The hospital ‘superbug’: social representations of MRSA

The so-called ‘hospital superbug’ methcillin resistant staphylococcus aureus (MRSA) became a topic of media and political concern from the middle of the 1990’s. It was increasingly politicised in the period leading up to the British General Election of 2005. This study examines the meanings of MRSA that circulate in Britain by analysing newspaper coverage of the disease over a ten year period. It utilises social representations theory and contextualises MRSA within existing research on representations of emerging infectious diseases (EIDs). A key pattern in the representation of EIDs is to externalise the threat they pose by linking the origin, risk and blame to ‘the other’ of those who represent them. In this light the study investigates who and what MRSA is associated with and the impact that these associations have on levels of alarm and blame. Key findings are that MRSA is represented as a potentially lethal ‘superbug’, marking the end of a ‘golden age of medicine’ in which the story of the discovery of antibiotics has played such a key role. Furthermore, MRSA is constructed around an “it could be you / me” set of assumptions by way of the plethora of human interest stories that dominate the coverage. Finally, the blame for MRSA focuses not on its genesis, but rather on why it spreads. This is attributed to poor hygiene in hospitals, which is ultimately caused by mismanagement of the National Health Service and erosion of the authority and morality symbolised by the ‘matron’ role. This constellation of meanings speaks to a somewhat different pattern of response to MRSA when compared to many past EIDs

Agroecological aspects of evaluating agricultural research and development:

In this paper we describe how biophysical data can be used, in conjunction with agroecological concepts and multimarket economic models, to systematically evaluate the effects of agricultural R&D in ways that inform research priority setting and resource allocation decisions. Agroecological zones can be devised to help estimate the varying, site-specific responses to new agricultural technologies and to evaluate the potential for research to spill over from one agroecological zone to another. The application of agroecological zonation procedures in an international agricultural research context is given special attention.Agricultural research., Technological innovations., Agricultural economics and policies.,

Cooperation between expert knowledge and data mining discovered knowledge: Lessons learned

Expert systems are built from knowledge traditionally elicited from the human expert. It is precisely knowledge elicitation from the expert that is the bottleneck in expert system construction. On the other hand, a data mining system, which automatically extracts knowledge, needs expert guidance on the successive decisions to be made in each of the system phases. In this context, expert knowledge and data mining discovered knowledge can cooperate, maximizing their individual capabilities: data mining discovered knowledge can be used as a complementary source of knowledge for the expert system, whereas expert knowledge can be used to guide the data mining process. This article summarizes different examples of systems where there is cooperation between expert knowledge and data mining discovered knowledge and reports our experience of such cooperation gathered from a medical diagnosis project called Intelligent Interpretation of Isokinetics Data, which we developed. From that experience, a series of lessons were learned throughout project development. Some of these lessons are generally applicable and others pertain exclusively to certain project types

Is the Emperor Naked? Rethinking approaches to responsible food marketing policy and research

The thesis aims to present a case for a rethinking of the paradigmatic frames underpinning food marketing control policy and research. In support of its contention, it reports on the methodological strategies, evidence outcomes and knowledge translation contributions of a series of research projects. The projects were commissioned by national and international policy makers during the period 2009-2015 in support of responsible food marketing policy development. They were conceptualised, developed and interpreted through participatory and iterative research planning processes. The research drew on theories and constructs from multiple disciplines. Public health, marketing and policy science contributed most, but information economics and management theories also informed research design and analysis and interpretation of findings. Its key generalizable findings can be summarised as follows: • The identification of a fragmented but convergent pool of evidence indicating contemporary food and beverage marketing is an interactive, dynamic phenomenon. • The identification of a fragmented but convergent pool of evidence demonstrating it significantly impacts sociocultural determinants of food behaviours. • The generation of evidence demonstrating a gap between the strategic aims of responsible marketing policy regimes and the inherent capacity of implemented interventions to constrain marketing’s food environment impacts. • The generation of evidence demonstrating that critical re-appraisal of food marketing policy research assumptions and preconceptions is a strategy supportive of policy innovation. • The generation of evidence that research intended to support real world multi-stakeholder policy development processes requires additional skills to those established and recognised as central to high quality research. These include the ability to engage with dynamic and politicised policy processes and their public communications challenges. • The generation of evidence that can inform future independent benchmark standard for responsible marketing development initiatives. • The generation of evidence that can inform future research on designing and developing policy that is ‘future proof’ and targets marketing’s sociocultural food environment impacts. Its most significant knowledge translation contributions have been: • Support for the WHO Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children (subsequently endorsed at the 2010 World Health Assembly and the 2011 United Nations General Assembly). • Participatory research contributions to the Scottish Government’s responsible marketing standard development initiative (PAS2500). • Supporting the planning and development of the Scottish Government’s Supporting Healthy Choices Policy initiative. • Knowledge exchange with policy makers and stakeholders engaged in a scoping and prioritisation initiative commissioned by the United Kingdom’s Department of Health (An analysis of the regulatory and voluntary landscape concerning the marketing and promotion of food and drink to children). • Supporting responsible marketing policy agendas targeted to the engagement of a broad mix of stakeholders in innovative policy development processes. • Supporting policy makers’ efforts to increase popular support for stronger, more effective responsible marketing policy controls. The thesis therefore aims to present evidence that the programme of research presented here has made useful and original contributions to evidence and knowledge on contemporary food marketing and its impacts on food behaviours and the food environment. It aims to build on this by demonstrating how this evidence informed and supported policy development. Through this the thesis aims to support its case that a rethinking of food marketing policy research assumptions and conceptions can expand and enrich the evidence base as well as real world policy innovation

What Is New in Rome IV

Functional gastrointestinal disorders (FGIDs) are diagnosed and classified using the Rome criteria; the criteria may change over time as new scientific data emerge. The Rome IV was released in May 2016. The aim is to review the main changes in Rome IV. FGIDs are now called disorders of gut-brain interaction (DGBI). Rome IV has a multicultural rather than a Western-culture focus. There are new chapters including multicultural, age-gender-women’s health, intestinal microenvironment, biopsychosocial, and centrally mediated disorders. New disorders have been included although not truly FGIDs, but fit the new definition of DGBI including opioid-induced gastrointestinal hyperalgesia, opioid-induced constipation, and cannabinoid hyperemesis. Also, new FGIDs based on available evidence including reflux hypersensitivity and centrally mediated abdominal pain syndrome. Using a normative survey to determine the frequency of normal bowel symptoms in the general population changes in the time frame for diagnosis were introduced. For irritable bowel syndrome (IBS) only pain is required and discomfort was eliminated because it is non-specific, having different meanings in different languages. Pain is now related to bowel movements rather than just improving with bowel movements (ie, can get worse with bowel movement). Functional bowel disorders (functional diarrhea, functional constipation, IBS with predominant diarrhea [IBS-D], IBS with predominant constipation [IBS-C], and IBS with mixed bowel habits) are considered to be on a continuum rather than as independent entities. Clinical applications such as diagnostic algorithms and the Multidimensional Clinical Profile have been updated. The new Rome IV iteration is evidence-based, multicultural oriented and with clinical applications. As new evidence become available, future updates are expected

Screen Time and Sleep Condition among Selected College Students

College students underestimate the value of adequate sleep. The purpose of this research was to measure the relationship between students’ sleep condition and screen time usage one hour prior to bed. The participants in this study were undergraduate students, from ages 18 to 25 years of age, enrolled in spring semester 2017 at a Midwestern University. A 15-item paper survey was distributed to participants for this research (55.7% female; 42.8% male). This research found that sampled undergraduate students’ amount of sleep each night ranged from 4 to 10 hours and averaged 6.9 hours of adequate sleep each night. This finding is consistent with previous literature that showed nearly 70% of college students receive five to seven hours of sleep each night (Gutierrez, 2002). Further, 92.9% of sampled students always or very often used electronic devices before bedtime. When measuring participants’ relationship between their overall sleep condition and screen time usage, no significant difference was found [r (321) =-.010, p =.857]. There also was no significant difference found when screen time usage before bedtime and hours of sleep received each night was compared [r(322) =.002, p =.966]

Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV

Functional gastrointestinal disorders (FGIDs), the most common diagnoses in gastroenterology are recognized by morphological and physiological abnormalities that often occur in combination including motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota and altered central nervous system processing. Research on these gut-brain interaction disorders is based on using specific diagnostic criteria. The Rome Foundation has played a pivotal role in creating diagnostic criteria thus operationalizing the dissemination of new knowledge in the field of FGIDs. Rome IV is a compendium of the knowledge accumulated since Rome III was published 10 years ago. It improves upon Rome III by: 1) updating the basic and clinical literature, 2) offering new information on gut microenvironment, gut-brain interactions, pharmacogenomics, biopsychosocial, gender and cross cultural understandings of FGIDs, 3) reduces the use of imprecise and occassionally stigmatizing terms when possible, 4) uses updated diagnostic algorithms, 5) incorporates information on the patient illness experience, and physiological subgroups or biomarkers that might lead to more targeted treatment. This introductory article sets the stage for the remaining 17 articles that follow and offers an historical overview of the FGIDs field, differentiates FGIDs from motility and structural disorders, discusses the changes from Rome III, reviews the Rome committee process, provides a biopsychosocial pathophysiological conceptualization of FGIDs, and offers an approach to patient care

Towards early recognition of hypogammaglobulinaemia:New insights into clinical presentation patterns and screening tools

Publiekssamenvatting Herhaaldelijke infecties van de luchtwegen komen veel voor; een onderliggende afweerstoornis is zeldzaam. Dat maakt het lastig om patiënten bij wie een afweerstoornis een rol zou kunnen spelen te onderscheiden van patiënten waarbij dit niet het geval is. Als de infecties heel vaak optreden of afwijkend verlopen, moet aan een onderliggende afweerstoornis worden gedacht. Van alle afweerstoornissen komt een tekort aan antistoffen - ook wel immuunglobulinen genoemd - het meest voor (primaire antistof deficiëntie, PAD), maar dit is nog steeds erg zeldzaam. De bekendste PAD is ‘common variable immunodeficiency’ (CVID). Deze diagnose wordt gesteld als er meerdere klassen van antistoffen verlaagd zijn, meestal immuunglobuline A (IgA) en immuunglobuline G (IgG) of soms verlaagd immuunglobuline M (IgM) en de patiënt na vaccinatie niet in staat is tot het aanmaken van antistoffen. Echter, veel meer patiënten met PAD voldoen niet precies aan deze criteria. Wij verwijzen naar deze vorm van PAD als ‘unclassified antibody deficiency’ (unPAD), een afweerstoornis die wordt beschouwd als milder. De kennis over deze groep afweerstoornissen is gering. De meeste artsen die niet gespecialiseerd zijn in afweerstoornissen, denken niet aan een onderliggende afweerstoornis bij patiënten met herhaaldelijke ‘normale’ infecties en/of chronische vermoeidheid. De diagnose wordt bij deze patiënten daarom vaak pas laat gesteld, met als gevolg dat er vaak al onherstelbare schade is ontstaan, zoals verwijde en ontstoken luchtwegen. Daarom is het belangrijk om PADs tijdig te herkennen. Hoofddoelen van deze thesis zijn: 1) PADs eerder herkennen, en 2) meer inzicht krijgen in de klachten waarmee PAD-patiënten bij de arts komen voordat de diagnose wordt gesteld. Dit proefschrift heeft aangetoond dat patiënten met ‘mildere’ PADs, vaak genegeerd worden in de literatuur en vaak niet volledig geanalyseerd of nauwkeurig beschreven worden. Het is echter belangrijk om ook deze patiëntgroep op tijd te herkennen en behandelen, omdat bij unPAD vaak ook andere ziekten voorkomen; 44% van de patiënten in ons algemeen ziekenhuis cohort had al schade aan de luchtwegen bij diagnose en hun kwaliteit van leven was verminderd op alle domeinen. In onze meta-analyse tonen we aan dat met de huidige waarschuwingssignalen, 25% van alle CVID-patiënten gemist worden. Naast deze medische aspecten kunnen ook niet-medische aspecten helpen om patiënten met PAD te onderscheiden van de patiënten met chronisch vermoeidheid syndroom of onschuldige infecties. Dit proefschrift heeft namelijk aangetoond dat patiënten met PAD hun klachten neigen te negeren en zoveel mogelijk doorgaan met hun normale leven. Dit verschilt van bijvoorbeeld patiënten met chronisch vermoeidheid syndroom, die vaker gebruik maken van passieve coping strategieën. Tenslotte toont ons proefschrift de bruikbaarheid van een screeningstest (23-valente Pneumokokken IgG test) aan om PAD eerder op te sporen. Onderzoek van een groter unPAD cohort is belangrijk om onze resultaten te bevestigen en klinische presentatie patronen beter in kaart te brengen. Hiervoor zal gebruik gemaakt worden van een reeds bestaande Europese patiëntenregistratie die opgezet is door de European Society for Immunodeficiencies (ESID online Database). Een groot cohort maakt daarnaast ook onderscheid van potentiele subgroepen mogelijk, waardoor bepaald kan worden welke patiëntencategorieën risico hebben op ernstigere complicaties en dus meer strikte follow-up en/of andere behandelingen nodig hebben. Om deze reden is de Europese multi-centrum ‘unPAD study’ ontwikkeld, waarbij gebruik wordt gemaakt van de ESID online Database en waarvan de dataverzameling nog steeds loopt