bluuebunny/crossref_metadata_2025_split huggingface dataset:
519 Comparing Evidence Based Equations and Indirect Calorimetry in Moderate Size Burns
Authors: Patton Lacey , Mueller Scott W , Wiktor Arek J , Gibson Cameron 
Published: April 2024

Abstract

Introduction
Burn survivors require additional calories due to hypermetabolic demands for large burn injuries consisting of &gt;20% total body surface area (TBSA). Evidence-based energy equations for the burn population can significantly overestimate or underestimate caloric needs. There is limited research regarding metabolic demands of moderate size burns, consisting of 10-19.9% TBSA. We aimed to correlate patient specific indirect calorimetry (IC) results with expected caloric needs using equation estimates.

Methods
This was a single center retrospective cohort study at an American Burn Association (ABA) verified burn center. We included patients with 10% and greater TBSA between 3/15/23 and 9/1/23 with a validated IC. Resting energy expenditure (REE) multiplied by 1.3 activity factor (IC 1.3) were compared to the Xie and Carlson, if within the first 30 days post injury, or Milner, if after 30 days since injury. In addition, we compared the Mifflin St Jeor (MSJ) equation to REE (no activity factor) in patient with TBSA 10-19.9%. Correlations coefficients and matched mean differences to assess for bias of equation based versus IC based caloric needs.

Results
A total of 15 patients, with a median age and TBSA of 31 years (30, 52.5) and 20% (13.6, 33.1), had 39 IC assessments performed. The average (standard deviation) of caloric requirements for IC 1.3, Xie, and Carlson/Milner were 3112 (±541), 2857 (±707), and 2881 (±753) Kcal, respectively. Caloric requirements by IC 1.3 correlated weakly with Xie (0.36, p=0.024) and Carlson/Milner (0.31, p=0.055). Xie and Carlson/Milner correlated strongly (0.94, p&lt; 0.001). Xie significantly underpredicted caloric needs while the Carlson/Milner trended towards a negative bias compared to IC 1.3 (matched mean difference: -255, p=0.033 and -231, p=0.072). In those 10-19.9% TBSA, 7 patients (median 12.75%; 10.8, 14.75) had 11 assessments. Average REE by IC was 2270 (±285) vs 1517 (±167) Kcal by MSJ. There was a moderate correlation between IC REE and MSJ (0.65, p=0.029). However, MSJ was significantly negatively biased compared to IC REE (matched mean difference -753, p&lt; 0.011).

Conclusions
Xie and Carlson/Milner equations had a weak correlation with IC 1.3 estimated caloric requirements. These equations tended to underpredict actual caloric needs. In the 10-19.9% TBSA group, MSJ significantly underpredicted IC REE. This suggests patients with TBSA 10-19.9% are hypermetabolic and may require more intense nutrition support. Larger studies in the TBSA range are required to validate these results.

Applicability of Research to Practice
Evidence-based energy equations are correlated weakly with patient-specific IC based results and should only be used if IC is unable to be performed. Greater caloric provision may be needed in the 10-19.9% TBSA burn population.
528 Efficacy of Autologous Skin Cell Suspension in the Closure of Thermal and Non-thermal Full-thickness Wounds
Authors: Brown Samantha , Hultman C Scott , McGroarty Carrie , McMoon Michelle , Rogers Corianne 
Published: April 2024

Abstract

Introduction
Autologous Skin Cell Suspension (ASCS) has documented success in the closure of partial-thickness burns, but far less is known about the safety and efficacy of ASCS in the closure of full-thickness injuries. The purpose of this study is to examine the utility of ASCS, when used in combination with widely-meshed skin grafts, in achieving closure of both thermal and non-thermal full-thickness defects and minimizing donor site morbidity.

Methods
In this case series, 40 consecutive patients with full-thickness defects (burns 7, MVC 12, infection 13, other 8) underwent debridement and were treated with the bilayer technique of 3:1 widely-meshed autograft and 80:1 expanded ASCS, from September 2022 through September 2023, at an urban Level 1 trauma center. Single cell suspension of keratinocytes, melanocytes, and fibroblasts underwent point-of-care preparation in the operating theater using trypsin, buffer, and micro-filtration. Aerosolized cells were sprayed over widely-meshed grafts and donor sites, fixated with tissue glue, covered with a non-adherent clear polymer dressing. End points were &gt;99% re-epithelialization by 4, 8, and 12 weeks, rate of limb salvage, size of donor site reduction, operative throughput, time from grafting until discharge and total length of stay, and incidence of early and late postoperative complications.

Results
Percentage of patients with &gt;99% wound closure was 75%, 95%, and 97.5% at 4, 8, and 12 weeks, respectively. Limb salvage was accomplished in 35 out of 36 patients (6 upper, 30 lower extremities). Mean area grafted was 506 cm2, with a donor site of 248 cm2 (reduction of 49%). Mean surgical time (start-to-finish) was 73 minutes, compared to OR time (in-to-out) of 129 minutes. Mean length-of-stay was 23.1 days, while time from ASCS to discharge was 9.5 days. Three out of 40 patients (7.5%) required reoperation for bleeding (1) and breakdown (2), and 4 out of 40 patients (10%) developed hypertrophic scarring. Mean follow-up was 101.5 days.

Conclusions
When used for closure of full-thickness, thermal and non-thermal defects, point-of-care ASCS is effective and safe. Particular benefits include rapid wound re-epithelialization, high rate of limb salvage, reduction of donor site size and morbidity, and low incidence of hypertrophic scarring.

Applicability of Research to Practice
This project demonstrates the efficacy and safety of spray-on skin for closure of full thickness defects.
530 Fractured Coverage for Fractional Laser: Describing the Insurance Landscape of Laser Therapy for Burn Scars
Authors: Reinoso Tyler R , Heron Matthew J , Dane Julia M , Rezwan Siam K , Broderick Kristen P , Caffrey Julie A 
Published: April 2024

Abstract

Introduction
Laser therapy can improve skin texture, range of motion, and cosmesis for patients with burn scars. Nevertheless, insurance coverage for laser therapy is highly variable, leaving patients and providers with unforeseen costs from denied claims. To determine optimal practices for patient documentation and claim reimbursement for laser therapy, we aimed to comprehensively review the insurance policy landscape of this modality for burn scars.

Methods
We identified the largest health insurers by enrollment and market share using data from the National Association of Insurance Commissioners. For each insurer, we identified their policy on laser therapy and conducted a dual, blind extraction of its documentation requirements, prior and continuing authorization requirements, and treatment guidelines. We also collected details on prerequisite failed treatments and suggested treatment alternatives.

Results
We identified 60 health insurance providers. Eleven (18.3%) had explicit policies on scar revision. Nine (15.0%) either had no publicly available policy or could not confirm coverage details. The remaining 40 had general reconstructive surgery policies that were non-specific to burn scars. Nineteen insurers (n = 19) considered laser therapy medically necessary for scar revision, and all policies required documentation of functional impairment to establish medical necessity; however, only nine policies defined functional impairment. Six insurers required patients to fail one or more alternate trials, including “standard therapy” (n = 6), silicone sheeting (n = 5), compression therapy (n = 4), intralesional corticosteroid injections (n = 2), intralesional 5-fluorouracil (5-FU) injections (n = 1), cryotherapy (n = 1), hypoallergenic paper tape (n = 1), or surgical excision (n = 1). Seven health insurers recommended alternatives to laser therapy. Surgical excision was the most recommended alternative (n = 6, 85.7%), followed by intralesional corticosteroid injections (n = 5, 71.4%), superficial radiation therapy (n = 4, 57.1%), silicone sheeting (n = 4, 57.1%), and compression therapy (n = 4, 57.1%). Intralesional 5-FU, cryotherapy, and pulsed-dye laser were recommended less frequently (n = 3 each, 42.9% each). Notably, 3 insurers explicitly denied laser coverage under any circumstance.

Conclusions
Most health insurers have vague policies on laser therapy for burn scar revision, complicating the reimbursement landscape for patients and providers. Burn surgeons can enhance their odds of claim approval by seeking prior authorization, maintaining detailed patient records, and using objective measures for functional impairment and improvement.

Applicability of Research to Practice
This study offers guidance to burn surgeons who use lasers for scar revision and want to maximize their likelihood of insurance reimbursement.
536 A Novel Mobile Application for Burn Surface Area Calculation
Authors: Malkoff Nicolas , Cannata Brigette , Wang Sarah , Choe Deborah , Manasyan Artur , Koegler Lyle , Kashani Saman , Johnson Maxwell B , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2024

Abstract

Introduction
The percent total body surface area (TBSA) burned is a critical determinant of required level of care, initial management, and prognosis in burn patients. The current gold standard for TBSA estimation, the Lund-Browder (LB) chart, requires familiarity with its construction and is not necessarily feasible in the field. Recently, many mobile applications (apps) have been developed to calculate TBSA. However, few have been rigorously validated. In this study, we present a novel TBSA calculator app developed for first responders and validate its accuracy.

Methods
Infant, pediatric, and adult mannequins were fabricated with eight simulated burns (Figure 1). Thirteen first- and second-year medical students with no experience in burn care were tasked with calculating the TBSA of these burns using both LB and our app. Students then completed a questionnaire to assess their experience using both methods. A paired t-test was used to compare absolute mean differences in TBSA between student estimates using both methods and those of two expert burn surgeons using LB.

Results
The app performed significantly better than LB for three of the simulated burns with mean TBSA values better approximating expert values (Burn 2 p = 0.002, Burn 5 p = 0.039, and Burn 8 p = 0.006). For the remaining five simulated burns, there was no significant difference in performance between the two methods (Table 1). Students overwhelmingly reported the app was easier and faster to use (92%, n = 12), and universally preferred it over LB for the calculation of TBSA. Students cited the visual nature of the app interface and the lack of need for manual calculations as reasons for their preference.

Conclusions
The app offered an easier, faster, and more accurate alternative to LB for calculation of TBSA among inexperienced users. Future directions include replicating this study with first responders.

Applicability of Research to Practice
Our app may be a valid alternative to LB for TBSA calculation.
553 Nursing-Led Education and Interventions to Reduce Fungal Infections on a Burn Unit
Authors: Thielges Hannah , Rhodes Abigail , Marvin Sophia A , Kraeger Trevor M , Rasmussen Megan M , Gade Clea , Thibodeau Eleanor , Rogers Bradley , Mitchell Iniabasi Nkanga , Rufi Katelyn 
Published: April 2024

Abstract

Introduction
Fungal infections cause major complications in patients with significant burns who are also hospitalized for more than seven days. In this project, significant burns are defined as meeting this burn unit’s Total Body Surface Area (TBSA) isolation precaution requirements: adult patients with TBSA greater than 20 percent and pediatric patients with TBSA greater than 15 percent. Complications of fungal infections include increased length of stay (LOS) and increased risk of mortality, sepsis, and graft loss (Herndon, 2018). Implementing effective strategies to reduce fungal infections is crucial to improving patient outcomes. At this time, there is limited research regarding how bedside nursing-led initiatives can decrease fungal infections in burn units. The purpose of this project is to determine if bedside nursing-led policy revision followed by nursing-generated education and implementation decreases the rate of fungal infections in burn patients that meet the TBSA isolation precaution requirements compared to infection rates prior to this initiative.

Methods
In this quality improvement project, a group of bedside nurses revised an infection prevention protocol and delivered education to all burn nursing staff regarding the new and improved policies, including Burn TBSA Contact Precautions, Standard Burn Precautions, and Advanced Burn Precautions. Nursing staff were empowered to enforce these new precautions with all other hospital staff and visitors on the Burn Unit. Fungal infection rates were analyzed before and after the policy implementation, educational interventions, and staff empowerment.

Results
Our final analysis will compare data from June 12, 2022 through Dec 12, 2022 to data from June 12, 2023 through December 12, 2023. Our preliminary findings demonstrate 2 out of 11 burn patients (eighteen percent) meeting project criteria developed a fungal infection in 2023 compared to 6 out of 18 eligible patients (thirty-three percent) in the 2022 timeframe. This demonstrates a fifteen percent decrease in the rate of infection of eligible burn patients. Confounding variables during the intervention period include a variety of environmental and supply chain adjustments that were also aimed at decreasing infection risk. These changes occurred in tandem with nursing-led initiatives.

Conclusions
Bedside nurse-driven policy changes, education, and interventions may be an effective way to decrease the rate of fungal infections in patients with significant burn injuries.

Applicability of Research to Practice
This project could demonstrate the efficacy of nurse driven policy development and education in the reduction of fungal infection in burn patients. Research in this area is currently lacking.
575 Disparities in Burn Hospitalizations in New York City 2010-2019
Authors: Lopez Christine , Luna Diego , Sheffield Perry 
Published: April 2024

Abstract

Introduction
Burn injury is a major source of morbidity, mortality and economic cost in the United States. Current literature does not describe the epidemiology of burn injury in New York City within the last decade. This analysis establishes an important understanding of the recent burden and demographics of burn injury and serves to support tracking of the effectiveness of ongoing policies that aspire to reduce the incidence and disparities within the realm of burn injury. By looking at injury rates by borough and race/ethnicity, we identify at-risk populations to support targeted public health interventions.

Methods
This analysis used data from the de-identified NYS Department of Health Statewide Planning and Research Cooperative System (SPARCS) publically available online database of inpatient records from 2010-2019. Incidence rates were calculated using the 2010 Decennial Census data and boroughs were compared using Zip Code Tabulation Areas (ZCTA). All data was analyzed using Python.

Results
Data included 11,444 burn injury hospitalizations from 2010-2019 across NYC for all ages. Data reviewed over the 10 years showed some persistent and shifting distribution patterns across geography and demographics. Staten Island had the highest incidence every year while Brooklyn and Queens had the highest total number of burn injuries compared to the other boroughs. Males had a higher rate of burn injury than females every year in NYC from 2010-2019. Age 0-17 had the highest burn injury rate in every year except 2016, which had 70+ as the highest rate. 70+ had the second highest rate of burn injury in all other years. In the 5 boroughs those who identified as white had the highest rate of burns in 2010 and 2011. This data shifted over time, with incidence rates in the Black/African American, Multi-Racial, and Other Race category increasing. Average length of stay in New York City for inpatient burn hospitalization was 8.12 days from 2010-2019 excluding patient stays that were &gt;120 days.

Conclusions
This New York City data analysis provides a unique insight into the prevalence and disparities of burn injuries in an urban health setting. Data augments existing literature regarding differences in burn injury and can guide future injury prevention initiatives.

Applicability of Research to Practice
This descriptive analysis provides a basis by which work can be done across New York state that focuses on preventative public health measures to reduce burn injury. The work also creates further research questions on why specific areas or populations are more impacted by burn injury.
606 Artificial Intelligence-powered Mobile Tool for Burn Injury Evaluation for First Responders
Authors: Perry Alexander , Dodd Shawn , Chan Hannah O , Joshi Rakesh , Wong Joshua N , Hong Collin 
Published: April 2024

Abstract

Introduction
Accurate assessment and early interventions in the field are crucial to the prognosis of burn injuries. Studies have indicated that up to 35% of burn patients are inappropriately transferred to hospitals. In some pediatric burns, reports have suggested the total burn surface area (TBSA) has been overestimated as much as 44%. First responders play a pivotal role in the assessment and management of burn injuries, especially in remote areas. An intuitive mobile application that incorporates the standardized practices of Advanced Burn Life Support (ABLS) with integrated artificial intelligence (AI) to assist in burn size, depth, and management is needed.

Methods
The mobile application was designed with an experienced team of burn specialists, physicians, and software engineers to identify the gaps in first responder burn care and to standardize methods for initial burn assessment. Previously assessed burn photos were characterized based on their depth into split partial thickness, deep partial thickness, and full thickness burns. Laser doppler imaging taken at the time of clinical assessment confirmed the burn depth. These images were used to build a convolutional neural network from to predict burn depth and boundaries.

Results
An AI-integrated mobile application was developed encompassing a primary survey with management solutions with the fundamentals based on ABLS. The application ensures the collection of pertinent information for burns, such as the patient's weight for calculating fluid resuscitation and provides recommendations based on burn depth and surface area. Photos taken using the mobile device can be analyzed by the AI in real time to aid in burn assessment. The accuracy of the prototype AI model can in distinguish severity assessment with an F1 accuracy score of 78% with a receiver operating characteristic of 85%. Furthermore, the model has a 92% accuracy for determining the boundaries of the burn.

Conclusions
A smartphone burn application provides an integrated way to improve the efficiency and accuracy of first responders to assess, manage, and triage burns before reaching the hospital. Through the application, management recommendations are tailored to the extent of the injury and provides a detailed report to secondary healthcare providers.

Applicability of Research to Practice
A state-of-the-art burn application can be a tool that can be used by first responders to capture essential data while ensuring the accuracy of the initial assessment. The integration of artificial intelligence will help personalize and streamline the management pathway improving communication between field and hospital care providers and improving patient care.
Inherited cultural diversity and wages: surname-based evidence
Authors: Ehrl Philipp , Monasterio Leonardo 
Published: April 2024

Abstract
This article shows that inherited cultural diversity at the regional level generates a positive wage externality. We use administrative panel data on formally employed individuals in Rio Grande do Sul in Brazil from 2008 to 2013 and apply machine learning to infer the ancestry of workers from their surnames. We distinguish inherited diversity from birthplace diversity and use the plausibly exogenous location of former colonies to build an instrumental variable. The positive wage externality of inherited diversity withstands alternative explanations such as institutional quality, municipality size, human capital externalities, individual productivity differences, and sorting of workers.
Adolescents and young adults with cancer: the clinical course of COVID-19 infections
Authors: Wolfson Julie A , Davis Elizabeth S , Saha Aniket , Martinez Isaac , McCall David , Kothari Prachi , Brackett Julienne , Dickens David S , Kahn Alissa R , Schwalm Carla , Sharma Archana , Richman Joshua , Cuglievan Branko ,   POCC Consortium, Bhatia Smita , Dai Chen , Levine Jennifer M , Johnston Emily E 
Published: April 2024

Abstract
Adolescents and young adults (ie, individuals aged 15-39 years, known as AYAs) with cancer face unique vulnerabilities yet remain underrepresented in clinical trials, including adult registries of COVID-19 in cancer (AYAs: 8%-12%). We used the Pediatric Oncology COVID-19 Case Report to examine the clinical course of COVID-19 among AYAs with cancer. The Pediatric Oncology COVID-19 Case Report collects deidentified clinical and sociodemographic data regarding individuals aged from birth to 39 years with cancer (37%) and COVID-19 from more than 100 institutions. Between April 1, 2020, and November 28, 2023, 191 older AYAs (individuals 22-39 years of age) and 640 younger AYAs (individuals 15-21 years of age) were captured. Older AYAs were less often hospitalized (P &lt; .001), admitted to the intensive care unit (P = .02), and required respiratory support (P = .057). In multivariable analyses, older AYAs faced 80% lower odds of intensive care unit admission but 2.3-times greater odds of changes to cancer-directed therapy. Unvaccinated patients had 5.4-times higher odds of intensive care unit admission. Among AYAs with cancer, the COVID-19 course varies by age. These findings can inform oncology teams directing COVID-19 management and prevention in AYA patients with cancer.
GABA does not regulate stomatal CO2 signalling in Arabidopsis
Authors: Piechatzek Adriane , Feng Xueying , Sai Na , Yi Changyu , Hurgobin Bhavna , Lewsey Mathew , Herrmann Johannes , Dittrich Marcus , Ache Peter , Müller Tobias , Kromdijk Johannes , Hedrich Rainer , Xu Bo , Gilliham Matthew 
Published: April 2024

Abstract
Optimal stomatal regulation is important for plant adaptation to changing environmental conditions and for maintaining crop yield. The guard cell signal γ-aminobutyric acid (GABA) is produced from glutamate by glutamate decarboxylase (GAD) during a reaction that generates CO2 as a by-product. Here, we investigated a putative connection between GABA signalling and the more clearly defined CO2 signalling pathway in guard cells. The GABA-deficient mutant Arabidopsis lines gad2-1, gad2-2, and gad1/2/4/5 were examined for stomatal sensitivity to various CO2 concentrations. Our findings show a phenotypical discrepancy between the allelic mutant lines gad2-1 and gad2-2—a weakened CO2 response in gad2-1 (GABI_474_E05) in contrast to a wild-type response in gad2-2 (SALK_028819) and gad1/2/4/5. Through transcriptomic and genomic investigation, we traced the response of gad2-1 to a deletion of full-length Mitogen-activated protein kinase 12 (MPK12) in the GABI-KAT line, thereafter renamed as gad2-1*. Guard cell-specific complementation of MPK12 in gad2-1* restored the wild-type CO2 phenotype, which confirms the proposed importance of MPK12 in CO2 sensitivity. Additionally, we found that stomatal opening under low atmospheric CO2 occurs independently of the GABA-modulated opening channel ALUMINIUM-ACTIVATED MALATE TRANSPORTER 9 (ALMT9). Our results demonstrate that GABA has a role in modulating the rate of stomatal opening and closing, but not in response to CO2per se.