bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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 (&lt; 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

Abstract

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

Abstract

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

Abstract

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

Abstract
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

AbstractResting 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.
Denitrification performance of
Pseudomonas fluorescens
Z03 immobilized by graphene oxide-modified polyvinyl-alcohol and sodium alginate gel beads at low temperature
Authors: Tang Meizhen , Jiang Jie , Lv Qilin , Yang Bin , Zheng Mingna , Gao Xin , Han Jindi , Zhang Yingjie , Yang Yuewei 
Published: March 2020

Improving the effect of microbial denitrification under low-temperature conditions has been a popular focus of research in recent years. In this study, graphene oxide (GO)-modified polyvinyl-alcohol (PVA) and sodium alginate (SA) (GO/PVA–SA) gel beads were used as a heterotrophic nitrification–aerobic denitrification (HN–AD) bacteria (
Pseudomonas fluorescens
Z03) carrier to enhance nitrogen removal efficiency levels at low temperatures (6–8°C). The removal efficiency of

N

H
4

+

-N

and

N

O
3

−

-N

and the variations in concentrations of extracellular polymeric substances (EPS) under different GO doses (0.03–0.15 g l
−1
) were studied. The results indicated that the addition of GO can improve the efficiency of nitrogen removal, and the highest removal efficiency level and highest carbohydrate, protein, and total EPS content levels (50.28 mg, 132.78 mg and 183.06 mg (g GO/PVA–SA gel)
−1
, respectively) were obtained with 0.15 g l
−1
GO. The simplified Monod model accurately predicted the nitrogen removal efficiency level. These findings suggested that the application of GO serves as an effective means to enhance nitrogen removal by stimulating the activity of HN–AD bacteria.
Modeling an Integrated HIV Prevention and Care Continuum to Achieve the Ending the HIV Epidemic Goals
Authors: Jenness Samuel M. , Johnson Jordan A. , Hoover Karen W. , Smith Dawn K. , Delaney Kevin P. 
Published: March 2020

ABSTRACTObjectiveWe sought to evaluate which combinations of HIV prevention and care activities would have the greatest impact towards reaching the US Ending the HIV Epidemic (EHE) plan goals of reducing HIV incidence at least 75% by 2025 and 90% by 2030.DesignA stochastic HIV transmission model for men who have sex with men (MSM), calibrated to local surveillance estimates in the Atlanta area, a focal EHE target jurisdiction.MethodsModel scenarios varied HIV screening rates relative to current levels, under different assumptions of how HIV-negative MSM would be linked to PrEP initiation, and also considered improvements to HIV care linkage and retention for those screening positive.ResultsA 10-fold relative increase in HIV screening rates (to approximately biannual screening for black and Hispanic MSM and quarterly for white MSM) would lead to 43% of infections averted if integrated with PrEP initiation. Improvements to HIV care retention would avert 41% of infections if retention rates were improved 10-fold. If both screening and retention were jointly improved 10-fold, up to 74% of cumulative infections would be averted. Under this scenario, it would take 4 years to meet the 75% EHE goal and 12 years to meet the 90% goal for MSM in Atlanta.ConclusionsInterventions to improve HIV screening linked with PrEP for those screening negative, and HIV care retention would have a substantial impact on HIV prevention. However, additional interventions may be necessary to reach the EHE goal of a 90% reduction in incidence for Atlanta MSM by 2030.
Description and Validation of the Colorectal Cancer and Adenoma Incidence & Mortality (CRC-AIM) Microsimulation Model
Authors: Piscitello Andrew , Saoud Leila , Matney Michael , Borah Bijan J , Fendrick A Mark , Lich Kristen Hassmiller , Rinde Harald , Limburg Paul J 
Published: March 2020

AbstractBackgroundMicrosimulation models of colorectal cancer (CRC) have helped inform national screening guidelines and health policy decision-making. However, detailed descriptions of particular underlying assumptions are not published, limiting access to robust platforms for exploratory analyses. We describe the development and validation of the Colorectal Cancer and Adenoma Incidence and Mortality (CRC-AIM) microsimulation model, a robust model built to facilitate collaborative simulation studies on disease progression and early detection through screening interventions.DesignWe used the Cancer Intervention and Surveillance Modeling Network (CISNET) CRC models, specifically CRC-SPIN, as a foundation for CRC-AIM’s formulas and parameters. In addition, we developed novel submodels and recalibrated various parameters to address gaps and discrepancies in publicly available information. Along with evaluating the natural history and screening detection outcomes from CRC-AIM, we determined the impact of using different life tables (cohort versus period) on natural history outcomes.ResultsCRC-AIM demonstrated substantial cross-model validity when comparing multiple natural history and screening outputs and probability curves to those from CISNET models, particularly CRC-SPIN. Additionally, using period life tables, CRC-AIM’s cumulative probability of developing CRC from ages 40 to 100 (7.1%) lies within the range of the CISNET models (6.7% to 7.2%). Using cohort tables, that probability increases to 8.0%. One notable difference is that, regardless of life table used, the cumulative probability of dying from CRC (3.2% for period; 3.8% for cohort) is slightly higher in CRC-AIM than the CISNET models (2.7% to 2.8%), due to CRC-AIM’s different methodology for determining survival. Additionally, there is substantial overlap (e.g. 94-95% overall agreement for strategies on and off the efficient frontier for stool-based strategies) across multiple screening overlay outputs between CRC-AIM and the CISNET models, especially CRC-SPIN.ConclusionsWe developed and validated a robust CRC microsimulation model, CRC-AIM, and demonstrate the influence of life table choice on downstream outputs. We further describe CRC-AIM’s parameters and include complete component tables to enhance transparency and encourage collaboration.
Cetaceans of the Black Sea: where did they survive glacial?
Authors: Dekanoidze Davit , Kopaliani Natia , Gurielidze Zurab , Ninua Levan , Devidze Nana , Tarkhnishvili David 
Published: March 2020

AbstractThree species of cetaceans,Phocoena phocoena,Delphinus delphisandTursiops truncatus ponticusare found in the Black Sea. The Black Sea populations of all three species show morpho-ecological peculiarities that leaded to their subspecific status:P. p. relicta(PPR),D. d. ponticus(DDP), andT. t. ponticus(TTP). It is not clear how long-lasting was their isolation from the core conspecific populations that ensured the development of adaptive features of PPR, DDP, and TTP. The analysis of mitochondrial haplotypes of PPR suggests that the split time of the at least maternal lineage of the Black Sea population of harbour porpoise lasted for over 100 ky (i.e. they should survive at least the latest glacial maximum within the Black Sea). However, the analysis of multiple microsatellite genotypes leaded some authors to suggest that the isolation is much less long, since middle Holocene. We re-analysed published mitochondrial sequences of all three Black Sea cetaceans along with several tens of sequences obtained from the stranded cetaceans. Our analyses suggest that Black Sea populations of all three cetacean species have an important input of populations that survived the last (and maybe earlier) glacial maxima within the Black Sea, most likely in its south-eastern fragment, which did not freeze in winter time even during the glacial peaks. This analysis is supported by both molecular clock approach and simple population modelling based on the assumption on the effective population size range. Different from the PPR, whose Black Sea population is currently fully isolated, there is a limited migration between the Black Sea and Atlantic populations ofT. truncatusandD. delphis, through the Mediterranean “bridge” population. However, the migration rates are not sufficient to overweight differential selection between the Black Sea and Mediterranean populations, and the local morpho-ecological specifics is successfully maintained.