Early Burn Research Articles

Acceptability and Usability of Smileyscope Virtual Reality for Paediatric Pain Management During Burn Procedures: Perspectives of Patients, Carers and Clinicians.

To explore clinician, child and parent acceptability and usability of the Smileyscope VR device in the context of addressing the unique pain and distress needs of young burn patients. A survey comprising closed and open-ended questions. Descriptive statistics analysed participant characteristics, pain and analgesia. Qualitative content was collected from April 2022-August 2022 and analysed to identify barriers and enablers. Categories were then mapped onto the Capabilities, Opportunities and Motivation-Behaviour Wheel (COM-B) framework. Smileyscope was found to be effective for reducing pain and anxiety during dressing changes by both patients (n = 39) and parents (n = 37). Clinicians (n = 35) reported high self-efficacy and willingness to reuse the device. However, concerns arose regarding the device's fit and the need for age-appropriate programmes. Smileyscope demonstrated promise in reducing procedural pain and distress. The device is well accepted by all participants implying ease of implementation. Feedback suggests further program development and fitting optimisation is required. Improved procedural pain has proven to decrease wound healing times, decreasing possible need for further scar management and long-term consequences after sustaining a burn injury. Smileyscope use in rural hospitals presents valuable opportunities for optimising early paediatric burn pain. Increased burn pain can delay wound healing and have long term physical and psychological impact on patients. Smileyscope was well received within this cohort; however, improvements in device design and programmes were suggested. This study shows the potential for use of Smileyscope as a non-pharmacological approach to improving paediatric burn pain and distress. While our study included patients, parents and clinicians as research participants, there was no patient or public contribution in the design or conduct of the study, analysis or interpretation of the data.

The impact of subdermal adipose derived stem cell injections and early excision on systemic oxidative stress and wound healing in rats with severe scald burns

AimThis study aims to develop an experimental treatment model effective against oxidative stress in the acute period of severe burns and to analyze the mechanisms of healing large wound defects. MethodsFive rats, including 2 females and 3 males, were used as donors to obtain adipose-derived stem cells (ADSC) from the inguinal fat pad. The stem cells were labeled with green fluorescent protein. The study included four groups of 17 rats, each with grade 3 scalding burns on 30 % of their body surface, and a control group of 10 rats with an equal number of males and females. After early excision, 106 ADSC-derived stem cells were administered subdermally to the burned wound and autografted to the stem cell group (n = 17). The early excision group (n = 17) received early excision and autograft, with 2 ml of normal saline injected subdermally into the burn wound edge. The PLM group (n = 17) was treated with a polylactic membrane (PLM) dressing after the burn. No treatment was given to the burn group (n = 17). Ten rats from all groups were sacrificed on the 4th day post-burn for oxidative stress evaluation. The control group (n = 10) was sacrificed on day 4. Blood and tissue samples were collected post-sacrifice. Oxidative stress and inflammation in the blood, as well as cell damage in the skin, liver, kidneys, and lungs, were investigated histopathologically and biochemically on the 4th day post-burn. On the 70th day after burn, wound healing was examined macroscopically and histopathologically. ResultsOn the 4th day, oxidative stress results showed that the levels of Total Oxidative Capacity (TOC) in the blood were lowest in the stem cell (7.4 [6–8.8]), control (6.7 [5.9–7.6]), and early excision (7.5 [6.6–8.5]) groups, with no significant difference between them. The burn group (14.7 [12.5–16.9]) had the highest TOC levels. The PLM group (9.7 [8.6–10.7]) had lower TOC levels than the burn group but higher levels than the other groups.Histopathological examination on the 4th day revealed low liver caspase-3 immunoreactivity in the stem cell and early excision groups among the burn groups. Caspase-3 immunoreactivity levels were as follows: stem cell group (20 [10–30]), early excision group (25 [15–50]), PLM group (70 [50–100]), control group (0), and burn group (80 [60–120]). Other oxidative stress and end-organ damage outcomes were consistent with these results.All rats in the stem cell group had burn wounds that healed completely by the 70th day. Examination of the skin and its appendages from the stem cell group with an immunofluorescence microscope demonstrated green coloration, indicating incorporation of stem cells. ConclusionStem cells may have the potential to form new skin and its appendages, providing better healing for large skin defects. Early excision treatment, by removing local necrotic tissues after extensive and deep burns, can prevent end-organ damage due to systemic oxidative stress and inflammation. We also believe that when these two treatments are used together, they can achieve the best results.

Effect of three different exercise trainings on functional capacity in early stage severe burn patients: A randomized controlled trial.

This study investigated the effects of three different exercise protocols on functional capacity in early-stage burn patients. A total of 25 patients hospitalized in the Burn Center (wards and intensive care unit) were included in the study. The individuals were divided into three groups by covariate adaptive randomization according to burn percentage and type: 1 - standard treatment, 2 - standard treatment + aerobic exercise training, 3 - standard treatment + combined exercise (aerobic and resistance) determined by metabolic status. Individuals were evaluated weekly for six weeks from the first day of hospitalization using the 6-minute walk test, physiological cost index, and Medical Research Council muscle-strength measurements to assess functional capacity. A portable metabolism tracker device measured the metabolic status of all patients. Aerobic exercises and combined exercise (aerobic and resistance), when added to standard treatment and determined by metabolic status, were more effective in enhancing functional capacity than standard treatment alone (p<0.05). Patients performing the combined exercise (aerobic and resistance) showed faster improvement in functional capacity determined according to metabolic status than those in the other two groups (p<0.05). Aerobic exercises, when added to standard treatment and combined with aerobic and resistance exercises based on metabolic status, are more effective at improving functional capacity than standard treatment alone. Further controlled studies are required to explore the potential long-term benefits of this approach.

Stroke Volume and Stroke Volume Variation, but not Cardiac Index Is Associated With Survival of Majorly Burned Patients in Early Burn Shock.

Adequate fluid therapy is crucial to maintain organ function after burn trauma. Major burns lead to a systemic response with fluid loss and cardiac dysfunction. To guide fluid therapy, measurement of cardiac pre- and afterload is helpful. Whereas cardiac function is usually measured after admission to intensive care unit (ICU), in this study, hemodynamic monitoring was performed directly after arrival at hospital. We conducted a prospective cohort study with inclusion of 19 patients (male/female 13/6, 55 ± 18 years, mean total body surface area 36 ± 19%). Arterial waveform analysis (PulsioFlexProAqt®, Getinge) was implemented immediately after admission to hospital to measure cardiac pre- and afterload and to guide resuscitation therapy. Cardiac parameters 3.75 (2.67-6.0) h after trauma were normal regarding cardiac index (3.45 ± 0.82) L/min/m², systemic vascular resistance index (1749 ± 533) dyn sec/cm5 m2, and stroke volume (SV; 80 ± 20) mL. Stroke volume variation (SVV) was increased (21 ± 7) % and associated with mortality (mean SVV survivors vs nonsurvivors 18.92 (±6.37) % vs 27.6 (±5.68) %, P = .017). Stroke volume was associated with mortality at the time of ICU-admission (mean SV survivors vs nonsurvivors 90 (±20) mL vs 50 (±0) mL, P = .004). Changes after volume challenge were significant for SVV (24 ± 9 vs19 ± 8%, P = .01) and SV (68 ± 24 vs 76 ± 26 mL, P = .03). We described association of SVV and SV with survival of severely burned patients in an observational study. This indicates high valence of those parameters in the early postburn period. The use of an autocalibrated device enables a very early monitoring of parameters relevant to burn shock survival.

Restorative pyric herbivory practices in shrub-encroached grasslands enhance nutrient resource availability and spatial heterogeneity

Pyric herbivory (PH), the combination of prescribed burnings and targeted herbivory, is a promising tool for landscape restoration that emulates historical disturbance regimes. Nitrogen (N) and phosphorus (P) are crucial nutrients for plant growth and although several studies have analysed the single effects of fire or grazers in their availability, the combined effect of both disturbances in the soil nutrient budgets have been rarely considered. This research was planned to analyse the 2-year impact of PH restoration practices on the availability of N and P in two Ulex gallii-encroached grasslands in the Pyrenees. We monitored available forms of N and P for two years using periodic replacements of ion exchange resins to test the hypothesis that mid-term effect of targeted grazing was more relevant than short-term effect of burning. Additionally, we investigated the role of temperature and precipitation on nutrients accumulation and compared its significance to management factors. Burning transformed vegetation and litter into a spatially heterogeneous layer of ash and charred material, which resulted in a variable availability of N and P at the rhizosphere level. After two periods of PH, nutrient availability was higher in soils from grazed plots compared to ungrazed, and the impacts of early burns were scarcely discernible. Nitrate was found to be the most rainfall-dependent nutrient, and grazing also affected its spatial distribution. Our results suggest that the heterogeneous nutrient enrichment enhanced by PH is important for promoting the establishment of a diverse pool of plant species, including both N2-fixing and non-fixing species. In these rainy areas, the use of burnings alone, without grazing, may perpetuate the dynamics of N2-fixing shrub encroachment.

Ecosystem‐wide responses to fire and large mammal herbivores in an African savanna

AbstractFire and large mammal herbivores (LMH) are the principal top‐down forces maintaining savanna structure. Nonetheless, experiments designed to investigate interactions between fire and LMH are rare in savannas, and relationships between environmental variation and biodiversity in the context of fire and LMH are poorly understood. This study addresses these gaps by manipulating the presence of LMH and early and late dry season fires in a tropical African savanna. In addition, this work simultaneously explores environmental variables including soil and foliar quality, vegetation cover, and nearby water sources to more holistically describe factors affecting savanna functioning and biodiversity. After 1 year of experimental treatments, changes in vegetation were already apparent. Shrub abundance and richness and grass richness were higher in the absence of LMH, while grass biomass increased three‐fold in burned plots as compared to unburned plots. Foliar nutrients tended to increase in open plots, while phenolics decreased. Amphibian abundance decreased with early burns and was higher with LMH. In contrast, small mammal abundance and richness increased without LMH and with time since fire. Richness and foraging of LMH were highest after late burns. These results demonstrate ecosystem‐wide effects of LMH, illustrating the importance of considering multiple taxa when designing fire management programs. For example, burning negatively affected amphibians and small mammals and changed vegetation at the same time it increased LMH foraging. In the long‐term, this experiment will shed light on interacting effects of fire and LMH on savanna biodiversity and function.Abstract in Portuguese is available with the online material.

A Systematic Review of Simulation in Burn Care: Education, Assessment, and Management.

Assessment and management of burns require nuanced, timely interventions in high-stake settings, creating challenges for trainees. Simulation-based education has become increasingly popular in surgical and nonsurgical subspecialties to supplement training without compromising patient safety. This study aimed to systematically review the literature on existing burn management-related simulations. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing burn-specific surgical and nonsurgical simulation models were included. The model type, study description, simulated skills, assessment methods, fidelity, cost, and outcomes were collected. Of 3,472 articles, 31 met inclusion criteria. The majority of simulations were high-fidelity (n=17, 54.8%). Most were immersive (n=17, 54.8%) and used synthetic benchtop models (n=13, 41.9%), whereas none were augmented/virtual reality. Simulations of acute and early surgical intervention techniques (n=16, 51.6%) and burn wound assessments (n=15, 48.4%) were the most common, whereas burn reconstruction was the least common (n=3, 9.7%). Technical skills were taught more often (n=29, 93.5%) than non-technical skills (n=15, 48.4%). Subjective assessments (n=18, 58.1%) were used more often than objective assessments (n=23, 74.2%). Of the studies that reported costs, 91.7% (n=11) reported low costs. This review identified the need to expand burn simulator options, especially for burn reconstruction, and highlighted the paucity of animal, cadavers, and augmented/virtual reality models. Developing validated, accessible burn simulations to supplement training may improve education, patient safety, and outcomes.

1,25-Dihydroxyvitamin D3 reduces early mortality post severe burn injury via alleviating endotoxemia, oxidative stress and inflammation

Severe burn patients frequently suffer from 1,25-Dihydroxyvitamin D3 (1,25-[OH]2-D3) deficiency. In this study, we investigated the effect of 1,25-[OH]2-D3 on early mortality post severe burn and potential underlying mechanisms. Our results indicate that 1,25-[OH]2-D3 significantly reduced early mortality in mice post severe burn injury. A decrease in serum lipopolysaccharide levels and an increase in serum superoxide dismutase activity were found after administration of 1,25-[OH]2-D3. Furthermore, 1,25-[OH]2-D3 demonstrated protective effects on both intestinal and lung histology and ameliorated lung inflammation. Its anti-inflammatory effect was further confirmed in airway epithelial cells. In conclusion, our study provides evidence that 1,25-[OH]2-D3 has a significant impact on the reduction of early mortality post severe burn injury, possibly through its ability to alleviate endotoxemia, oxidative stress, and inflammation. Our findings highlight the potential of 1,25-[OH]2-D3 to protect the intestinal mucosal barrier in the early stage following major burn injury and opens up new avenues for clinical application of 1,25-[OH]2-D3 in burn patients.

Pediatric Facial Burn Reconstruction.

Contrary to prior pediatric burn treatment philosophies, we now know that early burn excision and grafting for non life-threatening burns can compromise future reconstruction. Extensive scar excision should be minimized and scar rehabilitation maximized, as secondary iatrogenic deformities can become even more difficult to fix. Scar remodeling with local tissue rearrangement can relieve tension and soften scars over time. The majority of facial burns often only involve skin and can be adequately treated without the need for complex flap reconstruction. Facial burn scars are a different problem than facial burn scar contracture. The former needs scar rehabilitation, whereas the latter needs the addition of skin. Laser therapy has transformed the treatment of burn scars and is an incredibly valuable adjunct to local tissue rearrangement and grafting. The most favorable functional, aesthetic, and psychological outcomes require a long-term multidisciplinary effort and customized protocol utilizing the vast armamentarium of reconstructive tools described below.

Recent alcohol intake impacts microbiota in adult burn patients

Alcohol use is associated with an increased incidence of negative health outcomes in burn patients due to biological mechanisms that include a dysregulated inflammatory response and increased intestinal permeability. This study used phosphatidylethanol (PEth) in blood, a direct biomarker of recent alcohol use, to investigate associations between a recent history of alcohol use and the fecal microbiota, short chain fatty acids, and inflammatory markers in the first week after a burn injury for nineteen participants. Burn patients were grouped according to PEth levels of low or high and differences in the overall fecal microbial community were observed between these cohorts. Two genera that contributed to the differences and had higher relative abundance in the low PEth burn patient group were Akkermansia, a mucin degrading bacteria that improves intestinal barrier function, and Bacteroides, a potentially anti-inflammatory bacteria. There was no statistically significant difference between levels of short chain fatty acids or intestinal permeability across the two groups. To our knowledge, this study represents the first report to evaluate the effects of burn injury and recent alcohol use on early post burn microbiota dysbiosis, inflammatory response, and levels of short chain fatty acids. Future studies in this field are warranted to better understand the factors associated with negative health outcomes and develop interventional trials.

Advanced Management of the Burn Patient

Burn injuries are a significant public health concern, with a substantial global burden. These injuries can result in complex, life-threatening situations that require advanced management strategies. This review explores the epidemiology, significance, and advanced management of burn patients. We delve into the theoretical framework, covering definitions, risk factors, complications, and various management approaches. The discussion highlights the latest advances in burn care, including early burn wound excision, fluid resuscitation, infection control, and rehabilitation. The evolving landscape of burn care research and its implications for improved patient outcomes are emphasized. In conclusion, this article underscores the importance of a multidisciplinary approach to burn patient care and the need for continued research to enhance the quality of life for survivors.

Characteristics of blood clotting on thromboelastography in patients with early burns

BackgroundThromboelastography (TEG) is a viscoelastic test that may be used to evaluate the hemostatic function of whole blood, and it may be useful for burn patients with multiple hemostatic defects. MethodsWe retrospectively recruited patients with burns between January 2019 and July 2021. Blood samples were drawn on admission and subjected to coagulation parameter assessment, including conventional coagulation tests and TEG assessment. Receiver operating characteristic (ROC) analysis was performed to predict the occurrence of complications in patients with early burns. ResultsNinety-three patients with early burns met the inclusion criteria. Patients with minor, moderate, severe, and extremely severe burns accounted for 19.4 %, 36.6 %, 16.1 %, and 27.9 % of all patients, respectively. Compared with the healthy controls, patients with early burns showed significant reductions in the R and K values, and significant elevation in the maximum amplitude (MA), coagulation index (CI), and alpha angle. Compared with minor and moderate burn patients, patients with severe and extremely severe burns had lower K values and thrombin time and higher alpha angle, CI, prothrombin time, international normalized ratio, D-dimer, and fibrin degradation products. Patients with hypercoagulation had lower R and K values, longer MA, longer CI, and greater alpha angle. After ROC analysis, the areas under the ROC curve for acute lung injury, acute kidney injury, and bleeding were 0.789, 0.802, and 0.900, respectively. ConclusionTEG provides insight into the hemostatic state of patients with early burns, and can predict complications in early burn patients when combined with conventional coagulation tests.

Direct and indirect effects of fire on germination of shortleaf pine seeds

BackgroundShortleaf pine is a fire-adapted tree species, and prescribed fire is commonly used to increase its regeneration success, improve wildlife habitat, and reach conservation objectives associated with open forest ecosystems. We studied direct effects of heat and smoke on shortleaf pine germination in a greenhouse study and effects of season of burning on the number of new germinants in a field study. Improved understanding of fire effects on shortleaf pine seed and regeneration success can help refine burn prescriptions to better meet specific management objectives.ResultsTemperatures ≥ 120 °C eliminated germination of shortleaf pine seeds in a greenhouse trial, and exposure of seeds to 60 °C resulted in no reduction in germination compared to the unheated control regardless of duration of exposure. At 80 °C, duration of heat exposure mattered, with exposure for 10 min reducing germination compared to unheated controls. Smoke exposure had no effect on germination. A field experiment showed that fall burns (prior to seedfall) resulted in greater initial germinant counts than early spring burns (after seedfall but before germination) or unburned controls, which both resulted in greater initial germinant counts than late spring burns (after germination).ConclusionsSeason of prescribed burning can affect the success of shortleaf pine germination. Late spring burning resulted in high mortality of young germinants. Burning in early spring likely resulted in direct damage to some seeds due to heating but may have also had indirect benefit by exposing mineral soil. Fall burning, before the dispersal of shortleaf pine seed, yielded the highest germinant count and is recommended if improving natural regeneration from seed is the primary objective.

Carbon dioxide laser treatment of burn-related scarring: Results of the ELIPSE (Early Laser Intervention Promotes Scar Evolution) prospective randomized controlled trial

To investigate the impact of ablative fractional carbon dioxide laser (AFCO2L) on patient-reported outcomes measures, subjective scar appearance, dermal architecture, and gene transcription in early burn scars. Fifteen adult patients with a burn-related scar were recruited. Inclusion criteria were two non-contiguous scar areas of 1% total body surface area, similar baseline Vancouver scar scale (VSS) score and 3months since the time of injury. All participants acted as their own control. Scars were randomized to treatment or control. Treatment scars received three AFCO2L treatments at 6-week intervals. Outcome measures were recorded at baseline, 3, 6, and 12-months post-treatment. Measures included blinded VSS, Patient Observer Scar Assessment Scale (POSAS), Brisbane Burn Scar Impact Profile (BBSIP), blinded scar photo assessment, histological tissue analysis, and RNA sequencing analysis. No significant difference was found in VSS, scar erythema, or pigmentation. Patient POSAS improved in scar thickness and texture following AFCO2L. All elements of BBSIP improved in control and laser groups. AFCO2L-treated scars were scored better than control scars by blinded raters. RNA sequencing illustrated that AFCO2L induced sustained changes in fibroblast gene expression. AFCO2L treated scars had significantly altered scar thickness and texture 6 months post-laser and were rated better than controls on blinded photo analysis after 3 treatments. RNASeq results suggest laser treatment alters the transcriptome of treated fibroblasts for at least 3 months after treatment. Expansion of this research to study in more depth fibroblast changes in response to laser, as well as assessing the impact on daily activity and quality of life, will be beneficial.

Laser, Intense Pulsed Light, and Radiofrequency for the Treatment of Burn Scarring: A Systematic Review and Meta-Analysis.

Burns and scarring are considered some of the greatest problems in public health because of their frequent occurrence. Today, photo-electric technology shows promising results in the treatment of burn scars. Over the years, more clinical trials and more technologies for scarring have emerged. The aim of this study was to determine better timing and methods of photo-electric therapy for burn scars. This study was registered in PROSPERO (CRD42023397244), following the PRISMA statement, and was carried out in concordance with the PRISMA checklist. In October 2022, we searched PubMed.gov, Embase, and the Cochrane library (1980-present) for published studies related to the photo-electric treatment of burn scars. Two review authors independently selected the studies, extracted the data, assessed the risk of bias among the studies included, and carried out NIH assessments to assess the certainty of the evidence. A third review author arbitrated any disagreements. Our research included 39 studies. We found evidence suggesting that photo-electric therapy between six months and one year offers significantly better outcomes than treatment of scarring after one year. The evidence also suggests the use of IPL for the treatment of early burn scarring. However, it is important to emphasize that the scientific evidence remains insufficient. We need more clinical trials of higher quality and with less heterogeneity to confirm our results.

The Effects of Prescribed Dry Season Burning on Woody Species Composition, Mole National Park, Ghana

Fire use in protected savannas of Africa is a common practice. Fires in these savannas create many environmental benefits, such as reducing grass, brush and trees that can fuel large and severe wildfires and improving wildlife habitat. However, wrong timing of fire can threaten plants, animals and habitats. This study investigated the effects of time of burning on woody plant composition, diversity and density in the Mole National Park, Ghana. A total of twelve 300 m2 plots were systematically sampled in a 200 m × 200 m treatment plot established by Park Management each for early burn, late burn and no-burn plots. Twenty-seven different woody species belonging to fourteen families were recorded in all the treatments. Most of the species identified belonged to the families Fabaceae and Combretaceae. Vitellaria paradoxa (Shea), Terminalia avicennioides, Combretum adenogonium and Combretum molle were the most common and abundant in all treatments. A TWINSPAN on sites and species revealed four species groups based on affinity to burning time. A follow-up DCA showed a strong association between burning time and species composition, with the first two axes explaining 65% of variation. The late burn and no-burn treatments recorded the lowest diversity amongst the three treatments. Stem density was highest in no-burn treatment which had lowest species richness and diversity compared to early and late burn treatments. Early burn treatment had the highest diversity and the lowest density of woody species. The study revealed that the different times of prescribed burning influenced vegetation differently. Prescribed early dry season burning could contribute to the management of indigenous woody species in protected fire-prone savannas, because it can promote the diversity of species, as found in the Mole National Park in the Guinea savanna of Ghana.

"Clinical Observation of Microplasma Radiofrequency Technology Combined With Glucocorticoid Injection in the Treatment of Hundreds of Cases of Hypertrophic Scar After Early Deep Burn and Scald".

To investigate the clinical efficacy and safety of microplasma radiofrequency technology combined with glucocorticoid injection in the treatment of hypertrophic scarring after early deep burns and scalding. A total of 150 patients with hypertrophic scars after early deep burns from June 2018 to June 2021 were randomly divided into 3 groups, with 50 cases in each group. The patients were treated with compound betamethasone injection (Group A), microplasma radiofrequency technique (Group B), and compound betamethasone injection combined with microplasma radiofrequency technology (Group C). Each course of treatment included 5 standard treatments, and they were performed 6 weeks apart. Each patient was analyzed using the Vancouver scar scale and visual analogy scale after each treatment. The results were compared over time and across groups using repeated measurement analysis of variance. A total of 138 patients in these 3 groups completed this study. As treatment continued, the Vancouver scar scale value of Group C decreased more rapidly than that of Group A and Group B, and the difference was statistically significant (P<0.05). In the improvement of scar pain and itching, there was little difference between Group C and Group A (P>0.05), but both were better than Group B, and the difference was statistically significant (P<0.05). Regarding the incidence of adverse reactions, there was little difference between Group C and Group B (P>0.05), but the incidence of adverse reactions was lower than that of Group A, and the difference was statistically significant (P<0.05). Microplasma radiofrequency combined with glucocorticoid injection in the treatment of hypertrophic scarring after early deep burns is effective, safe, and has a low incidence of adverse reactions, and it merits clinical promotion.

Burning Skin Detection System in Human Body

Early accurate burn depth diagnosis is crucial for selecting the appropriate clinical intervention strategies and assessing burn patient prognosis quality. However, with limited diagnostic accuracy, the current burn depth diagnosis approach still primarily relies on the empirical subjective assessment of clinicians. With the quick development of artificial intelligence technology, integration of deep learning algorithms with image analysis technology can more accurately identify and evaluate the information in medical images. The objective of the work is to detect and classify burn area in medical images using an unsupervised deep learning algorithm. The main contribution is to developing computations using one of the deep learning algorithm. To demonstrate the effectiveness of the proposed framework, experiments are performed on the benchmark to evaluate system stability. The results indicate that, the proposed system is simple and suits real life applications. The system accuracy was 75%, when compared with some of the state-of-the-art techniques.

Prescribed burning of endophyte-infected tall fescue plots: Effects on forage production, ergot-like alkaloid concentrations, and botanical composition

Our objective was to evaluate the effects of early-spring prescribed fire on forage production and botanical composition in Kentucky 31 tall fescue plots. Treatments were applied in a completely randomized design with 10 plots per treatment. Treatments were (1) no burn (CON), (2) March mowed (MWD), (3) March burn (EBRN, early burn), and (4) April burn (LBRN, late burn). Beginning in May and repeated monthly until October, tall fescue tillers were hand clipped at ground level while walking an “X” pattern. In May of each year, tall fescue seedheads were counted in twelve 0.09-m2 quadrats per plot, and species frequencies were recorded. Species frequency was collected again in October. Tall fescue seedheads were reduced by 72% (P < 0.01) for LBRN. Spring forage accumulation was reduced (P < 0.01) by MWD, EBRN, and LBRN treatments, with EBRN and LBRN having a greater reduction (P = 0.03) than MWD. Nonfescue forage species frequency increased (P ≤ 0.01) in October for LBRN. Ergovaline concentration did not differ (P = 0.57) among treatments but differed (P = 0.01) by month, with a substantial increase in June compared with other months. Early-spring prescribed fire reduced tall fescue seedhead production; however, fire also reduced forage production. Removal of a portion of seedheads from tall fescue plots did not affect ergovaline concentration in plant samples. Thus, future research should evaluate ergot-like alkaloid concentrations in various plant parts from tall fescue subjected to seedhead control measures.

Knowledge, attitude, and practice towards burn first aid and its associated factors among caregivers attending burn units in Addis Ababa, Ethiopia. A cross-sectional study

BackgroundBurn injuries are thought to be preventable but are still a prevalent global health problem, especially in low- and middle-income countries. It continues to remain a leading cause of morbidity and mortality in Ethiopia. Proper knowledge about burn first aid minimizes the overall impact of the injury. PurposeThis study aimed to assess the knowledge, attitude, and practice toward burn first aid and its associated factors among caregivers attending burn units in Addis Ababa, Ethiopia, 2021/22. MethodsA hospital-based cross-sectional study was conducted among caregivers of burn patients attending Yekatit 12 hospital medical college and Addis Ababa Burn Emergency and Trauma (AaBET) hospital burn units. A total of 305 caregivers were recruited by a simple random sampling method from both hospitals. Data was collected using a standard interviewer-administrated questionnaire, cleaned, coded, and entered into EPI data version 6, and then exported to SPSS version 26 for further analysis. The generated data were compiled by frequency tables, charts, and graphs. A logistic regression model was used to measure the association between independent versus outcome variables, considering the AOR, 95% CI, and p < 0.05 as significant for all the independent variables. ResultA total of 305 participants responded to this study. Among these, the majority, 185(60.7%) of caregivers were females, while 120(39.3%) were Males. The main source of knowledge for those who had previous information on a burn and its first aid treatment were families, friends, colleagues, and guardians. A significant portion of 246(80.7%) respondents did not take any form of burn first aid training. The study indicates that 202(66.2%) and 195(63.9%) of the study participants have poor knowledge and practice, respectively, despite the majority. 225(73.8%) of responders have a favorable attitude regarding burn first aid. Conclusion and recommendationThis study showed an explicit knowledge and practice gap among caregivers towards burn first aid even though the majorities have a favorable attitude. Developing an effective nationwide burn prevention program and early burn first aid treatment in Ethiopia and promoting a consistent guideline for burn first aid.