bluuebunny/crossref_metadata_2025_split huggingface dataset:
782 The Effect of Medical Comorbidites on Mortality in Burn Patients
Authors: Satahoo Shevonne S , Okeke Barbara , Kaufman Joyce I , Nabeta Geraldine , Pizano Louis R , Schulman Carl I 
Published: August 2023

Abstract

Introduction
Age, percent total burn surface area (TBSA) burn, and presence of inhalation injury have been well accepted as prognostic factors associated with burn injury. However, there may be additional comorbidities that affect mortality to consider. Recently published data include comorbidities specifically in the elderly population or focus on a specific comorbidity. As such, this analysis sought to identify comorbidities with a more comprehensive approach while focusing on the adult population.

Methods
The National Inpatient Sample was queried for all patients with age 18-65 years with ICD-9 codes for total body surface area (TBSA) burn ≥ 20% and non-elective admissions. Years included were 2013- third quarter of 2015. Age, race, comorbidities and mortality were recorded. Cases with missing data for mortality were excluded. Statistical analysis was done with Chi-Square testing. Mortality was then used to perform a binary logistic regression using these variables.

Results
There were 5545 weighted cases. The median age was 41.0 years (IQR 29-52 years). Mortality was 14.7%. The presence of AIDS, chronic blood loss anemia, chronic pulmonary disease, congestive heart failure, peptic ulcer disease (excluding bleeding), peripheral vascular disease, renal failure, rheumatoid arthritis/collagen vascular disease, and solid tumor without metastasis were not found to be statistically significant. The significant variables were then entered into a binary regression model on mortality. For the regression analysis, age, gender and race were also included. Age and race were statistically significant (p &lt; 0.001 for both), while gender was not (p=0.072). While significant on univariate analysis, alcohol abuse (p=0.059), diabetes with chronic complications (p=0.244), metastatic cancer (p=0.999), psychoses (p=0.053) and valvular disease (p=0.998) were no longer significant on multivariate analysis. The results of the significant comorbidities are listed in the table. In those who died, there were increased odds of having coagulopathy, uncomplicated diabetes, liver disease, paralysis, pulmonary circulation disorders and obesity.

Conclusions
Identification of these significant comorbidities potentially highlights the need for updated models to assist clinicians in determining risk of mortality in burn patients. Theses comorbidities also point to the importance of resources for primary care physicians to optimize these patient populations and potentially minimize the risk of complications should patients become injured.

Applicability of Research to Practice
293 Risk of Clostridium Difficile Enterocolitis in SJS/TENS Patients Treated with Antibiotics
Authors: Skidmore Savannah , Hink Ashley , Kahn Steven A , Ozhathil Deepak 
Published: August 2023

Abstract

Introduction
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are both rare conditions derived from adverse drug reactions. SJS/TENS patients are often treated with antibiotics, both prophylactically and therapeutically, for secondary infections. However, the subsequent development of Clostridium Difficile (C. Difficile) enterocolitis is unknown. Due to the rarity of SJS/TENS, institution trials are limited in their data quantify the additional risk of sequelae such as enterocolitis development after antibiotic administration. Therefore, we used a large commercially available database derived from inpatient hospital coding data to assess the incidence of C. Difficile enterocolitis within 2 weeks of antibiotic administration after development of SJS/TENS.

Methods
: Our study utilized a large commercially available database. Inclusion criteria identified adult patients ( &gt;18 years old) diagnosed with SJS/TENS between 2002 and 2022, who were treated with antibiotics within 2 weeks of diagnosis, and who subsequently went on to develop Clostridium Difficile enterocolitis within 6 months. We compared our cohort to a control group which did not receive antibiotics and propensity score matched them for age, sex, race, HIV status, cancer, transplant status, and severe sepsis and SIRS and analyzed the risk of developing C. Difficile enterocolitis.

Results
There were 4,792 SJS/TENS patients who did not receive antibiotics and 5,652 who did. Our matched cohorts contained 4,595 patients. The relative risk of mortality between our cohorts was 4.962 (RR: 2.562, CI 95% 2.125-3.088; p&lt; 0.0001). SJS/TENS who received antibiotics developed C. Difficile 68/4595 vs 30/495 and had a relative risk of 0.827% (RR: 2.267, 1.478-3.476, CI 95%; p&lt; 0.0001). Therefore, an SJS/TENS patient incurred a 2.267 times higher risk of developing C. difficile enterocolitis after receiving antibiotics.

Conclusions
While causality cannot be affirmed with retrospective data, our findings do suggest that patients with SJS/TENS due to the statistically significant risk of C. Difficile enterocolitis development. However, the overall absolute risk of C. difficile enterocolitis remains disproportionately low in this population that warrants further exploration.

Applicability of Research to Practice
SJS/TENS patients are difficult to develop evidence-based treatment plans for because of their rarity and the multitude of conflicting small cohort studies available in the literature. Our study utilizes a large database to more robustly suggest that clinicians should be cautious about administering antibiotics to patients diagnosed with SJS/TENS.
295 Topical Tranexamic Acid in Burn Surgery – A Randomized Controlled Trial
Authors: Colclough Robert Norheim , Almeland Stian Kreken , Ausen Kjersti , Brekke Ragnvald Ljones L , Nordgaard Håvard , Pleym Hilde , Spigset Olav 
Published: August 2023

Abstract

Introduction
Early excision and grafting of large burn wounds can result in considerable bleeding. Systemic use of tranexamic acid (TXA) generally reduces surgical bleeding by 30-40%, but its safety in burn surgery has not been studied. Topical use may provide a sufficient wound concentration with negligible risk of systemic adverse events. However, it is unclear whether topical use may delay wound re-epithelialization. This pilot double-blinded randomized controlled trial aimed to evaluate the therapeutic potential of topical TXA for reducing blood loss and the effect on wound re-epithelialization in burn surgery.

Methods
Between Jan 2021 – April 2022, burn patients at a single national burn center who needed at least two separate donor sites for split-thickness skin grafting were included. In total, 36 wound pairs in similar anatomical areas were made in 23 patients. Donor sites were infiltrated with tumescence containing epinephrine before harvesting. Paired wounds were randomized to topical application of standard epinephrine solution, with or without added TXA 25 mg/ml, before coverage with vaseline and dry gauze. Endpoints were time to re-epithelialization and surrogate bleeding estimates defined as net weight gain of dressings per cm2 wound area, bloodstain area per wound area, and visual rating of the amount of blood in dressings on the first postoperative day.

Results
There was no difference in healing time between wounds. The results trended towards less increase in dressing weight gain per cm2 of wound area in the TXA group, though not significant (p=0.12). However, when dividing the results in two at the median bleeding volume, there was a significant reduction in bleeding in the high-bleed group (p=0.012). Similar observations were made for the other two bleeding endpoints, but the differences did not reach statistical significance.

Conclusions
Moistening a superficial wound surface with TXA 25 mg/ml does not impair wound re-epithelialization. Topical TXA may reduce bleeding from graft donor sites with low risk of systemic complications.

Applicability of Research to Practice
This pilot study suggests that topical TXA is of value in reducing bleeding in burn surgery without delaying donor site healing. The effect may be larger in wounds not prepared with epinephrine infiltration. More research is warranted regarding the optimal mode of topical drug delivery and systemic concentrations after topical application in burns. Furthermore, it remains to investigate whether topical TXA affects graft take.
297 Pressure in the Operating Room (OR): another Possible Contributor to Hospital Acquired Pressure Injuries (HAPIs)
Authors: Milazzo Thomas , Cartotto Robert , Loo Hannah , Rogers Alan D 
Published: August 2023

Abstract

Introduction
Burn patients are at risk for HAPIs. An unexamined factor that may contribute to HAPI development is the effect of pressure from the OR table. Burn patients often require multiple prolonged surgical procedures. The purpose of this study was to measure pressure on the buttocks and sacral area during burn OR procedures under general anesthesia (GA). This has not been previously assessed in the burn literature.

Methods
Prospective study of consecutive adult burn patients admitted to an ABA-verified burn center who required surgery under GA between 06/01/22 and 08/12/22. We studied only cases that were supine, including those with both legs down (BLD), one leg suspended (one leg up: 1LU) or both legs suspended (two legs up: 2LU). Pressures on the buttocks and sacral area were measured using a commercial sensor mat which sent continuous real-time pressure measurements wirelessly to a laptop computer. Thousands of individual pressure measurements were integrated and organized to show average and peak pressures over repetitive 10-minute intervals during the entire operative procedure. Also, a continuous visual color-coded map of the sacral and buttock areas showing high ( &gt;75 mmHg-red), medium (10-75 mmHg -yellow) and low ( &lt; 10 mmHg -blue/green) pressures was created for each procedure. Results are shown as mean ± SD.

Results
Recordings were completed in 41 procedures (35 acute excision & grafting, 5 reconstructive, 1 tracheostomy) among 28 patients ( 48 ± 17 yrs, % TBSA burn 19 ± 17, weight 80 ± 20 kg, BMI 27 ± 6). During BLD, over 125 ± 81 min, the average pressure (Pave) was 47 ± 7 mmHg and peak pressure (Ppeak) reached 82 ± 23 mmHg. During isolated 1LU periods, Pave was 53 ± 9 mmHg over 74 ± 58 minutes with a Ppeak of 93 ± 23 mmHg and during isolated 2LU, Pave and Ppeak were respectively 55 ± 10 mmHg over 78 ± 40 min and 98 ± 23 mmHg. Both Pave and Ppeak increased significantly from procedures with BLD to 1LU to 2LU (p&lt; 0.001). Pave crept steadily upwards during both BLD and 1LU or 2LU procedures (Figure). We observed that Pave had a positive relationship with weight, regardless of operative position.

Conclusions
Prolonged moderate to high pressures are exerted on the sacral and buttock areas, especially with one or both legs suspended, during burn surgery. These novel observations suggest that pressure from the OR table could contribute to HAPI development.

Applicability of Research to Practice
With this risk identified, interventions to lower or interrupt pressure exposure during burn surgery should be identified next.
301 Youtube as a Source of Information for Skin Graft Procedures
Authors: Torres Grant B , Branski Ludwik K , Brondeel Kimberley C , Kamma Sai , Nus Bradley , Sledge Trey , Wu Kylie 
Published: August 2023

Abstract

Introduction
YouTube, one of the most popular sites on the internet, has become a primary source of healthcare information for patients. Although YouTube videos about skin graft procedures have accrued millions of views, there lacks a publication defining their educational quality. With recent articles revealing the misleading nature of healthcare information on YouTube, this study aims to evaluate the quality of videos pertaining to skin graft procedures.

Methods
YouTube was searched for various terms such as “Skin Graft Procedures” and “Skin Graft Surgery” with content stratified by total view count. After applying exclusion criteria, the top 84 most viewed videos were assessed, 24 of which implicating burn injuries. Four independent reviewers rated the material with the Global Quality Scale (GQS; 5 = highest quality, 1 = lowest quality) to judge educational value based upon factors such as publisher credibility, delivery of accurate information, and presence of biases. Viewership, source, educational modality, and date of upload were also collected from each video and compiled for further analysis.

Results
The mean GQS score of all videos was 2.60. Videos uploaded by physicians (80.1%) had a significantly higher average GQS score than those not uploaded by physicians (p &lt; 0.01). When grouped by modality, patient-friendly delivery methods (animations, news reports, etc.) contained the lowest quality information, while physician-led presentations provided the highest educational value (p &lt; 0.01). Assessment of videos split into cohorts based on viewership noted a significantly higher GQS in videos with lower view counts (p &lt; 0.05). There was no correlation between upload date and quality.

Conclusions
Overall, skin graft videos found on YouTube provide low quality information. This is especially true for the “popular” videos, where an inverse correlation was found between view count and GQS score. Likewise, patient-friendly videos received the lowest GQS scores amongst the cohorts. Alternatively, videos performed by physicians, most notably physician-led presentations, significantly improved the educational quality of videos pertaining to skin graft procedures. As such, further analysis of skin graft videos found on YouTube could poise physician involvement in producing videos of high educational quality while potentially bridging the gap spanning quality content and video popularity.

Applicability of Research to Practice
With online platforms such as YouTube evolving into conventional sources of healthcare information, physicians must act to improve the quality of online content to better guide patients in navigating treatment options and making healthcare decisions.
Drug approval delays in hematologic malignancies between Europe and the US and between Japan and the US: a clinical perspective
Authors: Matsuda Kensuke , Nagai Sumimasa , Sugimoto Koichi 
Published: August 2023

Abstract

Objective
Since novel therapeutic agents for malignancies are developed rapidly mainly in the US, the interval of approval timing between the US and other countries is an important issue. Among them, drugs for hematologic malignancies tended to have a particularly long delays in Japan, but its characteristics have not been fully understood. This study assessed the approval delays in drugs for hematologic malignancies in Japan compared with that in Europe.

Methods
Using the public database of Europe, Japan and the US, we analyzed the differences in drug approval delays between Europe and the US and between Japan and US according to disease. New molecular entity drugs for hematologic malignancies that were already approved in the US and were approved from April 2010 to March 2022 in Europe or Japan were identified.

Results
The results showed the longer drug approval delays in Japan compared with that in Europe (29 vs. 9.4 months, median), presumably due to the lower proportion of participation in global clinical trials (37 vs. 94%). Notably, the participation rate in global clinical trials varied widely by disease in Japan, resulting in a greater difference in drug approval delays by disease. In contrast, when focusing on early phase trials, Japanese participation was uniformly very limited regardless of the disease.

Conclusions
The current study provided data that can be used as a basis for discussion on how to improve drug approval delays in drugs for hematologic malignancies.
Slicing Through the Layers of Pediatric Unintentional Injury With the Swiss Cheese Model: A Topical Review
Authors: Pugliese Brian J , Barton Benjamin K 
Published: August 2023

Abstract
Pediatric unintentional injury significantly burdens children, families, and society. Behavioral researchers have examined the problem for decades, identifying many risk factors and greatly enhancing knowledge of the injury antecedent process. Approaches using theories and models to guide inquiry into etiology and prevention are still needed. We offer an approach borrowed from the field of human factors to enhance understanding and prevention. We focus our exploration on an error modeling and accident investigation tool called the Swiss Cheese Model. We first introduce the basic elements of the model. Next, we apply error modeling concepts to example scenarios drawn from real unintentional incidents and discuss the implications for understanding etiology and prevention. Finally, potential future directions are discussed to illustrate paths for the advancement of injury etiology and prevention.
Long-term outcomes of whole-pelvis radiation therapy using volumetric modulated arc therapy for high-risk prostate cancer
Authors: Takemura Reiko , Ishii Kentaro , Hosokawa Yukinari , Morimoto Hideyuki , Matsuda Shogo , Ogino Ryo , Shibuya Keiko 
Published: August 2023

Abstract
This study investigated the outcomes of whole-pelvis radiation therapy (WPRT) using volumetric modulated arc therapy (VMAT) for high-risk prostate cancer. We retrospectively analysed 112 patients with high-risk prostate cancer who started WPRT at our hospital between August 2011 and August 2015. The prescribed dose was 78 Gy in 39 fractions to the prostate and 46.8 Gy in 26 fractions to the pelvic lymph node (LN) area. All patients received long-term androgen deprivation therapy. We evaluated late gastrointestinal (GI) and genitourinary (GU) toxicities using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period for censored cases was 97 (interquartile range [IQR] = 85–108) months. The median age was 72 (IQR = 67–75) years. The high-risk and very-high-risk groups included 41 (36.6%) and 71 patients (63.4%), respectively. The median risk of LN invasion calculated by the Roach formula was 36.9 (IQR = 26.6–56.3) %. The 8-year overall survival, biochemical failure-free survival, disease-free survival and distant metastasis-free survival rates were 88.4, 91.9, 83.8 and 98.0%, respectively. Only one patient experienced common iliac LN recurrence, which was outside the pelvic irradiation area. All patients with recurrent disease were categorized into the very-high-risk group. The 8-year cumulative rates of ≥Grade 2 late GI and GU toxicities were 12.8 and 11.8%, respectively. No patients experienced Grade 4 or higher toxicities. WPRT using VMAT for high-risk prostate cancer was well tolerated and effective.
Corporate disclosure, ESG and green fintech in the energy industry
Authors: Lee Joseph , Serafin Alberto Mattia , Courteau Clément 
Published: August 2023

Abstract
This article examines the crucial role of non-financial disclosure in achieving environmental sustainability across economies and legal systems, focusing on the Corporate Sustainability Reporting Directive (CSRD). It scrutinizes the efficacy of current reporting regimes and their capacity to capture the distinct nature of company activities. The study underscores the importance of flexibility tools in customizing disclosure obligations to individual companies, striking a balance between competing informational interests and adhering to principles of reasonableness and proportionality. It highlights the double materiality criteria and the ‘comply or explain’ mechanism as pivotal in tailoring reporting duties. Moreover, the article argues for better integration of fintech and greentech to modernize the disclosure obligation, making the disclosed information digitally tagged and machine-readable. It also investigates the potential for technology to ease the existing negative or preventive approach characterizing enforcement mechanisms, possibly setting the incentive for information disclosure. The conclusions encompass policy recommendations aiming to harness the opportunities offered by technology in the context of CSRD, aligning the reporting duties with contemporary needs.
Triose phosphate utilization in leaves is modulated by whole-plant sink–source ratios and nitrogen budgets in rice
Authors: Zhou Zhenxiang , Zhang Zichang , van der Putten Peter E L , Fabre Denis , Dingkuhn Michael , Struik Paul C , Yin Xinyou 
Published: August 2023

Abstract
Triose phosphate utilization (TPU) is a biochemical process indicating carbon sink–source (im)balance within leaves. When TPU limits leaf photosynthesis, photorespiration-associated amino acid exports probably provide an additional carbon outlet and increase leaf CO2 uptake. However, whether TPU is modulated by whole-plant sink–source relations and nitrogen (N) budgets remains unclear. We address this question by model analyses of gas-exchange data measured on leaves at three growth stages of rice plants grown at two N levels. Sink–source ratio was manipulated by panicle pruning, by using yellower-leaf variant genotypes, and by measuring photosynthesis on adaxial and abaxial leaf sides. Across all these treatments, higher leaf N content resulted in the occurrence of TPU limitation at lower intercellular CO2 concentrations. Photorespiration-associated amino acid export was greater in high-N leaves, but was smaller in yellower-leaf genotypes, panicle-pruned plants, and for abaxial measurement. The feedback inhibition of panicle pruning on rates of TPU was not always observed, presumably because panicle pruning blocked N remobilization from leaves to grains and the increased leaf N content masked feedback inhibition. The leaf-level TPU limitation was thus modulated by whole-plant sink–source relations and N budgets during rice grain filling, suggesting a close link between within-leaf and whole-plant sink limitations.
Effects of film-formingPichiaandCandidayeasts on cider and wine as post-fermentation contaminants
Authors: Lorenzini Marilinda , Cappello Maria Stella , Green Anthony , Zapparoli Giacomo 
Published: August 2023

AbstractFilm-forming yeasts are potential sources of defects in alcoholic beverages. The aim of this study is to assess the growth capacity of Pichia and Candida film-forming yeasts in cider and wine and the effects on their chemical composition. Cider, partially and fully fermented wine were inoculated with strains of C. californica, P. fermentans, P. kluyveri, P. kudriavzevii, P. manshurica, and P. membranifaciens to simulate a post-fermentative contamination. The former three species grew only in cider. Pichia manshurica and P. kudriavzevii displayed high viability in wine up to 13.18% (v v–1) ethanol. Significant changes in odour-active molecules from different chemical groups were observed in cider and wine in the inoculated samples, compared to the non-inoculated ones. Cider is more susceptible to contamination by all of the species tested, due to its low alcohol content, while P. membranifaciens, P. manshurica, and P. kudriavzevii are additionally potential spoilage agents of wine. This study highlights the risk of cider and wine contamination by film-forming yeasts. Their impact on aroma profiles depends on their ability to grow and their metabolism. This study contributes to an understanding of the possible physiological and metabolic mechanisms responsible for film formation and chemical changes in alcoholic beverages.