晚期乳腺癌原发灶局部处理的若干问题

乳腺癌仍然是严重威胁女性健康的重大疾病。每年新发乳腺癌患者中约有6％为Ⅳ期乳腺癌,而这类患者5年生存率小于20％,局部处理（外科、放疗）可以根除局部病灶及微小转移灶,以延缓或者缓解症状,但是否可以带来生存获益尚无定论。本文对Ⅳ期乳腺癌原发灶的局部处理等方面的若干问题作一综述。     

手术治疗单一局部复发或远处转移病灶乳腺癌的临床观察

探索手术治疗单一局部复发或唯一远处转移病灶乳腺癌的临床价值。收集2006年6月至2013年6月湖南省人民医院乳甲外科收治的64例局部复发或术后远处转移乳腺癌患者,其中28例为单发病灶病例。根据是否采取了包含手术的综合治疗,将其分为手术组与非手术组。回顾性分析两组的临床资料和随访数据,分析手术治疗局部复发或远处转移乳腺癌有无临床意义。结果28例都采取了含化疗的综合治疗,8例局部单发病灶与9例远处单一脏器转移病例进行了手术治疗。手术组的局部缓解率与控制率明显优于非手术组,均为100％。两组无进展生存时间（PFS）和总生存时间（（）S）比较,手术组明显长于非手术组;但在单一远处脏器转移手术组中0S没有优势。2年生存率方面手术组与非手术组比较有统计学意义。对于术后单一局部复发病灶或唯一远处脏器转移的乳腺癌患者,采取含手术的综合治疗方案能带来明显的PFS优势,若有手术机会和条件成熟,手术仍是不应放弃的有效治疗方法。     

政策执行偏差严重程度对公众地方政府责任判断的影响机制

为探讨地方政府政策执行偏差严重程度对公众地方政府责任判断的影响机制。采用问卷法对728名社会公众进行调查,结果显示：（1）公众地方政府有意性判断和公众地方政府可控归因中介了政策执行偏差严重程度与公众地方政府责任判断之间的关系。（2）政策执行偏差严重程度还通过公众地方政府有意性判断→公众地方政府可控归因的中介链作用于公众地方政府道德责任判断。并对研究的实践启示进行了讨论。     

The Community Story,Relationality and Process: Bridging Tools for Researching Local Knowledge in a Peri‐urban Township

In intervening in social challenges impacting local communities, Western forms of dispute/conflict resolution have been critiqued for imparting norms, values and practices that marginalise worldviews of indigenous people. From a decolonizing stance, indigenous scholars have emphasised the need for recovery of ‘lost’ values, beliefs and practices to advance indigenous knowledge. We highlight some of the conceptual challenges associated with applying ‘indigenous knowledge’ and culture‐specific ‘indigenous methodologies’ to a marginalised peri‐urban, ethnically plural township community situated on the outskirts of Johannesburg, South Africa. In embracing the mutuality of indigenous and Western knowledge forms, we explore three elements: the community story, relationality and process in relation to initial engagements with our study community. We attempt to transcend the dualism between ‘Western’ epistemologies and ‘indigenous knowledge’ through these ‘bridging concepts’. What is offered is not a formula or model but an orientation that aims to foster mutual learning through collaborative partnerships within and between communities and researchers with a view to inspiring possibilities for creative and meaningful solutions for violence prevention and dispute/conflict resolution. Copyright © 2014 John Wiley & Sons, Ltd.     

Polytomous multilevel testlet models for testlet‐based assessments with complex sampling designs

A pplications of standard item response theory models assume local independence of items and persons. This paper presents polytomous multilevel testlet models for dual dependence due to item and person clustering in testlet‐based assessments with clustered samples. Simulation and survey data were analysed with a multilevel partial credit testlet model. This model was compared with three alternative models – a testlet partial credit model (PCM), multilevel PCM, and PCM – in terms of model parameter estimation. The results indicated that the deviance information criterion was the fit index that always correctly identified the true multilevel testlet model based on the quantified evidence in model selection, while the Akaike and Bayesian information criteria could not identify the true model. In general, the estimation model and the magnitude of item and person clustering impacted the estimation accuracy of ability parameters, while only the estimation model and the magnitude of item clustering affected the item parameter estimation accuracy. Furthermore, ignoring item clustering effects produced higher total errors in item parameter estimates but did not have much impact on the accuracy of ability parameter estimates, while ignoring person clustering effects yielded higher total errors in ability parameter estimates but did not have much effect on the accuracy of item parameter estimates. When both clustering effects were ignored in the PCM, item and ability parameter estimation accuracy was reduced.     

Lost in Translation? The Need for ‘Upstream Engagement’ with Nanotechnology on Trial

Nowadays, the criticism of the so-called ‘deficit model’ and the need for ‘upstream engagement’ in science and technology are becoming part of the master narratives of public policies in many countries, especially concerning nanotechnology. This may be considered as a major success for STS scholars, whose research results have largely contributed to this change, especially those concerning the GMO controversies. Some STS scholars thus move from a position of distant and critical observers to the role of experts in social engineering or advisers of policy-makers. However, in their enthusiasm concerning the expected benefits of upstream engagement, institutions, TA practitioners and social scientists seem to ignore some important limitations as well as the implicit framing assumptions of the concept. Based on an experience made by a group of social scientists in the Grenoble area—one of the major ‘nanodistricts’ in Europe—our paper shows that the ‘upstream engagement’ concept is still embedded in a linear model of innovation and is not very useful to anyone pursuing the co-production of innovations. It is especially true when socio-technical networks are already aligned by powerful actors and a worldwide agenda as in the case of nanotechnology. In order to give an opportunity for public engagement to have a larger impact on decision-making, we propose an alternative approach, which combines Actor–Network Theory (ANT), as an analytical tool, with the reflexive and ongoing implementation of public participation. Public engagement is probably one of the critical loci where STS scholars must reflect on the articulation between the knowledge they produce and public policies in action.     

Embedding irony and the semantics/pragmatics distinction

This paper argues that we need to re-think the semantics/pragmatics distinction in the light of new evidence from embedding of irony. This raises a new version of the old problem of ‘embedded implicatures’. I argue that embedded irony isn’t fully explained by solutions proposed for other embedded implicatures. I first consider two strategies: weak pragmatics and strong pragmatics. These explain embedded irony as truth-conditional content. However, by trying to shoehorn irony into said-content, they raise problems of their own. I conclude by considering how a modified Gricean model can explain that irony embeds qua implicature. This leads us to prefer a local implicature model. This has important consequences for how we draw the semantics/pragmatics distinction.     

Functional hemispheric asymmetries of global/local processing mirrored by the steady-state visual evoked potential

While hemispheric differences in global/local processing have been reported by various studies, it is still under dispute at which processing stage they occur. Primarily, it was assumed that these asymmetries originate from an early perceptual stage. Instead, the content-level binding theory (Hübner & Volberg, 2005) suggests that the hemispheres differ at a later stage at which the stimulus information is bound to its respective level. The present study tested this assumption by means of steady-state evoked potentials (SSVEPs). In particular, we presented hierarchical letters flickering at 12 Hz while participants categorised the letters at a pre- cued level (global or local). The information at the two levels could be congruent or incongruent with respect to the required response. Since content-binding is only necessary if there is a response conflict, asymmetric hemispheric processing should be observed only for incongruent stimuli. Indeed, our results show that the cue and congruent stimuli elicited equal SSVEP global/local effects in both hemispheres. In contrast, incongruent stimuli elicited lower SSVEP amplitudes for a local than for a global target level at left posterior electrodes, whereas a reversed pattern was seen at right hemispheric electrodes. These findings provide further evidence for a level-specific hemispheric advantage with respect to content-level binding. Moreover, the fact that the SSVEP is sensitive to these processes offers the possibility to separately track global and local processing by presenting both level contents with different frequencies.     

Psychometric evaluation of the eating disorder inventory (edi) in a clinical group

Abstract

This study examined the psychometric properties of the Eating Disorder Inventory (EDI) with a clinical sample of 79 female clients seen at an outpatient eating disorder program. The means and standard deviations for the bulimia nervosa subgroup in this study (n = 48) compared favorably with the bulimia group in the EDI Manual Supplement (1986) on all eight subscales, except Drive for Thinness. The present non-student sample had significantly lower scores on this particular subscale than did the norm group (mostly students). Another difference was that the local bulimic subgroup had significantly higher present and minimum weights (as a percentage of the expected average weight according to height). The EDI subscales also displayed respectable internal consistency reliability with this sample. In contrast to previous research, however, only five factors were found in a factor analysis rather than eight corresponding to the original subscales for the EDI. Differences between bulimic and a not-otherwise-specified (NOS) diagnostic groups were also found on both the EDI Ineffectiveness and Bulimia subscales (NOS had lower scores). The results of this study are discussed in terms of the importance of undertaking local standardization of tests in clinical settings.     

Diffusion dynamics of laser-ablated noble-metal nanoparticles in liquids

The diffusion dynamics in water of Brownian particles constituted by noble-metal nanoclusters has been treated by a transport model across a limiting surface that separates two layers of the same fluid, having different values of density and temperature. This model, developed by Parrondo and adapted by Streater, has recently been shown to be useful in several situations like ours by the work of Grillo et al. By this approach, which introduces a one-dimensional vertical adiabatic potential produced by density gradients governing the net current of particles across the limiting surface, we are able to explain the mass and thermal energy transport, which rapidly restores the equilibrium conditions when they are perturbed by laser ablation of a noble-metal target vertically submerged in water. Experimentally, the laser ablation of noble-metal targets has been performed by irradiating pure metal sheets submerged in water with a pulsed Nd:YAG laser at 500 mJ cm^?2 fluency for 5 min and pulses of duration on the nanosecond timescale.