Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists

Despite the fact that consensus guidelines recommend long-term dopamine agonist (DA) therapy as a first-line approach to the treatment of small prolactinoma, some patients continue to prefer a primary surgical approach. Concerns over potential adverse effects of long-term medical therapy and/or the desire to become pregnant and avoid long-term medication are often mentioned as reasons to pursue surgical removal. In this retrospective study, 34 consecutive patients (30 female, 4 male) preferably underwent primary pituitary surgery without prior DA treatment for small prolactinomas (microprolactinoma 1-10 mm, macroprolactinoma 11-20 mm) at the Department of Neurosurgery, University of Bern, Switzerland. At the time of diagnosis, 31 of 34 patients (91%) presented with symptoms. Patients with microprolactinomas had significantly lower preoperative prolactin (PRL) levels compared to patients with macroprolactinomas (median 143 μg/l vs. 340 μg/l). Ninety percent of symptomatic patients experienced significant improvement of their signs and symptoms upon surgery. The postoperative PRL levels (median 3.45 μg/l) returned to normal in 94% of patients with small prolactinomas. There was no mortality and no major morbidities. One patient suffered from hypogonadotropic hypogonadism after surgery despite postoperative normal PRL levels. Long-term remission was achieved in 22 of 24 patients (91%) with microprolactinomas, and in 8 of 10 patients (80%) with macroprolactinomas after a median follow-up period of 33.5 months. Patients with small prolactinomas can safely consider pituitary surgery in a specialized centre with good chance of long-term remission as an alternative to long-term DA therapy.

eLEARNING - A CHANCE FOR SMALL AND MEDIUM SIZED ENTERPRISES

eLearning through its flexibility and facility of access is seen as a major enabler of lifelong learning (LLL), as a catalyst of change and a chance for small and medium-sized enterprises (SMEs) to improve their business and to integrate into European market. But so far the eLearning in the context of vocational educational training has been mainly adopted by large enterprises, while only little activity can be observed in SMEs. The question arises what the chances and challenges for SMEs are and what is the experience with its usage. In this paper after a presentation of key issues in eLearning chances and challenges of eLearning for SMEs are discussed and experiences are exemplified by three EU-funded eLearning projects. The focus lies on the ongoing project ARIEL - Analysing and Reporting the Implementation of Electronic Learning in Europe - coordinated by the Institut Arbeit und Technik (IAT).

Market, Management and Profession. Social Business in the Polder

In a recent policy document of the organized employers in the care and welfare sector in The Netherlands (the MO Group), directors and board members of care and welfare institutions present themselves as "social entrepreneurs", managing their institutions as look-a like commercial companies. They are hardly criticized and there is not any countervailing power of significance. The workers are focusing on their own specialized professional fields and divided as a whole. Many government officials are in favour or do not bother. The relatively small number of intellectual workers in Dutch care and welfare are fragmented and pragmatic. From a democratic point of view this is a worrying situation. From a professional point of view the purpose and functions of professional care and welfare work are at stake. The penetration of market mechanisms and the take-over by commercially orientated managers result from unquestioned adaptation of Anglo-Saxon policy in The Netherlands in the 1990's, following the crisis of the Welfare State in the late 1980's. The polder country is now confronted fully with the pressure and negative effects of unbalanced powers in the institutions, i.e. Managerialism. After years of silence, the two principal authentic critics of Dutch care and welfare, Harry Kunneman and Andries Baart, are no longer voices crying in the wilderness, but are getting a response from a growing number of worried workers and intellectuals. Kunneman and Baart warn against the restriction of professional space and the loss of normative values and standards in the profession. They are right. It is high time to make room for criticism and to start a debate about the future of the social professions in The Netherlands, better: in Europe. Research, discussion and action have to prove how worrying the everyday situation of professional workers is, what goals have to be set and what strategy to be chosen.

Scaling the Costs of 404 Testing to Fit the Needs of Small Public Companies

In July of 2002, the Sarbanes-Oxley Act was passed by Congress, including section 404 which requires the auditors to test and opine on the company's internal controls. Since that time there has been much debate about whether the intended benefits of increased investor confidence and financial statement transparency trump the unexpectedly high compliance costs, especially for public companies with market-caps less than $75 million. Before these companies begin complying in the upcoming year, interest groups are calling for the requirements to be 'scaled' to better fit the needs of these companies. While auditors already are expected to scale their audit approach to each individual client, more must be done to significantly decrease the costs in order to reverse the trend of small companies foregoing listing on U.S. capital markets. Increased guidance from the PCAOB, SEC, and other related parties could help the small-cap companies and their auditors be aware of best practices. Also, exempting industries that already follow similar guidelines or are significantly injured by the compliance requirements could help. Lastly, the controversial proposal of rotational audits could be put in place if the affected parties cooperate to remove the undue burden on these small-cap companies. Without some form of significant action, the investors could soon lose the ability to buy small-cap companies in U.S. markets.

Family Business in Peru: Survival and Expansion under the Liberalization

It is argued that joint stock companies would be transformed from family firms to managerial firms with their development in size and scope. Such managerial firms would have many small shareholders; hence the ownership and management of the firm would be separated. However, in many developing countries including Peru, family businesses, in which families control both ownership and management, still play an important role in the national economy. After the liberalization of economy, which started in Peru in the 1990s, the national market has become more competitive due to the increase in participation of foreign capitals. To secure competitiveness, it is indispensable for family businesses to obtain management resources such as financial, human and technological resources from outside of the families. In order to do so without losing the control over ownership and management, Peruvian family businesses have incorporated companies with distinct characteristics to the extent that they can secure the control over ownership and management inside of their group. While keeping exclusive control of companies in traditional sectors, they actively seek alliance with other families and foreign capitals in competitive sectors. The management of companies with different degrees of control allows them to survive in today's rapidly changing business environment.

Unlocking the Potential of Zambian Micro, Small and Medium Enterprises "Learning from the international best practices - the Southeast Asian Experience"

This paper examines the SMEs performance in Zambia and attempts to identify some practical lessons that Zambia can learn from Southeast Asian countries (with reference to Malaysia) in order to facilitate industrial development through unlocking the potential of its SMEs sector. Malaysia and Zambia were at the same level of economic development as evidenced by similar per capita incomes but Zambia has remained behind economically and its manufacturing sector has stagnated as if both countries did not have similar initial endowments. It therefore, becomes imperative that Zambia learns from such countries on how they managed to take-off economically with a focus on SME development. Training (education), research & development, market availability and technological advancement through establishment of industrial linkages coupled with cluster formation were some of the outstanding strategies identified that Zambia could use as a “key” to unlock its SMEs’ potential as it strives to meet the UN MDGs in particular halving its poverty levels by 2015 and also realizing its vision of becoming a middle income earner by 2030.

Incorporating small-scale farmers into sustainable supply chains: the Manobi case

Increased globalization and outsourcing to developing countries is fostering the interest in supply chain sustainability. From the academic point of view, while environmental impacts of supply chains have been largely analysed, the research on social issues has been scattered and fragmented. This paper thereby sets out to close this gap. We have identified an emerging sphere of knowledge at the interface between sustainable supply chain management, business strategy and international development literature, which seeks to propose innovative strategies for poverty alleviation. The incorporation of impoverished farmers into supply chains is presented here as one of those strategies, and illustrated through a case study on the integration of these farmers in the Senegalese horticulture supply chain.

CSR Policies: Effects on Labour Productivity in Spanish Micro and Small Manufacturing Companies

This paper analyses empirical evidence of efforts to enable Spanish micro and small manufacturing companies to boost their labour productivity rates through the development of the main pillars of their corporate social responsibility (CSR) policies. This study aims to develop new approaches and sensibilities towards work from an ethical, values (virtues) and CSR perspective, showing how internal dimensions of CSR, such those related to relationships with employees and responsibility in processes and product quality, can improve labour performance and labour efficiency, thereby contributing to a better society. The results of a sample of 929 small businesses indicate that the social responsibility policies that most contributed to a short-term increase in labour productivity are those related to internal aspects of the company, in particular its involvement in the quality of processes and products, promotion of innovation and employee care. However, the impact on labour productivity of CSR policies related to external factors, such as relationship with stakeholders and environmental concern, could not be empirically proven in this paper.

How small and medium enterprises can begin their implementation of ITIL?

Sequencing of Information Technology Infrastructure Library (ITIL) processes related to their order of implementation is one of the pending issues in the ITIL handbooks. Other frameworks and process models related to service management (e.g., COBIT, COSO and CMMI-SVC) are quite well described in the literature and their handbooks. However, the identifi cation of the fi rst process to be implemented has not been deeply analysed in the previous frameworks and models, and it is also a complex question to answer for organizations, especially Small and Medium Enterprises (SMEs). Moreover, SMEs are the organizations that have the largest presence in the world economy; offi cial data of General Business Directory, show that their range of presence in different countries around the world is between 93% and 99%, and the average of employment contribution is around 60%. Consequently, the improvement of information technology service management is of vital importance to accomplish in this type of enterprises. This research has focused on two surveys that aim at helping SMEs to select the ITIL process by which starting the implementation of ITIL. In the fi rst survey, data were gathered through a questionnaire to SMEs registered in the region of Madrid. The second survey obtained data from experts and enterprises in countries as Spain, Ecuador, Chile, Luxembourg, Colombia, Norway, El Salvador, and Venezuela. Finally, the results of both surveys show that the tendency for starting an ITIL implementation in SMEs points to one of the processes included in the Service Operation.

Os efeitos da adoção de práticas de inovação gerencial sobre a flexibilidade organizacional

desenvolvem capacidades dinâmicas. Um tipo de inovação é a inovação gerencial que trata de mudanças na maneira de gerir a empresa. As capacidades dinâmicas são responsáveis pela percepção de oportunidades e ameaças e ajustamento da organização respondendo a elas. Tais capacidades causam o desenvolvimento de flexibilidade. Assim, o objetivo deste trabalho é relacionar a adoção de práticas de inovação gerencial à sua contribuição para o desenvolvimento de capacidades dinâmicas, medidas por meio da flexibilidade. O estudo é importante pela pequena atenção dada aos fatores organizacionais nos estudos de inovação, do pequeno número de pesquisas empíricas sobre capacidades dinâmicas e do desconhecimento dos mecanismos que atuam nessas capacidades. Para atender ao objetivo foi realizada uma pesquisa descritiva com etapas qualitativa e quantitativa. Na etapa qualitativa foram listadas práticas de inovação gerencial encontradas na bibliografia. Um painel de especialistas classificou essas práticas de acordo com os tipos de inovação gerencial. Na etapa quantitativa foi feito um levantamento usando questionário estruturado aplicado online no qual se mediu a adoção das práticas de inovação gerencial e uma escala pré-existente mediu a flexibilidade. A lista de respondentes foi obtida da Brasscom, do prêmio Great Place to Work, do Anuário Informática Hoje e Anuário Telecom. Compuseram a população da pesquisa 343 empresas escolhidas por conveniência. O questionário foi enviado para indivíduos do nível estratégico e foram obtidas respostas de 102 empresas. Os dados foram analisados por meio de estatística descritiva, análise fatorial exploratória e modelagem de equações estruturais. Os resultados mostram que entre as empresas do setor de TIC as práticas de organização do local de trabalho são as mais adotadas, e que as empresas que mais adotam inovação e são mais flexíveis são empresas entre 13 e 21 anos de idade, de capital estrangeiro ou misto, e que atuam também no Exterior. Verificou-se ainda que a flexibilidade estratégica, estrutural e operacional compõem as capacidades dinâmicas que por sua vez são afetadas pela adoção de inovação gerencial, especialmente das práticas de negócio. Para as empresas recomenda-se cuidado na adoção de práticas, para que estas não precisem ser abandonadas causando perda de flexibilidade. Nesse processo a atuação proativa dos gestores contribui para manter o ciclo de inovação gerencial funcionando. Como contribuição para a academia, destaca-se uma maior compreensão de como as capacidades dinâmicas são colocadas em prática e a medida dessa capacidade por meio da flexibilidade. Para pesquisas futuras recomendam-se estudos que identifiquem causas e consequências do abandono de práticas de inovação gerencial e a comprovação do modelo com dados de outros setores. Conclui-se que maior atenção deve ser dada ao estudo da inovação gerencial e seus efeitos sobre as capacidades dinâmicas.

Paving the Way for Micro-, Small- and Medium-Sized Enterprises in the Southern Mediterranean. CEPS Policy Brief No. 314, 14 January 2014

The upheavals of the Arab Spring in the southern Mediterranean led to domestic and international demands on the governments in the region to implement reforms aimed at enhancing business and investment conditions especially for micro, small- and medium-sized enterprises (MSMEs), which carry out an overwhelming majority of the region’s economic activity. A comprehensive survey among some 600 high-growth potential MSMEs in Algeria, Egypt, Morocco and Tunisia identified and ranked the key obstacles impeding their high-growth potential. This Policy Brief summarises the main results and policy recommendations that can be drawn from this survey, which has been analysed in depth by Ayadi & De Groen (2014).

Micro-, Small- and Medium-Sized Enterprises with High-Growth Potential in the Southern Mediterranean: Identifying Obstacles and Policy Responses. CEPS Paperbacks. January 2014

The Arab Spring, which took root in Tunisia and Egypt in the beginning of 2011 and gradually spread to other countries in the southern Mediterranean, highlighted the importance of private-sector development, job creation, improved governance and a fairer distribution of economic opportunities. The developments led to domestic and international calls for the region’s governments to implement the needed reforms to enhance business and investment conditions, modernise their economies and support the development of enterprises. Central to these demands are calls to enhance the growth prospects of micro-, small- and medium-sized enterprises (MSMEs), which represent an overwhelming majority of the region’s economic activity.

Big business in Belarus - its genesis, conditions and prospects. OSW Commentary No. 113, 2013-09-09

Over the past ten to twenty years, Belarus has seen a steep rise in the number of local dollar millionaires. This has somewhat undermined the myth of an egalitarian model of society promoted through the Belarusian state propaganda. There is a small group of businessmen among the top earners who, in exchange for their political loyalty and their consent to share profits with those in power, have enjoyed a number of privileges that allow them to safely conduct business in an environment typically hostile to private enterprise. The favourable conditions under which they are operating have enabled them not only to accumulate substantial capital, but also to invest it abroad. However, since such businesses are seen as providing a financial safety net for the regime, in 2011 and 2012 some of their directors received an EU travel ban, while their companies were subjected to economic sanctions by Brussels. At the same time, fearing that Belarus’s big business could become powerful enough to influence the country’s political scene (as has been the case in Russia and Ukraine), Alexander Lukashenka has actively prevented such players from becoming too independent. Consequently, Belarus has so far not developed its own elite class of oligarchs who would be able to actively influence government policy. The current informal agreement between the government in Minsk and big business has proved stable and is unlikely to change in the near future. Nonetheless, a reordering of state power giving Belarus’s big business significant political influence would be possible should Mr Lukashenka lose power in the next presidential election.