Total Surface Research Articles

Assessment of Cartilaginous and Tendinous Lesions Following Intramedullary Compression Screw Fixation of Middle Phalangeal Fractures: A Cadaveric Study.

Assessment of Cartilaginous and Tendinous Lesions Following Intramedullary Compression Screw Fixation of Middle Phalangeal Fractures: A Cadaveric Study.

Diamond Wire Wear and Its Effect on Surface Quality in Cutting of Monocrystalline Silicon

Monocrystalline silicon is widely used in the semiconductor industry. During wafer machining with a diamond wire saw (DWS), a worn diamond wire can affect the slicing quality. To assess the effect of diamond wire wear on wafer machining, in this study, the impact of diamond wire wear on the wafer’s total thickness variation (TTV) and surface quality was examined at a wire velocity of 1.8 m/s and a feed rate of 0.5 mm/min. Through a single-factor experiment, the effects of the wire velocity, feed rate, and workpiece thickness on diamond wire wear were explored. The outcomes demonstrate that the wear rate was higher in the early and late wear periods, and the wafer machining quality was poor in these two periods. During the stable wear period, the machined wafer exhibited high quality, while the wear rate remained stable. Under the condition of machining the same area of the workpiece, with an increase in wire velocity, the wear quantity for the diamond wire was reduced. As the feed rate and workpiece thickness increased, the wear quantity of the diamond wire increased. The diamond wire wear remained roughly constant when the wire velocity and feed rate increased at the same ratio.

Ice nucleating particle sources and transports between the Central and Southern Arctic regions during winter cold air outbreaks

Ice nucleating particles (INPs) initiate ice formation, affecting the liquid versus ice distribution and radiative properties of clouds. INPs have been measured around the Arctic, but few INP concentration measurements have been reported for air during movement south out of central Arctic pack ice regions during cold air outbreaks (CAOs). We analyzed cases of transports connecting the Central Arctic location of the Multidisciplinary Drifting Observatory for the Study of Arctic Climate (MOSAiC) expedition to the near sea ice edge in Svalbard and across ice-free ocean to the Cold-air Outbreaks in the Marine Boundary Layer Experiment (COMBLE) site at Andenes, Norway, during the 2019–2020 Arctic winter. Aerosol surface area concentration measurements during CAOs indicate a switch from primarily accumulation mode at MOSAiC toward marine coarse mode (from sea spray emissions) at COMBLE. INP concentrations were independent of aerosol surface area or volume over the pack ice in MOSAiC in winter. At Svalbard, INPs related best to supermicron aerosol surface area and supermicron volume. At the COMBLE site, INPs related best with total aerosol surface area and total aerosol volume. In 5 of 6 case studies analyzed, INP concentrations increased in association with the transition to a dominance of sea spray aerosols. The INPs at COMBLE had a unique INP concentration mode near −18°C and higher ice nucleation active site densities (e.g., INPs per surface area) compared to those previously reported for other open ocean regions dominated by marine aerosols. While the INP sources in this case appear to be from oceanic emissions from shallower oceans under turbid water conditions, attribution solely to sea spray aerosols versus mixing down of free tropospheric aerosols by CAO clouds remains as a future topic. These studies provide a basis for parameterization of INPs for numerical modeling studies of CAO cloud systems.

Examining the effect of preoperative antibiotics for skin grafting surgery on the microbiome in burn patients: a pilot study

Aim: Severely burn injured patients present in an immunocompromised state with loss of skin integrity. Systemic antibiotics are necessary to treat infection in this population, but even small doses may select resistant organisms and alter the host microbiome. Despite this, preoperative antibiotics in burn injury remain debated and their impact on the host microbiome has not been fully elucidated. This work examined the effect of a single preoperative antibiotic dose on the microbiome and clinical outcomes in burn patients. Methods: Patients with burns < 10% total body surface area (TBSA) requiring a single excision and grafting operation were enrolled and randomized to receive a single preoperative dose of cefazolin (ABX) or no antibiotics (no-ABX). Blood samples, wound swabs, and buccal swabs were obtained serially during and after hospitalization to determine bacterial taxonomy characteristics. Graft loss was determined at clinic follow-up. Results: In ABX patients, there were 29 enriched bacterial taxa within wound beds at dressing takedown [log(LDA) ≥ 2, P ≤ 0.05] and greater than 10 bacterial taxa in buccal swabs at follow-up [log(LDA) ≥ 2, P ≤ 0.05]. There was increasing alpha diversity in ABX patients intraoperatively and at dressing takedown. There were no significant differences in graft loss between groups. Extremophile infiltration was noted in oral and wound microbiomes in ABX patients. Conclusion: Though not affected clinically, these data suggest that a single preoperative antibiotic dose significantly impacts the wound and oral microbiome. Innovative approaches to examining the antibiotic impact on the host microbiome of burn patients may help better tailor antibiotic stewardship.

Experiences from Burn Registry Pilot Study in Northern India: Patient Profile and Implementation Perspectives.

In India, burns represent a serious public health concern due to high death and disability rates. A national burn registry was proposed under the National Program on Prevention and Management of Burn Injuries. This study reports experiences from the first pilot burn registry in India, presenting patient profiles and implementation perspectives. Five burn centres were selected to implement a prospective, multicentric burn registry in northern India. Every burn patient at the study sites who met the inclusion criteria was recruited. Patients' sociodemographic and burn injury profiles, determinants of mortality, and predictors of poor recovery outcome (death or discharge with disability) are presented based on descriptive, bivariate and binary logistic regression analyses. From August 2020 to March 2022, a total of 908 patients were enrolled, with 61% being male and 39% female. Approximately 43% of acute burn patients were referred from other health facilities. The most frequent causes of burns were flame (37%), hot liquid (28%), and electric (28%). Accidental burns accounted for 88% of cases, with 73% occurring at patients' homes, and 48% being classified as major burns (≥20% Total Body Surface Area [TBSA]). Mortality was significantly higher among female patients with TBSA higher than 40% and non-accidental burns. The odds of poor recovery were higher for TBSA >40%, electric burns, and non-accidental burns. The implementation experience highlights the need to broaden the scope of the burn registry to include more comprehensive data, which can enhance the planning and delivery of burn care services.

Prenatal alcohol exposure alters brain structure and neurocognitive outcomes for 6‐ to 7‐year‐old children in a South African birth cohort

AbstractBackgroundSeveral studies have demonstrated an association between prenatal alcohol exposure (PAE) and altered brain structure. However, more research is needed to understand how structural brain changes may influence neurocognitive performance in children with PAE at the age of school entry. We investigated the associations between PAE and cortical and subcortical gray matter morphology and whether PAE‐related structural brain changes mediate the associations between PAE and neurocognitive outcomes in 6‐ to 7‐year‐old children.MethodsOne hundred fifty‐eight children (49 PAE, 109 unexposed controls; 46% female; mean age 76 ± 5 months) who participated in a brain imaging substudy of the population‐based Drakenstein Child Health Study were included. The children had moderate‐to‐high PAE without other substance exposure, except prenatal tobacco exposure. T1‐weighted brain structural scans were acquired using a 3T MRI scanner. General linear models and mediation analyses tested the associations of PAE with cortical and subcortical metrics and associated neurocognitive outcomes.ResultsPAE was associated with a smaller total cortical surface area and had multivariate effects on regional cortical volume and surface area in the temporal lobe. The smaller volume and surface area of the left middle temporal gyrus mediated associations between PAE and neurocognitive outcomes for numeracy and mathematics and/or cognition and executive functioning. Findings persisted when adjusting for age, sex, maternal education, prenatal tobacco exposure, and, in volumetric and surface area models, intracranial volume.ConclusionThis study suggests that there is persistent altered brain structural development in children with PAE, consistent with previous findings in this cohort at infancy and age 2–3 years. Cortical changes in regions known to play a role in numeracy and semantic memory mediated associations between PAE and neurocognitive deficits, highlighting clinical relevance. Efforts to prevent PAE and improve neurocognitive development in children with PAE should be implemented as early as possible after birth.

Investigating the accuracy of tropical woody stem CO2 efflux estimates: scaling methods, and vertical and diel variation

Summary Stem CO2 efflux (EA) significantly contributes to autotrophic and ecosystem respiration in tropical forests, but field methodologies often introduce biases and uncertainty. This study evaluates these biases and their impact on scaling EA at the stand‐level. Diel and vertical patterns of EA were investigated, along with the accuracy of estimating stem surface area from allometric equations vs terrestrial light dection and ranging (LiDAR) scanning (TLS) in Maliau Basin Conservation Area, Sabah, Malaysian Borneo. Diel EA exhibited no uniform pattern due to inter‐tree variability, but results suggest measuring EA before 15:00 h. EA was significantly higher on buttresses and above the first major branching point, but vertical variations in EA did not impact stand‐level EA when stem surface area was accurately estimated. Allometric equations underestimated total stem surface area by c. 40% compared with TLS, but applying a site‐specific correction factor yielded a similar stand‐level EA and total stem surface area to TLS. This study provides guidance for measuring EA in the field and suggests that measuring at one time point and one height along the stem can produce accurate results if conducted using the correct time frame and if stem surface area is accurately estimated.

Geomorphological Effects of Land Reclamation on the Coastal Plain East of the Venice Lagoon (Italy)

The present study aimed at identifying the transformations that occurred since the 1600s in a low-lying territory located east of the Venice Lagoon. The environmental modifications were examined in a GIS environment through the interpretation of multidisciplinary data. The analysis of historical maps realized from 1641 to 1943, as well as aerial photographs and satellite images taken in the last few decades, was fundamental to reconstruct the evolution of the study area mainly in relation to anthropogenic processes. Over the past few centuries, various attempts of land reclamation partially or totally failed. However, even if an overall general decrease in both the total pond surface area and the marsh extension has been observed since the 19th century, the territory appeared entirely dry back only in the 1940s owing to the efficacy of the main most recent works.

Amputations in adult burns patients: a 10-year retrospective study.

Amputation is an uncommon but potentially life-changing complication of burns. No studies of amputation among UK burns patients currently exist. A 10-year review of burns patients with amputations at the Queen Elizabeth Hospital Birmingham was conducted. Descriptive analysis was undertaken to identify patient characteristics. Statistical analysis was conducted to identify relationships between patient and injury details and the number of amputations, and relationships between the number of amputations and patient outcomes. Thirty-five adult burns patients (mean age 48.1 years, 65.7% male) were identified, 62.9% of whom suffered flame burns. The median total body surface area (TBSA) burned was 24%. The amputation risk among admitted burns patients was 1.2%. Major burns patients (≥25% TBSA burned) underwent more minor (p=0.018) and upper limb amputations (p=0.035) compared with minor burns patients. Median length of hospital stay was 67.5 days. Length of stay was positively correlated with the number of total (p=0.001), minor (p=0.004) and upper limb (p=0.002) amputations. In total, 67.6% of amputees underwent revisional procedures. The number of revisions was positively correlated with the number of major (p=0.010) and lower limb (p=0.001) amputations. A minority of adult burns patients underwent amputations. Patient and injury information may predict a greater number of amputations, which in turn may predict longer hospital stays and a requirement for more revisional procedures. This information could be used to better counsel patients about their likely outcomes. A multicentre case-control study is required to clarify risk factors for amputation in burns.

The role of topical therapy in the complex treatment of tonsillopharyngitis in children

Acute tonsillopharyngitis is a common disease (2–5% of paediatric outpatient visits) for which systemic antimicrobials are often prescribed. However, streptococcal tonsillopharyngitis, infection caused by group A beta-hemolytic streptococci (GABHS), is one of the main indications for antibiotic therapy in acute tonsillopharyngitis in children. When developing a treatment regimen for the disease, preference is given to topical therapy (except in cases of streptococcal tonsillopharyngitis), and the topical antimicrobial therapy methodology recognises that laryngospasm may occur in young children, and the microbiome of the oral cavity and pharynx may need correction in frequently ill children after intensive antimicrobial therapy. Aerosol therapy in the form of inhalation of pharmacological agents that have higher chemical and physical activity than their liquid counterparts due to larger total surface area of the dispersed phase is the optimal method for delivering pharmacological agents into the oral cavity and pharynx. In recent years, a new generation antiseptic benzyldimethyl-myristoylamino-propylammonium chloride has become increasingly common. It showed pronounced activity against Gram-positive and Gram-negative bacteria, fungi, complex viruses, including the SARS-CoV-2 coronavirus, protozoa, aerobic, anaerobic flora in the form of monocultures and microbial associations, including strains with multiple antibiotic resistance. This antiseptic agent refers to drugs of low-toxicity, and does not have any local irritating, allergenic, mutagenic, carcinogenic or embryotoxic effect. It has been identified as having immunoadjuvant effect. The review of clinical observations showed that an aerosolized form of benzyldimethyl-myristoylaminopropylammonium chloride had a favourable clinical effect in patients with tonsillopharyngitis of both streptococcal and other, in particular viral, etiology. The aerosolized form of the drug provides a wide spray angle and finely dispersed diffusion, as opposed to a spraying device, due to which the drops of the drug cover the mucous membrane in a more accurate way. The findings of the analysis of systematic reviews on the etiology, clinical picture and diagnosis of acute tonsillopharyngitis, updates on the oropharynx microbiocenosis and methods for its correction, and clinical studies on the efficacy and safety of the aerosolized form of benzyldimethyl-myristoylamino-propylammonium chloride have led to the conclusion that its application as topical therapy is useful for the treatment of acute tonsillopharyngitis in children.

New Challenges in the Diagnosis and Treatment of Primary Cutaneous Aspergillosis in Extensive Pediatric Burns

The aim of this study is to share our experience regarding the diagnosis and therapeutic management of primary cutaneous aspergillosis (PCA) in the burn patient, an uncommon infection associated with increased mortality, morbidity, and treatment costs. The uniqueness of this article is the presence of PCA in pediatric patients where the Meek micrografting technique was used. We performed a retrospective study from June 2020 to November 2024. The inclusion criteria were the concomitant presence of burn injuries and confirmed PCA. We identified six patients, aged between 12 and 17 years, admitted with deep burns ranging from 55% to 90% of the total body surface area (TBSA). They required complex ICU treatment and underwent extensive excision–grafting surgeries. The suspicion of infection was raised by changes in the appearance of wounds. Systemic and topical antifungal treatment was established in patients after a PCA diagnosis. Five out of the six cases had a favorable outcome. The use of the Meek micrografting technique in burn treatment represents a new challenge in the treatment of PCA due to the polyamide gauze that covers the micrografts. Early detection and appropriate topical antifungal agents combined with systemic treatment may save the infected grafts and limit the infection spread without necessarily removing the polyamide gauze.

573 Feasibility of an Unfunded Multicenter Trial Group for Older Adult Burn Patients: A Retrospective Study

Abstract Introduction Older adults represent a significant portion of the burn patient population, presenting unique physiological challenges and requiring tailored treatment approaches. Yet, comprehensive data specific to this demographic are limited. The relatively small number of older burn patients at each center makes single-center studies insufficient to address key questions about their care. The development of a multicenter trial group focused on older adult burn patients could yield valuable insights into clinical outcomes, yet funding for such initiatives is often restricted. This study explores the feasibility of creating an unfunded multicenter trial group and conducting a retrospective pilot study to examine clinical trends and outcomes for older adult burn patients. Methods Following IRB approval and the creation of data use agreements, a retrospective pilot study was conducted across twelve burn centers in North America. Each center was tasked with collecting standardized data on burn patients aged 60 and older from January 2017 to December 2019. Data included demographic information, burn characteristics (total body surface area burned, type of burn, etc.), treatment interventions, and outcomes such as mortality, length of hospital stay, and complications. Where possible, data were sourced from each center’s submission to the Burn Care Quality Platform (BCQP). BCQP and additional data were manually entered into a centralized REDCap database managed by one institution. Descriptive statistics of the pilot study are presented. Results The study included 1,632 older adult burn patients. Median age was 68 years (interquartile range [IQR] 13); 1,095 patients (67%) were male and 1,187 (73%) were White with a median BMI of 27.5 (IQR 7.87). The median burn size was 3.5% total body surface area (IQR 9, range 0-100%). Patients presented a median of 4.68 hours after injury (IQR 15.35), with a median modified Baux score of 76.21 (IQR 20.5). These patients underwent a median of 1 operation (IQR 1), typically 3 days after injury (IQR 6). The median length of hospital stay was 6 days (IQR 13), with an ICU stay of 1 day (IQR 5). In-hospital mortality was 10.4% and the median time to wound healing was 40 days (IQR 48). Conclusions Creating an unfunded multicenter trial group for older adult burn patients is feasible. The group successfully conducted a retrospective study on care trends for burn-injured older adults. Key factors in the success of this initiative included standardized data collection protocols and strong collaboration between centers. Applicability of Research to Practice Although challenges remain, this project illustrates the potential for establishing a larger, sustainable multicenter trial group aimed at improving clinical practices and outcomes for older burn patients. Funding for the Study No financial compensation or technical support was provided to the participating institutions.

Comparison of Operative Efficiency Using Autologous Skin Cell Suspension Versus Standard Split Thickness Autografting.

Noncultured autologous skin cell suspensions (ASCS) have been applied to burn wounds with comparable results to split-thickness autologous grafts (STSG) while reducing donor graft size and morbidity, making it ideal for patients with large total body surface area (TBSA) burns. However, there is significant cost associated with ASCS. This study aims to compare the size of burn wound coverage per operative minute for ASCS versus STSG, hypothesizing that utilizing ASCS decreases operative time for definitive coverage of large burn wounds, thereby offsetting unit cost. This is a case-control study of ASCS surgical encounters in adults versus matched standard-of-care STSG encounters performed by a single burn surgeon at an American Burn Association-verified burn center between September 2015 and August 2024. Patient demographics, burn characteristics, and operative details were collected from electronic medical records. ASCS patients were matched with STSG controls prioritizing total burn surface area and anatomic location, followed by burn etiology, patient age, and sex. Fifty-one ASCS surgeries performed in 45 patients were matched to 51 STSG surgeries performed in 45 patients. The ASCS and STSG groups were similar regarding demographics, hospital length of stay, complication profile, and operative duration. Significantly more square centimeters of wound were treated with ASCS: 2714 ± 1378 versus 1555 ± 1209 (P < 0.0001), and more square centimeters of wound were treated per minute with ASCS over STSG: 34.5 ± 25.4 vs 20.1 ± 10.9 (P = 0.001). Matched groups comparable at baseline demonstrated higher operative efficiency with use of ASCS with similar hospital length of stay and complication profile.

28 Cutaneous Functional Units versus Total Body Surface Area– Which Is Better for Predicting Motion Loss?

Abstract Introduction Total body surface area (TBSA) is a well-known risk factor for short-term outcomes after burn injury, such as mortality or sepsis. It is less effective for predicting longer-term outcomes like burn scar contractures. Early and reliable identification of patients at risk of contractures and other scar-related problems could help guide preventative efforts and improve outcomes for burn survivors. Cutaneous Functional Units (CFUs) offer a potential metric for predicting scar outcomes because they quantify burn severity and extent within more localized and functionally relevant areas of the body. This study compared predictive models using CFUs, TBSA, and both CFU+TBSA to determine the value of incorporating CFU data into models that predict loss of range of motion (ROM) after a burn injury. Methods The following predictive models were compared: 1) TBSA - included patient-level extent (%) of burn; 2) CFU - included % of burn within each defined CFU area; and 3) CFU+TBSA - included % burn at both body-level and CFU-level. All models included core variables of sex, age, race, and individual joint motion. The outcome variable was ROM, measured at hospital discharge at the joint level using degrees converted to a proportion of typical ROM. Model discrimination was assessed using the Area Under the Receiver operating characteristic curve (Harrell’s C statistic). The models were developed using fractional regression and logit function with one dataset and validated on an independent dataset to ensure unbiased assessment. Results Models were developed using data from a prospective, longitudinal, multi-site cohort study including 7463 joint motions from 307 adult burn survivors. The combined CFU+TBSA model had the highest C statistic, followed by the CFU model, then the TBSA model (Table 1). The improvements in the C-statistic of the CFU model (p=0.03) and TBSA+CFU model (p=0.00) were statistically significant compared to the TBSA model but were not different from each other (p=0.48), suggesting that models including CFU are better. The CFU +TBSA model was applied to an independent dataset of 66 patients and 1467 joint motion observations from a prospective cross-sectional study of adults with burn scar contractures. The C statistic was.639 (95%CI: 0.571, 0.707; p=0.00), demonstrating significant but lower discrimination in this external dataset. Conclusions Predictive models that include CFUs alone or CFU+TBSA can better distinguish joint motions at risk for loss of ROM than TBSA alone. The CFU+TBSA model also demonstrated moderate discriminatory power in an independent dataset. This study established the statistical value and utility of using CFUs to predict motion loss and sets the stage for further investigation, including clinical relevance and validation with other patient samples. Applicability of Research to Practice Prediction of scar problems after burn injury. Funding for the Study N/A

118 Violent Burns Are Associated with Poorer Life Satisfaction and Unemployment After Injury: A Nationwide Analysis

Abstract Introduction Assaults can result in violent burn injuries that have long-lasting effects on survivors. Resulting physical pain and psychological trauma can impact quality of life and employment. In this study, we aim to explore socioeconomic demographics and longitudinal psychosocial outcomes associated with violent burns. Methods Adult participants admitted for acute burn injury between 1996 and 2023 within a multi-center longitudinal survey study were included in the present study. Violent burns were defined as circumstances of injury including suspected assault (both domestic and non-domestic) and arson. Patients with self-inflicted burn injuries were excluded. Participant demographics were summarized using descriptive statistics and compared between the violent and unintentional burn cohorts with Wilcoxon-Mann-Whitney and Chi-square tests. Mixed effects regression models were constructed to investigate longitudinal associations between violent burn injuries and anxiety, depression, posttraumatic stress symptoms, posttraumatic growth, and satisfaction with life. In each of these models, age, sex, total body surface area (TBSA) burn size and time were included as covariates. A logistic regression model examined associations between violent burns and employment status at 12 months post injury. This model controlled for pre-injury employment status, burn center, TBSA, age, and sex. Results A total of 4,668 patients were included in the study, of whom 147 (3.15%) sustained violent burns. The violent burn cohort was more likely to be Black (p&amp;lt; 0.001), unemployed (p&amp;lt; 0.001), have lower income (p=0.001), and less likely to have completed graduate education (p&amp;lt; 0.001). Participants with violent burn injuries had larger burns (24.0 vs. 16.6% total body surface area, p&amp;lt; 0.001). Post-burn anxiety, depression, post-traumatic growth, and post-traumatic stress were not significantly associated with burn intentionality. However, survivors were more likely, after controlling for TBSA, to experience unemployment (p&amp;lt; 0.001) and lower satisfaction with life (p&amp;lt; 0.001) after injury. Conclusions Violent burn injuries disproportionately impact historically marginalized and socioeconomically disadvantaged individuals. These injuries lead to poorer quality of life than unintentional burns, but there were similar impacts on psychological health regardless of intentionality of injury. Future research should focus on exploring dissatisfaction with life, barriers to employment, and the role of vocational counseling in addressing these challenges within this patient population. Applicability of Research to Practice Our research highlights the need for targeted interventions and support systems to improve employment prospects and overall satisfaction for survivors. Implementing these findings in clinical practice can help tailor rehabilitation programs and social services to address the unique challenges faced by this population. Funding for the Study The contents of this abstract were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPBU0007). NIDILRR is a Center within the Administration for Community Living (ACL), Department of health and Human Services (HHS). The contents of this abstract do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

619 Utilization of a Designated Burn Case Manager Reduces Length of Stay After Burn Injury

Abstract Introduction Burn patients’ discharge planning is more complex than most, so much so that it should be thought of as a perishable skill. Due to staffing shortages, our burn unit’s discharge planning needs were met by a rotating pool of Licensed Clinical Social Workers (LCSWs) who would cover the burn service for periods of time ranging from several hours to several weeks before rotating off to other parts of the hospital. After advocating for the position we were granted a designated burn case manager (DBCM), an LCSW whose primary responsibility would be to the burn unit. We undertook a quality improvement project to assess the impact of a DBCM on length of stay (LOS) after burn injury. Methods A DBCM was designated for our burn unit beginning 01 Oct 2022. Prior to that date, the DBCM in question had no experience with burn injury, treatment regimens, or burn discharge planning. We queried our burn registry performance improvement database for all patients admitted with an acute burn injury with or without concomitant trauma who spent at least 1 midnight in the hospital between 01 Oct 2020 to 30 Sep 2022 (PRE-DBCM) and 01 Oct 2022 to 30 June 2024 (POST-DBCM). Patients were excluded if they died during the index admission, signed out against medical advice, or were admitted with an exfoliative skin disorder or necrotizing soft tissue infection. Patients for whom hospice was arranged as a disposition prior to their death were allowed to remain in the analysis. LOS was normalized as days per percent total body surface area (TBSA) burned. As the data was skewed, all values are reported as medians with interquartile ranges and analyzed with Mann-Whitney-U tests. Alpha was set at 0.05. Daily hospital costs for this time period were taken from our institution’s financial administrative data. Results Four hundred thirty subjects were in the overall cohort (PRE-DBCM n=210, POST-DBCM n=220). Age and TBSA between the cohorts were similar (p=ns). Median LOS was 1.46 [0.85, 2.67] days/%TBSA burned in the PRE-DBCM cohort and 1.23 [0.67, 2.43] days/%TBSA burned in the POST-DBCM cohort (p=0.049). Given that a day in our hospital cost $3,200 during the time period of this QI project, utilization of a DBCM resulted in a savings to the hospital of $1.89 million USD. Conclusions The burn-specific knowledge and resources required to provide optimal burn case management are most easily acquired when the job is performed on a daily basis. Designating one case manager to be responsible to the burn unit results in a significantly shorter LOS and a financial savings to the institution that more than offsets the cost of the hire. Applicability of Research to Practice Due to the financial solvency, the hiring of a dedicated case manager is something that every unit should consider. Funding for the Study N/A

856 Summary of Case Study: Management of Full Thickness Genital Burns in an 18-Year-Old Male

Abstract Introduction This case study addresses the complex surgical management of full thickness genital burns, focusing on maintaining urogenital function, preventing scar contracture, and achieving satisfactory aesthetic outcomes. An 18-year-old male sustained 43.5% total body surface area (TBSA) burns from an electrical arc incident at work, affecting his abdomen, torso, and genital regions. Methods The treatment involved multiple surgical interventions in staged reconstruction, including burn wound excision and graft applications over several weeks. Key procedures included: Day 2: Initial excision and allograft application to lower extremities, abdomen, penis, and scrotum. Day 8: Additional excisions and allograft application to penis and scrotum. Day 11: Repeat excision with application of synthetic matrix skin substitute to his perineum, scrotum, and penis. Day 39: Final operation involving intraoperative artificial erection to maximize penile length, followed by a 1:1 autograft to scrotum and sheet graft to penis with immediate splinted negative pressure therapy to prevent contracture during early post-operative healing. The patient gave consent for the purpose of this case study. Results The patient achieved 100% scrotal and 99% penile graft adherence on evaluation after two days of negative pressure therapy. At the nine-month follow-up, he reported non-painful erections. However, his hospital course was complicated by a cefepime-resistant Pseudomonas aeruginosa urinary tract infection, multi-organism bacteremia, and colonic dilation due to ileus. Conclusions This case illustrates the significant surgical challenges in managing full thickness genital burns, emphasizing the necessity for tailored approaches in both intraoperative and postoperative care. The use of negative pressure therapy and diverse grafting techniques contributed to positive outcomes, despite the complications encountered. Applicability of Research to Practice The study underscores the importance of careful monitoring and innovative strategies in the management of such complex burn injuries. Funding for the Study N/A

A Comparative Study of Velocity and Transport Estimates Along the Oleander Line Between Bermuda and New Jersey

AbstractThe Oleander project, a program to monitor upper ocean currents between Bermuda and New Jersey, started in fall 1992, at about the same time modern satellite altimetry began. This study has two purposes. First, it revisits earlier work that compared Oleander estimates of sea level with altimetry. They agree well with respect to mean surface transport, but the Oleander velocity data exhibit significant temporal variability principally due to a varying Ekman layer. Second, we compare Oleander and altimetry‐derived transport estimates with a set of oceanographic products (OSCAR, GLORYS12, GREPV2, ARMOR3D) as well as with transport estimates from hydrography. All agree with respect to surface transport reflecting the dominant influence of altimetry. Upper ocean (0–1,000 m) transports agree poorly except for acoustic Doppler current profiler estimates, and dynamic height. The analysis products give completely different results with respect to total (surface to bottom) transport.

66 TLR-Mediated Trained Immunity Augments Leukocyte Metabolic Function After Burn

Abstract Introduction Nosocomial infections affect over 100 million people globally, costing the US $9.8 billion annually in inpatient care alone. Severe burn injuries significantly increase infection risk by impairing both innate and adaptative immune cell function. Our prior research has shown that trained immunity may offer protection against infections after burn. Trained immunity, induced by toll-like receptor (TLR) agonists, promotes sustained metabolic, antimicrobial, and epigenetic alterations in innate leukocytes, priming them for robust, non-specific responses that provide broad protection against diverse pathogens. We hypothesize that treatment with TLR agonists can reverse burn-induced immunosuppression by enhancing metabolic and antimicrobial reprogramming in monocytes and macrophages. This project aims to assess how severe burn affects innate immune cell function in mice, with and without TLR agonist treatment, and to refine these assays in human leukocytes for future burn patient studies. Methods In our mouse model, BALB/C mice with a 30% total body surface area (TBSA) scald burn were administered 20 mg of TLR4 agonist monophosphoryl lipid A (MPLA) intraperitoneally 2 days post-burn. On day 7, a subset of mice received intraperitoneal infection with 1x108 CFUs of Pseudomonas aeruginosa. Peritoneal cells were harvested 6 hours later for flow cytometry, Seahorse assays, and Single Cell Energetic metabolism by profiling Translation Inhibition (SCENITH) assay. Plasma cytokines were measured by MagPix multiplex analysis. Additionally, human monocytes from healthy volunteers and a single burn patient (with &amp;gt;20% TBSA burn) were trained with 40 μg/ml MPLA for 24 hours. Seahorse and SCENITH analyses were performed immediately after MPLA exposure and 3 days after its removal to assess metabolic changes. Results Burn-injured mice displayed impaired glucose and mitochondrial dependence in monocytes and macrophages, compared to sham controls. However, these impairments were reversed by MPLA training. Flow cytometry revealed reduced expression of immunosuppressive marker CD38 in MPLA-treated cells, while vehicle-treated cells maintained elevated levels. Burn and infected mice also showed elevated inflammatory cytokines, which were reduced by MPLA. Human monocytes treated with MPLA showed increased glycolytic and oxidative capacities, consistent with SCENITH results indicating higher glucose and mitochondrial dependence. Conclusions In conclusion, burn injury impaired glucose and mitochondrial dependence in macrophages and monocytes, and increased immunosuppressive markers, all of which were reversed by MPLA training. MPLA-trained human monocytes also demonstrated effective metabolic reprogramming. Applicability of Research to Practice TLR agonists represent a promising immunomodulatory strategy for safeguarding burn patients from life-threatening infections. Funding for the Study N/A

63 Immunomodulators Reverse Immune Dysfunction ex-vivo After Pediatric Thermal Injury

Abstract Introduction Pediatric thermal injury induces a heightened inflammatory response and immune dysfunction, which is associated with adverse clinical outcomes (e.g., infections). Specifically, burns with ≥20% total body surface area or ≥5% full thickness in pediatric patients, results in immune suppression and are most at risk to develop subsequent infections. As such, immunomodulating therapeutics have been of great interest to augment the immune response following thermal injury. Our hypothesis was that immune suppression after pediatric thermal injury is reversible ex-vivo using immunomodulators. Methods Pediatric burn patients from a single, ABA-verified pediatric burn center with acute thermal injury were included. Blood samples were taken within the first week after injury. Within 1 h of collection, 50 µL of heparinized whole blood was added to two tubes of lipopolysaccharide (LPS) stimulation reagent (500 pg/mL) one of which contained granulocyte macrophage colony-stimulating factor (GM-CSF; 10 ng). The samples were incubated for 4 h at 37°C. Two additional tubes containing phytohemagglutinin (PHA; 10 μg/mL), one of which held Varlilumab (10 ng; an anti-CD27 antibody), was also incubated with 50 µL heparinized whole blood for 24 hours at 37°C. After incubation, the samples were centrifuged, and the supernatants were collected for batch cytokine analysis. A Mann–Whitney test was conducted to determine differences between burn patients who go on to develop a nosocomial infection relative to burn patients who did not. A Wilcoxon matched pairs signed rank test was performed to identify differences in ex-vivo cytokine production between samples incubated with the immunomodulators relative to samples that did not. Results Pediatric burn patients who went on to develop a nosocomial infection displayed a decrease in both LPS and PHA induced cytokine production compared to burn patients who recovered without infection. The addition of GM-CSF (N=25) significantly increased ex-vivo LPS-induced tumor necrosis factor alpha compared to samples that did not receive GM-CSF (p=0.0157). Varlilumab (N=10) also significantly increased PHA induced interleukin-4 (p=0.0156) and interleukin-10 (p=0.0059) cytokine production in pediatric burn patients. Conclusions The results of our studies provide early evidence that immunomodulators may enhance immune function early after pediatric burn injury and prior to the development of nosocomial infection. Applicability of Research to Practice Based on these early studies, there may be an opportunity to reverse immune dysfunction using GM-CSF and/or CD27 specifically in patients at highest risk for infection identified through standard burn severity as well as ex-vivo induced cytokine production measurements. Funding for the Study NIH-National Institute of General Medical Sciences