Die Krankheit Depression kann jeden treffen [In Process Citation].

The survey "Datenerhebung zur Depression in der Allgemeinbevölkerung" was conducted from fall 2010 to spring 2011 on several online platforms. The results show that there is a considerable timespan between the appearance of initial symptoms of depression and the first diagnosis of a patient. Intervention at early stages of the disease can reduce a potentially long time of suffering and can lead to the successful treatment of depression. General practitioners play an important role as the link between patient and psychiatrist.

Identifying the unmet health needs of patients with congenital hypogonadotropic hypogonadism using a web-based needs assessment: implications for online interventions and peer-to-peer support.

BACKGROUND: Patients with rare diseases such as congenital hypogonadotropic hypogonadism (CHH) are dispersed, often challenged to find specialized care and face other health disparities. The internet has the potential to reach a wide audience of rare disease patients and can help connect patients and specialists. Therefore, this study aimed to: (i) determine if web-based platforms could be effectively used to conduct an online needs assessment of dispersed CHH patients; (ii) identify the unmet health and informational needs of CHH patients and (iii) assess patient acceptability regarding patient-centered, web-based interventions to bridge shortfalls in care. METHODS: A sequential mixed-methods design was used: first, an online survey was conducted to evaluate health promoting behavior and identify unmet health and informational needs of CHH men. Subsequently, patient focus groups were held to explore specific patient-identified targets for care and to examine the acceptability of possible online interventions. Descriptive statistics and thematic qualitative analyses were used. RESULTS: 105 male participants completed the online survey (mean age 37 ± 11, range 19-66 years) representing a spectrum of patients across a broad socioeconomic range and all but one subject had adequate healthcare literacy. The survey revealed periods of non-adherence to treatment (34/93, 37%) and gaps in healthcare (36/87, 41%) exceeding one year. Patient focus groups identified lasting psychological effects related to feelings of isolation, shame and body-image concerns. Survey respondents were active internet users, nearly all had sought CHH information online (101/105, 96%), and they rated the internet, healthcare providers, and online community as equally important CHH information sources. Focus group participants were overwhelmingly positive regarding online interventions/support with links to reach expert healthcare providers and for peer-to-peer support. CONCLUSION: The web-based needs assessment was an effective way to reach dispersed CHH patients. These individuals often have long gaps in care and struggle with the psychosocial sequelae of CHH. They are highly motivated internet users seeking information and tapping into online communities and are receptive to novel web-based interventions addressing their unmet needs.

The management of iron deficiency in inflammatory bowel disease--an online tool developed by the RAND/UCLA appropriateness method.

BACKGROUND: Iron deficiency is a common and undertreated problem in inflammatory bowel disease (IBD). AIM: To develop an online tool to support treatment choice at the patient-specific level. METHODS: Using the RAND/UCLA Appropriateness Method (RUAM), a European expert panel assessed the appropriateness of treatment regimens for a variety of clinical scenarios in patients with non-anaemic iron deficiency (NAID) and iron deficiency anaemia (IDA). Treatment options included adjustment of IBD medication only, oral iron supplementation, high-/low-dose intravenous (IV) regimens, IV iron plus erythropoietin-stimulating agent (ESA), and blood transfusion. The panel process consisted of two individual rating rounds (1148 treatment indications; 9-point scale) and three plenary discussion meetings. RESULTS: The panel reached agreement on 71% of treatment indications. 'No treatment' was never considered appropriate, and repeat treatment after previous failure was generally discouraged. For 98% of scenarios, at least one treatment was appropriate. Adjustment of IBD medication was deemed appropriate in all patients with active disease. Use of oral iron was mainly considered an option in NAID and mildly anaemic patients without disease activity. IV regimens were often judged appropriate, with high-dose IV iron being the preferred option in 77% of IDA scenarios. Blood transfusion and IV+ESA were indicated in exceptional cases only. CONCLUSIONS: The RUAM revealed high agreement amongst experts on the management of iron deficiency in patients with IBD. High-dose IV iron was more often considered appropriate than other options. To facilitate dissemination of the recommendations, panel outcomes were embedded in an online tool, accessible via http://ferroscope.com/.

Insights into the regulation of two caspase-activating platforms, the inflammasome and the PIDDosome

Résumé: Les organismes multicellulaires ont adopté diverses stratégies pour répondre aux stress auxquels ils sont exposés. Cette étude a exploré deux de ces stratégies l'inflammation en réponse à une invasion par un pathogène, et l'apoptose ou la survie en réponse aux dommages à l'ADN. L'interleukine-lß (IL-lß) est une importante cytokine inflammatoire. Elle est synthétisée sous forme d'un précurseur inactif et nécessite un clivage par la caspase-1 pour être activée. La caspase-1 elle-même est activée dans un complexe appelé inflammasome. Certains NLRs (Nod-like receptors), IPAF et les NALPs, sont capables de former des inflammasomes fonctionnels. Cette étude s'est intéressée au rôle d'un autre NLR structurellement proche, la protéine NAIP, dans la régulation de la caspase-1 et la maturation de l'IL-1 ß. NAIP est incorporé à l'inflammasome contenant NALP3 et est capable d'inhiber l'activation de la caspase-1 et la maturation de l'IL-lß. Cette fonction inhibitrice dépend des ses domaines BIR et est inhibée par ses LRRs. Le mécanisme exact d'inhibition reste à définir et la régulation de l'activation de NAIP est discutée. La deuxième partie de cette étude concerne la protéine PIDD. Cette protéine est impliquée avec RAIDD dans l'activation de la caspase-2, et est aussi capable, avec l'aide de RIP et de NEMO, d'activer NF-κB en réponse aux dommages à l'ADN. Deux isoformes de PIDD ont déjà été décrites dans la littérature, PIDD (isoforme 1) et LRDD (isoforme 2) et une troisième isoforme est rapportée ici. L'étude de l'expression de ces isoformes a montré qu'elles sont exprimées différemment dans les tissus et dans les lignées cellulaires, et que l'isoforme 3 est induite en réponse à un stress génotoxique. La caractérisation fonctionnelle a établi que les trois isoformes sont capables d'activer NF-κB, donc la survie, mais que seule l'isoforme 1 peut interagir avec RAIDD pour activer la caspase-2 et sensibiliser les cellules à la mort induite par un stress génotoxique. Le domaine intermédiaire de PIDD, situé entre le deuxième ZU5 et le DD est essentiel pour l'interaction entre PIDD et RAIDD et l'activation de la caspase-2 qui en découle. En conclusion, l'épissage différentiel de l'ARNm de PIDD permet la production d'au moins trois protéines possédant des fonctions agonistes ou antagonistes et qui peuvent participer au choix cellulaire entre survie et apoptose en réponse aux dommages à l'ADN. Summary: Multicellular organisms have evolved several strategies to cope with the stresses they encounter. The present study has explored two of these strategies: inflammation in response to a pathogenic invasion, and apoptosis or repair/survival in response to DNA damage. Interleukin-lß (IL-lß) is a key mediator of inflammation. It is synthesized as an inactive precursor and requires cleavage by caspase-1 to be activated. caspase-1 itself is activated in molecular platforms called inflammasomes, which can be formed by members of the NOD-like receptors (NLR) family, like IPAF and NALPs. This study has investigated the role of another NLR, the structurally related protein NAIP, in the regulation of caspase-1 activation and IL-lß maturation. An inhibitory role of NAIP on caspase-1 activation and IL-lß maturation was demonstrated, as well as NAIP incorporation in the NALP3 inflammasome. This inhibitory property relies on NAIP BIR domains and is inhibited by NAIP LRRs. The exact mechanism of NAIP-mediated caspase-1 activation remains to be elucidated and the regulation of NAIP activation is discussed. The second part of this study focused on the caspase-2 activating protein PIDD. This protein is known to mediate caspase-2 activation via RAIDD and to signal NF-κB via RIP and NEMO in response to DNA damage. Two isoforms of PIDD, PIDD (isoform 1) and LRDD (isoform 2), have already been reported and a third isoform is described here. Investigation of the expressional regulation of these isoforms indicated that they are differentially expressed in tissues and cell lines, and that isoform 3 mRNA levels are upregulated in response to genotoxic stress. Functional studies demonstrated that all three isoforms can activate NF-κB in response to DNA damage, but only isoform 1 is able to interact with RAIDD and activate caspase-2, sensitizing cells to genotoxic stress-induced cell death. The intermediate domain located between the second ZUS and the DD is essential for the interaction of PIDD and RAIDD and the subsequent caspase-2 activation. Thus the differential splicing of PIDD mRNA leads to the formation of at least thrée proteins with antagonizing/agonizing functions that could participate in determining cell fate in response to DNA damage.

Online estimation of respiratory mechanics in non-invasive pressure support ventilation: a bench model study.

An online algorithm for determining respiratory mechanics in patients using non-invasive ventilation (NIV) in pressure support mode was developed and embedded in a ventilator system. Based on multiple linear regression (MLR) of respiratory data, the algorithm was tested on a patient bench model under conditions with and without leak and simulating a variety of mechanics. Bland-Altman analysis indicates reliable measures of compliance across the clinical range of interest (± 11-18% limits of agreement). Resistance measures showed large quantitative errors (30-50%), however, it was still possible to qualitatively distinguish between normal and obstructive resistances. This outcome provides clinically significant information for ventilator titration and patient management.

Understanding consumers repurchase in the context of online shopping: an empirical study

L'utilisation de l'Internet comme medium pour faire ses courses et achats a vu une croissance exponentielle. Cependant, 99% des nouveaux business en ligne échouent. La plupart des acheteurs en ligne ne reviennent pas pour un ré-achat et 60% abandonnent leur chariot avant de conclure l'achat. En effet, après le premier achat, la rétention du consommateur en ligne devient critique au succès du vendeur de commerce électronique. Retenir des consommateurs peut sauver des coûts, accroître les profits, et permet de gagner un avantage compétitif.Les recherches précédentes ont identifié la loyauté comme étant le facteur le plus important dans la rétention du consommateur, et l'engagement ("commitment") comme étant un des facteurs les plus importants en marketing relationnel, offrant une réflexion sur la loyauté. Pourtant, nous n'avons pu trouver d'étude en commerce électronique examinant l'impact de la loyauté en ligne et de l'engagement en ligne ("online commitment") sur le ré-achat en ligne. Un des avantages de l'achat en ligne c'est la capacité à chercher le meilleur prix avec un clic. Pourtant, nous n'avons pu trouver de recherche empirique en commerce électronique qui examinait l'impact de la perception post-achat du prix sur le ré-achat en ligne.L'objectif de cette recherche est de développer un modèle théorique visant à comprendre le ré-achat en ligne, ou la continuité d'achat ("purchase continuance") du même magasin en ligne.Notre modèle de recherche a été testé dans un contexte de commerce électronique réel, sur un échantillon total de 1,866 vrais acheteurs d'un même magasin en ligne. L'étude est centrée sur le ré-achat. Par conséquent, les répondants sélectionnés aléatoirement devaient avoir acheté au moins une fois de ce magasin en ligne avant le début de l'enquête. Cinq mois plus tard, nous avons suivi les répondants pour voir s'ils étaient effectivement revenus pour un ré-achat.Notre analyse démontre que l'intention de ré-achat en ligne n'a pas d'impact significatif sur le ré-achat en ligne. La perception post-achat du prix en ligne ("post-purchase Price perception") et l'engagement normatif en ligne ("Normative Commitment") n'ont pas d'impact significatif sur l'intention de ré-achat en ligne. L'engagement affectif en ligne ("Affective Commitment"), l'attitude loyale en ligne ("Attitudinal Loyalty"), le comportement loyal en ligne ("Behavioral Loyalty"), l'engagement calculé en ligne ("Calculative Commitment") ont un impact positif sur l'intention de ré-achat en ligne. De plus, l'attitude loyale en ligne a un effet de médiation partielle entre l'engagement affectif en ligne et l'intention de ré-achat en ligne. Le comportement loyal en ligne a un effet de mediation partielle entre l'attitude loyale en ligne et l'intention de ré-achat en ligne.Nous avons réalisé deux analyses complémentaires : 1) Sur un échantillon de premiers acheteurs, nous trouvons que la perception post-achat du prix en ligne a un impact positif sur l'intention de ré-achat en ligne. 2) Nous avons divisé l'échantillon de l'étude principale entre des acheteurs répétitifs Suisse-Romands et Suisse-Allemands. Les résultats démontrent que les Suisse-Romands montrent plus d'émotions durant l'achat en ligne que les Suisse-Allemands. Nos résultats contribuent à la recherche académique mais aussi aux praticiens de l'industrie e-commerce.AbstractThe use of the Internet as a shopping and purchasing medium has seen exceptional growth. However, 99% of new online businesses fail. Most online buyers do not comeback for a repurchase, and 60% abandon their shopping cart before checkout. Indeed, after the first purchase, online consumer retention becomes critical to the success of the e-commerce vendor. Retaining existing customers can save costs, increase profits, and is a means of gaining competitive advantage.Past research identified loyalty as the most important factor in achieving customer retention, and commitment as one of the most important factors in relationship marketing, providing a good description of what type of thinking leads to loyalty. Yet, we could not find an e-commerce study investing the impact of both online loyalty and online commitment on online repurchase. One of the advantages of online shopping is the ability of browsing for the best price with one click. Yet, we could not find an e- commerce empirical research investigating the impact of post-purchase price perception on online repurchase.The objective of this research is to develop a theoretical model aimed at understanding online repurchase, or purchase continuance from the same online store.Our model was tested in a real e-commerce context with an overall sample of 1, 866 real online buyers from the same online store.The study focuses on repurchase. Therefore, randomly selected respondents had purchased from the online store at least once prior to the survey. Five months later, we tracked respondents to see if they actually came back for a repurchase.Our findings show that online Intention to repurchase has a non-significant impact on online Repurchase. Online post-purchase Price perception and online Normative Commitment have a non-significant impact on online Intention to repurchase, whereas online Affective Commitment, online Attitudinal Loyalty, online Behavioral Loyalty, and online Calculative Commitment have a positive impact on online Intention to repurchase. Furthermore, online Attitudinal Loyalty partially mediates between online Affective Commitment and online Intention to repurchase, and online Behavioral Loyalty partially mediates between online Attitudinal Loyalty and online Intention to repurchase.We conducted two follow up analyses: 1) On a sample of first time buyers, we find that online post-purchase Price perception has a positive impact on Intention. 2) We divided the main study's sample into Swiss-French and Swiss-German repeated buyers. Results show that Swiss-French show more emotions when shopping online than Swiss- Germans. Our findings contribute to academic research but also to practice.

www.fevertravel.ch : an online study prototype to evaluate the safety and feasibility of computerized guidelines for fever in returning travellers and migrants

Résumé Suite à la publication des recommandations de pratiques cliniques sur la prise en soins de patients fébriles au retour des tropiques, nous avons développé un site internet de consultation www.fevertravel.ch qui comprend un arbre décisionnel et des caractéristiques diagnostiques spécifiques fournissant une assistance diagnostique aux médecins de premier recours. Nous avons ensuite intégré une composante de recherche afin d'évaluer l'implémentation de ces recommandations de pratiques cliniques informatisées. De plus, le site est capable d'enregistrer : (1) le chemin parcouru par le médecin au travers de l'arbre décisionnel, (2) les tests diagnostics effectués, (3) les diagnostics initial et final ainsi que les devenirs des patients et (4) les raisons de non-adhérence lorsque les médecins divergent de l'attitude proposée. Nous croyons que la technologie internat est un moyen puissant pour atteindre des médecins provenant de différents horizons dans leur propre environnement et qu'il pourrait se montrer être un outil de recherche efficace pour disséminer les recommandations de pratiques cliniques et évaluer leur justesse-adéquation. Dans cet article, nous décrivons le design, le contenu, l'architecture et l'implémentation du système de ce prototype d'étude interactive qui vise à intégrer une recherche opérationnelle en médecine de premier recours.

Evaluation of an online, case-based interactive approach to teaching pathophysiology

AIM: The aim of this study was to evaluate a new pedagogical approach in teaching fluid, electrolyte and acid-base pathophysiology in undergraduate students. METHODS: This approach comprises traditional lectures, the study of clinical cases on the web and a final interactive discussion of these cases in the classroom. When on the web, the students are asked to select laboratory tests that seem most appropriate to understand the pathophysiological condition underlying the clinical case. The percentage of students having chosen a given test is made available to the teacher who uses it in an interactive session to stimulate discussion with the whole class of students. The same teacher used the same case studies during 2 consecutive years during the third year of the curriculum. RESULTS: The majority of students answered the questions on the web as requested and evaluated positively their experience with this form of teaching and learning. CONCLUSIONS: Complementing traditional lectures with online case-based studies and interactive group discussions represents, therefore, a simple means to promote the learning and the understanding of complex pathophysiological mechanisms. This simple problem-based approach to teaching and learning may be implemented to cover all fields of medicine.

Designing business models of cloud platforms

Cloud computing and its three facets (Software as a Service (SaaS), Platform as a Service (PaaS), and Infrastructure as a Service (IaaS)) are terms that denote new developments in the software industry. In particular, PaaS solutions, also referred to as cloud platforms, are changing the way software is being produced, distributed, consumed, and priced. Software vendors have started considering cloud platforms as a strategic option but are battling to redefine their offerings to embrace PaaS. In contrast to SaaS and IaaS, PaaS allows for value co-creation with partners to develop complementary components and applications. It thus requires multisided business models that bring together two or more distinct customer segments. Understanding how to design PaaS business models to establish a flourishing ecosystem is crucial for software vendors. This doctoral thesis aims to address this issue in three interrelated research parts. First, based on case study research, the thesis provides a deeper understanding of current PaaS business models and their evolution. Second, it analyses and simulates consumers' preferences regarding PaaS business models, using a conjoint approach to find out what determines the choice of cloud platforms. Finally, building on the previous research outcomes, the third part introduces a design theory for the emerging class of PaaS business models, which is grounded on an extensive action design research study with a large European software vendor. Understanding PaaS business models from a market as well as a consumer perspective will, together with the design theory, inform and guide decision makers in their business model innovation plans. It also closes gaps in the research related to PaaS business model design and more generally related to platform business models.

Use of mobile devices to answer online surveys: implications for research.

BACKGROUND: There is a growing use of mobile devices to access the Internet. We examined whether participants who used a mobile device to access a brief online survey were quicker to respond to the survey but also, less likely to complete it than participants using a traditional web browser. FINDINGS: Using data from a recently completed online intervention trial, we found that participants using mobile devices were quicker to access the survey but less likely to complete it compared to participants using a traditional web browser. More concerning, mobile device users were also less likely to respond to a request to complete a six week follow-up survey compared to those using traditional web browsers. CONCLUSIONS: With roughly a third of participants using mobile devices to answer an online survey in this study, the impact of mobile device usage on survey completion rates is a concern. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01521078.