bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ludic Limbos
Authors: Tartici Ayten 
Published: September 2018

Abstract
The minor character of Belacqua from Dante’s Purgatorio recurs often in Beckett’s early work. This article emphasizes the comic in its critical reading of Molloy, by studying how Beckett both adapted and parodied the language of the Commedia. Such an approach reveals the complex tension created by Beckett’s simultaneously parodic yet reverential appropriation of Dante’s language. This rhetorical strategy also points to a larger theme in the novel: subversive laughter aimed at theological, philosophical and literary authority.
Vertically Sheared Horizontal Flow-Forming Instability in Stratified Turbulence: Analytical Linear Stability Analysis of Statistical State Dynamics Equilibria
Authors: Fitzgerald Joseph G. , Farrell Brian F. 
Published: September 2018

Abstract
Vertically banded zonal jets are frequently observed in weakly or nonrotating stratified turbulence, with the quasi-biennial oscillation in the equatorial stratosphere and the ocean’s equatorial deep jets being two examples. Explaining the formation of jets in stratified turbulence is a fundamental problem in geophysical fluid dynamics. Statistical state dynamics (SSD) provides powerful methods for analyzing turbulent systems exhibiting emergent organization, such as banded jets. In SSD, dynamical equations are written directly for the evolution of the turbulence statistics, enabling direct analysis of the statistical interactions between the incoherent component of turbulence and the coherent large-scale structure component that underlie jet formation. A second-order closure of SSD, known as S3T, has previously been applied to show that meridionally banded jets emerge in barotropic β-plane turbulence via a statistical instability referred to as the zonostrophic instability. Two-dimensional Boussinesq turbulence provides a simple model of nonrotating stratified turbulence analogous to the β-plane model of planetary turbulence. Jets known as vertically sheared horizontal flows (VSHFs) often emerge in simulations of Boussinesq turbulence, but their dynamics is not yet clearly understood. In this work S3T analysis of the zonostrophic instability is extended to study VSHF emergence in two-dimensional Boussinesq turbulence using an analytical formulation of S3T amenable to perturbation stability analysis. VSHFs are shown to form via an instability that is analogous in stratified turbulence to the zonostrophic instability in β-plane turbulence. This instability is shown to be strikingly similar to the zonostrophic instability, suggesting that jet emergence in both geostrophic and nonrotating stratified turbulence may be understood as instances of the same generic phenomenon.
Assessing Impacts of the High-Frequency Assimilation of Surface Observations for the Forecast of Convection Initiation on 3 April 2014 within the Dallas–Fort Worth Test Bed
Authors: Gasperoni Nicholas A. , Wang Xuguang , Brewster Keith A. , Carr Frederick H. 
Published: September 2018

AbstractThe Nationwide Network of Networks (NNoN) concept was introduced by the National Research Council to address the growing need for a national mesoscale observing system and the continued advancement toward accurate high-resolution numerical weather prediction. The research test bed known as the Dallas–Fort Worth (DFW) Urban Demonstration Network was created to experiment with many kinds of mesoscale observations that could be used in a data assimilation system. Many nonconventional observations, including Earth Networks and Citizen Weather Observer Program surface stations, are combined with conventional operational data to form the test bed network. A principal component of the NNoN effort is the quantification of observation impact from several different sources of information. In this study, the GSI-based EnKF system was used together with the WRF-ARW Model to examine impacts of observations assimilated for forecasting convection initiation (CI) in the 3 April 2014 hail storm case. Data denial experiments tested the impact of high-frequency (5 min) assimilation of nonconventional data on the timing and location of CI and subsequent storm evolution. Results showed nonconventional observations were necessary to capture details in the dryline structure causing localized enhanced convergence and leading to CI. Diagnosis of denial-minus-control fields showed the cumulative influence each observing network had on the resulting CI forecast. It was found that most of this impact came from the assimilation of thermodynamic observations in sensitive areas along the dryline gradient. Accurate metadata were found to be crucial toward the future application of nonconventional observations in high-resolution assimilation and forecast systems.
Long-term results of isolated acetabular revisions with reinforcement rings: a 10- to 15-year follow-up
Authors: Marongiu Giuseppe , Podda Daniele , Mastio Michele , Capone Antonio 
Published: September 2018

Purpose: The management of severe acetabular bone deficiency and a stable femoral stem can be a challenging problem in revision hip surgery. Replacement of both the acetabular and femoral component in elderly patients can increase perioperative risks without the certainty of a better functional outcome. We report the long-term outcome of reinforcement rings in isolated acetabular revision to determine whether this procedure allows hip function restoration and implant longevity. Methods: A retrospective study was conducted to evaluate the long-term results of isolated acetabular revision in thirty patients with a mean age of 70.6 years. 16 patients (16 hips) received an acetabular reinforcement ring, and 14 patients received a reconstruction cage. Acetabular defects were classified as Paprosky Type II in 16 cases and Type III in 14 cases. The mean follow-up was 11.3 years (range 10–15 years). Results: Radiographic signs of loosening were found in 9 cases (30%). 4 cases (13.3%) with severe osteolysis and implant migration underwent further revision surgery. All 30 unrevised femoral stems were considered stable. 1 (3%) early dislocation, was conservatively treated. Clinical assessment showed a significantly improved mean Harris Hip Score from 45.1 points preoperatively to 85.4 at the latest follow-up ( p < 0.05). The 15-year survival rate was 86.7%. Conclusions: Our long-term results showed that in selected patients, isolated acetabular revision with rings or antiprotrusio cages represents a reasonable surgical technique for the management of severe acetabular bone loss. However, concerns about the high radiographic loosening rates are possibly related to low bone ingrowth compared to new porous implants.
Medication safety in a German telemedicine centre: Implementation of a telepharmaceutical expert consultation in addition to existing tele-intensive care unit services
Authors: Amkreutz Julia , Lenssen Rebekka , Marx Gernot , Deisz Robert , Eisert Albrecht 
Published: September 2018

Introduction Tele-intensive care unit (tele-ICU) services offer the possibility to provide specialized medical care in remote areas and to improve patient outcomes. The aim of this study was to implement and evaluate an additional telepharmaceutical expert consultation as part of tele-ICU services. Methods This is a prospective observational study conducted in the telemedicine centre of the University Hospital RWTH Aachen, Germany. Between March and July 2015, all tele-ICU patients of one internal and two remote ICUs received telepharmaceutical consultation. Number and type of drug related problems (DRPs) were identified in a comprehensive medication safety check. Implementation of DRPs was discussed interdisciplinarily by tele-ICU pharmacist, tele-ICU physician and remote ICU physician. Special focus was on drug–drug interactions (DDIs) and dosage adjustment in renal and liver failure. Results A total of 210 DRPs in 103 patients were identified and discussed. On average, 2.0 (range 0–17) DRPs per patient were found. At least one DRP was found in 62% of patients. Antibacterials for systemic use were most involved in DRPs. A total of 1129 DDI-alerts were generated by ID PHARMA CHECK®. Fifty-six DDIs (5%) were discussed in tele-ICU rounds. The tele-ICU team discussed 28 cases of dosage adjustment in organ failure. Discussion Telepharmaceutical consultation as part of tele-ICU services was successfully implemented and can improve medication safety. Telemedicine infrastructure provides the possibility to implement guidelines recommending pharmaceutical service in the ICU in remote hospitals not having access to clinical pharmacists. Thus, quality of care can be improved.
Role of Superantigens in Allergic Inflammation: Their Relationship to Allergic Rhinitis, Chronic Rhinosinusitis, Asthma, and Atopic Dermatitis
Authors: Muluk Nuray Bayar , Altın Fazilet , Cingi Cemal 
Published: September 2018

Objectives Our intention was to review all material published to date regarding superantigens (SAgs) and allergy from an otorhinolaryngological viewpoint to understand this association more clearly. Methods We identified all materials published mentioning both SAg and allergic rhinitis (AR), chronic sinusitis, asthma, and atopic dermatitis (AD) that are indexed on PubMed, Google, or the ProQuest Central databases. Results Staphylococcus aureus is a significant bacterial pathogen in humans and has the ability to produce enterotoxins with superantigenic features. The inflammatory response in allergy seen in both B cell and T cell may be attributed to SAgs. Sufferers of both allergic asthma with rhinitis and AR alone produce serological evidence of immunoglobulin E formation to SAgs produced by S. aureus. Perennial AR sufferers carry S. aureus more frequently and the presence of the organism within the nasal cavity may exacerbate perennial AR. SAg produced by S. aureus potentially worsens the asthmatic inflammatory response within the airway and may lead to the airways becoming hyperresponsive, as well as possibly activating T cells if asthmatic control is poor. Staphylococcal SAgs potentially increase the risk of developing chronic rhinosinusitis with nasal polyposis, additionally being a marker for more severe disease. If SAgs bring about chronic inflammatory responses in the nose and sinuses, then T cells excreting interferon-gamma may be a crucial mediator. In allergic dermatitis, S. aureus could be a key player in exacerbation of the condition. Even in younger pediatric patients with allergic dermatitis, allergic hypersensitivity to SAgs is frequent and may be a factor explaining how severe the condition becomes. Conclusion Just as SAgs are known to feature in many allergic conditions, they play their part in AR, chronic rhinosinusitis, asthma, and AD. Further research is required before the relationship between SAgs and allergy can be adequately explained.
Masked hypertension incidence and risk factors in a prospective cohort study
Authors: Trudel Xavier , Brisson Chantal , Gilbert-Ouimet Mahée , Duchaine Caroline S , Dalens Violaine , Talbot Denis , Milot Alain 
Published: September 2018

Aims Masked hypertension may affect up to 30% of the general population and is associated with a high cardiovascular disease risk. No previous study has examined the incidence of masked hypertension and its risk factors. The study aim was to determine the incidence of masked hypertension and to examine its related risk factors. Methods This is a cohort study including 1836 initially normotensive participants followed up on average for 2.9 years. Blood pressure was measured using Spacelabs 90207. Manual blood pressure was defined as the mean of the first three readings taken at rest. Ambulatory blood pressure was defined as the mean of the next readings recorded every 15 minutes during daytime working hours. Masked hypertension incidence at follow-up was defined as manual blood pressure less than 140 and less than 90 mmHg and ambulatory blood pressure at least 135 or at least 85 mmHg. Generalised estimating equations were used. Results The cumulative incidence of masked hypertension was 10.3% and was associated with male gender (relative risk (RR) 1.51, 95% confidence interval (CI) 1.18–1.94), older age (RR40–49 years 1.56, 95% CI 1.16–2.11, RR≥50 years 1.50, 95% CI 1.06–2.10), higher education (RRcollege 1.31, 95% CI 1.03–1.65), body mass index (RR≥27 1.43, 95% CI 1.11–1.85), smoking (RR 1.51, 95% CI 1.09–2.010) and alcohol intake (RR≥6/week 1.65, 95% CI 1.13–2.03). Conclusion The present study is the first to identify risk factors for the incidence of masked hypertension. Current guidelines for hypertension detection recommend ambulatory blood pressure in patients with an elevated blood pressure reading at the clinic. As it is impractical to measure ambulatory blood pressure in all normotensive patients, factors identified in the present study should be considered for the screening of at-risk individuals and for primary prevention of masked hypertension.
Exchange Rate Dynamics, Endogenous Risk Premium and the Balance Sheet Effect: An Effective Demand Model
Authors: Basu Moumita , Sengupta Jonaki , Nag Ranjanendra Narayan 
Published: September 2018

This article describes a macroeconomic framework for analysing the interaction between output, domestic interest rate and exchange rate in the presence of the endogenous risk premium and balance sheet effect of exchange rate depreciation on investment demand. Output is demand determined. There are three assets: money, domestic bonds and foreign bonds. Domestic bonds and foreign bonds are not perfect substitutes due to the presence of risk premium. The endogenous risk premium depends on certain macroeconomic fundamentals, namely budget deficit and current account balance. Using this framework, we will examine implications of monetary policy, fiscal policy, tariff liberalization and global interest rate hike for exchange rate dynamics and output. The balance sheet effect and the risk premium together explain how an expansionary fiscal policy may generate recession, while tariff liberalization may produce favourable macroeconomic outcomes. Moreover, the model shows that an increase in world interest rate may have contractionary effect on the domestic output level due to the presence of the balance sheet effect of exchange rate depreciation. JEL Classification: E27, E63, F13, F32
China Intracranial Aneurysm Project (CIAP): protocol for a registry study on a multidimensional prediction model for rupture risk of unruptured intracranial aneurysms
Authors: Chen Junfan , Liu Jian , Zhang Yisen , Tian Zhongbin , Wang Kun , Zhang Ying , Mu Shiqing , Lv Ming , Jiang Peng , Duan ChuanZhi , Zhang Hongqi , Qu Yan , He Min , Yang Xinjian 
Published: September 2018

AbstractBackgroundRuptured aneurysms, the commonest cause of nontraumatic subarachnoid hemorrhage, can be catastrophic; the mortality and morbidity of affected patients being very high. Some risk factors, such as smoking, hypertension and female sex have been identified, whereas others, such as hemodynamics, imaging, and genomics, remain unclear. Currently, no accurate model that includes all factors for predicting such rupture is available. We plan to use data from a large cohort of Chinese individuals to set up a multidimensional model for predicting risk of rupture of unruptured intracranial aneurysms (UIAs).MethodsThe China Intracranial Aneurysm Project-2 (CIAP-2) will comprise screening of a cohort of 500 patients with UIA (From CIAP-1) and focus on hemodynamic factors, high resolution magnetic resonance imaging (HRMRI) findings, genetic factors, and biomarkers. Possible risk factors for rupture of UIA, including genetic factors, biomarkers, HRMRI, and hemodynamic factors, will be analyzed. The first project of the China Intracranial Aneurysm Project (CIAP-1; chaired by the Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China) will prospectively collect a cohort of 5000 patients with UIA from 20 centers in China, and collect baseline information for each patient. Multidimensional data will be acquired in follow-up assessments. Statistically significant clinical features in the UIA cohort will also be analyzed and integrated into the model for predicting risk of UIA rupture. After the model has been set up, the resultant evidence-based prediction will provide a preliminary theoretical basis for treating aneurysms at high risk of rupture.DiscussionThis study will explore the risk of rupture of aneurysms and develop a scientific multidimensional model for predicting rupture of unruptured intracranial aneurysms.Clinical Trials registrationA Study on a Multidimensional Prediction Model for Rupture Risk of Unruptured Intracranial Aneurysms (CIAP-2), NCT03133624. Registered: 16 April 2017.https://clinicaltrials.gov/ct2/show/NCT03133624
Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal- a prospective cohort study
Authors: Siwakoti Shraddha , Subedi Asish , Sharma Abhilasha , Baral Ratna , Bhattarai Narayan Raj , Khanal Basudha 
Published: September 2018

Abstract
Background
Infections caused by multi-drug resistant gram-negative bacterial infections are the principle threats to the critically ill patients of intensive care units. Increasing reports of these infections from the Nepalese intensive care unit underline the clinical importance of these pathogens. However, the impact of these infections on the patient’s clinical outcome has not yet been clearly evaluated. The objective of our study was to determine the incidence and associated clinical outcome of multi-drug resistant gram-negative bacterial infections in intensive care unit from a tertiary care center of Nepal.

Methods
A prospective cohort study was conducted among adult patients admitted in intensive care unit of B. P Koirala Institute of Health Sciences from July to December 2017. Patients infected with multi-drug resistant gram-negative bacteria, non-multi-drug resistant gram-negative bacteria and those without infection were included. Identification of gram-negative bacteria and their antibiotic susceptibility pattern was performed with standard microbiological methods. Demographic, clinical profiles and outcomes (in-hospital-mortality, intensive care unit and hospital length of stay) were documented.

Results
The incidence rate of multi-drug resistant gram-negative bacteria infections was 47 per 100 admitted patients (64/137) with 128 episodes. Acinetobacter species (41%, 52/128) was the commonest followed by Klebsiella pneumoniae (28%, 36/128) and Pseudomonas spp (21%, 27/128). Patients with multi-drug resistant gram-negative bacteria in comparison to non-multi-drug resistant gram-negative bacteria had high healthcare-associated infections (95%, 61/64 versus 20%, 2/10; p = < 0.001). In-hospital-mortality was 38% (24/64), 20% (2/10) and 10% (4/41) in multi-drug resistant, non-multi-drug resistant and uninfected group respectively (p = 0.007). After adjustment for independent risk factors, compared to uninfected patients, the odds ratio (CI) for in-hospital-mortality in multi-drug resistant and non-multi-drug resistant group was (4.7[1.4–15.5], p = 0.01) and 2.60 [0.38–17.8], p = 0.32) respectively. Multi-drug resistant patients also had longer intensive care unit and hospital stay, however, it was statistically insignificant.

Conclusion
The incidence of multi-drug resistant gram-negative bacterial infections was remarkably high in our intensive care unit and showed a significant association with healthcare-associated infections and in-hospital-mortality.
Characterization of drug responses of mini patient‐derived xenografts in mice for predicting cancer patient clinical therapeutic response
Authors: Zhang Feifei , Wang Wenjie , Long Yuan , Liu Hui , Cheng Jijun , Guo Lin , Li Rongyu , Meng Chao , Yu Shan , Zhao Qingchuan , Lu Shun , Wang Lili , Wang Haitao , Wen Danyi 
Published: September 2018

AbstractBackgroundPatient‐derived organoids and xenografts (PDXs) have emerged as powerful models in functional diagnostics with high predictive power for anticancer drug response. However, limitations such as engraftment failure and time‐consuming for establishing and expanding PDX models followed by testing drug efficacy, and inability to subject to systemic drug administration for ex vivo organoid culture hinder realistic and fast decision‐making in selecting the right therapeutics in the clinic. The present study aimed to develop an advanced PDX model, namely MiniPDX, for rapidly testing drug efficacy to strengthen its value in personalized cancer treatment.MethodsWe developed a rapid in vivo drug sensitivity assay, OncoVee® MiniPDX, for screening clinically relevant regimens for cancer. In this model, patient‐derived tumor cells were arrayed within hollow fiber capsules, implanted subcutaneously into mice and cultured for 7 days. The cellular activity morphology and pharmacokinetics were systematically evaluated. MiniPDX performance (sensitivity, specificity, positive and negative predictive values) was examined using PDX as the reference. Drug responses were examined by tumor cell growth inhibition rate and tumor growth inhibition rate in PDX models and MiniPDX assays respectively. The results from MiniPDX were also used to evaluate its predictive power for clinical outcomes.ResultsMorphological and histopathological features of tumor cells within the MiniPDX capsules matched those both in PDX models and in original tumors. Drug responses in the PDX tumor graft assays correlated well with those in the corresponding MiniPDX assays using 26 PDX models generated from patients, including 14 gastric cancer, 10 lung cancer and 2 pancreatic cancer. The positive predictive value of MiniPDX was 92%, and the negative predictive value was 81% with a sensitivity of 80% and a specificity of 93%. Through expanding to clinical tumor samples, MiniPDX assay showed potential of wide clinical application.ConclusionsFast in vivo MiniPDX assay based on capsule implantation was developed‐to assess drug responses of both PDX tumor grafts and clinical cancer specimens. The high correlation between drug responses of paired MiniPDX and PDX tumor graft assay, as well as translational data suggest that MiniPDX assay is an advanced tool for personalized cancer treatment.