bluuebunny/crossref_metadata_2025_split huggingface dataset:
603 A Burn Survivor- & Burn Community Stakeholder-Generated & Prioritized Research Agenda
Authors: Thompson Callie M , Webb Crystal D , Lewis Giavonni M , Prazak Ann Marie B , Quinn Kristen C 
Published: April 2024

Abstract

Introduction
Burn survivors are involved in burn research but typically as a research subject. We believe that the outcomes & impact of burn research can be improved by engaging survivors as collaborators in the planning, implementation, & dissemination of burn research. The goal of the work presented here was to produce the first research agenda generated & prioritized by burn survivors & other invested members of our burn community.

Methods
A research collaborative with a focus of co-production with burn survivors was formed in early 2022. This collaborative is run by governance committees, the majority of whom are burn survivors. Other members of the governance are family members & caregivers of burn survivors, & members of the burn community. The first goal of the collaborative was to form a stakeholder-generated & prioritized agenda for future burn research. The collaborative decided on 4 broad topics for Engagement Sessions (ES) in addition to a 5th topic of “Barriers to Participate in Research”. We then held 16 separate ES with burn survivors & their caregivers. The collaborative leadership then identified specific research questions/topics from the ES transcripts & prioritized those questions via anonymous survey. Notably, all participants in the ES & all committee members were compensated for their time.

Results
In over 26 hours of ES, 117 participants shared their thoughts on 5 broad topics: patient & family education, aftercare, navigating the healthcare system, recovery-physical & psychosocial, & barriers to research participation. From these sessions, 37 research question/topics were identified & ranked. In addition, 19 research barriers were identified & ranked. The top 10 research topics/questions are shown in Table 1. The top 3 barriers to research were: timing for researchers & survivors doesn’t line up (ex: researchers want to study 2 weeks after injury but patients are not in a place to participate), lack of understanding of the expected outcome or benefit, & lack of resources to have bandwidth to participate.

Conclusions
Burn survivors & their caregivers are experts in their lived experiences. By involving them in burn research as collaborators & contributors from the very first steps of research & throughout the continuum of planning, implementing, & dissemination of findings, we believe that the research will be both more successful & more impactful. We have taken the first steps to form the first co-produced collaborative & the first stakeholder generated research agenda for the burn community.

Applicability of Research to Practice
Our research collaborative is a well-informed & invested group that can participate in future studies. This research agenda will be readily available & all are encouraged to answer the questions that our burn survivors have identified to be the most pressing.
709 Scar-Related Outcomes in Burn Patients with Heterotopic Ossification
Authors: Sim Danielle J , Kuo Keith T , Caffrey Julie A 
Published: April 2024

Abstract

Introduction
Heterotopic ossification (HO) and aberrant scar formation are pathologic wound healing processes that may occur after burns. Hypertrophic scars occur in up to 70% of burn patients and can negatively affect quality of life. HO is characterized by the development of osseous lesions in the soft tissue and occurs in about 3.5% of burn patients, causing significant pain and delays in rehabilitation. Burns can incite a prolonged systemic inflammatory response involving innate and adaptive immune mediators, and this process has been shown to play a role in the development of both hypertrophic and keloid scars as well as HO. TGF-β1-producing macrophages are also implicated in excess extracellular matrix deposition and osteogenic differentiation in pathologic scarring and HO, respectively. Given the similar biologic mechanisms involved in these sequelae, this study aims to identify the clinical impact of HO on scarring in burn patients.

Methods
The Burn Model System (BMS) National Database was queried from August 1, 2015 - May 2, 2022 to identify adult patients (=&gt;18 years) with and without HO at discharge. Patients with a burn etiology other than thermal, acid, or electrical were excluded. RStudio 4.3.0 (Posit, Boston, MA) was used for statistical analyses.

Results
In this sample, 135 (3.3%) patients had HO at discharge. The HO group was younger and exhibited a greater proportion of flame burns compared to non-HO group. The HO sample also had a larger average %TBSA and a higher incidence of other injuries.
On multivariate logistic regression, after controlling for sex, age, other injuries, and etiology, HO patients were more likely to have surgery for scar management at least once during the 24-month follow-up period (OR 2.43, 95% CI: 1.43—4.04, p&lt; 0.001). HO patients were also more likely to report use of medications for itch symptoms (OR 1.80, 95% CI: 1.00—3.05, p = 0.0382). There was no difference in the incidence of pruritis between the two groups.

Conclusions
Patients with HO sustained more severe injuries than non-HO patients and required more frequent surgical and medical scar management. The increased use of itch medications suggests that HO patients experienced more severe symptoms despite having a similar incidence in pruritis overall. Therefore, HO is associated with worse scar outcomes after burns, potentially through immune-related mechanisms involved in both processes. Pruritis may also be related to a prolonged systemic inflammatory response as it is stimulated by cytokine IL-31 via induction of TGF-β1. Future research should identify methods of attenuating the immune response to prevent these sequelae without compromising wound healing or infection control.

Applicability of Research to Practice
This study advocates for increased awareness of symptomatic scarring in patients with HO. It also indicates the need to develop an immunomodulatory approach for reducing the risk of pathologic wound healing sequelae.
712 Outcomes of Transplants with CEA Derived from a Modified Composite Culture Technique: A Case Series
Authors: Kleintjes Wayne G , Prinsloo Tarryn K 
Published: April 2024

Abstract

Introduction
Establishing low-cost and efficient culture environments comparable to standard techniques would undoubtedly improve technique usage in under-resourced settings. The aim of this prospective, cohort case series was to report on the CEA graft-take using a modified culture technique that could benefit under-resourced clinical environments in terms of CEA accessibility and expense.

Methods
Burn patients (n=25) with low survival prognosis, large total body surface area (TBSA), and/or exhausted donor sites were transplanted with CEA grown on routinely used hydrophobic gauze in a pediatric incubator. Transplants occurred at our specialized Burns Centre between October 2014 and March 2016, following emergency ethical approval. Keratinocytes were retrieved from 3 x 2 cm full-thickness skin biopsies, placed in trypsin solution, and seeded onto the gauze. The cells were incubated in pediatric incubators at 37 °C and fresh autogenous plasma was applied daily while Intrasite gel® every third or fourth day until confluency on day 14 was reached. CEA was transplanted onto the debrided wound beds. Xenografts were used for temporary cover during the culture period. Graft take was assessed on burns patients that survived after the CEA transplant for ≥ 21 days (final assessment). The primary outcome was graft take, calculated as a surface area percentage of skin graft to CEA and the secondary outcome was main complications (nutrition, perineum burns, and hypoxic brain). Central indices were described as mean (95% CI) and/or frequency (%) for the following parameters: age, %TBSA, abbreviated burn severity index (ABSI) scores, % survival relative to ABSI and % graft take.

Results
Eleven patients (44%) survived until the final assessment (mortality occurred during the culture period), however, one case was excluded since treatment was for cosmetic purposes. Of the transplant cases, 10 out of 11 patients survived. A mean age of 36.1 years (95% CI 25.8-46.4), 45.0 %TBSA burns (95% CI 35.1-54.9), 9.7 ABSI scores (95% CI 8.6-10.8) and 79.5% graft take (95% CI) was observed. Reduced graft take (61.2%) was observed in patients with perineum burns compared to those with the remaining reported complications (91.8%).

Conclusions
CEA graft take was 79.5% using a low-cost culture technique was comparable to the largest CEA-based case series in literature. The survival of the major burn cases was highly favourable considering the severity of injuries, expected outcomes without CEA and the reported challenges.

Applicability of Research to Practice
Consistent graft take with a reliable, low-cost CEA method has been elusive until this method was applied in our setting. There is a potential for this method to be applicable in other settings as well and therefore make a value contribution to the accessibility of CEAs in general.
731 A Distressing Trend: Increased Prevalence of Self-Immolation Burns in a Single Burn Center
Authors: Hollowell Jamie L , Maxwell Eli , King Booker , Williams Felicia 
Published: April 2024

Abstract

Introduction
Attempting suicide via self-immolation is one of the more traumatic injuries leading to burn center admission. Patients with acute or acute-on-chronic suicidality are now faced with coping with a new trauma, and often were poorly resourced prior to burn center admission. These patients require a multidisciplinary approach to optimize their healing while addressing their mental health. We aimed to describe the increase in prevalence of self-immolation burns in our burn center.

Methods
Patients were identified using the Institutional Burn Center registry and linked to the clinical and administrative data. All patients admitted to the BICU between January 1, 2018, to Sept 30, 2023, were included. Demographics, length of stay (LOS), co-morbid conditions, and mortality were evaluated.

Results
There were a total of 45 patients over the 5-year, 9 month period. There were six self-immolations each year for 2018-2020. There were eight self-immolation admissions for 2021, nine for 2022, and ten for 2023, as of September 30, 2023. The patients were majority male, with 31 males and 14 females; average age was 35.4, (12-69); average TBSA was 21% (0 to 95%), most common etiology was flame with accelerant.

Conclusions
There continues to be a mismatch between the need for and access to mental health providers and resources in the community at large, leading to an yearly increase in the frequency of self-immolation admissions in our burn unit. These patients present unique challenges that require multidisciplinary coordination, with many patients still lacking appropriate disposition at discharge, taking up valuable burn center beds. Self-immolation as a form of suicide adds a new layer of emotional trauma for the patient, and often for the staff, which can make their recovery and rehabilitation that much more difficult. The ongoing mental health crisis in our country will likely see a further increase in these tragic injuries and the burn community needs to develop additional prevention and treatment strategies for this population.

Applicability of Research to Practice
This study reinforces the need for additional mental health resources with enhanced access for the community at large. The increased admission rate demonstrates an ongoing need for psychiatric care in the at-risk burn trauma population.
767 Preoperative Edema Management for the Burned Hand
Authors: Lucio J Xavier , Anyan Walter R , DuRose Lily , Ellsworth Madelyn P , Fleming Irma D , Lewis Giavonni M , Thompson Callie M , LaChapelle Christopher R 
Published: April 2024

Abstract

Introduction
At admission, we manage hand burns in four ways: (1) pre-operative hand edema control through elevation and application of ace bandages over the dorsal hand, (2) range of motion (ROM) protocols based on injury depth are used to restrict ROM to the digits to avoid injury to the ligamentous/tendinous structures of the hand/digit, (3) use of an intrinsic plus position hand splint, and (4) applying a silver sulfadiazine, gauze and netting dressing.
This practice has done an unsatisfactory job at reducing hand edema, resulted in prolonged immobilization and ROM restrictions, limited our patients’ ability to use their hands immediately post injury and ultimately lead to suboptimal functional outcomes at discharge.
As result, our center initiated a more aggressive pre-operative edema management plan which includes a preoperative self-adherent compression dressing (SACD) and a consistent practice for hand elevation.

Methods
Upon admission, a thorough hand assessment is done. Edema management is started within 24 hours of admit. The hand injury is placed in clear antibiotic ointment and SACD. Elevation is managed with pillows stacked so the hand is consistently above the bedrail. Figure of 8 measurements are taken every other day when SACD is changed. This process continues until the edema has stabilized at which time a glove compression is applied. If edema increases after the glove compression is started, the patient returns to a SACD until the edema remains stable.

Results
A total of 10 patients were treated with this protocol (8 B hands, 2 R hands, 18 hands total). All subjects were right hand dominant, nine males, and ages ranged from 17-74 years of age. TBSA burn ranged from 1-24% with (n=6) having TBSA &lt; 10%. Split thickness autograft was placed on 16 hands (9R/7L). Figure of 8 values decreased during the pre- and post-operative phases of care (Table 1). No hand infections were noted. Composite flexion was improved at D/C: 12 hands (67%) able to make a full composite fist, 4 hands (22%) unable and 2 hands (11%) were not allowed to attempt due to ROM restriction per the surgeon (Figure 1).

Conclusions
This approach better manages edema associated with all depths of hand burns and leads to better functional outcomes at D/C.

Applicability of Research to Practice
We anticipate that this practice will allow us to move beyond our restrictive ROM protocols and reconsider pre-operative splinting practices. Which, in turn, will allow us to be able to progress patients' hand function more rapidly.
790 A Single Institution’s Surgical Model for Pediatric Burns with ≤ 10% Body Surface Area Involvement
Authors: Fish Joel , Lee David , Chakera Hawwa , Kelly Charis , Zuccaro Jennifer 
Published: April 2024

Abstract

Introduction
Burn injuries continue to be prevalent in the pediatric population and are the fifth most common cause of non-fatal injury according to the World Health Organization. Unlike the adult population, most pediatric burns in the United States are small in size and are often the result of scalds. Despite the high incidence of small burns, a standardized treatment algorithm does not currently exist, and care is often influenced by clinical judgement and resource availability. As a result, various techniques to close the burn wound and promote further healing are currently utilized. This study explores the utility of a multi-stage grafting technique, involving allograft and autograft, for treating small burns (≤ 10% total body surface area (TBSA)) in pediatric patients.

Methods
A retrospective review of patients aged 0-18 years who had a burn that was ≤ 10% TBSA and underwent a multi-stage grafting procedure involving the use of allograft and autograft between 09-01-2018 and 09-01-2022 was conducted. Demographic information including data pertaining to the burn injury was collected for all patients. The primary outcome measure for this study was the percentage of graft take at the graft dressing takedown procedure. All variables were summarized using descriptive statistics. P values &lt; 0.05 indicated statistical significance.

Results
One hundred and sixty-eight patients met the inclusion criteria for this study. The mean time from presentation to allograft surgery was 10.8 days (SD 5.6) followed by autograft surgery approximately one week later. Most patients were discharged within 24 hours following allograft surgery (88.1%) and autograft surgery (80.9%). Mean autograft take was 97.7% (SD 11.1%) with only four patients experiencing significant graft loss requiring subsequent re-grafting. The main causes of graft loss were infection and inadequate excision of the wound bed.

Conclusions
This analysis revealed that patients who underwent a multi-stage grafting procedure involving the use of allograft and autograft experienced minimal graft loss. These positive outcomes demonstrate that the multi-stage grafting technique, which has traditionally been employed for larger burn injuries, can be successfully adapted for smaller burns in children. Moreover, the findings from this study help to address the significant knowledge gap regarding the optimal approach to treating small burn wounds. Further research in this area is warranted to learn more about cosmetic outcomes following multi-stage grafting and determine how it compares to other techniques for treating small burns.

Applicability of Research to Practice
The findings from this study will allow us to begin benchmarking our treatment of small burn wounds with other centers resulting in improvements in patient care and outcomes.
Persistent homology reveals strong phylogenetic signal in 3D protein structures
Authors: Bou Dagher Léa , Madern Dominique , Malbos Philippe , Brochier-Armanet Céline 
Published: April 2024

Abstract
Changes that occur in proteins over time provide a phylogenetic signal that can be used to decipher their evolutionary history and the relationships between organisms. Sequence comparison is the most common way to access this phylogenetic signal, while those based on 3D structure comparisons are still in their infancy. In this study, we propose an effective approach based on Persistent Homology Theory (PH) to extract the phylogenetic information contained in protein structures. PH provides efficient and robust algorithms for extracting and comparing geometric features from noisy datasets at different spatial resolutions. PH has a growing number of applications in the life sciences, including the study of proteins (e.g. classification, folding). However, it has never been used to study the phylogenetic signal they may contain. Here, using 518 protein families, representing 22,940 protein sequences and structures, from 10 major taxonomic groups, we show that distances calculated with PH from protein structures correlate strongly with phylogenetic distances calculated from protein sequences, at both small and large evolutionary scales. We test several methods for calculating PH distances and propose some refinements to improve their relevance for addressing evolutionary questions. This work opens up new perspectives in evolutionary biology by proposing an efficient way to access the phylogenetic signal contained in protein structures, as well as future developments of topological analysis in the life sciences.
Jurisdiction in Switzerland in cross-border successions
Authors: Weiss Kinga M , Müller-Zhang Michael 
Published: April 2024

Abstract
When a legal dispute has an international or so-called “cross-border” connection before the Swiss courts or authorities, the private international law of Switzerland (codified in the Federal Act on Private International Law) determines whether Swiss courts and authorities have jurisdiction, which substantive law is applicable, and the recognition and enforcement of foreign decisions, measures, deeds, and rights. In Swiss international law, “residence” is the main connecting factor. Thus, the terminology of “residence” is to be defined, as it is typically the entry point of any case heard in Switzerland, which does not necessarily follow the tax authorities’ or other authorities’ assessment or tax rulings for residency. In recent years, the Federal Supreme Court has had the chance to decide on various cases where residence in cross-border inheritance cases was disputed and some findings led to unexpected and unintended results.
Assessment of Rehabilitation Practices During Hematopoietic Stem Cell Transplantation in the United States: A Survey
Authors: Leite Victor F. , Oza Sonal , Parke Sara C. , Barksdale Touré , Herbert Aliea E. , Bansal Vishal , Fu Jack B. , Ngo-Huang An 
Published: April 2024

Background:
Rehabilitation therapy is important to treat physical and functional impairments that may occur in individuals receiving physically taxing, yet potentially curative hematopoietic stem cell transplants (HSCTs). However, there are scarce data on how rehabilitation is delivered during HSCT in real-life setting. Our objective is to assess the rehabilitation practices for adult patients hospitalized for HSCT in the United States.

Methods:
We conducted a 48-question online survey with cancer centers with the top 10% HSCT volumes (per American registries). We obtained data on patient characteristics, rehabilitation therapy details (timing, indication, and administering providers), physical function objective and subjective outcome measures, and therapy activity precautions.

Results:
Out of 21 institutions, 14 were included. Rehabilitation therapy referrals occurred at admission for all patients at 35.7% of the centers for: functional decline (92.9%), fall risk (71.4%), and discharge planning (71.4%). Participating institutions had physical therapists (92.9%), occupational therapists (85.7%), speech-language pathologists (64.3%), and therapy aides (35.7%) in their rehabilitation team. Approximately 71% of centers used objective functional measures including sit-to-stand tests (50.0%), balance measures (42.9%), and 6-minute walk/gait speed (both 35.7%). Monitoring of blood counts to determine therapy modalities frequently occurred and therapies held for low platelet or hemoglobin values, but absolute neutrophil values were not a barrier to participate in resistance or aerobic therapies (42.9%).

Conclusion:
Rehabilitation practices during HSCT varied among the largest volume cancer centers in the United States, but most centers provided skilled therapy, utilized objective, clinician- and patient-reported outcomes, and monitored blood counts for safety of therapy administration.