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Leikkausmäärän vaikutus haimasyöpäpotilaiden hoitoon ja ennusteeseen Suomessa
No full textHaimasyöpä on tunnetusti huonoennusteinen syöpä. Tällä hetkellä kasvaimen poistoleikkaus yhdistettynä solunsalpaajahoitoihin on paras keino parantaa ennustetta merkittävästi. Kuitenkin vain noin 15 - 20% potilaista kuuluu leikkaushoidon piiriin diagnosointihetkellä. (Ducreaux et al. 2015) Haimaleikkauksiin liittyy myös korkeaa kuolleisuutta ja sairastuvuutta. Kansainvälisissä tutkimuksissa on todettu, että riittävä leikkausvolyymi parantaa haimaleikkauksen jälkeistä ennustetta. Tämän väitöskirjatyön tarkoitus oli tutkia leikkausmäärän vaikutusta haimasyöpäpotilaiden hoitolinjoihin ja ennusteeseen leikkauksen jälkeen Suomessa. Tutkimuksessa korkean leikkausmäärän rajana pidettiin 20 haiman ja pohjukaissuolen ja koko haiman poistoa vuosittain. Tutkimus koostui neljästä rekisteripohjaisesta retrospektiivisesta osatyöstä, joiden aineistot olivat valtakunnallisia.
Ensimmäisessä osatyössä käsiteltiin vuosina 2000 - 2008 leikattujen haiman duktaalista denokarsinoomaa (PDAC) sairastavien potilaiden pitkäaikaisennustetta leikkauksen jälkeen. Tutkimuksessa todettiin että monella pitkäaikaiselossaolijalla tauti oli leikattu T3N1-vaiheessa, ja että korkeat leikkausmäärät vaikuttivat suotuisasti pitkäaikaiselossaoloon.
Toinen osatyö käsitteli leikkausmäärän vaikutusta vuosina 2002 – 2008 leikattujen PDAC-potilaiden ennusteeseen. Tutkimus osoitti, että sekä 30 vuorokauden että 90 vuorokauden kuolleisuus oli matalammillaan, kun leikkausmäärä on suuri. Lisäksi todettiin, että kahden ja kolmen vuoden elossaolot olivat korkeimmat suuren leikkausmäärän ryhmässä. Korkean leikkausmäärän yksiköissä myös patologian raportit vaikuttivat kattavimmilta.
Kolmas osatyö kuvasi vuonna 2003 tai 2008 diagnosoitujen haimasyöpäpotilaiden hoitolinjoja suhteessa sairaanhoitopiiriin, jossa diagnoosi on tehty. Tutkimustulokset kertovat, että alueilla, joissa on korkean leikkausmäärän haimakeskus, suurempi osa haimasyöpäpotilaista päätyy leikkaushoitoon.
Neljäs osatyö käsitteli leikkausmäärien vaikutusta haimaleikkausten jälkeiseen 90 vuorokauden ennusteeseen, komplikaatioihin ja kulutettuihin taloudellisiin voimavaroihin. Aineisto käsitteli vuosina 2012 - 2014 tehtyjä haimaleikkauksia. Tutkimuksessa todettiin, että korkeat leikkausmäärät johtivat matalampaan 30- ja 90 vuorokauden kuolleisuuteen ja kokonaishoitokustannuksiin.
Johtopäätöksenä voidaan esittää, että haimasyövän hoidossa on eroja sairaanhoitopiirien välillä Suomessa. Tulokset korostavat riittävän leikkausmäärän merkitystä kirurgisen hoidon suunnittelussa ja toteuttamisessa. Lisäksi voidaan todeta, että riittävä leikkausmäärän voi alentaa kokonaishoidon kustannuksia haimasyöpäpotilailla. Tutkimustulokset puoltavat haimaresektioiden keskittämistä yksiköihin, joissa leikkausmäärä on suuri.Pancreatic cancer (PC) is known for poor overall prognosis. Surgery combined with oncologic therapy is currently the best way to improve five- year survival and only 15-20% (Ducreaux et al. 2015) of patients are candidates for surgery. Moreover, pancreatic resections are associated with high mortality and morbidity rates. Internationally it has been reported that a sufficient operation volume has a beneficial effect on the short- and long- term prognosis after surgery. This thesis aimed to study the effect of operation volume on postoperative prognosis and quality of management of PC patients in Finland. A high volume centre (HVC) was defined as a centre performing at least 20 pancreatoduodenectomies (PD) and total pancreatectomies (TP) per year. The thesis comprises four retrospective studies based on national Finnish data.
The first part focuses on long-term survival after pancreatic resection among pancreatic ductal adenocarcinoma (PDAC) patients. The data comprise patients operated on between 2000 and 2008. The study shows that many long-term survivors carried a T3N1-disease. High operation volume was associated with lenghtened survival.
The second part analyses the effect of operation volume on post- operative prognosis among PDAC patients operated on between 2002 and 2008. The study shows that both 30- and 90-day mortalities were lowest in HVCs. Moreover, two- and three-year survivals were highest in the high volume group. Pathological reports seemed more precise in centres with higher operation volumes.
The third part comprises data on patients with PC diagnosed either in 2003 or in 2008. The treatment strategies are analysed in relation to the health care district where the diagnoses was set. The study shows that more patients were selected for surgery in those health care districts having a high volume pancreatic centre.
The fouth part analyses the effect of operation volume on complications, prognosis and resource utilisation after a pancreatic resection during the first 90 days among patients undergoing pancreatic resection between 2012 and 2014. The study showed that a high operation volume was associated with lower 30 and 90- day mortality and lower overall costs.
As a conclusion, this study shows that management of PC differed across health care districts in Finland. The results emphasize the benefits of high operation volume in planning and conducting the surgical care of PC patients. Moreover, pancreatic resections performed in HVCs can result in lower overall treatment costs. These findings support the centralization of pancreatic resections to HVCs
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
Author Under Sail The Imagination of Jack London, 1893-1902
No full textIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Intro -- Title Page -- Copyright Page -- Dedication -- Contents -- Acknowledgments -- Introduction -- 1. Spirit Truth -- 2. From Absorption to Theatricality and Back Again -- 3. "I Will Build a New Present" -- 4. Sons as Authors -- 5. Fathers as Publishers -- 6. The Daughter as Author -- 7. Lovers as Authors -- 8. At Sea with the Family -- 9. Yellow News, Yellow Stories -- 10. The Return Home -- Notes -- Bibliography -- Index -- About Jay WilliamsIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries
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