Un guide pratique au traitement des gliomes [A practical guide for the management of gliomas]

The management of gliomas in daily clinical practice is challenging. It requires a multidisciplinary and coordinated approach involving neurosurgery, radiotherapy and, finally, chemotherapy. Important progress has been made during the last years with the introduction of a combined treatment associating standard radiotherapy with concomitant chemotherapy using temozolomide, a novel alkylating agent. For the first time in many years a new treatment strategy translated into a significant prolongation of survival. In parallel, molecular markers (e.g. loss of heterozygosity on chromosomes 1p and 19q or methylation of the methyl-guanine methyl transferase [MGMT] gene promoter) allowed for identification of distinct subtypes of glioma or prediction of treatment response. In this "Practical Guide", we describe the daily practice and aim at answering some common questions in the management of patients suffering from glioblastoma, astrocytoma, oligodendroglioma and low grade glioma. The therapeutic options presented here are based on evidences from the literature. In the absence of documented evidence, the empirical choices from our local practice are explained and justified.

Design Guide for Improved Quality of Roadway Subgrades and Subbases, TR-525, 2008

The performance of a pavement depends on the quality of its subgrade and subbase layers; these foundational layers play a key role in mitigating the effects of climate and the stresses generated by traffic. Therefore, building a stable subgrade and a properly drained subbase is vital for constructing an effective and long lasting pavement system. This manual has been developed to help Iowa highway engineers improve the design, construction, and testing of a pavement system’s subgrade and subbase layers, thereby extending pavement life. The manual synthesizes current and previous research conducted in Iowa and other states into a practical geotechnical design guide [proposed as Chapter 6 of the Statewide Urban Design and Specifications (SUDAS) Design Manual] and construction specifications (proposed as Section 2010 of the SUDAS Standard Specifications) for subgrades and subbases. Topics covered include the important characteristics of Iowa soils, the key parameters and field properties of optimum foundations, embankment construction, geotechnical treatments, drainage systems, and field testing tools, among others.

Practical Data Collection: Establishing Methods and Procedures for Measuring Water Clarity and Turbidity of Storm Water Run-Off from Active Major Highway Construction Sites, 2014

In anticipation of regulation involving numeric turbidity limit at highway construction sites, research was done into the most appropriate, affordable methods for surface water monitoring. Measuring sediment concentration in streams may be conducted a number of ways. As part of a project funded by the Iowa Department of Transportation, several testing methods were explored to determine the most affordable, appropriate methods for data collection both in the field and in the lab. The primary purpose of the research was to determine the exchangeability of the acrylic transparency tube for water clarity analysis as compared to the turbidimeter.

How to Prepare a Patient for Transarterial Radioembolization? A Practical Guide.

Transarterial radioembolization consist in delivering small particles loaded with Yttrium90, a pure beta emitter, in order to treat primary and secondary liver tumors. This treatment needs precaution since inadequate delivery of these beads can lead to severe complications. Moreover, a precise radiation dosing is crucial to achieve a good clinical success and to avoid complications such as radioembolization-induced liver disease. This review describes all the precautions and highlights clinical and technical considerations that need to be taken to avoid complications.

A practical guide for the formulation of propositions in the bayesian approach to DNA evidence interpretation in an adversarial environment

The interpretation of complex DNA profiles is facilitated by a Bayesian approach. This approach requires the development of a pair of propositions: one aligned to the prosecution case and one to the defense case. This note explores the issue of proposition setting in an adversarial environment by a series of examples. A set of guidelines generalize how to formulate propositions when there is a single person of interest and when there are multiple individuals of interest. Additional explanations cover how to handle multiple defense propositions, relatives, and the transition from subsource level to activity level propositions. The propositions depend on case information and the allegations of each of the parties. The prosecution proposition is usually known. The authors suggest that a sensible proposition is selected for the defense that is consistent with their stance, if available, and consistent with a realistic defense if their position is not known.

Evolutionary Ecology of Mountain Birch in Subarctic Stress Gradients: Interplay of Biotic and Abiotic Factors in Plant-Plant Interactions and Evolutionary Processes

In nature, variation for example in herbivory, wind exposure, moisture and pollution impact often creates variation in physiological stress and plant productivity. This variation is seldom clear-cut, but rather results in clines of decreasing growth and productivity towards the high-stress end. These clines of unidirectionally changing stress are generally known as ‘stress gradients’. Through its effect on plant performance, stress has the capacity to fundamentally alter the ecological relationships between individuals, and through variation in survival and reproduction it also causes evolutionary change, i.e. local adaptations to stress and eventually speciation. In certain conditions local adaptations to environmental stress have been documented in a matter of just a few generations. In plant-plant interactions, intensities of both negative interactions (competition) and positive ones (facilitation) are expected to vary along stress gradients. The stress-gradient hypothesis (SGH) suggests that net facilitation will be strongest in conditions of high biotic and abiotic stress, while a more recent ‘humpback’ model predicts strongest net facilitation at intermediate levels of stress. Plant interactions on stress gradients, however, are affected by a multitude of confounding factors, making studies of facilitation-related theories challenging. Among these factors are plant ontogeny, spatial scale, and local adaptation to stress. The last of these has very rarely been included in facilitation studies, despite the potential co-occurrence of local adaptations and changes in net facilitation in stress gradients. Current theory would predict both competitive effects and facilitative responses to be weakest in populations locally adapted to withstand high abiotic stress. This thesis is based on six experiments, conducted both in greenhouses and in the field in Russia, Norway and Finland, with mountain birch (Betula pubescens subsp. czerepanovii) as the model species. The aims were to study potential local adaptations in multiple stress gradients (both natural and anthropogenic), changes in plant-plant interactions under conditions of varying stress (as predicted by SGH), potential mechanisms behind intraspecific facilitation, and factors confounding plant-plant facilitation, such as spatiotemporal, ontogenetic, and genetic differences. I found rapid evolutionary adaptations (occurring within a time-span of 60 to 70 years) towards heavy-metal resistance around two copper-nickel smelters, a phenomenon that has resulted in a trade-off of decreased performance in pristine conditions. Heavy-metal-adapted individuals had lowered nickel uptake, indicating a possible mechanism behind the detected resistance. Seedlings adapted to heavy-metal toxicity were not co-resistant to others forms of abiotic stress, but showed co-resistance to biotic stress by being consumed to a lesser extent by insect herbivores. Conversely, populations from conditions of high natural stress (wind, drought etc.) showed no local adaptations, despite much longer evolutionary time scales. Due to decreasing emissions, I was unable to test SGH in the pollution gradients. In natural stress gradients, however, plant performance was in accordance with SGH, with the strongest host-seedling facilitation found at the high-stress sites in two different stress gradients. Factors confounding this pattern included (1) plant size / ontogenetic status, with seedling-seedling interactions being competition dominated and host-seedling interactions potentially switching towards competition with seedling growth, and (2) spatial distance, with competition dominating at very short planting distances, and facilitation being strongest at a distance of circa ¼ benefactor height. I found no evidence for changes in facilitation with respect to the evolutionary histories of plant populations. Despite the support for SGH, it may be that the ‘humpback’ model is more relevant when the main stressor is resource-related, while what I studied were the effects of ‘non-resource’ stressors (i.e. heavy-metal pollution and wind). The results have potential practical applications: the utilisation of locally adapted seedlings and plant facilitation may increase the success of future restoration efforts in industrial barrens as well as in other wind-exposed sites. The findings also have implications with regard to the effects of global change in subarctic environments: the documented potential by mountain birch for rapid evolutionary change, together with the general lack of evolutionary ‘dead ends’, due to not (over)specialising to current natural conditions, increase the chances of this crucial forest-forming tree persisting even under the anticipated climate change.

Management of interdependency in project portfolio

Project management has evolved in recent decades. Project portfolio management, together with multi project management, is an emerging area in the project management field in practice, and correspondingly in academic research and forums. In multi project management, projects cannot be handled isolated from each other, as they often have interdependencies that have to be taken into account. If the interdependencies between projects are evaluated during the selection process, the success rate of the project portfolio is increased. Interdependencies can be human resources, technological, and/or market based. Despite of the fact that interdependency as a phenomenon has roots in the 1960s and is related to famous management theories, it has not been much studied, although in practice most companies use it to great extent. There exists some research on interdependency, but prior publications have not emphasized the phenomenon per se, because a practical orientation practitioner techniques prevails in the literature. This research applies the method triangulation, electronic surveys and multiple case study. The research concentrates on small to large companies in Estonia and Finland, mainly in construction, engineering, ICT, and machinery industries. The literature review reveals that interdependencies are deeply involved in R&D and innovation. Survey analysis shows that companies are aware of interdependency issues in general, but they i have lack of detailed knowledge to use it thoroughly. Empirical evidence also indicates that interdependency techniques influence the success rate and other efficiency aspects to different extents. There are a lot of similarities in interdependency related managerial issues in companies of varying sizes and countries in Northern Europe. Differences found in the study are for instance the fact that smaller companies face more difficulties in implementing and evaluating interdependency procedures. Country differences between Estonia and Finland stem from working solutions to manage interdependencies on a daily basis.historical and cultural reasons, such as the special features of a transition country compared to a mature country. An overview of the dominant problems, best practices, and commonly used techniques associated with interdependency is provided in the study. Empirical findings show that many interdependency techniques are not used in practice. A multiple case study was performed in the study to find out how interdependencies are managed in real life on a daily basis. The results show that interdependencies are mostly managed in an informal manner. A description of managing the interdependencies and implementation procedures is given. Interdependency procedures are hard to implement, especially in smaller companies. Companies have difficulties in implementing interdependency procedures and evaluating them. The study contains detailed results on how companies have implemented working solutions to manage interdependencies on a daily basis

The backwoods of our backyards : Ontario pioneers and the crisis of ecology /

Early in his landmark ecocritical book The Comedy of Survival, Joseph Meeker develops an intriguing hypothesis about human behaviour. He remarks the species Homo sapiens tend to behave like an invasive or pioneering organism, entering a bio-geographical region and aggressively outcompeting all other species for space and resources. Moreover, he suggests, human cultural traditions, at least in the West, have reinforced such behaviour, continually insisting that the impulses he describes are both necessary and right. While Meeker's work goes on to assess a number of literary works in both the tragic and comic modes, his work never fully explores this hypothesis in the context of human pioneers; that is, there is no ~xploration o( how these themes manifest themselves within our culture and what role they might play in the culture of specific pioneering groups. This project is an attempt at just such an analysis, examining the validity of Meeker's hypothesis through a case study of settler literature in Upper Canada/Ontario between the . years 1800-1867. It explores Meeker's work within three main areas: first, Chapter Two situates his book historically within the field of ecocriticism, showing what came before and the explosion of ecocritical inquiry that followed its release. This chapter also delves into the rift between the natural sciences and humanities, arguing that a move towards deeper interdisciplinarity is r:tecessary for the future. Chapter Three examines the biological and ecological ground on which Meeker rests his hypothesis through exploring evolutionary biology as well as invasive and pioneer species behaviour. Lastly, Chapter Four examines how these ecological principles are manifested in the writings of early Canadian settlers, suggesting that Meeker's hypothesis indeed finds itself on stable footing.

Recherche qualitative des enjeux de la mise en lumière urbaine : création d’un modèle opératoire pour la conception des projets d’éclairage

Cette étude traite de la complexité des enjeux de la mise en lumière urbaine et de sa conception. Le but est de déceler les mécanismes opératoires du projet d’éclairage afin de générer une analyse et une compréhension de ce type d’aménagement. Cette recherche met à jour les enjeux lumineux à différents niveaux comme l’urbanisme, l’environnement, la culture, la communication, la vision et la perception mais aussi au niveau des acteurs et de leurs pratiques sur le terrain. En utilisant une approche qualitative déductive, cette recherche théorique cherche à mieux comprendre les différentes significations du phénomène lumineux : comment dans la réalité terrain ces enjeux de la lumière sont compris, interprétés et traduits au travers de la réalisation des projets et des processus mis en place pour répondre aux besoins d’éclairage ? La pertinence de cette recherche est de questionner les enjeux complexes de la mise en lumière afin de savoir comment concevoir un « bon éclairage ». Comment se déroule un projet d’éclairage de sa conception à sa réalisation ? Quels sont les différents acteurs, leurs modes d’intervention et leurs perceptions du projet d’éclairage ? Le but est de vérifier comment ces enjeux se concrétisent sur le terrain, notamment au travers de l’activité et de l’interprétation des professionnels. Nous souhaitons créer un modèle opératoire qui rende compte des enjeux et du processus de ce type de projet. Modèle qui servira alors de repère pour la compréhension des mécanismes à l’œuvre comme le contexte, les acteurs, les moyens et les finalités des projets. Une étude des recherches théoriques nous permettra de comprendre la polysémie du phénomène lumineux afin d’en déceler la complexité des enjeux et de créer une première interprétation de ce type de projet. Nous déterminerons théoriquement ce que recouvre la notion de « bon éclairage » qui nous permettra de créer une grille analytique pour comparer notre approche avec la réalité sur le terrain. Ces recherches seront ensuite confrontées au recueil des données des études de cas, des stages en urbanisme et en conception lumière, et des interviews de professionnels dans le domaine. Nous confronterons les enjeux définis théoriquement aux collectes de données issues du terrain. Ces données seront collectées à partir de projets réalisés avec les professionnels durant la recherche immersive. La recherche-action nous permettra de collaborer avec les professionnels pour comprendre comment ils sélectionnent, déterminent et répondent aux enjeux des projets d’éclairage. Nous verrons grâce aux entretiens semi-dirigés comment les acteurs perçoivent leurs propres activités et nous interprèterons les données à l’aide de la « théorisation ancrée » pour dégager le sens de leurs discours. Nous analyserons alors les résultats de ces données de manière interprétative afin de déterminer les points convergeant et divergent entre les enjeux théoriques définis en amont et les enjeux définis en aval par la recherche-terrain. Cette comparaison nous permettra de créer une interprétation des enjeux de la mise en lumière urbaine dans toutes leurs complexités, à la fois du point de vue théorique et pratique. Cette recherche qualitative et complexe s’appuie sur une combinaison entre une étude phénoménologique et les méthodologies proposées par la « théorisation ancrée ». Nous procéderons à une combinaison de données issues de la pratique terrain et de la perception de cette pratique par les acteurs de l’éclairage. La recherche d’un « bon éclairage » envisage donc par une nouvelle compréhension l’amélioration des outils de réflexion et des actions des professionnels. En termes de résultat nous souhaitons créer un modèle opératoire de la mise en lumière qui définirait quels sont les différents éléments constitutifs de ces projets, leurs rôles et les relations qu’ils entretiennent entre eux. Modèle qui mettra en relief les éléments qui déterminent la qualité du projet d’éclairage et qui permettra de fournir un outil de compréhension. La contribution de ce travail de recherche est alors de fournir par cette nouvelle compréhension un repère méthodologique et analytique aux professionnels de l’éclairage mais aussi de faire émerger l’importance du phénomène de mise en lumière en suscitant de nouveaux questionnements auprès des activités liées au design industriel, à l’architecture et à l’urbanisme.

Définition de la pastorale de la Création en tant que nouveau ministère dans l’Église catholique du Québec

Cette recherche tente de définir la pastorale de la Création afin qu’elle soit reconnue en tant que ministère dans l’Église catholique au Québec. J’emprunte la méthode de praxéologie pastorale, inspirée des sciences humaines, afin de rendre cette pratique à la fois efficace sur le terrain et fidèle à l’Évangile de Jésus-Christ. L’objet d’analyse est la pratique elle-même, c’est-à-dire les activités en paroisse sur le thème de l’environnement. J’ai observé quelques activités pertinentes, dont une formation donnée à des animateurs de pastorale. Ensuite, j’ai interprété ces observations à la lumière de la tradition chrétienne en puisant dans la Bible, quelques référents théologiques et des déclarations ecclésiales. J’ai préparé une nouvelle intervention en organisant une nouvelle formation pour le personnel pastoral, le projet d’un guide pratique et le plan de cours universitaire sur la pastorale de la Création. Finalement, la prospective m’a permis d’imaginer cette pratique à long terme afin d’assurer une Église durable… dans tous les sens du terme.

Experiences of participants in the field of food insecurity through the lens of Bourdieu's cultural capital : practical and theoretical explorations

Ce mémoire utilise des données qualitatives provenant d’entretiens semi-structurés pour examiner les ressources qu’utilisent les individus qui font face à l’insécurité alimentaire sous l’angle du capital culturel de Pierre Bourdieu. Les participants étaient choisis parmi les usagers des organismes alternatifs qui œuvrent en sécurité alimentaire à Montréal. Tous étaient en situation d’insécurité alimentaire. Des analyses inductives et déductives étaient exécutées. Seize indicateurs de la forme du capital culturel incorporée, et trois indicateurs de chacune des formes institutionnalisées et objectivées ont été trouvés à être reliés aux stratégies qu’utilisaient les répondants pour améliorer leur situation alimentaire. Cette recherche nous indique que le capital culturel individuel joue un rôle dans les stratégies utilisées, incluant la participation dans les organismes communautaires. De plus, un manque de capital approprié peut servir comme barrière à la participation dans certaines stratégies ce qui pourra avancer des réflexions sur la justesse et l’efficacité des stratégies actuelles.

Gestión de estrategias Costumer Relationship Management (CRM) sector porcícola Bogotá

Esta tesis, pretende describir la situación actual del Sector Porcícola, los procedimientos desarrollados por las empresas en la adopción, implantación y uso de estrategias CRM. Con una revisión confiable y el estudio de casos relacionados con el tema permitirán contrastar la realidad del sector con los conceptos claves que proponen los diferentes autores. Los resultados obtenidos le permitirán al sector y a los gerentes desarrollar estrategias que ayuden a la satisfacción y fidelización de sus clientes. En el campo académico, este estudio servirá de guía teórico-práctica para estudiantes y profesores del área que necesiten afianzar sus conocimientos en temas de marketing relacional, CRM, fidelización y servicio. El presente proyecto permitirá al futuro administrador enfrentar y asumir paradigmas en escenarios empresariales reales. La información estratégica acerca de los clientes es vital para las organizaciones, ayuda para la toma de decisiones, pronostica cambios en la demanda y establece un control sobre todos los procesos en los que está involucrado el cliente. La adopción, implantación y uso de estrategias CRM ayuda a que la empresa esté más atenta a la manera como interactúa con sus clientes y por ende, mejorará la percepción que tenga el cliente de la organización. En el sector Porcícola hay tendencia a las economías de escala y es importante segmentar y especializar el servicio dependiendo el potencial del cliente. En un mercado tan competitivo encontrar nuevos clientes no es fácil, y menos retenerlos ya que los productos están logrando estándares similares y el cliente basa su decisión en el precio. Al no haber diferenciación debemos ofrecer valor en el servicio lo cual nos ayudará a que el cliente haga una segunda compra prefiriendo nuestra empresa en lugar de la competencia. Hoy en día las estrategias CRM definen el rumbo de una empresa, ayudando no solamente a adquirir nuevos clientes, sino también, a mantener felices a los clientes actuales, de este modo se logran más ventas, y una mayor rentabilidad en el negocio. Razones por las cuales el sector Porcícola se verá beneficiado y Frigocárnicos Monserrate por medio de las estrategias CRM podrá ofrecer un mejor servicio a sus clientes ayudando a las fidelización de estos.

La sabiduría como competencia gerencial

Aunque el concepto de sabiduría ha sido ampliamente estudiado por expertos de áreas como la filosofía, la religión y la psicología, aún enfrenta limitaciones en cuanto a su definición y evaluación. Por esto, el presente trabajo tiene como objetivo, formular una definición del concepto de sabiduría que permita realizar una propuesta de evaluación del concepto como competencia en los gerentes. Para esto, se realizó un análisis documental de tipo cualitativo. De esta manera, se analizaron diversos textos sobre la historia, las definiciones y las metodologías para evaluar tanto la sabiduría como las competencias; diferenciando la sabiduría de otros constructos y analizando la diferencia entre las competencias generales y las gerenciales para posteriormente, definir la sabiduría como una competencia gerencial. Como resultado de este análisis se generó un prototipo de prueba denominado SAPIENS-O, a través del cuál se busca evaluar la sabiduría como competencia gerencial. Como alcances del instrumento se pueden identificar la posibilidad de medir la sabiduría como competencia en los gerentes, la posibilidad de dar un nuevo panorama a las dificultades teóricas y empíricas sobre la sabiduría y la posibilidad de facilitar el estudio de la sabiduría en ambientes reales, más específicamente en ambientes organizacionales.

Definition of an it project portfolio management methodology for a pharmaceutical company

Con la creciente popularidad de las soluciones de IT como factor clave para aumentar la competitividad y la creación de valor para las empresas, la necesidad de invertir en proyectos de IT se incrementa considerablemente. La limitación de los recursos como un obstáculo para invertir ha obligado a las empresas a buscar metodologías para seleccionar y priorizar proyectos, asegurándose de que las decisiones que se toman son aquellas que van alineadas con las estrategias corporativas para asegurar la creación de valor y la maximización de los beneficios. Esta tesis proporciona los fundamentos para la implementación del Portafolio de dirección de Proyectos de IT (IT PPM) como una metodología eficaz para la gestión de proyectos basados en IT, y una herramienta para proporcionar criterios claros para los directores ejecutivos para la toma de decisiones. El documento proporciona la información acerca de cómo implementar el IT PPM en siete pasos, el análisis de los procesos y las funciones necesarias para su ejecución exitosa. Además, proporciona diferentes métodos y criterios para la selección y priorización de proyectos. Después de la parte teórica donde se describe el IT PPM, la tesis aporta un análisis del estudio de caso de una empresa farmacéutica. La empresa ya cuenta con un departamento de gestión de proyectos, pero se encontró la necesidad de implementar el IT PPM debido a su amplia cobertura de procesos End-to-End en Proyectos de IT, y la manera de asegurar la maximización de los beneficios. Con la investigación teórica y el análisis del estudio de caso, la tesis concluye con una definición práctica de un modelo aproximado IT PPM como una recomendación para su implementación en el Departamento de Gestión de Proyectos.