Large Burns Research Articles

Clinical Indications of Cultured Epithelial Autografts.

Cultured epithelial autografts (CEAs) have been used for decades as a treatment for massive burn injuries. Cultured epithelial autografts allow for wounds to heal by taking a small sample and growing a patient's own epithelium in culture to create large, graftable sheets. This technique is especially useful in large wounds where donor sites are limited compared with conventional skin grafting. However, CEAs have a variety of uses in wound healing and reconstruction and have the potential to aid in the closure of several types of defects. Cultured epithelial autografts have shown applicability in large burns, chronic nonhealing wounds, ulcerating wounds of various etiologies, congenital defects, wounds requiring specialized epithelium to replace like by like, and wounds in critically ill patients. Several factors must be considered when using CEAs, such as time, cost, and outcomes. In this article, we detail the various clinical applications of CEAs and how they can be situationally advantageous outside of their original purpose.

Effect of boundary layer thickness on supersonic combustion in a scramjet combustor

In this study, the effect of boundary layer thickness on supersonic combustion in an ethylene-fueled scramjet combustor under Mach 5.5 flight conditions is studied by employing experiments, numerical simulations, and theoretical modeling. The plate flow quantitative results show that the absolute thickness of the boundary layer is higher for a larger combustor. But the relative thickness is thin. Although boundary layer thickness changes greatly as the combustion chamber scale enlarges, the influence on the transverse jet and cavity flow is limited. In contrast, the combustion chamber scale change has a great impact on the combustion. More violent flames exist in large-scale combustion chambers. A theoretical model demonstrated that a large subsonic region led to a long fuel residence time, resulting in larger Damköhler numbers. This indicated that a large combustor could maintain large combustion. Based on the above analysis, although the relative thickness of the boundary layer is thinner, the absolute subsonic region of the boundary layer full of combustion is increased, which is conducive to intense combustion. In addition, a verification calculation of the 50 mm shortening isolation section is carried out. It is found from the flame cloud diagram and the quantitative wall pressure data that the combustion is significantly weakened.

Surface topography characterization using a simple optical device and artificial neural networks

State-of-the-art methods for quantifying wear in cylinder liners of large internal combustion engines for stationary power generation require disassembly and cutting of the examined liner. This is followed by laboratory-based high-resolution microscopic surface depth measurement that quantitatively evaluates wear based on bearing load curves (also known as Abbott-Firestone curves). Such reference methods are destructive, time-consuming and costly. The goal of the research presented here is to develop nondestructive yet reliable methods for quantifying the surface topography. A novel machine learning framework is proposed that allows prediction of the bearing load curves representing the depth profiles from reflection RGB images of the liner surface. These images can be collected with a simple handheld microscope. A joint deep learning approach involving two neural network modules optimizes the prediction quality of surface roughness parameters as well. The network stack is trained using a custom-built database containing 422 perfectly aligned depth profile and reflection image pairs of liner surfaces of large gas engines. The observed success of the method suggests its great potential for on-site wear assessment of engines during service.

Core temperature responses in well-healed burn survivors during exercise heat stress: effect of cooling modalities

Introduction: Every year, ~150,000 patients are treated in the United States with burn-related injuries. Previously, our group has shown that ~75% of burn survivors have a maximal aerobic capacity in the lowest 20th percentile rankings, relative to sex and age-adjusted non-burned individuals. This level of impairment is strongly associated with cardiovascular-specific, as well as all cause, morbidity, and mortality. Moreover, burn injuries that require grafting impair thermoregulation, and the subsequent increases in skin and core temperature may dissuade these individuals from engaging in exercise and/or physical activity. Low-energy cooling strategies have potential to attenuate increases in core temperature in burn survivors, which may promote regular physical activity. Thus, the purpose of this study was to evaluate the efficacy of low-energy cooling modalities on thermoregulatory responses during physical activity in the heat. Methods: Twenty-four adults with NO-BURN (n = 9), MODERATE burns (20-40% body surface area burned, n = 7), or LARGE burns (> 40% body surface area burned, n = 8) walked for one hour at a moderate intensity (rate of metabolic heat production of 4.5 W/kg body mass) in an environmental chamber (39°C, 40% RH). Burn survivors were at least 2 years post-injury. Participants performed this activity four times, with the following modalities randomly applied throughout each trial on separate days: no cooling (i.e., control), fan at 4 m/s (FAN), water spray (WS, minimum 10-50 g every 5 min, scaled to burn area size), or WS+FAN. Core temperature (Tcore) was recorded throughout each trial via a telemetric pill. Final Tcore values for each cooling modality were compared against the no cooling condition. Results: For the LARGE burn group, WS reduced end-exercise Tcore by 0.37°C (range 0.09 to 0.66°C) compared with no cooling ( p = 0.01). FAN and WS+FAN did not impact end-exercise Tcore for the LARGE burn group ( p ≥ 0.48). No cooling modality affected Tcore for the MODERATE burn group ( p ≥ 0.12) or the NO-BURN group (p ≥ 0.55). Conclusion: At the assessed workload and environmental condition, the efficacy of the applied cooling modalities on Tcore responses for burn survivors appears to be dependent on both the selected modality and the size of the burn surface area. Namely, WS attenuated the increases in Tcore in participants with LARGE burn injuries, but FAN and WS+FAN did not attenuate Tcore responses in any group. Supported by NIHGrant R01GM068865 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Predicting blood loss in burn excisional surgery.

Blood loss during burn excisional surgery remains an important factor as it is associated with significant comorbidity, mortality and longer length of stay. Blood loss is, among others, influenced by length of surgery, burn size, excision size and age. Most literature available is aimed at large burns and little research is available for small burns. Therefore, the goal of this study is to investigate blood loss and develop a prediction model to identify patient at risk for blood loss during burn excisional surgery ≤10% body surface area. This retrospective study included adult patients who underwent burn excisional surgery of ≤10% body surface area in the period 2013-2018. Duplicates, patients with missing data and delayed surgeries were excluded. Primary outcome was blood loss. A prediction model for per-operative blood loss (>250ml) was built using a multivariable logistic regression analysis with stepwise backward elimination. Discriminative ability was assessed by the area under the ROC-curve in conjunction with optimism and calibration. In total 269 patients were included for analysis. Median blood loss was 50ml (0-150) / % body surface area (BSA) excised and 0.28 (0-0.81) ml / cm2. Median burn size was 4% BSA and median excision size was 2% BSA. Blood loss of>250ml was present in 39% of patients. The model can predict blood loss>250ml based on %BSA excised, length of surgery and ASA-score with an AUC of 0.922 (95% CI 0.883 - 0.949) and an AUC after optimism correction of 0.915. The calibration curve showed an intercept of 0.0 (95% CI -0.36 to 0.36) with a slope of 1.0 (95% CI 0.78-1.22). Median blood loss during burn excisional surgery of ≤10% BSA is 50ml / % BSA excised and 0.28ml / cm2 excised. However, a substantial part of patients is at risk for higher blood loss. The prediction model can predict P(blood loss>250ml) with an AUC of 0.922, based on expected length of surgery, ASA-score and size of excision. The model can be used to identify patients at risk for significant blood loss (>250ml).

Development of hierarchical auxetic skin graft simulants with high expansion potential

Skin grafting is a surgical procedure to treat extensive burn injuries, and the design of skin grafts plays an essential role in burn surgery. In skin grafting, parallel incisions are projected onto a small section of healthy skin that has been removed for maximum expansions and coverage of a larger burn area. Currently, in the traditional method, skin graft expansions are insufficient to cover large burn areas. This work studied the hierarchy of alternating slit (AS) shaped and rotating rectangle (RR) shaped auxetic skin graft patterns. The 3D models of hierarchical structures were designed and developed using SolidWorks and additive manufacturing methods, respectively. These moulds were used to fabricate the hierarchical skin graft simulants. Statistical analysis was performed to calculate the significance among the groups. These hierarchical skin graft simulants were tested uniaxially and calculated the effective Poisson's ratio, meshing ratio, and induced stress up to 300% strain. From the results, all the auxetic skin graft simulants showed very high expansion. The first-order AS-shaped skin graft simulant showed the maximum expansion among all the hierarchical models. Till now, skin grafts have not achieved such high expansion experimentally. This research will be useful to the doctors to improve burn surgery outcomes and guide the manufacturers to develop new mesher with higher expansion potential.

Factor XIII: More than just a fibrin stabilizer for the burn patient? A matched-pair analysis

Acquired factor XIII deficiency is an underestimated risk in patients with large surface burns, which potentially exposes these patients to prolonged bleeding and delayed wound healing if undetected. A retrospective matched-pair analysis of the burn registry of the Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery of Hannover Medical School was performed from 2018 to 2023. A total of 18 patients were included. Acquired factor XIII deficiency was not statistically significant correlated with age, sex, or body mass index. Patients who developed acquired factor XIII deficiency had a significantly longer hospital stay (72.8 days) compared with those in the matched group (46.4 days), although burn depths, total body surface area, and Abbreviated Burn Severity Index were not statistically correlated with factor XIII deficiency. Little is known about acquired factor XIII deficiency in patients with burns. Factor XIII supplementation may improve hemostasis, wound healing, and general outcome while reducing the patient's exposure to blood products.

Weighted Network Degree Screening Method for Low-Temperature Combustion Mechanism Reduction.

A new method is proposed for the reduction mechanism used in the low-temperature negative temperature coefficient region on the basis of the statistical degree screening (SDS) method. Dynamic information is used to redefine network structure and exclude the influence of very weak interactions on node degree according to the statistics character of their distribution as edge weight. Representative low-temperature conditions are used to set weight thresholds to redefine the network structure so that an effective low-temperature oxidation mechanism is covered while negligible interactions are overlooked. Then, the reduction mechanism is obtained by the SDS method through screening out the redundant species and corresponding reactions according to the scale-free character of the degree distribution. This weighted network degree screening (WNDS) method is demonstrated in the n-heptane system. The performance of the reduced mechanism is evaluated in a closed homogeneous reactor for the fuel over T = 600-1000 K, P = 1-30 atm, and φ = 0.5-2. Results show WNDS yields a skeletal mechanism with comparable or even better prediction ability over a wide parameter range than those generated by directed relation graph. WNDS is a novel statistical property-based reduction method that is suitable for low-temperature oxidation reduction. Its good reduction application indicates a brand-new angle for large combustion mechanism reduction.

Bilayered skin substitute incorporating rutin nanoparticles for antioxidant, anti-inflammatory, and anti-fibrotic effect

Hypertrophic scarring in large burns and delayed healing in chronic wounds are consequences of prolonged and aggravated inflammation, sustained infiltration of immune cells, free radical generation, and abundance of inflammatory mediators. Therefore, it is imperative to curb hyperinflammation to expedite wound healing. In this study, rutin nanoparticles (RNPs) were synthesized without an encapsulant and incorporated into eggshell membrane powder-crosslinked gelatin-chitosan cryogels to impart antioxidant and anti-inflammatory properties for treating hyperinflammation. The resultant nanoparticles were found to be 17.53 ± 4.03 nm in size and were stable at room temperature for a month with no visible sedimentation. RNPs were found to be non-cytotoxic and exhibited anti-inflammatory (by increasing IL-10 levels) and antioxidant properties (by controlling the generation of reactive oxygen species and enhancing catalase production in human macrophages). Additionally, RNPs were found to reduce α-SMA expression in fibroblasts, thereby demonstrating their anti-scarring effect. In vivo studies with a bilayered skin substitute constituting an RNP-incorporated cryogel proved that it is biocompatible, does not induce renal toxicity, aids wound healing, and induces better re-epithelialization than the control groups at the initial stages. Thus, RNP-incorporated cryogels containing bilayered skin substitutes are an advanced and novel alternative to commercial dermo-epidermal substitutes that lack anti-inflammatory or anti-scarring properties.

Data-Driven Prediction of Key Combustion Parameters Based on an Intelligent Diesel Fuel Injector for Large Engine Applications

<div class="section abstract"><div class="htmlview paragraph">Digital technologies are capable of making a significant contribution to improving large internal combustion engine technology. In particular, methods from the field of artificial intelligence are opening up new avenues. So-called “intelligent” engine components rely on advanced instrumentation and data analytics to create value-added data, which in turn can serve as the basis for applications such as condition monitoring, predictive maintenance and controls. For related components and systems, these data may also allow for novel condition monitoring approaches. This paper describes the use of value-added data from an intelligent diesel fuel injection valve that give detailed information about the injection process for real-time prediction of key combustion parameters such as indicated mean effective pressure, maximum cylinder pressure and combustion phasing. These parameters are usually involved in combustion controls and power unit condition monitoring and normally acquired using in-cylinder pressure indication systems, which are costly and prone to wear. On the one hand, a data-driven model for key combustion parameters based on an intelligent fuel injection valve could replace an indication system. On the other hand, such a model may enable backup functionality and mutual condition monitoring of the fuel injection valve and the indication system. The data required for model building were acquired from a medium-speed four-stroke single-cylinder research engine with a displacement of approximately 15.7 dm<sup>3</sup>. Different machine learning methods are compared to obtain an accurate yet reliable model for each of the desired combustion parameters. In addition to the value-added injection data, readily available parameters on production engines serve as model inputs (e.g., engine speed, charge air and exhaust gas pressures). Based on the results, the quality of the model predictions is evaluated, and it is assessed whether the approach might be useful for series engine applications.</div></div>

Development of novel hierarchical designs for skin graft simulants with high expansion potential

Skin graft designs play an essential role in healing severe burn injuries. Split-thickness skin grafting (STSG) is one of the commonly used techniques for treating large burn injuries. In STSG, parallel cuts are projected onto a small portion of excised healthy skin for expansion and covering a larger burn area. To date, expansions reported for STSG are very low and insufficient to cover large burn areas. In this work, novel traditional and auxetic hierarchical cuts were designed on skin graft simulants, which were mechanically tested to study their expansion potential. Additive manufacturing and a two-part polymeric material were employed to fabricate the skin graft simulants. The nonlinear mechanical behavior of the hierarchical skin graft simulants was characterized using hyperelastic models. The effective Poisson’s ratio, meshing ratios, and induced stresses in first and second-order hierarchical cut patterns were estimated across all skin graft simulants for up to 300% strain. Also, Statistical analysis was performed to calculate the significance among the groups. From the analysis, the skin graft simulants with second-order auxetic incision patterns were found to exhibit the lowest induced stresses and maximum expansion of approximately four times, at 300% strain. To date, traditional skin grafts have only been able to achieve up to three times expansion. Therefore, the expansions realized with the novel hierarchical skin graft simulants is unprecedented, with the potential to generate ground-breaking advances in burn injury treatment.

A Pilot Randomised Controlled Trial Evaluating a Regenerative Epithelial Suspension for Medium-Size Partial-Thickness Burns in Children: The BRACS Trial

Background: There is little evidence regarding the efficacy of Regenerative Epidermal Suspension (RES™) management for paediatric partial-thickness burns. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) Trial evaluated three dressings for the re-epithelialisation of partial-thickness burns in children. Methods: Eligible children (age ≤ 16 years; ≥5% TBSA; ≤48 h of injury) were randomised to silver dressings, RES™/Biobrane® or Biobrane®. The measured outcomes were the time to re-epithelialisation (primary outcome), pain, itch, intervention fidelity, treatment satisfaction, health-related quality of life, health resource utilisation and adverse effects. Results: The median time to re-epithelialisation in days was no different for RES™/Biobrane® at 12 (IQR: 5.6–18.4; n = 7) and slower by two days for Biobrane® at 14 (IQR: 6.3–21.7; n = 7) when compared to silver dressings 12 (IQR: 3.7–20.3; n = 8). Reduced pain, fewer infections, no sepsis, no skin graft, and the lowest impact on health-related quality of life were reported in the RES™/Biobrane® group compared to other groups. Due to the COVID-19 pandemic, recruitment suspension resulted in a smaller cohort than expected and an underpowered study. Conclusions: The pilot trial findings should be interpreted cautiously; however, they indicate that a fully powered randomised controlled trial is warranted to substantiate the role of RES™ for medium to large paediatric partial-thickness burn management.

State of Implementation of European Legislation Regarding Water Resources Management, Industrial Pollution and Man-Made Hazards in Ukraine

The Association Agreement between Ukraine, on the one hand, and the European Union, the European Atomic Energy Community and their member states, on the other hand, requires Ukraine to bring its national legislation closer to EU law and policy. Environmental protection can be singled out as a separate direction. The article analyzes Ukraine's progress in fulfilling its obligations under the Association Agreement with the EU in the field of industrial pollution and technogenic threats and water resources management. The process of harmonization of the Ukraine legislation and the EU in the field of emissions control from large combustion plants is described. The specifics of the implementation of the Concept of state policy implementation in the field of industrial pollution provisions have been established. The analysis of the legislative acts of Ukraine regarding the reduction and control of industrial pollution was carried out. The problems of implementing the provisions of directives 2001/80/EU and 2010/75/EU into the Ukraine legislation are described. Significant disputes between the Verkhovna Rada of Ukraine and business representatives in the field of industrial pollution control and prevention are indicated. The article provides information on the environmental policy of Ukraine in the field of water resources use and protection. Cooperation between Ukraine and the EU in this direction is carried out in accordance with Section V of Chapter 6 of the Association Agreement with the European Union. It is noted that the system of water resources integrated management based on the basin principle is being implemented in the country. The process of implementing the provisions of the Water Framework Directive 2000/60/EU into the legislation of Ukraine is described. The article presents the principles of developing river basin management plans, activities of Basin Councils, and procedures for state monitoring.

High Expansion Auxetic Skin Graft Simulants for Severe Burn Injury Mitigation

Burn injuries are commonly treated with split-thickness skin grafting. However, low expansions offered by spilt-thickness skin grafting inhibit the treatment of large and severe burn injuries when limited donor skin is available. To overcome this gap, in this work, it was attempted to study the expansion potential of skin grafts with novel auxetic incisions with rotating rectangle (RR), honeycomb (HC), alternating slit (AS), H-shaped (HS), Y-shaped (YS), and I-shaped (IS) unit cells, through development of skin graft simulants. Clinically relevant biaxial load testing was conducted to estimate the stress–strain response, void area, and meshing ratio. Moreover, hyperelastic constitutive models were employed to characterize the non-linear biomechanical behavior of the skin graft simulants. The maximum void area increase was observed in the HS skin graft simulant, indicating low skin cover. Overall, the IS auxetic skin graft design exhibited meshing ratio higher than traditional grafts (>3:1), low void area and stresses, which can be beneficial for large skin cover and burn wound healing. With further optimization and clinical tests, the auxetic skin graft designs may find a place with the graft manufacturers for fabrication of grafts with better surgical outcomes for severe burn injuries.

Engineered multi-functional, pro-angiogenic collagen-based scaffolds loaded with endothelial cells promote large deep burn wound healing.

The lack of vascularization associated with deep burns delays the construction of wound beds, increases the risks of infection, and leads to the formation of hypertrophic scars or disfigurement. To address this challenge, we have fabricated a multi-functional pro-angiogenic molecule by grafting integrin αvβ3 ligand LXW7 and collagen-binding peptide (SILY) to a dermatan sulfate (DS) glycosaminoglycan backbone, named LXW7-DS-SILY (LDS), and further employed this to functionalize collagen-based Integra scaffolds. Using a large deep burn wound model in C57/BLK6 mice (8-10weeks old, 26-32g, n = 39), we demonstrated that LDS-modified collagen-based Integra scaffolds loaded with endothelial cells (ECs) accelerate wound healing rate, re-epithelialization, vascularization, and collagen deposition. Specifically, a 2 cm × 3cm full-thickness skin burn wound was created 48h after the burn, and then wounds were treated with four groups of different dressing scaffolds, including Integra + ECs, Integra + LDS, and Integra + LDS + ECs with Integra-only as the control. Digital photos were taken for wound healing measurement on post-treatment days 1, 7, 14, 21, 28, and 35. Post-treatment photos revealed that treatment with the Intgera + LDS + ECs scaffold exhibited a higher wound healing rate in the proliferation phase. Histology results showed significantly increased re-epithelialization, increased collagen deposition, increased thin and mixed collagen fiber content, increased angiogenesis, and shorter wound length within the Integra + LDS + ECs group at Day 35. On Day 14, the Integra + LDS + ECs group showed the same trend. The relative proportions of collagen changed from Day 14 to Day 35 in the Integra + LDS + ECs and Integra + ECs groups demonstrated decreased thick collagen fiber deposition and greater thin and mixed collagen fiber deposition. LDS-modified Integra scaffolds represent a promising novel treatment to accelerate deep burn wound healing, thereby potentially reducing the morbidity associated with open burn wounds. These scaffolds can also potentially reduce the need for autografting and morbidity in patients with already limited areas of harvestable skin.

Hematogenous septic arthritis after second degree burn and rational use of antibiotics

A 51-month-old female patient, who has meningomyelocele, presented with complaints of pain, fever, and inability to move her left leg from the hip while receiving antibiotic treatment after a localized second degree burn (9%). Physical findings, radiographic findings, and aspiration fluid from the hip joint were consistent with septic arthritis (SA). Methicillin-sensitive staphylococcus aureus growth was observed in wound culture, blood culture and synovial fluid culture sent after the operation. As the clinical condition of the patient with hematogenous spread was stable, treatment with ampicillin-sulbacsite was started. In burn patients, SA should be suspected in cases with fever and joint movement limitation, and it should be predicted that infections related to the burn may be pathogenic for SA. A rational antibiotic approach should be adopted in order to prevent resistance. Cases occurring after the development of large surface burns are available in the literature, and our case is the first pediatric case to develop septic arthritis after small surface area burn.

Management of purpura fulminans skin loss at a regional burns centre: Sixteen-year experience

Purpura fulminans (PF) is a rare syndrome of cutaneous purpura which is the consequence of severe circulatory shock causing intravascular thrombosis, haemorrhagic necrosis, and consequent tissue loss. The aim of this study was to present our 16-year experience of managing PF in a regional burns centre. We performed a single-centre retrospective case series of all patients admitted to the St Andrews Burns Centre at Broomfield Hospital, Chelmsford, Essex, UK, between June 2006 and July 2022 with a diagnosis of PF. Data were extracted by retrospectively searching hospital case notes. Thirteen individuals were identified [five children (mean age 5, range 1-14) and eight adults (mean age 39, range 24-54)]. The total body surface area of cutaneous necrosis ranged from 5% to 80%, with a mean of 27.2%. Patients were treated with an established surgical sequence of total wound debridement and immediate coverage with a cadaveric allograft, followed by staged wound autografting. The mean time from disease onset to wound autografting was 37.3 days (range 20-64 days). Eight individuals (61.6%) required major amputation of at least one limb (proximal to the ankle or wrist joint). Only one mortality (of 80% total body surface area skin loss) was observed in the identified cohort. The large body surface areas often involved in PF cases make management of these wounds well suited for burns centres, wherein established facilities and multidisciplinary teams exist that are familiar with managing large cutaneous burns. We provide a suggested algorithm to aid the management of PF.

Burn injury characteristics, referral pattern, treatment (costs), and outcome in burn patients admitted to a hospital with or without a specialized Burn Centre (BURN-Pro)

PurposeData on the epidemiology, treatment, and outcome of burn patients treated at non-burn centre hospitals are not available. The primary aim was to compare the burn characteristics of patients admitted to a hospital with or without a specialized burn centre.MethodsThis multicentre, prospective, cohort study enrolled patients with burns admitted to a hospital without a burn centre and patients with < 10% total body surface area (TBSA) burned admitted to the burn centre. Primary outcome measure was the burn-related injury characteristics. Secondary outcome measures were adherence to the Emergency Management of Severe Burns (EMSB) referral criteria, treatment (costs), quality of life, and scar quality.ResultsDuring the 2-year study period, 48 patients were admitted to a non-burn centre and 148 patients to the burn centre. In the non-burn centre group, age [44 (P25–P75 26–61) versus 30 (P25–P75 8–52) years; P = 0.007] and Injury Severity Score [2 (P25–P75 1–4) versus 1 (P25–P75 1–1); P < 0.001] were higher. In the burn centre group, the TBSA burned was significantly higher [4% (P25–P75 2–6) versus 2% (P25–P75 1–4); P = 0.001], and more surgical procedures were performed (in 54 versus 7 patients; P = 0.004). At 12 months, > 85% of the non-burn centre group and > 75% of the burn centre group reported no problems in quality of life. Scar quality score was < 1.5 in both groups, with significantly poorer scores in the burn centre group (P ≤ 0.007).ConclusionBoth groups differed in patient, burn, and treatment characteristics. At 12 months, quality of life and scar quality were good in both groups. Significantly poorer scar quality scores were found in the burn centre group. This might be related to their larger burns and more frequent surgery. The organization of burn care in the Netherlands seems to work adequately. Patients are treated locally when possible and are transferred when necessary.

The role of ecotoxicology in the health impact assessment: an innovative ecosystem approach for the protection of human health in Italy.

The Health Impact Assessment (HIA) is a procedure with the aim to protect the populations exposed to the impacts deriving from the establishment or upgrading of large industrial enterprises, i.e. large combustion plants (>300 MWth). In Italy a guideline for the HIA procedure has been published in compliance with the 2014/52/EU Directive on the Environmental Impact Assessment (EIA) requirements. Italian HIA procedure. An ecotoxicological approach has been included for the first time in the HIA procedure with the aim to detect toxic effects caused by unknown not-monitored contaminants or mixtures in the ecosystem components affected by the potential emissions, discharges and releases of large industrial enterprises. Ecotoxicology plays an important bridge role between environment and human health in the scoping and monitoring step of the HIA procedure with a key function of early warning system and screening. The aim of this paper is to present the Italian experience in the first three years of the application of the new approach, proposing recommendations on specific case studies. Conclusion and future perspective. 80% of enterprises, that applied HIA, have delivered a robust, integrated and detailed documentation in relation to the ecotoxicological assessment, this positive feedback will generate environmental and human health benefits to the areas where the plants are established.

Race, area deprivation index, and access to surgical burn care in a pediatric population in North Carolina

BackgroundBurns represent a leading cause of morbidity and mortality for children. This study explores the intersecting effects of social deprivation and race in pediatric burn patients. MethodsWe performed a retrospective review of all pediatric patients (<18 years old) admitted to a tertiary burn center in North Carolina from 2009 to 2019. We used bivariate analysis to compare patients based on reported race, comparing African Americans (AA) to all others. Modified Poisson regression was used to model the probability of undergoing autologous skin grafting based on AA race. ResultsOf 4227 children admitted, AA children were disproportionally represented, comprising 33.7% of patients versus a state population of 22.3%. AA patients had larger %TBSA with a median of 3% (IQR 1–6) compared to 2% (IQR 1–5, p < 0.001) and longer median length of stay at 5.8 days (SD 13.6) versus 4.9 days (SD 13.8). AA patients were more likely to have autologous skin grafting compared to other races, with an adjusted RR of 1.49 (95% CI 1.22–1.83) when controlling for Area Deprivation Index (ADI) national rank, age, %TBSA, and burn type. ConclusionsAA children were disproportionately represented and had larger burns, even when controlling for ADI. They had longer hospital stays and were more likely to have autologous skin grafting, even accounting for burn size and type. The intersection between social deprivation and race creates a unique risk for AA patients. Further investigation into this phenomenon and factors underlying surgical intervention selection are indicated to inform best treatment practices and future preventative strategies.