Inhalation Injury.

Inhalation injury is a critical component of thermal injury that can significantly increase mortality in burn survivors. This poses significant challenges to managing these patients and profoundly impacts patient outcomes. This comprehensive literature review delves into the epidemiology, pathophysiology, diagnosis, classification, management, and outcomes of inhalation injury with burns.

The impact of COVID-19 on clinical outcomes of burn patients.

Background: Multiple studies have shown the SARS-CoV-2 virus (COVID-19) to be associated with deleterious outcomes in a wide range of patients. The impact of COVID-19 has not been well investigated among burned patients. We suspect that patients will have worsened respiratory and thrombotic complications, ultimately leading to increased mortality. The objective of this study is to determine the impact a concurrent infection of COVID-19 has on clinical outcomes after a burn injury. Methods: This is a retrospective, propensity matched, cohort study. We examined a de-identified database of electronic medical records of over 75 million patients across 75 health care associations in the United States for patients treated for thermal burns from 1 January 2020, to 31 July 2021, and those who also were diagnosed with COVID-19 infection within one day before or after injury based on International Classification of Disease, tenth revision (ICD-10) codes. Study participants included adults who were treated for a burn injury during the study period. Results: We included 736 patients with burn injury and concomitant COVID-19 infection matched to 736 patients with burn injury and no concurrent COVID-19 infection (total 1472 patients, mean age 36.3 ± 24.3). We found no significant increase in mortality observed for patients with concurrent COVID-19 (OR 1.203, 95% CI 0.517-2.803; p = 0.6675). We did observe significant increase in infections (OR 3.537, 95% CI 2.798-4.471; p = 0.0001), thrombotic complications (OR 2.342, 95% CI 1.351-4.058; p = 0.0018), as was the incidence of hypertrophic scarring (OR 3.368, 95% CI 2.326-4.877; p = 0.0001). Conclusions: We observed that concurrent COVID-19 infection was associated with an increase in infections, thrombosis and hypertrophic scarring but no increase in mortality in our cohort of burn patients.

Comprehensive Osteopathic Medical Licensing Examination-USA level 1 and level 2-cognitive evaluation preparation and outcomes.

The Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) assesses the competence of osteopathic physicians in training. It is designed to protect the public by setting minimum competence standards. All osteopathic medical students must pass COMLEX-USA Level 1, Level 2-Cognitive Evaluation, and Level 2-Performance Evaluation before being allowed to graduate from an osteopathic medical school. Residency training programs use COMLEX-USA scores as a major factor in deciding whom they will interview and admit into their programs. In addition, colleges of osteopathic medicine use student COMLEX-USA scores as an external assessment of their success in educating students. Because COMLEX-USA is a high-stakes examination series, it is important to understand predictive factors for performance. The authors review the literature on the relationship between COMLEX-USA scores and correlated student variables. Results from the Council on Osteopathic Student Government Presidents' survey on students' preparation methods and performance are also provided.

Crystallites of magnetic charges in artificial spin ice.

Artificial spin ice is a class of lithographically created arrays of interacting ferromagnetic nanometre-scale islands. It was introduced to investigate many-body phenomena related to frustration and disorder in a material that could be tailored to precise specifications and imaged directly. Because of the large magnetic energy scales of these nanoscale islands, it has so far been impossible to thermally anneal artificial spin ice into desired thermodynamic ensembles; nearly all studies of artificial spin ice have either treated it as a granular material activated by alternating fields or focused on the as-grown state of the arrays. This limitation has prevented experimental investigation of novel phases that can emerge from the nominal ground states of frustrated lattices. For example, artificial kagome spin ice, in which the islands are arranged on the edges of a hexagonal net, is predicted to support states with monopolar charge order at entropies below that of the previously observed pseudo-ice manifold. Here we demonstrate a method for thermalizing artificial spin ices with square and kagome lattices by heating above the Curie temperature of the constituent material. In this manner, artificial square spin ice achieves unprecedented thermal ordering of the moments. In artificial kagome spin ice, we observe incipient crystallization of the magnetic charges embedded in pseudo-ice, with crystallites of magnetic charges whose size can be controlled by tuning the lattice constant. We find excellent agreement between experimental data and Monte Carlo simulations of emergent charge-charge interactions.

Perpendicular magnetization and generic realization of the Ising model in artificial spin ice.

We have studied frustrated kagome arrays and unfrustrated honeycomb arrays of magnetostatically interacting single-domain ferromagnetic islands with magnetization normal to the plane. The measured pairwise spin correlations of both lattices can be reproduced by models based solely on nearest-neighbor correlations. The kagome array has qualitatively different magnetostatics but identical lattice topology to previously studied artificial spin ice systems composed of in-plane moments. The two systems show striking similarities in the development of moment pair correlations, demonstrating a universality in artificial spin ice behavior independent of specific realization in a particular material system.

Geomorphology-based interpretation of sedimentation rates from radiodating, lower Passaic River, New Jersey, USA.

Analysis of site geomorphology and sedimentation rates as an indicator of long-term bed stability is central to the evaluation of remedial alternatives for depositional aquatic environments. In conjunction with various investigations of contaminant distribution, sediment dynamics, and bed stability in the Passaic River Estuary, 121 sediment cores were collected in the early 1990s from the lower 9.7 km of the Passaic River and analyzed for lead-210 (210Pb), cesium-137 (137Cs), and other analytes. This paper opportunistically uses the extensive radiochemical dataset to examine the spatial patterns of long-term sedimentation rates in, and associated geomorphic aspects of, this area of the river. For the purposes of computing sedimentation rates, the utility of the 210Pb and 137Cs depositional profiles was assessed to inform appropriate interpretation. Sedimentation rates were computed for 90 datable cores by 3 different methods, depending on profile utility. A sedimentation rate of 0 was assigned to 17 additional cores that were not datable and for which evidence of no deposition exists. Sedimentation patterns were assessed by grouping results within similar geomorphic areas, delineated through inspection of bathymetric data. On the basis of channel morphology, results reflect expected patterns, with the highest sedimentation rates observed along point bars and channel margins. The lowest rates of sedimentation (and the largest percentage of undatable cores) were observed in the areas along the outer banks of channel bends. Increasing sedimentation rates from upstream to downstream were noted. Average and median sedimentation rates were estimated to be 3.8 and 3.7 cm/y, respectively, reflecting the highly depositional nature of the Passaic River estuary. This finding is consistent with published descriptions of long-term geomorphology for Atlantic Coastal Plain estuaries.

Incorporating sediment stability within the management of contaminated sediment sites: a synthesis approach.

At the Third International Conference on Remediation of Contaminated Sediments, a panel discussion was held to consider how best to incorporate sediment stability assessment (SSA) results when managing risks at contaminated sediment sites. This remains a challenge to the scientific and regulatory community, especially at sites where large volumes of legacy sediment are present below layers of recent sediment of better quality, and where in-place management may be viable. Use of a suite of empirical and predictive approaches collectively to assess potential risks resulting from bed erosion has emerged as the state-of-the-art approach for SSA, yet current practice lacks consistent guidance for conducting such assessments and for dealing with and communicating implications of uncertainty. The regulatory community lacks a decision-making framework that specifically incorporates SSA results, though it is a consideration in US Environmental Protection Agency (USEPA 2002) Principles for Sediment Management. Practitioners have not consistently communicated SSA results from a risk perspective to the stakeholder community. We believe this combination of factors, especially the inconsistent framing of results in a risk context, has contributed to discounted use of sediment stability information in decision making, fostering application of the precautionary principle, where removal is viewed as a presumed conservative but more expensive approach over in-place management options. We assert that the incorporation of SSA in decision making will be improved through the use of a consistent SSA assessment framework built around the conceptual site model, incorporating multiple lines of evidence detailing the potential impacts of large, low-probability events (e.g., the 100-y storm) on exposure and risk, and the associated uncertainties. Further advocacy of this approach was realized through panel-audience discussion at the conference. The technical methods discussed are not new; rather, it is the synthesis approach emphasized here, which by providing a framework for the systematic evaluation of how SSA is best addressed from site to site, makes the results of SSA efforts more accessible and acceptable to stakeholders and decision makers.

Field observation and modeling of dissolved fraction sediment-water exchange coefficients for PCBs in the Hudson River.

Chemical fate and transport models that simulate sediment-water exchange of contaminants typically employ empirically determined sediment-water exchange coefficients for the dissolved fraction to describe the net effect of poorly understood mechanisms. This paper presents field-derived observations of the coefficient for 12 PCB congeners and two PCB mixtures in the Thompson Island Pool, Hudson River, and also presents an evaluation of a theoretical sediment-water exchange model. An extensive PCB data set was used to compute apparent coefficients for PCBs in the pool. Average exchange coefficients for the 12 congeners ranged from 2.6 to 18.8 cm/ day, and results showed a strong seasonal dependence. Peak coefficient values occurred in mid-May to early July, preceding peak water temperatures by 1 month and lagging the spring high-flow period. The coefficients increase with increasing partition coefficients, suggesting a dependence on congener properties. The large magnitude of the coefficients and the variation among the congeners is inconsistent with the pore-water molecular-diffusion transport process. A theory-based, mechanistic two-layer model reproduces the nonlinear relationship between the sediment-water exchange coefficients and partition coefficients. This model includes transfer through the mixed sediment layer by bioturbation and diffusion transfer through a water-side boundary layer governed by flow velocity. Results suggest that this algorithm can provide increased accuracyto future system-level fate and transport models for hydrophobic chemicals. The seasonal variation in the transfer coefficient appears to be a poorly understood interaction of physical and biological processes and merits further study.