Results Results indicated that all three groups had comparable outcomes. However, usage was generally low (less than 10% of the program) and SC usage accounted for less than 1% of the variance in outcome. Conclusions These results suggest that internet-delivered therapy may be a viable alternative to in-person therapy.Background A major goal of hospice care is to provide individually tailored emotional and spiritual support to caregivers of hospice patients. Objectives Examine the association between reported emotional support and caregivers' overall rating of hospice care, overall and by race/ethnicity/language. Subjects We analyzed survey data corresponding to 657,805 decedents/caregivers who received care from 3160 hospice programs during January 2017-December 2018. Measurements Linear regression models examined the association between caregiver-reported receipt of emotional and spiritual support ("too little" vs. https://www.selleckchem.com/products/ver155008.html "right amount" vs. "too much") and overall rating of the hospice (0 vs. 100 rating). Interaction terms assessed variation in this association by race/ethnicity/language. Results "Too much" emotional support was less common than "too little," except for caregivers of Hispanic decedents responding in Spanish. "Too little" support was strongly associated with lower hospice ratings for all groups (compared to "right amount" of support, p  less then  0.001). In contrast, the negative association between "too much" support and hospice rating was much smaller (p  less then  0.001) among caregivers of white and black decedents. "Too much" support was associated with more positive ratings among caregivers of Hispanic decedents (p  less then  0.001). Conclusions Receipt of "too much" support is a less common and much weaker driver of poor hospice ratings than receipt of "too little" support for all groups, and is not always viewed negatively. This suggests that for hospice evaluation, "too much" support should not be scored equivalently to "too little" support and that providing enough support should be a hospice priority.Background Giant inguinal hernia (GIH) is a rare disease but it can cause serious complications, such as intestinal obstruction and strangulation. Few studies have explored surgical treatment with respect to the transabdominal preperitoneal (TAPP) approach or measures to reduce the occurrence of postoperative seroma. Purpose To investigate the safety and efficacy of the TAPP approach with negative pressure drainage in GIHs. Methods From January 2017 to December 2019, 32 patients who underwent TAPP procedures with negative pressure drainage for GIHs at our hospital were reviewed. Demographic information, surgical characteristics, and follow-up data were obtained. Results The mean age of the patients was 66, and more than half of them had medical comorbidities. All GIHs were defined as Type 1 and were successfully repaired through the TAPP approach with negative pressure drainage. The mean operative time was 146 minutes (range 122-251). After surgery, the mean drainage time was 7 days (range 5-10 days), and the mean volume of drainage in each patient was 820 mL (range 655-1020 mL). Complications occurred in 3 cases. For 1 case, the inferior epigastric artery was injured during surgery. A seroma was observed in 1 patient, which occurred 2 days after removal of the drainage tube. Finally, 1 patient developed an umbilical puncture site infection, and the wound healed after changing the dressing. The mean follow-up was 13 months (range 1-32), and there was no recurrence or mesh infection during that time. Conclusion TAPP is a safe and effective approach for treating Type 1 GIHs with low operative complications. Negative pressure drainage through the scrotum to the preperitoneal space may reduce the incidence of seroma. Recurrence of hernias was not observed, and chronic pain seldom occurred during the follow-up period in our study. To perform a cross-sectional survey to estimate prevalence of and potential risk factors for spp infection and exposure in peri-urban wildlife throughout California. 723 animals representing 12 wildlife species. Blood and urine samples were obtained from wildlife in California from 2007 to 2017. Live animals were captured in humane traps, anesthetized, and released. Carcasses were donated by wildlife services and necropsied for urine, blood, and kidney tissue samples. Samples were tested for antibodies against 6 serovars of spp with a microscopic agglutination test and for pathogenic spp DNA with a real-time PCR assay targeting the gene. Potential risk factors for spp exposure were assessed by logistic regression. Genetic relatedness of spp were assessed with DNA sequencing of the gene and multiple locus sequence analysis. Statewide spp seroprevalence was 39.1%, and prevalence of positive PCR assay results for spp DNA was 23.0%. Risk factors for spp exposure included being an adult, being from northern California, and being a western gray squirrel, coyote, striped skunk, raccoon, gray fox, or mountain lion. Antibodies against serovar Pomona predominated in most species, followed by serovar Copenhageni. Complete sequences were identified as and multiple locus sequence type analysis revealed sequence type 140. Pathogenic spp appeared to be common and widespread among peri-urban wildlife in California. Our data highlight the potential for exposure to infectious disease for both humans and domestic animals at the urban-wildland interface. Pathogenic Leptospira spp appeared to be common and widespread among peri-urban wildlife in California. Our data highlight the potential for exposure to infectious disease for both humans and domestic animals at the urban-wildland interface. To evaluate SC administration of 2 sedation protocols, ketamine-midazolam (KM) and alfaxalone-midazolam (AM), in African pygmy hedgehogs ( ). 9 healthy adult hedgehogs (5 males, 4 females). A randomized, blinded, complete crossover study was performed. Sedation was induced by SC administration of either ketamine (30 mg/kg [14 mg/lb]) with midazolam (1 mg/kg [0.45 mg/lb]) or alfaxalone (3 mg/kg [1.4 mg/lb]) with midazolam (1 mg/kg), including a 2-week washout period between treatments. Flumazenil (0.05 mg/kg [0.02 mg/lb], SC) was administered 45 minutes after administration of either protocol to reverse the effects of midazolam. Physiologic variables, reflexes, and behaviors were monitored. Food intake and body weight were measured before and after sedation. Deep sedation characterized by complete loss of the righting reflex, decreased jaw tone, decreased pelvic limb withdrawal reflex, and preservation of the palpebral reflex was produced in 7 of 9 hedgehogs after KM administration and all 9 hedgehogs after AM administration.