Tuning participatory processes is often insufficient to achieve transition from authoritative state to democratic and participatory forest governance due to institutional inertia and unwillingness to truly decentralize decision-making power. Social innovations as reconfigurations of relationships between state, market actors, civil society and science can help to meet concerns of local people about forest Ecosystem Services (ES). In Ukraine, the Swiss-Ukrainian Forest Development (FORZA) pilot project initiated a social innovation process complementing regional forest planning with local participatory community development plans in Transcarpathia. This paper examines what kind of changes need to accompany the succession of participatory practices in transition processes from authoritative state to democratic forest governance, and what are the lessons learned for social innovations based on the Ukrainian case study. This paper synthesizes knowledge on the FORZA case analyzed by inductive content analysis, and integrates these local level results with a national survey (N = 244) on Ukrainian forest governance. Transition processes need to go ''beyond participation'' by (i) legal reforms to better acknowledge ES ().,-volV) ( 01234567 89().,-volV) important for local people, (ii) a change from an exclusive focus on timber to acknowledging multiple ES, (iii) changed spatial and temporal rationales of state-based governance, and (iv) recognition of local people as credible experts. Social innovations can detect key barriers to the transition during the policy experiments, and need to pay significant attention on how the novel practices can be sustained after the pilot, replicated elsewhere and up-scaled. Without such considerations, social innovation projects may only remain as a marginal curiosity.
Multiple sclerosis (MS) is a neurological disorder characterized by inflammatory demyelination and neurodegeneration in the central nervous system. Until recently, disease-modifying treatment was based on agents requiring parenteral delivery, thus limiting long-term compliance. Basic treatments such as beta-interferon provide only moderate efficacy, and although therapies for second-line treatment and highly active MS are more effective, they are associated with potentially severe side effects. Fingolimod (Gilenya®) is the first oral treatment of MS and has recently been approved as single disease-modifying therapy in highly active relapsing-remitting multiple sclerosis (RRMS) for adult patients with high disease activity despite basic treatment (beta-interferon) and for treatment-naïve patients with rapidly evolving severe RRMS. At a scientific meeting that took place in Vienna on November 18th, 2011, experts from ten Central and Eastern European countries discussed the clinical benefits and potential risks of fingolimod for MS, suggested how the new therapy fits within the current treatment algorithm and provided expert opinion for the selection and management of patients.
Background and purposeImpaired ambulation is a prominent disabling symptom of multiple sclerosis and can lead to reduced quality of life. Whether natalizumab, a monoclonal antibody shown to reduce disease activity in relapsing−remitting multiple sclerosis, could impact ambulation performance was examined.MethodsA prospective open-label study, TIMER, was conducted in natalizumab-naive patients (n = 215). The timed 25-foot walk (T25FW) and timed 100-m walk (T100MW) were assessed at baseline and at weeks 24 and 48 of natalizumab therapy, together with Expanded Disability Status Scale scores. The effects of natalizumab on T25FW performance were also examined in a retrospective analysis of natalizumab-treated patients (n = 627) and placebo control patients (n = 315) from the AFFIRM study.ResultsIn TIMER, a significant increase from baseline in T25FW speed was seen at week 24 (P = 0.0074) and in T100MW speed at weeks 24 and 48 (both P < 0.001). A greater proportion of patients showed clinically meaningful increases (≥20%) in walking speed on the T100MW (25%) than on the T25FW (13%) at week 48 (P = 0.032). In AFFIRM, natalizumab increased the proportion of patients with ≥20% confirmed improvement in T25FW speed at year 2 by 78% versus placebo (P = 0.0133).ConclusionsNatalizumab increased walking speed in patients with relapsing−remitting multiple sclerosis. The T100MW may be more sensitive to changes in ambulation capacity than the T25FW, and both tests appear to detect clinically meaningful improvements in ambulatory function.
Сравнительная эффективность гормональной пульс-терапии при рецидивирующем и вторично-прогредиентном типах течения рассеянного склероза с разным характером прогноза Сообщение I Эффективность гормональной пульс-терапии в дебютах и на рецидивирующем этапе при рецидивирующем и вторично-прогредиентном типах течения рассеянного склероза с разным характером прогноза Резюме. Изучена эффективность пульс-терапии глюкокортикоидами (ГКТ) в дебютах и на рецидивирующем этапе (РЭ) у 98 больных с рассеянным склерозом (РС): 28 человек (24 женщины и 4 мужчины) с неопределенным прогнозом при рецидивирующем течении (РТ)-1-я группа; 30 человек (21 женщина и 9 мужчин) с неопределенным прогнозом при вторично-прогредиентном течении (ВПТ)-2-я группа; 40 человек (36 женщин и 4 мужчины) с неблагоприятным прогнозом при ВПТ-3-я группа. Проводился учет следующих клинических показателей: возраст, длительность заболевания, возраст дебюта, тяжесть дебютов, длительность ремиссии после дебюта, длительность рецидивирующего этапа, тяжесть и число рецидивов на РЭ, средняя частота рецидивов и длительность ремиссий на РЭ, степень инвалидизации по шкале EDSS. Проведено 287 курсов ГКТ-терапии: при неопределенном прогнозе РТ-98 (в дебютах-9, на РЭ-89); при неопределенном прогнозе ВПТ-99 (в дебютах-3, на РЭ-96); при неблагоприятном прогнозе ВПТ-90 (в дебютах-8, на РЭ-82). Клинико-диагностические критерии эффективности лечения во всех группах больных включали динамику регресса неврологической симптоматики под влиянием первого курса ГКТ-терапии на этапе дебютов; сравнительную оценку длительности ремиссии после дебюта при приеме и без приема ГКТ; среднюю частоту рецидивов на РЭ под влиянием повторных курсов ГКТ-терапии; длительность ремиссий после 1-го курса гормональной терапии; продолжительность РЭ в зависимости от длительности ремиссий после первого курса ГКТ-терапии. В группе больных с неопределенным прогнозом РТ дополнительно учитывались: длительность ремиссий перед последним курсом ГКТ; скорость прогрессирования на РЭ; динамика баллов по шкале инвалидизации EDSS после 1-го и перед последним курсами ГКТ-терапии. Проведенное исследование показало, что в процессе лечения клинические показатели, характеризующие течение дебютов и РЭ, претерпевают сложную системную реорганизацию в зависимости от типа течения и характера прогноза. Наиболее эффективной гормо-ОРИГІНАЛЬНІ ДОСЛІДЖЕННЯ /ORIGINAL RESEARCHES/
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