Adopting Health Apps, What’s Hindering Doctors and Patients?

There are high expectations for Mobile Health to transform health into a sustainable and preven-tion-based system. Unfortunately it has not reached its scale of adoption many had hoped for, due to the existence of adoption barriers. More insight into these barriers fosters adoption of mHealth and the innovation it can bring to worldwide healthcare. This study investigates the main bar-riers in the adoption of mHealth, their underlying causes and their breakthrough possibilities. All the data are gathered from an international and multi-stakeholder point of view. First of all we tried to identify the main barriers by doing an international literature study. Second of all we asked Dutch mHealth Key Opinion Leaders (KOLs) to rank the barriers to importance. These KOLs were from different stakeholder groups; policy-makers, users and developers. At last we asked the KOLs in interviews for underlying causes and breakthrough opportunities of the barriers. Even-tually twelve main adoption barriers emerged. According to literature and to the KOLs the most important barriers are “Integration and interoperability ” and “Business case”. An underlying cause for the barrier “Integration and interoperability ” might be the active closed power system of tech-nology suppliers, which exists in the Netherlands. Furthermore there seems to be a difference i

Increased Prevalence of Testicular Adrenal Rest Tumours during Adolescence in Congenital Adrenal Hyperplasia

Item does not contain fulltextTesticular adrenal rest tumours (TART) are one of the most important causes of infertility in adult male patients with congenital adrenal hyperplasia (CAH). These benign tumours are already detected in children, but screening of TART is not routinely performed.To define retrospectively the prevalence of TART in 41 paediatric male CAH patients aged 0-19 years regularly followed by high-frequency (Fcentral 12-MHz) ultrasound techniques.Above the age of 10 years, there was a clear increase in the prevalence of TART: 10-12 years, 28\% (2 of 7 patients), 13-14 years, 50\% (4/8), and 15-16 years, 75\% (3/4). Above the age of 16 years, TART were detected in 100\% of the patients (7/7). The tumours were not detectable by palpation.TART is already present in childhood with an increasing prevalence after onset of puberty. We recommend regular ultrasound from the onset of puberty in all boys with classic CAH. © 2014 S. Karger AG, Basel

Protection from graft-versus-host disease by HIV-1 envelope protein gp120-mediated activation of human CD4+CD25+ regulatory T cells

Naturally occurring CD4( )CD25( ) regulatory T cells (Tregs) represent a unique T-cell lineage that is endowed with the ability to actively suppress immune responses. Therefore, approaches to modulate Treg function in vivo could provide ways to enhance or reduce immune responses and lead to novel therapies. Here we show that the CD4 binding human immunodeficiency virus-1 envelope glycoprotein gp120 is a useful and potent tool for functional activation of human Tregs in vitro and in vivo. Gp120 activates human Tregs by binding and signaling through CD4. Upon stimulation with gp120, human Tregs accumulate cyclic adenosine monophosphate (cAMP) in their cytosol. Inhibition of endogeneous cAMP synthesis prevents gp120-mediated Treg activation. Employing a xenogeneic graft versus host disease model that has been shown to be applicable for the functional analysis of human Tregs in vivo, we further show that a single dose of gp120 is sufficient to prevent lethal graft versus host disease and that the tolerizing effect of gp120 is strictly dependent on the presence of human Tregs and their up-regulation of cAMP upon gp120-mediated activation. Our findings demonstrate that stimulation via the CD4 receptor represents a T-cell receptor-independent Treg activating pathway with potential to induce immunologic tolerance in vivo