bluuebunny/crossref_metadata_2025 huggingface dataset:
515 Compliance with a Restrictive Blood Transfusion Strategy: Do We Actually Follow Scientific Evidence?
Authors: Wallace David L , Rogers Alan D , Cartotto Robert
Published: March 2020

Introduction

Many burn centers use a restrictive blood transfusion strategy based on randomized controlled trials in burn patients (e.g. Transfusion Requirements in Burn Care Evaluation -TRIBE) and non-burn populations (e.g. Transfusion Requirements in Critical Care – TRICC), which have demonstrated no increased morbidity or mortality between restrictive and liberal transfusion approaches. The purpose of this study was to evaluate the adherence to a restrictive hemoglobin transfusion trigger strategy of 7 g/dL.

Methods

Retrospective study of all patients admitted to an adult regional ABA-verified burn centre between 15/11/ 2015 and 15/6/2018 who received at least one unit of blood (RBC). We use a restrictive transfusion strategy that administers RBC for a hemoglobin (HGb) < 7 gm/dL, one unit at a time, with a pre and post HGb level for each RBC transfusion, unless the patient is actively bleeding and/or hemodynamically unstable. RBC transfusions in the operating room do not follow this policy and were not studied. Values are presented as mean ± SD or median (IQR) as appropriate.

Results

We studied 66 patients (30% female) with age 53.2 ± 18.3 years, % TBSA burn 22 (11–41), % TBSA full thickness burn 6.5 (0.5 -21.8), and with 41% having inhalation injury. Overall, there were 691 RBC transfusions (TXns). A pre-TXn HGb was obtained 95% of the time and was 6.8 (6.5–7) gm/dL. TXn for a HGb > 7 gm/dL occurred in 35%. A post TXn HGb was obtained for 92% of these TXns with a HGb of 7.6 (7.2–8) gm/dL. RBC TXns during nighttime (1700 to 0800, n=449) were given for a HGb trigger of 6.8 (6.4–6.9) and were not compliant with our restrictive strategy 22% of the time. Daytime transfusions (0800 to 1700, n=207) were given for a significantly higher HGb [7 (6.7–7.1), p< 0.001] with significantly more non-compliance with the restrictive strategy (50%, p< 0.001). We also compared TXns before and after the TRIBE publication. Pre-TRIBE TXns (n=484) were given for significantly lower HGb than 172 post TRIBE TXns [6.8 (6.4–7) vs 6.9 (6.6–7.1) gm/dL respectively, p=0.001] and at significantly lower rate of non-compliance with the 7 gm/dL threshold than post TRIBE transfusions (28.1% vs 37.8%, respectively, p=0.02).

Conclusions

While a pre-TXn HGb level was available for 95% of blood transfusions, approximately one-third were given for a HGb > 7 gm/dL. Transfusion during nighttime (being predominantly ordered by housestaff physicians) were administered at a significantly lower HGb trigger and with significantly better compliance with the restrictive strategy than daytime transfusions. Paradoxically, compliance with the restrictive strategy was worse following the TRIBE publication.

Applicability of Research to Practice

These results identify important areas for improvement in adherence to our restrictive transfusion strategy.
553 Work-related Burn Injuries Among Burn Patients in a Tertiary Care Burn Facility, 2013 – 2018
Authors: Williams Felicia N , Nurczyk Kamil , Sljivic Sanja , Chrisco Lori , Calvert Catherine , Nizamani Rabia , Jones Samuel W , Cairns Bruce
Published: March 2020

Introduction

The characteristics of work-related (WR) burn injuries compared to non-work-related (non-WR) burns are not well defined in the literature. In an effort to determine the potential impact of commonly accepted prevention efforts, we compared WR and non-WR burn injuries in our facility for the last five years.

Methods

All patients admitted to the burn center between January 1st, 2013 and December 31st, 2018, of working age were included. Demographics, burn characteristics, and patient outcomes were evaluated using Student’s t-test and chi-squared test where appropriate, significance was accepted at p< 0.05.

Results

3,545 patients were included in this study. WR patients were 22% of all patients in this cohort. The majority of patients in both cohorts were white males in their twenties. Compared to non-WR patients, WR patients had fewer comorbidities with 30% smaller total body surface area burns, and shorter lengths of stay (see table). WR patients were more likely to suffer chemical (14.5% vs 2.3%) and electrical burns (11.9% vs 1.2%) compared to non-WR patients, respectively. 67% percent of WR burn fatalities were from electrical injuries, while flame was the leading cause of death in non-WR patients.

Conclusions

WR burn injured patients are young males with fewer co-morbid conditions. Etiologies of injuries are vastly different between non-lethal and lethal WR and non-WR injuries. Classic burn prevention strategies that target flame burn injuries and fatalities will have little impact on WR burn injuries.

Applicability of Research to Practice

This study highlights the importance of focusing prevention campaigns to industry as well as schools and homes.
577 The Intersection Between Burns and Psychiatric Disorders
Authors: Gasteratos Konstantinos , Voitsidis Pantelis , Vlahopoulos Nikolaos , Shen Abra H
Published: March 2020

Introduction

Burns constitute a major health problem accounting together with fires for more than 300.000 deaths per year worldwide and for a great rate of disability-adjusted life years (DALYs). Identifying the relationship between mental disorders and burns is crucial since the former seems to constitute an important risk factor for the latter. At the same time, clinical experience and scientific evidence suggest that survivors of burns often develop psychiatric sequelae, causing poorer outcomes and lower quality of life.

Methods

We conducted a systematic review in order to study the relationship between burns and psychopathology as well as the quality of life. We used the search engine “PubMed” with the term “((psychiatric[Title/Abstract]) OR psychological[Title/Abstract]) AND burns[Title/Abstract]” without limits regarding the time of publication, resulting in 761 studies. Using the Covidence online platform that enables screening of the articles by two reviewers, we screened the articles, first by title and abstract and then by full text. Non-English papers or papers with no full texts will be excluded from the study. We aim to register the review in the official international prospective register of the National Institute for Health Research (PROSPERO).

Results

Preliminary results suggest that a history of mental disorder is common among burn patients, whether self-inflicted or not. Research tends to focus on self-inflicted burns which are expected to show such an association. Indeed, psychotic disorders, drug dependence and depression constitute significant risk factors for self-immolation. At the same time, the presence of a mental disorder may be associated with a worse prognosis (burn complications, patient morbidity, and mortality, multiple hospitalizations, increased cost for treatment). Burn survivors are also at risk for developing psychiatric complications, such as Post Traumatic Stress Disorder (PTSD), depression and anxiety disorders, as well as experiencing a lower quality of life. It appears that the disfigurement, loss of function and change in body image perception caused by the burns lead to the emergence or recurrence of a psychiatric condition. Last but not least, the relationship between delirium in the Burns Intensive Care Unit patients is well established.

Conclusions

There seems to exist a significant ambidirectional connection between burns and mental disorders. Higher rates of mental disorders among burn patients in the pre- and post-burn period complicate the situation and lead to poorer results if left untreated.

Applicability of Research to Practice

Identifying risk factors for burns associated with the medical history, early recognition and appropriate treatment of mental disorders after the burn incident, improving rehabilitation and psychosocial re-integration of this patient population.
590 Is There a Burn Center Community Standard on How to Best Manage Pediatric Burn Patients?
Authors: Helmold Emily , Eshraghi Niknam
Published: March 2020

Introduction

A burn center is defined by the American College of Surgeons as a program that facilitates the provision of specialized multidisciplinary care in a designated setting. The Children’s Hospital Association states that pediatric patients need age specific health care delivered by specialty trained clinicians in an environment designed just for kids. When these two different specialty areas within one organization cross paths, how does the organization determine all the factors that go into determining the standard of care? One burn center found itself at the heart of this question when asked to determine the best location and how to care for pediatric burn patients.

Methods

An email survey was sent to burn centers verified with the American Burn Association (ABA) to care for both adult and pediatric patients and located within their region or with a similar volume. The questions included:

Results

Thirteen burn centers responded. Nine of the thirteen were located within the western region, two in the mid-west, one each in the south and northeast regions. Eight burn centers were categorized as academic and the other five as teaching hospitals. Bed size ranged from 8–44 with an average of 18 beds. Eighty-five percent of the respondents stated they admitted most if not all pediatric burn patients to the burn unit with two of those centers being the only location within their hospital for pediatric patients. Over seventy-five percent provided 24/7 provider coverage. There was more variability in answers regarding rate of pediatrician consultation, code blue team response, and geographic proximity to a children’s hospital however pediatric consultation was obtained in the majority of cases.

Conclusions

The survey responses were helpful to communicate some degree of burn center community standard although more centers and increased specificity would have strengthened the argument for a burn center remaining the preferred location for all pediatric burn admissions.

Applicability of Research to Practice

Sharing of our experience and recommendation that the ABA establish a burn community standard, especially one that takes how to manage competing specialties into consideration, will be helpful to all burn centers who could face this same challenge.
654 Investigation of Germ Patency of a Polylactic Acid-based Membrane for the Treatment of Burns
Authors: Haller Herbert , Held-Föhn Evi
Published: March 2020

Introduction

Infections are a very serious complication during the treatment of burns. To avoid such infections, burn care dressings and skin substitutes should be impermeable to germs. Polylactic membranes (PLM) are based on polylactic acid (PLA) and as an elastic membrane it mimics the natural skin. They are indicated for superficial (2a°) and deep dermal/partial thickness (2b°) skin loss diseases like burns. While being permeable to oxygen and water vapor, they provide a physical barrier for microorganisms. The infection rate of the PLM in burns was about 2,9% on average and was published in 11 studies. The effectiveness of the physical barrier for microorganism was tested in an in-vitro model.

Methods

The sterile PLM samples were aseptically transferred into sterile petri dishes and inoculated with 100 µl each of a bacterial suspension. The test strains Staphylococcus aureus (ATCC 6538) with approximately 730 colony forming units (cfu) and Pseudomonas aeruginosa (ATCC 10145) with approximately 350 CFU / sample were used. The bacterial suspension was spread over the surface and dried. PLM were transferred to Tryptic Soy Agar (TSA) plates.

The incubation was carried out in each case with 3 batches per test strain after 1 day and 3 days at 37°C.

After incubation, the PLM samples were visually examined for microbial growth under the samples and photographically documented. A control group with inoculation of culture medium and covered with PLM was also tested.

Results

There was no growth of bacteria detectable after 1 day and after 3 days under the PLM indicating that the PLM is not permeable to germs. The control group resulted in growth of bacteria and colony forming units and thus confirms that test method works well.

Conclusions

PLM is an effective physical barrier for microorganisms as germs do not pass the PLM.

Applicability of Research to Practice

immediately.
730 Establishing Thresholds for Clinically Significant Donor Skin Reduction – Initial Findings from a Physician Delphi Consensus Panel
Authors: Gibson Angela , Smiell Janice , McClure Erika I Brockfeld , Patel Reema , Skorija Kristi , Holmes James H , Yu Tzy-Chyi , Boing Elaine A , Merikle Elizabeth
Published: March 2020

Introduction

Definitive closure with autograft, as a current standard of care, is a critical outcome in severe burn treatment. Harvest of donor skin for autograft is associated with pain, scarring and potential infection. New treatment modalities aim to reduce the amount of donor skin required to achieve definitive closure of the burn wound. A threshold that defines the clinically significant reduction in amount of harvested skin for the treatment of deep partial (DPT) and full-thickness (FT) burns is not available. This study convened a Delphi Consensus Panel (DCP) to determine this threshold. The DCP is an accepted method to synthesize opinions and feedback from experts and to systematically achieve consensus.

Methods

Panel members were burn physicians with ≥3 years of experience post-residency, with either a total career experience of caring for ≥1,000 patients or working in a facility with an annual volume of ≥200 patients and caring for ≥500 patients. Round 1 consisted of open-ended questions regarding clinical decision-making, use of skin substitutes (SS) in DPT and FT burn treatment, and what would constitute a clinically significant reduction in donor skin.

Results

Panelists reported using SS to promote healing and achieve definitive closure without autograft for DPT burns, and as a temporizing measure between excision and surgery for FT burns. Total body surface area (TBSA) affected by burn and burn location influenced SS use. For DPT and FT burns, other patient outcomes influencing treatment decisions were cosmesis, pain control, and reducing functional limitations. Almost all panelists reported that reduction in the amount of donor skin were important. As expected in Round 1, a range for the minimum percentage of donor skin reduction regarded as clinically significant was provided for DPT (20%-50%) and FT (10%-20%) burns. The main factors influencing these estimates were TBSA burned, patient outcomes, patient preference, and patient type. Final results will provide consensus estimates for clinical significance for donor skin reduction based on subsequent rounds.

Conclusions

Preliminary results indicate that reduction of the amount of donor skin is important to physicians with burn care experience, and the thresholds for clinical significant reduction in donor skin are influenced by patient outcomes and preferences, TBSA burned, and patient type.

Applicability of Research to Practice

These data will provide a research-based definition surrounding the clinical significance of new treatment modalities for severely burned patients.
762 Burn Mechanisms in Pediatric Patients with Autism Spectrum Disorders and Attention Deficit/hyperactivity Disorder: A Multisite Retrospective Study
Authors: Munoz Elena Maria S , Sadeq Farzin , Ceranoglu Atilla , Sheridan Robert
Published: March 2020

Introduction

Although autism spectrum disorders (ASD) and attention deficit/hyperactivity disorder (ADHD) have been associated with higher risk of specific types of burns, mechanisms and circumstances of injury should be investigated for prevention and education.

Methods

A multisite retrospective review of 841 patients treated at pediatric burns hospitals assessed a subsample of Burn Outcomes Questionnaire (BOQ) data collected from years 2001 to 2010. Demographic and clinical characteristics of burn injury were compared. The current study evaluates burn mechanisms and patients diagnosed with ASD/ADHD as indicated in the co-morbid conditions field of the BOQ through logistic regression analyses.

Results

Of the 841 patients who completed the BOQ, there were 227 patients with diagnoses of ASD/ADHD. Age is not statistically significant when considering burn injury due to Play, which includes match play, fire play, and similar behaviors (P=0.36). However, patients with ASD/ADHD were older than the reference group (10.2 years, 8.32 years, P< .0001) and the same pattern is observed when considering burn injury due to Self-Infliction (10.7 years, 8.04 years, P< .001), Play (10.7 years, 8.27 years, P< .01), and Self-Infliction Not Play (10.7 years, 4.40 years, P=.03). Pediatric burn patients with ASD/ADHD are 1.80 times as likely to have sustained burn injury due to Play than the reference group and have 2 times the odds (odds ratio [OR]: 2, [95% confidence interval (CI): 1.32, 3.03], P< .001). Additionally, pediatric patients with ASD/ADHD are 4.06 times as likely to have sustained burn injury due to Self-Infliction Not Play and have 4.18 times the odds (OR: 4.18, 95% CI (1.47,11.89), P< .01).

Conclusions

The research suggests that pediatric burn patients with ASD/ADHD are more likely to sustain burn injury through Play and other methods of Self-Infliction. Pediatric patients with ASD/ADHD are older than the reference group. Difference in age is partly due to older patients who sustained burn injury secondary to seizure. Though more research is needed for burn circumstances, these secondary injuries mostly present as contact and scald burns occurring in outdoor settings or kitchens. Patients without ASD/ADHD and burn injury due to Self-Infliction Not Play were predominantly toddler and preschool aged, and presented with scald and contact burns related to bathing and feeding.

Applicability of Research to Practice

Further research is needed to better understand ASD/ADHD and burns, with particular emphasis on differentiating the 2 diagnoses and burn circumstances. Patients with ASD/ADHD and caregivers may benefit from research in burn injury risk for prevention and counseling.
774 Examination of the Religious and Spiritual Needs of Acutely Injured Burn Patients
Authors: Cox Carrie A , Javia Vidhi , Smith Lisa C , Hill Rachel C , Hultman C Scott
Published: March 2020

Introduction

Despite advances in burn care that dramatically increase survivability for severe burn injuries, individuals who suffer such injuries will likely experience long recovery periods complicated by declines in psychological, social, behavioral, occupational, and sexual functioning. We compared the self-importance of spirituality in a patient’s life with select demographic data in order to better understand the role of spirituality in the treatment and recovery of patients in the Burn Intensive Care Unit (BICU).

Methods

In this survey study and subsequent retrospective review, we explored the importance of spiritual beliefs and practices to the burn patient population within the BICU. We utilized the Belief into Action Scale (BIAC), which is a validated survey tool designed to quantify the full range of an individual’s religious involvement. Each participant completed one BIAC survey during his or her inpatient stay. We then collected patient demographics, including religious affiliation and the number of pastoral visits received. Injury characteristics and outcome measures were examined including, Total Body Surface Area (TBSA) burn, length of stay (LOS), and Charlson Comorbidity Index (CCI).

Results

Between April and June of 2019, surveys were administered to 32 adult participants. The participants ranged in age from 21 to 83 (mean 52.5), 59% (19/32) were male and 41% (13/32) were female. Of the 32 participants, 69% were Caucasian, 25% were African American, 3% were Hispanic/Latino, and 3% were other. Sixty-six percent (21/32) had no religious affiliation identified within their medical record and 31% (10/32) of patients had at least 1 pastoral visit (range 0–5 visits). TBSA ranged from 0% (10/32) to 35%, seven (22%) participants had an inhalation injury, the most common mechanism of burn injury was flame (43.75%), and the average length of stay was 16 days (range 1–75 days). Mean BIAC score was 44.8 (out of 100), with a median of 46.5 and a standard deviation of 22.6, indicating a moderate degree of spiritual and religious beliefs.

Conclusions

Acutely injured burn patients, admitted to an urban burn center, report a moderate degree of spiritual and religious beliefs, strongly supporting the need for pastoral care in this population.

Applicability of Research to Practice

The increased likelihood of survival for severely burn injured patients has led to the need for a greater emphasis on the potential psychological and social morbidity for these individuals. This research highlights the importance of addressing the spiritual needs of burn patients.
801 Improving Pain HCAHPS in the Burn Population
Authors: Vorholt Elizabeth , Huff Teri , Young Justin
Published: March 2020

Introduction

Controlling pain in burn patients is one of the most important components of patient satisfaction. At our institution, pain specific HCAHPS scores indicate that burn patients consistently rate pain control less than the 25th percentile in the nation. Research shows that patients who felt that their pain was well managed reported more trust in their health care team and that pain management directly affects length of stay for burn patients. This project aims to increase HCAHPS pain scores to greater than the 75th percentile, encourage improved communication, and optimize patient education regarding pain management.

Methods

A multimodal approach to pain management was identified as the best way to intervene. The multidisciplinary team met to assess the problem and completed a fishbone diagram and A3 to better understand the drivers of poor pain control. It is understood that patient satisfaction data is a lagging indicator and more real-time actionable data was needed. A focus was placed on improved communication, managing expectations, and education about types of burn pain and pain management. The self-reporting pain tool was developed as a daily assessment of pain satisfaction and a facilitator of communication between nurses and patients about pain.

The self-reporting pain tool was implemented as a task for night shift nurses to be completed with their initial shift assessment.

Results

After implementation of the pain tool, daily compliance was documented and displayed on a visual management board on the unit. As a result of daily and intentional communication with patients about their pain using the pain tool, the pain HCAHPS indicators have sustained above the 75th percentile for quarter four of FY17.

Conclusions

Both the patient and the nurse is more satisfied when they are effectively communicating about pain. Efficiency is improved because interventions such as physical therapy, occupational therapy, and wound care are able to be more successfully completed when patients’ pain management is optimized. Daily indicators and visual management are key components of successful implementation to ensure accountability and that nurses are seeing the progress of the project. The results of this project identify a need for standardized education about burn pain and pain management.

Applicability of Research to Practice
821 Burn Injury Prevention: A New Focus on the Older Population
Authors: Martinat Mary L
Published: March 2020

Introduction

Historically our burn center has focused its injury prevention messaging on the pediatric population, but with the ever changing age demographic in the valley, the burn center is working on ways to ensure that our injury prevention program is putting the right message out to the right population. With this goal in mind we looked at our hospital admissions, patient length of stay and inpatient hospital charges by age group to identify the populations in most need of injury prevention messaging.

Methods

A 3-year retrospective data review of burn admissions to our facility was performed. the review looked at patients separated into 9 different age groups, these groups were ranked (1 being the highest incidence to the lowest ranked 9th), comparing number of admissions, length of stay and cost of care. We looked at how each age group ranked as a total as well as average per patient. The rankings were used to identify high risk age groups.

Results

Burn registry data showed that the most frequent burn admissions to our burn center were not our pediatric or young adult populations. We further discovered that the older populations were admitted in the largest numbers and tended to have greater length of stays as well as higher hospital charges.

Conclusions

The focus of the hospital’s current injury prevention efforts is on the pediatric population. While this is a group that must always have a high priority in our prevention efforts, there is an under-served population in our community. The senior population in our valley need a customized injury prevention plan to help decrease burn injuries and admissions to the hospital. Registry data will be used to focus prevention efforts based on: seasonality of injury, mechanism of injury, and geographical location.

Applicability of Research to Practice

Utilization of burn registry data divulged gaps in our burn injury prevention efforts. Age specific prevention campaigns need to be created, implemented and tracked for effectiveness.
831 Optimal Timing for Range of Motion to Upper Extremities Following Split Thickness Skin Autographing: A Five Year Retrospective Review
Authors: Rucks Greta M , Gonzalez Rachel B , Smith Susan L , Smith Howard G
Published: March 2020

Introduction

The hand and upper extremity is one of the most common sites for burn injury. The total body surface area (TBSA) of the hand is small but the resultant impairment can limit a patient’s ability to return to functional independence. Split thickness skin grafting (STSG) has long been supported in the literature as the main means of treatment following full thickness burn injury. Surgical placement of STSG is often followed by a period of immobilization to the grafted area for graft adherence. The length of time which the grafted area is immobilized has evolved over time as surgical methods have improved. There is no set standard to balance the length of time necessary to prevent complications while maintaining functional mobility.

A literature review revealed several studies and a meta-analysis examining the optimal timing for immobilization and bedrest following STSG to the lower extremities. Additional studies have examined guidelines for range of motion protocols and splinting as well as reconstructive procedures for improved function following burn injury. There are currently no studies examining the optimal timing for immobility following the placement of STSG and the implications this can have on functional independence. The proposed study details the results of one burn center’s standard of treatment following STSG to the upper extremity.

Methods

Following obtaining approval from the IRB, deidentified data was retrospectively collected from the electronic medical record from January 1, 2014-January 1, 2019 for all inpatients ages 18 and up who underwent split thickness skin grafting to the upper extremity.

Results

Data collected from 2014–2018 revealed a decreasing trend in the days of immobilization following STSG from an average of 4 days to 2 days to the resumption of range of motion (ROM). Additional trends include a decrease in the utilization of splinting as a prophylactic treatment for contractures with a shift towards interventional splinting. Access to home health care services upon hospital discharge also showed a decline from 2014–2018.

Conclusions

The decrease in days of immobilization following STSG combined with the shift from prophylactic to interventional splinting put more emphasis on increasing patient autonomy for functional independence. This trend coincides with a significant decrease in the utilization of home health services upon hospital discharge in the same time period.

Applicability of Research to Practice

The findings of this retrospective study provide evidence supporting that decreasing the length of immobilization following STSG to 2 days did not result in an increase in post-operative complications. There was also not a significant decrease in functional independence found with a change in splinting practices from prophylactic to interventional.
Endogenous Childlessness and Stages of Development
Authors: Baudin Thomas , de la Croix David , Gobbi Paula
Published: March 2020

Although developing countries are characterized by high average fertility rates, they are as concerned by childlessness as developed countries. Beyond natural sterility, there are two main types of childlessness: one driven by poverty and another by the high opportunity cost of child-rearing. We measure the importance of the components of childlessness with a structural model of fertility and marriage. Deep parameters are identified using census data from 36 developing countries. As average education increases, poverty-driven childlessness first decreases to a minimum, and then the opportunity-driven part of childlessness increases. We show that neglecting the endogenous response of marriage and childlessness may lead to a poor understanding of the impact that social progress, such as universal primary education, may have on completed fertility. The same holds for family planning, closing the gender pay gap, and the eradication of child mortality.
Detection of Rickettsia asembonensis in Fleas (Siphonaptera: Pulicidae, Ceratophyllidae) Collected in Five Counties in Georgia, United States
Authors: Eremeeva Marina E , Capps Danielle , McBride Cynthia Logan , Williams-Newkirk Amanda J , Dasch Gregory A , Salzer Johanna S , Beati Lorenza , Durden Lance A
Published: March 2020

We conducted a molecular survey of Rickettsia in fleas collected from opossums, road-killed and live-trapped in peridomestic and rural settings, state parks, and from pet cats and dogs in Georgia, United States during 1992–2014. The cat flea, Ctenocephalides felis (Bouché) was the predominant species collected from cats and among the archival specimens from opossums found in peridomestic settings. Polygenis gwyni (Fox) was more prevalent on opossums and a single cotton rat trapped in sylvatic settings. Trapped animals were infested infrequently with the squirrel flea, Orchopeas howardi (Baker) and C. felis. TaqMan assays targeting the BioB gene of Rickettsia felis and the OmpB gene of Rickettsia typhi were used to test 291 flea DNAs for Rickettsia. A subset of 53 C. felis collected from a cat in 2011 was tested in 18 pools which were all bioB TaqMan positive (34% minimum infection prevalence). Of 238 fleas tested individually, 140 (58.8%, 95% confidence interval [CI]: 52.5–64.9%) DNAs were bioB positive. Detection of bioB was more prevalent in individual C. felis (91%) compared to P. gwyni (13.4%). Twenty-one (7.2%) were ompB TaqMan positive, including 18 C. felis (9.5%) and 3 P. gwyni (3.2%). Most of these fleas were also positive with bioB TaqMan; however, sequencing of gltA amplicons detected only DNA of Rickettsia asembonensis. Furthermore, only the R. asembonensis genotype was identified based on NlaIV restriction analysis of a larger ompB fragment. These findings contribute to understanding the diversity of Rickettsia associated with fleas in Georgia and emphasize the need for development of more specific molecular tools for detection and field research on rickettsial pathogens.
Definiteness, Uniqueness, and Maximality in Languages With and Without Articles
Authors: Šimík Radek , Demian Christoph
Published: March 2020

We present a number of experiments testing influential hypotheses about the meaning of definite descriptions (in languages with articles, represented here by German) and bare nominals (in articleless languages, represented here by Russian). Our results are in line with the commonly entertained hypothesis that definite descriptions convey uniqueness (if singular) or maximality (if plural), but fail to support two hypotheses about bare nominal interpretation, namely that singular bare nominals convey uniqueness ( Dayal 2004) and that topical bare nominals convey uniqueness/maximality ( Geist 2010, among many others). Uniqueness or maximality inferences are expected to arise via covert type-shifting under these approaches. Our results are compatible with what we take to be the null hypothesis, namely that bare nominals in articleless languages are existential and free of presuppositional semantics, even if they correspond—in their use—to definite descriptions ( Heim 2011).
Giulia Frasi: Singer of Sentiment
Authors: Lee Jonathan Rhodes
Published: March 2020

Handel and his artistic collaborators worked in an age that prized the moral potential of emotion, particularly as mobilized in artistic representation. From weeping comedies and moving she-tragedies on the English stage to sentimental novels in the private closet and even powerfully moving sermons from the nation’s pulpits, eighteenth-century audiences received a constant onslaught of emotionally charged rhetoric that aimed at inspiring virtue. This article provides several examples of how Handel’s music, particularly his works of the 1740s and 1750s, operated within this contemporary culture of sentiment; it uses the career of Handel’s last leading lady, Giulia Frasi (fl. 1742–72), as an illustration of the nexus between these ethical-aesthetic trends, Handel’s musical works, and this singer’s career. Examination of Frasi’s musical education, the works that she performed, and her public persona shows that she cultivated a place in the culture of sentiment, both on and off the stage.
Evolution of an Amniote-Specific Mechanism for Modulating Ubiquitin Signaling via Phosphoregulation of the E2 Enzyme UBE2D3
Authors: Roman-Trufero Monica , Ito Constance M , Pedebos Conrado , Magdalou Indiana , Wang Yi-Fang , Karimi Mohammad M , Moyon Benjamin , Webster Zoe , di Gregorio Aida , Azuara Veronique , Khalid Syma , Speck Christian , Rodriguez Tristan , Dillon Niall
Published: March 2020

Genetic variation in the enzymes that catalyze posttranslational modification of proteins is a potentially important source of phenotypic variation during evolution. Ubiquitination is one such modification that affects turnover of virtually all of the proteins in the cell in addition to roles in signaling and epigenetic regulation. UBE2D3 is a promiscuous E2 enzyme, which acts as an ubiquitin donor for E3 ligases that catalyze ubiquitination of developmentally important proteins. We have used protein sequence comparison of UBE2D3 orthologs to identify a position in the C-terminal α-helical region of UBE2D3 that is occupied by a conserved serine in amniotes and by alanine in anamniote vertebrate and invertebrate lineages. Acquisition of the serine (S138) in the common ancestor to modern amniotes created a phosphorylation site for Aurora B. Phosphorylation of S138 disrupts the structure of UBE2D3 and reduces the level of the protein in mouse embryonic stem cells (ESCs). Substitution of S138 with the anamniote alanine (S138A) increases the level of UBE2D3 in ESCs as well as being a gain of function early embryonic lethal mutation in mice. When mutant S138A ESCs were differentiated into extraembryonic primitive endoderm, levels of the PDGFRα and FGFR1 receptor tyrosine kinases were reduced and primitive endoderm differentiation was compromised. Proximity ligation analysis showed increased interaction between UBE2D3 and the E3 ligase CBL and between CBL and the receptor tyrosine kinases. Our results identify a sequence change that altered the ubiquitination landscape at the base of the amniote lineage with potential effects on amniote biology and evolution.
Limited Evidence for Selection at the FADS Locus in Native American Populations
Authors: Mathieson Iain
Published: March 2020

The FADS locus contains the genes FADS1 and FADS2 that encode enzymes involved in the synthesis of long-chain polyunsaturated fatty acids. This locus appears to have been a repeated target of selection in human evolution, likely because dietary input of long-chain polyunsaturated fatty acids varied over time depending on environment and subsistence strategy. Several recent studies have identified selection at the FADS locus in Native American populations, interpreted as evidence for adaptation during or subsequent to the passage through Beringia. Here, we show that these signals are confounded by independent selection—postdating the split from Native Americans—in the European and, possibly, the East Asian populations used in the population branch statistic test. This is supported by direct evidence from ancient DNA that one of the putatively selected haplotypes was already common in Northern Eurasia at the time of the separation of Native American ancestors. An explanation for the present-day distribution of the haplotype that is more consistent with the data is that Native Americans retain the ancestral state of Paleolithic Eurasians. Another haplotype at the locus may reflect a secondary selection signal, although its functional impact is unknown.
Assessing the diet of octopuses: traditional techniques and the stable isotopes approach
Authors: de Souza Dantas Renato Junqueira , Leite Tatiana Silva , de Albuquerque Cristiano Queiroz
Published: March 2020

Most studies of the feeding habits of octopuses have focused on the use of a single technique, often selected on the basis of its familiarity or minimal impact on study animals. Although over time new methods have been developed for dietary assessment, no comparative analysis has ever been done. Using Octopus insularis as a model, we examined the results of three methods of diet analysis to understand how these techniques can influence study conclusions. Octopus diets were assessed through the analysis of (1) fresh prey remains deposited in midden piles, (2) digestive contents from the octopus crop and stomach, and (3) stable isotope data on the octopus and its potential food sources. The research was conducted at Rocas Atoll, a pristine oceanic reef off the northeastern coast of Brazil, with data from a coastal environment with substantial human impact (i.e. Rio do Fogo, northeastern Brazil) being evaluated as well. Overall, the three methods differed in the type of data they produced and the timescale represented, reflecting their own biases, the biology and behaviour of the octopus, and even the local oceanographic and other environmental conditions. We therefore provide a conceptual diagram to help researchers to consider the inherent aspects of each method when planning and performing studies of octopus diet, and also when interpreting study results.
G-quadruplex ligands mediate downregulation of DUX4 expression
Authors: Ciszewski Lukasz , Lu-Nguyen Ngoc , Slater Alex , Brennan Andrew , Williams Huw E L , Dickson George , Searle Mark S , Popplewell Linda
Published: March 2020

Abnormal DUX4 expression in skeletal muscles plays a key role in facioscapulohumeral muscular dystrophy (FSHD) pathogenesis, although the molecular mechanisms regulating DUX4 expression are not fully defined. Using bioinformatic analysis of the genomic DUX4 locus, we have identified a number of putative G-quadruplexes (GQs) forming sequences. Their presence was confirmed in synthetic oligonucleotiode sequences derived from the enhancer, promoter and transcript of DUX4 through circular dichroism and nuclear magnetic resonance analysis. We further examined the binding affinity of a naturally occurring GQ stabilizing compound, berberine, to these non-canonical genetic structures using UV–Vis and fluorescence spectroscopy. Subsequent in vitro study in FSHD patient myoblasts indicated that berberine treatment reduced DUX4 expression and also expression of genes normally switched on by DUX4. Further investigation in a mouse model overexpressing exogenous DUX4 confirmed the therapeutic effects of berberine in downregulating DUX4 protein expression, inhibiting muscle fibrosis, and consequently rescuing muscle function. Our data demonstrate for the first time that GQs are present in the DUX4 locus and that the GQ interactive ligand reduces DUX4 expression suggesting potential role of GQs in FSHD pathogenesis. Our work provides the basis of a novel therapeutic strategy for the treatment of FSHD.
Impact of longer term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS
Authors: Lopes Marcelo Barreto , Karaboyas Angelo , Bieber Brian , Pisoni Ronald L , Walpen Sebastian , Fukagawa Masafumi , Christensson Anders , Evenepoel Pieter , Pegoraro Marisa , Robinson Bruce M , Pecoits-Filho Roberto
Published: March 2020

Background

Serial assessment of phosphorus is currently recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, but its additional value versus a single measurement is uncertain.

Methods

We studied data from 17 414 HD patients in the Dialysis Outcomes and Practice Patterns Study, a prospective cohort study, and calculated the area under the curve (AUC) by multiplying the time spent with serum phosphorus >4.5 mg/dL over a 6-month run-in period by the extent to which this threshold was exceeded. We estimated the association between the monthly average AUC and cardiovascular (CV) mortality using Cox regression. We formally assessed whether AUC was a better predictor of CV mortality than other measures of phosphorus control according to the Akaike information criterion.

Results

Compared with the reference group of AUC = 0, the adjusted hazard ratio (HR) of CV mortality was 1.12 [95% confidence interval (CI) 0.90–1.40] for AUC > 0–0.5, 1.26 (95% CI 0.99–1.62) for AUC > 0.5–1, 1.44 (95% CI 1.11–1.86) for AUC > 1–2 and 2.03 (95% CI 1.53–2.69) for AUC > 2. The AUC was predictive of CV mortality within strata of the most recent phosphorus level and had a better model fit than other serial measures of phosphorus control (mean phosphorus, months out of target).

Conclusions

We conclude that worse phosphorus control over a 6-month period was strongly associated with CV mortality. The more phosphorus values do not exceed 4.5 mg/dL the better is survival. Phosphorus AUC is a better predictor of CV death than the single most recent phosphorus level, supporting with real-world data KDIGO’s recommendation of serial assessment of phosphorus to guide clinical decisions.
Association of tubular solute clearances with the glomerular filtration rate and complications of chronic kidney disease: the Chronic Renal Insufficiency Cohort study
Authors: Chen Yan , Zelnick Leila R , Wang Ke , Katz Ronit , Hoofnagle Andrew N , Becker Jessica O , Hsu Chi-Yuan , Go Alan S , Feldman Harold I , Mehta Rupal C , Lash James P , Waikar Sushrut S , Hamm L , Chen Jing , Shafi Tariq , Kestenbaum Bryan R ,   the CRIC Study Investigators
Published: March 2020

Background

The secretion of organic solutes by the proximal tubules is an essential intrinsic kidney function. The degree to which secretory solute clearance corresponds with the glomerular filtration rate (GFR) and potential metabolic implications of net secretory clearance are largely unknown.

Methods

We evaluated 1240 participants with chronic kidney disease (CKD) from the multicenter Chronic Renal Insufficiency Cohort (CRIC) Study. We used targeted mass-spectrometry to quantify candidate secretory solutes in paired 24-h urine and plasma samples. CRIC study personnel measured GFR using 125I-iothalamate clearance (iGFR). We used correlation and linear regression to determine cross-sectional associations of secretory clearances with iGFR and common metabolic complications of CKD.

Results

Correlations between iGFR and secretory solute clearances ranged from ρ  = +0.30 for hippurate to ρ = +0.58 for kynurenic acid. Lower net clearances of most secretory solutes were associated with higher serum concentrations of parathyroid hormone (PTH), triglycerides and uric acid. Each 50% lower kynurenic acid clearance was associated with a 21% higher serum PTH concentration [95% confidence interval (CI) 15–26%] and a 10% higher serum triglyceride concentration (95% CI 5–16%) after adjustment for iGFR, albuminuria and other potential confounders. Secretory solute clearances were not associated with statistically or clinically meaningful differences in serum calcium, phosphate, hemoglobin or bicarbonate concentrations.

Conclusions

Tubular secretory clearances are modestly correlated with measured GFR among adult patients with CKD. Lower net secretory clearances are associated with selected metabolic complications independent of GFR and albuminuria, suggesting potential clinical and biological relevance.
Developing logic models to inform public health policy outcome evaluation: an example from tobacco control
Authors: Langley Tessa , Gillespie Duncan , Lewis Sarah , Eminson Katie , Brennan Alan , Docherty Graeme , Young Ben
Published: March 2020

Background

The evaluation of large-scale public health policy interventions often relies on observational designs where attributing causality is challenging. Logic models—visual representations of an intervention’s anticipated causal pathway—facilitate the analysis of the most relevant outcomes. We aimed to develop a set of logic models that could be widely used in tobacco policy evaluation.

Methods

We developed an overarching logic model that reflected the broad categories of outcomes that would be expected following the implementation of tobacco control policies. We subsequently reviewed policy documents to identify the outcomes expected to result from the implementation of each policy and conducted a literature review of existing evaluations to identify further outcomes. The models were revised according to feedbacks from a range of stakeholders.

Results

The final models represented expected causal pathways for each policy. The models included short-term outcomes (such as policy awareness, compliance and social cognitive outcomes), intermediate outcomes (such as changes in smoking behaviour) and long-term outcomes (such as mortality, morbidity and health service usage).

Conclusions

The use of logic models enables transparent and theory-based planning of evaluation analyses and should be encouraged in the evaluation of tobacco control policy, as well as other areas of public health.
TERTIARY X-RADIATION—A PROBLEM FOR STAFF PROTECTION?
Authors: Eder H , Seidenbusch M , Oechler L S
Published: March 2020

The influence of tertiary x-radiation on the radiological staff is widely unknown. Tertiary radiation is caused as the scattered radiation of the patient impacts the walls, floor, ceiling and surrounding air. The question that arises is does tertiary x-radiation provide a relevant contribution to the staff doses. The impact of tertiary radiation was investigated by means of measurements of the personal dose equivalent Hp(10) on an anthropomorphic Alderson Rando male phantom and also on operators/assistants staying in clinical practice. Further, the protective effect of lead foils, especially under tertiary radiation was also investigated. Correlations could be derived for clinical angiographic/interventional procedures between dose area products (DAPs) and dose length products (DLPs) vs. dorsal doses of staff persons. Generally, the staff doses that are a result of tertiary radiation depend on the x-ray energy and range from 0.15 to 0.55% of the scattered radiation impact caused by irradiation of the patient. Hence, a back panel with 0.125-mm lead equivalent is sufficient to protect the staff from tertiary radiation created within the room environment.