Strategic considerations for construction in the People’s Republic of China: the case of German contractors in the 1990s

The construction industry has been struggling to integrate business strategies that are anticipating the internationalisation and infiltration of international markets. This article attempts to evaluate the China operations of German contractors from a strategic management decision perspective in the period between 1990 and 2000. Existing internationalisation theories have appeared to be inappropriate to explain international construction due to the unique project nature of construction business. The Ownership, Location and Internationalisation (OLI)-paradigm was initially developed to explain international production pattern was revised to form the basis for the evaluation of the Construction contractors’ market activities. The interviews indicate an industry-specific culture that affects how companies approach foreign markets. Some exceptional companies illustrated a higher degree of openness towards a more strategic and consistent approach in terms of the development of overseas markets

Estudio y análisis jurídico de la Ley 17/04 relativa al Código del Medicamento y de la Farmacia en Marruecos

La memoria de esta tesis doctoral, que se expone a continuación, trata de analizar la Ley 17-04 relativa al Código del Medicamento y de la Farmacia, considerada hoy en día como el texto legislativo de mayor importancia, y fuente principal, del Derecho Farmacéutico en Marruecos. A través del estudio realizado se pretende detectar los puntos positivos y negativos de la Ley 17-04, norma que lleva más de una década en vigor. Destaca la coherencia y la armonía de dicha ley y la de sus textos reglamentarios de desarrollo, con respecto a los textos legislativos y reglamentarios anteriores que rigen el medicamento y la farmacia en Marruecos. Al mismo tiempo, recordaremos las principales enmiendas que han sido propuestas por las corporaciones farmacéuticas al proyecto de Ley 17-04, haciendo hincapié en aquellas que han sido rechazadas analizando si todavía siguen de actualidad. Para llevar a cabo este estudio hemos recurrido en primer lugar a una recopilación y sistematización de datos: disposiciones jurídicas (textos legislativos y reglamentarios), jurisprudencia y doctrina. Luego hemos procedido al análisis de la situación actual y al estudio analítico y propuesta de posibles reformas instando a las autoridades competentes. Así, hemos tratado las distintas partes de la Ley 17-04 junto con sus correspondientes textos de aplicación, estudiando las disposiciones de sus artículos comparándolas con aquellas que figuraban en el Dahir de 1960 y al mismo tiempo relacionándolas con otras disposiciones que figuren en otros textos jurídicos vigentes relacionados con el medicamento y la farmacia, insistiendo sobre la cuestión de la armonía que debe existir entre todas las disposiciones de las diferentes normas jurídicas. Entre los principales resultados de este estudio destacamos, sobre todo, que la Ley 17-04 supone un gran avance con respecto a la ley anterior de 1960. Sin embargo, la lentitud y la falta de publicación de los textos de aplicación del Código del Medicamento y de la Farmacia impiden la aplicación del mismo. Por otra parte, las atribuciones del Colegio de Farmacéuticos, tal y como vienen fijadas en la Ley 17-04, no se ajustan a las disposiciones del Dahir de 1976. Cabe señalar también, que siete artículos del Código del Medicamento y de la Farmacia hacen referencia al Dahir de 1922 de sustancias venenosas, cuestión que parece incongruente al tratarse de un texto muy obsoleto que no corresponde con el ejercicio profesional de la farmacia de hoy en día. Es preciso mencionar también que las principales enmiendas, presentadas por las corporaciones farmacéuticas, al proyecto de Ley 17-04 han sido rechazadas por la administración, y por tanto están en vigor. El estudio analítico y crítico que aquí se presenta podrá servir como base para argumentar y justificar las reivindicaciones de las corporaciones farmacéuticas de Marruecos que abogan por la reforma del sector farmacéutico y la instauración de un nuevo modelo de ejercicio profesional en el marco de las recomendaciones de la Organización Mundial de la Salud (OMS) y la International Pharmaceutical Federation (FIP). Por otra parte, este trabajo podrá servir también como base para futuros trabajos de investigación de Derecho Farmacéutico comparado entre las normas marroquíes y las de otros países próximos, como por ejemplo España

Die deutschen Bauunternehmen – kein Hang zur Größe

Die deutsche Bauwirtschaft hat seit dem Beginn der neunziger Jahre einen fundamentalen Strukturwandel vollzogen, der bis heute noch anhält. In der ersten Hälfte der neunziger Jahre wurde sie – insbesondere durch zahlreiche staatliche Programme sowie hohe steuerliche Anreize begünstigt – von umfangreichen Bauinvestitionen im Gefolge der deutschen Wiedervereinigung geprägt. Daran anschließend folgten zehn Jahre mit schwindender Baunachfrage. Trotz eines weiterhin latenten Bedarfs in vielen Bereichen ging die Bautätigkeit kontinuierlich zurück. Preisbereinigt wurde 2005 ein Viertel weniger in Bauten investiert als zehn Jahre zuvor. Seitdem ist jedoch eine merkliche Erholung zu verzeichnen. Die negative Entwicklung über einen so langen Zeitraum hinweg ist auch an den bauausführenden Firmen nicht spurlos vorbeigegangen. Während sich die Anzahl der Firmen des Bauhauptgewerbes in den letzten knapp zwei Jahrzehnten sogar leicht erhöhte, halbierte sich die Zahl der Beschäftigten. Die heftigsten Rückgänge verzeichneten die Großunternehmen. In Deutschland waren 2009 nur noch 25 Baufirmen mit mehr als 500 Beschäftigten tätig; 1991 waren es noch 180. Auch im europäischen Vergleich zeigt sich, dass deutsche Bauunternehmen anscheinend keinen Hang zur Größe haben. Von den 50 größten Baukonzernen in Europa waren 2008 lediglich zwei in Deutschland angesiedelt, aber 13 in Großbritannien, sieben in den Niederlanden und sechs in Spanien. Und bald könnte es nur noch einer sein – nach einer möglichen Übernahme von Hochtief durch ACS.Bauwirtschaft, Unternehmen, Beschäftigung, Preiswettbewerb, Deutschland

L’exstrophie vésicale chez l’adulte: A propos de 5 cas

RésuméButle but de cette étude est d’analyser les particularités de l’exstrophie vésicale chez l’adulte, sur les plans psycho-social et chirurgical.Patients et méthodesil s’agit d’une étude rétrospective de 5 patients, âgés entre 18 et 25ans, hospitalisés pour prise en charge d’une exstrophie vésicale. Les scores ICIQ-SF et MCS-SF36 ont été utilisés pour évaluer respectivement la continence urinaire et la qualité de vie avant et après réalisation d’une urostomie de type de vessie iléo-coecale continente VICC.Résultatsune amélioration significative a été notée sur les plans de continence et qualité de vie: l’ICIQ-SF après 6 mois était de 4,2+- 4,02 contre 18,8+- 2,28 avant chirurgie (p=0,0003), et le MCS-SF à 6 mois était de 57,15+/-13,37 contre 37,2+/-13,22 avant chirurgie (p=0,045). Des complications stomiales à long terme ont été enregistrées.Conclusionl’urostomie continente à type de VICC améliore la qualité de vie et la continence des patients adultes ayant une exstrophie vésicale, mais au prix de complications stomiales à long terme.AbstractObjectivethe aim of this study is to analyze sexual, psycho-social and surgical particularities of bladder exstrophy in adulthood.Patients and methodsa retrospective study was performed including 5 patients, from 18 to 25 years old, admitted for management of bladder exstrophy. ICIQ-SF and MCS-SF36 scores were used to assess respectively urinary continence and quality of life before and after continent ileo-coecal bladder.Resultsa significant improvement was noted in both urinary continence and quality of life: the ICIQ-SF after 6 months was 4.2+/- 4.02 against 18.8+/- 2.28 before surgery (p=0.0003), and MCS-SF at 6 months was 57.15+/-13.37 against 37.2+/-13.22 before surgery (p=0.045). Stomal complications were recorded in the long term.Conclusionthe continent ileocoecal bladder improves the quality of life and urinary continence in adult patients with bladder exstrophy, but at the cost of long-term stomal complications

Targeting Hsp27/eIF4E interaction with phenazine compound: A promising alternative for castration-resistant prostate cancer treatment

The actual strategy to improve current therapies in advanced prostate cancer involves targeting genes activated by androgen withdrawal, either to delay or prevent the emergence of the castration-refractory phenotype. However, these genes are often implicated in several physiological processes, and long-term inhibition of survival proteins might be accompanied with cytotoxic effects. To avoid this problem, an alternative therapeutic strategy relies on the identification and use of compounds that disrupt specific protein-protein interactions involved in androgen withdrawal. Specifically, the interaction of the chaperone protein Hsp27 with the initiation factor eIF4E leads to the protection of protein synthesis initiation process and enhances cell survival during cell stress induced by castration or chemotherapy. Thus, in this work we aimed at i) identifying the interaction site of the Hsp27/eIF4E complex and ii) interfere with the relevant protein/protein association mechanism involved in castration-resistant progression of prostate cancer. By a combination of experimental and modeling techniques, we proved that eIF4E interacts with the C-terminal part of Hsp27, preferentially when Hsp27 is phosphorylated. We also observed that the loss of this interaction increased cell chemo-and hormone-sensitivity. In order to find a potential inhibitor of Hsp27/eIF4E interaction, BRET assays in combination with molecular simulations identified the phenazine derivative 14 as the compound able to efficiently interfere with this protein/protein interaction, thereby inhibiting cell viability and increasing cell death in chemo- and castration-resistant prostate cancer models in vitro and in vivo

Controversy and consensus on indications for sperm DNA fragmentation testing in male infertility: a global survey, current guidelines, and expert recommendations.

PURPOSE: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. MATERIALS AND METHODS: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. RESULTS: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. CONCLUSIONS: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians

Technical aspects and clinical limitations of sperm DNA fragmentation testing in male infertility: a global survey, current guidelines, and expert recommendations.

PURPOSE: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. MATERIALS AND METHODS: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. RESULTS: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). CONCLUSIONS: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial

Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: a global survey, current guidelines, and expert recommendations

PURPOSE: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. MATERIALS AND METHODS: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. RESULTS: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. CONCLUSIONS: This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians

Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

PURPOSE: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. MATERIALS AND METHODS: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. RESULTS: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). CONCLUSIONS: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial

Artificial intelligence in andrology: From Semen Analysis to Image Diagnostics

Artificial intelligence (AI) in medicine has gained a lot of momentum in the last decades and has been applied to various fields of medicine. Advances in computer science, medical informatics, robotics, and the need for personalized medicine have facilitated the role of AI in modern healthcare. Similarly, as in other fields, AI applications, such as machine learning, artificial neural networks, and deep learning, have shown great potential in andrology and reproductive medicine. AI-based tools are poised to become valuable assets with abilities to support and aid in diagnosing and treating male infertility, and in improving the accuracy of patient care. These automated, AI-based predictions may offer consistency and efficiency in terms of time and cost in infertility research and clinical management. In andrology and reproductive medicine, AI has been used for objective sperm, oocyte, and embryo selection, prediction of surgical outcomes, cost-effective assessment, development of robotic surgery, and clinical decision-making systems. In the future, better integration and implementation of AI into medicine will undoubtedly lead to pioneering evidence-based breakthroughs and the reshaping of andrology and reproductive medicine