Why IT is not being used for financial advisory

Swiss banks have returned to their roots and pay an increasing amount of attention to differentiating themselves from others through good financial advisory services. This has led to a loudly publicized standardization of IT-advisory processes, but not to an increasing use of supporting IT tools. This paper uses interviews with Swiss advisors, sales managers and IT managers, as well as focus groups of users and a survey with users to identify reasons for non-usage. The analysis is based on a framework combining principal-agent theory, IT-business alignment, technology acceptance and information behaviour. We provide evidence that the key problem explanation is the incentive system of the advisors and that poor usability of the software and lack of engagement by sales managers also contribute to the non-usage of most tools

The development and test of a relationship model on system use, job learning, and impact

Swiss banks have returned to their roots and pay an increasing amount of attention to differentiating themselves from others through good financial advisory services. This has led to a loudly publicized standardization of IT-advisory processes, but not to an increasing use of supporting IT tools. This paper uses interviews with Swiss advisors, sales managers and IT managers, as well as focus groups of users and a survey with users to identify reasons for non-usage. The analysis is based on a framework combining principal-agent theory, IT-business alignment, technology acceptance and information behaviour. We provide evidence that the key problem explanation is the incentive system of the advisors and that poor usability of the software and lack of engagement by sales managers also contribute to the non-usage of most tool

Designing for Cost Transparency in Investment Advisory Service Encounters

Investment advisory services of financial service providers (FSPs) exhibit several characteristics that are detrimental to advisory quality. The interaction of advisor and client is strained by a lack of transparency regarding the advisory process (what activities are performed and why) and the information used therein (what information is used for what purpose and with what effect), as well as regarding the precise costs of the service and the recommended products. In prior research, we suggested that process and information transparency issues may be appropriately addressed with collaborative information technology (IT) artifacts. In this paper, we argue that collaborative, transparent artifacts may also be a premise of enabling cost transparency. To this end, we describe a complete research cycle of designing, implementing, and evaluating a shared cost-transparent IT artifact to support client-advisor interaction in investment advisory encounters. Evaluation results suggest the efficacy of our design in improving the clients' perceived cost transparency as well as increase their satisfaction and their willingness to pay for the received investment advice. These findings may also challenge the common belief of FSPs that transparent, fee-based advisory services would neither be accepted by clients nor be economically viable. Practical implications of these findings for designing advisory encounters with supportive IT are discusse

a retrospective study

Introduction Emergency treatment of major sub-/total traumatic amputations continue to represent a clinical challenge due to high infection rates and serious handicaps. Effective treatment is based on two columns: surgery and antimicrobial therapy. Detailed identification of pathogen spectrum and epidemiology associated with these injuries is of tremendous importance as it guides the initial empiric antibiotic regimen and prevents adverse septic effents. Methods In this retrospective study 51 patients with major traumatic amputations (n = 16) and subtotal amputations (n = 35) treated from 2001 to 2010 in our trauma center were investigated. All patients received emergency surgery, debridement with microbiological testing within 6 h after admission and empircic antimicrobial therapy. Additionally to baseline patient characteristics, the incidence of positive standardized microbiologic testing combined with clinical signs of infection, pathogen spectrum, administered antimicrobial agents and clinical complications were analyzed. Results 70.6% of the patients (n = 36) acquired wound infection. In 39% wounds were contaminated on day 1, whereas the mean length of duration until first pathogen detection was 9.1 ± 13.4 days after injury. In 37% polymicrobial colonization and 28% Pseudomonas were responsible for wound infections during hospitalization. In 45% the empirc antimicrobial therapy focussed on Gram positive strains did not cover the detected bacteria, according antimicrobial resistogram. It was significantly more often found in infections associated with Pseudomonas (p 0.02) or polymicrobial wound infections. Conclusions This epidemiologic study reveals a pathogen shift from Gram-positive to Gram- negative strains with high incidence of Pseudomonas and polymicrobial infections in sub-/total major traumatic amputations. Therefore, empiric antimicrobial treatment historically focussing on Gram-positive strains must be adjusted. We recommend the use of Piperacillin/Tazobactam for these injuries. As soon as possible antimicrobial treatment should be changed from empiric to goal directed therapy according to the microbiological tests and resistogram results

Impact of high prevalence of pseudomonas and polymicrobial gram-negative infections in major sub-/total traumatic amputations on empiric antimicrobial therapy: a retrospective study

INTRODUCTION: Emergency treatment of major sub-/total traumatic amputations continue to represent a clinical challenge due to high infection rates and serious handicaps. Effective treatment is based on two columns: surgery and antimicrobial therapy. Detailed identification of pathogen spectrum and epidemiology associated with these injuries is of tremendous importance as it guides the initial empiric antibiotic regimen and prevents adverse septic effents. METHODS: In this retrospective study 51 patients with major traumatic amputations (n = 16) and subtotal amputations (n = 35) treated from 2001 to 2010 in our trauma center were investigated. All patients received emergency surgery, debridement with microbiological testing within 6 h after admission and empircic antimicrobial therapy. Additionally to baseline patient characteristics, the incidence of positive standardized microbiologic testing combined with clinical signs of infection, pathogen spectrum, administered antimicrobial agents and clinical complications were analyzed. RESULTS: 70.6% of the patients (n = 36) acquired wound infection. In 39% wounds were contaminated on day 1, whereas the mean length of duration until first pathogen detection was 9.1 ± 13.4 days after injury. In 37% polymicrobial colonization and 28% Pseudomonas were responsible for wound infections during hospitalization. In 45% the empirc antimicrobial therapy focussed on Gram positive strains did not cover the detected bacteria, according antimicrobial resistogram. It was significantly more often found in infections associated with Pseudomonas (p 0.02) or polymicrobial wound infections. CONCLUSIONS: This epidemiologic study reveals a pathogen shift from Gram-positive to Gram-negative strains with high incidence of Pseudomonas and polymicrobial infections in sub-/total major traumatic amputations. Therefore, empiric antimicrobial treatment historically focussing on Gram-positive strains must be adjusted. We recommend the use of Piperacillin/Tazobactam for these injuries. As soon as possible antimicrobial treatment should be changed from empiric to goal directed therapy according to the microbiological tests and resistogram results

NewHope on ARM Cortex-M

Recently, Alkim, Ducas, Pöppelmann, and Schwabe proposed a Ring-LWE-based key exchange protocol called NewHope (Usenix Securitz 2016) and illustrated that this protocol is very efficient on large Intel processors. Their paper also claims that the parameter choice enables efficient implementation on small embedded processors. In this paper we show that these claims are actually correct and present NewHope software for the ARM Cortex-M family of 32-bit microcontrollers. More specifically, our software targets the low-end Cortex-M0 and the high-end Cortex-M4 processor from this family. Our software starts from the C reference implementation by the designers of NewHope and then carefully optimizes subroutines in assembly. In particular, compared to best results known so far, our NTT implementation achieves a speedup of almost a factor of 2 on the Cortex-M4. Our Cortex-M0 NTT software slightly outperforms previously best results on the Cortex-M4, a much more powerful processor. In total, the server side of the key exchange executes in only 1,476,101 cycles on the M0 and only 834,524 cycles on the M4; the client side executes in 1,760,837 cycles on the M0 and 982,384 cycles on the M4

The Digital Transformation of Physician–Patient Consultations: Identifying Problems and Approaches to Improve Adherence

There is evidence for a correlation between effective physician–patient communication in consultations and improved adherence to treatment. Lack of time, limited communication training, growing administrative duties, and low recall of physicians’ information and recommendations by patients are antagonists to effective physician–patient communication. In interviews with physicians, therapists, and patients, we first identify problems of current consultation practices and condense them in a problem scenario. We then use interview results to explore potential solutions, applying modern information technology such as digital medical assistants. Lastly, those potential solutions are condensed in an activity scenario that can be used for further design science research activities

Piwi-interacting RNAs as novel prognostic markers in clear cell renal cell carcinomas

Background Piwi-interacting RNAs (piRNAs) are small RNAs of 27–30 nucleotides mapping to transposons or clustering in repeat genomic regions. Preliminary studies suggest an important role in cancerogenesis. This study is the first one investigating their prognostic impact in clear cell renal cell cancer (ccRCC) patients. Methods Three piRNAs (piR-30924, piR-57125, and piR-38756) selected on the basis of initial piRNA microarray analyses were determined using RT-qPCR in non-metastatic (n = 76) and metastatic (n = 30) ccRCC tissue at the time of nephrectomy in comparison to normal renal tissue (n = 77) and tissue from distant ccRCC metastases (n = 13). Primary clinical end points were recurrence-free and overall survival. Results piR-57125 showed lower expression in metastatic than in non-metastatic tumors, whereas the expression of piR-30924 and piR-38756 increased in metastatic tumors. The higher expression of piR-30924 and piR-38756 as well as the lower expression of piR-57125 in metastatic primary tumors were significantly associated with tumor recurrence and overall survival. Multivariate Cox regression analyses revealed both piR-30924 and piR-57125 as independent prognostic predictors. This impact was even more pronounced in non-metastatic patients. Conclusions This study demonstrates that the expression levels of these piRNAs in primary non-metastatic and metastatic ccRCC tissue can serve as potential prognostic biomarkers in combination with clinicopathological factors

The effect of air-powder polishing on the fluoride release of bracket adhesives

Fragestellung: In vitro sollte der Einfluss von Pulver-Wasser-Strahlgeräten (PWS) auf die Fluoridfreisetzung von Bracketadhäsiven untersucht werden. Material und Methode: Untersuchte Adhäsive: Tectosan (fluoridfreie Kontrollgruppe) [BonaDent], ConTec LC [Dentaurum], Beauty Ortho Bond [SHOFU], Transbond PLUS Color Change Adhesive [3M Unitek], Light Bond [Reliance Orthodontic Products], Phase II [Reliance Orthodontic Products], BonaBond plus LC [BonaDent]. Pro Material wurden 130 Delrin-Ringe [DuPont] (1,5 mm hoch, 7 mm Innen-durchmesser) mit Adhäsiv gefüllt und zwischen Polyethylenfolie [MDS] und Glasscheiben [Becht] unter einer Last von 5 N mit der bluephase 20i [Ivoclar Vivadent] bei 1200 mW/cm² photopolymerisiert (außer Phase II). Die Polymerisation erfolgte von oben und unten im 90° Winkel durch die jeweilige Glasplatte (Abstand zum Prüfkörper 5 bis 6 mm). Die Kompositscheiben wurden in 2,5 ml deionisiertem Wasser bei 37 °C in Polypropylen-Röhrchen [Th. Geyer] gelagert. Die Ober-flächenbearbeitung wurde mit zwei unterschiedlichen Pulver- Wasser-Strahlgeräten (Prophy-Mate neo [NSK], easyjet pro [mectron]) durchgeführt, die mit drei verschiedenen Reinigungspulvern (FLASH pearl/CaCO3 [NSK], prophylaxis powder/NaHC03 [mectron], Clinpro Prophy Powder/Glycin [3M ESPE]) kombiniert wurden. In Abständen von 28 d ± 4 h wurden die Proben bis zur 20. Woche entnommen, halbseitig für 4 Sekunden mit einem PWS bestrahlt (Abstand: 3 bis 5 mm, Winkel: 30° bis 60°), (außer 10 Referenzproben) und in ein neues Polypropylen-Röhrchen mit frischem Wasser gegeben. Anschließend wurde die Fluoridfreisetzung im Eluat mittels ionenselektiver Elektrode (HI 4110 [HANNA Instruments]) bestimmt. Ergebnisse: Die signifikant höchste Fluoridfreisetzung wurde für Transbond PLUS Color Change Adhesive gemessen, gefolgt von Beauty Ortho Bond. Die statistische Auswertung zwischen der 17. und 20. Versuchswoche zeigte, dass durch die Oberflächenbearbeitung keine generelle Erhöhung der Fluoridfreisetzung erreicht wurde. Bei verschiedenen Materialien wurde in Abhängigkeit von der gewählten Bearbeitungsvariante eine Steigerung der Fluoridfreisetzung bewirkt, jedoch wurden damit nicht die starken Unterschiede in der Fluoridfreisetzung zwischen den untersuchten Materialien ausgeglichen. Auffällig war, dass die Verwendung von Kalziumkarbonat (FLASH pearl) als Strahlmittel in beiden PWS-Geräten bei gleicher Geräteeinstellung (ohne Wasserzufuhr) eine deutliche Steigerung der Fluoridfreisetzung gegenüber den unbestrahlten Referenzgruppen und den übrigen Reinigungspulvern (Glycin und Natriumbikarbonat) bewirkte (Ausnahme: Transbond PLUS Color Change Adhesive). Vergleicht man die Wirkung beider Pulver-Wasser- Strahlgeräte hinsichtlich der Verteilung von signifikanten Steigerungen der Fluoridkonzentrationen gegenüber den unbestrahlten Referenzgruppen, so wurden bei Betrachtung aller Adhäsive und Bearbeitungsvarianten mit Prophy-Mate neo im Verhältnis 4:3 mehr signifikante Steigerungen als mit easyjet pro beobachtet. Schlussfolgerung: Da Bracketadhäsive in der Regel relativ rau sind, ist es vorteil-haft, dass durch eine PWS-Anwendung die Fluoridfreisetzung erhöht werden kann.Aim: It was the aim of this study to investigate the effect of air-powder polishing on the fluoride release of bracket adhesives in vitro. Material and methods: The following adhesives were investigated: Tectosan (fluoride-free control group) [BonaDent], ConTec LC [Dentaurum], Beauty Ortho Bond [SHOFU], Transbond PLUS Color Change Adhesive [3M Unitek], Light Bond [Reliance Orthodontic Products], Phase II [Reliance Orthodontic Products], BonaBond plus LC [BonaDent]. For each of these materials, 130 plastic rings made from Delrin [DuPont] (1.5 mm thick, diameter 7 mm) were filled with adhesive and photopolymerized (bluephase 20i, 1200 mW/cm² [Ivoclar Vivadent]), (except for Phase II) between a polyethylene foil [MDS] and a glass plate [Becht] under a load of 5 N. The Polymerization was carried out at a 90° angle through the bottom- and the top glass plate (5 to 6 mm thick). The composite discs were stored in 2.5 ml of deionized water at 37 °C in polypropylene vials [Th. Geyer]. Surface treatment was carried out with two different air-powder- polishing devices (APP) (Prophy-Mate neo [NSK], easyjet pro [mectron]), that were combined with three different cleaning powders (FLASH pearl/CaCO3 [NSK], prophylaxis powder/NaHC03 [mectron], Clinpro Prophy Powder/glycine [3M ESPE]). Specimens were taken at intervals of 28 days ± 4 hours up to week 20 from their vials, were then air-polished on half of their upper and lower surfaces for 4 seconds (distance: 3-5 mm, angle: 30°-60°), (with the exception of ten reference specimens) and subsequently transferred into a new polypropylene vial with fresh deionized water. After that, the fluoride release in the eluate was determined with a fluoride ion-selective electrode (HI 4110 [HANNA Instruments]). Results: The significantly highest fluoride release was measured for Transbond PLUS Color Change Adhesive, followed by Beauty Ortho Bond. The statistical evaluation between week 17 and 20 showed that no general increase in the fluoride release was achieved through air-polishing. For various materials, an increase in the fluoride release was achieved as a function of the treatment option selected, but this did not compensate for the big differences in the fluoride release between the materials investigated. It was noticeable that the use of calcium carbonate (FLASH pearl) as an abrasive in both APP with the same instrument setting (without water) caused a significant increase in fluoride release compared with the unexposed reference groups and the other abrasives (glycine and sodium bicarbonate), (except for Transbond PLUS Color Change Adhesive). Comparing the effect of both APP in the allocation of significant increases in the fluoride concentrations compared with the unexposed reference groups, in view of all adhesives and processing variants with Prophy-Mate neo were observed more significant increases than with easyjet pro in ratio of 4 to 3. Conclusion: As bracket adhesives usually have rather rough surfaces it seems to be a beneficial effect that air- polishing has the potential to increase the fluoride release under certain conditions

Experimental investigations for prevention and improvement of surgical therapy of tibia shaft non-unions

Die Inzidenz von Pseudarthrosen nach Frakturen im Bereich des Tibiaschaftes liegt in Abhängigkeit der initialen Traumacharakteristik bei 3-54%. Die Behandlung von Pseudarthrosen des Tibiaschaftes ist langwierig und stellt sowohl den behandelnden Chirurgen, als auch den Patienten vor eine anspruchsvolle Aufgabe. Wir konnten erstmals nachweisen, dass selbst bei erfolgreich therapierten Patienten mit einer adäquaten Knochen- und Weichteilheilung auch im Langzeitverlauf signifikante Einschränkungen bezüglich des funktionellen Outcomes und der Lebensqualität bestehen. Vor dem Hintergrund dieser Aspekte wurden experimentelle Ansätze zur Prophylaxe und Optimierung der Therapie vorgestellt und evaluiert. Als neues Konzept wurde die lokale Applikation von bioaktiven Substanzen über eine Poly(D,L-laktid) Beschichtung (PDLLA) für Implantate eingeführt. Dabei fungiert das Implantat zum einen als mechanischer Stabilisator für die Fraktur, bzw. Pseudarthrose, und zum anderen als „Drugcarrier“ für pharmokologische Substanzen, mit der Potenz den Knochenstoffwechsel positiv zu beeinflussen. Das PDLLA stellt in seiner Form als Implantatbeschichtung das Bindeglied zwischen dem Implantat und dem Pharmakon dar. Während in Vorarbeiten die Biodegradierbarkeit und Freisetzungskinetik von Substanzen aus der Beschichtung bereits dargestellt wurde, konnte nun auch die Biokompatibilität nachgewiesen werden. Im ersten Ansatz wurde über das Konzept des bioaktiven Implantates ein non-viraler Gentransfer durchgeführt. Dafür wurden Copolymer-geschützte, für BMP-2 kodierende, DNA-Plasmide in die Implantatbeschichtung eingearbeitet und das Verfahren in einem etablierten Frakturmodell der Rattentibia hinsichtlich seiner Sicherheit und Effektivität beurteilt. Der Gentransfer führte zu keiner systemischen Distribution und konnte als sicher eingestuft werden. Es konnte eine transgene Expression von BMP-2 über den gesamten Versuchszeitraum nachgewiesen werden, wobei der stimulierende Effekt auf die Frakturheilung moderat war. In der folgenden Aufarbeitung humanen Pseudarthrosengewebes, inklusive der Konzentrationsbestimmung einzelner Wachstumsfaktoren, war die BMP-2 Expression unterhalb der Nachweisgrenze. Die Wachstumsfaktoren BMP-7 und PDGF-AB waren im Vergleich zum Kallusgewebe aus regelhaft geheilten Frakturen vermindert, während gleichzeitig die BMP-Gegenregulatoren Noggin und Sklerostin im Gewebe nachweisbar waren. Obgleich der Limitationen dieser Studie ergaben sich hieraus Gedanken hinsichtlich der Sinnhaftigkeit der Gabe einzelner BMPs zur Prophylaxe und Therapie von Pseudarthrosen im Kontext der bekannten, engen Regulation und Steuerung durch die Interaktion einer Vielzahl von molekularen Aktionspartnern. Während die BMPs einen pro-anabolen Effekt auf den Knochenstoffwechsel haben, sollte im nächsten Ansatz die Applikation von Bisphosphonaten, als anti-katabole Substanzgruppe, auf die Knochenheilung untersucht werden. Zolendronat ist als Bisphosphonat der dritten Generation für andere Indikationen bereits im breiten klinischen Einsatz. Mit dem etablierten Frakturmodell der Rattentibia sollte der Einfluss von Zolendronat in der bekannten PDLLA-Beschichtung auf die Knochenheilung untersucht werden. Das Ergebnis zeigte eine signifikant beschleunigte Frakturheilung mit erhöhten Kallusvolumina für die Zolendronat-Gruppe im Vergleich zu den Kontrollgruppen nach 42 Tagen, während sich der Effekt nach 84 Tagen tendenziell nivellierte. Grundsätzlich könnte dieser Ansatz im Rahmen der Akutversorgung zur Prophylaxe von Tibiaschaftpseudarthrosen beitragen oder im Rahmen der operativen Therapie von manifesten, atrophen Pseudarthrosen einen sinnvollen Bestandteil darstellen, um die Knochenheilung positiv zu beeinflussen. Mit der Fokussierung auf die prophylaktische Anwendung hinsichtlich der Ausbildung von postoperativen Infektionen bei der primären Knochendefektauffüllung bei atrophen Pseudarthrosen oder zum Schutz des Knochenregenerates bei der sekundären Defektauffüllung bei Infektpseudarthrosen wurde die Kombination des Knochenersatzmaterials DBM mit verschiedenen Antibiotika zur perioperativen Anwendung untersucht. Das Mischsystem erwies sich dabei als sicher und reliabel. Es konnten in vitro solide Freisetzungskinetiken von Tobramycin, Gentamicin und Vancomycin aus der DBM nachgewiesen werden. Die Antibiotika zeigten nach Freisetzung ihre biologische Aktivität und es konnten in der Zellkultur mit osteoblastären Zellen keine toxischen Nebenwirkungen gefunden werden. Das Konzept zeigt in vitro großes Potential und gerade die perioperative Anwendung könnte ein eleganter Baustein in der oftmals individualisierten Therapie von Tibiaschaftpseudarthrosen darstellen.Non-unions after fractures of the tibia shaft show an incidence of 3-54%. The treatment of tibial shaft non-unions is time consuming and demanding for the surgeon and the patient. We could demonstrate that even sucessfully treated patients in terms of an adequate bone and soft tissue consolidation are suffering from a significant loss of function and reduction in quality of life. Therefore experimental approaches for prevention and treatment of tibial non-union have been introduced and evaluated. As a new concept the local application of bioactive substances with a poly(D,L-laktid) coating (PDLLA) for orthopaedic implants was introduced. The implant serves as mechanical stabilisation device and as a „drug carrier“ for pharmaceutical substances with the potency to positively influence bone metabolism. In this case the PDLLA acts as the connector between implant and therapeutic drug. Whereas previous work already displayed biodegradability and release kinetics from substances applied via the PDLLA coating, the biocompatibility was now confirmed. Applying this concept of a bioactive implant a non-viral gene transfer was performed. Therefore copolymer protected DNA plasmid coding for BMP-2 were incoporated into the PDLLA coating of osteosynthetic implants. In a standardized rat fracture model of the tibia this concept was tested for safety and efficacy. This gene transfer did not lead to a systemic distribution and was therefore considered to be safe. A transgene expression of BMP-2 was detected throughout the whole study period, whereas the stimulating effect on fracture healing was only moderate. In the following analysis of human non-union tissue the BMP-2 expression was below detection level. Growth factors BMP-7 and PDGF-AB were diminished in comparison to the callus of fractures with uneventful healing, whereas the BMP antagonists Noggin and Sclerostin were detectable in the non-union tissue. Despite some limitations of this study thoughts about the efficiency of a single BMP administration in the treatment of non-unions arose, especially in the context of the tight regulation of multiple molecular mechanisms in bone healing. BMPs have a pro anabolic effect on the bone metabolism. As a different concept, the application of bishosphonates, as anti catabolic substances, were investigated for their role in bone healing. Zolendronate is a third generation bisphosphonate, which already is established for a variety of clinical indications. The influence of zolendronate incorporated in the PDLLA coating was investigated using the same rat fracture model. This led to significantly higher callus volumes in the zolendronate group compared to the control groups after 42 days, whereas this effect alleviated after 84 days. Generally this concept may be beneficial in terms of prevention during the acute treatment of tibial fractures or might also be an advantageous adjunct for the surgical therapy of manifest atrophic non-unions. With a focus on prevention against postoperative infections after primary bone defect filling in atrophic non- unions or as protection after secondary bone defect filling in the treatment of infectious non-unions, the combination of demineralized bone matrix with different antibiotic agents for a perioperative utilization has been investigated. The mixing procedure was safe and reliable. In vitro, stable release kinetics of Tobramycin, Gentamicin and Vancomycin from the demineralized bone matrix were verified. All antibiotic agents showed biologic activity after their release and no toxic side effects were present. This concept shows great potential and especially the perioperative application could be an elegant part of a foremost individualized therapy of tibial non- unions