bluuebunny/crossref_metadata_2025 huggingface dataset:
uORF4u: a tool for annotation of conserved upstream open reading frames
Authors: Egorov Artyom A , Atkinson Gemma C
Published: May 2023

Upstream open reading frames (uORFs, often encoding so-called leader peptides) can regulate translation and transcription of downstream main ORFs (mORFs) in prokaryotes and eukaryotes. However, annotation of novel functional uORFs is challenging due to their short size of usually <100 codons. While transcription- and translation-level next-generation sequencing methods can be used for genome-wide functional uORF identification, this data are not available for the vast majority of species with sequenced genomes. At the same time, the exponentially increasing amount of genome assemblies gives us the opportunity to take advantage of evolutionary conservation in our predictions of functional ORFs.

Here, we present a tool for conserved uORF annotation in 5ʹ upstream sequences of a user-defined protein of interest or a set of protein homologs. It can also be used to find small conserved ORFs within a set of nucleotide sequences. The output includes publication-quality figures with multiple sequence alignments, sequence logos, and locus annotation of the predicted conserved uORFs in graphical vector format.

Availability and implementation

uORF4u is written in Python3 and runs on Linux and MacOS. The command-line interface covers most practical use cases, while the provided Python API allows usage within a Python program and additional customization. Source code is available from the GitHub page: github.com/GCA-VH-lab/uorf4u. Detailed documentation that includes an example-driven guide available at the software home page: gca-vh-lab.github.io/uorf4u. A web version of uORF4u is available at server.atkinson-lab.com/uorf4u.
Phylogeography of the European ground squirrel, Spermophilus citellus (Rodentia: Sciuridae), in the Balkans
Authors: Rammou Dimitra-Lida , Karaiskou Nikoleta , Minoudi Styliani , Kazilas Christos , Moulistanos Aristotelis , Gkagkavouzis Konstantinos , Ćirović Duško , Nikolić Tijana , Ćosić Nada , Youlatos Dionisios , Triantafyllidis Alexandros
Published: May 2023

The Balkan Peninsula acted as a refugium for many steppic species during the Pleistocene, resulting in a high genetic variability, which, in some cases, presents a northward decreasing latitudinal gradient. In the present study, we investigate the genetic diversity of the European ground squirrel (Spermophilus citellus) in its Balkan distribution, sampled comprehensively across its entire distribution in Greece (133 samples from 21 localities). These samples are compared with others from Serbia (54 samples from eight localities) and the available published data from its range in Europe (124 sequences from GenBank). Our results show that the genetic diversity of the Greek and Serbian populations is not correlated with a latitudinal gradient. However, when the entire European range is considered, the model that best fits the genetic variation of the species is based on the ‘centre–periphery’ hypothesis. The founder (centre) populations of the species were most probably situated in south-eastern Bulgaria and European Turkey and underwent rapid expansion post-glacially, during the Holocene, both northwards (Central Europe) and southwards (Greece), as revealed by the decreased genetic diversity and phylogeographical inference analysis in these marginal regions. These results indicate a particular phylogeographical history of a European species and set a baseline for conservation management in its southern populations.
Fluorescence-guided surgery: comprehensive review
Authors: Sutton Paul A , van Dam Martijn A , Cahill Ronan A , Mieog Sven , Polom Karol , Vahrmeijer Alexander L , van der Vorst Joost
Published: May 2023

Background

Despite significant improvements in preoperative workup and surgical planning, surgeons often rely on their eyes and hands during surgery. Although this can be sufficient in some patients, intraoperative guidance is highly desirable. Near-infrared fluorescence has been advocated as a potential technique to guide surgeons during surgery.

Methods

A literature search was conducted to identify relevant articles for fluorescence-guided surgery. The literature search was performed using Medical Subject Headings on PubMed for articles in English until November 2022 and a narrative review undertaken.

Results

The use of invisible light, enabling real-time imaging, superior penetration depth, and the possibility to use targeted imaging agents, makes this optical imaging technique increasingly popular. Four main indications are described in this review: tissue perfusion, lymph node assessment, anatomy of vital structures, and tumour tissue imaging. Furthermore, this review provides an overview of future opportunities in the field of fluorescence-guided surgery.

Conclusion

Fluorescence-guided surgery has proven to be a widely innovative technique applicable in many fields of surgery. The potential indications for its use are diverse and can be combined. The big challenge for the future will be in bringing experimental fluorophores and conjugates through trials and into clinical practice, as well as validation of computer visualization with large data sets. This will require collaborative surgical groups focusing on utility, efficacy, and outcomes for these techniques.
Value-based neural representations predict social decision preferences
Authors: Guassi Moreira João F , Méndez Leal Adriana S , Waizman Yael H , Tashjian Sarah M , Galván Adriana , Silvers Jennifer A
Published: May 2023

Social decision-making is omnipresent in everyday life, carrying the potential for both positive and negative consequences for the decision-maker and those closest to them. While evidence suggests that decision-makers use value-based heuristics to guide choice behavior, very little is known about how decision-makers’ representations of other agents influence social choice behavior. We used multivariate pattern expression analyses on fMRI data to understand how value-based processes shape neural representations of those affected by one’s social decisions and whether value-based encoding is associated with social decision preferences. We found that stronger value-based encoding of a given close other (e.g. parent) relative to a second close other (e.g. friend) was associated with a greater propensity to favor the former during subsequent social decision-making. These results are the first to our knowledge to explicitly show that value-based processes affect decision behavior via representations of close others.
Pretreatment Vitamin D Concentrations Do Not Predict Therapeutic Outcome to Anti-TNF Therapies in Biologic-Naïve Patients With Active Luminal Crohn’s Disease
Authors: Chanchlani Neil , Lin Simeng , Smith Rebecca , Roberts Christopher , Nice Rachel , McDonald Timothy J , Hamilton Benjamin , Bishara Maria , Bewshea Claire , Kennedy Nicholas A , Goodhand James R , Ahmad Tariq
Published: May 2023

Background and Aims

Vitamin D has a regulatory role in innate and adaptive immune processes. Previous studies have reported that low pretreatment vitamin D concentrations are associated with primary non-response (PNR) and non-remission to anti-TNF therapy. This study aimed to assess whether pretreatment 25-hydroxyvitamin D concentrations predicted PNR and non-remission to infliximab and adalimumab in patients with active luminal Crohn’s disease.

Methods

25-Hydroxyvitamin D concentrations were measured in stored baseline samples from 659 infliximab- and 448 adalimumab-treated patients in the Personalised Anti-TNF Therapy in Crohn’s disease (PANTS) study. Cut-offs for vitamin D were deficiency <25 nmol/L, insufficiency 25–50 nmol/L, and adequacy/sufficiency >50 nmol/L.

Results

About 17.1% (189/1107; 95% CI, 15.0–19.4) and 47.7% (528/1107; 95% CI, 44.8–50.6) of patients had vitamin D deficiency and insufficiency, respectively. 22.2% (246/1107) of patients were receiving vitamin D supplementation. Multivariable analysis confirmed that sampling during non-summer months, South Asian ethnicity, lower serum albumin concentrations, and non-treatment with vitamin D supplementation were independently associated with lower vitamin D concentrations. Pretreatment vitamin D status did not predict response or remission to anti-TNF therapy at week 14 (infliximab Ppnr = .89, adalimumab Ppnr = .18) or non-remission at week 54 (infliximab P = .13, adalimumab P = .58). Vitamin D deficiency was, however, associated with a longer time to immunogenicity in patients treated with infliximab, but not adalimumab.

Conclusions

Vitamin D deficiency is common in patients with active Crohn’s disease. Unlike previous studies, pretreatment vitamin D concentration did not predict PNR to anti-TNF treatment at week 14 or nonremission at week 54.
Maximum phonation time: an independent predictor of late-onset pneumonia after esophageal cancer surgery
Authors: Tawada Kakeru , Higaki Eiji , Abe Tetsuya , Takatsu Jun , Fujieda Hironori , Nagao Takuya , Komori Koji , Ito Seiji , Yoshida Masahiro , Oze Isao , Shimizu Yasuhiro
Published: May 2023

Dysphagia after esophagectomy is a major risk factor for aspiration pneumonia, thus preoperative assessment of swallowing function is important. The maximum phonation time (MPT) is a simple indicator of phonatory function and also correlates with muscle strength associated with swallowing. This study aimed to determine whether preoperative MPT can predict postoperative aspiration pneumonia. The study included 409 consecutive patients who underwent esophagectomy for esophageal cancer between 2017 and 2021. Pneumonia detected by routine computed tomography on postoperative days 5–6 was defined as early-onset pneumonia, and pneumonia that developed later (most often aspiration pneumonia) was defined as late-onset pneumonia. The correlation between late-onset pneumonia and preoperative MPT was investigated. Patients were classified into short MPT (<15 seconds for males and <10 seconds for females, n = 156) and normal MPT groups (≥15 seconds for males and ≥10 seconds for females, n = 253). The short MPT group was significantly older, had a lower serum albumin level and vital capacity, and had a significantly higher incidence of late-onset pneumonia (18.6 vs. 6.7%, P < 0.001). Multivariate analysis showed that short MPT was an independent risk factor for late-onset pneumonia (odds ratio: 2.26, P = 0.026). The incidence of late-onset pneumonia was significantly higher in the short MPT group (15.6 vs. 4.7%, P = 0.004), even after propensity score matching adjusted for clinical characteristics. MPT is a useful predictor for late-onset pneumonia after esophagectomy.
The impact of climate and management on recent mortality inPinus pinasterresin-tapped forests of inland Spain
Authors: Calama Rafael , Martínez César , Gordo Javier , Del Río Miren , Menéndez-Miguélez María , Pardos Marta
Published: May 2023

Recent forest decline and amplified mortality have been documented around the world, mainly triggered by the rising water stress associated with more frequent extreme weather events. However, other abiotic and biotic factors may predispose and contribute to these processes. Mediterranean forests are among the biomes considered highly vulnerable to drought-induced decline and mortality. Pinus pinaster ssp. mesogeensis, is a typical western Mediterranean Forest species widely distributed in Spain, where traditional management has focused on a mixed timber-resin production. In the last decades, the species has experienced a severe and generalized process of decline and mortality, especially on inland areas in the Spanish Northern Plateau. The main objectives of this study were to (1) provide an accurate assessment of P. pinaster mortality in resin-tapped forests within the region, (2) identify the main predisposing and inciting abiotic factors controlling the process of dieback and mortality of the species and (3) develop a model for forecasting the annual rate of mortality at landscape scale. We used operational data collected by the Forest Service during 2012–2019, including annual censuses of tree mortality carried out in lots under resin-tapping and periodical forest management inventories. Analysis using spatiotemporal generalized linear mixed models indicated widespread mortality of the species in the territory, which in some areas reached 20 per cent of the trees over an 8-year period. Tree mortality is triggered in warm and dry years and was accelerated following the extreme droughts of 2017 and 2019. High stand stocking and tree aging have been identified as predisposing factors increasing susceptibility to forest decline and mortality. In addition, stands where the species grows mixed with Pinus pinea are more vulnerable, pointing to a possible displacement of P. pinaster in the territory. The developed spatiotemporal generalized linear mixed model allows unbiased estimates of the annual rate of mortality to be calculated through the territory. The model may be used by forest managers in order to identify the most vulnerable areas where the application of adaption strategies should be prioritized, in order to preserve these forests and their associated provision of ecosystem services.
Transcriptome profiling of the Caenorhabditis elegans intestine reveals that ELT-2 negatively and positively regulates intestinal gene expression within the context of a gene regulatory network
Authors: Williams Robert T P , King David C , Mastroianni Izabella R , Hill Jessica L , Apenes Nicolai W , Ramirez Gabriela , Miner E Catherine , Moore Andrew , Coleman Karissa , Nishimura Erin Osborne
Published: May 2023

ELT-2 is the major transcription factor (TF) required for Caenorhabditis elegans intestinal development. ELT-2 expression initiates in embryos to promote development and then persists after hatching through the larval and adult stages. Though the sites of ELT-2 binding are characterized and the transcriptional changes that result from ELT-2 depletion are known, an intestine-specific transcriptome profile spanning developmental time has been missing. We generated this dataset by performing Fluorescence Activated Cell Sorting on intestine cells at distinct developmental stages. We analyzed this dataset in conjunction with previously conducted ELT-2 studies to evaluate the role of ELT-2 in directing the intestinal gene regulatory network through development. We found that only 33% of intestine-enriched genes in the embryo were direct targets of ELT-2 but that number increased to 75% by the L3 stage. This suggests additional TFs promote intestinal transcription especially in the embryo. Furthermore, only half of ELT-2's direct target genes were dependent on ELT-2 for their proper expression levels, and an equal proportion of those responded to elt-2 depletion with over-expression as with under-expression. That is, ELT-2 can either activate or repress direct target genes. Additionally, we observed that ELT-2 repressed its own promoter, implicating new models for its autoregulation. Together, our results illustrate that ELT-2 impacts roughly 20–50% of intestine-specific genes, that ELT-2 both positively and negatively controls its direct targets, and that the current model of the intestinal regulatory network is incomplete as the factors responsible for directing the expression of many intestinal genes remain unknown.
All-Cause Readmission or Potentially Avoidable Readmission: Which Is More Predictable Using Frailty, Comorbidities, and ADL?
Authors: Mitsutake Seigo , Ishizaki Tatsuro , Yano Shohei , Tsuchiya-Ito Rumiko , Uda Kazuaki , Toba Kenji , Ito Hideki
Published: May 2023

Background and Objectives

Readmission-related health care reforms have shifted their focus from all-cause readmissions (ACR) to potentially avoidable readmissions (PAR). However, little is known about the utility of analytic tools from administrative data in predicting PAR. This study determined whether 30-day ACR or 30-day PAR is more predictable using tools that assess frailty, comorbidities, and activities of daily living (ADL) from administrative data.

Research Design and Methods

This retrospective cohort study was conducted at a large general acute care hospital in Tokyo, Japan. We analyzed patients aged ≥70 years who had been admitted to and discharged from the subject hospital between July 2016 and February 2021. Using administrative data, we assessed each patient’s Hospital Frailty Risk Score, Charlson Comorbidity Index, and Barthel Index on admission. To determine the influence of each tool on readmission predictions, we constructed logistic regression models with different combinations of independent variables for predicting unplanned ACR and PAR within 30 days of discharge.

Results

Among 16 313 study patients, 4.1% experienced 30-day ACR and 1.8% experienced 30-day PAR. The full model (including sex, age, annual household income, frailty, comorbidities, and ADL as independent variables) for 30-day PAR showed better discrimination (C-statistic: 0.79, 95% confidence interval: 0.77–0.82) than the full model for 30-day ACR (0.73, 0.71–0.75). The other prediction models for 30-day PAR also had consistently better discrimination than their corresponding models for 30-day ACR.

Discussion and Implications

PAR is more predictable than ACR when using tools that assess frailty, comorbidities, and ADL from administrative data. Our PAR prediction model may contribute to the accurate identification of at-risk patients in clinical settings who would benefit from transitional care interventions.
Awareness of Age-Related Gains and Losses in a National Sample of Adults Aged 80 Years and Older: Cross-Sectional Associations With Health Correlates
Authors: Kaspar Roman , Wahl Hans-Werner , Diehl Manfred
Published: May 2023

Background and Objectives

Advanced old age is a life stage with a high likelihood of age-related loss experiences. However, little is known about remaining gain experiences and their relation with perceived losses and health correlates in community-dwelling very old adults. Moreover, virtually nothing is known in this regard about the experiences of individuals in long-term care settings. First, we strived to establish the normative course of age-related gains and losses in advanced old age. Second, we examined whether such gain/loss perceptions in advanced aging moderated health correlates.

Research Design and Methods

Data came from the nationally representative survey “Old Age in Germany D80+” conducted in 2020/2021. The sample comprised 10 578 individuals aged 80–106 years, including 587 individuals in long-term care. We used the multidimensional Awareness of Age-Related Change (AARC) questionnaire and moderated regression to analyze associations with late-life health and functioning correlates.

Results

Levels of AARC-Gains were higher than those of AARC-Losses across most of the age range. Long-term care residents showed more AARC-Losses and fewer AARC-Gains compared with community-dwelling adults and contributed significantly to an overall negative balance of more losses than gains in those aged 90 years or older. Regarding functional health and autonomy, negative age effects were amplified by AARC-Losses, but buffered by AARC-Gains. A more positive ratio of gains-to-losses predicted better health and functioning.

Discussion and Implications

Findings suggest that the loss aspect of development in very late life might have been overstated in the existing literature. Perceived gains and losses are of critical importance for the understanding of health correlates in very old age.
Shareholder Claims for Reflective Loss in Investor-State Dispute Settlement: Proposing Reform Options for States
Authors: Suraweera Anuki
Published: May 2023

The rule against reflective loss claims by shareholders is a fundamental tenet of corporations law, accepted across numerous domestic law jurisdictions and under customary international law. Yet bilateral investment treaties (BITs) have long broken from this conventional approach by allowing shareholders to bring claims for their indirect loss. UNCITRAL Working Group III has identified that this anomalous approach to shareholder claims may be an issue in relation to which reform is desirable. In support of Working Group III’s multilateral reform agenda, this article examines a range of reforms options available to States concerning shareholder reflective loss claims, and suggests that treaty-based derivative claims mechanisms are a suitable choice for reform. Derivative claims mechanisms have been included in a number of international investment agreements (IIAs), although the arbitral practice in relation to such provisions has not previously been the subject of close scrutiny. The examination of this arbitral practice, drawing in particular from past practice applying the North American Free Trade Agreement, reveals that tribunals have not consistently interpreted these mechanisms as precluding shareholder reflective loss claims, indicating that States need to include explicit clarificatory treaty language to render these clauses effective.
All surgical supra-annular aortic valvar tissue prostheses are labelled too large
Authors: van Boxtel Astrid Gerritje Maria , Mariani Massimo Alessandro , Ebels Tjark
Published: May 2023

OBJECTIVES

Surgical supra-annular aortic valvar tissue prostheses are labelled in an inconsistent and confusing manner. If the replaced valve is too small for a given patient, the risk of patient-prosthesis mismatch is increased, which is associated with the risk of morbidity and mortality. The labelled diameter (LD) of these valves should coincide with the inflow orifice diameter (IOD). Therefore, our goal was to measure all relevant IODs.

METHODS

Valvar design was assessed in terms of the intended position of the valve in relation to the patient’s annulus. The IODs of all available supra-annular aortic valvar prostheses were measured using a conical gauge. The IODs were compared to the LDs. We searched for instructions for use, websites, packing boxes and regulatory institutions involved in the process.

RESULTS

Eight valve models from 4 manufacturers were included. None of these valves were clearly labelled as supra-annular on the packing box, although for 3, the supra-annular label could be found in the written specifications. All valves had an IOD smaller than their LD, with a median difference of 15% (range: 4%–25%). The departure from LD differed per valve model and valve size.

CONCLUSIONS

Valve packages should be labelled accurately and clearly so that surgeons can make a well-informed choice. Currently essential information is missing because the intended position in relation to the annulus is not consistently marked on the packing boxes, and valve sizes are labelled incorrectly. We propose a change for the better: relabel all valves according to their true IOD in a structured manner.
Sharp concentration results for heavy-tailed distributions
Authors: Bakhshizadeh Milad , Maleki Arian , de la Pena Victor H
Published: May 2023

We obtain concentration and large deviation for the sums of independent and identically distributed random variables with heavy-tailed distributions. Our concentration results are concerned with random variables whose distributions satisfy $P(X>t) \leq{\text{ e}}^{- I(t)}$, where $I: \mathbb{R} \rightarrow \mathbb{R}$ is an increasing function and $I(t)/t \rightarrow \alpha \in [0, \infty )$ as $t \rightarrow \infty $. Our main theorem can not only recover some of the existing results, such as the concentration of the sum of sub-Weibull random variables, but it can also produce new results for the sum of random variables with heavier tails. We show that the concentration inequalities we obtain are sharp enough to offer large deviation results for the sums of independent random variables as well. Our analyses which are based on standard truncation arguments simplify, unify and generalize the existing results on the concentration and large deviation of heavy-tailed random variables.
T1 Burn Behavioral Health: Development and Preliminary Results of Burn Center-Based Stepped-Care Program for Burn Survivors
Authors: Gavrilova Yulia , Cerre Raleigh , Ficalora Julia , Tatiana Davidson , Ruggiero Kenneth , Lesher Aaron , Kahn Steven A
Published: May 2023

Introduction

Annually, nearly half a million people in the U.S. receive medical treatment for burns, 40,000 of whom are hospitalized. Burn patients experience significant psychological burden during acute burn treatment. Long-term psychiatric problems are highly prevalent compared to patients with other injuries. Undetected or untreated psychiatric symptoms can complicate recovery, increase length of stay, and cause long-term problems and readmission. Burn centers are ideally suited to provide these services to burn patients on an inpatient and outpatient basis; however, few burn centers in the U.S. have mental health programs to address patients’ needs. This presentation will describe the Burn Behavioral Health (BBH) program, a burn center-based technology-enhanced stepped-care model of delivering mental health services for burn survivors, spanning the inpatient to outpatient continuum. This model was adapted from the Trauma Resilience and Recovery Program which has been successful in meeting the needs of traumatic injury patients.

Methods

Data were collected as part of clinical care. BBH includes 4 main steps: (1) initial screening, education, and early intervention; (2) symptom self-monitoring and self-help resources; (3) follow-up screening 30 days post-injury; and (4) provision of best-practice mental health treatment for patients who need it, using both in-person and telehealth modalities, including individual and skill-based group therapy.

Results

Between February 2021 and September 2022, 384 patients were identified as eligible for BBH services. Of these, 342 (90%) were enrolled in BBH and completed initial screening. 50% of patients screened positive for depression/PTSD risk or symptoms and were offered brief intervention. 54% of enrolled survivors received brief intervention, 21% of whom completed more than one session. We reached 84% of patients for the 30-day follow-up, 20% of whom screened positive for depression/PTSD and 29% were connected to mental health services.

Conclusions

This study provides preliminary support demonstrating that BBH is sustainable and capable of reaching and engaging a large proportion of burn patients across the inpatient to outpatient continuum. In the U.S., only 25% of burn centers have structured screening in place for inpatient and 11% for outpatient burn survivors. Data from the traumatic injury population (which includes burns) suggest only 10% of patients received intervention after a positive screen and 42% did not know how or where to get help. Psychological recovery is an essential component of a comprehensive burn program and availability of psychological screening and intervention is a requirement for the ABA verification.

Applicability of Research to Practice

BBH shows promise in increasing access and quality of mental health care to address the unique needs of burn survivors.
T5 Temperature Derangement on Admission Predicts Mortality in Burn Patients—a Nationwide Analysis and Opportunity for Improvement
Authors: Stanton Eloise
Published: May 2023

Introduction

While single-institution studies have described the relationship between hypothermia, burn severity, and complications, there are no national estimates on how temperature on admission impacts hospital mortality. This study aims to evaluate the relationship between admission temperature and complications on a national scale to expose opportunities for improved outcomes.

Methods

The US National Trauma Data Bank (NTDB) was analyzed between 2007-2018. Mortality was modeled using multivariable logistic regression including burn severity variables (% total burn surface area (TBSA), inhalation injury, emergency department (ED) temperature), demographics, and facility variables. Temperature was parsed into three categories: hypothermia ( < 36.0°C), euthermia (36.0-37.9°C), and hyperthermia (≥38.0°C).

Results

116,796 burn encounters were included of which 77.9% were euthermic, 20.6% were hypothermic and 1.45% were hyperthermic on admission. For every 1.0C drop in body temperature from 36.0°C, mortality increased by 5%. Both hypothermia and hyperthermia were independently associated with increased odds of mortality when controlling for age, gender, inhalation injury, number of comorbidities, and %TBSA (p < .001). All temperatures below 36.0°C were significantly associated with increased odds of mortality. Patients with ED temperatures between 32.5-33.5°C had the highest odds of mortality across the cohort (22.0, 95% CI 15.6-31.0, p< .001).

Conclusions

ED hypothermia and hyperthermia are independently associated with mortality even when controlling for known covariates associated with inpatient death. These findings underscore the importance of early warming interventions both at the prehospital stage and upon ED arrival. ED temperature could become a quality metric in benchmarking burn centers to improve mortality.

Applicability of Research to Practice

This study provides national-scale data on the important relationship between ED temperature and mortality that can substantially impact both prehospital and hospital policies and practice and subsequently improve patient care.
38 Burn Prevention and Education for Newcomers to North America
Authors: Bharadia Shyla , Galbraith Andrew , Lamb Alec , Babwani Ali , Gabriel Vincent , Sahota Preet , Chockalingam Keerthana , Sinha Sarthak
Published: May 2023

Introduction

The experience of a city’s fire department suggested regions typically home to immigrant and multigenerational families show increased occurrence of fire calls. This study explored the incidence of fire calls in our city stratified by geographic ward and identified opportunities for fire and thermal injury prevention in immigrants.

Methods

This study was approved by our university’s research ethics board. Fire call data from 2016-2021 was used to characterize adjusted fire totals, civilian injuries, incident descriptions, sources of fire ignition, type of material, area of origin, and contribution to ignition of these fires by ward. ANOVAs were performed to reveal differences in fire characteristics between wards. High fire occurrence wards were classed as at greater risk and probable targets for prevention. To follow, an open ended interview was conducted with a newcomer organization in the city to elucidate factors that contribute to thermal injury risk in immigrants. Interview content was informed by a literature search around the factors and impact of burn injury in immigrants to North America, Europe, and Australia. Interview responses were thematically analyzed.

Results

The city is stratified into 14 wards, within which there are several communities described by income, education, immigration diversity and more. Between wards, total adjusted fire incidents were not significantly different (p = 0.119). Though, fire characteristics did differ regionally. Common fire incident descriptions included vehicle/structure, trash and cooking fires with less variability by ward in the number of cooking fires compared to the two former. Contributions to ignition were frequently human related. The supplementary interview highlighted individual burn risk as multifactorial. Cultural norms (notably cooking practices and equipment such as pressure cookers), inexperience (related to weather and frostbite risk), and participation in entry level jobs (including cooking) may impart increased burn risk to immigrants. Senior immigrants were noted to be specifically at risk for burns given their propensity to retain cultural cooking norms.

Conclusions

Newcomers may face increased fire and thermal injury risk that can be attributed to occupational hazards not specific to immigrants and adjustment to a new way of life. Given that many fires and injuries are connected to cooking, kitchen safety and environmental education becomes important to enable safer engagement in cultural practices. Follow up to this work includes matching high fire incidence wards to their resident immigrant groups for targeted prevention.

Applicability of Research to Practice

Inclusion of race and ethnicity in burn registries may assist in recognizing at risk groups for burn prevention and serve as a retrospective comparator to assess the impact of population specific burn prevention efforts.
41 An Examination of Factors Predicting Inpatient Rehabilitation Stay After Burn Injury
Authors: Turgeon Lori , Dellheim Vanessa , O'Neil Audrey , Schneider Jeffrey , Shepler Lauren J , Bamer Alyssa , Ryan Colleen , Kazis Lewis , Kowalske Karen , Suman-Vejas oscar , Orton Caitlin , Stewart Barclay
Published: May 2023

Introduction

Rehabilitation services improve the functional recovery of people who have experienced burn injury. Therapy services are often initiated during patients’ hospitalization and continue for months to years after discharge. However, numerous factors contribute to a patient’s overall complexity and functional impairments following discharge and need for Inpatient Rehabilitation (IR). Characteristics associated with longer IR stays have not been well explored. This study aimed to examine patient and clinical factors associated with length of IR stay. We hypothesized that burn severity, including size and location, as well as insurance payor will be associated with length of rehabilitation time.

Methods

Adult participants in Burn Model System National Database (1994-2022) who were discharged to IR following their hospital stay were included. A negative binomial regression analysis examined the association between IR days and demographic and injury characteristics including age, gender, burns to critical areas (head and neck, perineum, hand), payor, etiology, circumstance of injury, and range of motion deficits. A p-value less than 0.05 was considered significant.

Results

The study included 585 participants who were 72% male with mean age 46.1 (SD 16.8), and mean burn size 34.6% (20.5) total body surface area (TBSA). Average IR days were 22.8 (19.3). For every 1% increase in TBSA burned there was a 1% increase in IR days. Similarly, each additional 1 ventilator day was associated with an 1% increase in IR days. Electrical injuries were associated with 44% more IR days than flame injuries. Self-inflicted injuries were associated with 55% more IR days, while hand burns were associated with 18% decrease in IR days. Self-pay, philanthropy or other insurance coverage was associated with 37% fewer IR days. Of note, range of motion deficits were not significantly associated with IR days.

Conclusions

Longer IR stays were associated with greater burn severity, etiology (electrical), and circumstance (self-inflicted), all of which are markers of overall case complexity. Shorter IR stays were associated with specific injury location (hand), though reasoning for this needs further investigation. Payor type was also associated with shorter IR stay, which highlights risk of inequity in rehabilitation service delivery.

Applicability of Research to Practice

These findings can help clinicians set expectations regarding IP for patients and families, and advocate for strategies to deliver rehabilitation services more equitably.
45 A Three Year Analysis of a Multi-tiered Orthotic Protocol
Authors: Martinez Andria , Verdugo Selene , Warthman Renee , Islas Claudia , Murray Derek , Foster Kevin
Published: May 2023

Introduction

A variety of factors affect the fit of custom orthoses in those with burn injuries. A resting hand orthosis (RHO) is a common device within burn care, yet fabrication and fitting of this custom orthosis requires precision and expert assessment. However, burn therapists have varying degrees of education and credentials and previously we had noted preventable complications. Our center implemented a multi-tiered protocol focused on custom RHOs and found a marked decrease in complications immediately following implementation. The purpose of this QI project was to evaluate whether these improvements had been sustained over the following three-year period.

Methods

This was a retrospective chart review. Per protocol an RHO could be fabricated by a single certified hand therapist (CHT) or co-fabricated by two (non-CHT) therapists. Incidence of orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) was the primary outcome measure. Other data collected were average time to fabricate & modify devices and average refabrication(s) required between CHT vs non-CHT devices. Patients with missing data points was excluded.

Results

Eighty-five patient hands were examined from 2019-2022. Prior to implementation, total erythema occurrences were reported in 23.4% of orthoses (n=18) and total orthotic induced partial thickness injury occurred in 11.7% (n=9) of cases. Post protocol implementation erythema occurred in 5% of cases (n=5), and partial thickness injury in 0% of cases (n=0). This represents a decrease of 95% and 100%, respectively. On average CHTs fabricated RHOs in 59 minutes vs 48 minutes for non CHTs. CHTs had a complication rate of 0.0% vs 10.98% for non-CHTs. Potential complication was also limited to 0.0% for CHTS and 27% of non-CHTs. Modification rates were limited to 18.75% for CHTS vs 47.56% of non-CHTs.

Conclusions

Data from this QI project showed a clinically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses. Since instituting our protocol focusing on RHOs, our center has decreased complications and potential complications to improve patient outcomes. Although, most therapists receive standard education, it can be inferred that CHTs may approach orthotic fabrication through a different lens. The required studying and education required to maintain an advanced practice certification may benefit burn therapy departments. Therapists without this specialty certification can enhance skill and outcomes via co-fabrication and assessment.

Applicability of Research to Practice

Orthotic induced erythema may be decreased by utilizing CHTs or two non-CHTs to manage RHOs. This protocol can be expanded to include other orthoses or with other advanced certifications.
46 Integration of Cutaneous Functional Units Principles in Burn Rehabilitation: A Diffusion of Innovations Assessment
Authors: Yelvington Miranda , Parry Ingrid
Published: May 2023

Introduction

Early recognition of burn scar contractures can lead to a more targeted and effective therapy regimen, potentially preventing loss of range of motion and improving burn survivors' quality of life. In burn rehabilitation, consideration of the principles of cutaneous functional units (CFUs), or fields of skin as they relate to movement at associated joint, can allow occupational and physical therapists to explain and predict limitations and formulate treatment plans individualized to each patient’s pattern of injury. Evidence-based research demonstrates the potential of CFU principles to improve upon the current standard of care, but the consistent use of these principles has been slow to diffuse through burn care. The Diffusion of Innovations theory, by Everett M. Rogers, provides a framework for the examination of the process by which CFU principles (innovation) have been diffused into clinical burn practice (channel) since its emergence in burn literature (time) within the burn therapy network (social system).

Methods

Using purposive sampling survey invitations were sent to occupational and physical therapists who work in burn care and posted to therapy-related social media groups. Responses were collected and demographic variables and trends were analyzed and are reported here.

Results

Respondents (297) were Occupational Therapist (52%) and Physical Therapists (49%) and were inclusive of all practice areas. The majority of respondents work in a burn unit (81%) in North America (70.7%). Most respondents (78.4%) report familiarity with the term CFU as it relates to burn rehabilitation. Of those familiar, the majority of respondents reported their knowledge (66.7%) and ability to apply (65.7%) at an intermediate level or greater. A slight majority (59.3%) responded that the CFU concepts influenced their performance of burn rehab, while 40.7% said the concepts did not influence their practice. 40-69% of respondents correctly answered CFU knowledge questions but only 15% of respondents correctly completed CFU identification questions. Respondents (77%) report barriers to the use of CFUs including difficulty incorporating into practice, time constraints, and the need for more education. Only 5.9% of respondents endorsed no interest in using CFU concepts.

Conclusions

Survey respondents recognize the relative advantage of using CFU concepts and find them compatible with current values and practices. However, barriers in knowledge and applicability exist, suggesting that current educational resources have not enabled the information to be easily understood and applied. Diffusion can be improved by developing tools to assist therapists in understanding and incorporating CFU principles.

Applicability of Research to Practice

This framework can be used to develop a strategy to enhance CFU diffusion within the burn therapy community.
47 Burn Injury Assessment Study (BIAS): Is There Room To Improve?
Authors: Carter Jeffrey , Phelan Herbert , Friedstat John , Hickerson William , Holmes James , Hwang James , Kahn Steven , Savetamal Alisa , Shupp Jeffrey
Published: May 2023

Introduction

The treatment of burn injured patients requires accurate wound assessment to determine appropriate interventions. Clinical assessment of burn depth, even by experts in the field, has an accuracy of only 60–80%. The purpose of this study is to estimate the performance of burn wound assessment by burn care professionals from still images.

Methods

This was an IRB-approved prospective cohort study in which burn care providers used a tablet-based digital interface to answer a 10-item questionnaire and to identify non-healing burn wounds from 5 patients scenarios. Each wound was evaluated using a polygon software interface to mark non-healing regions within the wound. Each wound had a ground truth determined by a consensus panel of study investigators using still photograph at 21-days post-injury to discern healing and non-healing regions. A power analysis and sample size of 100 participants produced a two-sided 95% confidence interval with a width equal to 0.20 when the sample proportion is 0.60. Continuous variables were analyzed by mean, standard deviations, median and quartiles while categorical data was analyzed as exact number and percentage. Burn wound assessment performance metrics for the providers were calculated for the whole cohort and then for subgroups using point estimate at a pixel level. Accuracy, sensitivity, specificity, area positive predictive value (APPV), and area negative predictive value (ANPV) were calculated from the ground truth and participants selected regions of non-healing wounds.

Results

One hundred fifty-six healthcare providers enrolled (50 physicians, 14 APPs, 63 nurses, 24 therapists, and 5 paramedics) with 9.96 ± 9.49 mean years of experience and 70% employed at a verified burn center. All five regions were represented in the analysis (Eastern Great Lakes (4%), Midwestern (6.5%), Northeastern (22%), Southern (53.5%), and Western (14%). 29.3% of the participants selected “schedule for surgery” when reviewing images of wounds that healed without surgery. 28.7% of the participants selected, “local wound care no surgery needed or, “local wound care, reassess in 7+ days for possible surgery.” Performance measures were not associated with years of experience. Overall performance is available in Table 1.

Conclusions

Improving burn wound assessment performance could improve our use of limited resources in burn care by optimizing patient transfers/treatments and avoiding unnecessary surgeries. Our study expands upon prior work in the field and demonstrates that burn wound assessment has significant room for improvement. These findings open the proverbial door for diagnostic devices found in other fields of medicine and our partnership with emergency room providers to advance burn care.

Applicability of Research to Practice

More accurate wound assessment will lead to improved treatment and triage by EM and Burn practitioners.
48 Iatrogenic Vitamin A Toxicity Leading to Hypervitaminosis and Hypercalcemia: A Case Series and Cautionary Tale
Authors: Hall Alexandria , King Jessie , Tobias Laura , Stewart Barclay , Rhodes Lori
Published: May 2023

Introduction

Patients with major burn injuries receive micro-nutrient supplementation to promote wound healing and mitigate hypermetabolic complications. Vitamin A promotes epithelialization, angiogenesis and collagen synthesis and is included in ‘trauma vitamin’ bundles. As a fat-soluble vitamin, prolonged supplementation can lead to cumulative toxicity. Hypercalcemia can cause polyuria, ECG changes, and organ dysfunction. We report a case series of potential iatrogenic vitamin A toxicity among people with major burn injury.

Methods

Concern for vitamin A toxicity was raised by pharmacy and endocrinology after two patients were found with severe hypercalcemia and a consistent toxidrome. In response, we performed a chart review of adult patients with ≥20% TBSA who received vitamin A 25,000 units thrice weekly for at >2 weeks during March 2021 – July 2022. Hypercalcemia was defined as serum calcium concentration >10.4 mg/dL ( >2.60 mmol/L) or ionized serum calcium >5.2 mg/dL ( >1.30 mmol/L). Kruskal-Wallis test examined differences in median values.

Results

A total of 67 patients met screening criteria with 25 included in the series. Nine patients (36%) developed hypercalcemia. One patient developed hypercalcemia on day 5 of admission and was excluded. Median days to hypercalcemia was 52 (IQR 39-72). There were no differences in age, burn size, or weight between patients with and without hypercalcemia. Patients with hypercalcemia had significantly longer courses of vitamin A (56 vs 27 days, p=0.03) as well as length of stay (122 vs 63 days, p=0.01). One patient required treatment with a bisphosphonate. All improved with cessation of vitamin A supplementation.

Conclusions

A third of patients who received high-dose vitamin A as per a micronutrient supplementation protocol developed hypercalcemia. Our protocol was changed to limit vitamin A therapy to 21 days. Given that hypercalcemia among hospitalized patients is multifactorial, further evaluation with a larger case-control study is required to determine if high-dose vitamin A is a contributing factor.

Applicability of Research to Practice

Recommended daily allowance of vitamin A is ~3,000 units daily. Given that patients on enteral feedings receive approximately 3,600 units daily, vitamin A supplementation may result in toxicity if provided for >3-5 weeks.