bluuebunny/crossref_metadata_2025_split huggingface dataset:
643 The Latest Rendition of the Ring Neck Collar Formally Known as “Watusi”
Authors: Sabel Jody , Kristine Parker , Terken Tonya , Costa Beth A , Alinson Daffodil Y 
Published: April 2021

Abstract

Introduction
The “Watusi” neck collar originally described by Koenig has gone through a few renditions since it was introduced in 1976. Our facility adopted its use as described by Nosanov et. al, but have since made modifications to the construction that have improved positioning of the neck, patient comfort, and tolerance.

Methods
We used the construction design of the “Watusi” collar as described by Nosanov et. al. in 2017
• Measure patients neck length and circumference
• Cut 3/8” plastic tubing
• Cut a strip of 2”loop Velcro and sew a piece of hook Velcro to the underside of the loop Velcro for adhesive closure
• Cut horizontal strips along the remaining loop Velcro and thread plastic tubing through
Here we divert from the previously published design:
• Cut ~ 8” piece of betapile and thread Velcro through (this is to pad the back of the neck).
• Using 1 1/8” and 7/8” cylindrical foam tubes, cut a slit along the length of cylindrical foam to allow for insertion of the plastic tubes. This allows for ease of application and removal for hygiene/cleaning.
• Lay the betapile pad on the posterior neck and apply the rings w/ cylindrical foam inserts (using clinical judgement regarding number and location of foam inserts until optimal neck position is achieved).

Results
We have used this method on 15 patients since 2017 and have found improved neck extension with use of foam inserts as well as pressure along cervicomental region (see attached photos). It continues to allow for some neck movement while applying targeted pressure over anterior/lateral neck bands. The removable foam inserts make cleaning easier compared to earlier versions. The application process of our modified ring neck collar is not as straight forward as alternative neck positioning devices and staff require additional training on proper application and management, however we find that when applied with adequate tension, the ring neck collar provides excellent targeted pressure to the cervicomental region as well as lateral neck bands to reduce banding and soft tissue contractures. Many patients report improved comfort with use of ring neck collar when compared to hard orthoplast anterior neck conformers and the associated risk of pressure injury is less than that of a hard neck conformer.

Conclusions
The modified ring neck collar can provide targeted pressure to soft tissue bands of the neck and should be considered as a tool to use to reduce risk of soft tissue neck contractures. Our facility will continue to utilize this device as well as seek ways to improve the design and patient tolerance.
645 Adjustable Dynamic Ankle Foot Orthosis for Recovery of Functional Mobility
Authors: Quick Charles D , Meyer Adam M , Cancio Jill M , Dewey William S , Ridge Cindy M , Brown James K , Pittman Tiffany T , Cancio Leopoldo C 
Published: April 2021

Abstract

Introduction
We present a case of a 23-year-old woman with primary-onset peroneal nerve impairment following diagnosis of purpura fulminans involving 30% total body surface area, who was treated in our burn center. Medical complexity required a unique rehabilitation intervention. The purpose of this case study is to demonstrate the effectiveness of a dynamic ankle-foot orthosis (AFO) to recover functional ambulation.

Methods
Upon initial evaluation and during weekly re-evaluations, a physical therapist (PT) and an occupational therapist (OT) measured active range of motion (AROM), passive range of motion (PROM), and strength. Absent to trace common peroneal nerve function was identified bilaterally 8 days after admission. The patient underwent 41 surgeries and spent 231 days in the burn intensive care unit. Medical complications included 3 episodes of acute respiratory distress syndrome and septic shock, acute renal failure requiring 150 days of continuous renal replacement therapy, and 51 ventilator days. Due to post-operative restrictions and/or medical complications, lower-extremity ROM was restricted for 63 days and supine position was restricted for 49 days. Rehabilitation interventions included PROM, AROM and continuous passive motion. Weight-bearing activities included a tilt table, Moveo™, standing frame, transfer and gait training with a rolling walker (RW). Positional interventions were sitting in a Total Lift Chair, serial casting, and custom AFO fabrication.

Results
On hospital day 215 the patient ambulated 15 feet using a platform walker and required assistance of 4 staff to support the ankle and foot. On hospital day 229, static custom AFOs were implemented and the patient ambulated 325 feet with contact guard assist (CGA). The static AFOs required frequent re-fabrication due to daily ROM progress. Adjustable dynamic AFOs were fabricated to decrease resource burden. With the dynamic AFOs, the patient progressed to 745 feet CGA on hospital day 258. The patient discharged to an acute rehabilitation center on hospital day 260.

Conclusions
Extensive medical, surgical and positional restrictions required innovative interventions by a multidisciplinary team. This resulted in the fabrication of dynamic custom AFOs for gait training. Utilization of these AFOs significantly increased activity tolerance and ambulation distance, and enabled eventual discharge to a rehabilitation center.
651 Inconspicuous Donor Sites- A Patient-Centered Approach to Donor Site Management with Autologous Skin Cell Suspension
Authors: Kopari Nicole M 
Published: April 2021

Abstract

Introduction
Donor site morbidity (DSM) is a major patient dissatisfier due to pain and scarring leading to aesthetic and functional limitations acutely and over time. Many of the recent advancements in burn care such as autologous skin cell suspension (ASCS), cultured tissues, and engineered tissues are driven to reduce DSM. One of the most important advancements in reducing DSM has been the approval of ASCS. Our study assesses donor site (DS) location using real-world data after ASCS procedures with an inconspicuous surgical approach for DS.

Methods
An IRB approved, retrospective chart review of all burn patients undergoing ASCS at an American Burn Center verified burn center between January 2019 and August 2020 was completed. Patients were excluded who received ASCS in combination with widely meshed skin graft or who died during their hospitalization. Demographics were reported including age, gender, % total body surface area (TBSA), length of stay (LOS), ASCS size in cm2 and % TBSA, and location of burn. All DS were harvested at 0.004–0.008 inch after clysis of the prep site with injectable saline and 0.25% Marcaine with a dermatome or Weck knife. Photographs of the DS and burn wounds were uploaded to the EMR by the surgeon of record and assessed by two experienced burn nurses that were blinded to DS location and intraoperative procedures.

Results
83 patients underwent ASCS with 25 patients meeting inclusion criteria. The average age was 33 years (range 15 months to 88 years). 68% of patients were male with an average TBSA of 11% (range 2.5–40). The mean LOS was 5.8 days (range 1–16). Burn locations included face/neck (n=9), torso (n=16), extremity (n=20), hand (n=10), and two patients had single site involvement. The adult patient average size of ASCS applied was 1700cm2 (range 250–6200) while pediatric patients had an average size of 13% TBSA (range 6–32). 21 of the 25 patients had DS adjacent to the burn. No significant difference was noted in healing time, infection rate, or hypertrophic scarring. None of the patients complained of DS pain that was distinguishable from the burn wound. Blinded observers were unable to discern the DS in 56% of the patients from the initial burn wound.

Conclusions
DSM is an iatrogenic insult to non-burn skin and a significant cause of morbidity. ASCS DS may be taken adjacent to the burn wound without risk of delayed re-epithelization, infection, or hypertrophic scarring. Placing ASCS DS adjacent to the burn wound is a more patient-centered approach with indistinguishable pain from the burn wound, a more pleasing cosmetic outcome, and potential greater patient satisfaction.
654 Successful Wound Closure in Patients with Large Total Body Surface Area Calciphylaxis with Aggressive Multi-modal Therapy Including Excision and Skin Grafting
Authors: Curfman Eric , Khandelwal Anjay 
Published: April 2021

Abstract

Introduction
Calcific Uremic Arteriolopathy (CUA), commonly known as Calciphylaxis, is a rare disorder characterized by ischemic necrosis of the skin and histologically by arteriolar calcification. CUA is most commonly seen in patients with end-stage renal disease (ESRD) but can be seen in other patients as well. CUA carries an extremely high mortality rate, with up to 80% in some studies, even in patients with limited disease. In light of this, many surgeons have adopted a “do-not-touch” practice with these patients. Over the past several years, our institution has seen an increase in referrals for the management of large total-body-surface-area (TBSA) CUA.

Methods
Retrospective review of all patients with biopsy-proven (by dermatopathology) large TBSA (&gt;=5% TBSA) CUA admitted to a Verified Adult and Pediatric Burn Center from 2015 to present. Demographics, laboratory data, treatment modalities and outcomes including mortality and wound closure were recorded.

Results
A total of 8 patients with large TBSA CUA were admitted after being transferred from outside hospitals. Average TBSA affected was 13.76% (SD 7.27). 6 of these patients (75%) were noted to have non-uremic calciphylaxis. All patients had positive wound cultures on admission, and 1 patient (12.5%) developed a bacteremia in hospital. There were no central line associated bloodstream infections, catheter associated urinary tract infections or ventilator associated infections. All patients underwent surgical debridement (average 4.125, range 2–5), and 5 patients (62.5%) underwent grafting, (average 1.6, range 2–5) and subsequently proceeded to wound closure. In-hospital mortality was 25% and another patient was referred to a hospice facility after being readmitted with medical complications of her calciphylaxis. Secondary findings included 50% of the patients recently experienced significant weight loss (&gt;100 lbs). On admission, 2 patients (25%) had abnormal serum calcium, 3 patients (37.5%) had abnormal serum PO4, and 4 (50%) patients had abnormal PTH levels. 2 patients (25%) had a recent exposure to warfarin (within 6 months).

Conclusions
Utilizing a multi-modal management strategy that includes surgical debridement and skin grafting, patients with calciphylaxis can progress to wound closure.
662 Single Surgeon Experience Using a Polyactide-based Copolymer Dressing to Over and Secure Split Thickness Skin Grafts in Burn Patients.
Authors: Navarro Eduardo , Thigpin Tera , Carson Joshua S 
Published: April 2021

Abstract

Introduction
In both partial thickness burns and skin graft donor sites, coverage with Polylactide-based copolymer dressing (PLBC dressing) has been shown to result in expedited healing and improved pain outcomes when compared to more traditional techniques. These advantages are generally attributed to the way in which PLBC remains as an intact coating over the wound bed throughout the healing process, protecting wounds from the contamination and microtraumas associated with changes more conventional dressings. At our institution, we began selectively utilizing PLBC as a means of securing and protecting fresh skin graft, in hopes that we would find similar benefits in this application.

Methods
Clinical Protocol-- The PLBC dressing was used at the attending surgeon’s discretion. In these cases, meshed STSG was placed over prepared wound beds. Staples were not utilized. PLBC dressing was then placed over the entirety of the graft surface, securing graft in place by adhering to wound bed through intercises. (Staples were not used.) The graft and PLBC complex was further dressed with a layer of non-adherent cellulose based liner with petroleum based lubricant, and an outer layer of cotton gauze placed as a wrap or bolster. Post operatively, the outer layer (“wrap”) of gauze was replaced as needed for saturation. The PLBC and adherent “inner” liner were left in place until falling off naturally over the course of outpatient follow-up.
Retrospective Review-- With IRB approval, patients treated PLBC over STSG between April 2018 to March 2019 were identified via surgeon’s log and pulled for review. Documentation gathered from operative notes, progress notes (inpatient and outpatient) and clinical photography was used to identify demographics, mechanism of injury, depth, total body surface area percentage (TBSA%), size of area treated with PLBC dressing, graft loss, need for re-grafting, signs of wound infection, antibiotic treatment, and length of stay.

Results
Twenty-two patients had STSG secured and dressed with PLBC. Median patient age was 36.5 years. Median TBSA was 5.1%, and median treated area 375 cm2. Follow up ranged from 21 to 232 days post-operatively, with two patients lost to follow up. All patients seen in outpatient follow up were noted to have “complete graft take” or “minimal” graft. None of the areas treated with PLBC dressing required re-grafting. There were no unplanned readmissions, and no wound infections were diagnosed or treated. Practitioners in in-patient setting and in follow up clinic reported satisfaction with the PLBC dressing.

Conclusions
The PLBC dressing was a feasible solution for securing and dressings STSGs. Future work is needed to determine whether its use is associated with an improvement in patient outcomes.
666 Autologous Skin Cell Therapy After Dermal Matrix with STSG in a 5-year-old African-American Female - How Adjunct Therapies are Refining the Dogmatic Treatment Approach to Burns
Authors: Coward Alexandra 
Published: April 2021

Abstract

Introduction
Split-thickness skin grafting (STSG) is the standard of care for the treatment of full thickness skin injuries. Skin grafts are associated with long-term morbidity including graft loss, adjacent structural injury, anesthetic complications, scarring, and scar contractures. Large surface area burns are additionally challenging due to limited donor site availability. Autologous skin cell suspension (ASCS) is a new adjunct for STSG using device that provides a suspension of non-cultured, autologous skin cells applied overtop of STSG. Dermal matrix templates are placed on wounds after burn excision and induces dermal regeneration in preparation for STSG, allowing for a thinner graft to be harvested and applied. This technique has been shown to require both smaller areas of donor skin as well as thinner skin harvest which improves both healing time and aesthetic outcomes of donor sites, enhancing the time-tested and well accepted technique of STSG.

Methods
We present the case of a 5-year-old African American female who suffered 18% TBSA deep partial thickness burns and full thickness burns to her abdomen, trunk and left back after her shirt was accidentally lit on fire at home. She was transferred from a local hospital to our burn center for further evaluation. She was evaluated by both the burn surgery and pediatric teams and admitted for wound cares and surgical planning.

Results
On hospital day five she underwent burn excision and placement of acellular dermal regeneration template. She returned to the operating room on hospital day 22 after daily wound cares for autografting with autologous skin cell suspension application to anterior and posterior torso and left arm, as well as to back and thigh donor sites. Her takedown on hospital day 29 showed excellent graft take. She was ultimately discharged on hospital day 47. She continued to undergo wound care in the outpatient burn clinic and daily physical and occupational therapy.

Conclusions
This case illustrates the use of dermal matrix and ASCS on a large burn with excellent aesthetic outcomes and improved healing time. This case is unique in highlighting the versatility of this therapy in a darker skinned patient. There are significant challenges with long term morbidity from STSG and the use of both dermal regenerative matrix and ASCS may provide surgeons with new approaches to decreasing depth and size of donor sites, as well as improving the length of hospital stay and overall aesthetic outcomes of donor and graft sites, specifically in darker skinned patients.
Femoral neck rotational osteotomy: a modified method for treating necrotic femoral heads with large and laterally located lesions
Authors: Zhu Junfeng , Chen Kangming , Peng Jianping , Li Yang , Shen Chao , Chen Xiaodong 
Published: April 2021

Abstract
In this study, we retrospectively investigated the short-term outcome of femoral neck rotational osteotomy (FNRO) for treating necrotic femoral heads with large and laterally located lesions. Twelve necrotic femoral heads (ARCO stage II or III) with an average Kerboul angle of 210° underwent FNRO through surgical hip dislocation. By circumferential release of capsule and retinaculum, femoral neck osteotomy was performed at the base of femoral neck just 1.5 cm above lesser trochanter. The severed femoral neck was rotated with a mean angle of 120.4° and fixed with a mean varus angulation of 10.2°. Both Harris hip score and International hip outcome tool improved at a mean follow-up of 29 months. The average post-operative intact rate was 55.3%. Subsequent collapse or progression to osteoarthritis was found in four hips but only one hip failed with a Harris hip score of 44 and converted to hip replacement. Post-operative leg length discrepancy was 1.1 cm. Limp presented in seven hips. Six hips had osteophyte formation. FNRO through surgical hip dislocation had the advantages of safe exposure, direct visualization of necrotic lesion and high reorientation of healthy bone and articular cartilage on femoral head. We observed satisfactory short-term survivorship and improved patient-reported outcomes in necrotic femoral heads treated with FNRO.
Law and economics challenges of natural gas—the hard case of Mexico
Authors: Cervantes Miguel Marmolejo , Rivera Rafael Garduño 
Published: April 2021

Abstract
This article addresses the risks and uncertainties for Mexico derived from the excessive dependency on US natural gas. It will take as a reference Btu price fluctuation and the covenants contained on the based contract for sale and purchase of natural gas, particularly in the context of the behaviour displayed by market participants (including governments) during the recent winter storm energy crisis in Texas which consequently forced shortages in Mexico due to a lack of ‘available’ natural gas to produce power (electricity). The research question includes: Should Mexico exploit its vast natural gas resources although it might not be a sustainable or a cost-effective (economically–socially and environmentally) decision? (The curse of the TEX-MEX-NG). Or instead, would it be better to prepare (within the limits of its financial situation) to address the US natural gas price fluctuations, like price hedging? Or a combination of both?
Driving forces behind open acreage resource allocation systems for petroleum upstream activities: a comparative assessment between Brazil, Colombia, India and Uruguay
Authors: Mariano Jacqueline , Szklo Alexandre , Draeger Rebecca 
Published: April 2021

ABSTRACT
Facing flattening international oil prices in the next years (due to a combination of changing industry fundamentals, pandemics effects and the challenges of the global low-carbon energy transition), oil frontier countries are reviewing their petroleum exploration and production fiscal systems to increase their attractiveness to private investment. This article analyses certain open resource allocation systems by comparing the recently launched Brazilian offering to similar systems already existing in Colombia, India and Uruguay. The comparison focuses on four driving forces behind the adoption of open resource allocation systems: energy security, local economic development, government take and the so-called green paradox (reflecting the race to monetize petroleum reserves ahead of stricter climate change international regulations). Findings show that each of the analysed countries has its own target for designing a permanent offering, although the same driving forces can be found in more than one of the countries.
EVALUATION OF TWO CHEST TOMOSYNTHESIS CYSTIC FIBROSIS SCORING SYSTEMS USING HIGH-RESOLUTION COMPUTED TOMOGRAPHY BRODY SCORING AS REFERENCE
Authors: Rossi Norrlund Rauni , Meltzer Carin , Söderman Christina , Johnsson Åse Allansdotter , Vikgren Jenny , Molnar David , Gilljam Marita , Båth Magnus 
Published: April 2021

AbstractPurposeTo evaluate two chest tomosynthesis (CTS) scoring systems for cystic fibrosis (CF), one system developed by Vult von Steyern et al. (VvS) and one system based on the Brody scoring system for high-resolution computed tomography (HRCT) (modified Brody (mB)). Brody scoring of HRCT was used as reference.MethodsIn conjunction with routine control HRCT at clinical follow-up, 10 consecutive adult CF patients underwent CTS for research purposes. Four radiologists scored the CTS examinations using the mB and VvS scoring systems. All scores were compared to the Brody HRCT scores. The agreement between the evaluated CTS scoring systems and the reference HRCT scoring system was determined using Spearman’s rank correlation coefficient and the intraclass correlation coefficient (ICC).Major findingsSpearman’s rank correlation coefficient showed strong correlations between HRCT score and both the mB and the VvS CTS total scores (median rs = 0.81 and 0.85, respectively). The ICC showed strong correlation between the CTS scoring systems and the reference: 0.88 for mB and 0.85 for VvS scoring. The median time for scoring was 20 and 10 minutes for the mB and VvS scoring systems, respectively.ConclusionsBoth evaluated CTS scoring systems correlate well with the reference standard Brody HRCT scoring. The VvS CTS scoring system has a shorter reading time, suggesting its advantage in clinical practice.