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.

Effect of intradialytic resistance band exercise on physical function in patients on maintenance hemodialysis: a pilot study.

Although physical activity is recommended in patients on maintenance hemodialysis (MHD), randomized controlled trials testing the effects of exercise in this population have given conflicting results. In general, aerobic exercises mostly failed to produce improvements in physical function, whereas resistance exercises, although less studied, appeared to be more promising. The use of sophisticated materials such as leg press and free weights may preclude widespread application of resistance training in patients on MHD. Simple and cheap elastic bands may thus be an attractive alternative. We tested the feasibility of a supervised intradialytic resistance band exercise training program, and its effects on physical function, in patients on MHD. A total of 11 unselected adult patients on MHD from our center, aged 70 ± 10.7 (mean ± standard deviation) years, including 8 men and 3 women, accepted to follow the program under the supervision of qualified physiotherapists. Thirty-six exercise sessions of moderate intensity (twice a week, mean duration 40 minutes each, during 4.5 to 6 months), mainly involving leg muscles against an elastic resistance, were performed. The exercise program was well tolerated and all patients completed it. Statistically significant improvements were observed in the following tests: Tinetti test, 23.9 ± 3.9 points before versus 25.7 ± 3.5 points after the program (P = .022); the Timed Up and Go test, 12.1 ± 6.6 versus 10 ± 5.8 seconds (P = .0156). Improvements in the 6-minute walk distance and in the one-leg balance tests just failed to reach statistical significance. In this single-center pilot study, an intradialytic resistance band exercise program was feasible, well tolerated, and showed encouraging results on physical function.

Pulmonary embolism severity index and troponin testing for the selection of low-risk patients with acute symptomatic pulmonary embolism.

Summary Background: The combination of the Pulmonary Embolism Severity Index (PESI) and troponin testing could help physicians identify appropriate patients with acute pulmonary embolism (PE) for early hospital discharge. Methods: This prospective cohort study included a total of 567 patients from a single center registry with objectively confirmed acute symptomatic PE. On the basis of the PESI, each patient was classified into 1 of 5 classes (I to V). At the time of hospital admission, patients had troponin I (cTnI) levels measured. The endpoint of the study was all-cause mortality within 30 days after diagnosis. We calculated the mortality rates in 4 patient groups: group 1: PESI class I-II plus cTnI <0.1 ng mL(-1); group 2: PESI classes III-V plus cTnI <0.1 ng mL(-1); group 3: PESI classes I-II plus cTnI >/= 0.1 ng mL(-1); and group 4: PESI classes III-V plus cTnI >/= 0.1 ng mL(-1). Results: The study cohort had a 30-day mortality of 10% (95% confidence interval [CI], 7.6 to 12.5%). Mortality rates in the 4 groups were 1.3%, 14.2%, 0% and 15.4%, respectively. Compared to non-elevated cTnl, the low-risk PESI had a higher negative predictive value (NPV) (98.9% vs 90.8%) and negative likelihood ratio (NLR) (0.1 vs 0.9) for predicting mortality. The addition of non-elevated cTnI to low-risk PESI did not improve the NPV or the NLR compared to either test alone. Conclusions: Compared to cTnl testing, PESI classification more accurately identified patients with PE who are at low risk of all-cause death within 30-days of presentation.

Product Platform Development from the Product Lines' Perspective: Case of Switching Platform

In the era of fast product development and customized product requirements, the concept of product platform has proven its power in practice. The product platform approach has enabledcompanies to increase the speed of product introductions while simultaneously benefit from efficiency and effectiveness in the development and production activities. The product platforms are technological bases, which can be used to develop several derivative products, and hence, the differentiation can be pushed closer to the product introduction. The product platform development has some specific features, which differ somewhat from the product development of single products. The time horizon is longer, since the product platform¿slife cycle is longer than individual product's. The long time-horizon also proposes higher market risks and the use of new technologies increases the technological risks involved. The end-customer interface might be far away, but there is not a lack of needs aimed at the product platforms ¿ in fact, the product platform development is very much balancing between the varying needs set to it by thederivative products. This dissertation concentrated on product platform development from the internal product lines' perspective of a singlecase. Altogether six product platform development factors were identified: 'Strategic and business fit of product platform', 'Project communication and deliverables', 'Cooperation with product platform development', 'Innovativeness of product platform architecture and features', 'Reliability and quality of product platform', and 'Promised schedules and final product platform meeting the needs'. From the six factors, three were found to influence quite strongly the overall satisfaction, namely 'Strategic and business fit of product platform', 'Reliability and quality of product platform', and 'Promised schedules and final product platform meeting the needs'. Hence, these three factors might be the ones a new product platform development unit should concentrate first in order to satisfy their closest customers, the product lines. The 'Project communication and deliverables' and 'Innovativeness of product platform architecture and features' were weaker contributors to the overall satisfaction. Overall, the factors explained quite well the satisfaction of the product lines with product platform development. Along the research, several interesting aspects about the very basic nature of the product platform development were found. The long time horizon of the product platform development caused challenges in the area of strategic fIT - a conflict between the short-term requirements and long term needs. The fact that a product platform was used as basis of several derivative products resulted into varying needs, and hence the match with the needs and the strategies. The opinions, that the releases of the larger product lines were given higher priorities, give an interesting contribution to the strategy theory of powerand politics. The varying needs of the product lines, the strengths of them as well as large number of concurrent releases set requirements to prioritization. Hence, the research showed the complicated nature of the product platform development in the case unIT - the very basic nature of the product platform development might be its strength (gaining efficiency and effectiveness in product development and product launches) but also the biggest challenge (developing products to meet several needs). As a single case study, the results of this research are not directly generalizable to all the product platform development activities. Instead, the research serves best as a starting point for additional research as well as gives some insights about the factors and challengesof one product development unit.

Building a usable and accessible semantic web interaction platform

Semantic Web applications take off is being slower than expected, at least with respect to “real-world” applications and users. One of the main reasons for this lack of adoption is that most Semantic Web user interfaces are still immature from the usability and accessibility points of view. This is due to the novelty of these technologies, but this also motivates the exploration of alternative interaction paradigms, different from the “traditional” Web or Desktop applications ones. Our proposal is realized in the Rhizomer platform, which explores the possibilities of the object–action interaction paradigm at the Web scale. This paradigm is well suited for heterogeneous resource spaces such as those common in the Semantic Web. Resources, described by metadata, correspond to the objects in the paradigm. Semantic web services, which are dynamically associated to these objects, correspond to the actions. The platform is being put into practice in the context of a research project in order to build an open application for media distribution based on Semantic Web technologies. Moreover, its usability and accessibility have been evaluated in this real setting and compared to similar systems.

An open source browser-based software tool for graph drawing and visualisation

In this research work we searched for open source libraries which supports graph drawing and visualisation and can run in a browser. Subsequent these libraries were evaluated to find out which one is the best for this task. The result was the d3.js is that library which has the greatest functionality, flexibility and customisability. Afterwards we developed an open source software tool where d3.js was included and which was written in JavaScript so that it can run browser-based.

Methods of Design and Testing of Real Time Systems

Teollusuussovelluksissa vaaditaan nykyisin yhä useammin reaaliaikaista tiedon käsittelyä. Luotettavuus on yksi tärkeimmistä reaaliaikaiseen tiedonkäsittelyyn kykenevän järjestelmän ominaisuuksista. Sen saavuttamiseksi on sekä laitteisto, että ohjelmisto testattava. Tämän työn päätavoitteena on laitteiston testaaminen ja laitteiston testattavuus, koska luotettava laitteistoalusta on perusta tulevaisuuden reaaliaikajärjestelmille. Diplomityössä esitetään digitaaliseen signaalinkäsittelyyn soveltuvan prosessorikortin suunnittelu. Prosessorikortti on tarkoitettu sähkökoneiden ennakoivaa kunnonvalvontaa varten. Uusimmat DFT (Desing for Testability) menetelmät esitellään ja niitä sovelletaan prosessorikortin sunnittelussa yhdessä vanhempien menetelmien kanssa. Kokemukset ja huomiot menetelmien soveltuvuudesta raportoidaan työn lopussa. Työn tavoitteena on kehittää osakomponentti web -pohjaiseen valvontajärjestelmään, jota on kehitetty Sähkötekniikan osastolla Lappeenrannan teknillisellä korkeakoululla.

Elinkaarikustannusanalyysi teknologiayrityksessä

Työn tavoitteena oli suunnitella ja toteuttaa elinkaarikustannusten laskentasovellus teknologiaympäristössä. Ensin luotiin elinkaarikustannuslaskennalle viitekehys ja työlle teoreettinen pohja kirjallisuuslähteiden perusteella. Varsinainen tutkimus aloitettiin strategisille asiakkaille suunnatulla tutkimuksella heidän käyttämistään sovelluksista elinkaarikustannusten laskentaan, laskennan menetelmistä sekä yhteistyön kannalta oleellisista kustannusparametreista. Lisäksi selvitettiin yrityksen omat tarpeet laskennalle.Seuraavaksi kartoitettiin markkinoilta löytyviä sovelluksia elinkaarikustannusten hallintaan, joista valittiin neljä tarkempaan vertailuun aiemmin selvitettyjen vaatimusten perusteella. Vaihtoehtona harkittiin myös oman laskentasovelluksen kehittämistä, mutta todettiin vertailussa löytyneen valmiin ohjelmiston täyttävän sovellukselle asetetut vaatimukset niin hyvin, ettei oman sovelluksen suunnittelun katsottu olevan tarpeellista.Lopuksi muokattiin valittu sovellus toimimaan tulevassa käyttöympäristössä ja luotiin käytön kannalta oleelliset tietokannat elinkaarikustannusten laskennassa tarvittaville lähtötiedoille. Samalla luotiin myös toimintarutiinit ja jaettiin vastuut sovelluksen tulevaa käyttöä ja tietokantojen päivitystä varten. Tutkimuksen tuloksena saatiin yrityksen käyttöön luotua sekä yrityksen että asiakkaiden vaatimukset täyttävä sovellus elinkaarikustannusten laskentaan.

Applying TTCN to testing of Mobile IP

Diplomityö käsittelee ISO:n yhdenmukaisuustestin menetelmien sekä ISO-9646:n kehysten soveltamista Mobile IPv6 protokollan testauksessa. Mobile IPv6 protokollaa tarkastellaan määrittelyjen pohjalta, myös testien tärkeyttä ja tulosten johtamista käsitellään. Työssä käsitellän MSC:n (Message Sequence Charts) käyttöä testaustyössä mahdolliset edut huomioiden. TTCN kieli, testausmenetelmät ja OpenTTCN testauskone käsitellään. Testin kohteena olevien yhdyskäytävän ja palvelimen määrittelyt kuvataan. Osia abstract test suite :sta (ATS) esitellään esimerkin antamiseksi todellisesta sovelluksesta ja sen yhteydestä tehtyyn dokumenttiin.

Centralized Identity Management for Web Applications

Internet-palvelujen määrä kasvaa jatkuvasti. Henkilöllä on yleensä yksi sähköinen identiteetti jokaisessa käyttämässään palvelussa. Autentikointitunnusten turvallinen säilytys käy yhä vaikeammaksi, kun niitä kertyy yhdet jokaisesta uudesta palvelurekisteröitymisestä. Tämä diplomityö tarkastelee ongelmaa ja ratkaisuja sekä palvelulähtöisestä että teknisestä näkökulmasta. Palvelulähtöisen identiteetinhallinnan liiketoimintakonsepti ja toteutustekniikat – kuten single sign-on (SSO) ja Security Assertion Markup Language (SAML) – käydään läpi karkeiden esimerkkien avulla sekä tutustuen Nokia Account -hankkeessa tuotetun ratkaisun konseptiin ja teknisiin yksityiskohtiin. Nokia Account -palvelun ensimmäisen version toteutusta analysoidaan lopuksi identiteetinhallintapalveluiden suunnitteluperiaatteita ja vaatimuksia vasten.

Desarrollo de mejoras y nuevas funcionalidades a eXeLearning.net y colaboración con la comunidad de software libre exelearning.net

En este TFM se detallan las mejoras realizadas a la aplicación eXeLearning.net, así como otras aportaciones a la comunidad realizadas durante el proyecto de fin de máster de Software libre. eXeLearning.net es una aplicación de software libre para la creación de materiales educativos digitales, desarrollada en Python, con una interfaz web (HTML + JavaScript). En este proyecto se desarrollaron entre otras cosas: un repositorio de estilos en la web oficial de la aplicación, disponibles para su descarga desde la aplicación de escritorio, la creación y mantenimiento de un repositorio en Launchpad y una funcionalidad para publicar los contenidos creados con eXeLearning.net directamente en Google Drive.

UDDI palvelurekisterin merkitys Web palveluissa

Tietojärjestelmien integraatio on nykypäivänä tärkeä osa alue yritysten toiminnassa ja kilpailukyvyn ylläpitämisessä. Palvelukeskeinen arkkitehtuuri ja Web palvelut on uusi joustava tapa tehdä tietojärjestelmien välinen integraatio. Web palveluiden yksi ydinkomponentti on UDDI, Universal Description, Discovery and Integration. UDDI toimii palvelurekisterin tavoin. UDDI määrittää tavan julkaista, löytää ja ottaa käyttöön Web palveluja. Web palveluja voidaan hakea UDDI:sta erilaisin kriteerein, kuten esimerkiksi palvelun sijainnin, yrityksen nimen ja toimialan perusteella. UDDI on myös itsessään Web palvelu, joka perustuu XML kuvauskieleen ja SOAP protokollaan. Työssä paneudutaan tarkemmin UDDI:in. UDDI:ta käsitellään tarkemmin myös teknisesti. Oleellinen osa UDDI:ta on ollut julkaisijoiden ja käyttäjien mielestä tietoturvan puute, joka on rajoittanut huomattavasti UDDI:n käyttöä ja käyttöönottamista. Työssä tarkastellaankin tarkemmin juuri tietoturvaan liittyviä asioita ja ratkaisuja sekä myös UDDI:n merkitystä yrityksille.

Kuormitustestausvälineen valinta Microsoft Office SharePoint Server 2007 – toteutuksessa

Kuormitustestaus on osa web-sovellusten kehitystä ja käyttöönottoa. Sillä varmistetaan sovellusten toimivuus ennalta määrätyn kuorman alla. Microsoft Office SharePoint Server 2007 (MOSS) on palvelintuote nykyaikaisten web-sovellusten luontiin ja ylläpitoon. Työssä vertaillaan kahta eri uormitustestaustyökalua: SilkPerformer 2008 ja Visual Studio Team System 2008 Test Edition ja valitaan MOSS – web-sovelluksille paremmin sopiva työkalu. Työssä vertaillaan työkaluja niiden ominaisuuksien perusteella sekä suorittamalla kuormitustestausta testausta varten luodulle MOSS – web-sovellukselle. Vaikuttavien tekijöiden perusteella työkaluja arvioidaan ja tämän perusteella saadaan tulos vertailulle. Työn tuloksena Visual Studio Team System 2008 Test Edition sopii paremmin MOSS – web-sovelluksen kuormitustestausvälineeksi. Vertailussa kuitenkin havaittiin, että työkalut ovat melko tasavertaisia, ja käytännön tilanteesta riippuu, kumpi sopii paremmin. Tämä työ auttaa valinnan teossa.

Empirical study on the adoption, use and effects of cloud-based testing

Cloud computing is a practically relevant paradigm in computing today. Testing is one of the distinct areas where cloud computing can be applied. This study addressed the applicability of cloud computing for testing within organizational and strategic contexts. The study focused on issues related to the adoption, use and effects of cloudbased testing. The study applied empirical research methods. The data was collected through interviews with practitioners from 30 organizations and was analysed using the grounded theory method. The research process consisted of four phases. The first phase studied the definitions and perceptions related to cloud-based testing. The second phase observed cloud-based testing in real-life practice. The third phase analysed quality in the context of cloud application development. The fourth phase studied the applicability of cloud computing in the gaming industry. The results showed that cloud computing is relevant and applicable for testing and application development, as well as other areas, e.g., game development. The research identified the benefits, challenges, requirements and effects of cloud-based testing; and formulated a roadmap and strategy for adopting cloud-based testing. The study also explored quality issues in cloud application development. As a special case, the research included a study on applicability of cloud computing in game development. The results can be used by companies to enhance the processes for managing cloudbased testing, evaluating practical cloud-based testing work and assessing the appropriateness of cloud-based testing for specific testing needs.

Preoperative cobalt60 irradiation delays the healing of rectal anastomoses in rats

The healing of colorectal anastomoses after irradiation therapy continues to be a major concern. The authors evaluated the healing of rectal anastomoses in a rat model after a preoperative 500-cGy dose of cobalt60 irradiation. Thirty-six male Wistar rats were divided into two equal groups: control (group A), and irradiation group (group B). Group B received a single 500-cGy dose of irradiation, and a rectal resection and end-to-end anastomosis was performed in both groups on the 7th day after irradiation. Parameters of the healing process included bursting pressure and collagen content on the 5th, 7th, and 14th days after surgery. In the irradiation group, the mean bursting pressure on the 5th, 7th, and 14th days was 116, 218, and 273 mmHg, respectively. The collagen content assessed by histomorphometry was 9.0, 20.8, and 32%, respectively. In contrast, the control group had a mean bursting pressure of 175, 225 and 263 mmHg, and a collagen content of 17.8, 28.1, and 32.1%, respectively. The adverse effect of irradiation on healing was detectable only on the 5th postoperative day, as demonstrated by lower bursting pressure (P < 0.013) and collagen content (P < 0.008). However, there was no failure of anastomotic healing such as leakage or dehiscence due to irradiation. We conclude that a single preoperative 500-cGy dose of irradiation delays the healing of rectal anastomosis in rats.