Thesis (doctoral)--University of Helsinki.

Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2009. / Directed by Gerald Duffy; submitted to the Dept. of Curriculum and Instruction. Title from PDF t.p. (viewed May 10, 2010). Includes bibliographical references (p. 173-180).

Thesis (Ph. D.)--Drexel University, 2005. / Includes abstract and vita. Includes bibliographical references (leaves 120-134).

Abstract Imaging of the head and spine with CT and/or MRI was performed on 125 Northern Finnish NF1 patients to evaluate the CNS lesions in patients of different ages and their role in diagnosis and follow-up. Manifestations of NF1 in the head were more common in children than in adults. 77% of the children and 33% of the adults had T2 hyperintense brain lesions. Optic gliomas were present in 29% of the patients, in 44% of the children and 10 % of the adults. 8% of the patients had other intracranial tumours . Spinal lesions were seen in 75% of the patients. Hyperintense T2 lesions were most common in the age group of 5 to 9 years. During follow-up of the children, the lesions diminished in 25%, remained unchanged in 36%, showed mixed behaviour in 20% and disappeared in 10%. In 15% they increased in size and number. In one patient a malignant tumour developed at the site of a T2 lesion. Optic gliomas were located intraorbitally and/or prechiasmally in 94%, chiasmally and/or at the hypothalamus in 58% and in other optic areas in 14% of the patients. 52 % of the intraorbital gliomas were bilateral. The gliomas remained unchanged in 68% of the children and 50% of the adults. Other lesions included plexiform neurofibromas, sphenoid bone dysplasias and hydrops of the optic sheath. Optic glioma was more common in children with T 2 hyperintense brain lesions than without them. The other brain tumours included six astrocytomas, including an affected mother and her son. In one patient the astrocytoma regressed spontaneously. Hydrocephalus was seen in 5% of the patients. T2 hyperintense brain lesions were more common and numerous in macrocephaly; all macrocephalic children, but only 59% of the normocephalic children were affected. All children without T2 lesions were normocephalic. The brain measurements did not reveal any specific area to be responsible for macrocephaly. Spinal postural changes and dural ectasias were more common in adults. The spinal cord was affected in two patients. Spinal neurofibromas were seen in 19% of the children and 55% of the adults. Even young children may have severe manifestations. In one family a rare familial type of spinal neurofibromatosis (FSNF) was observed in four adults with bilateral spinal neurofibromas at all levels of the spine. Although both CT and MRI were valuable in CNS imaging, MRI proved to be the method of choice in detecting T2 hyperintense brain lesions, in evaluating the intracranial extent of optic gliomas and hydrops of the optic sheath and lesions of the spinal cord and nerves. MR imaging proved necessary for evaluating the extent of NF1 manifestations and helpful in the diagnosis, screening and follow-up of NF1 patients.

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The purpose of this study was to examine the key factors associated with sustaining an effective educational program. The primary research question was: How did the Bright Beginnings: Fantastic Follow Through program sustain itself for more than 25 years? The secondary research questions asked in this study were: (a) what role did the school context play in sustaining the program; (b) what role did leadership play in sustaining the program; (c) how did the school culture affect sustaining the program; (d) how did the implementation, continuation, and evaluation phases of the change effort affect sustaining the program; and (e) what effect, if any, did external factors have on sustaining the program? This study was a descriptive case study of one exemplary program in an urban elementary school in a mid-Atlantic state. A naturalistic, responsive inquiry approach was employed through in-depth interviews, combined with document reviews as data sources. The key participants included local school administrators, teachers, parents, and the central administrative liaison to the program. The participants were interviewed in-person for approximately 30-60 minutes in length. Materials gathered during the in-depth interviews were transcribed and analyzed after the interviews were completed. First the researcher read the transcribed interviews and hand-coded the consistencies and emerging themes onto a large chart. Second, a matrix was made of the hand-coded data using a word processor. Third, the researcher identified themes, common patterns and important stories shared by the participants regarding the elements essential to the institutionalization of an educational program. Discussion of the summary, conclusions, implications for practice, and recommendations for further research are provided in Chapter Five. / Ed. D.

Cette thèse de doctorat porte sur la compréhension des aspects concurrentiels du marché de l’innovation incrémentale en France en s’appuyant sur une approche empirique. A cette fin, l’analyse porte plus particulièrement sur l’innovation incrémentale et les dynamiques concurrentielles des médicaments appelés en France « similaires ». La littérature anglophone retient les expressions « me-too » ou « follow-on » pour définir les produits pharmaceutiques à faible valeur ajoutée et qui ont des caractéristiques anatomiques, thérapeutiques et chimiques proches des molécules précédemment mises sur le marché. Le premier chapitre vise notamment l’étude sur les parts de marché des médicaments « follow-on » et le lien avec la variable stratégique définie par l’ordre d’arrivée sur le marché. Dans ce chapitre de thèse, on vérifie que les premiers follow-on d’une classe thérapeutique ont un avantage concurrentiel en ce qui concerne la capacité des capturer et de maintenir des parts de marché pendant une longue période. En outre, les parts de marché sont positivement corrélés avec l’habilité de la firme de fixer un prix supérieur au premier médicament de la classe. Cet avantage stratégique des premiers entrants est aussi intrinsèquement lié aux caractéristiques qualitatives des produits puisque nous avons pu constater que les parts de marché des médicaments sont directement corrélés avec le niveau d’innovation du produit. Le deuxième chapitre de la thèse apporte des éléments sur la nature concurrentielle en termes de prix du marché de l’innovation pharmaceutique incrémentale. Deux variables dépendantes mesurant le prix ont été considérées : le prix du produit calculé en coût du traitement journalier et le prix du médicament divisé par la moyenne des prix des médicaments similaires dans la classe. Nous vérifions que les derniers entrants ont une tendance à avoir un prix inférieur aux premières molécules « follow-on ». Cela implique une caractérisation des derniers entrants ayant un moindre pouvoir de négociation avec le régulateur autour du prix, notamment en raison d’une qualité innovatrice intrinsèque plus faible. Le troisième chapitre présente une analyse empirique autour de la confrontation des deux marchés émergents et d’importance majeure pour la régulation des systèmes de santé : le marché des génériques et le marché des médicaments « follow-on ». L’analyse se concentre sur les aspects de l’intensité de la compétition dans le marché des médicaments brevetés similaires et son impact sur la pénétration des versions génériques de ces derniers. Le constat est que l’intensité de la compétition de médicaments similaires est positivement et significativement corrélée avec l’introduction des génériques. Plus de produits « follow-on » entrainerait donc une baisse encore plus importante des prix des génériques des derniers « follow-on » dans la classe thérapeutique. L’approche essentiellement empirique de cette thèse doctorale permet ainsi de mieux comprendre les déterminants et la dynamique de ce marché relativement émergent et qui suscite des nombreux débats au sein de la communauté scientifique. Enfin nous terminons par une brève conclusion générale fondé autour des résultats de cette recherche permettent d’affirmer que dans un marché régulé comme celui qui prévaut en France, l’intensité de la compétition, engendré notamment par l’arrivé sur le marché des médicaments « follow-on », peut avoir des conséquences positives sur les aspects concurrentiels du secteur du médicament...... / The dynamics of pharmaceutical markets have been constantly changing last years. The development of the so called “follow-on” or “me-too” drugs has been in the centre of a major debate concerning the ability of innovation in the health sector. These drugs are characterized by having a minor level of innovation and do not add any therapeutic value in relation to the previous drugs launched in the market. This doctoral dissertation proposes three empirical essays concerning competition aspects in the market of incremental innovation in France. The first chapter focuses on the impact of entry order on “follow-on” drugs competition in the French market between years 2001 and 2007. More precisely, this study examines the effects on market share of first entrants in the follow-on drug market and how this possible competitive advantage changes over time. Our results are coherent with theoretical microeconomic issues concerning the importance of being first. We find evidence that first movers in the follow on drug market have the ability to capture and maintain greater market share for a long period of time. The hierarchical market position of follow on drugs does not seem to be affected by generic drugs emergence. From a dynamic perspective, our analysis shows that market share is positively correlated with the ability of follow on drugs to set prices higher than the average follow-on drug price in a specific therapeutic class (ATC) which means that market power remains considerably important for first movers. Finally we found that the optimum level of innovation to maximize market share is the highest one.The second chapter examines the relationship between entry order of follow-on drugs and their prices on the French pharmaceutical market. We used a representative panel data of 1047 follow-on drug formulations distributed in 118 ATC classes set over 2001-2007. Two measures of prices were used in the econometric specifications: the absolute price and the relative price of the follow-on drugs. The former concerns simply the absolute price of the drug in daily costs and the latter is the price of the drug relative to the average price of the follow-on drugs in the class. Both prices are calculated on the basis of manufacturer prices. These different indicators give us similar results for the impact of entry order on prices but they are differently correlated with market share. Moreover, our study analyses the potential impact of several variables on prices of pharmaceutical incremental innovation such as firm size, innovation and intensity of competition. Our results suggest that big firms have more ability to negotiate higher prices and that the number of follow-on drugs in the class and the emergence of generic competition may help decrease general prices in the ATC class. We have not found any relationship between prices and innovation in the French pharmaceutical market.The third chapter investigates the potential relationship between follow-on drugs dissemination and generic drug market emergence. It explores the structural determinants of off-patented drugs development at the therapeutic class level with a focus on explanatory variables that reflect the intensity of competition amongst similar interchangeable drugs. We found that generic market growth is greater in therapeutic classes where the number of similar drugs is high and the average brand price is low. This could be due to the fact that brand name drugs reduce their prices to keep market share when generic drugs enter the market. We study also the generic to follow-on brand price ratio at the individual drug level and we found that generic prices of later follow-on drugs are closer to the price of the brand name than generics of first follow-on movers. Our results are coherent with the fact that intensity of competition in the follow-on drugs may help reduce prices not only in the patented drug markets but also in the off-patented sector.

Follow-up is a natural component of both project management and projects which, curiously enough, the research community has not previously addressed. The purpose of this paper is to investigate the role of the follow-up process in project management. The follow-up process is defined as a process where execution and implementation is improved through the exertion of continuous control. The method used was a multiple-case study, building on data from four organizations actively implementing follow-up processes. The data comprised interviews with project managers from the case organizations, company documentation, annual reports, publicly available information and presentations. The sectors the case organizations operated in were IT services, manufacturing, event organization, and a governmental administrative authority. Five themes emerged from an analysis of the empirical data which were found to influence the follow-up process in projects. The five themes are Documentation, Standardization, Accountability, Learning and Risk Assessment. With insights from the five themes, the research community and project managers can gain a strong understanding of what the follow-up process looks like and its role in project management. The implications for project managers include a better appreciation of the follow-up process and knowledge of the aspects to consider when setting up a new project process. With this paper the authors hope to contribute to the improvement of project management research and practice through a heightened awareness and understanding of the follow-up process.

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