bluuebunny/crossref_metadata_2025 huggingface dataset:
Ranking earthquake forecasts using proper scoring rules: binary events in a low probability environment
Authors: Serafini Francesco , Naylor Mark , Lindgren Finn , Werner Maximilian J , Main Ian
Published: March 2022

Operational earthquake forecasting for risk management and communication during seismic sequences depends on our ability to select an optimal forecasting model. To do this, we need to compare the performance of competing models in prospective experiments, and to rank their performance according to the outcome using a fair, reproducible and reliable method, usually in a low-probability environment. The Collaboratory for the Study of Earthquake Predictability conducts prospective earthquake forecasting experiments around the globe. In this framework, it is crucial that the metrics used to rank the competing forecasts are ‘proper’, meaning that, on average, they prefer the data generating model. We prove that the Parimutuel Gambling score, proposed, and in some cases applied, as a metric for comparing probabilistic seismicity forecasts, is in general ‘improper’. In the special case where it is proper, we show it can still be used improperly. We demonstrate the conclusions both analytically and graphically providing a set of simulation based techniques that can be used to assess if a score is proper or not. They only require a data generating model and, at least two forecasts to be compared. We compare the Parimutuel Gambling score’s performance with two commonly used proper scores (the Brier and logarithmic scores) using confidence intervals to account for the uncertainty around the observed score difference. We suggest that using confidence intervals enables a rigorous approach to distinguish between the predictive skills of candidate forecasts, in addition to their rankings. Our analysis shows that the Parimutuel Gambling score is biased, and the direction of the bias depends on the forecasts taking part in the experiment. Our findings suggest the Parimutuel Gambling score should not be used to distinguishing between multiple competing forecasts, and for care to be taken in the case where only two are being compared.
Defining novel causal SNPs and linked phenotypes at melanoma-associated loci
Authors: Castaneda-Garcia Carolina , Iyer Vivek , Nsengimana Jérémie , Trower Adam , Droop Alastair , Brown Kevin M , Choi Jiyeon , Zhang Tongwu , Harland Mark , Newton-Bishop Julia A , Bishop D Timothy , Adams David J , Iles Mark M , Robles-Espinoza Carla Daniela
Published: March 2022

A number of genomic regions have been associated with melanoma risk through genome-wide association studies; however, the causal variants underlying the majority of these associations remain unknown. Here, we sequenced either the full locus or the functional regions including exons of 19 melanoma-associated loci in 1959 British melanoma cases and 737 controls. Variant filtering followed by Fisher’s exact test analyses identified 66 variants associated with melanoma risk. Sequential conditional logistic regression identified the distinct haplotypes on which variants reside, and massively parallel reporter assays provided biological insights into how these variants influence gene function. We performed further analyses to link variants to melanoma risk phenotypes and assessed their association with melanoma-specific survival. Our analyses replicate previously known associations in the melanocortin 1 receptor (MC1R) and tyrosinase (TYR) loci, while identifying novel potentially causal variants at the MTAP/CDKN2A and CASP8 loci. These results improve our understanding of the architecture of melanoma risk and outcome.
Genome-wide association study and genomic prediction of white rust resistance in USDA GRIN spinach germplasm
Authors: Shi Ainong , Bhattarai Gehendra , Xiong Haizheng , Avila Carlos A , Feng Chunda , Liu Bo , Joshi Vijay , Stein Larry , Mou Beiquan , du Toit Lindsey J , Correll James C
Published: March 2022

White rust, caused by Albugo occidentalis, is one of the major yield-limiting diseases of spinach (Spinacia oleracea) in some major commercial production areas, particularly in southern Texas in the United States. The use of host resistance is the most economical and environment-friendly approach to managing white rust in spinach production. The objectives of this study were to conduct a genome-wide associating study (GWAS), to identify single nucleotide polymorphism (SNP) markers associated with white rust resistance in spinach, and to perform genomic prediction (GP) to estimate the prediction accuracy (PA). A GWAS panel of 346 USDA (US Dept. of Agriculture) germplasm accessions was phenotyped for white rust resistance under field conditions and GWAS was performed using 13 235 whole-genome resequencing (WGR) generated SNPs. Nine SNPs, chr2_53 049 132, chr3_58 479 501, chr3_95 114 909, chr4_9 176 069, chr4_17 807 168, chr4_83 938 338, chr4_87 601 768, chr6_1 877 096, and chr6_31 287 118, located on chromosomes 2, 3, 4, and 6 were associated with white rust resistance in this GWAS panel. Four scenarios were tested for PA using Pearson’s correlation coefficient (r) between the genomic estimation breeding value (GEBV) and the observed values: (1) different ratios between the training set and testing set (fold), (2) different GP models, (3) different SNP numbers in three different SNP sets, and (4) the use of GWAS-derived significant SNP markers. The results indicated that a 2- to 10-fold difference in the various GP models had similar, although not identical, averaged r values in each SNP set; using GWAS-derived significant SNP markers would increase PA with a high r-value up to 0.84. The SNP markers and the high PA can provide valuable information for breeders to improve spinach by marker-assisted selection (MAS) and genomic selection (GS).
Heterografted chrysanthemums enhance salt stress tolerance by integrating reactive oxygen species, soluble sugar, and proline
Authors: Li Wenjie , Meng Rui , Liu Ye , Chen Sumei , Jiang Jiafu , Wang Likai , Zhao Shuang , Wang Zhenxing , Fang Weimin , Chen Fadi , Guan Zhiyong
Published: March 2022

Chrysanthemum, one of the most important commercial ornamental crops, is susceptible to salinity, which limits its cultivation and application in coastal and inland saline areas. Grafting is widely used to improve the salt tolerance of horticultural crops, but the mechanisms of grafted chrysanthemum responses to salt stress remain unclear. In this study, we showed that heterografted chrysanthemums with Artemisia annua as rootstock exhibited increased salt tolerance compared with self-grafted and self-rooted chrysanthemums. Under high salt stress, the roots of heterografted chrysanthemums enrich Na+, resulting in a reduction of Na+ toxicity in the scion, with only a small amount of Na+ being transported to the leaves. On the other hand, the roots of heterografted chrysanthemums alleviated high Na+ stress via enhanced catalase enzyme activity, downregulation of the expression of reactive oxygen species (ROS) accumulation-related genes, massive accumulation of soluble sugars and proline, and upregulation of the expression of heat shock protein-related genes to enhance salt tolerance. In addition, the leaves of heterografted chrysanthemums respond to low Na+ stress by increasing peroxidase enzyme activity and soluble sugar and proline contents, to maintain a healthy state. However, self-grafted and self-rooted plants could not integrate ROS, soluble sugars, and proline in response to salt stress, and thus exhibited a salt-sensitive phenotype. Our research reveals the mechanisms underlying the increased salt tolerance of heterografted chrysanthemums and makes it possible to have large-scale cultivation of chrysanthemums in saline areas.
Patient Involvement in RSV Research: Towards Patients Setting the Research Agenda
Authors: Derksen-Lazet Nicole D , Parmentier Corline E J , Wildenbeest Joanne G , Bont Louis J ,   RESCEU Investigators, Derksen-Lazet Nicole , Parmentier Corline , Bont Louis , Wildenbeest Joanne , Nair Harish , Campbell Harry , Beutels Philippe , Pollard Andrew , Openshaw Peter , Martinon-Torres Federico , Heikkinen Terho , Meijer Adam , Fischer Thea , van den Berge Maarten , Giaquinto Carlo , Abram Michael , Kena Swanson Tin Tin Myint , Rizkalla Bishoy , Vernhes Charlotte , Gallichan Scott , Aerssens Jeroen , Kumar Veena , Molero Eva
Published: March 2022

Respiratory syncytial virus (RSV) causes a substantial disease burden among children, elderly and immunocompromised adults. Recognition of patient involvement in research is gradually increasing. Most research is being carried out without active patient involvement other than patients participating as study subjects, and most knowledge gained through research only partially reaches the general public. Since 2016, the RSV Patient Advisory Board has officially been involved as an advisory group in the Respiratory Syncytial Virus Consortium in Europe (RESCEU). What started as a small single-center initiative, is now growing towards an international organization providing patient perspectives as inputs to scientists, and improving awareness of RSV. This article summarizes the history, current role, and future aims of the RSV Patient Advisory Board as an advocate to improve patient involvement in research. RSV patients and their representatives are important stakeholders in setting the global research agenda, and educating patients, professionals, and the general public.
Applying a socioecological framework to chronic disease management: implications for social informatics interventions in safety-net healthcare settings
Authors: Nguyen Kim Hanh , Cemballi Anupama G , Fields Jessica D , Brown William , Pantell Matthew S , Lyles Courtney Rees
Published: March 2022

Objective

Vulnerable populations face numerous barriers in managing chronic disease(s). As healthcare systems work toward integrating social risk factors into electronic health records and healthcare delivery, we need better understanding of the interrelated nature of social needs within patients’ everyday lives to inform effective informatics interventions to advance health equity.

Materials and Methods

We conducted in-depth interviews, participant-led neighborhood tours, and clinic visit observations involving 10 patients with diabetes in underserved San Francisco neighborhoods and 10 community leaders serving those neighborhoods. We coded health barriers and facilitators using a socioecological framework. We also linked these qualitative data with early persona development, focusing on patients’ experiences in these communities and within the healthcare system, as a starting place for our future informatics design.

Results

We identified social risk and protective factors across almost every socioecological domain and level—from physical disability to household context to neighborhood environment. We then detailed the complex interplay across domains and levels within two critical aspects of patients’ lives: housing and food. Finally, from these data we generated 3 personas that capture the intersectional nature of these determinants.

Conclusion

Drawing from different disciplines, our study provides a socioecological approach to understanding health promotion for patients with chronic disease in a safety-net healthcare system, using multiple methodologies. Future digital health research should center the lived experiences of marginalized patients to effectively design and implement informatics solutions for this audience.
T4 Validation of the Burn Survivor Fear-avoidance Questionnaire
Authors: Nedelec Bernadette , Chen Jocelyn , Caluori Cassandra , Alberton Laura , Zhang Jinny , Shashoua Danielle , Calva Valérie , Gauthier Nathalie , de Oliveira Ana , Marois-Pagé Elisabeth
Published: March 2022

Introduction

According to the Fear-Avoidance (FA) Model, FA beliefs can lead to disability due to avoidance of activities expected to result in pain or further injury. Extensive research on the relationship of FA, pain, catastrophizing, and disability has been generated with patients suffering from chronic neck and back pain, but little research has been conducted with burn survivors. To address the need for a valid evaluation of FA in burn survivors, Langlois and colleagues developed, but did not validate, the Burn Survivor Fear-Avoidance Questionnaire (BSFAQ). Thus, the primary objective of this study was to investigate the construct validity of the BSFAQ among burn survivors. The secondary objective was to examine the relationship between FA and (i) pain intensity and (ii) catastrophizing at baseline (admission to rehab), 3 months and 6 months post-burn, and (iii) disability among burn survivors at 6 months post-burn.

Methods

A prospective mixed methods approach was used to examine the construct validity by comparing the quantitative scores of the BSFAQ to independently performed qualitative interviews of burn survivors (n=31) that explored their lived-experiences, to determine if the BSFAQ discriminated those who had, from those who did not have FA beliefs and behaviors. Data for the secondary objective, scores of burn survivors (n=51) pain intensity (measured by the Numeric Rating Scale), catastrophizing (measured by the Pain Catastrophizing Scale), and disability (measured by the Burn Specific Health Scale-brief), were collected through a retrospective chart review.

Results

For the primary objective, Wilcoxon Rank Sum Test results showed a statistically significant difference (p=0.015) between the BSFAQ scores of participants who were identified from the qualitative interviews as fear-avoidant compared to those who were identified as non-fear-avoidant. For the secondary objective, the Spearman correlation test results showed a moderate correlation between FA and (i) pain at baseline (r=0.466, p=0.002), a moderate correlation with (ii) catastrophizing thoughts over time (r=0.557, p=0.000; r=0.470, p=0.00; r=0.559, p=0.002 respectively at each time point), and a moderate correlation with (iii) disability at 6 months post-burn (r=-0.639, p=0.000).

Conclusions

These results support that the BSFAQ is able to discriminate which BS are experiencing fear-avoidant beliefs and behaviours. As has been reported in other patient populations, burn survivors who express FA are more likely to report higher levels of pain early during their recovery that correlates with elevated catastrophizing thoughts, which are maintained across time and ultimately results in higher self-reported disability, which is consistent with the FA model.
29 Efficacy of a Novel LAM Femoral Cutaneous Block Technique for Acute Donor Site Pain
Authors: Hill David M , Velamuri Sai R , Desai Jay P , Ly Austin , Ly Eric , Jones Jerry
Published: March 2022

Introduction

Patients with severe burn injuries often require split thickness skin grafting to expedite would healing with the thigh being a common donor site. Uncontrolled pain is associated with increased opioid consumption, longer lengths of stay, and delay in functional recovery. Regional nerve blocks are increasing in popularity although supportive literature is limited, and techniques vary. Recently, we presented a case demonstrating a novel LAM (lateral, anterior, medial) femoral cutaneous block technique. The purpose of the case series is to assess the safety, feasibility, and clinical efficacy in a larger cohort.

Methods

The study was a dual IRB approved, observational case series from a single verified burn center. The electronic health record was retrospectively reviewed for patients admitted between June 2018 to June 2020 who had the LAM block placed for donor site pain by the acute pain service (APS) team. Patient demographics, and data pertinent to the LAM regional anesthesia block were collected (eg opioid usage before and after the block, pain, and physical therapy outcomes). The data were tabulated and analyzed using Microsoft Excel© and SPSS version 27.0. Descriptive statistics were utilized to describe the patient demographics and LAM block feasibility & safety. Morphine Milligram Equivalent (MME) were statistically compared utilizing repeated measures ANOVA on ranks and graphically presented.

Results

Twenty-four patients had total of 27 blocks placed, where 3 patients received the LAM block on two separate occasions. One patient had bilateral LAM blocks placed and was included as the single instance for the analysis. The majority were Caucasian males, but mechanism of injury varied. Two-thirds had a neurologic or psychiatric history. Seventy-one percent used tobacco and a quarter had a history of polysubstance abuse. Median area of the donor site was 360 cm2 (207, 1140). Median day from admission to LAM was 8 (3, 12) with a median duration of 4 (3, 5) days. Median day until first ambulation after LAM was 3 (1,3). Eighty percent reported a decreased temperature sensation at the donor site. Pain was adequately controlled, and there were no adverse events or quadricep weakness noted. There was a significant reduction in MME after block placement (Figure 1).

Conclusions

Regional nerve blocks offer an advantageous means of analgesia, while reducing potential adverse events associated with opioids. While the novel LAM technique reduced some sensation, early ambulation was not inhibited and patients able to participate with rehabilitation therapy.
39 Implementation of a Screening Tool for Wellbeing in the Burn Clinic for Patients < 5 Years
Authors: Magnuson Erica Y , Joe Victor C , Chin Theresa L
Published: March 2022

Introduction

Pediatric burn survivors and their parents experience higher rates of psychological disorders compared to their uninjured peers. In the early years, children experience rapidly changing development, which can impact responses to psychological outcomes. Early identification of developmental delays is vital to recovery and coping with burn injury. As a quality improvement project, a survey tool was implemented in the burn clinic to screen for issues impacting pediatric burn survivors and their family’s coping, who may benefit from additional referrals.

Methods

A free comprehensive tool, which screens for behavior, development and family stressors was chosen based on its high reliability, validity, and usability including being available in multiple languages. Prior to implementation and following the trial phase, staff completed qualitative and quantitative surveys regarding their input on the importance of screening and ease of execution. The Child Life Specialist (CLS) screened and scored children ages 12 to 65 months upon their initial visit and were rescreened two to four months later if they scored “Needs Review” in any category, indicating additional assessment was needed. Those who scored 50% of expected score for their age on initial assessment or a repeat “Needs Review” on the second assessment, were referred to additional resources by the CLS, social worker or physician team.

Results

Of the 43 children whose parents completed the survey (3 in Spanish), there were 25 males and 18 females. The median age was 2.6 years (IQR:2.0-3.52). The score of the survey determined that 42% (n=18) of children evaluated as “Needs Review” or ≤50% expected in one or more category on initial assessment. Only 5 children were already receiving services and two children scored ≤50% threshold score for immediate referral. Initial surveys demonstrated staff (n=9) strongly agreed assessing children’s need for support services was important. Majority (88%) of children were assessed upon their initial visit to the outpatient burn clinic. Most staff agreed the tool had been effectively implemented in the outpatient clinic.

Conclusions

The tool was effectively integrated into the burn clinic and identified children who needed referral for support services. Screening in the burn clinic provides an opportunity to identify critical factors related to children’s development and behavior, which can compound psychological responses to burn injury and addresses parental concerns for development.
41 Peripheral Mononuclear Cell Expression of IL-10, IL-12, ARG1, & NOS2 Correlates with Outcomes After Burn
Authors: Mahung Cressida , Stepp Wesley H , Malfitano Madison , Wallet Shannon , Zhou Laura Y , Zhou Haibo , Maile Robert
Published: March 2022

Introduction

In the burned patient, clinical outcomes are inextricably linked with immune function. Patients are subject to an early pro-inflammatory response and a subsequent compensatory anti-inflammatory response syndrome. This dysregulation can lead to infection, multiple organ dysfunction syndrome, and death. Despite continuing efforts, a profile of immune gene expression from burn patients that can be transformed into an “immune suppression index”, which accurately reflects the underlying degree of immune insult and significantly correlates with the degree compromise, has yet to be developed. The development of such an approach that can predict graft failure, susceptibility to infection, length-of-stay in the hospital, and/or that can inform a provider on how to better manage the timing of surgical interventions would be transformative.

Objective

To determine a set of peripheral biomarkers that correlates with clinical outcomes of burn patients.

Methods

This observational study enrolled two participant cohorts within a single burn center. Initial unbiased analysis compared 23 burn patients and 6 healthy controls. Confirmatory outcomes analysis was performed in 109 burn patients and 19 healthy controls. We employed multiplex gene expression analysis to identify differential peripheral blood mononuclear cells (PBMC) immune gene expression. qPCR was used to validate these findings, identify, and model associations with outcomes.

Results

We identified 149 genes with a significant difference in expression within PBMCs from burn patients compared to controls (Figure 1a). Pathway analysis identified pathways related to IL-10 and inducible nitric oxide synthase (iNOS) signaling (Figure 1b). qPCR analysis of IL-10, IL-12, arginase-1 (ARG1), and iNOS demonstrated that burn injury was associated with increased expression of ARG1 and IL-10, and decreased expression of NOS2 and IL-12. Burn severity, acute lung injury (ALI), development of infection, failure of skin autograft, and mortality significantly correlated with expression of one or more of these genes. Ratios of IL-10/IL-12, ARG1/NOS2 and (ARG1+IL-10)/(NOS2+IL-12) transcript levels further improved the correlation with outcomes. A multivariate regression model, adjusting for confounders, demonstrated that (ARG1+IL-10)/(NOS2+IL-12) significantly correlated with burn severity and development of ALI (Table 1).

Conclusions

We present a robust model to predict patient outcomes early after burn injury using non-invasive methods, allowing early identification of underlying immune dysfunction.
43 Mapping the Hypermetabolic Response in Burn Patients
Authors: Knuth Carly M , Ricciuti Zachary , Barayan Dalia , Rehou Sarah , Jeschke Marc G
Published: March 2022

Introduction

Hypermetabolism, characterized by drastic increases in whole-body catabolism and resting energy expenditure (REE), is a hallmark response to a severe burn injury. This is believed to be driven in part by alterations in adipose tissue metabolism. We proposed to define the hypermetabolic response in adipose tissue from burn patients and create a roadmap of markers indicative of hypermetabolism to improve prognosis. We hypothesized that catabolic markers, such as uncoupling protein-1 (Ucp1) and growth differentiation factor-15 (Gdf15), would positively correlate with increasing days post-burn and REE.

Methods

Adult burn patients (n=65) admitted to our burn center between 2011—2019 were included in this study. Subcutaneous white adipose tissues (sWAT) from the site of injury (n=85) and plasma were collected from severely burned patients ( ³20% total body surface area). Gene expression and circulating cytokine levels were measured by RT-qPCR and multiplex assays, respectively.

Results

We found a significant correlation between increasing Ucp1 gene expression and days post-burn (p< 0.0001). Moreover, when samples were stratified into acute (1-3 days post-burn), moderate (4-9 days post-burn), and long-term ( >10 days post-burn) timepoints, a significant increase in Ucp1 gene expression was detected only in adipose tissues from long-term time points in comparison to non-burned control tissues (p< 0.01). However, we found that REE remained stagnant throughout hospital stay after a burn injury in our patient cohort. Thus, we did not detect a significant correlation between Ucp1 gene expression and REE. Further, while Gdf15 expression was most pronounced, albeit statistically insignificant, during the moderate timepoints, we did not detect any significant differences when correlated with days post-burn. Additionally, we determined that circulating levels of IL-6, IL-10, and monocyte chemoattractant protein-1 (MCP-1) were greatly elevated within the first seven days post-burn and gradually decreased over time, while vascular endothelial growth factor (VEGF) concentrations followed a similar pattern to Ucp1 gene expression.

Conclusions

While Gdf15 expression may not accurately reflect catabolism in the adipose tissues of burn patients, Ucp1 gene expression may be used as a marker indicating a peak hypermetabolic period after ten days post-burn. This may also be reflected by circulating concentrations of VEGF. Moreover, IL-6, IL-10 and MCP-1 may be used as early determinants before the onset of hypermetabolism.
56 Evaluation of a Smartphone Application as a Method for Calculating Total Body Surface Area Burned
Authors: Colson Cindy D , Alberto Emily A , Milestone Zachary P , Batra Nikita , Salvadore Tyler , Fooladi Hadi , Cleary Kevin , Izem Rima , Burd Randall S
Published: March 2022

Introduction

Current methods of burn estimation can lead to incorrect estimates of the total body surface area burned, especially among injured children. Inaccurate estimation of burn size can impact initial management, including unnecessary transfer to burn centers and fluid overload during resuscitation. To address these challenges, we developed a smartphone application that calculates the total body surface area of a burn using a body-part by body-part approach. The aims of this study were to assess the accuracy of the smartphone application and compare its performance to three established methods of burn size estimation (Lund-Browder Chart, Rule of Nines, Rule of Palms).

Methods

Twenty-four healthcare providers used each method to estimate burn sizes on moulaged manikins. The manikins represented different ages (infant, child, adult) with different total body surface area burns (small < 20%, medium 20-49%, large >49%). We calculated the accuracy of each method as the difference between the user-estimated and actual total body surface area. We used multivariable modeling to control for manikin size and method.

Results

Among all age groups and burn sizes, the smartphone application had the greatest accuracy for burn size estimation (-0.01%, SD 3.59%) followed by the Rule of Palms (3.92%, SD 10.71%), the Lund-Browder Chart (4.42%, SD 5.52%), and the Rule of Nines (5.05%, SD 6.87%).

Conclusions

The smartphone application may improve the estimation of total body surface area burned compared to existing methods.
61 A Burn Center’s Experience with COVID-19 Positive Burn Patients
Authors: McLawhorn Melissa M , Carney Bonnie C , Burkey Sarah E , Delatore Cara , Brantley Melissa , Moffatt Lauren T , Johnson Laura S , Shupp Jeffrey W
Published: March 2022

Introduction

The emergence of SARS-COV-2 and the COVID-19 pandemic has complicated the presentation, treatment, and prognosis of all types of patients. Further characterization and analysis of how concomitant COVID-19 infection impacts different patient populations is important for improving treatment strategies. Patients with burn injures often require ICU-level care, mechanical ventilation, and extensive surgical intervention. Concomitant COVID-19 infection in this population presents a new challenge to clinical teams. The purpose of this project is to compare COVID-19 positive burn patients treated at a regional burn center with those that are not.

Methods

Following IRB approval, our institution’s burn registry was queried from March 2020-June 2021. Data on demographics, injury circumstances, COVID-19 status, and outcomes were collected. Continuous variables were nonparametric and\compared using Mann-Whitney U test. Categorical variables were compared using Chi-squared with Fischer’s Exact test, where appropriate.

Results

Of the 622 patients admitted at our institution, 19 tested positive for COVID-19 during their hospitalization. Demographic and injury information is reported in Table 1. There were statistically significant differences between the COVID-19 positive and negative groups in regard to race and presence of inhalation injury (p=0.0002, p=0.0002). The TBSA burned was slightly higher in the COVID-19 positive group (9.1 vs 6.7%). COVID-19 positive patients spent more time ventilated (48±32.5 vs.12.2 ± 16.2 days, p=0.0035**) and had both longer ICU (42.71±37.41 vs 11.1±15.4 days, p=0.0175*) and hospital (26.32±32.14 vs 8.177±11.95 days, p< 0.0001***) lengths of stay (LOS). No COVID-19 positive patients died while 5% of the COVID-19 negative patients did. All outcomes were statistically significant.

Conclusions

Despite similar TBSA injury burden and age breakdown, patients at our institution who tested positive for COVID-19 required more time on the ventilator and were hospitalized longer. People of color had a higher percentage of positive tests than their Caucasian counterparts. While mortality rates were higher in the COVID-19 negative cohort, morbidities associated with longer LOS must be considered.
63 Left out in the Cold: The Impact of Psychosocial Comorbidities on Victims of Frostbite
Authors: Tran Aurelie , Glick Hannah , Shen Mary R , Bettencourt Amanda , Vercruysse Gary
Published: March 2022

Introduction

Patients with psychiatric or substance use disorders (SUD) and those experiencing homelessness have been identified as populations likely disproportionately affected by frostbite injury. However, the literature is sparse in regards to morbidity and mortality in these patients. As such, we sought to examine and characterize factors associated with worse outcomes and increased resource utilization in this patient population.

Methods

Adult patients admitted to a single ABA-accredited burn center for frostbite between 2013-2021 were identified using an institution-specific data registry. A retrospective chart review was conducted on patients meeting inclusion criteria, as identified by ICD-10 and ICD-9 codes. The primary outcome was morbidity and mortality associated with frostbite, including hospital length of stay, number of operations, and readmission. Chi-square and t-tests were utilized to compare patients with and without SUD (alcohol, drug, or positive urine drug screen), psychiatric disorders, or homelessness.

Results

In total, 54 patients were identified (70% male), 19% had documented non-alcoholic SUD, 50% had alcohol use disorder, and 14% were homeless. No significant differences were found between these patients and others in terms of the number of operations or amputations required. However, patients with positive SUD screen (32.0% vs 8.0% p=0.03), positive UDS (46.7% vs. 0%, p=0.015), psychiatric disorders (27% vs. 0%, p=0.034), active drug use (50% vs 14.3%, p=0.01), or homelessness (50% vs 15%, p=0.026) were more likely to be readmitted with wound infections or progression of gangrene. Finally, patients with psychiatric disorders were more likely to require additional operations (1.8 vs 0.6, p=0.02) and longer length of hospital stay (16.0 +/- 2.9 vs 7.7 +/- 2.8, p=0.046).

Conclusions

Our results suggest significant differences in resource utilization and morbidity between those with and without a history of SUD, psychiatric disorder, or homelessness. Subsequent allocation of resources should target outpatient needs of at-risk patients to avoid similar outcomes. Future research should be focused on elucidating reasons for these differences which may include issues accessing follow-up care, inability to adhere to wound care, and more.
66 The Association of Burn Size and Global Functioning: A Preschool LIBRE1-5 Study
Authors: Surette Kate E , Ni Pengsheng , Patel Khushbu F , Rodríguez-Mercedes Silvanys L , Rencken Camerin A , Fabia Renata , Tully Carrie , Palmieri Tina L , Romanowski Kathleen S , Warner Petra , Stoddard Frederick J J , Schneider Jeffrey C , Kazis Lewis E , Ryan Colleen M
Published: March 2022

Introduction

Between the ages of one and five, children gain increased mobility and begin to explore their surroundings. This makes them a particularly vulnerable age group for burn-related injuries, which can influence a child’s physical and psychosocial development. Previous research in adult burn survivors associated larger burn size with poorer functional outcomes for social activities. Currently, there are limited data on the association in preschool aged survivors between burn size and functioning. The aim of this study is to understand how demographic characteristics, particularly burn size, correlate with the global functioning items using data from the Preschool-LIBRE1-5 study.

Methods

The Preschool-LIBRE1-5 was field-tested with 426 parents of burn survivors. Eight global items assessed change in functioning in four domains (physical, psychological, communication & language, and social) compared to pre-burn functioning. Demographic variables included gender, race, age at survey completion, total body surface area burned (TBSA), ethnicity, and pain severity. Post-burn abilities were assessed with “Following the burn injury, my child lost abilities he/she had before the burn injury in…”, measured with a yes or no response and compared to other children without burns with, “Compared to other children in the same age, in general, how would you rate your child’s…”, measured with a 5-point Likert scale ranging from much worse to much better. Multivariate logistic regression with multiple imputation for missing values were used to measure the association between demographic characteristics and global items.

Results

The population had a mean age at time of burn injury of 1.9 + 1.1 years and mean TBSA% of 4.2 + 8.0. Of the 426 participants, 305 have a TBSA < 5%, 45 have a TBSA between 5%-15% and 45 have a TBSA >15%. Larger TBSA was associated with lower odds of abilities in functional status for all four global functioning items. Adjusted odd ratios with 95% CI’s included communication and language 0.57(0.35,0.93), physical function 0.55(0.37,0.83), social function 0.33(0.2,0.52), and psychological/behavioral function 0.49(0.31,0.75). There was also a negative correlation of larger TBSA with weaker social abilities of the child compared to other children without burns.

Conclusions

The findings of this study show a negative association between a child’s burn size and parent-reported functioning in the four domains post-burn injury. These findings may help clinicians improve pediatric recovery and rehabilitation.
71 Burn Intensive Care Unit Early Mobility Competency Based Orientation
Authors: McGillicuddy Jennie , Bello Gina , Bergeron Kiane , Lee Jeanne
Published: March 2022

Introduction

Competencies in healthcare are used to teach practice standards, to establish expectations for professional growth, and to evaluate and improve the effectiveness of educational programs. Benefits of early mobilization of Burn Intensive Care Unit (BICU) patients include improved ICU related weakness and delirium, range of motion, and decreased length of stay while promoting functional independence. A rehabilitation competency was developed for early mobility with the patient in the BICU using nationally agreed-upon standards for competence. By design this competency for BICU early mobility is part of a tiered training structure, with the burn rehabilitation and pediatric competencies serving as additional tiers of burn therapist training at our organization. The goal of this competency is to provide direct therapist training, including alignment with the inter-professional team involved with this intervention.

Methods

A pretest was issued regarding BICU early mobility competency. The pretest asked the therapist to indicate their perceived level of competence in the areas of functional mobility, indications and contraindications of BICU early mobility, Respiratory Care Provider (RCP) protocols and documentation of BICU early mobility. Based on the results of this pretest, it was identified that BICU early mobility would be prioritized as the next training tier. The BICU Early Mobility Competency was created in Competency Based Orientation (CBO) format, including nationally agreed-upon standards for burn therapist competence. The method of this training is designed to occur with an ongoing patient case study for validation, with the CBO as the teaching tool.

Results

Creation of this competency as part of a tiered training allows our burn center to have an educational program which aligns with the nationally agreed-upon standards for burn therapist competence. Creation of this competency resulted in direct communication channels between rehabilitation, RCP, nursing and physician teams.

Conclusions

This tiered system allows for time management of the validator signing off on competencies, and encourages use of current resources and literature in the areas of burn therapist competence and professional development.
74 The Association Between Burn Injury and Peer Relations: A preschool-libre1-5 Study
Authors: Patel Khushbu F , Ni Pengsheng , Rodríguez-Mercedes Silvanys L , Surette Kate E , Rencken Camerin A , Fabia Renata , Tully Carrie , Palmieri Tina L , Romanowski Kathleen S , Warner Petra , Stoddard Frederick J J , Schneider Jeffrey C , Kazis Lewis E , Ryan Colleen M
Published: March 2022

Introduction

Children ages one to five years old are naturally curious and build their personality and social skills through interactions with others. Positive peer relations are especially important after a burn injury as bullying and peer rejection can delay development of social skills. This study assessed the association between burn injuries and burn survivors’ ability to connect with and maintain peer relations in this age group using the Preschool-LIBRE 1-5 (Life Impact Burn Recovery Evaluation).

Methods

The Preschool-LIBRE1-5 was field-tested with 426 parents of burn survivors. Each item was scored on a 5-point Likert scale ranging from 0 (never) to 4 (always). Data was recoded for selected items such that higher scores denote better functioning. Classic test theory methods were used to assess the peer relation items from a social functioning domain. Individual items and mean scores in the domain were examined. Multiple linear regression analyses (controlling for gender, race and ethnicity, pain severity, burn injury to critical area, burn size, and age at survey completion) measured the association between demographic and clinical characteristics and calculated a peer relation score based on multiple imputation samples.

Results

The mean age was 3.06 + 1.41 years, mean time since injury of 1.16 + 1.34 years, mean total body surface area (TBSA%) of 4.21 + 7.92, and 55.16% male and 74.18% white. Items from peer relations item pool (n=15) were identified as a unidimensional scale (α=0.92, item-total correlations for all 15 items >0.4, ratio of the 1st and 2nd eigenvalues (8.729/1.287=6.78) = > 4). The mean peer relation score was 2.86 + 0.76. The two items with the lowest and highest score were “My child would ask for things nicely when playing with other children” (x̄ = 2.09) and “My child liked to play near and be with family members and friends (x̄ = 3.59) respectively. Results indicated that age was a significant predictor, such that older age at survey completion was significantly associated with higher peer relation score (β = 0.16, p < 0.0001). With each year of age increase, peer relationship score increased by 0.16 + 0.21 points.

Conclusions

Preschool-aged burn survivors, as reported by parents, often had the ability to connect with peers through imitation and participating in play activities, and maintained peer relationships well. These findings emphasize the importance of promoting early interventions that build social skills, allowing for positive interactions with peers and improving social functioning in the long-term.
80 Validation of PROMIS-25 Among Children Living with Burn Injuries
Authors: McMullen Kara , Bamer Alyssa M , Humbert Andrew , Ryan Colleen M , Schneider Jeffrey C , Kazis Lewis E , Stewart Barclay T , Suman-Vejas Oscar E , Amtmann Dagmar
Published: March 2022

Introduction

Patient-reported outcomes are important for burn injury research and clinical practice. The NIH-funded Patient Reported Outcomes Measurement System (PROMIS)-25 profile has been validated for use in diverse populations of children with many conditions, though not among children living with burn injuries. The purpose of this study was to examine the reliability and validity of PROMIS-25 scores in children living with burn injury.

Methods

Data were provided by children who were participating in a multi-center longitudinal study of outcomes after burn injury. The PROMIS-25 Profile, which includes 4 items for each domain of physical function mobility, anxiety, depression, fatigue, peer relationships, and pain interference, was evaluated for reliability and validity. Floor and ceiling effects, unidimensionality, internal consistency, and reliability were examined. Correlations with other measures (Post-Traumatic Growth Inventory-Child (PTGI-C), Child PTSD Symptom Scale (CPSS) and Burn Outcome Questionnaire Body Image Scale (BOQBI)) were calculated to assess concurrent validity.

Results

256 children living with burn injury who sustained a moderate to severe injury provided responses on PROMIS-25 domains 6 months-10 years post burn. Participants’ age ranged from 8-18 years at time of assessment; mean years since injury was 4.3 (SD 4.1). All PROMIS-25 domains showed high internal consistency (Cronbach’s α=0.90–0.95). Substantial portions of the sample reported no symptoms (anxiety [58.2%], depressive symptoms [54.6%], fatigue [50.8%], pain [60.1%]). There was a large ceiling effect on peer relationships (46.8%) and physical function mobility (57.5%). One-factor confirmatory factor analyses supported unidimensionality for all domains (all CFI >0.98). Reliability was credible for group mean comparisons ( >0.8) across at least some trait levels for all domains except fatigue and anxiety which had low reliability (< 0.8) across the entire trait range. The magnitude and direction of correlations were as anticipated (0.32 for peer relationships and body image; 0.51 for depressive symptoms and PTSD) with the exception of weak negative correlations between PTGI-C and the anxiety and depression domains.

Conclusions

The results provide some evidence of reliability and validity of PROMIS-25 scores among children living with burn injury. Reliability of all domains was low to moderate and would likely be improved, and ceiling effects reduced, by administering the PROMIS-37, which includes 6 items per domain.
88 Pediatric Postburn Ear Reconstruction of Significant Cartilage Defects
Authors: Buta Martin , DePamphilis Matthew , Bojovic Branko , Driscoll Daniel N
Published: March 2022

Introduction

The ear is a protruding appendage with multiple functional and aesthetic implications. Literature indicates that up to 40-60% of facial burns involve the ear. Ear burns with considerable tissue loss and sensory deficits can negatively impact quality of life, psychosocial functioning, and physical health. Successful ear reconstruction mitigates these undesirable outcomes. The complex architecture of the external ear presents a formidable surgical challenge after burn injury, when scar tissue, impaired blood supply, and trauma to cartilage all influence reconstructive options. A lack of materials that truly replicate the characteristics of uninjured elastic cartilage also presents a longstanding surgical dilemma. In this retrospective study, the authors highlight the utility of reconstructive techniques to address significant cartilage deficits, including conchal transposition flap, composite graft, costal cartilage graft, and porous polyethylene implant.

Methods

A retrospective review was conducted on patients aged 0 to 21 years who underwent cartilage framework reconstruction between January 2004 to January 2021 at a specialized pediatric burn center. Medical records from the hospital’s patient database were screened, and 52 patients (60 ears) who met study criteria were identified. Patient demographics, procedural characteristics, and patient outcomes were analyzed.

Results

For helical rim cartilage defects, 20 patients (23 ears) with an average age of 15 ± 4 years underwent a conchal transposition flap, which was associated with no major complications. In cases involving repair of small to medium cartilage deficits, 9 patients (9 ears) with an average age of 13 ± 5 years underwent a composite graft, which was associated with one case of infection. A total of 20 patients (23 ears) with an average age of 13 ± 6 years underwent porous polyethylene implantation, which was associated with two cases of exposure and one case of infection. Of these porous polyethylene cases, 20 ears involved helical rim reconstruction and 3 involved total ear reconstruction. Costal cartilage grafting was performed in 4 patients (5 ears) with an average age of 13 ± 5 years and was associated with one case of infection. Costal cartilage grafting was utilized to reconstruct 2 helical rims and 3 total ears.

Conclusions

In cases of focal cartilage defects or medium-sized helical rim cartilage loss, highly aesthetic results and minimal complication rates can be achieved with composite graft or conchal transposition flap. When presented with large to total helical rim loss or total ear loss, either costal cartilage graft or porous polyethylene implantation is typically necessary.