bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerical study of spun pile with steel jacket
Authors: Reagen J , Lase Y , Prakoso W A , Orientilize M
Published: May 2023

The confinement ratio of spun piles manufactured in Indonesia has been a matter of concern since it does not meet the applicable requirements. Additional steel jacketing retrofitting was used to cope with the problem as well as improve the strength of spun pile to pile cap connection. A numerical study was performed to study the effect of steel jacketing on a spun pile with concrete infill reinforcement. Furthermore, a parametric study was conducted to study the effect of steel jacketing length to spun pile behaviour. Pushover analysis using the Opensees software will be performed with a monotonic loading approach. The results were compared in terms of load – displacement curve, shear and bending capacity, and displacement ductility. It is found that the presence of steel jacketing provides a better behaviour and significantly increases the ductility of specimens. The study also found that a minimum length 1.5D of steel jacketing retrofitting was necessary for better results and remain easily repairable for future concerns.
The threat of tsunami debris due to non-permanent buildings in Cilacap City
Authors: Widiyanto W , Purnomo S N , Santoso P B
Published: May 2023

Run-up tsunamis have the ability to pick up debris along their path. More severe damage may result from the debris and their force of impact. Therefore, it is important to analyse the potential for debris in a tsunami-prone area. This study examines the threat of tsunami debris in Cilacap City, especially the source of debris from temporary or non-permanent buildings along the coast of Cilacap City. A site assessment was conducted to observe the existence of non-permanent buildings along with their number and characteristic. The results of the study show that the infrastructure of Cilacap City faces a serious threat from tsunami debris which is source from non-permanent buildings. The material transported by the tsunami run-up to cause debris was maximum 465 tons found in area around Pasir Emas Street cause potential debris for one-meter perpendicular to tsunami run-up direction 503 kg and generate tsunami impact force 28,284.3 N. In addition, the fishing port, Pendem fort and Pertamina oil refinery are also potentially affected by tsunami debris because each location has a significant number of non-permanent buildings.
Hydraulic gradient analysis on embankment dam foundation associated with internal erosion
Authors: Putra R A M , Pratiwi D , Putra A D , Wahono E P , Kusumastuti D I , Fitri A
Published: May 2023

Internal erosion is susceptible to occur in conditions where there are cracks or pre-formed cavities at the interface between the dam foundation and embankment. The initiation of internal erosion is related to the critical gradient (Ic
) and hydraulic gradient (Ixy
) at a certain position. The addition of repair materials in foundation improvement will change the total head, especially on the dam foundation, so the value of the hydraulic gradient will also change simultaneously from upstream to downstream. This study examines the value of the hydraulic gradient (Ixy
) at certain points on the dam foundation under the condition of foundation with and without improvement. Several scenarios were simulated using Geostudio Seep/W software to get an estimated value of the hydraulic gradient. The upstream blanket foundation improvement method increases the hydraulic gradient in the upstream zone when compared to the curtain grouting method, thereby increasing the potential for internal erosion in a related area. Increasing the depth of curtain grouting from 25 m to 35 m does not significantly reduce the value of the hydraulic gradient in the dam foundation. Research results can be used for analysis to improve design and construction, and as a reference for similar dams.
Comparative Analysis of Riverbanks Retrofitting Planning Using Strauss Pile and Ground Anchor
Authors: Yelvi  , Prayoga W A , Fachmi W M , Salimah A , Setiawan Y , Hazmi M
Published: May 2023

This research was conducted to reinforce the sheet pile located on the embankment of the Ciliwung Lama river – Inspection Road (RSCM) in Central Jakarta. The road is beside the riverbanks of the collapsed river for 40 m and the position of the sheet pile that slopes towards the river. Based on field observations and analysis of the stability of the slopes carried out, the road’s collapse was not due to the unstableness of the embankment but due to the inability of the sheet pile to receive lateral soil pressure. The research method used Plaxis 2D Software to analyze the reinforcement applied to the sheet pile in withstanding lateral soil pressure. The planned reinforcement of the sheet pile uses a Strauss pile with a sling and ground anchor. In retrofitting, using a Strauss pile, a diameter of 0.4 meters, a length of 9 meters, and a sling with a diameter of D32 with a distance between slings of 2.5 meters. Ground Anchor retrofitting is planned to be 27 m long, 159 mm in diameter, and 88 mm in body grout. Compared to the Safety Factor that occurs between the Strauss pile with the sling and the ground anchor, the safety factor of the Strauss pile with the sling is greater. The Strauss pile’s safety factor was obtained by 1.75, while the ground anchor safety factor was 1.55 without considering the earthquake load.
Understanding of flow liquefaction in Lolu Village based on seismic refraction tomography method
Authors: Andika P P , Tohari A , Yudistira T , Soebowo E , Arifin J
Published: May 2023

A big earthquake may induce flow liquefaction phenomena in lowland areas made up of sedimentary deposits. To understand the factors controlling such a hazard, it is necessary to have knowledge of the sub-surface geological conditions of the liquified area. This paper presents the results of a series of seismic refraction measurements in Lolu Village where flow liquefaction occurred during the 2018 Palu-Donggala earthquake. The results of seismic refraction tomography indicate the presence of horst-graben structures, probably associated with the localized pull-apart basin. The results of this study suggest that the sub-surface geological structure is also a governing factor for the occurrence of flow liquefaction phenomena in an area with a complex fault system.
An investigation of the changing patterns of rainfall in the Indravathi subbasin utilizing the Mann-Kendall and Sen’s slope methods
Authors: Bambang Istijono , Saravanan Subbarayan , Reddy Nagireddy Masthan , Abijith Devanantham
Published: May 2023

In hydro-meteorological studies, precipitation is an important parameter that is utilized in irrigation system design and management, as well as agricultural planning. Under the effects of climate change, precipitation is predicted to alter, which will have an impact on sustainable development. Using rainfall data for the Indravathi subbasin, Godavari basin, from 1998 to 2016, the spatial variability and temporal trend of precipitation were examined over the region, which has a humid tropical climate. Using non-parametric tests like Mann-Kendall (MK) and Sen’s slope approach, analysis for trend detection was conducted. The test data were loaded into ArcGIS software, which then performed monthly, seasonal, and annual analyses of the spatial and temporal trends of rainfall. According to an analysis of the monthly rainfall trends, February had the largest spatiotemporal declining trend in rainfall, while September had the highest spatiotemporal increasing trend. An analysis of seasonal rainfall data revealed a considerable increase in the tendency for summer rainfall over nearly 80% of the basin. Data on annual precipitation revealed an increase in annual precipitation for the basin’s central eastern sections. The findings of this research may help the decision makers and stakeholders make the most efficient use of hydrological resources by providing insight on the effects of climate change and climatic changes on precipitation patterns in the Indravathi subbasin.
Disaster management and its importance: a review paper of Dakshina Kannada and Kodagu districts, Karnataka, India
Authors: Jayaprakash M C , Reddy D Venkat , Istijono B
Published: May 2023

An extreme occurrence within the earth’s system that causes human fatalities, injuries, and property destruction is referred to as a “disaster” from a social perspective. Disaster management is one of the most critical topics around the world. Many countries are getting affected because of its high magnitude impact on economy and loss of life. The Karnataka government must always be on guard and ready to meet problems due to the frequent natural disasters like landslides, floods, droughts, and human-induced dangers. In order to lessen the effect of disasters on the community, the Government of Karnataka has built enhanced institutional structures for disaster risk reduction. The main aim of the review paper of this, is to create awareness about the situations occurring due to any form of disasters and to develop preparedness in younger generation to face disaster situations.
The pattern of material supply chain in post-disaster reconstruction: a case study in Indonesia’s disaster-prone area
Authors: Putranesia  , Ophiyandri T , Ismail F A , Hidayat B
Published: May 2023

The government, the community, or non-governmental organisations can all participate in the reconstruction process after a disaster. The management of material procurement and logistics may entail participation from several stakeholders. It may be crucial to a project’s success in reconstruction. A reliable supply chain is required to guarantee an appropriate building supply. The supply chain for building materials significantly impacts the course and results of reconstruction after a disaster. This study intends to map the post-disaster restoration process’s formation of the construction supply chain pattern. In order to detect potential issues and disturbances that could contribute to the failure of the post-disaster restoration process, the supply chain pattern for building materials is being mapped. The path of the supply chain for construction materials is undoubtedly significantly impacted by post-disaster environmental circumstances. Because it can impact project prices and timelines, the choice of building material suppliers is crucial in construction supply chain management. During the reconstruction process in disaster-affected areas, this research used qualitative approaches by conducting surveys and questionnaires to gather data and facts.
Estimating the Cost of Strauss Pile Retaining Wall Works Using the Cost Significant Method
Authors: Setiawan Y , Yelvi  , Broto A B , Rafli M M , Supriyadi I , Salimah A
Published: May 2023

Cost estimation is an important element in a project. In the early stages of a project, information for estimates tends to be less accurate. Therefore, a cost estimation model is needed that can explain most of the projects based on the lack of information. The estimation method used is the Cost Significant Model. The aim is to determine the accuracy of the Strauss Mast Retaining Wall Work cost estimation model against the actual project cost. Data was collected using the sampling method, and 5 (five) similar project packages were obtained from 2019-2021. Produce 2 (two) Significant Cost Items that have cumulative costs (80%), namely Strauss Pile Work (X3) of 32% and Pile Work (X4) of 48%. Then it is analyzed to produce a regression equation formula using the SPSS application, and the equation is Y = 5696.59+5.270 X3-1,389X4 with a Cost Model Factor of 1.11. Estimated accuracy ranges from -7.3% to +8.4%. With an average of +0%. The accuracy rate is in class 1 of the International AACE classification, which has a lower limit of -3% to -10% and an upper limit of +3% to 15%. The estimation model is feasible to use to check the bid estimate.
Identification of Lean Implementation in the Post-Disaster Housing Reconstruction
Authors: Octavia D M , Ophiyandri T , Suraji A , Hidayat B
Published: May 2023

Housing reconstruction is a significant determinant of the post-disaster recovery process and one of the most complex challenges, especially in developing countries. Post-disaster housing reconstruction sometimes results in poor environmental quality, delayed construction completion, low performance, and wasteful materials. Previous research has shown the success of the lean application in construction projects as well as in reconstruction projects. Its means that post-disaster housing reconstruction can also apply lean principles and techniques. This study aims to identify and analyze lean theories and techniques that can be implemented to overcome, minimize or resolve problems in Indonesia’s post-disaster housing reconstruction stage to obtain a lean model (Lean Housing Reconstruction). This study is the initial stage of developing a lean implementation model in post-disaster housing reconstruction. A systematic literature review (SLR) was conducted to obtain lean principles and techniques for post-disaster housing reconstruction. The results of the SLR obtained five lean construction techniques that can be used for housing reconstruction, including Lean Six Sigma, Last Planner System, 5S (Sort, Straight, Shine, Standardize, and Sustain), Value Stream Mapping, and Pull Scheduling.
Investigation on the wear rate and COF of AA356 metal matrix composites reinforced with zirconium silicate (ZrSiO4) particles
Authors: Prabhu S Narayana , Moshi A Arul Marcel , Hariharasakthisudhan P , Bharathi S R Sundara
Published: May 2023

These days, metal matrix composites (MMCs) are frequently investigated by incorporating the proper reinforcement particles. In order to enhance various properties of the manufactured MMCs, reinforcement particles are embedded into the base metal. In the present investigation, A356 MMCs reinforced with 5 wt% of zirconium silicate (ZrSiO4) particles have been prepared and tested for the friction and wear behaviour. Utilizing the stir-casting technique, the composites were produced; and the test specimens have been prepared with ASTM G99 standards. Three significant process variables have been considered for performing the wear test such as normal load, sliding velocity and sliding distance. The Taguchi’s L9 orthogonal array design has been used to plan the experimental design for the wear test. Main Effect Plots (MEPs) have been drawn for the coefficient of friction (COF) and wear rate values obtained during the test for different combinations of selected input variables, and analyzed. To determine the optimal input variable combinations that lead to lower COF and wear rate, Grey-Fuzzy Reasoning Grade Analysis (GFRGA) has been used. For the taken into account input conditions and the recorded output responses, an artificial neural network (ANN) model has been created. The surfaces of the worn out samples have been tested with the aid of the micrographs taken by a Scanning Electron Microscope (SEM).
Peer or Parent: The Role of Adolescent Children of Local Authority Foster Carers
Authors: Pratchett Rebecca C
Published: May 2023

When I was sixteen years old, my parents became local authority foster carers. There is no legal recognition of the role that older children play in the care of younger foster siblings. We are not recognised as carers and yet are often involved in providing care and supervision of younger siblings. There are recorded benefits to being a foster sibling, but there are also challenges that come with the role. Within this reflective narrative piece, I seek to trigger a discussion within the field around the role that young adults play in the fostering process. I use my own experience to raise key issues around the safeguarding of not only young people who are looked after but also those whose parents choose to foster. In doing so I aim to open debate around the responsibilities of practitioners to recognise and adequately prepare young adults for the role they will play in a fostering household.
Expectation violations produce error signals in mouse V1
Authors: Price Byron H , Jensen Cambria M , Khoudary Anthony A , Gavornik Jeffrey P
Published: May 2023

Repeated exposure to visual sequences changes the form of evoked activity in the primary visual cortex (V1). Predictive coding theory provides a potential explanation for this, namely that plasticity shapes cortical circuits to encode spatiotemporal predictions and that subsequent responses are modulated by the degree to which actual inputs match these expectations. Here we use a recently developed statistical modeling technique called Model-Based Targeted Dimensionality Reduction (MbTDR) to study visually evoked dynamics in mouse V1 in the context of an experimental paradigm called “sequence learning.” We report that evoked spiking activity changed significantly with training, in a manner generally consistent with the predictive coding framework. Neural responses to expected stimuli were suppressed in a late window (100–150 ms) after stimulus onset following training, whereas responses to novel stimuli were not. Substituting a novel stimulus for a familiar one led to increases in firing that persisted for at least 300 ms. Omitting predictable stimuli in trained animals also led to increased firing at the expected time of stimulus onset. Finally, we show that spiking data can be used to accurately decode time within the sequence. Our findings are consistent with the idea that plasticity in early visual circuits is involved in coding spatiotemporal information.
Revised structure model of norovirus-binding fucoidan from Undaria pinnatifida: oligofucose chains branch off from a β6-galactane
Authors: Hanisch Franz-Georg
Published: May 2023

Fucoidans are discussed as antiviral agents, and fucoidan from Undaria pinnatifida (UpF), in particular has gained interest as potential food additive in antinoroviral strategies. As the competitive blocking activity of antinoroviral agents increases with the valency of terminal nonreducing fucose on the competitor, an effective processing of fucoidans to inhibitory oligosaccharides will depend on basic structural features of the polysaccharide. We demonstrate increased antiviral binding activity of processed low-mass UpF generated by hydrothermal degradation contrasting with decreased efficacy of low-mass fucoidan from Fucus vesiculosus. As this finding is in conflict with current structural models of UpF, we undertook a re-investigation of the glycan backbone in UpF. Applying solvolytical desulfation combined with enzymatic cleavage of low-mass fucoidan by endo-β6-galactanase and terminal labeling of oligosaccharides by deutero-reduction and bis-5-phenyl-3-methyl-1-pyrazolone (PMP) substitution, evidence from mass spectrometry and methylation linkage analysis of the oligosaccharides indicates that fucoses and galactoses in the glycan backbone are organized in homomeric blocks, where oligo-fucoses branch off from a galactane-type core: Fuc(1-3Fuc)n1-3[Gal(1-6Gal)n1-6]Gal(1-6Gal)n.
The association between social functioning and health literacy among rural Southeastern African Americans with hypertension
Authors: Gutierrez Iliana , Bryan Joanna , Baquero Elizabeth , Safford Monika M
Published: May 2023

African Americans living in low socioeconomic circumstances are at high risk of poor health outcomes; this is particularly true for those with hypertension. Many African Americans with chronic hypertension living in the rural impoverished Southeastern USA have low health literacy and are socially isolated. These factors are known to have a negative impact on health outcomes, but it is possible that social support may overcome some of the effect of low health literacy. Since little has been reported about this association, we examined the association between social functioning and health literacy in a rural African American population in the Southeast USA. We used baseline data from participants in the Southeastern Collaboration to Improve Blood Pressure Control, a pragmatic trial that recruited rural African Americans with persistently uncontrolled hypertension and collected survey data. Overall, 33.5% of the 1221 person sample reported social isolation, 26.0% reported low instrumental support, 36.0% reported low emotional support, and 63.4% had inadequate health literacy. All three domains of low social functioning were significantly associated with low health literacy, and this effect was robust to multivariable adjustment for sociodemographics and cognitive functioning for social isolation (adjusted odds ratio 1.62, 95% confidence intervals 1.20–2.20). In conclusion, the majority of this sample living in the NC and AL Black Belt had high social functioning but inadequate health literacy. Tests of interventions to improve social support, especially social isolation, may be warranted to overcome low health literacy in this high-risk rural population.
37 The Epidemiology of Burn Injury in A Large Southern Geographic Area
Authors: Haggerty Christopher , Ramsey Walter , O'Neil Christopher , Satahoo Shevonne , Kaufman Joyce , Pizano Louis , Schulman Carl
Published: May 2023

Introduction

Given the resource-intense nature of treatment for burn injuries and the knowledge of at-risk populations, a public health approach to reducing individual and societal burden is indicated. To accomplish this, it is critical to understand the regional distribution of these injuries and the risk factors influencing one’s susceptibility to being burned. We hypothesize that there are common sociodemographic trends in burn injuries in a large southern geographic area.

Methods

Data was retrospectively reviewed for all burn patients admitted between 08/2013 and 12/2021 at a major burn center in a large southern geographic area. Sociodemographic data, burn characteristics and outcomes were analyzed. Patients with isolated inhalation injuries were excluded. One-way ANOVA was used for continuous variables with a P-value < 0.05. Binary logistic regression was used to evaluate independent risk factors for mortality. GIS software mapped injury locations alongside census data to augment statistics with visuospatial analysis.

Results

1753 patients were included with an annual incidence rate of 36 per 100,000 person-years. Most were male (68%), Caucasian (60%) and non-Hispanic (67%). The most common etiology was cooking-related (14%), with scald and flame burns collectively making up 80%. Flame burns were significantly larger when compared to scald, electrical and chemical mechanisms (p< 0.05). Those between 19 and 45 years old were the largest age group (40%) with significantly larger burns compared to those 0-18 and 46-64 (p< 0.05), but not those > 65. Non-Hispanic patients had significantly larger burns than their Hispanic counterparts (p< 0.05) but no difference in mortality (p=.306). Patients utilizing Medicare/Medicaid were over three times more likely to die compared to those with commercial insurance.

Conclusions

In this cohort, male patients are injured at higher rates, however, they do not have more severe burns. The larger burns are distributed in a bimodal fashion between those 19-45 and those > 65, with hispanic ethnicity protective against larger burn injuries. This suggests separate mechanisms mediating larger burns in these two groups, and warrants further investigation. Insurance type, a surrogate for socioeconomic status (SES), is not associated with TBSA or LOS, however it does confer an increase in mortality in those with Medicare/Medicaid. GIS mapping verifies neighborhoods concentrated in more urban areas with lower median household incomes have higher injury rates. This highlights populations worth targeting for injury prevention, namely those between 19 and 45 of lower SES, particularly in the setting of cooking and food preparation.

Applicability of Research to Practice

Understanding regional trends in burn injury can target prevention efforts and identify at risk populations where further resources might be best allocated to ease the burden of burn injury.
59 Predictors and Impact of Pneumonia on Adverse Outcomes in Inhalation Injury Patients
Authors: Galet Colette , Richey Karen , Foster Kevin , Wibbenmeyer Lucy , Ronkar Nicolas
Published: May 2023

Introduction

Next to age and burn size, the presence of inhalation injury (II) is the third mortality prognostic factor for burn injury. II can lead to pulmonary complications such as pneumonia, acute respiratory distress syndrome (ARDS), and acute lung injury (ALI), all of which have been hypothesized to increase mortality in II. Herein, we aimed to identify variables associated with the risk of developing pneumonia and to determine the impact of pneumonia on selected outcomes.

Methods

De-identified data from the Prospective Inhalation study (ISIS) were used. II was confirmed by fiberoptic bronchoscopy. Baseline demographics, injury data, burn size, laboratory data, radiographic results, treatment, and hospital course were recorded. Ventilator use, complications, including pneumonia, ARDS, ALI, and death, were tracked daily for seven days and then weekly until discharge. Univariate and multivariate analysis were performed. Variables included in multivariate analysis had a p value of 0.1 or less. A p value of < 0.05 was considered significant.

Results

Of the 108 ISIS study group, 106 had complete data and were included in the analysis. Median age was 48.5 y, 59.4% of the subjects were male, 76.4% White and 9.4% Black. Regarding complications, 46.2% of the subjects developed pneumonia, 11.3% ARDS, 9.4% ALI, and 17% died. On univariate analysis, subjects who developed pneumonia were more likely to be white (87.8% vs. 66.7%, p = 0.006), to present with higher total burn surface area (24.70 [8.00-49.50] vs. 2.85 [0.00-25.38], p = 0.002), and full thickness burn (55.1% vs. 31.6%, p = 0.018). On multivariate analysis, being white (p = 0.033) and receiving colloids in the first 24 h of admission (OR = 3.582 [1.157-11.087], p = 0.027) were associated with increased risk of pneumonia while higher level of MMP-9 in the plasma (OR = 0.999 [0.998-1], p = 0.041) lowered the risk. Admission radiographs, FB score, clinical examination findings, and other demographic factors were not related to developing pneumonia. Pneumonia was independently associated with increased risk of developing ARDS (OR = 8.496 [1.322-54.61], p = 0.024) but not with ALI or mortality. Pneumonia was also associated with a longer hospital length of stay (B = 15.2 [2.4-28], p = 0.020) and higher number of days on a ventilator (B = 15.6 [8.2-23], p < 0.001).

Conclusions

Pneumonia is associated with increased LOS and ventilator days but not mortality. Those who received colloids were 3.5 times more likely to develop pneumonia. The relationship between colloid and pneumonia requires more research, however, the search for other intervenable clinical variables to prevent pneumonia remains elusive.

Applicability of Research to Practice

As colloids may affect the glycocalyx and contribute to inflammation, their role in developing pneumonia needs to be elucidated.
74 Secondary Immunohistochemical Analysis of Viable Cells as Determined by Hematoxylin and Eosin Staining
Authors: Carney Bonnie , D'Orio Cameron , Shupp Jeffrey , Carter Jeffrey , Hickerson William , Holmes James , Phelan Herbert
Published: May 2023

Introduction

Accurate clinical differentiation of deep partial-thickness (DPT) and full-thickness (FT) wounds is essential in justifying appropriate treatments for heterogeneous burns. Only recently has non-invasive burn depth imaging been ground-truthed with tissue punch biopsies; an endeavor that will no doubt improve AI imaging algorithms in the near future. Prior literature supports unique apoptotic and necrotic properties of DPT and FT wounds, suggesting a use for not only standard stains (H&E), but apoptotic marker staining in assisting clinical diagnosis of burn depth, progression and/or conversion.

Methods

The aim of this study was to evaluate the presence of apoptotic cells in DPT and FT samples previously diagnosed by a burn biopsy algorithm (BBA-V2) for burn depth and severity by expert review of H&E-stained slides. Eight paired biopsies were collected from DPT and FT wounds in four patients within 72 hours of thermal injury and were immunofluorescently labeled for apoptosis markers by detection of deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and cleaved caspase-3 (CC-3) staining. Fluorescence intensity in dermal appendages within images was used to quantify signal at 40x magnification for CC-3. % positive TUNEL cells were graded by an investigator blinded to the burn severity. A higher grade indicated higher % positivity. TUNEL grading was evaluated by Chi square test. CC-3 intensity was evaluated by Student’s t-test.

Results

Across all four patients, FT burns had higher levels of CC-3 in dermal appendages compared to DPT burns (Cy3:DAPI ratios: 1.53 ± 0.28 vs. 0.75 ± 0.13; p=0.1074). Within each patient, all FT biopsy sites had significantly higher levels of CC-3 versus DPT biopsy sites (p< 0.05)(Table). DPT burns had a greater proportion of patients with increasing grades of TUNEL positive cells (DPT: Grade 1: 16%, Grade 2: 36%, Grade 3: 48%; FT: Grade 1: 42.3%, Grade 2: 23.1%, Grade 3: 34.6%, p=0.1178).

Conclusions

CC-3 and TUNEL levels within dermal appendages align with burn depth classification by H&E staining, wherein appendages graded as necrotic had higher levels of CC-3 and lower levels of TUNEL. Therefore, CC-3 and TUNEL are potential secondary histological markers for burn depth. Further analysis of isolated, individual dermal appendages is underway to identify what additional information this secondary marker may add to the diagnosis of burn depth.

Applicability of Research to Practice

For the first time there is access to a large tissue repository of biopsies from burn wounds. Although staining from these samples has been used to build diagnosis algorithms with success, much more can be learned from the cellular pathophysiology when secondary analyses are performed. These assays may help us understand the processes of burn conversion.
78 Improvement of Cell Viability in Temporary Storage of Split Thickness Skin Grafts
Authors: Couch Brandon , Batchinsky Maria , Pang Alan , Warraich Irfan , Melkus Michael , Kim Seungman , Bharadia Deepak , Griswold John
Published: May 2023

Introduction

Autologous split thickness skin grafts (STSGs) are the preferred donor tissue for restoration of large tissue deficits. Although grafting should be done at the time of donor harvest, various factors necessitate tissue storage, traditionally in saline solution (SS) at 4oC. However, STSGs often expire before grafting in these conditions. Patients then require further excision procedures or die due to inadequate skin coverage. For patients’ wellbeing, establishing a new storage protocol is imperative. This study sought to determine an effective storage media for prolongation of graft viability for subsequent incorporation into excision and grafting practice.

Methods

Following patient consent, excess tissue >1cm2 was collected after grafting procedures. Tissue was stored at 4oC in RPMI, DMEM, and SS with penicillin/streptomycin. Samples were evaluated at 2, 5, 7, and 14 days. Cell viability was measured by Trypan blue dye exclusion test in an automated cell counter yielding percentage of viable keratinocytes (PVK). An unbiased pathologist assessed tissue integrity by epidermal-dermal junction, perinuclear keratinocyte halos, and collagen organization with higher scores denoting deterioration. Data were evaluated by ANOVA and Effect size.

Results

A total of 155 sets of two specimens each were collected from 13 patients. Mean PVK values at day 2, 5, 7, and 14: SS (57.38, 36.96, 38.38, 27.50), RPMI (69.46, 69.92, 70.33, 62.67), DMEM (63.17, 53.50, 54.83, 37.92). By pairwise comparison, RPMI preserved PVK better than SS at days 5, 7, and 14 (p = 0.001 for each day). DMEM preserved PVK better than SS when comparing all days (p = 0.011) but failed to produce a statistically significant difference at any specific day. RPMI preserved PVK greater than DMEM each day. However, statistically significant differences were only revealed at day 14 (p = 0.017) and when comparing all days (p < 0.001). Effect size was large for overall group differences of PVK at day 5, 7, and 14 (Cohen’s f = 0.72, 0.73, and 0.75). Tissue integrity scores at day 2, 5, 7, and 14: SS (0.69, 1.0, 1.38, 2.0), RPMI (0.54, 0.92, 0.85, 1.54), DMEM (0.77, 0.92, 0.77, 1.15). Although culture media preserved tissue integrity greater than SS, no statistically significant differences were found.

Conclusions

RPMI preserved cell viability better than DMEM and SS. This suggests that STSGs stored in RPMI may prolong the time of which tissue could be stored and successfully amalgamated with skin.

Applicability of Research to Practice

Storing tissue in RPMI could benefit burn patients by decreasing tissue disposal therefore reducing future donor site area or eliminating repetitious excision procedures entirely. These effects decrease inpatient days and healthcare costs. Most importantly, successful tissue storage will save patients’ lives, especially those of large surface area burns who lack sufficient donor sites.
104 Indocyanine Green Fluorescence Differentiates Necrotic Cells from Healthy and Apoptotic Cells
Authors: Zajac Jocelyn , Hassan Sameeha , Gibson Angela , Liu Aiping
Published: May 2023

Introduction

No objective technique exists to distinguish necrotic from viable tissue, risking over-excision in burns and loss of wound healing potential. Using delayed fluorescence imaging of indocyanine green (ICG), a method called second window ICG (SWIG), we have shown that high dose ICG persists in burn wounds in both animals and patients 24 hours after infusion. The necrotic avidity of ICG is proposed as the underlying mechanism, although inflammation also likely has a role. The objective of this study is to examine the hypothesis at both the tissue and cellular levels.

Methods

To examine the localization of ICG in burn tissue, 4-mm biopsies taken from burn patients who underwent SWIG were embedded and sequentially sectioned for H&E (tissue architecture) and LDH (tissue viability) and ICG fluorescence imaging. To examine whether ICG preferentially binds to necrotic cells, primary skin cells (fibroblasts or keratinocytes) were subjected to thermal injury at 65ºC for 0 (untreated), 2.5 or 5 minutes. The cells were subsequently incubated with ICG at concentrations ranging from 0.5 to 5 μg/mL at 37ºC for 30 minutes. A necrosis and apoptosis detection kit with Yo-Pro™-1 and propidium iodide (PI) was used to differentiate live, apoptotic and necrotic cell populations in flow cytometry. The ICG florescence intensity of each cell population was measured with flow cytometry.

Results

The fluorescence microscopic imaging revealed that ICG intensity was most intense in the superficial severely thermally-injured tissue and gradually decreased with depth. This zone of high ICG intensity was co-localized with high cellularity (shown in H&E) consisting of a mixture of nonviable skin cells (shown in LDH) and inflammatory infiltrates. Using flow cytometry, the optimal concentration of ICG with the highest ICG florescence median intensity (FMI) and the best separation of live, apoptotic and necrotic cell populations was 2.5 μg/mL, which was used for subsequent flow cytometry experiments. For both fibroblasts and keratinocytes, the ICG FMI was significantly higher in the necrotic cell population than that of either the live or apoptotic cell population, suggesting higher affinity of ICG to necrotic cells. The ICG FMI of necrotic cells with longer heat exposure (5 minutes) was significantly higher than that of necrotic cells with shorter heat exposure (2.5 minutes), suggesting that the binding sites for ICG increase with the degree of thermal injury.

Conclusions

This study demonstrates the necrotic avidity of ICG in burned skin tissue and two primary skin cell types. Further studies are needed to study the ICG binding characteristics with inflammatory cell populations and single cell suspensions dissociated from human burn tissue.

Applicability of Research to Practice

This, along with our pilot study of SWIG in patients, supports the feasibility of SWIG in guiding surgical decision-making in burn excision by defining thresholds of fluorescence intensity values.
109 Effects of Fat-Rich Nutrients in the Pancreas of an Experimental Burn Model
Authors: Santelis Santiago , Abali Ayse Ebru , Basci Tutuncu Neslihan , Ozdemir B Handan , Ozgun Gonca , Bayraktar Nilufer , Colak Meric Yavuz , Haberal Mehmet
Published: May 2023

Introduction

Oversupply of nutrients overstimulates beta cells in standard conditions, and severe burn injuries increase the metabolic needs. In this study, we investigated the effects of fat-rich nutrients on the endocrine pancreas during the acute phase of severe burns.

Methods

Twenty-one Wistar albino rats were randomly divided into 3 groups. Two groups were fed with standard commercial rat chow (1 with sham procedure and 1 with burn procedure), and the third group (also with burn procedure) was fed a fat-rich diet (60% kcal fat). The burn procedure involved a 25% total body surface area fullthickness burn. Blood samples were taken at 36 hours and 7 days after burn injury or sham procedure. On postburn day 7, skin biopsies were taken and a pancreatectomy was performed. Pancreatic tissues were examined under light microscopy; islets size and cellularity were calculated and investigated immunohistochemically.

Results

Plasma glucose, C-Peptide, and insulin levels were similar in all the study groups 36 hours and 7 days after burn induction or sham procedure. There was a significant increase in the number of cells per one islet in the burn group given a fat-rich diet compared with the other groups (P = .05). Caspase-3 was strongly expressed in both groups with burn injuries.

Conclusions

Overconsumption of certain fats can lead to a compensatory response by beta cells that eventually can progress to beta-cell dysfunction during the acute phase of burns. Severe burns induce pancreatic islet cell hyperplasia. Providing excessive fat nutrients during the acute postburn period attenuates this response. Despite the morphophysiological changes observed in the pancreas, all animals in our study achieved similar glycemic homeostasis.

Applicability of Research to Practice

The delivery of nutritional support is a vital element of burn care, and the main goal is simply to avoid nutritional complications. Lipotoxicity contributes to multisystem organ failure and worse clinical outcomes in obese patients and mice with pancreatitis. Neutralization of IL-1β produces beneficial effects on postburn glycemic control and improves survival. apoptosis in the pancreas of patients with severe burns may be linked to a series of events that can induce Caspase-1 activation and IL-1β release, and these pathways may be influenced by the nutritional status, especially in the early postburn phase. Effective nutritional assessment and management can optimize wound healing and decrease complications and mortality.
114 Social Participation Trajectories: Results from the LIBRE Journey Study
Authors: Schneider Jeffrey , Shepler Lauren J , Kazis Lewis , Slavin Mary D , Ryan Colleen , Ni Pengsheng , Acton Amy , Kelter Brian , Santos Edward
Published: May 2023

Introduction

Social rehabilitation is a critical step in the recovery process post burn injury, yet there is limited published data on the topic. The LIBRE Profile was developed as a burn specific instrument to examine social participation outcomes across six domains. The objective of this study is to use the LIBRE Profile to measure social participation and explore the trajectories of recovery in each domain.

Methods

Data from the LIBRE Journey Study was analyzed, utilizing both the LIBRE Profile Computer Adaptive Test and fixed short forms. Demographic and clinical characteristics included age, gender, race, ethnicity, education, marital status, burn size and time since injury. LIBRE Profile scores collected at five time-points from baseline to two years, approximately 6 months apart, calculated score trajectories for each of the LIBRE Profile domains (Family and Friends (FF), Social Activities (SA), Romantic Relationships (RR), Sexual Activity (SX), Social Interactions (SI), and Work and Employment (WE)). Linear mixed models with the log of time since burn injury were applied to each domain, adjusting for demographic and clinical variables. Models were fit using the score trajectories with 95% confidence intervals to demonstrate change over time and significant impact of the covariates.

Results

Analyses included 454 participants with a mean age of 45.4 (SD 15.4) and mean burn size of 38.7% (SD 24.6). Time since burn injury ranged from 13 days to 71 years. All participants were included in analyses of the FF, SA, and SI, with 265, 292, and 288 participants included in the WE, RR, and SX domains based on screening questions for relevance, respectively. Multiple predictors were found to significantly effect LIBRE domain scores (Table 1), with all domain scores increasing with time since burn injury (p < 0.0001) and decreasing with an increase in burn size (p < 0.04), except for FF and RR.

Conclusions

Analyses showed significant improvement of social recovery post burn injury for both the short- and long-term in four of the six domains. Analysis of LIBRE Journey data demonstrates the social participation trajectories with findings that can establish future applications in clinical practice.

Applicability of Research to Practice

The LIBRE Profile is a tool used to monitor social participation after burn injury. Understanding the trajectories of social recovery after injury will inform and optimize both clinical care and resource allocation by providing the ability to benchmark an individual’s recovery with one’s peers.
501 The Role of a Tracheostomy in the Critically Ill Burn Patient
Authors: Saquib Syed , Jesic Lana , Carroll Joseph , Flores Carmen , Chestovich Paul , Fraser Douglas
Published: May 2023

Introduction

Tracheostomy is a commonly performed procedure in critically ill patients requiring prolonged mechanical ventilation. However, nationwide practice patterns for the role of a tracheostomy in critically ill burn patients have not been well described.

Methods

A 25-question Qualtrics online survey was distributed by the American Burn Association (ABA) to their physician members. Questions pertained to practitioner demographics, indications, type of tracheostomy performed, and timing of procedure. The questionnaire further ascertained how presence of inhalation injury and Total Body Surface Area (TBSA) influence timing of tracheostomy; if concurrent percutaneous endoscopic gastrostomy (PEG) tubes were performed, and whether enteral feeds were held prior to tracheostomy.

Results

Thirty-seven surgeons responded to the survey and worked primarily at ABA verified academic burn centers. Open tracheostomy was performed more frequently than percutaneous tracheostomy (73% vs 27%). Eighty-three percent of surgeons deferred concomitant PEG despite healthy overlying skin due to the belief that a patient would eventually pass a swallow evaluation (74%). Tube feeds were routinely held by 67% of surgeons, most commonly 6 or 8 hours prior. The most common indication for tracheostomy was prolonged mechanical ventilation. Fifty-four percent of surgeons routinely perform a tracheostomy through open uninfected 2nd degree neck burns. As for 3rd degree neck burns, 35% will perform a tracheostomy only after excision and grafting. For patients requiring prolonged mechanical ventilation 35% of surgeons had no standard time frame for tracheostomy regardless of TBSA. For mechanically ventilated patients with >20% TBSA burns (excluding neck burns), 40% performed early tracheostomy (0-7 days) and 24% performed delayed tracheostomy (8+days). For ventilated patients with inhalational injuries and TBSA < 20%, 35% had no standard time frame, 16% performed early tracheostomy and 49% performed delayed tracheostomy.

Conclusions

A national tendency toward open tracheostomy, deferring concomitant PEG, and holding tube feeds 6-8 hours prior to tracheostomy was identified. Patients with TBSA >20% seem to undergo earlier tracheostomy more frequently, whereas those with TBSA < 20% with inhalational injury more frequently undergo delayed tracheostomy. Although TBSA appears to impact timing of tracheostomy, evidence based guidelines are lacking to guide clinical practice and additional studies are needed.

Applicability of Research to Practice

Survey results infer practice patterns favoring consideration toward early tracheostomy for patients with >20% TBSA burns requiring prolonged mechanical ventilation.
504 Single Center Outcome Comparisons of Skin Disorders Versus Burns: Time to Reconsider the Automatic Transfer?
Authors: Hollowell Jamie , Nam Jason , Matthew Robert , King Booker , Nizamani Rabia , Williams Felicia , Pak Joyce , Agala Chris
Published: May 2023

Introduction

Patients with complicated wound care, rashes, desquamating skin disorders and necrotizing soft tissue infections are often transferred to burn centers due to the multi-disciplinary expertise in wound care despite the pathophysiology of burn injury being different. Our objective was to critically evaluate outcomes of patients admitted to our institution with skin disorders to patients with burn injury.

Methods

Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All adult patients admitted between January 1, 2012 and June 30, 2022 were eligible for inclusion. Demographics, length of stay (LOS), and mortality were evaluated. Bivariate logistic regression and inverse probability of treatment weighting (IPTW) was performed, and significance was accepted as p< 0.05.

Results

We included 9,821 patients in the study, of whom 805 (8.2%) were admitted with skin disorders. These patients were more likely to be older, Black, of female sex, have longer ICU stays, be on mechanical ventilation, and have complications, p< 0.001. Unadjusted estimates show that patients with skin disorders had 3.84 higher odds of mortality compared to patients admitted for burn injury. However, after adjusting for age, involved body surface area, sex, race, intensive care unit days, mechanical ventilation, inhalation injury, and complications using IPTW, patients with skin disorders twice higher odds of mortality.

Conclusions

Patients with skin disorders have increased morbidity and mortality compared to burn injured patients even when controlling for age, involved body surface area, sex, race, intensive care unit days, mechanical ventilation, inhalation injury, and complications when admitted to our burn unit. Further study is warranted to investigate and mitigate these outcome disparities in this patient population.

Applicability of Research to Practice

This study may demonstrate that all skin conditions are not the same, and may warrant different specialties to improve and optimize outcomes.