bluuebunny/crossref_metadata_2025_split huggingface dataset:
730 Establishing Thresholds for Clinically Significant Donor Skin Reduction – Initial Findings from a Physician Delphi Consensus Panel
Authors: Gibson Angela , Smiell Janice , McClure Erika I Brockfeld , Patel Reema , Skorija Kristi , Holmes James H , Yu Tzy-Chyi , Boing Elaine A , Merikle Elizabeth 
Published: March 2020

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

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

Abstract

Introduction
The hand and upper extremity is one of the most common sites for burn injury. The total body surface area (TBSA) of the hand is small but the resultant impairment can limit a patient’s ability to return to functional independence. Split thickness skin grafting (STSG) has long been supported in the literature as the main means of treatment following full thickness burn injury. Surgical placement of STSG is often followed by a period of immobilization to the grafted area for graft adherence. The length of time which the grafted area is immobilized has evolved over time as surgical methods have improved. There is no set standard to balance the length of time necessary to prevent complications while maintaining functional mobility.
A literature review revealed several studies and a meta-analysis examining the optimal timing for immobilization and bedrest following STSG to the lower extremities. Additional studies have examined guidelines for range of motion protocols and splinting as well as reconstructive procedures for improved function following burn injury. There are currently no studies examining the optimal timing for immobility following the placement of STSG and the implications this can have on functional independence. The proposed study details the results of one burn center’s standard of treatment following STSG to the upper extremity.

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

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

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

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

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

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

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

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

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