bluuebunny/crossref_metadata_2025_split huggingface dataset:
581 The Effects of the COVID Pandemic on Burn Clinic
Authors: Chin Theresa L , Frerk Rita , Joe Victor C , Sabeti Sara , Burton Kimberly , Bernal Nicole O , Ochtli Ché R , Tay Erika , Carmean Melissa 
Published: April 2021

Abstract

Introduction
The COVID19 pandemic has led to anxiety and fears for the general public. People were concerned about coming to a medical facility where the virus might be transmitted. Furthermore, stay-at-home orders that were implemented during the pandemic did not apply to clinic visits but contributed to people staying at home even for medical care. We hypothesized that there were delays in burn care due to the pandemic.

Methods
We queried our clinic data for number of clinic visits and new burn evaluations by month. Patients referred to our clinic from March 15, 2020 to Sept 15, 2020 were reviewed for time of presentation after injury. Days from injury date to clinic referral date and days from clinic referral date to appointment date were calculated. Patients who were referred but did not show and were not seen in our ED were not included because injury date could not be determined. Univariate analysis was performed.

Results
As seen in Figure 1, our in-person clinic volume decreased in April and May 2020 but rebounded in June 2020 as compared to the number of clinic visits for the same months last year. Similarly, in Figure 2, our new burn evaluations decreased in April and May 2020 compared to our new burn volume from 2019. However, our video telehealth visits increased in March and April then decreased in June-August.

Conclusions
Our burn clinic remained open to see patients with burn injury throughout the pandemic, however, clinic visits were delayed early in the pandemic. While we had an increase in video telehealth, it does not account for the decrease in clinic visits. This may be due to low enrollment in the electronic medical record encrypted communication platform and/or limited knowledge/access to the technology. Additional care may have been informally given via telephone but not well captured. Furthermore, burn care was delivered in the following months. Additional investigation is necessary to see if the incidence of burn injury decreased.
587 Methadone and Morphine for Outpatient CO2 Laser Pain Management
Authors: Talon Mark D , McQuitty Alexis L , Zapata-Sirvent Ramon 
Published: April 2021

Abstract

Introduction
Burn reconstruction with CO2 laser is now very popular. Providing adequate analgesia is imperative for large total body surface area (TBSA) resurfacing. CO2 lasers’ cause significant pain during the procedure and pain similar to that of a severe sunburn post-operatively. Thus, adequate analgesia that provides peri-operative and post discharge management without delaying discharge is beneficial. At our institution, we use a multimodal analgesic preoperative and intra-operative approach to deal with this issue. The preoperative intervention utilizes a novel approach of oral methadone for older children and avoids the use of intra-operative morphine as a preemptive measure for pain management. The purpose of this outcomes review was to determine if our peri-operative analgesic practices were effective in controlling peri-operative pain.

Methods
After corporate IRB review, this project was undertaken as a quality improvement initiative and was not formally supervised by an institutional review board. A chart review of all patients who received CO2 laser treatment (CLT) was conducted. Using a Donabedian model for outcomes measure, postoperative and pre-discharge observational pain scores (scale 1–10), peri-operative analgesics, demographics, percent burn treated, incidents of rescue medication before discharge home, time to discharge and adverse reactions were collected.

Results
74 patients were reviewed (47 male, 27 female), ages 4 to 30, average age 17. Average percent body surface area treated was 17.5%. Out of 74 cases, 18 received intra-operative morphine and 56 received oral methadone pre-operatively. All patients received routine intra-operative ketorolac and lidocaine/prilocaine cream, based on weight. In the PACU there were 2 recorded rescue doses of morphine in the morphine group and 0 in the methadone group. There was one post- operative recorded observational pain score of 5 in the methadone group and one each of 3 and 8 in the morphine group, both of which received rescue morphine. There were no differences in mean times to discharge between groups. Observational pain scores were 0 for both groups at discharge. Chi square analysis showed no statistical difference between groups. No adverse outcomes (respiratory arrest or readmission for pain) were recorded in either group.

Conclusions
Both pre-operative oral methadone and intra-operative morphine are effective in controlling peri-operative pain in our children undergoing laser surgery. Categorical age differences and low group sizes may have contributed to outcomes and should be considered in the next review.
591 A 15-Year Review of Iatrogenic Burn Injuries in an Academic Public Hospital
Authors: Andersen Emily S , Powell Lauren E , Marcaccini Robert , Feldman Michael J , Drake Mack 
Published: April 2021

Abstract

Introduction
Hospital-acquired burn injuries can result in significant psychological and physical consequences for patients and their families. These injuries are typically rare, but when they do occur this can lead to increased length of hospitalization, costs of stay, and potential for additional procedures. The aim of this study is to describe iatrogenic burn injuries that occurred over a 15-year period at an academic public hospital system.

Methods
After Institutional Review Board approval this study collected data on patients sustaining iatrogenic burn injuries between January 2004 and June 2019 at a large, academic public hospital system. Data was obtained from an internal database of self-reported incidents. This data included: time of injury, location in the hospital, mechanism, level of harm caused, and anatomic location of the injury. Mean and standard deviation were calculated by year, and a two-tailed t test was used to assess for significance.

Results
122 iatrogenic burn injuries met inclusion criteria and underwent focused analysis. Incidence of burn injuries were highest between 2005–2012 (average 12.3 ± 4.1 per year) as compared to 2013–2019 (average: 2.9 ± 2.1 per year). The difference between these time periods was statistically significant (P = 0.0001). A majority (77%) resulted in harm caused to the patient, with 13.1% of cases requiring additional treatment. Most (41%) of the injuries occurred on the general medical floors, followed by the operating room (33.6%). The most common etiology was hot liquid (23%), followed by electrocautery (14.8%) and other, unspecified medical devices (21.3%). None of the burn injuries had burn consults and none of these patients required surgery for their burn injuries despite the level of harm reported.

Conclusions
Iatrogenic burns are overall rare and appear to be decreasing in number over the last six years. While a large majority were reported to have caused patient harm, none required surgery and none had a burn consult while inpatient. The majority of the injuries occurred on the medical floors with a scald mechanism. This review highlights an opportunity for large academic medical systems to put more emphasis prevention in these situations as these are presumably avoidable. There is also an opportunity to reach out to the hospital system about the involvement of the burn team. In addition, this highlights the limitations of self-reported inpatient injuries as there may be under-reporting.
610 Effects of Burn Related Factors on Pediatric Burn Survivors’ Quality of Life: A Review of PROMIS Peer Relationship Survey Scores
Authors: Mandell Justin A , Andre John A , Sen Soman , Palmieri Tina L , Greenhalgh David G , Romanowski Kathleen S 
Published: April 2021

Abstract

Introduction
Care of the burn injured child is complex and highly individualized as no two burn injuries are exactly alike. In order to assess our outcomes in treating these children we have integrated the use of the Patient Reported Outcomes Measurement Information System (PROMIS), a standardized, valid and reliable PRO tool funded by the National Institute of Health (NIH) into our clinical practice in order to evaluate aspects of the patient’s health-related quality of life. The PROMIS pediatric assessment was developed to capture self-reported anger, depression, peer relationships, pain, and physical function. This study specifically assessed the PROMIS Pediatric Peer Relationship summary scores in burn survivors to assess quality of life. The goal of this study is to examine the relationship between such quality-of-life outcomes and burn injury related factors.

Methods
Following IRB approval, we performed a retrospective review of children with burn injuries who had completed the PROMIS at our institution between 2017 and 2019. Data collected includes patient demographics, burn injury information, PROMIS peer relationship T-scores and time since injury. Statistical analysis was conducted using chi-square, t-test ANOVA, or Pearson’s correlation coefficient. The PROMIS Peer Relationships Pediatric Item Banks assess self-reported quality of relationships with friends and other acquaintances. A standardized score, or T-score, of 50 is the average for the United States general population with a standard deviation of 10. A peer relationships T-score of 60 is one standard deviation (SD) above the average while a T-score of 40 is one SD below the average. A higher T-score correlates to a better social health.

Results
164 pediatric burn patients completed 159 initial surveys. Burn injuries (n=164) consisted of the following types: contact (n=16), electrical (n=10), fire/flame (n=75), and scald (n=63) with approximately equal representation of females (n=81) and males (n=83). The mean age at injury was 6.9 years (median 6.4) with a mean burn TBSA of 21.8% (median 15.0). On average, the initial peer relationship score was 50 (median 49). Gender, type of injury, injury age, total TBSA, hospital days, ICU days, ventilator days, OR visits, and months since injury did not significantly affect the initial PROMIS score measurement.

Conclusions
This study of pediatric burn patients from a single US burn center during follow-up demonstrates that burn injury related factors appear to have no statistically significant effect on initial PROMIS Pediatric Peer Relationship score measurements. In addition, on average survivors have a quality of life as it relates to peer relationships that is on par with the US general population.
640 Relationship of Pre-existing Impaired Functional Mobility to Burn Outcomes
Authors: Smith Susan L , Seoane Jacqueline , Smith Howard G , Rainey Andrew , Emerson Lisa E 
Published: April 2021

Abstract

Introduction
It is well-established that burn severity is determined by size of surface area affected, temperature of source and duration of exposure. Patients with impaired mobility, regardless of etiology, are less capable of avoiding and escaping traumatic injuries. Additionally, patients with impaired mobility frequently suffer from other co-morbid conditions and have specialized needs which can complicate their acute illness/injury, prolong their hospital length of stay, and impact recovery.

Methods
This was an IRB- Exempted retrospective electronic medical records review of all adult patients, aged 18 years and older with pre-existing mobility impairment, admitted as inpatients for treatment of burn-related injuries from January 1, 2009 to December 31, 2019

Results
The 10 year review of 1648 adult burn admissions meeting the initial criteria of inpatient admission and burn injury, 178 were found to have documentation supporting pre-existing functional mobility impairment (11%). Rolling walker use (33%) was most common, followed by cane (28%). Contrary to the initial hypothesis, patients actually had overall lengths of stays consistent with all burn populations at 0.81 days per % total body surface area, with average length of stay being 6.7 days. The demographic data was also consistent with national burn registry data as primarily male, Caucasian population, though older, with mean age of 61.1 years. Regression analysis identified relationships between burn size and discharge disposition. Additionally, statistically significant relationships were identified between BMI and the pre-existing co-morbid illness Diabetes and Chronic Obstructive Pulmonary Disease.

Conclusions
There is a paucity of literature describing the needs of this unique burn population. Burn-injured patients with pre-existing impaired mobility suffer from similar mechanisms of injury, although the source for the thermal burns is more likely to originate from smoking on home oxygen, are treated conservatively and return home without home health.
647 The Superhero in You: Engaging Pediatric Patients in Therapeutic Exercises
Authors: Yelvington Miranda L 
Published: April 2021

Abstract

Introduction
Engaging pediatric burn survivors in necessary range of motion exercises can be challenging. For younger children, difficulty understanding the reasoning behind prescribed exercises, fear and anxiety can all lead to refusal to participate. Traditional rote range of motion exercises do not engage the child’s sense of curiosity and adventure and seem more like medicine than play. We have developed a range of motion exercise program based on well-known superhero actions. For children who need to address active wrist extension and digit extension, they become “Iron Man” (Example included), “Hulk Smash” lets us work on grip and active composite flexion while becoming “Spiderman” encourages digit isolation. “Superman”, “Wonder Woman” and “Batman” allow utilization of total body movements but can be focus on shoulder flexion or abduction and cross body movements.

Methods
Traditional superhero movements were assessed to determine similarity to traditional therapy exercises. Exercises were drawn with the extremities performing the desired movements. Pediatric patients are introduced to these exercises and encouraged to act out the superhero movements with therapist directing the desired end range and directionality of movements.

Results
These characters are well known and loved by pediatric patients. In many instances, a fearful patient may become an active therapy participant through these engaging activities. Goal attainment becomes more fun and less when children are engaged in a purposeful play task. Caregivers can carry these exercises well beyond the therapy session to encourage day long exercise which is essential for contracture prevention and remediation. A recent feedback comment from the parent of a 4-year-old burn survivor specifically focused on these exercises. “Absolutely phenomenal. The therapist did “superhero” moves with my son and got him to open and close his hands. I was so relieved that the movement was normal”

Conclusions
Modifying instruction methods to include familiar and fun techniques can increase therapy participation and can decrease the fear experienced by young burn survivors when faced with moving an injured extremity.
661 Burns in the Time Of COVID: The Use Of a Poly Lactic Acid Polymer Skin Substitute Helped A Combined Adult/Pediatrics Burn Unit Change Clinical Practice During the Coronavirus Lockdown
Authors: Short Tracee 
Published: April 2021

Abstract

Introduction
As a verified burn center, we prepare for mass casualty & constantly strive to remain at the forefront of the burn technology & research. There was nothing that prepared us for a statewide stay-at-home order nor the hospital lockdown that would come with the coronavirus pandemic. The hospital lockdowns resulted in disheartening loneliness that would prohibit the visitation of family to the ill or injured patients. The difficulty of locking down well parents proved challenging. Our new hospital policy restricted parent movements & their anxiety of exposure also heightened the desire to discharge. We questioned whether the peds patient was better suited in the hospital or at home. This shifted our usual practice. During March-May, our hospital restricted parent movements out of the patient’s room, no visitors, no swap outs during the day. This resulted in early debridements, often at the bedside, & application of the polylactic acid polymer substitute. This allowed for a discharge within 24 hrs & return to clinic in 48 hrs.

Methods
We reviewed the charts of 10 pediatric patients that normally would have remained hospitalized pre-COVID & these patients were admitted underwent debridement & early application of a polylactic acid polymer skin substitute. The charts were reviewed to determine if there were any readmissions, ER visits, delays in wound healing, delays in OR time, if needed, opposition from parents or nurses from about readiness for discharge.

Results
The charts indicated there was one return admission. The readmit was from a planned split thickness skin graft & the polylactic acid polymer was used to stage the deeper area while allowing the majority to heal. Charts demonstrated satisfaction of the parents that didn’t want to be in the hospital during COVID. No nurses felt uncomfortable & all patients demonstrated stable vitals & good UOP at the time of discharge. This indicates several initial application on admission & was discharged within 24 hours.

Conclusions
This could at face value be a simple means to an end. The review of records indicates this was successful by most definitions of outcome. The limitation discovered was the ability to optimize outpatient therapy. Burns in the time of COVID, made use reexamine how we have cared for burns & whether there was room to perform more without an inpatient or a decreased inpatient stay. This change in practice also illustrated the ability to the wounds we initially thought may be deeper & possibly need excision actually healed well with no current development of hypertrophic scarring. Our institution will consider the early practice of debridement & lactic acid polymer application even when the restriction are eased. It also forced us to reevaluate how much we are grafting & reexamine what can heal on its own.
Legal Air Cover
Authors: Bolton Patrick , Panizza Ugo , Gulati Mitu 
Published: April 2021

ABSTRACT
The economic harm being caused by the novel coronavirus may soon result in multiple sovereign debtors moving into default territory, but the existing playbook for dealing with multi-sovereign emerging market debt crises is blank. Currently, the only way to deal with a debt crisis is to carry out protracted country-by-country and contract-by-contract negotiated workouts. Expert groups are attempting to design a mechanism to run multiple sovereign debt workouts simultaneously but any design will take time to configure and get international buy-in. This article sets forth some options to provide temporary legal protection to debtor countries while they are diverting resources to respond to the Covid-19 pandemic. This is the notion of ‘legal air cover’. The options we propose involve ex-post state intervention in debt contracts and come with risks, but we show that in the case of Greece, where such an intervention was necessary in 2012, there were no negative spillovers on periphery eurozone debt markets associated with the Greek ex-post modification of contract terms.
Unusual visual and olfactory perceptions during radiotherapy sessions: an investigation of the organs responsible
Authors: Hara N , Isobe A , Yamada K , Kosugi Y , Oshima M , Kawamoto T , Shikama N , Sasai K 
Published: April 2021

Abstract
During radiotherapy sessions to treat brain tumors or head-and-neck cancers, some patients experience unusual visual and/or olfactory perceptions. This prospective study sought to answer two questions: (i) what proportion of patients experience these unpleasant sensations?, and (ii) which organs are responsible? Eligible patients had brain or near-orbital tumors treated by helical tomotherapy. All were aged 10 years or older, able to communicate, and interviewed by a radiation oncologist at least once weekly during radiation therapy. If they had experienced such sensations, they were encouraged to join the second phase of the study. The patients were asked to indicate, using a button, when a sensation commenced and ended. The recorded data were collated with the treatment log. Thirty-eight consecutive patients were eligible. Twenty-six experienced visual and 13 olfactory sensations. The radiation doses to the organs related to the visual or olfactory sensations did not differ between patients who reported sensations and those who did not. Seventeen patients were enrolled in the second phase of the study. All 14 with visual sensations reported that the sensations occurred when the X-rays passed at eye level. Olfactory sensations were reported by eight out of nine patients when the X-rays passed through the olfactory epithelium and/or ethmoid sinus level. In conclusion, 68% of patients experienced visual sensations caused by X-rays passing through the level of the eyes, and 34% complained of olfactory sensations. With the exception of one patient, olfactory sensations occurred when the X-rays passed through the levels of the olfactory epithelium and/or ethmoid sinus.
A morphological analysis of energy policy analysis research—emerging issues and concerns
Authors: Govindarajan Hari Krishnan , L.S. Ganesh 
Published: April 2021

Abstract
Morphological analysis (MA) is a reliable technique for identifying research opportunities in policy analysis. This article presents a MA of the energy policy analysis literature of over four decades of research to enable structured understanding of the field. A three-stage research method has been adopted to identify and review journal articles and research publications. The MA affirms that energy policy analysis research literature points to energy–economy–sustainability–policy interactions. These interactions are studied from the issues and concerns perspective. The MA framework (MAF) representation of energy policy issues and concerns comprises 4 dimensions, 11 sub-dimensions and 50 variants. This MAF representation of the energy policy analysis literature can be useful for researchers to systematically study the domain and identify significant research opportunities, emerging themes and priorities in energy policy analysis research. The article also suggests immediate and promising research opportunities in the domain using the MAF. MA is also a reliable method for researchers who study other public policy domains.
Prospects for plant productivity: from the canopy to the nucleus
Authors: González Fernanda G , Manavella Pablo A 
Published: April 2021

Abstract
Population growth has been closely associated with agricultural production, since the first famine predicted by Malthus (1798) up to the Green Revolution of the past century. Today, we continue to face increasing demand for food and crop production (Tilman et al., 2011). Considering the combined caloric or protein content of the 275 major crops used directly as human foods or as livestock and fish feeds, Tilman et al. (2011) forecast a 100% increase in global demand for crops from 2005 to 2050. Meeting this demand with the lowest impact on the environment could be achieved by sustainable intensification of existing cropland with reduced land clearing (Tilman et al., 2011; Fischer and Connor, 2018).