bluuebunny/crossref_metadata_2025_split huggingface dataset:
755 State-wide One-year Mortality for Stevens-Johnson/toxic Epidermal Necrolysis Spectrum Disorders Is Greater at Burn Facilities: Expected, or Sobering Wake-up Call?
Authors: Hewes Philip D , Bell Derek 
Published: March 2020

Abstract

Introduction
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) exist on a spectrum of disease and are rare dermatologic emergencies with a significant risk of morbidity and mortality in the post-onset period. Retrospective studies attribute differing impacts of specialized treatment facilities on outcomes. However, the role of comorbidities and hospital-acquired conditions is unknown. We hypothesized that additional factors determine post-discharge mortality.

Methods
We queried a dataset from a statewide mandatory-reporting administrative database. We evaluated for initial presentations to acute care facilities of unique patients with discharge diagnoses of SJS, SJS/TEN overlap syndrome, and TEN over 16 years. We extracted all available pre- and post-onset records for these patients. Burn centers were identified. We accounted for all transfers. We evaluated demographic, comorbidity, and management data for the index presentation and subsequent transfers, evaluating the outcome of mortality and secondary outcomes. Exclusion criteria focused on detecting incomplete records. Comorbidities were captured by the Elixhauser comorbidity index. Univariate and multivariate logistic analyses were performed for risk of mortality.

Results
There were a total of 1903 unique initial patient encounters. Of these, 847 satisfied all exclusion criteria. 579 patients (68.4%) had a discharge (or pretransfer) diagnosis of SJS, 117 patients (13.8%) had SJS/TEN overlap syndrome, and 151 patients (17.8%) had TEN. Application of exclusion criteria caused no significant change in distribution of the occurrence of spectrum diseases (p = 0.31) nor in the frequency of care at a burn care facility (p = 0.60), suggesting no bias from exclusion. Of the 847 included patients, 22.8% of patients were treated at burn centers, of whom 32.1% were transferred from external facilities. Crude 90-day and 1-year mortality were identical, 21.7% at non-burn centers versus 32.1% at burn centers (p &lt; 0.01). Pre-existing comorbidities did not significantly impact mortality (p = 0.86). Final logistic model details are shown below. The model’s predictive capability was acceptable (c-statistic = 0.88) and there was good fit (Hosmer-Lemeshow p = 0.42).

Conclusions
These results suggest crude evaluation of outcomes by treatment facility may be confounded by analysis that does not account for complex comorbidities and hospital diagnoses. Furthermore, severity of illness is not a independent predictor. Further research is necessary.

Applicability of Research to Practice
SJS/TEN spectrum disorders have a complex and prolonged impact on patient health. The role of burn centers is complex.
763 Burn Camp Multidisciplinary Staff: Efficacy of Training
Authors: Jackson Brad , Boulter Trudy , Mikolaj Kerry 
Published: March 2020

Abstract

Introduction
One of the strengths of burn camps is the multidisciplinary staff who passionately combine their areas of expertise to create the camp experience, including fire service, burn survivors, burn center staff, camping professionals, donors, and community members. This gift also brings a challenge in developing a staff training program and experience that meets the needs of a diverse staff. This project utilizes post camp staff surveys to enhance our training and overall camp experience.

Methods
Staff at a residential medical specialty burn camp participated in a two-day training and then week-long camp for pediatric burn survivors, ages 7 – 19. Staff training included: burn treatment and rehabilitation with nursing / PT / OT / psych; focused review of all campers; intentionality with level 1 & 2 skills (adapted from M. Brandwein).
36 staff responded anonymously to an online survey about their experience of staff training and success enacting skills and approaches during the week with campers.

Results
85% reported staff training met the goals of getting to know each other, learning the flow / layout of camp, identifying leadership styles, and learning about the campers.
90% indicated the training met the goal of understanding general burn care and healing process, while 88% reported achieving the goal of learning the impact of trauma, the significance of telling our stories, and learning general counseling tips.
This year we added a focus on intentionality to ensure that campers were learning camp skills AND life skills in each activity (e.g., learning how to safely belay climb AND to trust others to support you).
Content analysis of the open-ended comments about the impact of intentionality on success revealed the following themes: Increased goal setting, thoughtfulness, planning/preparation, clarity, insight, presence. Some staff commented that it was less applicable for younger cabins and a concern about developing too many themes/goals.
88 percent of counselor respondents agreed / strongly agreed that individualized goal plans were implemented in their cabins based on camper review and camper assessment.

Conclusions
The development and implementation of staff training for burn camp brings a variety of challenges. Staff come with varied experience, knowledge, and training. There are also multiple goals around knowledge and teamwork. Counselor feedback supports the multidisciplinary training model for transmission of knowledge specific to the camp. An increased focus on intentionality in each of our camp activities brought mostly positive responses, particularly benefitting older camper activities (e.g., 3 day outcamps), while younger campers might be learning camp related skills initially in preparation for the life skills down the road.

Applicability of Research to Practice
These results help to support and create developmentally informed training and programming for rehabilitative burn camps.
793 Development and Validation of a Burn Center Discharge Readiness Checklist to Identify Patients at High Risk of 30 Day Readmission
Authors: Liberio Julie N , McElligott Kelly , Ibgui Tracy , Liu Yuk Ming , Sanford Arthur , Baldea Anthony J 
Published: March 2020

Abstract

Introduction
With increased focus amongst hospital systems regarding the quality of care provided, there has been augmented awareness on minimizing unplanned 30 day hospital readmission rates. As part of our burn center’s internal quality improvement process, a discharge readiness checklist was developed to identify patients at high risk for readmission.

Methods
A 20 item checklist of potential risk factors was developed, and was then cross referenced to all patients readmitted within 30 days of discharge over a one year period (September 2018-August 2019). Retrospective chart review was used to determine how many checklist factors were positive for each patient. The primary outcome was determining the main risk factors leading to a high risk for readmission.

Results
During this time period, there were 683 admission to our burn center. A total of 13 patients led to a sum of 14 readmissions (2.0%). The age range of patients was between 37 and 84 years old, with a median and average age of approximately 59 years. The distribution of patients included 7 with burn injuries (50%), 6 with soft tissue infections (42.9%) and 1 with frostbite (7.1%). Traditional LACE (Length of stay, Acuity, Co-morbidities, ED visits) score calculation would have identified only 1 of 14 readmissions in the high risk category. Average LACE score was 8.1 for all patients. Of the 20 item checklist, the risk factors most commonly associated with readmission were lack of family support (12/14, 85.7%), surgery performed during index hospitalization (11/14, 78.6%), significant co-morbidities (11/14, 78.6%), location of injuries in difficult to access anatomical regions (8/14, 57.1%), poor nutritional status (6/14. 42.8%) and length of stay greater than 1 day per percent of total body surface area burn involvement (5/7, 71.4%). The average number of identifiable risk factors was 5.38 per patient (ranging from 2 to 9 risk factors per patient).

Conclusions
Traditional risk assessment scores (i.e. LACE) do not capture patients at high risk for readmission in a burn center. Development of an alternative checklist may help to identify these patients prior to discharge, with the potential to allocate additional resources to ultimately decrease 30 day readmission rates.

Applicability of Research to Practice
Decreased 30 day readmission rates would lead to overall cost savings and improved patient outcomes.
805 A Retrospective Review of Factors Influencing Post-hospital Discharge Follow-up in Patients with Burn Injuries and Necrotizing Soft Tissue Infections
Authors: Taylor Ryan , Islas Claudia , Barrot Cindy A , Richey Karen J , Foster Kevin N 
Published: March 2020

Abstract

Introduction
Approximately 486,000 burn injuries requiring medical treatment occur each year. Medical treatments for burns vary and are dependent on the extent of the injury. Several physical and psychosocial problems may develop after discharge, including pain, itching, scarring, anxiety and depression, making it important and necessary for burn care treatment to continue even after discharge. Often, patients do not continue outpatient care due to unknown circumstances. The purpose of this study is to help identify factors that affect outpatient burn clinic visits after hospital discharge.

Methods
A retrospective chart review of patients admitted to the burn center who had an outpatient follow up visit in 2018 was performed. Patients were grouped by lost to follow up versus completed patients. Completed patients were categorized as those who were discharged from clinic as PRN follow up visits.

Results
A total of 211 patients were scheduled for outpatient visits in 2018, mean age was 36.4 years and 74% were male. Population consisted mainly of Caucasian (41%) and Hispanic (31%). The most common payor source was Medicaid (58%) and Medicare (17%). The mean TBSA was 5.8 % with the most common mechanisms were Flame/Flash and Scald (30% each). The mean length of stay was 10.3 days, mean number of surgeries was 1.5. Majority of patients were discharged Home (71%) and SNF (20%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. Lost to follow up (LTF) patients had a smaller TBSA (4.69%) compared to those who completed follow-up (9.62%). Comparison between LTF and completed patients, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=&lt; 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p&lt; 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group.

Conclusions
There were a large percentage of patients who discharged themselves from clinic care. Factors that were associated with self-discharge include healed wounds, no scarring issues noted, and patients with complications, smokers, substance abuse and mental illness. Self-discharge / LTF may be related to resolution of ongoing issues prior to last scheduled appointment.

Applicability of Research to Practice
Additional research is needed to determine additional factors affecting lost to follow up in our outpatient burn clinic.
811 Comparison of an Enzymatic Debrider with Antibiotic Ointment in the Outpatient Care of Minor Partial Thickness Burns
Authors: Mitchell Suzanne , Bhavsar Dhaval , Reynolds Jessica , Jones Jessica , Pena Julia M 
Published: March 2020

Abstract

Introduction
In the U.S. about 450,000 people per year receive medical burn care through hospital emergency departments, hospital outpatient clinics, free-standing urgent care centers and private physician offices. Burns are generally classified in terms of depth and severity.
Outpatient management of partial thickness burns normally involves the application of an ointment, which may contain an antibiotic and is widely used in burn care. This clinical study has been designed to prospectively evaluate potential benefits of an enzymatic debrider in partial thickness burn wounds compared to antibiotic only treatment. The primary purpose of this study is to compare an enzymatic debrider with a topical antibiotic ointment in the proportion healed at 3 weeks after initiation of treatment, and time to healing (in weeks).

Methods
A convenience sample of 20 subjects, aged 19–56, with an acute thermal burn injury less than 72 hours old, and less than 10% TBSA were randomly assigned to outpatient treatment with an enzymatic debrider or a topical antibiotic. The proportion of subjects healed after 3 weeks of treatment was analyzed using ANOVA. In addition, a t-test comparison between the enzymatic debrider and the topical antibiotic was performed.

Results
For partial thickness burns, the mean time to heal using an enzymatic debrider was 18 days compared to 28 days for the topical antibiotic. However, there was no statistical significance in burn wound closure between subjects receiving an enzymatic debrider compared to a topical antibiotic, t (13) = .677; p = .510. An analysis of variance comparing an enzymatic debrider and a topical antibiotic also showed no statistical significance in time to heal (F=.849, p=374).

Conclusions
Due to the small sample size, the results from this study do not support the use of an enzymatic debrider versus a topical antibiotic in treating partial thickness burn injuries to advance wound closure or shorten time to heal. The results of this study show clinical significance, with burn wounds healed in 18 days when an enzymatic debrider was used compared to 28 days when a topical antibiotic was used. The lack of statistical significance was due to an under-powered study. Furthermore, partial thickness burns should spontaneously heal within 7–14 days, regardless of the topical treatment, excluding concomitant co-morbidities.

Applicability of Research to Practice
Continued research is necessary, employing larger sample sizes to adequately compare the use of an enzymatic debrider compared to topical antibiotics in deep partial thickness burn wounds. In addition, outpatient management of deep thickness and full-thickness burn injuries, utilizing sharp debridement in conjunction with enzymatic debridement, in patients who decline surgical treatment of burn wounds should be explored, analyzing time to heal, scar evaluation, and cost analysis,
835 Annual Burn Competencies for Burn Therapist: Maximizing Patient Outcomes with Ongoing Education
Authors: Yang Leng , Santoyo Ascension , Hati Jeffery , Kopari Nicole M 
Published: March 2020

Abstract

Introduction
Burn injuries often result in functional mobility impairments limiting return to pre-burn activity. Early mobility within 24 hours of admission is recommended to minimize risks of joint and soft tissue contractures while promoting functional independence. To maximize these services, burn therapists undergo annual competency education to evaluate, develop a plan of care, and treat burn patients. Designated burn therapy staff coverage is often not 24/7 resulting in delayed times to early interventions. We identified a need to provide education within the therapy department specifically addressing burn rehab interventions.

Methods
An in-service presentation introducing Cutaneous Function Units (CFU) as a new functional assessment tool was developed and presented to the therapy department. An 8 question test was administered before and after the presentation to assess staff retention and application of learned techniques. A total of 15 therapist, both occupational and physical, attended the presentation with the results of the tests analyzed.

Results
Pre-test average scores were 73% with post-test average improved to 95%. Therapist learned 2 additional methods of assessing burn wounds. After analyzing the test results, we were able to identify specific areas that required further education. We used the pre- and post- test results to tailor further educational sessions focusing on hands-on education and small focus groups.

Conclusions
Despite annual burn rehab competencies with therapy staff, there continues to be a deficit in retention of education. This may result in delay of early mobility and burn rehab services in our burn population. With focused education tailored to specific areas of burn therapy competencies, we were able to impact burn patient therapy sessions.

Applicability of Research to Practice
Ongoing education can be tailored to specific ares of burn therapy competencies to improve overall patient outcomes.
Generating metal-polluting debris in white dwarf planetary systems from small-impact crater ejecta
Authors: Veras Dimitri , Kurosawa Kosuke 
Published: March 2020

ABSTRACT
Metal pollution in white dwarf photospheres originates from the accretion of some combination of planets, moons, asteroids, comets, boulders, pebbles, and dust. When large bodies reside in dynamically stagnant locations – unable themselves to pollute or even closely approach the white dwarf – then smaller reservoirs of impact debris may become a complementary or the primary source of metal pollutants. Here, we take a first step towards exploring this possibility by computing limits on the recoil mass that escapes the gravitational pull of the target object following a single impact onto an atmosphere-less surface. By considering vertical impacts only with the full-chain analytical prescription from Kurosawa & Takada, we provide lower bounds for the ejected mass for basalt, granite, iron, and water-rich target objects across the radii range 100–103 km. Our use of the full-chain prescription as opposed to physical experiments or hydrocode simulations allows us to quickly sample a wide range of parameter space appropriate to white dwarf planetary systems. Our numerical results could be used in future studies to constrain freshly generated small debris reservoirs around white dwarfs given a particular planetary system architecture, bombardment history, and impact geometries.
The upper bounds on supersymmetry breaking scales in split supersymmetry from the Higgs mass and electroweak vacuum stability
Authors: Ahmed Waqas , Mansha Adeel , Li Tianjun , Raza Shabbar , Roy Joydeep , Xu Fangzhou 
Published: March 2020

Abstract
The null results of the LHC searches have put strong bounds on new physics scenarios such as supersymmetry (SUSY). With the latest values for the top quark mass and strong coupling, we study the upper bounds on the sfermion masses in split SUSY from the observed Higgs boson mass and electroweak (EW) vacuum stability. To be consistent with the observed Higgs mass, we find that the largest values of supersymmetry breaking scales $M_{S}$ for $\tan\beta=2$, $\tan\beta=4$, and $\tan\beta=50$ are $10^{6.2}$, $10^{4.5}$, and $10^{4.3}\, {\rm GeV}$, respectively. In particular, split SUSY with $\tan\beta \gtrsim 4$ can be probed in future 100 TeV proton–proton colliders such as FCC-hh and SppC. In addition, the Higgs quartic coupling becomes negative at about $10^{8.2}$, $10^{8.7}$, and $10^{9.6}\, {\rm GeV}$ respectively for $m_h =$ 123, 125, and 127 GeV from EW vacuum stability. These bounds are about one order smaller than the Standard Model due to the extra Higgs–Higgsino–gaugino couplings. We briefly comment on the lifetime of gluinos in our study and compare it with the current LHC observations. Additionally, we comment on the prospects of the discovery of prompt gluinos at the FCC-hh and SppC.
The effects of digital cognitive behavioral therapy for insomnia on cognitive function: a randomized controlled trial
Authors: Kyle Simon D , Hurry Madeleine E D , Emsley Richard , Marsden Antonia , Omlin Ximena , Juss Amender , Spiegelhalder Kai , Bisdounis Lampros , Luik Annemarie I , Espie Colin A , Sexton Claire E 
Published: March 2020

AbstractStudy ObjectivesWe sought to examine the impact of digital cognitive behavioral therapy (dCBT) for insomnia on both self-reported cognitive impairment and objective cognitive performance.MethodsThe Defining the Impact of Sleep improvement on Cognitive Outcomes (DISCO) trial was an online, two-arm, single-blind, randomized clinical trial of dCBT versus wait-list control. Participants were aged 25 years and older, met DSM-5 diagnostic criteria for insomnia disorder, and reported difficulties with concentration or memory. Assessments were carried out online at baseline, and 10 and 24 weeks post-randomization. The primary outcome measure was self-reported cognitive impairment, assessed with the British Columbia Cognitive Complaints Inventory (BC-CCI). Secondary outcomes included tests of cognitive performance, insomnia symptoms, cognitive failures, fatigue, sleepiness, depression, and anxiety.ResultsFour hundred and ten participants with insomnia were recruited and assigned to dCBT (N = 205) or wait-list control (N = 205). At 10 weeks post-randomization the estimated adjusted mean difference for the BC-CCI was −3.03 (95% CI: −3.60, −2.47; p &lt; 0.0001, d = −0.86), indicating that participants in the dCBT group reported less cognitive impairment than the control group. These effects were maintained at 24 weeks (d = −0.96) and were mediated, in part, via reductions in insomnia severity and increased sleep efficiency. Treatment effects in favor of dCBT, at both 10 and 24 weeks, were found for insomnia severity, sleep efficiency, cognitive failures, fatigue, sleepiness, depression, and anxiety. We found no between-group differences in objective tests of cognitive performance.ConclusionsOur study shows that dCBT robustly decreases self-reported cognitive impairment at post-treatment and these effects are maintained at 6 months.
Increasing hay inclusion in silage-based receiving diets and its effects on performance and energy utilization in newly weaned beef steers
Authors: Smerchek Dathan T , Buckhaus Elizabeth M , Miller Katie D , Smith Zachary K 
Published: March 2020

Abstract
The influence of grass hay (GH) inclusion in replacement of corn silage in receiving diets on growth performance and dietary net energy (NE) utilization was evaluated in newly weaned beef steers (n = 162 Charolais-Red Angus cross steers; initial body weight [BW] = 278 ± 13.4 kg). Treatments were (DM basis): 1) 0% GH, 2) 10% GH, or 3) 20% GH inclusion in replacement of corn silage in receiving diets fed to newly weaned beef steers for 56 d. The study was conducted from October to December of 2019. Data were analyzed as randomized complete block design with pen serving as the experimental unit for all analyses. Increasing dietary inclusion of hay had no influence (P ≥ 0.11) on final BW, ADG, gain:feed or observed/expected dietary NEM and NEG, observed/expected dry matter intake (DMI), or observed/expected ADG. GH inclusion increased (linear effect, P = 0.01) DMI. Observed DMI for all treatments was approximately 15% to 17% less than anticipated based upon steer growth performance and tabular NE values. Evaluation of observed/expected ADG was 31% to 37% greater than expected for the steers in the present study. Particles less than 4 mm increased (linear effect, P = 0.01) and greater than 4 mm decreased (linear effect, P = 0.01) as GH replaced corn silage in the receiving diet. As the proportion of particles greater than 4 mm increased, cumulative ADG was decreased. These data indicate that GH should be considered in corn silage-based receiving diets to improve DMI. In high-risk calves, improved DMI could result in a lesser incidence of morbidity, although no morbidity was observed in any steers from the present study.