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Introduction: Literature is lacking on the safety of storing contaminated PPE in paper bags for reuse, potentially increasing exposure to frontline healthcare workers (HCW) and patients. The aim of this study is to evaluate the effectiveness of paper bags as a barrier for fomite transmission of SARS-CoV-2 by storing face masks, respirators, and face shields. Methods: This quasi-experimental study evaluated the presence of SARS-CoV-2 on the interior and exterior surfaces of paper bags containing PPE that had aerosolized exposures in clinical and simulated settings. Between May and October 2020, 30 unique PPE items were collected from COVID-19 units at two urban hospitals. Exposed PPE, worn by either an infected patient or HCW during a SARS-CoV-2 aerosolizing event, were placed into an unused paper bag. Samples were tested at 30-minute and 12-hour intervals. Results: A total of 177 swabs were processed from 30 PPE samples. We found a 6.8% positivity rate among all samples across both collection sites. Highest positivity rates were associated with ventilator disconnection and exposure to respiratory droplets from coughing. Positivity rates differed between hospital units. Total positivity rates were similar between 30-minute (6.7%) and 12-hour (6.9%) sample testing time intervals. Control samples exposed to inactivated SARS-CoV-2 droplets had higher total viral counts than samples exposed to nebulized aerosols. Conclusions: Data suggests paper bags are not a significant fomite risk for SARS-CoV-2 transmission. However, controls demonstrated a risk with droplet exposure. Data can inform guidelines for storing and re-using PPE in situations of limited supplies during future pandemics. [ABSTRACT FROM AUTHOR]

Acute pediatric burn injuries often result in chronic sequelae that affect physical, psychological, and social outcomes. To date, no review has comprehensively reported on the impact of burn injuries across all three domains in school-aged children. The aim of this systematic review was to identify published literature that focuses on the impact of burn injuries on physical, psychological, or social functioning, and report upon the nature of study characteristics and their outcomes. We included literature published after 1980, focusing on burn outcomes in children aged 5 to 18 years. Each eligible study was systematically reviewed and primary outcomes were classified into outcome domains based on existing frameworks. Fifty-eight studies met inclusion criteria, and reported on physical (n = 24), psychological (n = 47), and social (n = 29) domains. The majority of the studies had sample sizes of <100 participants, burn size of <40%, and findings reported by parents and/or burn survivors. Only eight of 107 different measures were used in three or more studies. Parents and burn survivors generally reported better physical and social outcomes and worse psychological functioning compared to non-burn populations. Physical disabilities were associated with psychological and social functioning in several studies. Follow-up data reported improvements across domains. This review demonstrates the importance of physical, psychological, and social status as long-term outcomes in burn survivors. Mixed findings across three outcome domains warrant long-term research. Findings of this review will guide the foundation of comprehensive burn and age-specific instruments to assess burn recovery. [ABSTRACT FROM AUTHOR]

Pediatric burn injuries can alter the trajectory of the survivor's entire life. Patient-centered outcome measures are helpful to assess unique physical and psychosocial needs and long-term recovery. This study aimed to develop a conceptual framework to measure pediatric burn outcomes in survivors aged 5 to 12 years as a part of the School-Aged Life Impact Burn Recovery Evaluation Computer Adaptive Test (SA-LIBRE5-12 CAT) development. This study conducted a systematic literature review guided by the WHO International Classification of Functioning-Child and Youth and domains in the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire5-18. Interviews with eight parents and seven clinicians were conducted to identify important domains in child recovery. One clinician focus group with four clinicians was completed to identify gaps in the preliminary framework, and semiweekly expert consensus meetings were conducted with three experts to solidify the framework. Qualitative data were analyzed by grounded theory methodology. Three major thematic outcome domains emerged: 1) Physical Functioning: fine motor and upper extremity, gross motor and lower extremity, pain, skin symptoms, sleep and fatigue, and physical resilience; 2) Psychological Functioning: cognitive, behavioral, emotional, resilience, and body image; and 3) Family and Social Functioning: family relationships, and parental satisfaction, school, peer relations, and community participation. The framework will be used to develop item banks for a CAT-based assessment of school-aged children's health and developmental outcomes, which will be designed for clinical and research use to optimize interventions, personalize care, and improve long-term health outcomes for burned children. [ABSTRACT FROM AUTHOR]

δ 15 N values of coastal biota have been used as indicators of land-derived N-loads and sources to estuarine systems and should respond predictably to differences in nitrogen and be sensitive to changes in nitrogen, preferably at the low end of eutrophication. We evaluated Spartina alterniflora as an indicator species of N-loads and sources of δ 15 N throughout the growing season, and compared the average δ 15 N to estuarine nitrogen loads and sources for several estuaries receiving different watershed N-loads. δ 15 N of S . alterniflora differed among estuaries, and these differences were maintained even as δ 15 N declined during the end of the growing season. δ 15 N values increased with increasing nitrogen loads to the subestuaries and with increasing percent wastewater-derived nitrogen load. The response of δ 15 N of S . alterniflora to increased N loads was greater at low N-loads, and decreased as N-loads increased, suggesting that S . alterniflora is a good indicator of incipient nitrogen load. [ABSTRACT FROM AUTHOR]

Introduction Acute burn injuries often result in chronic sequelae that affect functional and psychosocial outcomes. Few prior reviews on pediatric populations report on outcomes across multiple domains. The aim of this systematic review was to identify study characteristics and design of published burn literature that focus on the impact of burns on physical and psychosocial outcomes. Methods We included literature published after 1980, focusing on multifunctional burn outcomes in children aged 5–18 years. PubMed and Web of Science were searched with keywords covering broad and domain specific terms (e.g. "pediatric burns", "outcomes", "psychosocial recovery") along with a manual reference check. After screening 751 potential abstracts, each eligible study was systematically reviewed using the McMaster Critical Review Form and assigned a score by two coordinators. Dyad discussions resolved inconsistencies. Extracted data elements included study designs, participant types, measurements, outcomes, clinical and demographic information, and main findings of each study. Results Sixty-two studies met inclusion criteria, and outcomes were classified into physical (n=31), psychological (n=53), and social (n=38) domains. The majority of studies were cross-sectional designs (n=33) and received a complete critical review score on all applicable categories (n=42). Study population ranged from six to 678 patients. Half of the studies did not have a comparison group. Patient- and parent-report measures were used in 43 and 41 studies respectively, with 25 studies using both types of measures. Across 62 studies, 85 different measures used, with only nine used in more than three studies. Parents and children generally reported better functioning in social and physical domains compared to age-matched groups, and worse psychological outcomes compared to non-burned population. Physical disabilities were associated with psychosocial functioning in 16 studies. Physical and social functioning improved where follow-up data was reported in six studies. Examples of selected factors that significantly impacted physical and psychosocial outcomes across domains included burn size, pain and itch, visible scars, body image satisfaction, athletic competence, peer relations, and adjustment skills. Conclusions This review demonstrated important associations with physical health and psychosocial status as outcomes. Additionally, there is a need for a standardized burn-specific measurement tool. These findings are relevant to burn clinicians and researchers to understand pathways and outcomes that affect quality of life in pediatrics post-burns. [ABSTRACT FROM AUTHOR]

Introduction The transition from early childhood to teen years (5–12) is a critical time of development, which can be made particularly challenging by a burn injury. Currently, few validated standardized measures exist for this age group. This study aimed to generate item pools to create a computer adaptive test (CAT) assessing post-burn recovery in school-aged children. Methods Item pool development was based on the School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) Conceptual Model and the World Health Organization's International Classification of Functioning, Disability, and Health for Children and Youth. Additional elements included a literature review, expert consensus meetings, and parent cognitive interviews. Candidate items assessing health outcomes were extracted from existing legacy measures during the literature review. Details of expert consensus meetings and parent cognitive interviews are in Table 1. Results Items assessing health outcomes (n=3,732) were extracted during the literature review. Experts binned items across three domains: 1) Physical Functioning (55 items), 2) Psychological Functioning (80 items), and 3) Family and Social Functioning (57 items). Six cognitive interviews were conducted. Qualitative data resulted in further review of 86 items. The results of the cognitive interviews indicated that item stems and response choices were interpretable by respondents. Conclusions This study developed an item pool (n=192) to assess post-burn recovery of school-aged children. The next step in the SA-LIBRE5-12 CAT Profile development will be field-testing for the calibration and item response theory-based validation of the assessment. [ABSTRACT FROM AUTHOR]

Introduction Pediatric burn injuries can alter the trajectory of the survivor's entire life. Patient-centered outcome measures are helpful to capture and assess their unique physical and psychosocial needs and long-term recovery. This study aimed to develop a conceptual model framework to measure outcomes most important to pediatric burn survivors aged 5 to 12 years as a part of the SA-LIBRE5-12 Computer Adaptive Test (CAT) development. Methods This study used a systematic literature review guided by the WHO International Classification of Functioning – Child and Youth. Previously established domains in the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire5-18 further guided framework development. Individual interviews with parents and clinicians were conducted to obtain perspectives on domains most important to assess following a burn injury in children aged 5 to 12 years. One clinician focus group was completed to identify gaps in the preliminary framework, and semi-weekly expert consensus meetings were conducted to solidify the framework. Qualitative data were analyzed by grounded theory methodology in NVivo 12 software. Results The literature review identified 82 articles. Eight parents and seven clinicians participated in individual interviews, four clinicians participated in one focus group, and three consultants were included in the expert consensus meetings. The consultants included a burn surgeon, psychiatrist, and health services researcher. Three major domains emerged from the grounded theory approach, including: 1) Physical Functioning: fine motor and upper extremity, gross motor and lower extremity, pain, skin sensitivity, sleep and fatigue, and physical resilience; 2) Psychological Functioning: cognitive, behavioral, emotional, resilience, and body image; and 3) Family and Social Functioning: school, peer relations, community participation, family relationships, and parental satisfaction. Conclusions The comprehensive literature review, clinician and parent individual interviews, clinician focus group, and expert consensus meetings resulted in a conceptual model framework for parent-reported health outcomes after a burn injury in school-aged children aged 5 to 12 years. The framework will be used to develop item banks for a CAT-based assessment of school-aged children's health and developmental outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Couplings between land use and marine food webs in tropical systems are poorly understood. We compared land–sea coupling in seven sites around Puerto Rico, differing in the degree of precipitation and urbanization, by measuring δ 13C and δ 15N in producers and consumers. δ 15N values were influenced by human activity: the food web from sites near urbanized centers was on average 1‰ heavier in δ 15N compared to undeveloped sites. This is most likely due to wastewater inputs from septic systems relatively near the shoreline. Changes in δ 13C were best explained by differences in the degree of marine influence. Where terrestrial inputs from a major river dominated, δ 13C values were lighter, whereas sites further from land and in locations exposed to oceanic currents had heavier δ 13C values, characteristic of a marine source of dissolved organic carbon. We found no significant effect of precipitation on connectivity in spite of a twofold difference in annual average rainfall between the north and south coast. The results suggest there is some connectivity between land and sea in Puerto Rico, despite high rates of evaporation relative to precipitation. [Copyright &y& Elsevier]