text: Update on breast cancer surgery approachesKaram, AmerCurrent Opinion in Obstetrics and Gynecology: February 2013 - Volume 25 - Issue 1 - p 74–80 doi: 10.1097/GCO.0b013e32835c03fa BREAST CANCER: Edited by Gottfried E. Konecny Abstract Author Information Article Outline Purpose of review This review seeks to review the latest developments in breast cancer surgery. Recent findings The manuscript will cover the latest developments in breast conservation therapy such as oncoplastic surgery, partial, and accelerated breast irradiation as well as nipple and areola sparing mastectomies, breast reconstruction, and recent developments in axillary staging. Summary At the conclusion of this article the reader will have a comprehensive overview of the latest developments and principles of breast cancer surgical management. Division of Gynecologic Oncology, The David Geffen School of Medicine at UCLA, Los Angeles, California, USA Correspondence to Amer Karam, MD, Assistant Clinical Professor, Division of Gynecologic Oncology, The David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza Suite 220, Los Angeles, CA 90095, USA. Tel: +1 310 794 7274; fax: +1 310 794 9110; e-mail: email@example.com Abstract INTRODUCTION MASTECTOMY BREAST-CONSERVING THERAPY AXILLARY STAGING CONCLUSION Acknowledgements Conflicts of interest REFERENCES AND RECOMMENDED READING REFERENCES Back to Top | Article Outline INTRODUCTION When radical mastectomy was introduced by Halsted [1], the average patient presented for treatment with locally advanced disease, and a relatively extensive procedure was often necessary just to remove all gross cancer. This is no longer the case as most patients now present with much smaller, less locally advanced lesions. The emergence of breast-conserving therapy (BCT) has provided early-stage breast cancer patients with a chance to preserve a cosmetically acceptable breast and equivalent outcomes in terms of breast cancer survival. Back to Top | Article Outline MASTECTOMY Historically, Halsted [1] is credited with performing the first modern radical mastectomy in 1882 in the United States. This surgical procedure required the en bloc removal of the breast, pectoral muscles, and axillary lymph nodes. Radical mastectomy was the standard surgical procedure performed for breast cancer in the United States from the turn of the 20th century until the 1950s. The curative potential of this procedure was limited as a series of 1438 patients followed over 30 years showed that only 13% were free of disease, whereas 57% had succumbed to breast cancer [2]. In an effort to improve locoregional and distant control several authors proposed using an extended radical mastectomy, which in addition to the en-bloc removal of the breast, pectoral muscles, and axillary lymph nodes required the resection of the internal mammary lymph nodes. A randomized trial, however, proved no benefit to the extended radical mastectomy [3,4]. Currently, radical mastectomy is rarely indicated or performed and in advanced cases, less-invasive surgery coupled with neoadjuvant chemotherapy is preferred. The modified radical mastectomy (MRM) involves the removal of the breast, underlying pectoralis major fascia but not the muscle, and evaluation of selected axillary lymph nodes. MRM provides a better cosmetic and functional result than radical mastectomy. Two prospective randomized trials, single-institution data, and several retrospective studies all demonstrate no difference in disease-free or overall survival rates between radical mastectomy and MRM for early-stage breast cancer [5,6]. Until the early 1980s and the emergence of BCT, MRM was the standard treatment available to women for early-stage breast cancer. With the emergence of sentinel node biopsy simple mastectomies have become more frequently performed then MRM. As with MRM, a total or simple mastectomy requires the removal of the entire breast tissue without an axillary dissection. Similarly, with advent of immediate reconstruction at the time of mastectomy, 'skin-sparing mastectomy' (SSM) was developed as a technique to preserve the majority of the natural skin envelope of the breast in an effort to improve the cosmetic outcome of the procedure and allow for immediate reconstruction [7]. The results of retrospective and prospective series have found that the local recurrence rates were comparable to those seen with standard mastectomies, ranging from 0 to 7% [8–10], and a meta-analysis of retrospective studies did not detect a significant difference in local recurrences between patients undergoing SSM with immediate reconstruction and patients undergoing conventional mastectomies without reconstruction [11]. More recently, in carefully selected patients, nipple and areola sparing mastectomy (NSM) has been utilized to preserve the entire skin envelope, including the areola and nipple but removes the major ducts within the nipple along the entire breast parenchyma followed by immediate breast reconstruction. This approach appears to be particularly appealing for patients undergoing risk-reducing surgery but is more controversial for the treatment of cancer and has been reserved for patients with tumors less than 2 cm in size and more than 2 cm from the nipple with clinically negative lymph nodes [12,13]. No long-term clinical series or randomized trials have examined the safety of this approach; however, retrospective series indicate that the recurrence rates associated with NSM are comparable to the more traditional SSM and MRM [12,14]. SSM and NSM are contraindicated in patients with inflammatory breast cancer (IBC) because of the dermal lymphatic involvement. With the advent of research reporting on the quality of life improvements and psychological benefits associated with breast reconstruction, the number of women undergoing breast reconstruction has increased although the absolute number and proportion remain low [15,16]. Most patients when they choose to undergo breast reconstruction elect to have it carried out at the time of the mastectomy (immediate reconstruction) as opposed to a subsequent operation (delayed reconstruction) that may be more appropriate for patients with locally advanced breast cancer or IBC [17]. Reconstructive options include prosthetic devices such as saline or silicone implants, which are technically simpler and associated with a more rapid recovery, or autologous tissue reconstruction using pedicled or free tissue flaps from the lower abdomen, the latissimus dorsi or the buttock area, which provide for a more natural and pleasing cosmetic result [18,19]. Box 1 Back to Top | Article Outline BREAST-CONSERVING THERAPY BCT involves an excision of the tumor mass with a negative surgical margin, an axillary evaluation, and postoperative irradiation. In the 1980s, six prospective randomized trials were conducted worldwide that showed no significant difference in locoregional relapse or overall survival between breast-conserving surgery and radiation versus MRM for early-stage invasive breast cancer. BCT has gained increasing acceptance as a treatment option for stages I and II and selected stage III breast cancers as a result of six prospective randomized trials as well as an overview of all completed trials that showed its therapeutic equivalence with mastectomy [20–26]. Patient selection for BCT is crucial for its success. The few absolute contraindications for BCT include the following: A history of prior therapeutic radiotherapy that would result in an excessively high total radiation dose to the chest wall. Persistently positive resection margins despite multiple attempts at re-excision. Multicentric disease with two or more tumors in separate quadrants of the breast. Diffuse malignant calcifications on mammography. Radiation therapy is absolutely contraindicated in pregnancy; however, it may be possible to proceed with breast-conserving surgery in the third trimester and defer irradiation until after delivery [27,28]. Similarly, radiation-induced toxicities in patients with a history of connective tissue disease have kept them from undergoing BCT [29]. Carefully matched retrospective case–control studies have, however, failed to show a statistically significant increase in radiation induced acute and late toxicities in all but patients with scleroderma and active systemic lupus erythematosus [30–33]. Tumor size itself is not a contraindication for BCT and is only a relative contraindication should an adequate resection to negative margins result in an unacceptable cosmetic result. In some cases preoperative or neoadjuvant chemotherapy can reduce the tumor size and allow for breast conservation as long as a metallic clip is placed prior to initiating therapy in order to accurately localize the tumor at the time of surgery [34,35]. Positive or unknown margins should prompt re-excision, as these patients are at higher risk for recurrence [36]. Residual disease is discovered in about half of these patients depending on the histology with tumors containing an extensive intraductal component having the highest likelihood of residual tumor [37,38]. There is no standard definition for close margins, although most authorities recommend re-excision for margins less than 2 mm including the National Comprehensive Cancer Network that deems margins less than 1 mm to be inadequate except when at the chest or close to the skin [39,40]. In many cases radiation oncologists will choose to boost the lumpectomy bed in an effort to reduce the locoregional recurrence rate [41]. A commonly held belief is that young age that is usually defined as 40 or less years is a relative contraindication for BCT as it was associated with an increased risk of locoregional recurrence [42,43]. This may have been due to adverse pathologic features such as larger tumor size, higher grade, absence of estrogen receptors, and lymphovascular invasion as well as inherited genetic predispositions [44–46]. However, locoregional recurrences were also more commonly seen in young women with breast cancer following mastectomy [46,47]. When the long-term results of two large randomized trials as well as a large retrospective review of patients with breast cancer aged 20–49 years were reviewed, the choice of therapy was not associated with a noticeable difference in recurrence-free or cancer-specific survival [48–50]. Patients with an inherited predisposition for breast cancer, such as BRCA1 and BRCA2 mutation carriers, who are diagnosed and treated for breast cancer are not only at increased risk for a contralateral cancer following their diagnosis and treatment but may also be at increased risk for an in breast recurrence or ipsilateral new primary breast tumors [51–53]. Systemic chemotherapy and risk reducing salpingo-oophorectomies seem to reduce the frequency of ipsilateral breast tumor recurrences and contralateral breast cancers in this patient population but the decision to pursue BCT needs to be thoroughly discussed with the assistance of specialized genetic counselors [52,54]. In addition to providing an optimal oncologic outcome, one of the goals of BCT is to achieve a cosmetically acceptable result. Many factors play a role in the final appearance of the breast among which the amount of resected breast tissue and postoperative radiation therapy play a determining role [55,56]. Oncoplastic surgical techniques aim to provide wide surgical margins all the while preserving the appearance and shape of the breast [57,58▪]. Despite the consistent evidence showing the therapeutic equivalence of BCT and mastectomy, BCT continues to still be underutilized with more than a quarter of patients with early-stage breast cancer still choosing mastectomy [59]. Possible explanations include patient preference over concerns about locoregional cancer recurrence and the effects of radiation therapy [60,61]. Preoperative breast MRI has also been used preoperatively in an effort to define the extent of disease and help achieve clear surgical margins, however, there is no evidence that such an approach results in a lower rate of positive margins and reoperation [62], in fact some evidence suggests that mastectomy rates increase when MRI results are used to direct surgical planning [63]. Conventional radiation therapy after breast-conserving surgery delivers 45–50 Gy to the entire breast over 4–5 weeks resulting in a reduction in locoregional recurrence, distant recurrences, and death [64▪▪]. In an effort to increase the convenience of radiation therapy and decrease the cost and strain on resources associated with conventional radiation therapy, accelerated irradiation schedules have grown in popularity and a recent meta-analysis of four randomized trials concluded that the shorter fractionation schedule was equivalent to conventional radiation therapy in terms of locoregional recurrences, overall survival, breast cosmesis, early and late toxicities [65]. The accelerated scheduled has not, however, been sufficiently examined in patients under the age of 50 years, with positive lymph nodes, or close margins. Similarly, accelerated partial breast irradiation (APBI) techniques were developed in order to deliver focused radiation therapy to a limited volume of tissue over a shorter period using higher doses of radiation in order to decrease the toxicity associated with conventional radiation therapy and decrease healthcare costs, although increasing patient convenience [66]. APBI can be delivered using conformal external beam radiation therapy such intensity modulated radiation therapy or brachytherapy using interstitial catheters surrounding the lumpectomy site, intracavitary balloon catheter placed into the lumpectomy site or intraoperative radiation therapy using a spherical radiation device or portable linear accelerator [67–69]. Although the initial outcomes are promising when comparing APBI to conventional radiation therapy, follow-up is limited and the patients were highly selected with small unifocal tumors with wide negative margins and without adverse histologic features [70]. In addition a recent population-based cohort study of women with invasive breast cancer who were 67 years or older revealed that APBI was associated with a higher incidence of subsequent mastectomy at 5 years and of postoperative infectious and noninfectious complications [71▪▪]. Back to Top | Article Outline AXILLARY STAGING Axillary staging remains one of the most important prognostic indicators in women with early-stage breast cancer. Axillary lymph node dissection (ALND) has traditionally been the linchpin for axillary evaluation and is still the standard of care in patients with clinically palpable/positive axillary nodes. The purported benefits of ALND beyond its prognostic role include local regional control and survival benefits. The impact of ALND on survival remains, however, unclear with available data showing conflicting results. In the National Surgical Adjuvant Breast and Bowel Project trial B-04, women assigned to a modified radical mastectomy did not fare any better at 10–25 years of follow-up than the women who underwent a simple mastectomy with nodal irradiation or a simple mastectomy and ALND when lymphadenopathy occurred [72]. Similarly, in a meta-analysis of three randomized trials comparing axillary dissection versus no dissection in clinically node negative early-stage breast cancer patients, ALND did not confer a survival advantage, although the rate of axillary recurrences was increased in the absence of dissection [73]. ALND may also result in nerve injury, lymphedema, shoulder dysfunction and injury/thrombosis of the axillary vein [74]. Sentinel lymph node biopsy (SLNB) has been developed as a method of accurately evaluating the axilla with less morbidity than ALND with several studies showing significantly lower arm morbidity and lymphedema rates in patients undergoing SLNB [75,76]. Using injection of vital blue dye and/or radiolabeled colloid around the area of the tumor or intradermally, sentinel lymph nodes (SLNs) can be consistently identified in about 96% of cases with a false-negative rate of less than 5–10% in experienced hands [77,78]. Using a combination of radiocolloid and blue dye may result in a significantly higher success rate for SLN identification as well as a lower false-negative rate [79]. The outcome of patients undergoing SLNB followed by ALND if the SLN was positive was similar to that of patients who underwent ALND in terms of regional control and overall survival [80]. More recently the role of completion ALND in patients with micrometastases or macrometastases in less than three SLNs has been questioned as the SLN is found to be the sole site of metastasis in up to 60% of patients overall and 90% of patients with micrometastases [81]. In the American College Of Surgeons Oncology Group (ACOSOG) Z-0011 trial patients with clinically node negative breast cancer undergoing BCT were randomized to completion ALND versus observation if they had less than three positive SLNs. The overall survival and local regional recurrence rates were similar between the two groups [82▪▪]. However, these results cannot be extrapolated to patients who undergo PBI and the trial failed to meet its enrollment goal of 1900 patients due to slow accrual [75]. Predictive nomograms have also been developed to estimate the risk of additional positive nodes in patients with SLN metastases in an effort to spare them from a potentially morbid ALND. A retrospective analysis examining the performance of four different nomograms did not show them to be sufficiently accurate and reliable [83,84]. Clinical circumstances in which SLNB is controversial include locally advanced breast cancer or IBC due to an unusually high false-negative rate presumably because of partially obstructed subdermal lymphatics. The size of the primary tumor is not in itself a contraindication as long as the axilla is clinically negative [85,86]. Similar concerns regarding the accuracy and false-negative rates for SLNB in patients following neoadjuvant chemotherapy have been reported and the National Comprehensive Cancer Network (NCCN) guidelines recommend that SLNB be performed prior to initiating chemotherapy [87,88▪]. The American Society of Clinical Oncology (ASCO) guidelines recommended against SLNB in patients with a previous axillary surgery, although there are increasing reports of successful SLNB in patients with local regional breast recurrence following a previous SLNB and/or ALND [89,90]. Supravital dyes such as isosulfan blue are contraindicated in pregnant patients, although the available data suggest that the radiation dose to the fetus is minimal using radiocolloid during SLNB [91,92]. Even though the NCCN guidelines report that radiocolloid use in pregnancy is well tolerated, the 2005 ASCO guidelines recommend against SLNB in pregnant patients. For patients with ductal carcinoma in situ a SLNB is not required in most cases except when there is evidence of microinvasion on the biopsy, a strong suspicion for invasive disease on imaging or exam or in the event of a mastectomy as the performance of a SLNB following a mastectomy may not always be successful [93,94]. Back to Top | Article Outline CONCLUSION The treatment for breast cancer has evolved over the past few decades from the Halsted radical mastectomy to breast-conserving surgery in most patients with early-stage breast cancer. This approach has been able to offer such patients a cosmetically acceptable result all the while preserving their excellent oncologic outcome. For patients who undergo a mastectomy many patients opt for immediate reconstruction and preservation of the skin envelope thereby improving their cosmetic outcome. Similarly, the trend in axillary staging has been toward a more limited approach in an effort to minimize the long-term morbidities associated with a traditional ALND whose therapeutic value has been increasingly questioned. Back to Top | Article Outline Acknowledgements None. Back to Top | Article Outline Conflicts of interest The author has no relevant conflicts of interest or sources of funding to disclose. Back to Top | Article Outline REFERENCES AND RECOMMENDED READING Papers of particular interest, published within the annual period of review, have been highlighted as: ▪ of special interest ▪▪ of outstanding interest Additional references related to this topic can also be found in the Current World Literature section in this issue (p. 89).Back to Top | Article Outline REFERENCES1. Halsted WSI. The results of radical operations for the cure of carcinoma of the breast. Ann Surg 1907; 46:1–19. Cited Here... 2. Adair F, Berg J, Joubert L, Robbins GF. Long-term follow up of breast cancer patients: the 30-year report. Cancer 1974; 33:1145–1150. Cited Here... 3. Veronesi U, Valagussa P. Inefficacy of internal mammary nodes dissection in breast cancer surgery. Cancer 1981; 47:170–175. Cited Here... 4. Veronesi U, Marubini E, Mariani L, et al. The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomised trial. Eur J Cancer 1999; 35:1320–1325. Cited Here... 5. Maddox WA, Carpenter JT, Laws HL, et al. A randomized prospective trial of radical (Halsted) mastectomy versus modified radical mastectomy in 311 breast cancer patients. Ann Surg 1983; 198:207–212. Cited Here... 6. Turner L, Swindell R, Bell WG, et al. Radical versus modified radical mastectomy for breast cancer. Ann R Coll Surg Engl 1981; 63:239–243. Cited Here... 7. Simmons RM, Adamovich TL. Skin-sparing mastectomy. Surg Clin North Am 2003; 83:885–899. Cited Here... 8. Simmons RM, Fish SK, Gayle L, et al. Local and distant recurrence rates in skin-sparing mastectomies compared with nonskin-sparing mastectomies. Ann Surg Oncol 1999; 6:676–681. Cited Here... 9. Slavin SA, Schnitt SJ, Duda RB, et al. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 1998; 102:49–62. Cited Here... 10. Foster RD, Esserman LJ, Anthony JP, et al. Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma. Ann Surg Oncol 2002; 9:462–466. Cited Here... 11. Lanitis S, Tekkis PP, Sgourakis G, et al. Comparison of skin-sparing mastectomy versus nonskin-sparing mastectomy for breast cancer: a meta-analysis of observational studies. Ann Surg 2010; 251:632–639. Cited Here... 12. Sacchini V, Pinotti JA, Barros ACSD, et al. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg 2006; 203:704–714. Cited Here... 13. Chung AP, Sacchini V. Nipple-sparing mastectomy: where are we now? Surg Oncol 2008; 17:261–266. Cited Here... 14. Gerber B, Krause A, Dieterich M, et al. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 2009; 249:461–468. Cited Here... 15. Brandberg Y, Malm M, Blomqvist L. A prospective and randomized study, 'SVEA,' comparing effects of three methods for delayed breast reconstruction on quality of life, patient-defined problem areas of life, and cosmetic result. Plast Reconstr Surg 2000; 105:66–74.discussion75–76. Cited Here... 16. Alderman AK, Wei Y, Birkmeyer JD. Use of breast reconstruction after mastectomy following the Women's Health and Cancer Rights Act. JAMA 2006; 295:387–388. Cited Here... 17. Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 2000; 26:17–19. Cited Here... 18. Alderman AK, Kuhn LE, Lowery JC, Wilkins EG. Does patient satisfaction with breast reconstruction change over time? Two-year results of the Michigan Breast Reconstruction Outcomes Study. J Am Coll Surg 2007; 204:7–12. Cited Here... 19. Kroll SS, Baldwin B. A comparison of outcomes using three different methods of breast reconstruction. Plast Reconstr Surg 1992; 90:455–462. Cited Here... 20. Early Breast Cancer Trialists' Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med 1995; 333:1444–1455. Cited Here... 21. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347:1233–1241. Cited Here... 22. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347:1227–1232. Cited Here... 23. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000; 92:1143–1150. Cited Here... 24. Jacobson JA, Danforth DN, Cowan KH, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 1995; 332:907–911. Cited Here... 25. Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer 2003; 98:697–702. Cited Here... 26. Arriagada R, Lê MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 1996; 14:1558–1564. Cited Here... 27. Annane K, Bellocq J-P, Brettes J-P, Mathelin C. Infiltrative breast cancer during pregnancy and conservative surgery. Fetal Diagn Ther 2005; 20:442–444. Cited Here... 28. Kuerer HM, Gwyn K, Ames FC, Theriault RL. Conservative surgery and chemotherapy for breast carcinoma during pregnancy. Surgery 2002; 131:108–110. Cited Here... 29. Fleck R, McNeese MD, Ellerbroek NA, et al. Consequences of breast irradiation in patients with preexisting collagen vascular diseases. Int J Radiat Oncol Biol Phys 1989; 17:829–833. Cited Here... 30. Phan C, Mindrum M, Silverman C, et al. Matched-control retrospective study of the acute and late complications in patients with collagen vascular diseases treated with radiation therapy. Cancer J 2003; 9:461–466. Cited Here... 31. Chen AM, Obedian E, Haffty BG. Breast-conserving therapy in the setting of collagen vascular disease. Cancer J 2001; 7:480–491. Cited Here... 32. Morris MM, Powell SN. Irradiation in the setting of collagen vascular disease: acute and late complications. J Clin Oncol 1997; 15:2728–2735. Cited Here... 33. Ross JG, Hussey DH, Mayr NA, Davis CS. Acute and late reactions to radiation therapy in patients with collagen vascular diseases. Cancer 1993; 71:3744–3752. Cited Here... 34. Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monographs 2001; 30:96–102. Cited Here... 35. Alm El-Din MA, Taghian AG. Breast conservation therapy for patients with locally advanced breast cancer. Semin Radiat Oncol 2009; 19:229–235. Cited Here... 36. Kearney TJ, Morrow M. Effect of reexcision on the success of breast-conserving surgery. Ann Surg Oncol 1995; 2:303–307. Cited Here... 37. Schnitt SJ, Connolly JL, Khettry U, et al. Pathologic findings on re-excision of the primary site in breast cancer patients considered for treatment by primary radiation therapy. Cancer 1987; 59:675–681. Cited Here... 38. Gwin JL, Eisenberg BL, Hoffman JP, et al. Incidence of gross and microscopic carcinoma in specimens from patients with breast cancer after re-excision lumpectomy. Ann Surg 1993; 218:729–734. Cited Here... 39. Morrow M. Breast conservation and negative margins: how much is enough? Breast 2009; 18 (Suppl 3):S84–S86. Cited Here... 40. Blair SL, Thompson K, Rococco J, et al. Attaining negative margins in breast-conservation operations: is there a consensus among breast surgeons? J Am Coll Surg 2009; 209:608–613. Cited Here... 41. Jones HA, Antonini N, Hart AAM, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol 2009; 27:4939–4947. Cited Here... 42. Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 1994; 12:888–894. Cited Here... 43. Miles RC, Gullerud RE, Lohse CM, et al. Local recurrence after breast-conserving surgery: multivariable analysis of risk factors and the impact of young age. Ann Surg Oncol 2012; 19:1153–1159. Cited Here... 44. Kurtz JM, Jacquemier J, Amalric R, et al. Why are local recurrences after breast-conserving therapy more frequent in younger patients? J Clin Oncol 1990; 8:591–598. Cited Here... 45. Vrieling C, Collette L, Fourquet A, et al. Can patient-, treatment- and pathology-related characteristics explain the high local recurrence rate following breast-conserving therapy in young patients? Eur J Cancer 2003; 39:932–944. Cited Here... 46. Chan A, Pintilie M, Vallis K, et al. Breast cancer in women. Ann Oncol 2000; 11:1255–1262. Cited Here... 47. la Rochefordiere de A, Asselain B, Campana F, et al. Age as prognostic factor in premenopausal breast carcinoma. Lancet 1993; 341:1039–1043. Cited Here... 48. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995; 333:1456–1461. Cited Here... 49. Veronesi U, Salvadori B, Luini A, et al. Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1973 patients. Eur J Cancer 1995; 31A:1574–1579. Cited Here... 50. Coulombe G, Tyldesley S, Speers C, et al. Is mastectomy superior to breast-conserving treatment for young women? Int J Radiat Oncol Biol Phys 2007; 67:1282–1290. Cited Here... 51. Pierce LJ, Strawderman M, Narod SA, et al. Effect of radiotherapy after breast-conserving treatment in women with breast cancer and germline BRCA1/2 mutations. J Clin Oncol 2000; 18:3360–3369. Cited Here... 52. Robson M, Levin D, Federici M, et al. Breast conservation therapy for invasive breast cancer in Ashkenazi women with BRCA gene founder mutations. J Natl Cancer Inst 1999; 91:2112–2117. Cited Here... 53. Haffty BG, Harrold E, Khan AJ, et al. Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status. Lancet 2002; 359:1471–1477. Cited Here... 54. Pierce LJ, Levin AM, Rebbeck TR, et al. Ten-year multiinstitutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer. J Clin Oncol 2006; 24:2437–2443. Cited Here... 55. Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 1979; 5:257–261. Cited Here... 56. Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1992; 10:356–363. Cited Here... 57. Kronowitz SJ, Feledy JA, Hunt KK, et al. Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg 2006; 117:1–11.discussion 12–14. Cited Here... 58▪. Gainer SM, Lucci A. Oncoplastics: techniques for reconstruction of partial breast defects based on tumor location. J Surg Oncol 2011; 103:341–347. Cited Here... Overview of oncoplastic techniques available in BCT based on tumor location.59. Temple WJ, Russell ML, Parsons LL, et al. Conservation surgery for breast cancer as the preferred choice: a prospective analysis. J Clin Oncol 2006; 24:3367–3373. Cited Here... 60. Morrow M, Jagsi R, Alderman AK, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA 2009; 302:1551–1556. Cited Here... 61. Katz SJ, Lantz PM, Janz NK, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol 2005; 23:5526–5533. Cited Here... 62. Turnbull L, Brown S, Harvey I, et al. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet 2010; 375:563–571. Cited Here... 63. Pettit K, Swatske ME, Gao F, et al. The impact of breast MRI on surgical decision-making: are patients at risk for mastectomy? J Surg Oncol 2009; 100:553–558. Cited Here... 64▪▪. Darby S, McGale P, Correa C, , et al.; Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet 2011; 378:1707–1716. Cited Here... Meta-analysis showing that after breast-conserving surgery, radiotherapy halves the risk of recurrence and reduces the breast cancer death rate by about a sixth.65. James ML, Lehman M, Hider PN, et al. Fraction size in radiation treatment for breast conservation in early breast cancer. Cochrane Database Syst Rev 2010:CD003860. Cited Here... 66. Njeh CF, Saunders MW, Langton CM. Accelerated Partial Breast Irradiation (APBI): a review of available techniques. Radiat Oncol 2010; 5:90. Cited Here... 67. Vaidya JS, Tobias JS, Baum M, et al. Intraoperative radiotherapy for breast cancer. Lancet Oncol 2004; 5:165–173. Cited Here... 68. Khan AJ, Arthur D, Vicini F, et al. Six-year analysis of treatment-related toxicities in patients treated with accelerated partial breast irradiation on the American Society of Breast Surgeons MammoSite Breast Brachytherapy registry trial. Ann Surg Oncol 2012; 19:1477–1483. Cited Here... 69. Ott OJ, Hildebrandt G, Pötter R, et al. Accelerated partial breast irradiation with interstitial implants: risk factors associated with increased local recurrence. Int J Radiat Oncol Biol Phys 2011; 80:1458–1463. Cited Here... 70. Valachis A, Mauri D, Polyzos NP, et al. Partial breast irradiation or whole breast radiotherapy for early breast cancer: a meta-analysis of randomized controlled trials. Breast J 2010; 16:245–251. Cited Here... 71▪▪. Smith GL, Xu Y, Buchholz TA, et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA 2012; 307:1827–1837. Cited Here... This is the first cohort study showing that breast brachytherapy was associated with an increased risk of complications and subsequent mastectomy compared with whole breast irradiation.72. Fisher B, Jeong J-H, Anderson S, et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 2002; 347:567–575. Cited Here... 73. Sanghani M, Balk EM, Cady B. Impact of axillary lymph node dissection on breast cancer outcome in clinically node negative patients: a systematic review and meta-analysis. Cancer 2009; 115:1613–1620. Cited Here... 74. Erickson VS, Pearson ML, Ganz PA, et al. Arm edema in breast cancer patients. J Natl Cancer Inst 2001; 93:96–111. Cited Here... 75. Lucci A, McCall LM, Beitsch PD, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol 2007; 25:3657–3663. Cited Here... 76. Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol 2010; 102:111–118. Cited Here... 77. Mabry H, Giuliano AE. Sentinel node mapping for breast cancer: progress to date and prospects for the future. Surg Oncol Clin N Am 2007; 16:55–70. Cited Here... 78. Veronesi U, Viale G, Paganelli G, et al. Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg 2010; 251:595–600. Cited Here... 79. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 2006; 106:4–16. Cited Here... 80. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010; 11:927–933. Cited Here... 81. Chagpar AB. Clinical significance of minimal sentinel node involvement and management options. Surg Oncol Clin N Am 2010; 19:493–505. Cited Here... 82▪▪. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 2011; 305:569–575. Cited Here... | PubMed Randomized controlled trial showing that among patients with limited nodal disease undergoing BCT survival was equivalent when ALND was omitted.83. Gur AS, Unal B, Johnson R, et al. Predictive probability of four different breast cancer nomograms for nonsentinel axillary lymph node metastasis in positive sentinel node biopsy. J Am Coll Surg 2009; 208:229–235. Cited Here... 84. Unal B, Gur AS, Ahrendt G, et al. Can nomograms predict nonsentinel lymph node metastasis after neoadjuvant chemotherapy in sentinel lymph node-positive breast cancer patients? Clin Breast Cancer 2009; 9:92–95. Cited Here... 85. Kaufmann M, Morrow M, Minckwitz von G, Harris JR. Biedenkopf Expert Panel MembersLocoregional treatment of primary breast cancer: consensus recommendations from an International Expert Panel. Cancer 2010; 1184–1191. Cited Here... 86. Hidar S, Bibi M, Gharbi O, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy in inflammatory breast cancer. Int J Surg 2009; 7:272–275. Cited Here... 87. Nason KS, Anderson BO, Byrd DR, et al. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 2000; 89:2187–2194. Cited Here... 88▪. Tausch C, Steger GG, Haid A, et al. Sentinel node biopsy after primary chemotherapy in breast cancer: a note of caution from results of ABCSG-14. Breast J 2011; 17:230–238. Cited Here... Subgroup analysis of a randomized controlled trial of neoadjuvant chemotherapy showing an unacceptably high risk of false negative SLNs at the time of surgery.89. Newman EA, Cimmino VM, Sabel MS, et al. Lymphatic mapping and sentinel lymph node biopsy for patients with local recurrence after breast-conservation therapy. Ann Surg Oncol 2006; 13:52–57. Cited Here... 90. Intra M, Trifirò G, Viale G, et al. Second biopsy of axillary sentinel lymph node for reappearing breast cancer after previous sentinel lymph node biopsy. Ann Surg Oncol 2005; 12:895–899. Cited Here... 91. Gentilini O, Cremonesi M, Toesca A, et al. Sentinel lymph node biopsy in pregnant patients with breast cancer. Eur J Nucl Med Mol Imaging 2010; 37:78–83. Cited Here... 92. Spanheimer PM, Graham MM, Sugg SL, et al. Measurement of uterine radiation exposure from lymphoscintigraphy indicates safety of sentinel lymph node biopsy during pregnancy. Ann Surg Oncol 2009; 16:1143–1147. Cited Here... 93. Karam A, Stempel M, Cody HS, Port ER. Reoperative sentinel lymph node biopsy after previous mastectomy. J Am Coll Surg 2008; 207:543–548. Cited Here... 94. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005; 23:7703–7720. Cited Here... Keywords:axillary staging; breast conservation therapy; nipple and areola sparing mastectomy; oncoplastic surgery; sentinel node biopsy © 2013 Lippincott Williams & Wilkins, Inc.


text:
Grant, Melinda wrote: > Dean said: > >> Aside: I'm not sure why these are in Paged Media. They seem >> applicable to continuous media too. >> > > Yes, as indicated by their 'Applies to' field. > > They're there because (1) the print implementations were the first to implement these; and (2) because we wanted them in a module that could progress rapidly to REC once CSS 2.1 is done. They certainly could be moved if there is a better place to put them... > This argumentation sounds really weak I would say. So if someone needs to push through some attribute it is a matter of inclusion it in module that comes first and is not so visible. Really this http://dev.w3.org/csswg/css3-page/#img-fit looks like a design hack. What if someone needs the same type of image rendering but for the background image? Say background-repeat: fill; for example? And how to define url for the image in CSS? There are also quite useful background-*** image attributes than also make sense for the foreground image. Why only these two was chosen? Probably it is better to define the same set of attributes but for the [foreground]image ? Like image-source, image-repeat, image-position, image-attachment, image-position, image-clip, image-origin, image-size. And so to expand these attributes for all elements. That will make the set complete and very useful. -- Andrew Fedoniouk. http://terrainformatica.com <http://dev.w3.org/csswg/css3-page/#img-fit> > These properties have been changed significantly (but not in ways that diminish their applicability here) so there will be another Last Call on this-- see http://dev.w3.org/csswg/css3-page/#img-fit for the latest. > > Best wishes, > > Melinda > > >Received on Friday, 5 December 2008 00:28:50 UTC
This archive was generated by hypermail 2.3.1 : Monday, 2 May 2016 14:27:42 UTC

subset: commoncrawl


text:
The Corriere dello Sport is reporting that Dejan Stankovic could end his relationship with Inter this summer.
Although still tied to the outfit until June 2014, the Nerazzurri are ready to release a player who earns €3.5m a season.
The Beneamata are trying to lower their wage bill given that they have failed to qualify for next season's Champions League.
The Serbian joined Inter in January 2004 from Lazio. The 33-year-old played in just 19 League games this term.
Inter are expected to complete the signing of midfielder Andrea Poli from Sampdoria for a fee of around €6m after his loan stint came to an end.
The Nerazzurri are also set to wave goodbye to veteran stopper Lucio, another of the club's older players who earns big money.
See the latest Serie A predictions and betting tips with Eurotips.co.uk


text: Alexander Wirt <firstname.lastname@example.com> writes: > The question is: who decides? I have a bunch of packages and an established > workflow that served me well over the last years. I don't want to learn > another *censored* system, just because someone said its the new standard or > it is better. Thing is, 3.0 (quilt) is an accepted source format, 3.0 (dpatch) isn't (thankfully). It wasn't me who decided that, I didn't make 3.0 (quilt) a "new standard". It's the people who migrate towards it who are making it so. While dpatch and 3.0 (quilt) don't neccessarily conflict, for the vast majority of cases, 3.0 (quilt) should be an improvement over dpatch, and that is one of the driving forces behind the deprecation. I don't believe in forcing people to migrate to something they feel is inferior, though. While the lintian error might seem like a condtradiction to that statement, keep in mind that it's made for the majority who don't really care, and who are happy to migrate to quilt aswell, given some prodding. The lintian error is that prodding. For those of you, who feel strongly about dpatch: I'd like to ask for some patience. dpatch is not going away until there are reverse dependencies, and I'm not going to force an inferior tool on anyone. If that means dpatch will stick around forever, so be it. I don't like that prospect, but I'm willing to accept it. However, I'd like to persuade dpatch users that there ARE better tools, or at least, better tools can be made. My plan, which still stands, is to remove dpatch in 6 years time. I'm fairly sure we can come to an agreement within that timeframe. But for now, I'd like to concentrate on getting the easy cases out of the way, so I can concentrate on the harder ones, such as yours. > I can't remember that somebody asked about deprecating well > established and working tools. http://lists.debian.org/debian-devel-announce/2006/03/msg00019.html debmake used to be a well established and working tool (I dare say, it usually worked better than dpatch), and it was officially deprecated with still 60 reverse dependencies. That's a considerably smaller number than dpatchs' reverse build-deps, but still. In its prime, I believe debmake had similar number of reverse-deps, if not more. It's just that debhelper was far more lucrative compared to debmake than 3.0 quilt is to dpatch. -- |8]


text:
Perfect for social media campaigns and blogs. Web photos (up to .5 MP). 1 Seat.
Learn More
Build a high res library or promote your brand. Up to Large (2.5-4.5 MP). 5 Seats.
Learn More
Get more high res photos and more. Up to Large (2.5-4.5 MP). 25 Seats.
Learn More
white, brown, round, food, plate, tableware, ware, flatware, circular
Burger with fried egg, pickles, tomato, lettice with curly fries on checkered plate on white tabletop


text:
Phil Town's first book, the number-one New York Times best seller Rule #1, was a guide to stock trading for people who believe they lack the knowledge to trade. But because many people arent ready to go from mutual funds directly into trading without understanding investing for the long term, he created Payback Time.
Too often, people see long-term investing as mutual-fund contributing - otherwise known as long-term hoping. But the sad truth is that mutual fund investors are, to a stunning degree, pinning their hopes on an institution that is hopeless. It turns out that only 4% of fund managers consistently beat the S&P 500 index over the long term, which means that 96% of fund investors see a smaller return on their nest egg than a chimpanzee who simply buys stocks in the 500 biggest companies in America and watches what happens.
But its worse than that. The net effect of hitching your wagon to mutual funds is that over a lifetime theyll fritter away as much 60% of your nest egg in fees. Once you understand how funds engineer this, you'll rush to invest on your own.
Payback Time's risk-free approach is called stockpiling and it's how billionaires get rich in bad markets. Its a set of rules for investing (not trading but investing) in the right businesses at the right time -- rules that will ensure you make the big money.
©2010 Phil Town (P)2010 Random House
"An incredible book that will teach you how to achieve financial independence faster than you ever thought possible." (Brian Tracy, President, Brian Tracy International)
There are no listener reviews for this title yet.
"You will need the book!"
This book has a lot of good content regarding calculations and formulas. You would want the book to help out.
One big problem with this audio book is the narrator. So dry. Sounds like you're in a boring lecture. Makes you not want to listen to this book. Phil Town, of course, does a better job narrating his own material.
"must have"
if you like rule #1, then you must buy this book
the idea stockpile makes you feel much better when in down market because you can build your portfolio in a much lower price
"this book has helped my investment"
this book has helped my investment strategy so far in real investments. I recommend this book to anyone starting their investing journey.
"Outdated reference information to websites"
Outdated web sites... overall great information. Save yourself the time and go to the free website
"Great book"
Lots of info in this step by step guide to a investing strategy that sounds reasonable. Narrater is horrible he sound like the weather warning guy very monotone.
"Not very compelling"
And I am a fan of Phil. And I didn't find much in this book that was a new except the idea of buying as a stock goes down which isn't that novel of an idea overall I didn't take much from this book some of the ideas towards the end about not using a company
Match in a 401(k) I thought was just crazy
I will become a RULER! Phil is a master teacher and I cannot wait for his workshop!
"very long advertisement"
The we're too many references to his website. things that could have been covered in the book which makes things frustrating because it makes me wonder why I got the book in the first place. the information provided was of very little help. many of the same concepts are explained better in other books and with out the " fluff". As an audio book especially I would not recommend this book. the concepts that sounded like they may be useful were lost to me as there was a lot of numbers and math being drawn from several sources and there was no way I can keep it all in my head at one time. I have not read it but it sounds like his first book has more detail and may be a bit more useful to readers.
"Follow up success."
Great book, it has taught me how to do the math to pick good Companies to invest in.
"Loved the book"
Both Payback Time and Rule 1 where really good. The narrator is enthusiastic which makes me interested. He also gives a step by step approach which is easy to understand.
Rich Dad series... because it is simple to understand
he was enthusiastic
Report Inappropriate Content
If you find this review inappropriate and think it should be removed from our site, let us know. This report will be reviewed by Audible and we will take appropriate action.


text: Something first off -- if we get together a complete list of issues we have with the licence (which are, after all, mostly matters of interpretation), do you believe that OCaml upstream will get shirty if you ask them for clarification of intent with regards to those issues? If so, that may be of more use than these swings and roundabouts we seem to be enjoying so much. Oh, and by the way, I've been getting bounces on my posts to debian-ocaml. On Wed, Jul 21, 2004 at 11:37:57AM +0200, Sven Luther wrote: > On Tue, Jul 20, 2004 at 08:47:54PM +1000, Matthew Palmer wrote: > > On Tue, Jul 20, 2004 at 11:03:05AM +0200, Sven Luther wrote: > > > On Tue, Jul 20, 2004 at 03:31:34PM +1000, Matthew Palmer wrote: > > > > On Tue, Jul 20, 2004 at 04:06:22AM +0200, Sven Luther wrote: > > That is *the* big problem with the QPL, IMO. The initial developer, by > > virtua of being the plankowner of the software, gets special rights, which > > no future developer gets. It's even worse, because who exactly the "initial > > developer" actually is is not clearly specified. Am I, a future modifier of > > the software, now one of the "initial developers" of the modified software? > > Well, whatever, it is another issues, so please don't muddle the water. > > > Those problems *might* be ameliorated by an appropriate definition of > > "initial developer", but the fact that one, special, person gets > > preferential treatment under the licence basically kills it for me, no > > matter what terminology you wish to use. > > This may be discussable, but offtopic in this thread. OK, but rest assured that 3b *is* a problem, and by dropping it from this thread, you're only prolonging your time here. > > > > The licence of the original software was "must distribute > > > > (changed|linked)[1] versions to O. Author". Now, does the licence of the > > > > modifications Q say "must distribute changes (of the modifications) to O. > > > > Author" or "must distribute changes (of the modifications) to J. Modifier"? > > > > If the former, then J. Modifier, the author of the modification Q, is being > > > > denied options that original author had, which is a DFSG #5 problem, and if > > > > the licence is the latter, it fails DFSG #3 because the licence is not the > > > > same as the original. > > > > > > Well, compare it to the GPL ? The original authour had the choice of > > > of using whatever licence he wanted, but a work linked with the GPLed > > > software has no choice but to be the GPL (or some minor derivative). > > > > You consider the BSD licence to be a minor derivative of the GPL? > > Ah, you claim that you can get some GPLed code, make modifications to it, and > then release it under the BSD ? I seriously doubt that and would like you to > reconsider, or give some real argumentation of it. You seem to have trouble keeping your arguments straight. You yourself have said that section 6 deals with linking, not modification. We're not supposed to be talking about modification here. And yet you are. And what you say I'm saying is not what I'm saying. You said "[A] work linked with the GPLed software has no choice but to be the GPL (or some minor derivative)". The straight 2-clause BSD licence is suitable to be linked with GPLed software. Hence, by your reasoning "GPL (or some minor derivative)", the 2-clause BSD is either the GPL or some minor derivative. > > > > Firstly, what exactly is meant by linking? I'd say "the inclusion (by > > > > inclusion or reference) of some (typically) object code into an executable > > > > for the purpose of future execution". > > > > > > Whatever, we are both in the software world, as is the author of ocaml, as is > > > the author of the QPL, and we all clearly know what is meant by linking.. > > > > I like to be clear on these points. I take it that you don't disagree with > > my definition for the purposes of this discussion? > > Well, i disagree with discussion for the purpose of discussing, let's get > things done, as this already lost enough of my time. You'll waste more of your time if we're talking at cross-purposes because of differences in definitions. > > > > If the original code is entirely contained within A.o, and I make various > > > > modifications to A.c (producing A'.c) and recompile (producing A'.o), my > > > > modifications are essentially linked with various parts of the original A.o > > > > to produce A'.o. Hence, essentially every modification I make is a linked > > > > work, especially considering that the QPL only allows patch distribution. > > > > > > I don't believe this is what is meant here, and if so, why did the QPL not > > > choose another language ? > > > > I don't know. There's no shortage of questionable language in licence > > texts. > > Sure, and just making bogus interpetations of it, is not going to advance us, > why not use some common sense instead ? Because there's no guarantee that the arguments used in court will necessarily contain common sense. > > In these sorts of situations, we tend to get clarifications from upstream, > > usually through the debian maintainer. Would you be willing to seek > > clarification from upstream on this point, if it is not deemed "clean" by > > consensus? I'm happy to accept an appropriate clarification from ocaml > > upstream on this point. > > And did you read the annotated QPL from trolltech, it says : And did you notice that trolltech is not a copyright holder on OCaml, and therefore their opinion isn't worth a hill of beans? Annotations are useful to determine the state of mind of a copyright holder. A statement from the copyright holders of OCaml stating that their views match those expressed in the Annotated QPL would go some way to solving these problems. > This is a license designed for libraries, therefore we must also talk about [...] > Is there still some doubt after that ? And how does it apply to some > program who is not a library. Why is INRIA trying to apply a licence for libraries to a regular program? I suspected that was a large part of the problem. > > > > To make a clearer example, consider an original work with A.c and B.c. If I > > > > create a C.c, which replaces B.c, my modifications are very definitely > > > > linking with A.o when I compile. > > > > > > Sure, all this is known from the technicalities of the GPL, which goes to some > > > length to ensure that hidden modification using a linked library is not > > > allowed. But both of we know what is meant here, and i doubt a judge would be > > > sympatic to use tiptoeing around it. Furthermore, the normal modification is > > > covered by section 3 to 4. > > > > You appear to believe that that just because the issue is discussed in one > > clause it cannot be revisited later. Do you have any basis for that belief? > > I would imagine that the licensor may wish to discuss different aspects of > > the same act in different places. > > Do you have any belief on the contrary ? Did you even read the annotated QPL > from trolltech, i believe i or someone else has posted the link here before. Whose authority prevails if we both hold our beliefs? I haven't read the annotated QPL from Trolltech, because it has infinitesimal bearing on what INRIA thinks of the licence. > > > > Seriously, the "only force distribution of linked code" argument is not > > > > going to fly. > > > > > > Reread : > > > > > > 6. You may develop application programs, reusable components and other > > > software items that link with the original or modified versions of the > > > Software. > > > > > > How do you justify your vision that any work linked with the software is a > > > modification thereof, given the above sentence construction, which nominatedly > > > mentions the modified version of the software ? > > > > I'm arguing the other way around. That modification is a form of linking, > > and hence all modifications fall under clause 6. Linking isn't necessarily > > Bogus arguing, please don't delay this just for the fun of it, it is _NOT_ > funny. I think it's quite funny. You think that merely by saying "bogus arguing" you can make my argument disappear. If it's bogus, show it to be so. Bald assertions have very little mass. > > > > To attack the problem from an entirely different perspective, I > > > > think we need to revisit the question of "does linking qualify as > > > > creating a derivative work?". I don't want to really try and answer > > > > the question, and I don't think it matters in this case, but here > > > > are the options: > > > > > > Well, explain to me how the formulation of 6. explained above enters > > > in this consideration. > > > > Linking is what we're talking about. Whether that (dynamic) linking creates > > a derived work determines which of the options I gave comes into play. > > Thanks for not responding to my question. It is clear you decided not to > read QPL 6, and refuse to take the formulation of it into consideration. > Thus your argument here is unreceivable. The formulation of section 6 in what way? That it talks about linking? I think we've established that. If you've got something more to add, please add it right here. The "explained above" could cover any number of paragraphs that you'd written. > And i am not interested in following bogus argumentation just for the fun > of it. Let's go to the real problems, and not create new ones just to > delay this. You seem to really relish calling arguments bogus, but don't actually show *how* their bogus. If all my arguments are made of straw, why aren't you pulling them apart? Instead you resort to pure assertion, and hope nobody notices. > > > the intuitive understanding of everyone which will do the modification will > > > point to the above meaning. The wording of 6. explicitly support that > > > intuitive understanding, does it not ? > > > > Not particularly. In fact, it's a pretty counter-intuitive licence on the > > whole. Clause 6 talks about works that I create which link to the QPL'd > > software, but what about libraries that are linked to the QPL'd software? > > What about them ? I did kinda cover why it's important to consider them in the next section... > They are linked to it, so what ? This would include a > library wrapper over Qt for example. They are thus derived works, linked with > the library, but not modifications thereof. OK, let me go with a bit of ASCII art here to show this. QPL 6: "You may develop application programs, reusable components and other software items [A] that link with the original or modified versions of the Software[B]." There's two ways of reading this: 1) Either clause 6 applies to all A which is combined with B, regardless of the direction of the relationship; or 2) It only applies to items A which rely on B for operation, but does not apply to items A which B relies on. To put it in Debian terms, it applies to packages A which Depend: on B, but not packages A which B Depends: on. If the first interpretation is the correct one, then in order for me to be able to make a modified version, I have to have the ability to distribute the source of every library my modified version links against to the initial developer on request. That includes proprietary system libraries that might be on my crapola commercial Unix. (The GPL gets around this by having a system library exception, of which there is none in the QPL). Nor can we use "available to the general public", because those proprietary system libraries aren't. Hopefully, you can see that interpretation 1 is unworkable. If the second interpretation is correct, then I can hide my proprietary modifications in a library which the QPL'd program uses, because I only need to provide source to anything that relies on the QPL'd program. That's a loophole you can drive a truck through. I'll give you a hint as to how you can rebut this point: you can give another workable interpretation of the above quoted sentence; you can show that both of my interpretations above are flawed; or you can attempt to demonstrate that my extrapolations from both readings are flawed. > > those? If that's OK, it's a short hop to doing a total end-run around the > > licence by just rewriting bits and pieces of it as libraries which the QPL'd > > program links to. In the dependency tree, those rewritten library bits are > > used by the QPL'd program, not the other way around, so it's OK (for the > > same reason that the QPL'd program is OK on OpenSewer). > > I don't buy this, please provide real argumentation, rooted in the licence. Done. > > These sorts of issues are rife in this licence. Looking at the practical > > implications of this licence make it look worse and worse. > > Again, please provide real analysis, and not just bogus claims. OK, that might have been a bit of hyperbole. > > As for whether requiring modifiers to send programs linking to the QPL'd > > software is a fee, consider my modification to QPL'd program Q to use the > > pre-existing, non-free library X. This library X wasn't developed to link > > with Q (and hence, technically, is not covered by "you may develop ... > > reusable components ... that link with the ... software", but nevertheless, > > the modifications I make are useless to anyone without the library. If the > > licence is read as to compel me to send my proprietary library to the > > original author under the terms of the QPL, I hope you see that as being > > non-free. > > Well, indeed, you have a point, linking indeed goes both way. Now, is the > annotated QPL enough to solve this ? No, for the reasons given the first time you raised the annotated QPL above. > > > > closer. What about changing the software to reorder a few arguments to make > > > > the software compile work with a library with an > > > > almost-but-not-quite-the-same API? It's a nightmare. > > > > > > Notice that FSF counsel i had over my parted contribution and the amiga > > > headers, mentions that it is ok to ship the header files, and it is not > > > copyright breach. So a changing to stay compatible with the API would be of > > > same kind. > > > > Not a copyright breach? I don't find that relevant. Does it constitute a > > modification of the work, or linking, or both? > > It is acceptable to reproduce the needed info found in headers needed to link > with another work. As thus, even though my modification reuse the headers > defining the RDB partition table format, it doesn't constitue a derived work > of tge amiga OS code base. If you're talking about the issue I think you're talking about, the header files were considered to not constitute a derived work because there were not a creative work, and therefore didn't enjoy copyright protection. > > > > There is also an additional issue with this linking clause: it applies to > > > > libraries which OCaml links with. I imagine this is, in fact, the reason > > > > Trolltech made it apply to linking -- they didn't want people burying their > > > > own code in other libraries, modify the QPL code to rely on it, and then > > > > refuse to release the (proprietary) library. But for dynamic linking, that > > > > doesn't work, because I might give you essentially a stub library, which > > > > provides the API with minimal functionality, while using a different > > > > (ABI-compatible) library for my own private purposes. > > > > > > As ocaml doesn't support dynamic linking, the point is moot though, isn't > > > it ? > > > > I wasn't talking about ocaml the language, I'm talking about the dynamic > > Well, i am. I have no interest whatsoever in loosing time discussing generic > stuff which doesn't affect me. That's quite interesting, as the whole reason you're here, I thought, was because the OCaml licencing situation affects you as the maintainer. I was raising a problem with the linking clause of the OCaml licence. You should probably spend some time addressing the points raised, rather than just deciding to discuss something else. > > libraries which the QPL'd ocaml components link with in the ordinary course > > of business. > > Ah. Well. i guess that means the libc and a few others. Since you can link > them with prorietary software too, i doubt they would cause problems. They don't cause problems because of the licences of the libraries, they cause problems because of the licence of OCaml. > > > > > Ok, i believe i have the first point Josh mentioned covered, let's go to the > > > > > second one. > > > > > > > > > > 2) Choice of the court of venue being set to versaille, france, this being > > > > > the domicile of the ocaml authors, not some court chosen for tactical > > > > > reasons like the amsterdam court in the original QPL licence. > > > > > > > > > > First point to notice, that the choice of law in the licence of being the > > > > > french law has not been disputed here, and there thus seems to be a general > > > > > consensus of it being ok. > > > > > > > > Choice of law is essentially OK because it doesn't cause a major imposition > > > > on either party, and is in fact nice (for d-legal at least) because we can > > > > analyse the interaction between the laws of the chosen jurisdiction and the > > > > licence, rather than having to consider all sorts of issues of varying > > > > jurisdictions. > > > > > > > > > Second, it is argued that the choice of venue is not DFSG free, because it > > > > > means a trigger happy lawsuit harrasment from the upstream author over some > > > > > user could be possible. > > > > > > > > That doesn't require choice of venue in order to occur, but it does badly > > > > screw up the defendant in said frivolous lawsuit, because they may have to > > > > be put to considerably more expense in order to defend themselves. > > > > > > As in hiring a legal counsel fluent in french law, and sending a letter > > > explaining its innocence ? Or like hiring a french counsel local to the > > > venue, and informing him through long distance communication off your > > > position ? > > > > Hiring competent legal counsel in a far-away jurisdiction is likely to be > > Oh, come on, the french phone directory is available online, so the cost is an > internet connection and a phone call, followed by a few formal letter > exchanges. The important word there is "competent". Over here, some lawyers are good and some are poor. I imagine the situation is similar in France. Picking someone out of the phonebook is not likely to produce a competent lawyer. > > significantly inconvenient. First you've got to find someone with > > sufficient clue -- likely to be some overseas phone calls and whatnot. Then > > you've got to retain their services, which might be fairly costly. And I > > seriously doubt that a single letter saying "it wasn't me, it was the one > > armed man!" is going to stop a lawsuit. > > But you could get local legal advice in order to help you draft that letter. But it doesn't matter, because the letter isn't going to be the end of it. > > > cheap ? Come on, we live in the ago of telecommunication, not in the stone age > > > where this would represent a major hurdle. Phone, quick letters, email, video > > > conferencing, all this make the choice of venue probably moot. > > > > Not a hope. See the link I sent you about the EmarketersAmerica suit. A > > couple were europeans, but most were people just from other parts of the US. > > Their debt, from memory, ran into the high tens of thousands of dollars, for > > a suit which was about as frivolous as you can get without the litigant's > > attorney showing up in clown shoes. > > Sure, but they clearly hadn't clear concience, did they ? I believe that the plaintiffs and their cheap-suited lawyer are incapable of having a conscience, but that's something of a different matter. And I don't see what the conscience of a plaintiff has to do with the fact that the defendants in a foreign-jurisdiction lawsuit are going to be out of pocket to the tune of some tens of thousands of dollars. > > > > > Well, as my personal knowledge of both the french judicial system (but IANAL), > > > > > and the upstream authors, and with the authority of over 6 years of > > > > > maintainership and good interaction with them, i believe this threat to be > > > > > bogus, and thus had a real hardtime accepting it. > > > > > > > > That is a package analysis, not a licence one. Unfortunately, saying "oh, I > > > > know them and they won't do that" holds absolutely no water whatsoever, > > > > because (the royal) we have no knowledge of this, and things can change. If > > > > the licence allows it, we have to assume it will be executed. > > > > > > Well, sure, first came the generic analysis, and then how it applies to the > > > ocaml package. > > > > That's nice. How does this address the problem that your word that you > > don't think upstream will exercise their licence is all we have to go on? > > Well, i am the maintainer, am i not ? Let's try that again: "How does this address the problem that your word that you don't think upstream will exercise their licence is *ALL* we have to go on?" All we have to go on is your word. You are probably quite sure that upstream won't exercise their licence. That's great for you. But what about everyone else? Are you seriously standing up and saying "trust me"? I believe that's what US presidential candidates do. > > > > The lack of the software might be a harm to our users, but you're not making > > > > that argument, you're saying that it would harm *authors*. > > > > > > Well, the point is one of respect, and some of the participants in the > > > previous threads have clearly stated that the free availability of the > > > upstream code is a due, and that upstream should behave. > > > > That's bollocks, and I'm happy to say that to anyone who tries to assert it. > > Then why didn't you ? Probably because I didn't see it. Nobody brought it to my attention, and as chief bollocks-sayer of debian-legal (self-appointed), I believe I should have been alerted to the fact that someone was saying something bollocks-worthy. > > Authors gift their code to the community, we can't demand it. > > But in exchange of their gift, they should get at least basic courtesy, > don't they ? Please never forget that. And i doubt it is courteous and > respectfull to go upstream with half backed legal theories and asking them > to modify their licence. In the long run, it will harm debian. It will also harm Debian if we distribute something to our users, who proceed to use it in a manner consistent with the DFSG, and then they get properly sued for copyright infringement. > > assignment or permission grant from all contributors. That gives them > > (effectively) the ability to sell the software under other licences to > > generate revenue, but without hitting the problems which the QPL has. > > Sure, but i believe that a courteous and respectfull way would be to give > some proper arguing of what the problems are, without far fetched desert > island and chinese dissident stuff, and wild theories without any real > legal backing. A request: please demonstrate exactly *how* my theories are wild. You appear to be very good at assertion, but your reasoning seems weak. > Well, thereis always redhat, suse, and other suches. Upstream distribute .rpm > packages anyway on their site, so ... ... people can download those and use alien. Problem solved. - Matt


text:
New McHargue Website
The new McHargue family website is up and running, though still a work in progress.There is a comprehensive family genealogy which is accessible by registering for a passward and in the near future photos and documents will also be accessible by password.There are several articles, including a family history and other information that are available to the public without registration.
The URL is www.mchargueclan.org
If you have additional documented family history information or genealogy that you would like to contribute, please contact the webmaster at the "Contact Us" tab at the website.We welcome new information.
More Replies:
Re: New McHargue Website
linda mckee 12/03/10
Re: New McHargue Website
Glynis Patterson 12/03/10
- Re: New McHargue Website


text:
Apologies for being a bit quiet this last week… it was my birthday so I was a bit of a busy bee!
This weekend, Paul and I met some friends at the Alexandra Palace Fireworks and before it got dark, we took a few snaps!
Topshop Camel Jumper .:. Topshop Coated Jeans .:. Zara Leather Jacket .:. Topshop Cut Out Boots .:. New Look Necklace .:. Primark Hat (Present) .:. Mulberry Satchel
It was a tad windy and I had to keep hold of my hat pretty tight, but the view over London was amazing! To keep a little warm during the fireworks, I wore a new purchase I made on my birthday day off – this organza camel jumper. It's quite light but super cosy, and the organza panel on the front makes it a little different to your usual knit. I do have a mild obsession with knitwear but this is currently one of my faves!
I've also wanted a jewelled necklace for a while and found this little gem in New Look the other week whilst browsing with my bff, who actually bought me my new hat for my birthday! (Fankoo! ;-)) The berry colour really compliments the camel jumper, which is good news as it will go perfectly with my camel coat too!
What do you think to my autumnal outfit?
Hope you all had a lovely weekend!


text:
Each Friday before the ALA Conference, the Independent Reference Publishers Group (IRPG) gets together to have a program and discussion of issues surrounding reference publishing. The ALA Annual meeting was no exception. A large group of publishers and librarians gathered to figure out, "how did we get here?" A panel of librarians, LIS instructors, reference contributors, and wholesalers, organized by Peter Tobey at Salem Press, presented some thoughts and challenges for reference content and reference publishing. A summary of these comments is below. The panelists included: Buffy Hamilton, a teacher/librarian from Creekview H.S. in Canton, GA and blogger at The Unquiet Librarian and 1/4 blogger for Libraries and Transliteracy; Sue Polanka (me); Dave Tyckoson, Associate Dean of the Madden Library, CSU – Fresno; Bernadette Low, a frequent contributor to reference content from the Community College of Baltimore City; William Taylor, Manager, Continuations iSelect (R) and Standing Orders at Ingram Content Group; and Jessica Moyer, a doctoral candidate in literacy education at the U of Minnesota and instructor of a MLIS reference course. Continue reading Independent Reference Publishers Group (IRPG) Meeting Summary – ALA Conference
Tag Archives: University of Minnesota
NFAIS workshop – Improving the User Search Experience
The National Federation of Advanced Information Services (NFAISâ"¢) is organizing a one-day meeting — Improving the User Search Experience Part I: Leveraging Technology, to be held on May 14, 2010 at the Lyrasis Office in Philadelphia, PA, from 9:00am to 5:00pm. Virtual attendance is optional for those unable to travel to Philadelphia.
While content itself continues to form the foundation of modern information solutions, the real differentiator is becoming the broader "user experience[1]." Today's information seekers expect a seamless, multi-sensory, interactive – and enjoyable – search experience that is their benchmark for an acceptable information retrieval service. Their product loyalty and satisfaction are "driven by a different set of values that goes beyond content and extends to the experience of using that content.[2]" Content providers and librarians need to be acutely aware of the overall "experience" that their products and services provide. Continue reading NFAIS workshop – Improving the User Search Experience
Booklist launches new reference blog
CHICAGOBooklist Online announces the addition of Points of Reference to its growing family of blogs. Mary Ellen Quinn and a team of front-line experts from academic, public and school libraries post about reference sources and trends in reference publishing and services. Continue reading Booklist launches new reference blog


text:
Forgotten Rebels
"The Forgotten Rebels" are a punk rock band from Hamilton, Ontario, Canada. With roots dating back to 1977 right up until the present time, the Forgotten Rebels have left a legacy of seven albums and a collection of EPs and singles that have influenced many other Canadian and international bands forming in their wake.
Forgotten Rebels
Although the band went through many lineup changes over the last 28 years, Mickey DeSadist (vocals) and Dave McGhire (drums) remained the creative foundation of the group through most of its history. McGhire quit in 2003 leaving DeSadist as sole survivor. The main song writers were: Mickey DeSadist, Dave McGhire and Chris Houston.
''In Love With the System'' (1979)
*Produced by Bob "Cowboy" Bryden
*Star Records
''This Ain't Hollywood'' (1981)
*Produced by Bob "Cowboy" Bryden
*Star Records
''The Pride and Disgrace'' (1986)
*Produced by Chris Spedding (Sex pistols, Clash, and Robert Gordon among others)
*OPM / EMI records
''Surfin' on Heroin'' (1988)
*Produced by Ken McNeil
*Restless / Enigma / EMI records
''(Untitled)'' (1989)
*Produced by Stacy Heydon (David Bowie, Teenage Head)


text:
Changing to a Customer-oriented Culture
It was noted in the empirical section (see Chapter 5) that dairy and coffee cooperatives in Kenya are still embedded with supplier- and government-oriented culture. Although there is willingness to change into a more profit- and customer-oriented culture, the transition has been too slow. Some positive change in this direction was noted in the well managed co-operatives, but the fairly well-managed co-operatives still have much to improve and it may now be too late for them to survive.
Co-operatives need a change of culture to be able to compete in the liberalised environment, where markets require customer orientation and suppliers require ever-higher payments and the organisation needs growth, liquidity and solvency.
Improving Financial Reporting to Members
In their financial statements, Kenyan dairy and coffee co-operatives express payment to members (for their crop) as a percentage of the total turnover (in coffee or milk sales). This is due to the general norm given by the Ministry that members should be paid at least 80% of the total sales value of the crop. While such a gross percentage can give an indication of the internal efficiency of co-operative, it does so only in stable production and market environments, where the processing technology remains static. Should the added value of processing increase, the payment percentage share of raw material is likely to decrease because such improvements would allow the co-operative to set a higher end-product price. Such an improvement in the processing technology and subsequent increases in production would also improve employment in the long run. Therefore, current financial reporting practices, which overvalue raw material costs within the society, may actually discourage new investments for value addition. Are there alternative ways to report member interest in the financial statement?
The expense item: Member payments for raw material received in cooperative financial statements should include payments to members for raw material at the realistic current market price. At the moment, co-operatives use this expense item to adjust their financial result to zero profitability for tax purposes. All other services like transport and AI should also be priced correctly at their current market prices and reported in the co-operative financial statement according to their purpose. This is important for the following reasons:
1. Members would acknowledge the market costs of the services that they use. They would then allocate their use of those services better. Free and low-cost services would be used more. In addition, if certain services were perceived to be of major importance for the long-run strategic development of the society and their own long-term benefit, that service would also be used more if it were financially subsidised.Reforming Kenyas Tax Laws
2. By using market prices, managers of the society would gain additional information on the efficiency and profitability of various services like transport, dairy plant or coffee factory processing. This would undoubtedly lead to more efficient management of resources.
3. In the financial statement, the payments for raw materials or other costs and excess earnings8 should be separated to better describe the profitability of the society and the contribution of each service to that end. This would provide information to both to the members and managers whether coffee or milk production is profitable or not. Such data would also help members and managers to figure out that the co-operative generates profits and they must decide what should be done with the profits. Should the money be paid back to the members or invested in the co-operative to finance its growth? This would help develop a new kind of understanding of capital investments and capital formation in cooperatives, since such a decision would be an explicit choice made by members and managers instead of an automatic transfer of profitability into raw material payments or price reductions on services. In this way, the co-operative may generate capital internally prior to making any capital investment decisions.8 The problems of measuring return on cooperative equity is discussed by Cropp et al. (1998).4. In the long run, such a separation of various kinds of payments to and deductions from members and explicit profitability figures would eventually lead to better capital investment decisions and improved capital formation. This separation would lead to more explicit consideration of profitability of capital investments in liberalised markets. We would expect that these capital investments would enhance technology and production levels in rural areas, which would attract more labour into rural areas.
Because taxation is based on the profitability of a society, management tends to counter this by making higher payments to members in order to reduce the profitability of the society to zero. Consequently, tax revenues to the Government from the societies are very low. An effect, of the suggested changes in financial accounting above, would be to raise profitability, which would lead to paying higher taxes especially in the short run.
To encourage capital formation, it would important to allow societies to set up capital investment reserves. A capital investment reserve is an internally generated tax-exempted reserve used to set aside funds to meet foreseen future expenses or investments. The allocation of internally generated surpluses to such a fund could be make tax-exempt on the provision that investments should be made no later than five years otherwise the reserve would become taxable. As a result, the Government would not loose any tax income, because it does not currently gain much from the societies. In the long run, Government would benefit from tax income due to improved capital formation within societies and taxes paid by the additional employed staff.
Reducing Delays in Financial Reporting
Financial reporting to agricultural co-operative members in Kenya is notoriously slow. Typically, financial information is disclosed to the members with more than a years delay, which further reduces transparency in transactions and makes management as well as member monitoring of the co-operative business next to impossible. The member consensus in the sampled co-operatives was that this delay was excessive, that annual financial statements should be audited within a four-month time period, and that all Annual General Meetings should be held within six months after the end of the financial year. Implementation of these reforms would make co-operative management more accountable to members and a closer connection could be maintained between actions and financial figures. Excessive delays do not serve members interest. Only a dishonest management will benefit from long delays.
The major cause of these delays in the examined co-operatives appeared to be the low level of automation of their financial accounting and reporting systems. None of the societies examined used computers for financial reporting purposes. Some of the sample societies served very high numbers of members and had consequently high volumes of transactions, but only one society had acquired a computer, which was not yet put into operation. In stark contrast, two out of three of the private companies used computers for financial reporting. These two companies were also quite dynamic from a production and marketing point of view.
Computerisation of financial reporting would improve the societies in several ways:
1. The financial reporting within a society would be faster. Managers would get information without long delays. This would also improve the timeliness of managerial responses to the unexpected changes.Each society should be computerised with a simple bookkeeping system, which can create simple monthly financial reports, especially financial statements. In a similar vein, the unions should also be computerised, but each society should keep their own accounts. As the societies do not much differ from each other, a uniform bookkeeping system may be developed for all societies. This would make the system cheaper and easier to manage at union level.
2. The accounting function would become more efficient. Less people would be required for accounting work, because all the computerised phases of the accounting system would become simpler, including the input and storage of information and the preparation of financial reports and financial statements.
3. Auditing would be easier, because auditors familiar with the bookkeeping programmes would not have to manually go through all the programmed features of the bookkeeping system.
4. The members would get their information in time and semi-annual reporting would also be possible without any additional effort.
5. Once the reporting system would be working properly, the managers would have more time to plan for the future of the society.
What would be the best strategy for computerisation?
Computerisation is not only a technical problem to be solved, but it provides, more importantly, a seed of change of the organisational culture and a tool to upgrade communication and norms. This is expected to fundamentally modernise the management of co-operatives, which is urgently required in the whole East African sub-region.
However, interventions have to be introduced with care and tested on a small-scale pilot basis in only a few selected co-operatives that appear most ready for computerisation as a means for increasing member participation and improving coop business performance. Computerisation should be introduced in highly participatory and non-threatening manner and there should be a strong training and sensitisation component in collaboration with a local NGO or private firm.
Once tested, the approach could be gradually replicated within Kenya by developing a phased computerisation-cum-training strategy for the targeted cooperatives and for key Government officials. The replication phase would focus on field testing of the approach and development of materials, which would culminate in the development of a national computerisation and training programme with strategies based on the test experience.
Implementation could later be extended also to the other countries of the sub-region, possibly in the beginning in either Uganda or Tanzania.
Hiring More Qualified Managers
Management committee members in Kenyan agricultural co-operatives are expected to serve on a voluntary basis. Committee members do not receive any salary, but only a sitting allowance for their management work. The employed managers receive salaries paid either by the society or the union, but the salaries are not competitive compared to the private sector firms. This practise is still common, because the Ministry used to set the salary scales earlier during monopoly era of co-operatives. For co-operatives to attract qualified staff, they will have to compete with private companies in paying comparable salaries and incentive bonuses Bonus wages to employed managers and honoraria to committee members could be partly based on profits to motivate them to act in the best interest of the members and to improve capital formation within the society. When losses are incurred, punishments such as loss of incentives and retrenchments should also be applied. Co-operative unions employ many of the society managers and pay them salaries, which are ultimately financed by a society commission paid to the union. This type of secondment belongs to the Government controlled era, which dilutes member control. By direct society employment, managers would be better accountable to the management committee and the members of the society. This would, in turn, make management and member control more effective.
Improving Co-operative Business Training
The above suggestions will not have positive effects unless they change the current practices and the way both members and managers structure the purpose, aims and activities of the societies. Therefore, training of the members and managers is important. Such training should stress the following:
1. First, business rather than the social dimension of co-operatives should be emphasised, which would include focus on accounting, marketing and administration of co-operatives. Members should have basic training in the understanding of financial accounting and interpretation of financial statements so that they will be able to maintain accountability pressures over managers. This training should also introduce the required changes in financial accounting and the improved role of the members within the society. Managers need also to gain improved skills in controlling the society activities by training in management accounting and finance.
2. Managers need to learn new marketing skills and techniques to compete in the liberalised markets and satisfy customer demands for higher quality products. Such training is very important to improve quality control considerations. Currently, there are no such pressures on the members and therefore, the concerns of quality of the raw material lies with the members without any major pressures from the society.
3. Training in business administration will be important both for the members and the managers. This includes issues such as development of a good business plan and its implementation to the operational level, control and payment systems and a proper governance system.


text: On Wed, 2 Jan 2002, Darren Reed wrote: > In some email I received from matthew green, sie wrote: > [...] > > sometimes the kernel image isn't available to the NetBSD userland > > at all. eg, a shark netbooted kernel doens't have to exist in > > the machine's / at all. i might have loaded my kernel over the > > ethernet and then used a local root filesystem... so while you can > > add to the times when this _is_ available, you can never make it > > always possible. > > Netbooting always seems to be the "forgotten child". > > The problem here is that it _may_ be the same or it _may not_, with no > rule of thumb either way. The safest thing might be to err on the side > of caution and just have netbooting pass the kernel a null kernel name > rather than what it's loaded Or pass the kernel name as a URI. If it's a file, "file:/file/path" says where it is. If it's tftp'd, "tftp://host/file". To the extent our boot methods match standard URI types (file:, ftp:, etc.) we should use the standard format. For other formats, we should make up URI formats (like macosfile: for mac68k where the kernel is loaded off of a MacOS file system). Take care, Bill


text:
You call me and text me every morning, every afternoon, every night.
I can't wait to see you. Your love is all I need.
Distance is not a problem. We understand where we are at in our lives.
We know, when we are done, we will spend the rest of our lives…Together.


text:
The Masonair Turn-Style system incorporates the functions of lateral rotation and low air loss in one unit.
The user friendly high flow control unit offers 10 comfort levels, adjustable turning cycles and maximum turn angle adjustment of up to 40 degrees.
5" Alternating Pressure / Low Air Loss Overlay System
| Caregiver Support
| Store Policy
| Terms of Use
| Privacy Policy
| Career
©2004-2018 All rights reserved by uCan Health LLC.


text:
Fully Furnished Resort-Type Condominium, Fully-Airconditioned Unit with 2 Bedrooms, Hot & Cold Shower, Balcony, Laundry area complete with Washing & Drying Machines, Basement Parking, TV x 2 with Cable, telephone connection-ready, and with good view from balcony. East Raya Condominium is located along Mercedes Ave.-Pasig City with 24Hr-Security, Adult & Kiddie Pool, WiFi connectivity at the Clubhouse, Basketball Court, Gym, Function & Entertainment Rooms at the Clubhouse, Convenience Store, strong Water Supply even at the Deck/Laundry Floor.
San Miguel Elementary School, CCF - C. Raymundo Ave., Puregold - C.Raymundo Ave., SAA Medical Clinic, Tricity Medical Center
Adult's Swimming Pool, Children's Swimming Pool, Children's Playground, Basketball Court, Fitness Gym, 24-hour Security/Gated, CCTV Cameras, Electric Fence, Elevator/s, Wi-Fi Access/Ready, Function Rooms, Entertainment Room, Laundry cages at roof deck level, Assigned Parking, Convenience Store
Get the freshest property listings, latest news, and top real estate tips delivered straight to your inbox!