The Grizzly, December 7, 2006

Facing Facebook: Ursinus Administrators Show Students the Dangers of Internet Use • New Berman Exhibit to be Longest Running Show • Ursinus Administration Supports WeCAN\u27s Backing of Workers\u27 Rights • Sounds of Gospel Music Bless the Lenfest Stage • Unraveling the Floy Lewis Bakes Center • What is Rushing? • Health in Ten Questions: Influenza • Opinions: What\u27s Happened to our Movies?; Christmas: A Season of Pretension • Men\u27s Basketball Looks for Three-peat, Women Contenders in Centennial Conferencehttps://digitalcommons.ursinus.edu/grizzlynews/1727/thumbnail.jp

Ideal Outcome After Pancreatoduodenectomy:A Transatlantic Evaluation of a Harmonized Composite Outcome Measure

OBJECTIVE: The aim of this study is to define and assess Ideal Outcome in the national or multicenter registries of North America, Germany, the Netherlands, and Sweden. BACKGROUND: Assessing outcomes after pancreatoduodenectomy among centers and countries requires a broad evaluation that cannot be captured by a single parameter. Previously, 2 composite outcome measures (textbook outcome and optimal pancreatic surgery) for pancreatoduodenectomy have been described from Europe and the United States. These composites were harmonized into ideal outcome (IO). METHODS: This analysis is a transatlantic retrospective study (2018-2020) of patients after pancreatoduodenectomy within the registries from North America, Germany, The Netherlands, and Sweden. After 3 consensus meetings, IO for pancreatoduodenectomy was defined as the absence of all 6 parameters: (1) in-hospital mortality, (2) severe complications-Clavien-Dindo ≥3, (3) postoperative pancreatic fistula-International Study Group of Pancreatic Surgery (ISGPS) grade B/C, (4) reoperation, (5) hospital stay &gt;75th percentile, and (6) readmission. Outcomes were evaluated using relative largest difference (RLD) and absolute largest difference (ALD), and multivariate regression models. RESULTS: Overall, 21,036 patients after pancreatoduodenectomy were included, of whom 11,194 (54%) reached IO. The rate of IO varied between 55% in North America, 53% in Germany, 52% in The Netherlands, and 54% in Sweden (RLD: 1.1, ALD: 3%, P &lt;0.001). Individual components varied with an ALD of 2% length of stay, 4% for in-hospital mortality, 12% severe complications, 10% postoperative pancreatic fistula, 11% reoperation, and 9% readmission. Age, sex, absence of chronic obstructive pulmonary disease, body mass index, performance status, American Society of Anesthesiologists (ASA) score, biliary drainage, absence of vascular resection, and histologic diagnosis were associated with IO. In the subgroup of patients with pancreatic adenocarcinoma, country, and neoadjuvant chemotherapy also was associated with improved IO. CONCLUSIONS: The newly developed composite outcome measure "Ideal Outcome" can be used for auditing and comparing outcomes after pancreatoduodenectomy. The observed differences can be used to guide collaborative initiatives to further improve the outcomes of pancreatic surgery.</p

Transatlantic registries of pancreatic surgery in the United States of America, Germany, the Netherlands, and Sweden: Comparing design, variables, patients, treatment strategies, and outcomes

Background: Registries of pancreatic surgery have become increasingly popular as they facilitate both quality improvement and clinical research. We aimed to compare registries for design, variables collected, patient characteristics, treatment strategies, clinical outcomes, and pathology. Methods: Registered variables and outcomes of pancreatoduodenectomy (2014–2017) in 4 nationwide or multicenter pancreatic surgery registries from the United States of America (American College of Surgeons National Surgical Quality Improvement Program), Germany (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie - Studien-, Dokumentations- und Qualitätszentrum), the Netherlands (Dutch Pancreatic Cancer Audit), and Sweden (Swedish National Pancreatic and Periampullary Cancer Registry) were compared. A core registry set of 55 parameters was identified and evaluated using relative and absolute largest differences between extremes (smallest versus largest). Results: Overall, 22,983 pancreatoduodenectomies were included (15,224, 3,558, 2,795, and 1,406 in the United States of America, Germany, the Netherlands, and Sweden). Design of the registries varied because 20 out of 55 (36.4%) core parameters were not available in 1 or more registries. Preoperative chemotherapy in patients with pancreatic ductal adenocarcinoma was administered in 27.6%, 4.9%, 7.0%, and 3.4% (relative largest difference 8.1, absolute largest difference 24.2%, P < .001). Minimally invasive surgery was performed in 7.8%, 4.5%, 13.5%, and unknown (relative largest difference 3.0, absolute largest difference 9.0%, P < .001). Median length of stay was 8.0, 16.0, 12.0, and 11.0 days (relative largest difference 2.0, absolute largest difference 8.0, P < .001). Reoperation was performed in 5.7%, 17.1%, 8.7%, and 11.2% (relative largest difference 3.0, absolute largest difference 11.4%, P < .001). In-hospital mortality was 1.3%, 4.7%, 3.6%, and 2.7% (relative largest difference 3.6, absolute largest difference 3.4%, P < .001). Conclusion: Considerable differences exist in the design, variables, patients, treatment strategies, and outcomes in 4 Western registries of pancreatic surgery. The absolute largest differences of 24.3% for the use of preoperative chemotherapy, 9.0% for minimally invasive surgery, 11.4% for reoperation rate, and 3.4% for in-hospital mortality require further study and improvement. This analysis provides 55 core parameters for pancreatic surgery registries

Informative hypotheses in EffectLiteR

Met behulp van informatieve hypothesen kunnen we restricties opleggen aan regressiecoëfficiënten zodat ze een bepaalde richting of een bepaalde volgorde hebben. Vervolgens kunnen we aangepaste versies gebruiken van de reguliere Wald-, Score- en Likelihood-Ratio test, evenals de afstandsstatistiek. Deze statistieken zijn goed beschreven in de literatuur, maar praktische informatie ontbreekt. Door middel van simulatiestudies in het kader van zowel lineaire als veralgemeende lineaire regressie voorzien we toegepaste onderzoekers van bruikbare richtlijnen omtrent type I fouten en de keuze van de informatieve toetsingsgrootheid. Bovendien richt onderzoek zich vaak op inferentie omtrent gemiddelde of voorwaardelijke effecten. Deze kunnen worden gedefinieerd als een lineaire of niet-lineaire combinatie van regressiecoëfficiënten. De EffectLiteR-benadering biedt een raamwerk en een R-pakket voor de schatting van gemiddelde en voorwaardelijke effecten van een categorische predictor op een continue uitkomstvariabele, rekening houdend met categorische en continue covariaten. We demonstreren hoe informatieve hypothesetesten kunnen worden geïntegreerd in het EffectLiteR-raamwerk, rekening houdend met de stochastische aard van de groepsgroottes

Construct and Character: Literary Tropes and Societal Expectations in Shakespeare's Heroines

Elizabethan drama heavily features male leads, with female characters often developmentally neglected or presented in constrictive and discriminatory stereotypes. However, William Shakespeare sets himself apart by developing heroines who display features of being whole, round, and interesting characters, significant in their accurate portrayal of elements of the feminine experience that ring true in any era. In Much Ado About Nothing and Romeo and Juliet, Beatrice and Juliet defy expectations for female literary constructs by volitionally taking control of their situations while remaining desirable and feminine. In King Lear and Othello, Cordelia and Desdemona challenge Elizabethan expectations for women, but still fail to save themselves as a result of a constrictive and gendered society. All four plays present women who are complex and interesting as well as literarily and dramatically significant. As both constructs and characters, Shakespeare’s women can be seen to break stereotypes and provide a metaphor for the feminine experience that is relevant both in Elizabethan England and today

Les Effets indésirables des glucocorticoïdes chez le chien et le chat

LYON1-BU Santé (693882101) / SudocSudocFranceF