bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Gentamicin Gut Decontamination for Prevention of KPC-Producing Klebsiella pneumoniae Infections: Relevance of Concomitant Systemic Antibiotic Therapy
Authors: Tascini Carlo , Sbrana Francesco , Flammini Sarah , Tagliaferri Enrico , Arena Fabio , Leonildi Alessandro , Ciullo Ilaria , Amadori Francesco , Di Paolo Antonello , Ripoli Andrea , Lewis Russell , Rossolini Gian Maria , Menichetti Francesco 
Published: January 2014

ABSTRACT

Gut colonization represents the main source for KPC-producing
Klebsiella pneumoniae
(KPC-Kp) epidemic dissemination. Oral gentamicin, 80 mg four times daily, was administered to 50 consecutive patients with gut colonization by gentamicin-susceptible KPC-Kp in cases of planned surgery, major medical intervention, or need for patient transfer. The overall decontamination rate was 68% (34/50). The median duration of gentamicin treatment was 9 days (interquartile range, 7 to 15 days) in decontaminated patients compared to 24 days (interquartile range, 20 to 30 days) in those with persistent colonization (
P
< 0.001). In the six-month period of follow-up, KPC-Kp infections were documented in 5/34 (15%) successfully decontaminated patients compared to 12/16 (73%) persistent carriers (
P
< 0.001). The decontamination rate was 96% (22/23) in patients receiving oral gentamicin only, compared to 44% (12/27) of those treated with oral gentamicin and concomitant systemic antibiotic therapy (CSAT) (
P
< 0.001). The multivariate analysis confirmed CSAT and KPC-Kp infection as the variables associated with gut decontamination. In the follow-up period, KPC-Kp infections were documented in 2/23 (9%) of patients treated with oral gentamicin only and in 15/27 (56%) of those also receiving CSAT (
P
= 0.003). No difference in overall death rate between different groups was documented. Gentamicin-resistant KPC-Kp strains were isolated from stools of 4/16 persistent carriers. Peak gentamicin blood levels were below 1 mg/liter in 12/14 tested patients. Oral gentamicin was shown to be potentially useful for gut decontamination and prevention of infection due to KPC-Kp, especially in patients not receiving CSAT. The risk of emergence of gentamicin-resistant KPC-Kp should be considered.
Acute Alcohol Intoxication Impairs Methicillin-Resistant Staphylococcus aureus Clearance in the Lung by Impeding Epithelial Production of Reg3γ
Authors: Choi Sun-Mi , McAleer Jeremy P. , Trevejo-Nunez Giraldina , Pociask Derek A. , Armentrout Rachel A. , Chen Kong , Kolls Jay K. 
Published: January 2014

ABSTRACT

The incidence of community-associated methicillin-resistant
Staphylococcus aureus
(MRSA) pneumonia in previously healthy individuals has increased in the past 5 years. Such infections are associated with bronchiectasis and high mortality rates, making them a significant public health concern. The mechanisms of host defense against this pathogen are not well characterized. However, patients diagnosed with MRSA, as opposed to methicillin-susceptible
S. aureus
(MSSA), are more likely to have abused alcohol in the past, and these patients are more likely to die from sepsis. In the United States, USA300 is the predominant strain that causes necrotizing pneumonia. To investigate whether acute ethanol exacerbates MRSA pneumonia, mice were intraperitoneally (i.p.) administered 2 or 4 g/kg of ethanol 30 min prior to oropharyngeal inoculation of 2 × 10
7
CFU of USA300. An increased pulmonary bacterial burden was observed in alcohol-intoxicated mice at 16 and 24 h and was associated with decreased levels of interleukin 6 (IL-6). IL-6 activates signal transducer and activator of transcription 3 (STAT3) as part of an acute-phase response of infection. Reg3γ is an antimicrobial C-type lectin that is induced by STAT3 signaling in response to Gram-positive bacteria. Previously,
in situ
hybridization studies showed that
Reg3g
is highly expressed in lung epithelium. In the present study, we found that acute ethanol exacerbated USA300 in a murine model of USA300 pneumonia. This was associated with reduced IL-6 expression
in vivo
as well as inhibition of IL-6 induction of STAT3 signaling and
Reg3g
expression in mouse lung epithelial (MLE12) cells
in vitro
. Furthermore, recombinant Reg3γ administration 4 h after MRSA infection in alcohol-intoxicated mice rescued USA300 clearance
in vivo
. Therefore, acute alcohol intoxication leads to decreased MRSA clearance in part by inhibiting IL-6/STAT3 induction of the antimicrobial protein Reg3γ in the pulmonary epithelium.
Distinct Roles of the Salmonella enterica Serovar Typhimurium CyaY and YggX Proteins in the Biosynthesis and Repair of Iron-Sulfur Clusters
Authors: Velayudhan Jyoti , Karlinsey Joyce E. , Frawley Elaine R. , Becker Lynne A. , Nartea Margaret , Fang Ferric C. 
Published: January 2014

ABSTRACT

Labile [4Fe-4S]
2+
clusters found at the active sites of many dehydratases are susceptible to damage by univalent oxidants that convert the clusters to an inactive [3Fe-4S]
1+
form. Bacteria repair damaged clusters in a process that does not require
de novo
protein synthesis or the Isc and Suf cluster assembly pathways. The current study investigates the participation of the bacterial frataxin ortholog CyaY and the YggX protein, which are proposed to play roles in iron trafficking and iron-sulfur cluster repair. Previous reports found that individual mutations in
cyaY
or
yggX
were not associated with phenotypic changes in
Escherichia coli
and
Salmonella enterica
serovar Typhimurium, suggesting that CyaY and YggX might have functionally redundant roles. However, we have found that individual mutations in
cyaY
or
yggX
confer enhanced susceptibility to hydrogen peroxide in
Salmonella enterica
serovar Typhimurium. In addition, inactivation of the
stm3944
open reading frame, which is located immediately upstream of
cyaY
and which encodes a putative inner membrane protein, dramatically enhances the hydrogen peroxide sensitivity of a
cyaY
mutant. Overexpression of STM3944 reduces the elevated intracellular free iron levels observed in an
S
. Typhimurium
fur
mutant and also reduces the total cellular iron content under conditions of iron overload, suggesting that the
stm3944
-encoded protein may mediate iron efflux. Mutations in
cyaY
and
yggX
have different effects on the activities of the iron-sulfur cluster-containing aconitase, serine deaminase, and NADH dehydrogenase I enzymes of
S
. Typhimurium under basal conditions or following recovery from oxidative stress. In addition,
cyaY
and
yggX
mutations have additive effects on 6-phosphogluconate dehydratase-dependent growth during nitrosative stress, and a
cyaY
mutation reduces
Salmonella
virulence in mice. Collectively, these results indicate that CyaY and YggX play distinct supporting roles in iron-sulfur cluster biosynthesis and the repair of labile clusters damaged by univalent oxidants.
Salmonella
experiences oxidative and nitrosative stress within host phagocytes, and CyaY-dependent maintenance of labile iron-sulfur clusters appears to be important for
Salmonella
virulence.
Evidence for Strain-Specific Immunity in Patients Treated for Early Lyme Disease
Authors: Khatchikian Camilo E. , Nadelman Robert B. , Nowakowski John , Schwartz Ira , Wormser Gary P. , Brisson Dustin 
Published: January 2014

ABSTRACT

Lyme disease, caused by
Borrelia burgdorferi
, is the most commonly reported vector-borne disease in the United States. Many patients treated for early Lyme disease incur another infection in subsequent years, suggesting that previous exposure to
B. burgdorferi
may not elicit a protective immune response. However, identical strains are almost never detected from patients who have been infected multiple times, suggesting that
B. burgdorferi
exposure may elicit strain-specific immunity. Probabilistic and simulation models assuming biologically realistic data derived from patients in the northeastern United States suggest that patients treated for early Lyme disease develop protective immunity that is strain specific and lasts for at least 6 years.
Development of the Rapid Assessment, Prioritisation and Referral Tool (RAPaRT) for multidisciplinary teams in emergency care settings
Authors: McPhail Steven M , Vivanti Angela , Robinson Kate 
Published: January 2014

ObjectiveThis investigation utilised the expertise of allied members of multidisciplinary teams working in emergency care settings to develop and validate a Rapid Assessment Prioritisation and Referral Tool (RAPaRT). This instrument is intended for use among patients (with non-life threatening acuity) presenting to emergency care settings to indicate when referral to an allied member of the multidisciplinary team is warranted.MethodThis three stage instrument development and validation study included: a Delphi panel process to determine key criteria to guide instrument development and identify potential items to be carried forward for testing (stage 1); a prospective cohort of consecutive admissions (n=153) to investigate item sensitivity and specificity and retain only the most suitable items (stage 2); then final consultation with the Delphi panel to ensure the final instrument was clinically amenable (stage 3).Results23 potential items were identified following stage 1. At the completion of item sensitivity and specificity analysis and in consultation with the Delphi panel, seven items were retained in the instrument. Area under the receiver operating characteristic curve was 0.803 for these seven items in predicting when a referral was warranted. Final consultation with the Delphi panel members also resulted in the addition of an open ended (eighth) item to allow description of any infrequent, but important, reason for referral.ConclusionsThe RAPaRT has demonstrated substantial promise as an efficient clinically amenable instrument to assist multidisciplinary teams in emergency care settings. Further research to investigate the wider implementation of the RAPaRT is warranted.
A simple tool to predict admission at the time of triage
Authors: Cameron Allan , Rodgers Kenneth , Ireland Alastair , Jamdar Ravi , McKay Gerard A 
Published: January 2014

AimTo create and validate a simple clinical score to estimate the probability of admission at the time of triage.MethodsThis was a multicentre, retrospective, cross-sectional study of triage records for all unscheduled adult attendances in North Glasgow over 2 years. Clinical variables that had significant associations with admission on logistic regression were entered into a mixed-effects multiple logistic model. This provided weightings for the score, which was then simplified and tested on a separate validation group by receiving operator characteristic (ROC) analysis and goodness-of-fit tests.Results215 231 presentations were used for model derivation and 107 615 for validation. Variables in the final model showing clinically and statistically significant associations with admission were: triage category, age, National Early Warning Score (NEWS), arrival by ambulance, referral source and admission within the last year. The resulting 6-variable score showed excellent admission/discharge discrimination (area under ROC curve 0.8774, 95% CI 0.8752 to 0.8796). Higher scores also predicted early returns for those who were discharged: the odds of subsequent admission within 28 days doubled for every 7-point increase (log odds=+0.0933 per point, p<0.0001).ConclusionsThis simple, 6-variable score accurately estimates the probability of admission purely from triage information. Most patients could accurately be assigned to ‘admission likely’, ‘admission unlikely’, ‘admission very unlikely’ etc., by setting appropriate cut-offs. This could have uses in patient streaming, bed management and decision support. It also has the potential to control for demographics when comparing performance over time or between departments.
Application of the American Heart Association/American College of Sports Medicine Adult Preparticipation Screening Checklist to a Nationally Representative Sample of US Adults Aged ≥40 Years From the National Health and Nutrition Examination Survey 2001 to 2004
Authors: Whitfield Geoffrey P. , Pettee Gabriel Kelley K. , Rahbar Mohammad H. , Kohl Harold W. 
Published: January 2014

Background—
Although the American Heart Association/American College of Sports Medicine’s Preparticipation Questionnaire (AAPQ) is a recommended preexercise cardiovascular screening tool, it has never been systematically evaluated. The purpose of this research is to provide preliminary evidence of its effectiveness among adults aged ≥40 years.

Methods and Results—
Under the assumption that participants would respond to AAPQ items as they responded to a general health survey, we calculated the sex- and age-specific proportions of adult participants in the National Health and Nutrition Examination Survey 2001 to 2004 who would receive a recommendation for physician consultation based on AAPQ referral criteria. Additionally, we compared recommended AAPQ referrals to a similar assessment using the Physical Activity Readiness Questionnaire in the study sample. AAPQ referral proportions were higher with older age. Across all age groups ≥40 years, 95.5% (94.3% to 96.8%) of women and 93.5% (92.2% to 94.7%) of men in the United States would be advised to consult a physician before exercise. Prescription medication use and age were the most commonly selected items. When referral based on AAPQ was compared with that of the Physical Activity Readiness Questionnaire, the 2 screening tools produced similar results for 72.4% of respondents.

Conclusions—
These results suggest that >90% of US adults aged ≥40 years would receive a recommendation for physician consultation by the AAPQ. Excessive referral may present an unnecessary barrier to exercise adoption and stress the healthcare infrastructure.
The Effect of Medial and Lateral Calcaneal Osteotomies on the Tarsal Tunnel
Authors: Bruce Benjamin G. , Bariteau Jason T. , Evangelista Peter E. , Arcuri Daniel , Sandusky Matthew , DiGiovanni Christopher W. 
Published: January 2014

Background: As an entrapment phenomenon, tarsal tunnel syndrome has been described after calcaneal osteotomy, and since the tibial nerve has also been shown to be very sensitive to ankle position, position of the calcaneus after osteotomy and displacement was thought to likely influence the environment of the tibial nerve within the tarsal canal. The respective volume of the tarsal canal was therefore hypothesized to decrease with medial or lateral displacement osteotomies of the calcaneus. Methods: Anterior and posterior calcaneal osteotomies were made in cadaveric matched pairs and brought through sequential medial and lateral displacements. Magnetic resonance imaging was used to estimate the comparative resultant volume of the tarsal canal after each of these new positions were assumed, as compared with baseline. The proximity of the osteotomy cut to the nerve’s location was also measured. Results: The tarsal tunnel volume was calculated for all 5 displacement states and were as follows: far-lateral (9506 mm3), near-lateral (10 073 mm3), normal (11 839 mm3), near-medial (11 489 mm3), and far-medial (11 760 mm3). No significant difference in tarsal tunnel volume was identified between the normal, nondisplaced specimens in the anterior or posterior groups (11 954 mm3 vs 11 809 mm3). No difference in tarsal tunnel volume was identified between the anterior and posterior osteotomies at any of the 4 displacements. The distance from tibial nerve to the medial exit site of the osteotomy was found to be significantly less in the anterior group compared to the posterior group (4 mm vs 14.2 mm, P < .0001). Conclusion: Lateral, but not medial, osteotomy fragment displacement results in significant reduction of tarsal tunnel volume. The location of the cut does not seem to affect any substantive change in volume. Anteriorly placed osteotomies appear to jeopardize the neurovascular structures more than posteriorly placed osteotomies. Clinical Relevance: These findings provide surgeons with clinical evidence in support of performing a prophylactic tarsal tunnel release for patients undergoing lateralizing calcaneal osteotomies.
Medication safety and the administration of intravenous vincristine: International survey of oncology pharmacists
Authors: Gilbar Peter , Chambers Carole R , Larizza Maria 
Published: January 2014

Purpose The risk of medication errors with vincristine administration is well documented. Our objective was to ascertain how vincristine is administered worldwide and determine what strategies for preventing the accidental intrathecal administration of vincristine are in place. Methods A survey, comprising 28 questions, was distributed to 363 International Society of Oncology Pharmacy Practitioners members from 42 countries via email. Questions were asked on methods of vincristine administration, intrathecal drug administration and strategies used to prevent medication errors. A reminder was sent and the survey was available on the International Society of Oncology Pharmacy Practitioners website. Only one survey per institution was requested. Results In all, 62 responses from 15 countries were received, with the majority from Australia. Vincristine was dispensed in mini-bags in 77.4% of centres, though some also used syringes. Syringes were used in 31.1% of centres, with half these doses prepared undiluted. Administration took 5 to 15 minutes in most centres (78.8%). The most common reasons for still using syringes were perceived risk of extravasation and faster infusion time. Despite numerous vincristine administrations, extravasation was very rare. Other recommended strategies for error prevention were in use in the majority of centres. Conclusion Comparisons with three previous surveys are difficult as the majority of respondents in those studies were from the USA. A number of areas appear to have improved, particularly the preparation of vincristine in mini-bags, but they are far from perfect. Deaths continue to occur following accidental intrathecal administration of vincristine. International Society of Oncology Pharmacy Practitioner members are urged to lead the way in incorporating strategies for prevention into institutions worldwide.
Cost effectiveness of a pragmatic exercise intervention (EXIMS) for people with multiple sclerosis: economic evaluation of a randomised controlled trial
Authors: Tosh J , Dixon S , Carter A , Daley A , Petty J , Roalfe A , Sharrack B , Saxton JM 
Published: January 2014

Background: Exercise is a safe, non-pharmacological adjunctive treatment for people with multiple sclerosis but cost-effective approaches to implementing exercise within health care settings are needed. Objective: The objective of this paper is to assess the cost effectiveness of a pragmatic exercise intervention in conjunction with usual care compared to usual care only in people with mild to moderate multiple sclerosis. Methods: A cost-utility analysis of a pragmatic randomised controlled trial over nine months of follow-up was conducted. A total of 120 people with multiple sclerosis were randomised (1:1) to the intervention or usual care. Exercising participants received 18 supervised and 18 home exercise sessions over 12 weeks. The primary outcome for the cost utility analysis was the incremental cost per quality-adjusted life year (QALY) gained, calculated using utilities measured by the EQ-5D questionnaire. Results: The incremental cost per QALY of the intervention was £10,137 per QALY gained compared to usual care. The probability of being cost effective at a £20,000 per QALY threshold was 0.75, rising to 0.78 at a £30,000 per QALY threshold. Conclusion: The pragmatic exercise intervention is highly likely to be cost effective at current established thresholds, and there is scope for it to be tailored to particular sub-groups of patients or services to reduce its cost impact.
Implementation of the ‘Sapere Migliora’ information aid for newly diagnosed people with multiple sclerosis in routine clinical practice: a late-phase controlled trial
Authors: Giordano A , Lugaresi A , Confalonieri P , Granella F , Radice D , Trojano M , Martinelli V , Solari A ,   on behalf of the SIMS-Practice group, Giordano A , Martinelli V , Lugaresi A , Pucci E , Granella F , Trojano M , Solari A , Martinelli V , Pucci E , Messmer Uccelli M , Lugaresi A , Giordano A , Granella F , Solari A , Giordano A , Ferrari G , Martini F , Solari A , Radice D , D’Annunzio G , Lugaresi A , Farina D , Travaglini D , Pietrolongo E , Onofrj M , Torri Clerici V , Bonanno S , Brambilla L , Confalonieri P , Martinelli V , Radaelli M , Messina J , Comi G , Tortorella C , Luciannatelli E , Trojano M , Senesi C , Tsantes E , Granella F , Conti MZ , Rottoli MR , Bellantonio P , Fischetti M , Fantozzi R , Pala A , Traccis S , Di Battista G , Bianchi M , Benedetti MD , Gaetani L , Di Filippo M , Carolei A , Totaro R , Lanzillo R , Brescia Morra V , Coppola R , Cottone S , Chiavazza C , Cavalla P , Leonardi C , Aguglia U , Ziuliani C , Valla P , Sasanelli F , Valentino P , Quattrone A , Martino Policlinico G. , Russo M , Vita G , Immovilli P 
Published: January 2014

Background: The SIMS-Trial showed that the ‘Sapere Migliora’ information aid (IA) for newly diagnosed people with multiple sclerosis (PwMS) effectively improved patient knowledge and satisfaction with care. Objectives: The objectives of this paper are to assess the effectiveness of the IA in clinical practice and to compare the whole IA with the take-home booklet/website component alone. Methods: After updating the IA and replacing the CD with a website, a prospective, open-label non-randomised controlled trial compared the whole IA (group A, five SIMS-Trial centres) to take-home (group B, 16 centres). One month after the intervention, participants completed the MS Knowledge Questionnaire (MSKQ), care satisfaction questionnaire (COSM-R) (primary study outcomes), Hospital and Anxiety Depression Scale, and ad hoc questionnaire appraising the IA. Results: We enrolled 159 newly diagnosed PwMS (May 2012–March 2013). Drop-outs were four of 77 (5%, group A) and 11/82 (13%, group B). Primary endpoint (highest tertile both for MSKQ and COSM-R section 2 scores) was achieved by 38/77 (49%) group A and 33/82 (40%) group B ( p = 0.25). Attainment of secondary outcomes was also similar between groups. Conclusions: This study shows that the entire IA is not superior to the booklet/website alone, and that both are comparable in efficacy to the intervention arm of the SIMS-Trial. Trial registration number: ISRCTN78940214.