An unusual Association Between Parkinson's Disease (PD) and Essential Tremor (ET) Characterized by opposite Lateral Predominance.

The occurrence of disabling postural and action tremor, which is repotted in less than 15 % of cases of PD. may be due to a combination of ET and PD, We report the case of a patient suffering bilaterally from postural tremor of different etiology on either side. A 69 year-old, right-handed woman with a family history of ET, was referred for bilateral hand tremor which was disabling on the right side. At the age of 61 she noticed a right hand postural tremor. not responsive to $- blockers, followed. two years later, by the onset of postural and action tremor on the opposite side. In the following two years. the patient developed asymmetric right-sided parkinsonism, while the postural and action tremor on the left remained unchanged. At time of evaluation, the patient had asymmetric parkinsonism with a 5 Hz rest and postural tremor on the right side and a postural-action tremor of the left hand. Dopaminergic acute challenge tests were performed. The administration of levodopalcarbidopa (ZOO/SO mg) improved the tremor on the right but not on the left. A progressive and more significant improvement was observed after the administration of increasing doses of apomorphine ( 1.6-3-4.5-6 mg). At the dose of 6 mg, apomorphine nearly completely abolished tremor on the right. The tremor of the left hand remained unchanged. The distinction between the two types of tremor was confirmed by the chronic treatment (using levodopa and dopaminergic agonists). Which improved only the right-sided tremor. Primidone was later introduced and improved selectively the tremor on the left. Conclusions: This patient developed both PD and ET with an unusual opposite prevalence. Drug challenge permitted the differentiation the clinically similar tremor types, which have a different pathophysiology.

Corporate Social and Regional Responsibility - The View of Small and Medium-sized Enterprises

The objective of this research was to understand and describe what corpo-rate social and regional responsibility is in SMEs and define the meaning of these concepts to the community and region. Corporate social respon-sibility (CSR) creates a basis for regional responsibility. Regional respon-sibility is a new concept and this research examines it from SMEs’ view-point. This is a theoretical research and the aim is to create a theoretical framework of SMEs’ corporate social and regional responsibility. This framework supports the future research on the subject. The research results show that CSR of SMEs is practical, informal and dependent on the scarce resources of SMEs. CSR is a complex and deep concept and SMEs have their own way of interpreting it. It can be stated that CSR-practises in SMEs are closely connected to employment, envi-ronment, community and supply chain. The challenge is to find motivation to socially and regionally responsible behaviour in SMEs. Benefiting from responsible behaviour and the attitude of SME’s owner-manager are the key reasons for SMEs to involve in CSR and regional responsibility. The benefits of this involvement are for example improved image, reputation and market position. CSR can also be used in SMEs as risk management tool and in cost reduction. This study indicates also that creation of strate-gic partnerships, local government participation, a proper legal system and financial support are the basic issues which support CSR of SMEs. This research showed that regional responsibility of SMEs includes active participation in regional strategy processes, L&RED initiatives and regional philanthropy. For SMEs regional responsibility means good relationships with the community and other related stakeholders, involvement in L&RED initiatives and acting responsibly towards the operating environment. In SMEs’ case this means that they need to understand the benefits of this kind of involvement in order to take action and participate. As regional responsibility includes the relationships between firm and the community, it can be stated that regional responsibility extends CSR’s view of stakeholders and emphasises both, the regional stakeholders and public-private partnerships. Community engagement and responsible be-haviour towards community can be seen as a part of SMEs’ social and regional responsibility. This study indicates that social and regional re-sponsibility of SMEs have a significant influence on the community and region where they are located. Better local and regional relationships with regional and community actors are the positive impacts of social and re-gional responsibility of SMEs. Socially and regionally responsible behav-iour creates a more positive environment and deepens the involvement of SMEs to community and L&RED initiatives.

Suorituskyvyn mittaaminen sahateollisuudessa

Diplomityön tarkoituksena oli rakentaa sahateollisuuteen sopiva suoritus kykymittaristo. Järjestelmästä tehtiin koko yrityksen kattava ja tasapainoinen järjestelmä, jota voidaan käyttää hyväksi johtamisessa, tiedottamisessa ja palautteen antamisessa. Apua suorituskyvyn analysointiin ja mittaamiseen pyrittiin saamaan suunnittelemalla myös strategiakartta, joka selventää suorituskyvyn taustoja. Aluksi esiteltiin suorituskyvyn mittaamista ja strategiakarttoja käsittelevää kirjallisuutta. Itse järjestelmän suunnittelu lähti liikkeelle yrityksen visiosta, strategiasta ja menestystekijöistä. Niiden perusteella valittiin viisi seurattavaa suorituskyvyn osa-aluetta ja niihin kuhunkin omat mittarit. Nämä viisi osa aluetta otettiin mukaan myös, kun strategiakartta visualisoitiin. Koekäytön jälkeen järjestelmä otettiin virallisesti käyttöön. Tutkimuksessa havaittiin, että pienillä ja keskisuurilla sahoilla on suorituskyvyn analysointijärjestelmän suunnittelussa otettava huomioon erityisesti raaka aineeseen liittyvät tekijät, koska raaka-aine on merkittävä kustannustekijä ja sen saatavuus on välillä epävarmaa. Strategiakartta selkeytti kohdeyrityksen visiota ja strategiaa. Strategiakarttaa voidaan myöhemmin hyödyntää kehityskeskusteluissa. Yrityksessä koettiin jo pelkkä suunnitteluprosessi hyödylliseksi, mutta järjestelmän toimivuus voidaan havaita vasta myöhemmin, kun tuloksia on kerätty pidemmältä ajalta. Järjestelmää pitää kehittää ja parantaa sekä tuloksia pitää analysoida, jotta järjestelmästä lopulta saadaan hyöty irti. Yrityksessä uskotaan, että järjestelmällä saavutetaan myöhemmin hyviä tuloksia

Effects of medium on nuclear properties in multifragmentation

In multifragmentation of hot nuclear matter, properties of fragments embedded in a soup of nucleonic gas and other fragments should be modified as compared with isolated nuclei. Such modifications are studied within a simple model where only nucleons and one kind of heavy nuclei are considered. The interaction between different species is described with a momentum-dependent two-body potential whose parameters are fitted to reproduce properties of cold isolated nuclei. The internal energy of heavy fragments is parametrized according to a liquid-drop model with density- and temperature-dependent parameters. Calculations are carried out for several subnuclear densities and moderate temperatures, for isospin-symmetric and asymmetric systems. We find that the fragments get stretched due to interactions with the medium and their binding energies decrease with increasing temperature and density of nuclear matter.

The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group.

OBJECTIVE: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. METHODS: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. RESULTS: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. CONCLUSION: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking.

English as a medium of instruction in teaching other languages: attitudes and practices

Internationalisation of HE and emergence of English as a global academic lingua franca used by people who share neither a common native tongue nor cultural and educational background have not only offered more opportunities but also raised challenges. According to recent European surveys, the percentage of pupils attaining the level of independent user in English varies from 14% to 82%, which evidences the potential and the complexity for English as a medium of instruction at tertiary level. This study aims to present the model of foreign language instruction at Vytautas Magnus University where one third of 30 languages are taught through English. It investigates the attitudes and practices of teachers in delivering their English-medium language courses by discussing the questions whether teaching other languages through English is psychologically, culturally and educationally preferable for teachers and students, whether it can limit the content taught and require a special methodology, how the teaching process changes with multiple languages used in the classroom and what level of English is necessary for teachers and students to ensure high quality of English-medium language teaching. The study is based on qualitative methodology with 12 language teachers participating as respondents. The results reveal areas in need of improvement.

L'impacte d'un programa de tennis com a eina de millora de la qualitat de vida i l'estrès percebut en dones físicament inactives d'entre 43 i 50 anys

Introducció: L’activitat física és una necessitat imprescindible per a la salut de les persones, i tot i ser conscients dels seus beneficis encara es troben alts percentatges d’inactivitat física i sedentarisme. Per aquest motiu, els objectius principals d’aquest estudi són esbrinar si les dones adultes d’entre 43 i 50 anys que realitzen activitat física regularment, més concretament que practiquen l’esport del tennis, tenen una qualitat de vida i un estrès percebut millor que les que no realitzen activitat física, i per tant, valorar l’impacte d’un programa de tennis adequat i específic, és a dir, adaptat a les característiques i les necessitats dels alumnes, com a eina per millorar aquestes dues variables: l’estrès percebut i la qualitat de vida. Metodologia: El treball és un estudi experimental el qual consta d’una mostra total de 12 dones, 6 es varen assignar al grup control (practiquen el tennis) i 6 al grup intervenció (no realitzen AF), i totes elles de manera aleatòria. Les participants del grup intervenció varen realitzar un programa de 8 sessions de 60 minuts de treball durant 4 setmanes, mentre que les participants del grup control van seguir la seva rutina habitual. Les variables dependents (qualitat de vida i estrès percebut) es varen mesurar abans i després de la intervenció. Resultats: Els resultats obtinguts mostren, pel que fa al grup intervenció, millores significatives respecte a les dues variables mentre que el grup control presenta alguna mínima millora puntual però, en general no es produeixen canvis. Quan a la variable de qualitat de vida, les participants del grup intervenció han obtingut millores en les 8 dimensions del qüestionari un cop finalitzat el programa, les quals han estat més significatives pel que fa al rol emocional i la funció física. I respecte a l’estrès percebut, el grup intervenció ha aconsegui reduir el seu nivell d’estrès 3’17 punts. Discussió: Per tant, podem dir que el tennis, amb el disseny adequat d’un programa, millora l’estat de salut de les persones, en aquest cas redueix l’estrès percebut i millora la qualitat de vida. Extretes les conclusions i coneixent l’elevat nombre de dones que practiquen el tennis és de gran interès i molt factible oferir aquest programa a clubs de tennis amb l’objectiu de millorar la salut de les persones.

Multilevel control of arabidopsis 3-hydroxy-3-methylglutaryl coenzyme A reductase by protein phosphatase 2A

Plants synthesize a myriad of isoprenoid products that are required both for essential constitutive processes and for adaptive responses to the environment. The enzyme 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR) catalyzes a key regulatory step of the mevalonate pathway for isoprenoid biosynthesis and is modulated by many endogenous and external stimuli. In spite of that, no protein factor interacting with and regulating plant HMGR in vivo has been described so far. Here, we report the identification of two B99 regulatory subunits of protein phosphatase 2A (PP2A), designated B99a and B99b, that interact with HMGR1S and HMGR1L, the major isoforms of Arabidopsis thaliana HMGR. B99a and B99b are Ca2+ binding proteins of the EF-hand type. We show that HMGR transcript, protein, and activity levels are modulated by PP2A in Arabidopsis. When seedlings are transferred to salt-containing medium, B99a and PP2A mediate the decrease and subsequent increase of HMGR activity, which results from a steady rise of HMGR1-encoding transcript levels and an initial sharper reduction of HMGR protein level. In unchallenged plants, PP2A is a posttranslational negative regulator of HMGR activity with the participation of B99b. Our data indicate that PP2A exerts multilevel control on HMGR through the fivemember B99 protein family during normal development and in response to a variety of stress conditions.

Functional and evolutionary analysis of DXL1, a non-essential gene encoding a 1-deoxy-D-xylulose 5-phosphate synthase like protein in Arabidopsis thaliana

The synthesis of 1-deoxy-D-xylulose 5-phosphate (DXP), catalyzed by the enzyme DXP synthase (DXS), represents a key regulatory step of the 2-C-methyl-D-erythritol 4-phosphate (MEP) pathway for isoprenoid biosynthesis. In plants DXS is encoded by small multigene families that can be classified into, at least, three specialized subfamilies. Arabidopsis thaliana contains three genes encoding proteins with similarity to DXS, including the well-known DXS1/CLA1 gene, which clusters within subfamily I. The remaining proteins, initially named DXS2 and DXS3, have not yet been characterized. Here we report the expression and functional analysis of A. thaliana DXS2. Unexpectedly, the expression of DXS2 failed to rescue Escherichia coli and A. thaliana mutants defective in DXS activity. Coherently, we found that DXS activity was negligible in vitro, being renamed as DXL1 following recent nomenclature recommendation. DXL1 is targeted to plastids as DXS1, but shows a distinct expression pattern. The phenotypic analysis of a DXL1 defective mutant revealed that the function of the encoded protein is not essential for growth and development. Evolutionary analyses indicated that DXL1 emerged from DXS1 through a recent duplication apparently specific of the Brassicaceae lineage. Divergent selective constraints would have affected a significant fraction of sites after diversification of the paralogues. Furthermore, amino acids subjected to divergent selection and likely critical for functional divergence through the acquisition of a novel, although not yet known, biochemical function, were identified. Our results provide with the first evidences of functional specialization at both the regulatory and biochemical level within the plant DXS family.

CDK4 is an essential insulin effector in adipocytes.

Insulin resistance is a fundamental pathogenic factor that characterizes various metabolic disorders, including obesity and type 2 diabetes. Adipose tissue contributes to the development of obesity-related insulin resistance through increased release of fatty acids, altered adipokine secretion, and/or macrophage infiltration and cytokine release. Here, we aimed to analyze the participation of the cyclin-dependent kinase 4 (CDK4) in adipose tissue biology. We determined that white adipose tissue (WAT) from CDK4-deficient mice exhibits impaired lipogenesis and increased lipolysis. Conversely, lipolysis was decreased and lipogenesis was increased in mice expressing a mutant hyperactive form of CDK4 (CDK4R24C). A global kinome analysis of CDK4-deficient mice following insulin stimulation revealed that insulin signaling is impaired in these animals. We determined that insulin activates the CCND3-CDK4 complex, which in turn phosphorylates insulin receptor substrate 2 (IRS2) at serine 388, thereby creating a positive feedback loop that maintains adipocyte insulin signaling. Furthermore, we found that CCND3 expression and IRS2 serine 388 phosphorylation are increased in human obese subjects. Together, our results demonstrate that CDK4 is a major regulator of insulin signaling in WAT.

The role of gadoxetic acid as a paramagnetic contrast medium in the characterization and detection of focal liver lesions: a review

Recent studies have demonstrated that the use of paramagnetic hepatobiliary contrast agents in the acquisition of magnetic resonance images remarkably improves the detection and differentiation of focal liver lesions, as compared with extracellular contrast agents. Paramagnetic hepatobiliary contrast agents initially show the perfusion of the lesions, as do extracellular agents, but delayed contrast-enhanced images can demonstrate contrast uptake by functional hepatocytes, providing further information for a better characterization of the lesions. Additionally, this intrinsic characteristic increases the accuracy in the detection of hepatocellular carcinomas and metastases, particularly the small-sized ones. Recently, a hepatobiliary contrast agent called gadolinium ethoxybenzyl dimeglumine, that is simply known as gadoxetic acid, was approved by the National Health Surveillance Agency for use in humans. The authors present a literature review and a practical approach of magnetic resonance imaging utilizing gadoxetic acid as contrast agent, based on patients' images acquired during their initial experiment.