bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microbiological quality of irrigation water on highly diverse fresh produce smallholder farms: elucidating environmental routes of contamination
Authors: Viviers Sheldon A , Richter Loandi , du Plessis Erika M , Korsten Lise 
Published: April 2024

AbstractAimTo evaluate the microbiological safety, potential multidrug-resistant bacterial presence and genetic relatedness (DNA fingerprints) of Escherichia coli isolated from the water-soil-plant nexus on highly diverse fresh produce smallholder farms.Methods and resultsIrrigation water (n = 44), soil (n = 85), and fresh produce (n = 95) samples from six smallholder farms with different production systems were analysed for hygiene indicator bacterial counts and the presence of shigatoxigenic E. coli and Salmonella spp. using standard microbiological methods. Identities of isolates were confirmed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and the genetic relatedness of the E. coli isolates determined using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) analysis. Irrigation water E. coli levels ranged between 0 and 3.45 log MPN/100 ml−1 with five farms having acceptable levels according to the World Health Organization limit (3 log MPN/100 ml−1). Fresh produce samples on four farms (n = 65) harboured E. coli at low levels (&lt;1 log CFU/g−1) except for one sample from kale, spring onion, green pepper, onion, and two tomato samples, which exceeded international acceptable limits (100 CFU/g−1). Only one baby carrot fresh produce sample tested positive for Salmonella spp. Of the 224 samples, E. coli isolates were identified in 40% (n = 90) of all water, soil, and fresh produce types after enrichment. Additionally, the DNA fingerprints of E. coli isolates from the water-soil-plant nexus of each respective farm clustered together at high similarity values (&gt;90%), with all phenotypically characterized as multidrug-resistant.ConclusionsThe clustering of E. coli isolated throughout the water-soil-plant nexus, implicated irrigation water in fresh produce contamination. Highlighting the importance of complying with irrigation water microbiological quality guidelines to limit the spread of potential foodborne pathogens throughout the fresh produce supply chain.
7 Alcohol Use Acuity and Burn Mortality: A Ten-Year Retrospective Analysis
Authors: Hollowell Jamie L , Levine Ashley , Bodek Benjamin , Agala Chris B , Maxwell Eli , Chrisco Lori , Matthews Robert W , King Booker , Williams Felicia 
Published: April 2024

Abstract

Introduction
The high incidence of alcohol consumption nationally is linked to increased susceptibility for burn injuries in both cases of acute intoxication as well as chronic misuse. While detection of elevated blood ETOH levels on admission intuitively does not always reflect a patient’s history of use, it does introduce bias and can influence clinical decision-making. Understanding these inherent biases at play, our institution through a retrospective analysis, sought to investigate the differing effects a positive blood alcohol level and true chronic alcohol use disorder had on overall mortality within our burn center.

Methods
We conducted a retrospective analysis utilizing data from the Institutional Burn Center Registry, which was linked to clinical and administrative records. Our study included all adult patients admitted to the Burn Center between January 1, 2012, and December 31, 2022. We collected and analyzed various parameters, including patient demographics, length of hospital stay (LOS), comorbid conditions, and mortality outcomes. Using logistic regression modeling we evaluated the association between burn mortality and ETOH.

Results
Over the ten-year study period, a total of 9,955 adult patients were admitted to our burn center. 6,943 tested negative and 541 patients tested positive for blood ETOH on admission. The remaining 2,471 had no test. 567 were determined to have a diagnosis of alcohol use disorder. A positive for ETOH did not have significant impact on mortality (p=0.76) while history of chronic ETOH use had a nearly three-fold increase in odds of mortality (OR 2.58, CI 1.52-4.24, p=0.000) when accounting for factors present in traditional predictive models such as burn size, age, and inhalational injury.

Conclusions
Chronic alcoholism has a greater association with mortality than acute alcohol intoxication at our institution. Further, clinicians should exercise caution when presuming alcohol use disorder solely based on a positive test. This highlights the necessity of accurate medical history taking when estimating and counseling patients on mortality risk.

Applicability of Research to Practice
This emphasizes the pressing need for research into the effects of multiple comorbidities and social determinants on mortality among burn patients. The insights gained have practical implications for refining clinical approaches and optimizing care strategies for this vulnerable patient population.
17 Fluid Resuscitation Effects Endothelial Glycocalyx Shedding in a Swine Model of Severe Burn Injury
Authors: Ziedins Eriks , Kelly Edward J , Parajuli Babita , Carney Bonnie C , Shupp Jeffrey W , Moffatt Lauren T , Burmeister David M 
Published: April 2024

Abstract

Introduction
Severe burn injury is associated with altered hemodynamics and inflammation that can lead to reduced organ perfusion with subsequent organ dysfunction. While this may be mitigated with aggressive IV fluid administration, both over and under resuscitation can lead to poor outcomes. Confounding matters is endothelial glycocalyx (EGL) damage, which has also shown to be affected by crystalloid administration and is normally represented with syndecan-1 (SDC1) levels. The aim of this study was to examine EGL damage with respect to the amount of fluid administered in a swine model of burn resuscitation.

Methods
Yorkshire pigs were anesthetized and subjected to 40% total body surface area burn and 15% total blood volume-controlled hemorrhage to combat splenic autoresuscitation. Pigs were randomly selected to receive: decision support driven (adequate), fluid withholding (under), and high constant rates (over) of resuscitation. Pigs were monitored for 24 hours post-injury. Blood and urine samples were collected at pre-determined timepoints and analyzed for SDC-1 and sulfated glycosaminoglycans (sGAGs).

Results
A total of 27 pigs were analyzed. Total fluid requirements was significantly elevated in the over group compared to the under resuscitated group (11052 ± 235 mL vs. 794 ± 535 mL, p=0.003), with higher urine output as well (3145 ± 382 mL vs. 861 ± 176 mL, p=0.0008). Lower MAP and higher heart rates at hour 18 post-burn were seen in the under resuscitated group compared to subjects receiving fluids (p=0.003 and p=0.03 for MAP and heart rate, respectively). Kidney damage was also seen with higher blood creatine level at hour 18 post-burn in the under group compared to both the adequate and over resuscitated groups (2.6 ± 0.18, 1.9 ± 0.3, and 1.2 ± 0.15 mg/dL, p=0.02 and p&lt; 0.0001 respectively). There were significantly elevated levels of plasma SDC1 for the under group compared to the over resuscitated group at hour 6 and 12 (p &lt; 0.05 for both) (Figure 1). There were significantly elevated levels of sGAGs for the under group compared to the adequate and over resuscitated groups at hours 1, 2, 3, and 6 post-burn (p &lt; 0.05 for all) (Figure 1).

Conclusions
This animal model showed significant differences in some markers of EGL damage based on varying levels of resuscitation.

Applicability of Research to Practice
Further elucidation of these parameters as they relate to resuscitation may help aid in more individualized care for burn patients.
31 Establishing Pressure Parameters and Viability of a 3D Printed Dynamic Microstomia Prevention Orthosis
Authors: Whitehead Christopher , Hall Courtney 
Published: April 2024

Abstract

Introduction
Microstomia prevention orthoses (MPOs) are a standard of care for perioral burns to prevent and correct contractures due to hypertrophic burn scar. A simple, cost effective 3D printed MPO was designed with a dynamic middle component and two mouthpieces. Our goal was to establish parameters for providing appropriate pressure and to examine the viability of the design before implementation. Although effective pressure standards for dynamic MPOs have not been established, our objective is 15-25 mmHg based on the current literature for effective pressure therapy of hypertrophic burn scars.

Methods
Multiple MPOs were fabricated with varying levels of elasticity. Two variables were modified: the length in 1 cm increments (9 cm to 13 cm) and the level of infill by 10% (80% to 100%), resulting in fifteen separate devices. A digital force gauge was used to measure peak force in four positions of compression to determine pressure for the MPOs along the varying levels of mouth opening. Starting with the mouth pieces 1 cm apart, the distance was increased by 1 cm increments (1 cm to 4 cm) and measured. Using the force divided by the surface area of the device, the pressure was calculated. Three of the MPOs that provided consistent pressure through the widest coverage of mouth opening were selected for further testing. Ten duplicates of each of the three MPOs were fabricated and re-tested in the same four positions to assess the precision of the design. Another ten duplicates of each size were measured for force at one-minute intervals for ten minutes with the mouthpieces 2.5 cm apart to assess a decline in elasticity over time.

Results
The lengths of 10 cm, 11 cm, and 12 cm with 80% infill were selected because they provide coverage from 27.3 mmHg at 1 cm to 21.2 mmHg at 4 cm apart. The mean, standard deviation, and coefficient of variation were calculated to assess precision for all sizes in all four positions. The standard deviation ranged from 0.21 to 0.49 mmHg and was 0.9 % to 2.2% of the mean. When assessing decline in elasticity, the MPOs dropped an average of 3.97 mmHg over a 10-minute period with 76.97% of the decrease occurring within the first three minutes.

Conclusions
The use of three MPOs of the same infill but different lengths provide sufficient pressure across the various degrees of mouth opening. They demonstrate consistent pressures between orthoses of the same length and infill. While there is an initial drop in pressure after application, the devices continue to provide therapeutic levels of pressure during use.

Applicability of Research to Practice
These orthoses have been shown to reliably provide pressure and are ready to be incorporated into clinical practice. A sizing chart can be used to select the correct size MPO based on horizontal mouth opening. This simple but effective design has the potential to provide a low cost solution for burn microstomia with worldwide availability.
58 Objective and Subjective Melanin Measurements Within Dyschromic Scars Do Not Correlate: A Treatment Evaluation Problem
Authors: Collins Monica , Huang Jennifer , Travis Taryn E , McLawhorn Melissa M , Shupp Jeffrey W , Carney Bonnie C 
Published: April 2024

Abstract

Introduction
Dyschromia, the presence of hyper- and/or hypopigmented epidermis, is a common result of burn injury and is associated with negative aesthetic outcomes. Three clinical scales, the Patient and Observer Scar Assessment Scale - Patient (POSAS-P), Patient and Observer Scar Assessment Scale - Observer (POSAS-O), and modified Vancouver Scar Scale (mVSS) are used to evaluate dyschromia when assessing treatment options and outcomes. However, these assessment tools have yet to be validated against objective scar tissue melanin measurements. We hypothesize that these scar scales do not adequately capture pigmentation changes, necessitating more accurate metrics for clinical assessment.

Methods
Patients (n=98) with dyschromic burn scars due to thermal, chemical, electrical, or friction burns were recruited from a local burn center. Scars were rated on the POSAS-P, POSAS-O, and mVSS and the melanin content of uninjured skin and hyper-pigmented scar tissue was assessed using a Skin Color Catch non-invasive probe. The “degree of hyperpigmentation” (DOH) was calculated by the change in melanin content from the normal skin (NS) to the hyper-pigmented scar tissue, which was tested for correlation with POSAS-P-color and POSAS-O-pigmentation scores. The DOH between scars in each of the four categories of the mVSS-pigment was compared. For POSAS-P and POSAS-O, a higher score indicates more dyschromia. For mVSS, dyschromia is categorized.

Results
Hyperpigmented scars were on average 96.08±6.08 Melanin Index points higher than NS. Observers rated hyperpigmented scars high at 7.14±0.28 while patients rated higher at 7.67±0.24 (both out of 10). The most common mVSS-pigment category observed was 2, mixed pigmentation. The correlations between POSAS-P-color and DOH and POSAS-O-pigmentation and DOH were not significant (r=-0.033, p=0.7455 and r=-0.12, p=0.2323). Additionally, there were no significant differences in melanin index means between scars in the four mVSS-pigment categories (p &lt; 0.05).

Conclusions
The non-significant correlation between the scoring value from the POSAS-P, POSAS-O, and mVSS with DOH indicate that these tools do not adequately capture degree of dyschromia in patients with dyspigmentation following burn injury.

Applicability of Research to Practice
The data from these scales should not solely be used to evaluate treatment effect.
132 Detailed Characterization of a Novel Human Ex Vivo Model for Burn Injuries
Authors: Kotzbeck Petra , Hofmann Elisabeth , Foessl Ines , Fink Julia , Eberl Anita , Magnes Christoph , Kolb Dagmar , Birngruber Thomas , Funk Martin , Kamolz Lars-Peter 
Published: April 2024

Abstract

Introduction
Burn injuries belong to the most common soft tissue injuries and often result in extensive trauma but are also associated with cases of major emergency such as sepsis or systemic inflammatory response syndrome. The early phase after burn injury is critical and decides about later potential complications in wound healing. Burn injuries activate numerous processes, including heat shock, inflammation and tissue regeneration responses and thereby promote the release of cytokines and other signalling molecules such as miRNAs and metabolites. Despite extensive research, skin tissue reactions in the early phases after burn injuries still need to be investigated in more detail. Therefore, reliable burn models are needed to elucidate the exact sequence of events during the healing process and to monitor potential biomarkers that could give information about treatment success.

Methods
We induced contact burns on fresh human abdominal skin explants that were resected during abdominoplasty. Gene and miRNA expression patterns, cytokine production profiles of key mediators such as IL8 and IL6 and skin ultrastructure were analysed for 24 hours after the burn injury. Additionally, we used open flow microperfusion (OFM), a sampling technique that allows time and location dependent collection of dermal interstitial fluid (dISF), to also monitor the release of specific miRNAs, cytokines and metabolites.

Results
In burn injuries, we found significant changes in gene and miRNA expression as soon as one hour after burn injury. Inflammatory genes such as IL8 were significantly up-regulated whereas miRNAs were systematically down-regulated. miRNAs were actively released and mobilized into the dISF, while miR-497-5p could be identified stably downregulated in tissue and dISF in the early phase after a burn injury. Metabolome analysis of dISF showed a striking metabolic shift in burn injuries, linking burn injury to increased amino acid and glucose turnover in wounds.

Conclusions
By using this ex vivo human skin model for burn injuries we were able to study the immediate early responses to burns for up to 24 h. We found that miR-497-5p could serve as potential biomarker to assess burn severity since it is not only down-regulated in skin but also mobilized into the dISF after burn injury. Furthermore, we found distinct metabolite signatures after burn injury.

Applicability of Research to Practice
Identification and research on potential biomarkers to assess burn severity and treatment success.
512 Length of Stay Prediction Based on an Artificial Neural Network
Authors: Bandaru Vishal , Youssi Brandon , Morgan Ryan D D , Nguyen Kevin M , Liu Xiyu , Chaudhury Tristin , Griswold John A , Pang Alan 
Published: April 2024

Abstract

Introduction
Hospital length of stay (LOS) is difficult to predict in patients with burn injuries due to the complexity of the injuries and the wide variability in patient outcomes. Predicting hospital LOS in patients with burn injuries can have numerous benefits for patients, physicians, and insurance companies. Artificial neural networks may offer insight into more accurate LOS predictions.

Methods
We obtained electronic health records (EHR) for burn patients from July 01, 2011 - July 01, 2021. An artificial neural network was used to model the relationship between the input features and LOS. The input features were preprocessed by normalizing each feature to the range [0, 1] and transformed using log normal. The preprocessed data was split into training (70%), validation (15%), and testing (15%) sets. The neural network consisted of one hidden layer with 13 neurons and a linear output layer.

Results
The neural network achieved an R-squared (R2) value of 0.72 on the training data, indicating that 72% of the variance in the data (n=1347). The validation and testing R2 values were 0.66 and 0.68, respectively. The overall R2 value, computed by combining the predictions on the training, validation, and testing data, was 0.70. The best performance, validation performance, and testing performance achieved by the neural network during the training process were 0.28, 0.27, and 0.30, respectively. These values indicate the average squared difference between the predicted output and the true output for each set, with lower values indicating better performance.

Conclusions
The results suggest that the neural network can model the relationship between the input features and LOS with reasonable accuracy. The R2 values indicate that the model explains a substantial amount of the variability in the data. Further testing and validation may be needed to assess the robustness and reliability of the model.

Applicability of Research to Practice
Patient outcomes are largely variable and determining LOS to a closer degree helps planning more robust treatment plans. Additionally, these models have the potential to serve as a more accurate gauge of whether they are following closely to their expected treatment timeline. As survival rates continue to improve, the improvement focus has and will continue to shift towards patient outcomes.
524 Nutritional Risk in Frostbite
Authors: Graves Caran , LaChapelle Christopher R , Thompson Callie M , Fleming Irma D , Lewis Giavonni M 
Published: April 2024

Abstract

Introduction
People with frostbite are often unhoused and have a history of substance use which increases risk of malnutrition. In this retrospective study, we sought to evaluate malnutrition risk and incidence in those with frostbite admitted to an academic medical center.

Methods
Medical records of adults admitted with frostbite (ICD codes T33, T34) in 2019-2021 and with stays &gt;4 days were reviewed. Data included anthropometrics, housing status, substance use and nutritional status. Patients were screened for nutritional risk using a modified malnutrition screening tool which focused on recent weight loss. High risk patients received an in-depth nutritional assessment. Nutritional interventions provided were also noted.

Results
A total of 109 patients were admitted with frostbite and 42 (93% male) met inclusion criteria. Most had stable housing (69% housed; 31% unhoused) and 90% had insurance (mainly Medicare/Medicaid). Patient-reported alcohol (33%) and drug use (29%) were common among both housed and unhoused. Housed patients reported higher use of alcohol than unhoused (43% vs 6%) with similar reported use of other drugs. Three patients were at high risk for malnutrition based on recent weight loss. The remainder did not meet high risk screening criteria as 31 denied weight loss and 8 did not know. Five patients (12%) received a focused malnutrition evaluation but only three (all with reported weight loss) met criteria for malnutrition. All patients tolerated oral diets and 6 (14%) received supplemental enteral nutrition; no one required parenteral nutrition.

Conclusions
This study population included a higher percentage of unhoused people than our usual thermal burn injured population. Frostbite patients also commonly used alcohol and drugs. Housing status and substance use are frequently cited risks for malnutrition, however, we did not identify malnutrition often in this population. Weight loss is a major risk factor for malnutrition and given the paucity of reported pre-admit weight loss this risk factor may have limited use for referral for a more focused nutritional evaluation.

Applicability of Research to Practice
Few patients had malnutrition identified on admission which is inconsistent with published reports. Relying on self-reported weight and intake may obscure risk in this population and presents opportunity for more focused screening in our patients.