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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.

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]

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]

Objectives: Determine whether Pre-Game Safety Huddles, a novel and low-resource approach to concussion education, increase the expected likelihood of concussion reporting for youth athletes., Methods: A cluster-randomised trial compared Safety Huddles to usual care. Safety Huddles bring together athletes and coaches from both teams before the start of each game for coaches to briefly affirm the importance of speaking up if a concussion is suspected. Participants were athletes from 22 competitive community-based American football and girls and boys soccer teams (ages 9-14), and randomisation into intervention or control occurred at the level of the bracket (group of teams that compete against each other during the regular season). The primary outcome was expected likelihood of reporting concussion symptoms to the coach, measured via validated athlete survey at the beginning and end of the season., Results: Of 343 eligible participants, 339 (99%) completed baseline surveys and 303 (88%) completed surveys at season end. The mean (SD) age was 11.4 (1.1) years, 26% were female soccer athletes, 27% were male soccer athletes and 47% were football athletes. In adjusted analyses accounting for baseline values and clustering by sport and team via random effects, expected likelihood of concussion reporting at the end of the season was significantly higher in the intervention group compared to controls (mean difference=0.49, 95% CI 0.11 to 0.88; Cohen's d=0.35)., Conclusions and Relevance: Pre-Game Safety Huddles increased the expected likelihood of athletes reporting concussion symptoms. While further study is warranted, sport organisations should consider this approach a promising low-resource option for improving concussion safety in their setting., Trial Registration Number: NCT04099329., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

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., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

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 delta(13)C and delta(15)N in producers and consumers. delta(15)N values were influenced by human activity: the food web from sites near urbanized centers was on average 1 per thousand heavier in delta(15)N compared to undeveloped sites. This is most likely due to wastewater inputs from septic systems relatively near the shoreline. Changes in delta(13)C were best explained by differences in the degree of marine influence. Where terrestrial inputs from a major river dominated, delta(13)C values were lighter, whereas sites further from land and in locations exposed to oceanic currents had heavier delta(13)C 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 2009 Elsevier Ltd. All rights reserved.)