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Hohe Werte von Bluteosinophilen unter exazerbierten COPD Patienten sind assoziiert mit einer kürzeren Krankenhausverweildauer - eine retrospektive Datenanalyse
No full textMorbidity and mortality of chronic obstructive pulmonary disease is associated
with severe exacerbations. In severely exacerbated patients, the courses of
disease are strongly varying. This might be due to the existence of different
exacerbation phenotypes and their respective respond to the chosen treatment.
As a marker for the responsiveness to inhaled corticosteroids, current
recommendations emphasize blood eosinophil cell counts. For the treatment of
moderate to severe exacerbations, the administration of systemic steroids is
recommended. Analyses from randomized clinical trials indicate a favorable
response to systemic corticosteroids in exacerbated patients with blood
eosinophils >2%, however data outside clinical trials are scarce.
We retrospectively evaluated the association between baseline eosinophil blood
count and both short- and long-term clinical outcomes, as well as different
inflammatory parameters and markers of disease severity in patients hospitalized
due to an exacerbation of their underlying chronic obstructive pulmonary disease.
We evaluated data from 1007 cases of patients who were admitted to the
University Medical Center Marburg between 01/2013 and 12/2018. All patients
had been diagnosed with an acute exacerbation of chronic obstructive pulmonary
disease. Patients were predominantly male (65%), had a median age of 74 years
and a median forced expiratory volume in one second of 1.03l (42.6% predicted).
Our analysis was based on a subgroup of 417 patients in whom a full blood cell
count was obtained at the day of admission. We compared the hospital length of
stay, inflammatory parameters and long-term outcome using established
thresholds for the eosinophil blood cell count (100 and 300/μl and 2%). For
patients that were re-hospitalized or died in our hospital during the observational
time period, Kaplan-Meier curves were used to evaluate the long-term outcome.
Patients with low eosinophils (< 2%, < 100/μl) had a longer median time in
hospital (length of hospital stay) as compared to patients with high eosinophils (<
2%: 9.31 vs. ≥ 2%: 7 days, and 300/μl: 7
days). The median C-reactive protein and more inflammatory markers
(Procalcitonin, Neutrophil-to-lymphocyte ratio, neutrophils, leucocytes and
fibrinogen) were higher in patients with low eosinophils as compared to the other
groups (
300/μl: 7.1 mg/dl). Time to re-hospitalization or time to death did not differ
between the strata of eosinophils.
To further reinforce the generalizability of our results and to prevent avoidable
influences, we did three subgroup analyses, excluding a) patients that had
received systemic steroids before blood collection, b) patients with radiological
signs of pneumonia and c) patients who did not receive any systemic steroids
either before their hospital stay and/or during admission. These restricted
analyses did not alter the results significantly. In an additional subgroup analysis,
we compared both short- and long-term outcome between patients with low
eosinophil blood counts and high parameters of inflammation (demonstrated by
C-reactive protein and Neutrophil-to-lymphocyte ratio) and those with high
eosinophils and low parameters of inflammation. Hospital length of stay was
significantly higher in patients with low eosinophils and high C-reactive protein/
Neutrophil-to-lymphocyte ratio. Time to re-hospitalization and time to death did
not differ significantly among the groups.
The shorter length of hospital stay and the lower levels of inflammation in
eosinophilic patients can be interpreted as an indication for the existence of
different exacerbation phenotypes. This could be an explanation for the better
responsiveness to steroid treatment in eosinophilic patients and the notion that a
more non-eosinophilic phenotype (which may include bacterial or viral infections)
may need a longer time to clinical improvement.
Our data confirms the results of other clinical studies and add to the growing body
of evidence that blood eosinophils may serve as a biomarker not only for inhaled
corticosteroid-responsiveness with regard to the prevention of exacerbations but
also for responsiveness towards systemic steroids during an acute exacerbation
of chronic obstructive pulmonary disease.Das Auftreten akuter Exazerbationen im Rahmen der chronisch obstruktiven
Lungenerkrankung ist mit einer Erhöhung der Morbidität und Mortalität assoziiert.
Entscheidend für den Schweregrad und Verlauf der Exazerbation ist das
Ansprechen auf die medikamentöse Therapie, welche bei moderaten und
schweren Exazerbationen leitliniengerecht in Form von systemischen Steroiden
erfolgen soll. Aus Analysen anderer klinischer Studien geht hervor, dass an
chronisch obstruktiver Lungenerkrankung leidende Patienten während einer
Exazerbation besser auf systemische Kortikosteroide ansprechen, wenn ihre
Eosinophilenzahl im peripheren Blut > 2% beträgt. Aktuelle Leitlinien empfehlen
die Anwendung der Eosinophilenzahl als Biomarker für das Ansprechen auf
inhalative Kortikosteroide.
Die vorliegende Statistik beruht auf einer retrospektiven Datenanalyse von 1007
Fällen von Patienten, die im Zeitraum von 01/2013 bis 12/2018 im
Universitätsklinikum Marburg behandelt worden sind. Es wurden all diejenigen
Patienten in die Analyse mit eingeschlossen, welche die ICD-10-Diagnose einer
akuten Exazerbation der chronisch obstruktiven Lungenerkrankung erhalten
hatten. Das klinische Ergebnis der exazerbierten Patienten mit hohen
Eosinophilenwerten wurde dem der Patienten mit niedrigen Eosinophilenwerten
gegenübergestellt: Hierbei verglichen wir den Zusammenhang der Blut-
Eosinophilen mit der Verweildauer im Krankenhaus und mit unterschiedlichen
Entzündungsmarkern. Zur Beurteilung von Langzeitauswirkungen wurden
Kaplan-Meier-Überlebenszeitanalysen (Zeit bis zur Rehospitalisierung und zum
Tod der Patienten) durchgeführt. Wir zogen hierfür unterschiedliche, in der
Literatur bereits verwendete, Grenzwerte für die Zahl der Eosinophilen im Blut
heran (100 und 300/μl und 2%).
Die Patienten waren überwiegend männlich (65%), hatten ein medianes Alter von
74 Jahren und eine mediane Einsekundenkapazität von 1.03l (42.6% des
Sollwerts). Die Analyse selbst bezieht sich auf 417 Fälle von Patienten, bei denen
zu Beginn des Krankenhausaufenthalts ein Differentialblutbild abgenommen
wurde.
Patienten mit wenig Eosinophilen im peripheren Blut (< 2%, < 100/μl) verbrachten
im Median eine längere Zeit im Krankenhaus als Patienten mit einer hohen Zahl
an Eosinophilen (> 2%, > 300/μl). Dies gilt sowohl für die Relativ- als auch für die
Absolutwerte (< 2%: 9.31 vs. ≥ 2%: 7 Tage und <100/μl: 10 vs. 100-300/μl: 8 vs.
>300/μl: 7 Tage). Der mediane Wert des C-reaktiven Proteins, sowie weitere
inflammatorische Marker (Procalcitonin, Neutrophilen-Lymphozyten-Ratio,
Neutrophile, Leukozyten und Fibrinogen) waren bei Patienten mit niedriger
Eosinophilenzahl im Vergleich zur anderen Gruppe signifikant erhöht (< 2%: 22.7
vs. ≥ 2%: 9 mg/dl und 300/μl: 7.1 mg/dl).
In Bezug auf die Zeit bis zur Rehospitalisierung und das Überleben waren keine
signifikanten Unterschiede zwischen den jeweiligen Gruppen nachzuweisen.
Zur besseren Generalisierbarkeit der Ergebnisse wurden weitere
Subgruppenanalysen durchgeführt, in denen erstens Patienten, die bereits vor
der ersten Blutentnahme Kortison bekommen hatten, zweitens, Patienten mit
radiologischen Zeichen einer Pneumonie und drittens, Patienten, die gar kein
Kortison erhalten hatten, ausgeschlossen wurden. Die Auswertung der jeweiligen
Subgruppenanalysen führte zu keiner signifikanten Veränderung der Ergebnisse.
In einer zusätzlichen Analyse wurden Kurz- und Langzeitergebnisse von
Patienten mit niedrigen Eosinophilen und hohen Entzündungswrten (dargestellt
anhand von C-reaktivem Protein und Neutrophilen-Lymphozyten-Ratio) und
jenen mit hohen Eosinophilen und niedrigen Entzündungswerten verglichen. Die
stationäre Verweildauer war bei Patienten mit niedrigen Eosinophilen und hohem
C-reaktivem Protein/ Neutrophilen-Lymphozyten-Ratio signifikant erhöht,
wohingegen die Langzeitergebnisse keine signifikanten Unterschiede zeigten.
Die kürzere Krankenhausverweildauer und die geringeren Entzündungswerte
unter schwer exazerbierten Patienten mit chronisch obstruktiver
Lungenerkrankung und hohen Werten von Blut-Eosinophilen (> 2% oder >
300/μl) kann sowohl als Hinweis für ein besseres Ansprechen auf systemische
Steroide als auch für das Existieren spezifischer Exazerbationstypen gedeutet
werden. Unsere Ergebnisse bestätigen die Daten anderer klinischer Studien und
sind damit ein wichtiges Kriterium für die Anwendbarkeit der Blut-Eosinophilen
als Biomarker für das Ansprechen auf systemische Steroide auch im klinischen
Alltag
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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