bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of the Axial Spacing Between Rotor and Stator With Regard to the Indexing in an Axial Compressor
Authors: Layachi M. Y. , Bölcs A. 
Published: July 2014

An experimental investigation was carried out to examine the influence of the axial spacing between rotor and stator. The test facility of the Swiss Federal Institute of Technology is made up of an inlet guide vane (IGV), a rotor and a stator.
Temperature and aerodynamic measurements determined the characteristics of the compressor stage. Data were acquired over a range of flow coefficients for four different axial spacings. A refined measurement mesh was used for Pitot probe measurements in different sections of the compressor.
As the compressor has a rather low aspect ratio of 1.21, the flow was governed by strong secondary flows. The interaction between the different secondary flows, especially the Influence of the IGV wake on the secondary flows in the stator, were detected by the detailed Pitot probe measurements. Shifting the stator axially changes the circumferential position of the IGV wake entering the stator. From this statement, the link between an axial variation of the distance between rotor and stator and the clocking between IGV and stator will be shown. Further Pitot measurement with different indexings between IGV and stator were performed. The Pitot measurements for the different axial spacings as for the different indexings brought to light strong interactions in the wall regions especially between the IGV wake and the clearances at the rotor tip and at the stator hub. The structure of the flow thus changes with the indexing and with the axial spacing.
Highly Recombinant VGII Cryptococcus gattii Population Develops Clonal Outbreak Clusters through both Sexual Macroevolution and Asexual Microevolution
Authors: Billmyre R. Blake , Croll Daniel , Li Wenjun , Mieczkowski Piotr , Carter Dee A. , Cuomo Christina A. , Kronstad James W. , Heitman Joseph 
Published: July 2014

ABSTRACT

An outbreak of the fungal pathogen
Cryptococcus gattii
began in the Pacific Northwest (PNW) in the late 1990s. This outbreak consists of three clonal subpopulations: VGIIa/major, VGIIb/minor, and VGIIc/novel. Both VGIIa and VGIIc are unique to the PNW and exhibit increased virulence. In this study, we sequenced the genomes of isolates from these three groups, as well as global isolates, and analyzed a total of 53 isolates. We found that VGIIa/b/c populations show evidence of clonal expansion in the PNW. Whole-genome sequencing provided evidence that VGIIb originated in Australia, while VGIIa may have originated in South America, and these were likely independently introduced. Additionally, the VGIIa outbreak lineage may have arisen from a less virulent clade that contained a mutation in the
MSH2
ortholog, but this appears to have reverted in the VGIIa outbreak strains, suggesting that a transient mutator phenotype may have contributed to adaptation and evolution of virulence in the PNW outbreak. PNW outbreak isolates share genomic islands, both between the clonal lineages and with global isolates, indicative of sexual recombination. This suggests that VGII
C. gattii
has undergone sexual reproduction, either bisexual or unisexual, in multiple locales contributing to the production of novel, virulent subtypes. We also found that the genomes of two basal VGII isolates from HIV
+
patients contain an introgression tract spanning three genes. Introgression substantially contributed to intra-VGII polymorphism and likely occurred through sexual reproduction with VGI. More broadly, these findings illustrate how both microevolution and sexual reproduction play central roles in the development of infectious outbreaks from avirulent or less virulent progenitors.

IMPORTANCE
Cryptococcus gattii
is the causative agent responsible for ongoing infections in the Pacific Northwest of the United States and western Canada. The incidence of these infections increased dramatically in the 1990s and remains elevated. These infections are attributable to three clonal lineages of
C. gattii
, VGIIa, VGIIb, and VGIIc, with only VGIIa identified once previously in the Pacific Northwest prior to the start of the outbreak, albeit in a less virulent form. This study addresses the origin and emergence of this outbreak, using whole-genome sequencing and comparison of both outbreak and global isolates. We show that VGIIa arose mitotically from a less virulent clonal group, possibly via the action of a mutator phenotype, while VGIIb was likely introduced from Australia, and VGIIc appears to have emerged in the United States or in an undersampled locale via sexual reproduction. This work shows that multiple processes can contribute to the emergence of an outbreak.
The nature and importance of quality of therapeutic relationships in the delivery of palliative care to people with intellectual disabilities
Authors: Ryan Karen , Guerin Suzanne , McEvoy John 
Published: July 2014

BackgroundThe importance of the therapeutic relationship in the delivery of palliative care is well recognised. Little has been published on the nature or quality of relationships formed between staff and patients with intellectual disabilities despite case reports suggesting that difficulties exist in providing palliative care to this group.AimsThis study was part of a project that aimed to describe the delivery of palliative care to people with intellectual disabilities in a region of Ireland and to conduct a corporate assessment of palliative care need. We detail findings that explore the nature and importance of the quality of relationship in the delivery of care.Methods91 staff from palliative care and intellectual disability services participated in 16 focus groups.FindingsStaff valued their relationships with service users, and felt that the quality of their relationship affected its therapeutic potential. Participants described factors fundamental to the development of quality relationships. Palliative care and intellectual disability staff commented on the importance of trust, of continuity of relationship and of knowing the individual. However, palliative care staff admitted to difficulties in these areas when providing care to people with intellectual disabilities. It appeared that quality of care was affected in situations where staff failed to form authentic relationships.ConclusionsThis study adds to our knowledge of the processes of delivery of care to people with intellectual disabilities. The description of difficulties experienced by palliative care staff gives us an opportunity to develop strategies to improve the quality of services provided.
Harnessing the Intestinal Microbiome for Optimal Therapeutic Immunomodulation
Authors: Viaud S. , Daillère R. , Boneca I.G. , Lepage P. , Pittet M.J. , Ghiringhelli F. , Trinchieri G. , Goldszmid R. , Zitvogel L. 
Published: July 2014

Abstract
Distinct cytotoxic agents currently used in the oncological armamentarium mediate their clinical benefit by influencing, directly or indirectly, the immune system in such a way that innate and adaptive immunity contributes to the tumoricidal activity. Now, we bring up evidence that both arms of anticancer immunity can be triggered through the intervention of the intestinal microbiota. Alkylating agents, such as cyclophosphamide, set up the stage for enhanced permeability of the small intestine, facilitating the translocation of selected arrays of Gram-positive bacteria against which the host mounts effector pTh17 cells and memory Th1 responses. In addition, gut commensals, through lipopolysaccharide and other bacterial components, switch the tumor microenvironment, in particular the redox equilibrium and the TNF production of intratumoral myeloid cells during therapies with platinum salts or intratumoral TLR9 agonists combined with systemic anti-IL10R Ab respectively. Consequently, antibiotics can compromise the efficacy of certain chemotherapeutic or immunomodulatory regimens. Cancer Res; 74(16); 4217–21. ©2014 AACR.
Dual Inhibition of EGFR with Afatinib and Cetuximab in Kinase Inhibitor–Resistant EGFR-Mutant Lung Cancer with and without T790M Mutations
Authors: Janjigian Yelena Y. , Smit Egbert F. , Groen Harry J.M. , Horn Leora , Gettinger Scott , Camidge D. Ross , Riely Gregory J. , Wang Bushi , Fu Yali , Chand Vikram K. , Miller Vincent A. , Pao William 
Published: July 2014

Abstract
EGFR-mutant lung cancers responsive to reversible EGFR inhibitors (gefitinib/erlotinib) develop acquired resistance, mediated by second-site EGFR T790M mutation in &gt;50% of cases. Preclinically, afatinib (irreversible ErbB family blocker) plus cetuximab (anti-EGFR monoclonal antibody) overcomes T790M-mediated resistance. This phase Ib study combining afatinib and cetuximab enrolled heavily pretreated patients with advanced EGFR-mutant lung cancer and acquired resistance to erlotinib/gefitinib. Patients provided post–acquired-resistance tumor samples for profiling EGFR mutations. Among 126 patients, objective response rate (overall 29%) was comparable in T790M-positive and T790M-negative tumors (32% vs. 25%; P = 0.341). Median progression-free survival was 4.7 months (95% confidence interval, 4.3–6.4), and the median duration of confirmed objective response was 5.7 months (range, 1.8–24.4). Therapy-related grade 3/4 adverse events occurred in 44%/2% of patients. Afatinib–cetuximab demonstrated robust clinical activity and a manageable safety profile in EGFR-mutant lung cancers with acquired resistance to gefitinib or erlotinib, both with and without T790M mutations, warranting further investigation.
Significance: This article reports the results of a trial combining afatinib and cetuximab in patients with acquired resistance and details the first clinical proof-of-concept for the preclinical hypothesis that a significant proportion of tumors in patients with acquired resistance to gefitinib/erlotinib remain dependent on EGFR signaling for survival. Cancer Discov; 4(9); 1036–45. ©2014 AACR.
See related commentary by Gibbons and Byers, p. 991
This article is highlighted in the In This Issue feature, p. 973
Tricuspid Regurgitation in Hypoplastic Left Heart Syndrome
Authors: Kutty Shelby , Colen Timothy , Thompson Richard B. , Tham Edythe , Li Ling , Vijarnsorn Chodchanok , Polak Amanda , Truong Dongngan T. , Danford David A. , Smallhorn Jeffrey F. , Khoo Nee Scze 
Published: July 2014

Background—
Our purpose was to test the following hypotheses: (1) patients with hypoplastic left heart syndrome who develop significant tricuspid regurgitation (TR) or require tricuspid valve (TV) surgery in the medium term have detectable TV abnormalities by 3-dimensional echocardiography (3DE) prestage 1 palliation and (2) TR is associated with reduced survival and increased TV intervention.

Methods and Results—

Infants were prospectively studied with 3DE and 2DE prestage 1 and followed up for the end points of TR, TV surgery, transplantation, or death. From prestage 1 3DE, spatial coordinates of TV annulus and leaflets were extracted; annulus size, leaflet area, prolapse volume, tethering volume, bending angle, and papillary muscle angle were measured. TR was assessed prestage 1 and at latest follow-up. Of 70 patients, 62 (88.6%) had mild or less TR and 8 (11.4%) had moderate or greater TR prestage 1. Prestage 1 tethering volume correlated to leaflet area (
r
=0.736;
P
<0.001), annulus area (
r
=0.651;
P
<0.001), right ventricular end-diastolic area (
r
=0.347;
P
=0.003), fractional area change (
r
=−0.387;
P
<0.001), and TR grade (
r
=0.447;
P
<0.001). At follow-up, 46 (65.7%) had mild or less TR (group A) and 24 (34.3%) had moderate or greater TR (group B). Prestage 1 3DE showed greater TV tethering volume and flatter annulus in group B. Survival was better in group A.

Conclusions—
Increased TV tethering volume and flatter bending angle prestage 1 palliation is associated with TV failure at medium-term follow-up. Increased prestage 1 tethering is related to having larger TV annulus, larger leaflet area, larger right ventricular size, and reduced systolic function. TR progression results in increased TV intervention and decreased survival.
Impact of Time of Presentation on Process Performance and Outcomes in ST-Segment–Elevation Myocardial Infarction
Authors: Dasari Tarun W. , Roe Matthew T. , Chen Anita Y. , Peterson Eric D. , Giugliano Robert P. , Fonarow Gregg C. , Saucedo Jorge F. 
Published: July 2014

Background—
Prior studies demonstrated that patients with ST-segment–elevation myocardial infarction presenting during off-hours (weeknights, weekends, and holidays) have slower reperfusion times. Recent nationwide initiatives have emphasized 24/7 quality care in ST-segment–elevation myocardial infarction. It remains unclear whether patients presenting off-hours versus on-hours receive similar quality care in contemporary practice.

Methods and Results—

Using Acute Coronary Treatment and Intervention Outcomes Network-Get With The Guidelines (ACTION-GWTG) database, we examined ST-segment–elevation myocardial infarction performance measures in patients presenting off-hours (n=27 270) versus on-hours (n=15 972; January 2007 to September 2010) at 447 US centers. Key quality measures assessed were aspirin use within first 24 hours, door-to-balloon time, door-to-ECG time, and door-to-needle time. In-hospital risk-adjusted all-cause mortality was calculated. Baseline demographic and clinical characteristics were similar. Aspirin use within 24 hours approached 99% in both groups. Among patients undergoing primary percutaneous coronary intervention (n=41 979; 97.1%), median door-to-balloon times were 56 versus 72 minutes (
P
<0.0001) for on-hours versus off-hours. The proportion of patients achieving door-to-balloon time ≤90 minutes was 87.8% versus 79.2% (
P
<0.0001), respectively. There were no differences attaining door-to-ECG time ≤10 minutes (73.4% versus 74.3%,
P
=0.09) and door-to-needle time ≤30 minutes (62.3% versus 58.7%;
P
=0.44) between on-hours versus off-hours. Although in-hospital all-cause mortality was similar (4.2%) in both groups, the risk-adjusted all-cause mortality was higher for patients presenting off-hours (odds ratio, 1.13; 95% confidence interval, 1.02–1.26).

Conclusions—
In contemporary community practice, achievement of quality performance measures in patients presenting with ST-segment–elevation myocardial infarction was high, regardless of time of presentation. Door-to-balloon time was, however, slightly delayed (by an average of 16 minutes), and risk-adjusted in-hospital mortality was 13% higher in patients presenting off-hours.
Elizabeth I and Pope Paul IV
Authors: Booth Ted W. 
Published: July 2014

This article is a historical look at the political and religious relationship between England’s Elizabeth I and Pope Paul IV. In 1558 when Elizabeth I ascended the throne of England, there was much speculation about how she would be received by a Pope so well-known for his intolerance of heresy and zeal for the Inquisition. This article will argue that a complex set of forces were at work during Elizabeth’s early reign which allowed her time to pass legislation to establish the English Church as a separate entity from Rome. It would be Paul IV’s inaction, possibly born out of a hope that Elizabeth might still be redeemed to the Catholic faith, that in the end allowed the English Church to consolidate its gains and left his Catholic subjects with no recourse but to give allegiance to their prince whether they thought her illegitimate or not.
Cloud Banding and Winds in Intense European Cyclones: Results from the DIAMET Project
Authors: Vaughan G. , Methven J. , Anderson D. , Antonescu B. , Baker L. , Baker T. P. , Ballard S. P. , Bower K. N. , Brown P. R. A. , Chagnon J. , Choularton T. W. , Chylik J. , Connolly P. J. , Cook P. A. , Cotton R. J. , Crosier J. , Dearden C. , Dorsey J. R. , Frame T. H. A. , Gallagher M. W. , Goodliff M. , Gray S. L. , Harvey B. J. , Knippertz P. , Lean H. W. , Li D. , Lloyd G. , Martínez–Alvarado O. , Nicol J. , Norris J. , Öström E. , Owen J. , Parker D. J. , Plant R. S. , Renfrew I. A. , Roberts N. M. , Rosenberg P. , Rudd A. C. , Schultz D. M. , Taylor J. P. , Trzeciak T. , Tubbs R. , Vance A. K. , van Leeuwen P. J. , Wellpott A. , Woolley A. 
Published: July 2014

Abstract
The Diabatic Influences on Mesoscale Structures in Extratropical Storms (DIAMET) project aims to improve forecasts of high-impact weather in extratropical cyclones through field measurements, high-resolution numerical modeling, and improved design of ensemble forecasting and data assimilation systems. This article introduces DIAMET and presents some of the first results. Four field campaigns were conducted by the project, one of which, in late 2011, coincided with an exceptionally stormy period marked by an unusually strong, zonal North Atlantic jet stream and a succession of severe windstorms in northwest Europe. As a result, December 2011 had the highest monthly North Atlantic Oscillation index (2.52) of any December in the last 60 years. Detailed observations of several of these storms were gathered using the U.K.’s BAe 146 research aircraft and extensive ground-based measurements. As an example of the results obtained during the campaign, observations are presented of Extratropical Cyclone Friedhelm on 8 December 2011, when surface winds with gusts exceeding 30 m s–1 crossed central Scotland, leading to widespread disruption to transportation and electricity supply. Friedhelm deepened 44 hPa in 24 h and developed a pronounced bent-back front wrapping around the storm center. The strongest winds at 850 hPa and the surface occurred in the southern quadrant of the storm, and detailed measurements showed these to be most intense in clear air between bands of showers. High-resolution ensemble forecasts from the Met Office showed similar features, with the strongest winds aligned in linear swaths between the bands, suggesting that there is potential for improved skill in forecasts of damaging winds.
Dynamics of Landfalling Atmospheric Rivers over the North Pacific in 30 Years of MERRA Reanalysis
Authors: Payne Ashley E. , Magnusdottir Gudrun 
Published: July 2014

AbstractA large-scale analysis of landfalling atmospheric rivers (ARs) along the west coast of North America and their association with the upper-tropospheric flow is performed for the extended winter (November–March) for the years 1979–2011 using Modern-Era Retrospective Analysis for Research and Applications (MERRA) reanalysis data. The climatology, relationship to the El Niño–Southern Oscillation and the Madden–Julian oscillation, and upper-level characteristics of approximately 750 landfalling ARs are presented based on the 85th percentile of peak daily moisture flux. AR occurrence along the West Coast is dominated by early season events. In composites of upper-level fields during AR occurrences, certain characteristics stand out irrespective of the tropical climate indices. This suggests that extratropical dynamical processes play a key role in AR dynamics.The influence of the large-scale circulation on AR intensity prior to landfall is examined by objectively selecting an extreme subset of 112 landfalling AR dates representing the 95th percentile of strongest cases. Each landfalling AR date that is identified is traced backward in time using a novel semiautomated tracking algorithm based on spatially and temporally connected organized features in integrated moisture transport. Composites of dynamical fields following the eastward progression of ARs show a close relationship of the location of the jet, Rossby wave propagation, and anticyclonic Rossby wave breaking in the upper troposphere of the eastern Pacific and moisture transport in the lower troposphere. Comparison between the strongest and the weakest ARs within the most extreme subset shows differences in both the intensity of moisture transport and the scale and development of anticyclonic Rossby wave breaking in the eastern Pacific.
Social Media and Severe Weather: Do Tweets Provide a Valid Indicator of Public Attention to Severe Weather Risk Communication?
Authors: Ripberger Joseph T. , Jenkins-Smith Hank C. , Silva Carol L. , Carlson Deven E. , Henderson Matthew 
Published: July 2014

AbstractEffective communication about severe weather requires that providers of weather information disseminate accurate and timely messages and that the intended recipients (i.e., the population at risk) receive and react to these messages. This article contributes to extant research on the second half of this equation by introducing a “real time” measure of public attention to severe weather risk communication based on the growing stream of data that individuals publish on social media platforms, in this case, Twitter. The authors develop a metric that tracks temporal fluctuations in tornado-related Twitter activity between 25 April 2012 and 11 November 2012 and assess the validity of the metric by systematically comparing fluctuations in Twitter activity to the issuance of tornado watches and warnings, which represent basic but important forms of communication designed to elicit, and therefore correlate with, public attention. The assessment finds that the measure demonstrates a high degree of convergent validity, suggesting that social media data can be used to advance our understanding of the relationship between risk communication, attention, and public reactions to severe weather.
The Impact of Nasal Surgery on Sleep Quality: A Prospective Outcomes Study
Authors: Stapleton Amanda L. , Chang Yue‐Fang , Soose Ryan J. , Gillman Grant S. 
Published: July 2014

Objective(1) Evaluate the impact of nasal airway surgery on sleep quality using validated outcome measurements, (2) compare the utility of Epworth Sleepiness Scale (ESS) versus Pittsburgh Sleep Quality Index (PSQI) as a reflection of sleep quality, and (3) identify perioperative variables that might correlate with a beneficial effect of nasal surgery on sleep quality.Study DesignProspective outcome study of patients with symptomatic nasal obstruction undergoing nasal airway surgery.SettingAcademic medical center.MethodsPatients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale, ESS, PSQI, and Ease‐of‐Breathing and Sleep Quality Likert scales preoperatively and 3 months postoperatively. A nonparametric analysis compared pre‐ and postoperative values, and associations were examined using Spearman correlations.ResultsSixty‐one patients completed the study. Mean NOSE scores decreased significantly from 68.2 preoperatively to 17.5 three months after surgery. Mean ESS scores and PSQI scores improved (P <. 0001) over that same interval (7.5 to 5.3 and 7.8 to 4.6, respectively). There was a correlation seen between the degree of change in both NOSE scores and Ease‐of‐Breathing scores and the change in sleep quality measured using the PSQI or Sleep Quality Likert scores. The PSQI correlated better with Sleep Quality Likert scores than the ESS. Overall, 86.9% of subjects reported subjective improvement in sleep quality postoperatively.ConclusionIn patients undergoing nasal airway surgery there may be a secondary improvement in subjective sleep quality. The degree of change in sleep quality correlates with the severity of nasal obstruction preoperatively and the degree of improvement in obstruction with surgery.