bluuebunny/crossref_metadata_2025 huggingface dataset:
Familial Abuse During Childhood and Later-Life Health: Exploring the Role of Victim–Perpetrator Relationships
Authors: Lee Chioun , Park Soojin , Lee Juha
Published: April 2024

Objectives

Childhood abuse has been extensively studied in relation to later-life health, yet relatively little attention has been given to understanding the nuanced dynamics across victim–perpetrator relationships. This study addresses this gap by identifying typologies of familial perpetrators of childhood abuse in a national sample and examining their associations with various health outcomes, including physical and mental health as well as substance abuse.

Methods

We used 2 waves of data from the Midlife in the US Study (n = 6,295, mean age = 46.9 at baseline). The analysis was completed in 3 stages. Using Latent Class Analysis (LCA), we identified subpopulations of victims with distinct familial perpetrator histories. With assigned LCA memberships and propensity score weighting, we investigated the extent to which specific victim–perpetrator relationships are associated with health outcomes measured at baseline and a 10-year follow-up adjusting for other early-life risks. We evaluated whether the observed associations differ across the waves.

Results

Parental and sibling abuse commonly co-occur, surpassing the occurrence of single perpetrators. Although minimal health disparities are evident between sibling-only abuse and no/little abuse groups at baseline, parent-only abuse is associated with compromised health outcomes. Severe abuse from both siblings and parents is linked to the most adverse health outcomes. At the follow-up survey, the associations between familiar abuse and health outcomes weakened, particularly for substance abuse.

Discussion

This study, delving into family relationships, family violence, and health disparities, provides new evidence to augment our comprehension of the enduring link between childhood abuse and health within the family context.
Pharmacogenetics of aminoglycoside-related ototoxicity: a systematic review
Authors: Gaafar D , Baxter N , Cranswick N , Christodoulou J , Gwee A
Published: April 2024

Background

Aminoglycosides (AGs) are important antibiotics in the treatment of Gram-negative sepsis. However, they are associated with the risk of irreversible sensorineural hearing loss (SNHL). Several genetic variants have been implicated in the development of ototoxicity.

Objectives

To evaluate the pharmacogenetic determinants of AG-related ototoxicity.

Methods

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses and was registered on Prospero (CRD42022337769). In Dec 2022, PubMed, Cochrane Library, Embase and MEDLINE were searched. Included studies were those reporting original data on the effect of the AG-exposed patient’s genome on the development of ototoxicity.

Results

Of 10 202 studies, 31 met the inclusion criteria. Twenty-nine studies focused on the mitochondrial genome, while two studied the nuclear genome. One study of neonates found that 30% of those with the m.1555A > G variant failed hearing screening after AG exposure (level 2 evidence). Seventeen additional studies found the m.1555A > G variant was associated with high penetrance (up to 100%) of SNHL after AG exposure (level 3–4 evidence). Nine studies of m.1494C > T found the penetrance of AG-related SNHL to be up to 40%; however, this variant was also identified in those with SNHL without AG exposure (level 3–4 evidence). The variants m.1005T > C and m.1095T > C may be associated with AG-related SNHL; however, further studies are needed.

Conclusions

This review found that the m.1555A > G and m.1494C > T variants in the MT-RNR1 gene have the strongest evidence in the development of AG-related SNHL, although study quality was limited (level 2–4). These variants were associated with high penetrance of a SNHL phenotype following AG exposure.
Iron efflux by IetA enhances β-lactam aztreonam resistance and is linked to oxidative stress through cellular respiration in Riemerella anatipestifer
Authors: Liu Mafeng , Wang Mengying , Huang Mi , Gao Qun , Zhu Dekang , Wang Mingshu , Jia Renyong , Chen Shun , Zhao Xinxin , Yang Qiao , Wu Ying , Zhang Shaqiu , Huang Juan , Ou Xumin , Mao Sai , Tian Bin , Sun Di , Cheng Anchun
Published: April 2024

Background

Riemerella anatipestifer encodes an iron acquisition system, but whether it encodes the iron efflux pump and its role in antibiotic resistance are largely unknown.

Objectives

To screen and identify an iron efflux gene in R. anatipestifer and determine whether and how the iron efflux gene is involved in antibiotic resistance.

Methods

In this study, gene knockout, streptonigrin susceptibility assay and inductively coupled plasma mass spectrometry were used to screen for the iron efflux gene ietA. The MIC measurements, scanning electron microscopy and reactive oxygen species (ROS) detection were used to verify the role of IetA in aztreonam resistance and its mechanism. Mortality and colonization assay were used to investigate the role of IetA in virulence.

Results

The deletion mutant ΔietA showed heightened susceptibility to streptonigrin, and prominent intracellular iron accumulation was observed in ΔfurΔietA under excess iron conditions. Additionally, ΔietA exhibited increased sensitivity to H2O2-produced oxidative stress. Under aerobic conditions with abundant iron, ΔietA displayed increased susceptibility to the β-lactam antibiotic aztreonam due to heightened ROS production. However, the killing efficacy of aztreonam was diminished in both WT and ΔietA under anaerobic or iron restriction conditions. Further experiments demonstrated that the efficiency of aztreonam against ΔietA was dependent on respiratory complexes Ⅰ and Ⅱ. Finally, in a duckling model, ΔietA had reduced virulence compared with the WT.

Conclusion

Iron efflux is critical to alleviate oxidative stress damage and β-lactam aztreonam killing in R. anatipestifer, which is linked by cellular respiration.
Environmental health of water bodies from a Brazilian Amazon Metropolis based on a conventional and metagenomic approach
Authors: Siqueira Jones Anderson Monteiro , Teixeira Dielle Monteiro , da Piedade Guilherme Junior Leite , Souza Cintya de Oliveira , Moura Tuane Carolina Ferreira , Bahia Marcia de Nazaré Miranda , Brasiliense Danielle Murici , Santos Denise Suéllen Amorim de Sousa , Morais Lena Lillian Canto de Sa , da Silva Dorotéa de Fátima Lobato , Carneiro Bruno Santana , Pinheiro Kenny da Costa , Junior Edivaldo Costa Sousa , Catete Clístenes Pamplona , Souza e Guimarães Ricardo José de Paula , Ferreira James Lima , Chagas Junior Wanderley Dias das , Machado Raiana Scerni , Tavares Fernando Neto , Resque Hugo Reis , dos Santos Lobo Patrícia , Guerra Sylvia de Fátima dos Santos , Soares Luana Silva , da Silva Luciana Damascena , Gabbay Yvone Benchimol
Published: April 2024

Aims

The present study aimed to use a conventional and metagenomic approach to investigate the microbiological diversity of water bodies in a network of drainage channels and rivers located in the central area of the city of Belém, northern Brazil, which is considered one of the largest cities in the Brazilian Amazon.

Methods and results

In eight of the analyzed points, both bacterial and viral microbiological indicators of environmental contamination—physical–chemical and metals—were assessed. The bacterial resistance genes, drug resistance mechanisms, and viral viability in the environment were also assessed. A total of 473 families of bacteria and 83 families of viruses were identified. Based on the analysis of metals, the levels of three metals (Cd, Fe, and Mn) were found to be above the recommended acceptable level by local legislation. The levels of the following three physicochemical parameters were also higher than recommended: biochemical oxygen demand, dissolved oxygen, and turbidity. Sixty-three bacterial resistance genes that conferred resistance to 13 different classes of antimicrobials were identified. Further, five mechanisms of antimicrobial resistance were identified and viral viability in the environment was confirmed.

Conclusions

Intense human actions combined with a lack of public policies and poor environmental education of the population cause environmental degradation, especially in water bodies. Thus, urgent interventions are warranted to restore the quality of this precious and scarce asset worldwide.
Evaluating the validity of the nursing statements algorithmically generated based on the International Classifications of Nursing Practice for respiratory nursing care using large language models
Authors: Kim Hyeoneui , Park Hyewon , Kang Sunghoon , Kim Jinsol , Kim Jeongha , Jung Jinsun , Taira Ricky
Published: April 2024

Objective

This study aims to facilitate the creation of quality standardized nursing statements in South Korea’s hospitals using algorithmic generation based on the International Classifications of Nursing Practice (ICNP) and evaluation through Large Language Models.

Materials and Methods

We algorithmically generated 15 972 statements related to acute respiratory care using 117 concepts and concept composition models of ICNP. Human reviewers, Generative Pre-trained Transformers 4.0 (GPT-4.0), and Bio_Clinical Bidirectional Encoder Representations from Transformers (BERT) evaluated the generated statements for validity. The evaluation by GPT-4.0 and Bio_ClinicalBERT was conducted with and without contextual information and training.

Results

Of the generated statements, 2207 were deemed valid by expert reviewers. GPT-4.0 showed a zero-shot  AUC of 0.857, which aggravated with contextual information. Bio_ClinicalBERT, after training, significantly improved, reaching an AUC of 0.998.

Conclusion

Bio_ClinicalBERT effectively validates auto-generated nursing statements, offering a promising solution to enhance and streamline healthcare documentation processes.
Generative large language models are all-purpose text analytics engines: text-to-text learning is all your need
Authors: Peng Cheng , Yang Xi , Chen Aokun , Yu Zehao , Smith Kaleb E , Costa Anthony B , Flores Mona G , Bian Jiang , Wu Yonghui
Published: April 2024

Objective

To solve major clinical natural language processing (NLP) tasks using a unified text-to-text learning architecture based on a generative large language model (LLM) via prompt tuning.

Methods

We formulated 7 key clinical NLP tasks as text-to-text learning and solved them using one unified generative clinical LLM, GatorTronGPT, developed using GPT-3 architecture and trained with up to 20 billion parameters. We adopted soft prompts (ie, trainable vectors) with frozen LLM, where the LLM parameters were not updated (ie, frozen) and only the vectors of soft prompts were updated, known as prompt tuning. We added additional soft prompts as a prefix to the input layer, which were optimized during the prompt tuning. We evaluated the proposed method using 7 clinical NLP tasks and compared them with previous task-specific solutions based on Transformer models.

Results and Conclusion

The proposed approach achieved state-of-the-art performance for 5 out of 7 major clinical NLP tasks using one unified generative LLM. Our approach outperformed previous task-specific transformer models by ∼3% for concept extraction and 7% for relation extraction applied to social determinants of health, 3.4% for clinical concept normalization, 3.4%-10% for clinical abbreviation disambiguation, and 5.5%-9% for natural language inference. Our approach also outperformed a previously developed prompt-based machine reading comprehension (MRC) model, GatorTron-MRC, for clinical concept and relation extraction. The proposed approach can deliver the “one model for all” promise from training to deployment using a unified generative LLM.
42 Multimodal NRF2 and mTOR-targeted Microparticle-based Therapy Reprograms Systemic and Pulmonary Immune Programming After Combined Injury
Authors: Alves Matthew , Maile Robert , Clark Ryan , Hernandez Denise A , Willis Micah L , Smythe Madelyn P , Wallet Shannon , Keselowsky Ben
Published: April 2024

Introduction

Despite recent advancements in burn wound management, individuals afflicted with severe burn injuries face heightened susceptibility to opportunistic infections, largely attributed to a hyper pro-inflammatory response followed by a chronic compensatory anti-inflammatory response. Our prior research has identified 1) Nuclear Factor-Erythroid-2-Related Factor (NRF2) as a critical immunomodulatory component, that when activated, induces protective anti-inflammatory pathways after injury, and 2) Mammalian Target of Rapamycin (mTOR) that, when inhibited, reduces pro-inflammatory responses. However, therapeutic use of these targets is limited, as known modulators of these pathways are insoluble in saline and require long-term application. We hypothesized that administering NRF2 agonist (CDDO) in addition to Rapamycin encapsulated in soluble Poly (lactic-co-glycolic acid) (PLGA) microparticles (MP) will reduce the acute hyper-inflammatory response following a burn injury.

Methods

To assess this, we conducted in vivo experiments using our murine model of burn and smoke inhalation (BI) injury. We utilized female C57BL/6 mice and separated them into four groups (n=6 per group): (1) Sham, (2) BI, (3) BI+CDDO, and (4) BI+CDDO+Rapamycin MP (combo-MP). An hour after the burn, the mice were resuscitated, and MP administered IP. After 48 hours, we collected and isolated total splenic and lung tissue mRNA and analyzed immune gene expression using nanoString.

Results

We found significant changes in the activation patterns of immune genes and their associated pathways. For example, in mice administered with CDDO-MP, splenic tissue displayed a significant reduction (p < 0.05) in the activation of inflammatory genes when compared to untreated BI, such as CASP1 gene and CD9. Mice treated with combo-MP had a significant reduction in inflammatory genes associated with mTOR pathway, such as CCL9 and C3 when compared to those only treated with CDDO-MP. To examine the molecular pathways influenced by the drugs, we conducted an Ingenuity Pathway Analysis (IPA). The IPA confirmed the significantly (p-value < 0.05) increased anti-inflammatory signaling by downregulation of Pathogen Induced Cytokine Storm Signaling when compared to CDDO mice

Conclusions

Our findings strongly suggest that the multi-modal MP-based therapy holds considerable promise in reprogramming the immune response after burn injuries, particularly by mitigating the hyper-inflammatory phase.

Applicability of Research to Practice

This research identifies targets that are likely applicable to therapeutic targeting to reduce patient morbidity and mortality after burn and combined injuries.
43 The Development of the Preschool Life Impact Burn Recovery Evaluation Short Forms
Authors: McGwin Madeleine , Ni Pengsheng , Patel Khushbu F , Surette Kate , Gladstone Alexandra R , Palmieri Tina L , Murphy Michael , Stoddard, Jr. Frederick J , Schneider Jeffrey C , Kazis Lewis E , Ryan Colleen M
Published: April 2024

Introduction

The Preschool Life Impact Burn Recovery Evaluation Computer adaptive test (PS-LIBRE1-5 CAT) has been developed using item response theory methods and CAT technologies. While the CAT can provide precise, real-time assessment, it can be limited in its use due to advanced technological requirements. Therefore, the aim of the present study was to develop PS-LIBRE1-5 short forms (SFs). This is the next logical step for the PS-LIBRE1-5 project as it will improve the accessibility of the instrument in the absence of advanced computer technology.

Methods

Data from the field-testing and calibration of the PS-LIBRE1-5 was assessed for SF usage. The items were iteratively added into a short form. The candidate item was selected based on maximizing the expected value of the test information function (TIF), which is the sum of TIF weighted by the sample score distribution. This process considers both information function and sample distribution, however it does not prevent from selecting an item with very high information value, covering a narrow score range. Therefore, the highest test information value for each candidate short form was constrained to a reliability value of 0.8. Differential item functioning (DIF) was examined for age, burn size, sex, parent education level, and burn location. Cronbach alpha and score correlations were used to assess internal consistency, reliability and validity. The number of items for a SF was set at 10.

Results

The PS-LIBRE1-5 SFs were developed using data from 498 parents of burn survivors, ages 1 to 5 years, who participated in the field-testing of the item pool. The mean ± SD child age was 3.0 ± 1.4 years with 55.2% males. Mean TBSA burned was 4.2% and average time since burn was 1.1 years. 10-item short forms were developed to cover three PS-LIBRE1-5 scales: Communication and Language, Physical Functioning and Emotional Well-being. The DIF analysis resulted in two short forms for Communication and Language; >3 and ≤3 years old. Ceiling effects were ≤15% and floor effects were < 1% for all scales. The marginal reliability of the SFs ranged from 0.74 to 0.90. The Cronbach’s alpha ranged from 0.86 to 0.90. Score correlation of the SFs to full item bank was 0.97 to 0.98.

Conclusions

The scales of the PS-LIBRE1-5 performed credibly well and were psychometrically sound in the development of SFs. Following final validation, these short forms will be tested for use in clinical practice and for future observational studies and clinical interventions.

Applicability of Research to Practice

PS-LIBRE1-5 SFs have been developed and can be used to generate reasonable estimations of the CAT score for the PS- LIBRE1-5, with the goal to improve accessibility of the instrument in clinical and research settings.
72 Daily Physical Activity Moderates the Relationship Between Symptoms and Social Participation Outcomes After Burn Injury
Authors: Deng Huan , Abouzeid Cailin , Shepler Lauren , Slavin Mary D , Herrera-Escobar Juan , Kazis Lewis E , Ryan Colleen M , Schneider Jeffrey C
Published: April 2024

Introduction

Prior literature shows that early physical and psychological symptoms predict late social participation outcomes after burn injury. However, there is little information on the role of survivor’s daily behavior as it relates to physical and psychological symptoms and social participation outcomes. This study examines if daily behaviors moderate the association of pain, depression, and anxiety symptoms with social participation outcomes after burn injury.

Methods

Adult burn survivors living in the community were enrolled in a 6-month study. Participants completed weekly surveys assessing physical symptom of pain (Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity and Pain Interference), psychological symptoms of depression (Patient Health Questionnaire (PHQ)) and anxiety (PROMIS Anxiety), as well as social participation outcomes (Life Impact Burn Recovery Evaluation (LIBRE) Profile Social Interactions and Social Activities). Additionally, a smartphone app and phone logs automatically recorded participants’ daily behaviors, including number of steps, travel miles, activity minutes, sleep hours, and number of phone call and message contacts. Multilevel models controlling for demographic and burn injury variables were separately conducted for each daily behavior to examine its moderation effect in the association between symptoms and social participation outcomes.

Results

A total of 24 burn survivors were included in this study with an average of 25 years after injury and 43% total body surface area burned. Lower (worse) LIBRE Social Interactions and LIBRE Social Activities scores were significantly associated with higher (worse) PROMIS Pain Intensity, PROMIS Pain Interference, PHQ, and PROMIS Anxiety scores (p < 0.05). Additionally, within-person daily number of steps and activity minutes significantly moderated the association between PROMIS Anxiety and LIBRE Social Activities (p < 0.001).

Conclusions

The study findings indicate that survivors’ social participation outcomes are related to pain, depression, and anxiety symptoms after burn injury, and are buffered by daily physical activity.

Applicability of Research to Practice

This study may inform future interventions that target physical activity to improve outcomes and promote recovery after burn injury.
501 The Effect of Renal Failure on Acute Burn Mortality at a Tertiary Care Burn Center
Authors: Levine Ashley , Hollowell Jamie L , Bodek Benjamin , Agala Chris B , Maxwell Eli , Chrisco Lori , Matthews Robert W , King booker , Williams Felicia
Published: April 2024

Introduction

There is an increased incidence of renal failure in the expanding aging population. However, the effect of renal failure as a co-morbid condition on burn mortality remains overlooked in conventional predictive models. Our retrospective analysis of burn survivors and non-survivors aims to critically evaluate management of burn patients with pre-existing renal failure.

Methods

We conducted a retrospective analysis utilizing data from the Institutional Burn Center registry, which was linked to clinical and administrative records. Our study included all adult patients admitted to the Burn Center between January 1, 2012, and December 31, 2022. We collected and analyzed various parameters, including patient demographics, length of hospital stay (LOS), comorbid conditions, and mortality outcomes. We evaluated the association between renal failure and burn mortality using logistic regression modeling.

Results

Over the ten-year study period, a total of 9,955 adult patients were admitted to the BICU. 124 patients presented with a diagnosis of renal failure: 18 non-survivors, 106 survivors. Our analysis revealed that renal failure was associated with a nearly three-fold increase in the odds of mortality (OR 2.64, CI 1.33-5.01, p=0.004) when accounting for factors present in traditional predictive models such as burn size, age, and inhalational injury. Additionally, renal failure was identified as a co-morbidity in 6% of all deaths for this time frame and 14.5% of patients with this diagnosis on admission are deceased. These findings underscore the significant impact of renal failure on burn patient outcomes.

Conclusions

As our population continues to age, burn providers will increasingly encounter the complex challenge of managing an acute burn with multiple comorbidities. Our study highlights the intuitive understanding that patients with pre-existing renal failure have a heightened mortality risk when suffering from an acute burn injury. In light of this, it is imperative to consider potential adjustments to burn resuscitation and care protocols for this at-risk population, with the ultimate goal of enhancing the chances of survival to hospital discharge.

Applicability of Research to Practice

This study emphasizes the pressing need for further research into the effects of multiple comorbidities on mortality among burn patients. The insights gained from this research have practical implications for refining clinical approaches and optimizing care strategies for this vulnerable patient population.
519 Comparing Evidence Based Equations and Indirect Calorimetry in Moderate Size Burns
Authors: Patton Lacey , Mueller Scott W , Wiktor Arek J , Gibson Cameron
Published: April 2024

Introduction

Burn survivors require additional calories due to hypermetabolic demands for large burn injuries consisting of >20% total body surface area (TBSA). Evidence-based energy equations for the burn population can significantly overestimate or underestimate caloric needs. There is limited research regarding metabolic demands of moderate size burns, consisting of 10-19.9% TBSA. We aimed to correlate patient specific indirect calorimetry (IC) results with expected caloric needs using equation estimates.

Methods

This was a single center retrospective cohort study at an American Burn Association (ABA) verified burn center. We included patients with 10% and greater TBSA between 3/15/23 and 9/1/23 with a validated IC. Resting energy expenditure (REE) multiplied by 1.3 activity factor (IC 1.3) were compared to the Xie and Carlson, if within the first 30 days post injury, or Milner, if after 30 days since injury. In addition, we compared the Mifflin St Jeor (MSJ) equation to REE (no activity factor) in patient with TBSA 10-19.9%. Correlations coefficients and matched mean differences to assess for bias of equation based versus IC based caloric needs.

Results

A total of 15 patients, with a median age and TBSA of 31 years (30, 52.5) and 20% (13.6, 33.1), had 39 IC assessments performed. The average (standard deviation) of caloric requirements for IC 1.3, Xie, and Carlson/Milner were 3112 (±541), 2857 (±707), and 2881 (±753) Kcal, respectively. Caloric requirements by IC 1.3 correlated weakly with Xie (0.36, p=0.024) and Carlson/Milner (0.31, p=0.055). Xie and Carlson/Milner correlated strongly (0.94, p< 0.001). Xie significantly underpredicted caloric needs while the Carlson/Milner trended towards a negative bias compared to IC 1.3 (matched mean difference: -255, p=0.033 and -231, p=0.072). In those 10-19.9% TBSA, 7 patients (median 12.75%; 10.8, 14.75) had 11 assessments. Average REE by IC was 2270 (±285) vs 1517 (±167) Kcal by MSJ. There was a moderate correlation between IC REE and MSJ (0.65, p=0.029). However, MSJ was significantly negatively biased compared to IC REE (matched mean difference -753, p< 0.011).

Conclusions

Xie and Carlson/Milner equations had a weak correlation with IC 1.3 estimated caloric requirements. These equations tended to underpredict actual caloric needs. In the 10-19.9% TBSA group, MSJ significantly underpredicted IC REE. This suggests patients with TBSA 10-19.9% are hypermetabolic and may require more intense nutrition support. Larger studies in the TBSA range are required to validate these results.

Applicability of Research to Practice

Evidence-based energy equations are correlated weakly with patient-specific IC based results and should only be used if IC is unable to be performed. Greater caloric provision may be needed in the 10-19.9% TBSA burn population.
528 Efficacy of Autologous Skin Cell Suspension in the Closure of Thermal and Non-thermal Full-thickness Wounds
Authors: Brown Samantha , Hultman C Scott , McGroarty Carrie , McMoon Michelle , Rogers Corianne
Published: April 2024

Introduction

Autologous Skin Cell Suspension (ASCS) has documented success in the closure of partial-thickness burns, but far less is known about the safety and efficacy of ASCS in the closure of full-thickness injuries. The purpose of this study is to examine the utility of ASCS, when used in combination with widely-meshed skin grafts, in achieving closure of both thermal and non-thermal full-thickness defects and minimizing donor site morbidity.

Methods

In this case series, 40 consecutive patients with full-thickness defects (burns 7, MVC 12, infection 13, other 8) underwent debridement and were treated with the bilayer technique of 3:1 widely-meshed autograft and 80:1 expanded ASCS, from September 2022 through September 2023, at an urban Level 1 trauma center. Single cell suspension of keratinocytes, melanocytes, and fibroblasts underwent point-of-care preparation in the operating theater using trypsin, buffer, and micro-filtration. Aerosolized cells were sprayed over widely-meshed grafts and donor sites, fixated with tissue glue, covered with a non-adherent clear polymer dressing. End points were >99% re-epithelialization by 4, 8, and 12 weeks, rate of limb salvage, size of donor site reduction, operative throughput, time from grafting until discharge and total length of stay, and incidence of early and late postoperative complications.

Results

Percentage of patients with >99% wound closure was 75%, 95%, and 97.5% at 4, 8, and 12 weeks, respectively. Limb salvage was accomplished in 35 out of 36 patients (6 upper, 30 lower extremities). Mean area grafted was 506 cm2, with a donor site of 248 cm2 (reduction of 49%). Mean surgical time (start-to-finish) was 73 minutes, compared to OR time (in-to-out) of 129 minutes. Mean length-of-stay was 23.1 days, while time from ASCS to discharge was 9.5 days. Three out of 40 patients (7.5%) required reoperation for bleeding (1) and breakdown (2), and 4 out of 40 patients (10%) developed hypertrophic scarring. Mean follow-up was 101.5 days.

Conclusions

When used for closure of full-thickness, thermal and non-thermal defects, point-of-care ASCS is effective and safe. Particular benefits include rapid wound re-epithelialization, high rate of limb salvage, reduction of donor site size and morbidity, and low incidence of hypertrophic scarring.

Applicability of Research to Practice

This project demonstrates the efficacy and safety of spray-on skin for closure of full thickness defects.
530 Fractured Coverage for Fractional Laser: Describing the Insurance Landscape of Laser Therapy for Burn Scars
Authors: Reinoso Tyler R , Heron Matthew J , Dane Julia M , Rezwan Siam K , Broderick Kristen P , Caffrey Julie A
Published: April 2024

Introduction

Laser therapy can improve skin texture, range of motion, and cosmesis for patients with burn scars. Nevertheless, insurance coverage for laser therapy is highly variable, leaving patients and providers with unforeseen costs from denied claims. To determine optimal practices for patient documentation and claim reimbursement for laser therapy, we aimed to comprehensively review the insurance policy landscape of this modality for burn scars.

Methods

We identified the largest health insurers by enrollment and market share using data from the National Association of Insurance Commissioners. For each insurer, we identified their policy on laser therapy and conducted a dual, blind extraction of its documentation requirements, prior and continuing authorization requirements, and treatment guidelines. We also collected details on prerequisite failed treatments and suggested treatment alternatives.

Results

We identified 60 health insurance providers. Eleven (18.3%) had explicit policies on scar revision. Nine (15.0%) either had no publicly available policy or could not confirm coverage details. The remaining 40 had general reconstructive surgery policies that were non-specific to burn scars. Nineteen insurers (n = 19) considered laser therapy medically necessary for scar revision, and all policies required documentation of functional impairment to establish medical necessity; however, only nine policies defined functional impairment. Six insurers required patients to fail one or more alternate trials, including “standard therapy” (n = 6), silicone sheeting (n = 5), compression therapy (n = 4), intralesional corticosteroid injections (n = 2), intralesional 5-fluorouracil (5-FU) injections (n = 1), cryotherapy (n = 1), hypoallergenic paper tape (n = 1), or surgical excision (n = 1). Seven health insurers recommended alternatives to laser therapy. Surgical excision was the most recommended alternative (n = 6, 85.7%), followed by intralesional corticosteroid injections (n = 5, 71.4%), superficial radiation therapy (n = 4, 57.1%), silicone sheeting (n = 4, 57.1%), and compression therapy (n = 4, 57.1%). Intralesional 5-FU, cryotherapy, and pulsed-dye laser were recommended less frequently (n = 3 each, 42.9% each). Notably, 3 insurers explicitly denied laser coverage under any circumstance.

Conclusions

Most health insurers have vague policies on laser therapy for burn scar revision, complicating the reimbursement landscape for patients and providers. Burn surgeons can enhance their odds of claim approval by seeking prior authorization, maintaining detailed patient records, and using objective measures for functional impairment and improvement.

Applicability of Research to Practice

This study offers guidance to burn surgeons who use lasers for scar revision and want to maximize their likelihood of insurance reimbursement.
536 A Novel Mobile Application for Burn Surface Area Calculation
Authors: Malkoff Nicolas , Cannata Brigette , Wang Sarah , Choe Deborah , Manasyan Artur , Koegler Lyle , Kashani Saman , Johnson Maxwell B , Yenikomshian Haig A , Gillenwater Justin
Published: April 2024

Introduction

The percent total body surface area (TBSA) burned is a critical determinant of required level of care, initial management, and prognosis in burn patients. The current gold standard for TBSA estimation, the Lund-Browder (LB) chart, requires familiarity with its construction and is not necessarily feasible in the field. Recently, many mobile applications (apps) have been developed to calculate TBSA. However, few have been rigorously validated. In this study, we present a novel TBSA calculator app developed for first responders and validate its accuracy.

Methods

Infant, pediatric, and adult mannequins were fabricated with eight simulated burns (Figure 1). Thirteen first- and second-year medical students with no experience in burn care were tasked with calculating the TBSA of these burns using both LB and our app. Students then completed a questionnaire to assess their experience using both methods. A paired t-test was used to compare absolute mean differences in TBSA between student estimates using both methods and those of two expert burn surgeons using LB.

Results

The app performed significantly better than LB for three of the simulated burns with mean TBSA values better approximating expert values (Burn 2 p = 0.002, Burn 5 p = 0.039, and Burn 8 p = 0.006). For the remaining five simulated burns, there was no significant difference in performance between the two methods (Table 1). Students overwhelmingly reported the app was easier and faster to use (92%, n = 12), and universally preferred it over LB for the calculation of TBSA. Students cited the visual nature of the app interface and the lack of need for manual calculations as reasons for their preference.

Conclusions

The app offered an easier, faster, and more accurate alternative to LB for calculation of TBSA among inexperienced users. Future directions include replicating this study with first responders.

Applicability of Research to Practice

Our app may be a valid alternative to LB for TBSA calculation.
553 Nursing-Led Education and Interventions to Reduce Fungal Infections on a Burn Unit
Authors: Thielges Hannah , Rhodes Abigail , Marvin Sophia A , Kraeger Trevor M , Rasmussen Megan M , Gade Clea , Thibodeau Eleanor , Rogers Bradley , Mitchell Iniabasi Nkanga , Rufi Katelyn
Published: April 2024

Introduction

Fungal infections cause major complications in patients with significant burns who are also hospitalized for more than seven days. In this project, significant burns are defined as meeting this burn unit’s Total Body Surface Area (TBSA) isolation precaution requirements: adult patients with TBSA greater than 20 percent and pediatric patients with TBSA greater than 15 percent. Complications of fungal infections include increased length of stay (LOS) and increased risk of mortality, sepsis, and graft loss (Herndon, 2018). Implementing effective strategies to reduce fungal infections is crucial to improving patient outcomes. At this time, there is limited research regarding how bedside nursing-led initiatives can decrease fungal infections in burn units. The purpose of this project is to determine if bedside nursing-led policy revision followed by nursing-generated education and implementation decreases the rate of fungal infections in burn patients that meet the TBSA isolation precaution requirements compared to infection rates prior to this initiative.

Methods

In this quality improvement project, a group of bedside nurses revised an infection prevention protocol and delivered education to all burn nursing staff regarding the new and improved policies, including Burn TBSA Contact Precautions, Standard Burn Precautions, and Advanced Burn Precautions. Nursing staff were empowered to enforce these new precautions with all other hospital staff and visitors on the Burn Unit. Fungal infection rates were analyzed before and after the policy implementation, educational interventions, and staff empowerment.

Results

Our final analysis will compare data from June 12, 2022 through Dec 12, 2022 to data from June 12, 2023 through December 12, 2023. Our preliminary findings demonstrate 2 out of 11 burn patients (eighteen percent) meeting project criteria developed a fungal infection in 2023 compared to 6 out of 18 eligible patients (thirty-three percent) in the 2022 timeframe. This demonstrates a fifteen percent decrease in the rate of infection of eligible burn patients. Confounding variables during the intervention period include a variety of environmental and supply chain adjustments that were also aimed at decreasing infection risk. These changes occurred in tandem with nursing-led initiatives.

Conclusions

Bedside nurse-driven policy changes, education, and interventions may be an effective way to decrease the rate of fungal infections in patients with significant burn injuries.

Applicability of Research to Practice

This project could demonstrate the efficacy of nurse driven policy development and education in the reduction of fungal infection in burn patients. Research in this area is currently lacking.
575 Disparities in Burn Hospitalizations in New York City 2010-2019
Authors: Lopez Christine , Luna Diego , Sheffield Perry
Published: April 2024

Introduction

Burn injury is a major source of morbidity, mortality and economic cost in the United States. Current literature does not describe the epidemiology of burn injury in New York City within the last decade. This analysis establishes an important understanding of the recent burden and demographics of burn injury and serves to support tracking of the effectiveness of ongoing policies that aspire to reduce the incidence and disparities within the realm of burn injury. By looking at injury rates by borough and race/ethnicity, we identify at-risk populations to support targeted public health interventions.

Methods

This analysis used data from the de-identified NYS Department of Health Statewide Planning and Research Cooperative System (SPARCS) publically available online database of inpatient records from 2010-2019. Incidence rates were calculated using the 2010 Decennial Census data and boroughs were compared using Zip Code Tabulation Areas (ZCTA). All data was analyzed using Python.

Results

Data included 11,444 burn injury hospitalizations from 2010-2019 across NYC for all ages. Data reviewed over the 10 years showed some persistent and shifting distribution patterns across geography and demographics. Staten Island had the highest incidence every year while Brooklyn and Queens had the highest total number of burn injuries compared to the other boroughs. Males had a higher rate of burn injury than females every year in NYC from 2010-2019. Age 0-17 had the highest burn injury rate in every year except 2016, which had 70+ as the highest rate. 70+ had the second highest rate of burn injury in all other years. In the 5 boroughs those who identified as white had the highest rate of burns in 2010 and 2011. This data shifted over time, with incidence rates in the Black/African American, Multi-Racial, and Other Race category increasing. Average length of stay in New York City for inpatient burn hospitalization was 8.12 days from 2010-2019 excluding patient stays that were >120 days.

Conclusions

This New York City data analysis provides a unique insight into the prevalence and disparities of burn injuries in an urban health setting. Data augments existing literature regarding differences in burn injury and can guide future injury prevention initiatives.

Applicability of Research to Practice

This descriptive analysis provides a basis by which work can be done across New York state that focuses on preventative public health measures to reduce burn injury. The work also creates further research questions on why specific areas or populations are more impacted by burn injury.
606 Artificial Intelligence-powered Mobile Tool for Burn Injury Evaluation for First Responders
Authors: Perry Alexander , Dodd Shawn , Chan Hannah O , Joshi Rakesh , Wong Joshua N , Hong Collin
Published: April 2024

Introduction

Accurate assessment and early interventions in the field are crucial to the prognosis of burn injuries. Studies have indicated that up to 35% of burn patients are inappropriately transferred to hospitals. In some pediatric burns, reports have suggested the total burn surface area (TBSA) has been overestimated as much as 44%. First responders play a pivotal role in the assessment and management of burn injuries, especially in remote areas. An intuitive mobile application that incorporates the standardized practices of Advanced Burn Life Support (ABLS) with integrated artificial intelligence (AI) to assist in burn size, depth, and management is needed.

Methods

The mobile application was designed with an experienced team of burn specialists, physicians, and software engineers to identify the gaps in first responder burn care and to standardize methods for initial burn assessment. Previously assessed burn photos were characterized based on their depth into split partial thickness, deep partial thickness, and full thickness burns. Laser doppler imaging taken at the time of clinical assessment confirmed the burn depth. These images were used to build a convolutional neural network from to predict burn depth and boundaries.

Results

An AI-integrated mobile application was developed encompassing a primary survey with management solutions with the fundamentals based on ABLS. The application ensures the collection of pertinent information for burns, such as the patient's weight for calculating fluid resuscitation and provides recommendations based on burn depth and surface area. Photos taken using the mobile device can be analyzed by the AI in real time to aid in burn assessment. The accuracy of the prototype AI model can in distinguish severity assessment with an F1 accuracy score of 78% with a receiver operating characteristic of 85%. Furthermore, the model has a 92% accuracy for determining the boundaries of the burn.

Conclusions

A smartphone burn application provides an integrated way to improve the efficiency and accuracy of first responders to assess, manage, and triage burns before reaching the hospital. Through the application, management recommendations are tailored to the extent of the injury and provides a detailed report to secondary healthcare providers.

Applicability of Research to Practice

A state-of-the-art burn application can be a tool that can be used by first responders to capture essential data while ensuring the accuracy of the initial assessment. The integration of artificial intelligence will help personalize and streamline the management pathway improving communication between field and hospital care providers and improving patient care.
Inherited cultural diversity and wages: surname-based evidence
Authors: Ehrl Philipp , Monasterio Leonardo
Published: April 2024

This article shows that inherited cultural diversity at the regional level generates a positive wage externality. We use administrative panel data on formally employed individuals in Rio Grande do Sul in Brazil from 2008 to 2013 and apply machine learning to infer the ancestry of workers from their surnames. We distinguish inherited diversity from birthplace diversity and use the plausibly exogenous location of former colonies to build an instrumental variable. The positive wage externality of inherited diversity withstands alternative explanations such as institutional quality, municipality size, human capital externalities, individual productivity differences, and sorting of workers.
Adolescents and young adults with cancer: the clinical course of COVID-19 infections
Authors: Wolfson Julie A , Davis Elizabeth S , Saha Aniket , Martinez Isaac , McCall David , Kothari Prachi , Brackett Julienne , Dickens David S , Kahn Alissa R , Schwalm Carla , Sharma Archana , Richman Joshua , Cuglievan Branko ,   POCC Consortium, Bhatia Smita , Dai Chen , Levine Jennifer M , Johnston Emily E
Published: April 2024

Adolescents and young adults (ie, individuals aged 15-39 years, known as AYAs) with cancer face unique vulnerabilities yet remain underrepresented in clinical trials, including adult registries of COVID-19 in cancer (AYAs: 8%-12%). We used the Pediatric Oncology COVID-19 Case Report to examine the clinical course of COVID-19 among AYAs with cancer. The Pediatric Oncology COVID-19 Case Report collects deidentified clinical and sociodemographic data regarding individuals aged from birth to 39 years with cancer (37%) and COVID-19 from more than 100 institutions. Between April 1, 2020, and November 28, 2023, 191 older AYAs (individuals 22-39 years of age) and 640 younger AYAs (individuals 15-21 years of age) were captured. Older AYAs were less often hospitalized (P < .001), admitted to the intensive care unit (P = .02), and required respiratory support (P = .057). In multivariable analyses, older AYAs faced 80% lower odds of intensive care unit admission but 2.3-times greater odds of changes to cancer-directed therapy. Unvaccinated patients had 5.4-times higher odds of intensive care unit admission. Among AYAs with cancer, the COVID-19 course varies by age. These findings can inform oncology teams directing COVID-19 management and prevention in AYA patients with cancer.
GABA does not regulate stomatal CO2 signalling in Arabidopsis
Authors: Piechatzek Adriane , Feng Xueying , Sai Na , Yi Changyu , Hurgobin Bhavna , Lewsey Mathew , Herrmann Johannes , Dittrich Marcus , Ache Peter , Müller Tobias , Kromdijk Johannes , Hedrich Rainer , Xu Bo , Gilliham Matthew
Published: April 2024

Optimal stomatal regulation is important for plant adaptation to changing environmental conditions and for maintaining crop yield. The guard cell signal γ-aminobutyric acid (GABA) is produced from glutamate by glutamate decarboxylase (GAD) during a reaction that generates CO2 as a by-product. Here, we investigated a putative connection between GABA signalling and the more clearly defined CO2 signalling pathway in guard cells. The GABA-deficient mutant Arabidopsis lines gad2-1, gad2-2, and gad1/2/4/5 were examined for stomatal sensitivity to various CO2 concentrations. Our findings show a phenotypical discrepancy between the allelic mutant lines gad2-1 and gad2-2—a weakened CO2 response in gad2-1 (GABI_474_E05) in contrast to a wild-type response in gad2-2 (SALK_028819) and gad1/2/4/5. Through transcriptomic and genomic investigation, we traced the response of gad2-1 to a deletion of full-length Mitogen-activated protein kinase 12 (MPK12) in the GABI-KAT line, thereafter renamed as gad2-1*. Guard cell-specific complementation of MPK12 in gad2-1* restored the wild-type CO2 phenotype, which confirms the proposed importance of MPK12 in CO2 sensitivity. Additionally, we found that stomatal opening under low atmospheric CO2 occurs independently of the GABA-modulated opening channel ALUMINIUM-ACTIVATED MALATE TRANSPORTER 9 (ALMT9). Our results demonstrate that GABA has a role in modulating the rate of stomatal opening and closing, but not in response to CO2per se.