bluuebunny/crossref_metadata_2025 huggingface dataset:
Leading the post-industrial revolution? Policy windows, issue linkage and decarbonization dynamics in the UK’s net-zero strategy (2010–2022)
Authors: Sovacool Benjamin K , Iskandarova Marfuga , Geels Frank W
Published: April 2024

Industrial decarbonization and the net-zero climate strategy has arisen as one of the most important policy challenges of the modern era. But how do industrial decarbonization policy efforts link with other issues? The UK claims to be the first major economy in the world to posit a net-zero target. In this paper, drawn from an original qualitative dataset involving expert interviews (N = 46), site visits (N = 20), and a review of the literature, we explore ongoing policy windows and efforts to decarbonize both the Humber and Merseyside. These regions have aggressive implementation plans in place for the deployment of net-zero infrastructure, with Zero Carbon Humber and HyNet seeking billions of dollars of investment to build green and blue hydrogen facilities coupled with carbon storage networks. These two clusters are leading national net-zero ambitions, with actual, enforceable timetables to achieve decarbonization. Investigating the unfolding efforts being undertaken by these two regions to decarbonize industry offers insight into the “green gold rush” and nascent business opportunities in the so-called carbon economy, including large-scale investment of capital into the policies nominally designed to tackle climate change. Through the identification of 24 different issues linked to decarbonization, the paper also offers more conceptual depth into the interplay between policy windows and issue linkage, which coevolve and shape each other as net-zero ambitions solidify.
A proof-of-concept study: advantages of the subxiphoid over the lateral intercostal approach
Authors: He Gengxu , Yao Tong , Zhao Lei , Geng Hong , Ji Qiang , Zuo Kun , Luo Yuanzhi , Zhou Kai
Published: April 2024

OBJECTIVES

The study was designed to evaluate the superiority of the subxiphoid approach compared with the lateral intercostal approach during the operation and other perioperative indices.

METHODS

Patients diagnosed with anterior mediastinal disease in our hospital between January 2018 and October 2019 were prospectively assigned to 2 groups; 1 group underwent the lateral intercostal approach and 1 group underwent the subxiphoid approach of video-assisted thoracoscopic surgery to resect the diseased tissue. The PaCO2, SaO2, PaO2 and circulation changes were recorded during the operation; the neutrophil-to-lymphocyte ratio and other perioperative outcomes, including clinical and surgical results, operating time, blood loss, postoperative complication and postoperative pain score were compared.

RESULTS

A total of 59 patients diagnosed with an anterior mediastinal tumour or myasthenia gravis underwent a video-assisted thoracoscopic resection. Thirty-one patients were treated via the subxiphoid approach, and 28 patients were treated via the lateral intercostal approach. The PaCO2 increased significantly and the SaO2 remained stable in the subxiphoid group during the operation, whereas PaCO2 increased significantly and SaO2 decreased at the same time in the lateral intercostal group. Operations were more frequently interrupted for the hypoxia or circulation disturbance during the process of dissecting the thymus in the lateral intercostal approach. Compared with the lateral intercostal approach, patients treated via the subxiphoid approach experienced less inflammation and exhibited lower pain scores and shorter postoperative hospital stays. There were no significant differences in postoperative complications between the 2 groups. All of the patients recovered well when discharged.

CONCLUSIONS

Our study results suggested that the subxiphoid approach has less of an influence on the pulmonary circulation than the lateral intercostal approach, that the whole procedure is safer and easier and that the subxiphoid approach may be the ideal choice for patients with anterior mediastinal disease.
Clinical Severity of Enteric Viruses Detected Using a Quantitative Molecular Assay Compared With Conventional Assays in the Global Enteric Multicenter Study
Authors: Cates Jordan , Powell Helen , Platts-Mills James , Nasrin Dilruba , Panchalingam Sandra , Sow Samba O , Traore Awa , Sur Dipika , Ramamurthy Thandavarayan , Zaidi Anita K M , Kabir Furqan , Faruque Abu S G , Ahmed Dilruba , Breiman Robert F , Omore Richard , Ochieng John Benjamin , Hossain M Jahangir , Antonio Martin , Mandomando Inácio , Vubil Delfino , Nataro James P , Levine Myron M , Parashar Umesh D , Kotloff Karen L , Tate Jacqueline E
Published: April 2024

Background

Quantitative molecular assays are increasingly used for detection of enteric viruses.

Methods

We compared the clinical severity using the modified Vesikari score (mVS) of enteric viruses detected by conventional assays (enzyme immunoassays [EIAs] for rotavirus and adenovirus 40/41 and conventional polymerase chain reaction for astrovirus, sapovirus, and norovirus) and a quantitative molecular assay (TaqMan Array Card [TAC]) among children aged 0–59 months in the Global Enteric Multicenter Study. For rotavirus and adenovirus 40/41, we compared severity between EIA-positive and TAC-positive cases assigned etiologies using different cycle threshold (Ct) cutoffs.

Results

Using conventional assays, the median mVS (interquartile range) was 10 (8–11) for rotavirus, 9 (7–11) for adenovirus 40/41, 8 (6–10) for astrovirus, sapovirus, and norovirus GII, and 7 (6–9) for norovirus GI. Compared with rotavirus EIA-positive cases, the median mVS was 2 and 3 points lower for EIA-negative/TAC-positive cases with Ct <32.6 or Ct ≥32.6 and <35, respectively (P < .001). Adenovirus 40/41 EIA-positive and EIA-negative/TAC-positive cases were similar, regardless of Ct cutoff.

Conclusions

Quantitative molecular assays compared with conventional assays, such as EIA, may influence the severity of identified cases, especially for rotavirus. Cutoffs to assign etiology for quantitative assays should be considered in the design and interpretation of enteric virus studies.
A review of AppalachianDasycerusBrongniart and the recognition of cryptic diversity withinDasycerus carolinensis(Coleoptera: Staphylinidae: Dasycerinae)
Authors: Caterino Michael S , Harden Curt W
Published: April 2024

Previous analyses have revealed deep divergences among populations of the relictual and enigmatic rove beetle, Dasycerus carolinensis Horn. New data from additional populations, molecular markers, and morphology unambiguously reveal this “species” to represent a complex of closely related species, distinguishable by characters of the male genitalia and corresponding closely to geographically coherent clades discovered by molecular analyses. Calibrated dating analyses show Appalachian Dasycerus to have been diverging in the region for more than 10 million years, yet largely respecting important biogeographic barriers in the region, such as the French Broad and Little Tennessee River drainages. In addition to discussing finer scale biogeographic patterns in the group, we formally recognize 9 new species from within what was formerly known as Dasycerus carolinensis: Dasycerus virginiensis sp. nov., Dasycerus tuckasegee sp. nov., Dasycerus pacolet sp. nov., Dasycerus chattooga sp. nov., Dasycerus itseyi sp. nov., Dasycerus unicoi sp. nov., Dasycerus nikwasi sp. nov., Dasycerus egwanulti sp. nov., and Dasycerus gadalutsi sp. nov. It was not, however, possible to assign all samples to one of these species, and specimens from some sparsely sampled outlying areas, northern Alabama and central Tennessee in particular, may represent additional species.
Two new clades recovered at high temperatures provide novel phylogenetic and genomic insights into Candidatus Accumulibacter
Authors: Xie Xiaojing , Deng Xuhan , Chen Jinling , Chen Liping , Yuan Jing , Chen Hang , Wei Chaohai , Liu Xianghui , Qiu Guanglei
Published: April 2024

Candidatus Accumulibacter, a key genus of polyphosphate-accumulating organisms, plays key roles in lab- and full-scale enhanced biological phosphorus removal (EBPR) systems. A total of 10 high-quality Ca. Accumulibacter genomes were recovered from EBPR systems operated at high temperatures, providing significantly updated phylogenetic and genomic insights into the Ca. Accumulibacter lineage. Among these genomes, clade IIF members SCELSE-3, SCELSE-4, and SCELSE-6 represent the to-date known genomes encoding a complete denitrification pathway, suggesting that Ca. Accumulibacter alone could achieve complete denitrification. Clade IIC members SSA1, SCUT-1, SCELCE-2, and SCELSE-8 lack the entire set of denitrifying genes, representing to-date known non-denitrifying Ca. Accumulibacter. A pan-genomic analysis with other Ca. Accumulibacter members suggested that all Ca. Accumulibacter likely has the potential to use dicarboxylic amino acids. Ca. Accumulibacter aalborgensis AALB and Ca. Accumulibacter affinis BAT3C720 seemed to be the only two members capable of using glucose for EBPR. A heat shock protein Hsp20 encoding gene was found exclusively in genomes recovered at high temperatures, which was absent in clades IA, IC, IG, IIA, IIB, IID, IIG, and II-I members. High transcription of this gene in clade IIC members SCUT-2 and SCUT-3 suggested its role in surviving high temperatures for Ca. Accumulibacter. Ambiguous clade identity was observed for newly recovered genomes (SCELSE-9 and SCELSE-10). Five machine learning models were developed using orthogroups as input features. Prediction results suggested that they belong to a new clade (IIK). The phylogeny of Ca. Accumulibacter was re-evaluated based on the laterally derived polyphosphokinase 2 gene, showing improved resolution in differentiating different clades.
Convergence effect during spatiotemporal succession of lacustrine plastisphere: loss of priority effects and turnover of microbial species
Authors: Zhang Weihong , Liang Shuxin , Grossart Hans-Peter , Christie-Oleza Joseph Alexander , Gadd Geoffrey Michael , Yang Yuyi
Published: April 2024

Succession is a fundamental aspect of ecological theory, but studies on temporal succession trajectories and ecological driving mechanisms of plastisphere microbial communities across diverse colonization environments remain scarce and poorly understood. To fill this knowledge gap, we assessed the primary colonizers, succession trajectories, assembly, and turnover mechanisms of plastisphere prokaryotes and eukaryotes from four freshwater lakes. Our results show that differences in microbial composition similarity, temporal turnover rate, and assembly processes in the plastisphere do not exclusively occur at the kingdom level (prokaryotes and eukaryotes), but also depend on environmental conditions and colonization time. Thereby, the time of plastisphere colonization has a stronger impact on community composition and assembly of prokaryotes than eukaryotes, whereas for environmental conditions, the opposite pattern holds true. Across all lakes, deterministic processes shaped the assembly of the prokaryotes, but stochastic processes influenced that of the eukaryotes. Yet, they share similar assembly processes throughout the temporal succession: species turnover over time causes the loss of any priority effect, which leads to a convergent succession of plastisphere microbial communities. The increase and loss of microbial diversity in different kingdoms during succession in the plastisphere potentially impact the stability of entire microbial communities and related biogeochemical cycles. Therefore, research needs to integrate temporal dynamics along with spatial turnovers of the plastisphere microbiome. Taking the heterogeneity of global lakes and the diversity of global climate patterns into account, we highlight the urgency to investigate the spatiotemporal succession mechanism of plastisphere prokaryotes and eukaryotes in more lakes around the world.
The Shadow of Official Development Assistance: ODA, Corruption, and the Shadow Economy in Recipients
Authors: Moon Chungshik , Kim Youngwan , Kim Da Sul
Published: April 2024

Abstracts

While the shadow economy seems to have both positive and negative effects on a country’s macroeconomy, almost all governments have attempted to control the shadow economy to prevent the loss of tax revenues and the attendant impact on the government budget. Even though official development assistance (ODA) has no formal link with the shadow economy, we often observe a relationship between the two in recipient countries. We argue that ODA can increase the size of the shadow economy in recipient countries through both government and individual-level flows of ODA to the shadow economy. We analyzed data on the shadow economies of 107 ODA recipients from 1990 to 2018 using both fixed effect and Driscoll–Kraay estimators. The results show that recipients receiving a higher volume of ODA are more likely to have a larger shadow economy. Moreover, the relationship between ODA and the shadow economy is stronger in more corrupt recipients. We dealt with endogeneity issues using the generalized method of moments, which supported our findings.
Joy as Contextualized Feeling: Two Contrasting Pictures of Joy in East Asian Yogācāra
Authors: Li Jingjing
Published: April 2024

In this article, I elaborate on the approach to joy preserved in East Asian Yogācāra texts authored by Xuanzang and his disciple, Kuiji. I argue that these Yogācāra Buddhists propose a contextualist approach that does not presume joy to be an emotion with an essential property but rather perceives joy as always contextualized in lifeworlds at the personal and interpersonal levels. As such, Xuanzang and Kuiji outline two contrasting pictures of joy to capture how it is experienced in the lifeworld of ignorance and the lifeworld of wisdom, respectively. Upon delineating what joy is and how it is experienced, I continue to explore what joy can promise. Since joy does not have an inherent property, people can always make a collaborative effort to recontextualize joy for inclusion and emancipation. As such, I hope to draw on the Yogācāra analysis of joy to enrich the feminist discussion on happiness.
The Effects of Antenatal Care Utilisation on Birthweight: Evidence from Ghana
Authors: Bawuah Alex , Appleton Simon , Li Yang , Song Lina
Published: April 2024

In 2015, about 20.5 million babies were born with low birthweight (LBW), with the majority from low- and middle-income countries. The use of antenatal care (ANC) is a recommended health policy measure to reduce the risk of LBW. However, there is limited evidence for its effectiveness in reducing LBW in sub-Saharan Africa, although the region accounts for almost one-quarter of LBW babies, second only to Asia. Moreover, while the number of LBW in other regions is reducing, the number of LBW babies in sub-Saharan Africa is increasing. We therefore use data from Ghana (a sub-Saharan African country with a high incidence rate of LBW) to investigate the effect of using ANC on birthweight. The number of ANC visits and the month of ANC initiation were used as indicators for ANC utilisation. We applied an extended linear regression technique to deal with the potential sample selection bias and endogeneity associated with the use of ANC. The results from the study indicate that early ANC initiation and having more ANC visits are both associated with an increase in birthweight; however, the estimated effect of an early ANC visit is larger than having an additional visit. Therefore, we recommend that policies aimed at tackling the problem of LBW should mostly be geared towards promoting ANC utilisation, especially early ANC initiation. We also find that estimating the effect of ANC on birthweight without accounting for sample selection bias and endogeneity of ANC underestimates the effect of ANC on birthweight.
14 Bacterial Dysbiosis and Decreased SCFAs Following Alcohol Intoxication and Burn Injury
Authors: Murray Mary Grace , Herrnreiter Caroline , Li Xiaoling , Choudhry Mashkoor A , Luck Marisa , Cannon Abigail
Published: April 2024

Introduction

Ethanol intoxication seen in over 50% of burn patients is associated with more adverse outcomes, longer hospitalization, and increased mortality. Ethanol is known to exacerbate the intestinal damage and gut leakiness seen in burn and is associated with a significant increase in bacterial translocation which may contribute to SIRS and bacteremia. Short chain fatty acids (SCFAs) are imperative bacterial metabolites that provide a major source of energy for the intestinal epithelium and aid in maintenance of the intestinal epithelial barrier. In this study we aim to identify whether ethanol and burn injury influences the bacterial composition and SCFA contents of the GI tract of ethanol burn mice in hopes of identifying potential targets for therapeutic intervention.

Methods

Male and female mice were gavaged with either EtOH or water. 12.5% TBSA was exposed and burn animals were immersed in 85°C water bath for 7s or a 37°C water bath for sham animals. Small intestinal (SI) and cecum fecal contents were collected. DNA was isolated and 16S rRNA gene sequencing was performed and analyzed with QIIME. Microbial composition was analyzed by UniFrac PCA and a pairwise permanova analysis. Difference between medians for bacterial populations were calculated with Mann-Whitney U test.

Results

Ethanol burn (EB) versus sham vehicle (SV) samples exhibited distinct microbial populations in the SI and cecum. Male and female mice showed consistent changes in the relative abundance of bacterial phyla following EB in the SI and cecum. The pathogenic Enterococcaceae (p < 0.01) and Enterobacteriaceae (p < 0.01) families including the species of Shigella (p < 0.05), were increased following EB while SCFA producing bacteria Akkermansia (p < 0.05) and Roseburia (p < 0.05) were decreased. There was a decreasing trend in the concentration of total SCFAs following EB (p = 0.06), with the most significantly reduced SCFA being butyrate (p < 0.001).

Conclusions

Taken together these findings suggest bacterial dysbiosis following ethanol and burn injury with increases in pathogenic bacteria and decreases in SCFA producing commensal bacteria. Decreased SCFAs are known to contribute to gut leakiness and disruption of the integrity of the GI barrier. Roseburia is a known butyrate producer, and Akkermansia is known to produce propionate and acetate.

Applicability of Research to Practice

Understanding the perturbations within the gut microbiome following ethanol binge and burn gives us insights into failures of the GI tract barrier that may contribute to SIRS and bacteremia. Now that we have identified the reduction in potentially beneficial bacterial species, this reveals a mechanism of dysbiosis within the microbiome that may be targetable with probiotic therapies such as Akkermansia or Roseburia in hopes of ameliorating the gut leakiness and subsequent bacterial translocation from the GI tract observed in burn.
29 Virtual Reality to Reduce Patients’ Procedural Pain and Anxiety
Authors: Blacker Hayley , Thomas Mini , Grywalski Maria Michelle M
Published: April 2024

Introduction

Patients undergo multiple anxiety-inducing and painful procedures when admitted to the hospital setting. Virtual reality (VR) offers an interactive, nurse-driven adjunct to analgesia or anxiolytics. Our burn unit implemented VR as a non-pharmacological opportunity to reduce a patient’s perceived pain and anxiety via dissociative distraction, thereby promoting holistic patient-centered care. After introducing the novel technology to staff, we specifically focused on the potential for virtual reality to improve a patient’s experience during uncomfortable wound care procedures.

Methods

A protocol was developed for the use of VR in the patient care setting with appropriate inclusion/exclusion criteria. Once the protocol was developed, the burn unit nursing staff was in-serviced and encouraged to engage in hands-on practice to increase familiarity. A post-procedure patient survey was developed with two parameters: numeric pain scale and the institution's integrative nursing anxiety scale. Both scales were previously validated and active in the institution’s electronic charting record. This quantitative data was then collected from 20 patients’ individual pain and anxiety perceptions during wound care without VR over the course of one month. Then, the following month, data was collected from 20 patients’ individual pain and anxiety perceptions during wound care with VR implementation. For the VR intervention group, a third parameter was added to the survey that inquired if the patient would recommend VR to other patient’s undergoing wound care.

Results

Patients' average pain score dropped from 4.9 in the control group to 3.8 in the experimental group. Patients' average anxiety score dropped from 2.1 in the control group to 1.8 in the experimental group. These patient-reported survey responses demonstrate that the implementation of VR resulted in a 23% reduction in pain and a 15% reduction in anxiety during wound care procedures. In regards to the third parameter applicable only to the experimental group, 100% of patients reported that they would recommend VR to other patients.

Conclusions

Virtual reality is a nurse-driven, non-invasive modality that reduces a patient’s pain and anxiety during wound care procedures. Furthermore, patients enjoyed their experience with virtual reality as shown in the unanimous response to recommend to other patients.

Applicability of Research to Practice

Virtual reality is a vast realm with exponential opportunities. This low-risk intervention has the potential to optimize a patient’s hospital experience by acting as a modality that reduces patient’s pain and anxiety related to a variety of procedures and therapies led by a multidisciplinary team.
40 Inflamm-aging, Burns and the Gut-lung Axis in Mice
Authors: Kovacs Elizabeth J , Boe Devin M , Frank Daniel , Idrovo Juan-Pablo , McMahan Rachel H , Walrath Travis M , Najarro Kevin M
Published: April 2024

Introduction

The elderly have a heightened basal state of inflammation, known as “inflamm-aging,” which predisposes them to aberrant immune responses and may reduce their ability to withstand burn trauma. We and others believe that a combination of factors released from the burn site in the aged host trigger the gut to become more permeable and, along with shifts in fecal microbiota, sets the stage for excessive systemic and pulmonary inflammatory responses and poor prognosis after injury.

Methods

We used our well-established, clinically relevant murine model of burn injury in which young and aged mice are subjected to a 12% total body surface area dorsal scald burn or sham injury. At 24 hours after injury, mice were humanely euthanized and lungs, blood, ileum and feces were collected for analysis including histopathology, RNA sequencing, 16S rRNA gene sequencing, and real-time PCR.

Results

There were no differences in distribution of lung myeloid cell populations between groups; all samples were composed of >97% CD45+Ly6g-CD11c+SiglecF+ alveolar macrophages (AM). However, there were profound changes in transcriptional profiles of these cells both before and after injury. Compared with AM from young sham mice, AMs from young, burned mice displayed diverse and complex transcriptional changes, totaling 964 differentially expressed genes (cut-off p < 0.01; FDR < 0.05). In contrast, injury produced fewer changes in mRNA expression of AMs from aged mice relative to that of sham age-matched controls, with changes in only 216 genes. The genes differentially expressed with age included those involved in endosomal/lysosomal trafficking, antigen presentation, tissue remodeling, and receptors or secreted factors related to immune responses, possibly altering their ability to respond appropriately to invading pathogens. Since the gut is a motor of critical illness, we also examined the intestine in the same experimental groups. The fecal microbiota of aged-injured mice had significantly less Shannon alpha-diversity when compared to other groups (p < 0.05). This included a dramatic loss in gut-protective bacterial taxa, including Akkermansia muciniphila, in the microbiota of aged-injured mice relative to all other groups. Moreover, there was an 18-fold increase in gut leakiness, using orally gavaged FITC-dextran, when compared to other groups (p < 0.05).

Conclusions

Taken together, these findings suggest that the post-burn loss of protective commensal bacteria and the breach of the intestinal epithelial barrier in aged mice could contribute to the changes in AM gene expression and alter responses to lung infections.

Applicability of Research to Practice

Future studies will explore whether supplementation of protective bacteria, such as Akkermansia muciniphila, after burn injury could restore intestinal and pulmonary homeostasis and AM function in burn patients of all ages.
85 Sole Propofol Use in Burn Patients Is Associated with Better Postprocedural Outcomes Than Using Propofol-Ketamine
Authors: Ramgopal Yash , Richter Christopher G , Krishna Sunskruthi , Shah Suhaib , Segura Carolina , Obias Isabel B , Amador Dalton , Durand Jean pierre , ayadi Amina E I , Golovko Georgiy , Song Juquan , Wolf Steven E
Published: April 2024

Introduction

Propofol and its combination with ketamine have been used as sedatives in burn patients undergoing operative procedures such as surgical debridement and wound care. Although research has been conducted on comparing the complications of propofol-ketamine and sole propofol use in the emergency department (ED), limited research is available on the use of these sedatives specifically in burn patients who are in a hypermetabolic state. Our study aims to bridge this gap by comparing the postprocedural outcomes of using propofol-ketamine and propofol alone during operative procedures in pediatric and adult burn patients.

Methods

Data for this study was obtained from a national database of de-identified medical records. Two burn patient populations undergoing operative procedures were identified based on sedative use: propofol-ketamine and propofol alone. Patients with a past medical history of respiratory and cardiovascular conditions were excluded. Cohorts were balanced using propensity score matching of covariates: age at index, sex, race, and ethnicity. Five complications were studied 0-14 days post-administration of sedative: anxiety, hyperkalemia, renal failure, hypotension, and respiratory failure. Statistical analysis included risk differences with a significance value of p < 0.05.

Results

We identified 7,993 patients who were administered only propofol during operative procedures and 7,148 patients who were administered the combination of propofol and ketamine. Propofol-ketamine use had a statistically significant higher incidence of anxiety (2.91% vs 1.62%, p < 0.0001), hyperkalemia (1.19% vs 0.81%, p = 0.0402), renal failure (2.58% vs 1.83%, p = 0.0037), hypotension (1.56% vs 1.10%, p = 0.0247), and respiratory failure (3.40% vs 2.80%, p = 0.0488).

Conclusions

Our study indicates that sole propofol use in burn patients undergoing operative procedures is associated with better postprocedural outcomes than using a combination of propofol and ketamine. Indicators of propofol infusion syndrome (hyperkalemia and renal failure), which is a life-threatening rare complication of the sedative, are higher with the use of propofol-ketamine. Future directions of the study include analyzing the relationship of burn severity (measured by % total burn surface area) on outcomes in the two cohorts.

Applicability of Research to Practice

Wound dressing changes and surgical excision in burn patients often provoke considerable pain and anxiety, hence sedatives such as propofol and ketamine are routinely used to ease their concerns. The findings from this study have the potential to help physicians choose the right sedative by balancing patient comfort and the risk of adverse effects.
95 Moral Injury and Four-Quadrant Approach to Ethics Issues in Burn Care
Authors: Regel Eva
Published: April 2024

Introduction

The presentation will address the post-pandemic changes that take place in current healthcare in general and burn care specifically, such as dramatically increased rates of burnout and staff turnover. Particular attention will be given to introducing and discussing the concept of moral injury and its relevance to the everyday work in the Burn unit; the presentation will address and discuss the impact and causes of moral injury on nursing staff and clinicians in the context-specific Burn care setting. Particular attention will be devoted to the effects of moral injury on the paradigm of the “four-quadrant approach” commonly used in ethical decision-making in burn care. The presentation will offer a discussion of the moral underpinnings of moral injury and moral responsibility and the relevance of these complexities on providers’ ability to employ the “four-quadrant approach " will be discussed. The current research on moral injury and distress will be highlighted in the presentation.

Methods

Discussion

Results

Results will be based on a literature review.

Conclusions

Several possible solutions to mitigate the effects of moral injury will be offered. Specifically, changes to nursing curriculums and medical schools will be proposed.

Applicability of Research to Practice

Direct application as recognition and mitigation of the effects of moral injury can have a direct effect on decision making process as well as sustainability and resilience of staff on the Burn unit.
505 Fusarium Isolates in Burn-injured Patients: Clinical Characteristics and Susceptibility Patterns
Authors: Young Sierra R , Stoianovici Robyn N , Louie Erin L
Published: April 2024

Introduction

Fusarium species are ubiquitous in the environment and can cause opportunistic infections in burn-injured patients. Patients with larger burns, prolonged lengths of stay, concomitant antimicrobial use and invasive lines are at higher risk for Fusarium infections. Little data exists on clinical characteristics and in vivo antifungal susceptibilities in burn-injured patients.

Methods

All positive Fusarium species cultures were retrospectively identified between November 2017 to June 2023 at a regional burn center. Demographic, clinical and microbiologic susceptibility data was collected from the electronic medication record. Descriptive statistics were used to describe the cohort.

Results

A total of 18 patients had positive Fusarium wound cultures during the study period. The average age was 38.4 ± 11.9 years. The average %TBSA was 54.5 ± 23.4 % and R-Baux score of 92.9 ± 29.3. The most common mechanism of injury was thermal burn (17 patients, 94%). This cohort experienced prolonged ICU (68.9 ± 31.9 days) and hospital (73.6 ± 38.2 days) lengths of stay. The average time from burn injury to positive Fusarium cultures was 19.6 ± 9.0 days. Mechanical ventilation was prolonged (46.1 ± 23.3 days). The average central line duration prior to Fusarium infection was 9.8 ± 10.2 days. Susceptibility data was obtained for voriconazole in 15 patients and for amphotericin in 14 patients. For voriconazole, 5/15 tested isolates had an MIC of 4, 1/15 had an MIC of 8, and 9/15 (60%) isolates returned with MIC ≥ 16. A majority (13/14, 93%) of the MICs tested for amphotericin were ≤ 1. Patients were taken to the OR for source control in all cases. Ten of 18 patients with Fusarium positive infections survived to hospital discharge (55%). The most common cause of death was multi-system organ failure and sepsis (88%). Recorded adverse drug events possibly due to voriconazole and posaconazole included transaminitis (4 cases), QTc prolongation (1 case), and hallucinations (1 case). Amphotericin was suspected of contributing to an acute kidney injury in 1 case.

Conclusions

This case series reports the clinical characteristics and susceptibility data on Fusarium isolates in a burn-injured population. This cohort was critically ill based on the %TBSA, R-Baux score, and high rate of mechanical ventilation. The MIC results obtained for voriconazole demonstrated a majority of isolates with relatively high MIC values ≥ 16. A majority of the MICs for amphotericin were < 1. It is important to note that no established breakpoints exist for Fusarium species and clinical outcomes are dependent on a variety of factors beyond the susceptibility data.

Applicability of Research to Practice

Empiric double coverage with voriconazole and amphotericin or amphotericin monotherapy should be considered when Fusarium is a suspected primary pathogen.
527 Combination Treatment for Hypertrophic Burn Scars Utilizing Fractional Ablative and Continuous Wave CO2 Laser
Authors: Lee Punhae
Published: April 2024

Introduction

Hypertrophic scars remain a devastating consequence of severe burn wounds, producing anatomic deformities, as well as functional impairment. Fractional ablative CO2 laser treatment has shown scar - reducing effects. In this study, we compared the outcomes of combining two different CO 2 lasers or fractional ablative CO2 laser alone in treating hypertrophic burn scars.

Methods

Forty patients with hypertrophic burn scars were included in one of following two groups: fractional ablative CO2 laser combined with continuous wave CO2 laser (group 1) or fractional ablative CO2 laser alone (group 2). Three plastic surgeons rated the hypertrophic scars according to observer-rated Vancouver Scar Scale (VSS) before and after treatment (at least 6 months after the last laser) and by patient-completed questionnaires after treatment (at least 6 months after the last laser).

Results

Forty patients completed the laser treatment. Group 1 showed significant improvement in vascularity, pliability, and height than group 2 (p < 0.05) but not in pigmentation. Time-dependent analysis of total VSS scores suggested that group 1 experienced more improvement during a shorter treatment period than group 2 (p < 0.05). For patient-reported outcomes, group 1 showed significant improvement than group 2 in scar appearance, scar thickness, pain, and pruritus (p < 0.05).

Conclusions

Observer-reported VSS outcomes showed that combining laser treatment resulted in more improvement of vascularity, pliability, and height indices for hypertrophic burn scars. Patient-completed outcomes showed that combining laser therapy was considered more helpful for improving scar appearance, scar thickness, pain, and pruritus than fractional ablative laser alone. Furthermore, combination treatment appeared to produce more improvement in a shorter period of time.

Applicability of Research to Practice

The two lasers are widely used in scar treatment in South Korea, so yes this research can be applied to medical practice.
539 Do Not Put Burn Education on the Back Burner - Plastic Surgery in Burn Care
Authors: Arellano Jose Antonio , Pandya Sumaarg , Liu Hilary , Alessandri-Bonetti Mario , Jeong Tiffany , Egro Francesco
Published: April 2024

Introduction

Burns injuries represent a leading cause of mortality and morbidity in the United States, with about 40,000 hospital admissions annually. These injuries are typically managed by burn surgeons who were trained in either plastic or general surgery. However, due to the Accreditation Council for Graduate Medical Education (ACGME)’s recent elimination of the burn surgery requirement for general surgery training, the role of plastic surgery in burn surgery care has become increasingly important. The aim of this study is to quantitively investigate the current role of plastic surgery in burn care at a single academic institution with an affiliated ABA-verified Burn Center.

Methods

A retrospective cohort study was performed of burn patients admitted to UPMC Mercy, the only comprehensive ABA-verified Burn Center and Level I Trauma Center in Western PA, from January 1st, 2012, to December 31st, 2022. Data were obtained from a prospectively maintained internal database including all patients admitted for burn related health problems.

Results

A total of 3843 patients were admitted for burn injuries, with 39.3% (n=1509) requiring surgery. Plastic surgeons were consulted for 17.5% (n=264) of these patients, performing a total of 658 procedures. Burn patients operated on by plastic surgeons received an average of 2.49±2.02 procedures. Most of the procedures performed by plastic surgeons involved severe and deep burns or anatomically challenging areas, such as the hand (n=362; 55.0%) and head/neck (n=165; 25.1%). These procedures involved either acute coverage of complex burn injuries or delayed reconstruction of post-burn deficits. For hand-related surgeries, 55.8% (n=202) were acute and 44.2% (n=160) were delayed reconstruction. Similarly, head and neck-related surgeries included 53.3% acute (n=88) and 46.7% (n=77) delayed reconstruction.

Conclusions

Plastic surgeons play a crucial role in the acute and reconstructive care of burn patients, often performing multiple procedures for patients with injuries to anatomically complex areas such as the hand and head/neck. Since burn training is no longer required for general surgery residency, it is increasingly important that plastic surgeons be trained to perform complex burn reconstruction procedures and fill the ongoing shortage of burn specialists.

Applicability of Research to Practice

Our research underscores the growing significance of plastic surgeons in burn care, particularly in light of evolving training requirements. This study emphasizes the practical need for specialized training to meet the demands of complex burn cases and addresses the current shortage of burn specialists effectively.
557 Current Assessment and Evaluation of Burn-Induced Chronic Pain
Authors: Chapin-Grabowski Chloe E , Marshall Victoria
Published: April 2024

Introduction

Examine the current state of the literature regarding how chronic burn-induced pain is assessed and evaluated.

Methods

Whittemore and Knafl’s integrative methodology was utilized to guide this literature review. A search of Pubmed, CINAHL, and PsycInfo resulted in nine articles included in the final synthesis. Inclusion criteria consisted of peer-reviewed studies in the English language published within the last five years. No restriction was placed on the type of burn or degree of injury. Reviewing how chronic burn-related pain is conceptualized precludes treatment modalities therefore, intervention-based studies were excluded. In addition, studies that did not evaluate long-term burn pain as a primary outcome measure were also excluded.

Results

Chronic burn pain is most often assessed using numerical/visual analog scales and Likert scales. Occasionally, patients are asked to self-report characteristics they identified as chronic burn pain. The instruments used to evaluate pain are administered by various methods including pen-and-paper assessments, interviews, mail-in surveys and retroactive chart reviews. Studies assessed chronic burn pain at both a one-time basis and at intervals commencing as early as three months and extending as long as eight years post injury. Additionally, comorbid, psychological, and physical factors were found to be associated with the development of chronic burn pain.

Conclusions

Chronic pain-related complaints remain prevalent amongst the burn population. However, further studies are warranted to assess the reliability of measuring pain via numerical/ visual analog scales and Likert scales in the burn population. Chronic burn pain is recognized as a major influence on health-related quality of life outcomes with current research prioritizing the identification of predictive risk factors.

Applicability of Research to Practice

Early interventions and the implementation of preventative measures upon the recognition of risk factors associated with the development of chronic burn pain is critical. Increased use of multi-dimensional instruments can provide a comprehensive understanding of the various dimensions chronic burn pain. Finally, in depth assessments and evaluations of chronic burn pain can contribute to the development of integrative care and lead to improved long-term outcomes for the burn population. Improved patient outcomes include prioritizing burn survivors’ psychological well-being, providing individualized care for various classifications of burn injuries and differentiating neurogenic and neuropathic pain experiences.
577 Understanding Drivers of Fire Risk with People Experiencing Homelessness
Authors: Orton Caitlin M , Gannon Mark , Mesic Aldina , Chambers Mona , Pham Tam N , Stewart Barclay T
Published: April 2024

Introduction

Burn injuries among people experiencing homelessness (PEH) are a major and escalating public health problem affecting a population facing issues of socioeconomic disparities, racism, comorbidities (e.g., disabilities, substance use disorders), and inequitable housing policies. Given the intensifying issue of burn injuries among PEH, it is crucial to Identify key drivers of fire risk in this already marginalized population to inform injury prevention and control initiatives.

Methods

Key informant interviews (KII) with PEH who experienced burn injuries were conducted to identify fire risks and opportunities to mitigate hazards. Transcripts were coded using deductive and inductive strategies grounded in harm reduction theory. For the deductive component, an established conceptual model was applied to group factors into the following categories: weather conditions, neighborhood characteristics, group behavior, individual behavior, dwelling characteristics, and fire sources and containment. For the inductive component, emerging themes were identified and coded.

Results

Participants from 13 KII had varied etiologies of their burn injuries (e.g., sleeping by fire, assault by fire, tent fire, car heater contact burn, propane tank explosion). The most common fire sources identified were propane, hand sanitizer, and other alcohol-based liquids. Unsafely contained open flames and improper propane tank storage were frequently expressed hazards. Participants described the interplay of environmental, social, and behavioral factors that need to be accounted for when addressing fire hazards (Figure 1). For example, participants highlighted the relationship between fire risks and acts of violence (e.g., theft of fuel sources, assault, forced relocation), as well as the multitude of considerations that impact fuel choice (e.g., accessibility, cost, smoke exposure, burn duration, flame control, weather conditions). Furthermore, participants described other specific opportunities for prevention within the intersectional context of the environments and risks they experience.

Conclusions

A variety of fire hazards were identified and amenable to harm reduction (e.g., safe stove dissemination, education on safe storage, availability of warming shelters). To be effective, implementation of fire prevention and control strategies must be evaluated for their effectiveness in complex environments (e.g., exposure to severe weather, unsafe and potentially violent living conditions, substance use, social marginalization, and poor access to injury prevention media).

Applicability of Research to Practice

Understanding environmental and socioeconomic risks and their interplay with fire hazards is foundational for collaborative injury prevention and control initiatives to be implemented by PEH, homelessness service providers, public health officials, and burn centers.
590 An Occupation-Based Review of Outcome Assessments Used in Hand Function After Burn Injury
Authors: Cancio Jill M , Stav Wendy
Published: April 2024

Introduction

Since over 50% of those who survive burn injury have hand involvement, one of the most important functional outcomes of burn rehabilitation is hand function. Occupational therapists leverage the use of occupation to restore function. While occupation began as the central concept of occupational therapy at the dawn of the profession, the use of occupation throughout the therapy process, including assessment, has wavered in recent decades. Knowledge of the occupational nature of assessments is important to the delivery of authentic occupational therapy.

Methods

Outcome measures that have been cited in the burn rehabilitation literature to assess hand function were included in this review and were classified into 3 categories (traditional components, performance, and patient-reported outcome measures). Psychometrics to include established validity in the burn population were also described. The extent to which each measure utilizes occupation to assess function was determined with the Occupation Based Performance Assessment (OPBA). The OBPA consists of several scales (authentic occupation, meaningful and purposeful value, and therapeutic intent) to measure the presence of occupation in assessment tools and practice patterns used in occupational therapy practice. The OPBA is interpreted along a continuum divided into 3 categories: occupation-based, intermediate, or discrete.

Results

The searches of the data bases yielded identification of 2 traditional component measures, 4 performance measures, and 4 patient-reported measures. According to the OPBA there are 3 discrete measures, 6 intermediate measures, and 1 occupation-based measure. Of the 10 assessments identified in the literature, 6 are performance-based assessment tools. None of the performance-based assessments were classified above intermediate on the occupation-based continuum. A novel occupation-based measure was identified, the Suitcase Packing Activity (SPA); however, it has not been validated in the burn population.

Conclusions

This review of outcome measures to assess hand function after burn injury revealed a paucity of occupation-based assessments in this practice area which has implications for delivery of occupation-based care. The majority of outcome measures used in upper extremity burn rehabilitation are discrete in nature and do not measure occupations of clients. The SPA, after validation in the burn population, may be a viable addition to an assessment battery to address this essential need.

Applicability of Research to Practice

There is a paucity of occupation-based assessments in this practice area which has implications for delivery of occupation-based care. Valid occupation-based performance measures in the burn population are needed.