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Die Auswirkung von intraoperativer Hypotonie auf die Inzidenz von postoperativer Übelkeit und Erbrechen in der Frühphase (sog. early PONV)
Get PDFHintergrund. Postoperative Übelkeit und Erbrechen (PONV) tritt bei bis zu 30% der Allgemeinbevölkerung auf und stellt eine der häufigsten Komplikationen im Arbeitsumfeld des Anästhesisten dar. PONV beeinträchtigt nicht nur das Wohlbefinden der Patienten erheblich, sondern kann auch gravierende Komplikationen, einen erhöhten Therapieaufwand und höhere Gesundheitskosten nach sich ziehen. Als die gängigsten Risikofaktoren gelten das weibliche Geschlecht, der Nichtraucherstatus, PONV bzw. Reiseübelkeit in der Anamnese und die postoperative Therapie mit Opioiden. Über die Erforschung zusätzlicher Risikofaktoren wird versucht, das PONV-Risiko weiter zu senken und neue Präventionsstrategien zu etablieren.
Es ist bekannt, dass intraoperative Hypotonie an mehreren Organsystemen Schäden durch Minderperfusion verursacht und dass gastrointestinale Minderperfusion zu Übelkeit führen kann. Aus geburtshilflichen Untersuchungen ist der Zusammenhang zwischen intraoperativen Blutdruckabfällen nach rückenmarksnahen Betäubungsverfahren und PONV erwiesen. Wir stellten die Hypothese auf, dass auch an narkotisierten Patienten die intraoperative Hypotonie einen Einfluss auf die Inzidenz von PONV hat.
Methoden. Die Untersuchung fand als retrospektive Datenanalyse an einem großen Patientenkollektiv statt und basierte auf den Narkoseprotokollen von Patienten, die sich in dem Zeitraum von 2018 bis 2019 am Klinikum der Ludwig-Maximilians-Universität in München einem operativen Eingriff in Allgemeinanästhesie unterzogen. Die Patienten wurden anhand des Ausmaßes ihres Blutdruckabfalls in vier Studiengruppen eingeteilt: H50 (MAP 70 mmHg). Als Endpunkt wurde das Auftreten von early PONV in den ersten 6 Stunden postoperativ im Aufwachraum herangezogen. Neben den demografischen Basisdaten wurden weitere als PONV-Risikofaktoren bekannte Parameter ausgewertet und deren Verteilung in den unterschiedlichen Studiengruppen verglichen. Der Einfluss der intraoperativen Hypotonie auf die PONV-Inzidenz wurde mittels Chi-Quadrat-Tests untersucht. Zur Vermeidung verzerrender Effekte durch strukturelle Unterschiede zwischen den Studiengruppen wurde ein Propensity-Score Matching durchgeführt, nachdem relevante Einflussfaktoren mithilfe einer systematischen Literaturrecherche identifiziert wurden.
Ergebnisse. Die Daten von 18.674 Patienten gingen nach den von uns definierten Einschlusskriterien in die Auswertung ein. Im Propensity Score Matching zeigte sich für alle Patienten der drei Hypotonie-Studiengruppen im Vergleich mit den ihnen zugeordneten Patienten ohne intraoperative Hypotonie eine signifikant höhere Inzidenz von PONV. Am deutlichsten unterschied sich die Inzidenz der Gruppe H50 und H0 (17,4% vs. 11%). Hier betrug die Odds Ratio 1,695 (99%CI: 1,265-2,271, p0,001). Der Vergleich der Gruppen H70 und H0 (11,2% vs. 9,4%) ergab eine Odds Ratio von 1,2012 (99%CI 1,0260 – 1,4070, p<0,0027) und ein relatives Risiko von 1,1236 (99%CI 1,013 – 1,2454, p< 0,0027).
Schlussfolgerungen. In allen Studiengruppen mit intraoperativer Hypotonie zeigte sich ein signifikant häufigeres Auftreten von early PONV verglichen mit den Patienten, deren Blutdruck stabil geblieben war. Somit konnte gezeigt werden, dass auch an einem gemischtgeschlechtlichen, heterogenen Patientenkollektiv von narkotisierten Patienten ein Zusammenhang zwischen intraoperativer Hypotonie und einer erhöhten Inzidenz von early PONV besteht. Je niedriger der Blutdruck der Patientengruppe ausfiel, desto größer war die PONV-Inzidenz. Besonders in der Gruppe mit den niedrigsten Blutdruckwerten (MAP < 50 mmHg) fiel die PONV-Inzidenz signifikant höher aus. Die Therapie von intraoperativen Blutdruckabfällen und die Erhaltung der hämodynamischen Stabilität ist somit nicht nur zur Vermeidung von Endorganschäden essenziell, sondern kann auch protektiv gegen early PONV wirken
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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