of this burn unit were evolving, and strategies may not have been consistent between providers. The study included a small sample size and baseline demographics demonstrated significant differences in age and TBSA between the two groups. Additionally, pain scores were not collected as part of this study, which would have provided better insight into the effectiveness of pain management. The use of methadone as an adjunct for pain control remains undetermined.
12 Outcomes in Ventilated Burn Patients with Acute Respiratory Distress Syndrome: An Evaluation of Early High-PEEP Strategy Using Berlin Criteria.
Authors: Perry Travis L , Pinette William , Lesch Heather , Parikh Priti , Miner Jason
Published: April 2021

Introduction

Acute respiratory distress syndrome (ARDS) remains a formidable sequela, complication, and mortality risk in patients with large burns with or without inhalation injury. Alveolar recruitment using higher positive end expiratory Pressures (PEEP) after the onset of ARDS has been tried with varying success. Subsequent studies have identified benefits for several rescue maneuvers in ARDS patients with refractory hypoxemia. A preventive strategy utilizing an early recruitment maneuver, however, has not, to our knowledge, been explored in ventilated burn patients. The purpose of this study was to evaluate the natural progression and clinical outcomes of ARDS severity (mild, moderate, and severe) using Berlin criteria in ventilated burn patients treated with an early high-PEEP ventilator strategy.

Methods

A single-center retrospective review of burn patients who were mechanically ventilated for more than 48 hours utilizing an early high-PEEP ventilator strategy was performed at our Level 1 trauma and regional burn center. ARDS severity was defined according to the Berlin criteria. Demographic data, as well as respiratory and clinical outcomes were evaluated.

Results

Eighty-three patients met inclusion criteria and were analyzed. According to the Berlin definition, 42.1% of patients met ARDS criteria on admission and nearly all patients (85.5%) developed ARDS within the first seven days: 28 (34%) mild, 32 (38.6%) moderate, and 11 (13.3%) severe ARDS. The mean percent total body surface area (%TBSA) was 24.6 ± 22.1, with 68.7% of patients diagnosed with inhalation injury. The highest incidence of ARDS was 57.8% on day 2 of admission. Most cases remained in the mild to moderate ARDS category with severe ARDS (2.4%) being less common by hospital day 7. Overall, 30-day in-hospital and inhalation injury mortality rates were 9.6% and 15.8%, respectively. No correlation was observed between plateau pressures (22.8), mean arterial pressures (84.4), or vasopressor requirements; and oxygen requirements down trended quickly over the first 24–48 hours.

Conclusions

In our study, prophylactic, immediate, high-PEEP in mechanically ventilated burn patients was associated with trends toward decreased severity and more rapid resolution of ARDS in the first week following burn injury. This correlated with lower 30-day in-hospital mortality in this population. This
38 Cost-effectiveness of Autologous Cell Harvesting Device for the Treatment of Burns Requiring Hospitalization: An Economic Evaluation Using Real World Data
Authors: Carter Jeffrey E , Hickerson William L , Carson Joshua S , Kowal Stacey
Published: April 2021

Introduction

Value is a prominent issue in healthcare measured by the clinical outcomes of good medical practices relative to the literal or figurative costs of care. As a result, cost effectiveness has become an essential measure when assessing new technologies in burn care. To help providers evaluate cost-effectiveness, the BEACON model was developed in 2018 using National Burn Repository (NBR) data. While the NBR data has tremendous value portraying a cumulative picture of burn care, it lacks resolution for new innovations such as autologous skin cell suspension (ASCS). In BEACON, ASCS was shown to reduce costs associated with the current treatment of severe burns, where this cost-saving was attributed to reductions in length of stay (LOS), the number of operations, the donor site size, and associated wound care. Our study examines the efficacy of the BEACON model by performing a multicenter real-world data (RWD) analysis of primary cost-savings measures of reduced LOS for patients treated with ASCS vs. standard of care (SOC).

Methods

De-identified electronic medical record data was collected over a 20-month period (1/2019 to 8/2020) from 43 burn centers in 14 states. Patients with burn injuries treated with ASCS were matched by age, gender, TBSA, and comorbidities to patients treated by current SOC treatment. Injury severity was calculated as categorical data with intervals: < 10%, 10–19%, 20–29%, 30–39%, and 40–49% TBSA. Co-morbidities were also assessed to facilitate a 1:1 comparison of patients across the two cohorts. Cost analysis was determined prior peer-reviewed literature in burn care.

Results

A total of 2,438 patients were reviewed, and 162 were used in the matched cohort analysis (n=81 in each cohort). In these patients, 68% had < 20% TBSA. When comparing patients matched on co-morbidities, burn %TBSA/extent, age, and gender, ASCS patients had a shorter LOS by 4.1 days. At an assumed cost of $6,795 per day, these differences in LOS produced a savings of over $28,000 in hospital bed costs alone per ASCS patient versus SOC. LOS was the same or shorter for ASCS patients in 63% of cases with an average reduction of 4.1 days resulting in an overall savings of $2,269,530 for ASCS-treated patients compared to SOC.

Conclusions

Our study is the largest RWD cost-effectiveness analysis of ASCS vs SOC. This analysis confirms the BEACON model with savings primarily originating from reducing LOS, even for small burns with 68% of patients having burns less than 20% TBSA.
42 COVID-19 Slowdown? Not in Our Burn Center!
Authors: Greenhalgh David G , Romanowski Kathleen S , Sen Soman , Palmieri Tina L
Published: April 2021

Introduction

There has been a great concern that the COVID-19 pandemic has interfered with burn care. The feeling has been that resources have been shifted to treating the COVID patients and that “shelter-in-place” requirements have reduced the risks for burn injury. The ABA and other organizations have sent biweekly surveys in order to determine how the pandemic has interfered with burn care. Despite these concerns, we seemed very busy.

Methods

The inpatient data was collected in our adult and pediatric burn centers between January 1, 2020 and August 31, 2020.

Results

During the COVID-19 pandemic there was an increase in burn admissions in both adult and pediatric centers. At the same time there were 1270 COVID-19 adult admissions and 4 COVID-positive admissions at the pediatric center. In the adult center, there was increase from 414 total admissions from fiscal year 2019 (7/2018-6/2019) of 414 to 495 for fiscal year 2020 (7/2019-6/2020). The average daily census also increased from 18.33 to 18.36 during the same period. The monthly number of burn admissions increased from 38.5/month for the last six months of 2019 to 44/month for the first six months of 2020. The admission rate continued in July (41) and August (47). In the first 8 months of 2020, there were 356 admissions with a mean TBSA of 11.3%. There were many large burns admitted in late summer. The mean TBSA of the 12 bed ICU on September 11, 2020 was 60.6% (range 25–85%). In the pediatric unit, there were 174 admissions through July 2020, a 6% increase from the preceding same period. There was a 6% decrease in burn reconstruction.

Conclusions

Despite a significant burden of COVID-19 patients, burn admissions also increased at the same time. There was no evidence that “shelter-in-place” requirements changed the risk for burn injuries. Resources for critical care needs should not be siphoned away from burn centers during pandemics. Risky behaviors leading to burns do not go away despite new health crises.
44 Examining the Impact of the COVID-19 Pandemic on Participants in a Longitudinal Study of Burn Outcomes
Authors: Kelter Brian M , Wolfe Audrey E , Abouzeid Callie , Gibran Nicole S , Holavanahalli Radha K , Kowalske Karen J , Ni Pengsheng , Kazis Lewis E , Ryan Colleen M , Schneider Jeffrey C
Published: April 2021

Introduction

The COVID-19 pandemic has had widespread effects on healthcare and society at large. There are limited data on the impact of the pandemic on the long-term recovery of the burn survivor. This study aims to compare physical and psychosocial outcomes of the burn survivor population before and during the COVID-19 pandemic.

Methods

Data from the Burn Model System National Database (2015-present) were analyzed. Data were divided into pre- and during-pandemic groups (before and after March 1st, 2020). Outcomes were compared at four cross-sectional time points: 6, 12, 24, and 60 months after burn injury. The following patient reported outcome measures were examined: SF-12 Health Survey, PROMIS-29, Post-Traumatic Growth Indicator, Community Integration Questionnaire, Patient Civilian Checklist, Satisfaction with Life Scale, Burn Specific Health Scale, NeuroQOL Stigma, 4-D Itch, and CAGE Questionnaire (drug/alcohol misuse). Given the cross-sectional design, potential differences in clinical and demographic characteristics were examined for each group at each time point. Adjusted mean outcome scores at each time point were compared between groups using a two stage multi-variable regression model with propensity score matching. For each time point, subjects from each group were matched. The propensity score was calculated using the following matching variables: gender, age, race, ethnicity, etiology, length of stay, and burn size. The mean score difference of outcomes within each matched sample was examined.

Results

Sample sizes varied by time point with a range from 420 at 6 months to 94 at 60 months. The during-COVID group comprised 10% of the total sample size. There were no significant differences in demographic and clinical characteristics between the groups at any time point. There were no significant differences between the groups in adjusted mean outcome scores across the different time points.

Conclusions

This preliminary examination showed no differences in myriad long-term outcomes at multiple time points after injury among burn survivors before and during the start of the COVID-19 pandemic. The results may suggest an element of resilience, however given the sample size and cross-sectional limitations further investigation is required to better understand the impact of COVID-19 on the burn population.
48 Higher Admission Frailty Scores Predict Increased Mortality, Morbidity and Healthcare Utilization in the Elderly Burn Population
Authors: Iles Kathleen A , Duchesneau Emilie D , Strassle Paula , Chrisco Lori , Howell Thomas , King Booker , Williams Felicia N , Nizamani Rabia
Published: April 2021

Introduction

The Rockwood Clinical Frailty Scale is a validated rapid assessment of frailty phenotype, predictor of mortality and other clinical outcomes in the geriatric population, even when applied retrospectively. Using data from a large tertiary care burn center, we assessed the association between admission frailty in an elderly burn population and outcomes.

Methods

Retrospective analysis of burn patients > 65 years, admitted to a tertiary care referral burn center from 2015–2019 (n= 652). Patients were assigned to Rockwood frailty subgroups, low (1–3), moderate (4–6), or high (7–9), based on comprehensive medical, social work, physical and occupational therapy assessments. Patients who did not have complete assessments to allow for appropriate frailty scoring were excluded. Hospital-associated infections (HAIs) were identified through the institutional epidemiology database and healthcare utilization data were extracted from burn registry and medical records. Cox proportional hazards regression was used to estimate associations between admission frailty and 30-day inpatient mortality.

Results

Our study included 644 patients (low: 262, moderate: 345, and high: 37 frailty subgroups). Frailty was associated with higher percent TBSA (median TBSA: low 2.0%; moderate 3.0%; high 3.0%; p=0.01) and older age at admission (p=0.0004). The 30-day cumulative incidence of mortality was 2.3%, 7.0%, and 24.3% among the low, moderate, and high frailty strata, respectively. After adjustment for age, TBSA and inhalation, high frailty was associated with increased 30-day mortality (HR 5.73; 95% CI 1.86, 17.62). Moderate frailty appeared to increase 30-day mortality, although estimates were imprecise (HR 2.19; 95% CI 0.87–5.50).

Morbidity and healthcare utilization results are reported in Table 1. Higher frailty was associated with any ICU stay during the hospitalization, need for mechanical ventilation, and higher median hospital cost/day. HAIs were infrequent in all frailty subgroups. The proportion of patients discharged to hospice, rehab, long and short-term care facilities was highest in the high frailty subgroup. Those in the moderate and low subgroups were more likely to be discharged home or home with services.

Conclusions

High admission frailty is associated with an increased 30-day mortality regardless of age group. Higher frailty correlates with increased morbidity and healthcare utilization.