Variation in the use of chemotherapy in lung cancer

Factors influencing the use of chemotherapy for the initial (6 months) treatment of lung cancer in South East England were investigated. The variables explored as possibly influencing the use of chemotherapy were sex, age, the year of diagnosis, the type of lung cancer, the stage, the index of multiple deprivation and the cancer network of residence. Chi2 analysis and multivariate logistic regression models were used to examine the effect of each of the variables on the use of chemotherapy. The results showed a highly significant trend in use of chemotherapy over time; the adjusted proportion of patients receiving chemotherapy increasing from 13.6% in 1994 to 29.3% in 2003. However, age, cancer network and type of lung cancer had the strongest influence on the use of chemotherapy. This finding is important when we consider that the NHS Cancer Plan aims at improving inequalities in cancer care in the UK.

Factors influencing the use of antitumoral chemotherapy in the South East of England

Influences on the use of chemotherapy for the treatment of cancer within the South East region of England for patients diagnosed with colorectal, lung, breast and prostate cancer were investigated. The variables investigated as possibly influencing the selection of chemotherapy were the sex of the patients, their age, the year of diagnosis, the cancer site, the cancer stage, the index of multiple deprivation (IMD) and the cancer network of residence. Logistic regression used to adjust the proportion receiving chemotherapy in relation to other variables considered showed significant differences in the proportion of patients receiving chemotherapy between different cancer sites and different networks. There was also a highly significant trend seen in use of chemotherapy over time; the adjusted proportion of patients receiving chemotherapy increasing from 10.6% in 1993 to 24.3% in 2002. Age, stage and cancer site seemed to have the most influence on the use of chemotherapy.

The power of perceptions: exploring the role of urban design in cycling behaviours and healthy ageing

Good urban design has the power to aid in the provision of inclusive journey environments, yet traditionally neglects the perspective of the cyclist. This paper starts from the premise that more can be done to understand and articulate cyclists’ experiences and perceptions of the urban environment in which they cycle, as part of a closer linking of urban design qualities with transport planning and infrastructure interventions. This approach is particularly applicable in relation to older cyclists, a group whose needs are often poorly understood and for whom perceptions can significantly influence mobile behaviours. Currently, knowledge regarding the relationship between the built environment and physical activity, including cycling, in older adults is limited. As European countries face up to the challenges associated with ageing populations, some metropolitan regions, such as Munich, Germany, are making inroads into widening cycling’s appeal across generations through a combination of urban design, policy and infrastructure initiatives. The paper provides a systematic understanding of the urban design qualities and built environment features that affect cycling participation and have the potential to contribute towards healthy ageing. Urban design features such as legibility, aesthetics, scale and open space have been shown to influence and affect other mobile behaviours (e.g. walking), but their role as a mediator in cycle behaviour remains under-explored. Many of these design ‘qualities’ are related to individual perceptions; capturing these can help build a picture of quality in the built environment that includes an individual’s relationship with their local neighbourhood and its influences on their mobility choices. Issues of accessibility, facilities, and safety in cycling remain crucial, and, when allied to these design ‘qualities‘, provides a more rounded reflection of everyday journeys and trips taken or desired. The paper sets out the role that urban design might play in mediating these critical mobility issues, and in particular, in better understanding the ‘quality of the journey’. It concludes by highlighting the need for designers, policy makers, planners and academics to consider the role that design can play in encouraging cycle participation, especially as part of a healthy ageing agenda.

Managing change in complex projects: configuration management, asset information and big data

As we enter an era of ‘big data’, asset information is becoming a deliverable of complex projects. Prior research suggests digital technologies enable rapid, flexible forms of project organizing. This research analyses practices of managing change in Airbus, CERN and Crossrail, through desk-based review, interviews, visits and a cross-case workshop. These organizations deliver complex projects, rely on digital technologies to manage large data-sets; and use configuration management, a systems engineering approach with mid-20th century origins, to establish and maintain integrity. In them, configuration management has become more, rather than less, important. Asset information is structured, with change managed through digital systems, using relatively hierarchical, asynchronous and sequential processes. The paper contributes by uncovering limits to flexibility in complex projects where integrity is important. Challenges of managing change are discussed, considering the evolving nature of configuration management; potential use of analytics on complex projects; and implications for research and practice.

Legal and regulatory barriers to effective public-private partnership governance in Kazakhstan

Purpose – The purpose of this paper is to provide a critical assessment of legal and regulatory impediments to effective governance of public-private partnerships (PPPs) in Kazakhstan. Design/methodology/approach – The qualitative study develops propositions from the PPP literature and then tests them against findings from in-depth interviews. Interviewees have been selected by a purposeful sampling from PPP projects in Kazakhstan as well as from national and regional PPP centres. Findings – The identified barriers to effective PPP management include irregularities in the PPP legal framework, such as lack of legal definition of a PPP and controversy with the government guarantee’s legal status for its long-term payments to partnerships; bureaucratic tariff setting for partnership services; non-existent opportunity for private asset ownership; and excessive government regulation of PPP workers’ wage rates. Practical implications – The partners’ opposing perspectives on a number of PPP issues show that management needs to identify and carefully reconcile stakeholder values in a partnership in order to achieve more effective PPP governance. Practitioners, particularly those in the public agencies, have to be concerned with ways to reduce the government overregulation of the private operators, which is likely to result in greater PPP flexibility in management and, ultimately, higher efficiency in delivering the public services. Originality/value – By elucidating multiple examples of overregulation and PPPs’ inefficiency, the paper demonstrates that the government dominance in PPP management is conceptually inappropriate. Instead, the government should adopt the concept of co-production and manage its relations with the private sector partner in a collaborative fashion.

'They would never receive you without a husband' : Paradoxical barriers to antenatal care scale-up in Rwanda

OBJECTIVE: to explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy ('near-miss'). DESIGN: a study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda. FINDINGS: all informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women's disincentive to complete all four recommended visits and men's interest in attending to ensure their partners' reception of care. However, the participants experienced a restriction of men's access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy. CONCLUSIONS: 'near-miss' women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications IMPLICATIONS FOR PRACTICE: these findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women's and men's real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.

Social media crises in the organization: exploring management strategies through cases from France and Brazil

The aim of this Master’s thesis has been to shed light on the response strategies that organizations are implementing when facing a crisis created on or amplified by social media. Since the development of social media in the late 1990s, the interplay between the online and the offline spheres has become more complex, and characterized by dynamics of a new magnitude, as exemplified by the wave of “Twitter” Revolutions or the Wikileaks scandal in the mid 2000s, where online behaviors deeply affected an offline reality. The corporate world does not escape to this worldwide phenomenon, and there are more and more examples of organizational reputations destroyed by social media “fireballs”. As such, this research aims to investigate, through the analysis of six recent cases of corporate crises (2013-2015) from France and Brazil, different strategies currently in use in order to identify examples of good and bad practices for companies to adopt or avoid when facing a social media crisis. The first part of this research is dedicated to a review of the literature on crisis management and social media. From that review, we were able to design a matrix model, the Social Media Crisis Management Matrix, with which we analyzed the response strategies of the six companies we selected. This model allows the conceptualization of social media crises in a multidimensional matrix built to allow the choice, according to four parameters, of the most efficient (that is: which will limit the reputational damage) response strategy. Attribution of responsibility for the crisis to the company by stakeholders, the origin of the crisis (internal or external), the degree of reputational threat, and the emotions conveyed online by stakeholders help companies determining whether to adopt a defensive response, or an accommodative response. The results of the analysis suggest that social media crises are rather manichean objects for they are, unlike their traditional offline counterparts, characterized by emotional involvement and irrationality, and cannot be dealt with traditionally. Thus analyzing the emotions of stakeholders proved to be, in these cases, an accurate thermometer of the seriousness of the crisis, and as such, a better rudder to follow when selecting a response strategy. Consequently, in the cases, companies minimized their reputational damage when responding to their stakeholders in an accommodative way, regardless of the “objective” situation, which might be a change of paradigm in crisis management.

Encapsulation of single hMSCs in polyelectrolyte shells

The main objective of this Thesis was to encapsulate single viable cells within polyelectrolyte films using the Layer-by-Layer (LbL) technique. Most of the experiments used human mesenchymal stem cells (MSCs) whose characteristics (capacity of selfrenewal and potential to differentiate into several types of cells) make them particularly interesting to be used in biomedical applications. Also, most of the experiments used alginate (ALG) as the anionic polyelectrolyte and chitosan (CHI) or poly(allylamine hydrochloride) (PAH) as the cationic polyelectrolyte. Hyaluronic acid (HA) was also tested as an anionic polyelectrolyte. At the beginning of the work, the experimental conditions necessary to obtain the encapsulation of individual cells were studied and established. Through fluorescence microscopy visualization by staining the cell nucleus and using polyelectrolytes conjugated to fluorescent dyes, it was possible to prove the obtainment of capsules containing one single cell inside. Capsules aggregation was an observed problem which, despite the efforts to design an experimental process to avoid this situation (namely, by playing with cell concentration and different means of re-suspending and stirring the cells), was not completely overcome. In a second part of the project, single cells were encapsulated within polyelectrolyte layers made of CHI/ALG, PAH/ALG and PAH/HA and their viability was evaluated through the resazurin reduction assay and the Live/Dead assay. In these experiments, during the LbL process, polyelectrolyte solutions were used at a concentration of 1mg/mL based on literature. In general, the viability of the encapsulated cells was shown to be very low/absent. Then, as a consequence of the lack of viability of cells encapsulated within polyelectrolyte layers, the LbL technique was applied in cells growing adherent to the surface of cell culture plates. The cells were cultured like in a sandwich, between the surface of the cell culture dish and the polyelectrolyte layers. Also here, the polyelectrolyte solutions were used at a concentration of 1mg/mL during the LbL process. Surprisingly, cell viability was also absent in these systems. A systematic study (dose-effect study) was performed to evaluate the effect of the concentration of the individual polyelectrolytes (ALG, CHI and PAH were studied) in cell viability. Experiments were performed using cells growing adherent to the surface of cell culture plates. The results pointed out that a very high (cytotoxic) concentration of polyelectrolytes had been in use. Also, in general, PAH was much more cytotoxic than CHI, whereas ALG was the less cytotoxic polyelectrolyte. Finally, using alginate and chitosan solutions with adequate concentrations (low concentrations: 50ng/mL and 1μg/mL), the encapsulation of single viable cells was again attempted. Once again, the encapsulated cells were not shown to be viable. In conclusion, the viability of the encapsulated cells is not only dependent on the cytotoxic characteristics (or combined cytotoxic characteristics) of the polyelectrolytes but it seems that, when detached from the culture plates, the cells become too fragile and lose their viability very easily.

H-infinity control design for time-delay linear systems: a rational transfer function based approach

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Nesting architecture and population structure of the fungus-growing ant Cyphomyrmex transversus (Formicidae: Myrmicinae: Attini) in the Brazilian coastal zone of Ilheus, Bahia

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Comparison of indigestible markers from in situ and in vivo incubation to predict apparent digestibility in hay- and corn-fed horses

Foram utilizados quatro cavalos castrados sem raça definida pelo delineamento em blocos casualizados. Objetivou-se viabilizar os indicadores internos indigestíveis, FDNi e FDAi, obtidas pelas técnicas in situ nos bovinos e in vivo nos equinos por meio do saco de náilon móvel (SNM). Os tratamentos consistiram de digestibilidade determinada por método direto com a coleta total de fezes (CT) e indireto pelo uso de FDNi e FDAi obtidos pelas técnicas in situ (IS) na cavidade ruminal de bovinos e in vivo (IV) nos equinos por meio do SNM. As FDNi-IV e FDAi-IV promoveram a melhor taxa de recuperação (TR) do indicador, igualando-se ao grupo CT, em 91,50%, enquanto a técnica in situ resultou nas piores taxas, na média 86,50%, para ambos os indicadores indigestíveis (p < 0,05). As estimativas dos CD dos nutrientes foram adequadamente preditos pela FDAi-IV, para equinos alimentados com feno, no qual os valores observados foram de 46,41; 48,16; 47,92 e 45,51% para MS, MO, FDN e EB, respectivamente. Concluiu-se que o SNM em equinos pode ser usado para obter a FDAi em equinos alimentados exclusivamente com feno de coast-cross e para cavalos consumindo dieta mista, as FDNi e FDAi foram eleitas para predizer CD de nutrientes.

Economic design of two-stage (X)over-bar charts: the Markov chain approach

When the (X) over bar chart is in use, samples are regularly taken from the process, and their means are plotted on the chart. In some cases, it is too expensive to obtain the X values, but not the values of a correlated variable Y. This paper presents a model for the economic design of a two-stage control chart, that is. a control chart based on both performance (X) and surrogate (Y) variables. The process is monitored by the surrogate variable until it signals an out-of-control behavior, and then a switch is made to the (X) over bar chart. The (X) over bar chart is built with central, warning. and action regions. If an X sample mean falls in the central region, the process surveillance returns to the (Y) over bar chart. Otherwise. The process remains under the (X) over bar chart's surveillance until an (X) over bar sample mean falls outside the control limits. The search for an assignable cause is undertaken when the performance variable signals an out-of-control behavior. In this way, the two variables, are used in an alternating fashion. The assumption of an exponential distribution to describe the length of time the process remains in control allows the application of the Markov chain approach for developing the cost function. A study is performed to examine the economic advantages of using performance and surrogate variables. (C) 2003 Elsevier B.V. All rights reserved.

Model to design drip hose lateral line using two spacing between emitters

The use of non-pressure compensating drip hose in horticultural and annual cycle fruits is growing in Brazil. In this case, the challenge for designers is getting longer lateral lines with high values of uniformity. The objective of this study was to develop a model to design longer lateral lines using non-pressure compensating drip hose. Using the developed model, the hypotheses to be evaluated were: a) the use of two different spacing between emitters in the same lateral line allows longer length; b) it is possible to get longer lateral lines using high values of pressure variation in the lateral lines since the distribution uniformity stays below allowable limits. A computer program was developed in Delphi based on the model developed and it is able to design lateral lines in level using non-pressure compensating drip hose. The input data are: desired distribution uniformity (DU); initial and final pressure in the lateral line; coefficients of relationship between emitter discharge and pressure head; hose internal diameter; pipe cross-sectional area with the dripper; and roughness coefficient for the Hazen-Williams equation. The program allows calculate the lateral line length with three possibilities: selecting two spacing between emitters and defining the exchange point; using two pre-established spacing between emitters and calculating the length of each section with different spacing; using one emitter spacing. Results showed that the use of two sections with different spacing between drippers in the lateral line didn't allow longer length but got better uniformity when compared with lateral line with one spacing between emitters. The adoption of two spacing increased the flow rate per meter in the final section which represented approximately 80% of the lateral line total length and this justifies their use. The software allowed DU above 90% with pressure head variation of 40% and the use of two spacing between emitters. The developed model/software showed to be accurate, easy to handle and useful for lateral line design using non-pressure compensating drip hose.

Changes in the urban female labour market

Includes bibliography

A influência da função simbólica dos produtos de uso cotidiano na percepção e no esforço biomecânico: parâmetros para o design ergonômico

Pós-graduação em Design - FAAC