bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring the changes of peri-urban areas in Bogor Regency by multivariate analysis
Authors: Kasikoen K M
Published: March 2020

Bogor Regency borders several cities on the outskirts of Jakarta and Bogor City. This location explains the rapid developments that Bogor is experiencing. Notably, in line with the development of Jakarta and Bogor, people search for alternative locations to live in this regency. As a consequence,the conversion of land from agricultural into residential areas is taking place at an alarming rate. This is an issue the local government must consider. This research determined the changes inperi-urban areas in Bogor Regency by using multivariate analysis. This method was selected because of the availability of a large data set in Bogor Regency, mainly village potential data (PODES). Multivariate analysis can be used in determiningthe changes of peri-urban areas through factor analysis, principal component analysis, cluster analysis, and the mapping of peri-urban areas usingvillage potential data from 2011 and 2014. The study used 12out of 34 available variables to identify peri-urban areas in Bogor Regency. From a total of434 villages in Bogor Regency 82 villages were categorized as peri-urban in 2011, whereas by 2014, there were 288 peri-urban villages. Consequently, the number of villages categorized as rural decreased from 332 to125. These results indicatedthat the method is successful inshowing the development of a region. As such,itcan be used for drafting policies for rapidly developing areas.
Random Gromov’s monsters do not act non-elementarily on hyperbolic spaces
Authors: Gruber Dominik , Sisto Alessandro , Tessera Romain
Published: March 2020

We show that Gromov’s monster groups arising from i.i.d. labelings of expander graphs do not admit non-elementary actions on geodesic hyperbolic spaces. The proof relies on comparing properties of random walks on randomly labeled graphs and on groups acting non-elementarily on hyperbolic spaces.
Difference Galois groups under specialization
Authors: Feng Ruyong
Published: March 2020

We present a difference analogue of a result given by Hrushovski on differential Galois groups under specialization. Let

k
k

be an algebraically closed field of characteristic zero and let

X

\mathbb {X}

be an irreducible affine algebraic variety over

k
k

. Consider the linear difference equation

σ
(
Y
)
=
A
Y
,

\begin{equation*} \sigma (Y)=AY, \end{equation*}

where

A
∈

G
L

n

(
k
(

X

)
(
x
)
)

A\in \mathrm {GL}_n(k(\mathbb {X})(x))

and

σ
\sigma

is the shift operator

σ
(
x
)
=
x
+
1

\sigma (x)=x+1

. Assume that the Galois group

G
G

of the above equation over

k
(

X

)

¯

(
x
)

\overline {k(\mathbb {X})}(x)

is defined over

k
(

X

)

k(\mathbb {X})

, i.e., the vanishing ideal of

G
G

is generated by a finite set

S
⊂
k
(

X

)
[
X
,
1

/

det
(
X
)
]

S\subset k(\mathbb {X})[X,1/\det (X)]

. For a

c

∈

X

{\mathbf {c}}\in \mathbb {X}

, denote by

v

c

v_{{\mathbf {c}}}

the map from

k
[

X

]

k[\mathbb {X}]

to

k
k

given by

v

c

(
f
)
=
f
(

c

)

v_{{\mathbf {c}}}(f)=f({\mathbf {c}})

for any

f
∈
k
[

X

]

f\in k[\mathbb {X}]

. We prove that the set of

c

∈

X

{\mathbf {c}}\in \mathbb {X}

satisfying that

v

c

(
A
)

v_{\mathbf {c}}(A)

and

v

c

(
S
)

v_{\mathbf {c}}(S)

are well-defined and the affine variety in

G
L

n

(
k
)

\mathrm {GL}_n(k)

defined by

v

c

(
S
)

v_{{\mathbf {c}}}(S)

is the Galois group of

σ
(
Y
)
=

v

c

(
A
)
Y

\sigma (Y)=v_{{\mathbf {c}}}(A)Y

over

k
(
x
)

k(x)

is Zariski dense in

X

\mathbb {X}

.

We apply our result to van der Put-Singer’s conjecture which asserts that an algebraic subgroup

G
G

of

G
L

n

(
k
)

\mathrm {GL}_n(k)

is the Galois group of a linear difference equation over

k
(
x
)

k(x)

if and only if the quotient

G

/

G
∘

G/G^\circ

by the identity component is cyclic. We show that if van der Put-Singer’s conjecture is true for

k
=

C

k=\mathbb {C}

, then it will be true for any algebraically closed field

k
k

of characteristic zero.
PMTCT Adherence in Pregnant South African Women: The Role of Depression, Social Support, Stigma, and Structural Barriers to Care
Authors: Psaros Christina , Smit Jennifer A , Mosery Nzwakie , Bennett Kara , Coleman Jessica N , Bangsberg David R , Safren Steven A
Published: March 2020

Background

Depression is a robust predictor of nonadherence to antiretroviral (ARV) therapy, which is essential to prevention of mother-to-child transmission (PMTCT). Women in resource-limited settings face additional barriers to PMTCT adherence. Although structural barriers may be minimized by social support, depression and stigma may impede access to this support.

Purpose

To better understand modifiable factors that contribute to PMTCT adherence and inform intervention development.

Methods

We tested an ARV adherence model using data from 200 pregnant women enrolled in PMTCT (median age 28), who completed a third-trimester interview. Adherence scores were created using principal components analysis based on four questions assessing 30-day adherence. We used path analysis to assess (i) depression and stigma as predictors of social support and then (ii) the combined associations of depression, stigma, social support, and structural barriers with adherence.

Results

Elevated depressive symptoms were directly associated with significantly lower adherence (est = −8.60, 95% confidence interval [−15.02, −2.18], p < .01). Individuals with increased stigma and depression were significantly less likely to utilize social support (p < .01, for both), and higher social support was associated with increased adherence (est = 7.42, 95% confidence interval [2.29, 12.58], p < .01). Structural barriers, defined by income (p = .55) and time spent traveling to clinic (p = .31), did not predict adherence.

Conclusions

Depression and social support may play an important role in adherence to PMTCT care. Pregnant women living with HIV with elevated depressive symptoms and high levels of stigma may suffer from low social support. In PMTCT programs, maximizing adherence may require effective identification and treatment of depression and stigma, as well as enhancing social support.
Endogenous digoxin-like immunoreactive factors eliminated from serum samples by hydrophobic silica-gel extraction and enzyme immunoassay.
Authors: Skogen W F , Rea M R , Valdes R
Published: March 2020

Elimination of endogenous digoxin-like immunoreactive factors (DLIF) that interfere with accurate measurement of digoxin requires use of a highly specific anti-digoxin antibody, or that DLIF be separated from digoxin before immunoassay. Several commercial digoxin-assay kits include a step for separating serum proteins and other substances from digoxin before immunoassay. We tested six different immunoassay methods (some having pretreatment steps) for their ability to detect DLIF in serum from patients in renal failure, pregnant women, and neonates, all of whom were not taking digoxin. Extracting digoxin on a column of derivatized silicagel eliminated detectable DLIF from serum as measured by enzyme immunoassay (EMIT; Syva Co.), but recovery of added digoxin was quantitative. In contrast, protein precipitation with 5-sulfosalicylic acid left significant amounts of DLIF in samples, most probably because the procedure (TDx assay; Abbott Labs.) disrupted protein-DLIF binding. A glass-bead radioimmunoassay (Immophase; Corning Medical) had the most digoxin-specific antisera. By preparative silica-gel-chromatography of serum we could eliminate or significantly minimize inaccurate digoxin measurements attributable to endogenous DLIF.
Nationwide estimate of emergency department visits in the United States related to caustic ingestion
Authors: Li Yiting , Langworthy James , Xu Lan , Cai Haifeng , Yang Yingwei , Lu Yuanyuan , Wallach Sara L , Friedenberg Frank K
Published: March 2020

Introduction

Caustic ingestion, whether intentional or unintentional, may result in significant morbidity. Our aim was to provide an estimate of the incidence and outcomes of caustic ingestion among emergency department (ED) visits across the United States.

Methods

The Nationwide Emergency Department Sample (NEDS) is part of the family of databases developed for the Healthcare Cost and Utilization Project. We analyzed NEDS for the period 2010–2014. Adults (≥18 years of age) with a diagnosis of caustic ingestion were identified by ICD-9 codes. The weighted frequencies and proportions of caustic ingestion-related ED visits by demographic characteristics and disposition status were examined. A weighted multivariable logistic regression model was performed to examine factors associated with inpatient admission for caustic ingestion-related visits.

Results

From 2010 to 2014, there were 40,844 weighted adult ED visits related to caustic ingestion among 533.8 million visits (7.65/100,000, 95% CI 7.58/100,000–7.73/100,000), resulting in over $47 million in annual cost. Among ED visits related to caustic ingestion, 28% had comorbid mental and substance use disorders. Local and systemic complications were rare. There was significant regional, gender, and insurance variability in the decision as to perform endoscopy. Males, insured patients, patients domiciled in the Southeast region of the United States, and patients with mental or substance use disorders had significantly higher percentages of receiving endoscopic procedures. Overall, 6,664 (16.27%) visits resulted in admission to the same hospital and 1,063 (2.60%) visits resulted in transfer to another hospital or facility. The risk factors for admission were increasing in age, male gender, local or systemic complications related to caustic ingestion, and comorbid mental and substance use disorders. A total of 161 (0.39%) patients died related to caustic ingestion.

Conclusion

Our results from NEDS provide national estimates on the incidence of caustic ingestions involving adults seen in US EDs. Further studies are needed to examine the standard management of caustic ingestion and investigate the factors causing variability of esophagogastroduodenoscopy performance and caustic ingestion care.
Graft-versus-host disease: a case report of a rare but reversible cause of constrictive pericarditis
Authors: Pieri Christopher A , Roberts Neil , Gribben John , Manisty Charlotte
Published: March 2020

Background 

Constrictive pericarditis (CP), although an uncommon cause of heart failure, requires specialist multidisciplinary input and multi-modality imaging to identify the underlying aetiology and treat potentially reversible causes.

Case summary 

We report the case of a 74-year-old gentleman referred for assessment of progressive exertional dyspnoea and peripheral oedema, 30 months following treatment of acute myeloid leukaemia with high-dose chemotherapy and allogeneic stem cell transplantation. Clinical examination and cardiac imaging revealed a small pericardial effusion and pericardial thickening with constrictive physiology; however, no aetiology was identified despite diagnostic pericardiocentesis. The patient required recurrent hospital admissions for intravenous diuresis, therefore, following multidisciplinary discussions, surgical partial pericardectomy was performed. Histology suggested graft-vs.-host disease (GvHD) and post-operatively, the patient improved clinically. Following immunomodulatory therapy with ruxolitinib for both pericardial and pulmonary GvHD, his functional status improved further with no subsequent hospital admissions.

Discussion 

Although pericardial disease in cancer patients is common, CP is unusual. Determining the underlying aetiology is important for subsequent management, and here, we describe the use of multi-modality imaging to diagnose a rare cause, GvHD, which responded to surgical treatment and immunomodulatory therapy.
Fleshing out a massacre: the storming of Shelford House and social forgetting in Restoration England*
Authors: Appleby David J
Published: March 2020

This article investigates the circumstances behind the slaughter of a royalist garrison in Nottinghamshire in November 1645, using the case study as a window into wider issues regarding the relationship between the memorialization of the British civil wars and the fragility of Charles II’s regime in the years following the Restoration. Contemporary sources illustrate how the factors which led to the massacre gave both parliamentarian and royalist leaders impelling motives to wipe the incident from their respective narratives of the conflict.
Global aid and faith actors: the case for an actor-orientated approach to the ‘turn to religion’
Authors: Tomalin Emma
Published: March 2020

In this article, drawing on the work of the development sociologist Norman Long, I make the case for an actor-oriented approach to understanding the ‘turn to religion’ by global aid actors over the past couple of decades. I ask, is the ‘turn to religion’ evidence of the emergence of post-secular partnerships or are faith actors being instrumentalized to serve neo-liberal development goals? I argue that neither option captures the whole story and advocate that the study of religion and development needs to move beyond a binary between the ‘turn to religion’ as either evidence of post-secular partnerships or of the ‘instrumentalization’ of religion by the secular global aid business, and instead to think about how faith actors themselves encounter and shape development discourses and frameworks, translate them into relevant formats and strategically employ them. Alongside the adoption of an actor-orientated approach, I build on the work of Lewis and Mosse, Olivier de Sardan and Bierschenk to view international faith-based organizations (IFBOs) as development brokers and translators. This approach allows me to articulate the distinctive role that many members of IFBOs report they play as intermediaries who shift register between the secular development language and the faith-inspired language of their local faith partners. I take the engagement of faith actors with the new Sustainable Development Goals framework as a case-study to explore this.
Religious violence, gender and post-secular counterterrorism
Authors: Brown Katherine E
Published: March 2020

This article argues that despite the framing of religion in the discipline and practice of International Relations (IR) as a force for good, or a cause of evil in the world, IR fails to treat religion on its own terms (as sui generis). With a few exceptions, the discipline has pigeonholed religion as a variable of IR, one that can be discussed as one might GDP, HIV, or numbers of nuclear missiles: measurable, with causality and essential properties. IR has also tended to treat religion as equivalent to features of global politics that it already recognizes—as an institution or community or ideology, for example—but in doing so, it misses intrinsic (and arguably unique) elements of religion. Drawing on feminist insights about how gender works in IR, namely that gender is a construct, performative and structural, this article argues a similar case for religion. A reframing of religion is applied to the case of Daesh (so-called Islamic State of Iraq and Syria, ISIS) to show how our understanding of the organization changes when we view religion differently. The implications for counterterrorism policies if religion is viewed as more than a variable are explored in light of recent territorial and military losses for Daesh. The article therefore proposes a post-secular counterterrorism approach.
Unpacking the role of religion in political transnationalism: the case of the Shi'a Iraqi diaspora since 2003
Authors: Kadhum Oula
Published: March 2020

This article explores the role of religion in political transnationalism using the case of the Shi'a Iraqi diaspora since 2003. The article focuses on three areas that capture important trends in Shi'a transnationalism and their implications for transnational Shi'a identity politics. These include Shi'a diasporic politics, transnational Shi'a civic activism, and the cultural production of Iraqi Shi'a identity through pilgrimages, rituals and new practices. It is argued that understanding Shi'a Islam and identity formation requires adopting a transnational lens. The evolution of Shi'a Islam is not only a result of the dictates of the Shi'a clerical centres, and how they influence Shi'a populations abroad, but also the transnational interrelationships and links to holy shrine cities, Shi'i national and international politics, humanitarianism and commemorations and rituals. The article demonstrates that Shi'a political transnationalism is unexceptional in that it echoes much of the literature on diasporic politics and development where diaspora involve themselves from afar in the politics and societies of their countries of origin. At the same time, it shows the exceptionalism of Shi'a diasporic movements, in that their motivations and mobilizations are contributing to the reification of sectarian geographical and social borders, creating a transnationalism that is defined by largely Shi'a networks, spaces, actors and causes. The case of Shi'a political transnationalism towards Iraq shows that this is increasing the distance between Shi'is and Iraq's other communities, simultaneously fragmenting Iraq's national unity while deepening Shi'a identity and politics both nationally and supra-nationally.
Mapping the field of religious environmental politics
Authors: Kidwell Jeremy
Published: March 2020

Until fairly recently, consideration of religion has been marginal or even non-existent in the scholarly discourse about environmental politics. Renewed attention to the intersection of these fields has been encouraged by a recent widening in discussions of ‘environmental values’ to include the role of religious institutions and personal belief in forming spiritual environmental values and renewed attention to the place of ethics and religious institutions in global environmental politics. Following a range of historic declarations by religious leaders, the recent encyclical by Pope Francis signalled a new level of integration between Catholic concerns for social and environmental justice. Yet, much of the continued engagement by large environmental NGOs and governments has continued to ignore the complex interrelation of local, intermediate and transnational religious political ecology. In this article, which is based on data gathered during five years of fieldwork, primarily with British Christian REMOs (religious environmental movement organizations), I probe the complexities of political engagement with religious environmentalism which arise from the many different organizational iterations these groups may take. On the basis of such investigation I suggest that effective high-level engagement with REMO groups will be greatly enhanced by a nuanced understanding of the many different shapes that these groups can take, the various scales at which these groups organize, and the unique inflection that political action and group identity can take in a religious context.
High-mobility Group Box 1 Facilitates CD4 T Cell Self-aggregation Via Integrin and STAT3 Activation Before Homing
Authors: Yu Ying , Ou-Yang Wenxian , Zhang Hui , Jiang Tao , Cho William C , Zhu Huang , Xiao Zhenghui , Li Shuangjie
Published: March 2020

Background

High-mobility group box 1 (HMGB1) is one of the delayed pro-inflammatory cytokines produced in the later stages of pathogenesis and plays an important role in the progression of various inflammatory and autoimmune diseases. High-mobility group box 1 is able to stimulate interaction between integrins and cell adhesion molecules to facilitate cell-cell aggregation in “tissue-specific” endothelium; however, whether and how HMGB1 affects the adhesive capability of early acting immune cells in bloodstream remains largely unknown.

Methods

Human peripheral blood samples were collected from healthy adult donors. The CD4 T cells were isolated from blood using CD4 T cell isolation kit and identified using flow cytometry and immunofluorescence staining. The effect of HMGB1 on adhesive ability of CD4 T cells was accessed by cell self-aggregation assay and endothelial adhesion assay. The migratory ability of CD4 T cells was evaluated by cell migration assay. Secretion of pro-inflammatory cytokines or chemokine C-X-C motif chemokine 12 (CXCL12) were detected by ELISA. Expression of integrins β1, β7, and α4β7 were determined by flow cytometric analysis. Inhibition of integrins was achieved with anti-integrin antibodies or cyclic peptide inhibitors. Activation of signal transducers and activators of transcription 3 (STAT3) was measured by flow cytometry and fluorescent staining.

Results

High-mobility group box 1 facilitated CD4 T cell self-aggregation with simultaneous reduction of CD4 T single-cell counts in the bloodstream. The CD4 T cell self-aggregation induced by HMGB1 resulted in upregulation of integrins β1, β7, and α4β7; release of other pro-inflammatory cytokines or chemokine CXCL12; and activation of STAT3 signaling. Intriguingly, pro-inflammatory cytokines induced by HMGB1 could further amplify CD4 T cell self-aggregation. HMGB1 induced CD4 T cell apoptosis via activation of caspase-3/7. Furthermore, HMGB1 promoted migration and adhesion of CD4 T cells to endothelial cells.

Conclusions

These results provide proof of concept that HMGB1 promotes CD4 T cell self-aggregation before homing to inflammatory sites and highlight the potential of blocking immune cell self-aggregation in blood as a novel therapeutic approach against the development and progression of HMGB1-related inflammatory diseases.

HMGB1 induces CD4 T cell self-aggregation in blood resulting in upregulation of integrins expression and release of pro-inflammatory cytokines/chemokines via activation of STAT3 signaling. This study highlights the potential of preventive and therapeutic intervention on immune cell self-aggregation in the bloodstream.
T3 Randomized, Controlled, Within-patient, Single-blinded Study to Evaluate the Efficacy of Corticosteroid Injections for the Treatment of Hypertrophic Scar in Adult Burn Survivors
Authors: Nedelec Bernadette , de Oliveira Ana , LaSalle Leo , Correa Jose
Published: March 2020

Introduction

Intralesional corticosteroid injections (CSI) have become one of the cornerstone treatments of hypertrophic scar (HSc). However, the evidence is of limited-quality and published investigations have almost exclusively been performed in linear scars rather than hypertrophic burn scars. Thus, the aim of this study was to perform an appropriately powered, single-blinded, randomized controlled trial (RCT) to evaluate the impact of CSI on burn HSc compared to patient-matched control (C) scars.

Methods

Fifty burn survivors with 2 independent scars (separated by non-scarred skin preferably on the contralateral side or an anatomically similar site) were selected based on high-frequency ultrasound thickness (>2.034 mm to ensure that the site were outside of the range of normal scar). Baseline thickness measurements of the 2 sites were within 0.5 mm of each other, to ensure homogeneity and an erythema index >300 to establish they were immature HSc. The sites were randomly assigned to treatment (Tx) or C. The Tx HSc received a 10 mg/ml CSI. The CSI was repeated 6 weeks later and a 3rd final injection 6 weeks later if deemed necessary. Objective evaluation of thickness, pliability, erythema and melanin were obtained at the Tx and C sites at baseline, end of Tx and 6 weeks after the last injection. Thirty one participants completed the study, reaching the required number for an adequately powered sample based on pilot study data analyses.

Results

The mean number of injections per site was 2.1(±0.7 SD). An ANCOVA comparing the Tx vs C post-Tx, controlling for baseline and Fitzpatrick skin type, revealed a significant decrease (↓) in thickness and increase (↑) in pliability of the Tx compared to C HSc (p=0.0003), but no significant difference in erythema or melanin. Baseline to post-Tx comparisons using paired t-tests revealed significant ↓ in thickness of both the Tx and C HSc and ↑ in pliability of the Tx HSc during the Tx period, but no significant change in C HSc pliability or erythema. Wilcoxon Signed Rank Test revealed a significant ↑ in melanin of both Tx (p< 0.001) and C (p=0.0035) HSc. A regression model for repeated measures, controlling for baseline and skin type, revealed no significant change in thickness, pliability, erythema or melanin during the 6 week follow up.

Conclusions

Although HSc thickness ↓ at both the Tx and C site across time there was a significantly greater reduction at the CSI site and significantly greater ↑ in pliability. Melanin significantly ↑ at both the Tx and C site. There was no significant change during follow up of any of the HSc characteristics.

Applicability of Research to Practice

This well-controlled RCT demonstrated the benefits CSI for burn HSc thickness and pliability and the need for patient-matched C HSc.
11 Tube Feeding Through Surgery, Impact on Glucose Control in Burn Patients
Authors: Cooper Chloe R , Hess Andrea L , Hope Brianna , Hope Landon , Sorensen Grant , Wagner Clayton E , O’Banion Scott , Kesey Jennifer , Griswold John
Published: March 2020

Introduction

The hypermetabolic state experienced by burn patients post injury puts nutritional support at the forefront of these patients’ care. Enhanced Recovery After Surgery (ERAS) algorithms include a radical approach of feeding patients up to surgery with reported advantages like earlier recovery of GI function, among others. The purpose of this study was to assess perioperative blood glucose (BG) levels in patients fed up to and through surgery at our institution.

Methods

Charts of selected surgical burn patients were reviewed and categorized on the basis of diabetic status and whether they had procedures in which feeds were continued to within four hours of surgery (“fed”) and stopped at least four hours prior to surgery (“unfed”). Percent change in pre- and post-op BG levels were compared between groups. Wilcoxon Rank-Sum and Two-Sample testing were used for statistical analyses.

Results

See Table 1. Data collection yielded 32 patients with 106 unfed and 92 fed procedures. There was a significantly larger percent change in BG levels from 24-hr pre-op to 12- and 24-hr post-op in the unfed vs. fed groups across all procedures, prior to grouping based on diabetic status (p = 0.014 and p = 0.009, respectively). There was a statistically significant difference in the percent change in BG levels from 24-hr pre-op to 12- and 24-hr post-op in the pre-diabetes group (p = 0.021 and p = 0.026, respectively).

Conclusions

Our data shows better BG control in fed procedures with lower percent change from pre-op to post-op overall, and in the pre-diabetes group. These findings are in line with ERAS literature. Controlling BG ranges post-op is critical to prevent complications and promote healing. Improved BG control using perioperative nutrition could guide practices related to perioperative workup of burn patients. This is worth further investigation since better BG management has been associated with superior patient outcomes.

Applicability of Research to Practice

1) Using enteral nutrition up to and/or through surgery contributes to better glycemic control postoperatively in surgical burn patients.

2) The most pronounced benefits of perioperative enteral nutrition in terms of glycemic control are seen in burn patients with pre-diabetes.
22 16-year State-wide Population-based Analysis of Burn and Inhalation Injury – Demographics, Injury Characteristics, Management, and One-year Outcomes
Authors: Hewes Philip D , Bell Derek
Published: March 2020

Introduction

Estimates on frequency and outcomes of burn or inhalation injury in the United States are limited since reported databases are confined to specific phases of care, included facilities, length of follow-up, facility/provider/patient identification and/or lack of longitudinal tracking. A population-based database addresses these issues.

Methods

We queried a statewide mandated-reporting database for the years from 2000 through 2015 at the time of injury using a set of ICD9-CM codes for second degree or deeper burns, inhalation injury, and chemical and electrical burns. Burn total body surface area percentage by anatomical region was assigned as appropriate using modified and age-stratified Lund and Browder charts. Records for each patient were extracted out to one year pre- and post-injury, as available. Provider and facility burn volume and survival was stratified into quartiles. We applied the Committee on Trauma/American Burn Association referral criteria to the index presentation. Kaplan-Meier curves were generated to 1-year post injury for testing combinations of burn percent total body surface area of 20% and inhalation injury for age ranges < 15, 15 - 60, and >60 years. Regression models were developed to model the probabilities of in-patient, 90-day, and 365-day mortality and readmission.

Results

56,712 patients were included. Overall, 22% of patients meeting referral criteria were never seen at a burn center within 1-year post-injury. The greatest positive predictors of in-patient mortality were facility case volume and burn percent total body surface area. The greatest negative predictors were high provider burn case volume (for highest quartile, adjusted odds ratio 0.08, 95% confidence intervals 0.06 – 0.12). The highest risk of unscheduled 30-day readmission was associated with index presentation to a non-burn care facility (p < 0.001). For all groups, the first 100 days had the greatest mortality rate, the most severe being among patients of age greater than 60 with >20% burn percent total body surface area and inhalation injury, with a 40% survival rate.

Conclusions

This study is the first to be able to simultaneously evaluate in-patient, post-discharge, and facility-based parameters for outcomes. A significant number of patients are not accounted with current databases.

Applicability of Research to Practice

A population-based approach with longitudinal tracking allows for greater realization of the outcomes of all patients following burn injury. Existing association-supported or government databases fail to account for a significant portion of burn victims, motivating further evaluation of burn care efforts.
25 Social Integration in the First 2 Years After Moderate to Severe Burn Injury: A Burn Model System National Database Study
Authors: McMullen Kara , Bamer Alyssa M , Gibran Nicole S , Holavanahalli Radha K , Schneider Jeffrey C , Carrougher Gretchen J , Amtmann Dagmar
Published: March 2020

Introduction

Feeling a part of community and participating in social life are important aspects of overall quality of life. Burn survivors consider community reintegration one of the most important issues affecting their recovery. Integration, including social integration, has been studied in this population, but longitudinal analyses to examine factors associated with successful integration are lacking. The current study aims to assess variables associated with social integration during the first two years post-burn.

Methods

Adult (18+ years) burn survivors enrolled in the Burn Model System national longitudinal database responded to questionnaires at hospital discharge and 6-, 12-, and 24-months postburn. Social integration was assessed at all follow-up timepoints using the Community Integration Questionnaire Social Integration Component Scale, which has a possible range of scores from 0 (no community integration) to 12 (excellent community integration). To examine variables associated with social integration over time, linear mixed effect models utilizing generalized least squares with maximum likelihood and robust standard errors were used. Independent variables in the model included age, sex, % total body surface area (TBSA) burned, race/ethnicity, living status at time of injury, facial burn, history of psychiatric treatment preburn, employment at follow-up assessment, and SF-12 or VR-12 mental health component scores at the time of each follow-up assessment.

Results

Data from 1,848 adult burn survivors were included in the analyses. Average age of the survivors was 42.9 years, 74.0% were male, 77.7% were white, 47.0% were married or living common-law with a partner, and mean total body surface area burned was 18.2%. Factors associated with better social integration over time included younger age, female sex, lower TBSA (< 40%) burn size, white/non-Hispanic race, no preburn psychiatric treatment, postburn employment, and better mental health. Time was not a significant predictor, indicating that social integration scores remain relatively stable over the 24-month follow-up period.

Conclusions

We identified several factors that contribute to greater social integration including age, gender, burn size, race/ethnicity, employment, and mental health, with the association between age, gender, and employment status and community integration a novel finding in this population.

Applicability of Research to Practice

This study suggests that while most factors associated with social integration are not modifiable, interventions aimed at improving mental health and helping burn survivors return to work could also improve self-reported social integration.
27 Utilization of an Ethics Service in a Large Urban Burn Center
Authors: Greenway Andrew , Heffernan Jamie , Markow Nicole , Yang Jennifer , Gibbons Linda , Stewart Jacob , Walker Joan , Huberman Barrie J
Published: March 2020

Introduction

Ethical dilemmas arise related to tension between one or more values held by stake-holders. Identifying which ethical principles (i.e., autonomy, beneficence, non-maleficence, and justice) are in tension represents one way to categorize ethical dilemmas that arise in clinical cases. The purpose of this review is to describe the population of patients for whom Medical Ethicists (ME) were consulted and identify the primary ethical principles in tension for these cases.

Methods

A retrospective chart review of patients admitted from 2/2014–8/2019 (n=3701) capturing ME notes. Each note was independently rated by burn team RNs and medical ethicists to identify which two of the four common ethical principles were perceived to be in tension. Reviewers also noted if surrogate decision-making and/or goals of care were prominent themes in the case. Additional data points include circumstances of injury, total body surface area (TBSA) involved, age, mortality, length of stay (LOS), Hospital Day (HD) of ethics consult (EC), +/- psychology/psychiatry note, +/-chaplaincy, +/-palliative care, initiator of and stated reason for the EC.

Results

Of the 3701 patients admitted, 26 had formal EC’s (0.7%). Twelve died. Average age was 55.6 (7–85). Two patients had Calciphylaxis and four self-immolated. One EC concerned interests of fetus vs the pregnant patient. TBSA for the burned group averaged 39.7% (2–100). Average LOS was 55.6 days. Average HD of ethics consults was 20.5. For mortalities, EC was 10.8 HDs prior to death. LOS for survivors was 55.6 vs 42.33 days for non-survivors. TBSA for survivors was less than those who died (29% vs 50%). Chaplaincy was involved in 19/26 (73%), palliative care 3/26 (12%), Psychology/ psychiatry 15/26 (58%) of EC’s. The burn RNs most often characterized the ethical dilemmas as tension between beneficence and nonmaleficence while the ethicist found autonomy vs. nonmaleficence. All raters found only 1 or 2 cases involved justice. The team identified GOC tension in 20/26 cases, the ethicist, fewer than half. The burn team requested ethics consultation in all cases of self-immolation. Initiators of ethics consults were 14 burn team, 7 burn MD, 1 burn nursing, 2 chaplaincy and 2 not stated.

Conclusions

Circumstances of injury, the nature of wound and intensive care management and the association of significant injury with end of life care present challenges to the burn team. Many may be framed and addressed as ethical dilemmas. This pilot exploration of clinical utilization of medical ethics suggests patterns and questions that warrant further discussion and study. Value-driven tensions between the professional duties to do good, the duty to do no harm, and the duty to respect autonomous decisions by patients and by extension, surrogate decision makers, account for most triggers for ECs initiated by the burn team.

Applicability of Research to Practice

Directly Applicable.
28 Childhood Burn Injuries: The Uninjured Sibling Perspective
Authors: Dillard Dana R
Published: March 2020

Introduction

When considering burn-injured children as part of a larger family unit, it is expected their injury will stress the system; yet the focus has mainly been on the injured child and treated as incidental for the family. Though research on the family is evolving, less is known from the uninjured sibling perspective. Sibling relationships have a unique impact on development. This study aimed to understand the experience of growing up with a burn-injured sibling in childhood, with attention to how identity was shaped. Acquiring knowledge from uninjured siblings will facilitate a more integrative understanding and holistic approach to aid families. Thus, this exploratory study fills a gap by engaging the uninjured sibling’s perspective with implications for program enhancement/development.

Methods

Narrative inquiry was utilized to explicate the narratives of adults who grew up with a burn-injured sibling in childhood via semi-structured interviews (N=7). The research questions were: 1) What are the experiences, or stories, of identified adults whose sibling experienced a burn injury? 2) What do the narratives of identified adults whose sibling experienced a burn injury reveal about how their identities were shaped? 3) What are the implications for program/service development and/or enhancement elucidated by identified adults whose sibling experienced a burn injury? A purposeful criterion sampling method was used, but challenges accessing participants resulted in sequential and emergence-driven strategies. Participants’ self-identified as Caucasian (n=7), female (n=4), and male (n=3). Age ranged from 20 to 57 (M=33.14, SD=14.32) at the time of the interview and 0 to 13 (M=5.25, SD=4.25) at the time of their siblings’ injury. Interviews queried the burn incident, family relations, communication, and support received. Riessman’s thematic approach to narrative inquiry was employed for analysis.

Results

Findings supported five themes: 1) separation and alternative caregiving, 2) altered interactions and ambivalent roles, 3) (r)evolving emotional pain, 4) communication concerns, and 5) identity through autobiographical reasoning. The data suggest uninjured siblings have their own unique narratives that have failed to be acknowledged in research and practice, though identity clarity and meaning-making were articulated in their reflections. Moreover, findings support consideration of many experiences as a primary trauma.

Conclusions

The needs of uninjured siblings—specifically related to inclusion, identity, and resource acquisition—should be addressed to mitigate the impact of burn trauma. The family system remains a critical area for research and program enhancement/development.

Applicability of Research to Practice

Findings can contribute to program planning for the family with increased attention to the uninjured sibling’s experience and concern for their specific needs.
34 Family Needs of Adult & Pediatric Burn Patients
Authors: Fox Jasmine , Hsu-Chang NaiWei , Shames Stacey , Lillington Linda
Published: March 2020

Introduction

Family members play a significant role in recovery of the burn patient (Goyata & Rosi, 2009). A better understanding of their specific needs can greatly influence a burn patient’s rehabilitation and family adaptation during recovery. Prior research has identified family needs of critically ill patients (Hinkle 2009; Kinrade, 2009); few studies have looked at the specific needs in adult versus pediatric burn patients and whether these needs change throughout the course of hospitalization. The purpose of this study is to explore the needs of family members of burn patients to identify similarities and differences between adult and pediatric populations in order to aid nurses in prioritizing care instructions for burn families.

Methods

This IRB approved descriptive repeated measures study took place in a 12-bed burn center. 64 family members (39 adult; 25 pediatric) of burn patients participated. The 45-item Critical Care Family Needs Inventory (CCFNI) identified family member’s psychosocial needs related to assurance, information, proximity, comfort, & support on admission (ADM) and prior to discharge (DC). Descriptive statistics summarized study participant characteristics. T-test & chi-square techniques determined similarities and differences in adult and pediatric family members’ needs perceptions during the hospital stay.

Results

Majority of respondents were female (84%) often mother or spouse/significant other; age < 40yrs (96% peds; 64% adults). CCFNI scores were similar in adult vs. peds family members: ADM (3.27 vs 3.37), DC (2.91 vs 3.29). Assurance needs were greatest; self-care needs were least important. Adult family member needs for information, proximity and comfort decreased significantly from ADM to DC (p 0.05) but assurance needs were unchanged. Peds family member needs for assurance, information, proximity and comfort did not change from ADM to DC. Pediatric family needs remained “important to very important” throughout the stay while adult family member needs decreased in importance.

Conclusions

Identifying needs of family members of burn victims in the Burn ICU allows for early assessment and can aid in developing specific individualized plans for successful transition upon discharge. These findings can help nurses best meet the needs of the family & promote patient & family centered care.

Applicability of Research to Practice

Findings from this study can help inform the development of approaches to better understand the particular needs of family members and develop strategies to address those needs.
45 Unravelling the Unique Burn-induced Temporal Alterations in Adipose Tissue Metabolism
Authors: Knuth Carly M , Auger Chris , Abdullahi Abdikarim , Jeschke Marc G
Published: March 2020

Introduction

A severe burn elicits a systemic hypermetabolic response that substantially alters the function of multiple organs and contributes to increased morbidity and mortality. A consequence of hypermetabolism is the activation of UCP1-mediated browning of white adipose tissue (WAT), which may further facilitate the hypermetabolic response. In this study, we aimed to provide comprehensive characterization of the acute and long term pathophysiological responses to burns to determine the persistence of adipose tissue browning and its potential contribution to the hypermetabolic response.

Methods

Mice were subjected to either a 30% total body surface area (TBSA) scald burn or were denoted sham. Body weight and food intake were monitored throughout the duration of the study. Cohorts were sacrificed at 6hrs, 1, 3, 5, 7, 14, 30 and 60d post-burn and adipose tissue depots were harvested. Mitochondrial respiration, protein expression, and morphology in adipose tissues were assessed.

Results

Despite consuming considerably more food, the burn group lost significantly more weight throughout the duration of the study. We also detected increases in free fatty acids and interleukin-6, markers of whole-body lipolysis and inflammation, respectively. At the tissue level, eWAT mass significantly decreased over time, suggesting that this depot provides substrate to fuel the hypermetabolic response. This was further supported by a decrease in adipocyte area and an increase in lipolytic markers which remains significant up until 60d post-burn relative to sham. There were no significant difference in iWAT mass, however we detected significant increases in the protein content of UCP1, the master regulator of adipose tissue browning, as early as day 3 which persisted until day 60. This was corroborated by the presence of UCP1+ adipocytes.

Conclusions

Consistent with previous human studies, a burn injury elicits a dynamic response that cannot be simply characterized by a single timepoint. The alterations that occur in adipose tissue are depot-specific, time-dependent, and this notion likely extends to other metabolic tissues. Further, we demonstrate that in our 30% TBSA burn murine model, the effects of the hypermetabolic response persist for up to 60 days following initial injury.

Applicability of Research to Practice

Our data indicate the hypermetabolic response persists for up to 60 days, the equivalent of approximately 7 years in humans. This underscores the severity of adipose tissue browning and potentially provides an explanation as to how the hypermetabolic response persists even after the wound has healed. Moreover, providing a comprehensive map of the time-dependent changes in a murine model gives clinicians a better indication of the metabolic effects in a burn patient and will contribute to the development of effective, targeted treatments.
64 E-cigarette and Vaporizer-related Burn Injury: Demographics and Injury Patterns
Authors: Dyamenahalli Kiran U , Wengryn Derek M , Wiktor Arek J , Kovacs Elizabeth J , Duffy Patrick , Wagner Anne L Lambert
Published: March 2020

Introduction

E-cigarettes and vaporizers (E-cigs) have seen a dramatic surge in popularity. The Centers for Disease Control now estimates that 1 in 4 United States (US) high school students use E-cigs. Recent recognition of E-cig-related lung injury has garnered significant attention. However, relatively little is known about E-cig-related burn injuries, which are often due to battery explosion and liquid ignition. The objective of this study was to characterize population demographics and injury patterns associated with E-cig burns.

Methods

A retrospective review of all patients presenting with E-cig-related cutaneous burn injury to a verified US burn center between January 2015 and August 2019 was performed using an institutional database. In addition, media reports covering the same mechanism of injury and date range were collected using databases for the National Electronic Injury Surveillance System, American Nonsmokers’ Rights Foundation, and international news outlets. Demographic data and injury metrics were recorded.

Results

309 international media reports and 30 institutional cases of E-cig-related burn injuries were identified. Media-reported injuries varied with respect to geographic location: US-185, United Kingdom-35, Canada-6, all other countries-8, unclear-75. Annual incidence peaked in 2016 in media reports (2019-19, 2018–61, 2017–68, 2016–106, 2015–55) and institutional records (2019-3, 2018-5, 2017-6, 2016-16, 2015-0). Injuries predominantly involved men in both media (Male 75.7%, Female 13.9%, unknown 10.4%) and institutional (Male 93.3%, Female 6.7%) datasets. Average age was 31.0 years (media) and 30.3 years (institutional). The institutional data revealed an average TBSA of 3.5% (range 1–8.5%), an average length of stay of 3.8 days (range 0–14 days), and a median number of operations of 1 (range 0–2). 90% (n=27) of patients required inpatient admission and one patient required mechanical ventilation. On admission, 58% (n=14) of patients screened positive for cannabis use. A ranking of anatomic regions by frequency of involvement was consistent between datasets: lower extremity > hands > head/neck > torso > groin. Mortality rates were also similar: 1.62% (media) and 0% (institutional).

Conclusions

E-cig-related burns are non-trivial injuries, most of which require inpatient admission, operative management, and substantial resource use. They disproportionately affect young men and burns often involve sensitive areas like the hands and face.

Applicability of Research to Practice

Combined with rising popularity, lax regulation, proliferation of counterfeit products, and associated lung injury, E-cig-related burns represent an evolving health threat. This study highlights the importance of reporting injuries to consumer product regulatory agencies and the need for further research into the causes and consequences of E-cig explosion.