bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antagonistic effect of Bacillus and Pseudomonas combinations against Fusarium oxysporum and their effect on disease resistance and growth promotion in watermelon
Authors: Yang Dongya , Zhang Xueqing , Li Zhaoxuan , Chu Rui , Shah Sadiq , Wang Xiaozhuo , Zhang Xueyan 
Published: April 2024

Abstract

Aims
We aimed to develop an effective bacterial combination that can combat Fusarium oxysporum infection in watermelon using in vitro and pot experiments.

Methods and results
In total, 53 strains of Bacillus and 4 strains of Pseudomonas were screened. Pseudomonas strains P3 and P4 and Bacillus strains XY-2–3, XY-13, and GJ-1–15 exhibited good antagonistic effects against F. oxysporum. P3 and P4 were identified as Pseudomonas chlororaphis and Pseudomonas fluorescens, respectively. XY-2–3 and GJ-1–15 were identified as B. velezensis, and XY-13 was identified as Bacillus amyloliquefaciens. The three Bacillus strains were antifungal, promoted the growth of watermelon seedlings and had genes to synthesize antagonistic metabolites such as bacilysin, surfactin, yndj, fengycin, iturin, and bacillomycin D. Combinations of Bacillus and Pseudomonas strains, namely, XY-2–3 + P4, GJ-1–15 + P4, XY-13 + P3, and XY-13 + P4, exhibited a good compatibility. These four combinations exhibited antagonistic effects against 11 pathogenic fungi, including various strains of F. oxysporum, Fusarium solani, and Rhizoctonia. Inoculation of these bacterial combinations significantly reduced the incidence of Fusarium wilt in watermelon, promoted plant growth, and improved soil nutrient availability. XY-13 + P4 was the most effective combination against Fusarium wilt in watermelon with the inhibition rate of 78.17%. The number of leaves; aboveground fresh and dry weights; chlorophyll, soil total nitrogen, and soil available phosphorus content increased by 26.8%, 72.12%, 60.47%, 16.97%, 20.16%, and 16.50%, respectively, after XY-13 + P4 inoculation compared with the uninoculated control. Moreover, total root length, root surface area, and root volume of watermelon seedlings were the highest after XY-13 + P3 inoculation, exhibiting increases by 265.83%, 316.79%, and 390.99%, respectively, compared with the uninoculated control.

Conclusions
XY-13 + P4 was the best bacterial combination for controlling Fusarium wilt in watermelon, promoting the growth of watermelon seedlings, and improving soil nutrient availability.
23 Beyond the Bedside: Mediating Vacancy in a Specialty Educator Role
Authors: Richerbach Stacey , Hockenberry Tiffany , Foster Kevin N 
Published: April 2024

Abstract

Introduction
National recognition of burn nursing as a specialty is new, but nationwide challenges to recruitment and retention of qualified burn nurses are longstanding. As nursing shortages have reverberated throughout the US, the role of the nurse educator has become integral to onboarding success and continuing education. In a specialty such as burn, the role of the nurse educator is of immense importance. In 2021, the Burn Nurse Educator (BNE) at our facility transitioned from full to part-time. The vacancy in the BNE role proved difficult to fill. Rather than lower the requirements for the position, our team opted to bridge the gap with implementation of a staff-led Burn Education Committee.

Methods
The part-time BNE and Burn Nurse Specialist worked in tandem as co-chairs and recruited committee members. Recruitment was initiated through word of mouth and formal advertisements in the weekly staff newsletter. Recruitment for the Burn Education Committee (BEC) was restricted to staff employed in the Burn Center, but remained open to various roles (e.g., registered nurses, certified burn techs, therapists, etc.). Upon recruiting members, the committee instituted bi-monthly meetings. A Learning Needs Assessment was disseminated to Burn Staff. Topics of interest for education were introduced within the committee, and members collaborated within the group to produce education in a variety of formats.

Results
The BEC developed presentations, tipsheets and flyers, assisted with simulation and mock code events, and members aided in burn-specific course development. As the learning needs expressed by staff per the Learning Needs Assessment were satisfied, the BEC worked to develop education to aid with onboarding and continuing education. Two buckets of virtual lessons were developed for staff. In the first bucket, virtual modules included Introduction to Burn course and Burn Nurse Standards. The first bucket is completed by new staff during orientation and is scheduled to recur annually. The second bucket includes the virtual lessons: Intra-abdominal Pressure Monitoring, Management of Patients with Large Burns, Pediatric Fluid Resuscitation, Train of Four Peripheral Nerve Stimulation, and Warming Measures for Burn Patients. This recurring bucket is scheduled annually and completion is due before our busy season commences.

Conclusions
Feedback from staff was positive, and interest in the committee increased as evidenced by additional staff joining the committee. Implementation of a staff-led BEC has revealed several benefits. Clinical staff have an expedited means of sharing education needs. Additionally, committee members have an expanded sense of purpose in the Burn Center and make an impact that spans beyond the bedside.

Applicability of Research to Practice
This study demonstrates a novel and effective method to provide ongoing burn education to nursing staff in the face of limited resources.
535 An Analysis of Hospital Cost and Reimbursement for Burn Care : Are We Keeping Up?
Authors: Fleischman Mariah , Bhavsar Dhaval , Jean Grace 
Published: April 2024

Abstract

Introduction
Hospital based care for burn patients is very resource intensive. Care of large surface area burn patients involve prolonged ICU stays, numerous surgeries, routine use of costly skin substitutes, almost daily wound care, longitudinal rehabilitation services. Discrepancies between hospital-related burn care costs and reimbursement can negatively impact financial health of burn centers. In this study, we evaluated trends in cost of burn care and reimbursement.

Methods
We reviewed available data from Center for Medicare and Medicaid Services (CMS) for years 2013-2021. The information obtained included submitted total hospital charges, total payments, and hospital payment for DRG (disease related group) codes 9127, 928, and 929 (related to burn care). Additionally, same data was collected for DRG codes related to Bronchitis, Heart Failure, and skin ulcer. Burn associated cost of care and reimbursement was compared against skin ulcer wounds, heart failure, and bronchitis to determine funding variance between different diagnoses. Rate of increase in cost of providing burn care and CMS reimbursement were compared. These changes were also compared to annualized inflation data available through Department of Labor.

Results
We observed trend of increasing burn care costs as evidenced by submitted charges from 2013-2021. Year to year increase for submitted charges was nearly 12%. Reimbursement for burn care increased over the same period too though this increase lagged the increase in cost of care. Year to year increase for total medicare reimbursement was nearly 8% over 2013-2021. Increase in CMS reimbursement was higher than the anticipated numbers based on inflation adjustment alone though lagged far behind real increase in cost of care. Reimbursement data for Skin ulcer, but not Bronchitis and Heart Failure, followed similar trend. Results are tabulated in attached graph.

Conclusions
Cost of providing burn care has increased significantly over the observed period of 2013-2021. Though reimbursements have increased also during this time, they have not kept up with increase in cost of care. This discrepancy suggests burn centers may be experiencing worsening financial stress. While healthcare costs increase annually due to inflation, the greater incremental increase in burn and skin ulcer wound care compared to other conditions reflects a financial demand that cannot be due to inflation alone.

Applicability of Research to Practice
Understanding healthcare economics related to burn care may help us run improve fiscal health of burn centers.
578 A Cross-Sectional Study of Sex, Race, and Ethnic Representation in Burn Clinical Trials
Authors: Sheikh-Oleslami Sara , Tao Brendan , Papp Bettina , Luthra Shreya , Papp Anthony 
Published: April 2024

Abstract

Introduction
The demographic proportions of plastic surgery trials approximating real-world disease are not well studied. Judicious trial representation is essential in treatment evaluation across diverse patient populations. Herein, we investigate sex, racial and ethnic disparities in patient enrollment across burn trials.

Methods
Cross-sectional analysis of participants enrolled in high-quality, reduced risk of bias, randomized controlled trials (RCT) registered on clinicaltrials.gov under the query “burn”. Completed RCTs reporting minimum two demographic groups, employing double masking or greater, with results accessible through registry or publications were included. Trial characteristics (country, site location, year, study phase, masking) and demographic data (sex, race, ethnicity) were collected. The Global Burden of Disease database provided sex-based burn disease burdens.

Results
The primary outcome was the population-to-prevalence ratio of enrolled female participants. Secondary outcomes included representation of racial and ethnic populations as related to blinding, phase, and study/sponsor locations. Of 546 trials, 41 were included (2919 participants). All reported sex demographics, females comprising 37.02% of all participants (PPR=0.71, 95%CI [0.59,0.82], likely indicating underrepresentation against their empiric disease burden). Only 7 and 9 reported ethnicity and race, respectively, although not comprehensively. Caucasians and Black persons comprised 57.52% and 21.80% of participants, respectively, while only 9.80% had Hispanic/Latino ethnicity.

Conclusions
Females are likely underrepresented in high-quality, US-registered burn trials, unreflective of their real-world disease burden. Further, severe underreporting of race and ethnicity was noted. It is imperative that future trials collect and report demographic data, namely race and ethnicity, and attempt enrolment of diverse demographics and equitable populations for promotion of study generalizability of efficacy data across relevant populations.

Applicability of Research to Practice
As there is natural variation in the effect of various medications, treatments, or medical products used amongst different sexes and diverse races due to factors such as differing physiological and genetic characteristics, enrolment of participants reflective of the disease pool studied is essential in investigations of treatments or devices intended for clinical practice. Failure to encompass all populations, due to lack of diversity in undergoing treatments further compounds healthcare disparity.
579 An Analysis of Burn ICU Days from the National Injury Resource Database
Authors: Ivanko Anastasiya , Schoen Jonathan E , Hickerson William L , Phelan Herb A , Phillips Bart D , Carter Jeffrey E , Danos Denise 
Published: April 2024

Abstract

Introduction
Burns are a time-sensitive injury that require accurate assessment, triage, and treatment. Access to burn treatment has been a challenge since only 2% of hospitals in the United States have a burn center. To guide clinicians, the ABA created burn center referral guidelines. The objective of this study was to investigate the National Injury Resource Database (NIRD) and 2021 claims data to discern if patients with a primary diagnosis of burn injury and requiring ICU-level care were treated at burn centers.

Methods
After obtaining IRB approval, NIRD, a validated composite of 53 databases representing Burn and Trauma centers in the United States, and de-identified 2021 claims data, which included hospitals, free-standing emergency rooms, Burn Centers (BC), and Trauma Centers (TC), were merged. Burn ICU days (BICUD) were used as opposed to admissions given the potential for interfacility transfers. Descriptive statistics were calculated using Excel, with logistic regression analysis of additional facility variables

Results
Our study included 8,241 facilities with 615 TCs, and 134 BCs. Previous work has noted that 481 of the 615 TCs are NOT at facilities with a BC, and that 18 of the 134 BCs are NOT at facilities with a TC. Of the total 784,309 BICUD, 60.7% occurred at facilities without BCs or TCs and 39.3% occurred at facilities with either a TC or BC. 10.8% occurred at facilities with TC without a BC. 28.5% occurred at facilities with a BC, of which 87.2% occurred at facilities with TCs and 12.8% occurred at BCs without TCs.

Conclusions
Our data shows that the majority of BICUD occur at facilities with neither BCs nor TCs. Patients requiring BICUD likely meet ABA referral criteria and if treated at non-BC, are not included in the Burn Care Quality Platform (BCQP). Additional studies are needed to discern the validity of the data, and the quantity/quality of the care occurring at all facilities, and if that care meets ABA referral criteria to a BC.

Applicability of Research to Practice
This abstract sheds light on where the majority of burn patients are treated, and therefore will help pave the road to better understanding the quantity/quality burn care that occurs outside of burn and trauma centers.
584 Improving the Quality of Trainee Burn Size Estimation on Admission to a Regional Burn Center
Authors: Bullis Jack , Kurup Meghna , Mickelson Lori , Gibson Angela , Faucher Lee D , Nosanov Lauren B 
Published: April 2024

Abstract

Introduction
Accurate estimation of total body surface area (TBSA) with documentation on a Lund Browder (LB) chart is critical in guiding burn treatment and determining proper level of care. Recent quality improvement (QI) review of a series of patients admitted to our regional burn center has raised concerns about inaccurate admission TBSA estimations. The purpose of this study is to evaluate initial LB charts and subsequent iterations throughout the hospitalization in order to identify opportunities to improve TBSA fidelity and subsequent delivered care.

Methods
The Burn Center institutional registry was queried for all patients admitted over a three-month period. After exclusion of those with non-burn etiologies, retrospective chart review was performed for remaining patients to gather data on demographics, injury characteristics, and clinical outcomes. TBSA estimations assessed included outside hospital, Emergency Department, burn center admission, and all other completed LB diagrams from the index hospitalization. Patients were subcategorized by time of admission and whether admitting attending staff was primarily specialized in Burns. Percentage difference between admission and final LB was computed to analyze under- and over-estimation tendencies.

Results
After exclusions, 100 patients – 53 adult and 47 pediatric cases – admitted 5/2023-8/2023 were included for analysis. The patient cohort was young (median 19 years) and predominantly male (65.0%). Most common burn etiologies were flame (33.0%), scald (28.0%), and contact (24.0%). Night/weekend admissions by the covering Acute Care surgeons comprised 54.0%. Admission total TBSA was equivalent to final TBSA for 75.0%, while 14.0% initially underestimated and 11.0% overestimated. Among patients with TBSA ≧ 20.0%, 44.4% had consistent initial to final TBSA while 55.6% underestimated, all of whom were admitted by a non-Burn physician at night or on the weekend. In this large burn cohort, the percent difference of underestimation ranged from 4.1-21.9%.

Conclusions
Lack of experience and familiarity with burn size estimation may make LB completion challenging, with associated clinical consequences. In our patient population this was particularly a problem in larger burns admitted by covering Acute Care Surgery staff. While over-estimation by referring facility and Emergency Medicine providers is common, admission initial LBs tended to underestimate in these cases. Further QI work is planned to improve the accuracy of initial TBSA calculations through use of a physician-nursing huddle protocol.

Applicability of Research to Practice
Inaccurate estimations of TBSA, especially upon admission, can lead to life-threatening consequences from inappropriate resuscitation and mis-triage. Our goal is to target initial LB completion processes to improve care while also fostering interprofessional teamwork.
595 Unremitting Pro-inflammatory Cell Phenotypes and Macrophage Activity, Following Paediatric Burn Injury
Authors: Langley Donna , Krenske Emma , Zimmermann Kate , Stefanutti Giorgio , Kimble Roy M , Holland Andrew J A , Fear Mark , Wood Fiona M , Kenna Tony , Cuttle Leila 
Published: April 2024

Abstract

Introduction
Burns patients are susceptible to infection, and some studies suggest patients exhibit post-burn immunosuppression. However, the trajectory of immune cells after a burn injury are unknown. Furthermore, the immune cells associated with poor healing outcomes are also unknown. Aim 1 of this study characterised the immune profile of paediatric burn patients for over 18 months post-burn. Aim 2 identified the immune cells and inflammatory markers related to delayed burn wound healing.

Methods
Flow cytometry was used to measure 26 cell lineage markers, chemokines and cytokines from both pro-inflammatory and anti-inflammatory immune profiles. In aim 1, Peripheral Blood Mononuclear Cells from 6 paediatric burn patients who had returned for burn and scar treatments over 4+ timepoints within 12 months post-burn were compared to 4 healthy controls. Aim 2 recruited 10 burn patients who re-epithelialized in &lt; 21 days, 10 patients who re-epithelialized in &gt;21 days, and 10 healthy control patient cells. All participants were children under 10 years age, with partial or full thickness scald or contact burns, 1-34% TBSA. Healthy controls were age and gender-matched.

Results
While the level of basic immune cells such as CD4 and CD8 T cells remained relatively constant, over time T cells differentiated into proinflammatory cell phenotypes including Th17 and γδ-T cells. There was a 3-fold increase of IL-17 production from γδ-T cells in the first 3 weeks post-burn(p&lt; 0.01). CCR4+CCR6+ T-regulatory cells positive were elevated at 9-18 months post-burn (p&lt; 0.05). Alternatively activated (M2) macrophages displayed a 3.5-fold increase compared with controls (p&lt; 0.01). Aim 2 preliminary results showed children with burns who re-epithelialized in under 21 days had variable abundance of T regulatory cells. Further, children with burns had a higher abundance of double positive CCR4+CCR6+ Tregs than healthy controls.

Conclusions
Our results indicate immune cells do not increase or decrease over time post-burn, but they become highly specialised, inflammatory, and skin homing. These changes persist for 18 months post-burn, and this post-burn “immune distraction” may limit the ability of immune cells to prioritise responses to other threats, such as infections. Additionally, therapies which target the immune cells associated with delayed wound healing may enhance healing outcomes for paediatric burn patients.

Applicability of Research to Practice
This project identifies targets in the immune/inflammatory response which if mediated, could improve burn wound healing outcomes.
598 Structural Characterization and Safety Validation of Cultured Skin Cells in Pediatric Incubators: A Preliminary Report
Authors: Kleintjes Wayne G , Prinsloo Tarryn K 
Published: April 2024

Abstract

Introduction
Skin substitutes, such as cultured epithelial autografts (CEA), have been utilized for wound treatment with improved outcomes. CEA can be used as a ‘stand-alone’ treatment, but combining it with temporary coverage has shown to increase graft take. The aim of this preliminary observational and prospective controlled study was to report on the histological findings of the cultured CEA and to demonstrate its safety for routine use.

Methods
Skin cells were retrieved from biopsies and placed in autologous platelet-rich plasma. The cells were then seeded onto bacteria- and fungi binding dressing pads that is routinely used and incubated in pediatric incubators at 37 °C. Fresh plasma was applied daily and amorphous hydrogel administered every third or fourth day. After 2 weeks, confluence was reached, the culture sample was fixed with to the slide. Hematoxylin and eosin, and Masson’s Trichrome stains were used for histological evaluation. Light microscopy at 4X and 10X magnification was used to observe the cultured epithelial layers and cells, respectively. Bacteriological safety was externally assessed by analyzing wound swabs of the confluent monolayers grown in both pediatric and standard culture incubators (n=10 each) before and after transplant for microscopy and culturing. The primary outcome of was skin histology and the secondary outcome was the presence of pathogens.

Results
Typical epidermal and dermal (papillary and reticular) layers were clearly observed, along with the classical differentiation patterns of the epidermal sublayers. Keratinocytes were observed as densely packed colonies along with the mediated spread of collagen. The potential presence of adipose droplets could not be excluded. No pathogenic organisms were observed in any of the cell culture specimens tested.

Results
Typical epidermal and dermal (papillary and reticular) layers were clearly observed, along with the classical differentiation patterns of the epidermal sublayers. Keratinocytes were observed as densely packed colonies along with the mediated spread of collagen. The potential presence of adipose droplets could not be excluded. No pathogenic organisms were observed in any of the cell culture specimens tested.

Conclusions
The differentiated nature of this dressing-grown CEA emulated the epidermis to a large degree. Cell differentiation was not only indicative of functional integrity, but mechanical integrity outcomes of the technique as well. No difference could be demonstrated between the different incubators in terms of the pathogenic bacteria grown or cell culture growth.

Applicability of Research to Practice
These preliminary findings suggest that the cultivated CEA using the modified technique may possess ideal skin-related characteristics that is safe for use. This is essential for favorable grafting outcomes that is not limited as treatment for burn wounds only.