bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a Psychological Intervention to Promote Meaningful Activity in People Living With Mild Dementia: An Intervention Mapping Approach
Authors: Orgeta Vasiliki , Palpatzis Eleni , See Yi Na , Tuijt Remco , Verdaguer Elisabet Sole , Leung Phuong 
Published: April 2021

Abstract

Background and Objectives
Despite the importance of meaningful activity in mild dementia, only limited data are available on the development of interventions supporting people with mild dementia to engage in meaningful activity. In this article, we describe the development of an intervention that responds to this need.

Research Design and Methods
Intervention mapping (IM), an evidence-based approach, was used to develop STAYING ACTIVE (STAYing well and active—schedulINg meaninGful and enjoyAble aCTIvities to promote Vitality and wEll-being in mild dementia). The first step, a needs assessment, comprised a literature review, focus groups, and individual interviews with service users. Performance objectives of the intervention were formulated in Step 2, followed by the development of theory-based methods in Step 3. In Step 4, the new intervention was developed based on data collected in previous steps, existing interventions, and pilot testing. Qualitative data were analyzed using framework analysis.

Results
The needs assessment indicated that people with dementia and their carers view “staying active” as an important part of “enjoying life.” Adapting to loss through compensation and receiving support were key facilitators of engaging in meaningful activity. Ecological, psychosocial, and activity-oriented theories guided the development of theory-based intervention strategies, which were based on awareness, skills, and addressing barriers of meaningful activity.

Discussion and Implications
STAYING ACTIVE is grounded on theory, and service user experiences and aims at promoting meaningful activity in mild dementia. The IM framework may be useful in the development of future psychosocial interventions for people with dementia, facilitating transparency when efficacy is evaluated.
Weight Loss through Lifestyle Intervention Improves Mobility in Older Adults
Authors: Albert Steven M , Venditti Elizabeth M , Boudreau Robert M , Kieffer Lori A , Rager Judith R , Zgibor Janice C , Vander Bilt Joni , Danielson Michelle E , Burke Lora E , Glynn Nancy W , Jakicic John M , Smith Kenneth J , Semler Linda N , Newman Anne B 
Published: April 2021

Abstract

Background and Objectives
The high prevalence of overweight or obesity in older adults is a public health concern because obesity affects health, including the risk of mobility disability.

Research Design and Methods
The Mobility and Vitality Lifestyle Program, delivered by community health workers (CHWs), enrolled 303 community-dwelling adults to assess the impact of a 32-session behavioral weight management intervention. Participants completed the program at 26 sites led by 22 CHWs. Participation was limited to people aged 60–75 who had a body mass index (BMI) of 27–45 kg/m2. The primary outcome was the performance on the Short Physical Performance Battery (SPPB) over 12 months.

Results
Participants were aged 67.7 (SD 4.1) and mostly female (87%); 22.7% were racial minorities. The mean (SD) BMI at baseline was 34.7 (4.7). Participants attended a median of 24 of 32 sessions; 240 (80.3%) completed the 9- or 13-month outcome assessment. Median weight loss in the sample was 5% of baseline body weight. SPPB total scores improved by +0.31 units (p &lt; .006), gait speed by +0.04 m/s (p &lt; .0001), and time to complete chair stands by −0.95 s (p &lt; .0001). Weight loss of at least 5% was associated with a gain of +0.73 in SPPB scores. Increases in activity (by self-report or device) were not independently associated with SPPB outcomes but did reduce the effect of weight loss.

Discussion and Implications
Promoting weight management in a community group setting may be an effective strategy for reducing the risk of disability in older adults.
A distortion matrix framework for high-resolution passive seismic 3-D imaging: application to the San Jacinto fault zone, California
Authors: Touma Rita , Blondel Thibaud , Derode Arnaud , Campillo Michel , Aubry Alexandre 
Published: April 2021

SUMMARYReflection seismic imaging usually suffers from a loss of resolution and contrast because of the fluctuations of the wave velocities in the Earth’s crust. In the literature, phase distortion issues are generally circumvented by means of a background wave velocity model. However, it requires a prior tomography of the wave velocity distribution in the medium, which is often not possible, especially in depth. In this paper, a matrix approach of seismic imaging is developed to retrieve a 3-D image of the subsoil, despite a rough knowledge of the background wave velocity. To do so, passive noise cross-correlations between geophones of a seismic array are investigated under a matrix formalism. They form a reflection matrix that contains all the information available on the medium. A set of matrix operations can then be applied in order to extract the relevant information as a function of the problem considered. On the one hand, the background seismic wave velocity can be estimated and its fluctuations quantified by projecting the reflection matrix in a focused basis. It consists in investigating the response between virtual sources and detectors synthesized at any point in the medium. The minimization of their cross-talk can then be used as a guide star for approaching the actual wave velocity distribution. On the other hand, the detrimental effect of wave velocity fluctuations on imaging is overcome by introducing a novel mathematical object: The distortion matrix. This operator essentially connects any virtual source inside the medium with the distortion that a wavefront, emitted from that point, experiences due to heterogeneities. A time reversal analysis of the distortion matrix enables the estimation of the transmission matrix that links each real geophone at the surface and each virtual geophone in depth. Phase distortions can then be compensated for any point of the underground. Applied to passive seismic data recorded along the Clark branch of the San Jacinto fault zone (SJFZ), the present method is shown to provide an image of the fault until a depth of 4 km over the frequency range 10–20Hz with an horizontal resolution of 80 m. Strikingly, this resolution is almost one eighth below the diffraction limit imposed by the geophone array aperture. The heterogeneities of the subsoil play the role of a scattering lens and of a transverse waveguide which increase drastically the array aperture. The contrast is also optimized since most of the incoherent noise is eliminated by the iterative time reversal process. Beyond the specific case of the SJFZ, the reported approach can be applied to any scales and areas for which a reflection matrix is available at a spatial sampling satisfying the Nyquist criterion.
Developing a checklist for reporting research using simulated patient methodology (CRiSP): a consensus study
Authors: Amaratunge Suvini , Harrison Morgan , Clifford Rhonda , Seubert Liza , Page Amy , Bond Christine 
Published: April 2021

Abstract

Objectives
Simulated patients are increasingly used to measure outcomes in health services but reporting is suboptimal. This study aims to create a checklist for the reporting of simulated patient (SP) methodology.

Methods
This was a Delphi study. The authors of health service research studies using SP methodology were invited to participate. Round 1 questionnaire assessed the applicability of the TIDieR (Template for Intervention Description and Replication) reporting checklist for SP methodology and asked for rewording of/additional items. Responses were thematically analysed to generate Round 2 items in which participants rated each item for importance (seven-point Likert scale) and median, mode and IQR were calculated. In Round 3, participants were invited to rescore their Round 2 responses. Consensus was defined as an IQR ≤ 1 (Extremely important) and median ≤ 2 (Very important). All consensus items were considered for inclusion in the checklist. Similarly, worded items were rationalised and items not specific to SP methodology or other existing checklists were excluded.

Key findings
Twenty-nine authors participated in Round 1 and a further seven for Rounds 2 and 3. Twenty-six responses were analysed for Round 1, 30 for Round 2 and 28 for Round 3. There was consensus on 29 of 54 items in Round 2 and 45 of 63 items in Round 3. The final checklist comprised 28 items.

Conclusions
A new reporting checklist to guide the reporting of studies, using simulated patients, complementary to CONSORT or STROBE, has been developed and will now be tested for usability.
T1 Initial Results of the American Burn Association (ABA) Multi-Center Evaluation on the Effectiveness of the Burn Navigator
Authors: Rizzo Julie A , Serio-Melvin Maria L , Coates Elsa , Liu Nehemiah T , Salinas Jose 
Published: April 2021

Abstract

Introduction
The Burn Navigator (BN) is an FDA-cleared clinical decision support tool used to aid fluid resuscitation after major burn injury. The BN provides users with hourly recommendations for fluid titration during the initial resuscitation based on various factors. The objective of this multi-center observational study was to evaluate the resuscitation volumes and related outcomes of patients admitted to five ABA verified burn centers who underwent intravenous fluid resuscitation utilizing the BN.

Methods
Data was collected from 300 patients who were resuscitated utilizing the BN. Two analyses were performed: examination of the first 24 hours of resuscitation after burn injury and examination of 24 hours of resuscitation using the BN, regardless of when the resuscitation began, to account for patients who presented in a delayed fashion. Patients were classified as having followed the BN device if all hourly fluid rates were within 40 mL of the BN recommendations (20 mL above or below) for that hour at least 75% of the time.

Results
For 285 patients, average age, weight, and TBSA were 45.6 ± 16.8 years, 87.0 ± 22.8 kg, and 39.0 ± 17.8%, with partial/full thickness percentages of 22.2 ± 15.2% and 17.0 ± 19.7%, respectively. Analysis of 286 patients in the first 24 hours of resuscitation revealed an average of 4.07 ± 1.76 mL/kg/TBSA and 151.48 ± 77.46 mL/kg of primary crystalloid fluid. When considering all fluids administered to include colloids and medications, enteral and oral feeds, and oral resuscitation fluids, average volumes in the first 24 hours were 4.68 ± 2.06 mL/kg/TBSA and 175.01 ± 92.22 mL/kg. To account for delayed presentation after burn injury, examining 24 hours of resuscitation regardless of the initiation of resuscitation, average volumes for primary and total fluids were 5.28 ± 2.54 mL/kg/TBSA, 201.11 ± 106.53 mL/kg, 6.35 ± 2.95 mL/kg/TBSA and 244.08 ± 133.5 mL/kg respectively. There was a significant decrease incidence of shock in the BN-guided group versus the non-BN-guided group (p&lt; 0.05).

Conclusions
The Burn Navigator provides comparable resuscitation volumes of primary crystalloid fluid to the Parkland Formula. When all fluids are considered, the BN device recommends total fluid infusion less than the Ivy Index (250 mL/kg/24 hrs) and was associated with a decreased incidence of shock. Early initiation of the BN device resulted in lower overall fluid volumes during the first 24 hours of resuscitation.
10 A Multi-center Study Analyzing Association of Vitamin D Deficiency and Replacement with Infectious Outcomes in Patients with Burn Injuries
Authors: Garner Katelyn , Zavala Sarah , Pape Kate , Walroth Todd A , Reger Melissa A , Kiracofe Brittany , Thomas Wendy L , Adams Beatrice , Hill David M 
Published: April 2021

Abstract

Introduction
Vitamin D (25OHD) deficiency has been associated with poor outcomes in intensive care populations. A recent single-center, burn study found a high incidence of 25OHD deficiency. A difference was noted in infectious complications, but was underpowered. The primary objective of this multi-center study was to determine if 25OHD deficiency is associated with infectious outcomes in adult burn patients.

Methods
Adult patients were eligible for inclusion in this 7 center, retrospective study if admitted January 1, 2016 - July 25, 2019 and had a 25OHD concentration drawn within the first 7 days of admission. Patients were excluded if admitted for a non-burn injury, had total body surface area (TBSA) burned of less than 5%, a readmission, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. Expecting a 3:1 enrollment, goal was at least 250 total patients to be appropriately powered (β = 0.2; α = 0.05) to detect a 33% difference in composite infectious outcome (bacteremia, pneumonia, urinary tract infection, wound infection, graft loss, or death) between patients with 25OHD deficiency (&lt; 20 ng/mL) and control (≥ 20 ng/mL). Generalized linear mixed modelling was used to control for center effect, % TBSA, age, and presence of inhalation injury and find the most predictive model.

Results
A total of 1147 patients were initially included. After exclusions, 234 (56.8%) in the deficient and 178 in the control group remained. Patients in the control group had their concentration drawn earlier (p &lt; 0.001), were more likely to be male (p = 0.006), Caucasian (p &lt; 0.001), lower body mass index (p = 0.009), lower % TBSA burn (p = 0.002), and taking a 25OHD supplement prior to admission (p &lt; 0.001). Deficient patients were more likely to have an infectious outcome (52.1% vs 36.0%, p = 0.002), acute kidney injury requiring renal replacement therapy (p = 0.009), less ventilator free days in the first 28 days (p &lt; 0.001), and more days requiring vasopressors (p = 0.008). After controlling for center, % TBSA, age, and inhalation injury the best model also included presence of deficiency (odds ratio = 2.425 [1.035 - 1.252]), days until 25OHD supplement initiation (1.139 [1.035 - 1.252]), and choice of cholecalciferol over ergocalciferol 2.112 [1.151 - 3.877]).

Conclusions
Dilution concerns were controlled by including %TBSA in the regression model. Even if low 25OHD concentrations were an acute reaction to burn injury and not representative of true deficiency, low concentrations and delay in supplementation were independently associated with increased risk of an infectious outcome.
17 Long-Term Pulmonary Sequelae After Inhalation Injury: A Retrospective Cohort Study
Authors: Wier Julian , Hulsebos Ian F , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Inhalation injury (INHI) has strong associations with increased rates of in-patient mortality and pneumonia. Data describing long-term health outcomes after inhalation injury are scarce and the true sequelae are largely unknown. The aim of the study is to review long-term pulmonary outcomes in inhalation injury patients. We hypothesize that INHI patients are at greater risk of developing long-term pulmonary sequelae.

Methods
We present a retrospective case-control of burn patients admitted to an ABA certified facility. We included burn patients with or without medically confirmed INHI who were admitted between 06/2016 to 11/2019 and were part of the regional Department of Health Services (DHS) system. The experimental group was patients with bronchoscopy confirmed INHI. The control groups were ventilated patients with confirmed non-inhalation injury (V) and non-ventilated patients with confirmed non-inhalation injury (NV). These were matched for age, TBSA, sex, previous comorbid pulmonary disease, and smoking status. Primary study outcomes were rates of post-discharge pulmonary sequelae, including ineffective airway clearance, infections, shortness of breath, and malignancy. Secondary outcomes included rates of post-discharge surgeries and readmission, post-discharge non-pulmonary sequelae, and post-discharge days to pulmonary/non-pulmonary sequelae.

Results
The study population included 33 INHI, 45 V, and 50 NV patients. There were no significant differences in age (P=.98), sex (P=.68), TBSA (P=.18), pulmonary comorbidity (P=.5), or smoking status (P=.92). Outpatient pulmonary sequelae were significantly higher for both INHI and V groups as compared to NV (21% and 17% vs 4%, P=.023, .043). The number of days from discharge to pulmonary sequelae was significantly shorter in the INHI group versus the V group (162±139 days vs 513±314 days, P=.024). Multinomial logistic regression for both INHI and V groups using the variables comorbid pulmonary disease, smoking status, and inpatient course and complications, indicated no effect on post-discharge pulmonary sequelae (all P &gt;.05). All other measures were not significant when comparing INHI to V or NV (all P &gt;.05).

Conclusions
Both INHI and V groups resulted in higher rates of outpatient pulmonary sequelae independent of inpatient course as compared to NV. While outpatient pulmonary sequelae were not significantly different between INHI and V, the INHI patients presented with complaints earlier. Thus one can conclude that ventilation alone is a significant contributing factor for the long-term pulmonary sequelae reported in this patient population.
18 The Risks of Sedation and Pain Control in the ICU: Can Increased Sedation Lead to Over-Resuscitation and More Hypotension?
Authors: McClellan John M , Sheckter Clifford C , O’Neal Jessie , Anderson Jeffrey , Mandell Samuel P 
Published: April 2021

Abstract

Introduction
Pain control and sedation of burn patients is a complex and necessary aspect of initial care and resuscitation. Each patient’s pain experience is unique. Balancing pain needs with obtundation and hemodynamic changes can be difficult, even for experienced clinicians. We hypothesize that in the first 48 hours of ICU admission, increased sedation in burned patients will be associated with increased resuscitation and hemodynamic instability.

Methods
A 6-year (2014–19) retrospective review of our hospital’s burn database collected patients admitted to the ICU with greater than 20% TBSA burns. In the first 48 hours of admission, we compared total amounts of sedation/pain medications (morphine milligram equivalents (MME), propofol, dexmedetomidine, benzodiazepines) given with total resuscitation and hemodynamic data. A linear regression model was chosen to determine if higher amounts of sedation/pain medication could predict greater resuscitation and episodes of hypotension (MAP &lt; 65).

Results
208 patients were included with median age, %TBSA, and resuscitation of 43 years (0–99), 31% (20–93), and 3.3 ml/kg/%TBSA (0.13–19.05), respectively. The majority of our patients were white (80%) males (68%). Patients received a combination of MMEs (99% of patients), propofol (31%), dexmedetomidine (11%), and benzodiazepines (73%). Using a multivariable linear regression model, we found associations between total MMEs given and greater resuscitation (95% CI: 0.15–0.54, p=0.01) as well as number of hypotensive events (95% CI: 1.57–2.7, p&lt; 0.001) in the first 48 hours of admission. No associations were noted with other sedative medications when comparing the number of hypotensive events and increased resuscitation.

Conclusions
While acute pain and sedation management is crucial in treating critically-ill burn patients, it often becomes routine. We find that pain management is not without physiological consequences and should be carefully monitored during resuscitation.
22 Acute Kidney Injury in Burn Patients Following Combination Antibiotic Therapy: A Large Database Analysis
Authors: El Ayadi Amina , Africa Robert , Prasai Anesh , Ozhathil Deepak K , Golovko George , Song Juquan , Lee Jong , Wolf Steven E 
Published: April 2021

Abstract

Introduction
Burn patients are prone to infections, which often warrants broad-spectrum antibiotic coverage. Vancomycin is a common antibiotic used at burn centers and is administered alone, or in combination with other agents such as piperacillin-tazobactam (Pip/Tazo). A recent study showed that this combination therapy was associated with increased rates of acute kidney injury (AKI) in adult and pediatric burn patients when compared to vancomycin in combination with other antibiotics. However, other studies failed to demonstrate these findings. The degree of nephrotoxic effect of the combination therapy relative to its drug components has not been demonstrated in burn patients. Using a large national database encompassing 41 health care organizations, we sought to determine whether a combination of vancomycin and Pip/Tazo exacerbates AKI in burn patients.

Methods
Using the TriNetX Global Health Research Network, we identified the population of burn patients with ICD-10 codes T20-T25 and T30-T32 between 2000–2020. We then grouped this population into 4 cohorts based on the administration of broad-spectrum antibiotics they received after the burn incident: vancomycin, Pip/Tazo alone, combination, and neither vancomycin nor Pip/Tazo. All cohorts were balanced for age, gender, and race. We explored the distribution of these cohorts and conducted comparative outcome analysis to determine the relative risk of developing AKI using the ICD10 code N17.

Results
Comparative analysis showed burn patients who received vancomycin had a 4.81% increased associated risk with AKI compared to those who did not receive either vancomycin or Pip/Tazo (p&lt; 0.0001, RR =3.35, 95%CI= 2.63–4.26). Patients who received Pip/Tazo monotherapy had a 5.1% increased association with AKI compared to those who did not receive either drug (p&lt; 0.0001, RR =3.57, 95%CI: 2.33–5.45). The combination of vancomycin with Pip/Tazo increased the association with AKI by 9.49% compared to patients who did not receive either drug (p&lt; 0.00001, RR=5.65, 95%CI: 4.40–7.26). Combination therapy also increased the risk of AKI when compared to the vancomycin monotherapy (5.01%, p&lt; 0.00001, RR= 1.69, 95%CI: 1.42–2.00) and Pip/Tazo monotherapy (4.85%, p&lt; 0.00002, RR= 1.62, 95%CI: 4.40–7.26).

Conclusions
The use of broad-spectrum antibiotics in burn patients is associated with a higher risk of AKI. The combination of these drugs affords an increased relative risk of AKI when compared to monotherapy with the respective component drugs. Whether this is associated with selection bias or drug-effect warrants further investigation.