Cancer diagnosis disclosure from Portuguese physicians

OBJECTIVE: Doctor-patient communication in oncology, particularly concerning diagnostic disclosure, is a crucial factor related to the quality of the doctor-patient relationship and the psychological state of the patient. The aims of our study were to investigate physicians' opinions and practice with respect to disclosure of a cancer diagnosis and to explore potential related factors. METHOD: A self-report questionnaire developed for our study was responded to by 120 physicians from Coimbra University Hospital Centre and its primary healthcare units. RESULTS: Some 91.7% of physician respondents generally disclosed a diagnosis, and 94.2% were of the opinion that the patient knowing the truth about a diagnosis had a positive effect on the doctor-patient relationship. A need for training about communicating with oncology patients was reported by 85.8% of participants. The main factors determining what information to provide to patients were: (1) patient intellectual and cultural level, (2) patient desire to know the truth, and (3) the existence of family. SIGNIFICANCE OF RESULTS: Our results point to a paradigm shift in communication with cancer patients where disclosure of the diagnosis should be made part of general clinical practice. Nevertheless, physicians still experience difficulties in revealing cancer diagnoses to patients and often lack the skills to deal with a patient's emotional responses, which suggests that more attention needs to be focused on communication skills training programs.

Early analysis of fault-attack effects for cryptographic hardware

International audience

Legal disclosure of childhood sexual abuse: what can professionals tell us?

ABSTRACT: Purpose: This study explores how the decision to disclose Childhood Sexual Abuse (CSA) to the legal setting for adult victims is perceived by key informants, specifically factors that are believed to facilitate or prevent legal disclosure from occurring. Background: Prevalence rates of CSA are high (Pereda, Guilera, Forns & Gomez-Benito, 2009) and the negative consequences caused by the abuse acknowledged (Filipas & Ullman, 2006). Disclosure of this crime is understood to be complex and delayed disclosure recognised (Arata, 1998) but little is known about disclosure to the legal system. Rates of legal disclosure of CSA remain low and the attrition rates high (London, Bruck, Ceci & Shuman, 2005), but investigation and understanding of the contributory factors is rare. Disclosure of CSA to the legal system enables prosecution of the abuser and protection of the victim and others. Method: 10 “key informants” consisting of specialised clinicians working with adult victims of CSA were interviewed. Each informant completed an indepth interview exploring their beliefs about factors that facilitated or prevented adult victims of CSA from disclosing their experience to the legal system. Interviews were transcribed and the qualitative data subjected to Thematic Analysis. Conclusions: Two super-ordinate themes (Legal Disclosures Are Rare: “Why would they do that?” and The Anomalies: Acknowledging that this is a crime) and four sub-ordinate themes emerged from the analysis and an analytical narrative constructed. Themes emphasised the rarity of legal disclosure and the significant number of barriers adult victims of CSA perceive. Implications for clinical practice and future research are outlined.

Protecting databases from schema disclosure: a CRUD-based protection model

Database schemas, in many organizations, are considered one of the critical assets to be protected. From database schemas, it is not only possible to infer the information being collected but also the way organizations manage their businesses and/or activities. One of the ways to disclose database schemas is through the Create, Read, Update and Delete (CRUD) expressions. In fact, their use can follow strict security rules or be unregulated by malicious users. In the first case, users are required to master database schemas. This can be critical when applications that access the database directly, which we call database interface applications (DIA), are developed by third party organizations via outsourcing. In the second case, users can disclose partially or totally database schemas following malicious algorithms based on CRUD expressions. To overcome this vulnerability, we propose a new technique where CRUD expressions cannot be directly manipulated by DIAs any more. Whenever a DIA starts-up, the associated database server generates a random codified token for each CRUD expression and sends it to the DIA that the database servers can use to execute the correspondent CRUD expression. In order to validate our proposal, we present a conceptual architectural model and a proof of concept.

Fault tolerance logging-based model for deterministic systems

Fault tolerance allows a system to remain operational to some degree when some of its components fail. One of the most common fault tolerance mechanisms consists on logging the system state periodically, and recovering the system to a consistent state in the event of a failure. This paper describes a general fault tolerance logging-based mechanism, which can be layered over deterministic systems. Our proposal describes how a logging mechanism can recover the underlying system to a consistent state, even if an action or set of actions were interrupted mid-way, due to a server crash. We also propose different methods of storing the logging information, and describe how to deploy a fault tolerant master-slave cluster for information replication. We adapt our model to a previously proposed framework, which provided common relational features, like transactions with atomic, consistent, isolated and durable properties, to NoSQL database management systems.

Ground fault protectionmethods for distribution systems

The system grounding method option has a direct influence on the overall performance of the entire medium voltage network as well as on the ground fault current magnitude. For any kind of grounding systems: ungrounded system, solidly and low impedance grounded and resonant grounded, we can find advantages and disadvantages. A thorough study is necessary to choose the most appropriate grounding protection system. The power distribution utilities justify their choices based on economic and technical criteria, according to the specific characteristics of each distribution network. In this paper we present a medium voltage Portuguese substation case study and a study of neutral system with Petersen coil, isolated neutral and impedance grounded.

HIV Disclosure: Parental dilemma in informing HIV infected Children about their HIV Status in Malawi

Background Increasingly many perinatally HIV-infected children are surviving through adolescence and adulthood as a result of improvements in the management of paediatric HIV infection, particularly the increased use of combination therapy. It is usually the parents or guardians of these children who are faced with the task of informing the child living with HIV about his or her positive status. However, many parents—particularly biological parents —find this disclosure process difficult to initiate, and this study explored some of the difficulties that these parents encounter. Objective This study set out to explore potential factors that challenge parents and guardians when informing their perinatally HIV-infected child about the child’s HIV status. Design This was a qualitative narrative study that employed in-depth interviews with parents or guardians of children perinatally infected with HIV. A total of 20 parents and guardians of children who attend the outpatient HIV clinic at the Baylor College of Medicine-Abbott Fund Children’s Clinical Centre of Excellence (COE) in Lilongwe, Malawi were interviewed. Of these, 14 were biological parents and six were guardians. Results Guardians and parents expressed uneasiness and apprehension with the disclosure conversation, whether or not they had already told their child that he or she had HIV. Participants who had not told their children recounted that they had contemplated starting the conversation but could not gather enough courage to follow through with those thoughts. They cited the fear of robbing their child of the happiness of living without the knowledge of being positive, fear of making their own status known to more people, and fear of confrontation or creating enmity with their child as impediments to disclosing their child’s positive HIV status to him or her. Conclusions It is apparent that guardians—more particularly biological parents—of children perinatally infected by HIV find it difficult to inform their children about their children’s HIV status. From this disempowered position, parents dread the disclosure of a positive HIV status to a child as a psychosocial process that has the potential to disturb a family’s previously established equilibrium with threats of stigmatization, marginalization, and parent-child conflict. This calls for strategies that could support parents to make disclosure to the child less challenging.

Blame Attributions Among Child Sexual Abuse Survivors and Disclosure of the Abuse

Child sexual abuse (CSA) disclosure is critical for survivor´s psychosocial adjustment later in life. The aim of the present study was to analyze the relationship between attributions of blame for child sexual abuse by the victim and the disclosure of the abuse to parents or caregivers while controlling for characteristics of the abuse. Female college students between 17 and 24 years of age (M = 19.44, SD = 1.64) from a southern Spanish University were surveyed. Of 1547 respondents, 153 (9.90%) reported having suffered some form of CSA before the age of 15. Information about the characteristics of abuse (age of onset, type of abuse suffered, continuity of abuse, and relationship with and age of the perpetrator) and the existence of abuse disclosure by the survivor was obtained from a self-reported questionnaire developed for the present study. The Attributions of Responsibility and Blame Scale (McMillen & Zuravin, 1997) was used to assess attributions made about CSA (self-blame, perpetrator blame and family blame). The results of a logistic regression model was statistically significant, χ² (9) = 43.856, p < .001. The model explained 41% (Nagelkerke R²) of the variance of abuse disclosure and correctly classified 85.6% of cases. Survivor disclosure was 5.50 times more likely to occur when the perpetrator was not a family member (Wald = 8.14, p < .01) and 3.95 times more likely to occur when there was not physical contact with the perpetrator (Wald = 4.30, p < .05). The occurrence of disclosure was also related to increased perpetrator age (Wald = 4.83, p < .05). With regard to the attributions of blame, the occurrence of disclosure was related to lower scores on self-blame (Wald = 6.78, p < .01) and higher scores on family blame (Wald = 9.67, p < .001). However, no relationship was found between perpetrator blame and disclosure of abuse. The results confirm the idea that not only self-blame attributions, but also family blame attributions are critical to the decision of a CSA victim to disclose abuse. The possibility that children who do not disclose abuse have a greater need to deny the occurrence of abuse, or have more confusion about being abused is discussed. Attributions of blame should be taken into serious consideration when evaluating children for possible sexual abuse.

Fault detection with Conditional Gaussian Network

International audience

Disclosure corporativo e liquidez acionária : uma análise de diferentes níveis de tamanho das empresas brasileiras

Dissertação (mestrado)—Universidade de Brasília, Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, Programa Multiinstitucional e Inter-regional de Pós-Graduação em Ciências Contábeis, 2016.

FAULT MORPHOLOGY WITHIN THE SOUTHERN KENYAN PORTION OF THE EAST AFRICAN RIFT VALLEY

Faults form quickly, geologically speaking, with sharp, crisp step-like profiles. Logic dictates that erosion wears away this "sharpness" or angularity creating more rounded features. As erosion occurs, debris accumulates at the base of the scarp slope. The stable end point of this process is when the scarp slope approaches an ideal sigmoid shape. This theory of fault end process, in combination with a new method developed in this report for fault profile delineation, has the potential to enable observation and categorization of fault profiles over large, diverse swaths of fault formation-- in remote areas such as the Southern Kenyan Rift Valley. This up-to date method uses remote sensing data and the digitizer tool in Global Mapper to create shape files of fault segments. This method can provide further evidence to support the notion that sigmoidal- shaped profiles represent a natural endpoint of the erosional process of fault scarps. Over time, faults of many different ages would exist in this similar shape over a wide region. However, keeping in mind that other processes can be at work on scarps-- most notably drainage patterns, when anomalies in profiles are observed, reactivation in some form possibly has occurred.

Adaptive Software Fault Prediction Approach Using Object-Oriented Metrics

As users continually request additional functionality, software systems will continue to grow in their complexity, as well as in their susceptibility to failures. Particularly for sensitive systems requiring higher levels of reliability, faulty system modules may increase development and maintenance cost. Hence, identifying them early would support the development of reliable systems through improved scheduling and quality control. Research effort to predict software modules likely to contain faults, as a consequence, has been substantial. Although a wide range of fault prediction models have been proposed, we remain far from having reliable tools that can be widely applied to real industrial systems. For projects with known fault histories, numerous research studies show that statistical models can provide reasonable estimates at predicting faulty modules using software metrics. However, as context-specific metrics differ from project to project, the task of predicting across projects is difficult to achieve. Prediction models obtained from one project experience are ineffective in their ability to predict fault-prone modules when applied to other projects. Hence, taking full benefit of the existing work in software development community has been substantially limited. As a step towards solving this problem, in this dissertation we propose a fault prediction approach that exploits existing prediction models, adapting them to improve their ability to predict faulty system modules across different software projects.

Design Optimization of Modern Machine-drive Systems for Maximum Fault Tolerant and Optimal Operation

Modern electric machine drives, particularly three phase permanent magnet machine drive systems represent an indispensable part of high power density products. Such products include; hybrid electric vehicles, large propulsion systems, and automation products. Reliability and cost of these products are directly related to the reliability and cost of these systems. The compatibility of the electric machine and its drive system for optimal cost and operation has been a large challenge in industrial applications. The main objective of this dissertation is to find a design and control scheme for the best compromise between the reliability and optimality of the electric machine-drive system. The effort presented here is motivated by the need to find new techniques to connect the design and control of electric machines and drive systems. A highly accurate and computationally efficient modeling process was developed to monitor the magnetic, thermal, and electrical aspects of the electric machine in its operational environments. The modeling process was also utilized in the design process in form finite element based optimization process. It was also used in hardware in the loop finite element based optimization process. The modeling process was later employed in the design of a very accurate and highly efficient physics-based customized observers that are required for the fault diagnosis as well the sensorless rotor position estimation. Two test setups with different ratings and topologies were numerically and experimentally tested to verify the effectiveness of the proposed techniques. The modeling process was also employed in the real-time demagnetization control of the machine. Various real-time scenarios were successfully verified. It was shown that this process gives the potential to optimally redefine the assumptions in sizing the permanent magnets of the machine and DC bus voltage of the drive for the worst operating conditions. The mathematical development and stability criteria of the physics-based modeling of the machine, design optimization, and the physics-based fault diagnosis and the physics-based sensorless technique are described in detail. To investigate the performance of the developed design test-bed, software and hardware setups were constructed first. Several topologies of the permanent magnet machine were optimized inside the optimization test-bed. To investigate the performance of the developed sensorless control, a test-bed including a 0.25 (kW) surface mounted permanent magnet synchronous machine example was created. The verification of the proposed technique in a range from medium to very low speed, effectively show the intelligent design capability of the proposed system. Additionally, to investigate the performance of the developed fault diagnosis system, a test-bed including a 0.8 (kW) surface mounted permanent magnet synchronous machine example with trapezoidal back electromotive force was created. The results verify the use of the proposed technique under dynamic eccentricity, DC bus voltage variations, and harmonic loading condition make the system an ideal case for propulsion systems.

Fault Line

FAULT LINE examines the fragile humanity connected to the themes of sexuality, violence, addiction, family dynamics, and death. The book is not broken into sections; rather, as poems build upon one another to explore a narrative arc, FAULT LINE tracks a single speaker’s experience from girlhood to the verge of independent womanhood. The speaker employs formal structures such as the prose poem, sestina, and particularly the list poem to examine the fluidity of inner experience and also the culture at large while challenging the narrow definitions of femininity and masculinity. FAULT LINE works to not only address the question of blame but also the literal breaks in lines of poetry. By looking at a single speaker’s struggle, the book, like life, is both humorous and horrifying.