bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Consistent and Predictable Commercial Broiler Chicken Bacterial Microbiota in Antibiotic-Free Production Displays Strong Correlations with Performance
Authors: Johnson Timothy J. , Youmans Bonnie P. , Noll Sally , Cardona Carol , Evans Nicholas P. , Karnezos T. Peter , Ngunjiri John M. , Abundo Michael C. , Lee Chang-Won 
Published: April 2018

ABSTRACTDefining the baseline bacterial microbiome is critical to understanding its relationship with health and disease. In broiler chickens, the core microbiome and its possible relationships with health and disease have been difficult to define, due to high variability between birds and flocks. Presented here are data from a large, comprehensive microbiota-based study in commercial broilers. The primary goals of this study included understanding what constitutes the core bacterial microbiota in the broiler gastrointestinal, respiratory, and barn environments; how these core players change across age, geography, and time; and which bacterial taxa correlate with enhanced bird performance in antibiotic-free flocks. Using 2,309 samples from 37 different commercial flocks within a vertically integrated broiler system and metadata from these and an additional 512 flocks within that system, the baseline bacterial microbiota was defined using 16S rRNA gene sequencing. The effects of age, sample type, flock, and successive flock cycles were compared, and results indicate a consistent, predictable, age-dependent bacterial microbiota, irrespective of flock. The tracheal bacterial microbiota of broilers was comprehensively defined, andLactobacilluswas the dominant bacterial taxon in the trachea. Numerous bacterial taxa were identified, which were strongly correlated with broiler chicken performance across multiple tissues. While many positively correlated taxa were identified, negatively associated potential pathogens were also identified in the absence of clinical disease, indicating that subclinical dynamics occur that impact performance. Overall, this work provides necessary baseline data for the development of effective antibiotic alternatives, such as probiotics, for sustainable poultry production.IMPORTANCEMultidrug-resistant bacterial pathogens are perhaps the greatest medical challenge we will face in the 21st century and beyond. Antibiotics are necessary in animal production to treat disease. As such, animal production is a contributor to the problem of antibiotic resistance. Efforts are underway to reduce antibiotic use in animal production. However, we are also challenged to feed the world's increasing population, and sustainable meat production is paramount to providing a safe and quality protein source for human consumption. In the absence of antibiotics, alternative approaches are needed to maintain health and prevent disease, and probiotics have great promise as one such approach. This work paves the way for the development of alternative approaches to raising poultry by increasing our understandings of what defines the poultry microbiome and of how it can potentially be modulated to improve animal health and performance.
Characterization of the Trehalose Utilization Operon in Streptococcus mutans Reveals that the TreR Transcriptional Regulator Is Involved in Stress Response Pathways and Toxin Production
Authors: Baker J. L. , Lindsay E. L. , Faustoferri R. C. , To T. T. , Hendrickson E. L. , He X. , Shi W. , McLean J. S. , Quivey R. G. 
Published: April 2018

ABSTRACT

Streptococcus mutans
, the organism most frequently associated with the development of dental caries, is able to utilize a diverse array of carbohydrates for energy metabolism. One such molecule is trehalose, a disaccharide common in human foods, which has been recently implicated in enhancing the virulence of epidemic strains of the pathogen
Clostridium difficile
. In this study, mutants with deletions of all three genes in the putative
S. mutans
trehalose utilization operon were characterized, and the genes were shown to be required for wild-type levels of growth when trehalose was the only carbohydrate source provided. Interestingly, the TreR transcriptional regulator appeared to be critical for responding to oxidative stress and for mounting a protective stress tolerance response following growth at moderately acidic pH. mRNA sequencing (RNA-seq) of a
treR
deletion mutant suggested that in
S. mutans
, TreR acts as a trehalose-sensing activator of transcription of the
tre
operon, rather than as a repressor, as described in other species. In addition, deletion of
treR
caused the downregulation of a number of genes involved in genetic competence and bacteriocin production, supporting the results of a recent study linking trehalose and the
S. mutans
competence pathways. Finally, deletion of
treR
compromised the ability of
S. mutans
to inhibit the growth of the competing species
Streptococcus gordonii
and
Lactococcus lactis
. Taking the results together, this study solidifies the role of the
S. mutans tre
operon in trehalose utilization and suggests novel functions for the TreR regulator, including roles in the stress response and competitive fitness.

IMPORTANCE
S. mutans
is the primary etiologic agent of dental caries, which globally is the most common chronic disease.
S. mutans
must be able to outcompete commensal organisms in its dental plaque niche in order to establish persistence and pathogenesis. To that end,
S. mutans
metabolizes a diverse array of carbohydrates to generate acid and impede its acid-sensitive neighbors. Additionally,
S. mutans
utilizes quorum signaling through genetic competence-associated pathways to induce production of toxins to kill its rivals. This study definitively shows that the
S. mutans
trehalose utilization operon is required for growth in trehalose. Furthermore, this study suggests that the
S. mutans
TreR transcriptional regulator has a novel role in virulence through regulation of genes involved in genetic competence and toxin production.
Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost
Authors: Bansal Vivek , Mottalib Adham , Pawar Taranveer K , Abbasakoor Noormuhammad , Chuang Eunice , Chaudhry Abrar , Sakr Mahmoud , Gabbay Robert A , Hamdy Osama 
Published: April 2018

ObjectiveWe compared the cost-effectiveness of two inpatient diabetes care models: one offered by a specialized diabetes team (SDT) versus a primary service team (PST).Research design and methodsWe retrospectively evaluated 756 hospital admissions of patients with diabetes to non-critical care units over 6 months. Out of 392 patients who met the eligibility criteria, 262 were matched 1:1 based on the mean of the initial four blood glucose (BG) values after admission. Primary outcomes were 30-day readmission rate and frequency, hospital length of stay (LOS) and estimated hospital cost. Secondary outcomes included glycemic control and BG variability.ResultsDiabetes complexity and in-hospital complications were significantly higher among patients treated by SDT versus PST. Thirty-day readmission rate to medical services was lower by 30.5% in the SDT group versus the PST group (P<0.001), while 30-day readmission rate to surgical services was 5% higher in the SDT group versus the PST group (P<0.05), but frequency of 30-day readmissions was lower (1.1 vs 1.6 times, P<0.05). LOS in medical services was not different between the two groups, but it was significantly longer in surgical services in SDT (P<0.05). However, LOS was significantly lower in patients who were seen by SDT during the first 24 hours of admission compared with those who were seen after that (4.7 vs 6.1 days, P<0.001). Compliance to follow-up was higher in the SDT group. These changes were translated into considerable cost saving.ConclusionsInpatient diabetes management by an SDT significantly reduces 30-day readmission rate to medical services, reduces inpatient diabetes cost, and improves transition of care and adherence to follow-up. SDT consultation during the first 24 hours of admission was associated with a significantly shorter hospital LOS.
Acupuncture for stable angina pectoris: a systematic review protocol
Authors: Yang Mingxiao , Du Ting , Sun Mingsheng , Long Hulin , Li Dehua , Shen Zhifu , Wu Qiaofeng , Lao Lixing , Liang Fanrong 
Published: April 2018

IntroductionPrevious reviews indicate that the effect of acupuncture on stable angina pectoris (SAP) remains controversial. The results of trials published in the past 5 years may possibly change this situation, but an updated systematic review is not available. We therefore designed this study to systematically assess the efficacy and safety of acupuncture for treating SAP.Methods and analysisNine online databases will be searched without language or publication status restrictions from their inception to September 2017. Randomised controlled trials that include patients with stable angina receiving acupuncture therapy versus a control group will be deemed eligible. The selection of studies, data extraction and risk of bias assessment will be carried out by two independent reviewers. Data synthesis will be performed using RevMan V.5.3 software with either a fixed effects model or random effects model, depending on the heterogeneity test. Evidence quality will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. The efficacy–effectiveness spectrum for each included trial will be rated using the Rating of Included Trials on the Efficacy-effectiveness Spectrum tool. Outcomes of interest include the improvement of weekly angina attacks and reduction of nitroglycerin medication use after receiving acupuncture treatment, the incidence of cardiovascular events, heart rate variability, pain intensity measured on a visual analogue scale, total workload and exercise duration at peak exercise, safety and adverse events. A meta-analysis will be conducted if no considerable heterogeneity is detected. The results will be presented as risk ratios with 95% CIs for dichotomous data and weighted mean differences or standardised mean differences with 95% CIs for continuous data.Ethics and disseminationThis systematic review will not involve private information from individuals or endanger their rights, and therefore does not necessarily require ethical approval. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.Trial registration numberCRD42015016201.
British Thoracic Society Quality Standards for acute non-invasive ventilation in adults
Authors: Davies Michael , Allen Martin , Bentley Andrew , Bourke Stephen C , Creagh-Brown Ben , D’Oliveiro Rachel , Glossop Alastair , Gray Alasdair , Jacobs Phillip , Mahadeva Ravi , Moses Rachael , Setchfield Ian 
Published: April 2018

IntroductionThe purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice.MethodsDevelopment of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards.Results6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice.ConclusionBTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline’s recommendations.
Is recreational running associated with earlier delivery and lower birth weight in women who continue to run during pregnancy? An international retrospective cohort study of running habits of 1293 female runners during pregnancy
Authors: Kuhrt Katy , Harmon Mark , Hezelgrave Natasha L , Seed Paul T , Shennan Andrew H 
Published: April 2018

Background
Increasingly, women of reproductive age participate in recreational running, but its impact on pregnancy outcome is unknown. We investigated whether running affects gestational age at delivery and birth weight as indicators of cervical integrity and placental function, respectively.

Methods
1293 female participants were recruited from parkrun, which organises weekly runs involving 1.25 million runners across 450 parks worldwide. Those under 16 or unable to provide outcome data were excluded. Women were categorised according to whether they continued to run during pregnancy or not. Those who continued were further stratified dependent on average weekly kilometres, and which trimester they ran until. Retrospectively collected primary outcomes were gestational age at delivery and birthweight centile. Other outcomes included assisted vaginal delivery rate and prematurity at clinically important gestations.

Results
There was no significant difference in gestational age at delivery: 279.0 vs 279.6 days (mean difference 0.6 days, CI −1.3 to 2.4 days; P=0.55) or birthweight centile: 46.9%vs 44.9% (mean difference 2.0%, CI −1.3% to −5.3%; P=0.22) in women who stopped running and those who continued, respectively. Assisted vaginal delivery rate was increased in women who ran: 195/714 (27%) vs 128/579 (22%) (OR 1.32; CI 1.02 to 1.71; P=0.03).

Conclusion
Continuing to run during pregnancy does not appear to affect gestational age or birthweight centile, regardless of mean weekly distance or stage of pregnancy. Assisted vaginal delivery rates were higher in women who ran, possibly due to increased pelvic floor muscle tone. Randomised prospective analysis is necessary to further explore these findings.
Risk stratifying chest pain patients in the emergency department using HEART, GRACE and TIMI scores, with a single contemporary troponin result, to predict major adverse cardiac events
Authors: Reaney Peter D W , Elliott Hamish I , Noman Awsan , Cooper Jamie G 
Published: April 2018

BackgroundThe majority of patients presenting to the ED with cardiac sounding chest pain have a non-diagnostic ECG and the problem of differentiating those suffering an acute coronary syndrome from those without is familiar to all ED clinical staff. To stratify risk in these patients, specific scores have been developed. Recent work has focused on incorporating newer high-sensitivity cardiac troponin (hs-cTn) assays; however, issues regarding performance and availability of these assays remain.AimProspectively compare HEART, Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores, using a single contemporary cTn at admission, to predict a major adverse cardiac event (MACE) at 30 days.MethodProspective observational cohort study performed in a UK tertiary hospital in patients with suspected cardiac chest pain and no significant ST elevation on initial ECG. Data collection took place 2 December 2014 to 8 February 2016. The treating clinician recorded risk score data real time and a single contemporary cTn taken at presentation was used in score calculation. The primary endpoint was 30-day MACE. C-statistic was determined for each score and diagnostic characteristics of high-risk and low-risk cut-offs were calculated.Results189/1000 patients in the study developed a 30-day MACE. The c-statistic of HEART for 30-day MACE (0.87 (95% CI 0.84 to 0.90)) was higher than TIMI (0.78 (95% CI 0.74 to 0.81)) and GRACE (0.74 (95% CI 0.70 to 0.78)).HEART score ≤3 identified low-risk patients with sensitivity 99.5% (95% CI 97.1% to 99.9%) and negative predictive value (NPV) 99.6% (95% CI 97.3% to 99.9%) exceeding TIMI 0 (sensitivity 97.4% (95% CI 93.9% to 99.1%) and NPV 97.8% (95% CI 94.8% to 99.1%)) and GRACE score 0–55 (sensitivity 95.2% (95% CI 91.1% to 97.8%) and NPV 95.8% (95% CI 92.2% to 97.7%)).ConclusionHEART outperformed both TIMI and GRACE in overall discriminative capacity for 30-day MACE. Using a single contemporary cTn at presentation, a HEART score of ≤3 demonstrated sensitivity and NPV of ≥99.5% for 30-day MACE. These results reach the threshold for a safe discharge strategy but should be interpreted thoughtfully in light of other work.
Estimated individual lifetime benefit from PCSK9 inhibition in statin-treated patients with coronary artery disease
Authors: Kaasenbrood Lotte , Ray Kausik K , Boekholdt S Matthijs , Smulders Yvo M , LaRosa John C , Kastelein John J P , van der Graaf Yolanda , Dorresteijn Johannes A N , Visseren Frank L J 
Published: April 2018

ObjectiveIn statin-treated patients with stable coronary artery disease (CAD), residual risk of cardiovascular events is partly explained by plasma levels of low-density lipoprotein cholesterol (LDL-C). This study aimed to estimate individual benefit of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition in CAD patients already treated with high-dose statin.MethodsIndividual lifetime benefit was estimated in months gain free of stroke or myocardial infarction (MI) until age 80 years. Predictions were based on two competing risk models developed in data from 4853 patients with CAD originating from the atorvastatin 80 mg arm of the Treating to New Targets (TNT) trial. The relative effect of PCSK9 inhibition was added to the models and was assumed based on average estimates from large clinical trials. We accounted for individual LDL-C levels, assuming 50% LDL-C reduction by PCSK9 inhibition and 21% cardiovascular risk reduction per mmol/L (39 mg/dL) LDL-C lowering.ResultsEstimated individual gain was <6 months in 61% of the patients, 6–12 months in 28% of the patients and ≥12 months in 10% of the patients (median 5, quartiles 2–8 months). Highest estimated benefit was observed in younger patients (aged 40–60 years) with high risk factor burden, particularly if LDL-C levels were >1.8 mmol/L (>70 mg/dL). Estimated benefit was lowest (≤5 months) in older patients (≥70 years), in particular if LDL-C and other risk factors levels were low.ConclusionThe individual estimated lifetime benefit from PCSK9 inhibition in patients with stable CAD on high-dose statin varied from <6 to ≥12 months free of stroke or MI. Highest benefit is expected in younger patients (age 40–60 years) with high risk factor burden and relatively high LDL-C levels.Trial registration numberNCT00327691; Post-results
GP perceptions of the adequacy of community-based care for patients with advanced heart failure in a UK region (NI): a qualitative study
Authors: Chen Jingwen Jessica , Gamble Kathryn , Graham-Wisener Lisa , McGlade Kieran , Doherty Jennifer , Donnelly Patrick , Stone Carol A 
Published: April 2018

ObjectiveTo assess the adequacy of community-based services available in Northern Ireland (NI) and to meet the multidimensional needs of patients living with New York Heart Association Stage III and IV heart failure (HF), as experienced and perceived by general practitioners (GP).MethodsSemistructured interviews were conducted with GPs recruited via the University Department of General Practice and Northern Ireland Medical and Dental Agency. Interviews were transcribed, independently coded and analysed using a six-step thematic analysis approach.ResultsTwenty semistructured interviews were conducted. GPs reported managing patients in a ‘reactive rather than proactive’ way, responding only to acute medical needs, with hospital admission the default option due to lack of community-based expertise and services. Care provided by HF specialists was highly regarded but ‘access and coordination’ were lacking, related to inequity of access to Heart Failure Nursing Teams, lack of access to specialist advice and inadequate handover of information to GPs. Conversations regarding current and future care needs and preferences were important, but GPs described ‘neglecting conversations with the patient’, due to time constraints, prognostic uncertainty and fear of causing distress. They expressed the view that ‘specialist palliative care (SPC) is only a credible option in end stages’ related to limited understanding of the scope of SPC, a perception that timing of referral must depend on prognosis and concern that SPC services are cancer-focused.ConclusionsDespite the extensive body of research which evidences the unmet multidimensional needs of patients with advanced HF, and more recent evidence for the effectiveness of integrated SPC in improving quality of life for patients with HF, health and social care services within NI have not adapted to assess and meet these needs.
Measuring Efficiency of Hospitals by DEA: An Empirical Evidence from Pakistan
Authors: Rasool Syed Aziz , Saboor Abdul , Raashid Muhammad 
Published: April 2018

<p><strong><span style="text-decoration: underline;">ABSTRACT</span></strong></p> <p>There has been increasing focus on efficiency measurement in health sector around the world. This empirical study aims at measuring efficiency level of non-profit private organization by using Data Envelopment Analysis (DEA) in the health sector of Pakistan. DEA is non-parametric linear programming based approach for homogeneous decision making units. Layton Rehmatullah Benevolent Trust (non-profit private organization) will be subject matter for investigational analysis constituting over 16 sub-units spreading across the country. Secondary data of number of patient beds, specialists and nurses in all the 16 branches of LRBT hospitals will be used applying quantitative specification tool, both scale and technical efficiency levels in an environment where multiple of inputs and outputs are in place, will be used for final evaluation. The outcomes so expected will help policy makers to formulate effective plans and programs in order to enhance the efficiency of health measures conducted by non- profit private organizations.</p><p> </p>
The Formulation of High-Calorie and Rich-Fe Biscuits for Pregnant Women with Chronic Energy Malnutrition
Authors: Sunarti Sunarti , Hanim Diffah , Ahda Mustofa , Kusnandar Kusnandar 
Published: April 2018

Supplementary food distribution for pregnant women still depends on the local policy. This program is funded using Health Operational Funds and distributed in form of milk, eggs, raw materials such as green beans and others. The field constraints of this program were acceptability and willingness of pregnant women to process the raw materials. This study aims to address the problems of providing supplementary food for pregnant women who suffer from chronic energy malnutrition and anemia by making the formulation of high protein biscuits and Fe using soybean flour substitution catfish eggs and flour as a source of protein and Fe. Biscuits produced is expected to be one of the snacks and nutritions for women who suffer from chronic energy deficeincy. The ingredients were flour, fish powder, soy flour, eggs, milk powder, sugar, and maize flour. The method used was pure experimental approach completely randomized design with three times repetition. The formulation of the biscuits proportion between fish and soy flour as much as 2:1, 1:1, and 1:2. Proximate test shows that the proportion of fish and soy flour 1:2 has the highest energy value (496.81 kcal) with a value of 17.74% protein. Organoleptic test indicates that the most favorable taste and tekstur was the formulation with the proportion of fish flour and soy flour 1:2. The formulation of high protein and Fe biscuits for women with chronic energy malnutrition and anemia in Boyolali favoured by third trisemester pregnant women is the one with the proportion of 1:2.