Swiss consensus statement: Recommendations for optimising re-treatment with MabThera (rituximab) in rheumatoid arthritis.

Rituximab is an effective treatment of rheumatoid arthritis (RA), which has been approved for the treatment of moderate to severe disease in patients with an inadequate response to anti-TNF therapies. Rituximab differs from other available biological agents for RA by way of its unique mode of action and unrivalled long dosing interval. The efficacy of rituximab subsides progressively over time and re-therapy is generally required to maintain long term disease control. The timing of re-treatment is currently not well established and varies widely in clinical practice. The present document is a concise recommendation regarding re-treatment with rituximab, based on validated outcomes such as the DAS28 and the EULAR response criteria. The recommendation was established through consensus between practitioners familiar with rituximab therapy in RA. Optimisation of the rituximab re-treatment schedule may improve patient outcomes and balance risks and benefits for the individual patient.

Intra-individual stability of neuromotor tasks from 6 to 18 years: a longitudinal study.

This study investigates the intra-individual stability of the speed of several motor tasks and the intensity of associated movements in 256 children (131 girls, 125 boys) from the Zurich generational study using the Zurich neuromotor assessment battery (ZNA) over a 12-year period from the age of 6 to 18 years. The stability was assessed by correlograms of standard deviation scores calculated from age- and gender-adjusted normative values and compared with standing height and full scale intelligence quotient (IQ). While motor tasks of hand, finger and foot (HFT) and contralateral associated movements (CAM) exhibited a moderate stability (summary measure as correlation coefficients between two measurements made 4 years apart: .61 and .60), other tasks (dynamic balance, static balance and pegboard) were only weakly stable (.46, .47 and .49). IQ and height were more stable than neuromotor components (.72 and .86). We conclude that the moderately stable HFT and CAM may reflect "motor traits", while the stability of the pegboard and balance tasks is weaker because these skills are more experience related and state-dependent.

Hypomyelination Caused by Scap Deletion is Slowly Rescued by Extracellular Lipids that Alter Myelin Structure

Myelination requires a massive increase in glial cell membrane synthesis. Here we demonstrate that the acute phase of myelin lipid synthesis is regulated by SREBP cleavage activation protein (SCAP), an activator of sterol regulatory element-binding proteins (SREBPs). Deletion of SCAP in Schwann cells led to a loss of SREBP-mediated gene expression, congenital hypomyelination and abnormal gait. Interestingly, aging SCAP mutant mice showed partial regain of function; they exhibited improved gait and produced small amounts of myelin indicating a slow SCAP-independent uptake of external lipids. Accordingly, extracellular lipoproteins promoted myelination by SCAP mutant Schwann cells. However, SCAP mutant myelin never reached normal thickness and had biophysical abnormalities concordant with abnormal lipid composition. These data demonstrate that SCAP mediated regulation of glial lipogenesis is key to the proper synthesis of myelin membrane. The described defects in SCAP mutant myelination provide new insights into the pathogenesis, and open new avenues for treatment strategies, of peripheral neuropathies associated with lipid metabolic disorders.

Ambulatory assessment of 3D ground reaction force using plantar pressure distribution.

This study aimed to use the plantar pressure insole for estimating the three-dimensional ground reaction force (GRF) as well as the frictional torque (T(F)) during walking. Eleven subjects, six healthy and five patients with ankle disease participated in the study while wearing pressure insoles during several walking trials on a force-plate. The plantar pressure distribution was analyzed and 10 principal components of 24 regional pressure values with the stance time percentage (STP) were considered for GRF and T(F) estimation. Both linear and non-linear approximators were used for estimating the GRF and T(F) based on two learning strategies using intra-subject and inter-subjects data. The RMS error and the correlation coefficient between the approximators and the actual patterns obtained from force-plate were calculated. Our results showed better performance for non-linear approximation especially when the STP was considered as input. The least errors were observed for vertical force (4%) and anterior-posterior force (7.3%), while the medial-lateral force (11.3%) and frictional torque (14.7%) had higher errors. The result obtained for the patients showed higher error; nevertheless, when the data of the same patient were used for learning, the results were improved and in general slight differences with healthy subjects were observed. In conclusion, this study showed that ambulatory pressure insole with data normalization, an optimal choice of inputs and a well-trained nonlinear mapping function can estimate efficiently the three-dimensional ground reaction force and frictional torque in consecutive gait cycle without requiring a force-plate.

Comparison of plantar pressure distribution in adolescent runners at low vs. high running velocity

This study aimed to compare foot plantar pressure distribution while jogging and running in highly trained adolescent runners. Eleven participants performed two constant-velocity running trials either at jogging (11.2 ± 0.9 km/h) or running (17.8 ± 1.4 km/h) pace on a treadmill. Contact area (CA in cm(2)), maximum force (F(max) in N), peak pressure (PP in kPa), contact time (CT in ms), and relative load (force time integral in each individual region divided by the force time integral for the total plantar foot surface, in %) were measured in nine regions of the right foot using an in-shoe plantar pressure device. Under the whole foot, CA, F(max) and PP were lower in jogging than in running (-1.2% [p<0.05], -12.3% [p<0.001] and -15.1% [p<0.01] respectively) whereas CT was higher (+20.1%; p<0.001). Interestingly, we found an increase in relative load under the medial and central forefoot regions while jogging (+6.7% and +3.7%, respectively; [p<0.05]), while the relative load under the lesser toes (-8.4%; p<0.05) was reduced. In order to prevent overloading of the metatarsals in adolescent runners, excessive mileage at jogging pace should be avoided.

Measuring oscillating walking paths with a LIDAR

This work describes the analysis of different walking paths registered using a Light Detection And Ranging (LIDAR) laser range sensor in order to measure oscillating trajectories during unsupervised walking. The estimate of the gait and trajectory parameters were obtained with a terrestrial LIDAR placed 100 mm above the ground with the scanning plane parallel to the floor to measure the trajectory of the legs without attaching any markers or modifying the floor. Three different large walking experiments were performed to test the proposed measurement system with straight and oscillating trajectories. The main advantages of the proposed system are the possibility to measure several steps and obtain average gait parameters and the minimum infrastructure required. This measurement system enables the development of new ambulatory applications based on the analysis of the gait and the trajectory during a walk.

Tasapainoisen mittariston mahdollisuudet keskisuuressa omistajavetoisessa teollisuusyrityksessä

Tässä tutkimuksessa selvitettiin tasapainoisen mittariston mahdollisuuksia keskisuuressa omistajavetoisessa teollisuusyrityksessä. Tutkimusongelmaa tarkasteltiin case-yrityksen näkökulmasta huomioiden sen erityispiirteet. Tutkielman tavoitteena oli nykyisen mittariston selkeyttäminen ja tasapainottaminen sekä ei-taloudellisten mittareiden lisääminen. Mittariston avulla pyrittiin tehostamaan yrityksen strategiaa ja optimoimaan yrityksen kustannukset ja tuotot. Tutkimus jakaantuu johtamista ja kokonaisvaltaista suorituskyvyn mittausta käsittelevään teoria-osaan ja empiriaosaan, joka on lähestymistavaltaan konstruktiivinen case-tutkimus perustuen PMQ-kyselyyn. Tutkielmassa kehitetään kokonaisvaltainen suorituskykymittaristo nykyisen mittariston, vision , strategian, tavoitteiden ja kriittisten menestystekijöiden pohjalta. Mittariston kehittämistä helpotti se, että visio ja strategia oli selkeästi määritelty. Sen sijaan ongelmia aiheuttivat joidenkin asioiden mitattavuus, mittareiden tasapaino ja ennakoivien mittareiden valinta. Kehitetty mittaristo soveltuu hyvin keskisuuren teollisuusyrityksen käyttöön.

Ship Leases under IAS 17, case Fortum Shipping

International accounting standards will be applied from the1st of January 2005 in accounting of member states of the EU with a view of harmonizing the accounting practices in Europe, and on the long term even more widely. The purpose of adopting IAS accounting standards is to make the financial statements and financial information received from companies more comparable and more transparent for investors and other interest groups. IAS 17 introduces the treatment of a lease agreement in the light of the new accounting standards. Finnish companies have used finance leases widely as an alternative, off-balance sheet form of financing capital investments consistently with Finnish GAAP. Along with the appliance of IAS 17 the off-balance-sheet financing possibility of leases classified as finance leases will no longer exist. IAS 17 states that finance leases are going to be recognized in the balance sheet as both assets, in form of fixed assets, and loans in liabilities classified as long and short term loans. IAS 17 will make two major changes to the income statement. Firstly, the lease payments formerly treated as variable costs are moved below the operating profit level to finance costs. Secondly, the depreciations from the leased assets are also introduced. The effects to the case company's, Fortum Shipping's, income statement and balance sheet are remarkable. Along with the appliance of IAS Fortum Shipping's net assets are somewhat going to be doubled, the amount of liabilities increases significantly and the earnings before interests and taxes increases moderately. The preceding factors have a big effect on the case company's financial key figures. So, the IAS originated effects on balance sheet and income statement have essential impacts on a company's key financial indicators. Most significant changes can be found in key ratios measuring profitability, capital structure, and efficiency. This means that when comparing the IAS calculated profits of companies with the profits calculated prior with Finnish GAAP, the analysis should be made with prudence because the figures are not comparable on straight-forward basis.

Small business management in English

The goal was to define how growth creates problems in small companies with a staff of uner 20, and how the problems are solved. It is not about fast growing companies, but about smoothly or even slowly growing companies. The growth is started through the turnover and the main motive is to have a economic stability. Almost all the companies felt that the main reason for this strate-gic growth was to increase the competitivety. Growth was mainly from the domestic market, and new products and new markets. The biggest problem with this growth was providing capital and also a lack of reas-surance. In additinon to this it was dificult to find suitable personnel and there was a lack of time needed to plan and develop the operation. The lack of product develop-ment, was found to be a problem to some extent, particulary in smaller companies. The follow-up of the finances take place mainly through the profit and loss account, income statement and balance sheets. Apart from that they find the follow up by pro-duct was important. Another important element was to have company tailor-made consulting/sparring in order to develop the operation.

The effect on lower spine muscle activation of walking on a narrow beam in virtual reality

To what extent do people behave in immersive virtual environments as they would in similar situations in a physical environment? There are many ways to address this question, ranging from questionnaires, behavioral studies, and the use of physiological measures. Here, we compare the onsets of muscle activity using surface electromyography (EMG) while participants were walking under three different conditions: on a normal floor surface, on a narrow ribbon along the floor, and on a narrow platform raised off the floor. The same situation was rendered in an immersive virtual environment (IVE) Cave-like system, and 12 participants did the three types of walking in a counter-balanced within-groups design. The mean number of EMG activity onsets per unit time followed the same pattern in the virtual environment as in the physical environment-significantly higher for walking on the platform compared to walking on the floor. Even though participants knew that they were in fact really walking at floor level in the virtual environment condition, the visual illusion of walking on a raised platform was sufficient to influence their behavior in a measurable way. This opens up the door for this technique to be used in gait and posture related scenarios including rehabilitation.

Therapeutic benefits of body percussion using the BAPNE method

Body percussion using to the BAPNE method is a means of cognitive stimulation with multiple applications. The aim of this research is to assess their full potential as a source of therapy. The methodology used is theoretical in nature and makes use of a wide bibliography to find evidence for its therapeutic effect. In essence, body percussion can be seen to lead to improvements in three areas. the Physical, as it stimulates awareness of the body, control of movement and muscular strength, coordination and balance; the Mental, as it improves concentration, memory and perception; and finally Socio-affective, as it helps to build egalitarian relationships and leads to a decrease in anxiety in social interactions. This means of therapy has several different uses and it is targeted at different groups. In the present investigation we categorise them into five main groups: individuals with neurodegenerative diseases like Alzheimer's or Parkinson's disease; individuals with learning disorders such as dyslexia or ADHD; patients affected by diseases of the spinal cord, cranial neuropathies and trauma (Neurorehabilitation); and for the treatment of addictive behavior (addiction); and depressive disorders or anxiety disorders.After thorough analysis, we have found scientific evidence that the therapeutic body percussion using the BAPNE method improves the quality of life of patients and it is an important factor in stabilizing the development of different diseases.In addition, evidence involving certain biological indicators (in control and experimental groups, and through a pre-test and post-test) show its effect on levels of stress and anxiety (reduction of cortisol), as well as improvement of social relations as a result of working as a group (increased levels of oxytocin), and improvements seen in self-esteem and in a variety of personal aspects through the Aspects of Identity questionnaire.

Hans Viertler: professor, cientista, gestor e amigo

Hans Viertler, a visionary, an example of institutional commitment, a great scientist, excellent and dedicated teacher, highly respected as a professional and admired for his leadership, wisdom, generosity, good humor, professional capacity, and balance. A life dedicated to the consolidation of Chemistry in Brazil, the teaching chemistry, the IQ-USP, the Brazilian Chemical Society (SBQ) and the CRQ-fourth region. Hans, a friend with a heart bigger than himself!

Att förstå det stora i det lilla : byskolan som pedagogik, kultur och struktur

I det lilla sammanhanget synliggörs de stora frågorna om både pedagogik, kultur och struktur och om samverkan mellan dem. Studiet av de minsta enheterna i den finländska utbildningen ger kunskap om det viktiga i pedagogiska relationer och i skolgemenskaper, men synliggör också samhällsskeendets inbyggda konflikter om mål och värderingar. Det övergripande syftet med studien är att fördjupa kunskapen om de små skolornas pedagogiska, kulturella och strukturella innebörd och betingelser. Genom djupintervjuer med 12 finlandssvenska lärare i byskolor med färre än 30 elever, analys av skolindragningsdebatt och utbildningspolitiska styrdokument, samt genom teoretiskt förankrade reflektioner skapas en förståelse av såväl lärares arbete och pedagogiska tänkande som skolans funktion i samhället. Avhandlingen byggs upp enligt ett hermeneutiskt och narrativt tänkande. I studien framkommer att byskollärares pedagogiska tänkande syftar till det enskilda barnets optimala och balanserade helhetsutveckling i en gemenskap, där det är centralt att finna den pedagogiska balansen och möjligheten inom kontinuum mellan bl.a. elevbemyndigande och beledsagande. De pedagogiska intentionerna bär syftet att ge rötter och vingar, samhörighet och frihet. I lärarnas beskrivningar uttrycks en sammanvävning mellan deras pedagogiska intentioner och de kontextuella möjligheterna att realisera dessa. Byskollärarna är bärare av en pedagogisk professionalitet som utvecklas i relation till arbetets betingelser. Det praktiska yrkeskunnandet innefattar en balansgång mellan å ena sidan systematik och organisering och å andra sidan flexibilitet och frihet. Att samma lärare handhar eleverna en lång tid är en pedagogisk möjlighet och utmaning. I lärarnas berättelser aktualiseras vad balansgången i en god pedagogisk relation innebär. Både lärare och elever fostras in i en särskild skolkultur och undervisningskultur, i en växelverkan. Yrkeskulturen präglas av olika former av samverkan, både med skolans hela personal som ett teamarbete och med lokalsamhället. Lärarna uttrycker god arbetstrivsel, men friheten och ansvaret i arbetet kan vara både stimulerande och betungande. I en metaanalys skapas teoretiska modeller för vad arbete i närhetens och litenhetens spänningsfält kan innebära och hur det kan påverka lärares professionella utveckling och ork. Den lilla byskolan relaterad till en större samhällskontext öppnar för frågor om vad kvalitet innebär och vilka värderingar som är riktgivande inom utbildningsplanering. Kampen för kontinuiteten i byskolans berättelse tolkas som en kamp för det lokala rummet, för gemenskap, existens, framtid, likvärdighet och trygghet. Kampen för byskolan är ett försvar av både lokal livskvalitet och pedagogisk kvalitet för den enskilde eleven. I det övergripande kulturella sammanhanget synliggörs motsättningar. Det verkar finnas en inbyggd konflikt i utbildningsplaneringens föresatser att samtidigt uppnå jämlikhet, kostnadseffektivitet och kvalitet. En teoretisk modell synliggör hur pedagogik, kultur och struktur samverkar inom utbildning/byskola och påverkar lärares och elevers handlingsutrymme.

Sähköalan PK-yrityksen taloudellinen terveys

Työn kohteena on kaksi kotkalaista sähköasennusalan yritystä, Kotkan Käämityö Oy ja Kotkan Sähkötyö Oy. Kohdeyritysten taloudellinen tilanne on heikentynyt merkittävästi vuosien 2009 ja 2010 aikana. Työssä tarkastellaan kohdeyritysten talouden kehitystä sekä tähän kehitykseen johtaneita syitä vuosina 2005-2010. Työn pääasiallinen tutkimusmenetelmä on tunnuslukuja hyväksi käyttäen toteutettu tilinpäätösanalyysi. Tilinpäätösanalyysiä tuettiin vertailemalla kohdeyritysten talouden kehitystä kuvaavia tunnuslukuja sähköasennusalan ja alueellisten kilpailijoiden lukuihin. Lisäksi kohdeyrityksille laadittiin kannattavuusrajalaskelmat sekä skenaariomenetelmää hyväksi käyttäen tulos- ja tase-ennusteet vuosille 2011-2013. Kohdeyritykset ovat reagoineet taseidensa huononevaan tilaan myymällä omaisuutta ja järjestelemällä uudelleen liiketoimintaansa. Molempien kohdeyritysten kannattavuuden ennustettiin paranevan huomattavasti vuonna 2011. Epävarma toimintaympäristö muodostaa kuitenkin jatkuvan haasteen yritysten toiminnan kannattavuudelle ja jatkuvuudelle. Yritysten tulisi tulevaisuudessa keskittyä parantamaan varsinaisen liiketoimintansa kannattavuutta.

Johdon laskentatoimen ohjaus- ja hallintajärjestelmien hyödyntäminen yritysverkostoissa

Tutkimuksen aiheena on johdon laskentatoimen ohjaus- ja hallintajärjestelmien hyödyntäminen yritysverkostoissa. Yritysten välisten suhteiden hallinnassa käytettävät menetelmät koostuvat pääasiassa johdon laskentatoimen ja suorituskyvyn mittaamisen menetelmistä. Verkostojen ohjaus ja hallinta on tärkeää, koska se on verkostojen tehokkaan toiminnan kriittinen menestystekijä ja kilpailuedun lähde. Suorituskyvyn mittaamisella, johdon laskentatoimella ja johdon kontrollitehtävällä on keskenään riippuvuussuhteet, joiden pitäisi toimia sopusoinnussa. Suorituskyvyn mittaamisen ja johdon laskentatoimen tutkimus yritysten verkostoympäristöissä on kohtalaisen tuore ilmiö, jonka vuoksi aihealueen tutkimus on vielä varsin pirstaleista ja hajanaista. Tämän vuoksi tutkimuksen tavoite on muodostaa selkeä kokonaiskuva siitä kuinka johdon laskentatoimen ohjaus- ja hallintajärjestelmiä voidaan hyödyntää yritysverkostojen ohjauksessa ja hallinnassa. Tutkimuksessa myös selvitetään mitä haasteita näiden menetelmien hyödyntämiseen yritysverkostoissa sisältyy. Tutkimusaineistona on käytetty aikaisempia tutkimuksia sekä tutkimusta varten tehtyjä haastatteluita. Tutkimukseen haastateltiin neljästä yritysverkostosta henkilöitä, jotka vastasivat verkoston toiminnasta. Haastatteluiden avulla pyritään täydentämään kirjallisuuskatsauksen pohjalta luotua teoriaa ja selvittämään kuinka verkoston ohjaus- ja hallinta hoidetaan haastateltavissa verkostoissa, millä menetelmin ja mitä haasteita siihen liittyy. Verkostotoimintaan soveltuvien menetelmien ja suorituskykymittareiden kehittäminen on hankalaa, koska jokaisen verkoston tarpeet ja haasteet ovat erilaiset. Uusien menetelmien kehittämiselle ei nähdä tarvetta, vaan kyse on olemassa olevien menetelmien soveltamisesta verkostonäkökulmasta. Menetelmät on rakennettu yksittäisen yrityksen mittaamiseen, joten ne eivät sovellu sellaisenaan käytettäväksi verkostoihin, vaan niitä täytyy kehittää verkoston yksilöllisten tarpeiden mukaan. Tämä vaatii kuitenkin verkostolta osaamista ja halua kehittyä. Verkostojen haasteet liittyvät sekä yritystasolle että verkostotasolle. Yritysten tuottaman informaation, laskentajärjestelmien, tietotaidon, resurssien ja kehityshalun tulee olla hyvällä tasolla, jotta koko verkoston mittaaminen onnistuu luotettavasti. Lisäksi verkostotoiminta pitää sisällään laskentateknisiä, menetelmiin ja informaation vaihtamiseen liittyviä haasteita. Verkostoympäristön laskentatoimen tutkimuksessa ei ole yhtenäistä, laajasti hyväksyttyä teoriaa, koska tutkimussuuntaukset ja –tulokset ovat moniulotteisia ja vaihtelevia.