A Generic Approach for Developing and Executing Electronic Questionnaires on the iOS Platform

The creation of questionnaires is a very time-consuming and costly task when developing a study. In most cases they are created in a paper-based form. However, this paper-based approach leaves less scope for interaction with the participant to motivate them when filling in the questionnaire. Moreover, data collection and subsequent evaluation is very cumbersome because all data has to be transferred manually to electronic worksheets. To deal with these issues, this master’s thesis presents a concept and implementation of an electronic questionnaire application to solve the mentioned problems. Thereby, different generic approaches are introduced and compared with each other. In general, questions and answers are determined using an XML document. In addition, a generic XML schema is provided to validate the specified questionnaires during the creation. When running such a questionnaire, user interface elements like textfields, checkboxes, radiobuttons or sliders are automatically generated by the application. Moreover, the results of completed questionnaires can be viewed and exported for later analysis. Requirements and styleguides for an iOS specific application development are determined an discussed. The theoretical characterization ends in a practical part whereby a possible scenario for the utilization of the electronic questionnaire application is shown. In addition, the steps to create, deploy and enact such an electronic questionnaire are discussed

New pharmacotherapy options for noninfectious posterior uveitis

Introduction: Noninfectious inflammation of the posterior eye segment represents an important cause of visual impairment. It often affects relatively young people and causes a significant personal and social impact. Although steroids and nonbiologic- Disease-Modifying Antirheumatic Drugs (nbDMARDs) are effective both in acute and long- lasting diseases, however they are increasingly being replaced by biologic (DMARDs). bDMARD. This article therefore aims to identify recent advances in the therapy of noninfectious posterior segment uveitis. Methods: A Medline-search was conducted using the terms: nbDMARD, bDMARD, posterior uveitis, intermediate uveitis, treatment, corticosteroid. In addition, clinical studies were included as registered at ClinicalTrials.gov. Results: Currently two major lines of treatments can be identified: (1) the intraocular application of anti-inflammatory agents and (2) the introduction of new agents, e.g., (bDMARDs) and small-molecule-inhibitors. Whereas intravitreal treatments have the advantage to avoid systemic side effects, new systemic agents are progressively earning credit on the basis of their therapeutic effects. Conclusion: Even when current treatment strategies are still hampered by the limited number of randomized controlled trials, promising progress and continuous efforts are seen

Vom digitalen zum didaktischen Zwilling. Auf dem Weg zum digitalen Fachkonzept

Der Artikel beschreibt ein Lehrkonzept, das die Studiengänge Digitalisierungsingenieurwesen, Innovative Produktionssysteme und Wirtschaftsingenieurwesen an der Technischen Hochschule Ostwestfalen-Lippe (TH OWL) semesterübergreifend mit einem digitalen und physischen Lernträger erweitern soll. Das zu entwickelnde Fachkonzept baut dabei auf einem Anwendungsteil auf, in dem die Erstellung eines gemeinsamen digitalen Produktes praxisnah durchlaufen wird. Der Weg vom digitalen zum didaktischen Zwilling umfasst neben dem direkten Anwendungsbezug eine fächerübergreifende Zusammenarbeit, er fördert das vernetzte Denken, den Aufbau eines Systemverständnisses sowie das selbstständige Arbeiten und das eigenverantwortliche Handeln. Als übergeordnete Ziele werden die Motivation der Studierenden sowie deren Employability gefördert. Der Artikel beschreibt den aktuellen Forschungsstand und die Herausforderungen der Hochschullehre sowie die Perspektiven der digitalen Bildung. (Herausgeber)From digital to didactic twin - on the way to a digital subject concept: This article describes a teaching concept that is intended to expand the courses of study in digitalization engineering, innovative production systems and industrial engineering at the Ostwestfalen-Lippe University of Applied Sciences and Arts (TH OWL) across semesters with a digital and physical learning carrier. The subject concept to be developed builds on an application part in which the creation of a common digital product is run through in a practical way. In addition to the direct application reference, the path from the digital to the didactic twin includes interdisciplinary collaboration, it promotes networked thinking, the development of an understanding of systems as well as independent work and independent action. As overriding goals, the motivation of the students as well as their employability are promoted. The article describes the current state of research and the challenges of university teaching as well as the perspectives of digital education. (Editor

Patients’ Perspectives on Artificial Intelligence in Dentistry: A Controlled Study

Background: As artificial intelligence (AI) becomes increasingly important in modern dentistry, we aimed to assess patients' perspectives on AI in dentistry specifically for radiographic caries detection and the impact of AI-based diagnosis on patients' trust. Methods: Validated questionnaires with Likert-scale batteries (1: "strongly disagree" to 5: "strongly agree") were used to query participants' experiences with dental radiographs and their knowledge/attitudes towards AI as well as to assess how AI-based communication of a diagnosis impacted their trust, belief, and understanding. Analyses of variance and ordinal logistic regression (OLR) were used (p < 0.05). Results: Patients were convinced that "AI is useful" (mean Likert +/- standard deviation 4.2 +/- 0.8) and did not fear AI in general (2.2 +/- 1.0) nor in dentistry (1.6 +/- 0.8). Age, education, and employment status were significantly associated with patients' attitudes towards AI for dental diagnostics. When shown a radiograph with a caries lesion highlighted by an arrow, patients recognized the lesion significantly less often than when using AI-generated coloured overlays highlighting the lesion (p < 0.0005). AI-based communication did not significantly affect patients' trust in dentists' diagnosis (p = 0.44; OLR). Conclusions: Patients showed a positive attitude towards AI in dentistry. AI-supported diagnostics may assist communicating radiographic findings by increasing patients' ability to recognize caries lesions on dental radiographs

Attentional bias in individuals with depression and adverse childhood experiences: influence of the noradrenergic system?

Rationale: Major depressive disorder (MDD) is a severe mental disorder with affective, cognitive, and somatic symptoms. Mood congruent cognitive biases, including a negative attentional bias, are important for development, maintenance, and recurrence of depressive symptoms. MDD is associated with maladaptive changes in the biological stress systems such as dysregulations of central noradrenergic alpha2-receptors in the locus coeruleus-noradrenergic system, which can affect cognitive processes including attention. Patients with adverse childhood experiences (ACE), representing severe stress experiences in early life, might be particularly affected. Objectives: With an experimental design, we aimed to gain further knowledge about the role of noradrenergic activity for attentional bias in MDD patients with and without ACE. Methods: We tested the effect of increased noradrenergic activity induced by the alpha2-receptor blocker yohimbine on attentional bias in a placebo-controlled repeated measures design. Four groups were included as follows: MDD patients with and without ACE, and healthy participants with and without ACE (total N = 128, all without antidepressant medication). Results: A significant effect of MDD on attentional bias scores of sad face pictures (p = .037) indicated a facilitated attentional processing of sad face pictures in MDD patients (compared to non-MDD individuals). However, we found no such effect of ACE. For attentional bias of happy face pictures, we found no significant effects of MDD and ACE. Even though a higher increase of blood pressure and salivary alpha-amylase following yohimbine compared to placebo indicated successful noradrenergic stimulation, we found no significant effects of yohimbine on attentional bias of happy or sad face pictures. Conclusions: Our results are consistent with the hypothesis of a negative attentional bias in MDD patients. However, as we found no effect of ACE or yohimbine, further research is needed to understand the mechanisms by which ACE increases the risk of MDD and to understand the biological basis of the MDD-related negative attentional bias

Inflammatory measures in depressed patients with and without a history of adverse childhood experiences

Background: Major depressive disorder (MDD) is a complex psychiatric condition with different subtypes and etiologies. Exposure to adverse childhood experiences (ACE) is an important risk factor for the development of MDD later in life. Evidence suggests that pro-inflammatory processes may convey this risk as both MDD and ACE have been related to increased levels of inflammation. In the present study, we aimed to disentangle the effects of MDD and ACE on inflammation levels. Methods: Markers of inflammation (plasma interleukin(IL)-6 and high sensitive C-reactive protein (hsCRP) concentrations, white blood cell (WBC) count and a composite inflammation score (CIS) combining all three) were assessed in 23 MDD patients with ACE, 23 MDD patients without ACE, 21 healthy participants with ACE, and 21 healthy participants without ACE (mean age: 35 +/- 11 (SD) years). None of the patients and participants was taking psychotropic medication. ACE was assessed with the Early Trauma Inventory (ETI) and was defined as moderate to severe exposure to sexual or physical abuse. Results: Group differences in the different inflammatory measures were observed. MDD patients with ACE showed significantly higher IL-6 concentrations (p = 0.018), higher WBC counts (p = 0.003) and increased general inflammation levels as indicated by the CIS (p = 0.003) compared to healthy controls. In contrast, MDD patients without ACE displayed similar inflammation levels to the control group (p = 0.93). Conclusion: We observed elevated inflammation in MDD patients with a history of ACE, which could indicate a subtype of "inflammatory depression". Accordingly, MDD patients with ACE might potentially benefit from anti-inflammatory therapies

No association between major depression with and without childhood adversity and the stress hormone copeptin

Background: Adverse childhood experiences (ACE) are associated with an increased risk of major depressive disorder (MDD) and hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Within the HPA axis, corticotropin-releasing hormone and vasopressin (AVP) synergistically stimulate the release of adrenocorticotropic hormone, which promotes cortisol release. The cleavage product copeptin is produced during AVP synthesis and is a surrogate marker of AVP release. Children with ACE and young adults with depressive symptoms have higher levels of copeptin than healthy controls. Objective: To uncover the effects of MDD and ACE on copeptin levels in adult females. Methods: We recruited 94 women (mean age: 34.0 +/- 3.6 years): 23 with MDD and ACE, 24 with MDD without ACE, 22 with ACE without MDD, and 25 healthy controls. ACE was defined as repeated sexual or physical abuse at least once a month over at least one year before the age of 18 years. MDD was defined by the DSM-IV criteria. Copeptin plasma levels were measured with an immunoluminometric assay. Results: The four groups did not differ in demographic variables. We found a significant negative correlation between body mass index (BMI) and copeptin plasma levels (r = -.21; p = .045). Copeptin plasma levels did not differ between the four groups after controlling for BMI. Conclusion: Neither MDD nor ACE was associated with altered plasma copeptin levels. Thus, copeptin does not seem to play a major role in MDD and ACE in adult females

Psychosocial stress increases testosterone in patients with borderline personality disorder, post-traumatic stress disorder and healthy participants

Background: The gonadal hormone testosterone not only regulates sexual behavior but is also involved in social behavior and cognition in both sexes. Changes in testosterone secretion in response to stress have been reported. In addition, stress associated mental disorders such as borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) are characterized by alterations in basal testosterone metabolism. However, testosterone changes to stress have not been investigated in mental disorders such as BPD and PTSD so far. Methods: In the study described, we investigated testosterone reactivity to an acute psychosocial stressor, the Trier Social Stress Test (TSST). Our sample consisted of young adult women with BPD (n = 28), PTSD (n = 22) or both disorders (n = 22), and healthy control (n = 51). Based on previous studies on basal testosterone secretion in these disorders, we expected the stress-associated testosterone reactivity to be higher in the BPD group and lower in the PTSD group, when compared to the healthy control group. Results: The study could demonstrate an increase in testosterone after acute stress exposure across all groups and independent of BPD or PTSD status. Different possible explanations for the absence of a group effect are discussed. Conclusions: From the results of this study, we conclude that stress-related changes in testosterone release are not affected by BPD or PTSD status in a female patient population. This study expands the knowledge about changes in gonadal hormones and stress reactivity in these disorders

Cognitive and emotional empathy after stimulation of brain mineralocorticoid and NMDA receptors in patients with major depression and healthy controls

Mineralocorticoid receptors (MR) are predominantly expressed in the hippocampus and prefrontal cortex. Both brain areas are associated with social cognition, which includes cognitive empathy (ability to understand others’ emotions) and emotional empathy (ability to empathize with another person). MR stimulation improves memory and executive functioning in patients with major depressive disorder (MDD) and healthy controls, and leads to glutamate-mediated N-methyl-D-aspartate receptor (NMDA-R) signaling. We examined whether the beneficial effects of MR stimulation can be extended to social cognition (empathy), and whether DCS would have additional beneficial effects. In this double-blind placebo-controlled single-dose study, we randomized 116 unmedicated MDD patients (mean age 34 years, 78% women) and 116 age-, sex-, and education years-matched healthy controls to four conditions: MR stimulation (fludrocortisone (0.4 mg) + placebo), NMDA-R stimulation (placebo + D-cycloserine (250 mg)), MR and NMDA-R stimulation (both drugs), or placebo. Cognitive and emotional empathy were assessed by the Multifaceted Empathy Test. The study was registered on clinicaltrials.gov (NCT03062150). MR stimulation increased cognitive empathy across groups, whereas NMDA-R stimulation decreased cognitive empathy in MDD patients only. Independent of receptor stimulation, cognitive empathy did not differ between groups. Emotional empathy was not affected by MR or NMDA-R stimulation. However, MDD patients showed decreased emotional empathy compared with controls but, according to exploratory analyses, only for positive emotions. We conclude that MR stimulation has beneficial effects on cognitive empathy in MDD patients and healthy controls, whereas NMDA-R stimulation decreased cognitive empathy in MDD patients. It appears that MR rather than NMDA-R are potential treatment targets to modulate cognitive empathy in MDD