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Introduction Our burn center is located in a state that takes referrals from rural areas up 160 miles away. Transfer to our often at capacity emergency department for burn wound care and to be discharged is an expense to the patient and the medical system. Using existing transfer center nurses, the EMR system, and hospitals connected in the stroke network hypothesized we could create a TeleBurn program without additional equipment or resources. This was developed to expedite patient care and move the burn evaluation for smaller burns to the outpatient clinic from the emergency department. Calls were covered by the on-call trauma attending. Methods The TeleBurn program used 27 care connect hospitals in our stroke network. Calls were received through transfer center Figure 1. If the call was one where the physician was asking for opinion or possible follow up, the stroke robot was brought into the room, photographs taken and uploaded to EMR. A page/EMR message alerted call trauma attending physician. If the patient’s burn were small, they were set up for follow-up in clinic the next day in designate protected slots, if they needed surgery, admission for pain or wound care transfer, was arranged. The transfer center sent clinic staff message through EMR. Results Compared to previous year there was reduction of 3-10 ED visits per month and doubled new clinic visits in those same months. During the three-month pilot period, only one patient required admission when seen in clinic. Table 1. Our no show rate for protected slots was higher at 33% compared to no show rate of 12% for scheduled burn patients. Conclusions We demonstrated that TeleBurn triage can be done in a HIPPA compliant manor without having to purchase a new technology or platform. The development of a process with pictures and guaranteed followed up gave both the on call physician and transferring physician the confidence not to transfer a patent in middle of the night. More work is needed to determine why the no-show rate is high and how to adjust appointments to correct. Applicability of Research to Practice It is feasible to create a successful system that uses your EMR and limits additional steps for transferring physicians and on-call surgeon. Real time communication was utilized with the team to help vet issues quickly and allow for rapid feedback.

Non-statistical confirmatory factor analyses of the items on the Tennessee Self-Concept Scale (TSCS) were performed on samples of 678 university stu dents and 341 male juvenile offenders to test hy potheses regarding the internal structure of the in strument. For the college sample, good confirma tion of the external and internal frames of reference postulated by Fitts (1965) were obtained, but sup port for the internal x external cross-classification was not obtained. No support for any of the hy potheses was found for the juvenile sample; rather, one major factor emerged. These findings are re lated to Super's theory of self-concept development, and implications of these findings regarding the psychometric properties of the TSCS and its use are discussed.

Questions addressed by this study included: “how well do children understand and how do they evaluate defense mechanisms in other children?”; “how does defense understanding relate to perceptions of defensiveness?”; and “do egocentric children have greater difficulty understanding defenses?”; To answer such questions, a sample of children were presented with seven stories illustrating defense mechanisms in “make‐believe”; peers. Children were asked to explain each story character's behavior and evaluate defensive characters for goodness, smartness, happiness, and likableness. Age trends reflected increasing defense understanding with age. Children who better rnderstood defenses were less egocentric. Externalizing defenses (projection, displacement) were perceived in highly unfavorable terms while an internalizing defense (self‐blame) was viewed more positively. Surprisingly, defense understanding related inversely to the favorability of children's evaluations of the defensive peer.