Als Akromegalie wird die klinische Manifestation eines bestehenden GH-Überschusses und des dadurch resultierenden erhöhten IGF-1-Spiegels bezeichnet. Die weit häufigste Ursache ist das Hypophysenadenom. Zur Diagnosestellung muss dem klinischen Verdacht die biochemische Krankheitsbestätigung folgen. Therapeutische Maßnahme der ersten Wahl ist die Operation, der zweiten die Medikation und der dritten die Bestrahlung. Die Therapie zielt auf die biochemische Remission (GH und IGF-1 normal), aber diese kann nicht immer erreicht werden. Abgesehen vom Fall einer nicht kontrollierten Akromegalie (pathologische GH- und IGF-1-Werte) kann auch eine biochemische Diskrepanz vorkommen. Präoperativer biochemischer Status, Tumorgröße, Tumorinvasivität und Wirkung der prä- oder postoperativen Medikation sowie die Radiotherapie können das Outcome beeinflussen. Ziel der vorliegenden Arbeit war die umfangreiche retrospektive Datenauswertung von Akromegaliepatienten. Auf der Basis des biochemischen Outcomes, welches auf die Effektivität der Therapie hinweist, wurden demographische, tumorassoziierte, medikamentenbedingte und operationsbezogene Daten detailliert analysiert.

The study explores the reproductive decision-making of eight self-identified lesbian women in same-gendered relationships as it is interested in the ways in which they construct their reproductive decisions, particularly as it relates to their gender. Four open-ended, semi-structured, joint interviews were conducted with couples who have already made the decision to parent, thereby offering retrospective accounts. Interview transcriptions were analysed by employing thematic analysis underpinned by principles of Foucauldian discourse analysis and rooted in a feminist poststructuralist theory. Three discursive themes are identified in participants' accounts namely: 1) the discourse of heterosexual gender roles; 2) the discourse of heteronormative parenting; and 3) the counter-discourse of parental responsibility and the responsible parent. In a context where lesbian mothers' reproductive decisions are often called into question and where lesbian mothers' parental roles are constructed according to gender binaries, the study concludes that in exercising their limited agency within restrictive heteronormative discourse, participants made their reproductive decisions based on their ability to care for a child in terms of pragmatic factors, their capacity to meet the child's emotional needs and to protect them from potential "othering" by segments of the society. The findings of this study carry implications for addressing the marginalisation and stigmatisation of lesbian women who wish to become parents and raise their children without having to justify their decisions purely because of their sexual identity. / Mini Dissertation (MA)--University of Pretoria, 2016. / Psychology / MA / Unrestricted

Bakgrund: Anestesisjuksköterskan ansvarar för att identifiera när ett förlopp avviker från det normala i den perioperativa vården. Tidigare studier visar att explorativ laparotomi har hög förekomst av allvarliga komplikationer och 30-dagarsmortalitet. Syfte: Syftet var att undersöka korrelation mellan preoperativa variabler och förekomst av allvarliga komplikationer hos vuxna patienter som genomgår akut explorativ laparotomi på en operationsavdelning. Syftet var även att undersöka korrelation mellan preoperativa variabler och mortalitet hos vuxna patienter som genomgår akut explorativ laparotomi på en operationsavdelning. Metod: Studien var en retrospektiv registerstudie med kvantitativ ansats. Registerdata innehållande pre-, intra- och postoperativa uppgifter om 387 patienter som genomgått explorativ laparotomi, inhämtades från Provisio för åren 2019–2021. Datamatris skapades utifrån Clavien-Dindos komplikationsklassifikation. Materialet analyserades med beskrivande statistik, Spearmans rho och multipel linjär korrelationsanalys. Huvudresultat: Allvarliga komplikationer förekom hos 33,6% av patienterna. 9,6% av patienterna avled inom 30-dagar. ASA-klass var statistiskt signifikant korrelerat till allvarliga komplikationer (p: <0,001). Ålder (p:<0,001), ASA-klass (p: <0,001) och prioritetsnivå till operation (p: 0,049) var statistiskt signifikant korrelerat till 30-dagarsmortalitet. Slutsats: Explorativ laparotomi är en allvarlig operation som i de flesta fall utförs på redan svårt sjuka patienter. Anestesisjuksköterskan har en betydande roll i optimeringen av den intraoperativa omvårdnaden. Alla människor har rätt till god evidensbaserad vård och det finns utvecklingspotential vid explorativ laparotomi. / Background: The nurse anesthetist is responsible for identifying when a course of care deviates from the normal in perioperative care. Previous studies show that exploratory laparotomy has a high incidence of severe complications and 30-day mortality. Aim: The aim was to investigate correlation between preoperative variables and the presence of severe complications in adult patients undergoing acute exploratory laparotomy in an operating department. The aim was also to investigate correlation between preoperative variables and mortality in adult patients undergoing acute exploratory laparotomy in an operating department. Method: The study was a retrospective registry study with a quantitative approach. Registry data containing pre-, intra- and postoperative data on 387 patients who underwent exploratory laparotomy were obtained from Provisio for the years 2019–2021. A data matrix was created based on Clavien-Dindo's classification of complications. The material was analyzed with descriptive statistics, Spearman's rho and multiple linear correlation analysis. Result: Severe complications occurred in 33.6% of patients. 9.6% of patients died within 30 days. ASA class was statistically significantly correlated to severe complications (p:<0.001). Age (p:<0.001), ASA class (p: <0.001) and priority level to surgery (p: 0.049) were statistically significantly correlated to 30-day mortality. Conclusion: Exploratory laparotomy is a serious operation that in most cases is performed on already severely ill patients. The nurse anesthetist has a significant role in the optimization of intraoperative nursing. All people have the right to good evidence-based care and there is development potential in exploratory laparotomy.

This is a qualitative study that investigates a public organization where the areas of agility and knowledge management meet with a focus on the co-worker’s experience. There is currently not much research on knowledge management regarding organizations striving to work explicitly agile, especially not within the public sector. The purpose of this thesis is therefore to contribute with more knowledge and understanding of the co-worker’s experience of knowledge, learning and sensemaking linked to agile working methods in a public organization. Eight qualitative interviews were conducted and then analyzed using a thematic framework based on the agile manifesto through the lens of sensemaking and practice-based knowledge management. This study shows that the co-workers are basically positive to agility but experience obstacles along the way, such as lack of evaluation and the existing public sector hierarchy. The study also shows that the most substantial benefit that employees experience with agile methods is co-operating. The results also show that cooperation in the agile context contributes to sensemaking when people meet. The key findings are that co-workers experience agility as the opposite of bureaucracy and hierarchy and that knowledge sharing, learning and sensemaking are promoted by agile working methods which encourage cooperation between internal and external stakeholders.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21301号 / 医博第4390号 / 新制||医||1030(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 小池 薫, 教授 福原 俊一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13220号 / 論医博第2167号 / 新制||医||1033(附属図書館) / (主査)教授 高橋 淳, 教授 宮本 享, 教授 伊佐 正 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Game-Based Sprint Retrospectives are a well-used tool in Agile practices as a way to structure Sprint Retrospective meetings. However, this tool has very little scientific proof to back up why Scrum Masters should opt to conduct their retrospectives in game form. While the little research that exists provides proof that Game-Based Sprint Retrospectives help negate common issues with Retrospective meetings, it does not delve deeper into the potential positive effects of the practice. This study aims to start filling this gap by conducting Canonical Action Research with semi-structured interviews and surveys to investigate the effect implementing the Retrospective Game Sailboat has on a game development teams dialogue. The key finding was that the participating team's dialogue did improve over the course of the study as the team went from being quiet and uncertain to being lively and engaging. Possible causes for this change are how the post-it notes provided anonymity, an easier way to formulate team members' thoughts, and an opportunity for equal participation, as well as the game structure encouraging a less serious environment with playfulness.

African-American male students are systematically forced to confine themselves to the social construct that European-American society has developed for them. Actions, behaviors, and words that communicate this message spread both interracially and intraracially within schools and affect African-American males tremendously in terms of their identity development and personal well-being. While many studies examine the overt forms of racism and more obvious microaggressions that African-American male students encounter in their schooling, few look at the deep-seated forms of racism that are less noticeable but that have a disastrous psychological impact on these students. This study shows the effects on the psyche and development of the three African-American male students involved as they retrospectively recount their secondary school experiences. Portraiture is used to capture each participant’s story accurately and clearly while critical race theory is interwoven throughout as theoretical framework for this research. Using both critical race theory and portraiture, a complete examination of how racism occurs within schools and its effects on African-American males is shown.

Neonatal abstinence syndrome (NAS) is a syndrome of withdrawal symptoms in newborn infants that have a history of prenatal exposure to certain substances. Affected infants may have gastrointestinal (GI) issues, such as gassiness and diarrhea. Although infants with known exposures may be monitored in the first few days of life, it is unclear how long these symptoms persist. This poster will examine GI issues in the first six months of life across four groups of infants: those with prenatal opioid exposure, those with prenatal substance exposure that does not include opioids, those with polysubstance exposure, and those without substance exposure in a pediatric clinic in northeast TN. A retrospective chart review of 600 charts of infants born from 2017—2020 was conducted with IRB approval in a pediatric clinic in rural middle Appalachia. Of these, 300 charts were selected based on known prenatal substance exposure, and the other 300 charts were randomly selected. A REDCap extraction manual was created, research assistants were trained, and % agreement was determined. Data was collected about type of prenatal substance exposure, growth, and medical conditions in the first three years of life. Infants were divided into groups by type of prenatal substance exposure for analysis. The opioid-only group included exposure to buprenorphine, methadone, or other opiates. The other (non-opioid) exposure group included exposure to marijuana, cocaine, benzodiazepines, methamphetamines, and prescription ADHD medications. The polysubstance exposure group included exposure to both opiate and non-opiate substances. The control group had no prenatal substance exposure. Analyses were performed using SAS version 9.4. Descriptive statistics showed the demographics of the sample were representative of the population in rural middle Appalachia, with a predominantly Caucasian sample of 121 females and 123 males, mostly receiving TennCare. Chi-square results showed there was only a statistically significant difference between the prenatal substance exposure groups at 2 months, X2 (3, N = 176) = 8.03, p = 0.045, but not at hospital discharge, within the first few days of life, at 1 month, 4 months, or 6 months. Infants in the opioid-only exposure group were most likely to have GI issues. These findings suggest that GI issues are more likely to occur in infants with certain prenatal substance exposures. This poster also shows a longitudinal perspective of these issues, indicating that the symptoms may persist in the first few months of life. Thus, caregivers of infants at risk for NAS may benefit with information about the long-term effects. Because the retrospective chart review is still in progress, this poster only analyzes a preliminary number of charts. Future research should also take into consideration other factors that may be associated with GI issues in this population, such as nutrition.

Res-IRF is an energy-economy model of heating consumption in French dwellings developed at CIRED and calibrated against 2012. It is meant to project the evolution of the building stock and the heating demand by 2050 in response to socio-economic parameters, such as energy price and population, and public policies, such as thermal regulations or incentives for renovation. Res-IRF captures the relevant determinants of household decisions related to energy efficiency improvements and energy demand (sufficiency). The aim of the work presented in this report is to calibrate the model against a past year, to run it from this start date to 2012, and to compare the simulation results with observed data on this period. After an overview of the French residential sector in the last 40 years, this report aims at presenting the model and how it was calibrated against year 1984 and adjusted to the past situation of the building stock. Then, the results of a sensitivity analysis on key parameters of the model are compared to reality and it is discussed how the model can be improved to fit the data better. The main results show that the model accurately replicates the evolution of the building stock until 2012. However, the results do not fit well the data of repartition of heating fuels, especially for fuel oil and natural gas. This may be due to the structure of the model which allows fuel switch only for renovating dwellings; then it could miss possible fuel switches from fuel oil to natural gas without renovation due to the expansion of the natural gas network in France between 1980 and 2000. Furthermore, the actual unit consumption, which is a key output of the model, is well replicated by the model, with an error of 5 to 10%. / Res-IRF är en energi-ekonomi modell av värmebehovet i franska byggnader utvecklad av CIRED och kalibrerad mot data för 2012. Det är avsett att förutsäga utvecklingen för byggnadsbeståndet och värmebehovet fram till 2050 med utgångspunkt från socio-ekonomiska parametrar såsom energipriser och befolkningsmängd, politiska beslut som regleringar rörande uppvärmningssektorn och incitament för renoveringar. Res-IRF fångar upp de relevanta faktorer som påverkar hushållens beslut relaterade till förbättringar av energieffektiviteten och energibehoven. Målet med arbetet som presenteras i denna rapport är att kalibrera modellen mot ett redan passerat år, att köra modellen från startåret till 2012, och att jämföra simuleringsresultaten med verkliga observationer för denna period. Efter en översikt över den franska bostadssektorn de senaste 40 åren, följer i rapporten en presentation av modellen och hur den kalibrerades mot året 1984 och sedan anpassats till det dåvarande läget i byggnadsbeståndet. Därefter jämförs resultaten av en känslighetsanalys av nyckelparametrar i modellen med verkligt utfall och en diskussion följer om hur modellen kan förbättras för att bättre passa verkliga data. Huvudresultaten visar att modellen på ett korrekt sätt avbildar utvecklingen av byggnadsbeståndet fram till 2012. Däremot ger resultaten inte god överensstämmelse vad gäller fördelning av bränslen, speciellt inte fördelningen mellan olja och naturgas. Detta kan bero på modellens struktur, som tillåter bränslebyte bara vid renovering; därmed missar den bränslebyten som görs utan samtidig renovering, som tillkommit på grund av utbyggnaden av naturgasnäten i Frankrike mellan 1980 och 2000. Vidare visar modellen god överensstämmelse vad gäller energitillförsel per enhet, vilket är en nyckelparameter bland resultaten från modellen. Denna parameter predikteras med ett fel av 5 till 10%.