bluuebunny/crossref_metadata_2025 huggingface dataset:
Kinetic study of electrostatic modes in a Lorentzian Electron-Positron-Ion (EPI) plasma
Authors: Ahmad Zeeshan , Hadi Fazli , Ullah Zakir , Rashid Ul Haq
Published: April 2021

The propagation and Landau damping of Langmuir Waves (LWs) and Ion-Acoustic Waves (IAWs) in Electron-Positron-Ion (EPI) plasma are investigated using Kinetic theory approach, with all the species to be Kappa or Lorentzian distributed. We observed that the Landau damping rates γ(κ) of Langmuir waves and IAWs in Lorentzian EPI plasma strongly depend upon the spectral index κ i.e., non-thermality parameter, wave number k, the positron temperature T

p
and the positron concentration or number density n

p
. The Landau damping γ(κ) of Langmuir waves was found to be increased with higher positron temperatures T

p
, whereas, that of IAWs was found to increase with lower positron temperatures T

p
. Moreover, it was observed γ(κ) of LWs shows a decrease with increase in positron concentration while γ(κ) of IAWs tends to increase.
Simultaneous effects of temperature, pressure, polaronic mass, and conduction band non-parabolicity on a single dopant in conical GaAs-Al
x
Ga1–x
As quantum dots
Authors: Iqraoun E , Sali A , El-Bakkari K , Ezzarfi A , Mora-Ramos M E , Duque C A
Published: April 2021

This paper is devoted to the theoretical study of the simultaneous effects of temperature, hydrostatic pressure, conduction band non-parabolicity, and polaronic mass on the electronic states and the photoionization cross-section of a shallow donor impurity confined in a GaAs-Al
x
Ga

1
−
x

As conical quantum dot. The calculations have been made within the effective mass approximation. The shallow donor impurity energy levels have been calculated by employing two methods: the variational approach and the finite element method with finite and infinite confining potential. The obtained results suggest that the effects of conduction band non-parabolicity, temperature, hydrostatic pressure, and variation of the conical quantum dot geometries play a significant role in determining of the electronic states system, as well as in the photoionization cross-section. It is also shown that the donor binding energy is very sensitive to temperature and hydrostatic pressure. Indeed, the temperature decreases the donor binding energy while it is increasing with the applied hydrostatic pressure. Also, the quantum dot effective gap is severely affected by the conduction band non-parabolicity. In the case of polaronic mass effects, the present study suggests that they can be omitted without significantly affecting the study’s main conclusions. In this paper, structures with an apical angle ranging from 10° to 150° are approached, allowing simulating quantum dots with a radius of the base much greater than the height and structures with a height much greater than the radius of the base. In the case of hydrostatic pressure and for quantum dots with finite confinement potential, the Γ-X crossover effect has been considered, which is responsible for significant changes in the carriers’ confinement potential.
Development of a 83mKr source for the calibration of the CENNS-10 liquid argon detector
Authors: Akimov D. , An P. , Awe C. , Barbeau P.S. , Becker B. , Belov V. , Bernardi I. , Blackston M.A. , Blokland L. , Bolozdynya A. , Cabrera-Palmer B. , Chen N. , Chernyak D. , Conley E. , Daughhetee J. , del Valle Coello M. , Detwiler J.A. , Durand M.R. , Efremenko Y. , Elliott S.R. , Fabris L. , Febbraro M. , Fox W. , Galindo-Uribarri A. , Gallo Rosso A. , Green M.P. , Hansen K.S. , Heath M.R. , Hedges S. , Hughes M. , Johnson T. , Khromov A. , Konovalov A. , Kozlova E. , Kumpan A. , Li L. , Librande J.T. , Link J.M. , Liu J. , Mann K. , Markoff D.M. , McGoldrick O. , Mueller P.E. , Newby J. , Parno D.S. , Penttila S. , Pershey D. , Radford D. , Rapp R. , Ray H. , Raybern J. , Razuvaeva O. , Reyna D. , Rich G.C. , Rudik D. , Runge J. , Salvat D.J. , Scholberg K. , Shakirov A. , Simakov G. , Sinev G. , Snow W.M. , Sosnovtsev V. , Suh B. , Tayloe R. , Tellez-Giron-Flores K. , Thornton R.T. , Tolstukhin I. , Vanderwerp J. , Varner R.L. , Venkataraman R. , Virtue C.J. , Visser G. , Wiseman C. , Wongjirad T. , Yang J. , Yen Y.-R. , Yoo J. , Yu C.-H. , Zettlemoyer J.
Published: April 2021

We report on the preparation of and calibration measurements with a 83mKr source for the CENNS-10 liquid argon detector. 83mKr atoms generated in the decay of a 83Rb source were introduced into the detector via injection into the Ar circulation loop. Scintillation light arising from the 9.4 keV and 32.1 keV conversion electrons in the decay of 83mKr in the detector volume were then observed. This calibration source allows the characterization of the low-energy response of the CENNS-10 detector and is applicable to other low-energy-threshold detectors. The energy resolution of the detector was measured to be 9% at the total 83mKr decay energy of 41.5 keV. We performed an analysis to separately calibrate the detector using the two conversion electrons at 9.4 keV and 32.1 keV.
Fabrication of DSSC using doctor blades method incorporating polymer electrolytes
Authors: Abrol Shivani Arora , Bhargava Cherry , Sharma Pardeep Kumar
Published: April 2021

Amongst various sources of renewable energy, solar energy is becoming prime due to its advantages of cleanliness, abundance and low operating cost. Currently, amorphous silicon PV cells are most into commercialization but to contradict, they have a very high manufacturing cost and due to usage of hazardous materials, they lead to environmental degradation. Hence, they are less preferred now a days. To overcome these complications, Dye sensitized solar cells (DSSC) are replacing customary cells at a very fast rate. In this research, fabrication of DSSC was done based polymer gel electrolytes prepared by in situ gelation. The ionic properties of the polymer gel electrolyte were also observed with the help of various tests performed like FESEM, FTIR, XRD & TGA. FTIR & XRD affirmed the good electron emission characteristics of the polymer electrolyte. XRD & TGA give amorphous nature and weight loss indication near 360 °C for cell based on polymer electrolytes. The performance evaluation of hence fabricated DSSC’s was done in terms of calculating efficiency, fill factor, current density (short circuit) and photovoltage (open circuit). The efficiency of the cell was found out to be 11.32% and fill factor came out to be 0.439.
Model construction and application for automated measurement of CE angle on pelvis orthograph based on MASK-R-CNN algorithm
Authors: Li Qiang , Yang Wenzhuo , Xu Meng , An Nan , Wang Dawei , Wang Xing , Jin Hui , Wang Jiajiong , Wang Jincheng
Published: April 2021

Developmental dysplasia of the hip (DDH) is a common orthopedic disease. A simple and cost-effective scientific tool for assisting the early diagnosis of DDH is urgently needed. This study proposed a new artificial intelligence (AI) model for automated measure of the CE angle to aid the diagnosis of DDH by modifying the Mask R-CNN algorithm.13228 anteroposterior pelvic x-ray images were collected from the PACS system of the second Hospital of Jilin University, of which 104 images were randomly selected as test data. The rest of x-ray images were labelled and preprocessed for model development. The new AI model was the constructed based modified Mask R-CNN model to detect key points for CE angle measurement. The performance of AI model on measuring CE angle was verified by comparing with three attending orthopaedic doctors. The mean CE angles on left and right pelvis measured by the AI model was 29.46 ± 6.98°and 27.92 ± 6.56°, respectively, while the mean CE angle measured by the three doctors was 29.85 ± 6.92°and 27.75 ± 6.45°, respectively. AI model displayed a higly consistency with the doctors in measuring CE angles. Besides, AI model showed a much high efficiency in term of measuring time-consumption. In this study, we successfully constructed a new effective model for measuring CE angle by identifying key points, which provided a new intelligent measurement tool for orthopedic image measurement and evaluation.
Real-time feedback improves multi-stakeholder design for complex environmental systems
Authors: Guo Niles , Davis Alex , Mauter Meagan , Whitacre Jay
Published: April 2021

We test whether providing quantitative real-time feedback relating design decisions to system objectives improves group solutions in an interdependent energy-water design task. While prior research suggests an important role of real-time feedback on task performance, few studies have examined the role of real-time feedback in the design of complex environmental systems. We tested a real-time feedback approach using a mixed within- and between-subject experiment (n = 88 Carnegie Mellon University students, divided into 22 groups of four). When compared to individual designs and informal collaborations, real-time performance feedback yielded solutions closer to the Pareto frontier and reduced both financial (by 26% and 21%) and environmental cost (by 34% and 12%). In addition, informal collaboration did not improve group decision-making when compared to individual designs. The results suggest that optimal solutions to meeting energy and water demand while minimizing cost and environmental impact can be obscured in informal collaborations, but that real-time feedback to system designers can help avoid waste of public resources.
The carbon sequestration potential of Scottish native woodland
Authors: Fletcher Tasmin I , Scott Catherine E , Hall Jeanette , Spracklen Dominick V
Published: April 2021

Woodland creation sequesters carbon and contributes to climate change mitigation. Most previous assessments of the carbon sequestration of new UK woodlands have focused on tree planting, little is known about the scale of the potential contribution from natural regeneration. We used a Potential for Native Woodland Model to make the first estimate of carbon sequestration by large-scale native woodland expansion through natural regeneration in Scotland. We estimate native woodland could expand to cover an additional 3.9 million hectares of the Scottish uplands removing an average of 6.96 million tons of CO2 per year. This represents 35%–45% of the carbon removal target for UK woodlands that has been suggested by the UK Committee on Climate Change. Expanding woodlands to just 10% of this potential would double existing native woodland and could provide a multitude of benefits, including carbon removal equivalent to approximately 4% of this target. The next few decades are critical in terms of climate change mitigation, therefore further work is now required to improve these estimates and better constrain this potentially large contribution.
Exploration of multiple post-extinction compensatory scenarios improves the likelihood of determining the most realistic ecosystem future
Authors: Garcia Clement , Solan Martin , Bolam Stefan G. , Sivyer David , Parker Ruth , Godbold Jasmin A
Published: April 2021

A research agenda is currently developing around predicting the functional response of ecosystems to local alterations of biodiversity associated with anthropogenic activity, but existing conceptual and empirical frameworks do not serve this area well as most lack ecological realism. Here, in order to advance credible projections of future ecosystems, we use a trait-based model for marine benthic communities to inform how increasing trawling pressure changes the biological-mediation of seabed functioning. Our simulations reveal that local loss of species, and the associated compensatory community response, lead to multiple and disparate biogeochemical alterations that are contingent on relative vulnerabilities to extinction, environmental and biological context, and the level of functional redundancy within replacement taxa. Consequently, we find that small changes in faunal mediation caused by community re-organisation can disproportionately affect some biogeochemical components (macronutrients), whilst having less effect on others (carbon, pigments). Our observations indicate that the vulnerability of communities to future human-induced change is better established by identifying the relative magnitude and direction of covariance between community response and effect traits. Hence, projections that primarily focus on the most common or most productive species are unlikely to prove reliable in identifying the most likely ecological outcome necessary to support management strategies.
Customized de novo mutation detection for any variant calling pipeline: SynthDNM
Authors: Lian Aojie , Guevara James , Xia Kun , Sebat Jonathan
Published: April 2021

Motivation

As sequencing technologies and analysis pipelines evolve, de novo mutation (DNM) calling tools must be adapted. Therefore, a flexible approach is needed that can accurately identify DNMs from genome or exome sequences from a variety of datasets and variant calling pipelines.

Results

Here, we describe SynthDNM, a random-forest based classifier that can be readily adapted to new sequencing or variant-calling pipelines by applying a flexible approach to constructing simulated training examples from real data. The optimized SynthDNM classifiers predict de novo SNPs and indels with robust accuracy across multiple methods of variant calling.

Availabilityand implementation

SynthDNM is freely available on Github (https://github.com/james-guevara/synthdnm).

Supplementary information

Supplementary data are available at Bioinformatics online.
Using a satisficing model of experimenter decision-making to guide finite-sample inference for compromised experiments
Authors: Heckman James J , Karapakula Ganesh
Published: April 2021

This paper presents a simple decision-theoretic economic approach for analysing social experiments with compromised random assignment protocols that are only partially documented. We model administratively constrained experimenters who satisfice in seeking covariate balance. We develop design-based small-sample hypothesis tests that use worst-case (least favourable) randomization null distributions. Our approach accommodates a variety of compromised experiments, including imperfectly documented rerandomization designs. To make our analysis concrete, we focus much of our discussion on the influential Perry Preschool Project. We reexamine previous estimates of programme effectiveness using our methods. The choice of how to model reassignment vitally affects inference.
Signal-mediated localization of Candida albicans pheromone response pathway components
Authors: Costa Anna Carolina Borges Pereira , Omran Raha Parvizi , Law Chris , Dumeaux Vanessa , Whiteway Malcolm
Published: April 2021

A MAPK cascade consists of three kinases, (MEKK, MEK and MAPK), that are sequentially activated in response to a stimulus and serve to transmit signals. In C. albicans and in yeast, an MAPK cascade is linked to the pheromone pathway through a scaffold protein (Cst5 and Ste5, respectively). Cst5 is much shorter and lacks key domains compared to Ste5, so in C. albicans, other elements, in particular the MEKK Ste11, play key roles in controlling the associations and localizations of network components.

Candida albicans opaque cells release pheromones to stimulate cells of opposite mating type to activate their pheromone response pathway. Although this fungal pathogen shares orthologous proteins involved in the process with Saccharomyces cerevisiae, the pathway in each organism has unique characteristics. We have used GFP-tagged fusion proteins to investigate the localization of the scaffold protein Cst5, as well as the MAP kinases Cek1 and Cek2, during pheromone response in C. albicans. In wild-type cells, pheromone treatment directed Cst5-GFP to surface puncta concentrated at the tips of mating projections. These puncta failed to form in cells defective in either the Gα or β subunits. However, they still formed in response to pheromone in cells missing Ste11, but with the puncta distributed around the cell periphery in the absence of mating projections. These puncta were absent from hst7Δ/Δ cells, but could be detected in the ste11Δ/Δ hst7Δ/Δ double mutant. Cek2-GFP showed a strong nuclear localization late in the response, consistent with a role in adaptation, while Cek1-GFP showed a weaker, but early increase in nuclear localization after pheromone treatment. Activation loop phosphorylation of both Cek1 and Cek2 required the presence of Ste11. In contrast to Cek2-GFP, which showed no localization signal in ste11Δ/Δ cells, Cek1-GFP showed enhanced nuclear localization that was pheromone independent in the ste11Δ/Δ mutant. The results are consistent with CaSte11 facilitating Hst7-mediated MAP kinase phosphorylation and also playing a potentially critical role in both MAP kinase and Cst5 scaffold localization.
Diligent Bureaucrats and the Expulsion of Jews from West Prussia, 1772–1786
Authors: Dahms Thomas
Published: April 2021

Historiography has repeatedly highlighted the mitigating influence of the Prussian administration on Frederick the Great’s oppressive policies toward the Jews. Scholars have argued that officials frequently opposed the king’s discriminatory legislation and intentionally delayed its implementation. These actions, they claimed, were influenced by the Enlightenment humanism of the Prussian administrators and their training in natural law theories and mercantilist economics, both taught at German universities at the time. Such descriptions are central in the influential narrative of late eighteenth-century Prussia as a remarkably tolerant state that developed relatively lenient policies towards the Jews. This article challenges the traditional portrayal of the Prussian administration by examining the actions of three officials involved in the expulsion of several thousand Jews from the province of West Prussia between 1772 and 1786. It argues that the remarkably positive assessment of the Prussian bureaucrats and their role in the Jewish policies of the time needs significant revision. First, previous historiography has overstated the extent to which Prussian officials objected to the king’s discriminatory policies. Secondly, occasional instances of resistance from within the administration were mainly motivated by political, economic and demographic objectives or even careerist pursuits that had little to do with the Jewish communities. Lastly, the Prussian administrators did not merely adhere to economic principles or even to ideals of tolerance and humanity. To a significant extent, their actions were also influenced by anti-Jewish sentiment.
Minimal epitope for Mannitou IgM on paucimannose-carrying glycoproteins
Authors: Robakiewicz Stefania , Bridot Clarisse , Serna Sonia , Gimeno Ana , Echeverria Begoña , Delgado Sandra , de Ruyck Jérôme , Semwal Shubham , Charro Diego , Dansercoer Ann , Verstraete Kenneth , Azkargorta Mikel , van Noort Kim , Wilbers Ruud H P , Savvides Savvas N , Abrescia Nicola G A , Arda Ana , Reichardt Niels C , Jiménez-Barbero Jesús , Bouckaert Julie
Published: April 2021

Paucimannosidic glycans are restricted to the core structure [Man1–3GlcNAc2Fuc0–1] of N-glycans and are rarely found in mammalian tissues. Yet, especially [Man2-3GlcNAc2Fuc1] have been found significantly upregulated in tumors, including in colorectal and liver cancer. Mannitou IgM is a murine monoclonal antibody that was previously shown to recognize Man3GlcNAc2 with an almost exclusive selectivity. Here, we have sought the definition of the minimal glycan epitope of Mannitou IgM, initiated by screening on a newly designed paucimannosidic glycan microarray; among the best binders were Man3GlcNAc2 and its α1,6 core-fucosylated variant, Man3GlcNAc2Fuc1. Unexpectedly and in contrast to earlier findings, Man5GlcNAc2-type structures bind equally well and a large tolerance was observed for substitutions on the α1,6 arm. It was confirmed that any substitution on the single α1,3-linked mannose completely abolishes binding. Surface plasmon resonance for kinetic measurements of Mannitou IgM binding, either directly on the glycans or as presented on omega-1 and kappa-5 soluble egg antigens from the helminth parasite Schistosoma mansoni, showed submicromolar affinities. To characterize the epitope in greater and atomic detail, saturation transfer difference nuclear magnetic resonance spectroscopy was performed with the Mannitou antigen-binding fragment. The STD-NMR data demonstrated the strongest interactions with the aliphatic protons H1 and H2 of the α1–3-linked mannose and weaker imprints on its H3, H4 and H5 protons. In conclusion, Mannitou IgM binding requires a nonsubstituted α1,3-linked mannose branch of paucimannose also on proteins, making it a highly specific tool for the distinction of concurrent human tumor-associated carbohydrate antigens.
T5 The Impact of Burn Survivor Pre-injury Income and Payer on Health-Related Quality of Life Outcomes
Authors: Sheckter Clifford C , Carrougher Gretchen J , Smith Mallory B , Wolf Steven E , Schneider Jeffrey C , Gibran Nicole S , Stewart Barclay T
Published: April 2021

Introduction

The critical care, surgery, and rehabilitation required to recover patients with serious burn injuries are associated with high financial costs. In the US, these costs are often borne by patients. However, the relationship between pre-injury finances (personal income and payer) and health-related quality of life (HRQL) of burn survivors has not been reported. We hypothesized that lower income and public payers would be independent predictors of poorer HRQL.

Methods

Burn survivors with complete data for pre-injury personal income and payer were extracted from the NIDILRR Burn Model System National Database. HRQL outcomes included VA-Rand 12 (VR-12) scores at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, gender, self-identified race, measures of burn injury severity). Model performance was assessed with Akaike Information Coefficient.

Results

453 burn survivors had complete data for income and payer status. 36.4% earned less than $25k/year, 24% earned $25k-49k/year, 23% earned $50k-99k/year, 10% earned $100k-149k/year, 3% earned $150k-199k/year, and 3% earned ≥$200k/year. Mental component summary (MCS) and physical component summary (PCS) scores were highest for those who earned $150-199k/year (55.8, 55.8), and lowest for those who earned < $25k/year (49.0, 46.4). There was a negative relationship between income < $25k/year and MCS scores at 6-, 12-, and 24-months post-injury (p< 0.05). This relationship was not observed with PCS scores. After adjusting for demographics, payer, and burn severity, 24-month PCS scores were negatively associated with Medicare payer (p=0.025), black race (p=0.008) and number of operations during index admission (p=0.026). There were no significant associations with MCS scores.

Conclusions

HRQL was highest for burn survivors earning between $150-199k/year. Participants who earned < $25k/year had the lowest VR-12 scores and particularly MCS scores. On multivariable analysis, most of the differences in HRQL associated with pre-injury income were explained by differences in demographic, payer and burn severity factors.
1 Development of the School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE: 5–12) Profile: A Conceptual Model Framework
Authors: Rencken Camerin A , Rodríguez-Mercedes Silvanys L , Patel Khushbu F , Grant Gabrielle G , Kinney Erin M , Sheridan Robert L , Brady Keri J , Palmieri Tina L , Warner Petra , Fabia Renata , Schneider Jeffrey C , Stoddard Frederick J , Kazis Lewis E , Ryan Colleen M
Published: April 2021

Introduction

Pediatric burn injuries can alter the trajectory of the survivor’s entire life. Patient-centered outcome measures are helpful to capture and assess their unique physical and psychosocial needs and long-term recovery. This study aimed to develop a conceptual model framework to measure outcomes most important to pediatric burn survivors aged 5 to 12 years as a part of the SA-LIBRE5-12 Computer Adaptive Test (CAT) development.

Methods

This study used a systematic literature review guided by the WHO International Classification of Functioning – Child and Youth. Previously established domains in the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire5-18 further guided framework development. Individual interviews with parents and clinicians were conducted to obtain perspectives on domains most important to assess following a burn injury in children aged 5 to 12 years. One clinician focus group was completed to identify gaps in the preliminary framework, and semi-weekly expert consensus meetings were conducted to solidify the framework. Qualitative data were analyzed by grounded theory methodology in NVivo 12 software.

Results

The literature review identified 82 articles. Eight parents and seven clinicians participated in individual interviews, four clinicians participated in one focus group, and three consultants were included in the expert consensus meetings. The consultants included a burn surgeon, psychiatrist, and health services researcher. Three major domains emerged from the grounded theory approach, including: 1) Physical Functioning: fine motor and upper extremity, gross motor and lower extremity, pain, skin sensitivity, sleep and fatigue, and physical resilience; 2) Psychological Functioning: cognitive, behavioral, emotional, resilience, and body image; and 3) Family and Social Functioning: school, peer relations, community participation, family relationships, and parental satisfaction.

Conclusions

The comprehensive literature review, clinician and parent individual interviews, clinician focus group, and expert consensus meetings resulted in a conceptual model framework for parent-reported health outcomes after a burn injury in school-aged children aged 5 to 12 years. The framework will be used to develop item banks for a CAT-based assessment of school-aged children’s health and developmental outcomes.
2 Rates of Follow up After Burn Injury Are Disturbingly Low and Linked with Social Factors
Authors: Karashchuk Irina P , Solomon Eve A , Greenhalgh David G , Sen Soman , Palmieri Tina L , Romanowski Kathleen S
Published: April 2021

Introduction

Due to risks of scarring and difficulties with re-socialization, it is important that burn patients attend follow up appointments to minimize adverse sequelae. Studies in trauma and emergency medicine have shown a correlation between reduced follow up and low socioeconomic status. Our goal was to examine the factors leading to missed follow up appointments in the burn center population.

Methods

Following IRB approval, a retrospective chart review was conducted using electronic medical records of all adult patients admitted to the burn center from 2016–2018. Data collected included information on burn injury, social status, substance use, and zip code demographics. Exclusions included patients with non-burn injuries, who died in the hospital, who were transferred to another hospital, who did not have any scheduled outpatient follow up, who had insurance which precluded follow up at our institution, and prisoners. Data analysis was conducted using chi-square, t-test, linear, and logistic regression models.

Results

A total of 878 patients (mean age 45.1 ± 16.8 years, 646 males (73.6%), mean burn size (TBSA) 10.16±11.7%) were analyzed. In our population, 96 (10.93%) patients were homeless, 284 (32.35%) had drug dependence, 128 (14.58%) had alcoholism, and the mean poverty level was 17.7±8.34%. Of those analyzed, 224 (25.5%) failed to attend any follow up appointments and 492 (56.0%) had at least one missed appointment. Patients who did not attend any follow up appointments had smaller burns (8.2±9.5% vs. 10.8±12.3%), traveled farther (91.8±101.1 miles vs. 69.0±68.7 miles), were more likely to be homeless (22.8% vs. 6.9%) and to have drug dependence (47.3% vs. 27.2%). Patients who missed at least one appointment were younger (43.8±16.1vs. 46.8±17.4 years), more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never returning to clinic were: Distance from hospital (odds ratio (OR) 1.004, p=0.0001), TBSA (OR 0.96, p= 0.0001), Drug Dependence (OR 0.49, p< 0.0001), and Homelessness (OR 0.31, p< 0.0001). Factors associated with missing at least one appointment were: Age (OR 0.99 p< 0.03), Drug Dependence (OR 0.51, p< 0.0001), Homelessness (OR 0.20, p< 0.0001), and ED visits (OR 0.57, p< 0.05).

Conclusions

In our population, a high percentage of patients fail to make any appointment following their injury and an even higher number miss at least one appointment. The factors that influence failure to return and missing at least one appointment are similar but not exactly the same. Both follow up and missed appointments are influenced by social determinants of health.
7 Patterns for Monitoring Burn Recovery: Preliminary Results from the LIBRE Journey Study
Authors: Kelter Brian M , Wolfe Audrey E , Acton Amy , Slavin Mary D , Ni Pengsheng , Ryan Colleen M , Kazis Lewis E , Schneider Jeffrey C
Published: April 2021

Introduction

While social rehabilitation after burn injury is one of the multiple facets of recovery, there are limited data on long term social participation outcomes. The computer adaptive test LIBRE Profile was developed to examine social participation outcomes across six domains. The objective of the study is to use the LIBRE Profile to measure social integration and explore the trajectories of recovery in multiple outcome domains.

Methods

Preliminary data from the ongoing LIBRE Journey research study were analyzed. Demographic and clinical characteristics examined included age, gender, race, ethnicity, education level, marital status, burn size and time since injury. LIBRE Profile scores collected at baseline (time of study enrollment), 6 months, and 12 months were used to develop score trajectories for each of the six LIBRE Profile domains (Family and Friends, Social Activities, Romantic Relationships, Sexual Relationships, Social Interactions, and Work and Employment). Recovery was analyzed for time since injury from 1 year to 70 years. Linear mixed models were applied to each domain, adjusting for demographic and clinical characteristics. Models were fit with the score trajectory and 95% confidence intervals to demonstrate change across time and the impact of the covariates.

Results

The study population included 343 burn survivors with mean age at injury of 45.3 years (SD 15.5) and mean burn size of 18.7% (SD 25.4). The population was 42.1% male, 83.1% white, and 91.6% non-Hispanic. With the exception of Family and Friends and Romantic Relationships, all other domain scores increased with times since injury (p< 0.001).(Example curve: Figure) Those with larger burn size scored worse in Social Activities and Work and Employment. Males demonstrated higher scores than females on Romantic Relationships and Sexual Relationships. Higher education was associated with higher scores on the Family and Friends domain; Marriage was associated with higher scores on Family and Friends, Romantic Relationships and Work and Employment domains.

Conclusions

Preliminary analysis of LIBRE Journey data demonstrates ability to generate trajectories of recovery for each of the six domains of social participation. Four of the six domains demonstrate evidence of improvement over time, suggesting important positive patterns of social integration occurring in the short- and long-term post injury.
15 Use of Bioelectric Impedance Analysis in Burn Patients: A Pilot Study
Authors: Hulsebos Ian F , Johnson Maxwell B , Spera Leigh J , Fobar Megan C , Collier Zachary J , Yenikomshian Haig A , Gillenwater Justin
Published: April 2021

Introduction

Bioelectric Impedance Analysis (BIA) is a rapid, non-invasive, and inexpensive technology based on electrical conductivity. BIA assesses body composition, fluid shifts, and phase angle, an electrical force vector where smaller values suggest cellular injury. Our objective was to use BIA to longitudinally track the clinical status of burn patients. We hypothesized that BIA would detect progressive decreases in muscle mass throughout the patient’s hospital course and that low phase angle values would correlate with severity of injury.

Methods

A cohort study of 10 patients from January 1, 2020 to March 13, 2020 was performed at an ABA-verified burn center. Patient and burn characteristics and laboratory data were collected. BIA measurements were performed daily for the first 10 days of admission and then twice weekly until discharge. The primary outcome was to detect changes in body composition. The secondary objectives were to detect differences between low and high-risk patients in terms of water composition and phase angle. Patients with APACHE II > 15, measured at burn unit admission, were considered high risk for burn injury related morbidity and mortality.

Results

BIA detected a statistically significant negative correlation between time spent hospitalized and leg lean mass (LM) (r2=0.56, P< 0.0001), right arm LM (r2=0.52, P< 0.0001) and left leg LM (r2=0.57, P< 0.0001), and positive correlation between body fat mass (BFM) and time spent hospitalized (r2=0.50, P=0.0004). Water composition (volume of extracellular water (ECW) per total body water (TBW)) negatively correlated with low-risk patients: right arm (r2=0.51, P< 0.0001), left arm (0.71, P< 0.001), thorax (0.66, P< 0.0001), right leg (0.74, P< 0.0001), left leg (0.35, P=0.002). Full body phase angle increased with low-risk patients over their hospital course (r2=0.62, P< 0.0001), while phase angle decreased with high-risk patients (r2=0.71, P=0.0006). Full body phase angle differentiated high risk patients (P< 0.0001), and phase angle of thorax differentiated between patients with and without inhalation injury (P=0.002).

Conclusions

Our study demonstrates that BIA measures changes in body composition and fluid shifts, identifies inhalation injury, and correlates with severity of injury in hospitalized burn patients. This pilot study included a limited number of participants with varying anatomic injuries presenting unique measurement challenges. Regardless, our preliminary data justifies a larger prospective study to confirm these results and correlate them with clinical outcomes.
26 Clogged Feeding Tubes: Why Does It Matter?
Authors: Zavala Sarah , Wang Ashley , Zhang Cheryl W , Larson Jennifer M , Liu Yuk Ming
Published: April 2021

Introduction

Many patients treated on a burn unit require tube feeding as their primary caloric source or as supplemental feeding due to their injuries. Burn patients specifically require higher caloric intake due to the hypermetabolic state of burn injuries. Inadequate nutritional support contributes to longer ICU stays and higher mortality. Clogged feeding tubes reduce nutrition provided due to temporary discontinuation of feeding. The objective of this study was to identify risk factors for the incidence of tube clogging.

Methods

This was a single-center retrospective chart review of all patients admitted to an American Burn Association-verified Burn Unit between August 2017 and October 2019 who received tube feeds during their admission. Data collected included baseline demographics, clinical outcomes, and details about tube feed formulations, number of clogs, and details leading up to the clog. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test.

Results

A total of 170 patients were included; admission diagnoses included burn (97), soft tissue infections (29), SJS/TEN (11), and others (33). At least one clogged feeding tube was experienced by 51 patients and some experienced up to seven separate clogs. SJS/TEN patients were less likely to experience a clog (9.2 vs 0%, p = 0.035) and frostbite patients were more likely to experience a clog (0 vs 5.9%, p = 0.026). Burn mechanism did not affect incidence of tube feed clog, but patients with larger total body surface area (TBSA) burned were more likely to have a clog (15.55 vs 25.03%, p = 0.004). It was a median of 12 days until the first clog occurred (IQR 7.8–17.3). Two tube feed formulas demonstrated an increased likelihood of clog: a renal formulation (16.8 vs 33.3%, p = 0.017) and a polymeric concentrated product (5.0 vs 17.6%, p = 0.008). Both products have a high viscosity. Patients who experienced a clog had a longer length of stay (21.5 vs 44.0 days, p = 0.001).

Conclusions

This study identified several risk factors associated with higher incidence of clogged feeding tube in the burn unit including tube feed formulation and viscosity, admission diagnosis, and larger TBSA in burn patients. This study also confirms that clogged feeding tubes, and the resultant insufficient nutritional support, may contribute to an increased length of stay.
27 Oral Supplementation for Burn Patients: Would YOU Eat That?
Authors: Savetamal Alisa , Ebdon Melissa
Published: April 2021

Introduction

The metabolic demands of burn injury often require that patients consume a high-calorie diet. For patients taking nutrition solely by the oral route, this can be challenging, and supplementation is necessary. The burn team is sometimes frustrated at patients’ inability or perceived unwillingness to consume the daily prescribed supplementation. The purpose of this study was to expose the burn team to the various nutritional supplements offered to patients, and to gain a better understanding of the palatability those supplements.

Methods

Nine volunteers from the burn team participated in this blinded study: an attending surgeon; surgical residents (2); students (1); therapists (2); and nurses (3). Samples of 9 different nutritional supplements were placed in numbered cups, with the contents known only to the dietitians. The supplements consisted of: “milkshake” consistency drinks (#1,4,6,7, 9); gelatin (#2); frozen custard (#3); clear thin liquid (#5); and pudding (#8). Each participant received one cup of each supplement and was asked to rate the contents on a scale of 1 to 10, with 10 being tastiest. Mean, trimmed mean, and median taste scores were noted. Data were analyzed by t-test and by regression to assess for differences based on protein content.

Results

The highest mean and trimmed mean scores (7.3 and 7.4) were given to product #8. Product #1 had slightly lower scores (6.4 and 6.1). Product #9 received the lowest mean score (2.2); the trimmed mean was even lower (1.7). Median scores for the products upheld these results, and most of the remainder of the products received median scores of 4 or 5. T-test analysis showed significant differences in preference for products 1 and 8 versus the rest of the products (with means of 2.2 to 5.3). Regression analysis suggests that taste scores tend to be higher for products with a lower percentage of calories from protein, while the higher protein products fare less well in taste (a decline of roughly 0.47 in mean taste score for every 10-percentage point increase in percentage of calories from protein).

Conclusions

A blinded taste test of commonly offered supplements revealed that most products are, at best, moderately acceptable (median score 4–5). This suggests two potential changes in the approach to oral supplementation. First, the burn team should be sympathetic to the challenges that patients face with oral supplements, particularly the high-protein versions. Second, the burn team may need to be innovative. Chilling the drinks, offering different flavors, mixing flavors, or mixing with other liquids may help patients to take oral supplements more enthusiastically. Sampling these oral supplements has helped our team to understand better what we ask our patients to do to achieve their nutritional goals.
29 The Effectiveness of Laser Therapy for Hypertrophic Burn Scars in Pediatric Patients: A Prospective Investigation
Authors: Zuccaro Jennifer , Fish Joel , Kelly Charis
Published: April 2021

Introduction

Laser therapy has emerged as a valuable treatment option for hypertrophic burn scars over the past decade. Improvements in scar symptoms have been found using the ablative fractional carbon dioxide laser (AFCL) as well as the pulsed dye laser (PDL). However, research regarding the use of laser therapy among pediatric burn patients remains limited. Thus, the aim of this study was to investigate the effectiveness of using laser therapy to improve hypertrophic burn scars in a pediatric population using a comprehensive set of subjective and objective scar assessment tools.

Methods

A single-center, prospective observational study was carried out at a tertiary pediatric hospital. Twenty participants with hypertrophic burn scars that had not received previous laser treatment were included. Laser procedures were administered at approximately two-month intervals and each participant attended five study visits over the course of one year. A comprehensive set of scar assessment tools including the Vancouver Scar Scale, the Patient and Observer Scar Assessment Scale, conventional ultrasound, ultrasound elastography, and a multi-parameter skin analysis device were used to evaluate scar properties at each study visit.

Results

Seventy-one laser procedures were carried out with most participants receiving treatment with both the AFCL and the PDL at the same session (83%). All participants underwent at least three laser procedures with no complications noted. From baseline to study completion, statistically significant improvements in all scar measures, both subjective and objective, were observed (p < 0.05). More specifically, improvements in overall scarring and in specific scar properties including thickness (p < 0.05), stiffness (p < 0.05), and color (p < 0.05) were found.

Conclusions

To our knowledge, this is the most comprehensive study to date to evaluate the effect of laser treatment on hypertrophic burn scars in a pediatric population. Our findings suggest that laser therapy is a highly beneficial treatment for burn-injured children that should be integrated into current scar treatment practices. In addition to obtaining strong evidence to support the use of laser therapy, we utilized rigorous scar assessment and laser treatment protocols that can be easily adopted by other clinicians.
34 Rete Ridges are Decreased in Dyschromic Burn Hypertrophic Scar: A Histological Study
Authors: Carney Bonnie C , Travis Taryn E , Deldar Romina , Moffatt Lauren T , Johnson Laura S , McLawhorn Melissa M , Shupp Jeffrey W
Published: April 2021

Introduction

Dyschromic hypertrophic scar (HTS) with areas of hyper- and hypo-pigmentation is a common sequelae of burn injury. The mechanism behind the development of dyschromia has not been elucidated. In this study, we provide a histological analysis of these scars with a focus on rete ridge presence. Rete ridges occur in epithelial tissues such as oral mucosa and skin and can be described as undulating “pegs” that are interdigitated with dermal papillae. Rete ridges enhance adhesion of the epidermis to the dermis. We hypothesize that rete ridge presence is important for normal skin physiology, and their absence or presence may hold mechanistic significance in post-burn HTS dyschromia.

Methods

Subjects with post-burn dyschromic HTS were consented and enrolled (n=27). Punch biopsies of hyper-, hypo-, and normally pigmented scar and skin were collected and stored in formalin. Biopsies were paraffin embedded, sectioned, stained with H&E, and imaged. The number of rete ridges were investigated by calculating a rete ridge ratio from the length of the basement membrane and the length of the epidermis.

Results

The patient population was predominantly female (55.5%), black (70.4%), and had Fitzpatrick skin Type V (51.9%). The injuries were primarily as a result of flame (37%) and scald (33.3%) and resulted in a median TBSA burn of 7%. The median age of the scar at the time of sample acquisition was 12.2 months. The rete ridge ratio of normally pigmented, un-injured skin was above 1 (1.31 ± 0.04), indicating that normal skin’s basement membrane is longer than its epidermal length due to the presence of rete ridges. HTSs resulting from burn wounds that healed without split thickness autografts were first investigated. The number of rete ridges was higher in normal skin compared to HTS that was either hypo- or hyperpigmented (1.31 ± 0.04 vs. 1.13 ± 0.05 and 1.14 ± 0.04 vs, p< 0.05). This difference was similar despite pigmentation phenotype. When hyper-pigmented scars resulting from wounds that were treated with split thickness autografts (Hyper(+)) were investigated, rete ridge number was significantly higher than in Hyper(-) (1.89 ± 0.23, p< 0.01). Patient age showed a weak correlation (R=-0.33) with rete ridge ratio where older patients had lower rete ridge ratios in normal, un-injured skin. Hyper(+) showed a weak correlation between rete ridge ratio and age of scar (R=-0.38).

Conclusions

Post-burn HTS that is dyschromic has fewer rete ridges than normal skin. This finding may explain the decreased epidermal barrier function that is associated with HTS.
36 Using Pressure Mapping to Understand and Prevent Hospital-Acquired Pressure Injuries in the Burn ICU
Authors: El Eter Leen , Yesantharao Pooja S , Javia Vidhi , Werthman Emily h , Cox Carrie A , Orosco Rowena , Cooney Carisa , Caffrey Julie
Published: April 2021

Introduction

Real-time pressure mapping devices may help prevent hospital-acquired pressure injury (HAPI) in Burn ICU (BICU) patients who are at a high baseline risk for HAPIs. While prior studies have demonstrated the utility of pressure monitoring devices in preventing pressure injuries, there has been little investigation into using pressure mapping data to better understand HAPI development, and to determine specific predictors of HAPIs. Such data could help risk stratify patients upon admission to the BICU and result in improved patient care as well as cost savings. This study retrospectively investigated the utility of pressure mapping data in predicting/preventing pressure injury among BICU patients, and estimated HAPI-related cost savings associated with the implementation of pressure monitoring.

Methods

This was a retrospective chart review of real-time pressure mapping in the BICU. Incidence of HAPIs and costs of HAPI-related care were determined through clinical record review, before and after implementation of pressure mapping. Multivariable-adjusted logistic regression was used to determine predictors of HAPIs, in the context of pressure mapping recordings.

Results

In total, 122 burn ICU patients met inclusion criteria during the study period, of whom 57 (47%) were studied prior to implementation of pressure mapping, and 65 (53%) were studied after implementation. The HAPI rate was 18% prior to implementation of pressure monitoring, which declined to 8% after implementation (chi square: p=0.10). HAPIs were more likely to be less severe in the post-implementation cohort (p< 0.0001). Upon multivariable-adjusted regression accounting for known predictors of HAPIs in burn patients (BMI, length of stay, co-morbidities, age, total body surface area burned, mobility), having had at least 12 hours of sustained pressure loading in one area significantly increased odds of developing a pressure injury in that area (odds ratio 1.3, 95%CI 1.0–1.5, p=0.04). When comparing patients who developed HAPIs to those who did not, pressure mapping demonstrated that patients who developed HAPIs were significantly more likely to have had unsuccessful repositioning efforts prior to HAPI development, defined as persistent high pressure in the at-risk area (60% versus 17%, respectively; p=0.02). Finally, implementation of pressure mapping resulted in significant cost savings ($2,063 prior to implementation, versus $1,082 after implementation, p=0.008).

Conclusions

The use of real-time pressure mapping decreased incidence of HAPIs in the burn ICU patients and resulted in significant cost savings.