Evaluation of protocol change in burn-care management using the Cox proportional hazards model with time-dependent covariates.

PubMed

Ichida, J M; Wassell, J T; Keller, M D; Ayers, L W

1993-02-01

Survival analysis methods are valuable for detecting intervention effects because detailed information from patient records and sensitive outcome measures are used. The burn unit at a large university hospital replaced routine bathing with total body bathing using chlorhexidine gluconate for antimicrobial effect. A Cox proportional hazards model was used to analyse time from admission until either infection with Staphylococcus aureus or discharge for 155 patients, controlling for burn severity and two time-dependent covariates: days until first wound excision and days until first administration of prophylactic antibiotics. The risk of infection was 55 per cent higher in the historical control group, although not statistically significant. There was also some indication that early wound excision may be important as an infection-control measure for burn patients.

Periorbital burns – a 6 year review of management and outcome.

PubMed

Fitzgerald O'Connor, Edmund; Frew, Q; Din, A; Pleat, J; Ashraff, S; Ghazi-Nouri, S; El-Muttardi, N; Philp, B; Dziewulski, P

2015-05-01

Periorbital burns are an infrequent but potentially devastating injury. This study aimed to elucidate the spectrum of such injuries presenting to a UK burns centre and the outcome achieved in the cases requiring periorbital reconstruction for the restoration of function and form. Patients admitted to a UK regional burns centre between January 2005 and January 2011 with periorbital burns were identified from the Patient Administration System (PAS), theatre logs and the International Burns Injury database (IBID). Multiple parameters were assessed using patient notes, ITU and hospital image databases. Over 6 years, 167 patients with facial burns requiring surgery were treated, including 103 patients with eyelid burns. The mean burn size was 33% total body surface area. The eyelid burn depth varied; 67% superficial partial thickness, 17% deep dermal and 16% full thickness. Two patients lost complete vision in one eye, one patient underwent amniotic membrane grafting. In total 16 patients required periorbital reconstruction to maintain eye closure, with 1.8 operations on average per patient. Acute surgery was required in 11 patients, whilst late intervention (>3 months) was needed in 5, 2 patients had both acute and delayed surgery. Of the 5 late intervention patients 4 were treated with full thickness skin grafts and 1 with a Z plasty. Average time for final reconstruction with delayed surgery was 4.5 months. The goal in management of periorbital burns is preservation of vision, prevention of future complications and restoration of an acceptable aesthetic outcome. Total visual loss is thankfully rare, but early ophthalmology intervention is vital given the evidence of corneal damage as a brief therapeutic window exists. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring.

PubMed

van der Wal, Martijn B A; Vloemans, Jos F P M; Tuinebreijer, Wim E; van de Ven, Peter; van Unen, Ella; van Zuijlen, Paul P M; Middelkoop, Esther

2012-01-01

Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p < 0.001) improvement in scar quality at 12 months compared with the 3- and 6-month data. Predictors for severe scarring are depth of the wound (p < 0.001) and total body surface area burned (p < 0.001). Etiology (p = 0.753) and age (p > 0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively. © 2012 by the Wound Healing Society.

Burned area detection based on Landsat time series in savannas of southern Burkina Faso

NASA Astrophysics Data System (ADS)

Liu, Jinxiu; Heiskanen, Janne; Maeda, Eduardo Eiji; Pellikka, Petri K. E.

2018-02-01

West African savannas are subject to regular fires, which have impacts on vegetation structure, biodiversity and carbon balance. An efficient and accurate mapping of burned area associated with seasonal fires can greatly benefit decision making in land management. Since coarse resolution burned area products cannot meet the accuracy needed for fire management and climate modelling at local scales, the medium resolution Landsat data is a promising alternative for local scale studies. In this study, we developed an algorithm for continuous monitoring of annual burned areas using Landsat time series. The algorithm is based on burned pixel detection using harmonic model fitting with Landsat time series and breakpoint identification in the time series data. This approach was tested in a savanna area in southern Burkina Faso using 281 images acquired between October 2000 and April 2016. An overall accuracy of 79.2% was obtained with balanced omission and commission errors. This represents a significant improvement in comparison with MODIS burned area product (67.6%), which had more omission errors than commission errors, indicating underestimation of the total burned area. By observing the spatial distribution of burned areas, we found that the Landsat based method misclassified cropland and cloud shadows as burned areas due to the similar spectral response, and MODIS burned area product omitted small and fragmented burned areas. The proposed algorithm is flexible and robust against decreased data availability caused by clouds and Landsat 7 missing lines, therefore having a high potential for being applied in other landscapes in future studies.

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.

Large forest fires in Canada, 1959-1997

NASA Astrophysics Data System (ADS)

Stocks, B. J.; Mason, J. A.; Todd, J. B.; Bosch, E. M.; Wotton, B. M.; Amiro, B. D.; Flannigan, M. D.; Hirsch, K. G.; Logan, K. A.; Martell, D. L.; Skinner, W. R.

2002-01-01

A Large Fire Database (LFDB), which includes information on fire location, start date, final size, cause, and suppression action, has been developed for all fires larger than 200 ha in area for Canada for the 1959-1997 period. The LFDB represents only 3.1% of the total number of Canadian fires during this period, the remaining 96.9% of fires being suppressed while <200 ha in size, yet accounts for ˜97% of the total area burned, allowing a spatial and temporal analysis of recent Canadian landscape-scale fire impacts. On average ˜2 million ha burned annually in these large fires, although more than 7 million ha burned in some years. Ecozones in the boreal and taiga regions experienced the greatest areas burned, with an average of 0.7% of the forested land burning annually. Lightning fires predominate in northern Canada, accounting for 80% of the total LFDB area burned. Large fires, although small in number, contribute substantially to area burned, most particularly in the boreal and taiga regions. The Canadian fire season runs from late April through August, with most of the area burned occurring in June and July due primarily to lightning fire activity in northern Canada. Close to 50% of the area burned in Canada is the result of fires that are not actioned due to their remote location, low values-at-risk, and efforts to accommodate the natural role of fire in these ecosystems. The LFDB is updated annually and is being expanded back in time to permit a more thorough analysis of long-term trends in Canadian fire activity.

Large forest fires in Canada, 1959-1997

NASA Astrophysics Data System (ADS)

Stocks, B. J.; Mason, J. A.; Todd, J. B.; Bosch, E. M.; Wotton, B. M.; Amiro, B. D.; Flannigan, M. D.; Hirsch, K. G.; Logan, K. A.; Martell, D. L.; Skinner, W. R.

2003-01-01

A Large Fire Database (LFDB), which includes information on fire location, start date, final size, cause, and suppression action, has been developed for all fires larger than 200 ha in area for Canada for the 1959-1997 period. The LFDB represents only 3.1% of the total number of Canadian fires during this period, the remaining 96.9% of fires being suppressed while <200 ha in size, yet accounts for ~97% of the total area burned, allowing a spatial and temporal analysis of recent Canadian landscape-scale fire impacts. On average ~2 million ha burned annually in these large fires, although more than 7 million ha burned in some years. Ecozones in the boreal and taiga regions experienced the greatest areas burned, with an average of 0.7% of the forested land burning annually. Lightning fires predominate in northern Canada, accounting for 80% of the total LFDB area burned. Large fires, although small in number, contribute substantially to area burned, most particularly in the boreal and taiga regions. The Canadian fire season runs from late April through August, with most of the area burned occurring in June and July due primarily to lightning fire activity in northern Canada. Close to 50% of the area burned in Canada is the result of fires that are not actioned due to their remote location, low values-at-risk, and efforts to accommodate the natural role of fire in these ecosystems. The LFDB is updated annually and is being expanded back in time to permit a more thorough analysis of long-term trends in Canadian fire activity.

Implications for would healing of patient age and time elapsed since burn injury.

PubMed

Mountford, E M; Blight, A; Cheshire, I M

1995-01-01

To determine the relationship between growth potential in culture and the age of the patient, skin biopsies were obtained from over 60 patients of varying ages. The relationship between the length of time elapsed since burn injury and growth potential was also examined, using biopsies obtained from patients with burns during their treatment. Keratinocytes were extracted from biopsies and assessed for colony-forming ability by standard methods. Repeated subculture of cells was undertaken to determine the reproductive capacity of cells in vitro. Age had no effect on the colony-forming ability of keratinocytes in primary culture; however age did affect the total number of generations achieved by these cells. The growth potential of keratinocytes from patients with severe burns showed considerable variation according to the amount of time which had elapsed since the injury. This was most apparent around one week post-burn. These results need to be investigated further to understand their clinical implications. The study provides an insight into the influence of age and physiological response on the wound healing process in burn injuries.

A Computer Program to Evaluate Experimental Therapies for Treating Burned Patients

PubMed Central

Flora, Jairus D.; Flora, Sharyl Ann

1980-01-01

Determining the worth of new therapies for burn patients has been difficult because of the rarity of the burn injury and the disparate survival chances associated with different sizes of burns. Recently a burn survival model has been developed that estimates the risk of death from a burn as a function of the patient's age, sex, area of full thickness (third degree) burn, area of partial thickness burn, involvement of the perineum, and time from burn to admission. An alternative risk model uses the total area burned in place of the areas of partial thickness burn and full thickness burn, and is appropriate if the amount of full thickness burn is not determined accurately. This paper describes a program that uses these risk models to correct or standardize for demographic and severity factors, then, after that adjustment, tests whether a group of burn patients who received a new or experimental therapy shows a significantly better survival rate than that predicted by a baseline model. The program is a simple one written in Fortran for easy adaptation to other computer systems.

Improved Survival of Patients With Extensive Burns: Trends in Patient Characteristics and Mortality Among Burn Patients in a Tertiary Care Burn Facility, 2004-2013.

PubMed

Strassle, Paula D; Williams, Felicia N; Napravnik, Sonia; van Duin, David; Weber, David J; Charles, Anthony; Cairns, Bruce A; Jones, Samuel W

Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury. Our objective was to describe temporal trends in patient and burn characteristics, inpatient mortality, and the relationship between these characteristics and inpatient mortality over time. All patients aged 18 years or older and admitted with burn injury, including inhalation injury only, between 2004 and 2013 were included. Adjusted Cox proportional hazards regression models were used to estimate the relationship between admit year and inpatient mortality. A total of 5540 patients were admitted between 2004 and 2013. Significant differences in sex, race/ethnicity, burn mechanisms, TBSA, inhalation injury, and inpatient mortality were observed across calendar years. Patients admitted between 2011 and 2013 were more likely to be women, non-Hispanic Caucasian, with smaller burn size, and less likely to have an inhalation injury, in comparison with patients admitted from 2004 to 2010. After controlling for patient demographics, burn mechanisms, and differential lengths of stay, no calendar year trends in inpatient mortality were detected. However, a significant decrease in inpatient mortality was observed among patients with extensive burns (≥75% TBSA) in more recent calendar years. This large, tertiary care referral burn center has maintained low inpatient mortality rates among burn patients over the past 10 years. While observed decreases in mortality during this time are largely due to changes in patient and burn characteristics, survival among patients with extensive burns has improved.

Emission of polycyclic aromatic hydrocarbons and lead during Chinese mid-autumn festival.

PubMed

Kuo, Chung-Yih; Lee, Hong-Shen; Lai, Jeang-Hung

2006-07-31

The emission factors of total particulate polycyclic aromatic hydrocarbons (PAHs), Benzo(a)pyrene (BaP), BaP-equivalent doses (BaP(eq)) and Pb for burning three kinds of charcoal were investigated in this study: fast-lighting charcoal, Taiwanese, and Indonesian charcoal (the latter two of which are not fast-lighting). Compared to the burning of Taiwanese and Indonesian charcoal, the burning of fast-lighting charcoal can emit much larger amounts of total PAHs, BaP(eq) and Pb into the atmosphere. The emission factors of total PAHs, BaP and BaP(eq) for broiling meat were noticeably higher than those for broiling vegetables and non-fish seafood. When using Indonesian charcoal to broil meat, the total emission factors of particulate PAHs and BaP were about 15.7 and 0.39 mg/kg, respectively. The total amounts of particulate PAHs and Pb emitted from cookouts during Mid-Autumn Festival were 2881 and 120 g, respectively. Total PAHs and BaP(eq) in PM(10) aerosols on Mid-Autumn Festival nights increased about 1.6 and 1.5 times, respectively, higher than those on non-festival nights. The mean concentration of Pb on the nights of Mid-Autumn Festival increases to about 2.8 times that of non-festival nights.

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

PubMed Central

2011-01-01

Background 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. Methods 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. Results 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. Conclusions 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. Trial registration The trial has been registered on the International Standard Randomised Controlled Trial Number Register (ISRCTN) and given the registration number ISRCTN74058791. PMID:22132709

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.

General surgery resident rotations in surgical critical care, trauma, and burns: what is optimal for residency training?

PubMed

Napolitano, Lena M; Biester, Thomas W; Jurkovich, Gregory J; Buyske, Jo; Malangoni, Mark A; Lewis, Frank R

2016-10-01

There are no specific Accreditation Council for Graduate Medical Education General Surgery Residency Program Requirements for rotations in surgical critical care (SCC), trauma, and burn. We sought to determine the experience of general surgery residents in SCC, trauma, and burn rotations. Data analysis of surgical rotations of American Board of Surgery general surgery resident applicants (n = 7,299) for the last 8 years (2006 to 2013, inclusive) was performed through electronic applications to the American Board of Surgery Qualifying Examination. Duration (months) spent in SCC, trauma, and burn rotations, and postgraduate year (PGY) level were examined. The total months in SCC, trauma and burn rotations was mean 10.2 and median 10.0 (SD 3.9 months), representing approximately 16.7% (10 of 60 months) of a general surgery resident's training. However, there was great variability (range 0 to 29 months). SCC rotation duration was mean 3.1 and median 3.0 months (SD 2, min to max: 0 to 15), trauma rotation duration was mean 6.3 and median 6.0 months (SD 3.5, min to max: 0 to 24), and burn rotation duration was mean 0.8 and median 1.0 months (SD 1.0, min to max: 0 to 6). Of the total mean 10.2 months duration, the longest exposure was 2 months as PGY-1, 3.4 months as PGY-2, 1.9 months as PGY-3, 2.2 months as PGY-4 and 1.1 months as PGY-5. PGY-5 residents spent a mean of 1 month in SCC, trauma, and burn rotations. PGY-4/5 residents spent the majority of this total time in trauma rotations, whereas junior residents (PGY-1 to 3) in SCC and trauma rotations. There is significant variability in total duration of SCC, trauma, and burn rotations and PGY level in US general surgery residency programs, which may result in significant variability in the fund of knowledge and clinical experience of the trainee completing general surgery residency training. As acute care surgery programs have begun to integrate emergency general surgery with SCC, trauma, and burn rotations, it is an ideal time to determine the optimal curriculum and duration of these important rotations for general surgery residency training. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

Survival of Burns Involving 90% of the Total Body Surface Area After Treatment With Autologous Engineered Skin Substitutes

DTIC Science & Technology

2008-12-01

during acute hospitalization, and can result in long-term morbidity from scars . In this study, autologous ESS were compared with split-thickness...meshed skin autograft treatment of two pediatric patients with burns of 90% TBSA or greater, and evaluated qualitatively for formation of scar , and...populations ( Armour et al. 2007). Availability of ESS for treatment of extensive, deep burns may reduce time to wound closure, morbidity and

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.

Operating efficiency of an emergency Burns theatre: An eight month analysis.

PubMed

Mohan, Arvind; Lutterodt, Christopher; Leon-Villapalos, Jorge

2017-11-01

The efficient use of operating theatres is important to insure optimum cost-benefit for the hospital. We used the emergency Burns theatre as a model to assess theatre efficiency at our institution. Data was collected retrospectively on every operation performed in the Burns theatre between 01/04/15 and 30/11/15. Each component of the operating theatre process was considered and integrated to calculate values for surgical/anaesthetic time, changeover time and ultimately theatre efficiency. A total of 426 operations were carried out over 887h of allocated theatre time (ATT). Actual operating time represented 67.7%, anaesthetic time 8.8% and changeover time 14.2% of ATT. The average changeover time between patients was 30.1min. Lists started on average 27.7min late each day. There were a total of 5.8h of overruns and 9.6h of no useful activity. Operating theatre efficiency was 69.3% for the 8 month period. Our study highlights areas where theatre efficiency can be improved. We suggest various strategies to improve this that may be applied universally. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

1984–2010 trends in fire burn severity and area for the conterminous US

USGS Publications Warehouse

Picotte, Joshua J.; Peterson, Birgit E.; Meier, Gretchen; Howard, Stephen M.

2016-01-01

Burn severity products created by the Monitoring Trends in Burn Severity (MTBS) project were used to analyse historical trends in burn severity. Using a severity metric calculated by modelling the cumulative distribution of differenced Normalized Burn Ratio (dNBR) and Relativized dNBR (RdNBR) data, we examined burn area and burn severity of 4893 historical fires (1984–2010) distributed across the conterminous US (CONUS) and mapped by MTBS. Yearly mean burn severity values (weighted by area), maximum burn severity metric values, mean area of burn, maximum burn area and total burn area were evaluated within 27 US National Vegetation Classification macrogroups. Time series assessments of burned area and severity were performed using Mann–Kendall tests. Burned area and severity varied by vegetation classification, but most vegetation groups showed no detectable change during the 1984–2010 period. Of the 27 analysed vegetation groups, trend analysis revealed burned area increased in eight, and burn severity has increased in seven. This study suggests that burned area and severity, as measured by the severity metric based on dNBR or RdNBR, have not changed substantially for most vegetation groups evaluated within CONUS.

Airborne characterization of smoke marker ratios from prescribed burning

Treesearch

A. P. Sullivan; A. A. May; T. Lee; G. R. McMeeking; S. M. Kreidenweis; S. K. Akagi; R. J. Yokelson; S. P. Urbanski; J. L. Collett

2014-01-01

A Particle-Into-Liquid Sampler - Total Organic Carbon (PILS-TOC) and fraction collector system was flown aboard a Twin Otter aircraft sampling prescribed burning emissions in South Carolina in November 2011 to obtain smoke marker measurements. The fraction collector provided 2 min time-integrated offline samples for carbohydrate (i.e., smoke markers levoglucosan,...

Simultaneous measurement of the HT and DT fusion burn histories in inertial fusion implosions

DOE PAGES

Zylstra, Alex B.; Herrmann, Hans W.; Kim, Yong Ho; ...

2017-05-23

Measuring the thermonuclear burn history is an important way to diagnose inertial fusion implosions. Here, using the gas Cherenkov detectors at the OMEGA laser facility, we measure the HT fusion burn in a H 2+T 2 gas-fueled implosion for the first time. Then, using multiple detectors with varied Cherenkov thresholds, we demonstrate a technique for simultaneously measuring both the HT and DT burn histories from an implosion where the total reaction yields are comparable. This new technique will be used to study material mixing and kinetic phenomena in implosions.

Simultaneous measurement of the HT and DT fusion burn histories in inertial fusion implosions

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

Zylstra, Alex B.; Herrmann, Hans W.; Kim, Yong Ho

Measuring the thermonuclear burn history is an important way to diagnose inertial fusion implosions. Here, using the gas Cherenkov detectors at the OMEGA laser facility, we measure the HT fusion burn in a H 2+T 2 gas-fueled implosion for the first time. Then, using multiple detectors with varied Cherenkov thresholds, we demonstrate a technique for simultaneously measuring both the HT and DT burn histories from an implosion where the total reaction yields are comparable. This new technique will be used to study material mixing and kinetic phenomena in implosions.

Change of serum phosphate level and clinical outcome of hypophosphatemia in massive burn patient.

PubMed

Yang, Hyeong Tae; Yim, Haejun; Cho, Yong Suk; Kim, Dohern; Hur, Jun; Kim, Jong Hyun; Lee, Boung Chul; Seo, Cheong Hoon; Chun, Wook

2012-11-01

Hypophosphatemia is relatively common phenomenon in patients with massive burn injury. Therefore, we check serum phosphate level routinely and try to supply phosphate in a timely manner. The purpose of this study was to investigate the change of the serum phosphate level of early postburn period and the impact of hypophosphatemia on the prognosis of patients. A total of 227 patients with burn injury were reviewed retrospectively. We performed analysis of serum phosphate level within 20 days from burn injury. Patients' mean (SD) age was 47.0 (14.1) years, and mean (SD) percentage of total body surface area burned were 47.7 (21.9). Severe hypophosphatemia (phosphate < 1.0 mg/dL) was observed in 35 patients (15.8%), and moderate hypophosphatemia (1.0 ≤ phosphate < 2.0 mg/dL) was found in 115 patients (50.6%). Therefore, overall incidence of hypophosphatemia was 66.4%. There was no significant difference in serum phosphate level with survival, total body surface area burned, and mechanical ventilation. Age (odds ratio [OR], 3.180; 95% confidence interval [CI], 1.025-9.871; p = 0.045), total body surface area burned (OR, 20.934; 95% CI, 6.845-64.024; p = 0.000), and mechanical ventilation (OR, 5.581; 95% CI, 2.380-13.085; p = 0.002) were independently associated with mortality. However, serum phosphate level (OR, 0.828; 95% CI, 0.275-2.495; p = 0.737) does not have a statistical significance. Although multiple studies have evaluated the efficacy and safety of phosphate repletion regimens, the effect on mortality and morbidity is not well reported. However, our results show that patients with massive burn injury have high incidence of hypophosphatemia, and hypophosphatemia can result in many complications. Therefore, routine check and supply of phosphate can be suggested in patients with massive burn injury. Prognostic study, level II.

Where are lengths of stay longer and total charges higher for pediatric burn patients?

PubMed

Myers, John; Lehna, Carlee

2014-01-01

Treatment of pediatric burn patients is costly and may require long length of stay in the hospital (LOS). Establishing where these LOS and charges are highest is warranted. The current study investigated whether pediatric burn patients had higher total charges and longer LOS when seen at teaching hospitals, when compared with nonteaching hospitals. The study reviewed inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 by using the Kids' Inpatient Database, which is part of the Healthcare Cost and Utilization Project. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 940-947 were used to define burn injury, LOS, total charges, and type of hospital. The authors tested for differences between the LOS and total charges between children seen at three types of hospitals (pediatric, nonpediatric/teaching, nonpediatric/nonteaching) while adjusting for traditional risk factors (eg age, total burn surface area) by using generalized linear mixed-effects modeling. A total of N=28,777 children had burn injuries (n=16,115, 56.0% seen at pediatric hospitals; n=9353, 32.5% seen at nonpediatric/teaching hospitals; and n=3309, 11.5% seen at nonpediatric/nonteaching hospitals). Pediatric burn patients seen at pediatric hospitals, unadjusted, have significantly longer LOS (5.54 days vs 4.25 days and 4.00 days, P<.001) and more total charges in 2009 dollars ($31,319 vs $24,413 and $21,499, P<.001). In addition, patients seen at pediatric hospitals had significantly more total burn surface area (P<.001), more comorbidities (P=.021), and were younger (P<.001). After adjusting for total burn surface area, number of comorbidities, and age, no differences existed between teaching and nonteaching hospitals for LOS (P=.481) or total charges (P=.758). Although pediatric burn patients may have increased LOS and total charges when seen at teaching hospitals, when taking an unadjusted perspective, this may be an artifact that teaching hospitals see pediatric burn patients who are younger, have more comorbidities, and have more total burn surface area. As such, after adjustment, type of hospital may have no influence on LOS and total charges.

Muscle Contractile Properties in Severely Burned Rats

PubMed Central

Wu, Xiaowu; Wolf, Steven E.; Walters, Thomas J.

2010-01-01

Burn induces a sustained catabolic response which causes massive loss of muscle mass after injury. A better understanding of the dynamics of muscle wasting and its impact on muscle function is necessary for the development of effective treatments. Male Sprague-Dawley rats underwent either a 40% total body surface area (TBSA) scald burn or sham burn, and were further assigned to subgroups at four time points after injury (days 3, 7, 14 and 21). In situ isometric contractile properties were measured including twitch tension (Pt), tetanic tension (Po) and fatigue properties. Body weight decreased in burn and sham groups through day 3, however, body weight in the sham groups recovered and increased over time compared to burned groups, which progressively decreased until day 21 after injury. Significant differences in muscle wet weight and protein weight were found between sham and burn. Significant differences in muscle contractile properties were found at day 14 with lower absolute Po as well as specific Po in burned rats compared to sham. After burn, the muscle twitch tension was significantly higher than the sham at day 21. No significant difference in fatigue properties was found between the groups. This study demonstrates dynamics of muscle atrophy and muscle contractile properties after severe burn; this understanding will aid in the development of approaches designed to reduce the rate and extent of burn induced muscle loss and function. PMID:20381255

Total N exports from once vs. repeatedly burnt Pine plantations

NASA Astrophysics Data System (ADS)

Gonzalez Pelayo, Oscar; Hosseini, Mohammadreza; Varandas, Daniela; Machado, Ana Isabel; Prats Alegre, Sergio; Coelho, Celeste O. A.; Geissen, Violette; Ritsema, Coen; Keizer, Jan Jacob

2014-05-01

Post-fire nutrient losses in Mediterranean forested areas have been suggested as a key driver for ecosystem degradation. The role of fire recurrence in soil nutrient depletion, however, has been poorly studied. The EU-funded CASCADE project addresses this research gap in the study case in Portugal, having as overarching aim to assess if repeated wildfires lead to land degradation in Maritime Pine stands through a gradual process or, instead, through tipping-points in plant-water-soil relationships. Following a large wildfire in September 2012 affecting more than 3000 ha in the municipality of Viseu (central Portugal), total N losses are being monitored in three zones: 4x burnt since 1975; 1x burnt since 197, i.e. in 2012); unburnt since 1975. Within each zone, three replicate slopes were selected with similar slope angles and expositions and, at each slope, three pairs of erosion plots of approximately 0.25 m2 were installed on the lower, middle and lower slope section. Additionally, a catchment outlet within the 4x burned zones was equipped with a gauging station for automatic recording of water level sensor and tubidity and for collecting stream flow samples using an automatic sampler. Preliminary results from the first 6 months after the 2012-wildfire suggested that total N losses were, on average, twice as high at the 4x times burned slopes than at the 1x burned slopes. Nonetheless, temporal patterns in average losses during these initial six months were similar for the two zones. By contrast, the results obtained during the subsequent spring and summer seasons suggested that average total N losses from the 1x burned slopes closely approximated those from the 4x burned slopes. At the unburned slopes, total N losses were very small and limited to few rainfall events. Interestingly, at the catchment outlet the total N values were 66% higher compared to the 4x times burned microplots, highlighting the importance of up-scaling effects in terms of nutrient losses. Preliminary results on total N losses during the first post-fire year showed that nutrient depletion can be triggered by increasing the fire regime. The up-scaling effect suggested an increase in nutrient exportations from micro-plot to catchment scale. These results are being further investigated to establish the relationships between soil fertility losses and fire recurrence.

Impaired Respiratory Function and Heightened Pulmonary Inflammation in Episodic Binge Ethanol Intoxication and Burn Injury

PubMed Central

Shults, Jill A.; Curtis, Brenda J.; Chen, Michael M.; O'Halloran, Eileen B.; Ramirez, Luis; Kovacs, Elizabeth J.

2015-01-01

Clinical data indicate that cutaneous burn injuries covering greater than ten percent total body surface area are associated with significant morbidity and mortality, where pulmonary complications, including acute respiratory distress syndrome (ARDS), contribute to nearly half of all patient deaths. Approximately 50% of burn patients are intoxicated at the time of hospital admission, which increases days on ventilators by three-fold, and doubles length of hospital admittance, compared to non-intoxicated burn patients. The most common drinking pattern in the United States is binge drinking, where one rapidly consumes alcoholic beverages (4 for women, 5 for men) in 2 hours and an estimated 38 million Americans binge drink, often several times per month. Experimental data demonstrate a single binge ethanol exposure prior to scald injury, impairs innate and adaptive immune responses, thereby enhancing infection susceptibility and amplifying pulmonary inflammation, neutrophil infiltration, and edema, and is associated with increased mortality. Since these characteristics are similar to those observed in ARDS burn patients, our study objective was to determine whether ethanol intoxication and burn injury and the subsequent pulmonary congestion affects physiological parameters of lung function using non-invasive and unrestrained plethysmography in a murine model system. Furthermore, to mirror young adult binge drinking patterns, and to determine the effect of multiple ethanol exposures on pulmonary inflammation, we utilized an episodic binge ethanol exposure regimen, where mice were exposed to ethanol for a total of 6 days (3 days ethanol, 4 days rest, 3 days ethanol) prior to burn injury. Our analyses demonstrate mice exposed to episodic binge ethanol and burn injury have higher mortality, increased pulmonary congestion and neutrophil infiltration, elevated neutrophil chemoattractants, and respiratory dysfunction, compared to burn or ethanol intoxication alone. Overall, our study identifies plethysmography as a useful tool for characterizing respiratory function in a murine burn model and for future identification of therapeutic compounds capable of restoring pulmonary functionality. PMID:26364264

Predictors of functional independence, quality of life, and return to work in patients with burn injuries in mainland China.

PubMed

Tang, Dan; Li-Tsang, Cecilia W P; Au, Ricky K C; Shen, Xia; Li, Kui-Cheng; Yi, Xian-Feng; Liao, Lin-Rong; Cao, Hai-Yan; Feng, Ya-Nan; Liu, Chuan-Shun

2016-01-01

Burn injury may be associated with long-term rehabilitation and disability, while research studies on the functional performance after injuries, quality of life (QOL), and abilities to return to work of burn patients are limited. These outcomes are related not just to the degree and nature of injuries, but also to the socio-economical background of the society. This study aimed to identify the factors which might affect burn patients' abilities to reintegrate back to the society based on a sample in mainland China. A retrospective study was conducted to collect data of demographic characteristics, medical data about burn injuries, physical and psychological status, and self-perceived QOL at the initial phase and upon discharge from a rehabilitation hospital, timing of rehabilitation, and duration of rehabilitation intervention. Four hundred fifteen patients with burn injuries were recruited in the study. Multiple linear regression and logistic regression were used to obtain a model to predict the functional abilities and the perceived QOL at discharge and their changes during rehabilitation, as well as the post-injury work status within 6 months after discharge. The functional performance at discharge and its change were significantly predicted by the functional abilities and QOL at the admission, duration of treatment, timing of rehabilitation, payer source, and total body surface area burned. The perceived QOL at discharge and its change were significantly predicted by the baseline QOL at admission and duration of treatment. The significant predictors of work status within 6 months post-discharge included age, education, payer source, total body surface area burned, perceived QOL, and bodily pain at admission. The present study identified a number of factors affecting the rehabilitation outcomes of people with burn injuries. Identification of these predictors may help clinicians assess the rehabilitation potential of burn survivors and assist in resource allocation. Policy makers should ensure that resources are adequate to improve the outcomes based on these factors.

Cultured allogenic keratinocytes for extensive burns: a retrospective study over 15 years.

PubMed

Auxenfans, Celine; Shipkov, Hristo; Bach, Christine; Catherine, Zulma; Lacroix, Pierre; Bertin-Maghit, Marc; Damour, Odile; Braye, Fabienne

2014-02-01

The aim was to review the use and indications of cultured allogenic keratinocytes (CAlloK) in extensive burns and their efficiency. This retrospective study comprised 15 years (1997-2012). all patients who received CAlloK. patients who died before complete healing. Evaluation criteria were clinical. Time and success of wound healing after CAlloK use were evaluated. The CAlloK were used for 2 indications - STSG donor sites and deep 2nd degree burns in extensively burned patients. A total of 70 patients were included with severity Baux score of 99.2 (from 51 to 144) and mean percentage of TBSA of 63.49% (from 21 to 96%). Fifty nine patients received CAlloK for STSG donor sites with a mean number of applications of 4 and mean surface of 3800 cm(2) per patient. Treated donor sites were re-harvested 2.5 times. The mean time of complete epithelialization was 7 days. In 11 patients, CAlloK were used for deep 2nd degree burns. The mean percentage of burned surface was 73.7%. The mean surface of CAlloK per patient was 2545 cm(2). Complete healing was achieved in 6.4 days. The CAlloK allow rapid healing of STSG donor-sites and deep 2nd second degree burns in extensively burned patients. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Adult survivors' lived experience of burns and post-burn health: A qualitative analysis.

PubMed

Abrams, Thereasa E; Ogletree, Roberta J; Ratnapradipa, Dhitinut; Neumeister, Michael W

2016-02-01

The individual implications of major burns are likely to affect the full spectrum of patients' physical, emotional, psychological, social, environmental, spiritual and vocational health. Yet, not all of the post-burn health implications are inevitably negative. Utilizing a qualitative approach, this heuristic phenomenological study explores the experiences and perceptions early (ages 18-35) and midlife (ages 36-64) adults providing insight for how participants perceived their burns in relationship to their post-burn health. Participants were interviewed using semi-structured interview questions framed around seven domains of health. Interview recordings were transcribed verbatim then coded line by line, identifying dominant categories related to health. Categories were analyzed identifying shared themes among the study sample. Participants were Caucasian, seven males and one female. Mean age at time of interviews was 54.38 and 42.38 at time of burns. Mean time since burns occurred was 9.38 years with a minimum of (20%) total body surface area (TBSA) burns. Qualitative content analysis rendered three emergent health-related categories and associated themes that represented shared meanings within the participant sample. The category of "Physical Health" reflected the theme physical limitations, pain and sensitivity to temperature. Within the category of "Intellectual Health" were themes of insight, goal setting and self-efficacy, optimism and humor and within "Emotional Health" were the themes empathy and gratitude. By exploring subjective experiences and perceptions of health shared through dialog with experienced burned persons, there are opportunities to develop a more complete picture of how holistic health may be affected by major burns that in turn could support future long-term rehabilitative trajectories of early and midlife adult burn patients. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Effects of open burning of rice straw on concentrations of atmospheric polycyclic aromatic hydrocarbons in central Taiwan.

PubMed

Chen, Kang-Shin; Wang, Hsin-Kai; Peng, Yen-Ping; Wang, Wen-Cheng; Chen, Chia-Hsiu; Lai, Chia-Hsiang

2008-10-01

The sizes and concentrations of 21 atmospheric polycyclic aromatic hydrocarbons (PAHs) were measured at Jhu-Shan (a rural site) and Sin-Gang (a town site) in central Taiwan in October and December 2005. Air samples were collected using semi-volatile sampling trains (PS-1 sampler) over 16 days for rice-straw burning and nonburning periods. These samples were then analyzed using a gas chromatograph with a flame-ionization detector (GC/FID). Particle-size distributions in the particulate phase show a bimode, peaking at 0.32-0.56 microm and 3.2-5.6 microm at the two sites during the nonburning period. During the burning period, peaks also appeared at 0.32-0.56 microm and 3.2-5.6 microm at Jhu-Shan, with the accumulation mode (particle size between 0.1 and 3.2 microm) accounting for approximately 74.1% of total particle mass. The peaks at 0.18-0.32 microm and 1.8-3.2 microm at Shin-Gang had an accumulation mode accounting for approximately 70.1% of total particle mass. The mass median diameter (MMD) of 3.99-4.35 microm in the particulate phase suggested that rice-straw burning generated increased numbers of coarse particles. The concentrations of total PAHs (sum of 21 gases + particles) at the Jhu-Shan site (Sin-Gang site) were 522.9 +/- 111.4 ng/ml (572.0 +/- 91.0 ng/ml) and 330.1 +/- 17.0 ng/ml (or 427.5 +/- 108.0 ng/ml) during burning and nonburning periods, respectively, accounting for a roughly 58% (or 34%) increase in the concentrations of total PAHs due to rice-straw burning. On average, low-weight PAHs (about 87.0%) represent the largest proportion of total PAHs, followed by medium-weight PAHs (7.1%), and high-weight PAHs (5.9%). Combustion-related PAHs during burning periods were 1.54-2.57 times higher than those during nonburning periods. The results of principal component analysis (PCA)/absolute principal component scores (APCS) suggest that the primary pollution sources at the two sites are similar and include vehicle exhaust, coal/wood combustion, incense burning, and incineration emissions. Open burning of rice straw was estimated to contribute approximately 5.0-33.5% to the total atmospheric PAHs at the two sites.

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

The validation study on a three-dimensional burn estimation smart-phone application: accurate, free and fast?

PubMed

Cheah, A K W; Kangkorn, T; Tan, E H; Loo, M L; Chong, S J

2018-01-01

Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional methods of estimation can often lead to large discrepancies in burn percentage estimation. We aim to compare a new method of TBSAB estimation using a three-dimensional smart-phone application named 3D Burn Resuscitation (3D Burn) against conventional methods of estimation-Rule of Palm, Rule of Nines and the Lund and Browder chart. Three volunteer subjects were moulaged with simulated burn injuries of 25%, 30% and 35% total body surface area (TBSA), respectively. Various healthcare workers were invited to use both the 3D Burn application as well as the conventional methods stated above to estimate the volunteer subjects' burn percentages. Collective relative estimations across the groups showed that when used, the Rule of Palm, Rule of Nines and the Lund and Browder chart all over-estimated burns area by an average of 10.6%, 19.7%, and 8.3% TBSA, respectively, while the 3D Burn application under-estimated burns by an average of 1.9%. There was a statistically significant difference between the 3D Burn application estimations versus all three other modalities ( p  < 0.05). Time of using the application was found to be significantly longer than traditional methods of estimation. The 3D Burn application, although slower, allowed more accurate TBSAB measurements when compared to conventional methods. The validation study has shown that the 3D Burn application is useful in improving the accuracy of TBSAB measurement. Further studies are warranted, and there are plans to repeat the above study in a different centre overseas as part of a multi-centre study, with a view of progressing to a prospective study that compares the accuracy of the 3D Burn application against conventional methods on actual burn patients.

Relationship between Slivering Point and Gas Generation Rules of 19-Perforation TEGDN Propellants with Different Length/Outside Diameter Ratios and Perforation Diameters

NASA Astrophysics Data System (ADS)

Xiao, Zhenggang; Xu, Fuming

2018-04-01

In order to investigate the relationship between the slivering point and burning progressivity, a set of 19-perforation propellants containing triethylene glycol dinitrate (TEGDN) with different lengths/outside diameter ratios and perforation diameters was prepared and tested in a closed vessel. The mass fraction of burnt propellant was derived from the recorded pressure-time history of 19-perforation TEGDN propellants in the closed vessel according to the gas state equation and the form function of tested propellants. Based on the form function calculation and the mass fraction of burnt propellant, instantaneous burning surface area and the burning rate were obtained. The influence of length/outside diameter ratios and perforation diameters on the progressive combustion performance is studied through the dynamic vivacity method. With an increase in the length/outsider diameter, the slivering point occurs earlier and the slivering process lasts longer. Further, the burning progressivity of surface area can be improved. For propellants with same length/outside diameter ratio, with a decreasing of perforation diameter, the slivering point lags behind and the burning progressivity becomes greater. The slivering point corresponds to the instantaneous burning area, which is related to the form function and total burning process as well. However, the total burning progressivity of propellant is a very comprehensive result of propellant under multiple actions, including the mass fraction of burnt propellant, grain size and burning rate at different pressure regions. The correlation between them can boost a better understanding on the interaction between grain size, slivering burning process and burning progressivity.

Uncontrolled burning of solid waste by households in Mexico is a significant contributor to climate change in the country.

PubMed

Reyna-Bensusan, Natalia; Wilson, David C; Smith, Stephen R

2018-05-01

Uncontrolled burning of municipal solid waste (MSW) is an important source of air pollution and is wide spread in many developing countries, but only limited data quantify the extent of domestic open burning of household waste. Here, we present some of the first field data to be reported on the uncontrolled domestic burning of waste. A representative community of Mexico (Huejutla de Reyes Municipality) was investigated and household surveys, interviews with waste operators and a waste characterisation analysis were completed to assess the extent of, and factors controlling, the open burning of waste. Waste collection provision to rural communities was very limited and, consequently 92% of households in rural areas reported that they disposed of waste by uncontrolled burning in backyards or unofficial dumps. Overall, 24% of the total MSW generated in the Municipality was disposed by uncontrolled burning. Urban and periurban areas received twice-weekly collections and the rate of uncontrolled burning was considerably smaller compared to rural households, corresponding to approximately 2% of total waste generation. Carbon equivalency calculations showed that burning waste in backyards represented approximately 6% of the total and 8.5% of fuel related CO 2 Eq emissions by the municipality. Moreover, the equivalent carbon dioxide (CO 2 Eq) from black carbon (BC) emitted by uncontrolled burning in backyards was over fifteen times larger compared to methane (CH 4 ) potentially released from equivalent amounts of combustible biodegradable waste disposal at the official dumpsite. An assessment of local respiratory health data showed the incidence of disease was higher in rural than in urban areas, when the opposite trend is typically observed in the international literature; given the high rate of burning activity found in rural areas we suggest that open burning of waste could be a major reason for the apparent poorer respiratory health status of the rural population and requires further investigation. The results emphasise the importance of including BC from uncontrolled burning of waste in international emission inventories of greenhouse gases and in the assessment of the health status of local communities in developing countries where this practice is prevalent. Copyright © 2018 Elsevier Inc. All rights reserved.

[Etiological analysis of subambient temperature burn in 351 cases of Hefei area].

PubMed

Shi, Jie; Qi, Weiwei; Xu, Qinglian; Zhou, Shunying; Wang, Guobao

2010-06-01

To study the preventive measure of the subambient temperature burn by analysing the pathogenesis feature. The clinical data were analysed from 351 cases of subambient temperature burn between February 2004 and February 2009, including age, sex, burn season, burn factors, burn position, burn area, burn degree, treatment way, and wound healing. Subambient temperature burn occurred in every age stage. The susceptible age stages included infant, children, and the elderly. Female patients were more than male patients. The common burn reasons were hot-water bottle burn, honey warm keeper burn, and heating device burn. The peak season was winter. Lower limb was the most common site of the subambient temperature burn. The deep II degree to III degree were the most common level, and the burn area was always small, often < or = 1% of total body surface area. Most of patients were treated with changing dressings at clinic and few patients needed hospitalization. Though the surface of wound could heal finally, and the wound healed well with no obvious scar in patients who received operation. Subambient temperature burn is the frequently encountered disease in winter. Use of the warming articles should be cautious, at the same time safety awareness should be strengthened so as to decrease the incidence rate of subambient temperature burn and the injury degree.

Total sugars in atmospheric aerosols: An alternative tracer for biomass burning

NASA Astrophysics Data System (ADS)

Scaramboni, C.; Urban, R. C.; Lima-Souza, M.; Nogueira, R. F. P.; Cardoso, A. A.; Allen, A. G.; Campos, M. L. A. M.

2015-01-01

Ambient aerosols were collected in an agro-industrial region of São Paulo State (Brazil) between May 2010 and February 2012 (n = 87). The atmosphere of the study region is highly affected by the emissions of gases and particles from sugar and fuel ethanol production, because part of the area planted with sugarcane is still burned before manual harvesting. This work proposes the quantification of total sugars as an alternative chemical tracer of biomass burning, instead of levoglucosan. The quantification of total sugars requires a small area of a filter sample and a simple spectrophotometer, in contrast to the determination of levoglucosan, which is much more complex and time-consuming. Total sugars concentrations in the aerosol ranged from 0.28 to 12.5 μg m-3, and (similarly to levoglucosan) the emissions were significantly higher at night and during the sugarcane harvest period, when most agricultural fires occur. The linear correlation between levoglucosan and total sugars (r = 0.612) was stronger than between levoglucosan and potassium (r = 0.379), which has previously been used as a biomass burning tracer. In the study region, potassium is used in fertilizers, and this, together with substantial soil dust resuspension, makes potassium unsuitable for use as a tracer. On average, ca. 40% of the total sugars was found in particles smaller than 0.49 μm. By including data from previous work, it was possible to identify from 35 to 42% of the total sugars, with biomass burning making the largest contribution. The high solubility in water of these sugars means that determination of their concentrations could also provide important information concerning the hydrophilic properties of atmospheric aerosols.

Oriental bittersweet (Celastrus orbiculatus): Spreading by fire

USGS Publications Warehouse

Pavlovic, Noel B.; Leicht-Young, Stacey A.; Grundel, Ralph

2016-01-01

In many forest ecosystems, fire is critical in maintaining indigenous plant communities, but can either promote or arrest the spread of invasive species depending on their regeneration niche and resprouting ability. We examined the effects of cutting and burning treatments on the vegetative response (cover, stem density) and root resources of Oriental bittersweet (Celastrus orbiculatus), a liana invasive to North America that was introduced from East Asia. Treatments were control, spring cut, spring burn, spring cut & burn, summer cut, fall cut, fall burn, fall cut & burn, and fall herbicide. Cover was reduced the greatest by herbicide and summer cutting treatments, but increased more in the second year on moraine soils than on sandy soils. Burning and cutting & burning combined resulted in a resprout density four times greater than stem density prior to treatment for stems <2.5 mm diameter than cutting alone. For stems, across all diameter classes, there was a more than 100% increase in stem density with burning and almost a 300% increase in stem density with cutting & burning in the spring. Density of resprouts and root-suckers, and survival increased with increasing stem size. While cutting of C. orbiculatus during the growing season (summer) reduced total nonstructural carbohydrates by 50% below early growing season levels and 75% below dormant season levels, burning did not significantly reduce total nonstructural carbohydrates. Thus, Oriental bittersweet is quite responsive to burning as a disturbance and resprouting and root-suckering creates additional opportunities for growth and attainment of the forest canopy. The positive response of Oriental bittersweet to burning has important implications for management of invasive lianas in fire-dependent forest landscapes.

Myocardial Autophagy after Severe Burn in Rats

PubMed Central

Zhang, Qiong; Shi, Xiao-hua; Huang, Yue-sheng

2012-01-01

Background Autophagy plays a major role in myocardial ischemia and hypoxia injury. The present study investigated the effects of autophagy on cardiac dysfunction in rats after severe burn. Methods Protein expression of the autophagy markers LC3 and Beclin 1 were determined at 0, 1, 3, 6, and 12 h post-burn in Sprague Dawley rats subjected to 30% total body surface area 3rd degree burns. Autophagic, apoptotic, and oncotic cell death were evaluated in the myocardium at each time point by immunofluorescence. Changes of cardiac function were measured in a Langendorff model of isolated heart at 6 h post-burn, and the autophagic response was measured following activation by Rapamycin and inhibition by 3-methyladenine (3-MA). The angiotensin converting enzyme inhibitor enalaprilat, the angiotensin receptor I blocker losartan, and the reactive oxygen species inhibitor diphenylene iodonium (DPI) were also applied to the ex vivo heart model to examine the roles of these factors in post-burn cardiac function. Results Autophagic cell death was first observed in the myocardium at 3 h post-burn, occurring in 0.008 ± 0.001% of total cardiomyocytes, and continued to increase to a level of 0.022 ± 0.005% by 12 h post-burn. No autophagic cell death was observed in control hearts. Compared with apoptosis, autophagic cell death occurred earlier and in larger quantities. Rapamycin enhanced autophagy and decreased cardiac function in isolated hearts 6 h post-burn, while 3-MA exerted the opposite response. Enalaprilat, losartan, and DPI all inhibited autophagy and enhanced heart function. Conclusion Myocardial autophagy is enhanced in severe burns and autophagic cell death occurred early at 3 h post-burn, which may contribute to post-burn cardiac dysfunction. Angiotensin II and reactive oxygen species may play important roles in this process by regulating cell signaling transduction. PMID:22768082

Prognostic factors in electrical burns: a review of 101 patients.

PubMed

Saracoglu, Ayten; Kuzucuoglu, Tamer; Yakupoglu, Sezer; Kilavuz, Oguzhan; Tuncay, Erhan; Ersoy, Burak; Demirhan, Recep

2014-06-01

Electrical burn wounds are among the most devastating of burns, with wide-ranging injuries. We aimed to document the factors affecting the mortality rate of patients presenting with electrical burn wounds to our regional burn centre. This retrospective study was conducted on 101 patients from January 2009 to June 2012. Factors were classified under 11 topics and evaluated according to their relationship with the mortality rate. The major causes of death in burn victims were multiple organ failure and infection. Twenty-six percent of the 101 patients died, all of whom were male. One (1.4%) of the patients who survived was female; 73 (98.6%) survivors were male. The mean age in the deceased group was statistically higher than that of the other patients (32.7 vs. 35.6 years; P < 0.05). All-cause mortality was 2.79 times higher for larger burns (> 25% total body surface area). The values for creatine kinase, creatine kinase-MB, total body surface area of burn, hospitalised period in the intensive care unit and intubation rate were significantly higher in the exitus group. Renal injury requiring haemofiltration was associated with an almost 12-fold increased risk for mortality. There was no statistically significant difference between patients regarding surgical interventions. Electrical injury remains a major cause of mortality and long-term disability among young people. Our data demonstrated several risk factors associated with increased mortality rate in patients with electrical burn wounds. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

MORBIDITY AND SURVIVAL PROBABILITY IN BURN PATIENTS IN MODERN BURN CARE

PubMed Central

Jeschke, Marc G.; Pinto, Ruxandra; Kraft, Robert; Nathens, Avery B.; Finnerty, Celeste C.; Gamelli, Richard L.; Gibran, Nicole S.; Klein, Matthew B.; Arnoldo, Brett D.; Tompkins, Ronald G.; Herndon, David N.

2014-01-01

Objective Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn. Design and Patients Burn patients were prospectively enrolled as part of the multicenter prospective cohort study, Inflammation and the Host Response to Injury Glue Grant, with the following inclusion criteria: 0–99 years of age, admission within 96 hours after injury, and >20% total body surface area burns requiring at least one surgical intervention. Setting Six major burn centers in North America. Measurements and Main Results Burn size cutoff values were determined for mortality, burn wound infection (at least two infections), sepsis (as defined by ABA sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (DENVER2 score >3) for both children (<16 years) and adults (16–65 years). Five-hundred seventy-three patients were enrolled, of which 226 patients were children. Twenty-three patients were older than 65 years and were excluded from the cutoff analysis. In children, the cutoff burn size for mortality, sepsis, infection, and multiple organ failure was approximately 60% total body surface area burned. In adults, the cutoff for these outcomes was lower, at approximately 40% total body surface area burned. Conclusions In the modern burn care setting, adults with over 40% total body surface area burned and children with over 60% total body surface area burned are at high risk for morbidity and mortality, even in highly specialized centers. PMID:25559438

Use of porcine acellular dermal matrix following early dermabrasion reduces length of stay in extensive deep dermal burns.

PubMed

Guo, Zhi-Qian; Qiu, Le; Gao, You; Li, Jin-Hu; Zhang, Xin-He; Yang, Xin-Lei; Peszel, April; Chen, Xu-Lin

2016-05-01

Extensive deep partial-thickness burns still seriously challenge the surgeon's abilities. This study aimed to assess the impact of early dermabrasion combined with porcine acellular dermal matrix (ADM) in extensive deep dermal burns. From September 2009 to September 2013, a total of 60 adult patients sustained greater than 50% total body surface area (TBSA) burn by hot water or gas explosion were divided into three groups based on dermabrasion: group A (early dermabrasion and porcine ADM), group B (early dermabrasion and nano-silver dressings), and group C (conservative group). The wound healing time and length of hospital stay were analyzed. Scar assessment was performed at 3 and 12 months after the injury with a modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA). No significant difference was found in mean burn size, burn depth, age, male-to-female ratio, or incidence of inhalation injury between the patients in the three groups (p>0.05). Compared with groups B and C, the patients that received early dermabrasion combined with porcine ADM had a shorter wound healing time (p<0.01). The burn patients treated with early dermabrasion and porcine ADM coverage had a mean length of hospital stay of 28.3 days (±7.2), which was significantly shorter than that of groups B and C (p<0.05-0.01). The mVSS-TBSA of patients in group A was significantly improved in comparison with groups B and C at 3 and 12 months after the injury. There was no significant difference in the mortality rate between the three groups (p>0.05). Early dermabrasion combined with porcine ADM coverage facilitates wound healing, reduces the length of hospital stay, and improves esthetic and functional results in extensive deep dermal burns with burn size over 50% TBSA. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital.

PubMed

Kilyewala, C; Alenyo, R; Ssentongo, R

2017-07-06

Blood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Today advocacy is for restrictive blood transfusion taking into account individual patient characteristics. We went out to identify the parameters that may determine transfusion requirement and the time to blood transfusion for thermal burn patients in Mulago Hospital in order to build statistics and a basis to standardize future practice and Hospital protocol. 112 patients with thermal burns were enrolled into a prospective cohort study conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities like surgical intervention. Patients were clinically followed up for a maximum period of 28 days and we identified those that were transfused. 22.3% of patients were transfused. The median time to transfusion was 17 days from time of injury and varied with different patient characteristics. The median pre-transfusion hemoglobin (Hb) level was 8.2 g/dL. Transfusion was significantly related to; admission to the intensive care unit (p = 0.001), a body mass index (BMI) <2 kg/m 2 (p = 0.021), % total burn surface area (TBSA) >20 (p = 0.049), pre-existing illness (p = 0.046), and white blood cell (WBC) count <4000 or >12,000/μL (p = 0.05). Pre-existing illnesses, a low BMI, TBSA of >20%, admission to the intensive care unit and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago Hospital. The precise time to transfusion from time of burns injury cannot be generalized. With close monitoring of each individual patient lies the appropriateness and timeliness of their management.

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.

Cost analysis of acute burn patients treated in a burn centre: the Gulhane experience

PubMed Central

Sahin, I.; Ozturk, S.; Alhan, D.; Açikel, C.; Isik, S.

2011-01-01

Summary Even if calculating the exact cost of burn treatment is a very hard task, the study of cost analysis provides financial perspective. We performed a cost analysis study in our burn centre to respond to questions about total patient treatment cost and the length of hospital stay. We reviewed all patients admitted to the Gulhane Military Medical Academy Burn Centre in Ankara, Turkey, between March 2005 and August 2008. Forty-three patients with major burns were identified on the basis of the study criteria. The data regarding total treatment cost and the length of hospital stay for each type of burn (flame, scald, electric) were collected at the end of the study. The average total body surface area burned was 36 ± 7%.. The average duration of hospital stay was 73 ± 33 days. Patients with electrical burns stayed longer in hospital than patients with other types of burn injuries. Each one per cent of burn corresponded to a mean hospital stay of two days. The overall mean total cost was $US 15,250. The mean total cost of electrical burns was the highest, with $US 22,501 ± 24,039. Even if the costs associated with burn injury are higher than some other well-known health-related problems, they have not been much studied. Reports have produced different results, but it should be kept in mind that although the results of cost analysis studies may vary they must be performed in all newly established burn centres in order to form a financial overview. PMID:21991233

Epidemiology of pediatric burns and future prevention strategies-a study of 475 patients from a high-volume burn center in North India.

PubMed

Dhopte, Amol; Tiwari, V K; Patel, Pankaj; Bamal, Rahul

2017-01-01

Pediatric burns have a long-term social impact. This is more apparent in a developing country such as India, where their incidence and morbidity are high. The aim of this study was to provide recent prospective epidemiological data on pediatric burns in India and to suggest future preventive strategies. Children up to 18 years old admitted to the Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, between January and December 2014 were included in the study. Data regarding age, sex, etiology, total body surface area (TBSA), circumstances of injury, and clinical assessment were collected. The Mann-Whitney test or Kruskal-Wallis test or ANOVA was used to compare involved TBSA among various cohort groups accordingly. Univariate and multivariate linear regression analyses were used to determine the predictors of TBSA. There were a total of 475 patients involved in the study, including seven suicidal burns, all of whom were females with a mean age greater than the cohort average. Age, type of burns, mode of injury, presence or absence of inhalation injury, gender, and time of year (quarter) for admission were found to independently affect the TBSA involved. Electrical burns also formed an important number of presenting burn patients, mainly involving teenagers. Several societal issues have come forth, e.g., child marriage, child labor, and likely psychological problems among female children as suggested by a high incidence of suicidal burns. This study also highlights several issues such as overcrowding, lack of awareness, dangerous cooking practices, and improper use of kerosene oil. There is an emergent need to recognize the problems, formulate strategies, spread awareness, and ban or replace hazardous substances responsible for most burn accidents.

Return to work after specialised burn care: A two-year prospective follow-up study of the prevalence, predictors and related costs.

PubMed

Goei, H; Hop, M J; van der Vlies, C H; Nieuwenhuis, M K; Polinder, S; Middelkoop, E; van Baar, M E

2016-09-01

Burn injuries may cause long-term disability and work absence, and therefore result in high healthcare and productivity costs. Up to now, detailed information on return to work (RTW) and productivity costs after burns is lacking. The aim of this study was to accurately assess RTW after burn injuries, to identify predictors of absenteeism and to calculate healthcare and productivity costs from a societal perspective. A prospective cohort study was conducted in the burn centre of Rotterdam, the Netherlands, including all admitted working-age patients from 1 August 2011 to 31 July 2012. At 3, 12 and 24 months post-burn, patients were sent a questionnaire: including the Work and Medical Consumption questionnaire for the assessment of work absence and medical consumption and the EQ-5D-3L plus a cognitive dimension to assess post-burn and pre-burn quality of life (QOL). Cost analyses were from a societal perspective according the micro-costing method and the friction cost method was applied for the calculation of productivity loss. Univariate logistic regression was used to identify predictors of absenteeism at three months. A total of 104 patients were included in the study with a mean total body surface area (TBSA) burned of 8% (median 4%). 66 respondents were pre-employed, at 3 months 70% was back at work, at 12 months 92% and 8% had not returned to work at time of final follow-up at 24 months. Predictors of absenteeism at 3 months were: TBSA, length of stay, ICU-admission and surgery. Mean costs related to loss in productivity were €11.916 [95% CI 8.930-14.902] and accounted for 30% of total costs in pre-employed respondents in the first two years. This two-year follow-up study demonstrates that burn injuries cause substantial and prolonged productivity loss amongst burn survivors with mixed burn severity. This absenteeism contributes to already high societal costs of burn injuries. Predictors of absenteeism found in this study were primarily fixed patient and treatment related factors, future studies should focus on modifiable factors, in order to improve RTW outcomes. Also, more attention in the rehabilitation trajectory is needed to optimally support RTW in burn survivors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Wound management and outcome of 595 electrical burns in a major burn center.

PubMed

Li, Haisheng; Tan, Jianglin; Zhou, Junyi; Yuan, Zhiqiang; Zhang, Jiaping; Peng, Yizhi; Wu, Jun; Luo, Gaoxing

2017-06-15

Electrical burns are important causes of trauma worldwide. This study aims to analyze the clinical characteristics, wound management, and outcome of electric burns. This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University during 2013-2015. Data including the demographics, injury patterns, wound treatment, and outcomes were collected and analyzed. A total of 595 electrical burn patients (93.8% males) were included. The average age was 37.3 ± 14.6 y, and most patients (73.5%) were aged 19∼50 years. Most patients (67.2%) were injured in work-related circumstances. The mean total body surface area was 8.8 ± 11.8% and most wounds (63.5%) were full-thickness burns. Operation times of high-voltage burns and current burns were higher than those of low-voltage burns and arc burns, respectively. Of the 375 operated patients, 83.2% (n = 312) underwent skin autografting and 49.3% (n = 185) required skin flap coverage. Common types of skin flaps were adjacent (50.3%), random (42.2%), and pedicle (35.7%). Amputation was performed in 107 cases (18.0%) and concentrated on the hands (43.9%) and upper limbs (39.3%). The mean length of stay was 42.9 ± 46.3 d and only one death occurred (0.2%). Current burns and higher numbers of operations were major risk factors for amputation and length of stay, respectively. Electrical burns mainly affected adult males with occupational exposures in China. Skin autografts and various skin flaps were commonly used for electric burn wound management. More standardized and effective strategies of treatment and prevention are still needed to decrease amputation rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Monitoring Shuttle Burns and Rocket Launches with GPS

NASA Astrophysics Data System (ADS)

Coster, A. J.; Bhatt, A.; O'Hanlon, B.; Rideout, W.

2009-12-01

We report on different GPS analysis techniques that can be used to examine the effects of rocket exhaust on the upper atmosphere. GPS observations of artificially produced electron density holes created by chemical releases from Space Shuttle Orbital Maneuvering System (OMS) engine burns will be discussed. The percentage drop in total electron content (TEC) and the temporal and spatial scales observed in the electron density hole for different Shuttle burn experiments will be compared. We will also report on observations of TEC depletions associated with Titan rocket launches on 8 April 2003 and on 19 October 2005. Finally we will discuss the use of GPS measurements of precipitable water vapor from time periods before, during, and after Shuttle burns.

Body Composition Changes in Severely Burned Children During ICU Hospitalization.

PubMed

Cambiaso-Daniel, Janos; Malagaris, Ioannis; Rivas, Eric; Hundeshagen, Gabriel; Voigt, Charles D; Blears, Elizabeth; Mlcak, Ron P; Herndon, David N; Finnerty, Celeste C; Suman, Oscar E

2017-12-01

Prolonged hospitalization due to burn injury results in physical inactivity and muscle weakness. However, how these changes are distributed among body parts is unknown. The aim of this study was to evaluate the degree of body composition changes in different anatomical regions during ICU hospitalization. Retrospective chart review. Children's burn hospital. Twenty-four severely burned children admitted to our institution between 2000 and 2015. All patients underwent a dual-energy x-ray absorptiometry within 2 weeks after injury and 2 weeks before discharge to determine body composition changes. No subject underwent anabolic intervention. We analyzed changes of bone mineral content, bone mineral density, total fat mass, total mass, and total lean mass of the entire body and specifically analyzed the changes between the upper and lower limbs. In the 24 patients, age was 10 ± 5 years, total body surface area burned was 59% ± 17%, time between dual-energy x-ray absorptiometries was 34 ± 21 days, and length of stay was 39 ± 24 days. We found a significant (p < 0.001) average loss of 3% of lean mass in the whole body; this loss was significantly greater (p < 0.001) in the upper extremities (17%) than in the lower extremities (7%). We also observed a remodeling of the fat compartments, with a significant whole-body increase in fat mass (p < 0.001) that was greater in the truncal region (p < 0.0001) and in the lower limbs (p < 0.05). ICU hospitalization is associated with greater lean mass loss in the upper limbs of burned children. Mobilization programs should include early mobilization of upper limbs to restore upper extremity function.

Fire history of the Peron Peninsula, Shark Bay, Western Australia based on remote sensing, dendrochronology, and anecdotal evidence

NASA Astrophysics Data System (ADS)

Beller, Benjamin J.

Remote sensing data, dendrochronology, Geographical Information Systems (GIS), and anecdotal information were used to describe the fire regime of the 180,000 ha Peron Peninsula of Western Australia. Fire scars present in 1944 aerial photos were still visible in 2009, both in imagery and on the ground. Tree-ring dates from specimens sampled within these burned areas indicated the occurrence of at least three separate fires before 1944. The oldest fire occurred ca. 1911 and burned at least 5,880 ha. Subsequent fires ca. 1922 and 1936 burned across 8,240 ha and 9,400 ha respectively. The fire dates determined from tree-ring counts were consistent with precipitation data which showed conditions particularly favorable for fire before or during the estimated year of each fire. Plant communities most often burned before 1944 were the Acacia ramulosa var. linophylla Scrub and the Acacia - Lamarchea hakefolia Thicket with, respectively, 73% and 75% of these plant community types at the study area found to have been burned at some time. Remote sensing imagery from 1944-2009 identified only 300 additional hectares burned, a 25 ha fire in 1991 in the combined Acacia ramulosa var. linophylla Scrub and A.ligulata and A. rostellifora Thicket, ten prescribed burns in 1995 totaling 274 ha in various habitats, and two late 1990's scars from prescribed burns designed to create fire buffers, one 4.6 km and the other 7.4 km long. Combined data for all years assessed showed 59,000 ha (66%) of the total study area to have been burned or reburned since ca. 1911, most prior to 1944, with a total of nearly 24,000 ha (27%) of the study area unburned for more than 110 years. Birridas, which cannot burn, accounted for the remaining 6,000 ha (7%) of the study area. These results show fire occurred more frequently 100 years ago (fires every 10-15 years) than at present (> 65 years between fires) suggesting that more frequent prescribed burning than occurs at present on the Peron Peninsula would be most consistent with the pre-European fire regimes of the region and the ecosystems they maintained.

Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model.

PubMed

Mehra, Tarun; Koljonen, Virve; Seifert, Burkhardt; Volbracht, Jörk; Giovanoli, Pietro; Plock, Jan; Moos, Rudolf Maria

2015-01-01

Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems. A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established. The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782-328 618 CHF vs 4 874-27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range -6 720 - 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of -33 178 CHF (30 856 EUR) (interquartile range -95 533 - 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2 of 0.67 (p <0.001 for LOS). Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.

[Influence of three-level collaboration network of pediatric burns treatment in Anhui province on treatment effects of burn children].

PubMed

Xia, Z G; Zhou, X L; Kong, W C; Li, X Z; Song, J H; Fang, L S; Hu, D L; Cai, C; Tang, Y Z; Yu, Y X; Wang, C H; Xu, Q L

2018-03-20

Objective: To explore the influence of three-level collaboration network of pediatric burns in Anhui province on treatment effects of burn children. Methods: The data of medical records of pediatric burn children transferred from Lu'an People's Hospital and Fuyang People's Hospital to the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2015 and January 2016 to September 2017 (before and after establishing three-level collaboration network of pediatric burns treatment) were analyzed: percentage of transferred burn children to hospitalized burn children in corresponding period, gender, age, burn degree, treatment method, treatment result, occurrence and treatment result of shock, and operative and non-operative treatment time and cost. Rehabilitation result of burn children transferred back to local hospitals in 2016 and 2017. Data were processed with t test, chi-square test, Mann-Whitney U test, and Fisher's exact test. Results: (1) Percentage of burn children transferred from January 2014 to December 2015 was 34.3% (291/848) of the total number of hospitalized burn children in the same period of time, which was close to 30.4% (210/691) of burn children transferred from January 2016 to September 2017 ( χ (2)=2.672, P >0.05). (2) Gender, age, burn degree, and treatment method of burn children transferred from the two periods of time were close ( χ (2)=3.382, Z =-1.917, -1.911, χ (2)=3.133, P >0.05). (3) Cure rates of children with mild, moderate, and severe burns transferred from January 2016 to September 2017 were significantly higher than those of burn children transferred from January 2014 to December 2015 ( χ (2)=11.777, 6.948, 4.310, P <0.05). Cure rates of children with extremely severe burns transferred from the two periods of time were close ( χ (2)=1.181, P >0.05). (4) Children with mild and moderate burns transferred from the two periods of time were with no shock. The incidence of shock of children with severe burns transferred from January 2014 to December 2015 was 6.0% (4/67), and 3 children among them were cured. The incidence of shock of children with severe burns transferred from January 2016 to September 2017 was 3.9% (2/51), and both children were cured. The incidences and cures of shock of children with severe burns transferred from the two periods of time were close ( χ (2)=0.006, P >0.05). Incidence of shock of children with extremely severe burns transferred from January 2014 to December 2015 was 57.1% (32/56), significantly higher than that of burn children transferred from January 2016 to September 2017 [34.5% (10/29), χ (2)=3.925, P <0.05]. Shock of 25 children with extremely severe burns transferred from January 2014 to December 2015 were cured, and shock of 9 children with extremely severe burns transferred from January 2016 to September 2017 were cured. The cures of shock of children with extremely severe burns transferred from the two periods of time were close ( χ (2)=0.139, P >0.05). (5) Time of operative treatment of children with moderate, severe, and extremely severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 ( t =2.335, 2.065, 2.310, P <0.05). Time of operative treatment of children with mild burns transferred from the two periods of time was close ( Z =-0.417, P >0.05). Costs of operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were significantly more than those of burn children transferred from January 2016 to September 2017 ( Z =-3.324, t =2.167, P <0.05). Costs of operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close ( t =0.627, 0.808, P >0.05). (6)Time of non-operative treatment of children with mild, moderate, and severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 ( t =2.335, Z =-2.095, t =2.152, P <0.05). Time of non-operative treatment of children with extremely severe burns transferred from the two periods of time was close ( t =0.450, P >0.05). Costs of non-operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were obviously higher than those of burn children transferred from January 2016 to September 2017 ( Z =-2.164, t =2.040, P <0.05). Costs of non-operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close ( t =0.146, 1.235, P >0.05). (7) Sixty-seven burn children transferred from January 2016 to September 2017 were transferred back to local hospitals for rehabilitation under the guidance of experts of the First Affiliated Hospital of Anhui Medical University, with 25 patients in 2016 and 42 patients in 2017. Effective rehabilitation rates of burn children transferred back to local hospitals for rehabilitation in 2016 and 2017 were both 100%. Conclusions: The three-level collaboration network of pediatric burns treatment in Anhui province can effectively increase cure rate of children with mild, moderate, and severe burns, reduce incidence of shock of children with extremely severe burns, shorten time of operative treatment of burn children with moderate, severe, and extremely severe burns, and time of non-operative treatment of children with mild, moderate, and severe burns, reduce treatment costs of children with moderate and severe burns, and improve rehabilitation effectiveness of children transferred from Lu'an People's Hospital and Fuyang People's Hospital to the the First Affiliated Hospital of Anhui Medical University.

A Soft Casting Technique for Managing Pediatric Hand and Foot Burns.

PubMed

Choi, Young Mee; Nederveld, Cindy; Campbell, Kristen; Moulton, Steven

2018-04-04

Hand and foot burns in children are difficult to dress. The authors have developed a soft casting technique to manage burns to these areas. The aim of this study is to report the outcomes using weekly dressing changes with a soft casting technique to manage pediatric hand and foot burns in the outpatient setting. A retrospective chart review was performed on children with burns to the hands or feet, who underwent dressing changes with a soft casting technique at the Children's Hospital Colorado Burn Center. Soft casting was performed by placing antibiotic ointment-impregnated nonadherent gauze over the burn wound(s), wrapping the extremity using rolled gauze, applying soft cast pad, plaster, soft cast tape, and an elastic bandage. This was changed weekly. Two hundred ninety-eight children with hand burns had a mean age of 16.8 ± 2 months. Two hundred forty-eight children had partial thickness burn injuries (83%), 50 had full thickness burn injuries (17%), and the mean total body surface area (TBSA) was 1 ± 2.4%. The mean time to heal was 10.1 ± 1.7 days for all subjects. Sixty-six children with foot burns were identified with a mean age of 24 ± 2.6 months. Forty-six children had partial thickness injuries (70%), 20 had full thickness burn injuries (30%), and the mean TBSA was 2.3 ± 2.9%. The mean time to heal was 14.1 ± 2.2 days for all subjects. Weekly dressing changes using a soft casting technique are effective for the outpatient management of pediatric hand and foot burns. This method avoids costly inpatient hospital care, reduces the number of painful dressing changes, and allows children to heal in their own environment.

Survival after burn in a sub-Saharan burn unit: challenges and opportunities.

PubMed

Tyson, Anna F; Boschini, Laura P; Kiser, Michelle M; Samuel, Jonathan C; Mjuweni, Steven N; Cairns, Bruce A; Charles, Anthony G

2013-12-01

Burns are among the most devastating of all injuries and a major global public health crisis, particularly in sub-Saharan Africa. In developed countries, aggressive management of burns continues to lower overall mortality and increase lethal total body surface area (TBSA) at which 50% of patients die (LA50). However, lack of resources and inadequate infrastructure significantly impede such improvements in developing countries. This study is a retrospective analysis of patients admitted to the burn center at Kamuzu Central Hospital in Lilongwe, Malawi between June 2011 and December 2012. We collected information including patient age, gender, date of admission, mechanism of injury, time to presentation to hospital, total body surface area (TBSA) burn, comorbidities, date and type of operative procedures, date of discharge, length of hospital stay, and survival. We then performed bivariate analysis and logistic regression to identify characteristics associated with increased mortality. A total of 454 patients were admitted during the study period with a median age of 4 years (range 0.5 months to 79 years). Of these patients, 53% were male. The overall mean TBSA was 18.5%, and average TBSA increased with age--17% for 0-18 year olds, 24% for 19-60 year olds, and 41% for patients over 60 years old. Scald and flame burns were the commonest mechanisms, 52% and 41% respectively, and flame burns were associated with higher mortality. Overall survival in this population was 82%; however survival reduced with increasing age categories (84% in patients 0-18 years old, 79% in patients 19-60 years old, and 36% in patients older than 60 years). TBSA remained the strongest predictor of mortality after adjusting for age and mechanism of burn. The LA50 for this population was 39% TBSA. Our data reiterate that burn in Malawi is largely a pediatric disease and that the high burn mortality and relatively low LA50 have modestly improved over the past two decades. The lack of financial resources, health care personnel, and necessary infrastructure will continue to pose a significant challenge in this developing nation. Efforts to increase burn education and prevention in addition to improvement of burn care delivery are imperative. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Self-inflicted Burns: 10 year review and comparison to national guidelines.

PubMed

Caine, P L; Tan, A; Barnes, D; Dziewulski, P

2016-02-01

There is an increasing trend of self-inflicted burns noted in the literature, often seen in patients with complex psychosocial backgrounds. These patients are challenging to manage as the recovery from the acute burn may be compounded by difficult rehabilitation and suboptimal coping strategies. We aimed to review patients presenting to our burns unit with self-inflicted burns, the management strategies and examine the complexities surrounding their management. We assessed patient outcomes with a particular interest in psychosocial support given. A retrospective review of all patients presenting with self-inflicted burns over a 10 year period (2005-2014 inclusive) was conducted. Patients were identified through IBID database coded as either 'self-inflicted' or 'suicidal.' We reviewed patient and burn demographics, the clinical management, psychosocial management and patient outcomes such as wound healing, re-admission rates, and survival. We identified 118 self-inflicted burns in total. 50/118 (42%) were admitted. 64 (54%) were male and the total body surface burn area ranged from <0.5% to 99% with a median of 14%. 60/118 (51%) had TBSA <10% and 58/118 (49%) had TBSA >10%. 24 (48%) underwent admission to the Burn Intensive Care Unit (BITU). All patients admitted to BITU had TBSA >10%. Of those admitted to BITU 6 were palliative, 18 had full resuscitation and surgical management. Of those 18 patients who had active treatment, 10/18 (56%) died. Mean total length of stay was 31 days, range 1-130 days. 9% of patients sustained injuries whilst being a current inpatient at a psychiatric institution. Of all patients reviewed, 16% (n=19) had a previous history of deliberate self-harm through burns. Of those patients admitted, 98% of were reviewed by the mental health team during their admission with time to psychological review varying depending on fitness for assessment. The overall mean length of stay for all admitted patients who were actively treated but who subsequently died was 53 days. 84% of admitted patients were managed surgically. Self-inflicted burns patients would benefit from a more complex pathway of treatment as their management aims to achieve not only physical health but also psychological health. They would benefit from enhanced care to manage the acute burn but also psychiatric support to ensure patients do not re-offend. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Survival after burn in a sub-Saharan burn unit: Challenges and opportunities

PubMed Central

Tyson, Anna F.; Boschini, Laura P.; Kiser, Michelle M.; Samuel, Jonathan C.; Mjuweni, Steven N.; Cairns, Bruce A.; Charles, Anthony G.

2013-01-01

Background Burns are among the most devastating of all injuries and a major global public health crisis, particularly in sub-Saharan Africa. In developed countries, aggressive management of burns continues to lower overall mortality and increase lethal total body surface area (TBSA) at which 50% of patients die (LA50). However, lack of resources and inadequate infrastructure significantly impede such improvements in developing countries. Methods This study is a retrospective analysis of patients admitted to the burn center at Kamuzu Central Hospital in Lilongwe, Malawi between June 2011 and December 2012. We collected information including patient age, gender, date of admission, mechanism of injury, time to presentation to hospital, total body surface area (TBSA) burn, comorbidities, date and type of operative procedures, date of discharge, length of hospital stay, and survival. We then performed bivariate analysis and logistic regression to identify characteristics associated with increased mortality. Results A total of 454 patients were admitted during the study period with a median age of 4 years (range 0.5 months to 79 years). Of these patients, 53% were male. The overall mean TBSA was 18.5%, and average TBSA increased with age—17% for 0–18 year olds, 24% for 19–60 year olds, and 41% for patients over 60 years old. Scald and flame burns were the commonest mechanisms, 52% and 41% respectively, and flame burns were associated with higher mortality. Overall survival in this population was 82%; however survival reduced with increasing age categories (84% in patients 0–18 years old, 79% in patients 19–60 years old, and 36% in patients older than 60 years). TBSA remained the strongest predictor of mortality after adjusting for age and mechanism of burn. The LA50 for this population was 39% TBSA. Discussion Our data reiterate that burn in Malawi is largely a pediatric disease and that the high burn mortality and relatively low LA50 have modestly improved over the past two decades. The lack of financial resources, health care personnel, and necessary infrastructure will continue to pose a significant challenge in this developing nation. Efforts to increase burn education and prevention in addition to improvement of burn care delivery are imperative. PMID:23768710

Comparison Between Civilian Burns and Combat Burns From Operation Iraqi Freedom and Operation Enduring Freedom

PubMed Central

Wolf, Steven E.; Kauvar, David S.; Wade, Charles E.; Cancio, Leopoldo C.; Renz, Evan P.; Horvath, Edward E.; White, Christopher E.; Park, Myung S.; Wanek, Sandra; Albrecht, Michael A.; Blackbourne, Lorne H.; Barillo, David J.; Holcomb, John B.

2006-01-01

Objective: To assess outcome differences between locally burned civilians and military personnel burned in a distant combat zone treated in the same facility. Summary Background Data: The United States Army Institute of Surgical Research (USAISR) Burn Center serves as a referral center for civilians and is the sole center for significant burns in military personnel. We made the hypothesis that outcomes for military personnel burned in the current conflict in Iraq and Afghanistan would be poorer because of delays to definitive treatment, other associated injury, and distance of evacuation. Methods: We reviewed the civilian and military records of patients treated at the USAISR from the outset of hostilities in Iraq in April 2003 to May 2005. Demographics, injury data, mortality, and clinical outcomes were compared. Results: We cared for 751 patients during this time period, 273 of whom were military (36%). Military injuries occurred in a younger population (41 ± 19 vs. 26 ± 7 years for civilian and military respectively, P < 0.0001) with a longer time from injury to burn center arrival (1 ± 5 days vs. 6 ± 5, P < 0.0001), a higher Injury Severity Score (ISS 5 ± 8 vs. 9 ± 11, P < 0.0001), and a higher incidence of inhalation injury (8% vs. 13%, P = 0.024). Total burn size did not differ. Mortality was 7.1% in the civilian and 3.8% in the military group (P = 0.076). When civilians outside the age range of the military cohort were excluded, civilian mortality was 5.0%, which did not differ from the military group (P = 0.57). Total body surface area (TBSA) burned, age ≥40 years, presence of inhalation injury, and ventilator days were found to be important predictors of mortality by stepwise regression, and were used in a final predictive model with the area under receiver operator characteristic curve of 0.97 for both populations considered together. No significant effect of either group was identified during development. Conclusions: Mortality does not differ between civilians evacuated locally and military personnel injured in distant austere environments treated at the same center. PMID:16772782

Time-dependent morphological and biochemical changes following cutaneous thermal burn injury and their modulation by copper nicotinate complex: an animal model.

PubMed

Nassar, Muammar A Y; Eldien, Heba M Saad; Tawab, Hanem S Abdel; Saleem, Tahia H; Omar, Hossam M; Nassar, Ahmed Y; Hussein, Mahmoud Rezk Abdelwahed

2012-10-01

Thermal tissue injury is partly mediated by reactive oxygen metabolites. Oxygen free radicals are contributory to local tissue damage following thermal injury and accordingly an interventional therapy using antioxidants may be beneficial. Copper nicotinate complex can scavenge reactive oxygen species (i.e., has antioxidant activity). To examine time-related morphological and biochemical changes following skin thermal injury and their modulation by copper nicotinate complex. An animal model composed of 80 albino rats was established. Ten rats (nonburn group) served as a control group. Seventy rats (burn group) were anesthetized, given a 10% total body surface area, full-thickness burn. Ten rats (from the postburn group) were sacrificed after 24 h (without treatment, i.e., untreated-burn group). The remaining rats were divided into three subgroups (20 rats, each) and were treated topically either with soft paraffin, moist exposed burn ointment (MEBO, a standard therapeutic treatment for burns), or copper nicotinate complex. Five animals from each subgroup were sacrificed every week over a period of 4 weeks. The morphological and biochemical changes were evaluated and compared among the different groups. High levels of the plasma and skin nitiric oxide (marker of oxidative stress) were observed in the untreated-burn group. These levels were significantly low following the application of copper nicotinate complex. Low levels of plasma and skin superoxide dismutase (marker of oxidative stress) and plasma ceruloplasmin were observed in the untreated-burn group. These levels were significantly high following copper nicotinate complex treatment. The total and differential leukocyte counts were low following the onset of the thermal injury. They gradually returned to normal levels over a 4-week period following the application of MEBO or copper nicotinate complex. Compared to untreated-burn group, postburn-healing changes (resolution of the inflammatory reaction, reepithelization of the epidermis, angiogenesis, deposition of collagen fibers, and recovery of the subcellualr organelles) were significantly accelerated following the application of either MEBO or copper nicotinate complex. Application of copper nicotinate complex was associated with improved healing of the thermal burns of the skin. The underlying molecular changes underlying these effects await further investigations.

Comparison between civilian burns and combat burns from Operation Iraqi Freedom and Operation Enduring Freedom.

PubMed

Wolf, Steven E; Kauvar, David S; Wade, Charles E; Cancio, Leopoldo C; Renz, Evan P; Horvath, Edward E; White, Christopher E; Park, Myung S; Wanek, Sandra; Albrecht, Michael A; Blackbourne, Lorne H; Barillo, David J; Holcomb, John B

2006-06-01

To assess outcome differences between locally burned civilians and military personnel burned in a distant combat zone treated in the same facility. The United States Army Institute of Surgical Research (USAISR) Burn Center serves as a referral center for civilians and is the sole center for significant burns in military personnel. We made the hypothesis that outcomes for military personnel burned in the current conflict in Iraq and Afghanistan would be poorer because of delays to definitive treatment, other associated injury, and distance of evacuation. We reviewed the civilian and military records of patients treated at the USAISR from the outset of hostilities in Iraq in April 2003 to May 2005. Demographics, injury data, mortality, and clinical outcomes were compared. : We cared for 751 patients during this time period, 273 of whom were military (36%). Military injuries occurred in a younger population (41 +/- 19 vs. 26 +/- 7 years for civilian and military respectively, P < 0.0001) with a longer time from injury to burn center arrival (1 +/- 5 days vs. 6 +/- 5, P < 0.0001), a higher Injury Severity Score (ISS 5 +/- 8 vs. 9 +/- 11, P < 0.0001), and a higher incidence of inhalation injury (8% vs. 13%, P = 0.024). Total burn size did not differ. Mortality was 7.1% in the civilian and 3.8% in the military group (P = 0.076). When civilians outside the age range of the military cohort were excluded, civilian mortality was 5.0%, which did not differ from the military group (P = 0.57). Total body surface area (TBSA) burned, age > or =40 years, presence of inhalation injury, and ventilator days were found to be important predictors of mortality by stepwise regression, and were used in a final predictive model with the area under receiver operator characteristic curve of 0.97 for both populations considered together. No significant effect of either group was identified during development. Mortality does not differ between civilians evacuated locally and military personnel injured in distant austere environments treated at the same center.

Burn Severity Based Stream Buffers for Post Wildfire Salvage Logging Erosion

NASA Astrophysics Data System (ADS)

Bone, E. D.; Robichaud, P. R.; Brooks, E. S.; Brown, R. E.

2017-12-01

Riparian buffers may be managed for timber harvest disturbances to decrease the risk of hillslope erosion entering stream channels during runoff events. After a wildfire, burned riparian buffers may become less efficient at infiltrating runoff and reducing sedimentation, requiring wider dimensions. Testing riparian buffers under post-wildfire conditions may provide managers guidance on how to manage post-fire salvage logging operations on hillslopes and protect water quality in adjacent streams. We tested burned, unlogged hillslopes at the 2015 North Star Fire and 2016 Cayuse Mountain Fire locations in Washington, USA for their ability to reduce runoff flows and sedimentation. Our objectives were to: 1) measure the travel distances of concentrated flows using three sediment-laden flow rates, 2) measure the change in sediment concentration as each flow moves downslope, 3) test hillslopes under high burn-severity, low burn-severity and unburned conditions, and 4) conduct experiments at 0, 1 and 2 years since the fire events. Mean total flow length at the North Star Fire in year 1 was 211% greater at low burn-severity sites than unburned sites, and 467% greater at high burn-severity sites than unburned sites. Results decreased for all burned sites in year 2; by 40% at the high burn-severity sites, and by 30% at the low burn-severity sites, with no significant changes at the unburned sites. We tested only high burn-severity sites at the Cayuse Mountain Fire in year 0 and 1 where the mean total flow length between year 0 and year 1 decreased by 65%. The results of sediment concentration changes tracked closely with the magnitude of changes in flow travel lengths between treatments. Results indicate that managers may need to increase the widths of burned stream buffers during post-wildfire salvage logging for water quality protection, but stream buffer widths may decrease with less severe burn severity and increasing elapsed time (years) since fire.

A comparison of burn season effects on nesting birds in North Dakota mixed-grass prairie

USGS Publications Warehouse

Higgins, K.F.

1986-01-01

During 1982-1985, the effects of single spring and fall burn treatments on ground nesting birds and residual cover were studied on five paired areas of native mixed-grass prairie in northwestern Stutsman County, ND. Annually, visual obstruction readings to index the height-density of residual cover were taken once and nest searches were made four times on each area. Residual nesting cover on fall burn plots averaged taller and denser than on spring burn plots during post-fire growing years 2-4. A total of 259 duck nests and 63 nests of non-passerine birds were found during the four years. Duck nesting success was significantly greater (P < 0.05) in fall burn plots than in spring burn plots for all species and years combined. Too few nests of other bird species were found for valid comparisons. Results suggest that vegetation structure and duck nesting response to spring and fall burns became similar again by the third post-fire growing season.

A comparative analysis of advanced techniques for skin reconstruction with autologous keratinocyte culture in severely burned children: own experience

PubMed Central

Nessler, Michał B.; Drukala, Justyna; Bartoszewicz, Marzenna; Mądry, Ryszard

2014-01-01

Introduction The local treatment in burns larger than 50% of total body surface area is still the great challenge for surgeons. Aim This paper presents a review of different solutions for deep burn wound healing in children and the early outcomes of treatment with combined autologous cell culture technique. Material and methods For this study, 20 children aged between 4 and 12 years with 55–65% of TBSA III grade burn injury were analyzed. A skin sample, 1 cm × 1 cm in size, for keratinocyte cultivation, was taken on the day of the burn. After necrotic tissue excision, the covering of the burned area with an isolated meshed skin graft was carried out between day 4 and 7. After 7 days of keratinocyte cultivation, the mentioned areas were covered with cells from the culture. We divided the burned regions, according to the way of wound closure, into 3 groups each consisting of 15 treated regions of the body. We used meshed split thickness skin grafts (SSG group), cultured autologous keratinocytes (CAC group), and both techniques applied in one stage (SSG + CAC group). Results In the SSG group, the mean time for complete closure of wounds was 12.7 days. Wounds treated with CAC only needed a non-significantly longer time to heal – 14.2 days (p = 0.056) when compared to SSG. The shortest time to heal was observed in the group treated with SSG + CAC – 8.5 days, and it was significantly shorter when compared to the SSG and CAC groups (p < 0.001). Conclusions This study suggests that cultured keratinocytes obtained after short-time multiplication, combined with meshed autologous split thickness skin grafts, constitute the optimal wound closure in burned children. PMID:25097488

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).

Clinical outcome of patients with self-inflicted burns.

PubMed

Cornet, P A; Niemeijer, A S; Figaroa, G D; van Daalen, M A; Broersma, T W; van Baar, M E; Beerthuizen, G I J M; Nieuwenhuis, M K

2017-06-01

Patients with self-inflicted burns (SIB) are thought to have a longer length of stay compared to patients with accidental burns. However, other predictors for a longer length of stay are often not taken into account, e.g. percentage of the body surface area burned, age or comorbidities. Therefore, we wanted to study the outcome of patients with SIB at our burn center. A retrospective, observational study was conducted. All adult patients with acute burns admitted to the burn center of the Martini Hospital Groningen, between January 1, 2009 and December 31, 2013 were included. Data on characteristics of the patient, injury, and outcome (LOS, mortality, discharge destination) were collected. In patients with SIB, suicide attempts (SA) were distinguished from self-harm without the intention to die (non-suicidal self-injury, NSSI). To evaluate differences in outcome, each patient with SIB was matched on variables and total score of the Abbreviated Burn Severity Index (ABSI) to a patient with accidental burns (AB). In total 29 admissions (21 SA and 8 NSSI) were due to SIB and 528 due to accidents. Overall, when compared to AB, there were significant differences with respect to mortality and LOS for SA and/or NSSI. Mortality was higher in the SA group, while the LOS was higher in both the SA and NSSI groups compared to the AB group. However, after matching on ABSI, no statistical significant differences between the SA and SA-match or the NSSI and NSSI-match group were found. With the right and timely treatment, differences in mortality rate or length of stay in hospital could all be explained by the severity of the burn and the intention of the patient. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Stormwater contaminant loading following southern California wildfires.

PubMed

Stein, Eric D; Brown, Jeffrey S; Hogue, Terri S; Burke, Megan P; Kinoshita, Alicia

2012-11-01

Contaminant loading associated with stormwater runoff from recently burned areas is poorly understood, despite the fact that it has the potential to affect downstream water quality. The goal of the present study is to assess regional patterns of runoff and contaminant loading from wildfires in urban fringe areas of southern California. Postfire stormwater runoff was sampled from five wildfires that each burned between 115 and 658 km(2) of natural open space between 2003 and 2009. Between two and five storm events were sampled per site over the first one to two years following the fires for basic constituents, metals, nutrients, total suspended solids, and polycyclic aromatic hydrocarbons (PAHs). Results were compared to data from 16 unburned natural areas and six developed sites. Mean copper, lead, and zinc flux (kg/km(2)) were between 112- and 736-fold higher from burned catchments and total phosphorus was up to 921-fold higher compared to unburned natural areas. Polycyclic aromatic hydrocarbon flux was four times greater from burned areas than from adjacent urban areas. Ash fallout on nearby unburned watersheds also resulted in a threefold increase in metals and PAHs. Attenuation of elevated concentration and flux values appears to be driven mainly by rainfall magnitude. Contaminant loading from burned landscapes has the potential to be a substantial contribution to the total annual load to downstream areas in the first several years following fires. Copyright © 2012 SETAC.

Interactive home telehealth and burns: A pilot study.

PubMed

Hickey, Sean; Gomez, Jason; Meller, Benjamin; Schneider, Jeffery C; Cheney, Meredith; Nejad, Shamim; Schulz, John; Goverman, Jeremy

2017-09-01

The objective of this study is to review our experience incorporating Interactive Home Telehealth (IHT) visits into follow-up burn care. A retrospective review of all burn patients participating in IHT encounters over the course of 15 months was performed. Connections were established through secure video conferencing and call-routing software. Patients connected with a personal computer or tablet and providers connected with a desktop computer with a high-definition web camera. In some cases, high-definition digital images were emailed to the provider prior to the virtual consultation. For each patient, the following was collected: (1) patient and injury demographics (diagnosis, prognosis, and clinical management), (2) total number of encounters, (3) service for each encounter (burn, psychiatry, and rehabilitation), (4) length of visit, including travel distance and time saved and, (5) complications, including re-admissions and connectivity issues. 52 virtual encounters were performed with 31 patients during the first year of the pilot project from March 2015 to June 2016. Mean age of the participant was 44 years (range 18-83 years). Mean total burn surface area of the participant was 12% (range 1-80%). Average roundtrip travel distance saved was 188 miles (range 4-822 miles). Average round trip travel time saved was 201min (range 20-564min). There were no unplanned re-admissions and no complications. Five connectivity issues were reported, none of which prevented completion of the visit. Interactive Home Telehealth is a safe and feasible modality for delivering follow-up care to burn patients. Burn care providers benefit from the potential to improve outpatient clinic utilization. Patients benefit from improved access to multiple members of their specialized burn care team, as well as cost-reductions for patient travel expenses. Future studies are needed to ensure patient and provider satisfaction and to further validate the significance, cost-effectiveness and safety. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Burn injury mortality in patients with preexisting and new onset renal disease.

PubMed

Knowlin, Laquanda T; Purcell, Laura; Cairns, Bruce A; Charles, Anthony G

2018-06-01

We sought to examine the impact of preexisting and new onset renal disease on burn injury mortality. Retrospective analysis of patients admitted to a regional burn center from 2002-2012 was performed. Variables analyzed included demographics, burn mechanism, inhalation injury status, and % TBSA. Poisson regression was performed to estimate risk of in-hospital burn mortality. There were a total of 7640 patients over the study period. The adjusted 60-day risk of in-hospital mortality in patients with preexisting renal disease (PRD was 3 times higher compared to patients with no preexisting renal disease (IRR = 3.22, 95% CI = 1.26-8.25). The adjusted 60-day risk of mortality is 2 times higher for patients with new onset renal disease compared to those without (IRR = 2.11, 95% CI = 1.55-2.87). Preexisting and new onset renal disease results in a significantly higher risk of mortality following burn injury compared to patients without renal disease. Prevention of new onset renal injury and careful management of patients with preexisting renal disease to prevent exacerbation should be pursued. Copyright © 2018 Elsevier Inc. All rights reserved.

The enhanced total body wrap--the new frontier in dressing care for burns.

PubMed

Low, O-Wern; Chong, Si Jack; Tan, Bien-Keem

2013-11-01

The management of extensive burns with their associated high fluid exudate following burn excision and skin grafting has always posed a challenge in burn wound care. The ideal dressing should protect the wound from physical damage and micro-organisms; be comfortable and durable; allow high humidity at the wound; and be able to allow maximal activity for wound healing without retarding or inhibiting any stage of the process. The dressing technique described in this paper fulfils all the criteria above and at the same time provides an efficient channel to effectively clear the excessive exudate produced while keeping the wounds moist. Advantages conferred include accurate charting of wound exudate; reduced frequency of dressing changes; lower infection rates through prevention of strike-through; and securing and improving the viability of skin grafts. An enhancement to a technique previously described by us through the use of long thin strips of VAC sponges to transmit negative pressure, the enhanced Total Body Wrap aims to provide ideal conditions to promote healing in burns. Using negative pressure wound therapy (NPWT), this technique is simple and straightforward enough to be applied in majority of tertiary centres around the world. Copyright © 2013. Published by Elsevier Ltd.

Using a 3D tool to document and determine graft loss: A mini-review and case report.

PubMed

Benjamin, Nicole C; Wurzer, Paul; Voigt, Charles D; Benjamin, Debra A; Herndon, David N

2016-06-01

In severe burns, accurate determination of burn wound size and areas of debridement and graft loss is challenging. In this case report, we describe the use of 3D wound measurement software (BurnCase 3D, RISC Software GmbH, Hagenberg, Austria) in a 29-year-old patient with burns covering 92% of the total body surface area. BurnCase 3D was used to assess burn and monitor all surgical interventions. The software allowed us to calculate areas of graft loss and graft take throughout the acute hospitalization (until 90% of the wounds were covered with homografts). It also enabled preoperative planning for wound coverage and blood loss. Thus, BurnCase 3D appears to be a useful tool for accurate determination of burn wound areas and preoperative planning. However, whether the benefit of more efficient preoperative planning overcomes the disadvantage of the additional time needed to document the wound using the software needs to be evaluated further. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

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.

Two-year hospital records of burns from a referral center in Western Iran: March 2010-March 2012.

PubMed

Ahmadijouybari, Touraj; Najafi, Farid; Moradinazar, Mehdi; Karami-matin, Behzad; Karami-matin, Reza; Ataie, Maria; Hatami, Masoumeh; Purghorbani, Samira; Amee, Vahid

2014-01-01

Burns are among the most common injuries affecting a great number of people worldwide annually. In Iran, especially in its western region and in Kermanshah province, burns have a relatively high incidence. The present study was aimed at investigating epidemiological characteristics in Western Iran. Within a cross-sectional study, the data on all patients attending the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during 2010-2011 and 2011-2012 (24 months) were collected. Then, age, gender, cause of burns, total body surface area, and time of the occurrence were extracted from the hospital records. The data were analyzed using the SPSS statistical package (Version 19, for Windows). We used chi-squared test when we compared the categorical responses between two or more groups. For comparing means between two groups we used t-test. In addition, trends were investigated using linear regression. Overall 13,248 people were referred to the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during the period of study, including 328 cases of self-immolation. The mean age of the patients was 27±19 years and 29±13 years for unintentional burns and self-immolation respectively. Out of the total number of unintentional cases, 6,519 (50.5%) were men, while the corresponding percentage of men among the self-immolation cases was 16.6% (p less than 0.001). Trends in the number of cases were cyclic, with the highest and lowest number of burns cases being in March and May. Overall, hot liquids and flammable materials were the two most important causes of unintentional burns. However, flammable materials were the main cause of burns among self-immolation cases. During hospital admission, 168 (51%) self-immolation victims and 43 (0.33%) unintentional burn victims died. While major preventive measures are not adequately used in developing countries, burns and their burden can be significantly reduced by increasing public awareness and by applying simple preventive measures. © 2014 KUMS, All rights reserved.

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.

Pediatric deep burns caused by hot incense ashes during 2014 Spring Festival in Fuyang city, China.

PubMed

Wang, Jian; Zhou, Bo; Tao, Ren Qin; Chen, Xu Lin

2016-01-01

The Chinese people in Fuyang city, a northwest city of Anhui Province, are accustomed to burning incense at home for blessing during the Spring Festival. Their children, especially toddlers, like playing around the burning incense and are at risk of burning by hot incense ashes. The purpose of this study was to describe the unique cause and clinical characteristics of pediatric deep burns caused by hot incense ashes during 2014 Spring Festival. Twelve consecutive children admitted to our Burn Center and Fuyang People's Hospital during 2014 Spring Festival, with burn injuries caused by hot incense ashes which were epidemiologically studied retrospectively. Data on age, gender, size, depth and site of burn, incidence by day, number of operation, hospital stay, and causes of burns were collected. All patients came from Fuyang city. Of the 12 patients, the average age was 2.17 years, with a range of 1-6. The boy-to-girl ratio was 2: 1. The mean total burn surface area (TBSA) was 5.83%, and 91.67% of the children sustained full-thickness burn. Hands were the most common parts of the body to be injured. Dry necrosis developed in 14 fingers of 3 patients. January 31, 2014, the first day of the Chinese New Year, was the time of highest incidence. Six patients (50%) required surgical intervention while the number of operations including escharectomy, excision, skin grafting, or amputation of necrotic fingers, per patient was 2. A total of 14 fingers were amputated of the necrotic parts. All children survived and mean length of hospital stay of the patients was 20 days. Hot incense ashes cause serious injuries to children in Fuyang city during the Spring Festival. Preventive programs should be directed towards high risk groups to reduce the incidence of this burn.

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.

Effects of normal acceleration on transient burning rate augmentation of an aluminized solid propellant

NASA Technical Reports Server (NTRS)

Northam, G. B.

1972-01-01

Instantaneous burning rate data for a polybutadiene acrylic acid propellant, containing 16 weight percent aluminum, were calculated from the pressure histories of a test motor with 96.77 sq cm of burning area and a 5.08-cm-thick propellant web. Additional acceleration tests were conducted with reduced propellant web thicknesses of 3.81, 2.54, and 1.27 cm. The metallic residue collected from the various web thickness tests was characterized by weight and shape and correlated with the instantaneous burning rate measurements. Rapid depressurization extinction tests were conducted in order that surface pitting characteristics due to localized increased burning rate could be correlated with the residue analysis and the instantaneous burning rate data. The acceleration-induced burning rate augmentation was strongly dependent on propellant distance burned, or burning time, and thus was transient in nature. The results from the extinction tests and the residue analyses indicate that the transient rate augmentation was highly dependent on local enhancement of the combustion zone heat feedback to the surface by the growth of molten residue particles on or just above the burning surface. The size, shape, and number density of molten residue particles, rather than the total residue weight, determined the acceleration-induced burning rate augmentation.

[Bibliometric analysis of scientific articles on epidemiological study of burns in China].

PubMed

Cheng, W F; Shen, Z A; Zhao, D X; Li, D W; Shang, Y R

2017-04-20

Objective: To analyze the current status of epidemiological study of burns in China, and to explore the related strategies. Methods: Retrospective or cross-sectional scientific articles in Chinese or English on epidemiological study of burns in China published from January 2005 to December 2015 were systemically retrieved from 4 databases. The databases include PubMed, Embase, China Biology Medicine disc, and Chinese Journals Full - text Database . From the results retrieved, data with regard to publication year, journal distribution, number of institutions participated in the study, affiliation of the first author and its location, and admission time span and age of patients in all the scientific articles were collected. Furthermore, the definition of age range and the grouping method of age of pediatric patients in English articles on epidemiological study of pediatric burns of China were recorded. Data were processed with descriptive statistical analysis. Results: A total of 256 scientific articles conforming to the study criteria were retrieved, among which 214 (83.59%) articles were in Chinese, and 42 (16.41%) articles were in English; 242 (94.53%) articles were retrospective studies, and 14 (5.47%) articles were cross-sectional studies. During the 11 years, the number of the relevant articles was fluctuant on the whole. The scientific articles were published in 130 journals, with 42 English articles in source journals for SCIENCE CITATION INDEX EXPANDED - JOURNAL LIST, accounting for 16.41%, and 116 Chinese articles in Source Journal for Chinese Scientific and Technical Papers, accounting for 45.31%. Totally 215 (83.98%) articles were single-center studies, and 29 (11.33%) articles were multicenter studies which were conducted by three or more centers. The number of affiliations of the first author of articles was 161 in total. The top 10 institutions regarding the article publishing number published 58 articles, accounting for 22.66%. Scientific articles on epidemiological study of burns were retrieved with location of affiliation of the first author in 31 provinces, autonomous regions, and municipalities directly under the Central Government in Mainland China, and also in Taiwan Province and Hong Kong Special Administrative Region, among which Shanghai ranked first with 24 (9.38%) articles published. The admission time span of patients in the articles ranged from 3 months to 47 years, with 120 (46.87%) articles from 3 months to 5 years, 79 (30.86%) articles from 6 to 10 years, and 57 (22.27%) articles more than 10 years, respectively. Regarding the age of patients in the study, 123 articles were on epidemiological study of pediatric burns, and 16 articles on epidemiological study of elderly burns, accounting for 48.05% and 6.25%, respectively. Further analysis of articles on epidemiological study of pediatric burns in English showed that there was no standard definition of age range or unified grouping method of age for pediatric burn patients. Conclusions: The epidemiological study of burns in China has been carried out nationwide, but the number of institutions conducted relevant study is not that much, and multicenter epidemiological studies remain scanty. The quality of the articles needs to be further improved. The epidemiological study of elderly burns is relatively deficient and calls for more attention. The epidemiological study of burns in China lacks regularity or continuity in time scope. There is an urgent need for the guideline on classification method for items of epidemiological study of burns in China so as to standardize the related research.

Evaluation of white blood cell count, neutrophil percentage, and elevated temperature as predictors of bloodstream infection in burn patients.

PubMed

Murray, Clinton K; Hoffmaster, Roselle M; Schmit, David R; Hospenthal, Duane R; Ward, John A; Cancio, Leopoldo C; Wolf, Steven E

2007-07-01

To investigate whether specific values of or changes in temperature, white blood cell count, or neutrophil percentage were predictive of bloodstream infection in burn patients. Retrospective review of electronic records. Intensive care center at the US Army Institute of Surgical Research Burn Center. Burn patients with blood cultures obtained from 2001 to 2004. Temperature recorded at the time blood cultures were obtained; highest temperature in each 6-hour interval during the 24 hours prior to this; white blood cell count and neutrophil percentage at the time of obtaining the blood culture and during the 24 hours preceding the blood culture; demographic data; and total body surface area burned. A total of 1063 blood cultures were obtained from 223 patients. Seventy-three people had 140 blood cultures from which microorganisms were recovered. Organisms that were recovered from blood cultures included 80 that were gram negative, 54 that were gram positive, 3 that were mixed gram positive/gram negative, and 3 yeasts. Although white blood cell count and neutrophil percentage at the time of the culture were statistically different between patients with and patients without bloodstream infection, receiver operating characteristic curve analysis revealed these values to be poor discriminators (receiver operating characteristic curve area = 0.624). Temperature or alterations in temperature in the preceding 24-hour period did not predict presence, absence, or type of bloodstream infection. Temperature, white blood cell count, neutrophil percentage, or changes in these values were not clinically reliable in predicting bloodstream infection. Further work is needed to identify alternative clinical parameters, which should prompt blood culture evaluations in this population.

Wintertime aerosol chemical composition and source apportionment of the organic fraction across Ireland

NASA Astrophysics Data System (ADS)

Ovadnevaite, J.; Lin, C.; Ceburnis, D.; Huang, R. J. J.; O'Dowd, C. D. D.

2017-12-01

A national wide characterization of PM1 was studied for the first time using a high-time resolution Aerosol Chemical Speciation Monitor (ACSM) and Aethalometer in Ireland during the heating season. Dublin, the capital of Ireland, is the most polluted area with an average PM1 of 7.6 μg/m3, with frequent occurrence of peak concentration over 200 μg/m3 primarily due to solid fuels burning, while Mace Head, in the west coast, is least polluted with an average PM1 of 0.8 μg/m3 due to the distance from the emission sources. The organic aerosol is the most dominant species across Ireland, contributing 65%, 58%, 32%, 33% to total PM1 mass in Dublin, Birr, Carnsore Point, and Mace Head, respectively. Birr, a small town in the midland of Ireland, has comparable PM1 levels (4.8 μg/m3) and similar chemical compositions with that in Dublin. Carnsore Point, on the southeast coast, has similar composition with that at Mace Head, but nearly 3 times the levels of PM1 mass due to its relative closeness to other European countries. Positive matrix factorization (PMF) with the multi-linear engine (ME-2) was performed on the organic matrix to quantify the contribution of factor candidates. Peat burning was found to be the dominant factor across Ireland, contributing more than 40% of the total organic mass in Dublin and Birr while OOA is dominant at rural Carnsore Point and Mace Head. Possible geographic origins of PM1 species and organic factors using polar plots were explored. The findings of solid fuels burning (primarily peat burning) driving the pollution episodes suggest an elimination or controlled emission of solid fuels burning would reduce PM1 by at least 50%.

[Clinical and biological monitoring of nutritional status in severe burns].

PubMed

Bargues, L; Cottez-Gacia, S; Jault, P; Renard, C; Vest, P

2009-01-01

Burn patients are subject to hypermetabolism and catabolic states. Aim was to evaluate our current practice in nutrition. Twenty-one severely burned patients were prospectively included during three months period. Body weight was measured at least two times in a week during all stay in burn ICU. Biological markers of inflammation (C-reactive protein, CRP) and nutrition (prealbumin) were performed weekly. Protocol included early nasogastric feeding, tolerated gastric stasis less than 250 mL at four hours nasogastric aspirations, caloric target value of 40 Kcal/kg per day and measurement of total daily calorie intakes. Patient demographics showed a mean percent total body surface burn of 51.1+/-27 % (range 20-90), age of 38.7+/-13.1 years (range 18-67) and 57.3 % of smoke inhalation. All patients were ventilated and 19 patients survived. Length of stay was 75.7+/-47 days (range 22-184). Patients received only 58.9+/-10 % of calorie intakes recommended by French burn society. Loss of body mass was 15.2+/-9 kg (range 3-31) or 19.1+/-10 % of admission weight (range 5-37). Erosion of body mass was not correlated with burned surface (p=0.08), calorie intakes (p=0.26), smoke inhalation (p=0.46), lengths of stay (p=0.53), lengths of ventilation (p=0.08) or nutrition (p=0.12), days of antibiotic (p=0.72), number of dressing changes (p=0.6) or surgery (p=0.64). Biological parameters showed CRP decreasing and prealbumin improving values. New strategies of nutrition are necessary to improve outcome and reduce body mass loss in burns.

Global biomass burning - Atmospheric, climatic, and biospheric implications

NASA Technical Reports Server (NTRS)

Levine, Joel S.

1991-01-01

On a global scale, the total biomass consumed by annual burning is about 8680 million tons of dry material; the estimated total biomass consumed by the burning of savanna grasslands, at 3690 million tons/year, exceeds all other biomass burning (BMB) components. These components encompass agricultural wastes burning, forest burning, and fuel wood burning. BMB is not restricted to the tropics, and is largely anthropogenic. Satellite measurements indicate significantly increased tropospheric concentrations of CO and ozone associated with BMB. BMB significantly enhances the microbial production and emission of NO(x) from soils, and of methane from wetlands.

Effect of blood transfusion on outcome after major burn injury: a multicenter study.

PubMed

Palmieri, Tina L; Caruso, Daniel M; Foster, Kevin N; Cairns, Bruce A; Peck, Michael D; Gamelli, Richard L; Mozingo, David W; Kagan, Richard J; Wahl, Wendy; Kemalyan, Nathan A; Fish, Joel S; Gomez, Manuel; Sheridan, Robert L; Faucher, Lee D; Latenser, Barbara A; Gibran, Nicole S; Klein, Robert L; Solem, Lynn D; Saffle, Jeffrey R; Morris, Stephen E; Jeng, James C; Voigt, David; Howard, Pamela A; Molitor, Fred; Greenhalgh, David G

2006-06-01

To delineate blood transfusion practices and outcomes in patients with major burn injury. Patients with major burn injury frequently require multiple blood transfusions; however, the effect of blood transfusion after major burn injury has had limited study. Multicenter retrospective cohort analysis. Regional burn centers throughout the United States and Canada. Patients admitted to a participating burn center from January 1 through December 31, 2002, with acute burn injuries of >or=20% total body surface area. Outcome measurements included mortality, number of infections, length of stay, units of blood transfused in and out of the operating room, number of operations, and anticoagulant use. A total of 21 burn centers contributed data on 666 patients; 79% of patients survived and received a mean of 14 units of packed red blood cells during their hospitalization. Mortality was related to patient age, total body surface area burn, inhalation injury, number of units of blood transfused outside the operating room, and total number of transfusions. The number of infections per patient increased with each unit of blood transfused (odds ratio, 1.13; p<.001). Patients on anticoagulation during hospitalization received more blood than patients not on anticoagulation (16.3+/-1.5 vs. 12.3+/-1.5, p<.001). The number of transfusions received was associated with mortality and infectious episodes in patients with major burns even after factoring for indices of burn severity. The utilization of blood products in the treatment of major burn injury should be reserved for patients with a demonstrated physiologic need.

Influence of biomass burning from South Asia at a high-altitude mountain receptor site in China

NASA Astrophysics Data System (ADS)

Zheng, Jing; Hu, Min; Du, Zhuofei; Shang, Dongjie; Gong, Zhaoheng; Qin, Yanhong; Fang, Jingyao; Gu, Fangting; Li, Mengren; Peng, Jianfei; Li, Jie; Zhang, Yuqia; Huang, Xiaofeng; He, Lingyan; Wu, Yusheng; Guo, Song

2017-06-01

Highly time-resolved in situ measurements of airborne particles were conducted at Mt. Yulong (3410 m above sea level) on the southeastern edge of the Tibetan Plateau in China from 22 March to 14 April 2015. The detailed chemical composition was measured by a high-resolution time-of-flight aerosol mass spectrometer together with other online instruments. The average mass concentration of the submicron particles (PM1) was 5.7 ± 5.4 µg m-3 during the field campaign, ranging from 0.1 up to 33.3 µg m-3. Organic aerosol (OA) was the dominant component in PM1, with a fraction of 68 %. Three OA factors, i.e., biomass burning organic aerosol (BBOA), biomass-burning-influenced oxygenated organic aerosol (OOA-BB) and oxygenated organic aerosol (OOA), were resolved using positive matrix factorization analysis. The two oxygenated OA factors accounted for 87 % of the total OA mass. Three biomass burning events were identified by examining the enhancement of black carbon concentrations and the f60 (the ratio of the signal at m/z 60 from the mass spectrum to the total signal of OA). Back trajectories of air masses and satellite fire map data were integrated to identify the biomass burning locations and pollutant transport. The western air masses from South Asia with active biomass burning activities transported large amounts of air pollutants, resulting in elevated organic concentrations up to 4-fold higher than those of the background conditions. This study at Mt. Yulong characterizes the tropospheric background aerosols of the Tibetan Plateau during pre-monsoon season and provides clear evidence that the southeastern edge of the Tibetan Plateau was affected by the transport of anthropogenic aerosols from South Asia.

Minimum deltaV Burn Planning for the International Space Station Using a Hybrid Optimization Technique, Level 1

NASA Technical Reports Server (NTRS)

Brown, Aaron J.

2015-01-01

The International Space Station's (ISS) trajectory is coordinated and executed by the Trajectory Operations and Planning (TOPO) group at NASA's Johnson Space Center. TOPO group personnel routinely generate look-ahead trajectories for the ISS that incorporate translation burns needed to maintain its orbit over the next three to twelve months. The burns are modeled as in-plane, horizontal burns, and must meet operational trajectory constraints imposed by both NASA and the Russian Space Agency. In generating these trajectories, TOPO personnel must determine the number of burns to model, each burn's Time of Ignition (TIG), and magnitude (i.e. deltaV) that meet these constraints. The current process for targeting these burns is manually intensive, and does not take advantage of more modern techniques that can reduce the workload needed to find feasible burn solutions, i.e. solutions that simply meet the constraints, or provide optimal burn solutions that minimize the total DeltaV while simultaneously meeting the constraints. A two-level, hybrid optimization technique is proposed to find both feasible and globally optimal burn solutions for ISS trajectory planning. For optimal solutions, the technique breaks the optimization problem into two distinct sub-problems, one for choosing the optimal number of burns and each burn's optimal TIG, and the other for computing the minimum total deltaV burn solution that satisfies the trajectory constraints. Each of the two aforementioned levels uses a different optimization algorithm to solve one of the sub-problems, giving rise to a hybrid technique. Level 2, or the outer level, uses a genetic algorithm to select the number of burns and each burn's TIG. Level 1, or the inner level, uses the burn TIGs from Level 2 in a sequential quadratic programming (SQP) algorithm to compute a minimum total deltaV burn solution subject to the trajectory constraints. The total deltaV from Level 1 is then used as a fitness function by the genetic algorithm in Level 2 to select the number of burns and their TIGs for the next generation. In this manner, the two levels solve their respective sub-problems separately but collaboratively until a burn solution is found that globally minimizes the deltaV across the entire trajectory. Feasible solutions can also be found by simply using the SQP algorithm in Level 1 with a zero cost function. This paper discusses the formulation of the Level 1 sub-problem and the development of a prototype software tool to solve it. The Level 2 sub-problem will be discussed in a future work. Following the Level 1 formulation and solution, several look-ahead trajectory examples for the ISS are explored. In each case, the burn targeting results using the current process are compared against a feasible solution found using Level 1 in the proposed technique. Level 1 is then used to find a minimum deltaV solution given the fixed number of burns and burn TIGs. The optimal solution is compared with the previously found feasible solution to determine the deltaV (and therefore propellant) savings. The proposed technique seeks to both improve the current process for targeting ISS burns, and to add the capability to optimize ISS burns in a novel fashion. The optimal solutions found using this technique can potentially save hundreds of kilograms of propellant over the course of the ISS mission compared to feasible solutions alone. While the software tool being developed to implement this technique is specific to ISS, the concept is extensible to other long-duration, central-body orbiting missions that must perform orbit maintenance burns to meet operational trajectory constraints.

Childhood burns in Sulaimaniyah province, Iraqi Kurdistan: a prospective study of admissions and outpatients.

PubMed

Othman, Nasih; Kendrick, Denise; Al-Windi, Ahmad

2015-03-01

While it is globally observed that young children are at a higher risk of burn injuries, little is known about childhood burns in Iraqi Kurdistan. This study was undertaken to describe the epidemiology of burns amongst pre-school children in this region. A prospective study was undertaken from November 2007 to November 2008 involving all children aged 0-5 years attending the burns centre in Sulaimaniyah province for a new burn injury whether treated as an outpatient or admitted to hospital. 1,122 children attended the burns centre of whom 944 (84%) were interviewed (male 53%, female 47%). Mean age was 1.9 years with children aged 1 year comprising 32% and those aged 2 years comprising 21% of the sample. The incidence of burns was 1044/100,000 person-years (1030 in females and 1057 in males). Mechanisms of injury included scalds (80%), contact burns (12%) flames (6%) and other mechanisms (2%). Almost 97% of burns occurred at home including 43% in the kitchen. Winter was the commonest season (36%) followed by autumn (24%). There were 3 peak times of injury during the day corresponding to meal times. The majority of burns were caused by hot water (44%) and tea (20%) and the most common equipment/products responsible were tea utensils (41%). There were 237 admissions with an admission rate of 95 per 100,000 person-years. Scald injuries accounted for most admissions (84%). Median total body surface area affected by the burn or scald (TBSA) was 11% and median hospital stay was 7 days. In-hospital mortality was 8%. Mortality rate was 4% when TBSA was ≤25%, and 100% when TBSA was over 50%. Burn incidence is high in young children especially those aged 1-2 years. Preventive interventions targeted at families with young children & focusing on home safety measures could be effective in reducing childhood burns. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Relationships between fire danger and the daily number and daily growth of active incidents burning in the northern Rocky Mountains, USA

Treesearch

Patrick H. Freeborn; Mark A. Cochrane; W. Matt Jolly

2015-01-01

Daily National Fire Danger Rating System (NFDRS) indices are typically associated with the number and final size of newly discovered fires, or averaged over time and associated with the likelihood and total burned area of large fires. Herein we used a decade (2003-12) of NFDRS indices and US Forest Service (USFS) fire reports to examine daily relationships between fire...

Recent changes in the fire regime across the North American boreal region-Spatial and temporal patterns of burning across Canada and Alaska

NASA Astrophysics Data System (ADS)

Kasischke, Eric S.; Turetsky, Merritt R.

2006-05-01

We used historic records from 1959-99 to explore fire regime characteristics at ecozone scales across the entire North American boreal region (NABR). Shifts in the NABR fire regime between the 1960s/70s and the 1980s/90s were characterized by a doubling of annual burned area and more than a doubling of the frequency of larger fire years because of more large fire events (>1,000 km2). The proportion of total burned area from human-ignited fires decreased over this same time period, while the proportion of burning during the early and late- growing-seasons increased. Trends in increased burned area were consistent across the NABR ecozones, though the western ecozones experienced greater increases in larger fire years compared to the eastern ecozones. Seasonal patterns of burning differed among ecozones. Along with the climate warming, changes in the fire regime characteristics may be an important driver of future ecosystem processes in the NABR.

Deep sole burns in several participants in a traditional festival of the firewalking ceremony in Kee-lung, Taiwan--clinical experiences and prevention strategies.

PubMed

Chang, Shun-Cheng; Hsu, Chih-Kang; Tzeng, Yuan-Sheng; Teng, Shou-Cheng; Fu, Ju-Peng; Dai, Niann-Tzyy; Chen, Shyi-Gen; Chen, Tim-Mo; Feng, Chun-Che

2012-11-01

Firewalking is a common Taoist cleansing ceremony in Taiwan, but burns associated with the practice have rarely been reported. We analyzed the patients with plantar burns from one firewalking ceremony. In one firewalking ceremony, 12 Taoist disciples suffered from contact burns to the soles of their feet while walking over burning coals. Eight of them had at least second-degree burns over areas larger than 1% of their total body surface areas (TBSAs). The age, sex, medical history, date of injury, time taken to traverse the fire pit, depth and TBSA of the burns, treatment, length of stay, and outcome were recorded and analyzed. Deep, disseminated second- to third-degree burns were noted and healing took as long as three weeks in some patients. Because disseminated hypertrophic scars form after burns, the soles involved regain much of their tensile strength while walking. The patients experienced only a few difficulties in their daily lives three months after injury. From our experience treating patients with deep disseminated second- to third-degree plantar burns caused by firewalking, we conclude that they should be treated conservatively, with secondary healing rather than a skin graft. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

Impaired zinc and copper status in children with burn injuries: need to reassess nutritional requirements.

PubMed

Voruganti, V Saroja; Klein, Gordon L; Lu, Hong-Xing; Thomas, Suchmor; Freeland-Graves, Jeanne H; Herndon, David N

2005-09-01

Major burns are associated with impaired Zn and Cu status. These micronutrients are essential for bone matrix formation, linear growth, and wound healing. This study evaluated the status of Zn and Cu in burned children and assessed adequacy of supplementation. Six children, mean total body surface area (TBSA), 54+/-9% (S.D.), were recruited. Nutrient intakes, plasma, wound exudate, and 24h urine samples were collected and analyzed for Zn and Cu. Bone mineral content was assessed by dual energy X-ray absorptiometry. Dietary Zn and Cu were three times the dietary reference, and mean plasma concentrations of Zn and Cu were low at admission and discharge. Urinary Zn was elevated at admission, whereas Cu was elevated at both times. Wound Zn and Cu concentrations exceeded plasma concentrations, suggesting that inflammatory wound exudate was a primary route of loss. We demonstrate that burn injury in children results in low plasma levels of Zn and Cu that are inadequately compensated during hospitalization.

Cultured autologous keratinocytes in the treatment of large and deep burns: a retrospective study over 15 years.

PubMed

Auxenfans, Celine; Menet, Veronique; Catherine, Zulma; Shipkov, Hristo; Lacroix, Pierre; Bertin-Maghit, Marc; Damour, Odile; Braye, Fabienne

2015-02-01

The aim was to review the use and indications of cultured autologous epidermis (CAE) in extensive burns and to evaluate the efficiency of our strategy of burn treatment. This retrospective study comprised 15 years (1997-2012). all patients who received CAE. patients who died before complete healing and patients who received exclusively cultured allogeneic keratinocytes. Evaluation criteria were clinical. Time and success of wound healing after CAE graft were evaluated. A total of 63 patients were included with severity Baux score of 107 (from 70 to 140) and mean percentage of TBSA of 71% (from 40% to 97%). The CAE were used as Cuono method, in STSG donor sites and deep 2nd degree burns and in combination with large-meshed STSG (1:6-1:12) in extensively burned patients. Cuono method was used in 6 patients. The final take was 16% (0-30) because of the great fragility of the obtained epidermis. Nine patients with deep 2nd degree burns (mean TBSA 81%, from 60 to 97%) were successfully treated with only CAE without skin grafting. Combined technique (STSG meshed at 1:6-1:12 covered with CAE) was used in 27 patients (mean TBSA 69%, from 49% to 96%) with 85% success rate. Finally, donor sites treated with CAE in 49 patients could be harvested several times thanks to rapid epithelialization (time of wound healing was 7 days (from 5 to 10 days)). The CAE allow rapid healing of STSG donor sites and deep 2nd second degree burns in extensively burned patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Measuring the impact of a burns school reintegration programme on the time taken to return to school: A multi-disciplinary team intervention for children returning to school after a significant burn injury.

PubMed

Arshad, Sira N; Gaskell, Sarah L; Baker, Charlotte; Ellis, Nicola; Potts, Jennie; Coucill, Theresa; Ryan, Lynn; Smith, Jan; Nixon, Anna; Greaves, Kate; Monk, Rebecca; Shelmerdine, Teresa; Leach, Alison; Shah, Mamta

2015-06-01

Returning to school can be a major step for burn-injured children, their family, and staff and pupils at the receiving school. Previous literature has recognised the difficulties children may face after a significant injury and factors that may influence a successful reintegration. A regional paediatric burns service recognised that some patients were experiencing difficulties in returning to school. A baseline audit confirmed this and suggested factors that hindered or facilitated this process, initiating the development of a school reintegration programme (SRP). Since the programme's development in 2009, it has been audited annually. The aim of this paper was to evaluate the impact of the SRP by presenting data from the 2009 to 2011 audits. For the baseline audit, the burn care team gathered information from clinical records (age, gender, total body surface area burned (TBSA), skin grafting and length of stay) and telephone interviews with parents and teachers of the school returners. For the re-audits, the same information was gathered from clinical records and feedback questionnaires. Since its introduction, the mean length of time from discharge to return to school has dropped annually for those that opted into the programme, when compared to the baseline by 62.3% (53 days to 20 days). Thematic analysis highlights positive responses to the programme from all involved. Increased awareness and feeling supported were amongst the main themes to emerge. Returning to school after a significant burn injury can be challenging for all involved, but we hypothesise that outreach interventions in schools by burns services can have a positive impact on the time it takes children to successfully reintegrate. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Near-death experiences, posttraumatic growth, and life satisfaction among burn survivors.

PubMed

Royse, David; Badger, Karen

2017-03-01

Survivors of large burns may face positive and negative psychological after-effects from close-to-death injuries. This study is the first to examine their near-death experiences (NDEs) and posttraumatic growth (PTG) and life satisfaction afterwards. With an available sample of 92 burn survivors, half met the criteria for an NDE using an objective scale. Those who indicated religion was a source of strength and comfort had high scores on life satisfaction, PTG, and the NDE Scale. Individuals with larger burns reported greater PTG than those with smaller total body surface area burned (TBSA). There were no significant differences on life satisfaction, PTG, or NDEs when examined by gender or years since the burn injury. Elements of the NDE most frequently reported were: An altered sense of time, a sense of being out of the physical body, a feeling of peace, vivid sensations, and sense of being in an "other worldly" environment. Social workers and other health providers need to be comfortable helping burn survivors discuss any NDEs and process these through survivors' spirituality and religious belief systems as they recover.

Characterization of phenolic compounds in Pinus laricio needles and their responses to prescribed burnings.

PubMed

Cannac, Magali; Pasqualini, Vanina; Greff, Stéphane; Fernandez, Catherine; Ferrat, Lila

2007-07-30

Fire is a dominant ecological factor in Mediterranean-type ecosystems. Management strategies include prescribed (controlled) burning, which has been used in the management of several species, such as Pinus nigra ssp laricio var. Corsicana, a pine endemic to Corsica of great ecological and economic importance. The effects of prescribed burning on Pinus laricio have been little studied. The first aim of this study was to characterize total and simple phenolic compounds in Pinus laricio. The second aim was to understand: i) the short term (one to three months) and medium term (three years) effects of prescribed burning, and ii) the effects of periodic prescribed burning on the production of phenolic compounds in Pinus laricio. The first result of this study is the presence of total and simple phenolic compounds in the needles of Pinus laricio. 3-Vanillyl propanol is the major compound. After a prescribed burning, the synthesis of total phenolic compounds increases in Pinus laricio for a period of three months. Total phenolic compounds could be used as bioindicators for the short-term response of Pinus laricio needles to prescribed burning. Simple phenolic compounds do not seem to be good indicators of the impact of prescribed burning because prescribed burnings are low in intensity.

Biomass burning losses of carbon estimated from ecosystem modeling and satellite data analysis for the Brazilian Amazon region

NASA Astrophysics Data System (ADS)

Potter, Christopher; Brooks Genovese, Vanessa; Klooster, Steven; Bobo, Matthew; Torregrosa, Alicia

To produce a new daily record of gross carbon emissions from biomass burning events and post-burning decomposition fluxes in the states of the Brazilian Legal Amazon (Instituto Brasileiro de Geografia e Estatistica (IBGE), 1991. Anuario Estatistico do Brasil, Vol. 51. Rio de Janeiro, Brazil pp. 1-1024). We have used vegetation greenness estimates from satellite images as inputs to a terrestrial ecosystem production model. This carbon allocation model generates new estimates of regional aboveground vegetation biomass at 8-km resolution. The modeled biomass product is then combined for the first time with fire pixel counts from the advanced very high-resolution radiometer (AVHRR) to overlay regional burning activities in the Amazon. Results from our analysis indicate that carbon emission estimates from annual region-wide sources of deforestation and biomass burning in the early 1990s are apparently three to five times higher than reported in previous studies for the Brazilian Legal Amazon (Houghton et al., 2000. Nature 403, 301-304; Fearnside, 1997. Climatic Change 35, 321-360), i.e., studies which implied that the Legal Amazon region tends toward a net-zero annual source of terrestrial carbon. In contrast, our analysis implies that the total source fluxes over the entire Legal Amazon region range from 0.2 to 1.2 Pg C yr -1, depending strongly on annual rainfall patterns. The reasons for our higher burning emission estimates are (1) use of combustion fractions typically measured during Amazon forest burning events for computing carbon losses, (2) more detailed geographic distribution of vegetation biomass and daily fire activity for the region, and (3) inclusion of fire effects in extensive areas of the Legal Amazon covered by open woodland, secondary forests, savanna, and pasture vegetation. The total area of rainforest estimated annually to be deforested did not differ substantially among the previous analyses cited and our own.

A 10 year epidemiological study of paediatric burns at the Welsh Centre for burns and plastic surgery.

PubMed

Sanyaolu, Leigh; Javed, Muhammad Umair; Eales, Micheal; Hemington-Gorse, Sarah

2017-05-01

Paediatric burns make up a significant proportion of burn injured patients seen within the hospital setting and worldwide account for a significant proportion of unintentional deaths. Currently there is limited data on severe paediatric burns requiring intensive care support. Our study aimed primarily to describe the epidemiology of severe burns admitted to the intensive care unit at our centre receiving fluid resuscitation over a 10 year period. A secondary aim was to describe the referrals patterns in general over the same time period. A retrospective analysis was performed for paediatric patients referred to our centre receiving fluid resuscitation and intensive care support from 2003 to 2013. We also analysed the patterns of referrals, admissions and need for surgical intervention over the same time period retrospectively. Children less than 5 years old made up 65% of admissions to intensive care and scald injuries (56%) were the commonest aetiology. Both total length of stay (25 days in 2003 to 10 days in 2013) and intensive care length of stay (7.2 days in 2003 to 3 days in 2013) decreased during the study and less patients underwent operative intervention. Referrals to our centre increased from 261 in 2003 to 366 in 2013, however admission rates declined from 145 to 85 during that time period. Currently there is limited data on severe burns within the paediatric population. Our study provides epidemiological data in this area, an important step for developing future prevention strategies. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Prediction of Maximal Aerobic Capacity in Severely Burned Children

PubMed Central

Porro, Laura; Rivero, Haidy G.; Gonzalez, Dante; Tan, Alai; Herndon, David N.; Suman, Oscar E.

2011-01-01

Introduction Maximal oxygen uptake (VO2 peak) is an indicator of cardiorespiratory fitness, but requires expensive equipment and a relatively high technical skill level. Purpose The aim of this study is to provide a formula for estimating VO2 peak in burned children, using information obtained without expensive equipment. Methods Children, with ≥40% total surface area burned (TBSA), underwent a modified Bruce treadmill test to asses VO2 peak at 6 months after injury. We recorded gender, age, %TBSA, %3rd degree burn, height, weight, treadmill time, maximal speed, maximal grade, and peak heart rate, and applied McHenry’s select algorithm to extract important independent variables and Robust multiple regression to establish prediction equations. Results 42 children; 7 to 17 years old were tested. Robust multiple regression model provided the equation: VO2=10.33 – 0.62 *Age (years) + 1.88 * Treadmill Time (min) + 2.3 (gender; Females = 0, Males = 1). The correlation between measured and estimated VO2 peak was R=0.80. We then validated the equation with a group of 33 burned children, which yielded a correlation between measured and estimated VO2 peak of R=0.79. Conclusions Using only a treadmill and easily gathered information, VO2 peak can be estimated in children with burns. PMID:21316155

An epidemiological analysis of paediatric burns in urban and rural areas in south central China.

PubMed

Zhou, Bo; Zhou, Xiao; Ouyang, Li-zhi; Huang, Xiao-yuan; Zhang, Pi-hong; Zhang, Ming-hua; Ren, Li-cheng; Liang, Peng-fei

2014-02-01

This study aims to analyse the epidemiology of paediatric burns in south central China, illustrate the differences between rural and urban areas, and discern prevention measures to reduce paediatric burns. Data were obtained from all paediatric patients admitted to Department of Burns unit of Xiangya Hospital during 2009-2012. A retrospective review was performed, including cause of burn, pre-hospital treatment, place of burn occurrence, anatomical areas involved, extent of burn, date of injury, number of operations, complications, length of hospital stay, hospitalisation cost and cure rate. A total of 278 hospitalised paediatric patients were admitted in this study. The majority (56.47%) were 1-3 years old. Rural patients accounted for 67.99% in total; the ratio of boys to girls was 2.05. Scalding with hot fluids was the most common cause of burns in children (62.59%), followed by flame (17.63), fireworks (9.71%), electricity (5.76%) and other factors such as contact and chemical (4.32%). The living room was the location with the highest frequency of burns in children (53.24%). Burns were more likely to happen in winter and the upper extremities were the most involved anatomic site (53.24%). Total burn surface area (TBSA) ranging from 0% to 9% accounted for 55.4% in total. Rural patients underwent more operations and had longer and costlier hospital stays than urban patients. Compared with treatment in urban areas, rural burn patients received less first-aid treatment, underwent more surgery, had more complications and longer and more costly hospital stays. This finding strongly suggests that it is necessary to make more efforts to prevent burns, especially in rural areas. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Three Orbital Burns to Molniya Orbit Via Shuttle_Centaur G Upper Stage

NASA Technical Reports Server (NTRS)

Williams, Craig H.

2015-01-01

An unclassified analytical trajectory design, performance, and mission study was done for the 1982 to 1986 joint National Aeronautics and Space Administration (NASA)-United States Air Force (USAF) Shuttle/Centaur G upper stage development program to send performance-demanding payloads to high orbits such as Molniya using an unconventional orbit transfer. This optimized three orbital burn transfer to Molniya orbit was compared to the then-baselined two burn transfer. The results of the three dimensional trajectory optimization performed include powered phase steering data and coast phase orbital element data. Time derivatives of the orbital elements as functions of thrust components were evaluated and used to explain the optimization's solution. Vehicle performance as a function of parking orbit inclination was given. Performance and orbital element data was provided for launch windows as functions of launch time. Ground track data was given for all burns and coasts including variation within the launch window. It was found that a Centaur with fully loaded propellant tanks could be flown from a 37 deg inclination low Earth parking orbit and achieve Molniya orbit with comparable performance to the baselined transfer which started from a 57 deg inclined orbit: 9,545 versus 9,552 lb of separated spacecraft weight, respectively. There was a significant reduction in the need for propellant launch time reserve for a 1 hr window: only 78 lb for the three burn transfer versus 320 lb for the two burn transfer. Conversely, this also meant that longer launch windows over more orbital revolutions could be done for the same amount of propellant reserve. There was no practical difference in ground tracking station or airborne assets needed to secure telemetric data, even though the geometric locations of the burns varied considerably. There was a significant adverse increase in total mission elapsed time for the three versus two burn transfer (12 vs. 1-1/4 hr), but could be accommodated by modest modifications to Centaur systems. Future applications were discussed. The three burn transfer was found to be a viable, arguably preferable, alternative to the two burn transfer.

Three Orbital Burns to Molniya Orbit via Shuttle Centaur G Upper Stage

NASA Technical Reports Server (NTRS)

Williams, Craig H.

2014-01-01

An unclassified analytical trajectory design, performance, and mission study was done for the 1982-86 joint NASA-USAF Shuttle/Centaur G upper stage development program to send performance-demanding payloads to high orbits such as Molniya using an unconventional orbit transfer. This optimized three orbital burn transfer to Molniya orbit was compared to the then-baselined two burn transfer. The results of the three dimensional trajectory optimization performed include powered phase steering data and coast phase orbital element data. Time derivatives of the orbital elements as functions of thrust components were evaluated and used to explain the optimization's solution. Vehicle performance as a function of parking orbit inclination was given. Performance and orbital element data was provided for launch windows as functions of launch time. Ground track data was given for all burns and coasts including variation within the launch window. It was found that a Centaur with fully loaded propellant tanks could be flown from a 37deg inclination low Earth parking orbit and achieve Molniya orbit with comparable performance to the baselined transfer which started from a 57deg inclined orbit: 9,545 lb vs. 9,552 lb of separated spacecraft weight respectively. There was a significant reduction in the need for propellant launch time reserve for a one hour window: only 78 lb for the three burn transfer vs. 320 lb for the two burn transfer. Conversely, this also meant that longer launch windows over more orbital revolutions could be done for the same amount of propellant reserve. There was no practical difference in ground tracking station or airborne assets needed to secure telemetric data, even though the geometric locations of the burns varied considerably. There was a significant adverse increase in total mission elapsed time for the three vs. two burn transfer (12 vs. 11/4 hrs), but could be accommodated by modest modifications to Centaur systems. Future applications were discussed. The three burn transfer was found to be a viable, arguably preferable, alternative to the two burn transfer.

The effect of family characteristics on the recovery of burn injuries in children.

PubMed

Sheridan, Robert L; Lee, Austin F; Kazis, Lewis E; Liang, Matthew H; Li, Nien-Chen; Hinson, Michelle I; Bauk, Helena; Meyer, Walter J; Stubbs, Teresa K; Palmieri, Tina L; Tompkins, Ronald G

2012-09-01

Interactions between family members and characteristics of family life and function may affect a child's recovery from burn injury. We prospectively examined the relationship between family characteristics and physical and psychosocial recovery from burns. The families of 399 burned children aged 5 years to 18 years admitted to one of four Shriners Hospitals for Children for management of acute burns completed the Family Environment Scale within 7 days of admission and then the American Burn Association/Shriners Hospitals for Children Burn Outcome Questionnaire (BOQ) at baseline, 3, 6, 12, 18, 24, 36, and 48 months. Generalized estimating equations with random effects for the time since burn were used to track recovery of the BOQ patient-centered domains associated with baseline family characteristics during the course of the study. The children had a mean age of 11 years and burn size of 32% total body surface area burned. Higher Family Environment Scale scores in cohesion, independence, organization, and active recreational orientation were associated with significantly better rates of recovery in multiple BOQ domains of health-related quality of life. Higher scores in conflict and achievement orientation predicted statistically significant impaired recovery. Higher expressiveness predicted greater difficulty with school reentry. Family characteristics affect the recovery of children after serious burns. Some of these may be amenable to focused anticipatory family interventions to help optimize outcomes. In particular, those characteristics that impair school reentry should be targeted.

Predicting the proportion of full-thickness involvement for any given burn size based on burn resuscitation volumes.

PubMed

Liu, Nehemiah T; Salinas, José; Fenrich, Craig A; Serio-Melvin, Maria L; Kramer, George C; Driscoll, Ian R; Schreiber, Martin A; Cancio, Leopoldo C; Chung, Kevin K

2016-11-01

The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early burn care. The goal of this study was to determine the degree to which full-thickness (FT) involvement affected overall 24-hour burn resuscitation volumes. We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, with significant burns that required resuscitation using our computerized decision support system for burn fluid resuscitation. We defined the degree of FT involvement as FT Index (FTI; percentage of FT injury/percentage of total body surface area (TBSA) burned [%FT / %TBSA]) and compared variables on actual 24-hour fluid resuscitation volumes overall as well as for any given burn size. A total of 203 patients admitted to our burn center during the study period were included in the analysis. Mean age and weight were 47 ± 19 years and 87 ± 18 kg, respectively. Mean %TBSA was 41 ± 20 with a mean %FT of 18 ± 24. As %TBSA, %FT, and FTI increased, so did actual 24-hour fluid resuscitation volumes (mL/kg). However, increase in FTI did not result in increased volume indexed to burn size (mL/kg per %TBSA). This was true even when patients with inhalation injury were excluded. Further investigation revealed that as %TBSA increased, %FT increased nonlinearly (quadratic polynomial) (R = 0.994). Total burn size and FT burn size were both highly correlated with increased 24-hour fluid resuscitation volumes. However, FTI did not correlate with a corresponding increase in resuscitation volumes for any given burn size, even when patients with inhalation injury were excluded. Thus, there are insufficient data to presume that those who receive more volume at any given burn size are likely to be mostly full thickness or vice versa. This was influenced by a relatively low sample size at each 10%TBSA increment and larger burn sizes disproportionately having more FT burns. A more robust sample size may elucidate this relationship better. Therapeutic/care management study, level IV.

How important is biomass burning in Canada to mercury contamination?

NASA Astrophysics Data System (ADS)

Fraser, Annemarie; Dastoor, Ashu; Ryjkov, Andrei

2018-05-01

Wildfire frequency has increased in past four decades in Canada and is expected to increase in future as a result of climate change (Wotton et al., 2010). Mercury (Hg) emissions from biomass burning are known to be significant; however, the impact of biomass burning on air concentration and deposition fluxes in Canada has not been previously quantified. We use estimates of burned biomass from FINN (Fire INventory from NCAR) and vegetation-specific emission factors (EFs) of mercury to investigate the spatiotemporal variability of Hg emissions in Canada. We use Environment and Climate Change Canada's GEM-MACH-Hg (Global Environmental Multi-scale, Modelling Air quality and Chemistry model, mercury version) to quantify the impact of biomass burning in Canada on spatiotemporal variability of air concentrations and deposition fluxes of mercury in Canada. We use North American gaseous elemental mercury (GEM) observations (2010-2015), GEM-MACH-Hg, and an inversion technique to optimize the EFs for GEM for five vegetation types represented in North American fires to constrain the biomass burning impacts of mercury. The inversion results suggest that EFs representing more vegetation types - specifically peatland - are required. This is currently limited by the sparseness of measurements of Hg from biomass burning plumes. More measurements of Hg concentration in the air, specifically downwind of fires, would improve the inversions. We use three biomass burning Hg emissions scenarios in Canada to conduct three sets of model simulations for 2010-2015: two scenarios where Hg is emitted only as GEM using literature or optimized EFs and a third scenario where Hg is emitted as GEM using literature EFs and particle bound mercury (PBM) emitted using the average GEM/PBM ratio from lab measurements. The three biomass burning emission scenarios represent a range of possible values for the impacts of Hg emissions from biomass burning in Canada on Hg concentration and deposition. We find total biomass burning Hg emissions to be highly variable from year to year and estimate average 2010-2015 total atmospheric biomass burning emissions of Hg in Canada to be between 6 and 14 t during the biomass burning season (i.e. from May to September), which is 3-7 times the mercury emission from anthropogenic sources in Canada for this period. On average, 65 % of the emissions occur in the provinces west of Ontario. We find that while emissions from biomass burning have a small impact on surface air concentrations of GEM averaged over individual provinces/territories, the impact at individual sites can be as high as 95 % during burning events. We estimate average annual mercury deposition from biomass burning in Canada to be between 0.3 and 2.8 t, compared to 0.14 t of mercury deposition from anthropogenic sources during the biomass burning season in Canada. Compared to the biomass burning emissions, the relative impact of fires on mercury deposition is shifted eastward, with on average 54 % percent of the deposition occurring in provinces west of Ontario. While the relative contribution of Canadian biomass burning to the total mercury deposition over each province/territory is no more than 9 % between 2010 and 2015, the local contribution in some locations (including areas downwind of biomass burning) can be as high as 80 % (e.g. northwest of Great Slave Lake in 2014) from May to September. We find that northern Alberta and Saskatchewan, central British Columbia, and the area around Great Slave Lake in the Northwest Territories are at greater risk of mercury contamination from biomass burning. GEM is considered to be the dominant mercury species emitted from biomass burning; however, there remains an uncertainty in the speciation of mercury released from biomass burning. We find that the impact of biomass burning emissions on mercury deposition is significantly affected by the uncertainty in speciation of emitted mercury because PBM is more readily deposited closer to the emission sources than GEM; an addition of ˜ 18 % percent of mercury emission from biomass burning in the form of PBM in the model increases the 6-year average deposition by ˜ 4 times.

Particle and Gas Emissions from an In Situ Burn of Crude Oil on the Ocean.

PubMed

Hobbs, John L Ross Ronald J Ferek And Peter V

1996-03-01

Burning is a very effective way of removing oil spills from the ocean; the tradeoff is the potential for significant air pollution. Airborne measurements are described for particles and gases from two test burns of crude oil offshore of St. Johns, Newfoundland during the Newfoundland Offshore Burn Experiment (NOBE). The smoke plumes from the burns initially rose 200-400 m into the air and then continued to rise and disperse laterally downwind. The concentrations of accumulation-mode particles in the smoke were ~45,000 cm -3 at 1.5 km from the fires, and they remained as high as ~4,000 cm -3 after an hour or more of travel time downwind. Total particle mass loadings in the plumes were over 1000 µg m -3 near the fires, but decreased to ~100 µg m -3 at 25 km downwind. For each kilogram of fuel consumed, ~770 g of carbon was released in the form of CO2, ~13 g of carbon as CO, -5 g as volatile organic compounds (VOCs), and -87 g as particles with diameters <3.5 µm, of which ~66 g was elemental carbon and ~7 g condensed organic carbon. Also, ~3 g of SO2 was released per kilogram of fuel burned. A relatively low combustion efficiency was indicated by the average molar ratio of the concentration of CO to excess CO2 of 0.017. The molar ratio of NOX to excess CO2 typically varied from 0.3 x 10 -3 to 0.4 x 10 -3 , implying little fixation of atmospheric nitrogen and low concentrations of NOX. For comparison, the total smoke particle production rate in the NOBE burns was about the same as that for a nineacre slash burn.

Survival function and protein malnutrition in burns patients at a rural hospital in Africa.

PubMed

Kingu, H J; Longo-Mbenza, Benjamin; Dhaffala, A; Mazwai, E L

2011-07-01

The aim of this study was to estimate the incidence of acute malnutrition and to identify predictors of case fatality among burn patients in the poorest South African province, Eastern Cape. This longitudinal follow-up study was conducted among consecutive burn patients admitted to Nelson Mandela Academic Hospital, Mthatha, South Africa, between 2006 and 2008. Patients were monitored and treated daily from admission to discharge. Outcomes were acute protein malnutrition and mortality. Patients' demography, total body surface area (TBSA) of the burn, cause of the burn, weight, height, location of the burn, hemoglobin, serum albumin, wound infection, and antibiotics after culture and sensitivity results were the potential predictors of in-hospital mortality. A Cox's proportional hazards model for the time to death was then used to identify independent predictors of mortality after adjusting for confounding factors. Kaplan-Meier survival curves were generated for each arm of exposure status. In all, 67 patients (35 males, 59 children) were studied. The mean (range) age was 8±12 years (1 month to 59 years). The cumulative incidence of acute malnutrition was 62.0% (n=42): 46.3% (n=31) at admission and 15.7% (n=11) after 7 days of hospitalization. Incidence of mortality was 16.4% (n=11 with in-hospital acute malnutrition). The only significant and independent predictors of mortality were total body surface area (TBSA) burn>40% [hazard ratio (HR) 10.5, 95% confidence interval (CI) 1.7-63; P<0.01] and affected anterior trunk (HR 4.4, 95% CI 1.3-14.7; P=0.018). Urgent prevention strategies of burns and evidence-based practice with early nutritional supplementation are needed to reduce high rates of malnutrition and mortality.

Moderate glycemic control safe in critically ill adult burn patients: A 15 year cohort study.

PubMed

Stoecklin, Patricia; Delodder, Frederik; Pantet, Olivier; Berger, Mette M

2016-02-01

Hyperglycemia is a metabolic alteration in major burn patients associated with complications. The study aimed at evaluating the safety of general ICU glucose control protocols applied in major burns receiving prolonged ICU treatment. 15 year retrospective analysis of consecutive, adult burn patients admitted to a single specialized centre. death or length of stay <10 days, age <16 years. demographic variables, burned surface (TBSA), severity scores, infections, ICU stay, outcome. Metabolic variables: total energy, carbohydrate and insulin delivery/24h, arterial blood glucose and CRP values. Analysis of 4 periods: 1, before protocol; 2, tight doctor driven; 3, tight nurse driven; 4, moderate nurse driven. 229 patients, aged 45 ± 20 years (mean ± SD), burned 32 ± 20% TBSA were analyzed. SAPSII was 35 ± 13. TBSA, Ryan and ABSI remained stable. Inhalation injury increased. A total of 28,690 blood glucose samples were analyzed: the median value remained unchanged with a narrower distribution over time. After the protocol initiation, the normoglycemic values increased from 34.7% to 65.9%, with a reduction of hypoglycaemic events (no extreme hypoglycemia in period 4). Severe hyperglycemia persisted throughout with a decrease in period 4 (9.25% in period 4). Energy and glucose deliveries decreased in periods 3 and 4 (p<0.0001). Infectious complications increased during the last 2 periods (p=0.01). A standardized ICU glucose control protocol improved the glycemic control in adult burn patients, reducing glucose variability. Moderate glycemic control in burns was safe specifically related to hypoglycemia, reducing the incidence of hypoglycaemic events compared to the period before. Hyperglycemia persisted at a lower level. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Epidemiology and financial implications of self-inflicted burns.

PubMed

George, S; Javed, M; Hemington-Gorse, S; Wilson-Jones, N

2016-02-01

The cost of the treatment of burns is high especially in self-inflicted burns with prolonged treatment. We performed a retrospective review of the self-inflicted burns at our regional burns centre to determine the costs incurred in their management and to identify factors which could reduce the financial burden in the future. The data was collected retrospectively of all the inpatient and outpatient self-inflicted burns presenting to our regional burns centre in the year 2011. Twenty one patients (out of a total of 870 patients) presented with self-inflicted burns to our centre in 2011. Five (23.8%) were major burns with an average of 53.2% Total Body Surface Area (TBSA) and 16 (76.2%) were minor burns with an average of 0.5% TBSA. 11 (52.4%) patients had flame burns including 4 self-immolation burns. The mortality rate was 4.8% (n=1). Five (23.8%) patients underwent surgical treatment. Seven (33.3%) patients were treated in intensive care and with average stay of 46.85 days. Critical care and theatre attendances made up most of the costs with average ICU stay per patient calculated at £313,131/day. The total cost of all 21 patients was £1,581,856. Burns are preventable injuries, early detection and intervention in patients with propensity to self-inflict burns can possibly reduce the costs of treatment in the future. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

A fire model with distinct crop, pasture, and non-agricultural burning: use of new data and a model-fitting algorithm for FINAL.1

NASA Astrophysics Data System (ADS)

Rabin, Sam S.; Ward, Daniel S.; Malyshev, Sergey L.; Magi, Brian I.; Shevliakova, Elena; Pacala, Stephen W.

2018-03-01

This study describes and evaluates the Fire Including Natural & Agricultural Lands model (FINAL) which, for the first time, explicitly simulates cropland and pasture management fires separately from non-agricultural fires. The non-agricultural fire module uses empirical relationships to simulate burned area in a quasi-mechanistic framework, similar to past fire modeling efforts, but with a novel optimization method that improves the fidelity of simulated fire patterns to new observational estimates of non-agricultural burning. The agricultural fire components are forced with estimates of cropland and pasture fire seasonality and frequency derived from observational land cover and satellite fire datasets. FINAL accurately simulates the amount, distribution, and seasonal timing of burned cropland and pasture over 2001-2009 (global totals: 0.434×106 and 2.02×106 km2 yr-1 modeled, 0.454×106 and 2.04×106 km2 yr-1 observed), but carbon emissions for cropland and pasture fire are overestimated (global totals: 0.295 and 0.706 PgC yr-1 modeled, 0.194 and 0.538 PgC yr-1 observed). The non-agricultural fire module underestimates global burned area (1.91×106 km2 yr-1 modeled, 2.44×106 km2 yr-1 observed) and carbon emissions (1.14 PgC yr-1 modeled, 1.84 PgC yr-1 observed). The spatial pattern of total burned area and carbon emissions is generally well reproduced across much of sub-Saharan Africa, Brazil, Central Asia, and Australia, whereas the boreal zone sees underestimates. FINAL represents an important step in the development of global fire models, and offers a strategy for fire models to consider human-driven fire regimes on cultivated lands. At the regional scale, simulations would benefit from refinements in the parameterizations and improved optimization datasets. We include an in-depth discussion of the lessons learned from using the Levenberg-Marquardt algorithm in an interactive optimization for a dynamic global vegetation model.

Characterization of Emissions from Liquid Fuel and Propane Open Burns.

PubMed

Aurell, Johanna; Hubble, David; Gullett, Brian K; Holder, Amara; Washburn, Ephraim; Tabor, Dennis

2017-11-07

The effect of accidental fires are simulated to understand the response of items such as vehicles, fuel tanks, and military ordnance and to remediate the effects through re-design of the items or changes in operational procedures. The comparative combustion emissions of using jet propellant (JP-5) liquid fuel pools or a propane manifold grid to simulate the effects of accidental fires was investigated. A helium-filled tethered aerostat was used to maneuver an instrument package into the open fire plumes to measure CO, CO 2 , fine particulate matter (PM 2.5 ), polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and elemental/organic/total carbon (EC/OC/TC). The results showed that all emissions except CO 2 were significantly higher from JP-5 burns than from propane. The major portion of the PM mass from fires of both fuels was less than 1 μm in diameter and differed in carbon content. The PM 2.5 emission factor from JP-5 burns (129 ± 23 g/kg Fuel c ) was approximately 150 times higher than the PM 2.5 emission factor from propane burns (0.89 ± 0.21 g/kg Fuel c ). The PAH emissions as well as some VOCs were more than one hundred times higher for the JP-5 burns than the propane burns. Using the propane test method to study flammability responses, the environmental impact of PM 2.5 , PAHs, and VOCs would be reduced by 2300, 700, and 100 times per test, respectively.

Effects of forest fire on soil nutrients in Turkish pine (Pinus brutia, Ten) ecosystems.

PubMed

Yildiz, Oktay; Esen, Derya; Sarginci, Murat; Toprak, Bulent

2010-01-01

Fire is a long-standing and poorly understood component of the Mediterranean forestlands in Turkey. Fire can alter plant composition, destroy biomass, alter soil physical and chemical properties and reduce soil nutrient pools. However fire can also promote productivity of certain ecosystems by mineralizing soil nutrients and promoting fast growing nitrogen fixing plant species. Fire effects on soils and ecosystems in Turkey and Mediterranean regions are not well understood. This study uses a retrospective space-for-time substitution to study soil macro-nutrient changes on sites which were burned at different times during the last 8 years. The study sites are in the Fethiye Forest Management Directorate in the western Mediterranean Sea region of Turkey. Our samples show 40% less Soil C, and cation exchange capacity (CEC) at 0-20 cm soil depth two weeks after the fire. Soil C and CEC appear to recover to pre-fire level in one year. Concentrations of Mg were significantly lower on new-burn sites, but returned to pre-fire levels in one year. Total soil N concentrations one and two years after fire were 90% higher than other sites, and total P was 9 times higher on new-burn site than averages from other sites. Some implications of these results for forest managers are discussed.

Emissions of volatile organic compounds from maize residue open burning in the northern region of Thailand

NASA Astrophysics Data System (ADS)

Sirithian, Duanpen; Thepanondh, Sarawut; Sattler, Melanie L.; Laowagul, Wanna

2018-03-01

Emission factors for speciated volatile organic compounds (VOCs) from maize residue burning were determined in this study based on chamber experiments. Thirty-six VOC species were identified by Gas Chromatography/Mass Spectrometer (GC/MS). They were classified into six groups, including alkanes, alkenes, oxygenated VOCs, halogenated VOCs, aromatics and other. The emission factor for total VOCs was estimated as about 148 mg kg-1 dry mass burned. About 68.4% of the compounds were aromatics. Field samplings of maize residues were conducted to acquire the information of fuel characteristics including fuel loading, fraction of maize residues that were actually burned as well as proximate and elemental analysis of maize residues. The emission factors were then applied to estimate speciated VOC emissions from maize residue open burning at the provincial level in the upper-northern region of Thailand for the year 2014. Total burned area of maize covered an area of about 500,000 ha which was about 4.7% of the total area of upper-northern region of the country. It was found that total VOC emissions released during the burning season (January-April) was about 79.4 tons. Ethylbenzene, m,p-xylene, 1,2,4-trimethylbenzene, acetaldehyde and o-xylene were the major contributors, accounting for more than 65% of total speciated VOC emissions.

An Outcomes Study on the Effects of the Singapore General Hospital Burns Protocol.

PubMed

Liang, Weihao; Kok, Yee Onn; Tan, Bien Keem; Chong, Si Jack

2018-01-01

The Singapore General Hospital Burns Protocol was implemented in May 2014 to standardize treatment for all burns patients, incorporate new techniques and materials, and streamline the processes and workflow of burns management. This study aims to analyze the effects of the Burns Protocol 2 years after its implementation. Using a REDCap electronic database, all burns patients admitted from May 2013 to April 2016 were included in the study. The historical preimplementation control group composed of patients admitted from May 2013 to April 2014 (n = 96). The postimplementation prospective study cohort consisted of patients admitted from May 2014 to April 2016 (n = 243). Details of the patients collected included age, sex, comorbidities, total body surface area (TBSA) burns, time until surgery, number of surgeries, number of positive tissue and blood cultures, and length of hospital stay. There was no statistically significant difference in the demographics of both groups. The study group had a statistically significant shorter time to surgery compared with the control group (20.8 vs 38.1, P < 0.0001). The study group also averaged fewer surgeries performed (1.96 vs 2.29, P = 0.285), which, after accounting for the extent of burns, was statistically significant (number of surgeries/TBSA, 0.324 vs 0.506; P = 0.0499). The study group also had significantly shorter length of stay (12.5 vs 16.8, P = 0.0273), a shorter length of stay/TBSA burns (0.874 vs 1.342, P = 0.0101), and fewer positive tissue cultures (0.6 vs 1.3, P = 0.0003). The study group also trended toward fewer positive blood culture results (0.09 vs 0.35, P = 0.0593), although the difference was just shy of statistical significance. The new Singapore General Hospital Burns Protocol had revolutionized Singapore burns care by introducing a streamlined, multidisciplinary burns management, resulting in improved patient outcomes, lowered health care costs, and improved system resource use.

Vacuum-assisted closure device as a split-thickness skin graft bolster in the burn population.

PubMed

Waltzman, Joshua T; Bell, Derek E

2014-01-01

The vacuum-assisted closure device (VAC) is associated with improved wound healing outcomes. Its use as a bolster device to secure a split-thickness skin graft has been previously demonstrated; however, there is little published evidence demonstrating its benefits specifically in the burn population. With use of the VAC becoming more commonplace, its effect on skin graft take and overall time to healing in burn patients deserves further investigation. Retrospective review of burn registry database at a high-volume level I trauma center and regional burn center during a 16-month period was performed. Patients who had a third-degree burn injury requiring a split-thickness skin graft and who received a VAC bolster were included. Data points included age, sex, burn mechanism, burn location, grafted area in square centimeters, need for repeat grafting, percent graft take, and time to complete reepithelialization. Sixty-seven patients were included in the study with a total of 88 skin graft sites secured with a VAC. Age ranged from <1 year to 84 years (average 41 years). The average grafted area was 367 ± 545 cm. The three most common were the leg, thigh, and arm (28, 15, and 12%, respectively). Average percent graft take was 99.5 ± 1.5%. Notably, no patients returned to the operating room for repeat grafting. The average time to complete reepithelialization was 16 ± 7 days. The VAC is a highly reliable and reproducible method to bolster a split-thickness skin graft in the burn population. The observed rate of zero returns to the operating room for repeat grafting was especially encouraging. Its ability to conform to contours of the body and cover large surface areas makes it especially useful in securing a graft. This method of bolstering results in decreased repeat grafting and minimal graft loss, thus decreasing morbidity compared with conventional bolster dressings.

Comparison of combat and non-combat burns from ongoing U.S. military operations.

PubMed

Kauvar, David S; Cancio, Leopoldo C; Wolf, Steven E; Wade, Charles E; Holcomb, John B

2006-05-15

Military burns result from either combat or non-combat causes. We compared these etiologies from patients involved in ongoing conflicts to evaluate their impact and provide prevention recommendations. All military patients with significant burns treated at the United States Army Institute of Surgical Research from April 2003 to May 2005 were reviewed. Injuries were categorized as having resulted from combat or non-combat causes. Demographics, burn severity and pattern, mortality, and early outcomes were compared. There were 273 burn patients seen with 63% injured in combat. A high early rate of non-combat injuries was noted. Feedback on non-combat burn prevention was provided to the combat theater, and the incidence of non-combat burns decreased. Mean age and time from injury to admission did not differ. The majority of combat injuries resulted from explosive device detonation. Waste burning, ammunition handling, and gasoline caused most non-combat injuries. Combat casualties had more associated and inhalation injuries and greater full-thickness burn size; total body surface area burned was equivalent. The hands and the face were the most frequently burned body areas. Mortality was 5% in combat and 2% in non-combat patients. The majority of survivors in both groups returned to military duty. The disparity in full-thickness burn size and incidence of inhalation and associated injuries resulted from differing mechanisms of injury, with explosions and penetrating trauma more common in combat wounds. Despite the severity of combat burns, mortality was low and outcomes generally good. Non-combat burns are preventable and have decreased in incidence.

Epidemiology of pediatric burns in southwest China from 2011 to 2015.

PubMed

Li, Haisheng; Wang, Song; Tan, Jianglin; Zhou, Junyi; Wu, Jun; Luo, Gaoxing

2017-09-01

Burns are a major form of injury in children worldwide. This study aimed to investigate the epidemiology, outcome, cost and risk factors of pediatric burns in southwest China. This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University from 2011 to 2015. Data, including demographic, injury-related, and clinical data and patient outcome, were collected from medical records. A total of 2478 children with burns (58.03% boys), accounting for 39.2% of total burn patients, were included. The average age of the burn patients was 2.86±2.86years, and most patients (85.55%) were under five years old. The incidence of burns peaked in January, February and May. Scald burns were the most frequent (79.06%), followed by flame burns (14.0%) and electrical burns (3.35%). Limbs were the most common burn sites (69.73%), and the average total body surface area (TBSA) was 11.57±11.61%. The percentage of children who underwent operations and the number of operations were significantly increased in cases of electrical burns, the older-age group, a larger TBSA and full-thickness burns. Six deaths were recorded, yielding a mortality of 0.24%. The median length of stay and cost were 14days and 9541 CNY, respectively, and the major risk factors for length of stay and cost were the TBSA, number of operations, full-thickness burns and outcome. In southwest China, among children under five years old, scald and flame burns should become the key prevention target, and future prevention strategies should be based on related risk factors. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Biomass Burning

Atmospheric Science Data Center

2015-07-27

Projects:  Biomass Burning Definition/Description:  Biomass Burning: This data set represents the geographical and temporal distribution of total amount of biomass burned. These data may be used in general circulation models (GCMs) and ...

Direct measurements of tropospheric ozone from TOMS data

NASA Technical Reports Server (NTRS)

Hudson, Robert D.

1993-01-01

In the past year, we have made measurements of the tropospheric total column of ozone during the biomass burning season in Africa (August to October). Fishman et. al. had reported previously that by taking a time average of the low spatial resolution data from TOMS (Total Ozone Mapping Spectrometer) on Nimbus-7 (referred to as the Grid-T data set), during the biomass burning season in Africa, a plume of ozone extends from the East coast of Africa into the Atlantic. In this report, we present an analysis that we have made using the measured TOMS radiances taken from the High Density TOMS data set (referred as the HDT data set), which examines this plume in more detail.

Temporal Changes Rather than Long-Term Repeated Burning Predominately Control the Shift in the Abundance of Soil Denitrifying Community in an Australian Sclerophyll Forest.

PubMed

Liu, Xian; Chen, C R; Hughes, J M; Wang, W J; Lewis, Tom

2017-01-01

To understand the temporal dynamics of soil bacterial denitrifying community in response to long-term prescribed burning and its resilience and recovery following a fire, a wet sclerophyll forest study site under two treatments (2 yearly burning (2YB) and no burning (NB)) and with 40-year-old burning history was used. Similar temporal patterns in the abundance of total (16S rRNA) and denitrifying (narG, nirK, nirS, nosZ) bacteria between two burning treatments revealed strong temporal influences. The magnitude of burning impacts on the abundance of 16S rRNA and denitrification genes was smaller compared with the impact of sampling time, but significant burning and temporal impacts were recorded for all (P < 0.001)-except for the nirS gene. Impacts of prescribed fire on the abundance of soil denitrifying community could be observed immediately after fire, and this impact diminished over a 24-month period prior to the next prescribed burning event. In conclusion, temporal changes govern the fluctuations of the abundance of soil denitrifying genes over the sampling period and the denitrifying community can recover after fire, suggesting that this community is resilient to the effects of prescribed burning. A combination of biotic and abiotic factors may account for the different temporal dynamics of denitrification gene abundance.

Better Protection of Glass-Fronted Stoves Is Needed in Sweden Because of the Increase in the Number of Contact Burns Among Small Children.

PubMed

Zötterman, Johan; Steinvall, Ingrid; Elmasry, Moustafa

2018-06-13

The impression among the attending physicians at their Burn Centre is that the number of contact burns caused by glass-fronted stoves is increasing, particularly in the youngest group of patients. It is an interesting subgroup, as these injuries are preventable. The authors' aim of this study was to find out whether the incidence of burns after contact with glass-fronted stoves has increased.The authors included all patients aged between 0 and 3.9 years who presented to the National Burn Centre during the period 2008-2015 with contact burn injuries caused by glass-fronted stoves. The change in incidence over time was calculated from national records and analyzed with simple linear regression.Fifty-six patients were included, of whom 20 were treated during the past 2 years of the study. Thirty-seven of the 56 were boys (66%), median (10-90 percentiles) age was 1.1 (0.7-2.5) years, percentage total body surface area burned was 0.6% (0.1-2.0), 12 were admitted for overnight stay in hospital, and seven needed operations. The incidence was 0.34/100 000 children-years during the first 2 years, and it was three times as high during the past 2 years. The increase in incidence was 0.24/100 000 children-years by each 2-year period (P = .02).The authors' results indicate that contact burns among children caused by glass-fronted stoves are increasing in Sweden. The authors propose that there should be a plan for their prevention put in place.

Time to rehabilitation in the burn population: incidence of zero onset days in the UDSMR national dataset.

PubMed

Schneider, Jeffrey C; Tan, Wei-Han; Goldstein, Richard; Mix, Jacqueline M; Niewczyk, Paulette; Divita, Margaret A; Ryan, Colleen M; Gerrard, Paul B; Kowalske, Karen; Zafonte, Ross

2013-01-01

A preliminary investigation of the burn rehabilitation population found a large variability of zero onset day frequency between facilities. Onset days is defined as the time from injury to inpatient rehabilitation admission; this variable has not been investigated in burn patients previously. This study explored if this finding was a facility-based phenomena or characteristic of burn inpatient rehabilitation patients. This study was a secondary analysis of Uniform Data System for Medical Rehabilitation (UDSmr) data from 2002 to 2007 examining inpatient rehabilitation characteristics among patients with burn injuries. Exclusion criteria were age less than 18 years and discharge against medical advice. Comparisons of demographic, medical and functional data were made between facilities with a high frequency of zero onset days versus facilities with a low frequency of zero onset days. A total of 4738 patients from 455 inpatient rehabilitation facilities were included. Twenty-three percent of the population exhibited zero onset days (n = 1103). Sixteen facilities contained zero onset patients; two facilities accounted for 97% of the zero onset subgroup. Facilities with a high frequency of zero onset day patients demonstrated significant differences in demographic, medical, and functional variables compared to the remainder of the study population. There were significantly more zero onset day admissions among burn patients (23%) than other diagnostic groups (0.5- 3.6%) in the Uniform Data System for Medical Rehabilitation database, but the majority (97%) came from two inpatient rehabilitation facilities. It is unexpected for patients with significant burn injury to be admitted to a rehabilitation facility on the day of injury. Future studies investigating burn rehabilitation outcomes using the Uniform Data System for Medical Rehabilitation database should exclude facilities with a high percentage of zero onset days, which are not representative of the burn inpatient rehabilitation population.

Burns to the genitalia, perineum, and buttocks increase the risk of death among U.S. service members sustaining combat-related burns in Iraq and Afghanistan.

PubMed

Clemens, Michael S; Janak, Judson C; Rizzo, Julie A; Graybill, John C; Buehner, Michelle F; Hudak, Steven J; Thompson, Charles K; Chung, Kevin K

2017-08-01

Among service members injured in Iraq and Afghanistan, to determine the risk of mortality associated with combat-related burns to the genitalia, perineum, and buttocks. The prospectively maintained burn registry from the United States Army Institute of Surgical Research was retrospectively reviewed to identify all service members with combat-related burns sustained in Iraq and Afghanistan from March 2003 to October 2013. The two primary risk factors of interest were (1) any burn to the genitals, perineum, and/or buttocks (PB) and (2) burns involving the entire perineal, genital, and buttock region (complete PB). Cox proportional hazard models were used to estimate the risk of mortality for both primary risk factors, and adjusted for severe non-burn-related trauma, percent of burn over total body surface area (TBSA), inhalational injury, time to urinary tract infection, and time to bacteremia. A post-hoc analysis was performed to explore the potential effect modification of TBSA burned on the relationship between PB and mortality. Among the 902 U.S. service members with combat-related burns sustained during the study period, 226 (25.0%) had involvement of the genitalia, perineum, and/or buttocks. Complete PB was associated with a crude risk of mortality (HR: 5.3; 2.9-9.7), but not an adjusted risk (HR=1.8; 0.8-4.0). However, TBSA burned was identified as a potential negative effect modifier. Among patients with burns <60% TBSA, sustaining a complete PB conferred an adjusted risk of death (HR=2.7; 1.1-6.8). Further, patients with a perineal burn had a five-fold increased incidence of bacteremia. In adjusted models, each event of bacteremia increased the risk of mortality by 92% (HR 1.92; 1.39-2.65). Perineal burns were associated with a two-fold increased incidence of severe non-burn related trauma that also doubled mortality risk in adjusted models (HR 2.29; 1.23-4.27). Among those with relatively survivable combat-related burns (<60% TBSA), genital/perineal/buttock involvement increases the risk of death. Bacteremia may account for part of this increased risk, but does not fully explain the independent risk associated with perineal burns. Published by Elsevier Ltd.

The epidemiology of pediatric burns undergoing intensive care in Burn Centre Brno, Czech Republic, 1997-2009.

PubMed

Lipový, B; Brychta, P; Gregorová, N; Jelínková, Z; Rihová, H; Suchánek, I; Kaloudová, Y; Mager, R; Krupicová, H; Martincová, A

2012-08-01

The aim of this study was to determine the basic epidemiological characteristics of severely burned children who were admitted to the intensive care unit (ICU), Department of Burns and Reconstructive Surgery Faculty Hospital Brno, Czech Republic in the years 1997-2009. We collected and evaluated epidemiological data such as age, sex, burn etiology, length of hospitalization, duration of the ICU stay, surgical or conservative therapeutic strategies, the use of mechanical ventilation and its duration, day and month of injury and the extent of burned area. In total 383 children (253 boys, 130 girls) aged 0-14 years, underwent intensive care for at least 48h. Male to female ratio was 1.95:1. The average range of burn area in the group was 16.43±12.86% TBSA (total body surface area). During the reporting period, 16 children were admitted with burns over 50% TBSA. 328 children suffered burns indoors, with 55 children being burned outdoors. Indoor/outdoor ratio was set at 5.96:1. The most frequent etiological agent was scalding (hot water, soup, coffee, oil, tea). The total number of scalded children in this group was 312 (81.46%). Mechanical ventilation was used in 96 cases (25.07% of all the admitted patients). The duration of mechanical ventilation in these patients was 8.03±5.67 days in average. The average length of stay in ICU was 10.71±10.92 days and total length of hospital stay was an average of 21.55±14.55 days. A total of 184 patients (48.04%) were treated surgically and therefore required necrectomy and skin grafting. The other 199 (51.96%) patients were treated conservatively. During the reporting period 3 children died (0.78%). In our report we identify basic epidemiological data defined in the aim of this study for burned children requiring intensive care. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Whole body protein kinetics measured with a non-invasive method in severely burned children

PubMed Central

Børsheim, Elisabet; Chinkes, David L.; McEntire, Serina J.; Rodriguez, Nancy R.; Herndon, David N.; Suman, Oscar E.

2010-01-01

Persistent and extensive skeletal muscle catabolism is characteristic of severe burns. Whole body protein metabolism, an important component of this process, has not been measured in burned children during the long-term convalescent period. The aim of this study was to measure whole body protein turnover in burned children at discharge (95% healed) and in healthy controls by a non-invasive stable isotope method. Nine burned children (7 boys, 2 girls; 54 ± 14 (SD)% total body area burned; 13 ± 4 yrs; 45 ± 20 kg; 154 ± 14 cm) and 12 healthy children (8 boys, 4 girls; 12 ± 3 yrs; 54 ± 16 kg;150 ± 22 cm) were studied. A single oral dose of 15N-alanine (16 mg/kg) was given, and thereafter urine was collected for 34 hours. Whole body protein flux was calculated from labeling of urinary urea nitrogen. Then, protein synthesis was calculated as protein flux minus excretion, and protein breakdown as flux minus intake. At discharge, total protein turnover was 4.53 ± 0.65 (SE) g kg bodyweight−1 day−1 in the burned children compared to 3.20 ± 0.22 g kg−1 day−1 in controls (P = 0.02). Expressed relative to lean body mass (LBM), the rates were 6.12 ± 0.94 vs. 4.60 ± 0.36 g kg LBM−1 day−1 in burn vs. healthy (P = 0.06). Total protein synthesis was also elevated in burned vs. healthy children, and a tendency for elevated protein breakdown was observed. Conclusion: Total protein turnover is elevated in burned children at discharge compared to age-matched controls, possibly reflecting the continued stress response to severe burn. The oral 15N-alanine bolus method is a convenient, non-invasive, and no-risk method for measurement of total body protein turnover. PMID:20392565

The interactive effects of herbivory and fire on an oligohaline marsh, Little Lake, Louisiana, USA

USGS Publications Warehouse

Taylor, K.L.; Grace, J.B.; Guntenspergen, G.R.; Foote, A.L.

1994-01-01

Herbivory and fire have been shown to affect the structure and composition of marsh communities. Because fire may alter plant species composition and cover, and these alterations may have an effect on this study, the effects of fire and vertebrate herbivory in a Louisiana oligohaline marsh were studied using small, controlled burns and animal enclosures. Mean total biomass was nearly 2 times greater in the plots protected from herbivory than in the plots subject to natural herbivory. Additionally, mean total biomass was over 1.5 times greater in the plots that remained unburned than in those that were burned. Two dominant perennial species, Spartina patens and Scirpus olneyi, were negatively affected by herbivory, but two annual sedges, Cyperus flavescens and Cyperus odorata, were positively affected. Burning reduced the aboveground biomass of Spartina patens and Bacopa monnieri. No species increased in biomass as a result of fire. No significant differences were found in species richness between herbivory treatments or between fire treatments. Although both herbivory and fire were found to cause significant changes in the vegetation, the interaction between herbivory and fire was not found to produce any significant effects in any test conducted.

Effects of early enteral nutrition on the gastrointestinal motility and intestinal mucosal barrier of patients with burn-induced invasive fungal infection

PubMed Central

Zhang, Yu; Gu, Fang; Wang, Fengxian; Zhang, Yuanda

2016-01-01

Objective: To evaluate the effects of early enteral nutrition on the gastrointestinal motility and intestinal mucosal barrier of patients with burn-induced invasive fungal infection. Methods: A total of 120 patients with burn-induced invasive fungal infection were randomly divided into an early enteral nutrition (EN) group and a parenteral nutrition (PN) group (n=60). The patients were given nutritional support intervention for 14 days, and the expression levels of serum transferrin, albumin, total protein, endotoxin, D-lactic acid and inflammatory cytokines were detected on the 1st, 7th and 14th days respectively. Results: As the treatment progressed, the levels of serum transferrin, albumin and total protein of the EN group were significantly higher than those of the PN group (P<0.05), while the levels of serum endotoxin and D-lactic acid of the form group were significantly lower (P<0.05). After treatment, the expression levels of IL-6 and TNF-α were decreased in the EN group, which were significantly different from those of the PN group (P<0.05). During treatment, the incidence rates of complications such as abdominal distension, diarrhea, sepsis, nausea, vomiting and gastric retention were similar. The mean healing time of wound surface was 9.34±0.78 days in the EN group and 12.46±2.19 days in the PN group, i.e. such time of the former was significantly shorter than that of the latter (P<0.05). Conclusion: Treating patients having burn-induced invasive fungal infection by early enteral nutrition support with arginine can safely alleviate malnutrition and stress reaction, strengthen cellular immune function and promote wound healing, thereby facilitating the recovery of gastrointestinal motility and the function of intestinal mucosal barrier. PMID:27375697

Seasonal Distribution of African Savanna Fires

NASA Technical Reports Server (NTRS)

Cahoon, Donald R.; Stocks, Brian J.; Levine, Joel S.; Cofer, Wesley R., III; O'Neill, Katherine P.

1992-01-01

Savannas consist of a continuous layer of grass interspersed with scattered trees or shrubs, and cover approx. 10 million square kilometers of tropical Africa. African savanna fires, almost all resulting from human activities, may produce as much as a third of the total global emissions from biomass burning. Little is known, however, about the frequency and location of these fires, and the area burned each year. Emissions from African savanna burning are known to be transported over the mid-Atlantic, south Pacific and Indian oceans; but to study fully the transport of regional savanna burning and the seasonality of the atmospheric circulation must be considered simultaneously. Here we describe the temporal and spatial distribution of savanna fires over the entire African continent, as determined from night-time satellite imagery. We find that, contrary to expectations, most fires are left to burn uncontrolled, so that there is no strong diurnal cycle in the fire frequency. The knowledge gained from this study regarding the distribution and variability of fires will aid monitoring of the climatically important trace gases emitted from burning biomass.

An Analysis Framework Using Satellite Remote Sensing to Understand Landscape Patterns of High Severity Burns from Wildfires in Coastal Woodlands of California and Italy

NASA Astrophysics Data System (ADS)

Potter, C. S.

2016-12-01

The central California coastal landscape has a history of frequent large wildfires that have threatened or destroyed many residential structures at the wildland interface. This study starts with the largest wildfires on the Central Coast over the past 30 years and analyzes the fraction and landscape patterns of high severity burned (HBS) areas from the Landsat-based Monitoring Trends in Burn Severity (MTBS) data base as a function of weather conditions and topographic variations. Results indicate that maximum temperatures at the time of fire and the previous 12 months of rainfall explained a significant portion of the variation in total area burned and the fraction of HBS area. Average patch size and aggregation metrics of HBS areas were included in the analysis framework. Within each burned area, the Landsat (30-meter resolution) differenced Normalized Burn Ratio (dNBR), a continuous index of vegetation burn severity, was correlated against slope, aspect, and elevation to better understand landscape level-controls over HBS patches. The Landsat dNBR analysis framework is being extended next to the island of Sardinia, Italy for a comparison of Mediterranean climates and wildfire patterns since the mid-1980s.

[An epidemiological investigation of pediatric patients under 14 with large area burns: a multicenter study].

PubMed

Cheng, W F; Zhao, D X; Shen, Z A; Zhang, H Y; Tu, J J; Yuan, Z Q; Duan, P; Song, G D

2017-02-14

Objective: To investigate and evaluate the epidemiological characteristics of patients under 14 with large area burns in China. Methods: Data of pediatric patients aged 0-14yr with ≥30% total body surface area (TBSA) burned admitted into 106 burn centers in the mainland of China in 2014 were retrieved. The children were divided into three age groups: 0-3, 4-6 and 7-14 years according to the age. Information of age, gender, time of burn injury, causes of burns, admission time, prehospital emergency care of burn wound, burn area, inhalation injuries, the case fatality rate and length of hospital stay were collected for analysis. Results: Of the 486 cases included, 285 (58.6%) were boys and 201 (41.4%) were girls. The mean age of the children was (3.4±2.8) years. Children under 3 years old accounted for 67.5% of all the cases. 271 of the burn injuries (55.8%) occurred from April through August. Scalds and flames were the main causes of burns, which were the causes of 394 cases (81.1%) and 71 cases (14.6%), respectively. The burn injuries resulted from scalds and flames accounted for 89.6% and 7.3%, 70.8% and 21.9%, 51.6% and 41.9% in the age group of 0-3, 4-6 and 7-14 years respectively. The distribution of burn etiology in different age groups differed significantly (χ(2)=21.239, 59.442, 7.333, all P <0.01). Most of the patients (57.8%) were admitted within 2 hours after injury. However, when it came to the pre-hospital emergency management of burn wound, 164 patients (33.7%) did not use any drug or wound dressing, whereas the wound area of 236 patients (48.6%) were treated improperly with toothpaste, soy sauce, eggs or other non-standard disposal. The mean TBSA area of the patients was (42.1±14.5)%, while 288 (59.3%) of the patients suffered full thickness burns with mean TBSA of (24.5±17.9)%. The case fatality rate (CFR) was 4.1%, and the CFR of patients complicated with inhalation injury was significantly higher than those without ( P <0.01). The average length of stay for pediatric burn patients was (52.3±40.2) days. Conclusions: Children under 3 years old are important target population of severe burns. Scald is the most common type of burns, while the proportion of flames increases as age goes up. Most patients are likely to get clinical treatment in time, however, the pre-hospital emergency burn care is not satisfying at present.

Apollo 16 mission report. Supplement 2: Service Propulsion system final flight evaluation

NASA Technical Reports Server (NTRS)

Smith, R. J.; Wood, S. C.

1974-01-01

The Apollo 16 Mission was the sixteenth in a series of flights using Apollo flight hardware and included the fifth lunar landing of the Apollo Program. The Apollo 16 Mission utilized CSM 113 which was equipped with SPS Engine S/N 66 (Injector S/N 137). The engine configuration and expected performance characteristics are presented. Since previous flight results of the SPS have consistently shown the existence of a negative mixture ratio shift, SPS Engine S/N 66 was reorificed to increase the mixture ratio for this mission. The propellant unbalance for the two major engine firings is compared with the predicted unbalance. Although the unbalance at the end of the TEI burn is significantly different than the predicted unbalance, the propellant mixture ratio was well within limits. The SPS performed six burns during the mission, with a total burn duration of 575.3 seconds. The ignition time, burn duration and velocity gain for each of the six SPS burns are reported.

Inflammatory response in multiple organs in a mouse model of acute alcohol intoxication and burn injury*

PubMed Central

Li, Xiaoling; Akhtar, Suhail; Kovacs, Elizabeth J.; Gamelli, Richard L.; Choudhry, Mashkoor A.

2011-01-01

The present study characterized the inflammatory response following burn injury and determined whether ethanol (EtOH) intoxication at the time of burn injury influences this response. To accomplish this, male mice were gavaged with EtOH (2.9 g/Kg) 4 hours prior to 12–15% total body surface area sham or burn injury. Mice were sacrificed on day one after injury; blood, small intestine, lung and liver were collected to measure IL-6, IL-10, IL-18 and MCP-1 levels. In addition, neutrophil infiltration, MPO activity and edema formation were also measured in the small intestine, lung and liver. There was no difference in the inflammatory markers in the small intestine, lung and liver in mice receiving either sham or burn injury alone except IL-6 which was increased in all 4 tissue compartments following burn injury alone. However, as compared to EtOH or burn injury alone, EtOH combined with burn injury resulted in a significant increase in cytokines, neutrophil infiltration, MPO activity and edema in the small intestine, liver and lung tissue. Furthermore, a significant increase in IL-6 and MCP-1 was observed in circulation following EtOH and burn injury compared to either EtOH intoxication or burn injury alone, no other cytokines were detected in circulation. These findings suggest that acute EtOH intoxication exacerbates the inflammatory response following burn injury. PMID:21593683

Alcohol potentiates post burn remote organ damage through shifts in fluid compartments mediated by bradykinin

PubMed Central

Chen, Michael M.; O’Halloran, Eileen B.; Ippolito, Jill A.; Choudhry, Mashkoor A.; Kovacs, Elizabeth J.

2014-01-01

Of the 450,000 burn patients each year, 50% have a positive blood alcohol content and this predisposes them to worsened clinical outcomes. Despite high prevalence and established consequences, the mechanisms responsible for alcohol-mediated complications of post burn remote organ damage are currently unknown. To this end, mice received a single dose of alcohol (1.12 g/kg) or water by oral gavage and were subjected to a 15% total body surface area burn. Animals with a burn alone lost ~5% of their body weight in 24 hours whereas intoxicated and burned mice lost only 1% body weight (p<0.05) despite a 17% increase in hematocrit (p<0.05) and a 57% increase in serum creatinine (p<0.05) over burn injury alone. This retention of water weight despite increased dehydration suggests that intoxication at the time of a burn causes a shift in fluid compartments that may exacerbate end organ ischemia and damage as evidenced by a 3-fold increase in intestinal bacterial translocation (p<0.05), a 30% increase (p<0.05) in liver weight to body weight ratio, and an increase in alveolar wall thickness over a burn alone. Furthermore, administration of the bradykinin antagonist HOE140 30 minutes after intoxication and burn restored fluid balance and alleviated end organ damage. These findings suggest that alcohol potentiates post burn remote organ damage through shifts in fluid compartments mediated by bradykinin. PMID:25243425

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.

The impact of infield biomass burning on PM levels and its chemical composition.

PubMed

Dambruoso, P; de Gennaro, G; Di Gilio, A; Palmisani, J; Tutino, M

2014-12-01

In the South of Italy, it is common for farmers to burn pruning waste from olive trees in spring. In order to evaluate the impact of the biomass burning source on the physical and chemical characteristics of the particulate matter (PM) emitted by these fires, a PM monitoring campaign was carried out in an olive grove. Daily PM10 samples were collected for 1 week, when there were no open fires, and when biomass was being burned, and at two different distances from the fires. Moreover, an optical particle counter and a polycyclic aromatic hydrocarbon (PAH) analyzer were used to measure the high time-resolved dimensional distribution of particles emitted and total PAHs concentrations, respectively. Chemical analysis of PM10 samples identified organic and inorganic components such as PAHs, ions, elements, and carbonaceous fractions (OC, EC). Analysis of the collected data showed the usefulness of organic and inorganic tracer species and of PAH diagnostic ratios for interpreting the impact of biomass fires on PM levels and on its chemical composition. Finally, high time-resolved monitoring of particle numbers and PAH concentrations was performed before, during, and after biomass burning, and these concentrations were seen to be very dependent on factors such as weather conditions, combustion efficiency, and temperature (smoldering versus flaming conditions), and moisture content of the wood burned.

Landsat-Based Detection and Severity Analysis of Burned Sugarcane Plots in Tarlac, Philippines Using Differenced Normalized Burn Ratio (dNBR)

NASA Astrophysics Data System (ADS)

Baloloy, A. B.; Blanco, A. C.; Gana, B. S.; Sta. Ana, R. C.; Olalia, L. C.

2016-09-01

The Philippines has a booming sugarcane industry contributing about PHP 70 billion annually to the local economy through raw sugar, molasses and bioethanol production (SRA, 2012). Sugarcane planters adapt different farm practices in cultivating sugarcane, one of which is cane burning to eliminate unwanted plant material and facilitate easier harvest. Information on burned sugarcane extent is significant in yield estimation models to calculate total sugar lost during harvest. Pre-harvest burning can lessen sucrose by 2.7% - 5% of the potential yield (Gomez, et al 2006; Hiranyavasit, 2016). This study employs a method for detecting burn sugarcane area and determining burn severity through Differenced Normalized Burn Ratio (dNBR) using Landsat 8 Images acquired during the late milling season in Tarlac, Philippines. Total burned area was computed per burn severity based on pre-fire and post-fire images. Results show that 75.38% of the total sugarcane fields in Tarlac were burned with post-fire regrowth; 16.61% were recently burned; and only 8.01% were unburned. The monthly dNBR for February to March generated the largest area with low severity burn (1,436 ha) and high severity burn (31.14 ha) due to pre-harvest burning. Post-fire regrowth is highest in April to May when previously burned areas were already replanted with sugarcane. The maximum dNBR of the entire late milling season (February to May) recorded larger extent of areas with high and low post-fire regrowth compared to areas with low, moderate and high burn severity. Normalized Difference Vegetation Index (NDVI) was used to analyse vegetation dynamics between the burn severity classes. Significant positive correlation, rho = 0.99, was observed between dNBR and dNDVI at 5% level (p = 0.004). An accuracy of 89.03% was calculated for the Landsat-derived NBR validated using actual mill data for crop year 2015-2016.

Electricity and fishing - a dangerous mix.

PubMed

Fodor, Lucian; Bota, Ioan O; Abbas, Yusuf; Fodor, Marius; Ciuce, Constantin

2011-05-01

The advent of fishing rods made of carbon fiber and graphite rods has greatly increased the risks of electrical injuries associated with fishing. The braided fishing lines and metal hooks put the fishermen at risk for electrical injuries. We review our burn center's experience with electrical injuries related to fishing activities during the last four years. We retrospectively collected data on patients with electrical burns related to fishing activities between January 2006, when our burns unit was established, and December 2009. Eight patients with electrical burns were admitted during this period of time, five who sustained the injury while fishing, due to contact of the fishing rod with overhead high-voltage cables and three who were injured during illegal fishing, using electricity to stun the fish. The total burn surface area ranged from 0.5% to 70%. Three of the patients sustained fourth degree burns, while the rest had second and third degree burns. One patient underwent scapulohumeral disarticulation and an above-knee amputation. Two patients had fingers and toes amputated. Latissimus dorsi and anterolateral thigh flaps were used to cover the defects in two cases. Local flaps were employed in other two cases to cover the tissue defects. Two patients died. Fishing-related burns and illegal fishing can lead to serious injuries and death. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

Alkali ocular burns in Martinique (French West Indies) Evaluation of the use of an amphoteric solution as the rinsing product.

PubMed

Merle, Harold; Donnio, Angélique; Ayeboua, Lucas; Michel, Franck; Thomas, Félix; Ketterle, Jeannine; Leonard, Christian; Josset, Patrice; Gerard, Max

2005-03-01

During the 4 years of this study, we noted 66 cases of alkali ocular burns, or approximately 16 cases per year, nearly half (45.5%) of which are due to an assault. For grade 1 and 2 burns the time elapsed to reepithelialization appears to be shorter when rinsed with Diphoterine* versus physiological solution. Comparison of the effectiveness of two rinsing solutions for emergency use: a physiological solution and an amphoteric solution (Diphoterine*, Laboratories Prevor, Valmondois, France). Description of the clinical and progressive characteristics of alkali burns treated at the University Hospital Center of Fort de France in Martinique (French West Indies). Prospective consecutive observational case series and nonrandomized comparative study. Sixty-six patients were included. The total number of burned eyes is 104. Forty-eight eyes (46%) were rinsed with physiological solution and 56 eyes (54%) with Diphoterine*. All patients benefited from an ocular rinse with 500ml of physiological solution or Diphoterine*, followed by a complete ophthalmologic exam. The ocular injuries were classified according to the Roper-Hall modification of the Hughes classification system. The same standardized therapeutic protocol was applied and adapted to the seriousness of the burn. Demographic data, time to corneal reepithelialization, final best corrected visual acuity and complications were analysed. Twenty-eight (42.4%) patients have a unilateral burn and 38 (57.6%) patients have bilateral burns. In decreasing order of frequency, the circumstances surrounding the injury are: assaults in 45.5% of cases (n=30), work-related accidents in 32% of cases (n=31), and domestic accidents in 23% of cases (n=15). For grade 1 and 2 burns the time elapsed to reepithelialization appears to be shorter when rinsed with Diphoterine* versus physiological solution (respectively): 1.9+/-1 days versus 11.1+/-1.4 days (p=10(-7)) and 5.6+/-4.9 days versus 10+/-9.2 days (p=0.02). For grade 3 and 4 burns, there are complications in 11 cases (11.6%): 8 corneal opacities and 3 perforations. This study is the first conducted in humans that takes into account the type of ocular rinse product used in the progressive follow-up study of injuries. The time elapsed to reepithelialization is shorter with Diphoterine* for grade 1 and 2 burns. There are not enough cases of grade 3 and 4 burns to make a conclusion. Diphoterine* seems very effective in terms of its mechanism of action and the experimental and clinical results.

Use of ordinary kriging to interpolate observations of fire radiative heat flux sampled with airborne imagery

NASA Astrophysics Data System (ADS)

Klauberg Silva, C.; Hudak, A. T.; Bright, B. C.; Dickinson, M. B.; Kremens, R.; Paugam, R.; Mell, W.

2016-12-01

Biomass burning has impacts on air pollution at local to regional scales and contributes to greenhouse gases and affects carbon balance at the global scale. Therefore, is important to accurately estimate and manage carbon pools (fuels) and fluxes (gases and particulate emissions having public health implications) associated with wildland fires. Fire radiative energy (FRE) has been shown to be linearly correlated with biomass burned in small-scale experimental fires but not at the landscape level. Characterization of FRE density (FRED) flux in J m-2 from a landscape-level fire presents an undersampling problem. Specifically, airborne acquisitions of long-wave infrared radiation (LWIR) from a nadir-viewing LWIR camera mounted on board fixed-wing aircraft provide only samples of FRED from a landscape-level fire, because of the time required to turn the plane around between passes, and a fire extent that is broader than the camera field of view. This undersampling in time and space produces apparent firelines in an image of observed FRED, capturing the fire spread only whenever and wherever the scene happened to be imaged. We applied ordinary kriging to images of observed FRED from five prescribed burns collected in forested and non-forested management units burned at Eglin Air Force Base in Florida USA in 2011 and 2012. The three objectives were to: 1. more realistically map FRED, 2. more accurately estimate total FRED as predicted from fuel consumption measurements, and 3. compare the sampled and kriged FRED maps to modeled estimates of fire rate of spread (ROS). Observed FRED was integrated from LWIR images calibrated to units of fire radiative flux density (FRFD) in W m-2. Iterating the kriging analysis 2-10 times (depending on the burn unit) led to more accurate FRED estimates, both in map form and in terms of total FRED, as corroborated by independent estimates of fuel consumption and ROS.

Improved survival following thermal injury in adult patients treated at a regional burn center.

PubMed

Gomez, Manuel; Cartotto, Robert; Knighton, Judy; Smith, Karen; Fish, Joel S

2008-01-01

Since January 1999, changes in the management of acute burn patients at a regional adult burn center included no hydrotherapy, blood sparing surgical techniques, a restrictive blood transfusion strategy, newer protective modes of mechanical ventilation, aggressive surgical wound excision, temporary wound closure with allograft skin, employment of advanced critical care trained nurses, and an increased number of dedicated full-time fellowship-trained burn surgeons. The purpose of this study was to determine the composite effect of these modifications on burn patients' survival. A retrospective hospital chart review was conducted among adult burn patients admitted during a 10-year period (1996-2005). Patients were stratified in two time periods: PAST (1996-1998) and RECENT (1999-2005). RECENT patients were selected by matching age, gender, total body surface area burn, full thickness burn, and presence of inhalation injury with PAST patients. All values are mean +/- SD. Student's t-test and chi2 analysis were performed accordingly with a P < .05 considered significant. Of 1569 acute burn patients admitted between 1996 and 2005, 96 (6%) were excluded because they received comfort measures only. Of the remaining 1473 patients, 684 patients (PAST = 342, RECENT = 342) were selected by the matching criteria. More RECENT patients required mechanical ventilation (25% vs 17%, P = .011), with a trend toward more prolonged duration (9 vs 11.5 days, P = .175), more escharotomies (9.6% vs 5.6%, P = .036), more operations (1.1 vs 0.8, P = .003), and more temporary allograft skin (10% vs 2%, P < .001) than did PAST patients. RECENT patients had lower mortality than did PAST patients (2.3% vs 5.6%, P = .048), specifically patients aged 60 or older (5.4% vs 25.5%, P = .004), patients with TBSA lower than 20% (1% vs 3.9%, P = .031), patients on mechanical ventilation (9.3% vs 27.6%, P = .006), and patients who had surgery (2.6% vs 7.3%, P = .032). The significant decrease in burn patient's mortality was likely due to the composite effects of improvements in clinical care between the two time periods.

Characterization of gas-phase organics using proton transfer reaction time-of-flight mass spectrometry: fresh and aged residential wood combustion emissions

NASA Astrophysics Data System (ADS)

Bruns, Emily A.; Slowik, Jay G.; El Haddad, Imad; Kilic, Dogushan; Klein, Felix; Dommen, Josef; Temime-Roussel, Brice; Marchand, Nicolas; Baltensperger, Urs; Prévôt, André S. H.

2017-01-01

Organic gases emitted during the flaming phase of residential wood combustion are characterized individually and by functionality using proton transfer reaction time-of-flight mass spectrometry. The evolution of the organic gases is monitored during photochemical aging. Primary gaseous emissions are dominated by oxygenated species (e.g., acetic acid, acetaldehyde, phenol and methanol), many of which have deleterious health effects and play an important role in atmospheric processes such as secondary organic aerosol formation and ozone production. Residential wood combustion emissions differ considerably from open biomass burning in both absolute magnitude and relative composition. Ratios of acetonitrile, a potential biomass burning marker, to CO are considerably lower ( ˜ 0.09 pptv ppbv-1) than those observed in air masses influenced by open burning ( ˜ 1-2 pptv ppbv-1), which may make differentiation from background levels difficult, even in regions heavily impacted by residential wood burning. A considerable amount of formic acid forms during aging ( ˜ 200-600 mg kg-1 at an OH exposure of (4.5-5.5) × 107 molec cm-3 h), indicating residential wood combustion can be an important local source for this acid, the quantities of which are currently underestimated in models. Phthalic anhydride, a naphthalene oxidation product, is also formed in considerable quantities with aging ( ˜ 55-75 mg kg-1 at an OH exposure of (4.5-5.5) × 107 molec cm-3 h). Although total NMOG emissions vary by up to a factor of ˜ 9 between burns, SOA formation potential does not scale with total NMOG emissions and is similar in all experiments. This study is the first thorough characterization of both primary and aged organic gases from residential wood combustion and provides a benchmark for comparison of emissions generated under different burn parameters.

Temporal Cytokine Profiles in Severely Burned Patients: A Comparison of Adults and Children

PubMed Central

Finnerty, Celeste C; Jeschke, Marc G; Herndon, David N; Gamelli, Richard; Gibran, Nicole; Klein, Matthew; Silver, Geoff; Arnoldo, Brett; Remick, Daniel; Tompkins, Ronald G

2008-01-01

A severe burn leads to hypermetabolism and catabolism resulting in compromised function and structural changes of essential organs. The release of cytokines has been implicated in this hypermetabolic response. The severity of the hypermetabolic response following burn injury increases with age, as does the mortality rate. Due to the relationship between the hypermetabolic and inflammatory responses, we sought to compare the plasma cytokine profiles following a severe burn in adults and in children. We enrolled 25 adults and 24 children who survived a flame burn covering more than 20% of total body surface area (TBSA). The concentrations of 22 cytokines were measured using the Linco multiplex array system (St. Charles, MO, USA). Large perturbations in the expression of pro- and anti-inflammatory cytokines were seen following thermal injury. During the first week following burn injury, IFN-γ, IL-10, IL-17, IL-4, IL-6, and IL-8 were detected at significantly higher levels in adults compared with children, P < 0.05. Significant differences were measured during the second week post-burn for IL-1β (higher in children) and IL-5 (higher in adults), P < 0.05. IL-18 was more abundant in children compared with adults during the third week post-burn, P < 0.05. Between post-burn d 21 and d 66, IL-1α was detected at higher concentrations in pediatric compared with adult patients, P < 0.05. Only GM-CSF expression was significantly different at all time points; it was detected at lower levels in pediatric patients, P < 0.05. Eotaxin, G-CSF, IL-13, IL-15, IP-10, MCP-1, and MIP-1α were detected at significantly different concentrations in adult compared with pediatric patients at multiple time points, P < 0.05. There were no differences in IL-12, IL-2, IL-7, or TNF levels in adult compared with pediatric burn patients at any of these time points. Following severe flame burns, the cytokine profiles in pediatric patients differ compared with those in adult patients, which may provide insight with respect to the higher morbidity rate in adults. Furthermore, the dramatic discrepancies observed in plasma cytokine detection between children and adults suggest that these two patient populations may benefit from different therapeutic interventions to achieve attenuation of the post-burn inflammatory response. PMID:18548133

Tensile and burning properties of clay/phenolic/GF composite and its application

NASA Astrophysics Data System (ADS)

Diharjo, Kuncoro; Armunanto, V. Bram; Kristiawan, S. Adi

2016-03-01

Composite material has been widely used in automotive due to its properties can be improved by combining with reinforcement, like fiber and particle to enhance mechanical properties and burning resistance. This study aims to investigate the tensile and burning properties of hybrid composite combining glass fiber and clay in phenolic resin. The clay was produced from roof tile rejected by tile industries in Sokka, Kebumen, Indonesia. The composite was made using a press mold method for different number of laminates and orientation of woven-roving-glass-fiber/ WRGF (0/90 and ±45), and the total volume fraction of fiber and clay is constant 40%. The specimens were tested using universal testing machine for tensile properties and burning tests apparatus for burning resistance (time to ignite/ TTI and burning rate/ BR). The enhancing of the Clay/Penolic/GF composite can be performed by the increasing of GF laminates, and the composite with 0/90 orientation of WRGF has higher tensile strength and modulus compared to that with ±45 orientation of WRGF. Both composite with 0/90 and ±45 orientation of WRGF have similar burning resistance (TTI and BR) and the composite containing 13 laminates of WR-GF shows the best burning resistance. According to these properties, this composite has good opportunity to be applied as car body panels or other structure in industries due to save weight and high burning resistance.

Development and evaluation of a novel smart device-based application for burn assessment and management.

PubMed

Godwin, Zachary; Tan, James; Bockhold, Jennifer; Ma, Jason; Tran, Nam K

2015-06-01

We have developed a novel software application that provides a simple and interactive Lund-Browder diagram for automatic calculation of total body surface area (TBSA) burned, fluid formula recommendations, and serial wound photography on a smart device platform. The software was developed for the iPad (Apple, Cupertino, CA) smart device platforms. Ten burns ranging from 5 to 95% TBSA were computer generated on a patient care simulator using Adobe Photoshop CS6 (Adobe, San Jose, CA). Burn clinicians calculated the TBSA first using a paper-based Lund-Browder diagram. Following a one-week "washout period", the same clinicians calculated TBSA using the smart device application. Simulated burns were presented in a random fashion and clinicians were timed. Percent TBSA burned calculated by Peregrine vs. the paper-based Lund-Browder were similar (29.53 [25.57] vs. 28.99 [25.01], p=0.22, n=7). On average, Peregrine allowed users to calculate burn size significantly faster than the paper form (58.18 [31.46] vs. 90.22 [60.60]s, p<0.001, n=7). The smart device application also provided 5 megapixel photography capabilities, and acute burn resuscitation fluid calculator. We developed an innovative smart device application that enables accurate and rapid burn size assessment to be cost-effective and widely accessible. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Epidemiology of burns undergoing hospitalization to the National Burns Unit in the Sultanate of Oman: a 25-year review.

PubMed

Al-Shaqsi, Sultan; Al-Kashmiri, Ammar; Al-Bulushi, Taimoor

2013-12-01

The aim of this study was to describe the epidemiology of burns admitted to the National Burns Unit (NBU) in the Sultanate of Oman between 1987 and 2011. This is a retrospective review of burn patients admitted to Oman's National Burns Unit (NBU) between 1987 and 2011. The data extracted from the national burn registry. The study describes the admission rate by gender and age groups, occupation, causes of burns, time-to-admission, length of stay and in-hospital mortality of burns between 1987 and 2011. During a 25-year from 1987 to 2011, there were 3531 burn patients admitted to the National Burns Unit in Oman. The average admission rate to NBU is 7.02 per 100,000 persons per year. On average, males were more likely to be admitted to the NBU than females during the study period (P value < 0.04). Patients aged 1-10 years old constituted 46.6% of caseload during the study period. Flames and scalds caused 88.4% of burns. About half of all patients admitted to the NBU have burns to more than 11% of total body surface area (TBSA). The average stay in hospital was estimated to be 15.3 days per patient. The average in-hospital mortality rate was estimated to be 8.2% per year (range 1.9-22%). Burns are significant public health issue in the Sultanate of Oman. Children are disproportionately over-represented in this study. Prevention programmes are urgently needed to address this "silent and costly epidemic." Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Early management in children with burns: Cooling, wound care and pain management.

PubMed

Baartmans, M G A; de Jong, A E E; van Baar, M E; Beerthuizen, G I J M; van Loey, N E E; Tibboel, D; Nieuwenhuis, M K

2016-06-01

Early management in burns, i.e. prior to admission in a burn center, is essential for an optimal process and outcome of burn care. Several publications have reported suboptimal early management, including low levels of pain medication after trauma, especially in children. The aim of this study was to evaluate the current practice in the Netherlands and factors related to early management in pediatric burns, i.e. cooling, wound covering and pain management. To study possible change and improvement over time, two study periods were compared. This study involved two periods; January 2002-March 2004 (period 1) and January 2007-August 2008 (period 2). All children (0-15 years of age) with acute burns admitted within 24h after burn to one of the three Dutch Burn centers with a formal referral were eligible. Data were obtained from patient records, both retrospectively and prospectively. A total of 323 and 299 children were included in periods 1 and 2, respectively. The vast majority of children in both study periods had been cooled before admission (>90%). Over time, wound covering increased significantly (from 64% to 89%) as well as pain treatment (from 68% to 79%). Predominantly paracetamol and morphine were used. Referral from ambulance services (OR=41.4, 95%CI=16.6-103.0) or general practitioners (OR=59.7, 95%CI=25.1-141.8) were strong independent predictors for not receiving pre-burn center pain medication. On the other hand, flame burns (OR=0.2, 95%CI=0.1-0.5) and more extensive burns (TBSA 5-10%: OR=0.4, 95%CI=-0.2 to 0.8; TBSA≥10%: OR=0.2, 95%CI=0.1-0.4) were independent predictors of receiving pain medication. Referring physicians of children with burns were overall well informed: they cool the wound after burns and cover it before transport to prevent hypothermia and reduce the pain. Additional studies should be conducted to clarify the duration and temperature for cooling to be effective. Furthermore, there is room and a need for improvement regarding early pain management. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Burns functional disabilities among burn survivors: a study in Komfo Anokye Teaching Hospital, Ghana

PubMed Central

Agbenorku, Pius

2013-01-01

Aim: To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. Patients and Methods: The descriptive study was carried out in Komfo Anokye Teaching Hospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. Results: A total of 70 participants consented for the study. Their ages ranged from 8/12 – 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). Conclusion: The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers’ time and financial constrains. PMID:23638325

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.

Landscape Patterns of Burn Severity in the Soberanes Fire of 2016

NASA Technical Reports Server (NTRS)

Potter, Christopher

2016-01-01

The Soberanes Fire started on July 22, 2016 in Monterey County on the California Central Coast from an illegal campfire. This fire burned for 10 weeks at a record cost of more than $208 million for protection and control. A progressive analysis of the normalized burn ratio from the Landsat satellite showed that the final high burn severity (HBS) area for the Soberanes Fire comprised 22 percent of the total area burned, whereas final moderate burn severity (MBS) area comprised about 10 percent of the total area burned of approximately 53,470 ha (132,130 acres). The resulting landscape pattern of burn severity classes from the 2016 Soberanes Fire revealed that the majority of HBS area was located in the elevation zone between 500 and 1000 m, in the slope zone between 15 percent and 30 percent, or on south-facing aspects.

Experimental Constraints on Iron Mobilization into Biomass Burning Aerosols

NASA Astrophysics Data System (ADS)

Sherry, A. M.; Romaniello, S. J.; Herckes, P.; Anbar, A. D.

2017-12-01

Atmospheric deposition of iron (Fe) can limit marine primary productivity and, therefore, carbon dioxide uptake. Recent modeling studies suggest that biomass burning aerosols may contribute a significant amount of soluble Fe to the surface ocean. To address this hypothesis, we collected foliage samples from species representative of several biomes impacted by severe fire events. Existing studies of burn-induced trace element mobilization have often collected both entrained soil particles along with material from burning biomass, making it difficult to determine the actual source of aerosolized trace metals. In order to better constrain the importance of biomass vs. entrained soil as a source of trace metals in burn aerosols, we conducted burn experiments using soil-free foliage representative of a variety of fire-impacted ecosystems. The resulting burn aerosols were collected in two stages (PM > 2.5 μm and PM < 2.5 μm) on cellulose filters using a high-volume air sampler equipped an all-Teflon impactor. Unburned foliage and burn aerosols were analyzed for Fe and other trace metals using inductively coupled plasma mass spectrometry (ICP-MS). Our results show that 0.06-0.86 % of Fe in plant biomass is likely mobilized as atmospheric aerosols during biomass burning events, depending on the type of foliage. We used these results and estimates of annual global wildfire area to estimate the impact of biomass burning aerosols on total atmospheric Fe flux to the ocean. We estimate that biomass-derived Fe likely contributes 3% of the total soluble Fe flux from aerosols. Prior studies, which implicitly included both biomass and soil-derived Fe, concluded that biomass burning contributed as much as 7% of the total marine soluble Fe flux from aerosols. Together, these studies suggest that biomass and fire-entrained soil probably contribute equally to the total fire-derived Fe aerosol flux. Further study of solubility differences between plant- and soil-derived Fe is needed to improve estimates of the soluble Fe contribution from biomass burning to the marine soluble Fe flux.

The effects of relaxation breathing on procedural pain and anxiety during burn care.

PubMed

Park, Eunok; Oh, Hyunjin; Kim, Taeim

2013-09-01

Burn patients experience high levels of pain and anxiety during dressing changes. Relaxation breathing is a simple behavioral intervention to manage pain and anxiety. However, the information about the effects of relaxation breathing on pain and anxiety levels for burn patients during dressing changes is limited. This study followed a quasi-experimental, pretest-posttest comparison group design without random assignment to groups. A total of 64 burn patients from Daejeon, South Korea were recruited by a convenience sequential sampling approach. With institutional approval and written consent, the experimental group practiced relaxation breathing during dressing change procedures. Data were collected from June to September 2011 using a VAS for pain and a VAS-A for anxiety. The homogeneity test was used to detect any significant group differences in the demographic data and pretest measures. The pain scores significantly differed between the 2 groups after intervention (RB group vs. control group, P=.01) and over time (pretest vs. posttest, P=.001). The anxiety scores significantly differed between the 2 groups (P=.01) and over time (P=.02). Relaxation breathing is a simple and inexpensive technique nurses can use to help burn patients manage pain and anxiety during dressing changes. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Estimates of global biomass burning emissions for reactive greenhouse gases (CO, NMHCs, and NOx) and CO2

NASA Astrophysics Data System (ADS)

Jain, Atul K.; Tao, Zhining; Yang, Xiaojuan; Gillespie, Conor

2006-03-01

Open fire biomass burning and domestic biofuel burning (e.g., cooking, heating, and charcoal making) algorithms have been incorporated into a terrestrial ecosystem model to estimate CO2 and key reactive GHGs (CO, NOx, and NMHCs) emissions for the year 2000. The emissions are calculated over the globe at a 0.5° × 0.5° spatial resolution using tree density imagery, and two separate sets of data each for global area burned and land clearing for croplands, along with biofuel consumption rate data. The estimated global and annual total dry matter (DM) burned due to open fire biomass burning ranges between 5221 and 7346 Tg DM/yr, whereas the resultant emissions ranges are 6564-9093 Tg CO2/yr, 438-568 Tg CO/yr, 11-16 Tg NOx/yr (as NO), and 29-40 Tg NMHCs/yr. The results indicate that land use changes for cropland is one of the major sources of biomass burning, which amounts to 25-27% (CO2), 25 -28% (CO), 20-23% (NO), and 28-30% (NMHCs) of the total open fire biomass burning emissions of these gases. Estimated DM burned associated with domestic biofuel burning is 3,114 Tg DM/yr, and resultant emissions are 4825 Tg CO2/yr, 243 Tg CO/yr, 3 Tg NOx/yr, and 23 Tg NMHCs/yr. Total emissions from biomass burning are highest in tropical regions (Asia, America, and Africa), where we identify important contributions from primary forest cutting for croplands and domestic biofuel burning.

The Baux score is dead. Long live the Baux score: a 27-year retrospective cohort study of mortality at a regional burns service.

PubMed

Roberts, Geoffrey; Lloyd, Mark; Parker, Mike; Martin, Rebecca; Philp, Bruce; Shelley, Odhran; Dziewulski, Peter

2012-01-01

To assess trends in mortality after burn injuries treated in a regional specialist burns service between 1982 and 2008. Patient and burn-specific information and mortality were collated from written admission ledgers and the hospital coding department for 11,109 patients. The data set was divided into age cohorts (0-14, 15-44, 45-64, and >65 years) and time cohorts (1982-1991, 1992-2000, and 2000-2008). Lethal area 50 (LA50) was calculated by logistic regression and probit analysis. Mortality was related to the Baux score (age + total % burned surface area) by logistic regression. In the time period 2000 to 2008, the LA50 values with approximate 95% confidence intervals (CIs) were 100% (CI, 85.5-100%) in the 0 to 14 cohort (LA10, 78.3%; CI, 64.1-92.5%), 76.4% (CI, 69.1-83.8%) in the 15 to 44 cohort, 58.6% (CI, 50.8-66.5%) in the 45 to 64 cohort, and 30.8% (CI, 24.7-36.9%) in the >65 cohort. The point of futility (the Baux Score at which predicted mortality is 100%) was 160 and the Baux50 (the Baux score at which predicted mortality is 50%) was 109.6 (CI, 105.9-113.4) in the 2000 to 2008 cohort. Mortality is markedly improved over earlier data from this study and other historical series and compares favorably with outcomes published from the US National Burn Repository. The Baux Score continues to provide an indication of the risk of mortality. Survival after major burn injury is increasingly common, and decisions by nonspecialist about initial triage, management, and futility of care should be made after consultation with a specialist burn service.

Accelerated Burn Wound Closure in Mice with a New Formula Based on Traditional Medicine

PubMed Central

Mehrabani, Mehrnaz; Seyyedkazemi, Seyyed Mohsen; Nematollahi, Mohammad Hadi; Jafari, Elham; Mehrabani, Mitra; Mehdipour, Mohammad; Sheikhshoaee, Zahra; Mandegary, Ali

2016-01-01

Background A combination of the oils of sesame, hemp, wild pistachio, and walnut has been used for treatment of skin disorders, including wound burns, in some parts of Kerman, Iran. Evaluation of this remedy in the form of a pharmaceutical formulation in animal models can pave the way for its future application in wound burn healing in humans. Objectives This experimental study investigated the healing potential of a new formula (NF) based on folk medicine from Iran for the treatment of third degree burns in mice. The formula was a combination of the oils of four plants: sesame (Sesamum indicum L.), wild pistachio (Pistacia atlantica Desf.), hemp (Cannabis sativa L.), and walnut (Juglans regia L.) Methods Twenty-four mice were selected based on simple random sampling. Twenty-five percent of the total body surface area was burned by exposure to boiling water, according to the Walker-Mason method. NF and silver sulfadiazine (the positive control) were applied topically twice a day for 21 days. The burned area in the negative control group was left untreated. Epithelialization time and the percent of wound contraction were measured during the treatment period. The process of wound repairing was evaluated using histological (H and E and trichrome staining) and immunohistological (anti-pancytokeratin) methods. Results When compared to the controls, NF significantly improved wound contraction after day 10. Epithelialization time in the NF group was significantly faster than in the other groups (20 vs. 25.5 days) (P < 0.001). Histopathological and immunohistochemical findings confirmed the efficacy of the NF. Conclusions A new therapeutic remedy was introduced for the treatment of burn wounds. Further clinical and molecular studies are suggested to determine the exact mechanism(s) involved in the burn wound healing effect of NF. PMID:28191338

Burns in a major burns center in East China from 2005 to 2014: Incidence and outcome.

PubMed

Fan, Xiaoming; Ma, Bing; Zeng, Ding; Fang, Xiao; Li, Haihang; Xiao, Shichu; Wang, Guangyi; Tang, Hongtai; Xia, Zhaofan

2017-11-01

Information about epidemiology on burns is rare in China. The aim of this article is to describe the pattern of burns in East China during a 10-year time period. A retrospective data analysis was performed on all hospitalized patients to the burn center at the Changhai hospital, one of major burn centers in East China, from 2005 to 2014. We included 3376 patients in this study. Among them, 48.1% were from 27 provinces out of Shanghai and nearly 90% were from East China. August saw the most admissions and November saw the fewest. Spring and summer separately dominated in number of female and male patients. Children aged 2-5 and working-age adult were the most commonly treated. Home was the commonest place of injury, followed by industrial-related places, outdoors, public buildings, and vehicles or roads. Scalds remained the primary reason, followed by fire, contact burns, electricity, and chemicals. The average %TBSA of male patients was 14.2±21.3, significantly different from that of female patients (10.4±16.9). Extremities were the most vulnerable body region burned, followed by the trunk, face and hands. The average hospital length of stay in male patients was 25.4±72.4 days, significantly different from that of females' 19.9±27.6 days. The total mortality was 1.8% and the lethal area burned resulting in 50% mortality was 96.5% TBSA. Compared with published data, these result are encouraging, which demonstrate that burn care and treatment has made significant progress. Burn clinicians should bear not only the responsibility to treat and cure burns, but also the popularization of knowledge about burn precautions and emergency treatments. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Cost Analysis of 48 Burn Patients in a Mass Casualty Explosion Treated at Chang Gung Memorial Hospital.

PubMed

Mathews, Alexandra L; Cheng, Ming-Huei; Muller, John-Michael; Lin, Miffy Chia-Yu; Chang, Kate W C; Chung, Kevin C

2017-01-01

Little is known about the costs of treating burn patients after a mass casualty event. A devastating Color Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This study was performed to investigate the economic effects of treating burn patients at a single medical center after an explosion disaster. A detailed retrospective analysis on 48 patient expense records at Chang Gung Memorial Hospital after the Color Dust explosion was performed. Data were collected during the acute treatment period between June 27, 2015 and September 30, 2015. The distribution of cost drivers for the entire patient cohort (n=48), patients with a percent total body surface area burn (%TBSA)≥50 (n=20), and those with %TBSA <50 (n=28) were analyzed. The total cost of 48 burn patients over the acute 3-month time period was $2,440,688, with a mean cost per patient of $50,848 ±36,438. Inpatient ward fees (30%), therapeutic treatment fees (22%), and medication fees (11%) were found to be the three highest cost drivers. The 20 patients with a %TBSA ≥50 consumed $1,559,300 (63.8%) of the total expenses, at an average cost of $77,965±34,226 per patient. The 28 patients with a %TBSA <50 consumed $881,387 (36.1%) of care expenses, at an average cost of $31,478±23,518 per patient. In response to this mass casualty event, inpatient ward fees represented the largest expense. Hospitals can reduce this fee by ensuring wound dressing and skin substitute materials are regionally stocked and accessible. Medication fees may be higher than expected when treating a mass burn cohort. In preparation for a future event, hospitals should anticipate patients with a %TBSA≥50 will contribute the majority of inpatient expenses. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cost Analysis of 48 Burn Patients in a Mass Casualty Explosion Treated at Chang Gung Memorial Hospital

PubMed Central

Mathews, Alexandra L.; Cheng, Ming-Huei; Muller, John-Michael; Lin, Miffy Chia-Yu; Chang, Kate W.C.; Chung, Kevin C.

2016-01-01

Introduction Little is known about the costs of treating burn patients after a mass casualty event. A devastating Color Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This study was performed to investigate the economic effects of treating burn patients at a single medical center after an explosion disaster. Methods A detailed retrospective analysis on 48 patient expense records at Chang Gung Memorial Hospital after the Color Dust explosion was performed. Data were collected during the acute treatment period between June 27, 2015 and September 30, 2015. The distribution of cost drivers for the entire patient cohort (n=48), patients with a percent total body surface area burn (%TBSA) ≥ 50 (n=20), and those with %TBSA <50 (n=28) were analyzed. Results The total cost of 48 burn patients over the acute 3-month time period was $2,440,688, with a mean cost per patient of $50,848 ±36,438. Inpatient ward fees (30%), therapeutic treatment fees (22%), and medication fees (11%) were found to be the three highest cost drivers. The 20 patients with a %TBSA ≥50 consumed $1,559,300 (63.8%) of the total expenses, at an average cost of $77,965 ± 34,226 per patient. The 28 patients with a %TBSA <50 consumed $881,387 (36.1%) of care expenses, at an average cost of $31,478 ± 23,518 per patient. Conclusions In response to this mass casualty event, inpatient ward fees represented the largest expense. Hospitals can reduce this fee by ensuring wound dressing and skin substitute materials are regionally stocked and accessible. Medication fees may be higher than expected when treating a mass burn cohort. In preparation for a future event, hospitals should anticipate patients with a %TBSA ≥ 50 will contribute the majority of inpatient expenses. PMID:27553390

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.

The trend of indexed papers in PubMed covering different aspects of self-immolation.

PubMed

Rezaeian, Mohsen

2014-01-01

Self-immolation is a fatal and devastating method of committing suicide used around the world. The chief aim of the present article is to look at the trend of indexed papers in PubMed covering different aspects of self-immolation. PubMed search engine (http://www.ncbi.nlm.nih.gov) was searched by using six keywords i.e. "self-immolation", "self-inflicted burn", "self-burning", "self-incineration", "suicidal burns" and "suicide by burning". These keywords should appear either in the title or the abstract of the articles. The time frame was set as to retrieve papers expanding from early indexing time up to end of the year 2011. Based on the search strategy 132 papers were retrieved from these total numbers; 12 (9%) were categorized as review papers; 24 (18%) as case reports and the rest 96 (73%) were original studies. It seems that the number of papers increased during the years of investigations and the highest indexed papers i.e. 14 (10.6%) belonged to the year 2011. While most journals, published only one article the highest indexed papers i.e. 35 (26.5%) belonged to Burns. There was an increasing trend in the number of self-immolation articles indexed in PubMed since 1965. Three journals i.e. Burns, Journal of Burn Care and Rehabilitation and Journal of Forensic Sciences hosted for more than 37% of all those indexed articles. However, given the increasing trend of self-immolation still more studies are needed to shed light on the diverse aspects of this appalling human behavior.

Biomass Burning Data and Information

Atmospheric Science Data Center

2015-04-21

Biomass Burning Data and Information This data set represents ... geographical and temporal distribution of total amount of biomass burned. These data may be used in general circulation models (GCMs) and ... models of the atmosphere. Project Title:  Biomass Burning Discipline:  Tropospheric Composition ...

Exhaust system-related burns affecting children: a UK perspective and literature review

PubMed Central

Vermaak, P.V.; Deall, C.E.; McArdle, C.; Burge, T.

2016-01-01

Summary Burns caused by exhaust systems in children may be associated with considerable morbidity. Current epidemiological data varies, but no data are available for the UK population. We aim to identify the pattern of exhaust-related burns affecting children who presented to a regional centre for paediatric burn care in the UK. Patients who sustained burns related to exhaust mechanisms between May 2005 and August 2012 were identified via the departmental database. Data collected included patient demographics, burn injury information, management and outcomes. Thirty-nine patients sustained 43 burns from contact with exhaust mechanisms, and the majority were less than 5 years of age. 77% of the patients were male. Burns affected critical areas such as the hands and feet in 26% of cases. Most burns involved a total body surface area of ≤1% and were partial thickness in depth. Thirty-three percent of patients required operative intervention. Time to heal was less than 3 weeks in 69% of cases and 3 patients healed with hypertrophic scarring. The majority of burns were small in size and partial thickness in depth. Most were treated conservatively and healed with low complication rates. More than 1 in 5 injuries involved critical burn areas, highlighting the potential for considerable morbidity. The age profile in our study contrasted with other results worldwide. Our study highlights the need for vigilant supervision of children around motorcycles. We recommend the wearing of protective long trousers when riding motorcycles and the fitting of external shields to motorcycle exhaust pipes. PMID:28149228

Operation Upshot-Knothole, Nevada Proving Grounds, March-June 1953. Project 8.5. Thermal Radiation Protection Afforded Test Animals by Fabric Assemblies

DTIC Science & Technology

1955-07-01

material. More recently its efforts have been concentrated on the development of an inanimate backing material that will simulate the time-temperature...the front and to the side of thc animals photographed. The motion photography for the 4500 ft. station was obtained by moving a total of six test... concentrated in areas adjacent to that covered by the drawstring. An example of such a burn is shown in Fig. 3.1. Seventeen pigs which were burned did

Perineal tap water burns in the elderly: at what cost?

PubMed

Potter, Michael D E; Maitz, Peter K M; Kennedy, Peter J; Goltsman, David

2017-11-01

Burn injuries are expensive to treat. Burn injuries have been found to be difficult to treat in elderly patients than their younger counterparts. This is likely to result in higher financial burden on the healthcare system; however, no population-specific study has been conducted to ascertain the inpatient treatment costs of elderly patients with hot tap water burns. Six elderly patients (75-92 years) were admitted for tap water burns at Concord Hospital during 2010. All costs incurred during their hospitalization were followed prospectively, and were apportioned into 'direct' and 'indirect' costs. Direct costs encompassed directly measurable costs, such as consumables used on the ward or in theatres, and indirect costs included hospital overheads, such as bed and theatre costs. Three males and three females admitted with burns to the buttocks, legs or feet. Total burn surface area (TBSA) ranged from 9-21% (mean 12.8%). Length of stay ranged from 26-98 days (mean 46 days). One patient died, and four required surgical management or grafting. Total inpatient costs ranged from $69 782.33 to $254 652.70 per patient (mean $122 800.20, standard deviation $67 484.46). TBSA was directly correlated with length of stay (P < 0.01) and total cost (P < 0.01). Hot water burns among the elderly are associated with high treatment costs, which are proportional to the size of the burn. The cost of treating this cohort is higher than previously reported in a general Australian burn cohort. © 2016 Royal Australasian College of Surgeons.

Feasibility of an advanced thrust termination assembly for a solid propellant rocket motor

NASA Technical Reports Server (NTRS)

1975-01-01

A total of 68 quench tests were conducted in a vented bomb assembly (VBA). Designed to simulate full-scale motor operating conditions, this laboratory apparatus uses a 2-inch-diameter, end-burning propellant charge and an insulated disc of consolidated hydrated aluminum sulfate along with the explosive charge necessary to disperse the salt and inject it onto the burning surface. The VBA was constructed to permit variation of motor design parameters of interest; i.e., weight of salt per unit burning surface area, weight of explosive per unit weight of salt, distance from salt surface to burning surface, incidence angle of salt injection, chamber pressure, and burn time. Completely satisfactory salt quenching, without re-ignition, occurred in only two VBA tests. These were accomplished with a quench charge ratio (QCR) of 0.023 lb salt per square inch of burning surface at dispersing charge ratios (DCR) of 13 and 28 lb of salt per lb of explosive. Candidate materials for insulating salt charges from the rocket combustion environment were evaluated in firings of 5-inch-diameter, uncured end-burner motors. A pressed, alumina ceramic fiber material was selected for further evaluation and use in the final demonstration motor.

Life expectancy in elderly patients following burns injury.

PubMed

Sepehripour, Sarvnaz; Duggineni, Sirisha; Shahsavari, Somaya; Dheansa, Baljit

2018-05-18

Burn injuries commonly occur in vulnerable age and social groups. Previous research has shown that frailty may represent a more important marker of adverse outcome in healthcare rather than chronological age (Roberts et al., 2012). In this paper we determined the relationship between burn injury, frailty, co-morbidities and long-term survival. Retrospective data collection from patients aged 75 with burns injuries, treated and discharged at Queen Victoria Hospital. The Clinical Frailty Scale (Rockwood et al., 2005) was used to calculate frailty at the time of admission. The expected mortality age (life expectancy) of deceased patients was obtained from two survival predictors. The data shows a statistically significant correlation between frailty score and complications and a statistically significant correlation between total body surface area percentage and complications. No significant difference was found between expected and observed age of death or life expectancy amongst the deceased (p value of 0.109). Based on the data from our unit, sustaining a burn as an elderly person does not reduce life expectancy. Medical and surgical complications, immediate, early and late, although higher with greater frailty and TBSA of burn, but do not adversely affect survival in this population. Copyright © 2018 Elsevier Ltd. All rights reserved.

Burn care delivery in a sub-saharan african unit: A cost analysis study.

PubMed

Gallaher, Jared R; Mjuweni, Stephen; Cairns, Bruce A; Charles, Anthony G

2015-07-01

There are significant resource challenges to burn surgical care delivery in low and middle-income countries at baseline and only a few burn cost analysis studies from sub-Saharan Africa have been performed. This is a retrospective database analysis of prospectively collected data from all patients recorded in the burn registry between June 2011 and August 2014 located at the Kamuzu Central Hospital Burn Unit in Lilongwe, Malawi. We utilized activity-based costing, a bottom-up cost analysis methodology with cost allocation that allows determination of unit cost or cost per service. 905 patients were admitted to the burn unit during the study period. The calculated total monthly burn expenditure for all cost centers was $11,622.66. Per day, the total unit cost was $387.42 with a mean daily per-patient cost of $24.26 (SD ± $6.44). Consequently, the mean cost per in-patient admission was $559.85 (SD ± $736.17). The mean daily cost per 1% total burn surface per patient at our center is $2.65 (SD ± $3.01). This burn care cost analysis study helps quantify the relative contribution of differing cost centers that comprise burn care delivery and hospital costs in a sub-Saharan African setting. Accurate and relevant cost information on hospital services at the patient level is therefore fundamental for policy makers, payers, and hospitals. Our study has demonstrated that comprehensive burn care is possible at a cost much lower than found in other burn centers in low or middle-income countries and can be sustained with moderate funding. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Biological markers of stress in pediatric acute burn injury.

PubMed

Brown, Nadia J; Kimble, Roy M; Rodger, Sylvia; Ware, Robert S; McWhinney, Brett C; Ungerer, Jacobus P J; Cuttle, Leila

2014-08-01

Burns and their associated wound care procedures evoke significant stress and anxiety, particularly for children. Little is known about the body's physiological stress reactions throughout the stages of re-epithelialization following an acute burn injury. Previously, serum and urinary cortisol have been used to measure stress in burn patients, however these measures are not suitable for a pediatric burn outpatient setting. To assess the sensitivity of salivary cortisol and sAA in detecting stress during acute burn wound care procedures and to investigate the body's physiological stress reactions throughout burn re-epithelialization. Seventy-seven participants aged four to thirteen years who presented with an acute burn injury to the burn center at the Royal Children's Hospital, Brisbane, Australia, were recruited between August 2011 and August 2012. Both biomarkers were responsive to the stress of burn wound care procedures. sAA levels were on average 50.2 U/ml higher (p<0.001) at 10 min post-dressing removal compared to baseline levels. Salivary cortisol levels showed a blunted effect with average levels at ten minutes post dressing removal decreasing by 0.54 nmol/L (p<0.001) compared to baseline levels. sAA levels were associated with pain (p=0.021), no medication (p=0.047) and Child Trauma Screening Questionnaire scores at three months post re-epithelialization (p=0.008). Similarly, salivary cortisol was associated with no medication (p<0.001), pain scores (p=0.045) and total body surface area of the burn (p=0.010). Factors which support the use of sAA over salivary cortisol to assess stress during morning acute burn wound care procedures include; sensitivity, morning clinic times relative to cortisol's diurnal peaks, and relative cost. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

How Much Global Burned Area Can Be Forecast on Seasonal Time Scales Using Sea Surface Temperatures?

NASA Technical Reports Server (NTRS)

Chen, Yang; Morton, Douglas C.; Andela, Niels; Giglio, Louis; Randerson, James T.

2016-01-01

Large-scale sea surface temperature (SST) patterns influence the interannual variability of burned area in many regions by means of climate controls on fuel continuity, amount, and moisture content. Some of the variability in burned area is predictable on seasonal timescales because fuel characteristics respond to the cumulative effects of climate prior to the onset of the fire season. Here we systematically evaluated the degree to which annual burned area from the Global Fire Emissions Database version 4 with small fires (GFED4s) can be predicted using SSTs from 14 different ocean regions. We found that about 48 of global burned area can be forecast with a correlation coefficient that is significant at a p < 0.01 level using a single ocean climate index (OCI) 3 or more months prior to the month of peak burning. Continental regions where burned area had a higher degree of predictability included equatorial Asia, where 92% of the burned area exceeded the correlation threshold, and Central America, where 86% of the burned area exceeded this threshold. Pacific Ocean indices describing the El Nino-Southern Oscillation were more important than indices from other ocean basins, accounting for about 1/3 of the total predictable global burned area. A model that combined two indices from different oceans considerably improved model performance, suggesting that fires in many regions respond to forcing from more than one ocean basin. Using OCI-burned area relationships and a clustering algorithm, we identified 12 hotspot regions in which fires had a consistent response to SST patterns. Annual burned area in these regions can be predicted with moderate confidence levels, suggesting operational forecasts may be possible with the aim of improving ecosystem management.

Pre-existing psychiatric disorder in the burn patient is associated with worse outcomes.

PubMed

Hudson, Alexandra; Al Youha, Sarah; Samargandi, Osama A; Paletz, Justin

2017-08-01

To compare patient and burn characteristics between patients who had a pre-existing psychiatric diagnosis and patients who did not in a Burn Unit at an academic hospital. Psychosocial issues are common in patients recovering from a burn; however, little is known regarding hospital course and discharge outcomes in patients with a pre-existing psychiatric diagnosis presenting with a burn. Baseline medical comorbidities of burn patients have been shown to be a significant risk for in-hospital mortality. A retrospective chart review of 479 consecutive patients admitted to the Burn Unit of an academic hospital in Halifax, Nova Scotia between March 2nd 1995 and June 1st 2013 was performed. Extensive data regarding patient and burn characteristics and outcomes was collected. Patients with and without pre-existing psychiatric diagnoses at the time of hospital admission were compared. Sixty-three (13%) patients had a psychiatric diagnosis, with the most common being depression (52%). Forty-percent (n=25/63) of these patients had multiple pre-existing psychiatric diagnoses. Patients with a psychiatric diagnosis had a greater total-body-surface-area (TBSA)% covered by a third-degree burn (p=0.001), and were more likely to have an inhalation injury (p<0.001). These patients were also significantly more likely to experience 6 of the 10 most prevalent in-hospital complications and had a higher mortality rate (p=0.02). They were less likely to be discharged home (p=0.001), and more likely to go to a home hospital (p=0.04) or rehabilitation facility (p=0.03). Psychiatric diagnosis was associated with significantly more placement issues (e.g. rehab bed unavailability, homeless) upon discharge from the Burn Unit (p=0.01). The risk of death in burn patients with pre-existing psychiatric disorders was about three times the risk of death in patients with no psychiatric disorders when adjusting for other potential confounders (95% CI, 1.13-9.10; p-value 0.03). Presence of a pre-existing psychiatric disorder in the burn patient was associated with worse outcomes and was a significant predictor of death. Psychiatric diagnoses should be identified early in burn treatment and efforts should be made to ensure a comprehensive approach to inpatient support and patient discharge to reduce unfavorable burn outcomes and placement issues. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Biogeochemical patterns of intermittent streams over space and time as surface flows decrease

NASA Astrophysics Data System (ADS)

MacNeille, R. B.; Lohse, K. A.; Godsey, S.; McCorkle, E. P.; Parsons, S.; Baxter, C.

2016-12-01

Climate change in the western United States is projected to lead to earlier snowmelt, increasing fire risk and potentially transitioning perennial streams to intermittent ones. Differences between perennial and intermittent streams, especially the temporal and spatial patterns of carbon and nutrient dynamics during periods of drying, are understudied. We examined spatial and temporal patterns in surface water biogeochemistry in southwest Idaho and hypothesized that as streams dry, carbon concentrations would increase due to evapoconcentration and/or increased in-stream production. Furthermore, we expected that biogeochemical patterns of streams would become increasingly spatially heterogeneous with drying. Finally, we expected that these patterns would vary in response to fire. To test these hypotheses, we collected water samples every 50 meters from two intermittent streams, one burned and one unburned, in April, May and June, 2016 to determine surface water biogeochemistry. Results showed average concentrations of dissolved inorganic carbon (DIC) and dissolved organic carbon (DOC) increased 3-fold from April to June in the burned site compared to the unburned site where concentrations remained relatively constant. Interestingly, average concentrations of total nitrogen (TN) dropped substantially for the burned site over these three months, but only decreased slightly for the unburned site over the same time period. We also assessed changes in spatial correlation between the burned and unburned site: carbon concentrations were less spatially correlated at the unburned site than at the burned site. Scatterplot matrices of DIC values indicated that at a lag distance of 300 m in April and June, the unburned site had r-values of 0.7416 and 0.5975, respectively, while the burned site had r-values of 0.9468 and 0.8783, respectively. These initial findings support our hypotheses that carbon concentrations and spatial heterogeneity increased over time.

[Autogenous platelet-rich plasma gel with acellular xenogeneic dermal matrix for treatment of deep II degree burns].

PubMed

Hao, Tianzhi; Zhu, Jingmin; Hu, Wenbo; Zhang, Hua; Gao, Zhenhui; Wen, Xuehui; Zhou, Zhi; Lu, Gang; Liu, Jingjie; Li, Wen

2010-06-01

To investigate the effectiveness of autogenous platelet-rich plasma (PRP) gel with acellular xenogeneic dermal matrix in the treatment of deep II degree burns. From January 2007 to December 2009, 30 cases of deep II degree burns were treated. There were 19 males and 11 females with an average age of 42.5 years (range, 32-57 years). The burn area was 10% to 48% of total body surface area. The time from burn to hospitalization was 30 minutes to 8 hours. All patients were treated with tangential excision surgery, one side of the wounds were covered with autogenous PRP gel and acellular xenogeneic dermal matrix (PRP group), the other side of the wounds were covered with acellular xenogeneic dermal matrix only (control group). The healing rate, healing time, infection condition, and scar formation were observed. At 7 days after operation, the infection rate in PRP group (6.7%, 2/30) was significantly lower than that in control group (16.7%, 5/30, P < 0.05). The healing times were (18 +/- 4) days and (22 +/- 4) days respectively in PRP group and control group, showing significant difference (P < 0.05). The healing rates at 14 days and 21 days were 75% +/- 7% and 88% +/- 5% in PRP group, were 62% +/- 15% and 73% +/- 7% in control group, showing significant difference (P < 0.05). RPR group was superior to control group in elasticity, color, appearance, softness, scar formation, and healing quality. Autogenous PRP gel with acellular xenogeneic dermal matrix can accelerate the wound healing of deep II degree burns as well as alleviate the scar proliferation.

Burden of burns in Portugal, 2000-2013: A clinical and economic analysis of 26,447 hospitalisations.

PubMed

Santos, João V; Oliveira, Andreia; Costa-Pereira, Altamiro; Amarante, José; Freitas, Alberto

2016-06-01

There is a lack of recent and nation-wide epidemiological studies of burns in Europe, mainly in southern Europe. There are no recent studies describing the clinical and economic burden of burns in this European area. Hence, this research aimed to describe the clinical and economic burden of burn hospitalisations in Portugal. A retrospective observational study was performed and the Portuguese hospitalisation database of public hospitals was used; all inpatients, discharged between 2000 and 2013, with a main or secondary diagnosis of burns (ICD-9-CM: 940.xx-949.xx) were taken into account. Furthermore, admissions to hospitals with and without burn centres were compared. A total of 26,447 burn hospitalisations were registered (mean of 1889burn admissions/year). The total hospitalisation rate was of 18.9hospitalisations/100,000inhabitants/year, and there was a higher incidence of male patients. Burn hospitalisations and hospitalisation rates are significantly decreasing - mostly in 0-14-year-old patients - and children below the age of 5 years represented a fifth of all admissions. Besides the important morbidity, the in-hospital mortality rate was of 4.4%. With a total annual charge of almost 13million Euros, the average cost per burn admission is increasing, and reached 8032Euros in 2013. Additionally, more than half of the patients admitted to hospitals without burn centres were not transferred to hospitals with burn centres, not following the European Burns Association transferral criteria. As the largest southern European nation-wide epidemiological study of burn patients, this research highlights that burn admissions, as well as hospitalisation rates, are decreasing significantly. This was particularly obvious among the youngest patients despite the fact that the numbers still remain very high. Moreover, the in-hospital mortality rate is still excessively high and the burn transferral criteria are not being followed. Thus, it is important to improve preventive measures, reach out to and educate providers about the burn transferral criteria, and develop specific health care strategies for children with these injuries. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Assault by burning in Jordan.

PubMed

Haddadin, W

2012-12-31

Criminal attacks by burns on women in Jordan are highlighted in this retrospective study carried out of all proved cases of criminal burns in female patients treated at the burn unit of the Royal Rehabilitation Center in Jordan between January 2005 and June 2012. Thirteen patients were included in our study, out of a total of 550 patients admitted, all in the age range of 16-45 yr. Of these 13 women, six were burned by acid throwing, five by hot water, and two by direct flames from fuel thrown over them. Burn percentage ranged from 15 to 75% of the total body surface area, with involvement in most cases of the face and upper trunk. The mean hospital stay was 33 days and the mortality rate was 3/13, i.e. 23%. Violence against women exists in Jordanian society, yet burning assaults are rare. Of these, burning by throwing acid is the most common and most disfiguring act, with a higher mortality rate in domestic environments.

Assault by burning in Jordan

PubMed Central

Haddadin, W.

2012-01-01

Summary Criminal attacks by burns on women in Jordan are highlighted in this retrospective study carried out of all proved cases of criminal burns in female patients treated at the burn unit of the Royal Rehabilitation Center in Jordan between January 2005 and June 2012. Thirteen patients were included in our study, out of a total of 550 patients admitted, all in the age range of 16-45 yr. Of these 13 women, six were burned by acid throwing, five by hot water, and two by direct flames from fuel thrown over them. Burn percentage ranged from 15 to 75% of the total body surface area, with involvement in most cases of the face and upper trunk. The mean hospital stay was 33 days and the mortality rate was 3/13, i.e. 23%. Violence against women exists in Jordanian society, yet burning assaults are rare. Of these, burning by throwing acid is the most common and most disfiguring act, with a higher mortality rate in domestic environments. PMID:23766757

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases.

PubMed

Türegün, M; Sengezer, M; Selmanpakoglu, N; Celiköz, B; Nişanci, M

1997-01-01

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the first, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0-10 years old (40 per cent) and moderate to major burns in the age group 21-30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.

A review of burns patients admitted to the Burns Unit of Hospital Universiti Kebangsaan Malaysia.

PubMed

Chan, K Y; Hairol, O; Imtiaz, H; Zailani, M; Kumar, S; Somasundaram, S; Nasir-Zahari, M

2002-12-01

This is a retrospective review of 110 patients admitted to the Burns Units between October 1999 and November 2001. The aim was to determine the burns pattern of patients admitted to hospital UKM. There was an increasing trend for patients admitted. Female to male ratio was 1:2. Children consisted 34% of the total admission. Children had significant higher number of scald burns as compare to adult (p < 0.01). Domestic burns were consist of 75% overall admission. Mean percentage of TBSA (total body surface area) burns was 19%. Thirty percent of patients sustained more than 20% of TBSA. Sixty percent of patients had scald burns. Ninety percents of patients with second degree burns that were treated with biologic membrane dressing or split skin graft. Mean duration of hospital stay was 10 days. Over 70% of patients were discharged within 15 days. Overall mortality rate was 6.3%. The patients who died had significantly larger area of burns of more than 20% TBSA (p < 0.05) and a higher incidence of inhalation injury (p < 0.02). Hence, this study suggests a need for better preventive measures by the authority to prevent burns related accident and the expansion of the service provided by the Burns Unit.

Ignition transient analysis of solid rocket motor

NASA Technical Reports Server (NTRS)

Han, Samuel S.

1990-01-01

To predict pressure-time and thrust-time behavior of solid rocket motors, a one-dimensional numerical model is developed. The ignition phase of solid rocket motors (time less than 0.4 sec) depends critically on complex interactions among many elements, such as rocket geometry, heat and mass transfer, flow development, and chemical reactions. The present model solves the mass, momentum, and energy equations governing the transfer processes in the rocket chamber as well as the attached converging-diverging nozzle. A qualitative agreement with the SRM test data in terms of head-end pressure gradient and the total thrust build-up is obtained. Numerical results show that the burning rate in the star-segmented head-end section and the erosive burning are two important parameters in the ignition transient of the solid rocket motor (SRM).

Use of the videophone to collect quality of life data from burn patients

PubMed Central

Yoder, Linda H; McFall, D Curk; Cancio, Leopoldo C

2012-01-01

Collecting quality of life (QOL) data longitudinally from burn survivors is difficult; especially if they live in geographically distant areas from the burn center. Although mailed surveys can be used, response rates to these surveys may be low. The purpose of this feasibility study was to examine the use of the videophone to collect QOL data from burn patients over 5 time points after discharge from the U.S. Army Institute of Surgical Research Burn Center. Twenty-five patients agreed to participate, using the Starview 2000 Pro II videophone. Participant satisfaction with the technology was measured using the Telemedicine Perception Questionnaire. Qualitative comments from participants and the researchers conducting the videophone data collection sessions also were collected. Military participants were approximately 20 years younger than civilian participants. Most burns were from a thermal cause and civilian patients had a slightly shorter length of stay in the burn center than military participants. The majority of participants were relatively happy with the telehealth technology, rating it with a mean score of 61.84 out of a possible total score of 85. Qualitative comments also reflected a positive attitude about the use of the videophone for research data collection; 60% of the participants said they remained in the study because they were allowed to use the videophone rather than using only the telephone or a mailed survey. The researchers collecting the data also commented about the ease of using the videophone. Negative comments were related to dropped calls or lack of audio or video at certain times. Findings from this study are consistent with the two other studies that reported use of telemedicine to clinically evaluate burn patients. With the rapid advancement of technology, QOL research data could be collected longitudinally from burn patients by using laptops with high resolution, portable video cameras. PMID:23272295

Work-related burn injuries in Ontario, Canada: a follow-up 10-year retrospective study

PubMed Central

Clouatre, Elsa; Gomez, Manuel; Banfield, Joanne; Jeschke, Marc G

2013-01-01

Work-related burn injuries contribute to a quarter of all burn injuries in USA. In 2009, the provincial Workplace Safety and Insurance Board reported 64,824 work-related injuries that resulted in time-lost, 1188 injuries (2%) were a result of burns. There have been two previous studies performed at a regional burn centre (1984-1990 and 1998-2000) looking at incidence and characteristics of work-related burns. There was no significant change between these two groups. The purpose of this study was to identify the recent pattern of work-related burns from 2001 to 2010 and to compare it to the previous studies. During the study period, 1427 patients were admitted for an acute injury to the regional burn centre. Of these, 330 were due to a work-related incident (23%). The mean age of patients was 40.5±11.9 years, 95% were male. The mean total body surface area burn was 11.9±16.2%. The most common mechanism of burn injury was flame (32.7%) followed by electrical (27%) and scald (19.7%), inhalation injury was present in 4.8% of patients and the mortality was 1.8%. Our study has shown that there has been a significant decrease in the incidence in work-related burns treated at the regional burn centre (23.1%, vs. 28.2% vs. 30.2% p<0.01), flame burns have now become the leading cause of injury, there was a significant reduction in inhalation injury (4.8% vs. 23% vs. 14.8%, p<0.00001), and mortality overtime (1.8%, vs. 4% vs. 6.7% p=0.02). These findings strongly suggests a change in the cause of work-related burns, improvement in burn care, and that prevention strategies may have been more effective. PMID:23352030

Forward-looking infrared imaging predicts ultimate burn depth in a porcine vertical injury progression model.

PubMed

Miccio, Joseph; Parikh, Shruti; Marinaro, Xavier; Prasad, Atulya; McClain, Steven; Singer, Adam J; Clark, Richard A F

2016-03-01

Current methods of assessing burn depth are limited and are primarily based on visual assessments by burn surgeons. This technique has been shown to have only 60% accuracy and a more accurate, simple, noninvasive method is needed to determine burn wound depth. Forward-looking infrared (FLIR) thermography is both noninvasive and user-friendly with the potential to rapidly assess burn depth. The purpose of this paper is to determine if early changes in burn temperature (first 3 days) can be a predictor of burn depth as assessed by vertical scarring 28 days after injury. While under general anesthesia, 20 burns were created on the backs of two female Yorkshire swine using a 2.5cm×2.5cm×7.5cm, 150g aluminum bar, for a total of 40 burns. FLIR imaging was performed at both early (1, 2 and 3 days) and late (7, 10, 14, 17, 21, 24 and 28 days) time points. Burns were imaged from a height of 12 inches from the skin surface. FLIR ExaminIR(©) software was used to examine the infrared thermographs. One hundred temperature points from burn edge to edge across the center of the burn were collected for each burn at all time points and were exported as a comma-separated values (CSV) file. The CSV file was processed and analyzed using a MATLAB program. The temperature profiles through the center of the burns generated parabola-like curves. The lowest temperature (temperature minimum) and a line midway between the temperature minimum and ambient skin temperature at the burn edges was defined and the area of the curve calculated (the "temperature half-area"). Half-area values 2 days after burn had higher correlations with scar depth than did the minimum temperatures. However, burns that became warmer from 1 day to 2 days after injury had a lower scar depth then burns that became cooler and this trend was best predicted by temperature minima. When data were analyzed as a diagnostic test for sensitivity and specificity using >3mm scarring, i.e. a full-thickness burn, as a clinically relevant criterion standard, temperature minima at 2 days after burn was found to be the most sensitive and specific test. FLIR imaging is a fast and simple tool that has been shown to predict burn wound outcome in a porcine vertical injury progression model. Data showed that more severe burn wounds get cooler between 1 and 2 days after burn. We found four analytic methods of FLIR images that were predictive of burn progression at 1 and 2 days after burn; however, temperature minima 2 days after burn appeared to be the best predictive test for injury progression to a full-thickness burn. Although these results must be validated in clinical studies, FLIR imaging has the potential to aid clinicians in assessing burn severity and thereby assisting in burn wound management. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Direct Mouse Trauma/Burn Model of Heterotopic Ossification

PubMed Central

Peterson, Jonathan R.; Agarwal, Shailesh; Brownley, R. Cameron; Loder, Shawn J.; Ranganathan, Kavitha; Cederna, Paul S.; Mishina, Yuji; Wang, Stewart C.; Levi, Benjamin

2015-01-01

Heterotopic ossification (HO) is the formation of bone outside of the skeleton which forms following major trauma, burn injuries, and orthopaedic surgical procedures. The majority of animal models used to study HO rely on the application of exogenous substances, such as bone morphogenetic protein (BMP), exogenous cell constructs, or genetic mutations in BMP signaling. While these models are useful they do not accurately reproduce the inflammatory states that cause the majority of cases of HO. Here we describe a burn/tenotomy model in mice that reliably produces focused HO. This protocol involves creating a 30% total body surface area partial thickness contact burn on the dorsal skin as well as division of the Achilles tendon at its midpoint. Relying solely on traumatic injury to induce HO at a predictable location allows for time-course study of endochondral heterotopic bone formation from intrinsic physiologic processes and environment only. This method could prove instrumental in understanding the inflammatory and osteogenic pathways involved in trauma-induced HO. Furthermore, because HO develops in a predictable location and time-course in this model, it allows for research to improve early imaging strategies and treatment modalities to prevent HO formation. PMID:26274052

Dementia: A risk factor for burns in the elderly.

PubMed

Harvey, Lara; Mitchell, Rebecca; Brodaty, Henry; Draper, Brian; Close, Jacqueline

2016-03-01

Older people are disproportionately at risk of burn and have a high risk of dementia; however the impact of dementia on risk of burn is unknown. Linked hospitalisation and death records for individuals aged 65 years and older admitted to a NSW hospital for a burn over the ten year period 2003-2012 were analysed. Demographic and burn characteristics and health outcomes were compared for people with and without dementia. Incidence rates were calculated per 100,000 population and negative binomial regression was used to examine temporal trends. Of the 1535 older people hospitalised for a burn, 11.0% had a record of dementia. The age-standardised incidence rate for people with dementia was 22.7 per 100,000, and for people without dementia was 14.2 per 100,000 population, an incident rate ratio (IRR) of 1.6 (95%CI 1.3-2.0, p<0.0001). There was no significant change in rates over time. People with dementia were more likely to be admitted with burns to the trunk and have greater than 20% total body surface area (TBSA) burn. Mean length of stay (LOS) was more than double (24 vs 12 days) and 30-day mortality three times higher (15.4% vs 5.1%) for people with dementia. Adjusting for differences in age, sex, TBSA, inhalation injury, comorbidities and complications eliminated the increased mortality but not the difference in LOS. People with dementia were more likely to have been burnt by hot tap water (RR 2.3; 95%CI 1.8-2.8, p<0.0001) and ignition of clothing/nightwear (RR 2.6; 95% CI 1.2-5.4, p=0.0149) and to have sustained the burn in residential aged care (20.0%). Burns in people with dementia are significant injuries, which have not decreased over the past ten years despite prevention efforts to reduce burns in older people. Targeted prevention education in the home and residential aged care facilities is warranted. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Radiocarbon-based impact assessment of open biomass burning on regional carbonaceous aerosols in North China.

PubMed

Zong, Zheng; Chen, Yingjun; Tian, Chongguo; Fang, Yin; Wang, Xiaoping; Huang, Guopei; Zhang, Fan; Li, Jun; Zhang, Gan

2015-06-15

Samples of total suspended particulates (TSPs) and fine particulate matter (PM2.5) were collected from 29th May to 1st July, 2013 at a regional background site in Bohai Rim, North China. Mass concentrations of particulate matter and carbonaceous species showed a total of 50% and 97% of the measured TSP and PM2.5 levels exceeded the first grade national standard of China, respectively. Daily concentrations of organic carbon (OC) and elemental carbon (EC) were detected 7.3 and 2.5 μg m(-3) in TSP and 5.2 and 2.0 μg m(-3) in PM2.5, which accounted 5.8% and 2.0% of TSP while 5.6% and 2.2% for PM2.5, respectively. The concentrations of OC, EC, TSP and PM2.5 were observed higher in the day time than those in the night time. The observations were associated with the emission variations from anthropogenic activities. Two merged samples representing from south and north source areas were selected for radiocarbon analysis. The radiocarbon measurements showed 74% of water-insoluble OC (WINSOC) and 59% of EC in PM2.5 derived from biomass burning and biogenic sources when the air masses were from south region, and 63% and 48% for the air masses from north, respectively. Combined with backward trajectories and daily burned area, open burning of agricultural wastes was found to be predominating, which was confirmed by the potential source contribution function (PSCF). Copyright © 2015 Elsevier B.V. All rights reserved.

Cardiovascular risk profile in burn survivors.

PubMed

Leung, Becky; Younger, John F; Stockton, Kellie; Muller, Michael; Paratz, Jennifer

2017-11-01

Burn patients have prolonged derangements in metabolic, endocrine, cardiac and psychosocial systems, potentially impacting on their cardiovascular health. There are no studies on the risk of cardiovascular disease (CVD) after-burn. The aim of our study was to record lipid values and evaluate CVD risk in adult burn survivors. In a cross-sectional study patients ≥18 years with burn injury between 18-80% total burn surface area (TBSA) from 1998 to 2012 had total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides measured via finger prick. Means were compared to optimal ranges. Multivariate regression models were performed to assess the association of lipids with age, years after-burn and total body surface area % (TBSA). A p value <0.05 was considered significant. The Framingham General Cardiovascular Risk Score (FGCRS) was calculated. Fifty patients were included in the study. Compared to optimal values, patients had low HDL and high triglycerides. Greater %TBSA was associated with statistically significant elevation of triglycerides (p=0.007) and total cholesterol/HDL ratio (p=0.027). The median FGCRS was 3.9% (low) 10-year risk of CVD with 82% of patients in the low-risk category. Patients involved in medium/high level of physical activity had optimal values of HDL, TC/HDL and triglycerides despite the magnitude of TBSA%. Adult burn survivors had alterations in lipid profile proportional to TBSA, which could be modified by exercise, and no increase in overall formally predicted CVD risk in this cross sectional study. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Biomass burning emissions of reactive gases estimated from satellite data analysis and ecosystem modeling for the Brazilian Amazon region

NASA Astrophysics Data System (ADS)

Potter, Christopher; Brooks-Genovese, Vanessa; Klooster, Steven; Torregrosa, Alicia

2002-10-01

To produce a new daily record of trace gas emissions from biomass burning events for the Brazilian Legal Amazon, we have combined satellite advanced very high resolution radiometer (AVHRR) data on fire counts together for the first time with vegetation greenness imagery as inputs to an ecosystem biomass model at 8 km spatial resolution. This analysis goes beyond previous estimates for reactive gas emissions from Amazon fires, owing to a more detailed geographic distribution estimate of vegetation biomass, coupled with daily fire activity for the region (original 1 km resolution), and inclusion of fire effects in extensive areas of the Legal Amazon (defined as the Brazilian states of Acre, Amapá, Amazonas, Maranhao, Mato Grosso, Pará, Rondônia, Roraima, and Tocantins) covered by open woodland, secondary forests, savanna, and pasture vegetation. Results from our emissions model indicate that annual emissions from Amazon deforestation and biomass burning in the early 1990s total to 102 Tg yr-1 carbon monoxide (CO) and 3.5 Tg yr-1 nitrogen oxides (NOx). Peak daily burning emissions, which occurred in early September 1992, were estimated at slightly more than 3 Tg d-1for CO and 0.1 Tg d-1for NOx flux to the atmosphere. Other burning source fluxes of gases with relatively high emission factors are reported, including methane (CH4), nonmethane hydrocarbons (NMHC), and sulfur dioxide (SO2), in addition to total particulate matter (TPM). We estimate the Brazilian Amazon region to be a source of between one fifth and one third for each of these global emission fluxes to the atmosphere. The regional distribution of burning emissions appears to be highest in the Brazilian states of Maranhao and Tocantins, mainly from burning outside of moist forest areas, and in Pará and Mato Grosso, where we identify important contributions from primary forest cutting and burning. These new daily emission estimates of reactive gases from biomass burning fluxes are designed to be used as detailed spatial and temporal inputs to computer models and data analysis of tropospheric chemistry over the tropical region.

Thinning and burning result in low-level invasion by nonnative plants but neutral effects on natives.

PubMed

Nelson, Cara R; Halpern, Charles B; Agee, James K

2008-04-01

Many historically fire-adapted forests are now highly susceptible to damage from insects, pathogens, and stand-replacing fires. As a result, managers are employing treatments to reduce fuel loadings and to restore the structure, species, and processes that characterized these forests prior to widespread fire suppression, logging, and grazing. However, the consequences of these activities for understory plant communities are not well understood. We examined the effects of thinning and prescribed fire on plant composition and diversity in Pinus ponderosa forests of eastern Washington (USA). Data on abundance and richness of native and nonnative plants were collected in 70 stands in the Colville, Okanogan, and Wenatchee National Forests. Stands represented one of four treatments: thinning, burning, thinning followed by burning, or control; treatments had been conducted 3-19 years before sampling. Multi-response permutation procedures revealed no significant effect of thinning or burning on understory plant composition. Similarly, there were no significant differences among treatments in cover or richness of native plants. In contrast, nonnative plants showed small, but highly significant, increases in cover and richness in response to both thinning and burning. In the combined treatment, cover of nonnative plants averaged 2% (5% of total plant cover) but did not exceed 7% (16% of total cover) at any site. Cover and richness of nonnative herbs showed small increases with intensity of disturbance and time since treatment. Nonnative plants were significantly less abundant in treated stands than on adjacent roadsides or skid trails, and cover within these potential source areas explained little of the variation in abundance within treated stands. Although thinning and burning may promote invasion of nonnative plants in these forests, our data suggest that their abundance is limited and relatively stable on most sites.

A review of the burns caseload of a physician-based helicopter emergency medical service.

PubMed

Hall, Karina; Burns, Brian

2017-08-01

The aim of this study was to describe patient demographics, injuries, physiology and interventions performed by retrieval physicians in the care of burns patients in both a pre-hospital and interhospital setting. A retrospective review of patient records from a large Australian Helicopter Emergency Medical Service was conducted. Demographics, injury, burn type, physiology and intervention data were extracted into a database for statistical analysis. Basic descriptive statistics were calculated, and patient physiology measures were compared at arrival and destination. A total of 490 burns cases were identified from a 5 year period (January 2010-August 2015). The majority (78.6%) were interhospital transfers conducted by road (49.4%) or helicopter (36.9%). Patients were predominantly men (75.7%) with a median age of 37 years (interquartile range [IQR] 23-50). Median estimated total body surface area burned was 15% (IQR 8.5-20) and 18% (IQR 10-30) in pre-hospital and interhospital groups, respectively; however, retrieval physicians tended to overestimate total body surface area burned in comparison to destination burns units. Flash burn or explosion were the predominant aetiology of burn (49.4%), although the majority (95.3%) of patients had no associated traumatic injuries. Sixty patients were intubated by the Service. Escharotomies were performed on eight occasions resulting in improvement in circulation or ventilation. Overall mortality was 3.7% at 24 h. The Service cares for 80-100 burns patients annually, a proportion of whom require complex interventions such as intubation and escharotomy, which was performed by retrieval physicians appropriately. Associated traumatic injuries were infrequent in patients who sustained burns from flashes or explosions. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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.

Grizzly Gulch Fire, South Dakota

NASA Technical Reports Server (NTRS)

2002-01-01

Burning next door to the South Dakota towns of Deadwood and Lead, the Grizzly Gulch fire forced the evacuation of many residents in the first week of July, 2002. In addition, smoke closed many of the roads in the area. At the time the fire's behavior was extreme, with 'torching, spotting, and running.' In other words, the fire was primarily burning along the ground, with entire trees occasionally erupting into flame (torching). At the same time, burning embers were being thrown ahead of the fire (spotting). In some areas the fire was spreading from the crown of one tree to another (running). (This glossary of fire terms has a good list of definitions) The above image shows the fire on the morning of July 1, 2002. Actively burning areas, concentrated on the east (right) side of the fire, are colored red and orange. Dark red areas indicate burn scars, while forest and other vegetation appears green. The exposed rock of the Homestake gold mine, now the National Underground Science Laboratory, is pinkish-brown. The total extent of the fire is oulined in yellow. The image was acquired by the Enhanced Thematic Mapper plus (ETM+) aboard the Landsat 7 satellite. More news about current wildfires in the United States is available from the National Fire Information Center. Image provided by the USGS EROS Data Center Satellite Systems Branch.

Data Filtering of Western Hemisphere GOES Wildfire ABBA Products

NASA Astrophysics Data System (ADS)

Theisen, M.; Prins, E.; Schmidt, C.; Reid, J. S.; Hunter, J.; Westphal, D.

2002-05-01

The Fire Locating and Modeling of Burning Emissions (FLAMBE') project was developed to model biomass burning emissions, transport, and radiative effects in real time. The model relies on data from the Geostationary Operational Environment Satellites (GOES-8, GOES-10), that is generated by the Wildfire Automated Biomass Burning Algorithm (WF ABBA). In an attempt to develop the most accurate modeling system the data set needs to be filtered to distinguish the true fire pixels from false alarms. False alarms occur due to reflection of solar radiation off of standing water, surface structure variances, and heat anomalies. The Reoccurring Fire Filtering algorithm (ReFF) was developed to address such false alarms by filtering data dependent on reoccurrence, location in relation to region and satellite, as well as heat intensity. WF ABBA data for the year 2000 during the peak of the burning season were analyzed using ReFF. The analysis resulted in a 45% decrease in North America and only a 15% decrease in South America, respectively, in total fire pixel occurrence. The lower percentage decrease in South America is a result of fires burning for longer periods of time, less surface variance, as well as an increase in heat intensity of fires for that region. Also fires are so prevalent in the region that multiple fires may coexist in the same 4-kilometer pixel.

Development of the life impact burn recovery evaluation (LIBRE) profile: assessing burn survivors' social participation.

PubMed

Kazis, Lewis E; Marino, Molly; Ni, Pengsheng; Soley Bori, Marina; Amaya, Flor; Dore, Emily; Ryan, Colleen M; Schneider, Jeff C; Shie, Vivian; Acton, Amy; Jette, Alan M

2017-10-01

Measuring the impact burn injuries have on social participation is integral to understanding and improving survivors' quality of life, yet there are no existing instruments that comprehensively measure the social participation of burn survivors. This project aimed to develop the Life Impact Burn Recovery Evaluation Profile (LIBRE), a patient-reported multidimensional assessment for understanding the social participation after burn injuries. 192 questions representing multiple social participation areas were administered to a convenience sample of 601 burn survivors. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to identify the underlying structure of the data. Using item response theory methods, a Graded Response Model was applied for each identified sub-domain. The resultant multidimensional LIBRE Profile can be administered via Computerized Adaptive Testing (CAT) or fixed short forms. The study sample included 54.7% women with a mean age of 44.6 (SD 15.9) years. The average time since burn injury was 15.4 years (0-74 years) and the average total body surface area burned was 40% (1-97%). The CFA indicated acceptable fit statistics (CFI range 0.913-0.977, TLI range 0.904-0.974, RMSEA range 0.06-0.096). The six unidimensional scales were named: relationships with family and friends, social interactions, social activities, work and employment, romantic relationships, and sexual relationships. The marginal reliability of the full item bank and CATs ranged from 0.84 to 0.93, with ceiling effects less than 15% for all scales. The LIBRE Profile is a promising new measure of social participation following a burn injury that enables burn survivors and their care providers to measure social participation.

Risk Factors for the Development of Heterotopic Ossification in Seriously Burned Adults: A NIDRR Burn Model System Database Analysis

PubMed Central

Levi, Benjamin; Jayakumar, Prakash; Giladi, Avi; Jupiter, Jesse B.; Ring, David C.; Kowalske, Karen; Gibran, Nicole S.; Herndon, David; Schneider, Jeffrey C.; Ryan, Colleen M.

2015-01-01

Purpose Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study we utilize a multicenter database of adults with burn injuries to identify and analyze clinical factors that predict HO formation. Methods Data from 6 high-volume burn centers, in the Burn Injury Model System Database, were analyzed. Univariate logistic regression models were used for model selection. Cluster-adjusted multivariate logistic regression was then used to evaluate the relationship between clinical and demographic data and the development of HO. Results Of 2,979 patients in the database with information on HO that addressed risk factors for development of HO, 98 (3.5%) developed HO. Of these 98 patients, 97 had arm burns, and 96 had arm grafts. Controlling for age and sex in a multivariate model, patients with >30% total body surface area (TBSA) burn had 11.5x higher odds of developing HO (p<0.001), and those with arm burns that required skin grafting had 96.4x higher odds of developing HO (p=0.04). For each additional time a patient went to the operating room, odds of HO increased 30% (OR 1.32, p<0.001), and each additional ventilator day increase odds 3.5% (OR 1.035, p<0.001). Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO. Conclusion Risk factors for HO development include >30% TBSA burn, arm burns, arm grafts, ventilator days, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments. PMID:26496115

Multiple remote sensing data sources to assess spatio-temporal patterns of fire incidence over Campos Amazônicos Savanna Vegetation Enclave (Brazilian Amazon).

PubMed

Alves, Daniel Borini; Pérez-Cabello, Fernando

2017-12-01

Fire activity plays an important role in the past, present and future of Earth system behavior. Monitoring and assessing spatial and temporal fire dynamics have a fundamental relevance in the understanding of ecological processes and the human impacts on different landscapes and multiple spatial scales. This work analyzes the spatio-temporal distribution of burned areas in one of the biggest savanna vegetation enclaves in the southern Brazilian Amazon, from 2000 to 2016, deriving information from multiple remote sensing data sources (Landsat and MODIS surface reflectance, TRMM pluviometry and Vegetation Continuous Field tree cover layers). A fire scars database with 30 m spatial resolution was generated using a Landsat time series. MODIS daily surface reflectance was used for accurate dating of the fire scars. TRMM pluviometry data were analyzed to dynamically establish time limits of the yearly dry season and burning periods. Burned area extent, frequency and recurrence were quantified comparing the results annually/seasonally. Additionally, Vegetation Continuous Field tree cover layers were used to analyze fire incidence over different types of tree cover domains. In the last seventeen years, 1.03millionha were burned within the study area, distributed across 1432 fire occurrences, highlighting 2005, 2010 and 2014 as the most affected years. Middle dry season fires represent 86.21% of the total burned areas and 32.05% of fire occurrences, affecting larger amount of higher density tree surfaces than other burning periods. The results provide new insights into the analysis of burned areas of the neotropical savannas, spatially and statistically reinforcing important aspects linked to the seasonality patterns of fire incidence in this landscape. Copyright © 2017 Elsevier B.V. All rights reserved.

[Experimental determination of the time-dependent extent of after-burning with reference to possibilities of the plastic surgery reconstruction of 3d degree burns].

PubMed

Bäumer, F; Henrich, H A; Ussmüller, J

1986-02-01

The present experiments try to answer the question as to the time-dependent extent of the after-burning process after full-thickness burn (third degree). For an early plastic surgical treatment it was of interest to determine the most early time of escharotomy. The time-dependent spreading of the after-burning area reached its maximum five days after the burn injury. The after-burning area was marked by intravenous injections of Patentblau which caused distinct intravital colouring. Subsequently no further progress could be observed. In the present experiments we suggest this time as the earliest time for plastic covering in case it would be dependent upon the end of the after-burning process.

Automobile carburetor- and radiator-related burns.

PubMed

Renz, B M; Sherman, R

1992-01-01

Seventy-nine persons who had sustained automobile engine carburetor- and radiator-related burns were admitted to Grady Memorial Hospital Burn Unit between June 1, 1984 and September 30, 1990. Forty patients with carburetor-priming flame burns had a mean age of 31.5 years, a mean burn size of 13.4% total body surface area, and a mean length of stay of 13.8 days. There were 37 male patients. Four patients had an inhalation injury. Twenty-two surgical procedures were performed on 13 patients. One patient was an innocent bystander, and one patient died. The clothing of 16 patients had ignited, which resulted in larger, deeper burns and in one death. Burns predominantly involved the right sides of the face, head, and torso; the right upper extremity; and the right hand. Thirty-nine patients had scald burns that were associated with uncapping a radiator. These patients had a mean age of 29.6 years, a mean burn size of 8.9% total body surface area, and a mean length of stay of 6.4 days. There were 36 male patients and three innocent bystanders. One autografting procedure was performed, and there were no deaths in this group of patients. The burn-prone person is the young adult male. The circumstances that result in such dangerous behavior are predictable, and resultant burn injuries are preventable.

Spatial and temporal selectivity patterns of fires in Attika, Greece from 1984 to 2015 delineated from Landsat time series satellite images

NASA Astrophysics Data System (ADS)

Stamos, Zoi; Koutsias, Nikos

2017-04-01

The aim of this study is to assess spatial and temporalfire selectivity patterns in the region of Attica - Greece from 1984 to 2015. Our work is implemented in two distinct phases: the first consists of the accurate delineation of the fire perimeter using satellite remote sensing technology, and the second consists of the application of suitable GIS supported analyses to develop thematic layers that optimally summarised the spatial and temporal information of fire occurrence. Fire perimeters of wildland fires occurred within the time window 1984-2015 were delineated from freely available Landsat images from USGS and ESA sources.More than three thousands satellite images were processed in order to extract fire perimeters and create maps of fire frequency and fire return interval. In total one thousand and one hundred twenty fire perimeters were recorded during this thirty years' period. Fire perimeters within each year of fire occurrence were compared against the available to burn under complete random processes to identify selectivity patterns over (i) CORINE land use/land cover, (ii) fire frequency and (iii) time since last firemaps. For example, non- irrigated arable lands, complex cultivation patterns and discontinuous urban fabrics are negative related with fires, while coniferous forests, sclerophyllous vegetation and transitional woodlands seem to be preferable by the fires. Additionally, it seems that fires prefer their old burnings (two and three times burned) and also places with different patterns of time since last fire depending on the time needed by the type of vegetation to recover and thus to re-burn.

Fire Season 2015 in Alaska Set to Break Records

NASA Image and Video Library

2017-12-08

Fires have raged throughout Alaska in 2015. The Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA’s Aqua satellite acquired this image on July 14, 2015. Actively burning areas, detected by the thermal bands on MODIS, are outlined in red. According to the most recent update (July 16, 2015) from the Alaska Interagency Coordination Center, about 304 fires were actively burning when MODIS imaged the area. To date, fires have charred a total of 4,854,924 acres in Alaska. The worst fire season in Alaska's history was in 2004. At this point in time, 2015 is a month ahead of the totals in 2004 putting it on track surpass the fire totals in 2004. The amount of acreage burned in Alaska during June 2015 shattered the previous acreage record set in June 2004 by more than 700,000 acres delivering a sobering piece of news for Alaskan residents. Credit: NASA/GSFC/Jeff Schmaltz/MODIS Land Rapid Response Team NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

Early excision and grafting versus delayed excision and grafting of deep thermal burns up to 40% total body surface area: a comparison of outcome

PubMed Central

Saaiq, M.; Zaib, S.; Ahmad, S.

2012-01-01

Summary This is a study of 120 patients of either sex and all ages who had sustained deep burns of up to 40% of the total body surface area. Half the patients underwent early excision and skin autografting (i.e., within 4-7 days of sustaining burn injury) while the rest underwent delayed excision and skin autografting (i.e., within 1-4 weeks post-burn). Significant differences were found in favour of the early excision and grafting group with regard to the various burn management outcome parameters taken into consideration, i.e. culture positivity of wounds, graft take, duration of post-graft hospitalization, and mortality. PMID:23467391

[Effects of low-dose insulin on oxidation-reduction in rat organs after major burns].

PubMed

Wang, Wei; Jiang, Hong-mei; Li, Wei-ren; Zuo, Lu; Tao, Lei; Yu, Xiang

2013-11-12

To explore the effects of low-dose insulin on oxidation-reduction of heart and kidney in rats immediately after severe burns. Twenty four male Sprague-Dawley (SD) rats were randomly divided into 3 groups of sham burn, burn and treatment (n = 8 each). The sham burn group was placed into 37 °C warm water for 15 seconds to simulate burn process and received no fluid replacement. The burn and treatment groups were immersed into (95 ± 0.5) °C hot water for 15 seconds to make a rat model of 30% total burn surface area, III degree burn injury and immediately received an intraperitoneal injection of physiological saline (40 ml/kg). At the same time, a subcutaneous injection of insulin (1.0 U×kg(-1)×d(-1)) was given in the treatment group and a subcutaneous injection of same-volume physiological saline in the burn group. The rats were sacrificed after 24 post-scald hours (PSH). Abdominal aortic blood was collected for an analysis of blood glucose. The oxidation and antioxidation parameters of heart and kidney, such as malondialdehyde (MDA), xanthine oxidase (XO), myeloperoxidase (MPO), total superoxide dismutase (T-SOD), superoxide dismutase 1, 2 (SOD1, 2), catalase (CAT) and glutathione peroxidase (GPx), were detected by spectrophotometry. Compared with the sham burn group, MDA content, XO and MPO activities of heart and kidney were significantly higher in the burn group (all P < 0.05); in the treatment group, MDA content and XO activity of heart were significantly lower than the burn group ((0.85 ± 0.07) vs (1.11 ± 0.07) nmol/mg, (69.72 ± 1.94) vs (77.21 ± 2.10) U/g) while the MPO activities of heart and kidney were significantly lower (all P < 0.05).compared with the sham burn group, the activities of T-SOD, CAT, GPx of heart and kidney were significantly lower in the burn group, SOD1 activity of kidney was significantly lower, but SOD2 activity of kidney was significantly higher while SOD2 activity of heart was significantly lower (all P < 0.05); Compared with the burn group, the activities of T-SOD and SOD1 of heart in the treatment group were significantly higher ((83.5 ± 2.5) vs (79.6 ± 3.2), (62.8 ± 2.3) vs (58.8 ± 3.0) U/mg), CAT and GPx activity of heart and kidney were significantly higher (all P < 0.05). Compared with the sham burn group, blood glucose in the burn and treatment group were significantly higher ((7.81 ± 0.30), (7.19 ± 0.22) vs (6.30 ± 0.24) mmol/L) and blood glucose in the treatment group was significantly lower than the burn group((7.81 ± 0.30) mmol/L)(all P < 0.05). During an early stage, a low-dose insulin may intervene in heart tissue lipid peroxidation of severely burned rats. And differences exist in the effects of oxidation-reduction between heart and kidney.

Simulation of differential die-away instrument’s response to asymmetrically burned spent nuclear fuel

DOE PAGES

Martinik, Tomas; Henzl, Vladimir; Grape, Sophie; ...

2015-03-04

Here, previous simulation studies of Differential Die–Away (DDA) instrument’s response to active interrogation of spent nuclear fuel from a pressurized water reactor (PWR) yielded promising results in terms of its capability to accurately measure or estimate basic spent fuel assembly (SFA) characteristics, such as multiplication, initial enrichment (IE) and burn-up (BU) as well as the total plutonium content. These studies were however performed only for a subset of idealized SFAs with a symmetric BU with respect to its longitudinal axis. Therefore, to complement the previous results, additional simulations have been performed of the DDA instrument’s response to interrogation of asymmetricallymore » burned spent nuclear fuel in order to determine whether detailed assay of SFAs from all 4 sides will be necessary in real life applications or whether a cost and time saving single sided assay could be used to achieve results of similar quality as previously reported in case of symmetrically burned SFAs.« less

Pollicization for thumb reconstruction in severe pediatric hand burns.

PubMed

Ward, J W; Pensler, J M; Parry, S W

1985-12-01

Our experience in pollicization of the index ray for severely burned hands in children is reviewed with attention to severity of burn, functional impairment, age at pollicization, procedure used, operative time, length of hospital stay, and long-term functional results. Fifteen pollicizations were performed in 11 patients with an average follow-up of over 5 years. Indication for pollicization was lack of prehension due to total loss of the thumb with the presence of a transposable index ray. The bipedicle flap method was used in two cases and the neurovascular pedicle technique was employed in all others. Skin grafts were necessary in all cases. Results were graded according to presence or absence of tip pinch, key pinch, grasp, and opposition. Significant functional improvement was seen in 14 of 15 cases (94 percent). Four patients (27 percent) developed complications requiring secondary procedures. In our experience, pollicization provides the most rapid and effective means of restoration of thumb function in the severe pediatric hand burn with multiple digit loss.

Simulation of differential die-away instrument’s response to asymmetrically burned spent nuclear fuel

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

Martinik, Tomas; Henzl, Vladimir; Grape, Sophie

Here, previous simulation studies of Differential Die–Away (DDA) instrument’s response to active interrogation of spent nuclear fuel from a pressurized water reactor (PWR) yielded promising results in terms of its capability to accurately measure or estimate basic spent fuel assembly (SFA) characteristics, such as multiplication, initial enrichment (IE) and burn-up (BU) as well as the total plutonium content. These studies were however performed only for a subset of idealized SFAs with a symmetric BU with respect to its longitudinal axis. Therefore, to complement the previous results, additional simulations have been performed of the DDA instrument’s response to interrogation of asymmetricallymore » burned spent nuclear fuel in order to determine whether detailed assay of SFAs from all 4 sides will be necessary in real life applications or whether a cost and time saving single sided assay could be used to achieve results of similar quality as previously reported in case of symmetrically burned SFAs.« less

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.

Epidemiology and outcome analysis of hand burns: A 5-year retrospective review of 378 cases in a burn center in Eastern China.

PubMed

Wang, Kang-an; Sun, Yu; Wu, Guo-sheng; Wang, Yi-ru; Xia, Zhao-fan

2015-11-01

Hands are frequent sites of burn but few related studies were reported in China. The aim of this study was to examine the impacts of gender, age, seasons, place, etiology, total body surface area (TBSA), depth, infection and comorbidities on prognosis following injury in a cohort of hand burn inpatients. This is a retrospective study of total 378 inpatients admitted to the burn center of Changhai hospital from January 2009 to December 2013. The present research showed the male inpatients were predominant and most of the inpatients aged from 20 to 49. Flame (37.04%) and electricity (25.40%) were the major causes of hand burns. Hand burns happened more commonly in work place (60.85%). The study preliminarily pointed out that male, flame and depth were the most significant factors impacting surgery. The main factors relevant to amputation were identified including the electrical burns and other etiology of burns. In addition, depth of hand burns was proved to have a higher impact on length of hospital stay (LOS) than other factors. The results of this study not only provide the necessary information of hand burns in Eastern China but also give the suggestions for the prevention of hand burns. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Logistics of building a laser practice for the treatment of hypertrophic burn scars.

PubMed

Hultman, Charles Scott; Edkins, Renee E; Cairns, Bruce A; Meyer, Anthony A

2013-05-01

Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars. We analyzed the clinical, operational, and financial components of our laser practice, focusing on treatment of hypertrophic burn scars, using pulsed dye laser, fractional CO2 laser, and intense pulsed light. Cases were performed in an operating room, with anesthesia, after preauthorization. We examined professional charges and collections, case time, variable and indirect expenses, and breakeven volumes. Our practice grew as follows: 2008, 1 case; 2009, 44 cases; 2010, 169 cases; and 2011, 415 cases. Overall collection rate was 32.1%. Expenses incurred by the provider, per 8-hour session, included laser rental/lease ($2375), personnel salaries ($1900), and physician overhead ($808), for a total cost of $5083. Mean charge was $1642 per case; mean collection was $527 per case. Median case time (procedure plus turnover) was 40 minutes. In this model, breakeven volume is 9.7 cases per day; breakeven time is 49.7 minutes. Provider profit margin for 10 cases per day, or 83% capacity utilization, is $187 per day (income - expenses = $5270 - $5083). Despite high costs associated with starting and operating a laser practice for the treatment of hypertrophic burn scars, a sustainable enterprise can be achieved when the provider has accrued enough volume to batch cases over an entire day. Critical to achieving breakeven is preauthorization, controlling overhead, and efficient throughput.

Porcine Burn Shock - Development of a Reliable Model and Response to Sodium, Water, and Plasma Loads Administered for Resuscitation

DTIC Science & Technology

1973-06-01

nm.ddt. inital, Diet n*Mf) Thomas L. Wachtel, M.D. G. R. McCahan, Jr., D.V.M. 0 REPORT CATS 70. TOTAL No. Or PAGE Nb O. or mrs June 1973 - w 78 0. CON...observations of caloric uptake of pigskin, rise in temperature at the dermis-fat interface as a function of both time and skin surface temperature and an...of Iso-, Hypo - and Hypertonic Sodium Solutions in the Treatment of Burn Shock in Mice," Surgery, 57: 698-704, May 1965. 24. Rosenthal, S. M

[Investigation of burn rehabilitation development of China in 2014].

PubMed

Ao, M; Wu, J; Chen, J

2017-05-20

Objective: To further study the development of burn rehabilitation in China, so as to promote the development of burn rehabilitation in China. Methods: The questionnaire about the development of burn rehabilitation treatment was started by Specialized Committee of Burn Treatment and Rehabilitation Science of Chinese Association of Rehabilitation Medicine (hereinafter referred to as Specialized Committee) in the end of 2014, and 65 affiliations of Specialized Committee members participated in. There was a total of 26 questions, mainly focusing on problems as below: (1) General information of the burn department of the units, including the number of authorized beds, annual admitted burn patients, annual admitted patients with extremely severe burn, doctors, nurses, rehabilitation therapists, and the condition of rehabilitation area and rehabilitation beds, etc. (2) Development of burn rehabilitation treatment, including the development of rehabilitation treatment, the intervention time of rehabilitation treatment, the rehabilitation treatment carried out in intensive care unit (ICU), the composition of rehabilitation treating personnel, and the professional title and background, educational background, and division of responsibilities of rehabilitation therapists, etc. (3) Major problems affecting the development of burn rehabilitation treatment of the units. The burn treatment units were grouped according to the number of annual admitted patients. The units' situation of authorized beds, admitted patients, allocation of medical personnel and rehabilitation, and the ratio of beds to doctors, beds to nurses, beds to full-time burn rehabilitation treating personnel were recorded. Data were processed with t test, one-way analysis of variance, and chi-square test. Results: (1) A total of 65 questionnaires were sent, and 45 questionnaires (69.2%) were retrieved. Among the 45 units that replied the questionnaires, 35 units were burn treatment units. (2) The 35 burn treatment units were divided into less than 500 cases group ( n =8), 501-1 000 cases group ( n =11), 1 001-1 500 cases group ( n =10), and more than 1 500 cases group ( n =6) according to the number of annual admitted patients. The number of authorized beds of units in 1 001-1 500 cases group was significantly more than that in less than 500 cases group ( t =4.563, P <0.05). The number of authorized beds of units in more than 1 500 cases group was significantly more than that in the other 3 groups, respectively (with t values from 1.859 to 3.743, P values below 0.05). The number of annual admitted patients of units in 501-1 000 cases group, 1 001-1 500 cases group, and more than 1 500 cases group was dramatically more than that in less than 500 cases group (with t values from 6.027 to 12.684, P values below 0.05). The number of annual admitted patients of units in 1 001-1 500 cases group and more than 1 500 cases group was significantly more than that in 501-1 000 cases group (with t values respectively 7.408 and 6.980, P values below 0.05). The number of annual admitted patients of units in more than 1 500 cases group was significantly more than that in 1 001-1 500 cases group ( t =4.239, P <0.05). The number of annual admitted patients with extremely severe burn and the condition of rehabilitation area and rehabilitation beds of units in the 4 groups was similar ( F =0.820, with χ (2) values respectively 5.266 and 2.848, P values above 0.05). The number of doctors of units in more than 1 500 cases group was significantly more than that in less than 500 cases group ( t =2.836, P <0.05). The number of nurses of units in 1 001-1 500 cases group was significantly more than that in less than 500 cases group ( t =2.837, P <0.05). The number of nurses and that of rehabilitation therapists of units in more than 1 500 cases group were significantly more than those in the other 3 groups (with t values from 1.762 to 4.789, P values below 0.05). (3) The 35 burn treatment units were able to provide at least one rehabilitation treatment for patients, among which body positioning, motion of joint exercise, infrared ray irradiation, hydrotherapy, function training, activities of daily life training, scar massage, and drug injection in scar were carried out well, while psychological therapy, music therapy, occupational rehabilitation, and social rehabilitation were mostly not carried out. (4) Only 9 (25.7%) burn treatment units started rehabilitation treatment for patients within 3 days after injury. (5) Twenty-seven (77.1%) burn treatment units could carry out body positioning in ICU. (6) Twenty-three burn treatment units had full-time rehabilitation treating personnel, and the units were divided into less than 500 cases group ( n =1), 501-1 000 cases group ( n =8), 1 001-1 500 cases group ( n =9), and more than 1 500 cases group ( n =5) according to the number of annual admitted patients. The ratio of beds to doctors of units in more than 1 500 cases group was significantly higher than that in 501-1 000 cases group ( t =2.810, P <0.05) and the ratios of beds to doctors of units in 501-1 000 cases group and 1 001-1 500 cases group were similar ( t =1.506, P >0.05). The ratios of beds to nurses and beds to full-time burn rehabilitation treating personnel in 4 groups were similar (with F values respectively 0.783 and 0.434, P values above 0.05). (7) Twenty burn treatment units had rehabilitation therapists with rehabilitation treatment related professional background (a total of 73 person, account for 76.0%), 80.8% (59/73) rehabilitation therapists with rehabilitation and therapeutic professions, 60.3% (44/73) with bachelor degree or above, and 87.7% (64/73) with primary and intermediate titles. Besides, 39.7% (29/73) rehabilitation therapists did physical therapy; 12.3% (9/73) rehabilitation therapists did occupational therapy; 38.4% (28/73) rehabilitation therapists did not have specific duties. (8) During the development of burn rehabilitation treatment of 35 burn treatment units, the common problems were reflected in the authorized strength and professional technology level of rehabilitation treatment relating personnel, and the area and equipment for rehabilitation. There were also many problems in cooperation between burn surgeons and rehabilitation therapists and fund. The supports from hospital and department leaders were good. Conclusions: Through the development of several years, the general condition and the development of rehabilitation treatment of burn treatment units in China are improved; the beginning time of burn rehabilitation treatment is advanced; the number of rehabilitation treatment personnel is increased with their speciality improved; the burn rehabilitation work get great support from hospitals and departments.

Early Hg mobility in cultivated tropical soils one year after slash-and-burn of the primary forest, in the Brazilian Amazon.

PubMed

Béliveau, Annie; Lucotte, Marc; Davidson, Robert; Lopes, Luis Otávio do Canto; Paquet, Serge

2009-07-15

In the Brazilian Amazon, forest conversion to agricultural lands (slash-and-burn cultivation) contributes to soil mercury (Hg) release and to aquatic ecosystem contamination. Recent studies have shown that soil Hg loss occurs rapidly after deforestation, suggesting that Hg mobility could be related to the massive cation input resulting from biomass burning. The objective of this research was to determine the effects of the first year of slash-and-burn agriculture on soil Hg levels at the regional scale of the Tapajós River, in the state of Pará, Brazilian Amazon. A total of 429 soil samples were collected in 26 farms of five riparian communities of the Tapajós basin. In September 2004, soil samples were collected from primary forest sites planned for slash-and-burn cultivation. In August 2005, one year after the initial burning, a second campaign was held and the exact same sites were re-sampled. Our results showed that total Hg levels in soils did not change significantly during the first year following slash-and-burn, suggesting no immediate release of soil Hg at that point in time. However, an early Hg mobility was detected near the surface (0-5 cm), reflected by a significant shift in Hg distribution in soil fractions. Indeed, a transfer of Hg from fine to coarser soil particles was observed, indicating that chemical bonds between Hg and fine particles could have been altered. A correspondence analysis (CA) showed that this process could be linked to a chemical competition caused by cation enrichment. The regional dimension of the study highlighted the prevailing importance of soil types in Hg dynamics, as shown by differentiated soil responses following deforestation according to soil texture. Confirming an early Hg mobility and indicating an eventual Hg release out of the soil, our results reinforce the call for the development of more sustainable agricultural practices in the Amazon.

A Model to Improve Detection of Nonaccidental Pediatric Burns.

PubMed

Nigro, Lauren C; Feldman, Michael J; Foster, Robin L; Pozez, Andrea L

2018-06-01

Pediatric burn patients warrant thorough evaluation because a sizeable proportion of pediatric burns are nonaccidental. A multidisciplinary method involving an internal child protection team (CPT) was developed and used to identify suspected nonaccidental pediatric burns in all pediatric burn patients 5 years of age or younger who were evaluated by the CPT and social workers at our institution over a 55-month period. We identified 343 cases for review that fit our age criteria, 6 of which we identified as cases of suspected abuse or neglect. On average, these patients were younger, suffered greater total body surface area burns (TBSA), and required a longer length of stay in the hospital than the total population. We have not had readmissions for repeat nonaccidental pediatric burn injuries in this group of patients since this model was implemented. Our multidisciplinary method might provide a more consistent and reliable method for identifying cases of suspected abuse. © 2018 American Medical Association. All Rights Reserved.

Alcohol potentiates postburn remote organ damage through shifts in fluid compartments mediated by bradykinin.

PubMed

Chen, Michael M; O'Halloran, Eileen B; Ippolito, Jill A; Choudhry, Mashkoor A; Kovacs, Elizabeth J

2015-01-01

Of the 450,000 burn patients each year, 50% have a positive blood alcohol content, and this predisposes them to worsened clinical outcomes. Despite high prevalence and established consequences, the mechanisms responsible for alcohol-mediated complications of postburn remote organ damage are currently unknown. To this end, mice received a single dose of alcohol (1.12 g/kg) or water by oral gavage and were subjected to a 15% total body surface area burn. Animals with a burn alone lost ∼5% of their body weight in 24 h, whereas intoxicated and burned mice lost only 1% body weight (P < 0.05) despite a 17% increase in hematocrit (P < 0.05) and a 57% increase in serum creatinine (P < 0.05) over burn injury alone. This retention of water weight despite increased dehydration suggests that intoxication at the time of a burn causes a shift in fluid compartments that may exacerbate end-organ ischemia and damage as evidenced by a 3-fold increase in intestinal bacterial translocation (P < 0.05), a 30% increase (P < 0.05) in liver weight-to-body weight ratio, and an increase in alveolar wall thickness over a burn alone. Furthermore, administration of the bradykinin antagonist HOE140 30 min after intoxication and burn restored fluid balance and alleviated end-organ damage. These findings suggest that alcohol potentiates postburn remote organ damage through shifts in fluid compartments mediated by bradykinin.

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.

Smart phones make smart referrals: The use of mobile phone technology in burn care - A retrospective case series.

PubMed

den Hollander, Daan; Mars, Maurice

2017-02-01

Telemedicine using cellular phones allows for real-time consultation of burn patients seen at distant hospitals. Telephonic consultations to our unit have required completion of a proforma, to ensure collection of the following information: demographics, mechanism of injury, vital signs, relevant laboratory data, management at the referring hospital and advice given by the burn team. Since December 2014 we have required referring doctors to send photographs of the burn wounds to the burns specialist before making a decision on acceptance of the referral or providing management advice. The photographs are taken and sent by smartphone using MMS or WhatsApp. The cases, with photographs, are entered into a database of telemedicine consultations which we have retrospectively reviewed. During the study period (December 2014-July 2015) we were consulted about 119 patients, in 100 of whom the telemedicine consultation was completed. Inappropriate transfer to the burns centre was avoided in 38% of cases, and in 28% a period of treatment in the referral hospital was advised before transfer. For a total of 66% of patients the telemedicine consultation changed, and either avoided an inappropriate admission, or delayed admission in late referrals until the patient was ready for definitive treatment. We conclude that telemedicine consultations using a cellular phone significantly change referral pathways in burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Novel burn device for rapid, reproducible burn wound generation.

PubMed

Kim, J Y; Dunham, D M; Supp, D M; Sen, C K; Powell, H M

2016-03-01

Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200±5°C) and pressed into the skin for 40s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40s at a constant pressure and at pressures of 1 or 3lbs with a constant contact time of 40s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). The custom burn device maintained both its internal temperature and the skin surface temperature near target temperature throughout contact time. In contrast, the standard burner required more than 20s of contact time to raise the skin surface temperature to target due to its quickly decreasing internal temperature. The custom burner was able to create four consecutive burns in less than half the time of the standard burner. Average burn depth scaled positively with time and pressure in both burn units. However, the distribution of burn depth within each time-pressure combination in the custom device was significantly smaller than with the standard device and independent of user. The custom burn device's ability to continually heat the burn stylus and actively control pressure and temperature allowed for more rapid and reproducible burn wounds. Burns of tailored and repeatable depths, independent of user, provide a platform for the study of anti-scar and other wound healing therapies without the added variable of non-uniform starting injury. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Novel burn device for rapid, reproducible burn wound generation

PubMed Central

Kim, J.Y.; Dunham, D.M.; Supp, D.M.; Sen, C.K.; Powell, H.M.

2016-01-01

Introduction Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. Methods A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200 ± 5 °C) and pressed into the skin for 40 s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40 s at a constant pressure and at pressures of 1 or 3 lbs with a constant contact time of 40 s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). Results The custom burn device maintained both its internal temperature and the skin surface temperature near target temperature throughout contact time. In contrast, the standard burner required more than 20 s of contact time to raise the skin surface temperature to target due to its quickly decreasing internal temperature. The custom burner was able to create four consecutive burns in less than half the time of the standard burner. Average burn depth scaled positively with time and pressure in both burn units. However, the distribution of burn depth within each time-pressure combination in the custom device was significantly smaller than with the standard device and independent of user. Conclusions The custom burn device's ability to continually heat the burn stylus and actively control pressure and temperature allowed for more rapid and reproducible burn wounds. Burns of tailored and repeatable depths, independent of user, provide a platform for the study of anti-scar and other wound healing therapies without the added variable of non-uniform starting injury. PMID:26803369

Silk sericin ameliorates wound healing and its clinical efficacy in burn wounds.

PubMed

Aramwit, Pornanong; Palapinyo, Sirinoot; Srichana, Teerapol; Chottanapund, Suthat; Muangman, Pornprom

2013-09-01

The aim of this study was to evaluate the effect of silk sericin, a protein from silkworm cocoon, on scratch wound healing in vitro. For applicable result in clinical use, we also study the efficacy of sericin added to a standard antimicrobial cream, silver zinc sulfadiazine, for open wound care in the treatment of second-degree burn wounds. In vitro scratch assays show that sericin at concentration 100 μg/mL can promote the migration of fibroblast L929 cells similar to epidermal growth factor (positive control) at 100 μg/mL. After 1 day of treatment, the length of scratch in wounds treated with sericin was significantly shorter than the length of negative control wounds (culture medium without sericin). For clinical study, a total of 29 patients with 65 burn wounds which covered no less than 15 % of total body surface area were randomly assigned to either control (wounds treated with silver zinc sulfadiazine cream) or treatment (wounds treated with silver zinc sulfadiazine with added sericin cream) group in this randomized, double-blind, standard-controlled study. The results showed that the average time to reach 70 % re-epithelialization of the burned surface and complete healing in the treatment group was significantly shorter, approximately 5-7 days, than in the control group. Regarding time for complete healing, control wounds took approximately 29.28 ± 9.27 days, while wounds treated with silver zinc sulfadiazine with added sericin cream took approximately 22.42 ± 6.33 days, (p = 0.001). No infection or severe reaction was found in any wounds. This is the first clinical study to show that silk sericin is safe and beneficial for burn wound treatment when it is added to silver sulfadiazine cream.

Regeneration of Pinus pinaster Aiton after prescribed fires: Response to burn timing and biogeographical seed provenance across a climatic gradient.

PubMed

Sagra, J; Ferrandis, P; Plaza-Álvarez, P A; Lucas-Borja, M E; González-Romero, J; Alfaro-Sánchez, R; De Las Heras, J; Moya, D

2018-05-17

Prescribed fires are used as a fuel reduction tool, but heat alter microsite conditions affecting the natural regeneration of Mediterranean pine forests. Our study tested the hypothesis that implementing prescription before or after pine seed release may influence the composition of tree communities by changing the regeneration patterns of Pinus pinaster Aiton across a climatic gradient in the eastern Iberian Peninsula. We ran a seed-sowing experiment to analyse the recruitment patterns of this pine species in prescribed-burned stands, in two different biogeographical seed provenances from wetter and drier areas than the local seeding site. Survival of seedlings was through one year, until the end of the first drought and winter period, respectively. >5400 seeds were sown during the study distributed in sixty plots (30 burned, 30 unburned) per site and treatment, with 10 seeding units per plot. General linear models (GLMs) and ANOVA analyses indicated higher performance for the Drier seed provenance in burned areas, whereas a similar performance was recorded in the control area. Control areas showed higher germination and success rates for plant establishment throughout the study period. Total germination and survival after one year were slightly higher, respectively, at northern sites due to massive mortality during summer in the southern stands. At the burned sites, the mean germination time was significantly longer in those seeds sown before fire passage than those sown after fire. Total germination and successful establishment were significantly higher in the individuals sown before the passage of the fire than in those sown after fire. Most of the mortality occurred in summer for the southern stand, while winter was the most constraining period at the northern sites. The understanding of the dynamics in this species' establishment can help managers to perform a better management planning according to the species' ecology. Copyright © 2018 Elsevier B.V. All rights reserved.

Emissions of PAHs derived from sugarcane burning and processing in Chiapas and Morelos México.

PubMed

Mugica-Alvarez, Violeta; Santiago-de la Rosa, Naxieli; Figueroa-Lara, Jesús; Flores-Rodríguez, Julio; Torres-Rodríguez, Miguel; Magaña-Reyes, Miguel

2015-09-15

Sugarcane burning is an agricultural practice implemented to ease farm worker duties; nevertheless, as a consequence, tons of particles are emitted to the atmosphere. Additionally, during harvesting the sugar-mills operate the whole day emitting hundreds of tons of pollutants. Therefore, health risks to neighboring population should be a major governmental concern, leading first to identification and quantification of toxic compounds, such as polycyclic aromatic hydrocarbons (PAHs). In order to establish the magnitude of the problem, four sampling campaigns of PM10 and PM2.5 were carried out in this study, during harvesting and no-harvesting seasons in two municipalities of México, with different climatic and social conditions. Concentrations of PM10, PM2.5, and organic compounds were determined daily, followed by extraction, identification and quantification of the 17 EPA-established PAHs from all samples. The results showed that during harvest, the PM10 mass increased lightly in Chiapas, but approximately twice in Morelos, whereas total PAH concentrations increased twice and six times, respectively. The most abundant PAHs, namely: indene [1,2,3cd] pyrene, benzo[b]fluoranthene, benzo[a]pyrene and dibenzo [a,h] anthracene are composed of 5 or more aromatic rings. Of the total PAHs quantified, 44% to 52% corresponded to carcinogenic compounds, consequently, the overall carcinogenic potential increased twice or three times. Principal component analysis with varimax rotation was applied to source apportionment at each site, suggesting three different sources during harvesting: the combustion process in the sugar mill, sugarcane burning and vehicular emissions. The combustion markers for sugar mill are, BAA, BBF, BKF, BAP, IND and BGP, whereas for sugarcane burning were ANT, PHE, FLT and PYR. The results obtained indicate that processing and burning sugarcane are the main sources of the PAH levels measured, proving that the health risks are boosted during harvesting due to increases of PM and PAHs. Copyright © 2015 Elsevier B.V. All rights reserved.

Use of methylnaltrexone to induce laxation in acutely injured patients with burns and necrotizing soft-tissue infections.

PubMed

Hewitt, Kelly; Lin, Hsin; Faraklas, Iris; Morris, Stephen; Cochran, Amalia; Saffle, Jeffrey

2014-01-01

The routine use of high-dose opioids for analgesia in patients with acute burns and soft-tissue injuries often leads to the development of opioid-induced constipation. The opioid antagonist methylnaltrexone (MLTX) reverses narcotic-related ileus without affecting systemic pain treatment. The authors' burn center developed a bowel protocol that included administration of MLTX for relief of opioid-induced constipation after other methods failed. The authors performed a retrospective review of patients with acute burns or necrotizing soft-tissue infections, who had been given subcutaneous MLTX to induce laxation. All patients who received MLTX were included and all administrations of the drug were included in the analysis. The primary outcome examined was time to laxation from drug administration. Forty-eight patients received MLTX a total of 112 times. Six patients were admitted with soft-tissue injuries and the rest suffered burns with an average TBSA of 17%. The median patient age was 41 years and the majority (75%) were men. Administration of a single dose of MLTX resulted in laxation within 4 hours in 38% of cases, and within 24 hours in 68%. Patients given MLTX received an average of 174 mg morphine equivalents daily for pain control. MLTX was given after an average of 52 hours since the last bowel movement. As this experience has evolved, it has been incorporated into an organized bowel protocol, which includes MLTX administration after other laxatives have failed. MLTX is an effective laxation agent in patients with burn and soft-tissue injuries, who have failed conventional agents.

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

Frenje, J. A.; Hilsabeck, T. J.; Wink, C. W.

The next-generation magnetic recoil spectrometer for time-resolved measurements of the neutron spectrum has been conceptually designed for the National Ignition Facility. This spectrometer, called MRSt, represents a paradigm shift in our thinking about neutron spectrometry for inertial confinement fusion applications, as it will provide simultaneously information about the burn history and time evolution of areal density (ρR), apparent ion temperature (T i), yield (Y n), and macroscopic flows during burn. From this type of data, an assessment of the evolution of the fuel assembly, hotspot, and alpha heating can be made. According to simulations, the MRSt will provide accurate datamore » with a time resolution of ~20 ps and energy resolution of ~100 keV for total neutron yields above ~10 16. Lastly, at lower yields, the diagnostic will be operated at a higher-efficiency, lower-energy-resolution mode to provide a time resolution of ~20 ps.« less

Generation and distribution of PAHs in the process of medical waste incineration

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

Chen, Ying, E-mail: echochen327@163.com; National Center of Solid Waste Management, Ministry of Environmental Protection, Beijing 100029; Zhao, Rongzhi

Highlights: ► PAHs generation and distribution features of medical waste incineration are studied. ► More PAHs were found in fly ash than that in bottom ash. ► The highest proportion of PAHs consisted of the seven most carcinogenic ones. ► Increase of free oxygen molecule and burning temperature promote PAHs degradation. ► There is a moderate positive correlation between total PCDD/Fs and total PAHs. - Abstract: After the deadly earthquake on May 12, 2008 in Wenchuan county of China, several different incineration approaches were used for medical waste disposal. This paper investigates the generation properties of polycyclic aromatic hydrocarbons (PAHs)more » during the incineration. Samples were collected from the bottom ash in an open burning slash site, surface soil at the open burning site, bottom ash from a simple incinerator, bottom ash generated from the municipal solid waste (MSW) incinerator used for medical waste disposal, and bottom ash and fly ash from an incinerator exclusively used for medical waste. The species of PAHs were analyzed, and the toxicity equivalency quantities (TEQs) of samples calculated. Analysis results indicate that the content of total PAHs in fly ash was 1.8 × 10{sup 3} times higher than that in bottom ash, and that the strongly carcinogenic PAHs with four or more rings accumulated sensitively in fly ash. The test results of samples gathered from open burning site demonstrate that Acenaphthylene (ACY), Acenaphthene (ACE), Fluorene (FLU), Phenanthrene (PHE), Anthracene (ANT) and other PAHs were inclined to migrate into surrounding environment along air and surface watershed corridors, while 4- to 6-ring PAHs accumulated more likely in soil. Being consistent with other studies, it has also been confirmed that increases in both free oxygen molecules and combustion temperatures could promote the decomposition of polycyclic PAHs. In addition, without the influence of combustion conditions, there is a positive correlation between total PCDD/Fs and total PAHs, although no such relationship has been found for TEQ.« less

Planning for burn disasters: lessons learned from one hundred years of history.

PubMed

Barillo, David J; Wolf, Steven

2006-01-01

The terrorist attacks of September 11th have prompted interest in developing plans to manage thousands of burn casualties. There is little actual experience in the United States in managing disasters of this magnitude. As an alternative, lessons may be learned from the historical experiences of previous civilian burn or fire disasters occurring in this country. A review of relevant medical, fire service, and popular literature pertaining to civilian burn or fire disasters occurring in the United States between the years 1900 and 2000 was performed. In the 20th century, 73 major U.S. fire or burn disasters have occurred. With each disaster prompting a strengthening of fire regulations or building codes, the number of fatalities per incident has steadily decreased. Detailed examination of several landmark fires demonstrated that casualty counts were great but that most victims had fatal injuries and died on the scene or within 24 hours. A second large cohort comprised the walking wounded, who required minimal outpatient treatment. Patients requiring inpatient burn care comprise a small percentage of the total casualty figure but consume enormous resources during hospitalization. Burn mass casualty incidents are uncommon. The number of casualties per incident decreased over time. In most fire disasters, the majority of victims either rapidly die or have minimal injuries and can be treated and released. As a result, most disasters produce fewer than 25 to 50 patients requiring inpatient burn care. This would be a rational point to begin burn center preparations for mass casualty incidents. A robust outpatient capability to manage the walking wounded is also desirable.

Strength and Cardiorespiratory Exercise Rehabilitation for Severely Burned Patients During Intensive Care Units: A Survey of Practice.

PubMed

Cambiaso-Daniel, Janos; Parry, Ingrid; Rivas, Eric; Kemp-Offenberg, Jennifer; Sen, Soman; Rizzo, Julie A; Serghiou, Michael A; Kowalske, Karen; Wolf, Steven E; Herndon, David N; Suman, Oscar E

2018-03-22

Minimizing the deconditioning of burn injury through early rehabilitation programs (RP) in the intensive care unit (ICU) is of importance for improving the recovery time. The aim of this study was to assess current standard of care (SOC) for early ICU exercise programs in major burn centers. We designed a survey investigating exercise RP on the ICU for burn patients with >30% total burned surface area. The survey was composed of 23 questions and submitted electronically via SurveyMonkey® to six major (pediatric and adult) burn centers in Texas and California. All centers responded and reported exercise as part of their RP on the ICU. The characteristics of exercises implemented were not uniform. All centers reported to perform resistive and aerobic exercises but only 83% reported isotonic and isometric exercises. Determination of intensity of exercise varied with 50% of centers using patient tolerance and 17% using vital signs. Frequency of isotonic, isometric, aerobic, and resistive exercise was reported as daily by 80%, 80%, 83%, and 50% of centers, respectively. Duration for all types of exercises was extremely variable. Mobilization was used as a form of exercise by 100% of burn centers. Our results demonstrate that although early RP seem to be integral during burn survivor's ICU stay, no SOC exists. Moreover, early RP are inconsistently administered and large variations exist in frequency, intensity, duration, and type of exercise. Thus, future prospective studies investigating the various components of exercise interventions are needed to establish a SOC and determine how and if early exercise benefits the burn survivor.

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.

Emissions of fine particulate nitrated phenols from the burning of five common types of biomass.

PubMed

Wang, Xinfeng; Gu, Rongrong; Wang, Liwei; Xu, Wenxue; Zhang, Yating; Chen, Bing; Li, Weijun; Xue, Likun; Chen, Jianmin; Wang, Wenxing

2017-11-01

Nitrated phenols are among the major constituents of brown carbon and affect both climates and ecosystems. However, emissions from biomass burning, which comprise one of the most important primary sources of atmospheric nitrated phenols, are not well understood. In this study, the concentrations and proportions of 10 nitrated phenols, including nitrophenols, nitrocatechols, nitrosalicylic acids, and dinitrophenol, in fine particles from biomass smoke were determined under three different burning conditions (flaming, weakly flaming, and smoldering) with five common types of biomass (leaves, branches, corncob, corn stalk, and wheat straw). The total abundances of fine nitrated phenols produced by biomass burning ranged from 2.0 to 99.5 μg m -3 . The compositions of nitrated phenols varied with biomass types and burning conditions. 4-nitrocatechol and methyl nitrocatechols were generally most abundant, accounting for up to 88-95% of total nitrated phenols in flaming burning condition. The emission ratios of nitrated phenols to PM 2.5 increased with the completeness of combustion and ranged from 7 to 45 ppmm and from 239 to 1081 ppmm for smoldering and flaming burning, respectively. The ratios of fine nitrated phenols to organic matter in biomass burning aerosols were comparable to or lower than those in ambient aerosols affected by biomass burning, indicating that secondary formation contributed to ambient levels of fine nitrated phenols. The emission factors of fine nitrated phenols from flaming biomass burning were estimated based on the measured mass fractions and the PM 2.5 emission factors from literature and were approximately 0.75-11.1 mg kg -1 . According to calculations based on corn and wheat production in 31 Chinese provinces in 2013, the total estimated emission of fine nitrated phenols from the burning of corncobs, corn stalks, and wheat straw was 670 t. This work highlights the apparent emission of methyl nitrocatechols from biomass burning and provides basic data for modeling studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Plane flame furnace combustion tests on JPL desulfurized coal

NASA Technical Reports Server (NTRS)

Reuther, J. J.; Kim, H. T.; Lima, J. G. H.

1982-01-01

The combustion characteristics of three raw bituminous (PSOC-282 and 276) and subbituminous (PSOC-230) coals, the raw coals partially desulfurized (ca -60%) by JPL chlorinolysis, and the chlorinated coals more completely desulfurized (ca -75%) by JPL hydrodesulfurization were determined. The extent to which the combustion characteristics of the untreated coals were altered upon JPL sulfur removal was examined. Combustion conditions typical of utility boilers were simulated in the plane flame furnace. Upon decreasing the parent coal voltaile matter generically by 80% and the sulfur by 75% via the JPL desulfurization process, ignition time was delayed 70 fold, burning velocity was retarded 1.5 fold, and burnout time was prolonged 1.4 fold. Total flame residence time increased 2.3 fold. The JPL desulfurization process appears to show significant promise for producing technologically combustible and clean burning (low SO3) fuels.

Emissions of volatile organic compounds and particulate matter from small-scale peat fires

NASA Astrophysics Data System (ADS)

George, I. J.; Black, R.; Walker, J. T.; Hays, M. D.; Tabor, D.; Gullett, B.

2013-12-01

Air pollution emitted from peat fires can negatively impact regional air quality, visibility, climate, and human health. Peat fires can smolder over long periods of time and, therefore, can release significantly greater amounts of carbon into the atmosphere per unit area compared to burning of other types of biomass. However, few studies have characterized the gas and particulate emissions from peat burning. To assess the atmospheric impact of peat fires, particulate matter (PM) and volatile organic compounds (VOCs) were quantified from controlled small-scale peat fire experiments. Major carbon emissions (i.e. CO2, CO, methane and total hydrocarbons) were measured during the peat burn experiments. Speciated PM mass was also determined from the peat burns from filter and polyurethane foam samples. Whole air samples were taken in SUMMA canisters and analyzed by gas chromatography-mass spectrometry to measure 82 trace VOCs. Additional gaseous carbonyl species were measured by sampling with dinitrophenylhydrazine-coated cartridges and analyzed with high performance liquid chromatography. VOCs with highest observed concentrations measured from the peat burns were propylene, benzene, chloromethane and toluene. Gas-phase carbonyls with highest observed concentrations included acetaldehyde, formaldehyde and acetone. Emission factors of major pollutants will be compared with recommended values for peat and other biomass burning.

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

Streets, D. G.; Yarber, K. F.; Woo, J.-H.

Estimates of biomass burning in Asia are developed to facilitate the modeling of Asian and global air quality. A survey of national, regional, and international publications on biomass burning is conducted to yield consensus estimates of 'typical' (i.e., non-year-specific) estimates of open burning (excluding biofuels). We conclude that 730 Tg of biomass are burned in a typical year from both anthropogenic and natural causes. Forest burning comprises 45% of the total, the burning of crop residues in the field comprises 34%, and 20% comes from the burning of grassland and savanna. China contributes 25% of the total, India 18%, Indonesiamore » 13%, and Myanmar 8%. Regionally, forest burning in Southeast Asia dominates. National, annual totals are converted to daily and monthly estimates at 1{sup o} x 1{sup o} spatial resolution using distributions based on AVHRR fire counts for 1999--2000. Several adjustment schemes are applied to correct for the deficiencies of AVHRR data, including the use of moving averages, normalization, TOMS Aerosol Index, and masks for dust, clouds, landcover, and other fire sources. Good agreement between the national estimates of biomass burning and adjusted fire counts is obtained (R{sup 2} = 0.71--0.78). Biomass burning amounts are converted to atmospheric emissions, yielding the following estimates: 0.37 Tg of SO{sub 2}, 2.8 Tg of NO{sub x}, 1100 Tg of CO{sub 2}, 67 Tg of CO, 3.1 Tg of CH{sub 4}, 12 Tg of NMVOC, 0.45 Tg of BC, 3.3 Tg of OC, and 0.92 Tg of NH{sub 3}. Uncertainties in the emission estimates, measured as 95% confidence intervals, range from a low of {+-}65% for CO{sub 2} emissions in Japan to a high of {+-}700% for BC emissions in India.« less

[Fluid management and cause of death during shock period in patients with severe burns or burns complicated by inhalation injury].

PubMed

Zhang, Ming-liang; Li, Chi; Ma, Chun-xu

2003-11-01

To explore fluid management and cause of death during shock period in severe burns or burns with inhalation injury. One hundred and twelve patients with severe burns or burn complicated by inhalation injury admitted to our hospital from 1991 to 2000 were analyzed. The fluid management and death conditions during shock period were discussed. The fluid volume for resuscitation could be described as follows: the total fluid volume was 2.2 ml/(%TBSA.kg) including colloid fluid 0.5 ml/(%TBSA.kg), crystalloid fluid 1 ml/(%TBSA.kg)and water 0.7 ml/(%TBSA.kg) during first 24 hours. The total fluid volume was 1.8 ml/(%TBSA.kg) including colloid fluid 0.4 ml/(%TBSA.kg), crystalloid fluid 0.7 ml/(%TBSA.kg) and water 0.7 ml/(%TBSA.kg) during second 24 hours. There were no difference in fluid management between burns and burns with inhalation injury. Seven patients died due to respiratory failure during shock period. Many fluid formula can provide guidance for resuscitation and it is very important that early fluid therapy should accord with concrete clinical conditions of patients in order to pass smoothly through shock period. Early fluid management is not different between burns and burns with inhalation injury.

Don't be a flamin' fool: effectiveness of an adult burn prevention media campaign in two regions in Queensland, Australia--an interventional study.

PubMed

Muller, Michael J; Dulhunty, Joel M; Paratz, Jennifer D; Harrison, John M; Redman, Bruce R

2013-02-01

Major burn injuries cause devastating physical and psychosocial morbidity, combined with significant health care and community costs. The aim of this study was to evaluate the effectiveness of a targeted burn prevention message on burn safety knowledge and behavior. An 11-year retrospective review of patients admitted to an adult tertiary burn center identified flammable liquid burn injuries in males older than 15 years as 23% of admissions and the most common preventable injury. Burn safety knowledge and experience were measured in a single-blinded, controlled, restricted (male, >15 years), interventional, (therapeutic) prevention study using a total of 2,053 computer-assisted telephone interviews in an intervention region (IR) and control region. A two-week multimedia campaign with the theme "Don't Be a Flamin' Fool" was delivered in the IR. The preintervention survey revealed that 13% (218 of 1,637) reported having previously had a gasoline (petrol) burn. Following the intervention, there was a higher percentage of respondents in the IR that had seen or heard a burn prevention message in the previous 3 months (51% vs. 10%; p < 0.001) and perceived that gasoline was a danger when used to start a fire (97% vs. 91%; p = 0.001), that any volume of gasoline was unsafe (85% vs. 65%; p < 0.001), and that gasoline can explode (96% vs. 92%; p = 0.001). Awareness and memory reverted to preintervention levels at 12 months. Eighty-three percent of respondents (100 of 120) who had seen the "Flamin' Fool" campaign thought it was effective in getting its message across. This collaborative study found that a media prevention message had a significant impact on burn safety knowledge, which diminished over time.

Revised Baux Score and updated Charlson comorbidity index are independently associated with mortality in burns intensive care patients.

PubMed

Heng, Jacob S; Clancy, Olivia; Atkins, Joanne; Leon-Villapalos, Jorge; Williams, Andrew J; Keays, Richard; Hayes, Michelle; Takata, Masao; Jones, Isabel; Vizcaychipi, Marcela P

2015-11-01

The purpose of the current study was to utilise established scoring systems to analyse the association of (i) burn injury severity, (ii) comorbid status and (iii) associated systemic physiological disturbance with inpatient mortality in patients with severe burn injuries admitted to intensive care. Case notes of all patients with acute thermal injuries affecting ≥15% total body surface area (TBSA) admitted to the Burns Intensive Care Unit (BICU) at Chelsea and Westminster Hospital during a 10-year period were retrospectively reviewed. Revised Baux Score, Belgian Outcome in Burn Injury (BOBI) Score, Abbreviated Burn Severity Index (ABSI), APACHE II Score, Sequential Organ Failure Assessment (SOFA) Score and Updated Charlson Comorbidity Index (CCI) were computed for each patient and analysed for association with inpatient mortality. Ninety mechanically ventilated patients (median age 45.7 years, median % TBSA burned 36.5%) were included. 72 patients had full thickness burns and 35 patients had inhalational injuries. Forty-four patients died in hospital while 46 survived to discharge. In a multivariate logistic regression model, only the Revised Baux Score (p<0.001) and updated CCI (p=0.014) were independently associated with mortality. This gave a ROC curve with area under the curve of 0.920. On multivariate cox regression survival analysis, only the Revised Baux Score (p<0.001) and the updated CCI (p=0.004) were independently associated with shorter time to death. Our data suggest that the Revised Baux Score and the updated CCI are independently associated with inpatient mortality in patients admitted to intensive care with burn injuries affecting ≥15% TBSA. This emphasises the importance of comorbidities in the prognosis of patients with severe burn injuries. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Clinical and demographic features of pediatric burns in the eastern provinces of Turkey

PubMed Central

2011-01-01

Background The aim of this study is to perform a retrospective analysis of the causes of burns observed in children in the eastern provinces of Turkey. Method In this study, patients were studied retrospectively with regard to their age, sex, cause of burns, seasonal variations, social and economic factors, length of hospital stay, burned body surface area, medical history, site of injury, and mortality. Results A total of 125 patients undergoing inpatient treatment were male, (53.2%) and 110 were female (46.8%). The most common causes of burns in patients treated on an inpatient basis were scald burns (65.5%) and tandir burns (15.7%). The mean total body surface area of all the patients was 12.17+9.86%. When the patients were grouped according to tandir, cauldron, and others burn causes, a significant difference was seen between the in burn percentages caused by tandir and cauldron burns and other causes (p < 0.001). Higher burn percentages were seen for cauldron burns than for tandir burns (p < 0.05). The average length of hospital stay was 17.67+13.64 days. When the patients were grouped according to burn causes (tandir, cauldron, and others), a significant difference was determined between the hospitalization periods of patients with tandir burns and other burn causes (p = 0.001) The most commonly proliferating microorganism in burned areas was Pseudomonas aeruginosa (20.4%). Of the 235 patients, 61 were treated in operating rooms. During the 24-month period of the study, 2 of the 235 patients died (0.85%). Conclusion Pediatric burns in the eastern part of Turkey are different from those in other parts of Turkey, as well as in other countries. Due to the lifestyle of the region, tandir and cauldron burns, which cause extensive burn areas and high morbidity, are frequently seen in children. Therefore, precautions and educational programs related to the use of tandirs and cauldrons are needed in this region. PMID:21244683

Immediate changes in topsoil chemical properties after controlled shrubland burning in the Central Pyrenees

NASA Astrophysics Data System (ADS)

Zufiaurre-Galarza, Raquel; Fernández Campos, Marta; Badía-Villas, David; María Armas-Herrera, Cecilia; Martí-Dalmau, Clara; Girona-García, Antonio

2016-04-01

Prescribed fire has recently been adopted as an encroachment-fighting strategy in the Central Pyrenees. Despite relatively large information on wildfire impacts on soil, there is little information on prescribed fire effects, especially in mountain ecosystems (Shakesby et al, 2015). Fire effects are noticeable in the topsoil, particularly in relation to soil organic matter and nutrient contents and quality (Alexis et al, 2012). These components change with time after fire and at the scale of the upper few centimetres of mineral soil (Badía et al, 2014). The aim of this study is to evaluate the immediate effects of prescribed shrubland burning on soil's nutrients and organic matter content to detect changes at cm-scale, trying to differentiate the heat shock from the subsequent incorporation of ash and charcoal. The study area, densely covered with spiny broom (Echinospartum horridum), is located in Tella (Central Pyrenees, NE Spain) at 1900 meters above sea level. Three sites were sampled before burning and immediately after burning just in its adjacent side. The soils belong to the WRB unit Leptic Eutric Cambisol, Soil samples were collected separating carefully the organic layers (litter in unburned soils and ashes and fire-altered organic residues in burned soils) and the mineral horizon at 0-1, 1-2 and 2-3 cm depths. Soil samples were air-dried and sieved to 2 mm. Soil organic C (by the wet oxidation method), total N (Kjeldahl method), water-soluble ions (Ca2+, Mg2+, Na+, K+, SO4=, NO3- and NH4+), exchangeable ions (Ca2+, Mg2+, K+, Na+, Fe3+ and Mn2+), total and available P, pH (1:5) and the electrical conductivity (in a 1:10 soil-to-water ratio) were measured. Immediately after the controlled fire, soil organic carbon content on burned topsoil decreases significantly within 0-3 cm of soil depth studied while total N decrease was not significant. Moreover, only a slight increase of the electrical conductivity, water-soluble ions and exchangeable ions was observed on burned topsoil. These changes detected immediately after fire (SOC decrease and slight nutrients increase) are related to the heat released during the severe intensity of prescribed burning. Few changes in nutrients are yet observed due to the negligible incorporation of ashes into the soil, still remaining on the surface. In the medium term, it can be expected its partial incorporation into the soil and, also, ash and soil losses depending on the rain intensity and the amount of time in which the soil is kept bare. REFERENCES Alexis et al. (2012). Evolution of soil organic matter after prescribed fire: A 20-year chronosequence. Geoderma 189-190: 98-107. Badía et al. (2014). Wildfire effects on nutrients and organic carbon of a Rendzic Phaeozem in NE Spain: Changes at cm-scale topsoil. Catena 113: 267-275. Shakesby et al. (2015). Impacts of prescribed fire on soil loss and soil quality: An assessment based on an experimentally-burned catchment in central Portugal. Catena 128: 278-293

A prospective randomized trial comparing silver sulfadiazine cream with a water-soluble polyantimicrobial gel in partial-thickness burn wounds.

PubMed

Black, Jonathan S; Drake, David B

2015-01-01

The lipid base of silver sulfadiazine (SSD) makes removal of the product painful for the patient and difficult for the physician to accurately assess particularly in partial-thickness burn injuries. As an alternative, a water-soluble antimicrobial gel is used at the University of Virginia. We present a prospective, randomized comparison of these two therapies using pain with dressing changes and time to perform dressing changes as our primary endpoints. Adult inpatients with partial-thickness burn wounds were randomized to begin therapy with either SSD cream or the water-soluble burn wound gel (BWG), and then therapies were alternated daily. Pain assessments, time to complete dressing care, total narcotic medication administered, and the number of personnel required for dressing changes were recorded. Eight patients were enrolled resulting in 13 pairs (26 points) of data comparison between the two therapies. Four of the eight enrolled patients (50%) refused to continue receiving SSD because of pain associated with dressing changes and voluntarily withdrew from the study. The amount of time to perform dressing changes was an average of 79 nurse-minutes longer for SSD. A 6.08 greater morphine equivalent was delivered to those having BWG removed.A water-soluble polyantimicrobial gel was superior to SSD in the parameters measured as exhibited by our patient dropout rate and differential time to perform dressing care. Limiting the time to perform dressing care will reduce the cumulative pain experience, improve patient satisfaction, and reduce the resources to deliver care.

Characterisation of the impact of open biomass burning on urban air quality in Brisbane, Australia.

PubMed

He, Congrong; Miljevic, Branka; Crilley, Leigh R; Surawski, Nicholas C; Bartsch, Jennifer; Salimi, Farhad; Uhde, Erik; Schnelle-Kreis, Jürgen; Orasche, Jürgen; Ristovski, Zoran; Ayoko, Godwin A; Zimmermann, Ralf; Morawska, Lidia

2016-05-01

Open biomass burning from wildfires and the prescribed burning of forests and farmland is a frequent occurrence in South-East Queensland (SEQ), Australia. This work reports on data collected from 10 to 30 September 2011, which covers the days before (10-14 September), during (15-20 September) and after (21-30 September) a period of biomass burning in SEQ. The aim of this project was to comprehensively quantify the impact of the biomass burning on air quality in Brisbane, the capital city of Queensland. A multi-parameter field measurement campaign was conducted and ambient air quality data from 13 monitoring stations across SEQ were analysed. During the burning period, the average concentrations of all measured pollutants increased (from 20% to 430%) compared to the non-burning period (both before and after burning), except for total xylenes. The average concentration of O3, NO2, SO2, benzene, formaldehyde, PM10, PM2.5 and visibility-reducing particles reached their highest levels for the year, which were up to 10 times higher than annual average levels, while PM10, PM2.5 and SO2 concentrations exceeded the WHO 24-hour guidelines and O3 concentration exceeded the WHO maximum 8-hour average threshold during the burning period. Overall spatial variations showed that all measured pollutants, with the exception of O3, were closer to spatial homogeneity during the burning compared to the non-burning period. In addition to the above, elevated concentrations of three biomass burning organic tracers (levoglucosan, mannosan and galactosan), together with the amount of non-refractory organic particles (PM1) and the average value of f60 (attributed to levoglucosan), reinforce that elevated pollutant concentration levels were due to emissions from open biomass burning events, 70% of which were prescribed burning events. This study, which is the first and most comprehensive of its kind in Australia, provides quantitative evidence of the significant impact of open biomass burning events, especially prescribed burning, on urban air quality. The current results provide a solid platform for more detailed health and modelling investigations in the future. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of prescribed fire for pasture management on soil organic matter and biological properties: A 1-year study case in the Central Pyrenees.

PubMed

Girona-García, Antonio; Badía-Villas, David; Martí-Dalmau, Clara; Ortiz-Perpiñá, Oriol; Mora, Juan Luis; Armas-Herrera, Cecilia M

2018-03-15

Prescribed burning has been readopted in the last decade in the Central Pyrenees to stop the regression of subalpine grasslands in favour of shrublands, dominated among others by Echinospartum horridum (Vahl) Rothm. Nevertheless, the effect of this practice on soil properties is uncertain. The aim of this work was to analyse the effects of these burnings on topsoil organic matter and biological properties. Soil sampling was carried out in an autumnal prescribed fire in Buisán (NE-Spain, November 2015). Topsoil was sampled at 0-1cm, 1-2cm and 2-3cm depth in triplicate just before (U), ~1h (B0), 6months (B6) and 12months (B12) after burning. We analysed soil total organic C (TOC), total nitrogen (TN), microbial biomass C (C mic ), soil respiration (SR) and β-D-glucosidase activity. A maximum temperature of 438°C was recorded at soil surface while at 1cm depth only 31°C were reached. Burning significantly decreased TOC (-52%), TN (-44%), C mic (-57%), SR (-72%) and β-D-glucosidase (-66%) at 0-1cm depth while SR was also reduced (-45%) at 1-2cm depth. In B6 and B12, no significant changes in these properties were observed as compared to B0. It can be concluded that the impact of prescribed burning has been significant and sustained over time, although limited to the first two topsoil centimetres. Copyright © 2017 Elsevier B.V. All rights reserved.

Transfer time to a specialist burn service and influence on burn mortality in Australia and New Zealand: A multi-centre, hospital based retrospective cohort study.

PubMed

Cassidy, T John; Edgar, Dale W; Phillips, Michael; Cameron, Peter; Cleland, Heather; Wood, Fiona M

2015-06-01

In Australia and New Zealand (ANZ), health care is provided for ∼26 million people dispersed across the eight million square kilometres of the two countries. Providing optimal care prior to and during transfer across such vast distances is challenging. Lengthening the time taken to definitive burn care has a negative impact on burn outcome. The aims of this study were to determine if transfer time and admission pathway influenced burn mortality and to identify the factors predicting burn mortality in ANZ. The study included all adult burn patient admission data from 15 of 17 burn services submitted to the Australian and New Zealand Burn Association bi-national registry (2010-2012). Multivariate logistic regression analyses were conducted to address the study aims. Of the 2892 patients, 69 (2.4%) died following burn. Time to admission and direct admission to a burn centre did not independently influence burn mortality except when patients with inhalation injury took >16 h to transfer to definitive care. The risk of death was increased 5.7 times in the presence of inhalation injury. Burn size and age amplified the risk of death while gender did not. In ANZ, pre-hospital transport systems and peripheral hospital stabilisation were not associated with an increased risk of death due to burn except when inhalation injury was present. The results of this study indicate that burn patients with inhalation injury should be stabilised and transferred to a burn service within 16 h of burn. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Characterization of polychlorinated dibenzo-p-dioxin/dibenzofuran emissions from joss paper burned in a furnace with air pollution control devices.

PubMed

Hu, Ming-Tsan; Chen, Shui-Jen; Huang, Kuo-Lin; Lin, Yuan-Chung; Chang-Chien, Guo-Ping; Tsai, Jen-Hsiung

2009-05-01

Burning joss paper, a common practice in temples in some Asian countries, can release toxic pollutants. This study investigated polychlorinated dibenzo-p-dioxin/dibenzofuran (PCDD/F) emissions and profiles from burning joss paper in a temple furnace connected to two wet scrubbers. The mean total PCDD/F content and corresponding toxic equivalent quantity (TEQ) in joss paper were 193 ng kg(-1) and 0.645 ng I-TEQ kg(-1), respectively, whereas those in bottom ash from burned joss paper were 18.5 ng kg(-1) and 1.92 ng I-TEQ kg(-1), respectively. The wet scrubbers decreased individual PCDD/F emissions by 26.7-71.0% and those of total PCDD/Fs and I-TEQ by 47.2% and 66.0%, respectively. The total PCDD/F TEQ emission factors before and after the wet scrubbers were 8.14 and 3.42 microg I-TEQ ton-feedstock(-1), respectively. The estimated total PCDD/F and corresponding TEQ emissions were 5.29 g year(-1) and 0.462 g I-TEQ year(-1), respectively, in Taiwan. Burning joss paper in temple furnaces is a significant source of PCDD/F emissions.

Global atmospheric emissions of polycyclic aromatic hydrocarbons from 1960 to 2008 and future predictions.

PubMed

Shen, Huizhong; Huang, Ye; Wang, Rong; Zhu, Dan; Li, Wei; Shen, Guofeng; Wang, Bin; Zhang, Yanyan; Chen, Yuanchen; Lu, Yan; Chen, Han; Li, Tongchao; Sun, Kang; Li, Bengang; Liu, Wenxin; Liu, Junfeng; Tao, Shu

2013-06-18

Global atmospheric emissions of 16 polycyclic aromatic hydrocarbons (PAHs) from 69 major sources were estimated for a period from 1960 to 2030. Regression models and a technology split method were used to estimate country and time specific emission factors, resulting in a new estimate of PAH emission factor variation among different countries and over time. PAH emissions in 2007 were spatially resolved to 0.1° × 0.1° grids based on a newly developed global high-resolution fuel combustion inventory (PKU-FUEL-2007). The global total annual atmospheric emission of 16 PAHs in 2007 was 504 Gg (331-818 Gg, as interquartile range), with residential/commercial biomass burning (60.5%), open-field biomass burning (agricultural waste burning, deforestation, and wildfire, 13.6%), and petroleum consumption by on-road motor vehicles (12.8%) as the major sources. South (87 Gg), East (111 Gg), and Southeast Asia (52 Gg) were the regions with the highest PAH emission densities, contributing half of the global total PAH emissions. Among the global total PAH emissions, 6.19% of the emissions were in the form of high molecular weight carcinogenic compounds and the percentage of the carcinogenic PAHs was higher in developing countries (6.22%) than in developed countries (5.73%), due to the differences in energy structures and the disparities of technology. The potential health impact of the PAH emissions was greatest in the parts of the world with high anthropogenic PAH emissions, because of the overlap of the high emissions and high population densities. Global total PAH emissions peaked at 592 Gg in 1995 and declined gradually to 499 Gg in 2008. Total PAH emissions from developed countries peaked at 122 Gg in the early 1970s and decreased to 38 Gg in 2008. Simulation of PAH emissions from 2009 to 2030 revealed that PAH emissions in developed and developing countries would decrease by 46-71% and 48-64%, respectively, based on the six IPCC SRES scenarios.

Global atmospheric emissions of polycyclic aromatic hydrocarbons from 1960 to 2008 and future predictions

PubMed Central

Shen, Huizhong; Huang, Ye; Wang, Rong; Zhu, Dan; Li, Wei; Shen, Guofeng; Wang, Bin; Zhang, Yanyan; Chen, Yuanchen; Lu, Yan; Chen, Han; Li, Tongchao; Sun, Kang; Li, Bengang; Liu, Wenxin; Liu, Junfeng; Tao, Shu

2013-01-01

Global atmospheric emissions of 16 polycyclic aromatic hydrocarbons (PAHs) from 69 major sources were estimated for a period from 1960 to 2030. Regression models and a technology split method were used to estimate country and time specific emission factors, resulting in a new estimate of PAH emission factor variation among different countries and over time. PAH emissions in 2007 were spatially resolved to 0.1°× 0.1° grids based on a newly developed global high-resolution fuel combustion inventory (PKU-FUEL-2007). The global total annual atmospheric emission of 16 PAHs in 2007 was 504 Gg (331-818 Gg, as interquartile range), with residential/commercial biomass burning (60.5%), open-field biomass burning (agricultural waste burning, deforestation, and wildfire, 13.6%), and petroleum consumption by on-road motor vehicles (12.8%) as the major sources. South (87 Gg), East (111 Gg), and Southeast Asia (52 Gg) were the regions with the highest PAH emission densities, contributing half of the global total PAH emissions. Among the global total PAH emissions, 6.19% of the emissions were in the form of high molecular weight carcinogenic compounds and the percentage of the carcinogenic PAHs was higher in developing countries (6.22%) than in developed countries (5.73%), due to the differences in energy structures and the disparities of technology. The potential health impact of the PAH emissions was greatest in the parts of the world with high anthropogenic PAH emissions, because of the overlap of the high emissions and high population densities. Global total PAH emissions peaked at 592 Gg in 1995 and declined gradually to 499 Gg in 2008. Total PAH emissions from developed countries peaked at 122 Gg in the early 1970s and decreased to 38 Gg in 2008. Simulation of PAH emissions from 2009 to 2030 revealed that PAH emissions in developed and developing countries would decrease by 46-71% and 48-64%, respectively, based on the six IPCC SRES scenarios. PMID:23659377

Preparation of Partial-Thickness Burn Wounds in Rodents Using a New Experimental Burning Device.

PubMed

Sakamoto, Michiharu; Morimoto, Naoki; Ogino, Shuichi; Jinno, Chizuru; Kawaguchi, Atsushi; Kawai, Katsuya; Suzuki, Shigehiko

2016-06-01

The manual application of hot water or hot metal to an animal's skin surface is often used to prepare burn wound models. However, manual burn creation is subject to human variability. We developed a new device that can control the temperature, time, and pressure of contact to produce precise and reproducible animal burn wounds and investigated the conditions required to prepare various burn wounds using our new device. We prepared burn wounds on F344 rats using 3 contact times 2, 4, and 10 seconds using a stamp heated to 80°C. We observed the wound-healing process macroscopically and histologically and evaluated the burn depth using a laser speckle contrast-imaging device, which evaluated the blood flow of the wound. The changes in the burned area over time, tissue perfusion of the burn wounds, histological evaluation of the burn depth by hematoxylin-eosin and azocarmine and aniline blue staining, and the epithelialization rate (the ratio of the epithelialized area to the wound length) were evaluated on histological sections. Results indicated that the burn wounds prepared with contact times of 2, 4, and 10 seconds corresponded to superficial dermal burns, deep dermal burns, and full-thickness burns, respectively. We demonstrated that partial- and full-thickness burn wounds can be precisely and reproducibly created with our new automated burning device.

Predicting resource utilization of elderly burn patients in the baby boomer era.

PubMed

Richards, Winston T; Richards, Winston A; Miggins, Makeesha; Liu, Huazhi; Mozingo, David W; Ang, Darwin N

2013-01-01

Census predictions for Florida suggest a 3-fold increase in the 65 and older population within 20 years. We predict resource utilization for burn patients in this age group. Using the Florida Agency for Healthcare Administration admission dataset, we evaluated the effect of age on length of stay, hospital charges, and discharge disposition while adjusting for clinical and demographic factors. Using US Census Bureau data and burn incidence rates from this dataset, we estimated future resource use. Elderly patients were discharged to home less often and were discharged to short-term general hospitals, intermediate-care facilities, and skilled nursing facilities more often than the other age groups (P < .05). They also required home health care and intravenous medications significantly more often (P < .05). Their length of stay was longer, and total hospital charges were greater (P < .05) after adjusting for sex, race, Charleson comorbidity index, payer, total body surface area burned, and burn center treatment. Our data show an age-dependent increase in the use of posthospitalization resources, the length of stay, and the total charges for elderly burn patients. Copyright © 2013 Elsevier Inc. All rights reserved.

How incense and joss paper burning during the worship activities influences ambient mercury concentrations in indoor and outdoor environments of an Asian temple?

PubMed

Shen, Huazhen; Tsai, Cheng-Mou; Yuan, Chung-Shin; Jen, Yi-Hsiu; Ie, Iau-Ren

2017-01-01

This study firstly investigated the species, concentration variation, and emission factors of mercury emitted from the burning of incenses and joss papers in an Asian temple. Both indoor and outdoor speciated mercury (GEM, GOM, and PHg) were sampled by manual samplers, while ambient GEM at an indoor site was in-situ monitored by a continuous GEM monitor. Field measurement results showed that the total atmospheric mercury (TAM) concentrations in indoor and outdoor environments were in the range of 8.03-35.72 and 6.03-31.35 ng/m 3 , respectively. The indoor and outdoor ratios (I/O) of TAM in the daytime and at nighttime were in the range of 0.64-0.90 and 1.50-2.04, respectively. The concentrations of GEM, GOM, and PHg during the holiday periods were approximately 1-4 times higher than those during the non-holiday periods. GEM was the dominant mercury species in the indoor and outdoor environments and accounted for 63-81% of TAM, while the oxidized mercury accounted for 19-37% of TAM. Burning incenses and joss papers in a combustion chamber showed that the concentration of GEM from joss paper burning ranged from 4.07 to 11.62 μg/m 3 , or about 13.97 times higher than that of incense burning, while the concentration of PHg from incense burning ranged from 95.91 to 135.07 ng/m 3 , or about 3.29 times higher than that of joss paper burning. The emission factors of incense burning were 10.39 ng/g of GEM and 1.40 ng/g of PHg, while those of joss paper burning were 12.65 ng/g of GEM and 1.27 ng/g of PHg, respectively. This study revealed that speciated mercury emitted from worship activities had significant influence on the indoor and outdoor mercury concentrations in an Asian temple. Higher intensity of worship activities during holidays resulted in a higher concentration of speciated mercury in indoor and outdoor air, which might cause health threats to worshipers, staffs, and surrounding inhabitants through long-term exposure. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Clinical effect of three dimensional human body scanning system BurnCalc in the evaluation of burn wound area].

PubMed

Lu, J; Wang, L; Zhang, Y C; Tang, H T; Xia, Z F

2017-10-20

Objective: To validate the clinical effect of three dimensional human body scanning system BurnCalc developed by our research team in the evaluation of burn wound area. Methods: A total of 48 burn patients treated in the outpatient department of our unit from January to June 2015, conforming to the study criteria, were enrolled in. For the first 12 patients, one wound on the limbs or torso was selected from each patient. The stability of the system was tested by 3 attending physicians using three dimensional human body scanning system BurnCalc to measure the area of wounds individually. For the following 36 patients, one wound was selected from each patient, including 12 wounds on limbs, front torso, and side torso, respectively. The area of wounds was measured by the same attending physician using transparency tracing method, National Institutes of Health (NIH) Image J method, and three dimensional human body scanning system BurnCalc, respectively. The time for getting information of 36 wounds by three methods was recorded by stopwatch. The stability among the testers was evaluated by the intra-class correlation coefficient (ICC). Data were processed with randomized blocks analysis of variance and Bonferroni test. Results: (1) Wound area of patients measured by three physicians using three dimensional human body scanning system BurnCalc was (122±95), (121±95), and (123±96) cm(2,) respectively, and there was no statistically significant difference among them ( F =1.55, P >0.05). The ICC among 3 physicians was 0.999. (2) The wound area of limbs of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (84±50), (76±46), and (84±49) cm(2,) respectively. There was no statistically significant difference in the wound area of limbs of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc ( P >0.05). The wound area of limbs of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). There was no statistically significant difference in the wound area of front torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc ( F =0.33, P >0.05). The wound area of side torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (169±88), (150±80), and (169±86) cm(2,) respectively. There was no statistically significant difference in the wound area of side torso of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc ( P >0.05). The wound area of side torso of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). (3) The time for getting information of wounds of patients by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (77±14), (10±3), and (9±3) s, respectively. The time for getting information of wounds of patients by transparency tracing method was longer than that by NIH Image J method and three dimensional human body scanning system BurnCalc (with P values below 0.05). The time for getting information of wounds of patients by three dimensional human body scanning system BurnCalc was close to that by NIH Image J method ( P >0.05). Conclusions: The three dimensional human body scanning system BurnCalc is stable and can accurately evaluate the wound area on limbs and torso of burn patients.

Impacts of Wildfires on Mercury Contamination in Canada

NASA Astrophysics Data System (ADS)

Dastoor, A.; Fraser, A.; Ryjkov, A.

2017-12-01

Wildfires frequency has increased in past four decades in Canada, and is expected to increase in future as a result of climate change. Biomass Burning Mercury Emissions (BBMEs) are known to be significant; however, the impact of biomass burning on Mercury (Hg) burden in Canada has not been previously quantified. We investigated the spatio-temporal variability of BBME in Canada, and used Environment and Climate Change Canada's air quality and mercury model, GEM-MACH-Hg, to quantify the impacts of BBME on spatio-temporal variability of air concentrations and deposition fluxes of Hg in Canada. We optimized the biomass burning Emission Factors (EFs) for gaseous elemental mercury (GEM) using observations, GEM-MACH-Hg and an inversion technique for five vegetation types represented in North American fires to constrain the BBME impacts of Hg. We used three BBME scenarios (i.e., two scenarios where mercury is emitted only as GEM using literature or optimized EFs, and a third scenario where mercury is emitted as GEM using literature EFs and particle bound mercury (PBM) emitted using a GEM/PBM ratio from lab measurements) in Canada to conduct three sets of model simulations for 2010-2015. The three BBME scenarios represent the range of possible values for the impacts of BBME in Canada on mercury concentration and deposition. We found total BBME and its spatial distribution to be highly variable from year to year, and total atmospheric BBME averaged for 2010-2015 in Canada to be between 6 - 14 tonnes, which is 3 - 7 times the mercury emission from anthropogenic sources in Canada during the biomass burning season (i.e., from May to September). We found that while BBME have a small impact on surface air concentrations of GEM and total Hg deposition averaged over individual provinces/territories, these impacts for individual ecosystems can be as high as 95% during the burning season. We found that northern Alberta and Saskatchewan, central British Columbia, and the area around Great Slave Lake in the Northwest Territories are at greater risk of mercury contamination from biomass burning. We analysed the uncertainties in BBME, and found that reducing uncertainty in the speciation of Hg in BBME would provide the largest benefit to constraining the mercury contamination from biomass burning source to Canadian ecosystems.

Limitation of using Angstrom exponent for source apportionment of black carbon in complex environments - A case study from the North West Indo- Gangetic plain

NASA Astrophysics Data System (ADS)

Garg, S.; Sinha, B.; Sinha, V.; Chandra, P.; Sarda Esteve, R.; Gros, V.

2015-12-01

Determining the contribution of different sources to the total BC is necessary for targeted mitigation. Absorption Angstrom exponent (αabs) measurements of black carbon (BC) have recently been introduced as a novel tool to apportion the contribution of biomass burning sources to BC. Two-component Aethalometer model for apportioning BC to biomass burning sources and fossil fuel combustion sources, which uses αabs as a generic indicator of the source type, is widely used for determining the contribution of the two types of sources to the total BC. Our work studies BC emissions in the highly-populated, anthropogenic emissions-dominated Indo-Gangetic Plain and demonstrates that the αabs cannot be used as a generic tracer for biomass burning emissions in a complex environment. Simultaneously collected high time resolution data from a 7-wavelength Aethalometer (AE 42, Magee Scientific, USA) and a high sensitivity Proton Transfer Reaction- Quadrupole Mass Spectrometer (PTR-MS) installed at a sub-urban site in Mohali (Punjab), India, were used to identify a number of biomass combustion plumes during which BC enhancements correlated strongly with an increase in acetonitrile (a well-established biomass burning tracer) mixing ratio. Each type of biomass combustion is classified and characterized by distinct emission ratios of aromatic compounds and oxygenated VOCs to acetonitrile. The identified types of biomass combustion include two different types of crop residue burning (paddy and wheat), burning of leaf-litter, and garbage burning. Traffic (fossil-fuel burning) plumes were also selected for comparison. We find that the two-component Aethalometer source-apportionment method cannot be extrapolated to all types of biomass combustion and αabs of traffic plumes can be >1 in developing countries like India, where use of adulterated fuel in vehicles is common. Thus in a complex environment, where multiple anthropogenic BC sources and air masses of variable photochemical age impact a receptor site, the angstrom exponent is not representative of the combustion type and therefore, cannot be used as a generic tracer to constrain source contributions.

Satisfaction With Appearance Scale-SWAP: Adaptation and validation for Brazilian burn victims.

PubMed

Caltran, Marina P; Freitas, Noélle O; Dantas, Rosana A S; Farina, Jayme Adriano; Rossi, Lidia A

2016-09-01

Methodological study that aimed to adapt the Satisfaction with Appearance Scale (SWAP) into Brazilian Portuguese language and to assess the validity, the reliability and the dimensionality of the adapted version in a sample of Brazilian burn victims. We carried out the adaptation process according to the international literature. Construct validity was assessed by correlating the adapted version of SWAP scores with depression (Beck Depression Index), self-esteem (Rosenberg Self-Esteem Scale), health-related quality of Life (Short Form Health Survey-36) and health status of burn victims (Burn Specific Health Scale-Revised), and with gender, total body surface area burned, and visibility of the scars. We tested dimensionality using Exploratory Factor Analysis (EFA) and the reliability by means of Cronbach's alpha. Participants were 106 adult burned patients. The correlations between the Brazilian version of the SWAP scores and the correlated construct measures varied from moderate to strong (r=.30-.77). The participants who perceived their burn sequelae was visible reported being more dissatisfied with their body image than the participants who answered that their scars would not be visible (p<.001). Cronbach's alpha for the adapted version was 0.88 and the item-total correlation varied from moderate to strong (r=.35-.73). The EFA resulted in three factors with a total explained variance percentage of 63.2%. The Brazilian version of the SWAP was valid and reliable for use with Brazilian burn victims. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Quantifying the air quality-CO2 tradeoff potential for airports

NASA Astrophysics Data System (ADS)

Ashok, Akshay; Dedoussi, Irene C.; Yim, Steve H. L.; Balakrishnan, Hamsa; Barrett, Steven R. H.

2014-12-01

Aircraft movements on the airport surface are responsible for CO2 emissions that contribute to climate change and other emissions that affect air quality and human health. While the potential for optimizing aircraft surface movements to minimize CO2 emissions has been assessed, the implications of CO2 emissions minimization for air quality have not been quantified. In this paper, we identify conditions in which there is a tradeoff between CO2 emissions and population exposure to O3 and secondary PM2.5 - i.e. where decreasing fuel burn (which is directly proportional to CO2 emissions) results in increased exposure. Fuel burn and emissions are estimated as a function of thrust setting for five common gas turbine engines at 34 US airports. Regional air quality impacts, which are dominated by ozone and secondary PM2.5, are computed as a function of airport location and time using the adjoint of the GEOS-Chem chemistry-transport model. Tradeoffs between CO2 emissions and population exposure to PM2.5 and O3 occur between 2-18% and 5-60% of the year, respectively, depending on airport location, engine type, and thrust setting. The total duration of tradeoff conditions is 5-12 times longer at maximum thrust operations (typical for takeoff) relative to 4% thrust operations (typical for taxiing). Per kilogram of additional fuel burn at constant thrust setting during tradeoff conditions, reductions in population exposure to PM2.5 and O3 are 6-13% and 32-1060% of the annual average (positive) population exposure per kilogram fuel burn, where the ranges encompass the medians over the 34 airports. For fuel burn increases due to thrust increases (i.e. for constant operating time), reductions in both PM2.5 and O3 exposure are 1.5-6.4 times larger in magnitude than those due to increasing fuel burn at constant thrust (i.e. increasing operating time). Airports with relatively high population exposure reduction potentials - which occur due to a combination of high duration and magnitude of tradeoff conditions - are identified. Our results are the first to quantify the extent of the tradeoff between CO2 emissions and air quality impacts at airports. This raises the possibility of reducing the air quality impacts of airports beyond minimizing fuel burn and/or optimizing for minimum net environmental impact.

Scheduled Civil Aircraft Emission Inventories for 1999: Database Development and Analysis

NASA Technical Reports Server (NTRS)

Sutkus, Donald J., Jr.; Baughcum, Steven L.; DuBois, Douglas P.

2001-01-01

This report describes the development of a three-dimensional database of aircraft fuel burn and emissions (NO(x), CO, and hydrocarbons) for the scheduled commercial aircraft fleet for each month of 1999. Global totals of emissions and fuel burn for 1999 are compared to global totals from 1992 and 2015 databases. 1999 fuel burn, departure and distance totals for selected airlines are compared to data reported on DOT Form 41 to evaluate the accuracy of the calculations. DOT Form T-100 data were used to determine typical payloads for freighter aircraft and this information was used to model freighter aircraft more accurately by using more realistic payloads. Differences in the calculation methodology used to create the 1999 fuel burn and emissions database from the methodology used in previous work are described and evaluated.

Incidence and Clinical Outcome of Hypophosphatemia in Pediatric Burn Patients.

PubMed

Leite, Heitor Pons; Pinheiro Nogueira, Larissa Araújo; Teodosio, Ariane Helena Calassa

The objective of this study is to investigate the factors associated with serum phosphate concentrations in severely burned children and whether hypophosphatemia is associated with outcome. Seventy-eight children with a total body surface area of 24% (6.0-68.5) were retrospectively analyzed for serum phosphate concentrations during the first 10 days of stay in the intensive care unit (ICU). The method of generalized estimating equations was used to evaluate the effect of the exposure variables for serum phosphate concentrations during the study period. Outcome variables were the probability of ICU discharge at 30 days and time on mechanical ventilation. Potential explanatory variables for clinical outcome were hypophosphatemia (serum phosphate <3.8 mg/dL for children <2 years and <3.5 mg/dL for older children), age, sex, percent total body surface area burn, inhalation injury, and severe sepsis and/or septic shock. Competing-risk analysis was applied to calculate the probability of ICU discharge at 30 days, and death was assumed as the competing event. The rate of hypophosphatemia was 79.5%. Serum phosphate concentrations were associated with C-reactive protein (coefficient: -0.63; 95% confidence interval [CI]: -0.96 to -0.30; P = .001). Hypophosphatemia was independently associated with a 68% decrease in the probability of ICU discharge at 30 days (subhazard ratio: -0.32; 95% CI: 0.20, 0.53; P = .001) and an increase of 2.9 days in mechanical ventilation (coefficient: 2.91; 95% CI: 1.16, 4.66; P = .001). Serum phosphate concentrations in pediatric burn patients are associated with the magnitude of inflammatory response. Hypophosphatemia is associated with decreased probability of ICU discharge and increased time on mechanical ventilation.

Healthcare resource utilization and epidemiology of pediatric burn-associated hospitalizations, United States, 2000.

PubMed

Shields, Brenda J; Comstock, R Dawn; Fernandez, Soledad A; Xiang, Huiyun; Smith, Gary A

2007-01-01

The objective of this study was to describe the epidemiology and financial burden of burn-associated hospitalizations for children younger than 18 years in the United States. Retrospective data analysis of pediatric burn-associated hospitalizations was done using the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2000. An estimated 10,000 children younger than 18 years were hospitalized for burn-associated injuries in the United States in 2000. These children spent an estimated 66,200 days in the hospital with associated hospital charges equal to USD 211,772,700. Total charges and length of stay for pediatric burn-associated hospitalizations in the United States during 2000 were associated with degree of burn, percentage of total body surface area burned, child's age, region of the United States, hospital location, and hospital type. Children 2 years old or younger were more likely to be nonwhite, be hospitalized for burns, and burn their hands/wrists, compared with children 3 to 17 years of age. Male children in both age groups were more likely to be hospitalized for burns than female children. Children 2 years old or younger were more likely to be burned by hot liquids/vapors and contact with hot substances/objects, while children 3 to 17 years were more likely to be burned by fire/flames. This study is the first national study on healthcare resource utilization for pediatric burn-associated hospitalizations to utilize the KID database. Burns are a major source of pediatric morbidity and are associated with significant national healthcare resource utilization annually. Future burn prevention efforts should emphasize implementing passive injury prevention strategies, especially for young children who are nonwhite and live in low-income communities.

Scar formation following excisional and burn injuries in a red Duroc pig model.

PubMed

Blackstone, Britani N; Kim, Jayne Y; McFarland, Kevin L; Sen, Chandan K; Supp, Dorothy M; Bailey, J Kevin; Powell, Heather M

2017-08-01

Scar research is challenging because rodents do not naturally form excessive scars, and burn depth, size, and location cannot be controlled in human longitudinal studies. The female, red Duroc pig model has been shown to form robust scars with biological and anatomical similarities to human hypertrophic scars. To more closely mimic the mode of injury, recreate the complex chemical milieu of the burn wound environment and enhance scar development, an animal model of excessive burn-induced scarring was developed and compared with the more commonly used model, which involves excisional wounds created via dermatome. Standardized, full-thickness thermal wounds were created on the dorsum of female, red Duroc pigs. Wounds for the dermatome model were created using two different total dermatome settings: ∼1.5 mm and ≥ 1.9 mm. Results from analysis over 150 days showed that burn wounds healed at much slower rate and contracted more significantly than dermatome wounds of both settings. The burn scars were hairless, had mixed pigmentation, and displayed fourfold and twofold greater excess erythema values, respectively, compared with ∼1.5 mm and ≥ 1.9 mm deep dermatome injuries. Burn scars were less elastic, less pliable, and weaker than scars resulting from excisional injuries. Decorin and versican gene expression levels were elevated in the burn group at day 150 compared with both dermatome groups. In addition, transforming growth factor-beta 1 was significantly up-regulated in the burn group vs. the ∼1.5 mm deep dermatome group at all time points, and expression remained significantly elevated vs. both dermatome groups at day 150. Compared with scars from dermatome wounds, the burn scar model described here demonstrates greater similarity to human hypertrophic scar. Thus, this burn scar model may provide an improved platform for studying the pathophysiology of burn-related hypertrophic scarring, investigating current anti-scar therapies, and development of new strategies with greater clinical benefit. © 2017 by the Wound Healing Society.

Pediatric Burns: A Single Institution Retrospective Review of Incidence, Etiology, and Outcomes in 2273 Burn Patients (1995-2013).

PubMed

Lee, Christina J; Mahendraraj, Krishnaraj; Houng, Abraham; Marano, Michael; Petrone, Sylvia; Lee, Robin; Chamberlain, Ronald S

Unintentional burn injury is the third most common cause of death in the U.S. for children age 5 to 9, and accounts for major morbidity in the pediatric population. Pediatric burn admission data from U.S. institutions has not been reported recently. This study assesses all pediatric burn admissions to a State wide Certified Burn Treatment Center to evaluate trends in demographics, burn incidence, and cause across different age groups. Demographic and clinical data were collected on 2273 pediatric burn patients during an 18-year period (1995-2013). Pediatric patients were stratified by age into "age 0 to 6," "age 7 to 12," and "age 13 to 18." Data were obtained from National Trauma Registry of the American College of Surgeons and analyzed using standard statistical methodology. A total of 2273 burn patients under age 18 were treated between 1995 and 2013. A total of 1663 (73.2%) patients were ages 0 to 6, 294 (12.9%) were 7 to 12, and 316 (13.9%) were age 13 to 18. A total of 1400 (61.6%) were male and 873 (38.4%) were female (male:female ratio of 1.6:1). Caucasians had the highest burn incidence across all age groups (40.9%), followed by African-Americans (33.6%), P < .001. Caucasian teenagers formed 62.1% of patients age 13-18, P < .001. A total of 66.3% of all pediatric burns occurred at home, P < .001. Mean TBSA burned was 8.9%, with lower extremity being the most common site (38.5%). Scald burns constituted the majority of cases (71.1%, n = 1617), with 53% attributable to hot liquids related to cooking, including coffee or tea, P < .001. In the teenage group, flame burns were the dominant cause (53.8%). Overall mean length of stay was 10.5 ± 10.8 days for all patients, and15.5 ± 12 for those admitted to the intensive care unit, P < .005. One hundred (4.4%) patients required ventilator support (P = .02), and average duration of mechanical ventilation was 11.9 ± 14.5 days. Skin grafting was performed for 520 (22.9%) patients, P < .001. Overall mortality was 0.9% (n = 20), with mean TBSA involved of 61.5%. The majority of pediatric burn injuries are scald burns that occur at home and primarily affect the lower extremities in Caucasian and African-American males. Among Caucasian teenagers flame burns predominate. Mean length of stay was 10 days, 23% of patients required skin grafting surgery, and mortality was 0.9%. The results of this study highlight the need for primary prevention programs focusing on avoiding home scald injuries in the very young, as well as fire safety training for teenagers.

Two-year follow-up of outcomes related to scarring and distress in children with severe burns.

PubMed

Wurzer, Paul; Forbes, Abigail A; Hundeshagen, Gabriel; Andersen, Clark R; Epperson, Kathryn M; Meyer, Walter J; Kamolz, Lars P; Branski, Ludwik K; Suman, Oscar E; Herndon, David N; Finnerty, Celeste C

2017-08-01

We assessed the perception of scarring and distress by pediatric burn survivors with burns covering more than one-third of total body surface area (TBSA) for up to 2 years post-burn. Children with severe burns were admitted to our hospital between 2004 and 2012, and consented to this IRB-approved-study. Subjects completed at least one Scars Problems and/or Distress questionnaire between discharge and 24 months post burn. Outcomes were modeled with generalized estimating equations or using mixed linear models. Significance was accepted at p < 0.01. Responses of 167 children with a mean age of 7 ± 5 years and burns covering an average 54 ± 14% of TBSA were analyzed. Significant improvements over the 2-year period were seen in reduction of pain, itching, sleeping disturbance, tightness, range of motion, and strength (p < 0.01). There was a significantly increased persistent desire to hide the scarred body areas over time (p < 0.01). The perception of mouth scarring, inability to portray accurate facial expressions, and skin coloration did not improve over the follow-up period. According to self-assessment questionnaires, severely burned children exhibit significant improvements in their overall perception of scarring and distress. However, these patients remain self-conscious with respect to their body image even 2 years after burn injury. Implications for Rehabilitation According to self-assessment questionnaires, severely burned children perceive significant improvements in scarring and distress during the first 2 years post burn. Significant improvements were seen in reduction of pain, itching, sleeping disturbances, tightness, range of motion, and strength (p < 0.01). Burn care providers should improve the treatment of burns surrounding the mouth that with result in scarring, and develop strategies to prevent skin discoloration. Careful evaluation of pain and sleeping disorders during the first year post burn are warranted to improve the patient rehabilitation. Overall, significantly more female patients expressed a persistent desire to hide their scarred body areas. The rehabilitation team should provide access to wigs or other aids to pediatric burn survivors to address these needs.

Carbon dioxide emissions and energy balance closure before, during, and after biomass burning in mid-South rice fields

NASA Astrophysics Data System (ADS)

Fong, B.; Adviento-Borbe, A.; Reba, M. L.; Runkle, B.; Suvocarev, K.

2017-12-01

Biomass burning or field burning is a crop management practice that removes rice straw, reduces tillage, controls pests and releases nutrients for the next cropping season. Current field burning emissions are not included in agricultural field annual emissions largely because of the lack of studies, especially on the field scale. Field burning measurements are important for greenhouse gas emission inventories and quantifying the annual carbon footprint of rice. Paired eddy covariance systems were used to measure energy balance, CO2 fluxes, and H2O fluxes in mid-South US rice fields (total area of 25 ha) before, during and after biomass burning for 20 days after harvest. During the biomass burning, air temperatures increased 29°C, while ambient CO2 concentration increased from 402 to 16,567 ppm and H2O concentrations increased from 18.73 to 25.62 ppt. For the burning period, 67-86 kg CO2 ha-1 period-1 was emitted calculated by integrating fluxes over the biomass burning event. However, the estimated emission using aboveground biomass and combustion factors was calculated as 11,733 kg CO2 ha-1 period-1. Part of the difference could be attributed to sensor sensitivity decreasing 80% during burning for two minutes due to smoke. Net ecosystem exchange (NEE) increased by a factor of two, 1.14 before burning to 2.44 μmol m-2 s-1 possibly due to greater reduction of plant material and photosynthesis following burning. This study highlights the contribution of rice straw burning to total CO2 emissions from rice production.

Minor burn management: potions and lotions

PubMed Central

Hyland, Ela J; Connolly, Siobhan M; Fox, Jade A; Harvey, John G

2015-01-01

Summary The first aid for burns is to run cold water over the burn for 20 minutes. This is effective for up to three hours after the injury. Assess the affected body surface area using the rule of nines. Consult a burn unit if more than 5% of the total body surface area is burnt in a child or if more than 10% in an adult. Extensive or deep burns and burns to special areas, such as the hands, should be referred. Chemical or electrical burns should also be assessed by a burn unit. For minor burns, antimicrobial dressings are recommended, but oral antibiotics should be avoided unless there are signs of infection. As burns are tetanus prone, check the patient’s immunisation status. Burns that become infected or are slow to heal should be discussed with a burn unit. The burn unit can also provide advice if there are uncertainties about how to manage a patient. PMID:26648640

Incidence and cost of non-fatal burns in Iran: a nationwide population-based study.

PubMed

Abouie, Abolfazl; Salamati, Payman; Hafezi-Nejad, Nima; Rahimi-Movaghar, Afarin; Saadat, Soheil; Amin-Esmaeili, Masoumeh; Sharifi, Vandad; Hajebi, Ahmad; Rahimi-Movaghar, Vafa

2018-03-01

To determine the incidence and cost of non-fatal burns in Iran; this cross-sectional household survey of a nationally representative sample of 15-64 years old was conducted. Through face-to-face interviews and telephone calls, the data on the demographics, history and cost of burns were collected. The annual incidence rate of burns was estimated 129.85 per 1000 population. Burns occurred higher in younger age, female gender and urban residency. The most common burn description was as follows: unpaid work (activity during burn), home (place of burn), heat and hot substances (mechanism of burn) and upper limb (site of burn). The average total cost of burn includes victims seeking medical care was US$124 per case. The main findings of this study suggest that burns are a major public health concern in Iran. To stop this important health issue, a national program for burn prevention and education must be developed.

Semi-automated mapping of burned areas in semi-arid ecosystems using MODIS time-series imagery

NASA Astrophysics Data System (ADS)

Hardtke, Leonardo A.; Blanco, Paula D.; Valle, Héctor F. del; Metternicht, Graciela I.; Sione, Walter F.

2015-06-01

Understanding spatial and temporal patterns of burned areas at regional scales, provides a long-term perspective of fire processes and its effects on ecosystems and vegetation recovery patterns, and it is a key factor to design prevention and post-fire restoration plans and strategies. Remote sensing has become the most widely used tool to detect fire affected areas over large tracts of land (e.g., ecosystem, regional and global levels). Standard satellite burned area and active fire products derived from the 500-m Moderate Resolution Imaging Spectroradiometer (MODIS) and the Satellite Pour l'Observation de la Terre (SPOT) are available to this end. However, prior research caution on the use of these global-scale products for regional and sub-regional applications. Consequently, we propose a novel semi-automated algorithm for identification and mapping of burned areas at regional scale. The semi-arid Monte shrublands, a biome covering 240,000 km2 in the western part of Argentina, and exposed to seasonal bushfires was selected as the test area. The algorithm uses a set of the normalized burned ratio index products derived from MODIS time series; using a two-phased cycle, it firstly detects potentially burned pixels while keeping a low commission error (false detection of burned areas), and subsequently labels them as seed patches. Region growing image segmentation algorithms are applied to the seed patches in the second-phase, to define the perimeter of fire affected areas while decreasing omission errors (missing real burned areas). Independently-derived Landsat ETM+ burned-area reference data was used for validation purposes. Additionally, the performance of the adaptive algorithm was assessed against standard global fire products derived from MODIS Aqua and Terra satellites, total burned area (MCD45A1), the active fire algorithm (MOD14); and the L3JRC SPOT VEGETATION 1 km GLOBCARBON products. The correlation between the size of burned areas detected by the global fire products and independently-derived Landsat reference data ranged from R2 = 0.01-0.28, while our algorithm performed showed a stronger correlation coefficient (R2 = 0.96). Our findings confirm prior research calling for caution when using the global fire products locally or regionally.

In vivo burn diagnosis by camera-phone diffuse reflectance laser speckle detection.

PubMed

Ragol, S; Remer, I; Shoham, Y; Hazan, S; Willenz, U; Sinelnikov, I; Dronov, V; Rosenberg, L; Bilenca, A

2016-01-01

Burn diagnosis using laser speckle light typically employs widefield illumination of the burn region to produce two-dimensional speckle patterns from light backscattered from the entire irradiated tissue volume. Analysis of speckle contrast in these time-integrated patterns can then provide information on burn severity. Here, by contrast, we use point illumination to generate diffuse reflectance laser speckle patterns of the burn. By examining spatiotemporal fluctuations in these time-integrated patterns along the radial direction from the incident point beam, we show the ability to distinguish partial-thickness burns in a porcine model in vivo within the first 24 hours post-burn. Furthermore, our findings suggest that time-integrated diffuse reflectance laser speckle can be useful for monitoring burn healing over time post-burn. Unlike conventional diffuse reflectance laser speckle detection systems that utilize scientific or industrial-grade cameras, our system is designed with a camera-phone, demonstrating the potential for burn diagnosis with a simple imager.

In vivo burn diagnosis by camera-phone diffuse reflectance laser speckle detection

PubMed Central

Ragol, S.; Remer, I.; Shoham, Y.; Hazan, S.; Willenz, U.; Sinelnikov, I.; Dronov, V.; Rosenberg, L.; Bilenca, A.

2015-01-01

Burn diagnosis using laser speckle light typically employs widefield illumination of the burn region to produce two-dimensional speckle patterns from light backscattered from the entire irradiated tissue volume. Analysis of speckle contrast in these time-integrated patterns can then provide information on burn severity. Here, by contrast, we use point illumination to generate diffuse reflectance laser speckle patterns of the burn. By examining spatiotemporal fluctuations in these time-integrated patterns along the radial direction from the incident point beam, we show the ability to distinguish partial-thickness burns in a porcine model in vivo within the first 24 hours post-burn. Furthermore, our findings suggest that time-integrated diffuse reflectance laser speckle can be useful for monitoring burn healing over time post-burn. Unlike conventional diffuse reflectance laser speckle detection systems that utilize scientific or industrial-grade cameras, our system is designed with a camera-phone, demonstrating the potential for burn diagnosis with a simple imager. PMID:26819831

Prescribed Burning on Large Landholdings in the South During 1975

Treesearch

Ragnar W. Johansen; William H. McNab

1982-01-01

Approximately 1.85 million acres of commercialtimberland in large private and Federal holdings were prescription burned in the South during 1975.At least an additional 298,000 acres of wild land were burned for wildlife habitat and range improvement.Thus, in excess of 2.15 million acres of total wild land (timberland plus other wild land) was prescription burned on...

Healthcare costs of burn patients from homes without fire sprinklers

PubMed Central

Banfield, Joanne; Rehou, Sarah; Gomez, Manuel; Redelmeier, Donald A.; Jeschke, Marc G.

2014-01-01

The treatment of burn injuries requires high-cost services for healthcare and society. Automatic fire sprinklers are a preventive measure that can decrease fire injuries, deaths, property damage and environmental toxins. This study’s aim was to conduct a cost-analysis of patients with burn or inhalation injuries due to residential fires, and to compare this to the cost of implementing residential automatic fire sprinklers. We conducted a cohort analysis of adult burn patients admitted to our provincial burn center (1995–2012). Patient demographics and injury characteristics were collected from medical records, and clinical and coroner databases. Resource costs included average cost per day at our intensive care and rehabilitation program, transportation, and property loss. During the study period there were 1,557 residential fire-related deaths province-wide and 1,139 patients were admitted to our provincial burn center due to a flame injury occurring at home. At our burn center, the average cost was CAN$84,678 per patient with a total cost of CAN$96,448,194. All resources totaled CAN$3,605,775,200. This study shows the considerable healthcare costs of burn patients from homes without fire sprinklers. PMID:25412056

Preventable burns associated with the misuse of gasoline.

PubMed

Barillo, D J; Stetz, C K; Zak, A L; Shirani, K Z; Goodwin, C W

1998-08-01

Gasoline is intended for use as a motor fuel, but the universal availability of gasoline in the home encourages misuse as a solvent, insecticide, accelerant or cleaning solution. The careless or inappropriate use of gasoline may result in burn injury. We examined the circumstance of gasoline-related injury in a population admitted to one burn centre to determine the potential for burn prevention efforts. A retrospective review of all burn admissions to one centre for the years 1978 to 1996 demonstrated hat 1011 of 4339 acute admissions (23.3%) were gasoline-related. This group had an average total burn size of 29.8% total body surface (TBSA) and an average full thickness injury of 14.4% TBSA. There were 144 fatalities resulting from gasoline-associated burn injury. Where such determination could be made, the use of gasoline was judged to be inappropriate or unsafe in 687 of 788 cases (87.1%). Ninety of 144 fatalities (62.5%) were associated with inappropriate or unsafe use of gasoline. The careless or inappropriate use of gasoline poses significant risk of burn injury. The indoor use of gasoline, as well as use of gasoline for purposes other than as a motor fuel, should be strongly discouraged.

The revised burn diagram and its effect on diagnosis-related group coding.

PubMed

Turner, D G; Berger, N; Weiland, A P; Jordan, M H

1996-01-01

Diagnosis-related group (DRG) codes for burn injuries are defined by thresholds of the percentage of total body surface area and depth of burns, and by whether surgery, debridement, or grafting or both occurred. This prospective study was designed to determine whether periodic revisions of the burn diagram resulted in more accurate assignment of the International Classification of Diseases and DRG codes. The admission burn diagrams were revised after admission and after each surgical procedure. All areas grafted (deep second-and third-degree burns) were diagrammed as "third-degree," after the current convention that both are biologically the same and require grafting. The multiple diagrams from 82 charts were analyzed to determine the disparities in the percentage of total body surface area burn and the percentage of body surface area third-degree burn. The revised diagrams differed from the admission diagrams in 96.5% of the cases. In 77% of the cases, the revised diagram correctly depicted the percentage of body surface area third-degree burn as confirmed intraoperatively. In 7.3% of the cases, diagram revision changed the DRG code. Documenting wound evolution in this manner allows more accurate assignment of the International Classification of Diseases and DRG codes, assuring optimal reimbursement under the prospective payment system.

Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults.

PubMed

Ali, Arham; Herndon, David N; Mamachen, Ashish; Hasan, Samir; Andersen, Clark R; Grogans, Ro-Jon; Brewer, Jordan L; Lee, Jong O; Heffernan, Jamie; Suman, Oscar E; Finnerty, Celeste C

2015-05-04

Propranolol, a nonselective β-blocker, exerts an indirect effect on the vasculature by leaving α-adrenergic receptors unopposed, resulting in peripheral vasoconstriction. We have previously shown that propranolol diminishes peripheral blood following burn injury by increasing vascular resistance. The purpose of this study was to investigate whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults. Sixty-nine adult patients with burns covering ≥ 30% of the total body surface area (TBSA) were enrolled in this IRB-approved study. Patients received standard burn care with (n = 35) or without (control, n = 34) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20% from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and postoperative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge. Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 ± 3.0 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group (P < 0.05). The average number of days between skin grafting procedures was also lower in propranolol patients (10 ± 5 days) than in control patients (17 ± 12 days; P = 0.02), indicative of a faster donor site healing time in the propranolol group. Packed red blood cell infusion was similar between groups (control 5.3 ± 5.4 units vs. propranolol 4.4 ± 3.1 units, P = 0.89). Propranolol was associated with a 5 to 7% improvement in perioperative hematocrit during grafting procedures of 4,000 to 16,000 cm(2) compared to control (P = 0.002). Administration of propranolol during the acute hospitalization period diminishes blood loss during skin grafting procedures and markedly improves wound healing in severely burned adults. As burn patients require serial surgical interventions for motor and cosmetic repair, restricting blood loss during operative intervention is optimal.

Cognition in patients with burn injury in the inpatient rehabilitation population.

PubMed

Purohit, Maulik; Goldstein, Richard; Nadler, Deborah; Mathews, Katie; Slocum, Chloe; Gerrard, Paul; DiVita, Margaret A; Ryan, Colleen M; Zafonte, Ross; Kowalske, Karen; Schneider, Jeffrey C

2014-07-01

To analyze potential cognitive impairment in patients with burn injury in the inpatient rehabilitation population. Rehabilitation patients with burn injury were compared with the following impairment groups: spinal cord injury, amputation, polytrauma and multiple fractures, and hip replacement. Differences between the groups were calculated for each cognitive subscale item and total cognitive FIM. Patients with burn injury were compared with the other groups using a bivariate linear regression model. A multivariable linear regression model was used to determine whether differences in cognition existed after adjusting for covariates (eg, sociodemographic factors, facility factors, medical complications) based on previous studies. Inpatient rehabilitation facilities. Data from Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury (N=5347) were compared with other rehabilitation populations (N=668,816). Not applicable. Comparison of total cognitive FIM scores and subscales (memory, verbal comprehension, verbal expression, social interaction, problem solving) for patients with burn injury versus other rehabilitation populations. Adults with burn injuries had an average total cognitive FIM score ± SD of 26.8±7.0 compared with an average FIM score ± SD of 28.7±6.0 for the other groups combined (P<.001). The subscale with the greatest difference between those with burn injury and the other groups was memory (5.1±1.7 compared with 5.6±1.5, P<.001). These differences persisted after adjustment for covariates. Adults with burn injury have worse cognitive FIM scores than other rehabilitation populations. Future research is needed to determine the impact of this comorbidity on patient outcomes and potential interventions for these deficits. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Assessing Transboundary Wildfire Exposure in the Southwestern United States.

PubMed

Ager, Alan A; Palaiologou, Palaiologos; R Evers, Cody; Day, Michelle A; G Barros, Ana M

2018-04-25

We assessed transboundary wildfire exposure among federal, state, and private lands and 447 communities in the state of Arizona, southwestern United States. The study quantified the relative magnitude of transboundary (incoming, outgoing) versus nontransboundary (i.e., self-burning) wildfire exposure based on land tenure or community of the simulated ignition and the resulting fire perimeter. We developed and described several new metrics to quantify and map transboundary exposure. We found that incoming transboundary fire accounted for 37% of the total area burned on large parcels of federal and state lands, whereas 63% of the area burned was burned by ignitions within the parcel. However, substantial parcel to parcel variation was observed for all land tenures for all metrics. We found that incoming transboundary fire accounted for 66% of the total area burned within communities versus 34% of the area burned by self-burning ignitions. Of the total area burned within communities, private lands contributed the largest proportion (36.7%), followed by national forests (19.5%), and state lands (15.4%). On average seven land tenures contributed wildfire to individual communities. Annual wildfire exposure to structures was highest for wildfires ignited on state and national forest land, followed by tribal, private, and BLM. We mapped community firesheds, that is, the area where ignitions can spawn fires that can burn into communities, and estimated that they covered 7.7 million ha, or 26% of the state of Arizona. Our methods address gaps in existing wildfire risk assessments, and their implementation can help reduce fragmentation in governance systems and inefficiencies in risk planning. Published 2018. This article is a U.S. government work and is in the public domain in the USA.

Total body surface area overestimation at referring institutions in children transferred to a burn center.

PubMed

Swords, Douglas S; Hadley, Edmund D; Swett, Katrina R; Pranikoff, Thomas

2015-01-01

Total body surface area (TBSA) burned is a powerful descriptor of burn severity and influences the volume of resuscitation required in burn patients. The incidence and severity of TBSA overestimation by referring institutions (RIs) in children transferred to a burn center (BC) are unclear. The association between TBSA overestimation and overresuscitation is unknown as is that between TBSA overestimation and outcome. The trauma registry at a BC was queried over 7.25 years for children presenting with burns. TBSA estimate at RIs and BC, total fluid volume given before arrival at a BC, demographic variables, and clinical variables were reviewed. Nearly 20 per cent of children arrived from RIs without TBSA estimation. Nearly 50 per cent were overestimated by 5 per cent or greater TBSA and burn sizes were overestimated by up to 44 per cent TBSA. Average TBSA measured at BC was 9.5 ± 8.3 per cent compared with 15.5 ± 11.8 per cent as measured at RIs (P < 0.0001). Burns between 10 and 19.9 per cent TBSA were overestimated most often and by the greatest amounts. There was a statistically significant relationship between overestimation of TBSA by 5 per cent or greater and overresuscitation by 10 mL/kg or greater (P = 0.02). No patient demographic or clinical factors were associated with TBSA overestimation. Education efforts aimed at emergency department physicians regarding the importance of always calculating TBSA as well as the mechanics of TBSA estimation and calculating resuscitation volume are needed. Further studies should evaluate the association of TBSA overestimation by RIs with adverse outcomes and complications in the burned child.

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.

Fire recurrence effects on aboveground plant and soil carbon stocks in Mediterranean shrublands with Aleppo pine

NASA Astrophysics Data System (ADS)

Herman, J.; den Ouden, J.; Mohren, G. M. J.; Retana, J.; Serrasolses, I.

2009-04-01

Changes in fire regime due to intensification of human influence during the last decades led to changes in vegetation structure and composition, productivity and carbon sink strength of Mediterranean shrublands and forests. It is anticipated that further climate warming and lower precipitation will enhance fire frequency, having consequences for the carbon budget and carbon storage in Mediterranean ecosystems. The purpose of this study was to determine whether fire recurrence modifies aboveground plant and soil carbon stocks, soil organic carbon content and total soil nitrogen content in shrublands with Aleppo pine on the Garraf Massif in Catalonia (Spain). Stands differing in fire frequency (1, 2 and 3 fires since 1957) were examined 13 years after the stand-replacing fire of 1994 and compared with control stands which were free of fire since 1957. Recurrent fires led to a decrease in total ecosystem carbon stocks. Control sites stored 12203 g m-2C which was 3.5, 5.0 and 5.5 times more than sites that burned 1, 2 and 3 times respectively. Carbon stored in the aboveground biomass exceeded soil carbon stocks in control plots, while soils were the dominant carbon pool in burned plots. An increasing fire frequency from 1 to 2 fires decreased total soil carbon stock. Control soils stored 3551 g m-2C, of which 70 % was recovered over 13 years in once burned soils and approximately 50 % in soils that had 2 or 3 fires. The soil litter (LF) layer carbon stock decreased with increasing fire frequency from 1 to 2 fires, whereas humus (H) layer and upper mineral soil carbon stocks did not change consistently with fire frequency. Fire decreased the organic carbon content in LF and H horizons, however no significant effect of fire frequency was found. Increasing fire frequency from 1 to 2 fires caused a decrease in the organic carbon content in the upper mineral soil. Total soil N content and C/N ratios were not significantly impacted by fire frequency. Recurrent fires had the greatest impact on aboveground plant carbon stocks. Aboveground plants in control plots amounted to 8652 g m-2C, of which 93 % was stored in trees, while carbon storage in the most frequently burned sites was only 509 g m-2C. Shrub carbon varied barely between fire frequencies, corroborating the high resilience of resprouting shrub species to fire recurrence. The most striking result was the immense decrease in Aleppo pine carbon stock which varied between 7770 g m-2in control plots and 25.6 g m-2in 3-fires plots. Differences between control and burned plots are principally explained by the age of the plots. The decrease in Aleppo pine carbon stock within burned plots was not associated with a growth reduction, but was due to a decrease in stem density. The results indeed indicate that the recruitment of Aleppo pine on more frequently burned plots is obstructed due to cumulative effects of short fire return-intervals (

[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.

The burning issues of motor vehicle radiator scald injuries revisited – a fresh review and changing prevention strategies

PubMed Central

Patel, J.N.; Tan, A.; Frew, Q.; Dziewulski, P.

2016-01-01

Summary A preventable subgroup of burn injuries is scalds sustained from motor vehicle radiators. This study was to determine changes in trends in epidemiology of such injuries and to discuss whether current and other prevention efforts proposed previously require reinforcement. We conducted a retrospective study (February 2007-August 2015) of all motor vehicle-related burn referrals to our regional burns service. 68 cases of motor vehicle radiator burns were identified. Male to female ratio was 65:3. Mean age was 35.1 (range = 9-71). Most cases occurred in the summer months (22/68 = 32.4%). 65 cases (95.6%) involved car radiators. 66% of injuries resulted from actively removing the pressure cap of an overheated radiator in the motor vehicle. Mean total burn surface area (%TBSA) was 2.1% (range = 0.5- 11%). The depths of burn injuries were mostly superficial partial thickness. Face, chest and upper limbs were the most common sites of injury. Mean healing time was 14.2 days (range = 4-60). Following the introduction of safety measures by vehicle manufacturers, motor vehicle radiator burns in this era are mostly minor injuries and can be potentially managed conservatively as an outpatient. This contrasts with findings from previous studies over a decade ago of larger, more significant injuries requiring admission and surgery. Whilst manufacturers have installed safety measures into the design of radiator caps, our findings suggest that re-educating the public to allow a period of cooling prior to opening caps should be reinforced. PMID:28289357

The burning issues of motor vehicle radiator scald injuries revisited - a fresh review and changing prevention strategies.

PubMed

Patel, J N; Tan, A; Frew, Q; Dziewulski, P

2016-12-31

A preventable subgroup of burn injuries is scalds sustained from motor vehicle radiators. This study was to determine changes in trends in epidemiology of such injuries and to discuss whether current and other prevention efforts proposed previously require reinforcement. We conducted a retrospective study (February 2007-August 2015) of all motor vehicle-related burn referrals to our regional burns service. 68 cases of motor vehicle radiator burns were identified. Male to female ratio was 65:3. Mean age was 35.1 (range = 9-71). Most cases occurred in the summer months (22/68 = 32.4%). 65 cases (95.6%) involved car radiators. 66% of injuries resulted from actively removing the pressure cap of an overheated radiator in the motor vehicle. Mean total burn surface area (%TBSA) was 2.1% (range = 0.5- 11%). The depths of burn injuries were mostly superficial partial thickness. Face, chest and upper limbs were the most common sites of injury. Mean healing time was 14.2 days (range = 4-60). Following the introduction of safety measures by vehicle manufacturers, motor vehicle radiator burns in this era are mostly minor injuries and can be potentially managed conservatively as an outpatient. This contrasts with findings from previous studies over a decade ago of larger, more significant injuries requiring admission and surgery. Whilst manufacturers have installed safety measures into the design of radiator caps, our findings suggest that re-educating the public to allow a period of cooling prior to opening caps should be reinforced.

Repeated wildfires alter forest recovery of mixed-conifer ecosystems.

PubMed

Stevens-Rumann, Camille; Morgan, Penelope

2016-09-01

Most models project warmer and drier climates that will contribute to larger and more frequent wildfires. However, it remains unknown how repeated wildfires alter post-fire successional patterns and forest structure. Here, we test the hypothesis that the number of wildfires, as well as the order and severity of wildfire events interact to alter forest structure and vegetation recovery and implications for vegetation management. In 2014, we examined forest structure, composition, and tree regeneration in stands that burned 1-18 yr before a subsequent 2007 wildfire. Three important findings emerged: (1) Repeatedly burned forests had 15% less woody surface fuels and 31% lower tree seedling densities compared with forests that only experienced one recent wildfire. These repeatedly burned areas are recovering differently than sites burned once, which may lead to alternative ecosystem structure. (2) Order of burn severity (high followed by low severity compared with low followed by high severity) did influence forest characteristics. When low burn severity followed high, forests had 60% lower canopy closure and total basal area with 92% fewer tree seedlings than when high burn severity followed low. (3) Time between fires had no effect on most variables measured following the second fire except large woody fuels, canopy closure and tree seedling density. We conclude that repeatedly burned areas meet many vegetation management objectives of reduced fuel loads and moderate tree seedling densities. These differences in forest structure, composition, and tree regeneration have implications not only for the trajectories of these forests, but may reduce fire intensity and burn severity of subsequent wildfires and may be used in conjunction with future fire suppression tactics. © 2016 by the Ecological Society of America.

Long-Term Skeletal Muscle Mitochondrial Dysfunction is Associated with Hypermetabolism in Severely Burned Children.

PubMed

Porter, Craig; Herndon, David N; Børsheim, Elisabet; Bhattarai, Nisha; Chao, Tony; Reidy, Paul T; Rasmussen, Blake B; Andersen, Clark R; Suman, Oscar E; Sidossis, Labros S

2016-01-01

The long-term impact of burn trauma on skeletal muscle bioenergetics remains unknown. Here, the authors determined respiratory capacity and function of skeletal muscle mitochondria in healthy individuals and in burn victims for up to 2 years postinjury. Biopsies were collected from the m. vastus lateralis of 16 healthy men (26 ± 4 years) and 69 children (8 ± 5 years) with burns encompassing ≥30% of their total BSA. Seventy-nine biopsies were collected from cohorts of burn victims at 2 weeks (n = 18), 6 months (n = 18), 12 months (n = 25), and 24 months (n = 18) postburn. Hypermetabolism was determined by the difference in predicted and measured metabolic rate. Mitochondrial respiration was determined in saponin-permeabilized myofiber bundles. Outcomes were modeled by analysis of variance, with differences in groups assessed by Tukey-adjusted contrasts. Burn patients were hypermetabolic for up to 2 years postinjury. Coupled mitochondrial respiration was lower at 2 weeks (17 [8] pmol/sec/mg; P < .001), 6 months (41 [30] pmol/sec/mg; P = .03), and 12 months (35 [14] pmol/sec/mg; P < .001) postburn compared with healthy controls (58 [13] pmol/sec/mg). Coupled respiration was greater at 6, 12, and 24 months postburn vs 2 weeks postburn (P < .001). Mitochondrial adenosine diphosphate and oligomycin sensitivity (measures of coupling control) were lower at all time-points postburn vs control (P < .05), but greater at 6, 12, and 24 months postburn vs 2 weeks postburn (P < .05). Muscle mitochondrial respiratory capacity remains significantly lower in burn victims for 1-year postinjury. Mitochondrial coupling control is diminished for up to 2 years postinjury in burn victims, resulting in greater mitochondrial thermogenesis. These quantitative and qualitative derangements in skeletal muscle bioenergetics likely contribute to the long-term pathophysiological stress response to burn trauma.

The effect of transfers between health care facilities on costs and length of stay for pediatric burn patients.

PubMed

Myers, John; Smith, Michael; Woods, Charles; Espinosa, Claudia; Lehna, Carlee

2015-01-01

Hospitals vary widely in the services they offer to care for pediatric burn patients. When a hospital does not have the ability or capacity to handle a pediatric burn, the decision often is made to transfer the patient to another short-term hospital. Transfers may be based on available specialty coverage for children; which adult and non-teaching hospitals may not have available. The effect these transfers have on costs and length of stay (LOS) has on pediatric burn patients is not well established and is warranted given the prominent view that pediatric hospitals are inefficient or more costly. The authors examined inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 using the Kids' Inpatient Database, which is part of the Healthcare Cost and Utilization Project. ICD-9-CM codes 940 to 947 were used to define burn injury. The authors tested if transfer status was associated with LOS and total charges for pediatric burn patients, while adjusting for traditional risk factors (eg, age, TBSA, insurance status, type of hospital [pediatric vs adult; teaching vs nonteaching]) by using generalized linear mixed-effects modeling. A total of n = 28,777 children had a burn injury. Transfer status (P < .001) and TBSA (P < .001) was independently associated with LOS, while age, insurance status, and type of hospital were not associated with LOS. Similarly, transfer status (P < .001) and TBSA (P < .001) was independently associated with total charges, while age, insurance status, and type of hospital were not associated with total charges. In addition, the data suggest that the more severe pediatric burn patients are being transferred from adult and non-teaching hospitals to pediatric and teaching hospitals, which may explain the increased costs and LOS seen at pediatric hospitals. Larger more severe burns are being transferred to pediatric hospitals with the ability or capacity to handle these conditions in the pediatric population, which has a dramatic impact on costs and LOS. As a result, unadjusted, pediatric hospitals are seen as being inefficient in treating pediatric burns. However, since pediatric hospitals see more severe cases, after adjustment, type of hospital did not influence costs and LOS. TBSA and transfer status were the predictors studied that independently affect costs and LOS.

Epidemiology and outcome analysis of scalds in children caused by "guo lian kang": an 11-year review in a burn center in China.

PubMed

Zhu, Liqiang; Zhang, Hong; Shi, Fusheng; Yi, Dong; Zhu, Guangjun

2015-03-01

The objective of this study was to investigate the epidemiological characteristics of scalds induced by "guo lian kang" (literally "stove connected to bed") in children. The demographic, burn features, outcome, and other information of 0-14-year-old children with "guo lian kang"-induced scalds admitted to the burn treatment center of the 322 Hospital of the People's Liberation Army in Datong from 30 September 2001 to 31 December 2011 were analyzed. Among the 1993 children clearly documented with scalds due to hot liquid in vessels, 795 (39.89%) had burns due to "guo lian kang." The proportion of the pediatric burns caused by "guo lian kang" was 55.56% in 2002 and 37.30% in 2011, with a decreasing trend. One-year-old children accounted for the highest proportion of children with burns due to "guo lian kang" (male:female=1.54:1). Scalding mostly occurred from October to May; the most common times were around 8:00 AM, 11:00 AM, and 7:00 PM. Most scalds occurred on the upper limbs, 90.22% of which were dermal burns. The median burn area was 11% of the total body surface area. The burn agent was mainly hot water in pots. Scalding mostly occurred when the children accidentally sat on, or fell or stepped into the pot while playing. Among the children with "guo lian kang"-induced scalds, up to 42.26% of the children did not receive any treatment before hospital admission, and 18.86% of the children were admitted to the hospital ≥6h after the occurrence of burns. In addition, 74.97% of the children's families can afford the medical expenses, while 5.28% abandoned treatment because of financial difficulties. There were no significant differences between children with scalds caused by "guo lian kang" and scalds caused due to other reasons considering the age and sex. Compared to scalds due to other reasons, children with "guo lian kang"-induced scalds had greater burn area and depth, shock incidence, surgery rate, blood transfusion rate, length of hospital stay, and hospitalization costs. Preventive measures against burns should be taken from October to May and mainly during cooking time in order to prevent burns in children less than 3 years of age, especially in 1-year-old boys. The most simple and effective preventive measure is to install a barrier between the pot and bed. The incidence of shock in children may be reduced if parents and primary medical staff undergo training to perform first aid for burns and if there are improvements in the referral system after burns. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

The magnetic recoil spectrometer (MRSt) for time-resolved measurements of the neutron spectrum at the National Ignition Facility (NIF)

DOE PAGES

Frenje, J. A.; Hilsabeck, T. J.; Wink, C. W.; ...

2016-08-02

The next-generation magnetic recoil spectrometer for time-resolved measurements of the neutron spectrum has been conceptually designed for the National Ignition Facility. This spectrometer, called MRSt, represents a paradigm shift in our thinking about neutron spectrometry for inertial confinement fusion applications, as it will provide simultaneously information about the burn history and time evolution of areal density (ρR), apparent ion temperature (T i), yield (Y n), and macroscopic flows during burn. From this type of data, an assessment of the evolution of the fuel assembly, hotspot, and alpha heating can be made. According to simulations, the MRSt will provide accurate datamore » with a time resolution of ~20 ps and energy resolution of ~100 keV for total neutron yields above ~10 16. Lastly, at lower yields, the diagnostic will be operated at a higher-efficiency, lower-energy-resolution mode to provide a time resolution of ~20 ps.« less

The magnetic recoil spectrometer (MRSt) for time-resolved measurements of the neutron spectrum at the National Ignition Facility (NIF).

PubMed

Frenje, J A; Hilsabeck, T J; Wink, C W; Bell, P; Bionta, R; Cerjan, C; Gatu Johnson, M; Kilkenny, J D; Li, C K; Séguin, F H; Petrasso, R D

2016-11-01

The next-generation magnetic recoil spectrometer for time-resolved measurements of the neutron spectrum has been conceptually designed for the National Ignition Facility. This spectrometer, called MRSt, represents a paradigm shift in our thinking about neutron spectrometry for inertial confinement fusion applications, as it will provide simultaneously information about the burn history and time evolution of areal density (ρR), apparent ion temperature (T i ), yield (Y n ), and macroscopic flows during burn. From this type of data, an assessment of the evolution of the fuel assembly, hotspot, and alpha heating can be made. According to simulations, the MRSt will provide accurate data with a time resolution of ∼20 ps and energy resolution of ∼100 keV for total neutron yields above ∼10 16 . At lower yields, the diagnostic will be operated at a higher-efficiency, lower-energy-resolution mode to provide a time resolution of ∼20 ps.

Method and apparatus for determining time, direction, and composition of impacting space particles

NASA Technical Reports Server (NTRS)

Kinard, William H. (Inventor); Wortman, Jim J. (Inventor); Kassel, Philip C., Jr. (Inventor); Singer, Fred S. (Inventor); Humes, Donald H. (Inventor); Stanley, John E. (Inventor)

1990-01-01

A space particle collector for recording the time specific particles are captured, and its direction at the time of capture, utilizes an array of targets, each comprised of an MOS capacitor on a chip charged from an external source and discharged upon impact by a particle through a tab on the chip that serves as a fuse. Any impacting particle creates a crater, but only the first will cause a discharge of the capacitor. A substantial part of the metal film around the first crater is burned off by the discharge current. The time of the impulse which burns the tab, and the identification of the target, is recorded together with data from flight instruments. The metal film is partitioned into pie sections to provide a plurality of targets on each of an array of silicon wafers, thus increasing the total number of identified particles that can be collected. It is thus certain which particles were captured at what specific times.

The magnetic recoil spectrometer (MRSt) for time-resolved measurements of the neutron spectrum at the National Ignition Facility (NIF)

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

Frenje, J. A., E-mail: jfrenje@psfc.mit.edu; Wink, C. W.; Gatu Johnson, M.

The next-generation magnetic recoil spectrometer for time-resolved measurements of the neutron spectrum has been conceptually designed for the National Ignition Facility. This spectrometer, called MRSt, represents a paradigm shift in our thinking about neutron spectrometry for inertial confinement fusion applications, as it will provide simultaneously information about the burn history and time evolution of areal density (ρR), apparent ion temperature (T{sub i}), yield (Y{sub n}), and macroscopic flows during burn. From this type of data, an assessment of the evolution of the fuel assembly, hotspot, and alpha heating can be made. According to simulations, the MRSt will provide accurate datamore » with a time resolution of ∼20 ps and energy resolution of ∼100 keV for total neutron yields above ∼10{sup 16}. At lower yields, the diagnostic will be operated at a higher-efficiency, lower-energy-resolution mode to provide a time resolution of ∼20 ps.« less

Developing a burn injury severity score (BISS): adding age and total body surface area burned to the injury severity score (ISS) improves mortality concordance.

PubMed

Cassidy, J Tristan; Phillips, Michael; Fatovich, Daniel; Duke, Janine; Edgar, Dale; Wood, Fiona

2014-08-01

There is limited research validating the injury severity score (ISS) in burns. We examined the concordance of ISS with burn mortality. We hypothesized that combining age and total body surface area (TBSA) burned to the ISS gives a more accurate mortality risk estimate. Data from the Royal Perth Hospital Trauma Registry and the Royal Perth Hospital Burns Minimum Data Set were linked. Area under the receiver operating characteristic curve (AUC) measured concordance of ISS with mortality. Using logistic regression models with death as the dependent variable we developed a burn-specific injury severity score (BISS). There were 1344 burns with 24 (1.8%) deaths, median TBSA 5% (IQR 2-10), and median age 36 years (IQR 23-50). The results show ISS is a good predictor of death for burns when ISS≤15 (OR 1.29, p=0.02), but not for ISS>15 (ISS 16-24: OR 1.09, p=0.81; ISS 25-49: OR 0.81, p=0.19). Comparing the AUCs adjusted for age, gender and cause, ISS of 84% (95% CI 82-85%) and BISS of 95% (95% CI 92-98%), demonstrated superior performance of BISS as a mortality predictor for burns. ISS is a poor predictor of death in severe burns. The BISS combines ISS with age and TBSA and performs significantly better than the ISS. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Validation of the French version of the Burn Specific Health Scale-Brief (BSHS-B) questionnaire.

PubMed

Gandolfi, S; Auquit-Auckbur, I; Panunzi, S; Mici, E; Grolleau, J-L; Chaput, B

2016-11-01

The Burn Specific Health Scale-Brief questionnaire is a widely validated tool for estimating the health related quality of life and for assessing the best multidisciplinary management of burn patients. The aim of this study was to translate the BSHS-B into French and to investigate its reliability and validity. According to the procedure proposed by the Scientific Advisory Committee of the Medical Outcomes Trust, the Burn Specific Health Scale-Brief (BSHS-B) was translated from the English version into French. In order to test the reliability of the French version of the BSHS-B, 53 burn patients French speakers completed the BSHS-B and SF-36 questionnaires from two to four years after burn. Ten of them have been re-tested at 6 months after the first evaluation. To evaluate clinical utility of the BSHS-F, internal consistency, construct validity (using SF-36) and stability in time were assessed using Cronbach's alpha statistic, Spearman rank test, and intra-class correlation coefficient respectively. The French version of the BSHS-B Cronbach's alpha coefficient was 0.93 and was >0.80 for all the sub-domains. French version of the BSHS-B and the SF-36 were positively correlated, all the associations were statistically significant (p<0.01). Intra-class correlation coefficients for test-retest ranged between 0.95 and 0.99 for the sub-domains. The intra-class correlation coefficient (ICC) for the total score was 0.98. The French version of the BSHS-B shows a robust rate of internal consistency, construct validity and stability in time, supporting its application in routine clinical practice as well as in international studies. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Report From the California Burn Registry—The Causes of Major Burns

PubMed Central

Bongard, Frederic S.; Ostrow, Louis B.; Sacks, Susan T.; McGuire, Andrew; Trunkey, Donald D.

1985-01-01

In its first four years of operation, the California Burn Registry recorded 3,332 cases of burns, of which 73.1% were in male and 26.9% were in female patients of all ages. The average total body surface area burned was 15.4±0.3%. Flame burns were the most common (31.4%). Other common sources included scalds (24.5%) and flammable liquids (12.9%). Several other causes were cited with less frequency. Burns taking place at home occurred more commonly than at all other locations combined. In all, 221 deaths (6.6%) were reported, most (66.1%) of which were due to flame burns. PMID:4013280

Use of mineral oil Fleet enema for the removal of a large tar burn: a case report.

PubMed

Carta, Tricia; Gawaziuk, Justin; Liu, Song; Logsetty, Sarvesh

2015-03-01

Extensive hot tar burns are relatively uncommon. Management of these burns provides a significant clinical challenge especially with respect to tar removal involving a large total body surface area (TBSA), without causing further tissue injury. We report a case of an over 40-year old male construction worker who was removing a malfunctioning cap from broken valve. This resulted in tar spraying over the anterior surface of his body including legs, feet, chest, abdomen, arms, face and oral cavity (80% TBSA covered in tar resulting in a 50% TBSA burn injury). Initially, petrolatum-based, double antibiotic ointment was used to remove the tar, based on our previous experience with small tar burns. However, this was time-consuming and ineffective. The tar was easily removed with mineral oil without irritation. In order to meet the demand for quantity of mineral oil, the pharmacy suggested using mineral oil Fleet enema (C.B. Fleet Company, Inc., Lynchburg, Virginia, USA). The squeezable bottle and catheter tip facilitated administration of oil into the patient's construction boots and under clothing that was adhered to the patient's skin. Tar removal requires an effective, non-toxic and non-irritating agent. Mineral oil is such an agent. For patients that may present with a large surface area tar burn, using mineral oil Fleet enema is a viable option that facilitates application into difficult areas. Grant Support: The Firefighters' Burn Fund (Manitoba) supported this project. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

An alteration of the gut-liver axis drives pulmonary inflammation after intoxication and burn injury in mice

PubMed Central

Chen, Michael M.; Zahs, Anita; Brown, Mary M.; Ramirez, Luis; Turner, Jerrold R.; Choudhry, Mashkoor A.

2014-01-01

Approximately half of all adult burn patients are intoxicated at the time of their injury and have worse clinical outcomes than those without prior alcohol exposure. This study tested the hypothesis that intoxication alters the gut-liver axis, leading to increased pulmonary inflammation mediated by burn-induced IL-6 in the liver. C57BL/6 mice were given 1.2 g/kg ethanol 30 min prior to a 15% total body surface area burn. To restore gut barrier function, the specific myosin light chain kinase inhibitor membrane-permeant inhibitor of kinase (PIK), which we have demonstrated to reduce bacterial translocation from the gut, was administered 30 min after injury. Limiting bacterial translocation with PIK attenuated hepatic damage as measured by a 47% reduction in serum alanine aminotransferase (P < 0.05), as well as a 33% reduction in hepatic IL-6 mRNA expression (P < 0.05), compared with intoxicated and burn-injured mice without PIK. This mitigation of hepatic damage was associated with a 49% decline in pulmonary neutrophil infiltration (P < 0.05) and decreased alveolar wall thickening compared with matched controls. These results were reproduced by prophylactic reduction of the bacterial load in the intestines with oral antibiotics before intoxication and burn injury. Overall, these data suggest that the gut-liver axis is deranged when intoxication precedes burn injury and that limiting bacterial translocation in this setting attenuates hepatic damage and pulmonary inflammation. PMID:25104501

Total Intravenous Anesthesia for Major Burn Surgery

DTIC Science & Technology

2013-04-30

been used in burn centers, particularly for frequent debride- ments, dressing changes, and tanking (hydro- therapy) procedures outside of the...2.0 mg/kg for patients with, e.g., burn shock or septic shock. Several conditions are typically considered con- traindications to ketamine use, but

Whitewater-Baldy Fire

Atmospheric Science Data Center

2015-03-05

... June 12, 2012, it had burned a total of 278,708 acres (1,128 square kilometers), making it the largest wildfire on record in New Mexico. ... June 12, 2012, it had burned a total of 278,708 acres (1,128 square kilometers), making it the largest wildfire on record in New Mexico. The ...

Properties of Deflagration Fronts and Models for Type IA Supernovae

NASA Astrophysics Data System (ADS)

Domínguez, I.; Höflich, P.

2000-01-01

Detailed models of the explosion of a white dwarf that include self-consistent calculations of the light curve and spectra provide a link between observational quantities and the underlying explosion model. These calculations assume spherical geometry and are based on parameterized descriptions of the burning front. Recently, the first multidimensional calculations for nuclear burning fronts have been performed. Although a fully consistent treatment of the burning fronts is beyond the current state of the art, these calculations provide a new and better understanding of the physics. Several new descriptions for flame propagation have been proposed by Khokhlov et al. and Niemeyer et al. Using various descriptions for the propagation of a nuclear deflagration front, we have studied the influence on the results of previous analyses of Type Ia supernovae, namely, the nucleosynthesis and structure of the expanding envelope. Our calculations are based on a set of delayed detonation models with parameters that give a good account of the optical and infrared light curves and of the spectral evolution. In this scenario, the burning front first propagates in a deflagration mode and subsequently turns into a detonation. The explosions and light curves are calculated using a one-dimensional Lagrangian radiation-hydro code including a detailed nuclear network. We find that the results of the explosion are rather insensitive to details of the description of the deflagration front, even if its speed and the time from the transition to detonation differ almost by a factor of 2. For a given white dwarf (WD) and a fixed transition density, the total production of elements changes by less than 10%, and the distribution in the velocity space changes by less than 7%. Qualitatively, this insensitivity of the final outcome of the explosion to the details of the flame propagation during the (slow) deflagration phase can be understood as follows: for plausible variations in the speed of the turbulent deflagration, the duration of this phase is several times longer than the sound crossing time in the initial WD. Therefore, the energy produced during the early nuclear burning can be redistributed over the entire WD, causing a slow preexpansion. In this intermediate state, the WD is still bound but its binding energy is reduced by the amount of nuclear energy. The expansion ratio depends mainly on the total amount of burning during the deflagration phase. Consequently, the conditions are very similar under which nuclear burning takes place during the subsequent detonation phase. In our example, the density and temperature at the burning front changes by less than 3%, and the expansion velocity changes by less than 10%. The burning conditions are very close to previous calculations which used a constant deflagration velocity. Based on a comparison with observations, those required low deflagration speeds (~2%-3% of the speed of sound). Exceptions to the similarity are the innermost layers of ~0.03-0.05 Msolar. Still, nuclear burning is in nuclear statistical equilibrium, but the rate of electron capture is larger for the new descriptions of the flame propagation. Consequently, the production of very neutron-rich isotopes is increased. In our example, close to the center Ye is about 0.44, compared to 0.46 in the model with constant deflagration speed. This increases the 48Ca production by more than a factor of 100 to 3.E-6 Msolar. Conclusions from previous analyses of light curves and spectra on the properties of the WD and the explosions will not change, and even with the new descriptions, the delayed detonation scenario is consistent with the observations. Namely, the central density results with respect to the chemical structure of the progenitor and the transition density from deflagration to detonation do not change. The reason for this similarity is the fact that the total amount of burning during the long deflagration phase determines the restructuring of the WD prior to the detonation. Therefore, we do not expect that the precise, microphysical prescription for the speed of a subsonic burning front has a significant effect on the outcome. However, at the current level of uncertainties for the burning front, the relation between properties of the burning front and of the initial white dwarf cannot be obtained from a comparison between observation and theoretical predictions by one-dimensional models. Multidimensional calculations are needed (1) to get inside the relations between model parameters such as central density and properties of the deflagration front and its relation to the transition density between deflagration and detonation and (2) to make use of information on asphericity that is provided by polarization measurements. These questions are essential to test, estimate, and predict some of the evolutionary effects of SNe Ia and their use as cosmological yardsticks.

Nursing Activities Score: nursing work load in a burns Intensive Care Unit1

PubMed Central

Camuci, Marcia Bernadete; Martins, Júlia Trevisan; Cardeli, Alexandrina Aparecida Maciel; Robazzi, Maria Lúcia do Carmo Cruz

2014-01-01

Objective to evaluate the nursing work load in a Burns Intensive Care Unit according to the Nursing Activities Score. Method an exploratory, descriptive cross-sectional study with a quantitative approach. The Nursing Activities Score was used for data collection between October 2011 and May 2012, totalling 1,221 measurements, obtained from 50 patients' hospital records. Data for qualitative variables was described in tables; for the quantitative variables, calculations using statistical measurements were used. Results the mean score for the Nursing Activities Score was 70.4% and the median was 70.3%, corresponding to the percentage of the time spent on direct care to the patient in 24 hours. Conclusion the Nursing Activities Score provided information which involves the process of caring for patients hospitalized in a Burns Intensive Care Unit, and indicated that there is a high work load for the nursing team of the sector studied. PMID:26107842

Yellow pine regeneration as a function of fire severity and post-burn stand structure in the southern Appalachian Mountains

Treesearch

Michael A. Jenkins; Robert N. Klein; Virginia L. McDaniel

2011-01-01

We used pre- and post-burn fire effects data from six prescribed burns to examine post-burn threshold effects of stand structure (understory density, overstory density, shrub cover, duff depth, and total fuel load) on the regeneration of yellow pine (Pinus subgenus Diploxylon) seedlings and cover of herbaceous vegetation in six prescribed-fire management units located...

Production of CO2 from Fossil Fuel Burning by Fuel Type, 1860-1982

DOE Data Explorer

Rotty, R.M. [Oak Ridge Associated Univ., Oak Ridge, TN (United States); Marland, G. [Oak Ridge Associated Univ., Oak Ridge, TN (United States)

2004-01-01

Global carbon dioxide emissions for 1950 through 1982 were estimated by Marland and Rotty (1984) from fuel production data from the U.N. Energy Statistics Yearbook (1983, 1984). Data before 1950 came from Keeling (1973). Fuel-production data were used in these calculations because they appeared to be more reliable on a global basis than fuel-consumption data. The data given are the year and annual global CO2 emissions (annual global total; cumulative global total since 1860; and annual global emissions from solid fuels, liquid fuels, natural gas, gas flaring, and cement manufacturing). These data provide the only pre-1950 estimates of the amount of carbon emitted to the atmosphere from fossil-fuel burning. The CO2 emission record since 1950 has been updated and revised several times with the most recent estimates being published by Marland et al. (1989).

Rockets -- Part II.

ERIC Educational Resources Information Center

Leitner, Alfred

1982-01-01

If two rockets are identical except that one engine burns in one-tenth the time of the other (total impulse and initial fuel mass of the two engines being the same), which rocket will rise higher? Why? The answer to this question (part 1 response in v20 n6, p410, Sep 1982) is provided. (Author/JN)

Do burns increase the severity of terror injuries?

PubMed

Peleg, Kobi; Liran, Alon; Tessone, Ariel; Givon, Adi; Orenstein, Arie; Haik, Josef

2008-01-01

The use of explosives and suicide bombings has become more frequent since October 2000. This change in the nature of terror attacks has marked a new era in the Israeli-Palestinian conflict. We previously reported that the incidence of thermal injuries has since risen. However, the rise in the incidence of burns among victims of terror was proportionate to the rise in the incidence of burns among all trauma victims. This paper presents data from the Israeli National Trauma Registry during the years 1997--2003, to compare the severity of injuries and outcome (mortality rates) in terror victims with and without burn injuries. We also compare the severity of injuries and outcome (mortality rates) for patients with terror-attack related burns to non terror-attack related burns during the same period. Data was obtained from the Israeli National Trauma Registry for all patients admitted to 8 to 10 hospitals in Israel between 1997 and 2003. We analyzed and compared demographic and clinical characteristics of 219 terror-related burn patients (terror/burn), 2228 terror patients with no associated burns (Terror/no-burn) and 6546 non terror related burn patients (burn/no-terror). Severity of injuries was measured using the injury severity score, and burn severity by total body surface percentage indices. Admission rates to Intensive Care Units (ICU) and total length of hospitalization were also used to measure severity of injuries. In-hospital mortality rates were used to indicate outcome. Of burn/terror patients, 87.2% suffered other accompanying injuries, compared with 10.4% of burn/no-terror patients. Of burn/terror patients, 49.8% were admitted to ICU compared with only 11.9% of burn/no-terror patients and 23.8% of no-burn/terror patients. Mean length of hospital stay was 18.5 days for the terror/burn group compared with 11.1 days for the burn/no-terror group and 9.5 days for the terror/no-burn group. Burn/terror patients had a significantly higher injury severity score compared with the other groups. In-hospital mortality rate for the burn/no-terror group was 3.4%. The burn/terror group had a mortality rate of 6.4% which was similar to the no-burn/terror group (6.6%). Terror-attack injuries with accompanying burns have a more complex presentation, are of higher severity, and are associated with increased length of hospital stay and a higher ICU admissions rate, compared with terror-attack injuries without burns and non terror-attack related burns. However, mortality rates in terror-attack injuries are not affected by burns.

Electrical burns: The trend and risk factors in the Ghanaian population.

PubMed

Agbenorku, P; Agbenorku, E; Akpaloo, J; Obeng, G; Agbley, D

2014-12-31

The usefulness of electricity in daily life offers several advantages which cannot be underestimated. Electricity is needed by industries for manufacturing and also in homes for lighting, cooking, washing, etc. However, electricity can cause severe life-threatening complications. This study investigates the trend and mortality risk factors of electrical burn injuries at the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital (KATH), Ghana. The Burns Registry at KATH BICU containing information on patients who were admitted for electrical burns was used. Data on the sex, age, occupation, cause of injury, Total Body Surface Area burned (TBSA) and outcome of admissions was obtained. GraphPad version 5 was used for the analysis. There were 13 (2.7%) electrical burns, suffered by 11 males (84.6%) and 2 females (15.4%) out of a total 487 BICU admissions over a 4-year period (July 1, 2009 - June 30, 2013); the mean age of the electrical burn victims was 37.8 years (range = 22-56); the TBSA ranged from 5.0% - 98.0%. Mortality risk factors identified were high voltage electrical burns, older age (P=0.0250) and TBSA>20% (P=0.048). Four cases (30.8%) were transferred to the Main Burns Ward (Ward D2C); 6 cases (46.1%) were discharged home; 3 patients (23.1%) died; all deaths were recorded in persons who had high voltage electrical burns. Electrical burns can be severe and can cause death. Even though the current study showed that a small population was affected by electrical burns, society has to be continually conscious of the detrimental effects of electrical energy and take the necessary precautions to minimize this type of accident.

Electrical burns: The trend and risk factors in the Ghanaian population

PubMed Central

Agbenorku, P.; Agbenorku, E.; Akpaloo, J.; Obeng, G.; Agbley, D.

2014-01-01

Summary The usefulness of electricity in daily life offers several advantages which cannot be underestimated. Electricity is needed by industries for manufacturing and also in homes for lighting, cooking, washing, etc. However, electricity can cause severe life-threatening complications. This study investigates the trend and mortality risk factors of electrical burn injuries at the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital (KATH), Ghana. The Burns Registry at KATH BICU containing information on patients who were admitted for electrical burns was used. Data on the sex, age, occupation, cause of injury, Total Body Surface Area burned (TBSA) and outcome of admissions was obtained. GraphPad version 5 was used for the analysis. There were 13 (2.7%) electrical burns, suffered by 11 males (84.6%) and 2 females (15.4%) out of a total 487 BICU admissions over a 4-year period (July 1, 2009 – June 30, 2013); the mean age of the electrical burn victims was 37.8 years (range = 22–56); the TBSA ranged from 5.0% - 98.0%. Mortality risk factors identified were high voltage electrical burns, older age (P=0.0250) and TBSA>20% (P=0.048). Four cases (30.8%) were transferred to the Main Burns Ward (Ward D2C); 6 cases (46.1%) were discharged home; 3 patients (23.1%) died; all deaths were recorded in persons who had high voltage electrical burns. Electrical burns can be severe and can cause death. Even though the current study showed that a small population was affected by electrical burns, society has to be continually conscious of the detrimental effects of electrical energy and take the necessary precautions to minimize this type of accident. PMID:26336364

Source characterization of ambient fine aerosol in Singapore during a haze episode in 2015

NASA Astrophysics Data System (ADS)

Hapsari Budisulistiorini, Sri; Riva, Matthieu; Williams, Michael; Miyakawa, Takuma; Komazaki, Yuichi; Chen, Jing; Surratt, Jason; Kuwata, Mikinori

2017-04-01

Recurring transboundary haze from Indonesia peatland fires in the previous decades has significantly elevated particulate matter (PM) concentration in Southeast Asia, particularly during the 2015 El Niño event. Previous studies have investigated chemical composition of particles emitted during haze episodes; however, they were limited to time-integrated samples and the number of identified compounds. Low time-resolution measurement results in co-variance of PM sources; therefore, higher time-resolution measurement is important in PM source apportionment. Between October 10-31, 2015, Aerodyne Time-of-Flight Aerosol Chemical Speciation Monitor (ToF-ACSM) was deployed for real-time chemical characterization of ambient submicron PM (NR-PM1) in Singapore. Simultaneously, PM2.5 filter samples were collected for molecular-level organic aerosol (OA) constituents, organic carbon (OC), elemental carbon (EC) and water-soluble OC (WSOC) analyses. OA constituents were quantified by gas chromatography interfaced to electron ionization mass spectrometry (GC/EI-MS) and ultra-performance liquid chromatography interfaced to electrospray ionization high-resolution quadrupole time-of-flight mass spectrometer operated in the negative ion mode (UPLC/(-)ESI-HR-Q-TOFMS). OA and SO42- are dominant components of the haze particles, accounting for ˜77% and ˜12% of the total NR-PM1 mass, respectively. OC/EC ratio of 4.8 might indicate formation of secondary OA (SOA) and aerosols from biomass burning, including those from peat burning. OA fraction from ToF-ACSM measurements was analyzed for source apportionment using a bilinear model through multi-linear engine algorithm (ME-2) in graphical user interface SoFi (Source Finder). Five OA factors were identified: hydrocarbon-like OA (HOA), biomass burning OA (BBOA), peat burning OA (PBOA), low-volatility oxygenated OA (LV-OOA), and semi-volatile oxygenated OA (SV-OOA). The HOA factor shows a distinct diurnal profile peaking in the morning and evening, suggesting traffic influences. The BBOA factor was identified based on factor profile of wood burning particles and correlated with known biomass burning tracers (i.e. levoglucosan and mannosan). The PBOA factor was identified based on factor profile of laboratory-generated peat burning particles. This factor would be further identified with OA constituents in peat burning particles, such as brown carbon constituents. The LV-OOA and SV-OOA factors peak in the afternoon indicating they were likely formed through photochemistry. The LV-OOA factor might be a product of biomass burning aerosol aging as indicated by temporal trend correlations with BBOA and PBOA factors (r2 = 0.7-0.8). Contributions of the HOA and SV-OOA factors to OA mass are ˜12% and ˜21%, respectively. The biomass burning-related factors (BBOA and PBOA) account for ˜29% of OA mass, which likely indicates a lower-bound estimate of the transboundary impacts of primary emissions from peatland fires. The transboundary impacts of secondary aerosol from peatland fires might be represented by the LV-OOA factor accounting for ˜37% of OA mass. Overall, the transboundary haze could contribute to ˜66% of OA concentration, suggesting the strong influence of Indonesia peatland fires on the air quality of Singapore.

Laboratory Studies of Carbon Emission from Biomass Burning for use in Remote Sensing

NASA Technical Reports Server (NTRS)

Wald, Andrew E.; Kaufman, Yoram J.

1998-01-01

Biomass burning is a significant source of many trace gases in the atmosphere. Up to 25% of the total anthropogenic carbon dioxide added to the atmosphere annually is from biomass burning. However, this gaseous emission from fires is not directly detectable from satellite. Infrared radiance from the fires is. In order to see if infrared radiance can be used as a tracer for these emitted gases, we made laboratory measurements to determine the correlation of emitted carbon dioxide, carbon monoxide and total burned biomass with emitted infrared radiance. If the measured correlations among these quantities hold in the field, then satellite-observed infrared radiance can be used to estimate gaseous emission and total burned biomass on a global, daily basis. To this end, several types of biomass fuels were burned under controlled conditions in a large-scale combustion laboratory. Simultaneous measurements of emitted spectral infrared radiance, emitted carbon dioxide, carbon monoxide, and total mass loss were made. In addition measurements of fuel moisture content and fuel elemental abundance were made. We found that for a given fire, the quantity of carbon burned can be estimated from 11 (micro)m radiance measurements only within a factor of five. This variation arises from three sources, 1) errors in our measurements, 2) the subpixel nature of the fires, and 3) inherent differences in combustion of different fuel types. Despite this large range, these measurements can still be used for large-scale satellite estimates of biomass burned. This is because of the very large possible spread of fire sizes that will be subpixel as seen by Moderate Resolution Imaging Spectroradiometer (MODIS). Due to this large spread, even relatively low-precision correlations can still be useful for large-scale estimates of emitted carbon. Furthermore, such estimates using the MODIS 3.9 (micro)m channel should be even more accurate than our estimates based on 11 (micro)m radiance.

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)

High voltage electrical injuries.

PubMed

Kaloudová, Y; Sín, R; Rihová, H; Brychta, R; Suchánek, I; Martincová, A

2006-01-01

Between 1999 and 2005, a total of 41 patients were hospitalized at the Burn Centre of Brno University Hospital with high voltage electrical injuries, representing 6.06% of the total number of patients treated at the Burn Intensive Care Unit (ICU) for extensive burn trauma. The average age of patients with serious electrotraumas was 27.29 years. The youngest patient was 9 years old, the oldest 64 years. Lethality amounted to 17.07% of the total number of patients. The article clearly shows the sinister dimension (a frighteningly high number of cases) of high voltage electrical injuries suffered outside work context in the vicinity of railway tracks and affecting in particular the youngest age groups--children.

Smoke aerosol chemistry and aging of Siberian biomass burning emissions in a large aerosol chamber

NASA Astrophysics Data System (ADS)

Kalogridis, A.-C.; Popovicheva, O. B.; Engling, G.; Diapouli, E.; Kawamura, K.; Tachibana, E.; Ono, K.; Kozlov, V. S.; Eleftheriadis, K.

2018-07-01

Vegetation open fires constitute a significant source of particulate pollutants on a global scale and play an important role in both atmospheric chemistry and climate change. To better understand the emission and aging characteristics of smoke aerosols, we performed small-scale fire experiments using the Large Aerosol Chamber (LAC, 1800 m3) with a focus on biomass burning from Siberian boreal coniferous forests. A series of burn experiments were conducted with typical Siberian biomass (pine and debris), simulating separately different combustion conditions, namely, flaming, smoldering and mixed phase. Following smoke emission and dispersion in the combustion chamber, we investigated aging of aerosols under dark conditions. Here, we present experimental data on emission factors of total, elemental and organic carbon, as well as individual organic compounds, such as anhydrosugars, phenolic and dicarboxylic acids. We found that total carbon accounts for up to 80% of the fine mode (PM2.5) smoke aerosol. Higher PM2.5 emission factors were observed in the smoldering compared to flaming phase and in pine compared to debris smoldering phase. For low-temperature combustion, organic carbon (OC) contributed to more than 90% of total carbon, whereas elemental carbon (EC) dominated the aerosol composition in flaming burns with a 60-70% contribution to the total carbon mass. For all smoldering burns, levoglucosan (LG), a cellulose decomposition product, was the most abundant organic species (average LG/OC = 0.26 for pine smoldering), followed by its isomer mannosan or dehydroabietic acid (DA), an important constituent of conifer resin (DA/OC = 0.033). A levoglucosan-to-mannosan ratio of about 3 was observed, which is consistent with ratios reported for coniferous biomass and more generally softwood. The rates of aerosol removal for OC and individual organic compounds were investigated during aging in the chamber in terms of mass concentration loss rates over time under dark conditions and compared to the loss rate of EC. The latter is used as an inert tracer for estimating aerosol mechanical deposition and wall losses of the otherwise chemically conserved aerosol species. The OC/EC ratio increased with smoke aging for the flaming phase, suggesting a production/partitioning of organic compounds after emission. On the other hand, for smoldering burns OC/EC ratios decreased further with aging due to additional sinks of OC, other than those related to deposition and wall losses alone, such as evaporation of semi-volatile compounds. The chemical fingerprints of the major PM components of fresh and aged smoke found in this study are proposed to be used for the assessment of contributions from Siberian biomass burning to atmospheric pollution in source apportionment studies like those using molecular marker approaches.

Chemical and Common Burns in Children.

PubMed

Yin, Shan

2017-05-01

Burns are a common cause of preventable morbidity and mortality in children. Thermal and chemical burns are the most common types of burns. Their clinical appearance can be similar and the treatment is largely similar. Thermal burns in children occur primarily after exposure to a hot surface or liquid, or contact with fire. Burns are typically classified based on the depth and total body surface area, and the severity and onset of the burn can also depend on the temperature and duration of contact. Chemical burns are caused by chemicals-most commonly acids and alkalis-that can damage the skin on contact. In children, the most common cause of chemical burns is from household products such as toilet bowl cleaners, drain cleaners, detergents, and bleaches. Mild chemical burns generally cause redness and pain and can look similar to other common rashes or skin infections, whereas severe chemical burns are more extreme and may cause redness, blistering, skin peeling, and swelling.

Temporal patterns of charcoal burning suicides among the working age population in Hong Kong SAR: the influence of economic activity status and sex

PubMed Central

2012-01-01

Background Charcoal burning in a sealed room has recently emerged as the second most common suicide means in Hong Kong, causing approximately 200 deaths each year. As charcoal burning suicide victims have a unique sociodemographic profile (i.e., predominantly economically active men), they may commit suicide at specific times. However, little is known about the temporal patterns of charcoal burning suicides. Methods Suicide data from 2001 to 2008 on victims of usual working age (20–59) were obtained from the registered death files of the Census and Statistics Department of Hong Kong. A total of 1649 cases of charcoal burning suicide were analyzed using a two-step procedure, which first examined the temporal asymmetries in the incidence of suicide, and second investigated whether these asymmetries were influenced by sex and/or economic activity status. Poisson regression analyses were employed to model the monthly and daily patterns of suicide by economic activity status and sex. Results Our findings revealed pronounced monthly and daily temporal variations in the pattern of charcoal burning suicides in Hong Kong. Consistent with previous findings on overall suicide deaths, there was an overall spring peak in April, and Monday was the common high risk day for all groups. Although sex determined the pattern of variation in charcoal burning suicides, the magnitude of the variation was influenced by the economic activity status of the victims. Conclusion The traditional classification of suicide methods as either violent or nonviolent tends to elide the temporal variations of specific methods. The interaction between sex and economic activity status observed in the present study indicates that sex should be taken into consideration when investigating the influence of economic activity status on temporal variations of suicide. This finding also suggests that suicide prevention efforts should be both time- and subgroup-specific. PMID:22770504

Temporal patterns of charcoal burning suicides among the working age population in Hong Kong SAR: the influence of economic activity status and sex.

PubMed

Law, Chi-kin; Leung, Candi M C

2012-07-06

Charcoal burning in a sealed room has recently emerged as the second most common suicide means in Hong Kong, causing approximately 200 deaths each year. As charcoal burning suicide victims have a unique sociodemographic profile (i.e., predominantly economically active men), they may commit suicide at specific times. However, little is known about the temporal patterns of charcoal burning suicides. Suicide data from 2001 to 2008 on victims of usual working age (20-59) were obtained from the registered death files of the Census and Statistics Department of Hong Kong. A total of 1649 cases of charcoal burning suicide were analyzed using a two-step procedure, which first examined the temporal asymmetries in the incidence of suicide, and second investigated whether these asymmetries were influenced by sex and/or economic activity status. Poisson regression analyses were employed to model the monthly and daily patterns of suicide by economic activity status and sex. Our findings revealed pronounced monthly and daily temporal variations in the pattern of charcoal burning suicides in Hong Kong. Consistent with previous findings on overall suicide deaths, there was an overall spring peak in April, and Monday was the common high risk day for all groups. Although sex determined the pattern of variation in charcoal burning suicides, the magnitude of the variation was influenced by the economic activity status of the victims. The traditional classification of suicide methods as either violent or nonviolent tends to elide the temporal variations of specific methods. The interaction between sex and economic activity status observed in the present study indicates that sex should be taken into consideration when investigating the influence of economic activity status on temporal variations of suicide. This finding also suggests that suicide prevention efforts should be both time- and subgroup-specific.

Early Enteral Nutrition in Burns: Compliance With Guidelines and Associated Outcomes in a Multicenter Study

PubMed Central

Mosier, Michael J.; Pham, Tam N.; Klein, Matthew B.; Gibran, Nicole S.; Arnoldo, Brett D.; Gamelli, Richard L.; Tompkins, Ronald G.; Herndon, David N.

2013-01-01

Early nutritional support is an essential component of burn care to prevent ileus, stress ulceration, and the effects of hypermetabolism. The American Burn Association practice guidelines state that enteral feedings should be initiated as soon as practical. The authors sought to evaluate compliance with early enteral nutrition (EN) guidelines, associated complications, and hospitalization outcomes in a prospective multicenter observational study. They conducted a retrospective review of mechanically ventilated burn patients enrolled in the prospective observational multicenter study “Inflammation and the Host Response to Injury.” Timing of initiation of tube feedings was recorded, with early EN defined as being started within 24 hours of admission. Univariate and multivariate analyses were performed to distinguish barriers to initiation of EN and the impact of early feeding on development of multiple organ dysfunction syndrome, infectious complications, days on mechanical ventilation, intensive care unit (ICU) length of stay, and survival. A total of 153 patients met study inclusion criteria. The cohort comprised 73% men, with a mean age of 41 ± 15 years and a mean %TBSA burn of 46 ± 18%. One hundred twenty-three patients (80%) began EN in the first 24 hours and 145 (95%) by 48 hours. Age, sex, inhalation injury, and full-thickness burn size were similar between those fed by 24 hours vs after 24 hours, except for higher mean Acute Physiology and Chronic Health Evaluation II scores (26 vs 23, P = .03) and smaller total burn size (44 vs 54% TBSA burn, P = .01) in those fed early. There was no significant difference in rates of hyperglycemia, abdominal compartment syndrome, or gastrointestinal bleeding between groups. Patients fed early had shorter ICU length of stay (adjusted hazard ratio 0.57, P = 0.03, 95% confidence interval 0.35–0.94) and reduced wound infection risk (adjusted odds ratio 0.28, P = 0.01, 95% confidence interval 0.10–0.76). The investigators have found early EN to be safe, with no increase in complications and a lower rate of wound infections and shorter ICU length of stay. Across institutions, there has been high compliance with early EN as part of the standard operating procedure in this prospective multicenter observational trial. The investigators advocate that initiation of EN by 24 hours be used as a formal recommendation in nutrition guidelines for severe burns, and that nutrition guidelines be actively disseminated to individual burn centers to permit a change in practice. PMID:21116188

Ghg and Aerosol Emission from Fire Pixel during Crop Residue Burning Under Rice and Wheat Cropping Systems in North-West India

NASA Astrophysics Data System (ADS)

Acharya, Prasenjit; Sreekesh, S.; Kulshrestha, Umesh

2016-10-01

Emission of smoke and aerosol from open field burning of crop residue is a long-standing subject matter of atmospheric pollution. In this study, we proposed a new approach of estimating fuel load in the fire pixels and corresponding emissions of selected GHGs and aerosols i.e. CO2, CO, NO2, SO2, and total particulate matter (TPM) due to burning of crop residue under rice and wheat cropping systems in Punjab in north-west India from 2002 to 2012. In contrasts to the conventional method that uses RPR ratio to estimate the biomass, fuel load in the fire pixels was estimated as a function of enhanced vegetation index (EVI). MODIS fire products were used to detect the fire pixels during harvesting seasons of rice and wheat. Based on the field measurements, fuel load in the fire pixels were modelled as a function of average EVI using second order polynomial regression. Average EVI for rice and wheat crops that were extracted through Fourier transformation were computed from MODIS time series 16 day EVI composites. About 23 % of net shown area (NSA) during rice and 11 % during wheat harvesting seasons are affected by field burning. The computed average fuel loads are 11.32 t/ha (±17.4) during rice and 10.89 t/ha (±8.7) during wheat harvesting seasons. Calculated average total emissions of CO2, CO, NO2, SO2 and TPM were 8108.41, 657.85, 8.10, 4.10, and 133.21 Gg during rice straw burning and 6896.85, 625.09, 1.42, 1.77, and 57.55 Gg during wheat burning. Comparison of estimated values shows better agreement with the previous concurrent estimations. The method, however, shows its efficiency parallel to the conventional method of estimation of fuel load and related pollutant emissions.

Transported vs. local contributions from secondary and biomass burning sources to PM2.5

NASA Astrophysics Data System (ADS)

Kim, Bong Mann; Seo, Jihoon; Kim, Jin Young; Lee, Ji Yi; Kim, Yumi

2016-11-01

The concentration of fine particulates in Seoul, Korea has been lowered over the past 10 years, as a result of the city's efforts in implementing environmental control measures. Yet, the particulate concentration level in Seoul remains high as compared to other urban areas globally. In order to further improve fine particulate air quality in the Korea region and design a more effective control strategy, enhanced understanding of the sources and contribution of fine particulates along with their chemical compositions is necessary. In turn, relative contributions from local and transported sources on Seoul need to be established, as this city is particularly influenced by sources from upwind geographic areas. In this study, PM2.5 monitoring was conducted in Seoul from October 2012 to September 2013. PM2.5 mass concentrations, ions, metals, organic carbon (OC), elemental carbon (EC), water soluble OC (WSOC), humic-like substances of carbon (HULIS-C), and 85 organic compounds were chemically analyzed. The multivariate receptor model SMP was applied to the PM2.5 data, which then identified nine sources and estimated their source compositions as well as source contributions. Prior studies have identified and quantified the transported and local sources. However, no prior studies have distinguished contributions of an individual source between transported contribution and locally produced contribution. We differentiated transported secondary and biomass burning sources from the locally produced secondary and biomass burning sources, which was supported with potential source contribution function (PSCF) analysis. Of the total secondary source contribution, 32% was attributed to transported secondary sources, and 68% was attributed to locally formed secondary sources. Meanwhile, the contribution from the transported biomass burning source was revealed as 59% of the total biomass burning contribution, which was 1.5 times higher than that of the local biomass burning source. Four-season average source contributions from the transported and the local sources were 28% and 72%, respectively.

Pyrogenic carbon from tropical savanna burning: production and stable isotope composition

NASA Astrophysics Data System (ADS)

Saiz, G.; Wynn, J. G.; Wurster, C. M.; Goodrick, I.; Nelson, P. N.; Bird, M. I.

2015-03-01

Widespread burning of mixed tree-grass ecosystems represents the major natural locus of pyrogenic carbon (PyC) production. PyC is a significant, pervasive and yet poorly understood "slow-cycling" form of carbon present in the atmosphere, hydrosphere, soils and sediments. We conducted 16 experimental burns on a rainfall transect through northern Australian savannas with C4 grasses ranging from 35 to 99% of total biomass. Residues from each fire were partitioned into PyC and further into recalcitrant (HyPyC) components, with each of these fluxes also partitioned into proximal components (>125 μm), likely to remain close to the site of burning, and distal components (<125 μm), likely to be transported from the site of burning. The median (range) PyC production across all burns was 16.0 (11.5) % of total carbon exposed (TCE), with HyPyC accounting for 2.5 (4.9) % of TCE. Both PyC and HyPyC were dominantly partitioned into the proximal flux. Production of HyPyC was strongly related to fire residence time, with shorter duration fires resulting in higher HyPyC yields. The carbon isotope (δ13C) compositions of PyC and HyPyC were generally lower by 1-3‰ relative to the original biomass, with marked depletion up to 7‰ for grasslands dominated by C4 biomass. δ13C values of CO2 produced by combustion were computed by mass balance and ranged from ~0.4 to 1.3‰. The depletion of 13C in PyC and HyPyC relative to the original biomass has significant implications for the interpretation of δ13C values of savanna soil organic carbon and of ancient PyC preserved in the geologic record, as well as for global 13C isotopic disequilibria calculations.

EVALUATION OF EFFECTIVENESS IN A NOVEL WOUND HEALING OINTMENT-CROCODILE OIL BURN OINTMENT

PubMed Central

Li, Hua-Liang; Deng, Yi-Tao; Zhang, Zi-Ran; Fu, Qi-Rui; Zheng, Ya-Hui; Cao, Xing-Mei; Nie, Jing; Fu, Li-Wen; Chen, Li-Ping; Xiong, You-Xiong; Shen, Dong-Yan; Chen, Qing-Xi

2017-01-01

Background: Crocodile oil and its products are used as ointments for burns and scalds in traditional medicines. A new ointment formulation - crocodile oil burn ointment (COBO) was developed to provide more efficient wound healing activity. The purpose of the study was to evaluate the burn healing efficacy of this new formulation by employing deep second-degree burns in a Wistar rat model. The analgesic and anti-inflammatory activities of COBO were also studied to provide some evidences for its further use. Materials and methods: The wound healing potential of this formulation was evaluated by employing a deep second-degree burn rat model and the efficiency was comparatively assessed against a reference ointment - (1% wt/wt) silver sulfadiazine (SSD). After 28 days, the animals were euthanized and the wounds were removed for transversal and longitudinal histological studies. Acetic acid-induced writhing in mice was used to evaluate the analgesic activity and its anti-inflammatory activity was observed in xylene -induced edema in mice. Results: COBO enhanced the burn wound healing (20.5±1.3 d) as indicated by significant decrease in wound closure time compared with the burn control (25.0±2.16 d) (P<0.01). Hair follicles played an importance role in the physiological functions of the skin, and their growth in the wound could be revealed for the skin regeneration situation. Histological results showed that the hair follicles were well-distributed in the post-burn skin of COBO treatment group, and the amounts of total, active, primary and secondary hair follicles in post-burn 28-day skin of COBO treatment groups were more than those in burn control and SSD groups. On the other hand, the analgesic and anti-inflammatory activity of COBO were much better than those of control group, while they were very close to those of moist exposed burn ointment (MEBO). Conclusions: COBO accelerated wound closure, reduced inflammation, and had analgesic effects compared with SSD in deep second degree rat burn model. These findings suggest that COBO would be a potential therapy for treating human burns. Abbreviations: COBO, crocodile oil burn ointment; SSD, silver sulfadiazine; MEBO, moist exposed burn ointment; TCM, traditional Chinese medicine; CHM, Chinese herbal medicine; GC-MS, gas chromatography-mass spectrometry. PMID:28480384

EVALUATION OF EFFECTIVENESS IN A NOVEL WOUND HEALING OINTMENT-CROCODILE OIL BURN OINTMENT.

PubMed

Li, Hua-Liang; Deng, Yi-Tao; Zhang, Zi-Ran; Fu, Qi-Rui; Zheng, Ya-Hui; Cao, Xing-Mei; Nie, Jing; Fu, Li-Wen; Chen, Li-Ping; Xiong, You-Xiong; Shen, Dong-Yan; Chen, Qing-Xi

2017-01-01

Crocodile oil and its products are used as ointments for burns and scalds in traditional medicines. A new ointment formulation - crocodile oil burn ointment (COBO) was developed to provide more efficient wound healing activity. The purpose of the study was to evaluate the burn healing efficacy of this new formulation by employing deep second-degree burns in a Wistar rat model. The analgesic and anti-inflammatory activities of COBO were also studied to provide some evidences for its further use. The wound healing potential of this formulation was evaluated by employing a deep second-degree burn rat model and the efficiency was comparatively assessed against a reference ointment - (1% wt/wt) silver sulfadiazine (SSD). After 28 days, the animals were euthanized and the wounds were removed for transversal and longitudinal histological studies. Acetic acid-induced writhing in mice was used to evaluate the analgesic activity and its anti-inflammatory activity was observed in xylene -induced edema in mice. COBO enhanced the burn wound healing (20.5±1.3 d) as indicated by significant decrease in wound closure time compared with the burn control (25.0±2.16 d) ( P <0.01). Hair follicles played an importance role in the physiological functions of the skin, and their growth in the wound could be revealed for the skin regeneration situation. Histological results showed that the hair follicles were well-distributed in the post-burn skin of COBO treatment group, and the amounts of total, active, primary and secondary hair follicles in post-burn 28-day skin of COBO treatment groups were more than those in burn control and SSD groups. On the other hand, the analgesic and anti-inflammatory activity of COBO were much better than those of control group, while they were very close to those of moist exposed burn ointment (MEBO). COBO accelerated wound closure, reduced inflammation, and had analgesic effects compared with SSD in deep second degree rat burn model. These findings suggest that COBO would be a potential therapy for treating human burns. Abbreviations: COBO, crocodile oil burn ointment; SSD, silver sulfadiazine; MEBO, moist exposed burn ointment; TCM, traditional Chinese medicine; CHM, Chinese herbal medicine; GC-MS, gas chromatography-mass spectrometry.

Control of burn wound sepsis in rats by methylene blue-mediated photodynamic treatment

NASA Astrophysics Data System (ADS)

Hasegawa, Hiroyuki; Sato, Shunichi; Kawauchi, Satoko; Saitoh, Daizoh; Shinomiya, Nariyoshi; Ashida, Hiroshi; Terakawa, Mitsuhiro

2012-02-01

Control of wound sepsis is an important challenge in traumatology. However, increase in the drug-resistant bacteria makes this challenge considerably difficult in recent years. In this study, we attempted to control burn wound sepsis in rats by photodynamic treatment, which has been reported to be effective against some drug-resistant bacteria. A 20% TBSA (total body surface area) full-thickness burn was made in rat dorsal skin, and five days after injury, a suspension of P. aeruginosa was applied to the wound surface. At 30 min after infection, a methylene blue (MB) solution was applied to the wound surface; 5 min afterwards, the wound was illuminated with a 665-nm light emitting diode (LED) array for 10 min. This treatment (application of MB and illumination) was repeated 3 times successively. The averaged light intensity on the wound surface was 3.3 mW/cm2, the corresponding total light dose being 5.9 J/cm2. One week after injury, the numbers of bacteria in the blood and liver were counted by colony forming assay. In the liver, the number of bacteria of the treated group was significantly lower than that of the sham control group without photodynamic treatment. In the blood, no bacteria were detected in the treated group, while a certain amount of bacteria was detected in the control group. These results demonstrate the efficacy of MB-mediated PDT with a red LED array to control burn wound sepsis.

40 CFR 60.4325 - What emission limits must I meet for NOX if my turbine burns both natural gas and distillate oil...

Code of Federal Regulations, 2012 CFR

2012-07-01

... NOX if my turbine burns both natural gas and distillate oil (or some other combination of fuels)? 60... Combustion Turbines Emission Limits § 60.4325 What emission limits must I meet for NOX if my turbine burns... burning that fuel. Similarly, when your total heat input is greater than 50 percent distillate oil and...

40 CFR 60.4325 - What emission limits must I meet for NOX if my turbine burns both natural gas and distillate oil...

Code of Federal Regulations, 2014 CFR

2014-07-01

... NOX if my turbine burns both natural gas and distillate oil (or some other combination of fuels)? 60... Combustion Turbines Emission Limits § 60.4325 What emission limits must I meet for NOX if my turbine burns... burning that fuel. Similarly, when your total heat input is greater than 50 percent distillate oil and...

40 CFR 60.4325 - What emission limits must I meet for NOX if my turbine burns both natural gas and distillate oil...

Code of Federal Regulations, 2013 CFR

2013-07-01

... NOX if my turbine burns both natural gas and distillate oil (or some other combination of fuels)? 60... Combustion Turbines Emission Limits § 60.4325 What emission limits must I meet for NOX if my turbine burns... burning that fuel. Similarly, when your total heat input is greater than 50 percent distillate oil and...

Professional Practice and Innovation: Level of Agreement between Coding Sources of Percentage Total Body Surface Area Burnt (%TBSA).

PubMed

Watterson, Dina; Cleland, Heather; Picton, Natalie; Simpson, Pam M; Gabbe, Belinda J

2011-03-01

The percentage of total body surface area burnt (%TBSA) is a critical measure of burn injury severity and a key predictor of burn injury outcome. This study evaluated the level of agreement between four sources of %TBSA using 120 cases identified through the Victorian State Trauma Registry. Expert clinician, ICD-10-AM, Abbreviated Injury Scale, and burns registry coding were compared using measures of agreement. There was near-perfect agreement (weighted Kappa statistic 0.81-1) between all sources of data, suggesting that ICD-10-AM is a valid source of %TBSA and use of ICD-10-AM codes could reduce the resource used by trauma and burns registries capturing this information.

Translation and psychometric evaluation of Persian versions of Burn Specific Pain Anxiety Scale and Impact of Event Scale.

PubMed

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

2013-09-01

Burn as a traumatic life incident manifests severe pain and psychological problems. Specific instruments are needed to evaluate burn patients' psychological issues related to the injury. The aim of this study was to translate and evaluate the reliability and validity of the Persian versions of Impact of Burn Specific Pain Anxiety scale (BSPAS) and Impact of Event Scale (IES). In this cross-sectional study, convenience sampling method was utilized to select 55 Iranian hospitalized burn patients. Combined translation was utilized for translating scales. Alpha cronbach, item-total correlation, convergent and discriminative validity were evaluated. The Cronbach's α for both BSPAS- and IES-Persian version was 0.96. Item-total correlation coefficients ranged from 0.70 to 0.90. Convergent construct validity was confirmed by indicating high correlation between the scales designed to measure the same concepts. The mean score of BSPAS- and IES-Persian version was lower for individuals with a lower TBSA burn percentage which assessed discriminative construct validity of scales. BSPAS- and IES-Persian version showed high internal consistency and good validity for the assessment of burn psychological outcome in hospitalized burn patients. Future studies are needed to determine repeatability, factor structure, sensitivity and specificity of the scales. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

High-Resolution Mapping of Biomass Burning Emissions in Three Tropical Regions.

PubMed

Shi, Yusheng; Matsunaga, Tsuneo; Yamaguchi, Yasushi

2015-09-15

Biomass burning in tropical regions plays a significant role in atmospheric pollution and climate change. This study quantified a comprehensive monthly biomass burning emissions inventory with 1 km high spatial resolution, which included the burning of vegetation, human waste, and fuelwood for 2010 in three tropical regions. The estimations were based on the available burned area product MCD64A1 and statistical data. The total emissions of all gases and aerosols were 17382 Tg of CO2, 719 Tg of CO, 30 Tg of CH4, 29 Tg of NOx, 114 Tg of NMOC (nonmethane organic compounds), 7 Tg of SO2, 10 Tg of NH3, 79 Tg of PM2.5 (particulate matter), 45 Tg of OC (organic carbon), and 6 Tg of BC (black carbon). Taking CO as an example, vegetation burning accounted for 74% (530 Tg) of the total CO emissions, followed by fuelwood combustion and human waste burning. Africa was the biggest emitter (440 Tg), larger than Central and South America (113 Tg) and South and Southeast Asia (166 Tg). We also noticed that the dominant fire types in vegetation burning of these three regions were woody savanna/shrubland, savanna/grassland, and forest, respectively. Although there were some slight overestimations, our results are supported by comparisons with previously published data.

The effect of seasonality on burn incidence, severity and outcome in Central Malawi.

PubMed

Tyson, Anna F; Gallaher, Jared; Mjuweni, Stephen; Cairns, Bruce A; Charles, Anthony G

2017-08-01

In much of the world, burns are more common in cold months. However, few studies have described the seasonality of burns in sub-Saharan Africa. This study examines the effect of seasonality on the incidence and outcome of burns in central Malawi. A retrospective analysis was performed at Kamuzu Central Hospital and included all patients admitted from May 2011 to August 2014. Demographic data, burn mechanism, total body surface area (%TBSA), and mortality were analyzed. Seasons were categorized as Rainy (December-February), Lush (March-May), Cold (June-August) and Hot (September-November). A negative binomial regression was used to assess the effect of seasonality on burn incidence. This was performed using both the raw and deseasonalized data in order to evaluate for trends not attributable to random fluctuation. A total of 905 patients were included. Flame (38%) and Scald (59%) burns were the most common mechanism. More burns occurred during the cold season (41% vs 19-20% in the other seasons). Overall mortality was 19%. Only the cold season had a statistically significant increase in burn . The incidence rate ratios (IRR) for the hot, lush, and cold seasons were 0.94 (CI 0.6-1.32), 1.02 (CI 0.72-1.45) and 1.6 (CI 1.17-2.19), respectively, when compared to the rainy season. Burn severity and mortality did not differ between seasons. The results of this study demonstrate the year-round phenomenon of burns treated at our institution, and highlights the slight predominance of burns during the cold season. These data can be used to guide prevention strategies, with special attention to the implications of the increased burn incidence during the cold season. Though burn severity and mortality remain relatively unchanged between seasons, recognizing the seasonal variability in incidence of burns is critical for resource allocation in this low-income setting. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant: A Reconstructive Solution for the Full Face and Total Scalp Burn.

PubMed

Sosin, Michael; Ceradini, Daniel J; Levine, Jamie P; Hazen, Alexes; Staffenberg, David A; Saadeh, Pierre B; Flores, Roberto L; Sweeney, Nicole G; Bernstein, G Leslie; Rodriguez, Eduardo D

2016-07-01

Reconstruction of extensive facial and scalp burns can be increasingly challenging, especially in patients that have undergone multiple procedures with less than ideal outcomes resulting in restricting neck and oral contractures, eyelid dysfunction, and suboptimal aesthetic appearance. To establish a reconstructive solution for this challenging deformity, a multidisciplinary team was assembled to develop the foundation to a facial vascularized composite allotransplantation program. The strategy of developing and executing a clinical transplant was derived on the basis of fostering a cohesive and supportive institutional clinical environment, implementing computer software and advanced technology, establishing a cadaveric transplant model, performing a research facial procurement, and selecting an optimal candidate with the aforementioned burn defect who was well informed and had the desire to undergo face transplantation. Approval from the institutional review board and organ procurement organization enabled our face transplant team to successfully perform a total face, eyelids, ears, scalp, and skeletal subunit transplant in a 41-year-old man with a full face and total scalp burn. The culmination of knowledge attained from previous experiences continues to influence the progression of facial vascularized composite allotransplantation. This surgical endeavor methodically and effectively synchronized the fundamental principles of aesthetic, craniofacial, and microvascular surgery to restore appearance and function to a patient suffering from failed conventional surgery for full face and total scalp burns. This procedure represents the most extensive soft-tissue clinical face transplant performed to date. Therapeutic, V.

BurnCase 3D software validation study: Burn size measurement accuracy and inter-rater reliability.

PubMed

Parvizi, Daryousch; Giretzlehner, Michael; Wurzer, Paul; Klein, Limor Dinur; Shoham, Yaron; Bohanon, Fredrick J; Haller, Herbert L; Tuca, Alexandru; Branski, Ludwik K; Lumenta, David B; Herndon, David N; Kamolz, Lars-P

2016-03-01

The aim of this study was to compare the accuracy of burn size estimation using the computer-assisted software BurnCase 3D (RISC Software GmbH, Hagenberg, Austria) with that using a 2D scan, considered to be the actual burn size. Thirty artificial burn areas were pre planned and prepared on three mannequins (one child, one female, and one male). Five trained physicians (raters) were asked to assess the size of all wound areas using BurnCase 3D software. The results were then compared with the real wound areas, as determined by 2D planimetry imaging. To examine inter-rater reliability, we performed an intraclass correlation analysis with a 95% confidence interval. The mean wound area estimations of the five raters using BurnCase 3D were in total 20.7±0.9% for the child, 27.2±1.5% for the female and 16.5±0.1% for the male mannequin. Our analysis showed relative overestimations of 0.4%, 2.8% and 1.5% for the child, female and male mannequins respectively, compared to the 2D scan. The intraclass correlation between the single raters for mean percentage of the artificial burn areas was 98.6%. There was also a high intraclass correlation between the single raters and the 2D Scan visible. BurnCase 3D is a valid and reliable tool for the determination of total body surface area burned in standard models. Further clinical studies including different pediatric and overweight adult mannequins are warranted. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Global emissions of trace gases, particulate matter, and hazardous air pollutants from open burning of domestic waste.

PubMed

Wiedinmyer, Christine; Yokelson, Robert J; Gullett, Brian K

2014-08-19

The open burning of waste, whether at individual residences, businesses, or dump sites, is a large source of air pollutants. These emissions, however, are not included in many current emission inventories used for chemistry and climate modeling applications. This paper presents the first comprehensive and consistent estimates of the global emissions of greenhouse gases, particulate matter, reactive trace gases, and toxic compounds from open waste burning. Global emissions of CO2 from open waste burning are relatively small compared to total anthropogenic CO2; however, regional CO2 emissions, particularly in many developing countries in Asia and Africa, are substantial. Further, emissions of reactive trace gases and particulate matter from open waste burning are more significant on regional scales. For example, the emissions of PM10 from open domestic waste burning in China is equivalent to 22% of China's total reported anthropogenic PM10 emissions. The results of the emissions model presented here suggest that emissions of many air pollutants are significantly underestimated in current inventories because open waste burning is not included, consistent with studies that compare model results with available observations.

Phenolic compounds of Pinus laricio needles: a bioindicator of the effects of prescribed burning in function of season.

PubMed

Cannac, Magali; Pasqualini, Vanina; Barboni, Toussaint; Morandini, Frederic; Ferrat, Lila

2009-07-15

Fire is a dominant ecological factor in Mediterranean-type ecosystems. Forest management includes many preventive tools, in particular for fire prevention, such as mechanical treatments and prescribed burning. Prescribed burning is a commonly used method for treating fuel loads, but fuel reduction targets for reducing wildfire hazards must be balanced against fuel retention targets in order to maintain habitat and other forest functions. This approach was used on Pinus nigra ssp laricio var. Corsicana, a pine endemic to Corsica of great ecological and economic importance. Many studies of plant phenolic compounds have been carried out concerning responses to various stresses. The aim of this study was to understand i) the effects of prescribed burning 1 to 16 months later and ii) the effects of the seasonality of burning, spring or fall, on the production of phenolic compounds in Pinus laricio. After prescribed burning conducted in spring, Pinus laricio increases the synthesis of total phenolic compounds for a period of 7 months. The increase is greater after spring-burning than fall-burning. With regard to simple phenols, only dihydroferulic acid responds about 1 year after both types of prescribed burning. The causes of these increases are discussed in this paper. Total phenolic compounds could be used as a bioindicator for the short-term response of Pinus laricio needles to prescribed burning. Simple phenols may be useful for revealing the medium-term effects of prescribed burning. The results of this study include recommending forest managers to use prescribed burning in the fall rather than spring to reduce fuel loads and have less impact on the trees.

Global burned-land estimation in Latin America using MODIS composite data.

PubMed

Chuvieco, Emilio; Opazo, Sergio; Sione, Walter; Del Valle, Hector; Anaya, Jesús; Di Bella, Carlos; Cruz, Isabel; Manzo, Lilia; López, Gerardo; Mari, Nicolas; González-Alonso, Federico; Morelli, Fabiano; Setzer, Alberto; Csiszar, Ivan; Kanpandegi, Jon Ander; Bastarrika, Aitor; Libonati, Renata

2008-01-01

This paper presents results of the AQL2004 project, which has been develope within the GOFC-GOLD Latin American network of remote sensing and forest fires (RedLatif). The project intended to obtain monthly burned-land maps of the entire region, from Mexico to Patagonia, using MODIS (moderate-resolution imaging spectroradiometer) reflectance data. The project has been organized in three different phases: acquisition and preprocessing of satellite data; discrimination of burned pixels; and validation of results. In the first phase, input data consisting of 32-day composites of MODIS 500-m reflectance data generated by the Global Land Cover Facility (GLCF) of the University of Maryland (College Park, Maryland, U.S.A.) were collected and processed. The discrimination of burned areas was addressed in two steps: searching for "burned core" pixels using postfire spectral indices and multitemporal change detection and mapping of burned scars using contextual techniques. The validation phase was based on visual analysis of Landsat and CBERS (China-Brazil Earth Resources Satellite) images. Validation of the burned-land category showed an agreement ranging from 30% to 60%, depending on the ecosystem and vegetation species present. The total burned area for the entire year was estimated to be 153 215 km2. The most affected countries in relation to their territory were Cuba, Colombia, Bolivia, and Venezuela. Burned areas were found in most land covers; herbaceous vegetation (savannas and grasslands) presented the highest proportions of burned area, while perennial forest had the lowest proportions. The importance of croplands in the total burned area should be taken with reserve, since this cover presented the highest commission errors. The importance of generating systematic products of burned land areas for different ecological processes is emphasized.

Airborne bacterial dispersal during and after dressing and bed changes on burns patients.

PubMed

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

2015-02-01

It is acknowledged that activities such as dressing changes and bed sheet changes are high-risk events; creating surges in levels of airborne bacteria. Burns patients are particularly high dispersers of pathogens; due to their large, often contaminated, wound areas. Prevention of nosocomial cross-contamination is therefore one of the major challenges faced by the burns team. In order to assess the contribution of airborne spread of bacteria, air samples were taken repeatedly throughout and following these events, to quantify levels of airborne bacteria. Air samples were taken at 3-min intervals before, during and after a dressing and bed change on a burns patient using a sieve impaction method. Following incubation, bacterial colonies were enumerated to calculate bacterial colony forming units per m(3) (cfu/m(3)) at each time point. Statistical analysis was performed, whereby the period before the high-risk event took place acted as a control period. The periods during and after the dressing and bed sheet changes were examined for significant differences in airborne bacterial levels relative to the control period. The study was carried out four times, on three patients with burns between 35% total burn surface area (TBSA) and 51% TBSA. There were significant increases in airborne bacteria levels, regardless of whether the dressing change or bed sheet change took place first. Of particular note, is the finding that significantly high levels (up to 2614cfu/m(3)) of airborne bacteria were shown to persist for up to approximately 1h after these activities ended. This is the most accurate picture to date of the rapidly changing levels of airborne bacteria within the room of a burns patient undergoing a dressing change and bed change. The novel demonstration of a significant increase in the airborne bacterial load during these events has implications for infection control on burns units. Furthermore, as these increased levels remained for approximately 1h afterwards, persons entering the room both during and after such events may act as vectors of transmission of infection. It is suggested that appropriate personal protective equipment should be worn by anyone entering the room, and that rooms should be quarantined for a period of time following these events. Airborne bacteria significantly increase during dressing and sheet changes on moderate size burns, and remain elevated for up to an hour following their cessation. Copyright © 2014 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.

Anxiety, depression and PTSD-related symptoms in spouses and close relatives of burn survivors: When the supporter needs to be supported.

PubMed

Bond, Suzie; Gourlay, Catherine; Desjardins, Alexandra; Bodson-Clermont, Paule; Boucher, Marie-Ève

2017-05-01

The aim of the study was to assess the prevalence of anxiety, depression and PTSD-related symptoms reported by spouses and close relatives of adult burn survivors. Potential associations between these symptoms and variables such as the severity of the burn were also explored. Participants were spouses (n=31) and close relatives (n=25) of hospitalized patients with acute burns. Anxiety and depression symptoms were assessed by the Hospital Distress Anxiety and Depression Scale and PTSD-related symptoms by the Modified PTSD Symptom Scale at both admission to and discharge from the burn unit. At admission, 77% of spouses and 56% of close relatives of burn patients reported anxiety, depression or PTSD-related symptoms in the clinical range. While spouses had higher scores than close relatives on symptom measures, significant differences were only established for anxiety symptoms (p<.02). A significant effect was found for gender, with women reporting more anxiety (p=.01) and depression (p=.02) symptoms than men. Results also showed a main effect for time, with anxiety (p<.0001), depression (p<.0001) and PTSD-related (p<.0001) symptoms being higher at admission than at discharge. Variables associated with the index patient, such as total body surface area burned, length of stay, number of ventilated days, facial burns, or level of care at admission, were not associated with outcome measures. Spouses and close relatives of burn survivors showed high levels of psychological distress in the first few days following admission, and more than a quarter still reported symptoms in the clinical range at discharge. Our analysis points to the need to offer psychological support and guidance to family members so that they can in turn provide effective support to the burn survivor. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

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.

Effect of aquatic versus land based exercise programs on physical performance in severely burned patients: a randomized controlled trial.

PubMed

Zoheiry, Ibrahim M; Ashem, Haidy N; Ahmed, Hamada Ahmed Hamada; Abbas, Rami

2017-12-01

[Purpose] To compare the effect of an aquatic-based versus a land-based exercise regimen on the physical performance of severely burned patients. [Subjects and Methods] Forty patients suffering from severe burn (total body surface area more than 30%) were recruited from several outpatient clinics in Greater Cairo. Their ages ranged between 20 to 40 years and were randomly assigned into two equal groups: group (A), which received an aquatic based exercise program, and group (B), which received a land-based exercise program. The exercise program, which took place in 12 consecutive weeks, consisted of flexibility, endurance, and lower and upper body training. Physical performance was assessed using 30 seconds chair stand test, stair climb test, 30 meter fast paced walk test, time up and go test, 6-minute walk test and a VO2max evaluation. [Results] Significantly increase in the 30 second chair stand, 6-minute walk, 30 meter fast paced walk, stair climb, and VO2 max tests and significantly decrease in the time up and go test in group A (aquatic based exercise) compared with group B (a land-based exercise) at the post treatment. [Conclusion] Twelve-week program of an aquatic program yields improvement in both physical performance and VO2 max in patients with severe burns.

Effect of aquatic versus land based exercise programs on physical performance in severely burned patients: a randomized controlled trial

PubMed Central

Zoheiry, Ibrahim M.; Ashem, Haidy N.; Ahmed, Hamada Ahmed Hamada; Abbas, Rami

2017-01-01

[Purpose] To compare the effect of an aquatic-based versus a land-based exercise regimen on the physical performance of severely burned patients. [Subjects and Methods] Forty patients suffering from severe burn (total body surface area more than 30%) were recruited from several outpatient clinics in Greater Cairo. Their ages ranged between 20 to 40 years and were randomly assigned into two equal groups: group (A), which received an aquatic based exercise program, and group (B), which received a land-based exercise program. The exercise program, which took place in 12 consecutive weeks, consisted of flexibility, endurance, and lower and upper body training. Physical performance was assessed using 30 seconds chair stand test, stair climb test, 30 meter fast paced walk test, time up and go test, 6-minute walk test and a VO2max evaluation. [Results] Significantly increase in the 30 second chair stand, 6-minute walk, 30 meter fast paced walk, stair climb, and VO2 max tests and significantly decrease in the time up and go test in group A (aquatic based exercise) compared with group B (a land-based exercise) at the post treatment. [Conclusion] Twelve-week program of an aquatic program yields improvement in both physical performance and VO2 max in patients with severe burns. PMID:29643605

Moist occlusive dressing (Aquacel(®) Ag) versus moist open dressing (MEBO(®)) in the management of partial-thickness facial burns: a comparative study in Ain Shams University.

PubMed

Mabrouk, Amr; Boughdadi, Nahed Samir; Helal, Hesham A; Zaki, Basim M; Maher, Ashraf

2012-05-01

The face is the central point of the physical features; it transmits expressions and emotions, communicates feelings and allows for individual identity. Facial burns are very common and are devastating to the affected patient and results into numerous physical, emotional and psychosocial sequels. Partial thickness facial burns are very common especially among children. This study compares the effect of standard moist open technique management and a moist closed technique for partial thickness burns of the face. Patients with partial-thickness facial burns admitted in the burn unit, Ain Shams University, Cairo, Egypt in the period from April 2009 to December 2009 were included in this study. They were divided into two groups to receive either open treatment with MEBO(®) (n=20) or coverage with Aquacel(®) Ag (n=20). Demographics (age, gender, ethnicity, TBSA, burn areas), length of hospital stay (LOS), rate of infections, time to total healing, frequency of dressing changes, pain, cost benefit and patient discomfort were compared between the two groups. The long-term outcome (incidence of hypertrophic scarring) was assessed for up to 6 months follow-up period. There were no significant differences in demographics between the two groups. In the group treated with the Aquacel(®) Ag, the mean time for re-epithelialization was 10.5 days, while it was 12.4 days in the MEBO(®) group (p<0.05). Frequency of changes, pain and patient discomfort were less with Aquacel(®) Ag. Cost was of no significant difference between the two groups. Scar quality improved in the Aquacel(®) Ag treatment group. Three and 6 months follow-up was done and long-term outcomes were recorded in both groups. Moist occlusive dressing (Aquacel(®) Ag) significantly improves the management and healing rate of partial thickness facial burns with better long-term outcome compared to moist open dressing (MEBO(®)). Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

Puerarin attenuates severe burn-induced acute myocardial injury in rats.

PubMed

Liu, Sheng; Ren, Hong-Bo; Chen, Xu-Lin; Wang, Fei; Wang, Ren-Su; Zhou, Bo; Wang, Chao; Sun, Ye-Xiang; Wang, Yong-Jie

2015-12-01

Puerarin, the main isoflavone glycoside extracted from the root of Pueraria lobata, is widely prescribed for patients with cardiovascular disorders in China. This study investigates the effect of puerarin on severe burn-induced acute myocardial injury in rats and its underlying mechanisms. Healthy adult Wistar rats were divided into three groups: (1) sham group, sham burn treatment; (2) burn group, third-degree burns over 30% of the total body surface area (TBSA) with lactated Ringer's solution for resuscitation; and (3) burn plus puerarin group, third-degree burns over 30% of TBSA with lactated Ringer's solution containing puerarin for resuscitation. The burned animals were sacrificed at 1, 3, 6, 12, and 24 h after burn injury. Myocardial injury was evaluated by analyzing serum creatine kinase MB fraction (CK-MB) activity and cardiac troponin T (cTNT) level. Changes in cardiomyocyte ultrastructure were also determined using a transmission electron microscope. Tumor necrosis factor (TNF)-α concentration in serum was measured by radioimmunoassay. Cardiac myeloperoxidase (MPO) activity and malondialdehyde (MDA) concentration were measured to determine neutrophil infiltration and oxidative stress in the heart, respectively. The expression of p38 mitogen-activated protein (MAP) kinase in the heart was determined by Western blot analysis. After the 30% TBSA full-thickness burn injury, serum CK-MB activities and cTnT levels increased markedly, both of which were significantly decreased by the puerarin treatment. The level of serum TNF-α concentration in burn group at each time-point was obviously higher than those in sham group (1.09±0.09 ng/ml), and it reached the peak value at 12 h post burn. Burn trauma also resulted in worsen ultrastructural condition, elevated MPO activity and MDA content in heart tissue, and a significant activation of cardiac p38 MAP kinase. Administration of puerarin improved the ultrastructural changes in cardiomyocytes, decreased TNF-α concentration in serum as well as suppressed cardiac MPO activity and reduced MDA content, and abolished the activation of p38 MAP kinase in heart tissue after severe burn. These results suggest that puerarin attenuates inflammatory responses, reduces neutrophil infiltration and oxidative stress in the heart, and protects against acute myocardial injury induced by severe burn. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Experience and outcomes of micrografting for major paediatric burns.

PubMed

Rode, H; Martinez, R; Potgieter, D; Adams, S; Rogers, A D

2017-08-01

The deficit of donor sites in major burns over 50% of the total body surface area has necessitated the application of methods besides traditional meshed autografting to achieve definitive skin cover. The Meek micrografting technique was introduced at this hospital in 2011, especially in the absence of a reliable source of deceased donor allograft skin. The purpose of this study was to evaluate this strategy with reference to its technical execution, efficacy and indications in the context of major paediatric burn surgery. A cohort study was performed of all paediatric patients with major burn who underwent Meek micrografting at a dedicated paediatric burn centre in a developing country over a five year period. Demographics, details of their burns, operative management and clinical course and outcomes were collected from patient records and operative notes and analysed. Thirty-five patients were managed using the micrografting technique during the study period. The mean patient age was 4.1 years (range 3 months-11 years) and their mean total body surface area (TBSA) burn was 49.7% (range 15-86%). Eleven patients sustained inhalation injuries and five developed a re-feeding syndrome on account of delayed referral. The mean abbreviated burn severity index (ABSI) was 8.5 (range 2-13). The hospital length of stay in the 27 survivors was a mean of 75.5 days, equating to 1.4 days per percentage burn. Eight patients died during the course of treatment, with a mean TBSA burn of 67.75% (range 38-86%). Graft take one month after surgery was documented to be more than 90% in 24 patients, of whom 3 subsequently died. Eleven patients had less than 90% graft take at this time, of whom 5 died. There is a considerable 'learning curve' associated with this technique. In order to achieve success one must ensure a completely viable, non-infected bed, obtained by tangential or fascial excision, followed by allografting as temporary coverage and to 'test the wound bed' for definitive coverage. Infection resulted in the majority of autograft loss in this series, and in addition to risk factors like burn size and inhalation injury, accounted for many of the deaths in this series. Meek micrografting offers high expansion ratios, thereby facilitating durable wound cover in the presence of limited donor sites. It is unlikely that a lethal dose, 50% (LD 50 ) of almost 70% TBSA would have been possible in this context without the regular application of this technique. This study advocates for the widespread availability of Meek micrografting and deceased donor allograft skin in developing countries. Copyright © 2017. Published by Elsevier Ltd.

Sources, Transport, and Climate Impacts of Biomass Burning Aerosols

NASA Technical Reports Server (NTRS)

Chin, Mian

2010-01-01

In this presentation, I will first talk about fundamentals of modeling of biomass burning emissions of aerosols, then show the results of GOCART model simulated biomass burning aerosols. I will compare the model results with observations of satellite and ground-based network in terms of total aerosol optical depth, aerosol absorption optical depth, and vertical distributions. Finally the long-range transport of biomass burning aerosols and the climate effects will be addressed. I will also discuss the uncertainties associated with modeling and observations of biomass burning aerosols

Emissions of polychlorinated dibenzodioxins and dibenzofurans and polychlorinated biphenyls from uncontrolled burning of garden and domestic waste (backyard burning).

PubMed

Hedman, Björn; Näslund, Morgan; Nilsson, Calle; Marklund, Stellan

2005-11-15

To assess emissions of dioxins (chlorinated dibenzodioxins and dibenzofurans) and PCB from uncontrolled domestic combustion of waste ("backyard burning"), test combustions in barrels and open fires were monitored. The waste fuels used were garden waste, paper, paper and plastic packaging, refuse-derived fuel (RDF), PVC, and electronic scrap. Combustions including PVC and electronic scrap emitted several orders of magnitude more dioxins than the other waste fuels. Emissions from the other fuels had considerable variations, but the levels were difficult to relate to waste composition. Emission factors of PCDD/F and PCB from the backyard burning ranged from 2.2 to 13 000 ng (WHO-TEQ)/kg. The levels found in ash usually were less than 5% of the total. For assessment of total emissions of dioxins and PCB from backyard burning of low and moderately contaminated wastes, an emission factor range of 4-72 ng (WHO-TEQ)/kg is suggested. These figures implythat combusting waste in the backyard could contribute substantially to total emissions, even if the amounts of fuel involved are equivalent to just a few tenths of a percent of the amounts combusted in municipal waste incinerators.

Accuracy of burn size estimation in patients transferred to adult Burn Units in Sydney, Australia: an audit of 698 patients.

PubMed

Harish, Varun; Raymond, Andrew P; Issler, Andrea C; Lajevardi, Sepehr S; Chang, Ling-Yun; Maitz, Peter K M; Kennedy, Peter

2015-02-01

The purpose of this study was to compare burn size estimation between referring centres and Burn Units in adult patients transferred to Burn Units in Sydney, Australia. A review of all adults transferred to Burn Units in Sydney, Australia between January 2009 and August 2013 was performed. The TBSA estimated by the referring institution was compared with the TBSA measured at the Burns Unit. There were 698 adults transferred to a Burns Unit. Equivalent TBSA estimation between the referring hospital and Burns Unit occurred in 30% of patients. Overestimation occurred at a ratio exceeding 3:1 with respect to underestimation, with the difference between the referring institutions and Burns Unit estimation being statistically significant (P<0.001). Significant overestimation occurs in the early transfer of burn-injured patients as well as in patients transferred more than 48h after the burn (P<0.005). Underestimation occurs with less frequency but rises with increasing time after the burn (P<0.005) and with increasing TBSA. Throughout the temporal spectrum of transferred patients, severe burns (≥20% TBSA) were found to have more satisfactory burn size estimations compared with less severe injuries (<20% TBSA; P<0.005). There are significant inaccuracies in burn size assessment by referring centres. The systemic tendency for overestimation occurs throughout the entire TBSA spectrum, and persists with increasing time after the burn. Underestimation occurs less frequently but rises with increasing time after the burn and with increasing TBSA. Severe burns (≥20% TBSA) are more accurately estimated by the referring hospital. The inaccuracies in burn size assessment have the potential to result in suboptimal treatment and inappropriate referral to specialised Burn Units. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

The Burn Medical Assistant: Developing Machine Learning Algorithms to Aid in the Estimation of Burn Wound Size

DTIC Science & Technology

2017-10-01

hypothesis that a computer machine learning algorithm can analyze and classify burn injures using multispectral imaging within 5% of an expert clinician...morbidity. In response to these challenges, the USAISR developed and obtained FDA 510(k) clearance of the Burn Navigator™, a computer decision support... computer decision support software (CDSS), can significantly change the CDSS algorithm’s recommendations and thus the total fluid administered to a

The effect of Burns & Wounds (B&W)/burdock leaf therapy on burn-injured Amish patients: a pilot study measuring pain levels, infection rates, and healing times.

PubMed

Kolacz, Nicole M; Jaroch, Mark T; Bear, Monica L; Hess, Rosanna F

2014-12-01

The purposes of this pilot study were to measure pain associated with dressing changes, assess the presence of infection, and document healing times of burn-injured Amish in central Ohio using an herbal therapy consisting of Burns and Wounds™ ointment (B&W) and burdock (Arctium ssp.) leaves. B&W contains honey, lanolin, olive oil, wheat germ oil, marshmallow root, Aloe vera gel, wormwood, comfrey root, white oak bark, lobelia inflata, vegetable glycerin, bees wax, and myrrh. A prospective, case series design guided the study within a community-based participatory research framework. Amish burn dressers provided burn care. Registered nurses monitored each case and documented findings. Pain scores were noted and burns were inspected for infection during dressing changes; healing times were measured from day of burn to complete closure of the skin. All cases were photographed. Between October 2011 and May 2013, five Amish were enrolled. All had first- and second-degree burns. B&W/burdock leaf dressing changes caused minimal or no pain; none of the burns became infected, and healing times averaged less than 14 days. The use of this herbal remedy appears to be an acceptable alternative to conventional burn care for these types of burns. The trauma of dressing changes was virtually nonexistent. Nurses working in communities with Amish residents should be aware of this herbal-based method of burn care and monitor its use when feasible. © The Author(s) 2014.

Prescribed burning supports grassland biodiversity - A multi-species study

NASA Astrophysics Data System (ADS)

Valkó, Orsolya; Deák, Balázs; Magura, Tibor; Török, Péter; Kelemen, András; Tóth, Katalin; Horváth, Roland; Nagy, Dávid; Debnár, Zsuzsanna; Zsigrai, György; Kapocsi, István; Tóthmérész, Béla

2017-04-01

During ancient times, fire was an important factor shaping European landscapes. Nowadays, prescribed burning can be one of the most effective conservation tools for the management of open landscapes, controlling dominant species, reducing accumulated litter or decreasing wildfire risk. In a prescribed burning experiment, we studied the effects of fire on dry alkaline grasslands. We tested whether autumn prescribed burning can be an alternative conservation measure in these grasslands. We selected six sites in Hungary: in three sites, prescribed burning was applied in November 2011, while three sites remained unburnt. We studied the effects of fire on soil characteristics, plant biomass and on the vegetation and arthropod assemblages (isopods, spiders, ground beetles and rove beetles). Soluble salt content increased significantly in the burnt sites, but soil pH, organic matter, potassium and phosphorous did not change. We found that prescribed fire had several positive effects from the nature conservation viewpoint. Diversity and the number of flowering shoots were higher, and the cover of the dominant grass was lower in the burnt sites. Graminoid biomass was lower, while total, green and forb biomass were higher in the burnt plots compared to the control ones. Our findings suggest that prescribed burning fire did not harm arthropods; species-level analyses showed that out of the most abundant invertebrate species, the abundance of ten was not affected, one decreased and one increased after burning. Our findings highlight that mosaic prescribed fire is a viable management tool in open landscapes, because it supports plant diversity and does not threaten arthropods.

Total available carbohydrates in serviceberry after late dummer and fall burning

Treesearch

Benjamin Zamora; Thomas Gnojek

2001-01-01

Total available carbohydrate (TAC) storage and depletion was measured in late summer and fall burned and unburned serviceberry (Amelanchier alnifolia). The purpose of the study was to assess the influence of late season prescribed fire on the vigor of serviceberry, a key browse species on white-tailed deer (Odecoileus virginianus ochrourus) winter range in northeastern...

Use of a copolymer dressing on superficial and partial-thickness burns in a paediatric population.

PubMed

Everett, M; Massand, S; Davis, W; Burkey, B; Glat, P M

2015-07-01

Despite extensive research into the treatment of partial-thickness burns, to date there has not been the emergence of a preeminent modality. This pilot study, the first such study to be performed in a burn unit in the US, was designed to evaluate the efficacy and outcomes of the application of copolymer dressing (Suprathel; PolyMedics Innovations Corporation, Stuttgart, Germany) for both superficial and deeper partial-thickness burns. The copolymer dressing was used as a primary wound dressing to treat superficial and deep partial-thickness burns (average 5% total body surface area) in paediatric patients. Burns were debrided within 24 hours, at bedside, in the burn unit or in the operating room. The copolymer dressing was then applied directly to the wound and covered with a non-adherent second layer and an absorptive outer dressing. After discharge, patients were seen every 5-7 days until healed. Parameters evaluated included average hospital length of stay, average number of intravenous doses of narcotics administered, pain score at first follow-up visit, average time to complete re epithelialisation, incidence of burn wound infection, and patient/parent satisfaction on a 4-point scale. We also evaluated our experience with the dressing. Data were evaluated retrospectively under an Investigational Review Board approved protocol. Of the 17 patients assessed the average hospital length of stay was 1.4 days during which the average number of intravenous narcotic doses administered before copolymer dressing application was 1.5 and after was 0.1 doses. At the first follow-up visit, average pain score was 1.2 on a 10-point scale and the average time to re epithelialisation was 9.5 days. There was no incidence of burn wound infection. Patient/parent satisfaction was average of 3.66 on a 4-point scale. The staff had found that the self-adherence and elasticity of the dressing made it easy to apply and stay adherent, especially in areas of difficult contour. There were no readmissions for further debridement or skin grafting. Our experience shows that patients may be discharged shortly after the application of the copolymer dressing, with manageable pain scores and ease of use as determined by the caretakers high satisfaction. This new, fully synthetic copolymer dressing is easy to apply, does not require any additional antimicrobial coverage and may be used to successfully manage deeper partial-thickness burns, donor sites or burns in areas of contour, where many other dressings might not be considered or be appropriate. None declared.

Burning mouth syndrome and oral health-related quality of life: is there a change over time?

PubMed

Ni Riordain, R; Moloney, E; O'Sullivan, K; McCreary, C

2010-10-01

The symptoms associated with burning mouth syndrome can be quite varied and can interfere with the every day lives of patients. Management of the condition can be challenging for clinicians. To determine the oral health-related quality of life (OHRQOL) implications of BMS on patients over a period of time whilst undergoing treatment and to evaluate whether treatment interventions had a positive effect on OHRQOL. Thirty-two individuals (26 females, 6 males, mean age 61 years, range 38-83 years) were enrolled in this study. Individuals were interviewed using Short-Form McGill Pain Questionnaire (SFMPQ), Visual Analogue Scale (VAS), the Hospital Anxiety and Depression Scale (HADS) and the Oral Health Impact Profile (OHIP-14), at weeks 0, 8 and 16. Scores from all outcome measures used decreased over the 16 weeks of the study. Statistically significant differences were found between time points for VAS pain scores (P < 0.001), HADS depression scores (P = 0.029), SFMPQ sensory pain scores (P < 0.01) and total scores for OHIP-14 (P < 0.05). Burning mouth syndrome has a negative impact on OHRQOL; however, individually tailored management of the condition can result in an improvement in patient-reported outcome measures including quality of life.

Detection of the long-range transport of wildfire pollution to the Arctic using a network of ground-based FTIR spectrometers, satellite observations and model result

NASA Astrophysics Data System (ADS)

Lutsch, E.; Conway, S. A.; Strong, K.; Jones, D. B. A.; Drummond, J. R.; Ortega, I.; Hannigan, J. W.; Makarova, M.; Notholt, J.; Blumenstock, T.; Sussmann, R.; Mahieu, E.; Kasai, Y.; Clerbaux, C.

2017-12-01

We present a multi-year time series of the total columns of carbon monoxide (CO), hydrogen cyanide (HCN) and ethane (C2H6) obtained by Fourier Transform Infrared (FTIR) spectrometer measurements at nine sites. Six are high-latitude sites: Eureka, Nunavut; Ny Alesund, Norway; Thule, Greenland; Kiruna, Sweden; Poker Flat, Alaska and St. Petersburg, Russia and three are mid-latitude sites; Zugspitze, Germany; Jungfraujoch, Switzerland and Toronto, Ontario. For each site, the inter-annual trends and seasonal variabilities of the CO total column time series are accounted for, allowing ambient concentrations to be determined. Enhancements above ambient levels are then used to identify possible wildfire pollution events. Since the abundance of each trace gas species emitted in a wildfire event is specific to the type of vegetation burned and the burning phase, correlations of CO to the other long-lived wildfire tracers HCN and C2H6 allow for further confirmation of the detection of wildfire pollution. Back-trajectories from HYSPLIT and FLEXPART as well as fire detections from the Moderate Resolution Spectroradiometer (MODIS) allow the source regions of the detected enhancements to be determined while satellite observations of CO from the Measurement of Pollution in the Troposphere (MOPITT) and Infrared Atmospheric Sounding Interferometer (IASI) instruments can be used to track the transport of the smoke plume. Differences in travel times between sites allows ageing of biomass burning plumes to be determined, providing a means to infer the physical and chemical processes affecting the loss of each species during transport. Comparisons of ground-based FTIR measurements to GEOS-Chem chemical transport model results are used to investigate these processes, evaluate wildfire emission inventories and infer the influence of wildfire emissions on the Arctic.

High-frequency spectral ultrasound imaging (SUSI) visualizes early post-traumatic heterotopic ossification (HO) in a mouse model.

PubMed

Ranganathan, Kavitha; Hong, Xiaowei; Cholok, David; Habbouche, Joe; Priest, Caitlin; Breuler, Christopher; Chung, Michael; Li, John; Kaura, Arminder; Hsieh, Hsiao Hsin Sung; Butts, Jonathan; Ucer, Serra; Schwartz, Ean; Buchman, Steven R; Stegemann, Jan P; Deng, Cheri X; Levi, Benjamin

2018-04-01

Early treatment of heterotopic ossification (HO) is currently limited by delayed diagnosis due to limited visualization at early time points. In this study, we validate the use of spectral ultrasound imaging (SUSI) in an animal model to detect HO as early as one week after burn tenotomy. Concurrent SUSI, micro CT, and histology at 1, 2, 4, and 9weeks post-injury were used to follow the progression of HO after an Achilles tenotomy and 30% total body surface area burn (n=3-5 limbs per time point). To compare the use of SUSI in different types of injury models, mice (n=5 per group) underwent either burn/tenotomy or skin incision injury and were imaged using a 55MHz probe on VisualSonics VEVO 770 system at one week post injury to evaluate the ability of SUSI to distinguish between edema and HO. Average acoustic concentration (AAC) and average scatterer diameter (ASD) were calculated for each ultrasound image frame. Micro CT was used to calculate the total volume of HO. Histology was used to confirm bone formation. Using SUSI, HO was visualized as early as 1week after injury. HO was visualized earliest by 4weeks after injury by micro CT. The average acoustic concentration of HO was 33% more than that of the control limb (n=5). Spectroscopic foci of HO present at 1week that persisted throughout all time points correlated with the HO present at 9weeks on micro CT imaging. SUSI visualizes HO as early as one week after injury in an animal model. SUSI represents a new imaging modality with promise for early diagnosis of HO. Copyright © 2018 Elsevier Inc. All rights reserved.

[Epidemiological investigation on 2 133 hospitalized patients with electrical burns].

PubMed

Jiang, M J; Li, Z; Xie, W G

2017-12-20

Objective: To analyze the epidemiological characteristics of the hospitalized patients with electrical burns in Institute of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital (hereinafter referred to as Institute of Burns of Wuhan Third Hospital), so as to provide reference for the prevention and treatment of electrical burns. Methods: Medical records of all hospitalized burn patients in Institute of Burns of Wuhan Third Hospital from January 2004 to December 2016 were collected. Genders, ages, social categories, seasons of injury, total burn areas, depths of wounds, electrical voltages of injury, sites of wound, treatment methods, amputation rates, lengths of hospital stay, operation costs, hospitalization costs, and treatment outcomes of the electrical burn patients were collected. Treatment methods, lengths of hospital stay, operation costs, and hospitalization costs of the thermal burn patients were collected and compared with those of the electrical burn patients. Electrical voltages of injury, amputation rates, operation costs, hospitalization costs, and treatment outcomes were compared and analyzed between the electrical contact burn patients and the electrical arc burn patients. Data were processed with Chi-square test and Wilcoxon rank-sum test. Results: During the 13 years, 23 534 burn patients were admitted to Institute of Burns of Wuhan Third Hospital, among whom 2 133 (9.1%) were with electrical burns, without obvious variation in admission number of electrical burn patients every year. There were 1 418 patients (66.5%) with electrical contact burns and 715 patients (33.5%) with electrical arc burns. The ratio of male to female was 11.2∶1.0 among the electrical burn patients with known genders. The proportions of three age groups of more than 20 years old and less than or equal to 30 years old, more than 30 years old and less than or equal to 40 years old, and more than 40 years old and less than or equal to 50 years old were relatively higher, which were 18.3% (391/2 133), 22.1% (471/2 133), and 24.6% (525/2 133), respectively. The first three social category groups in proportions were workers, peasants, and preschool children, which were 57.9% (1 235/2 133), 14.6% (311/2 133), and 6.0% (128/2 133), respectively. Among the electrical burn patients with known seasons of injury, most cases were injured in summer (659 cases, accounting for 34.1%), obviously more than the proportions in autumn (537 cases, accounting for 27.8%), spring (455 cases, accounting for 23.5%), and winter (283 cases, accounting for 14.6%), with χ (2) values from 8.414 to 149.573, P values below 0.01. The group of patients with total burn areas less than 10% total body surface area (TBSA) occupied the highest proportion (1 603 cases, accounting for 75.15%), among whom 229 (10.74%) were with scattered small wounds which were less than 1% TBSA. The percentage of electrical contact burn patients with deep wounds was 79.1% (1 122/1 418), which was obviously higher than 2.5% (18/715) of the electrical arc burn patients ( χ (2)=381.741, P <0.001). Among the patients with known electrical voltages of injury, patients injured by high voltage among the electrical contact burn patients accounted for 78.4% (469/598), which was obviously higher than 8.7% (11/127) of the electrical arc burn patients ( χ (2)=227.893, P <0.001). The most common wound site of the electrical burn patients was upper limbs (1 650 cases, accounting for 63.2%), followed by lower limbs (382 cases, accounting for 14.6%), head and neck (292 cases, accounting for 11.2%), trunk (247 cases, accounting for 9.5%), and hip and perineum (40 cases, accounting for 1.5%). The operation rate of electrical burn patients was 32.4% (691/2 133), obviously higher than 19.1% (3 860/20 209)of the thermal burn patients during the same period ( χ (2)=210.255, P <0.001). Wounds of 116 electrical contact burn patients were repaired with free flap by vascular anastomosis, of which 9 (7.8%) failed. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were (28±29) d, (9 534±16 935) and (44 258±93 012) Yuan, respectively, obviously longer or higher than those of the thermal burn patients during the same period [(17±19) d, (2 990±8 916) and (23 291±88 340) Yuan, respectively, with Z values from -21.323 to -10.996, P values below 0.001]. The amputation rate and the death rate of electrical burn patients were 3.8% (82/2 133) and 0.8% (16/2 133) respectively. Compared with those of electrical arc burn patients, the amputation rate and the operation cost of electrical contact burn patients were obviously higher ( χ (2)=36.970, Z =-11.351, P values below 0.001), and the length of hospital stay of electrical contact burn patients was obviously longer ( Z =-5.181, P <0.001). There were no significant differences in hospitalization cost and treatment outcome between the electrical contact burn patients and the electrical arc burn patients ( Z =-1.461, χ (2)=1.673, P values above 0.05). Conclusions: The number and the proportion of hospitalized electrical burn patients in Institute of Burns of Wuhan Third Hospital were relatively high, indicating a hard task of prevention for electrical burns in Wuhan area. Working-age workers and farmers, and preschool children were the key groups in prevention from electrical burns. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were obviously higher than those of thermal burn patients. The amputation rate and the operation cost of electrical contact burn patients were obviously higher than those of electrical arc burn patients, but there were no obvious differences in hospitalization cost or treatment outcome between them. Actively using tissue flaps including free flap to repair of wounds may be helpful to reduce the amputation rate, improve the results, and shorten the time of treatment.

Characteristics and source apportionment of black carbon aerosols over an urban site.

PubMed

Rajesh, T A; Ramachandran, S

2017-03-01

Aethalometer based source apportionment model using the measured aerosol absorption coefficients at different wavelengths is used to apportion the contribution of fossil fuel and wood burning sources to the total black carbon (BC) mass concentration. Temporal and seasonal variabilities in BC mass concentrations, equivalent BC from fossil fuel (BC f f ), and wood burning (BC w b ) are investigated over an urban location in western India during January 2014 to December 2015. BC, BC f f , and BC w b mass concentrations exhibit strong diurnal variation and are mainly influenced by atmospheric dynamics. BC f f was higher by a factor of 2-4 than BC w b and contributes maximum to BC mass throughout the day, confirming consistent anthropogenic activities. Diurnal contribution of BC f f and BC w b exhibits opposite variation due to differences in emission sources over Ahmedabad. Night time BC values are about a factor of 1.4 higher than day time BC values. The annual mean percentage contributions of day time and night time are 42 and 58 %, respectively. BC, BC f f , and BC w b mass concentrations exhibit large and significant variations during morning, afternoon, evening, and night time. During afternoon, mass concentration values are minimum throughout the year because of the fully evolved boundary layer and reduced anthropogenic activities. BC exhibits a strong seasonal variability with postmonsoon high (8.3 μg m -3 ) and monsoon low (1.9 μg m -3 ). Annual mean BC f f and BC w b contributions are 80 and 20 %, respectively, to total BC, which suggests that major contribution of BC in Ahmedabad comes from fossil fuel emissions. The results show that the study location is dominated by fossil fuel combustion as compared to the emissions from wood burning. The results obtained represent a regional value over an urban regime which can be used as inputs on source apportionment to model BC emissions in regional and global climate models.

Blood transfusions in severe burn patients: Epidemiology and predictive factors.

PubMed

Wu, Guosheng; Zhuang, Mingzhu; Fan, Xiaoming; Hong, Xudong; Wang, Kangan; Wang, He; Chen, Zhengli; Sun, Yu; Xia, Zhaofan

2016-12-01

Blood is a vital resource commonly used in burn patients; however, description of blood transfusions in severe burns is limited. The purpose of this study was to describe the epidemiology of blood transfusions and determine factors associated with increased transfusion quantity. This is a retrospective study of total 133 patients with >40% total body surface area (TBSA) burns admitted to the burn center of Changhai hospital from January 2008 to December 2013. The study characterized blood transfusions in severe burn patients. Univariate and Multivariate regression analyses were used to evaluate the association of clinical variables with blood transfusions. The overall transfusion rate was 97.7% (130 of 133). The median amount of total blood (RBC and plasma), RBC and plasma transfusions was 54 units (Interquartile range (IQR), 20-84), 19 units (IQR, 4-37.8) and 28.5 units (IQR, 14.8-51.8), respectively. The number of RBC transfusion in and outside operation room was 7 (0, 14) and 11 (2, 20) units, and the number of plasma was 6 (0.5, 12) and 21 (11.5, 39.3) units. A median of one unit of blood was transfused per TBSA and an average of 4 units per operation was given in the series. The consumption of plasma is higher than that of RBC. On multivariate regression analysis, age, full-thickness TBSA and number of operations were significant independent predictors associated with the number of RBC transfusion, and coagulopathy and ICU length showed a trend toward RBC consumption. Predictors for increased plasma transfusion were female, high full-thickness TBSA burn and more operations. Severe burn patients received an ample volume of blood transfusions. Fully understanding of predictors of blood transfusions will allow physicians to better optimize burn patients during hospitalization in an effort to use blood appropriately. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Patient controlled sedation using a standard protocol for dressing changes in burns: patients' preference, procedural details and a preliminary safety evaluation.

PubMed

Nilsson, Andreas; Steinvall, Ingrid; Bak, Zoltan; Sjöberg, Folke

2008-11-01

Patient controlled sedation (PCS) enables patients to titrate doses of drugs by themselves during different procedures involving pain or discomfort. We studied it in a prospective crossover design using a fixed protocol without lockout time to examine it as an alternative method of sedation for changing dressings in burned patients. Eleven patients with >10% total burn surface area (TBSA) had their dressings changed, starting with sedation by an anaesthetist (ACS). The second dressing change was done with PCS (propofol/alfentanil) and the third time the patients had to choose ACS or PCS. During the procedures, data on cardiopulmonary variables, sedation (bispectral index), pain intensity (VAS), procedural details, doses of drugs, and patients' preferences were collected to compare the two sedation techniques. The study data indicated that wound care in burned patients is feasible with a standardized PCS protocol. The patients preferred PCS to ACS on the basis of self-control, and because they had less discomfort during the recovery period. Wound care was also considered adequate by the staff during PCS. No respiratory (respiratory rate/transcutaneous PCO(2)) or cardiovascular (heart rate/blood pressure) adverse events were recorded at any time during any of the PCS procedures. The doses of propofol and alfentanil and BIS index decrease were less during PCS than ACS. Procedural pain was higher during PCS but lower after the procedure. We suggest that PCS using a standard protocol is an interesting alternative to anaesthetist-provided sedation during dressing changes. It seems effective, saves resources, is safe, and at same time is preferred by the patients. The strength of these conclusions is, however, hampered by the small size of this investigation and therefore further studies are warranted.

Polar and non-polar organic aerosols from large-scale agricultural-waste burning emissions in Northern India: Implications to organic mass-to-organic carbon ratio.

PubMed

Rajput, Prashant; Sarin, M M

2014-05-01

This study focuses on characteristics of organic aerosols (polar and non-polar) and total organic mass-to-organic carbon ratio (OM/OC) from post-harvest agricultural-waste (paddy- and wheat-residue) burning emissions in Northern India. Aerosol samples from an upwind location (Patiala: 30.2°N, 76.3°E) in the Indo-Gangetic Plain were analyzed for non-polar and polar fractions of organic carbon (OC1 and OC2) and their respective mass (OM1 and OM2). On average, polar organic aerosols (OM2) contribute nearly 85% of the total organic mass (OM) from the paddy- and wheat-residue burning emissions. The water-soluble-OC (WSOC) to OC2 ratio, within the analytical uncertainty, is close to 1 from both paddy- and wheat-residue burning emissions. However, temporal variability and relatively low WSOC/OC2 ratio (Av: 0.67±0.06) is attributed to high moisture content and poor combustion efficiency during paddy-residue burning, indicating significant contribution (∼30%) of aromatic carbon to OC2. The OM/OC ratio for non-polar (OM1/OC1∼1.2) and polar organic aerosols (OM2/OC2∼2.2), hitherto unknown for open agricultural-waste burning emissions, is documented in this study. The total OM/OC ratio is nearly identical, 1.9±0.2 and 1.8±0.2, from paddy- and wheat-residue burning emissions. Copyright © 2013 Elsevier Ltd. All rights reserved.

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.

The effect of fire on habitat selection of mammalian herbivores: the role of body size and vegetation characteristics.

PubMed

Eby, Stephanie L; Anderson, T Michael; Mayemba, Emilian P; Ritchie, Mark E

2014-09-01

Given the role of fire in shaping ecosystems, especially grasslands and savannas, it is important to understand its broader impact on these systems. Post-fire stimulation of plant nutrients is thought to benefit grazing mammals and explain their preference for burned areas. However, fire also reduces vegetation height and increases visibility, thereby potentially reducing predation risk. Consequently, fire may be more beneficial to smaller herbivores, with higher nutritional needs and greater risks of predation. We tested the impacts of burning on different sized herbivores' habitat preference in Serengeti National Park, as mediated by burning's effects on vegetation height, live : dead biomass ratio and leaf nutrients. Burning caused a less than 4 month increase in leaf nitrogen (N), and leaf non-N nutrients [copper (Cu), potassium (K), and magnesium (Mg)] and a decrease in vegetation height and live : dead biomass. During this period, total herbivore counts were higher on burned areas. Generally, smaller herbivores preferred burned areas more strongly than larger herbivores. Unfortunately, it was not possible to determine the vegetation characteristics that explained burned area preference for each of the herbivore species observed. However, total herbivore abundance and impala (Aepyceros melampus) preference for burned areas was due to the increases in non-N nutrients caused by burning. These findings suggest that burned area attractiveness to herbivores is mainly driven by changes to forage quality and not potential decreases in predation risk caused by reductions in vegetation height. © 2014 The Authors. Journal of Animal Ecology © 2014 British Ecological Society.

Determination of burning area and port volume in complex burning regions of a solid rocket motor

NASA Technical Reports Server (NTRS)

Kingsbury, J. A.

1977-01-01

An analysis of the geometry of the burning in both star-cylindrical port interface regions and regions of partially inhibited slots is presented. Some characteristics parameters are defined and illustrated. Methods are proposed for calculating burning areas which functionally depend only on the total distance burned. According to this method, several points are defined where abrupt changes in geometry occur, and these are tracked throughout the burn. Equations are developed for computing port perimeter and port area at pre-established longitudinal positions. Some common formulas and some newly developed formulas are then used to compute burning surface area and port volume. Some specific results are presented for the solid rocket motor committed to the space shuttle project.

The impact of patient demographics and comorbidities upon burns admitted to Tygerberg Hospital Burns Unit, Western Cape, South Africa.

PubMed

Cloake, T; Haigh, T; Cheshire, J; Walker, D

2017-03-01

In South Africa, burns are a major public health problem responsible for significant morbidity and long-term physical disability. This is, in part, due to a significant proportion of the urban population living in poorly constructed, combustible accommodation. The presence of co-morbid diseases such as diabetes and malignancy in patients with burns has been associated with a poorer outcome. The impact of other diseases such as HIV has yet to be defined. A retrospective data collection study analysed the 221 patients admitted to Tygerberg Hospital Burns Unit in 2011 and the first six months of 2013. Using hospital records, patient demographic data was collected alongside burn agent, ICU admission, complications, and patient outcome in terms of length of stay and mortality. The most common burn agent was hot liquid (45.7%). A significant proportion of patients were subject to intentional attacks (34.3%). Shack fires and flame accounted cumulatively for 85% of total inhalational burns, the highest rates of admission to ICU (85.5%), the highest rate of complications, as well as 92.3% of all total fatalities. HIV+ patients had a higher mortality (13.3% vs 5%, p=0.22) and a higher complication rate (46.7% vs 30%, p=0.21). There was no difference in length of stay between the HIV+ and HIV- cohort (12days vs. 15.5 days, p=0.916). Burns are a significant yet preventable cause of mortality and morbidity. The rising number of shack fires, responsible for extensive burns and resultant mortality is concerning and indicates urgent attention and action. HIV complicates the recovery from burn and is responsible for an increased rate of in hospital mortality. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Genital burns in the national burn repository: incidence, etiology, and impact on morbidity and mortality.

PubMed

Harpole, Bethany G; Wibbenmeyer, Lucy A; Erickson, Bradley A

2014-02-01

To better characterize national genital burns (GBs) characteristics using a large burn registry. We hypothesized that mortality and morbidity will be higher in patients with GBs. The National Burn Repository, a large North American registry of hospitalized burn patients, was queried for patients with GB. Burn characteristics and mechanism, demographics, mortality, and surgical interventions were retrieved. Outcomes of interest were mortality, hospital-acquired infection (HAI), and surgical intervention on the genitalia. Adjusted odds ratios (aOR) for outcomes were determined with binomial logistic regression controlling for age, total burn surface area, race, length of stay, gender, and inhalation injury presence. GBs were present in 1245 cases of 71,895 burns (1.7%). Patients with GB had significantly greater average total burn surface area, length of stay, and mortality. In patients with GB, surgery of the genitalia was infrequent (10.4%), with the aOR of receiving surgery higher among men (aOR 2.7, P <.001) and those with third-degree burns (aOR 3.1, P <.002). Presence of a GB increased the odds of HAI (aOR 3.0, P <.0001) and urinary tract infections (aOR 3.4, P <.0001). GB was also an independent predictor of mortality (aOR 1.54) even after adjusting for the increased HAI risk. GBs are rare but associated with higher HAI rates and higher mortality after adjusting for well-established mortality risk factors. Although a cause and effect relationship cannot be established using these registry data, we believe this study suggests the need for special management considerations in GB cases to improve overall outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Outcomes After Cardiac Arrest in an Adult Burn Center

DTIC Science & Technology

2013-12-07

defibrillation at our institution, either in the burn operating room (BOR) or burn intensive care unit (BICU). We included patients who experi- enced CA in...of this study design. In other studies, the time between CA and defibrillation and, in children, the time between burn and fluid resuscitation have

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.

Hyperosmolar metabolic acidosis in burn patients exposed to glycol based topical antimicrobials-A systematic review.

PubMed

Leibson, Tom; Davies, Paige; Nickel, Cheri; Koren, Gideon

2018-06-01

The well documented susceptibility of burn patients to acquired infections via damaged skin mandates application of antimicrobial agents. These agents are dissolved in various vehicles that augment skin absorption thus allowing greater efficacy. Polyethylene glycol (PEG) and Propylene glycol (PropG) are among the most commonly used vehicles, and both have been used in numerous medications and cosmetic products over the past few decades. Rarely, burn patients treated with agents containing these glycols present with a life threatening systemic toxidrome of hyperosmolar metabolic acidosis. We present a systematic review of outcomes in burn patients treated with similar agents. Relevant studies were identified through systematic searches conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Thomson Reuters), from database inception to August 4th, 2016. All publications of clinical burn patient studies included at least one arm receiving a glycol based topical therapy. A total of 61 studies involving 10,282 patients and 4 different antimicrobial medications fulfilled the inclusion criteria. Nine burn patients (0.09%) were documented to present with hyperosmolar metabolic acidosis during topical silver sulfadiazine treatment. Propylene glycol isolated from their blood accounted for the high osmole gap. This first systematic review found very few cases of documented hyperosmolar metabolic acidosis, all within one study that had set to specifically explore this toxidrome. High index of suspicion with frequent osmolar gap monitoring may help identify future toxicities in a timely manner. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Work-Related Burn Injuries Hospitalized in US Burn Centers: 2002 to 2011.

PubMed

Huang, Zhenna; Friedman, Lee S

2017-03-01

To develop a comprehensive definition to identify work-related burns in the National Burn Repository (NBR) based on multiple fields and describes injuries by occupation. The NBR, which is an inpatient dataset, was used to compare type and severity of burn injuries by occupation. Using the definition developed for this analysis, 22,969 burn injuries were identified as work-related. In contrast, the single work-related field intended to capture occupational injuries only captured 4696 cases. The highest numbers of burns were observed in construction/extraction, food preparation, and durable goods production occupations. Occupations with a mean total body surface area (TBSA) burned greater than 10% include transportation and material-moving, architecture and engineering, and arts/design/entertainment/sports/media occupations. The NBR dataset should be further utilized for occupational burn injury investigations and multiple fields should be considered for case ascertainment.

Trends and causes of severity, size, and number of fires in northwestern California, USA.

PubMed

Miller, J D; Skinner, C N; Safford, H D; Knapp, E E; Ramirez, C M

2012-01-01

Research in the last several years has indicated that fire size and frequency are on the rise in western U.S. forests. Although fire size and frequency are important, they do not necessarily scale with ecosystem effects of fire, as different ecosystems have different ecological and evolutionary relationships with fire. Our study assessed trends and patterns in fire size and frequency from 1910 to 2008 (all fires > 40 ha), and the percentage of high-severity in fires from 1987 to 2008 (all fires > 400 ha) on the four national forests of northwestern California. During 1910-2008, mean and maximum fire size and total annual area burned increased, but we found no temporal trend in the percentage of high-severity fire during 1987-2008. The time series of severity data was strongly influenced by four years with region-wide lightning events that burned huge areas at primarily low-moderate severity. Regional fire rotation reached a high of 974 years in 1984 and fell to 95 years by 2008. The percentage of high-severity fire in conifer-dominated forests was generally higher in areas dominated by smaller-diameter trees than in areas with larger-diameter trees. For Douglas-fir forests, the percentage of high-severity fire did not differ significantly between areas that re-burned and areas that only burned once (10% vs. 9%) when re-burned within 30 years. Percentage of high-severity fire decreased to 5% when intervals between first and second fires were > 30 years. In contrast, in both mixed-conifer and fir/high-elevation conifer forests, the percentage of high-severity fire was less when re-burned within 30 years compared to first-time burned (12% vs. 16% for mixed conifer; 11% vs. 19% for fir/high-elevation conifer). Additionally, the percentage of high-severity fire did not differ whether the re-burn interval was less than or greater than 30 years. Years with larger fires and greatest area burned were produced by region-wide lightning events, and characterized by less winter and spring precipitation than years dominated by smaller human-ignited fires. Overall percentage of high-severity fire was generally less in years characterized by these region-wide lightning events. Our results suggest that, under certain conditions, wildfires could be more extensively used to achieve ecological and management objectives in northwestern California.

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.

Cement-related injuries: review of a series, the National Burn Repository, and the prevailing literature.

PubMed

Chung, Joseph Y; Kowal-Vern, Areta; Latenser, Barbara A; Lewis, Robert W

2007-01-01

The spectrum of cement-related injuries encompasses contact dermatitis, abrasions, ulcerations, chemical burns, and burns from explosions during the manufacturing process. The purpose of this study was to compile cement-related conditions seen in two burn units (1999-2005), literature case reports and series (1950-2006) and the (1989-2001) National Burn Repository (NBR). There were 3597 admissions in two Midwestern burn units, of which 12 cases (0.8%) were cement burns. They occurred in men, aged 15 to 64 years with a burn range of 0.25 to 10% TBSA, exposure time of 1 to 6 hours, treatment delay of 1 day to 2 weeks, hospitalization (2-14 days). Literature review of 109 cases indicated that cement-related injuries were predominantly seen in men, aged 26 to 45 years; with a cement-exposure time of 1.5 to 4 hours, treatment delay (1 day to 5 weeks), hospitalization (10-33 days), and healing time (2-7 weeks). There were 52,219 burn admissions in the NBR, of which 44 (0.08%) were cement-related burns; 95% were men with a mean age of 41 years, 6% TBSA cement burn and an 8-day hospital stay. The demographic characteristics of the burn units and NBR cases were similar to those in the literature. This preventable injury occurred primarily in the working age male patient and was associated with long healing times. Public awareness and enhanced manufacturer package warnings and education may decrease future cement-related injuries.

Methane Emissions from Leak and Loss Audits of Natural Gas Compressor Stations and Storage Facilities.

PubMed

Johnson, Derek R; Covington, April N; Clark, Nigel N

2015-07-07

As part of the Environmental Defense Fund's Barnett Coordinated Campaign, researchers completed leak and loss audits for methane emissions at three natural gas compressor stations and two natural gas storage facilities. Researchers employed microdilution high-volume sampling systems in conjunction with in situ methane analyzers, bag samples, and Fourier transform infrared analyzers for emissions rate quantification. All sites had a combined total methane emissions rate of 94.2 kg/h, yet only 12% of the emissions total resulted from leaks. Methane slip from exhausts represented 44% of the total emissions. Remaining methane emissions were attributed to losses from pneumatic actuators and controls, engine crankcases, compressor packing vents, wet seal vents, and slop tanks. Measured values were compared with those reported in literature. Exhaust methane emissions were lower than emissions factor estimates for engine exhausts, but when combined with crankcase emissions, measured values were 11.4% lower than predicted by AP-42 as applicable to emissions factors for four-stroke, lean-burn engines. Average measured wet seal emissions were 3.5 times higher than GRI values but 14 times lower than those reported by Allen et al. Reciprocating compressor packing vent emissions were 39 times higher than values reported by GRI, but about half of values reported by Allen et al. Though the data set was small, researchers have suggested a method to estimate site-wide emissions factors for those powered by four-stroke, lean-burn engines based on fuel consumption and site throughput.

Broadband optical properties of biomass burning aerosol and identification of brown carbon chromophores

NASA Astrophysics Data System (ADS)

Rudich, Y.; Bluvshtein, N.; Lin, P.; Flores, J. M.; Segey, L.; Tas, E.; Snider, G.; Weagle, C. L. M.; Brown, S. S.; Laskin, J.; Laskin, A.

2017-12-01

Accurate modeling of the radiative effects of smoke aerosols requires wavelength-dependent measurements and parameterizations of their optical properties in the UV and visible spectral ranges along with improved description of their chemical composition. To address this issue, we used a recently developed approach to retrieve the time- and spectral-dependent optical properties of ambient biomass burning aerosols from 300 to 650 nm wavelengths during a regional nighttime bonfire festival in Israel. During the biomass burning event, the overall absorption at 400 nm increased by about two orders of magnitude, changing the single scattering albedo from a background level of 0.95 to 0.7. In addition, PM2.5 filter samples were collected for detailed chemical analysis of the water soluble organics that contribute to light absorption. Nitroaromatic compounds were identified as major organic species responsible for the 50-80% of the total visible light absorption (> 400 nm). Typical chromophores include 4-nitrocatechol, 4-nitrophenol, nitro-syringol and nitro-guaiacol; oxidation-nitration products of methoxyphenols, and known products of lignin pyrolysis. Our results suggests that night time chemistry of nitrogen oxides with particles may play a significant role in atmospheric transformations of brown carbon.

Long-term impact of wildfire on soils exposed to different fire severities. A case study in Cadiretes Massif (NE Iberian Peninsula).

PubMed

Francos, Marcos; Úbeda, Xavier; Pereira, Paulo; Alcañiz, Meritxell

2018-02-15

Wildfires affect ecosystems depending on the fire regime. Long-term studies are needed to understand the ecological role played by fire, especially as regards its impact on soils. The aim of this study is to monitor the long-term effects (18years) of a wildfire on soil properties in two areas affected by low and high fire severity regimes. The properties studied were total nitrogen (TN), total carbon (TC), C/N ratio, soil organic matter (SOM) and extractable calcium (Ca), magnesium (Mg), sodium (Na) and potassium (K). The study was carried out in three phases: short- (immediately after the wildfire), medium- (seven years after the wildfire) and long-term (18years after the wildfire). The results showed that in both fire regimes TN decreased with time, TC and SOM were significantly lower in the burned plots than they were in the control in the medium- and long-terms. C/N ratio was significantly lower at short-term in low wildfire severity area. Extractable Ca and Mg were significantly higher in control plot than in the burned plots in the medium-term. In the long-term, extractable Ca and Mg were significantly lower in the area exposed to a high severity burning. No differences were identified in the case of extractable Na between plots on any of the sampling dates, while extractable K was significantly higher in the plot exposed to low wildfire than it was in the control. Some restoration measures may be required after the wildfire, especially in areas affected by high severity burning, to avoid the long-term impacts on the essential soil nutrients of TC, SOM, extractable Ca and Mg. This long-term nutrient depletion is attributable to vegetation removal, erosion, leaching and post-fire vegetation consumption. Soils clearly need more time to recover from wildfire disturbance, especially in areas affected by high severity fire regimes. Copyright © 2017 Elsevier B.V. All rights reserved.

Projecting climate-driven increases in North American fire activity

NASA Astrophysics Data System (ADS)

Wang, D.; Morton, D. C.; Collatz, G. J.

2013-12-01

Climate regulates fire activity through controls on vegetation productivity (fuels), lightning ignitions, and conditions governing fire spread. In many regions of the world, human management also influences the timing, duration, and extent of fire activity. These coupled interactions between human and natural systems make fire a complex component of the Earth system. Satellite data provide valuable information on the spatial and temporal dynamics of recent fire activity, as active fires, burned area, and land cover information can be combined to separate wildfires from intentional burning for agriculture and forestry. Here, we combined satellite-derived burned area data with land cover and climate data to assess fire-climate relationships in North America between 2000-2012. We used the latest versions of the Global Fire Emissions Database (GFED) burned area product and Modern-Era Retrospective Analysis for Research and Applications (MERRA) climate data to develop regional relationships between burned area and potential evaporation (PE), an integrated dryness metric. Logistic regression models were developed to link burned area with PE and individual climate variables during and preceding the fire season, and optimal models were selected based on Akaike Information Criterion (AIC). Overall, our model explained 85% of the variance in burned area since 2000 across North America. Fire-climate relationships from the era of satellite observations provide a blueprint for potential changes in fire activity under scenarios of climate change. We used that blueprint to evaluate potential changes in fire activity over the next 50 years based on twenty models from the Coupled Model Intercomparison Project Phase 5 (CMIP5). All models suggest an increase of PE under low and high emissions scenarios (Representative Concentration Pathways (RCP) 4.5 and 8.5, respectively), with largest increases in projected burned area across the western US and central Canada. Overall, near-term climate projections point to pronounced changes in fire season length, total burned area, and the frequency of extreme events across North America by 2050.

Whole blood neutrophil gelatinase-associated lipocalin predicts acute kidney injury in burn patients.

PubMed

Sen, Soman; Godwin, Zack R; Palmieri, Tina; Greenhalgh, David; Steele, Amanda N; Tran, Nam K

2015-06-15

Early detection of acute kidney injury (AKI) in severely burn-injured patients can help alter treatment to prevent progression to acute failure and reduce the need for renal replacement therapy. We hypothesized that whole blood neutrophil gelatinase-associated lipocalin (NGAL) will be increased in severely burn-injured patients who develop AKI during acute resuscitation. We performed a prospective observation study of adult burn patients with a 20% total body surface area (TBSA) burned or greater burn injury. Two-hour serial measurements of NGAL, serum creatinine (Cr), and hourly urine output (UO) were collected for 48 h after admission. Our primary goal was to correlate the risk of AKI in the first week after burn injury with serial NGAL levels in the first 48 h after admission. Our secondary goal was to determine if NGAL was an earlier independent predictor of AKI compared with Cr and UO. We enrolled 30 adult (age ≥ 18 y) burn patients with the mean ± standard deviation age of 40.9 ± 15.4 and mean TBSA of 46.4 ± 22.4. Fourteen patients developed AKI within the first 7 d after burn injury. There were no differences in age, TBSA, fluid administration, mean arterial pressure, UO, and Cr between AKI and no-AKI patients. NGAL was significantly increased as early as 4 h after injury (182.67 ± 83.3 versus 107.37 ± 46.15) in the AKI group. Controlling for age, TBSA, and inhalation injury, NGAL was a predictor of AKI at 4 h after injury (odds ratio, 1.02) and remained predictive of AKI for the period of more than the first 24 h after admission. UO and Cr were not predictive of AKI in the first 24 h after admission. Whole blood NGAL is markedly increased in burn patients who develop AKI in the first week after injury. In addition, NGAL is an early independent predictor of AKI during acute resuscitation for severe burn injury. UO and Cr are not predictive of AKI during this time period. Copyright © 2015 Elsevier Inc. All rights reserved.

Quality of life and mediating role of patient scar assessment in burn patients.

PubMed

Oh, Hyunjin; Boo, Sunjoo

2017-09-01

In this study, we examined the plausibility of the mediating effect of the levels of patient scar assessment on the relationship between burn severity measured with total body surface area and burn-specific health-related quality of life (HRQL) among patients with burns in South Korea. In this cross sectional descriptive study, we collected data from 100 burn patients in three burn centers specializing in burn care in South Korea. Patient scar assessment, burn specific HRQL, and burn-related characteristics were self-reported with anonymous, paper-based surveys. The findings showed a positive correlation between burn severity, patient scar assessment, and HRQL in burn patients. The evidence of this paper is that quality of life after burns more determined by scar characteristics than burn severity. In the light of the poor HRQL in burn patients, the results of this study support that improving scar status could improve patients' HRQL. Health care providers should keep in mind that patients' perspectives of their scars would be a great indicator of their HRQL, so the providers' focus should be on intensive scar management intervention in their care. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

The determination of total burn surface area: How much difference?

PubMed

Giretzlehner, M; Dirnberger, J; Owen, R; Haller, H L; Lumenta, D B; Kamolz, L-P

2013-09-01

Burn depth and burn size are crucial determinants for assessing patients suffering from burns. Therefore, a correct evaluation of these factors is optimal for adapting the appropriate treatment in modern burn care. Burn surface assessment is subject to considerable differences among clinicians. This work investigated the accuracy among experts based on conventional surface estimation methods (e.g. "Rule of Palm", "Rule of Nines" or "Lund-Browder Chart"). The estimation results were compared to a computer-based evaluation method. Survey data was collected during one national and one international burn conference. The poll confirmed deviations of burn depth/size estimates of up to 62% in relation to the mean value of all participants. In comparison to the computer-based method, overestimation of up to 161% was found. We suggest introducing improved methods for burn depth/size assessment in clinical routine in order to efficiently allocate and distribute the available resources for practicing burn care. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

A Randomized, Double-Blind, Placebo-Controlled Trial to Determine the Effectiveness and Safety of a Thermogenic Supplement in Addition to an Energy-Restricted Diet in Apparently Healthy Females.

PubMed

Kendall, Kristina L; Hyde, Parker N; Fairman, Ciaran M; Hollaway, Kaitlyn M; Mumford, Petey W; Haun, Cody T; Mobley, Brooks; Kephart, Wesley C; Tribby, Aaron C; Kimber, Dylan; Moon, Jordan R; Beck, Darren T; Roberts, Michael D; Young, Kaelin C

2017-11-02

The increasing interest in weight loss has seen a concurrent rise in the supplemental use of thermogenics to aid weight loss efforts. To date, the effectiveness and safety of supplemental proprietary blend thermogenics, in conjunction with high-protein energy-restricted diets have not been thoroughly evaluated. The purpose of this study was to investigate the efficacy of a low-calorie, high-protein diet with and without the concomitant use of a thermogenic supplement on body weight and body composition in apparently healthy females. Subjects were divided into three groups, Bizzy Diet+FitMiss Burn (BURN, N = 12), Bizzy Diet+Placebo (PLA, N = 13), and Control (CON, N = 14), and underwent two testing sessions separated by approximately 3 weeks. Resting blood pressure (BP), resting heart rate (RHR), clinical safety markers, body weight (BW), and body composition were assessed during each testing session. Repeated measures analysis of variance (ANOVA) revealed a significant effect for time relative to BW, total body fat mass (FM), leg FM, and trunk FM. Post hoc analysis revealed that the BURN and PLA groups experienced significant decreases in both BW and total body FM compared to CON (p <.05). There were no significant interactions for BP, RHR, or clinical safety markers over the course of the study. The Bizzy Diet, both with and without the addition of FitMiss Burn thermogenic, appears to be safe for short-term use and may lead to greater improvement in body composition and BW in an apparently healthy female population.

J-2X powerpack

NASA Image and Video Library

2012-12-13

The J-2X powerpack assembly was fired up one last time on Dec. 13 at NASA's John C. Stennis Space Center in Mississippi, finishing a year of testing on an important component of America's next heavy-lift rocket. The powerpack assembly burned millions of pounds of propellants during a series of 13 tests during 2012 totaling more than an hour and a half.

Effects of insulin combined with ethyl pyruvate on inflammatory response and oxidative stress in multiple-organ dysfunction syndrome rats with severe burns.

PubMed

Wang, Zhanke; Chen, Rongjian; Zhu, Zhongzhen; Zhang, Xiaoyun; Wang, Shiliang

2016-11-01

Inflammation response and oxidative stress promote the occurrence and development of multiple-organ dysfunction syndrome (MODS). Eighty MODS rats with third-degree burns were divided randomly into 4 groups: insulin, ethyl pyruvate (EP), insulin combined with EP, and control. Blood levels of glucose, alanine aminotransferase (ALT), creatine (CRE), creatine kinase (CK), tumor necrosis factor α (TNF-α), high-mobility group box 1 (HMGB-1), malondialdehyde (MDA), and total antioxidant capacity (TAC) before as well as 1, 3, 5, and 7 days after burns were measured. Blood levels of ALT, CRE, CK, TNF-α, HMGB-1, and MDA in INS, EP, and INS+EP groups at different time points were significantly lower, and TAC was significantly higher than that in the control group (C) (P<.01). These parameters in the INS+EP group were significantly lower, and TAC was significantly higher than that in INS and EP groups (P<.01). Blood levels of TNF-α, HMGB-1, and TAC in the INS group at different time points after burns were significantly lower, and MDA was significantly higher than that in the EP group (P<.01). Insulin combined with EP can effectively reduce the inflammatory response, oxidative stress, and main organ dysfunctions in MODS rats after severe burns. The therapeutic effect of insulin combined with EP is superior to single-agent treatment. The insulin anti-inflammatory effect is better than that of pyruvic acid ethyl ester, and the ethyl pyruvate antioxidation effect is better than that of insulin. The insulin can treat inflammation, whereas EP can reduce oxidative stress in MODS rats. Copyright © 2016 Elsevier Inc. All rights reserved.

[Clinical evaluation of the postburn retention and the metabolism of Imipenem in the third space].

PubMed

Rong, Xin-Zhou; Bei, Chun-Hua; Huang, Xiao-Hua; Li, Qing-Hui

2003-04-01

To explore the half life and retention of Imipenem in the third space. Eight severely burned patients and eight healthy volunteers were enrolled as the burn group (B) and normal control group (C), respectively. HPLC (high performance liquid chromatography) was employed to determine the contents of Imipenem in the plasma, subeschar tissue fluid (STF) and the changes in its pharmacokinetics. Furthermore, the Imipenem content in the third space was calculated according to the systemic edema degree. The half life of Imipenem in STF (2.53 h) was longer than that in plasma (1.73 h), P < 0.05). The Imipenem content in STF increased gradually along with the lapse of time after repeated intravenous infusion of Imipenem, and at the same the total content of imipenem was increased significantly in the third space. There was antibiotic retention in the third space after severe burn injury, and a prolonged action of the drug could be expected when the drug re-entered the blood stream.

Theoretical studies of massive stars. I - Evolution of a 15-solar-mass star from the zero-age main sequence to neon ignition

NASA Technical Reports Server (NTRS)

Endal, A. S.

1975-01-01

The evolution of a star with mass 15 times that of the sun from the zero-age main sequence to neon ignition has been computed by the Henyey method. The hydrogen-rich envelope and all shell sources were explicitly included in the models. An algorithm has been developed for approximating the results of carbon burning, including the branching ratio for the C-12 + C-12 reaction and taking some secondary reactions into account. Penetration of the convective envelope into the core is found to be unimportant during the stages covered by the models. Energy transfer from the carbon-burning shell to the core by degenerate electron conduction becomes important after the core carbon-burning stage. Neon ignition will occur in a semidegenerate core and will lead to a mild 'flash.' Detailed numerical results are given in an appendix. Continuation of the calculations into later stages and variations with the total mass of the star will be discussed in later papers.

A Fuel-Efficient Conflict Resolution Maneuver for Separation Assurance

NASA Technical Reports Server (NTRS)

Bowe, Aisha Ruth; Santiago, Confesor

2012-01-01

Automated separation assurance algorithms are envisioned to play an integral role in accommodating the forecasted increase in demand of the National Airspace System. Developing a robust, reliable, air traffic management system involves safely increasing efficiency and throughput while considering the potential impact on users. This experiment seeks to evaluate the benefit of augmenting a conflict detection and resolution algorithm to consider a fuel efficient, Zero-Delay Direct-To maneuver, when resolving a given conflict based on either minimum fuel burn or minimum delay. A total of twelve conditions were tested in a fast-time simulation conducted in three airspace regions with mixed aircraft types and light weather. Results show that inclusion of this maneuver has no appreciable effect on the ability of the algorithm to safely detect and resolve conflicts. The results further suggest that enabling the Zero-Delay Direct-To maneuver significantly increases the cumulative fuel burn savings when choosing resolution based on minimum fuel burn while marginally increasing the average delay per resolution.

Measurement of Body Composition: is there a Gold Standard?

PubMed Central

Branski, Ludwik K; Norbury, William B; Herndon, David N; Chinkes, David L; Cochran, Amalia; Suman, Oscar; Benjamin, Deb; Jeschke, Marc G

2015-01-01

Background Maintaining lean body mass (LBM) after a severe burn is an essential goal of modern burn treatment. An accurate determination of LBM is necessary for short- and longterm therapeutic decisions. The aim of this study was to compare 2 measurement methods for body composition, wholebody potassium counting (K count) and dual x-ray absorptiometry (DEXA), in a large prospective clinical trial in severely burned pediatric patients. Methods Two-hundred seventy-nine patients admitted with burns covering 40% of total body surface area (TBSA) were enrolled in the study. Patients enrolled were controls or received long-term treatment with recombinant human growth hormone (rhGH). Near-simultaneous measurements of LBM with DEXA and fat-free mass (FFM) with K count were performed at hospital discharge and at 6, 9, 12, 18, and 24 months post injury. Results were correlated using Pearson’s regression analysis. Agreement between the 2 methods was analyzed with the Bland-Altman method. Results Age, gender distribution, weight, burn size, and admission time from injury were not significantly different between control and treatment groups. rhGH and control patients at all time points postburn showed a good correlation between LBM and FFM measurements (R2 between 0.9 and 0.95). Bland-Altman revealed that the mean bias and 95% limits of agreement depended only on patient weight and not on treatment or time postburn. The 95% limits ranged from 0.1 ± 2.9 kg for LBM or FFM in 7- to 18-kg patients to 16.3 ± 17.8 kg for LBM or FFM in patients >60 kg. Conclusions DEXA can provide a sufficiently accurate determination of LBM and changes in body composition, but a correction factor must be included for older children and adolescents with more LBM. DEXA scans are easier, cheaper, and less stressful for the patient, and this method should be used rather than the K count. PMID:19884353

Evaluation and Parameter Analysis of Burn up Calculations for the Assessment of Radioactive Waste - 13187

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

Fast, Ivan; Aksyutina, Yuliya; Tietze-Jaensch, Holger

2013-07-01

Burn up calculations facilitate a determination of the composition and nuclear inventory of spent nuclear fuel, if operational history is known. In case this information is not available, the total nuclear inventory can be determined by means of destructive or, even on industrial scale, nondestructive measurement methods. For non-destructive measurements however only a few easy-to-measure, so-called key nuclides, are determined due to their characteristic gamma lines or neutron emission. From these measured activities the fuel burn up and cooling time are derived to facilitate the numerical inventory determination of spent fuel elements. Most regulatory bodies require an independent assessment ofmore » nuclear waste properties and their documentation. Prominent part of this assessment is a consistency check of inventory declaration. The waste packages often contain wastes from different types of spent fuels of different history and information about the secondary reactor parameters may not be available. In this case the so-called characteristic fuel burn up and cooling time are determined. These values are obtained from a correlations involving key-nuclides with a certain bandwidth, thus with upper and lower limits. The bandwidth is strongly dependent on secondary reactor parameter such as initial enrichment, temperature and density of the fuel and moderator, hence the reactor type, fuel element geometry and plant operation history. The purpose of our investigation is to look into the scaling and correlation limitations, to define and verify the range of validity and to scrutinize the dependencies and propagation of uncertainties that affect the waste inventory declarations and their independent verification. This is accomplished by numerical assessment and simulation of waste production using well accepted codes SCALE 6.0 and 6.1 to simulate the cooling time and burn up of a spent fuel element. The simulations are benchmarked against spent fuel from the real reactor Obrigheim in Germany for which sufficiently precise experimental reference data are available. (authors)« less

Landscape fragmentation, severe drought, and the new Amazon forest fire regime.

PubMed

Alencar, Ane A; Brando, Paulo M; Asner, Gregory P; Putz, Francis E

2015-09-01

Changes in weather and land use are transforming the spatial and temporal characteristics of fire regimes in Amazonia, with important effects on the functioning of dense (i.e., closed-canopy), open-canopy, and transitional forests across the Basin. To quantify, document, and describe the characteristics and recent changes in forest fire regimes, we sampled 6 million ha of these three representative forests of the eastern and southern edges of the Amazon using 24 years (1983-2007) of satellite-derived annual forest fire scar maps and 16 years of monthly hot pixel information (1992-2007). Our results reveal that changes in forest fire regime properties differentially affected these three forest types in terms of area burned and fire scar size, frequency, and seasonality. During the study period, forest fires burned 15% (0.3 million ha), 44% (1 million ha), and 46% (0.6 million ha) of dense, open, and transitional forests, respectively. Total forest area burned and fire scar size tended to increase over time (even in years of average rainfall in open canopy and transitional forests). In dense forests, most of the temporal variability in fire regime properties was linked to El Nino Southern Oscillation (ENSO)-related droughts. Compared with dense forests, transitional and open forests experienced fires twice as frequently, with at least 20% of these forests' areas burning two or more times during the 24-year study period. Open and transitional forests also experienced higher deforestation rates than dense forests. During drier years, the end of the dry season was delayed by about a month, which resulted in larger burn scars and increases in overall area burned later in the season. These observations suggest that climate-mediated forest flammability is enhanced by landscape fragmentation caused by deforestation, as observed for open and transitional forests in the Eastern portion of the Amazon Basin.

Emission characteristics of carboxylates in PM2.5 from incense burning with the effect of light on acetate

NASA Astrophysics Data System (ADS)

Kuo, Su-Ching; Tsai, Ying I.; Sopajaree, Khajornsak

2016-08-01

Incense burning produces potentially harmful particulate matter. In this study we investigated the emissions of PM2.5 and gaseous acetic acid from four brands of traditional incense; Liao and Shang Lao Shan (SLS), sold in Taiwan, and Thai Yellow (Thai Y) and Thai Black (Thai B), sold in Thailand. Additionally, photochemical reactions of PM2.5 carboxylates emitted from incense burning were studied via a simulated light experiment. The average PM2.5 mass emission factor of each incense type was inversely correlated with the ash production of that incense. The Thailand incense carboxylate emissions were markedly higher than the Taiwan incense. Acetate accounted for 87.46% of total carboxylate emissions, with acetate emitted from the Thailand incense 1.26 times higher than from the Taiwan incense. Phthalate was detected in the PM2.5, indicating the presence of plasticizer. Concentrations of PM2.5 acetate, formate, pyruvate, glutarate, succinate, fumarate and tartarate were reduced in simulated light (51.5%-97.1% of those under dark), indicating that these seven types of carboxylate are easily photodegradable. In contrast, malonate, maleate, oxalate and phthalate concentrations in light were 1.17-1.84 times higher than in darkness, indicating photochemical reactions contribute to the formation of these species. The formation of the low-molecular weight dicarboxylates oxalate and malonate was most noticeable. Acetic acid, highly irritating to the respiratory system and skin, was present at high levels for all four incense types, as shown by the gaseous acetic acid/PM2.5 acetate ratios of 1.03-3.61. Burning incense indoors can generate high concentrations of PM2.5 acetate that increases the risks of respiratory and contact irritation, particularly when burning the Thailand incense. Moreover, burning incense in poorly ventilated, dimly lit indoor areas (e.g., temples and homes) can markedly increase the risk of irritation because the gaseous acetic acid is not degraded as it would be in light.

Burns caused by flambé foods.

PubMed

Peters, W; Knighton, J

1993-01-01

From 1978 to 1990, five patients were admitted to the hospital for treatment of burns that were sustained during the preparation of flambé foods in restaurants. Three patients were patrons, and two were waiters. The average body surface area involved was 14% (range 10% to 18%). The average area of full-thickness burn was 3% (0% to 10%). All patrons required long-term psychologic support and were involved with lengthy and expensive litigation proceedings. The two waiters lost a total of 5 months from work. Although these injuries are quite rare, it is hoped that they can be totally prevented by adherence to certain safety guidelines.

Emergency burn rehabilitation: cost, risk, effectiveness

Treesearch

Scott R. Miles; Donald M. Haskins; Darrel W. Ranken

1989-01-01

The fires of 1987 had a heavy impact on the Hayfork Ranger District. Over 50,000 acres were burned within the South Fork Trinity River watershed, which contains an important anadromous fishery. Major problems within the burned area were found to be: (1) slopes having highly erodible soils where intense wildfire resulted in a total loss of ground cover, and (2) burnout...

Pseudomonas aeruginosa, an emerging pathogen among burn patients in Kurdistan Province, Iran.

PubMed

Kalantar, Enayat; Taherzadeh, Shadi; Ghadimi, Tayeb; Soheili, Fariborz; Salimizand, Heiman; Hedayatnejad, Alireza

2012-05-01

This study was conducted to determine the incidence of Pseudomonas aeruginosa infections among burn patients at Tohid Hospital, Iran. A total of 176 clinical specimens were obtained from 145 burn patients admitted to the burn unit of Tohid Hospital to detect the presence of P. aeruginosa. Antimicrobial susceptibility testing was conducted to detect extended spectrum beta-lactamase (ESBL) producing P. aeruginiosa using Clinical and Laboratory Standards Institute guidelines with the double disc synergy test (DDST). A polymerase chain reaction was used to detect PER-1 and OXA-10 among the isolates. The mean age, total body surface area and length of hospital stay among patients were 29 years, 37.7%, and 10 days, respectively. Kerosene was the commonest cause of burn (60%), followed by gas (30%). During the study, P. aeruginosa was detected in 100 isolates. The antibiotics they were most commonly resistant to were cefotaxime, ceftriaxone and ciprofloxacin. Of the 100 P. aeroginusa isolates, 28% were positive for ESBL production with the DDST, 48% and 52% were PER-1 and OXA-10 producers, respectively. The high frequency of PER-1 and OXA-10 producers at this hospital is of concern considering their potential spread among burn patients.

Reciprocal Risk of Acute Kidney Injury and Acute Respiratory Distress Syndrome in Critically Ill Burn Patients.

PubMed

Clemens, Michael S; Stewart, Ian J; Sosnov, Jonathan A; Howard, Jeffrey T; Belenkiy, Slava M; Sine, Christy R; Henderson, Jonathan L; Buel, Allison R; Batchinsky, Andriy I; Cancio, Leopoldo C; Chung, Kevin K

2016-10-01

To evaluate the association between acute respiratory distress syndrome and acute kidney injury with respect to their contributions to mortality in critically ill patients. Retrospective analysis of consecutive adult burn patients requiring mechanical ventilation. A 16-bed burn ICU at tertiary military teaching hospital. Adult patients more than 18 years old requiring mechanical ventilation during their initial admission to our burn ICU from January 1, 2003, to December 31, 2011. None. A total 830 patients were included, of whom 48.2% had acute kidney injury (n = 400). These patients had a 73% increased risk of developing acute respiratory distress syndrome after controlling for age, gender, total body surface area burned, and inhalation injury (hazard ratio, 1.73; 95% CI, 1.18-2.54; p = 0.005). In a reciprocal multivariate analysis, acute respiratory distress syndrome (n = 299; 36%) demonstrated a strong trend toward developing acute kidney injury (hazard ratio, 1.39; 95% CI, 0.99-1.95; p = 0.05). There was a 24% overall in-hospital mortality (n = 198). After adjusting for the aforementioned confounders, both acute kidney injury (hazard ratio, 3.73; 95% CI, 2.39-5.82; p < 0.001) and acute respiratory distress syndrome (hazard ratio, 2.16; 95% CI, 1.58-2.94; p < 0.001) significantly contributed to mortality. Age, total body surface area burned, and inhalation injury were also significantly associated with increased mortality. Acute kidney injury increases the risk of acute respiratory distress syndrome in mechanically ventilated burn patients, whereas acute respiratory distress syndrome similarly demonstrates a strong trend toward the development of acute kidney injury. Acute kidney injury and acute respiratory distress syndrome are both independent risks for subsequent death. Future research should look at this interplay for possible early interventions.

Fire-climate relationships and long-lead seasonal wildfire prediction for Hawaii

Treesearch

Pao-Shin Chu; Weiping Yan; Francis Fujioka

2002-01-01

We examined statistical relationships between the seasonal Southern Oscillation Index (SOI) and total acreages burned (TAB) and the number of fires in the Hawaiian Islands. A composite of TAB during four El Niño/ Southern Oscillation (ENSO) events reveals that a large total of acres burned is likely to occur from spring to summer in the year following an ENSO event....

Colloid normalizes resuscitation ratio in pediatric burns.

PubMed

Faraklas, Iris; Lam, Uyen; Cochran, Amalia; Stoddard, Gregory; Saffle, Jeffrey

2011-01-01

Fluid resuscitation of burned children is challenging because of their small size and intolerance to over- or underresuscitation. Our American Burn Association-verified regional burn center has used colloid "rescue" as part of our pediatric resuscitation protocol. With Institutional Review Board approval, the authors reviewed children with ≥15% TBSA burns admitted from January 1, 2004, to May 1, 2009. Resuscitation was based on the Parkland formula, which was adjusted to maintain urine output. Patients requiring progressive increases in crystalloid were placed on a colloid protocol. Results were expressed as an hourly resuscitation ratio (I/O ratio) of fluid infusion (ml/kg/%TBSA/hr) to urine output (ml/kg/hr). We reviewed 53 patients; 29 completed resuscitation using crystalloid alone (lactated Ringer's solution [LR]), and 24 received colloid supplementation albumin (ALB). Groups were comparable in age, gender, weight, and time from injury to admission. ALB patients had more inhalation injuries and larger total and full-thickness burns. LR patients maintained a median I/O of 0.17 (range, 0.08-0.31), whereas ALB patients demonstrated escalating ratios until the institution of albumin produced a precipitous return of I/O comparable with that of the LR group. Hospital stay was lower for LR patients than ALB patients (0.59 vs 1.06 days/%TBSA, P = .033). Twelve patients required extremity or torso escharotomy, but this did not differ between groups. There were no decompressive laparotomies. The median resuscitation volume for ALB group was greater than LR group (9.7 vs 6.2 ml/kg/%TBSA, P = .004). Measuring hourly I/O is a helpful means of evaluating fluid demands during burn shock resuscitation. The addition of colloid restores normal I/O in pediatric patients.

Quantifying the potential for low-level transport of black carbon emissions from cropland burning in Russia to the snow-covered Arctic.

NASA Astrophysics Data System (ADS)

Hall, Joanne V.; Loboda, Tatiana V.

2017-12-01

Short-lived aerosols and pollutants transported from northern mid-latitudes have amplified the short term warming in the Arctic region. Among those black carbon is recognized as the second most important human emission in regards to climate forcing, behind carbon dioxide, with a total climate forcing of +1.1Wm-2. Studies have suggested that cropland burning may be a large contributor to the black carbon emissions which are directly deposited on the snow in the Arctic. However, commonly applied atmospheric transport models rely on estimates of black carbon emissions from cropland burning which are known to be highly inaccurate in both the amount and the timing of release. Instead, this study quantifies the potential for the deposition of hypothetical black carbon emissions from known cropland burning in Russia, identified by the Moderate Resolution Imaging Spectroradiometer (MODIS) active fire detections, through low-level transport to the snow in the Arctic using wind vectors from the European Centre for Medium-Range Weather Forecasts’ ERA-Interim Reanalysis product. Our results confirm that Russian cropland burning is a potentially significant source of black carbon deposition on the Arctic snow in the spring despite the low injection heights associated with cropland burning. Approximately 10% of the observed spring (March - May) cropland active fires (7% annual) likely contribute to black carbon deposition on the Arctic snow from as far south as at least 40°N. Furthermore, our results show that potential spring black carbon emissions from cropland burning in Russia can be deposited beyond 80°N, however, the majority ( 90% - depending on injection height) of all potential spring deposition occurs below 75°N.

Speciated Chemical Composition of Biomass Burning Aerosol from Various Fuels during FIREX

NASA Astrophysics Data System (ADS)

Jen, C.; Hatch, L. E.; Kreisberg, N. M.; Selimovic, V.; Yokelson, R. J.; Barsanti, K.; Goldstein, A. H.

2017-12-01

Biomass burning is the largest global source of atmospheric primary carbonaceous aerosols and the second largest global source of non-methane organic compounds, including volatile and semi-volatile organic compounds that are now understood to be major contributors to secondary particle formation in the atmosphere. As wildfires in forested regions such as the western United States become larger and more frequent, understanding the chemical composition of biomass burning organic aerosol is needed to better predict their increasing impact on human health, air quality, and climate. This study presents emission profiles of chemically speciated intermediate and semi-volatile organic compounds present in biomass burning aerosol particles ≤1.0 μm. Biomass burning organic aerosol (BBOA) samples from a variety of fuel types and burning conditions were collected during the FIREX campaign at the USDA Fire Lab (Missoula, MT). Fuels were primarily selected from vegetation commonly found in the western United States, such as ponderosa pine, lodgepole pine, ceanothus, and chaparral. Collected BBOA was thermally desorbed from the filters and analyzed using online derivatization and 2-dimensional gas chromatography with an electron impact (70 eV) and vacuum ultra violet light (10.5 eV) high resolution time of flight mass spectrometer for compound identification. Emission profiles for specific compounds (e.g., levoglucosan) and families of compounds (e.g., sugars and methoxyphenols) show distinct variations between different fuel types, with major differences between fresh and partially decomposed fuels. Results also illustrate the variability in chemical species between burns conducted under similar conditions. Furthermore, chemical fingerprints, representing ratios of normalized emissions for key chemical compounds, were measured for specific fuels/conditions and could be used in future field studies to help identify contributions of various vegetation to total BBOA and in models to estimate the chemical composition of BBOA emissions.

Spatial and temporal distribution of tropical biomass burning

NASA Astrophysics Data System (ADS)

Hao, Wei Min; Liu, Mei-Huey

1994-12-01

A database for the spatial and temporal distribution of the amount of biomass burned in tropical America, Africa, and Asia during the late 1970s is presented with a resolution of 5° latitude × 5° longitude. The sources of burning in each grid cell have been quantified. Savanna fires, shifting cultivation, deforestation, fuel wood use, and burning of agricultural residues contribute about 50, 24, 10, 11, and 5%, respectively, of total biomass burned in the tropics. Savanna fires dominate in tropical Africa, and forest fires dominate in tropical Asia. A similar amount of biomass is burned from forest and savanna fires in tropical America. The distribution of biomass burned monthly during the dry season has been derived for each grid cell using the seasonal cycles of surface ozone concentrations. Land use changes during the last decade could have a profound impact on the amount of biomass burned and the amount of trace gases and aerosol particles emitted.

Radiation exposure and performance of multiple burn LEO-GEO orbit transfer trajectories

NASA Technical Reports Server (NTRS)

Gorland, S. H.

1985-01-01

Many potential strategies exist for the transfer of spacecraft from low Earth orbit (LEO) to geosynchronous (GEO) orbit. One strategy has generally been utilized, that being a single impulsive burn at perigee and a GEO insertion burn at apogee. Multiple burn strategies were discussed for orbit transfer vehicles (OTVs) but the transfer times and radiation exposure, particularly for potentially manned missions, were used as arguments against those options. Quantitative results concerning the trip time and radiation encountered by multiple burn orbit transfer missions in order to establish the feasibility of manned missions, the vulnerability of electronics, and the shielding requirements are presented. The performance of these multiple burn missions is quantified in terms of the payload and propellant variances from the minimum energy mission transfer. The missions analyzed varied from one to eight perigee burns and ranged from a high thrust, 1 g acceleration, cryogenic hydrogen-oxygen chemical prpulsion system to a continuous burn, 0.001 g acceleration, hydrogen fueled resistojet propulsion system with a trip time of 60 days.

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.

Epidemiology and outcome analysis of 6325 burn patients: a five-year retrospective study in a major burn center in Southwest China

PubMed Central

Li, Haisheng; Yao, Zhihui; Tan, Jianglin; Zhou, Junyi; Li, Yi; Wu, Jun; Luo, Gaoxing

2017-01-01

Burns are a major cause of injury worldwide. We investigated the epidemiology and outcomes of burn patients in a major burn center in southwest China between 2011 and 2015 to provide guidance for burn prevention. Of the 6,325 included burn patients, 66.8% were male and 34.7% were 0 ~ 6 years old. The incidence of burns peaked in autumn. Scald was the most common cause of burns, which was predominant in patients aged 0 ~ 6 years. The mean total body surface area (TBSA) of burns was 13.4%, and patients with burns ≤10% TBSA comprised 64.1% of all cases. Patients with full-thickness burns accounted for 40.1% of all patients and 81.0% of operated patients; these burns were primarily caused by flame (34.8%), scald (21.0%), and electricity (20.4%). Fifty-six deaths occurred (mortality 0.9%), and risk factors included full-thickness burns, larger TBSA and older age. The median length of stay was 17 days, and major risk factors included more operations, better outcomes and larger TBSA. Our data showed that closer attention should be paid to children under 6 years old, males, incidents in autumn and scald burns to prevent burn injuries. Furthermore, individualized burn prevention and treatment measures based on related risk factors should be adopted. PMID:28383066

Carbon and water fluxes from ponderosa pine forests disturbed by wildfire and thinning.

PubMed

Dore, S; Kolb, T E; Montes-Helu, M; Eckert, S E; Sullivan, B W; Hungate, B A; Kaye, J P; Hart, S C; Koch, G W; Finkral, A

2010-04-01

Disturbances alter ecosystem carbon dynamics, often by reducing carbon uptake and stocks. We compared the impact of two types of disturbances that represent the most likely future conditions of currently dense ponderosa pine forests of the southwestern United States: (1) high-intensity fire and (2) thinning, designed to reduce fire intensity. High-severity fire had a larger impact on ecosystem carbon uptake and storage than thinning. Total ecosystem carbon was 42% lower at the intensely burned site, 10 years after burning, than at the undisturbed site. Eddy covariance measurements over two years showed that the burned site was a net annual source of carbon to the atmosphere whereas the undisturbed site was a sink. Net primary production (NPP), evapotranspiration (ET), and water use efficiency were lower at the burned site than at the undisturbed site. In contrast, thinning decreased total ecosystem carbon by 18%, and changed the site from a carbon sink to a source in the first posttreatment year. Thinning also decreased ET, reduced the limitation of drought on carbon uptake during summer, and did not change water use efficiency. Both disturbances reduced ecosystem carbon uptake by decreasing gross primary production (55% by burning, 30% by thinning) more than total ecosystem respiration (TER; 33-47% by burning, 18% by thinning), and increased the contribution of soil carbon dioxide efflux to TER. The relationship between TER and temperature was not affected by either disturbance. Efforts to accurately estimate regional carbon budgets should consider impacts on carbon dynamics of both large disturbances, such as high-intensity fire, and the partial disturbance of thinning that is often used to prevent intense burning. Our results show that thinned forests of ponderosa pine in the southwestern United States are a desirable alternative to intensively burned forests to maintain carbon stocks and primary production.

Albumin administration for fluid resuscitation in burn patients: A systematic review and meta-analysis.

PubMed

Eljaiek, Roberto; Heylbroeck, Christophe; Dubois, Marc-Jacques

2017-02-01

The objective was to systematically review the literature summarizing the effect on mortality of albumin compared to non-albumin solutions during the fluid resuscitation phase of burn injured patients. We searched MEDLINE, EMBASE and CENTRAL and the content of two leading journals in burn care, Burns and Journal of Burn Care and Research. Two reviewers independently selected randomized controlled trials comparing albumin vs. non-albumin solutions for the acute resuscitation of patients with >20% body surface area involvement. Reviewers abstracted data independently and assessed methodological quality of the included trials using predefined criteria. A random effects model was used to assess mortality. We identified 164 trials of which, 4 trials involving 140 patients met our inclusion criteria. Overall, the methodological quality of the included trials was fair. We did not find a significant benefit of albumin solutions as resuscitation fluid on mortality in burn patients (relative risk (RR) 1.6; 95% confidence interval (CI), 0.63-4.08). Total volume of fluid infusion during the phase of resuscitation was lower in patients receiving albumin containing solution -1.00ml/kg/%TBSA (total body surface area) (95% CI, -1.42 to -0.58). The pooled estimate demonstrated a neutral effect on mortality in burn patients resuscitated acutely with albumin solutions. Due to limited evidence and uncertainty, an adequately powered, high quality trial could be required to assess the impact of albumin solutions on mortality in burn patients. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care.

PubMed

Wallis, Lee A; Fleming, Julian; Hasselberg, Marie; Laflamme, Lucie; Lundin, Johan

2016-01-01

Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back. The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care. In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be integrated into routine acute clinical care and thereby promote equity in injury emergency care, a growing public health burden.

A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care

PubMed Central

Wallis, Lee A.; Fleming, Julian; Hasselberg, Marie; Laflamme, Lucie; Lundin, Johan

2016-01-01

Background Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back. Methods and Results The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care. Conclusions In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be integrated into routine acute clinical care and thereby promote equity in injury emergency care, a growing public health burden. PMID:26918631

Effect of perceived social support and dispositional optimism on the depression of burn patients.

PubMed

He, Fei; Zhou, Qin; Zhao, Zhijing; Zhang, Yuan; Guan, Hao

2016-06-01

Burn wounds have a significant impact on the mental health of patients. This study aimed to investigate the impact of perceived social support and dispositional optimism on depression of burn patients. A total of 246 burn patients accomplished the Multidimensional Scale of Perceived Social Support, the Revised Life Orientation Test, and Depression Scale. The results revealed that both perceived social support and optimism were significantly correlated with depression. Structural equation modeling indicated that optimism partially mediated the relationship between perceived social support and depression. Implications for prevention of depression in burn patients were discussed. © The Author(s) 2014.

Low-thrust chemical orbit to orbit propulsion system propellant management study

NASA Technical Reports Server (NTRS)

Dergance, R. H.

1980-01-01

Propellant requirements, tankage configurations, preferred propellant management techniques, propulsion systems weights, and technology deficiencies for low thrust expendable propulsion systems are examined. A computer program was utilized which provided a complete propellant inventory (including boil-off for cryogenic cases), pressurant and propellant tank dimensions for a given ullage, pressurant requirements, insulation requirements, and miscellaneous masses. The output also includes the masses of all tanks; the mass of the insulation, engines and other components; total wet system and burnout mass; system mass fraction; total impulse and burn time.

[Effects of ω-3 polyunsaturated fatty acids on damage of intestinal mucosa of rats with severe burn in early stage and the mechanism].

PubMed

Cai, C; Xia, Z G; Xu, Q L; Li, X Z

2017-08-20

Objective: To observe the effects of ω-3 polyunsaturated fatty acids (PUFA) on damage of intestinal mucosa of rats with severe burn in early stage and to explore the mechanism. Methods: One hundred and twenty SD rats were divided into sham injury group, pure burn group, and ω-3 PUFA group according to the random number table, with 40 rats in each group. Rats in sham injury group were sham injured, while rats in pure burn group and ω-3 PUFA group were inflicted with 30% total body surface area full-thickness scald (hereinafter referred to as burn) on the back. Rats in sham injury group and pure burn group were injected with normal saline solution (1 mL/kg) by tail vein, while rats in ω-3 PUFA group were injected with ω-3 PUFA solution (1 mL/kg) by the same way at 5 minutes post injury. At post injury hour (PIH) 3, 6, 12, 24, and 48, abdominal aorta blood and intestinal mucosa were collected from 8 rats in each group, respectively. Serum content of diamine oxidase (DAO) was detected by spectrophotography. Serum content of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) was determined by enzyme-linked immunosorbent assay. Protein expression of NF-κB-p65 in intestinal mucosa was determined by Western blotting. Data were processed with analysis of variance of factorial design, one-way analysis of variance, chi-square test, LSD test, and Bonferroni correction. Results: (1) At all time points post injury, serum content of DAO of rats in pure burn group and ω-3 PUFA group was significantly higher than that in sham injury group (with P values below 0.01), and serum content of DAO of rats in ω-3 PUFA group was significantly lower than that in pure burn group (with P values below 0.01). (2) At all time points post injury, serum content of TNF-α and IL-6 of rats in pure burn group and ω-3 PUFA group was significantly higher than that in sham injury group (with P values below 0.01), and serum content of TNF-α and IL-6 of rats in ω-3 PUFA group was obviously lower than that in pure burn group (with P values below 0.01). (3) At all time points post injury, protein expressions of NF-κB-p65 in intestinal mucosa of rats in pure burn group and ω-3 PUFA group were significantly higher than those in sham injury group (with P values below 0.01). At PIH 3, 6, 12, 24, and 48, protein expressions of NF-κB-p65 in intestinal mucosa of rats in ω-3 PUFA group were 1.398±0.016, 1.999±0.948, 2.803±0.065, 1.739±0.602, and 1.484±0.645, obviously lower than 2.096±0.113, 3.402±0.189, 4.183±0.558, 3.618±0.408, and 2.614±0.775 in pure burn group (with P values below 0.01). Conclusions: The ω-3 PUFA may alleviate intestinal mucosa injury of rats with severe burn in early stage through reducing protein expression of NF-κB-p65 of intestinal mucosa, serum content of DAO, TNF-α, and IL-6, and inhibiting inflammatory response.

Management of patients in a dedicated burns intensive care unit (BICU) in a developing country.

PubMed

Hashmi, Madiha; Kamal, Rehana

2013-05-01

In Pakistan the practice of managing extensive burns in dedicated intensive care units is not well established. This audit aims to define the characteristics of the victims of major burns and factors that increase mortality and outcome of the protocol-based management in a dedicated burns intensive care unit (BICU). This prospective audit included all patients admitted to the BICU of Suleiman Dawood Burns Unit in Karachi from 1st September 2002 to 31st August 2011. Demographic information, type and place of burn, total body surface area burn (TBSA), type of organ support provided, length of ICU stay, any associated medical diseases, and out outcome were documented. A total of 1597 patients were admitted to the BICU in 9 years. Median age of the patients was 22 (IQR =32-7). 32% victims were children <14 years and only 7% were >50 years old. Male to female ratio was 1.4:1. Fire was the leading cause of burns in adults (64%) and scald burns were most common in (64%) in children. 72.4% of the accidents happened at home, where kitchen was the commonest location (597 cases). Mean TBSA burnt was 32.5% (SD ± 22.95%, 95%CI: 31.36-33.61). 27% patients needed ventilatory support, 4% were dialyzed and split skin graftings were performed in 20% patients. Average length of ICU stay was 10.42 days. Epilepsy, psychiatric illness and drug addiction were not common associations with burns. Overall mortality was 41.30% but it decreased over the years from 75% to 27%. Groups of people most vulnerable to sustain burn are young females getting burnt in the kitchen, young males getting burnt at work, and small children falling in pots of hot water stored for drinking or bathing. TBSA >40%, age >50 years, fire burn and female gender were associated with a higher risk of death. Carefully planned, protocol based management of burn patients by burn teams of dedicated healthcare professionals, even with limited resources reduced mortality. Burn hazard awareness, prevention and educational programmes targeted at the vulnerable population, i.e. women and young children at home and men at their work place is the single most cost-effective way of reducing the incidence of burns in developing countries. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Can we make an early 'do not resuscitate' decision in severe burn patients?

PubMed

Yüce, Yücel; Acar, Hakan Ahmet; Erkal, Kutlu Hakan; Tuncay, Erhan

2017-03-01

The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. Between January 2009 and December 2014, 29 patients (3.44%) with very severe burns were admitted to burn unit. Average total burn surface area (TBSA) was 94.24% (range: 85-100%), and in 10 patients, TBSA was 100%. Additional inhalation burns were present in 26 of the patients (89.65%). All of the patients died, despite every medical intervention. Mean survival was 4.75 days (range: 1-24 days). Total of 17 patients died within 72 hours. Lethal dose 50 (% TBSA at which certain group has 50% chance of survival) rate of our burn center is 62%. Baux indices were used for prognostic evaluation of the patients; mean total Baux score of the patients was 154.13 (range: 117-183). It is well known that numerous problems may be encountered during triage of severely burned patients in Turkey. These patients are referred to burn centers and are frequently transferred via air ambulance between cities, and even countries. They are intubated and mechanical ventilation is initiated at burn center. Many interventions are performed to treat these patients, such as escharotomy, fasciotomy, tangential or fascial excision, central venous catheterization and tracheostomy, or hemodialysis. Yet despite such interventions, these patients die, typically within 48 to 96 hours. Integrity of the body is often lost as result of aggressive intervention with no real benefit, and there are also economic costs to hospital related to use of materials, bed occupancy, and distribution of workforce. For these reasons, as well as patient comfort, early do-not-resuscitate or do-not-intubate protocol for these patients is suggested. Resources could then be directed to other patients with high expectancy of life and patients with burns that are beyond treatment can experience more comfortable end of life. At present in Turkey, it is not possible to give DNR order for patient with severe burns that are incompatible with survival due to legal interdiction. This subject should be discussed at high-level meetings with participation of doctors, legal experts, economists, and theologians.

Retrospective analysis of patients with burn injury treated in a burn center in Turkey during the Syrian civil war

PubMed Central

Yuce, Yucel; Acar, Hakan A.; Erkal, Kutlu H.; Arditi, Nur B.

2017-01-01

Objectives: To report the management of burn injuries that occured in the Syria civil war, which were referred to our burn center. Methods: Forty-three patients with burns, injured in the civil war in Syria and whom were referred to Dr. Lütfi Kırdar Kartal Educating and Training Hospital Burn Centre of İstanbul, Turkey between 2011-2015 were analyzed in a retrospective study. Results: Most of our patients were in major burn classification (93%; 40/43) and most of them had burns >15% total on body surface area. Most of them were admitted to our center late after first management at centers with improper conditions and in cultures of these patients unusual and resistant strains specific to the battlefield were produced. Conclusion: Immediate transfer of the patients from the scene of incidence to burn centers ensures early treatment, this factor may be effective on the outcome of these patients. PMID:28042637

Retrospective analysis of patients with burn injury treated in a burn center in Turkey during the Syrian civil war.

PubMed

Yuce, Yucel; Acar, Hakan A; Erkal, Kutlu H; Arditi, Nur B

2017-01-01

To report the management of burn injuries that occured in the Syria civil war, which were referred to our burn center. Methods: Forty-three patients with burns, injured in the civil war in Syria and whom were referred to Dr. Lütfi Kırdar Kartal Educating and Training Hospital Burn Centre of İstanbul, Turkey between 2011-2015 were analyzed in a retrospective study. Results: Most of our patients were in major burn classification (93%; 40/43) and most of them had burns greater than 15% total on body surface area. Most of them were admitted to our center late after first management at centers with improper conditions and in cultures of these patients unusual and resistant strains specific to the battlefield were produced. Conclusion: Immediate transfer of the patients from the scene of incidence to burn centers ensures early treatment, this factor may be effective on the outcome of these patients.

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.

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.

Funding fuels management in the national park service: costs and benefits

Treesearch

Stephen J. Botti

1995-01-01

Despite a quarter of a century of prescribed burning by the National Park Service (NPS) in California, there is reason to believe that the fuels situation is getting worse rather than better. The area burned in the past 10 years has declined by 42 percent compared to the previous 10 years. The total area burned per year from wildfire and prescribed fire is...

Joint simulation of regional areas burned in Canadian forest fires: A Markov Chain Monte Carlo approach

Treesearch

Steen Magnussen

2009-01-01

Areas burned annually in 29 Canadian forest fire regions show a patchy and irregular correlation structure that significantly influences the distribution of annual totals for Canada and for groups of regions. A binary Monte Carlo Markov Chain (MCMC) is constructed for the purpose of joint simulation of regional areas burned in forest fires. For each year the MCMC...

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...

Recovery Curves for Pediatric Burn Survivors: Advances in Patient-Oriented Outcomes.

PubMed

Kazis, Lewis E; Lee, Austin F; Rose, Mary; Liang, Matthew H; Li, Nien-Chen; Ren, Xinhua S; Sheridan, Robert; Gilroy-Lewis, Janet; Stoddard, Fred; Hinson, Michelle; Warden, Glenn; Stubbs, Kim; Blakeney, Patricia; Meyer, Walter; McCauley, Robert; Herndon, David; Palmieri, Tina; Mooney, Kate; Wood, David; Pidcock, Frank; Reilly, Debra; Cullen, Marc; Calvert, Catherine; Ryan, Colleen M; Schneider, Jeffrey C; Soley-Bori, Marina; Tompkins, Ronald G

2016-06-01

Patient-reported outcomes serving as benchmarks for recovery of pediatric burn survivors are lacking, and new approaches using longitudinal cohorts for monitoring their expected recovery based on statistical models are needed for patient management during the early years following the burn. To describe multidimensional patient-reported outcomes among pediatric burn survivors younger than 5 years to establish benchmarks using recovery curve methods. Prospective cohort study of pediatric burn survivors younger than 5 years at 12 burn centers. Age-matched nonburned reference groups were studied to define expected results in normal growth and development. The Burn Outcomes Questionnaire for children aged 0 to 5 years (BOQ0-5) was administered to parents of children who had burns and were younger than 5 years. Mixed models were used to generate 48-month recovery curves for each of the 10 BOQ0-5 domains. The study was conducted between January 1999 and December 2008. The 10 BOQ0-5 domains including play, language, fine motor skills, gross motor skills, emotional behavior, family functioning, pain/itching, appearance, satisfaction with care, and worry/concern up to 48 months after burn injury. A total of 336 pediatric burn survivors younger than 5 years (mean [SD] age, 2.0 [1.2] years; 58.4% male; 60.2% white, 18.6% black, and 12.0% Hispanic) and 285 age-matched nonburned controls (mean [SD] age, 2.4 [1.3] years; 51.1% male; 67.1% white, 8.9% black, and 15.0% Hispanic) completed the study. Predicted scores improved exponentially over time for 5 of the BOQ0-5 domains (predicted scores at 1 month vs 24 months: play, 48.6 vs 52.1 [P = .03]; language, 49.2 vs 54.4 [P < .001]; gross motor skills, 48.7 vs 53.0 [P = .002]; pain/itching, 15.8 vs 33.5 [P < .001]; and worry/concern, 31.6 vs 44.9 [P < .001]). Pediatric burn survivors had higher scores in language, emotional behavior, and family functioning domains compared with healthy children in later months. This study demonstrates significant deficits in multiple functional domains across pediatric burn survivors compared with controls. Recovery curves can be used to recognize deviation from the expected course and tailor care to patient needs.

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.

Soil Dynamics Following Fire in Juncus and Spartina Marshes

NASA Technical Reports Server (NTRS)

Schmalzer, Paul A.; Hinkle, C. Ross

1992-01-01

We examined soil changes in the O-5 and 5-15 cm layers for one year after a fire in burned Juncus roemerianus and Spartina bakeri marshes and an unburned Juncus marsh. Each marsh was sampled (N = 25) preburn, immediately postburn, and 1, 3, 6, 9, and 12 months postburn. All marshes were flooded at the time of the fire; water levels declined below the surface by 6 months but reflooded at 12 months after the fire. Soil samples were analyzed for pH, conductivity, organic matter, exchangeable Ca, Mg, and K, available PO4-P, total Kjeldahl nitrogen (TKN), exchangeable NO3-N, NO2-N, and NH4-N. Changes due to burning were most pronounced in the surface (0-5 cm) layer. Soil pH increased 0.16-0.28 units immediately postburn but returned to preburn levels in 1 month. Organic matter increased by 1 month and remained elevated through 9 months after the fire. Calcium, Mg, K, and PO4-P all increased by 1 month after burning, and the increases persisted for 6 to 12 months. Conductivity increased in association with these cations. Burning released ions from organic matter as indicated by the increase in pH, conductivity, Ca, Mg, K, and PO4-P. NH4-N in burned marshes was elevated 6 months and NO3-N 12 months after burning. TKN showed seasonal variations but no clear fire-related changes. Nitrogen species were affected by the seasonally varying water levels as well as fire; these changes differed from those observed in many upland systems.

Diurnal variations of ambient particulate wood burning emissions and their contribution to the concentration of Polycyclic Aromatic Hydrocarbons (PAHs) in Seiffen, Germany

NASA Astrophysics Data System (ADS)

Poulain, L.; Iinuma, Y.; Müller, K.; Birmili, W.; Weinhold, K.; Brüggemann, E.; Gnauk, T.; Hausmann, A.; Löschau, G.; Wiedensohler, A.; Herrmann, H.

2011-12-01

Residential wood burning is becoming an increasingly important cause of air quality problems since it has become a popular source of alternative energy to fossil fuel. In order to characterize the contribution of residential wood burning to local particle pollution, a field campaign was organized at the village of Seiffen (Saxony, Germany). During this campaign, an Aerosol Mass Spectrometer (AMS) was deployed in parallel to a PM1 high volume filter sampler. The AMS mass spectra were analyzed using Positive Matrix Factorization (PMF) to obtain detailed information about the organic aerosol (OA). Biomass-burning organic aerosol (BBOA), Hydrocarbon-like organic aerosol (HOA), and Oxygenated Organic Aerosol (OOA) were identified and represented 20%, 17% and 62% of total OA, respectively. Additionally, Polycyclic Aromatic Hydrocarbons (PAH) were measured by the AMS with an average concentration of 10 ng m-3 and short term events of extremely high PAH concentration (up to 500 ng m-3) compared to the mean PAH value were observed during the whole measurement period. A comparison with the results from PM1 filter samples showed that the BBOA factor and the AMS PAH are good indicators of the total concentration of the different monosaccharide anhydrides and PAH measured on the filter samples. Based on its low correlation with CO and the low car traffic, the HOA factor was considered to be related to residential heating using liquid fuel. An influence of the time of the week (week vs. weekend) on the diurnal profiles of the different OA components was observed. The weekdays were characterized by two maxima; a first one early in the morning and a stronger one in the evening. During the weekend days, the different OA components principally reached only one maximum in the afternoon. Finally, the PAH emitted directly from residential wood combustion was estimated to represent 1.5% of the total mass of the BBOA factor and around 62% of the total PAH concentration measured at Seiffen. This result highlights the important contribution of residential wood combustion to air quality and PAH emissions at the sampling place, which might have a significant impact on human health. Moreover, it also emphasizes the need for a better time resolution of the chemical characterization of toxic particulate compounds in order to provide more information on variations of the different sources through the days as well as to better estimate the real human exposure.

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.

Timing constraints on remote sensing of wildland fire burned area in the southeastern US

USGS Publications Warehouse

Picotte, J.J.; Robertson, K.

2011-01-01

Remote sensing using Landsat Thematic Mapper (TM) satellite imagery is increasingly used for mapping wildland fire burned area and burn severity, owing to its frequency of collection, relatively high resolution, and availability free of charge. However, rapid response of vegetation following fire and frequent cloud cover pose challenges to this approach in the southeastern US. We assessed these timing constraints by using a series of Landsat TM images to determine how rapidly the remotely sensed burn scar signature fades following prescribed burns in wet flatwoods and depression swamp community types in the Apalachicola National Forest, Florida, USA during 2006. We used both the Normalized Burn Ratio (NBR) of reflectance bands sensitive to vegetation and exposed soil cover, as well as the change in NBR from before to after fire (dNBR), to estimate burned area. We also determined the average and maximum amount of time following fire required to obtain a cloud-free image for burns in each month of the year, as well as the predicted effect of this time lag on percent accuracy of burn scar estimates. Using both NBR and dNBR, the detectable area decreased linearly 9% per month on average over the first four months following fire. Our findings suggest that the NBR and dNBR methods for monitoring burned area in common southeastern US vegetation community types are limited to an average of 78-90% accuracy among months of the year, with individual burns having values as low as 38%, if restricted to use of Landsat 5 TM imagery. However, the majority of burns can still be mapped at accuracies similar to those in other regions of the US, and access to additional sources of satellite imagery would improve overall accuracy. ?? 2011 by the authors.

Timing constraints on remote sensing of wildland fire burned area in the southeastern US

USGS Publications Warehouse

Picotte, Joshua J.; Robertson, Kevin

2011-01-01

Remote sensing using Landsat Thematic Mapper (TM) satellite imagery is increasingly used for mapping wildland fire burned area and burn severity, owing to its frequency of collection, relatively high resolution, and availability free of charge. However, rapid response of vegetation following fire and frequent cloud cover pose challenges to this approach in the southeastern US. We assessed these timing constraints by using a series of Landsat TM images to determine how rapidly the remotely sensed burn scar signature fades following prescribed burns in wet flatwoods and depression swamp community types in the Apalachicola National Forest, Florida, USA during 2006. We used both the Normalized Burn Ratio (NBR) of reflectance bands sensitive to vegetation and exposed soil cover, as well as the change in NBR from before to after fire (dNBR), to estimate burned area. We also determined the average and maximum amount of time following fire required to obtain a cloud-free image for burns in each month of the year, as well as the predicted effect of this time lag on percent accuracy of burn scar estimates. Using both NBR and dNBR, the detectable area decreased linearly 9% per month on average over the first four months following fire. Our findings suggest that the NBR and dNBR methods for monitoring burned area in common southeastern US vegetation community types are limited to an average of 78–90% accuracy among months of the year, with individual burns having values as low as 38%, if restricted to use of Landsat 5 TM imagery. However, the majority of burns can still be mapped at accuracies similar to those in other regions of the US, and access to additional sources of satellite imagery would improve overall accuracy.

Daily and 3-hourly Variability in Global Fire Emissions and Consequences for Atmospheric Model Predictions of Carbon Monoxide

NASA Technical Reports Server (NTRS)

Mu, M.; Randerson, J. T.; vanderWerf, G. R.; Giglio, L.; Kasibhatla, P.; Morton, D.; Collatz, G. J.; DeFries, R. S.; Hyer, E. J.; Prins, E. M.;

A review of ecological consequences of shifting the timing of burning tallgrass prairie

USDA-ARS?s Scientific Manuscript database

Prescribed burning is widely accepted as a critical management tool in the tallgrass prairie, however, the ecological effects of burning at different times of the season are poorly understood. In the Kansas Fleet Hills, timing of fire is an important management issue that carries socio-economic as w...

Treatment with gelsolin reduces brain inflammation and apoptotic signaling in mice following thermal injury.

PubMed

Zhang, Qing-Hong; Chen, Qi; Kang, Jia-Rui; Liu, Chen; Dong, Ning; Zhu, Xiao-Mei; Sheng, Zhi-Yong; Yao, Yong-Ming

2011-09-21

Burn survivors develop long-term cognitive impairment with increased inflammation and apoptosis in the brain. Gelsolin, an actin-binding protein with capping and severing activities, plays a crucial role in the septic response. We investigated if gelsolin infusion could attenuate neural damage in burned mice. Mice with 15% total body surface area burns were injected intravenously with bovine serum albumin as placebo (2 mg/kg), or with low (2 mg/kg) or high doses (20 mg/kg) of gelsolin. Samples were harvested at 8, 24, 48 and 72 hours postburn. The immune function of splenic T cells was analyzed. Cerebral pathology was examined by hematoxylin/eosin staining, while activated glial cells and infiltrating leukocytes were detected by immunohistochemistry. Cerebral cytokine mRNAs were further assessed by quantitative real-time PCR, while apoptosis was evaluated by caspase-3. Neural damage was determined using enzyme-linked immunosorbent assay of neuron-specific enolase (NSE) and soluble protein-100 (S-100). Finally, cerebral phospho-ERK expression was measured by western blot. Gelsolin significantly improved the outcomes of mice following major burns in a dose-dependent manner. The survival rate was improved by high dose gelsolin treatment compared with the placebo group (56.67% vs. 30%). Although there was no significant improvement in outcome in mice receiving low dose gelsolin (30%), survival time was prolonged against the placebo control (43.1 ± 4.5 h vs. 35.5 ± 5.0 h; P < 0.05). Burn-induced T cell suppression was greatly alleviated by high dose gelsolin treatment. Concurrently, cerebral abnormalities were greatly ameliorated as shown by reduced NSE and S-100 content of brain, decreased cytokine mRNA expressions, suppressed microglial activation, and enhanced infiltration of CD11b+ and CD45+ cells into the brain. Furthermore, the elevated caspase-3 activity seen following burn injury was remarkably reduced by high dose gelsolin treatment along with down-regulation of phospho-ERK expression. Exogenous gelsolin infusion improves survival of mice following major burn injury by partially attenuating inflammation and apoptosis in brain, and by enhancing peripheral T lymphocyte function as well. These data suggest a novel and effective strategy to combat excessive neuroinflammation and to preserve cognition in the setting of major burns.

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.

Ten-year epidemiology of chemical burns in western Zhejiang Province, China.

PubMed

Ye, Chunjiang; Wang, Xingang; Zhang, Yuanhai; Ni, Liangfang; Jiang, Ruiming; Liu, Liping; Han, Chunmao

2016-05-01

Chemical burns occur frequently in western Zhejiang Province. This study documents the epidemiology of chemical burns in the region using burn data from a local specialized hospital. Results from this analysis will assist in the planning of prevention strategies for high-risk occupations and groups. A 10-year retrospective analysis was conducted for all patients with chemical burns admitted to the Department of Burn and Plastic Surgery from January 2004 to December 2013. Information obtained for each patient included demographics (gender, age, occupation and education), location of the burn, cause of the burn, and categories of chemicals. Data regarding the season of admittance, prehospital treatment, wound site/size (area, region, and depth), accompanying injuries, operations, length of hospital stay and mortality were also assessed. A total of 690 patients (619 males, 71 females; average age: 30.6±12.4 years) were admitted to the department for chemical burns. Over the 10-year period, the incidence of chemical burns showed an increasing tendency. Chemical burns occurred most frequently in patients aged 20-59 years (94.79%). Most of the chemical burns were work-related, primarily in private enterprises (47.97%) and state-owned enterprises (24.93%). Operations (68.99%) and machine problems (17.26%) were the main causes of chemical burns in the workplace. With regard to burns caused by chemicals, most were caused by acids (72.01%), with hydrofluoric acid and sulphuric acid causing 51.45%. Most chemical burns occurred in the summer and autumn seasons (61.02%). The burn size was <10% of the total body surface area (TBSA) for 445 patients (64.49%), while only 26 patients (3.76%) had burns covering >40% TBSA. The most common burn sites were the upper extremities (31.57%), lower extremities (19.86%), and head and neck (28.83%). Most patients (581 (84.20%)) received water washing treatment on site immediately after exposure. The most common accompanying injuries included inhalation injury, ocular burns and digestive tract injury. The average hospital stay was 17.0±23.1 days (range 1-333 days). Surgery was performed in 146 patients (21.16%), and the overall mortality rate was 0.58%. Chemical burns are preventable. The high morbidity of chemical burns in western Zhejiang Province is related to the industrial structure of the area. Governmental management in the fields of production, transportation, and utilization of chemicals could be improved. Workplaces have the responsibility to provide safe work environments and equipment, as well as occupational education and safety training for high-risk work groups. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

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.

Linking Satellite-Derived Fire Counts to Satellite-Derived Weather Data in Fire Prediction Models to Forecast Extreme Fires in Siberia

NASA Astrophysics Data System (ADS)

Westberg, David; Soja, Amber; Stackhouse, Paul, Jr.

2010-05-01

Fire is the dominant disturbance that precipitates ecosystem change in boreal regions, and fire is largely under the control of weather and climate. Boreal systems contain the largest pool of terrestrial carbon, and Russia holds 2/3 of the global boreal forests. Fire frequency, fire severity, area burned and fire season length are predicted to increase in boreal regions under climate change scenarios. Meteorological parameters influence fire danger and fire is a catalyst for ecosystem change. Therefore to predict fire weather and ecosystem change, we must understand the factors that influence fire regimes and at what scale these are viable. Our data consists of NASA Langley Research Center (LaRC)-derived fire weather indices (FWI) and National Climatic Data Center (NCDC) surface station-derived FWI on a domain from 50°N-80°N latitude and 70°E-170°W longitude and the fire season from April through October for the years of 1999, 2002, and 2004. Both of these are calculated using the Canadian Forest Service (CFS) FWI, which is based on local noon surface-level air temperature, relative humidity, wind speed, and daily (noon-noon) rainfall. The large-scale (1°) LaRC product uses NASA Goddard Earth Observing System version 4 (GEOS-4) reanalysis and NASA Global Precipitation Climatology Project (GEOS-4/GPCP) data to calculate FWI. CFS Natural Resources Canada uses Geographic Information Systems (GIS) to interpolate NCDC station data and calculate FWI. We compare the LaRC GEOS- 4/GPCP FWI and CFS NCDC FWI based on their fraction of 1° grid boxes that contain satellite-derived fire counts and area burned to the domain total number of 1° grid boxes with a common FWI category (very low to extreme). These are separated by International Geosphere-Biosphere Programme (IGBP) 1°x1° resolution vegetation types to determine and compare fire regimes in each FWI/ecosystem class and to estimate the fraction of each of the 18 IGBP ecosystems burned, which are dependent on the FWI. On days with fire counts, the domain total of 1°x1° grid boxes with and without daily fire counts and area burned are totaled. The fraction of 1° grid boxes with fire counts and area burned to the total number of 1° grid boxes having common FWI category and vegetation type are accumulated, and a daily mean for the burning season is calculated. The mean fire counts and mean area burned plots appear to be well related. The ultimate goal of this research is to assess the viability of large-scale (1°) data to be used to assess fire weather danger and fire regimes, so these data can be confidently used to predict future fire regimes using large-scale fire weather data. Specifically, we related large-scale fire weather, area burned, and the amount of fire-induced ecosystem change. Both the LaRC and CFS FWI showed gradual linear increase in fraction of grid boxes with fire counts and area burned with increasing FWI category, with an exponential increase in the higher FWI categories in some cases, for the majority of the vegetation types. Our analysis shows a direct correlation between increased fire activity and increased FWI, independent of time or the severity of the fire season. During normal and extreme fire seasons, we noticed the fraction of fire counts and area burned per 1° grid box increased with increasing FWI rating. Given this analysis, we are confident large-scale weather and climate data, in this case from the GEOS-4 reanalysis and the GPCP data sets, can be used to accurately assess future fire potential. This increases confidence in the ability of large-scale IPCC weather and climate scenarios to predict future fire regimes in boreal regions.

Seasonal variations and source estimation of saccharides in atmospheric particulate matter in Beijing, China.

PubMed

Liang, Linlin; Engling, Guenter; Du, Zhenyu; Cheng, Yuan; Duan, Fengkui; Liu, Xuyan; He, Kebin

2016-05-01

Saccharides are important constituents of atmospheric particulate matter (PM). In order to better understand the sources and seasonal variations of saccharides in aerosols in Beijing, China, saccharide composition was measured in ambient PM samples collected at an urban site in Beijing. The highest concentrations of total saccharides in Beijing were observed in autumn, while an episode with abnormal high total saccharide levels was observed from 15 to 23 June, 2011, due to extensive agricultural residue burning in northern China during the wheat harvest season. Compared to the other two categories of saccharides, sugars and sugar alcohols, anhydrosugars were the predominant saccharide group, indicating that biomass burning contributions to Beijing urban aerosol were significant. Ambient sugar and sugar alcohol levels in summer and autumn were higher than those in spring and winter, while they were more abundant in PM2.5 during winter time. Levoglucosan was the most abundant saccharide compound in both PM2.5 and PM10, the annual contributions of which to total measured saccharides in PM2.5 and PM10 were 61.5% and 54.1%, respectively. To further investigate the sources of the saccharides in ambient aerosols in Beijing, the PM10 datasets were subjected to positive matrix factorization (PMF) analysis. Based on the objective function to be minimized and the interpretable factors identified by PMF, six factors appeared to be optimal as to the probable origin of saccharides in the atmosphere in Beijing, including biomass burning, soil or dust, isoprene SOA and the direct release of airborne fungal spores and pollen. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

Self-inflicted burns fatalities in Manipal, India.

PubMed

Mohanty, Manoj Kumar; Arun, M; Monteiro, Francis N P; Palimar, Vikram

2005-01-01

Death due to burns is an important public health problem. Suicide by burning is uncommon in the Western world compared with Asian countries. This study presents retrospective research carried out in the tertiary care teaching hospital of Kasturba Medical College, Manipal, Southern India, between January 1993 to December 2003 (11 years). Out of a total of 343 burns deaths during the above-mentioned period, 39 were victims of suicide. The majority of deaths (46.1%) occurred in the 21-30 years age group, with a preponderance of the female sex (79.5%). Most of the victims belonged to the Hindu religion and the incident occurred mostly during the daytime. In the overwhelming majority of cases, the incident occurred at home (97.4%). In all cases kerosene was the accelerant and flame was the causative agent. In more than fifty per cent of cases, the total body surface area (TBSA) involved was more than 80%. Dowry demands and harassment were the reasons for committng suicide in 12 cases. More stringent laws and empowering female independence, both mentally and economically, will reduce suicidal burns in young women.

Predicting Resource Utilization of Elderly Burn Patients in the Baby Boomer Era

PubMed Central

Richards, Winston A.; Miggins, Makeesha; Liu, Huazhi; Mozingo, David W.; Ang, Darwin

2014-01-01

Background Census predictions for Florida suggest a threefold increase in the population 65 or older within 20 years. We predict resource utilization for this age group. Methods Using the Florida Agency for Healthcare Administration admission dataset we evaluated the effect of age on length of stay, hospital charges and discharge disposition while adjusting for clinical and demographic factors. Using U.S. Census Bureau data and burn incidence rates from this dataset we estimated future resource utilization. Results Elderly patients were discharged to home less often and were discharged to short term general hospitals, intermediate care facilities and skilled nursing facilities more often than the other age groups (p < 0.05). They also required home health care and IV medications significantly more often (p <0.05). Their length of stay was longer and total hospital charges were greater (p < 0.05) after adjusting for gender, race, Charleson comorbidity index, payer, TBSA burned and burn center treatment. Conclusions Our data show an age dependent increase in the utilization of post-hospitalization resources, LOS and total charges for elderly burn patients. PMID:23017253

[Lay emphasis on the treatment of massive burn casualties in conflagration].

PubMed

Tang, Hong-tai; Ma, Bing; Xia, Zhao-fan

2012-06-01

Burn surgery belongs to disaster medicine. Burn is a common trauma that occurs in social activities of human beings in all ages, either in the time of peace or war. During the development of human medicine in modern times, the summary of experience in treating massive burn casualties due to severe fire accidents has effectively promoted the renovation of treating technology and theory of burns and the development of burn surgery. The results of treatment of burn injury in casualties occurred in the fire of Cocoanut Grove night club in Boston in 1942, and the high-rise apartment house fire in Shanghai in 2010 were summarized and analyzed in this article, emphasizing the correlating issues of inhalation injury.

Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients.

PubMed

Wang, Xue-Qing; Mill, Julie; Kravchuk, Olena; Kimble, Roy M

2010-12-01

This study describes the ultrasound assessment of burn scars in paediatric patients and the association of these scar thickness with laser Doppler imaging (LDI) determined burn depth. A total of 60 ultrasound scar assessments were conducted on 33 scars from 21 paediatric burn patients at 3, 6 and 9 months after-burn. The mean of peak scar thickness was 0.39±0.032 cm, with the thickest at 6 months (0.40±0.036 cm). There were 17 scald burn scars (0.34±0.045 cm), 4 contact burn scars (0.61±0.092 cm), and 10 flame burn scars (0.42±0.058 cm). Each group of scars followed normal distributions. Twenty-three scars had original burns successfully scanned by LDI and various depths of burns were presented by different colours according to blood perfusion units (PU), with dark blue <125, light blue 125-250, and green 250-440 PU. The thickness of these scars was significantly different between the predominant colours of burns, with the thinnest scars for green coloured burns and the thickest for dark blue coloured burns. Within light blue burns, grafted burns healed with significantly thinner scars than non-grafted burns. This study indicates that LDI can be used for predicting the risk of hypertrophic scarring and for guiding burn care. To our knowledge, this is the first study to correlate the thickness of burns scars by ultrasound scan with burn depth determined by LDI. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

Acute Kidney Injury: It's not just the 'big' burns.

PubMed

Kimmel, L A; Wilson, S; Walker, R G; Singer, Y; Cleland, H

2018-02-01

Acute Kidney Injury (AKI) complicates the management of at least 25% of patients with severe burns and is associated with long term complications. Most research focuses on the patients with more severe burns, and whether the same factors are associated with the development of AKI in patients with burns between 10 and 19% total body surface area (TBSA) is unknown. The aims of this study were to examine the incidence of, and factors associated with, the development of AKI in patients with %TBSA≥10, as well as the relationship with hospital metrics such as length of stay (LOS). Retrospective medical record review of consecutive burns patients admitted to The Alfred Hospital, the major adult burns centre in Victoria, Australia. Demographic and injury details were recorded. Factors associated with AKI were determined using multiple logistic regression. Between 2010 and June 2014, 300 patients were admitted with burn injury and data on 267 patients was available for analysis. Median age was 54.5 years with 78% being male. Median %TBSA was 15 (IQR 12, 20). The AKI incidence, as measured by the RIFLE criteria, was 22.5%, including 15% (27/184) in patients with %TBSA 10-19. Factors associated with AKI included increasing age and %TBSA (OR 1.05 p<0.001) as well as increased surgeries (p<0.041) and a cardiac comorbidity (p<0.01). All patients with renal comorbidity developed AKI. In the %TBSA 10-19 cohort, only increasing age (OR 1.05 p<0.001) was associated with AKI. After accounting for confounding factors, the probability of discharge from hospital in Non-AKI group was greater than for the AKI patients at all time points (P<0.001). This is the first study to show an association between patients with %TBSA 10-19 and AKI. Given the association between AKI and complications, prospective research is needed to further understand AKI in burns with the aim of risk reduction. Copyright © 2017 Elsevier Ltd. All rights reserved.

Managing burn victims of suicide bombing attacks: outcomes, lessons learnt, and changes made from three attacks in Indonesia.

PubMed

Chim, Harvey; Yew, Woon Si; Song, Colin

2007-01-01

Terror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003 (Jakarta), 2004 (Jakarta), and 2005 (Bali) have turned terrorist attacks into an ever-present reality. The authors reviewed medical charts of victims evacuated to the Singapore General Hospital (SGH) Burns Centre during three suicide attacks involving Bali (2002 and 2005) and the Jakarta Marriott hotel (2003). Problems faced, lessons learnt, and costs incurred are discussed. A burns disaster plan drawing on lessons learnt from these attacks is presented. Thirty-one patients were treated at the SGH Burns Centre in three attacks (2002 Bali attack [n = 15], 2003 Jakarta attack [n = 14], and 2005 Bali attack [n = 2]). For the 2002 Bali attack, median age was 29 years (range 20 to 50 years), median percentage of total burn surface area (TBSA) was 29% (range 5% to 55%), and median abbreviated burn severity index (ABSI) was 6 (range 3 to 10). Eight of 15 patients were admitted to the intensive care unit. For the 2003 Jakarta attack, median age was 35 years (range 24 to 56 years), median percentage of TBSA was 10% (range 2% to 46%), and median ABSI was 4 (range 3 to 9). A large number of patients had other injuries. Problems faced included manpower issues, lack of bed space, shortage of blood products, and lack of cadaver skin. The changing nature of terror attacks mandates continued vigilance and disaster preparedness. The multidimensional burns patient, complicated by other injuries, is likely to become increasingly common. A burns disaster plan with emphasis on effective command, control, and communication as well as organisation of health care personnel following a 'team concept' will do much to ensure that the sudden onset of a crisis situation at an unexpected time does not overwhelm hospital manpower and resources.

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

Prescribed-fire effects on an aquatic community of a southwest montane grassland system

USGS Publications Warehouse

Caldwell, Colleen A.; Jacobi, Gerald Z.; Anderson, Michael C.; Parmenter, Robert R.; McGann, Jeanine; Gould, William R.; DuBey, Robert; Jacobi, M. Donna

2013-01-01

The use of prescription fire has long been recognized as a reliable management tool to suppress vegetative succession processes and to reduce fuel loading to prevent catastrophic wildfires, but very little attention has been paid to the effects on aquatic systems. A late-fall prescribed burn was implemented to characterize effects on an aquatic community within a montane grassland system in north-central New Mexico. The fire treatment was consistent with protocols of a managed burn except that the fire was allowed to burn through the riparian area to the treatment stream to replicate natural fire behavior. In addition to summer and fall preburn assessment of the treatment and reference stream, we characterized immediate postfire effects (within a week for macroinvertebrates and within 6 months for fish) and seasonal effects over a 2-year period. Responses within the treatment stream were compared with an unburned reference stream adjacent to the prescription burn. During the burn, the diel range in air temperature increased by 5°C while diel range in water temperature did not change. Carbon–nitrogen ratios did not differ between treatment and reference streams, indicating the contribution of ash from the surrounding grassland was negligible. Although total taxa and species richness of aquatic macroinvertebrates were not altered, qualitative indices revealed departure from preburn condition due to loss of sensitive taxa (mayflies [order Ephemeroptera] and stoneflies [order Plecoptera]) and an increase in tolerant taxa (midges [order Chironomidae]) following the burn. Within 1 year of the burn, these attributes returned to preburn conditions. The density and recruitment of adult Brown Trout Salmo trutta did not differ between pre- and postburn collections, nor did fish condition differ. Fire is rarely truly replicated within a given study. Although our study represents one replication, the results will inform managers about the importance in timing (seasonality) of prescription burn and anticipated effects on aquatic communities.

Treatment of burning mouth syndrome with a low-level energy diode laser.

PubMed

Yang, Hui-Wen; Huang, Yu-Feng

2011-02-01

To test the therapeutic efficacy of low-level energy diode laser on burning mouth syndrome. Burning mouth syndrome is characterized by burning and painful sensations in the mouth, especially the tongue, in the absence of significant mucosal abnormalities. Although burning mouth syndrome is relatively common, little is known regarding its etiology and pathophysiology. As a result, no treatment is effective in all patients. Low-level energy diode laser therapy has been used in a variety of chronic and acute pain conditions, including neck, back and myofascial pain, degenerative osteoarthritis, and headache. A total of 17 patients who had been diagnosed with burning mouth syndrome were treated with an 800-nm wavelength diode laser. A straight handpiece was used with an end of 1-cm diameter with the fiber end standing 4 cm away from the end of handpiece. When the laser was applied, the handpiece directly contacted or was immediately above the symptomatic lingual surface. The output used was 3 W, 50 msec intermittent pulsing, and a frequency of 10 Hz, which was equivalent to an average power of 1.5 W/cm(2) (3 W × 0.05 msec × 10 Hz = 1.5 W/cm(2)). Depending on the involved area, laser was applied to a 1-cm(2) area for 70 sec until all involved area was covered. Overall pain and discomfort were analyzed with a 10-cm visual analogue scale. All patients received diode laser therapy between one and seven times. The average pain score before the treatment was 6.7 (ranging from 2.9 to 9.8). The results showed an average reduction in pain of 47.6% (ranging from 9.3% to 91.8%). The burning sensation remained unchanged for up to 12 months. Low-level energy diode laser may be an effective treatment for burning mouth syndrome.

Managing burn victims of suicide bombing attacks: outcomes, lessons learnt, and changes made from three attacks in Indonesia

PubMed Central

Chim, Harvey; Yew, Woon Si; Song, Colin

2007-01-01

Introduction Terror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003 (Jakarta), 2004 (Jakarta), and 2005 (Bali) have turned terrorist attacks into an ever-present reality. Methods The authors reviewed medical charts of victims evacuated to the Singapore General Hospital (SGH) Burns Centre during three suicide attacks involving Bali (2002 and 2005) and the Jakarta Marriott hotel (2003). Problems faced, lessons learnt, and costs incurred are discussed. A burns disaster plan drawing on lessons learnt from these attacks is presented. Results Thirty-one patients were treated at the SGH Burns Centre in three attacks (2002 Bali attack [n = 15], 2003 Jakarta attack [n = 14], and 2005 Bali attack [n = 2]). For the 2002 Bali attack, median age was 29 years (range 20 to 50 years), median percentage of total burn surface area (TBSA) was 29% (range 5% to 55%), and median abbreviated burn severity index (ABSI) was 6 (range 3 to 10). Eight of 15 patients were admitted to the intensive care unit. For the 2003 Jakarta attack, median age was 35 years (range 24 to 56 years), median percentage of TBSA was 10% (range 2% to 46%), and median ABSI was 4 (range 3 to 9). A large number of patients had other injuries. Problems faced included manpower issues, lack of bed space, shortage of blood products, and lack of cadaver skin. Conclusion The changing nature of terror attacks mandates continued vigilance and disaster preparedness. The multidimensional burns patient, complicated by other injuries, is likely to become increasingly common. A burns disaster plan with emphasis on effective command, control, and communication as well as organisation of health care personnel following a 'team concept' will do much to ensure that the sudden onset of a crisis situation at an unexpected time does not overwhelm hospital manpower and resources. PMID:17274813

Harborview Burns – 1974 to 2009

PubMed Central

Engrav, Loren H.; Heimbach, David M.; Rivara, Frederick P.; Kerr, Kathleen F.; Osler, Turner; Pham, Tam N.; Sharar, Sam R.; Esselman, Peter C.; Bulger, Eileen M.; Carrougher, Gretchen J.; Honari, Shari; Gibran, Nicole S.

2012-01-01

Background Burn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974–2009) at the Harborview Burn Center in Seattle, WA, USA. Methods and Findings 14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved. Conclusions 1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate. PMID:22792216

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 .

Smartphone applications in burns.

PubMed

Wurzer, Paul; Parvizi, Daryousch; Lumenta, David B; Giretzlehner, Michael; Branski, Ludwik K; Finnerty, Celeste C; Herndon, David N; Tuca, Alexandru; Rappl, Thomas; Smolle, Christian; Kamolz, Lars P

2015-08-01

Since the introduction of applications (apps) for smartphones, the popularity of medical apps has been rising. The aim of this review was to demonstrate the current availability of apps related to burns on Google's Android and Apple's iOS store as well as to include a review of their developers, features, and costs. A systematic online review of Google Play Store and Apple's App Store was performed by using the following search terms: "burn," "burns," "thermal," and the German word "Verbrennung." All apps that were programmed for use as medical apps for burns were included. The review was performed from 25 February until 1 March 2014. A closer look at the free and paid calculation apps including a standardized patient was performed. Four types of apps were identified: calculators, information apps, book/journal apps, and games. In Google Play Store, 31 apps were related to burns, of which 20 were calculation apps (eight for estimating the total body surface area (TBSA) and nine for total fluid requirement (TFR)). In Apple's App Store, under the category of medicine, 39 apps were related to burns, of which 21 were calculation apps (19 for estimating the TBSA and 17 for calculating the TFR). In 19 out of 32 available calculation apps, our study showed a correlation of the calculated TFR compared to our standardized patient. The review demonstrated that many apps for medical burns are available in both common app stores. Even free available calculation apps may provide a more objective and reproducible procedure compared to manual/subjective estimations, although there is still a lack of data security especially in personal data entered in calculation apps. Further clinical studies including smartphone apps for burns should be performed. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Economics of pediatric burns.

PubMed

Bass, Michael J; Phillips, Linda G

2008-07-01

Sustaining a burn injury sets in motion a cycle of pain, disfigurement, and a search for survival. In pediatric burns, the injury extends to the parents where fear, ignorance, and helplessness forever change their lives. Pediatric burn injuries are caused by fire, hot liquids, clothing irons, hair curlers, caustic substances like drain cleaner, the grounding of an electrical source, and exposure to radiation. Efficiency in the delivery of pediatric burn care is critical. Maximizing resource utilization means continual self-evaluation and economic analysis of therapeutic modalities. Griffiths et al found that most childhood burns are due to scalds, which can be treated for $1061 per percent burn. Paddock et al reduced the cost of treating superficial pediatric burns and reduced the length of stay in hospital using silver-impregnated gauze over traditional methods. Barrett et al found improved cosmesis of skin grafts using cultured epithelial autografts but at a substantially increased cost. Corpron et al showed that pediatric burn units that treat burns >10% total body surface area and operative treatment of pediatric burns regardless of size generate positive revenue. There is a paucity of evidentiary pediatric burn economic data. More research is needed to address areas of pediatric burn care inefficiency. Improving knowledge of cost in all health care endeavors will create competition and drive down expenditures.

A review of campfire burns in children: The QLD experience.

PubMed

Okon, O; Zhu, L; Kimble, R M; Stockton, K A

2018-03-27

Campfire burns in children are a significant health issue. It is imperative that the extent of the problem is examined and strategies discussed to inform future prevention campaigns. A retrospective review of data from the Queensland Paediatric Burns Registry for all children presenting with campfire burns between January 2013 and December 2014 (inclusive). Information collected included patient demographics, detail regarding mechanism of injury, first aid, Total Body Surface Area (TBSA), burn depth, and treatment. Seventy-five children with campfire burns were seen in our paediatric burns centre during this 2-year period. The median age of patients was 3 years (range 10 days-14 years). The hands and feet were the areas most commonly affected. Eleven percent of patients suffered flame burns, whilst 89% suffered contact burns from the hot coals or ashes. Of the latter group, approximately half experienced burns from campfires that had been extinguished for at least one night. Thirteen percent of patients underwent split thickness skin grafting. The incidence of burns was increased during school holiday months. We have previously demonstrated the effectiveness of targeted campaigns in reducing the incidence of campfire burns. A significant portion of patients sustained burns from incorrectly extinguished campfires. These injuries are likely to be preventable with ongoing public awareness campaigns. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

Photoacoustic diagnosis of burns in rats: two-dimensional photo-acoustic imaging of burned tissue

NASA Astrophysics Data System (ADS)

Yamazaki, Mutsuo; Sato, Shunichi; Saito, Daizo; Okada, Yoshiaki; Kurita, Akira; Kikuchi, Makoto; Ashida, Hiroshi; Obara, Minoru

2003-06-01

We previously reported that for rat burn models, deep dermal burns and deep burns can be well differentiated by measuring the propagation time of the photoacoustic signals originated from the blood in the healthy skin tissue under the damaged tissue layer. However, the diagnosis was based on point measurement in the wound, and therefore site-dependent information on the injuries was not obtained; such information is very important for diagnosis of extended burns. In the present study, we scanned a photoacoustic detector on the wound and constructed two-dimensional (2-D) images of the blood-originated photoacoustic signals for superficial dermal burns (SDB), deep dermal burns (DDB), deep burns (DB), and healthy skins (control) in rats. For each burn model, site-dependent variation of the signal was observed; the variation probably reflects the distribution of blood vessels in the skin tissue. In spite of the variation, clear differentiation was obtained between SDB, DDB, and DB from the 2D images. The images were constructed as a function of post burn time. Temporal signal variation will be also presented.

Geologic history of natural coal-bed fires, Powder River basin, USA

USGS Publications Warehouse

Heffern, E.L.; Coates, D.A.

2004-01-01

Coal-bed fires ignited by natural processes have baked and fused overlying sediments to form clinker, a hard red or varicolored rock, through much of the northern Great Plains of the United States (USA). The gently dipping coal beds in the region burn when regional downwasting brings them above the local water table. The resulting clinker forms a rim along the exposed edge of the coal bed in an ongoing process through geologic time. The resistant clinker is left capping buttes and ridges after the softer unbaked strata erode away. Clinker outcrops cover more than 4100 km2 in the Powder River basin (PRB), which lies in Wyoming (WY) and Montana (MT). The clinker in place records tens of billions of tons of coal that have burned, releasing gases into the atmosphere. The amount of clinker that has eroded away was at least an order of magnitude greater than the clinker that remains in place. Fission-track and uranium-thorium/ helium ages of detrital zircon crystals in clinker, and paleomagnetic ages of clinker, show that coal beds have burned naturally during at least the past 4 million years (Ma). The oldest in-place clinker that has been dated, collected from a high, isolated, clinker-capped ridge, has a fission track age of 2.8??0.6 Ma. Evidence of erosion and downcutting is also preserved by clinker clasts in gravel terraces. One clinker boulder in a terrace 360 m above the Yellowstone River has a fission track age of 4.0??0.7 Ma. Coal-bed fires are caused by lightning, wildfires, spontaneous combustion, or human activity on coal outcrops and in mines. Miners, government agencies, and ranchers have extinguished thousands of coal bed fires, but natural ignition continues where fresh coal has access to air. At any given time, hundreds of fires, mostly small, are burning. In the Powder River basin, the total amount of coal burned by natural fires in the last 2 Ma is one to two orders of magnitude greater than the total amount of coal removed by mining in the past century. However, current annual rates of coal mining are three to four orders of magnitude greater than estimated prehistoric annual rates of coal consumption by natural fires. ?? 2004 Published by Elsevier B.V.

Evaluation of phytochemicals, antioxidant and burn wound healing activities of Cucurbita moschata Duchesne fruit peel

PubMed Central

Bahramsoltani, Roodabeh; Farzaei, Mohammad Hosein; Abdolghaffari, Amir Hossein; Rahimi, Roja; Samadi, Nasrin; Heidari, Mohammad; Esfandyari, Mohammadamin; Baeeri, Maryam; Hassanzadeh, Gholamreza; Abdollahi, Mohammad; Soltani, Saba; Pourvaziri, Ali; Amin, Gholamreza

2017-01-01

Objective(s): Cucurbita moschata Duchesne (pumpkin) is a well-known plant with several pharmacological effects. The aim of the present study was to assess burn wound healing activity of C. moschata peel extract (CE). Also, standardized CE was assessed for antioxidant activity and antibacterial effects against major pathogens of burns. Materials and Methods: Healing properties of topical preparation of 10% and 20% concentrations of CE were assessed on second degree burn in rats during a 14-day period as well as histological studies, total antioxidant power, lipid peroxidation and total thiol content of skin tissue samples. Results: Radical scavenging IC50 and ferric-reducing antioxidant power value were 4.015±0.20 mg/ml and 142.63±2.65 mmol Fe2+/g, respectively. Total mucilage content was 13.8%. The optimal results were obtained by 20% CE that showed 90.80±5.86 % wound closure and tissue repair as well as significant reduction of tissue oxidative stress biomarkers. Histological analyses confirmed wound healing activity of pumpkin peel extract. Conclusion: Considering the high mucilage content of the plant, providing a moist environment for wound, C. moschata peel extract could be a natural remedy for treatment of burns. Further clinical studies are suggested to confirm C. moschata peel extract as a wound healing agent. PMID:28852445

Seasonal variation, risk assessment and source estimation of PM 10 and PM10-bound PAHs in the ambient air of Chiang Mai and Lamphun, Thailand.

PubMed

Pengchai, Petch; Chantara, Somporn; Sopajaree, Khajornsak; Wangkarn, Sunanta; Tengcharoenkul, Urai; Rayanakorn, Mongkon

2009-07-01

Daily PM10 concentrations were measured at four sampling stations located in Chiang Mai and Lamphun provinces, Thailand. The sampling scheme was conducted during June 2005 to June 2006; every 3 days for 24 h in each sampling period. The result revealed that all stations shared the same pattern, in which the PM10 (particulate matters with diameter of less than 10 microm) concentration increased at the beginning of dry season (December) and reached its peak in March before decreasing by the end of April. The maximum PM10 concentration for each sampling station was in the range of 140-182 microg/m(3) which was 1.1-1.5 times higher than the Thai ambient air quality standard of 120 microg/m(3). This distinctly high concentration of PM10 in the dry season (Dec. 05-Mar. 06) was recognized as a unique seasonal pattern for the northern part of Thailand. PM10 concentration had a medium level of negative correlation (r = -0.696 to -0.635) with the visibility data. Comparing the maximum PM10 concentration detected at each sampling station to the permitted PM10 level of the national air quality standard, the warning visibility values for the PM10 pollution-watch system were determined as 10 km for Chiang Mai Province and 5 km for Lamphun Province. From the analysis of PM10 constituents, no component exceeded the national air quality standard. The total concentrations of PM10-bond polycyclic aromatic hydrocarbons (PAHs) are calculated in terms of total toxicity equivalent concentrations (TTECs) using the toxicity equivalent factors (TEFs) method. TTECs in Chiang Mai and Lamphun ambient air was found at a level comparable to those observed in Nagasaki, Bangkok and Rome and at a lower level than those reported at Copenhagen. The annual number of lung cancer cases for Chiang Mai and Lamphun Provinces was estimated at two cases/year which was lower than the number of cases in Bangkok (27 cases/year). The principal component analysis/absolute principal component scores (PCA/APCS) model and multiple regression analysis were applied to the PM10 and its constituents data. The results pointed to the vegetative burning as the largest PM10 contributor in Chiang Mai and Lamphun ambient air. Vegetative burning, natural gas burning & coke ovens, and secondary particle accounted for 46-82%, 12-49%, and 3-19% of the PM10 concentrations, respectively. However, natural gas burning & coke ovens as well as vehicle exhaust also deserved careful attention due to their large contributions to PAHs concentration. In the wet season and transition periods, 42-60% of the total PAHs concentrations originated from vehicle exhaust while 16-37% and 14-38% of them were apportioned to natural gas burning & coke ovens and vegetative burning, respectively. In the dry period, natural gas burning & coke ovens, vehicle exhaust, and vegetative burning accounted for 47-59%, 20-25%, and 19-28% of total PAHs concentrations. The close agreement between the measured and predicted concentrations data (R(2) > 0.8) assured enough capability of PCA/APCS receptor model to be used for the PM10 and PAHs source apportionment.

A Large Underestimate of Formic Acid from Tropical Fires: Constraints from Space-Borne Measurements.

PubMed

Chaliyakunnel, S; Millet, D B; Wells, K C; Cady-Pereira, K E; Shephard, M W

2016-06-07

Formic acid (HCOOH) is one of the most abundant carboxylic acids and a dominant source of atmospheric acidity. Recent work indicates a major gap in the HCOOH budget, with atmospheric concentrations much larger than expected from known sources. Here, we employ recent space-based observations from the Tropospheric Emission Spectrometer with the GEOS-Chem atmospheric model to better quantify the HCOOH source from biomass burning, and assess whether fire emissions can help close the large budget gap for this species. The space-based data reveal a severe model HCOOH underestimate most prominent over tropical burning regions, suggesting a major missing source of organic acids from fires. We develop an approach for inferring the fractional fire contribution to ambient HCOOH and find, based on measurements over Africa, that pyrogenic HCOOH:CO enhancement ratios are much higher than expected from direct emissions alone, revealing substantial secondary organic acid production in fire plumes. Current models strongly underestimate (by 10 ± 5 times) the total primary and secondary HCOOH source from African fires. If a 10-fold bias were to extend to fires in other regions, biomass burning could produce 14 Tg/a of HCOOH in the tropics or 16 Tg/a worldwide. However, even such an increase would only represent 15-20% of the total required HCOOH source, implying the existence of other larger missing sources.

Pavement temperature and burns: streets of fire.

PubMed

Harrington, W Z; Strohschein, B L; Reedy, D; Harrington, J E; Schiller, W R

1995-11-01

To measure pavement temperatures over a 24-hour period to determine when patients are at risk for burns and to report cases of pavement burns with predisposing factors. Descriptive study of pavement temperatures and retrospective case series of 23 patients with pavement burns admitted to the Maricopa Medical Center during the years 1986 to 1992. Twenty-three patients with pavement burns serious enough for them to be admitted to the burn center. We measured the temperatures of asphalt, cement, and other outdoor materials hourly for one 24-hour period using a thermocouple thermometer. Asphalt pavement was hot enough to cause burns from 9 AM to 7 PM during the summer months. It was hot enough to cause a second-degree burn within 35 seconds from 10 AM to 5 PM. The group of burned patients could be divided into three categories: incapacitated, restrained, and sensory deficient. All burns involved less than 13% of the total body surface area. During summer days in the desert, pavement is often hot enough to cause burns and does so with regularity in the southwestern United States. No one should be allowed to remain in contact with hot pavement, even transiently.

Comparison of traditional burn wound mapping with a computerized program.

PubMed

Williams, James F; King, Booker T; Aden, James K; Serio-Melvin, Maria; Chung, Kevin K; Fenrich, Craig A; Salinas, José; Renz, Evan M; Wolf, Steven E; Blackbourne, Lorne H; Cancio, Leopoldo C

2013-01-01

Accurate burn estimation affects the use of burn resuscitation formulas and treatment strategies, and thus can affect patient outcomes. The objective of this process-improvement project was to compare the accuracy of a computer-based burn mapping program, WoundFlow (WF), with the widely used hand-mapped Lund-Browder (LB) diagram. Manikins with various burn representations (from 1% to more than 60% TBSA) were used for comparison of the WF system and LB diagrams. Burns were depicted on the manikins using red vinyl adhesive. Healthcare providers responsible for mapping of burn patients were asked to perform burn mapping of the manikins. Providers were randomized to either an LB or a WF group. Differences in the total map area between groups were analyzed. Also, direct measurements of the burn representations were taken and compared with LB and WF results. The results of 100 samples, compared using Bland-Altman analysis, showed no difference between the two methods. WF was as accurate as LB mapping for all burn surface areas. WF may be additionally beneficial in that it can track daily progress until complete wound closure, and can automatically calculate burn size, thus decreasing the chances of mathematical errors.

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.

Stand restoration burning in oak-pine forests in the southern Applachians: effects on aboveground biomass and carbon and nitrogen cycling

Treesearch

Robert M. Hubbard; James M. Vose; Barton D. Clinton; Katherine J. Elliott; Jennifer D. Knoepp

2004-01-01

Understory prescribed burning is being suggested as a viable management tool for restoring degraded oak–pine forest communities in the southern Appalachians yet information is lacking on how this will affect ecosystem processes. Our objectives in this study were to evaluate the watershed scale effects of understory burning on total aboveground biomass, and the carbon...

Rainfall and geomorphic aspects of post-fire soil erosion - Schultz Fire 2010

Treesearch

Ann Youberg; Karen A. Koestner; Daniel G. Neary; Peter E. Koestner

2011-01-01

The human-caused Schultz Fire near Flagstaff, Arizona burned 6,100 ha (15,075 acres) on the Coconino National Forest between June 20th and 30th, 2010. Ignited by an abandoned campfire, high winds drove the fire over approximately 60% of the total area burned during the first 12 hours (U.S. Forest Service, 2010). The majority of the area burned at moderate (27%) or high...

[Thermal injuries in the OEAMTC air rescue service. Epidemiological characteristics of burns/scalds in children and adults].

PubMed

Selig, H F; Nagele, P; Lumenta, D B; Voelckel, W G; Trimmel, H; Hüpfl, M; Kamolz, L P

2014-04-01

Few data exist on the epidemiological characteristics of thermal injuries in prehospital emergency care, especially in the context of air rescue. Therefore, this study aimed to analyze the epidemiology of pediatric and adult thermal injuries in the helicopter emergency medical service (HEMS) run by the Austrian Automobile Motorcycle Touring Club (OEAMTC) air rescue service from an almost nationwide sample. All OEAMTC-HEMS rescue missions flown for thermal injuries in 2009 were retrospectively reviewed. Primary (n=88) and secondary missions (n=17) were collated and all primary missions were analyzed in detail. In total 71 out of 16,100 (0.4 %) primary HEMS rescue missions were for patients suffering from burns or scalds (children n=27, adults n=44). The proportion of major burns (burns covering >20 % of the total body surface area) was 40.7 % in children and 54.5 % in adults, 44 (62 %) burn/scald injuries were related to the head/neck, 37 (52.1 %) to the upper limbs and 10 (14.1 %) to the anogenital region. More than half of the victims (63.4%) suffered potentially life-threatening injury. In HEMS thermal injuries are infrequent but mostly life-threatening. Differences in epidemiological characteristics of pediatric and adult burns/scalds may have important operational, training and public health implications.

[Risk factors for development of hypomagnesemia in the burned patient].

PubMed

Durán-Vega, Héctor César; Romero-Aviña, Francisco Javier; Gutiérrez-Salgado, Jorge Eduardo; Silva-Díaz, Teresita; Ramos-Durón, Luis Ernesto; Carrera-Gómez, Francisco Javier

2004-01-01

Electrolyte abnormalities are common in the severely burned patient. There is little information with regard to the frequency and magnitude of hypomagnesemia, as well as on risk factors for this condition. We performed an observational, retrospective analysis of 35 burned patients treated at the Plastic and Reconstructive Surgery Service at the Hospital Central Sur PEMEX, Mexico City. We determined serum magnesium behavior and divided patients into two groups: the first included 11 patients with burns and hypomagnesemia, and the second, 24 patients with burns but without hypomagnesemia. Risk factor identification was performed. We found patient at risk was the one with more than 40% of 2nd or 3rd degree total burned body area, in day 4 or 10 after the burn, and with hypokalemia, hypocalcemia, or both, and without intravenous (i.v.) supplementation of magnesium. The best way to prevent or avoid major complications is to identify the high-risk patient, or to diagnose earlier.

Improving the accuracy of burn-surface estimation.

PubMed

Nichter, L S; Williams, J; Bryant, C A; Edlich, R F

1985-09-01

A user-friendly computer-assisted method of calculating total body surface area burned (TBSAB) has been developed. This method is more accurate, faster, and subject to less error than conventional methods. For comparison, the ability of 30 physicians to estimate TBSAB was tested. Parameters studied included the effect of prior burn care experience, the influence of burn size, the ability to accurately sketch the size of burns on standard burn charts, and the ability to estimate percent TBSAB from the sketches. Despite the ability for physicians of all levels of training to accurately sketch TBSAB, significant burn size over-estimation (p less than 0.01) and large interrater variability of potential consequence was noted. Direct benefits of a computerized system are many. These include the need for minimal user experience and the ability for wound-trend analysis, permanent record storage, calculation of fluid and caloric requirements, hemodynamic parameters, and the ability to compare meaningfully the different treatment protocols.

Prescribed burning in the North Central States.

Treesearch

Linda R. Donoghue; Von J. Johnson

1975-01-01

Describes 5 years of prescribed burning in the North Central States from 1968 through 1972. Provides information concerning participating agencies, burned-acreage, purpose-of-burn, fuels, and weather. Also examines other aspects such as ignition and burning techniques, hours-to-complete, time of fire start, and cost-per-acre.

Controls on boreal peat combustion and resulting emissions of carbon and mercury

NASA Astrophysics Data System (ADS)

Kohlenberg, Andrew J.; Turetsky, Merritt R.; Thompson, Dan K.; Branfireun, Brian A.; Mitchell, Carl P. J.

2018-03-01

Warming in the boreal forest region has already led to changes in the fire regime. This may result in increasing fire frequency or severity in peatlands, which could cause these ecosystems to shift from a net sink of carbon (C) to a net source of C to the atmosphere. Similar to C cycling, peatlands serve as a net sink for mercury (Hg), which binds strongly to organic matter and accumulates in peat over time. This stored Hg is also susceptible to re-release to the atmosphere during peat fires. Here we investigate the physical properties that influence depth of burn in experimental peat columns and the resulting emissions of CO, CO2, CH4, and gaseous and particulate Hg. As expected, bulk density and soil moisture content were important controls on depth of burn, CO2 emissions, and CO emissions. However, our results show that CH4 and Hg emissions are insensitive to combustion temperature or fuel moisture content. Emissions during the burning of peat, across a wide range of moisture conditions, were associated with low particulate Hg and high gaseous Hg release. Due to strong correlations between total Hg and CO emissions and because high Hg emissions occurred despite incomplete combustion of total C, our results suggest that Hg release during peat burning is governed by the thermodynamics of Hg reduction more so than by the release of Hg associated with peat combustion. Our measured emissions ratios, particularly for CH4:CO2, are higher than values typically used in the upscaling of boreal forest or peatland fire emissions. These emission ratios have important implications not only for our understanding of smouldering chemistry, but also for potential influences of peat fires on the Earth’s climate system.

Network analysis of wildfire transmission and implications for risk governance

PubMed Central

Ager, Alan A.; Evers, Cody R.; Day, Michelle A.; Preisler, Haiganoush K.; Barros, Ana M. G.; Nielsen-Pincus, Max

2017-01-01

We characterized wildfire transmission and exposure within a matrix of large land tenures (federal, state, and private) surrounding 56 communities within a 3.3 million ha fire prone region of central Oregon US. Wildfire simulation and network analysis were used to quantify the exchange of fire among land tenures and communities and analyze the relative contributions of human versus natural ignitions to wildfire exposure. Among the land tenures examined, the area burned by incoming fires averaged 57% of the total burned area. Community exposure from incoming fires ignited on surrounding land tenures accounted for 67% of the total area burned. The number of land tenures contributing wildfire to individual communities and surrounding wildland urban interface (WUI) varied from 3 to 20. Community firesheds, i.e. the area where ignitions can spawn fires that can burn into the WUI, covered 40% of the landscape, and were 5.5 times larger than the combined area of the community core and WUI. For the major land tenures within the study area, the amount of incoming versus outgoing fire was relatively constant, with some exceptions. The study provides a multi-scale characterization of wildfire networks within a large, mixed tenure and fire prone landscape, and illustrates the connectivity of risk between communities and the surrounding wildlands. We use the findings to discuss how scale mismatches in local wildfire governance result from disconnected planning systems and disparate fire management objectives among the large landowners (federal, state, private) and local communities. Local and regional risk planning processes can adopt our concepts and methods to better define and map the scale of wildfire risk from large fire events and incorporate wildfire network and connectivity concepts into risk assessments. PMID:28257416

Pyrogenic carbon from tropical savanna burning: production and stable isotope composition

NASA Astrophysics Data System (ADS)

Saiz, G.; Wynn, J. G.; Wurster, C. M.; Goodrick, I.; Nelson, P. N.; Bird, M. I.

2014-10-01

Widespread burning of mixed tree-grass ecosystems represents the major natural locus of pyrogenic carbon (PyC) production. PyC is a significant, pervasive, and yet poorly understood "slow-cycling" form of carbon present in the atmosphere, hydrosphere, soils and sediments. We conducted sixteen experimental burns on a rainfall transect in northern Australian savannas with C4 grasses ranging from 35 to 99% of total biomass. Residues from each fire were partitioned into PyC and further into recalcitrant (HyPyC) components, with each of these also partitioned into proximal (> 125 μm) and distal (< 125 μm) fluxes. The median [range] PyC production across all burns was 16.0 [11.5]% of total carbon exposed (TCE), with HyPyC accounting for 2.5 [4.9]% of TCE. Both PyC and HyPyC were dominantly partitioned into the proximal flux, likely to remain (initially) close to the site of production. Production of HyPyC was strongly related to fire residence time, with shorter duration fires resulting in higher HyPyC yields. The carbon isotope (δ13C) compositions of PyC and HyPyC were generally lower by 1-3‰ relative to the original biomass, with marked depletion up to 7 ‰ for grasslands dominated by C4 biomass. δ13C values of CO2 produced by combustion was computed by mass balance and ranged from ~0.4 to 1.3‰. The depletion of 13C in PyC and HyPyC relative to the original biomass has significant implications for the interpretation of δ13C values of savanna soil organic carbon and of ancient PyC preserved in the geologic record, and for global 13C isotopic disequilibria calculations.

Network analysis of wildfire transmission and implications for risk governance.

PubMed

Ager, Alan A; Evers, Cody R; Day, Michelle A; Preisler, Haiganoush K; Barros, Ana M G; Nielsen-Pincus, Max

2017-01-01

We characterized wildfire transmission and exposure within a matrix of large land tenures (federal, state, and private) surrounding 56 communities within a 3.3 million ha fire prone region of central Oregon US. Wildfire simulation and network analysis were used to quantify the exchange of fire among land tenures and communities and analyze the relative contributions of human versus natural ignitions to wildfire exposure. Among the land tenures examined, the area burned by incoming fires averaged 57% of the total burned area. Community exposure from incoming fires ignited on surrounding land tenures accounted for 67% of the total area burned. The number of land tenures contributing wildfire to individual communities and surrounding wildland urban interface (WUI) varied from 3 to 20. Community firesheds, i.e. the area where ignitions can spawn fires that can burn into the WUI, covered 40% of the landscape, and were 5.5 times larger than the combined area of the community core and WUI. For the major land tenures within the study area, the amount of incoming versus outgoing fire was relatively constant, with some exceptions. The study provides a multi-scale characterization of wildfire networks within a large, mixed tenure and fire prone landscape, and illustrates the connectivity of risk between communities and the surrounding wildlands. We use the findings to discuss how scale mismatches in local wildfire governance result from disconnected planning systems and disparate fire management objectives among the large landowners (federal, state, private) and local communities. Local and regional risk planning processes can adopt our concepts and methods to better define and map the scale of wildfire risk from large fire events and incorporate wildfire network and connectivity concepts into risk assessments.

Paediatric burn unit in Portugal: Beds needed using a bed-day approach.

PubMed

Santos, João V; Viana, João; Amarante, José; Freitas, Alberto

2017-03-01

Despite the high burden of children with burns, there is not a paediatric burn unit (PBU) in Portugal. We aimed to estimate the Portuguese health care providing needs on paediatric burns. We performed a nation-wide retrospective study, between 2009 and 2013, among less than 16 years-old inpatients with burns that met the transfer criteria to a burn unit in Portugal. A bed-day approach was used, targeting an occupancy rate of 70-75%, and possible locations were studied. The primary outcome was the number of beds needed, and secondary outcomes were the overload and revenue for each possible number of beds in a PBU. A total of 1155 children met the transfer criteria to a burn unit, representing a total of 17,371 bed-days. Occupancy rates of 11-bed, 12-bed, 13-bed and 14-bed PBU were, respectively, 79.7%, 75.3%, 71.0% and 66.8%. The 13-bed PBU scenario would represent an overload of 523 bed-days, revenue of more than 5 million Euros and a ratio of 1 PBU bed per 123,409 children. Using a groundbreaking approach, the optimal number of PBU beds needed in Portugal is 13. However, as half of the patients who met burn transfer criteria are not transferred, this bed number might be overestimated if this pattern maintains, despite the underestimation with our method approach. If a PBU is to be created the preferable location is Porto. Cost-effectiveness studies should be performed. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Targeting burn prevention in Ukraine: evaluation of base knowledge in burn prevention and first aid treatment.

PubMed

Gamelli, Liza; Mykychack, Iryna; Kushnir, Antin; Driscoll, Daniel N; Fuzaylov, Gennadiy

2015-01-01

Burn prevention has been identified by the World Health Organization (WHO) as a topic in need of further investigation and education throughout the world, with an increased need in low-income countries. It has been noted that implementing educational programs for prevention in high income countries has aided in lowering the rate of burn injuries. The purpose of this study is to evaluate the current education level of knowledge of prevention and first aid treatment of scald burns. A prevention campaign will target these educational needs as a part of an outreach program to improve burn care in Ukraine. The research team evaluated the current health structure in Ukraine and how it could benefit from the increased knowledge of burn prevention and first aid. A test was designed to assess the baseline level of knowledge with regard to first aid and scald prevention in parents, pregnant woman, and healthcare and daycare providers. A total of 14,456 tests were sent to pediatric clinics, obstetrician clinics, and daycare facilities to test respondents. A total of 6,120 completed tests were returned. Doctors presented with the highest level of knowledge averaging 77.0% on prevention and 67.5% on first aid while daycare workers presented the largest gap in knowledge at 65.0% in prevention and 54.3% in first aid. Interest in further educational materials was reported by 92% of respondents. The results of this study clearly show a lack of knowledge in first aid and prevention of scald burn injury in all the populations tested.

Effect of prescribed fire on soil properties and N transformation in two vegetation types in South China.

PubMed

Wang, Faming; Li, Jian; Zou, Bi; Xu, Xin; Li, Zhian

2013-06-01

Prescribed fire is a common site preparation practice in forest management in southern China. However, the effect of fire on soil properties and N transformations is still poorly understood in this region. In this study, soil properties and N transformations in burned and unburned site of two vegetation types (Eucalyptus plantation and shrubland) were compared in rainy and dry seasons after 2 years' prescribed fire. Soil pH and soil NH4-N were all higher in the burned site compared to the unburned control. Furthermore, burned sites had 30-40 % lower of soil total phosphorus than conspecific unburned sites. There was no difference in soil organic matter, total N, soil exchangeable cations, available P or NO3-N. Nitrogen mineralization rate of 0-5 cm soil in the unburned site ranged from 8.24 to 11.6 mg N kg(-1) soil month(-1) in the rainy season, compared to a lower level of 4.82-5.25 mg N kg(-1) soil month(-1) in the burned sites. In contrast, 0-5 cm layer nitrification rate was overall 2.47 mg N kg(-1) soil month(-1) in the rainy season, and was not significantly affected by burning. The reduced understory vegetation coverage after burning may be responsible for the higher soil NH4-N in the burned site. This study highlights that a better understanding the effect of prescribed burning on soil nutrients cycling would provide a critical foundation for management decision and be beneficial to afforestation in southern China.

Lawn mower-related burns.

PubMed

Still, J; Orlet, H; Law, E; Gertler, C

2000-01-01

Lawn mower-related injuries are fairly common and are usually caused by the mower blades. Burns may also be associated with the use of power lawn mowers. We describe 27 lawn mower-related burn injuries of 24 male patients and 3 female patients. Three of the patients with burn injuries were children. Burn sizes ranged from 1% to 99% of the total body surface area (mean, 18.1%). Two of the patients died. The hospital stay ranged from 1 day to 45 days. Twenty-six injuries involved gasoline, which is frequently associated with refueling accidents. Safety measures should involve keeping children away from lawn mowers that are being used. The proper use and storage of gasoline is stressed.

County-level analysis of the impact of temperature and population increases on California wildfire data

USGS Publications Warehouse

Baltar, M.; Keeley, Jon E.; Schoenberg, F.P.

2013-01-01

The extent to which the apparent increase in wildfire incidence and burn area in California from 1990 to 2006 is affected by population and temperature increases is examined. Using generalized linear models with random effects, we focus on the estimated impacts of increases in mean daily temperatures and populations in different counties on wildfire in those counties, after essentially controlling for the overall differences between counties in their overall mean temperatures and populations. We find that temperature increase appears to have a significant positive impact on both total burn area and number of observed wildfires. Population growth appears to have a much less pronounced impact on total burn area than do annual temperature increases, and population growth appears to be negatively correlated with the total number of observed wildfires. These effects are especially pronounced in the winter season and in Southern California counties.

Response of a local hospital to a burn disaster: Contributory factors leading to zero mortality outcomes.

PubMed

Yeong, Eng-Kean; O'Boyle, Ciaran P; Huang, Hui-Fu; Tai, Hao-Chih; Hsu, Yen-Chun; Chuang, Shu-Yang; Wu, Yu-Feng; Chang, Che-Wei; Liu, Tom J; Lai, Hong-Shiee

2018-05-09

To investigate the outcomes of a local healthcare system in managing a burn mass casualty incident (BMCI). Thirty-three victims admitted to the National Taiwan University Hospital within 96h of the explosion were included in the study. Data were recorded on: patient demographics, Baux score, laboratory data, management response, treatment strategies, and outcomes. Case notes from June 27, 2015 to November 2015 were reviewed with a focus on fluid resuscitation, ventilation support, nutrition, infection control, sepsis treatment, and wound closure plan. Female predominance (mean age: 21.7 years) and lower extremity circumferential flame burns were the characteristics of the burn injury. The mean Baux score was 70±18. The mean burn area was 42% of the total body surface area (TBSA). A total of 79% patients arrived at the hospital within 24h of sustaining injuries. Intensive care unit (ICU) admission criteria were modified to accommodate patients with 40% TBSA of burns, facilities were expanded from 4 ICU beds to 18 beds, and new staff was recruited. A total of 36% patients (n=12/33, 62±13 TBSA of burns) required fluid resuscitation. The mean volume of Lactate Ringer administered in the first 24h of burns was 3.34±2.18ml/kg/%TBSA, while the mean volume of fresh frozen plasma administered was 0.60±0.63ml/kg/h. Forty-two percent patients were intubated on the day of admission, and 71% of the intubated patients had inhalation injuries that were confirmed by diagnostic bronchoscopy. The mean intubation period was 17±9 days. The incidence of pulmonary edema was 58% (n=7/12), possibly due to sub-optimal monitoring. Of these, 57% (n=4/7) patients progressed to adult respiratory distress syndrome, but were successfully treated with early strict fluid restriction, systemic antibiotics, ventilation support, and bronchial lavage. A total of 94% patients received grafting. The mean grafted area was 4432.3±3891cm 2 . Tube feeding was provided to patients with burns >40% TBSA. All patients tolerated gastric tube feeding without conversion to duodenal switch. On admission, all patients received prophylactic antibiotics. Septic shock was noted in 12 patients, but no mortality occurred. The mean hospital stay was 1.5 days per percent burn. This article highlights the value of precise triage, traffic control, and effective resource allocation in treating a BMCI. Effective supporting systems for facility expansion, staff recruitment, medical supplies and clear-cut treatment strategies for severely burned patients are contributory factors leading to zero mortalities in our series, in addition to young age and minimal inhalation injuries. The need for reevaluation of the safety of cornstarch powder in festival activities is clear. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

Burns in sub-Saharan Africa: A review.

PubMed

Nthumba, Peter M

2016-03-01

Burns are important preventable causes of morbidity and mortality, with a disproportionate incidence in sub-Saharan Africa. The management of these injuries in sub-Saharan Africa is a challenge because of multiple other competing problems such as infectious diseases (HIV/AIDS, tuberculosis and malaria), terrorist acts and political instability. There is little investment in preventive measures, pre-hospital, in-hospital and post-discharge care of burns, resulting in high numbers of burns, high morbidity and mortality. Lack of data that can be used in legislation and policy formulation is a major hindrance in highlighting the problem of burns in this sub-region. An online search of publications on burns from sub-Saharan countries was performed. A total of 54 publications with 32,862 patients from 14 countries qualified for inclusion in the study. The average age was 15.3 years. Children aged 10 years and below represented over 80% of the burn patient population. Males constituted 55% of those who suffered burns. Scalds were the commonest cause of thermal injuries, accounting for 59% of all burns, while flame burns accounted for 33%. The burn mortality averaged 17%, or the death of one of every five burn victims. These statistics indicate the need for an urgent review of burn policies and related legislation across the sub-Saharan region to help reduce burns, and provide a safe environment for children. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

NICER Discovers mHz Oscillations and Marginally Stable Burning in GS 1826-24

NASA Astrophysics Data System (ADS)

Strohmayer, Tod E.; Gendreau, Keith C.; Keek, Laurens; Bult, Peter; Mahmoodifar, Simin; Chakrabarty, Deepto; Arzoumanian, Zaven; NICER Science Team

2018-01-01

To date, marginally stable thermonuclear burning, evidenced as mHz X-ray flux oscillations, has been observed in only five accreting neutron star binaries, 4U 1636-536, 4U 1608-52, Aql X-1, 4U 1323-619 and Terzan 5 X-2. Here we report the discovery with NASA's Neutron Star Interior Composition Explorer (NICER) of such oscillations from the well-known X-ray burster GS 1826-24. NICER observed GS 1826-24 on 9 September, 2017 for a total exposure of about 4 ksec. Timing analysis revealed highly significant oscillations at a frequency of 8.2 mHz in two successive pointings. The oscillations have a fractional modulation amplitude of approximately 3% for photon energies less than 6 keV. The observed frequency is consistent with the range observed in the other mHz QPO systems, and indeed is slightly higher than the frequency measured in 4U 1636-536 below which mHz oscillations ceased and unstable burning (X-ray bursts) resumed. We discuss the mass accretion rate dependence of the oscillations as well as the X-ray spectrum as a function of pulsation phase. We place the observations in the context of the current theory of marginally stable burning and briefly discuss the potential for constraining neutron star properties using mHz oscillations.

Decreasing incidence of cutaneous chemical burns in a resource limited burn centre: is this a positive effect of modernization?

PubMed

Nnabuko, R E E; Okoye, C P; Ogbonnaya, I S; Isiwele, Egi

2017-01-01

Burns present a devastating injury to patients. Burns caused by chemical agents, present a worse scenario. In a resource limited country like Nigeria, readily available sources of these corrosive agents are mainly from lead-acid battery vendors and to some extent local small scale soap manufacturers who use caustic soda. We hypothesized that with the reduction in small scale soap manufacturing and increasing trend towards modernization in the use of dry cell batteries, chemical burns may be on the decline, and we sought to investigate this. The records of all acute burn patients seen at the Burns and Plastic Department of the National Orthopaedic Hospital Enugu Nigeria between January 2011 and December 2014 were retrospectively reviewed. The results were compared to similar studies carried out at the same centre. A questionnaire was administered to corrosive chemical (sulphuric and caustic soda) vendors to assess the trends in product sales and use in recent times. A total of 624 acute burn cases were treated during the period; among which, 12 cases (1.9%) were chemical burns. When compared with previous studies at the centre, Chemical burn cases were  recorded as the lowest rate. The median age of patients was 24 years. There were eight males and four females. Interpersonal assault was the commonest mechanism of injury with sulphuric acid suspected to be the commonest agent in 83.3% of the cases, while 16.7% of the cases were from accidental use of caustic soda. The head and neck as well as the upper limbs were the most affected (30%). Twenty-six questionnaires to lead-acid vendors were analyzed and revealed that all respondents noticed a marked downward trend in the sale of either sulphuric acid or caustic soda, and they attributed this to the ready availability of imported alternatives to locally manufactured soap or wet lead-acid batteries. Ease of use, durability and convenience of the dry cell batteries were cited as principal reasons. There appears to be a downward trend in the prevalence of chemical burns in our study compared to previous studies in the centre which may be due to reduced availability and access of corrosive chemicals to the general public. Further prospective multicentre studies to confirm this are recommended.

A New Method of Deriving Time-Averaged Tropospheric Column Ozone over the Tropics Using Total Ozone Mapping Spectrometer (TOMS) Radiances: Intercomparison and Analysis Using TRACE A Data

NASA Technical Reports Server (NTRS)

Kim, J. H.; Hudson, R. D.; Thompson, A. M.

1996-01-01

Error analysis of archived total 03 from total ozone mapping spectrometer (TOMS) (version 6) presented. Daily total 03 maps for the tropics, from the period October 6-21, 1992, are derived from TOMS radiances following correction for these errors. These daily maps, averaged together, show a wavelike feature, which is observed in all latitude bands, underlying sharp peaks which occur at different longitudes depending on the latitude. The wave pattern is used to derive both time-averaged stratospheric and tropospheric 03 fields. The nature of the wave pattern (stratospheric or tropospheric) cannot be determined with certainty due to missing data (no Pacific sondes, no lower stratospheric Stratospheric Aerosol and Gas Experiment (SAGE) ozone for 18 months after the Mt. Pinatubo eruption) and significant uncertainties in the corroborative satellite record in the lower stratosphere (solar backscattered ultraviolet (SBUV), microwave limb sounder (MLS)). However, the time- averaged tropospheric ozone field, based on the assumption that the wave feature is stratospheric, agrees within 10% with ultraviolet differential absorption laser Transport and Atmospheric Chemistry near the Equator-Atlantic) (TRACE A) 03 measurements from the DC-8 and with ozonesonde measurements over Brazzaville, Congo, Ascension Island, and Natal, Brazil, for the period October 6-21, 1992. The derived background (nonpolluted) Indian Ocean tropospheric ozone amount, 26 Dobson units (DU), agrees with the cleanest African ozonesonde profiles for September-October 1992. The assumption of a totally tropospheric wave (flat stratosphere) gives 38 DU above the western Indian Ocean and 15-40% disagreements with the sondes. Tropospheric column 03 is high from South America to Africa, owing to interaction of dynamics with biomass burning emissions. Comparison with fire distributions from advanced very high resolution radiometer (AVHHR) during October 1992 suggests that tropospheric 03 produced from biomass burning in South America and Africa dominates the 03 budget in the tropical southern hemisphere during the study period.

Neuromuscular pharmacodynamics of mivacurium in adults with major burns.

PubMed

Han, T-H; Martyn, J A J

2011-05-01

Mivacurium is metabolized by plasma pseudocholinesterase (PChE) enzyme, which is decreased in burns. We tested whether the decreased metabolism of mivacurium due to decreased PChE activity can overcome the pharmacodynamic resistance to non-depolarizing relaxants previously seen in major burns. Thirty adults with 35 (13)% [mean (sd)] burn were studied at 5-91 post-burn days and 31 non-burns matched controls. Mivacurium 0.2 mg kg(-1) was administered as a single bolus. Neuromuscular block was monitored with single-twitch response using TOF-Watch™. Onset time (drug administration to maximal twitch suppression) and spontaneous recovery were measured. Onset time was significantly prolonged in burns when compared with non-burns (115 vs 90 s; P<0.001). The PChE levels were lower in burns [1432 (916) vs 2866 (731) IU litre(-1); P<0.001] and the neuromuscular recovery to 50% of baseline twitch height was prolonged in burns (41 vs 26 min; P<0.001). There was a significant correlation between PChE and time to 50% recovery for the whole group together (r=-0.6; P<0.001). The dibucaine numbers were not different. The prolonged onset time suggests resistance to neuromuscular effects, whereas the prolonged recovery suggests increased sensitivity. This divergent response can be explained by qualitative and quantitative changes in acetylcholine receptor expression causing resistance and decreased PChE activity causing sensitivity. Despite using a relatively large dose of mivacurium (0.2 mg kg(-1)) in the presence of decreased PChE levels, this did not overcome the resistance resulting from up-regulated receptors.

Methylated spirit burns: an ongoing problem.

PubMed

Jansbeken, J R H; Vloemans, A F P M; Tempelman, F R H; Breederveld, R S

2012-09-01

Despite many educational campaigns we still see burns caused by methylated spirit every year. We undertook a retrospective study to analyse the impact of this problem. We retrospectively collected data of all patients with burns caused by methylated spirit over twelve years from 1996 to 2008. Our main endpoints were: incidence, age, mechanism of injury, total body surface area (TBSA) burned, burn depth, need for surgery and length of hospital stay. Ninety-seven patients with methylated spirit burns were included. During the study period there was no decrease in the number of patients annually admitted to the burn unit with methylated spirit burns. 28% of the patients (n=27) were younger than eighteen years old, 15% (n=15) were ten years old or younger. The most common cause of burns was carelessness in activities involving barbecues, campfires and fondues. Mean TBSA burned was 16% (SD 12.4). 70% (n=68) had full thickness burns. 66% (n=64) needed grafting. Mean length of hospital stay was 23 days (SD 24.7). The use of methylated spirit is an ongoing problem, which continues to cause severe burns in adults and children. Therefore methylated spirit should be banned in households. We suggest sale only in specialised shops, clear labelling and mandatory warnings. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Particle and gas emissions from a simulated coal-burning household fire pit.

PubMed

Tian, Linwei; Lucas, Donald; Fischer, Susan L; Lee, S C; Hammond, S Katharine; Koshland, Catherine P

2008-04-01

An open fire was assembled with firebricks to simulate the household fire pit used in rural China, and 15 different coals from this area were burned to measure the gaseous and particulate emissions. Particle size distribution was studied with a microorifice uniform-deposit impactor (MOUDI). Over 90% of the particulate mass was attributed to sub-micrometer particles. The carbon balance method was used to calculate the emission factors. Emission factors for four pollutants (particulate matter, CO2, total hydrocarbons, and NOx) were 2-4 times higherfor bituminous coals than for anthracites. In past inventories of carbonaceous emissions used for climate modeling, these two types of coal were not treated separately. The dramatic emission factor difference between the two types of coal warrants attention in the future development of emission inventories.

Electronic diary evidence on energy erosion in clinical burnout.

PubMed

Sonnenschein, Mieke; Sorbi, Marjolijn J; van Doornen, Lorenz J P; Schaufeli, Wilmar B; Maas, Cora J M

2007-10-01

Burnout is generally defined as a state of severe exhaustion. So far, research has predominantly focused on relatively mild burnout in employees able to work despite their complaints. This study examines energy depletion in clinical burnout (e.g., the severest cases on extended sick leave) by comparing the diurnal patterns of fatigue and exhaustion with those of healthy individuals. Sixty clinically burned-out and 40 healthy participants kept an electronic diary for 14 days, 7 times a day, yielding a total of 8,116 diary entries. This study shows that burned-out individuals typically suffer continuously from a severe fatigue throughout the day. The resulting flattened diurnal cycles mark a stable exhaustion that is uncommon in healthy persons. The current results provide novel support for the existence of severe energy erosion in clinical burnout.

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

Ezzati, M.; Mbinda, B.M.; Kammen, D.M.

Suspended particulate matter and carbon emissions from the combustion of biomass, in addition to their environmental consequences, have been causally associated with the incidence of respiratory and eye infections. Improved stoves offer the potential for emissions reduction. The authors compare the emissions of suspended particulate matter and carbon monoxide from traditional and improved biofuel stoves in Kenya under the actual conditions of household use. Data for analysis is from 137 14-h days of continuous real-time emission concentration monitoring in a total of 38 households. Their analysis shows that improved (ceramic) wood-burning stoves reduce daily average suspended particulate matter concentration bymore » 48% during the active burning period and by 77% during the smoldering phase. Ceramic stoves also reduce the median and the 75th and 95th percentiles of daily emission concentration during the burning period and the 95th percentile during the smoldering phase, and therefore shift the overall emission profile downward. Improved charcoal-burning stoves also offer reductions in indoor air pollution compared to the traditional metal stove, but these are not statistically significant. The greatest reduction in emission concentration is achieved as a result of transition from wood to charcoal where mean emission concentrations drop by 87% during the burning period and by 92% when smoldering as well as large reductions in the median and 75th and 95th percentiles. These results indicate that transition to charcoal, followed by the use of improved wood stoves, are viable options for reduction of human exposure to indoor air pollution in many developing nations.« less

Assessing Satellite-Based Fire Data for use in the National Emissions Inventory

NASA Technical Reports Server (NTRS)

Soja, Amber J.; Al-Saadi, Jassim; Giglio, Louis; Randall, Dave; Kittaka, Chieko; Pouliot, George; Kordzi, Joseph J.; Raffuse, Sean; Pace, Thompson G.; Pierce, Thomas E.;

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.

Vagus nerve stimulation blocks vascular permeability following burn injury in both local and distal sites

PubMed Central

Ortiz-Pomales, Yan T; Krzyzaniak, Michael; Coimbra, Raul; Baird, Andrew; Eliceiri, Brian P.

2012-01-01

Recent studies have shown that vagus nerve stimulation (VNS) can block the burn injury-induced systemic inflammatory response (SIRS). In this study we examined the potential for VNS to modulate vascular permeability (VP) in local sites (i.e. skin) and in secondary sites (i.e. lung) following burn injury. In a 30% total body surface area burn injury model, VP was measured using intravascular fluorescent dextran for quantification of the VP response in skin and lung. A peak in VP of the skin was observed 24 hours post-burn injury, that was blocked by VNS. Moreover, in the lung, VNS led to a reduction in burn-induced VP compared to sham-treated animals subjected to burn injury alone. The protective effects of VNS in this model were independent of the spleen, suggesting that the spleen was not a direct mediator of VNS. These studies identify a role for VNS in the regulation of VP in burns, with the translational potential of attenuating lung complications following burn injury. PMID:22694873

Lone star tick abundance, fire, and bison grazing in tall-grass prairie

USGS Publications Warehouse

Cully, J.F.

1999-01-01

Lone star ticks (Amblyomma americanum L.) were collected by drag samples of 1 km transects on 12 watersheds at Konza Prairie Research Natural Area near Manhattan, Kans., during summer 1995-1996. Watersheds were treated to 2 experimental treatments: 3 burn intervals (1-year, 4-year, and 20-year) and 2 grazing treatments (grazed by bison (Bos bison L.) or ungrazed). The objectives were to determine whether fire interval, time since most recent burn, and the presence of large ungulate grazers would cause changes in lone star tick abundance in tallgrass prairie in central Kansas. Watersheds burned at 1-year intervals had fewer larvae and adults than watersheds burned at 4-year or 20-year intervals. Watersheds burned during the year of sampling had fewer ticks than watersheds burned one or more years in the past. For watersheds burned 1 or more years in the past there was no effect from time since burn. The presence of bison did not affect tick abundance. Spring burning is an effective method to reduce tick populations in tallgrass prairie during the year of the burn.

An assessment of biofuel use and burning of agricultural waste in the developing world

NASA Astrophysics Data System (ADS)

Yevich, Rosemarie; Logan, Jennifer A.

2003-12-01

We present an assessment of biofuel use and agricultural field burning in the developing world. We used information from government statistics, energy assessments from the World Bank, and many technical reports, as well as from discussions with experts in agronomy, forestry, and agro-industries. We estimate that 2060 Tg biomass fuel was used in the developing world in 1985; of this, 66% was burned in Asia, and 21% and 13% in Africa and Latin America, respectively. Agricultural waste supplies about 33% of total biofuel use, providing 39%, 29%, and 13% of biofuel use in Asia, Latin America, and Africa, and 41% and 51% of the biofuel use in India and China. We find that 400 Tg of crop residues are burned in the fields, with the fraction of available residue burned in 1985 ranging from 1% in China, 16-30% in the Middle East and India, to about 70% in Indonesia; in Africa about 1% residue is burned in the fields of the northern drylands, but up to 50% in the humid tropics. We distributed this biomass burning on a spatial grid with resolution of 1° × 1°, and applied emission factors to the amount of dry matter burned to give maps of trace gas emissions in the developing world. The emissions of CO from biofuel use in the developing world, 156 Tg, are about 50% of the estimated global CO emissions from fossil fuel use and industry. The emission of 0.9 Pg C (as CO2) from burning of biofuels and field residues together is small, but nonnegligible when compared with the emissions of CO2 from fossil fuel use and industry, 5.3 Pg C. The biomass burning source of 10 Tg/yr for CH4 and 2.2 Tg N/yr of NOx are relatively small when compared with total CH4 and NOx sources; this source of NOx may be important on a regional basis.

Major burn injuries associated with Christmas celebrations: a 41-year experience from Switzerland

PubMed Central

Rohrer-Mirtschink, S.; Forster, N.; Giovanoli, P.; Guggenheim, M.

2015-01-01

Summary In Switzerland it is customary to light candles on Christmas trees and advent wreaths. This tradition leads to an increased risk of home fires. We reviewed the records of patients who sustained burn injuries from a lit Christmas tree or advent wreath during the Christmas holidays between January 1971 and January 2012. We treated 28 patients and observed 4 fatalities (mortality rate: 14%). 61% of the patients were male, 39% were female. The mean abbreviated burn severity index (ABSI) was 6.5 points in the group of the survivors and 10.8 points in the group of the non-survivors. The mean total body surface area burned (TBSA) for survivors was 18.9%, with 14.1% having full thickness burns; for the non-survivors the mean TBSA was 45.2%, with 38% having full thickness burns. The Mann-Whitney U-test showed a significant difference between the survivors and the fatalities concerning the mean total and full thickness burned body surface area (p value 0.009 and 0.012). More than sixty percent of the fires occurred in January and the most severe accidents were seen after January 4th. Despite Christmas decoration-associated fires being relatively uncommon, they tend to cause more serious injuries than regular household fires. We recommend that in countries where it is customary to set up flammable Christmas decorations, state-issued information pamphlets with instructions on fire safety conduct should be distributed. PMID:26668566

Quantifying the effects of wildfire on changes in soil properties by surface burning of soils from the Boulder Creek Critical Zone Observatory

USGS Publications Warehouse

Wieting, Celeste; Ebel, Brian A.; Singha, Kamini

2017-01-01

Study regionThis study used intact soil cores collected at the Boulder Creek Critical Zone Observatory near Boulder, Colorado, USA to explore fire impacts on soil properties.Study focusThree soil scenarios were considered: unburned control soils, and low- and high-temperature burned soils. We explored simulated fire impacts on field-saturated hydraulic conductivity, dry bulk density, total organic carbon, and infiltration processes during rainfall simulations.New hydrological insights for the regionSoils burned to high temperatures became more homogeneous with depth with respect to total organic carbon and bulk density, suggesting reductions in near-surface porosity. Organic matter decreased significantly with increasing soil temperature. Tension infiltration experiments suggested a decrease in infiltration rates from unburned to low-temperature burned soils, and an increase in infiltration rates in high-temperature burned soils. Non-parametric statistical tests showed that field-saturated hydraulic conductivity similarly decreased from unburned to low-temperature burned soils, and then increased with high-temperature burned soils. We interpret these changes result from the combustion of surface and near-surface organic materials, enabling water to infiltrate directly into soil instead of being stored in the litter and duff layer at the surface. Together, these results indicate that fire-induced changes in soil properties from low temperatures were not as drastic as high temperatures, but that reductions in surface soil water repellency in high temperatures may increase infiltration relative to low temperatures.

Psychometric properties of the Brisbane Burn Scar Impact Profile in adults with burn scars

PubMed Central

Kimble, Roy; McPhail, Steven; Plaza, Anita; Simons, Megan

2017-01-01

Objective The aim of the study was to determine the longitudinal validity, reproducibility, responsiveness and interpretability of the adult version of the Brisbane Burn Scar Impact Profile, a patient-report measure of health-related quality of life. Methods A prospective longitudinal cohort study of patients with or at risk of burn scarring was conducted at three assessment points (at baseline around the time of wound healing, one to two weeks post-baseline and 1-month post-baseline). Participants attending a major metropolitan adult burn centre at baseline were recruited. Participants completed the Brisbane Burn Scar Impact Profile and the 36-item Short Form Health Survey and Patient Observer Scar Assessment Scale. Intraclass Correlation Coefficients (ICCs), smallest detectable change, percentage of those who improved, stayed the same or worsened and Area under the Receiver Operating Characteristic Curve (AUC) were used to test the aim. Results Data were included for 118 participants at baseline, 68 participants at one to two weeks and 57 participants at 1-month post-baseline. All groups of items had acceptable reproducibility, except for the overall impact of burn scars (ICC = 0.69), the impact of sensations which was not expected to be stable (ICC = 0.63), mobility and daily activities (ICC = 0.63, 0.67 respectively). The responsiveness of six out of seven groups of items able to be tested against external criterion was supported (AUC = 0.72–0.75). Hypothesised correlations of changes in the Brisbane Burn Scar Impact Profile items with changes in criterion measures generally supported longitudinal validity (e.g., nine out of thirteen hypotheses using the SF-36 as an external criterion were supported). Internal consistency estimates, item-total and inter-item correlations indicated there was likely redundancy of some groups of items, particularly in the relationships and social interaction, appearance and emotional reactions items (Chronbach’s alpha range = 0.94–0.95). Conclusion Support was found for the reproducibility, longitudinal validity, responsiveness and interpretability of most groups of Brisbane Burn Scar Impact Profile items and some individual items in the test population. Potential redundancy of items should be investigated further. PMID:28902874

Basic investigation into the present burn care system in China: burn units, doctors, nurses, beds and special treatment equipment.

PubMed

Zhanzeng, Feng; Yurong, Zheng; Chuangang, You; Yunyun, Jin; Xingang, Wang; Zhaofan, Xia; Chunmao, Han

2015-03-01

The aim of the study was to survey the current burn units in China to understand the burn care system in the country and supply basic data for the National Burn Repository of China (NBRC) and further research. A questionnaire was developed and sent to burn unit directors in China via e-mail, which was followed up with reminder text messages to obtain information for the study. Of the 405 hospitals from the 31 provinces in mainland China that responded to the questionnaire, 63.7% of the responses came from Grade 3A hospitals, and the most popular model of organisation was the Burns and Plastic Surgery arrangement (63.0%). An average of 9.43±0.351 doctors work in each burn unit with 70.4% of all units having 4-11 doctors. The ratio of chief surgeon to associate chief surgeon to attending surgeon to resident surgeon and surgeon assistant was 1:1.8:2.2:2.3. An average of 30% of all doctors in each burn unit held postgraduate degrees, and more than 90% of all surgeons held a bachelor's degree or higher. There were 16.48±0.637 nurses per burn unit, 56.5% of burn units had 8-15 nurses, and the ratio of chief nurse to associate chief nurse to supervisor nurse to nurse practitioner to junior nurse was 1:11.8:57.0:82.1:86.1. More than 80% of all nurses had received a college education or above. However, only 30% of nurses held bachelor's degrees or higher, while only 0.66% of nurses had received postgraduate degrees. A total of 39.91±1.50 beds were available in each burn unit and 45% of burn units had 20-39 beds. Up to 70% of the total beds were prepared for patients with burn, and more than 10% of the beds were specifically for patients with severe burn. The ratios of doctors to nurses, beds to doctors, beds to nurses, and beds to doctors and nurses were 0.64±0.01, 4.48±0.12, 2.67±0.09, and 1.66±0.06, respectively. The workload of each doctor and nurse was most heavy in units with 40-59 beds. In addition, we estimated that there were 0.05, 0.5, 0.8, and 1.9 burn units, burn doctors, nurses, and beds, respectively, per 100,000 members of the population in mainland China. Chinese burn units lack special burn treatments, nursing equipment, and operation apparatuses. To the best of our knowledge, this is the first survey of the present burn care system in China. These results confirm that the burn care system is not equivalent to the national power of this country and the system lacks a great number of trained burn professionals. Burn doctors and nurses bear a heavy burden of work. This report supplies basic data to spur further research. We propose creating a burn unit registration system and a special database in China. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

[Timing of bacterial colonization in severe burns: is strict isolation necessary?].

PubMed

Barret, Juan P

2003-12-01

Infection is still one of the main causes of mortality in severe burn patients. Strict isolation has been used for the prevention of infection, but the efficacy of this measure is debatable. The aim of this study was to determine the timing of bacterial colonization in these patients and to ascertain whether strict isolation is indicated. Thirty consecutive children with severe burns were studied. Patients were only barrier-nursed during dressing changes. On admission and twice weekly over the entire hospital stay, burn, sputum, gastric aspirates, feces, and blood samples were obtained for culture. All isolates were tested for specific biotypes. Results were studied with linear regression and repeated measures ANOVA to determine the timing of colonization and cross-colonization between patients. On admission, normal cutaneous flora were isolated from burn cultures of all patients. The remaining cultures were negative. After one week, gastric aspirates were found to be colonized by gram-negative bacteria and fungi. This was followed by colonization of feces, burn, and sputum cultures. Biotype identification showed unidirectional colonization from the gastrointestinal tract to burns and upper airway. There were no cross infections between patients. Microbial colonization in severe burn patients was endogenous in nature and there were no cross infections. Thus, strict isolation is not necessary in burn centers, except during outbreaks of multi-resistant microorganisms.

When do children get burnt?

PubMed

Verey, Frances; Lyttle, Mark D; Lawson, Zoe; Greenwood, Rosemary; Young, Amber

2014-11-01

Burns are a cause of more than 5000 paediatric hospital admissions per year in England and Wales. Injury prevention and service provision may be better planned with knowledge of burn timing. Prospectively collected records from 1st January 2010 to 31st December 2011 were analysed. All episodes involving patients less than 16 years of age reviewed by the South West Children's Burns Centre were included. Data was collected from 1480 records to investigate seasonal, weekly, and daily variation. Day to day analysis showed significantly more burns occurred on Saturday and Sunday than Monday-Friday (p<0.001). Of all burns, 46% occurred within the time-period 08:00-15:59; however the mean hourly rate of burns was highest between 16:00 and 18:59. Of the larger burns (>10% body surface area), 38% occurred after 19:00. There was no statistically significant variation in the monthly (p=0.105) or seasonal (p=0.270) distribution of burns. Bank holidays did not cause a statistically significant increase in numbers. Injury prevention strategies are likely to have most volume impact by increasing awareness of the peak time for burns in children, enabling parents at home with young children to modify any risky behaviour and by targeting older children and their behaviour. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Burns in South Korea: An analysis of nationwide data from the Health Insurance Review and Assessment Service.

PubMed

Oh, Hyunjin; Boo, Sunjoo

2016-05-01

The purpose of the study was to identify and describe the incidence of burn injuries in patients seen and treated in South Korea. Characteristics of inpatients and outpatients with burns were analyzed according to gender, age, burn site, and burn severity. This retrospective study examined the characteristics of a stratified sample of burn patients seen and treated in South Korea during the calendar year 2011. The sample was drawn from the national patient database Health Insurance Review and Assessment (HIRA). Approximately 1.71% of the total patients in the Patient Sample of HIRA for 2011 were burn-injured patients. The numbers of patients treated for burns were 913/10(5) males (n=8009) and 1454/10(5) females (n=11,881). Nearly all of these patients (94.1%) were covered by national health insurance and the majority of these patients (80.6%) were treated as outpatients. Nearly half of the burn injuries were of the upper extremities (43.5%), and most of these injuries (71.5%) were rated as second-degree burns. A review of the national data on patients seen and treated for burns in 2011 revealed that people in South Korea may experience higher numbers and more severe cases of burns and burn-related injuries than found in other countries. General burn prevention programs as well as gender- and age-specific prevention strategies are needed to reduce the risk of burns in this population. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.