Burning Mechanism Research Articles

Massage Therapy Utilization in Pediatric Acute Burns: A Retrospective Cohort Study.

Patient-centered burn care extends beyond physical treatment to incorporate the management of the psychological impacts including stress, pain, and anxiety. This study explores the novel application of massage therapy (MT) in children with acute burns, assessing utilization and impact on pain and relaxation. A retrospective review of 198 children with thermal injury admitted to an American Burn Association-verified pediatric burn center between January 2022 and July 2023 was conducted, excluding those requiring intensive care admission. Demographics, injury details, and MT variables were summarized using descriptive statistics. A logistic regression explored the impact of age, length of stay (LOS), and total body surface area on MT provision. All patients received MT consultation, with 13.6% of patients (n = 27) undergoing 43 MT sessions, with a median duration of 25.0 min. Common burn mechanisms in the MT group were scalds (55.6%), flame (22.2%), and contact (14.8%) burns. Of patients reporting pain pre-massage, 75.0% experienced pain relief, and 95.3% were content, relaxed or resting comfortably post-intervention. Barriers to MT included patients being asleep (42.1%), off the unit (33.7%), or attended to by other health-care providers (21.1%). Patients receiving MT had a longer median LOS compared to those who did not (p < 0.001). MT is potentially valuable for children admitted with acute burns, reducing pain and promoting relaxation. However, patients admitted on weekends and with short admissions frequently missed MT treatment. Addressing barriers through additional weekend resources, provider education, and increased awareness of patient readiness for sessions may improve access to MT.

Management considerations in grease versus non-grease scald burns in adults: A retrospective cohort study at a tertiary burn care facility

IntroductionScald burns are challenging to manage due to their evolutionary nature and nuanced injury pattern. Different mediums, such as hot water, steam, or grease, each have unique physical properties that may inflict more damage and incite a different inflammatory response. While pediatric patients are often the focus of scald burn research, a significant number of adults still suffer from scald burns, especially while cooking with hot grease. Our study aimed to analyze differences in injury pattern and management between grease versus non-grease scald burns. Materials and MethodsA retrospective chart review was done on all scald burn patients at a tertiary burn care center from January 2020 to December 2022. The primary outcomes were admission and length of stay with the primary exposure being grease versus non-grease scald burns. Secondary outcomes included rates of surgical excision and changes in surgical management plans. Multivariate regressions were employed to control for sex, age, total body surface area (TBSA), and burn thickness. ResultsOf 165 patients with scald burns, 41 out of 91 (45.1 %) with grease burns and 43 out of 74 (58.1 %) with non-grease burns were admitted. No statistically significant difference in length of hospital stay existed between admitted grease and non-grease burns (p = 0.45). Additionally, no differences were observed for surgical excision (p = 0.63) and changes in surgical management plans (p = 0.47) ConclusionThe mechanism of scald burn caused by either a grease or non-grease source is not associated with any differences in admission, length of hospital stay, or surgical management. Scald burn management should still focus on patient age, TBSA, and burn thickness regardless of the causative agent.

Central Venous Catheter Use in Burn Patients: Complications and Preventive Measures

Summary: The use of a central venous catheter (CVC) is essential in the management of burn patients, especially due to the difficulty of venous access, the length of hospitalization, and the need for routine fluid replenishment and medication administration, particularly antibiotics. Aim of the study: The aim of this study is to identify the rate of complications associated with central venous catheters in the context of burn patients to discuss its indications and the benefit/risk ratio. Methods: This descriptive retrospective study was conducted in the Plastic Surgery Department of CHU Mohamed VI in Marrakech, involving patients who received a central venous catheter during their admission to the burn unit from March 2023 to March 2024. Data collection included basic demographic data, comorbidities, burn mechanism, burn depth, percentage of burned body surface area (BSA), central catheter location (subclavian, femoral, jugular), the site (healthy/burned), the duration of catheter placement, complications (infection and venous thrombosis), detection of germs during culture, and the length of hospital stay. Results: Infection and venous thrombosis were identified as the most frequent complications of CVC use. Further research is needed to evaluate the role of regular CVC changes (every 10 to 15 days after insertion) in preventing infections and to establish a clear anticoagulation protocol for preventing deep vein thrombosis (DVT). Conclusion: While CVCs can be a valuable resource in the treatment of burn patients, they are associated with significant risks, some of which may be life-threatening. The duration of CVC placement should be minimized, and blood cultures (preferably from the CVC tip) should be systematically sent after 10 days or at the first suspicion of complications to reduce the incidence and severity of CVC-related infections.

THE USE OF POLOXAMER 188 IN BURN INJURY TREATMENT: A SYSTEMATIC LITERATURE REVIEW.

Although there have been numerous advancements in burn wound management, burn injuries are still a major cause of morbidity and mortality in the United States, and novel therapeutics are still needed to improve outcomes. Poloxamer 188 (P188) is a synthetic copolymer with Food and Drug Administration (FDA) approval that has many biological applications. This study aimed to review the literature on P188 in burn injuries and its effects based on burn mechanisms. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to complete this systematic literature review. We searched the databases of Google Scholar, PubMed, and SCOPUS using the keywords burn, p188, poloxamer 188, and pluronic F68 in combination. Two reviewers independently screened the articles for inclusion. Articles that were not in English, were book chapters or conference proceedings, or did not evaluate P188 in the setting of burn injuries were excluded. We included a total of 33 full-text articles with both in vivo and in vitro preclinical studies. P188 was found to be beneficial in animal and cell studies evaluating electrical and thermal burn injuries. P188 was also found to be useful in burn wound management. Although its utility may be limited in radiation injuries, P188 may be helpful in delaying the initial damage caused by radiation burns. P188 therefore has the potential to be used as a therapy in both burn wound management and in the treatment of systemic injuries sustained through burns. Future studies should aim to assess the efficacy of P188 in clinical models of burn injury.

Understanding burn injury among Aboriginal and Torres Strait Islander children – results of a two-year cohort study

BackgroundDespite known inequalities, little is understood about the burden and healthcare experiences of Aboriginal and Torres Strait Islander children who sustain a burn injury and their families. MethodsThe Coolamon Study recruited parents and carers whose children (aged <16 years) were Aboriginal and / or Torres Strait Islander children and had presented to burn units across four Australian states, New South Wales (Sydney), Northern Territory (Darwin), Queensland (Brisbane, Townsville) and South Australia (Adelaide), between 2015 and 2018. Consent was obtained and carers completed baseline and subsequent interviews at 3, 6, 12 and 24 months. Data were collected on the injury event, patient care and safety, sociodemographic factors, health related quality of life (PedsQual), and psychological distress (Kessler K-5). ResultsOf the 208 participants, 64 % were male; 26 % were aged less than 2 years and 37 % aged 2–4 years. The most common burn mechanisms were scalds (37 %), contact (33 %) and flame burns (21 %), with more severe burns and flame burns occurring in rural and remote settings. Most carers rated their child’s care as either excellent or very good (82 %). Family distress, measured by the K-5, lessened over the 24 months, however the changes were not statistically significant. While 77 % of carers reported that they received enough information, 18 % reported they would have liked more, and 3 % reported no information was provided before treatment. Parents described mixed access to information about the types of support available to them, such as accommodation, meals, travel or cultural support. ConclusionData from this cohort provide rich new information about risk factors and care received from point of injury through to rehabilitation for Aboriginal and Torres Strait Islander children with burns, providing unique insights into what is needed for appropriate, culturally safe care.

Adipokines-A Cohort Prospective Study in Children with Severe Burns.

Burns generate every year an important burden of morbidity, being a major global public health problem through prolonged hospitalization, complications, and increased mortality. This study's purpose was to evaluate the serum levels of three adipokines and to establish significant correlations with other circulating molecules and with some clinical parameters. We evaluated 32 children with severe burns (over 25% total burned surface area-TBSA) at 48 h, day 10, and day 21 post burn, and 21 controls. The serum levels of adiponectin, resistin, leptin, tumor necrosis factor-α (TNF-α), plasminogen activator inhibitor-1 (PAI-1), and C-reactive protein (CRP) (among nine other biochemical parameters) were detected by Multiplex technique. Significant statistical differences were obtained for resistin and leptin compared to the control group, in different moments of measurements. Adiponectin serum levels presented statistically significant correlations with hot liquid mechanism of burn, the Revised Baux score, TBSA, resistin, PAI-1, CRP, TNF-α, and triglycerides (TGLs) serum levels. Resistin serum levels presented statistically significant correlations with adiponectin, CRP, PAI-1, leptin, and TNF-α. Additionally, we found statistically significant correlations between leptin serum levels and length of hospitalization, TNF-α, resistin, adiponectin, and PAI-1 serum levels. In severely burned children, adiponectin, resistin, and leptin specifically correlate with clinical parameters and with proteins involved in the systemic inflammatory response and the hypermetabolic response.

Too hot to handle − Microwaved drinkware: An emerging cause of contact burn injuries?

Purpose of the studyTo investigate the local and national incidence of contact burns secondary to microwave-heated drinkware and specifically those with a metallic coating. MethodsThis retrospective analysis from November 2018 to December 2022 includes UK-wide data on burn mechanism, demographics, TBSA (total body surface area), depth and additionally, local data on injury details, management, complications, healing duration, return-to-work time, and follow-up duration within our service. ResultsNational: In the UK, 87 patients sustained burns related to microwave heating of drinkware. Median (IQR) burn size was 0.21% (+/−0.15) TBSA. Most burn injuries were superficial dermal (SD) (88.7%). All cases were treated conservatively.Regional: Contact burns from microwave-heated metallic coated drinkware were identified in 28 patients. The median (IQR) TBSA was 0.12% (+/−0). Most injuries were assessed as SD (90%, 45/50), however, 4/5 (80%) of the deeper burns were caused by metallic-coated drinkware. The median (IQR) follow-up was 6.04 days (+/−4.5). Median (IQR) healing time was 14.17 (+/−0) days and mean time to return to work was 7.57 (+/−3.5) days. ConclusionsMicrowave-heated drinkware burns, while constituting a small portion of referrals to UK burns services, may have a larger true population incidence. Due to their size, these injuries are probably treated locally without referral to a burns service. Regional data analysis highlighted that metallic coated drinkware related injuries were associated with longer healing times.

A Comparison of Racial and Ethnic Disparities in Complications Following Burn Injury in Adult Patients.

Burn injury contributes to significant morbidity and mortality in the United States. Despite an increased focus on racial and ethnic disparities in healthcare, there remains a critical knowledge gap in our understanding of the effect of these disparities on complications experienced by burn patients. The American Burn Association's National Burn Repository data were reviewed from 2010-2018. Information regarding demographics, burn mechanism and severity, complications, and clinical outcomes were recorded. Data analysis was performed using 1:1 propensity-score-matching and logistic regression modeling. A separate analysis of Hispanic and non-Hispanic patients was performed using Chi squared tests. Among 215,071 patients, racial distribution was 65.16% white, 19.13% black, 2.18% Asian, 0.74% American Indian/Alaskan Native, and 12.78% other. Flame injuries were the most common cause (35.2%), followed by scald burns (23.3%). All comparisons were made in reference to the white population. Black patients were more likely to die (OR: 1.28; 95%CI: 1.17-1.40), experience all (OR: 1.08; 95%CI: 1.03-1.14), cardiovascular (OR: 1.24; 95%CI: 1.08-1.43), or infectious (OR: 1.64; 95%CI: 1.40-1.91) complications, and less likely to experience airway complications (OR: 0.83; 95%CI: 0.74-0.94). American Indian/Alaskan Native patients were more likely to experience any complication (OR: 1.33; 95%CI: 1.05-1.70). All minority groups had increased length of hospital stay. Black, Asian, and other patients had longer length of ICU stay. Black patients had longer ventilator duration. Among 82,775 patients, 24,075 patients were identified as Hispanic and 58,700 as non-Hispanic. Statistically significant differences were noted between groups in age, TBSA, proportion of 2nd degree burn, and proportion of 3rd degree burn (p<0.01). These findings highlight the need for further work to determine the etiology of these disparities to improve burn care for all patients.

The Epidemiology and Outcomes of Perineal and Genital Burn Injury in Low- and Middle- Income Countries: A Global Burn Registry Study

IntroductionThe epidemiology, care, and outcomes of perineal and genital burns (PG) in high-income countries have been previously described, but an analysis of this topic in LMICs has yet to be performed. We use the World Health Organization’s Global Burn Registry to fill this gap. MethodsThe GBR was searched from inception to November 2023 to identify all burn patients, excluding cases from high-income countries. Demographics and mechanism of injury were retrieved. Primary outcomes were length of hospital stay (LOHS), surgical intervention, discharge with physical impairment, and mortality. A multivariate regression analysis was performed controlling for burnt total body surface area (TBSA), age, sex, inhalation injury, mechanism of burn and care center characteristics. ResultsOf 9041 patients identified, 1213 (13.4 %) had PG burns with 136 (1.6 %) isolated to the PG region. PG patients had higher TBSA (p < 0.001) and more inhalation injury (p < 0.001). They had better access to rehabilitation and lower access to theater space for burns (p < 0.001). Multivariable analysis showed that PG patients had longer LOHS (p = 0.001), greater mortality (p < 0.001), were less likely to undergo surgery (p = 0.01) or be discharged home with physical impairment (p = 0.03). ConclusionSimilarities and differences exist between high- and low/middle-income countries in terms of the patterns of injury, care, and recovery in patients with PG burns. The longer LOHS and higher mortality among PG patients, previously reported in high-income countries, are verified. This highlights the importance of greater vigilance when caring for such patients.

545 A PRospective, Case-controlled Evaluation of oLIceridine for Moderate or sEVEre Pain After Burn Injury. (RELIEVE)

Abstract Introduction After acute burn injury, injured tissue and adjacent non-burned tissue, upregulate response to painful and non-painful stimulus (hyperalgesia and allodynia, respectively). Currently, high-dose fentanyl, oxycodone, hydromorphone, and morphine are used at profound doses to mitigate pain. Oliceridine (OLI), a biased, selective opioid agonist, has shown a 3-fold preferential activation of the G-protein (i.e., analgesia) over β-arrestin pathway. There is no literature of use in patients with burn injuries. We hypothesized the use of OLI would provide adequate and safe analgesia after acute burn injury. Methods This single-center, prospective, case-controlled trial was dual IRB approved and included patients with burn injuries admitted between April and September 2023. Informed consent was obtained from the 10 patients receiving OLI. OLI was the only allowed analgesic except for acetaminophen. Dosing and assessments were followed per study protocol and safety and efficacy assessed per study team daily at a minimum. The historical control (CTL) group (i.e., fentanyl, oxycodone, hydromorphone, morphine, etc) was matched 2:1 with the prospective OLI group. The CTL were screened in reverse chronology to find comparable groups according to age, % total body surface area burned (TBSA), history of opioid and illicit drug use, and number of operations. SAS 9.4 was used for descriptive statistics and modelling via UNIVARIATE and GLM procedures. Results Two CTL patients were excluded in the final analysis due to missing assessments. The OLI (n = 10) and CTL (n = 18) groups were comparable in age (52.3 ± 12.3 vs 63.1 ± 17.3 years, p = 0.228), TBSA [8 (3.3, 11.2) vs 6 (2.6, 9.3) percent], operations (0.5 per patient for both), and burn mechanism. No patient had a known history of opioid, cocaine, or methamphetamine use. The baseline Numeric Pain Rating Scale (NRS) for OLI and CTL were similar [9 (7.8, 10) vs 9.5 (8.8, 10); p = 0.360); however, the first day’s mean pain score was higher for CTL (4.8 vs. 5.9, p = 0.035). Over the 7-day period, mean daily pain scores significantly declined in patients receiving OLI (-2.65, p = 0.010), but not for CTL (+0.69, p = 0.496). Whereas, opioid usage [i.e., oral morphine milligram equivalents (MME)] was not significantly different across groups (p = 0.689) or days (p = 0.684). Total MME averaged per patient day were 65.2 and 69.6 mg/day in the OLI and control groups, respectively (P = 0.688). There were no unexpected adverse events related to OLI. Conclusions Although this sample of 10 patients limits inferences outside of acute burn injuries less than 20% TBSA, OLI demonstrated significant pain relief, which was maintained over the 7 days study period. Importantly, the control group demonstrated initial relief, but was not maintained, despite similar MME. Applicability of Research to Practice Oliceridine offers an effective solution for analgesia in patients with acute burn injury.

Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC)

BackgroundNational estimates suggest pediatric trauma recidivism is uncommon but are limited by short follow up and narrow ascertainment. We aimed to quantify the long-term frequency of trauma recidivism in a statewide pediatric population and identify risk factors for re-injury. MethodsThe Maryland Health Services Cost Review Commission Dataset was queried for 0–19-year-old patients with emergency department or inpatient encounters for traumatic injuries between 2013 and 2019. We measured trauma recidivism by identifying patients with any subsequent presentation for a new traumatic injury. Univariate and multivariable regressions were used to estimate associations of patient and injury characteristics with any recidivism and inpatient recidivism. ResultsOf 574,472 patients with at least one injury encounter, 29.6% experienced trauma recidivism. Age ≤2 years, public insurance, and self-inflicted injuries were associated with recidivism regardless of index treatment setting. Of those with index emergency department presentations 0.06% represented with an injury requiring inpatient admission; unique risk factors for ED-to-inpatient recidivism were age >10 years (aOR 1.61), cyclist (aOR 1.31) or burn (aOR 1.39) mechanisms, child abuse (aOR 1.27), and assault (aOR 1.43). Among patients with at least one inpatient encounter, 6.3% experienced another inpatient trauma admission, 3.4% of which were fatal. Unique risk factors for inpatient-to-inpatient recidivism were firearm (aOR 2.48) and motor vehicle/transportation (aOR 1.62) mechanisms of injury (all p < 0.05). ConclusionsPediatric trauma recidivism is more common and morbid than previously estimated, and risk factors for repeat injury differ by treatment setting. Demographic and injury characteristics may help develop and target setting-specific interventions. Level of EvidenceIII (Retrospective Comparative Study)

High rate of negligence induced burns in children: A rising cause for concern of the world's burn community

One of the most important causes of death in burn patients is burn [1-10]. Accurate evaluation, timely diagnosis, and proper treatment of burn patients can reduce their mortality rate [11-21]. On the other hand, one of the most important causes of injury among children aged 1 to 15 is burns [22]. Usually, children and teenagers are more vulnerable in burn injuries than other age groups [23]. Severe burns can affect children's health both in the acute stage of burns and in the later stages of their lives [24]. Burns in children often occur due to injuries caused by hot liquids. The mechanism of burns among children can be due to exploratory behaviors without understanding the dangers in the environment [25]. Most burn injuries are due to accidental causes, but in some cases, it can be due to negligence in children [22]. It is difficult to distinguish whether the burn was accidental or caused by negligence [24]. Burn hospitalizations and deaths due to negligent burns are more than accidental burns. The interesting point is that some cases of children's burn injuries can be due to misbehavior and negligence that were not diagnosed at the time of admission. Identifying these people is important because preventive efforts by health care teams for children are necessary [22]. Hence, most negligence induced burns in children are preventable because negligence and carelessness are the main causes of burns in them [24]. The consequences of negligence induced burns in children can have physical, mental, and emotional effects on children and their families [23]. Burn scars often persist after healing and lead to functional and aesthetic problems [24]. On the other hand, psychological care after burns should be considered; because, children experience a high level of acute stress, anxiety, and depression after burns, and hospitalization can be scary for children [23]. The negative consequences of negligence induced burns in children in the long term can lead to chronic diseases in childhood and even adulthood. Therefore, special attention should be paid to the timely prevention, diagnosis, and treatment of negligence induced burns in children [22]. However, previous evidence regarding negligence induced burns in children is very limited. Hence, one study showed that 56% of burns in children were due to negligence [24].

Detection methods and bearing failure characteristics analysis related to grinding burns

Grinding burn is one of the bearing failure causes for components. In order to quickly confirm that grinding burn is the cause of bearing failure, detection methods for the grinding burns and characteristics of bearing failure caused by grinding burns have been studied in this paper. The results show that cold acid pickling examination, microhardness test and Barkhausen noise analysis can be used in the detection of heavy grinding burns but have several disadvantages to hinder their application on the detection of slight grinding burns. A grinding burn detection procedure is recommended for the analysis of bearing failure induced by grinding burn. It has been found that the modes of bearing failure induced by grinding burns were contact fatigue spalling developed from the contact fatigue crack, the propagation mechanism of the contact fatigue crack was obtained. And the unique phenomenon of fracture or fragmentation with cracks distributed in the origin or surrounding the spalling pit of the grinding burn layer was also obtained. Based on the above results the future work on detection methods and influence on bearing failure mechanism and life of grinding burn are proposed.

Ignition mechanism of near α high temperature titanium alloy

The risk of titanium fire increases significantly with the development of future aero-engine, however, the burning mechanisms of titanium alloys remain uncertain. Therefore, the ignition behavior and mechanism of near α high-temperature titanium alloy are studied in this work by an integrated experiment method, including laser-oxygen concentration ignition method, infrared temperature measurement and observation of molten metal by high-speed camera. Based on this, the ignition boundary curve is determined and the ignition temperature of the alloy is found to decrease from 1595 to 1527 ℃ with the laser power increasing from 200 to 325 W and oxygen concentration increasing from 21% to 60%. The ignition microstructure is characterized by FIB and TEM to study the evolution of reaction products. Pores are found to form beneath the TiO&lt;sub&gt;2&lt;/sub&gt; surface layer, which can be attributed to the instablity of TiO. The failure mechanism of protective oxide layer is further analyzed according to the thermal stress caused oxide layer damage model. When the temperature approaches the ignition temperature, which is below the melting point, the high vapor pressure of TiO leads to the formation of porous defects beneath the TiO&lt;sub&gt;2&lt;/sub&gt; surface, thus accelerating the fracture and failure of the TiO&lt;sub&gt;2&lt;/sub&gt; layer under thermal stress. It is revealed that critical conditions of temperature and instantaneous temperature change rate are needed to realize ignition. Based on this, an ignition model is further constructed to discuss the relationship among ignition temperature, laser power and oxgyen concentration. According to the experimental data fitting, the reaction activation energy of TA19 alloy during the ignition stage is calculated to be about 280 kJ/mol, and the function for calculating ignition temperature is given as follows: &lt;inline-formula&gt;&lt;tex-math id="M2"&gt;\begin{document}$ 1.2 \times {10^{10}}{{\mathrm{e}}^{\frac{{ - 280000}}{{R{T_{{\text{ig}}}}}}}}{c^{\frac{1}{2}}} + $\end{document}&lt;/tex-math&gt;&lt;alternatives&gt;&lt;graphic specific-use="online" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="8-20240003_M2.jpg"/&gt;&lt;graphic specific-use="print" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="8-20240003_M2.png"/&gt;&lt;/alternatives&gt;&lt;/inline-formula&gt;&lt;inline-formula&gt;&lt;tex-math id="M2-1"&gt;\begin{document}$ 0.52{P_{\mathrm{L}}} - 315 = 0 $\end{document}&lt;/tex-math&gt;&lt;alternatives&gt;&lt;graphic specific-use="online" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="8-20240003_M2-1.jpg"/&gt;&lt;graphic specific-use="print" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="8-20240003_M2-1.png"/&gt;&lt;/alternatives&gt;&lt;/inline-formula&gt;. This provides a theoretical reference for predicting the ignition temperatures of near α high temperature titanium alloy and other types of titanium alloys under complex airflow conditions in aircraft engines.

Multi-side incentive compatible transaction fee mechanism

Propelled by ongoing advances in blockchain technologies, transaction volumes of major cryptocurrencies like Bitcoin and Ethereum have surged, causing strain on network capacities—a challenge known as the scarcity of transaction inclusion resources. While the widely adopted Transaction Fee Mechanism (TFM) efficiently allocates transaction resources, existing research falls short in achieving simultaneous user incentive compatibility (UIC), miner incentive compatibility (MIC), and miner-user side contract proofness (SCP), essential for blockchain security. In response, we propose the Optimal Revenue Burning (ORB) mechanism, adjusting reserve price and burning rate to deter deviations from honest strategies. Our theoretical analysis strongly supports that ORB mechanism simultaneously satisfy UIC, MIC, and SCP. We also outline conditions for equilibrium strategies. Through simulations, ORB mechanism not only ensures stable miner revenue but also reduces user payments by an average of 5.34%, addressing exorbitant transaction fees. Our research has significant implications for guiding blockchain TFM design.

Health-related quality of life after burn injury due to bioethanol-fueled fireplaces

ObjectiveCommercially available bioethanol-fueled fireplaces are a potential source of burns and are commonly used for home use. The present study aimed to evaluate the quality of life following burn injuries that were caused by bioethanol-related accidents. MethodsBurned patients who were admitted to our burn unit with burn injury due to bio-ethanol fueled fire places between January 2010 and December 2021 were contacted to ask for their willingness to participate in this study. They were asked to answer questions regarding the circumstances of the accident and three questionnaires to capture burn specific and general health related quality of life (Burn Specific Health Scale-Brief (BSHS-B), Short-Form Health Survey 36 (SF-36)) and general information about the accident. Patients were matched and compared to a group of patients suffering comparable burns from other burn mechanisms, which were also admitted to our burn unit at the same time. ResultsOf 35 patients that met the inclusion criteria, 19 answered the questionnaire and were compared to 38 patients with other burn mechanisms. There were no statistical differences regarding age (bioethanol: 37.4 ± 14.7 years vs. control: 36.2 ± 14.3 years, p = 0.777), TBSA (9.9 ± 6.8% vs. 8.9 ± 10.4, p = 0.715), and sex (42.1% females vs. 36.8% females, p = 0.882). Most patients in the bioethanol-group reported that they did not follow the manual instructions (68.4%) and that the accident happened during the refilling process (52.6%).There was no significant difference in any subscale of the BSHS-B or the SF-36. DiscussionBurns related to bioethanol-fueled fireplaces are rare compared to other typical burn mechanisms. However, as they are used for personal pleasure and interior design, psychological impairment following burn may be even more critical. Detailed education on the use of these fireplaces needs to take place in order to reduce the risk of accidents.

Features of the mechanism of pasty propellants burning

The composition of a pasty propellant for small-sized space engines has been proposed. For this propellant, a research of the burning process was carried out. This research included the determination of the burning rate law, the characteristics of the agglomeration process, and the properties of the surface layer. The presence of an intermediate structure, a skeleton layer, during the burning of such propellants, and the nature of the influence of pressure, additives, and the size of oxidizer particles on this structure, have been established. The determining influence of this structure on the burning process is shown. Composition solutions that provide control over the burning rate law of such propellants are determined. These solutions make it possible to change the absolute value of the burning rate, as well as its dependence on pressure. Regularities of the agglomeration process have been established. These regularities are associated with the features of the formation of the skeleton layer, which depend on the structure of the propellant, pressure, and the presence of additives.

A Review of NDT Methods for Wheel Burn Detection on Rails.

Wheel burn can affect the wheel-rail contact state and ride quality. With long-term operation, it can cause rail head spalling or transverse cracking, which will lead to rail breakage. By analyzing the relevant literature on wheel burn, this paper reviews the characteristics, mechanism of formation, crack extension, and NDT methods of wheel burn. The results are as follows: Thermal-induced, plastic-deformation-induced, and thermomechanical-induced mechanisms have been proposed by researchers; among them, the thermomechanical-induced wheel burn mechanism is more probable and convincing. Initially, the wheel burns appear as an elliptical or strip-shaped white etching layer with or without deformation on the running surface of the rails. In the latter stages of development, this may cause cracks, spalling, etc. Magnetic Flux Leakage Testing, Magnetic Barkhausen Noise Testing, Eddy Current Testing, Acoustic Emission Testing, and Infrared Thermography Testing can identify the white etching layer, and surface and near-surface cracks. Automatic Visual Testing can detect the white etching layer, surface cracks, spalling, and indentation, but cannot detect the depth of rail defects. Axle Box Acceleration Measurement can be used to detect severe wheel burn with deformation.

High area deprivation index is associated with increased injury severity in pediatric burn patients

BackgroundBurn injuries play a significant role in pediatric injury-related mortality and morbidity. In this study, we aim to explore the relationship between patient demographics, socioeconomic factos and burn severity in pediatric patients. MethodsPatients under age 14 hospitalized at Westchester Medical Center for burn injury between 2015 and 2021 were reviewed. Demographic variables including mechanism of burn, total body surface area (TBSA) involvement, surgical intervention, hospital length of stay (LOS), and LOS per TBSA burn were extracted. The Area Deprivation Index (ADI) was calculated to further assess socioeconomic factors. ResultsWe included 399 patients under the age of 14 hospitalized for burn injuries at our institution between 2015 and 2021. The median age was 2 (IQR 1–6) years old, and 42.6% were female. High ADI (p = 0.018), Caucasian race (p = 0.001), and flame mechanism (p < 0.001) were independently associated with burn TBSA> 5%. LOS per TBSA was shorter in the Caucasian population (p = 0.022). ConclusionIn burn injury patients, further research is necessary to investigate modifiable risk factors in individuals of Caucasian race or lower socioeconomic status to target effective prevention campaigns.

Association of Prehospital Transfusion With Mortality in Pediatric Trauma

Optimal hemostatic resuscitation in pediatric trauma is not well defined. To assess the association of prehospital blood transfusion (PHT) with outcomes in injured children. This retrospective cohort study of the Pennsylvania Trauma Systems Foundation database included children aged 0 to 17 years old who received a PHT or emergency department blood transfusion (EDT) from January 2009 and December 2019. Interfacility transfers and isolated burn mechanism were excluded. Analysis took place between November 2022 and January 2023. Receipt of a blood product transfusion in the prehospital setting compared with the emergency department. The primary outcome was 24-hour mortality. A 3:1 propensity score match was developed balancing for age, injury mechanism, shock index, and prehospital Glasgow Comma Scale score. A mixed-effects logistic regression was performed in the matched cohort further accounting for patient sex, Injury Severity Score, insurance status, and potential center-level heterogeneity. Secondary outcomes included in-hospital mortality and complications. Of 559 children included, 70 (13%) received prehospital transfusions. In the unmatched cohort, the PHT and EDT groups had comparable age (median [IQR], 47 [9-16] vs 14 [9-17] years), sex (46 [66%] vs 337 [69%] were male), and insurance status (42 [60%] vs 245 [50%]). The PHT group had higher rates of shock (39 [55%] vs 204 [42%]) and blunt trauma mechanism (57 [81%] vs 277 [57%]) and lower median (IQR) Injury Severity Score (14 [5-29] vs 25 [16-36]). Propensity matching resulted in a weighted cohort of 207 children, including 68 of 70 recipients of PHT, and produced well-balanced groups. Both 24-hour (11 [16%] vs 38 [27%]) and in-hospital mortality (14 [21%] vs 44 [32%]) were lower in the PHT cohort compared with the EDT cohort, respectively; there was no difference in in-hospital complications. Mixed-effects logistic regression in the postmatched group adjusting for the confounders listed above found PHT was associated with a significant reduction in 24-hour (adjusted odds ratio, 0.46; 95% CI, 0.23-0.91) and in-hospital mortality (adjusted odds ratio, 0.51; 95% CI, 0.27-0.97) compared with EDT. The number needed to transfuse in the prehospital setting to save 1 child's life was 5 (95% CI, 3-10). In this study, prehospital transfusion was associated with lower rates of mortality compared with transfusion on arrival to the emergency department, suggesting bleeding pediatric patients may benefit from early hemostatic resuscitation. Further prospective studies are warranted. Although the logistics of prehospital blood product programs are complex, strategies to shift hemostatic resuscitation toward the immediate postinjury period should be pursued.