Perioperative Morbidität und Mortalität bei Patienten mit einem BMI über 50kg/m2 : Indikation für ein abgestuftes Therapiekonzept

Magdeburg, Univ., Med. Fak., Diss., 2013

Lineare versus zirkuläre Gastrojejunostomie bei Roux-en-Y-Magenbypass : Einfluss auf die perioperative Morbidität und die Gewichtsreduktion ; Analyse der Daten der Qualitätssicherungsstudie für operative Therapie der Adipositas 2005 - 2010

Magdeburg, Univ., Med. Fak., Diss., 2014

Vertical competition and multi-period interaction : a theoretical and behavioral analysis on the impact of strategic inventories in supply chain management

Otto-von-Guericke-Universtität Magdeburg, Fakultät für Wirtschaftswissenschaft, Univ., Dissertation, 2015

Proto Lima; a middle period culture of Peru / A.L. Kroeber. Appendix: Cloths. [by] Dwight T. Wallace

v.44:no.1(1954)

The diet of the South American sea lion (Otaria flavescens) at Río Negro, Patagonia, Argentina, during the winter-spring period

The South American sea lion, Otaria flavescens (Shaw, 1800) population is steadily expanding along the Patagonian coast of Argentina in the last decades. However, little is known about the feeding ecology of the species in the area. The aim of this study was to analyze the food habits of O. flavescens from 91 scats collected at Río Negro province, during the winter and spring of 2005. Fish occurred in 96% of scats containing prey remains, followed by cephalopods (26%). Raneya brasiliensis (Kaup, 1856) was the most frequent and abundant species occurring in 58.6% of samples and constituting almost 50% of fish predated. Second in importance were Porichthys porosissimus (Cuvier, 1829) and Cynoscion guatucupa (Cuvier, 1830) in terms of occurrence (%FO 20.7) and numbers (29.6%) respectively. The squid Loligo gahi (d'Orbigny, 1835) was the most frequent cephalopod prey (42.1%), whereas Octopus tehuelchus (d'Orbigny, 1834) was the most abundant (77%). The higher amount and diversity of prey found in the spring in comparison with the winter season might be related to a higher feeding activity of seals or to a seasonal increase in food availability in the area.

Single period Markowitz portfolio selection, performance gauging and duality: a variation on Luenberger's shortage function

Markowitz portfolio theory (1952) has induced research into the efficiency of portfolio management. This paper studies existing nonparametric efficiency measurement approaches for single period portfolio selection from a theoretical perspective and generalises currently used efficiency measures into the full mean-variance space. Therefore, we introduce the efficiency improvement possibility function (a variation on the shortage function), study its axiomatic properties in the context of Markowitz efficient frontier, and establish a link to the indirect mean-variance utility function. This framework allows distinguishing between portfolio efficiency and allocative efficiency. Furthermore, it permits retrieving information about the revealed risk aversion of investors. The efficiency improvement possibility function thus provides a more general framework for gauging the efficiency of portfolio management using nonparametric frontier envelopment methods based on quadratic optimisation.

The period function of the generalized Lotka-Volterra centers

"Vegeu el resum a l'inici del document del fitxer adjunt"

On the relation between tax rates and evasion in a multi-period economy

We extend the basic tax evasion model to a multi-period economy exhibiting sustained growth. When individuals conceal part of their true income from the tax authority, they face the risk of being audited and hence of paying the corresponding fine. Both taxes and fines determine individual saving and the rate of capital accumulation. In this context we show that the sign of the relation between the level of the tax rate and the amount of evaded income is the same as that obtained in static setups. Moreover, high tax rates on income are typically associated with low growth rates as occurs in standard growth models that disregard the tax evasion phenomenon.

Poliomyelitis: epidemiological aspects in Rio de Janeiro (Guanabara State) and adjacent areas in the period from 1961 to 1970

Based on the available data from the Hospital responsible for the care of paralitic poliomyelitis cases in Rio de Janeiro City (Guanabara State) and adjacent areas, and the laboratory studies carried out on these patients, the authors analize epidemiological aspects of poliomyelitis in a period of ten years (1961 to 1970). Paralitic poliomyelitis remains a public health problem, with a typical incidence in the less than 4 year age group. All three poliovirus types have been prevalent for at least one period of time during the last ten years. Trivalent oral vaccine has been used since 1961 but the vaccination levels achieved were not enough to a permanent control of the disease. A definite seasonal distribution of cases could not be observed with the available data. Active mass campaign vaccinations with previous motivation of all segments of the population, specially the low-income groups instead of passive waiting of children in Vaccination Centers seems to be the best aproach to control poliomyelitis in this area.

Perioperative antiplatelet therapy.

Aspirin is recommended as a lifelong therapy that should never be interrupted for patients with cardiovascular dis- ease. Clopidogrel therapy is mandatory for six weeks after placement of bare-metal stents, three to six months after myocardial infarction, and at least 12 months after placement of drug-eluting stents. Because of the hypercoagulable state induced by surgery, early withdrawal of antiplatelet therapy for secondary prevention of cardiovascular disease increases the risk of postoperative myocardial infarction and death five- to 10-fold in stented patients who are on continuous dual antiplatelet therapy. The shorter the time between revascularization and surgery, the higher the risk of adverse cardiac events. Elective surgery should be postponed beyond these periods, whereas vital, semiurgent, or urgent operations should be performed under continued dual antiplatelet therapy. The risk of surgical hemorrhage is increased approximately 20 percent by aspirin or clopidogrel alone, and 50 percent by dual antiplatelet therapy. The present clinical data suggest that the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during surgery in a closed space (e.g., intracranial, posterior eye chamber) or surgeries associated with massive bleeding and difficult hemostasis.

Perioperative stress in dogs underwent elective surgery: evaluation of the antioxidant activity

Projecte de recerca elaborat a partir d’una estada al Department of Biological Science a la University of Lincoln, a la Gran Bretanya, entre octubre i desembre del 2006. L'objectiu del present assaig va ser desciure les respostes antioxidants d'estrès en gossos sotmesos a cirurgia electiva, en condicions de pràctica clínica normals, durant les fases de preoperatori i postoperatori.Setze gossos van ser sotmesos a orquiectomia o ovariohisterectomia electives, utilitzant un protocol quirúrgic estàndard. Durant les fases preoperatoria i postoperatoria, cada animal va ser confinat a la Unitat de Cures Intensives, temps durant el qual es va estudiar la seva resposta antioxidant. Els valors obtinguts a diferents temps van ser comparats amb el valor basal, que s'havia obtingut del mateix animal estant aquest en el seu ambient habitual. No es van detectar variacions significants causades per l'estrès perioperatori. Els valors màxims es van observar durant la fase preoperatoria, just després que l'animal fós confinat a la Unitat de Cures Intensives, moment en el que l'estrès percebut era degut a les amenaces psicològiques de una àrea restringida i de la manipulació per persones desonegudes. L'abscència de variacions significants podrien ser degudes al sistema i el temps d'emmagatzement de les mostres. En humana s'han descrit les alteracions en l'activitat dels antioxidants sèrics després d'un mes d'emmagatzematent. Per definir l'estabilitat, després de la recollida de mostres, de l'activitat dels antioxidants en sèrum de gos és necessari realitzar més estudis.

The effect of the N-methyl-D-aspartate receptor antagonist dextromethorphan on perioperative brain injury in children undergoing cardiac surgery with cardiopulmonary bypass: results of a pilot study.

Experimental evidence indicates a role of the N-methyl-D-aspartate receptor in the pathogenesis of brain injury occurring during cardiac surgery with cardiopulmonary bypass (CPB). Dextromethorphan is a noncompetitive antagonist of this receptor with a favorable safety profile. Thirteen children age 3-36 months undergoing cardiac surgery with expected CPB of 60 minutes or more were randomly assigned to treatment with dextromethorphan (36-38 mg/kg/day) or placebo administered by naso-gastric tube. Dextromethorphan was absorbed well and reached putative therapeutic levels in blood and cerebrospinal fluid. Adverse effects were not observed. Mild hemiparesis developed after operation in one child of each group, and severe encephalopathy in one of the placebo group. Sharp waves were recorded in postoperative continuous electroencephalography in all placebo (n = 7) but only in 2/6 dextromethorphan treated children (p = 0.02). Pre- and postoperative cranial magnetic resonance imaging (MRI) revealed less pronounced ventricular enlargement in the dextromethorphan group (not significant). An increase of periventricular white matter lesions was visible in two placebo-treated children only. No elevations of cerebrospinal fluid enzymes were observed in either group. Although children with dextromethorphan showed less abnormalities in electroencephalography and MRI, dissimilarities of the treatment groups by chance diminished conclusions to possible protective effects of dextromethorphan at this time.

Evaluation of a summary score of cognitive performance for use in trials in perioperative and critical care.

Background/Aims: Cognitive dysfunction after medical treatment is increasingly being recognized. Studies on this topic require repeated cognitive testing within a short time. However, with repeated testing, practice effects must be expected. We quantified practice effects in a demographically corrected summary score of a neuropsychological test battery repeatedly administered to healthy elderly volunteers. Methods: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychological Assessment Battery (for which a demographically corrected summary score was developed), phonemic fluency tests, and trail-making tests were administered in healthy volunteers aged 65 years or older on days 0, 7, and 90. This battery allows calculation of a demographically adjusted continuous summary score. Results: Significant practice effects were observed in the CERAD total score and in the word list (learning and recall) subtest. Based on these volunteer data, we developed a threshold for diagnosis of postoperative cognitive dysfunction (POCD) with the CERAD total score. Conclusion: Practice effects with repeated administration of neuropsychological tests must be accounted for in the interpretation of such tests. Ignoring practice effects may lead to an underestimation of POCD. The usefulness of the proposed demographically adjusted continuous score for cognitive function will have to be tested prospectively in patients.

Impact of preoperative central neurologic dysfunction on patients undergoing emergency surgery for type a dissection.

BACKGROUND: Preoperative central neurologic deficits in the context of acute type A dissection are a complex comorbidity and difficult to handle. The aim this study was to analyze this subgroup of patients by comparing them with neurologically asymptomatic patients with type A dissection. Results may help the surgeon in preoperative risk assessment and thereby aid in the decision-making process. METHODS: We reviewed the data of patients admitted for acute type A dissection during the period from 1999 to 2010. Associated risk factors, time to surgery from admission, extension of the dissection, localization of central nervous ischemic lesions, and the influence of perioperative brain protective strategies were analyzed in a comparison of preoperative neurologically deficient to nondeficient patients. RESULTS: Forty-seven (24.5%) of a total of 192 patients had new-onset central neurologic symptoms prior to surgery. Concomitant myocardial infarction (OR 4.9, 95% CI 1.6-15.3, P = 0.006), renal failure (OR 5.9, 95% CI 1.1-32.8, P = 0.04), dissected carotid arteries (OR 9.2, 95% CI 2.4-34.7, P = 0.001), and late admission to surgery at >6 hours after symptom onset (OR 2.7, 95% CI 1.1-6.8, P = 0.04) were observed more frequently in neurologically deficient patients. These patients had a higher 30-day in-hospital mortality on univariate analysis (P = 0.01) and a higher rate of new postoperative neurologic deficits (OR 9.2, 95% CI 2.4-34.7, P = 0.02). Neurologic survivors had an equal hospital stay, and 67% of them had improved symptoms. CONCLUSIONS: The predominance of neurologic symptoms at admission may be responsible for an initial misdiagnosis. The concurrent central nervous system ischemia and myocardial infarction explains a higher mortality rate and a more extensive "character" of the disease. Neurologically deficient patients are at higher risk of developing new postoperative neurologic symptoms, but prognosis for the neurologic evolution of survivors is generally favorable.

Optimal latent period in a bacteriophage population model structured by infection-age

We study the lysis timing of a bacteriophage population by means of a continuously infection-age-structured population dynamics model. The features of the model are the infection process of bacteria, the natural death process, and the lysis process which means the replication of bacteriophage viruses inside bacteria and the destruction of them. We consider that the length of the lysis timing (or latent period) is distributed according to a general probability distribution function. We have carried out an optimization procedure and we have found the latent period corresponding to the maximal fitness (i.e. maximal growth rate) of the bacteriophage population.