Management of multiple sclerosis patients in central European countries: current needs and potential solutions

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Slovensko v EMÚ a ich spoločná budúcnost'

The task was to show on an example of Slovakia, which has accepted the euro, in comparison with V4 countries, which have kept their own currencies, that common currency does not necessarily bring only negatives. Current EMU problems don't come from the nature of euro but the key problem comes from the public finance and irresponsibility of politicians. On the base of this knowledge, the work suggests an alternative approach to solve debt crisis on the example of Greece, meaning a fiscal rent of Greek touristic islands. The work also deals with the vision of EMU in future to avoid this kind of problems and to change the overall approach to fiscal policy. I see a solution in monetary-fiscal union, which is based on the new fiscal rule derived from Okun's law and also on common supervision institution over national government budgets with the right to arbitrarily intervene in case of need

The judgement on entry of SVK to the Eurozone as a member of V4

The aim of bachelor work is to analyze and evaluate the entry of Slovak Republic to the Eurozone in the beginning of year 2009. Possible early entrance and the option of waiting for other states of Visegrad Four is what I will be interested in. In the theoretical part I will be talking about historical evolution of Economic and monetary union and nominal and real convergence criteria, which I analyze concerning The Theory of Optimum Currency Areas. In the second, practical part, I will put my mind to satisfying each real convergence criteria (from years 2004 to 2006) in the Slovakia and I will compare it with other states of European Union, especially with Visegrad Four. In the final part I will analyze pros and cons of adopting Euro in Slovakia

Data advance preparation factors affecting results of sequence rule analysis in web log mining

One of the main tasks of web log mining is discovering patterns of behaviour of portal visitors. Based on the found patterns of users behaviour, which are represented by sequence rules it is possible to modify and improve the web page of an organisation. This article aims at finding out by means of an experiment to what degree it is necessary to realize data preparation for web log mi- ning and it aims also at specifying inevitable steps for obtaining valid data from the log file. Results of the experiment are very important for the portal, which is regularly analysed and modified, since they can prove correctness of individual steps at analysis, or through an identification of “usele- ss” steps they can make the advance preparation of data simpler. These results show that data cleaning from crawlers accesses has a significant impact on the quantity of extracted rules only in case, when we use the method of paths completion. On the contrary, the impact on the reduction of the portion of inexplicable rules as well as the impact on the quality of extracted rules in terms of their basic characteristics was not proved. Paths completing was proved crucial in data prepa- ration for web log mining. It was proved that paths completing has a significant impact both on the quantity and the quality of extracted rules. However, it was prov ed that allowing the used browser upon identifying sessions has neither any significant impact on the quantity nor on the quality of extracted rules. There exist a number of models for identification of users sessions, which are cru- cial in data preparation, however, there e xists also a method, which identifies them expressly. Our next goal is to additionally programme this functionality into the existing system and analyse various parameters of individual methods of identification of sessions compared with the reference direct identification. It also mentions the necessity to pay attention to the analysis of web logs in the real time and to reduce the time needed for the advance preparation of these logs and at the same time to increase accuracy of these data depending on the time of their collection

Treatment with Cladribine Tablets Beyond Year 4: A Position Statement by Southeast European Multiple Sclerosis Centers

Based on the results of the pivotal CLARITY study, cladribine tablets were approved for use in the European Union in 2017 as a high-efficacy therapy for highly active relapsing-remitting multiple sclerosis (MS). Cladribine tablets are used as an induction therapy: half of the total dose is given in year 1 and the other half in year 2. In the CLARITY Extension trials, repeating the dose routinely in years 3 and 4, was not associated with significantly improved disease control. However, there is very limited evidence on how to manage people with MS (pwMS) beyond year 4, which is increasingly important because more and more patients are now ≥ 4 years after cladribine treatment. Overall, postapproval data show that treatment with two cladribine cycles effectively controls disease activity in the long term. However, there is general agreement that some pwMS with suboptimal response could benefit from retreatment. This study reviews the practical aspects of using cladribine tablets, summarizes the evidence from clinical trials and real-world studies on the safety and efficacy of cladribine, and proposes a treatment algorithm developed by expert consensus for pwMS previously treated with cladribine. In brief, we propose that additional courses of cladribine tablets should be considered in patients with minimal (no relapses, 1-2 new lesions) or moderate (1 relapse, 3-4 new lesions) disease activity, while significant disease activity (> 1 relapse, > 3 new lesions) or progression should warrant a switch to another high-efficacy treatment (HET). More evidence is needed to improve the treatment guidelines for pwMS who previously received cladribine

No Difference in Sleep Desaturations Severity between Patients with Wake-Up and Non-Wake-Up Stroke: A PRESS Study Results

Background: Wake-up stroke (WUS) is a certain type of ischemic stroke in which a patient wakes up with a new neurological deficit due to cerebral ischemia. Sleep-disordered breathing is an independent risk factor for stroke, but the role of nocturnal oxygen desaturation in the pathophysiology of WUS is still insufficiently explored. According to several studies, patients with WUS have a significantly more severe sleep apnea syndrome and lower mean blood oxygen saturation. This study aimed to assess the severity of nocturnal desaturations in acute WUS and non-WUS patients using nocturnal pulse oximetry. Material and Methods: The cohort of 225 consecutive patients with neuroimaging-verified acute cerebral ischemia was prospectively enrolled. For further analyses, 213 subjects with known WUS/non-WUS status were selected (111 males and 102 females, average age 70.4 ±12.9, median baseline NIHSS = 5, median baseline mRS = 3). Patients were divided into the WUS group (n = 45) and the non-WUS group (n = 168). Overnight pulse oximetry was performed within 7 days of the stroke onset and data of both of the studied groups were compared. Results: We found oxygen desaturation index (ODI) in the WUS group was 14.5 vs. 16.6 (p = 0.728) in the non-WUS group, basal O2 saturation was 92.2% vs. 92.5% (p = 0.475), average low O2 saturation was 90.3% vs. 89.6% (p = 0.375), minimal O2 saturation was 79.5% vs. 80.6% (p = 0.563), and time with O2 saturation p = 0.729). Conclusions: In the studied sample, monitored respiratory parameters including ODI, basal O2 saturation, average low O2 saturation, minimal O2 saturation, and T90 did not significantly differ between groups of WUS and non-WUS patients

Spruce Protection against <i>Ips typographus</i> with Anti-Attractant Blend of Tree-Based Semiochemicals: From Small Experimental Plots to Stand Scales

Tree-killing bark beetles require rapid management, such as anti-attractants, to stop the enlargement of attack hot-spots. We tested two newer anti-attractant blends, both without verbenone and one with the addition of trans-4-thujanol, in traps against standard pheromone baits for inhibition of catch. Both blends provided effective catch reduction (>95%). We also tested these anti-attractant blends in tree protection experiments for two years. We had experimental plots with a center of an anti-attractant protected tree zone, with no traditional control area, but we followed tree kills in 10 m wide concentric rings to 100 m. In 2020, we had 12 plots, and 9 plots in 2021. Monitoring by low-strength pheromone traps followed beetle flight averaging 300/trap during the shorter period, August 2020, and 5000/trap during the longer period, May to August 2021. The blends of anti-attractants were 100% effective in avoiding tree mortality in both treated trees and their surroundings. There were no bark beetle attacks on any treated trees, and there was zero tree mortality up to 19 m in 2020, and up to 30 m in 2021, thus full protection to circa 20 m. The density of killed trees then increased from close to zero, over 20 to 50 m, reaching a level of ca 30 (trees/ha) then declined. The spatial pattern of tree mortality on our experimental plots was highly heterogeneous and individual 10m-ring data points on tree kill density could not be statistically separated. In contrast, a non-linear regression model showed a continuous increase of attacks over the distance from the center to a peak ca 60m, followed by a decline. This model agrees partly with the only similar study in the literature, but importantly, it does not give a peak of kill density at distances between the first and second rings close to treatment zones. Such patterns of close-quarter kills have been observed as a “switching” of attack in this and other scolytid systems manipulated by anti-attractants, but not in the present study, likely due to the elimination of verbenone from our blends

Management of multiple sclerosis patients in central European countries: current needs and potential solutions

Multiple sclerosis (MS) experts in Europe are facing rapidly rising demands of excellence due to the increasing complexity of MS therapy and management. A central European expert board of MS experts met to identify needs and obstacles with respect to raising quality of MS care in central and Eastern European countries. There are substantial variations across countries regarding delivery of care and its cost structure, as well as access to treatment. To date, Eastern European countries are often less able to afford reimbursement of immunomodulatory agents than Western countries. Overall, approximately 40% of working-age patients are not working due to MS. Costs rise steeply with increasing disability; indirect costs constitute the bulk of the financial burden in patients with severe MS. Magnetic resonance imaging (MRI) assessment is meanwhile obligatory as the diagnostic interface in the management of MS patients. Recommended measures directed at improving quality of care include the collection of patient data in registries, enhanced education of healthcare professionals, implementation of national strategies aiming at reducing regional variation, optimization of approval processes, and removal of administrative barriers. Local partnerships with authorities such as those that represent the interests of employees can contribute to leverage the importance of epidemiological data. The need for education extends to (neuro)radiologists who are responsible for reporting MRI findings in expert quality. Dissemination of the Magnetic Resonance Imaging in MS (MAGNIMS) protocol would be an important step in this context. Also, clinical freedom of choice is rated as essential. Physicians should have access to a range of treatment options due to the complexity of disease. Guidelines such as the upcoming EAN-ECTRIMS clinical practice guideline also aim at providing a basis for argumentation in negotiations with national health authorities