bluuebunny/crossref_metadata_2025_split huggingface dataset:
Warriors and Ruins
Authors: Mottram Stewart 
Published: March 2019

Abstract
This chapter explores Shakespeare’s response to the ‘bare ruined choirs’ of dissolved churches and monasteries, focusing on Cymbeline (c.1610) and showing how this play’s language of ruin works to remind Shakespeare’s contemporaries of the potential for anti-catholic intolerance to incite further acts of religious violence in early Stuart England and Wales. Cymbeline conveys a double vision of Wales, the site of Britain’s heroic victory over Rome, but also the scene for Welsh acts of savagery and rebellion that coalesce around the image of Cloten’s headless corpse, described by Lucius in the play as a ‘ruin … that sometime | … was a worthy building’ (4.2.353–4). The chapter shows how Shakespeare uses this language of ruin to reflect anxieties over the role of Welsh catholics in the Essex rising (1601) and Gunpowder Plot (1605), in which demands for greater toleration of catholics were a recurrent concern. Cymbeline condemns these acts of catholic rebellion, but the chapter argues that it also questions the merits of England’s Jacobean culture of intolerance towards catholics—an intolerance that, as Shakespeare hints, must also take some measure of responsibility for catholic acts of rebellion in the early seventeenth century. Shakespeare’s emphasis on the need for toleration of catholic loyalism need not, however, imply Shakespeare’s own sympathies for catholic beliefs and practices. The chapter shows how Shakespeare remembers the monastic ruinations under Henry VIII in order to reflect on the continuing cycles of religious violence that this originary moment of reformation iconoclasm unleashed.
Introduction
Authors: Mottram Stewart 
Published: March 2019

Abstract
This chapter introduces the book as a whole, tracing the history of protestant iconoclasm and ruin creation across the long reformation, from the dissolution of the monasteries in the 1530s to the disestablishment of the English protestant church in the 1650s. It focuses attention on the poet George Herbert, whose poems, in The Temple (1633), on aspects of church interiors bear witness to the sanctioned iconoclasm of successive Tudor governments—iconoclasm that had broken altars, upended statues, and whitewashed church walls. Herbert was a protestant minister whose poetry celebrates the church established under Elizabeth I, defining its reformed appearance as a middle ground—‘Neither too mean, nor yet too gay’—between Genevan Calvinism and Roman catholicism. But Herbert’s poetry also reveals anxieties about the future of English protestantism—besieged not only by catholic plots but also by puritan and presbyterian clamours for further church reform. Herbert’s anxieties over this twofold threat to the English church are at once anti-catholic and anti-iconoclastic. Although Herbert celebrates the protestant reforms that had dissolved monasteries and destroyed catholic shrines, his poetry also attacks puritans, whose dissatisfaction with the half-hearted reforms of the Elizabethan settlement sought in Herbert’s eyes to ruin the church from within. Herbert’s paranoid poetry provides a keynote for this study’s exploration of the ruined churches and monasteries represented in early modern English literature—ruins, the study argues, that betray similar anxieties about the consequences of catholic plots and puritan iconoclasm for the fate of the English church in its formative century.
The Prologue as a Paschal Hymn
Authors: Behr John 
Published: March 2019

Abstract
On the basis of the analysis of the Gospel of John given so far, and in particular the celebration of Pascha that began with him, this chapter offers a radically new interpretation of the Prologue to the Gospel of John. Rather than a pre-existing hymn to the Word adopted and modified by the Evangelist, or a Prologue to the Gospel written by the Evangelist himself, explaining how the Word became flesh as the prelude to the narrative that follows, it is argued that the Prologue is best understood as a Paschal hymn in three parts. The first verse celebrates the one who is in first place, the crucified and exalted Jesus Christ, on his way to God, and as himself God. Verses 1:2—5 speak not of creation and the presence of the Word in creation before his sojourn on earth, but of how everything that occurs throughout the Gospel happens at his will, specifically the life that comes to be in him, a light which enlightens human beings, that is, those who receive and follow him. The third part, verses 1:6—18, are a chiastically structured celebration of what has come to be in Christ, where 1:14, ‘the Word became flesh and dwelt in us’ refers to the Eucharist, the flesh that he now offers to those who receive him and so become his body, following on from baptism in verses 1:12–13; the chiastic center of this section is 1:10–11, his rejection by the world but reception by his own, and the beginning and end of this section is the witness provided by John the Baptist.
Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data
Authors: Blevins Peratikos Meridith , Weeks Hannah L , Pisansky Andrew J B , Yong R Jason , Stringer Elizabeth Ann 
Published: March 2019

AbstractObjectiveBetween 17% and 40% of patients undergoing elective arthroplasty are preoperative opioid users. This US study analyzed patients in this population to illustrate the relationship between preoperative opioid use and adverse surgical outcomes.DesignRetrospective study of administrative medical and pharmaceutical claims data.SubjectsAdults (aged 18+) who received elective total knee, hip, or shoulder replacement in 2014–2015.MethodsA patient was a preoperative opioid user if opioid prescription fills occurred in two periods: 1–30 and 31–90 days presurgery. Zero-truncated Poisson (incidence rate ratio [IRR]), logistic (odds ratio [OR]), Cox (hazard ratio [HR]), and quantile regressions modeled the effects of preoperative opioid use and opioid dose, adjusted for demographics, comorbidities, and utilization.ResultsAmong 34,792 patients (38% hip, 58% knee, 4% shoulder), 6,043 (17.4%) were preoperative opioid users with a median morphine equivalent daily dose of 32 mg. Preoperative opioid users had increased length of stay (IRR = 1.03, 95% CI = 1.02 to 1.05), nonhome discharge (OR = 1.10, 95% CI = 1.00 to 1.21), and 30-day unplanned readmission (OR = 1.43, 95% CI = 1.17 to 1.74); experienced 35% higher surgical site infection (HR = 1.35, 95% CI = 1.14 to 1.59) and 44% higher surgical revision (HR = 1.44, 95% CI = 1.21 to 1.71); had a median $1,084 (95% CI = $833 to $1334) increase in medical spend during the 365 days after discharge; and had a 64% lower rate of opioid cessation (HR = 0.34, 95% CI = 0.33 to 0.35) compared with patients not filling two or more prescriptions across periods.ConclusionsPreoperative opioid users had longer length of stay, increased revision rates, higher spend, and persistent opioid use, which worsened with dose. Adverse outcomes after elective joint replacement may be reduced if preoperative opioid risk is managed through increased monitoring or opioid cessation.
Cost–risk–benefit analysis in diagnostic radiology with special reference to the application of referral guidelines
Authors: Moores B Michael 
Published: March 2019

Abstract
Cost–risk–benefit analysis has been applied to protection of the patient in diagnostic radiology with special reference to the application of referral guidelines. The analysis presented has extended previous work in this field to provide a theoretical framework that encompasses key factors that need to be considered in the optimisation of patient protection from both diagnostic and radiation risks. The fraction of patients whose symptoms do not meet criteria contained in the referral guidelines and, therefore, for whom an X-ray examination is not indicated has been termed the selectivity of the guidelines. Also included are the detriments arising from rejected or repeated examinations as well as the levels of patient dose employed in order to achieve given levels of true and false diagnostic outcomes. A comprehensive framework for optimisation is outlined and its relationship to justification discussed.
Clinical Level of Evidence Presented at the Lumbar Spine Research Society (LSRS) Annual Meeting Over 10 Years (2008–2017)
Authors: Eyrich Nicholas W. , Rodoni Bridger M. , Patel Rakesh , Aleem Ilyas S. 
Published: March 2019

Study Design.
A systematic review.

Objective.
The Lumbar Spine Research Society (LSRS) is dedicated to advancing knowledge of the lumbar spine to promote evidence-based care. We sought to systematically review the level of clinical evidence presented at LSRS annual meetings from 2008 through 2017.

Summary of Background Data.
Improvements in clinical evidence have been reported at similar bone and joint scientific meetings.

Methods.
A total of 458 paper abstracts presented at LSRS annual meetings were independently assessed by two reviewers. Only clinical studies being included for analysis. Reviewers designated a clinical level of evidence (LOE) to each included abstract from level I to level IV based on criteria set forth by the Oxford Centre for Evidence-Based Medicine. Reviewer agreement was assessed using Cohens Kappa coefficient (k). Student t test was used to assess for differences in mean LOE grades. Chi-squared testing was used to assess nonrandom changes in LOE.

Results.
A total of 299 abstracts met inclusion criteria. Over the last 10 LSRS meetings, 2.68% of the presentations were level I, 22.4% were level II, 37.1% were level III, and 37.8% were level IV. We found the average LOE from 2008 to 2017 to be 3.10 (median = 3). In addition, 63.9% presentations were Therapeutic Studies, 30.1% were Prognostic Studies, and 6.02% were Diagnostic studies. When comparing the first 5 years (2008–2012) to the last 5 years (2013–2017), we observed a significant increase in Level II (P < 0.05) and Level III (P < 0.05) evidence along with a corresponding decrease in level IV evidence (P < 0.01). The average LOE improved significantly from 3.28 (2008–2012) to 2.88 (2013–2017) (P < 0.001).

Conclusion.
Emphasis on evidence-based medicine within spine surgery, specifically pertaining to the lumbar spine, has positively influenced the clinical LOE disseminated at LSRS annual meetings between 2008 and 2017.

Level of Evidence: 4
Cardiac Arrest and Subsequent Hospitalization–Induced Posttraumatic Stress Is Associated With 1-Year Risk of Major Adverse Cardiovascular Events and All-Cause Mortality
Authors: Agarwal Sachin , Presciutti Alex , Cornelius Talea , Birk Jeffrey , Roh David J. , Park Soojin , Claassen Jan , Elkind Mitchell S. V. , Edmondson Donald 
Published: March 2019

Objectives:
To compare 1-year all-cause mortality and major adverse cardiovascular events in cardiac arrest survivors with and without posttraumatic stress disorder symptomatology at hospital discharge.

Design:
Prospective, observational cohort.

Setting:
ICUs at a tertiary-care center.

Patients:
Adults with return of spontaneous circulation after in-hospital or out-of-hospital cardiac arrest between September 2015 and September 2017. A consecutive sample of survivors with sufficient mental status to self-report cardiac arrest and subsequent hospitalization–induced posttraumatic stress disorder symptoms (cardiac arrest–induced posttraumatic stress symptomatology) at hospital discharge were included.

Interventions:
None.

Measurements and Main Results:
The combined primary endpoint was all-cause mortality or major adverse cardiovascular event—hospitalization for nonfatal myocardial infarction, unstable angina, congestive heart failure, emergency coronary revascularization, or urgent implantable cardio-defibrillators/permanent pacemaker placements within 12 months of discharge. An in-person posttraumatic stress disorder symptomatology was assessed at hospital discharge via the Posttraumatic Stress Disorder Checklist-Specific scale; a suggested diagnostic cutoff of 36 for specialized medical settings was adopted. Outcomes for patients meeting (vs not meeting) this cutoff were compared using Cox-hazard regression models. Of 114 included patients, 36 (31.6%) screened positive for cardiac arrest–induced posttraumatic stress symptomatology at discharge (median 21 d post cardiac arrest; interquartile range, 11–36). During the follow-up period (median = 12.4 mo; interquartile range, 10.2–13.5 mo), 10 (8.8%) died and 29 (25.4%) experienced a recurrent major adverse cardiovascular event: rehospitalizations due to myocardial infarction (n = 4; 13.8%), unstable angina (n = 8; 27.6%), congestive heart failure exacerbations (n = 4; 13.8%), emergency revascularizations (n = 5, 17.2%), and urgent implantable cardio-defibrillator/permanent pacemaker placements (n = 8; 27.6%). Cardiac arrest–induced posttraumatic stress symptomatology was associated with all-cause mortality/major adverse cardiovascular event in univariate (hazard ratio, 3.19; 95% CI, 1.7–6.0) and in models adjusted for age, sex, comorbidities, preexisting psychiatric condition, and nonshockable initial rhythm (hazard ratio, 3.1; 95% CI, 1.6–6.0).

Conclusions:
Posttraumatic stress disorder symptomatology is common after cardiac arrest, and cardiac arrest–induced posttraumatic stress symptomatology was associated with significantly higher risk of death and cardiovascular events. Further studies are needed to better understand the underlying mechanisms.
Center Effects in Hospital Mortality of Critically Ill Patients With Hematologic Malignancies*
Authors: Biard Lucie , Darmon Michaël , Lemiale Virginie , Mokart Djamel , Chevret Sylvie , Azoulay Elie , Resche-Rigon Matthieu 
Published: March 2019

Objectives:
We aimed to investigate center effects on hospital mortality of ICU patients with hematologic malignancies and to explore interactions between center and patients characteristics.

Design:
Multicenter prospective cohort.

Setting:
Seventeen ICUs across France and Belgium.

Patients:
One-thousand eleven patients with hematologic malignancies hospitalized in ICUs.

Interventions:
Reanalysis of the original data using state-of-the-art statistical methods with permutation procedures for testing multiple random effects.

Measurements and Main Results:
Average crude mortality was 39% and varied from 11% to 58% across centers. There was a significant center effect on the mean hospital mortality, after adjustment on individual prognostic factors (p < 0.001; median adjusted odds ratio for center effect 1.57 [interquartile range, 1.24–2.18]). There was also a quantitative interaction between center and the effect of the Sequential Organ Failure Assessment score: higher scores were associated with higher mortality (odds ratio for 1 point = 1.24 on average; 95% CI, 1.15–1.33) but with a magnitude that depended on center (p = 0.028).

Conclusions:
Between-center heterogeneity in hospital mortality was confirmed after adjustment for individual prognostic factors. It was partially explained by center experience in treating oncology patients. Interestingly, center effect was similar in magnitude to that of known mortality risk factors.
Outcomes of Cancer Patients Discharged From ICU After a Decision to Forgo Life-Sustaining Therapies
Authors: Praça Ana P. A. , Nassar Antonio P. , Caruso Pedro 
Published: March 2019

Objectives:
Many cancer patients are admitted to an ICU and decisions to forgo life-sustaining therapies are frequent during ICU stay. A significant proportion of these patients are subsequently discharged from ICU, but their outcomes are unknown.

Design:
Retrospective.

Setting:
ICU of oncological hospital.

Patients:
Adult cancer patients admitted to ICU, then with a decision to forgo life-sustaining therapies and that were discharged from ICU.

Interventions:
None.

Measurements and Main Results:
Hospital mortality, long-term survival, recommencement of cancer treatment, and ICU readmission were recorded. Hospital mortality predictors were evaluated. The propensity score method was used to test the hypothesis that decision to forgo life-sustaining therapies was independently associated with hospital mortality. Among the 16,998 patients that were admitted to ICU, in 1,369 patients (8.1%) a decision to forgo life-sustaining therapies was made during ICU stay. Among the latter group, 507 were discharged from ICU and were examined in this study. The hospital mortality of this group was 80.1% and was independently predicted according to the occurrence of delirium or acute kidney injury during their ICU stay. Six-month and 12-month survival rates were 3.6% and 0.6%. Sixty-four patients (12.6%) resumed cancer treatment and had a longer survival (p < 0.01). Fifty-two patients (10.3%) were readmitted to ICU and had a longer survival (p < 0.01). The decision to forgo life-sustaining therapies was associated with higher hospital mortality (80.0% vs 26.3%, respectively; p < 0.01) and lower rates of survival (p < 0.01).

Conclusions:
Approximately 20% of cancer patients discharged from our ICU after a decision to forgo life-sustaining therapies were discharged from hospital. Delirium and acute kidney injury during ICU stay were predictors of hospital mortality. The decision to forgo life-sustaining therapies was independently associated with hospital mortality. Patients readmitted to the ICU and those that resumed cancer treatment had longer survival. Knowledge of these outcomes is important for providing proper therapeutic planning and counseling for patients and their relatives.
Trigeminal Nerve Stimulation: A Novel Method of Resuscitation for Hemorrhagic Shock*
Authors: Li Chunyan , Chiluwal Amrit , Afridi Adil , Chaung Wayne , Powell Keren , Yang Weng-Lang , Wang Ping , Narayan Raj K. 
Published: March 2019

Objectives:
To determine if trigeminal nerve stimulation can ameliorate the consequences of acute blood loss and improve survival after severe hemorrhagic shock.

Design:
Animal study.

Setting:
University research laboratory.

Subjects:
Male Sprague-Dawley rats.

Interventions:
Severe hemorrhagic shock was induced in rats by withdrawing blood until the mean arterial blood pressure reached 27 ± 1 mm Hg for the first 5 minutes and then maintained at 27 ± 2 mm Hg for 30 minutes. The rats were randomly assigned to either control, vehicle, or trigeminal nerve stimulation treatment groups. The effects of trigeminal nerve stimulation on survival rate, autonomic nervous system activity, hemodynamics, brain perfusion, catecholamine release, and systemic inflammation after severe hemorrhagic shock in the absence of fluid resuscitation were analyzed.

Measurements and Main Results:
Trigeminal nerve stimulation significantly increased the short-term survival of rats following severe hemorrhagic shock in the absence of fluid resuscitation. The survival rate at 60 minutes was 90% in trigeminal nerve stimulation treatment group whereas 0% in control group (p < 0.001). Trigeminal nerve stimulation elicited strong synergistic coactivation of the sympathetic and parasympathetic nervous system as measured by heart rate variability. Without volume expansion with fluid resuscitation, trigeminal nerve stimulation significantly attenuated sympathetic hyperactivity paralleled by increase in parasympathetic tone, delayed hemodynamic decompensation, and improved brain perfusion following severe hemorrhagic shock. Furthermore, trigeminal nerve stimulation generated sympathetically mediated low-frequency oscillatory patterns of systemic blood pressure associated with an increased tolerance to central hypovolemia and increased levels of circulating norepinephrine levels. Trigeminal nerve stimulation also decreased systemic inflammation compared with the vehicle.

Conclusions:
Trigeminal nerve stimulation was explored as a novel resuscitation strategy in an animal model of hemorrhagic shock. The results of this study showed that the stimulation of trigeminal nerve modulates both sympathetic and parasympathetic nervous system activity to activate an endogenous pressor response, improve cerebral perfusion, and decrease inflammation, thereby improving survival.
Immunotherapy in recurrent and or metastatic squamous cell carcinoma of the head and neck
Authors: Saada-Bouzid Esma , Peyrade Frederic , Guigay Joël 
Published: March 2019

Purpose of review
Checkpoint inhibitors (CPI) are revolutionizing the treatment of advanced cancers including recurrent and or metastatic squamous cell carcinoma of the head and neck (RM-SCCHN).

Recent findings
In this review, we will summarize the results of prospective trials evaluating CPI and particularly antiprogrammed death 1 (PD-1)/antiprogrammed death-ligand 1 (PD-L1) in RM-SCCHN.

Summary
Nivolumab and Pembrolizumab, two anti-PD-1 CPI, were associated with longer overall survival than standard chemotherapy in pretreated RM-SCCHN in two randomized phase 3 trials (respectively CHECKMATE-141 and KEYNOTE-040). Both are now approved in this setting. In the KEYNOTE-048 trial, the pembrolizumab was also associated with a longer survival when compared with the EXTREME regimen in first-line RM-SCCHN patients whose tumors overexpressed PD-L1 (combined positive score ≥20%). This trial also showed a superiority of platinum-based chemotherapy and pembrolizumab vs. EXTREME regimen in unselected first-line RM-SCCHN. Pembrolizumab will probably be the next standard of care for first-line RM-SCCHN with high expression of PD-L1. Further evaluation of CPI combined with other antitumoral agents is ongoing in advanced and locally advanced SCCHN.
Fertility, sexuality and cancer in young adult women
Authors: Condorelli Margherita , Lambertini Matteo , Del Mastro Lucia , Boccardo Francesco , Demeestere Isabelle , Bober Sharon L. 
Published: March 2019

Purpose of review
To provide an up-to-date overview on indications, efficacy and safety of the existing fertility preservation strategies as well as on the features and management of sexual dysfunction in young adult women with newly diagnosed cancer.

Recent findings
Because of the improved life expectancy of cancer survivors, a growing attention should be given to the side effects of anticancer treatments. Among young cancer patients, risk of infertility and sexual dysfunction are of great concern.

Summary
As advocated by guidelines, patients need to be thoroughly informed of potential side effects of treatment before starting them. On this regard, efforts should be made to improve the counseling of young adult patients around fertility and sexuality. Fertility preservation strategies should be properly and extensively explained to all young patients, weighting the pros and cons to choose the more appropriate options for each situation. In addition, discussing sexual dysfunction and delivering sexual rehabilitation for cancer survivors not only allows for renewal of sexual function but can also promote increased quality of life and help women create a new and satisfying chapter in their life for many years after cancer.