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Predictive Value of HAS-BLED Score Regarding Bleeding Events and Graft Survival following Renal TransplantationHau, Hans Michael, Eckert, Markus, Laudi, Sven, Völker, Maria Theresa, Stehr, Sebastian, Rademacher, Sebastian, Seehofer, Daniel, Sucher, Robert, Piegeler, Tobias, Jahn, Nora 02 November 2023 (has links)
Objective: Due to the high prevalence and incidence of cardio- and cerebrovascular diseases
among dialysis-dependent patients with end-stage renal disease (ERSD) scheduled for kidney
transplantation (KT), the use of antiplatelet therapy (APT) and/or anticoagulant drugs in this patient
population is common. However, these patients share a high risk of complications, either due to
thromboembolic or bleeding events, which makes adequate peri- and post-transplant anticoagulation
management challenging. Predictive clinical models, such as the HAS-BLED score developed for
predicting major bleeding events in patients under anticoagulation therapy, could be helpful tools for
the optimization of antithrombotic management and could reduce peri- and postoperative morbidity
and mortality. Methods: Data from 204 patients undergoing kidney transplantation (KT) between
2011 and 2018 at the University Hospital Leipzig were retrospectively analyzed. Patients were
stratified and categorized postoperatively into the prophylaxis group (group A)—patients without
pretransplant anticoagulation/antiplatelet therapy and receiving postoperative heparin in prophylactic
doses—and into the (sub)therapeutic group (group B)—patients with postoperative continued
use of pretransplant antithrombotic medication used (sub)therapeutically. The primary outcome
was the incidence of postoperative bleeding events, which was evaluated for a possible association
with the use of antithrombotic therapy. Secondary analyses were conducted for the associations of
other potential risk factors, specifically the HAS-BLED score, with allograft outcome. Univariate and
multivariate logistic regression as well as a Cox proportional hazard model were used to identify risk
factors for long-term allograft function, outcome and survival. The calibration and prognostic accuracy
of the risk models were evaluated using the Hosmer–Lemshow test (HLT) and the area under
the receiver operating characteristic curve (AUC) model. Results: In total, 94 of 204 (47%) patients received
(sub)therapeutic antithrombotic therapy after transplantation and 108 (53%) patients received
prophylactic antithrombotic therapy. A total of 61 (29%) patients showed signs of postoperative
bleeding. The incidence (p < 0.01) and timepoint of bleeding (p < 0.01) varied significantly between
the different antithrombotic treatment groups. After applying multivariate analyses, pre-existing
cardiovascular disease (CVD) (OR 2.89 (95% CI: 1.02–8.21); p = 0.04), procedure-specific complications
(blood loss (OR 1.03 (95% CI: 1.0–1.05); p = 0.014), Clavien–Dindo classification > grade II (OR 1.03
(95% CI: 1.0–1.05); p = 0.018)), HAS-BLED score (OR 1.49 (95% CI: 1.08–2.07); p = 0.018), vit K antagonists
(VKA) (OR 5.89 (95% CI: 1.10–31.28); p = 0.037), the combination of APT and therapeutic
heparin (OR 5.44 (95% CI: 1.33–22.31); p = 0.018) as well as postoperative therapeutic heparin (OR 3.37
(95% CI: 1.37–8.26); p < 0.01) were independently associated with an increased risk for bleeding. The
intraoperative use of heparin, prior antiplatelet therapy and APT in combination with prophylactic heparin was not associated with increased bleeding risk. Higher recipient body mass index (BMI)
(OR 0.32 per 10 kg/m2 increase in BMI (95% CI: 0.12–0.91); p = 0.023) as well as living donor KT
(OR 0.43 (95% CI: 0.18–0.94); p = 0.036) were associated with a decreased risk for bleeding. Regarding
bleeding events and graft failure, the HAS-BLED risk model demonstrated good calibration (bleeding
and graft failure: HLT: chi-square: 4.572, p = 0.802, versus chi-square: 6.52, p = 0.18, respectively) and
moderate predictive performance (bleeding AUC: 0.72 (0.63–0.79); graft failure: AUC: 0.7 (0.6–0.78)).
Conclusions: In our current study, we could demonstrate the HAS-BLED risk score as a helpful tool
with acceptable predictive accuracy regarding bleeding events and graft failure following KT. The
intensified monitoring and precise stratification/assessment of bleeding risk factors may be helpful
in identifying patients at higher risks of bleeding, improved individualized anticoagulation decisions
and choices of antithrombotic therapy in order to optimize outcome after kidney transplantation
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Co-designing with “She Has a Name”: Active Learning for Johns and Best Practice Tools for John School AdministratorsFontenele de Matos Rodrigues, Natalia January 2022 (has links)
No description available.
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A experiência de estigma e discriminação em homem que faz sexo com homens (HSH) vivendo com HIVGarcia, Roberto 09 May 2012 (has links)
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Roberto Garcia.pdf: 3656242 bytes, checksum: bf0a4acdaa32cc9c59550a43e611dd9e (MD5)
Previous issue date: 2012-05-09 / Since its beginning, the Aids epidemic has established a series of social representations which hampers the daily life of men who have sex with men (MSM) living with HIV, who see themselves as doubly stigmatized due to their sexual orientation. The main objective of this study is observing the experience of stigma and discrimination in man who has sex with men living with HIV. With this ample target in mind, the specific objectives are: firstly, to observe the possible implications that HIV may cause on seropositive individuals as regards to perception of disease, self-perception as infected, social network, sexual orientation and involved contexts of vulnerability; and secondly, to observe the differences in the experiences of HIV-positive MSM through diagnosis disclosing to the social network by individuals infected before chronification and those infected after chronification. Based on the Theory of Social Representations, this work adopts the technique of the Discourse of the Collective Subject (LEFEVRE & LEFEVRE, 2010), a method of quali-quantitative nature. The corpus of the study is formed by a sample of thirty three MSM living with HIV, between 20 and 60 years of age, from a municipal clinic at the Greater São Paulo. The results reveal a high index of stigma and discrimination, manifested by sensations of fear, rejection, constant state of alert and guilt, in a social network that is fragile and unreliable. These high indexes were reflected in the increase of vulnerability of these individuals, demonstrated by the non-use of condom, by the fear of aggression, by the discrimination and the isolation, among others / A epidemia da aids, desde seu início, vem estabelecendo uma série de representações sociais que dificultam o cotidiano de homens que fazem sexo com homens (HSH) vivendo com HIV, que se veem duplamente estigmatizados devido à sua orientação sexual. O objetivo geral deste estudo é observar a experiência de estigma e discriminação em homem que faz sexo com homens vivendo com HIV. Partindo desse objetivo amplo, os objetivos específicos são: primeiro, observar as possíveis implicações que o HIV pode ocasionar nos indivíduos soropositivos, no que tange à percepção da doença, percepção de si enquanto infectado (autopercepção), à rede social, à orientação sexual e aos contextos de vulnerabilidade envolvidos; e segundo, observar as diferenças nas experiências dos HSH HIV+ por meio da revelação do diagnóstico à rede social, pelos indivíduos que se infectaram antes e os que se infectaram depois da cronificação. Fundamentada na Teoria das Representações Sociais, esta dissertação adota a técnica do Discurso do Sujeito Coletivo (LEFEVRE e LEFEVRE, 2010), que é um método de natureza qualiquantitativa. O corpus de estudo compõe-se de uma amostra de trinta e três HSH vivendo com HIV, entre 20 a 60 anos, de uma clínica municipal da Grande São Paulo. Os resultados mostraram alto índice de estigma e discriminação, manifestadas pelas sensações de medo, rejeição, constante estado de alerta e culpa, em uma rede social frágil e não confiável. Estes índices elevados refletiram-se no aumento da vulnerabilidade desses sujeitos, demonstrado pelo não uso da camisinha, pelo medo de ser agredido, pela discriminação e pelo isolamento, dentre outros
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Education Resource Guide: Tanya Lee Stone – In Search of Wonder: Common Core and MoreLyons, Reneé C. 01 January 2014 (has links) (PDF)
This education resource guide supplements the presentation made by Tanya Lee Stone at In Search of Wonder: Common Core and More, a professional development day presented by The National Children’s Book and Literacy Alliance, in conjunction with the Perry Ohio School District. Included on these pages are engaging activities and discussion questions based on Common Core English Language Standards for two of Stone’s books: Courage Has No Color and Who Says Women Can’t Be Doctors?
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Discrimination and its effects in the electricity industry / P.D. Molefe.Molefe, Pinkie Dikeletso January 2009 (has links)
Aim
This study contends and explains why discrimination in the workforce is a growing problem that has affected thousands of organisations, large and small, operating in today's global marketplace. The research is aimed at describing the perceived experiences of discrimination as well as its effects on employees within the organisation.
Method
Using a qualitative research design, interviews were used to facilitate the informal
sharing of experiences amongst employees. The purpose of this was to understand the
different experiences employees had and the impact discrimination had on the individual performance within the organisation.
Results
Results reveal that employees experience three broad categories of activities that led to experiences of discrimination, namely activities that relates to management and supervision, daily interaction between various groups from diverse backgrounds and unfair general human resource functions.
Conclusion
The results of the empirical study were discussed according to the themes of
Supervision/ Management, Human Resources/ Employee relations and Interactions. It
was found that employees were exposed to different types of discrimination, which are
explored in the literature review. / Thesis (M.B.A.)--North-West University, Vaal Triangle Campus, 2010.
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”Jag var för sjuk för att få a-kassa. Och för frisk för att få sjukpenning! ” : En studie om konsekvenser för individer i samband med och efter utförsäkring från sjukförsäkringen.Sik, Laila, Skoglund, Therése January 2011 (has links)
Sammanfattning Regeringens intention med den nya lagen om sjukförsäkring som infördes i juli 2008 och kompletterades i januari 2010, var att gå från en passiv långtidssjukskrivning till ökad rehabilitering och en möjlighet till återgång till arbetsmarknaden samt ett minskat utanförskap. Den mediala debatten i samklang med våra praktikplatser gjorde oss nyfikna på hur förändringen har påverkat livet för den enskilde individen. Vårt syfte är således att undersöka vilka konsekvenserna blir för enskilda individer i samband med och efter beskedet om utförsäkring från sjukförsäkringen. Vi ville utan att ha några förutfattade meningar lyfta fram intervjupersonernas berättelse så vi valde att ha en explorativ ansats, men tog stöd av en semistrukturerad intervjuguide baserad på tre teman som vi ville veta mer om. Temana är; ekonomisk situation, upplevelser av relationer med berörda myndigheter och upplevelser av samhällets syn och deras syn på sin självbild. Resultaten är komplexa och visar att de teman vi valt ut påverkar varandra, med det menar vi att det ena inverkar på det andra. De teorier vi valt att använda i analys av materialet är Ekonomi- skam modellen, Kasamteori samt teori om social uteslutning. Vi kan se en väg som leder från ekonomisk uteslutning vidare till social uteslutning för personer som utförsäkrats samt att den ekonomiska stress de utsätt för i kombination med skamgörande erfarenheter ger hög risk för psykisk ohälsa. I vår avslutande diskussion reflekterar vi om lagstiftarens intention med reformerna har haft den avsedda effekten för de utförsäkrade. / Abstract The governments intentions with the new law in sickness benefits that was introduced in July 2008 and was supplemented in January 2010, was to go from a passive long-term sick leave to increased rehabilitation and a possibility to return to the labor market, along with reduced exclusion. The media debate in unison with our trainee jobs made us curious about how this change has affected the individual. Our purpose is accordingly to make researches into the consequences for the individuals in connection with and after expiration of sickness benefits. We wanted without preconceived opinions emphasize the interviewee’s stories so we chose to have an explorative inception. But we took support in a semi- structured interviewguide based on three topics we wanted to know more about. The topics are; economic situation, experiences of the relation with concerned public authorities and experiences of societies view on them and their own view on themselves. The results are complex and show that one factor affects another, which means that one thing, leads to another. The theories we have used are a model for Economics- shame, Kasam and social exclusion theories. We can see a road that leads from economic exclusion to social exclusion for the persons whose period of sickness benefits has expired. And also that the economic stress combined with shameful experiences gives a high risk of psychic illness. In our concluding discussion we reflect about if the government’s intentions with the new laws have had the intended effect for these persons.
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Democratic progressive party place party duty director has the system stable researchWang, Jinn-ming 29 November 2009 (has links)
The succession is Taiwan's in 1986 (75 years) under the martial
law authority system, the aboriginality democratic progressive party's in at the end of fall the beginning of winter (9/28) date, just happene to meet atthat time the Kuomintang being in power authority ountedscout densely covered with under the atmosphere which withered finally
to establish. This is the organizational structure which loose has notoperated the rudder from non-party time each place enters into officiallyby the central party committee political party essence institution operation start, previously like the mushroom growth various places non-partyorganization also one after another one after another reformed the beingestablished development, and by place standing organization institution(party committee) the state has opened in our country democraticinstitutions the party politics competition.
Democratic progressive party place county municipal party headquarters party duty director is situated the strategic point, actually the political party stationing in various places county city party organization institution's actual person in charge, has the strong party spirit and theshoulder political party develops the place politics domain the mission,and holds superiority of the county municipal party headquarters partyresources utilization.The present paper the theory surface which will study by heavy practice surface matching analyzes it, place county municipal party headquarters party duty director will have the system stable really tobe supposed take Democratic Progressive Party's in system lengthwisesection and the non-system surface cross section of as the elaboration axlecenter. System surface: Such as the place party committee sets up the means, the county municipal party headquarters organizes the regulations, the party duty personnel to elect the means, the county municipal party headquarters fourth, five kind of public official elects the nominationmeans or the party member year to year party dues captures depth contents and so on the means and financial control rule, has the system by viewparty duty director to stabilize rests on what. Non-system surface: Then iscontinual by the cross section, such as and pocket party member wealthyand powerful family (foot of pile) transportation and maintenance, rulingcounty city and non-ruling county city time party duty director and countymayor like for same clique either homogeneity of or difference non-sameclique its interaction situation or the role acting why? But other each kindof public service mover or is the coordination also can accept regardingthe party duty director's direction? Furthermore, with for the party dutynational party representative, the county city party members representsand holds comments committee member to link party duty director to havethe system to have what influence and the subtle relations stably.
Moreover, these perform its own functions each kind of party duty
mover duty department revises the rules and regulations in particular thenational party representative nearly has also not acted must revise changesparty duty director to have the system.If is by the view, above these manymay affect party duty director to produce the system party duty moverreally little to change this system the fact result, is opposite by the word,but ¡§the rational choice system theory¡¨ the viewpoint not also talliesappears party duty director to have the system stable relative most majorcharacteristic even more suddenly.
Your in the recent several dozens years, no matter is the East and West world national laws and regulations or the article, also perhaps in anynational big enterprise, the small organization or the political party and the association and so on, its internal custom, the means or the main point, allseek the change and between the transformation activation voice in onepiece, but noisy changes changes does not have set of flawless full easy touse well-mannered systems to be satisfying. In this, production of take thedemocratic progressive party place party duty director as the example,strengthens the system stable invariable usability, even more may verify isthe question which the system custom transforms, but is the stable systemperformer or the influence system stable mover, all takes it by the rationalchoice to oneself's advantageous, determinism and may grasp on fairly,fair, openness, urges place party duty director to have the system stably toexist truly.
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De obändiga : Formellt och informellt lärande i den svenska hästvärldenPergament Crona, Nicole January 2018 (has links)
I anslutning till det ökade vetenskapliga intresset för relationen djur – människa ämnar jag här undersöka varför många hästmänniskor söker sig informella kunskapsvägar, vägar som inte sällan står i strid med hegemoniska diskurser och maktstrukturer inom den svenska hästvärlden. Mina frågeställningar är följande: Hur ser den formella kunskapsvägen i Hästsverige ut och varför tycks det finnas ett motstånd mot denna? Hur ser motståndet ut? Vad är det man väljer bort? Vad söker man istället? Materialet består av intervjuer med människor som valt informella sätt att nå kunskap om hästar, författarens egna erfarenheter samt texter som behandlar den svenska hästvärlden i stort. Resultatet kan sammanfattas i att människor dras till de informella kunskapsvägarna därför att dessa i större utsträckning än de formella betraktar hästen som en individ vars vilja och agens förtjänar respekt och förståelse.
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Development of Multipoint Haptic Device for Spatial PalpationMuralidharan, Vineeth January 2017 (has links) (PDF)
This thesis deals with the development of novel haptic array system that can render distributed pressure pattern. The haptic devices are force feedback interfaces, which are widely seen from consumer products to tele-surgical systems, such as vibration feedback in game console, mobile phones, virtual reality applications, and daVinci robots in minimally invasive surgery. Telemedicine and computer-enabled medical training system are modern medical infrastructures where the former provides health care services to people especially in rural and remote places while the latter is meant for training the next generation of doctors and medical students. In telemedicine, a patient at a remote location consults the physician at a distant place through the telecommunication media whereas in computer enabled medical training system, physician and medical students interact with the virtual patient. The experience of physical presence of the remote patient in telemedicine and immersive interaction with virtual patient on the computer-enabled training system can be attained through haptic devices. In this work we focus on palpation simulation in telemedicine and medical training systems. Palpation is a primary diagnostic method which involves multi-finger, multi-contact interaction between the patient and physician. During palpation, a distributed pressure pattern rather than point load is perceived by the physician. The commercially available haptic devices are single and five point devices, which lack the face validity in rendering distributed pressure pattern; there are only a few works reported in literatures that deal with palpation simulation. There is a strong need of a haptic device which provide distributed force pattern with multipoint feedback which can be applied for palpation simulation in telemedicine and medical training purposes. The haptic device should be a multipoint device to simulate palpation process, an array device to render distributed force pattern, light weight to move from one place to another and finally it has to cover hand portion of physician. We are proposing a novel under-actuated haptic array device, called taut cable haptic array system (TCHAS), which in general is a m x n system, consist of m+n actuators to obtain m.nhaptels, that are multiple end effectors. A prototype of 3 x 3 TCHAS is developed during this work and detailed study on its characterisation is explored. The performance of device is validated with elaborate user study and it establishes that the device has promising capability in rendering distributed spatio-temporal pressure pattern.
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Developing an emulator for 360° video : intended for algorithm developmentLindskog, Eric January 2020 (has links)
Streaming 360° video has become more commonplace with content delivery services such as YouTube having support for it. By its nature, 360° video requires more bandwidth as only a fraction of the image is actually in view, while the user is expecting the same "in view" quality as with a regular video. Several studies and lots of work have been done to mitigate this higher demand for bandwidth. One solution is advanced algorithms that take in to account the direction that the user is looking when fetching the video from the server; e.g., by fetching content that is not in the user’s view at a lower quality or by not fetching this data at all. Developing these algorithms is a timely process, especially in the later stages where tweaking one parameter might require the video to be re-encoded, and therefore taking up time that could otherwise be spent on getting results and continued iteration on the algorithm. The viewer should also be considered as the best experience might not correlate with the mathematically best solution calculated by the algorithm. This thesis presents a modular emulator that allows for easy implementation of fetching algorithms that make use of state-of-the-art techniques. It intends to reduce the time it takes to iterate over an algorithm through removing the need to set up a server and encode the video in all of the wanted quality levels when a parameter change would require it. It also makes it easy to include the viewer in the process so that the subjective performance is taken into consideration. The emulator is evaluated through the implementation and evaluation of two algorithms, one serving as a baseline to the second one, which is based on an algorithm developed by another group of researchers. These algorithms are tested on two different types of 360° videos, under four different network conditions and with two values for the maximum buffer size. The results from the evaluation of the two algorithms suggest that the emulator functions as intended from a technical point of view, and as such fulfills its purpose. There is, however, future work that would further prove the emulators performance in regards to replicating real scenarios and a few examples are suggested.
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