A qualitative comparison of how older breast cancer survivors process treatment information regarding endocrine therapy.

BACKGROUND:It remains unclear how information about aromatase inhibitors (AI) impacts women's decision-making about persistence with endocrine therapy. PURPOSE:To describe and compare how women treated for primary early stage breast cancer either persisting or not persisting with an AI received, interpreted, and acted upon AI-related information. DESIGN:Thematic analysis was used to sort and compare the data into the most salient themes. PARTICIPANTS:Women (N = 54; 27 persisting, 27 not persisting with an AI) aged 65-93 years took part in qualitative interviews. RESULTS:Women in both subgroups described information similarly in terms of its value, volume, type, and source. Aspects of AI-related information that either differed between the subgroups or were misunderstood by one or both subgroups included: (1) knowledge of AI or tamoxifen prior to cancer diagnosis, (2) use of online resources, (3) misconceptions about estrogen, hormone replacement therapies and AI-related symptoms, and (4) risk perception and the meaning and use of recurrence statistics such as Oncotype DX. CONCLUSIONS:Persisters and nonpersisters were similar in their desire for more information about potential side effects and symptom management at AI prescription and subsequent appointments. Differences included how information was obtained and interpreted. Interactive discussion questions are shared that can incorporate these findings into clinical settings

Growth and Yield of a Tropical Rain Forest in the Brazilian Amazon 13 Years After Logging

Successive inventories of a silvicultural experiment in terra firme rain forest within the Tapajos National Forest in the Brazilian Amazon are examined to provide guidelines for operational forest management on a sustainable basis. The experiment was logged in 1979 without additional silvicultural treatment, but included protection from further logging and encroachment ("log and leave"). Thirty-six permanent plots established in 1981, were remeasured in 1987 and 1992. Logging changed the canopy structure and altered the composition of the stand, reducing the number of shade tolerant species and stimulating light demanding species. There was a nett increase in stem number and stand basal area during the 11 year observation period, and this trend also holds for most of the individual species. The stand basal area 13 years after logging was about 75% of that in a comparable unlogged forest. Logging stimulated growth, but this effect was short-lived, lasting only about 3 years, and current growth rates are similar to those in the unlogged forest. Between the first and second remeasures, average diameter increment decreased from 0.4 to 0.2 cm/yr, mortality remained relatively constant at 2.5% per year, while recruitment (at 5 cm dbh) decreased from 5% to 2%. Total volume production declined from approx. 6 to 4 cu m/ha/yr, while commercial production remained about 0.8 cu m/ha/yr. New commercial species increased the commercial volume in 1992 from 18 to 54 cu m/ha, and the increment to 1.8 cu m/ha/yr. Results from this experiment provide the first quantitative information for management planning in the Tapajos Forest, and may guide the choice of cutting cycle and annual allowable cut. Silvicultural treatment to stimulate growth rates in forest areas zoned for timber production should be considered as a viable management option. Extrapolations of these results to an anticipated 30-35 year cutting cycle must be interpreted with caution. On-going remeasurement and analysis of these and other plots over the next 30 years or more are necessary to provide a stronger basis for management inferences

Survey of European neurosurgeons’ management of unruptured intracranial aneurysms: inconsistent practice and organization

Background - The discovery of an unruptured intracranial aneurysm creates a dilemma between observation and treatment. Neurosurgeons’ routines for risk assessment and treatment decision-making are unknown. The position of evidence-based medicine in European neurosurgery is considered to be weak, high-grade guidelines do not exist and variations between institutions are probable. We aimed to explore European neurosurgeons’ management routines for newly discovered unruptured intracranial aneurysms. Methods - In cooperation with the European Association of Neurosurgical Societies (EANS), we conducted an online, cross-sectional survey of 420 European neurosurgeons during Spring/Summer 2016 (1533 non-Norwegians invited through the EANS, and 16 Norwegians invited through heads of departments because of the need for additional information for a separate study). We asked about demographic variables, routines for management and risk assessment of newly discovered unruptured intracranial aneurysms and presented a case. We collected information about gross domestic product (GDP) per capita from the International Monetary Fund. Results - The respons rate to the invite from the EANS was 26%, with respondents from 47 countries. More than half of the respondents (n = 226 [54%]) reported that their department treated less than 25 unruptured aneurysms yearly. Forty percent said their department used aneurysm size cut-off to guide treatment decisions, with a mean size of 6 mm. Presented with a case, respondents from countries with a lower GDP per capita recommended intervention more often than respondents from higher-income countries. Vascular neurosurgeons more commonly recommended observation. Conclusion - The answers to this self-reported survey indicate that many centers have a treatment volume lower than recommended by international guidelines, and that there are socioeconomic differences in care. Better documentation of treatment and outcome, for example with clinical quality registries, is needed to drive improvements of care

KM Maturity Factors Affecting High Performance in Universities

This paper aims to measure Knowledge Management Maturity (KMM) in the universities to determine the impact of knowledge management on high performance. This study was applied on Al-Quds Open University in Gaza strip, Palestine. Asian productivity organization model was applied to measure KMM. Second dimension which assess high performance was developed by the authors. The controlled sample was (306). Several statistical tools were used for data analysis and hypotheses testing, including reliability Correlation using Cronbach’s alpha, “ANOVA”, Simple Linear Regression and Step Wise Regression.The overall findings of the current study suggest that KMM is suitable for measuring high performance. KMM assessment shows that maturity level is in level three. Findings also support the main hypothesis and it is sub- hypotheses. The most important factors effecting high performance are: Processes, KM leadership, People, KM Outcomes and Learning and Innovation. Furthermore the current study is unique by the virtue of its nature, scope and way of implied investigation, as it is the first comparative study in the universities of Palestine explores the status of KMM using the Asian productivity Model

Unstable Slope Management Program

INE/AUTC 11.1

Review of: Sociology of Work - An Encyclopedia

This reference resource with versions available in a twovolume print edition as well as online, consists of 335 entries from leading scholars and subject experts. The entries cover a broad spectrum of international topics ranging from “alienation” to “working poor.” Entries in both formats include “see also” references and “further readings,” while the online version includes links to cited articles

The Role of Perfusion Computed Tomography in the Prediction of Cerebral Hyperperfusion Syndrome

Hyperperfusion syndrome (HPS) following carotid angioplasty with stenting (CAS) is associated with significant morbidity and mortality. At present, there are no reliable parameters to predict HPS. The aim of this study was to clarify whether perfusion computed tomography (CT) is a feasible and reliable tool in predicting HPS after CAS.We performed a retrospective case-control study of 54 patients (11 HPS patients and 43 non-HPS) with unilateral severe stenosis of the carotid artery who underwent CAS. We compared the prevalence of vascular risk factors and perfusion CT parameters including regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and time to peak (TTP) within seven days prior to CAS. Demographic information, risk factors for atherosclerosis, and perfusion CT parameters were evaluated by multivariable logistic regression analysis. The rCBV index was calculated as [(ipsilateral rCBV - contralateral rCBV)/contralateral rCBV], and indices of rCBF and TTP were similarly calculated. We found that eleven patients had HPS, including five with intracranial hemorrhages (ICHs) of whom three died. After a comparison with non-HPS control subjects, independent predictors of HPS included the severity of ipsilateral carotid artery stenosis, 3-hour mean systolic blood pressure (3 h SBP) after CAS, pre-stenting rCBV index >0.15 and TTP index >0.22.The combination of severe ipsilateral carotid stenosis, 3 h SBP after CAS, rCBV index and TTP index provides a potential screening tool for predicting HPS in patients with unilateral carotid stenosis receiving CAS. In addition, adequate management of post-stenting blood pressure is the most important treatable factor in preventing HPS in these high risk patients

Ascertaining the nature and timing of mire degradation : using palaeoecology to assist future conservation management in Northern England

This study was initiated under contract VT0419 from English Nature (Natural England) to CECQR. In 2015, additional funding was provided by the Yorkshire Peat Partnership, for 210Pb dating, to refine age–depth estimates. We thank the following for fieldwork co-ordination, logistics or field assistance: Miriam Baynes, Mike Sutcliffe, Martin Furness, Gez Marshall, Paul Duncan, Tim Page, Andrew Windrum, Craig Sandham and Jackie Smith. We thank the Editor and two anonymous reviewers for suggestions for improvements.Peer reviewedPublisher PD

Barriers to adherence to COPD guidelines among primary care providers

Background: Despite efforts to disseminate guidelines for managing chronic obstructive pulmonary disease (COPD), adherence to COPD guidelines remains suboptimal. Barriers to adhering to guidelines remain poorly understood. Methods: Clinicians from two general medicine practices in New York City were surveyed to identify barriers to implementing seven recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Barriers assessed included unfamiliarity, disagreement, low perceived benefit, low self-efficacy, and time constraints. Exact conditional regression was used to identify barriers independently associated with non-adherence. Results: The survey was completed by 154 clinicians. Adherence was lowest to referring patients with a forced expiratory volume in 1 s (FEV_1) <80% predicted to pulmonary rehabilitation (5%); using FEV_1 to guide management (12%); and ordering pulmonary function tests (PFTs) in smokers (17%). Adherence was intermediate to prescribing inhaled corticosteroids when FEV1 <50% predicted (41%) and long-acting bronchodilators when FEV1 <80% predicted (54%). Adherence was highest for influenza vaccination (90%) and smoking cessation counseling (91%). In unadjusted analyses, low familiarity with the guidelines, low self-efficacy, and time constraints were significantly associated with non-adherence to ≥2 recommendations. In adjusted analyses, low self-efficacy was associated with less adherence to prescribing inhaled corticosteroids (OR: 0.28; 95% CI: 0.10, 0.74) and time constraints were associated with less adherence to ordering PFTs in smokers (OR: 0.31; 95% CI: 0.08, 0.99). Conclusions: Poor familiarity with recommendations, low self-efficacy, and time constraints are important barriers to adherence to COPD guidelines. This information can be used to develop tailored interventions to improve guideline adherence