Interstitial pregnancies' diagnosis and management: an eleven cases series.

PRINCIPLES: Interstitial pregnancy represents 2% of ectopic pregnancies, but it is a highly morbid condition with a 2.5% of maternal mortality. Its diagnostic and therapeutic management remains controversial. The aim of this review is to describe the management of interstitial pregnancy in our institution between 2001 and 2011 and to define some general rules for the clinical practice. METHODS: Single institution retrospective study. RESULTS: Eleven women were treated for interstitial pregnancy. The median age was 33 years and the median gestity was 4. Seven patients had a history of gynaecological surgery and four interstitial pregnancies followed in vitro fertilisation. The diagnosis was made at a median gestational age of seven weeks with a median beta-HCG level of 5,838 U/l. Six of the eleven patients received an initial treatment with intracornual methotrexate, three with intramuscular methotrexate and two with surgery. The median time to beta-HCG resolution was 58 days. Three of the eleven patients needed a second line treatment: two after intramuscular methotrexate and one after intracornual methotrexate. Six patients had further pregnancies and delivered by caesarean section. CONCLUSIONS: A high prevalence of previous ectopic pregnancies, gynaecological surgery and of pregnancies resulting from in vitro fertilisation was observed. The earliness of the diagnosis was the factor that allowed a conservative treatment in most cases. Beta-HCG level follow up was fundamental in allowing a second line therapy but beta-HCG can persist over a long period of time and this must be taken into account due to its possible psychological impact. Intracornual methotrexate seems to be more efficacious than intramuscular methotrexate in our series.

Regional differences in self-reported screening, prevalence and management of cardiovascular risk factors in Switzerland.

BACKGROUND: In Switzerland, health policies are decided at the local level, but little is known regarding their impact on the screening and management of cardiovascular risk factors (CVRFs). We thus aimed at assessing geographical levels of CVRFs in Switzerland.¦METHODS: Swiss Health Survey for 2007 (N = 17,879). Seven administrative regions were defined: West (Leman), West-Central (Mittelland), Zurich, South (Ticino), North-West, East and Central Switzerland. Obesity, smoking, hypertension, dyslipidemia and diabetes prevalence, treatment and screening within the last 12 months were assessed by interview.¦RESULTS: After multivariate adjustment for age, gender, educational level, marital status and Swiss citizenship, no significant differences were found between regions regarding prevalence of obesity or current smoking. Similarly, no differences were found regarding hypertension screening and prevalence. Two thirds of subjects who had been told they had high blood pressure were treated, the lowest treatment rates being found in East Switzerland: odds-ratio and [95% confidence interval] 0.65 [0.50-0.85]. Screening for hypercholesterolemia was more frequently reported in French (Leman) and Italian (Ticino) speaking regions. Four out of ten participants who had been told they had high cholesterol levels were treated and the lowest treatment rates were found in German-speaking regions. Screening for diabetes was higher in Ticino (1.24 [1.09 - 1.42]). Six out of ten participants who had been told they had diabetes were treated, the lowest treatment rates were found for German-speaking regions.¦CONCLUSIONS: In Switzerland, cardiovascular risk factor screening and management differ between regions and these differences cannot be accounted for by differences in populations' characteristics. Management of most cardiovascular risk factors could be improved.

Stratégies thérapeutiques pour le traitement des gliomes [Therapeutic strategies for the management of gliomas]

The management of gliomas remains challenging and requires a multidisciplinary approach that involves neurosurgeons, radiation therapists and oncologists. For patients with glioblastomas, progress has been made in recent years with the introduction of a combined modality treatment associating radiation therapy and concomitant chemotherapy with the novel alkylating agent temozolomide. This combination resulted in a significant prolongation of survival and increase in the number of patients with survival well beyond two years. Since then, interest in developing new agents in this disease has dramatically increased. In parallel, molecular markers, such as methylation status of MGMT or identification of the translocation of 1p and 19q in oligodendrogliomas have allowed to identify distinct subtypes with exquisite response to treatment or different prognosis. These developments have implications for the development of clinical trials of new potential drug treatments. In this article, we provide a review of the current management of low- and high-grade gliomas, including astrocytomas, oligodendrogliomas and glioblastomas and provide an outlook into future potential therapies.

Prise en charge des facteurs de risque des maladies cardiovasculaires: qu'est-ce qui a vraiment changé en 15 ans [Management of cardiovascular diseases in adults from 1999 to 2014: what has really changed?].

Every year, a considerable number of clinical guidelines for the management of cardiovascular risk factors are issued. It may give the idea that this area is constantly evolving with regular changes for ambulatory clinical practice, including family medicine. Sometimes important differences between the various recommendations are observed. This led us to wonder about the evolution of recommendations for the management of diabetes, dyslipidemia and high blood pressure over time. This article presents a historical review of US and European recommendations between 1999 and 2014 to highlight what has actually changed.

Project Controlling and Management in IT Consulting Enterprise

Liiketoiminnan organisoiminen projekteiksi on erittäin yleistä nykyisin. Suuri osa projekteista erityisesti IT-alalla epäonnistuu kuitenkin saavuttamaan tavoitteensa. Projektin menestys on tyypillisesti mitattu budjetin, aikataulun, laadun ja sidosryhmien tyytyväisyyden perusteella. Tämän Pro Gradu -tutkielman tarkoituksena on etsiä tyypillisimpiä syitä projektien epäonnistumiseen ja löytää projektien seurannan ja mittaamisen avulla keinoja näiden epäonnistumisten ehkäisemiseen. Tutkimusmenetelmänä on laadullinen tapaustutkimus. Empiirinen aineisto on kerätty haastattelujen, eri materiaalien analysoinnin ja havainnoinnin avulla. Teoriaosuus tarjoaa kattavan yhteenvedon projektiliiketoiminnan ja yksittäisten projektien johtamiseen sekä projektien seurantaan ja mittaamiseen aikaisemman kirjallisuuden perusteella. Empiirisessä osiossa suoritetaan analyysi Case -yrityksen projektien seurantaan ja valittuihin projekteihin. Analyysien, haastattelujen ja havainnoinnin pohjalta tehdään johtopäätökset tyypillisimmistä, ongelmia projekteissa aiheuttavista tekijöistä sekä näiden esiintymisestä projektin elinkaaren eri vaiheissa. Mahdolliset ongelmia ehkäisevät keinot esitetään myös. Ehdotuksia kehityskohteiksi esitetään lopuksi teorian ja empirian pohjalta.

How CSR and stakeholder engagement encourage the development of Industrial symbiosis from the management viewpoint?

The thesis aims to understand how CSR and stakeholder engagement can contribute to the development of industrial symbiosis. Theory suggests that corporate social responsibility and stakeholder engagement theories have many similar aspects that correlate with the development of industrial symbiosis. This study is qualitative and empirical suggestions are derived from integrative analysis of literature, secondary data and case study analysis. The empirical findings from the interviews support the framework that is created from the findings of the literature review. The results discovered throughout the thesis research suggest that CSR functions as a theoretical background for industrial symbiosis and stakeholder engagement helps develop more thorough understandings of it from the management viewpoint. Empirical findings and literature review also suggest that in the developing of industrial symbiosis the key aspect are the social characteristics such as a robust management structure, trust between partners and long-term commitment to the common goals that support the development of these symbioses. Also, communication and transparency supports the development of industrial symbiosis. For managerial contribution, this thesis presents organizational practices that can help managers to understand how they can engage in effective engagement with stakeholders in the development of industrial symbiosis.

Towards the development of a questionnaire of post transgression motives and behaviours /

The primary purpose of this study was to develop a questionnaire that assesses both forgiveness-seeking motives and behaviours. This questionnaire was based on the premise that, following the commitment of an offense in the context of a relationship, a perpetrator will be motivated to reduce the damage that has taken place. The . ' questionnaire examined several motives that a perpetrator might have for seeking forgiveness. These motives were divided into five proposed domains of posttransgression concerns: God, Self, Victim, Others/Society, and Relationship. Within these domains, the following more specific types of concern were explored: Avoidance of punishment, concern about public image, emotional well-being, self-image, sense of fairness/justice, loss of relationship, loss or gain of power, and loss of ability to trust. The questionnaire also assessed which behaviours (approach and avoidance) a perpetrator might use in order to address these concerns. In addition, this study explored whether or not the severity of the situation and the personality of the perpetrator influenced post transgression motives and behaviours. Participants were 221 individuals from the community and Brock University. They filled out a questionnaire package that assessed personality traits, social desirability, and forgiveness-seeking motives and behaviours. In order to answer items assessing motives and behaviours, participants were asked to imagine themselves as perpetrators in three hypothetical transgression scenarios. These scenarios ranged in severity fi^om low to high. Participants were asked to rate their motives and behaviours both in an immediate time frame (immediately following the transgression) and in the long-term (in order to move on from the situation). Results indicated that the motivation items could be classified into the following subscales:Concern about God, Damaged Self-worth Concerns, Justice Concerns, Impression Management Concerns, Victim and Others Concerns, and Relationship Concerns. The behaviour items formed the following subscales: Approach, Avoidance, Denial and Hiding, and Groveling. Results also indicated differences in motivations and behaviours based on the severity of the situation as well as the personality (assessed using the HEXACO inventory) of the perpetrator.

Understanding the financial status of a group of high performance athletes

With the 2010 Vancouver Winter Olympic Games quickly approaching, there has been a heightened interest in the performance of Canadian athletes at international competitions (Duffy, 2007; Fidlin, 2005; Longley, 2006). Two significant documents outline Canada's goal to become the number one sporting nation at the 2010 Olympic Games, and improve Canada's performance at the 2008 Olympic Games: Own the Podium and Road to Excellence (Priestner Allinger & Allinger, 2004; Road to Excellence, 2006). These two documents represent heightened interest in the performance of our elite athletes, in conjunction with Canada's hosting status of the Vancouver 2010 Winter Olympic Games. The requirements to train and compete at the international level have become more demanding both in terms of financial resources and time commitment. The need to financially assist athletes with their training and competition costs has been an important topic of debate over the past decades (Beamish & Borowy, 1987; Gatehouse, 2004; Macintosh, 1996; Munro, 1970; Owens, 2004). Two sources of fiinding for high performance athletes in Canada are the Athlete Assistance Program (AAP) provided by the Federal Government and the Canadian Olympic Excellence Fund provided by the Canadian Olympic Committee. The importance of these fiinds for athletes has been discussed in various forums (Ekos, 1992, 1997, 2005; Priestner Allinger & Allinger, 2004; Thibault «& Babiak, 2005). However, alternative sources of funds for high performance athletes have never been the object of research. As such the purpose of this study was to describe a group of athlete applicants from the time period of November 2004 to April 2006, and to contextualize these applications within the development of the Charitable Fund for Athletes.

Relating leadership, thinking styles, self-concept, motivation and stress management in education

Seventy-five principals and vice-.wincipals from public elementary and secondary schools in Hamilton, Ontario, Canada participated in this study. Participants provided ,information concerning their thinking styles, motivations, and the physical effects of stress. This information was examined to find out how satisfaction-oriented, and how security-oriented the thinking styles of the participants were. Second, the data were analysed to see how the thinking style orientations related to life style habits and the effects of stress. The satisfaction-oriented thinking styles scored higher than all of the security-oriented thinking styles by a wide margin with a small preference for the satisfaction-people-oriented styles labelled humanistic-helpful, and affiliative as opposed to the satisfaction-task-oriented styles labeled achievement, and self-actualizing. Although all eight of the security-oriented thinking styles scored well below all of the satisfaction-oriented thinking styles on the Life Styles Inventory, the perfectionistic style scored higher than all of the security-oriented styles by an impressive margin. The next highest scores were recorded by a cluster of three passive-defensive people-oriented thinking styles labeled approval, conventional, and dependent. The competitive style scored lower, and the styles labeled avoidance, oppositional, and power scored the lowest of all the defensive-security-oriented styles. These findings suggest that principals and vice-principals see themselves as relaxed, flexible, and satisfied with their ability to adapt to the stress levels they experience in their lives; however, there was some support for medical research findings that suggest that specific security-oriented thinking styles are associated with emotional stresses that contribute to the development of specific lifestyle habits, physical symptoms, and illnesses. Although the number of females in this study provides very limited generalizability, the findings of this study suggest that high achieving females tend to develop satisfaction-growth styles to a higher level than males, and they tend to use security-oriented styles to a lesser degree than males.

An exploration of the impact of a mandatory quality assurance program on the staff nurse's commitment to professional development /

This study explored experiences in relation to the impact of the College of Nurses of Ontario's (CNO's) mandatory Quality Assurance (QA) program on registered nurses (RNs) working in a clinical setting of an acute care hospital. A qualitative descriptive research design was used and data collection was done in 2 stages. First, a survey with open-ended questions was given to 45 nurses. Second, 8 respondents from the survey were interviewed using a semistructured format. Data were obtained from 2 groups-diploma-prepared and post diploma-prepared RNs. Findings demonstrated that the CNO's QA program had varying influences on the RNs' learning paths, and these differences appeared to be related to the educational background of the individual. The diploma-prepared nurses reported that their commitment to professional development was influenced by their level of internal motivation, the pressures associated with time, and the need for a strong external motivator, namely the obligation of management to conduct formal performance appraisals. They further reported that the QA program played a part in positively altering their commitment to continuing education. The post-diploma baccalaureate nurses reported that the QA program played a positive role in influencing their ongoing learning, along with their level of internal motivation, the work and health care environment, and the element of professionalism. Several implications for nursing practice, theory, and fiirther research also became evident.

Examining sport commitment and intentions to participate in intramural sports : application of the Sport Commitment Model and the Theory of Planned Behaviour in a campus recreational sport setting

Fifty-six percent of Canadians, 20 years of age and older, are inactive (Canadian Community Health Survey, 200012001). Research has indicated that one of the most dramatic declines in population physical activity occurs between adolescence and young adulthood (Melina, 2001; Stephens, Jacobs, & White, 1985), a time when individuals this age are entering or attending college or university. Colleges and universities have generally been seen as environments where physical activity and sport can be promoted and accommodated as a result of the available resources and facilities (Archer, Probert, & Gagne, 1987; Suminski, Petosa, Utter, & Zhang, 2002). Intramural sports, one of the most common campus recreational sports options available for post-secondary students, enable students to participate in activities that are suited for different levels of ability and interest (Lewis, Jones, Lamke, & Dunn, 1998). While intramural sports can positively affect the physical activity levels and sport participation rates of post-secondary students, their true value lies in their ability to encourage sport participation after school ends and during the post-school lives of graduates (Forrester, Ross, Geary, & Hall, 2007). This study used the Sport Commitment Model (Scanlan et aI., 1993a) and the Theory of Planned Behaviour (Ajzen, 1991) with post secondary intramural volleyball participants in an effort to examine students' commitment to intramural sport and 1 intentions to participate in intramural sports. More specifically, the research objectives of this study were to: (1.) test the Sport Commitment Model with a sample of postsecondary intramural sport participants(2.) determine the utility of the sixth construct, social support, in explaining the sport commitment of post-secondary intramural sport participants; (3.) determine if there are any significant differences in the six constructs of IV the SCM and sport commitment between: gender, level of competition (competitive A vs. B), and number of different intramural sports played; (4.) determine if there are any significant differences between sport commitment levels and constructs from the Theory of Planned Behaviour (attitudes, subjective norms, perceived behavioural control, and intentions); (5.) determine the relationship between sport commitment and intention to continue participation in intramural volleyball, continue participating in intramurals and continuing participating in sport and physical activity after graduation; and (6.) determine if the level of sport commitment changes the relationship between the constructs from the Theory of Planned Behaviour. Of the 318 surveys distributed, there were 302 partiCipants who completed a usable survey from the sample of post-secondary intramural sport participants. There was a fairly even split of males and females; the average age of the students was twenty-one; 90% were undergraduate students; for approximately 25% of the students, volleyball was the only intramural sport they participated in at Brock and most were part of the volleyball competitive B division. Based on the post-secondary students responses, there are indications of intent to continue participation in sport and physical activity. The participation of the students is predominantly influenced by subjective norms, high sport commitment, and high sport enjoyment. This implies students expect, intend and want to 1 participate in intramurals in the future, they are very dedicated to playing on an intramural team and would be willing to do a lot to keep playing and students want to participate when they perceive their pursuits as enjoyable and fun, and it makes them happy. These are key areas that should be targeted and pursued by sport practitioners.

The Effects of the Length of the Period of Commitment on the Size of Stable International Environmental Agreements

This paper extends the standard model of self-enforcing dynamic international environmental agreements by allowing the length of the period of commitment of such agreements to vary as a parameter. It analyzes the pattern of behavior of the size of stable coalitions, the stock of pollutant and the emission rate as a function of the length of the period of commitment. It is shown that the length of the period of commitment can have very significant effects on the equilibrium. Three distinct intervals for the length of the period of commitment are identified, across which the equilibrium and its dynamic behavior differ considerably. Whereas for sufficiently high values of the period of commitment only self-enforcing agreements of two countries are possible, for sufficiently low such values full cooperation can be generated. Lengths of periods of commitment between those two thresholds are characterized by an inverse relationship between the length of commitment and the membership size of the agreement. This suggests that considerable attention should be given to the determination of the length of such international agreements.

Email Evidence Preservation. How to Balance the Obligation and the High Cost

With the great advancement of computer technologies, electronic information starts to play a more and more important role in modern business transactions. Therefore, electronic data, such as e-mail, is frequently required in the process of litigation. Companies, on the one hand, have the legal obligations to produce this kind of e-mail evidence. On the other hand, they also undertake a high cost of e-mail evidence preservation due to the great volume on a daily basis. This Article firstly analyzed features of e-mail evidence with the comparison of paper evidence. Then, it discussed about how e-mail is authenticated and admitted into evidence. By using the case laws in different legal aspects and current Canadian legislations, the Author demonstrated the importance of e-mail evidence preservation in ordinary business course. After that, the Article focused on the practical dilemma of the companies between their legal obligation and the expensive cost to preserve e-mail evidence. Finally, the Author proposed suggestions to both companies and courts on how to coordinate the obligation and cost. More specifically, while companies should adopt a document management policy to implement e-mail evidence preservation, courts need to take into consideration of the high cost of e-mail evidence preservation in electronic discovery.

Bridging Knowledge Gaps in the Management of Acute Coronary Syndromes

Contexte L’occlusion d’une artère du cœur cause un syndrome coronarien aigu (SCA) soit avec une élévation du segment ST (IAMEST) ou sans élévation du segment ST (1). Le traitement des patients avec un IAMEST requiert soit une intervention coronarienne d’urgence (ICP primaire) ou une thérapie fibrinolytique (FL). La thérapie FL peut être administrée soit dans un contexte pré-hospitalier (PHL) ou à l’hôpital. Une prise en charge précoce des patients avec SCA peut être améliorée par un simple indice de risque. Objectifs Les objectifs de cette thèse étaient de : 1) comparer l’ICP primaire et la thérapie FL (2); décrire plusieurs systèmes internationaux de PHL; (3) développer et valider un indice de risque simplifié pour une stratification précoce des patients avec SCA. Méthodes Nous complétons des méta-analyses, de type hiérarchique Bayésiennes portant sur l’effet de la randomisation, d’études randomisées et observationnelles; complétons également un sondage sur des systèmes internationaux de PHL; développons et validons un nouvel indice de risque pour ACS (le C-ACS). Résultats Dans les études observationnelles, l’ICP primaire, comparée à la thérapie FL, est associée à une plus grande réduction de la mortalité à court-terme; mais ce sans bénéfices concluants à long terme. La FL pré-hospitalière peut être administrée par des professionnels de la santé possédant diverses expertises. Le C-ACS a des bonnes propriétés discriminatoires et pourrait être utilisé dans la stratification des patients avec SCA. Conclusion Nous avons comblé plusieurs lacunes importantes au niveau de la connaissance actuelle. Cette thèse de doctorat contribuera à améliorer l’accès à des soins de qualité élevée pour les patients ayant un SCA.

Study of baleen whales’ ecology and interaction with maritime traffic activities to support management of a complex socio-ecological system

Thesis written in co-mentorship with Robert Michaud.