Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience

Ultrasound (US) has become a useful tool in the detection of early disease, differential diagnosis, guidance of treatment decisions and treatment monitoring of rheumatoid arthritis (RA). In 2008, the Swiss Sonography in Arthritis and Rheumatism (SONAR) group was established to promote the use of US in inflammatory arthritis in clinical practice. A scoring system was developed and taught to a large number of Swiss rheumatologists who already contributed to the Swiss Clinical Quality Management (SCQM) database, a national patient register. This paper intends to give a Swiss consensus about best clinical practice recommendations for the use of US in RA on the basis of the current literature knowledge and experience with the Swiss SONAR score. Literature research was performed to collect data on current evidence. The results were discussed among specialists of the Swiss university centres and private practice, following a structured procedure. Musculoskelatal US was found to be very helpful in establishing the diagnosis and monitoring the evolution of RA, and to be a reliable tool if used by experienced examiners. It influences treatment decisions such as continuing, intensifying or stepping down therapy. The definite modalities of integrating US into the diagnosis and monitoring of RA treatments will be defined within a few years. There are, however, strong arguments to use US findings as of today in daily clinical care. Some practical recommendations about the use of US in RA, focusing on the diagnosis and the use of the SONAR score, are proposed.

Practical approach to the use of daylight photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: a European consensus

INTRODUCTION Daylight-mediated photodynamic therapy has been shown to be an effective therapy for actinic keratoses (AKs) and a simple and tolerable treatment procedure in three randomized Scandinavian studies and two recent Phase III randomized controlled studies in Australia and Europe. OBJECTIVES To establish consensus recommendations for the use of daylight photodynamic therapy (DL-PDT) using topical methyl aminolaevulinate (MAL) in European patients with AKs. METHODS The DL-PDT consensus recommendations were developed on behalf of the European Society for Photodynamic Therapy in Dermatology and comprised of 10 dermatologists from different European countries with experience in how to treat AK patients with PDT. Consensus was developed based on literature review and experience of the experts in the treatment of AK using DL-PDT. RESULTS The recommendations arising from this panel of experts provide general guidance on the use of DL-PDT as a dermatological procedure with specific guidance regarding patient selection, therapeutic indications, when to treat, pre-treatment skin preparation, MAL application and daylight exposure for patients with AK in different countries of Europe. CONCLUSIONS This consensus recommendation provides a framework for physicians to perform DL-PDT with MAL cream while ensuring efficiency and safety in the treatment of patients with AK in different European countries.

Unlocking the Potential of Zambian Micro, Small and Medium Enterprises "Learning from the international best practices - the Southeast Asian Experience"

This paper examines the SMEs performance in Zambia and attempts to identify some practical lessons that Zambia can learn from Southeast Asian countries (with reference to Malaysia) in order to facilitate industrial development through unlocking the potential of its SMEs sector. Malaysia and Zambia were at the same level of economic development as evidenced by similar per capita incomes but Zambia has remained behind economically and its manufacturing sector has stagnated as if both countries did not have similar initial endowments. It therefore, becomes imperative that Zambia learns from such countries on how they managed to take-off economically with a focus on SME development. Training (education), research & development, market availability and technological advancement through establishment of industrial linkages coupled with cluster formation were some of the outstanding strategies identified that Zambia could use as a “key” to unlock its SMEs’ potential as it strives to meet the UN MDGs in particular halving its poverty levels by 2015 and also realizing its vision of becoming a middle income earner by 2030.

Educating in Project Management: an innovative approach. A shared-experience among Spanish Universities

This work presents an educational formal initiative aimed to monitor the acquisition and strengthening of competences by students that are being taught in project management subject. Groups of students belonging to three universities, embracing different knowledge areas such as engineering, biology, etc., were selected to run the experience. All of them had nevertheless a common and basic starting point: inexperience in project management field. In this scenario, we propose a new theoretical and practical approach oriented to reinforce problem-solving and related competences in a project management subject context. For this purpose, a Project-Based Learning (PjBL) initiative has been specifically designed and developed. The main idea is to bring a real world engineering project management case into the classroom, where students must face up to a completely new learning approach –groups in different locations, collaborative mode and unspecific solution, supported by a powerful internet platform:.project.net (http://www.Project.net). Other relevant aspects such as project climate, knowledge increasing, have also been monitored during the course. Results show and overall improvement in key competences. The obtained information will be used in two ways: to feed the students back about personal opportunities for improvement in specific competences, and to fine-tune the experience for further initiatives.

Project-based learning experience on Data Structures course

This paper presents the innovations in the practical work of the Data Structures subject carried out in the last five years, including a transition period and a first year of implantation of the European Higher Education Area. The practical coursework is inspired by a project-based methodology and from 2008/2009 additional laboratory sessions are included in the subject schedule. We will present the academic results and ratios of the mentioned time period which imply a significant improvement on students' performance.

Survey on integration of Applied Geology and Geomorphology in Civil Engineering curricula in the framework of the European Higher Education Area (EHEA) by using practical trips

The engineer must have sufficient theoretical knowledge to be applied to solve specific problems, with the necessary capacity to simplify these approaches, and taking into account factors such as speed, simplicity, quality and economy. In Geology, its ultimate goal is the exploration of the history of the geological events through observation, deduction, reasoning and, in exceptional cases by the direct underground exploration or experimentation. Experimentation is very limited in Geology. Reproduction laboratory of certain phenomena or geological processes is difficult because both time and space become a large scale. For this reason, some Earth Sciences are in a nearly descriptive stage whereas others closest to the experimental, Geophysics and Geochemistry, have assimilated progress experienced by the physics and chemistry. Thus, Anglo-Saxon countries clearly separate Engineering Geology from Geological Engineering, i.e. Applied Geology to the Geological Engineering concepts. Although there is a big professional overlap, the first one corresponds to scientific approach, while the last one corresponds to a technological one. Applied Geology to Engineering could be defined as the Science and Applied Geology to the design, construction and performance of engineering infrastructures in and field geology discipline. There has been much discussion on the primacy of theory over practice. Today prevails the exaggeration of practice, but you get good workers and routine and mediocre teachers. This idea forgets too that teaching problem is a problem of right balance. The approach of the action lines on the European Higher Education Area (EHEA) framework provides for such balance. Applied Geology subject represents the first real contact with the physical environment with the practice profession and works. Besides, the situation of the topic in the first trace of Study Plans for many students implies the link to other subjects and topics of the career (tunnels, dams, groundwater, roads, etc). This work analyses in depth the justification of such practical trips. It shows the criteria and methods of planning and the result which manifests itself in pupils. Once practical trips experience developed, the objective work tries to know about results and changes on student’s motivation in learning perspective. This is done regardless of the outcome of their knowledge achievements assessed properly and they are not subject to such work. For this objective, it has been designed a survey about their motivation before and after trip. Survey was made by the Unidad Docente de Geología Aplicada of the Departamento de Ingeniería y Morfología del Terreno (Escuela Técnica Superior de Ingenieros de Caminos, Canales y Puertos, Universidad Politécnica de Madrid). It was completely anonymous. Its objective was to collect the opinion of the student as a key agent of learning and teaching of the subject. All the work takes place under new teaching/learning criteria approach at the European framework in Higher Education. The results are exceptionally good with 90% of student’s participation and with very high scores in a number of questions as the itineraries, teachers and visited places (range of 4.5 to 4.2 in a 5 points scale). The majority of students are very satisfied (average of 4.5 in a 5 points scale).

Preliminary approach to neutron instrument selecction at ESSB-Bilbao based on experience at ISIS molecular spectroscopy group

Collaborative efforts between the Neutronics and Target Design Group at the Instituto de Fusión Nuclear and the Molecular Spectroscopy Group at the ISIS Pulsed Neutron and Muon Source date back to 2012 in the context of the ESS-Bilbao project. The rationale for these joint activities was twofold, namely: to assess the realm of applicability of the low-energy neutron source proposed by ESS-Bilbao - for details; and to explore instrument capabilities for pulsed-neutron techniques in the range 0.05-3 ms, a time range where ESS-Bilbao and ISIS could offer a significant degree of synergy and complementarity. As part of this collaboration, J.P. de Vicente has spent a three-month period within the ISIS Molecular Spectroscopy Group, to gain hands-on experience on the practical aspects of neutron-instrument design and the requisite neutron-transport simulations. To date, these activities have resulted in a joint MEng thesis as well as a number of publications and contributions to national and international conferences. Building upon these previous works, the primary aim of this report is to provide a self-contained discussion of general criteria for instrument selection at ESS-Bilbao, the first accelerator-driven, low-energy neutron source designed in Spain. To this end, Chapter 1 provides a brief overview of the current design parameters of the accelerator and target station. Neutron moderation is covered in Chapter 2, where we take a closer look at two possible target-moderator-reflector configurations and pay special attention to the spectral and temporal characteristics of the resulting neutron pulses. This discussion provides a necessary starting point to assess the operation of ESSB in short- and long-pulse modes. These considerations are further explored in Chapter 3, dealing with the primary characteristics of ESS-Bilbao as a short- or long-pulse facility in terms of accessible dynamic range and spectral resolution. Other practical aspects including background suppression and the use of fast choppers are also discussed. The guiding principles introduced in the first three chapters are put to use in Chapter 4 where we analyse in some detail the capabilities of a small-angle scattering instrument, as well as how specific scientific requirements can be mapped onto the optimal use of ESS-Bilbao for condensed-matter research. Part 2 of the report contains additional supporting documentation, including a description of the ESSB McStas component, a detailed characterisation of moderator response and neutron pulses, and estimates ofparameters associated with the design and operation of neutron choppers. In closing this brief foreword, we wish to thank both ESS-Bilbao and ISIS for their continuing encouragement and support along the way.

Agent-based modeling and simulation for the design of the future european Air Traffic Management system: the experience of CASSIOPEIA

The SESAR (Single European Sky ATM Research) program is an ambitious re-search and development initiative to design the future European air traffic man-agement (ATM) system. The study of the behavior of ATM systems using agent-based modeling and simulation tools can help the development of new methods to improve their performance. This paper presents an overview of existing agent-based approaches in air transportation (paying special attention to the challenges that exist for the design of future ATM systems) and, subsequently, describes a new agent-based approach that we proposed in the CASSIOPEIA project, which was developed according to the goals of the SESAR program. In our approach, we use agent models for different ATM stakeholders, and, in contrast to previous work, our solution models new collaborative decision processes for flow traffic management, it uses an intermediate level of abstraction (useful for simulations at larger scales), and was designed to be a practical tool (open and reusable) for the development of different ATM studies. It was successfully applied in three stud-ies related to the design of future ATM systems in Europe.

Communication Project for development: 25 years of experience in andean rural communities in Ecuador

IThis paper analyses communication for development from a new perspective: the project in its broader and most genuine sense, as an instrument for changing current reality. This is examined from both its theoretical and practical implementation side. Knowledge/action binomial as a two-way relationship is one of the basis of the project cycle. It allows for better knowing the reality that the project itself (what constitutes the action) is intended to improve. Besides that, this knowledge/action binomial also offers new knowledge that nourishes future actions (projects). From a project based communication perspective, the project nourishes the knowledge, which leads to a transformative action. Reflecting about the action is a new knowledge source whose adoption by the community is eased by the communication process. Radio Mensaje project among the indigenous Andean communities in Cayambe (Ecuador) was born and also developed within this approach, supporting the collaborative participation in project management. This leads to the development process which is described in this case study.

MDWEnet: a practical approach to achieving interoperability of model-driven web engineering methods

Current model-driven Web Engineering approaches (such as OO-H, UWE or WebML) provide a set of methods and supporting tools for a systematic design and development of Web applications. Each method addresses different concerns using separate models (content, navigation, presentation, business logic, etc.), and provide model compilers that produce most of the logic and Web pages of the application from these models. However, these proposals also have some limitations, especially for exchanging models or representing further modeling concerns, such as architectural styles, technology independence, or distribution. A possible solution to these issues is provided by making model-driven Web Engineering proposals interoperate, being able to complement each other, and to exchange models between the different tools. MDWEnet is a recent initiative started by a small group of researchers working on model-driven Web Engineering (MDWE). Its goal is to improve current practices and tools for the model-driven development of Web applications for better interoperability. The proposal is based on the strengths of current model-driven Web Engineering methods, and the existing experience and knowledge in the field. This paper presents the background, motivation, scope, and objectives of MDWEnet. Furthermore, it reports on the MDWEnet results and achievements so far, and its future plan of actions.

Practical considerations for the measurement of free light chains in serum

Background: A new immunoassay for free light chain measurements has been reported to be useful for the diagnosis and monitoring of monoclonal light chain diseases and nonsecretory myeloma. We describe experience with and some potential pitfalls of the assay. Methods: The assay was assessed for precision, sample type and stability, recovery, and harmonization of results between two analyzers on which the reagents are used. Free-light-chain concentrations were measured in healthy individuals (to determine biological variation), patients with monoclonal gammopathy of undetermined significance, myeloma patients after autologous stem cell transplants, and patients with renal disease. Results: Analytical imprecision (CV) was 6-11% for kappa and A free-light-chain measurement and 16% for the calculated kappa/lambda ratio. Biological variation was generally insignificant compared with analytical variation. Despite the same reagent source, values were not completely harmonized between assay systems and may produce discordant free-light-chain ratios. In some patients with clinically stable myeloma, or post transplantation, or with monoclonal gammopathy of undetermined significance, free-light-chain concentration and ratio were within the population reference interval despite the presence of monoclonal intact immunoglobulin in serum. In other patients with monoclonal gammopathy of undetermined significance, values were abnormal although there was no clinical evidence of progression to multiple myeloma. Conclusions: The use of free-light-chain measurements alone cannot differentiate some groups of patients with monoclonal gammopathy from healthy individuals. As with the introduction of any new test, it is essential that more scientific data about use of this assay in different subject groups are available so that results can be interpreted with clinical certainty. (C) 2003 American Association for Clinical Chemistry.

Mini-dose glucagon rescue for mild hypoglycaemia in children with type 1 diabetes: The Brisbane experience

Objectives: To evaluate the use of small doses of glucagon using an insulin syringe in mild or impending hypoglycaemia in children with type 1 diabetes. Methods: Data were collected from patients attending the Paediatric Diabetes Clinic at the Queensland Diabetes Centre at the Mater Hospital, Brisbane in 2002-2004 following the institution of a new protocol for home management of mild or impending hypoglycaemia associated with inability or refusal to take oral carbohydrate. The protocol recommended the use of subcutaneous injections of glucagon using insulin syringes at a dose of two ' units ' (20 mu g) in children 2 years of age or younger, and for older children one unit per year of age up to a maximum of 15 units (150 mu g), with an additional doubled dose given if the blood glucose had not increased in 20 min. Results: Over a 2-year period, 25 children were treated with mini-dose glucagon on a total of 38 occasions. Additional doses were required for recurring hypoglycaemia on 20 (53%) occasions. The child could be managed at home on 32 (84%) of these 38 occasions, with only 6 (16%) children needing hospital treatment. Conclusions: Our study confirmed that small doses of glucagon given subcutaneously with an insulin syringe is a simple, practical and effective home treatment of mild or impending hypoglycaemia due to gastroenteritis or food refusal in children with type 1 diabetes.

Navigating through the maze: the practical issues of conducting research for novices

New postgraduate students embark on their research journey typically with little or no experience in doing research. Supervisors and other more experienced student researchers might help them to find their feet during the first few weeks of their research by sharing their own experience of how they solved similar problems during their research. In this way each novice researcher can learn and benefit from other researchers´ ways of resolving problems. This paper discusses the real concerns that researchers reflected upon during a two-day research workshop, where researchers share problems, exchange ideas for overcoming them and learn from each other´s experiences of conducting research. The output from the workshop is in the form of hints and tips that can guide novice researchers when faced with initial problems. The paper can also be used by a department to induct a novice researcher into their environment.

Building team-based working:a practical guide to organizational transformation

Building Team-based Working is designed for use by managers and consultants who are introducing team-based working into organizations. The book synthesizes knowledge about how to build team-based organizations, focusing particularly on the psychological and social processes that can facilitate or obstruct successful teamwork. Rather than advise managers on how to build effective teams, as most books in this area tend to do, this book instead focuses on how to build organizations structured around teams. The text is divided into six sections describing the six main stages of developing team-based working in an organization. The chapters follow a common structure. Each one opens with a summary of the aims and activities relevant to that stage and concludes with a selection of appropriate support materials and tools. These materials can also be downloaded from the CD accompanying the text. The advice given is based on evidence gathered by the authors over 20 years of practical management experience, research work in organizations, and consultancy across the public, manufacturing and service sectors.

Between a rock and a hard place:exploring women's experience of participation and progress in managerial careers

Purpose – The growth of women in management has been argued to offer a route to reduce organizational and social inequality. The purpose of this paper is to explore the careers and experiences of female managers from a variety of organizations operating in the West Midlands region of the UK. Design/methodology/approach – This study is based on 56 interviews conducted with women managers within various sectors. The interviewees also completed pictorial careers maps, which along with interview recordings were analyzed. Findings – The key themes to emerge from this research centre upon the factors that draw women into management (which we term seductive elements) as well as some of the hindering practices that prevent women from progressing. Significantly, we find that managerial careers are associated with gendered assumptions and practices (e.g. facilitating and developing people) which contribute to construct management (done by women) as bounded-up characteristically with “feminized” behaviours. Research limitations/implications – The research is based upon a relatively small sample that is multi-sectorial. Wider studies that increase population size, together with deeper studies that hold sectorial variables constant would further add weight to the findings presented here. Practical implications – The paper draws attention to the “lived reality” of doing management, which, we argue often, for women in particular involves the reconciliation of contradictions and conflicting pressures. We draw attention to the lack of “alternative models” of organization and highlight the potential for gender-focus mentoring and management education. Originality/value – The paper is of value in giving voice to a selection of women managers by allowing them to reflect upon and explore their experience of management. The paper also documents the day-to-day reality of women's managerial careers that require the re-enactment and reproduction of stereotypical gender norms.