bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic-Induced Alterations of the Murine Gut Microbiota and Subsequent Effects on Colonization Resistance against Clostridium difficile
Authors: Schubert Alyxandria M. , Sinani Hamide , Schloss Patrick D. 
Published: July 2015

ABSTRACTPerturbations to the gut microbiota can result in a loss of colonization resistance against gastrointestinal pathogens such asClostridium difficile. AlthoughC. difficileinfection is commonly associated with antibiotic use, the precise alterations to the microbiota associated with this loss in function are unknown. We used a variety of antibiotic perturbations to generate a diverse array of gut microbiota structures, which were then challenged withC. difficilespores. Across these treatments we observed thatC. difficileresistance was never attributable to a single organism, but rather it was the result of multiple microbiota members interacting in a context-dependent manner. Using relative abundance data, we built a machine learning regression model to predict the levels ofC. difficilethat were found 24 h after challenging the perturbed communities. This model was able to explain 77.2% of the variation in the observed number ofC. difficileper gram of feces. This model revealed important bacterial populations within the microbiota, which correlation analysis alone did not detect. Specifically, we observed that populations associated with thePorphyromonadaceae,Lachnospiraceae,Lactobacillus, andAlistipeswere protective and populations associated withEscherichiaandStreptococcuswere associated with high levels of colonization. In addition, a population affiliated with theAkkermansiaindicated a strong context dependency on other members of the microbiota. Together, these results indicate that individual bacterial populations do not drive colonization resistance toC. difficile. Rather, multiple diverse assemblages act in concert to mediate colonization resistance.IMPORTANCEThe gastrointestinal tract harbors a complex community of bacteria, known as the microbiota, which plays an integral role preventing its colonization by gut pathogens. This resistance has been shown to be crucial for protection againstClostridium difficileinfections (CDI), which are the leading source of hospital-acquired infections in the United States. Antibiotics are a major risk factor for acquiring CDI due to their effect on the normal structure of the indigenous gut microbiota. We found that diverse antibiotic perturbations gave rise to altered communities that varied in their susceptibility toC. difficilecolonization. We found that multiple coexisting populations, not one specific population of bacteria, conferred resistance. By understanding the relationships betweenC. difficileand members of the microbiota, it will be possible to better manage this important infection.
Early mobilisation versus plaster immobilisation of simple elbow dislocations: results of the FuncSiE multicentre randomised clinical trial
Authors: Iordens Gijs I T , Van Lieshout Esther M M , Schep Niels W L , De Haan Jeroen , Tuinebreijer Wim E , Eygendaal Denise , Van Beeck Ed , Patka Peter , Verhofstad Michael H J , Den Hartog Dennis 
Published: July 2015

Background/aimTo compare outcome of early mobilisation and plaster immobilisation in patients with a simple elbow dislocation. We hypothesised that early mobilisation would result in earlier functional recovery.MethodsFrom August 2009 to September 2012, 100 adult patients with a simple elbow dislocation were enrolled in this multicentre randomised controlled trial. Patients were randomised to early mobilisation (n=48) or 3 weeks plaster immobilisation (n=52). Primary outcome measure was theQuickDisabilities of the Arm, Shoulder, and Hand (Quick-DASH) score. Secondary outcomes were the Oxford Elbow Score, Mayo Elbow Performance Index, pain, range of motion, complications and activity resumption. Patients were followed for 1 year.ResultsQuick-DASH scores at 1 year were 4.0 (95% CI 0.9 to 7.1) points in the early mobilisation group versus 4.2 (95% CI 1.2 to 7.2) in the plaster immobilisation group. At 6 weeks, early mobilised patients reported less disability (Quick-DASH 12 (95% CI 9 to 15) points vs 19 (95% CI 16 to 22); p<0.05) and had a larger arc of flexion and extension (121° (95% CI 115° to 127°) vs 102° (95% CI 96° to 108°); p<0.05). Patients returned to work sooner after early mobilisation (10 vs 18 days; p=0.020). Complications occurred in 12 patients; this was unrelated to treatment. No recurrent dislocations occurred.ConclusionsEarly active mobilisation is a safe and effective treatment for simple elbow dislocations. Patients recovered faster and returned to work earlier without increasing the complication rate. No evidence was found supporting treatment benefit at 1 year.Trial registration numberNTR 2025.
Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis
Authors: Lack Simon , Barton Christian , Sohan Oliver , Crossley Kay , Morrissey Dylan 
Published: July 2015

BackgroundProximal muscle rehabilitation is commonly prescribed to address muscle strength and function deficits in individuals with patellofemoral pain (PFP). This review (1) evaluates the efficacy of proximal musculature rehabilitation for patients with PFP; (2) compares the efficacy of various rehabilitation protocols; and (3) identifies potential biomechanical mechanisms of effect in order to optimise outcomes from proximal rehabilitation in this problematic patient group.MethodsWeb of Knowledge, CINAHL, EMBASE and Medline databases were searched in December 2014 for randomised clinical trials and cohort studies evaluating proximal rehabilitation for PFP. Quality assessment was performed by two independent reviewers. Effect size calculations using standard mean differences and 95% CIs were calculated for each comparison.Results14 studies were identified, seven of high quality. Strong evidence indicated proximal combined with quadriceps rehabilitation decreased pain and improved function in the short term, with moderate evidence for medium-term outcomes. Moderate evidence indicated that proximal when compared with quadriceps rehabilitation decreased pain in the short-term and medium-term, and improved function in the medium term. Limited evidence indicated proximal combined with quadriceps rehabilitation decreased pain more than quadriceps rehabilitation in the long term. Very limited short-term mechanistic evidence indicated proximal rehabilitation compared with no intervention decreased pain, improved function, increased isometric hip strength and decreased knee valgum variability while running.ConclusionsA robust body of work shows proximal rehabilitation for PFP should be included in conservative management. Importantly, greater pain reduction and improved function at 1 year highlight the long-term value of proximal combined with quadriceps rehabilitation for PFP.
Epidemiology of HEV in the Mediterranean basin: 10-year prevalence in Italy
Authors: Lanini Simone , Garbuglia Anna Rosa , Lapa Daniele , Puro Vincenzo , Navarra Assunta , Pergola Catia , Ippolito Giuseppe , Capobianchi Maria Rosaria 
Published: July 2015

ObjectivesThe present study is aimed at describing the seroprevalence and exploring potential risk factor(s) for hepatitis E virus (HEV) in participants who voluntarily underwent anti-HIV antibody testing.Study designSeroprevalence study.SettingThe HIV prevention unit at the National Institute for Infectious Diseases Lazzaro Spallanzani, serving as a referral centre for HIV infection in Lazio, an Italian Region with about 5.6 million inhabitants.ParticipantsParticipants are a random sample of all subjects who receive counselling and undergo serological tests for anti-HIV antibody (Ab) between 2002 and 2011.Risk factors and outcomeA set of 16 epidemiological variables (risk factors) were assessed for association with positivity to anti-HEV IgG (outcome).ResultsBetween 2002 and 2011, 27 351 serum specimens and related epidemiological information were collected; of these 1116 were randomly selected and analysed. The overall anti-HEV IgG prevalence was 5.38% (60 out of 1116) with evidence of potential heterogeneity between years of sampling (p=0.055). Multivariate analysis provided evidence that anti-HEV IgG prevalence increases by 4% per year of participants’ age (95% CI 1% to 7%, p=0.002). In addition, men who have sex with men and participants who were born outside Italy have an OR for past HEV infection that is about two times higher than in those who were not (p=0.040 and p=0.027, respectively). Analysis of temporal trend showed that variation of anti-HEV IgG can be well explained by a cubic logistic regression model, which describes the variation of prevalence over time as a fluctuation within a 3-year period (p=0.032).ConclusionsThis study provides new evidence that besides the orofecal and zoonotic routes, intimate contacts between males may be a significant mode of HEV transmission.
Barriers to uptake among high-risk individuals declining participation in lung cancer screening: a mixed methods analysis of the UK Lung Cancer Screening (UKLS) trial
Authors: Ali Noor , Lifford Kate J , Carter Ben , McRonald Fiona , Yadegarfar Ghasem , Baldwin David R , Weller David , Hansell David M , Duffy Stephen W , Field John K , Brain Kate 
Published: July 2015

ObjectiveThe current study aimed to identify the barriers to participation among high-risk individuals in the UK Lung Cancer Screening (UKLS) pilot trial.SettingThe UKLS pilot trial is a randomised controlled trial of low-dose CT (LDCT) screening that has recruited high-risk people using a population approach in the Cambridge and Liverpool areas.ParticipantsHigh-risk individuals aged 50–75 years were invited to participate in UKLS. Individuals were excluded if a LDCT scan was performed within the last year, if they were unable to provide consent, or if LDCT screening was unable to be carried out due to coexisting comorbidities.Outcome measuresStatistical associations between individual characteristics and UKLS uptake were examined using multivariable regression modelling. In those who completed a non-participation questionnaire (NPQ), thematic analysis of free-text data was undertaken to identify reasons for not taking part, with subsequent exploratory linkage of key themes to risk factors for non-uptake.ResultsComparative data were available from 4061 high-risk individuals who consented to participate in the trial and 2756 who declined participation. Of those declining participation, 748 (27.1%) completed a NPQ. Factors associated with non-uptake included: female gender (OR=0.64, p<0.001), older age (OR=0.73, p<0.001), current smoking (OR=0.70, p<0.001), lower socioeconomic group (OR=0.56, p<0.001) and higher affective risk perception (OR=0.52, p<0.001). Among non-participants who provided a reason, two main themes emerged reflecting practical and emotional barriers. Smokers were more likely to report emotional barriers to participation.ConclusionsA profile of risk factors for non-participation in lung screening has emerged, with underlying reasons largely relating to practical and emotional barriers. Strategies for engaging high-risk, hard-to-reach groups are critical for the equitable uptake of a potential future lung cancer screening programme.Trial registration numberThe UKLS trial was registered with the International Standard Randomised Controlled Trial Register under the reference 78513845.
Improving the quality of handover by addressing handover culture and introducing a new, multi-disciplinary, team-based handover meeting
Authors: Walton Henry , Munro Wendy 
Published: July 2015

AbstractHandover is a "major preventable cause of patient harm"[1] and this project aims to improve the quality of night handover within a teaching hospitals general medicine department, resulting in the safe transfer of patient care to the night team.Quality of handover was assessed both qualitatively, via structured qualitative interviews with trainees and a baseline survey assessing doctor's opinions of night handover, and quantitatively through the collection of a data set during regular observation of night handover.The initial intervention instituted a new handover meeting with a set time and new location and invited the night nurse practitioner to attend. A prompt card, standardised documentation, defined leadership, and an attendance register were also introduced. Successive PDSA cycles introduced technology to the intervention, enabled the nurse night practitioners to actually attend and re-branded the prompt card as an agenda.Results show a sustained reduction in length of handover from 70 minutes (n=7) to 34 minutes (n=13) post-intervention as well as a reduction in the number of distractions occurring during each handover from a mean of 14 to a mean of 8.5. An improved quality of handover was also demonstrated with an overall increase in the percentage of task handovers containing hospital number, an admitting diagnosis, comorbidities and a time allocated for the task to be performed of at least 10%. When trainees were surveyed post-implementation they unanimously identified the new handover system as safer than the previous handover process (n=30).This project demonstrates that replacing an ad-hoc system of handover with a multi-disciplinary, team based approach to handover improves handover quality. In addition it provides a useful guide to introducing a new handover meeting to a department and contains useful lessons on how to combat cultural barriers to change within a department.
The missing complexity in seismically imaged normal faults: what are the implications for geometry and production response?
Authors: Wood Alan M. , Paton Douglas A. , Collier Richard E. Ll. 
Published: July 2015

Abstract
The impact of geometric uncertainty on across-fault flow behaviour at the scale of individual intra-reservoir faults is investigated in this study. A high resolution digital elevation model (DEM) of a faulted outcrop is used to construct an outcrop-scale geocellular grid capturing high-resolution fault geometries (5 m scale). Seismic forward modelling of this grid allows generation of a 3D synthetic seismic cube, which reveals the corresponding seismically resolvable fault geometries (12.5 m scale). Construction of a second geocellular model, based upon the seismically resolvable fault geometries, allows comparison with the original outcrop geometries. Running fluid flow simulations across both models enables us to assess quantitatively the impact of outcrop resolution v. seismic resolution fault geometries upon across-fault flow. The results suggest that seismically resolvable fault geometries significantly underestimate the area of across-fault juxtaposition relative to realistic fault geometries. In turn this leads to overestimates in the sealing ability of faults, and inaccurate calculation of fault plane properties such as transmissibility multipliers (TMs).
Atrial Fibrillation Burden and Short-Term Risk of Stroke
Authors: Turakhia Mintu P. , Ziegler Paul D. , Schmitt Susan K. , Chang Yuchiao , Fan Jun , Than Claire T. , Keung Edmund K. , Singer Daniel E. 
Published: July 2015

Background—
The temporal relationship of atrial fibrillation (AF) and stroke risk is controversial. We evaluated this relationship via a case-crossover analysis of ischemic strokes in a large cohort of patients with cardiac implantable electronic devices.

Methods and Results—
We identified 9850 patients with cardiac implantable electronic devices remotely monitored in the Veterans Administration Health Care System between 2002 and 2012. There were 187 patients with acute ischemic stroke and continuous heart rhythm monitoring for 120 days before the stroke (age, 69±8.4 years; 98% with an implantable defibrillator). We compared each patient’s daily AF burden in the 30 days before stroke (case period) with their AF burden during days 91 to 120 pre stroke (control period). Defining positive AF burden as ≥5.5 hours of AF on any given day, 156 patients (83%) had no positive AF burden in both periods and, in fact, had little to no AF; 15 (8%) patients had positive AF burden in both periods. Among the discordant (informative) patients, 13 exceeded 5.5 hours of AF in the case period but not in the control period, whereas 3 had positive AF burden in the control but not in the case period (warfarin-adjusted odds ratio for stroke, 4.2; 95% confidence interval, 1.5–13.4). Odds ratio for stroke was highest (17.4; 95% confidence interval, 5.39–73.1) in the 5 days immediately after a qualifying occurrence of AF and decreased toward 1.0 as the period after the AF occurrence increased beyond 30 days.

Conclusions—
In this population with continuous heart rhythm recording, multiple hours of AF had a strong but transient effect raising stroke risk.
Preclinical Systolic and Diastolic Dysfunctions in Metabolically Healthy and Unhealthy Obese Individuals
Authors: Wang Yi-Chih , Liang Chang-seng , Gopal Deepa M. , Ayalon Nir , Donohue Courtney , Santhanakrishnan Rajalakshmi , Sandhu Harpaul , Perez Alejandro J. , Downing Jill , Gokce Noyan , Colucci Wilson S. , Ho Jennifer E. 
Published: July 2015

Background—
Despite the substantial overlap of obesity and metabolic disease, there is heterogeneity with respect to cardiovascular risk. We sought to investigate preclinical differences in systolic and diastolic function in obesity, and specifically compare obese individuals with and without metabolic syndrome (MS).

Methods and Results—

Obese individuals without cardiac disease with (OB/MS+, n=124) and without (OB/MS−, n=37) MS were compared with nonobese controls (n=29). Diastolic function was assessed by transmitral and tissue Doppler. Global longitudinal strain (LS) and time-based dyssynchrony were assessed by speckle tracking. Both OB/MS− and OB/MS+ groups had similar ejection fraction but worse systolic mechanics as assessed by LS and dyssynchrony when compared with nonobese controls. Specifically, OB/MS− had 2.5% lower LS (SE, 0.7%;
P
=0.001 in multivariable-adjusted analyses) and 10.8 ms greater dyssynchrony (SE, 3.3 ms;
P
=0.002), and OB/MS+ had 1.0% lower LS (SE, 0.3%;
P
<0.001) and 7.8 ms greater dyssynchrony (SE, 1.5 ms;
P
<0.001) when compared with controls. Obesity was associated with impaired diastolic function regardless of MS status, as evidenced by greater left atrial diameter and left ventricular mass although diastolic dysfunction was more pronounced in OB/MS+ than in OB/MS− individuals.

Conclusions—
Obesity is associated with subclinical differences in both systolic and diastolic function regardless of the presence or absence of MS although MS seems to be associated with worse diastolic dysfunction. When compared with controls, metabolically healthy obese had lower LS, greater dyssynchrony, and early diastolic dysfunction, supporting the notion that obesity per se may have adverse cardiovascular effects regardless of metabolic disease.
Is Aspiration Thrombectomy Beneficial in Patients Undergoing Primary Percutaneous Coronary Intervention?
Authors: Elgendy Islam Y. , Huo Tianyao , Bhatt Deepak L. , Bavry Anthony A. 
Published: July 2015

Background—
It is unclear whether intravenous glycoprotein IIb/IIIa inhibitors or ischemic time might modify any clinical benefits observed with aspiration thrombectomy before primary percutaneous coronary intervention (PCI) in patients with ST-segment–elevation myocardial infarction.

Methods and Results—

Electronic databases were searched for trials that randomized ST-segment–elevation myocardial infarction patients to aspiration thrombectomy before PCI versus conventional PCI. Summary estimates were constructed using a DerSimonian-Laird model. Seventeen trials with 20 960 patients were available for analysis. When compared with conventional PCI, aspiration thrombectomy was not associated with a significant reduction in the risk of mortality 2.8% versus 3.2% (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.76–1.04;
P
=0.13), reinfarction 1.3% versus 1.4% (RR, 0.93; 95% CI, 0.73–1.17;
P
=0.52), the combined outcome of mortality or reinfarction 4.1% versus 4.6% (RR, 0.90; 95% CI, 0.79–1.02;
P
=0.11), or stent thrombosis 0.9% versus 1.2% (RR, 0.82; 95% CI, 0.62–1.08;
P
=0.15). Aspiration thrombectomy was associated with a nonsignificant increase in the risk of stroke 0.6% versus 0.4% (RR, 1.45; 95% CI, 0.96–2.21;
P
=0.08). Meta-regression analysis did not identify a difference for the log RR of mortality, reinfarction, and the combined outcome of mortality or reinfarction with intravenous glycoprotein IIb/IIIa inhibitors (
P
=0.17, 0.70, and 0.50, respectively) or with ischemic time (
P
=0.29, 0.66, and 0.58, respectively).

Conclusions—
Aspiration thrombectomy before primary PCI is not associated with any benefit on clinical end points and might increase the risk of stroke. Concomitant administration of intravenous glycoprotein IIb/IIIa inhibitors and ischemic time did not seem to influence any potential benefits observed with aspiration thrombectomy.
Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART)
Authors: Redfors Björn , Angerås Oskar , Råmunddal Truls , Petursson Petur , Haraldsson Inger , Dworeck Christian , Odenstedt Jacob , Ioaness Dan , Ravn‐Fischer Annika , Wellin Peder , Sjöland Helen , Tokgozoglu Lale , Tygesen Hans , Frick Erik , Roupe Rickard , Albertsson Per , Omerovic Elmir 
Published: July 2015

Background
Cardiovascular disease is the most common cause of death for both genders. Debates are ongoing as to whether gender‐specific differences in clinical course, diagnosis, and management of acute myocardial infarction (MI) exist.

Methods and Results

We compared all men and women who were treated for acute MI at cardiac care units in Västra Götaland, Sweden, between January 1995 and October 2014 by obtaining data from the prospective SWEDEHEART (Swedish Web‐System for Enhancement of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. We performed unadjusted and adjusted Cox proportional hazards and logistic regression analyses on complete case data and on imputed data sets. Overall, 48 118 patients (35.4% women) were diagnosed with acute MI. Women as a group had better age‐adjusted prognosis than men, but this survival benefit was absent for younger women (aged <60 years) and for women with ST‐segment elevation MI. Compared with men, younger women and women with ST‐segment elevation MI were more likely to develop prehospital cardiogenic shock (adjusted odds ratio 1.67, 95% CI 1.30 to 2.16,
P
<0.001 and adjusted odds ratio 1.31, 95% CI 1.16 to 1.48,
P
<0.001) and were less likely to be prescribed evidence‐based treatment at discharge (
P
<0.001 for β‐blockers, angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, statins, and P2Y
12
antagonists). Differences in treatment between the genders did not decrease over the study period (
P
>0.1 for all treatments).

Conclusions
Women on average have better adjusted prognosis than men after acute MI; however, younger women and women with ST‐segment elevation MI have disproportionately poor prognosis and are less likely to be prescribed evidence‐based treatment.