A multicentre randomised controlled trial evaluating lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea in older people admitted to hospital: the PLACIDE study protocol

<p>Abstract</p> <p>Background</p> <p>Antibiotic associated diarrhoea complicates 5–39% of courses of antibiotic treatment. Major risk factors are increased age and admission to hospital. Of particular importance is <it>C. difficile</it> associated diarrhoea which occurs in about 4% of antibiotic courses and may result in severe illness, death and high healthcare costs. The emergence of the more virulent 027 strain of <it>C. difficile</it> has further heightened concerns. Probiotics may prevent antibiotic associated diarrhoea by several mechanisms including colonization resistance through maintaining a healthy gut flora.</p> <p>Methods</p> <p>This study aims to test the hypothesis that administration of a probiotic comprising two strains of lactobacilli and two strains of bifidobacteria alongside antibiotic treatment prevents antibiotic associated diarrhoea. We have designed a prospective, parallel group trial where people aged 65 years or more admitted to hospital and receiving one or more antibiotics are randomly allocated to receive either one capsule of the probiotic or a matching placebo daily for 21 days. The primary outcomes are the frequency of antibiotic associated and <it>C. difficile</it> diarrhoea during 8–12 weeks follow-up. To directly inform routine clinical practice, we will recruit a sufficient number of patients to demonstrate a 50% reduction in the frequency of <it>C. difficile</it> diarrhoea with a power of 80%. To maximize the generalizability of our findings and in view of the well-established safety record of probiotics, we will recruit a broad range of medical and surgical in-patients from two different health regions within the UK.</p> <p>Discussion</p> <p>Antibiotic associated diarrhoea constitutes a significant health burden. In particular, current measures to prevent and control <it>C. difficile</it> diarrhoea are expensive and disrupt clinical care. This trial may have considerable significance for the prevention of antibiotic associated diarrhoea in hospitals.</p> <p>Trial registration</p> <p>International Standard Randomised Controlled Trial Number Register ISRCTN70017204.</p

The investigation of regional ecology using 2km x 2km scale botanical distribution data

A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of PhilosophyTetrad vascular plant data from Staffordshire (VC 39), accumulated 1995 - 2009, were analysed using Two Way Indicator Species Analysis and Principal Components Analysis, explored using GIS, to examine major floristic distribution patterns. Environmental data were also examined using Redundancy Analysis. The strongest floristic trend was a human influence axis, arranged south—north, with the south being most anthropocentric and the north having a high proportion of semi-natural habitats. Indicator species for different parts of the County showed a corresponding strong biogeographic element, with ‘Southern-temperate’ and ‘Boreo-temperate’ characteristics in south and north respectively. The next most important factor in the distribution of plant species in Staffordshire was habitat quality and richness, which separated intensively-managed farmland from areas with seminatural habitats and from human influenced urban areas. Environmental variables associated with the main division in the data were mainly climate and altitude and the extent of developed land. Historic field patterns, identified by Staffordshire County Council, were associated with semi-natural habitats, linking an historical landscape characterisation with vascular plant analysis for the first time in the UK. The investigation set out to characterise and classify spatial units in terms of biodiversity importance, and to produce an objective ecological classification of the Staffordshire region based on botanical and physical features. The resulting classification characterises different areas of the County in terms of plant species composition, and has many potential applications in terms of nature conservation strategy development, targeting of resources and monitoring. A further aim was to facilitate the selection of indicator species for high quality habitats – the study has enabled revision of Staffordshire’s axiophyte plant list. Both the ecological classification and indicator species will be of strategic value because the information provided is authenticated by being based on objective analysis of a wide range of data. In Staffordshire, further work is required to develop environmental data, especially an effective dataset for hedges, while comparison of the data with historical botanical data could provide further information about the County’s previous environment. The techniques developed in the study could be used more widely to: produce of lists of key species, provide information for environmental modeling, climate change monitoring, target nature conservation activity, and to develop landscape strategies

Remembrance and Resurrection: Ry Cooder's Chavez Ravine

This article explores Los Angeles guitarist Ry Cooder’s project to excavate and resurrect through music the lost community of Chávez Ravine, the vibrant Mexican‐American neighbourhood bulldozed in 1958 to make way for the construction of the Dodger baseball stadium. The article draws critical parallels with Marcel Proust, of whom Hannah Segal writes: “On realizing the destruction of a whole world that had been his he decides to write, to sacrifice himself to the re‐creation of the dying and the dead. By virtue of his art he can give his objects an eternal life in his work”. Proust’s medium is the written word; Cooder’s is the dance music of the Pachucos, the corridos of the Ravine’s local heroes and the laments of the residents driven away by the bulldozers. Through this music, Cooder’s aim is to ensure that the name “Chávez Ravine” and “all the images that had been living in it” (Proust) will not remain eclipsed by the corporate power and self‐congratulation of the Los Angeles Dodgers