646 research outputs found
Avaliação de desempenho de sistemas educacionais : uma abordagem utilizando conjuntos difusos
Full text linkTese (doutorado) - Universidade Federal de Santa Catarina, Centro TecnologicoNeste trabalho são discutidos modelos para avaliação de desempenho de sistemas, mais especificamente, sistemas educacionais. Um sistema educacional é um sistema complexo. Em sistemas educacionais, um elemento marcante é a presença viva de relações humanas. Modelos tradicionais de análise não são tão adequados na caracterização dessas relações e, conseqüentemente, a aplicação desses modelos se torna problemática. A teoria da lógica difusa é especialmente aplicável a modelos nos quais é grande a presença de incertezas próprias do pensamento humano, processos de raciocínio, processos cognitivos, processos de percepção ou, de forma mais ampla, informação cognitiva. A incorporação destes elementos subjetivos na análise torna-se possível quando da utilização dos conceitos de conjuntos difusos. Este trabalho apresenta, numa primeira etapa, uma descrição de modelos de análise tradicionais, discutindo-se os requisitos necessários a sua aplicação. Posteriormente, é apresentado uma análise da teoria dos conjuntos difusos, enfatizando as técnicas que podem ser utilizadas com sucesso na análise de desempenho de sistemas. Um modelo teórico para o tratamento de questões relativas a escolha qualitativa, baseado na lógica difusa, é proposto. Através de aplicações procura-se demonstrar a viabilidade da utilização dos modelos de análise de dados difusos. Entre estas aplicações, um estudo de caso, utilizando dados reais, é realizado. Neste estudo de caso demonstra-se como políticas educacionais podem ser utilizadas para aferição de desempenho de um sistema educacional. Nestas aplicações realizadas, modelos são construídos para avaliar como fatores relacionados às características organizacionais do sistema, como por exemplo, localização de um estabelecimento d ensino ou seu estado de conservação podem vir a interferir no desempenho do sistema
Patterns and frequency of recurrences of squamous cell carcinoma of the vulva
Full text linkJorien M. Woolderink, Geertruida H. de Bock, Joanne A. de Hullu, Margaret J. Davy, Ate G.J. van der Zee, Marian J.E. Mourit
Breast cancer screening, outside the population-screening program, of women from breast cancer families without proven BRCA1/BRCA2 mutations: a simulation study
No full textPurpose: We assessed the cost-effectiveness of mammography screening for women under the age of 50, from breast cancer families without proven BRCA1./BRCA2 mutations, because current criteria for screening healthy women from breast cancer families are not evidence-based. Methods: We did simulation studies with mathematical models on the cost-effectiveness of mammography screening, for women under the age of 50 with breast cancer family histories. Breast cancer screening was simulated with varying screening intervals (6, 12, 18, and 24 months) and screening cohorts (starting at ages 30, 35, 40, and 45, and continuing to age 50). Incremental costs of screening were compared with chose of women ages 50 to 52 years, the youngest age group currently routinely screened in the nationwide screening program of the Netherlands, to determine cost-effectiveness. Sensitivity analyses were done to explore the effects of model assumptions. The cost-effectiveness of breast cancer screening for women over the age of 50 was not debated. Results: The most effective screening interval was found to be 12 months, which, however, seems only to be cost-effective in a small group of women under the age of 50 with at least two affected relatives, including at least one affected in the first degree diagnosed under the age of 50. Significantly, early breast cancer screening never seemed to be cost-effective in women with only one affected first-degree or second-degree relative. Conclusion: Annual breast cancer screening with mammography for women under the age of 50 seems to be cost-effective in women with strong family histories of breast cancer, even when no BRCA1/BRCA2 mutation was found in affected family members
Optimization of breast cancer screening: informed decisions on benefits and harms
Full text linkThis thesis demonstrated an association between less regular participation in breastcancer screening and significantly lower odds of cancer detection as well as higher odds ofadvanced stage cancer detection. Regular screening is key to detecting breast cancer at anearly stage. However, whereas women of both high and low SES had high non-participationrates in organized screening, it was mostly women of high SES who participated inopportunistic screening. To improve the efficiency of organized screening, we needto evaluate strategies that can reach non-participating women and we must improverecruitment efforts for women of low SES who may face barriers to screening. It was alsoshown that overdiagnosis was more related to DCIS than to invasive breast cancer, and thatestimates of invasive breast cancer overdiagnosis depend on the follow-up time and age ofscreening. Moving forward, we must ensure a sufficient follow-up time of at least 10 yearsto obtain unbiased overdiagnosis estimates
Severity, not type, is the main predictor of decreased quality of life in elderly women with urinary incontinence: a population-based study as part of a randomized controlled trial in primary care
No full textSeverity, not type, is the main predictor of decreased quality of life in elderly women with urinary incontinence Barentsen, J.A.; Visser, Els; Hofstetter, H.; Maris, A.M.; Dekker, J.H.; de Bock, G.H. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Background: Urinary incontinence negatively influences the lives of 25-50% of elderly women, mostly due to feelings of shame and being limited in activities and social interactions. This study explores whether differences exist between types of urinary incontinence (stress, urgency or mixed) and severity of the symptoms, with regard to their effects on generic and condition-specific quality of life. Methods: This is a cross-sectional study among participants of a randomized controlled trial in primary care. A total of 225 women (aged ≥ 55 years) completed a questionnaire (on physical/emotional impact and limitations) and were interviewed for demographic characteristics and co-morbidity. Least squares regression analyses were conducted to estimate differences between types and severity of urinary incontinence with regard to their effect on quality of life. Results: Most patients reported mixed urinary incontinence (50.7%) and a moderate severity of symptoms (48.9%). Stress urinary incontinence had a lower impact on the emotional domain of condition-specific quality of life compared with mixed urinary incontinence (r = −7.81). There were no significant associations between the types of urinary incontinence and generic quality of life. Severe symptoms affected both the generic (r = −0.10) and condition-specific (r = 17.17) quality of life. Conclusions: The effects on condition-specific quality of life domains differ slightly between the types of incontinence. The level of severity affects both generic and condition-specific quality of life, indicating that it is not the type but rather the severity of urinary incontinence that is the main predictor of decreased quality of life
Exogenous steroids for menopausal symptoms and breast/endometrial cancer risk
No full textA literature search was performed to collect information concerning hormone replacement therapy (HRT) for menopausal symptoms by exogenous steroids and breast and endometrial cancer risk. Relevant studies in English were selected from Medline. HRT can alleviate vasomotor symptoms at least partially. HRT in women >50 years of age induces increased risk of breast and endometrial cancer. In women <50 years of age, HRT does not completely negate the breast cancer risk reduction by premature menopause. No data exist on endometrial cancer risk in these young women taking HRT. In conclusions, the decision to use HRT should be weighed against the risks and discouraged in women older than 50 years of age and after breast cancer. Counseling should be performed in an individual manner
The guidelines of the Ducth College of General Practitioners on diagnosis of breast carcinoma
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