bluuebunny/crossref_metadata_2025 huggingface dataset:
594 Improving the Accuracy of Discharge Wound Care Instructions in a Teaching Facility
Authors: Robinson Kara , McMahon Melanie , Campbell Stephanie
Published: March 2020

Introduction

Clinic staff at a regional verified burn center reported a trend of patients coming in for follow up appointments confused about home wound care due to written discharge instructions that did not match what they were taught in their last inpatient wound care session. Examples of inaccurate instructions included referring to topicals the patient was not currently using or failing to address the care of all wound types present. The reported cases were reviewed by nursing and physician leadership through the burn center quality improvement process.

Methods

A retrospective chart review of all patients discharged with open wounds was completed for the previous 5-month period to establish a baseline rate of inaccurate instructions. Discharge instructions were counted as inconsistent if they did not match the wound types, dressings, and topicals charted in the patient’s last inpatient wound care. Contributing factors identified included that the instructions were most often free texted by rotating surgical residents. It was decided that pre-written choices might improve the accuracy of the instructions. A wound care discharge template was developed through a collaboration with the hospital clinical informatics department. The design included drop down choices for dressings, topicals, and body parts. Standard phrases within each selection were written by an experienced burn service provider. Discharge education was added to the monthly in-service for resident physicians. A large sign with instructions for the template was placed in the physician workroom along with cards posted to the top of each computer. Audits comparing the discharge instructions to the last wound care note then continued for a 4-month period.

Results

The retrospective chart review revealed an average of 28% of discharge instructions were incorrect or incomplete each month, with a range of 25–32.7%. In the 4-month period after the template was released, the monthly average dropped to 12.85%, with a range of 7.7–17.9%. It was also noted that inaccurate instructions in the post-template audits typically only had a small error compared to the more complicated errors noted prior to the template implementation.

Conclusions

The incidence of incorrect wound care discharge instructions written by burn team providers decreased with the introduction of a discharge wound care template. More analysis is needed to identify additional opportunities to further decrease the rate of inconsistencies.

Applicability of Research to Practice

Thorough and accurate wound care instructions with standardized language may improve the patient’s confidence with performing wound care at home and improve their post-discharge experience. Consistent wound care instructions also help to ensure that the wounds are cleaned and dressed with the appropriate topicals and dressings, potentially decreasing the risk of infection and graft loss.
598 Protection Against Thermal Stress in Humans: Application of “Cooling Wear” Under Heated Conditions in Burn Centers
Authors: Luze Hanna , Holzer Judith , Nischwitz Sebastian P , Kamolz Lars-Peter
Published: March 2020

Introduction

Many professional groups have to work in places with high temperatures; this includes, for example, doctors and nursing staff working at burn centres. Increased ambient temperature during the care of severely burned patients in the operating theatre and intensive care unit is used to mitigate the loss of thermoregulation, prevent hypothermia, and minimize the impact of hypermetabolism. However, experimental evidence indicates, that even relatively mild thermal stress may affect human performance. Novel cooling strategies have been invented for reducing thermal stress in people, who are occupationally exposed to high temperatures and have for instance already been tested in the military field. Here, the present study investigated the effects of cooling wear on the performance under high ambient temperatures.

Methods

Effects of cooling wear on concentration and performance of surgeons were investigated in 12 subjects during a simulated burn surgery. Subjects were divided into two groups, one group wearing cooling wear and one control group with normal scrubs. Directly before the exposure to high ambient temperatures, subjects of both groups underwent standardized tests for concentration, manual dexterity and measurements of physiological parameters. After a simulated burn surgery of 1 hour, subjects underwent the same analysing procedure again.

Results

Results proved that even relatively mild thermal stress affects performance whereby complex actions, that require high concentration, are primarily affected. Initial values of both groups showed approximately homogenous values. After heat exposure, however, subjects who received cooling wear showed higher results in tests for concentration and manual dexterity. Furthermore, the comparison of physical parameters indicates the ability of cooling wear to reduce thermal stress and its’ negative effects on the human organism.

Conclusions

Decrements in vigilance, performance and endurance are well-documented effects of thermal stress. As an opportunity to withstand thermal stress and therefore improve medical care, cooling wear showed good results in many aspects.

Applicability of Research to Practice

Based on these promising results cooling strategies may be used as an important tool in medical sectors in the future. Burn medicine may particularly profit from further development and rigorous investigation of cooling strategies.
602 Managing Hypothermia in the Surgical Burn Patient
Authors: Regojo Patricia , Mohan Molly
Published: March 2020

Introduction

It is known, hypothermia, core body temperature at or below 36oC/96.8oF, can lead to dangerous complications for burn patients. Due to loss of their protective thermoregulation, burn patients are at an increased risk of hypothermia during surgery. Findings from a Quality Assurance audit revealed burn patients were returning from surgery hypothermic and hemodynamically unstable. There was little evidence of intra-operative temperature management in the electronic medical record (EMR) or reported to the nurse upon the patients’ return from the operating room (OR). Only 73% of patients had temperatures recorded during their surgery and of those, 40% had a drop of temperature >2 degrees from their baseline. The purpose of this collaborative evidence-based quality assurance project was to improve temperature management in the operating room and prevent hypothermia in the intra and post operative periods. Our aim was to develop warming methods pre-operatively that would establish a goal for keeping the patients’s temperature within 2 degrees of their baseline preoperative temperature during surgery.

Methods

A literature search obtained from CINAHL, Cochrane, EMBASE, and MEDLINE from 2010–2018, provided current surgical guidelines and evidence-based practices for managing surgical hypothermia in burn patients (levels of evidence I, III, V, & VI). Recommendations from the burn unit staff for preoperative warming initiatives were listed and shared with the OR staff. Hemodynamic documentation, including core temperature, estimated blood loss, and intra-operative warming methods were monitored for twelve months after the Burn Unit Warming Protocol was implemented. Progress was reported quarterly in our Burn and Trauma Quality Committees.

Results

After implementing the Burn Unit Warming Protocol, temperature management of the burn patient improved. Intra-operative warming methods were initiated. Patients began returning from surgery warmer with improved hemodynamics. 96% of the patients had their temperatures recorded and managed intra-operatively. Of those patients, only 2.6% had a drop in temperature > 2 degrees from their pre-operative baseline.

Conclusions

Implementing a nurse-driven warming protocol from the pre-operative stage through surgery can aid in reducing post-operative hypothermia in burn patients.

Applicability of Research to Practice

Managing hypothermia will help reduce complications that can lead to increase morbidity and mortality in burn patients.
632 Heterotopic Ossification Related Contractures: Success with Bodyweight Stretches
Authors: Tinlin Kristen E , Comstock Jill , Sood Rajiv
Published: March 2020

Introduction

Heterotopic Ossification (HO) occurs following a trauma and is a complication in therapy recovery following burn injuries. Burn literature reveals the incidence of HO is present in approximately 2% of the burn population. There is limited evidence supporting bodyweight stretches in the treatment of HO related contractures. When present, HO can result in a loss of range of motion (ROM), significant pain and limit independence with daily activities. This case study identifies therapeutic interventions, specifically bodyweight stretches, with associated positive outcomes that improved HO related contractures. This challenges the common practice of discontinuation of aggressive ROM with an HO diagnosis.

Methods

Two patients were identified as having been diagnosed with HO and subsequent loss of joint ROM that successfully regained motion without requiring surgical intervention. Retrospective chart reviews were completed that compared demographics, hospital course, timing of HO diagnosis, outpatient therapy frequency and duration, treatment interventions and time to resolve ROM deficits. Graphs were created that tracked rehab course and ROM progression along with therapeutic interventions to identify common factors that contributed to regaining mobility.

Results

Both patients were of similar age with an average TBSA of 64% and comparable hospital stays. At the outpatient therapy evaluation, each patient presented with approximately 50% loss of joint ROM in one upper extremity joint. The pair received occupational and physical therapy services. With different frequencies and durations, both achieved nearly normal joint ROM at the completion of their rehab. Patient 1 attended therapy 3-4x weekly over 4 months and regained 70° of active shoulder flexion motion. Patient 2 attended burn therapy once weekly for a period of 9 months and regained 60° of elbow flexion. In each case, the most significant ROM improvements were noted after initiating bodyweight exercises to maximize end range stretches and total body strengthening. Interventions included planks, modified yoga positions, push ups and pull ups. Both patients demonstrated a high pain tolerance and motivation to progress stretches to end range that resulted in maximum ROM gains.

Conclusions

Therapy guided, self administered stretches using bodyweight as an external force strongly contributed to significant ROM improvements and remediation of HO related contractures. Higher therapy dosage with a frequency of 3x weekly resulted in quicker resolution of ROM deficits as compared to 1x weekly dosage.

Applicability of Research to Practice

Rehab success following a burn injury can be strongly limited with the diagnosis of HO. This research utilizes a common therapy practice of bodyweight stretches to improve HO related contractures, leading to greater mobility gains and a quicker return to their desired lifestyle.
636 Case Report on Continuous Passive Motion (CPM) Therapy on Hand Burns in a Patient with a Large Total Body Surface Area (TBSA) Burn
Authors: Mullen Audrey , Mullins Robert F , Fagan Shawn , Hassan Zaheed , Homsombath Bounthavy , Collins James , Askari Morad
Published: March 2020

Introduction

Methods

Results

Expectations: To lose ROM as healing progressed due to the extent of the injuries (based on prior experience) & because some contracture was assessed as early as 1 week.

Outcomes

Conclusions

Applicability of Research to Practice

That other therapists might consider this therapy and experience similar outcomes when treating deeply burned hands.
710 Use of Airway Pressure Relief Ventilation (APRV) in Burn Patients with and Without Inhalation Injury
Authors: Foster Kevin N , Buchanan Dylon , Durr Timothy , Richey Karen J
Published: March 2020

Introduction

Burn patients often require ventilator management because of large % TBSA injury, the presence of inhalation injury, and/or other factors. Airway pressure relief ventilation (APRV) offers several advantages over conventional ventilation modes including improved alveolar recruitment, better oxygenation and hemodynamics, preservation of spontaneous breathing, and possibly less ventilator-induced lung injury. This study reviews the use of APRV as the primary ventilator mode in burn patients with and without inhalation injury.

Methods

A retrospective chart review of patients admitted to the burn center and requiring APRV ventilation over a ten year period was performed. Data collected included demographic data, burn injury data, ventilator settings, arterial blood gas data, and development of ventilator-associated pneumonia (VAP).

Results

There were 411 patients identified over the ten year period. Mean age was 46 years, and mean % TBSA burned was 33. Seventy-three percent were male. One-half (51%) of patients had an inhalation injury. Mean hospital length of stay was 32 days with 22 mean ventilator days. Average number of surgeries was 4.4 per patient. Mean high pressure (P high) was 23 mm Hg. Mean FiO2 was 88% on post-injury day (PID) 1, 65% on day PID 2, and 45% thereafter. Mean P/F ratio was 333. Mean pH was 7.40, mean pCO2 was 40 mmHg, and mean HCO3 was 25 mm Hg. Forty-six percent of patients met criteria for diagnosis of VAP.

Conclusions

These data demonstrate that burn patients requiring mechanical ventilation can be safely and effectively managed with APRV. Oxygenation, carbon dioxide removal, normal acid-base status, and excellent P/F ratios were maintained with relatively low ventilator settings such as peak airway pressure and FiO2. Patients were able to breathe spontaneously when able and were easily liberated form the ventilator at the appropriate time.

Applicability of Research to Practice

This study defines an unconventional and potentially improved ventilator mode use in burn patients.
751 Airway Management of Patients Burned While Smoking on Oxygen: Intubation Rates and Associated Risks
Authors: Leonard Clinton D , Bennett Crystal
Published: March 2020

Introduction

A growing population among burn units across the country includes those burned while smoking on oxygen, occasionally resulting in resulting in complications such as full thickness burns requiring grafting, COPD exacerbations and arguably the most serious among this population, inhalation injury. First responders assess the respiratory status of these patients, occasionally choosing to intubate based on signs of respiratory distress. Due to the high proportion of intubated patients in our burn center and the risks of unnecessary intubation, this study will look at trends for patients burned while smoking on oxygen, especially regarding airway management.

Methods

A retrospective chart review was performed for all patients who were treated by referring providers prior to transfer to our Burn Center between July 2012 – August 2014. A subset analysis was performed on patients whose mechanism was injury resulting from smoking on oxygen. Demographics, airway management, and outcome data were measured.

Results

33 of 623 total patients who were treated by referring providers met the inclusion criteria for this study.

Twenty-one (64%) were intubated prior to arrival at the Burn Center. Of those intubated, twelve patients (57%) were extubated within 24 hours. Only four patients (19%) were found to have inhalation injury.

Overall mortality rate for these patients was 18%, over four times as high as our total mortality rate for transfer patients.

Length of stay (LOS) for those who survived their hospital stay without being intubated (3.45 days) was less than those who survived after being intubated (4 days).

Conclusions

The relatively low proportion of inhalation injury and high rates of extubation within 24 hours indicate the necessity of education improvements regarding risks of unnecessary intubation for regional first responders and physicians.

The low incidence of inhalation injury and high rates of extubation by hospital day 1 support previously published reports of overintubation among this patient population.

These patients have mortality rates despite small TBSA burns.

Further study is warranted to further describe the unique attributes of this high-risk patient population to develop appropriate treatment algorithms.

Applicability of Research to Practice

Dissemination of this information to first responders and pre-Burn Center hospitals will help reduce the morbidity and mortality associated with overintubation, especially in a medically fragile patient population such as those who are on supplemental oxygen.
784 Automated SIRS Alert Systems Are Ineffective at Predicting Sepsis in Burn Patients
Authors: Grigsby Melissa , Palmieri Tina L , Sen Soman , Romanowski Kathleen S , Greenhalgh David G
Published: March 2020

Introduction

Burn injury patients represent a population at particularly high risk for sepsis and sepsis mortality due to the severe immunological insult. Because of the unique nature of burn injury, this population has largely been excluded from studies developing protocols for identification and treatment of sepsis. In our institution, the protocolized approach to sepsis starts with an alert if two SIRS criteria are met, regardless of the patient’s diagnosis. We examined whether the SIRS alert was an effective way to identify and treat sepsis in burn patients.

Methods

Patients admitted to the burn surgery service at an academic regional burn center were identified by querying the “SIRS alert” dashboard from the hospital’s quality and safety department. The dashboard is a record of every patient whose clinical status triggered a SIRS alert during hospital admission, and whether a screening order set was opened. The SIRS alert and order set usage data were analyzed directly from the dashboard. Each patient’s chart was then reviewed to decide whether there was clinical suspicion of sepsis at the time an order set was released. We determined that there was clinical suspicion of sepsis if antibiotics were initiated or escalated within 6 hours of a SIRS screening order set being opened.

Results

From January 1, 2019 until September 14, 2019 there were 225 patients admitted to the burn surgery service at an academic regional burn center. 70 patients, specifically receiving treatment in the burn ICU, met the criteria to trigger a SIRS alert at least once in that time. Across those 70 patients, a total of 1381 SIRS alerts were acknowledged by the nursing staff. Due to a lack of clinical suspicion for sepsis, the SIRS screening order set was opened 8.5% of the time an alert was acknowledged. Only two times in the 1381 alerts was an order set opened and then followed by the initiation or escalation of antibiotics within 6 hours.

Conclusions

SIRS criteria appear to be ineffective at helping clinicians to identify and treat sepsis in the burn patient population. This is consistent with the fact that burn patients are in a virtually constant state of inflammation, making SIRS alerts futile at picking up subtle changes that could indicate early sepsis.

Applicability of Research to Practice

Hospitals should abandon the use of the standard SIRS criteria as a starting point for sepsis protocols when treating burn patients. There does not yet exist a validated criteria set to replace the standard SIRS criteria. In the meantime, the Burn Sepsis Consensus Conference definitions could be used as a guideline to modify the criteria, and future research should continue seeking to identify early predictors of sepsis in the burn population.
798 Introduction of Bedside Echocardiography by Mid-level Providers into Burn Intensive Care
Authors: Chambers Michael G , Britton Garrett W , Cancio Leopoldo C
Published: March 2020

Introduction

Point-of-care ultrasound (US) has been shown to be a useful adjunct in assessment of various shock states and has been utilized to guide both resuscitation and post-resuscitation de-escalation. We aimed to characterize the use of bedside ultrasound examinations performed by advance practice providers (APPs) and attending physicians in a burn intensive care unit (BICU).

Methods

We introduced routine US by an APP into our BICU and evaluated our experience under an approved PI project. Daily beside US exams were performed utilizing a portable US machine with a cardiac probe and tissue filter. US exams included focused transthoracic echocardiography, assessment of inferior vena cava diameter with distensibility/collapsibility indices, and pulmonary evaluation. The images were archived to a centralized repository and reviewed daily during multi-disciplinary rounds. US data were utilized in conjunction with physical exam, radiographic, and laboratory findings for medical management decision making.

Results

Thirty-four exams of 34 patients have been conducted to date. 91% of US findings corresponded to physical, laboratory, and radiographic findings, and contributed positively to medical decision making. 9% of US findings either did not contribute to medical decision making or conflicted with physical exam, radiographic, or laboratory findings.

Conclusions

Our results demonstrate the feasibility of routine US by an APP in the BICU, and indicate that bedside US helps guide both resuscitative and post-resuscitative care.

Applicability of Research to Practice

It is well known that positive fluid balance is associated with worse clinical outcomes. We believe point-of-care US is a viable tool in preventing over-resuscitation as well as to guide post-resuscitative diuresis.
808 Utilizing High Fidelity Simulation in Advanced Burn Life Support Scenarios
Authors: Hellebusch Katie , Curtis Alyson , Westlake Bethany , Siemons Kimberly
Published: March 2020

Introduction

Keeping staff up-to-date on required certifications has always been a gold standard for optimum care of specialty patients in our facility. We currently house a 12-bed American Burn Association(ABA) verified burn unit within this 800-bed hospital. All critical care nurses hired into the Burn Unit are required to obtain Advanced Burn Life Support(ABLS) certification within one year of hire. After the first year, all Burn Unit nurses are required to maintain ABLS certification through renewal.

Our hospital currently has seven active ABLS instructors. However, it is difficult to find volunteers willing to have moulage applied and be assessed head-to-toe. Another confounding issue is utilizing additional Burn Unit staff as “scenario patients” causing unfavorable staffing patterns. In March of 2019, we set out to investigate the functionality of high fidelity simulation during ABLS patient assessment performance test outs.

Methods

Our hospital has a simulation expert that facilitates high fidelity simulations with physician, residents and fellows. We sought out his expertise to understand the feasibility of having a mannequin follow scenario requirements. Both adult and small-child mannequins had the ability. Vital signs could be activated on the monitor screen once an ABLS candidate stated they had assessed the patient. Vital signs could then be adjusted throughout the scenario to coincide accordingly. Both mannequins had the ability to be turned and assessed head-to-toe. Both mannequins were fully dressed at the start of the each scenario, with the expectation each would be fully undressed in proper sequence during the test out.The burns were simulated using mix-and-pour skin effects silicone rubber. The moulage reflected the appropriate degree of burn for each scenario.

Results

High fidelity simulation has been utilized in our facility for two ABLS courses with great success. ABLS pass rates remain constant. A more realistic setting was obtained when utilizing simulation labs. Further improvements could be made to utilize the simulation’s highest functionality.

Conclusions

The use of simulation for a variety of burn patient scenarios that represent potential situations allowed learning to occur in a safe and realistic environment. Moving forward, improvement opportunities include utilizing the simulation mannequins and simulation-experts to their fullest capability. An additional component needs to be added prior to test-out, orienting the ABLS candidates to the simulation environment.

Applicability of Research to Practice

Mixed teaching modalities have been utilized for decades. Simulation has led to more realistic assessments and hands-on learning. There remains a need to merge scenario-based education with simulation-based education to further learners thought process and move from route memorization, to functional knowledge and application.
815 Outpatient Opioid Use in Burn Injuries Following Hospital Discharge: A Single Institution Evaluation
Authors: Weinstein Brielle , Pagnozzi Dominique , Abitabilo Alexa , Kis Lilla , Carney Madeline , Smith David J
Published: March 2020

Introduction

There is a growing concern regarding the unprecedented increase in morbidity and mortality related to the use of opioids. Prescription opioid abuse has been increasing dramatically in recent years. Prescription opioids have been shown to be favorable in perioperative management, however, their impact on chronic usage remains unclear. As an effort to help reduce opioid consumption following hospitalization for burn injuries, we look to evaluate the outpatient opioid consumption following hospital discharge at our institution.

Methods

After IRB approval, we obtained demographics, medical history, inpatient and outpatient opioid usage, treatment, and length of hospital stay of patients admitted with burn injuries who met study inclusion criteria (age ≥ 12 years and no history of opioid abuse prior to hospitalization) from January 1, 2011 to January 1, 2018. Data was analyzed using SAS v9.4.

Results

Our preliminary data included 210 patients with average age of 58 years, 75% non-Hispanic Caucasians and average total burn surface area of 18%. Medical histories observed included: hypertension (40%), diabetes (15%), hyperlipidemia (11%), depression (7%), and bipolar disorder (3%) among many others. 79% of patients had surgical intervention including excision and grafting, of which 32% had autografting procedures. All patients were treated with opioids during hospitalization, which included: fentanyl, hydromorphone, oxycodone-acetaminophen, morphine and oxycodone. 6% of patients had pain management consultation during hospitalization. 79% of patients were discharged with an opioid prescription, of which 21% had their opioid refilled during follow-up. There was no statistically significant difference in discharge opioid prescriptions (79% had surgical intervention versus 76% had no surgical intervention, p=0.69) and outpatient opioid prescription refills (17% had surgical intervention versus 17% had no surgical intervention, p=0.99) between patients who had surgical intervention for burn injuries versus those who did not.

Conclusions

This evaluation shows that there is no statistical difference in opioid usage between patients who had surgical intervention and those who did not for their burn injury treatments. Therefore, prescription opioids may not be necessary in postoperative care following hospital discharge.

Applicability of Research to Practice

With further research, we hope to evaluate the need for outpatient opioid prescriptions this treatment modality in effort of decreasing the order and use of opioids following hospital discharge in burn patients.
816 Geographic Analysis of the Outpatient Burn Population of an Urban Burn Center
Authors: Chandramouli Mathangi A , Heffernan Jamie , Rabbitts Angela , Chang Philip
Published: March 2020

Introduction

Previous work has utilized geospatial mapping of pediatric burn inpatients at a major urban burn center to analyze the distribution of patients across the catchment area. Over the past several years, our center has seen a significant shift in the number of patients cared for inpatient to outpatient care. The purpose of our study was to geographically identify and compare the incidence and location of burn inpatients versus outpatients within the catchment area.

Methods

Demographic and clinical data from both inpatient and outpatients was collected from a single urban ABA verified burn center over a 3 year period between 1/2016 and 12/2018 with an age range from 1 month to 101 years old. Geriatric patients were defined as age 60 or greater to facilitate comparison with NBR data which breaks down age by decades. The patients were mapped by their home zip code.

Results

1985 burn patients were admitted to this single tertiary burn center between 1/2016 and 12/2018 with an age range from 1 month-101 years of age. During the same time period, 11281 outpatient encounters occurred with an age range of 1 month to 101 years of age. 28.9% of the inpatients were 60 years or older while 17.4% of the outpatient encounters involved patients 60 years or older. For pediatrics (< age 16), 31.4% of the inpatients were 15 years and younger vs. 26% of the outpatient encounters. The top “hotspots” for inpatient burn zip codes vs. outpatient burn zip codes were different for 3 of the 6 zip codes compared.

Conclusions

The inpatient and outpatient populations at this tertiary urban burn center appear to be different with the geographic distribution of the patient’s domicile and the age distribution. Further analysis of the etiologies of burn injury and socioeconomic status of the patients will elucidate additional trends.

Applicability of Research to Practice

Applying geospatial mapping to a burn center’s outpatient and inpatient populations may reveal differential patterns of injury that can better focus prevention and outreach efforts in the community better target etiologies and age groups.
823 Airbag Burns: An Unnecessary Consequence of Motor Vehicle Safety
Authors: Skibba Kathryn , Cleveland Chelsea , Bell Derek
Published: March 2020

Introduction

Over 7,500 Americans are injured by motor vehicle crashes every day and air bags save an estimated 2,790 lives per year.6,7 All vehicles are mandated to have airbags installed. The ubiquity of airbags has shown a surge in airbag related injuries including abrasions, contusions, lacerations, burns, fractures, and retinal detachment.1,3

Methods

A retrospective review of all patients evaluated by the burn service was performed from 5/1/2015-4/30/2019. Inclusion criteria was patients of all ages with burn injuries resulting from airbag deployment. Demographic data and burn characteristics were reviewed.

Results

A total of seventeen patients met inclusion criteria: 82.4% female, 17.6% male. The average age was 40.4 years.

No patients required hospitalization for their burn care. Etiology of the burn was often not clinically distinguishable; six patients were categorized as chemical burns and three from thermal injury. The remaining eight patients had unspecified etiology.

Fifteen patients had second degree and two had third degree burns. The average TBSA for all patients was 0.45%. Burn location: ten hand or wrist; six arm, two chest, one neck, and anterior thigh burn. Eight patients suffered burns to more than one site.

All patients were able to heal from their burns with wound care; no patients required surgical intervention. The average time to re-epithelialization was 11 days.

Conclusions

There is no question about the efficacy of airbags in preventing death and serious injury. However, the current mechanism of airbag deployment is intrinsically hazardous to passengers as it releases hot gases and alkaline substance into the cabin. The clinical manifestation of the burn may not distinguish whether it was a chemical or thermal etiology, as seen in 47% of our patients. If there is a suspicion for burn resulting from an airbag, the wound should be copiously irrigated and treated as though there is alkali chemical contamination. The average wound size was small at 0.45% TBSA. Most wounds were determined to be second degree and all were able to heal without surgical intervention. The most common area burned was the hands or upper extremity (88%). Airbag related burns should not be minimized as they cause pain, scarring, and a financial and time burden to the patient.

Applicability of Research to Practice

It is important to recognize and properly treat burns related to airbag deployment. If etiology of the burn is in question, the wound should be irrigated copiously as it may be caused by chemical contamination.
845 Serum S100 Calcium-binding Protein B (S100B) Is Elevated in Severe Burn
Authors: Song Jusong , Wang Xiaofu , Huebinger Ryan M , Radhakrishnan Ravi S , Wolf Steven E
Published: March 2020

Introduction

Severe burn causes a dramatic metabolic response associated with multi-organ damage. Mononeuropathy is also associated to muscle wasting after injury. Schwann cells are the glial cells that support neurons in the nervous system. S100 calcium-binding protein B (S100B) and Myelin basic protein (MBP) are biomarkers of Schwann cells. We hypothesize that severe burn affects these biomarkers, and is related to burn induced nerve impairment. The purpose of the study was to investigate biomarkers related to neural damage in response to severe burn.

Methods

Thirty-five Sprague Dawley rats received 40% total body surface area scald burn. Serum was collected at 6 hours, 1, 3, 7 and 14 days after injury. Six underwent sham burn as controls. Serum was analyzed for S100B and myelin basic protein using ELISA. One way ANOVA was applied for statistical analysis.

Results

The baseline of S100B level was 45.01±3.58 pg/ml in the sham group. S100B significantly increased to 99.42±9.13 pg/ml with no significant change at other time points. MBP serum level is 4.12± 0.13 ng/ml at baseline. MBP level did not change significantly in burn compared to sham.

Conclusions

In summary, S100B serum increased markedly after burn and returned to baseline thereafter. Burn did not change MBP levels. The findings could lead to further efforts in elucidating changes in neural function after burn.

Applicability of Research to Practice

The current study implies a novel biomarker candidate in response to severe burn related to nerve damage.
869 Opioid Utilization in Pediatric Burn Patients
Authors: Shahi Niti , Meier Maxene , Phillips Ryan , Shirek Gabrielle , Banks Ashley , Recicar John , Fry Candace , Bielsky Alan , Moulton Steven
Published: March 2020

Introduction

Childhood burns are extremely common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, disrupting care and increasing the risk of post-traumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of burns in pediatric patients. We sought to evaluate the current use of multimodal therapy as well as the use, storage, and disposal of opioids in this patient population.

Methods

We prospectively surveyed parents of pediatric burn patients (0–18 years old) who presented to the burn clinic within two weeks of burn injury. Parents were surveyed regarding over-the-counter pain medication use and opioid medication use, storage, and disposal in the treatment of their child. Medians and interquartile ranges were used to describe continuous variables and frequencies and percentages were used for categorical variables.

Results

A total of 92 parents of burn-injured children were surveyed at a single institution in the outpatient burn clinic. The median age of burn-injured children was 3.1 years old, and 50% of patients were male. The majority had a TBSA of 1%. The hand was the most frequently burned location (45.7%). Acetaminophen (58.7%) and ibuprofen (69.6%) were the most common treatments for both constant and breakthrough pain.

Approximately 28% (26/92) of patients were prescribed opioids, of which 18.5% (17/92) filled their prescription. Only 29% of patients (5/17) consumed their entire prescription, and a median of 3 doses of opioids remained for those who did not finish the entire prescription. Parents most commonly decided to give their children opioid pain medications because “my child is in severe pain” or “I give my child pain medications as scheduled (written on prescription).” Approximately 40% (7/17) of patients who filled opioid prescriptions stored them in a locked area, and only 35.3% (6/17) were educated on how to dispose of excess opioid pain medication.

Conclusions

Presently, multimodal therapy with over-the-counter pain medications is used to treat the majority of pediatric burns. This study demonstrates an increased need for education on opioid administration, storage, and disposal for parents of burn-injured children.

Applicability of Research to Practice

We aimed to evaluate what current trends in opioid use are in pediatric burn patients and areas for improvement in parent education for over-the-counter pain medication use, opioid use, opioid storage, and disposal. From the study, we were able to glean that the majority of patients are successfully managed with over-the-counter pain medications. However, parents and patients managed with opioids need additional education on appropriate administration of opioid pain medications, safe locked storage of opioids, and opioid disposal. This demonstrates an area for quality improvement inpatient and outpatient.
What Happened to John Franklin? Danish and British Perspectives from Francis McClintock’s Arctic Expedition, 1857–59
Authors: Kaalund Nanna Katrine Lüders
Published: March 2020

By the autumn of 1847 it was clear that John Franklin and his crew were lost in the Arctic. The explorer John Rae famously reported that Franklin’s men had died, and that the last survivors had resorted to cannibalism. This was not the news Franklin’s widow Lady Jane Franklin wanted to hear, and Rae was subsequently condemned by many prominent British figures including Charles Dickens. Not accepting Rae’s testimony, Lady Franklin organized an expedition led by Captain Francis Leopold McClintock using the steam yacht Fox. One of the crewmembers on board the Fox was the Danish Arctic explorer Carl Petersen. Using both Petersen’s narrative Den Sidste Franklin Expedition med Fox (1860), and McClintock’s narrative from the same expedition, The Voyage of the ‘Fox’ in the Arctic Seas (1859), as its starting point, this article examines key differences in the perceptions of the controversy surrounding Rae’s report to the Admiralty, and how Arctic explorers were represented in the Danish and British contexts. While the idea that Franklin’s men had resorted to cannibalism in a final attempt to sustain themselves before they passed away was a significant affront to the British notion of the heroic Arctic explorer, this was not the case in the Danish context. The lost Franklin expedition generated international interest, international collaboration, and financial assistance for search missions, and therefore affords us an opportunity to explore national differences in the construction of the Arctic and the Arctic explorer.
A Comparison of Different Immune Activation Strategies to Reverse HIV-1 Latency
Authors: Garliss Caroline C , Kwaa Abena K , Blankson Joel N
Published: March 2020

Resting CD4+ T cells are the best characterized component of the latent reservoir. Activation of these CD4+ T cells is needed to optimize transcription and viral replication, and this strategy has been used to measure the inducible reservoir. There are several methods that can be used to activate CD4+ T cells, and in this study, we compared 3 different strategies: the combination of the lectin phytohaemagglutinin (PHA) and irradiated allogeneic feeders, a combination of PHA and a superagonistic anti-CD28 antibody, and the combination of the protein kinase C agonist phorbol 12-myristate 13-acetate and the calcium ionophore ionomycin. We show that each strategy induces a different pattern of expression of activation markers on CD4+ T cells. However, the different activation strategies induced similar frequencies of latently infected CD4+ T cells from people living with HIV on suppressive antiretroviral therapy regimens to produce replication-competent virus. Furthermore, the frequency of infectious units per million induced by each regimen was positively correlated with the copies of intact proviral DNA per million CD4+ T cells. Our results suggest that no single pattern of activation marker expression is most associated with latency reversal and demonstrate that different immune activation strategies reverse latency in a low frequency of CD4+ T cells that harbor intact proviral DNA.
Draft Genome Resource for the Ex-types of Phytophthora ramorum, P. kernoviae, and P. melonis, Species of Regulatory Concern, Using Ultra–Long Read MinION Nanopore Sequencing
Authors: Srivastava Subodh K. , Abad Z. Gloria , Knight Leandra M. , Zeller Kurt , Mavrodieva Vessela , Nakhla Mark
Published: March 2020

Phytophthora ramorum, P. kernoviae, and P. melonis are each species of current regulatory concern in the United States, the United Kingdom, and other areas of the world. Ex-type material are cultures and duplicates of the type that was used to describe each species and that are deposited in additional culture collections. Using these type specimens as references is essential to designing correct molecular identification and diagnostic systems. Here, we report a whole genome sequence for the Ex-type material of P. ramorum, P. kernoviae, and P. melonis generated using high-throughput sequencing via the MinION third generation platform from Oxford Nanopore Technology. We assembled the quality filtered reads into contigs for each species. We assembled the continuous contigs of P. ramorum, P. kernoviae, and P. melonis (1,322, 545, and 2,091 contigs, respectively). The ab initio prediction of genes from these species reveals that there are 16,838, 12,793, and 34,580 genes in P. ramorum, P. kernoviae, and P. melonis, respectively. Of the 34,580 P. melonis genes, 10,164 genes were conserved among all three of these Phytophthora species which may include pathogenicity genes. We compared the ex-type of P. ramorum EU1 lineage assembly with another selected isolate of EU1 available at the National Center for Biotechnology Information and found 251,859 single nucleotide polymorphisms (SNPs) genome-wide; the comparison with the EU2 lineage genome isolate revealed 441,859 SNPs genome-wide. This genome resource of the ex-types of P. ramorum, and P. kernoviae is a significant contribution as these species are among the most important pathogens of regulatory concern in different regions of the world.
A Genome Sequence Resource for the Geographically Widespread Anthracnose Pathogen Colletotrichum asianum
Authors: Meng Yanan , Ren Yihua , Wang Wenjing , Gleason Mark L. , Zhang Rong , Sun Guangyu
Published: March 2020

Colletotrichum asianum is a worldwide plant pathogen causing serious fruit or leaf anthracnose diseases on a variety of plant hosts such as mango, coffee berry, chili, and other potential hosts, and it is distributed widely in Asia, America, Africa, and Oceania. This is the first genome resource available for C. asianum. The draft genome assembly will allow further analysis of species diversity and evolutionary mechanisms, and may serve as a foundation for genetic analysis that leads to greater understanding of interactions between plants and fungal pathogens.
The sex with the reduced sex chromosome dies earlier: a comparison across the tree of life
Authors: Xirocostas Zoe A. , Everingham Susan E. , Moles Angela T.
Published: March 2020

Many taxa show substantial differences in lifespan between the sexes. However, these differences are not always in the same direction. In mammals, females tend to live longer than males, while in birds, males tend to live longer than females. One possible explanation for these differences in lifespan is the unguarded X hypothesis, which suggests that the reduced or absent chromosome in the heterogametic sex (e.g. the Y chromosome in mammals and the W chromosome in birds) exposes recessive deleterious mutations on the other sex chromosome. While the unguarded X hypothesis is intuitively appealing, it had never been subject to a broad test. We compiled male and female longevity data for 229 species spanning 99 families, 38 orders and eight classes across the tree of life. Consistent with the unguarded X hypothesis, a meta-analysis showed that the homogametic sex, on average, lives 17.6% longer than the heterogametic sex. Surprisingly, we found substantial differences in lifespan dimorphism between female heterogametic species (in which the homogametic sex lives 7.1% longer) and male heterogametic species (in which the homogametic sex lives 20.9% longer). Our findings demonstrate the importance of considering chromosome morphology in addition to sexual selection and environment as potential drivers of sexual dimorphism, and advance our fundamental understanding of the mechanisms that shape an organism's lifespan.
New application of strontium isotopes reveals evidence of limited migratory behaviour in Late Cretaceous hadrosaurs
Authors: Terrill David F. , Henderson Charles M. , Anderson Jason S.
Published: March 2020

Dinosaur migration patterns are very difficult to determine, often relying solely on the geographical distribution of fossils. Unfortunately, it is generally not possible to determine if a fossil taxon's geographical distribution is the result of migration or simply a wide distribution. Whereas some attempts have been made to use isotopic systems to determine migratory patterns in dinosaurs, these methods have yet to achieve wider usage in the study of dinosaur ecology. Here, we have used strontium isotope ratios from fossil enamel to reconstruct the movements of an individual hadrosaur from Dinosaur Provincial Park in Alberta, Canada. Results from this study are consistent with a range or migratory pattern between Dinosaur Provincial Park and a contemporaneous locality in the South Saskatchewan River area, Alberta, Canada. This represents a minimum distance of approximately 80 km, which is consistent with migrations seen in modern elephants. These results suggest the continent-wide distribution of some hadrosaur species in the Late Cretaceous of North America is not the result of extremely long-range migratory behaviours.
Emergent social cohesion for coping with community disruptions in disasters
Authors: Fan Chao , Jiang Yucheng , Mostafavi Ali
Published: March 2020

Social cohesion is an important determinant of community well-being, especially in times of distress such as disasters. This study investigates the phenomena of emergent social cohesion, which is characterized by abrupt, temporary and extensive social ties with the goal of sharing and receiving information regarding a particular event influencing a community. In the context of disasters, emergent social cohesion, enabled by social media usage, could play a significant role in improving the ability of communities to cope with disruptions in recent disasters. In this study, we employed a network reticulation framework to examine the underlying mechanisms influencing emergent social cohesion on social media while communities cope with disaster-induced disruptions. We analysed neighbourhood-tagged social media data (social media data whose users are tagged by neighbourhoods) in Houston, TX, USA, during Hurricane Harvey to characterize four modalities of network reticulation (i.e. enactment, activation, reticulation and performance) giving rise to emergent social cohesion. Our results show that, unlike regular social cohesion, communication history and physical proximity do not significantly affect emergent social cohesion. The results also indicate that weak social ties play an important role in bridging different social network communities, and hence reinforce emergent social cohesion. The findings can inform public officials, emergency managers and decision-makers regarding the important role of neighbourhood-tagged social media, as a new form of community infrastructure, for improving the ability of communities to cope with disaster disruptions through enhanced emergent social cohesion.