bluuebunny/crossref_metadata_2025 huggingface dataset:
667 A Retrospective Review of Vitamin D Levels and Dosing in Burn Center Patients
Authors: Calder Sara , Quan Asia N , Osborn Suzanne , Nisbet Virginia , Richey Karen J , Bay Curt , Foster Kevin N
Published: March 2020

Introduction

The potential consequences of vitamin D insufficiency/deficiency (I/D) in critically ill patients include: increased ICU length of stay, organ dysfunction, infectious complications, and mortality. Burn patients, in particular, may be at increased risk of vitamin D I/D due to bleeding, systemic inflammatory response syndrome, increased utilization of vitamin D by injured tissues, compromised vascular integrity, fluid shifts, and leakage of vitamin D binding protein (VDBP) and albumin. The purpose of this study is to determine the incidence of vitamin D I/D and evaluate the institutional vitamin D dosing regimen.

Methods

A retrospective chart review was performed on all adult patients from January 1, 2018 through December 31, 2019 who received cholecalciferol and had at least one 25-hydroxy vitamin D level during their hospitalization. Vitamin D level was drawn on admission, then weekly thereafter. Patients found to be I/D were initiated on high dose vitamin D supplementation and then adjusted based on the weekly levels. The therapeutic goal for vitamin D supplementation was set at 50 ng/ml.

Results

Three hundred and sixteen patients met criteria for review. Of those patients, 293 patients (93%) were vitamin D I/D. The magnitude of vitamin D deficiency was strongly negatively correlated with increasing % total body surface area (TBSA) burn size (p< 0.001). Mean time to reach therapeutic vitamin D levels following initiation of supplementation was 19 days, requiring an average of 116,125 units cholecalciferol weekly. Time to reach therapeutic levels was also positively correlated with increasing burn size (p< 0.05). Many patients, however, were discharged prior to reaching therapeutic levels.

Conclusions

Vitamin D I/D is present in over 90% of burn center patients and the degree of I/D was profound. Additionally, vitamin D I/D was not easily corrected, taking almost 3 weeks to reach therapeutic levels using an aggressive supplementation regimen. Further studies documenting the consequences of vitamin D I/D and development of evidence-based supplementation dosing regimens are warranted.

Applicability of Research to Practice

This study documents common and severe vitamin D deficiency in burn patients, and difficulty in correcting this deficiency.
700 A Comparison of Pediatric Burn Injuries Based on Cultural Environment
Authors: Bennie Nicole , Belacic Heather , Bruckman David , Mondozzi Mary A , Crow John
Published: March 2020

Introduction

The Amish maintain cultural customs that preserve their identity minimizing assimilation into American culture and selectively use technology. Cultural beliefs and environmental situations can predispose the Amish, especially children to burn injuries. As a burn center it is important to examine demographics, incidence and causes of burn injury to bring awareness for prevention efforts. The purpose of this study was to determine if burns in Amish children are associated with greater severity when compared to non-Amish children.

Methods

A retrospective analysis of the burn registry at a verified burn center collected data on inpatient children < 14 years with an acute burn injury from 2012 through 2018. Children with frostbite and non-accidental burn trauma were excluded.

Results

Of the 273 children, 16 (5.9%) Amish children were similar to the 257 (94.1%) non-Amish children in age (mean age 4.8y, SD=3.8 vs. 4.0y, SD=3.7), male gender (63% vs. 59%) and percent needing surgery (44% vs. 26%, p=0.14). However, Amish children had a greater median injury severity score (ISS) (9.0, IQR [1, 25] vs. 1.0, [1, 4], p< 0.0001), median TBSA (19.5% [5.2, 52] vs. 4.0 [1.7, 7], p< 0.0001), median length of stay (LOS) (10.5 days [4, 50] vs. 2.0 days [1, 8], p< 0.0001), and median number of surgeries (0.5 [0, 6.5] vs. 0 [0, 1], p< 0.0074). Complications of ARDS (25%), sepsis (25%), compartment syndrome (18.8%), acute renal injury/failure (12.5%) and amputation (18.8%) were more prevalent among Amish children (all p< 0.0033) and non-existent in the non-Amish group. Amish children had a higher incidence of fire/flame burn (43.8% vs. 19.5%) and need for rehabilitation (37.5% vs. 0.8%).

Conclusions

In this study, Amish children had greater burn area, severity, longer LOS, more surgical interventions and complications than non-Amish children.

Applicability of Research to Practice

Culturally appropriate prevention efforts and education are needed to enhance existing care and burn or fire awareness with the Amish population.
701 Outcome Evaluation of High Dose Ascorbic Acid Infusion in Adult Burn Patients
Authors: Curry Dominick M , Smith Susan L , Hobbs Brandon , Schlosser Alexis , Smith Howard G
Published: March 2020

Introduction

High dose ascorbic acid (HDAA) infusion has been associated with lower resuscitation volumes following severe burn injuries. Recent data has linked the use of HDAA to an increased risk of renal failure. HDAA infusion causes an osmotic diuresis which confounds fluid titration. For these two reasons, HDAA has become controversial. The objective of this study is to examine the outcomes of adult burn patients who received HDAA infusion during acute burn resuscitation.

Methods

This study is an IRB approved retrospective chart review of all adult burn patients admitted from January 2016 through December 2018 who received HDAA for resuscitation. Patients were excluded if age < 18 years, had pre-existing hemodialysis-dependent chronic kidney disease, received < 16 hours of HDAA, or expired/withdrew from care within 48 hours of admission. The primary outcome was the incidence of patients receiving HDAA infusion who required renal replacement therapy (RRT) within 7 days of admission. Secondary outcomes included the incidence of abdominal compartment syndrome (ACS), duration of mechanical ventilation, actual crystalloid volume administered in the first 24 hours compared to estimated volume, ICU length of stay (LOS), and mortality.

Results

Twenty-four patients were included with a mean age of 48 (+/-16) and a mean TBSA of 49.1% (+/-17.8). The estimated fluid requirements in the 1st 24 hours were calculated using 4mL/kg/TBSA. Four patients required RRT (16.7%) and 12 patients were diagnosed with ACS (50%). The mean volume of crystalloid administered in the 1st 24 hours was 4.7 mL/kg/TBSA (+/-1.9), and the ratio of actual to estimated crystalloid in the 1st 24 hours was 1.2 (+/-0.5). Seventeen patients received albumin therapy in the 1st 24 hours. The mean urine output in 1st 24 hours was 1.7 mL/kg/hr. Mean duration of mechanical ventilation and ICU LOS was 15 and 16 days respectively. Thirteen patients died (54.2%).

Conclusions

The incidence of patients requiring RRT, along with the crystalloid volume administered and the observed to expected ratio of crystalloids in the 1st 24 hours were comparable to recent literature. The known effect of osmotic diuresis from HDAA potentially impacted fluid titration practice, increasing the risk of complications from over-resuscitation such as ACS, and mortality. Additionally, the estimation of 24-hour fluid requirements using 4mL/kg/TBSA may have contributed to the rates of ACS. Further studies comparing fluid management strategies are necessary.

Applicability of Research to Practice

This study describes the outcomes associated with HDAA during acute burn resuscitation at an adult burn center. Given the current controversy surrounding HDAA infusion, this study provides further data to help burn centers make a decision regarding their opinion of HDAA during acute burn resuscitation.
702 Acute Burn Treatment and Mechanical Ventilation
Authors: Duraes Eliana F , Slama Eliza , Modica Ashley , Asif Mohammed , Caffrey Julie , Hultman C Scott
Published: March 2020

Introduction

Our aim was to explore MV during the acute burn treatment and factors associated with successful extubation.

Methods

A retrospective review was performed on all burn patients that required MV in a reference burn center from December 2015 to April 2018. Patients successfully extubated or on trach collar (Group1) were compared to those that required re-intubation or died on MV (group2). The patients were also grouped depending on duration of MV, after excluding the patients that died under MV: Group A, 3 or less days; Group B, 4 or more days. A p 0.05 was considered significant.

Results

Out of a total of 104 burn patients on MV, 7 patients arrived intubated after coding on the field, were confirmed dead on the first 24 hours, and were excluded from the analysis. The mean expected mortality rate was 21.5±31%, 19 (19.5%) died during the admission. The patients remained intubated for 13±19 days, tracheostomy was performed in 20 (21%), after 26±15 days. Fifty-five (56.7%) of the patients were smokers or former smokers, 34 (35%) were illicit drug users, 16 (16.5%) had alcohol intoxication when burned. Inhalation injury was suspected in 80 (82.5%) of the patients, and confirmed in 41 (42.3%). Group 1 was younger: 48.42±18.66 vs 59.15 ± 21.38, p=0.032. Although a smaller rate of confirmed inhalation injury was seen among group1, it was not statistically significant (Group1: 25 (36.8%); group2: 16 (55.2%) (P=0.09). The TBSA burned was bigger on group 2: 18.4%±19.72 vs 34.39%±25.86, p=0.002. History of drug use was not associated with extubation success: group1: 26 (38%); group2: 8 (27.6%); (P=0.314). The expected mortality was significantly higher among group2: 10%±16.1% vs 48.54%±39.33%, p< 0.001. Group1 was associated with the use of less albumin and crystalloids on the first 24h and a bigger volume of urine on Day1 (Table1). A sub-analysis of the group that required re-intubation (n=10) and the successfully extubated showed an increased rate of psychiatric illness among the group requiring re-intubation: 18 (26.5%) vs 7 (70%), p< 0.001. The group that required a shorter time on the MV (GroupA) had a shorter length of stay, smaller percentage of TBSA, required fewer surgeries, and received less albumin and crystalloids on Day1 (Table2).

Conclusions

Lower expected mortality and age, and smaller %TBSA burned are associated with a successful extubation. Psychiatric illness may be associated with the need for re-intubation.

Applicability of Research to Practice

This study highlights the association of psychiatric illness and difficulty extubating the burn patient.
712 Title: Monitored Anesthesia Care (MAC) Burn Dressing Changes Even in Critically Ill Patients Is Incredibly Safe
Authors: Lozenski Jeanette , Voss Jordan , Kovac Anthony , Parks Jennifer , Northrop Kayla , Bhavsar Dhaval , Salerno Shannon
Published: March 2020

Introduction

Objective: Identify prevalence and factors associated with hypoxia and blood pressure changes during MAC anesthesia for inpatient burn dressing change.

Methods

Retrospective chart review on 112 adult inpatients undergoing 1 or more burn dressing changes under MAC from March 2014 to December 2017 at a single burn center.

Results

Study population was 112 burn inpatients undergoing 210 burn dressing changes under MAC. Median age was 43 years (range 18–93) with 78% male and 95% Caucasian. Average BMI was 29.7 (range 18–66). Average % total body surface area (TBSA) burn was 24% (range 1%-70%). Number of MAC dressing changes per patient was 1 to 16 with most (71.4%) undergoing 1 MAC dressing change. Among 210 MAC cases, 5 involved a hypoxemic event (defined as a % O2 saturation of < 90%) and 14 involved a blood pressure changed (defined as a mean arterial pressure (MAP) of < 60 mmHg) on 7 different patients Three of the hypoxic events were also associated with hypotension (1.4%) None of these events were associated with poor outcomes.

Conclusions

MAC anesthesia for dressing changes are performed on inpatients during all stages of the burn recovery. Anesthesia is involved with the initial dressing changes on the critical care individuals. The MAC anesthesia is titrated to the condition of the patient with very low frequency of hypoxia or severe hypotension.

Applicability of Research to Practice

Burn dressing changes are challenging anesthesias because of the often associated co-morbidities of the presenting patients. Other factors that are considered are the NPO status and nutritional requirements of the patients. The desire to accomplish the dressing changes with the least amount of disruption of this while caring for these ill patients can be safely accomplished with MAC dressing changes. This provides an incredibly safe environment for the patient with the rapidly titratable medications that allow the dressing changes to be completed efficiently.
746 Racial and Ethnic Disparities Among Burn Surgery Leadership
Authors: Egro Francesco M , Kettering Caroline E , Konanur Anisha , Corcos Alain C , Stofman Guy M , Ziembicki Jenny A
Published: March 2020

Introduction

The underrepresentation of racial and ethnic minority groups has existed and been well documented in general and plastic surgery literature but has not been described in burn surgery. The aim of this study is to evaluate current minority group representation among burn surgery leadership.

Methods

A cross-sectional study was performed in January 2019 to evaluate minority group representation among burn surgery leadership. Burn surgeons included were directors of American Burn Association (ABA)-verified burn centers in the US, past and current presidents of the ABA and International Society of Burn Injuries (ISBI), and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and h-index.

Results

Among 71 burn center directors, 68 societal presidents, and 197 journal editors, minority ethnic groups represented 18.3, 7.4, and 34.5 percent, respectively. Among US burn center directors, the group classified collectively as non-white was significantly younger (white = 56 years, non-white = 49 years; p< 0.01), graduated more recently (white = 1996, non-white = 2003; p < 0.01), and had a lower h-index (white = 17.4, non-white = 9.5; p < 0.05) than white colleagues. There were no significant differences in gender, type of residency training, advanced degrees obtained, and fellowships completed between white and non-white groups.The were no significant differences in the likelihood of white and non-white directors in academia to be full professor, residency or fellowship director, or chair of the department.When compared to the 2018 US National Census, burn unit directors had a 5.1 percent decrease in non-white representation. Specifically, Asians had an 8.3 percent increase in representation, while there was a decrease in both Black (12.0%) and Hispanic (15.3%) representation.

Conclusions

Disparities in representation of ethnic and racial minorities exist in burn surgery leadership. The most extreme disparities were seen with Black and Hispanic surgeons. However, because these surgeons are younger and graduated more recently, it is promising that minority representation will continue to rise in the future.

Applicability of Research to Practice

Programs should be initiated in burn surgery that address the implicit biases of burn surgeons and increase mentorship opportunities for underrepresented minorities.
755 State-wide One-year Mortality for Stevens-Johnson/toxic Epidermal Necrolysis Spectrum Disorders Is Greater at Burn Facilities: Expected, or Sobering Wake-up Call?
Authors: Hewes Philip D , Bell Derek
Published: March 2020

Introduction

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) exist on a spectrum of disease and are rare dermatologic emergencies with a significant risk of morbidity and mortality in the post-onset period. Retrospective studies attribute differing impacts of specialized treatment facilities on outcomes. However, the role of comorbidities and hospital-acquired conditions is unknown. We hypothesized that additional factors determine post-discharge mortality.

Methods

We queried a dataset from a statewide mandatory-reporting administrative database. We evaluated for initial presentations to acute care facilities of unique patients with discharge diagnoses of SJS, SJS/TEN overlap syndrome, and TEN over 16 years. We extracted all available pre- and post-onset records for these patients. Burn centers were identified. We accounted for all transfers. We evaluated demographic, comorbidity, and management data for the index presentation and subsequent transfers, evaluating the outcome of mortality and secondary outcomes. Exclusion criteria focused on detecting incomplete records. Comorbidities were captured by the Elixhauser comorbidity index. Univariate and multivariate logistic analyses were performed for risk of mortality.

Results

There were a total of 1903 unique initial patient encounters. Of these, 847 satisfied all exclusion criteria. 579 patients (68.4%) had a discharge (or pretransfer) diagnosis of SJS, 117 patients (13.8%) had SJS/TEN overlap syndrome, and 151 patients (17.8%) had TEN. Application of exclusion criteria caused no significant change in distribution of the occurrence of spectrum diseases (p = 0.31) nor in the frequency of care at a burn care facility (p = 0.60), suggesting no bias from exclusion. Of the 847 included patients, 22.8% of patients were treated at burn centers, of whom 32.1% were transferred from external facilities. Crude 90-day and 1-year mortality were identical, 21.7% at non-burn centers versus 32.1% at burn centers (p < 0.01). Pre-existing comorbidities did not significantly impact mortality (p = 0.86). Final logistic model details are shown below. The model’s predictive capability was acceptable (c-statistic = 0.88) and there was good fit (Hosmer-Lemeshow p = 0.42).

Conclusions

These results suggest crude evaluation of outcomes by treatment facility may be confounded by analysis that does not account for complex comorbidities and hospital diagnoses. Furthermore, severity of illness is not a independent predictor. Further research is necessary.

Applicability of Research to Practice

SJS/TEN spectrum disorders have a complex and prolonged impact on patient health. The role of burn centers is complex.
763 Burn Camp Multidisciplinary Staff: Efficacy of Training
Authors: Jackson Brad , Boulter Trudy , Mikolaj Kerry
Published: March 2020

Introduction

One of the strengths of burn camps is the multidisciplinary staff who passionately combine their areas of expertise to create the camp experience, including fire service, burn survivors, burn center staff, camping professionals, donors, and community members. This gift also brings a challenge in developing a staff training program and experience that meets the needs of a diverse staff. This project utilizes post camp staff surveys to enhance our training and overall camp experience.

Methods

Staff at a residential medical specialty burn camp participated in a two-day training and then week-long camp for pediatric burn survivors, ages 7 – 19. Staff training included: burn treatment and rehabilitation with nursing / PT / OT / psych; focused review of all campers; intentionality with level 1 & 2 skills (adapted from M. Brandwein).

36 staff responded anonymously to an online survey about their experience of staff training and success enacting skills and approaches during the week with campers.

Results

85% reported staff training met the goals of getting to know each other, learning the flow / layout of camp, identifying leadership styles, and learning about the campers.

90% indicated the training met the goal of understanding general burn care and healing process, while 88% reported achieving the goal of learning the impact of trauma, the significance of telling our stories, and learning general counseling tips.

This year we added a focus on intentionality to ensure that campers were learning camp skills AND life skills in each activity (e.g., learning how to safely belay climb AND to trust others to support you).

Content analysis of the open-ended comments about the impact of intentionality on success revealed the following themes: Increased goal setting, thoughtfulness, planning/preparation, clarity, insight, presence. Some staff commented that it was less applicable for younger cabins and a concern about developing too many themes/goals.

88 percent of counselor respondents agreed / strongly agreed that individualized goal plans were implemented in their cabins based on camper review and camper assessment.

Conclusions

The development and implementation of staff training for burn camp brings a variety of challenges. Staff come with varied experience, knowledge, and training. There are also multiple goals around knowledge and teamwork. Counselor feedback supports the multidisciplinary training model for transmission of knowledge specific to the camp. An increased focus on intentionality in each of our camp activities brought mostly positive responses, particularly benefitting older camper activities (e.g., 3 day outcamps), while younger campers might be learning camp related skills initially in preparation for the life skills down the road.

Applicability of Research to Practice

These results help to support and create developmentally informed training and programming for rehabilitative burn camps.
793 Development and Validation of a Burn Center Discharge Readiness Checklist to Identify Patients at High Risk of 30 Day Readmission
Authors: Liberio Julie N , McElligott Kelly , Ibgui Tracy , Liu Yuk Ming , Sanford Arthur , Baldea Anthony J
Published: March 2020

Introduction

With increased focus amongst hospital systems regarding the quality of care provided, there has been augmented awareness on minimizing unplanned 30 day hospital readmission rates. As part of our burn center’s internal quality improvement process, a discharge readiness checklist was developed to identify patients at high risk for readmission.

Methods

A 20 item checklist of potential risk factors was developed, and was then cross referenced to all patients readmitted within 30 days of discharge over a one year period (September 2018-August 2019). Retrospective chart review was used to determine how many checklist factors were positive for each patient. The primary outcome was determining the main risk factors leading to a high risk for readmission.

Results

During this time period, there were 683 admission to our burn center. A total of 13 patients led to a sum of 14 readmissions (2.0%). The age range of patients was between 37 and 84 years old, with a median and average age of approximately 59 years. The distribution of patients included 7 with burn injuries (50%), 6 with soft tissue infections (42.9%) and 1 with frostbite (7.1%). Traditional LACE (Length of stay, Acuity, Co-morbidities, ED visits) score calculation would have identified only 1 of 14 readmissions in the high risk category. Average LACE score was 8.1 for all patients. Of the 20 item checklist, the risk factors most commonly associated with readmission were lack of family support (12/14, 85.7%), surgery performed during index hospitalization (11/14, 78.6%), significant co-morbidities (11/14, 78.6%), location of injuries in difficult to access anatomical regions (8/14, 57.1%), poor nutritional status (6/14. 42.8%) and length of stay greater than 1 day per percent of total body surface area burn involvement (5/7, 71.4%). The average number of identifiable risk factors was 5.38 per patient (ranging from 2 to 9 risk factors per patient).

Conclusions

Traditional risk assessment scores (i.e. LACE) do not capture patients at high risk for readmission in a burn center. Development of an alternative checklist may help to identify these patients prior to discharge, with the potential to allocate additional resources to ultimately decrease 30 day readmission rates.

Applicability of Research to Practice

Decreased 30 day readmission rates would lead to overall cost savings and improved patient outcomes.
805 A Retrospective Review of Factors Influencing Post-hospital Discharge Follow-up in Patients with Burn Injuries and Necrotizing Soft Tissue Infections
Authors: Taylor Ryan , Islas Claudia , Barrot Cindy A , Richey Karen J , Foster Kevin N
Published: March 2020

Introduction

Approximately 486,000 burn injuries requiring medical treatment occur each year. Medical treatments for burns vary and are dependent on the extent of the injury. Several physical and psychosocial problems may develop after discharge, including pain, itching, scarring, anxiety and depression, making it important and necessary for burn care treatment to continue even after discharge. Often, patients do not continue outpatient care due to unknown circumstances. The purpose of this study is to help identify factors that affect outpatient burn clinic visits after hospital discharge.

Methods

A retrospective chart review of patients admitted to the burn center who had an outpatient follow up visit in 2018 was performed. Patients were grouped by lost to follow up versus completed patients. Completed patients were categorized as those who were discharged from clinic as PRN follow up visits.

Results

A total of 211 patients were scheduled for outpatient visits in 2018, mean age was 36.4 years and 74% were male. Population consisted mainly of Caucasian (41%) and Hispanic (31%). The most common payor source was Medicaid (58%) and Medicare (17%). The mean TBSA was 5.8 % with the most common mechanisms were Flame/Flash and Scald (30% each). The mean length of stay was 10.3 days, mean number of surgeries was 1.5. Majority of patients were discharged Home (71%) and SNF (20%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. Lost to follow up (LTF) patients had a smaller TBSA (4.69%) compared to those who completed follow-up (9.62%). Comparison between LTF and completed patients, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=< 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p< 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group.

Conclusions

There were a large percentage of patients who discharged themselves from clinic care. Factors that were associated with self-discharge include healed wounds, no scarring issues noted, and patients with complications, smokers, substance abuse and mental illness. Self-discharge / LTF may be related to resolution of ongoing issues prior to last scheduled appointment.

Applicability of Research to Practice

Additional research is needed to determine additional factors affecting lost to follow up in our outpatient burn clinic.
811 Comparison of an Enzymatic Debrider with Antibiotic Ointment in the Outpatient Care of Minor Partial Thickness Burns
Authors: Mitchell Suzanne , Bhavsar Dhaval , Reynolds Jessica , Jones Jessica , Pena Julia M
Published: March 2020

Introduction

In the U.S. about 450,000 people per year receive medical burn care through hospital emergency departments, hospital outpatient clinics, free-standing urgent care centers and private physician offices. Burns are generally classified in terms of depth and severity.

Outpatient management of partial thickness burns normally involves the application of an ointment, which may contain an antibiotic and is widely used in burn care. This clinical study has been designed to prospectively evaluate potential benefits of an enzymatic debrider in partial thickness burn wounds compared to antibiotic only treatment. The primary purpose of this study is to compare an enzymatic debrider with a topical antibiotic ointment in the proportion healed at 3 weeks after initiation of treatment, and time to healing (in weeks).

Methods

A convenience sample of 20 subjects, aged 19–56, with an acute thermal burn injury less than 72 hours old, and less than 10% TBSA were randomly assigned to outpatient treatment with an enzymatic debrider or a topical antibiotic. The proportion of subjects healed after 3 weeks of treatment was analyzed using ANOVA. In addition, a t-test comparison between the enzymatic debrider and the topical antibiotic was performed.

Results

For partial thickness burns, the mean time to heal using an enzymatic debrider was 18 days compared to 28 days for the topical antibiotic. However, there was no statistical significance in burn wound closure between subjects receiving an enzymatic debrider compared to a topical antibiotic, t (13) = .677; p = .510. An analysis of variance comparing an enzymatic debrider and a topical antibiotic also showed no statistical significance in time to heal (F=.849, p=374).

Conclusions

Due to the small sample size, the results from this study do not support the use of an enzymatic debrider versus a topical antibiotic in treating partial thickness burn injuries to advance wound closure or shorten time to heal. The results of this study show clinical significance, with burn wounds healed in 18 days when an enzymatic debrider was used compared to 28 days when a topical antibiotic was used. The lack of statistical significance was due to an under-powered study. Furthermore, partial thickness burns should spontaneously heal within 7–14 days, regardless of the topical treatment, excluding concomitant co-morbidities.

Applicability of Research to Practice

Continued research is necessary, employing larger sample sizes to adequately compare the use of an enzymatic debrider compared to topical antibiotics in deep partial thickness burn wounds. In addition, outpatient management of deep thickness and full-thickness burn injuries, utilizing sharp debridement in conjunction with enzymatic debridement, in patients who decline surgical treatment of burn wounds should be explored, analyzing time to heal, scar evaluation, and cost analysis,
835 Annual Burn Competencies for Burn Therapist: Maximizing Patient Outcomes with Ongoing Education
Authors: Yang Leng , Santoyo Ascension , Hati Jeffery , Kopari Nicole M
Published: March 2020

Introduction

Burn injuries often result in functional mobility impairments limiting return to pre-burn activity. Early mobility within 24 hours of admission is recommended to minimize risks of joint and soft tissue contractures while promoting functional independence. To maximize these services, burn therapists undergo annual competency education to evaluate, develop a plan of care, and treat burn patients. Designated burn therapy staff coverage is often not 24/7 resulting in delayed times to early interventions. We identified a need to provide education within the therapy department specifically addressing burn rehab interventions.

Methods

An in-service presentation introducing Cutaneous Function Units (CFU) as a new functional assessment tool was developed and presented to the therapy department. An 8 question test was administered before and after the presentation to assess staff retention and application of learned techniques. A total of 15 therapist, both occupational and physical, attended the presentation with the results of the tests analyzed.

Results

Pre-test average scores were 73% with post-test average improved to 95%. Therapist learned 2 additional methods of assessing burn wounds. After analyzing the test results, we were able to identify specific areas that required further education. We used the pre- and post- test results to tailor further educational sessions focusing on hands-on education and small focus groups.

Conclusions

Despite annual burn rehab competencies with therapy staff, there continues to be a deficit in retention of education. This may result in delay of early mobility and burn rehab services in our burn population. With focused education tailored to specific areas of burn therapy competencies, we were able to impact burn patient therapy sessions.

Applicability of Research to Practice

Ongoing education can be tailored to specific ares of burn therapy competencies to improve overall patient outcomes.
Generating metal-polluting debris in white dwarf planetary systems from small-impact crater ejecta
Authors: Veras Dimitri , Kurosawa Kosuke
Published: March 2020

Metal pollution in white dwarf photospheres originates from the accretion of some combination of planets, moons, asteroids, comets, boulders, pebbles, and dust. When large bodies reside in dynamically stagnant locations – unable themselves to pollute or even closely approach the white dwarf – then smaller reservoirs of impact debris may become a complementary or the primary source of metal pollutants. Here, we take a first step towards exploring this possibility by computing limits on the recoil mass that escapes the gravitational pull of the target object following a single impact onto an atmosphere-less surface. By considering vertical impacts only with the full-chain analytical prescription from Kurosawa & Takada, we provide lower bounds for the ejected mass for basalt, granite, iron, and water-rich target objects across the radii range 100–103 km. Our use of the full-chain prescription as opposed to physical experiments or hydrocode simulations allows us to quickly sample a wide range of parameter space appropriate to white dwarf planetary systems. Our numerical results could be used in future studies to constrain freshly generated small debris reservoirs around white dwarfs given a particular planetary system architecture, bombardment history, and impact geometries.
The upper bounds on supersymmetry breaking scales in split supersymmetry from the Higgs mass and electroweak vacuum stability
Authors: Ahmed Waqas , Mansha Adeel , Li Tianjun , Raza Shabbar , Roy Joydeep , Xu Fangzhou
Published: March 2020

The null results of the LHC searches have put strong bounds on new physics scenarios such as supersymmetry (SUSY). With the latest values for the top quark mass and strong coupling, we study the upper bounds on the sfermion masses in split SUSY from the observed Higgs boson mass and electroweak (EW) vacuum stability. To be consistent with the observed Higgs mass, we find that the largest values of supersymmetry breaking scales $M_{S}$ for $\tan\beta=2$, $\tan\beta=4$, and $\tan\beta=50$ are $10^{6.2}$, $10^{4.5}$, and $10^{4.3}\, {\rm GeV}$, respectively. In particular, split SUSY with $\tan\beta \gtrsim 4$ can be probed in future 100 TeV proton–proton colliders such as FCC-hh and SppC. In addition, the Higgs quartic coupling becomes negative at about $10^{8.2}$, $10^{8.7}$, and $10^{9.6}\, {\rm GeV}$ respectively for $m_h =$ 123, 125, and 127 GeV from EW vacuum stability. These bounds are about one order smaller than the Standard Model due to the extra Higgs–Higgsino–gaugino couplings. We briefly comment on the lifetime of gluinos in our study and compare it with the current LHC observations. Additionally, we comment on the prospects of the discovery of prompt gluinos at the FCC-hh and SppC.
The effects of digital cognitive behavioral therapy for insomnia on cognitive function: a randomized controlled trial
Authors: Kyle Simon D , Hurry Madeleine E D , Emsley Richard , Marsden Antonia , Omlin Ximena , Juss Amender , Spiegelhalder Kai , Bisdounis Lampros , Luik Annemarie I , Espie Colin A , Sexton Claire E
Published: March 2020

Study Objectives

We sought to examine the impact of digital cognitive behavioral therapy (dCBT) for insomnia on both self-reported cognitive impairment and objective cognitive performance.

Methods

The Defining the Impact of Sleep improvement on Cognitive Outcomes (DISCO) trial was an online, two-arm, single-blind, randomized clinical trial of dCBT versus wait-list control. Participants were aged 25 years and older, met DSM-5 diagnostic criteria for insomnia disorder, and reported difficulties with concentration or memory. Assessments were carried out online at baseline, and 10 and 24 weeks post-randomization. The primary outcome measure was self-reported cognitive impairment, assessed with the British Columbia Cognitive Complaints Inventory (BC-CCI). Secondary outcomes included tests of cognitive performance, insomnia symptoms, cognitive failures, fatigue, sleepiness, depression, and anxiety.

Results

Four hundred and ten participants with insomnia were recruited and assigned to dCBT (N = 205) or wait-list control (N = 205). At 10 weeks post-randomization the estimated adjusted mean difference for the BC-CCI was −3.03 (95% CI: −3.60, −2.47; p < 0.0001, d = −0.86), indicating that participants in the dCBT group reported less cognitive impairment than the control group. These effects were maintained at 24 weeks (d = −0.96) and were mediated, in part, via reductions in insomnia severity and increased sleep efficiency. Treatment effects in favor of dCBT, at both 10 and 24 weeks, were found for insomnia severity, sleep efficiency, cognitive failures, fatigue, sleepiness, depression, and anxiety. We found no between-group differences in objective tests of cognitive performance.

Conclusions

Our study shows that dCBT robustly decreases self-reported cognitive impairment at post-treatment and these effects are maintained at 6 months.
Increasing hay inclusion in silage-based receiving diets and its effects on performance and energy utilization in newly weaned beef steers
Authors: Smerchek Dathan T , Buckhaus Elizabeth M , Miller Katie D , Smith Zachary K
Published: March 2020

The influence of grass hay (GH) inclusion in replacement of corn silage in receiving diets on growth performance and dietary net energy (NE) utilization was evaluated in newly weaned beef steers (n = 162 Charolais-Red Angus cross steers; initial body weight [BW] = 278 ± 13.4 kg). Treatments were (DM basis): 1) 0% GH, 2) 10% GH, or 3) 20% GH inclusion in replacement of corn silage in receiving diets fed to newly weaned beef steers for 56 d. The study was conducted from October to December of 2019. Data were analyzed as randomized complete block design with pen serving as the experimental unit for all analyses. Increasing dietary inclusion of hay had no influence (P ≥ 0.11) on final BW, ADG, gain:feed or observed/expected dietary NEM and NEG, observed/expected dry matter intake (DMI), or observed/expected ADG. GH inclusion increased (linear effect, P = 0.01) DMI. Observed DMI for all treatments was approximately 15% to 17% less than anticipated based upon steer growth performance and tabular NE values. Evaluation of observed/expected ADG was 31% to 37% greater than expected for the steers in the present study. Particles less than 4 mm increased (linear effect, P = 0.01) and greater than 4 mm decreased (linear effect, P = 0.01) as GH replaced corn silage in the receiving diet. As the proportion of particles greater than 4 mm increased, cumulative ADG was decreased. These data indicate that GH should be considered in corn silage-based receiving diets to improve DMI. In high-risk calves, improved DMI could result in a lesser incidence of morbidity, although no morbidity was observed in any steers from the present study.
An economic analysis of ransomware and its welfare consequences
Authors: Hernandez-Castro J. , Cartwright A. , Cartwright E.
Published: March 2020

We present in this work an economic analysis of ransomware, a relatively new form of cyber-enabled extortion. We look at how the illegal gains of the criminals will depend on the strategies they use, examining uniform pricing and price discrimination. We also explore the welfare costs to society of such strategies. In addition, we present the results of a pilot survey which demonstrate proof of concept in evaluating the costs of ransomware attacks. We discuss at each stage whether the different strategies we analyse have been encountered already in existing malware, and the likelihood of them being implemented in the future. We hope this work will provide some useful insights for predicting how ransomware may evolve in the future.
Functional volumes, niche packing and species richness: biogeographic legacies in the Congo Basin
Authors: Van de Perre Frederik , Willig Michael R. , Presley Steven J. , Mukinzi Itoka Jean-Claude , Gambalemoke Mbalitini Sylvestre , Leirs Herwig , Verheyen Erik
Published: March 2020

Understanding the determinants of species coexistence in complex and species-rich communities is a fundamental goal of ecology. Patterns of species coexistence depend on how biotic interactions and environmental filtering act over ecological and evolutionary time scales. Climatic fluctuations in lowland rainforests of the Congo Basin led to the number of vertebrate species being significantly lower in central compared with northern ecoregions of the Basin. We used null models to assess whether climatic variations affected the community assembly of shrews. A consistent limit to functional similarity of species was not related to species richness. Rather, species richness is constrained by environmental factors, and these constraints are stronger in the central lowland forests of the Congo Basin. By constraining species geographic distributions, historical effects of rainforest refugia arising from climatic fluctuations may affect contemporary species composition of local shrew communities. The Congo River represents a vicariance event that led to allopatric speciation of shrews and continues to represent a barrier to dispersal. Ultimately, the historical effects of this barrier have led to differences in the functional volume of shrew communities in northern and central ecoregions. We suggest that the analyses of community assembly can be used to identify Holocene refugia in the Congo Basin.
Research on stress release for the gob-side roadway using the roof-cutting technology with a chainsaw arm
Authors: Tai Yang , Yu Bin , Xia Binwei , Li Zhao , Xia Hongchu
Published: March 2020

The narrow pillar mining method is widely adopted for working faces in coal mines. However, in cases of an overlying hard roof, a suspended triangle roof plate or a cantilever will be formed near the goaf. At this point, the coal pillar extrusion and serious deformation will occur in the gob-side roadway. In order to mitigate the problem, the roof-cutting technology with a chainsaw arm and its equipment have been developed. In this paper, based on the analysis of deformation and failure characteristics of 2312 roadway, which is close to the goaf of 2311 working face in Tashan Coal, the roof-cutting technology with a chainsaw arm was chosen to be applied in 2311 roadway. Then, the roof-cutting process and the load acting on the coal pillar were discussed and analysed. A numerical model was established to analyse the stress releasing effects after roof cutting. Moreover, the roof-cutting height and the support parameters of the roadway were optimized through numerical analysis and the results manifested that the roof cutting was the most effective when the roof-cutting height was 6.4 m. After roof cutting, the vertical stresses within the coal pillars were lowered by about 25.0%. Finally, the roof-cutting experiment was carried out in the 2311 roadway in Tashan Coal Mine. The on-site roof-cutting depth was 6.4 m and the roof-cutting width was 42 mm guided by the numerical analysis. To verify the stress-relieving effects, the borehole stress meters were applied to monitor the peak advancing stresses of narrow pillars at various depths. The measured results indicated that the peak advancing stresses decreased by 22.8% on average, and therefore, roof cutting and stress releasing effects were achieved.
The Flexiscope: a low cost, flexible, convertible and modular microscope with automated scanning and micromanipulation
Authors: Courtney Amy , Alvey Luke M. , Merces George O. T. , Burke Niamh , Pickering Mark
Published: March 2020

With technologies rapidly evolving, many research institutions are now opting to invest in costly, high-quality, specialized microscopes which are shared by many researchers. As a consequence, the user may not have the ability to adapt a microscope to their specific needs and limitations in experimental design are introduced. A flexible work-horse microscopy system is a valuable tool in any laboratory to meet the diverse needs of a research team and promote innovation in experimental design. We have developed the Flexiscope; a multi-functional, adaptable, efficient and high-performance microscopy/electrophysiology system for everyday applications in a neurobiology laboratory. The core optical components are relatively constant in the three configurations described here: an upright configuration, an inverted configuration and an upright/electrophysiology configuration. We have provided a comprehensive description of the Flexiscope. We show that this method is capable of oblique infrared illumination imaging, multi-channel fluorescent imaging and automated three-dimensional scanning of larger specimens. Image quality is conserved across the three configurations of the microscope, and conversion between configurations is possible quickly and easily, while the motion control system can be repurposed to allow sub-micrometre computer-controlled micromanipulation. The Flexiscope provides similar performance and usability to commercially available systems. However, as it can be easily reconfigured for multiple roles, it can remove the need to purchase multiple microscopes, giving significant cost savings. The modular reconfigurable nature allows the user to customize the system to their specific needs and adapt/upgrade the system as challenges arise, without requiring specialized technical skills.
Influence factors on the critical micelle concentration determination using pyrene as a probe and a simple method of preparing samples
Authors: Li Hao , Hu Danna , Liang Feiqing , Huang Xiaowei , Zhu Qiuhua
Published: March 2020

The critical micelle concentration (CMC) is an important parameter of widely used surfactants and needs to be measured in the application and development of surfactants. Fluorometric method is a widely used method determining CMC values owing to the advantages of highly sensitivity, fast response and wide application range. There are two common methods (I and II) of preparing samples for CMC fluorometric determination. In the process of developing CMC probes with aggregation-induced emission (AIE) characteristics, we found that methods I and II were not suitable for CMC probes with AIE charateristics and developed a new sample preparation method (III), which is not only suitable for CMC probes with AIE characteristic but also decreases operation procedures and errors owing to omitting the addition of micro amount of dyes into each sample. To ascertain if method III is also suitable for other CMC probes without AIE characteristics, the CMC values of surfactants were determined by fluorometric method using widely used pyrene without AIE charateristic as probe and methods I–III to prepare samples. The obtained experimental results proved that method III not only was suitable for preparation of samples for CMC determination of surfactants using pyrene as probe but also led to the least average deviation (methods I–III led to ±0.13, ±0.34 and ±0.05 mM deviation for the CMC determination of sodium dodecyl sulfate (SDS), respectively). The CMC determination using pyrene as probe is based on its change in the ratio (
I
FIII
/
I
FI
) of its emission peaks I and III with surfactant concentration. Unexpectedly, it was found that the
I
FIII
/
I
FI
value of pyrene in surfactant solutions is sensitive to the measurement conditions changing exciting light energy, such as slit widths and sample-measured number. In addition, it was found that surfactant SDS or cetrimonium bromide from different suppliers not only has significantly different CMC values but also leads to very different
I
FIII
/
I
FI
values of pyrene in a certain concentration of surfactant, which can be used as a simple method to distinguish the same surfactant with different CMC values.