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Diagnostik der akuten Subarachnoidalblutung mit computertomografischer digitaler Subtraktionsangiographie (CT-DSA)Aulbach, Peter 10 October 2018 (has links)
Einleitung: Die schnelle Detektion und genaue Beurteilbarkeit (Charakterisierung) von rupturierten, zerebralen Aneurysmen ist entscheidend für die Wahl der adäquaten endovaskulären oder neurochirurgischen Intervention (Therapie), um Patienten mit akuter Subarachnoidalblutung (SAB) eine möglichst gute Prognose zu verschaffen. Es war das Ziel der Studie zu untersuchen, ob und wie weit die Knochensubtraktions-CT-Angiografie (CT-DSA), bereits mit einem relativ alten 16-Kanal-MSCT in der Lage ist die invasive Digitale Subtraktionsangiografie (DSA; Goldstandard) hinsichtlich der Detektion, morphologischer Charakterisierung und letztendlich Therapieentscheidung zu ersetzen und damit den klinischen Pfad dieser Patienten zu beeinflussen.
Methodik: Zu diesem Zweck untersuchten wir 116 Patienten mit akuter SAB vor der intrakraniellen Aneurysmatherapie. Die SAB Patienten wurden jeweils erst mit 16-Kanal-MSCT Angiografie und verbesserter, automatisierter Knochensubtraktion untersucht. Der verbesserte CT-DSA Algorithmus beinhaltet eine block- oder scheibenweise Patienten Bewegungskorrektur und eine lokal adaptierbare 3D dilatierte Knochenmaske. Die lokale Adaption der Maske wurde für eine präzisere Knochensubtraktion an der Grenze von Gefäß zu Knochen entwickelt. Danach wurde die konventionelle DSA angewandt. Zwei erfahrene Neuroradiologen beurteilten die CT-DSA und die DSA Daten unabhängig voneinander. Es wurde die Genauigkeit der verbesserten CT-DSA Methode für die Detektion, morphologische Charakterisierung sowie die Vermessung der Aneurysmadimensionen bestimmt. Im Fall von Uneinigkeit wurde ein Ergebnis im Konsens ermittelt. Zudem wurde die Röntgendosis beider Methoden für die Diagnostik von Aneurysmen verglichen.
Ergebnisse: Mit der DSA wurden in 71 Patienten 74 Aneurysmen entdeckt. Achtundsechzig Patienten hatten 1 und 3 Patienten zwei Aneurysmen. Mit den CT-DSA Daten konnten 73 der 74 in der DSA delektierten Aneurysmen gefunden werden. Hier hatten 66 Patienten 1 und 4 Patienten 2 Aneurysmen. Mit der CT-DSA wurde noch ein weiteres kleines Aneurysma detektiert. Die Auswertung per Aneurysma, für die Sensitivität, Spezifität, den negativen und positiven Vorhersagewert, zeigte für die CT-DSA jeweils 99% und 100%, sowie 100% und 98%. Für kleine Aneurysmen, ≤3,0 mm betrug die Sensitivität 94%, mit einem 95%-Konfidenzintervall zwischen 73%–99%. Längenmessungen mit der CT-DSA waren ebenso genau wie bei der DSA und stimmten bei kleineren Messungen sogar noch besser überein als bei größeren. Die CT-DSA Fundus/Hals-Verhältnisse lagen mit 0,03 (ca. 2%) unter denen der DSA. Das Dosis-Längen-Produkt für die CT-DSA lag bei 565 mGy × cm ±201 [SD] und für die DSA bei 1.609 mGy × cm ±1.300 [SD].
Diskussion: Die CT-Angiografie mit 16-Kanal-MSCT und modernen Knochen-subraktionsalgorithmen ist für die Detektion von zerebralen Aneurysmen bei Patienten mit akuter SAB ebenso genau wie die DSA. Sie erzielt ähnliche Ergebnisse für die Aneurysmamorphologie und -abmessungen. Diese gilt selbst für schädelbasisnahe und kleine Aneurysmen oder bei Patientenbewegung. In Fällen, in denen die erste CT-DSA die Ursache der SAB nicht zeigt, ist es nicht mehr zwingend notwendig eine DSA durchzuführen. Eine zweite CT-DSA ist ausreichend. Weiterhin benötigt die CT-DSA bis zu 65% weniger Röntgendosis für die Diagnose als die DSA. Zudem ist die Diagnose mit der CT-DSA in kürzerer Zeit und für den Patienten risikoärmer, weil nichtinvasiv.
Schlussfolgerung: Die CT-DSA mit einem verbesserten Algorithmus, der Bewegungsartefakte und artifizielle Stenosen an der Grenze von Gefäß zu Knochen minimierte, zeigt in Verbindung mit einem 16-Kanal-MSCT eine diagnostische Äquivalenz zur DSA. Diese Tatsache und die zusätzlich deutlich geringere Röntgenstrahlenbelastung sprechen dafür, die DSA Diagnostik bei Patienten mit spontaner SAB durch die schnellere und schonendere CT-DSA zu ersetzten. Damit kann die CT-DSA Therapieentscheidungen schneller, schonender, kostengünstiger und zielgerichteter herbeiführen. Bei der Einführung dieses Verfahrens ist weniger auf die eingesetzte CT-Technologie (16-, 64-, 320-Zeilen oder Zwei-Röhren MSCT) als auf den Einsatz der aktuellsten Knochensubtraktions-Technologie sowie ein angemessenes Training (Erfahrung) des Befunders zu achten.:1 Einleitung 1
1.1 Ätiologie der Subarachnoidalblutung (SAB) 1
1.2 SAB Pathogenese 2
1.3 SAB Epidemiologie 4
1.4 SAB Risikofaktoren 4
1.5 SAB Grading 5
1.6 SAB Letalität 5
1.7 SAB Diagnostik 6
1.7.1 Invasive Digitale Subtraktionsangiografie (DSA) 6
1.7.2 Nichtinvasive Mehrschicht-Computertomografie (CT) 10
1.8 Aneurysma Therapie 15
1.9 Zielsetzung 17
2 Patienten und Methoden 20
2.1 Patienten 20
2.2 Ein – und Ausschlusskriterien 20
2.3 Nativ-CT und CT-DSA 22
2.3.1 Nativ-CT Technik 22
2.3.2 CT-DSA Technik 22
2.3.3 Prototypische, automatisierte CT-DSA Auswertung 24
2.4 Digitale Subtraktionsangiografie (DSA) 27
2.5 Vermessung der Aneurysmen 27
2.6 Vergleich der Messmethoden 29
2.7 Befundungsqualität der Untersucher 29
2.8 Beurteilung der Ergebnisse 29
2.9 Beurteilung der Strahlenbelastung 30
2.10 Statistische Methoden 31
2.10.1 Fallzahlplanung 32
2.10.2 Diagnostische Genauigkeit 33
2.10.3 Methodenvergleich 34
2.10.4 Inter- und Intraobserver-Variabilität 35
3 Ergebnisse 36
3.1 Patienten 36
3.2 Nativ-CT 36
3.3 CT-DSA 36
3.4 DSA - Referenz für die Aneurysmadetektion 42
3.5 Vergleich CT-DSA mit DSA 45
3.5.1 CT-DSA Genauigkeit 45
3.5.1.1 Basierend auf prospektiver DSA 45
3.5.1.2 Basierend auf retrospektiver DSA 47
3.5.2 Aneurysma-Messergebnisse 49
3.5.3 Untersucher und Aneurysma-Konfiguration 59
3.5.4 Röntgendosis 59
3.5.5 Bildinterpretationszeiten 60
4 Diskussion 61
4.1 CT-DSA Genauigkeit für den Aneurysmanachweis 61
4.1.1 Besonderheiten der CT-DSA Anwendung 63
4.1.2 Besonderheit der CT-DSA Prototypen Software 63
4.2. CT-DSA Informationen als alleinige Planungsbasis für neurochirurgische oder endovaskuläre Eingriffe 64
4.3 Robustheit und Reproduzierbarkeit 67 / Background and purpose: Detection and evaluation of ruptured aneurysms is critical for choosing an appropriate endovascular or neurosurgical intervention (therapy) in patients with acute subarachnoid hemorrhage (SAH). Our aim was to assess whether 16-detector row multislice CT (MSCT) bone-subtraction CTA is capable of guiding treatment for cerebral aneurysms in patients with acute SAH and could replace DSA – the current reference standard.
Materials and methods: In a prospective study, 116 consecutive patients with SAH were examined with 16–detector row MSCT with an advanced bone-subtraction CTA prototype and DSA before intracranial aneurysm treatment. The advancements of the prototype CT-DSA algorithm were a slab-based patient motion correction and a locally optimized 3D dilated bonemask. The local adaption of the bone mask was designed for more precise bone subtraction at bone-to-vessel interfaces. Two independent neuroradiologists reviewed the bone-subtraction CTA blinded to DSA. The accuracy of the advanced bone-subtraction CTA for aneurysm detection, morphological characterization and the measurement of aneurysm dimensions were determined. In case of disagreement the result was attained in consensus. Additionally the radiation doses of the 2 diagnostic imaging modalities compared.
Results: Seventy-one patients (61%) had 74 aneurysms on DSA. Sixty-eight patients had 1 and 3 patients 2 aneurysms. Bone-subtraction CTA detected 73 of these aneurysms. With CT-DSA 66 patients had 1 and 4 patients 2 aneurysms. CT-DSA discovered an additional small aneurysm. On a per-aneurysm basis, sensitivity, specificity, and positive and negative predictive values for bone-subtraction CTA were 99%, 100%, and 100% and 98%, respectively. For aneurysms of ≤3 mm, sensitivity was 94% (95% CI, 73%–99%). Length measurements with bone-subtraction CTA were as exact as the DSA measurements and agreed even better for small measurements than for larger ones. CT-DSA dome-to-neck ratios were on average 0.03 smaller (2%) than with DSA. Dose-length product was 565 mGy × cm ±201 [SD] for bone-subtraction CTA and 1.609 mGy × cm ±1.300 [SD ]for DSA.
Discussion: 16–detector row MSCT with advanced bone-subtraction CTA is as accurate as DSA in detecting cerebral aneurysms after SAH, provides similar information about aneurysm configuration and measures. This is even true for small aneurysms adjacent to bony structures (e.g. the base of the scull) or under patient motion. In SAB patients in whom the initial CT-DSA doesn’t show the root cause of the SAH, a DSA is not imperative any longer. In this case a second CT-DSA is sufficient. Additionally the CT-DSA reduces the average effective radiation dose for vascular diagnostics by 65%. Furthermore the CT-DSA-based diagnosis can be performed in shorter time and at less patient risk due to its non-invasive nature.
Conclusion: The advanced CT-DSA algorithm - that minimized patient motion and artificial stenosis at the bone-to-vessel interfaces - in combination with commonly available 16-detector row MSCT demonstrated diagnostic equivalence in comparison to the DSA reference. Diagnostic equivalence in association with dose reduction suggests replacing DSA with the faster and more patient friendly bone-subtraction CTA in the diagnostic work-up of spontaneous SAH. Thus CT-DSA can accelerate targeted therapy decisions more cost effective and at less risk for the patient. Using the latest and appropriate subtraction technology and ensuring adequate training (reader experience) is more relevant than the used CT-technology (16-, 64-, 320-detector row or dual source MSCT) when introducing CT-DSA protocols.:1 Einleitung 1
1.1 Ätiologie der Subarachnoidalblutung (SAB) 1
1.2 SAB Pathogenese 2
1.3 SAB Epidemiologie 4
1.4 SAB Risikofaktoren 4
1.5 SAB Grading 5
1.6 SAB Letalität 5
1.7 SAB Diagnostik 6
1.7.1 Invasive Digitale Subtraktionsangiografie (DSA) 6
1.7.2 Nichtinvasive Mehrschicht-Computertomografie (CT) 10
1.8 Aneurysma Therapie 15
1.9 Zielsetzung 17
2 Patienten und Methoden 20
2.1 Patienten 20
2.2 Ein – und Ausschlusskriterien 20
2.3 Nativ-CT und CT-DSA 22
2.3.1 Nativ-CT Technik 22
2.3.2 CT-DSA Technik 22
2.3.3 Prototypische, automatisierte CT-DSA Auswertung 24
2.4 Digitale Subtraktionsangiografie (DSA) 27
2.5 Vermessung der Aneurysmen 27
2.6 Vergleich der Messmethoden 29
2.7 Befundungsqualität der Untersucher 29
2.8 Beurteilung der Ergebnisse 29
2.9 Beurteilung der Strahlenbelastung 30
2.10 Statistische Methoden 31
2.10.1 Fallzahlplanung 32
2.10.2 Diagnostische Genauigkeit 33
2.10.3 Methodenvergleich 34
2.10.4 Inter- und Intraobserver-Variabilität 35
3 Ergebnisse 36
3.1 Patienten 36
3.2 Nativ-CT 36
3.3 CT-DSA 36
3.4 DSA - Referenz für die Aneurysmadetektion 42
3.5 Vergleich CT-DSA mit DSA 45
3.5.1 CT-DSA Genauigkeit 45
3.5.1.1 Basierend auf prospektiver DSA 45
3.5.1.2 Basierend auf retrospektiver DSA 47
3.5.2 Aneurysma-Messergebnisse 49
3.5.3 Untersucher und Aneurysma-Konfiguration 59
3.5.4 Röntgendosis 59
3.5.5 Bildinterpretationszeiten 60
4 Diskussion 61
4.1 CT-DSA Genauigkeit für den Aneurysmanachweis 61
4.1.1 Besonderheiten der CT-DSA Anwendung 63
4.1.2 Besonderheit der CT-DSA Prototypen Software 63
4.2. CT-DSA Informationen als alleinige Planungsbasis für neurochirurgische oder endovaskuläre Eingriffe 64
4.3 Robustheit und Reproduzierbarkeit 67
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Assessing the political and investment risk climate of the PRC : a SAB-Miller case studyLanhove, Tom 03 1900 (has links)
Thesis (MA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: This research assignment has investigated the overall nature of the
investment climate in the People's Republic of China (PRC).The investment
climate was analysed using a Political Risk Analysis (PRA) framework,
whereby the PRC was scrutinised closely for its most defining socioeconomic
features and, especially, for its most salient political risk factors.
Based on this, the assignment evaluated this climate with specific relevance
to the investment plans of the South African company SAB-Miller.
Since its accession to the World Trade Organisation (WTO)in 2001, the PRC
has intensified its economic restructuring process, a necessary and
inevitable process, in order to comply with the terms of the WTOframework.
This period of adjustment has heightened the anxiety over the strength of
the Chinese economy, and the repercussions and/or opportunities for the
multinational SAB-Miller.To remedy this uncertainty, this assignment has
drawn up an in-depth qualitative scenario, in order to forecast the major
trends of the PRC's short-term socio-political future. The main findings of
the assignment indicate that a 'high-road' scenario is the most likely to
occur in the PRC in the short-term. Clearly, this favourable forecast 1S
dependent on the continuation of the current economic and socio-political
restructuring process in the PRC.
With regards to the main macro-political risks factors, the assignment draws
attention to several critical areas of concern. Firstly, the lack of
legitimatisation from the 'bottom-up' is a worrying feature, especially in light
of the growing economic disparities between citizens and between provinces.
Secondly, the financial and governmental sectors need a thorough
restructuring, according to WTO criteria. Thirdly, the fragmentation of the
market inside the PRe undermines the potential of the PRC government to
diffuse the benefits of economic growth and to absorb the downsides of
globalisation. Micro-specific risk factors for the company SAB-Miller are
focussed predominantly on the speed and the depth of the implementation of
the guidelines of the WTO. Especially with regards to the lowering of intra-provincial trade barriers and the efficacy of the distribution networks. Lastly,
SAB-Miller should eliminate any risk factors, which may originate from
inside the company's behaviour, such as the effects of its adopted labour
policies. Lastly, it should maintain a clear level of transparency in their
associations with governmental institutions. Throughout the assignment,
these risk factors will be investigated and related to the overall political risk
climate and utilised to draw conclusions concerning the potential of the
investment plans of SAB-Miller. / AFRIKAANSE OPSOMMING: Hierdie werkstuk het die beleggingsklimaat van die Volksrepubliek China
(VRC) ondersoek. Die beleggingssklimaat is ontleed deur gebruik te maak
van 'n model vir Politieke Risiko Analise (PRA), waarby die VRC sorgvuldig
onderwerp is aan 'n ondersoek van sy mees kenmerkende sosio-ekonomiese
faktore en van die belangrikste risiko faktore. Hierop gebaseer, het die
werkstuk ook die beleggingsklimaat ontleed met spesifieke betrekking tot die
beleggingsplanne van die Suid Afrikaanse maatskappy SAB-Miller.
Sedert toetreding tot die Wêreld Handelsorganisasie (WHO) in 2001, het die
VRC sy transformasie proses versnel ten einde te voldoen aan die WHO se
toelatingskriteria. Hierdie tydperk van aanpassing het kommer gewek oor die
Chinese ekonomie asook oor die gevolge daarvan vir die maatskappy SABMiller.
Om hierdie onsekerheid aan te spreek het die werkstuk 'n
kwalitatiewe scenario voorgestel, ten einde die hoofpunte van die VRC se
sosio-ekonomiese kort-termyn toekoms vooruit te skat. Die gevolgtrekking
van hierdie werkstuk toon aan dat 'n 'high-road' scenario die waarskynlikste
is gedurende die kort termyn. Dis ook duidelik dat die gunstige
vooruitskattings afhanklik is van die voortsetting van die huidige sosioekonomiese
transformasie proses van die VRC.
Met betrekking tot die vernaamste makro-politieke risiko faktore het die
werkstuk aandag gegee aan verskeie kommerwekkende aspekte. Eerstens,
die gebrek aan elektorale regmatigheid van die 'grond-af, waarskynlik in die
lig van die toenemende ekonomisiese verskille tussen burgers asook tussen
provinsies. Tweedens, moet die finansiële- en staatssektore grondig
herstruktureer word volgens die WHO riglyne. Derdens, ondermyn die
fragmentasie van die mark van binne China die mag van die VRCse regering
om die voordele van die ekonomiese groei gelykmatig te versprei, asook om
die nadele van Globalisasie te absorbeer. Mikro-spesifieke risiko faktore vir
die SAB-Miller maatskappy het hoofsaaklik gefokus op die spoed en die
diepgang van die implementering van die WHO riglyne. In besonder met
betrekking tot die hoë interprovinsiale handelsbelemmerings en die optimale
effektiwiteit van die verspreidingskakels. Laatstens, moet SAB-Miller enige risiko faktore elimineer wat as gevolg van die maatskappy se eie gedrag kan
onstaan, byvoorbeeld die maatskappy se arbeidsvoorwaardes. SAB-Miller
moet ook 'n duidelike aanspreeklikheidsfunksie daarstel, in hulle
betrekkinge met Chinese staatsinstellings. Deur die hele werkstuk word
hierdie risiko faktore ondersoek en in verband gebring met die algemene
politieke risiko klimaat, en word ook gebruik om gevolgtrekkinge te maak
aangaande die potensiaal van SAB-Millerse beleggingsplanne.
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Síndrome de ardência bucal: estudo duplo cego cruzado placebo-controlado da efetividade do ácido alfa-lipóico sobre a sintomatologia e avaliação da função gustatória / Burning mouth syndrome: double-blind placebo-controlled crossover trial of effectiveness of alpha lipoic acid and taste evaluationCavalcanti, Desirée Rosa 02 June 2008 (has links)
A síndrome de ardência bucal (SAB) é uma condição crônica, caracterizada por sensação de ardor bucal sem alterações clinicamente detectáveis. Afeta predominantemente mulheres no período pós-menopausa e sua terapêutica ainda não está estabelecida. Pelo menos dois terços destes pacientes apresentam queixa subjetiva de disgeusia como sintoma secundário associado. O objetivo deste estudo foi avaliar a efetividade do ácido alfa lipóico, como alternativa terapêutica no controle dos sintomas da SAB, por meio de um estudo duplo-cego cruzado, placebocontrolado. Foi realizada também uma investigação da função gustatória destes pacientes, pela aplicação de teste objetivo de reconhecimento dos quatro sabores básicos. Foram incluídos trinta e cinco pacientes (31 mulheres, 4 homens, média de idade 63,1 anos, variação 36-78 anos) e 31 pacientes completaram o estudo terapêutico. Os pacientes foram randomizados para dois ciclos de tratamento um com ácido alfa lipóico e um com placebo, ambos administrados em cápsulas idênticas. Estes ciclos de tratamento foram separados por um período de washout de 20 dias. O sintoma de ardor bucal e a resposta terapêutica foram avaliadas utilizando uma escala visual de sintomatologia (EVS) numérica de 10 pontos antes do início e ao término de cada ciclo e pelo efeito global percebido (EGP), usando uma escala de 5 pontos ao término de cada ciclo de tratamento. O nível de redução sobre o sintoma de ardor avaliado pela EVS foi estatisticamente significante para ambos os tratamentos (31,15% com ácido alfa lipoico e 34,09% ao término do do primeiro ciclo; 12,55% para ácido alfa lipóico e 28,09% para placebo ao término do segundo ciclo). Considerando-se os resultados de EGP dos dois ciclos, 22 pacientes reportaram pelo menos alguma melhora após utilizarem ácido alfa lipóico e 23 pacientes após utilizarem placebo. A comparação dos scores obtidos dos dois ciclos pelo teste t falharam em demonstrar efetividade para ácido alfa lipóico sobre placebo. A queixa subjetiva de disgeusia esteve associada à de ardor em 60% dos casos. No teste objetivo de paladar foram verificados erros de identificação dos sabores básicos em 35,23% das amostras para o amargo, 20% para o azedo, 20% para o doce e 19% para salgado, estes erros foram observados também entre pacientes que não apresentavam a queixa subjetiva de disgeusia. Apenas 5 pacientes (14,28%) conseguiram identificar corretamente os quatro sabores básicos. A maior parte dos erros de identificação ocorreu para o sabor amargo e em baixas concentrações. A análise dos dados obtidos nos permitiu concluir que o ácido alfa lipóico não foi efetivo no controle dos sintomas associados à síndrome de ardência bucal e que existe uma associação da síndrome com as alterações da função gustatória. / The burning mouth syndrome is a chronic condition caractherized by an oral burning sensation without clinical signs. Post menopausean women are mostly affected and the therapy is not stablished. Two thirds or more of these patients shown dysgeusia as a secondary associate complaint. The purpose of this study was to evaluate the effectiveness of alpha lipoic acid in the management of burning mouth syndrome symptoms through a randomized double-blind placebo-controlled crossover trial. In addiction, a preliminary evaluation of taste function was performed by objective test to recognition of the four basic flavors. Thirty-five patients (31 women, 4 men, median age 63.1 years, range 36-78) were included and 31 completed the therapeutic study. The patients were randomized for two cycles of treatmentone with alpha lipoic acid and one with placebo, both administered in identical capsules. These cycles were separated by a washout period of 20 days. The oral symptoms and the treatment response were assessed using a 10 point numerical visual analogue scale (VAS) before and after each cycle and the global perceived effect (GPE) score, using a 5- point scale at the end of each treatment cycle. The level of burning reduction assessed by VAS was significant for both treatments (31.15% with ALA treatment and 34.09% with placebo after first cycle and 12.55% for ALA and 28.09% for placebo after second cycle). Considering the results of GPE in the two cycles together, twenty-two patients reported at least some improvement after alpha lipoic acid use and twenty-three patients after placebo. Comparison of the oral assessment scores of the two cycles with t test failed to demonstrate effectiveness for alpha lipoic acid over placebo. Dysgeusia was associated with burning mouth in 60% of the cases. In the objective taste evaluation, identification errors were observed in 35,23% of the samples for bitter, 20% for sour, 20% for sweet and 19% for salty. Moreover, these errors were observed among patients whose not complain of dysgeusia. Only 5 patients (14,28%) had correct identification of four basic flavors. Most of identifications errors were observed in bitter taste and in lower concentrations. We concluded that alpha lipoic acid was not effective in the control of burning mouth syndrome symptoms in this study and there is a relation of taste disfunction with the syndrome.
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Marginaliserad kunskap? : En kritisk studie av representationen av genusvetenskaplig litteratur i klassifikationssystem och ämnesordslistor / Marginalized knowledge? : A critical approach towards the representation of gender studies in classification systems and subject heading lists’Folkesson, Isabel, März, Klara January 2006 (has links)
The main focus of this master’s thesis concerns the relation between subject representation, power and gender. Classification systems and subject heading lists are products of their cultural and social context and some subjects and disciplines are given a greater value than others. Our aim in this thesis is twofold; to discuss and critically analyse the prevailing gender norms that are expressed trough classification systems and subject heading lists and to examine how they manage to represent gender studies as a multidisciplinary subject in theory as well as in practice. We are also discussing the particular problems with the representation of multidisciplinary subjects in general. The analysis is grounded in the field of gender studies, where feminist, masculinity and queer theory are included, and the area of critical classification theory. The classification systems and subject heading list that are discussed here are DDC, SAB, SAO, LCSH and KVINNSAM. In the case of DDC and SAB, the analysis concerns the hierarchal structure and principal arrangement of subjects. The focus in the analysis of SAO, LSCH and KVINNSAM is on the assigned subject headings and the lists’ possibilities to adequately represent gender studies. The result of this study shows that both the systems and the subject heading list have considerable problems with integrating and fully representing gender studies as a multidisciplinary subject. It also shows that the available vocabularies for describing gender and feminist literature are very limited. The practise in indexing and classifying multidisciplinary subjects in general are neither sufficient nor consistent. / Uppsatsnivå: D
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Sab Concentration Determines the Chemotherapeutic Efficacy in Gynecological CancerPaudel, Iru 29 March 2018 (has links)
The American Cancer Society predicts there will be 110,070 new cases and 32,120 deaths due to gynecological malignancies in 2018. A major contributing factor to the high mortality associated with gynecological cancers is the recurrence of treatment-resistant tumors. Ovarian cancer (OC) remains the most lethal gynecological malignancy, yet the mechanisms responsible for regulating tumor resistance and vulnerability are largely unknown or undruggable. Therefore, the goal of this research is to identify mechanisms responsible for therapeutic resistance in gynecological cancers and discover innovative approaches to circumvent these molecular alterations. Our efforts began in OC where secondary analysis of gene expression data from OC studies revealed that Sab, an outer mitochondrial membrane (OMM) scaffold protein, was down-regulated in OC tumors compared to normal tissue controls. Our previous studies demonstrate that Sab-mediated OMM signaling induces cell death in cervical cancer. In the current study, we found that Sab concentrations corresponded to chemoresponsiveness in a panel of OC cells; wherein, OC cells with low Sab levels were chemo resistant. Dynamic BH3 profiling revealed that cells with high Sab expression were primed for apoptosis. Furthermore, over-expression of Sab in chemo resistant cells enhanced apoptotic priming and restored cellular vulnerability to cisplatin/paclitaxel treatment. Additionally, an examination of treatment-resistant metastatic uterine cancer (UC) cells were found to have low Sab concentrations compared to vulnerable primary site-derived UC cells. Ectopic expression of Sab in chemo resistant UC cells enhanced the susceptibility towards megestrol acetate and BH3-mimetic ABT-737. To exploit the relationship between Sab concentrations and chemo-responsiveness in gynecological cancer cells, we developed a high-throughput screening assay to detect Sab levels in chemo-resistant OC cells. In collaboration with the Torrey Pines Institute for molecular studies, we have identified compounds that can increase Sab levels in resistant OC cells. The identified compounds improved the effectiveness of cisplatin/paclitaxel therapy. We propose that Sab may be a prognostic marker to discern personalized treatments for gynecological cancer patients. Furthermore, pharmacologically enhancing Sab-mediated signaling may increase the efficacy of chemotherapeutic agents, which would mean lower doses that would limit toxic side-effects.
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Sverige och övergången till klassifikationssystemet DDC : Problematiken med hylluppställning ur ett användarperspektivEriksson, Sofia January 2009 (has links)
<p>Ett antal bibliotek i Sverige, med Kungliga biblioteket i spetsen, har tagit beslut att byta klassifikationssystem från SAB-systemet till Dewey Decimal Classification (DDC). Den aspekt på denna övergång som utreds här är att ur ett användarperspektiv utvärdera Kungliga bibliotekets förslag på hylluppställningar som biblioteken kan använda sig av vid en övergång till DDC. Först jämför jag hur SAB och DDC:s huvudklasser skiljer sig åt och därefter diskuterar jag de olika hylluppställningarna ur ett användarperspektiv.</p><p> </p><p>SAB-systemet har 25 huvudklasser och DDC endast tio. Detta innebär att SAB-systemet har mer utkristalliserade ämnen i sina huvudklasser, medan DDC behandlar fler ämnen i varje huvudklass. SAB-systemet har fokus på humanistiska ämnen, medan naturvetenskapliga ämnen hamnar längre ned i systemet. DDC är mer sammansatt och inte lika tydligt humanistisk i sin uppbyggnad. De naturvetenskapliga ämnena prioriteras högre i DDC.</p><p> </p><p>De hylluppställningsförslag som är aktuella och som diskuteras bland biblioteken är ren DDC-uppställning, bruten hylluppställning, blandad hylluppställning eller behålla befintliga system. Förslaget att införa ren DDC-uppställning innebär att all litteratur måste omklassificeras enligt DDC. Bruten hylluppställning innebär att den äldre litteraturen får stå kvar med samma hylluppställning som tidigare medan den nya litteraturen ställs upp enligt DDC. Blandad uppställning innebär att alla böcker ställs tillsammans på hyllorna, men den äldre litteraturen omklassificeras inte utan får behålla samma koder som tidigare. Att behålla samma hylluppställningssystem som tidigare eller använda sig av något helt annat system är också ett alternativ. Detta förslag innebär dock att klassificeringen av bibliotekens material inte kommer att ha något att göra med hylluppställningen och i och med det uppkommer en annan fråga; finns det någon mening att använda sig av ett klassifikationssystem som sedan inte kommer att användas vid uppställningen av bibliotekets material? Utifrån dessa förslag på hylluppställningar som kungliga biblioteket presenterar så är det mest användarvänliga att ha samma hylluppställning som klassifikationssystem. Men detta innebär också mest jobb för biblioteken och det förslag som istället diskuteras flitigast är blandad uppställning. Det förslaget kan ses som den gyllene medelvägen för både låntagare och bibliotek. Låntagarna får de böcker som behandlar samma ämne samlade på samma ställe vilket ger en bra översikt i hyllan och dessutom sparar detta förslag tid för biblioteken i arbetet med övergången till DDC. Det mest användarvänliga på sikt är dock en total övergång till DDC-hylluppställning. <strong></strong></p>
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Sverige och övergången till klassifikationssystemet DDC : Problematiken med hylluppställning ur ett användarperspektivEriksson, Sofia January 2009 (has links)
Ett antal bibliotek i Sverige, med Kungliga biblioteket i spetsen, har tagit beslut att byta klassifikationssystem från SAB-systemet till Dewey Decimal Classification (DDC). Den aspekt på denna övergång som utreds här är att ur ett användarperspektiv utvärdera Kungliga bibliotekets förslag på hylluppställningar som biblioteken kan använda sig av vid en övergång till DDC. Först jämför jag hur SAB och DDC:s huvudklasser skiljer sig åt och därefter diskuterar jag de olika hylluppställningarna ur ett användarperspektiv. SAB-systemet har 25 huvudklasser och DDC endast tio. Detta innebär att SAB-systemet har mer utkristalliserade ämnen i sina huvudklasser, medan DDC behandlar fler ämnen i varje huvudklass. SAB-systemet har fokus på humanistiska ämnen, medan naturvetenskapliga ämnen hamnar längre ned i systemet. DDC är mer sammansatt och inte lika tydligt humanistisk i sin uppbyggnad. De naturvetenskapliga ämnena prioriteras högre i DDC. De hylluppställningsförslag som är aktuella och som diskuteras bland biblioteken är ren DDC-uppställning, bruten hylluppställning, blandad hylluppställning eller behålla befintliga system. Förslaget att införa ren DDC-uppställning innebär att all litteratur måste omklassificeras enligt DDC. Bruten hylluppställning innebär att den äldre litteraturen får stå kvar med samma hylluppställning som tidigare medan den nya litteraturen ställs upp enligt DDC. Blandad uppställning innebär att alla böcker ställs tillsammans på hyllorna, men den äldre litteraturen omklassificeras inte utan får behålla samma koder som tidigare. Att behålla samma hylluppställningssystem som tidigare eller använda sig av något helt annat system är också ett alternativ. Detta förslag innebär dock att klassificeringen av bibliotekens material inte kommer att ha något att göra med hylluppställningen och i och med det uppkommer en annan fråga; finns det någon mening att använda sig av ett klassifikationssystem som sedan inte kommer att användas vid uppställningen av bibliotekets material? Utifrån dessa förslag på hylluppställningar som kungliga biblioteket presenterar så är det mest användarvänliga att ha samma hylluppställning som klassifikationssystem. Men detta innebär också mest jobb för biblioteken och det förslag som istället diskuteras flitigast är blandad uppställning. Det förslaget kan ses som den gyllene medelvägen för både låntagare och bibliotek. Låntagarna får de böcker som behandlar samma ämne samlade på samma ställe vilket ger en bra översikt i hyllan och dessutom sparar detta förslag tid för biblioteken i arbetet med övergången till DDC. Det mest användarvänliga på sikt är dock en total övergång till DDC-hylluppställning.
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Análise de frequência de secas utilizando análise de agrupamento e distribuições de probabilidades.MELO, Valneli da Silva. 17 July 2018 (has links)
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Previous issue date: 2016-06 / Capes / O objetivo deste trabalho foi o de ajustar funções densidades de probabilidades aos dados das variáveis Severidade e Duração de secas em três sub-regiões do Semiárido do Brasil (SAB). Para tanto, foram utilizados dados de totais mensais precipitados de 320 postos pluviométricos, no período de 1984 a 2014, gentilmente cedidos pela Agência Nacional de Águas (ANA). Foi utilizado o método “RUN” para se obter os dados de Severidade e Duração de secas, a partir dos totais mensais precipitados. Em seguida utilizou-se a técnica de Análise de Agrupamento para regionalizar a Severidade e Duração de secas. O passo seguinte foi obter os ajustes à função distribuição de probabilidades para cada sub-região. As funções distribuição de probabilidades: Gama, GEV e Logística foram as que melhor se ajustaram à variável Severidade de secas, já a os modelos GEV, Weibull com três parâmetros e Gama com dois parâmetros se ajustaram melhor aos dados de Duração de secas para as sub-regiões homogêneas 1, 2 e 3 respectivamente. Os ajustes das variáveis Severidade e Duração de secas à distribuição de probabilidades Normal bivariada não logrou êxito em nenhuma sub-região do SAB. / The objective of this study was to adjust probability density functions to data of severity and duration of droughts in three sub-regions of the semiarid region of Brazil (SAB). To accomplish this task, the totals monthly precipitated of 320 rain gauges were used in the period 1984-2014. These data were kindly provided by the National Water Agency (ANA). Then, was used the method "RUN" to get the severity and duration of droughts based on totals monthly precipitated. Then we used the Cluster Analysis technique to regionalize the severity and duration of droughts. The next step was to get the adjustment of data to Probability Distribution Function (PDF) for each sub-region. The GEV and Logistics were the PDFs that best fitted to the severity of droughts. On the other hands, the GEV models, Weibull three parameters and Gamma with two parameters were adjusted better to the duration of droughts in the sub homogeneous-regions 1, 2 and 3 respectively. Lastly, the severity and duration of droughts were adjusted to normal bivariate distribution. This adjustment was not successful in any subregion of the SAB studied.
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Síndrome de ardência bucal: estudo duplo cego cruzado placebo-controlado da efetividade do ácido alfa-lipóico sobre a sintomatologia e avaliação da função gustatória / Burning mouth syndrome: double-blind placebo-controlled crossover trial of effectiveness of alpha lipoic acid and taste evaluationDesirée Rosa Cavalcanti 02 June 2008 (has links)
A síndrome de ardência bucal (SAB) é uma condição crônica, caracterizada por sensação de ardor bucal sem alterações clinicamente detectáveis. Afeta predominantemente mulheres no período pós-menopausa e sua terapêutica ainda não está estabelecida. Pelo menos dois terços destes pacientes apresentam queixa subjetiva de disgeusia como sintoma secundário associado. O objetivo deste estudo foi avaliar a efetividade do ácido alfa lipóico, como alternativa terapêutica no controle dos sintomas da SAB, por meio de um estudo duplo-cego cruzado, placebocontrolado. Foi realizada também uma investigação da função gustatória destes pacientes, pela aplicação de teste objetivo de reconhecimento dos quatro sabores básicos. Foram incluídos trinta e cinco pacientes (31 mulheres, 4 homens, média de idade 63,1 anos, variação 36-78 anos) e 31 pacientes completaram o estudo terapêutico. Os pacientes foram randomizados para dois ciclos de tratamento um com ácido alfa lipóico e um com placebo, ambos administrados em cápsulas idênticas. Estes ciclos de tratamento foram separados por um período de washout de 20 dias. O sintoma de ardor bucal e a resposta terapêutica foram avaliadas utilizando uma escala visual de sintomatologia (EVS) numérica de 10 pontos antes do início e ao término de cada ciclo e pelo efeito global percebido (EGP), usando uma escala de 5 pontos ao término de cada ciclo de tratamento. O nível de redução sobre o sintoma de ardor avaliado pela EVS foi estatisticamente significante para ambos os tratamentos (31,15% com ácido alfa lipoico e 34,09% ao término do do primeiro ciclo; 12,55% para ácido alfa lipóico e 28,09% para placebo ao término do segundo ciclo). Considerando-se os resultados de EGP dos dois ciclos, 22 pacientes reportaram pelo menos alguma melhora após utilizarem ácido alfa lipóico e 23 pacientes após utilizarem placebo. A comparação dos scores obtidos dos dois ciclos pelo teste t falharam em demonstrar efetividade para ácido alfa lipóico sobre placebo. A queixa subjetiva de disgeusia esteve associada à de ardor em 60% dos casos. No teste objetivo de paladar foram verificados erros de identificação dos sabores básicos em 35,23% das amostras para o amargo, 20% para o azedo, 20% para o doce e 19% para salgado, estes erros foram observados também entre pacientes que não apresentavam a queixa subjetiva de disgeusia. Apenas 5 pacientes (14,28%) conseguiram identificar corretamente os quatro sabores básicos. A maior parte dos erros de identificação ocorreu para o sabor amargo e em baixas concentrações. A análise dos dados obtidos nos permitiu concluir que o ácido alfa lipóico não foi efetivo no controle dos sintomas associados à síndrome de ardência bucal e que existe uma associação da síndrome com as alterações da função gustatória. / The burning mouth syndrome is a chronic condition caractherized by an oral burning sensation without clinical signs. Post menopausean women are mostly affected and the therapy is not stablished. Two thirds or more of these patients shown dysgeusia as a secondary associate complaint. The purpose of this study was to evaluate the effectiveness of alpha lipoic acid in the management of burning mouth syndrome symptoms through a randomized double-blind placebo-controlled crossover trial. In addiction, a preliminary evaluation of taste function was performed by objective test to recognition of the four basic flavors. Thirty-five patients (31 women, 4 men, median age 63.1 years, range 36-78) were included and 31 completed the therapeutic study. The patients were randomized for two cycles of treatmentone with alpha lipoic acid and one with placebo, both administered in identical capsules. These cycles were separated by a washout period of 20 days. The oral symptoms and the treatment response were assessed using a 10 point numerical visual analogue scale (VAS) before and after each cycle and the global perceived effect (GPE) score, using a 5- point scale at the end of each treatment cycle. The level of burning reduction assessed by VAS was significant for both treatments (31.15% with ALA treatment and 34.09% with placebo after first cycle and 12.55% for ALA and 28.09% for placebo after second cycle). Considering the results of GPE in the two cycles together, twenty-two patients reported at least some improvement after alpha lipoic acid use and twenty-three patients after placebo. Comparison of the oral assessment scores of the two cycles with t test failed to demonstrate effectiveness for alpha lipoic acid over placebo. Dysgeusia was associated with burning mouth in 60% of the cases. In the objective taste evaluation, identification errors were observed in 35,23% of the samples for bitter, 20% for sour, 20% for sweet and 19% for salty. Moreover, these errors were observed among patients whose not complain of dysgeusia. Only 5 patients (14,28%) had correct identification of four basic flavors. Most of identifications errors were observed in bitter taste and in lower concentrations. We concluded that alpha lipoic acid was not effective in the control of burning mouth syndrome symptoms in this study and there is a relation of taste disfunction with the syndrome.
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Feasibility study for wind power at SAB NewlandsBrosius, Walter 12 1900 (has links)
Thesis (MScEng (Mechanical and Mechatronic Engineering))--University of Stellenbosch, 2009. / This paper describes a MEng thesis project for a MEng in
Renewable Energy Systems program at the Centre for Renewable
Energy Studies at the University of Stellenbosch, South Africa. The
aim of this paper was to offer to SAB (South African Breweries), in
Cape Town, a feasibility study for the possibilities of the usage of
wind energy on site.
The small scale wind power technology has a long history
and has been in South Africa for more than a hundred years in the
form of water pump wind mills. All wind mills have an absolute
maximum power output defined by the Betz limit. The choice of a
wind turbine depends not only on this, but also on the wind speed
distribution, the power curve, the location and financing. The small
scale turbines have many different design which are predominantly
grouped in horizontal axis (HAWT) and vertical axis (VAWT)
machines.
The choice of turbine for SAB depends on the available wind
energy, the available budget, the available space and the
application. The aim of the measurements on site was threefold;
find a correlation with existing weather stations in the area like at
Cape Town International Airport, propose a turbine for SAB’s
budget and research the possibility for installing the turbine on one
of the buildings. This is also known as building integrated wind
turbines.
Wind speeds can increase over buildings due to venturi
effects and it could therefore be viable to locate these acceleration
zones and install a turbine there. The data analysis shows that the
wind above the brewery is very well correlated with the wind at the
airport. We can therefore use the average speed values of this
station to predict average power production. This leads to the
proposal of a 1kW or 3kW turbine from a South African
manufacturer: Kestrel. Building integration is however not a good
idea. The wind is too turbulent and can therefore not be used. This
is mainly caused by the fact that the surroundings of the brewery
are too high and irregularly shaped. This makes it difficult for the
wind to “lower” in between the buildings and accelerate.
The wind turbine for SAB is proposed to be installed on the
highest point of the roof and based on the neighbouring average
wind speed values. The wind turbine should be connected directly
to the brewery’s grid with an inverter and would then solely
function as an energy saver. Another important aspect is the
promotional value in the energy efficiency strategy of SAB. / Centre for Renewable and Sustainable Energy Studies
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