Minimal disease activity for rheumatoid arthritis: A preliminary definition

Agreement on response criteria in rheumatoid arthritis (RA) has allowed better standardization and interpretation of clinical trial reports. With recent advances in therapy, the proportion of patients achieving a satisfactory state of minimal disease activity (MDA) is becoming a more important measure with which to compare different treatment strategies. The threshold for MDA is between high disease activity and remission and, by definition, anyone in remission will also be in MDA. True remission is still rare in RA; in addition, the American College of Rheumatology definition is difficult to apply in the context of trials. Participants at OMERACT 6 in 2002 agreed on a conceptual definition of minimal disease activity (MDA): "that state of disease activity deemed a useful target of treatment by both the patient and the physician, given current treatment possibilities and limitations." To prepare for a preliminary operational definition of MDA for use in clinical trials, we asked rheumatologists to assess 60 patient profiles describing real RA patients seen in routine clinical practice. Based on their responses, several candidate definitions for MDA were designed and discussed at the OMERACT 7 in 2004. Feedback from participants and additional on-site analyses in a cross-sectional database allowed the formulation of 2 preliminary, equivalent definitions of MDA: one based on the Disease Activity Score 28 (DAS28) index, and one based on meeting cutpoints in 5 out the 7 WHO/ILAR core set measures. Researchers applying these definitions first need to choose whether to use the DAS28 or the core set definition, because although each selects a similar proportion in a population, these are not always the same patients. In both MDA definitions, an initial decision node places all patients in MDA who have a tender joint count of 0 and a swollen joint count of 0, and an erythrocyte sedimentation rate (ESR) no greater than 10 mm. If this condition is not met: center dot The DAS28 definition places patients in MDA when DAS28

Connective tissue panniculitis in a child with vitiligo and Hashimoto's thyroiditis

A 9-year-old girl presented with a 6-month history of inflamed tender nodules in the pretibial area. These eventually healed leaving depressed areas of atrophy and loss of subcutaneous tissue. Histology showed a predominantly lymphocytic lobular panniculitis, consistent with connective tissue panniculitis. Investigations revealed an elevated thyroid stimulating hormone, elevated thyroid antiperoxidase antibody and a weakly positive antinuclear antibody (titre 1 in 40). She was commenced on hydroxychloroquine 300 mg daily, which resulted in resolution of the pannictulitis. She developed focal Vitiligo oil the thighs. This gradually improved with 0.1% mometasone furoate ointment. The hydroxychloroquine dose was tapered to 200 mg daily after 12 months, then to 100 mg daily after 18 months therapy. Her thyroid autoantibody levels continued to rise and the hydroxychloroquine was increased again to 300 mg daily. She became borderline hyothyroid. Hashimoto's thyroiditis was diagnosed. Thyroxine was instituted with a resultant improvement in her thyroid blood tests. The lipoatrophy has not developed further during 2-year follow up.

Combined arteriovenous fistula and venous aneurysm following knee arthrodesis

We study a case of a 65-year-old woman who developed popliteal arteriovenous fistula (AVF) and venous aneurysm following left knee arthrodesis. Presenting features included left popliteal and calf pain, a tender pulsatile mass posterior to her left knee, popliteal bruit and a thrill at the popliteal fossa and ankle. Left femoral angiography showed an AVF arising from the right tibioperoneal trunk and an aneurysm at the level of the AVF. Findings at open investigation included AVF between the tibioperoneal trunk and the popliteal vein, and a venous aneurysm arising from the popliteal vein opposite the neck of the arteriovenous communication. The aneurysm and fistula were repaired using prolene suture.

Multi-level zero-inflated Poisson regression modelling of correlated count data with excess zeros

Count data with excess zeros relative to a Poisson distribution are common in many biomedical applications. A popular approach to the analysis of such data is to use a zero-inflated Poisson (ZIP) regression model. Often, because of the hierarchical Study design or the data collection procedure, zero-inflation and lack of independence may occur simultaneously, which tender the standard ZIP model inadequate. To account for the preponderance of zero counts and the inherent correlation of observations, a class of multi-level ZIP regression model with random effects is presented. Model fitting is facilitated using an expectation-maximization algorithm, whereas variance components are estimated via residual maximum likelihood estimating equations. A score test for zero-inflation is also presented. The multi-level ZIP model is then generalized to cope with a more complex correlation structure. Application to the analysis of correlated count data from a longitudinal infant feeding study illustrates the usefulness of the approach.

Deregulation, competition policy and intra-professional contests in medical education

This paper investigates how government policy directions embracing deregulation and market liberalism, together with significant pre-existing tensions within the Australian medical profession, produced ground breaking change in the funding and delivery of medical education for general practitioners. From an initial view between and within the medical profession, and government, about the goal of improving the standards of general practice education and training, segments of the general practice community, particularly those located in rural and remote settings, displayed increasingly vocal concerns about the approach and solutions proffered by the predominantly urban-influenced Royal Australian College of General Practitioners (RACGP). The extent of dissatisfaction culminated in the establishment of the Australian College of Rural and Remote Medicine (ACRRM) in 1997 and the development of an alternative curriculum for general practice. This paper focuses on two decades of changes in general practice training and how competition policy acted as a justificatory mechanism for putting general practice education out to competitive tender against a background of significant intra-professional conflict. The government's interest in increasing efficiency and deregulating the 'closed shop' practices of professions, as expressed through national competition policy, ultimately exposed the existing antagonisms within the profession to public view and allowed the government some influence on the sacred cow of professional training. Government policy has acted as a mechanism of resolution for long standing grievances of the rural GPs and propelled professional training towards an open competition model. The findings have implications for future research looking at the unanticipated outcomes of competition and internal markets.

A PROPAGANDA POLÍTICA NA CONSTRUÇÃO DO IMAGINÁRIO COLETIVO NO CINEMA DE RESISTÊNCIA: Estudo de caso do filme Jango de Silvio Tendler

Este estudo tem como objetivo propor uma análise do modo como se constrói a representação da imagem eleitoral de João Goulart, sob a ótica da propaganda política no cinema brasileiro no período pós-ditadura. Para a realização desse objetivo contamos com o longa-metragem de Silvio Tendler de 1984, intitulado Jango. Cremos que este estudo se justifica por contribuir para identificar, compreender e mapear o imaginário da sociedade brasileira sobre João Goulart. Para o desenvolvimento do tema foram analisadas teorias de marketing político, propaganda ideológica e persuasão. A pesquisa foi norteada pelo método qualitativo e aplicadas as técnicas de pesquisa histórica e estudo de caso. Concluímos que o Filme de Silvio Tendler reconstruiu a imagem de João Goulart ressaltando seu papel na luta pelas reformas de base. A mistificação de Jango foi exposta no documentário expositivo.

AVALIAÇÃO DE SINTOMAS DEPRESSIVOS E DA QUALIDADE DE VIDA EM PACIENTES COM SÍNDROME FIBROMIÁLGICA

Fibromialgia é uma síndrome de etiologia desconhecida com dor difusa, generalizada e crônica. O diagnóstico da fibromialgia deve ser feito de acordo com o critério do American College of Rheumatology (ACR) 1990. O paciente deve apresentar dor difusa por mais de três meses e relatar dor à palpação em pelo menos 11 de 18 pontos sensíveis, chamados de tender points , caracaterizando assim a síndrome. A maioria dos pacientes acometidos são mulheres, e o pico de incidência etária na ocasião do diagnóstico está entre 40 e 50 anos. A dor crônica promove um impacto na qualidade de vida dessas pessoas, diminuindo sua auto-estima, isolando-as do convívio social e fazendo com que percam o controle dos seus pensamentos e sentimentos. Sintomas depressivos podem ser o resultado da disfunção orgânica, associada às condições de limitação das atividades diárias.Este estudo tem como objetivo investigar a presença dos sintomas depressivos e analisar o impacto dos mesmos sobre a qualidade de vida das pacientes com SF. Foram selecionadas 30 mulheres com diagnóstico de SF, em atendimento no período de outubro a novembro de 2005, as quais responderam a dois questionários: Inventário de Depressão de Beck, para investigar a presença de sinto- mas depressivos e o SF-36 Medical Outcome Survey Short Form -36, para avaliar a qualidade de vida. Os resultados obtidos na estatística pelo programa SPS demons- tram que os sintomas depressivos são responsáveis pelo impacto na qualidade de vida dessas pessoas, principalmente nos domínios: aspectos físicos, aspectos sociais, saú- de mental, vitalidade e saúde geral. A análise dos dados sugere que os sintomas depressivos podem influenciar negativamente a qualidade de vida das mulheres fibromiálgicas, pois aumenta a sensação de incapacidade física, diminui a qualidade das relações sociais, aumenta o pessimismo, a fadiga e o desânimo

Cost models for engineering services

This thesis describes the procedure and results from four years research undertaken through the IHD (Interdisciplinary Higher Degrees) Scheme at Aston University in Birmingham, sponsored by the SERC (Science and Engineering Research Council) and Monk Dunstone Associates, Chartered Quantity Surveyors. A stochastic networking technique VERT (Venture Evaluation and Review Technique) was used to model the pre-tender costs of public health, heating ventilating, air-conditioning, fire protection, lifts and electrical installations within office developments. The model enabled the quantity surveyor to analyse, manipulate and explore complex scenarios which previously had defied ready mathematical analysis. The process involved the examination of historical material costs, labour factors and design performance data. Components and installation types were defined and formatted. Data was updated and adjusted using mechanical and electrical pre-tender cost indices and location, selection of contractor, contract sum, height and site condition factors. Ranges of cost, time and performance data were represented by probability density functions and defined by constant, uniform, normal and beta distributions. These variables and a network of the interrelationships between services components provided the framework for analysis. The VERT program, in this particular study, relied upon Monte Carlo simulation to model the uncertainties associated with pre-tender estimates of all possible installations. The computer generated output in the form of relative and cumulative frequency distributions of current element and total services costs, critical path analyses and details of statistical parameters. From this data alternative design solutions were compared, the degree of risk associated with estimates was determined, heuristics were tested and redeveloped, and cost significant items were isolated for closer examination. The resultant models successfully combined cost, time and performance factors and provided the quantity surveyor with an appreciation of the cost ranges associated with the various engineering services design options.

Study on Methodologies for Gas Transmission Network Tariffs and Gas Balancing Fees in Europe

A REKK a KEMA International B.V. partnereként a DGTREN által kiírt tender keretében az európai földgáz átviteli hálózati díjszabásokat és a kiegyenlítő gázforgalom lebonyolításának és elszámolásának nemzeti rendszereit hasonlította össze. Az uniós tagállamok körében folytatott kutatás azt is vizsgálta, hogy a nemzeti hálózati és kiegyenlítő rendszerek különbözősége milyen mértékben akadályozza a közös földgázpiac kialakulását.

Karl Marx és Karl Menger néhány gondolata a pénz eredetéről = The thoughts of Karl Marx and Karl Menger about the origin of money

Kisebb bizonytalankodás után a legtöbb közgazdászhallgató a pénz funkcióinak felsorolásába kezd, ha megkérdezik, hogyan határozná meg a pénz fogalmát. A gyakorlatiasabb, vagy a számvitel iránt elkötelezettebb diákok esetleg felidézik a banki mérleget és – részben helyesen – a pénzt kötelezettségként helyezik el benne. Mintha azonban még mindig egy kicsit pironkodnánk, hogy nem találjuk a megfelelő definíciót. És ez már így megy évszázadok óta. Jelen tanulmányban két XIX. századi közgazdász – Karl Marx és Karl Menger – néhány pénzelméleti következtetését igyekszem összehasonlítani, figyelembe véve az általuk képviselt közgazdasági elmélet alapvető eltéréseit. A mára általánosan elfogadottá váló szubjektív értékelmélet és a kissé elfeledett munkaérték-elmélet látszólag teljesen eltérő feltevéseire alapozva a két gondolkodó egészen hasonló eredményre jutott. Számukra a pénz nem egy egyszerű eszköz, sem követelés és kötelezettség, ahogyan most elkönyvelnénk, hanem áru. Eredetét nem állami törvényekből vezetik le, hanem társadalmi konszenzus során létrejött jelenségnek tekintik a pénzt, ami fölötte áll a törvényeknek, eredendően nem jelképet testesít meg, hanem különleges jószágként válik alkalmassá értékjel kifejezésére. / === / If being asked how to define money most students of economics would start listing the functions of money, or those students with more practical insight would place money as liability in the balance sheet of banks. It seems, however, as if we were still embarrassed by not finding the right definition. In the present study I am endeavouring to give a brief overview of various theoretical findings on the essence of money in the economy preceding the 19th century and then compare some money theoretical conclusions of two economists – Karl Marx and Karl Menger – considering the major differences of the economic theories represented by them. On the basis of the premises of the widely accepted subjective value theory and the somewhat forgotten labour theory of value the two 19th century thinkers came to rather similar results. For them money is not a simple means of payment, nor liability or claim, the way we would account for them now, but a special commodity. They do not attach its creation to the appearance of state laws on money as a legal tender but regard it as a social phenomenon which became capable of expressing a value token due to its peculiar characteristics.

Computer aided licence selection

A model of multiple criteria decision making is presented for selecting the “best” of a finite number of alternatives. Techniques of scoring the alternatives and weighting the criteria are combined with different evaluating procedures and amalgamated in an interactive algorithm. Application of this method for choosing the best tender in a competitive bidding is discussed and a case is presented in some detail.

Vállalati vezetők innovációs érzékenysége, szemlélete és szándékaik – egy felmérés tapasztalatai (Managers' innovation sensivity, approach, and purposes – experience of a survey)

A magyar vállalatok innovatív képességét felmérő kérdőíves kutatások eltérő eredményeket adtak, ami a piaci szereplők eltérő innováció-értelmezésével magyarázható. A szerzők feltevése szerint a vállalati vezetők jellemzően innovatívnak tartják magukat, és ez alapján jelentős részük fejlesztéseket tervez a jövőben, amelyhez pályázati forrásokat kívánnak igénybe venni. A gyakorlati életben az innováció fogalmát a tudományos definíciónál tágabban értelmezik, a vállalatnál bevezetett újdonságokat (például a piaci versenytársaktól átvett új terméket) is innovációnak értékelik. A vállalati növekedést a finanszírozási nehézségek korlátozzák. A támogatások, a hitelek és a kockázati tőke jellegű források eltérő mértékben játszanak szerepet a vállalatok életében. A szerzők tanulmányukban a vállalatok innovatív tevékenysége és a különböző források megléte közötti kapcsolatot, valamint a pályázati rendszerhez fűződő vállalati tapasztalatokat vizsgálják. /===/ Questionnaire surveys of innovation abilities of the Hungarian enterprises have given different results, which could be explained by different innovation interpretation of the market players. According to the authors' hypothesis the managers consider themselves innovative, and many of them plan developments in the future to realize them with tender sources. In the practice idea of innovation is broader interpreted than the scientific definition, and novelties introduced at the companies (eg. a new product taken over from competitors) is also considered innovation. Corporate growth is limited by financing difficulties. Supports, credits and sources of venture capital character play a role int he corporate life to different extent. Authors investigate the connection between the innovative activity of companies and the existence of several sources, and corporate experience linked to tendering system.

Az erősödő állami szerepvállalás értékelése a magyarországi elektronikus hírközlő hálózati fejlesztésekben (Evaluation of the increasingstate’s rolein the electronic communications network development in Hungary)

Az elektronikus hírközlő hálózat rohamszerű fejlesztésének igénye az elektronikus szolgáltatások széles körű elterjedésével az állami döntéshozókat is fejlesztéspolitikai koncepciók kidolgozására és azok végrehajtására ösztönzi. Az (információs) társadalom fejlődése és az ennek alapjául szolgáló infokommunikációs szolgáltatások használata alapvetően függ a szélessávú infrastruktúra fejlesztésétől, az elektronikus hírközlő hálózat elérésének lehetőségétől. Az állami szerepvállalási hajlandóság 2011-től kezdődően jelentősen megnőtt az elektronikus hírközlési területen. Az MVM NET Zrt. megalapítása, a NISZ Zrt. átszervezése, a GOP 3.1.2-es pályázat és a 4. mobilszolgáltató létrehozásának terve mind mutatják a kormányzat erőteljes szándékát a terület fejlesztésére. A tanulmányban bemutatásra kerül, hogy az állam milyen beavatkozási eszközökkel rendelkezik az elektronikus hírközlő hálózat fejlesztésének ösztönzésére. A szerző ezt követően a négy, jelentős állami beavatkozás elemzését végzi el annak vizsgálatára, hogy megfelelő alapozottsággal született-e döntés az állami szerepvállalásról. _____ With the widespread use of the Internet, the need for the rapid development of the digital communication networks has prompted government policy makers also to conceptualize and implement development policy. The advancement of the (information) society and the use of information communication technology as a prerequisite of it are fundamentally determined by the development of broadband infrastructure and whether broadband access to the digital telecommunication network is available. The propensity of the government to play a bigger role in the field of electronical communication has increased significantly from 2011. The setup of MVM NET Zrt. / Hungarian Electricity NET Ltd./, the realignment of NISZ Zrt. / National Info communication Services Company Limited by Shares - NISZ Ltd./, the GOP 3.1.2. tender and the plan to enable a new, i.e. the fourth mobile network operator to enter the market all indicate the robust intention of the government to develop this field. The study shows the tools of government intervention for the incentive of the development of the electronical communication network. Then the author analyses the four main government interventions to examine whether the decision on the role of the state was adequately well-founded.

The corruption risks of EU funds in Hungary

In corruption, a group of players gain an economic advantage without providing any socially beneficial services in return, therefore corruption is considered to be a form of rent-seeking. Similar to other forms of rent-seeking, corruption causes losses on a societal level, due to the less efficient allocation of resources, as well as the costs of operation and prosecution. Fighting corruption is important not just because of ethical but also economic considerations. Contributions from the European Union are making possible the use of more funds than ever, and spending the full amount of this money is a priority preference of the government. The abundance of funds and the pressure on absorption increase corruption, by the managers of the funds overplanning the amount of money to be allocated to individual tender invitations, setting generous rules on eligible costs, and specifying low rates of own contribution wherever possible. As a result, the opportunities for rent-seeking are increased, as it is worth it for beneficiaries to carry out the project even after relinquishing part of the funds they have been awarded. Thus, the abundance of funds generates a sphere of corruption in which rent-seekers may appear on various levels of the system, often even without the knowledge or approval of those on higher decisionmaking levels.

Ageism in the workplace: Examining the influence of age conceptualization on the advancement opportunities of older workers

This study examined variables that may influence managers' perceptions of the need for and benefits of training and promoting older workers. Age conceptualization, worker gender, tender-mindedness, openness to values, and emotional intelligence were predicted to affect the relationship between worker age and the probability and perceived benefits of training and promoting older workers. Approximately 500 working professionals read one of four training and promotion vignettes and provided training probability ratings, training benefits ratings, promotion probability ratings, and promotion benefits ratings in order to test twenty-four hypotheses. Results provided evidence that both worker age and the way in which age was conceptualized affected the extent to which workers were recommended for training as well as the perceived benefits of training workers. It was also found that worker age and the way in which age was conceptualized affected the extent to which workers were recommended for promotions and the perceived benefits of doing so. Of the individual characteristics studied, openness to values was found to act as a moderator of the relationship between age conceptualization and the extent to which older workers were recommended for a promotion and the relationship between age conceptualization and the perceived benefits of promoting older workers. Findings from this study suggest that organizations that wish to protect older workers from discrimination should make decision-makers aware of the influence of age conceptualizations on the salience of older worker stereotypes. By being cognizant of individual raters' levels of the personality characteristics examined in this study, organizations can create decision-making teams that are not only representative in terms of demographic characteristics (i.e. race, gender, age, etc.) but also diverse in terms of personality composition. Additionally, organizations that wish to decrease discrimination against older workers should take care to create guidelines and procedures for training and promotion decisions that systematically reduce the opportunities for older worker stereotypes to influence outcomes. ^