PURPOSE/OBJECTIVES: To examine differences in nursing care received by patients with breast cancer enrolled in clinical trials and those not enrolled in clinical trials. DESIGN: Retrospective review of clinic charts. SETTING: Oncology outpatient department of a tertiary-care hospital. SAMPLE: 90 women with early stage breast cancer. The mean age of the women was 53 years. More than half of the women (51 of 90) were treated in a clinical trial. METHODS: Retrospective chart review of all the nurse-patient clinic encounters for (...) a six-month period from date of cancer diagnosis. The content of each encounter was coded using a modified version of the Nursing Action Classification System. MAIN RESEARCH VARIABLES: Nursing interventions (i.e., assessment, medical scheduling, psychosocial scheduling, reassurance, and teaching) and phone calls. FINDINGS: Women enrolled in clinical trials had more phone interactions with nursing staff (p = 0.003) and received teaching (p < 0.001) and reassurance (p = 0.005) from nursing staff more often than women not enrolled in clinical trials. Controlling for age and stage of disease, teaching (p < 0.001), and reassurance (p = 0.10) were the primary differences in nursing care between the patients enrolled in clinical trials and those not enrolled. CONCLUSION: Differences in nursing care received exist between patients with breast cancer enrolled in clinical trials and those not enrolled. IMPLICATIONS FOR NURSING PRACTICE: Both teaching and reassurance are important components of caring for patients with cancer and are associated with treatment compliance. If the results of this study are confirmed, measures must be employed to ensure that all patients receive optimal care. (shrink)

The revelation that data obtained for the US-based National Surgical Adjuvant Breast and Bowel Project (NSABP) from subjects enrolled at Hôpital Saint-Luc in Montreal was falsified has eroded public trust in research. Institutions can educate researchers and help prevent unethical research practices by establishing procedures to monitor research involving human subjects. Research monitoring encompasses four categories of activity: annual reviews of continuing research, monitoring of informed consent, monitoring of adherence to approved protocols and monitoring of the integrity of data. The (...) authors describe characteristics of research projects that may call for monitoring procedures in each category. The form taken by such monitoring depends on the nature of the protocol. Although appropriate research monitoring requires substantial investment of personnel and financial resources, it is required under guidelines regulating research involving human subjects in Canada. Research monitoring is a step forward in re-establishing public confidence in medical research. (shrink)

We studied changes in eligibility criteria--the largest impediment to patient accrual--in two samples of clinical trials. Trials from the NSABP (National Surgical Adjuvant Breast and Bowel Program) and POG (Pediatric Oncology Group) were analyzed. After eliminating duplications, the criteria in each protocol were enumerated and classified according to a novel schema. NSABP trials contained significantly more criteria than POG trials, and added precision criteria (making study populations homogeneous) at a faster rate than POG studies. The difference between NSABP studies (explanatory (...) trials) and POG studies (pragmatic trials) suggest that large numbers of eligibility criteria are not necessary for quality studies. We recommend that: (1) the inclusion/exclusion criteria distinction be abandoned; (2) eligibility criteria be explicitly justified; (3) the need for each criterion be assessed when new trials are planned; (4) criteria in phase III trials restricting patient accrual be minimized; and (5) further research be done to assess the impact of criteria on generalizability. (shrink)

OBJECTIVE: Pilot study to characterize treatment differences between patients treated in clinical trials and those treated in a clinical setting. Previous studies have shown higher survival rates for participants in trials of cancer therapy. This difference is observed even after rates are adjusted for important covariates such as age and stage of disease. DESIGN: Retrospective chart review. SETTING: Oncology outpatient department in a tertiary care hospital. PATIENTS: Ninety women 18 to 70 years of age with early-stage breast cancer who were (...) diagnosed in 1990. Fifty-one of the women were treated through clinical trials and 39 were treated outside of clinical trials. OUTCOME MEASURES: Number of blood tests, telephone calls, clinic visits and imaging procedures as well as intensity of chemotherapy and use of radiation therapy. The age of the patient and the stage of disease were important covariates. RESULTS: After the analysis was controlled for patient age and stage of disease, patients treated through a clinical trial were more likely to receive standard-dose chemotherapy (p = 0.020, 95% confidence interval 1.20 to 200.73) and more frequent blood tests (p < 0.001, 95% confidence interval 1.02 to 1.13) than other patients treated in the clinic. CONCLUSIONS: Our results provide a plausible mechanism for the observed survival advantage for participants in clinical trials in oncology. Further study is called for. If these results are confirmed, they have important implications for informed consent to participate in clinical trials and for clinical practice. (shrink)

OBJECTIVE: To investigate whether eligibility criteria that exclude the elderly, persons with psychiatric disease, and persons with substance abuse problems from participation in randomized controlled trials (RCTs) are subjective and hence a source of variability in enrolment decisions and investigator uncertainty. DESIGN: Survey questionnaire. PARTICIPANTS: Cancer investigators from the United States and Canada. INTERVENTIONS: Investigators were presented with clinical vignettes from 3 patient categories--eligible, ineligible and uncertain--for each of 5 eligibility criteria--3 subjective and 2 objective--and were asked whether they would (...) enrol the patient in a trial and how sure they were of this decision. Demographic characteristics of the investigators were also collected. OUTCOME MEASURES: The difference in enrolment decisions between subjective and objective criteria, and the difference in the certainty associated with these decisions. RESULTS: Of 365 questionnaires sent out, 224 usable ones were returned. Compared with the objective criteria, the subjective criteria were associated with more variable enrolment decisions (p = 0.07 for the "eligible" scenario and p = 0.0001 for the "ineligible" and "uncertain" scenarios), and investigators were less sure about the decisions they made (p = 0.0001 for all scenarios). Demographic characteristics of the investigators failed to explain the observed differences. CONCLUSIONS: Subjective eligibility criteria may interfere with the conduct and interpretation of RCTs and, therefore, their use ought to be justified explicitly in the study protocol. RCT designers, funding agencies and research ethics boards have an important role in reviewing eligibility criteria for their necessity. (shrink)

Music is a stimulus capable of triggering an array of basic and complex emotions. We investigated whether and how individuals employ music to induce specific emotional states in everyday situations for the purpose of emotion regulation. Furthermore, we wanted to examine whether specific emotion-regulation styles influence music selection in specific situations. Participants indicated how likely it would be that they would want to listen to various pieces of music (which are known to elicit specific emotions) in various emotional situations. Data (...) analyses by means of non-metric multidimensional scaling revealed a clear preference for pieces of music that were emotionally congruent with an emotional situation. In addition, we found that specific emotion-regulation styles might influence the selection of pieces of music characterised by specific emotions. Our findings demonstrate emotion-congruent music selection and highlight the important role of specific emotion-regulation styles in the selection of music in everyday situations. (shrink)

Focusing on the interactions between people suffering from neuromuscular diseases and their wheelchairs, the author raises the question of action: how is action made possible for people suffering from neuromuscular diseases? Starting with actor-network theory, the author shows that action not only results from distribution and delegation to heterogeneous entities but emerges from hard and lengthy work that makes the relation between them possible and transforms the entities involved. The author describes this work, called the process of adjustment, as work (...) on the links making a person, his or her body, and his or her world. Through this work, new possibilities of action emerge for the person, but also new abilities; the person’s identity is transformed and shaped. This analysis leads to a particular conception of the person as made up through his or her relations to other entities. (shrink)

O tema dos estágios da existência perpassa toda a produção de Kierkegaard. Ele teve sempre o cuidado de mostrar que estético, ético e religioso não são etapas que acontecem apartadas uma da outra, como num modelo sistemático, mas acontecem ao mesmo tempo, uma vez que se dão na existência e se realizam enquanto existência. Mas, em termos da construção de um pensamento clínico em psicologia, o que seria importante ainda se entender acerca dos estágios? Que relação ainda podemos fazer entre (...) as caracterizações e personificações, às quais Kierkegaard, sob pseudônimo ou não, lança mão para apresentar os estágios? E, finalmente, como essa questão perpassa um pensamento clínico ou um pensamento existencial em psicologia? Nosso objetivo com este texto é responder a estas questões. Começaremos por esclarecer o sentido de comunicação indireta no projeto de Kierkegaard. Em seguida, apresentaremos as caracterizações dos diferentes estágios para, então, esclareceremos o sentido de tarefa por meio da apresentação de algumas personificações dos estágios. Por fim, pensaremos as repercussões para um pensamento clínico em psicologia. Veremos que Kierkegaard recorre aos estágios e suas personificações ambicionando tirar o leitor de seu modo confortável de pensar e agir. (shrink)

Current approaches to cyber-security are not working. Rather than producing more security, we seem to be facing less and less. The reason for this is a multi-dimensional and multi-faceted security dilemma that extends beyond the state and its interaction with other states. It will be shown how the focus on the state and “its” security crowds out consideration for the security of the individual citizen, with detrimental effects on the security of the whole system. The threat arising from cyberspace to (...) (national) security is presented as possible disruption to a specific way of life, one building on information technologies and critical functions of infrastructures, with relatively little consideration for humans directly. This non-focus on people makes it easier for state actors to militarize cyber-security and (re-)assert their power in cyberspace, thereby overriding the different security needs of human beings in that space. Paradoxically, the use of cyberspace as a tool for national security, both in the dimension of war fighting and the dimension of mass-surveillance, has detrimental effects on the level of cyber-security globally. A solution out of this dilemma is a cyber-security policy that is decidedly anti-vulnerability and at the same time based on strong considerations for privacy and data protection. Such a security would have to be informed by an ethics of the infosphere that is based on the dignity of information related to human beings. (shrink)

La sexualité préoccupe le Moyen Âge occidental : miroir de la nature peccamineuse de l’homme, elle en révèle le meilleur (tempérance, renoncement) et le pire (appétit, violence). Envisagée dans le seul mariage chrétien, elle est hors de ce cadre adultère, condamnée (juridiquement, judiciairement) et expose les individus à la vindicte populaire. Les lettres de rémission (grâce royale des crimes) des xiv e et xv e siècles témoignent de façon originale de l’impact que le type de conjugalité vécu peut avoir sur (...) les violences sexuelles faites aux femmes. Si les sources sont muettes et absentes sur les violences matrimoniales, isolement, célibat laïc, séparation et adultère exposent les femmes médiévales au viol. Mariée, la femme est appropriée, son corps territorialisé, gardé ; seule ou concubine, elle est mal famée et son corps à prendre. C’est dans ce paradigme que la question du couple et des violences sexuelles se pose alors. (shrink)

La sexualité préoccupe le Moyen Âge occidental : miroir de la nature peccamineuse de l’homme, elle en révèle le meilleur (tempérance, renoncement) et le pire (appétit, violence). Envisagée dans le seul mariage chrétien, elle est hors de ce cadre adultère, condamnée (juridiquement, judiciairement) et expose les individus à la vindicte populaire. Les lettres de rémission (grâce royale des crimes) des xiv e et xv e siècles témoignent de façon originale de l’impact que le type de conjugalité vécu peut avoir sur (...) les violences sexuelles faites aux femmes. Si les sources sont muettes et absentes sur les violences matrimoniales, isolement, célibat laïc, séparation et adultère exposent les femmes médiévales au viol. Mariée, la femme est appropriée, son corps territorialisé, gardé ; seule ou concubine, elle est mal famée et son corps à prendre. C’est dans ce paradigme que la question du couple et des violences sexuelles se pose alors. (shrink)

Avec sa succession de bouleversements institutionnels, le dix-septième siècle anglais fut un fabuleux terrain d'expérimentation et de réflexion politique d'où surgirent les grandes théories modernes. A cette période, philosophes et acteurs engagés tentèrent de penser, avec une acuité particulière liée aux événements (guerres civiles, régicide, république, dictature), les tensions inhérentes au pouvoir, tout à la fois perçu comme contraignant, tyrannique et libérateur. Quatre d'entre eux ont été retenus : Thomas Hobbes (1588-1679), le théoricien de l’absolutisme, James Harrington (1611-1677), le républicain (...) classique, Algernon Sidney (1623-1683), le martyr whig, John Locke (1632-1704), le père du libéralisme. Le propos de l’ouvrage est de montrer que, par-delà leurs différences, ces quatre penseurs partagent une approche qui constitue le socle commun d’une théorie de l’Etat moderne. Leur doctrine s’affranchit de l’exercice utopique comme de la théorie de la raison d’Etat et se conçoit comme une anatomie du corps politique. Par un examen minutieux des textes, l’auteur cherche à s’écarter de l' interprétation trop « idéologique » sans doute accentuée par les combats de l’histoire. Elle met en évidence un objet philosophique commun aux quatre auteurs, que l’on retrouve au cœur de toute conception moderne du pouvoir. (shrink)

Le tragique n'est pas uniquement à l'Age classique une catégorie théâtrale ; il est également un concept philosophique, et si pour des auteurs comme Corneille ou Racine, il est une donnée littéraire reçue de l'Antiquité, il est chez des philosophes comme Descartes, Pascal ou Spinoza, un concept à construire ou à élaborer. Cette relation idéale entre hommes de théâtre et philosophes a un enjeu important : quelles solutions apporter au tragique?

Les figurations diverses de la rationalité dans la correspondance de Spinoza n’ont pas qu’une valeur pédagogique ; paraissent-elles singulières, ce sont autant de déclinaisons du spinozisme. On y ressaisit les difficultés que le système a rencontrées auprès de publics divers; difficultés qu’illustrent les postures irrationnelles de bien des correspondants. La correspondance, en marge de l’œuvre, expose la définition spinoziste de la philosophie et en souligne l’originalité ; ne perdant jamais de vue l’idée d’adéquation, elle noue de façon unique les rapports (...) entre spinozisme, tradition et cartésianisme, entre le philosophe et la cité. La rationalité produite dans les lettres conduit à réexaminer des questions traitées dans l’œuvre : la définition intervient comme un élément important du dispositif rationnel et le présage s’y donne comme n’étant pas dénué non plus de rationalité. Le dynamisme et la force de cette philosophie rendent raison d’échanges souvent inféconds et violents, comme ceux avec Burgh, Blyenbergh et Boxel : ils nous confrontent à un Spinoza intransigeant sur ses principes rationnels et qui ne pouvait composer ni avec les dogmes de la religion ni avec l’opinion. (shrink)

Résumé La littérature hétérolingue serait-elle susceptible de contribuer à une poétique du traduire? Notre investigation, qui nous fera quitter la linguistique pour les théories de l’énonciation puis aborder l’analyse rhétorique en termes d’ ethos, s’achèvera sur l’étude d’une phrase extraite d’ Hijo de hombre, roman guarani-hispanophone du Paraguayen Augusto Roa Bastos (1917-2005). Les trois versions françaises étayeront l’hypothèse selon laquelle chaque traduction est un acte de ré-énonciation où se rejoue le rapport à l’altérité linguistique.

Introduction: Globally, vitamin D deficiency is one of the most common deficiencies, affecting nearly half the world's population. The objective of this survey was to assess and compare the knowledge about vitamin D and the perceived state of health in Emirati and international tourist female students in Dubai, UAE. Methods: This is a cross-sectional study that took place in universities in Dubai, UAE. This survey consisted of 17 multiple choice questions. The first part of the survey assessed levels of supplementation, (...) diet and UV exposure. Another section evaluated the participants’ self-assessed state of health regarding vitamin D testing, symptoms related to vitamin D deficiency and general welbeing. The collected data were statistically analyzed using SPSS statistics for windows version 26.0 (SPSS Inc., Chicago, IL). Statistical significance was set at P<0.05. Results: 105 respondents were Emiratis and 65 were international students. The average age was 21, with an average BMI 23.3. Almost one-third of each group reported using Vitamin D supplements once weekly. The majority of both groups reported rarely getting tanned. Almost all participants reported regular consumption of Vitamin-D rich foods. In both groups, more than half reported consuming milk and cheese regularly and up to one-third reported consuming fish in a regular manner. Although more than half of the students rated their health as good; more than two-thirds reported experiencing muscle pain; only half reported having their blood Vitamin D levels measured once; half reported experiencing problems with concentration and more than three-quarters reported experiencing bad mood in the past month. The prevalence of these symptoms was almost similar across different categories of vitamin D supplementation, tanning habits, dietary intake, or nationality. No statistically significant differences were noted between the 2 groups. Conclusion: more Emirati students were aware of the association between vitamin D and osteoporosis than International tourist students (40% vs. 21.9%, respectively; p<0.05). On the other hand, both groups had lower knowledge about the relationship between vitamin D deficiency and depression, Rheumatoid Arthritis and Hypertension, and the optimal vitamin D level; however, no statistically significant differences were noted regarding this knowledge of Emiratis and international students. (shrink)

Huit mois après le dépôt du rapport de la Commission Charbonneau, nous avons souhaité explorer les défis liés à la mise en place des recommandations. Avec un regard constructif, nous nous questionnons sur le fait de savoir à qui incombe le suivi d’un rapport de cette envergure ainsi que les obligations légales liées à cette question et nous nous permettons d’émettre certaines idées liées à une vision globale en matière de reddition de comptes. Tout en partageant nos réflexions inspirées des (...) bonnes pratiques en matière de gestion du risque de fraude, nous présentons la complexité de la mise en place d’une recommandation tels le soutien et la protection des lanceurs d’alerte. (shrink)

More and more frequently, the organisation of design fits into a project organisation where different designers have to cooperate with flexibility and reactivity. In order to help these cooperative design processes, we have to respond to new types of needs: a relatively unformalised coordination that requires permanent mutual adjustment, the fact that members of the team are geographically distant, the difficulty of building a shared reference via design documents and technical and organisational decisions that structure the project. In order to (...) provide computer support for these needs, asynchronous Group Ware is often recommended. However, the efficiency of these tools depends on the models that structure the work processes and the knowledge exchanged. In this paper, we present ABRICo, a new Design Rationale formalism that permits the recording of cooperative decision-making processes in complex design situations. We describe the formalism and explain how we intend to use it to specify cooperative design tools usable via an Intranet for computing projects. (shrink)

This volume addresses current issues in the semantics and the pragmatics of discourse and dialogue. Collected papers aim at providing insights on different theoretical approaches, all of them in the dynamic semantics tradition, such as Dynamic Predicate Logic (DPL), Discourse Representation Theory (DRT), and Segmented Discourse Representation Theory (SDRT). They reflect the current move of formal semantics from short multisentential texts towards structured discourses and dialogues, accounting for more and more phenomena at the semantics-pragmatics interface (e.g., subtleties of anaphora and (...) presupposition, the role of temporal connectives in discourse or the establishment of common references in dialogue). (shrink)

Este artículo se concentrará en las estrategias impulsadas por la Dirección Provincial de Educación Secundaria de la provincia de Buenos Aires, destinadas a impulsar la participación estudiantil y la convivencia, entre los años 2020 y 2021. Se presenta la experiencia de trabajo en soporte digital llevada adelante desde las líneas de trabajo “Construir Ciudadanía” y “Lenguajes contemporáneos” en el marco del ASPO y DISPO producto de la pandemia.

Pour une part, les récents échanges sur l’esclavage ont eu l’intérêt de faire émerger un phénomène historique raturé depuis le XIXe siècle. Alors que l’historiographie se saisit cycliquement de grandes questions à la faveur des commémorations nationales, comme ces derniers temps la Grande Guerre ou la Shoah, en ce qui concerne l’esclavage il n’en est rien. Passe le temps, demeure le silence.

L'Inopos, qui constitue le principal cours d'eau de Délos, prend sa source au Sud-Ouest du Cynthe. Il coule d'abord vers le Nord puis il s'oriente vers l'Ouest pour déboucher à l'emplacement de l'Agora des Hermaïstes. Un barrage associé à un vaste bassin de retenue a été construit à l'endroit où il change d'orientation. La paroi d'amont du mur qui barre le vallon est constituée de blocs de poros dont les joints verticaux ont été remplis de plomb et dont les assises (...) successives ont été associées par des barres métalliques se développant sur toute la longueur de l'ouvrage. Des drains ménagés dans l'épaisseur du mur conduisaient vers l'aval les eaux d'infiltration. Cette construction, qui atteste une remarquable connaissance des problèmes de stabilité des barrages, est sans doute une œuvre des Athéniens réalisée vers la fin du Ve ou le début du IVe s. Le barrage et son bassin furent réaménagés au début de l'Indépendance. A l'époque impériale, le barrage fut percé en sous-œuvre et associé à un aqueduc. (shrink)