Fatigue in a cohort of geriatric patients with and without Parkinson's disease

We evaluated the frequency of fatigue in geriatric patients with and without Parkinson's disease (PD) and correlated it with depression and excessive daytime sleepiness. We evaluated 100 patients from Hospital São Paulo, 50 with PD from the Neurologic Outpatient Clinic and 50 with non-neurologic diseases or oncologic diseases from the Geriatric Outpatient Clinic (controls). All patients who scored 28 or more on the Fatigue Severity Scale (FSS) were considered to have fatigue. Also, all patients were submitted to a structured interview to diagnose depression by the criteria of the American Psychiatric Association (DSM-IV, 4th version) and were evaluated by the Modified Impact of Fatigue Scale and the Epworth Sleepiness Scale (ESE) to detect excessive daytime sleepiness. Demographic and disease details of all PD patients were recorded and the patients were examined and rated by the Unified Parkinson's Disease Rating Sale (UPDRS) and Hoehn-Yahr staging. Frequency of fatigue (FSS ≥28) was 70% for PD and 22% for controls. Twenty of 35 PD patients with fatigue had concomitant depression. Compared to controls, PD patients were found more frequently to have depression by DSM-IV criteria (44 vs 8%, respectively) and excessive daytime sleepiness by the ESE (44 vs 16%), although only depression was associated with fatigue. Fatigue was more frequent among depressed PD and control patients and was not correlated with PD duration or with UPDRS motor scores. ESE scores did not differ between patients with or without fatigue.

NEW BUSINESS MODELS – Sustainability as a main focus

A business model is a structure frame of an organization that can bring significant benefits and competitive advantage when structured properly. The aim of this paper was to observe and describe development of business models’ and identify factors and elements of a business model that are in a key role from the perspective of an organizational sustainability. One is striving to bring out in this thesis how should truly sustainable business model look like and what are main characteristics of it. Additionally, some recommendations that could be helpful in order to build sustainable and balanced business model in a company are presented in this work. The meaning was to make theoretical and in some extent practical acquaintance with such new business models as open business model and sustainable business model. Long-term sustainability achievement in a company was in a centric role and used as a main criteria when constructing sustainable business model structure. The main research question in this study aims to answer: What a firm should consider in order to develop profitable and sustainable business model? This study is qualitative in nature and it was conducted using content analyze as a main method of this research. The perspective of the target data in this study is an outlook of its producers of how sustainability is reached in an organization throw business model and which practices are important and has to be taken into account. The material was gathered mainly from secondary sources and the theoretical framework was outright built based on secondary data. The secondary data that have been mostly dissertations, academic writings, cases, academic journals and academic books have been analyzed from the point of view of sustainability perspective. As a result it became evident that a structure of a business model and its implementation along with a strategy is often what leads companies to success. However, for the most part, overall business environment decides and delimits how the most optimal business model should be constructed in order to be effective and sustainable. The evaluation of key factors and elements in business model leading organization to sustainability should be examined throw triple bottom line perspective, where key dimensions are environmental, social and economic. It was concluded that dimensions should be evaluated as equal in order to attain total long lasting sustainability, contradicting traditional perspective in business where profit production is seen as only main goal of a business.

SME Growth Strategy - Exploring New Market Segments

Tämän tutkimuksen tarkoituksena oli tunnistaa uusia markkinoita ja markkinasegmenttejä yrityksen kasvustrategiaa varten. Yritys on kasvanut erittäin voimakkaasti viime vuosina nykyisillä markkinoillaan ja haluaa nyt jatkaa kasvuaan uusilla markkinoilla. Työ koostuu kirjallisuuskatsauksesta ja empiirisestä osuudesta. Kirjallisuuskatsauksessa on tunnistettu useita pk-yrityksen kasvuun vaikuttavia tekijöitä, uusien markkinoiden kartoittamiseen ja arvioimiseen vaikuttavia tekijöitä, ja lisäksi liiketoimintastrategiaan ja markkinasegmentin valintaan vaikuttavia tekijöitä. Empiirisen osuuden data kerättiin 60 asiantuntijahaastattelusta, joilla kartoitettiin kokonaismarkkinoita ja saatiin tarkkaa markkinainformaatiota kohdemarkkinoista. Tutkimuksessa tunnistettiin kymmenen potentiaalista toimialaa ja 54 potentiaalista markkinasegmenttiä. Kirjallisuudesta tunnistetuilla kriteereillä, teknologisin perustein ja yrityksen omien näkökulmien perusteella näistä valittiin kohdemarkkinoiksi kahdeksan. Tutkimuksessa kehitettiin markkinasegmenttien arviointiin malli. Mallin avulla valitut kahdeksan markkinasegmenttiä listattiin järjestykseen niiden houkuttelevuuden perusteella. Jatkotoimenpiteenä yrityksessä tullaan kehittämään kasvustrategia perustuen tutkimuksen tuloksille.

Elementary computer-mediated online distance education : identification of criteria for successful implementation and practice

This study had three purposes related to the effective implem,entation and practice of computer-mediated online distance education (C-MODE) at the elementary level: (a) To identify a preliminary framework of criteria 'or guidelines for effective implementation and practice, (b) to identify areas ofC-MODE for which criteria or guidelines of effectiveness have not yet been developed, and (c) to develop an implementation and practice criteria questionnaire based on a review of the distance education literature, and to use the questionnaire in an exploratory survey of elementary C-MODE practitioners. Using the survey instrument, the beliefs and attitudes of 16 elementary C'- MODE practitioners about what constitutes effective implementation and practice principles were investigated. Respondents, who included both administrators and instructors, provided information about themselves and the program in which they worked. They rated 101 individual criteria statenlents on a 5 point Likert scale with a \. point range that included the values: 1 (Strongly Disagree), 2 (Disagree), 3 (Neutral or Undecided), 4 (Agree), 5 (Strongly Agree). Respondents also provided qualitative data by commenting on the individual statements, or suggesting other statements they considered important. Eighty-two different statements or guidelines related to the successful implementation and practice of computer-mediated online education at the elementary level were endorsed. Response to a small number of statements differed significantly by gender and years of experience. A new area for investigation, namely, the role ofparents, which has received little attention in the online distance education literature, emerged from the findings. The study also identified a number of other areas within an elementary context where additional research is necessary. These included: (a) differences in the factors that determine learning in a distance education setting and traditional settings, (b) elementary students' ability to function in an online setting, (c) the role and workload of instructors, (d) the importance of effective, timely communication with students and parents, and (e) the use of a variety of media.

Reliability of a new measure of motoneuron excitability

Objectlve:--This study examined the intraclass reliability· of different measures of the excitability of the Hoffmann reflex, derived from stimulus-response curves. The slope of the regression line of the H-reflex stimulus-response curve advocated by Funase et al. (1994) was also compared to the peak of the first derivative of the H-reflex stimulus-response curve (dHIdVmax), a new measure introduced in this investigation. A secondary purpose was to explore the possibility of mood as a covariate when measuring excitability of the H-reflex arc. Methods: The H-reflex amplitude at a stimulus intensity corresponding to 5% of the maximum M-wave (Mmax) is an established measure that was used as an additional basis of comparison. The H-reflex was elicited in the soleus for 24 subjects (12 males and 12 females) on five separate days. Vibration was applied to the Achilles tendon prior to stimulation to test the sensitivity of the measures on test day four. The means of five evoked potentials at each gradually increasing intensity, from below H-reflex threshold to above Mmax, were used to create both the H-reflex and M-wave stimulus response curves for each subject across test days. The mood of the subjects was assessed using the Subjective Exercise Experience Scale (SEES) prior to the stimulation protocol each day. Results: There was a modest decrease in all H-reflex measures from the first to third test day, but it was non-significant (P's>0.05). All measures of the H-reflex exhibited a profound reduction following vibration on test day four, and then returned to baseline levels on test day five (P's<0.05). The intraclass correlation coefficient (ICC) for H-reflex amplitude at 5% of Mmax was 0.85. The ICC for the slope of the regression line was 0.79 while it was 0.89 for dH/dVmax. Maximum M-wave amplitude had an ICC of 0.96 attesting to careful methodological controls. The SEES subscales of fatigue and psychological well-being remained unchanged IV across the five days. The psychological distress subscale (PO.05). Conclusions: The peak of the first derivative of the H-reflex stimulus-response curve (dH/dVmax) was shown to have comparable reliability and sensitivity to other more established measures of excitability. Psychological distress and the amplitude of the H-reflex at 5% Mmax follow similar trends across days, however there was no significant correlation between the two measures. Significance: The proposed method appears to be a more robust measure ofH-reflex excitability than the other methods tested. As such it would be an advantageous method to apply in clinical and investigative settings. Additionally, the results suggest that the relationship between psychological distress and H-reflex amplitude should be investigated further.

A point-prevalence survey of antimicrobial utilisation within New Brunswick hospitals to focus antimicrobial stewardship efforts and decrease low-value care.

Introduction: Il est important de minimiser le gaspillage et les risques associés aux soins sans valeur. La gestion de l’utilisation des antimicrobiens vise à optimiser leur emploi et doit être adaptée au milieu et à sa population. Objectifs: Évaluer les profiles d’utilisation actuels des antimicrobiens et fixer des objectifs pour les interventions en matière de gestion des antimicrobiens. Méthode: Vingt-et-un hôpitaux du Nouveau-Brunswick offrant des soins de courte durée en médecine générale, en chirurgie et en pédiatrie ont pris part à une enquête sur la prévalence ponctuelle. Tous les patients admis aux hôpitaux participants et ayant reçu au moins un antimicrobien systémique ont été inscrits à l’étude. Les principaux critères d’évaluation étaient le profil d’utilisation, selon l’indication et l’antimicrobien prescrit, le bienfondé de l’utilisation et la durée de la prophylaxie chirurgicale. Des statistiques descriptives et un test d’indépendance 2 furent utilisés pour l’analyse de données. Résultats: L’enquête a été menée de juin à août 2012. Un total de 2244 patients ont été admis pendant la durée de l’étude et 529 (23,6%) ont reçu un antimicrobien. Au total, 691 antimicrobiens ont été prescrits, soit 587 (85%) pour le traitement et 104 (15%) pour la prophylaxie. Les antimicrobiens les plus souvent prescrits pour le traitement (n=587) étaient des classes suivantes : quinolones (25,6%), pénicillines à spectre étendu (10,2%) et métronidazole (8,5%). Les indications les plus courantes du traitement étaient la pneumonie (30%), les infections gastro-intestinales (16%) et les infections de la peau et des tissus mous (14%). Selon des critères définis au préalable, 23% (n=134) des ordonnances pour le traitement étaient inappropriées et 20% (n=120) n’avaient aucune indication de documentée. Les domaines où les ordonnances étaient inappropriées étaient les suivants : défaut de passage de la voie intraveineuse à la voie orale (n=34, 6%), mauvaise dose (n=30, 5%), traitement d’une bactériurie asymptomatique (n=24, 4%) et doublement inutile (n=22, 4%). Dans 33% (n=27) des cas, les ordonnances pour la prophylaxie chirurgicale étaient pour une période de plus de 24 heures. Conclusions: Les résultats démontrent que les efforts de gestion des antimicrobiens doivent se concentrer sur les interventions conventionnelles de gestion de l’utilisation des antimicrobiens, l’amélioration de la documentation, l’optimisation de l’utilisation des quinolones et la réduction au minimum de la durée de la prophylaxie chirurgicale.

New Generation Antidepressants in Painful Diabetic Neuropathy

The incidence of diabetic neuropathy increases with the duration of diabetes and the degree of hyperglycaemia. Pain is one of the most common and incapacitating symptoms of diabetic neuropathy and its pharmacological control is complex. The effectiveness of antidepressive agents has been described in different types of neuropathic pain, but their effectiveness, when used as analgesics in painful diabetic neuropathy, still remains controversial. Objective: To review the possible role of new-generation antidepressive agents in the treatment of pain in diabetic peripheral neuropathy. This work has thus consisted of a meta-analysis for determining which antidepressive agent had the best analgesic potential in managing pain in patients suffering from painful diabetic neuropathy. Methods: This search covered the Cochrane, MEDLINE, EMBASE and LILACS databases, between January 2000 and August 2007. The following information was obtained from each article: criteria for diagnosing diabetic neuropathy, patients' age average, antidepressant drug received and dose, sample size, duration of the disease and treatment follow-up, outcome measurement, evaluation of pain and rescue medication. Results: A combined RR: 1.67 (95% CI 1.38 - 2.02) was obtained; this result indicated that the antidepressive agent duloxetine, was effective for controlling pain in diabetic neuropathy. The corresponding NNT for Duloxetine was established, according to our interests; NNT = 6 (95% CI 5- 8) for achieving greater than 50% analgesia in patients suffering from painful diabetic neuropathy. Discussion: Antidepressive agents are frequently employed in the specific case of diabetic neuropathy; their analgesic benefit has been demonstrated.

Simulation of delamination in composites under quasi-static and fatigue loading using cohesive zone models

Es desenvolupa una eina de disseny per l'anàlisi de la tolerància al dany en composites. L'eina pot predir el inici i la propagació de fisures interlaminars. També pot ser utilitzada per avaluar i planificar la necessitat de reparar o reemplaçar components durant la seva vida útil. El model desenvolupat pot ser utilitzat tan per simular càrregues estàtiques com de fatiga. El model proposat és un model de dany termodinàmicament consistent que permet simular la delaminació en composites sota càrregues variables. El model es formula dins el context de la Mecànica del Dany, fent ús dels models de zona cohesiva. Es presenta un metodologia per determinar els paràmetres del model constitutiu que permet utilitzar malles d'elements finits més bastes de les que es poden usar típicament. Finalment, el model és també capaç de simular la delaminació produïda per càrregues de fatiga.

The use of a multiple criteria decision analysis to evaluate the effectiveness of landscape and habitat enhancement mechanisms: an example from the South Downs

A range of funding schemes and policy instruments exist to effect enhancement of the landscapes and habitats of the UK. While a number of assessments of these mechanisms have been conducted, little research has been undertaken to compare both quantitatively and qualitatively their relative effectiveness across a range of criteria. It is argued that few tools are available for such a multi-faceted evaluation of effectiveness. A form of Multiple Criteria Decision Analysis (MCDA) is justified and utilized as a framework in which to evaluate the effectiveness of nine mechanisms in relation to the protection of existing areas of chalk grassland and the creation of new areas in the South Downs of England. These include established schemes, such as the Countryside Stewardship and Environmentally Sensitive Area Schemes, along with other less common mechanisms, for example, land purchase and tender schemes. The steps involved in applying an MCDA to evaluate such mechanisms are identified and the process is described. Quantitative results from the comparison of the effectiveness of different mechanisms are presented, although the broader aim of the paper is that of demonstrating the performance of MCDA as a tool for measuring the effectiveness of mechanisms aimed at landscape and habitat enhancement.

Using historical lesion volume data in the design of a new phase II clinical trial in acute stroke

Background and Purpose-Clinical research into the treatment of acute stroke is complicated, is costly, and has often been unsuccessful. Developments in imaging technology based on computed tomography and magnetic resonance imaging scans offer opportunities for screening experimental therapies during phase II testing so as to deliver only the most promising interventions to phase III. We discuss the design and the appropriate sample size for phase II studies in stroke based on lesion volume. Methods-Determination of the relation between analyses of lesion volumes and of neurologic outcomes is illustrated using data from placebo trial patients from the Virtual International Stroke Trials Archive. The size of an effect on lesion volume that would lead to a clinically relevant treatment effect in terms of a measure, such as modified Rankin score (mRS), is found. The sample size to detect that magnitude of effect on lesion volume is then calculated. Simulation is used to evaluate different criteria for proceeding from phase II to phase III. Results-The odds ratios for mRS correspond roughly to the square root of odds ratios for lesion volume, implying that for equivalent power specifications, sample sizes based on lesion volumes should be about one fourth of those based on mRS. Relaxation of power requirements, appropriate for phase II, lead to further sample size reductions. For example, a phase III trial comparing a novel treatment with placebo with a total sample size of 1518 patients might be motivated from a phase II trial of 126 patients comparing the same 2 treatment arms. Discussion-Definitive phase III trials in stroke should aim to demonstrate significant effects of treatment on clinical outcomes. However, more direct outcomes such as lesion volume can be useful in phase II for determining whether such phase III trials should be undertaken in the first place. (Stroke. 2009;40:1347-1352.)

Toughness & cutting: A new way of determining ductile fracture toughness and strength

A review is given of the mechanics of cutting, ranging from the slicing of thin floppy offcuts (where there is negligible elasticity and no permanent deformation of the offcut) to the machining of ductile metals (where there is severe permanent distortion of the offcut/chip). Materials scientists employ the former conditions to determine the fracture toughness of ‘soft’ solids such as biological materials and foodstuffs. In contrast, traditional analyses of metalcutting are based on plasticity and friction only, and do not incorporate toughness. The machining theories are inadequate in a number of ways but a recent paper has shown that when ductile work of fracture is included many, if not all, of the shortcomings are removed. Support for the new analysis is given by examination of FEM simulations of metalcutting which reveal that a ‘separation criterion’ has to be employed at the tool tip. Some consideration shows that the separation criteria are versions of void-initiation-growth-and-coalescence models employed in ductile fracture mechanics. The new analysis shows that cutting forces for ductile materials depend upon the fracture toughness as well as plasticity and friction, and reveals a simple way of determining both toughness and flow stress from cutting experiments. Examples are given for a wide range of materials including metals, polymers and wood, and comparison is made with the same properties independently determined using conventional testpieces. Because cutting can be steady state, a new way is presented for simultaneously measuring toughness and flow stress at controlled speeds and strain rates.

A fuzzy multi-criteria decision approach for enhanced auto-tracking of seismic events

The main activity carried out by the geophysicist when interpreting seismic data, in terms of both importance and time spent is tracking (or picking) seismic events. in practice, this activity turns out to be rather challenging, particularly when the targeted event is interrupted by discontinuities such as geological faults or exhibits lateral changes in seismic character. In recent years, several automated schemes, known as auto-trackers, have been developed to assist the interpreter in this tedious and time-consuming task. The automatic tracking tool available in modem interpretation software packages often employs artificial neural networks (ANN's) to identify seismic picks belonging to target events through a pattern recognition process. The ability of ANNs to track horizons across discontinuities largely depends on how reliably data patterns characterise these horizons. While seismic attributes are commonly used to characterise amplitude peaks forming a seismic horizon, some researchers in the field claim that inherent seismic information is lost in the attribute extraction process and advocate instead the use of raw data (amplitude samples). This paper investigates the performance of ANNs using either characterisation methods, and demonstrates how the complementarity of both seismic attributes and raw data can be exploited in conjunction with other geological information in a fuzzy inference system (FIS) to achieve an enhanced auto-tracking performance.

A new framework for understanding inequalities between expatriates and host country nationals

An interdisciplinary theoretical framework is proposed for analysing justice in global working conditions. In addition to gender and race as popular criteria to identify disadvantaged groups in organizations, in multinational corporations (MNCs) local employees (i.e. host country nationals (HCNs) working in foreign subsidiaries) deserve special attention. Their working conditions are often substantially worse than those of expatriates (i.e. parent country nationals temporarily assigned to a foreign subsidiary). Although a number of reasons have been put forward to justify such inequalities—usually with efficiency goals in mind—recent studies have used equity theory to question the extent to which they are perceived as fair by HCNs. However, since perceptual equity theory has limitations, this study develops an alternative and non-perceptual framework for analysing such inequalities. Employment discrimination theory and elements of Rawls’s ‘Theory of Justice’ are the theoretical pillars of this framework. This article discusses the advantages of this approach for MNCs and identifies some expatriation practices that are fair according to our non-perceptual justice standards, whilst also reasonably (if not highly) efficient.

Demonstrating the importance of criteria and sub-criteria in building assessment methods

Building assessment methods have become a popular research field since the early 1990s. An international tool which allows the assessment of buildings in all regions, taking into account differences in climates, topographies and cultures does not yet exist. This paper aims to demonstrate the importance of criteria and sub-criteria in developing a new potential building assessment method for Saudi Arabia. Recently, the awareness of sustainability has been increasing in developing countries due to high energy consumption, pollution and high carbon foot print. There is no debate that assessment criteria have an important role to identify the tool’s orientation. However, various aspects influence the criteria and sub-criteria of assessment tools such as environment, economic, social and cultural to mention but a few. The author provides an investigation on the most popular and globally used schemes: BREEAM, LEED, Green Star, CASBEE and Estidama in order to identify the effectiveness of the different aspects of the assessment criteria and the impacts of these criteria on the assessment results; that will provide a solid foundation to develop an effective sustainable assessment method for buildings in Saudi Arabia. Initial results of the investigation suggest that each country needs to develop its own assessment method in order to achieve desired results, while focusing upon the indigenous environmental, economic, social and cultural conditions. Keywords: Assessment methods, BREEAM, LEED, Green Star, CASBEE, Estidama, sustainability, sustainable buildings, Environment, Saudi Arabia.

New age estimates for the Palaeolithic assemblages and Pleistocene succession of Casablanca, Morocco

Marine and aeolian Quaternary sediments from Casablanca, Morocco were dated using the optically stimulated luminescence (OSL) signal of quartz grains. These sediments form part of an extensive succession spanning the Pleistocene, and contain a rich faunal and archaeological record, including an Acheulian lithic assemblage from before the Brunhes–Matayama boundary, and a Homo erectus jaw from younger cave deposits. Sediment samples from the sites of Reddad Ben Ali, Oulad J’mel, Sidi Abderhamane and Thomas Quarries have been dated, in order to assess the upper limits of OSL. The revision of previously measured mammalian tooth enamel electron spin resonance (ESR) dates from the Grotte des Rhinocéros, Oulad Hamida Quarry 1, incorporating updated environmental dose rate measurements and attenuation calculations, also provide chronological constraint for the archaeological material preserved at Thomas Quarries. Several OSL age estimates extend back to around 500,000 years, with a single sample providing an OSL age close to 1 Ma in magnetically reversed sediments. These luminescence dates are some of the oldest determined, and their reliability is assessed using both internal criteria based on stratigraphic consistency, and external lithostratigraphic, morphostratigraphic and independent chronological constraints. For most samples, good internal agreement is observed using single aliquot regenerative-dose OSL measurements, while multiple aliquot additive-dose measurements generally have poorer resolution and consistency. Novel slow-component and component-resolved OSL approaches applied to four samples provide significantly enhanced dating precision, and an examination of the degree of signal zeroing at deposition. A comparison of the OSL age estimates with the updated ESR dates and one U-series date demonstrate that this method has great potential for providing reliable age estimates for sediments of this antiquity. We consider the cause of some slight age inversion observed at Thomas Quarries, and provide recommendations for further luminescence dating within this succession.