Women do Worse than Men after Burn Injury: A Systematic Review of the Literature

Burn injuries are a public health problem that although decreasing in incidence in the United States (US), can be devastating with lifelong health, social and economic ramifications. Studies have shown that extremes of age, greater percent total body surface area (%TBSA), and inhalation injury, are all associated with greater morbidity and mortality after burn injury. Unlike other forms of trauma, women appear to do worse after burn injury as compared to men, but little research has been done to understand why this is the case. We thus aimed to do a systematic review of studies designed to specifically assess the effect of sex on outcomes after burn injury in adult patients. We searched PubMed, Medline, Embase, Clinical Key, CINAHL for studies that looked at the relationship between burn or thermal injury, sex, gender and outcome. Our search criteria resulted in a total of 939 articles. After review of the articles, a total of ten articles were identified for final review. All of the identified articles were retrospective in nature and relied on large single or multicenter registry sources of data for analysis. While the studies were heterogeneous in nature, the majority of articles showed that women had greater mortality after burn injury as compared to men. Given the retrospective nature of all of the studies, none were able to offer causality for why women do worse. Many studies speculated that sex hormones, i.e. estrogen, likely cause dysregulation of the immune system leading to worse outcomes. There may also be an interplay between sex hormones and the differential distribution of adipose tissue, in men and women, which may contribute to the differences seen in mortality between the sexes. In addition to physiologic and immunologic mechanisms, there may be social, economic and psychological/psychiatric factors that may prime women for longer lengths of stay, slower recovery and worse long term outcomes after burns as compared to men. Many studies found that women who are burned tend to be older, have lower socioeconomic status, have greater co-morbidities, and tend to have lower social capital as compared to men who are burned. Although no definitive answers were provided in the papers, it is clear that there is a complex interaction between physiologic and social factors that increase women’s risk for worse outcomes and greater mortality after burns. The results of this systematic review highlight the need for prospective, translational studies designed to explore why women do worse than men after burns. In addition, there are many opportunities for the public health community to engage in interdisciplinary burn research to improve burn prevention efforts and to help better understand the interactions between behavior, social isolation and health, with respect to burn trauma.Master of Public Healt

On the activity of the γ -Ursae Minorids meteoroid stream in 2010 and 2011

Accurate orbital data obtained for the recently discovered γ -Ursae Minorids meteoroid stream during the 2010 and 2011 Spanish Meteor Network and Finnish Fireball Network observing ampaigns are presented. In particular, we focus on an outburst detected in 2010 and on the analysis of the first emission spectrum recorded for a member of this meteoroid stream. An array of high-sensitivity CCD video devices operating from different locations in Spain and Finland was used to perform this study. We have obtained precise trajectory, radiant and orbital information for seven members of this stream. Considerations about its likely parent body based on orbital dissimilarity criteria are made. We also present an estimation of the tensile strength for these meteoroids and a unique emission spectrum of a γ -Ursae inorid fireball that reveals that the main rocky components have chondritic abundances.Ministerio de Ciencia e Innovación AYA2009-13227, AYA2009-14000-C03-01, AYA2011-26522, AYA2011-30106-C02-01CSIC #201050I043Junta de Andalucía P09-FQM-455

Building a viable weight management program in a patient-centered medical home

.001), an average decrease in HbA1c of 0.2 points (P=.004), and an average blood pressure reduction of 2.8 mmHg systolic (P=.002) and 1.9 mmHg diastolic (P=.03). One-third of participants (n=60) achieved clinically significant weight loss (&gt5%) at 18 months. The program has become financially sustainable through billing for preventive counseling services and a $125 out-of-pocket enrollment fee. CONCLUSIONS: WMP provides one model for primary care practices to de-velop a financially sustainable and evidence-based behavioral therapy weight management program for their patients with obesity. Future work will include assessment of longer-term program benefits, quality metrics, and health care costs.BACKGROUND AND OBJECTIVES: The growing prevalence of obesity in the United States and globally highlights the need for innovative strategies to provide obesity treatment in primary care settings. This report describes and evaluates the Weight Management Program (WMP), an interprofessional program in an academic family medicine clinic delivering intensive behavioral therapy (IBT) following evidenced-based guidelines. METHODS: We extracted WMP participant health data from the electronic health record and evaluated retrospectively. Eligible participants completed at least four WMP visits and had a baseline weight, blood pressure, and he-moglobin A1c (HbA1c) recorded within 1 year prior to their first visit. Paired t tests were used to assess changes in, weight, HbA1c and systolic and diastolic blood pressures from baseline. RESULTS: WMP counseled 673 patients over 3,895 visits from September 2015 to June 2019. Of these, 186 met eligibility criteria (at least four vis-its), with a median of eight visits (mean=11.3, SD=8.1). Participants saw an average weight decrease during program participation of 9.7 lbs (P&l

Life-threatening Skin Disorders Treated in the Burn Center: Impact of Health care–associated Infections on Length of Stay, Survival, and Hospital Charges

This article reviews a single burn center experience with life-threatening skin disorders, over a 10-year period. It explores the incidence of health care–associated infections and the impact on length of stay, hospital charges, and mortality

The 2011 October Draconids outburst. I. Orbital elements, meteoroid fluxes and 21P/Giacobini-Zinner delivered mass to Earth

On October 8th, 2011 the Earth crossed the dust trails left by comet 21P/Giacobini-Zinner during its XIX and XX century perihelion approaches with the comet being close to perihelion. The geometric circumstances of that encounter were thus favorable to produce a meteor storm, but the trails were much older than in the 1933 and 1946 historical encounters. As a consequence the 2011 October Draconid display exhibited several activity peaks with Zenithal Hourly Rates of about 400 meteors per hour. In fact, if the display had been not forecasted, it could have passed almost unnoticed as was strongly attenuated for visual observers due to the Moon. This suggests that most meteor storms of a similar nature could have passed historically unnoticed under unfavorable weather and Moon observing conditions. The possibility of obtaining information on the physical properties of cometary meteoroids penetrating the atmosphere under low-geocentric velocity encounter circumstances motivated us to set up a special observing campaign. Added to the Spanish Fireball Network wide-field all-sky and CCD video monitoring, other high-sensitivity 1/2" black and white CCD video cameras were attached to modified medium-field lenses for obtaining high resolution orbital information. The trajectory, radiant, and orbital data of 16 October Draconid meteors observed at multiple stations are presented. The results show that the meteors appeared from a geocentric radiant located at R.A.=263.0+-0.4 deg. and Dec.=+55.3+-0.3 deg. that is in close agreement with the radiant predicted for the 1873-1894 and the 1900 dust trails. The estimated mass of material from 21P/Giacobini-Zinner delivered to Earth during the six-hours outburst was around 950+-150 kg.Comment: Manuscript in press in Monthly Notices of the Royal Astronomical Society, submitted to MNRAS on November 16th, 2012 Accepted for publication in MNRAS on April 28th, 2013 Manuscript Pages: 21 Tables: 8 Figures: 4 Manuscript associated: "The 2011 October Draconids outburst. II. Meteoroid chemical abundances from fireball spectroscopy" by J.M. Madiedo is also in press in the same journa

The Employed Surgeon: A Changing Professional Paradigm

OBJECTIVE: To identify trends and characteristics of surgeon employment in the United States. Surgeons are increasingly choosing hospital or large group employment as their practice environment. DESIGN American Medical Association Physician Masterfile data were analyzed for the years 2001 to 2009. SETTING: Surgeons identified within the American Medical Association Masterfile. PARTICIPANTS: Surgeons were defined using definitions from the American Medical Association specialty data and the American Board of Medical Specialties certification data and included active, nonfederal, and nonresident physicians younger than 80 years of age. MAIN OUTCOME MEASURES: Employment status and trends. RESULTS: The number of surgeons who reported having their own self-employed practice decreased from 48% to 33% between 2001 and 2009, and this decrease corresponded with an increase in the number of employed surgeons. Sixty-eight percent of surgeons in the United States now self-identify their practice environment as employed. Between 2006 and 2011, there was a 32% increase in the number of surgeon in a full-time hospital employment arrangement. Younger surgeons and female surgeons increasingly favor employment in large group practices. Employment trends were similar for both urban and rural practices. CONCLUSIONS: General surgeons and surgical subspecialists are choosing hospital employment instead of independent practice. The trend is especially notable among younger surgeons and among female surgeons. The trend denotes a professional paradigm shift of major importance

Even Better Than the Real Thing? Xenografting in Pediatric Patients with Scald Injury

This article reviews a single burn center experience with porcine xenografts to treat pediatric scald injuries, over a 10-year period. The authors compare xenografting to autografting, as well as wound care only, and provide outcome data on length of stay, incidence of health care–associated infections, and need for reconstructive surgery

Chest High-Frequency Oscillatory Treatment for Severe Atelectasis in a Patient With Toxic Epidermal Necrolysis:

Atelectasis is a significant risk factor for the development of pneumonia, especially in pediatric populations that are more prone to alveolar collapse or those who may have weakened muscular tone. The Metaneb® System is a pneumatic, non-invasive physiotherapy technique that delivers chest high frequency oscillations (CHFO). CHFO has been shown to enhance mucociliary clearance of secretions and help resolve patchy atelectasis. This report describes the case of a 17 year old female who developed significant left sided atelectasis after extubation and was effectively managed with complete resolution of her atelectasis with the Metaneb System, obviating the need for reintubation

Differential regulation of innate immune cytokine production through pharmacological activation of Nuclear Factor-Erythroid-2-Related Factor 2 (NRF2) in burn patient immune cells and monocytes

Burn patients suffer from immunological dysfunction for which there are currently no successful interventions. Similar to previous observations, we find that burn shock patients (≥15% Total Burn Surface Area (TBSA) injury) have elevated levels of the innate immune cytokines Interleukin-6 (IL-6) and Monocyte Chemoattractant Protein-1 (MCP-1)/CC-motif Chemokine Ligand 2(CCL2) early after hospital admission (0–48 Hours Post-hospital Admission (HPA). Functional immune assays with patient Peripheral Blood Mononuclear Cells (PBMCs) revealed that burn shock patients (≥15% TBSA) produced elevated levels of MCP-1/CCL2 after innate immune stimulation ex vivo relative to mild burn patients. Interestingly, treatment of patient PBMCs with the Nuclear Factor-Erythroid-2-Related Factor 2 (NRF2) agonist, CDDO-Me(bardoxolone methyl), reduced MCP-1 production but not IL-6 or Interleukin-10 (IL-10) secretion. In enriched monocytes from healthy donors, CDDO-Me(bardoxolone methyl) also reduced LPS-induced MCP1/CCL2 production but did not alter IL-6 or IL-10 secretion. Similar immunomodulatory effects were observed with Compound 7, which activates the NRF2 pathway through a different and non-covalent Mechanism Of Action (MOA). Hence, our findings with CDDO-Me(bardoxolone methyl) and Compound 7 are likely to reflect a generalizable aspect of NRF2 activation. These observed effects were not specific to LPS-induced immune responses, as NRF2 activation also reduced MCP-1/CCL2 production after stimulation with IL-6. Pharmacological NRF2 activation reduced Mcp-1/Ccl2 transcript accumulation without inhibiting either Il-6 or Il-10 transcript levels. Hence, we describe a novel aspect of NRF2 activation that may contribute to the beneficial effects of NRF2 agonists during disease. Our work also demonstrates that the NRF2 pathway is retained and can be modulated to regulate important immunomodulatory functions in burn patient immune cells

Blood utilization in patients with burn injury and association with clinical outcomes (CME)

Uncontrolled bleeding is an important cause of increased transfusion in burn victims; however, description of blood utilization patterns in the burn population is lacking