bluuebunny/crossref_metadata_2025_split huggingface dataset:
286 A Comparison of Teleburn to In-person Consultations of Pediatric Patients in a Children’s Emergency Department
Authors: Ayers Claci , Byrd Hannah , Gondek Stephen , Kidd Rebecca , Mubang Ronnie , Solomon Barbara J , Wagner Anne L 
Published: August 2023

Abstract

Introduction
Regional Burn Centers provide burn care but there are disparities in access to regional burn centers for pediatric patients. Teleburn is a tool that enables providers without a certified burn center to provide photos of a burn to experts and receive recommendations on burn care. Our facility implemented a Teleburn system in December 2019. The purpose of this study is to evaluate the effectiveness of a Teleburn system to the gold standard in-person consultation in regards to burn infection rate, clinic follow up rate, post-burn admission rate, and 72-hour bounce back rate.

Methods
Data was collected from December 2019-March 2022 through the electronic medical record. A total of 416 patient encounters that met criteria were analyzed. The criteria for a Teleburn encounter are displayed in Fig. 1 and this was the criteria applied to the in-person burn consults. A non-inferiority study was designed comparing proportional outcomes of telemedicine burn initial visits to emergency department visits in regard to burn infection rate, clinic follow up rate, post-burn admission rate, and 72-hour bounce back rate. The data were compared with a difference of greater than 10% being considered inferior.

Results
Amongst the patient encounters 45.6% were female and ages ranged from 7 weeks to 19 years. Most common burn type was scald at 47.5%, with thermal being second at 43.7%. No differences were identified in rates of readmission - 1.67% difference (95% CI -27%&lt; x&lt; 23.8%) and return within 72 hours – 0.7% difference (-18.4%&lt; x&lt; 19.7%). Teleburn patients were 12.6% less likely to follow up (2.7%&lt; x&lt; 22.40%). Only one infection was identified, which is insufficient to conclude non-inferiority in terms of infection events.

Conclusions
While convenient, Teleburn consult could not be demonstrated to be non-inferior to in-person consultation. No differences in infection rates were identified, and difference in readmission and return were clinically insignificant. Efforts to improve follow-up may prove successful in raising the standard to that of in person visits given the large geographic areas covered by most regional burn centers.

Applicability of Research to Practice
This research advocates for more enhancement of Teleburn consult systems for pediatric acute minor burns and presents easily surmountable limitations. This study demonstrates that telemedicine may be effective and feasible to regional burn centers if follow up can be improved.
291 Hypernatremia Is Associated with Acute Renal Dysfunction in Severe Burn Patients
Authors: Obias Isabel B , Amador Dalton , Arceneaux Amy M , El Ayadi Amina , Golovko Georgiy , Karam Kathleen , Song Juquan , Soudah Chris K , Wolf Steven E 
Published: August 2023

Abstract

Introduction
Hypernatremia often occurs concurrently with acute kidney disease and is associated with increased mortality. It is a common electrolyte disorder presenting in severe burn patients, who are additionally at high risk for acute kidney disease. The purpose of this study is to determine if burn patients presenting with hypernatremia are at greater risk of developing acute kidney disease and related complications.

Methods
Patients diagnosed with severe burns (20% or more of total body surface area) were identified using the TriNetX Research Network and the relevant ICD-10 Codes. TriNetX is a national research database that provides real-time access to de-identified medical records.
Burn patients were stratified into hypernatremic (serum sodium ≥ 145 mmol/L) and eunatremic (serum sodium between 135 and 145 mmol/L) groups. Both groups excluded patients with a prior diagnosis of diabetes or hypothyroidism, as both may render patients more susceptible to electrolyte dysregulation. Patients with a personal history of diseases involving the circulatory, urinary, and respiratory systems were also excluded to control for pre-existing conditions that may affect the outcomes of this study.
We analyzed acute kidney disease, mortality, pulmonary edema, and respiratory failure one month after the onset of hypernatremia; these latter two complications are often associated with kidney injury. Statistical analysis was performed within TriNetX to generate the risk ratios and risk differences for each outcome.

Results
A total of 10,352 patients across 53 healthcare organizations were identified. Excluded from the study were 1,039 (10.04%) patients who were diagnosed with comorbidities. The remaining 9,313 patients were sorted respectively into the hypernatremic (n = 1,116) and eunatremic (n = 6,656) groups. The two cohorts were balanced using (1:1) propensity score matching for age, race, sex, ethnicity, and burn surface area.
The hypernatremic group showed a greater risk of developing acute kidney disease (risk ratio [RR], 4.343, p &lt; 0.001) and associated complications. Severe burn patients with hypernatremia had a 1.987 times greater risk of developing pulmonary edema (p &lt; 0.001), a 2.896 times greater risk of developing respiratory failure (p &lt; 0.001), and a 2.873 times greater 30-day mortality rate (p &lt; 0.001).

Conclusions
Hypernatremia in severe burn patients is associated with an increased risk of developing acute kidney injury, mortality, and related pulmonary complications.

Applicability of Research to Practice
This study indicates that hypernatremia is a potential marker for the development of renal and pulmonary complications.
294 Outcomes in Stevens-johnson Syndrome/toxic Epidermal Necroylsis Patients Treated Without Admission to a Verified Burn Center
Authors: Lewcun Joseph , Feldman Michael J , Kontzias Christina , Newsom Megan , Vagonis Alex 
Published: August 2023

Abstract

Introduction
The care of patients with Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necroylsis (TEN) has traditionally been delivered within a burn center. Our burn center utilizes a multi-disciplinary approach which involves admission to the medicine service, with support from the burn team. The aim of this study is to determine whether SJS/TEN patients cared for with our system, including burn involvement but not burn admission, demonstrate equivalent outcomes.

Methods
A retrospective review of all SJS/TEN patients admitted to the medicine service at a single academic medical center from 2009 to 2021 was conducted. Demographic characteristics and outcome measures such as mortality, length of intensive care unit (ICU) stay and total length of hospitalization were collected. The Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) was used to calculate expected mortality rates within the cohort [2]. The observed mortality rates were then compared to the expected mortality rates.

Results
126 patients who were admitted for SJS/TEN were included (70 SJS, 40 SJS/TEN overlap, 16 TEN). The mortality rate for the entire cohort was 10.32% as compared to a 22.33% expected mortality rate (p=0.010). The observed and expected mortality rates for SJS, SJS/TEN overlap, and TEN sub-groups were 1.43% observed versus 10.22% expected (p=0.029), 20.00% observed versus 35.83% expected (p=0.133), and 25.00% observed version 44.06% expected (p=0.264) respectively. The mean ICU length of stay was 3.58 days, and the mean length of total hospitalization was 11.69 days.

Conclusions
Mortality rates in SJS/TEN patients admitted to medicine units are equivalent or decreased as compared to SCORTEN predicted mortality rates.

Applicability of Research to Practice
Admission of SJS/TEN patients to a medicine unit is appropriate as long as there is burn team involvement in their care, which may be more suitable for patients who require management of complex medical comorbidities.
304 A Novel Burn Education Program in a New Comprehensive Burn Center
Authors: ONeill Keisha M , Hollowed Kathleen , Kahn Steven A , Lesher Aaron , Smith Tiffany 
Published: August 2023

Abstract

Introduction
In 2020 a large academic hospital with an existing pediatric burn program expanded its services to take adults. Prior to opening the comprehensive center, training and education for the nursing staff was designed and implemented, in amalgamation with the existing pediatric education program. This study describes and evaluates the implementation and efficacy of a novel burn nursing education program, established using the American Burn Association’s (ABA) nursing competencies and Kolb’s Experiential Learning Model.

Methods
For the purpose of this study Cohort 1 (C1) is defined as 83 nurses hired prior to 2021 and Cohort 2 (C2) is defined as 304 nurses hired after 2022.
Didactic and simulated education sessions were created and presented in tandem for both initial and ongoing competency. Didactic sessions were evaluated in two cohorts because the program content was redesigned after 2021. C1 was evaluated using a pre-posttest, whereas, C2 was evaluated using only a post-test. Simulated content was evaluated using the verification in practice method with a check off sheet created using institutional wound care guidelines. Course efficacy was evaluated by attendees using a 1-5 Likert scale.
Test scores from 2020-2022 were compared using a T-test with a p-value of &lt; 0.05 considered significant.

Results
To date 387 nurses have completed a written exam, been validated in practice, and if in C1, completed an annual ongoing burn competency activity. In 2020, C1 showed a statistically significant increase in pre and posttest scores from 66.87%±9.36 to 88.26%±7.90, p=0.000015. When C1 was retested in 2021 using the same posttest, the scores were 80%±1.73 in 2020 to 84.33%±3.84 in 2022, p=0.36. The mean score for posttests for C2 in 2022 was 88%.
Course evaluations returned by 155 nurses (77%) in 2020 indicated the course was too long, and some of the information was exorbitant for nursing practice. Therefore, in 2021 the course was redesigned. An additional 251 (65%) nurses have taken the course since, and have reported a mean of 4.5/5 for course efficacy and 4.9/5 for an increase in nursing confidence to care for the burn patient population.

Conclusions
The education program resulted in significantly higher posttest scores in C1 during the 2020-2021 period showcasing an increase in initial burn knowledge. Although the scores for C1 in 2022 were not statistically significant, the increase in mean scores shows the nurses not only retained the initial information, but built on it throughout the year with the addition of clinical practice. Nurses in C1 continue to practice at high levels and train nurses in C2 who reported the course was critical to their understanding of burn care. Nurses in both C1 and C2 will be required to complete an annual burn competency module to ensure ongoing competency in burn care.

Applicability of Research to Practice
Nursing Education
306 Review of CRRT in Burn Patients with Non-survivable Injuries
Authors: Brock Amanda D , Coffey Rebecca , Mandell Samuel P 
Published: August 2023

Abstract

Introduction
There is a subset of burn patients that have a non-survivable injury. Careful and thoughtful use of health care resources in this population is needed to provide end of life care. The purpose of this quality improvement project was to review patients with non-survivable injuries (NSI), started on continuous renal replacement (CRRT), to identify areas of improvement in end-of-life care.

Methods
A retrospective review of all patients admitted to one verified burn center from 1/1/2020 – 5/9/2022 who received CRRT as a life prolonging measure in patients with NSI. NSI was defined as modified BAUX predicted mortality of &gt;90 0 and/or significant comorbidities, peri burn events ( i.e. Delayed presentation, cardiac arrest in the field) and physician judgement as documented in the chart. Data points collected include, age, TBSA and BAUX scores, indication for CRRT, any documented goals of care discussions, duration of CRRT, days from admit to initiation of CRRT and additional blood products and CRRT filters.

Results
A total of 21 patients who received CRRT were reviewed. Of those, 1 survived, 2 had incorrect MRNs in the hospital database, leaving 17 patients who died for analysis. The median age was 68 (IQR 18). The median TBSA was 43% (IQR 42). There were 2 patients with 0 % TBSA, 1 sustained a lightning strike and 1 with inhalation only. The median BAUX was 112 (IQR 37). The median hospital Length of stay (LOS) was 12 days (IQR 24). The median time in days to start of CRRT from time of injury was 2.5 days (IQR 11.5). Median time of CRRT initiation to time of death was 48 hours (IQR 239.5 range of 2.5 hours to 720 hours.). Blood product and filter use related to the initiation of CRRT for the 17 patients is in Table 1.
Of the patients included in the review, there were several issues related to the initiation of CRRT. One had a DNR, but family did not provide documentation and/or follow patient’s wishes. Several families were offered CRRT as an option despite futility and then insisted on that progression of care. Others were started on CRRT to allow time for family to be located or to arrive before transitioning to comfort care.

Conclusions
In patients with NSI, CRRT was often initiated within 24 hours of death. In several cases, when comfort measure only was the known plan of care. This in turn led to increased use of blood products and filters. For patients with non-survivable injuries, establishing early goals of care and discussing end of life care is imperative.

Applicability of Research to Practice
Early goals of care conversations and thoughtful use of resources in patients with non-survivable injuries should be examined to determine the appropriateness of care offered and interventions provided.
Epidemiology and survival of adult-type diffuse glioma in Belgium during the molecular era
Authors: Pinson Harry , Silversmit Geert , Vanhauwaert Dimitri , Vanschoenbeek Katrijn , Okito Jean-Pierre Kalala , De Vleeschouwer Steven , Boterberg Tom , De Gendt Cindy 
Published: August 2023

Abstract

Background
Survival data of diffuse adult-type glioma is mostly based on prospective clinical trials or small retrospective cohort studies. Real-world data with large patient cohorts is currently lacking.

Methods
Using the nationwide, population-based Belgian Cancer Registry, all known histological reports of patients diagnosed with an adult-type diffuse glioma in Belgium between 2017 and 2019 were reviewed. The ICD-O-3 morphology codes were matched with the histological diagnosis. The gathered data were transformed into the 2021 World Health Organization classification of CNS tumors using the IDH- and 1p/19q-mutation status.

Results
Between 2017 and 2019, 2233 diffuse adult-type gliomas were diagnosed in Belgium. Full molecular status was available in 67.1% of identified cases. The age-standardized incidence rate of diffuse adult-type glioma in Belgium was estimated at 8.55 per 100 000 person-years and 6.72 per 100 000 person-years for grade 4 lesions. Median overall survival time in IDH-wild-type glioblastoma was 9.3 months, significantly shorter compared to grade 4 IDH-mutant astrocytoma (median survival time: 25.9 months). The 3-year survival probability was 86.0% and 75.7% for grades 2 and 3 IDH-mutated astrocytoma. IDH-wild-type astrocytoma has a worse prognosis with a 3-year survival probability of 31.6% for grade 2 and 5.7% for grade 3 lesions.

Conclusions
This registry-based study presents a large cohort of adult-type diffuse glioma with known molecular status and uses real-world survival data. It adds to the current literature which is mainly based on historical landmark trials and smaller retrospective cohort studies.
YTHDF2-mediated regulations bifurcate BHPF-induced programmed cell deaths
Authors: Lin Jiebo , Zhan Guankai , Liu Jinfeng , Maimaitiyiming Yasen , Deng Zhiping , Li Baohua , Su Kunhui , Chen Jiafeng , Sun Siqi , Zheng Wanlin , Yu Xianghui , He Feng , Cheng Xiaodong , Wang Lingfang , Shen Bin , Yao Ziqin , Yang Xinquan , Zhang Jian , He Wentao , Wu Hengyu , Naranmandura Hua , Chang Kao-Jung , Min Junxia , Ma Jun , Björklund Mikael , Xu Peng-Fei , Wang Fudi , Hsu Chih-Hung 
Published: August 2023

ABSTRACT
N6-methyladenosine (m6A) is a critical regulator in the fate of RNA, but whether and how m6A executes its functions in different tissues remains largely obscure. Here we report downregulation of a crucial m6A reader, YTHDF2, leading to tissue-specific programmed cell deaths (PCDs) upon fluorene-9-bisphenol (BHPF) exposure. Currently, Bisphenol A (BPA) substitutes are widely used in plastic manufacturing. Interrogating eight common BPA substitutes, we detected BHPF in 14% serum samples of pregnant participants. In a zebrafish model, BHPF caused tissue-specific PCDs triggering cardiac and vascular defects. Mechanistically, BHPF-mediated downregulation of YTHDF2 reduced YTHDF2-facilitated translation of m6A-gch1 for cardiomyocyte ferroptosis, and decreased YTHDF2-mediated m6A-sting1 decay for caudal vein plexus (CVP) apoptosis. The two distinct YTHDF2-mediated m6A regulations and context-dependent co-expression patterns of gch1/ythdf2 and tnfrsf1a/ythdf2 contributed to YTHDF2-mediated tissue-specific PCDs, uncovering a new layer of PCD regulation. Since BHPF/YTHDF2-medaited PCD defects were also observed in mammals, BHPF exposure represents a potential health threat.
Conferring liver selectivity to a thyromimetic using a novel nanoparticle increases therapeutic efficacy in a diet-induced obesity animal model
Authors: Wu Ruiling , Prachyathipsakul Theeraphop , Zhuang Jiaming , Liu Hongxu , Han Yanhui , Liu Bin , Gong Shuai , Qiu Jingyi , Wong Siu , Ribbe Alexander , Medeiros Jewel , Bhagabati Jayashree , Gao Jingjing , Wu Peidong , Dutta Ranit , Herrera Roman , Faraci Steve , Xiao Hang , Thayumanavan S 
Published: August 2023

Abstract
Optimization of metabolic regulation is a promising solution for many pathologies, including obesity, dyslipidemia, type 2 diabetes, and inflammatory liver disease. Synthetic thyroid hormone mimics–based regulation of metabolic balance in the liver showed promise but was hampered by the low biocompatibility and harmful effects on the extrahepatic axis. In this work, we show that specifically directing the thyromimetic to the liver utilizing a nanogel-based carrier substantially increased therapeutic efficacy in a diet-induced obesity mouse model, evidenced by the near-complete reversal of body weight gain, liver weight and inflammation, and cholesterol levels with no alteration in the thyroxine (T4) / thyroid stimulating hormone (TSH) axis. Mechanistically, the drug acts by binding to thyroid hormone receptor β (TRβ), a ligand-inducible transcription factor that interacts with thyroid hormone response elements and modulates target gene expression. The reverse cholesterol transport (RCT) pathway is specifically implicated in the observed therapeutic effect. Overall, the study demonstrates a unique approach to restoring metabolic regulation impacting obesity and related metabolic dysfunctions.
Disproportionate impact of COVID-19 severity and mortality on hospitalized American Indian/Alaska Native patients
Authors: Hurwitz Ivy , Yingling Alexandra V , Amirkabirian Teah , Castillo Amber , Khan Jehanzaeb J , Do Alexandra , Lundquist Dominic K , Barnes October , Lambert Christophe G , Fieck Annabeth , Mertz Gregory , Onyango Clinton , Anyona Samuel B , Teixeira J Pedro , Harkins Michelle , Unruh Mark , Cheng Qiuying , Leng Shuguang , Seidenberg Philip , Worsham Anthony , Langsjoen Jens O , Schneider Kristan A , Perkins Douglas J 
Published: August 2023

Abstract
Epidemiological data across the United States of America illustrate health disparities in COVID-19 infection, hospitalization, and mortality by race/ethnicity. However, limited information is available from prospective observational studies in hospitalized patients, particularly for American Indian or Alaska Native (AI/AN) populations. Here, we present risk factors associated with severe COVID-19 and mortality in patients (4/2020–12/2021, n = 475) at the University of New Mexico Hospital. Data were collected on patient demographics, infection duration, laboratory measures, comorbidities, treatment(s), major clinical events, and in-hospital mortality. Severe disease was defined by COVID-related intensive care unit requirements and/or death. The cohort was stratified by self-reported race/ethnicity: AI/AN (30.7%), Hispanic (47.0%), non-Hispanic White (NHW, 18.5%), and Other (4.0%, not included in statistical comparisons). Despite similar timing of infection and comparable comorbidities, admission characteristics for AI/AN patients included younger age (P = 0.02), higher invasive mechanical ventilation requirements (P = 0.0001), and laboratory values indicative of more severe disease. Throughout hospitalization, the AI/AN group also experienced elevated invasive mechanical ventilation (P &lt; 0.0001), shock (P = 0.01), encephalopathy (P = 0.02), and severe COVID-19 (P = 0.0002), consistent with longer hospitalization (P &lt; 0.0001). Self-reported AI/AN race/ethnicity emerged as the highest risk factor for severe COVID-19 (OR = 3.19; 95% CI = 1.70–6.01; P = 0.0003) and was a predictor of in-hospital mortality (OR = 2.35; 95% CI = 1.12–4.92; P = 0.02). Results from this study highlight the disproportionate impact of COVID-19 on hospitalized AI/AN patients, who experienced more severe illness and associated mortality, compared to Hispanic and NHW patients, even when accounting for symptom onset and comorbid conditions. These findings underscore the need for interventions and resources to address health disparities in the COVID-19 pandemic.
Towards elucidating species diversity of European inlandStrigamia(Chilopoda: Geophilomorpha): a first reassessment integrating multiple lines of evidence
Authors: Bonato Lucio , Bortolin Francesca , De Zen Giada , Decker Peter , Lindner E Norman , Orlando Marco , Spelda Jörg , Voigtländer Karin , Wesener Thomas 
Published: August 2023

AbstractStrigamia centipedes are widespread in European forest soils. However, a complex and inconsistent taxonomy has developed over time. Based on a modern species concept, we evaluated multiple lines of evidence for speciation among inland populations of Strigamia from the Italian region to the Baltic region, across central Europe. Hypotheses of species delimitation were drawn independently from: (1) morphological differentiation, by means of model-based cluster analyses of 52 specimens, after controlling for allometry and sexual dimorphism; (2) syntopy of morphologically distinct individuals, assumed to be representatives of coexistent species, from &gt; 700 sites; and (3) molecular differentiation, by various methods applied to cytochrome c subunit I sequences of the same 52 specimens. Diagnoses and geographical distributions were revised by re-examining &gt; 2000 specimens and the entire literature. We found preliminary evidence for: a Strigamia acuminata species complex, widespread, including a candidate species from the Eastern Alps differing in the forcipules; a Strigamia carniolensis species complex, hitherto often called Strigamia crassipes, widespread south of the Alps but absent from Sicily; a Strigamia crassipes species complex, hitherto often called Strigamia transsilvanica, more widespread than previously known, including three candidate species co-occurring in the Western Alps and differing in body size and the number of legs despite little genetic divergence; and Strigamia engadina, exclusive to a narrow part of the Central Alps.