bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of burnout syndrome and job‐related risk factors in veterinary technicians in specialty teaching hospitals: a multicenter cross‐sectional study
Authors: Hayes Galina M. , LaLonde‐Paul Denise F. , Perret Jennifer L. , Steele Andrea , McConkey Marina , Lane William G. , Kopp Rosalind J. , Stone Hannah K. , Miller Meredith , Jones‐Bitton Andria 
Published: December 2019

AbstractObjectivesTo investigate veterinary technician burnout and associations with frequency of self‐reported medical error, resilience, and depression and job‐related risk factors.DesignCross‐sectional observational study using an anonymous survey conducted between November 2017 and June 2018.SettingFour referral teaching hospitals in the United States and Canada.SubjectsA total of 344 veterinary technicians were invited to participate. Response rate was 95%. Overall 256 surveys were ultimately analyzed.InterventionsBurnout, depression, and resilience were measured using validated instruments. Respondents reported perceptions of workload, working environment, and medical error frequency. Associations between burnout and factors related to physical work environment, workload and schedule, compensation package, interpersonal relationships, intellectual enrichment, and exposure to ethical conflicts were analyzed.Measurements and Main ResultsBurnout, characterized by high emotional exhaustion, depersonalization, and low sense of personal accomplishment was common, and was positively associated with perceived medical errors, desire to change career, and depression. Burnout levels on all 3 burnout subscales were higher in this population than previously reported for a contemporaneous group of trauma nurses working with human patients (P < 0.05). Burnout was negatively associated with resilience. Respondents’ feelings of fear or anxiety around supervisor communications, perception that patient load was too high to allow for excellent patient care, and perceived lack of available assistance during sudden workload increases were all associated with burnout.ConclusionsBurnout in veterinary technicians is common and is associated with numerous undesirable outcomes. Work‐related interventions to reduce burnout should focus on improving supervisor relationships and maintaining an appropriate patient:caregiver ratio.
Los palacios cinematográficos de la Ciudad de México
Authors: Alfaro Salazara Francisco Haroldo , Ochoa Vega Alejandro 
Published: December 2019

La historia de la ciudad de México, en continua construcción, está llena de momentos emblemáticos que permiten reconocer el paso de generaciones que la han moldeado. En su estructura urbana se han desarrollado tipologías arquitectónicas, que permiten comprender los procesos de consolidación y transformación; de crecimiento y complejidad. Alguna ocasión reconocida por los viajeros y exploradores como la ciudad de los palacios, durante el sigloXX su tradición de arquitectura emblemática, monumental y grandilocuente fue reforzada por los cinematógrafos, edificios producto de la evolución tecnológica, referentes de un mundo urbano y nocturno, plenamente moderno. Lospalacios cinematográficos de la ciudad de México se fueron consolidando paulatinamente, y desde los años veinte hasta los años setenta fueron referentes en el casco histórico, en los barrios tradicionales y en las nuevas expansionesurbanas. Arquitectura para el espectáculo, su imagen urbana fue parte de este, reforzando una historia que lentamente empieza a borrarse, y con ello también parte de la memoria de la ciudad
Lending an Ear: iPeer2Peer plus Teens Taking Charge online self-management to empower adolescents with arthritis in Ireland: protocol for a pilot randomised controlled trial
Authors: O'Higgins Siobhan , Stinson Jennifer , Ahola Kohut Sara , Caes Line , Heary Caroline , McGuire Brian E 
Published: December 2019

IntroductionJuvenile idiopathic arthritis (JIA) negatively affects adolescents’ everyday activities. To address the need for innovative, effective, convenient, low-cost psychosocial self-management programmes, we developed an Irish version of Canadian Teens Taking Charge (TTC) and integrated it with Skype-based peer support iPeer2Peer (iP2P).ObjectivesTo explore the feasibility and preliminary outcome impact (effectiveness) of an integrated iP2P and Irish TTC, via three-arm (treatment as usual, TTC and iP2P–TTC) pilot randomised controlled trial (RCT); and determine feasibility and sample size for a full RCT. To ensure active involvement of adolescents with JIA via a Young Person Advisory Panel and examine how participants experienced the study. Finally, to see if TTC and iP2P with TTC reduce costs for families.Methods and analysisRecruitment of 60 families will be ongoing until July 2019, via healthcare professionals and support groups. Analysis will consist of single-blinded (outcome assessment), three-arm pilot RCT, using online questionnaires, with assessments at baseline (T1), after intervention (T2) and 3 months post-intervention (T3). The primary outcomes on feasibility with comparisons of TTC and iP2P–TTC on fidelity, acceptability and satisfaction, engagement and degrees of tailoring. The secondary outcomes will be self-management and self-efficacy and a range of health-related quality-of-life factors, pain indicators and costs.Participants from the intervention groups will be invited to share their perspectives on the process in semistructured interviews. Quantitative data will be analysed using SPSS V.21 and the audio-taped and transcribed qualitative data will be analysed using qualitative content analysis.DisseminationVia journal articles, conference presentations, co-delivered by key stakeholders when possible, launch of accessible, effective and sustainable Internet self-management and peer support for Irish adolescents with JIA.Trial registration numberISRCTN13535901; Pre-results.
DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care
Authors: Costa Andrew P , Schumacher Connie , Jones Aaron , Dash Darly , Campbell Graham , Junek Mats , Agarwal Gina , Bell Chaim M , Boscart Veronique , Bronskill Susan E , Feeny David , Hébert Paul C , Heckman George A , Hirdes John P , Lee Linda , McKelvie Robert S , Mitchell Lori , Sinha Samir K , Davis Joy , Priddle Tammy , Rose Joanne , Gillan Roslyn , Mills Deborah , Haughton Dilys 
Published: December 2019

IntroductionHome care clients are increasingly medically complex, have limited access to effective chronic disease management and have very high emergency department (ED) visitation rates. There is a need for more appropriate and targeted supportive chronic disease management for home care clients. We aim to evaluate the effectiveness and preliminary cost effectiveness of a targeted, person-centred cardiorespiratory management model.Methods and analysisThe Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) — Collaboration Action Research and Evaluation (CARE) trial is a pragmatic, cluster-randomised, multicentre superiority trial of a flexible multicomponent cardiorespiratory management model based on the best practice guidelines. The trial will be conducted in partnership with three regional, public-sector, home care providers across Canada. The primary outcome of the trial is the difference in time to first unplanned ED visit (hazard rate) within 6 months. Additional secondary outcomes are to identify changes in patient activation, changes in cardiorespiratory symptom frequencies and cost effectiveness over 6 months. We will also investigate the difference in the number of unplanned ED visits, number of inpatient hospitalisations and changes in health-related quality of life. Multilevel proportional hazard and generalised linear models will be used to test the primary and secondary hypotheses. Sample size simulations indicate that enrolling 1100 home care clients across 36 clusters (home care caseloads) will yield a power of 81% given an HR of 0.75.Ethics and disseminationEthics approval was obtained from the Hamilton Integrated Research Ethics Board as well as each participating site’s ethics board. Results will be submitted for publication in peer-reviewed journals and for presentation at relevant conferences. Home care service partners will also be informed of the study’s results. The results will be used to inform future support strategies for older adults receiving home care services.Trial registration numberNCT03012256.
Diagnostic accuracy of presepsin in predicting bacteraemia in elderly patients admitted to the emergency department: prospective study in Japan
Authors: Imai Yoshiro , Taniguchi Kohei , Iida Ryo , Nitta Masahiko , Uchiyma Kazuhisa , Takasu Akira 
Published: December 2019

ObjectiveEarly prediction of bacteraemia in the elederly is needed in the emergency department (ED).Design, setting and participantsA prospective study in Japan; single-centre trial in patients who satisfied the sepsis criteria was conducted between September 2014 and March 2016. Forty-six elderly patients aged ≥70 years were included. The study protocol was approved by the ethics committee of Osaka Medical College. Ethics Committee approval number was 1585.InterventionsBlood sampling to evaluate C-reactive protein (CRP), procalcitonin (PCT) and presepsin plasma levels; two sets of blood sampling for bacterial cultures; and evaluations of the Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation scores were performed on arrival at the ED. The results were compared between patients with bacteraemia and those without bacteraemia.Main outcome measureThe accuracy of detecting bacteraemia.ResultsThe presepsin value was significantly higher in the bacteraemia group than in the non-bacteraemia group (866.6±184.6 vs 639.9±137.1 pg/mL, p=0.03). The PCT and CRP did not significantly differ between the groups. The area under the receiver operating characteristic curve values were not significantly different among presepsin (0.69), PCT (0.61) and CRP (0.53). Multivariate analysis showed that presepsin was independently associated with bacteraemia (OR 8.84; 95% CI 0.95 to 81.79; p=0.02).ConclusionPresepsin could be a good biomarker to predict bacteraemia in elderly patients with sepsis criteria admitted to the ED.
Drowning among fishing communities on the Tanzanian shore of lake Victoria: a mixed-methods study to examine incidence, risk factors and socioeconomic impact
Authors: Whitworth Hilary S , Pando Joyce , Hansen Christian , Howard Natasha , Moshi Amen , Rocky Otto , Mahanga Happiness , Jabbar Mtoro , Ayieko Philip , Kapiga Saidi , Grosskurth Heiner , Watson-Jones Deborah 
Published: December 2019

ObjectivesTo estimate the incidence of unintentional fatal drowning and describe associated risk factors among Lake Victoria fishing communities, and to assess perceived social, financial and other impacts among families and colleagues of persons who drowned.DesignA retrospective, observational mixed-methods study, conducted between September 2017 and February 2018.SettingEight Tanzanian fishing communities on Lake Victoria.ParticipantsPersons who drowned in the preceding 24 months were identified using an extensive community networking approach. Adult family members, colleagues or community members familiar with the habits and behaviours of people who drowned and/or circumstances of drowning incidents participated in surveys (n=44) and in-depth interviews (n=22).Main outcome measuresPooled drowning incidence, with sensitivity analyses allowing for uncertainties in population estimates. Risk factors were identified through the evaluation of behavioural characteristics of persons who drowned and circumstances of drowning incidents. Perceived socioeconomic impacts were assessed through semi-structured interviews with their family members and colleagues.ResultsThe estimated drowning incidence was 217/100 000 person-years (95% CI 118 to 425/100 000). Of 86 victims identified, 70 (81%) were fishermen (79% aged 18–40 years; all men) and 9 were children (all ≤10 years). All deaths occurred in the lake. Most adults (65/77; 84%) were fishing from a boat when they drowned; 57/77 (74%) died in the evening (from ~5 pm) or at night. Six children (67%) drowned while swimming/playing at the lakeshore unsupervised. Few victims (2/86; 2%) were wearing a life jacket at the time of death. Reported socioeconomic impacts of these deaths ranged from income loss to family break-up.ConclusionsDrowning is a significant risk in Tanzanian lakeside fishing communities, with estimated mortality exceeding national incidence rates of fatal malaria, tuberculosis or HIV, but preventative strategies appear uncommon. Socioeconomic impact at the family level may be substantial. Intervention strategies are required to reduce the drowning burden among this neglected at-risk population.
Variation in relationships between maternal age at first birth and pregnancy outcomes by maternal race: a population-based cohort study in the United States
Authors: Schummers Laura , Hacker Michele R , Williams Paige L , Hutcheon Jennifer A , Vanderweele Tyler J , McElrath Thomas F , Hernandez-Diaz Sonia 
Published: December 2019

ObjectiveTo estimate absolute risks of obstetric outcomes in the USA according to maternal age at first birth from age 15 to 45 separately by maternal race.Design and settingPopulation-based cohort study.SettingVital statistics Birth Cohort-Linked Birth- Infant Death Data Files and Fetal Death Data Files in the USA.Participants16 514 849 births to nulliparous women from 2004 to 2013.Outcome measuresWe estimated absolute risks of obstetric outcomes (multiple gestations, caesarean delivery, early and late preterm birth, small for gestational age birth, stillbirth, neonatal mortality, postneonatal infant mortality) at each year of maternal age from 15 to 45 years using logistic regression in the overall population and stratified by maternal race. We modelled maternal age flexibly to allow curvilinear shapes and plotted risk curves for each outcome.ResultsIn the overall population, multiple gestations, caesarean delivery and stillbirth risks were lowest at young maternal ages with linear or quadratic increases with age. Curves for preterm birth, small for gestational age, neonatal mortality and postneonatal mortality were u or j shaped, with nadirs between 20 and 29 years, and elevated risks at both younger and older maternal ages. In race-stratified analyses, the shapes of the curves were generally similar across races. Risks increased for all women for all outcomes after age 30. However, increased risks at young maternal ages were most pronounced for white and Asian/Pacific Islander women, for whom young childbearing was least common. Conversely, risks at older ages were more pronounced for Black and American Indian/Alaska Native women, for whom delayed childbearing was least common.ConclusionOur findings confirm risks associated with first births to women younger than 20 and older than 30 years, provide easily interpretable risk curves and illuminate variability in these relationships across categories of maternal race in the USA.
A structured medication review tool to promote psychotropic medication optimisation for adults with intellectual disability: feasibility study
Authors: Sheehan Rory , Strydom André , Marston Louise , Morant Nicola , Fiori Federico , Santosh Paramala , Hassiotis Angela 
Published: December 2019

ObjectivesTo investigate the feasibility of delivering structured psychotropic medication review in community services for adults with intellectual disability (ID).DesignSingle-arm feasibility study conducted over a 6-month period.SettingSpecialist community ID teams in England.ParticipantsPsychiatrists working with adults with ID and adults with ID who had been prescribed psychotropic medication.InterventionA structured web-based psychotropic medication review tool (the HealthTracker-based structured medication review) comprising measures of therapeutic benefit and adverse side-effects was made available for use by psychiatrists in routine clinic appointments. A summary measure of medication effectiveness was graphically presented to aid discussion and decision-making.Main outcome measuresFeasibility metrics including number of people with ID referred, eligible and recruited, and uptake of the medication review tool in naturalistic clinical settings. Psychiatrist and patient feedback was collected to assess acceptability of the intervention and suggestions for development.ResultsFifteen psychiatrists from five clinical teams took part. In total 94 potentially eligible people with ID were referred, of whom 79 (84%) were recruited and together underwent 97 medication reviews over the 6-month study period. Feedback from participants with ID was favourable. Psychiatrists indicated that the HealthTracker-based structured medication review was broadly acceptable and suggested adaptations to improve integration with existing information technology systems and to enhance patient involvement in the review.ConclusionsStructured psychotropic medication review can be used in community services for adults with ID as part of a programme of medication optimisation. It would be feasible to test clinical and patient outcomes of the HealthTracker-based medication review in a randomised clinical trial.
Number needed to treat with ursodeoxycholic acid therapy to prevent liver transplantation or death in primary biliary cholangitis
Authors: Harms Maren H , de Veer Rozanne C , Lammers Willem J , Corpechot Christophe , Thorburn Douglas , Janssen Harry L A , Lindor Keith D , Trivedi Palak J , Hirschfield Gideon M , Pares Albert , Floreani Annarosa , Mayo Marlyn J , Invernizzi Pietro , Battezzati Pier Maria , Nevens Frederik , Ponsioen Cyriel Y , Mason Andrew L , Kowdley Kris V , Hansen Bettina E , Buuren Henk R van , van der Meer Adriaan J 
Published: December 2019

ObjectiveThe clinical benefit of ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC) has never been reported in absolute measures. The aim of this study was to assess the number needed to treat (NNT) with UDCA to prevent liver transplantation (LT) or death among patients with PBC.MethodsThe NNT was calculated based on the untreated LT-free survival and HR of UDCA with respect to LT or death as derived from inverse probability of treatment weighting-adjusted Cox proportional hazard analyses within the Global PBC Study Group database.ResultsWe included 3902 patients with a median follow-up of 7.8 (4.1–12.1) years. The overall HR of UDCA was 0.46 (95% CI 0.40 to 0.52) and the 5-year LT-free survival without UDCA was 81% (95% CI 79 to 82). The NNT to prevent one LT or death within 5 years (NNT5y) was 11 (95% CI 9 to 13). Although the HR of UDCA was similar for patients with and without cirrhosis (0.33 vs 0.31), the NNT5ywas 4 (95% CI 3 to 5) and 20 (95% CI 14 to 34), respectively. Among patients with low alkaline phosphatase (ALP) (≤2× the upper limit of normal (ULN)), intermediate ALP (2–4× ULN) and high ALP (>4× ULN), the NNT5yto prevent one LT or death was 26 (95% CI 15 to 70), 11 (95% CI 8 to 17) and 5 (95% CI 4 to 8), respectively.ConclusionThe absolute clinical efficacy of UDCA with respect to LT or death varied with baseline prognostic characteristics, but was high throughout. These findings strongly emphasise the incentive to promptly initiate UDCA treatment in all patients with PBC and may improve patient compliance.
Mechanism of action of HTX-011: a novel, extended-release, dual-acting local anesthetic formulation for postoperative pain
Authors: Ottoboni Thomas , Quart Barry , Pawasauskas Jayne , Dasta Joseph F , Pollak Richard A , Viscusi Eugene R 
Published: December 2019

Background and objectives
Obtaining consistent efficacy beyond 12–24 hours with local anesthetics, including extended-release formulations, has been a challenging goal. Inflammation resulting from surgery lowers the pH of affected tissues, reducing neuronal penetration of local anesthetics. HTX-011, an investigational, nonopioid, extended-release dual-acting local anesthetic combining bupivacaine and low-dose meloxicam, was developed to reduce postsurgical pain through 72 hours using novel extended-release polymer technology. Preclinical studies and a phase II clinical trial were conducted to confirm the mechanism of action of HTX-011.

Methods
In a validated postoperative pain pig model and a phase II bunionectomy trial, the analgesic effects of HTX-011, oral meloxicam (preclinical only), liposomal bupivacaine (preclinical only) and saline placebo were evaluated. The optimal meloxicam:bupivacaine ratio for HTX-011 and the effect of HTX-011 on incisional tissue pH were also evaluated preclinically.

Results
Preclinical data demonstrate the ability of HTX-011 to address local tissue inflammation as demonstrated by a less acidic tissue pH, which was associated with potentiated and prolonged analgesic activity. In the phase II bunionectomy study, HTX-011 achieved superior and sustained pain relief through 72 hours after surgery compared with each component in the polymer.

Conclusions
Preclinical animal and clinical results confirm that the low-dose meloxicam in HTX-011 normalizes the local pH in the incision, resulting in superior and synergistic analgesic activity compared with extended-release bupivacaine. HTX-011 represents an extended-release local anesthetic with a dual-acting mechanism of action that may provide an important advancement in the treatment of postoperative pain.

Trial registration number

NCT02762929
.
Arthritis, panuveitis and hyperaesthesia associated with Borrelia afzelii infection in a warmblood gelding
Authors: Sommerauer Sophia , Blohm Klaas‐Ole , Spergser Joachim , Buchner Heinz Hans Florian 
Published: December 2019

A 13‐year‐old warmblood gelding presented with a history of lameness, muscle atrophy and weight loss of 3 months. The horse demonstrated extensive hyperaesthesia over the left dorsal trunk, marked effusion of several joints, laryngitis and a dampened mental attitude. Synovial fluid analysis revealed arthritis of the left tarsocrural joint, being PCR‐positive for Borreliaafzelii DNA. Subsequently, mild anterior uveitis of the right and severe panuveitis of the left eye with B. afzelii PCR‐positive aqueous and vitreous humour, respectively, were diagnosed. Treatment included arthroscopy of the left tarsocrural joint, oral doxycycline administration for 6 weeks, ophthalmic and systemic anti‐inflammatory therapy and left intravitreal preservative‐free gentamicin (4 mg) injection. After initial improvement, the gelding’s clinical signs deteriorated resulting in peracute recumbency and sudden death 12 months later. Lyme borreliosis should be considered as differential diagnosis in complex cases of equine lameness, particularly when accompanied by hyperaesthesia and bilateral uveitis.