Participation in the RACS sentinel node biopsy versus axillary clearance trial

Background: The Royal Australasian College of Surgeons (RACS) SNAC trial is a randomized controlled trial of sentinel node biopsy (SNB) versus axillary clearance (AC). It opened in May 2001 and is recruiting rapidly with good acceptance by consumers. Methods: A study of eligibility and treatment choices was conducted between November 2001 and September 2002 for women presenting with early breast cancer to 10 centres participating in the trial. Results: More than half of the 622 women (54%) were ineligible for trial entry because they had large (> 3 cm) or multicentric cancers. Participation was offered to 92% of eligible women and was taken up by 63%. The commonest reason for not participating was the desire to choose treatment rather than have it randomly allocated. Despite this there is a great acceptance of clinical trials because very few women (4% of those eligible) gave 'lack of interest in clinical trials' as the reason for non-participation. Few women who declined trial participation chose to have SNB alone (4.5% of those eligible). Conclusion: Sentinel node biopsy may become the standard of care for managing small breast cancers, but a significant number of patients will still require or choose axillary dissection. Results from large randomized trials are needed to determine the relative benefits and harms of SNB compared with AC. Surgeons must carefully discuss options for management with their patients.

Undermining patient and public engagement and limiting its impact:the consequences of the Health and Social Care Act 2012 on collective patient and public involvement

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care. © 2013 John Wiley & Sons Ltd.

Towards the Problems of an Evaluation of Data Uncertainty in Decision Support Systems

The question of forming aim-oriented description of an object domain of decision support process is outlined. Two main problems of an estimation and evaluation of data and knowledge uncertainty in decision support systems – straight and reverse, are formulated. Three conditions being the formalized criteria of aimoriented constructing of input, internal and output spaces of some decision support system are proposed. Definitions of appeared and hidden data uncertainties on some measuring scale are given.

The role of intuition in the translation process:A case study

This paper explores the psychological construct of intuition and its influence in decision-making behavior. Intuition was defined by Jung (1971) as a primary mode of perception operating subconsciously. As opposed to sensing personality types who prefer concrete details, intuitive personality types prefer to acquire information by imagining possibilities (Myers and Myers 1995). In this paper, an analysis of verbalization data from a translation process study is discussed in order to demonstrate the influence of intuition on decision-making during the translation process and to explore the implications of this influence. Recent studies have found that intuition plays a role in learning and decision-making tasks involving affect (Laborde et al. 2010: 786). Intuition is therefore here viewed as a potentially vital component of translator behavior which could predict individuals' translating effectiveness. © John Benjamins Publishing Company.

The Effect of Natural Products and Small Gtpases in Adipogenesis

Insulin signaling is one of the main initiators of adipogenesis, the conversion from pre-adipocyte to adipocyte or lipid droplet. Rab proteins are the master regulator of intracellular trafficking and endosome fusion in endocytosis, making them potential regulators of insulin signaling in adipogenesis. Pre-adipocytes 3T3-Ll cells expressing several Rab5 constructs were used to examine the effect of dehydroleucodine (DhL ), a sesquiterpene lactone isolated from aerial parts of Artemisia douglasiana Besser. The results obtained identify Rab5 deactivation as a key step for adipogenesis by forming signaling endosomes. The addition of DhL significantly inhibited the lipid droplet accumulation in a dose-dependent manner and dramatically attenuated the synthesis of adipogenic transcriptional factors, C/EBPa and PPARy. Activation of AMPKa, Erk and Akt during adipocytic differentiation was not inhibited by treatment with DhL. This data suggest that DhL has an important role in Rab5 dependent adipogenesis by regulating several transcriptional factors including PP ARy expression, which is known to play an essential role during fat formation.

O envelhecimento no espaço midiático: a produção de sentidos pelos meios jornalísticos

Aging as a social phenomenon is guided in the ways of production and reproduction, that is linked to the peculiarities and compliances of the social structure influence the values and erected senses. The search for the understanding of the reality will be given by the appropriation of knowledge/information that in contemporary times are increasingly tied to the media means, so that they go beyond the mere condition media, reaching the condition of instruments of direct, attitudes and opinions production. Among the media instruments, there are news medias, that are important means of information dissemination and consequently production of senses, including over aging. Thus, the objective is to: apprehend the social representations and meanings associated with aging in the media space about aging; browse the social representations about aging in media space and their influence on the relations that are established in the cultural socio-economic context. To do it The Theory of Social Representation will be used. To collect the data, 57 online news from the three main state newspapers were studied: Tribuna do Norte, Gazeta do Povo and Jornal de Hoje, which were captured through a search tol of these newspaper sites, using the words: “aging””elderly”. These materials were analyzed making use of Bardin’s Qualitative Analysis, which allowed the establishment of five categories, namely: Aging and violence; Aging in contemporary times; Aging and health; Aging and citizenship; and Aging, work and action. In the first category news reporting violent situations are framed the regardless of the victim’s condition or the one charged by the violence, the fragility of elderly persists. In Aging in contemporary times the attempts of the news media to explain the demographic changes of the quantitative increases in the elderly, the burden it may lead to the full development of the country are noticed. In Aging and health is noticed the imminent end of the condition brought on age, as a synonym for diseases and conditions. In the fourth category, Aging and citizenship situations are shown where peculiarities and needs or the elderly need to turn into obligation to be fulfilled, denouncing the condition of low expression and social power of the class. Finally, in Aging, work and action situations that indicate the non-expectation of elderly interaction with new technologies and participation in decision-making directions of society are brought. In a general and specific form this analysis allowed learning the ways of production of meanings about aging in the papers, as these ones tend to represent aging through intentioned situations as hegemonic needs, building the social representation of the elderly as fragile person, submissive, inactive, subject to violence and susceptible to becoming ill.

Políticas públicas de turismo: análise do desempenho das instâncias de governança turística e seus reflexos no fomento do turismo cultural no município de Manaus/AM (2003-2014)

This study has the main objective to analyze the role of the bodies of state and local governance of tourism, aimed at tourism development process in the city of Manaus / AM , by the public practices of planning, management and development activity in the respective municipality . To the specific objectives were established four aims: 1) To characterize the process of formation of governance entities active in tourism in the city of Manaus. 2) Lift the actions planned and executed by the authorities aimed at cultural tourism in the period 2003-2014. 3) To question through the perception of the actors representing the different classes and entities of the Amazonian society, the actions planned and executed by the authorities aimed at cultural tourism in the period 2003-2014 and 4) Identify key similarities and the differences in decision-making about actions aimed at cultural tourism in Manaus. We adopted a qualitative approach, using the methodological design of descriptive and exploratory, with the help of the use of the techniques of literature search, document, with on-site data collection through interviews with semi-structured script application forms to the representatives of sectorial institutions that make up the locations of governance in tourism. In addition, the treatment of information was used content analysis technique. In response to stated objectives, it can be concluded that the creation of public arenas, through the tourism of governance has enabled incipient discussion in a democratic manner and decision-making in the area of planning and management of tourism in Manaus. It was also observed that obstacles that hinder and undermine the structures of the bodies, which reflect the joint, in the promotion and cultural tourism development in the city of Manaus.

Às vezes faço de conta que não vejo dedos no ar. O estatuto da criança como codecisora nos contextos educativos

Relatório de estágio apresentado à Escola Superior de Educação de Paula Frassinetti para a obtenção de grau de mestre em educação pré-escolar e ensino do 1º ciclo do ensino básico

Effectiveness of three interventions to improve participation in colorectal cancer screening

Background and objective: Participation in colorectal cancer (CRC) screening varies widely among different countries and different socio-demographic groups. Our objective was to assess the effectiveness of three primary-care interventions to increase CRC screening participation among persons over the age of 50 years and to identify the health and socio-demographic-related factors that determine greater participation. Methods: We conducted a randomized experimental study with only one post-test control group. A total of 1,690 subjects were randomly distributed into four groups: written briefing; telephone briefing; an invitation to attend a group meeting; and no briefing. Subjects were evaluated 2 years post-intervention, with the outcome variable being participation in CRC screening. Results: A total of 1,129 subjects were interviewed. Within the groups, homogeneity was tested in terms of socio-demographic characteristics and health-related variables. The proportion of subjects who participated in screening was: 15.4% in the written information group (95% confidence interval [CI]: 11.2-19.7); 28.8% in the telephone information group (95% CI: 23.6-33.9); 8.1% in the face-to-face information group (95% CI: 4.5-11.7); and 5.9% in the control group (95% CI: 2.9-9.0), with this difference proving statistically significant (p < 0.001). Logistic regression showed that only interventions based on written or telephone briefing were effective. Apart from type of intervention, number of reported health problems and place of residence remained in the regression model. Conclusions: Both written and telephone information can serve to improve participation in CRC screening. This preventive activity could be optimized by means of simple interventions coming within the scope of primary health-care professionals.

A review selection method using product feature taxonomy

As of today, online reviews have become more and more important in decision making process. In recent years, the problem of identifying useful reviews for users has attracted significant attentions. For instance, in order to select reviews that focus on a particular feature, researchers proposed a method which extracts all associated words of this feature as the relevant information to evaluate and find appropriate reviews. However, the extraction of associated words is not that accurate due to the noise in free review text, and this affects the overall performance negatively. In this paper, we propose a method to select reviews according to a given feature by using a review model generated based upon a domain ontology called product feature taxonomy. The proposed review model provides relevant information about the hierarchical relationships of the features in the review which captures the review characteristics accurately. Our experiment results based on real world review dataset show that our approach is able to improve the review selection performance according to the given criteria effectively.

A normal-distribution based rating aggregation method for generating product reputations

With the extensive use of rating systems in the web, and their significance in decision making process by users, the need for more accurate aggregation methods has emerged. The Naïve aggregation method, using the simple mean, is not adequate anymore in providing accurate reputation scores for items [6 ], hence, several researches where conducted in order to provide more accurate alternative aggregation methods. Most of the current reputation models do not consider the distribution of ratings across the different possible ratings values. In this paper, we propose a novel reputation model, which generates more accurate reputation scores for items by deploying the normal distribution over ratings. Experiments show promising results for our proposed model over state-of-the-art ones on sparse and dense datasets.

Gestão tributária e a sua importância na tomada de decisão: uma análise comparativa Lucro Real versus Lucro Presumido em uma empresa prestadora de serviço

A globalização e a forte competitividade obrigam as empresas a tornarem-se cada vez mais inovadoras e criativas. O diferencial conquistado através das inovações tende a agregar valor à empresa tornando-a mais forte para enfrentar a concorrência. Entretanto o pesado ônus tributário pode inviabilizar ou criar uma situação desfavorável para as empresas. Nesse contexto a contabilidade por meio de seu sistema de informação busca auxiliar os gestores no melhor planejamento de sua carga tributária. A gestão tributária significa procurar formas lícitas para reduzir, suspender ou adiar o pagamento de tributos, dentre elas está a melhor escolha na forma de tributação. O trabalho apresenta um estudo de caso em uma empresa prestadora de serviços onde será analisada a aplicabilidade da melhor forma de tributação da pessoa jurídica, no qual empresa poderá optar pelo lucro presumido, Lucro real anual ou trimestral, pois uma vez feita a opção, será irretratável para todo o ano calendário, o que pode gerar um ônus tributário que poderá reduzir significativamente a performance econômico-financeira.

The musical enculturation of Irish traditional musicians: An ethnographic study of learning processes

The enculturation of Irish traditional musicians involves informal, non-formal, and sometimes formal learning processes in a number of different settings, including traditional music sessions, workshops, festivals, and classes. Irish traditional musicians also learn directly from family, peers, and mentors and by using various forms of technology. Each experience contributes to the enculturation process in meaningful and complementary ways. The ethnographic research discussed in this dissertation suggests that within Irish traditional music culture, enculturation occurs most effectively when learners experience a multitude of learning practices. A variety of experiences insures that novices receive multiple opportunities for engagement and learning. If a learner finds one learning practice ineffective, there are other avenues of enculturation. This thesis explores the musical enculturation of Irish traditional musicians. It focuses on the process of becoming a musician by drawing on methodologies and theories from ethnomusicology, education, and Irish traditional music studies. Data was gathered through multiple ethnographic methodologies. Fieldwork based on participant-observation was carried out in a variety of learning contexts, including traditional music sessions, festivals, workshops, and weekly classes. Additionally, interviews with twenty accomplished Irish traditional musicians provide diverse narratives and firsthand insight into musical development and enculturation. These and other methodologies are discussed in Chapter 1. The three main chapters of the thesis explore various common learning experiences. Chapter 2 explores how Irish traditional musicians learn during social and musical interactions between peers, mentors, and family members, and focuses on live music-making which occurs in private homes, sessions, and concerts. These informal and non-formal learning experiences primarily take place outside of organizations and institutions. The interview data suggests these learning experiences are perhaps the most pervasive and influential in terms of musical enculturation. Chapter 3 discusses learning experience in more organized settings, such as traditional music classes, workshops, summer schools, and festivals. The role of organizations such as Comhaltas Ceoltóirí Éireann and pipers’ clubs are discussed from the point of view of the learner. Many of the learning experiences explored in this chapter are informal, non-formal, and sometimes formal in nature, depending on the philosophy of the organization, institution, and individual teacher. The interview data and field observations indicate that learning in these contexts is common and plays a significant role in enculturation, particularly for traditional musicians who were born during and after the 1970s. Chapter 4 explores the ways Irish traditional musicians use technology, including written sources, phonography, videography, websites, and emerging technologies, during the enculturation process. Each type of technology presents different educational implications, and traditional musicians use these technologies in diverse ways and some more than others. For this, and other reasons, technology plays a complex role during the process of musical enculturation. Drawing on themes which emerge during Chapter 2, 3, and 4, the final chapter of this dissertation explores overarching patterns of enculturation within Irish traditional music culture. This ethnographic work suggests that longevity of participation and engagement in multiple learning and performance opportunities foster the enculturation of Irish traditional musicians. Through numerous and prolonged participation in music-making, novices become accustomed to and learn musical, social, and cultural behaviours. The final chapter also explores interconnections between learning experiences and also proposes directions for future research.

Teorias em estratégia

A estratégia empresarial é uma disciplina jovem. Comparado com os campos de estudo de economia e sociologia o campo de estratégia empresarial pode ser visto como um fenômeno de formação mais recente, embora extremamente dinâmico em sua capacidade de criar abordagens teóricas diferenciadas. Este trabalho discute a recente proliferação de teorias em estratégia empresarial, propondo um modelo de classificação destas teorias baseado na análise empírica do modelo de escolas de pensamento em estratégia empresarial desenvolvido por Mintzberg, Ahlstrand e Lampel em seu livro Safári de Estratégia (1998). As possíveis conseqüências relativas à interação entre teoria e prática são também discutidas apresentando o que definimos como a síndrome do ornitorrinco.

Variação da qualidade da água do escoamento superficial de duas bacias de drenagem de Natal/RN - Brasil

The urban drainage is one of the powers of environmental sanitation and its scope is the quantitative and qualitative aspects. In decision making of managers and the engineering aspects of design are almost always taken into account only the quantitative aspects. However, the waters of the runoff have the highest concentrations of pollutants at the beginning of precipitation. Thus, if the plot pollution removed, the remaining portion can be used for other purposes. This work has aimed to present the variation of water quality of two drainage basins in the city of Natal / RN-Brazil to support the implementation of drainage to consider the qualitative aspect, and identify potential for the use of water. The basins (M and C) are analyzed closed-type, are in the urban area, are predominantly residential occupation and its waters are used for detention ponds and infiltration. The samples were divided into three phases, the first two direct to final points in a basin and the third in traps distributed over the surface drainage. The parameters had been analyzed were pH, conductivity, dissolved oxygen, Color, Turbidity, COD, Ammonia, nitrite, nitrate, total phosphorus, orthophosphate, Sediments solids, total solids, chloride, sulfate, alkalinity, calcium, magnesium, sodium, potassium, Heavy Metals (Chromium, Cadmium, Lead, Zinc and Copper), Eschichia coli and total coliforms. The parameters studied showed high initial pollution load, events and located in different proportions, except nitrite, heavy metals and biological indicators. The size of the surface drainage and topographic its features influence the quality of water. However, the form of sampling is crucial in the qualitative study in the basin. The samplers developed at work, were generated economic and representative results. The urban rainwater presents organic faecal indicators. The runoff of water from both basins shows no risk of salinity and sodicity for use in irrigation, should be noted the content of chloride in the choice of method of irrigation