A Framework for Evaluating Field-Based, High-Throughput Phenotyping Systems: A Meta-Analysis.

This paper presents a framework for the evaluation of system complexity and utility and the identification of bottlenecks in the deployment of field-based, high-throughput phenotyping (FB-HTP) systems. Although the capabilities of technology used for high-throughput phenotyping has improved and costs decreased, there have been few, if any, successful attempts at developing turnkey field-based phenotyping systems. To identify areas for future improvement in developing turnkey FB-HTP solutions, a framework for evaluating their complexity and utility was developed and applied to total of 10 case studies to highlight potential barriers in their development and adoption. The framework performs system factorization and rates the complexity and utility of subsystem factors, as well as each FB-HTP system as a whole, and provides data related to the trends and relationships within the complexity and utility factors. This work suggests that additional research and development are needed focused around the following areas: (i) data handling and management, specifically data transfer from the field to the data processing pipeline, (ii) improved human-machine interaction to facilitate usability across multiple users, and (iii) design standardization of the factors common across all FB-HTP systems to limit the competing drivers of system complexity and utility. This framework can be used to evaluate both previously developed and future proposed systems to approximate the overall system complexity and identify areas for improvement prior to implementation.

Comparison of Continuous Sedatives in the Burn ICU on Delirium and Coma.

Lighter sedation targets over the past decade have resulted in improved outcomes for critically ill populations. Although guidelines exist for the general ICU population, these recommendations often exclude the burn population. The purpose of this study is to assess the impact of the initial continuous sedative on coma- and delirium-free days in critically ill patients with burns. This retrospective cohort study evaluated adult patients admitted to a burn intensive care unit at an academic medical center between January 2010 and September 2019. Patients were enrolled into 3 groups based on the depth of initial continuous sedation received (deep, light, or analgosedation). Intubated patients were randomly assessed for inclusion from the National V6 Burn Registry. Patients were included if they received a continuous sedative infusion for at least 48 h. A total of 107 patients were included in the study with 36, 41, and 30 patients receiving deep, light, and analgosedation, respectively. The primary outcome of coma- and delirium-free days was significantly different between sedation types with the most days free in analgosedation and the fewest in deep sedation (8 versus 3 days; P = 0.024). The composite primary outcome was divided into secondary outcomes of coma-free days and delirium-free days, with coma-free days being different (P = 0.00008). Other secondary outcomes of length of stay in the intensive care unit and hospital, time on mechanical ventilation, and survival to discharge were not statistically significant; however, a trend toward higher mortality in deep sedation was noted.

Effect of dexmedetomidine on fluid resuscitation in burn-injured patients.

Fluid creep occurs when resuscitation after extensive burn injury reaches volumes higher than predicted. Since this has been described in patients with high opioid requirements, continuous analgesics and sedatives, including dexmedetomidine, have been avoided during resuscitation. This study sought to describe the impact of dexmedetomidine on fluid resuscitation requirements. This retrospective cohort study included adult patients with burns greater than 20% total body surface area (TBSA) resuscitated between January 2017 and June 2022 at a regional burn center. Patients deceased within 48 hours of burn were excluded. Primary outcome was volume of fluid required in the first 24 and 48 hours post-burn. Secondary outcomes were the incidence of fluid-related adverse events within 7 days post-burn. A total of 170 patients were included: 55 in the dexmedetomidine cohort and 115 in the control cohort. After propensity matching for variables associated with fluid creep, the dexmedetomidine cohort required 4.2 ± 1.7 mL/kg/%TBSA in the first 24 hours compared to 3.6 ± 1.1 mL/kg/%TBSA in the control cohort (p=0.03). The difference was no longer significant at 48 hours (p=0.11). There were no differences in the incidence of acute respiratory distress syndrome, delayed escharotomy/fasciotomy, intraabdominal hypertension, or renal replacement therapy. Dexmedetomidine exposure during acute resuscitation resulted in increased fluid requirements in the first 24 hours, suggesting it is independently associated with fluid creep; however, this increase was not sustained at 48 hours. Clinical significance of this finding is unclear as there was no increase in adverse events related to excessive fluid resuscitation between cohorts.

Topical Liposomal Amphotericin (Ambisome®) for the Treatment of Cutaneous Fusarium in a Burn-Injured Patient.

Cutaneous Fusarium infections carry significant morbidity and mortality in burn-injured patients. Treatment involves surgical source control in combination of systemic and topical therapy. Given drug shortage constraints with conventional amphotericin deoxycholate, we describe the first case of successful treatment with adjunctive topical liposomal amphotericin in a critically ill burn-injured patient.

Design Considerations for In-Field Measurement of Plant Architecture Traits Using Ground-Based Platforms.

This work provides a high-level overview of system design considerations for measuring plant architecture traits in row crops using ground-based, mobile platforms. High-throughput phenotyping technologies are commonly deployed in isolated growth chambers or greenhouses; however, there is a need for field-based systems to measure large quantities of plants exposed to natural climates throughout a growing season. High-throughput methods using ground-based mobile systems collect valuable phenotypic information at higher temporal resolutions compared to manual methods (e.g., handheld calipers and measuring sticks). Additionally, the close proximity to plants when using ground-based systems compared to aerial platforms enables plant phenotyping at the organ level. While there is no single best platform for obtaining ground-based plant measurements across crop varieties with different planting configurations, there are a wide range of off-the-shelf systems and sensors that can be integrated to accommodate varying row widths, plant spacing, plant heights, and plot sizes, in addition to emerging commercially available platforms. This chapter will provide an overview of sensor types suitable for phenotyping plant size and shape, as well as provide guidance for deployment with ground-based systems, including push carts or buggies, modified tractors, and robotic platforms.

Disseminated Mycobacterium abscessus Infection in a Burn Patient.

Disseminated infection caused by nontuberculous mycobacteria (NTM) is very rare, with an incidence of 1.0 to 1.8 cases per 100,000 persons, and typically only occurs in severely immunocompromised hosts. Burn patients suffer a loss of the natural cutaneous barrier as well as injury-induced immune dysfunction, and as a result, commonly develop infections, especially with multidrug-resistant organisms. However, very few NTM infections in burn patients have been reported in the literature. Disseminated NTM infection, in particular, can be a challenge to diagnose in burn patients due to burn-related physiology such as hyperpyrexia and widespread skin injury. We present a case of disseminated infection leading to bacteremia caused by Mycobacterium abscessus in a critically ill burn patient with a 74% total body surface area burn. M. abscessus belongs to the subgroup of NTM known as rapidly growing mycobacteria, which are notable for their ability to form colonies in a matter of days, rather than weeks, and because they are often highly drug-resistant, which complicates antimicrobial therapy. This is the third reported case of bacteremia caused by NTM in a burn patient and the second case that was successfully transitioned from intravenous antimicrobials to an oral regimen.

Hyperspectral Imaging With Machine Learning to Differentiate Cultivars, Growth Stages, Flowers, and Leaves of Industrial Hemp (Cannabis sativa L.).

As an emerging cash crop, industrial hemp (Cannabis sativa L.) grown for cannabidiol (CBD) has spurred a surge of interest in the United States. Cultivar selection and harvest timing are important to produce CBD hemp profitably and avoid economic loss resulting from the tetrahydrocannabinol (THC) concentration in the crop exceeding regulatory limits. Hence there is a need for differentiating CBD hemp cultivars and growth stages to aid in cultivar and genotype selection and optimization of harvest timing. Current methods that rely on visual assessment of plant phenotypes and chemical procedures are limited because of its subjective and destructive nature. In this study, hyperspectral imaging was proposed as a novel, objective, and non-destructive method for differentiating hemp cultivars, growth stages as well as plant organs (leaves and flowers). Five cultivars of CBD hemp were grown greenhouse conditions and leaves and flowers were sampled at five growth stages 2-10 weeks in 2-week intervals after flower initiation and scanned by a benchtop hyperspectral imaging system in the spectral range of 400-1000 nm. The acquired images were subjected to image processing procedures to extract the spectra of hemp samples. The spectral profiles and scatter plots of principal component analysis of the spectral data revealed a certain degree of separation between hemp cultivars, growth stages, and plant organs. Machine learning based on regularized linear discriminant analysis achieved the accuracy of up to 99.6% in differentiating the five hemp cultivars. Plant organ and growth stage need to be factored into model development for hemp cultivar classification. The classification models achieved 100% accuracy in differentiating the five growth stages and two plant organs. This study demonstrates the effectiveness of hyperspectral imaging for differentiating cultivars, growth stages and plant organs of CBD hemp, which is a potentially useful tool for growers and breeders of CBD hemp.

Impact of Multimodal Analgesia in Critically Ill Burn Patients.

Opioids are the mainstay of treatment for burn pain. However, these medications may be associated with respiratory depression and dependence. Multimodal analgesia is an alternative method that utilizes both opioid and nonopioid medications with different mechanisms. This study examines the impact of multimodal therapy for postoperative pain control in a burn intensive care unit.  This was a retrospective cohort study of patients admitted to the burn unit at a tertiary medical center. Consecutively admitted patients with burns greater than or equal to 10% TBSA and intensive care unit length of stay greater than 7 days were eligible for inclusion (2012-2018). Patients were excluded if they received an opioid infusion greater than 48 hours.  Patients treated with multimodal analgesia were compared to those treated with opioids alone. Data were calculated for 5 days after surgery. There were 98 patients in the nonmultimodal group and 97 in the multimodal group. Mean cumulative opioid dose was lower in the multimodal group (1028.7 mg vs 1423.2 mg, P = .0031). Patients with greater than 20% burns had a larger reduction in mean opioid equivalents in the multimodal group (1106 vs 1594 mg, P = .009) compared to patients with burns less than 20% (940 vs 1282 mg, P = .058). There was no difference in mean pain scores on postoperative day 5 (6.2 ±â€¯2.2 vs 5.5 ±â€¯2.3, P = .07) or at intensive care unit discharge (4.7 ±â€¯2.4 vs 4.7 ±â€¯2.8, P = .99). The use of multimodal analgesia significantly reduced cumulative opioid equivalent dose without compromising pain control.    .