Introdução: elastografia ultrassônica é um método não invasivo validado e rotineiro para a determinação indireta do grau de fibrose hepática e em investigação para predizer a presença de varizes esofágicas. Entretanto, a elastografia foi validada somente em doenças que evoluem para cirrose. Na revisão de literatura que realizamos, observamos que há escassez de estudos de acurácia diagnóstica em pacientes com hipertensão portal não cirrótica. Objetivos: avaliar a acurácia diagnóstica das técnicas de elastografia hepatoesplênica (transitória por FibroScan e ARFI) para predizer a presença de varizes esofágicas e se as varizes são de risco de sangramento em pacientes com hipertensão portal não cirrótica. Avaliar a concordâncias das duas técnicas e correlacioná-las com outros índices (plaquetas/baço, APRI e FIB-4). Métodos: Foram incluídos pacientes com diagnóstico confirmado das seguintes condições: oclusão da veia porta extra-hepática, esquistossomose mansônica, hipertensão portal não cirrótica idiopática e fibrose hepática congênita. A endoscopia digestiva alta foi considerada como marcador da presença de hipertensão portal clinicamente significante. Critérios de inclusão: idade acima de um ano; diagnóstico etiológico definido; concordância do paciente ou responsável legal em participar do estudo. Critérios de exclusão: cirrose, confirmada pela combinação de critérios diagnósticos clínicos, de imagem e laboratoriais ou pela biópsia hepática quando o resultado estivesse disponível; hipertensão portal pós sinusoidal; condições que impeçam tecnicamente a realização da elastografia (ascite volumosa e insuficiência cardíaca); esplenectomia; gestação; carcinoma hepatocelular avançado. O desenho do estudo foi prospectivo, transversal, de acordo com a metodologia STARD, avaliando a acurácia, sensibilidade, especificidade, valores preditivos positivos e negativos e razões de verossimilhança positiva e negativa. Procedimentos no estudo: consulta aos dados de prontuário; ultrassonografia abdominal e elastografia hepatoesplênica com os equipamentos/métodos FibroScan e ARFI. Os pontos de corte foram determinados por curva ROC. Resultados: os valores de elastografia transitória hepática por FibroScan foram de 5,91 ± 1,87 kPa na oclusão da veia porta extra-hepática, 8,89 ± 3,96 kPa na esquistossomose, 10,60 ± 3,89 kPa na hipertensão portal não cirrótica idiopática e 10,30 ± 4,14 kPa na fibrose hepática congênita, enquanto os valores de ARFI foram de 1,27 ± 0,23 m/s; 1,35 ± 0,45 m/s; 1,43 ± 0,40 m/s; 1,55 ± 0,39 m/s; respectivamente. Os valores de elastografia transitória esplênica por FibroScan foram de 60,82 ± 20,56 kPa na oclusão da veia porta extra-hepática, 54,16 ± 22,94 kPa na esquistossomose, 52,64 kPa ± 21,97 kPa na hipertensão portal não cirrótica idiopática e 48,50 ± 24,86 kPa na fibrose hepática congênita, enquanto os valores de ARFI foram de 3,22 ± 0,62 m/s; 3,01 ± 0,74 m/s; 2,86 ± 0,53 m/s; 2,80 ± 0,55 m/s; respectivamente. A elastografia esplênica por FibroScan com ponto de corte 65,1 kPa apresentou acurácia de 0,62 (intervalo de confiança 95% 0,46-0,78; p=0,121) para presença de varizes. Para predizer varizes de alto risco de sangramento, o melhor ponto de corte foi 40,05 kPa, que apresentou acurácia de 0,63 (intervalo de confiança 95% 0,52-0,76; p=0,016). A elastografia esplênica ARFI com ponto de corte de 2,67m/s apresentou acurácia de 0,64 (intervalo de confiança 95%, 0,50-0,78; p=0,065) para presença de varizes. O melhor ponto de corte para predizer varizes de alto risco de sangramento com esse método foi de 3,17m/s, que apresentou acurácia de 0,61 (intervalo de confiança 95%, 0,51- 0,71; p=0,033). Conclusões: métodos de elastografia esplênica apresentaram uma acurácia moderada e valor preditivo positivo elevado para diagnosticar presença de varizes. A elastografia transitória esplênica por FibroScan quando associada à razão plaqueta/baço apresentou acurácia moderada com especificidade alta para predizer varizes de alto risco de sangramento. Entretanto, considerável superposição de valores foi observada entre pacientes com e sem varizes esofagianas, o que limita a aplicação a utilidade clínica do método / Background and rationale: transient elastography is a noninvasive, validated, method allowing evaluation of liver fibrosis by measurement of liver stiffness and under investigation to predict the presence of esophageal varices. However, elastography has been validated only in diseases that progress to cirrhosis. In a literature review we found few studies on diagnostic accuracy in patients with non-cirrhotic portal hypertension. Aims: to evaluate the accuracy of hepatosplenic elastography (FibroScan and ARFI) to predict the presence of esophageal varices and whether varices are at risk of bleeding in patients with non-cirrhotic portal hypertension. To evaluate the concordances of the two techniques and correlate them with other indexes such as the platelet /spleen diameter ratio, APRI and FIB-4. Methods: patients with confirmed diagnosis of the following conditions were included: extrahepatic portal vein occlusion, schistosomiasis, idiopathic non-cirrhotic portal hypertension and congenital hepatic fibrosis. Upper digestive endoscopy was considered as a marker of the presence of clinically significant portal hypertension. Inclusion criteria: age above one year; defined etiological diagnosis; agreement of the patient or legal guardian to participate in the study. Exclusion criteria: cirrhosis confirmed by combination of clinical, imaging and laboratory diagnostic criteria or by liver biopsy when the result was available; post sinusoidal portal hypertension; conditions that technically preclude the performance of elastography (massive ascites and heart failure); splenectomy; pregnancy; advanced hepatocellular carcinoma. The study design was prospective, transversal, according to the STARD methodology, evaluating the accuracy, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios. The procedures of the study were: review of medical records data, abdominal ultrasonography and hepatosplenic elastography with FibroScan and ARFI equipment / methods. Cut-off points for elastography were determined by ROC curves. Results: liver stiffness measurement by FibroScan were 5.91 ± 1.87 kPa in extrahepatic portal vein occlusion, 8.89 ± 3.96 kPa in schistosomiasis, 10.60 ± 3.89 kPa in portal hypertension non-cirrhotic idiopathic and 10.30 ± 4.14 kPa in congenital hepatic fibrosis, whereas by ARFI were 1.27 ± 0.23 m/s; 1.35 ± 0.45 m/s; 1.43 ± 0.40 m/s; 1.55 ± 0.39 m/s; respectively. Spleen stiffness measurement by FibroScan were 60.82 ± 20.56 kPa in extrahepatic portal vein occlusion, 54.16 ± 22.94 kPa in schistosomiasis, 52.64 ± 21.97 kPa in idiopathic non-cirrhotic portal hypertension, and 48.50 ± 24.86 kPa in congenital hepatic fibrosis, while by ARFI were 3.22 ± 0.62 m/s; 3.01 ± 0.74 m/s; 2.86 ± 0.53 m/s; 2.80 ± 0.55 m/s; respectively. Liver stiffness measurement by FibroScan with a cut-off of 65.1 kPa had an accuracy of 0.62 (95%confidence interval, 0.46-0.78, p=0.121) for the presence of esophageal varices. The best cut-off point for predicting the presence of varices at high risk of bleeding was 40.05 kPa (accuracy, 0.63, 95% confidence interval, 0.52-0.76, p = 0.016). The spleen stiffness measurement by ARFI with a cut-off of 2.67 m/s showed (accuracy, 0.64, 95% confidence interval, 0.50-0.78, p=0.065) for the presence of esophageal varices. The best cut-off point for predicting the presence of varices at high risk of bleeding was 3.17 m/s (accuracy, 0.61, 95% confidence interval, 0.51-0.71, p=0.033) for varices at high risk of bleeding. Conclusions: spleen stiffness measurement by transient elastography (FibroScan and ARFI) presented a moderate accuracy and a high positive predictive value to diagnose the presence of esophageal varices. Spleen stifness by FibroScan when associated with platelet/spleen diameter ratio, there is a moderate accuracy with a high specificity to predict varices at high risk of bleeding. However, overlapping values between patients with or without varices was high and this precludes the clinical applicability of these methods

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-05T12:07:23Z No. of bitstreams: 2 Dissertação - Norma Lúcia da Silva - 2016.pdf: 2114089 bytes, checksum: ba22651083bc81f19f06732d6c9f16aa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-05T12:09:09Z (GMT) No. of bitstreams: 2 Dissertação - Norma Lúcia da Silva - 2016.pdf: 2114089 bytes, checksum: ba22651083bc81f19f06732d6c9f16aa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-08-05T12:09:09Z (GMT). No. of bitstreams: 2 Dissertação - Norma Lúcia da Silva - 2016.pdf: 2114089 bytes, checksum: ba22651083bc81f19f06732d6c9f16aa (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-06-22 / Financiadora de Estudos e Projetos- Finep / The content covered in this dissertation, entitled "Digital marketing as a competitive strategy: Digital Portal using the Bank of Brazil SA" it is a descriptive and exploratory study. So describes the evolution of information technology in the banking sector and investigates the Digital Portal, available on the platform of this financial institution, contributes to a better relationship between customers three portfolios "Corporate" and that institution, as well as the advantages conferred on the use of it. / O conteúdo abordado nesta dissertação de mestrado, intitulada “Marketing digital como estratégia competitiva: o uso do Portal Digital do Banco do Brasil S.A.” trata-se de um estudo descritivo e exploratório. Assim, descreve a evolução da tecnologia da informação no setor bancário e investiga se o Portal Digital, disponível na plataforma desta instituição financeira, contribui para um melhor relacionamento entre os clientes de três carteiras “Pessoa Jurídica” e a referida instituição, bem como, as vantagens atribuídas quanto ao uso do mesmo.

Anomalia congênita (AC) é causada por alterações morfológicas e/ou funcionais ocasionada no desenvolvimento embrionário ou fetal devido a fatores genéticos, ambientais, multifatoriais ou desconhecidos. A detecção pode ser no período pré-natal, no recém-nascido ou posteriormente. Estudos recentes indicam que de 2% a 3% de todos os nascidos vivos no mundo apresentam AC. Alguns autores afirmam que no Brasil elas constituem a segunda causa de mortalidade infantil, com 11,2%. Particularmente, o país conta com sistemas de bancos de dados em saúde com informações sobre anomalias congênitas. Dentre estes sistemas, temos três que se destacam: o Sistema de Informações Hospitalares do SUS (SIH), o Sistema de Informações sobre Nascidos Vivos (SINASC) e o Sistema de Informações sobre Mortalidade (SIM). Todos são obtidos através do site do Departamento de Informática do Sistema Único de Saúde (DATASUS). Todavia, esses sistemas, de maneira isolada, não fornecem uma visão clara tanto da epidemiologia das anomalias congênitas, quanto dos indivíduos com esse agravo, se ao terem nascidos foram tratados ou em decorrência dela faleceram. Diante deste cenário, neste projeto tem-se por objetivo principal apresentar o sistema de vigilância de AC utilizando estas bases públicas com intuito de monitorar as anomalias no Brasil, mapeando os nascimentos, internações e óbitos. Este sistema tornou-se o Portal de Monitoramento de AC (PMAC), com dados que abrangem o período de janeiro 2001 a dezembro 2011. Ele conta com ferramentas que correspondem aos módulos de auditoria automática, que verifica subnotificações e inconsistência, módulos de análises epidemiológicas contendo incidência, fluxo de migração e coeficientes de mortalidade (infantil, perinatal, neonatal e segundo causas por AC). Este estudo também traz a realização da técnica do relacionamento probabilístico com a integração dos sistemas SINASC, SIH e SIM, que formaram um banco contribuindo com informações de rastreabilidade dos registros com anomalias, além de apresentar os resultados satisfatórios dos testes caixa-preta junto com a aplicação da técnica de avaliação heurística, realizados por usuários para avaliar a usabilidade do portal. Por fim, ressalta-se que o portal é dinâmico, e a manipulação dos dados por meio do acesso dos usuários a análises de cunho epidemiológico, em diversas agregações, permite auxiliar a gestão das informações, promover reflexões em torno desta temática, incentivar mais estudos e pesquisas, bem como prover recursos e apoiar medidas sociais e políticas para assistir os indivíduos acometidos por AC, suas famílias e a comunidade / Congenital anomaly (AC) is caused by morphological and / or functional alterations originated during embryonic or fetal development due to genetic, environmental, multifactorial or unknown factors. Detection may happen in the prenatal period, in the newborn or later. Recent studies indicate that AC is present in about 2% to 3% of all live births worldwide. Some authors affirm that in Brazil they are the second cause of infant mortality, with around 11.2%. In particular, Brazil has health databases systems with information about congenital anomalies. Among these systems we have three that stand out: the Hospital Information System of SUS (SIH), the Live Birth Information System (SINASC) and Mortality Information System (SIM). All of which can be obtained through the Informatics of public Health System Department\'s website (DATASUS). However, these systems in isolation do not provide a clear view both of the epidemiology of congenital anomalies as well as the individuals with this birth defect be treated or it result of their death. In this scenario, the main objective of this project is to present an AC surveillance system that uses these public databases to monitor the anomalies in Brazil by mapping births, hospitalizations and deaths. This system became the Portal of Monitoring of AC (PMAC), with data that cover the period from January 2001 to December 2011, with tools that correspond to the modules of automatic audit that verifies under notifications and inconsistency, modules of epidemiological analyzes containing incidence, migration flow and mortality coefficients (infant, perinatal, neonatal and second AC causes). This study also used the probabilistic linkage technique with an integration of the SINASC, SIH and SIM systems to build a database contributing with traceable information for the records with anomalies. In addition is presented satisfactory results for black box tests along with the portal usability evaluation performed with users through heuristic evaluation technique. Finally, it should be noted that the portal is dynamic offering options like user access to data manipulation through epidemiological analyzes in diverse aggregations. It helps to manage information, promote reflections around this theme, encourage further studies and research, as well as provide resources and support social and political measures to assist individuals affected by AC, their families and the community

L’essor des nouvelles techniques de traitement en radiothérapie externe a rendu nécessaire la mise en place de nouveaux contrôles qualité (CQ). Il est en effet capital de s’assurer que la dose délivrée au patient est bien conforme à celle qui lui a été prescrite. Les détecteurs EPID, initialement utilisés pour contrôler l’exactitude du positionnement du patient, sont de plus en plus employés pour vérifier la conformité du traitement. L’image qu’ils enregistrent au cours d’une irradiation peut par exemple être comparée à une image de référence, qui correspond à ce qui aurait été mesuré si le traitement s’était déroulé dans les conditions de sa planification. Le succès de ce CQ repose (1) sur la précision avec laquelle on peut prédire l’image EPID (ou portale) de référence et (2) sur les performances de l’outil de comparaison d’image utilisé. Nous avons étudié au cours de cette thèse ces deux points clés. Nous nous sommes tout d’abord tournés vers une méthode de prédiction d’images EPID haute résolution basée sur le couplage de simulations Monte-Carlo (MC) et de la technique de débruitage DGPLM. Pour la mettre en œuvre, nous avons modélisé un accélérateur linéaire d’électrons à usage médical (linac) dans le code MC PENELOPE et optimisé les paramètres de sa source d’électrons primaires pour des calculs de dose dans l’eau. L’analyse d’un fichier d’espace des phases (PSF) de 71 Go stocké sous le cône égalisateur nous a ensuite permis de développer un modèle de sources virtuelles (MSV) représenté par des histogrammes corrélés (environ 200 Mo). Ce nouveau MSV, plus compact que le PSF, est tout aussi précis pour les calculs de dose dans l’eau si son maillage est déterminé selon une méthode adaptative. La modélisation du détecteur EPID dans PENELOPE suggère que les hypothèses faites sur les propriétés de la tâche focale du linac sont trop simplistes et doivent être reconsidérées. L’évaluation du MSV pour la prédiction d’images EPID haute résolution a quant à elle conduit à d’excellents résultats. Une fois la chaine de prédiction de l’image portale de référence validée, nous l’avons utilisée pour détecter des irrégularités dans les traitements de RCMI. Dans une étude préliminaire, nous avons volontairement introduit des erreurs de traitement dans le calcul d’images EPID (dérive du faisceau d’irradiation, modification de la morphologie ou de la position du patient). Le γ-index traditionnellement utilisé en routine s’est avéré moins performant que le χ-index pour les détecter. Une étude plus approfondie aura pour objet de déterminer des seuils de détection d’erreurs en fonction de leur nature et d’éprouver les performances d’autres tests. / Advanced techniques used in radiotherapy for cancer treatment, such as Intensity-Modulated Radiation Therapy (IMRT), require extensive verification procedures to ensure the correct dose delivery. Electronic Portal Imaging Devices (EPIDs) are widely used for quality assurance in radiotherapy, and also for dosimetric verifications. For this latter application, the images obtained during the treatment session can be compared to a pre-calculated reference image in order to highlight dose delivery errors. The quality control performance depends (1) on the accuracy of the pre-calculated reference image (2) on the ability of the tool used to compare images to detect errors. These two key points were studied during this PhD work. We chose to use a Monte Carlo (MC)-based method developed in the laboratory and based on the DPGLM (Dirichlet process generalized linear model) denoising technique to predict high-resolution reference images. A model of the studied linear accelerator (linac Synergy, Elekta, Crawley, UK) was first developed using the PENELOPE MC codes, and then commissioned using measurements acquired in the Hôpital Nord of Marseille. A 71 Go phase space file (PSF) stored under the flattening filter was then analyzed to build a new kind of virtual source model based on correlated histograms (200 Mo). This new and compact VSM is as much accurate as the PSF to calculate dose distributions in water if histogram sampling is based on adaptive method. The associated EPID modelling in PENELOPE suggests that hypothesis about linac primary source were too simple and should be reconsidered. The use of the VSM to predict high-resolution portal images however led to excellent results. The VSM associated to the linac and EPID MC models were used to detect errors in IMRT treatment plans. A preliminary study was conducted introducing on purpose treatment errors in portal image calculations (primary source parameters, phantom position and morphology changes). The γ-index commonly used in clinical routine appears to be less effective than the χ-index. A future in-depth study will be dedicated to determine error detection threshold according to their nature and to evaluate other comparison test robustness. The developed portal image prediction method associated to robust analysis tools will then constitute an adapted way to assure treatment quality control.

Patient portals are web-based tools that provide patients with access to their health records and enhance communication with providers. Despite the efforts in expanding their use and patients interest in using them, patient portal usage remains low. Higher use of portals is associated with greater patient engagement and better healthcare quality and outcomes. This study investigated the impact of perceived usefulness (PU) and perceived ease of use (PEU) on patient portal usage. The conceptual framework was based on the Technology Acceptance Model, which suggests that PU and PEU of a system affect attitude and behavioral intention toward using the system, and ultimately the use of the system. The research questions focused on whether PU and PEU significantly affect portal usage. Participants included a convenience sample of 432 patients of Abington Health, located in Abington, PA, who had access to Abington's eClinicalWorks patient portal. Cross-sectional data collected from the completed online surveys included responses to Davis' PU and PEU measurement scale, self-reported portal login frequency and login duration, and some patient demographics. Data was analyzed by using chi-square test of independence and multinomial logistic regression. The study found that a significant relationship exists between PU and login frequency, PU and login duration, and PEU and login duration; however, the impact of PU and PEU on portal usage was not significant. The study could be repeated among a different population using a different patient portal. This study helps understand the relationship between PU/PEU and portal usage, something healthcare providers can capitalize upon when promoting portal use, and ultimately, encouraging greater patient engagement in their own health.

在所有網站中，入口網站(general portal)無疑是目前為止最令人印象深刻的網站類型；本研究者發現入口網站有一些新的發展，其中最令人感興趣的，就是專業垂直入口網站(vertical portal ; 本研究簡稱vortal)的產生。本研究整理幾本網路理論書籍，認為未來的企業注重的將是極端的客製化或個人化服務，雖然客製化或個人化服務已經發展很多年，但現在藉由資訊科技的幫助，網路世界中的客製化策略應有所調整。因此，本研究的研究目的包括： 1. 定義入口網站的價值。 2. 找出入口網站的各種可能類別。 3. 經由文獻整理出網路世界的商業模式與策略不同於傳統商業模式與策略的地方。（本研究在文獻探討過程中已發現客製化策略的關鍵性與差異性，因此最後著墨在客製化策略的研究） 4. 希望得到不同入口網站如何利用不同的策略提升網站自身的價值。 由於本研究的研究動機有一部份是因為對vortal的觀察所引發，因此第一步先定義傳統一般型入口網站(general portal)與專業垂直入口網站(vertical portal)。透過對價值理論的文獻探討，本研究可以對於入口網站的分類歸納出策略構面（顧客對多樣性與專業性的價值認知），而發展研究架構。藉由網路理論文獻的整理，本研究發現顧客參與和個人化是網路理論中不同於傳統理論之關鍵之一，藉由個案的觀察分析，來支持研究架構中對不同入口網站有不同客製化策略的假設，最後本研究同時從文獻理論與個案分析來歸結出入口網站客製化策略的可能命題與結論建議。 本研究以多樣化與專業化兩構面區分出三種入口網站：一般式、垂直式與複合式垂直入口網站。並分別從網站的標準化、多功化與模組化三方面來探討不同入口網站的特性，最後再以四種客製化策略：合作式、透明式、裝飾式與適應式客製化來作為不同入口網站的不同策略建議。 研究結果如下： 入口網站可以根據其顧客認知價值的兩構面-專業性與多樣性需求-分成三種類別。能夠滿足顧客多樣性需求，而不能滿足顧客專業性需求的入口網站稱為一般入口網站(general portal ; gortal)。能夠滿足顧客專業性需求，而不能滿足顧客多樣性需求的入口網站稱為垂直入口網站(vertical portal ; vortal)。能夠滿足顧客專業性需求，又能滿足顧客多樣性需求的入口網站稱為複合式垂直入口網站(multi-vortal ; mortal)。 多樣性程度高但專業性程度低的入口網站(gortal)，其產品標準化程度高，多功化程度低，模組化程度低。多樣性程度低但專業性程度高的入口網站(vortal)，其產品標準化程度低，多功化程度高，從主題層次來看其模組化程度低，從功能層次來看其模組化程度高。多樣性程度與專業性程度均高的入口網站(mortal)，從主題層次來看，其產品標準化程度低，從主題層次來看，其產品多功化程度高，模組化程度高。從功能層次來看，其產品整合化與模組化程度受設計者主觀影響。 高度標準化而低度多功化與模組化的入口網站(gortal)，其主題搜尋服務採適應式客製化策略。在主題層次上高度多功化而低度標準化與模組化的入口網站(vortal)，其主題搜尋服務採透明式客製化策略。在主題層次上低度標準化而高度多功化與模組化的入口網站(gortal)，其主題搜尋服務採透明式與合作式客製化共同使用策略。採取適應式客製化策略之入口網站，必須讓顧客在面對所有元件之下，仍能輕易自行搜尋所需元件。而採取透明式與合作式客製化策略之入口網站，可以一自己的專業能力篩選元件呈現在顧客眼前。採取透明式客製化的入口網站，若主題不多，可以設計專家服務元件，讓顧客接受專家人性化的服務；若主題多，則應設置主題負責人（可以由一個負責人負責多個主題），以調整主題設計。採取適應式客製化策略的入口網站，要設法讓顧客在實體世界的社群載網站上聯繫。採透明式與合作式客製化策略的網站，應利用主題來形成相同需求的社群，並且讓社群內的所有聯繫切合主題，進一步讓聯繫本身成為網站價值的一部份。

Nadine Höchstötter, Karlsruhe, berichtete über den letzten Stand ihrer Forschungen zum Suchverhalten in Suchmaschinen. Anhand von Datensätzen in Lycos lassen sich Muster von Suchanfragen ermitteln, aus denen Trends abgeleitet werden können. Es kann dabei zwischen vier grundsätzlichen Klassen unterschieden werden: „Eintagsfliegen“ treten im Erhebungszeitraum nur einmal auf, „Dauerbrenner“ hingegen während der Erhebungsperiode nahezu in jedem definierten Zeitintervall. Kleinere Ausschläge, bei denen bestimmte Suchbegriffe seltener als 100 Mal nachgefragt wurden, können weggelassen werden, um diese Muster schärfer darzustellen. Das abgeschnittene Volumen entspricht einem weißen Rauschen. Weiterhin sind Events und Impulse interessant. „Events“ treten bei Ereignissen auf, die vorher bekannt und durch einen gleichmäßigen Anstieg mit einem senkrechten Abfall am Tag des Events charakterisiert sind. Bei „Impulsen“ verhält sich das Muster genau andersherum. Eine Kombination der verschiedenen Klassen tritt beispielsweise bei aufkommenden Trends auf, die durch Mund-zu-Mund-Propaganda und zum Teil durch Werbemaßnahmen oder andere öffentlichen Medien verbreitet werden. Weiteres: (Diss. 2007). Untersuchung des Suchverhaltens im Web - Interaktion von Internetnutzern mit Suchmaschinen, ISBN 3-8300-2725-7

Une alimentation riche en protéines entraîne une importante diminution de la prise alimentaire, chez l’homme et l’animal, par rapport à une alimentation classique (riche en hydrates de carbones). Les précédents travaux du laboratoire chez le rat montrent que le mécanisme implique une induction de la production intestinale de glucose libéré dans la veine porte. Il s’ensuit un signal qui transite au cerveau via le nerf vague et se traduit par un effet anorexigène. Le régime protéique induit en fait une redistribution de la production endogène de glucose au profit du rein et de l’intestin chez le rat, et au profit de l’intestin et du foie chez la souris. L’effet anorexigène des protéines est présent également chez les souris, confirmant un rôle tout particulier de l’intestin, et du signal glucose portal, dans ce phénomène de satiété. Nos résultats montrent d’ailleurs que le signal glucose portal n’est pas impliqué dans l’augmentation de la production rénale de glucose induite par le régime protéique qui est observée uniquement chez le rat. Les mesures effectuées chez des rats nourris par différents régimes protéiques indiquent l’implication de mécanismes propres à la nature des protéines qui reste à déterminer. De plus nous avons mesuré une augmentation de la sensibilité à l’insuline de la production endogène de glucose chez le rat nourri par le régime protéique. Des études plus approfondies chez la souris devraient permettre de comprendre les mécanismes impliqués. Nos expériences suggèrent par ailleurs que le système mélanocortinergique ne serait pas impliqué dans l’effet anorexigène du régime à long terme mais pourrait constituer un élément important de contre-régulation face à l’hypophagie sévère temporaire provoquée par le changement de régime / Protein feeding is known to decrease hunger and subsequent food intake in animals and humans. Previous data point out the connection between the central nervous system and the intestinal glucose production in the central inhibitorycontrol of food intake by protein feeding. Our study demonstrates that protein feeding induces redistribution of endogenous glucose production to the kidney and intestine in rats and to the intestine and liver in the mouse. Anorexigenic effect of protein diet exists in both animal models, confirming a specific role of the intestine in this satiety phenomenon. Moreover, portal glucose sensing is not involved in the induction of renal glucose production by protein feeding that is only observed in rats. Measurement in rat fed with different protein diets suggest a role of the nature of the protein or structure, but proper mechanisms remain to be clarified. Moreover, protein feeding potentiates the endogenous glucose production suppression by insulin. Some additional studies have to be performed to find the mechanisms that are implicated. Our experiments suggest that the melanocortinergic system wouldn’t be involved in the longterm anorexigenic effect of protein feeding but could constitute an important counter-regulatory pathway against the temporary hypophagia induced by diet change

Vor einem Jahr, am 24. September 2014 wurde das Archivportal-D feierlich auf dem Deutschen Archivtag in Magdeburg freigeschaltet. Bereits seit rund 20 Jahren sind Archive mit eigenen Webseiten und Informationen in unterschied - licher qualitativer Ausprägung im weltweiten Internet präsent. Mit diesem neuen Portal ist es erstmals möglich zu deutschen Archiven archiv- und bestände übergreifend weltweit auf einem einheitlichen Portal zu recherchieren. Archivbesuche und Forschungsreisen werden für die Besucher nun viel besser planbar. Der Präsident des Landesarchivs Baden-Württemberg ist überzeugt, dass es „mit Hilfe des Archivportals-D gelingt (…), die spezifischen Merkmale von Archivgut abzubilden. Es wird der zentrale Einstiegspunkt für Recherchen in Archiven sein“.

Upper gastrointestinal bleeding episodes from variceal structures are severe complications in patients with portal hypertension. Endoscopic sclerotherapy and variceal ligation are the treatment options preferred for upper variceal bleeding owing to extrahepatic portal hypertension due to portal vein thrombosis (PVT). Recurrent duodenal variceal bleeding in non-cirrhotic patients with diffuse porto-splenic vein thrombosis and subsequent portal. cavernous transformation represent a clinical challenge if classic shunt surgery is not possible or suitable. In this study, we represent a case of recurrent bleeding of duodenal varices in a non-cirrhotic patient with cavernous transformation of the portal vein that was successfully treated with a collateral caval shunt operation.