bluuebunny/crossref_metadata_2025_split huggingface dataset:
77 Utility of a Decision-Making Aid for Patient Centered Management of Deep Hand Burns
Authors: Parker Kristine A , Sabel Jody I , Orton Caitlin M , Sheckter Clifford C , Pham Tam N 
Published: April 2024

Abstract

Introduction
Patients with deep finger and hand burns often face the challenge of early amputation vs. tissue salvage and complex rehabilitation. The decision-making aid for deep hand burns was developed to help patients/families identify and understand options and recovery goals. The visual aid outlines distinct pathways with anticipated rehabilitative needs across a timeline of months to years. This project aims to consumer test this tool to ensure it can be presented in an understandable, useful and acceptable manner to patients/families.

Methods
We conducted cognitive interviews with individuals living with deep hand burns and their family members. Interviews addressed the utility of the decision-making aid, burn injury and rehabilitation characteristics, use of the decision-making aid to outline patient goals and values, and the medical pathways, including surgical, rehabilitative, and wound care expectations anticipated with each pathway. Interviews were transcribed and coded by three analysts using both deductive and inductive approaches.

Results
A total of 10 interviews represented diverse perspectives (e.g., burn survivor versus family member/caregiver, time since injury, severity of injury). Within the knowledge, attitudes and beliefs framework, six themes emerged: i) time since injury and severity of injury both impact the ability to interpret recovery, ii) a gap in understanding exists about the recovery process (e.g., outcomes, therapy follow up, more operations, timelines), iii) participants prefer clear and concise messaging regarding options, iv) a knowledgeable advocate on deep hand burns (such as a burn therapist) should be included in discussions on treatment options, v) the decision-making aid needs to be more engaging, vi) repeated use of the tool can support decision-making at different stages of recovery.

Conclusions
The decision-making aid is useful in outlining the patient’s values and recovery goals. It facilitates conversations and helps identify gaps in knowledge. This tool should be utilized multiple times to revisit treatment options throughout the recovery process.

Applicability of Research to Practice
For individuals with complex burn injuries, clinicians should consider the routine use of visual decision-making aids to better understand the patient’s values and recovery goals.
128 Use of Sublingual Dexmedetomidine for Burn Wound Care
Authors: Madsen Laura K , Mueller Scott W , Glasheen Jeffrey , Gibson Cameron , Wiktor Arek J 
Published: April 2024

Abstract

Introduction
Dexmedetomidine is a sedative with advantageous analgesic properties. Sublingual administration (SL DEX) has been used successfully in various populations. Burn patients experience high levels of pain and anxiety, often difficult to treat with conventional agents. The aim of this quality improvement project was to evaluate the safety and efficacy of SL DEX when given prior to burn wound care.

Methods
This was a pre-post paired analysis at an ABA verified burn center. Patients who had inadequate pain control during burn wound care utilizing our standard opiate/benzodiazepine/ketamine methods were eligible for SL DEX (2 mcg/kg) 30 minutes prior to wound care provided a baseline heartrate (HR) and mean arterial pressure (MAP) were 65 or greater. Rescue analgesia/anxiolysis, pain/sedation scores (RASS), and hemodynamic variables were the primary outcome measures. Each SL DEX session was matched to an equal amount of previous wound care sessions and averaged overall for efficacy and safety analysis.

Results
A total of 20 patients (79% male) received SL DEX. A total of 86 wound care sessions were analyzed, 43 with SL DEX administrations and 43 without. The median age and TBSA burned were 40 years and 10% (IQR 4.5-22.5), Prior to SL DEX intervention, all patients had already received an oral opiate + lorazepam, 80% oral ketamine, 30% IV DEX, and 30% IV ketamine. Pre-wound care medications and clinical variables were similar between the groups. Non-exclusive indications for SL DEX included: escalation of wound care analgesia 65%, step-down therapy from IV DEX in 35%, pre-emptive for donor site dressing take down in 25%. SL DEX was associated with a significant reduction of average fentanyl administered (166mcg vs 134mcg; P=0.039), average pain and maximum pain scores (7.4 vs 5.9, p=0.042 and 8.6 vs 6.7, p=0.002; respectively), and a numerically less midazolam and IV ketamine (1.37mg vs 1.08mg, p=0.076 and 65.6mg vs 29.7mg, p=0.123). Intra-wound care RASS were not significantly different with SL DEX (matched mean difference -0.06, p&gt;0.8). MAP and HR variables (maximum and minimum) were not different prior to, during, or following wound care.

Conclusions
SL DEX was associated with decreased rescue analgesia requirements and lower patient reported pain scores without causing adverse hemodynamic effects in the difficult to treat burn population. A larger controlled trial is required to elucidate the efficacy and safety of SL DEX for wound care tolerance in the burn population.

Applicability of Research to Practice
SL DEX provides a unique route of an adjunctive agent to improve wound care tolerability, pain, and sedation in difficult to treat patients. It may be a viable alternative to IV DEX for wound care de-escalation.
509 Comparative Analysis of Presepsin and Other Biomarkers in Sepsis Diagnosis Among Burn Patients
Authors: Kym Dohern 
Published: April 2024

Abstract

Introduction
Sepsis and septic shock are life-threatening conditions that pose significant challenges in the medical field, particularly among burn patients. Early and accurate diagnosis is crucial for effective treatment and improved patient outcomes. This study aims to evaluate the diagnostic and prognostic utility of presepsin, a novel biomarker, in comparison to other established biomarkers like procalcitonin, Red Cell Distribution Width (RDW), and platelet count among burn patients suspected of infection.

Methods
A prospective cohort study was conducted, involving 167 patients admitted to the Burn Intensive Care Unit (BICU) with suspected infection. Blood samples were collected within 24 hours of admission for the measurement of presepsin, procalcitonin, RDW, and platelet count. Patients were categorized based on the diagnosis and progression of sepsis and septic shock according to the Sepsis-3 criteria. The study employed logistic regression models to assess the predictive power of each biomarker.

Results
Out of the 167 patients, 133 were diagnosed with sepsis, and the overall mortality rate was 38.9%. Presepsin demonstrated moderate predictive power for sepsis with an Area Under the Curve (AUC) of 0.660. However, it was not statistically significant for predicting mortality. In contrast, RDW and platelet count showed higher predictive values with AUCs of 0.780 and 0.760, respectively.

Conclusions
While presepsin showed limited utility in the diagnosis and prognosis of sepsis and septic shock, other biomarkers like RDW and platelet count exhibited stronger predictive capabilities. These findings suggest that a multi-biomarker approach could enhance the early diagnosis and management of sepsis and septic shock in burn patients.

Applicability of Research to Practice
The study's findings have significant implications for clinical practice. Understanding the predictive potential of various biomarkers can guide clinicians in the early diagnosis and effective management of sepsis and septic shock, particularly in burn patients.
574 Identifying New or Unmanaged Co-Morbidities to Improve Burn Care Management and Establish Care
Authors: Pinto Desiree , Moffatt Lauren T , Travis Taryn E , Shupp Jeffrey W , Tejiram Shawn 
Published: April 2024

Abstract

Introduction
Chronic co-morbidities impact the management of burn patients, as well as their short and long-term outcomes. Conversely and cumulatively, burn injury and the resulting hypermetabolic state can also worsen chronic co-morbidities. The prevalence of diagnosed or undiagnosed existing co-morbidities in burn patients is not well characterized. This study aims to identify the prevalence of new and/or unmanaged chronic co-morbidities after burn injury with admission lab work to determine whether opportunities exist in this area to improve burn care management and manage co-morbidity care.

Methods
This retrospective review included all patients over the age of 18 years old admitted to a regional burn center over a 6-month period (Jan- July 2022). Patient demographics, burn injury characteristics, laboratory values for hemoglobin A1c (Ha1c) and screening tests for HIV and acute hepatitis were collected. Undiagnosed diabetes mellitus (DM) was defined as no prior diagnosis/documentation of DM, no prior medication prescribed for glycemic control, and Ha1c ≥ 6.5. Uncontrolled DM was defined as a prior diagnosis/documentation of DM and a Ha1c &gt; 9. New diagnosis of HIV was defined as no prior diagnosis/documentation of HIV, no anti-retroviral medication prescribed, and a positive screening HIV Ab/Ag result. A new diagnosis of hepatitis C was defined as no prior diagnosis/documentation of hepatitis C and a positive result on the acute hepatitis panel.

Results
Of the 268 patients who presented to the hospital for burn injury, 265 patients were included in the analysis. The mean age was 48.5 and 56% were male. Based on insurance status, 50% of patients had Medicaid/Medicare, 33% had private insurance, and 5% had no insurance. Within our population, 2.2% of patients experienced homelessness. Prior to admission, 16.9% of patients had a diagnosis of DM, of which 22% had uncontrolled DM. There were 7 patients (3.2%) newly diagnosed with DM, and about 60% of these patients had Ha1c levels &gt; 9, a level high enough to consider immediate initiation of insulin therapy. Other screening tests identified a new diagnosis of HIV in 4 patients (1.5%) and hepatitis C in 9 patients (4%). For patients previously diagnosed with HIV or hepatitis C, 22% had unmanaged HIV and 75% have never received treatment for hepatitis C.

Conclusions
Burn injury was used as an opportunity to identify patients with new or unmanaged chronic co-morbidities. A high prevalence was seen in our population, indicating a need to continue screening. Identifying co-morbidities impacted treatment management and referral to other providers, including diabetes educators, infectious disease, and primary care physicians.

Applicability of Research to Practice
A screening tool to identify new or unmanaged co-morbidities is easy to implement and has the potential to improve acute and long-term management and outcomes after burn injury.
726 Impact of Opioid-Minimizing Pain Protocols After Burn Injury: An Update of Previous Quality Improvement Project
Authors: Abeln Andrea , Klugh James , Donthula Deepanjli , Almand Catherine , Campbell Taylor , Jiang Chuantao , Freet Daniel J , Huzar Todd F , Wainwright David J , Wade Charles E , Kao Lillian S , Harvin John A 
Published: April 2024

Abstract

Introduction
In 2019, a single-burn center QI project resulted in a significant reduction in opioid prescribing at discharge. Such reductions were achieved through implementation of a pill-based, opioid-minimizing pain protocol. After completion, no additional QI interventions were sustained other than dissemination of the protocols to providers on the unit. We hypothesized that the reductions in opioid prescribing at discharge have been sustained since the QI project ended.

Methods
Three groups of patients admitted to the burn service were compared: 1) Pre (01/2018 to 07/2019), 2) Post (01/2020 to 06/2020), and 3) Follow up (7/2020 to 3/2023). The Pre and Post groups were the same as described in the original QI report. The protocol was implemented from 08/2019 to 12/2019 and these patients are not included. Patient demographics, burn characteristics, and lengths of stay were abstracted from the burn registry. Opioid prescriptions at discharge were obtained from the electronic medical record. The primary outcome was opioid prescribing at discharge. Groups were compared using Kruskal-Wallis rank test, Pearson’s Chi-squared, and Fisher’s Exact test for continuous, binary, and sparse binary outcomes, respectively.

Results
A total of 1,575 patients were included: 495 Pre Group, 174 Post Group, and 906 Follow Up Group. Patients differed between cohorts in median age and proportion of operative burns. The Follow Up Group had a continued reduction in opioid prescribing at discharge (61%) as compared to the Pre Group (83%). The most prescribed opioids at discharge in the Follow Up Group were: 1) oxycodone (76%), 2) tramadol (21%), and hydrocodone (3%).

Conclusions
The previously found reduction in opioid prescribing at discharge after implementation of opioid-minimizing protocols for acute burn pain were found to be sustained. This finding was present despite the significant increase in operative burns admitted to the burn center.

Applicability of Research to Practice
Long-term reduction of opioid prescribing at discharge can be achieved using opioid-minimizing acute pain protocols.
765 Charting a Path to Enhanced Burn Care: Standardized Note Templates and Resident Perspectives
Authors: Malkoff Nicolas , Cannata Brigette , Johnson Dania B , Choe Deborah , Johnson Maxwell B , Gillenwater Justin 
Published: April 2024

Abstract

Introduction
Common Data Elements (CDE) are standardized questions with a set of limited responses that are used systematically across multiple sites. They have been proposed as a means of standardizing clinical documentation and improving interinstitutional data sharing. Our previous work identified 33 CDEs relevant to burn care based on published recommendations and found that they were documented inconsistently in our burn center. Our aim was to assess current charting practices and attitudes toward CDE-focused note templates at our institution as part of a larger effort to standardize and improve clinical documentation quality.

Methods
Four note templates incorporating 33 CDEs were prepared for inpatient history and physical notes (H&P), floor daily progress notes (PN), intensive care unit progress notes (ICU PN), and discharge summary notes (DC). Prior to their implementation, residents who previously rotated through the burn unit from 1/1/2023 to 9/4/2023 were administered a pre-template survey to assess their experiences and attitudes relating to charting with and without templates. Results were summarized using descriptive statistics.

Results
The pre-template survey was completed by 14 residents. The majority reported spending 15-30 minutes on average documenting H&Ps (57%), ICU PNs (57%), and DC summaries (64%), while 86% spent less than 15 minutes documenting floor PNs. When asked to rate the burden of charting, 50% reported a 7 or higher on a 10-point scale. Only 7% were 90% confident or higher that they commonly document all 33 CDEs. Most (57%) claimed to record fewer than 20 of the CDEs on average. Assessing resident attitudes towards note templates, it was found 86% agreed or strongly agreed that they would reduce the time spent and the burden of charting. When asked if templates would improve their wellness, 57% agreed or strongly agreed. While 72% of residents agreed or strongly agreed that templates would help them more thoroughly evaluate patients, only 43% thought note templates would provide educational value.

Conclusions
Current charting practices in our burn unit are time-consuming and burdensome for rotating residents, which may contribute to suboptimal acquisition and reporting of critical data elements. Most residents expressed positive attitudes towards the implementation of standardized note templates. Future directions for this quality improvement initiative include implementing note templates to study the effects this has on the inclusion of CDEs in patient notes and residents' charting experiences.

Applicability of Research to Practice
Readers may consider the methodology and results of this study when evaluating charting practices at their own institutions.
Symbolic knowledge innovation through bricolage in the periphery: the Bauhaus movement
Authors: Kesidou Effie , Plakoyiannaki Emmanuella , Tardios Janja Annabel 
Published: April 2024

Abstract
In this article, we examine how symbolic knowledge innovation—that is, the recombination of ideas on aesthetic value in new ways—emerges in the periphery. While symbolic knowledge innovation drives growth, its role in creating new paths in the periphery is largely under-investigated. New path creation has been largely envisaged through macro (e.g., policy) or meso (e.g., industrial R&D) aggregates, overlooking micro-level actors (e.g., individuals), and their agency in mobilizing heterogeneous resources vital for innovation. Viewed in this light, we investigate how the interaction of actors at different levels (macro, meso, and micro) shapes symbolic knowledge innovation in the periphery. We draw on the case of Bauhaus movement to investigate symbolic knowledge innovation in the peripheries of Weimar and Dessau. Our findings illustrate symbolic knowledge innovation at the Bauhaus in terms of three phases, namely, semiotic codes: Bauhaus idea generation and articulation; material basis: development of Bauhaus artefacts; and material basis: Bauhaus commercial success. We further unpack actors’ agency and show how each phase of symbolic knowledge innovation emerges through bricolage. We contribute to the economic geography literature by showing the role of bricolage and actors’ agency in symbolic knowledge innovation for new path creation in the periphery.
DAS-VSP coupled noise suppression based on U-Net network
Authors: Xu Jing-Xia , Ren Hao-Ran , Zhu Zhao-Lin , Wang Tong , Chen Zhi-Hao 
Published: April 2024

Abstract
The emerging distributed fiber-optic acoustic sensing (DAS) technology has broad prospects for application in vertical seismic profiles (VSP). However, the acquired DAS-VSP data often suffers from coupled noise that seriously affects data quality. Traditional methods for suppressing coupled noise are usually time-consuming and not suitable for the large-scale denoising of DAS-VSP data. To address this, a coupled noise suppression method based on the U-Net network is proposed, and a self-attention (SA) block is introduced to enhance the denoising ability of the network. Transfer learning is employed to achieve coupled noise suppression from synthetic data to field data. Denoising results demonstrate that the network can effectively suppress coupled noise in DAS-VSP data while preserving signal energy to a certain extent, exhibiting strong generalization capability. Upon completion of network training, denoising results can be obtained within seconds, making it more convenient and efficient compared to traditional methods.
Optimizing a 5-factor cocktail to prepare reparative macrophages for wound healing
Authors: Yong Rong , Mu Ruoyu , Han Congwei , Chao Tzuwei , Liu Yu , Dong Lei , Wang Chunming 
Published: April 2024

Abstract
The treatment of nonhealing wounds, such as diabetic ulcers, remains a critical clinical challenge. Recent breakthroughs in cell therapy have shown great promise, with one primary focus on preparing cells with comprehensive reparative functions and foreseeable safety. In our previous study, we recapitulated the proregenerative and immunosuppressive functions of tumor-associated macrophages in non-tumor-derived macrophages, endowing the latter with characteristics for promoting diabetic wound healing—termed tumor-associated macrophage–educated macrophages. To eliminate the use of tumor-derived sources and devise a more controllable method to prepare tumor-associated macrophage–educated macrophage–like cells, in this study, we identify a cocktail comprising 5 recombinant proteins as an essential condition to induce nonpolarized macrophages into therapeutic cells with prohealing functions. The screened 5 factors are osteopontin, macrophage inflammatory protein 2, chemokine (C-C motif) ligand 8, vascular endothelial growth factor B, and macrophage colony-stimulating factor. We demonstrate the rationale for screening these factors and the phenotype of the 5 factor-induced tumor-associated macrophage-educated macrophage-like macrophages prepared from murine bone marrow–derived macrophages, which exhibit angiogenic and immunomodulatory effects in vitro. Then, we induce primary human monocytes from periphery blood into the 5 factor-induced tumor-associated macrophage-educated macrophage-like macrophages, which show prohealing effects in a human primary cell-based ex vivo model (T-Skin™). Our study demonstrates a simple, effective, and controllable approach to induce primary macrophages to possess repairing activities, which may provide insights for developing cell-based therapeutics for nonhealing wounds clinically.
The structure of Congolese shrew ensembles: competition and spatial variation in resource abundance
Authors: Van de Perre Frederik , Willig Michael R , Presley Steven J , Leirs Herwig , Verheyen Erik 
Published: April 2024

Abstract
Interspecific competition, environmental filtering, or spatial variation in productivity can contribute to positive or negative spatial covariance in the abundances of species across ensembles (i.e., groups of interacting species defined by geography, resource use, and taxonomy). In contrast, density compensation should give rise to a negative relationship between ecomorphological similarity and abundance of species within ensembles. We evaluated (1) whether positive or negative covariances characterized the pairwise relationships of 21 species of Congolese shrew, and (2) whether density compensation characterized the structure of each of 36 Congolese shrew ensembles, and did so based on the abundances or biomasses of species. In general, positive covariance is more common than negative covariance based on considerations of abundance or biomass, suggesting dominant roles for environmental filtering and productivity. Nonetheless, negative covariance is more common for ecomorphologically similar species, suggesting a dominant role for competition within functional groups. Effects of abundance or biomass compensation, via pairwise or diffuse competitive interactions, were detected less often than expected by chance, suggesting that interspecific competition is not the dominant mechanism structuring these ensembles. Effects of competition may be balanced by responses to variation in resource abundance among sites in a landscape or among niche spaces within sites. Future studies of compensatory effects should incorporate considerations of heterogeneity in the abundance and distribution of resources in ecological space to better isolate the effects of competition and resource abundance, which can have opposing effects on community structure.
Thermal adaptation in plants: understanding the dynamics of translation factors and condensates
Authors: Lohmann Julia , Herzog Oliver , Rosenzweig Kristina , Weingartner Magdalena 
Published: April 2024

Abstract
Plants, as sessile organisms, face the crucial challenge of adjusting growth and development with ever-changing environmental conditions. Protein synthesis is the fundamental process that enables growth of all organisms. Since elevated temperature presents a substantial threat to protein stability and function, immediate adjustments of protein synthesis rates are necessary to circumvent accumulation of proteotoxic stress and to ensure survival. This review provides an overview of the mechanisms that control translation under high-temperature stress by the modification of components of the translation machinery in plants, and compares them to yeast and metazoa. Recent research also suggests an important role for cytoplasmic biomolecular condensates, named stress granules, in these processes. Current understanding of the role of stress granules in translational regulation and of the molecular processes associated with translation that might occur within stress granules is also discussed.