bluuebunny/crossref_metadata_2025_split huggingface dataset:
609 Combined Physical, Occupational, and Psychotherapies in the Holistic Care of the Burn
Authors: Dae Melanie K , Smith Tyler M , Goetz Stephen , Schnake Erin , Lambert Wagner Anne L 
Published: April 2021

Abstract

Introduction
Burn patients often experience pain and fear of the recovery process, negatively impacting their engagement in necessary treatments for maximal functional outcomes. Patients routinely exhibit aversions toward physical and occupational therapies (PT and OT). As a result, therapists have been tasked with managing the patient’s psychological reactions while simultaneously providing rehabilitation. We developed a program for our psychologist to co-treat patients with burn physical and occupational therapists to directly address the painful or feared aspects of burn recovery. These multidisciplinary visits offer in-vivo interventions for managing patient distress and allows therapists the ability to focus solely on their specialized interventions.

Methods
This program has been active for 12 months and was created during therapy to aid a patient with high distress during PT and OT. Therapists now work with psychology to co-treat improving patient engagement in rehabilitative interventions. During co-treatment, the patients are able to engage in PT and OT more effectively and achieve short-term goals. The burn center psychologist and therapists have developed an interventional method to explore potential generalization of co-treatment effectiveness. Patients are identified based on high need for psychological support during therapy sessions. Each patient case is reviewed and discussed to develop individualized treatment plans and establish goals. Through qualitative review of each co-treatment visit, common barriers have been identified as well as strategies to improve engagement and compliance.

Results
The common barriers encountered had a high association with a history of traumatic experiences and avoidant coping/low distress tolerance. The most effective co-treatment interventions included: collaboratively setting patient goals with PT, OT and psychology; scheduling patient therapy with burn psychology in advance; teaching distress tolerance skills to manage anticipatory and in-vivo distress related to rehabilitation.

Conclusions
Treating the emotional aspects of burn recovery during moments of acute distress is integral for holistic patient care. This multidisciplinary approach offers patients increased involvement through collaboratively tailored treatment planning and improved ability to tolerate distressing aspects of recovery. Additionally, therapists were taught various approaches to improve patient engagement and adherence.
614 Addressing Increasing Mental Health Needs in Burn Patient Population: Dedicated Burn Center Psychologist
Authors: Dae Melanie K , Smith Tyler M , Lambert Wagner Anne L 
Published: April 2021

Abstract

Introduction
During the past four years, mental health coverage at our burn center has evolved and become more robust. The emotional aspects of burn recovery are well documented; patients often present with co-morbid psychological conditions and develop psychological conditions as a result of the traumatic experience of their injury and subsequent hospitalization. To address this need, our burn center created a burn psychology fellowship and hired a dedicated full-time attending psychologist.

Methods
The burn center medical director has advocated for increased mental health support for several years. Mental health support was initially provided by the Psychiatry Consultation-Liaison team, and primarily focused on medication management for patients with severe mental illness. Recognizing the need for additional support, the burn center hired a part-time psychologist. After two years of part-time dedicated psychology coverage, a full-time position was approved. Through quantitative data review over the past several years, the number of patients with psychiatric diagnoses and the number of patients connected to mental health treatment during their hospitalization was analyzed.

Results
The overall patient census at the burn center has increased over the past several years (n=319 FY2016 vs n=506 FY2020). Burn patients with mental health diagnoses has increased along with and beyond the overall patient census growth; 34% (n=173) of patients admitted had a documented psych diagnosis in FY2020 compared to just 21% (n=68) of patients admitted in FY2016.

Conclusions
Integrating full-time psychology coverage dedicated to the burn center has allowed our patients to be evaluated and treated sooner, which has resulted in shortened time to psychotherapy and psychiatric medication management, and improved discharge planning to include outpatient mental health treatment. A full-time burn psychologist has improved holistic patient care of our burn patient population to positively aid in their overall recovery process.
620 Outbreak of Carbapenem-Polymyxin-Quat-Resistant Acinetobacter Baumannii Associated with Mafenide Acetate shortages: An Interdisciplinary Approach to Eradication
Authors: Fleming Irma D , Tang Carla , Lewis Giavonni M 
Published: April 2021

Abstract

Introduction
In the wake of Hurricane Maria, many US hospitals experienced massive drug shortages requiring substitution with alternative therapies. Our regional center experienced an increased incidence of Carbapenem-Polymyxin-Quat-Resistant Acinetobacter baumannii(CPQRA) infections, compared to a previous year of no infections. Here we describe a successful interdisciplinary approach to its eradication.

Methods
We conducted a retrospective review of CPQRA outbreaks for November and December 2018 in the burn ICU. De-identified data was collected and analyzed. In collaboration with the state’s department of health and epidemiology section, whole-genome sequencing was carried out on bacterial isolates. In addition, we instituted adenosine triphosphate (ATP) monitoring on all surfaces, a process of rapidly measuring actively growing microorganisms.

Results
Resistant Acinetobacter was isolated from five ICU patients, two of whom died with CPQRA bacteremia, producing a case-fatality rate of 40%. The two cases that died both suffered traumatic injuries with multiple fractures in addition to an average TBSA of 58%. Non-fatal cases suffered no other traumatic injuries and had an average TBSA of 51%.During this period, genitourinary irrigant (neomycin-Polymyxin B) and polymyxin ointment were the primary topical agents for wound care. Whole genome sequencing revealed a qacEdelta1 positive strain and identified the primary source as a patient that returned from a long-term care facility carrying the converted A. Baumannii infection. ATP testing also showed increased levels in patient rooms and surgical suite.

Conclusions
As a result of these findings, we achieved eradication by developing new and reinforcing traditional practices of infection control. This included UV light therapy to all ICU rooms and surgical suite, oversight of environmental services procedures, rigorous enforcement of hospital infection control procedures, auditing hand hygiene, increased efforts in antibiotic stewardship and discontinuing Polymyxin containing topicals. By January 2019 there were no new cases of CPQRA in the ICU. This study shows that the resistance and rapid spread of CPQRA can be controlled with the cooperation of hospital staff, environmental services, infection control, pharmacy, and the state’s department of health. With the coordinated efforts of all parties, we were able to successfully eradicate a virulent and fatal resistant A. baumannii strain.
664 “Minimally Invasive” Skin Grafting with Enzymatic Debridement and Autologous Skin Cell Spray
Authors: Kahn Steven , Hink Ashley , Karsch Jordan , Halicki Elizabeth , Hickerson William L , Holmes James H , Carter Jeffrey E 
Published: April 2021

Abstract

Introduction
Minimally invasive surgery is increasingly becoming standard of care across numerous subspecialties. However, burn surgery has lagged behind; as the mainstay of reconstruction still involves wound excision with a knife, a commensurately sized skin graft, and a painful donor site. In recent years, several new technologies have the potential to be used synergistically to perform “minimally invasive” skin grafts. Enzymatic debridement with bromelain and autologous skin cell spray (ASCS) have independently been shown to reduce the need for split-thickness skin graft (STSG) and decrease the donor site size when grafting is performed. Bromelain is more likely to preserve healthy dermis and ASCS allows an 80:1 expansion. Due to constraints regarding the temporal course of these products only being available via studies before one was FDA approved, these two therapies have not been utilized together in the US until recently. A paucity of literature regarding their use in combination currently exists.

Methods
This study is a single site review of patients treated the continued access study protocol for bromelain-based enzymatic debridement and with ASCS per the FDA-approved instructions for use. Enzymatic debridement was performed over a 4-hour period with appropriate analgesia. Deep partial-thickness burns with residual dermis were treated with ASCS after enzymatic debridement and superficial dermabrasion. Wounds were dressed with a small pore non-adherent film and layered gauze. Full-thickness burn injuries were treated with conventional STSG.

Results
Two patients were treated over a 2 week period. One was a 51 yr old male with 17% TBSA superficial and deep partial thickness flame burns, of which 11% were deemed deep enough to warrant treatment with enzymatic debridement. 15% TBSA was treated with ASCS including the arms, back, and posterior neck with a 24 sq cm donor site. Wound closure was noted post-operative day 7 with complete re-epithelialization. The second patient was a 21-year-old male with several comorbidities impairing wound healing (diabetes [HgbA1c of 9.9], scurvy, and zinc deficiency. He had deep-partial and full-thickness burns to bilateral feet. The dorsum of the right foot was reconstructed with ASCS only and a 6 sq cm donor site, and the left foot was treated with a 3:1 meshed STSG and ASCS overspray with 100% take.

Conclusions
Enzymatic debridement and ASCS can be utilized to treat deep partial-thickness burns with a “minimally invasive” reconstruction. The donor sites in both patients were much smaller than had they been treated with a conventional meshed STSG. Further study is needed to determine which subsets of patients and burn wound characteristics are optimal for this combination of technologies. More data regarding outcomes such as length of stay, costs, and scar formation compared to standard of care is also warranted.
670 Delayed Enzymatic Debridement of Burn Wounds using the Proteolytic Gel SN514
Authors: Jockheck-Clark Angela R , Stone Randolph , Holik Michelle , Schaffer Lucy , Natesan Shanmugasundaram , Roche Eric , Christy Robert J 
Published: April 2021

Abstract

Introduction
Thermal burns account for 5–10% of casualties sustained in present-day conflicts and are expected to be one of the most common wounds to occur in future conflicts. In prolonged field care (PFC) situations, medical evacuation could be delayed for days. During this time, burn wounds can become infected, detrimentally impact neighboring tissue, and cause systemic immune responses. Therefore, it is essential to test and evaluate non-surgical debridement agents that could be implemented prior to reaching a Role 3 military treatment facility. This work details how the proprietary proteolytic gel SN514 impacts burn debridement when applied within a PFC-like timeline. SN514 contains an enzyme formulation that is thermostable, easy to apply, and selectively degrades non-viable tissue in vitro and in vivo.

Methods
Deep-partial thickness contact burns were created using an established porcine model and covered with gauze or an antimicrobial incise drape. Four days later, the burns were treated with one of five treatments: 0.2% SN514, 0.8% SN514, a vehicle control, gauze, or an antimicrobial silver dressing. Treatments were re-applied every 24 hours for 72 to 96 hours. The effects of the treatment regiments were compared histologically. Biopsies were also taken to monitor bacterial contamination levels.

Results
Burns treated with SN514 were partially debrided and visually distinct from those treated with gauze, the silver dressing, or the vehicle control. Preliminary analyses suggest that SN514-treated burns that had been covered with “dry” gauze had a much lower debridement efficiency than those treated with the incise drape. This suggests that SN514 debridement efficiency may depend on the presence of a moist eschar. Preliminary analyses also suggest that there was little difference in burn wound bacterial counts among the five treatment groups.

Conclusions
SN514 is able to debride burns that experienced delayed treatment, without any evidence of harm to the surrounding tissue or evidence of exacerbating the original burn injury. SN514-treated wounds displayed little to no blood loss and did not increase burn wound infection levels compared to wounds treated with gauze or an antimicrobial silver dressing.
674 Machine Learning and Automation in Burn Care: A Systematic Review
Authors: Huang Samantha , Dang Justin , Sheckter Clifford C , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Current methods of burn evaluation and treatment are subjective and dependent on surgeon experience, with high rates of inter-rater variability leading to inaccurate diagnoses and treatment. Machine learning (ML) and automated methods are being used to develop more objective and accurate methods for burn diagnosis and triage. Defined as a subfield of artificial intelligence that applies algorithms capable of knowledge acquisition, machine learning draws patterns from data, which it can then apply to clinically relevant tasks. This technology has the potential to improve burn management by quantitating diagnoses, improving diagnostic accuracy, and increasing access to burn care. The aim of this systematic review is to summarize the literature regarding machine learning and automated methods for burn wound evaluation and treatment.

Methods
A systematic review of articles available on PubMed and MEDLINE (OVID) was performed. Keywords used in the search process included burns, machine learning, deep learning, burn classification technology, and mobile applications. Reviews, case reports, and opinion papers were excluded. Data were extracted on study design, study objectives, study models, devices used to capture data, machine learning, or automated software used, expertise level and number of evaluators, and ML accuracy of burn wound evaluation.

Results
The search identified 592 unique titles. After screening, 35 relevant articles were identified for systematic review. Nine studies used machine learning and automated software to estimate percent total body surface area (%TBSA) burned, 4 calculated fluid requirements, 18 estimated burn depth, 5 estimated need for surgery, 6 predicted mortality, and 2 evaluated scarring in burn patients. Devices used to estimate %TBSA burned showed an accuracy comparable to or better than traditional methods. Burn depth estimation sensitivities resulted in unweighted means &gt;81%, which increased to &gt;83% with equal weighting applied. Mortality prediction sensitivity had an unweighted mean of 96.75%, which increased to 99.35% with equal weighting.

Conclusions
Machine learning and automated technology are promising tools that provide objective and accurate measures of evaluating burn wounds. Existing methods address the key steps in burn care management; however, existing data reporting on their robustness remain in the early stages. Further resources should be dedicated to leveraging this technology to improve outcomes in burn care.
Dangerous Liaisons: The Story of Special Economic Zones, International Investment Agreements, and Investor–State Dispute Settlement
Authors: Chaisse Julien 
Published: April 2021

ABSTRACT
This article focuses on the interaction and relationship between Special Economic Zones (SEZs) as facets of unilateral economic law, international investment law, and the investor–state dispute settlement (ISDS) system in a four-fold manner. It initially explains the role of international investment agreements in protecting foreign investments in these zones. Then, it classifies the public or private nature of such zones and goes on to examine related claims through past case law, to determine how modern SEZs must be created to reduce host State liability. Whilst doing so, it provides important suggestions to improve the domestic and international success of SEZs by reducing costs associated with it. In this manner, this article endeavours to highlight the need for a balance in public policy between the rights of host States and foreign investors to ensure that SEZs continue to attract significant amounts of foreign investment. It also stresses on understanding transnational foreign investment rules and the implication of the previously concluded investor–ISDS proceedings so that host States can ensure better regulation of foreign direct investment in these areas.
Pharmacological intervention in oxidative stress as a therapeutic target in neurological disorders
Authors: Sharma Sudhanshu , Advani Dia , Das Ankita , Malhotra Nishtha , Khosla Akanksha , Arora Vanshika , Jha Ankita , Yadav Megha , Ambasta Rashmi K , Kumar Pravir 
Published: April 2021

Abstract

Objectives
Oxidative stress is a major cellular burden that triggers reactive oxygen species (ROS) and antioxidants that modulate signalling mechanisms. Byproducts generated from this process govern the brain pathology and functions in various neurological diseases. As oxidative stress remains the key therapeutic target in neurological disease, it is necessary to explore the multiple routes that can significantly repair the damage caused due to ROS and consequently, neurodegenerative disorders (NDDs). Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is the critical player of oxidative stress that can also be used as a therapeutic target to combat NDDs.

Key findings
Several antioxidants signalling pathways are found to be associated with oxidative stress and show a protective effect against stressors by increasing the release of various cytoprotective enzymes and also exert anti-inflammatory response against this oxidative damage. These pathways along with antioxidants and reactive species can be the defined targets to eliminate or reduce the harmful effects of neurological diseases.

Summary
Herein, we discussed the underlying mechanism and crucial role of antioxidants in therapeutics together with natural compounds as a pharmacological tool to combat the cellular deformities cascades caused due to oxidative stress
Strangulated Amyand’s hernia: management during the COVID-19 pandemic
Authors: Afzal Zeeshan , O’Neill Robert 
Published: April 2021

Abstract
Amyand’s hernia, presence of the appendix within an inguinal hernial sac, is a rare condition. We report a case of a 68-year-old woman who presented during the COVID-19 pandemic with an acute right groin pain due to a tender incarcerated inguinal hernia. Cross-sectional imaging confirmed an Amyand’s hernia. She proceeded to open appendectomy via the inguinal canal and primary suture repair of her inguinal hernia. Patient was discharged the following day. Surgical management of Amyand’s hernia varies depending on the resources, clinical findings and personal experience. In our opinion and experience, open hernia reduction, appendectomy and primary tissue repair repairs the most effective and appropriate approach especially during the COVID-19 pandemic.
Xylem versus phloem in secondary growth: a balancing act mediated by gibberellins
Authors: Carlsbecker Annelie , Augstein Frauke 
Published: April 2021

This article comments on:
Ben-Targem M, Ripper D, Bayer M, Ragni L. 2021. Auxin and gibberellin signaling cross-talk promotes hypocotyl xylem expansion and cambium homeostasis. Journal of Experimental Botany 72, 3647–3660.
Viscous and Knudsen gas flow through dry porous cometary analogue material
Authors: Schweighart M , Macher W , Kargl G , Gundlach B , Capelo H L 
Published: April 2021

ABSTRACTAccording to current theories of the formation of stellar systems, comets belong to the oldest and most pristine class of bodies to be found around a star. When approaching the Sun, the nucleus shows increasing activity and a pressure increase inside the material causes sublimated and trapped gas molecules to stream away from their regions of origin towards the surface. The present work studies two essential mechanisms of gas transport through a porous layer, namely the Darcy and the Knudsen flow. Gas flow measurements are performed in the laboratory with several analogue materials, which are mimicking dry cometary surface properties. In this first series of measurements, the aim was to separate gas transport properties from internal sources like local sublimation or release of trapped gases. Therefore, only dry granular materials were used and maintaining a low temperature environment was unnecessary. The gas permeability and the Knudsen diffusion coefficient of the sample materials are obtained, thereby representing the relative importance of the respective flow mechanism. The experiments performed with air at a stable room temperature show that the grain size distribution and the packing density of the sample play a major role for the permeability of the sample. The larger the grains, the bigger the permeability and the Knudsen diffusion coefficient. From the latter, we estimated effective pore diameters. Finally, we explain how these parameters can be adapted to obtain the gas flow properties of the investigated analogue materials under the conditions to be expected on the comet.
An energy-conserving dynamical model of GRB afterglows from magnetized forward and reverse shocks
Authors: Chen Qiang , Liu Xue-Wen 
Published: April 2021

ABSTRACT
In the dynamical models of gamma-ray burst (GRB) afterglows, the uniform assumption of the shocked region is known as provoking total energy conservation problem. In this work, we consider shocks originating from magnetized ejecta and extend the energy-conserving hydrodynamical model of Yan, Wei & Fan to the MHD limit by applying the magnetized jump conditions from Zhang & Kobayashi. Compared with the non-conservative models, our Lorentz factor of the whole shocked region is larger by a factor ${\lesssim}\sqrt{2}$. The total pressure of the forward shocked region is higher than the reversed shocked region, in the relativistic regime with a factor of about 3 in our interstellar medium (ISM) cases while ejecta magnetization degree σ &lt; 1, and a factor of about 2.4 in the wind cases. For σ ≤ 1, the non-conservative model loses 32–42 per cent of its total energy for ISM cases, and for wind cases 25–38 per cent, which happens specifically in the forward shocked region, making the shock synchrotron emission from the forward shock less luminous than expected. Once the energy conservation problem is fixed, the late-time light curves from the forward shock become nearly independent of the ejecta magnetization. The reverse shocked region does not suffer from the energy conservation problem since the changes of the Lorentz factor are recompensed by the changes of the shocked particle number density. The early light curves from the reverse shock are sensitive to the magnetization of the ejecta, thus are an important probe of the magnetization degree.