Agents, mechanisms and clinical features of non-scald burns in children: a prospective UK study

ABSTRACT Aims: To inform childhood burn prevention by identifying demographics, clinical features and circumstances of unintentional non-scald burns. Methods: A prospective cross-sectional study was conducted across Cardiff, Bristol and Manchester, including six emergency departments, three minor injury units and one burns unit between 13/01/2013-01/10/2015. Data collected for children aged <16 years with any burn (scald, contact, flame, radiation, chemical, electrical, friction) included: demographics, circumstances of injury and clinical features. Scalds and burns due to maltreatment were excluded from current analysis. Results: Of 564 non-scald cases, 60.8% were male, 51.1% were 0.6meters and 76.5% affected the hands. Hairstyling devices were the most common agent of contact burns (20.5%), 34.1% of hairstyling devices were on the floor. 63.7% of children aged 10-15 years sustained contact burns of which 23.2% were preparing food, and in burns from hairstyling devices, 73.3% were using them at the time of injury. Conclusions: Parents of toddlers must learn safe storage of hazardous items. Older children should be taught skills in safe cooking and hairstyling device use

Changes in mixed microbial inoculums to prevent the toxic side-effects in cattle grazing new varieties of Leucaena.

Leucaena leucocephala is a legume fodder crop that grows in tropical and subtropical environments. Leucaena provides a high quality feed for cattle boosting liveweight gain both per animal and per hectare, improving profitability for steer turnover by 121% compared with the base scenario of grazing buffel grass (Bowen and Chudleigh, 2018). A number of commercial leucaena cultivars, Cunningham, Peru, Taramba, El Salvadore, and Wondergraze, are used in Queensland. Leucaena contains a toxic amino acid, mimosine, which many rumen bacteria can degrade to a toxic metabolite 3-hydroxy-4-(1H)-pyridone (DHP). Productivity from leucaena-pasture can be reduced by DHP-induced depressions in intake. A DHP degrading bacterium, Synergistes jonesii was isolated from a mixed bacterial population isolated from a goat from Hawaii (Allison et al., 1992). For over twenty years DAF has provided a mixed bacterial rumen inoculum, containing S. jonesii, for cattle grazing Leucaenapastures, produced in an in vitro fermentation system with Cunningham cultivar as the feed source. All of the commercial cultivars are susceptible to attack by psyllid insects, limiting their use in higher rainfall areas - to address this limitation, a commercial psyllid-resistant cultivar, Redlands, was released in 2019. To assess if the leucaena inoculum is impacted by Redland’s anti-psyllid, chemical characteristics a series of 30 day in vitro anaerobic fermentations were undertaken feeding either Redlands, Cunningham or Wondergraze cultivars. The fermentations were conducted following the method of Klieve et al. (2002). Fermentations were started with either cryopreserved leuceana inoculum from a single day of a production fermentation; or day 30 of a Wondergraze or Redlands fermentation. Daily samples were taken and assays set up on days 10, 15, 20, 25 and 30 to monitor the fermentation’s ability to break down mimosine, 3,4 DHP and 2,3 DHP. Genomic DNA extracted from daily samples was used in a S. jonesii quantitative PCR and for barcoded amplicon sequencing of the 16S rRNA gene V3 –V4 region using the Illumina MiSeq platform

Shedding Light on the Microbial Community of the Macropod Foregut Using 454-Amplicon Pyrosequencing

Twenty macropods from five locations in Queensland, Australia, grazing on a variety of native pastures were surveyed and the bacterial community of the foregut was examined using 454-amplicon pyrosequencing. Specifically, the V3/V4 region of 16S rRNA gene was examined. A total of 5040 OTUs were identified in the data set (post filtering). Thirty-two OTUs were identified as 'shared' OTUS (i.e. present in all samples) belonging to either Firmicutes or Bacteroidetes (Clostridiales/Bacteroidales). These phyla predominated the general microbial community in all macropods. Genera represented within the shared OTUs included: unclassified Ruminococcaceae, unclassified Lachnospiraceae, unclassified Clostridiales, Peptococcus sp. Coprococcus spp., Streptococcus spp., Blautia sp., Ruminoccocus sp., Eubacterium sp., Dorea sp., Oscillospira sp. and Butyrivibrio sp. The composition of the bacterial community of the foregut samples of each the host species (Macropus rufus, Macropus giganteus and Macropus robustus) was significantly different allowing differentiation between the host species based on alpha and beta diversity measures. Specifically, eleven dominant OTUs that separated the three host species were identified and classified as: unclassified Ruminococcaceae, unclassified Bacteroidales, Prevotella spp. and a Syntrophococcus sucromutans. Putative reductive acetogens and fibrolytic bacteria were also identified in samples. Future work will investigate the presence and role of fibrolytics and acetogens in these ecosystems. Ideally, the isolation and characterization of these organisms will be used for enhanced feed efficiency in cattle, methane mitigation and potentially for other industries such as the biofuel industry

The Figure in Art: Selections from the Gettysburg College Collection

The Figure in Art: Selections from the Gettysburg College Collection is the second annual exhibition curated by students enrolled in the Art History Methods class. This exhibition is an exciting academic endeavor and provides an incredible opportunity for engaged learning, research, and curatorial experience. The eleven student curators are Diane Brennan, Rebecca Duffy, Kristy Garcia, Megan Haugh, Dakota Homsey, Molly Lindberg, Kathya Lopez, Kelly Maguire, Kylie McBride, Carolyn McBrady and Erica Schaumberg. Their research presents a multifaceted view of the representation of figures in various art forms from different periods and cultures.https://cupola.gettysburg.edu/artcatalogs/1017/thumbnail.jp

Learning Languages and Complex Subjects with Memory Palaces

A memory palace is an ancient technique of using space as a way of organizing memories. It’s a powerful tool for learning, retaining, and recalling large amounts of complex information quickly and effectively. In the middle ages, these techniques were widely used to learn and compose large texts and works of literature. In this paper, we present the fundamental theory behind memory palaces as the foundation for the project Macunx - a VR platform for building memory palaces to learn huge amounts in short time and with full retention - as well as the initial stages of its development. The paper concludes with a discussion of the future stages over the testing of the package with end-users for its final refinement

Bruising in children who are assessed for suspected physical abuse

Objective To describe the characteristics of bruising and mode of presentation of children referred to the paediatric child protection team with suspected physical abuse (PA), and the extent to which these differ between the children where abuse was confirmed and those where it was excluded. Design Cross-sectional study. Setting and patients 519 children, <6 years, referred to two paediatric child protection teams. Main outcome measures The mode of presentation, number, anatomical distribution, size and appearance of bruises according to whether PA was confirmed or excluded. ORs with 95% CI were calculated where relevant. Results PA was confirmed in 69% of children; the rate varied from 84% when abuse was witnessed, admitted, alleged or where explanation for injury was absent or implausible, to 50% where there was a concerning history. Significantly more children with PA had bruises (89.4%) than PA-excluded (69.9%) and had significantly more sites affected (p<0.001). The odds of a PA child having bruising to: buttocks/genitalia (OR 10.9 (CI 2.6 to 46), left ear (OR 7.10 (CI 2.2 to 23.4), cheeks (Left (OR 5.20 (CI 2.5 to 10.7), Right OR 2.83 (CI 1.5 to 5.4)), neck (OR 3.77 (CI 1.3 to 10.9), trunk (back (OR 2.85 (CI 1.6 to 5.0) front (OR 4.74 (CI 2.2 to 10.2), front of thighs (OR2.48 (CI 1.4 to 4.5) or upper arms (OR 1.90 (CI 1.1 to 3.2) were significantly greater than in children with PA-excluded. Petechiae, linear or bruises with distinct pattern, bruises in clusters, additional injuries or a child known to social services for previous child abuse concerns were significantly more likely in PA. Conclusions Features in the presenting history, the extent and pattern of bruising differed between children with confirmed PA and those where abuse was excluded. These findings can provide a deeper understanding of bruising sustained from PA

Enriching for rumen bacteria to degrade the Pimelea plant toxin simplexin, in an anaerobic in vitro fermenter

Three species of Australian native plants, Pimelea trichostachya, P. simplex and P. elongata, are endemic to the arid rangelands of Queensland, New South Wales and South Australia and are responsible for Pimelea poisoning, also known as St George or Marree disease. Pimelea poisoning occurs in cattle ingesting Pimelea plants, with the orthoester simplexin identified as the responsible toxin. There is no effective treatment and economic losses have been estimated at over $50 million during significant Pimelea poisoning events. In a previous feeding trial, animals were fed increasing amounts of Pimelea, and after initially showing signs of poisoning, the animals appeared to adapt to ingesting Pimelea, possibly through rumen microbial degradation of the toxin (Fletcher et al., 2014). Kangaroos, forestomach fermenters, often graze pastures containing Pimelea with no apparent ill effects. To investigate the degradation effect further, a series of 30 day in vitro, anaerobic fermentations were undertaken

Patterns of bruising in preschool children - a longitudinal study

ntroduction This study aims to identify the prevalence and pattern of bruises in preschool children over time, and explore influential variables Methods Prospective longitudinal study of children (<6 years) where bruises were recorded on a body chart, weekly for up to 12 weeks. The number and location of bruises were analysed according to development. Longitudinal analysis was performed using multilevel modelling. Results 3523 bruises recorded from 2570 data collections from 328 children (mean age 19 months); 6.7% of 1010 collections from premobile children had at least one bruise (2.2% of babies who could not roll over and 9.8% in those who could), compared with 45.6% of 478 early mobile and 78.8% of 1082 walking child collections. The most common site affected in all groups was below the knees, followed by ‘facial T’ and head in premobile and early mobile. The ears, neck, buttocks, genitalia and hands were rarely bruised (<1% of all collections). None of gender, season or the level of social deprivation significantly influenced bruising patterns, although having a sibling increased the mean number of bruises. There was considerable variation in the number of bruises recorded between different children which increased with developmental stage and was greater than the variation between numbers of bruises in collections from the same child over time. Conclusions These data should help clinicians understand the patterns of ‘everyday bruising’ and recognise children who have an unusual numbers or distribution of bruises who may need assessment for physical abuse or bleeding disorders

Patterns of bruising in preschool children with inherited bleeding disorders: a longitudinal study

Objective The extent that inherited bleeding disorders affect; number, size and location of bruises in young children <6 years. Design Prospective, longitudinal, observational study. Setting Community. Patients 105 children with bleeding disorders, were compared with 328 without a bleeding disorder and classified by mobility: premobile (non-rolling/rolling over/ sitting), early mobile (crawling/cruising) and walking and by disease severity: severe bleeding disorder factor VIII/IX/XI <1 IU/dL or type 3 von Willebrand disease. Interventions Number, size and location of bruises recorded in each child weekly for up to 12 weeks. Outcomes The interventions were compared between children with severe and mild/moderate bleeding disorders and those without bleeding disorders. Multiple collections for individual children were analysed by multilevel modelling. Results Children with bleeding disorders had more and larger bruises, especially when premobile. Compared with premobile children without a bleeding disorder; the modelled ratio of means (95% CI) for number of bruises/ collection was 31.82 (8.39 to 65.42) for severe bleeding disorders and 5.15 (1.23 to 11.17) for mild/moderate, and was 1.81 (1.13 to 2.23) for size of bruises. Children with bleeding disorders rarely had bruises on the ears, neck, cheeks, eyes or genitalia. Conclusions Children with bleeding disorder have more and larger bruises at all developmental stages. The differences were greatest in premobile children. In this age group for children with unexplained bruising, it is essential that coagulation studies are done early to avoid the erroneous diagnosis of physical abuse when the child actually has a serious bleeding disorder, however a blood test compatible with a mild/moderate bleeding disorder cannot be assumed to be the cause of bruising

Raising suspicion of maltreatment from burns:derivation and validation of the BuRN-Tool

Background 10–25% of childhood burns arise from maltreatment. Aim To derive and validate a clinical prediction tool to assist the recognition of suspected maltreatment. Methods Prospectively collected data from 1327 children with burns were analyzed using logistic regression. Regression coefficients for variables associated with ‘referral for child maltreatment investigation’ (112 cases) in multivariable analyses were converted to integers to derive the BuRN-Tool, scoring each child on a continuous scale. A cut-off score for referral was established from receiver operating curve analysis and optimal sensitivity and specificity values. We validated the BuRN-Tool on 787 prospectively collected novel cases. Results Variables associated with referral were: age <5 years, known to social care, concerning explanation, full thickness burn, uncommon body location, bilateral pattern and supervision concern. We established 3 as cut-off score, resulting in a sensitivity and specificity for scalds of 87.5% (95% CI:61.7–98.4) and 81.5% (95% CI:77.1–85.4) respectively and for non-scalds sensitivity was 82.4% (95%CI:65.5–93.2) and specificity 78.7% (95% CI:73.9–82.9) when applied to validation data. Area under the curve was 0.87 (95% CI:0.83–0.90) for scalds and 0.85 (95% CI:0.81–0.88) for non-scalds. Conclusion The BuRN-Tool is a potential adjunct to clinical decision-making, predicting which children warrant investigation for child maltreatment. The score is simple and easy to complete in an emergency department setting