Effects of cholecalciferol supplementation and optimized calcium intakes on vitamin D status, muscle strength and bone health: a one-year pilot randomized controlled trial in adults with severe burns.

PubMed

Rousseau, Anne-Françoise; Foidart-Desalle, Marguerite; Ledoux, Didier; Remy, Christophe; Croisier, Jean-Louis; Damas, Pierre; Cavalier, Etienne

2015-03-01

Burn patients are at risk of hypovitaminosis D and osteopenia or sarcopenia. Vitamin D pleiotropic effects may influence bone and muscle health. The aim of this pilot study was to assess effects of a cholecalciferol (VD3) supplementation and an optimized calcium (Ca) regimen on vitamin D (VD) status, bone and muscle health during sequelar stage of burn injury. Monocentric randomized controlled trial. Fifteen adults with thermal burns dating from 2 to 5 years were randomized into two groups. For 12 months, they either received a quarterly IM injection of 200,000IU VD3 and daily oral Ca (Group D) or placebo (Group P). VD status and bone remodeling markers were assessed every 3 months. Knee muscle strength and bone mineral density were, respectively, assessed using isokinetic dynamometry and dual X-ray absorptiometry at initiation (M0) and completion (M12) of the protocol. Of all the patients, 66% presented with VD deficiency and 53% (with 3 men <40y) were considered osteopenic at inclusion. After one year, calcidiol levels significantly increased in Group D to reach 40 (37-61)ng/ml. No significant change in bone health was observed in both groups while Group D significantly improved quadriceps strength when tested at high velocity. This VD3 supplementation was safe and efficient to correct hypovitaminosis D in burn adults. When combined with optimized Ca intakes, it demonstrated positive effects on muscle health but not on bone health. A high prevalence of hypovitaminosis D and osteopenia in these patients, as well as their wide range of muscle performances, seem to be worrying when considering rehabilitation and quality of life. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

PHP-HT (VitaResc Biotech).

PubMed

Baldwin, A; Wiley, E

2001-04-01

VitaResc (formerly Apex) is developing PHP-HT, pyridoxalated hemoglobin polyoxyethylene conjugate, for the potential treatment of nitric oxide-induced shock (characterized by hypotension), associated with various etiologies, initially in septic shock. A phase I safety study and an initial phase I/II patient trial for NO-induced shock have been completed, and VitaResc has enrolled patients in three of five planned cohorts in a continuation of these trials to include a protocol of continuous infusion and dose escalation [330680,349187,390918]. The results from the dose escalation trials are expected to provide the basis for a randomized, controlled phase II/III pivotal trial of PHP-HT [390918]. VitaResc has licensed PHP-HT exclusively from Ajinomoto for all indications, worldwide, except Japan [275263]. Ajinomoto originally developed the human derived and chemically modified hemoglobin preparation as a blood substitute, but no development has been reported by the company since 1997 [275277,303577]. The other potential indications of PHP-HT include shock associated with burns, pancreatitis, hemodialysis and cytokine therapies [275277]. VitaResc expects the annual market potential of PHP-HT to exceed 1 billion dollars [330680].

Long-term scar quality after hydrosurgical versus conventional debridement of deep dermal burns (HyCon trial): study protocol for a randomized controlled trial.

PubMed

Legemate, Catherine M; Goei, Harold; Middelkoop, Esther; Oen, Irma M M H; Nijhuis, Tim H J; Kwa, Kelly A A; van Zuijlen, Paul P M; Beerthuizen, Gerard I J M; Nieuwenhuis, Marianne K; van Baar, Margriet E; van der Vlies, Cornelis H

2018-04-19

Deep dermal burns require tangential excision of non-viable tissue and skin grafting to improve wound healing and burn-scar quality. Tangential excision is conventionally performed with a knife, but during the last decade hydrosurgery has become popular as a new tool for tangential excision. Hydrosurgery is generally thought to be a more precise and controlled manner of burn debridement leading to preservation of viable tissue and, therefore, better scar quality. Although scar quality is considered to be one of the most important outcomes in burn surgery today, no randomized controlled study has compared the effect of these two common treatment modalities with scar quality as a primary outcome. The aim of this study is, therefore, to compare long-term scar quality after hydrosurgical versus conventional tangential excision in deep dermal burns. A multicenter, randomized, intra-patient, controlled trial will be conducted in the Dutch burn centers of Rotterdam, Beverwijk, and Groningen. All patients with deep dermal burns that require excision and grafting are eligible. Exclusion criteria are: a burn wound < 50 cm 2 , total body surface area (TBSA) burned > 30%, full-thickness burns, chemical or electrical burns, infected wounds (clinical symptoms in combination with positive wound swabs), insufficient knowledge of the Dutch or English language, patients that are unlikely to comply with requirements of the study protocol and follow-up, and patients who are (temporarily) incompetent because of sedation and/or intubation. A total of 137 patients will be included. Comparable wound areas A and B will be appointed, randomized and either excised conventionally with a knife or with the hydrosurgery system. The primary outcome is scar quality measured by the observer score of the Patient and Observer Scar Assessment Scale (POSAS); a subjective scar-assessment instrument, consisting of two separate six-item scales (observer and patient) that are both scored on a 10-point rating scale. This study will contribute to the optimal surgical treatment of patients with deep dermal burn wounds. Dutch Trial Register, NTR6232 . Registered on 23 January 2017.

HANDBOOK: QUALITY ASSURANCE/QUALITY CONTROL (QA/QC) PROCEDURES FOR HAZARDOUS WASTE INCINERATION

EPA Science Inventory

Resource Conservation and Recovery Act regulations for hazardous waste incineration require trial burns by permit applicants. uality Assurance Project Plan (QAPjP) must accompany a trial burn plan with appropriate quality assurance/quality control procedures. uidance on the prepa...

TRIAL BURN RESULTS AND FUTURE ACTIVITES OF THE EPA MOBILE INCINERATOR

EPA Science Inventory

The EPA Mobile Incinerator has demonstrated its ability to successfully destroy dioxin. A trial burn conducted in 1987 demonstrated the incinerator's ability to destroy a wide variety of compounds. The destruction and removal efficiency (DRE) of carbon tetrachloride, hexachloro...

The wound/burn guidelines - 6: Guidelines for the management of burns.

PubMed

Yoshino, Yuichiro; Ohtsuka, Mikio; Kawaguchi, Masakazu; Sakai, Keisuke; Hashimoto, Akira; Hayashi, Masahiro; Madokoro, Naoki; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Isei, Taiki; Ito, Takaaki; Inoue, Yuji; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ogawa, Fumihide; Kadono, Takafumi; Kawakami, Tamihiro; Kukino, Ryuichi; Kono, Takeshi; Kodera, Masanari; Takahara, Masakazu; Tanioka, Miki; Nakanishi, Takeshi; Nakamura, Yasuhiro; Hasegawa, Minoru; Fujimoto, Manabu; Fujiwara, Hiroshi; Maekawa, Takeo; Matsuo, Koma; Yamasaki, Osamu; Le Pavoux, Andres; Tachibana, Takao; Ihn, Hironobu

2016-09-01

Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures. © 2016 Japanese Dermatological Association.

Comparison of three different dressings for partial thickness burns in children: study protocol for a randomised controlled trial

PubMed Central

2013-01-01

Background In the paediatric population, pain and distress associated with burn injuries during wound care procedures remain a constant challenge. Although silver dressings are the gold standard for burn care in Australasia, very few high-level trials have been conducted that compare silver dressings to determine which will provide the best level of care clinically. Therefore, for paediatric patients in particular, identifying silver dressings that are associated with lower levels of pain and rapid wound re-epithelialisation is imperative. This study will determine whether there is a difference in time to re-epithelialisation and pain and distress experienced during wound care procedures among Acticoat™, Acticoat™ combined with Mepitel™ and Mepilex Ag™ dressings for acute, paediatric partial thickness burns. Methods/Design Children aged 0 to 15 years with an acute partial thickness (superficial partial to deep partial thickness inclusive) burn injury and a burn total body surface area of ≤10% will be eligible for the trial. Patients will be randomised to one of the three dressing groups: (1) Acticoat™ or (2) Acticoat™ combined with Mepitel™ or (3) Mepilex Ag™. A minimum of 28 participants will be recruited for each treatment group. Primary measures of pain, distress and healing will be repeated at each dressing change until complete wound re-epithelialisation occurs or skin grafting is required. Additional data collected will include infection status at each dressing change, physical function, scar outcome and scar management requirements, cost effectiveness of each dressing and staff perspectives of the dressings. Discussion The results of this study will determine the effects of three commonly used silver and silicone burn dressing combinations on the rate of wound re-epithelialisation and pain experienced during dressing procedures in acute, paediatric partial thickness burn injuries. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000105741 PMID:24274190

Comparison of three different dressings for partial thickness burns in children: study protocol for a randomised controlled trial.

PubMed

Gee Kee, Emma; Kimble, Roy M; Cuttle, Leila; Stockton, Kellie

2013-11-25

In the paediatric population, pain and distress associated with burn injuries during wound care procedures remain a constant challenge. Although silver dressings are the gold standard for burn care in Australasia, very few high-level trials have been conducted that compare silver dressings to determine which will provide the best level of care clinically. Therefore, for paediatric patients in particular, identifying silver dressings that are associated with lower levels of pain and rapid wound re-epithelialisation is imperative. This study will determine whether there is a difference in time to re-epithelialisation and pain and distress experienced during wound care procedures among Acticoat™, Acticoat™ combined with Mepitel™ and Mepilex Ag™ dressings for acute, paediatric partial thickness burns. Children aged 0 to 15 years with an acute partial thickness (superficial partial to deep partial thickness inclusive) burn injury and a burn total body surface area of ≤ 10% will be eligible for the trial. Patients will be randomised to one of the three dressing groups: (1) Acticoat™ or (2) Acticoat™ combined with Mepitel™ or (3) Mepilex Ag™. A minimum of 28 participants will be recruited for each treatment group. Primary measures of pain, distress and healing will be repeated at each dressing change until complete wound re-epithelialisation occurs or skin grafting is required. Additional data collected will include infection status at each dressing change, physical function, scar outcome and scar management requirements, cost effectiveness of each dressing and staff perspectives of the dressings. The results of this study will determine the effects of three commonly used silver and silicone burn dressing combinations on the rate of wound re-epithelialisation and pain experienced during dressing procedures in acute, paediatric partial thickness burn injuries. Australian New Zealand Clinical Trials Registry ACTRN12613000105741.

Methodological quality of randomised controlled trials in burns care. A systematic review.

PubMed

Danilla, Stefan; Wasiak, Jason; Searle, Susana; Arriagada, Cristian; Pedreros, Cesar; Cleland, Heather; Spinks, Anneliese

2009-11-01

To evaluate the methodological quality of published randomised controlled trials (RCTs) in burn care treatment and management. Using a predetermined search strategy we searched Ovid MEDLINE (1950 to January 2008) database to identify all English RCTs related to burn care. Full text studies identified were reviewed for key demographic and methodological characteristics. Methodological trial quality was assessed using the Jadad scale. A total of 257 studies involving 14,535 patients met the inclusion criteria. The median Jadad score was 2 (out of a best possible score of 5). Information was given in the introduction and discussion sections of most RCTs, although insufficient detail was provided on randomisation, allocation concealment, and blinding. The number of RCTs increased between 1950 and 2008 (Spearman's rho=0.6129, P<0.001), although the reporting quality did not improve over the same time period (P=0.1896) and was better in RCTs with larger sample sizes (median Jadad score, 4 vs. 2 points, P<0.0001). Methodological quality did not correlate with journal impact factor (P=0.2371). The reporting standards of RCTs are highly variable and less than optimal in most cases. The advent of evidence-based medicine heralds a new approach to burns care and systematic steps are needed to improve the quality of RCTs in this field. Identifying and reviewing the existing number of RCTs not only highlights the need for burn clinicians to conduct more trials, but may also encourage burn health clinicians to consider the importance of conducting trials that follow appropriate, evidence-based standards.

Comparing oil based ointment versus standard practice for the treatment of moderate burns in Greece: a trial based cost effectiveness evaluation.

PubMed

Carayanni, Vilelmine J; Tsati, Evangelia G; Spyropoulou, Georgia C H; Antonopoulou, Fotini N; Ioannovich, John D

2011-12-01

The local treatment of burn wounds has long been a subject of debate. The objective of this study was to compare the cost and the effectiveness of Moist Exposed Burn Ointment -MEBO versus a combination of povidone iodine plus bepanthenol cream for partial thickness burns. The study was carried out in the Burn Center of a state hospital in Athens, Greece. 211 patients needing conservative therapy were prospectively selected according to the depth of the burn wound. The treatment was allocated according to the Stratified Randomization Design. The outcomes measured were mean cost of in-hospital stay, rate of complications, time of 50% wound healing, pain scores, in hospital stay diminution. We have adopted a societal perspective. In the total groups MEBO presented lower cost, (although not significantly different: p = 0.10) and better effectiveness. The data suggest that MEBO is the dominant therapy for superficial partial burn wound with significantly lower costs and significantly higher effectiveness due to a lesser time of recovery and consequently lower time of hospitalization and follow-up. MEBO presented similar percentages of complications with the comparator, lower pain levels and smaller time of no healthy appearance of the burn limits for superficial partial thickness burns. The data suggested that topical application of MEBO may be considered for further investigation as a potential first-line treatment modality for superficial partial thickness burns. The trial has been registered on the International Standard Randomised Controlled Trial Number Register (ISRCTN) and given the registration number ISRCTN74058791.

Systematic review of the use of honey as a wound dressing

PubMed Central

Moore, Owen A; Smith, Lesley A; Campbell, Fiona; Seers, Kate; McQuay, Henry J; Moore, R Andrew

2001-01-01

Objective To investigate topical honey in superficial burns and wounds though a systematic review of randomised controlled trials. Data sources Cochrane Library, MEDLINE, EMBASE, PubMed, reference lists and databases were used to seek randomised controlled trials. Seven randomised trials involved superficial burns, partial thickness burns, moderate to severe burns that included full thickness injury, and infected postoperative wounds. Review methods Studies were randomised trials using honey, published papers, with a comparator. Main outcomes were relative benefit and number-needed-to-treat to prevent an outcome relating to wound healing time or infection rate. Results One study in infected postoperative wounds compared honey with antiseptics plus systemic antibiotics. The number needed to treat with honey for good wound healing compared with antiseptic was 2.9 (95% confidence interval 1.7 to 9.7). Five studies in patients with partial thickness or superficial burns involved less than 40% of the body surface. Comparators were polyurethane film, amniotic membrane, potato peel and silver sulphadiazine. The number needed to treat for seven days with honey to produce one patient with a healed burn was 2.6 (2.1 to 3.4) compared with any other treatment and 2.7 (2.0 to 4.1) compared with potato and amniotic membrane. For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments. The quality of studies was low. Conclusion Confidence in a conclusion that honey is a useful treatment for superficial wounds or burns is low. There is biological plausibility. PMID:11405898

40 CFR 266.104 - Standards to control organic emissions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... DRE trial burn. (5) Low risk waste. Owners and operators of boilers or industrial furnaces that burn... HAZARDOUS WASTE MANAGEMENT FACILITIES Hazardous Waste Burned in Boilers and Industrial Furnaces § 266.104...) of this section, a boiler or industrial furnace burning hazardous waste must achieve a destruction...

40 CFR 266.104 - Standards to control organic emissions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... DRE trial burn. (5) Low risk waste. Owners and operators of boilers or industrial furnaces that burn... HAZARDOUS WASTE MANAGEMENT FACILITIES Hazardous Waste Burned in Boilers and Industrial Furnaces § 266.104...) of this section, a boiler or industrial furnace burning hazardous waste must achieve a destruction...

Prophylactic antibiotics for burns patients: systematic review and meta-analysis

PubMed Central

Avni, Tomer; Levcovich, Ariela; Ad-El, Dean D; Leibovici, Leonard

2010-01-01

Objective To assess the evidence for prophylactic treatment with systemic antibiotics in burns patients. Design Systematic review and meta-analysis of randomised or quasi-randomised controlled trials recruiting burns inpatients that compared antibiotic prophylaxis (systemic, non-absorbable, or topical) with placebo or no treatment. Data sources PubMed, Cochrane Library, LILACS, Embase, conference proceedings, and bibliographies. No language, date, or publication status restrictions were imposed. Review methods Two reviewers independently extracted data. The primary outcome was all cause mortality. Risk or rate ratios with 95% confidence intervals were pooled with a fixed effect model if no heterogeneity was present. Results 17 trials were included. Trials that assessed systemic antibiotic prophylaxis given for 4-14 days after admission showed a significant reduction in all cause mortality (risk ratio 0.54, 95% confidence interval 0.34 to 0.87, five trials). The corresponding number needed to treat was 8 (5 to 33), with a control event rate of 26%. Perioperative non-absorbable or topical antibiotics alone did not significantly affect mortality. There was a reduction in pneumonia with systemic prophylaxis and a reduction in wound infections with perioperative prophylaxis. Staphylococcus aureus infection or colonisation was reduced with anti-staphylococcal antibiotics. In three trials, resistance to the antibiotic used for prophylaxis significantly increased (rate ratio 2.84, 1.38 to 5.83). The overall methodological quality of the trials was poor. Conclusions Prophylaxis with systemic antibiotics has a beneficial effect in burns patients, but the methodological quality of the data is weak. As such prophylaxis is currently not recommended for patients with severe burns other than perioperatively, there is a need for randomised controlled trials to assess its use. PMID:20156911

Comparison of heat transfer and soil impacts of air curtain burner burning and slash pile burning

Treesearch

Woongsoon Jang; Deborah S. Page-Dumroese; Han-Sup Han

2017-01-01

We measured soil heating and subsequent changes in soil properties between two forest residue disposal methods: slash pile burning (SPB) and air curtain burner (ACB). The ACB consumes fuels more efficiently and safely via blowing air into a burning container. Five burning trials with different fuel sizes were implemented in northern California, USA. Soil temperature...

Honey as a topical treatment for wounds.

PubMed

Jull, Andrew B; Rodgers, Anthony; Walker, Natalie

2008-10-08

Honey is a viscous, supersaturated sugar solution derived from nectar gathered and modified by the honeybee, Apis mellifera. Honey has been used since ancient times as a remedy in wound care. Evidence from animal studies and some trials has suggested honey may accelerate wound healing. The objective was to determine whether honey increases the rate of healing in acute wounds (burns, lacerations and other traumatic wounds) and chronic wounds (venous ulcers, arterial ulcers, diabetic ulcers, pressure ulcers, infected surgical wounds). We searched the Cochrane Wounds Group Specialised Register (May 2008), CENTRAL (May 2008) and several other electronic databases (May 2008). Bibliographies were searched and manufacturers of dressing products were contacted for unpublished trials. Randomised and quasi randomised trials that evaluated honey as a treatment for any sort of acute or chronic wound were sought. There was no restriction in terms of source, date of publication or language. Wound healing was the primary endpoint. Data from eligible trials were extracted and summarised using a data extraction sheet by one author and independently verified by a second author. 19 trials (n=2554) were identified that met the inclusion criteria. In acute wounds, three trials evaluated the effect of honey in acute lacerations, abrasions or minor surgical wounds and nine trials evaluated the effect the honey in burns. In chronic wounds two trials evaluated the effect of honey in venous leg ulcers and one trial in pressure ulcers, infected post-operative wounds, and Fournier's gangrene respectively. Two trials recruited people with mixed groups of chronic or acute wounds. The poor quality of most of the trial reports means the results should be interpreted with caution, except in venous leg ulcers. In acute wounds, honey may reduce time to healing compared with some conventional dressings in partial thickness burns (WMD -4.68 days, 95%CI -4.28 to -5.09 days). All the included burns trials have originated from a single centre, which may have impact on replicability. In chronic wounds, honey in addition to compression bandaging does not significantly increase healing in venous leg ulcers (RR 1.15, 95%CI 0.96 to 1.38). There is insufficient evidence to determine the effect of honey compared with other treatments for burns or in other acute or chronic wound types. Honey may improve healing times in mild to moderate superficial and partial thickness burns compared with some conventional dressings. Honey dressings as an adjuvant to compression do not significantly increase leg ulcer healing at 12 weeks. There is insufficient evidence to guide clinical practice in other areas.

A multi-center study on the regenerative effects of erythropoietin in burn and scalding injuries: study protocol for a randomized controlled trial.

PubMed

Günter, Christina Irene; Bader, Augustinus; Dornseifer, Ulf; Egert, Silvia; Dunda, Sebastian; Grieb, Gerrit; Wolter, Thomas; Pallua, Norbert; von Wild, Tobias; Siemers, Frank; Mailänder, Peter; Thamm, Oliver; Ernert, Carsten; Steen, Michael; Sievers, Reiner; Reichert, Bert; Rahmanian-Schwarz, Afshin; Schaller, Hans; Hartmann, Bernd; Otte, Max; Kehl, Victoria; Ohmann, Christian; Jelkmann, Wolfgang; Machens, Hans-Günther

2013-05-03

Although it was initially assumed that erythropoietin (EPO) was a hormone that only affected erythropoiesis, it has now been proposed that EPO plays an additional key role in the regulation of acute and chronic tissue damage. This is a large, prospective, randomized, double-blind, multi-center study, funded by the German Federal Ministry of Education and Research, and fully approved by the designated ethics committee. The trial, which is to investigate the effects of EPO in severely burned patients, is in its recruitment phase and is being carried out in 13 German burn care centers. A total of 150 patients are to be enrolled to receive study medication every other day for 21 days (EPO 150 IU/kg body weight or placebo). A follow-up of one year is planned. The primary endpoint of this study is the time until complete re-epithelialization of a defined skin graft donor site is reached. Furthermore, clinical parameters such as wound healing, scar formation (using the Vancouver scar scale), laboratory values, quality of life (SF-36), angiogenic effects, and gene- and protein-expression patterns are to be determined. The results will be carefully evaluated for gender differences. We are seeking new insights into the mechanisms of wound healing in thermally injured patients and more detailed information about the role EPO plays, specifically in these complex interactions. We additionally expect that the biomimetic effects of EPO will be useful in the treatment of acute thermal dermal injuries. EudraCT Number: 2006-002886-38, Protocol Number: 0506, ISRCT Number: http://controlled-trials.com/ISRCTN95777824/ISRCTN95777824.

Safety and efficacy of an intensive insulin protocol in a burn-trauma intensive care unit.

PubMed

Cochran, Amalia; Davis, Lynn; Morris, Stephen E; Saffle, Jeffrey R

2008-01-01

Aggressive glycemic management in critically ill patients with acute burn injury or life-threatening soft-tissue infections has not been thoroughly evaluated. An intensive insulin protocol with target glucose values of less than 120 mg/dl was implemented in October 2005 in our regional Burn-Trauma intensive care unit. We reviewed our initial experience with this protocol to evaluate the safety and efficacy of aggressive glycemic control in these patient groups. Patients were placed on the intensive insulin protocol based upon the need for glycemic management during their hospitalization for burn or soft-tissue disease. Patient information prospectively collected while on protocol included all measured blood glucose values, total daily insulin use, and incidence of hypoglycemic episodes, defined as serum glucose <60 mg/dl. Thirty patients (17 burns, 13 soft-tissue infections) were placed on the intensive insulin protocol during the first 16 months of use. The mean daily blood glucose level for burn patients was 115.9 mg/dl and for soft-tissue disease patients was 119.5 mg/dl. There was a 5% incidence of hypoglycemic episodes per protocol day. All hypoglycemic episodes were treated by holding the insulin infusion, and no episode had known adverse effects. Hyperglycemia in critically ill patients with burns and extensive soft-tissue disease can be effectively managed with an insulin protocol that targets blood glucose values of less than 120 mg/dl with minimal incidence of hypoglycemia. A multicenter prospective randomized trial would provide the ideal forum for evaluating clinical outcome benefits of using an intensive insulin protocol.

Effectiveness of medical hypnosis for pain reduction and faster wound healing in pediatric acute burn injury: study protocol for a randomized controlled trial.

PubMed

Chester, Stephen J; Stockton, Kellie; De Young, Alexandra; Kipping, Belinda; Tyack, Zephanie; Griffin, Bronwyn; Chester, Ralph L; Kimble, Roy M

2016-04-29

Burns and the associated wound care procedures can be extremely painful and anxiety-provoking for children. Burn injured children and adolescents are therefore at greater risk of experiencing a range of psychological reactions, in particular posttraumatic stress disorder, which can persist for months to years after the injury. Non-pharmacological intervention is critical for comprehensive pain and anxiety management and is used alongside pharmacological analgesia and anxiolysis. However, effective non-pharmacological pain and anxiety management during pediatric burn procedures is an area still needing improvement. Medical hypnosis has received support as a technique for effectively decreasing pain and anxiety levels in adults undergoing burn wound care and in children during a variety of painful medical procedures (e.g., bone marrow aspirations, lumbar punctures, voiding cystourethrograms, and post-surgical pain). Pain reduction during burn wound care procedures is linked with improved wound healing rates. To date, no randomized controlled trials have investigated the use of medical hypnosis in pediatric burn populations. Therefore this study aims to determine if medical hypnosis decreases pain, anxiety, and biological stress markers during wound care procedures; improves wound healing times; and decreases rates of traumatic stress reactions in pediatric burn patients. This is a single-center, superiority, parallel-group, prospective randomized controlled trial. Children (4 to 16 years, inclusive) with acute burn injuries presenting for their first dressing application or change are randomly assigned to either the (1) intervention group (medical hypnosis) or (2) control group (standard care). A minimum of 33 participants are recruited for each treatment group. Repeated measures of pain, anxiety, stress, and wound healing are taken at every dressing change until ≥95 % wound re-epithelialization. Further data collection assesses impact on posttraumatic stress symptomatology, speed of wound healing, and parent perception of how easy the dressing change is for their child. Study results will elucidate whether the disease process can be changed by using medical hypnosis with children to decrease pain, anxiety, and stress in the context of acute burn wounds. Australian New Zealand Clinical Trials Registry ACTRN12615000419561.

Pain control in a randomized, controlled, clinical trial comparing moist exposed burn ointment and conventional methods in patients with partial-thickness burns.

PubMed

Ang, Erik; Lee, S-T; Gan, Christine S-G; Chan, Y-H; Cheung, Y-B; Machin, D

2003-01-01

Conventional management of partial-thickness burn wounds includes the use of paraffin gauze dressing, frequently with topical silver-based antibacterial creams. Some creams form an overlying slough that renders wound assessment difficult and are painful upon application. An alternative to conventional management, moist exposed burn ointment (MEBO), has been proposed as a topical agent that may accelerate wound healing and have antibacterial and analgesic properties. One hundred fifteen patients with partial-thickness burns were randomly assigned to conventional (n = 58) or MEBO treatment (n = 57). A verbal numerical rating score of pain was made in the morning, after burn dressing, and some 8 hours later. Patient pain profiles were summarized by locally weighted regression smoothing technique curves and the difference between treatments estimated using multilevel regression techniques. Mean verbal numerical rating scale pain levels (cm) in week 1 for all patients were highest at 3.2 for the after dressing assessment, lowest in the evening at 2.6, and intermediate in the morning at 3.0. This pattern continued at similar levels in week 2 and then declined by a mean of 0.5 in all groups in week 3. There was little evidence to suggest a difference in pain levels by treatment group with the exception of the postdressing pain levels in the first week when those receiving MEBO had a mean level of 0.7 cm (95% confidence interval, 0.2 to 1.1) lower than those on conventional therapy. MEBO appeared to bring greater pain relief for the postdressing assessment during the first week after burns. This initial relief, together with comparable pain levels experienced on other occasions, indicates that MEBO could be an alternative to conventional burns management.

Evaluating the role of alternative therapy in burn wound management: randomized trial comparing moist exposed burn ointment with conventional methods in the management of patients with second-degree burns.

PubMed

Ang, E S; Lee, S T; Gan, C S; See, P G; Chan, Y H; Ng, L H; Machin, D

2001-03-06

Moist exposed burn ointment (MEBO), from China, has been said to revolutionize burn management. Our study was conducted to compare MEBO with conventional management (C) with respect to the rate of wound healing, antibacterial and analgesic effect, and hospital costs. This is a prospective, randomized, controlled clinical trial conducted between 1 March 1997 and 24 October 1998. The trial was conducted in a specialized burn facility located in a tertiary referral hospital in a developed and industrialized island-state in Southeast Asia. We randomly assigned 115 consecutive patients between the ages of 12 and 80 who had partial-thickness thermal burns covering less than 40% of body surface area (BSA) to receive either MEBO or C. Fifty-seven patients were assigned to MEBO and 58 patients to C. The latter group received twice-daily dressing changes; MEBO patients received MEBO every 4 hours. Patients were hospitalized until 75% BSA had healed. BSA was determined by visual inspection and charted on Lund and Browder charts regularly. Wound healing rate, bacterial infection rate, pain score, and hospitalization costs were recorded. The median time to 75% healing was 17.0 and 20.0 days with MEBO and C, respectively (HR = 0.67, 95% CI = 0.41-1.11, P =.11), suggesting similar efficacy between the 2 modalities. Bacterial infection rates were similar between the 2 groups (HR = 1.10, 95% CI = 0.59-2.03, P =.76). MEBO imparted a greater analgesic effect in the first 5 days of therapy and reduced hospital costs by 8%. MEBO is as effective as conventional management but is not the panacea for all burn wounds. The use of MEBO eases the management of face and neck burns and facilitates early institution of occupational therapy in hand burns. It confers better pain relief such that fewer opiates are used during the first 5 days after burn injury.

Combustion of a Polymer (PMMA) Sphere in Microgravity

NASA Technical Reports Server (NTRS)

Yang, Jiann C.; Hamins, Anthony; Donnelly, Michelle K.

1999-01-01

A series of low gravity, aircraft-based, experiments was conducted to investigate the combustion of supported thermoplastic polymer spheres under varying ambient conditions. The three types of thermoplastic investigated were polymethylmethacrylate (PMMA), polypropylene (PP). and polystyrene (PS). Spheres with diameters ranging from 2 mm to 6.35 mm were tested. The total initial pressure varied from 0.05 MPa to 0. 15 MPa whereas the ambient oxygen concentration varied from 19 % to 30 % (by volume). The ignition system consisted of a pair of retractable energized coils. Two CCD cameras recorded the burning histories of the spheres. The video sequences revealed a number of dynamic events including bubbling and sputtering, as well as soot shell formation and break-up during combustion of the spheres at reduced gravity. The ejection of combusting material from the burning spheres represents a fire hazard that must be considered at reduced gravity. The ejection process was found to be sensitive to polymer type. All average burning rates were measured to increase with initial sphere diameter and oxygen concentration, whereas the initial pressure had little effect. The three thermoplastic types exhibited different burning characteristics. For the same initial conditions, the burning rate of PP was slower than PMMA, whereas the burning rate of PS was comparable to PMMA. The transient diameter of the burning thermoplastic exhibited two distinct periods: an initial period (enduring approximately half of the total burn duration) when the diameter remained approximately constant, and a final period when the square of the diameter linearly decreased with time. A simple homogeneous two-phase model was developed to understand the changing diameter of the burning sphere. Its value is based on a competition between diameter reduction due to mass loss from burning and sputtering, and diameter expansion due to the processes of swelling (density decrease with heating) and bubble growth. The model relies on empirical parameters for input, such as the burning rate and the duration of the initial and final burning periods.

Burns teaching in UK medical schools: Is it enough?

PubMed

Zinchenko, Ruslan; Perry, Fiona M; Dheansa, Baljit S

2016-02-01

Burns are frequently seen and managed in non-specialist settings. The crowding of the UK medical undergraduate curriculum may have resulted in the reduction of teaching on burns. To determine the burns education experience and the level of competence among UK final year medical students in assessing and acutely managing patients with burns. An online questionnaire was circulated among UK final year medical students. There was a total of 348 respondents. The majority of the respondents (70%) have not received any specific teaching on how to manage patients with burns. Nearly two-thirds of the students (66%) have never seen a patient being managed for burns throughout their training. Over 90% of respondents stated that they would not feel confident in initially managing a burn in the emergency department. The majority of the respondents (57%) have not heard of the criteria for referring a burns patient for further specialist management. There was almost universal agreement about the importance of knowing how to manage a burn initially. There seems to be a lack of consistent undergraduate training in burns management and final year students lack the experience and knowledge to initially manage burns. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Clinical effectiveness, quality of life and cost-effectiveness of Flaminal® versus Flamazine® in the treatment of partial thickness burns: study protocol for a randomized controlled trial.

PubMed

Rashaan, Zjir M; Krijnen, Pieta; van den Akker-van Marle, M Elske; van Baar, Margriet E; Vloemans, Adrianus F P; Dokter, Jan; Tempelman, Fenike R H; van der Vlies, Cees H; Breederveld, Roelf S

2016-03-05

Partial thickness burns are painful, difficult to manage and can have a negative effect on quality of life through scarring, permanent disfigurement and loss of function. The aim of burn treatment in partial thickness burns is to save lives, stimulate wound healing by creating an optimumly moist wound environment, to have debriding and analgesic effects, protect the wound from infection and be convenient for the patient and caregivers. However, there is no consensus on the optimal treatment of partial thickness wounds. Flaminal® and Flamazine® are two standard treatment options that provide the above mentioned properties in burn treatment. Nevertheless, no randomized controlled study has yet compared these two common treatment modalities in partial thickness burns. Thus, the aim of this study is to evaluate the clinical effectiveness, quality of life and cost-effectiveness of Flaminal® versus Flamazine® in the treatment of partial thickness burns. In this two-arm open multi-center randomized controlled trial, 90 patients will be randomized between Flaminal® and Flamazine® and followed for 12 months. The study population will consist of competent or temporarily non-competent (because of sedation and/or intubation) patients, 18 years of age or older, with acute partial thickness burns and a total body surface area (TBSA) of less than 30 %. The main study outcome is time to complete re-epithelialization (greater than 95 %). Secondary outcome measures include need for grafting, wound colonization/infection, number of dressing changes, pain and anxiety, scar formation, health-related quality of life (HRQoL), and costs. This study will contribute to the optimal treatment of patients with partial thickness burn wounds and will provide evidence on the (cost-)effectiveness and quality of life of Flaminal® versus Flamazine® in the treatment of partial thickness burns. Netherlands Trial Register NTR4486 , registered on 2 April 2014.

40 CFR 266.104 - Standards to control organic emissions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... HAZARDOUS WASTE MANAGEMENT FACILITIES Hazardous Waste Burned in Boilers and Industrial Furnaces § 266.104...) of this section, a boiler or industrial furnace burning hazardous waste must achieve a destruction... demonstrate conformance with this requirement, 99.99% DRE must be demonstrated during a trial burn for each...

40 CFR 266.104 - Standards to control organic emissions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... HAZARDOUS WASTE MANAGEMENT FACILITIES Hazardous Waste Burned in Boilers and Industrial Furnaces § 266.104...) of this section, a boiler or industrial furnace burning hazardous waste must achieve a destruction... demonstrate conformance with this requirement, 99.99% DRE must be demonstrated during a trial burn for each...

40 CFR 266.104 - Standards to control organic emissions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... HAZARDOUS WASTE MANAGEMENT FACILITIES Hazardous Waste Burned in Boilers and Industrial Furnaces § 266.104...) of this section, a boiler or industrial furnace burning hazardous waste must achieve a destruction... demonstrate conformance with this requirement, 99.99% DRE must be demonstrated during a trial burn for each...

In view of standardization: comparison and analysis of initial management of severely burned patients in Germany, Austria and Switzerland.

PubMed

Münzberg, Matthias; Ziegler, Benjamin; Fischer, Sebastian; Wölfl, Christoph Georg; Grützner, Paul Alfred; Kremer, Thomas; Kneser, Ulrich; Hirche, Christoph

2015-02-01

Initial treatment of severely injured patients in German speaking trauma centers follows precise sequences. Several guidelines and training courses ensure a constant quality in providing evidence-based treatment for these patients. Similar standards, algorithms and guidelines for the treatment of severely burned patients are lacking. This raises the question about the current standard of care for burn victims in German speaking burn centers. In order to achieve standardization, as a first step this study surveys principles of burn room organization and management in these burn centers. A questionnaire including 40 questions regarding burn room organization, personnel structure and qualification, infrastructural conditions and quality management was developed and sent to 21 level one burn centers in Germany, Austria and Switzerland. The rate of returned questionnaires was 81%. The analysis revealed varying personnel and infrastructural conditions in participating burn centers. Indications for admission to the burn room and admission procedures itself are different throughout surveyed hospitals. Individual standard operating procedure (SOP) for burn trauma admissions was available in most burn centers and nearly all participants register their burn trauma cases using an in-house burn register. The survey suggests a lack of standardization in personnel structure, infrastructure and treatment approach for the initial clinical care of severely burned patients in burn centers across the German speaking countries. Further evaluation of existing protocols and international standards in burn care is inevitable to develop standardized guidelines for burn care and to improve quality of care. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Cost-effectiveness of silver dressings for paediatric partial thickness burns: An economic evaluation from a randomized controlled trial.

PubMed

Gee Kee, E; Stockton, K; Kimble, R M; Cuttle, L; McPhail, S M

2017-06-01

Partial thickness burns of up to 10% total body surface area (TBSA) in children are common injuries primarily treated in the outpatient setting using expensive silver-containing dressings. However, economic evaluations in the paediatric burns population are lacking to assist healthcare providers when choosing which dressing to use. The aim of this study was to conduct a cost-effectiveness analysis of three silver dressings for partial thickness burns ≤10% TBSA in children aged 0-15 years using days to full wound re-epithelialization as the health outcome. This study was a trial based economic evaluation (incremental cost effectiveness) conducted from a healthcare provider perspective. Ninety-six children participated in the trial investigating Acticoat™, Acticoat™ with Mepitel™ or Mepilex Ag™. Costs directly related to the management of partial thickness burns ≤10% TBSA were collected during the trial from March 2013 to July 2014 and for a one year after re-epithelialization time horizon. Incremental cost effectiveness ratios were estimated and dominance probabilities calculated from bootstrap resampling trial data. Sensitivity analyses were conducted to examine the potential effect of accounting for infrequent, but high cost, skin grafting surgical procedures. Costs (dressing, labour, analgesics, scar management) were considerably lower in the Mepilex Ag™ group (median AUD$94.45) compared to the Acticoat™ (median $244.90) and Acticoat™ with Mepitel™ (median $196.66) interventions. There was a 99% and 97% probability that Mepilex Ag™ dominated (cheaper and more effective than) Acticoat™ and Acticoat™ with Mepitel™, respectively. This pattern of dominance was consistent across raw cost and effects, after a priori adjustments, and sensitivity analyses. There was an 82% probability that Acticoat™ with Mepitel dominated Acticoat™ in the primary analysis, although this probability was sensitive to the effect of skin graft procedures. This economic evaluation has demonstrated that Mepilex Ag™ was the dominant dressing choice over both Acticoat™ and Acticoat™ with Mepitel™ in this trial-based economic evaluation and is recommended for treatment of paediatric partial thickness burns ≤10% TBSA. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

The effects of honey compared to silver sulfadiazine for the treatment of burns: A systematic review of randomized controlled trials.

PubMed

Aziz, Zoriah; Abdul Rasool Hassan, Bassam

2017-02-01

Evidence from animal studies and trials suggests that honey may accelerate wound healing. The objective of this review was to assess the effects of honey compared with silver dressings on the healing of burn wounds. Relevant databases for randomized controlled trials (RCTs) of honey compared with silver sulfadiazine (SSD) were searched. The quality of the selected trials was assessed using the Cochrane Risk of Bias Assessment Tool. The primary endpoints considered were wound healing time and the number of infected wounds rendered sterile. Nine RCTs met the inclusion criteria. Based on moderate quality evidence there was a statistically significant difference between the two groups, favoring honey in healing time (MD -5.76days, 95% CI -8.14 to -3.39) and the proportions of infected wounds rendered sterile (RR 2.59; 95% CI 1.58-2.88). The available evidence suggests that honey dressings promote better wound healing than silver sulfadiazine for burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Delayed prescribed burning in a seedling and sapling Longleaf Pine plantation in Louisiana

Treesearch

James D. Haywood

2002-01-01

To examine the effects of delaying prescribed burning for several years, I initiated five treatments in a 5- to 6-year-old longleaf pine stand: a check of no control; biennial hardwood control by directed chemical application; and biennial burning in either early March, May, or July. After the initial burns, longleaf pine survival decreased from 82 percent in February...

Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children: study protocol for a randomised controlled trial.

PubMed

Wiseman, Jodie; Simons, Megan; Kimble, Roy; Ware, Robert; McPhail, Steven; Tyack, Zephanie

2017-02-16

Abnormal scar development following burn injury can cause substantial physical and psychological distress to children and their families. Common burn scar prevention and management techniques include silicone therapy, pressure garment therapy, or a combination of both. Currently, no definitive, high-quality evidence is available for the effectiveness of topical silicone gel or pressure garment therapy for the prevention and management of burn scars in the paediatric population. Thus, this study aims to determine the effectiveness of these treatments in children. A randomised controlled trial will be conducted at a large tertiary metropolitan children's hospital in Australia. Participants will be randomised to one of three groups: Strataderm® topical silicone gel only, pressure garment therapy only, or combined Strataderm® topical silicone gel and pressure garment therapy. Participants will include 135 children (45 per group) up to 16 years of age who are referred for scar management for a new burn. Children up to 18 years of age will also be recruited following surgery for burn scar reconstruction. Primary outcomes are scar itch intensity and scar thickness. Secondary outcomes include scar characteristics (e.g. colour, pigmentation, pliability, pain), the patient's, caregiver's and therapist's overall opinion of the scar, health service costs, adherence, health-related quality of life, treatment satisfaction and adverse effects. Measures will be completed on up to two sites per person at baseline and 1 week post scar management commencement, 3 months and 6 months post burn, or post burn scar reconstruction. Data will be analysed using descriptive statistics and univariate and multivariate regression analyses. Results of this study will determine the effectiveness of three noninvasive scar interventions in children at risk of, and with, scarring post burn or post reconstruction. Australian New Zealand Clinical Trials Registry, ACTRN12616001100482 . Registered on 5 August 2016.

Burn disaster response planning: an urban region's approach.

PubMed

Yurt, Roger W; Lazar, Eliot J; Leahy, Nicole E; Cagliuso, Nicholas V; Rabbitts, Angela C; Akkapeddi, Vijay; Cooper, Arthur; Dajer, Antonio; Delaney, Jack; Mineo, Frank P; Silber, Steven H; Soloff, Lewis; Magbitang, Kevin; Mozingo, David W

2008-01-01

The objective of this study was to describe a draft response plan for the tiered triage, treatment, or transportation of 400 adult and pediatric victims (50/million population) of a burn disaster for the first 3 to 5 days after injury using regional resources. Review of meeting minutes and the 11 deliverables of the draft response plan was performed. The draft burn disaster response plan developed for NYC recommended: 1) City hospitals or regional burn centers within a 60-mile distance be designated as tiered Burn Disaster Receiving Hospitals (BDRH); 2) these hospitals be divided into a four-tier system, based on clinical resources; and 3) burn care supplies be provided to Tier 3 nonburn centers. Existing burn center referral guidelines were modified into a hierarchical BDRH matrix, which would vector certain patients to local or regional burn centers for initial care until capacity is reached; the remainder would be cared for in nonburn center facilities for up to 3 to 5 days until a city, regional, or national burn bed becomes available. Interfacility triage would be coordinated by a central team. Although recommendations for patient transportation, educational initiatives for prehospital and hospital providers, city-wide, interfacility or interagency communication strategies and coordination at the State or Federal levels were outlined, future initiatives will expound on these issues. An incident resulting in critically injured burn victims exceeding the capacity of local and regional burn center beds may be a reality within any community and warrants a planned response. To address this possibility within New York City, an initial draft of a burn disaster response has been created. A scaleable plan using local, state, regional, or federal health care and governmental institutions was developed.

A multi-center study on the regenerative effects of erythropoietin in burn and scalding injuries: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Although it was initially assumed that erythropoietin (EPO) was a hormone that only affected erythropoiesis, it has now been proposed that EPO plays an additional key role in the regulation of acute and chronic tissue damage. Via the inhibition of inflammatory reactions and of apoptosis, stem cell recruitment, advancement of angiogenesis and growth factor release, EPO enhances healing and thus restitutio ad integrum after trauma. Human skin contains EPO receptors and is able to synthesize EPO. We therefore hypothesize that EPO is able to optimize wound healing in thermally injured patients. Methods/Design This is a large, prospective, randomized, double-blind, multi-center study, funded by the German Federal Ministry of Education and Research, and fully approved by the designated ethics committee. The trial, which is to investigate the effects of EPO in severely burned patients, is in its recruitment phase and is being carried out in 13 German burn care centers. A total of 150 patients are to be enrolled to receive study medication every other day for 21 days (EPO 150 IU/kg body weight or placebo). A follow-up of one year is planned. The primary endpoint of this study is the time until complete re-epithelialization of a defined skin graft donor site is reached. Furthermore, clinical parameters such as wound healing, scar formation (using the Vancouver scar scale), laboratory values, quality of life (SF-36), angiogenic effects, and gene- and protein-expression patterns are to be determined. The results will be carefully evaluated for gender differences. Discussion We are seeking new insights into the mechanisms of wound healing in thermally injured patients and more detailed information about the role EPO plays, specifically in these complex interactions. We additionally expect that the biomimetic effects of EPO will be useful in the treatment of acute thermal dermal injuries. Trial registration EudraCT Number: 2006-002886-38, Protocol Number: 0506, ISRCT Number: http://controlled-trials.com/ISRCTN95777824/ISRCTN95777824. PMID:23782555

A health intervention or a kitchen appliance? Household costs and benefits of a cleaner burning biomass-fuelled cookstove in Malawi.

PubMed

Cundale, Katie; Thomas, Ranjeeta; Malava, Jullita Kenala; Havens, Deborah; Mortimer, Kevin; Conteh, Lesong

2017-06-01

Pneumonia is the leading cause of mortality for children under five years in sub-Saharan Africa. Household air pollution has been found to increase risk of pneumonia, especially due to exposure from dirty burning biomass fuels. It has been suggested that advanced stoves, which burn fuel more efficiently and reduce smoke emissions, may help to reduce household air pollution in poor, rural settings. This qualitative study aims to provide an insight into the household costs and perceived benefits from use of the stove in Malawi. It was conducted alongside The Cooking and Pneumonia Study (CAPS), the largest village cluster-level randomised controlled trial of an advanced combustion cookstove intervention to prevent pneumonia in children under five to date. In 2015, using 100 semi-structured interviews this study assessed household time use and perceptions of the stove from both control and intervention participants taking part in the CAPS trial in Chilumba. Household direct and indirect costs associated with the intervention were calculated. Users overwhelming liked using the stove. The main reported benefits were reduced cooking times and reduced fuel consumption. In most interviews, the health benefits were not initially identified as advantages of the stove, although when prompted, respondents stated that reduced smoke emissions contributed to a reduction in respiratory symptoms. The cost of the stove was much higher than most respondents said they would be willing to pay. The stoves were not primarily seen as health products. Perceptions of limited impact on health was subsequently supported by the CAPS trial data which showed no significant effect on pneumonia. While the findings are encouraging from the perspective of acceptability, without innovative financing mechanisms, general uptake and sustained use of the stove may not be possible in this setting. The findings also raise the question of whether the stoves should be marketed and championed as 'health interventions'. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Physiological characteristics of dysphagia following thermal burn injury.

PubMed

Rumbach, Anna F; Ward, Elizabeth C; Cornwell, Petrea L; Bassett, Lynell V; Muller, Michael J

2012-09-01

The study aim was to document the acute physiological characteristics of swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and fiberoptic evaluation of swallowing (FEES). FEES confirmed six individuals (32%) had no aspiration risk and were excluded from further analyses. Of the remaining 13, CSE confirmed that two had specific oral-phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal-phase deficits, with the major findings evident in greater than 50% being impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 50% (n = 6/12 penetration aspiration events) of the cases. Most events occurred post swallow. Findings support the fact that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral-stage swallow function. This study has identified a range of factors that may contribute to both oral- and pharyngeal-stage dysfunction in this clinical population and has highlighted the importance of using a combination of clinical and instrumental assessments to fully understand the influence of burn injury on oral intake and swallowing.

Prehospital treatment of burns: a qualitative study of experiences, perceptions and reactions of victims.

PubMed

Sadeghi Bazargani, H; Fouladi, N; Alimohammadi, H; Sadeghieh Ahari, S; Agamohammadi, M; Mohamadi, R

2013-08-01

The manner in which burns are initially managed, at an incident scene, can affect the extent and depth of burn wounds and their final prognosis. The aim of this study was to understand people's experiences, perceptions and reactions towards the initial management of burns and fire accidents in Ardabil Province, Iran. In a qualitative study, 48 burn victims accompanied by their caregivers were enrolled. Focus group discussion (FGD) was used to collect data. All the interviews were recorded, transcribed and analysed using content analysis method. Four categories of information were retrieved in this study, including fire control, scald and burn wound management, seeking medical consultation and severity indicators. Uncertainty regarding what to do when someone catches fire was an evident finding that was explored through the discussions. The results revealed that transferring the patient to the hospital most often takes place after initial treatments administered at home. People believed that cooling a burn wound for a time longer than a few seconds may harm the wound. A strong belief in the efficacy of traditional remedies was disclosed when the statements of participants revealed that traditional or home-made remedies were widely used either to control pain immediately after burn and later during the wound repair process to accelerate the repair or to control the infection and prevent oedema and scar. Among these remedies, pennyroyal and grated potatoes seemed to be the most popular ones. Pennyroyal was thought to prevent infection and potatoes were used to relieve pain. People doubted the capability of health-care workers who work in rural health houses. People considered electrical burns and burns on the chest to be the most severe types of burns. Inappropriate perceptions regarding initial management of burns existed among the participants that should be addressed in future quantitative research or through developing programmes on secondary prevention of burns. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Clinical review: The critical care management of the burn patient

PubMed Central

2013-01-01

Between 4 and 22% of burn patients presenting to the emergency department are admitted to critical care. Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects. Burn care has seen renewed interest in colloid resuscitation, a change in transfusion practice and the development of anti-catabolic therapies. A literature search was conducted with priority given to review articles, meta-analyses and well-designed large trials; paediatric studies were included where adult studies were lacking with the aim to review the advances in adult intensive care burn management and place them in the general context of day-to-day practical burn management. PMID:24093225

Whole Arm Water Displacement Volumetry Is a Reliable and Sensitive Measure: A Pilot to Assess Acute Postburn Volume Change.

PubMed

Edgar, Dale W; Briffa, N Kathy; Wood, Fiona M

Water displacement volumetry (WDV) is a reliable method for measurement of wrist and hand volume in lymphedema patients. However, within session WDV reliability for the whole upper limb (UL) lacks comprehensive investigation, particularly in acute edema populations. This study aimed to confirm the reliability and investigate the impact of time between repeated trials on the sensitivity of WDV as a measure of whole UL volume change in an uninjured cohort and a burn injured pilot group. Within session, duplicate measures of whole UL WDV were recorded in two groups of noninjured volunteers and a group of burn patients. Each noninjured group differed only in the time between WDV repeats. The reliability trials were performed <10 minutes apart (T10) and 20 to 30 minutes apart (T20). The time between repetitions for burn patients was 20 to 30 minutes, based on the results of the noninjured participant trials. All trial groups demonstrated excellent correlation between trials (ICCT10 = 0.999, ICCT20 = 0.997). The minimum detectable difference calculated for WDV when measuring whole UL volume change of >50 ml for noninjured and >100 ml for burn patients. Despite this, a systematic bias was demonstrated between the T10 group means. The T20 group trials did not indicate such error on statistical testing (P = .297). The study confirms that WDV measurement of whole ULs is reliable and sensitive, if used at least 20 minutes apart. However, a significant and clinically relevant subject-by-method interaction was demonstrated. Researchers and clinicians are reminded to be aware of the performance of the technique when designing investigations in patient populations.

"What do kids know": a survey of 420 Grade 5 students in Cambodia on their knowledge of burn prevention and first-aid treatment.

PubMed

Hsiao, Marvin; Tsai, Brian; Uk, Pisey; Jo, Harrison; Gomez, Manuel; Gollogly, James G; Beveridge, Massey

2007-05-01

Cambodia is a developing country of 13 million people where there are an estimated 20,000 burns and 2000 burn deaths annually. Two thirds of the burns occur to children under the age of 10 years. The purpose of this study was to determine the knowledge of burn prevention and first aid for burns in Grade 5 Cambodian school children, as baseline information to design a burn prevention campaign. A 34-question survey regarding burn prevention and first-aid treatment for burn injuries was developed. Additional questions on TV watching habits were included to determine the feasibility of a targeted TV burn educational campaign. The survey was translated into Khmer language and tested on a trial class for accuracy and ease of administration. After obtaining the school director's permission and children's consent the survey was administered by Canadian medical students helped by trained translators and teachers to Grade 5 students from eight different elementary schools in the Kampot province. A total of 420 students were surveyed. Average age was 12.5 years (range 9-17 years) and 55% were females. Seventy-four percent routinely cared for other children. Only 52% had TV at home but still 78% managed to watch TV for an average 2h per day. Even though 36% of students indicated they had received information about burn prevention and first aid, only 13% mentioned application of cool water as initial treatment, only 7% knew to roll on the ground if their clothes caught fire, and nearly 50% would pour water on a burning pot of oil. Half of students indicated that they would not believe a TV message promoting application of cold water on acute burns. Top reasons given were parental influence, belief in other treatments, and not trusting TV messages. Interestingly, 62% of these skeptics would change their mind if the TV message was endorsed by an authority figure such as a physician, teacher, parent, or the Ministry of Health. A set of five Public Service Announcements for Cambodian TV were developed and produced based on the results of this survey. This survey identified significant inadequacies in Cambodian children's knowledge about burn prevention and first aid and suggested that a televised burn prevention campaign could be an effective method to improve their knowledge, especially if it was endorsed by an authority figure.

Is initiating tanning bed use as a minor associated with increased risky tanning behaviors and burning? An exploratory study.

PubMed

Seidenberg, Andrew B; Noar, Seth M; Sontag, Jennah M

2017-12-01

Tanning bed use is most common among youth and young adults, and is associated with an increased risk of skin cancer. Recently, numerous states have adopted restrictions on minors' access to tanning beds; however, little has been reported on how such policies may impact tanning behaviors and burning. The purpose of this study was to examine the associations between age of indoor tanning initiation and risky tanning behaviors and burning. Female students (n=567) attending a large southeastern public university completed a questionnaire (spring of 2015) assessing tanning bed use history, including age of initiation. The analytic sample was limited to participants reporting past year indoor tanning (n=134). Multivariable logistic regression was used to compare the odds of risky tanning behaviors and burning among those initiating indoor tanning before and after their 18th birthday. Participants initiating indoor tanning as a minor had significantly (ps<0.05) greater odds of using a tanning bed 10 or more times in the previous year, typically indoor tanning for ≥10min, ever indoor tanning without wearing goggles, and ever fallen asleep inside a tanning bed. Further, those that initiated as a minor had significantly greater odds of ever burning from indoor tanning (p<0.05). Indoor tanning initiation as a minor was associated with several risky tanning behaviors and burning. Youth access restrictions may help reduce the harms caused by tanning beds. Copyright © 2017. Published by Elsevier Inc.

40 CFR 60.2953 - What information must I submit prior to initial startup?

Code of Federal Regulations, 2011 CFR

2011-07-01

... initial startup? 60.2953 Section 60.2953 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... initial startup? You must submit the information specified in paragraphs (a) through (e) of this section prior to initial startup. (a) The type(s) of waste to be burned. (b) The maximum design waste burning...

40 CFR 60.2953 - What information must I submit prior to initial startup?

Code of Federal Regulations, 2012 CFR

2012-07-01

... initial startup? 60.2953 Section 60.2953 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... initial startup? You must submit the information specified in paragraphs (a) through (e) of this section prior to initial startup. (a) The type(s) of waste to be burned. (b) The maximum design waste burning...

40 CFR 60.2953 - What information must I submit prior to initial startup?

Code of Federal Regulations, 2010 CFR

2010-07-01

... initial startup? 60.2953 Section 60.2953 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... initial startup? You must submit the information specified in paragraphs (a) through (e) of this section prior to initial startup. (a) The type(s) of waste to be burned. (b) The maximum design waste burning...

Enzymatic debridement for the treatment of severely burned upper extremities - early single center experiences.

PubMed

Cordts, Tomke; Horter, Johannes; Vogelpohl, Julian; Kremer, Thomas; Kneser, Ulrich; Hernekamp, Jochen-Frederick

2016-06-24

Severe burns of hands and arms are complex and challenging injuries. The Standard of care (SOC) - necrosectomy with skin grafting - is often associated with poor functional or aesthetic outcome. Enzymatic debridement (ED) is considered one promising alternative but, until recently, results proved to be highly variable. Between 04/2014 and 04/2015, 16 patients with deep partial- to full-thickness burns of the upper extremities underwent enzymatic debridement (ED) in our Burn Center and were evaluated for extent of additional surgery, wound healing, pain management and functional parameters. Following ED, no further surgical intervention was required in 53.8 % of the study population. In patients who required surgical treatment, the the skin-grafted area could be reduced by 37.0 % when compared to initial assessment. Time from injury to ED was 24.4 h and patients were able to start physical therapy after 2.0 days but suffered from prolonged wound closure (28.0 days). Regionally administered anesthesia proved to be superior to pain medication alone as pain levels and consumed morphine-equivalent were lower. Post-demission follow-up showed good functional results and pain levels with low scores in two self-report questionnaires (DASH, PRWE-G) but 3 patients reported increased susceptibility to shear stress. Based on these early experiences, we developed a 3-step algorithm for consecutive patients allowing appropriate and individualized treatment selection. We see a potential benefit for ED in the treatment of severely burned hands and forearms but further investigations and proper prospective, randomized controlled trials are needed to statistically support any outlined assumptions.

Antiseptics for burns.

PubMed

Norman, Gill; Christie, Janice; Liu, Zhenmi; Westby, Maggie J; Jefferies, Jayne M; Hudson, Thomas; Edwards, Jacky; Mohapatra, Devi Prasad; Hassan, Ibrahim A; Dumville, Jo C

2017-07-12

Burn wounds cause high levels of morbidity and mortality worldwide. People with burns are particularly vulnerable to infections; over 75% of all burn deaths (after initial resuscitation) result from infection. Antiseptics are topical agents that act to prevent growth of micro-organisms. A wide range are used with the intention of preventing infection and promoting healing of burn wounds. To assess the effects and safety of antiseptics for the treatment of burns in any care setting. In September 2016 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions based on language, date of publication or study setting. We included randomised controlled trials (RCTs) that enrolled people with any burn wound and assessed the use of a topical treatment with antiseptic properties. Two review authors independently performed study selection, risk of bias assessment and data extraction. We included 56 RCTs with 5807 randomised participants. Almost all trials had poorly reported methodology, meaning that it is unclear whether they were at high risk of bias. In many cases the primary review outcomes, wound healing and infection, were not reported, or were reported incompletely.Most trials enrolled people with recent burns, described as second-degree and less than 40% of total body surface area; most participants were adults. Antiseptic agents assessed were: silver-based, honey, Aloe Vera, iodine-based, chlorhexidine or polyhexanide (biguanides), sodium hypochlorite, merbromin, ethacridine lactate, cerium nitrate and Arnebia euchroma. Most studies compared antiseptic with a topical antibiotic, primarily silver sulfadiazine (SSD); others compared antiseptic with a non-antibacterial treatment or another antiseptic. Most evidence was assessed as low or very low certainty, often because of imprecision resulting from few participants, low event rates, or both, often in single studies. Antiseptics versus topical antibioticsCompared with the topical antibiotic, SSD, there is low certainty evidence that, on average, there is no clear difference in the hazard of healing (chance of healing over time), between silver-based antiseptics and SSD (HR 1.25, 95% CI 0.94 to 1.67; I 2 = 0%; 3 studies; 259 participants); silver-based antiseptics may, on average, increase the number of healing events over 21 or 28 days' follow-up (RR 1.17 95% CI 1.00 to 1.37; I 2 = 45%; 5 studies; 408 participants) and may, on average, reduce mean time to healing (difference in means -3.33 days; 95% CI -4.96 to -1.70; I 2 = 87%; 10 studies; 979 participants).There is moderate certainty evidence that, on average, burns treated with honey are probably more likely to heal over time compared with topical antibiotics (HR 2.45, 95% CI 1.71 to 3.52; I 2 = 66%; 5 studies; 140 participants).There is low certainty evidence from single trials that sodium hypochlorite may, on average, slightly reduce mean time to healing compared with SSD (difference in means -2.10 days, 95% CI -3.87 to -0.33, 10 participants (20 burns)) as may merbromin compared with zinc sulfadiazine (difference in means -3.48 days, 95% CI -6.85 to -0.11, 50 relevant participants). Other comparisons with low or very low certainty evidence did not find clear differences between groups.Most comparisons did not report data on infection. Based on the available data we cannot be certain if antiseptic treatments increase or reduce the risk of infection compared with topical antibiotics (very low certainty evidence). Antiseptics versus alternative antisepticsThere may be some reduction in mean time to healing for wounds treated with povidone iodine compared with chlorhexidine (MD -2.21 days, 95% CI 0.34 to 4.08). Other evidence showed no clear differences and is of low or very low certainty. Antiseptics versus non-antibacterial comparatorsWe found high certainty evidence that treating burns with honey, on average, reduced mean times to healing in comparison with non-antibacterial treatments (difference in means -5.3 days, 95% CI -6.30 to -4.34; I 2 = 71%; 4 studies; 1156 participants) but this comparison included some unconventional treatments such as amniotic membrane and potato peel. There is moderate certainty evidence that honey probably also increases the likelihood of wounds healing over time compared to unconventional anti-bacterial treatments (HR 2.86, 95% C 1.60 to 5.11; I 2 = 50%; 2 studies; 154 participants).There is moderate certainty evidence that, on average, burns treated with nanocrystalline silver dressings probably have a slightly shorter mean time to healing than those treated with Vaseline gauze (difference in means -3.49 days, 95% CI -4.46 to -2.52; I 2 = 0%; 2 studies, 204 participants), but low certainty evidence that there may be little or no difference in numbers of healing events at 14 days between burns treated with silver xenograft or paraffin gauze (RR 1.13, 95% CI 0.59 to 2.16 1 study; 32 participants). Other comparisons represented low or very low certainty evidence.It is uncertain whether infection rates in burns treated with either silver-based antiseptics or honey differ compared with non-antimicrobial treatments (very low certainty evidence). There is probably no difference in infection rates between an iodine-based treatment compared with moist exposed burn ointment (moderate certainty evidence). It is also uncertain whether infection rates differ for SSD plus cerium nitrate, compared with SSD alone (low certainty evidence).Mortality was low where reported. Most comparisons provided low certainty evidence that there may be little or no difference between many treatments. There may be fewer deaths in groups treated with cerium nitrate plus SSD compared with SSD alone (RR 0.22, 95% CI 0.05 to 0.99; I 2 = 0%, 2 studies, 214 participants) (low certainty evidence). It was often uncertain whether antiseptics were associated with any difference in healing, infections, or other outcomes. Where there is moderate or high certainty evidence, decision makers need to consider the applicability of the evidence from the comparison to their patients. Reporting was poor, to the extent that we are not confident that most trials are free from risk of bias.

MESOSCALE MODELING OF DEFLAGRATION-INDUCED DECONSOLIDATION IN POLYMER-BONDED EXPLOSIVES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Springer, H K; Glascoe, E A; Reaugh, J E

Initially undamaged polymer-bonded explosives can transition from conductive burning to more violent convective burning via rapid deconsolidation at higher pressures. The pressure-dependent infiltration of cracks and pores, i.e., damage, by product gases at the burn-front is a key step in the transition to convective burning. However, the relative influence of pre-existing damage and the evolution of deflagration-induced damage during the transition to convective burning is not well understood. The objective of this study is to investigate the role of microstructure and initial pressurization on deconsolidation. We performed simulations using the multi-physics hydrocode, ALE3D. HMX-Viton A served as our model explosive.more » A Prout-Tompkins chemical kinetic model, Vielle's Law pressure-dependent burning, Gruneisen equation-of-state, and simplified strength model were used for the HMX. The propensity for deconsolidation increased with increasing defect size and decreasing initial pressurization, as measured by the increase in burning surface area. These studies are important because they enable the development of continuum-scale damage models and the design of inherently safer explosives.« less

In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland.

PubMed

Ziegler, Benjamin; Hirche, Christoph; Horter, Johannes; Kiefer, Jurij; Grützner, Paul Alfred; Kremer, Thomas; Kneser, Ulrich; Münzberg, Matthias

2017-03-01

Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered. 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance. While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of evidence. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Fire hazard after prescribed burning in a gorse shrubland: implications for fuel management.

PubMed

Marino, Eva; Guijarro, Mercedes; Hernando, Carmen; Madrigal, Javier; Díez, Carmen

2011-03-01

Prescribed burning is commonly used to prevent accumulation of biomass in fire-prone shrubland in NW Spain. However, there is a lack of knowledge about the efficacy of the technique in reducing fire hazard in these ecosystems. Fire hazard in burned shrubland areas will depend on the initial capacity of woody vegetation to recover and on the fine ground fuels existing after fire. To explore the effect that time since burning has on fire hazard, experimental tests were performed with two fuel complexes (fine ground fuels and regenerated shrubs) resulting from previous prescribed burnings conducted in a gorse shrubland (Ulex europaeus L.) one, three and five years earlier. A point-ignition source was used in burning experiments to assess ignition and initial propagation success separately for each fuel complex. The effect of wind speed was also studied for shrub fuels, and several flammability parameters were measured. Results showed that both ignition and initial propagation success of fine ground fuels mainly depended on fuel depth and were independent of time since burning, although flammability parameters indicated higher fire hazard three years after burning. In contrast, time since burning increased ignition and initial propagation success of regenerated shrub fuels, as well as the flammability parameters assessed, but wind speed had no significant effect. The combination of results of fire hazard for fine ground fuels and regenerated shrubs according to the variation in relative coverage of each fuel type after prescribed burning enabled an assessment of integrated fire hazard in treated areas. The present results suggest that prescribed burning is a very effective technique to reduce fire hazard in the study area, but that fire hazard will be significantly increased by the third year after burning. These results are valuable for fire prevention and fuel management planning in gorse shrubland areas. Copyright © 2010 Elsevier Ltd. All rights reserved.

Methoxyflurane analgesia for burns dressings

PubMed Central

Packer, Kathleen J.

1972-01-01

The requirements for analgesia for burns dressings are discussed. Methoxyflurane has proved satisfactory in a clinical trial, and can be administered by one of two types of vaporizer. The possibility of nephrotoxicity due to methoxyflurane has not been eliminated. PMID:5024149

Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement.

PubMed

Schulz, Alexandra; Fuchs, Paul Christian; Rothermundt, Irene; Hoffmann, Alexandra; Rosenberg, Lior; Shoham, Yaron; Oberländer, Henrik; Schiefer, Jennifer

2017-09-01

Facial burns occur frequently and depending on the injured skin layers often heal with scars which may cause permanent functional and cosmetic sequelae. Preservation of the sensitive facial skin layers, especially of the dermis is essential for scarless epithelialisation. Enzymatic debridement of deep thermal burns has already been shown to assist with preserving viable dermis. However, up to date, there are no published reports on wound healing and in the long term aesthetic outcome after enzymatic debridement of facial burns. Therefore we performed a-single centre clinical trial that included 26 subjects aged 18-78 years with facial burns clinically evaluated as deep dermal or deeper. Burns were treated either with enzymatic debridement or excisional surgical debridement. Then we compared both groups regarding debridement selectivity, wound closure and scar quality after more than 12 months. Enzymatic debridement significantly reduced time to complete wound closure after admission (19.85 days versus 42.23 days, p=0.002), and after enzymatic eschar removal (18.92 days versus 35.62 days, p=0.042). The number of procedures to complete debridement were significantly lower in the enzymatic debridement group (1.00 versus 1.77, p=0.003). 77% of facial burns that had been debrided enzymatically were found to be more superficially burned than initially estimated. Wounds undergoing autografting of any size were significantly reduced by enzymatic debridement (15% versus 77%, p=0.002). Scar quality after enzymatic debridement was superior compared to surgical debridement after 12 months regarding pigmentation (p=0.016), thickness (p=0.16), relief (p=0.10), pliability (p=0.01), surface area (p=0.004), stiffness (p=0.023), thickness (0.011) and scar irregularity (p=0.011). Regarding erythema and melanin, viscoelasticity and pliability, trans-epidermal water loss or laser tissue oxygen saturation, haemoglobin level and microcirculation we found no significant differences for treated and untreated skin in the EDNX group. In our current study we found Bromelain based enzymatic debridement better in some aspects of tissue preservation in deep dermal facial burn. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Full-Scale Incineration System Trial Burns at the Naval Construction Battalion Center, Gulfport, Mississippi. Volume 2, Part 2

DTIC Science & Technology

1991-07-01

The prime mover for the MWP-2000 is a single steam powered jet venturi scrubber that was manufactured by Hydrosonics, Inc. to develop a negative...orime mover for the MWP-2000 is a single steam powered jet venturi scrubber that was manufactured by Hydrosonics, inc. to develop a negative pressure...packed tower and the scrubber during the trial burn or opening of the TRV, you should include these AWISOs since these shut offs would normally be

Clinical Trial of Imipenem/Cilastatin in Severely Burned and Infected Patients

DTIC Science & Technology

1987-07-01

34"OT FILE CO.Y CLINICAL TRIAL OF IMIPENEM /CILASTATIN IN SEVERELY BURNED AND INFECTED PATIENTS Gary R. Culbertson, M.D., Albert T. McManus, PH.D., D T...NOV 1 3 1987 San Antonio, Texas b H Imipenem /cilastatin was examined for safety and effi- ,-;Opportunistic organisms causing infections in cacy in a...All of the clinical failures were in the pulmonary in ec- imipenem /cilastatin, a novel thienamycin alti- tion group. No serious toxicity or side

The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns: a randomized, double-blind, controlled clinical trial.

PubMed

Zhou, Ye-Ping; Jiang, Zhu-Ming; Sun, Yong-Hua; Wang, Xiu-Rong; Ma, En-Ling; Wilmore, Douglas

2003-01-01

This research was conducted to evaluate the effect of enterally administered glutamine (gln) dipeptide on metabolic, gastrointestinal, and outcome parameters after severe burn injury. Forty thermally injured patients with total body surface burns ranging between 50% and 80%, and third-degree burns ranging between 20% and 40% and without respiratory injuries, were randomized into a prospective, double-blind, controlled clinical trial. One group received gln-enriched enteral nutrition and the other group received the standard enteral formulation. Tube feedings were initiated on postburn day 1 (PBD +1), and isocaloric and isonitrogenous feedings were administered to both groups until PBD +12. The gln was given as the dipeptide of alanyl-gln (Ajinomoto, Tokyo, Japan), which provided 0.35 g gln/kg body weight/d. Plasma amino acid profiles, serum endotoxin concentrations, and the lactulose/mannitol absorption ratio (which reflects gut permeability) were measured at specific times throughout the clinical course. Wound healing at day 30 was assessed, and length of hospital stay and total costs were determined at discharge. The 2 groups were similar in terms of age and extent of injury. Plasma gln concentrations were approximately 300 umol/L in both groups on PBD +1 and remained low in the control group (399 +/- 40 umol/L, mean +/- SD) but increased toward normal in the supplemented group to 591 +/- 74 (p = .048). Lactulose/mannitol ratios were increased above normal on POD +1 (control, 0.221 +/- 0.169; gln, 0.268 +/- 0.202; not significant), reflecting increased intestinal permeability after burn injury. On POD +3, the ratio in the gln group was lower than control (0.025 +/- 0.008 versus 0.049 +/- 0.016; p = .0001), and both groups returned toward normal ratios with time. Endotoxin levels on PBD +1 were elevated in both groups (control, 0.089 +/- 0.023 EU/mL; gln, 0.103 +/- 0.037 EU/mL; NS) but decreased significantly on PBD +3 in the patients receiving gln. Hospital stay was significantly shorter in the gln group than controls (67 +/- 4 days versus 73 +/- 6; p = .026). On day 30, wound healing was 86% +/- 2% complete in the gln group compared with 72% +/- 3% in controls (p = .041). Total cost of hospitalization was 62794 +/- 6178 RMB (dollar 7593 +/- 747 US dollars) in the gln group and 68996 +/- 8620RMB (dollar 8343 +/- 1042, p = .031) in controls, although the cost of the enteral nutrition was higher in the gln-supplemented patients. Enteral gln supplementation using a commercially available dipeptide supported plasma gln levels, improved gut permeability, and initially decreased plasma endotoxin levels in severely thermally injured patients. These alterations were associated with a reduction in the length of hospitalization and lower costs.

Transfusion Requirement in Burn Care Evaluation (TRIBE): A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury.

PubMed

Palmieri, Tina L; Holmes, James H; Arnoldo, Brett; Peck, Michael; Potenza, Bruce; Cochran, Amalia; King, Booker T; Dominic, William; Cartotto, Robert; Bhavsar, Dhaval; Kemalyan, Nathan; Tredget, Edward; Stapelberg, Francois; Mozingo, David; Friedman, Bruce; Greenhalgh, David G; Taylor, Sandra L; Pollock, Brad H

2017-10-01

Our objective was to compare outcomes of a restrictive to a liberal red cell transfusion strategy in 20% or more total body surface area (TBSA) burn patients. We hypothesized that the restrictive group would have less blood stream infection (BSI), organ dysfunction, and mortality. Patients with major burns have major (>1 blood volume) transfusion requirements. Studies suggest that a restrictive blood transfusion strategy is equivalent to a liberal strategy. However, major burn injury is precluded from these studies. The optimal transfusion strategy in major burn injury is thus needed but remains unknown. This prospective randomized multicenter trial block randomized patients to a restrictive (hemoglobin 7-8 g/dL) or liberal (hemoglobin 10-11 g/dL) transfusion strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Eighteen burn centers enrolled 345 patients with 20% or more TBSA burn similar in age, TBSA burn, and inhalation injury. A total of 7054 units blood were transfused. The restrictive group received fewer blood transfusions: mean 20.3 ± 32.7 units, median = 8 (interquartile range: 3, 24) versus mean 31.8 ± 44.3 units, median = 16 (interquartile range: 7, 40) in the liberal group (P < 0.0001, Wilcoxon rank sum). BSI incidence, organ dysfunction, ventilator days, and time to wound healing (P > 0.05) were similar. In addition, there was no 30-day mortality difference: 9.5% restrictive versus 8.5% liberal (P = 0.892, χ test). A restrictive transfusion strategy halved blood product utilization. Although the restrictive strategy did not decrease BSI, mortality, or organ dysfunction in major burn injury, these outcomes were no worse than the liberal strategy (Clinicaltrials.gov identifier NCT01079247).

Literature review: should nursing take aromatherapy more seriously?

PubMed

Buckle, Jane

Aromatherapy is often misunderstood and consequently somewhat marginalized. Because of a basic misinterpretation, the integration of aromatherapy into UK hospitals is not moving forward as quickly as it might. Aromatherapy in UK is primarily aimed at enhancing patient care or improving patient satisfaction, and it is frequently mixed with massage. Little focus is given to the real clinical potential, except for a few pockets such as the Micap/South Manchester University initiative which led to a Phase 1 clinical trial into the effects of aromatherapy on infection carried out in the Burns Unit of Wythenshawe Hospital. This article discusses the expansion of aromatherapy within the US and follows 10 years of developing protocols and policies that led to pilot studies on radiation burns, chemo-induced nausea, slow-healing wounds, Alzheimers and end-of-life agitation. The article poses two questions: should nursing take aromatherapy more seriously and do nurses really need 60 hours of massage to use aromatherapy as part of nursing practice?

Assessing the Efficacy of Restricting Access to Barbecue Charcoal for Suicide Prevention in Taiwan: A Community-Based Intervention Trial

PubMed Central

Chen, Ying-Yeh; Chen, Feng; Chang, Shu-Sen; Wong, Jacky; Yip, Paul S F

2015-01-01

Objective Charcoal-burning suicide has recently been spreading to many Asian countries. There have also been several cases involving this new method of suicide in Western countries. Restricting access to suicide means is one of the few suicide-prevention measures that have been supported by empirical evidence. The current study aims to assess the effectiveness of a community intervention program that restricts access to charcoal to prevent suicide in Taiwan. Methods and Findings A quasi-experimental design is used to compare method-specific (charcoal-burning suicide, non-charcoal-burning suicide) and overall suicide rates in New Taipei City (the intervention site, with a population of 3.9 million) with two other cities (Taipei City and Kaohsiung City, the control sites, each with 2.7 million residents) before (Jan 1st 2009- April 30th 2012) and after (May 1st 2012-Dec. 31st 2013) the initiation of a charcoal-restriction program on May 1st 2012. The program mandates the removal of barbecue charcoal from open shelves to locked storage in major retail stores in New Taipei City. No such restriction measure was implemented in the two control sites. Generalized linear regression models incorporating secular trends were used to compare the changes in method-specific and overall suicide rates before and after the initiation of the restriction measure. A simulation approach was used to estimate the number of lives saved by the intervention. Compared with the pre-intervention period, the estimated rate reduction of charcoal-burning suicide in New Taipei City was 37% (95% CI: 17%, 50%) after the intervention. Taking secular trends into account, the reduction was 30% (95% CI: 14%, 44%). No compensatory rise in non-charcoal-burning suicide was observed in New Taipei City. No significant reduction in charcoal-burning suicide was observed in the other two control sites. The simulation approach estimated that 91 (95%CI [55, 128]) lives in New Taipei City were saved during the 20 months of the intervention. Conclusion Our results demonstrate that the charcoal-restriction program reduced method-specific and overall suicides. This study provides strong empirical evidence that restricting the accessibility of common lethal methods of suicide can effectively reduce suicide rates. PMID:26305374

Effect of protective filters on fire fighter respiratory health: field validation during prescribed burns.

PubMed

De Vos, Annemarie J B M; Cook, Angus; Devine, Brian; Thompson, Philip J; Weinstein, Philip

2009-01-01

Bushfire smoke contains a range of air toxics. To prevent inhalation of these toxics, fire fighters use respiratory equipment. Yet, little is known about the effectiveness of the equipment on the fire ground. Experimental trials in a smoke chamber demonstrated that, the particulate/organic vapor/formaldehyde (POVF) filter performed best under simulated conditions. This article reports on the field validation trials during prescribed burns in Western Australia. Sixty-seven career fire fighters from the Fire and Emergency Services Authority of Western Australia were allocated one of the three types of filters. Spirometry, oximetry, self-reported symptom, and personal air sampling data were collected before, during and after exposure to bushfire smoke from prescribed burns. Declines in FEV(1) and SaO(2) were demonstrated after 60 and 120 min exposure. A significant higher number of participants in the P filter group reported increases in respiratory symptoms after the exposure. Air sampling inside the respirators demonstrated formaldehyde levels significantly higher in the P filter group compared to the POV and the POVF filter group. The field validation trials during prescribed burns supported the findings from the controlled exposure trials in the smoke chamber. Testing the effectiveness of three types of different filters under bushfire smoke conditions in the field for up to 2 hr demonstrated that the P filter is ineffective in filtering out respiratory irritants. The performance of the POV and the POVF filter appears to be equally effective after 2 hr bushfire smoke exposure in the field.

Fire/burn risk with electrosurgical devices and endoscopy fiberoptic cables.

PubMed

Smith, Lee P; Roy, Soham

2008-01-01

The purpose of the study was to systematically explore the fire and burn risk associated with fiberoptic cables and electrosurgical devices. A 300-W light source was connected to a standard gray fiberoptic light cable. The end of the cable was either rested atop or buried within a cotton towel or polypropylene drape in the presence or absence of 100% oxygen for up to 10 minutes. A monopolar electrosurgical device set at 1 W, 10 W, or 30 W was tested on a cotton towel or polypropylene drape for a period of 30 seconds. All trials were repeated. Resting the light cable on top of the cotton towel or polypropylene drape with or without oxygen produced no result. Burying the end of the cable within the drape produced a hole in the drape within 15 seconds both with and without oxygen. Burying the end of the cable within the cotton towel produced a yellow discoloration after 2 minutes both with and without oxygen. The monopolar electrosurgical device set at 30 W burned immediately through the polypropylene drape, producing a skin burn. All other trials with monopolar electrocautery produced no result. No flame or fire was produced in any trial. Fiberoptic cables and electrosurgical generators represent a serious burn risk for surgical patients, with operating room drapes and towels affording only limited protection. Otolaryngologists should be keenly aware of the risks that these devices represent because our specialty uses them frequently.

40 CFR 63.7530 - How do I demonstrate initial compliance with the emission limits and work practice standards?

Code of Federal Regulations, 2011 CFR

2011-07-01

..., Fuel Analyses, and Initial Compliance Requirements § 63.7530 How do I demonstrate initial compliance... this section, and Tables 5 and 7 to this subpart OR conducting initial fuel analyses to determine... in one of the liquid fuel subcategories that burn only fossil fuels and other gases and do not burn...

The status of statewide burn prevention legislation.

PubMed

Hammond, J

1993-01-01

Successful programs in injury prevention can focus on changing an individual's attitude and behavior or on creating and amending the environment to reduce the likelihood of injury. To investigate the latter approach as it pertains to burn prevention, the American Burn Association Burn Prevention Committee catalogued statewide legislation (as opposted to county or municipal ordinances) in major areas of burn and fire prevention. Burn reporting was generally viewed by state fire marshals as a means to apprehend arsonists or investigate child abuse, as opposed to collect demographic data for injury prevention. Smoke detectors are mandated in new residential construction by the majority of states; however, one in six still leave this to local initiatives. Sprinkler systems have generally not been addressed by state legislation. The committee concludes that pursuing statewide legislative agendas as an area of burn and injury prevention is open to further initiatives.

Foot burns: epidemiology and management.

PubMed

Hemington-Gorse, S; Pellard, S; Wilson-Jones, N; Potokar, T

2007-12-01

This is a retrospective study of the epidemiology and management of isolated foot burns presenting to the Welsh Centre for Burns from January 1998 to December 2002. A total of 289 were treated of which 233 were included in this study. Approximately 40% were in the paediatric age group and the gender distribution varied dramatically for adults and children. In the adult group the male:female ratio was 3.5:1, however in the paediatric group the male:female ratio was more equal (1.6:1). Scald burns (65%) formed the largest group in children and scald (35%) and chemical burns (32%) in adults. Foot burns have a complication rate of 18% and prolonged hospital stay. Complications include hypertrophic scarring, graft loss/delayed healing and wound infection. Although isolated foot burns represent a small body surface area, over half require treatment as in patients to allow for initial aggressive conservative management of elevation and regular wound cleansing to avoid complications. This study suggests a protocol for the initial acute management of foot burns. This protocol states immediate referral of all foot burns to a burn centre, admission of these burns for 24-48 h for elevation, regular wound cleansing with change of dressings and prophylactic antibiotics.

Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves

PubMed Central

Semmens, Erin O.; Smith, Paul; Harrar, Solomon W.; Montrose, Luke; Weiler, Emily; McNamara, Marcy; Ward, Tony J.

2017-01-01

Background: Household air pollution due to biomass combustion for residential heating adversely affects vulnerable populations. Randomized controlled trials to improve indoor air quality in homes of children with asthma are limited, and no such studies have been conducted in homes using wood for heating. Objectives: Our aims were to test the hypothesis that household-level interventions, specifically improved-technology wood-burning appliances or air-filtration devices, would improve health measures, in particular Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores, relative to placebo, among children living with asthma in homes with wood-burning stoves. Methods: A three-arm placebo-controlled randomized trial was conducted in homes with wood-burning stoves among children with asthma. Multiple preintervention and postintervention data included PAQLQ (primary outcome), peak expiratory flow (PEF) monitoring, diurnal peak flow variability (dPFV, an indicator of airway hyperreactivity) and indoor particulate matter (PM) PM2.5. Results: Relative to placebo, neither the air filter nor the woodstove intervention showed improvement in quality-of-life measures. Among the secondary outcomes, dPFV showed a 4.1 percentage point decrease in variability [95% confidence interval (CI)=−7.8 to −0.4] for air-filtration use in comparison with placebo. The air-filter intervention showed a 67% (95% CI: 50% to 77%) reduction in indoor PM2.5, but no change was observed with the improved-technology woodstove intervention. Conclusions: Among children with asthma and chronic exposure to woodsmoke, an air-filter intervention that improved indoor air quality did not affect quality-of-life measures. Intent-to-treat analysis did show an improvement in the secondary measure of dPFV. Trial registration: ClincialTrials.gov NCT00807183. https://doi.org/10.1289/EHP849 PMID:28935614

Alpha lipoic acid efficacy in burning mouth syndrome. A controlled clinical trial

PubMed Central

Palacios-Sánchez, Begoña; Cerero-Lapiedra, Rocío; Llamas-Martínez, Silvia; Esparza-Gómez, Germán

2015-01-01

Background A double-blind placebo-controlled trial was conducted in order to evaluate the efficacy of alpha lipoic acid (ALA) and determine the statistical significance of the outcome variables. Burning mouth syndrome (BMS) is defined as an oral burning sensation in the absence of clinical signs which could justify the syndrome. Recent studies suggest the existence of neurological factors as a possible cause of the disease. Material and Methods 60 patients with BMS, in two groups: case group with 600 mg/day and placebo as control group; with follow up of 2 months. Results 64% of ALA patients reported some level of improvement, with a level of maintenance of 68.75% one month after treatment. 27.6% of the placebo group also demonstrated some reduction in BMS symptoms. Conclusions Long-term evolution and the intensity of symptoms are variables that reduce the probability of improvement with ALA treatment. Key words: Burning mouth syndrome, neuropathy, alpha lipoic acid. PMID:26034927

Virtual reality for acute pain reduction in adolescents undergoing burn wound care: a prospective randomized controlled trial.

PubMed

Kipping, Belinda; Rodger, Sylvia; Miller, Kate; Kimble, Roy M

2012-08-01

Effective pain management remains a challenge for adolescents during conscious burn wound care procedures. Virtual reality (VR) shows promise as a non-pharmacological adjunct in reducing pain. This study assessed off-the-shelf VR for (1) its effect on reducing acute pain intensity during adolescent burn wound care, and (2) its clinical utility in a busy hospital setting. Forty-one adolescents (11-17 years) participated in this prospective randomized controlled trial. Acute pain outcomes including adolescent self-report, nursing staff behavioral observation, caregiver observation and physiological measures were collected. Length of procedure times and adolescent reactions were also recorded to inform clinical utility. Nursing staff reported a statistically significant reduction in pain scores during dressing removal, and significantly less rescue doses of Entonox given to those receiving VR, compared to those receiving standard distraction. For all other pain outcomes and length of treatment, there was a trend for lower pain scores and treatment times for those receiving VR, but these differences were not statistically significant. Despite only minimal pain reduction achieved using off-the-shelf VR, other results from this trial and previous research on younger children with burns suggest a customized, adolescent and hospital friendly device may be more effective in pain reduction. Copyright © 2012. Published by Elsevier Ltd.

40 CFR 60.2195 - What information must I submit prior to initial startup?

Code of Federal Regulations, 2011 CFR

2011-07-01

... initial startup? 60.2195 Section 60.2195 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY..., 2001 Recordkeeping and Reporting § 60.2195 What information must I submit prior to initial startup? You... startup. (a) The type(s) of waste to be burned. (b) The maximum design waste burning capacity. (c) The...

40 CFR 60.2195 - What information must I submit prior to initial startup?

Code of Federal Regulations, 2012 CFR

2012-07-01

... initial startup? 60.2195 Section 60.2195 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY..., 2001 Recordkeeping and Reporting § 60.2195 What information must I submit prior to initial startup? You... startup. (a) The type(s) of waste to be burned. (b) The maximum design waste burning capacity. (c) The...

40 CFR 60.2195 - What information must I submit prior to initial startup?

Code of Federal Regulations, 2010 CFR

2010-07-01

... initial startup? 60.2195 Section 60.2195 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY..., 2001 Recordkeeping and Reporting § 60.2195 What information must I submit prior to initial startup? You... startup. (a) The type(s) of waste to be burned. (b) The maximum design waste burning capacity. (c) The...

Massage has no observable effect on distress in children with burns: A randomized, observer-blinded trial.

PubMed

van Dijk, Monique; O'Flaherty, Linda Anne; Hoedemaker, Tessa; van Rosmalen, Joost; Rode, Heinz

2018-02-01

In a previous observational study we found that massage therapy reduced anxiety and stress in pediatric burn patients. We aimed to test this effect in a randomized controlled trial. To determine whether (1) aromatherapy massage can provide relaxation to hospitalized children with burns; (2) massage with aromatherapy oil is more effective than without; and (3) massage sessions are more effective when repeated. Randomized controlled clinical trial with 3 arms conducted in a burns unit from April 2013 to December 2014 in Cape Town, South Africa. Massage with carrier oil, massage with aromatherapy oil, and standard nursing care only. Scores on the Muscle Tension Inventory (MTI) and Behavioral Relaxation Scale (BRS) to assess level of relaxation. Scores on the COMFORT behaviour scale and Numeric Rating Scale Distress to assess level of distress. Secondary outcomes were heart rate and oxygen saturation levels. Linear mixed models were used to determine the effect of condition and session number (1 to a maximum of 5 sessions per child) correcting for baseline outcomes of COMFORT behaviour scores and heart rates after sessions. Secondary analyses included the addition of sex, age, and total body surface area (TBSA) burned as covariates. We included 284 children aged 5 weeks to 13 years with TBSA burned between 10 and 45%. Two-thirds (65.5%) were under the age of 3 years. Mixed model analyses revealed no significant difference in reduction of COMFORT behavior scores (p=0.18), or heart rates (p=0.18) between the three study arms. These outcomes were also not associated with the session number (p=0.92 and p=0.13, respectively). Level of relaxation could not be reliably assessed with the MTI and BRS because 119 patients (41.9%) had bandages covering the larger part of the face, and in 40.1% of cases the child was not in the required position. Massage therapy with or without essential oil was not effective in reducing distress behavior or heart rate in hospitalized children with burns. Evaluating the effectiveness of massage in terms of relaxation proved difficult in young children. The Netherlands National Trial Registry: NRT3929. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Honey as a topical treatment for wounds.

PubMed

Jull, Andrew B; Cullum, Nicky; Dumville, Jo C; Westby, Maggie J; Deshpande, Sohan; Walker, Natalie

2015-03-06

Honey is a viscous, supersaturated sugar solution derived from nectar gathered and modified by the honeybee, Apis mellifera. Honey has been used since ancient times as a remedy in wound care. Evidence from animal studies and some trials has suggested that honey may accelerate wound healing. The objective of this review was to assess the effects of honey compared with alternative wound dressings and topical treatments on the of healing of acute (e.g. burns, lacerations) and/or chronic (e.g. venous ulcers) wounds. For this update of the review we searched the Cochrane Wounds Group Specialised Register (searched 15 October 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 9); Ovid MEDLINE (1946 to October Week 1 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 13 October 2014); Ovid EMBASE (1974 to 13 October 2014); and EBSCO CINAHL (1982 to 15 October 2014). Randomised and quasi-randomised trials that evaluated honey as a treatment for any sort of acute or chronic wound were sought. There was no restriction in terms of source, date of publication or language. Wound healing was the primary endpoint. Data from eligible trials were extracted and summarised by one review author, using a data extraction sheet, and independently verified by a second review author. All data have been subsequently checked by two more authors. We identified 26 eligible trials (total of 3011 participants). Three trials evaluated the effects of honey in minor acute wounds, 11 trials evaluated honey in burns, 10 trials recruited people with different chronic wounds including two in people with venous leg ulcers, two trials in people with diabetic foot ulcers and single trials in infected post-operative wounds, pressure injuries, cutaneous Leishmaniasis and Fournier's gangrene. Two trials recruited a mixed population of people with acute and chronic wounds. The quality of the evidence varied between different comparisons and outcomes. We mainly downgraded the quality of evidence for risk of bias, imprecision and, in a few cases, inconsistency.There is high quality evidence (2 trials, n=992) that honey dressings heal partial thickness burns more quickly than conventional dressings (WMD -4.68 days, 95%CI -5.09 to -4.28) but it is unclear if there is a difference in rates of adverse events (very low quality evidence) or infection (low quality evidence).There is very low quality evidence (4 trials, n=332) that burns treated with honey heal more quickly than those treated with silver sulfadiazine (SSD) (WMD -5.12 days, 95%CI -9.51 to -0.73) and high quality evidence from 6 trials (n=462) that there is no difference in overall risk of healing within 6 weeks for honey compared with SSD (RR 1.00, 95% CI 0.98 to 1.02) but a reduction in the overall risk of adverse events with honey relative to SSD. There is low quality evidence (1 trial, n=50) that early excision and grafting heals partial and full thickness burns more quickly than honey followed by grafting as necessary (WMD 13.6 days, 95%CI 9.82 to 17.38).There is low quality evidence (2 trials, different comparators, n=140) that honey heals a mixed population of acute and chronic wounds more quickly than SSD or sugar dressings.Honey healed infected post-operative wounds more quickly than antiseptic washes followed by gauze and was associated with fewer adverse events (1 trial, n=50, moderate quality evidence, RR of healing 1.69, 95%CI 1.10 to 2.61); healed pressure ulcers more quickly than saline soaks (1 trial, n= 40, very low quality evidence, RR 1.41, 95%CI 1.05 to 1.90), and healed Fournier's gangrene more quickly than Eusol soaks (1 trial, n=30, very low quality evidence, WMD -8.00 days, 95%CI -6.08 to -9.92 days).The effects of honey relative to comparators are unclear for: venous leg ulcers (2 trials, n= 476, low quality evidence); minor acute wounds (3 trials, n=213, very low quality evidence); diabetic foot ulcers (2 trials, n=93, low quality evidence); Leishmaniasis (1 trial, n=100, low quality evidence); mixed chronic wounds (2 trials, n=150, low quality evidence). It is difficult to draw overall conclusions regarding the effects of honey as a topical treatment for wounds due to the heterogeneous nature of the patient populations and comparators studied and the mostly low quality of the evidence. The quality of the evidence was mainly downgraded for risk of bias and imprecision. Honey appears to heal partial thickness burns more quickly than conventional treatment (which included polyurethane film, paraffin gauze, soframycin-impregnated gauze, sterile linen and leaving the burns exposed) and infected post-operative wounds more quickly than antiseptics and gauze. Beyond these comparisons any evidence for differences in the effects of honey and comparators is of low or very low quality and does not form a robust basis for decision making.

A phase II prospective, non-comparative assessment of a new silver sodium carboxymethylcellulose (AQUACEL(®) Ag BURN) glove in the management of partial thickness hand burns.

PubMed

Duteille, Franck; Jeffery, Steven L A

2012-11-01

Nylon-reinforced silver sodium carboxymethylcellulose (AQUACEL(®) Ag BURN) dressings were developed to be pliable and conforming for the management of partial-thickness burns. This study evaluated the AQUACEL(®) Ag BURN glove for the management of hand burns. This 21-day, phase II, prospective, non-comparative study included 23 patients with partial-thickness hand burn of at least two fingers. The AQUACEL(®) Ag BURN glove was applied to one hand and could remain in place up to 21 days until clinically indicated to change the glove. Dressings were evaluated 1, 2, 4, 6, 8, 14, and 21 days after initial application. Safety was the primary study endpoint. Sixteen (70%) hand burns re-epithelialized fully over a mean of 15.6 days. Initial application was easy/very easy for 20 (87%) patients. Mean time for initial dressing application was 5.4 min. At final evaluation, most patients gave ratings of excellent/good for conformability (91%), overall glove performance (74%), and appropriateness of sizes (83%). Mean pain score from 0 (none) to 10 (worst imaginable) was 3.43 at baseline; during the study, mean scores were 1.15 at rest and 2.29 during movement. Of 61 glove removals, most (72%) were easy/very easy, and 12% had fallen off. Adverse events (wound site or elsewhere) occurred in 15 (65%) patients. Treatment-related adverse events were wound pain (17%), maceration (9%), and stiff fingers (4%). The AQUACEL(®) Ag BURN glove was well tolerated in the management of partial-thickness hand burn. Many patients used only one glove. When glove changes were required, they were usually quick and easy. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

SUPERFUND TREATABILITY CLEARINGHOUSE: FULL SCALE ROTARY KILN INCINERATOR FIELD TRIAL: PHASE I, VERIFICATION TRIAL BURN ON DIOXIN/HERBICIDE ORANGE CONTAMINATED SOIL

EPA Science Inventory

This treatability study reports on the results of one of a series of field trials using various remedial action technologies that may be capable of restoring Herbicide Orange (HO)XDioxin contaminated sites. A full-scale field trial using a rotary kiln incinerator capable of pro...

Factors influencing occupancy of nest cavities in recently burned forests

USGS Publications Warehouse

Saab, V.A.; Dudley, J.; Thompson, W.L.

2004-01-01

Recently burned forests in western North America provide nesting habitat for many species of cavity-nesting birds. However, little is understood about the time frame and the variables affecting occupancy of postfire habitats by these birds. We studied factors influencing the occupancy and reuse of nest cavities from 1-7 years after fire in two burned sites of western Idaho during 1994-1999. Tree cavities were used for nesting by 12 species of cavity nesters that were classified by the original occupant (strong excavator, weak excavator, or nonexcavator) of 385 nest cavities. We used logistic regression to model cavity occupancy by strong excavators (n = 575 trials) and weak excavators (n = 206 trials). Year after fire had the greatest influence on occupancy of nest cavities for both groups, while site of the burn was secondarily important in predicting occupancy by strong excavators and less important for weak excavators. Predicted probability of cavity occupancy was highest during the early years (1-4) after fire, declined over time (5-7 years after fire), and varied by site, with a faster decline in the smaller burned site with a greater mosaic of unburned forest. Closer proximity and greater interspersion of unburned forest (15% unburned) may have allowed a quicker recolonization by nest predators into the smaller burn compared to the larger burn with few patches of unburned forest (4% unburned). In combination with time and space effects, the predicted probability of cavity occupancy was positively affected by tree and nest heights for strong and weak excavators, respectively.

40 CFR Table 4 to Subpart Eeee of... - Summary of Reporting Requirements

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Waste management plan; and § 60.2952. v. Anticipated date of initial startup. § 60.2952. 2. Startup notification a. Prior to initial startup i. Types of waste to be burned;ii. Maximum design waste burning... petition for site-specific operating limits; and § 60.2953. v. Anticipated date of initial startup. § 60...

40 CFR Table 4 to Subpart Eeee of... - Summary of Reporting Requirements

Code of Federal Regulations, 2012 CFR

2012-07-01

.... Waste management plan; and § 60.2952. v. Anticipated date of initial startup. § 60.2952. 2. Startup notification a. Prior to initial startup i. Types of waste to be burned;ii. Maximum design waste burning... petition for site-specific operating limits; and § 60.2953. v. Anticipated date of initial startup. § 60...

40 CFR Table 4 to Subpart Eeee of... - Summary of Reporting Requirements

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Waste management plan; and § 60.2952. v. Anticipated date of initial startup. § 60.2952. 2. Startup notification a. Prior to initial startup i. Types of waste to be burned;ii. Maximum design waste burning... petition for site-specific operating limits; and § 60.2953. v. Anticipated date of initial startup. § 60...

40 CFR Table 4 to Subpart Eeee of... - Summary of Reporting Requirements

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Waste management plan; and § 60.2952. v. Anticipated date of initial startup. § 60.2952. 2. Startup notification a. Prior to initial startup i. Types of waste to be burned;ii. Maximum design waste burning... petition for site-specific operating limits; and § 60.2953. v. Anticipated date of initial startup. § 60...

40 CFR Table 4 to Subpart Eeee of... - Summary of Reporting Requirements

Code of Federal Regulations, 2014 CFR

2014-07-01

.... Waste management plan; and § 60.2952. v. Anticipated date of initial startup. § 60.2952. 2. Startup notification a. Prior to initial startup i. Types of waste to be burned;ii. Maximum design waste burning... petition for site-specific operating limits; and § 60.2953. v. Anticipated date of initial startup. § 60...

40 CFR 266.106 - Standards to control metals emissions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... HAZARDOUS WASTE MANAGEMENT FACILITIES Hazardous Waste Burned in Boilers and Industrial Furnaces § 266.106... implemented by limiting feed rates of the individual metals to levels during the trial burn (for new... screening limit for the worst-case stack. (d) Tier III and Adjusted Tier I site-specific risk assessment...

40 CFR 266.106 - Standards to control metals emissions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... HAZARDOUS WASTE MANAGEMENT FACILITIES Hazardous Waste Burned in Boilers and Industrial Furnaces § 266.106... implemented by limiting feed rates of the individual metals to levels during the trial burn (for new... screening limit for the worst-case stack. (d) Tier III and Adjusted Tier I site-specific risk assessment...

40 CFR 264.342 - Principal organic hazardous constituents (POHCs).

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE... feed to be burned. This specification will be based on the degree of difficulty of incineration of the... results of waste analyses and trial burns or alternative data submitted with part B of the facility's...

The inter-rater reliability of estimating the size of burns from various burn area chart drawings.

PubMed

Wachtel, T L; Berry, C C; Wachtel, E E; Frank, H A

2000-03-01

The accuracy and variability of burn size calculations using four Lund and Browder charts currently in clinical use and two Rule of Nine's diagrams were evaluated. The study showed that variability in estimation increased with burn size initially, plateaued in large burns and then decreased slightly in extensive burns. The Rule of Nine's technique often overestimates the burn size and is more variable, but can be performed somewhat faster than the Lund and Browder method. More burn experience leads to less variability in burn area chart drawing estimates. Irregularly shaped burns and burns on the trunk and thighs had greater variability than less irregularly shaped burns or burns on more defined anatomical parts of the body.

The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: a randomized controlled trial [ISRCTN87413556].

PubMed

Das, Debashish A; Grimmer, Karen A; Sparnon, Anthony L; McRae, Sarah E; Thomas, Bruce H

2005-03-03

The management of burn injuries is reported as painful, distressing and a cause of anxiety in children and their parents. Child's and parents' pain and anxiety, often contributes to extended time required for burns management procedures, in particular the process of changing dressings. The traditional method of pharmacologic analgesia is often insufficient to cover the burnt child's pain, and it can have deleterious side effects 12. Intervention with Virtual Reality (VR) games is based on distraction or interruption in the way current thoughts, including pain, are processed by the brain. Research on adults supports the hypothesis that virtual reality has a positive influence on burns pain modulation. This study investigates whether playing a virtual reality game, decreases procedural pain in children aged 5-18 years with acute burn injuries. The paper reports on the findings of a pilot study, a randomised trial, in which seven children acted as their own controls though a series of 11 trials. Outcomes were pain measured using the self-report Faces Scale and findings of interviews with parent/carer and nurses. The average pain scores (from the Faces Scale) for pharmacological analgesia only was, 4.1 (SD 2.9), while VR coupled with pharmacological analgesia, the average pain score was 1.3 (SD 1.8) The study provides strong evidence supporting VR based games in providing analgesia with minimal side effects and little impact on the physical hospital environment, as well as its reusability and versatility, suggesting another option in the management of children's acute pain.

Vascular and Psychophysical Effects of Topical Capsaicin Application to Orofacial Tissues

PubMed Central

Boudreau, Shellie A.; Wang, Kelun; Svensson, Peter; Sessle, Barry J.; Arendt-Nielsen, Lars

2011-01-01

Aims To characterize and contrast human sensory and vascular changes produced by topical application of the algesic chemical capsaicin to the glabrous lips and tongue. Methods Applications of 1% capsaicin or vehicle cream to the glabrous lips and tongue were randomized between two two-trial sessions. The capsaicin trial followed the vehicle trial for each session. Before and 5, 15, and 30 minutes after capsaicin or vehicle cream application, six parameters were recorded from the glabrous lips or the tongue dorsum: (1) burning pain intensity, as measured on a visual analog scale; (2) burning pain area, as indicated by subjects on an orofacial drawing; (3) mechanical sensitivity, as measured by a von Frey filament; (4) visual flare; (5) blood flow and temperature, as measured by laser-Doppler imaging and thermography, respectively; and (6) areas of increased temperature (hot spots), as calculated by a digital tracer from the thermographs. Data were analyzed by ANOVAs and Pearson’s correlations. Results Compared to vehicle application, capsaicin elicited burning pain, increases in blood flow and temperature, but no change in mechanical sensitivity in the glabrous lips or tongue. Greater increases in blood flow and temperature paralleled more intense burning pain and larger areas of perceived pain for the lips compared to the tongue. The location of distinct areas of increased temperature within the orofacial area differed between the capsaicin-lip and capsaicin-tongue trials. Conclusion The several differences between these responses to noxious stimulation of the glabrous lips and tongue may have implications for examinations of orofacial somatosensory functions. PMID:19639105

Noncultured keratinocyte/melanocyte cosuspension: effect on reepithelialization and repigmentation--a randomized, placebo-controlled study.

PubMed

Back, Christopher; Dearman, Bronwyn; Li, Amy; Neild, Tim; Greenwood, John E

2009-01-01

Randomized controlled trials in the literature investigating the efficacy of noncultured keratinocyte/melanocyte suspensions are scarce; however, the advocates of such techniques press the value of their application based largely on case studies and anecdote. Caucasian patients with burn hypopigmentation seldom request cosmetic revision making worthwhile clinical trials difficult so that informal case treatments with new therapies generate anecdotal results. A randomized, placebo-controlled trial was carried out to evaluate whether cosuspensions of noncultured skin cells are capable of (1) decreasing the time to reepithelialization and (2) reestablishing pigmentation in vitiligo leukoderma following epidermal/superficial dermal ablation (in the knowledge that a positive result would make the technique likely to be successful in burn hypopigmentation). Vitiligo is common and is socially more debilitating such that suitable trial subjects for new therapies from this pool are more forthcoming. This study demonstrated that suspensions of noncultured keratinocytes and melanocytes do not decrease the time to epithelialization of superficial partial thickness wounds compared with controls. It also suggested that the achievement, quality, and duration of any pigmentation were unpredictable and largely disappointing. Some pigmentation was recorded in placebo-treated areas indicating an effect of the method of epidermal ablation in these patients. These findings have mandated a complete review of the use of these techniques in burn care at the Royal Adelaide Hospital; they have been omitted from surgical protocols where the aim of use was to speed reepithelialization. Their infrequent use in burns hypopigmentation will continue contingent on the successful repigmentation of a test patch.

Management of cyanide toxicity in patients with burns.

PubMed

MacLennan, Louise; Moiemen, Naiem

2015-02-01

The importance of cyanide toxicity as a component of inhalational injury in patients with burns is increasingly being recognised, and its prompt recognition and management is vital for optimising burns survival. The evidence base for the use of cyanide antidotes is limited by a lack of randomised controlled trials in humans, and in addition consideration must be given to the concomitant pathophysiological processes in patients with burns when interpreting the literature. We present a literature review of the evidence base for cyanide antidotes with interpretation in the context of patients with burns. We conclude that hydroxycobalamin should be utilised as the first-line antidote of choice in patients with burns with inhalational injury where features consistent with cyanide toxicity are present. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

A randomized control trial measuring the effectiveness of a mouth-exercising device for mucosal burning in oral submucous fibrosis.

PubMed

Patil, Pravinkumar G; Hazarey, Vinay; Chaudhari, Rekha; Nimbalkar-Patil, Smita

2016-12-01

To evaluate effect of ice-cream stick exercise regimen with or without a mouth-exercising device (MED) on mucosal burning sensation in oral submucous fibrosis. In total, 282 patients with oral submucous fibrosis were treated with topical corticosteroid and oral antioxidant and the ice-cream stick exercise regimen. Patients in subgroups A1, A2, and A3 were additionally given a new MED. Patients in subgroups A1 and B1 patients with interincisal distance (IID) of 20 to 35 mm were managed without any additional therapy; patients in subgroups A2 and B2 with IID of 20 to 35 mm were additionally managed with intralesional injections; and those in subgroups A3 and B3 with IID less than 20 mm were managed surgically. Subjective evaluation of decrease in the oral mucosal burning was measured on a visual analogue scale (VAS). Analysis of variance and Tukey's multiple post hoc analysis were carried out to present the results. Patients using the MED, that is, subgroups A1, A2, and A3, showed reduction in burning sensation in the range of 64.8% to 71.1% and 27.8% to 30.9%, whereas in subgroups B1, B2, and B3, reduction in burning sensation ranged from 64.7% to 69.9% and from 29.3% to 38.6% after 6 months. The wo-way analysis of variance indicated statistically significant results in changes in initial VAS scores to 6-monthly VAS scores between MED users and non-MED users. The MED helps to enhance the rate of reduction of mucosal burning sensation, in addition to the conventional ice-cream stick regimen, as an adjunct to local and surgical treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Transesophageal echocardiography in the management of burn patients.

PubMed

Maybauer, Marc O; Asmussen, Sven; Platts, David G; Fraser, John F; Sanfilippo, Filippo; Maybauer, Dirk M

2014-06-01

A systematic review was conducted to assess the level of evidence for the use of transesophageal echocardiography (TEE) in the management of burn patients. We searched any article published before and including June 30, 2013. Our search yielded 118 total publications, 11 met the inclusion criteria of burn injury and TEE. Available studies published in any language were rated and included. At the present time, there are no available systematic reviews/meta-analyses published that met our search criteria. Only a small number of clinical trials, all with a limited number of patients were available. Therefore, a meta-analysis on outcome parameters was not performed. However, the major pathologic findings in burn patients were reduced left ventricular (LV) systolic and diastolic function, mitral valve vegetation, pulmonary hypertension, pericardial effusion, fluid overload, and right heart failure. The advantages of TEE include offering direct assessment of cardiac valve competency, myocardial contractility, and most importantly real time assessment of adequacy of hemodynamic resuscitation and preload in the acute phase of resuscitation, with minimal additional risk. TEE serves multiple diagnostic purposes and is being used to better understand the fluid status and cardiac physiology of the critically ill burn patient. Randomized controlled trials especially on fluid resuscitation and cardiac performance in acute burns are warranted to potentially further improve outcome. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Internet-based information and support program for parents of children with burns: A randomized controlled trial.

PubMed

Sveen, Josefin; Andersson, Gerhard; Buhrman, Bo; Sjöberg, Folke; Willebrand, Mimmie

2017-05-01

The aim of the study was to evaluate the feasibility and effects of an internet-based information and self-help program with therapist contact for parents of children and adolescents with burns. The program aimed to reduce parents' symptoms of general and posttraumatic stress. Participants were parents of children treated for burns between 2009-2013 at either of the two specialized Swedish Burn centers. Sixty-two parents were included in a two-armed, randomized controlled trial with a six-week intervention group and a wait-list control group, including a pre and post-assessment, as well as a 3 and 12-month follow-up. The intervention contained psychoeducation, exercises and homework assignments, and the intervention group received weekly written feedback from a therapist. The main outcome was stress (post-traumatic stress, general stress and parental stress). The program had a beneficial effect on posttraumatic stress in the short term, but did not affect general stress or parental stress. The parents rated the program as being informative and meaningful, but some of them thought it was time-consuming. The program has the potential to support parents of children with burns. The intervention is easily accessible, cost-effective and could be implemented in burn care rehabilitation. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Laser treatment in patients with bilateral large drusen: the complications of age-related macular degeneration prevention trial.

PubMed

2006-11-01

To evaluate the efficacy and safety of low-intensity laser treatment in the prevention of visual acuity (VA) loss among participants with bilateral large drusen. Multicenter randomized clinical trial. One eye of each participant was assigned to treatment, and the contralateral eye was assigned to observation. A total of 1052 participants who had > or =10 large (>125 microm) drusen and VA> or =20/40 in each eye enrolled through 22 clinical centers. The initial laser treatment protocol specified 60 barely visible burns applied in a grid pattern within an annulus between 1500 and 2500 mum from the foveal center. At 12 months, eyes assigned to treatment that had sufficient drusen remaining were retreated with 30 burns by targeting drusen within an annulus between 1000 and 2000 mum from the foveal center. Proportion of eyes at 5 years with loss of > or =3 lines of VA from baseline. Secondary outcome measures included the development of choroidal neovascularization or geographic atrophy (GA), change in contrast threshold, change in critical print size, and incidence of ocular adverse events. At 5 years, 188 (20.5%) treated eyes and 188 (20.5%) observed eyes had VA scores > or = 3 lines worse than at the initial visit (P = 1.00). Cumulative 5-year incidence rates for treated and observed eyes were 13.3% and 13.3% (P = 0.95) for choroidal neovascularization and 7.4% and 7.8% (P = 0.64) for GA, respectively. The contrast threshold doubled in 23.9% of treated eyes and in 20.5% of observed eyes (P = 0.40). The critical print size doubled in 29.6% of treated eyes and in 28.4% of observed eyes (P = 0.70). Seven treated eyes and 14 observed eyes had an adverse event of a > or =6-line loss in VA in the absence of late age-related macular degeneration or cataract. As applied in the Complications of Age-Related Macular Degeneration Prevention Trial, low-intensity laser treatment did not demonstrate a clinically significant benefit for vision in eyes of people with bilateral large drusen.

Evidence of erosive burning in shuttle solid rocket motor

NASA Technical Reports Server (NTRS)

Martin, C. L.

1983-01-01

Known models of Shuttle Solid Rocket Motor (SRM) performance have failed to produce pressure-time traces which accurately matched actual motor performance, especially during the first 5 seconds after ignition and during the last quarter of web burn time. Efforts to compensate for these differences in model reconstruction and actual performance resulted in resorting to the use of a Burning Anomaly Rate Function (BARF). It was suspected that propellant erosive burning was primarily responsible for the variation of model from actual results. The three dimensional Hercules Grain Design and Internal Ballistics Evaluation Program was made operational and slightly modified and an extensive trial and error effort was begun to test the hypothesis of erosive burning as an explanation of the burning anomaly. It was found that introduction of erosive burning (using Green's erosive burning equation) over portions of the aft segment grain and above a threshold gas Mach number did, in fact, give excellent agreement with the actual motor trace.

Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves.

PubMed

Noonan, Curtis W; Semmens, Erin O; Smith, Paul; Harrar, Solomon W; Montrose, Luke; Weiler, Emily; McNamara, Marcy; Ward, Tony J

2017-09-13

Household air pollution due to biomass combustion for residential heating adversely affects vulnerable populations. Randomized controlled trials to improve indoor air quality in homes of children with asthma are limited, and no such studies have been conducted in homes using wood for heating. Our aims were to test the hypothesis that household-level interventions, specifically improved-technology wood-burning appliances or air-filtration devices, would improve health measures, in particular Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores, relative to placebo, among children living with asthma in homes with wood-burning stoves. A three-arm placebo-controlled randomized trial was conducted in homes with wood-burning stoves among children with asthma. Multiple preintervention and postintervention data included PAQLQ (primary outcome), peak expiratory flow (PEF) monitoring, diurnal peak flow variability (dPFV, an indicator of airway hyperreactivity) and indoor particulate matter (PM) PM2.5. Relative to placebo, neither the air filter nor the woodstove intervention showed improvement in quality-of-life measures. Among the secondary outcomes, dPFV showed a 4.1 percentage point decrease in variability [95% confidence interval (CI)=-7.8 to -0.4] for air-filtration use in comparison with placebo. The air-filter intervention showed a 67% (95% CI: 50% to 77%) reduction in indoor PM2.5, but no change was observed with the improved-technology woodstove intervention. Among children with asthma and chronic exposure to woodsmoke, an air-filter intervention that improved indoor air quality did not affect quality-of-life measures. Intent-to-treat analysis did show an improvement in the secondary measure of dPFV. ClincialTrials.gov NCT00807183. https://doi.org/10.1289/EHP849.

Emissions from Open Burning of Simulated Military Waste from Forward Operating Bases

EPA Science Inventory

Emissions from open burning of simulated military waste from forward operating bases (FOBs) were extensively characterized as an initial step in assessing potential inhalation exposure of FOB personnel and future disposal alternatives. Emissions from two different burning scenar...

Determining the role of nasolaryngoscopy in the initial evaluation for upper airway injury in patients with facial burns.

PubMed

Freno, Daniel; Sahawneh, James; Harrison, Sarah; Sahawneh, Tim; Patterson, Scott; Kahn, Steven A

2018-05-01

Upper airway injuries can be fatal in burn patients if not recognized, a scenario that causes a significant amount of anxiety for physicians providing initial assessment of burn patients. Early elective intubation is often performed; sometimes unnecessarily. However, some providers employ nasolaryngoscopy for patients presenting with facial burns or signs/symptoms of upper airway injury in order to assess the need for intubation, but this practice is not considered standard of care and may also be unnecessary. Evidence is currently lacking about the utility of nasolaryngoscopy as an adjuvant assessment during evaluation of potential upper airway burn injuries. The objective of this study was to determine if nasolaryngoscopy provides additional information to the history and physical in making the decision to electively intubate patients with facial burns. This study was a retrospective analysis of all patients who underwent fiberoptic nasolaryngoscopy after facial burn injury to evaluate for upper airway injury associated with burns over a 2 year period at a regional burn center. During this time period, all patients who presented with facial burns, soot, or carbonaceous sputum underwent nasolaryngoscopy to look for upper airway injury regardless of mechanism of injury. Patients intubated prior to arrival were excluded from the study. Patients were considered to have signs/symptoms of airway injury (symptomatic) if they presented with dyspnea, tachypnea, hypoxia, or significant burns to buccal mucosa. Procedure notes were used to determine if supraglottic/glottic injury (erythema or edema) was present on nasolaryngoscopy. Presence of pathologic changes and whether they led to intubation were evaluated in the asymptomatic and the symptomatic groups of patients. Select individual records were inspected further to help determine if the nasolaryngoscopy findings altered management plans and if intubation was ultimately necessary based upon the presence or absence of a cuff leak and the duration of intubation. Twenty-two patients were symptomatic upon presentation, 14 of which had positive findings on laryngoscopy and 7 (50%) were intubated. One-hundred and eighty-eight patients were asymptomatic, 58 (31%) of which had either erythema or edema or carbonaceous debris on nasolaryngoscopy, and only 2 (1%) were intubated. These patients were both extubated within two days. None of the 130 asymptomatic patients with negative nasolaryngoscopy were intubated. This study showed disparity between signs and symptoms of airway injury and nasolaryngoscopy findings. Asymptomatic patients showed pathologic changes in 30% of scopes, but this finding only changed management 1% of the time. Furthermore, the two patients in this group were extubated quickly, suggesting they may have been suitable for observation without intubation. These results indicate that the presence of erythema or edema is of questionable clinical significance in asymptomatic patients and nasolaryngoscopy is of limited benefit in this group. Only 50% of the symptomatic patients with airway injury evident on nasolaryngoscopy were actually intubated, also bringing into question the significance of the pathologic changes in this group. However, negative nasolaryngoscopy may have had some benefit in preventing intubation in a few, select symptomatic patients. This study suggests that a thorough history and physical is the best tool to identify patients at higher risk of upper airway injury who need intubation, but this should be further studied in prospective trials to determine the definitive role of nasolaryngoscopy. Copyright © 2017. Published by Elsevier Ltd.

Titanium subhydride potassium perchlorate (TiH1.65/KClO4) burn rates from hybrid closed bomb-strand burner experiments.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cooper, Marcia A.; Oliver, Michael S.

2012-08-01

A hybrid closed bomb-strand burner is used to measure the burning behavior of the titanium subhydride potassium perchlorate pyrotechnic with an equivalent hydrogen concentration of 1.65. This experimental facility allows for simultaneous measurement of the closed bomb pressure rise and pyrotechnic burn rate as detected by electrical break wires over a range of pressures. Strands were formed by pressing the pyrotechnic powders to bulk densities between 60% and 90% theoretical maximum density. The burn rate dependance on initial density and vessel pressure are measured. At all initial strand densities, the burn is observed to transition from conductive to convective burningmore » within the strand. The measured vessel pressure history is further analyzed following the closed bomb analysis methods developed for solid propellants.« less

Understory Plant Community Response to Season of Burn in Natural Longleaf Pine Forests

Treesearch

John S. Kush; Ralph S. Meldahl; William D. Boyer

2000-01-01

A season of burn study was initiated in 1973 on the Escambia Experimental Forest, near Brewton, Alabama. All study plots were established in the 14-year-old longleaf pine (Pinus palustris) stands. Treatments consisted of biennial burns in winter, spring, and summer, plus a no-burn check. Objectives of the current study were to determine...

Effects of seasonal prescribved fires on residual overstory trees in oak-dominate shelterwood stands

Treesearch

Patrick H. Brose; David H. Van Lear

1999-01-01

A study was initiated in 1994 to evaluate the degree of bole damage and crown decline residual overstory trees would experience because of prescribed burning of shelterwood stands. Three oak-dominated shelterwood stands, partially harvested 2 to 4 yr earlier, were divided into four treatments (unburned control, spring burn, summer burn, and winter burn). Fifteen...

Outcomes important to burns patients during scar management and how they compare to the concepts captured in burn-specific patient reported outcome measures.

PubMed

Jones, Laura L; Calvert, Melanie; Moiemen, Naiem; Deeks, Jonathan J; Bishop, Jonathan; Kinghorn, Philip; Mathers, Jonathan

2017-12-01

Pressure garment therapy (PGT) is an established treatment for the prevention and treatment of hypertrophic scarring; however, there is limited evidence for its effectiveness. Burn survivors often experience multiple issues many of which are not adequately captured in current PGT trial measures. To assess the effectiveness of PGT it is important to understand what outcomes matter to patients and to consider whether patient-reported outcome measures (PROMs) can be used to ascertain the effect of treatments on patients' health-related quality of life. This study aimed to (a) understand the priorities and perspectives of adult burns patients and the parents of burns patients who have experienced PGT via in-depth qualitative data, and (b) compare these with the concepts captured within burn-specific PROMs. We undertook 40 semi-structured interviews with adults and parents of paediatric and adolescent burns patients who had experienced PGT to explore their priorities and perspectives on scar management. Interviews were audio-recorded, transcribed and thematically analysed. The outcomes interpreted within the interview data were then mapped against the concepts captured within burn-specific PROMs currently in the literature. Eight core outcome domains were identified as important to adult patients and parents: (1) scar characteristics and appearance, (2) movement and function, (3) scar sensation, (4) psychological distress, adjustments and a sense of normality, (5) body image and confidence, (6) engagement in activities, (7) impact on relationships, and (8) treatment burden. The outcome domains presented reflect a complex holistic patient experience of scar management and treatments such as PGT. Some currently available PROMs do capture the concepts described here, although none assess psychological adjustments and attainment of a sense of normality following burn injury. The routine use of PROMs that represent patient experience and their relative contribution to trial outcome assessment versus clinical measures is now a matter for further research and debate. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

A novel rapid and selective enzymatic debridement agent for burn wound management: a multi-center RCT.

PubMed

Rosenberg, Lior; Krieger, Yuval; Bogdanov-Berezovski, Alex; Silberstein, Eldad; Shoham, Yaron; Singer, Adam J

2014-05-01

Excisional debridement followed by autografting is the standard of care (SOC) for deep burns, but is associated with serious potential complications. Conservative, non-surgical and current enzymatic debridement methods are inefficiently slow. We determined whether a non-surgical option of rapid enzymatic debridement with the debriding enzyme NexoBrid™ (NXB) would reduce need for surgery while achieving similar esthetic and functional outcomes as SOC. We conducted a multi-center, open-label, randomized, controlled clinical trial including patients aged 4-55 years with deep partial and full thickness burns covering 5-30% of their total body surface area (TBSA). Patients were randomly assigned to burn debridement with NXB (applied for 4h) or SOC, which included surgical excisional or non-surgical debridement. NXB significantly reduced the time from injury to complete débridement (2.2 vs. 8.7 days, P<0.0001), need for surgery (24.5% vs. 70.0%, P<0.0001), the area of burns excised (13.1% vs. 56.7%, P<0.0001) and the need for autografting (17.9% vs. 34.1%, P=0.01). Scar quality and quality of life scores were similar in both study groups as were the rates of adverse events. Enzymatic débridement with NXB resulted in reduced need for and extent of surgery compared with SOC while achieving comparable long-term results in patients with deep burns. Clinical Trials.gov NCT00324311. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Compliance with nutrition support guidelines in acutely burned patients.

PubMed

Holt, Brennen; Graves, Caran; Faraklas, Iris; Cochran, Amalia

2012-08-01

Adequate and timely provision of nutritional support is a crucial component of care of the critically ill burn patient. The goal of this study was to assess a single center's consistency with Society of Critical Care Medicine/American Society for Parenteral and Enteral Nutrition (SCCM/ASPEN) guidelines for nutritional support in critically ill patients. Acutely burned patients >45kg in weight admitted to a regional burn center during a two-year period and who required 5 or more days of full enteral nutritional support were eligible for inclusion in this retrospective review. Specific outcomes evaluated include time from admission to feeding tube placement and enteral feeding initiation and percent of nutritional goal received within the first week of hospital stay. Descriptive statistics were used for all analyses. IRB approval was obtained. Thirty-seven patients were included in this retrospective review. Median age of patients was 44.9 years (IQR: 24.2-55.1), and median burn injury size was 30% (IQR: 19-47). Median time to feeding tube placement was 31.1h post admission (IQR: 23.6-50.2h), while median time to initiation of EN was 47.9h post admission (IQR: 32.4-59.9h). The median time required for patients to reach 60% of caloric goal was 3 days post-admission (IQR: 3-4.5). The median time for initiation of enteral nutrition was within the SCCM/ASPEN guidelines for initial nutrition in the critically ill patient. This project identified a 16h time lag between placement of enteral access and initiation of enteral nutrition. Development of a protocol for feeding tube placement and enteral nutrition management may optimize early nutritional support in the acutely injured burn patient. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Full-Tree SKidding Black Spruce: Another Way to Favor Reproduction

Treesearch

William F. Johnston

1975-01-01

An alternative to burning is needed for clearcut peatlands where only slash disposal is required to rapidly reproduce black spruce. A 2-year trial in north-central Minnesota indicates that reproduction will be rapid after full-tree skidding on nonbrushy sites taht have well-distribted sphagnum seedbeds and ample natural seeding. Broadcast burning is still recommended...

Interim pressure garment therapy (4-6 mmHg) and its effect on donor site healing in burn patients: study protocol for a randomised controlled trial.

PubMed

Donovan, Michelle L; Muller, Michael J; Simpson, Claire; Rudd, Michael; Paratz, Jennifer

2016-04-26

Pressure garment therapy (PGT) is well accepted and commonly used by clinicians in the treatment of burns scars and grafts. The medium to high pressures (24-40 mmHg) in these garments can support scar minimisation, and evidence is well documented for this particular application. However, PGT specifically for burn donor sites, of which a sequela is also scarring, is not well documented. This study protocol investigates the impact of a low pressure (4-6 mmHg) interim garment on donor site healing and scarring. With a primary purpose of holding donor dressings in place, the application of the interim pressure garment (IPG) appears to have been twofold. IPGs for donor sites have involved inconsistent application with a focus on securing wound dressing rather than scar management. However, anecdotal and observational evidence suggests that IPGs also make a difference to some patient's scar outcomes for donor sites. This study protocol outlines a randomised controlled trial designed to test the effectiveness of this treatment on reducing scarring to burn donor sites. This study is a single-centre, single (assessor)-blinded, randomised control trial in patients with burns donor sites to their thighs. Patients will be randomly allocated to a control group (with no compression to donor sites) or to an experimental group (with compression to donor sites) as the comparative treatment. Groups will be compared at baseline regarding the important prognostic indicators: donor site location, depth, size, age, and time since graft (5 days). The IPG treatment will be administered post-operatively (on day 5). Follow-up assessments and garment replacement will be undertaken fortnightly for a period of 2 months. This study focuses on a unique area of burns scar management using a low-pressure tubular support garment for the reduction of donor site scars. Such therapy specifically for donor scar management is poorly represented in the literature. This study was designed to test a potentially cost-effective scar prevention for patients with donor sites to the thigh. No known studies of this nature have been carried out to date, and there is a need for rigorous clinical evidence for low-pressure support garments for donor site scar minimisation. Australian New Zealand Clinical Trials Registry identifier ACTRN12610000127000 . Registered 8 Mar 2010.

Honey as a topical treatment for wounds.

PubMed

Jull, Andrew B; Walker, Natalie; Deshpande, Sohan

2013-02-28

Honey is a viscous, supersaturated sugar solution derived from nectar gathered and modified by the honeybee, Apis mellifera. Honey has been used since ancient times as a remedy in wound care. Evidence from animal studies and some trials has suggested that honey may accelerate wound healing. The objective was to determine whether honey increases the rate of healing in acute wounds (e.g. burns, lacerations) and chronic wounds (e.g. skin ulcers, infected surgical wounds). For this first update of the review we searched the Cochrane Wounds Group Specialised Register (searched 13 June 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5); Ovid MEDLINE (2008 to May Week 5 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 12 June 2012); Ovid EMBASE (2008 to 2012 Week 23); and EBSCO CINAHL (2008 to 8 June 2012). Randomised and quasi-randomised trials that evaluated honey as a treatment for any sort of acute or chronic wound were sought. There was no restriction in terms of source, date of publication or language. Wound healing was the primary endpoint. Data from eligible trials were extracted and summarised by one review author, using a data extraction sheet, and independently verified by a second review author. We identified 25 trials (with a total of 2987 participants) that met the inclusion criteria, including six new trials that were added to this update. In acute wounds, three trials evaluated the effect of honey in acute lacerations, abrasions or minor surgical wounds and 12 trials evaluated the effect of honey in burns. In chronic wounds, two trials evaluated the effect of honey in venous leg ulcers, and single trials investigated its effect in infected post-operative wounds, pressure injuries, cutaneous Lieshmaniasis, diabetic foot ulcers and Fournier's gangrene. Three trials recruited people into mixed groups of chronic or acute wounds. Most trials were at high or unclear risk of bias. In acute wounds, specifically partial-thickness burns, honey might reduce time to healing compared with some conventional dressings (WMD -4.68 days, 95%CI -4.28 to -5.09 days), but, when compared with early excision and grafting, honey delays healing in partial- and full-thickness burns (WMD 13.6 days, 95% CI 10.02 to 17.18 days). In chronic wounds, honey does not significantly increase healing in venous leg ulcers when used as an adjuvant to compression (RR 1.15, 95% CI 0.96 to 1.38), and may delay healing in cutaneous Leishmaniasis when used as an adjuvant to meglumine antimoniate compared to meglumine antimoniate alone (RR 0.72, 95% CI 0.51 to 1.01). Honey dressings do not increase rates of healing significantly in venous leg ulcers when used as an adjuvant to compression. Honey may delay healing in partial- and full-thickness burns in comparison to early excision and grafting, and in cutaneous Leishmaniasis when used as an adjuvant with meglumine antimoniate. Honey might be superior to some conventional dressing materials, but there is considerable uncertainty about the replicability and applicability of this evidence. There is insufficient evidence to guide clinical practice in other types of wounds, and purchasers should refrain from providing honey dressings for routine use until sufficient evidence of effect is available.

78 FR 7860 - Initial Research on the Long-Term Health Consequences of Exposure to Burn Pits in Iraq and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

... design features. Existing research studies, such as the Million Veteran Program, the Cooperative Studies..., study designs, research and evaluation protocols, and results from burn pit emissions research. VA has... DEPARTMENT OF VETERANS AFFAIRS Initial Research on the Long-Term Health Consequences of Exposure...

The Hand Burn Severity (HABS) score: A simple tool for stratifying severity of hand burns.

PubMed

Bache, Sarah E; Fitzgerald O'Connor, Edmund; Theodorakopoulou, Evgenia; Frew, Quentin; Philp, Bruce; Dziewulski, Peter

2017-02-01

Hand burns represent a unique challenge to the burns team due to the intricate structure and unrivalled functional importance of the hand. The initial assessment and prognosis relies on consideration of the specific site involved as well as depth of the burn. We created a simple severity score that could be used by referring non-specialists and researchers alike. The Hand Burn Severity (HABS) score stratifies hand burns according to severity with a numerical value of between 0 (no burn) and 18 (most severe) per hand. Three independent assessors scored the photographs of 121 burned hands of 106 adult and paediatric patients, demonstrating excellent inter-rater reliability (r=0.91, p<0.0001 on testing with Lin's correlation coefficient). A significant relationship was shown between the HABS score and a reliable binary outcome of the requirement for surgical excision on Mann-Whitney U testing (U=152; Z=9.8; p=0.0001). A receiver operator characteristic (ROC) curve analysis found a cut off score of 5.5, indicating that those with a HABS score below 6 did not require an operation, whereas those with a score above 6 did. The HABS score was shown to be more sensitive and specific that assessment of burn depth alone. The HABS score is a simple to use tool to stratify severity at initial presentation of hand burns which will be useful when referring, and when reporting outcomes. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Predicting the effectiveness of virtual reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes.

PubMed

Konstantatos, A H; Angliss, M; Costello, V; Cleland, H; Stafrace, S

2009-06-01

Pain arising in burns sufferers is often severe and protracted. The prospect of a dressing change can heighten existing pain by impacting both physically and psychologically. In this trial we examined whether pre-procedural virtual reality guided relaxation added to patient controlled analgesia with morphine reduced pain severity during awake dressings changes in burns patients. We conducted a prospective randomized clinical trial in all patients with burns necessitating admission to a tertiary burns referral centre. Eligible patients requiring awake dressings changes were randomly allocated to single use virtual reality relaxation plus intravenous morphine patient controlled analgesia (PCA) infusion or to intravenous morphine patient controlled analgesia infusion alone. Patients rated their worst pain intensity during the dressing change using a visual analogue scale. The primary outcome measure was presence of 30% or greater difference in pain intensity ratings between the groups in estimation of worst pain during the dressing change. Of 88 eligible and consenting patients having awake dressings changes, 43 were assigned to virtual reality relaxation plus intravenous morphine PCA infusion and 43 to morphine PCA infusion alone. The group receiving virtual reality relaxation plus morphine PCA infusion reported significantly higher pain intensities during the dressing change (mean=7.3) compared with patients receiving morphine PCA alone (mean=5.3) (p=0.003) (95% CI 0.6-2.8). The addition of virtual reality guided relaxation to morphine PCA infusion in burns patients resulted in a significant increase in pain experienced during awake dressings changes. In the absence of a validated predictor for responsiveness to virtual reality relaxation such a therapy cannot be recommended for general use in burns patients having awake dressings changes.

Computer Program Applications to Tactical Missile Conceptual Design.

DTIC Science & Technology

1981-06-01

initialized at a potential maximum of 1.25 inches/second (Ref. 21 and is allowed to decrease to arrive at a compati- ble burn area and web thickness...the same restrictions. The burn rate starts at 0.45 inches/sec- ond (Ref. 21 and is decreased to provide an acceptable web thickness and burn area. The...0.45 inches/sec- ond to provide a proper web thickness. "THE.SUSTAINER MOTOR HAS AN END BURNING GRAIN." The required burn area for the sustainer was

[Analysis of the quality of papers dealing with clinical trails in "Chinese Journal of Burns" during 2000-2004 by the standard of evidence-based medicine].

PubMed

Jia, Chi-yu; Wang, Yun-chuan; Bai, Feng

2006-02-01

To investigate the quality of reports of clinical results concerning burn injury, in order to raise the standard of clinical study of burn care in accordance to the standard of evidence-based medicine (EBM), with the aim of improving clinical research in burn care of this country. All the papers of clinical study published in Chinese Journal of Burns (CJB) from 2000 to 2004 were evaluated according to EBM standard. There were 89 papers about clinical trials published in the past 5 years, in which 43 (48.3%) of the studies were carried out with random control trials (RCT), and 46 (51.7%) were clinical control trials (CCT). RCT papers increased year by year, while the number of CCT papers fluctuated greatly. The disparity in the quality of research was found as follows. In all the RCT and CCT papers, blinded research was adopted only in 5 papers (5.6%). Strict diagnostic standard including inclusion and exclusion standards were reported in 53 articles (59.6%). The comparison with baselines was not provided in 64 articles (71.9%). P value was given in 10 papers but statistical method was not mentioned (11.2%). Follow-up visits and lost information were only recorded in 2 articles, but no detailed follow-up visiting data were provided. Side effects were reported in 10 articles (11.2%). There were analysis and explanation of mixed interfering factors only in 5 papers (5.6%). There was no explanation of the evaluation of sample size in any one paper. In summary, the literature concerning clinical studies published in CJB in the past five years has become more extensive. However, the present study indicates that many clinical trials are not designed and ethical consideration is often missing. Therefore, it is deemed imperative to improve the quality of the clinical studies by improving the planning of the protocols of the study and statistical analysis of the research results in future.

40 CFR 270.22 - Specific part B information requirements for boilers and industrial furnaces burning hazardous...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., the design and operating information required by § 270.66 must be provided for both the similar device and the device to which the data is to be applied, and a comparison of the design and operating... provided to support the contention that a trial burn is not needed; (B) The design and operating conditions...

40 CFR 270.22 - Specific part B information requirements for boilers and industrial furnaces burning hazardous...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., the design and operating information required by § 270.66 must be provided for both the similar device and the device to which the data is to be applied, and a comparison of the design and operating... provided to support the contention that a trial burn is not needed; (B) The design and operating conditions...

40 CFR 270.22 - Specific part B information requirements for boilers and industrial furnaces burning hazardous...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., the design and operating information required by § 270.66 must be provided for both the similar device and the device to which the data is to be applied, and a comparison of the design and operating... provided to support the contention that a trial burn is not needed; (B) The design and operating conditions...

40 CFR 270.22 - Specific part B information requirements for boilers and industrial furnaces burning hazardous...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., the design and operating information required by § 270.66 must be provided for both the similar device and the device to which the data is to be applied, and a comparison of the design and operating... provided to support the contention that a trial burn is not needed; (B) The design and operating conditions...

40 CFR 270.22 - Specific part B information requirements for boilers and industrial furnaces burning hazardous...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., the design and operating information required by § 270.66 must be provided for both the similar device and the device to which the data is to be applied, and a comparison of the design and operating... provided to support the contention that a trial burn is not needed; (B) The design and operating conditions...

40 CFR 63.7530 - How do I demonstrate initial compliance with the emission limits and work practice standards?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Pollutants for Industrial, Commercial, and Institutional Boilers and Process Heaters Testing, Fuel Analyses... 5 and 7 to this subpart OR conducting initial fuel analyses to determine emission rates and... fuel subcategories that burn only fossil fuels and other gases and do not burn any residual oil must...

Firefighter willingness to participate in a stem cell clinical trial for burns: A mixed methods study.

PubMed

Horch, Jenny D; Carr, Eloise C J; Harasym, Patricia; Burnett, Lindsay; Biernaskie, Jeff; Gabriel, Vincent

2016-12-01

Adult stem cells represent a potentially renewable and autologous source of cells to regenerate skin and improve wound healing. Firefighters are at risk of sustaining a burn and potentially benefiting from a split thickness skin graft (STSG). This mixed methods study examined firefighter willingness to participate in a future stem cell clinical trial, outcome priorities and factors associated with this decision. A sequential explanatory mixed methods design was used. The quantitative phase (online questionnaire) was followed by the qualitative phase (semi-structured interviews). A sample of 149 firefighters completed the online survey, and a purposeful sample of 15 firefighters was interviewed. A majority (74%) reported they would participate in a future stem cell clinical trial if they experienced burn benefiting from STSG. Hypothetical concerns related to receiving a STSG were pain, itch, scarring/redness and skin durability. Participants indicated willingness to undergo stem cell therapy if the risk of no improvement was 43% or less. Risk tolerance was predicted by perceived social support and having children. Interviews revealed four main themes: a desire to help others, improving clinical outcomes, trusting relationships, and a belief in scientific investigation. Many participants admitted lacking sufficient knowledge to make an informed decision regarding stem cell therapies. Firefighters indicated they were largely willing to participate in a stem cell clinical trial but also indicated a lack of knowledge upon which to make a decision. Public education of the role of stem cells in STSG will be increasingly important as clinical trials are developed. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Assessment of fire-damaged mesquite trees 8 years following an illegal burn

Treesearch

Gerald J. Gottfried; Peter F. Ffolliott; Pablo Garcia; Diego Valdez-Zamudio; Akram Al-Khouri

2003-01-01

Effects of an illegal burn on the Santa Rita Experimental Range on mesquite (Prosopis velutina) survival in the semidesert grass-shrub ecosystem was initially assessed in terms of firedamage classes 18 months after the fire and again 8 years after the burn. While many of the mesquite trees on the burned site were damaged by the fire, some of the trees appear to have...

Risk factors for peri-traumatic distress and appearance concerns in burn-injured inpatients identified by a screening tool

PubMed Central

Oaie, Ecaterina; Piepenstock, Emma; Williams, Lisa

2018-01-01

Introduction: Psychosocial screening of burn-injured patients is a National Burn Care Guideline and is increasingly used to identify individuals most in need of support. It can also generate data that can inform our understanding of patient reported concerns following a burn injury. Method: As part of routine care, 461 patients admitted to a burns unit were screened soon after admission using a psychosocial screen designed by the service. The questionnaire included items on pre-existing social support, coping, emotional and psychological difficulties, as well as current trauma symptoms and current level of concern about changed appearance following the burn. Results: Overall, patients reported low levels of appearance concerns (mean 3.7/10) and trauma symptoms (18% reporting flashbacks) in the initial days following a burn injury. In those who did report concerns, there were some significant associations with demographic and other variables. Patients who experienced flashbacks were younger and had a larger total body surface area (TBSA) burn. Higher levels of appearance concern were associated with younger women, larger TBSA and facial burns. However, the relationships found were weak and frequently confounded by other factors. Conclusion: Overall, the findings indicate that initial trauma symptoms and appearance concerns are not inevitable in this group and there is no substitute for screening in identifying who is most at risk. PMID:29873338

Steel Primer Chamber Assemblies for Dual Initiated Pyrovalves

NASA Technical Reports Server (NTRS)

Guemsey, Carl S.; Mizukami, Masashi; Zenz, Zac; Pender, Adam A.

2009-01-01

A solution was developed to mitigate the potential risk of ignition failures and burn-through in aluminum primer chamber assemblies on pyrovalves. This was accomplished by changing the assembly material from aluminum to steel, and reconfiguration of flame channels to provide more direct paths from initiators to boosters. With the geometric configuration of the channels changed, energy is more efficiently transferred from the initiators to the boosters. With the alloy change to steel, the initiator flame channels do not erode upon firing, eliminating the possibility of burn-through. Flight qualification tests have been successfully passed.

Aspects of Cool-Flame Supported Droplet Combustion in Microgravity

NASA Technical Reports Server (NTRS)

Nayagam, Vedha; Dietrich, Daniel L.; Williams, Forman A.

2015-01-01

Droplet combustion experiments performed on board the International Space Station have shown that normal-alkane fuels with negative temperature coefficient (NTC) chemistry can support quasi-steady, low-temperature combustion without any visible flame. Here we review the results for n-decane, n-heptane, and n-octane droplets burning in carbon dioxidehelium diluted environments at different pressures and initial droplet sizes. Experimental results for cool-flame burning rates, flame standoff ratios, and extinction diameters are compared against simplified theoretical models of the phenomenon. A simplified quasi-steady model based on the partial-burning regime of Lin predicts the burning rate, and flame standoff ratio reasonably well for all three normal alkanes. The second-stage cool-flame burning and extinction following the first-stage hot-flame combustion, however, shows a small dependence on the initial droplet size, thus deviating from the quasi-steady results. An asymptotic model that estimates the oxygen depletion by the hot flame and its influence on cool-flame burning rates is shown to correct the quasi-steady results and provide a better comparison with the measured burning-rate results.This work was supported by the NASA Space Life and Physical Sciences Research and Applications Program and the International Space Station Program.

Ammunition Suite for the FCS Multi-role Armament and Ammunition System (MRAAS)

DTIC Science & Technology

2001-06-20

Cards Large Scale Gap Test (LSGT) Exploding Foil Initiator ( EFI ) Effort 19 Slow Burning Layer Fast Burning Layer FASTCORE Nitramines ETPEs RDX CL20...Center Burst Charge 48 M80 Grenades With Center Burst Charge ü Trade off performance with size, weight, etc. ü Develop initial space claim for...submunition ü Dynamic Analysis of projectile for different submunitions MRAAS Trades underway • Accomplishments – Initial meetings with TRADOC, Ft Knox and Ft

The effect of inhalation aromatherapy with damask rose (Rosa damascena) essence on the pain intensity after dressing in patients with burns: A clinical randomized trial.

PubMed

Bikmoradi, Ali; Harorani, Mehdi; Roshanaei, Ghodratollah; Moradkhani, Shirin; Falahinia, Golam Hossein

2016-01-01

Pain is one of the common problems encountered by patients with burns, which increases after each dressing. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on the pain of patients with burns that is caused after dressing. A randomized clinical trial was conducted on 50 patients with second- and third-degree burn wounds. The baseline pain of the patients was assessed 30 min before they entered into the dressing room on the first and second days of intervention. The patients in the experimental group inhaled five drops of damask rose essence 40% in distilled water, while those in the control group inhaled five drops of distilled water as placebo. The pain intensity was assessed using Visual Analogue Scale at 15 and 30 min after the patients exited from the dressing room. Data were analyzed by SPSS (version 18) using descriptive and inferential statistics. There was significant difference between the mean of pain intensity before and after intervention at 15 and 30 min after dressing (P < 0.001). Moreover, there was significant difference in reduction of pain intensity before and after aromatherapy in the experimental group (P < 0.05). Also, there was a significant reduction in severity of pain after dressing in the experimental group compared with the control group (P < 0.05). Inhalation aromatherapy with damask rose could be effective for relieving the pain caused after dressing in patients with burns. Therefore, it could be suggested as a complementary therapy in burn patients for pain relief.

Optimal treatment of partial thickness burns in children: a systematic review.

PubMed

Vloemans, A F P M; Hermans, M H E; van der Wal, M B A; Liebregts, J; Middelkoop, E

2014-03-01

A large part of the patient population of a burn centre consists of children, most of whom are younger than four years. The majority of these young children suffer from superficial and deep partial thickness scald burns that may easily deepen to full thickness burns. A proper wound therapy, that prevents infection and ensures a moist wound condition, might prevent the deterioration of the wound. Therefore, we performed a systematic review of wound management and dressing materials to select the best treatment option for children with burns. A search in Medline and Embase revealed 51 articles for a critical appraisal. The articles were divided into randomized controlled trials, cohort studies and a group of case-reports. Total appraisal did not differ much amongst the groups; the level of evidence was highest in the randomized controlled trials and lowest in the case-reports. In 16 out of 34 comparative studies, silver sulfadiazine or a silver sulfadiazine/chlorhexidine-gluconate combination was the standard of wound care treatment. The competitor dressing was Biobrane(®) in six studies and amnion membrane in three. Tulle gauze, or tulle gauze impregnated with an antibacterial addition were the standard of care treatment in seven studies. In general, membranous dressings like Biobrane(®) and amnion membrane performed better than the standard of care on epithelialization rate, length of hospital stay and pain for treatment of partial thickness burns in children. However, hardly any of the studies investigated long-term results like scar formation. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Computer tablet distraction reduces pain and anxiety in pediatric burn patients undergoing hydrotherapy: A randomized trial.

PubMed

Burns-Nader, Sherwood; Joe, Lindsay; Pinion, Kelly

2017-09-01

Distraction is often used in conjunction with analgesics to minimize pain in pediatric burn patients during treatment procedures. Computer tablets provide many options for distraction items in one tool and are often used during medical procedures. Few studies have examined the effectiveness of tablet distraction in improving the care of pediatric burn patients. This study examines the effectiveness of tablet distraction provided by a child life specialist to minimize pain and anxiety in pediatric burn patients undergoing hydrotherapy. Thirty pediatric patients (4-12) undergoing hydrotherapy for the treatment of burns participated in this randomized clinical trial. The tablet distraction group received tablet distraction provided by a child life specialist while those in the control group received standard care. Pain was assessed through self-reports and observation reports. Anxiety was assessed through behavioral observations. Length of procedure was also recorded. Nurses reported significantly less pain for the tablet distraction group compared to the control group. There was no significant difference between groups on self-reported pain. The tablet distraction group displayed significantly less anxiety during the procedure compared to the control group. Also, the tablet distraction group returned to baseline after the procedure while those in the control group displayed higher anxiety post-procedure. There was no difference in the length of the procedure between groups. These findings suggest tablet distraction provided by a child life specialist may be an effective method for improving pain and anxiety in children undergoing hydrotherapy treatment for burns. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Vegetation response to prescribed fire in the Kenai Mountains, Alaska.

Treesearch

Tina V. Boucher

2003-01-01

Between 1977 and 1997, 4000 ha were burned to promote regeneration of tree and shrub species used for browse by moose (Alces alces) in the Kenai Mountains. Species composition was documented along burned and unburned transects at 17 prescribed burn sites. Relationships among initial vegetation composition, physical site characteristics, browse...

Effects of burn with and without Escherichia coli infection in rats on intestinal vs. splenic T-cell responses.

PubMed

Ravindranath, T; Al-Ghoul, W; Namak, S; Fazal, N; Durazo-Arvizu, R; Choudhry, M; Sayeed, M M

2001-12-01

To evaluate the effect of burn injury with and without an Escherichia coliseptic complication on T-cell proliferation, interleukin-2 production, and Ca(2+) signaling responses in intestinal Peyer's patch and splenic T cells. Prospective, randomized, sham-controlled animal study. University medical center research laboratory. Adult male Sprague-Dawley rats. Rats were subjected to a 30% total body surface area, full skin thickness burn. Infection in rats was induced via intraperitoneal inoculation of E. coli, 10(9) colony forming units/kg, with or without a prior burn. Rat Peyer's patch and splenic T lymphocytes were isolated by using a nylon wool cell purification protocol. T-cell proliferation, interleukin-2 production, and Ca(2+) signaling responses were measured after stimulation of cells with the mitogen, concanavalin A. T-cell proliferation was determined by measuring incorporation of (3)H-thymidine into T-cell cultures. Interleukin-2 production by T-cell cultures was measured by using enzyme-linked immunosorbent assay. Intracellular T-cell Ca2(+ )concentration, [Ca(2+)](i), was measured by the use of Ca(2+)-specific fluorescent label, fura-2, and its fluorometric quantification. [Ca(2+)](i) was also evaluated by the use of digital video imaging of fura-2 loaded individual T cells. T-cell proliferation and interleukin-2 production were suppressed substantially in both Peyer's patch and splenic T cells 3 days after either the initial burn alone or burn followed by the E. coli inoculation at 24 hrs after the initial burn. There seemed to be no demonstrable additive effects of E. coli infection on the effects produced by burn injury alone. The T-cell proliferation and interleukin-2 production suppressions with burn or burn-plus-infection insults were correlated with attenuated Ca(2+) signaling. E. coli infection alone suppressed T-cell proliferation in Peyer's patch but not in splenic T cells at 2 days postbacterial inoculation; E. coli infection had no effect on Peyer's patch or splenic T cells at 1 day postinjury. On the other hand, burn injury alone caused a substantial T-cell proliferative suppression at 2 days postburn in both Peyer's patch and splenic cells and a significant suppression in T-cell proliferation on day 1 postburn in Peyer's patch but not in the spleen. An initial burn injury suppressed T-cell proliferation at a level that it would not be further affected by a subsequent infection even if the infection by itself has the potential of suppressing T-cell proliferation. An earlier onset of T-cell suppression in Peyer's patch cells than in the spleen with burn could be attributable to an initial hypoperfusion-related intestinal mucosal tissue injury. Overall, our study supports the concept that burn injury per se can significantly suppress T-cell mediated immunity and that the intestine is an early tissue site of such suppression.

Special considerations in paediatric burn patients

PubMed Central

Sharma, Ramesh Kumar; Parashar, Atul

2010-01-01

Burn injuries are a major cause of morbidity and mortality in children. In India, the figure constitutes about one-fourth of the total burn accidents. The management of paediatric burns can be a major challenge for the treating unit. One has to keep in mind that “children are not merely small adults”; there are certain features in this age group that warrant special attention. The peculiarities in the physiology of fluid and electrolyte handling, the uniqueness of the energy requirement and the differences in the various body proportions in children dictate that the paediatric burn management should be taken with a different perspective than for adults. This review article would deal with the special situations that need to be addressed while treating this special class of thermal injuries. We must ensure that not only the children survive the initial injury, but also the morbidity and complications are minimized. If special care is taken during the initial management of paediatric burn injuries, these children can be effectively integrated into the society as very useful and productive members. PMID:21321657

Apollo 16, LM-11 ascent propulsion system final flight evaluation

NASA Technical Reports Server (NTRS)

Griffin, W. G.

1974-01-01

The duty cycle for the LM-11 APS consisted of two firings, an ascent stage liftoff from the lunar surface, and the terminal phase initiation (TPI) burn. APS performance for the first firing was evaluated and found to be satisfactory. No propulsion data were received from the second APS burn; however, all indications were that the burn was nominal. Engine ignition for the APS lunar liftoff burn occured at the Apollo elapsed time (AET) of 175:31:47.9 (hours:minutes:seconds). Burn duration was 427.7 seconds.

Promoted Metals Combustion at Ambient and Elevated Temperatures

NASA Technical Reports Server (NTRS)

Engel, Carl D.; Herald, Stephen D.; Davis, S. Eddie

2005-01-01

Promoted combustion testing of materials, Test 17 of NASA STD-6001, has been used to assess metal propensity to burn in oxygen rich environments. An igniter is used at the bottom end of a rod to promote ignition, and if combustion is sustained, the burning progresses from the bottom to the top of the rod. The physical mechanisms are very similar to the upward flammability test, Test 1 of NASA STD-6001. The differences are in the normal environmental range of pressures, oxygen content, and sample geometry. Upward flammability testing of organic materials can exhibit a significant transitional region between no burning to complete quasi-state burning. In this transitional region, the burn process exhibits a probabilistic nature. This transitional region has been identified for metals using the promoted combustion testing method at ambient initial temperatures. The work given here is focused on examining the transitional region and the quasi-steady burning region both at conventional ambient testing conditions and at elevated temperatures. A new heated promoted combustion facility and equipment at Marshall Space Flight Center have just been completed to provide the basic data regarding the metals operating temperature limits in contact with oxygen rich atmospheres at high pressures. Initial data have been obtained for Stainless Steel 304L, Stainless Steel 321, Haynes 214, and Inconel 718 at elevated temperatures in 100-percent oxygen atmospheres. These data along with an extended data set at ambient initial temperature test conditions are examined. The pressure boundaries of acceptable, non-burning usage is found to be lowered at elevated temperature.

Burn Resuscitation

DTIC Science & Technology

2009-01-01

The modified Brooke formula may not be effective in preventing all complications of fluid loading in all patients. The important concept is that if...addition to complicated mathematical computations [39]. They used their knowledge of expected fluid loss rates to devise a formula, based on trials of...burn resuscitations in order to prevent such a complication . This has proven to be a difficult task. The use of colloid has been examined in

A meta-analysis of trials using the intention to treat principle for glutamine supplementation in critically ill patients with burn.

PubMed

Lin, Jiun-Jie; Chung, Xiu-Juan; Yang, Chung-Yih; Lau, Hui-Ling

2013-06-01

During critical illness, the demand for glutamine may exceed that which can be mobilized from muscle stores. Infections increase mortality, morbidity, length-of-stay, antibiotic usage and the cost of care. This is a major health care issue. RCTs were identified from the electronic databases: the Cochrane Library, MEDLINE, PubMed web of knowledge and hand searching journals. The trials compared the supplementation with glutamine and non-supplementation in burn. Statistical analysis was performed using RevMan5.1 software, from Cochrane Collaboration. 216 papers showed a match, in the keyword search. Upon screening the title, reading the abstract and the entire article, only four RCTs, involving 155 patients, were included. For both the glutamine group and control group, total burn surface area (TBSA) (MD=2.02, 95% CI -2.17, 6.21, p=0.34) was similar. Glutamine supplementation was associated with a statistically significant decrease in the number of patients with gram-negative bacteremia (OR 0.27, 95% CI 0.08-0.92, p=0.04) and hospital mortality (OR=0.13, 95% CI 0.03, 0.51, p=0.004), however, no statistical difference was noted between groups, for the other results. Glutamine supplemented nutrition can be associated with a reduction in mortality in hospital, complications due to gram-negative bacteremia in burn patients. Further larger and better quality trials are required, in order to determine whether any differences are statistically and clinically important. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Impact of Early Inpatient Rehabilitation on Adult Burn Survivors' Functional Outcomes and Resource Utilization.

PubMed

Gomez, Manuel; Tushinski, Morris; Jeschke, Marc G

On July 2012, a rehabilitation hospital merged with a trauma center where the regional burn center is located. That rehabilitation center provides the only burn rehabilitation program in our region. The objective of this study was to determine if earlier initiation of inpatient rehabilitation after merger had an effect on burn survivors' functional outcomes and resource utilization. A retrospective review of electronic data of burn survivors' functional outcomes (functional independence measure [FIM] ratings on admission, at discharge, and percent change), and resource utilization (waiting time for rehab, burn center length of stay [LOS], rehab LOS, physiotherapy and occupational therapy rehabilitation workload [RehabWorkload], and discharge destination) was undertaken. Adult burn survivors who required inpatient rehabilitation and were transferred from the burn center to the inpatient rehabilitation service before the merger (July 2010-June 2012) were compared with those transferred after the merger (July 2012-June 2014). One hundred thirty-eight burn survivors were transferred from the burn center to the inpatient rehabilitation service during the study period. Sixty (43.5%) were transferred before and 78 (56.5%) were transferred after the merger. There were 97 (70.3%) men and 41 (29.7%) women with a mean age of 47.9 ± 17.9 years. TBSA burn was 24.2 ± 16.9%, and full thickness burn was 13.1 ± 16.4%. The etiology of these burns were flame (72.5%), scald (19.6%), electrical (5.1%), chemical (2.2%), and contact (0.7%). Patients in both groups had similar age, inhalation injury, TBSA, full thickness burn, FIM ratings, RehabWorkload, and burn etiology. Patients transferred before the merger had significantly more chemical burns (5% vs 0%, P = .046), and more work-related burns (26.7% vs 7.7%, P = .004). Patients transferred after the merger had significantly shorter burn center LOS (28.5 ± 20.9 days vs 38.8 ± 34.2 days, P = .043), and shorter waiting time for rehab (0.7 ± 1.1 days vs 1.5 ± 2.3 days, P = .010) than patients transferred before the merger. Early initiation of inpatient rehabilitation, after the burn center and the inpatient rehabilitation service were located in the same hospital, improved burn survivors' resource utilization.

The Burn Wound Microenvironment

PubMed Central

Rose, Lloyd F.; Chan, Rodney K.

2016-01-01

Significance: While the survival rate of the severely burned patient has improved significantly, relatively little progress has been made in treatment or prevention of burn-induced long-term sequelae, such as contraction and fibrosis. Recent Advances: Our knowledge of the molecular pathways involved in burn wounds has increased dramatically, and technological advances now allow large-scale genomic studies, providing a global view of wound healing processes. Critical Issues: Translating findings from a large number of in vitro and preclinical animal studies into clinical practice represents a gap in our understanding, and the failures of a number of clinical trials suggest that targeting single pathways or cytokines may not be the best approach. Significant opportunities for improvement exist. Future Directions: Study of the underlying molecular influences of burn wound healing progression will undoubtedly continue as an active research focus. Increasing our knowledge of these processes will identify additional therapeutic targets, supporting informed clinical studies that translate into clinical relevance and practice. PMID:26989577

Hypertrophic scarring: the greatest unmet challenge following burn injury

PubMed Central

Finnerty, Celeste C; Jeschke, Marc G; Branski, Ludwik K; Barret, Juan P.; Dziewulski, Peter; Herndon, David N

2017-01-01

Summary Improvements in acute burn care have enabled patients to survive massive burns which would have once been fatal. Now up to 70% of patients develop hypertrophic scars following burns. The functional and psychosocial sequelae remain a major rehabilitative challenge, decreasing quality of life and delaying reintegration into society. The current approach is to optimise the healing potential of the burn wound using targeted wound care and surgery in order to minimise the development of hypertrophic scarring. This approach often fails, and modulation of established scar is continued although the optimal indication, timing, and combination of therapies have yet to be established. The need for novel treatments is paramount, and future efforts to improve outcomes and quality of life should include optimisation of wound healing to attenuate or prevent hypertrophic scarring, well-designed trials to confirm treatment efficacy, and further elucidation of molecular mechanisms to allow development of new preventative and therapeutic strategies. PMID:27707499

How to study the aetiology of burn injury: the epidemiological approach.

PubMed

Bouter, L M; Knipschild, P G; van Rijn, J L; Meertens, R M

1989-06-01

Effective prevention of burn injury should be based on sound aetiological knowledge. This article deals with epidemiological methods to study the incidence of burn injury as a function of its risk factors. Central methodological issues are comparability of baseline prognosis, comparability of measurements (of effects in cohort studies and of risk factors in case-control studies), and comparability of external circumstances. These principles are clarified with a number of fictitious examples of risk factors for burn injury. It is explained that in preventive trials comparability may be achieved by randomization, blinding and placebo intervention. The main tools in non-experimental studies are deliberate selection and multivariate analysis. Special attention is given to the definition of the source population and to reducing measurement incomparability in case-control studies. Some well-designed case-control studies following these principles might bring effective prevention of burn injury some steps nearer.

Brazil Fire Characterization and Burn Area Estimation Using the Airborne Infrared Disaster Assessment (AIRDAS) System

NASA Technical Reports Server (NTRS)

Brass, J. A.; Riggan, P. J.; Ambrosia, V. G.; Lockwood, R. N.; Pereira, J. A.; Higgins, R. G.; Peterson, David L. (Technical Monitor)

1995-01-01

Remotely sensed estimations of regional and global emissions from biomass combustion have been used to characterize fire behavior, determine fire intensity, and estimate burn area. Highly temporal, low resolution satellite data have been used to calculate estimates of fire numbers and area burned. These estimates of fire activity and burned area have differed dramatically, resulting in a wide range of predictions on the ecological and environmental impacts of fires. As part of the Brazil/United States Fire Initiative, an aircraft campaign was initiated in 1992 and continued in 1994. This multi-aircraft campaign was designed to assist in the characterization of fire activity, document fire intensity and determine area burned over prescribed, agricultural and wildland fires in the savanna and forests of central Brazil. Using a unique, multispectral scanner (AIRDAS), designed specifically for fire characterization, a variety of fires and burned areas were flown with a high spatial and high thermal resolution scanner. The system was used to measure flame front size, rate of spread, ratio of smoldering to flaming fronts and fire intensity. In addition, long transects were flown to determine the size of burned areas within the cerrado and transitional ecosystems. The authors anticipate that the fire activity and burned area estimates reported here will lead to enhanced information for precise regional trace gas prediction.

Serum albumin levels in burn people are associated to the total body surface burned and the length of hospital stay but not to the initiation of the oral/enteral nutrition

PubMed Central

Pérez-Guisado, Joaquín; de Haro-Padilla, Jesús M; Rioja, Luis F; DeRosier, Leo C; de la Torre, Jorge I

2013-01-01

Objective: Serum albumin levels have been used to evaluate the severity of the burns and the nutrition protein status in burn people, specifically in the response of the burn patient to the nutrition. Although it hasn’t been proven if all these associations are fully funded. The aim of this retrospective study was to determine the relationship of serum albumin levels at 3-7 days after the burn injury, with the total body surface area burned (TBSA), the length of hospital stay (LHS) and the initiation of the oral/enteral nutrition (IOEN). Subject and methods: It was carried out with the health records of patients that accomplished the inclusion criteria and were admitted to the burn units at the University Hospital of Reina Sofia (Córdoba, Spain) and UAB Hospital at Birmingham (Alabama, USA) over a 10 years period, between January 2000 and December 2009. We studied the statistical association of serum albumin levels with the TBSA, LHS and IOEN by ANOVA one way test. The confidence interval chosen for statistical differences was 95%. Duncan’s test was used to determine the number of statistically significantly groups. Results: Were expressed as mean±standard deviation. We found serum albumin levels association with TBSA and LHS, with greater to lesser serum albumin levels found associated to lesser to greater TBSA and LHS. We didn’t find statistical association with IOEN. Conclusion: We conclude that serum albumin levels aren’t a nutritional marker in burn people although they could be used as a simple clinical tool to identify the severity of the burn wounds represented by the total body surface area burned and the lenght of hospital stay. PMID:23875122

Serum albumin levels in burn people are associated to the total body surface burned and the length of hospital stay but not to the initiation of the oral/enteral nutrition.

PubMed

Pérez-Guisado, Joaquín; de Haro-Padilla, Jesús M; Rioja, Luis F; Derosier, Leo C; de la Torre, Jorge I

2013-01-01

Serum albumin levels have been used to evaluate the severity of the burns and the nutrition protein status in burn people, specifically in the response of the burn patient to the nutrition. Although it hasn't been proven if all these associations are fully funded. The aim of this retrospective study was to determine the relationship of serum albumin levels at 3-7 days after the burn injury, with the total body surface area burned (TBSA), the length of hospital stay (LHS) and the initiation of the oral/enteral nutrition (IOEN). It was carried out with the health records of patients that accomplished the inclusion criteria and were admitted to the burn units at the University Hospital of Reina Sofia (Córdoba, Spain) and UAB Hospital at Birmingham (Alabama, USA) over a 10 years period, between January 2000 and December 2009. We studied the statistical association of serum albumin levels with the TBSA, LHS and IOEN by ANOVA one way test. The confidence interval chosen for statistical differences was 95%. Duncan's test was used to determine the number of statistically significantly groups. Were expressed as mean±standard deviation. We found serum albumin levels association with TBSA and LHS, with greater to lesser serum albumin levels found associated to lesser to greater TBSA and LHS. We didn't find statistical association with IOEN. We conclude that serum albumin levels aren't a nutritional marker in burn people although they could be used as a simple clinical tool to identify the severity of the burn wounds represented by the total body surface area burned and the lenght of hospital stay.

[Effects of group psychological counseling on self-confidence and social adaptation of burn patients].

PubMed

Dang, Rui; Wang, Yishen; Li, Na; He, Ting; Shi, Mengna; Liang, Yanyan; Zhu, Chan; Zhou, Yongbo; Qi, Zongshi; Hu, Dahai

2014-12-01

To explore the effects of group psychological counseling on the self-confidence and social adaptation of burn patients during the course of rehabilitation. Sixty-four burn patients conforming to the inclusion criteria and hospitalized from January 2012 to January 2014 in Xijing Hospital were divided into trial group and control group according to the method of rehabilitation, with 32 cases in each group. Patients in the two groups were given ordinary rehabilitation training for 8 weeks, and the patients in trial group were given a course of group psychological counseling in addition. The Rosenberg's Self-Esteem Scale was used to evaluate the changes in self-confidence levels, and the number of patients with inferiority complex, normal feeling, self-confidence, and over self-confidence were counted before and after treatment. The Abbreviated Burn-Specific Health Scale was used to evaluate physical function, psychological function, social relationship, health condition, and general condition before and after treatment to evaluate the social adaptation of patients. Data were processed with t test, chi-square test, Mann-Whitney U test, and Wilcoxon test. (1) After treatment, the self-confidence levels of patients in trial group were significantly higher than those in control group (Z = -2.573, P < 0.05). Among trial group, the number of patients with inferiority complex was 17 (53.1%) before treatment, which was decreased to 6 (18.8%) after treatment; the number of patients with normal feeling and that of self-confidence were 8 (25.0%) and 4 (12.5%) before treatment, which were respectively increased to 13 (40.6%) and 10 (31.3%) after treatment. The overall difference in trial group was obvious between before and after treatment (Z = -4.123, P < 0.01) . There was no obvious difference in self-confidence level of patients in control group between before and after treatment (Z = -1.000, P > 0.05). (2) After treatment, the scores of psychological function, social relationship, health condition, and general condition were (87 ± 3), (47.8 ± 3.6), (49 ± 3), and (239 ± 10) points in trial group, which were significantly higher than those in control group [(79 ± 4), (38.3 ± 5.6), (46 ± 4), and (231 ± 9) points, with t values respectively -8.635, -8.125, -3.352, -3.609, P values below 0.01]. After treatment, the scores of physical function, psychological function, social relationship, health condition, and general condition in trial group were significantly higher than those before treatment (with t values from -33.282 to -19.515, P values below 0.05). The scores of physical function, psychological function, health condition, and general condition in control group after treatment were significantly higher than those before treatment (with t values from -27.137 to -17.790, P values below 0.05). Group psychological counseling combined with ordinary rehabilitation training give rise to significant effects on self-confidence level and social adaptation for burn patients.

[Multimodal distraction to relieve pain in children undergoing acute medical procedures].

PubMed

Miller, Kate; Rodger, Sylvia; Bucolo, Sam; Wang, Xue-Qing; Kimble, Roy M

2009-10-01

Non-pharmacological approaches to pain management have been used by therapists for decades to reduce the anxiety and pain experienced by children during burn care procedures. With a greater understanding of pain and the principles behind what causes a child to be distracted, combined with access to state of the art technology, we have developed an easy to use, hand held multimodal distraction device (MMD). MMD is an interactive device that prepares the child for a procedure and uses developmentally appropriate distraction stories and games during the procedures to alleviate anxiety and pain. This paper summarizes the results of three randomized control trials. The trials aimed to understand the effectiveness of MMD as a distraction and preparation tool in reducing anxiety and pain in children undergoing burns and non-burns medical procedures compared to pure pharmacological approaches Standard Distraction (SD) and off the shelf video games (VG). Three separate prospective randomized control trials involving 182 children having 354 dressing changes were conducted in the burns and orthopedic departments at Royal Children's Hospital, Brisbane, Australia, to address the above aims. Pain and anxiety scores were completed for the child, caregiver and nursing staff according to the Modified Faces, Legs, Activity, Cry and Consolability Scale, Faces Pain Scale-Revised, Visual Analogue Scale and Wong-Baker Faces Pain Rating Scale. Procedural length was recorded. MMD as a preparation and distraction tool were shown to have a significant impact on child, parent and nursing staff reported anxiety and pain during procedures compared to standard care and video games (P < 0.01). The MMD had a positive effect on clinical time and was shown to sustain its impact on pain and time with further dressing changes. MMD is more effective in reducing the pain and anxiety experienced by children in acute medical procedures as compared with SD and VG. MMD is continuing to be trialed and is continuing to show positive clinical outcomes.

Black Carbon in the Arctic: Assessment of and efforts to reduce black carbon emissions from wildfires and agricultural burning in Russia

NASA Astrophysics Data System (ADS)

Kinder, B.; Hao, W. M.; Larkin, N. K.; McCarty, G.; O'neal, K. J.; Gonzalez, O.; Luxenberg, J.; Rosenblum, M.; Petkov, A.

2011-12-01

Black carbon and other short-lived climate forcers exert a warming effect on the climate but remain in the atmosphere for short time periods when compared to carbon dioxide. Black carbon is a significant contributor to increasing temperatures in the Arctic region, which has warmed at twice the global rate over the past 100 years. Black carbon warms the Arctic by absorbing incoming solar radiation while in the atmosphere and, when deposited onto Arctic ice, leading to increased atmospheric temperatures and snow and ice melt. Black carbon remains in the atmosphere for a short time period ranging from days to weeks; therefore, local atmospheric conditions at the time of burning determine the amount of black carbon transport to the Arctic. Most black carbon transport and deposition in the Arctic results from the occurrence of wildfires, prescribed forest fires, and agricultural burning at latitudes greater than 40 degrees north latitude. Wildfire affects some 10-15 million hectares of forest, forest steppe, and grasslands in Russia each year. In addition to wildfire, there is widespread cropland burning in Russia occurring in the fall following harvest and in the spring prior to tilling. Agricultural burning is common practice for crop residue removal as well as suppression of weeds, insects and residue-borne diseases. The goal of the United States Department of Agriculture (USDA) Black Carbon Initiative is to assess black carbon emissions from agricultural burning and wildfires in Russia and explore practical options and opportunities for reducing emissions from these two sources. The emissions assessment combines satellite-derived burned area measurements of forest and agricultural fires, burn severity information, ancillary geospatial data, vegetation and land cover maps, fuels data, fire emissions data, fire/weather relationship information, and smoke transport models to estimate black carbon transport and deposition in the Arctic. The assessment addresses necessary improvements to fire and burned area detection algorithms to improve agricultural burned area mapping accuracy. Efforts to explore practical options for reducing black carbon emissions from wildfires and agricultural burning in Russia have been focused on designing community-based fire prevention and education programs in Siberia and the Russia Far East, two regions prone to frequent human-caused fires. The initiative also seeks to identify practical alternatives to reduce black carbon emissions from agricultural burning and to help promote these alternatives through outreach to farmers and other agricultural organizations. This submission will explore the initial findings and results of the emissions assessment and discuss the progress and challenges associated with implementation of local-level fire prevention and mitigation efforts in Russia. The results of this initiative will help inform future policy and management tools to address black carbon emissions from wildfires and agricultural burning in Russia and perhaps additional interested countries.

Influence of Fire on Oak Seedlings and Saplings in Southern Oak Woodland on the Santa Rosa Plateau Preserve, Riverside County, California

Treesearch

Earl W. Lathrop; Chris D. Osborne

1991-01-01

One wildfire and two prescription burns were monitored at 15 oak seedling/sapling regeneration sites and at four non-burned comparison sites to study the effect of fire on seedlings and saplings of Quercus engelmannii (Engelmann oak) and Q. agrifolia (coast live oak). The number of initial topkilled seedlings and saplings, initial...

Development of an effective communication strategy for the prevention of burns in children: the PRIUS project

PubMed Central

Cedri, S.; Briguglio, E.; Cedri, C.; Masellis, A.; Crenca, A.; Pitidis, A.

2015-01-01

Summary This study has developed a learning kit for the prevention of domestic burns in childhood. The main objective was to trial an educational package for children (nursery and primary classes), for the prevention of burns, to be implemented through education in schools. The educational kit comprises posters, information leaflets, comic books, and pre and post education evaluation materials for school children, parents and teachers. Recipients of the preliminary study were the students of nine schools in the eight Italian cities where Burn Centers are located. In order to reach the target groups of children, it was necessary to identify the most effective communication strategy to convey the burn prevention message. For nursery school children, it was not possible to use tools with written texts alone, as they were not yet literate. Moreover, even for older children, it was necessary to find an attractive tool to catch their attention and interest, promoting the understanding and memorization of lessons learned. The most suitable means was found to be comic strips, allowing the messages to be conveyed through images as well as words. A total of 370 children (195 from nurseries and 175 from primary schools) participated in the trial of the educational kit. Overall, for every environment represented in the evaluation table, the ability to recognize the dangers among both the pre-school and primary school children increased significantly after the training activity. In conclusion, the educational kit has been positively assessed. PMID:27252606

Development of an effective communication strategy for the prevention of burns in children: the PRIUS project.

PubMed

Cedri, S; Briguglio, E; Cedri, C; Masellis, A; Crenca, A; Pitidis, A

2015-06-30

This study has developed a learning kit for the prevention of domestic burns in childhood. The main objective was to trial an educational package for children (nursery and primary classes), for the prevention of burns, to be implemented through education in schools. The educational kit comprises posters, information leaflets, comic books, and pre and post education evaluation materials for school children, parents and teachers. Recipients of the preliminary study were the students of nine schools in the eight Italian cities where Burn Centers are located. In order to reach the target groups of children, it was necessary to identify the most effective communication strategy to convey the burn prevention message. For nursery school children, it was not possible to use tools with written texts alone, as they were not yet literate. Moreover, even for older children, it was necessary to find an attractive tool to catch their attention and interest, promoting the understanding and memorization of lessons learned. The most suitable means was found to be comic strips, allowing the messages to be conveyed through images as well as words. A total of 370 children (195 from nurseries and 175 from primary schools) participated in the trial of the educational kit. Overall, for every environment represented in the evaluation table, the ability to recognize the dangers among both the pre-school and primary school children increased significantly after the training activity. In conclusion, the educational kit has been positively assessed.

A rare case of failed healing in previously burned skin after a secondary burns.

PubMed

Goldie, Stephen J; Parsons, Shaun; Menezes, Hana; Ives, Andrew; Cleland, Heather

2017-01-01

Patients presenting with large surface area burns are common in our practice; however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. We report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. Our patient was a 33-year-old man who presented with a 5% TBSA burn on skin scarred by a previous 40% total body surface area (TBSA) burn and skin grafts. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings; however, they failed to heal and became infected requiring surgical management. Burns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage.

Reburn severity in managed and unmanaged vegetation in a large wildfire

PubMed Central

Thompson, Jonathan R.; Spies, Thomas A.; Ganio, Lisa M.

2007-01-01

Debate over the influence of postwildfire management on future fire severity is occurring in the absence of empirical studies. We used satellite data, government agency records, and aerial photography to examine a forest landscape in southwest Oregon that burned in 1987 and then was subject, in part, to salvage-logging and conifer planting before it reburned during the 2002 Biscuit Fire. Areas that burned severely in 1987 tended to reburn at high severity in 2002, after controlling for the influence of several topographical and biophysical covariates. Areas unaffected by the initial fire tended to burn at the lowest severities in 2002. Areas that were salvage-logged and planted after the initial fire burned more severely than comparable unmanaged areas, suggesting that fuel conditions in conifer plantations can increase fire severity despite removal of large woody fuels. PMID:17563370

Persistent Influences of the 2002 Hayman Fire on Stream Nitrate and Dissolved Organic Carbon

NASA Astrophysics Data System (ADS)

Rhoades, C.; Pierson, D. N.; Fegel, T. S., II; Chow, A. T.; Covino, T. P.

2016-12-01

Large, high severity wildfires alter the physical and biological conditions that determine how watersheds retain and release nutrients and regulate stream water quality. For five years after the 2002 Hayman Fire burned in Colorado conifer forests, stream nitrate concentrations and export increased steadily in watersheds with extensive high-severity burning. Stream temperature and turbidity also increased in relation to the extent of high-severity burning and remained elevated above background levels throughout the initial five year post-fire period. Our recent sampling documents that 14 years after the Hayman Fire stream nitrate remains an order of magnitude higher in extensively-burned (35-90%) compared to unburned watersheds (0.2 vs 2.8 mg L-1). Nitrate represents 83% of the total dissolved N in extensively-burned watersheds compared to 29% in unburned watersheds. In contrast, dissolved organic carbon (DOC), was highest in watersheds that burned to a moderate extent (10-20%) and lowest in those with extensive burning. Catchments with a moderate extent burned had DOC concentrations 2.5 and 1.7 times more than those with extensive burning and unburned catchments, respectively. Peak concentrations of DOC and nitrate track the rising limb of the streamflow hydrograph and reach a maximum in May, but patterns among burn extent categories were seasonally consistent. Current riparian conditions are linked to stream nitrate in burned watersheds. For example, stream nitrate increases proportionally to the extent of riparian zones with low shrub cover (R2 = 0.76). We found signs of watershed recovery compared to the initial post-fire period; stream temperature and turbidity remained elevated in extensively burned catchments, but increases were only significant during the spring season. The persistent stream nitrate concentrations as well as the relation between riparian cover and post-fire stream nitrate may help prioritize restoration planting efforts and mitigate chronic, elevated nitrate export from burned watersheds.

Resuscitation burn card--a useful tool for burn injury assessment.

PubMed

Malic, C C; Karoo, R O S; Austin, O; Phipps, A

2007-03-01

It is well recognised that the initial assessment of body surface area affected by a burn is often over estimated in Accident and Emergency Departments. A useful aide-memoir in the acute setting is Wallace's "rule of nines" or using the patients' palmar surface of the hand, which approximates 1% of the total body surface area, as a method of assessment. Unfortunately, as with every system, limitations apply. Factors such as patient size and the interpretation of what is exactly the 'palmar surface' may significantly influence burn size estimations and subsequently fluid resuscitation. Our aim is to develop a simple, quick and easy reproducible method of calculating burn injuries for medical professionals in the acute setting. Worldwide, the dimensions of a credit card are standardized (8.5 cm x 5.3 cm), thus producing a surface area of 45 cm2. We created a resuscitation burn card (RBC) using these exact same proportions, upon which a modified body surface area (BSA) nomogram was printed. Knowing the patient height and weight, we calculated the surface area of the card as percentage of total body surface area (TBSA). On the opposite site of the RBC, a Lund and Browder chart was printed, as well as the Parkland formula and a formula to calculate paediatric burn fluid requirements. The plastic, flexible RBC conformed well to the body contour and was designed for single use. We used the resuscitation burn card in the initial assessment of simulated burns in a Regional Burn Centre and in an Accident and Emergency Department. The information present on the card was found to be clear and straightforward to use. The evaluation of burn extent was found to be more accurately measured than the estimation obtained without the RBC. The resuscitation burn card can be a valuable tool in the hands of less experienced medical professionals for the early assessment and fluid resuscitation of a burn.

The effect of inhalation aromatherapy with damask rose (Rosa damascena) essence on the pain intensity after dressing in patients with burns: A clinical randomized trial

PubMed Central

Bikmoradi, Ali; Harorani, Mehdi; Roshanaei, Ghodratollah; Moradkhani, Shirin; Falahinia, Golam Hossein

2016-01-01

Background: Pain is one of the common problems encountered by patients with burns, which increases after each dressing. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on the pain of patients with burns that is caused after dressing. Materials and Methods: A randomized clinical trial was conducted on 50 patients with second- and third-degree burn wounds. The baseline pain of the patients was assessed 30 min before they entered into the dressing room on the first and second days of intervention. The patients in the experimental group inhaled five drops of damask rose essence 40% in distilled water, while those in the control group inhaled five drops of distilled water as placebo. The pain intensity was assessed using Visual Analogue Scale at 15 and 30 min after the patients exited from the dressing room. Data were analyzed by SPSS (version 18) using descriptive and inferential statistics. Results: There was significant difference between the mean of pain intensity before and after intervention at 15 and 30 min after dressing (P < 0.001). Moreover, there was significant difference in reduction of pain intensity before and after aromatherapy in the experimental group (P < 0.05). Also, there was a significant reduction in severity of pain after dressing in the experimental group compared with the control group (P < 0.05). Conclusions: Inhalation aromatherapy with damask rose could be effective for relieving the pain caused after dressing in patients with burns. Therefore, it could be suggested as a complementary therapy in burn patients for pain relief. PMID:27186201

LANDSAT digital analysis of the initial recovery of the Kokolik River tundra fire area, Alaska

NASA Technical Reports Server (NTRS)

Hall, D. K.; Ormsby, J. P.; Johnson, L.; Brown, J. (Principal Investigator)

1979-01-01

The author has identified the following significant results. Considerable regrowth of vegetation was observed between August 1977 and August 1978, both in the field and through analysis of LANDSAT near infrared digital data. The spectral reflectances in the burned areas were found to increase with the age of the burn in a one year period due to vegetation regrowth. Regrowth was particularly evident in the lightly burned portions of the burned area. Image analysis techniques using the AOIPS system permitted delineation of burn severity categories. The conditions and type of ground cover prior to the fire influenced the severity of burning, as did the direction of the winds while the burning was in progress as determined from field and LANDSAT observations. More severe burning was induced by winds blowing in the northeastern and southeastern portions of the burned area.

Low-volume and slow-burning vegetation for planting on clearings in California chaparral

Treesearch

Eamor C. Nord; Lisle R. Green

1977-01-01

Vegetation that is low-growing and either low in volume, slow burning, or both, is needed for reduction of fire hazard on fuelbreaks and other brush cleared areas in California. Of over 50 shrub species and many grass species that were test planted, about 20 shrubs and an equal number of grasses were chosen for plot and field trials. Creeping sage, a few saltbushes,...

The potential association of later initiation of oral/enteral nutrition on euthyroid sick syndrome in burn patients.

PubMed

Pérez-Guisado, Joaquín; de Haro-Padilla, Jesús M; Rioja, Luis F; Derosier, Leo C; de la Torre, Jorge I

2013-01-01

Objective. The aim of this study was to determine if early initiation of oral/enteral nutrition in burn patients minimizes the drop in fT3 levels, reduces the potential for euthyroid sick syndrome (ESS), and shortens the length of hospital stay (LHS). Subjects and Methods. We retrospectively evaluated the statistical association of serum fT3, fT4, and TSH at the first (2nd-5th day) and second sample collection (9th-12th day) after the burn injury in 152 burn patients. Three groups were established depending on time of initiation of the oral/enteral nutrition: <24 h before the injury (Group 1), 24-48 h after the injury (Group 2), and >48 h after the injury (Group 3). Results. They were expressed as mean ± standard deviation. We found that LHS and the fT3 levels were statistically different in the 3 groups. The LHS (in days) was, respectively, in each group, 16.77 ± 4.56, 21.98 ± 4.86, and 26.06 ± 5.47. Despite the quantifiable drop in fT3, ESS was present only at the first sample collection (2.61 ± 0.92 days) in Group 3, but there was no group with ESS at the second sample collection (9.89 ± 1.01 days). Our data suggest that early initiation of nutritional supplementation decreases the length of hospitalization and is associated with decreasing fT3 serum concentration depression. Conclusion. Early initiation of oral/enteral nutrition counteracts ESS and improves the LHS in burn patients.

Dual therapeutic functions of F-5 fragment in burn wounds: preventing wound progression and promoting wound healing in pigs.

PubMed

Bhatia, Ayesha; O'Brien, Kathryn; Chen, Mei; Wong, Alex; Garner, Warren; Woodley, David T; Li, Wei

2016-01-01

Burn injuries are a leading cause of morbidity including prolonged hospitalization, disfigurement, and disability. Currently there is no Food and Drug Administration-approved burn therapeutics. A clinical distinction of burn injuries from other acute wounds is the event of the so-called secondary burn wound progression within the first week of the injury, in which a burn expands horizontally and vertically from its initial boundary to a larger area. Therefore, an effective therapeutics for burns should show dual abilities to prevent the burn wound progression and thereafter promote burn wound healing. Herein we report that topically applied F-5 fragment of heat shock protein-90α is a dual functional agent to promote burn wound healing in pigs. First, F-5 prevents burn wound progression by protecting the surrounding cells from undergoing heat-induced caspase 3 activation and apoptosis with increased Akt activation. Accordingly, F-5-treated burn and excision wounds show a marked decline in inflammation. Thereafter, F-5 accelerates burn wound healing by stimulating the keratinocyte migration-led reepithelialization, leading to wound closure. This study addresses a topical agent that is capable of preventing burn wound progression and accelerating burn wound healing.

Numerical computation of Pop plot

DOE Office of Scientific and Technical Information (OSTI.GOV)

Menikoff, Ralph

The Pop plot — distance-of-run to detonation versus initial shock pressure — is a key characterization of shock initiation in a heterogeneous explosive. Reactive burn models for high explosives (HE) must reproduce the experimental Pop plot to have any chance of accurately predicting shock initiation phenomena. This report describes a methodology for automating the computation of a Pop plot for a specific explosive with a given HE model. Illustrative examples of the computation are shown for PBX 9502 with three burn models (SURF, WSD and Forest Fire) utilizing the xRage code, which is the Eulerian ASC hydrocode at LANL. Comparisonmore » of the numerical and experimental Pop plot can be the basis for a validation test or as an aid in calibrating the burn rate of an HE model. Issues with calibration are discussed.« less

40 CFR 63.6590 - What parts of my plant does this subpart cover?

Code of Federal Regulations, 2012 CFR

2012-07-01

... initial notification requirements: (i) Existing spark ignition 2 stroke lean burn (2SLB) stationary RICE... spark ignition 4 stroke lean burn (4SLB) stationary RICE with a site rating of more than 500 brake HP... spark ignition 4 stroke rich burn (4SRB) stationary RICE with a site rating of less than or equal to 500...

40 CFR 63.11211 - How do I demonstrate initial compliance with the emission limits?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Table 4 to this subpart, conducting a fuel analysis for each type of fuel burned in your boiler... evaluations according to § 63.11224. For affected boilers that burn a single type of fuel, you are exempted from the compliance requirements of conducting a fuel analysis for each type of fuel burned in your...

Effects of prescribed burning on vegetation and fuel loading in three east Texas state parks

Treesearch

Sandra Rideout; Brian P. Oswald

2002-01-01

This study was conducted to evaluate the initial effectiveness of prescribed burning in the ecological restoration of forests within selected parks in east Texas. Twenty-four permanent plots were installed to monitor fuel loads, overstory, sapling, seedling, shrub and herbaceous layers within burn and control units of Mission Tejas, Tyler and Village Creek state parks...

Model assessing the impact of biomass burning on air quality and photochemistry in Mexico City

Treesearch

W. Lei; G. Li; C. Wiedinmyer; R. J. Yokelson; L. T. Molina

2010-01-01

Biomass burning is a major global emission source for trace gases and particulates. Various multi-platform measurements during the Mexico City Metropolitan Area (MCMA)-2003 and Megacity Initiative: Local and Global Research Observations (MILAGRO)-2006 campaigns suggest significant influences of biomass burning (BB) on air quality in Mexico City during the dry season,...

40 CFR 63.11211 - How do I demonstrate initial compliance with the emission limits?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Table 4 to this subpart, conducting a fuel analysis for each type of fuel burned in your boiler... evaluations according to § 63.11224. For affected boilers that burn a single type of fuel, you are exempted from the compliance requirements of conducting a fuel analysis for each type of fuel burned in your...

A burn center paradigm to fulfill deferred consent public disclosure and community consultation requirements for emergency care research.

PubMed

Blackford, Martha G; Falletta, Lynn; Andrews, David A; Reed, Michael D

2012-09-01

To fulfill Food and Drug Administration and Department of Health and Human Services emergency care research informed consent requirements, our burn center planned and executed a deferred consent strategy gaining Institutional Review Board (IRB) approval to proceed with the clinical study. These federal regulations dictate public disclosure and community consultation unique to acute care research. Our regional burn center developed and implemented a deferred consent public notification and community consultation paradigm appropriate for a burn study. Published accounts of deferred consent strategies focus on acute care resuscitation practices. We adapted those strategies to design and conduct a comprehensive public notification/community consultation plan to satisfy deferred consent requirements for burn center research. To implement a robust media campaign we engaged the hospital's public relations department, distributed media materials, recruited hospital staff for speaking engagements, enlisted community volunteers, and developed initiatives to inform "hard-to-reach" populations. The hospital's IRB determined we fulfilled our obligation to notify the defined community. Our communication strategy should provide a paradigm other burn centers may appropriate and adapt when planning and executing a deferred consent initiative. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Combined Acupuncture and Auriculotherapy in Burning Mouth Syndrome Treatment: A Preliminary Single-Arm Clinical Trial.

PubMed

Franco, Faraína Rodrigues Vasconcelos; Castro, Luciano Alberto; Borsatto, Maria Cristina; Silveira, Erika Aparecida; Ribeiro-Rotta, Rejane Faria

2017-02-01

Burning mouth syndrome (BMS) is a chronic pain disorder that is difficult to diagnose and refractory to treatment; it is more prevalent in pre- and postmenopausal women. Acupuncture and auriculotherapy have been suggested as options for the treatment of pain because they promote analgesia and allow for the reduction of symptoms with lower doses of drugs; this leads to greater patient compliance with treatment and has a positive effect on quality of life. Clinical trials investigating the effectiveness of acupuncture in the treatment of BMS are scarce in the literature. To investigate the effect of combined acupuncture and auriculotherapy on pain management and quality of life in patients with BMS. Sixty patients with BMS were subjected to a thorough differential diagnosis. Of these, 12 met the inclusion criteria and agreed to participate. Eight patients completed treatment with acupuncture and auriculotherapy using a previously established protocol. The outcome variables were analyzed before and after treatment: pain/burning (visual analog scale; VAS), salivary flow (unstimulated sialometry), and quality of life (Short-Form Oral Health Impact Profile [OHIP-14]). Two-year follow-up was carried out by assessing VAS and OHIP-14. The intensity of pain/burning decreased significantly after the first treatment sessions, as shown by low values on the VAS (0-2) and a subjective indicator of quality of life (mean = 5.37 ± 3.50). There was no relationship between salivary flow and the intensity of pain/burning. At 2-year follow-up, no statistically significant difference was observed for VAS, but improvement on OHIP-14 was seen. Combined acupuncture/auriculotherapy was effective in reducing the intensity of burning and improving quality of life. There was no relationship between salivary flow and the intensity of burning mouth. Patients' status improved after acupuncture and auriculotherapy at 2-year follow-up.

The effects of massage and music on pain, anxiety and relaxation in burn patients: Randomized controlled clinical trial.

PubMed

Najafi Ghezeljeh, T; Mohades Ardebili, F; Rafii, F

2017-08-01

The aim of this study was to evaluate the effects of massage and music on pain intensity, anxiety intensity and relaxation level in burn patients. Pain and anxiety are common among burn patients, but there are many physical and psychological consequences. This randomized controlled clinical trial with factorial design 2×2 included 240 burn patients admitted at Shahid Motahari Burns Hospital, Tehran, Iran, between September 2013 and May 2015. The patients were allocated into the following groups: (i) control (n=60) receiving the conventional primary care, (ii) music group (n=60) receiving their favorite songs, (iii) massage group (n=60) receiving Swedish massage, and (iv) music-plus-massage group (n=60) receiving a combination of their favorite songs and Swedish massage, for 20min once a day for 3 consecutive days, using random permuted blocks of sizes 4 with a 1:1 ratio. To collect the data before and after the intervention, a specific Visual Analogue Scale (VAS) was applied for pain intensity, anxiety intensity, and relaxation level. The data were analyzed using SPSS, version 21. Our findings showed a decrease in pain and anxiety intensity and an increase in relaxation level in all three intervention groups as compared to the control group, indicating there was no significant difference among the interventions applied. Furthermore, following application of each intervention, pain and anxiety intensity decreased and relaxation level increased in the intervention groups as compared to before intervention. Our results revealed that music, massage and a combination of both interventions were effective on reducing pain and anxiety intensity and increasing relaxation level. Due to easy, low-cost and availability of the interventions applied, these complementary therapies are suggested for the burn patients. Although application of a single complementary therapy is cost-effective, further studies are required to determine the most effective and cost-effective method to improve the burn care. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Characteristics code for shock initiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Partom, Y.

1986-10-01

We developed SHIN, a characteristics code for shock initiation studies. We describe in detail the equations of state, reaction model, rate equations, and numerical difference equations that SHIN incorporates. SHIN uses the previously developed surface burning reaction model which better represents the shock initiation process in TATB, than do bulk reaction models. A large number of computed simulations prove the code is a reliable and efficient tool for shock initiation studies. A parametric study shows the effect on build-up and run distance to detonation of (1) type of boundary condtion, (2) burning velocity curve, (3) shock duration, (4) rise timemore » in ramp loading, (5) initial density (or porosity) of the explosive, (6) initial temperature, and (7) grain size. 29 refs., 65 figs.« less

Response of advance reproduction of oaks and associated species to repeated prescribed fires in upland oak-hickory forests, Missouri

Treesearch

Zhaofei Fan; Zhongqiu Ma; Daniel C. Dey; Scott D. Roberts

2012-01-01

The Chilton Creek prescribed burn project was initiated in 1996 by The Nature Conservancy (TNC) to restore native oak woodlands and test the effect of frequent, low intensity surface fires conducted in the dormant season (March-April) on upland oak-hickory forests in the Ozarks of Missouri. Burning treatments on five sites totaling 1000 ha were initiated in 1998. The...

Influence of Initial Moisture Content on Heat and Moisture Transfer in Firefighters' Protective Clothing

PubMed Central

He, Song

2017-01-01

This paper presents a model for heat and moisture transfer through firefighters' protective clothing (FPC) during radiation exposure. The model, which accounts for air gaps in the FPC as well as heat transfer through human skin, investigates the effect of different initial moisture contents on the thermal insulation performance of FPC. Temperature, water vapor density, and the volume fraction of liquid water profiles were monitored during the simulation, and the heat quantity absorbed by water evaporation was calculated. Then the maximum durations of heat before the wearer acquires first- and second-degree burns were calculated based on the bioheat transfer equation and the Henriques equation. The results show that both the moisture weight in each layer and the total moisture weight increase linearly within a given environmental humidity level. The initial moisture content in FPC samples significantly influenced the maximum water vapor density. The first- and second-degree burn injury time increase 16 sec and 18 sec when the RH increases from 0% to 90%. The total quantity of heat accounted for by water evaporation was about 10% when the relative humidity (RH) is 80%. Finally, a linear relationship was identified between initial moisture content and the human skin burn injury time before suffering first- and second-degree burn injuries. PMID:28466066

Influence of Initial Moisture Content on Heat and Moisture Transfer in Firefighters' Protective Clothing.

PubMed

Huang, Dongmei; He, Song

2017-01-01

This paper presents a model for heat and moisture transfer through firefighters' protective clothing (FPC) during radiation exposure. The model, which accounts for air gaps in the FPC as well as heat transfer through human skin, investigates the effect of different initial moisture contents on the thermal insulation performance of FPC. Temperature, water vapor density, and the volume fraction of liquid water profiles were monitored during the simulation, and the heat quantity absorbed by water evaporation was calculated. Then the maximum durations of heat before the wearer acquires first- and second-degree burns were calculated based on the bioheat transfer equation and the Henriques equation. The results show that both the moisture weight in each layer and the total moisture weight increase linearly within a given environmental humidity level. The initial moisture content in FPC samples significantly influenced the maximum water vapor density. The first- and second-degree burn injury time increase 16 sec and 18 sec when the RH increases from 0% to 90%. The total quantity of heat accounted for by water evaporation was about 10% when the relative humidity (RH) is 80%. Finally, a linear relationship was identified between initial moisture content and the human skin burn injury time before suffering first- and second-degree burn injuries.

Emissions from open burning of simulated military waste from forward operating bases.

PubMed

Aurell, Johanna; Gullett, Brian K; Yamamoto, Dirk

2012-10-16

Emissions from open burning of simulated military waste from forward operating bases (FOBs) were extensively characterized as an initial step in assessing potential inhalation exposure of FOB personnel and future disposal alternatives. Emissions from two different burning scenarios, so-called "burn piles/pits" and an air curtain burner/"burn box", were compared using simulated FOB waste from municipal and commercial sources. A comprehensive array of emissions was quantified, including CO(2), PM(2.5), volatile organic compounds (VOCs), polyaromatic hydrocarbons (PAHs), polychlorinated dibenzodioxins and -furans (PCDDs/PCDFs), polybrominated dibenzodioxins and -furans (PBDDs/PBDFs), and metals. In general, smoldering conditions in the burn box and the burn pile led to similar emissions. However, when the burn box underwent periodic waste charging to maintain sustained combustion, PM(2.5), VOCs, and PAH emissions dropped considerably compared to smoldering conditions and the overall burn pile results. The PCDD/PCDF and PBDD/PBDF emission factors for the burn piles were 50 times higher than those from the burn box likely due to the dominance of smoldering combustion in the burn piles.

Burns education for non-burn specialist clinicians in Western Australia.

PubMed

McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona

2015-03-01

Burn patients often receive their initial care by non-burn specialist clinicians, with increasingly collaborative burn models of care. The provision of relevant and accessible education for these clinicians is therefore vital for optimal patient care. A two phase design was used. A state-wide survey of multidisciplinary non-burn specialist clinicians throughout Western Australia identified learning needs related to paediatric burn care. A targeted education programme was developed and delivered live via videoconference. Pre-post-test analysis evaluated changes in knowledge as a result of attendance at each education session. Non-burn specialist clinicians identified numerous areas of burn care relevant to their practice. Statistically significant differences between perceived relevance of care and confidence in care provision were reported for aspects of acute burn care. Following attendance at the education sessions, statistically significant increases in knowledge were noted for most areas of acute burn care. Identification of learning needs facilitated the development of a targeted education programme for non-burn specialist clinicians. Increased non-burn specialist clinician knowledge following attendance at most education sessions supports the use of videoconferencing as an acceptable and effective method of delivering burns education in Western Australia. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Full-Scale Incineration System Demonstration at the Naval Battalion Construction Center, Gulfport, Mississippi. Volume 8. Delisting

DTIC Science & Technology

1991-07-01

concerning disposition of soil that is considered hazardous after treatment. The report also documents the data collected in support of soil disposition...regulatory and technical lessons learned concerning disposition of soil after treatment. The report also documents the data collected in support of soil...were undertaken to support delisting of the soil, including the Wii / verification test burn, a RCRA trial burn, and data collected during routine

Factors influencing psychological, social and health outcomes after major burn injuries in adults: cohort study protocol

PubMed Central

Newcombe, Peter A; Cameron, Cate M; Lipman, Jeffrey

2017-01-01

Introduction The goal of burn care is that ‘the quality of the outcome must be worth the pain of survival’. More research is needed to understand how best to deliver care for patients with burns to achieve this aim. Loss of independence, function as well as loss of income for patients with burns and carers cause a significant burden at both individual and societal levels. Much is being done to advance knowledge in the clinical care field; however, there has been a paucity of research exploring psychosocial outcomes. This paper describes the study background and methods, as implemented in an Australian cohort study of psychosocial outcomes after major burn injuries. Methods and analysis In this inception cohort study, a target sample of 230 participants, aged 18 years or over, admitted to a single statewide burns centre with a burn injury are identified by hospital staff for inclusion. Baseline survey data are collected either in person or by telephone within 28 days of the injury and participants then followed up with telephone interviews at 3, 6 and 12 months postburn. Injury and burns treatment information is collected from medical records. Social support is measured as a predictor variable using the Multidimensional Scale of Perceived Social Support. Outcome data are collected via standardised measures in the domains of Quality of Life (SF-12, EQ-5D, BSHS-B), depression (PHQ-9), post-traumatic stress disorder (PCL-C, PAS), community integration (CIQ-R) and Quality-Adjusted Life Years (EQ-5D). Additional survey questions measure life satisfaction, return to work and public services utilisation at 12 months postinjury. Data analysis methods will include analysis of variance, Pearson correlation and hierarchical multiple regression analyses. Ethics and dissemination Hospital-based and University of Queensland Human Research Ethics Committees have approved the protocol. Results from the study will be disseminated at national and international conferences, in peer-reviewed journals and in a doctoral thesis. Trial registration number Australia New Zealand Clinical Trials Registry (ACTRN12616000828426). Retrospectively registered on 23 June 2016; pre-results. PMID:28624761

Biomass Burning: The Cycling of Gases and Particulates from the Biosphere to the Atmosphere

NASA Astrophysics Data System (ADS)

Levine, J. S.

2003-12-01

Biomass burning is both a process of geochemical cycling of gases and particulates from the biosphere to the atmosphere and a process of global change. In the preface to the book, One Earth, One Future: Our Changing Global Environment (National Academy of Sciences, 1990), Dr. Frank Press, the President of the National Academy of Sciences, writes: "Human activities are transforming the global environment, and these global changes have many faces: ozone depletion, tropical deforestation, acid deposition, and increased atmospheric concentrations of gases that trap heat and may warm the global climate."It is interesting to note that all four global change "faces" identified by Dr. Press have a common thread - they are all caused by biomass burning.Biomass burning or vegetation burning is the burning of living and dead vegetation and includes human-initiated burning and natural lightning-induced burning. The bulk of the world's biomass burning occurs in the tropics - in the tropical forests of South America and Southeast Asia and in the savannasof Africa and South America. The majority of the biomass burning, primarily in the tropics (perhaps as much as 90%), is believed to be human initiated for land clearing and land-use change. Natural fires triggered by atmospheric lightning only accounts for ˜10% of all fires (Andreae, 1991). As will be discussed, a significant amount of biomass burning occurs in the boreal forests of Russia, Canada, and Alaska.Biomass burning is a significant source of gases and particulates to the regional and global atmosphere (Crutzen et al., 1979; Seiler and Crutzen, 1980; Crutzen and Andreae, 1990; Levine et al., 1995). Its burning is truly a multidiscipline subject, encompassing the following areas: fire ecology, fire measurements, fire modeling, fire combustion, remote sensing, fire combustion gaseous and particulate emissions, the atmospheric transport of these emissions, and the chemical and climatic impacts of these emissions. Recently, a series of dedicated books have documented much of our understanding of biomass burning in different ecosystems. These volumes include: Goldammer (1990), Levine (1991, 1996a, b), Crutzen and Goldammer (1993), Goldammer and Furyaev (1996), van Wilgen et al. (1997), Kasischke and Stocks (2000), Innes et al. (2000), and Eaton and Radojevic (2001).

Post-fire burn severity and vegetation response following eight large wildfires across the Western United States

Treesearch

Leigh B. Lentile; Penelope Morgan; Andrew T. Hudak; Michael J. Bobbitt; Sarah A. Lewis; Alistair M. S. Smith; Peter R. Robichaud

2007-01-01

Vegetation response and burn severity were examined following eight large wildfires that burned in 2003 and 2004: two wildfires in California chaparral, two each in dry and moist mixed-conifer forests in Montana, and two in boreal forests in interior Alaska. Our research objectives were: 1) to characterize one year post-fire vegetation recovery relative to initial fire...

Twenty Years of Prescribed Burning Influence the Development of Direct-Seeded Longleaf Pine on a Wet Pine Site in Louisiana

Treesearch

James D. Haywood; Harold E. Grelen

2000-01-01

Prescribed burning treatments were applied over a 20 yr period in a commonly randomized field study to determine the effects of various fire regimes on vegetation in a direct seeded standof longleaf pine (Pinus palustris Mill.). Seeding was done in November 1968. The study area was broadcast-burned about 16 months after seeding. The initial...

First results from a large, multi-platform study of trace gas and particle emissions from biomass burning

Treesearch

I. R. Burling; R. J. Yokelson; S. K. Akagi; T. J. Johnson; D. W. Griffith; Shawn Urbanski; J. W. Taylor; J. S. Craven; G. R. McMeeking; J. M. Roberts; C. Warneke; P. R. Veres; J. A. de Gouw; J. B. Gilman; W. C. Kuster; WeiMin Hao; D. Weise; H. Coe; J. Seinfeld

2010-01-01

We report preliminary results from a large, multi-component study focused on North American biomass burning that measured both initial emissions and post-emission processing. Vegetation types burned were from the relatively less-studied temperate region of the US and included chaparral, oak savanna, and mixed conifer forest from the southwestern US, and pine understory...

40 CFR 63.7510 - What are my initial compliance requirements and by what date must I conduct them?

Code of Federal Regulations, 2011 CFR

2011-07-01

... subpart, conducting a fuel analysis for each type of fuel burned in your boiler or process heater... sources that burn a single type of fuel, you are exempted from the compliance requirements of conducting a fuel analysis for each type of fuel burned in your boiler or process heater according to § 63.7521 and...

40 CFR 63.7510 - What are my initial compliance requirements and by what date must I conduct them?

Code of Federal Regulations, 2012 CFR

2012-07-01

... subpart, conducting a fuel analysis for each type of fuel burned in your boiler or process heater... sources that burn a single type of fuel, you are exempted from the compliance requirements of conducting a fuel analysis for each type of fuel burned in your boiler or process heater according to § 63.7521 and...

40 CFR 62.14815 - What are the emission limitations for air curtain incinerators that burn 100 percent wood wastes...

Code of Federal Regulations, 2011 CFR

2011-07-01

... air curtain incinerators that burn 100 percent wood wastes, clean lumber and/or yard waste? 62.14815... Before November 30, 1999 Air Curtain Incinerators That Burn 100 Percent Wood Wastes, Clean Lumber And/or... percent wood wastes, clean lumber and/or yard waste? (a) After the date the initial test for opacity is...

40 CFR 62.14815 - What are the emission limitations for air curtain incinerators that burn 100 percent wood wastes...

Code of Federal Regulations, 2010 CFR

2010-07-01

... air curtain incinerators that burn 100 percent wood wastes, clean lumber and/or yard waste? 62.14815... Before November 30, 1999 Air Curtain Incinerators That Burn 100 Percent Wood Wastes, Clean Lumber And/or... percent wood wastes, clean lumber and/or yard waste? (a) After the date the initial test for opacity is...

40 CFR 63.7530 - How do I demonstrate initial compliance with the emission limits and work practice standards?

Code of Federal Regulations, 2010 CFR

2010-07-01

...) of this section. (i) You must determine the fuel type or fuel mixture that you could burn in your... for HCl, you must determine the fraction of the total heat input for each fuel type burned (Qi) based... of each fuel type burned (Ci). (iii) You must establish a maximum chlorine input level using Equation...

Laser in the management of burn scars.

PubMed

Willows, Brooke M; Ilyas, Muneeb; Sharma, Amit

2017-11-01

Burn scars are associated with significant morbidity ranging from contractures, pruritus, and disfigurement to psychosocial impairment. Traditional therapies include silicone gel, compression garments, corticosteroid injections, massage therapy, and surgical procedures, however, newer and advanced therapies for the treatment of burn scars have been developed. Lasers, specifically ablative fractional lasers, show potential for the treatment of burn scars. Both MeSH and keyword searches of the PubMed, Medline and Embase databases were performed and relevant articles were read in full for the compilation of this review. Fifty-one relevant observational studies, clinical trials, and systematic reviews published in English from 2006 to 2016 were reviewed and summarized. Laser therapy is effective for the treatment of burn scar appearance, including measures such as pigmentation, vascularity, pliability, and thickness. Ablative fractional laser therapy, in particular, shows significant potential for the release of contractures allowing for improved range of motion of affected joints. Patients may benefit from the use of lasers in the treatment of burn scars, and the safety profile of lasers allows the benefits of treatment to outweigh the risks. Laser therapy should be included in burn scar treatment protocols as an adjuvant therapy to traditional interventions. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial.

PubMed

Cho, Yoon Soo; Jeon, Jong Hyun; Hong, Aram; Yang, Hyeong Tae; Yim, Haejun; Cho, Yong Suk; Kim, Do-Hern; Hur, Jun; Kim, Jong Hyun; Chun, Wook; Lee, Boung Chul; Seo, Cheong Hoon

2014-12-01

To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn. One hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter(®), Tewameter(®), Sebumeter(®), and Cutometer(®), respectively. The scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension. Our results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Assessment of anxiety and depression in patients with burning mouth syndrome: A clinical trial

PubMed Central

Malik, Rohit; Goel, Sumit; Misra, Deepankar; Panjwani, Sapna; Misra, Akansha

2012-01-01

Introduction: Burning mouth syndrome is a chronic pain syndrome primarily affecting elderly women with hormonal changes or psychological disorders. It is multifactorial in origin, often idiopathic and its etiopathogenesis, majorly being neuropathic, largely remains enigmatic. Aim: To determine the prevalence of burning mouth symptom, in elderly women and evaluate local and systemic causes responsible for burning sensation. Materials and Methods: 100 elderly postmenopausal women were included in the study out of which 56 had a chief complaint of burning sensation. These patients were evaluated for the levels of anxiety and depression by means of questionnaire. The severity of burning and the response to the treatment was assessed with a five point Visual Analog Scale. The results were analyzed using “Chi-square test”. Results: There was statistically significant increase in the levels of anxiety and depression in the study group. Conclusion: The present study clearly indicates that most of the patients had moderate to severe levels of depression, which suggests that anxiety and depression are constant features in postmenopausal female patients. PMID:22923978

Internal and Surface Phenomena in Heterogenous Metal Combustion

NASA Technical Reports Server (NTRS)

Dreizin, Edward L.

1997-01-01

The phenomenon of gas dissolution in burning metals was observed in recent metal combustion studies, but it could not be adequately explained by the traditional metal combustion models. The research reported here addresses heterogeneous metal combustion with emphasis on the processes of oxygen penetration inside burning metal and its influence on the metal combustion rate, temperature history, and disruptive burning. The unique feature of this work is the combination of the microgravity environment with a novel micro-arc generator of monodispersed metal droplets, ensuring repeatable formation and ignition of uniform metal droplets with a controllable initial temperature and velocity. Burning droplet temperature is measured in real time with a three wavelength pyrometer. In addition, particles are rapidly quenched at different combustion times, cross-sectioned, and examined using SEM-based techniques to retrieve the internal composition history of burning metal particles. When the initial velocity of a spherical particle is nearly zero, the microgravity environment makes it possible to study the flame structure, the development of flame nonsymmetry, and correlation of the flame shape with the heterogeneous combustion processes.

Dual therapeutic functions of F-5 fragment in burn wounds: preventing wound progression and promoting wound healing in pigs

PubMed Central

Bhatia, Ayesha; O’Brien, Kathryn; Chen, Mei; Wong, Alex; Garner, Warren; Woodley, David T.; Li, Wei

2016-01-01

Burn injuries are a leading cause of morbidity including prolonged hospitalization, disfigurement, and disability. Currently there is no Food and Drug Administration-approved burn therapeutics. A clinical distinction of burn injuries from other acute wounds is the event of the so-called secondary burn wound progression within the first week of the injury, in which a burn expands horizontally and vertically from its initial boundary to a larger area. Therefore, an effective therapeutics for burns should show dual abilities to prevent the burn wound progression and thereafter promote burn wound healing. Herein we report that topically applied F-5 fragment of heat shock protein-90α is a dual functional agent to promote burn wound healing in pigs. First, F-5 prevents burn wound progression by protecting the surrounding cells from undergoing heat-induced caspase 3 activation and apoptosis with increased Akt activation. Accordingly, F-5–treated burn and excision wounds show a marked decline in inflammation. Thereafter, F-5 accelerates burn wound healing by stimulating the keratinocyte migration-led reepithelialization, leading to wound closure. This study addresses a topical agent that is capable of preventing burn wound progression and accelerating burn wound healing. PMID:27382602

An Overview of the use of Bromelain-Based Enzymatic Debridement (Nexobrid®) in Deep Partial & Full Thickness Burns: Appraising the Evidence.

PubMed

Loo, Yew L; Goh, Benjamin K L; Jeffery, S

2018-03-22

Recent introduction of rapid bromelain-based enzymatic debridement has been increasingly popular in its use in non-surgical debridement in deep partial and full thickness burns. We designed this study to evaluate the evidence suggested by current studies on the perceived benefits of using Nexobrid® as compared to traditional surgical standard of care (SOC) in burns wound debridement. A comprehensive search on electronic databases Pubmed, Embase and Web of Science was done to identify studies published between 1986 to 2017 involving the use of Nexobrid in deep partial and full thickness burns. Studies were evaluated for proposed benefits and categorised under supporting evidence, contradicting evidence and anecdotal opinions. 7 well designed prospective studies met the inclusion comprising of 4 randomised controlled trials. 6 proposed benefits associated with the use of Nexobrid were extracted including reduced time to complete debridement, need for surgery, area of burns excised, need for autograft, time to wound closure and improved scar quality. Most proposed benefits have strong supporting evidences with minimal anecdotal opinions from controlled trials except the proposed improvement in scar quality and reduced time to wound healing that had at least 3 refuting evidence and 1 anecdotal evidence. Incidence of pain was also evaluated and were mainly anecdotal lacking formal objective assessment or cohort study. Despite the lack of literatures available, the benefits of Nexobrid is evident in published randomised and single arm studies. Large number of studies are needed to aid further evaluating the proposed benefits of Nexobrid.

Albumin in Burn Shock Resuscitation: A Meta-Analysis of Controlled Clinical Studies.

PubMed

Navickis, Roberta J; Greenhalgh, David G; Wilkes, Mahlon M

2016-01-01

Critical appraisal of outcomes after burn shock resuscitation with albumin has previously been restricted to small relatively old randomized trials, some with high risk of bias. Extensive recent data from nonrandomized studies assessing the use of albumin can potentially reduce bias and add precision. The objective of this meta-analysis was to determine the effect of burn shock resuscitation with albumin on mortality and morbidity in adult patients. Randomized and nonrandomized controlled clinical studies evaluating mortality and morbidity in adult patients receiving albumin for burn shock resuscitation were identified by multiple methods, including computer database searches and examination of journal contents and reference lists. Extracted data were quantitatively combined by random-effects meta-analysis. Four randomized and four nonrandomized studies with 688 total adult patients were included. Treatment effects did not differ significantly between the included randomized and nonrandomized studies. Albumin infusion during the first 24 hours showed no significant overall effect on mortality. However, significant statistical heterogeneity was present, which could be abolished by excluding two studies at high risk of bias. After those exclusions, albumin infusion was associated with reduced mortality. The pooled odds ratio was 0.34 with a 95% confidence interval of 0.19 to 0.58 (P < .001). Albumin administration was also accompanied by decreased occurrence of compartment syndrome (pooled odds ratio, 0.19; 95% confidence interval, 0.07-0.50; P < .001). This meta-analysis suggests that albumin can improve outcomes of burn shock resuscitation. However, the scope and quality of current evidence are limited, and additional trials are needed.

The Incidence of Burns Among Sex-Trafficking Victims in India

PubMed Central

Rahman, Nadia; Sinha, Indranil; Husain, Fatima; Shah, Ajul; Patel, Anup

2014-01-01

Sex trafficking remains a flagrant violation of human rights, creating many public health concerns. During the initiation period, these victims experience acts of violence including gang rapes, subjecting them to traumatic injuries that include burns. Furthermore, lack of access to health care, particularly surgical, keeps them from receiving treatment for these functionally debilitating contractures caused by burns. This piece provides an overview of burns among sex-trafficked victims in India and the efforts by Cents of Relief to address the associated surgical burden of disease. PMID:25191142

A trajectory modeling investigation of the biomass burning-tropical ozone relationship

NASA Technical Reports Server (NTRS)

Pickering, Kenneth E.; Thompson, Anne M.; Mcnamara, Donna P.; Schoeberl, Mark R.; Lait, Leslie R.; Newman, Paul A.; Justice, Christopher O.; Kendall, Jacqueline D.

1994-01-01

The hypothesis that tropical total O3 maxima seen by the TOMS satellite derive from African biomass burning has been tested using isentropic trajectory analyses with global meteorological data fields. Two case studies from the 1989 biomass burning season demonstrate that a large fraction of the air arriving at the location of TOMS O3 maxima passed over regions of intense burning. Other trajectories initiated at a series of points over Africa and the Atlantic suggest flight strategies for field studies to be conducted in September 1992.

A Minimum (Delta)V Orbit Maintenance Strategy for Low-Altitude Missions Using Burn Parameter Optimization

NASA Technical Reports Server (NTRS)

Brown, Aaron J.

2011-01-01

Orbit maintenance is the series of burns performed during a mission to ensure the orbit satisfies mission constraints. Low-altitude missions often require non-trivial orbit maintenance (Delta)V due to sizable orbital perturbations and minimum altitude thresholds. A strategy is presented for minimizing this (Delta)V using impulsive burn parameter optimization. An initial estimate for the burn parameters is generated by considering a feasible solution to the orbit maintenance problem. An example demonstrates the dV savings from the feasible solution to the optimal solution.

AmeriFlux US-An2 Anaktuvuk River Moderate Burn

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hobbie, John; Rocha, Adrian; Shaver, Gaius

This is the AmeriFlux version of the carbon flux data for the site US-An2 Anaktuvuk River Moderate Burn. Site Description - The Anaktuvuk River fire on the North Slope of Alaska started on July 16, 2007 by lightning. It continued until the end of September when nearby lakes had already frozen over and burned >256,000 acres, creating a mosaic of patches that differed in burn severity. The Anaktuvuk River Severe Burn, Moderate Burn, and Unburned sites are 40 km to the west of the nearest road and were selected in late May 2008 to determine the effects of the firemore » on carbon, water, and energy exchanges during the growing season. Because the fire had burned through September of the previous year, initial deployment of flux towers occurred prior to any significant vegetative regrowth, and our sampling campaign captured the full growing season in 2008. The Moderate Burn site consisted of a large area with small patches of completely and partially burned tundra intermixed across the landscape.« less

Critical issues in burn care.

PubMed

Holmes, James H

2008-01-01

Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in collaboration with other organizations. The American Burn Association has recommended that patients with serious burns be referred to a designated burn center, ie, a hospital outfitted with specialized personnel and equipment dedicated to burn care. Burn centers have been operational for over 50 years, but the complexity and costs of providing specialized burn care have given rise to a number of critical administrative and political issues. These include logistical limitations imposed by the uneven national distribution of burn centers and a potential shortage of burn beds, both during everyday conditions and in the event of a mass disaster. Burn surgeon shortages have also been identified, stemming, in part, from a lack of specialized burn care training opportunities. There is currently a lack of quality outcome data to support evidence-based recommendations for burn care, and burn care centers are compromised by problems obtaining reimbursement for the care of uninsured and publicly insured out-of-state burn patients. Initiatives are underway to maintain efficient burn care facilities that are fully funded, easily accessible, and most importantly, provide optimal, evidence-based care on a daily basis, and are well-equipped to handle a surge of patients during a disaster situation.

Comparison of Iontophoretic Lidocaine to EMLA Cream for Pain Reduction Prior to Intravenous Cannulation in Adults

DTIC Science & Technology

2000-10-01

Arvidsson, S.B., Ekroth, R.H., Hansby, M.C., Lindholm, A.H., & William- Olsson, G. (1984). Painless venipuncture. A clinical trial of iontophoresis of...T.J., & Hennes, H.M. (1999). A randomized clinical trial of dermal anesthesia by iontophoresis for peripheral intravenous catheter placement in...Health and Human Services. Brown, B.W.Jr. (1980). The crossover experiment for clinical trials . Biometrics, 36, 69-79. Burns, N., & Grove, S.K. (1997). The

Comparison of Iontophoretic Lidocaine to EMLA Cream for Pain Reduction Prior to Intravenous Fannulation in Adults

DTIC Science & Technology

2000-10-01

Medicine, 62, 989-993. Arvidsson, S.B., Ekroth, R.H., Hansby, M.C., Lindholm, A.H., & William- Olsson, G. (1984). Painless venipuncture. A clinical trial of...N.M., Troshynski, T.J., & Hennes, H.M. (1999). A randomized clinical trial of dermal anesthesia by iontophoresis for peripheral intravenous catheter...Department of Health and Human Services. Brown, B.W.Jr. (1980). The crossover experiment for clinical trials . Biometrics, 36, 69-79. Burns, N

A Randomized Controlled Trial Comparing Endoscopic-Assisted Versus Open Neck Tissue Expander Placement in Reconstruction of Post-Burn Facial Scar Deformities.

PubMed

As'adi, Kamran; Emami, Seyed Abolhassan; Salehi, Seyed Hamid; Shoar, Saeed

2016-08-01

Tissue expansion has evolved reconstruction surgery by providing a great source of additional tissue for large skin defects. Nevertheless, wide application of tissue expander reconstruction is challenging due to high complication rates and uncertainty about final outcomes. Recently, endoscopy has shown promise in reconstructive surgeries using tissue expander placement. This study aimed to compare outcomes between open and endoscopic-assisted neck tissue expander placement in reconstruction of post-burn facial scar deformities. Through a randomized clinical trial, 63 patients with facial burn scars were assigned to an open group or endoscopic group for placement of 81 tissue expanders. The complication rate, operative time, length of hospital stay, and time to full expansion were compared between the two groups. Thirty-one patients were assigned to the open group and 32 patients to the endoscopic group. The average operative time was significantly reduced in the endoscopic group compared with the open group (42.2 ± 3.6, 56.5 ± 4.5 min, p < 0.05). The complication rate was significantly lower in the endoscopic group than the open group (6 vs. 16, p < 0.05). Hospital stay was also significantly diminished from 26.3 ± 7.7 h in open group to 7.4 ± 4.5 h in endoscopic group (p < 0.0001). There was a significant reduction in time to full expansion in the endoscopic group as compared with the open group (93.5 ± 10.2 vs. 112.1 ± 14.2 days, p = 0.002). Endoscopic neck tissue expander placement significantly reduced operative time, the postoperative complication rate, length of hospital stay, and time to achieve full expansion and allowed early initiation of expansion and remote placement of the port in relation to the expander pocket. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Large-Scale Aerosol Modeling and Analysis

DTIC Science & Technology

2010-09-30

Application of Earth Sciences Products” supports improvements in NAAPS physics and model initialization. The implementation of NAAPS, NAVDAS-AOD, FLAMBE ...Forecasting of Biomass-Burning Smoke: Description of and Lessons From the Fire Locating and Modeling of Burning Emissions ( FLAMBE ) Program, IEEE Journal of

Role of burning season on initial understory vegetation response to prescribed fire in a mixed conifer forest

Treesearch

Eric E. Knapp; Dylan W. Schwilk; Jeffrey M. Kane; Jon E. Keeley

2007-01-01

Although the majority of fires in the western United States historically occurred during the late summer or early fall when fuels were dry and plants were dormant or nearly so, early-season prescribed burns are often ignited when fuels are still moist and plants are actively growing. The purpose of this study was to determine if burn season influences postfire...

40 CFR 63.7510 - What are my initial compliance requirements and by what date must I conduct them?

Code of Federal Regulations, 2010 CFR

2010-07-01

... for each type of fuel burned in your boiler or process heater according to § 63.7521 and Table 6 to... conducting CMS performance evaluations according to § 63.7525. For affected sources that burn a single type... each type of fuel burned in your boiler or process heater according to § 63.7521 and Table 6 to this...

40 CFR 63.7510 - What are my initial compliance requirements and by what date must I conduct them?

Code of Federal Regulations, 2011 CFR

2011-07-01

... for each type of fuel burned in your boiler or process heater according to § 63.7521 and Table 6 to... conducting CMS performance evaluations according to § 63.7525. For affected sources that burn a single type... each type of fuel burned in your boiler or process heater according to § 63.7521 and Table 6 to this...

40 CFR 63.7510 - What are my initial compliance requirements and by what date must I conduct them?

Code of Federal Regulations, 2012 CFR

2012-07-01

... for each type of fuel burned in your boiler or process heater according to § 63.7521 and Table 6 to... conducting CMS performance evaluations according to § 63.7525. For affected sources that burn a single type... each type of fuel burned in your boiler or process heater according to § 63.7521 and Table 6 to this...

Endothelial necrosis at 1h post-burn predicts progression of tissue injury

PubMed Central

Hirth, Douglas; McClain, Steve A.; Singer, Adam J.; Clark, Richard A.F.

2013-01-01

Burn injury progression has not been well characterized at the cellular level. To define burn injury progression in terms of cell death, histopathologic spatiotemporal relationships of cellular necrosis and apoptosis were investigated in a validated porcine model of vertical burn injury progression. Cell necrosis was identified by High Mobility Group Box 1 protein and apoptosis by Caspase 3a staining of tissue samples taken 1h, 24h and 7 days post-burn. Level of endothelial cell necrosis at 1h was predictive of level of apoptosis at 24h (Pearson's r=0.87) and of level of tissue necrosis at 7 days (Pearson's r=0.87). Furthermore, endothelial cell necrosis was deeper than interstitial cell necrosis at 1h (p<0.001). Endothelial cell necrosis at 1h divided the zone of injury progression (Jackson's zone of stasis) into an upper subzone with necrotic endothelial cells and initially viable adnexal and interstitial cells at 1h that progressed to necrosis by 24h, and a lower zone with initially viable endothelial cells at 1h, but necrosis and apoptosis of all cell types by 24h. Importantly, this spatiotemporal series of events and rapid progression resembles myocardial infarction and stroke, and implicates mechanisms of these injuries, ischemia, ischemia reperfusion, and programmed cell death, in burn progression. PMID:23627744

Topical silver sulfadiazine vs collagenase ointment for the treatment of partial thickness burns in children: a prospective randomized trial.

PubMed

Ostlie, Daniel J; Juang, David; Aguayo, Pablo; Pettiford-Cunningham, Janine P; Erkmann, Erin A; Rash, Diane E; Sharp, Susan W; Sharp, Ronald J; St Peter, Shawn D

2012-06-01

The 2 most commonly used topical agents for partial thickness burns are silver sulfadiazine (SSD) and collagenase ointment (CO). Silver sulfadiazine holds antibacterial properties, and eschar separation occurs naturally. Collagenase ointment is an enzyme that cleaves denatured collagen facilitating separation but has no antibacterial properties. Currently, there are no prospective comparative data in children for these 2 agents. Therefore, we conducted a prospective randomized trial. After institutional review board approval, patients were randomized to daily debridement with SSD or CO. Primary outcome was the need for skin grafting. Patients were treated for 2 days with SSD with subsequent randomization. Polymyxin was mixed with CO for antibacterial coverage. Debridements were performed daily for 10 days or until the burn healed. Grafting was performed after 10 days if not healed. From January 2008 to January 2011, 100 patients were enrolled, with no differences in patient characteristics. There were no differences in clinical course, outcome, or need for skin grafting. Wound infections occurred in 7 patients treated with CO and 1 patient treated with SSD (P = .06). Collagenase ointment was more expensive than SSD (P < .001). However, total hospital charges did not differ. There are no differences in outcomes between topical SSD or CO in the management of childhood burns results. Copyright © 2012 Elsevier Inc. All rights reserved.

Efficacy of low level laser therapy in the treatment of burning mouth syndrome: A systematic review.

PubMed

Al-Maweri, Sadeq Ali; Javed, Fawad; Kalakonda, Butchibabu; AlAizari, Nader A; Al-Soneidar, Walid; Al-Akwa, Ameen

2017-03-01

Burning mouth syndrome (BMS) is a chronic pain condition with indefinite cure, predominantly affecting post-menopausal women. The aim of this study was to systematically review the efficacy of low level laser therapy in the treatment of burning mouth syndrome (BMS). PubMed, Embase and Scopus were searched from date of inception till and including October 2016 using various combinations of the following keywords: burning mouth syndrome, BMS, stomatodynia, laser therapy, laser treatment and phototherapy. The inclusion criteria were: Prospective, retrospective and case series studies. Letter to editors, reviews, experimental studies, studies that were not published in English, theses, monographs, and abstracts presented in scientific events were excluded. Due to heterogeneity of data no statistical analyses were performed. Ten clinical studies fulfilled the eligibility criteria, five of which were randomized clinical trials. In these studies, the laser wavelengths, power output and duration of irradiation ranged between 630-980nm, 20-300mW, 10s-15min, respectively. Most of studies reported laser to be an effective therapy strategy for management of BMS. Majority of the studies showed that laser therapy seemed to be effective in reducing pain in BMS patients. However, due to the varied methodologies and substantial variations in laser parameters among these studies, more clinical trials are required to ascertain the efficacy of laser for treating BMS. Copyright © 2016 Elsevier B.V. All rights reserved.

Use of Human Cadaveric Mesenchymal Stem Cells for Cell Therapy of a Chronic Radiation-Induced Skin Lesion: A Case Report.

PubMed

Portas, M; Mansilla, E; Drago, H; Dubner, D; Radl, A; Coppola, A; Di Giorgio, M

2016-09-01

Acute and late radiation-induced injury on skin and subcutaneous tissues are associated with substantial morbidity in radiation therapy, interventional procedures and also are of concern in the context of nuclear or radiological accidents. Pathogenesis is initiated by depletion of acutely responding epithelial tissues and damage to vascular endothelial microvessels. Efforts for medical management of severe radiation-induced lesions have been made. Nevertheless, the development of strategies to promote wound healing, including stem cell therapy, is required. From 1997 to 2014, over 248 patients were referred to the Radiopathology Committee of Hospital de Quemados del Gobierno de la Ciudad de Buenos Aires (Burns Hospital) for the diagnosis and therapy of radiation-induced localized lesions. As part of the strategies for the management of severe cases, there is an ongoing research and development protocol on 'Translational Clinical Trial phases I/II to evaluate the safety and efficacy of adult mesenchymal stem cells from bone marrow for the treatment of large burns and radiological lesions'. The object of this work was to describe the actions carried out by the Radiopathology Committee of the Burns Hospital in a chronic case with more than 30 years of evolution without positive response to conventional treatments. The approach involved the evaluation of the tissular compromise of the lesion, the prognosis and the personalized treatment, including regenerative therapy. © World Health Organisation 2016. All rights reserved. The World Health Organization has granted Oxford University Press permission for the reproduction of this article.

The dubious effect of milnacipran for the treatment of burning mouth syndrome.

PubMed

Sugimoto, Koreaki

2011-01-01

Burning mouth syndrome (BMS) is a condition accompanied by oral burning symptoms, including glossal pain (glossodynia) without a detectable cause. Although BMS is a chronic-pain syndrome, only one self-controlled pilot study and some case reports have reported that milnacipran is effective for the treatment of chronic pain, including that caused by BMS. However, these papers assessed only pain, and the dosage of prescribed milnacipran varied from 30 to 150 mg/d in each patient. In this study, the dosage of prescribed milnacipran was set at 60 mg/d for 12 weeks for all patients, and depression and quality of life (QOL) were assessed in addition to pain. Twelve patients with glossodynia participated in this study. Milnacipran was initiated at a dosage of 15 mg/d and then raised gradually to 60 mg/d after 4 weeks of treatment; this dose was continued until the end of the study (total of 12 weeks). The evaluation included the Hamilton Rating Scale for Depression, the Visual Analog Scale score for pain evaluation, the General Oral Health Assessment Index for oral-related QOL evaluation, and the Medical Outcomes Study's 36-Item Short-Form Health Survey (SF-36) for whole QOL evaluation. The Hamilton Rating Scale for Depression score decreased significantly after treatment with a 60-mg/d dosage of milnacipran for 12 weeks. However, the Visual Analog Scale pain, General Oral Health Assessment Index, and SF-36 scores did not change. A randomized, double-blind, placebo-controlled multi-institution trial of milnacipran will be essential to determine its effectiveness for the treatment of BMS.

A Burning Rate Emulator (BRE) for Study in Microgravity

NASA Technical Reports Server (NTRS)

Markan, A.; Sunderland, P. B.; Quintiere, J. G.; DeRis, J.; Stocker, D. P.

2015-01-01

A gas-fueled burner, the Burning Rate Emulator (BRE), is used to emulate condensed-phase fuel flames. The design has been validated to easily measure the burning behavior of condensed-phase fuels by igniting a controlled stream of gas fuel and diluent. Four properties, including the heat of combustion, the heat of gasification, the surface temperature, and the laminar smoke point, are assumed to be sufficient to define the steady burning rate of a condensed-phase fuel. The heat of gasification of the fuel is determined by measuring the heat flux and the fuel flow rate. Microgravity BRE tests in the NASA 5.2 s drop facility have examined the burning of pure methane and ethylene (pure and 50 in N2 balance). Fuel flow rates, chamber oxygen concentration and initial pressure have been varied. Two burner sizes, 25 and 50 mm respectively, are chosen to examine the nature of initial microgravity burning. The tests reveal bubble-like flames that increase within the 5.2s drop but the heat flux received from the flame appears to asymptotically approach steady state. Portions of the methane flames appear to locally detach and extinguish at center, while its shape remains fixed, but growing. The effective heat of gasification is computed from the final measured net heat flux and the fuel flow rate under the assumption of an achieved steady burning. Heat flux (or mass flux) and flame position are compared with stagnant layer burning theory. The analysis offers the prospect of more complete findings from future longer duration ISS experiments.

Building a balanced scorecard for a burn center.

PubMed

Wachtel, T L; Hartford, C E; Hughes, J A

1999-08-01

The Balanced Scorecard provides a model that can be adapted to the management of any burn center, burn service or burn program. This model enables an organization to translate its mission and vision into specific strategic objectives across the four perspective: (1) the financial perspective; (2) the customer service perspective; (3) the internal business perspective; and (4) the growth and learning perspective. Once the appropriate objectives are identified, the Balanced Scorecard guides the organization to develop reasonable performance measures and establishes targets, initiatives and alternatives to meet programmatic goals and pursue longer-term visionary improvements. We used the burn center at the University of Colorado Health Sciences Center to test whether the Balanced Scorecard methodology was appropriate for the core business plan of a healthcare strategic business unit (i.e. a burn center).

Detection of Circulating Mucorales DNA in Critically Ill Burn Patients: Preliminary Report of a Screening Strategy for Early Diagnosis and Treatment.

PubMed

Legrand, Matthieu; Gits-Muselli, Maud; Boutin, Louis; Garcia-Hermoso, Dea; Maurel, Véronique; Soussi, Sabri; Benyamina, Mourad; Ferry, Axelle; Chaussard, Maïté; Hamane, Samia; Denis, Blandine; Touratier, Sophie; Guigue, Nicolas; Fréalle, Emilie; Jeanne, Mathieu; Shaal, Jean-Vivien; Soler, Charles; Mimoun, Maurice; Chaouat, Marc; Lafaurie, Matthieu; Mebazaa, Alexandre; Bretagne, Stéphane; Alanio, Alexandre

2016-11-15

 Invasive wound mucormycosis (IWM) is associated with an extremely poor outcome among critically ill burn patients. We describe the detection of circulating Mucorales DNA (cmDNA) for the early diagnosis of IWM in those patients and report the potential value of detecting cmDNA for treatment guidance.  Severely ill burn patients admitted to our tertiary referral center between October 2013 and February 2016 were included. Retrospective plasma samples were tested for the presence of cmDNA by quantitative real-time polymerase chain reaction (qPCR). Patients were then prospectively screened twice a week, and liposomal amphotericin-B therapy initiated based on a positive qPCR. The primary endpoint was the time between cmDNA detection and standard diagnosis. Secondary endpoints were the time from cmDNA detection and treatment initiation and mortality.  Seventy-seven patients (418 samples) were included. The average age was 46 (28-60) years, abbreviated burn severity index was 8 (7-10), and simplified acute physiology score was 33 (23-46). The total body surface area was 33% (22%-52%). cmDNA was detected 11 (4.5-15) days before standard diagnosis. The in-hospital mortality was 62% for patients with IWM and 24% for those without (P = .03). The mortality due to IWM was 80% during period A and 33% during period B (P = .46).  This study suggests that the detection of cmDNA allows earlier diagnosis of IWM in severely ill burn patients and earlier initiation of treatment. Further studies are needed to confirm the impact of earlier treatment initiation on patient outcome. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

49 CFR 173.50 - Class 1-Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... insensitive that there is very little probability of initiation or of transition from burning to detonation under normal conditions of transport. 1 The probability of transition from burning to detonation is... contain only extremely insensitive detonating substances and which demonstrate a negligible probability of...

EMISSIONS FROM BURNING CABINET MAKING SCRAPS

EPA Science Inventory

The report gives results of an initial determination of differences in missions when burning ordinary cordwood compared to kitchen cabinet making scraps. he tests were performed in an instrumented woodstove testing laboratory on a stove that simulated units observed in use at a k...

Nanofibrillar cellulose wound dressing in skin graft donor site treatment.

PubMed

Hakkarainen, T; Koivuniemi, R; Kosonen, M; Escobedo-Lucea, C; Sanz-Garcia, A; Vuola, J; Valtonen, J; Tammela, P; Mäkitie, A; Luukko, K; Yliperttula, M; Kavola, H

2016-12-28

Although new therapeutic approaches for burn treatment have made progress, there is still need for better methods to enhance wound healing and recovery especially in severely burned patients. Nanofibrillar cellulose (NFC) has gained attention due to its renewable nature, good biocompatibility and excellent physical properties that are of importance for a range of applications in pharmaceutical and biomedical fields. In the present study, we investigated the potential of a wood based NFC wound dressing in a clinical trial on burn patients. Previously, we have investigated NFC as a topical functionalized wound dressing that contributes to improve wound healing in mice. Wood based NFC wound dressing was tested in split-thickness skin graft donor site treatment for nine burn patients in clinical trials at Helsinki Burn Centre. NFC dressing was applied to split thickness skin graft donor sites. The dressing gradually dehydrated and attached to donor site during the first days. During the clinical trials, physical and mechanical properties of NFC wound dressing were optimized by changing its composition. From patient 5 forward, NFC dressing was compared to commercial lactocapromer dressing, Suprathel® (PMI Polymedics, Germany). Epithelialization of the NFC dressing-covered donor site was faster in comparison to Suprathel®. Healthy epithelialized skin was revealed under the detached NFC dressing. NFC dressing self-detached after 11-21days for patients 1-9, while Suprathel® self-detached after 16-28days for patients 5-9. In comparison studies with patients 5-9, NFC dressing self-detached on average 4days earlier compared with Suprathel®. Lower NFC content in the material was evaluated to influence the enhanced pliability of the dressing and attachment to the wound bed. No allergic reaction or inflammatory response to NFC was observed. NFC dressing did not cause more pain for patients than the traditional methods to treat the skin graft donor sites. Based on the preliminary clinical data, NFC dressing seems to be promising for skin graft donor site treatment since it is biocompatible, attaches easily to wound bed, and remains in place until donor site has renewed. It also detaches from the epithelialized skin by itself. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Randomized Controlled Trial to Determine the Efficacy of Long-Term Growth Hormone Treatment in Severely Burned Children

PubMed Central

Branski, Ludwik K.; Herndon, David N.; Barrow, Robert E.; Kulp, Gabriela A.; Klein, Gordon L.; Suman, Oscar E.; Przkora, Rene; Meyer, Walter; Huang, Ted; Lee, Jong O.; Chinkes, David L.; Mlcak, Ronald P.; Jeschke, Marc G.

2014-01-01

Background Recovery from a massive burn is characterized by catabolic and hypermetabolic responses that persist up to 2 years and impair rehabilitation and reintegration. The objective of this study was to determine the effects of long-term treatment with recombinant human growth hormone (rhGH) on growth, hypermetabolism, body composition, bone metabolism, cardiac work, and scarring in a large prospective randomized single-center controlled clinical trial in pediatric patients with massive burns. Patients and Methods A total of 205 pediatric patients with massive burns over 40% total body surface area were prospectively enrolled between 1998 and 2007 (clinicaltrials.gov ID NCT00675714). Patients were randomized to receive either placebo (n = 94) or long-term rhGH at 0.05, 0.1, or 0.2 mg/kg/d (n = 101). Changes in weight, body composition, bone metabolism, cardiac output, resting energy expenditure, hormones, and scar development were measured at patient discharge and at 6, 9, 12, 18, and 24 months postburn. Statistical analysis used Tukey t test or ANOVA followed by Bonferroni correction. Significance was accepted at P < 0.05. Results RhGH administration markedly improved growth and lean body mass, whereas hypermetabolism was significantly attenuated. Serum growth hormone, insulin-like growth factor-I, and IGFBP-3 was significantly increased, whereas percent body fat content significantly decreased when compared with placebo, P < 0.05. A subset analysis revealed most lean body mass gain in the 0.2 mg/kg group, P < 0.05. Bone mineral content showed an unexpected decrease in the 0.2 mg/kg group, along with a decrease in PTH and increase in osteocalcin levels, P < 0.05. Resting energy expenditure improved with rhGH administration, most markedly in the 0.1 mg/kg/d rhGH group, P < 0.05. Cardiac output was decreased at 12 and 18 months postburn in the rhGH group. Long-term administration of 0.1 and 0.2 mg/kg/d rhGH significantly improved scarring at 12 months postburn, P < 0.05. Conclusion This large prospective clinical trial showed that long-term treatment with rhGH effectively enhances recovery of severely burned pediatric patients. PMID:19734776

Community integration after burn injuries.

PubMed

Esselman, P C; Ptacek, J T; Kowalske, K; Cromes, G F; deLateur, B J; Engrav, L H

2001-01-01

Evaluation of community integration is a meaningful outcome criterion after major burn injury. The Community Integration Questionnaire (CIQ) was administered to 463 individuals with major burn injuries. The CIQ results in Total, Home Integration, Social Integration, and Productivity scores. The purposes of this study were to determine change in CIQ scores over time and what burn injury and demographic factors predict CIQ scores. The CIQ scores did not change significantly from 6 to 12 to 24 months postburn injury. Home integration scores were best predicted by sex and living situation; Social Integration scores by marital status; and Productivity scores by functional outcome, burn severity, age, and preburn work factors. The data demonstrate that individuals with burn injuries have significant difficulties with community integration due to burn and nonburn related factors. CIQ scores did not improve over time but improvement may have occurred before the initial 6-month postburn injury follow-up in this study.

The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis.

PubMed

Anzarut, Alexander; Olson, Jarret; Singh, Prabhjyot; Rowe, Brian H; Tredget, Edward E

2009-01-01

This study had three objectives. First, to conduct a systematic review to identify the available evidence for the use of pressure garment therapy (PGT); second, to assess the quality of the available evidence; and third, to conduct a meta-analysis to quantify the effectiveness of PGT for the prevention of abnormal scarring after burn injury. Standard care for the prevention of abnormal scarring after burn injury includes pressure garment therapy (PGT); however, it is associated with potential patient morbidity and high costs. We hypothesise that an assessment of the available evidence supporting the use of pressure garment therapy will aid in directing clinical care and future research. Randomised control trials were identified from CINHAL, EMBASE, MEDLINE, CENTRAL, the 'grey literature' and hand searching of the Proceedings of the American Burn Association. Primary authors and pressure garment manufacturers were contacted to identify eligible trials. Bibliographies from included studies and reviews were searched. Study results were pooled to yield weighted mean differences or standardised mean difference and reported using 95% confidence intervals. The review incorporated six unique trials involving 316 patients. Original data from one unpublished trial were included. Overall, studies were considered to be of high methodological quality. The meta-analysis was unable to demonstrate a difference between global assessments of PGT-treated scars and control scars [weighted mean differences (WMD): -0.46; 95% confidence interval (CI): -1.07 to 0.16]. The meta-analysis for scar height showed a small, but statistically significant, decrease in height for the PGT-treated group standardised mean differences (SMD): -0.31; 95% CI: -0.63, 0.00. Results of meta-analyses of secondary outcome measures of scar vascularity, pliability and colour failed to demonstrate a difference between groups. PGT does not appear to alter global scar scores. It does appear to improve scar height, although this difference is small and of questionable clinical importance. The beneficial effects of PGT remain unproven, while the potential morbidity and cost are not insignificant. Given current evidence, additional research is required to examine the effectiveness, risks and costs of PGT.

The Impact of Media Reporting on the Emergence of Charcoal Burning Suicide in Taiwan

PubMed Central

Chen, Ying-Yeh; Chen, Feng; Gunnell, David; Yip, Paul S. F.

2013-01-01

We investigated the association of the intensity of newspaper reporting of charcoal burning suicide with the incidence of such deaths in Taiwan during 1998–2002. A counting process approach was used to estimate the incidence of suicides and intensity of news reporting. Conditional Poisson generalized linear autoregressive models were performed to assess the association of the intensity of newspaper reporting of charcoal burning and non-charcoal burning suicides with the actual number of charcoal burning and non-charcoal burning suicides the following day. We found that increases in the reporting of charcoal burning suicide were associated with increases in the incidence of charcoal burning suicide on the following day, with each reported charcoal burning news item being associated with a 16% increase in next day charcoal burning suicide (p<.0001). However, the reporting of other methods of suicide was not related to their incidence. We conclude that extensive media reporting of charcoal burning suicides appears to have contributed to the rapid rise in the incidence of the novel method in Taiwan during the initial stage of the suicide epidemic. Regulating media reporting of novel suicide methods may prevent an epidemic spread of such new methods. PMID:23383027

Human herpes viruses in burn patients: A systematic review.

PubMed

Wurzer, Paul; Guillory, Ashley; Parvizi, Daryousch; Clayton, Robert P; Branski, Ludwik K; Kamolz, Lars-P; Finnerty, Celeste C; Herndon, David N; Lee, Jong O

2017-02-01

The contribution of human herpes viruses, including herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV) to morbidity and mortality after burns remains controversial. This systematic review was undertaken to assess evidence of herpes virus-related morbidity and mortality in burns. PubMed, Ovid, and Web of Science were searched to identify studies of HSV, CMV, or VZV infections in burn patients. Exclusion criteria included: A level of evidence (LoE) of IV or V; nonhuman in vivo studies; and non-English articles. There was no limitation by publication date. Fifty articles were subjected to full-text analysis. Of these, 18 had LoE between I-III and were included in the final review (2 LoE I, 16 LoE II-III). Eight had a prospective study design, 9 had a retrospective study design, and 1 included both. No direct evidence linked CMV and HSV infection with increased morbidity and mortality in burns. Following burn, CMV reactivation was more common than a primary CMV infection. Active HSV infection impaired wound healing but was not directly correlated to mortality. Infections with VZV are rare after burns but when they occur, VZV infections were associated with severe complications including mortality. The therapeutic effect of antiviral agents administered after burns warrants investigation via prospective randomized controlled trials. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

[Major Burn Trauma Management and Nursing Care].

PubMed

Lo, Shu-Fen

2015-08-01

Major burn injury is one of the most serious and often life-threatening forms of trauma. Burn patients not only suffer from the physical, psychological, social and spiritual impacts of their injury but also experience considerable changes in health-related quality of life. This paper presents a review of the literature on the implications of previous research and clinical care guidelines related to major burn injuries in order to help clinical practice nurses use evidence-based care guidelines to respond to initial injury assessments, better manage the complex systemic response to these injuries, and provide specialist wound care, emotional support, and rehabilitation services.

Emissions from open burning of used agricultural pesticide containers.

PubMed

Gullett, Brian K; Tabor, Dennis; Touati, Abderrahmane; Kasai, Jeanne; Fitz, Nancy

2012-06-30

Emissions from simulated open burning of used agricultural pesticide containers were sampled for polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDDs/PCDFs), polycyclic aromatic hydrocarbon compounds (PAHs), and particle matter (PM(10) and PM(2.5)). Clean high density polyethylene (HDPE) containers, containers with trace pesticide, and triple-rinsed containers were burned separately in an open combustion facility and their emissions compared. Two common chlorinated pesticides were used: 2,4-dichlorophenoxyacetic acid (2,4-D) and 1-chloro-3-ethylamino-5-isopropylamino-2,4,6-triazine (atrazine). PCDD/PCDF emission factors ranged from 0.1 to 24ng toxic equivalents (TEQ)/kg C burned with a mean and median of 4.9 and 1.9ng TEQ/kgC burned, respectively. In a limited number of trials, the trace 2,4-D in the HDPE container led to a statistically significant increase in PCDD/PCDF formation compare to all other conditions. Residual atrazine did not lead to more PCDD/PCDF than the unrinsed 2,4-D container. Total (16 compounds) PAH emission factors varied from 1.5 to 6.7mg/kgC burned. These limited data suggest that rinsing the 2,4-D container prior to burning reduces both PCDD/PCDF and PAH emissions. Nine PM(2.5) emission factors ranged from 9 to 35mg/gC burned and ten PM(10) values ranged from 6 to 43mg/gC burned. Neither pesticide appeared to have any effect on PM concentration. Published by Elsevier B.V.

The treatment effect of the burn wound healing by electrolytic-reduction ion water lotion combination therapy. Part 2: Two degree burn of forearm to the dorsum of the hand.

PubMed

Shu, Tetsuo; Okajima, Masahiro; Wada, Yuko; Shimokawa, Ken-ichi; Ishii, Fumiyoshi

2010-10-01

Patient 1: A 1-year-and-3-month-old boy suffered a burn injury extending from the left forearm to hand due to boiling water. An extensive skin defect from the left forearm to the dorsum of the hand was observed, and an IIb-III degree burn was diagnosed. Treatment of the burn was started with the application of electrolytic-reduction ion water (ERI) lotion, antibiotic/steroid combination ointment, and vitamin A/E ointment with wrap therapy. Two days after the initiation of therapy, redness and swelling were still observed despite a slight decrease in swelling. After 21 days, skin redness decreased, and there was no functional impairment. After 74 days, the skin color was almost normal, and no functional impairment was observed, showing a favorable course. Patient 2: An 8.5-month-old girl suffered a burn injury extending from the fingers to dorsum of the right hand and right wrist due to boiling water. There was an extensive skin defect accompanied by bulla formation extending from the fingers and dorsum of the right hand. An II-degree burn was diagnosed. Treatment of the burn was started treatment similar to the Patient 1. Bulla decreased, but redness and swelling were still present 2-8 days after the initiation of therapy. After 16-25 days, both skin redness and swelling decreased. After 30 days, the epithelialization of the dorsum of the hand had almost completed. After 60 days, the skin color was nearly normal, and there was no functional impairment, showing a favorable course. In these patients, burn wounds completely healed without hypertrophic or keloid scar formation or pigmentation. These results suggest that extensive II-III burns can be adequately treated by this topical therapy.

Sugarcane cultural practices to increase profits

USDA-ARS?s Scientific Manuscript database

Multiple experiments were initiated in an effort to reduce costs, increase ratooning, and maximize profits. A new method of mechanical removal using a modified rake produced yields similarly to burning, with both yielding an additional 1000 lbs/A than full retention. Where burning was not an option,...

Preliminary Assessment Of The Burning Dynamics Of Jp8 Droplets In Microgravity

NASA Technical Reports Server (NTRS)

Bae, J. H.; Avedisian, C. T.

2003-01-01

In this report we present new data for fuel droplet combustion in microgravity to examine the influence of ambient gas and fuel composition on flame structure and sooting dynamics for droplets with initial diameters in the range of 0.4mm to 0.5mm. The fuels are JP8 (a kerosene derivative) and nonane. The ambient gas is air and a mixture of 30% oxygen and 70% helium, the latter having been examined for burning under conditions where soot formation is minimal. Some data at elevated pressures are also reported. The burning process shows a nonlinear D2 progression which is independent of soot formation as burning in a helium inert showed the same nonlinear trend. Flames were proportionally farther from the droplet surface in helium than they were in air. A nondimensional parameter is presented that consolidates the three standoff distances for the droplet, flame and soot shell diameters within the initial diameter ranges examined.

Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis.

PubMed

Nímia, Heloisa Helena; Carvalho, Viviane Fernandes; Isaac, Cesar; Souza, Francisley Ávila; Gemperli, Rolf; Paggiaro, André Oliveira

2018-06-11

The aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed, ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified 873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p<0.0001; MD 3.83; 95% CI 2.03-5.62) and dressings without silver (p<0.007; MD 2.9; 95% CI 0.81-5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p>0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p<0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings with and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

Comparing the effects of aromatherapy massage and inhalation aromatherapy on anxiety and pain in burn patients: A single-blind randomized clinical trial.

PubMed

Seyyed-Rasooli, Alehe; Salehi, Feridoon; Mohammadpoorasl, Asghar; Goljaryan, Sakineh; Seyyedi, Zahra; Thomson, Brian

2016-12-01

Anxiety and pain are recognized as major problems of burn patients; because pharmaceutical treatments for controlling anxiety and pain symptoms lead to complications and an increase in health costs, nonpharmacological nursing interventions were considered for this group of patients. This led to the present study aimed at comparing the effect of aromatherapy massage with inhalation aromatherapy for anxiety and pain in burn patients. This single-blind clinical trial was carried out on 90 patients with burns <20%. Patients were randomly assigned to one of three groups, namely aromatherapy massage, inhalation aromatherapy, and control group. The patients assigned to the aromatherapy massage group received a massage for half an hour using a blend of lavender and almond oils, while a blend of rose and lavender aroma was used for the inhalation aromatherapy group. Spielberger State Anxiety Inventory was used for measuring anxiety and the visual analog scale (VAS) scale was used for measuring pain. The results showed that three groups were equal in terms of demographics, disease characteristics, and scores of anxiety and pain at the baseline. The mean decreases of anxiety scores were -0.04±5.08, 6.33±12.55, and 6.43±10.60 in the control group, aromatherapy massage group, and inhalation group, respectively (p=0.007). The mean decrease of pain scores were -0.10±0.96, 1.70±1.84, and 0.97±1.56 in the control group, aromatherapy massage group, and inhalation group, respectively (p<0.001). The study results showed the positive effect of aromatherapy massage and inhalation aromatherapy compared with the control group in reducing both anxiety and pain of burn patients. Therefore, both interventions, which are inexpensive, and noninvasive nursing tasks can be proposed for alleviating anxiety and pain of burn patients. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Quality-Controlled Small-Scale Production of a Well-Defined Bacteriophage Cocktail for Use in Human Clinical Trials

PubMed Central

Merabishvili, Maya; Pirnay, Jean-Paul; Verbeken, Gilbert; Chanishvili, Nina; Tediashvili, Marina; Lashkhi, Nino; Glonti, Thea; Krylov, Victor; Mast, Jan; Van Parys, Luc; Lavigne, Rob; Volckaert, Guido; Mattheus, Wesley; Verween, Gunther; De Corte, Peter; Rose, Thomas; Jennes, Serge; Zizi, Martin; De Vos, Daniel; Vaneechoutte, Mario

2009-01-01

We describe the small-scale, laboratory-based, production and quality control of a cocktail, consisting of exclusively lytic bacteriophages, designed for the treatment of Pseudomonas aeruginosa and Staphylococcus aureus infections in burn wound patients. Based on succesive selection rounds three bacteriophages were retained from an initial pool of 82 P. aeruginosa and 8 S. aureus bacteriophages, specific for prevalent P. aeruginosa and S. aureus strains in the Burn Centre of the Queen Astrid Military Hospital in Brussels, Belgium. This cocktail, consisting of P. aeruginosa phages 14/1 (Myoviridae) and PNM (Podoviridae) and S. aureus phage ISP (Myoviridae) was produced and purified of endotoxin. Quality control included Stability (shelf life), determination of pyrogenicity, sterility and cytotoxicity, confirmation of the absence of temperate bacteriophages and transmission electron microscopy-based confirmation of the presence of the expected virion morphologic particles as well as of their specific interaction with the target bacteria. Bacteriophage genome and proteome analysis confirmed the lytic nature of the bacteriophages, the absence of toxin-coding genes and showed that the selected phages 14/1, PNM and ISP are close relatives of respectively F8, φKMV and phage G1. The bacteriophage cocktail is currently being evaluated in a pilot clinical study cleared by a leading Medical Ethical Committee. PMID:19300511

Cost study of dermal substitutes and topical negative pressure in the surgical treatment of burns.

PubMed

Hop, M Jenda; Bloemen, Monica C T; van Baar, Margriet E; Nieuwenhuis, Marianne K; van Zuijlen, Paul P M; Polinder, Suzanne; Middelkoop, Esther

2014-05-01

A recently performed randomised controlled trial investigated the clinical effectiveness of dermal substitutes (DS) and split skin grafts (SSG) in combination with topical negative pressure (TNP) in the surgical treatment of burn wounds. In the current study, medical and non-medical costs were investigated, to comprehensively assess the benefits of this new treatment. The primary outcome was mean total costs of the four treatment strategies: SSG with or without DS, and with or without TNP. Costs were studied from a societal perspective. Findings were evaluated in light of the clinical effects on scar elasticity. Eighty-six patients were included. Twelve months post-operatively, highest elasticity was measured in scars treated with DS and TNP (p=0.027). The initial cost price of treatment with DS and TNP was €2912 compared to treatment with SSG alone €1703 (p<0.001). However, mean total costs per patient did not differ significantly between groups (range €29097-€43774). Costs of the interventional treatment contributed maximal 7% to the total costs and total costs varied widely within and between groups, but were not significantly different. Therefore, in the selection of the most optimal type of surgical intervention, cost considerations should not play an important role. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes: study protocol for a randomised controlled trial.

PubMed

Small, Charlotte; Stone, Robert; Pilsbury, Jane; Bowden, Michael; Bion, Julian

2015-08-05

The pain of a severe burn injury is often characterised by intense background pain, coupled with severe exacerbations associated with essential procedures such as dressing changes. The experience of pain is affected by patients' psychological state and can be enhanced by the anxiety, fear and distress caused by environmental and visual inputs. Virtual Reality (VR) distraction has been used with success in areas such as burns, paediatrics and oncology. The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli. Functional magnetic resonance imaging (fMRI) studies undertaken during VR distraction from experimental pain have demonstrated enhancement of the descending cortical pain-control system. The present study will evaluate the feasibility of introducing a novel VR system to the Burns Unit at the Queen Elizabeth Hospital Birmingham for dressing changes: virtual restorative environment therapy (VRET). The study will also explore the system's impact on pain during and after the dressing changes compared to conventional analgesia for ward-based burn dressing changes. A within-subject crossover design will be used to compare the following three conditions: 1. Interactive VRET plus conventional analgesics. 2. Passive VRET with conventional analgesics. 3. Conventional analgesics alone. Using the Monte Carlo method, and on the basis of previous local audit data, a sample size of 25 will detect a clinically significant 33 % reduction in worst pain scores experienced during dressing changes. The study accrual rate is currently slower than predicted by previous audits of admission data. A review of the screening log has found that recruitment has been limited by the nature of burn care, the ability of burn inpatients to provide informed consent and the ability of patients to use the VR equipment. Prior to the introduction of novel interactive technologies for patient use, the characteristics and capabilities of the target population needs to be evaluated, to ensure that the interface devices and simulations are usable. Current Controlled Trials ISRCTN23330756 . Date of Registration 25 February 2014.

Disaster planning: the basics of creating a burn mass casualty disaster plan for a burn center.

PubMed

Kearns, Randy D; Conlon, Kathe M; Valenta, Andrea L; Lord, Graydon C; Cairns, Charles B; Holmes, James H; Johnson, Daryhl D; Matherly, Annette F; Sawyer, Dalton; Skarote, Mary Beth; Siler, Sean M; Helminiak, Radm Clare; Cairns, Bruce A

2014-01-01

In 2005, the American Burn Association published burn disaster guidelines. This work recognized that local and state assets are the most important resources in the initial 24- to 48-hour management of a burn disaster. Historical experiences suggest there is ample opportunity to improve local and state preparedness for a major burn disaster. This review will focus on the basics of developing a burn surge disaster plan for a mass casualty event. In the event of a disaster, burn centers must recognize their place in the context of local and state disaster plan activation. Planning for a burn center takes on three forms; institutional/intrafacility, interfacility/intrastate, and interstate/regional. Priorities for a burn disaster plan include: coordination, communication, triage, plan activation (trigger point), surge, and regional capacity. Capacity and capability of the plan should be modeled and exercised to determine limitations and identify breaking points. When there is more than one burn center in a given state or jurisdiction, close coordination and communication between the burn centers are essential for a successful response. Burn surge mass casualty planning at the facility and specialty planning levels, including a state burn surge disaster plan, must have interface points with governmental plans. Local, state, and federal governmental agencies have key roles and responsibilities in a burn mass casualty disaster. This work will include a framework and critical concepts any burn disaster planning effort should consider when developing future plans.

Role of burning season on initial understory vegetation response to prescribed fire in a mixed conifer forest

USGS Publications Warehouse

Knapp, E.E.; Schwilk, D.W.; Kane, J.M.; Keeley, J.E.

2007-01-01

Although the majority of fires in the western United States historically occurred during the late summer or early fall when fuels were dry and plants were dormant or nearly so, early-season prescribed burns are often ignited when fuels are still moist and plants are actively growing. The purpose of this study was to determine if burn season influences postfire vegetation recovery. Replicated early-season burn, late-season burn, and unburned control units were established in a mixed conifer forest, and understory vegetation was evaluated before and after treatment. Vegetation generally recovered rapidly after prescribed burning. However, late-season burns resulted in a temporary but significant drop in cover and a decline in species richness at the 1 m 2 scale in the following year. For two of the several taxa that were negatively affected by burning, the reduction in frequency was greater after late-season than early-season burns. Early-season burns may have moderated the effect of fire by consuming less fuel and lessening the amount of soil heating. Our results suggest that, when burned under high fuel loading conditions, many plant species respond more strongly to differences in fire intensity and severity than to timing of the burn relative to stage of plant growth. ?? 2007 NRC.

[Enteral nutrition in burn patients].

PubMed

Pereira, J L; Garrido, M; Gómez-Cía, T; Serrera, J L; Franco, A; Pumar, A; Relimpio, F; Astorga, R; García-Luna, P P

1992-01-01

Nutritional support plays an important role in the treatment of patients with burns. Due to the severe hypercatabolism that develops in these patients, oral support is insufficient in most cases, and this makes it essential to initiate artificial nutritional support (either enteral or parenteral). Enteral nutrition is more physiological than parenteral, and data exist which show that in patients with burns, enteral nutrition exercises a protective effect on the intestine and may even reduce the hypermetabolic response in these patients. The purpose of the study was to evaluate the effectiveness and tolerance of enteral nutritional support with a hypercaloric, hyperproteic diet with a high content of branched amino acids in the nutritional support of patients suffering from burns. The study included 12 patients (8 males and 4 females), admitted to the Burns Unit. Average age was 35 +/- 17 years (range: 21-85 years). The percentage of body surface affected by the burns was 10% in two cases, between 10-30% in three cases, between 30-50% in five cases and over 50% in two cases. Initiation of the enteral nutrition was between twenty-four hours and seven days after the burn. The patients were kept in the unit until they were discharged, and the average time spent in the unit was 31.5 days (range: 17-63 days). Total energetic requirements were calculated based on Harris-Benedict, with a variable aggression factor depending on the body surface burned, which varied from 2,000 and 4,000 cal day. Nitrogenous balance was determined on a daily basis, and plasmatic levels of total proteins, albumin and prealbumin on a weekly basis. There was a significant difference between the prealbumin values at the initiation and finalization of the enteral nutrition (9.6 +/- 2.24 mg/dl compared with 19.75 +/- 5.48 mg/dl; p < 0.001). The nitrogenous balance improved, changing from -5.4 in the second week to positive values by the fourth and fifth weeks of treatment. Tolerance to the enteral diet was very good, and only mild complications such as diarrhoea developed in two patients. Enteral nutrition is a suitable nutritional support method for patients with burns, which maintains the nitrogenous balance positive and improves the visceral protein parameters in these patients at an early stage, with very few complications.

Food, forest wastes = low Btu fuel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goss, J.R.

1978-01-01

Development of an experimental gasifier at the Univ. of California at Davis is reviewed. The unit produces 6 to 8 million Btu/h by converting mulled walnut shells into a combustible gas. Experience gained in the project can be applied to other gasification projects. Three additional tests are planned for the pilot plant using densified rice hulls to supply heat for rice drying; using screened, densified gin trash to supply heat for a cotton gin; and using sawmill residues, primarily bark, to replace the natural gas fuel used in a dry kiln. After completion of these trials, further trials may includemore » burning cereal straw to power a diesel-electric generator for an irrigation project; burning timber harvesting residues to run a small municipal power plant; and supplying energy to operate a fuel cell pilot plant.« less

The effects of epidermal debridement of partial-thickness burns on infection and reepithelialization in swine.

PubMed

Singer, A J; Thode, H C; McClain, S A

2000-02-01

Early postburn debridement of burn blisters is controversial. This study was conducted to compare rates of infection and reepithelialization in debrided vs nondebrided second-degree burns in swine. This was a prospective, blinded, controlled, experimental trial using isoflurane-anesthetized swine. Standardized partial-thickness burns were inflicted by applying an aluminum bar preheated to 80 degrees C to the backs and flanks of two young pigs for 20 seconds. In half of the burns the necrotic epidermis was manually debrided. All burns were randomly treated with octylcyanoacrylate spray (OCA) or dry gauze (C). Full-thickness biopsies were taken at 7, 10, and 14 days for blinded histopathologic evaluation. The primary outcomes were the proportions of infected burns at days 7 and 10 and the proportion of completely reepithelialized burns at day 14. Burns were considered infected in the presence of intradermal neutrophils containing bacteria (intraobserver agreement, K = 1.00). A secondary outcome was the proportion of burns with the presence of scar tissue (abnormal collagen under polarized light; intraobserver correlation, K = 0.93). Chi-square tests were used for group comparisons. This study had 90% power to detect a 40-percentage-point difference in infection rates (alpha = 0.05). A total of 126 biopsies from 42 burns were available for review. Infection rates were higher in the debrided burns both at day 7 (55% vs 4.5%, p < 0.001) and at day 10 (65% vs 9%, p < 0.001) after injury. The proportion of nondebrided burns that were completely reepithelialized was higher at days 10 (68% vs 0%, p < 0.001) and 14 (100% vs 65%, p = 0.003). The presence of scar tissue was more common in debrided burns (75% vs 4.5%, p < 0.001). Burns treated with OCA had fewer infections than controls (4% vs 55%, p < 0.001). Fewer OCA-treated debrided burns were reepithelialized at 14 days than those that were not debrided (30% vs 100%, p = 0.001). Under the current study conditions, early postburn epidermal debridement of second-degree burns resulted in more infections and slower reepithelialization rates in swine. The effects of early postburn epidermal debridement in humans should be explored.

Shindand Airbase: Use of Open-Air Burn Pit Violated Department of Defense Requirements

DTIC Science & Technology

2014-07-01

discontinue the use of the burn pit as soon 7 A refractory liner is made from a cement -like...initial combustion), asbestos, mercury, foam tent material, or any item containing any of the above items. The instruction allows for a small

Human Mars Mission Performance Crew Taxi Profile. Part 1

NASA Technical Reports Server (NTRS)

Duaro, Vince A.

1999-01-01

This timeline was generated on the Integrated Mission Program (IMP). All burn events over 2 seconds are finite with IMP solving a two point boundary value setup for begin burn time, burn time and control angles. Perigee and apogee shown above are mean orbital values. Significant events are listed. Each finite thrust event has two lines. The first is the beginning time showing the initial conditions, thrust and ISP used. The second has the end burn conditions and the delta v and time of burn. This case is an abort from the 750 x 750 phasing abort, using the taxi's main engines. An abort using the Reaction Control System (RCS) was also investigated but required a large increase in RCS propellant and was abandoned.

Effect of gabapentin on morphine consumption and pain after surgical debridement of burn wounds: a double-blind randomized clinical trial study.

PubMed

Rimaz, Siamak; Alavi, Cyrus Emir; Sedighinejad, Abbas; Tolouie, Mohammad; Kavoosi, Sharareh; Koochakinejad, Leila

2012-01-01

Burn pain is recognized as being maximal during therapeutic procedures, and wound debridement can be more painful than the burn injury itself. Uncontrolled acute burn pain increases the stress response and the incidence of chronic pain and associated depression. Although opiates are excellent analgesics, they do not effectively prevent central sensitization to pain. The anticonvulsant gabapentin has been proven effective for treating neuropathic pain in large placebo-controlled clinical trials. Experimental and clinical studies have demonstrated antihyperalgesic effects in models with central neuronal sensitization. It has been suggested that central neuronal sensitization may play an important role in postoperative pain. The aim of this study was to investigate the effect of gabapentin on morphine consumption and postoperative pain in burn patients undergoing resection of burn wounds. In a randomized, double-blind, placebo-controlled study, 50 burn patients received a single oral dose of gabapentin (1200mg) or placebo 2h before surgery. Anesthesia was induced with propofol and fentanyl and maintained by infusingpropofol, remifentanil, and 50% N2O in O2. All patients received patient-controlled analgesia with morphine at doses of 2.5 mg bolus and a lock-out time of 10 min for 24h before the operation. Pain was assessed on a visual analog scale (VAS) at rest and during movement at 1,4,8,12,16,20, and 24 h before the operation. Heart rate, oxygen saturation, mean arterial blood pressure, respiratory rate, sedation score, and morphine consumption were studied. All the enrolled patients were able to complete the study; therefore, data from 50 patients wereanalyzed. The VAS scores at rest andduring movement at 1,4,8,12,16,20, and 24 h after the operation were significantly lower in the gabapentin group than in the placebo group (P < 0.05). Morphine consumption was significantly lessr in the gabapentin group than in the placebo group (P < 0.05). Sedation scores were similar in the 2 groups at all measured times. There were no differences in adverse effects between the groups. A single oral dose of 1200mg gabapentin resulted in a substantial reduction in postoperative morphine consumption and pain scores after surgical debridement in burn patients.

Combination of Landsat and Sentinel-2 MSI data for initial assessing of burn severity

NASA Astrophysics Data System (ADS)

Quintano, C.; Fernández-Manso, A.; Fernández-Manso, O.

2018-02-01

Nowadays Earth observation satellites, in particular Landsat, provide a valuable help to forest managers in post-fire operations; being the base of post-fire damage maps that enable to analyze fire impacts and to develop vegetation recovery plans. Sentinel-2A MultiSpectral Instrument (MSI) records data in similar spectral wavelengths that Landsat 8 Operational Land Imager (OLI), and has higher spatial and temporal resolutions. This work compares two types of satellite-based maps for evaluating fire damage in a large wildfire (around 8000 ha) located in Sierra de Gata (central-western Spain) on 6-11 August 2015. 1) burn severity maps based exclusively on Landsat data; specifically, on differenced Normalized Burn Ratio (dNBR) and on its relative versions (Relative dNBR, RdNBR, and Relativized Burn Ratio, RBR) and 2) burn severity maps based on the same indexes but combining pre-fire data from Landsat 8 OLI with post-fire data from Sentinel-2A MSI data. Combination of both Landsat and Sentinel-2 data might reduce the time elapsed since forest fire to the availability of an initial fire damage map. Interpretation of ortho-photograph Pléiades 1 B data (1:10,000) provided us the ground reference data to measure the accuracy of both burn severity maps. Results showed that Landsat based burn severity maps presented an adequate assessment of the damage grade (κ statistic = 0.80) and its spatial distribution in wildfire emergency response. Further using both Landsat and Sentinel-2 MSI data the accuracy of burn severity maps, though slightly lower (κ statistic = 0.70) showed an adequate level for be used by forest managers.

Analysis of Electrocardiograms Associated with Pediatric Electrical Burns.

PubMed

McLeod, Jennifer S; Maringo, Alison E; Doyle, Patrick J; Vitale, Lisa; Klein, Justin D; Shanti, Christina M

2017-05-26

The purpose of this study was to examine the utility of electrocardiograms (EKGs) for low-risk, low-voltage pediatric electrical burn victims. A retrospective chart review was conducted on 86 pediatric patients who presented to the children's hospital between 2000 and 2015 after sustaining electrical burns. Variables included source and estimated voltage, extent of injuries, length of stay, high risk factors, and EKG results. High risk factors included estimated voltage > 1000 V, lightning, tetany, symptoms, loss of consciousness, or seizures. Statistical analyses were conducted. Average age was 5 years. Of those who sustained burns, 84.5% (n = 71/84) had second-degree burns ≤ 1% TBSA or less. Eleven patients had high risk factors, 12.9% (n = 11/85) and most had length of stay < 3 days (91.8%; n = 78/85). Majority sustained burns from low-voltage (< 300 V) household electrical outlets, cords, or light bulb sockets (90.4%; n = 75/83). Among patients with available EKGs, 12 had arrhythmias on initial EKG (i.e., low right atrial rhythm, t-wave inversions, sinus tachycardia, bundle branch block; 20.7%; n = 12/58). All were transient and nonfatal. The data suggest that low estimated voltage (< 300 V) electrical injuries were associated with negative EKGs; however, due to the low rate of arrhythmias, a Fisher's exact test did not show significance, P = 0.09 (P > 0.05). Preliminary data suggest that most pediatric electrical burns are due to low voltage (< 300 V) household sources. Few have high risk factors or arrhythmias that were transient and nonfatal. These data suggest that low-risk, asymptomatic, low-voltage pediatric electrical burns may not require an initial screening EKG.

Epidemiology and outcome of burns at the Saud Al Babtain Burns, Plastic Surgery and Reconstructive Center, Kuwait: our experience over five years (from 2006 to 2010)

PubMed Central

Khashaba, H.A.; Al-Fadhli, A.N.; Al-Tarrah, K.S.; Wilson, Y.T.; Moiemen, N.

2012-01-01

Summary Aim To determine the epidemiology and clinical presentation, and any contributing factors responsible for burns and outcome of care in Kuwait over the 5-yr period January 2006 to December 2010. Patients and methods. The study reviewed 1702 burn patients admitted over the study period to the Saud Al Babtain Burns, Plastic and Reconstructive Surgery Center, Kuwait. Patient characteristics, including age, sex, type of burn, nationality, total body surface area (TBSA) burn, hospital stay in days, and mortality were recorded. Results. Seventy-one per cent of the 1702 burn patients admitted were males; 540 were children. The majority of patients (64%) had less than 15% TBSA burns and only 14% had more than 50% TBSA burns. Flame burns were the most common cause of burn injuries (60%), followed by scalds (29%). Scalds were most common in children. The mortality rate was 5.75%. Flame burn was the leading cause of mortality. Lethal dose 50 (% TBSA at which a certain group has a 50% chance of survival) for adults (16-40 yr) and for the elderly (>65 yr) was 76.5% and 41.8% TBSA respectively. Conclusion. Burn injury is an important public health concern and is associated with high morbidity and mortality. Flame and scald burns are commonly a result of domestic and occupational accidents and they are preventable. Effective initial resuscitation, infection control, and adequate surgical treatment improve outcomes. PMID:23766750

The Effects of Music Intervention on Background Pain and Anxiety in Burn Patients: Randomized Controlled Clinical Trial.

PubMed

Najafi Ghezeljeh, Tahereh; Mohades Ardebili, Fatimah; Rafii, Forough; Haghani, Hamid

2016-01-01

This study aimed to investigate the effect of music on the background pain, anxiety, and relaxation levels in burn patients. In this pretest-posttest randomized controlled clinical trial, 100 hospitalized burn patients were selected through convenience sampling. Subjects randomly assigned to music and control groups. Data related to demographic and clinical characteristics, analgesics, and physiologic measures were collected by researcher-made tools. Visual analog scale was used to determine pain, anxiety, and relaxation levels before and after the intervention in 3 consecutive days. Patients' preferred music was offered once a day for 3 days. The control group only received routine care. Data were analyzed using SPSS-PC (V. 20.0). According to paired t-test, there were significant differences between mean scores of pain (P < .001), anxiety (P < .001), and relaxation (P < .001) levels before and after intervention in music group. Independent t-test indicated a significant difference between the mean scores of changes in pain, anxiety, and relaxation levels before and after intervention in music and control groups (P < .001). No differences were detected in the mean scores of physiologic measures between groups before and after music intervention. Music is an inexpensive, appropriate, and safe intervention for applying to burn patients with background pain and anxiety at rest. To produce more effective comfort for patients, it is necessary to compare different types and time lengths of music intervention to find the best approach.

Aerostat-based sampling of emissions from open burning and open detonation of military ordnance.

PubMed

Aurell, Johanna; Gullett, Brian K; Tabor, Dennis; Williams, Ryan K; Mitchell, William; Kemme, Michael R

2015-03-02

Emissions from open detonation (OD), open burning (OB), and static firing (SF) of obsolete military munitions were collected using an aerostat-lofted sampling instrument maneuvered into the plumes with remotely controlled tether winches. PM2.5, PM10, metals, volatile organic compounds (VOCs), energetics, and polyaromatic hydrocarbons (PAHs) were characterized from 121 trials of three different munitions (Composition B (hereafter, "Comp B"), V453, V548), 152 trials of five different propellants (M31A1E1, M26, SPCF, Arc 451, 452A), and 12 trials with static firing of ammonium perchlorate-containing Sparrow rocket motors. Sampling was conducted with operational charge sizes and under open area conditions to determine emission levels representative of actual disposal practices. The successful application of the tethered aerostat and sampling instruments demonstrated the ability to sample for and determine the first ever emission factors for static firing of rocket motors and buried and metal-cased OD, as well as the first measurements of PM2.5 for OB and for surface OD. Published by Elsevier B.V.

Forest ecology and management

Treesearch

William D. Boyer; James H. Miller

1994-01-01

Over a period of 16 years, unburned longleaf pine (Pinus palustris Mill.) pole stands grew an average of 27% more volume than similar stands regularly burned. Treatments included biennial burns in winter, spring, and summer plus an unburned check, each of which was combined with three supplemental treatments, namely, initial herbicide injection of...

Protocol of a randomized controlled trial of sun protection interventions for operating engineers

PubMed Central

2013-01-01

Background Skin cancer are increasing and some types of skin cancer are among the most lethal cancers yet are easily preventable. However, sun protection interventions are rarely implemented among outdoor workers. Our prior work shows that Michigan Operating Engineers (heavy equipment operators) spend an average of 4–5 hours in the sun, about one-third reported getting sun burned at least once a summer, and over half burned more than once a summer. About three-quarters of the sample never or only sometimes used sun block. Methods/design Using the Health Belief Model as a guide, this randomized controlled trial (RCT) will test the efficacy of four sun protection interventions targeting Operating Engineers: a) education only; b) education and mailed sunscreen; c) education and text message reminders; and, d) education, mailed sunscreen, and text message reminders. Participations in the study will be offered during regularly scheduled safety trainings at the Local 324 Training Center. Pre- and post-intervention surveys will be collected to determine changes in sunscreen use and sun burning, the primary dependent variables. The analyses will include: a) paired t-tests to determine changes over time (from pre-intervention to post–intervention) in outcome variables (sunscreen use and burning) separately in the 4 intervention groups, b) Repeated Measures Analysis of Variance (RM-ANOVA) to compare the changes in outcomes across the 4 groups, and c) t-tests on change scores as follow-ups to the RM-ANOVA to determine exactly which groups differ from each other. Discussion Based on the outcome of this study, we will develop a RO1 for wider scale testing and dissemination in conjunction with the International Training Center which services North America (including the US, Mexico, and Canada). Wide scale dissemination of an efficacious sun protection intervention has the potential to substantially impact skin cancer rates among this population. The ultimate goal is for high reach, high efficacy, and low cost. Trial registration NCT01804595 PMID:23530608

The risk of burn injury during long-term oxygen therapy: a 17-year longitudinal national study in Sweden

PubMed Central

Tanash, Hanan A; Huss, Fredrik; Ekström, Magnus

2015-01-01

Background Long-term oxygen therapy (LTOT) improves the survival time in hypoxemic chronic obstructive pulmonary disease. Despite warnings about potential dangers, a considerable number of patients continue to smoke while on LTOT. The incidence of burn injuries related to LTOT is unknown. The aim of this study was to estimate the rate of burn injury requiring health care contact during LTOT. Methods Prospective, population-based, consecutive cohort study of people starting LTOT from any cause between January 1, 1992 and December 31, 2009 in the Swedish National Register of Respiratory Failure (Swedevox). Results In total, 12,497 patients (53% women) were included. The mean (standard deviation) age was 72±9 years. The main reasons for starting LTOT were chronic obstructive pulmonary disease (75%) and pulmonary fibrosis (15%). Only 269 (2%) were active smokers when LTOT was initiated. The median follow-up time to event was 1.5 years (interquartile range, 0.55–3.1). In total, 17 patients had a diagnosed burn injury during 27,890 person-years of LTOT. The rate of burn injury was 61 (95% confidence interval, 36–98) per 100,000 person-years. There was no statistically significant difference in the rate of burn injury between ever-smokers and never-smokers, or between men and women. Conclusion The rate of burn injuries in patients on LTOT seems to be low in Sweden. The strict requirements in Sweden for smoking cessation before LTOT initiation may contribute to this finding. PMID:26622175

OH-initiated Aging of Biomass Burning Aerosol during FIREX

NASA Astrophysics Data System (ADS)

Lim, C. Y.; Hagan, D. H.; Cappa, C. D.; Kroll, J. H.; Coggon, M.; Koss, A.; Sekimoto, K.; De Gouw, J. A.; Warneke, C.

2017-12-01

Biomass burning emissions represent a major source of fine particulate matter to the atmosphere, and this source will likely become increasingly important in the future due to changes in the Earth's climate. Understanding the effects that increased fire emissions have on both air quality and climate requires understanding the composition of the particles emitted, since chemical and physical composition directly impact important particle properties such as absorptivity, toxicity, and cloud condensation nuclei activity. However, the composition of biomass burning particles in the atmosphere is dynamic, as the particles are subject to the condensation of low-volatility vapors and reaction with oxidants such as the hydroxyl radical (OH) during transport. Here we present a series of laboratory chamber experiments on the OH-initiated aging of biomass burning aerosol performed at the Fire Sciences Laboratory in Missoula, MT as part of the Fire Influences on Regional and Global Environments Experiment (FIREX) campaign. We describe the evolution of biomass burning aerosol produced from a variety of fuels operating the chamber in both particle-only and gas + particle mode, focusing on changes to the organic composition. In particle-only mode, gas-phase biomass burning emissions are removed before oxidation to focus on heterogeneous oxidation, while gas + particle mode includes both heterogeneous oxidation and condensation of oxidized volatile organic compounds onto the particles (secondary organic aerosol formation). Variability in fuels and burning conditions lead to differences in aerosol loading and secondary aerosol production, but in all cases aging results in a significant and rapid increases in the carbon oxidation state of the particles.

From Baghdad to Boston: International Transfer of Burned Children in Time of War

DTIC Science & Technology

2014-10-01

369 Burns accounted for 13% of the large number of children admitted to U.S. combat support hospitals (CSHs) during recent conflicts in Iraq and...Afghani- stan.1 At the busiest CSH in Iraq, located at Ibn Sina Hospital in Baghdad, many of these burned children underwent wound care and discharge...initial care at the CSH, fol- lowed by transfer to one of the Shriners Hospitals for Children in Boston, Massachusetts. We conducted a review of the

Infection Casualty Estimation (ICE) Model: Predicting Sepsis in Nuclear Detonation Burn Patient Populations using Procalcitonin as a Biomarker

DTIC Science & Technology

2017-06-06

environments may be injured or killed from the primary blast wave, thermal pulse and ionizing radiation . Burn casualties surviving the initial blast wave are...32]/1.8 degree Celsius (oC) degree Fahrenheit (oF) [T(oF) + 459.67]/1.8 kelvin (K) Radiation activity of radionuclides [curie (Ci)] 3.7 × 1010...develop casualty estimation models for improvised nuclear device (IND) scenarios. The HSRDIPT team has developed health effects models of radiation , burn

Free tissue transfer in acute burns.

PubMed

Oni, Georgette; Saint-Cyr, Michel; Mojallal, Ali

2012-02-01

Major burn injuries can be devastating for the patients and their carers both in terms of morbidity and mortality. Therefore, it is important to optimize the treatment of the injured patient. After initial resuscitation and physiological stabilization, thorough surgical débridement of the burn is necessary. Often resultant defects can be resurfaced with split skin grafting or local flaps. However, in a small percentage of cases free flap surgery is necessary. Free tissue transfer in burns surgery is rare, but is indicated in those patients in which there is loss of a vascularized surface suitable for grafting such as exposed tendon, or bone following surgical débridement, and in extreme cases for limb salvage. This review article discusses the rationale for free flap surgery in terms of types of burn injuries, perioperative considerations, and summarizes the literature in free tissue transfer in acute burns. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Corticosteroid-impairment of healing and gastric pentadecapeptide BPC-157 creams in burned mice.

PubMed

Sikiric, P; Seiwerth, S; Mise, S; Staresinic, M; Bedekovic, V; Zarkovic, N; Borovic, S; Gjurasin, M; Boban-Blagaic, A; Batelja, L; Rucman, R; Anic, T

2003-06-01

The amelioration of corticosteroid-impairment of healing by a stable gastric pentadecapeptide BPC-157 (GEPPPGKPADDAGLV, M(w) 1419, currently in early clinical trials for inflammatory bowel disease) was studied in thermally injured mice. Its effects on corticosteroid impaired healing of deep partial skin thickness burns, and burn-gastric lesions were investigated. Male NMRI-Hannover mice (sacrificed at 1-3,7,14 and 21 days following burning 20% of total burn area at the back (open flame for 7s) received intraperitoneally (per kg bw) 6alpha-methylprednisolone (Depo-medrol, 1.0 or 10.0mg), or an equal volume of saline (5.0 ml), once daily, first application 30 min after injury, last 24h before sacrifice. The injury was subsequently treated by topical application of a thin layer of pentadecapeptide BPC-157 cream at three different levels a neutral cream of no treatment. Pentadecapeptide BPC-157 consistently improved given burn healing (both microscopical and tensionmetry assessment), and counteracted corticosteroid-impairment of burn healing. In burn-gastric lesions investigation of the effects of BPC showed an anti-ulcer effect of its own in burned non-corticosteroid-treated mice and potentiated the anti-ulcer effect observed in 6alpha-methylprednisolone-treated mice. Pentadecapeptide BPC-157 inhibited corticosteroid immunosuppression. In vitro, in spleenic cells assessment, animals (sacrificed at day 21) treated with 6alpha-methylprednisolone 1mg showed decreased reactivity to nitrogen in comparison with control, healthy animals, while the addition of BPC-157 (1 microg/g cream) returned cell reactivity to values noted in control healthy animals.

Pathophysiologic Response to Burns in the Elderly☆

PubMed Central

Jeschke, Marc G.; Patsouris, David; Stanojcic, Mile; Abdullahi, Abdikarim; Rehou, Sarah; Pinto, Ruxandra; Chen, Peter; Burnett, Marjorie; Amini-Nik, Saeid

2015-01-01

Over the last decades advancements have improved survival and outcomes of severely burned patients except one population, elderly. The Lethal Dose 50 (LD50) burn size in elderly has remained the same over the past three decades, and so has morbidity and mortality, despite the increased demand for elderly burn care. The objective of this study is to gain insights on why elderly burn patients have had such a poor outcome when compared to adult burn patients. The significance of this project is that to this date, burn care providers recognize the extreme poor outcome of elderly, but the reason remains unclear. In this prospective translational trial, we have determined clinical, metabolic, inflammatory, immune, and skin healing aspects. We found that elderly have a profound increased mortality, more premorbid conditions, and stay at the hospital for longer, p < 0.05. Interestingly, we could not find a higher incidence of infection or sepsis in elderly, p > 0.05, but a significant increased incidence of multi organ failure, p < 0.05. These clinical outcomes were associated with a delayed hypermetabolic response, increased hyperglycemic and hyperlipidemic responses, inversed inflammatory response, immune-compromisation and substantial delay in wound healing predominantly due to alteration in characteristics of progenitor cells, p < 0.05. In summary, elderly have substantially different responses to burns when compared to adults associated with increased morbidity and mortality. This study indicates that these responses are complex and not linear, requiring a multi-modal approach to improve the outcome of severely burned elderly. PMID:26629550

Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns.

PubMed

Malik, Kamran Ishaque; Malik, M A Nasir; Aslam, Azhar

2010-10-01

Burn injury is associated with a high incidence of death and disability; yet, its management remains problematic and costly. We conducted this clinical study to evaluate the efficacy of honey in the treatment of superficial and partial-thickness burns covering less than 40% of body surface area and compared its results with those of silver sulphadiazine (SSD). In this randomised comparative clinical trial, carried out Burn Center of POF Hospital, Wah Cantt, Pakistan, from May 2007 to February 2008, 150 patients of all ages having similar types of superficial and partial-thickness burns at two sites on different parts of body were included. Each patient had one burn site treated with honey and one treated with topical SSD, randomly. The rate of re-epithelialization and healing of superficial and partial-thickness burns was significantly faster in the sites treated with honey than in the sites treated with SSD (13·47 ± 4·06 versus 15·62 ± 4·40 days, respectively: P < 0·0001). The site treated with honey healed completely in less than 21 days versus 24 days for the site treated with SSD. Six patients had positive culture for Pseudomonas aeroginsa in honey-treated site, whereas 27 patients had positive culture in SSD-treated site. The results clearly showed greater efficacy of honey over SSD cream for treating superficial and partial-thickness burns. 2010 The Authors. Journal Compilation © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

A Semi-analytic Criterion for the Spontaneous Initiation of Carbon Detonations in White Dwarfs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Garg, Uma; Chang, Philip, E-mail: umagarg@uwm.edu, E-mail: chang65@uwm.edu

Despite over 40 years of active research, the nature of the white dwarf progenitors of SNe Ia remains unclear. However, in the last decade, various progenitor scenarios have highlighted the need for detonations to be the primary mechanism by which these white dwarfs are consumed, but it is unclear how these detonations are triggered. In this paper we study how detonations are spontaneously initiated due to temperature inhomogeneities, e.g., hotspots, in burning nuclear fuel in a simplified physical scenario. Following the earlier work by Zel’Dovich, we describe the physics of detonation initiation in terms of the comparison between the spontaneousmore » wave speed and the Chapman–Jouguet speed. We develop an analytic expression for the spontaneous wave speed and utilize it to determine a semi-analytic criterion for the minimum size of a hotspot with a linear temperature gradient between a peak and base temperature for which detonations in burning carbon–oxygen material can occur. Our results suggest that spontaneous detonations may easily form under a diverse range of conditions, likely allowing a number of progenitor scenarios to initiate detonations that burn up the star.« less

A Semi-analytic Criterion for the Spontaneous Initiation of Carbon Detonations in White Dwarfs

NASA Astrophysics Data System (ADS)

Garg, Uma; Chang, Philip

2017-02-01

Despite over 40 years of active research, the nature of the white dwarf progenitors of SNe Ia remains unclear. However, in the last decade, various progenitor scenarios have highlighted the need for detonations to be the primary mechanism by which these white dwarfs are consumed, but it is unclear how these detonations are triggered. In this paper we study how detonations are spontaneously initiated due to temperature inhomogeneities, e.g., hotspots, in burning nuclear fuel in a simplified physical scenario. Following the earlier work by Zel’Dovich, we describe the physics of detonation initiation in terms of the comparison between the spontaneous wave speed and the Chapman-Jouguet speed. We develop an analytic expression for the spontaneous wave speed and utilize it to determine a semi-analytic criterion for the minimum size of a hotspot with a linear temperature gradient between a peak and base temperature for which detonations in burning carbon-oxygen material can occur. Our results suggest that spontaneous detonations may easily form under a diverse range of conditions, likely allowing a number of progenitor scenarios to initiate detonations that burn up the star.

Efficacy of enzymatic debridement of deeply burned hands.

PubMed

Krieger, Yuval; Bogdanov-Berezovsky, Alexander; Gurfinkel, Reuven; Silberstein, Eldad; Sagi, Amiram; Rosenberg, Lior

2012-02-01

The burned hand is a common and difficult to care-for entity in the field of burns. Due to the anatomy of the hand (important and delicate structures crowded in a small limited space without sub-dermal soft tissue), surgical debridement of the burned tissue is technically difficult and may cause considerable complications and, therefore, should be performed judiciously. Selective enzymatic debridement of the burn wound can preserve the spontaneous epithelialisation potential and reduce the added injury to the traumatised tissue added by a surgical debridement. The aim of the study was to assess the implication of a selective enzymatic compound (Debrase(®) - Ds) in the special field of deep hand burns, by comparing the actual burn area that required surgical coverage after enzymatic debridement to the burn area clinically judged to require skin grafting prior to debridement. This was a retrospective data collection and analysis from 154 complete files of prospective, open-label study in 275 hospitalised, Ds-treated burn patients. A total of 69 hand burns diagnosed as 'deep' was analysed; 36% of the wounds required surgical intervention after enzymatic debridement; 28.6% of the total burned area estimated initially as deep was covered by skin graft (statistically significant p<0.001). Debridement of deep-hand burns with a selective enzymatic agent decreased the perceived full-thickness wound area and skin-graft use. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

Estimating the usage of allograft in the treatment of major burns.

PubMed

Horner, C W M; Atkins, J; Simpson, L; Philp, B; Shelley, O; Dziewulski, P

2011-06-01

To assess the amount of allograft used in the past treatment of major burns and calculate a figure to guide estimation of the quantity of allograft required to treat future patients and aid resource planning. A retrospective observational study. Records of 143 patients treated with major burns at a regional centre, from January 2004 to November 2008 were accessed with biometric data and quantity of allograft used being recorded. This data was used to calculate an allograft index (cm² allograft used/burn surface area (cm²)) (AI) for each patient. 112 of the 143 patients had complete sets of data, of the 112, 89 patients survived the initial stay in hospital. For all data average AI=1.077 ± 0.090. AI varied according to burn % area with burns < 40% requiring 0.490 cm² allo/cm²burn, increasing in a logarithmic fashion (R²=0.995) for burn areas > 40%. The ability to estimate deceased donor skin requirements based on % body surface area affected is important in the care planning for patients with major burns. Our findings of 0.5 cm² allograft/cm² burn for injuries less than 40% TBSA, increasing to 1.82 cm² allograft/cm² burn for injuries up to 80% TBSA can be used for planning purposes for individual services and for burn disaster planning. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

A randomized trial comparing ReCell system of epidermal cells delivery versus classic skin grafts for the treatment of deep partial thickness burns.

PubMed

Gravante, G; Di Fede, M C; Araco, A; Grimaldi, M; De Angelis, B; Arpino, A; Cervelli, V; Montone, A

2007-12-01

Our purpose was to directly compare results obtained with the ReCell system and the classic skin grafting for epidermal replacement in deep partial thickness burns. We recruited all patients with deep partial thickness burns admitted at the Burn Centre of S. Eugenio Hospital in Rome over 2 years. Enrollment was conducted with a controlled strategy--sampling chart--that allowed homogeneous groups (ReCell and skin grafting) for age, gender, type of burns and total burn surface area (TBSA). We evaluated as primary endpoints of the study the (i) time for complete epithelization (both treated area and biopsy site) and (ii) aesthetic and functional quality of the epithelization (color, joint contractures). Secondary endpoints were the assessment of infections, inflammations or any adverse effects of the ReCell procedure, particular medications assumed, postoperative pain. Eighty-two patients were analyzed in two homogeneous groups. All of them received adequate epidermal replacement, but skin grafting was faster than ReCell (p<0.05). On the contrary, ReCell biopsy areas and postoperative pain were smaller than classic grafting (p<0.05). The aesthetic and functional outcomes were similar between procedures. ReCell is a feasible, simple and safe technique. It gives similar results to skin grafting but, harvesting minor areas, can open possible future applications in the management of large-burns patients.

Pine Oil Effects on Chemical and Thermal Injury in Mice and Cultured Mouse Dorsal Root Ganglion Neurons

PubMed Central

Clark, SP; Bollag, WB; Westlund, KN; Ma, F; Falls, G; Xie, D; Johnson, M; Isales, CM; Bhattacharyya, MH

2013-01-01

A commercial resin-based pine oil derived from Pinus palustris and Pinus elliottii was the major focus of this investigation. Extracts of pine resins, needles and bark are folk medicines commonly used to treat skin ailments, including burns. The American Burn Association estimates that 500,000 people with burn injuries receive medical treatment each year; one-half of US burn victims are children, most with scald burns. This systematic study was initiated as follow-up to personal anecdotal evidence acquired over more than 10 years by MH Bhattacharyya regarding pine oil’s efficacy for treating burns. The results demonstrate that pine oil counteracted dermal inflammation in both a mouse ear model of contact irritant-induced dermal inflammation and a 2nd degree scald burn to the mouse paw. Furthermore, pine oil significantly counteracted the tactile allodynia and soft tissue injury caused by the scald burn. In mouse dorsal root ganglion (DRG) neuronal cultures, pine oil added to the medium blocked ATP-activated, but not capsaicin-activated, pain pathways, demonstrating specificity. These results together support the hypothesis that a pine-oil-based treatment can be developed to provide effective in-home care for 2nd degree burns. PMID:23595692

Relationships between human population density and burned area at continental and global scales.

PubMed

Bistinas, Ioannis; Oom, Duarte; Sá, Ana C L; Harrison, Sandy P; Prentice, I Colin; Pereira, José M C

2013-01-01

We explore the large spatial variation in the relationship between population density and burned area, using continental-scale Geographically Weighted Regression (GWR) based on 13 years of satellite-derived burned area maps from the global fire emissions database (GFED) and the human population density from the gridded population of the world (GPW 2005). Significant relationships are observed over 51.5% of the global land area, and the area affected varies from continent to continent: population density has a significant impact on fire over most of Asia and Africa but is important in explaining fire over < 22% of Europe and Australia. Increasing population density is associated with both increased and decreased in fire. The nature of the relationship depends on land-use: increasing population density is associated with increased burned are in rangelands but with decreased burned area in croplands. Overall, the relationship between population density and burned area is non-monotonic: burned area initially increases with population density and then decreases when population density exceeds a threshold. These thresholds vary regionally. Our study contributes to improved understanding of how human activities relate to burned area, and should contribute to a better estimate of atmospheric emissions from biomass burning.

Relationships between Human Population Density and Burned Area at Continental and Global Scales

PubMed Central

Bistinas, Ioannis; Oom, Duarte; Sá, Ana C. L.; Harrison, Sandy P.; Prentice, I. Colin; Pereira, José M. C.

2013-01-01

We explore the large spatial variation in the relationship between population density and burned area, using continental-scale Geographically Weighted Regression (GWR) based on 13 years of satellite-derived burned area maps from the global fire emissions database (GFED) and the human population density from the gridded population of the world (GPW 2005). Significant relationships are observed over 51.5% of the global land area, and the area affected varies from continent to continent: population density has a significant impact on fire over most of Asia and Africa but is important in explaining fire over < 22% of Europe and Australia. Increasing population density is associated with both increased and decreased in fire. The nature of the relationship depends on land-use: increasing population density is associated with increased burned are in rangelands but with decreased burned area in croplands. Overall, the relationship between population density and burned area is non-monotonic: burned area initially increases with population density and then decreases when population density exceeds a threshold. These thresholds vary regionally. Our study contributes to improved understanding of how human activities relate to burned area, and should contribute to a better estimate of atmospheric emissions from biomass burning. PMID:24358108

PERMITTING HAZARDOUS WASTE INCINERATORS

EPA Science Inventory

This publication is a compilation of information presented at a seminar series designed to address the issues that affect the issuance of hazardous waste incineration permits and to improve the overall understanding of trial burn testing. pecifically, the document provides guidan...

Modeling Smoke Plume-Rise and Dispersion from Southern United States Prescribed Burns with Daysmoke.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Achtemeier, Gary, L.; Goodrick, Scott, A.; Liu, Yongqiang

2011-08-19

We present Daysmoke, an empirical-statistical plume rise and dispersion model for simulating smoke from prescribed burns. Prescribed fires are characterized by complex plume structure including multiple-core updrafts which makes modeling with simple plume models difficult. Daysmoke accounts for plume structure in a three-dimensional veering/sheering atmospheric environment, multiple-core updrafts, and detrainment of particulate matter. The number of empirical coefficients appearing in the model theory is reduced through a sensitivity analysis with the Fourier Amplitude Sensitivity Test (FAST). Daysmoke simulations for 'bent-over' plumes compare closely with Briggs theory although the two-thirds law is not explicit in Daysmoke. However, the solutions for themore » 'highly-tilted' plume characterized by weak buoyancy, low initial vertical velocity, and large initial plume diameter depart considerably from Briggs theory. Results from a study of weak plumes from prescribed burns at Fort Benning GA showed simulated ground-level PM2.5 comparing favorably with observations taken within the first eight kilometers of eleven prescribed burns. Daysmoke placed plume tops near the lower end of the range of observed plume tops for six prescribed burns. Daysmoke provides the levels and amounts of smoke injected into regional scale air quality models. Results from CMAQ with and without an adaptive grid are presented.« less

Therapeutic effects of transdermal systems containing zinc-related materials on thermal burn rats.

PubMed

Otsuka, Makoto; Hatakeyama, Haruna; Shikamura, Masayuki; Otsuka, Kuniko; Ito, Atsuo

2015-01-01

The aim of the present study is to evaluate the efficacy of slow zinc (Zn) release from β-tricalcium phosphate powder (ZnTCP) containing 10 mol% Zn on rats with thermal burns. The first-aid tapes were contained zinc sulfate (ZnSO4) solution, ZnTCP suspensions or zinc oxide ointment. After thermal burn treatments were performed on Zn-deficient rats, the groups D1, D2 and D3 were treated with tapes containing ZnTCP, ZnSO4 and zinc oxide ointment. The effects of the tapes on wound area, plasma Zn levels and alkaline phosphatase activity (Alp) were investigated. The wound area profiles of all rat groups could be separated into before and after the scab formation at around day 6. The area under the curve (Aw-AUC) for wound area profiles, therefore, was evaluated as an index of therapeutic scores for the thermal wound. The order of Aw-AUC was D3>C>D2>D1. The degree of expansion at the initial stage by thermal burns of group D1 was the lowest and that of group D2 was the highest, and the order was D1

Root Disease, Longleaf Pine Mortality, and Prescribed Burning

Treesearch

William J. Otrosina; Charles H. Walkinshaw; Stanley J. Zarnoch; Shi-Jean S. Sung; Brian T. Sullivan

2002-01-01

Abstract - A study was initiated at the Savannah River Site, New Ellenton, SC, to determine factors involved in decline of longleaf pine associated with prescribed burning. Pretreatment and post-treatment surveys were conducted on all treatment plots. Symptomatic trees were recorded by means of a crown rating system based upon symptom severity. Three...

"First aid" for burned watersheds

Treesearch

J. S. Krammes; L. W. Hill

1963-01-01

Most of the vegetative cover on the San Dimas Experimental Forest was destroyed by a wildfire in 1960. Following the fire an emergency research program was initiated to test several "first -aid" treatments aimed at reducing flood and erosion damage from burned watersheds. This paper summarizes first - and second-year results of the research program.

No correlation between initial arterial carboxyhemoglobin level and degree of lung injury following ovine burn and smoke inhalation.

PubMed

Lange, Matthias; Cox, Robert A; Traber, Daniel L; Hamahata, Atsumori; Nakano, Yoshimitsu; Traber, Lillian D; Enkhbaatar, Perenlei

2014-04-01

Fire victims often suffer from burn injury and concomitant inhalation trauma, the latter significantly contributing to the morbidity and mortality in these patients. Measurement of blood carboxyhemoglobin levels has been proposed as a diagnostic marker to verify and, perhaps, quantify the degree of lung injury following inhalation trauma. However, this correlation has not yet been sufficiently validated. A total of 77 chronically instrumented sheep received sham injury, smoke inhalation injury, or combined burn and inhalation trauma following an established protocol. Arterial carboxyhemoglobin concentrations were determined directly after injury and correlated to several clinical and histopathological determinants of lung injury that were detected 48 hours post-injury. The injury induced severe impairment of pulmonary gas exchange and increases in transvascular fluid flux, lung water content, and airway obstruction scores. No significant correlations were detected between initial carboxyhemoglobin levels and all measured clinical and histopathological determinants of lung injury. In conclusion, the amount of arterial carboxyhemoglobin concentration cannot predict the degree of lung injury at 48 hours after ovine burn and smoke inhalation trauma.

Shine on: Review of Laser- and Light-Based Therapies for the Treatment of Burn Scars

PubMed Central

Hultman, C. Scott; Edkins, Renee E.; Lee, Clara N.; Calvert, Catherine T.; Cairns, Bruce A.

2012-01-01

Restoration of form and function after burn injury remains challenging, but emerging laser and pulsed light technologies now offer hope for patients with hypertrophic scars, which may be associated with persistent hyperemia, chronic folliculitis, intense pruritis, and neuropathic pain. In addition to impairing body image, these scars may limit functional recovery, compromise activities of daily living, and prevent return to work. Three different platforms are now poised to alter our reconstructive algorithm: (1) vascular-specific pulsed dye laser (PDL) to reduce hyperemia, (2) ablative fractional CO2 laser to improve texture and pliability of the burn scar, and (3) intense pulsed light (IPL) to correct burn scar dyschromia and alleviate chronic folliculitis. In this paper, we will provide an overview of our work in this area, which includes a systematic review, a retrospective analysis of our preliminary experience, and interim data from our on-going, prospective, before-after cohort trial. We will demonstrate that laser- and light-based therapies can be combined with each other safely to yield superior results, often at lower cost, by reducing the need for reconstructive surgery. Modulating the burn scar, through minimally invasive modalities, may replace conventional methods of burn scar excision and yield outcomes not previously possible or conceivable. PMID:22778719

Development of clinical process measures for pediatric burn care: Understanding variation in practice patterns.

PubMed

Kazis, Lewis E; Sheridan, Robert L; Shapiro, Gabriel D; Lee, Austin F; Liang, Matthew H; Ryan, Colleen M; Schneider, Jeffrey C; Lydon, Martha; Soley-Bori, Marina; Sonis, Lily A; Dore, Emily C; Palmieri, Tina; Herndon, David; Meyer, Walter; Warner, Petra; Kagan, Richard; Stoddard, Frederick J; Murphy, Michael; Tompkins, Ronald G

2018-04-01

There has been little systematic examination of variation in pediatric burn care clinical practices and its effect on outcomes. As a first step, current clinical care processes need to be operationally defined. The highly specialized burn care units of the Shriners Hospitals for Children system present an opportunity to describe the processes of care. The aim of this study was to develop a set of process-based measures for pediatric burn care and examine adherence to them by providers in a cohort of pediatric burn patients. We conducted a systematic literature review to compile a set of process-based indicators. These measures were refined by an expert panel of burn care providers, yielding 36 process-based indicators in four clinical areas: initial evaluation and resuscitation, acute excisional surgery and critical care, psychosocial and pain control, and reconstruction and aftercare. We assessed variability in adherence to the indicators in a cohort of 1,076 children with burns at four regional pediatric burn programs in the Shriners Hospital system. The percentages of the cohort at each of the four sites were as follows: Boston, 20.8%; Cincinnati, 21.1%; Galveston, 36.0%; and Sacramento, 22.1%. The cohort included children who received care between 2006 and 2010. Adherence to the process indicators varied both across sites and by clinical area. Adherence was lowest for the clinical areas of acute excisional surgery and critical care, with a range of 35% to 48% across sites, followed by initial evaluation and resuscitation (range, 34%-60%). In contrast, the clinical areas of psychosocial and pain control and reconstruction and aftercare had relatively high adherence across sites, with ranges of 62% to 93% and 71% to 87%, respectively. Of the 36 process indicators, 89% differed significantly in adherence between clinical sites (p < 0.05). Acute excisional surgery and critical care exhibited the most variability. The development of this set of process-based measures represents an important step in the assessment of clinical practice in pediatric burn care. Substantial variation was observed in practices of pediatric burn care. However, further research is needed to link these process-based measures to clinical outcomes. Therapeutic/care management, level IV.

Aloe vera for treating acute and chronic wounds.

PubMed

Dat, Anthony D; Poon, Flora; Pham, Kim B T; Doust, Jenny

2012-02-15

Aloe vera is a cactus-like perennial succulent belonging to the Liliaceae Family that is commonly grown in tropical climates. Animal studies have suggested that Aloe vera may help accelerate the wound healing process. To determine the effects of Aloe vera-derived products (for example dressings and topical gels) on the healing of acute wounds (for example lacerations, surgical incisions and burns) and chronic wounds (for example infected wounds, arterial and venous ulcers). We searched the Cochrane Wounds Group Specialised Register (9 September 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), Ovid MEDLINE (2005 to August Week 5 2011), Ovid MEDLINE (In-Process & Other Non-Indexed Citations 8 September 2011), Ovid EMBASE (2007 to 2010 Week 35), Ovid AMED (1985 to September 2011) and EBSCO CINAHL (1982 to 9 September 2011). We did not apply date or language restrictions. We included all randomised controlled trials that evaluated the effectiveness of Aloe vera, aloe-derived products and a combination of Aloe vera and other dressings as a treatment for acute or chronic wounds. There was no restriction in terms of source, date of publication or language. An objective measure of wound healing (either proportion of completely healed wounds or time to complete healing) was the primary endpoint. Two review authors independently carried out trial selection, data extraction and risk of bias assessment, checked by a third review author. Seven trials were eligible for inclusion, comprising a total of 347 participants. Five trials in people with acute wounds evaluated the effects of Aloe vera on burns, haemorrhoidectomy patients and skin biopsies. Aloe vera mucilage did not increase burn healing compared with silver sulfadiazine (risk ratio (RR) 1.41, 95% confidence interval (CI) 0.70 to 2.85). A reduction in healing time with Aloe vera was noted after haemorrhoidectomy (RR 16.33 days, 95% CI 3.46 to 77.15) and there was no difference in the proportion of patients completely healed at follow up after skin biopsies. In people with chronic wounds, one trial found no statistically significant difference in pressure ulcer healing with Aloe vera (RR 0.10, 95% CI -1.59 to 1.79) and in a trial of surgical wounds healing by secondary intention Aloe vera significantly delayed healing (mean difference 30 days, 95% CI 7.59 to 52.41). Clinical heterogeneity precluded meta-analysis. The poor quality of the included trials indicates that the trial results must be viewed with extreme caution as they have a high risk of bias. There is currently an absence of high quality clinical trial evidence to support the use of Aloe vera topical agents or Aloe vera dressings as treatments for acute and chronic wounds.

NASA's East and Southeast Asia Initiatives: BASE-ASIA and EAST-AIRE

NASA Technical Reports Server (NTRS)

Tsay, S.; Maring, H.

2005-01-01

Airborne dust from northern China influences air quality and regional climate in Asia during springtime. However, with the economic growth in China, increased emission of particulate air pollutants from industrial and vehicular sources will not only impact the earth's radiation balance, but also adversely affect human health year round. In addition, both of dust and aerosol pollutants can be transported swiftly across the Pacific affecting North America within a few days. Asian dust and pollutant aerosols can be detected by their colored appearance using current Earth observing satellites (e.g., MODIS, SeaWiFS, TOMS, etc.) and by sunphotometers deployed on the surface of the earth. Biomass burning has been a regular practice for land clearing and conversion in many countries, especially those in Africa, South America, and Southeast Asia. However, the climatology of Southeast Asia is very different than that of Africa and South America, such that large-scale biomass burning causes smoke to interact extensively with clouds during the peak-burning season of March to April. Globally significant sources of greenhouse gases (eg., CO2, CH4), chemically active gases (e.g., NO, CO, HC, CH3Br), and atmospheric aerosols are produced by biomass burning. These gases influence the Earth-atmosphere system, impacting both global climate and tropospheric chemistry. Some aerosols can serve as cloud condensation nuclei, which play a role in determining cloud lifetime and precipitation, altering the earth's radiation and water budgets. Biomass burning also affects the biogeochemical cycling of nitrogen and carbon compounds; the hydrological cycle; land surface reflectivity and emissivity; and ecosystem biodiversity and stability. Two NASA initiatives, EAST-AIRE (East Asian Study of Tropospheric Aerosols: an International Regional Experiment) and BASE-ASIA (Biomass-burning Aerosols in South East-Asia: Smoke Impact Assessment) will be presented. The objectives of these initiatives is to develop a better understanding of the impacts of aerosols on regional-to-global climate, hydrological and carbon cycles, and tropospheric chemistry.

Effects of silicone gel on burn scars.

PubMed

Momeni, Mahnoush; Hafezi, Farhad; Rahbar, Hossein; Karimi, Hamid

2009-02-01

To study the efficacy of silicone gel applied to hypertrophic burn scars, in reducing scar interference with normal function and improving cosmesis. A randomised, double-blind, placebo-controlled trial involving 38 people with hypertrophic burn scars. Each scar was divided into two segments; silicone gel sheet was applied randomly to one of the two and placebo to the other. Participants were seen again after 1 and 4 months. Their data and wound characteristics were collected using the Vancouver scar scale. The median age of participants was 22 years (1.5-60 years) and 16 were male; 4 did not attend follow-up and were excluded from the study. There were no significant differences in baseline characteristics. Although after 1 month all scar scale measures were lower in treated areas, only the vascularity scale was significantly different between the two areas. After 4 months, all scale measures were significantly lower in the silicone gel group than in the control group, except for the pain score. Silicone gel is an effective treatment for hypertrophic burn scars.

Rehabilitation and social adjustment of people with burns in society.

PubMed

Din, Sirajud; Shah, Mussawar; Asadullah; Jamal, Humera; Bilal, Muhammad

2015-02-01

The present study was conducted on rehabilitation and social adjustment of people with burns in society with the main objective to determine the relationship between social adjustment of people with burns and their psychosocial rehabilitation. The study was limited to the Burn Unit, Khyber Teaching Hospital, Peshawar, Pakistan. At bi-variate level, the following were observed: the relationship of psychosocial rehabilitation was highly significant (P=0.000) considering that people with burns feel shame in the society, a highly significant relation (P=0.000) was found between psychosocial rehabilitation and burn as the hurdle to contact other members of the society, a highly significant (P=0.000) relation was found between psychosocial rehabilitation and perception that society provides social support to people with burns, a highly significant (P=0.000) relationship between psychosocial rehabilitation and people with burns feel alienated from the society, a significant association (P=0.024) was found between psychosocial rehabilitation and loss of social network, and a significant (P=0.002) association between psychosocial rehabilitation and society insult toward people with burns. Regular provision of treatment, quota in job allocation for people with burns, initiation of stipend through Benazir Income Support Program, and keeping and updating record of burns at the district level in census centers were suggested as recommendations in light of the study. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

The First 3D Simulations of Carbon Burning in a Massive Star

NASA Astrophysics Data System (ADS)

Cristini, A.; Meakin, C.; Hirschi, R.; Arnett, D.; Georgy, C.; Viallet, M.

2017-11-01

We present the first detailed three-dimensional hydrodynamic implicit large eddy simulations of turbulent convection for carbon burning. The simulations start with an initial radial profile mapped from a carbon burning shell within a 15 M⊙ stellar evolution model. We considered 4 resolutions from 1283 to 10243 zones. These simulations confirm that convective boundary mixing (CBM) occurs via turbulent entrainment as in the case of oxygen burning. The expansion of the boundary into the surrounding stable region and the entrainment rate are smaller at the bottom boundary because it is stiffer than the upper boundary. The results of this and similar studies call for improved CBM prescriptions in 1D stellar evolution models.

A Minimum Delta V Orbit Maintenance Strategy for Low-Altitude Missions Using Burn Parameter Optimization

NASA Technical Reports Server (NTRS)

Brown, Aaron J.

2011-01-01

Orbit maintenance is the series of burns performed during a mission to ensure the orbit satisfies mission constraints. Low-altitude missions often require non-trivial orbit maintenance Delta V due to sizable orbital perturbations and minimum altitude thresholds. A strategy is presented for minimizing this Delta V using impulsive burn parameter optimization. An initial estimate for the burn parameters is generated by considering a feasible solution to the orbit maintenance problem. An low-lunar orbit example demonstrates the Delta V savings from the feasible solution to the optimal solution. The strategy s extensibility to more complex missions is discussed, as well as the limitations of its use.

HANDBOOK: HAZARDOUS WASTE INCINERATION MEASUREMENT GUIDANCE

EPA Science Inventory

This publication, Volume III of the Hazardous Waste Incineration Guidance Series, contains general guidance to permit writers in reviewing hazardous waste incineration permit applications and trial burn plans. he handbook is a how-to document dealing with how incineration measure...

Combustion-transition interaction in a jet flame

NASA Astrophysics Data System (ADS)

Yule, A. J.; Chigier, N. A.; Ralph, S.; Boulderstone, R.; Ventura, J.

1980-01-01

The transition between laminar and turbulent flow in a round jet flame is studied experimentally. Comparison is made between transition in non-burning and burning jets and between jet flames with systematic variation in initial Reynolds number and equivalence ratio. Measurements are made using laser anemometry, miniature thermocouples, ionization probes, laser-schlieren and high speed cine films. Compared with the cold jet, the jet flame has a longer potential core, undergoes a slower transition to turbulence, has lower values of fluctuating velocity near the burner but higher values further downstream, contains higher velocity gradients in the mixing layer region although the total jet width does not alter greatly in the first twenty diameters. As in the cold jet, transitional flow in the flame contains waves and vortices and these convolute and stretch the initially laminar interface burning region. Unlike the cold jet, which has Kelvin-Helmholtz instabilities, the jet flame can contain at least two initial instabilities; an inner high frequency combustion driven instability and an outer low frequency instability which may be influenced by buoyancy forces.

Treatments for Common Psychiatric Conditions Among Children and Adolescents During Acute Rehabilitation and Reintegration Phases of Burn Injury

PubMed Central

Arceneaux, Lisa L.; Meyer, Walter J.

2016-01-01

Advances in critical care and surgical management during the last 20 years have decreased mortality rates among children with severe burn injuries. This improved survival rate has prompted researchers to study the psychological aspects of recovering from a burn injury. Initially, research focused primarily on epidemiology, prevention and descriptions of the psychological phenomenon experienced by the children and adolescents. Whereas, previously, interventions were often utilized during the acute phases of burn injury without knowledge of the long-term effects, more recently, priorities have shifted to include long-term treatment outcome studies. The purpose of this paper is to review and discuss the current evidenced-based techniques and their efficacy in the treatment of common psychological and psychiatric conditions among children and adolescents during the 3 major phases of burn injury. PMID:19919208

Healing of burn wounds by topical treatment: A randomized controlled comparison between silver sulfadiazine and nano-crystalline silver

PubMed Central

Adhya, Abhishek; Bain, Jayanta; Ray, Oindri; Hazra, Avijit; Adhikari, Souvik; Dutta, Gouranga; Ray, Sudhin; Majumdar, Bijay Kumar

2014-01-01

Background: Silver sulfadiazine (SSD) has been the standard topical antimicrobial for burn wounds for decades. Recently, nanometer-sized silver particles are available which have high surface to volume ratio and remain effective even at a very low concentration and minimizes the chance for tissue toxicity due to silver. Hence, we conducted a randomized controlled trial to compare the effectiveness of topical SSD and nano-crystalline silver (AgNP) hydrogel in burn wounds management. Materials and Methods: Study was conducted in the Burn Unit of IPGME&R & SSKM Hospital Calcutta, from January 2011 to August 2012. Patients with 2° burn injury were randomly allocated to SSD and AgNP treatment group. Clinical assessments of burn wound were done on every week till 4th week and on completion of treatment. Results: Data for evaluation were obtained for 54 patients on SSD (2° deep-dermal cases 27) and 52 (2° deep-dermal cases 31) on AgNP treatment. Healing status of 2° deep-dermal burns was more satisfactory for AgNP group than SSD treatment at 4 weeks. Among patients receiving AgNP, 80.6% showed at least 50% healing of 2° deep-dermal wounds compared to 48.1% on SSD at 4 weeks (P = 0.001). The figures for complete healing at 4 weeks were, respectively, 4% and 0% (P = 0.116). Conclusions: AgNP can be an effective and superior alternative to SSD for burn wounds, particularly 2° deep-dermal burns. Healing can be expected, in general, in 6 to 8 weeks time, depending upon the extent of body surface involvement. PMID:25538469

Protocol for a systematic review of quantitative burn wound microbiology in the management of burns patients.

PubMed

Kwei, Johnny; Halstead, Fenella D; Dretzke, Janine; Oppenheim, Beryl A; Moiemen, Naiem S

2015-11-06

Sepsis from burn injuries can result from colonisation of burn wounds, especially in large surface area burns. Reducing bacterial infection will reduce morbidity and mortality, and mortality for severe burns can be as high as 15 %. There are various quantitative and semi-quantitative techniques to monitor bacterial load on wounds. In the UK, burn wounds are typically monitored for the presence or absence of bacteria through the collection and culture of swabs, but no absolute count is obtained. Quantitative burn wound culture provides a measure of bacterial count and is gaining increased popularity in some countries. It is however more resource intensive, and evidence for its utility appears to be inconsistent. This systematic review therefore aims to assess the evidence on the utility and reliability of different quantitative microbiology techniques in terms of diagnosing or predicting clinical outcomes. Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Bibliographic databases and ongoing trial registers will be searched and conference abstracts screened. Studies will be eligible if they are prospective studies or systematic reviews of burn patients (any age) for whom quantitative microbiology has been performed, whether it is compared to another method. Quality assessment will be based on quality assessment tools for diagnostic and prognostic studies and tailored to the review as necessary. Synthesis is likely to be primarily narrative, but meta-analysis may be considered where clinical and methodological homogeneity exists. Given the increasing use of quantitative methods, this is a timely systematic review, which will attempt to clarify the evidence base. As far as the authors are aware, it will be the first to address this topic. PROSPERO, CRD42015023903.

Imaging Techniques for Clinical Burn Assessment with a Focus on Multispectral Imaging

PubMed Central

Thatcher, Jeffrey E.; Squiers, John J.; Kanick, Stephen C.; King, Darlene R.; Lu, Yang; Wang, Yulin; Mohan, Rachit; Sellke, Eric W.; DiMaio, J. Michael

2016-01-01

Significance: Burn assessments, including extent and severity, are some of the most critical diagnoses in burn care, and many recently developed imaging techniques may have the potential to improve the accuracy of these evaluations. Recent Advances: Optical devices, telemedicine, and high-frequency ultrasound are among the highlights in recent burn imaging advancements. We present another promising technology, multispectral imaging (MSI), which also has the potential to impact current medical practice in burn care, among a variety of other specialties. Critical Issues: At this time, it is still a matter of debate as to why there is no consensus on the use of technology to assist burn assessments in the United States. Fortunately, the availability of techniques does not appear to be a limitation. However, the selection of appropriate imaging technology to augment the provision of burn care can be difficult for clinicians to navigate. There are many technologies available, but a comprehensive review summarizing the tissue characteristics measured by each technology in light of aiding clinicians in selecting the proper device is missing. This would be especially valuable for the nonburn specialists who encounter burn injuries. Future Directions: The questions of when burn assessment devices are useful to the burn team, how the various imaging devices work, and where the various burn imaging technologies fit into the spectrum of burn care will continue to be addressed. Technologies that can image a large surface area quickly, such as thermography or laser speckle imaging, may be suitable for initial burn assessment and triage. In the setting of presurgical planning, ultrasound or optical microscopy techniques, including optical coherence tomography, may prove useful. MSI, which actually has origins in burn care, may ultimately meet a high number of requirements for burn assessment in routine clinical use. PMID:27602255

Determinants of skeletal muscle protein turnover following severe burn trauma in children.

PubMed

Malagaris, Ioannis; Herndon, David N; Polychronopoulou, Efstathia; Rontoyanni, Victoria G; Andersen, Clark R; Suman, Oscar E; Porter, Craig; Sidossis, Labros S

2018-06-04

Burns remain the fifth cause of non-fatal pediatric injuries globally, with muscle cachexia being a hallmark of the stress response to burns. Burn-induced muscle wasting is associated with morbidity, yet the determinants of muscle protein catabolism in response to burn trauma remains unclear. Our objective was to determine the effect of patient and injury characteristics on muscle protein kinetics in burn patients. This retrospective, observational study was performed using protein kinetic data from pediatric patients who had severe burns (>30% of the total body surface area burned) and underwent cross-limb stable isotope infusions between 1999 and 2008 as part of prospective clinical trials. Mixed multiple regression models were used to assess associations between patient/injury characteristics and muscle protein fractional synthesis rate (FSR), net balance (NB), and rates of phenylalanine appearance (Ra; index of protein breakdown) and disappearance (Rd; index of protein synthesis) across the leg. A total of 268 patients who underwent 499 studies were analyzed. Increasing time post injury was associated with greater FSR (p < 0.001) and NB (p = 0.01). Males were more catabolic than females (as indicated by lower NB, p = 0.04 and greater Ra, p = 0.008), a consequence of higher protein breakdown rather than lower synthesis. Increasing burn size was associated with higher protein synthesis rate (as indicated by higher FSR, p = 0.019) and higher protein breakdown rates (as indicated by greater Ra, p = 0.001). FSR was negatively associated with age (p < 0.001). Data from this large patient cohort show that injury severity, sex, and time post injury influence skeletal muscle wasting in burned children. These findings suggest that individual patient characteristics should be considered when devising therapies to improve the acute care and rehabilitation of burn survivors. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Use and efficacy of a nutrition protocol for patients with burns in intensive care.

PubMed

Lown, D

1991-01-01

The University of Michigan Burn Center uses a protocol to standardize the assessment, initiation, and monitoring of nutritional support for patients with burns of greater than 30% total body surface area (TBSA). Six patients with 20% to 80% TBSA burns were followed for 3 weeks to determine the effect of the protocol on the assessment, initiation, monitoring, and adequacy of nutritional support. The protocol calls for resting energy expenditure (REE) measurement within 24 hours of injury, to be repeated 3 times per week, for assessment of caloric requirements. Patients experienced an average delay before first REE measurement of 3 days after burn injury because measurements were unavailable on weekends and surgical days. REE measurements were used to determine caloric requirements and to tailor nutritional support to fluctuating metabolic needs. In four of the six patients a Dobhoff feeding tube (Biosearch Medical Products, Inc., Somerville, N.J.) was placed in the small bowel and enteral nutrition was initiated within 24 hours of admission, as outlined in the protocol. Two patients received concurrent parenteral nutrition because of difficulty in placing the Dobhoff feeding tube when fluoroscopy was not available. The three patients receiving nutrition solely through enteral feeding had achieved 100% of their caloric requirements by day 2, 4, and greater than 7 days after injury, respectively. Overall, the six patients received enterally an average of 75% of their caloric requirements. The major reason for inadequate enteral support was interruption of tube feedings because of tube dislodgment or multiple surgical procedures. The protocol used weekly measurements of total iron-binding capacity and prealbumin level s parameters of nutritional support.(ABSTRACT TRUNCATED AT 250 WORDS)

Debris-flow generation from recently burned watersheds

USGS Publications Warehouse

Cannon, S.H.

2001-01-01

Evaluation of the erosional response of 95 recently burned drainage basins in Colorado, New Mexico and southern California to storm rainfall provides information on the conditions that result in fire-related debris flows. Debris flows were produced from only 37 of 95 (~40 percent) basins examined; the remaining basins produced either sediment-laden streamflow or no discernable response. Debris flows were thus not the prevalent response of the burned basins. The debris flows that did occur were most frequently the initial response to significant rainfall events. Although some hillslopes continued to erode and supply material to channels in response to subsequent rainfall events, debris flows were produced from only one burned basin following the initial erosive event. Within individual basins, debris flows initiated through both runoff and infiltration-triggered processes. The fact that not all burned basins produced debris flows suggests that specific geologic and geomorphic conditions may control the generation of fire-related debris flows. The factors that best distinguish between debris-flow producing drainages and those that produced sediment-laden streamflow are drainage-basin morphology and lithology, and the presence or absence of water-repellent soils. Basins underlain by sedimentary rocks were most likely to produce debris flows that contain large material, and sand- and gravel-dominated flows were generated primarily from terrain underlain by decomposed granite. Basin-area and relief thresholds define the morphologic conditions under which both types of debris flows occur. Debris flows containing large material are more likely to be produced from basins without water-repellent soils than from basins with water repellency. The occurrence of sand-and gravel-dominated debris flows depends on the presence of water-repellent soils.

Glue Guns: Aiming for Safety

ERIC Educational Resources Information Center

Roy, Ken

2010-01-01

While glue guns are very useful, there are safety issues. Regardless of the temperature setting, glue guns can burn skin. The teacher should demonstrate and supervise the use of glue guns and have a plan should a student get burned. There should be an initial first aid protocol in place, followed by a visit to the school nurse. An accident report…

Emissions from biomass burning in the Yucatan

Treesearch

R. J. Yokelson; J. D. Crounse; P. F. DeCarlo; T. Karl; S. Urbanski; E. Atlas; T. Campos; Y. Shinozuka; V. Kapustin; A. D. Clarke; A. Weinheimer; D. J. Knapp; D. D. Montzka; J. Holloway; P. Weibring; F. Flocke; W. Zheng; D. Toohey; P. O. Wennberg; C. Wiedinmyer; L. Mauldin; A. Fried; D. Richter; J. Walega; J. L. Jimenez; K. Adachi; P. R. Buseck; S. R. Hall; R. Shetter

2009-01-01

In March 2006 two instrumented aircraft made the first detailed field measurements of biomass burning (BB) emissions in the Northern Hemisphere tropics as part of the MILAGRO project. The aircraft were the National Center for Atmospheric Research C-130 and a University of Montana/ US Forest Service Twin Otter. The initial emissions of up to 49 trace gas or particle...

Soil reaction and germination of Douglas-fir seed.

Treesearch

Robert F. Tarrant

1954-01-01

Wood ash and its accompanying alkalinity have sometimes been cited as being harmful to germination of tree seed on slash-burned forest land. Unasylva, the United Nations forestry publication, recently carried a report of research in British Columbia on the effect of slash burning on germination and initial survival of lodgepole pine and Douglas-fir. One finding was...

40 CFR 63.11211 - How do I demonstrate initial compliance with the emission limits?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Table 4 to this subpart, conducting a fuel analysis for each type of fuel burned in your boiler... single type of fuel, you are exempted from the compliance requirements of conducting a fuel analysis for each type of fuel burned in your boiler. For purposes of this subpart, boilers that use a supplemental...

40 CFR 63.11211 - How do I demonstrate initial compliance with the emission limits?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Table 4 to this subpart, conducting a fuel analysis for each type of fuel burned in your boiler... single type of fuel, you are exempted from the compliance requirements of conducting a fuel analysis for each type of fuel burned in your boiler. For purposes of this subpart, boilers that use a supplemental...

Nosocomial infections due to Acinetobacter calcoaceticus.

PubMed

Zaer, F; Deodhar, L

1989-01-01

Fifty four isolates of Acinetobacter calcoaceticus were studied in a period of 6 months. Maximum isolates were from burns cases and environmental sampling from burns ward also grew the same organism, indicating their role as nosocomial pathogen. Acinetobacter may initially be mistaken for Neisseria species. As the organisms show multidrug resistance to commonly used antibiotics their correct identification is important.

Tree mortality 6 years after burning a thinned Quercus chrysolepis stand

Treesearch

T.E. Paysen; M.G. Narog

1993-01-01

Managers do not currently use prescribed fire in stands of canyon live oak (Quercus chrysolepis Liebm.) because it is highly susceptible to fire injury. A preliminary study investigating the effects of  prescribed burning on this species was initiated on the San Bernardino National Forest in southern California. The purpose was to assess the...

Renal Replacement Therapy in Severe Burns: A Multicenter Observational Study.

PubMed

Chung, Kevin K; Coates, Elsa C; Hickerson, William L; Arnold-Ross, Angela L; Caruso, Daniel M; Albrecht, Marlene; Arnoldo, Brett D; Howard, Christina; Johnson, Laura S; McLawhorn, Melissa M; Friedman, Bruce; Sprague, Amy M; Mosier, Michael J; Conrad, Peggie F; Smith, David J; Karlnoski, Rachel A; Aden, James K; Mann-Salinas, Elizabeth A; Wolf, Steven E

2018-06-20

Acute kidney injury (AKI) after severe burns is historically associated with a high mortality. Over the past two decades, various modes of renal replacement therapy (RRT) have been utilized in this population. The purpose of this multicenter study was to evaluate demographic, treatment and outcomes data among severe burn patients treated with RRT collectively at various burn centers around the United States. After institutional review board approval, a multicenter observational study was conducted. All adult patients 18 or older, admitted with severe burns who were placed on RRT for acute indications but not randomized into a concurrently enrolling interventional trial were included. Across 8 participating burn centers, 171 subjects were enrolled during a 4 year period. Complete data was available in 170 subjects with a mean age of 51±17, percent total body surface area (TBSA) burn of 38±26% and Injury Severity Score of 27±21. 80% of subjects were male and 34% were diagnosed with smoke inhalation injury. The preferred mode of therapy was continuous venovenous hemofiltration at a mean delivered dose of 37±19 (mL/kg/hr) and a treatment duration of 13±24 days. Overall, in hospital mortality was 50%. Among survivors, 21% required RRT upon discharge from the hospital while 9% continued to require RRT 6 months after discharge. This is the first multi-center cohort of burn patients who underwent RRT reported to date. Overall mortality is comparable to other critically ill populations who undergo RRT. Most patients who survive to discharge eventually recover renal function.

Reacting Chemistry Based Burn Model for Explosive Hydrocodes

NASA Astrophysics Data System (ADS)

Schwaab, Matthew; Greendyke, Robert; Steward, Bryan

2017-06-01

Currently, in hydrocodes designed to simulate explosive material undergoing shock-induced ignition, the state of the art is to use one of numerous reaction burn rate models. These burn models are designed to estimate the bulk chemical reaction rate. Unfortunately, these models are largely based on empirical data and must be recalibrated for every new material being simulated. We propose that the use of an equilibrium Arrhenius rate reacting chemistry model in place of these empirically derived burn models will improve the accuracy for these computational codes. Such models have been successfully used in codes simulating the flow physics around hypersonic vehicles. A reacting chemistry model of this form was developed for the cyclic nitramine RDX by the Naval Research Laboratory (NRL). Initial implementation of this chemistry based burn model has been conducted on the Air Force Research Laboratory's MPEXS multi-phase continuum hydrocode. In its present form, the burn rate is based on the destruction rate of RDX from NRL's chemistry model. Early results using the chemistry based burn model show promise in capturing deflagration to detonation features more accurately in continuum hydrocodes than previously achieved using empirically derived burn models.

AmeriFlux US-An1 Anaktuvuk River Severe Burn

DOE Data Explorer

Hobbie, John [Marine Biological Laboratory; Rocha, Adrian [Marine Biological Laboratory; Shaver, Gaius [Marine Biological Laboratory

2016-01-01

This is the AmeriFlux version of the carbon flux data for the site US-An1 Anaktuvuk River Severe Burn. Site Description - The Anaktuvuk River fire on the North Slope of Alaska started on July 16, 2007 by lightning. It continued until the end of September when nearby lakes had already frozen over and burned >256,000 acres, creating a mosaic of patches that differed in burn severity. The Anaktuvuk River Severe Burn, Moderate Burn, and Unburned sites are 40 km to the west of the nearest road and were selected in late May 2008 to determine the effects of the fire on carbon, water, and energy exchanges during the growing season. Because the fire had burned through September of the previous year, initial deployment of flux towers occurred prior to any significant vegetative regrowth, and our sampling campaign captured the full growing season in 2008. The Severe Burn site consisted of a large area in which all of the green vegetation were consumed in the fire and some of the organic matter had burnt to the mineral soil in many places. A bear damaged the tower during the last week of August 2008, and it was repaired shortly after.

40 CFR 60.2195 - What information must I submit prior to initial startup?

Code of Federal Regulations, 2014 CFR

2014-07-01

... initial startup? 60.2195 Section 60.2195 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... What information must I submit prior to initial startup? You must submit the information specified in paragraphs (a) through (e) of this section prior to initial startup. (a) The type(s) of waste to be burned...

40 CFR 60.2195 - What information must I submit prior to initial startup?

Code of Federal Regulations, 2013 CFR

2013-07-01

... initial startup? 60.2195 Section 60.2195 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... What information must I submit prior to initial startup? You must submit the information specified in paragraphs (a) through (e) of this section prior to initial startup. (a) The type(s) of waste to be burned...

Initial evaluation and management of the critical burn patient.

PubMed

Vivó, C; Galeiras, R; del Caz, Ma D P

2016-01-01

The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Economic Spillovers From Public Investments in Medical Countermeasures: A Case Study of a Burn Debridement Product.

PubMed

Farahati, Farah; Nystrom, Scott; Howell, David R; Jaffe, Richard

2017-12-01

The US federal government invests in the development of medical countermeasures for addressing adverse health effects to the civilian population from chemical, biological, and radiological or nuclear threats. We model the potential economic spillover effects in day-to-day burn care for a federal investment in a burn debridement product for responding to an improvised nuclear device. We identify and assess 4 primary components for projecting the potential economic spillover benefits of a burn debridement product: (1) market size, (2) clinical effectiveness and cost-effectiveness, (3) product cost, and (4) market adoption rates. Primary data sources were the American Burn Association's 2015 National Burn Repository Annual Report of Data and published clinical studies used to gain European approval for the burn debridement product. The study results showed that if approved for use in the United States, the burn debridement product has potential economic spillover benefits exceeding the federal government's initial investment of $24 million a few years after introduction into the burn care market. Economic spillover analyses can help to inform the prioritizing of scarce resources for research and development of medical countermeasures by the federal government. Future federal medical countermeasure research and development investments could incorporate economic spillover analysis to assess investment options. (Disaster Med Public Health Preparedness. 2017;11:711-719).

Study of Burn Scar Extraction Automatically Based on Level Set Method using Remote Sensing Data

PubMed Central

Liu, Yang; Dai, Qin; Liu, JianBo; Liu, ShiBin; Yang, Jin

2014-01-01

Burn scar extraction using remote sensing data is an efficient way to precisely evaluate burn area and measure vegetation recovery. Traditional burn scar extraction methodologies have no well effect on burn scar image with blurred and irregular edges. To address these issues, this paper proposes an automatic method to extract burn scar based on Level Set Method (LSM). This method utilizes the advantages of the different features in remote sensing images, as well as considers the practical needs of extracting the burn scar rapidly and automatically. This approach integrates Change Vector Analysis (CVA), Normalized Difference Vegetation Index (NDVI) and the Normalized Burn Ratio (NBR) to obtain difference image and modifies conventional Level Set Method Chan-Vese (C-V) model with a new initial curve which results from a binary image applying K-means method on fitting errors of two near-infrared band images. Landsat 5 TM and Landsat 8 OLI data sets are used to validate the proposed method. Comparison with conventional C-V model, OSTU algorithm, Fuzzy C-mean (FCM) algorithm are made to show that the proposed approach can extract the outline curve of fire burn scar effectively and exactly. The method has higher extraction accuracy and less algorithm complexity than that of the conventional C-V model. PMID:24503563

Astaxanthin protects against early burn-wound progression in rats by attenuating oxidative stress-induced inflammation and mitochondria-related apoptosis

PubMed Central

Fang, Quan; Guo, Songxue; Zhou, Hanlei; Han, Rui; Wu, Pan; Han, Chunmao

2017-01-01

Burn-wound progression can occur in the initial or peri-burn area after a deep burn injury. The stasis zone has a higher risk of deterioration mediated by multiple factors but is also considered salvageable. Astaxanthin (ATX), which is extracted from some marine organisms, is a natural compound with a strong antioxidant effect that has been reported to attenuate organ injuries caused by traumatic injuries. Hence, we investigated the potential effects of ATX on preventing early burn-wound progression. A classic “comb” burn rat model was established in this study for histological and biological assessments, which revealed that ATX, particularly higher doses, alleviated histological deterioration in the stasis zone. Additionally, we observed dose-dependent improvements in oxidative stress and the release of inflammatory mediators after ATX treatment. Furthermore, ATX dose-dependently attenuated burn-induced apoptosis in the wound areas, and this effect was accompanied by increases in Akt and Bad phosphorylation and a downregulation of cytochrome C and caspase expression. In addition, the administration of Ly 294002 further verified the effect of ATX. In summary, we demonstrated that ATX protected against early burn-wound progression in a rat deep-burn model. This protection might be mediated by the attenuation of oxidative stress-induced inflammation and mitochondria-related apoptosis. PMID:28128352

Microstructural Characterization of High Burn-up Mixed Oxide Fast Reactor Fuel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Melissa C. Teague; Brian P. Gorman; Steven L. Hayes

2013-10-01

High burn-up mixed oxide fuel with local burn-ups of 3.4–23.7% FIMA (fissions per initial metal atom) were destructively examined as part of a research project to understand the performance of oxide fuel at extreme burn-ups. Optical metallography of fuel cross-sections measured the fuel-to-cladding gap, clad thickness, and central void evolution in the samples. The fuel-to-cladding gap closed significantly in samples with burn-ups below 7–9% FIMA. Samples with burn-ups in excess of 7–9% FIMA had a reopening of the fuel-to-cladding gap and evidence of joint oxide-gain (JOG) formation. Signs of axial fuel migration to the top of the fuel column weremore » observed in the fuel pin with a peak burn-up of 23.7% FIMA. Additionally, high burn-up structure (HBS) was observed in the two highest burn-up samples (23.7% and 21.3% FIMA). The HBS layers were found to be 3–5 times thicker than the layers found in typical LWR fuel. The results of the study indicate that formation of JOG and or HBS prevents any significant fuel-cladding mechanical interaction from occurring, thereby extending the potential life of the fuel elements.« less

Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey.

PubMed

Stewart, Barclay T; Lafta, Riyadh; Esa Al Shatari, Sahar A; Cherewick, Megan; Burnham, Gilbert; Hagopian, Amy; Galway, Lindsay P; Kushner, Adam L

2016-02-01

Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. A two-stage, cluster randomized, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. Nine-hundred households, totaling 5148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2340 serious burns (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burns generally increased post-invasion to 8780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn than children aged less than 13 years (aOR 2.42; 95%CI 1.08-5.44). Nineteen burns (35%) involved ≥ 20% body surface area. Death (16% of burns), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn. Civilian burn in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn. Ongoing conflict will directly and indirectly generates more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Burns in Baghdad from 2003–2014: results of a randomized household cluster survey

PubMed Central

Stewart, Barclay T; Lafta, Riyadh; Shatari, Sahar A Esa Al; Cherewick, Megan; Burnham, Gilbert; Hagopian, Amy; Galway, Lindsay P; Kushner, Adam L

2015-01-01

Purpose Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. Methods A two-stage, cluster randomized, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. Results Nine-hundred households, totaling 5,148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2,340 serious burn injures (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burn injuries generally increased post-invasion to 8,780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn injury than children aged less than 13 years (aOR 2.42; 95%CI 1.08 – 5.44). Nineteen burns (35%) involved ≥20% body surface area. Death (16% of burn injuries), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn injury. Conclusion Civilian burn injury in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn injury. Ongoing conflict will directly and indirectly generate more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance. PMID:26526376

Heat Effects of Promoters and Determination of Burn Criterion in Promoted Combustion Testing

NASA Technical Reports Server (NTRS)

Sparks, Kyle M.; Stoltzfus, Joel M.; Steinberg, Theodore A.; Lynn, David

2010-01-01

Promoted ignition testing (NASA Test 17) [1] is used to determine the relative flammability of metal rods in oxygen-enriched atmospheres. A promoter is used to ignite a metal sample rod, initiating sample burning. If a predetermined length of the sample burns, beyond the promoter, the material is considered flammable at the condition tested. Historically, this burn length has been somewhat arbitrary. Experiments were performed to better understand this test by obtaining insight into the effect a burning promoter has on the preheating of a test sample. Test samples of several metallic materials were prepared and coupled to fast-responding thermocouples along their length. Thermocouple measurements and test video were synchronized to determine temperature increase with respect to time and length along each test sample. A recommended flammability burn length, based on a sample preheat of 500 F, was determined based on the preheated zone measured from these tests. This length was determined to be 30 mm (1.18 in.). Validation of this length and its rationale are presented.

Inhaled methoxyflurane for pain and anxiety relief during burn wound care procedures: an Australian case series.

PubMed

Wasiak, Jason; Mahar, Patrick D; Paul, Eldho; Menezes, Hana; Spinks, Anneliese B; Cleland, Heather

2014-02-01

Pain is a common and significant feature of burn injury. The use of intravenous opioids forms the mainstay of procedural burn pain management, but in an outpatient setting, the demand for novel agents that do not require parenteral access, are easy to administer and have a rapid onset are urgently needed. One such agent is the inhaled anaesthetic agent, methoxyflurane (MF). The aim of this study was to conduct a pilot investigation into the clinical effectiveness of MF inhaler on pain and anxiety scores in patients undergoing burn wound care procedures in an outpatient setting. A prospective case series involved recruiting patients undergoing a burn wound care procedure in an ambulatory burn care setting. Pain and anxiety were assessed using numerical rating scales. Overall, median numerical pain rating score was significantly higher post-dressing [pre-dressing: 2; interquartile range (IQR): 1-3 versus post-dressing: 3; IQR 1·5-4; P = 0·01], whereas median numerical anxiety score significantly reduced following the dressing (pre-dressing: 5; IQR 4-7 versus post-dressing: 2; IQR 1-2; P < 0·001). Our study suggests that there is a role for MF in the pain management armamentarium in those undergoing burn care procedures in the ambulatory care setting. However, there is an urgent need for larger case series and randomised controlled trials to determine its overall clinical effectiveness. © 2012 The Authors. International Wound Journal © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Efficacy of newly formulated ointment containing 20% active antimicrobial honey in treatment of burn wound infections.

PubMed

Tasleem, Samiyah; Naqvi, Syed Baqir Shyum; Khan, Saadat Ali; Hashmi, Khursheed

2013-01-01

Honey has been familiar to possess antimicrobial potential to clear infection against burn wound infecting bacteria since ancient times. The objective of the study was to evaluate the efficacy of the newly formulated honey ointment during the treatment of burn wound infections. The Experimental (Non comparative) study was conducted at outpatient department of Dermatology, Fauji Foundation Hospital, Rawalpindi from November 2009 to October 2010. The antimicrobial activity of different Pakistani floral sources (Acacia nilotica species indica, Zizyphus, Helianthus annuus and Carisa opaca) honey samples were investigated by disc diffusion method against freshly isolated burn wounds infecting bacteria. Ointment containing 20% active antimicrobial honey was formulated as a sovereign remedy. A total number of twenty patients with second degree of burn wounds on different parts of the body were studied. A thin layer of honey ointment on gauze was applied to the wounds two to three times a day up to the complete healing. During microbiological study, Pakistani honey samples were discovered to exhibit a very promising antimicrobial activity against all the wound infecting microorganisms tested. Clinical trials demonstrated that the topical application of honey ointment have significant control of infections arising form pathogenic bacteria and up to 100% healing results were observed in all burn wound cases within mean healing time for the duration of 8.15 (3-18) days time period. Newly formulated ointment containing 20% active antimicrobial honey is more effective and low-cost alternative preparation for the treatment of burn wound infections.

Impact of a clinical trial initiative on clinical trial enrollment in a multidisciplinary prostate cancer clinic.

PubMed

Madsen, Lydia T; Kuban, Deborah A; Choi, Seungtaek; Davis, John W; Kim, Jeri; Lee, Andrew K; Domain, Delora; Levy, Larry; Pisters, Louis L; Pettaway, Curtis A; Ward, John F; Logothetis, Christopher; Hoffman, Karen E

2014-07-01

Clinical oncology trials are hampered by low accrual rates, with fewer than 5% of adult patients with cancer treated on study. Clinical trial enrollment was evaluated at The University of Texas MD Anderson Cancer Center's Multidisciplinary Prostate Cancer Clinic (MPCC) to assess whether a clinical trial initiative, introduced in 2006, impacted enrollment. The trial initiative included posting trial-specific information in clinic, educating patients about appropriate clinical trial options during the treatment recommendation discussion, and providing patients with trial-specific educational information. The investigators evaluated the frequency of clinical trial enrollment for men with newly diagnosed prostate cancer seen in the MPCC from 2004 to 2008. Logistic regression evaluated the impact of patient characteristics and the clinical trial initiative on trial enrollment. The median age of the 1370 men was 64 years; 32% had low-risk, 49% had intermediate-risk, and 19% had high-risk disease. Overall, 74% enrolled in at least one trial and 29% enrolled in more than one trial. Trial enrollment increased from 39% before the initiative (127/326) to 84% (880/1044) after the trial initiative. Patient enrollment increased in laboratory studies (from 25% to 80%), quality-of-life studies (from 10% to 26%), and studies evaluating investigational treatments and systemic agents (from 6% to 15%) after the trial initiative. In multivariate analysis, younger men (P<.001) and men seen after implementation of the clinical trial initiative (P<.001) were more likely to enroll in trials. Clinical trial enrollment in the MPCC was substantially higher than that seen nationally in adult patients with cancer, and enrollment rates increased after the introduction of a clinical trial initiative. Copyright © 2014 by the National Comprehensive Cancer Network.

Quantifying bacterial transfer from patients to staff during burns dressing and bed changes: implications for infection control.

PubMed

Bache, Sarah E; Maclean, Michelle; Gettinby, George; Anderson, John G; MacGregor, Scott J; Taggart, Ian

2013-03-01

Routine nursing activities such as dressing/bed changes increase bacterial dispersal from burns patients, potentially contaminating healthcare workers (HCW) carrying out these tasks. HCW thus become vectors for transmission of nosocomial infection between patients. The suspected relationship between %total body surface area (%TBSA) of burn and levels of bacterial release has never been fully established. Bacterial contamination of HCW was assessed by contact plate samples (n=20) from initially sterile gowns worn by the HCW during burns patient dressing/bed changes. Analysis of 24 gowns was undertaken and examined for relationships between %TBSA, time taken for activity, and contamination received by the HCW. Relationships between size of burn and levels of HCW contamination, and time taken for the dressing/bed change and levels of HCW contamination were best described by exponential models. Burn size correlated more strongly (R(2)=0.82, p<0.001) than time taken (R(2)=0.52, p<0.001), with levels of contamination received by the HCW. Contamination doubled with every 6-9% TBSA increase in burn size. Burn size was used to create a model to predict bacterial contamination received by a HCW carrying out bed/dressing changes. This may help with the creation of burn-specific guidelines on protective clothing worn by HCW caring for burns patients. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

A comparative analysis of potential impact area of common sugar cane burning methods

NASA Astrophysics Data System (ADS)

Hiscox, A. L.; Flecher, S.; Wang, J. J.; Viator, H. P.

2015-04-01

The negative effects of agricultural burning are well-known, although the actual impact area of different activities has not previously been quantified. An elastic backscatter lidar system was used to examine the impact-area size and dispersion of smoke generated from different types of sugarcane burning activities; pre-harvest (standing) burning and post-harvest (ground) burning. Experiments were conducted in the sugarcane harvest season of 2010 and 2011 at two locations in Louisiana, USA. Current dispersion theory would suggest that the primary difference between burn types would be primarily in the initial plume rise, but that the overall plume shape would remain the same. However, remotely sensed lidar data with the capability to measure plume dispersion and the short time dynamics of plume location showed pre-harvest (standing) burning produced a larger plume with greater rise and more spread within the 300 m of the plume, but a decrease in dispersion, but not concentration further downwind. Post-harvest (ground) burning produced a more traditional plume shape, but still exceeded impact area predictions near the source. Moreover, large changes in plume size can occur with small increases in wind speed. These are the first instrumented measurements of the meteorological effects of the different types of sugarcane burning. These results indicate that ground burning is preferable, but should be avoided in lower wind speed conditions.

Outcome of Burns Treated With Autologous Cultured Proliferating Epidermal Cells: A Prospective Randomized Multicenter Intrapatient Comparative Trial.

PubMed

Gardien, Kim L M; Marck, Roos E; Bloemen, Monica C T; Waaijman, Taco; Gibbs, Sue; Ulrich, Magda M W; Middelkoop, Esther

2016-01-01

Standard treatment for large burns is transplantation with meshed split skin autografts (SSGs). A disadvantage of this treatment is that healing is accompanied by scar formation. Application of autologous epidermal cells (keratinocytes and melanocytes) may be a suitable therapeutic alternative, since this may enhance wound closure and improve scar quality. A prospective, multicenter randomized clinical trial was performed in 40 adult patients with acute full thickness burns. On two comparable wound areas, conventional treatment with SSGs was compared to an experimental treatment consisting of SSGs in combination with cultured autologous epidermal cells (ECs) seeded in a collagen carrier. The primary outcome measure was wound closure after 5-7 days. Secondary outcomes were safety aspects and scar quality measured by graft take, scar score (POSAS), skin colorimeter (DermaSpectrometer) and elasticity (Cutometer). Wound epithelialization after 5-7 days was significantly better for the experimental treatment (71%) compared to the standard treatment (67%) (p = 0.034, Wilcoxon), whereas the take rates of the grafts were similar. No related adverse events were recorded. Scar quality was evaluated at 3 (n = 33) and 12 (n = 28) months. The POSAS of the observer after 3 and 12 months and of the patient after 12 months were significantly better for the experimental area. Improvements between 12% and 23% (p ≤ 0.010, Wilcoxon) were detected for redness, pigmentation, thickness, relief, and pliability. Melanin index at 3 and 12 months and erythema index at 12 months were closer to normal skin for the experimental treatment than for conventional treatment (p ≤ 0.025 paired samples t-test). Skin elasticity showed significantly higher elasticity (p = 0.030) in the experimental area at 3 months follow-up. We showed a safe application and significant improvements of wound healing and scar quality in burn patients after treatment with ECs versus SSGs only. The relevance of cultured autologous cells in treatment of extensive burns is supported by our current findings.

The Effect of Prescribed Burns and Wildfire on Vegetation in Bastrop State Park, TX

NASA Astrophysics Data System (ADS)

Justice, C. J.

2014-12-01

In 2011, central Texas had its worst drought since the 1950's. This, in conjunction with the strong winds produced by Tropical Storm Lee created conditions that made possible the Bastrop County Complex Fire in September 2011. These record-breaking wildfires burned over 95% of the 6,565-acre Bastrop State Park (BSP). Since 2003, BSP had been using prescribed burns as a management practice to reduce fuel load and prevent high severity wildfires. Although these prescribed fires did not prevent the 2011 wildfires they may have mitigated their effects. This study considered the effect of prescribed burn history and wildfire burn severity on vegetation recovery in BSP since the 2011 wildfire. The hypotheses of this study are that prescribed burn history and wildfire burn severity separately and jointly have affected post wildfire vegetation. To test these hypotheses, data were collected in 2013 from 46 plots across BSP using the Fire Effects Monitoring and Inventory (FIREMON) protocol to determine herbaceous plant density, shrub density, overstory density, and midstory tree density. Data were analyzed using analyses of variance (ANOVA) to determine the effects of prescribed fire and wildfire severity on these vegetation measurements. It was found that more severely burned plots had more herbaceous plants, fewer midstory trees, and lower shrub densities than less severely burned plots. Contrary to an initial hypotheses, there were few relationships between prescribed burn history and wildfire effects. The only significant effect detected for prescribed burning was the positive effect of prescribed fire on midstory tree density, but only for plots that were not severely burned in the wildfire. In this system, burn severity had a greater effect on post-wildfire vegetation than prescribed burns.

The treatment of mixing in core helium-burning models - III. Suppressing core breathing pulses with a new constraint on overshoot

NASA Astrophysics Data System (ADS)

Constantino, Thomas; Campbell, Simon W.; Lattanzio, John C.

2017-12-01

Theoretical predictions for the core helium burning phase of stellar evolution are highly sensitive to the uncertain treatment of mixing at convective boundaries. In the last few years, interest in constraining the uncertain structure of their deep interiors has been renewed by insights from asteroseismology. Recently, Spruit proposed a limit for the rate of growth of helium-burning convective cores based on the higher buoyancy of material ingested from outside the convective core. In this paper we test the implications of such a limit for stellar models with a range of initial mass and metallicity. We find that the constraint on mixing beyond the Schwarzschild boundary has a significant effect on the evolution late in core helium burning, when core breathing pulses occur and the ingestion rate of helium is fastest. Ordinarily, core breathing pulses prolong the core helium burning lifetime to such an extent that models are at odds with observations of globular cluster populations. Across a wide range of initial stellar masses (0.83 ≤ M/M⊙ ≤ 5), applying the Spruit constraint reduces the core helium burning lifetime because core breathing pulses are either avoided or their number and severity reduced. The constraint suggested by Spruit therefore helps to resolve significant discrepancies between observations and theoretical predictions. Specifically, we find improved agreement for R2 (the observed ratio of asymptotic giant branch to horizontal branch stars in globular clusters), the luminosity difference between these two groups, and in asteroseismology, the mixed-mode period spacing detected in red clump stars in the Kepler field.

Contributions of Severe Burn and Disuse to Bone Structure and Strength in Rats

PubMed Central

Baer, L.A.; Wu, X.; Tou, J. C.; Johnson, E.; Wolf, S.E.; Wade, C.E.

2012-01-01

Burn and disuse results in metabolic and bone changes associated with substantial and sustained bone loss. Such loss can lead to an increased fracture incidence and osteopenia. We studied the independent effects of burn and disuse on bone morphology, composition and strength, and microstructure of the bone alterations 14 days after injury. Sprague-Dawley rats were randomized into four groups: Sham/Ambulatory (SA), Burn/Ambulatory (BA), Sham/Hindlimb Unloaded (SH) and Burn/Hindlimb Unloaded (BH). Burn groups received a 40% total body surface area full-thickness scald burn. Disuse by hindlimb unloading was initiated immediately following injury. Bone turnover was determined in plasma and urine. Femur biomechanical parameters were measured by three-point bending tests and bone microarchitecture was determined by microcomputed tomography (uCT). On day 14, a significant reduction in body mass was observed as a result of burn, disuse and a combination of both. In terms of bone health, disuse alone and in combination affected femur weight, length and bone mineral content. Bending failure energy, an index of femur strength, was significantly reduced in all groups and maximum bending stress was lower when burn and disuse were combined. Osteocalcin was reduced in BA compared to the other groups, indicating influence of burn. The reductions observed in femur weight, BMC, biomechanical parameters and indices of bone formation are primarily responses to the combination of burn and disuse. These results offer insight into bone degradation following severe injury and disuse. PMID:23142361

Quantification of the volatile organic compounds in the smoke from prescribed burning and comparison with the occupational exposure limits

NASA Astrophysics Data System (ADS)

Barboni, T.; Santoni, P.-A.

2013-11-01

Prescribed burning represents a serious threat to the personnel fighting fires because of smoke inhalation. This study aims to increase the knowledge about foresters exposure to the prescribed burning smoke by focusing on exposure to volatile organic compounds (VOCs). We initially assessed the methodology for smoke sampling. Then, we identified potentially dangerous molecules among the VOCs identified at 4 prescribed burning sites located around Corsica. The values measured were very high, exceeding the exposure limits, particularly for benzene, phenol, and furfural, whose concentrations were above short-term exposure limit (STEL) values. In conclusion, obvious but necessary recommendations were made for the protection of the personnel involved in fighting fires on a professional basis.

Propagation of Cutaneous Thermal Injury: A Mathematical Model

PubMed Central

Xue, Chuan; Chou, Ching-Shan; Kao, Chiu-Yen; Sen, Chandan K.; Friedman, Avner

2012-01-01

Cutaneous burn wounds represent a significant public health problem with 500,000 patients per year in the U.S. seeking medical attention. Immediately after skin burn injury, the volume of the wound burn expands due to a cascade of chemical reactions, including lipid peroxidation chain reactions. Based on these chemical reactions, the present paper develops for the first time a three-dimensional mathematical model to quantify the propagation of tissue damage within 12 hours post initial burn. We use the model to investigate the effect of supplemental antioxidant vitamin E for stopping the propagation. We show, for example, that if the production rate of vitamin E is increased, post burn, by five times the natural production in a healthy tissue, then this would slow down the lipid peroxide propagation by at least 50%. Our model is formulated in terms of differential equations, and sensitivity analysis is performed on the parameters to ensure the robustness of the results. PMID:22211391

Efect of an educative action on relatives' knowledge about childhood burns at home.

PubMed

Gimeniz-Paschoal, Sandra Regina; Pereira, Débora Morais; Nascimento, Edinalva Neves

2009-01-01

This article aimed to evaluate the effect of an educative action on the knowledge of children's relatives about burns at home. Participants were 40 relatives of children under four years of age, equally divided between an intervention and control group. An initial interview was held, the educative action involved a folder about burns and, after one week, another interview took place. The answers were compared using Fisher's statistical test. In the first interview, 60 answers on risk situations were registered in the control group and 62 in the intervention group; in the second, the results increased to 61 and 80, respectively. In the first interview, 90% of the control group and 80% of the intervention group expressed the belief that childhood burns can be avoided; in the second, this indication decreased to 84% and increased to 100%, respectively. This study showed the importance of the advisory folder on burns at home.

40 CFR 266.110 - Waiver of DRE trial burn for boilers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... percent of fuel fired to the device shall be fossil fuel, fuels derived from fossil fuel, tall oil, or, if... comparable to fossil fuel. Such fuels are termed “primary fuel” for purposes of this section. (Tall oil is a...

40 CFR 266.110 - Waiver of DRE trial burn for boilers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... percent of fuel fired to the device shall be fossil fuel, fuels derived from fossil fuel, tall oil, or, if... comparable to fossil fuel. Such fuels are termed “primary fuel” for purposes of this section. (Tall oil is a...

40 CFR 266.110 - Waiver of DRE trial burn for boilers.

Code of Federal Regulations, 2012 CFR

2012-07-01

... percent of fuel fired to the device shall be fossil fuel, fuels derived from fossil fuel, tall oil, or, if... comparable to fossil fuel. Such fuels are termed “primary fuel” for purposes of this section. (Tall oil is a...

40 CFR 266.110 - Waiver of DRE trial burn for boilers.

Code of Federal Regulations, 2013 CFR

2013-07-01

... percent of fuel fired to the device shall be fossil fuel, fuels derived from fossil fuel, tall oil, or, if... comparable to fossil fuel. Such fuels are termed “primary fuel” for purposes of this section. (Tall oil is a...

40 CFR 266.110 - Waiver of DRE trial burn for boilers.

Code of Federal Regulations, 2011 CFR

2011-07-01

... percent of fuel fired to the device shall be fossil fuel, fuels derived from fossil fuel, tall oil, or, if... comparable to fossil fuel. Such fuels are termed “primary fuel” for purposes of this section. (Tall oil is a...

FIELD EXPERIENCE IN SAMPLING HAZARDOUS WASTE INCINERATORS

EPA Science Inventory

This paper is for presentation at the 77th annual meeting of the Air Pollution Control Association, June 24-29, 1984. The paper contains much useful, pragmatic information gained through numerous hazardous waste incinerator trial burn-type investigations performed for EPA by the ...

A numerical modeling investigation of erosion and debris flows following the 2016 Fish Fire in the San Gabriel Mountains, CA, USA

NASA Astrophysics Data System (ADS)

Tang, H.; McGuire, L.; Rengers, F. K.; Kean, J. W.; Staley, D. M.

2017-12-01

Wildfire significantly changes the hydrological characteristics of soil for a period of several years and increases the likelihood of flooding and debris flows during high-intensity rainfall in steep watersheds. Hazards related to post-fire flooding and debris flows increase as populations expand into mountainous areas that are susceptible to wildfire, post-wildfire flooding, and debris flows. However, our understanding of post-wildfire debris flows is limited due to a paucity of direct observations and measurements, partially due to the remote locations where debris flows tend to initiate. In these situations, numerical modeling becomes a very useful tool for studying post-wildfire debris flows. Research based on numerical modeling improves our understanding of the physical mechanisms responsible for the increase in erosion and consequent formation of debris flows in burned areas. In this contribution, we study changes in sediment transport efficiency with time since burning by combining terrestrial laser scanning (TLS) surveys of a hillslope burned during the 2016 Fish Fire with numerical modeling of overland flow and sediment transport. We also combine the numerical model with measurements of debris flow timing to explore relationships between post-wildfire rainfall characteristics, soil infiltration capacity, hillslope erosion, and debris flow initiation at the drainage basin scale. Field data show that an initial rill network developed on the hillslope, and became more efficient over time as the overall rill density decreased. Preliminary model results suggest that this can be achieved when flow driven detachment mechanisms dominate and raindrop-driven detachment is minimized. Results also provide insight into the hydrologic and geomorphic conditions that lead to debris flow initiation within recently burned areas.

Early and Late Acute Kidney Injury in Severely Burned Patients

PubMed Central

Witkowski, Wojciech; Kawecki, Marek; Surowiecka-Pastewka, Agnieszka; Klimm, Wojciech; Szamotulska, Katarzyna; Niemczyk, Stanisław

2016-01-01

Background This study evaluated factors influencing early and late occurrence of AKI in severely burned patients and assessed the relationship between time of occurrence of AKI and mortality of AKI patients. Material/Methods Renal function was evaluated at 3 time points: at admission, at the critical point or middle point of hospitalization, and at the endpoint for which death or a discharge from the center was considered. AKI criteria were: decrease in GFR of less than 60 ml/min at admission, decrease in GFR of more than 75% compared to baseline, and decrease in the daily diuresis of less than 500 ml/24 h. Results At admission, 15.1% of the patients had eGFR <60 ml/min. AKI occurred in 38.5% of cases. The occurrence of AKI was associated with: elderly age (p<0.001), female sex (p=0.017), overweight and obesity (p=0.055); extent and depth of burns, respiratory failure, low protein concentration (for all p<0.001), low blood pressure (p=0.014), and high WBC (p=0.010). Early AKI was detected in 28% of patients. Mortality was 100% with the initial GFR ≥60, 100% with the initial GFR <60 and early deterioration of renal function, 80% with the initial GFR <60 and late worsening, and 60% with the initial GFR <60 and no worsening. Late AKI was observed in 10% of patients and mortality in this group was 79.2%. Mortality in the entire group with AKI was 88.0% versus 24.5%. Conclusions The frequent occurrence of AKI, especially early, worsens the prognosis for survival. Assessment of renal function should be included in the prognostic scales for burned patients. PMID:27746455

Acute pavement burns: a unique subset of burn injuries: a five-year review of resource use and cost impact.

PubMed

Silver, Andrew G; Dunford, Gerrit M; Zamboni, William A; Baynosa, Richard C

2015-01-01

This study focuses on the hospital care of a rare subset of burn injuries caused by contact with environmentally heated pavement, to further understand the required use of resources. This article aims to show that pavement burns are typically more severe than their flame/scald counterparts. A retrospective review of patients admitted to the burn center with injuries suffered from contact with hot pavement was performed. Patients were stratified on the presence or absence of altered mental status (AMS) and additional inciting factors. A representative sample of similarly sized flame and scald wounds treated in the same time period was compiled for comparison. Those with pavement burns had a significantly greater requirement for operative intervention, repetitive debridements, overall cost/percent burned, and lengthier hospital stays than those with flame/scald burns. Pavement burn victims with AMS were significantly more likely to require an operation, a greater cost/percent burned, and longer hospital stays than those without AMS. Pavement burns are significantly worse than similarly sized scald/flame burns with regards to length of stay and total hospital costs, and the necessity of initial and repetitive operative intervention. These discrepancies are even greater in patients with AMS as a concomitant inciting factor. It is apparent that these wounds often continue to deepen during a patient's stay, likely because of continued pressure on the wounds while recumbent. As such, this article highly recommends pressure off-loading beds and more aggressive debridement in the treatment of these unique injuries.

Initial effects of prescribed fire on quality of soil solution and streamwater in the Southern Appalachian Mountains

Treesearch

Katherine J. Elliott; James M. Vose

2005-01-01

Prescribed burning is being used in the Conasauga River Watershed in southeastern Tennessee and northern Georgia by National Forest managers to restore degraded pine/oak communities. The purpose of these burns is to restore shortleaf pine (Pinus echinata Miller)/mixed-oak forests with more diverse understories, which include native bluestem grasses...

Foliar nitrogen content and tree growth after prescribed fire in ponderosa pine.

Treesearch

J.D. Landsberg; P.H. Cochran; M.M. Finck; R.E. Martin

1984-01-01

This initial study of prescribed burning in ponderosa pine (Pinus ponderosa Doug. ex Laws.) stands in central Oregon showed that all periodic annual growth increments were reduced for trees alive four growing seasons later. Height growth was reduced 8 percent in areas burned by fires with moderate fuel consumption and 18 percent in areas with high...

Emissions from biomass burning in the Yucatan [Discussions

Treesearch

R. Yokelson; J. D. Crounse; P. F. DeCarlo; T. Karl; S. Urbanski; E. Atlas; T. Campos; Y. Shinozuka; V. Kapustin; A. D. Clarke; A. Weinheimer; D. J. Knapp; D. D. Montzka; J. Holloway; P. Weibring; F. Flocke; W. Zheng; D. Toohey; P. O. Wennberg; C. Wiedinmyer; L. Mauldin; A. Fried; D. Richter; J. Walega; J. L. Jimenez; K. Adachi; P. R. Buseck; S. R. Hall; R. Shetter

2009-01-01

In March 2006 two instrumented aircraft made the first detailed field measurements of biomass burning (BB) emissions in the Northern Hemisphere tropics as part of the MILAGRO project. The aircraft were the National Center for Atmospheric Research C-130 and a University of Montana/US Forest Service Twin Otter. The initial emissions of up to 49 trace gas or particle...

Effects of understory prescribed burning on shortleaf pine (Pinus echinata Mill.)/mixed-hardwood forests

Treesearch

Katherine J. Elliott; James M. Vose

2005-01-01

We examined the effects of a single dormant season fire on overstory and understory species diversity and composition and tree seedling regeneration patterns the first and second years following a prescribed burn in the Conasauga River Watershed of southeastern Tennessee and northern Georgia. We asked: Can a single dormant season fire initiate a trajectory of overstory...

Prescribed burning in the Kings River Ecosystem Project Area: lessons learned

Treesearch

David S. McCandliss

2002-01-01

The prescribed fire program on the Sierra National Forest is in its infancy. Prescription burning was initiated in 1994 in two 32,000-acre watersheds in the Kings River District of the Sierra National Forest. Primary objectives are to return fire to a more historical role in forest ecosystems and to provide opportunities for scientists from the Pacific Southwest...

The effects of fepeated prescribed burning on Pinus ponderosa growth

Treesearch

David L. Peterson; Stephen S. Sackett; Lindsay J. Robinson; Sally M. Haase

1994-01-01

The effect of repeated prescribed burning on long term growth of Pinus ponderosa in northern Arizona was examined. Fire treatments for hazard reduction were initiated in 1976,and growthwas evaluated in 1988 for fire rotations of 1, 2, 4, 6, 8, and 10 years. Dendroecological analysis shows that there were only small changes in treegrowth (compared tocontrols) in the...

Effects of magnetization on fusion product trapping and secondary neutron spectraa)

NASA Astrophysics Data System (ADS)

Knapp, P. F.; Schmit, P. F.; Hansen, S. B.; Gomez, M. R.; Hahn, K. D.; Sinars, D. B.; Peterson, K. J.; Slutz, S. A.; Sefkow, A. B.; Awe, T. J.; Harding, E.; Jennings, C. A.; Desjarlais, M. P.; Chandler, G. A.; Cooper, G. W.; Cuneo, M. E.; Geissel, M.; Harvey-Thompson, A. J.; Porter, J. L.; Rochau, G. A.; Rovang, D. C.; Ruiz, C. L.; Savage, M. E.; Smith, I. C.; Stygar, W. A.; Herrmann, M. C.

2015-05-01

By magnetizing the fusion fuel in inertial confinement fusion (ICF) systems, the required stagnation pressure and density can be relaxed dramatically. This happens because the magnetic field insulates the hot fuel from the cold pusher and traps the charged fusion burn products. This trapping allows the burn products to deposit their energy in the fuel, facilitating plasma self-heating. Here, we report on a comprehensive theory of this trapping in a cylindrical DD plasma magnetized with a purely axial magnetic field. Using this theory, we are able to show that the secondary fusion reactions can be used to infer the magnetic field-radius product, BR, during fusion burn. This parameter, not ρR, is the primary confinement parameter in magnetized ICF. Using this method, we analyze data from recent Magnetized Liner Inertial Fusion experiments conducted on the Z machine at Sandia National Laboratories. We show that in these experiments BR ≈ 0.34(+0.14/-0.06) MG . cm, a ˜ 14× increase in BR from the initial value, and confirming that the DD-fusion tritons are magnetized at stagnation. This is the first experimental verification of charged burn product magnetization facilitated by compression of an initial seed magnetic flux.

40 CFR Table 5 to Subpart Llll of... - Summary of Reporting Requirements for New Sewage Sludge Incineration Units a

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Documentation for siting requirements. 4. Anticipated date of initial startup. § 60.4915(a). Notification of initial startup Prior to initial startup 1. Maximum design dry sewage sludge burning capacity2.... 4. Anticipated date of initial startup. 5. Site-specific monitoring plan. 6. The site-specific...

40 CFR Table 5 to Subpart Llll of... - Summary of Reporting Requirements for New Sewage Sludge Incineration Units a

Code of Federal Regulations, 2014 CFR

2014-07-01

.... Documentation for siting requirements. 4. Anticipated date of initial startup. § 60.4915(a). Notification of initial startup Prior to initial startup 1. Maximum design dry sewage sludge burning capacity2.... 4. Anticipated date of initial startup. 5. Site-specific monitoring plan. 6. The site-specific...

Debris flow initiation by runoff in a recently burned basin: Is grain-by-grain sediment bulking or en masse failure to blame?

NASA Astrophysics Data System (ADS)

McGuire, Luke A.; Rengers, Francis K.; Kean, Jason W.; Staley, Dennis M.

2017-07-01

Postwildfire debris flows are frequently triggered by runoff following high-intensity rainfall, but the physical mechanisms by which water-dominated flows transition to debris flows are poorly understood relative to debris flow initiation from shallow landslides. In this study, we combined a numerical model with high-resolution hydrologic and geomorphic data sets to test two different hypotheses for debris flow initiation during a rainfall event that produced numerous debris flows within a recently burned drainage basin. Based on simulations, large volumes of sediment eroded from the hillslopes were redeposited within the channel network throughout the storm, leading to the initiation of numerous debris flows as a result of the mass failure of sediment dams that built up within the channel. More generally, results provide a quantitative framework for assessing the potential of runoff-generated debris flows based on sediment supply and hydrologic conditions.

Debris flow initiation by runoff in a recently burned basin: Is grain-by-grain sediment bulking or en masse failure to blame?

USGS Publications Warehouse

McGuire, Luke; Rengers, Francis K.; Kean, Jason W.; Staley, Dennis M.

2017-01-01

Postwildfire debris flows are frequently triggered by runoff following high-intensity rainfall, but the physical mechanisms by which water-dominated flows transition to debris flows are poorly understood relative to debris flow initiation from shallow landslides. In this study, we combined a numerical model with high-resolution hydrologic and geomorphic data sets to test two different hypotheses for debris flow initiation during a rainfall event that produced numerous debris flows within a recently burned drainage basin. Based on simulations, large volumes of sediment eroded from the hillslopes were redeposited within the channel network throughout the storm, leading to the initiation of numerous debris flows as a result of the mass failure of sediment dams that built up within the channel. More generally, results provide a quantitative framework for assessing the potential of runoff-generated debris flows based on sediment supply and hydrologic conditions.

[Quadruple regimens using domestically manufactured drugs in gastritis and duodenal ulcer patients for Helicobacter pylori eradication: a perspective, multicenter, randomized controlled trial].

PubMed

Gao, Wen; Hu, Fulian; Cheng, Hong; Wang, Huahong; Yang, Yunsheng; Liang, Hao; Zhang, Shutian; Meng, Fandong; Cui, Meihua; Wei, Hong; Sheng, Jianqiu; An, Hejuan J; Jiang, Bo; Chen, Ye; Li, Yanqing; Zuo, Xiuli; Gong, Jun; Zhao, Ping; Dong, Lei; Wang, Bangmao; Jiang, Kai; Zhang, Guiying; Li, Jiansheng; Zhao, Ye; Gao, Hengjun; Yang, Li

2016-01-26

To observe the effects and safety of quadruple regimens including domestically manufactured rabeprazole used as first line/initial therapy for Helicobacter pylori(H.pylori) eradication in gastritis and duodenal ulcer patients, and to investigate the effects of extended use of bismuth after the quadruple therapy on eradication of H. pylori. From January to August 2013, 430 patients with chronic gastritis or duodenal ulcer who were confirmed as H. pylori positive in gastroscopy for upper gastrointestinal symptoms were enrolled from 12 centers in China for initial treatment using quadruple regimens for H. pylori eradication. The study was a prospective, multicenter, randomized double-blinded double-dummy parallel-controlled clinical trial. The 310 chronic gastritis patients were divided into 2 groups: group A1 was given quadruple regime (rabeprazole+ amoxicillin+ clarithromycin+ bismuth potassium citrate) for 10 days followed by bismuth-placebo for 21 days; group A2 was given the quadruple regimen for 10 days and then bismuth potassium citrate for 21 days. The duodenal ulcer patients were given the quadruple for 10 days, then rabeprazole for 14 days. All the patients took (13)C urea breath test to detect H. pylori 28 days after medicine withdrawal. Altogether 428 cases were enrolled and 404 completed the trial. The total eradication rate in the chronic gastritis patients was 85.1% (262/308, intention-to-treat (ITT)analysis), which was 81.7% (125/153, ITT) in the A1 group and 88.4% (137/155, ITT) in the A2 group; the eradication rate in the duodenal ulcer patients was 85.8% (103/120, ITT). No severe adverse effects were reported. The symptoms (pain, burning sensation, reflux, belching, nausea, and vomiting) improvement status was similar among A1 and A2 groups. The quadruple regimen using rabeprazole manufactured in China and administered for 10 days as first line/initial therapy in chronic gastritis and duodenal ulcer patients could achieve good H. pylori eradication rate. The extended use of bismuth after 10-day quadruple regimen might further improve the eradication rate. The regimens containing proton-pump inhibitor and bismuth may be well tolerated and safe in clinical application.

Health-related quality of life (EQ-5D) early after injury predicts long-term pain after burn.

PubMed

Gauffin, Emelie; Öster, Caisa; Sjöberg, Folke; Gerdin, Bengt; Ekselius, Lisa

2016-12-01

Chronic pain after burn can have severe physical and psychological effects on former patients years after the initial injury. Although the issue of pain after burn has gained increased attention over the past years, prospective, longitudinal studies are scarce. Our aim was to prospectively investigate consecutive burn patients for pain severity over time and to evaluate the prevalence and characteristics of post-burn pain to 2-7 years after the burn. As an additional aim, the effects of burn and individual-related factors, especially health-related Quality of Life (HRQoL), were investigated. Sixty-seven consecutive burn patients were assessed during acute care at 3, 6, 12 and 24 months, as well as at 2-7 years post-burn. HRQoL, symptoms of post-traumatic stress disorder (PTSD) and other psychiatric disorders were investigated. During the interviews that took place 2-7 years after the injury (mean 4.6±1.9 years), current chronic post-burn pain was assessed using the Brief Pain Inventory-Short Form (BPI-SF). One-third of the patients still reported pain 2-7 years after the injury. Pain severity and interference with daily life were mainly mild to moderate though they were found to be associated with significantly lower HRQoL. Chronic pain after burn was associated with both burn- and individual-related factors. In logistic regression analysis HRQoL at 3 and 12 months and symptoms of PTSD at 12 months were independent factors in predicting chronic pain after burn. Pain after burn becomes a chronic burden for many former burn patients and decreases HRQoL. A novel finding in this study was that HRQoL assessed early after burn was a predictor for the development of chronic pain. This finding may help to predict future pain problems and serve as an indicator for pain preventive measures. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review.

PubMed

Morris, Linzette Deidré; Louw, Quinette Abegail; Grimmer-Somers, Karen

2009-01-01

To systematically review the current evidence for the effectiveness of Virtual Reality (VR), in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. A comprehensive search was conducted between December 2007 and January 2008, and updated in January 2009, before publication. Computerized bibliographic databases were individually searched using specifically developed search strategies to identify eligible studies. Nine studies were deemed eligible for inclusion in this review. Wound dressing changes was the most common procedure during which VR was trialed. Pain was the primary outcome measure in all of the studies included. Anxiety was a secondary outcome measure in 3 of the 9 included studies. VR, in conjunction with pharmacologic analgesics, significantly reduced pain experienced by burn injury patients during wound dressing changes and physiotherapy. There is equivocal evidence for the effect of VR in conjunction with pharmacologic analgesics on reducing anxiety in burn injury patients during wound dressing changes and physiotherapy. This is the first known systematic review to report on the effectiveness of VR, in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. Used as an adjunct to the current burn pain management regimens, VR could possibly assist health professionals in making the rehabilitation process for burn patients less excruciating, thereby improving functional outcomes. Further research investigating the effect of VR on anxiety in burn injury patients is warranted.

The effect of levamisole on mortality rate among patients with severe burn injuries

PubMed Central

Fatemi, Mohammad Javad; Salehi, Hamid; Akbari, Hossein; Alinejad, Faranak; Saberi, Mohsen; Mousavi, Seyed Jaber; Soltani, Majid; Taghavi, Shahrzad; Payandan, Hossein

2013-01-01

Background: Burn injuries are one of the main causes of mortality and morbidity throughout the world and burn patients have higher chances for infection due to their decreased immune resistance. Levamisole, as an immunomodulation agent, stimulates the immune response against infection. Materials and Methods: This randomized clinical trial was conducted in Motahari Burn Center, Tehran, Iran. Patients who had second- or third-degree burn with involvement of more than 50% of total body surface area (TBSA) were studied. The levamisole group received levamisole tablet, 100 mg per day. Meantime, both the levamisole and control groups received the standard therapy of the Burn Center, based on a standard protocol. Then, the outcome of the patients was evaluated. Results: 237 patients entered the study. After excluding 42 patients with inhalation injury, electrical and chemical burns, and the patients who died in the first 72 h, 195 patients remained in the study, including 110 patients in the control group and 85 in the treatment group. The mean age of all patients (between 13 to 64 years) was 33.29 ± 11.39 years (Mean ± SD), and it was 33.86 ± 11.45 years in the control group and 32.57 ± 11.32 years in the treatment group. The mean percentage of TBSA burn was 64.50 ± 14.34 and 68.58 ± 14.55 for the levamisole and control groups, respectively, with the range of 50-100% and 50-95% TBSA. The mortality rate was 68 (61.8%) patients in the control group and 50 (58.8%) patients in the treatment group (P = 0.8). Conclusion: According to this study, there was no significant relationship between improvement of mortality and levamisole consumption. PMID:24381625

Propranolol and Oxandrolone Therapy Accelerated Muscle Recovery in Burned Children.

PubMed

Chao, Tony; Porter, Craig; Herndon, David N; Siopi, Aikaterina; Ideker, Henry; Mlcak, Ronald P; Sidossis, Labros S; Suman, Oscar E

2018-03-01

Severe burns result in prolonged hypermetabolism and skeletal muscle catabolism. Rehabilitative exercise training (RET) programs improved muscle mass and strength in severely burned children. The combination of RET with β-blockade or testosterone analogs showed improved exercise-induced benefits on body composition and muscle function. However, the effect of RET combined with multiple drug therapy on muscle mass, strength, cardiorespiratory fitness, and protein turnover are unknown. In this placebo-controlled randomized trial, we hypothesize that RET combined with oxandrolone and propranolol (Oxprop) will improve muscle mass and function and protein turnover in severely burned children compared with burned children undergoing the same RET with a placebo. We studied 42 severely burned children (7-17 yr) with severe burns over 30% of the total body surface area. Patients were randomized to placebo (22 control) or to Oxprop (20) and began drug administration within 96 h of admission. All patients began RET at hospital discharge as part of their standardized care. Muscle strength (N·m), power (W), V˙O2peak, body composition, and protein fractional synthetic rate and fractional breakdown rate were measured pre-RET (PRE) and post-RET (POST). Muscle strength and power, lean body mass, and V˙O2peak increased with RET in both groups (P < 0.01). The increase in strength and power was significantly greater in Oxprop versus control (P < 0.01), and strength and power was greater in Oxprop over control POST (P < 0.05). Fractional synthetic rate was significantly higher in Oxprop than control POST (P < 0.01), resulting in improved protein net balance POST (P < 0.05). Rehabilitative exercise training improves body composition, muscle function, and cardiorespiratory fitness in children recovering from severe burns. Oxprop therapy augments RET-mediated improvements in muscle strength, power, and protein turnover.

HANDBOOK: GUIDANCE ON SETTING PERMIT CONDITIONS AND REPORTING TRIAL BURN RESULTS

EPA Science Inventory

This Handbook provides guidance for establishing operational conditions for incinerators. he document provides a means for state and local agencies to achieve a level of consistency in setting permit conditions that will result in establishment of more uniform permit conditions n...

A double-blind study on clonazepam in patients with burning mouth syndrome.

PubMed

Heckmann, Siegfried M; Kirchner, Elena; Grushka, Miriam; Wichmann, Manfred G; Hummel, Thomas

2012-04-01

In the treatment of burning mouth syndrome (BMS), various approaches have been tried with equivocal results. The aim of the present randomized clinical trial was to determine the efficacy of clonazepam, a GABA agonist designed as an antiepileptic drug that exerts the typical effects of benzodiazepines. Randomized clinical trial. Twenty patients with idiopathic BMS were carefully selected. Clonazepam (0.5 mg/day, n = 10) or placebo (lactose, n = 10) were randomly assigned to the patients. Patients on clonazepam significantly improved in pain ratings (P < .001). These changes were less pronounced in the placebo group (P < .11). No significant changes were observed in a mood scale (P = .56) or for depression scores (P = .56). Taste test and salivary flow increased over sessions, but were not different between groups (P = .83 and P = .06, respectively). Clonazepam appears to have a positive effect on pain in BMS patients. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Biomass Burning and the Production of Greenhouse Gases. Chapter 9

NASA Technical Reports Server (NTRS)

Levine, Joel S.

1994-01-01

Biomass burning is a source of greenhouse gases, carbon dioxide, methane, and nitrous oxide. In addition, biomass burning is a source of chemically active gases, including carbon monoxide, nonmethane hydrocarbons, and nitric oxide. These gases, along with methane, lead to the chemical production of tropospheric ozone (another greenhouse gas) as well as control the concentration of the hydroxyl radical, which regulates the lifetime of almost every atmospheric gas. Following biomass burning, biogenic emissions of nitrous oxide, nitric oxide, and methane are significantly enhanced. It is hypothesized that enhanced postburn biogenic emissions of these gases are related to fire-induced changes in soil chemistry and/or microbial ecology. Biomass burning, once believed to be a tropical phenomenon, has been demonstrated by satellite imagery to also be a regular feature of the world's boreal forests. One example of biomass burning is the extensive 1987 fire that destroyed more than 12 million acres of boreal forest in the People's Republic of China and across its border in the Soviet Union. Recent estimates indicate that almost all biomass burning is human-initiated and that it is increasing with time. With the formation of greenhouse and chemically active gases as direct combustion products and a longer-term enhancement of biogenic emissions of gases, biomass burning may be a significant driver for global change.

The Synthesis of 44Ti and 56Ni in Massive Stars

NASA Astrophysics Data System (ADS)

Chieffi, Alessandro; Limongi, Marco

2017-02-01

We discuss the influence of rotation on the combined synthesis of {}44{Ti} and {}56{Ni} in massive stars. While {}56{Ni} is significantly produced by both complete and incomplete explosive Si burning, {}44{Ti} is mainly produced by complete explosive Si burning, with a minor contribution (in standard non-rotating models) from incomplete explosive Si burning and O burning (both explosive and hydrostatic). We find that, in most cases, the thickness of the region exposed to incomplete explosive Si burning increases in rotating models (initial velocity, v ini = 300 km s-1) and since {}56{Ni} is significantly produced in this zone, the fraction of mass coming from the complete explosive Si burning zone necessary to get the required amount of {}56{Ni} reduces. Therefore the amount of {}44{Ti} ejected for a given fixed amount of {}56{Ni} decreases in rotating models. However, some rotating models at [Fe/H] = -1 develop a very extended O convective shell in which a consistent amount of {}44{Ti} is formed, preserved, and ejected in the interstellar medium. Hence a better modeling of the thermal instabilities (convection) in the advanced burning phases together with a critical analysis of the cross sections of the nuclear reactions operating in O burning are relevant for the understanding of the synthesis of {}44{Ti}.

Gut microbiota trajectory in patients with severe burn: A time series study.

PubMed

Wang, Xinying; Yang, Jianbo; Tian, Feng; Zhang, Li; Lei, Qiucheng; Jiang, Tingting; Zhou, Jihong; Yuan, Siming; Wang, Jun; Feng, Zhijian; Li, Jieshou

2017-12-01

This time series experiments aimed to investigate the dynamic change of gut microbiomes after severe burn and its association with enteral nutrition (EN). Seven severely burned patients who suffered from a severe metal dust explosion injury were recruited in this study. The dynamic changes of gut microbiome of fecal samples at six time points (1-3days, 2, 3, 4, 5 and 6weeks after severe burn) were detected using 16S ribosomal RNA pyrosequencing technology. Following the post-burn temporal order, gut microbiota dysbiosis was detected in the gut microbiome after severe burn, then it was gradually resolved. The bio-diversity of gut bacteria was initially decreased, and then returned to normal level. In addition, at the early stage (from 2 to 4weeks), the majority of those patients' gut microbiome were opportunistic pathogen genus, Enterococcus and Escherichia; while at the end of this study, the majority was a beneficial genus, Bacteroides. EN can promote the recovery of gut microbiota, especially in EN well-tolerated patients. Severe burn injury can cause a dramatic dysbiosis of gut microbiota. A trend of enriched beneficial bacteria and diminished opportunistic pathogen bacteria may serve as prognosis microbiome biomarkers of severe burn patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Estrogen treatment of acetic acid burns to the vagina, cervix, and perineum: a case report and review of the literature.

PubMed

Ching, Jessica A; Kuykendall, Lauren V; Troy, Jared S; Smith, David J

2014-01-01

In colposcopic evaluation of the cervix, acetic acid of 3 to 5% is commonly used for identification of preneoplastic and neoplastic cells. Acetic acid is a known caustic substance and has the potential to cause irritation and chemical burns when there is sufficient concentration or duration of contact. The authors present a unique case of a woman who inadvertently received undiluted acetic acid during a routine colposcopy, resulting in significant chemical burns of the vagina, cervix, and perineum. Her burns were treated with topical estrogen cream of 1 g twice daily applied directly to the wounds. The burn wounds were fully healed within 8 weeks without complication or additional treatment. At 6 months after the injury, the patient was allowed to engage in sexual activity, and vaginal dilation and pelvic floor therapy were initiated. At 12 months postinjury, her only symptomatic scarring at the left vaginal wall continues to improve. Thus, topical estrogen treatment of 1 g applied twice daily should be continued until burn scar maturation is complete and treatment improvement plateaus in cases of burns to the vagina, cervix, and perineum. This case is further clinical evidence of estrogen's positive effect on wound healing and its potential role in burn treatment.

Applications of virtual reality for pain management in burn-injured patients

PubMed Central

Miller, William; Teeley, Aubriana; Soltani, Maryam; Hoffman, Hunter G; Jensen, Mark P; Patterson, David R

2009-01-01

The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, depression and other complicating patient factors. On top of this, modern burn care involves the repetitive performance – often on a daily basis for weeks to months – of painful and anxiety-provoking procedures that create additional treatment-related pain, such as wound care, dressing changes and rehabilitation activities. Pain management in burn patients is primarily achieved by potent pharmacologic analgesics (e.g., opioids), but is necessarily complemented by nonpharmacologic techniques, including distraction or hypnosis. Immersive virtual reality provides a particularly intense form of cognitive distraction during such brief, painful procedures, and has undergone preliminary study by several research groups treating burn patients over the past decade. Initial reports from these groups are consistent in suggesting that immersive virtual reality is logistically feasible, safe and effective in ameliorating the pain and anxiety experienced in various settings of post-burn pain. Furthermore, the technique appears applicable to a wide age range of patients and may be particularly well-adapted for use in children, one of the most challenging populations of burn victims to treat. However, confirmation and extension of these results in larger numbers of patients in various types of burn-related pain is necessary to more clearly define the specific benefits and limitations of virtual reality analgesia in the burn care setting. PMID:18986237

A prospective observational study investigating all children presenting to a specialty paediatric burns centre.

PubMed

Stockton, K A; Harvey, J; Kimble, R M

2015-05-01

The aim of this study was to describe the mechanism of injury and outcome of all children who presented to The Stuart Pegg Paediatric Burns Centre (SPPBC) with a burn injury in the year 2013. A detailed proforma was completed prospectively at time of presentation to hospital. During the one year period, 758 children with a median age of 2 years 3 months presented with a burn injury. Overall, 12.7% of patients (n=96) were initially treated as inpatients. Similarities existed between in and outpatients. Over half the children admitted had a scald injury (53.1%). Whilst slightly higher than the outpatient scald rate of 43.1% there was no statistical significant difference. However, there was a significant difference between inpatients and outpatients with respect to other mechanisms of injury. Contact burns were under represented in inpatients (27.1%) compared to outpatients (44.5%), p<0.05. In contrast, flame burns were over represented in inpatients, 11.5% compared to outpatients, 2.9% (p<0.05). Paediatric burns are a common cause of childhood injury. The majority of children present with small to medium sized partial thickness injuries and are managed as outpatients. In order to understand the true impact of paediatric burn injury and to develop appropriate targeted injury prevention campaigns, data repositories must include detailed information regarding outpatient paediatric burns. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Black Saturday: the immediate impact of the February 2009 bushfires in Victoria, Australia.

PubMed

Cameron, Peter A; Mitra, Biswadev; Fitzgerald, Mark; Scheinkestel, Carlos D; Stripp, Andrew; Batey, Chris; Niggemeyer, Louise; Truesdale, Melinda; Holman, Paul; Mehra, Rishi; Wasiak, Jason; Cleland, Heather

2009-07-06

To examine the response of the Victorian State Trauma System to the February 2009 bushfires. A retrospective review of the strategic response required to treat patients with bushfire-related injury in the first 72 hours of the Victorian bushfires that began on 7 February 2009. Emergency department (ED) presentations and initial management of patients presenting to the state's adult burns centre (The Alfred Hospital [The Alfred]) were analysed, as well as injuries and deaths associated with the fires. There were 414 patients who presented to hospital EDs as a result of the bushfires. Patients were triaged at the emergency scene, at treatment centres and in hospital. National and statewide burns disaster plans were activated. Twenty-two patients with burns presented to the state's burns referral centres, of whom 18 were adults. Adult burns patients at The Alfred spent 48.7 hours in theatre in the first 72 hours. There were a further 390 bushfire-related ED presentations across the state in the first 72 hours. Most patients with serious burns were triaged to and managed at burns referral centres. Throughout the disaster, burns referral centres continued to have substantial surge capacity. Most bushfire victims either died, or survived with minor injuries. As a result of good prehospital triage and planning, the small number of patients with serious burns did not overload the acute health care system.

Results of Propellant Mixing Variable Study Using Precise Pressure-Based Burn Rate Calculations

NASA Technical Reports Server (NTRS)

Stefanski, Philip L.

2014-01-01

A designed experiment was conducted in which three mix processing variables (pre-curative addition mix temperature, pre-curative addition mixing time, and mixer speed) were varied to estimate their effects on within-mix propellant burn rate variability. The chosen discriminator for the experiment was the 2-inch diameter by 4-inch long (2x4) Center-Perforated (CP) ballistic evaluation motor. Motor nozzle throat diameters were sized to produce a common targeted chamber pressure. Initial data analysis did not show a statistically significant effect. Because propellant burn rate must be directly related to chamber pressure, a method was developed that showed statistically significant effects on chamber pressure (either maximum or average) by adjustments to the process settings. Burn rates were calculated from chamber pressures and these were then normalized to a common pressure for comparative purposes. The pressure-based method of burn rate determination showed significant reduction in error when compared to results obtained from the Brooks' modification of the propellant web-bisector burn rate determination method. Analysis of effects using burn rates calculated by the pressure-based method showed a significant correlation of within-mix burn rate dispersion to mixing duration and the quadratic of mixing duration. The findings were confirmed in a series of mixes that examined the effects of mixing time on burn rate variation, which yielded the same results.

Scald burns in children aged 14 and younger in Australia and New Zealand—an analysis based on the Burn Registry of Australia and New Zealand (BRANZ).

PubMed

Riedlinger, Dorothee I; Jennings, Paul A; Edgar, Dale W; Harvey, John G; Cleland, Ms Heather J; Wood, Fiona M; Cameron, Peter A

2015-05-01

Scalds are a common injury in children and a frequent reason for hospitalisation despite being a preventable injury. This retrospective two year study reports data from 730 children aged 14 years or younger who sustained a scald between 2009 and 2010 and were admitted to a burns centre in Australia or New Zealand. Data were extracted from the Burn Registry of Australia and New Zealand (BRANZ), which included data from 13 burns centres in Australia and New Zealand. Scald injury contributed 56% (95% CI 53-59%) of all pediatric burns. There were two high risk groups; male toddlers age one to two, contributing 34% (95% CI 31-38%) of all scalds, and indigenous children who were over 3 times more likely to experience a scald requiring admission to a burns unit than their non-indigenous peers. First aid cooling by non-professionals was initiated in 89% (95% CI 86-91%) of cases but only 20% (95% CI 16-23%) performed it as recommended. This study highlights that effective burn first aid reduces hospital stay and reinforces the need to encourage, carers and bystanders to deliver effective first aid and the importance of targeted prevention campaigns that reduce the burden of pediatric scald burns in Australia and New Zealand. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Effect of low-level laser therapy on the healing process of donor site in patients with grade 3 burn ulcer after skin graft surgery (a randomized clinical trial).

PubMed

Vaghardoost, Reza; Momeni, Mahnoush; Kazemikhoo, Nooshafarin; Mokmeli, Soheila; Dahmardehei, Mostafa; Ansari, Fereshteh; Nilforoushzadeh, Mohammad Ali; Sabr Joo, Parisa; Mey Abadi, Sara; Naderi Gharagheshlagh, Soheila; Sassani, Saeed

2018-04-01

Skin graft is a standard therapeutic technique in patients with deep ulcers, but managing donor site after grafting is very important. Although several modern dressings are available to enhance the comfort of donor site, using techniques that accelerate wound healing may enhance patient satisfaction. Low-level laser therapy (LLLT) has been used in several medical fields, including healing of diabetic, surgical, and pressure ulcers, but there is not any report of using this method for healing of donor site in burn patients. The protocols and informed consent were reviewed according to Medical Ethics Board of Shahid Beheshti University of Medical Sciences (IR.SBMU.REC.1394.363) and Iranian Registry of Clinical Trials (IRCT2016020226069N2). Eighteen donor sites in 11 patients with grade 3 burn ulcer were selected. Donor areas were divided into 2 parts, for laser irradiation and control randomly. Laser area was irradiated by a red, 655-nm laser light, 150 mW, 2 J/cm 2 , on days 0 (immediately after surgery), 3, 5, and 7. Dressing and other therapeutic care for both sites were the same. The patients and the person who analyzed the results were blinded. The size of donor site reduced in both groups during the 7-day study period (P < 0.01) and this reduction was significantly greater in the laser group (P = 0.01). In the present study, for the first time, we evaluate the effects of LLLT on the healing process of donor site in burn patients. The results showed that local irradiation of red laser accelerates wound healing process significantly.

Comparison Between Surf and Multi-Shock Forest Fire High Explosive Burn Models

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greenfield, Nicholas Alexander

PAGOSA1 has several different burn models used to model high explosive detonation. Two of these, Multi-Shock Forest Fire and Surf, are capable of modeling shock initiation. Accurately calculating shock initiation of a high explosive is important because it is a mechanism for detonation in many accident scenarios (i.e. fragment impact). Comparing the models to pop-plot data give confidence that the models are accurately calculating detonation or lack thereof. To compare the performance of these models, pop-plots2 were created from simulations where one two cm block of PBX 9502 collides with another block of PBX 9502.

Inhibition of Na+/H+ exchanger 1 by cariporide reduces burn-induced intestinal barrier breakdown.

PubMed

Yang, Xuekang; Chen, Ji; Bai, Hua; Tao, Ke; Zhou, Qin; Hou, Hongyi; Hu, Dahai

2013-12-01

Severe burns initiate an inflammatory cascade within the gut, which leads to intestinal mucosal injury. Although Na(+)/H(+) exchanger 1 (NHE1) is recognised as a pivotal player in several inflammatory processes, its role in burn-induced intestinal injury is relatively unknown. We hypothesised that NHE1 might be involved in the increased intestinal permeability and barrier breakdown after severe burns. Thus, we here investigate whether the inhibition of NHE1 has a protective effect on burn-induced intestinal injury. Mice were subjected to a 30% total body surface area (TBSA) full-thickness steam burn. Cariporide was used to assess the function of NHE1 in mice with burn-induced intestinal injury by fluorescence spectrophotometry, Western blotting and enzyme linked immunosorbent assay (ELISA). We found that severe burn increased intestinal permeability, associated with the up-regulation of NHE1 and raised inflammatory cytokine levels. Mice treated with the NHE1 inhibitor cariporide had significantly attenuated burn-induced intestinal permeability and a reduced inflammatory response. NHE1 inhibition also reduced nuclear factor-κB (NF-κB) activation and attenuated p38 mitogen-activated protein kinase (MAPK) phosphorylation. Our study suggests that NHE1 plays an important role in burn-induced intestinal permeability through the regulation of the inflammatory response. Inhibition of NHE1 may be adopted as a potential therapeutic strategy for attenuating intestinal barrier breakdown. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

In vivo terahertz imaging of rat skin burns

NASA Astrophysics Data System (ADS)

Tewari, Priyamvada; Kealey, Colin P.; Bennett, David B.; Bajwa, Neha; Barnett, Kelli S.; Singh, Rahul S.; Culjat, Martin O.; Stojadinovic, Alexander; Grundfest, Warren S.; Taylor, Zachary D.

2012-04-01

A reflective, pulsed terahertz (THz) imaging system was used to acquire high-resolution (d10-90/ λ~1.925) images of deep, partial thickness burns in a live rat. The rat's abdomen was burned with a brass brand heated to ~220°C and pressed against the skin with contact pressure for ~10 sec. The burn injury was imaged beneath a Mylar window every 15 to 30 min for up to 7 h. Initial images display an increase in local water concentration of the burned skin as evidenced by a marked increase in THz reflectivity, and this likely correlates to the post-injury inflammatory response. After ~1 h the area of increased reflectivity consolidated to the region of skin that had direct contact with the brand. Additionally, a low reflecting ring of tissue could be observed surrounding the highly reflective burned tissue. We hypothesize that these regions of increased and decreased reflectivity correlate to the zones of coagulation and stasis that are the classic foundation of burn wound histopathology. While further investigations are necessary to confirm this hypothesis, if true, it likely represents the first in vivo THz images of these pathologic zones and may represent a significant step forward in clinical application of THz technology.

Rice cooker steam hand burn in the pediatric patient.

PubMed

Roh, T S; Kim, Y S; Burm, J S; Chung, C H; Kim, J B; Oh, S J

2000-07-01

Burn injuries often lead to significant cosmetic and functional deformity. In the Orient, household electric rice cookers have caused a significant number of steam burns to infant hands. The clinical course and treatment outcome of these burns have been studied retrospectively in a review of the medical records of 79 pediatric patients treated for acute hand steam burns and of 38 other patients who underwent correction for postburn contracture. Electric rice cookers caused all of the acute pediatric steam burns treated at our institute. Of the 81 hands treated between 1995 and 1998, 38.3 percent healed with conservative treatment and 61.7 percent required skin grafting. The volar aspects of the index and middle fingers were those most frequently involved. Eighteen of 36 hands (50 percent) grafted with split-thickness skin developed late contractures requiring additional procedures. Among the 38 patients who underwent correction for postburn deformity, initial treatment was split-thickness grafting for 60.5 percent, full-thickness skin grafting for 7.9 percent, and spontaneous healing for 31.6 percent. Awareness among medical personnel and continued public education should be promoted to help prevent this unique type of pediatric steam burn from occurring.

[The Nutrition Care of Severe Burn Patients].

PubMed

Hsieh, Yu-Hsiu

2016-02-01

In addition to recent advances in burn patient care techniques such as maintaining warm circumambient temperature, the early excision of wounds, and the use of closed dressing, providing nutrition support through early feeding has proven instrumental in greatly increasing the survival rate of burn patients. Severe burns complicated by many factors initiate tremendous physiological stress that leads to postburn hypermetabolism that includes enhanced tissue catabolism, the loss of muscle mass, and decreases in the body's reservoirs of protein and energy. These problems have become the focus of burn therapy. Treating severe burns aims not only to enhance survival rates but also to restore normal bodily functions as completely as possible. Recent research evaluating the application of anabolic agents and immune-enhance formula for severe burns therapy has generated significant controversy. Inadequate caloric intake is one of the main differences among the related studies, with the effect of many special nutrients such as bran acid amides not taken into consideration. Therefore, considering the sufficiency of caloric and protein intake is critical in assessing effectiveness. Only after patients receive adequate calories and protein may the effect of special nutrients such as glutamine and supplements be evaluated effectively.

The effect of azeotropism on combustion characteristics of blended fuel pool fire.

PubMed

Ding, Yanming; Wang, Changjian; Lu, Shouxiang

2014-04-30

The effect of azeotropism on combustion characteristics of blended fuel pool fire was experimentally studied in an open fire test space of State Key Laboratory of Fire Science. A 30 cm × 30 cm square pool filled with n-heptane and ethanol blended fuel was employed. Flame images, burning rate and temperature distribution were collected and recorded in the whole combustion process. Results show that azeotropism obviously dominates the combustion behavior of n-heptane/ethanol blended fuel pool fire. The combustion process after ignition exhibits four typical stages: initial development, azeotropic burning, single-component burning and decay stage. Azeotropism appears when temperature of fuel surface reaches azeotropic point and blended fuel burns at azeotropic ratio. Compared with individual pure fuel, the effect of azeotropism on main fire parameters, such as flame height, burning rate, flame puffing frequency and centerline temperature were analyzed. Burning rate and centerline temperature of blended fuel are higher than that of individual pure fuel respectively at azeotropic burning stage, and flame puffing frequency follows the empirical formula between Strouhal and Froude number for pure fuel. Copyright © 2014 Elsevier B.V. All rights reserved.

Investigation of critical burning of fuel droplets

NASA Technical Reports Server (NTRS)

Allison, C. B.; Canada, G. S.; Faeth, G. M.

1972-01-01

Measurements were made on the burning of liquid hydrazine, MMH, and UDMH in a combustion gas environment. The experimental range of these tests involved gas temperatures of 1660-2530 K, oxygen concentrations of 0-42% by mass and droplet diameters (employing both droplets and porous spheres) of 0.11-1.91 cm. at atmospheric pressure. A simplified hybrid combustion theory was developed which was found to correlate the present results as well as the experimental measurements of other investigators. Measurements were also made of the monopropellant strand burning rates and liquid surface temperatures of a number of nitrate ester fuels and hydrazine at elevated pressures. The temperature measurements for the nitrate esters were found to be in good agreement with a theoretical model which allowed for gas solubility in the liquid phase at high pressures. Experimental results were also obtained on the burning rates and liquid surface temperatures of a number of paraffin and alcohol fuels burning in air pressures up to 72 atm. For these tests, the fuels were burned from porous spheres in a natural convection environment. Initial findings on a pressurized flat flame burner are also described as well as the design of an oscillatory combustion apparatus to test the response of burning liquid fuels.

Gel of chamomile vs. urea cream to prevent acute radiation dermatitis in patients with head and neck cancer: a randomized controlled trial.

PubMed

Ferreira, Elaine Barros; Ciol, Marcia A; Vasques, Christiane Inocêncio; Bontempo, Priscila de Souza Maggi; Vieira, Nayara Narley Pires; Silva, Luis Felipe Oliveira E; Avelino, Samuel Ramalho; Dos Santos, Marcos Antônio; Dos Reis, Paula Elaine Diniz

2016-08-01

To compare a gel made with chamomile (Chamomilla recutita) with a cream of urea as an intervention to delay the time to occurrence of radiation dermatitis. Radiation dermatitis is one of the most common adverse effects of radiotherapy in patients with head and neck cancer. It is characterized by erythema, itching, pain, skin breakage and burning sensation, and there is no consensus on how to prevent it. The study is a randomized controlled clinical trial. We will recruit 48 individuals with head and neck cancer who will be starting their radiotherapy and randomize them to receive either gel of chamomile or cream of urea, as an intervention for prevention of radiation dermatitis. Social-demographic data will be collected at baseline, and clinical data will be collected before the initiation of radiotherapy. Participants will be followed weekly to assess development of radiation dermatitis. The protocol is funded by Conselho Nacional de Pesquisa e Desenvolvimento Científico (Brazil). The study was approved by a research ethics committee. Given the clinical relevance of preventing radiation dermatitis and the lack of evidence supporting specific preventive interventions, it is important to study new products that might be efficacious to prevent this complication. This article presents the protocol of a randomized controlled trial comparing a gel made with chamomile (intervention) with a cream of urea (control) to prevent radiation dermatitis in patients with head and neck cancer undergoing radiotherapy. © 2016 John Wiley & Sons Ltd.

Monitoring the recovery of Juncus roemerianus marsh burns with the normalized difference vegetation index and Landsat Thematic Mapper data

USGS Publications Warehouse

Ramsey, Elijah W.; Sapkota, S.K.; Barnes, F.G.; Nelson, G.A.

2002-01-01

Nine atmospherically corrected Landsat Thematic Mapper images were used to generate mean normalized difference vegetation indices (NDVI) at 11 burn sites throughout a coastal Juncus roemerianus marsh in St. Marks National Wildlife Refuge, Florida. Time-since-burn, the time lapse from the date of burn to the date of image collection, was related to variation in mean NDVI over time. Regression analysis showed that NDVI increased for about 300 to 400 days immediately after the burn, overshooting the typical mean NDVI of a nonburned marsh. For about another 500 to 600 days NDVI decreased until reaching a nearly constant NDVI of about 0.40. During the phase of increasing NDVI the ability to predict time-since-burn was within about ??60 days. Within the decreasing phase this dropped to about ??88 days. Examination of each burn site revealed some nonburn related influences on NDVI (e.g., seasonality). Normalization of burn NDVI by site-specific nonburn control NDVI eliminated most influences. However, differential responses at the site-specific level remained related to either storm impacts or secondary burning. At these sites, collateral data helped clarify the abnormal changes in NDVI. Accounting for these abnormalities, site-specific burn recovery trends could be broadly standardized into four general phases: Phase 1-preburn, Phase 2-initial recovery (increasing NDVI), Phase 3-late recovery (decreasing NDVI), and Phase 4-final coalescence (unchanging NDVI). Phase 2 tended to last about 300 to 500 days, Phase 3 an additional 500 to 600 days, and finally reaching Phase 4, 900 to 1,000 days after burn.

Recent Biomass Burning in the Tropics and Related Changes in Tropospheric Ozone

NASA Technical Reports Server (NTRS)

Ziemke; Chandra, J. R. S.; Duncan, B. N.; Schoeberl, M. R.; Torres, O.; Damon, M. R.; Bhartia, P. K.

2009-01-01

Biomass burning is an important source of chemical precursors of tropospheric ozone. In the tropics, biomass burning produces ozone enhancements over broad regions of Indonesia, Africa, and South America including Brazil. Fires are intentionally set in these regions during the dry season each year to clear cropland and to clear land for human/industrial expansion. In Indonesia enhanced burning occurs during dry El Nino conditions such as in 1997 and 2006. These burning activities cause enhancement in atmospheric particulates and trace gases which are harmful to human health. Measurements from the Aura Ozone Monitoring Instrument (OMI) and Microwave Limb Sounder (MLS) from October 2004-November 2008 are used to evaluate the effects of biomass burning on tropical tropospheric ozone. These measurements show sizeable decreases approx.15-20% in ozone in Brazil during 2008 compared to 2007 which we attribute to the reduction in biomass burning. Three broad biomass burning regions in the tropics (South America including Brazil, western Africa, and Indonesia) were analyzed in the context of OMI/MLS measurements and the Global Modeling Initiative (GMI) chemical transport model developed at Goddard Space Flight Center. The results indicate that the impact of biomass burning on ozone is significant within and near the burning regions with increases of approx.10-25% in tropospheric column ozone relative to average background concentrations. The model suggests that about half of the increases in ozone from these burning events come from altitudes below 3 km. Globally the model indicates increases of approx.4-5% in ozone, approx.7-9% in NO, (NO+NO2), and approx.30-40% in CO.

Medieval warming initiated exceptionally large wildfire outbreaks in the Rocky Mountains

PubMed Central

Calder, W. John; Parker, Dusty; Stopka, Cody J.; Jiménez-Moreno, Gonzalo; Shuman, Bryan N.

2015-01-01

Many of the largest wildfires in US history burned in recent decades, and climate change explains much of the increase in area burned. The frequency of extreme wildfire weather will increase with continued warming, but many uncertainties still exist about future fire regimes, including how the risk of large fires will persist as vegetation changes. Past fire-climate relationships provide an opportunity to constrain the related uncertainties, and reveal widespread burning across large regions of western North America during past warm intervals. Whether such episodes also burned large portions of individual landscapes has been difficult to determine, however, because uncertainties with the ages of past fires and limited spatial resolution often prohibit specific estimates of past area burned. Accounting for these challenges in a subalpine landscape in Colorado, we estimated century-scale fire synchroneity across 12 lake-sediment charcoal records spanning the past 2,000 y. The percentage of sites burned only deviated from the historic range of variability during the Medieval Climate Anomaly (MCA) between 1,200 and 850 y B.P., when temperatures were similar to recent decades. Between 1,130 and 1,030 y B.P., 83% (median estimate) of our sites burned when temperatures increased ∼0.5 °C relative to the preceding centuries. Lake-based fire rotation during the MCA decreased to an estimated 120 y, representing a 260% higher rate of burning than during the period of dendroecological sampling (360 to −60 y B.P.). Increased burning, however, did not persist throughout the MCA. Burning declined abruptly before temperatures cooled, indicating possible fuel limitations to continued burning. PMID:26438834

Should early amputation impact initial fluid therapy algorithms in burns resuscitation? A retrospective analysis using 3D modelling.

PubMed

Staruch, Robert M T; Beverly, A; Lewis, D; Wilson, Y; Martin, N

2017-02-01

While the epidemiology of amputations in patients with burns has been investigated previously, the effect of an amputation on burn size and its impact on fluid management have not been considered in the literature. Fluid resuscitation volumes are based on the percentage of the total body surface area (%TBSA) burned calculated during the primary survey. There is currently no consensus as to whether the fluid volumes should be recalculated after an amputation to compensate for the new body surface area. The aim of this study was to model the impact of an amputation on burn size and predicted fluid requirement. A retrospective search was performed of the database at the Queen Elizabeth Hospital Birmingham Regional Burns Centre to identify all patients who had required an early amputation as a result of their burn injury. The search identified 10 patients over a 3-year period. Burn injuries were then mapped using 3D modelling software. BurnCase3D is a computer program that allows accurate plotting of burn injuries on a digital mannequin adjusted for height and weight. Theoretical fluid requirements were then calculated using the Parkland formula for the first 24 h, and Herndon formula for the second 24 h, taking into consideration the effects of the amputation on residual burn size. This study demonstrated that amputation can have an unpredictable effect on burn size that results in a significant deviation from predicted fluid resuscitation volumes. This discrepancy in fluid estimation may cause iatrogenic complications due to over-resuscitation in burn-injured casualties. Combining a more accurate estimation of postamputation burn size with goal-directed fluid therapy during the resuscitation phase should enable burn care teams to optimise patient outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Effects of Fuel Reduction Treatments on Incidence of Phytophthora Species in Soil of a Southern Appalachian Mountain Forest

Treesearch

I.M. Meadows; D.C. Zwart; S.N. Jeffers; T.A. Waldrop; W.C. Bridges

2011-01-01

The National Fire and Fire Surrogate Study was initiated to study the effects of fuel reduction treatments on forest ecosystems. Four fuel reduction treatments were applied to three sites in a southern Appalachian Mountain forest in western North Carolina: prescribed burning, mechanical fuel reduction, mechanical fuel reduction followed by prescribed burning, and a non...

Response of overstory and understory vegetation 37 years after prescribed burning in an aspen-dominated forest in northern Minnesota, USA – a case study

Treesearch

A. Dhar; C.D. Baker; H.B. Massicotte; Brian J. Palik; C.D.B. Hawkins

2016-01-01

Many studies have examined short-term changes in understory vegetation following prescribed burning. However, knowledge concerning longer term effects on both forest understory and overstory vegetation is lacking. This investigation was initiated to examine changes in understory (herbaceous and shrub) and overstory species composition almost four decades after logging...

Effects of Different Large-Scale Prescribed Burning Regimes of Advance Reproduction in the Missouri Ozarks

Treesearch

Daniel C. Dey; George Hartman

2004-01-01

In 1997, The Nature Conservancy initiated a large-scale prescribed fire management study on approximately 2,500 acres of their Chilton Creek property located in Shannon and Carter counties, Missouri. Since the spring of 1998, five management units, of roughly 500 acres each, have been burned in the dormant season to simulate a range of fire regimes that vary from...

Treatment Strategies for Hypopigmentation in the Context of Burn Hypertrophic Scars

PubMed Central

Carney, Bonnie C.; McKesey, Jacqueline P.; Rosenthal, Dean S.

2018-01-01

Dyspigmentation in burn scars can contribute to the development of psychosocial complications after injury and can be detrimental to social reintegration and quality of life for burn survivors. Although treatments for skin lightening to treat hyperpigmentation have been well reviewed in the literature, skin-darkening strategies to treat hypopigmentation have not. The following potential treatment options in the context of burn hypertrophic scar will be discussed: use of the melanocyte-keratinocyte transplantation procedure, use of ectopic synthetic analogues of alpha-melanocyte stimulating hormone to initiate melanogenesis, and use of FK506 to induce melanogenesis. A proposed future direction of research in laser-assisted drug delivery of inducers of local melanin production, with the hope of developing a targeted, effective approach to dyspigmentation in hypertrophic scar is also discussed. PMID:29464168

Surgical treatment and management of the severely burn patient: Review and update.

PubMed

Gacto-Sanchez, P

Since one of the main challenges in treating acute burn injuries is preventing infection, early excising of the eschar and covering of the wound becomes critical. Non-viable tissue is removed by initial aggressive surgical debridement. Many surgical options for covering the wound bed have been described, although split-thickness skin grafts remain the standard for the rapid and permanent closure of full-thickness burns. Significant advances made in the past decades have greatly improved burns patient care, as such that major future improvements in survival rates seem to be more difficult. Research into stem cells, grafting, biomarkers, inflammation control, and rehabilitation will continue to improve individualized care and create new treatment options for these patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Randomized Controlled Trial of Polyhexanide/Betaine Gel Versus Silver Sulfadiazine for Partial-Thickness Burn Treatment.

PubMed

Wattanaploy, Saruta; Chinaroonchai, Kusuma; Namviriyachote, Nantaporn; Muangman, Pornprom

2017-03-01

Silver sulfadiazine is commonly used in the treatment of partial-thickness burns, but it sometimes forms pseudo-eschar and delays wound healing. Polyhexanide/betaine gel, a new wound cleansing and moisturizing product, has some advantages in removing biofilm and promotes wound healing. This study was designed to compare clinical efficacy of polyhexanide/betaine gel with silver sulfadiazine in partial-thickness burn treatment. From September 2013 to May 2015, 46 adult patients with partial-thickness burn ≥10% total body surface area that were admitted to the Burn Unit of Siriraj Hospital within 48 hours after injury were randomly allocated into 2 groups. One group was treated with polyhexanide/betaine gel, and the other group was treated with silver sulfadiazine. Both groups received daily dressing changes and the same standard care given to patients with burns in this center. Healing times in the polyhexanide/betaine gel group and silver sulfadiazine group were 17.8 ± 2.2 days and 18.8 ± 2.1 days, respectively ( P value .13). There were no significant differences in healing times, infection rates, bacterial colonization rates, and treatment cost in both groups. The pain score of the polyhexanide/betaine gel group was significantly less than the silver sulfadiazine group at 4 to 9 days after treatment ( P < .001). The satisfactory assessment result of the polyhexanide/betaine gel group was better than that in the silver sulfadiazine group. These data indicate the need for adequately designed studies to elicit the full potential of polyhexanide gel as a wound dressing for partial-thickness burn wounds.

Psychological and psychosocial functioning of children with burn scarring using cosmetic camouflage: a multi-centre prospective randomised controlled trial.

PubMed

Maskell, Jessica; Newcombe, Peter; Martin, Graham; Kimble, Roy

2014-02-01

Burns leave patients with long-term physical scarring. Children with scarring are required to face challenges of reintegration into their community, including acceptance of an altered appearance and acceptance by others. This can be difficult given society's preoccupation with physical appearance. Limited research exists investigating validity of cosmetic camouflage as a psychosocial intervention for children with scarring. This study investigated whether using cosmetic camouflage (Microskin™) had a positive impact on health-related quality of life, self-concept and psychopathology for children and adolescents (8-17 years) with burn scarring. A prospective multi-centre randomised controlled trial was conducted across Australian and New Zealand paediatric hospitals. 63 participants (49 females, mean age 12.7 ± 2.1 years) were enrolled. Data points were baseline (Time 1) and at 8 weeks (Time 2) using reliable and valid psychometric measures. Findings indicate there were significant improvements in socialisation, school and appearance scales on the Paediatric Quality of Life Inventory and psychopathology scores particularly peer problems decreased. However self-concept remained stable from baseline throughout intervention use. Cosmetic camouflage appears to have a positive impact on quality of life particularly socialisation. Cosmetic camouflage is a valid tool to assist children with scarring to actively participate socially within their communities. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Dynamics of an Overdriven Nitromethane Initiation System

NASA Astrophysics Data System (ADS)

Hároz, E. H.; Rae, P. J.; Armstrong, C. L.; Baca, E. V.; Campbell, C.; Gunderson, J. A.; Holmes, M.; Lopez-Pulliam, I.; Vaughan, L. D.; Dickson, P. M.

2017-06-01

For upcoming large-scale HE experiments, an initiation system is needed to ensure uniform and simultaneous burn. To that end, we developed an initiation system based on nitromethane. Initial, small-scale tests characterized the response of the nitromethane in the proposed cylindrical initiator geometry, indicating robust detonation under a variety of conditions such as a plane wave lenses & cylinders of PBX 9501 into a flyer plate or direct-drive. Detonation velocity, as measured by piezoelectric pin time-of-arrival measurements along the length and at bottom of vessel, shows an overdriven response. All cases show a detonation velocity faster than the literature value of 7.3 km s-1 for nitromethane, with the fastest velocity occurring for the 8-detonator, 8'' cylinder case with a velocity = 7.7 km s-1. Streak camera imaging characterized the curvature of the shock front as it arrived at the bottom of the vessel via spark gap. A final test of the initiator system looked at the expansion of the initiator vessel walls via PDV, showing velocities up to 3.5 km s-1. Finally, our initiator was placed inside a secondary vessel containing 1000 lbs of nitromethane. High-speed photography & pin data indicate complete symmetrical burn of the secondary nitromethane.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Melody, M.

Waste Technologies Industries (WTI; East Liverpool, Ohio) is trying to wing what it hopes will be its final battle in a 13-year, $160 million war with the government, and community and environmental groups. The company since 1980 has sought EPA approval to operate a hazardous waste incinerator in East Liverpool, Ohio. WTI late last year conducted a pre-test burn, or shakedown, during which the incinerator burned certain types of hazardous waste. The test demonstrates the incinerator's performance under normal operating conditions, Regulatory authorities, including EPA and the Ohio Environmental Protection Agency (OEPA), monitored activity during the shakedown, which was limitedmore » to 720 hours of operation. In accordance with RCRA requirements, the company in March conducted a trial burn to demonstrate that the incinerator meets permit standards. WTI's permit specifies three performance parameters the incinerator must meet -- particulate and hydrogen chloride emissions limits, and destruction removal efficiencies (DREs).« less

A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial

PubMed Central

Mortimer, Kevin; Ndamala, Chifundo B; Naunje, Andrew W; Malava, Jullita; Katundu, Cynthia; Weston, William; Havens, Deborah; Pope, Daniel; Bruce, Nigel G; Nyirenda, Moffat; Wang, Duolao; Crampin, Amelia; Grigg, Jonathan; Balmes, John; Gordon, Stephen B

2018-01-01

Summary Background WHO estimates exposure to air pollution from cooking with solid fuels is associated with over 4 million premature deaths worldwide every year including half a million children under the age of 5 years from pneumonia. We hypothesised that replacing open fires with cleaner burning biomass-fuelled cookstoves would reduce pneumonia incidence in young children. Methods We did a community-level open cluster randomised controlled trial to compare the effects of a cleaner burning biomass-fuelled cookstove intervention to continuation of open fire cooking on pneumonia in children living in two rural districts, Chikhwawa and Karonga, of Malawi. Clusters were randomly allocated to intervention and control groups using a computer-generated randomisation schedule with stratification by site, distance from health centre, and size of cluster. Within clusters, households with a child under the age of 4·5 years were eligible. Intervention households received two biomass-fuelled cookstoves and a solar panel. The primary outcome was WHO Integrated Management of Childhood Illness (IMCI)-defined pneumonia episodes in children under 5 years of age. Efficacy and safety analyses were by intention to treat. The trial is registered with ISRCTN, number ISRCTN59448623. Findings We enrolled 10 750 children from 8626 households across 150 clusters between Dec 9, 2013, and Feb 28, 2016. 10 543 children from 8470 households contributed 15 991 child-years of follow-up data to the intention-to-treat analysis. The IMCI pneumonia incidence rate in the intervention group was 15·76 (95% CI 14·89–16·63) per 100 child-years and in the control group 15·58 (95% CI 14·72–16·45) per 100 child-years, with an intervention versus control incidence rate ratio (IRR) of 1·01 (95% CI 0·91–1·13; p=0·80). Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten (one death) in the control group (IRR 0·91 [95% CI 0·37–2·23]; p=0·83). Interpretation We found no evidence that an intervention comprising cleaner burning biomass-fuelled cookstoves reduced the risk of pneumonia in young children in rural Malawi. Effective strategies to reduce the adverse health effects of household air pollution are needed. Funding Medical Research Council, UK Department for International Development, and Wellcome Trust. PMID:27939058

Fast and Luminous Transients from the Explosions of Long-lived Massive White Dwarf Merger Remnants

NASA Astrophysics Data System (ADS)

Brooks, Jared; Schwab, Josiah; Bildsten, Lars; Quataert, Eliot; Paxton, Bill; Blinnikov, Sergei; Sorokina, Elena

2017-12-01

We study the evolution and final outcome of long-lived (≈ {10}5 years) remnants from the merger of an He white dwarf (WD) with a more massive C/O or O/Ne WD. Using Modules for Experiments in Stellar Astrophysics ({\\mathtt{MESA}}), we show that these remnants have a red giant configuration supported by steady helium burning, adding mass to the WD core until it reaches {M}{core}≈ 1.12{--}1.20 {M}⊙ . At that point, the base of the surface convection zone extends into the burning layer, mixing the helium-burning products (primarily carbon and magnesium) throughout the convective envelope. Further evolution depletes the convective envelope of helium and dramatically slows the mass increase of the underlying WD core. The WD core mass growth re-initiates after helium depletion, as then an uncoupled carbon-burning shell is ignited and proceeds to burn the fuel from the remaining metal-rich extended envelope. For large enough initial total merger masses, O/Ne WD cores would experience electron-capture triggered collapse to neutron stars (NSs) after growing to near Chandrasekhar mass ({M}{Ch}). Massive C/O WD cores could suffer the same fate after a carbon-burning flame converts them to ONe. The NS formation would release ≈ {10}50 erg into the remaining extended low mass envelope. Using the STELLA radiative transfer code, we predict the resulting optical light curves from these exploded envelopes. Reaching absolute magnitudes of {M}V≈ -17, these transients are bright for about one week and have many features of the class of luminous, rapidly evolving transients studied by Drout and collaborators.

Ponderosa pine snag densities following multiple fires in the Gila Wilderness, New Mexico

USGS Publications Warehouse

Holden, Z.A.; Morgan, P.; Rollins, M.G.; Wright, R.G.

2006-01-01

Fires create and consume snags (standing dead trees), an important structural and ecological component of ponderosa pine forests. The effects of repeated fires on snag densities in ponderosa pine forests of the southwestern USA have not been studied. Line intercept sampling was used to estimate snag densities in areas of the Gila Wilderness that had burned one to three times under Wildland Fire Use for Resource Benefit (WFU), a fire management policy implemented since 1974 aimed at restoring natural fire regimes. Twenty randomly located transects were measured in areas burned since 1946; six in once-burned areas, six in twice-burned areas and eight in thrice-burned areas. The mean density ?? standard errors of large (>47.5 cm dbh) snags for areas that burned once, twice and thrice was 7.0 ?? 2.7, 4.4 ?? 1.1 and 4.1 ?? 1.3 snags/ha, respectively. Differences in snag densities between once- and multiple-burned areas were significant (F-test; p < 0.05). There was no significant difference in density of large snags between twice- and thrice-burned areas. Proportions of type 1 snags (recently created) were higher in once- and twice-burned areas than in areas that burned three times, likely reflecting high tree mortality and snag recruitment resulting from an initial entry fire. Type 3 snags (charred by previous fire) were more abundant in areas that burned multiple times. The lack of differences in snag densities between areas that burned two and three times suggests that repeated fires leave many snags standing. The increasing proportion of type 3 snags with repeated fires supports this conclusion. ?? 2005 Elsevier B.V. All rights reserved.

Burn Wound Infections and Antibiotic Susceptibility Patterns at Pakistan Institute of Medical Sciences, Islamabad, Pakistan

PubMed Central

Saaiq, Muhammad; Ahmad, Shehzad; Zaib, Muhammad Salman

2015-01-01

BACKGROND Burn wound infections carry considerable mortality and morbidity amongst burn injury victims who have been successfully rescued through the initial resuscitation. This study assessed the prevalent microrganisms causing burn wound infections among hospitalized patients; their susceptibility pattern to commonly used antibiotics; and the frequency of infections with respect to the duration of the burn wounds. METHODS This study was carried out at Burn Care Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan over a period of two years (i.e. from June 2010 to May 2012). The study included all wound-culture-positive patients of either gender and all ages, who had sustained deep burns and underwent definitive management with wound excisions and skin auto-grafting. Patients with negative cultures of the wounds were excluded. Tissue specimens for culture and sensitivity were collected from burn wounds using standard collection techniques and analyzed at microbiological laboratory. RESULTS Out of a total of 95 positive microbial growths, 36 were Pseudomonas aeruginosa (35.29%) as the most frequent isolate found, followed by 21 Klebsiella pneumoniae (20.58%), 19 Staphylococcus aureaus (18.62%), 10 Proteus (9.80%), 7 E. coli (6.86%), 7 Acinetobacter (6.86%), and 4 Candida (3.92%). A variable antibiotic susceptibility pattern was observed among the grown microbes. Positive cultures were significantly more frequent among patients with over two weeks duration of burn wounds. CONCLUSION P. aeruginosa, K. pneumoniae and S. aureus constituted the most common bacterial microbes of burn wounds in our in-patients cases. Positive cultures were more frequent among patients with over two weeks duration of burn wounds. Early excision and skin grafting of deep burns and adherence to infection control measures can help to effectively reduce the burden of these infections. PMID:25606471

Perceptions of prescribed burning in a local forest community in Victoria, Australia.

PubMed

Bell, Tina; Oliveras, Immaculada

2006-11-01

The general perceptions of prescribed burning were elicited from forest users for an area that has been subject to this form of land management for at least 20 years. The largest group consisted of local residents living in and around the Wombat State Forest with two smaller groups of students from a nearby university campus and local professional land managers. A questionnaire was given to each participant in order to explore how the forest was used, to determine the level of knowledge of burning in the targeted forest and Victoria and the perception of the appearance, effectiveness of protection, and accessibility to the forest after prescribed burning. Generally all groups had similar responses with community members having stronger views on the effectiveness and practicalities of prescribed burning, whereas students were more neutral in their opinions. All participants claimed knowledge of prescribed burning activities within Victoria, but fewer had experience of planned fires in the Wombat State Forest. All groups agreed that areas that had not been recently burned had a better appearance than those that had, but this result may have included a range of value judgments. Land managers had a greater understanding of the ecological importance of season and timing of burning; however, some students and community members were equally knowledgeable. Prescribed burning did not impede access to the forest, nor did smoke from prescribed burns pose any great problem. The majority of the participants felt that the amount of prescribed burning done in the forest was adequate for engendering a feeling of protection to life and property, yet many were still suspicious of this management practice. These initial findings indicate several areas in which further research would be useful including the efficacy of education programs for community members and improved communication of burn plans by land managers.

A decade of the Clinical Trials Transformation Initiative: What have we accomplished? What have we learned?

PubMed

Tenaerts, P; Madre, L; Landray, M

2018-02-01

The Clinical Trials Transformation Initiative reflects on 10 years of working to improve the quality and efficiency of clinical trials. This article highlights many of the Clinical Trials Transformation Initiative's accomplishments and offers examples of the impact that the Clinical Trials Transformation Initiative has had on the clinical trials enterprise. After conducting more than 25 projects and issuing recommendations for specific strategies to improve the design and execution of clinical trials, some common themes and lessons learned have emerged. Lessons include the importance of engaging many stakeholders, advanced planning to address critical issues, discontinuation of non-value added practices, and new opportunities presented by technology. Through its work, the Clinical Trials Transformation Initiative has also derived some operational best practices for conducting collaborative, multi-stakeholder projects covering project selection, project team dynamics and execution, and multi-stakeholder meetings and team discussions. Through these initiatives, the Clinical Trials Transformation Initiative has helped move the needle toward needed change in the clinical trials enterprise that has directly impacted stakeholders and patients alike.

Establishing a Reproducible Hypertrophic Scar following Thermal Injury: A Porcine Model

PubMed Central

Rapp, Scott J.; Rumberg, Aaron; Visscher, Marty; Billmire, David A.; Schwentker, Ann S.

2015-01-01

Background: Our complete understanding of hypertrophic scarring is still deficient, as portrayed by the poor clinical outcomes when treating them. To address the need for alternative treatment strategies, we assess the swine animal burn model as an initial approach for immature scar evaluation and therapeutic application. Methods: Thermal contact burns were created on the dorsum of 3 domestic swine with the use of a branding iron at 170°F for 20 seconds. Deep partial-thickness burns were cared for with absorptive dressings over 10 weeks and wounds evaluated with laser and negative pressure transduction, histology, photographic analysis, and RNA isolation. Results: Overall average stiffness (mm Hg/mm) increased and elasticity (mm) decreased in the scars from the initial burn injury to 8 weeks when compared with normal skin (P < 0.01). Scars were thicker, more erythematous, and uniform in the caudal dorsum. The percent change of erythema in wounds increased from weeks 6 to 10. Histology demonstrated loss of dermal papillae, increased myofibroblast presence, vertically oriented vessels, epidermal and dermal hypercellularity, and parallel-layered collagen deposition. Immature scars remained elevated at 10 weeks, and minimal RNA was able to be isolated from the tissue. Conclusions: Deep partial-thickness thermal injury to the back of domestic swine produces an immature hypertrophic scar by 10 weeks following burn with thickness appearing to coincide with the location along the dorsal axis. With minimal pig to pig variation, we describe our technique to provide a testable immature scar model. PMID:25750848

Ecological and sampling constraints on defining landscape fire severity

USGS Publications Warehouse

Key, C.H.

2006-01-01

Ecological definition and detection of fire severity are influenced by factors of spatial resolution and timing. Resolution determines the aggregation of effects within a sampling unit or pixel (alpha variation), hence limiting the discernible ecological responses, and controlling the spatial patchiness of responses distributed throughout a burn (beta variation). As resolution decreases, alpha variation increases, extracting beta variation and complexity from the spatial model of the whole burn. Seasonal timing impacts the quality of radiometric data in terms of transmittance, sun angle, and potential contrast between responses within burns. Detection sensitivity candegrade toward the end of many fire seasons when low sun angles, vegetation senescence, incomplete burning, hazy conditions, or snow are common. Thus, a need exists to supersede many rapid response applications when remote sensing conditions improve. Lag timing, or timesince fire, notably shapes the ecological character of severity through first-order effects that only emerge with time after fire, including delayed survivorship and mortality. Survivorship diminishes the detected magnitude of severity, as burned vegetation remains viable and resprouts, though at first it may appear completely charred or consumed above ground. Conversely, delayed mortality increases the severity estimate when apparently healthy vegetation is in fact damaged by heat to the extent that it dies over time. Both responses dependon fire behavior and various species-specific adaptations to fire that are unique to the pre-firecomposition of each burned area. Both responses can lead initially to either over- or underestimating severity. Based on such implications, three sampling intervals for short-term burn severity are identified; rapid, initial, and extended assessment, sampled within about two weeks, two months, and depending on the ecotype, from three months to one year after fire, respectively. Spatial and temporal conditions of sampling strategies constrain data quality and ecological information obtained about fire severity. Though commonly overlooked, such considerations determine the objectives and hypotheses that are appropriate for each application, and are especially important when building comparative studies or long-term reference databases on fire severity.

AUDIT MATERIALS FOR SEMIVOLATILE ORGANIC MEASUREMENTS DURING HAZARDOUS WASTE TRIAL BURNS

EPA Science Inventory

Two new performance audit materials utilizing different sorbents have neen developed to assess the overall accuracy and precision of the sampling, desorption, and analysis of semivolatile organic compounds by EPA, SW 846 Method 0010 (i.e., the Modified Method 5 sampling train). h...

The conductive propagation of nuclear flames. I - Degenerate C + O and O + Ne + Mg white dwarfs

NASA Technical Reports Server (NTRS)

Timmes, F. X.; Woosley, S. E.

1992-01-01

The paper determines the physical properties - speed, width, and density structure - of conductive burning fronts in degenerate carbon-oxygen (C + O) and oxygen-neon-magnesium (O + Ne + Mg) compositions for a grid of initial densities and compositions. The dependence of the physical properties of the flame on the assumed values of nuclear reaction rates, the nuclear reaction network employed, the thermal conductivity, and the choice of coordinate system are investigated. The occurrence of accretion-induced collapse of a white dwarf is found to be critically dependent on the velocity of the nuclear conductive burning front and the growth rate of hydrodynamic instabilities. Treating the expanding area of the turbulent burning region as a fractal whose tile size is identical to the minimum unstable Rayleigh-Taylor wavelength, it is found, for all reasonable values of the fractal dimension, that for initial C + O or O + Ne + Mg densities above about 9 x 10 exp 9 g/cu cm the white dwarf should collapse to a neutron star.

Burnet Project

PubMed Central

Masellis, A.; Atiyeh, B.

2009-01-01

Summary The BurNet project, a pilot project of the Eumedis initiative, has become true. The Eumedis (EUro MEDiterranean Information Society) initiative is part of the MEDA programme of the EU to develop the Information Society in the Mediterranean area. In the health care sector, the objective of Eumedis is: the deployment of network-based solutions to interconnect - using userfriendly and affordable solutions - the actors at all levels of the "health care system" of the Euro-Mediterranean region. The Bur Net project interconnects 17 Burn Centres (BC) in the Mediterranean Area through an information network both to standardize courses of action in the field of prevention, treatment, and functional and psychological rehabilitation of burn patients and to coordinate interactions between BC and emergency rooms in peripheral hospitals using training/information activities and telemedicine to optimize first aid provided to burn patients before referral to a BC. Shared procedure protocols for prevention and the care and rehabilitation of patients, both at individual and mass level, will help to create an international specialized database and a Webbased teleconsultation system. PMID:21991176

Knowledge of childhood burn risks and burn first aid: Cool Runnings.

PubMed

Burgess, Jacqueline D; Watt, Kerrianne A; Kimble, Roy M; Cameron, Cate M

2018-01-31

The high incidence of hot beverage scalds among young children has not changed in the past 15 years, but preventive campaigns have been scarce. A novel approach was used to engage mothers of young children in an app-based hot beverage scald prevention campaign 'Cool Runnings'. This paper provides baseline data for this randomised controlled trial (RCT). Queensland-based mothers aged 18+ years with at least one child aged 5-12 months were recruited via social media to Cool Runnings, which is a two-group, parallel, single-blinded RCT. In total, 498 participants from across Queensland completed the baseline questionnaire. The most common source of burn first aid information was the internet (79%). One-third (33%) correctly identified hot beverage scalds as the leading cause of childhood burns, 43% knew the age group most at risk. While 94% reported they would cool a burn with water, only 10% reported the recommended 20min duration. After adjusting for all relevant variables, there were two independent predictors of adequate burn first aid knowledge: first aid training in the past year (OR=3.32; 95% CI 1.8 to 6.1) and smoking status (OR=0.17; 95% CI 0.04 to 0.7). In this study, mothers of young children were largely unaware how frequently hot beverage scalds occur and the age group most susceptible to them. Inadequate burn first aid knowledge is prevalent across mothers of young children; there is an urgent and compelling need to improve burn first aid knowledge in this group. Given the high incidence of hot beverages scalds in children aged 6-24 months, it is important to target future burn prevention/first aid campaigns at parents of young children. ACTRN12616000019404; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Can we improve the performance and reporting of investigator-initiated clinical trials? Rheumatoid arthritis as an example.

PubMed

Landewé, Robert B M; Smolen, Josef S; Weinblatt, Michael E; Emery, Paul; Dougados, Maxime; Fleischmann, Roy; Aletaha, Daniel; Kavanaugh, Arthur; van der Heijde, Désirée

2014-10-01

Investigator-initiated trials, some of which have been referred to as comparative effectiveness trials, pragmatic trials, or strategy trials, are sometimes considered to be of greater clinical importance than industry-driven trials, because they address important but unresolved clinical questions that differ from the questions asked in industry-driven trials. Regulatory authorities have provided methodological guidance for industry-driven trials for the approval of new treatments, but such guidance is less clear for investigator-initiated trials. The European League Against Rheumatism (EULAR) task force for the update of the recommendations for the management of rheumatoid arthritis has critically looked at the methodological quality and conduct of many investigator-initiated trials, and has identified a number of concerns. In this Viewpoint paper, we highlight commonly encountered issues that are discussed using examples of well-known investigator-initiated trials. These issues cover three themes: (1) design choice (superiority vs non-inferiority designs); (2) statistical power and (3) convenience reporting. Since we acknowledge the importance of investigator-initiated research, we also propose a shortlist of points-to-consider when designing, performing and reporting investigator-initiated trials. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Attenuation of Posttraumatic Muscle Catabolism and Osteopenia by Long-Term Growth Hormone Therapy

PubMed Central

Hart, David W.; Herndon, David N.; Klein, Gordon; Lee, Steven B.; Celis, Mario; Mohan, Subburaman; Chinkes, David L.; Wolf, Steven E.

2001-01-01

Objective To determine whether the beneficial effects of growth hormone persist throughout the prolonged hypermetabolic and hypercatabolic response to severe burn. Summary Background Data The hypermetabolic response to severe burn is associated with increased energy expenditure, insulin resistance, immunodeficiency, and whole body catabolism that persists for months after injury. Growth hormone is a potent anabolic agent and salutary modulator of posttraumatic metabolic responses. Methods Seventy-two severely burned children were enrolled in a placebo-controlled double-blind trial investigating the effects of growth hormone (0.05 mg/kg per day) on muscle accretion and bone growth. Drug or placebo treatment began on discharge from the intensive care unit and continued for 1 year after burn. Total body weight, height, dual-energy x-ray absorptiometry, indirect calorimetry, and hormone values were measured at discharge, then at 6 months, 9 months, and 12 months after burn. Results were compared between groups. Results Growth hormone subjects gained more weight than placebo subjects at the 9-month study point; this disparity in weight gain continued to expand throughout the remainder of the study. Height also increased in the growth hormone group compared with controls at 12 months. Change in lean body mass was greater in those treated with growth hormone at 6, 9, and 12 months. Bone mineral content was increased at 9 and 12 months; this was associated with higher parathormone levels. Conclusions Low-dose recombinant human growth hormone successfully abates muscle catabolism and osteopenia induced by severe burn. PMID:11371741

Persistent Effects of Fire Severity on Early Successional Forests in Interior Alaska

NASA Technical Reports Server (NTRS)

Shenoy, Aditi; Johnstone, Jill F.; Kasischke, Eric S.; Kielland, Knut

2011-01-01

There has been a recent increase in the frequency and extent of wildfires in interior Alaska, and this trend is predicted to continue under a warming climate. Although less well documented, corresponding increases in fire severity are expected. Previous research from boreal forests in Alaska and western Canada indicate that severe fire promotes the recruitment of deciduous tree species and decreases the relative abundance of black spruce (Picea mariana) immediately after fire. Here we extend these observations by (1) examining changes in patterns of aspen and spruce density and biomass that occurred during the first two decades of post-fire succession, and (2) comparing patterns of tree composition in relation to variations in post-fire organic layer depth in four burned black spruce forests in interior Alaska after 10-20 years of succession.Wefound that initial effects of fire severity on recruitment and establishment of aspen and black spruce were maintained by subsequent effects of organic layer depth and initial plant biomass on plant growth during post-fire succession. The proportional contribution of aspen (Populus tremuloides) to total stand biomass remained above 90% during the first and second decades of succession in severely burned sites, while in lightly burned sites the proportional contribution of aspen was reduced due to a 40- fold increase in spruce biomass in these sites. Relationships between organic layer depth and stem density and biomass were consistently negative for aspen, and positive or neutral for black spruce in all four burns. Our results suggest that initial effects of post-fire organic layer depths on deciduous recruitment are likely to translate into a prolonged phase of deciduous dominance during post-fire succession in severely burned stands. This shift in vegetation distribution has important implications for climate-albedo feedbacks, future fire regime, wildlife habitat quality and natural resources for indigenous subsistence activities in interior Alaska.

Measurements of Background and Polluted Air in Rural Regions of Rwanda

NASA Astrophysics Data System (ADS)

DeWitt, L.; Gasore, J.; Prinn, R. G.; Potter, K. E.

2015-12-01

Rwanda, a mountainous nation in Equatorial East Africa, is one of the least-urbanized nations in Africa. The majority of the population are subsistence farmers, and major sources of air pollution (e.g., particulates, greenhouse gases) in Rwanda include agricultural burning and cookstoves in rural areas, and older diesel vehicles and mototaxis in cities. Currently, initiatives to supply efficient cookstoves, development of cleaner-burning fuel from recycled agricultural waste, and new regulations on vehicle emissions and importation are underway. These initiatives seek to help Rwanda grow in the greenest way possible, to mitigate negative health and climate effects of development; however, little ambient data on air quality is available in different regions of Rwanda for a baseline study before and benefits study after these initiatives. The Rwanda Climate Observatory, located on the summit of Mt. Mugogo (-1.5833°, 29.5667°), a 2.5 km peak, has recently begun measurements of black carbon (BC) aerosol concentration and O3 and CO gas concentrations. BC measurements were performed with a 7-wavelength Magee Scientific aethalometer and the aethalometer model was used to calculate the influence of fossil fuel and biomass burning sources on BC concentrations. CO and O3 measurements were used in conjunction with BC aerosol data, and HYSPLIT back trajectories were also used to help discriminate between periods of heavy burning and periods of regional influence from traffic and general cookfire emissions. Since Mt. Mugogo is in a rural area, this station captures a snapshot of regional background pollution away from high anthropogenic influence. The nearby households and fields also allow case studies of household and crop burning during localized events and help quanitfy potential daily exposure to particulates and climate-forcing emissions in remote areas of this developing country. We will present time series of the BC, O3, CO and insolation measurements at Mt. Mugogo, and interpret them in terms of sources, circulation, air chemistry and physics, and sinks.

Determination of deuterium–tritium critical burn-up parameter by four temperature theory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nazirzadeh, M.; Ghasemizad, A.; Khanbabei, B.

Conditions for thermonuclear burn-up of an equimolar mixture of deuterium-tritium in non-equilibrium plasma have been investigated by four temperature theory. The photon distribution shape significantly affects the nature of thermonuclear burn. In three temperature model, the photon distribution is Planckian but in four temperature theory the photon distribution has a pure Planck form below a certain cut-off energy and then for photon energy above this cut-off energy makes a transition to Bose-Einstein distribution with a finite chemical potential. The objective was to develop four temperature theory in a plasma to calculate the critical burn up parameter which depends upon initialmore » density, the plasma components initial temperatures, and hot spot size. All the obtained results from four temperature theory model are compared with 3 temperature model. It is shown that the values of critical burn-up parameter calculated by four temperature theory are smaller than those of three temperature model.« less

AmeriFlux US-An3 Anaktuvuk River Unburned

DOE Data Explorer

Hobbie, John [Marine Biological Laboratory; Rocha, Adrian [Marine Biological Laboratory; Shaver, Gaius [Marine Biological Laboratory

2016-01-01

This is the AmeriFlux version of the carbon flux data for the site US-An3 Anaktuvuk River Unburned. Site Description - The Anaktuvuk River fire on the North Slope of Alaska started on July 16, 2007 by lightning. It continued until the end of September when nearby lakes had already frozen over and burned >256,000 acres, creating a mosaic of patches that differed in burn severity. The Anaktuvuk River Severe Burn, Moderate Burn, and Unburned sites are 40 km to the west of the nearest road and were selected in late May 2008 to determine the effects of the fire on carbon, water, and energy exchanges during the growing season. Because the fire had burned through September of the previous year, initial deployment of flux towers occurred prior to any significant vegetative regrowth, and our sampling campaign captured the full growing season in 2008. The Unburned site was located in a large area of tundra that was unaffected by the fire.

An experimental study of high-pressure droplet combustion

NASA Technical Reports Server (NTRS)

Norton, Chris M.; Litchford, Ron J.; Jeng, San-Mou

1990-01-01

The results are presented of an experimental study on suspended n-heptane droplet combustion in air for reduced pressures up to P(r) = 2.305. Transition to fully transient heat-up through the critical state is demonstrated above a threshold pressure corresponding to P(r) of roughly 1.4. A silhouette imaging technique resolves the droplet surface for reduced pressures up to about P(r) roughly 0.63, but soot formation conceals the surface at higher pressures. Images of the soot plumes do not show any sudden change in behavior indicative of critical transition. Mean burning rate constants are computed from the d-squared variation law using measured effective droplet diameters at ignition and measured burn times, and corrected burning times are computed for an effective initial droplet diameter. The results show that the burning rates increase as the fuel critical pressure is approached and decrease as the pressure exceeds the fuel critical pressure. Corrected burning times show inverse behavior.

Initial effects from re-introducing fire in Alabama montane longleaf stands: fifty years since last burn

Treesearch

Sharon M. Hermann; John S. Kush

2010-01-01

In 2006, after more than fifty years with no burns, the National Park Service reintroduced fire in montane longleaf pine stands at Horseshoe Bend National Military Park in central AL. Residual longleaf pine stands indicates that this tree once dominated many slopes. The prolonged period of fire exclusion resulted in accumulation of duff and litter that exceeds 4 to 5...

Eight years of seasonal burning and herbicidal brush control influence sapling longleaf pine growth, understory vegetation, and the outcome of an ensuing wildfire

Treesearch

James D. Haywood

2009-01-01

To study how fire or herbicide use influences longleaf pine (Pinus palustris Mill.) overstory and understory vegetation, five treatments were initiated in a 5–6-year-old longleaf pine stand: check, biennial arborescent plant control by directed herbicide application, and biennial burning in March, May, or July. The herbicide or prescribed fire...

Initial Burn Pan (JMTF) Testing Results

DTIC Science & Technology

2016-03-01

of Testing and Materials (ASTM) standard for fire - resistant boom. It had not been used for over 15 years and was almost completely destroyed when...Environment Canada had produced operational guides, provided standards for fire - resistant booms and igniting techniques needed to perform offshore burns...are currently in the smoke zone; and the heat from the fire could be felt from that area. While no one was injured, some miscommunication at the

Effects of long-term prescribed burning on timber value in hardwood forests of the Missouri Ozarks

Treesearch

Benjamin O. Knapp; Joseph M. Marschall; Michael C. Stambaugh

2017-01-01

Prescribed fire is commonly used for restoring and managing oak woodlands but raises concern over the risk of value loss to timber products. We used a long-term prescribed burning study to quantify standing timber volume and stumpage value, fire scar presence and size, and timber value loss in comparison to unburned stands. Three study treatments were initiated in 1949...

40 CFR 63.11223 - How do I demonstrate continuous compliance with the work practice and management practice standards?

Code of Federal Regulations, 2014 CFR

2014-07-01

... conduct the tune-up while burning the type of fuel (or fuels in the case of boilers that routinely burn two types of fuels at the same time) that provided the majority of the heat input to the boiler over...-up must be no later than 25 months after the initial startup of the new or reconstructed boiler. (1...

40 CFR 63.11223 - How do I demonstrate continuous compliance with the work practice and management practice standards?

Code of Federal Regulations, 2013 CFR

2013-07-01

... conduct the tune-up while burning the type of fuel (or fuels in the case of boilers that routinely burn two types of fuels at the same time) that provided the majority of the heat input to the boiler over...-up must be no later than 25 months after the initial startup of the new or reconstructed boiler. (1...

Experimental study and large eddy simulation of effect of terrain slope on marginal burning in shrub fuel beds

Treesearch

Xiangyang Zhou; Shankar Mahalingam; David Weise

2007-01-01

This paper presents a combined study of laboratory scale fire spread experiments and a three-dimensional large eddy simulation (LES) to analyze the effect of terrain slope on marginal burning behavior in live chaparral shrub fuel beds. Line fire was initiated in single species fuel beds of four common chaparral plants under various fuel bed configurations and ambient...

Care for the Critically Injured Burn Patient Modulation of Burn Scars Through Laser Deliver of Stem Cells

DTIC Science & Technology

2013-10-01

average 1 hour per response , including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed...dermal remodeling 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF RESPONSIBLE PERSON USAMRMC a...evaluations made prior to each biopsy. The initial grading system took into account vascularity , pliability, color, contour, texture, and

Effects of magnetization on fusion product trapping and secondary neutron spectra

DOE PAGES

Knapp, Patrick F.; Schmit, Paul F.; Hansen, Stephanie B.; ...

2015-05-14

In magnetizing the fusion fuel in inertial confinement fusion (ICF) systems, we found that the required stagnation pressure and density can be relaxed dramatically. This happens because the magnetic field insulates the hot fuel from the cold pusher and traps the charged fusion burn products. This trapping allows the burn products to deposit their energy in the fuel, facilitating plasma self-heating. Here, we report on a comprehensive theory of this trapping in a cylindrical DD plasma magnetized with a purely axial magnetic field. Using this theory, we are able to show that the secondary fusion reactions can be used tomore » infer the magnetic field-radius product, BR, during fusion burn. This parameter, not ρR, is the primary confinement parameter in magnetized ICF. Using this method, we analyze data from recent Magnetized Liner InertialFusion experiments conducted on the Z machine at Sandia National Laboratories. Furthermore, we show that in these experiments BR ≈ 0.34(+0.14/-0.06) MG · cm, a ~ 14× increase in BR from the initial value, and confirming that the DD-fusion tritons are magnetized at stagnation. Lastly, this is the first experimental verification of charged burn product magnetization facilitated by compression of an initial seed magnetic flux.« less

40 CFR 270.62 - Hazardous waste incinerator permits.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., at the request of the applicant when good cause is shown. The permit may be modified to reflect the...) Stack gas monitoring and pollution control equipment. (H) Nozzle and burner design. (I) Construction... imminent hazard to human health or the environment; (iii) The trial burn will help the Director to...

40 CFR 270.62 - Hazardous waste incinerator permits.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., at the request of the applicant when good cause is shown. The permit may be modified to reflect the...) Stack gas monitoring and pollution control equipment. (H) Nozzle and burner design. (I) Construction... imminent hazard to human health or the environment; (iii) The trial burn will help the Director to...

40 CFR 270.62 - Hazardous waste incinerator permits.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., at the request of the applicant when good cause is shown. The permit may be modified to reflect the...) Stack gas monitoring and pollution control equipment. (H) Nozzle and burner design. (I) Construction... imminent hazard to human health or the environment; (iii) The trial burn will help the Director to...

40 CFR 270.62 - Hazardous waste incinerator permits.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., at the request of the applicant when good cause is shown. The permit may be modified to reflect the...) Stack gas monitoring and pollution control equipment. (H) Nozzle and burner design. (I) Construction... imminent hazard to human health or the environment; (iii) The trial burn will help the Director to...

TEST REPORT FOR THE TRIAL BURN OF DINOSEB IN A PILOT-SCALE INCINERATOR

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) has determined that the herbicide Dinoseb represents a significant human health hazard. PA estimates that there are approximately 5 million gallons affected by this action. As part of a program by the EPA Office of Research and Devel...

Topically applied metal chelator reduces thermal injury progression in a rat model of brass comb burn.

PubMed

Wang, Cheng Z; Ayadi, Amina El; Goswamy, Juhi; Finnerty, Celeste C; Mifflin, Randy; Sousse, Linda; Enkhbaatar, Perenlei; Papaconstantinou, John; Herndon, David N; Ansari, Naseem H

2015-12-01

Oxidative stress may be involved in the cellular damage and tissue destruction as burn wounds continues to progress after abatement of the initial insult. Since iron and calcium ions play key roles in oxidative stress, this study tested whether topical application of Livionex formulation (LF) lotion, that contains disodium EDTA as a metal chelator and methyl sulfonyl methane (MSM) as a permeability enhancer, would prevent or reduce burns. We used an established brass comb burn model with some modifications. Topical application of LF lotion was started 5 min post-burn, and repeated every 8 h for 3 consecutive days. Rats were euthanized and skin harvested for histochemistry and immunohistochemistry. Formation of protein adducts of 4-hydroxynonenal (HNE), malonadialdehyde (MDA) and acrolein (ACR) and expression of aldehyde dehydrogenase (ALDH) isozymes, ALDH1 and ALDH2 were assessed. LF lotion-treated burn sites and interspaces showed mild morphological improvement compared to untreated burn sites. Furthermore, the lotion significantly decreased the immunostaining of lipid aldehyde-protein adducts including protein -HNE, -MDA and -ACR adducts, and restored the expression of aldehyde dehydrogenase isozymes in the unburned interspaces. This data, for the first time, demonstrates that a topically applied EDTA-containing lotion protects burns progression with a concomitant decrease in the accumulation of reactive lipid aldehydes and protection of aldehyde dehydrogenase isozymes. Present studies are suggestive of therapeutic intervention of burns by this novel lotion. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Topically Applied Metal Chelator Reduces Thermal Injury Progression in a Rat Model of Brass Comb Burn

PubMed Central

Wang, Cheng Z.; El Ayadi, Amina; Goswamy, Juhi; Finnerty, Celeste C.; Mifflin, Randy; Sousse, Linda; Enkhbaatar, Perenlei; Papaconstantinou, John; Herndon, David N.; Ansari, Naseem H.

2016-01-01

Oxidative stress may be involved in the cellular damage and tissue destruction as burn wounds continues to progress after abatement of the initial insult. Since iron and calcium ions play key roles in oxidative stress, this study tested whether topical application of Livionex formulation (LF) lotion, that contains disodium EDTA as a metal chelator and methyl sulfonyl methane (MSM) as a permeability enhancer, would prevent or reduce burn injury. Methods We used an established brass comb burn model with some modifications. Topical application of LF lotion was started 5 minutes post-burn, and repeated every 8 hours for 3 consecutive days. Rats were euthanized and skin harvested for histochemistry and immunohistochemistry. Formation of protein adducts of 4-hydroxynonenal (HNE), malonadialdehyde (MDA) and acrolein (ACR) and expression of aldehyde dehydrogenase (ALDH) isozymes, ALDH1 and ALDH2 were assessed. Results LF lotion-treated burn sites and interspaces showed mild morphological improvement compared to untreated burn sites. Furthermore, the lotion significantly decreased the immunostaining of lipid aldehyde-protein adducts including protein -HNE, -MDA and -ACR adducts, and restored the expression of aldehyde dehydrogenase isozymes in the unburned interspaces. Conclusion This data, for the first time, demonstrates that a topically applied EDTA-containing lotion protects burn injury progression with a concomitant decrease in the accumulation of reactive lipid aldehydes and protection of aldehyde dehydrogenase isozymes. Present studies are suggestive of therapeutic intervention of burn injury by this novel lotion. PMID:26392023

Instant hot noodles: do they need to burn?

PubMed

Wu, C; Tan, A L; Maze, D A E; Holland, A J A

2013-03-01

Scalds and contact burns in children may occur as the result of spillage of hot food and drinks, including instant hot noodles. This study sought to determine the frequency of noodle burns in children and investigate the thermal properties of instant hot noodles. Data on instant hot noodle burns in children were retrieved from the New South Wales Severe Burn Injury Database between 2005 and 2010. Five widely available brands of instant hot noodles, including three cup and two packet varieties, were prepared following the manufacturer's instructions. For each preparation the initial temperature after cooking was recorded, together with the time to cool to 50°C. 291 children sustained instant hot noodle burns over the 6 year study period, representing 5.4% of all children referred to our burns unit. Over a third received inadequate first aid. Cup noodles cooked with boiling water reached the highest temperature of over 80°C and took the longest time to cool to 50°C: on average 52.3 min. Cup noodles in smaller, narrower containers achieved higher post-cooking temperatures compared to noodles in wider, bowel shaped containers. Packet noodles cooked in a Microwave oven attained lower peak temperatures and shorter cooling times compared to cup noodles. Although relatively uncommon in children, instant hot noodle burns often received inadequate first aid. When cooked according to manufacturer's instructions, noodles generally exceeded temperatures sufficient to cause a burn. Consumers and parents need to be aware of the risks of burn when preparing these foods. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Factors related to child maltreatment in children presenting with burn injuries.

PubMed

Wibbenmeyer, Lucy; Liao, Junlin; Heard, Jason; Kealey, Lyn; Kealey, Gerald; Oral, Resmiye

2014-01-01

The underpinnings of maltreatment in children presenting with burn injuries are necessary to discern as detection and prevention rest on a clear delineation of factors associated with maltreatment. Inaccurate identification of child victims can result in perpetuation of the maltreatment and its attendant neuropsychological sequela. The authors sought to determine factors associated with maltreatment in children presenting with burn injuries, which would guide the burn team in assessing the likelihood of maltreatment. All consenting children admitted with burn injuries were surveyed regarding their injury mechanism and current sociodemographic status. Suspicious injuries were referred by the burn team to the multidisciplinary review team (MRT). The MRT reported injuries with signs of physical abuse, supervision neglect, neglect of other basic needs, or sexual abuse. These children constituted the cases in our study. Variables related to maltreatment were entered into stepwise logistic regression to identify independent predicting variables. P< .05 was considered significant. MRT identified 16 children (24%) admitted with burn injuries with suspicions of maltreatment. Risk factors related to suspicions of maltreatment included: young age, large burns, tap water injury, immersion lines, delay in care, absence of a two-parent family (unconventional family structure), young parents, inconsistent history, and injury pattern. In this single-center prospective study, the authors identified several factors that, when present in injuries with initial suspicion of maltreatment, should trigger a child maltreatment workup. Burn clinicians have an important role as advocates for children and their families. It is important to continue to further the knowledge of maltreatment detection and prevention among children presenting with burn injuries.

Development and Implementation of an Innovative Burn Nursing Handbook for Quality Improvement

PubMed Central

Olszewski, Anna; Yanes, Amber; Stafford, Jessica; Greenhalgh, David G.; Palmieri, Tina L.; Sen, Soman; Tran, Nam

2015-01-01

Objective Evidence-based burn nursing literature is extremely limited and often non-existent. As a result, there is a lack of standardization in burn nursing care. Our objective is to evaluate burn nursing knowledge at an academic medical center and implement innovative educational tools to enhance staff competency and improve the quality of care. Methods A collaboration of practicing clinical nurses developed a 24-question knowledge assessment survey (“pre-survey”) to evaluate fundamental burn nursing knowledge (fluid management, burn pathophysiology, burn-related procedures, wound care, infection control). Pre-education knowledge surveys were administered to 59 burn nurses electronically. A writing team of new and experienced nurses was established and developed a 51-page handbook focusing on areas of need identified in the survey. This book was disseminated to staff as required reading. Post-educational surveys were sent to the same nurses who completed the initial survey. Results Forty-six nurses (46/59, 78.0%) completed the survey with a mean (SD) of 55.9 (11.0)% of questions being answered correctly. Post-surveys sent to the same 46 nurses who completed the pre-survey had a response rate of 78.3% (36/46). We observed a significant increase in correctly answered questions (mean [SD]: 69.6 (8.7)%, P<0.001) in the post-survey intervention. Conclusion The handbook improved education and significantly improved overall fundamental burn knowledge of practicing nursing staff. Use of electronic surveys to drive development of targeted educational interventions provides evidence-based tools for establishing burn nursing standards and developing quality improvement metrics. PMID:26284646

Hot soup! Correlating the severity of liquid scald burns to fluid and biomedical properties.

PubMed

Loller, Cameron; Buxton, Gavin A; Kerzmann, Tony L

2016-05-01

Burns caused by hot drinks and soups can be both debilitating and costly, especially to pediatric and geriatric patients. This research is aimed at better understanding the fluid properties that can influence the severity of skin burns. We use a standard model which combines heat transfer and biomedical equations to predict burn severity. In particular, experimental data from a physical model serves as the input to our numerical model to determine the severity of scald burns as a consequence of actual fluid flows. This technique enables us to numerically predict the heat transfer from the hot soup into the skin, without the need to numerically estimate the complex fluid mechanics and thermodynamics of the potentially highly viscous and heterogeneous soup. While the temperature of the soup is obviously is the most important fact in determining the degree of burn, we also find that more viscous fluids result in more severe burns, as the slower flowing thicker fluids remain in contact with the skin for longer. Furthermore, other factors can also increase the severity of burn such as a higher initial fluid temperature, a greater fluid thermal conductivity, or a higher thermal capacity of the fluid. Our combined experimental and numerical investigation finds that for average skin properties a very viscous fluid at 100°C, the fluid must be in contact with the skin for around 15-20s to cause second degree burns, and more than 80s to cause a third degree burn. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Selective decontamination of the digestive tract ameliorates severe burn-induced insulin resistance in rats.

PubMed

Li, Jun; Zhu, Liang; Xu, Ming; Han, Juntao; Bai, Xiaozhi; Yang, Xuekang; Zhu, Huayu; Xu, Jie; Zhang, Xing; Gong, Yangfan; Hu, Dahai; Gao, Feng

2015-08-01

Severe burns often initiate the prevalence of hyperglycemia and insulin resistance, significantly contributing to adverse clinical outcomes. However, there are limited treatment options. This study was designed to investigate the role and the underlying mechanisms of oral antibiotics to selectively decontaminate the digestive tract (SDD) on burn-induced insulin resistance. Rats were subjected to 40% of total body surface area full-thickness burn or sham operation with or without SDD treatment. Translocation of FITC-labeled LPS was measured at 4h after burn. Furthermore, the effect of SDD on post-burn quantity of gram-negative bacteria in gut was investigated. Serum or muscle LPS and proinflammatory cytokines were measured. Intraperitoneal glucose tolerance test and insulin tolerance test were used to determine the status of systemic insulin resistance. Furthermore, intracellular insulin signaling (IRS-1 and Akt) and proinflammatory related kinases (JNK and IKKβ) were assessed by western blot. Burn increased the translocation of LPS from gut 4h after injury. SDD treatment effectively inhibited post-burn overgrowth of gram-negative enteric bacilli in gut. In addition, severe burns caused significant increases in the LPS and proinflammatory cytokines levels, activation of proinflammatory related kinases, and systemic insulin resistance as well. But SDD treatment could significantly attenuate burn-induced insulin resistance and improve the whole-body responsiveness to insulin, which was associated with the inhibition of gut-derived LPS, cytokines, proinflammatory related kinases JNK and IKKβ, as well as activation of IRS-1 and Akt. SDD appeared to have an effect on proinflammatory signaling cascades and further reduced severe burn-induced insulin resistance. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Benchmarks for multidimensional recovery after burn injury in young adults: the development, validation, and testing of the American Burn Association/Shriners Hospitals for Children young adult burn outcome questionnaire.

PubMed

Ryan, Colleen M; Schneider, Jeffrey C; Kazis, Lewis E; Lee, Austin; Li, Nien-Chen; Hinson, Michelle; Bauk, Helena; Peck, Michael; Meyer, Walter J; Palmieri, Tina; Pidcock, Frank S; Reilly, Debra; Tompkins, Ronald G

2013-01-01

Although data exist on burn survival, there are little data on long-term burn recovery. Patient-centered health outcomes are useful in monitoring and predicting recovery and evaluating treatments. An outcome questionnaire for young adult burn survivors was developed and tested. This 5-year (2003-2008) prospective, controlled, multicenter study included burned and nonburned adults ages 19 to 30 years. The Young Adult Burn Outcome Questionnaires were completed at initial contact, 10 days, and 6 and 12 months. Factor analysis established construct validity. Reliability assessments used Cronbach α and test-retest. Recovery patterns were investigated using generalized linear models, with generalized estimating equations using mixed models and random effects. Burned (n = 153) and nonburned subjects (n = 112) completed 620 questionnaires (47 items). Time from injury to first questionnaire administration was 157 ± 36 days (mean ± SEM). Factor analysis included 15 factors: Physical Function, Fine Motor Function, Pain, Itch, Social Function Limited by Physical Function, Perceived Appearance, Social Function Limited by Appearance, Sexual Function, Emotion, Family Function, Family Concern, Satisfaction With Symptom Relief, Satisfaction With Role, Work Reintegration, and Religion. Cronbach α ranged from 0.72 to 0.92, with 11 scales >0.8. Test-retest reliability ranged from 0.29 to 0.94, suggesting changes in underlying health status after burns. Recovery curves in five domains, Itch, Perceived Appearance, Social Function Limited by Appearance, Family Concern, and Satisfaction with Symptom Relief, remained below the reference group at 24 months. The Young Adult Burn Outcome Questionnaire is a reliable and valid instrument for multidimensional functional outcomes assessment. Recovery in some domains was incomplete.

The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care.

PubMed

Cleland, Heather; Greenwood, John E; Wood, Fiona M; Read, David J; Wong She, Richard; Maitz, Peter; Castley, Andrew; Vandervord, John G; Simcock, Jeremy; Adams, Christopher D; Gabbe, Belinda J

2016-03-21

Analysis of data from the Burns Registry of Australia and New Zealand (BRANZ) to determine the extent of variation between participating units in treatment and in specific outcomes during the first 4 years of its operation. BRANZ, an initiative of the Australian and New Zealand Burn Association, is a clinical quality registry developed in accordance with the Australian Commission on Safety and Quality in Healthcare national operating principles. Patients with burn injury who fulfil pre-defined criteria are transferred to and managed in designated burn units. There are 17 adult and paediatric units in Australia and New Zealand that manage almost all patients with significant burn injury. Twelve of these units treat adult patients. Data on 7184 adult cases were contributed by ten acute adult burn units to the registry between July 2010 and June 2014.Major outcomes: In-hospital mortality, hospital length of stay, skin grafting rates, and rates of admission to intensive care units. Considerable variations in unit profiles (including numbers of patients treated), in treatment and in outcomes were identified. Despite the highly centralised delivery of care to patients with severe or complex burn injury, and the relatively small number of specialist burn units, we found significant variation between units in clinical management and in outcomes. BRANZ data from its first 4 years of operation support its feasibility and the value of further development of the registry. Based on these results, the focus of ongoing research is to improve understanding of the reasons for variations in practice and of their effect on outcomes for patients, and to develop evidence-informed clinical guidelines for burn management in Australia and New Zealand.

Electrothermal ring burn from a car battery.

PubMed

Sibley, Paul A; Godwin, Kenneth A

2013-08-01

Despite prevention efforts, burn injuries among auto mechanics are described in the literature. Electrothermal ring burns from car batteries occur by short-circuiting through the ring when it touches the open terminal or metal housing. This article describes a 34-year-old male auto mechanic who was holding a wrench when his gold ring touched the positive terminal of a 12-volt car battery and the wrench touched both his ring and the negative terminal. He felt instant pain and had a deep partial-thickness circumferential burn at the base of his ring finger. No other soft tissues were injured. He was initially managed conservatively, but after minimal healing at 3 weeks, he underwent a full-thickness skin graft. The graft incorporated well and healed by 4 weeks postoperatively. He had full range of motion. The cause of ring burns has been controversial, but based on reports similar to the current patient's mechanism, they are most likely electrothermal burns. Gold, a metal with high thermal conductivity, can heat up to its melting point in a matter of seconds. Many treatments have been described, including local wound care to split- and full-thickness skin grafts. Because most burns are preventable, staff should be warned and trained about the potential risks of contact burns. All jewelry should be removed, and the live battery terminal should be covered while working in the vicinity of the battery. Copyright 2013, SLACK Incorporated.

From Cholera to Burns: A Role for Oral Rehydration Therapy

PubMed Central

Green, W.B.; Asuku, M.E.; Feldman, M.; Makam, R.; Noppenberger, D.; Price, L.A.; Prosciak, M.; van Loon, I.N.

2011-01-01

According to the practice guidelines of the American Burn Association on burn shock resuscitation, intravenous (IV) fluid therapy is the standard of care for the replacement of fluid and electrolyte losses in burn injury of ≥20% of the total body surface area. However, in mass burn casualties, IV fluid resuscitation may be delayed or unavailable. Oral rehydration therapy (ORT), which has been shown to be highly effective in the treatment of dehydration in epidemics of cholera, could be an alternate way to replace fluid losses in burns. A prospective case series of three patients was carried out as an initial step to establish whether oral Ceralyte®90 could replace fluid losses requiring IV fluid therapy in thermal injury. The requirement of the continuing IV fluid therapy was reduced by an average of 58% in the first 24 hours after the injury (range 37-78%). ORT may be a feasible alternative to IV fluid therapy in the resuscitation of burns. It could also potentially save many lives in mass casualty situations or in resource-poor settings where IV fluid therapy is not immediately available. Further studies are needed to assess the efficacy of this treatment and to determine whether the present formulations of ORT for cholera need modification. PMID:22283039

Accelerated re-epithelialization of partial-thickness skin wounds by a topical betulin gel: Results of a randomized phase III clinical trials program.

PubMed

Barret, Juan P; Podmelle, Fred; Lipový, Břetislav; Rennekampff, Hans-Oliver; Schumann, Hauke; Schwieger-Briel, Agnes; Zahn, Tobias R; Metelmann, Hans-Robert

2017-09-01

The clinical significance of timely re-epithelialization is obvious in burn care, since delayed wound closure is enhancing the risk of wound site infection and extensive scarring. Topical treatments that accelerate wound healing are urgently needed to reduce these sequelae. Evidence from preliminary studies suggests that betulin can accelerate the healing of different types of wounds, including second degree burns and split-thickness skin graft wounds. The goal of this combined study program consisting of two randomized phase III clinical trials in parallel is to evaluate whether a topical betulin gel (TBG) is accelerating re-epithelialization of split-thickness skin graft (STSG) donor site wounds compared to standard of care. Two parallel blindly evaluated, randomised, controlled, multicentre phase III clinical trials were performed in adults undergoing STSG surgery (EudraCT nos. 2012-003390-26 and 2012-000777-23). Donor site wounds were split into two equal halves and randomized 1:1 to standard of care (a non-adhesive moist wound dressing) or standard of care plus TBG consisting of 10% birch bark extract and 90% sunflower oil (Episalvan, Birken AG, Niefern-Oeschelbronn, Germany). The primary efficacy assessment was the intra-individual difference in time to wound closure assessed from digital photographs by three blinded experts. A total of 219 patients were included and treated in the two trials. Wounds closed faster with TBG than without it (15.3 vs. 16.5 days; mean intra-individual difference=-1.1 days [95% CI, -1.5 to -0.7]; p<0.0001). This agreed with unblinded direct clinical assessment (difference=-2.1 days [95% CI, -2.7 to -1.5]; p<0.0001). Adverse events possibly related to treatment were mild or moderate and mostly at the application site. TBG accelerates re-epithelialization of partial thickness wounds compared to the current standard of care, providing a well-tolerated contribution to burn care in practice. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Beneficial Effects of Hydrogen-Rich Saline on Early Burn-Wound Progression in Rats

PubMed Central

Guo, Song Xue; Jin, Yun Yun; Fang, Quan; You, Chuan Gang; Wang, Xin Gang; Hu, Xin Lei; Han, Chun-Mao

2015-01-01

Introduction Deep burn wounds undergo a dynamic process known as wound progression that results in a deepening and extension of the initial burn area. The zone of stasis is more likely to develop more severe during wound progression in the presence of hypoperfusion. Hydrogen has been reported to alleviate injury triggered by ischaemia/reperfusion and burns in various organs by selectively quenching oxygen free radicals. The aim of this study was to investigate the possible protective effects of hydrogen against early burn-wound progression. Methods Deep-burn models were established through contact with a boiled, rectangular, brass comb for 20 s. Fifty-six Sprague-Dawley rats were randomly divided into sham, burn plus saline, and burn plus hydrogen-rich saline (HS) groups with sacrifice and analysis at various time windows (6 h, 24 h, 48 h) post burn. Indexes of oxidative stress, apoptosis and autophagy were measured in each group. The zone of stasis was evaluated using immunofluorescence staining, ELISA, and Western blot to explore the underlying effects and mechanisms post burn. Results The burn-induced increase in malondialdehyde was markedly reduced with HS, while the activities of endogenous antioxidant enzymes were significantly increased. Moreover, HS treatment attenuated increases in apoptosis and autophagy postburn in wounds, according to the TUNEL staining results and the expression analysis of Bax, Bcl-2, caspase-3, Beclin-1 and Atg-5 proteins. Additionally, HS lowered the level of myeloperoxidase and expression of TNF-α, IL-1β, and IL-6 in the zone of stasis while augmenting IL-10. The elevated levels of Akt phosphorylation and NF-κB p65 expression post burn were also downregulated by HS management. Conclusion Hydrogen can attenuate early wound progression following deep burn injury. The beneficial effect of hydrogen was mediated by attenuating oxidative stress, which inhibited apoptosis and inflammation, and the Akt/NF-κB signalling pathway may be involved in regulating the release of inflammatory cytokines. PMID:25874619

Effect of gamma-hydroxybutyrate on keratinocytes proliferation: A preliminary prospective controlled study in severe burn patients.

PubMed

Rousseau, Anne-Françoise; Bargues, Laurent; Bever, Hervé Le; Vest, Philippe; Cavalier, Etienne; Ledoux, Didier; Piérard, Gérald E; Damas, Pierre

2014-04-01

Hypermetabolism and hyposomatotropism related to severe burns lead to impaired wound healing. Growth hormone (GH) boosts wound healing notably following stimulation of the production of insulin-like growth factor-1 (IGF1), a mitogen factor for keratinocytes. Gamma-hydroxybutyrate (GHB) stimulates endogenous GH secretion. To assess effects of GHB sedation on keratinocytes proliferation (based on immunohistochemical techniques). Monocentric, prospective, controlled trial. Patients (aging 18-65 years, burn surface area >30%, expected to be sedated for at least one month) were alternately allocated, at the 5(th) day following injury, in three groups according to the intravenous GHB dose administered for 21 days: Evening bolus of 50 mg/kg (Group B), continuous infusion at the rate of 10 mg/kg/h (Group C), or absence of GHB (Group P). They all received local standard cares. Immunohistochemistry (Ki67/MIB-1, Ulex europaeus agglutinin-1 and Mac 387 antibodies) was performed at D21 on adjacent unburned skin sample for assessing any keratinocyte activation. Serum IGF1 levels were measured at initiation and completion of the protocol. Categorical variables were compared with Chi-square test. Comparisons of medians were made using Kruskal-Wallis test. Post hoc analyses were performed using Mann-Whitney test with Bonferroni correction for multiple comparisons. A P < 0.05 was considered to be statistically significant. A total of 14 patients completed the study (Group B: n = 5, Group C: n = 5, Group P: n = 4). Continuous administration of GHB was associated with a significant higher Ki67 immunolabeling at D21 (P = 0.049) and with a significant higher increase in the IGF1 concentrations at D21 (P = 0.024). No adverse effects were disclosed. Our preliminary data support a positive effect of GHB on keratinocyte proliferation and are encouraging enough to warrant large prospective studies.

Effect of gamma-hydroxybutyrate on keratinocytes proliferation: A preliminary prospective controlled study in severe burn patients

PubMed Central

Rousseau, Anne-Françoise; Bargues, Laurent; Bever, Hervé Le; Vest, Philippe; Cavalier, Etienne; Ledoux, Didier; Piérard, Gérald E.; Damas, Pierre

2014-01-01

Background: Hypermetabolism and hyposomatotropism related to severe burns lead to impaired wound healing. Growth hormone (GH) boosts wound healing notably following stimulation of the production of insulin-like growth factor-1 (IGF1), a mitogen factor for keratinocytes. Gamma-hydroxybutyrate (GHB) stimulates endogenous GH secretion. Aim: To assess effects of GHB sedation on keratinocytes proliferation (based on immunohistochemical techniques). Design: Monocentric, prospective, controlled trial. Materials and Methods: Patients (aging 18-65 years, burn surface area >30%, expected to be sedated for at least one month) were alternately allocated, at the 5th day following injury, in three groups according to the intravenous GHB dose administered for 21 days: Evening bolus of 50 mg/kg (Group B), continuous infusion at the rate of 10 mg/kg/h (Group C), or absence of GHB (Group P). They all received local standard cares. Immunohistochemistry (Ki67/MIB-1, Ulex europaeus agglutinin-1 and Mac 387 antibodies) was performed at D21 on adjacent unburned skin sample for assessing any keratinocyte activation. Serum IGF1 levels were measured at initiation and completion of the protocol. Statistical Analysis: Categorical variables were compared with Chi-square test. Comparisons of medians were made using Kruskal-Wallis test. Post hoc analyses were performed using Mann-Whitney test with Bonferroni correction for multiple comparisons. A P < 0.05 was considered to be statistically significant. Results: A total of 14 patients completed the study (Group B: n = 5, Group C: n = 5, Group P: n = 4). Continuous administration of GHB was associated with a significant higher Ki67 immunolabeling at D21 (P = 0.049) and with a significant higher increase in the IGF1 concentrations at D21 (P = 0.024). No adverse effects were disclosed. Conclusions: Our preliminary data support a positive effect of GHB on keratinocyte proliferation and are encouraging enough to warrant large prospective studies. PMID:25024938

Effects of drop freezing on microphysics of an ascending cloud parcel under biomass burning conditions

NASA Astrophysics Data System (ADS)

Diehl, K.; Simmel, M.; Wurzler, S.

There is some evidence that the initiation of warm rain is suppressed in clouds over regions with vegetation fires. Thus, the ice phase becomes important as another possibility to initiate precipitation. Numerical simulations were performed to investigate heterogeneous drop freezing for a biomass-burning situation. An air parcel model with a sectional two-dimensional description of the cloud microphysics was employed with parameterizations for immersion and contact freezing which consider the different ice nucleating efficiencies of various ice nuclei. Three scenarios were simulated resulting to mixed-phase or completely glaciated clouds. According to the high insoluble fraction of the biomass-burning particles drop freezing via immersion and contact modes was very efficient. The preferential freezing of large drops followed by riming (i.e. the deposition of liquid drops on ice particles) and the evaporation of the liquid drops (Bergeron-Findeisen process) caused a further decrease of the liquid drops' effective radius in higher altitudes. In turn ice particle sizes increased so that they could serve as germs for graupel or hailstone formation. The effects of ice initiation on the vertical cloud dynamics were fairly significant leading to a development of the cloud to much higher altitudes than in a warm cloud without ice formation.

A mesoscopic reaction rate model for shock initiation of multi-component PBX explosives.

PubMed

Liu, Y R; Duan, Z P; Zhang, Z Y; Ou, Z C; Huang, F L

2016-11-05

The primary goal of this research is to develop a three-term mesoscopic reaction rate model that consists of a hot-spot ignition, a low-pressure slow burning and a high-pressure fast reaction terms for shock initiation of multi-component Plastic Bonded Explosives (PBX). Thereinto, based on the DZK hot-spot model for a single-component PBX explosive, the hot-spot ignition term as well as its reaction rate is obtained through a "mixing rule" of the explosive components; new expressions for both the low-pressure slow burning term and the high-pressure fast reaction term are also obtained by establishing the relationships between the reaction rate of the multi-component PBX explosive and that of its explosive components, based on the low-pressure slow burning term and the high-pressure fast reaction term of a mesoscopic reaction rate model. Furthermore, for verification, the new reaction rate model is incorporated into the DYNA2D code to simulate numerically the shock initiation process of the PBXC03 and the PBXC10 multi-component PBX explosives, and the numerical results of the pressure histories at different Lagrange locations in explosive are found to be in good agreements with previous experimental data. Copyright © 2016 Elsevier B.V. All rights reserved.

Feasibility intervention trial of two types of improved cookstoves in three resource-limited settings: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Exposure to biomass fuel smoke is one of the leading risk factors for disease burden worldwide. International campaigns are currently promoting the widespread adoption of improved cookstoves in resource-limited settings, yet little is known about the cultural and social barriers to successful improved cookstove adoption and how these barriers affect environmental exposures and health outcomes. Design We plan to conduct a one-year crossover, feasibility intervention trial in three resource-limited settings (Kenya, Nepal and Peru). We will enroll 40 to 46 female primary cooks aged 20 to 49 years in each site (total 120 to 138). Methods At baseline, we will collect information on sociodemographic characteristics and cooking practices, and measure respiratory health and blood pressure for all participating women. An initial observational period of four months while households use their traditional, open-fire design cookstoves will take place prior to randomization. All participants will then be randomized to receive one of two types of improved, ventilated cookstoves with a chimney: a commercially-constructed cookstove (Envirofit G3300/G3355) or a locally-constructed cookstove. After four months of observation, participants will crossover and receive the other improved cookstove design and be followed for another four months. During each of the three four-month study periods, we will collect monthly information on self-reported respiratory symptoms, cooking practices, compliance with cookstove use (intervention periods only), and measure peak expiratory flow, forced expiratory volume at 1 second, exhaled carbon monoxide and blood pressure. We will also measure pulmonary function testing in the women participants and 24-hour kitchen particulate matter and carbon monoxide levels at least once per period. Discussion Findings from this study will help us better understand the behavioral, biological, and environmental changes that occur with a cookstove intervention. If this trial indicates that reducing indoor air pollution is feasible and effective in resource-limited settings like Peru, Kenya and Nepal, trials and programs to modify the open burning of biomass fuels by installation of low-cost ventilated cookstoves could significantly reduce the burden of illness and death worldwide. Trial registration ClinicalTrials.gov NCT01686867 PMID:24112419

Analysis of Images and Spectra of Spacecraft-Induced Radiations

DTIC Science & Technology

1992-07-17

25 s after ignition, since it stems from the initial azimuthal nonuniformity of the propellant burn pattern--as we hypothesize later--, would not be...developing irregular luminosity and succeedin;g few seconds of transversely separated but otherwise relatively smooth glow (refer to Fig. 1) to nonuniform ...appears in the video photographs of the Star 27 burn (see Fig. 15), nonuniform in radiance but with about the same diameter as the later-developing

A Critical Assessment of the Aluminum Cartridge Case Failure Mechanism

DTIC Science & Technology

1976-03-01

achievements of an exploratory development program at Frankford Arsenal. The program was initiated to determine the engineering parameters required for...third that of brass cases, are ideal for improving the combat load effectiveness of an infantryman, a combat vehicle or a gunship« To enable...damage sus- tained by aluminum cartridge cases during "burn-through". A more accurate method of determining the effect of "burn- through" in a

Organizational Characteristics that Contribute to Success in Engaging the Public to Accomplish Fuels Management at the Wilderness/Non-Wilderness Interface

Treesearch

Katie Knotek; Alan E. Watson

2006-01-01

In the fall of 2003, the Rocky Mountain Ranger District of the Lewis and Clark National Forest initiated a multi-year, large-scale prescribed burn in the Scapegoat Wilderness. The objectives of this burn were to make the non-wilderness side of the wilderness boundary more defensible from wildfire and to establish conditions that will allow fire to play a more natural...

System for Initial Assessment, Management, and Physiologic Monitoring of Battlefield Casualties

DTIC Science & Technology

1986-03-01

largest volume of closed head injury patients of any single hospital in the United States, the ABER study has become a screening procedure of choice...ABBREVIATED INJURY SCALE Severity Category/Injury Description Severity code GENERAL 1. -- Aches all over -- Minor lacerations, contusions, and...surface 2* or 3* burns 5. -- Over 50% body surface 20 or 30 burns HEAD AND NECK 1. -- Cerebral injury with headache; dizziness; no loss of consciousness

Initial tree mortality, and insect and pathogen response to fire and thinning restoration treatments in an old growth, mixed-conifer forest of the Sierra Nevada, California

Treesearch

P. Maloney; T. Smith; C. Jensen; J. Innes; D. Rizzo; M. North

2008-01-01

Fire and thinning restoration treatments in fire-suppressed forests often damage or stress leave trees, altering pathogen and insect affects. We compared types of insect- and pathogen-mediated mortality on mixed-conifer trees 3years after treatment. The number of bark beetle attacked trees was greater in burn treatments compared with no-burn treatments, and in some...

The introduction of a protocol for the use of biobrane for facial burns in children.

PubMed

Rogers, A D; Adams, S; Rode, H

2011-01-01

BIOBRANE HAS BECOME AN INDISPENSIBLE DRESSING WITH THREE ESTABLISHED INDICATIONS IN ACUTE BURNS CARE AT OUR INSTITUTION: (1) as the definitive dressing of superficial partial thickness facial burns, (2) after tangential excision of deep burns when autograft or cadaver skin is unavailable, and (3) for graft reduction. This paper details our initial experience of Biobrane for the management of superficial partial thickness facial burns in children and the protocol that was compiled for its optimal use. A retrospective analysis of theatre records, case notes and photographs was performed to evaluate our experience with Biobrane over a one-year period. Endpoints included length of stay, analgesic requirements, time to application of Biobrane, healing times, and aesthetic results. Historical controls were used to compare the results with our previous standard of care. 87 patients with superficial partial thickness burns of the face had Biobrane applied during this period. By adhering to the protocol we were able to demonstrate significant reductions in hospital stay, healing time, analgesic requirements, nursing care, with excellent cosmetic results. The protocol is widely accepted by all involved in the optimal management of these patients, including parents, anaesthetists, and nursing staff.

Treatment modalities for burning mouth syndrome: a systematic review.

PubMed

de Souza, Isadora Follak; Mármora, Belkiss Câmara; Rados, Pantelis Varvaki; Visioli, Fernanda

2018-06-01

In the burning mouth syndrome (BMS), patients experience a burning sensation in the oral cavity with no associated injury or clinical manifestation. The etiology of this condition is still poorly understood, and therefore, treatment is challenging. The aim of this study is to perform a systematic review of treatment possibilities described in the literature for BMS. PubMed, Embase, and SciELO databases were searched for randomized clinical trials published between 1996 and 2016. Following application of inclusion and exclusion criteria, 29 papers were analyzed and divided into five subcategories according to the type of treatment described: antidepressants, alpha-lipoic acid, phytotherapeutic agents, analgesic and anti-inflammatory agents, and non-pharmacological therapies. In each category, the results found were compared with regard to the methodology employed, sample size, assessment method, presence or absence of adverse effects, and treatment outcomes. The analysis revealed that the use of antidepressants and alpha-lipoic acid has been showing promising results; however, more studies are necessary before we can have a first-line treatment strategy for patients with BMS. To review systematically the literature about Burning Mouth Syndrome treatment may aid the clinicians to choose the treatment modality to improve patients symptoms based on the best evidence.

Routine systemic antibiotic prophylaxis for burn injuries in developing countries: A best evidence topic (BET)

PubMed Central

Stewart, Barclay T; Gyedu, Adam; Agbenorku, Pius; Amankwa, Richcane; Kushner, Adam L; Gibran, Nicole

2015-01-01

Background Burns are common in low- and middle-income countries (LMICs) and complicated by unhygienic conditions, malnutrition, use of high-risk homemade dressings and delayed presentation. Resultantly, use of routine systemic antibiotic prophylaxis (SAP) to prevent wound infection is common practice despite this intervention being abandoned in high-income countries due to increased antimicrobial resistance and non-bacterial suprainfection, Methods A best evidence topic (BET) was constructed using a structured protocol. The question addressed was: In LMICs, does routine use of SAP reduce burn wound infection, morbidity or mortality? Results From 704 retrieved records, 48 reports met criteria to be examined. Of those, 3 studies represented the best available evidence. Together, two randomized clinical trials (RCTs) and a retrospective cohort study reported no difference in the proportion of wound infection, any infection or length of hospital stay between SAP groups and controls. One RCT described a greater proportion of wounds infected with P. aeruginosa among SAP arms compared to controls. The studies had few participants and significant methodological weaknesses. Conclusion On the basis of limited, currently available evidence, the use of SAP cannot be recommended for patients in LMICs that present soon after burn injury. PMID:26260622

The effectiveness and cost-effectiveness of first aid interventions for burns given to caregivers of children: A systematic review.

PubMed

Nurmatov, Ulugbek B; Mullen, Stephen; Quinn-Scoggins, Harriet; Mann, Mala; Kemp, Alison

2018-05-01

the effectiveness and cost-effectiveness of burns first-aid educational interventions given to caregivers of children. Systematic review of eligible studies from seven databases, international journals, trials repositories and contacted international experts. Of 985 potential studies, four met the inclusion criteria. All had high risk of bias and weak global rating. Two studies identified a statistically significant increase in knowledge after of a media campaign. King et al. (41.7% vs 63.2%, p<0.0001), Skinner et al. (59% vs 40%, p=0.004). Skinner et al. also identified fewer admissions (64.4% vs 35.8%, p<0.001) and surgical procedures (25.6% vs 11.4%, p<0.001). Kua et al. identified a significant improvement in caregiver's knowledge (22.9% vs 78.3%, 95% CI 49.2, 61.4) after face-to-face education intervention. Ozyazicioglu et al. evaluated the effect of a first-aid training program and showed a reduction in use of harmful traditional methods for burns in children (29% vs 16.1%, p<0.001). No data on cost-effectiveness was identified. There is a paucity of high quality research in this field and considerable heterogeneity across the included studies. Delivery and content of interventions varied. However, studies showed a positive effect on knowledge. No study evaluated the direct effect of the intervention on first aid administration. High quality clinical trials are needed. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Burn leads to long-term elevated admissions to hospital for gastrointestinal disease in a West Australian population based study.

PubMed

Stevenson, Andrew W; Randall, Sean M; Boyd, James H; Wood, Fiona M; Fear, Mark W; Duke, Janine M

2017-05-01

While the most obvious impact of burn is on the skin, systemic responses also occur after burn, including intestinal inflammation. The objective of this study was to assess if burns are associated with increased long-term admissions for gastrointestinal diseases. A population-based longitudinal study using linked hospital morbidity and death data from Western Australia was undertaken of adults aged at least 15 years when hospitalized for a first burn (n=20,561) in 1980-2012. A frequency matched non-injury comparison cohort was randomly selected from Western Australia's birth registrations and electoral roll (n=80,960). Crude admission rates and summed days in hospital for digestive diseases were calculated. Negative binomial and Cox proportional hazards regression modeling were used to generate incidence rate ratios (IRR) and hazard ratios (HR), respectively. After adjustment for demographic factors and pre-existing health status, the burn cohort had 1.54 times (95% confidence interval (CI): 1.47-1.62) as many admissions and almost three times the number of days in hospital with a digestive system diagnosis (IRR, 95% CI: 2.90, 2.60-3.25) than the uninjured cohort. Significantly elevated adjusted post-burn incident rates were identified, with the risk decreasing with increasing time: in the first month (HR, 95% CI: 3.02, 1.89-4.82), from one month to five years (HR, 95% CI: 1.42, 1.31-1.54), and from five to twenty years after burn (HR, 95% CI: 1.13, 1.06-1.20). Findings of increased hospital admission rates and prolonged length of hospital stay for gastrointestinal diseases in the burn cohort provide evidence to support that burns have effects that persist long after the initial injury. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Black carbon content in a ponderosa pine forest of eastern Oregon with varying seasons and intervals of prescribed burns

NASA Astrophysics Data System (ADS)

Matosziuk, L.; Hatten, J. A.

2016-12-01

Soil carbon represents a significant component of the global carbon cycle. While fire-based disturbance of forest ecosystems acts as a carbon source, the increased temperatures can initiate molecular changes to forest biomass that convert fast cycling organic carbon into more stable forms such as black carbon (BC), a product of incomplete combustion that contains highly-condensed aromatic structures and very low hydrogen and oxygen content. Such forms of carbon can remain in the soil for hundred to thousands of years, effectively creating a long-term carbon sink. The goal of this project is to understand how specific characteristics of prescribed burns, specifically the season of burn and the interval between burns, affect the formation, structure, and retention of these slowly degrading forms of carbon in the soil. Both O-horizon (forest floor) and mineral soil (0-15 cm cores) samples were collected from a season and interval of burn study in Malheur National Forest. The study area is divided into six replicate units, each of which is sub-divided into four treatment areas and a control. Beginning in 1997, each treatment area was subjected to: i) spring burns at five-year intervals, ii) fall burns at five-year intervals, iii) spring burns at 15-year intervals, or iv) fall burns at 15-year intervals. The bulk density, pH, and C/N content of each soil were measured to assess the effect of the burn treatments on the soil. Additionally, the amount and molecular structure of BC in each sample was quantified using the distribution of specific molecular markers (benzene polycarboxylic acids or BPCAs) that are present in the soil following acid digestion.

A thirty year, fine-scale, characterization of area burned in Canadian forests shows evidence of regionally increasing trends in the last decade

PubMed Central

2018-01-01

Fire as a dominant disturbance has profound implications on the terrestrial carbon cycle. We present the first ever multi-decadal, spatially-explicit, 30 meter assessment of fire regimes across the forested ecoregions of Canada at an annual time-step. From 1985 to 2015, 51 Mha burned, impacting over 6.5% of forested ecosystems. Mean annual area burned was 1,651,818 ha and varied markedly (σ = 1,116,119), with 25% of the total area burned occurring in three years: 1989, 1995, and 2015. Boreal forest types contained 98% of the total area burned, with the conifer-dominated Boreal Shield containing one-third of all burned area. While results confirm no significant national trend in burned area for the period of 1985 to 2015, a significant national increasing trend (α = 0.05) of 11% per year was evident for the past decade (2006 to 2015). Regionally, a significant increasing trend in total burned area from 1985 to 2015 was observed in the Montane Cordillera (2.4% increase per year), while the Taiga Plains and Taiga Shield West displayed significant increasing trends from 2006 to 2015 (26.1% and 12.7% increases per year, respectively). The Atlantic Maritime, which had the lowest burned area of all ecozones (0.01% burned per year), was the only ecozone to display a significant negative trend (2.4% decrease per year) from 1985 to 2015. Given the century-long fire return intervals in many of these ecozones, and large annual variability in burned area, short-term trends need to be interpreted with caution. Additional interpretive cautions are related to year used for trend initiation and the nature and extents of spatial regionalizations used for summarizing findings. The results of our analysis provide a baseline for monitoring future national and regional trends in burned area and offer spatially and temporally detailed insights to inform science, policy, and management. PMID:29787562

A thirty year, fine-scale, characterization of area burned in Canadian forests shows evidence of regionally increasing trends in the last decade.

PubMed

Coops, Nicholas C; Hermosilla, Txomin; Wulder, Michael A; White, Joanne C; Bolton, Douglas K

2018-01-01

Fire as a dominant disturbance has profound implications on the terrestrial carbon cycle. We present the first ever multi-decadal, spatially-explicit, 30 meter assessment of fire regimes across the forested ecoregions of Canada at an annual time-step. From 1985 to 2015, 51 Mha burned, impacting over 6.5% of forested ecosystems. Mean annual area burned was 1,651,818 ha and varied markedly (σ = 1,116,119), with 25% of the total area burned occurring in three years: 1989, 1995, and 2015. Boreal forest types contained 98% of the total area burned, with the conifer-dominated Boreal Shield containing one-third of all burned area. While results confirm no significant national trend in burned area for the period of 1985 to 2015, a significant national increasing trend (α = 0.05) of 11% per year was evident for the past decade (2006 to 2015). Regionally, a significant increasing trend in total burned area from 1985 to 2015 was observed in the Montane Cordillera (2.4% increase per year), while the Taiga Plains and Taiga Shield West displayed significant increasing trends from 2006 to 2015 (26.1% and 12.7% increases per year, respectively). The Atlantic Maritime, which had the lowest burned area of all ecozones (0.01% burned per year), was the only ecozone to display a significant negative trend (2.4% decrease per year) from 1985 to 2015. Given the century-long fire return intervals in many of these ecozones, and large annual variability in burned area, short-term trends need to be interpreted with caution. Additional interpretive cautions are related to year used for trend initiation and the nature and extents of spatial regionalizations used for summarizing findings. The results of our analysis provide a baseline for monitoring future national and regional trends in burned area and offer spatially and temporally detailed insights to inform science, policy, and management.

The influence of burn severity on postfire vegetation recovery and albedo change during early succession in North American boreal forests

NASA Astrophysics Data System (ADS)

Jin, Yufang; Randerson, James T.; Goetz, Scott J.; Beck, Pieter S. A.; Loranty, Michael M.; Goulden, Michael L.

2012-03-01

Severity of burning can influence multiple aspects of forest composition, carbon cycling, and climate forcing. We quantified how burn severity affected vegetation recovery and albedo change during early succession in Canadian boreal regions by combining satellite observations from the Moderate Resolution Imaging Spectroradiometer (MODIS) and the Canadian Large Fire Database. We used the MODIS-derived difference Normalized Burn Ratio (dNBR) and initial changes in spring albedo as measures of burn severity. We found that the most severe burns had the greatest reduction in summer MODIS Enhanced Vegetation Index (EVI) in the first year after fire, indicating greater loss of vegetation cover. By 5-8 years after fire, summer EVI for all severity classes had recovered to within 90%-108% of prefire levels. Spring and summer albedo progressively increased during the first 7 years after fire, with more severely burned areas showing considerably larger postfire albedo increases during spring and more rapid increases during summer as compared with moderate- and low-severity burns. After 5-7 years, increases in spring albedo above prefire levels were considerably larger in high-severity burns (0.20 ± 0.06; defined by dNBR percentiles greater than 75%) as compared to changes observed in moderate- (0.16 ± 0.06; for dNBR percentiles between 45% and 75%) or low-severity burns (0.13 ± 0.06; for dNBR percentiles between 20% and 45%). The sensitivity of spring albedo to dNBR was similar in all ecozones and for all vegetation types along gradients of burn severity. These results suggest carbon losses associated with increases in burn severity observed in some areas of boreal forests may be at least partly offset, in terms of climate impacts, by increases in negative forcing associated with changes in surface albedo.

The view of severely burned patients and healthcare professionals on the blind spots in the aftercare process: a qualitative study.

PubMed

Christiaens, Wendy; Van de Walle, Elke; Devresse, Sophie; Van Halewyck, Dries; Benahmed, Nadia; Paulus, Dominique; Van den Heede, Koen

2015-08-01

In most Western countries burn centres have been developed to provide acute and critical care for patients with severe burn injuries. Nowadays, those patients have a realistic chance of survival. However severe burn injuries do have a devastating effect on all aspects of a person's life. Therefore a well-organized and specialized aftercare system is needed to enable burn patients to live with a major bodily change. The aim of this study is to identify the problems and unmet care needs of patients with severe burn injuries throughout the aftercare process, both from patient and health care professional perspectives in Belgium. By means of face-to-face interviews (n = 40) with individual patients, responsible physicians and patient organizations, current experiences with the aftercare process were explored. Additionally, allied healthcare professionals (n = 17) were interviewed in focus groups. Belgian burn patients indicate they would benefit from a more integrated aftercare process. Quality of care is often not structurally embedded, but depends on the good intentions of local health professionals. Most burn centres do not have a written discharge protocol including an individual patient-centred care plan, accessible to all caregivers involved. Patients reported discontinuity of care: nurses working at general wards or rehabilitation units are not specifically trained for burn injuries, which sometimes leads to mistakes or contradictory information transmission. Also professionals providing home care are often not trained for the care of burn injuries. Some have to be instructed by the patient, others go to the burn centre to learn the right skills. Finally, patients themselves underestimate the chronic character of burn injuries, especially at the beginning of the care process. The variability in aftercare processes and structures, as well as the failure to implement locally developed best-practices on a wider scale emphasize the need for a comprehensive network, which can initiate transversal activities such as the development of discharge protocols, common guidelines, and quality criteria.

Scar massage for hypertrophic burns scarring-A systematic review.

PubMed

Ault, P; Plaza, A; Paratz, J

2018-02-01

Scar massage is used in burn units globally to improve functional and cosmetic outcomes of hypertrophic scarring following a burn, however, the evidence to support this therapy is unknown. To review the literature and assess the efficacy of scar massage in hypertrophic burn scars. MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library were searched using the key words "burn", "burn injury", "thermal injury" and "scar", "hypertrophic scar" and "massage", "manipulation", "soft tissue mobilisation", "soft tissue manipulation". The articles were scored by the assessors using the Physiotherapy Evidence Database (PEDro) scale and outcome measures on range of motion (ROM), cosmesis (vascularity, pliability, height), pain scores, pruritus, and psychological measures of depression and anxiety were extracted. Eight publications were included in the review with 258 human participants and 15 animal subjects who received scar massage following a thermal injury resulting in hypertrophic scarring. Outcome measures that demonstrated that scar massage was effective included scar thickness as measured with ultrasonography (p=0.001; g=-0.512); depression (Centre for Epidemiologic Studies - Depression [CES-D]) (p=0.031; g=-0.555); pain as measured with Visual Analogue Scale (VAS) (p=0.000; g=-1.133) and scar characteristics including vascularity (p=0.000; g=-1.837), pliability (p=0.000; g=-1.270) and scar height (p=0.000; g=-2.054). Outcome measures that trended towards significance included a decrease in pruritus (p=0.095; g=-1.157). It appears that there is preliminary evidence to suggest that scar massage may be effective to decrease scar height, vascularity, pliability, pain, pruritus and depression in hypertrophic burns scaring. This review reflects the poor quality of evidence and lack of consistent and valid scar assessment tools. Controlled, clinical trials are needed to develop evidence-based guidelines for scar massage in hypertrophic burns scarring. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

A systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns.

PubMed

Mudawarima, Tapfuma; Chiwaridzo, Matthew; Jelsma, Jennifer; Grimmer, Karen; Muchemwa, Faith Chengetayi

2017-10-23

Therapeutic exercises play a crucial role in the management of burn injuries. The broad objective of this review is to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Population = adults and children/adolescents with burns of any aspect of their bodies. Interventions = any aerobic and/or strength exercises delivered as part of a rehabilitation programme by anyone (e.g. physiotherapists, occupational therapists, nurses, doctors, community workers and patients themselves). Comparators = any comparator. Outcomes = any measure of outcome (e.g. quality of life, pain, muscle strength, range of movement, fear or quality of movement). Settings = any setting in any country. A systematic review will be conducted by two blinded independent reviewers who will search articles on PubMed, CiNAHL, Cochrane library, Medline, Pedro, OTseeker, EMBASE, PsychINFO and EBSCOhost using predefined criteria. Studies of human participants of any age suffering from burns will be eligible, and there will be no restrictions on total body surface area. Only randomised controlled trials will be considered for this review, and the methodological quality of studies meeting the selection criteria will be evaluated using the Cochrane Collaboration tool for assessing risk of bias. The PRISMA reporting standards will be used to write the review. A narrative analysis of the findings will be done, but if pooling is possible, meta-analysis will be considered. Burns may have a long-lasting impact on both psychological and physical functioning and thus it is important to identify and evaluate the effects of current and past aerobic and strength exercises on patients with burns. By identifying the characteristics of effective exercise programmes, guidelines can be suggested for developing intervention programmes aimed at improving the function of patients with burns. The safety and precautions of exercise regimes and the optimal frequency, duration, time and intensity will also be examined to inform further intervention. PROSPERO CDR42016048370 .

The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: A systematic review.

PubMed

Heyneman, A; Hoeksema, H; Vandekerckhove, D; Pirayesh, A; Monstrey, S

2016-11-01

For more than 40 years, silver sulphadiazine 1% (SSD) is considered as standard therapy for the conservative treatment of burn wounds. However, in the last 10 years, substantial disadvantages of SSD have been reported in the literature and probably as a result of this, several new dressings for burn wounds have been developed and put on the market. The objective of this systematic review is to evaluate the available evidence on SSD in the conservative treatment of burns, specifically in comparison with the newer burn dressings that are increasingly being used nowadays. A search filter was composed to select randomized controlled trials (RCTs) from the MEDLINE database. Only RCTs studying the effect of conservative treatment on burns were selected. At least one of the two comparative groups was treated with SSD. Each included article was analysed and relevant data (baseline parameters, interventions, outcomes and methodological parameters) were registered using Microsoft Office Excel 2007. Many dressings showed superior healing properties compared to SSD, but no dressing was able to show a clear benefit over SSD regarding infection. The number of dressing changes, pain and patient's satisfaction are more favourable in the newer dressings, especially with solid and biological dressings. The results of this systematic review clearly demonstrate that a faster wound healing is obtained with the newly developed burn dressings. Additionally, these new dressings tend to be more comfortable for the patients and easier to use for care givers. The minor differences in antibacterial activity between SSD and the new products did not seem to have any influence on the rate of wound healing. Since rapid wound closure is essential to obtain an optimal functional and aesthetic outcome, it can be concluded from the results of this systemic review that the standard use of SSD in the conservative treatment of burn wounds can no longer be supported. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

The effect of burn injury on CD8+ and CD4+ T cells in an irradiation model of homeostatic proliferation.

PubMed

Buchanan, Ian B; Maile, Robert; Frelinger, Jeffrey A; Fair, Jeffrey H; Meyer, Anthony A; Cairns, Bruce A

2006-11-01

Homeostatic proliferation of T cells has recently been shown to be an important mechanism in the host response to infection. However, its role in the T cell response to burn injury is unknown. In this study, we examine the effect of burn injury on CD4+ and CD8+ T cell homeostatic proliferation after irradiation. Wild-type C57BL/6 female mice were irradiated with six grays ionizing radiation and 48 hours later, syngeneic whole splenocytes or purified CD4+ or CD8+ T cells labeled with carboxy-fluorescein diacetate, succinimidyl ester were adoptively transferred. Two days later, mice underwent a 20% burn injury, followed by splenocyte harvest 3 and 10 days after injury. Burn mice demonstrate increased splenic cellularity and CD8+ T cell proliferation after adoptive transfer of either purified CD8+ cells or whole spleen populations compared with unburned (sham) mice. In contrast, CD4+ T cell proliferation after burn injury is unchanged after adoptive transfer of whole spleen cells and drastically decreased after adoptive transfer of a purified CD4+ population compared with sham mice. Ten days after burn injury CD8+ T cells continue to demonstrate greater proliferation than CD4+ T cells. CD8+ T cells are more robust than CD4+ T cells in their proliferative response after burn injury. In addition, CD8+ T cell proliferation appears less reliant on other immune cells than purified CD4+ T cell proliferation. These data reiterate the importance of CD8+ T cells in the initial immune response to burn injury.

Quantitative long term measurements of burns in a rat model using spatial frequency domain imaging and laser speckle imaging (Conference Presentation)

NASA Astrophysics Data System (ADS)

Ponticorvo, Adrien; Rowland, Rebecca A.; Baldado, Melissa L.; Kennedy, Gordon T.; Saager, Rolf B.; Choi, Bernard; Durkin, Anthony J.

2016-04-01

The ability to accurately assess burn wound severity in a timely manner is a critical component of wound management as it dictates the course of treatment. While full thickness and superficial burns can be easily diagnosed through visual inspection, burns that fall in between these categories are difficult to classify. Additionally, the ability to better quantify different stages of wound healing from a burn of any severity would be important for evaluating the efficacy of different treatment options. Here we present a longitudinal (28 day) study that employs spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI) as non-invasive technologies to characterize in-vivo burn wounds and healing in a murine model. Burn wounds were created using an established technique of a brass comb heated to a given temperature and applied for a set amount of time. They were imaged immediately after the initial injury and then at 2, 4, 7, 14, 21, and 28 days following the injury. Biopsies were taken on the day of the injury in order to verify the extent of the burn damage as well as at different time points after the injury in order to visualize different stages of inflammation and healing. The results of this study suggest that the reduced scattering coefficient measured using SFDI and blood flow as measured using LSI have the potential to provide useful metrics for quantifying the severity of burn injuries as well as track the different stages associated with wound healing progression.

[Deep alkali burns: Evaluation of a two-step surgical strategy].

PubMed

Devinck, F; Deveaux, C; Bennis, Y; Deken-Delannoy, V; Jeanne, M; Martinot-Duquennoy, V; Guerreschi, P; Pasquesoone, L

2018-04-10

Chemical burns are rare but often lead to deep cutaneous lesions. Alkali agents have a deep and long lasting penetrating power, causing burns that evolve over several days. The local treatment for these patients is excision of the wound and split thickness skin graft. Early excision and immediate skin grafting of alkali burns are more likely to be complicated by graft failure and delayed wound healing. We propose a two-step method that delays skin grafting until two-three days after burn wound excision. Our population included 25 controls and 16 cases. Men were predominant with a mean age of 41.9 years. In 78% of cases, burns were located on the lower limbs. The mean delay between the burn and excision was 16.5 days. In cases, the skin graft was performed at a mean of 11.3 days after the initial excision. We did not unveil any significant difference between both groups for the total skin surface affected, topography of the burns and the causal agent. Wound healing was significantly shorter in cases vs controls (37.5 days vs 50.3 days; P<0.025). Furthermore, we observed a decreased number of graft failures in cases vs controls (13.3% vs 46.7%; P=0.059). Our study shows the relevance of a two-step surgical strategy in patients with alkali chemical burns. Early excision followed by interval skin grafting is associated with quicker wound healing and decreased rate of graft failure. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Evaluation of who oral rehydration solution (ORS) and salt tablets in resuscitating adult patients with burns covering more than 15% of total body surface area (TBSA).

PubMed

Moghazy, A M; Adly, O A; Elbadawy, M A; Hashem, R E

2016-03-31

Intra-venous (IV) burn resuscitation is effective; nevertheless it has its disadvantages. WHO Oral Rehydration Solution (ORS) has shown high effectiveness in treating dehydration. WHO-ORS, with salt supplement, seems to be suitable for burn resuscitation, where IV resuscitation is not available, feasible or possible. The objective of the study was to evaluate acute phase efficacy and safety, as well as limitations and complications of burn resuscitation using WHO-ORS and salt tablets. This randomized controlled clinical trial was conducted in the Burn Unit, Suez Canal University Hospital, Ismailia, Egypt. The study group was given WHO-ORS (15% of body weight/day) with one salt tablet (5gm) per liter according to Sørensen's formula. The control group was given IV fluids according to the Parkland formula. Patients' vital signs and urine output were monitored for 72 hours after starting resuscitation. Both groups were comparable regarding age, sex, and percentage, etiology and degree of burns. For all assessed parameters, there were no major significant differences between the study group (10 cases) and control group (20 cases). Even where there was a significant difference, apart from blood pressure in the first hour of the first day, the study group never crossed safe limits for pulse, systolic blood pressure, urine output, respiratory rate and conscious level. WHO-ORS with 5gm salt tablets, given according to Sørenson's formula, is a safe and efficient alternative for IV resuscitation. It could even be a substitute, particularly in low resource settings and fire disasters.

Burning mouth syndrome: a review and update.

PubMed

Sun, Andy; Wu, Kai-Ming; Wang, Yi-Ping; Lin, Hung-Pin; Chen, Hsin-Ming; Chiang, Chun-Pin

2013-10-01

Burning mouth syndrome (BMS) is characterized by the presence of burning sensation of the oral mucosa in the absence of clinically apparent mucosal alterations. It occurs more commonly in middle-aged and elderly women and often affects the tongue tip and lateral borders, lips, and hard and soft palate. In addition to a burning sensation, the patients with BMS may also complain unremitting oral mucosal pain, dysgeusia, and xerostomia. BMS can be classified into two clinical forms: primary and secondary BMS. The primary BMS is essential or idiopathic, in which the organic local/systemic causes cannot be identified and a neuropathological cause is likely. The diagnosis of primary BMS depends mainly on exclusion of etiological factors. The secondary BMS is caused by local, systemic, and/or psychological factors; thus, its diagnosis depends on identification of the exact causative factor. When local, systemic or psychological factors are present, treatment or elimination of these factors usually results in a significant clinical improvement of BMS symptoms. Vitamin, zinc, or hormone replacement therapy has been found to be effective for reducing the oral burning or pain symptom in some BMS patients with deficiency of the corresponding factor. If patients still have the symptoms after the removal of potential causes, drug therapy should be instituted. Previous randomized controlled clinical trials found that drug therapy with capsaicin, alpha-lipoic acid, clonazepam, and antidepressants may provide relief of oral burning or pain symptom. In addition, psychotherapy and behavioral feedback may also help eliminate the BMS symptoms. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study.

PubMed

Sánchez, Manuel; García-de-Lorenzo, Abelardo; Herrero, Eva; Lopez, Teresa; Galvan, Beatriz; Asensio, María; Cachafeiro, Lucia; Casado, Cesar

2013-08-15

The use of urinary output and vital signs to guide initial burn resuscitation may lead to suboptimal resuscitation. Invasive hemodynamic monitoring may result in over-resuscitation. This study aimed to evaluate the results of a goal-directed burn resuscitation protocol that used standard measures of mean arterial pressure (MAP) and urine output, plus transpulmonary thermodilution (TPTD) and lactate levels to adjust fluid therapy to achieve a minimum level of preload to allow for sufficient vital organ perfusion. We conducted a three-year prospective cohort study of 132 consecutive critically burned patients. These patients underwent resuscitation guided by MAP (>65 mmHg), urinary output (0.5 to 1 ml/kg), TPTD and lactate levels. Fluid therapy was adjusted to achieve a cardiac index (CI) >2.5 L/minute/m² and an intrathoracic blood volume index (ITBVI) >600 ml/m2, and to optimize lactate levels. Statistical analysis was performed using mixed models. We also used Pearson or Spearman methods and the Mann-Whitney U-test. A total of 98 men and 34 women (mean age, 48 ± 18 years) was studied. The mean total body surface area (TBSA) burned was 35% ± 22%. During the early resuscitation phase, lactate levels were elevated (2.58 ± 2.05 mmol/L) and TPTD showed initial hypovolemia by the CI (2.68 ± 1.06 L/minute/m²) and the ITBVI (709 ± 254 mL/m²). At 24 to 32 hours, the CI and lactic levels were normalized, although the ITBVI remained below the normal range (744 ± 276 ml/m²). The mean fluid rate required to achieve protocol targets in the first 8 hours was 4.05 ml/kg/TBSA burned, which slightly increased in the next 16 hours. Patients with a urine output greater than or less than 0.5 ml/kg/hour did not show differences in heart rate, mean arterial pressure, CI, ITBVI or lactate levels. Initial hypovolemia may be detected by TPTD monitoring during the early resuscitation phase. This hypovolemia might not be reflected by blood pressure and hourly urine output. An adequate CI and tissue perfusion can be achieved with below-normal levels of preload. Early resuscitation guided by lactate levels and below-normal preload volume targets appears safe and avoids unnecessary fluid input.

Current knowledge of burn injury first aid practices and applied traditional remedies: a nationwide survey.

PubMed

Kattan, Abdullah E; AlShomer, Feras; Alhujayri, Abdulaziz K; Addar, Abdullah; Aljerian, Albaraa

2016-01-01

Burn first aid awareness has been shown to reduce morbidity and mortality. We present a report on the knowledge and practices of the Saudi population with regard to burn first aid and the application of traditional remedies. An internet-based survey was conducted to assess the public's knowledge on first aid practices and home remedies applied for burn injuries among Saudi adults. A total of 2758 individuals responded to the survey. There were 1178 (42.7 %) respondents who had previously received burn first aid information. One thousand five hundred fifty respondents had a history of burn exposure in which burn injury first aid was applied as follows: 1118 (72.1 %) removed clothing and accessories from the injured area; water was applied by 990 (63.9 %); among those who applied water, 877 (88.6 %) applied cold water; and only 57 (5.8 %) did so for more than 15 min. Wrapping the burn area was performed by 526 (33.9 %), and 985 (63.5 %) sought medical assistance. When it comes to traditional remedies, 2134 (77.4 %) knew of and/or implemented these remedies as first aid or to treat burns. Honey and toothpaste were the commonest among these remedies with 1491 (69.9 %) and 1147 (53.7 %), respectively. This was associated with female gender ( r  = 0.87, P  < 0.001), younger age group (19-25 years) ( r  = 0.077, P  < 0.001), from central region ( r  = 0.012, P  < 0.001), and university graduate ( r  = 0.05, P  = 0.002). Nearly half of those who knew of traditional remedies did not have previous knowledge of burn first aid. Proper burn first aid is a simple, cheap, and accessible means of managing burns initially. Although the majority of the respondents were university graduates (51.1 %), knowledge and implementation of burn first aid was very poor. Major healthcare agencies should review and promote a consistent guideline for burn first aid in an effort to tackle and minimize the effect of this grave injury.

Louisiana Air Quality - Using ASTER, Landsat 5, and MODIS to Assess the Impact of Sugar Cane and Marsh Burning Practices on Local Air Quality

NASA Technical Reports Server (NTRS)

Clark, Robert; Reahard, Ross; Robin, Chad; Zeringue, Jared

2010-01-01

Biomass burning is an event that occurs globally and encompasses both human-initiated and naturally-occurring fires. It is estimated that 3 billion metric tons of biomass are burned every year worldwide (Curtis 2002). Societies have used these burning techniques for cooking and heating, clearing land for agricultural use, and removing excess biomass from grazing and croplands (Levine 1991). Our study focuses on the state of Louisiana and its commonly occurring methods of sugarcane and marsh biomass burning (LSU Ag.Center 2000; Nyman and Chabreck 1995). Over the centuries, the sugarcane industry in this state has steadily grown to surpass all other agriculture commodities. To promote efficiency within this large industry, burning excess biomass takes place throughout the harvesting period (LSU Ag.Center 2000). In addition to sugarcane, Louisiana contains 30% of the total coastal marsh of the United States (LSU Ag.Center 2000). The periodic burning of such marshes is an ecologically important management tool that is practiced throughout the Atlantic and Gulf Coasts (Nyman and Chabreck 1995). In most biomass burning instances, the leading by-product is particulate matter that is less than 10 microns in diameter (PM10). Through past research, this fine material has been shown to have negative health effects on surrounding populations (Boopathy2001). While burning guidelines have been set into place by the Louisiana Department of Agriculture and Forestry (LDAF) to reduce health effects, the guidelines are voluntary (LDAF 2000). To help quantify emission estimates, we will focus on Iberia Parish for sugarcane burning and Cameron Parish for marsh burning. Through analysis of ASTER, Landsat 5 TM, and MODIS data, our goal is to determine the amount and location of land area burned for the years 2008 and 2009 due to these practices. With emissions algorithms from Seiler and Crutzen, 1980, total acreage burned can be used to estimate emissions. This information will help to document the impact of these smoke plumes on local populations for the improvement of biomass burning policies in Louisiana.

Upon admission coagulation and platelet function in patients with thermal and electrical injuries.

PubMed

Wade, Charles E; Baer, Lisa A; Cardenas, Jessica C; Folkerson, Lindley E; Nutall-Aurora, Kisha; Cotton, Bryan A; Matijevic, Nena; Holcomb, John B; Cross, James M; Huzar, Todd

2016-12-01

There has been increased focus on hemostatic potential and function in the initial assessment of the patient with traumatic injuries, that not been extensively studied in patients with burns. We proposed to determine the hemostatic potential of patients with burns upon admission to the emergency department and contrasted their condition with that of healthy controls and patients with other traumatic injuries. In addition we assessed differences due to thermal versus electrical injury and evaluated the effect of burn size. This is a patient based prospective observational study conducted with delayed consented. Subjects at the highest level of trauma activation upon admission to the ED had a blood sample collected for research purposes and were subsequently consented. Hemostatic potential was measured by rapid thromelastography (r-TEG ® ), thrombin generation by calibrated automated thrombogram (CAT) and platelet function by Multiplate ® using five activators. Burn subjects were compared to subjects with other traumatic injuries and controls. Within the burn subjects additional analysis compared mechanism (thermal vs. electrical) and burn size. Values are medians (IQR). Two hundred and eighty two trauma patients (with burns n=40, 14%) and 27 controls were enrolled. Upon admission, compared to controls, subjects with burns or trauma were hyper-coagulable based on r-TEG and CAT, with increased rates of clot formation and thrombin generation. There were no differences in burns compared to other traumatic injuries. The presence of hyper-coagulation did not appear to be related to the type of burn or the percentage of total body surface area involved. Employing previous defined cut points for R-TEG driven therapeutic interventions burn patients had similar rates of hyper- and hypo-coagulation noted in patients with traumatic injuries. Upon admission patients with burns are in a hyper-coagulable state similar to that of other trauma patients. Employing demonstrated cut points of hemostatic potential in trauma patients associated with increased risk of poor outcomes demonstrated the incidence in burn patients to be similar, suggesting that these values could be used in the early assessment of the patient with burns to guide treatment interventions. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Overview of the South American biomass burning analysis (SAMBBA) field experiment

NASA Astrophysics Data System (ADS)

Morgan, W. T.; Allan, J. D.; Flynn, M.; Darbyshire, E.; Hodgson, A.; Johnson, B. T.; Haywood, J. M.; Freitas, S.; Longo, K.; Artaxo, P.; Coe, H.

2013-05-01

Biomass burning represents one of the largest sources of particulate matter to the atmosphere, which results in a significant perturbation to the Earth's radiative balance coupled with serious negative impacts on public health. Globally, biomass burning aerosols are thought to exert a small warming effect of 0.03 Wm-2, however the uncertainty is 4 times greater than the central estimate. On regional scales, the impact is substantially greater, particularly in areas such as the Amazon Basin where large, intense and frequent burning occurs on an annual basis for several months (usually from August-October). Furthermore, a growing number of people live within the Amazon region, which means that they are subject to the deleterious effects on their health from exposure to substantial volumes of polluted air. Initial results from the South American Biomass Burning Analysis (SAMBBA) field experiment, which took place during September and October 2012 over Brazil, are presented here. A suite of instrumentation was flown on-board the UK Facility for Airborne Atmospheric Measurement (FAAM) BAe-146 research aircraft and was supported by ground based measurements, with extensive measurements made in Porto Velho, Rondonia. The aircraft sampled a range of conditions with sampling of fresh biomass burning plumes, regional haze and elevated biomass burning layers within the free troposphere. The physical, chemical and optical properties of the aerosols across the region will be characterized in order to establish the impact of biomass burning on regional air quality, weather and climate.

14 CFR 417.3 - Definitions and acronyms.

Code of Federal Regulations, 2010 CFR

2010-01-01

... vehicle during— (i) The ascent to initial orbital insertion and through at least one complete orbit; and (ii) Each subsequent orbital maneuver or burn from initial park orbit, or direct ascent to a higher or... launch vehicle achieves orbit or can no longer reach a populated or other protected area. Command...

14 CFR 417.3 - Definitions and acronyms.

Code of Federal Regulations, 2011 CFR

2011-01-01

... vehicle during— (i) The ascent to initial orbital insertion and through at least one complete orbit; and (ii) Each subsequent orbital maneuver or burn from initial park orbit, or direct ascent to a higher or... launch vehicle achieves orbit or can no longer reach a populated or other protected area. Command...

14 CFR 417.3 - Definitions and acronyms.

Code of Federal Regulations, 2014 CFR

2014-01-01

... vehicle during— (i) The ascent to initial orbital insertion and through at least one complete orbit; and (ii) Each subsequent orbital maneuver or burn from initial park orbit, or direct ascent to a higher or... launch vehicle achieves orbit or can no longer reach a populated or other protected area. Command...

14 CFR 417.3 - Definitions and acronyms.

Code of Federal Regulations, 2012 CFR

2012-01-01

... vehicle during— (i) The ascent to initial orbital insertion and through at least one complete orbit; and (ii) Each subsequent orbital maneuver or burn from initial park orbit, or direct ascent to a higher or... launch vehicle achieves orbit or can no longer reach a populated or other protected area. Command...

14 CFR 417.3 - Definitions and acronyms.

Code of Federal Regulations, 2013 CFR

2013-01-01

... vehicle during— (i) The ascent to initial orbital insertion and through at least one complete orbit; and (ii) Each subsequent orbital maneuver or burn from initial park orbit, or direct ascent to a higher or... launch vehicle achieves orbit or can no longer reach a populated or other protected area. Command...

Ballistically Initiated Fire Ball Generation Using M&S: Innovation Grant (Briefing Charts)

DTIC Science & Technology

2012-01-26

isotropic in nature Phenomenological models for explosives initiation. – HVRB, forest fire etc. Equation of state – Ideal gas, Mie-Gruneisen, JWL ...perfectly plastic description • EOS • Mie Gruneisen • JWL for explosive • Phenomenological Model for EFP • High Explosive input for programmed burn

Recent Arctic tundra fire initiates widespread thermokarst development.

PubMed

Jones, Benjamin M; Grosse, Guido; Arp, Christopher D; Miller, Eric; Liu, Lin; Hayes, Daniel J; Larsen, Christopher F

2015-10-29

Fire-induced permafrost degradation is well documented in boreal forests, but the role of fires in initiating thermokarst development in Arctic tundra is less well understood. Here we show that Arctic tundra fires may induce widespread thaw subsidence of permafrost terrain in the first seven years following the disturbance. Quantitative analysis of airborne LiDAR data acquired two and seven years post-fire, detected permafrost thaw subsidence across 34% of the burned tundra area studied, compared to less than 1% in similar undisturbed, ice-rich tundra terrain units. The variability in thermokarst development appears to be influenced by the interaction of tundra fire burn severity and near-surface, ground-ice content. Subsidence was greatest in severely burned, ice-rich upland terrain (yedoma), accounting for ~50% of the detected subsidence, despite representing only 30% of the fire disturbed study area. Microtopography increased by 340% in this terrain unit as a result of ice wedge degradation. Increases in the frequency, magnitude, and severity of tundra fires will contribute to future thermokarst development and associated landscape change in Arctic tundra regions.

Initial Observations on the Burning of an Ethanol Droplet in Microgravity

NASA Technical Reports Server (NTRS)

Kazakov, Andrei; Urban, Bradley; Conley, Jordan; Dryer, Frederick L.; Ferkul, Paul (Technical Monitor)

1999-01-01

Combustion of liquid ethanol represents an important system both from fundamental and practical points of view, Ethanol is currently being used as an additive to gasoline in order to reduce carbon monoxide and particulate emissions as well as to improve the fuel octane rating. A detailed physical understanding of liquid ethanol combustion is therefore necessary to achieve an optimal performance of such fuel blends in practical conditions. Ethanol is also a relatively simple model compound suitable for investigation of important combustion characteristics typical of more complex fuels. In particular, ethanol has been proposed for studies of sooting behavior during droplet burning. The sooting nature of ethanol has pressure sensitivities similar to that of n-heptane, but shifted to a higher range of pressures (1-3 atm). Additionally, liquid ethanol is miscible with water produced during its combustion forming mixtures with azeotropic behavior, a phenomenon important for understanding multi-component, liquid fuel combustion. In this work, we present initial results obtained in a series of recent space-based experiments and develop a detailed model describing the burning of ethanol droplet in microgravity.

Recent Arctic tundra fire initiates widespread thermokarst development

PubMed Central

Jones, Benjamin M.; Grosse, Guido; Arp, Christopher D.; Miller, Eric; Liu, Lin; Hayes, Daniel J.; Larsen, Christopher F.

2015-01-01

Fire-induced permafrost degradation is well documented in boreal forests, but the role of fires in initiating thermokarst development in Arctic tundra is less well understood. Here we show that Arctic tundra fires may induce widespread thaw subsidence of permafrost terrain in the first seven years following the disturbance. Quantitative analysis of airborne LiDAR data acquired two and seven years post-fire, detected permafrost thaw subsidence across 34% of the burned tundra area studied, compared to less than 1% in similar undisturbed, ice-rich tundra terrain units. The variability in thermokarst development appears to be influenced by the interaction of tundra fire burn severity and near-surface, ground-ice content. Subsidence was greatest in severely burned, ice-rich upland terrain (yedoma), accounting for ~50% of the detected subsidence, despite representing only 30% of the fire disturbed study area. Microtopography increased by 340% in this terrain unit as a result of ice wedge degradation. Increases in the frequency, magnitude, and severity of tundra fires will contribute to future thermokarst development and associated landscape change in Arctic tundra regions. PMID:26511650

High pressure droplet burning experiments in reduced gravity

NASA Technical Reports Server (NTRS)

Chauveau, Christian; Goekalp, Iskender

1995-01-01

A parametric investigation of single droplet gasification regimes is helpful in providing the necessary physical ideas for sub-grid models used in spray combustion numerical prediction codes. A research program has been initiated at the LCSR to explore the vaporization regimes of single and interacting hydrocarbon and liquid oxygen droplets under high pressure conditions. This paper summarizes the status of the LCSR program on the high pressure burning of single fuel droplets; recent results obtained under normal and reduced gravity conditions with suspended droplets are presented. In the work described here, parabolic flights of the CNES Caravelle is used to create a reduced gravity environment of the order of 10(exp -2) g(sub O). For all the droplet burning experiments reported here, the suspended droplet initial diameters are scattered around 1.5 mm; and the ambient air temperature is 300 K. The ambient pressure is varied between 0.1 MPa and 12 MPa. Four fuels are investigated: methanol (Pc = 7.9 MPa), n-heptane (Pc = 2.74 MPa), n-hexane (Pc = 3.01 MPa) and n-octane (Pc = 2.48 MPa).

Recent Arctic tundra fire initiates widespread thermokarst development

USGS Publications Warehouse

Jones, Benjamin M.; Grosse, Guido; Arp, Christopher D.; Miller, Eric K.; Liu, Lingli; Hayes, Daniel J.; Larsen, Christopher F.

2015-01-01

Fire-induced permafrost degradation is well documented in boreal forests, but the role of fires in initiating thermokarst development in Arctic tundra is less well understood. Here we show that Arctic tundra fires may induce widespread thaw subsidence of permafrost terrain in the first seven years following the disturbance. Quantitative analysis of airborne LiDAR data acquired two and seven years post-fire, detected permafrost thaw subsidence across 34% of the burned tundra area studied, compared to less than 1% in similar undisturbed, ice-rich tundra terrain units. The variability in thermokarst development appears to be influenced by the interaction of tundra fire burn severity and near-surface, ground-ice content. Subsidence was greatest in severely burned, ice-rich upland terrain (yedoma), accounting for ~50% of the detected subsidence, despite representing only 30% of the fire disturbed study area. Microtopography increased by 340% in this terrain unit as a result of ice wedge degradation. Increases in the frequency, magnitude, and severity of tundra fires will contribute to future thermokarst development and associated landscape change in Arctic tundra regions.

A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial.

PubMed

Mortimer, Kevin; Ndamala, Chifundo B; Naunje, Andrew W; Malava, Jullita; Katundu, Cynthia; Weston, William; Havens, Deborah; Pope, Daniel; Bruce, Nigel G; Nyirenda, Moffat; Wang, Duolao; Crampin, Amelia; Grigg, Jonathan; Balmes, John; Gordon, Stephen B

2017-01-14

WHO estimates exposure to air pollution from cooking with solid fuels is associated with over 4 million premature deaths worldwide every year including half a million children under the age of 5 years from pneumonia. We hypothesised that replacing open fires with cleaner burning biomass-fuelled cookstoves would reduce pneumonia incidence in young children. We did a community-level open cluster randomised controlled trial to compare the effects of a cleaner burning biomass-fuelled cookstove intervention to continuation of open fire cooking on pneumonia in children living in two rural districts, Chikhwawa and Karonga, of Malawi. Clusters were randomly allocated to intervention and control groups using a computer-generated randomisation schedule with stratification by site, distance from health centre, and size of cluster. Within clusters, households with a child under the age of 4·5 years were eligible. Intervention households received two biomass-fuelled cookstoves and a solar panel. The primary outcome was WHO Integrated Management of Childhood Illness (IMCI)-defined pneumonia episodes in children under 5 years of age. Efficacy and safety analyses were by intention to treat. The trial is registered with ISRCTN, number ISRCTN59448623. We enrolled 10 750 children from 8626 households across 150 clusters between Dec 9, 2013, and Feb 28, 2016. 10 543 children from 8470 households contributed 15 991 child-years of follow-up data to the intention-to-treat analysis. The IMCI pneumonia incidence rate in the intervention group was 15·76 (95% CI 14·89-16·63) per 100 child-years and in the control group 15·58 (95% CI 14·72-16·45) per 100 child-years, with an intervention versus control incidence rate ratio (IRR) of 1·01 (95% CI 0·91-1·13; p=0·80). Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten (one death) in the control group (IRR 0·91 [95% CI 0·37-2·23]; p=0·83). We found no evidence that an intervention comprising cleaner burning biomass-fuelled cookstoves reduced the risk of pneumonia in young children in rural Malawi. Effective strategies to reduce the adverse health effects of household air pollution are needed. Medical Research Council, UK Department for International Development, and Wellcome Trust. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Long term consequences of a controlled slash burn and slash mastication to soil moisture and CO2 at a southern Colorado site

Treesearch

W. J. Massman; J. M. Frank; A. E. Jimenez Esquilin; M. E. Stromberger; W. D. Shepperd

2006-01-01

Thinning of forest stands is frequently used to reduce the risk of catastrophic fire. But thinning requires that the refuse (or slash) be removed from the site, which can be done either by burning it or by mastication and dispersal. Either method has long term consequences to the soil and to soil moisture and soil CO2 levels. For example, after the initial drying of...

High-Nitrogen-Based Pyrotechnics: Longer- and Brighter-Burning, Perchlorate-Free, Red-Light Illuminants for Military and Civilian Applications

DTIC Science & Technology

2011-01-01

combustion of these materials. To address the aforementioned perchlorate issues, an effort was initiated by ARDEC to remove potassium per- chlorate ...with acceptable burn times for pyrotechnic applications by using potassium nitrate– amorphous boron–crystalline boron/boron carbide–epoxy binder mixtures...3,4] Moreover, it was discovered by ARDEC that a potassium nitrate–boron carbide–epoxy binder mix- ture alone was able to generate suitable green

Comparative effectiveness of different wound dressings for patients with partial-thickness burns: study protocol of a systematic review and a Bayesian framework network meta-analysis

PubMed Central

Jiang, Qiong; Chen, Zhao-Hong; Wang, Shun-Bin; Chen, Xiao-Dong

2017-01-01

Introduction Selecting a suitable wound dressing for patients with partial-thickness burns (PTBs) is important in wound care. However, the comparative effectiveness of different dressings has not been studied. We report the protocol of a network meta-analysis designed to combine direct and indirect evidence of wound dressings in the management of PTB. Methods and analysis We will search for randomised controlled trials (RCTs) evaluating the wound-healing effect of a wound dressing in the management of PTB. Searches will be conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register and CINAHL. A comprehensive search strategy is developed to retrieve articles reporting potentially eligible RCTs. Besides, we will contact the experts in the field and review the conference proceedings to locate non-published studies. The reference lists of articles will be reviewed for any candidate studies. Two independent reviewers will screen titles and abstracts of the candidate articles. All eligible RCTs will be obtained in full text to perform a review. Disagreement on eligibility of an RCT will be solved by group discussion. The information of participants, interventions, comparisons and outcomes from included RCTs will be recorded and summarised. The primary outcome is time to complete wound healing. Secondary outcomes include the proportion of burns completely healed at the end of treatment, change in wound surface area at the end of treatment, incidence of adverse events, etc. Ethics and dissemination The result of this review will provide evidence for the comparative effectiveness of different wound dressings in the management of PTB. It will also facilitate decision-making in choosing a suitable wound dressing. We will disseminate the review through a peer-review journal and conference abstracts or posters. Trial registration number PROSPERO CRD42016041574; Pre-results. PMID:28336737

Nursing preference of topical silver sulfadiazine versus collagenase ointment for treatment of partial thickness burns in children: survey follow-up of a prospective randomized trial.

PubMed

Sharp, Nicole E; Aguayo, Pablo; Marx, Daniel J; Polak, Erin E; Rash, Diane E; Peter, Shawn D; Ostlie, Daniel J; Juang, David

2014-01-01

We performed a nursing survey to inquire about nursing preferences toward the use of silver sulfadiazine (SSD) and collagenase (CO). We performed a survey between September 2012 and December 2012 asking nurses to rate the application/removal of both products and provide a description of their preferences. Ten study nurses (83%) preferred CO over SSD (P < .001). Two nurses (17%) had no preference. Negative comments on SSD were pseudoeschar (50%), difficult application burns (25%), messiness (67%), and increased number of dressing changes (25%). Negative comments on CO were the need for an additional antimicrobial agent (58%), although 1 nurse noted the higher expense with CO. Nurses preferred CO because of cleanliness of dressing (17%), lack of pseudoeschar (25%), and less pain with dressing changes (8%). Despite no difference in outcomes between SSD and CO, experienced burn nurses prefer CO because of perceptions of decreased trauma and frequency of dressing changes.

When Is It Appropriate to Use Glutamine in Critical Illness?

PubMed

Mundi, Manpreet S; Shah, Meera; Hurt, Ryan T

2016-08-01

Glutamine is a nonessential amino acid, which under trauma or critical illness can become essential. A number of historic small single-center randomized controlled trials (RCTs) have demonstrated positive treatment effects on clinical outcomes with glutamine supplementation. Meta-analyses based on these trials demonstrated a significant reduction in hospital mortality, intensive care unit (ICU) length of stay (LOS), and hospital LOS with intravenous (IV) glutamine. Similar results were not noted in 2 large multicenter RCTs (REDOXS and MetaPlus) assessing the efficacy of glutamine supplementation in ventilated ICU patients. The REDOXS trial of 40 ICUs randomized 1223 ventilated ICU patients to glutamine (IV and enteral), antioxidants, both glutamine and antioxidants, or placebo. The main conclusions were a trend toward increased 28-day mortality and significant increased hospital and 6-month mortality in those who received glutamine. The MetaPlus trial of 14 ICUs, which randomized 301 ventilated ICU patients to glutamine-enriched enteral vs an isocaloric diet, noted increased 6-month mortality in the glutamine-supplemented group. Newer RCTs have focused on specific populations and have demonstrated benefits in burn and elective surgery patients with glutamine supplementation. Whether larger studies will confirm these findings is yet to be determined. Recent American Society for Parenteral and Enteral Nutrition guidelines recommend that IV and enteral glutamine should not be used in the critical care setting based on the moderate quality of evidence available. We agree with these recommendations and would encourage larger multicenter studies to evaluate the risks and benefits of glutamine in burn and elective surgery patients. © 2016 American Society for Parenteral and Enteral Nutrition.

Carbon and nitrogen in Type 2 supernova diamonds

NASA Astrophysics Data System (ADS)

Clayton, Donald D.; Eleid, Mounib; Brown, Lawrence E.

1993-03-01

Abundant diamonds found in meteorites seem either to have condensed within supernova interiors during their expansions and coolings or to have been present around those explosions. Either alternative allows implantation of Xe-HL prior to interstellar mixing. A puzzling feature is the near normalcy of the carbon isotopes, considering that the only C-rich matter, the He-burning shell, is pure C-12 in that region. That last fact has caused many to associate supernova carbon with C-12 carbon, so that its SUNOCONS have been anticipated as very C-12-rich. We show that this expectation is misleading because the C-13-rich regions of Type 2's have been largely overlooked in this thinking. We here follow the idea that the diamonds nucleated in the C-12-rich He shell, the only C-rich site for nucleation, but then attached C-13-rich carbon during turbulent encounters with overlying C-13-rich matter. That is, the initial diamonds continued to grow during the same collisional encounters that cause the Xe-HL implantation. Instead of interacting with the small carbon mass having 13/12 = 0.2 in the upper He zone, however, we have calculated the remnants of the initial H-burning core, which left behind C-13-rich matter as it receded during core hydrogen burning. Howard et al. described why the velocity mixing would be essential to understanding the implantation of both the Xe-H and Xe-L components. Velocity mixing is now known to occur from the X-ray and gamma-ray light curves of supernova 1987A. Using the stellar evolution code developed at Goettingen, we calculated at Clemson the evolution of a grid of massive stars up to the beginning of core He burning. We paid attention to all H-burning reactions throughout the star, to the treatment of both convection and semiconvection, and to the recession of the outer boundary of the convective H-burning core as the star expands toward a larger redder state. This program was to generate a careful map of the CNO isotope distribution as He burning begins. Our result for the 30 solar mass star is shown.

Rapid response of soil fungal communities to low and high intensity fire

NASA Astrophysics Data System (ADS)

Smith, Jane E.; Cowan, Ariel D.; Reazin, Chris; Jumpponen, Ari

2016-04-01

Contemporary fires have created high-severity burn areas exceeding historical distributions in forests in the western United States. Until recently, the response of soil ecosystems to high intensity burns has been largely unknown. In complementary studies, we investigated the environmental effect of extreme soil heating, such that occurs with the complete combustion of large down wood during wildfires, on soil fungi and nutrients. We used TRFLP and next generation sequencing (Illumina MiSeq) to investigate the fungal communities. During the burning of large down wood, temperatures lethal to fungi were detected at 0-cm, 5-cm, and 10-cm depths in soils compared to 0-cm depth in soils receiving low intensity broadcast burns. We compared the soil fungal diversity in ten high intensity burned plots paired with adjacent low intensity burned plots before and one week after at 0-10 cm soil depth. Nonmetric Multidimensional Scaling (NMS) ordinations and analyses of taxon frequencies reveal a substantial community turnover and corresponding near complete replacement of the dominant basidiomycetes by ascomycetes in high intensity burns. These coarse-level taxonomic responses were primarily attributable to a few fire-responsive (phoenicoid) fungi, particularly Pyronema sp. and Morchella sp., whose frequencies increased more than 100-fold following high intensity burns. Pinus ponderosa seedlings planted one week post-burn were harvested after four months for EMF root tip analysis. We found: a) greater differences in soil properties and nutrients in high intensity burned soils compared to low intensity burned and unburned soils; b) no differences in EMF richness and diversity; and c) weak differences in community composition based on relative abundance between unburned and either burn treatments. These results confirm the combustion of large downed wood can alter the soil environment directly beneath it. However, an EMF community similar to low burned soils recolonized high burned soils within one growing season. Community results from both burn treatments suggest an increase in patchy spatial distribution of EMF. The importance of incorporating mixed fire effects in fuel management practices will help to provide EMF refugia for dry forest regeneration. Our studies highlight the strong and rapid fungal community responses to fires and differences among fires of different severities. We theorize that quick initiation of EMF recolonization is possible depending on the size of high burn patches, proximity of low and unburned soil, and survival of nearby hosts.

Photoacoustic diagnosis of edema in rat burned skin

NASA Astrophysics Data System (ADS)

Yoshida, Ken; Sato, Shunichi; Hatanaka, Kosuke; Saitoh, Daizoh; Ashida, Hiroshi; Sakamoto, Toshihisa; Obara, Minoru

2010-02-01

Diagnosis of edema, abnormal accumulation of water in tissue, is important for managing various traumatic injuries and diseases. However, there is no established method for real-time, noninvasive monitoring of edema. In severe extensive burn injuries, edema develops both topically and systemically due to the increased permeability of blood vessels. In this study, we examined photoacoustic (PA) monitoring of edema formed in rat burn models. Deep dermal burn with a 20% total body surface area was made in the dorsal skin of rats. Burn and its adjacent nonburn tissues were irradiated with 6-ns light pulses at 1430 nm, which is one of the absorption peak wavelengths of water in the near infrared. The PA signal amplitude increased until 12 - 24 hr postburn, and thereafter it gradually decreased to its initial level; the latter phase (after 24 hr postburn) coincided with a diuretic phase in the rats. There was a significant correlation between the PA signal amplitudes and water contents in the tissue measured by wet/dry weight method. These findings demonstrate the validity of PA measurement for real-time, noninvasive monitoring of edema.

Satellite Remote Sensing of Atmospheric Pollution: the Far-Reaching Impact of Burning in Southern Africa

NASA Technical Reports Server (NTRS)

Fishman, Jack; Al-Saadi, Jassim A.; Neil, Doreen O.; Creilson, John K.; Severance, Kurt; Thomason, Larry W.; Edwards, David R.

2008-01-01

When the first observations of a tropospheric trace gas were obtained in the 1980s, carbon monoxide enhancements from tropical biomass burning dominated the observed features. In 2005, an active remote-sensing system to provide detailed information on the vertical distribution of aerosols and clouds was launched, and again, one of the most imposing features observed was the presence of emissions from tropical biomass burning. This paper presents a brief overview of space-borne observations of the distribution of trace gases and aerosols and how tropical biomass burning, primarily in the Southern Hemisphere, has provided an initially surprising picture of the distribution of these species and how they have evolved from prevailing transport patterns in that hemisphere. We also show how interpretation of these observations has improved significantly as a result of the improved capability of trajectory modeling in recent years and how information from this capability has provided additional insight into previous measurements form satellites. Key words: pollution; biomass burning; aerosols; tropical trace gas emissions; Southern Hemisphere; carbon monoxide.

Face Allotransplantation and Burns: a Review

PubMed Central

A, Arno; JP, Barret; RA, Harrison; MG, Jeschke

2012-01-01

Burns may represent one of the main indications for face allotransplantation. Severely disfigured faces featuring a devastating appearance and great functional impairments are not only seen as burn sequelae, but also occur as a result of other traumatic injuries, oncological surgical resections, benign tumors (e.g., neurofibromatosis), and major congenital malformations. To date, sixteen human face composite tissue allotransplantations have been performed with success. Despite the initial scepticism about its applicability, due mainly to ethical and technical reasons, the previous worldwide cases and their associated positive outcomes –including acceptable immunosuppressive regimens, excellent aesthetic and functional results, and good psychological acceptance by the recipient- , enable the conclusion that face composite tissue allotransplantation has become another therapeutic strategy in the reconstructive surgical armamentarium, which bears special consideration when dealing with severely disfigured burned patients. The aim of this review is to describe the basics of face composite tissue allotransplantation and give an overview of some of the cases performed until now, with special attention paid to debating the pros and cons of its applicability in burn patients. PMID:22274632

Evolving forest fire burn severity classification algorithms for multispectral imagery

NASA Astrophysics Data System (ADS)

Brumby, Steven P.; Harvey, Neal R.; Bloch, Jeffrey J.; Theiler, James P.; Perkins, Simon J.; Young, Aaron C.; Szymanski, John J.

2001-08-01

Between May 6 and May 18, 2000, the Cerro Grande/Los Alamos wildfire burned approximately 43,000 acres (17,500 ha) and 235 residences in the town of Los Alamos, NM. Initial estimates of forest damage included 17,000 acres (6,900 ha) of 70-100% tree mortality. Restoration efforts following the fire were complicated by the large scale of the fire, and by the presence of extensive natural and man-made hazards. These conditions forced a reliance on remote sensing techniques for mapping and classifying the burn region. During and after the fire, remote-sensing data was acquired from a variety of aircraft-based and satellite-based sensors, including Landsat 7. We now report on the application of a machine learning technique, implemented in a software package called GENIE, to the classification of forest fire burn severity using Landsat 7 ETM+ multispectral imagery. The details of this automatic classification are compared to the manually produced burn classification, which was derived from field observations and manual interpretation of high-resolution aerial color/infrared photography.

Thermal decomposition of high-nitrogen energetic compounds: TAGzT and GUzT

NASA Astrophysics Data System (ADS)

Hayden, Heather F.

The U.S. Navy is exploring high-nitrogen compounds as burning-rate additives to meet the growing demands of future high-performance gun systems. Two high-nitrogen compounds investigated as potential burning-rate additives are bis(triaminoguanidinium) 5,5-azobitetrazolate (TAGzT) and bis(guanidinium) 5,5'-azobitetrazolate (GUzT). Small-scale tests showed that formulations containing TAGzT exhibit significant increases in the burning rates of RDX-based gun propellants. However, when GUzT, a similarly structured molecule was incorporated into the formulation, there was essentially no effect on the burning rate of the propellant. Through the use of simultaneous thermogravimetric modulated beam mass spectrometry (STMBMS) and Fourier-Transform ion cyclotron resonance (FTICR) mass spectrometry methods, an investigation of the underlying chemical and physical processes that control the thermal decomposition behavior of TAGzT and GUzT alone and in the presence of RDX, was conducted. The objective was to determine why GUzT is not as good a burning-rate enhancer in RDX-based gun propellants as compared to TAGzT. The results show that TAGzT is an effective burning-rate modifier in the presence of RDX because the decomposition of TAGzT alters the initial stages of the decomposition of RDX. Hydrazine, formed in the decomposition of TAGzT, reacts faster with RDX than RDX can decompose itself. The reactions occur at temperatures below the melting point of RDX and thus the TAGzT decomposition products react with RDX in the gas phase. Although there is no hydrazine formed in the decomposition of GUzT, amines formed in the decomposition of GUzT react with aldehydes, formed in the decomposition of RDX, resulting in an increased reaction rate of RDX in the presence of GUzT. However, GUzT is not an effective burning-rate modifier because its decomposition does not alter the initial gas-phase decomposition of RDX. The decomposition of GUzT occurs at temperatures above the melting point of RDX. Therefore, the decomposition of GUzT affects reactions that are dominant in the liquid phase of RDX. Although GUzT is not an effective burning-rate modifier, features of its decomposition where the reaction between amines formed in the decomposition of GUzT react with the aldehydes, formed in the decomposition of RDX, may have implications from an insensitive-munitions perspective.

Runoff-generated debris flows: observations and modeling of surge initiation, magnitude, and frequency

USGS Publications Warehouse

Kean, Jason W.; McCoy, Scott W.; Tucker, Gregory E.; Staley, Dennis M.; Coe, Jeffrey A.

2013-01-01

Runoff during intense rainstorms plays a major role in generating debris flows in many alpine areas and burned steeplands. Yet compared to debris flow initiation from shallow landslides, the mechanics by which runoff generates a debris flow are less understood. To better understand debris flow initiation by surface water runoff, we monitored flow stage and rainfall associated with debris flows in the headwaters of two small catchments: a bedrock-dominated alpine basin in central Colorado (0.06 km2) and a recently burned area in southern California (0.01 km2). We also obtained video footage of debris flow initiation and flow dynamics from three cameras at the Colorado site. Stage observations at both sites display distinct patterns in debris flow surge characteristics relative to rainfall intensity (I). We observe small, quasiperiodic surges at low I; large, quasiperiodic surges at intermediate I; and a single large surge followed by small-amplitude fluctuations about a more steady high flow at high I. Video observations of surge formation lead us to the hypothesis that these flow patterns are controlled by upstream variations in channel slope, in which low-gradient sections act as “sediment capacitors,” temporarily storing incoming bed load transported by water flow and periodically releasing the accumulated sediment as a debris flow surge. To explore this hypothesis, we develop a simple one-dimensional morphodynamic model of a sediment capacitor that consists of a system of coupled equations for water flow, bed load transport, slope stability, and mass flow. This model reproduces the essential patterns in surge magnitude and frequency with rainfall intensity observed at the two field sites and provides a new framework for predicting the runoff threshold for debris flow initiation in a burned or alpine setting.

Bi-Component Droplet Combustion in Reduced Gravity

NASA Technical Reports Server (NTRS)

Shaw, Benjamin D.

2004-01-01

This research deals with reduced-gravity combustion of bi-component droplets initially in the mm size range or larger. The primary objectives of the research are to study the effects of droplet internal flows, thermal and solutal Marangoni stresses, and species volatility differences on liquid species transport and overall combustion phenomena (e.g., gas-phase unsteadiness, burning rates, sooting, radiation, and extinction). The research program utilizes a reduced gravity environment so that buoyancy effects are rendered negligible. Use of large droplets also facilitates visualization of droplet internal flows, which is important for this research. In the experiments, droplets composed of low- and high-volatility species are burned. The low-volatility components are initially present in small amounts. As combustion of a droplet proceeds, the liquid surface mass fraction of the low-volatility component will increase with time, resulting in a sudden and temporary decrease in droplet burning rates as the droplet rapidly heats to temperatures close to the boiling point of the low-volatility component. This decrease in burning rates causes a sudden and temporary contraction of the flame. The decrease in burning rates and the flame contraction can be observed experimentally. Measurements of burning rates as well as the onset time for flame contraction allow effective liquid-phase species diffusivities to be calculated, e.g., using asymptotic theory. It is planned that droplet internal flows will be visualized in flight and ground-based experiments. In this way, effective liquid species diffusivities can be related to droplet internal flow characteristics. This program is a continuation of extensive ground-based experimental and theoretical research on bi-component droplet combustion that has been ongoing for several years. The focal point of this program is a flight experiment (Bi-Component Droplet Combustion Experiment, BCDCE). This flight experiment is under development. However, supporting ground-based studies have been performed. Some of the most recent ground-based research is summarized.

Burning mechanism and regression rate of RX-35-AU and RX-35-AV as a function of HMX particle size measured by the hybrid closed bomb-strand burner

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tao, W.C.; Costantino, M.S.; Ornellas, D.L.

1990-04-01

In this study, the average surface regression rate of two HMX-based cast explosives, RX-35-AU and RX-35-AV, is measured to pressures above 750 MPa using a hybrid closed bomb-strand burner. The hybrid design allows the simultaneous measurement of pressure and regression rate over a large range of pressures in each experiment. Nitroglycerin/Triacetin (75/25) and polyethylene glycol (PEG) are used as the energetic plasticizer and polymeric binder, respectively, in both formulations. The HMX solids loading in each formulation is 50 wt %, consisting of a narrow particle size distribution of 6--8 {mu}m for RX-35-AU and 150--177 {mu}m for RX-35-AV. Of special interestmore » are the regression rate and burning mechanism as a function of the initial particle size distribution and the mechanical properties fo the cast explosives. In general, the regression rate for the larger particle size formulation, RX-35-AV, is two to three times faster compared to that for RX-35-AU. Up to 750 MPa and independent of the initial confinement pressure, RX-35-AU exhibits a planar burning mechanism with the regression rate obeying the classical aP{sup n} formalism. For RX-35-AV, however, the burning behavior is erratic for samples ignited at 200 MPa confinement pressure. At confinement pressures above 400 MPa, the regression exhibits more of a planar burning mechanism. The unstable combustion behavior for RX-35-AV at lower confinement pressures is related to several mechanisms: (1) an abrupt increase in surface area due to particle fracture and subsequent translation and rotation, resulting in debonding and creating porosity, (2) thixotropic'' separation of the binder and nitramine, causing the significantly greater fracture damage to the nitramine during the loading cycle, (3) microscopic damage to the nitramine crystals that increase its intrinsic burning rate. 12 refs., 8 figs., 2 tabs.« less

Bi-Component Droplet Combustion in Reduced Gravity

NASA Technical Reports Server (NTRS)

Shaw, B. D.

2001-01-01

This research deals with reduced-gravity combustion of bi-component droplets initially in the mm size range or larger. The primary objectives of the research are to study the effects of droplet internal flows, thermal and solutal Marangoni stresses, and species volatility differences on liquid species transport and overall combustion phenomena (e.g., gas-phase unsteadiness, burning rates, sooting, radiation, and extinction). The research program utilizes a reduced-gravity environment so that buoyancy effects are rendered negligible. Use of large droplets also facilitates visualization of droplet internal flows, which is important for this research. In the experiments, droplets composed of low- and high-volatility species are burned. The low-volatility components are initially present in small amounts. As combustion of a droplet proceeds, the liquid surface mass fraction of the low-volatility component will increase with time, resulting in a sudden and temporary decrease in droplet burning rates as the droplet rapidly heats to temperatures close to the boiling point of the low-volatility component. This decrease in burning rates causes a sudden and temporary contraction of the flame. The decrease in burning rates and the flame contraction can be observed experimentally. Measurements of burning rates as well as the onset time for flame contraction allow effective liquid-phase species diffusivities to be calculated, e.g., using asymptotic theory. It is planned that droplet internal flows will be visualized in future flight and ground-based experiments. In this way, effective liquid species diffusivities can be related to droplet internal flow characteristics. This program is a continuation of extensive ground based experimental and theoretical research on bi-component droplet combustion that has been ongoing for several years. The focal point of this program is a flight experiment (Bi-Component Droplet Combustion Experiment, BCDCE). This flight experiment is under development. However, supporting studies have been performed. Because of space limitations, only some of the research performed over the last two years (since the 5th Microgravity Combustion Workshop) is summarized here.

Burn Eschar Stimulates Fibroblast and Adipose Mesenchymal Stromal Cell Proliferation and Migration but Inhibits Endothelial Cell Sprouting

PubMed Central

Monsuur, Hanneke N.; van den Broek, Lenie J.; Jhingoerie, Renushka L.; Vloemans, Adrianus F. P. M.

2017-01-01

The majority of full-thickness burn wounds heal with hypertrophic scar formation. Burn eschar most probably influences early burn wound healing, since granulation tissue only forms after escharotomy. In order to investigate the effect of burn eschar on delayed granulation tissue formation, burn wound extract (BWE) was isolated from the interface between non-viable eschar and viable tissue. The influence of BWE on the activity of endothelial cells derived from dermis and adipose tissue, dermal fibroblasts and adipose tissue-derived mesenchymal stromal cells (ASC) was determined. It was found that BWE stimulated endothelial cell inflammatory cytokine (CXCL8, IL-6 and CCL2) secretion and migration. However, BWE had no effect on endothelial cell proliferation or angiogenic sprouting. Indeed, BWE inhibited basic Fibroblast Growth Factor (bFGF) induced endothelial cell proliferation and sprouting. In contrast, BWE stimulated fibroblast and ASC proliferation and migration. No difference was observed between cells isolated from dermis or adipose tissue. The inhibitory effect of BWE on bFGF-induced endothelial proliferation and sprouting would explain why excessive granulation tissue formation is prevented in full-thickness burn wounds as long as the eschar is still present. Identifying the eschar factors responsible for this might give indications for therapeutic targets aimed at reducing hypertrophic scar formation which is initiated by excessive granulation tissue formation once eschar is removed. PMID:28820426

Protocol of a randomized controlled trial of sun protection interventions for operating engineers.

PubMed

Duffy, Sonia A; Ronis, David L; Waltje, Andrea H; Choi, Seung Hee

2013-03-26

Skin cancer are increasing and some types of skin cancer are among the most lethal cancers yet are easily preventable. However, sun protection interventions are rarely implemented among outdoor workers. Our prior work shows that Michigan Operating Engineers (heavy equipment operators) spend an average of 4-5 hours in the sun, about one-third reported getting sun burned at least once a summer, and over half burned more than once a summer. About three-quarters of the sample never or only sometimes used sun block. Using the Health Belief Model as a guide, this randomized controlled trial (RCT) will test the efficacy of four sun protection interventions targeting Operating Engineers: a) education only; b) education and mailed sunscreen; c) education and text message reminders; and, d) education, mailed sunscreen, and text message reminders. Participations in the study will be offered during regularly scheduled safety trainings at the Local 324 Training Center. Pre- and post-intervention surveys will be collected to determine changes in sunscreen use and sun burning, the primary dependent variables. The analyses will include: a) paired t-tests to determine changes over time (from pre-intervention to post-intervention) in outcome variables (sunscreen use and burning) separately in the 4 intervention groups, b) Repeated Measures Analysis of Variance (RM-ANOVA) to compare the changes in outcomes across the 4 groups, and c) t-tests on change scores as follow-ups to the RM-ANOVA to determine exactly which groups differ from each other. Based on the outcome of this study, we will develop a RO1 for wider scale testing and dissemination in conjunction with the International Training Center which services North America (including the US, Mexico, and Canada). Wide scale dissemination of an efficacious sun protection intervention has the potential to substantially impact skin cancer rates among this population. The ultimate goal is for high reach, high efficacy, and low cost. NCT01804595.

A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India.

PubMed

Daruwalla, Nayreen; Belur, Jyoti; Kumar, Meena; Tiwari, Vinay; Sarabahi, Sujata; Tilley, Nick; Osrin, David

2014-11-30

Most burns happen in low- and middle-income countries. In India, deaths related to burns are more common in women than in men and occur against a complex background in which the cause - accidental or non-accidental, suicidal or homicidal - is often unclear. Our study aimed to understand the antecedents to burns and the problem of ascribing cause, the sequence of medicolegal events after a woman was admitted to hospital, and potential opportunities for improvement. We conducted semi-structured interviews with 33 women admitted to two major burns units, their families, and 26 key informant doctors, nurses, and police officers. We used framework analysis to examine the context in which burns occurred and the sequence of medicolegal action after admission to hospital. Interviewees described accidents, attempted suicide, and attempted homicide. Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives. Space constraint, problems with cooking equipment, and inflammable clothing increased the risk of accidental burns, but coexisted with household conflict, gender-based violence, and alcohol use. Most burns were initially ascribed to accidents. Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process. Women's understandable reticence to describe burns as non-accidental, the contested nature of statements, their perceived history of changeability, the limited quality and validity of forensic evidence, and the requirement for resilience on the part of clients underlay a general pessimism. The similarities between accident and intention cluster so tightly as to make them challenging to distinguish, especially given women's understandable reticence to describe burns as non-accidental. The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction. The emphasis should be on improving documentation, communication between service providers, and public understanding of the risks of burns.

A review of community management of paediatric burns.

PubMed

Cox, S G; Martinez, R; Glick, A; Numanoglu, A; Rode, H

2015-12-01

This study was a component of a broader review to evaluate burn care in South Africa. A prospective audit of 353 children with thermal injuries admitted to the Red Cross War Memorial Children's Hospital in Cape Town was performed during 2012/2013. The audit was based to assess the adherence of initial burn management to the provincial policy guidelines on the clinical management of the burn wound. The community management of each patient prior to admission to a burns centre was assessed for the following: basic demographics, emergency home management, wound cover, analgesia and transport to medical facilities. Their ages ranged from 1 month to 14 years. The average total body surface area [TBSA] was 15% [1-86%]. Most of the injuries were due to hot water accidents [78.5%] followed by flame burns (9%), direct contact and electricity burns. Two hundred and twenty five children [63%] received first aid measures at home, including cooling with water [166] ice [30] and a cooling agent. No cooling was instituted in 130 and 65% of the patient's wounds were cooled for 10 min or less. Eighty percent proceeded to the referral centre or burns unit without their wounds being covered; with only 19 patients having any medical type of dressing available at home. Two hundred and ninety five children [83.6%] received pain medication prior to admission at the burns unit. Of the 316 patients not directly attending the burns unit, 137 received i.v. fluids of which 95 had burns greater than 10% TBSA. None of the patients were in shock on admission and all i.v. lines were functioning. Forty-four children with burns greater than 10% did not receive i.v. fluids. The audit identified six factors that were inadequately addressed during the pre-admission period: first aid, cooling of the wound, early covering of the wound, resuscitation, pain management and transfer. If these could be readdressed, basic burn care would be substantially improved in the study area. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Transfusion medicine in the Formosa Fun Coast water park explosion: The role of combined tissue and blood banking.

PubMed

Chang, Chih-Chun; Yeh, Chin-Chuan; Chu, Fang-Yeh

2016-10-01

The Formosa Fun Coast explosion, occurring in a recreational water park located in the Northern Taiwan on 27 June 2015, made 499 people burn-injured. For those who had severe burn trauma, surgical intervention and fluid resuscitation were necessary, and potential blood transfusion therapy could be initiated, especially during and after broad escharotomy. Here, we reviewed the literature regarding transfusion medicine and skin grafting as well as described the practicing experience of combined tissue and blood bank in the burn disaster in Taiwan. It was reported that patients who were severely burn-injured could receive multiple blood transfusions during hospitalization. Since the use of skin graft became a mainstay alternative for wound coverage after the early debridement of burn wounds at the beginning of the 20th century, the development of tissue banking program was initiated. In Taiwan, the tissue banking program was started in 2006. And the first combined tissue and blood bank was established in Far Eastern Memorial Hospital in 2010, equipped with the non-sterile, clean and sterile zones distinctly segregated with a unidirectional movement in the sterile area. The sterile zone was a class 10000 clean room equipped with high efficiency particulate air filter (HEPAF) and positive air pressure ventilation. The combined tissue and blood bank has been able to provide the assigned blood products and tissue graft timely and accurately, with the concepts of centralized management. In the future, the training of tissue and blood bank technicians would be continued and fortified, particularly on the regulation and quality control for further bio- and hemovigilance. Copyright © 2016 Elsevier Ltd. All rights reserved.