bluuebunny/crossref_metadata_2025 huggingface dataset:
Astrometric Calibration for All-sky Camera with Machine Learning
Authors: Tian J. F. , Ge L. , Wu Y. , Zhou Z. Z.
Published: March 2022

The night images obtained with an all-sky camera can provide spatial and time sampling, which can be used for measurement cloud coverage measurement and meteor monitoring. The astrometric calibration of an all-sky camera is necessary because of strong field distortions. We use machine learning to complete the calibration of an all-sky camera. In order to prepare the data sets needed for machine learning, a particle swarm optimization algorithm is used to determine the parameters of the method proposed by Borovicka in 1995. Machine learning can transform plate coordinates to celestial coordinates and transform celestial coordinates to plate coordinates. The actual test shows that the standard deviation of residuals is of the order of 1′ for the transformation from plate coordinates to celestial coordinates and the standard deviation of residuals is of the order of 0.3 px for the transformation from celestial coordinates to the plate coordinates.
Fluctuation assisted collapses of Bose–Einstein condensates
Authors: Pan Junqiao , Wang Yuqi , Shi Tao , Yi Su
Published: March 2022

We study the collapse dynamics of a Bose–Einstein condensate subjected to a sudden change of the scattering length to a negative value by adopting the self-consistent Gaussian state theory for mixed states. Compared to the Gross–Pitaevskii and the Hartree–Fock–Bogoliubov approaches, both fluctuations and three-body loss are properly treated in our theory. We find a new type of collapse assisted by fluctuations that amplify the attractive interaction between atoms. Moreover, the calculation of the fluctuated atoms, the entropy, and the second-order correlation function showed that the collapsed gas significantly deviated from a pure state.
Corrigendum: Simulation of Peak Tension Loads in Subsea Power Cables during Installation (2021 IOP Conf. Ser.: Mater Sci Eng.
1201 012010)
Authors: Okkerstrøm L , Gudmestad O T , Pedersen E
Published: March 2022

Please see Article PDF for corrigendum text.
Graphene quantum dot based ultrasensitive probe for biosensing of prostate cancer biomarkers: current updates and future challenges
Authors: Pantwalawalkar Jidnyasa , Chandankar Sachin , Tade Rahul , Khan Zamir , Shaikh Matin , Powar Trupti , Patil Prashant , Sugandhi Vrushabh , Nangare Sopan
Published: March 2022

Prostate cancer (PC) is significantly increasing as a principal cause of mortality among the men’s population. Accordingly, research scholars have made tremendous development for the effective treatment of PC. Despite this, the early diagnosis of PC is a challenging task for scientific fraternities due to the plenty of demerits of currently engaged methods in terms of sensitivity, selectivity, and many more. For that reason, PC management needs exceptional alternative strategies for proficient management of PC that can endow with early diagnosis of PC and eventually it will result in promising cure of PC. Strategies involved in advanced nanomaterials especially carbon nanomaterials have gained tremendous consideration due to their numerous benefits. Notably, graphene quantum dots (GQDs) are a promising next-generation carbon nanomaterial with manifold biomedical applications such as biosensing and drug delivery in cancer and different life-threatening health issues that may be due to the versatile and tunable properties of GQDs. In a nutshell, it provides high sensitivity and selectivity towards the target biomarker of PC. In this review, the prevalence and distribution of PC, major highlights and limitations of current diagnostics and treatments, as well as recent trends for PC management have been discussed in brief. Afterward, the synthesis methods, properties, biocompatibility, and bioconjugation of GQDs along with their impact on the performance of biosensors have been summarised in brief. Finally, the application of GQD based biosensors exhibited the lowest detection limit up to femtogram in simulated and real-time samples. As a result, the applications of GQDs as novel biosensors presents plentiful advantages including high sensitivity, high selectivity, high stability, rapid response, etc of the PC biomarkers. Therefore, this review will provide the details of recent updates to prepare and extend advanced biosensing prospects using GQDs as excellent nanomaterial probes in PC and other cancer types.
Royal jelly fatty acids downregulate ANGPTL8 expression through the decrease in HNF4α protein in human hepatoma HepG2 cells
Authors: Inoue Yuki , Ienaga Marina , Kamiya Tetsuro , Adachi Tetsuo , Ohta Mitsuhiro , Hara Hirokazu
Published: March 2022

Royal jelly (RJ) intake has been reported to be effective for reducing serum lipids; however, the mechanism is not fully understood. Angiopoietin-like protein 8 (ANGPTL8), a secreted protein, plays a key role in lipid metabolism. In this study, we investigated the effects of specific fatty acids included in RJ (RJ fatty acids), such as 10-hydroxy-2-decenoic acid, 10-hydroxydecanoic acid, and sebacic acid (SA), on expression of ANGPTL8 in human hepatoma HepG2 cells. SA markedly reduced the expression of ANGPTL8. Reporter assay revealed that SA suppressed ANGPTL8 promoter activity. In addition, we identified a functional binding site of hepatocyte nuclear factor-4α (HNF4α), a liver-enriched transcription factor, in the ANGPTL8 promoter. SA reduced the levels of HNF4α protein and the binding of HNF4α to the ANGPTL8 promoter. Moreover, siRNA knockdown of HNF4α suppressed the expression of ANGTPL8 mRNA. Taken together, we conclude that SA downregulates ANGPTL8 expression via the decrease in HNF4α protein.
Factors influencing dispersal initiation and timing in a facultative cooperative breeder
Authors: Dietz Samantha L , DuVal Emily H , Cox James A
Published: March 2022

Natal dispersal is a high-risk endeavor where decisions on whether and when to disperse have long-term consequences. Among facultative cooperative breeders, juveniles often forego dispersal and remain philopatric for one or more breeding seasons. This decision is key to the formation of cooperative breeding groups and could have significant effects on reproductive success. We investigated the probability and initiation of dispersal in the cooperatively breeding Brown-headed Nuthatch (Sitta pusilla) to determine the influence that social environments had on dispersal. This study was concurrent with another study where manipulation of population sex ratios increased the prevalence and size of cooperative groups. The concurrent manipulations enabled us to evaluate social effects on dispersal as a plausible mechanism driving the relationship between adult sex ratios and cooperation. We evaluated which factors best predicted whether males dispersed, and the timing of dispersal for both sexes. We considered variables related to the immediate nesting environment as well as characteristics of the local population. Social environments were related to dispersal for both males and females. Juvenile males dispersed earlier when a helper was present in the natal group. Females dispersed earlier in settings with more adult neighbors and when a lower proportion of those neighbors were males. Females with shorter tarsi relative to their siblings dispersed earlier, suggesting that size-based competitive interactions may also affect dispersal decisions. Our results suggest juveniles disperse more readily when they fledge in constrained social environments, and that competition with conspecifics is a major driver of dispersal in the Brown-headed Nuthatch.
Risks for donors associated with living kidney donation: meta-analysis
Authors: Bellini Maria Irene , Nozdrin Mikhail , Pengel Liset , Knight Simon , Papalois Vassilios
Published: March 2022

Background

Living kidney donation risk is likely to differ according to donor’s demographics. We aimed to analyse the effects of age, sex, body mass index (BMI) and ethnicity.

Methods

A systematic review and meta-analysis was undertaken of the effects of preoperative patient characteristics on donor kidney function outcomes, surgical complications, and hypertension.

Results

5129 studies were identified, of which 31 met the inclusion criteria, mainly from the USA and Europe. The estimated glomerular filtration rate (eGFR) in donors aged over 60 years was a mean of 9.54 ml per min per 1.73 m2 lower than that of younger donors (P < 0.001). Female donors had higher relative short- and long-term survival. BMI of over 30 kg/m2 was found to significantly lower the donor’s eGFR 1 year after donation: the eGFR of obese donors was lower than that of non-obese patients by a mean of −2.70 (95 per cent c.i. −3.24 to −2.15) ml per min per 1.73 m2 (P < 0.001). Obesity was also associated with higher blood pressure both before and 1 year after donation, and a higher level of proteinuria, but had no impact on operative complications. In the long term, African donors were more likely to develop end-stage renal disease than Caucasians.

Conclusion

Obesity and male sex were associated with inferior outcomes. Older donors (aged over 60 years) have a larger eGFR decline than younger donors, and African donors have a higher incidence of ESRD than Caucasians.
Immunotherapeutic targeting of activating natural killer cell receptors and their ligands in cancer
Authors: Peipp Matthias , Klausz Katja , Boje Ammelie Svea , Zeller Tobias , Zielonka Stefan , Kellner Christian
Published: March 2022

Natural killer (NK) cells exert an important role in cancer immune surveillance. Recognition of malignant cells and controlled activation of effector functions are facilitated by the expression of activating and inhibitory receptors, which is a complex interplay that allows NK cells to discriminate malignant cells from healthy tissues. Due to their unique profile of effector functions, the recruitment of NK cells is attractive in cancer treatment and a key function of NK cells in antibody therapy is widely appreciated. In recent years, besides the low-affinity fragment crystallizable receptor for immunoglobulin G (FcγRIIIA), the activating natural killer receptors p30 (NKp30) and p46 (NKp46), as well as natural killer group 2 member D (NKG2D), have gained increasing attention as potential targets for bispecific antibody-derivatives to redirect NK cell cytotoxicity against tumors. Beyond modulation of the receptor activity on NK cells, therapeutic targeting of the respective ligands represents an attractive approach. Here, novel therapeutic approaches to unleash NK cells by engagement of activating NK-cell receptors and alternative strategies targeting their tumor-expressed ligands in cancer therapy are summarized.
Connectome-based predictive modeling of compulsion in obsessive–compulsive disorder
Authors: Wu Xiangshu , Yang Qiong , Xu Chuanyong , Huo Hangfeng , Seger Carol A , Peng Ziwen , Chen Qi
Published: March 2022

Compulsion is one of core symptoms of obsessive–compulsive disorder (OCD). Although many studies have investigated the neural mechanism of compulsion, no study has used brain-based measures to predict compulsion. Here, we used connectome-based predictive modeling (CPM) to identify networks that could predict the levels of compulsion based on whole-brain functional connectivity in 57 OCD patients. We then applied a computational lesion version of CPM to examine the importance of specific brain areas. We also compared the predictive network strength in OCD with unaffected first-degree relatives (UFDR) of patients and healthy controls. CPM successfully predicted individual level of compulsion and identified networks positively (primarily subcortical areas of the striatum and limbic regions of the hippocampus) and negatively (primarily frontoparietal regions) correlated with compulsion. The prediction power of the negative model significantly decreased when simulating lesions to the prefrontal cortex and cerebellum, supporting the importance of these regions for compulsion prediction. We found a similar pattern of network strength in the negative predictive network for OCD patients and their UFDR, demonstrating the potential of CPM to identify vulnerability markers for psychopathology.
Mataioponēmata: the politics of failure in translating theAeneidin eighteenth- and nineteenth-century Greece
Authors: Papaioannou Sophia
Published: March 2022

The composition of translations of Classical texts in the nineteenth-century Greek state was a complex issue entwined with politics, ideology, and the cultural identity of the new nation that sought to construct its identity by looking back towards its glorious Classical Greek past. It is, moreover, an issue tied to the so-called ‘language question’, the ardent debate on the type of the national Greek language (archaizing Greek, katharevousa, or demotiki). The intellectual elite of the new nation-state, led by the professoriate of the newly founded Ottonian University and a number of influential Greek intellectuals of the Diaspora tried to acquaint the newly-liberated Greeks with the classical writers of antiquity primarily through education. Since these elites favoured the katharevousa, a conservative construct of the spoken Greek language fashioned as a compromise between Classical Greek and the spoken vernacular of the time, the produced translations of the ancient authors had limited appeal across time, and they never aspired to address an audience beyond academia. Thus, all translations of the Aeneid published in Greece during the eighteenth and nineteenth centuries were literary failures. They were never meant to be read independently from the original Latin, and, inevitably, were largely forgotten following the death of their authors.
SwissBioPics—an interactive library of cell images for the visualization of subcellular location data
Authors: Le Mercier Philippe , Bolleman Jerven , de Castro Edouard , Gasteiger Elisabeth , Bansal Parit , Auchincloss Andrea H , Boutet Emmanuel , Breuza Lionel , Casals-Casas Cristina , Estreicher Anne , Feuermann Marc , Lieberherr Damien , Rivoire Catherine , Pedruzzi Ivo , Redaschi Nicole , Bridge Alan
Published: March 2022

SwissBioPics (www.swissbiopics.org) is a freely available resource of interactive, high-resolution cell images designed for the visualization of subcellular location data. SwissBioPics provides images describing cell types from all kingdoms of life—from the specialized muscle, neuronal and epithelial cells of animals, to the rods, cocci, clubs and spirals of prokaryotes. All cell images in SwissBioPics are drawn in Scalable Vector Graphics (SVG), with each subcellular location tagged with a unique identifier from the controlled vocabulary of subcellular locations and organelles of UniProt (https://www.uniprot.org/locations/). Users can search and explore SwissBioPics cell images through our website, which provides a platform for users to learn more about how cells are organized. A web component allows developers to embed SwissBioPics images in their own websites, using the associated JavaScript and a styling template, and to highlight subcellular locations and organelles by simply providing the web component with the appropriate identifier(s) from the UniProt-controlled vocabulary or the ‘Cellular Component’ branch of the Gene Ontology (www.geneontology.org), as well as an organism identifier from the National Center for Biotechnology Information taxonomy (https://www.ncbi.nlm.nih.gov/taxonomy). The UniProt website now uses SwissBioPics to visualize the subcellular locations and organelles where proteins function. SwissBioPics is freely available for anyone to use under a Creative Commons Attribution 4.0 International (CC BY 4.0) license.

Database URL

www.swissbiopics.org
Safety of Recombinant Zoster Vaccine in Patients with Inflammatory Bowel Disease
Authors: Khan Nabeel , Trivedi Chinmay , Aberra Faten , Pernes Tyler , Yang Yu-Xiao
Published: March 2022

Background and Aims

Patients with inflammatory bowel disease [IBD] have an increased risk of contracting herpes zoster [HZ] infection. However, vaccination rates for HZ are low among IBD patients. A contributing factor may be fear of an IBD flare associated with vaccination. Our aim here was to evaluate if recombinant zoster vaccine [RZV] is associated with an IBD flare.

Methods

This was a retrospective cohort study using data from the Veterans Affairs Healthcare System [VAHS]. The exposure of interest was receiving RZV. We randomly matched such exposed patients with unexposed individuals. The primary outcome was the first episode of IBD flare within 90 days of the index date. Baseline characteristics were compared between groups using a t-test for continuous variables and Chi-square test for categorical variables. Conditional logistic regression was used to estimate the odds ratio [OR] and 95% confidence interval [CI].

Results

Among the eligible study cohort, 1677 patients received RZV. Thirty-six patients, 20 in the exposed group and 16 in the unexposed group, had a confirmed flare by chart review. The 90-day cumulative incidence of IBD flare was not different between the vaccinated and unvaccinated groups [1.2% among those exposed vs 1.0% among those unexposed, p = 0.503]. The OR for IBD flare associated with RZV vaccination was 1.25 [95% CI: 0.65–2.41].

Conclusion

In a nationwide cohort of stable IBD patients, administration of RZV was not associated with the risk of IBD flare within 90 days. These findings should motivate further use of this highly effective vaccine.
Estimation and inference on treatment effects under treatment-based sampling designs
Authors: Song Kyungchul , Yu Zhengfei
Published: March 2022

Causal inference in a programme evaluation setting faces the problem of external validity when the treatment effect in the target population is different from the treatment effect identified from the population of which the sample is representative. This paper focuses on a situation where such discrepancy arises by a stratified sampling design based on the individual treatment status and other characteristics. In such settings, the design probability is known from the sampling design but the target population depends on the underlying population share vector, which is often unknown, and, except for special cases, the treatment effect parameters are not identified. In this paper we propose a method of constructing confidence sets that are valid for a given range of population shares. When a benchmark population share vector and a corresponding estimator of a treatment effect parameter are given, we develop a method to discover the scope of external validity with familywise error rate control. Finally, we derive an optimal sampling design that minimizes the semiparametric efficiency bound given a population share associated with a target population. We provide Monte Carlo simulation results and an empirical application to demonstrate the usefulness of our proposals.
Effect of Ambient Bright Light on Behavioral and Psychological Symptoms in People With Dementia: A Systematic Review
Authors: Jao Ying-Ling , Wang Julian , Liao Yo-Jen , Parajuli Jyotsana , Berish Diane , Boltz Marie , Van Haitsma Kimberly , Wang Nan , McNally Lauren , Calkins Margaret
Published: March 2022

Background and Objectives

Behavioral and psychological symptoms of dementia (BPSD) commonly occur in persons living with dementia. Bright light (BL) interventions have shown some positive impact on BPSD. Ambient lighting is a more efficient approach to delivering BL with better compliance and less staff workload than individual-based lighting interventions. Yet, its effect has not been systematically reviewed. This review synthesized research evidence on the effect of ambient BL on BPSD.

Research Design and Methods

This review searched literature from PubMed (Medline), CINAHL, Scopus, Web of Science, and Cochrane in February 2021. Original research testing the effect of ambient BL on BPSD in persons with dementia was included. Two reviewers independently screened, extracted data, and assessed the quality of each article.

Results

Nine studies were reviewed with 1 randomized controlled trial and 8 quasi-experimental studies. The sample size ranged from 14 to 89 participants across care settings. While not all studies showed positive results, evidence from multiple studies revealed the positive effect of ambient BL on depressive symptoms and agitation in persons with dementia. The ambient BL that showed a positive effect targeted at approximately 350–750 lux, 4,500–9,325 K, and/or circadian stimulus = 0.375–0.4 for 10–12 hr a day for 4 weeks or longer. Evidence on other BPSD was mixed or too limited to draw conclusions.

Discussion and Implications

A preponderance of evidence suggests that, when properly designed and implemented, ambient BL shows promise in reducing depressive symptoms and agitation. Future research, using more rigorous designs, is needed to further test the effect of ambient BL on BPSD with attention to lighting parameters, measurement approaches, and intervention fidelity.
Application of an unbalanced optimal transport distance and a mixed L1/Wasserstein distance to full waveform inversion
Authors: Li Da , Lamoureux Michael P , Liao Wenyuan
Published: March 2022

Full waveform inversion (FWI) is an important and popular technique in subsurface Earth property estimation. In this paper, several improvements to the FWI methodology are developed and demonstrated with numerical examples, including a simple two-layer seismic velocity model, a cross borehole Camembert model and a surface seismic Marmousi model. We introduce an unbalanced optimal transport (UOT) distance with Kullback–Leibler divergence to replace the L2 distance in the FWI problem. Also, a mixed L1/Wasserstein distance is constructed that preserves the convex properties with respect to shift, dilation, and amplitude change operation. An entropy regularization approach and convolutional scaling algorithms are used to compute the distance and the gradient efficiently. Two strategies of normalization methods that transform the seismic signals into non-negative functions are discussed. The numerical examples are then presented at the end of the paper.
Information and communication technologies and firms’ export performance
Authors: Añón Higón Dolores , Bonvin Daniel
Published: March 2022

This study empirically examines the enabling role played by the use of information and communication technologies (ICT) on the firms’ export participation and the intensity with which they sell abroad. Using a representative panel of Spanish manufacturing firms between 2000 and 2014, we contribute to the literature by estimating a series of dynamic models that analyze the direct and indirect (via productivity) effects of ICT use on firms’ export performance. Overall, our results suggest that firms that use ICT, and in particular those that have a website, experience a direct increase in their probability of exporting, but not in their export intensity. Nevertheless, ICT increases export intensity indirectly through the productivity channel.
Investigation of the potential association between the use of fluoxetine and occurrence of acute pancreatitis: a Danish register-based cohort study
Authors: Aakjær Mia , Kristiansen Sarah Brøgger , Pape Kathrine , Sessa Maurizio , Dalhoff Kim Peder , De Bruin Marie Louise , Andersen Morten
Published: March 2022

Background

There is currently conflicting evidence of the association between the use of selective serotonin reuptake inhibitors (SSRIs) and acute pancreatitis. The SSRI fluoxetine has been suspected to be the driver of this serious outcome. Therefore, this study aims to investigate the potential association between fluoxetine use and the occurrence of acute pancreatitis.

Methods

We conducted a nationwide cohort study using Danish register-based data from 1996 to 2016. The exposed group were new users of fluoxetine (1-year washout). The control subjects were new users of citalopram or SSRIs, excluding fluoxetine. The outcome was an incident diagnosis of acute pancreatitis with a 5-year washout. We used an intention-to-treat approach following patients for a maximum of 6 months. Cox regression analyses were performed, estimating hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for age/sex, comorbidities and co-medications, using propensity score adjustment and matching.

Results

In the propensity score-matched analyses, 61 783 fluoxetine users were included. The incidence rates among users of fluoxetine and other SSRIs were 5.33 (3.05–8.66) and 5.36 (3.06–8.70) per 10 000 person-years, respectively. No increased risk of acute pancreatitis was identified following fluoxetine exposure compared with either citalopram [HR 1.00, 95% CI 0.50–2.00) or other SSRIs (0.76, 0.40–1.46).

Conclusions

Fluoxetine use was not associated with an increased risk of acute pancreatitis compared with citalopram or other SSRIs. The absolute risk of acute pancreatitis was low and did not vary between different SSRIs. Further research is needed to determine whether there is a class effect on the risk of acute pancreatitis.
The D2-like Dopamine Receptor Agonist Quinpirole Microinjected Into the Ventral Pallidum Dose-Dependently Inhibits the VTA and Induces Place Aversion
Authors: Peczely Laszlo , Ollmann Tamas , Laszlo Kristof , Lenard Laszlo , Grace Anthony A
Published: March 2022

Background

The ventral pallidum (VP) is a dopaminoceptive forebrain structure regulating the ventral tegmental area (VTA) dopaminergic population activity. We have recently demonstrated that in the VP, the D2-like dopamine (DA) receptor agonist quinpirole dose dependently facilitates memory consolidation in inhibitory avoidance and spatial learning. According to our hypothesis, quinpirole microinjected into the VP can modulate the VTA DAergic activity and influence motivation and learning processes of rats.

Methods

Quinpirole was microinjected at 3 different doses into the VP of male rats, and controls received vehicle. Single unit recordings were employed to assess VTA DAergic activity. To investigate the possible reinforcing or aversive effect of quinpirole in the VP, the conditioned place preference paradigm was used.

Results

Our results showed that intra-VP quinpirole microinjection regulates VTA DAergic neurons according to an inverted U-shaped dose-response curve. The largest dose of quinpirole decreased the population activity and strongly reduced burst activity of the DAergic neurons in the first hour after its application. In contrast, the 2 smaller doses increased DA population activity, but their effect started with a delay 1 hour after their microinjection. The CPP experiments revealed that the largest dose of quinpirole in the VP induced place aversion in the rats. Furthermore, the largest dose of quinpirole induced an acute locomotor activity reduction, while the medium dose led to a long-duration increase in locomotion.

Conclusions

In summary, quinpirole dose dependently regulates VTA DAergic activity as well as the motivation and motor behavior of the rats at the level of the VP.
Betti Structures of Hypergeometric Equations
Authors: Barco Davide , Hien Marco , Hohl Andreas , Sevenheck Christian
Published: March 2022

We study Betti structures in the solution complexes of confluent hypergeometric equations. We use the framework of enhanced ind-sheaves and the irregular Riemann–Hilbert correspondence of D’Agnolo–Kashiwara. The main result is a group theoretic criterion that ensures that enhanced solutions of such systems are defined over certain subfields of $\mathds{ C}$. The proof uses a description of the hypergeometric systems as exponentially twisted Gauß–Manin systems of certain Laurent polynomials.
T1 Healthcare Utilization After Thermal Injury: An Analysis Using a Commercial Claims Database
Authors: Lewis Aislinn E , Horns Joshua J , Fleming Irma D , Lewis Giavonni M , Thompson Callie M
Published: March 2022

Introduction

Burn Injuries directly affect more than 500,000 people per year in the United States but no previous studies have looked at the impact on the healthcare system. Several prior studies have shown decrease in unplanned healthcare utilization after acute care discharge following burn injury and increased healthcare costs in patients who have undergone grafting for burn injury. The goal of this study is to describe post-acute care hospitalization healthcare use in burn patients.

Methods

A retrospective commercial claims database review was performed of the Truven MarketScan (MS) database. In a 10 year MS sample, 23,262 patients with burn injuries were identified and were matched to a control population in a 1:1 ratio based on age, sex, and total time in the MS database. For the burn patient population in the study, pre-burn and post-burn utilization of therapy, emergency department, nutritional support, psychiatry/psychology, home health, skilled nursing facility, inpatient, and outpatient visits were recorded. For controls, we defined their pre-burn and post-burn periods using the burn event date of the matched case adjusted by the pair’s relative difference in initial enrollment into the MS database, and then recorded the same utilization metrics. A series of negative binomial regressions were completed to evaluate the data.

Results

At the conclusion of the study, for every outcome, except skilled nursing facility, healthcare utilization was greater in the pre-injury burn group relative to controls. Healthcare utilization for the burn cohort post-injury was greater for every outcome compared to controls. Relative to controls, healthcare utilization remains higher for at least 25 months post-injury in the burn patients and does not return to pre-injury levels during this time frame.

Conclusions

In a commercial claims database study, the healthcare utilization of the burn patients is higher both before and after burn injury than matched controls. Utilization does not return to preburn levels in the 25-month follow-up period. Additionally, burn patients have higher healthcare utilization prior to injury compared to matched controls, which may indicate an important difference in baseline health of these patients, and an opportunity for injury prevention.
T5 Tracking Cardiac Output During Burn Resuscitation via Pulse Wave Analysis
Authors: Kao Yi-Ming , ArabiDarrehDor Ghazal , Oliver Mary A , Reese Adam D , Keyloun John W , Chung Kevin K , Moffatt Lauren T , Shupp Jeffrey W , Hahn Jin-Oh , Burmeister David M
Published: March 2022

Introduction

Urine output (UOP) still remains the primary endpoint utilized as a surrogate for cardiac output (CO) and adequacy of perfusion during burn resuscitation. The role of arterial blood pressure (BP) waveform as a guiding tool for burn resuscitation has not been rigorously explored. As we move toward developing and validating novel endpoint to complement UOP, we compared the potential of pulse wave analysis (PWA) of arterial BP waveforms for estimating cardiac output (CO) and stroke volume (SV) in a large animal model of 40% total body surface area (TBSA) burns with varying resuscitation paradigms.

Methods

Anesthetized swine were instrumented and hemorrhaged 15% of their blood volume, and sustained a 40% TBSA full-thickness contact burn with aluminum billets. Animals were kept in a surgical ICU setting overnight, during which anesthesia was maintained with a combination of propofol, ketamine, and fentanyl. Animals were randomized to 3 different intravenous fluid (lactated Ringer’s, LR) levels: under resuscitation with no IV fluids, adequate resuscitation protocolized with a clinical decision support tool, or over resuscitation with a starting rate of 500mL/hour. We computed 20 surrogate measures of CO and SV (10 each) via PWA of arterial BP, and calibrated them to reference CO via thermo-dilution and SV on a subject-by-subject basis. Surrogate performance was quantified in terms of correlation coefficient and root-mean-squared error (RMSE) relative to reference CO and SV.

Results

Animals received 0±0, 4.4±1.6, and 9.1±1.3 mL/kg/% TBSA in the under, adequate, and over resuscitation groups (p=0.0036), respectively. Among the ten surrogate measures of CO and SV, 4 surrogates had positive proportionality to reference CO and SV consistently. The best surrogate measure of CO and SV was [mean BP-diastolic BP]/[heart period] and [mean BP-diastolic BP], respectively, which yielded r value of 0.82+/-0.19 and RMSE of 0.23+/-0.14 lpm for CO and r value of 0.85+/-0.17 and RMSE of 2.7+/-2.0 ml for SV (Fig. 1).

Conclusions

The initial results suggest that PWA-based surrogates of CO and SV have the potential to track reference CO and SV in extremes of resuscitation post-burn. The current model produces under-resuscitated, adequately resuscitated, and over-resuscitated animals, making it possible to rigorously examine the efficacy of PWA-based tracking of CO and SV in a wide spectrum of burn resuscitation scenarios. Hence, PWA may provide metrics useful for developing surrogates of CO and SV as novel treatment endpoints of burn resuscitation that indicate perfusion and volume status of burn injury patients.
4 Risk Association Between Race and Complications Following Burn
Authors: Haseem Maria , Wermine Kendall , Gotewal Sunny , Efejuku Tsola A , Chokshi Shivan N , Huang Lyndon G , Chaij Jasmine M , De La Tejera Giovanna , Corona Kassandra K , Golovko George , Song Juquan , Wolf Steven E , El Ayadi Amina
Published: March 2022

Introduction

Racial minorities have been recognized to experience worse health outcomes for many medical conditions. However, it is not clear if these outcomes are associated with pre-existing conditions or the quality of care those patients receive. In burns, little information on the relationship between race and burn comorbidities is available. This study examines the risk association between race and burn complications, such as pneumonia, sepsis, and ARDS while controlling for common comorbidities that affect burn recovery such as diabetes and hypertension.

Methods

Burn patient cohorts were identified by ICD10 codes for burn injury using TriNetX, a federated network of real-world data. The cohorts were stratified by race and balanced in terms of age at index, gender, BMI, and pre-existing comorbidities such as diabetes and hypertension. The following post burn outcomes were selected for analysis: renal failure, cardiovascular disease, sepsis, ARDS, graft complication, pneumonia, ICU admit, respiratory failure, hypertrophic scarring (HTS), hyperglycemia, and mortality. A measure of association analysis was performed to compare risk outcomes in black vs. white burn patients. Statistical significance was set at p< 0.05. The same cohorts were analyzed for treatment pathways to compare critical care billing CPT codes for the amount of time seen by a physician: Critical Care and Evaluation, first 30-74 minutes, and Critical Care and Evaluation, each additional 30 minutes.

Results

The balanced patient cohorts comprised 78,974 patients per cohort. Black patients experience a positive relative risk ratio (RR) to renal failure (p < 0.0001, RR = 1.372, 95% CI: 1.314-1.435), cardiovascular disease (p < 0.0001, RR = 1.115, CI: 1.08-1.15), sepsis (p < 0.0071 RR = 1.081, CI: 1.021-1.144), and ARDS (p < 0.0010, RR = 1.287 CI: 1.107-1.496) following burn injury. However, black patients experience a negative risk ratio to mortality (p < 0.0006, RR = 0.935, CI: 0.89-0.982) and pneumonia (p < 0.0014, RR = 0.937, CI: 0.901-0.975). The risk ratio was not significant for outcomes between black and white burn patients for respiratory failure, HTS, hyperglycemia, and ICU admit. Analysis of treatment pathways did not show significant differences in Critical Care and Evaluation billing between the two races.

Conclusions

Black burn patients are more likely to experience renal failure, cardiovascular disease, sepsis, and ARDS compared to white burn patients despite controlling for common comorbidities. They are less likely to experience pneumonia and mortality.
7 Impact of Chronic Alcohol Use on Fluid Resuscitation in Burn Patients
Authors: McEwan Sasha , Iles Kathleen A , Chrisco Lori , Pak Joyce , Agala Chris , Williams Felicia , King Booker , Nizamani Rabia
Published: March 2022

Introduction

Acute alcohol intoxication in burn patients has been associated with increased mortality, renal dysfunction and difficulty with adequate fluid resuscitation. It is less clear how chronic alcohol use, regardless of intoxication status on admission, impacts patient outcomes. In this study, we examine chronic alcohol use and both short- and long-term outcomes in burn patients.

Methods

Patients were identified using an institutional burn center registry and linked to clinical data. Adults admitted from 2017 to 2020 with a total body surface area (TBSA) % above 10% and a hospital stay greater than 2 days were eligible for inclusion. A total of 298 patients were enrolled and chart review completed for admission labs and fluid administration. Alcohol use was also examined and patients were staged based on severity and chronicity of alcohol use: none/minimal, early/moderate use, and problem/severe abuse. Renal dysfunction was defined based on Acute Kidney Injury Network criteria. Linear regression was used to assess the association between alcohol use and fluid resuscitation. Multiple logistic regression was used to assess alcohol use and renal dysfunction with adjustment for confounders.

Results

Compared to patients with none/minimal (NM) alcohol use and early/moderate (EM) alcohol use, patients in the problem/severe (PS) alcohol use category were older (NM 45.4 years, EM 44.1 years, PS 52.2 years; p=0.02), had larger mean TBSA burns (NM 18%, EM 14.9%, PS 23.1%; p=0.03), were more likely to have third degree burns (NM 53.8%, EM 36%, PS 72.4%; p=0.02), and more likely to have inhalation injury (NM 7.2%, EM 0%, PS 24.1%; p< 0.001). Patients in the PS category also had a significantly longer hospital length of stay (LOS) (p< 0.001), ICU LOS (p< 0.001), and ventilator days (p=0.005). Mortality was higher for the PS group (21.7%) compared to the NM (6.6%) and EM (0%) groups; p=0.001. These correlated to higher mean hospital costs for patients in the PS category compared to those in the NM category ($394,964 versus $868,126, p< 0.001). After adjusting for TBSA, patients in the PS category required more fluid resuscitation within 48 hours of admission compared to the NM category (p=0.0138), despite a lower mean admission BMI (27.1 vs 30.03, p=0.03). Although there was a trend toward increased rates of acute renal injury within 48 hours of admission in the PS group (32.7%) vs the NM group (21%), this did not reach statistical significance.

Conclusions

Chronic alcohol use was associated with more severe burn injury, increased morbidity and mortality, and greater resource use. Even after adjustment for comorbidities and TBSA, chronic alcohol use resulted in a need for increased initial fluid resuscitation.
11 A Twenty-one Year Review of Medical Malpractice Cases in Burn Care
Authors: Pham Christopher H , Dang Justin , Huang Melissa , Collier Zachary J , Gillenwater Justin , Garner Warren L , Kelly Richard
Published: March 2022

Introduction

Traumatic injuries are a common source of medical litigation but no prior studies have reported on the trends of medical malpractice in burn care. As a result, it is unclear what factors increase the likelihood that a medical professional caring for a burn patient will be named in a lawsuit. By understanding what drives patient discontent and the motivations behind their malpractice claims, burn care practitioners can better care for patients and decrease their own risk of involvement in medical litigation.

Methods

The Westlaw legal research database contains state and federal court documents from over 40,000 databases across the United States and was queried for all cases of burn injuries and medical malpractice from 2000 to 2021. All mechanisms-of-injury (e.g. flame, scald, electrical, chemical, Stevens-Johnson, etc.) were included. Case information including injury circumstances, plaintiff/defendant occupation, defendant burn care experience, and burn demographics (TBSA, mechanism) were recorded when available. The primary outcome was the case ruling (plaintiff or defendant), and settlement amounts were recorded when available.

Results

Forty of the 1,222 identified cases fit inclusion criteria. Twenty-seven percent (11/40) of cases involved treatment at a burn center and 82% of plaintiffs were men. The two most common mechanisms-of-injury were scald (38%) and flame burns (18%). The court ruled in favor of the plaintiff in 10% (4/40) of cases. When the court/jury ruled in favor of the plaintiff, the settlement amount ranged from $25,000 to $20,000,000. The most frequently sued medical specialty was Family Medicine (35%) and mid-level practitioners like physician assistants and nurse practitioners (35%). Physicians with a burn fellowship were named in only 5% (2/40) of cases. The most common claims were for burn depth misdiagnoses (7/40), deliberate indifference/treatments below standard-of-care (7/40), and delayed referrals to a burn specialist (6/40). All cases met American Burn Association transfer criteria. Patient mortality was the reason for litigation in 10% (4/40) of cases.

Conclusions

This study showed that most burn-specialized practitioners are not the subject of litigation. In fact, many patients filed malpractice claims because they were not referred to burn specialists. Based on case text analysis, all of the patients’ injuries fit American Burn Association transfer criteria and some lawsuits may have been avoidable.
15 Poverty and Frailty in Patients with Burn Injuries: Important but Unrelated
Authors: Wallace David L , Sloan Keturah , Williams Deborah , Heard Jason , Greenhalgh David , Palmieri Tina L , Sen Soman , Skipton Romanowski Kathleen S
Published: March 2022

Introduction

Previous work has demonstrated that frailty predicts mortality and patient disposition in burn patients >50 years old. It is unknown to what extent poverty contributes to these outcomes. There has been no work demonstrating the interplay of these two variables on patients with burn injuries. The purpose of this study was to determine the relationship of frailty and poverty in burn patients over the age of 50, and their association with patient outcomes.

Methods

A 9-year retrospective chart review from 2009-2018 of patients >50 years old admitted to an ABA verified burn center with acute burn injuries was completed. Patient demographics, burn characteristics, frailty scores and poverty levels were collected. Frailty scores were assigned using the Canadian Study of Health and Aging Clinical Frailty Scale (scored 1-7). Frailty was dichotomized with scores >5 being frail. Poverty data were obtained using zip code and US census data. Poverty level was categorized according to whether a patient came from a zip code that had >20% of people living in poverty. Descriptive statistics, univariate analysis, and multivariate analysis were completed to examine the relationship between frailty and poverty, as well as each variable independently on mortality and length of stay (LOS).

Results

A total of 953 patients were included. Mean age was 63.5 + 10.4 years and 675 (70.8%) were male. Mean %TBSA was 11.4%+14.2% and mean frailty score was 3.8 + 1.2. Upon admission, mean poverty score was 17.3+ 8.7. The overall mortality rate was 8.8%. Univariate analysis demonstrated that non-survivors had significantly higher chances of living in poverty (p=0.02). Similarly, univariate analysis showed that non-survivors were more likely to have frailty scores of 5 or greater compared to survivors. Multivariate logistic regression confirmed relationship between poverty and mortality (<20% vs >20%, OR 0.47 95% CI 0.25-0.89) and frailty and mortality ( >5 vs 1-4, OR 2.9 95%CI 1.4-5.8). It also demonstrated that the combined variable of frailty and poverty was not significantly associated with mortality (Wald χ2 2.0, p=0.15). Neither poverty (< 20% vs >20%, p=0.26) nor frailty (1-4 vs >5, p=0.52) were associated with LOS. Both poverty and frailty were associated with a patient’s disposition destination (p=0.03; p< 0.0001). Univariate analysis did not show a significant correlation between poverty and frailty (p=0.08), though there was a trend towards significance.

Conclusions

Poverty and frailty each independently predict mortality and discharge destination in burn patients >50, but they are not associated with LOS, and do not show a significant association with each other, nor a combined effect on mortality.
17 A Tissue-engineered Bi-layer Skin Substitute Polarizes Macrophages Towards an M2 Phenotype
Authors: Hernaez-Estrada Beatriz , Steele Lindsay , Spiller Kara
Published: March 2022

Introduction

Cellular and/or Tissue Product made of stratified keratinocyte-containing epidermis and fibroblast-embedded collagen dermis, has been shown to promote healing in patients with deep partial- thickness burns. The biological mechanisms behind these effects are poorly understood. Macrophages, the primary cell type of the innate immune system, are major regulators of all stages of tissue repair. They accomplish these diverse functions by shifting phenotype throughout the healing process from a pro- inflammatory population to a diverse population of phenotypes that orchestrate resolution of inflammation and healing. In burn injuries this transition is impaired. We hypothesized that skin substitutes promote this healthy transition in macrophage phenotype. The aim of this study was to analyze the crosstalk between skin substitutes and macrophages and to determine the influence of direct contact, secreted factors, and the substrate used in fabrication of the skin substitutes.

Methods

Primary human macrophages (N=4 donors) were co-cultured either directly or indirectly with a skin substitute via separation by transwell inserts. Macrophages were also cultured directly on the collagen scaffolds used in the skin substitute fabrication process or on low-activation plastic as an unactivated control. After 1 and 3 days, the macrophages were stained with a 10-marker flow cytometry panel to characterize macrophage phenotype: general marker (CD45), M1-related markers (CCR7, CD80, CD38 and PD-L1) and M2-related markers (CD206, CD209, CD163 and CXCR4). For a more thorough evaluation, multidimensional analysis was used to identify unique populations of macrophages. Large-scale Dimensionality reduction using triplets and clustering analysis with using FlowSOM algorithms were performed. Statistical analysis of individual marker expression or cell composition within clusters was performed with one-way ANOVA.

Results

In response to both direct and indirect interaction with skin substitutes, macrophages generally decreased M1 marker expression after 1 day in culture and increased M2 marker expression after 3 days. The suppression of M1 markers occurred when macrophages were co-cultured with skin substitutes, and in response to acellular collagen. The upregulation of M2 markers occurred only in response to direct or indirect interaction with cellular skin substitutes. Furthermore, multidimensional single cell analysis showed that contact with the skin substitutes also promoted unique populations of phenotypes that do not fit into the classical M1/M2 paradigm.

Conclusions

These results suggest that a potential mechanism by which skin substitutes promote healing is by promoting a transition of macrophages towards pro-reparative phenotypes.