Diabète. Quels repères pour la prise en charge du diabète en 2010 [Diabetes. Perspectives on the management of diabetes in 2010.].

In the absence of works which would significantly change the perspective on the management of diabetes in the elapsed year, this article proposes a reflection on the integration of the evolving knowledge over the past decade into clinical practice. The major preventive impact of an approach targeting all the cardiovascular risk factors in diabetic patients will remain as the main lesson of this decade. The therapeutic goals need to be tailored to the individual patient's situation based on the evaluation of the benefit: inconvenience-ratio of the treatments. The process of their choice has to include the quest for a shared vision with the patient who is in charge of diabetes management in daily life.

Why Objective Monitoring of Compliance is Important in the Management of Hypertension.

Hypertensive patients often experience poor adherence to treatment, a frequent cause of uncontrolled blood pressure. In this study, we have evaluated whether or not the use of electronic monitoring for drug adherence is a useful approach to identify and correct compliance problems in hypertensive patients, which may ultimately enhance the effect of antihypertensive therapy. Sixty-nine treated patients with an office blood pressure greater than 140/90 mm Hg were enrolled in this study. With patient consent, current antihypertensive therapy was dispensed in electronic pillboxes that record the time and date of each opening without changing the drug regimen. The intention was to provide physicians with objective measurements of drug compliance. The monitoring of compliance per se without any other intervention induced a marked decrease of blood pressure in the whole group (from 159/104Â+/-23/12 mm Hg to 143/92Â+/-20/15, meansÂ+/-standard deviation, p less than 0.001). A complete normalization of blood pressure (less than 140/90 mm Hg) was obtained in one third of the patients (group 1, n=23) during the monitoring period. A significant improvement of blood pressure control was found in another third (group 2, n=23), whereas in the remaining patients (group 3, n=23) no change in blood pressure was observed. The distribution of individual compliance values, as well as the mean compliances was comparable in the three subgroups. Conversely, the compliance reports have identified several potentially overtreated patients in group 1, a large number of patients with a poor adherence to the prescribed therapy in all groups, and patients who clearly needed a change in pharmacotherapy mainly in group 3. Thus, our results suggest that electronic monitoring of compliance can considerably enhance the efficacy of antihypertensive therapy in patients with uncontrolled hypertension. This procedure should be used more extensively in clinical practice whenever the blood pressure response to therapy appears insufficient. (c)2000 by Le Jacq Communications, Inc.

Prise en charge de l'asthme en médecine de premier recours [Management of asthma in primary care medicine].

The international recommendations issued by GINA (Global Initiative for Asthma) have undergone considerable adaptations over the last years. This article proposes the local adaptation of those guidelines bearing on the practical aspects of the treatment for the general practitioner's use. One of the fundamental changes in these new guidelines on good practice relates to the permanent adaptation of the treatment on the basis of symptom control rather than on the severity of the asthma. Another change from the old recommendations concerns the manner in which the asthma is categorised into different phases.

Diagnosis and management of blunt great vessel trauma.

Traditionally, thoracic aortic rupture, suspected after blunt thoracic trauma, is characterized by a chest radiograph showing a widened mediastinum. The diagnostic machinery consecutively activated still depends heavily on the pressure as additional traumatic lesions. A patient with additional cranio-cerebral trauma would typically undergo contrast-enhanced computed tomography or magnetic resonance imaging of head, chest, and other regions. In a number of patients these analyses would confirm the presence of blood in the mediastinum without formal proof of an aortic disruption. This is because mediastinal hematomas may be caused not only by an aortic rupture, but also by numerous other blood sources including fractures of the spine and other macro- and microvascular lesions providing similar images. Therefore, aortic angiography became our preferred diagnostic tool to identify or rule out acute traumatic lesions of not only the aorta but with great vessels. However recently, a number of traumatic aortic transsections have been identified by transoesophageal echocardiography (TEE). TEE has the additional advantage of being a bed-side procedure providing additional information about cardiac function. The latter analysis allows for identification and quantification of cardiac contusions, post-traumatic myocardial infarctions, and valvar lesions which are of prime importance to develop an adequate surgical strategy and to assess the risk of the numerous emergency procedures required in patients with polytrauma. The standard approach for repair of isthmic aortic rupture is through a lateral thoracotomy. Distal and proximal control of the aorta can be achieved in a substantial number of cases before complete aortic rupture occurs and a higher proportion of direct suture repair can be achieved under such circumstances. Most proximal descending aortic procedures are performed without cardiopulmonary bypass (clamp and go) but paraplegia may occur before, during, or after the procedure. Ascending aortic lesions and disruption of the aortic arch, the supra-aortic vessels, the main pulmonary arteries, the great veins as well as cardiac lesions are best approached through a sternotomy, which may have to be extended. Cardiopulmonary bypass allowing for deep hypothermia and circulatory arrest is often required and carries its own complications. It is not clear whether the increasing proportion of ascending aortic and cardiac lesions which are observed nowadays are due to a change in trauma mechanics (i.e., speed limits, seat belts, air-bags), an improvement of the diagnostic tools or both.

Coping with Technology: A Study on Economic Methodology and Strategic Management of Technology

There is a broad consensus among economists that technologicalchange has been a major contributor to the productivity growth and, hence, to the growth of the material welfare in western industrialized countries at least over the last century. Paradoxically, this issue has not been the focal point of theoretical economics. At the same time, we have witnessed the rise of the importance of technological issues at the strategic management level of business firms. Interestingly, the research has not accurately responded to this challenge either. The tension between the overwhelming empirical evidence of the importance of technology and its relative omission in the research offers a challenging target for a methodological endeavor. This study deals with the question of how different theories cope with technology and explain technological change. The focusis at the firm level and the analysis concentrates on metatheoretical issues, except for the last two chapters, which examine the problems of strategic management of technology. Here the aim is to build a new evolutionary-based theoreticalframework to analyze innovation processes at the firm level. The study consistsof ten chapters. Chapter 1 poses the research problem and contrasts the two basic approaches, neoclassical and evolutionary, to be analyzed. Chapter 2 introduces the methodological framework which is based on the methodology of isolation. Methodological and ontoogical commitments of the rival approaches are revealed and basic questions concerning their ways of theorizing are elaborated. Chapters 3-6 deal with the so-called substantive isolative criteria. The aim is to examine how different approaches cope with such critical issues as inherent uncertainty and complexity of innovative activities (cognitive isolations, chapter 3), theboundedness of rationality of innovating agents (behavioral isolations, chapter4), the multidimensional nature of technology (chapter 5), and governance costsrelated to technology (chapter 6). Chapters 7 and 8 put all these things together and look at the explanatory structures used by the neoclassical and evolutionary approaches in the light of substantive isolations. The last two cpahters of the study utilize the methodological framework and tools to appraise different economics-based candidates in the context of strategic management of technology. The aim is to analyze how different approaches answer the fundamental question: How can firms gain competitive advantages through innovations and how can the rents appropriated from successful innovations be sustained? The last chapter introduces a new evolutionary-based technology management framework. Also the largely omitted issues of entrepreneurship are examined.

Establishing the Stages and Processes of Change for Weight Loss by Consensus of Experts

The present study aimed to establish, by a consensus of experts, the stages and processes of change for weight management in overweight and obese people. The first step involved developing two questionnaires aimed at assessing stages and processes of change for weight loss in overweight and obese people. The processes-ofchange questionnaire consisted of 12 subscales, and contained 107 items. A three-round Delphi study was carried out through a website, where participants were asked to give their opinion about the representativeness and clarity of the scale items. The stages-of-change questionnaire consisted of five items and was presented in the final round of the study. A team of 66 experts in the obesity field from 29 countries participated in the study. They were selected either because they belonged to the organizing committee of international associations related to obesity, or because of their research career. The required changes in the questionnaire were made according to the opinions of the participants. Some of these were the result of the group statistical response, whereas others were due to the suggestions made by the participants. A final version of the questionnaire consisting of 63 items was eventually obtained. The present study produced two questionnaires to assess stages and processes of change for weight management. The strength of the study lies in the consensus reached by the panel of experts in order to establish the required content of the questionnaires. The two measures provide useful tools for practitioners who wish to tailor weight-management interventions according to transtheoretical model constructs.

Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes.

AIMS: We aimed to assess the prevalence and management of clinical familial hypercholesterolaemia (FH) among patients with acute coronary syndrome (ACS). METHODS AND RESULTS: We studied 4778 patients with ACS from a multi-centre cohort study in Switzerland. Based on personal and familial history of premature cardiovascular disease and LDL-cholesterol levels, two validated algorithms for diagnosis of clinical FH were used: the Dutch Lipid Clinic Network algorithm to assess possible (score 3-5 points) or probable/definite FH (>5 points), and the Simon Broome Register algorithm to assess possible FH. At the time of hospitalization for ACS, 1.6% had probable/definite FH [95% confidence interval (CI) 1.3-2.0%, n = 78] and 17.8% possible FH (95% CI 16.8-18.9%, n = 852), respectively, according to the Dutch Lipid Clinic algorithm. The Simon Broome algorithm identified 5.4% (95% CI 4.8-6.1%, n = 259) patients with possible FH. Among 1451 young patients with premature ACS, the Dutch Lipid Clinic algorithm identified 70 (4.8%, 95% CI 3.8-6.1%) patients with probable/definite FH, and 684 (47.1%, 95% CI 44.6-49.7%) patients had possible FH. Excluding patients with secondary causes of dyslipidaemia such as alcohol consumption, acute renal failure, or hyperglycaemia did not change prevalence. One year after ACS, among 69 survivors with probable/definite FH and available follow-up information, 64.7% were using high-dose statins, 69.0% had decreased LDL-cholesterol from at least 50, and 4.6% had LDL-cholesterol ≤1.8 mmol/L. CONCLUSION: A phenotypic diagnosis of possible FH is common in patients hospitalized with ACS, particularly among those with premature ACS. Optimizing long-term lipid treatment of patients with FH after ACS is required.

Innovation process management of complex consumer products and services in new innovation paradigm – case location based business

Innovation is the word of this decade. According to innovation definitions, without positive sales impact and meaningful market share the company’s product or service has not been an innovation. Research problem of this master thesis is to find out what is the innovation process of complex new consumer products and services in new innovation paradigm. The objective is to get answers to two research questions: 1) What are the critical success factors what company should do when it is implementing the paradigm change in mass markets consumer business with complex products and services? 2) What is the process or framework one firm could follow? The research problem is looked from one company’s innovation creation process, networking and organization change management challenges point of views. Special focus is to look the research problem from an existing company perspective which is entering new business area. Innovation process management framework of complex new consumer products and services in new innovation paradigm has been created with support of several existing innovation theories. The new process framework includes the critical innovation process elements companies should take into consideration in their daily activities when they are in their new business innovation implementing process. Case company location based business implementation activities are studied via the new innovation process framework. This case study showed how important it is to manage the process, look how the target market and the competition in it is developing during company’s own innovation process, make decisions at right time and from beginning plan and implement the organization change management as one activity in the innovation process. In the end this master thesis showed that all companies need to create their own innovation process master plan with milestones and activities. One plan does not fit all, but all companies can start their planning from the new innovation process what was introduced in this master thesis.

Innovations of ageing and societal transition : Dynamics of change of the socio-technical regime of ageing

The purpose of this dissertation is to examine the dynamics of the socio-technical system in the field of ageing. The study stems from the notion that the ageing of the population as a powerful megatrend has wide societal effects, and is not just a matter for the social and health sector. The central topic in the study is change: not only the age structures and structures of society are changing, but also at the same time there is constant development, for instance, in technologies, infrastructures and cultural perceptions. The changing concept of innovation has widened the understanding of innovations related to ageing from medical and assistive technological innovations to service and social innovations, as well as systemic innovations at different levels, which means the intertwined and co-evolutionary change in technologies, structures, services and thinking models. By the same token, the perceptions of older people and old age are becoming more multi-faceted: old age is no longer equated to illnesses and decline, but visions of active ageing and a third age have emerged, which are framed by choices, opportunities, resources and consumption in later life. The research task in this study is to open up the processes and mechanisms of change in the field of ageing, which are studied as a complex, multi-level and interrelated socio-technical system. The question is about co-effective elements consisting of macro-level landscape changes, the existing socio-technical regime (the rule system, practices and structures) and bottom-up niche-innovations. Societal transitions do not account for the things inside the regime alone, or for the long-term changes in the landscape, nor for the radical innovations, but for the interplay between all these levels. The research problem is studied through five research articles, which offer micro-level case studies to macro-level phenomenon. Each of the articles focus on different aspects related to ageing and change, and utilise various datasets. The framework of this study leans on the studies of socio-technical systems and multi-level perspective on transitions mainly developed by Frank Geels. Essential factors in transition from one socio-technological regime to another are the co-evolutionary processes between landscape changes, regime level and experimental niches. Landscape level changes, like the ageing of the population, destabilise the regime in the forms of coming pressures. This destabilization offers windows for opportunity to niche-innovations outside or at fringe of the regime, which, through their breakthrough, accelerate the transition process. However, the change is not easy because of various kinds of lock-ins and inertia, which tend to maintain the stability of the regime. In this dissertation, a constructionist approach of society is applied leaning mainly to the ideas of Anthony Giddens’ theory of structuration, with the dual nature of structures. The change is taking place in the interplay between actors and structures: structures shape people’s practices, but at the same time these practices constitute and reproduce social systems. Technology and other material aspects, as part of socio-technical systems, and the use of them, also take part in the structuration process. The findings of the study point out that co-evolutionary and co-effective relationships between economic, cultural, technological and institutional fields, as well as relationships between landscape changes, changes in the local and regime-level practices and rule systems, are a very complex and multi-level dynamic socio-technical phenomenon. At the landscape level of ageing, which creates the pressures and triggers to the regime change, there are three remarkable megatrends: demographic change, changes in the global economy and the development of technologies. These exert pressures to the socio-technical regime, which as a rule system is experiencing changes in the form of new markets and consumer habits, new ways of perceiving ageing, new models of organising the health care and other services and as new ways of considering innovation and innovativeness. There are also inner dynamics in the relationships between these aspects within the regime. These are interrelated and coconstructed: the prevailing perceptions of ageing and innovation, for instance, reflect the ageing policies, innovation policies, societal structures, organising models, technology and scientific discussion, and vice versa. Technology is part of the inner dynamics of the sociotechnological regime. Physical properties of the artefacts set limitations and opportunities with regard to their functions and uses. The use of and discussion about technology, contributes producing and reproducing the perceptions of old age. For societal transition, micro-level changes are also needed, in form of niche-innovations, for instance new services, organisational models or new technologies, Regimes, as stabilitystriven systems, tend to generate incremental innovations, but radically new innovations are generated in experimental niches protected from ‘normal’ market selection. The windows of opportunity for radical novelties may be opened if the circumstances are favourable for instance by tensions in the socio-technical regime affected by landscape level changes. This dissertation indicates that a change is taking place, firstly, in the dynamic interactionbetween levels, as a result of purposive action and governance to some extent. Breaking the inertia and using the window of opportunity for change and innovation offered by dynamics between levels, presupposes the actors’ special capabilities and actions such as dynamic capabilities and distance management. Secondly, the change is taking place the socio-technological negotiations inside the regime: interaction between technological and social, which is embodied in the use of technology. The use of technology includes small-level contextual scripts that also participate in forming broader societal scripts (for instance defining old age at the society level), which in their turn affect the formation of policies for innovation and ageing. Thirdly, the change is taking place by the means of active formation of the multi-actor innovation networks, where the role of distance management is crucial to facilitate the communication between actors coming from different backgrounds as well as to help the niches born outside the regime to utilise the window of opportunity offered by regime destabilisation. This dissertation has both theoretical and practical contributions. This study participates in the discussion of action-oriented view on transition by opening up of the socio-technological, coevolutionary processes of the multi-faceted phenomenon of ageing, which has lacked systematic analyses. The focus of this study, however, is not on the large-scale coordination and governance, but rather on opening up the incremental elements and structuration processes, which contribute to the transition little by little, and which can be affected to. This increases the practical importance of this dissertation, by highlighting the importance of very tiny, everyday elements in the change processes in the long run.

MANAGEMENT OF MAIZE STOVER WITH UNDERDOSES RATES OF GLYPHOSATE APPLICATIONS IN NO-TILLAGE

ABSTRACTGlyphosate has significant effects on the growth and development of plants when in underdoses. This work was developed to verify the effect of the application of glyphosate in underdoses in lignin synthesis and consequently decomposition of maize stover. Two experiments were conducted; the first one in a greenhouse for underdoses adjustments and the second one in the production area. The experimental design of the first trial was completely randomized with four replications. The treatments consisted in the application of the underdoses: 0, 25, 50 and 100 g ha-1 of glyphosate. In the production area, the experimental design was a randomized block with four replications, in underdoses: 0, 12.5, 25 and 50 g ha-1. The results were submitted to analysis of variance and regression. The underdoses of 25 g a.e. ha-1in a greenhouse promoted 36% increase in productivity of stover, in addition to increasing the lignin content in 16%, with no change in the unwanted growth of maize plants. In the production area, the concentration of 12.5 g a.e. ha-1 of glyphosate reduced the lignin content and the other underdoses have not changed this feature in maize plants. None of the underdoses affected the height and biomass produced by the maize plants. The highest underdose tested promoted acceleration in the decomposition of maize stover.

Eucalypt Growth Submitted to Management of Urochloa spp.

The objective of this work was to evaluate the initial growth and the physiological characteristics of eucalypt submitted to different managements of signalgrass. The experiment was conducted in a protected environment, using a randomized blocks design with five repetitions. The treatments were arranged in a (5 x 2) + 1 factorial design, and the first factor corresponded to the types of weed management (no control; chemical control keeping the signalgrass shoot on the soil; chemical control with removal of the signalgrass shoot; mechanical control keeping the signalgrass shoot on the soil, and mechanical control with removal of the signalgrass shoot); the second factor corresponded to the two weeds species (U. brizantha and U. decumbens) and a control relative to the eucalypt in monoculture. The eucalypt growth was not affected by the presence of the Urochloa species until 50 days after treatments (DAT). However, the coexistence of these species with eucalypt for 107 DAT reduced the collar diameter, total dry matter, and the leaf area, but did not alter the characteristics related to photosynthesis and transpiration. The control method adopted, with removal or maintenance of the signalgrass shoot, regardless of species, did not change the initial eucalypt growth. It can be concluded that the coexistence of eucalypt with Urochloa decumbens or Urochloa brizantha for 105 days reduces the eucalypt growth. However, the use of chemical or mechanical control, with or without removal of signalgrass residue, were effective methods to prevent interference of these weeds.

Pursuit of change versus organizational inertia: a study on strategic renewal in the Finnish broadcasting company

This doctoral dissertation explores the intra-organizational dynamics of a strategic renewal process. The main research question is how the pursuit of change and organizational inertia co-exist, intertwine, and collide in organizational cognition and capabilities during the strategic renewal. It is a comprehensive study on how organizational capabilities, organizational cognition, and structure enhance and inhibit change. Theoretically, the study is positioned in the modern tradition of strategy research, using the dynamic capability view and the organizational and managerial cognition research tradition as the main theoretical frames. Empirically, the study is a longitudinal case study of the Finnish Broadcasting Company (Yle), following the organizational changes during the years of 2011-1014. The analysis is based on both quantitative and qualitative data, which was collected during the research process using surveys, interviews, and archives. The main theoretical contribution is the application of the two theoretical approaches in one study. Empirically, the study contributes to operationalization of the concepts related to the dynamic capability view and organizational cognition, in a media context that is going through drastic changes due to digitalization. Furthermore, the case of a public broadcasting company extends the application of the theoretical concepts to the context of public management. The results suggest that renewal is a complex process, in which an organization’s perceptions intertwine with the strategic actions and decision-making. The change evolves pathdependently: the past experiences, routines, and organizational structures tend to dictate the future visions, desires, and actions. The study also reveals how the public nature of an organization adds to the tensions between change and organizational inertia, and hampers the decision-making. The doctoral dissertation consists of six research papers, each of which explores the phenomenon under study from a different perspective.

The effects of congestion in the daily management of a trauma hospital

Today’s healthcare organizations are under constant pressure for change, as hospitals should be able to offer their patients the best possible medical care with limited resources and, at the same time, to retain steady efficiency level in their operation. This is challenging, especially in trauma hospitals, in which the variation in the patient cases and volumes is relatively high. Furthermore, the trauma patient's care requires plenty of resources as most the patients have to be treated as single cases. Occasionally, the sudden increases in demand causes congestion in the operations of the hospital, which in Töölö hospital appears as an increase in the surgery waiting times within the yellow urgency class patients. An increase in the surgery waiting times may cause the diminution of the patient's condition, which also raises the surgery risks. The congestion itself causes overloading of the hospital capacity and staff. The aim of this master’s thesis is to introduce the factors contributing to the trauma process, and to examine the correlation between the different variables and the lengthened surgery waiting times. The results of this study are based on a three-year patient data and different quantitative analysis. Based on the analysis, a daily usable indicator was created in order to support the decision making in the operations management. By using the selected indicator, the effects of congestion can be acknowledged and the corrective action can also be taken more proactively.

Managing the change of organizational culture in cross-border mergers and acquisitions: The role of post-acquisition integration in organizational culture change

Over the years, cross-border mergers and acquisitions have become a popular strategic option for variety of firms. Companies often seek rapid growth through acquiring potentially valuable enterprises or attempting to enhance their organization’s profitability by merging with other firms. However, managing the change of organizational culture is a major managerial challenge as companies often confront difficulties when merging two previously autonomous organizational cultures into one, joint organizational culture. Therefore, the purpose of this study is to increase understanding related to the challenges and possibilities concerning the management of organizational culture change in cross-border mergers and acquisitions. The research question “How to manage the change of organizational culture in cross-border mergers and acquisitions?” is analysed in relation to the theories presented in this thesis regarding organizational culture, organizational change and acculturation as well as in relation with the collected empirical data. The research question is divided into three sub-questions according to the following: (1) “What is the role of organizational culture in organizations?”, (2) “How to manage organizational change in mergers and acquisitions?” and (3) “How to manage organizational culture change through acculturation?”. The thesis is conducted as a qualitative case study research including three personal interviews and one group interview. The interviews were conducted as a combination of semi-structured and unstructured interviews. Theories related to organizational culture, the management of change as well as acculturation are studied and further analysed in relation to empirical material collected by the researcher. Research findings indicate that that several factors can influence the success of managing the organizational culture change in cross-border mergers and acquisitions. Factors such as defining the preferred acculturation model prior the merger; managing the resistance of change; open communication; acknowledgement of local culture and cultural differences; involvement of personnel in change processes; as well as the formulation and implementation of comprehensive change plans proved to be important factors with relation to successful management of organizational culture change

Management of Higher Educational Institutions in Kerala

Economists consider education as an investment in man. Education develops human resources necessary for the economic and political growth of any nation. Adam Smith stressed the importance of education and included the acquired and useful activities of all the inhabitants or members of society in his concept of fixed capital.‘ Karl Marx shared with Smith's view when he laid down that the function of education in a socialist society will be to overcome the alienation of the worker from the means of production; while developing the technical skill it will make him a complete man as well as a producer.2 Education is also considered as a powerful instrument for social change. By inculcating moral and spiritual values, it brings changes both in the individual and in the society. It aims at creating a social order founded on the values of freedom, social justice and equal opportunity.3 The objective of this exploratory study is to enquire into the existing system of managing higher educational institutions in Kerala, compare it with the accepted principles of management believed to be applicable to all organisations, and develop a model capable of introducing more effective management practices