bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in work stress among doctors in Norway from 2010 to 2019: a study based on repeated surveys
Authors: Rosta Judith , Bååthe Fredrik , Aasland Olaf G , Isaksson Rø Karin 
Published: October 2020

ObjectivesTo explore and discuss the changes in the levels of work stress for Norwegian doctors in different job positions (hospital doctors, general practitioners (GPs), private practice specialists, doctors in academia) from 2010 to 2019.DesignRepeated questionnaire surveys in 2010, 2016 and 2019, where samples were partly overlapping.SettingNorway.ParticipantsA representative sample of 1500–2200 doctors in different job positions. Response rates were 66.7% (1014/1520) in 2010, 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019.Main outcome measureValidated 9-item short form of the ‘Effort–Reward Imbalance’ questionnaire. A risky level of work stress was defined as an effort/reward ratio above 1.0.AnalysesLinear mixed models with estimated marginal means of job positions controlled for gender and age. Proportions with 95% CIs.ResultsFrom 2010 to 2016 and further to 2019, GPs reported a significant increase in levels on the effort scale (ES: 2.96, 3.25, 3.51) and significant decrease in levels on the reward scale (RS: 4.27, 4.05, 3.67). No significant changes were reported by hospital doctors (ES: 3.13, 3.10, 3.14; RS: 4.09, 3.98, 4.04), private practice specialists (ES: 2.58, 2.61, 2.59; RS: 4.32, 4.32, 4.30) and doctors in academia (ES: 2.63, 2.51, 2.52; RS: 4.09, 4.11, 4.14). The proportion of doctors with risky levels of work stress increased significantly for GPs (10.3%, 27.7%, 40.1%), but did not significantly change for hospital doctors (23.0%, 27.3%, 26.9%), private practice specialists (8.2%, 12.7%, 9.4%) and doctors in academia (11.9%, 19.0%, 16.4%).ConclusionDuring a 9-year period, the proportion of risky levels of work stress increased significantly for GPs but did not significantly change for other job positions. This may be partly due to changes in expectations of younger GPs and several healthcare reforms and regulations.
Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation
Authors: Husabø Gunnar , Nilsen Roy Miodini , Solligård Erik , Flaatten Hans Kristian , Walshe Kieran , Frich Jan C , Bondevik Gunnar Tschudi , Braut Geir Sverre , Helgeland Jon , Harthug Stig , Hovlid Einar 
Published: October 2020

ObjectiveTo evaluate the effects of external inspections on (1) hospital emergency departments’ clinical processes for detecting and treating sepsis and (2) length of hospital stay and 30-day mortality.DesignIncomplete cluster-randomised stepped-wedge design using data from patient records and patient registries. We compared care processes and patient outcomes before and after the intervention using regression analysis.SettingNationwide inspections of sepsis care in emergency departments in Norwegian hospitals.Participants7407 patients presenting to hospital emergency departments with sepsis.InterventionExternal inspections of sepsis detection and treatment led by a public supervisory institution.Main outcome measuresProcess measures for sepsis diagnostics and treatment, length of hospital stay and 30-day all-cause mortality.ResultsAfter the inspections, there were significant improvements in the proportions of patients examined by a physician within the time frame set in triage (OR 1.28, 95% CI 1.07 to 1.53), undergoing a complete set of vital measurements within 1 hour (OR 1.78, 95% CI 1.10 to 2.87), having lactate measured within 1 hour (OR 2.75, 95% CI 1.83 to 4.15), having an adequate observation regimen (OR 2.20, 95% CI 1.51 to 3.20) and receiving antibiotics within 1 hour (OR 2.16, 95% CI 1.83 to 2.55). There was also significant reduction in mortality and length of stay, but these findings were no longer significant when controlling for time.ConclusionsExternal inspections were associated with improvement of sepsis detection and treatment. These findings suggest that policy-makers and regulatory agencies should prioritise assessing the effects of their inspections and pay attention to the mechanisms by which the inspections might contribute to improve care for patients.Trial registrationNCT02747121.
Natalizumab versus fingolimod for patients with active relapsing-remitting multiple sclerosis: results from REVEAL, a prospective, randomised head-to-head study
Authors: Butzkueven Helmut , Licata Stephanie , Jeffery Douglas , Arnold Douglas L , Filippi Massimo , Geurts Jeroen JG , Santra Sourav , Campbell Nolan , Ho Pei-Ran 
Published: October 2020

ObjectiveTo directly compare the efficacy of natalizumab and fingolimod in patients with active relapsing-remitting multiple sclerosis.MethodsThis phase 4, randomised, rater- and sponsor-blinded, prospective, parallel-group, clinic-based head-to-head study was conducted at 43 sites in nine countries. Patients were randomised (1:1) to intravenous natalizumab 300 mg every 4 weeks or oral fingolimod 0.5 mg once daily for ≤52 weeks. Enrolment-related early study termination precluded assessment of the primary endpoint (evolution of new on-treatment gadolinium-enhancing (Gd+) lesions to persistent black holes). Unplanned exploratory analyses of secondary endpoints evaluated the effects of treatment on the development of new T1 Gd+ lesions and new/newly enlarging T2 lesions, lesion volumes and relapse outcomes.ResultsThe intent-to-treat population comprised 108 patients (natalizumab, n=54; fingolimod, n=54); 63 completed ≥24 weeks of treatment. Due to the limited numbers of events and patients at risk, MRI and relapse outcomes were reported over up to 24 and 36 weeks, respectively. The mean number of new T1 Gd+ lesions was numerically lower with natalizumab than with fingolimod by 4 weeks; accumulation rates were 0.02 and 0.09 per week, respectively, over 24 weeks (p=0.004). The cumulative probability of developing ≥1 lesion at 24 weeks was 40.7% with natalizumab versus 58.0% with fingolimod (HR=0.60; 95% CI 0.31–1.16; p=0.126); the corresponding probabilities for ≥2 lesions were 11.5% vs 48.5% (HR=0.25; 95% CI 0.09–0.68; p=0.007). No significant between-group differences were observed for the other MRI outcomes at 24 weeks. The cumulative probability of relapse over follow-up was 1.9% with natalizumab versus 22.3% with fingolimod (HR=0.08; 95% CI 0.01–0.64; p=0.017). Adverse events were consistent with known safety profiles.ConclusionsThese results suggest that natalizumab is more efficacious than fingolimod in reducing multiple sclerosis relapses and T1 Gd+ lesion accumulation in patients with active disease.Trial registration numbersNCT02342704; EUCTR2013-004622-29-IT; Post-results.
Rapid ethnographic assessment of the COVID-19 pandemic April 2020 ‘surge’ and its impact on service delivery in an Acute Care Medical Emergency Department and Trauma Center
Authors: Palinkas Lawrence A , Whiteside Lauren , Nehra Deepika , Engstrom Allison , Taylor Mark , Moloney Kathleen , Zatzick Douglas F 
Published: October 2020

ObjectivesAssess the impacts of the COVID-19 pandemic on service delivery by frontline healthcare providers in acute care medical and emergency department settings and identify strategies used to cope with pandemic-related physical and mental health demands.DesignRapid clinical ethnography of patient–provider encounters during an initial pandemic ‘surge’ conducted by a team of clinician–researchers using a structured protocol for qualitative data collection and analysis.SettingLevel 1 trauma centre at Harborview Hospital in Seattle Washington in April 2020.ParticipantsFrontline clinical providers serving as participant observers during performance of their clinical duties recorded observations and summaries of conversations with other providers and patients.ResultsWe identified four different kinds of impacts: procedural, provider, patient and overall. Each impact highlighted two or more levels of a socioecological model of services delivery: (1) the epidemiology of COVID-19, (2) outer setting, (3) inner or organisational setting and (4) individual patient and provider. Despite significant changes in procedures that included COVID-19 screening of all admitted patients, social distancing and use of personal protective equipment, as well as changes in patient and provider behaviour, the overall impact of the pandemic on the emergency department and acute care service delivery was minimal. This is attributed to having a smaller surge than expected, a quick response by the healthcare system to anticipated demands for service delivery and protection of patients and providers, adequate supplies and high provider morale.ConclusionsAlthough limited to one setting in one healthcare system in one community, the findings offer some important lessons for healthcare systems that have yet to be impacted as well as systems that have been more severely impacted. Each of the socioecological framework levels was found to impact service delivery to patients, and variations at each of these levels account for variations in that quality of care globally.
Comparison of the detection rates for retinopathy of prematurity (ROP) of the 2013 Philippine Academy of Ophthalmology (PAO) Revised Philippine Guidelines and the 2005 PAO-Philippine Pediatric Society (PPS) Guidelines for ROP screening in the Philippine General Hospital: a 5-year review
Authors: Paulino Jose Antonio Tan , Santiago Alvina Pauline Dy , Santiago Darby Espiritu 
Published: October 2020

ObjectivesCompare the detection rates of the 2013 Philippine Academy of Ophthalmology (PAO) guidelines for retinopathy of prematurity (ROP) screening and the 2005 PAO-Philippine Pediatric Society guidelines in identifying infants who develop ROP in the 5-year study period in the Philippine General Hospital (PGH). Secondary objectives include determination of ROP prevalence; correlation of gestational age (GA), birth weight (BW) and other risk factors to ROP; and identification of the most common intervention.Methods and analysisRetrospective cross-sectional study of ROP records between 1 December 2013 and 30 November 2018 from the Medical Retina Service of the Department of Ophthalmology and Visual Sciences of the institution was studied. Variables with p value <0.05 were considered significant. STATA V.14 was used for all analysis.ResultsOnly 851 of 898 infants screened for ROP were included in the study. Of these 698 would have been screened based on 2005 guidelines. All 118 infants with ROP were identified by both guidelines. Detection rate was higher using the 2005 than the 2013 guidelines (16.9% vs 13.3%, p value=0.0496). ROP prevalence was 9.7%. Among those with ROP, 70% have at least one identified risk factor, topped by sepsis, pneumonia, hyaline membrane disease, blood transfusion and oxygen supplementation. Only 8% required intervention consisting of laser, anti-vascular endothelial growth factor injection, surgery or in combination.ConclusionIn PGH, no infants with ROP were missed using the 2005 recommendations. There was no added benefit of increasing threshold for BW and GA as recommended by the 2013 PAO guidelines. Screening guidelines should, however, be tailored to institutional needs, requirements and experience.
Prevalence and factors associated with HIV epidemic among female sex workers in Pakistan: results of the fifth round of integrated biological and behavioural surveillance
Authors: Emmanuel Faran , Achakzai Baseer Khan , Reza Tahira 
Published: October 2020

ObjectivesWe examined data collected as part of the fifth round of integrated biological and behavioural surveillance to determine the prevalence and factors associated with HIV infection among female sex workers (FSWs) in Pakistan.MethodsFSWs were defined as ‘all females, age 13 years and above, who receive money or goods in exchange for sexual services, regardless of the site of operation’. Data were collected between October 2016 and January 2017 in 18 cities using multistage sampling techniques to randomly select FSWs from spots facilitated by peers. Behavioural data were collected by interviewers using structured questionnaires, which was followed by obtaining finger prick blood samples tested for HIV using two rapid tests. Multivariate logistic regression analysis was done to assess independent associations of potential correlates using HIV status as dependent variable.ResultsWe invited 5728 FSWs to participate, of which 68 refused to participate (refusal rate=1.2%). Of the 5660 FSWs who participated, 121 were HIV seropositive (weighted HIV prevalence 2.3%; 95% CI 1.9% to 2.7%) mostly concentrated within cities in Sindh. Multivariate analysis showed being uneducated/illiterate (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.4), directly dealing with clients without a pimp (aOR 1.8; 95% CI 1.1 to 2.8), non-use of condom with clients (aOR 1.8; 95% CI 1.1 to 2.8), having sexual contact with people who inject drugs (PWID) (aOR 2.2; 95% CI 1.3 to 3.7) and non-participation in HIV programmes (aOR 1.7; 95% CI 1.0 to 3.1) as factors independently associated with HIV seropositivity.ConclusionsWe found a weighted national HIV prevalence of 2.3% and identified factors independently associated with HIV in FSWs. The country needs to scale up HIV prevention programmes to improve coverage, prioritising FSWs who are illiterate, work independently and have PWID as sex partners. Emphasis should be laid on strategies to improve condom use with both regular and non-regular partners.
Implementation of a standardised and quality-assured enhanced gonococcal antimicrobial surveillance programme in accordance with WHO protocols in Kampala, Uganda
Authors: Kakooza Francis , Musinguzi Patrick , Workneh Meklit , Walwema Richard , Kyambadde Peter , Mande Emmanuel , Lubega Christopher , Nakasi Jhamira M , Kiggundu Reuben , Hamill Matthew M , Bagaya Bernard S , Lamorde Mohammed , Unemo Magnus , Manabe Yukari C 
Published: October 2020

ObjectivesThe emergence of multidrug-resistantNeisseria gonorrhoeae(NG) is a major global health threat necessitating response and control measures. NG antimicrobial resistance (AMR) surveillance data from sub-Saharan countries is exceedingly limited. This paper aims to describe the establishment, design and implementation of a standardised and quality-assured gonococcal surveillance programme and to describe the susceptibility patterns of the cultured gonococcal isolates in Kampala, Uganda.MethodsFrom March 2018 to September 2019, using the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) protocol, consecutive males with urethral discharge syndrome were recruited from 10 surveillance sites in Kampala City, Uganda, in collaboration with the Ministry of Health. Males completed a questionnaire and provided a urethral swab specimen. Culture, identification and antimicrobial susceptibility testing (Etest) were performed.ResultsOf the 1013 males recruited, 73.1% (740/1013) had a positive Gram stain and 51.1% (n=518) were culture-positive for NG. Using Etest (458 isolates), the resistance to ciprofloxacin was 99.6%. Most isolates were susceptible to azithromycin, cefoxitin and gentamicin, that is, 99.8%, 98.5% and 92.4%, respectively, and all isolates were susceptible to ceftriaxone and cefixime.ConclusionsWe established a standardised, quality-assured WHO EGASP. Using Etest, 458 isolates were characterised, with associated epidemiological surveillance data, in 1.5 years, which by far exceed the minimum 100 isolates per year and country requested in the WHO Global GASP, to detect AMR levels with confidence. These isolates with the epidemiological data can be used to develop population level interventions.
Modified self-obtained pooled sampling to screen forChlamydia trachomatisandNeisseria gonorrhoeaeinfections in men who have sex with men
Authors: Ando Naokatsu , Mizushima Daisuke , Watanabe Koji , Takano Misao , Shiojiri Daisuke , Uemura Haruka , AOKI Takahiro , Yanagawa Yasuaki , Kikuchi Yoshimi , Oka Shinichi , Gatanaga Hiroyuki 
Published: October 2020

ObjectivesTo assess whether pooled sample testing with nucleic acid amplification tests was a potential alternative to three single-site sample testing to screen forChlamydia trachomatisandNeisseria gonorrhoeaeinfections in asymptomatic men who have sex with men.MethodsWe prospectively compared pooled sample testing with single-site sample testing in asymptomatic MSM. Self-obtained paired rectal samples, one gargle sample and one first-void urine sample were collected from participants to generate two sets of samples: one for pooled sample testing and the other for single-site testing. We used modified pooled sampling, which is defined as the use of gargle samples, instead of swabs, for the pooled sample to test for pharyngeal infection.ResultsThis study included 513 MSM. The positive rates ofC. trachomatisandN. gonorrhoeaewere 20.3% and 11.7%, respectively, for single-site sample testing. Compared with the sensitivity of single-site testing as the gold standard, the sensitivities of pooled sample testing forC. trachomatisandN. gonorrhoeaewere 94.2% (95% CI 88.0% to 97.3%) and 98.3% (95% CI 90.9% to 99.9%), respectively. The concordance rate and kappa coefficient were 98.3% (95% CI 96.7% to 99.2%) and 0.945 (95% CI 0.859 to 1.000), respectively, forC. trachomatisand 98.8% (95% CI 90.1% to 100%) and 0.943 (95% CI 0.857 to 1.000), respectively, forN. gonorrhoeae.ConclusionsThe modified pooled sampling had a comparably high consistency with single-site sample testing. The results strongly suggest that the gargle sample is suitable as a part of pooled sample for STI screening ofC. trachomatisandN. gonorrhoeae.
Shark-related injuries in Hawai’i treated at a level 1 trauma center
Authors: Scala Victoria A , Hayashi Michael S , Kaneshige Jason , Haut Elliott R , Ng Karen , Furuta Sho 
Published: October 2020

BackgroundAlthough rare, human–shark interactions can result in a wide spectrum of injuries. This is the first study to characterize shark-related injuries (SRIs) in Hawai’i.MethodsThis is a retrospective review of the State of Hawai’i Division of Aquatic Resources Shark Incidents List between January 1, 2009 and December 31, 2019. Trauma registry data and medical records of patients treated for SRIs at the only level 1 trauma center in Hawai’i were reviewed.ResultsSixty-one patients sustained SRIs in the Hawaiian Islands: 25 in Maui, 16 in O’ahu, 12 in Hawai’i, and 8 in Kaua’i. In cases where the shark species could be identified, tiger sharks were the most frequent (25, 41%). Four cases were fatal—all died on scene in Maui with the shark species unknown. Forty-five survivors (79%) received definitive care at regional facilities. Twelve (21%) were treated at the level 1 trauma center, of which two were transferred in for higher level of care. Of the 12 patients, 11 (92%) had extremity injuries, with 3 lower extremity amputations (25%), 2 with vascular injuries (17%), and 5 with nerve injuries (42%). One had an injury to the abdomen. All patients had local bleeding control in the prehospital setting, with 9 (75%) tourniquets and 3 (25%) hemostatic/pressure dressings applied for truncal or proximal extremity injuries. The mean time from injury to emergency department arrival was 63 minutes.DiscussionMost SRIs are managed at regional facilities, rather than at a level 1 trauma center. Prehospital hemorrhage control is an important survival skill as time to definitive care may be prolonged. For cases treated at the level 1 trauma center, nerve injuries were common and should be suspected even in the absence of major vascular injury. Correlating shark behavior with observed injury patterns may help improve public awareness and ocean safety.Level of evidenceLevel V, epidemiological.
Safety effects of maintenance treatments to improve pavement condition on two-lane rural roads — insights for pavement management
Authors: Jafari Anarkooli Alireza , Nemtsov Iliya , Persaud Bhagwant 
Published: October 2020

The research used data from two-lane rural roads in Ontario, Canada to evaluate the change in safety following maintenance treatments to improve pavement condition as measured by International Roughness Index (IRI). The state-of-the-art empirical Bayes (EB) before-after methodology was applied to estimate the effects on crashes, separately for arterial and collector roads. The results indicate statistically significant reductions (P < 0.05) in all crashes and property damage only (PDO) crashes of approximately 5% and 7%, respectively, for arterial roads and approximately 11% and 13% for collector roads. For fatal plus injury (FI) crashes, there were small, statistically insignificant changes for the two road types. The results provide interesting, and sometimes counterintuitive insights for those planning maintenance treatments to improve IRI. In sum, the results suggest that consideration should be given to designing and planning pavement maintenance treatments on a site-by-site basis, and, in so doing, to optimize the IRI levels and safety effects that may be accomplished with specific treatments.
Probing chemical freeze-out criteria in relativistic nuclear collisions with coarse grained transport simulations
Authors: Reichert Tom , Inghirami Gabriele , Bleicher Marcus 
Published: October 2020

AbstractWe introduce a novel approach based on elastic and inelastic scattering rates to extract the hyper-surface of the chemical freeze-out from a hadronic transport model in the energy range from E$$_\mathrm {lab}=1.23$$

lab

=
1.23

AGeV to $$\sqrt{s_\mathrm {NN}}=62.4$$

s
NN

=
62.4

GeV. For this study, the Ultra-relativistic Quantum Molecular Dynamics (UrQMD) model combined with a coarse-graining method is employed. The chemical freeze-out distribution is reconstructed from the pions through several decay and re-formation chains involving resonances and taking into account inelastic, pseudo-elastic and string excitation reactions. The extracted average temperature and baryon chemical potential are then compared to statistical model analysis. Finally we investigate various freeze-out criteria suggested in the literature. We confirm within this microscopic dynamical simulation, that the chemical freeze-out at all energies coincides with $$\langle E\rangle /\langle N\rangle \approx 1$$

⟨
E
⟩
/
⟨
N
⟩
≈
1

GeV, while other criteria, like $$s/T^3=7$$

s
/

T
3

=
7

and $$n_\mathrm {B}+n_{\bar{\mathrm {B}}}\approx 0.12$$

n
B

+

n

B

¯

≈
0.12

fm$$^{-3}$$

-
3

are limited to higher collision energies.
Stable and self-consistent compact star models in teleparallel gravity
Authors: Nashed G. G. L. , Capozziello S. 
Published: October 2020

AbstractIn the framework of Teleparallel Gravity, we derive a charged non-vacuum solution for a physically symmetric tetrad field with two unknown functions of radial coordinate. The field equations result in a closed-form adopting particular metric potentials and a suitable anisotropy function combined with the charge. Under these circumstances, it is possible to obtain a set of configurations compatible with observed pulsars. Specifically, boundary conditions for the interior spacetime are applied to the exterior Reissner–Nordström metric to constrain the radial pressure that has to vanish through the boundary. Starting from these considerations, we are able to fix the model parameters. The pulsar $$\textit{PSR J 1614-2230}$$

PSR J

1614
-
2230

, with estimated mass $$M= 1.97 \pm 0.04\, M_{\circledcirc },$$

M
=
1.97
±
0.04

M
⊚

,

and radius $$R= 9.69 \pm 0.2$$

R
=
9.69
±
0.2

km is used to test numerically the model. The stability is studied, through the causality conditions and adiabatic index, adopting the Tolman–Oppenheimer–Volkov equation. The mass–radius (M, R) relation is derived. Furthermore, the compatibility of the model with other observed pulsars is also studied. We reasonably conclude that the model can represent realistic compact objects.