bluuebunny/crossref_metadata_2025 huggingface dataset:
Formulating Instrumentalism
Authors: Brinkmann Matthias
Published: April 2024

Liberal instrumentalism claims that legitimacy depends on justice, similar to how consequentialism claims that rightness depends on goodness. This chapter considers some issues how one might formulate this relationship more precisely, coming to the result that: (1) legitimate institutions should best promote justice within feasible limits, instead of just being good enough at promoting justice (maximizing instrumentalism); (2) there is no privileged level on which instrumentalism applies, instead of setting a specific focus on, say, constitutional essentials (omnifocal instrumentalism); and (3) legitimate institutions best promote justice relative to the best theory of justice and the best available empirical evidence (mixed instrumentalism). Some problems with the possibility that justice’s scope might be limited are also discussed.
‘All brilliant gloss’: the liminal visual in Softley’s The Wings of the Dove
Authors: Bartlett Jami
Published: April 2024

This article examines Ian Softley’s 1997 adaptation of Henry James’s 1902 novel The Wings of the Dove as a study in the representation of liminal sociocultural moments, specifically through its infusive representation of the character of Aunt Maud, played in the film by Charlotte Rampling. James’s Maud is the financial centre of the narrative, a complex and contradictory weaponization of philistine convention and vulgar immorality, a collage of surfaces repeatedly described as gloss on a double-sided coin. James felt that the diffusiveness of Maud’s power was the novel’s structural problem, because it inhabited a liminal space where the desires of the individual coextend with the desires of the market, and thereby dislocated the centre of critique and control in the text, moving the reader further and further away from the commercial trappings of their cultural moment. The filmmakers claimed that eliminating Maud allowed them to update the novel’s language, costumes, etiquette, and environment for a younger audience, but the film was dismissed as a pandering cash grab, an attempt to make Henry James a brand. In this way, the film diminishes Maud’s presence but empowers her narrative agency; resituating James’s brand of displacement, alienation, and loss into a liminal environment makes Maud’s commercial influence so inescapable and self-reflexive that it makes the film look like one of her many enterprises.
Accuracy of MRI-ultrasound fusion-guided and systematic biopsy of the prostate
Authors: in de Braekt Thomas , van Rooij Sanne B T , Daniels-Gooszen Alette W , Scheepens Wout A , de Jongh Rik , Bosch Steven L , Nederend Joost
Published: April 2024

Objectives

Prostate multiparametric MRI (mpMRI) with subsequent targeted biopsy of suspicious lesions has a critical role in the diagnostic workup of prostate cancer. The objective was to evaluate the diagnostic accuracy of systematic biopsies, targeted biopsies, and the combination of both in prostate cancer detection.

Methods

From January 1, 2013 to June 1, 2022, biopsy-naïve and prior biopsy-negative patients who underwent both systematic and targeted biopsies were included. MRIs were evaluated according to PI-RADS with biopsy threshold set at PI-RADS ≥3. Systematic biopsies consisted of 8-12 cores, based on prostate volume. Overall prostate cancer and clinically significant cancer (Gleason Score ≥3 + 4) detection rates were stratified based on PI-RADS and location within the prostate, and compared between biopsy types using McNemar test.

Results

Among 867 patients, 615 had prostate cancer, with 434 clinically significant cases. Overall detection rates were: PI-RADS 3 48%, PI-RADS 4 72%, and PI-RADS 5 90%. Detection rates for clinically significant cancer were 21%, 53%, and 72%, respectively. The combination of biopsy methods was most accurate in detecting clinically significant prostate cancer (P < .001). Targeted biopsies alone detected more clinically significant prostate cancer than systematic biopsies alone (43.1% vs 40.3%, P = .046). For posterior PI-RADS 5 lesions, no statistically significant difference was found between all biopsy methods.

Conclusions

In the detection of clinically significant prostate cancer, the combination of systematic and targeted biopsies proves most effective. Targeted biopsies rarely missed significant cancer for posterior PI-RADS 5 lesions, suggesting systematic biopsies could be reserved for instances where targeted biopsy results are negative.

Advances in knowledge

This study emphasizes on the efficacy of mpMRI and targeted biopsies in suspected prostate cancer in real-world clinical context. For PI-RADS 5 lesions, systematic biopsies provide limited clinical benefit and may only be necessary when targeted biopsy results are negative.
I prefer the MitraClip in these cases: the 5-year COAPT data
Authors: Bartorelli Antonio L , Grancini Luca , Monizzi Giovanni , Gallinoro Emanuele , Mastrangelo Angelo , Mallia Vincenzo , Fabbiocchi Franco , Andreini Daniele
Published: April 2024

The COAPT 5-year data demonstrate that compared with medical treatment transcatheter edge-to-edge repair (TEER) with the MitraClip in symptomatic patients with Grade 3+/Grade 4+ secondary mitral regurgitation (SMR) reduced by nearly half the annualized hospitalization risk (33 vs. 57%), by almost 30% the death rate (57 vs. 67%) and achieved significant and durable SMR reduction in 95% of patients. Control patients who crossed over to TEER at 2 years had better prognosis, but nearly half of them died before reaching crossover eligibility. Death or hospitalization for heart failure (HHF) occurred in 73.6% of TEER patients and 91.5% of controls within 5 years, pointing to a need for further study to address left ventricle (LV) dysfunction, the underlying cause of patient’s disease. MTRA-FR targeted SMR using the same device and did not improve the composite endpoint of all-cause mortality or HHF at 12 months. Possible reasons for the discrepancy include enrolment of patients with more severe MR and less-advanced LV disease (dilation/dysfunction), less-procedural complications, and higher success in reducing MR in COAPT compared with MITRA-FR. Thus, the ideal patient for MitraClip treatment would be one with severe MR, but with no too severe LV dilation/dysfunction, which is what differentiates COAPT patients from those in MITRA-FR.
The role of sodium–glucose co-transporter 2 inhibitors in myocardial infarction: available evidence and future perspectives
Authors: Tavecchia Giovanni Amedeo , Gualini Elena , Sacco Alice , Oliva Fabrizio
Published: April 2024

There is an unmet need for new treatment options for patients with acute myocardial infarction (AMI) as progress in patients’ outcomes has plateaued over the past 15 years. Sodium–glucose co-transporter 2 (SGLT2) inhibitors have demonstrated cardio-renal benefits in various disease states, encompassing diabetes mellitus, chronic kidney disease, and heart failure. Experimental studies further support their use in AMI, demonstrating beneficial effects in animal models by reducing infarct size and mitigating adverse cardiac remodelling. Recently, two clinical trials have been published thus paving the way for a new field to explore. This paper briefly outlines the available evidence and future perspectives regarding the use of SGLT2 inhibitors in this clinical scenario.
Immediate multivessel revascularization after myocardial infarction: change of strategy?
Authors: Capranzano Piera , Lombardo Luca
Published: April 2024

Multivessel coronary artery disease (MVD) is a frequently encountered condition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) of the culprit vessel. Several studies have demonstrated the benefit of complete coronary revascularization compared with the treatment of the culprit lesion only in patients with STEMI. Based on this evidence, the current European guidelines recommend that in haemodynamically stable patients with STEMI and MVD, routine complete revascularization should be achieved either during the same procedure in concomitance with the treatment of the culprit lesion (immediate multivessel PCI) or with a subsequent intervention within 45 days from the index PCI of the culprit lesion (deferred multivessel PCI). However, the guidelines do not express a preference for immediate vs. delayed multivessel PCI. Therefore, the optimal timing of the treatment of non-culprit lesions in patients with STEMI and haemodynamic stability is still debated and has been evaluated in recent studies that showed the non-inferiority of immediate vs. delayed multivessel PCI. The article discusses the results and clinical implications of these studies on the timing of complete revascularization of non-culprit lesions in haemodynamically stable patients with STEMI.
The point on the treatment of arrhythmic storm
Authors: Lazzari Ludovico , Donzelli Stefano , Tordini Alessandra , Parise Antonio , Pirozzi Ciro , Di Meo Federica , Marallo Carmine , Pace Vincenzo , Marini Chiara , Carreras Giovanni
Published: April 2024

Arrhythmic storm is a clinical emergency associated with high mortality, which requires multi-disciplinary management. Reprogramming of the implantable cardiac defibrillator (ICD) aimed at reducing shocks, adrenergic blockade using beta-blockers, sedation/anxiolysis, and blockade of the stellate ganglion represent the first simple and effective manoeuvres, but further suppression of arrhythmias with antiarrhythmics is often required. A low-risk patient (e.g. monomorphic ventricular tachycardia, functioning ICD, and haemodynamically stable) should be managed with a beta-blocker (possibly non-selective) plus amiodarone, in addition to sedation with a benzodiazepine or dexmedetomidine; in patients at greater risk (high burden and haemodynamic instability), autonomic modulation with blockade of the stellate ganglion and the addition of a second antiarrhythmic (lidocaine) should be considered. In patients refractory to these measures, with advanced heart failure, general anaesthesia with intubation and the establishment of a haemodynamic circulatory support should be considered. Ablation, performed early, appears to be superior in terms of mortality and reduction of future shocks compared with titration of antiarrhythmics.
Brugada syndrome: identification of subjects at risk and therapy
Authors: Gaita Fiorenzo , Cerrato Natascia , Giustetto Carla , Garberoglio Lucia , Calò Leonardo
Published: April 2024

Brugada syndrome mainly affects young subjects with structurally normal heart and can cause x syncope or sudden death due to ventricular arrhythmias, even as the first manifestation, in approximately 5–10% of cases. To date, two questions remain open: how to recognize subjects who will experience arrhythmic events and how to treat them. The guidelines suggest treating subjects with a previous history of cardiac arrest or arrhythmogenic syncope, while they are unconclusive about the management of asymptomatic patients, who represent ∼90% of Brugada patients. We recently demonstrated that in asymptomatic patients, the presence of spontaneous Brugada type 1 electrocardiogram (ECG) pattern and inducibility of ventricular arrhythmias at electrophysiological study allows us to identify a group of patients at greater risk who deserve treatment. Regarding treatment, there are three options: implantable cardioverter defibrillator, drugs, and epicardial transcatheter ablation. Recent studies have shown that the latter is effective and free from serious side effects, thus opening a new scenario in the treatment of Brugada patients at risk. Subjects who present drug-induced-only type 1 Brugada ECG pattern, in whom a spontaneous type 1 pattern has been ruled out with repeated ECGs and 12-lead 24-h Holter monitoring, represent a very low-risk group, provided they adhere to behavioural recommendations and undergo regular follow-up.
Controversy in cardiology: clopidogrel or acetylsalicylic acid in the treatment of chronic coronary syndromes?
Authors: Gatto Laura , Scalia Lorenzo , Biccirè Flavio Giuseppe , Prati Francesco
Published: April 2024

Secondary prevention of patients with chronic coronary syndrome is based on the long-term use of a single anti-aggregating drug which is traditionally represented by acetylsalicylic acid (ASA) in light of the results of studies and meta-analyses which have demonstrated a clear anti-ischaemic efficacy against of an acceptable increase in the risk of bleeding, especially intracranial and gastrointestinal bleeding. The availability of drugs such as clopidogrel, which inhibits platelet activity through the P2Y12 receptor pathway, has called into question this paradigm, also in consideration of the fact that the scientific evidence that supports the use of ASA in secondary prevention is based on dated studies with some limitations. Over the last few years, randomized trials have demonstrated how clopidogrel has an efficacy profile comparable to that of ASA and a safety profile that is sometimes even better. In light of the new evidence, it is therefore legitimate to ask whether in this clinical scenario, ASA should still be considered the drug of choice or whether clopidogrel could represent the preferable alternative.
The golden hour in shock management: do a lot, do it quickly
Authors: Marini Marco , Belleggia Sara , Brugiatelli Leonardo , Francioni Matteo , Battistoni Ilaria , Shkoza Matilda , Pongetti Giulia , Angelini Luca , Belfioretti Leonardo , Matassini Maria Vittoria
Published: April 2024

Cardiogenic shock can be defined as a state of inadequate organ perfusion linked primarily to cardiac pump dysfunction. The two predominant causes of this condition are acute myocardial infarction and acutely decompensated heart failure (ADHF). In recent years, a significant increase in cases of cardiogenic shock from ADHF has been described. Recent evidence has defined that the factors with the greatest impact on the prognosis in this context are the early clinical assessment, the definition of the aetiology, the timely application of pharmacological therapies, or individualized mechanical supports for the circulation. Haemodynamic monitoring can help in the phenotyping of cardiogenic shock and therefore guide therapeutic choices, especially if implemented with the aid of advanced monitoring tools such as the Swan–Ganz catheter. Finally, the presence of a dedicated shock team in the ‘hub’ centres is fundamental, which facilitates the choice of the best therapeutic strategy on a case-by-case basis.
Management of atrial arrhythmias identified by cardiac devices
Authors: Stazi Filippo
Published: April 2024

Implantable cardiac devices have shown that atrial fibrillation (AF) is more frequent than previously assumed, with subclinical, asymptomatic, self-limiting manifestations called atrial high-rate events (AHREs) or subclinical AF. The clinical significance and correct therapeutic management of these episodes of subclinical AF is less well defined than in the case of clinically manifest AF. Two important randomized studies on the topic have recently been published, NOAH-AFNET 6 and ARTESIA, which, however, have not definitively clarified the topic. In patients with AHRE or subclinical AF, the average thrombo-embolic risk is lower than that in patients with clinically manifest AF and is ∼1%. For this reason, in these patients, the possibility that the benefit of anticoagulant therapy is overshadowed by the risk of bleeding is very high. Therefore, while waiting for new tools that allow a better stratification of low-risk patients, we must rely on individual clinical evaluation and overcome the qualitative dichotomy (AHRE yes vs. AHRE no), preferring instead an approach that is as quantitative as possible and takes into account the number of episodes, their duration, and the patient’s CHADSVASC score, before deciding, in each individual case, whether or not to use anticoagulant therapy.
Simultaneous magnitude and slip distribution characterization from high-rate GNSS using deep learning: case studies of the 2021 Mw 7.4 Maduo and 2023 Turkey doublet events
Authors: Cui Wenfeng , Chen Kejie , Wei Guoguang , Lyu Mingzhe , Zhu Feng
Published: April 2024

Rapid and accurate characterization of earthquake sources is crucial for mitigating seismic hazards. In this study, based on 18 000 scenario ruptures ranging from Mw 6.4 to Mw 8.3 and corresponding synthetic high-rate Global Navigation Satellite System (HR-GNSS) waveforms, we developed a multibranch neural network framework, the continental large earthquake agile response (CLEAR), to simultaneously determine the magnitude and slip distributions. We apply CLEAR to recent large strike-slip events, including the 2021 Mw 7.4 Maduo earthquake and the 2023 Mw 7.8 and Mw 7.6 Turkey doublet. The model generally estimates the magnitudes successfully at 32 s with errors of less than 0.15, and predicts the slip distributions acceptably at 64 s, requiring only approximately 30 ms on a single CPU (Central Processing Unit). With optimal azimuthal coverage of stations, the system is relatively robust to the number of stations and the time length of the received data.
“Train the World”: Examining the Logics of US Foreign Military Training
Authors: Joyce Renanah Miles , McLauchlin Theodore , Seymour Lee
Published: April 2024

Abstracts

Foreign military training has become a key component of the United States’ security policy. What explains the variation in US training allocation across countries and over time? Past work on security assistance, such as training, focuses on its effectiveness and consequences, largely overlooking questions about which countries receive it in the first place. To understand what drives US military training partnerships, we conducted a global statistical analysis of training from 1999 to 2018, structured around four logics: building relationships through defense diplomacy, deterrence against external, interstate threats, capacity-building in fragile states, and promoting democratic norms to advance democracy around the world. We find that the four logics receive support, with relationship-building and response to interstate and internal threats most consistently so. This analysis demonstrates the different ways the United States has used training in support of the US-led global order and raises questions about how to achieve accountability given these multiple logics. More broadly, the findings also have relevance for understanding how other states allocate training in conjunction with, in emulation of, or in opposition to the United States.
Dialectics of International Interventions through Scale, Space, and Time
Authors: Fagioli Monica , Malito Debora V
Published: April 2024

This Special Issue questions the problem of international interventions’ persistence and multidimensionality by asking what makes interventions still relevant and for whom. In this introduction, we advance a dialectical understanding of interventions to study their diverse modalities and enduring mechanisms of order-making, with specific attention to space, time, and scale. We elaborate on Laura Doyle's interimperial method to highlight interventions' relational, transformative, and durable aspects. We interpret interventions as coconstituted by diverse, overlapping, and contradictory rationales and modalities. We stress the intertwined histories and practices of interventions as integral components of colonial modernity in relation to empires, imperialism, and their contemporary rearticulations. As a method, we identify three key historical processes for a dialectical understanding of intervention: the coformation of interventions’ state-building, economic development, and cultural practices; the coproduction of institutions and infrastructural systems; and the cumulative accretion of interventions’ infrastructures and imaginaries.
Peace with Adjectives: Conceptual Fragmentation or Conceptual Innovation?
Authors: Boulanger Martel Simon Pierre , Jarstad Anna , Olivius Elisabeth , Söderström Johanna , Zahar Marie-Joëlle , Åkebo Malin
Published: April 2024

What strategies can be employed to conceptualize peace? In recent years, scholars have introduced an impressive array of “peace with adjectives” in order to make sense of some of the normative and empirical underpinnings of peace. Negative, positive, everyday, virtual, illiberal, partial, insecure, relational, emancipatory, agonistic, and feminist are some of the qualifiers that have been associated with the concept. While the growing attention to conceptualization is a welcomed development, we argue that the proliferation of new terms has led to increased fragmentation in the field of peace studies. Conceptual fragmentation impedes cumulative knowledge production and generates missed opportunities for fruitful discussions across theoretical and conceptual divides. In this article, we aim to provide more clarity to our field by mapping existing peace conceptualizations and identifying the strategies employed by scholars to construct innovative new terms. In our review, we identify 61 concepts and suggest that these conceptual innovations in peace research belong to one of three analytical strategies: developing diminished subtypes, conceptual narrowing, and conceptual expansion. Building on this categorization, we make recommendations for how peace researchers can enhance clarity and deepen constructive discussions between different conceptual approaches.
2 Differential Transcriptomic Responses Among Burn Injury Outcomes Related to Morality and Hospital Length of Stay
Authors: Misganaw Burook , Levi Benjamin , Pinto Desiree , Le Tuan D , Pusateri Anthony , Gautam Arti , Moffatt Lauren T , Shupp Jeffrey W , Hammamieh Rasha
Published: April 2024

Introduction

Severe burn injury induces a profound systemic molecular response. Yet, the various molecular mechanisms mediating clinical outcomes after burn injury are not well characterized. Using longitudinal global gene expression data, we investigate the evolution of transcriptomic responses to thermal injury. We hypothesized that burn patients with differing clinical outcomes will show diverging transcriptomic alterations over time.

Methods

This prospective observational study included patients from a regional burn center from 2013 to 2017. Patient demographics, burn injury characteristics, and blood samples for mRNA extraction and microarray whole genome gene expression profiling were collected at admission and set timepoints until 30 days. Patients were divided into 4 groups based on mortality status and hospital length of stay (LOS); G1 - died within 7 days, G2 - died after 7 days, G3 - discharged after 7 days, and G4 - discharged within 7 days. Transcriptomic abundances were compared between groups to identify differences in gene profiling. Pathway enrichment analysis was performed to determine the top significant pathways in each group.

Results

A total of 116 patients were analyzed. Most patients were male (72.4%) with a median age of 39 and TBSA of 12.3%. Overall mortality rate was 12.9%. The distribution of patients in G1 to G4 was 8%, 5%, 60%, and 27% respectively. A total of 1,245 blood samples and 17,289 transcripts were quantified. At admission, genes were differentially expressed in G1, G2 and G3 compared to G4 (FDR-corrected P < 0.05 and magnitude of log fold-change > 1). Significant gene sets were largely nonoverlapping, with only a few immune response related genes being activated across all groups. Pathway enrichment analysis showed significant up-regulated protein folding pathways in G1, and significant up-regulated pathways related to oxidative stress and temperature homeostasis in G3. Intra-individual transcriptomic changes from admission to 30 days showed distinct group- and time-dependent patterns. G4 showed the least pronounced transcriptomic response without any noticeable change over time, while G3 mounted a transcriptomic response that increased over time.

Conclusions

We identified transcriptomic alterations associated with distinct outcomes related to mortality and hospital LOS after burn injury. Alterations among groups were present at admission and persisted for 30 days. Connecting transcriptomic alterations to molecular mechanisms continues to evolve.

Applicability of Research to Practice

Enhanced understanding of transcriptomic alterations and molecular mechanisms of burn injury trajectories will allow for the development of early biomarkers, prognostic tools and novel intervention strategies.
54 A Retrospective Review of Copper and Zinc Levels in Burn Injured Patients
Authors: Taylor Billy Jay , Islas Claudia , Bay Curt C , Quan Asia N , Richey Karen J , Foster Kevin N
Published: April 2024

Introduction

Micronutrient deficiencies are common in critically ill patients. Both zinc (Zn) and copper (Cu) are important for wound healing and are commonly deficient in severely burned patients. Zn and Cu compete for the same absorption pathways and the simultaneous oral supplementation of both may severely hinder the body’s ability to absorb Cu. The purpose of this study was to better understand serum Zn and Cu levels in patients with a burn injury of ≥ 20% TBSA and the effect of Zn replacement on Cu levels.

Methods

This was a retrospective chart review of adult patients admitted over a 3-year period who had copper and zinc levels drawn as part of their routine and usual care. Descriptive statistics were calculated for demographic and clinical characteristic Spearman’s rank correlation was computed to assess the relationship between Zinc and Copper levels.

Results

A total of 85 patients met inclusion/exclusion criteria. Mean age was 44 years, mean total body surface area (TBSA) was 36%, mean BMI was 28.3. The population was predominantly male 77% (n=65), mean length of stay 47.7 days, mean ICU days 36, mean ventilator days 36. Mortality for the group was 26% (n=21). There was a positive correlation between Cu and Zn for the first two lab draws (p < .01). At the time of the third serum level, this correlation was diminished, and at tests 4 and 5 there was a negative correlation between Cu and Zn, that did not reach significance. When copper levels were correlated over time, there was a positive correlation between the first two levels (p < .01), levels 3 and 4 (p < .01) and levels 4 and 5 (p < .01). Beyond level 5 statistical power was inadequate to support hypothesis testing.

Conclusions

Initially, copper and zinc were positively correlated but over time, this relationship reversed and became negative. This may suggest a shift in the receptor binding competition between the two micronutrients secondary to zinc supplementation beyond that provided by enteral and oral nutrition. Larger scale research is warranted to ensure statistical power and better understand these relationships.

Applicability of Research to Practice

Zinc and copper levels should continue to be monitored until evidence-based protocols can be developed to further guide testing.
64 Higher Levels of Social Participation Are Associated with HRQOL Two Years Post Burn Injury
Authors: Turner Emma D , Le Vanessa , Solis-Beach Kyra , Bamer Alyssa M , McMullen Kara , Yenikomshian Haig A , Stoycos Sarah A , Schneider Jeffrey C , Ryan Colleen M , Kazis Lewis E , Orton Caitlin M , Roaten Kimberly
Published: April 2024

Introduction

Burn survivors experience lower levels of health-related quality of life (HRQOL) compared to U.S. population norms even one year post-injury. Research suggests that social support predicts functional outcomes, and while studies comparing life satisfaction pre-burn and at follow-up can begin to elucidate HRQOL following burn injury, there is a paucity of research focusing on the role of social participation in HRQOL. The current study sought to examine the roles of social participation and satisfaction with life pre-injury on HRQOL at two years post-injury.

Methods

Analyses were completed using data from a large national multi-center database. A total of 139 participants enrolled from October 2018 to May 2022 were included (34% female, mean age ± SD = 46.3 ± 16.9, mean TBSA burned ± SD = 19.4% ± 19.7). Measures of social participation included: LIBRE (Life Impact Burn Recovery Evaluation) Social Activities (SA) and Social Interaction (SI) subscales collected at 24-months post-injury. Measure of HRQOL included: VR-12 mental component summary score (MCS) and physical component summary score (PCS) collected at 24-months post-injury. Additional measures included: Satisfaction with Life Scale (SWLS) and Community Integration Questionnaire (CIQ) collected at discharge for pre-injury recall. Four regression models with an interaction term were run to analyze how SWLS pre-injury impacts the relationships amongst LIBRE-SA, LIBRE-SI, VR-12 MCS, and VR-12 PCS while controlling for pre-injury community participation (CIQ).

Results

After adjusting for preinjury CIQ, LIBRE-SI and LIBRE-SA were both positively associated with MCS (p < 0.001). While LIBRE-SA was positively associated with PCS (p < 0.001), LIBRE-SI was not significant. There was no evidence to support an interaction/moderation effect of the relationship between LIBRE-SA or LIBRE-SI and VR-12 MCS or VR-12 PCS by SWLS pre-injury.

Conclusions

Findings suggest higher levels of social participation are associated with increased mental HRQOL. However, only higher levels of social activities were related to increased physical HRQOL. The impact of increased social participation on improvements in both mental and physical HRQOL should be further investigated to inform program development and education for burn survivors on avenues to improve overall HRQOL. Further investigation is warranted to confirm the impact of life satisfaction pre-injury on these results.

Applicability of Research to Practice

These results reinforce the importance of social participation during recovery from burn injury, particularly as it relates to mental health.
130 Comparing Artificial Intelligence Guided Image Assessment to Current Methods of Burn Assessment
Authors: Lee Justin J , Abdolahnejad Mahla , Morzycki Alexander , Chan Hannah O , Joshi Rakesh , Hong Collin , Wong Joshua N
Published: April 2024

Introduction

Appropriate identification of burn depth and size is paramount. Despite the development of assessment aids [e.g., laser doppler imaging (LDI)], clinical assessment remains a gold standard, which assesses partial thickness burn depth with ~67% accuracy. We sought to develop an image-based artificial intelligence system that predicts burn severity and wound margins for use as a triaging tool in the community.

Methods

Modified EfficientNet architecture trained by 1684 mobile-device-captured burn datasets of different burn depths were previously utilized to create a convoluted neural network (CNN). The CNN was modified to a novel Boundary-Attention Mapping (BAM) algorithm using elements of saliency mapping, which was utilized to recognize the boundaries of burns. For validation, 144 patient charts that included clinical assessment, burn location, total body surface area, and LDI assessment were retrieved for a retrospective study at an academic burn center. The clinical images underwent CNN-BAM assessment and were directly compared with the LDI assessment.

Results

A CNN using a four-level burn severity classification achieved an accuracy of 85% (micro/macro-averaged ROC scores). The CNN-BAM system can successfully highlight burns from surrounding tissue with high confidence. Our method's burn area segmentations attained an accuracy of 91.60%, sensitivity of 78.17%, and specificity of 93.37%, when compared to LDI methodology and conducting a pixel-wise comparison of LDI’s from 104 patients (Figure 1). Results comparing the CNN-BAM outputs to clinical and LDI assessments have shown a high degree of correlation between the CNN-BAM burn severity predictions to those extrapolated from LDI healing potential (66% agreement Cohen’s Kappa analysis). This is in comparison to clinical vs LDI assessment, which had 28% agreement, and clinical vs CNN-BAM, which had 32% agreement (Figure 2).

Conclusions

CNN-BAM algorithm gives equivalent accuracy in detecting burn depth as LDI with a more economical and accessible application when embedded in a mobile device.

Applicability of Research to Practice

CNN-BAM algorithm can be embedded in a mobile application, which can be easily accessible to healthcare providers to rapidly assess burn depth. This can be especially useful in rural communities to accurately assess and transfer patients to specialized burn centres and reduce unnecessary transfers when injuries are less severe.
500 Anticoagulant Use Is Associated with Different Outcomes in Pediatric and Adult Burn Patients
Authors: Kleinhapl Julia , Knappskog Kristine , ayadi Amina E I , Song Juquan , Suman-Vejas oscar E , Branski Ludwik K , Wolf Steven E
Published: April 2024

Introduction

Anticoagulation therapy in pediatric burn patients remains an under-researched area of burn medicine lacking guidelines or scores to establish standardized therapy. The aim of this study is to evaluate the use of anticoagulants in pediatric compared to adult burn patients and to identify the most frequently used drug classes.

Methods

A large database was searched to create two cohorts of burn patients with more than 10% TBSA. Pediatric patients (age 0-17) were compared to adult burn patients (18-100) after propensity score matching was carried out for gender, ethnicity, and race.

Venous thromboembolic events (VTE), mortality, and bleeding events were defined as outcome variables. Data analysis was performed with the tools of descriptive statistics. Risk and odds ratios were presented with significance set at p< 0.05. We also examined and compared the number of cases in which burn victims were treated with anticoagulants and the frequency distribution of different anticoagulant classes. Anticoagulants were divided into 4 groups: heparins, factor Xa-inhibitors, vitamin K antagonists, and thrombin inhibitors.

Results

After propensity score matching, each of the cohorts included 5630 patients. 5.5% and therefore significantly (p< 0.001) more adult patients showed thromboembolic complications compared to 1.4% of pediatric patients, with RR 0.26 (95% CI 0.20-0.33) and OR 0.24 (95% CI 0.19-0.31). Bleeding events occurred in 4.9% of adult patients, which is more than twice as common as in pediatric patients (2.1%), with RR 0.42 (95% CI 0.34-0.52) and OR 0.41 (95% CI 0.33-0.51). With 5.8% vs. 1.5% deaths in adults compared to pediatrics, mortality was also significantly higher (p< 0.001) in the adult cohort, showing RR of 0.27 (95% CI 0.21-0.34) and OR of 0.26 (95% CI 0.20-0.32).

While 33.4% of adult burn patients were treated with anticoagulants within the first week after burn, only 6.7% of the pediatric burn population were treated. Further, the most frequently used drug group in both adult and pediatric burn patients was heparins, given in over 90% of the cases. Other drug classes were used in less than 10% of cases.

Conclusions

Anticoagulant treatment within the first 7 days after burn is more likely administered to adults than to pediatric patients. However, in most cases, heparins were the drug of choice in both groups. Bleeding events, the occurrence of VTE, and mortality was significantly higher in adult burn patients.

Applicability of Research to Practice

The discrepancy in the use of anticoagulants between adults and pediatrics in burn care highlights the need for larger studies to develop standardized guidelines for the use of different anticoagulants in pediatric burn patients.
511 Hydroxocobalamin Not the Clear Culprit of Nephrotoxicity After Cyanide Poisoning
Authors: Mann Elise M , Boyd Allison N , Walroth Todd A , Whitten Jessica , McIntire Allyson M , Dine Serena , Howell Molly M , Rhew Taylor , Hartman Brett C
Published: April 2024

Introduction

Inhalation injury (IHI) and cyanide poisoning are often observed in burn patients, but they may also present without cutaneous injury. If cyanide toxicity is suspected, the antidote, hydroxocobalamin, is indicated. Although a lifesaving drug, hydroxocobalamin has been associated with acute kidney injury (AKI) and oxalate nephropathy in recent literature. It remains unclear whether the renal issues observed after hydroxocobalamin administration are due to the drug itself or are influenced by other confounding variables. The objective of this study was to compare patients with IHI who either do or do not receive hydroxocobalamin and to assess whether there is a difference in incidence of nephrotoxicity.

Methods

This single-center, retrospective, matched, cohort study included adults 18 years or older admitted to the Medical ICU or Burn ICU for at least 72 hours between 10/2016 and 12/2022 with a documented diagnosis of IHI. The primary outcome was the incidence of AKI, defined per KDIGO criteria, within 72 hours of admission. Secondary outcomes included initiation of continuous renal replacement therapy (CRRT) within 72 hours, CRRT within 7 days, length of stay, and vasopressor requirements. A power calculation was not performed a priori as this was a convenience sample of all eligible patients. A post hoc analysis was conducted to assess the correlation of AKI after hydroxocobalamin administration in those with IHI and cutaneous injury vs. IHI only.

Results

A total of 100 patients, 50 who received hydroxocobalamin and 50 who did not, were matched based on TBSA and age and included in the analysis. Primary and secondary outcomes are included in Table 1 and Table 2. The was no difference in the incidence of AKI between the two groups. There were no differences in length of stay, Parkland Formula use, vasopressor requirement, or inpatient administration of nephrotoxic agents. Those who received hydroxocobalamin were found to have a higher median grade of IHI and had a higher incidence of CRRT initiation at 7 days. In the post-hoc analysis, there was no difference in AKI after hydroxocobalamin administration in those with IHI and cutaneous injury vs. IHI only.

Conclusions

This study did not demonstrate a difference in the incidence of AKI in patients with IHI who did or did not receive hydroxocobalamin. This outcome was not changed by the presence or lack of concurrent cutaneous injury.

Applicability of Research to Practice

To our knowledge, this is the first study that was controlled for hydroxocobalamin administration and evaluated clinical outcomes in both burn and non-burn IHI patients. Our findings differ from previous literature and suggest that hydroxocobalamin alone is not the clear culprit of nephrotoxicity in patients with IHI.
601 Potential Clinical Signatures for Early Inhalation Injury Prognosis in Burns Patients
Authors: Prinsloo Tarryn K , Kleintjes Wayne G , Najaar Kareemah
Published: April 2024

Introduction

Despite being one of the most important mortality co-factors; inhalation injury is complex and diagnosis remains variable with limitations, especially in a resource-constrained clinical setting. Potential relationships between inhalation injury and injury-related factors were investigated that could provide inferences suggestive of improving early prognosis in burns patients in the absence of diagnostic tools.

Methods

This cross-sectional, cohort study commenced following ethical approval and patient consent. Clinical information was collected from burns patients (n=59) admitted to our Burns Centre between 23 April 2016 and 15 August 2017 irrespective of etiology. The primary outcome was inhalation injury based on the patients’ total ventilation days and stratified into mild and severe (≥5 days). Parameters included sociodemographic (gender, age, etiology), burn severity (%TBSA and complications), and clinical variables (burns intensive care unit length of stay-BICU LOS, partial gas pressures, and lactate). Descriptive statistics (mean (95% CI) and/or frequency (%)), the Spearman Rank coefficient (rho) for correlation strength/direction, and partial least squares regression for variable of importance in prediction (VIP) values, were performed. Statistical significance was denoted by p< 0.05 (two-tailed) and analyses were performed using IBM SPSS Statistics version 28.

Results

An average of 2.7 patients (95% CI 2.3-3.4) were diagnosed with mild inhalation injury and 11.2 patients (95% CI 9.5-12.9) with severe inhalation injury. The latter was associated with a 93.3% mortality rate. Positive values were observed with all significantly correlated factors which ranged in strength from moderate (%TBSA rho=0.357 and lactate rho=0.331) to strong (complications rho=0.690) and very strong (BICU LOS rho=0.908). Complications (VIP=1.229) and BICU LOS (VIP=1.372) had the highest VIP values in the regression model.

Conclusions

Inhalation injury degree positively correlated to the presence or progression of the assessed parameters, with complications and BICU LOS observed as the best predictors in the current model. Initial in-hospital prognosis could benefit by considering the factors that would immediately present on admission or shortly thereafter. Complications may therefore be more suitable for the latter, whereas, increased BICU LOS could rather provide insight into degree progression.

Applicability of Research to Practice

Identifying the clinical parameters that would improve timeous treatment of inhalation injury could in turn reduce the exacerbated inflammatory state of burns patients and subsequent mortality likelihood. These findings suggest that increased inhalation injury presence and/or degree should at least be considered when these factors are present/increased.
604 Single Center 4-year Review of Synthetic Polyurethane Matrix Use in Burns and Other Complex Wounds
Authors: Mukit Muntazim , Grande Payton , Hill David M , Velamuri Sai R , Hassouba Mahmoud , Liu Xiangxia
Published: April 2024

Introduction

As not all wounds are amenable to immediate skin grafting, the search for the ideal skin substitute is ever present. The ideal skin substitute would be resistant to infection, inexpensive, readily available, quick to integrate and applicable to a variety of wounds. Here we describe the use of a synthetic polyurethane matrix in the setting of burns and other complex wounds in the largest case series to date.

Methods

A retrospective review was conducted at a verified, regional burn center. Dual IRB approval was obtained. All patients greater than 18 years of age who received this matrix between January 2019 and July 2023 were included. Data collected included: age, sex, wound etiology, social and medical history, presence of exposed critical structures, presence of infection, length of stay, time to matrix implantation, time to skin graft, percent of matrix survival, percent skin graft survival and disposition.

Results

A total of 182 patients with 250 wounds were included in this study. The average age was 50.5 ± 18.7 years and 61% were male. Thirty-seven percent were smokers, 23.6% had diabetes and 5.5% had peripheral vascular disease. The majority were acute burn wounds (60%), followed by, trauma (24.4%), chronic wounds (5.6%), infection (4%) and donor sites (2%). Exposed structures included fat (54%), muscle (30%), bone (16%) and tendon (14.4%). Infection was present in 143 (57.2%) of cases: 98 (39.2%) pre-application and 89 (35.6%) post application. The incidence of new infection post-application was 25.6%. The pathogens are detailed in figure 1; several infections were polymicrobial. Eighteen patients (10%) died. Median length of stay was 27 (13.3, 64) days. Median time to matrix implantation was 10 (6, 17) days. And median time from matrix placement to skin grafting was 35 (24.8, 42) days. Where documented, there were 162 wounds (83.5%) with > 95% matrix survival and 136 wounds (82.4%) with > 95% skin graft survival. The patient dispositions are detailed in table 2.

Conclusions

We describe to date the largest clinical series utilizing a synthetic polyurethane matrix. This matrix was successfully used in a large number of patients with burns, trauma and chronic wounds. Despite the presence of active smoking, diabetes or infection, there was greater than 95% matrix and skin graft survival in more than 80% of patients. This study demonstrates the robustness of this skin substitute to achieve successful reconstruction even in the setting of adverse patient or wound characteristics.

Applicability of Research to Practice

This study highlights the utility of using a synthetic polyurethane matrix to cover full thickness, difficult to reconstruct wounds secondary to trauma or other injuries. This matrix is resistant to infection and can allow for successful coverage of wounds even in patients who are smokers or have diabetes.
605 Differences in Management and Decision Making in Grease and Scald Burns
Authors: Reese Miles , Burgess Jessica , Yeluru Hemasree , Rendel Ricardo , Collins Jay
Published: April 2024

Introduction

There has been a longstanding belief that grease burns are more severe than scald burns due to the higher boiling point of grease. Grease burn patients may remain hospitalized to monitor progression of the burn due to the assumption that these burns may worsen over time, prompting a change in management. The objective of this study was to determine if there was a difference in the management, treatment and outcomes of scald and grease burns.

Methods

This study was a retrospective chart review of patients with thermal burns treated at a level I trauma center. The following data was collected: age, gender, grease or scald burn, total body surface area (TBSA%), depth of burn, evolution of burn depth, type of operative intervention, whether the decision to excise or graft changed from presentation and length of hospital stay (LOS). Data was analyzed using descriptive statistics; means between the two groups were compared using student’s T-Test and categorical variables were compared with chi squared analysis.

Results

A total of 165 patients treated between 2020 and 2023 were included. Of these, 44.8% were scald burns, and 55.2% were grease burns. Patients with scald burns had an increased LOS when compared to those with grease burns (2.96 vs 1.13 d; p = 0.01). However, there was no statistical difference in the rate of change of management for scald burns versus grease burns (6.8% v 3.3%, p=.3). Additionally, patients with scald burns had a slightly increased average TBSA% when compared to grease burns (4.32 vs 3.06; p>0.05). Amongst patients with scald burns, the TBSA% did not have a correlation to the hospital length of stay, however in patients with grease burns, a higher TBSA% was significantly associated with an increased length of hospital stay (p < 0.0001). Amongst patients with scald burns, 77% received a nonexcisional debridement, 16.2% required excision and 6.8% required grafting. For patients with grease burns, 85.7% received a debridement, 9.9% required excision and 6.6% required a skin graft.

Conclusions

This study aimed to highlight differences in presentation, hospital course, and outcomes for patients with grease and scald burns. There were no significant differences in rate of skin grafting or change in management. Although scald burn patients had an increased average length of hospital stay when compared to patients with grease burns, this could be explained by the wide range (0 to 45 days) in the sample due to concomitant medical and social issues which required prolonged hospitalization. Ultimately, this study suggests that grease burns should be treated in similar fashion to scald burns and are not more likely to progress to require a change in management such as excision or graft.

Applicability of Research to Practice

Grease burns should be treated similarly to scald burns in that their management can be based on the initial presentation with a low rate of burn progression necessitating a change in management.