Laryngeal Preservation Strategies in Locally Advanced Laryngeal and Hypopharyngeal Cancers.

For long, the treatment of locoregionally advanced laryngeal and hypopharyngeal squamous cell cancers (SCC) consisted of either total laryngectomy (TL) or definitive radiotherapy (RT). The development of induction cisplatin plus 5-fluorouracil (PF) and the correlation between chemosensitivity and radiosensitivity in previously untreated patients opened a new era of treatment aiming at laryngeal preservation (LP). The fundamental concept was to employ induction PF in order to select patients for subsequent treatment with either TL or RT according to tumor response to PF. The first two trials (VALGSG for laryngeal SCC and EORTC 24891 for hypopharyngeal SCC) concluded that such an approach could preserve nearly 60% of larynx without deleterious impact on survival. The EORTC 24954 trial compared 4 cycles of induction PF followed by RT in good responders vs. alternating PF-RT in laryngeal and hypopharyngeal SCC. There was no significant difference in 5-year overall survival with a functional larynx between the two arms (31 vs. 35%). The GORTEC 2000-01 trial compared induction PF to induction PF plus docetaxel (TPF) both followed by RT in good responders in larynx and hypopharynx SCC. The 5-year LP was significantly higher in the TPF arm (60 vs. 39%) but without a difference in survival. The RTOG 91-11 trial compared induction PF followed by RT in good responders vs. concurrent chemoradiotherapy (chemo-RT) vs. RT alone in laryngeal SCC. There was no significant difference in 5-year laryngectomy-free survival between the patients treated with induction chemotherapy (44%) vs. those treated with chemo-RT (47%), both being superior to RT alone (34%). At 5 years, LP was superior with chemo-RT: 84 vs. 71% with induction PF. Two phase II trials explored the role of cetuximab (E) in LP in laryngeal and hypopharyngeal SCC. The TREMPLIN trial compared RT+E or chemo-RT (RT + P) after TPF. The DeLOS-II trial compared TPE followed by RT+E vs. TP followed by RT. However, these trials failed to indicate an advantage for the incorporation of E in the treatment paradigm. To date, two approaches for LP have been validated: induction TPF followed by RT for laryngeal and hypopharyngeal SCC and concurrent chemo-RT for laryngeal SCC. An ongoing trial (SALTORL) is comparing these two approaches, induction TPF and chemo-RT, in laryngeal/ hypopharyngeal SCC

Towards Zero-Waste Furniture Design

In traditional design, shapes are first conceived, and then fabricated. While this decoupling simplifies the design process, it can result in inefficient material usage, especially where off-cut pieces are hard to reuse. The designer, in absence of explicit feedback on material usage remains helpless to effectively adapt the design -- even though design variabilities exist. In this paper, we investigate {\em waste minimizing furniture design} wherein based on the current design, the user is presented with design variations that result in more effective usage of materials. Technically, we dynamically analyze material space layout to determine {\em which} parts to change and {\em how}, while maintaining original design intent specified in the form of design constraints. We evaluate the approach on simple and complex furniture design scenarios, and demonstrate effective material usage that is difficult, if not impossible, to achieve without computational support

L’entreprise et l’éducation des adultes

L'entreprise, principalement la grande entreprise, est appelée à jouer un rôle très important dans l'enseignement formel, qu'il s'agisse de la récupération scolaire ou la formation professionnelle. L'auteur indique le pourquoi et les modes.*Business enterprises, principally the larger ones, will have in my opinion to play a very extensive role in the organization of formal education, whether in supplemental studies or in professional training. Important advantages would derive from a close cooperation between representatives of labour and management.It will be of much interest within one or two years from now, to assess the results of a pilot experiment taking place presently at Hydro Quebec. For some time already, many firms have been interested in training their employees but they have put too strong an emphasis on industrial techniques.Expenditures by firms in this area should not be considered to be merely philantropic ; education in fact constitutes a very sound investment. Why do interested parties not undertake to study the possibility of legislation dealing with the subject of leave of absence for study.For the purpose of paving the way to such legislation, the experiments presently carried out under collective agreements should be used more extensively

Surgery for Laryngopharyngeal SCC in the Era of Organ Preservation

Over the past decades, randomized clinical trials have assessed and validated the concept of larynx preservation. This new concept has obviously modified the treatment algorithm for laryngopharyngeal squamous cell carcinoma. However surgery for larynx and hypopharynx cancer remains indicated in many cases. Initial partial surgery is indicated for early diseases. This surgery may be performed endoscopically or openly. The results are excellent in terms of local control and function. Transoral robotic surgery is under evaluation. Initial radical surgery is indicated for advanced diseases in case of very infiltrative tumor, in case of cartilage destruction or when tolerance and/or compliance to chemotherapy-based approached is questionable. Larynx preservation is to be discussed between these two situations. In randomized trials evaluating the different larynx preservation strategies, a substantial number of larynxes could be preserved without compromising disease control or survival. The best approach in terms of quality of function preservation, overall acute and late toxicity, disease control and survival is still a matter of clinical research. It must be stressed that salvage surgery is a definite part of these larynx preservation protocols in order to maintain the ultimate disease control. This discussion underscored the need of a multidisciplinary decision making and the need of a coordinated clinical research

Measuring the Sustainability of Cities: A Survey-Based Analysis of the Use of Local Indicators

We analyze 17 studies of the use of sustainable development indicators (SDI) in an urban setting. The analysis reveals a lack of consensus not only on the conceptual framework and the approach favored, but also on the selection and optimal number of indicators. First, by performing different classifications and categorizations of SDI we identify problems inherent in territorial practices that use SDI. Second, we argue that the lack of consensus in several steps of the creation of SDI stems notably from the ambiguity in the definitions of sustainable development, objectives for the use of such indicators, the selection method and the accessibility of qualitative and quantitative data. Third, we propose a selection strategy for SDI through which we demonstrate the need to adopt a parsimonious list of SDI covering the sustainable development components and their constituent categories as broadly as possible while minimizing the number of indicators retained. Nous analysons 17 études traitant de l’utilisation d’indicateurs de développement durable (IDD) en milieu urbain pour différents pays, provinces ou états occidentaux. 188 IDD différents sont recensés dans ces études dont 135 (72 %) ne sont utilisés qu’une ou deux fois. L’analyse de ces études révèle ainsi un faible consensus non seulement au niveau du cadre conceptuel ou de l’approche préconisée, mais aussi en ce qui concerne la sélection et le nombre d’indicateurs optimal. Premièrement, différents classements et catégorisations des IDD recensés nous permettent d’observer et d’identifier les problèmes inhérents aux pratiques territoriales ayant recours aux IDD. Deuxièmement, nous argumentons que l’absence de consensus à plusieurs étapes de la création des IDD émergent entre autres de l’ambiguïté occasionnée par la définition du développement durable, des objectifs visées par l’utilisation de tels indicateurs, de la méthode de sélection préconisée et de l’accessibilité des données qualitatives et quantitatives en cette matière. Troisièmement, nous proposons une stratégie de sélection des IDD (que nous appelons SuBSeleC) où nous démontrons la nécessité d’adoption d’une liste parcimonieuse d’IDD couvrant le plus largement possible les volets du développement durable et des catégories qui les composent tout en minimisant le nombre d’indicateurs retenus. Le résultat est une liste concise et moins redondante d’indicateurs moins sectoriels et plus intégrateurs ayant l’avantage d’englober les dimensions intégrées du développement durable.Cities, Indicators, Sustainable Development, Environment, Local Governance., Villes, indicateurs, développement durable, environnement, gouvernance locale.

L’impact de la technologie informatique sur la main-d’oeuvre dans les organisations

Comment les dirigeants des entreprises québécoises perçoivent-ils les impacts de la technologie informatique sur la main-d’oeuvre dans leurs propres organisations? Nous exposons dans le cadre de cet article les résultats partiels d’une étude empirique à laquelle plus de 1 700 dirigeants ont participé. Cette recherche se situe donc dans une perspective strictement organisationnelle et non pas macro-économique. Les présents résultats indiquent que la taille mais non le secteur d’activité de l’entreprise, serait un facteur significatif à considérer lors de l’étude des variations du nombre d’emplois et de la productivité dans une organisation. De plus, il existerait des différences importantes selon les catégories d’employés.What is the impact of information technology on human resources in organizations as percieved by managers? This article provides empirical results from a survey of 1,708 organizations. The results indicate that firm size is a significant variable influencing the impact of technology on the number and productivity of employees. Futhermore, different categories of employees are affected differently