Prognostic factors and role of adjuvant therapies in the management of parasagittal meningiomas

L'objectif du présent travail de thèse est d'analyser rétrospectivement la série de méningiomes parasagittaux traités au CHUV, soit par traitements simples ou combinés (chirurgie et / ou radiochirurgie et radiothérapie fractionnée), afin de déterminer les facteurs qui influencent leur pronostic. Méthode: Entre Janvier 1999 et mai 2007, 37 méningiomes parasagittaux ont été traités dans notre centre. Nous avons analysé de manière rétrospective les différents paramètres du traitement de ces méningiomes ainsi que leur emplacement le long du sinus sagittal supérieur, leur volume, leur grade histologique et le degré de résection ainsi que le sexe et l'âge du patient afin de comprendre les facteurs qui influencent leur histoire naturelle. Résultats: Le suivi médian était de 6,7 ans (2,4 -12 ans). Les grades histologiques et le degré de résection tumorale (Simpson) étaient répartis uniformément le long du sinus sagittal supérieur. Le taux actuariel de contrôle global des tumeurs était de 65,9%. L'analyse de régression montre que le grade tumoral et le degré de résection sont deux facteurs extrêmement importants pour déterminer le contrôle tumoral (p <0,002 et ρ <0,008). La localisation le long du sinus sagittal supérieur a montré une baisse du taux de contrôle dans le tiers postérieur (p <0,002). Le sexe, l'âge et le volume de la tumeur n'étaient quand à eux pas des facteurs significatifs. Par ailleurs, et de façon inattendue, dans notre série, la proportion du traitement adjuvant a été beaucoup plus élevée que dans les séries décrites jusqu'à maintenant (39% vs 7%) mais avec un taux de contrôle similaire et diminution de la morbidité et la mortalité. Conclusions: Dans notre série, le grade histologique et le degré de résection tumorale (Simpson) sont des facteurs indépendants de récidive et de contrôle tumoral. Fait intéressant, l'emplacement dans le tiers postérieur du sinus sagittal supérieur semble être un autre facteur indépendant de récidive. Afin d'éviter les morbidités importantes liées à la chirurgie nous préconisons une utilisation précoce de traitements adjuvants pour les tumeurs grade histologique élevé et pour les tumeurs situées dans la partie postérieure du sinus sagittal supérieur

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.

Prevalence and management of cardiovascular risk factors in Portuguese living in Portugal and Portuguese who migrated to Switzerland.

BACKGROUND: Information regarding the health status of migrants compared to subjects who remain in the country of origin is scarce. We compared the levels and management of the main cardiovascular risk factors between Portuguese living in Porto (Portugal) and Portuguese migrants living in Lausanne (Switzerland). METHODS: Cross-sectional studies conducted in Porto (EPIPorto, 1999 to 2003, n = 1150) and Lausanne (CoLaus, 2003 to 2006, n = 388) among subjects aged 35-65 years. Educational level, medical history and time since migration were collected using structured questionnaires. Body mass index, blood pressure, cholesterol and glucose levels were measured using standardized procedures. RESULTS: Portuguese living in Lausanne were younger, more frequently male and had lower education than Portuguese living in Porto. After multivariate adjustment using Poisson regression, no differences were found between Portuguese living in Porto or in Lausanne: prevalence rate ratio (PRR) and (95% confidence interval) for Portuguese living in Lausanne relative to Portuguese living in Porto: 0.92 (0.71 - 1.18) for current smoking; 0.78 (0.59 - 1.04) for obesity; 0.81 (0.62 - 1.05) for abdominal obesity; 0.82 (0.64 - 1.06) for hypertension; 0.88 (0.75 - 1.04) for hypercholesterolemia and 0.92 (0.49 - 1.73) for diabetes. Treatment and control rates for hypercholesterolemia were higher among Portuguese living in Lausanne: PRR = 1.91 (1.15 - 3.19) and 3.98 (1.59 - 9.99) for treatment and control, respectively. Conversely, no differences were found regarding hypertension treatment and control rates: PRR = 0.98 (0.66 - 1.46) and 0.97 (0.49 - 1.91), respectively, and for treatment rates of diabetes: PRR = 1.51 (0.70 - 3.25). CONCLUSIONS: Portuguese living in Lausanne, Switzerland, present a similar cardiovascular risk profile but tend to be better managed regarding hypercholesterolemia than Portuguese living in Porto, Portugal.

Complications of systemic juvenile idiopathic arthritis: risk factors and management recommendations.

Systemic juvenile idiopathic arthritis (SJIA) is an inflammatory condition characterized by fever, lymphadenopathy, arthritis, rash and serositis. Systemic inflammation has been associated with dysregulation of the innate immune system, suggesting that SJIA is an autoinflammatory disorder. IL-1 and IL-6 play a major role in the pathogenesis of SJIA, and treatment with IL-1 and IL-6 inhibitors has shown to be highly effective. However, complications of SJIA, including macrophage activation syndrome, limitations in functional outcome by arthritis and long-term damage from chronic inflammation, continue to be a major issue in SJIA patients' care. Translational research leading to a profound understanding of the cytokine crosstalk in SJIA and the identification of risk factors for SJIA complications will help to improve long-term outcome.

Lost in translation: dietary management of cardiovascular risk factors is seldom implemented.

OBJECTIVE: To assess dietary management of cardiovascular risk factors (CVRFs) in the general population. METHOD: Cross-sectional study conducted between 2009 and 2012 on 4811 participants (2567 women, 58±11years) living in Lausanne, Switzerland. RESULTS: Sixteen percent of participants diagnosed with overweight/obesity reported a slimming diet. Slimming diet was associated with diagnosis of hypertension: Odds ratio and (95% confidence interval): 0.61 (0.40-0.93); older age [0.84 (0.58-1.21), 0.79 (0.53-1.18) and 0.47 (0.27-0.81) for [50-60[, [60-70[ and [70+ years, respectively]; female gender [1.84 (1.36-2.48)] and diagnosis of diabetes [2.16 (1.13-4.12)]. Only 8% of participants diagnosed with hypertension reported a low-salt diet. Low-salt diet was associated with antihypertensive drug treatment [2.17 (1.28-3.68)] and diagnosis of diabetes [2.72 (1.26-5.86)]. One-third of participants diagnosed with dyslipidemia reported a low-fat diet. Low-fat diet was associated with female gender [1.47 (1.17-1.86)]; older age [1.29 (0.89-1.87), 1.71 (1.18-2.48) and 2.01 (1.33-3.03) for [50-60[, [60-70[ and [70+ years, respectively]; hypolipidemic drug treatment [OR=1.68 (1.29-2.18)]; current smoking [0.70 (0.51-0.96)] and obesity [0.67 (0.45-1.00)]. Approximately half of participants diagnosed with diabetes reported an antidiabetic diet. Antidiabetic diet was associated with current smoking [0.44 (0.22-0.88)] and antidiabetic drug treatment [OR=3.26 (1.81-5.86)]. CONCLUSION: Dietary management of CVRFs is seldom implemented in Switzerland.

Critical Success and Failure Factors of Knowledge Management Implementation in a Large Multinational Company

More and more companies are interested in implementing knowledge management. However, the majority of knowledge management initiatives will fail to have any significant impact. In this study, theories regarding knowledge management implementation and adoption are investigated further. The objective of this study is to deepen understanding regarding the critical factors that contribute to successful knowledge management adoption in large multinational companies. The study is formulated around the following four research questions: 1. What are the key success and failure factors in knowledge management implementation? 2. How can knowledge management adoption be improved at the individual, group and organizational levels of the company? 3. What are the critical factors that hinder knowledge management adoption in the case company? 4. How can the case company promote the adoption of knowledge management among company personnel? The methodology used in this study is a combination of a literature review and an explanatory, exploratory, qualitative single-case study. The literature review answers the first and second research questions. Based on the literature review, a framework is presented to illustrate the factors contributing to the success of knowledge management implementation. The framework also links together knowledge management implementation and adoption. The third research question is answered by revealing the relevant findings from 21 expert interviews and 2 online questionnaires with 42 respondents in total. By comparing and contrasting the results of the literature review with the findings of the empirical case study, the fourth research question is answered. The concrete outcomes of this study are a framework to elucidate the factors contributing to the success of knowledge management implementation, a case study highlighting the issues that hinder knowledge management adoption within the case company, and recommendations for the case company.

Key success factors and process for IT project portfolio management

The importance of Information Technology (IT) in the business environment is continuously growing. This stimulates the increase of size, complexity and number of IT projects and raises the need for IT Project Portfolio Management (IT PPM). While being actively discussed for the last few decades, IT PPM has a short history of practical implementation. This creates inconsistency in the views of different authors and provides an opportunity for additional research. As a first step, this research explores the existing studies and brings together the views of different authors on IT PPM. As a result, a high-level IT PPM Process Cycle and a set of Key Success Factors for IT PPM are proposed. IT PPM Process Cycle gives an overview of the main elements of IT PPM process, while the set of Key Success Factors provides a number of factors that should be considered during the implementation. As a second step, both theoretical deliverables are empirically tested by a case study and a survey conducted in a big multinational company. The case study is used to analyze process framework of the studied company towards the developed IT PPM Process Cycle. Subsequently, a survey was conducted among subject matter experts of the same company to evaluate the importance and relevance of the proposed Key Success Factors. Finally, this thesis concludes with findings made during the case study and provides an empirically tested selection of factors to be taken into account. These two deliverables can be used by both academics and practitioners to close the gaps in existing literature and assist in IT PPM implementation.

Reporting of Green Supply Chain Management and Industrial Symbiosis

The purpose of this thesis is to examine how the reporting of operations related to green supply chain management and industrial symbiosis has evolved in UPM, Fortum and Kemira within the last ten years. The focus is on the improved operations, which are studied based on annual reports of these companies. The study provides a deeper understanding of the nature of green supply chain management and industrial symbiosis as well as the possibilites that their combination offers. The research is part of the DemaNET research project The study indicates that the environmental regulations and reporting standards have forced the studied companies to report their operations related to green supply chain management and industrial symbiosis more in detail during the last ten years. The operations related to green supply chain management in the studied companies are more common compared to operations related to industrial symbiosis. Often these two operations were also partially integrated, indicating a hybrid model. Even though firms often used hybrid models they still focused mainly on greening the internal operations rather than finding alternative ways for symbiosis outside the organization. The integration of green supply chain management and industrial symbiosis is most likely to occur when mutually beneficial relationships align the interests of all parties, thus resulting in the co-creation of value. The findings suggest that identifying mutual benefits and the flow of by-products are the ones that companies should give more attention to.

Factors that impact the sustainability of wait time management strategies for total joint replacement surgeries in canadian provinces

Pour répondre aux exigences du gouvernement fédéral quant aux temps d’attente pour les chirurgies de remplacement du genou et de la hanche, les établissements canadiens ont adopté des stratégies de gestion des listes d’attentes avec des niveaux de succès variables. Notre question de recherche visait à comprendre Quels facteurs ont permis de maintenir dans le temps un temps d’attente répondant aux exigences du gouvernement fédéral pendant au moins 6-12 mois? Nous avons développé un modèle possédant quatre facteurs, inspiré du modèle de Parsons (1977), afin d’analyser les facteurs comprenant la gouvernance, la culture, les ressources, et les outils. Trois études de cas ont été menées. En somme, le 1er cas a été capable d’obtenir les exigences pendant six mois mais incapable de les maintenir, le 2e cas a été capable de maintenir les exigences > 18 mois et le 3e cas a été incapable d’atteindre les objectifs. Des documents furent recueillis et des entrevues furent réalisées auprès des personnes impliquées dans la stratégie. Les résultats indiquent que l’hôpital qui a été en mesure de maintenir le temps d’attente possède certaines caractéristiques: réalisation exclusive de chirurgie de remplacement de la hanche et du genou, présence d’un personnel motivé, non distrait par d’autres préoccupations et un esprit d’équipe fort. Les deux autres cas ont eu à faire face à une culture médicale moins homogène et moins axés sur l’atteinte des cibles; des ressources dispersées et une politique intra-établissement imprécise. Le modèle d’hôpital factory est intéressant dans le cadre d’une chirurgie surspécialisée. Toutefois, les patients sont sélectionnés pour des chirurgies simples et dont le risque de complication est faible. Il ne peut donc pas être retenu comme le modèle durable par excellence.

Ecolabeling and Green Certification for Effective Fisheries Management – An Analysis

Nowadays there is a growing environmental concern and the business communities have slowly started recognising environmental protection and sustainable utilization of natural resources into their marketing strategies. This paper discusses the various Ecolabeling and Certification Systems developed world over to regulate and introduce Fair Trade in Ornamental Fish Industry. Ecolabeling and green certification are considered as part of these strategies implemented partly out of compulsion from the National and International Regulatory Bodies and Environmental Movements. All the major markets of ornamental fishes like European Union, USA and Japan have started putting restrictions on the trade to impose ecolabeling as a non tariff barrier like the one imposed on seafood and aqua cultured products. A review was done on the available Ecolabeling and Green Certification Schemes available at local, national and international levels for fisheries including aquaculture and ornamental fish trade and to examine the success and constraints faced by these schemes during its implementation. The primary downside of certification is the multiplicity of ecolabels and cost incurred by applicants for certification, costs which may in turn be passed on to consumers. The studies reveal serious inadequacies in a number of ecolabels and cast doubt on their overall contribution to effective fisheries management and sustainability. The paper also discusses the inititive taken in India to develop guidelines for Green Certification of Fresh water ornamental fishes.

From Subsistence Agriculture to Commercial Enterprise: Community management of green technologies for resilient food production

The aim of this paper is to emphasize the capacity and resilience of rural communities in regard to sustainable food security by adopting innovative approaches to irrigation. The shift from subsistence to commercial agriculture is promoted as a means to sustainable development. An analysis of the efficacy of irrigation schemes in Zimbabwe suggests that, in terms of providing sustainable agricultural production, they have neither been cost-effective nor have they provided long-term food security to their beneficiaries. This is certainly true of Shashe Scheme and most others in Beitbridge District. The Shashe Irrigation Scheme project represents a bold attempt at developing a fresh approach to the management of communal land irrigation schemes through a Private Public Community Partnership. The model illustrated represents a paradigm shift from subsistence agriculture to a system based on new technologies, market linkages and community ownership that build resilience and lead to sustainable food security and economic prosperity.

Participatory Farm Management methods for assessing the suitability of potential innovations. A case study on green manuring options for tomato producers in Ghana

This paper examines the potential of using Participatory Farm Management methods to examine the suitability of a technology with farmers prior to on-farm trials. A study examining the suitability of green manuring as a technology for use with wet season tomato producers in Ghana is described. Findings from this case-study demonstrate that Participatory Budgeting can be used by farmers and researchers to analyse current cultivation practices, identify the options for including green manures into the system and explore the direct and wider resource implications of the technology. Scored-Causal Diagrams can be used to identify farmers' perceptions of the relative importance of the problem that the technology seeks to address. The use of the methods in this examine evaluation process appears to have the potential to improve the effectiveness and efficiency of the adaptive research process. This ensures that technologies subsequently examined in trials ate relevant to farmers' interests, existing systems and resources, thereby increasing the chances of farmer adoption. It is concluded that this process has potential for use-with other technologies and in other farming systems. (C) 2002 Elsevier Science Ltd. All rights reserved.

Influence of socio-economic and cultural factors in rice varietal diversity management on-farm in Nepal

A questionnaire survey of 408 households explored the role of socio-economic and cultural factors in rice (Oryza sativa L.) varietal diversity management on-farm in two contrasting eco-sites in Nepal. Multiple regression outputs suggest that number of parcels of land, livestock number, number of rice ecosystems, agro-ecology (altitude), and use of chemical fertilizer have a significant positive influence on landrace diversity on-farm, while membership in farmers' groups linked to extension services has significant but negative influence on landrace diversity. Factors with significant positive influence on diversity of modern varieties on-farm were number of parcels of land and of rice ecosystems, access to irrigation, membership in farmers' groups, and use of insecticide. Within communities, resource-endowed households maintain significantly higher varietal diversity on-farm than resource-poor households and play a significant role in conserving landraces that are vulnerable to genetic erosion and those with socio-cultural and market-preferred traits. Resource-poor households also contribute to local diversity conservation but at lower richness and area coverage levels than resource-endowed households. Households where a female had assumed the role of head of household due to death or migrant work of her husband had less diversity due to lower labor availability. Landraces with socio-cultural and market-preferred traits are few in number but have potential to be conserved on-farm.