Health economic evaluation of a web-based intervention for depression: the EVIDENT-trial, a randomized controlled study.

Gräfe V, Berger T, Hautzinger M, et al. Health economic evaluation of a web-based intervention for depression: the EVIDENT-trial, a randomized controlled study. Health economics review. 2019;9(1): 16.BACKGROUND: Depression often remains undiagnosed or treated inadequately. Web-based interventions for depression may improve accessibility of treatment and reduce disease-related costs. This study aimed to examine the potential of the web-based cognitive behavioral intervention "deprexis" in reducing disease-related costs.; METHODS: Participants with mild to moderate depressive symptoms were recruited and randomized to either a 12-week web-based intervention (deprexis) in addition to care as usual (intervention group) or care as usual (control group). Outcome measures were health-related resource use, use of medication and incapacity to work as well as relating direct health care costs. Outcomes were assessed on patients' self-report at baseline, three months and six months.; RESULTS: A total of 1013 participants were randomized. In both groups total direct health care costs decreased during the study period, but changes from baseline did not significantly differ between study groups. Numeric differences between study groups existed in outpatient treatment costs. They could be attributed to differences in changes of costs for psychotherapeutic treatment from baseline. Whereas costs for psychotherapeutic treatment decreased in the intervention group, costs increased in the control group (-16.8% (80) vs. +14.7% (60)) (tdf=685=2.57; p=0.008).; CONCLUSION: The study indicates the health economic potential of innovative e-mental-health programs. There is evidence to suggest that the use of deprexis over a period of 12weeks leads to a decrease in outpatient treatment cost, especially in those related to different types of psychotherapeutic treatment

Consequences of inducing intrinsic disorder in a high-affinity protein-protein interaction

The kinetic and thermodynamic consequences of intrinsic disorder in protein-protein recognition are controversial. We address this by inducing one partner of the high-affinity colicin E3 rRNase domain-Im3 complex (Kd ≈ 10(-12) M) to become an intrinsically disordered protein (IDP). Through a variety of biophysical measurements, we show that a single alanine mutation at Tyr507 within the hydrophobic core of the isolated colicin E3 rRNase domain causes the enzyme to become an IDP (E3 rRNase(IDP)). E3 rRNase(IDP) binds stoichiometrically to Im3 and forms a structure that is essentially identical to the wild-type complex. However, binding of E3 rRNase(IDP) to Im3 is 4 orders of magnitude weaker than that of the folded rRNase, with thermodynamic parameters reflecting the disorder-to-order transition on forming the complex. Critically, pre-steady-state kinetic analysis of the E3 rRNase(IDP)-Im3 complex demonstrates that the decrease in affinity is mostly accounted for by a drop in the electrostatically steered association rate. Our study shows that, notwithstanding the advantages intrinsic disorder brings to biological systems, this can come at severe kinetic and thermodynamic cost

Myeloperoxidase Is a Negative Regulator of Phospholipid-Dependent Coagulation

Myeloperoxidase (MPO) is a cationic heme enzyme stored in neutrophilic polymorphonuclear leukocytes (PMNs) that has recently been implicated in inflammatory cell signaling and tissue damage. Although PMNs play a critical role in both innate immunity and vascular thrombosis, no previous study has systematically investigated the effect of MPO on blood coagulation. Here, we show that PMN-derived MPO inhibits the procoagulant activity (PCA) of lipidated recombinant human tissue factor (rhTF) in a time-and concentration-dependent manner that involves, but is not entirely dependent on the enzyme's catalytic activity. Similarly, MPO together with its substrate, H2O2, inhibited the PCA of plasma microvesicles isolated from lipopolysaccharide (LPS)-stimulated whole blood, an effect additive to that of a function blocking TF antibody. Treatment of whole blood with LPS or phorbol-myristate-acetate dramatically increased MPO plasma levels, and co-incubation with 4-ABAH, a specific MPO inhibitor, significantly enhanced the PCA in plasma supernatants. MPO and MPO/H2O2 also inhibited the PCA of activated platelets and purified phospholipids (PLs), suggesting that modulation of negatively charged PLs, i.e., phosphatidylserine, rather than direct interference with the TF/FVIIa initiation complex was involved. Consistently, pretreatment of activated platelets with MPO or MPO/H2O2 attenuated the subsequent binding of lactadherin, which specifically recognizes procoagulant PS on cell membranes. Finally, endogenously released MPO regulated the PCA of THP1 cells in an autocrine manner dependent on the binding to CD11b/CD18 integrins. Collectively, these findings indicate that MPO is a negative regulator of PL-dependent coagulation and suggest a more complex role of activated PMNs in haemostasis and thrombosis

Teacher Counternarratives: Transgressing and Restorying Disability in Education

This inquiry aims to explore the disconnect between the disability studies in education (DSE) perspectives on inclusive schooling held by a group of dually certified inclusive educators and the everyday, lived experiences of these same teachers who find themselves teaching students with labelled disabilities within the confines of the special education bureaucracy. Through a collaborative inquiry circle (with a teacher educator who is a faculty member in a dual-certification programme informed by a DSE perspective and seven teachers who are graduates of this teacher education programme), this study aims to: (1) articulate the dominant narratives or storylines about disability in education that may discipline teachers\u27 practice within the special education bureaucracy; (2) illustrate some of the ways in which teachers do resist and transgress the discursive structures of schooling in ways that enable them to restory disability in education; and (3) explore the implications of this work for preparing teachers to be dually certified, inclusive educators of all children in public schools

Stuttgart Region - Sustainable Industrialization in Stuttgart Metropolitan Region

The Stuttgart region is a very prosperous area. The economical backbone of the region is the production of industrial goods. The globalization is a trigger for changing economical dependencies. Industrial processes are changing because of the new challenges. Digitalization is a current topic which has huge influence on economical procedures. A main topic in this context is the German initiative “Industry 4.0”. New ways of thinking have a great impact on the way manufacturing is done and the digitalization opens up new possibilities. Current discussions on sustainability are influencing the economic thinking heavily. The importance of sustainable development with respect to environment and climate becomes more and more obvious to everybody. The climate conference in Paris was finished with a consensus of all present parties. Every important economic nation has a common sense on climate targets nowadays. Reasons for that are manifold, e.g. limited resources and huge amount of emissions. Nevertheless, society will only accept limitations, without a reduction of living quality. Based on that, it is necessary to implement a new procedures in existing structures. Additionally, it is required to implement changes without reducing economic potentials. The approach of symbiosis can support these developments. However, technology is a required extension to reach the target of sustainability. In this chapter, different views are discussed to facilitate long-term development. The first view is a holistic view. The idea of creating a symbiosis between enterprises in an industrial estate is easy to realize. On one hand the enterprise manager are able to shape the collaborations, and on the other hand the local administration is able to support the approach with small efforts. Besides the sustainable development of industrial estates the companies need a strategy for their own development. A development path towards urban manufacturing is helping the management of companies to create a strategy. A concrete step-by-step approach is the base. Additional technological drivers are analyzed in their capability of supporting sustainability