Immediate reconstruction following breast-conserving surgery: Management of the positive surgical margins and influence on secondary reconstruction

The efficacy of breast-conserving Surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving Surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled Surgical margin status on the type of breast-conserving Surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic Surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment Of Surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48 months. Two hundred and eighteen patients (88.5%) underwent breast-conserving Surgery and immediate reconstruction. Twelve (5.5%) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3%, a second reconstructive technique was indicated and in 2.2% a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins: however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic Surgeon and careful intraoperative management, (C) 2008 Elsevier Ltd. All rights reserved.

Exercise improves cardiovascular control in a model of dislipidemia and menopause

The present study investigated the effects of exercise training on arterial pressure, baroreflex sensitivity, cardiovascular autonomic control and metabolic parameters on female LDL-receptor knockout ovariectomized mice. Mice were divided into two groups: sedentary and trained. Trained group was submitted to an exercise training protocol. Blood cholesterol was measured. Arterial pressure (AP) signals were directly recorded in conscious mice. Baroreflex sensitivity was evaluated by tachycardic and bradycardic responses to AP changes. Cardiovascular autonomic modulation was measured in frequency (FFT) and time domains. Maximal exercise capacity was increased in trained as compared to sedentary group. Blood cholesterol was diminished in trained mice (191 +/- 8 mg/dL) when compared to sedentary mice (250 +/- 9 mg/dL, p<0.05). Mean AP and HR were reduced in trained group (101 +/- 3 mmHg and 535 +/- 14 bpm, p<0.05) when compared with sedentary group (125 +/- 3 mmHg and 600 +/- 12 bpm). Exercise training induced improvement in bradycardic reflex response in trained animals (-4.24 +/- 0.62 bpm/mmHg) in relation to sedentary animals (-1.49 +/- 0.15 bpm/mmHg, p<0.01); tachycardic reflex responses were similar between studied groups. Exercise training increased the variance (34 +/- 8 vs. 6.6 +/- 1.5 ms(2) in sedentary, p<0.005) and the high-frequency band (HF) of the pulse interval (IP) (53 +/- 7% vs. 26 +/- 6% in sedentary, p<0.01). It is tempting to speculate that results of this experimental study might represent a rationale for this non-pharmacological intervention in the management of cardiovascular risk factors in dyslipidemic post-menopause women. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Effects of exercise training on autonomic dysfunction management in an experimental model of menopause and myocardial infarction

Objective: The aim of this study was to investigate the effects of exercise training on cardiovascular autonomic dysfunction in ovariectomized rats submitted to myocardial infarction. Methods: Female Wistar rats were divided into the following ovariectomized groups: sedentary ovariectomized (SO), trained ovariectomized (TO), sedentary ovariectomized infarcted (SOI), and trained ovariectomized infarcted (TOI). Trained groups were submitted to an exercise training protocol on a treadmill (8 wk). Arterial baroreflex sensitivity was evaluated by heart rate responses to arterial pressure changes, and cardiopulmonary baroreflex sensitivity was tested by bradycardic and hypotension responses to serotonin injection. Vagal and sympathetic effects were calculated by pharmacological blockade. Results: Arterial pressure was reduced in the TO in comparison with the SO group and increased in the TOI in relation to the SOI group. Exercise training improved the baroreflex sensitivity in both the TO and TOI groups. The TOI group displayed improvement in cardiopulmonary reflex sensitivity compared with the SOI group at the 16 mu g/kg serotonin dose. Exercise training enhanced the vagal effect in both the TO (45%) and TOI (46%) animals compared with the SO and SOI animals and reduced the sympathetic effect in the TOI (38%) in comparison with the SOI animals. Significant correlations were obtained between bradycardic baroreflex responses and vagal (r = -0.7, P < 0.005) and sympathetic (r = 0.7, P < 0.001) effects. Conclusions: These results indicate that exercise training in ovariectomized rats submitted to myocardial infarction improves resting hemodynamic status and reflex control of the circulation, which may be due to an increase in the vagal component. This suggests a homeostatic role for exercise training in reducing the autonomic impairment of myocardial infarction in postmenopausal women.

INVENTORY CONTROL SYSTEM : Optimization of production system and reliability

The main idea of this research to solve the problem of inventory management for the paper industry SPM PVT limited. The aim of this research was to find a methodology by which the inventory of raw material could be kept at minimum level by means of buffer stock level.The main objective then lies in finding the minimum level of buffer stock according to daily consumption of raw material, finding the Economic Order Quantity (EOQ) reorders point and how much order will be placed in a year to control the shortage of raw material.In this project, we discuss continuous review model (Deterministic EOQ models) that includes the probabilistic demand directly in the formulation. According to the formula, we see the reorder point and the order up to model. The problem was tackled mathematically as well as simulation modeling was used where mathematically tractable solution was not possible.The simulation modeling was done by Awesim software for developing the simulation network. This simulation network has the ability to predict the buffer stock level based on variable consumption of raw material and lead-time. The data collection for this simulation network is taken from the industrial engineering personnel and the departmental studies of the concerned factory. At the end, we find the optimum level of order quantity, reorder point and order days.

Communication in Smoking Cessation and Self-management : a study at Nurse-led COPD-clinics in Primary Health Care

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

Implementing Policy Management through BDI

The requirement for Grid middleware to be largely transparent to individual users and at the same time act in accordance with their personal needs is a difficult challenge. In e-science scenarios, users cannot be repeatedly interrogated for each operational decision made when enacting experiments on the Grid. It is thus important to specify and enforce policies that enable the environment to be configured to take user preferences into account automatically. In particular, we need to consider the context in which these policies are applied, because decisions are based not only on the rules of the policy but also on the current state of the system. Consideration of context is explicitly addressed, in the agent perspective, when deciding how to balance the achievement of goals and reaction to the environment. One commonly-applied abstraction that balances reaction to multiple events with context-based reasoning in the way suggested by our requirements is the belief-desire-intention (BDI) architecture, which has proven successful in many applications. In this paper, we argue that BDI is an appropriate model for policy enforcement, and describe the application of BDI to policy enforcement in personalising Grid service discovery. We show how this has been implemented in the myGrid registry to provide bioinformaticians with control over the services returned to them by the service discovery process.

Effective Data Management Enables Intelligent Utility Management

Instrumentation and automation plays a vital role to managing the water industry. These systems generate vast amounts of data that must be effectively managed in order to enable intelligent decision making. Time series data management software, commonly known as data historians are used for collecting and managing real-time (time series) information. More advanced software solutions provide a data infrastructure or utility wide Operations Data Management System (ODMS) that stores, manages, calculates, displays, shares, and integrates data from multiple disparate automation and business systems that are used daily in water utilities. These ODMS solutions are proven and have the ability to manage data from smart water meters to the collaboration of data across third party corporations. This paper focuses on practical, utility successes in the water industry where utility managers are leveraging instantaneous access to data from proven, commercial off-the-shelf ODMS solutions to enable better real-time decision making. Successes include saving $650,000 / year in water loss control, safeguarding water quality, saving millions of dollars in energy management and asset management. Immediate opportunities exist to integrate the research being done in academia with these ODMS solutions in the field and to leverage these successes to utilities around the world.

Real-Time Control Of Floods Along The Demer River, Belgium, By Means Of MPC In Combination With GA And A Fast Conceptual River Model

Climate model projections show that climate change will further increase the risk of flooding in many regions of the world. There is a need for climate adaptation, but building new infrastructure or additional retention basins has its limits, especially in densely populated areas where open spaces are limited. Another solution is the more efficient use of the existing infrastructure. This research investigates a method for real-time flood control by means of existing gated weirs and retention basins. The method was tested for the specific study area of the Demer basin in Belgium but is generally applicable. Today, retention basins along the Demer River are controlled by means of adjustable gated weirs based on fixed logic rules. However, because of the high complexity of the system, only suboptimal results are achieved by these rules. By making use of precipitation forecasts and combined hydrological-hydraulic river models, the state of the river network can be predicted. To fasten the calculation speed, a conceptual river model was used. The conceptual model was combined with a Model Predictive Control (MPC) algorithm and a Genetic Algorithm (GA). The MPC algorithm predicts the state of the river network depending on the positions of the adjustable weirs in the basin. The GA generates these positions in a semi-random way. Cost functions, based on water levels, were introduced to evaluate the efficiency of each generation, based on flood damage minimization. In the final phase of this research the influence of the most important MPC and GA parameters was investigated by means of a sensitivity study. The results show that the MPC-GA algorithm manages to reduce the total flood volume during the historical event of September 1998 by 46% in comparison with the current regulation. Based on the MPC-GA results, some recommendations could be formulated to improve the logic rules.

Application Of Real-Time Control Strategy To Improve Nitrogen Removal In Wastewater Treatment

Biological nitrogen removal is an important task in the wastewater treatment. However, the actual removal of total nitrogen (TN) in the wastewater treatment plant (WWTP) is often unsatisfactory due to several causes, one of which is the insufficient availability of carbon source. One possible approach to improve the nitrogen removal therefore is addition of external carbon source, while the amount of which is directly related to operation cost of a WWTP. It is obviously necessary to determine the accurate amount of addition of external carbon source according to the demand depending on the influent wastewater quality. This study focused on the real-time control of external carbon source addition based on the on-line monitoring of influent wastewater quality. The relationship between the influent wastewater quality (specifically the concentration of COD and ammonia) and the demand of carbon source was investigated through experiments on a pilot-scale A/O reactor (1m3) at the Nanjing WWTP, China. The minimum doses of carbon source addition at different situations of influent wastewater quality were determined to ensure the effluent wastewater quality meets the discharge standard. The obtained relationship is expected to be applied in the full-scale WWTPs. .

Optimized Water Demand Management Through Intelligent Sensing And Analytics: The WISDOM Approach

New business and technology platforms are required to sustainably manage urban water resources [1,2]. However, any proposed solutions must be cognisant of security, privacy and other factors that may inhibit adoption and hence impact. The FP7 WISDOM project (funded by the European Commission - GA 619795) aims to achieve a step change in water and energy savings via the integration of innovative Information and Communication Technologies (ICT) frameworks to optimize water distribution networks and to enable change in consumer behavior through innovative demand management and adaptive pricing schemes [1,2,3]. The WISDOM concept centres on the integration of water distribution, sensor monitoring and communication systems coupled with semantic modelling (using ontologies, potentially connected to BIM, to serve as intelligent linkages throughout the entire framework) and control capabilities to provide for near real-time management of urban water resources. Fundamental to this framework are the needs and operational requirements of users and stakeholders at domestic, corporate and city levels and this requires the interoperability of a number of demand and operational models, fed with data from diverse sources such as sensor networks and crowsourced information. This has implications regarding the provenance and trustworthiness of such data and how it can be used in not only the understanding of system and user behaviours, but more importantly in the real-time control of such systems. Adaptive and intelligent analytics will be used to produce decision support systems that will drive the ability to increase the variability of both supply and consumption [3]. This in turn paves the way for adaptive pricing incentives and a greater understanding of the water-energy nexus. This integration is complex and uncertain yet being typical of a cyber-physical system, and its relevance transcends the water resource management domain. The WISDOM framework will be modeled and simulated with initial testing at an experimental facility in France (AQUASIM – a full-scale test-bed facility to study sustainable water management), then deployed and evaluated in in two pilots in Cardiff (UK) and La Spezia (Italy). These demonstrators will evaluate the integrated concept providing insight for wider adoption.

Board of directors and top management team: a study on CEO relative power and financial return

Best corporate governance practices published in the primers of Brazilian Securities and Exchange Commission and the Brazilian Corporate Governance Institute promote board independence as much as possible, as a way to increase the effectiveness of governance mechanism (Sanzovo, 2010). Therefore, this paper aims at understanding if what the managerial literature portraits as being self-evident - stricter governance, better performance - can be observed in actual evidence. The question answered is: do companies with a stricter control and monitoring system perform better than others? The method applied in this paper consists on comparing 116 companies in respect to the their independence level between top management team and board directors– being that measured by four parameters, namely, the percentage of independent outsiders in the board, the separation of CEO and chairman, the adoption of contingent compensation and the percentage of institutional investors in the ownership structure – and their financial return measured in terms return on assets (ROA) from the latest Quarterly Earnings release of 2012. From the 534 companies listed in the Stock Exchange of Sao Paulo – Bovespa – 116 were selected due to their level of corporate governance. The title “Novo Mercado” refers to the superior level of governance level within companies listed in Bovespa, as they have to follow specific criteria to assure shareholders ´protection (BM&F, 2011). Regression analyses were conducted in order to reveal the correlation level between two selected variables. The results from the regression analysis were the following: the correlation between each parameter and ROA was 10.26%; the second regression analysis conducted measured the correlation between the independence level of top management team vis-à-vis board directors – namely, CEO relative power - and ROA, leading to a multiple R of 5.45%. Understanding that the scale is a simplification of the reality, the second part of the analysis transforms all the four parameters into dummy variables, excluding what could be called as an arbitrary scale. The ultimate result from this paper led to a multiple R of 28.44%, which implies that the combination of the variables are still not enough to translate the complex reality of organizations. Nonetheless, an important finding can be taken from this paper: two variables (percentage of outside directors and percentage of institutional investor ownership) are significant in the regression, with p-value lower than 10% and with negative coefficients. In other words, counter affirming what the literature very often portraits as being self-evident – stricter governance leads to higher performance – this paper has provided evidences to believe that the increase in the formal governance structure trough outside directors in the board and ownership by institutional investor might actually lead to worse performance. The section limitations and suggestions for future researches presents some reasons explaining why, although supported by strong theoretical background, this paper faced some challenging methodological assumptions, precluding categorical statements about the level of governance – measured by four selected parameters – and the financial return in terms of financial on assets.

Late pest control in determinate tomato cultivars

O uso de plantas inseticidas e de variedades pode ser forte aliado ao Manejo Integrado de Pragas (MIP), podendo reduzir o número de aplicações de inseticidas e minimizar seus efeitos ao homem e ao meio ambiente. em condições de campo, visando o controle de pragas tardias do tomateiro em duas cultivares de crescimento determinado, compararam-se as seguintes táticas de controle: a) Convencional - pulverizações com os produtos metamidofós, buprofezin, acefato, cipermetrina, abamectina, permetrina, teflubenzuron e lufenuron, aplicados em intervalos de três a seis dias; b) MIP - nível de ação de cada praga para aplicações de imidacloprid, triflumuron, lufenuron e abamectina; c) MIP - Azadirachta indica (nim) - nível de ação de cada praga para aplicações de óleo de nim (1,2% de azadiractina) a 0,5%. As táticas de controle MIP e MIP - nim foram eficientes no controle das pragas tardias do tomateiro, quando a pressão da população é baixa, não diferindo do tratamento convencional que apresentou as menores médias de infestação. As táticas de controle convencional, MIP e MIP-nim promoveram maiores produções do tomateiro, com incrementos de até 74%. O número de pulverizações foi reduzido em até 77% com as táticas MIP e MIP - nim, comparado ao método convencional. O produto nim pode ser alternativa promissora no controle de pragas tardias do tomateiro em campo, que se ajusta ao MIP.

The predatory mite Stratiolaelaps scimitus as a control agent of the fungus gnat Bradysia matogrossensis in commercial production of the mushroom Agaricus bisporus

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Cover crops and herbicide timing management on soybean yield under no-tillage system

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Analysis of the efficiency of silicate clay on the control of Xanthomonas axonopodis PV. passiflorae in vitro and in seedlings of yellow passion fruit contaminated

The bacterial spot in yellow passion fruit plants, caused by the bacteria Xanthomonas axonopodis pv. passiflorae, occurs in all producing areas of the country, and is responsible for great economic losses in the culture of passion fruit. This study aimed to test the efficiency of the silicate clay in the inhibition of the bacteria Xanthomonas axonopodis pv. passiflorae in vitro, and in both preventive and curative control of the bacterial spot in seedlings of yellow passion fruit plants. The silicate clay was added to the growth medium at concentrations of. 0.5, 1.0, 1.5 and 2.0%, placed in Petri dishes. After the culture medium was cooler, the bacterial suspension was inoculates (10(7) UFC.mL(-1)) with a handle, and left incubating at 28 degrees C for three days, and then the bacterial growth was evaluated. Subsequently, the product at the same concentrations above was sprayed on seedlings of 'Afruvec' passion fruit, as preventive or curative. The inoculation of the bacteria was made by foliar spraying of bacterial suspension (10(7) ufc.mL(-1)), 24 hours before or after the curative and preventive treatments, respectively. The severity of the disease was measured comparing each four true leaves from bottom up, with a diagrammatic scale. In the concentrations evaluated, the silicate clay inhibited both bacteria in vitro and symptoms of bacterial spot in the curative treatment. In preventive treatment, significant results were obtained using more than 1.0% of clay silicates. Based on these results, the clay silicate can be recommended, the concentration of 1.0-2.0% for the control of bacterial spot of passion fruit plants, in foliar sprays.