Intermediate Reference Research Articles

Combined evaluation of aminotransferases improves risk stratification for overall and cause-specific mortality in older patients.

Recent studies identified low levels of alanine aminotransferase (ALT) as strong predictors of mortality in older people. Here we verified if the combined evaluation of aminotransferases may improve risk stratification for adverse outcomes in older patients. Data are from 761 participants aged more than 65years from a prospective population-based database (InCHIANTI study), without known baseline chronic liver disease or malignancies. Associations between aminotransferase levels and the risk of all-cause, cardiovascular- and cancer-death were assessed by Cox-models with time-dependent covariates. The association of ALT and aspartate aminotransferase (AST) with mortality was non-linear, mirroring a J- and a U-shaped curve, respectively. Based on quintiles of transaminase activities and on their association with overall mortality, low, intermediate (reference group) and high levels were defined. Having at least one transaminase in the low range [aHR 1.76 (1.31-2.36), p < 0.001], mainly if both [(aHR 2.39 (1.81-3.15), p < 0.001], increased the risk of overall mortality, as well as having both enzymes in the high range [aHR 2.14 (1.46-3.15), p < 0.001]. While similar trends were confirmed with respect to cardiovascular mortality, subjects with the highest risk of cancer mortality were those with both enzymes in the high range [aHR 3.48 (1.43-8.44), p = 0.006]. Low levels of transaminases were associated with frailty, sarcopenia and disability, while high levels did not capture any known proxy of adverse outcome. Conclusions and discussion The prognostic information is maximized by the combination of the 2 liver enzymes. While both aminotransferases in low range are characteristically found in the most fragile phenotype, both enzymes in high range are more likely to identify new-onset vascular/infiltrative diseases with adverse outcome.

Determining the Prevalence of Rifampicin Resistant Tuberculosis in A Tertiary Care Centre of North India by using Rapid Culture Method and Gene Xpert

The objective of the present study is to find the prevalence of Mycobacterium tuberculosis from respiratory samples like sputum, BAL and pleural fluid, compare conventional LJ culture with rapid culture method i.e Mycobacterium growth indicator tube (MGIT) and to determine the pattern of drug resistance by automated methods i.e Gene Xpert. Respiratory samples were collected in sterile, wide-mouth, disposable, leak proof containers without any preservatives. Specimens were inoculated into MGIT for primary isolation of Mycobacteria. The specimen was processed according to the SOP manual provided by Becton Dickinson Company. The tubes were read for increasing fluorescence by MGIT reader. Reported results only when a MGIT tube was positive by the MGIT reader and smear made from the positive broth is also positive for AFB. For further identification, TBcID card test was put from MGIT positive tube and the result was given accordingly as mentioned in the procedure for TBcID kit insert. Polymerase chain reaction (PCR) was done in all 17 positive cases. The drug sensitivity test (CB-NAAT) was done at State Intermediate Reference Laboratory, Chandan Nagar, Dehradun, Uttrakhand as per RNTCP laboratory operational guidelines. In our study total number of samples received from the clinically suspected cases of pulmonary tuberculosis were 156, out of which 11% were positive and 89% were negative. The predominant age group involved was 51-60 years 24%, followed by 61-70 years 22%. In young children and adolescent age group very less number of samples were received i.e. 0-5%. Out of 17 positive samples, 94.11% (16/17) were detected as sensitive for Rifampicin and 5.89% (1/17) were resistant. On the statistical analysis of our data for MGIT, Positive Predictive Value (PPV) was 29% against Negative Predictive Value (NPV) of 100%. The specificity of MGIT was 92% against a sensitivity of 100%. Culture is still needed for species identification, confirmation and drug susceptibility testing. The diagnostic superiority of MGIT, both in terms of sensitivity and specificity has been proven better as compared to LJ in previous other studies and supported by our study as well. In our study, the diagnostic efficacy of MGIT culture was found to be superior as compared to the conventional LJ culture. The positivity rate was 10.89% (17/156) in MGIT &amp; 3.2% (5/156) in LJ culture.

Literature by Other Mediums: Revisiting Lu Xun's Preface to Outcry

AbstractBy recounting how Lu Xun 鲁迅 went from studying medicine in Japan to writing for the magazine Xin qingnian 新青年 (New Youth), the preface to Nahan 呐喊 (Outcry, 1923), Lu Xun's first collection of short stories, not only presents an origin story of an important author but also contains important clues for understanding modern Chinese literature. This article offers a new reading of that canonical text by focusing on the problem of medium. Synthesizing author biography, media history, and textual analysis, it examines three intermedial references in the preface—the famous lantern slide, the modern periodical, and the recurring notion of outcry. As an autobiographical account, the preface contains narrated events that call for more media-centered analysis, including the “slide incident” (renamed “screen incident”) and Lu Xun's failed experiment with the periodical medium. Reading the preface as an act of narration, this article scrutinizes textual choices such as the confusing word dianying 电影 (film) and the outcry metaphor. The emergence of both modern vernacular literature and Lu Xun as a major literary figure, it is argued, should be historicized in a broader transnational media environment, in which diverse media practices intersected.

Velázquez, Wagner and the Red Skull. Intermediality and the Genesis of Meaning in a Particular Scene of Captain America: The First Avenger

Abstract In the 2011 superhero movie, Captain America: The First Avenger (produced by Marvel Studios, directed by Joe Johnston) the main opponent of the title character is a Nazi officer, Johann Schmidt, who turns out to be a kind of superhuman entity, the Red Skull. Throughout the movie, viewers can follow the process of him gradually leaving behind his identity as a Nazi officer, and presenting himself as the leader of the occult-high-tech terrorist organization, the Hydra. At a certain point we can see him visited by one of the scientists working for him, Doctor Zola, whom he puts wise to his plans. During the conversation a portrait is being painted of the Red Skull, but we cannot see his face, only that the artist uses a huge amount of red paint. In the background, excerpts of Wagner’s operas are being played, which is very unusual in a Marvel movie. The question is, should the viewer recognize the diegetic music and notice the possible reference to the painting Las Meninas by Velázquez? How the detection of these intermedial references and the awareness of the act of trespassing media borders would affect the semiotic processes of interpretation? And also, how would the more precise identification of the cited materials change the semiotic modality of intermediality here? The article tries to answer these questions by interpreting the scene and the role of the references in question within the entire film through the prism of intermedial semiotics.

Decoding Tableaux Vivants: the Metareferential Potential of Painterly References in Cinema

Abstract The article focuses on the intermedial relationship between cinema and painting, viewed as a self-referential process, and tries to determine various ways in which this type of signifying process can be used to “encode” various messages (within the work itself), or become an integral part of this (meta)communicative operation. Starting from a broad definition of intermedial references and continuing with a brief recontextualized detour through Gérard Genette’s taxonomy of transtextual instances, the author narrows down a specific technique that exemplifies this type of “codifying” procedure, namely the tableau vivant. In accordance with Werner Wolf’s proposed terminology, he attempts to determine the metareferential potential of this extra-compositional self-referential technique. The case studies focus on films by Peter Greenaway and Lars von Trier.

Prevalence and speciation of non-tuberculous mycobacteria among pulmonary and extrapulmonary tuberculosis suspects in South India

Background and objectivesNon tuberculous mycobacteria (NTM) is an emerging opportunistic pathogen increasing globally and indistinguishable from tuberculosis (TB), which remains a challenge particularly in developing countries. This study aimed to identify the prevalence and diversity of NTM among both pulmonary TB (PTB) and extrpulmonary TB (EPTB) clinical isolates from south India. MethodologyA total of 7633 specimens from TB suspects (PTB, n = 4327 and EPTB, n = 3306) were collected during the study period (July 2018–March 2020) in a tertiary care hospital. The study specimens were subjected to Ziehl Neelsen (ZN) staining and Auramine phenol (AP) staining followed by Lowenstein–Jensen (LJ) and mycobacteria growth indicator tube (MGIT) culture. The MPT64 immunochromatographic test (ICT) was performed among mycobacterial cultures and ICT negative isolates were subjected to Line Probe Assay (LPA). In addition, 53 (PTB, 48 and EPTB, 5) NTM MGIT positive cultures were collected from Intermediate Reference Laboratory (IRL), Puducherry and subjected to LPA for speciation. ResultsOf the 7633 TB suspects, 0.6% were diagnosed as NTM diseases and 5.5% with Mycobacterium tuberculosis (MTBC). NTM infection was observed among 0.7% (31/4327) of PTB and 0.4% (14/3306) of EPTB. MTBC was detected among 6.1% (264/4327) of PTB and 4.6% (153/3306) of EPTB. Among 98 NTM cultures, 80.6% of isolates were recovered from PTB and 19.4% from EPTB specimens. Among pulmonary specimens, Mycobacterium intracellulare (26.6%), Mycobacterium abscessus (17.7%) and Mycobacterium kansasii (12.7%) were the most frequently detected species, while Mycobacterium intracellulare (21.1%), Mycobacterium scrofulaceum (15.8%) and Mycobacterium fortuitum (10.5%) were common in extrapulmonary specimens. ConclusionThe frequency of NTM infection among TB suspects was low at a South Indian tertiary care hospital. The most predominant NTM species isolated from both pulmonary and extrapulmonary specimens was M. intracellulare.

О НЕСКОЛЬКИХ «ЭРМИТАЖНЫХ» ЭКФРАСИСАХ ВИКТОРА КРИВУЛИНА

In the practice of the Soviet literary underground, it was important to restore connections with tradition, hidden or edited according to the ideological models. Dialogue with tradition was recognized as a condition for achieving creative independence and cultural identity. Naturally, many texts created outside official Soviet literature have a wide layer of intertextual and intermedial references, often pointing to cultural layers and semantic areas that are not related to each other. A typical example of such an allusional multilayeredness and polyreferentiality is poetic ekphrasis. One of the most important literary figures of the Soviet samizdat was the poet Viktor Krivulin. In his samizdat books, many texts have obvious markers of ekphrastic descriptions referring to fine art, music, and cinema; a typical feature of his poetry is ‘complex ekphrasis’, which combines references to different works. This article deals with several of his poems related to the collection of paintings at the Hermitage, in particular the texts devoted to the paintings by Bartolomeo Murillo and Tiziano Vecellio. Krivulin’s reception of fine art was found to be influenced by his reading experience: the interpretation of the paintings is correlated with other examples of cultural reception of the same artist. Thus, ekphrasis is not only a description of a particular work but also the experience of reflection on the history of perception of an artist in culture, as well as the experience of self-relation with other ekphrases. The form of ekphrastic text thus appears for the poet as a means of historical and culturological reflection.

Alguns cruzamentos intermidiais em "Tropicália ou Panis et Circensis"

This article discusses the song’s approach from the theoretical perspective of intermediality and analyzes the intermedial character of the record Tropicália ou Panis et Circensis(Veloso et alli 1968), taking as cut-outs some of its paratexts and songs. Connections are established between the intermediality practices and the assumptions of Oswald de Andrade’s Anthropophagy integrated to the tropicalist project under the mediation of the critic and poet Augusto de Campos. On the record combination processes incidences, transposition and intermediate reference are observed according to the categorizations proposed by Rajewsky (2012), including an ekphrasis case. Through these examples, the intermedial character of tropicalist creations is evidenced, which at the same time operate in the middle text of the song and relate to other media in a crossing borders process.

CORREGGIO'S SKETCH IN HENRY JAMES' NOVEL «THE PORTRAIT OF A LADY»: FUNCTIONS OF AN INTERMEDIAL REFERENCE

The article is devoted to the analysis of an intermediate reference to the sketch of the Italian artist of the XVI century Correggio in the 24th chapter of the novel "Portrait of a Woman" by the American writer Henry James. The influence of an intermediate reference on the disclosure of the image of Gilbert Osmond is investigated, which allows the reader to learn his additional characteristics and form a holistic idea of this character of the novel.

From the Earth to the World. Ai Weiwei's Functional Dante Reference in the Music Album The Divine Comedy (2013) and in the Lego Portrait Dante Alighieri in LEGO (2016)

This article sets out to illuminate two intermedial Dante references in the artwork of the Chinese-western artist Ai Weiwei: the music album The Divine Comedy (2013) and the Lego portrait Dante Alighieri in LEGO (2016). By paying special attention to surfaces, the “surface reading” presented in this article seeks to interrogate the function of these references. However, in place of Why? the question in this article is shaped more by How? Due to Dante's inherent mediality, the intermedial Dante references function as a social medium. The article demonstrates, how mediality becomes evident through two operators: seriality and combinatorics. By placing the artist on one of the two sides of mediation, this article implicitly reverses the role long reserved for Ai Weiwei: that of the cultural mediator.

Postmodernist Literature and Theatre From the Perspective of Intermedial (Meta)reference

Postmodernist Literature and Theatre From the Perspective of Intermedial (Meta)reference

Intermedial references and signification: Perception versus conception

Abstract The paper focuses on the issue of intermedial references, the matters of conditions, necessity and relevance of their interpretation. It discusses the question of semantic value of an intermedial reference rather than of its aesthetic, pragmatic, modal or other aspects. It considers the lack of coherence between the theoretical propositions of intermedial studies, grounded in the studies of intertextuality, and the practice of analysis. In theory, every intermedial reference configures semantic dialogue between qualified media (configurations), thus requires conceptualisation. Yet, the practice of analysis reveals that some of them perform exclusively aesthetic function and invite to keep reception within the limits of perception. Therefore I make an attempt to define the criteria of textual request for conceptualisation/interpretation set up in a text as such. I propose to revise the relevant insights of different intertextual and semiotic approaches, to perform their revision, modification and extension, to articulate possible solution and exemplify it by filmic references to painting.

Inter/Multimedial Constructions of Islam in Post-9/11 TV Series: The West Wing and 24

Since The West Wing (NBC, 1999-2006), the political drama series has been a proliferating format for fictional engagements with American politics. Georgi-Findlay focuses on how The West Wing and 24 (Fox, 2001-2010) engage public narratives about Islam and Islamophobia, arguing that the shows go beyond what Evelyn Alsultany has termed “simplified complex representations” by creating contradictory, multivocal texts that display dynamics of internal disaccord. Representations of Arabs, Muslims and Muslim countries are embedded within storylines that challenge each other. Especially The West Wing stages discussions that can lead to informed debates, reflecting and exposing the contradictions within the American national identity discourse between an inclusionist civic and an exclusionist racialized nationalism. In both series, polyvocal narratives are brought across not only by intertwining multiple discourses, but also by way of aesthetic strategies and intermedial references that supply additional textual layers, complicating viewers’ processes of meaning-making and contributing to in-text dissensus and ideological ambivalences. Both series thus can be read against the grain, as contradictory, multivocal texts that both reflect and expose Islamophobia.

Intermedial textures

Relying on the concepts of intermediality, ekphrasis and intermedial reference, the essay discusses Gilberto Freyre´s vast œuvre as that of a multiple artist, working in different áreas_ poetry, painting, literary prose_ as well as the author of groundbreaking contributions to the social sciences. The article especially underscores the close relationships between his output in the verbal and in the visual arts, remarkable for their constant reference to events, characters and landscapes analyzed in his sociological texts. In this context, the whole of Freyre´s production may be taken as a multiple, kaleidoscopic text, which, in different media, explores close- knit themes.&#x0D;

Absence of a perfect intermediate reference wavefront for anamorphic systems.

An exact reference wavefront for a single paraxial surface that provides two perpendicular remote image lines instead of a single focal point has not been provided in the recent literature. A naïve estimate would state that it may have a toric form. We provide a proof for the nonexistence of an exact toric reference wavefront for intermediate spaces in cross-cylindic symmetrical optical systems where the two principal images do not coincide. As it will be shown, such a shape exists only at the second order in the coordinates x and y in departure from a plane.

Diagnostic Evaluation of Non-Interpretable Results Associated with rpoB Gene in Genotype MTBDRplus Ver 2.0.

BackgroundLine probe assay (LPA) is standard diagnostic tool to detect multidrug resistant tuberculosis. Non-interpretable (NI) results in LPA (complete missing or light wild-type 3 and 8 bands with no mutation band in rpoB gene region) poses a diagnostic challenge.MethodsSputum samples obtained between October 2016 and July 2017 at the Intermediate Reference Laboratory, All India Institute of Medical Sciences Hospital, New Delhi, India were screened. Smear-positive and smear-negative culture-positive specimens were subjected to LPA Genotype MTBDRplus Ver 2.0. Smear-negative with culture-negative and culture contamination were excluded. LPA NI samples were subjected to phenotypic drug susceptibility testing (pDST) using MGIT-960 and sequencing.ResultsA total of 1,614 sputum specimens were screened and 1,340 were included for the study (smear-positive [n=1,188] and smear-negative culture-positive [n=152]). LPA demonstrated 1,306 (97.5%) valid results with TUB (Mycobacterium tuberculosis) band, 24 (1.8%) NI, three (0.2%) valid results without TUB band, and seven (0.5%) invalid results. Among the NI results, 22 isolates (91.7%) were found to be rifampicin (RIF) resistant and two (8.3%) were RIF sensitive in the pDST. Sequencing revealed that rpoB mutations were noted in all 22 cases with RIF resistance, whereas the remaining two cases had wild-type strains. Of the 22 cases with rpoB mutations, the most frequent mutation was S531W (n=10, 45.5%), followed by S531F (n=6, 27.2%), L530P (n=2, 9.1%), A532V (n=2, 9.1%), and L533P (n=2, 9.1%).ConclusionThe present study showed that the results of the Genotype MTBDRplus assay were NI in a small proportion of isolates. pDST and rpoB sequencing were useful in elucidating the cause and clinical meaning of the NI results.

ILS-MPM: An implicit level-set-based material point method for frictional particulate contact mechanics of deformable particles

Finite element simulations of frictional multi-body contact problems via conformal meshes can be challenging and computationally demanding. To render geometrical features, unstructured meshes are often generated via a trial-and-error procedure. This treatment also unavoidably increases the degrees of freedom and makes the construction of slave/master pairs cumbersome. In this work, we introduce an implicit material point method designed to bypass meshing of bodies by employing level set functions to represent boundaries at structured grids. This implicit function representation provides an elegant mean to link an unbiased intermediate reference surface with the true boundaries by closest point projection as shown in Leichner et al. (2019). We then enforce the contact constraints by a penalty method where the Coulomb friction law is implemented such that a return mapping algorithm can be used to provide constitutive updates for both the stick and slip states. To evolve the geometry of the contacts properly, the Hamilton–Jacobi equation is solved incrementally such that the level set and material points are both updated according to the deformation field. To improve the accuracy and regularity of the numerical integration of the material point method, a moving least square method is used to project numerical values of the material points back to the standard locations for Gaussian-Legendre quadrature. Several benchmarks are used to verify the proposed model. Comparisons with discrete element simulations are made to analyze the importance of stress fields on predicting the macroscopic responses of granular assemblies.

Intermediale Strategien in Jakob Brossmanns Lampedusa im Winter (2015) und Gianfranco Rosis Fuocoammare (2016)

With Lampedusa in Winter ( A / CH / I 2015) and Fire at Sea (I/F 2016), the Italian and Austrian filmmakers Jakob Brossmann and Gianfranco Rosi more or less simultaneously pursue similar projects: for their cinematic long term observations, both films center on the small Sicilian island of Lampedusa, a focus of mass media interest due to current migration processes and the humanitarian crisis in the Mediterranean Both rely on visual traditions of (neo-)realistic cinema in order to avoid documentary cinema's frequently didactic approach Instead of techniques such as voice-over narration and interviews (expository mode), Brossmann and Rossi most notably employ indirect address and contrastive mon tage, thus enabling the audience to experience ’authentic‘ impressions of everyday life on the island (observational mode). At the same time, however, the films themselves are inevitably part of the hype surrounding Lampedusa as the very symbol of the humanitarian crisis in the Mediterranean The article analyses how, by means of different intermedial references, the two films situate Lampedusa between everyday life and emergency, between cinematic traditions of the Italian post-war era and their anthropological and metamedial transgression

The Missing “Confessions of a Plagiarist”: Intermedial Borrowings in Friedrich Dürrenmatt’s Der Besuch der alten Dame (1956)

Friedrich Dürrenmatt’s works have long been recognized as including borrowings and intermedial references. While Dürrenmatt revealed various sources himself throughout his lifetime, not least in the provokingly entitled “Bekenntnisse eines Plagiators” (1952), the cinema of his time remained one notable omission. A contemporaneous American western, the Oscar-nominated Bad Day at Black Rock (directed by John Sturges; Metro-Goldwyn-Mayer, USA, 1955), in particular, provides a fruitful line of inquiry within the context of Der Besuch der alten Dame (1956). Parallels between the play and the film include striking structural, compositional, and formal similarities, as well as shared socio-political concerns, which help uncover another source of Dürrenmatt’s masterpiece. This article reveals much about Dürrenmatt’s method of work, namely a playful use and creative reappropriation of sources, including blockbusters from American cinema.

Cartridge-based nucleic acid amplification test (Xpert Mycobacterium tuberculosis/Rifampicin Assay): An essential molecular diagnostic test for early diagnosis and initiation of treatment in childhood tuberculous meningitis and primary multidrug-resistant cases

Background: Tuberculosis (TB) still remains the major public health threat in India. Early diagnosis, so as to initiate early treatment is a priority as any delay, may complicate the prognosis further leading to the failure of an effective control. India accounts for 6% incidence of pediatric TB cases in a population that has 40% as estimated latent TB cases. Pediatric samples were considered as the key population in the study. TB remains the most common cause of childhood meningitis in high burden countries. India accounted for the highest number of TB deaths among children in the year 2015, followed by Nigeria and China. Of which, tuberculous meningitis (TBM) stands to be the most common cause of morbidity. Extrapulmonary TB accounts for 25% of the total TB cases reported among which the most severe form being TBM. Although severe and difficult to diagnose due to lack of specific tests to get confirmed, cartridge-based nucleic acid amplification test (CBNAAT) is the only solution for microbiological confirmation of the disease for early treatment initiation and reduction of morbidity and mortality. Previously, due to lower case detection rates owing to inadequate diagnostic facilities of higher analytical sensitivity, the mortality and morbidity continued to be in the higher range, and empirical treatment modality was the mainstay till the CBNAATs came into existence. The increase in the case detection for tuberculous meningitis at a manageable stage of the disease would help in decreasing the mortality rates. The study explores the increased case detection rates among pediatric population suffering from tuberculous meningitis from referral units to Intermediate Reference Laboratory (IRL), Kolkata. Cerebrospinal fluid (CSF) from the pediatric patients has not been very difficult procedure though invasive, especially in the pediatric age group, and can be practiced at peripheral unit having CBNAAT facility. Methods: CSF from pediatric patients showing obvious clinical signs of meningitis was collected from tertiary unit linked to IRL, Kolkata, and tested on CBNAAT by Xpert Mycobacterium tuberculosis/ rifampicin (RIF) (Cepheid) along with all the pulmonary and extrapulmonary samples based on the manufacturer's instruction. The data were captured in the Inbuilt software of the GeneXpert MTB/RIF (Xpert) and Genotype MTBDRplus (DRplus) (Cepheid , USA) of the cartridge based nucleic acid amplification test machines automatically during the tests and exported to the Microsoft Excel sheets for further analysis. A defined study design against each and every objective was setup to analyze the effective detection of tuberculous meningitis case and their resistance to RIF along with the other pulmonary and extrapulmonary samples. Results and Conclusions: The study concluded the confirmation of tuberculous meningitis cases by the help of CBNAAT. The detection of microbiologically confirmed TB by these specimens sent from the referral unit linked with IRL, Kolkata, for pulmonary and extrapulmonary cases along with tuberculous meningitis cases is significant and facilitates the early initiation of treatment for TB and more so to those who are newly detected as multidrug-resistant TB especially below the 6 months of age. About 5% prevalence and around 4.9% incidence are an alarming situation in the TB control scenario of West Bengal. The positive case detection among the CSF samples was found to be more in the 0.6–1-year group followed by the age group of 1–5 years. The percentage positivity of CSF is recorded as 2.38%, and the percentage of RIF resistance among positive cases from CSF was found to be 13.79% (n = 28).