bluuebunny/crossref_metadata_2025_split huggingface dataset:
High‐Sensitivity Cardiac Troponin I and T Response Following Strenuous Activity is Attenuated by Smokeless Tobacco: NEEDED (North Sea Race Endurance Exercise Study) 2014
Authors: Skranes Julia Brox , Kleiven Øyunn , Aakre Kristin Moberg , Skadberg Øyvind , Melberg Tor H. , Omland Torbjørn , Ørn Stein 
Published: September 2020

Background
Use of snus, a smokeless tobacco product, is increasing in Scandinavia. Strenuous physical activity is associated with an acute increase in high‐sensitivity cardiac troponin (swhs‐cTn) concentrations. Current smoking is associated with lower hs‐cTn, but whether this also holds true for smokeless tobacco and whether tobacco affects the hs‐cTn response to exercise remain unknown.

Methods and Results

We measured hs‐cTnI and hs‐cTnT concentrations in 914 recreational athletes before and 3 and 24 hours after a 91‐km bicycle race. Self‐reported snus tobacco habits were reported as noncurrent (n=796) and current (n=118). The association between snus use and change in log‐transformed hs‐cTnI and hs‐cTnT concentrations (ie, the differences between concentrations at baseline and 3 hours and 24 hours ) were assessed by multivariable linear regression analysis. Concentrations of hs‐cTn at baseline were lower in current than in noncurrent snus users (hs‐cTnI median, 1.7 ng/L; Q1 to Q3: 1.6–2.3 versus 2.0 ng/L; Q1 to Q3: 1.6–3.2 [
P
=0.020]; and hs‐cTnT: median, 2.9 ng/L, Q1 to Q3: 2.9–3.5 versus 2.9 ng/L, Q1 to Q3: 2.9–4.3 [
P
=0.021]). In fully adjusted multivariable models, use of snus was associated with lower change in hs‐cTn concentrations from baseline to 3 hours (hs‐cTnI: −29% [
P
=0.002], hs‐cTnT: −18% [
P
=0.010]) and 24 hours (hscTnI: −30% [
P
=0.010], hs‐cTnT −19%, [
P
=0.013]).

Conclusions
Resting hs‐cTn concentrations are lower and the exercise‐induced cardiac troponin response is attenuated in current users of smokeless tobacco compared with nonusers. Further insight into the pathophysiological processes underlying the attenuated cardiac troponin response to exercise in tobacco users is needed.

Registration

URL:
https://www.clini​caltr​ials.gov
; Unique identifier: NCT02166216.
Contemporary Pagan Pilgrimage: Ritual and Re-Storying in the Irish Landscape
Authors: Butler Jenny 
Published: September 2020

Abstract
In an examination of contemporary Pagan pilgrimage in Ireland, based on longitudinal ethnographic research, this article identifies and analyzes different cultural processes at work, focusing on the sacralization of the landscape through ritualization and re-storying. Correlations and differences between modern Pagan pilgrimage and the popular Roman Catholic pilgrimage tradition are identified since the way in which modern Pagan pilgrimage manifests is most similar to traditional Catholic site-specific pilgrimage. Contemporary Pagan activities and discourses are contextualized within Irish history and within other meaningful layers constructed over time in relation to Ireland’s sacred landscape. Counterheritagization processes and the contestation of meanings connected to pilgrimage sites is discussed as regards the process of Celticization in how a Celtic past is reactivated in the present by journeying to, and engaging with, significantly reclaimed and “re-storied” sites. For this new religious movement, the land itself plays a vital role as a dynamic and active space.
Opioid Prescribing and Use After Pediatric Umbilical Hernia Repair
Authors: L. Lee Matthew , B. Camp Lauren , V. Raval Mehul , Y. Huang Eunice 
Published: September 2020

Background Opioid overuse is a concern in adult and pediatric populations. Physician education may improve appropriate opioid prescribing and patient instruction for use. Prescribing and use of opioids for pain control after pediatric umbilical hernia (UH) repair before and after surgeon education was evaluated. This is a substudy of a multi-institutional study assessing prescribing practice before and after surgeon education. This study further assessed patient prescription filling patterns and parent report of pain control. Methods A retrospective study was performed evaluating children who underwent UH 6 months before and after an educational presentation on opioid use. Prescriptions, prescription fills, patient medication use, and pain control effectiveness were assessed. Adverse events were collected. Results There were 78 subjects in the pre-education and 99 in the post-education group. Opioid prescribed changed from 98.7% to 61.6% ( P < .0001), and nonopioid prescriptions increased following education ( P = .0063). The number of opioid prescriptions filled decreased ( P = .0296). There were limited data on opioid doses used and quality of pain control, but the post-education group showed good pain control. There was no difference in adverse events. Discussion Surgeon education on the current opioid epidemic and strategies for opioid stewardship improves opioid prescribing and use without adversely impacting pain control or clinical outcome.
Analysis of the American College of Surgeons Clinical Congress Twitter Hashtags and Its Impact on Online Engagement and Attendance Rates
Authors: Elkbuli Adel , Santarone Kristen , Boneva Dessy , Hai Shaikh , McKenney Mark 
Published: September 2020

Background Twitter at conferences facilitates remote interaction and spread of ideas. Through the use of hashtags, conference information can be gathered, referenced, disseminated, and discussed in 1 electronic location by attendees and nonattendees from remote locations. The aim of this study is to analyze the American College of Surgeons Clinical Congress (ACSCC) Twitter hashtag activities and evaluate its impact on meeting participation and engagement for the last 5 annual meetings. Methods Twitter hashtags #ACSCC15, #ACSCC16, #ACSCC17, #ACSCC18, and #ACSCC19 were studied to determine tweets, retweets, users, and impressions. Data regarding top influencers and the most tweeted links were analyzed. Symplur Signals, a software that specializes in hashtags, was utilized for the analyses. Results Between 2015 and 2017, there was a consistent increase in tweets from 12 800 to 18 300 to 24 700, respectively. However, in 2018 and 2019, tweets dropped significantly to 19 700 and 19 300, respectively ( P < .05). Additionally, impressions dropped significantly by 24 million impressions from 2017 to 2019 (115.1M to 91.1M, P < .05) despite the growth of users from 2700 in 2015 to 4100 in 2016 and ~6500 in 2017-2019. This change occurred despite no change in meeting attendance rates, regardless of specialty ( P > .05). The most influential organizations in hashtag use were the American College of Surgeons (ACS) and Association of Women Surgeons (AWS). Conclusion Despite the significant reduction in views and online engagement activities in the past 2 years, the use of Twitter at the ACS CC has greatly increased the potential dissemination of information but not meeting attendance rates.
What Is the Utility of Restaging Imaging for Patients With Clinical Stage II/III Rectal Cancer After Completion of Neoadjuvant Chemoradiation and Prior to Proctectomy?
Authors: Hendrick Leah E. , Buckner Jacob D. , Guerrero Whitney M. , Shibata David , Hinkle Nathan M. , Monroe Justin J. , Glazer Evan S. , Deneve Jeremiah L. , Dickson Paxton V. 
Published: September 2020

Background In the United States, patients with clinical stage II or III rectal cancer typically receive neoadjuvant chemoradiation therapy (chemo/XRT) over a 5-6 week period followed by a 6-10 week break prior to proctectomy. In the current study, we evaluate the utilization of restaging studies performed and detection of disease progression during this window. Methods A retrospective review of patients with clinical stage II/III rectal cancer was performed. Medical records were analyzed to collect clinicopathologic data and the performance and results of preoperative, early postoperative, and first surveillance CT and/or PET/CT in patients completing long course neoadjuvant chemo/XRT and undergoing proctectomy. Results Between 2005 and 2017, 176 patients with clinical stage II or III rectal adenocarcinoma completed neoadjuvant chemo/XRT and underwent proctectomy. Preoperative restaging with CT CAP and/or CT/PET was performed in 72 (40.9%) patients with no detection of disease progression. Of the 104 patients without preoperative restaging, 1 had intraoperative detection of liver metastases and 31 had early postoperative reimaging (within 30 days of proctectomy) of which 2 had detection of new pulmonary metastases. Among 72 patients with no preoperative or early postoperative reimaging, first surveillance imaging was available in 47 and detected new metastases in 8 (17%). Discussion In patients with clinical stage II/III rectal cancer who undergo long course neoadjuvant chemo/XRT, perioperative reimaging with CT CAP and/or PET/CT detects new metastases in a small percentage of patients. A multi-institutional, prospective analysis using standardized staging protocols is warranted to better determine the value of preoperative restaging in these patients.
Timing the First Pediatric Tracheostomy Tube Change: A Randomized Controlled Trial
Authors: Chorney Stephen R. , Patel Rosemary C. , Boyd Allison E. , Stow Joanne , Schmitt Mary M. , Lipman Deborah , Dailey Julia F. , Nhan Carol , Giordano Terri , Sobol Steven E. 
Published: September 2020

ObjectiveThe first pediatric tracheostomy tube change often occurs within 7 days after placement; however, the optimal timing is not known. The primary objective was to determine the rate of adverse events of an early tube change. Secondary objectives compared rates of significant peristomal wounds, sedation requirements, and expedited intensive care discharges.Study DesignProspective randomized controlled trial.SettingTertiary children’s hospital between October 2018 and April 2020.MethodsA randomized controlled trial enrolled children under 24 months to early (day 4) or late (day 7) first tracheostomy tube changes.ResultsSixteen children were enrolled with 10 randomized to an early change. Median age was 5.9 months (interquartile range, 5.4‐8.3), and 86.7% required tracheostomy for respiratory failure. All tracheostomy tube changes were performed without adverse events. There were no accidental decannulations. Significant wounds developed in 10% of children with early tracheostomy tube changes and 83.3% of children with late tracheostomy tube changes (odds ratio [OR], 45.0; 95% CI, 2.3‐885.6; P =. 01). This significant reduction in wound complications justified concluding trial enrollment. Hours of dexmedetomidine sedation (P =. 11) and boluses of midazolam during the first 7 days (P =. 08) were no different between groups. After the first change, 90% of the early group were discharged from intensive care within 5 weeks compared to 33.3% of patients in the late group (OR, 18.0; 95% CI, 1.2‐260.9; P =. 03).ConclusionThe first tracheostomy tube change in children can occur without adverse events on day 4, resulting in fewer significant peristomal wounds and earlier intensive care discharge.
Risk Factors for Post–acute care Following Free Flap Reconstruction of the Oral Cavity
Authors: Lepse Jason , Sykes Kevin J. , Kakarala Kiran 
Published: September 2020

ObjectiveIdentify previously unreported factors that predict the need for post–acute care after free flap reconstruction of the oral cavity.Study DesignRetrospective cohort study.SettingSingle academic medical center.MethodsA total of 134 patients with head and neck disease involving the oral cavity underwent free tissue transfer for reconstruction between August 2012 and October 2015. All patients had a tracheostomy placed at the time of surgery. Data were collected, including demographics, perioperative risk factors, and social variables. Univariate and multivariate logistic regression were used to identify risk factors for needing post–acute care.ResultsOf 134 patients, 37 (28%) required post–acute care upon discharge, and 97 of 134 (72%) were discharged home with assistance. Multivariate logistic regression revealed that lack of family support (adjusted odds ratio [AOR], 32.12; 95% CI, 13.75‐274.90; P =. 002), tracheostomy tube at discharge (AOR, 13.70; 95% CI, 3.20‐58.44; P <. 001), government insurance (AOR, 3.85; 95% CI, 1.13‐13.11; P =. 031), hospital stay >10 days (AOR, 3.52; 95% CI, 1.25‐9.90; P =. 017), and increasing age (AOR, 1.11; 95% CI, 1.04‐1.18; P =. 003) were significantly associated with post–acute care need.Conclusion:Lack of family support, tracheostomy tube at discharge, government insurance, hospital stay >10 days, and increasing age are independently associated with the need for post–acute care following free flap reconstruction of the oral cavity. Physicians, social workers, and nurse case managers are positioned to identify patients at high risk for needing post–acute care and to reduce the duration of hospitalizations.
Hearing loss in individuals at risk for neurosyphilis
Authors: Marra Christina M , Maxwell Clare L , Ramchandani Meena , Tantalo Lauren C , Sahi Sharon K , Dunaway Shelia B , Litvack Jamie R 
Published: September 2020

Otosyphilis is a serious complication of syphilis. 329 participants enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis underwent portable audiometry (250 Hz to 8000 Hz at 5–75 dB); it was repeated in 33 after otosyphilis treatment. Treponema pallidum spp pallidum ( T. pallidum) DNA in blood was quantitated by polymerase chain reaction. Odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were determined by logistic, ordinal or Cox regression. 166 (50.5%) had normal hearing; 15 (4.6%) had low frequency (LF) loss alone, 93 (28.3%) had high frequency (HF) loss alone, and 55 (16.7%) had both. Adjusted odds of any hearing loss were higher with detectable blood T. pallidum DNA (3.00 [1.58–5.69], p = 0.001), CSF pleocytosis (2.02 [1.12–3.66], p = 0.02), and older age (2.22 per 10-year increase, [1.70–2.91], p < 0.001). HRs of normalization of LF and HF loss were lower for older individuals (0.20 [0.07–0.63, p = 0.005] and 0.22 [0.05–0.94, p = 0.04]), and HRs for normalization of HF loss were lower for those with more severe loss (0.09 [0.02–0.43], p = 0.002), and in those with CSF pleocytosis (0.32 [0.11–0.96], p = 0.04). Older age and CSF pleocytosis increase the likelihood of otosyphilis and impair hearing recovery after otosyphilis treatment.
The New Patterns study: coordinated measures to combat child poverty
Authors: Mølland Eirin , Vigsnes Kristine L. , Bøe Tormod , Danielsen Hilde , Lundberg Kjetil Grimastad , Haraldstad Kristin , Ask Torunn Alise , Wilson Philip , Abildsnes Eirik 
Published: September 2020

Background Child poverty rates are rising in Norway with potential negative consequences for children. Services for families with low income are often fragmented and poorly integrated, and few coordinated initiatives have been implemented and evaluated in Norway. Aims: The aim of the current study is to evaluate how integrated and coordinated services provided over a prolonged period by a family coordinator are related to changes across a wide range of health, wellbeing and home environment indicators for the participants. Methods: The study uses a mixed methods approach utilising survey and register data, as well as information from interviews and shadowing, to document and evaluate outcomes associated with the intervention and the process of implementation. Data are gathered at baseline and annually throughout the duration of the study. Participants are identified to facilitate longer-term follow-up using register data. Conclusions: This project will develop important knowledge about the implementation of coordinated services to families with a low income, and how this way of organizing services influences important outcomes for the family members in the short and long term.
Nursing errors and their causes among nursing students
Authors: Mohsenpour Mohaddeseh , Shamabadi Zahra , Zoka Amir , Borhani Fariba , Chakani Fatemeh 
Published: September 2020

Introduction Errors are inevitable in medical practice and this issue has attracted the attention of healthcare systems worldwide. Therefore, it is of utmost importance to pay attention in educational systems. The present study aimed to investigate the frequency and cause of nursing students’ errors. Methods This descriptive study conducted based on a cross-sectional design. The researcher provided nursing students with a questionnaire. The participants were selected through a purposive sampling method. Eventually, the collected data were analyzed by SPSS17. Results The mean value of errors in students was 32.83 ± 28.5 and the prevalence rate of the errors ranged from 0 to 175. In total, 2922 errors were reported by the students, the most frequent of which were wearing the same pair of gloves for the care of more than one patient (2.61 ± 2.83), negligence to wash the hands (2.41 ± 2.95) and clean the thermometer before utilization (2.19 ± 4.68). Moreover, errors in oxygen therapy (0.69 ± 1.03) and medication (0.87) obtained the lowest frequency. Furthermore, most of the students’ errors were due to not having enough knowledge about medicines (2.1 ± 7.4), lack of appropriate equipment (2.6 ± 1.7), and poor clinical skills (2.1 ± 5.6). Discussion and conclusion: The most frequent nursing students’ errors are related to hand hygiene and personal protection. In addition, the lack of enough skills and appropriate equipment are prevalent causes of nursing students’ errors. Authorities in this field should attend to these errors in nursing education, clinical practice, and nursing studies in order to promote this profession in all of these three dimensions.
In vitro characterisation of ultrasound-induced heating effects in the mother and fetus: A clinical perspective
Authors: Smith Stephanie F , Miloro Piero , Axell Richard , ter Haar Gail , Lees Christoph 
Published: September 2020

Introduction The quantification of heating effects during exposure to ultrasound is usually based on laboratory experiments in water and is assessed using extrapolated parameters such as the thermal index. In our study, we have measured the temperature increase directly in a simulator of the maternal–fetal environment, the ‘ISUOG Phantom’, using clinically relevant ultrasound scanners, transducers and exposure conditions. Methods The study was carried out using an instrumented phantom designed to represent the pregnant maternal abdomen and which enabled temperature recordings at positions in tissue mimics which represented the skin surface, sub-surface, amniotic fluid and fetal bone interface. We tested four different transducers on a commercial diagnostic scanner. The effects of scan duration, presence of a circulating fluid, pre-set and power were recorded. Results The highest temperature increase was always at the transducer–skin interface, where temperature increases between 1.4°C and 9.5°C were observed; lower temperature rises, between 0.1°C and 1.0°C, were observed deeper in tissue and at the bone interface. Doppler modes generated the highest temperature increases. Most of the heating occurred in the first 3 minutes of exposure, with the presence of a circulating fluid having a limited effect. The power setting affected the maximum temperature increase proportionally, with peak temperature increasing from 4.3°C to 6.7°C when power was increased from 63% to 100%. Conclusions Although this phantom provides a crude mimic of the in vivo conditions, the overall results showed good repeatability and agreement with previously published experiments. All studies showed that the temperature rises observed fell within the recommendations of international regulatory bodies. However, it is important that the operator should be aware of factors affecting the temperature increase.
Assesment of Prelacrimal Recess in Patients With Maxillary Sinus Hypoplasia Using Cone Beam Computed Tomography
Authors: Duman Suayip Burak , Gumussoy İsmail 
Published: September 2020

Background The prelacrimal recess approach, is frequently preferred in creating a minimally invasive surgical corridors. Objective The aim of this study was to evaluate the Prelacrimal recess (PLR) anatomy using Cone Beam Computed Tomography in patients with Maxillary Sinus Hypoplasia. Methods The paranasal Cone Beam Computed Tomography series of 84 adults were analyzed retrospectively. The antero-posterior and mesio-distal widths of the PLR and the antero-posterior width of the naso-lacrimal duct were measured. The patients were divided into three groups according to the antero-posterior width of PLR to evaluate the feasibility of prelacrimal recess approach as Type 1 (0-3 mm), Type 2 (>3–7 mm) and Type 3 (>7 mm). Results The mean antero-posterior width of PLR was 3.11 ± 1.49mm in the patients and 4.77 ± 1.76 mm in the controls. The mean mesio-distal width of PLR was 7.64 ± 1.49 mm in the patients and 3.17 ± 2.05 mm in the controls. The mean antero-posterior width of naso-lacrimal duct was 9.58 ± 2.80 mm in the patients and 9.46 ± 2.42 mm in the controls. Conclusions The width of the antero-posterior PLR in patients with Maxillary Sinus Hypoplasia was found to be significantly lower in comparison to individuals with normal maxillary sinuses in the measurements performed on paranasal Cone Beam Computed Tomography scans. Hence, while planning a Functional Endoscopic Sinus Surgery with prelacrimal recess approach for maxillary sinus, the anatomical structure of the naso-sinusoidal region should be carefully analyzed, and individual anatomical variations such as Maxillary Sinus Hypoplasia should not be ignored.
Twenty-Two-Year Outcome of Cartilage Repair Surgery by Perichondrium Transplantation
Authors: Janssen Maarten P. F. , van der Linden Esther G. M. , Boymans Tim A. E. J. , Welting Tim J. M. , van Rhijn Lodewijk W. , Bulstra Sjoerd K. , Emans Peter J. 
Published: September 2020

Objective The main purpose of the present study was to assess the risk for major revision surgery after perichondrium transplantation (PT) at a minimum of 22 years postoperatively and to evaluate the influence of patient characteristics. Design Primary outcome was treatment success or failure. Failure of PT was defined as revision surgery in which the transplant was removed, such as (unicondylar) knee arthroplasty or patellectomy. The functioning of nonfailed patients was evaluated using the International Knee Documentation Committee (IKDC) score. In addition, the influence of patient characteristics was evaluated. Results Ninety knees in 88 patients, aged 16 to 55 years with symptomatic cartilage defects, were treated by PT. Eighty knees in 78 patients were eligible for analysis and 10 patients were lost to follow-up. Twenty-eight knees in 26 patients had undergone major revision surgery. Previous surgery and a longer time of symptoms prior to PT were significantly associated with an increased risk for failure of cartilage repair. Functioning of the remaining 52 patients and influence of patient characteristics was analyzed using their IKDC score. Their median IKDC score was 39.08, but a relatively young age at transplantation was associated with a higher IKDC score. Conclusions This 22-year follow-up study of PT, with objective outcome parameters next to patient-reported outcome measurements in a unique group of patients, shows that overall 66% was without major revision surgery and patient characteristics also influence long-term outcome of cartilage repair surgery.