Quality assessment of e-commerce websites using Bayesian belief networks

This thesis raises the issue of quality in E-commerce websites and addresses methodologies and approaches to standardize their assessment. The thesis blends the knowledge of academic research with the opinions and insights from experts and practitioners in the field to provide a comprehensive view of the issues and their remedies. The most experienced and successful E-commerce companies are beginning to realize that key determinants of success or failure are not merely a web presence or a low price but delivering a high quality website. Recent research shows that price and promotion are no longer the main draws for customers to make a decision on a purchase. More sophisticated online customers would rather pay a higher price to a provider with high quality service. Given that the establishment of an E-commerce website is mainly a software development effort; there are several standards that apply in governing the quality of such development. There seems to be an almost overwhelming abundance of quality standards that lead to a high level of cynicism and skepticism surrounding them and the eventual lack of use. Furthermore, no standard can directly predict the quality a website under development is going to achieve. Past approaches concerning the quality of E-commerce websites emphasize usability standards using techniques like feature inspection and collecting data about end-users' opinion by questionnaires. These methods provide important feedback and their results can be utilized as a useful background for future work, however, they do not contribute directly to a dynamic model that enables forecasting. The study of quality in the domain of the Internet in general, and E-commerce in particular, poses new challenges as technology evolves, including methods and metrics for estimating, managing quality during the product life cycle and quality-of-use measurement. The solution proposed by this research is to use a Bayesian Belief Network model. This model provides a consistent and practical approach to assessing the quality of the website. The assessment can be carried out before the completion of the website development, thus, providing insight on the trend and direction for correction and improvements. It can also be carried out on completed and operational work, providing analysis of areas for improvement. The model should be relatively quick and practical in providing an overall comprehensive assessment with root-cause analysis that would lead to corrective measures to improve the quality of the E-commerce website. In this research idioms were applied in realizing a complete Bayesian Belief Network model. The conclusions are measured against comparative assessment to validate the practical benefits of the work accomplished. The WebQual method was utilized to validate the "belief" established by the model.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Humoral response to Clostridium difficile in inflammatory bowel disease, including correlation with immunomodulatory treatment

Background and Aim: An abnormal immune response to intestinal bacteria has been observed in Crohn’s disease (CD). Clostridium difficile infection incidence and severity are increased in CD, but reports on the humoral response have provided conflicting results. We aimed to shed light on the possible role of C. difficile in CD pathogenesis by paying attention to the influence of immunomodulatory treatment on the humoral response. Methods: A total of 71 consecutive outpatients with CD, 67 with ulcerative colitis (UC), and 121 healthy controls were analyzed for serum IgA and IgG to C. difficile toxins A and B. Results: IgA levels were similar in all study groups. IgG to toxin A was increased similarly in CD and UC (P = 0.02 for both). In contrast, IgG to toxin B was elevated only in CD patients not receiving disease-modifying anti-inflammatory bowel disease drugs (DMAID) (n = 16) (P = 0.0001), while the CD medication subgroup (n = 47) had a level similar to healthy controls. The UC results were not influenced by DMAID treatment. Conclusion: Our findings add support to the idea of a disturbed interaction between intestinal cells and the microbiota being part of the CD disease mechanism. An abnormal immune response to C. difficile toxin B may be a critical component of this interaction.publishedVersio

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Genotyping should be considered the primary choice for pre-treatment evaluation of thiopurine methyltransferase functio

Clinical studies of thiopurine metabolism in inflammatory bowel disease.

Inflammatory bowel disease (IBD, i.e. primarily Crohn's disease and ulcerative colitis) is characterised by a chronic or relapsing inflammation of the digestive tract. The thiopurine drugs 6-mercaptopurine (6-MP) and azathioprine (AZA, an imidazol derivative and pro-drug of 6-MP) are currently used to an increased extent in IBD, particularly in Crohn's disease. Metabolism of thiopurines is complex and individually variable. Thus, the formation of biologically active thioguanine nucleotides (TGN) and methylated metabolites may vary considerably. Thiopurine methyltrasferase (TPMT) is a key enzyme in this metabolism and exhibits a genetic variability due to a number of variant alleles coding for an inactive enzyme when occurring in the homozygous form. Postulating that pharmacological monitoring and TPMT determinations may improve clinical efficacy and reduce side effects of thiopurine therapy we examined TMPT variation and metabolite levels in relation to clinical findings in patients with IBD. TPMT status was of clinical importance in the toxicity observed during thiopurine therapy. Patients with decreased TPMT activity were more prone to develop adverse events and less likely to tolerate a standard thiopurine dose due to toxicity. The formation of metabolites after dose escalation was influenced by TPMT status. Subjects with normal TPMT activity shifted the metabolism towards production of methylated metabolites, while subjects with intermediate TPMT activity exhibit pronounced elevations of TGN metabolites even with small dose escalations. There was no general induction of TPMT activity after standardized initiation of thiopurine therapy. We found no correlation between AZA dose and TGN levels in two independent patient populations, but there was a linear relationship between AZA dose and methylated metabolites. The level of TGN metabolites were related to disease activity, with higher levels in disease remission. It is thus clinically useful to monitor TGN metabolites as an evaluation of treatment intensity. The total number of adverse events was higher in patients both with high TGN and high meTIMP metabolite concentrations and high levels of methylated metabolites (meTIMP) were associated with the development of myelotoxicity. In conclusion, these results suggest that TPMT activity measurements and pharmacological monitoring of thiopurine metabolites are useful in the clinical setting

How are thiopurines used and monitored by Swedish gastroenterologists when treating patients with inflammatory bowel disease?

Objective. To perform a survey of thiopurine treatment in inflammatory bowel disease (IBD) among Swedish gastroenterologists. Material and methods. A web-based questionnaire consisting of 25 multiple-choice questions was sent to 322 gastroenterologists in adult practice. Results. A total of 132 questionnaires were received giving a response rate of 41%. Thiopurines were used by all 122 gastroenterologists in IBD practice and azathioprine was the first-choice thiopurine among 118 (97%) of them. Almost all gastroenterologists (97%) used weight-based dosing that was gradually escalated. The vast majority (89%) considered that efficacy should be evaluated within 6 months of therapy, while opinions regarding the optimal duration of therapy varied considerably. It was seen that 74% switched thiopurine in case of intolerance to the first-line substance. Thiopurine S-methyltransferase (TPMT) determinations were performed by 74% of the gastroenterologists and 67% used metabolite measurements. TPMT analyzers were more likely to measure metabolites (74 vs. 43%, p = 0.002). A quarter of the respondents were familiar with unconventional immunomodulation (co-administration of allopurinol, 6-thioguanine, mycophenolate mofetil or tacrolimus) and these respondents were also more likely to measure metabolites (79 vs. 52%; p = 0.002). Conclusions. Thiopurines are well established in the treatment of IBD among Swedish gastroenterologists. New and evolving knowledge about thiopurine therapy in IBD has been adapted to a large extent. Whether this change in clinical practice will have an impact on treatment outcomes has yet to be proven

A skewed thiopurine metabolism is a common clinical phenomenon that can be successfully managed with a combination of low-dose azathioprine and allopurinol

Background and aims: A skewed thiopurine metabolism is a phenomenon associated with both poor treatment response and toxicity. Our aim was to evaluate the frequency of this phenomenon and the relationship to thiopurine methyltransferase (TPMT) function. Methods: All thiopurine metabolite measurements in adult patients (n=4033) between January 2006 and April 2012 were assessed to evaluate the occurrence of a skewed metabolism and the relationship to TPMT genotype and activity. Results: A skewed metabolism was observed in 14% of all patients. It only developed in patients with a normal TPMT genotype, but was observed at all TPMT activity levels within the normal range (9.1-24.2 U/ml RBC). Two cases that illustrate typical clinical scenarios of a skewed metabolism and the effect of combination treatment with low-dose azathioprine and allopurinol are presented. Conclusions: A skewed metabolism is a common clinical phenomenon in patients with a normal TPMT function, which can develop at all TPMT activity levels within the normal range. We suggest that metabolite measurements should be considered in patients not responding to treatment and in those with hepatotoxicity or myelotoxicity in order to detect a skewed metabolism, since this phenomenon can be successfully managed by a combination of low-dose azathioprine and allopurinol. (C) 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved