Design, conduct, and analyses of Breast International Group (BIG) 1-98: a randomized, double-blind, phase-III study comparing letrozole and tamoxifen as adjuvant endocrine therapy for postmenopausal women with receptor-positive, early breast cancer.

BACKGROUND: Aromatase inhibitors provide superior disease control when compared with tamoxifen as adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer. PURPOSE: To present the design, history, and analytic challenges of the Breast International Group (BIG) 1-98 trial: an international, multicenter, randomized, double-blind, phase-III study comparing the aromatase inhibitor letrozole with tamoxifen in this clinical setting. METHODS: From 1998-2003, BIG 1-98 enrolled 8028 women to receive monotherapy with either tamoxifen or letrozole for 5 years, or sequential therapy of 2 years of one agent followed by 3 years of the other. Randomization to one of four treatment groups permitted two complementary analyses to be conducted several years apart. The first, reported in 2005, provided a head-to-head comparison of letrozole versus tamoxifen. Statistical power was increased by an enriched design, which included patients who were assigned sequential treatments until the time of the treatment switch. The second, reported in late 2008, used a conditional landmark approach to test the hypothesis that switching endocrine agents at approximately 2 years from randomization for patients who are disease-free is superior to continuing with the original agent. RESULTS: The 2005 analysis showed the superiority of letrozole compared with tamoxifen. The patients who were assigned tamoxifen alone were unblinded and offered the opportunity to switch to letrozole. Results from other trials increased the clinical relevance about whether or not to start treatment with letrozole or tamoxifen, and analysis plans were expanded to evaluate sequential versus single-agent strategies from randomization. LIMITATIONS: Due to the unblinding of patients assigned tamoxifen alone, analysis of updated data will require ascertainment of the influence of selective crossover from tamoxifen to letrozole. CONCLUSIONS: BIG 1-98 is an example of an enriched design, involving complementary analyses addressing different questions several years apart, and subject to evolving analytic plans influenced by new data that emerge over time.

Tendencias de la formación en las organizaciones

Este artículo presenta los resultados de un estudio descriptivo sobre los cambios que se presentan en los planteamientos actuales de la Formación en las Organizaciones. El análisis de los trabajos nacionales y extranjeros significativos en el campo permitieron identificar las áreas de interés sobre las que se centra el estudio. Se ha utilizado como estrategia de recogida de información la entrevista a informantes claves. Para ello se seleccionó a una muestra representativa de empresas de Cataluña que tuvieran experiencia en Formación dentro de su política de RRHH. Se tomó en consideración para la muestra las variables del tamaño de la empresa y sector productivo. Los resultados de la investigación han puesto de manifiesto el presente y los cambios que parecen vislumbrarse en las dimensiones que se han considerado relevantes para el análisis. Se señalan aquellos cambios que parecen apuntarse en un futuro inmediato en aspectos tales como la planificación de la formación, sus objetivos, modalidades, recursos, evaluación y, como resultado en cierta medida de todo ello, las competencias deseables y perfil profesional vinculado a las funciones y responsabilidades del director o gestor de la formación en las organizaciones.

Tendencias de la formación en las organizaciones

Este artículo presenta los resultados de un estudio descriptivo sobre los cambios que se presentan en los planteamientos actuales de la Formación en las Organizaciones. El análisis de los trabajos nacionales y extranjeros significativos en el campo permitieron identificar las áreas de interés sobre las que se centra el estudio. Se ha utilizado como estrategia de recogida de información la entrevista a informantes claves. Para ello se seleccionó a una muestra representativa de empresas de Cataluña que tuvieran experiencia en Formación dentro de su política de RRHH. Se tomó en consideración para la muestra las variables del tamaño de la empresa y sector productivo. Los resultados de la investigación han puesto de manifiesto el presente y los cambios que parecen vislumbrarse en las dimensiones que se han considerado relevantes para el análisis. Se señalan aquellos cambios que parecen apuntarse en un futuro inmediato en aspectos tales como la planificación de la formación, sus objetivos, modalidades, recursos, evaluación y, como resultado en cierta medida de todo ello, las competencias deseables y perfil profesional vinculado a las funciones y responsabilidades del director o gestor de la formación en las organizaciones.

Tendències de la formació a les empreses catalanes

Aquest article exposa els resultats d¿un estudi descriptiu, realitzat el 2003, sobre els canvis que presenten els plantejaments actuals de la formació en les organitzacions. L'anàlisi dels treballs nacionals i estrangers significatius en el camp va permetre identificar les àrees d'interès sobre les quals se centra l¿estudi. S'ha utilitzat com a estratègia de recollida d'informació l'entrevista a informants clau. Per això es va seleccionar una mostra representativa d¿empreses de Catalunya que tinguessin experiència en formació dintre de la seva política de recursos humans. Es va prendre en consideració per a la mostra les variables de la grandària de l'empresa i el sector productiu. Els resultats de la investigació han posat de manifest el present i les tendències en les dimensions que s'han considerat rellevants per a l¿anàlisi. S'assenyalen aquells canvis que semblen apuntar-se en un futur immediat en aspectes com la planificació de la formació, els seus objectius, modalitats, recursos, avaluació i, com a resultat en certa mesura de tot això, les competències desitjables i el perfil professional vinculat a les funcions i responsabilitats del director o gestor de la formació en les organitzacions.

Liability and Traffic Control Considerations for Low Water Stream Crossings, HR-218, 1981

The current shortage of highway funds precludes the immediate replacement of most of the bridges that have been evaluated as structurally deficient or functionally obsolete or both. A low water stream crossing (LWSC) affords an economical alternative to the replacement of a bridge with another bridge in many instances. However, the potential liability that might be incurred from the use of LWSCs has served as a deterrent to their use. Nor have guidelines for traffic control devices been developed for specific application to LWSCs. This research addressed the problems of liability and traffic control associated with the use of LWSCs. Input to the findings from this research was provided by several persons contacted by telephone plus 189 persons who responded to a questionnaire concerning their experience with LWSCs. It was concluded from this research that a significant potential for accidents and liability claims could result from the use of LWSCs. However, it was also concluded that this liability could be reduced to within acceptable limits if adequate warning of the presence of an LWSC were afforded to road users. The potential for accidents and liability could further be reduced if vehicular passage over an LWSC were precluded during periods when the road was flooded. Under these conditions, it is believed, the potential for liability from the use of an LWSC on an unpaved, rural road would be even less than that resulting from the continuing use of an inadequate bridge. The signs recommended for use in advance of an LWSC include two warning signs and one regulatory sign with legends as follows: FLOOD AREA AHEAD, IMPASSABLE DURING HIGH WATER, DO NOT ENTER WHEN FLOODED. Use of the regulatory sign would require an appropriate resolution by the Board of Supervisors having responsibility for a county road. Other recommendations include the optional use of either a supple mental distance advisory plate or an advisory speed plate, or both, under circumstances where these may be needed. It was also recommended HR-218 Liability & Traffic Control Considerations for Low Water Stream Crossings that LWSCs be used only on unpaved roads and that they not be used in locations where flooding of an LWSC would deprive dwelling places of emergency ground access.

Dynamic Pavement Deflection Measurements, Progress Report, HR-178, 1977

The Road Rater is a dynamic deflection measuring appa-ratus for flexible base pavements. The basic operating principle of the Road Rater is to impart a dynamic loading and measure the resultant movement of the pavement with velocity sensors. This data, when properly adjusted for temperature by use of a nomograph included in this report, can be used to determine pavement life expectancy and estimate overlay thickness required. Road Rater testing will be conducted in the spring, when pave-ments are in their weakest condition, until seasonal correction factors can be developed. The Road Rater does not have sufficient ram weight to effectively evaluate load carrying capacity of rigid pavements. All rigid pavements react similarly to Road Rater testing and generally deflect from 0.65 to 1.30 mils. Research will be continued to evaluate rigid pavements with the Road Rater, however. The Road Rater has proven to be a reliable, trouble free pavement evaluation machine. The deflection apparatus was originally front-mounted, but was rear-mounted during the winter of 1977-78. Since that time, van handling has greatly improved, and front suspension parts are no longer overstressed due to improper weight distribution. The Road Rater provides a fast, economical, nondestructive test method to evaluate flexible pavements. Road Rater test data can be used to predict pavement life, set priorities for asphaltic concrete resurfacing, and design asphaltic concrete overlays. Temperature and seasonal variations significantly affect Road Rater deflection readings and must be considered. A nomograph included in this report adjusts for temperature, but does not correct for seasonal effect. Road Rater testing will be conducted in the spring until seasonal correction factors can be developed. The Road Rater has not successfully evaluated rigid pavements, but research will continue in this area. 1. Recommendations for continuing Road Rater research, evaluation and application are as follows:A computer program should be established to reduce Road Rater raw data (Range and Sensor reading) to HR-178 Road Rater Dynamic Deflections For Determining Structural Rating Of Flexible Pavements mean deflection (mils) and/or structural rating. This computer printout would be similar to present friction testing printouts, and would greatly reduce Road Rater data reduction manpower needs and costs. 2. Seasonal variation study should continue to develop seasonal correction factors. Seasonal test roads will be studied concurrently with routine testing during 1979 to develop this relationship. All Road Rater testing will be conducted in the spring until the seasonal relationship is established. 3. An asphaltic concrete overlay design method should be established based on Road Rater de-flection readings. The AASHTO Interim Guide for Design of Pavement Structures 1972 will be used as a base document for this study. 4. AASHTO Structural numbers should be compared to Road Rater Structural Ratings during 1979 on asphaltic concrete overlay projects. This analysis will enable us to refine Road Rater evaluation of flexible pavements. Roads will be tested before resurfacing and several months

European guidelines for the development of mechanisms/tools supporting the individual demand for training through use of training Vouchers

El projecte de TAV es basa en la transferència d'un sistema de vals de capacitació, i en com aquest sistema de vals és adaptable a altres països o regions. En el document s'analitzen diferents conceptes teòrics sobre la conveniència o no de la implantació d'aquest sistema. A més a més, aquest document és una guia per a les organitzacions interessades en l'adaptació del sistema de vals formatius al seu territori, mostrant els passos a seguir i oferint eines útils per aconseguir-ho.

Etudiants en médecine et centres médico-sociaux: préparer l'avenir [Medical students and community health care centers: preparing the future].

Since 2011, second year medical students from Lausanne University follow a single day course in the community health care centers of the Canton of Vaud. They discover the medico-social network and attend to patients' visits at home. They experience the importance of the information transmission and the partnership between informal caregivers, professional caregivers, general practitioner and hospital units. The goal of this course is to help the future physicians to collaborate with the community health care centers teams. This will be particularly important in the future with an aging and more dependant population.

Renovació pedagógica i formació permanent

En dues ocasions anteriors i en circumstancies ben diferents per alguns de nosaltres, hem opinat o escrit sobre la formació permanent del professorat des d'aquesta "Tribuna» de Tempsd'Educació, per descriure les previsions del Pla de Formació del Departament d'Ensenyament (núm. 2, 1990) o per opinar i comentar les orientacions de la Comunitat Europea sobre la materia (núm. 5, 1991). En aquesta ocasió intentem aproximar-nos al tema des de la perspectiva de la Renovació Pedagógica i reflexionar sobre la marxa i la situació actual del Pla de Formació.

Frictional Properties of Asphalt Concrete Pavements in Iowa, MLR-87-5, 1987

Friction testing of pavements has been a continuing effort by the Iowa Department of Transportation since 1969. This report details results of tests of asphaltic concrete pavements on the primary and interstate road systems. Both sprinkle treated and non-sprinkle treated pavements placed between 1975 - 1985 are included. A total of 1785 miles representing 216 separate paving projects were examined. The effect of fog sealing sprinkle treated pavements was studied by testing friction levels before and after the application of the fog seals. Conclusions of the report are: 1. Current aggregate selection criteria for a.c. pavement surface courses provides adequate friction levels through 10 years and should remain effective through a 15 year design life. 2. Sprinkle treatment of pavements has, for the most part, provided macrotexture in the pavement surface as evidenced by smooth tire testing. 3. Fog sealing sprinkle treated pavements does not significantly alter the friction properties.

La incidencia de las tecnologías de la información y comunicación en los programas de formación continuada de jueces y magistrados

[spa] Los programas de formación continuada a distancia para jueces presentan problemas de ejecución debido de un lado a la dispersión geográfica de los destinatarios y de otra, a la necesidad de alcanzar cierto nivel de competencias tanto para su uso como para su diseño. En este contexto cobran especial significación la determinación de los objetivos así como el diseño curricular del programa que se pretende ejecutar.

Nouveau programme de formation en médecine interne générale: implications pour les médecins de premier recours [The new postgraduate training program in general internal medicine: implications for the primary care physician].

The Swiss postgraduate training program in general internal medicine is now designed as a competency-based curriculum. In other words, by the end of their training, the residents should demonstrate a set of predefined competences. Many of those competences have to be learnt in outpatient settings. Thus, the primary care physicians have more than ever an important role to play in educating tomorrows doctors. A competency-based model of training requires a regular assessment of the residents. The mini-CEX (mini-Clinical Evaluation eXercise) is the assessment tool proposed by the Swiss institute for postgraduate and continuing education. The mini-CEX is based on the direct observation of the trainees performing a specific task, as well as on the ensuing feedback. This article aims at introducing our colleagues in charge of residents to the mini-CEX, which is a useful tool promoting the culture of feedback in medical education.