bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolomics and bioinformatic analyses to determine the effects of oxygen exposure within longissimus lumborum steak on beef discoloration
Authors: Denzer Morgan L , Pfeiffer Morgan , Mafi Gretchen G , Ramanathan Ranjith 
Published: May 2023

Abstract
Meat discoloration starts from the interior and spreads to oxymyoglobin layer on the surface. The effects of oxygen exposure within a steak on the metabolome have not been evaluated. Therefore, the objective of this study was to evaluate the impact of oxygen exposure on the metabolome of the longissimus lumborum muscle. Six United States Department of Agriculture (USDA) Low Choice beef strip loins were sliced into steaks (1.91-cm) and packaged in polyvinyl chloride overwrap trays for 3 or 6 d of retail display. The oxygen exposed (OE) surface was the display surface during retail, and the non-oxygen exposed (NOE) surface was the intact interior muscle. The instrumental color was evaluated using a HunterLab MiniScan spectrophotometer. To analyze the NOE surface on days 3 and 6, steaks were sliced parallel to the OE surface to expose the NOE surface. Metmyoglobin reducing ability (MRA) was determined by nitrite-induced metmyoglobin reduction. A gas chromatography–mass spectrometry was used to identify metabolites. The a* values of steaks decreased (P &lt; 0.05) with display time. MRA was greater (P &lt; 0.05) in the NOE surface compared with the OE surface on days 3 and 6. The KEGG pathway analysis indicated the tricarboxylic acid (TCA) cycle, pentose and glucuronate interconversions, phenylalanine, tyrosine, and tryptophan metabolism were influenced by the oxygen exposure. The decrease in abundance of succinate from days 0 to 6 during retail display aligned with a decline in redness during display. Furthermore, citric acid and gluconic acid were indicated as important metabolites affected by oxygen exposure and retail display based on the variable importance in the projection in the PLS-DA plot. Citric acid was lower in the NOE surface than the OE surface on day 6 of retail display, which could relate to the formation of succinate for extended oxidative stability. Greater alpha-tocopherol (P &lt; 0.05) in the NOE surface supported less oxidative changes compared to the OE surface during retail display. These results indicate the presence of oxygen can influence metabolite profile and promote migration of the metmyoglobin layer from interior to surface.
T2 New York City Structural Fires are Linked to Inequities in Safe Heating for Immigrant Communities
Authors: Stanton Eloise , Sheckter Clifford C , Biedry Julia , Rochlin Danielle 
Published: May 2023

Abstract

Introduction
The US was rattled January 9th, 2022 when a structural fire claimed the lives of eight children and nine adults in New York City’s (NYC) Bronx borough. Existing reports suggest that in low-income historically Black/Latinx communities, heating complaints are often ignored. While this pattern implies housing inequities, landlord negligence, and greater risk of residential fires in the Bronx and other low socioeconomic neighborhoods, this postulation has not been scientifically evaluated. We investigated the relationship between structural fires and heating complaints in NYC, leveraging municipal data from 59 community districts.

Methods
Data from the NYC Open Data Portal Fire Incident Dispatch data and Heat/Hot Water Complaints were merged to identify the number of heating complaints and structural fires per month in each NYC community district from 2017-2022. Population and demographic comparisons were made using US Census–NYC Demographics 2020 data. The primary outcome was number of structural fires per month which was modeled with mixed effects multivariable regression. Community districts were treated as random intercepts given demographic and architectural variation between districts. Statistical analyses were performed using Stata/IC Version 17.0 (StataCorp LLC).

Results
Within NYC’s 59 community districts, 3,877 heating complaints were filed against 3,989 structural fires during the study period (Figure 1). The mixed effects model demonstrated a significant association between heat complaints and frequency of structural fires (coefficient 0.013, 95% CI .012-.014 p&lt; .001,). Further, the model demonstrated significant variance among community districts in predicting structural fires (σ2=215, p &lt; .001). The Likelihood ratio test comparing the mixed effects linear model to a simple linear regression yield a p-value of &lt; 0.001 in favor of the mixed effects model.

Conclusions
The frequency of heating complaints was significantly associated with the frequency of structural fires in NYC. Importantly, this association varied across community districts with more fires occurring in districts with greater proportions of Black/Latinx residents. Our results highlight a pattern adversely affecting marginalized racial/ethnic communities in which ongoing ignored heating complaints and landlord negligence may lead residents to use unsafe heating practices, inadvertently creating structure fires, morbidity, and death.

Applicability of Research to Practice
Our findings can help guide and educate both clinicians and policymakers in regard to socioeconomic disparities and epidemiological trends implicated in burn care.
33 Targeting Vulnerability in the Homeless–A National Analysis of Burn Injuries Presenting to the Emergency Department.
Authors: Shah Jennifer , Liu Farrah , Cevallos Priscila , Amakiri Uchechukwu , Johnstone Thomas , Sheckter Clifford , Nazerali Rahim 
Published: May 2023

Abstract

Introduction
Burn management is complex and outcomes depend on injury severity, timing of presentation, and specialized multidisciplinary care. Burn injuries among the homeless are an increasing problem in the United States (US) as record numbers of people are unsheltered and using unsafe heating practices. This study aims to characterize mechanism, demographic, and social factors related to burn injuries in homeless persons.

Methods
Burn encounters were extracted from the 2019 Nationwide Emergency Department Sample (NEDS) database. Two cohorts were created comparing homeless and non-homeless encounters. Burn characteristics (size, depth, location and mechanism), comorbidities, demographics, and ED treatments were compared with univariate testing. Multivariable regression evaluated the likelihood of admission. Discharge weights were used to yield national estimates.

Results
Of 316,334 ED visits meeting criteria for burn injuries in 2019, 1,919 (0.6%) had a diagnosis code for homelessness. Homelessness burn encounters were significantly older (mean age 32.4 vs. 44.8), were more often male (71% vs. 52%), were more often White (59% vs. 54%) or Black (24% vs. 21%), were more often presenting to EDs in the Western region of the US (43% vs. 19%), and more often had Medicaid as primary payer (51% vs 33%). Burns in homeless encounters more commonly resulted from flame injury and more commonly involved the lower extremity (p&lt; 0.001). Among homeless encounters, burn injuries were more often due to self-harm (12% vs. 2%) or assault (5% vs. 1%)(p&lt; 0.001). In addition, homeless encounters had significantly greater mental illness related to substance abuse (69% vs 16%, p&lt; 0.001) and had greater comorbidity burden (38% vs. 6% had Elixhauser index scores of 3 or higher; p&lt; 0.001). Homeless encounters experienced higher rates of third degree burns and concomitant injuries (p≤0.003). 49% vs 7% of homeless and non-homeless encounters, respectively, required admission, and homelessness was associated with higher odds of admission (adjusted OR 4.58; 95% CI 3.066–6.828; p&lt; 0.001).

Conclusions
Burn injuries in the homeless affect a vulnerable population who is older, has more comorbidities, and has deeper burns. Mental illness is over 4 times more likely in this population who is also at increased risk of getting burned through assault.

Applicability of Research to Practice
Burn injuries presenting to the ED should be screened for homelessness given the associated risk factors. Legal, medical, and mental health resources can then be appropriately targeted.
34 Evaluation of Socioeconomic Status and Burn Injuries: A Retrospective Review From a Desert Burn Center
Authors: Cohler Samuel , Chestovich Paul , Saquib Syed , Batra Kavita 
Published: May 2023

Abstract

Introduction
Incidence of burn injury rate appears to be affected by socioeconomic status (SES). Previous studies have indicated that patients with low SES have an increased risk of unintentional burn injuries. However, this association has not been explored robustly in the Southwest United States. This study aims to investigate the relationship between SES and burn injuries amongst patients in the Southwest United States.

Methods
A retrospective registry review was performed on all burn injury admissions to our ABA verified burn center from January 1, 2017 to December 31, 2021. Their zip code was then inputted into the Distressed Communities Index (DCI). This is a national database that stratifies communities by zip code into quintiles, indicating overall distress. The DCI was used as a measure of SES as it reflects employment status, education level, poverty rate, median income, business growth, and housing vacancies. Patients who did not report an accurate residential zip code or reported a zip code not included in the DCI were excluded. Many clinical variables were reviewed within each quintile including age, gender, total body surface area (TBSA), ICU days, hospital length of stay (LOS), ventilator days, surgical interventions, and discharge disposition. Student’s t-test and Chi-squared tests were used to compare groups, and statistical significance was defined at p &lt; 0.05.

Results
A total of 1,323 patients were identified in the study period. The most distressed quintile accounted for 481 (36.4%) admissions. Flame and contact burns were the most common etiology overall (46.5%), as well as within each quintile (Figure 1). The distribution of burn injury etiology was statistically significant by age, %TBSA, gender, race, and ethnicity (p &lt; 0.001, Table 1); however, it was not significant by SES (p = 0.202). Burn severity, categorized as less than or equal to second degree burns, or greater than or equal to third degree burns, showed significance when compared to age, LOS, ICU days, ventilator days, and total surgical interventions performed (p &lt; 0.001). However, the association between SES and burn severity was not found to be significant (p = 0.886).

Conclusions
The two most distressed quintiles represented over half of the burn admissions. A lower SES did not contribute to increased burn severity or utilization of healthcare resources. This study highlighted differences in burn injuries between age, gender, race, and ethnicity.

Applicability of Research to Practice
Identifying communities at increased risk for burn injuries can help with public health initiatives, focused on awareness and prevention of these injuries.
39 Certified Burn Center Access in the United States: The Geospatial and Transport Cost of Transfer
Authors: Edwards Shelly , Brown Madyson , Humphries Laura , Hoppe Ian 
Published: May 2023

Abstract

Introduction
Specialized burn centers are critical in minimizing burn-associated morbidity and mortality. However, American Burn Association (ABA)-verified burn centers are unequally distributed across the US, and fewer verified centers are available for pediatric patients relative to adults. The economic burden of transport to verified centers represents a significant proportion of the already high cost of burn-associated care. The present study aims to quantify inequitable burn care access in the contiguous US due to age group and locality as a function of physical proximity and transportation cost.

Methods
County-level distances (n=3,106) to the nearest ABA-verified adult or pediatric burn center were determined and mapped. Distances were then analyzed separately for rural (n = 1440) and urban (n = 1666) counties for both adult and pediatric burn centers. Distance calculations for each population were combined with transport cost data (2022 CMS Ambulance fee Schedules) to determine the average cost of transport for each patient population (adult vs. pediatric, urban vs. rural).

Results
59 Adult and 43 Pediatric ABA-verified centers were identified from the ABA burn center directory. Pediatric patients reside 30.57 miles (p &lt; 0.001) further than adults from the nearest center, accounting for a 10.5% - 15.9% transport cost increase. Transport costs increased dramatically between urban and rural counties, with rural patients facing a cost increase of 32.7% and 80.88% for ground and air transportation, respectively.

Conclusions
Physical proximity to burn care may appear to differ only modestly across age and region. However, the seemingly marginal increase in distance significantly impacts the cost of patient transport. The present study highlights both physical and economic barriers to burn care access faced by rural and pediatric patients. Increasing ABA burn center certification in targeted areas across the US may decrease the disparities in access to burn care faced by these groups.

Applicability of Research to Practice
Identify areas that may benefit from expansion of certified burn-care access and additional provider education.
42 Utilizing FAB Scores to Determine Next Level of Care for Patients with Burn Injury
Authors: Geib Teresa , Hill David , Mincey Meghan , Velamuri Sai , Fletchall Sandra 
Published: May 2023

Abstract

Introduction
Determining next level of care for burn patients is a difficult task for the entire medical team. Secondary to the nature of the injury, patients often do not have the social or economic support required to return to their prior level of function. The Functional Assessment for Burns (FAB) score has been shown an objective measure to determine functional independence and a predictor of discharge outcomes in adults. However, it is undetermined whether this assessment can be utilized to guide next level of care and time which it takes to return to prior level of function. We hypothesized the number of therapy sessions to be positively associated with patients’ return to baseline FAB.

Methods
This single center, retrospective study of patients admitted to a single ABA-verified burn center was completed by collecting FAB assessment scores within 48 hours of admission and within 48 hours of discharge over the last year. Demographics, injury characteristics, surgical procedures, and number of treatment sessions were collected. Shapiro-wilk test was utilized to test for normality. Regression analysis was utilized to analyze variable associations with changes in FAB scores. A paired t test was used to compare paired FAB scores between admission and discharge.

Results
One-hundred patients were included with a median age of 53 (38.5, 64) years and 7 (3.5, 14) percent total body surface area burned (TBSA). The median FAB for preadmission (preadm.), admission (adm.), and discharge (DC) were 35 (35, 35), 17 (14, 24), and 24 (19, 32), respectively. The paired difference between adm. and DC scores (&lt; 0.001) indicated significant improvement. TBSA and age, together, were significant predictors of change in preadm. to adm. FAB (r2=0.202, p&lt; 0.001). Adm. FAB and TBSA were both associated with number of therapy sessions. Only 16% of patients returned to preadm. level of functional independence by discharge with only 20% qualifying for / entering a post-acute inpatient rehabilitation facility. Number of combined therapy sessions was not associated with return to preadm. FAB. Of note, only 28% returned within 90% of preadmission FAB by discharge. In fact, 13% actually saw their FAB regress from adm. to DC. None of the collected variables were associated with the negative change in FAB scores through admission.

Conclusions
In this sample, number of sessions was not predictive of return to preadmission FAB; however, this may be due to the low numbers that achieved the milestone at all. Despite this fact, there was an alarmingly small number admitted to a subsequent inpatient rehabilitation facility. There was a significant improvement in paired scores from admission to discharge. Taken together, there may be value in reassessing inpatient rehabilitation facility adm. criteria.

Applicability of Research to Practice
FAB scores may be a useful indicator of further rehabilitation needs.
55 Risk of Sepsis and Mortality in SJS and TENS Patients Treated with Corticosteroids
Authors: Everett Catherine , Hink Ashley , Kahn Steven , Ozhathil Deepak 
Published: May 2023

Abstract

Introduction
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are a rare adverse cutaneous drug reaction that historically has a high risk of mortality. The use of corticosteroids (CS) to treat SJS/TENS remains controversial as the literature is limited to small cohort trials by the rarity of the condition. Some conflicting studies suggested that CS may increase mortality due to augmented infection risk. This study evaluated the incidence of sepsis and mortality following CS use in patients with SJS/TENS.

Methods
We performed a retrospective study utilizing a commercially available multi-institutional database derived from deidentified inpatient coding data to assess the incidence of sepsis and mortality within 30 days after diagnosis of SJS/TENS in patients &gt;18 years old treated with CS within one week of their initial diagnosis. Data was analyzed from years 2000-2022. Patients treated with CS within 1 week of diagnosis (n=3930) and those treated without CS (n=6557) were propensity matched for age, race, gender, severe sepsis and SIRS (n=3723) and were assessed for relative risk of mortality and sepsis occurrence.

Results
Of the patients who received CS 171 of 3723 died vs 98 of 3723 of those that did not receive CS. They incurred a 1.961% relative risk (RR: 1.745, 1.367, 2.227 95% CI, p=&lt; 0.0001) for mortality. Similarly, of the patients that received CS 245 of 3723 suffered sepsis vs 173 of 3723 that did not receive CS. This was a 1.934% relative risk (RR: 1.416, 1.172, 1.711 95% CI, p=0.0003) of developing sepsis. The number of instances and median days till instance were not statistically different between cohorts.

Conclusions
This study indicated that amongst adult patients diagnosed with SJS/TENS, the utilization of CS within the first week of diagnosis is affiliated with a statistically significant increased risk of sepsis and death within 30 days of diagnosis.

Applicability of Research to Practice
The application of CS therapy may enable the development of infections in patients such as sepsis, which may ultimately worsen prognosis, but the rarity of this condition prohibits effective single-institution assessment of this impact. Care should be taken to assess the risks and benefits of prescribing CS therapy in SJS/TENS patients.
69 Methamphetamine Positivity Prior to Burn Surgery Does not Adversely Affect Intraoperative or Inpatient Outcomes
Authors: Sheckter Clifford , Rizk Nada , Crawford David , Karanas Yvonne , Barnes Christopher , Pham Tam 
Published: May 2023

Abstract

Introduction
The treatment of burn patients using amphetamines is challenging for hemodynamic and behavioral reasons. In addition, recent amphetamine use may also pose intraoperative risks. Due to insufficient literature to guide the safety and timing of operative care, wide practice variation exists in the operative timing for this patient population. We hypothesize that burn excision without negative amphetamine toxicology is safe.

Methods
We queried the operative and electronic health records of amphetamine-positive patients treated from 2017-2022 at two ABA verified burn centers. The practice guideline at Center A obtains admission toxicology only and proceeds with surgery based on hemodynamic status and operative urgency, whereas Center B sends daily toxicology until a negative test results. The primary safety outcome was the use of vasoactive agents during the index operation. This risk was modeled via logistic regression and adjusted for injury severity and hospital day for index operation. Secondary outcomes included death and inpatient complications.

Results
A total of 270 patients were identified during the study period. Mean age was 45.5 years (SD 12.9 years), median TBSA was 9.2% and the majority were male (76.7%). There were no significant differences in injury size, age, or male/female proportion between the two sites. Whereas Center A only tested once on admission, Center B obtained a median of 4 toxicology screens prior to surgery. There were no difference in mean induction systolic blood pressure between the 2 sites, although Center A had more patients who had SBP&lt; 95 or &gt;160mmHg on induction (one-way ANOVA p=0.596). The adjusted OR of requiring vasoactive support during surgery was not associated with negative toxicology status (p=0.821). A larger injury size (%TBSA &gt;20) conferred a significant higher risk of vasoactive support (adj. OR 13.42 [3.90 – 46.23], p&lt; 0.001). Clinical outcomes at the 2 sites were similar in the terms of mortality, number of operations, stroke, and hospital length of stay.

Conclusions
Comparison between 2 ABA verified burn centers identifies a significant variation in practice with regards to serial amphetamine screenings prior to burn surgery. This study indicates that negative toxicology does not impact intraoperative anesthesia management nor subsequent burn clinical outcomes.

Applicability of Research to Practice
Serial toxicology tests are unnecessary to guide operative timing of burn patients with amphetamine use.