Estudo da formação de aderências e da cicatrização de anastomoses colônicas em ratos com sepse peritoneal induzida

OBJETIVO: Avaliar os efeitos da sepse abdominal sobre a formação de aderências e a cicatrização de anastomoses colônicas em ratos. MÉTODOS: 40 ratos distribuídos em dois grupos contendo 20 animais, para anastomose do cólon esquerdo na presença (grupo S) ou ausência (grupo N) de indução de sepse por ligadura e punção do ceco (CLP). Cada grupo foi dividido em subgrupos para eutanásia no terceiro (N3 e S3) ou sétimo (N7 e S7) dia de pós-operatório (DPO). Foi avaliada a quantidade de aderências e removido um segmento colônico contendo a anastomose para análise histopatológica, força de ruptura, hidroxiprolina e conteúdo de colágeno tecidual. RESULTADOS: Os animais submetidos à CLP apresentaram maior quantidade de aderências intra-abdominais tanto no 3° DPO (p=0,00) quanto no 7° DPO (p=0,00). Tiveram menores valores de força de ruptura no 3° DPO (p=0,00), porém maiores valores no 7° DPO (p=0,00). Não houve diferença na variação da concentração de hidroxiprolina, conteúdo de colágeno e histopatologia. CONCLUSÕES: A infecção peritoneal desencadeada por CLP aumentou a quantidade de aderências intra-cavitárias. Houve diminuição da resistência de anastomoses cólicas no 3° DPO, com posterior aumento no 7° DPO, sem efeito sobre os outros parâmetros da cicatrização. ________________________________________________________________________________ ABSTRACTPURPOSE: To evaluate the effects of abdominal sepsis on adhesion formation and colon anastomosis healing in rats. METHODS: Forty rats were distributed in two groups containing 20 rats each for left colon anastomosis in the presence (Group S) or absence (Group N) of induced sepsis by cecal ligation and puncture. Each group was divided into subgroups for euthanasia on the third (N3 and S3) or seventh (N7 or S7) post-operative day. The amount of adhesions was evaluated and a segment of the colon was removed for histopathologic analysis, bursting strength assessment, hydroxyproline and the determination of tissue collagen. RESULTS: The subjects which underwent cecal ligation and puncture presented a higher amount of intra-abdominal adherences in both third (p=0,00) and seventh (p=0,00) post-operatory days. Smaller bursting strengths were found in the S3 subgroup, and greater bursting strengths were found in the S7 subgroup. There was no difference in the variations on the concentrations of hydroxyproline, tissue collagen and histopathology. CONCLUSIONS: The peritoneal infection which was developed by cecal ligation and puncture raised the amount of intra-cavitary adhesions. There was a decrease in the amount of colonic anastomosis on the third post-operatory day with a following raise on the seventh without any effects on other healing parameters

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

En modell för dokumentdigitalisering inom företag : Förslag till en modell för att digitalisera företagsdokument

There exists many companies which wish to transition toward a more digital workflow. However, many of these companies lack the technical expertise required to undertake such an endeavor. To assist companies in this area, a digitization process model could be used as a stepping-stone toward successful digitization. Currently, however, there exists no such digitization process model. The purpose of this thesis is to suggest such a digitization process model. The goal is to help companies in digitizing their documents and their workflow. The research question used to reach this goal pertains to how a digitization process model should be structured. Due to the lack of currently existing digitization process models, different process models within the field of software engineering where analyzed as a basis. The research was qualitative and explorative in its nature, and it followed design science as its research paradigm. An extensive literature study was conducted before development of the model began. The model was evaluated using interviews together with action research. These interviews focused on evaluating the model based on five criteria which had been defined: (1) interviewee credibility, (2) semantic correctness, (3) syntactic correctness, (4) usefulness, and (5) process flexibility. The results of this thesis is the company document digitization process model (CODED), which, as the name suggests, is a proposed process model for document digitization. This model has been based on information gathered by, partly the literature study, and partly the interviews. The literature study proved the model to be unique, since no similar model existed prior to this thesis. While the interviews proved the model to be valid, since it accomplished all evaluation criteria which had been defined. Det är många företag som vill gå mot att digitalisera sitt arbetsflöde. Många av dessa företag har däremot en avsaknad av den tekniska expertis som krävs. För att assistera företag i detta skulle en processmodell kunna användas som ett redskap för framgångsrik dokumentdigitalisering. Problemet är att det just nu inte existerar någon sådan processmodell för dokumentdigitalisering. Syftet med denna avhandling är att föreslå en processmodell för digitalisering. Målet är att hjälpa företag i att digitalisera både deras dokument och deras arbetsflöde. Hur en sådan processmodell skulle kunna struktureras är denna rapports forskningsfråga. Det fanns ingen existerande modell att utgå ifrån. Därför användes andra modeller inom området för programvaruteknik som en bas under forskningen. Forskningen var kvantitative och explorativ, och den använde designvetenskap som ett forskningsparadigm. En omfattande litteraturstudie genomfördes innan utvecklingen av processmodellen påbörjades. Modellen evaluerades utifrån intervjuer tillsammans med aktionsforskning. Där intervjuerna har fokuserat på att evaluera modellen utifrån fem kriterier: (1) trovärdighet, (2) semantisk korrekthet, (3) syntaktisk korrekthet, (4) användbarhet, och (5) flexibilitet. Resultatet av denna avhandling är ett förslag till en processmodell för att digitalisera dokument, vid namnet CODED (company document digitization process model). Den föreslagna modellen har baserat både på information som samlats från litteraturstudien, och information från intervjuerna. Litteraturstudien visade att processmodellen är unik, då det ej existerade någon likartad modell tidigare. Intervjuerna visade att modellen är valid, då den uppfyllde de definierade evalueringskriterierna

Analysing meeting notes and their role in automatic meeting summarisation

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Bevarande av kulturhistoriskt värdefull bebyggelse enligt plan- och bygglagen

In today's society when the pressure is high on exploitation and on local governments and their decisions about resources, we must not forget our heritage. The built environment is an important part of the heritage and need to be taken care of and protected for future generations. Municipalities have the ability to work with preservation of historically valuable buildings with the help of the Planning and Building Law. By designing areas and impose restrictions on what the individual property owner may do with their building, the municipality can ensure that their ambitions of preservation are met. The purpose of this essay is to describe the methods that municipalities have available in the Planning and Building Law when it comes to the preservation of historically valuable buildings. The essay is partly based on a survey that was sent to the Swedish municipalities. The survey is primarily focused on the financial compensation a property owner may claim, if restrictions imposed on his building. An assumption that was made early in the process was that the compensation limits municipalities in planning for preservation. A previous study showed that financial compensation was not a problem in local preservation work. The conclusion I make after analyzed the answerers of the survey is that the majority of the responding municipalities, due to possible claims for financial compensation, in fact hesitant at imposing restrictions when planning for preservation of the historically valuable buildings. The survey also shows signs that building sanction fees rarely are charged for breaches.I dagens samhälle som kantas av högt exploateringstryck och den ökade pressen på kommunerna och deras beslut om resurser, så får vi inte glömma vårt kulturarv. Den byggda miljön är en viktig del i kulturarvet och behöver tas hand om och bevaras till kommande generationer. Kommunerna har möjligheten att arbeta med bevarande av kulturhistoriskt värdefull bebyggelse med hjälp av plan- och bygglagens regler. Genom att planlägga områden och införa restriktioner för vad den enskilde fastighetsägaren får göra med sin byggnad, kan kommunen säkerställa att deras bevarandeambitioner uppfylls. Syftet med denna uppsats är att beskriva de metoder som kommunerna har att tillgå i planoch bygglagen när det kommer till bevarande av kulturhistoriskt värdefull bebyggelse. Uppsatsen bygger delvis på en enkät som har skickats ut till Sveriges kommuner. Enkäten inriktar sig främst på den ekonomiska ersättning som en fastighetsägare kan göra anspråk på, om restriktioner påförs dennes byggnad. Ett antagande som gjordes tidigt i arbetet var att ersättningen begränsar kommunerna vid planläggning för bevarande. En tidigare studie visade att den ekonomiska ersättningen inte var ett problem i kommunernas bevarandearbete. Den slutsats som jag kommer till efter en analys av svaren från enkätundersökningen är att majoriteten av de svarande kommunerna, på grund av eventuella anspråk på den ekonomiska ersättningen, i själva verket tvekar vid införande av restriktioner för bevarande av kulturhistoriskt värdefull bebyggelse. Enkätundersökningen visar även tendenser på att byggsanktionsavgifter sällan tas ut vid överträdelser

En modell för dokumentdigitalisering inom företag : Förslag till en modell för att digitalisera företagsdokument

There exists many companies which wish to transition toward a more digital workflow. However, many of these companies lack the technical expertise required to undertake such an endeavor. To assist companies in this area, a digitization process model could be used as a stepping-stone toward successful digitization. Currently, however, there exists no such digitization process model. The purpose of this thesis is to suggest such a digitization process model. The goal is to help companies in digitizing their documents and their workflow. The research question used to reach this goal pertains to how a digitization process model should be structured. Due to the lack of currently existing digitization process models, different process models within the field of software engineering where analyzed as a basis. The research was qualitative and explorative in its nature, and it followed design science as its research paradigm. An extensive literature study was conducted before development of the model began. The model was evaluated using interviews together with action research. These interviews focused on evaluating the model based on five criteria which had been defined: (1) interviewee credibility, (2) semantic correctness, (3) syntactic correctness, (4) usefulness, and (5) process flexibility. The results of this thesis is the company document digitization process model (CODED), which, as the name suggests, is a proposed process model for document digitization. This model has been based on information gathered by, partly the literature study, and partly the interviews. The literature study proved the model to be unique, since no similar model existed prior to this thesis. While the interviews proved the model to be valid, since it accomplished all evaluation criteria which had been defined. Det är många företag som vill gå mot att digitalisera sitt arbetsflöde. Många av dessa företag har däremot en avsaknad av den tekniska expertis som krävs. För att assistera företag i detta skulle en processmodell kunna användas som ett redskap för framgångsrik dokumentdigitalisering. Problemet är att det just nu inte existerar någon sådan processmodell för dokumentdigitalisering. Syftet med denna avhandling är att föreslå en processmodell för digitalisering. Målet är att hjälpa företag i att digitalisera både deras dokument och deras arbetsflöde. Hur en sådan processmodell skulle kunna struktureras är denna rapports forskningsfråga. Det fanns ingen existerande modell att utgå ifrån. Därför användes andra modeller inom området för programvaruteknik som en bas under forskningen. Forskningen var kvantitative och explorativ, och den använde designvetenskap som ett forskningsparadigm. En omfattande litteraturstudie genomfördes innan utvecklingen av processmodellen påbörjades. Modellen evaluerades utifrån intervjuer tillsammans med aktionsforskning. Där intervjuerna har fokuserat på att evaluera modellen utifrån fem kriterier: (1) trovärdighet, (2) semantisk korrekthet, (3) syntaktisk korrekthet, (4) användbarhet, och (5) flexibilitet. Resultatet av denna avhandling är ett förslag till en processmodell för att digitalisera dokument, vid namnet CODED (company document digitization process model). Den föreslagna modellen har baserat både på information som samlats från litteraturstudien, och information från intervjuerna. Litteraturstudien visade att processmodellen är unik, då det ej existerade någon likartad modell tidigare. Intervjuerna visade att modellen är valid, då den uppfyllde de definierade evalueringskriterierna

Monolit till mikrotjänster med hjälp av djupinlärningsbaserad klusterdetektion

The microservice architecture is widely considered to be best practice. Yet, there still exist many companies currently working in monolith systems. This can largely be attributed to the difficult process of updating a systems architecture. The first step in this process is to identify microservices within a monolith. Here, artificial intelligence could be a useful tool for automating the process of microservice identification. The aim of this thesis was to propose a deep learning-based model for the task of microservice identification, and to compare this model to previously proposed approaches. With the goal of helping companies in their endeavour to move towards a microservice-based architecture. In particular, the thesis has evaluated whether the more complex nature of newer deep learning-based techniques can be utilized in order to identify better microservices. The model proposed by this thesis is based on overlapping community detection, where each identified community is considered a microservice candidate. The model was evaluated by looking at cohesion, modularity, and size. Results indicate that the proposed deep learning-based model performs similarly to other state-of-the-art approaches for the task of microservice identification. The results suggest that deep learning indeed helps in finding nontrivial relations within communities, which overall increases the quality of identified microservices, From this it can be concluded that deep learning is a promising technique for the task of microservice identification, and that further research is warranted.Allmänt anses mikrotjänstarkitekturen vara bästa praxis. Trots det finns det många företag som fortfarande arbetar i monolitiska system. Detta då det finns många svårigheter runt processesen av att byta systemaritekture. Första steget i denna process är att identifiera mikrotjänster inom en monolit. Här kan artificiell intelligens vara ett användbart verktyg för att automatisera processen runt att identifiera mikrotjänster. Denna avhandling syftar till att föreslå en djupinlärningsbaserad modell för att identifiera mikrotjänster och att jämföra denna modell med tidigare föreslagna modeller. Målet är att hjälpa företag att övergå till en mikrotjänstbaserad arkitektur. Avhandlingen kommer att utvärdera nyare djupinlärningsbaserade tekniker för att se ifall deras mer komplexa struktur kan användas för att identifiera bättre mikrotjänster. Modellen som föreslås är baserad på överlappande klusterdetektion, där varje identifierad kluster betraktas som en mikrotjänstkandidat. Modellen utvärderades genom att titta på sammanhållning, modularitet och storlek. Resultaten indikerar att den föreslagna djupinlärningsbaserade modellen identifierar mikrotjänster av liknande kvalitet som andra state-of-the-art-metoder. Resultaten tyder på att djupinlärning bidrar till att hitta icke triviala relationer inom kluster, vilket ökar kvaliteten av de identifierade mikrotjänsterna. På grund av detta dras slutsatsen att djupinlärning är en lovande teknik för identifiering av mikrotjänster och att ytterligare forskning bör utföras