DESIGNING A DIGITAL ARTIFACT FOR DATA COLLECTION TO IMPROVE DAILY ADHD MEDICATION

Hundreds of millions of persons are affected by Attention-Deficit/Hyperactivity Disorder (ADHD), struggling with lack of concentration, hyperactivity, and emotional regulation. Patients often have the prescription of the same dosage for months to years, and optimizing ADHD medication can be a complex and lengthy trial-and-error process. In this study, we adopt design science methodology to investigate how mobile technologies like smartphones and smartwatches can be used for monitoring and self-reporting data to enable a flexible and personalized pharmacological therapy for ADHD patients on a daily basis. In the initial development of the artifact H-app-y, we focus on patients\u27 self-reporting of emotions in combination with detecting sleep patterns as input in the general psychiatric clinical assessment. It is followed by an investigation about how to add additional input in the iterative development process. We hope that this study can help psychiatrists improve medication and help patients understand themselves better

Effect of pneumococcal conjugate vaccination on nasopharyngeal carriage in children with early onset of acute otitis media - a randomized controlled trial.

Abstract Conclusion: Although children vaccinated with heptavalent pneumococcal conjugate vaccine (PCV) had fewer episodes of acute otitis media (AOM), this trial was unable to prove a simultaneous decrease in nasopharyngeal carriage

Dissemination of Escherichia coli with CTX-M Type ESBL between Humans and Yellow-Legged Gulls in the South of France

Extended Spectrum beta-Lactamase (ESBL) producing Enterobacteriaceae started to appear in the 1980s, and have since emerged as some of the most significant hospital-acquired infections with Escherichia coli and Klebsiella being main players. More than 100 different ESBL types have been described, the most widespread being the CTX-M beta-lactamase enzymes (bla(CTX-M) genes). This study focuses on the zoonotic dissemination of ESBL bacteria, mainly CTX-M type, in the southern coastal region of France. We found that the level of general antibiotic resistance in single randomly selected E. coli isolates from wild Yellow-legged Gulls in France was high. Nearly half the isolates (47.1%) carried resistance to one or more antibiotics (in a panel of six antibiotics), and resistance to tetracycline, ampicillin and streptomycin was most widespread. In an ESBL selective screen, 9.4% of the gulls carried ESBL producing bacteria and notably, 6% of the gulls carried bacteria harboring CTX-M-1 group of ESBL enzymes, a recently introduced and yet the most common clinical CTX-M group in France. Multi locus sequence type and phylogenetic group designations were established for the ESBL isolates, revealing that birds and humans share E. coli populations. Several ESBL producing E. coli isolated from birds were identical to or clustered with isolates with human origin. Hence, wild birds pick up E. coli of human origin, and with human resistance traits, and may accordingly also act as an environmental reservoir and melting pot of bacterial resistance with a potential to re-infect human populations

Containing the burden of infectious diseases is everyone’s responsibility.:A call for an integrated strategy for developing and promoting hygiene behaviour change in home and everyday life

Across the world, health agencies recognize the profound impact of infectious disease on health and prosperity. Equally, they recognize that prevention is central to fighting infection, and that hygiene in home and everyday life (HEDL) is a key part of this. A current driver is the part that hygienei plays in tackling antibiotic resistance, but it also reflects growing numbers of people at greater risk of infection being cared for in the community. Sustaining the quality of state-funded healthcare requires that the public take greater responsibility for their own health, including protecting themselves and their families against infection. Hygiene must be must be everyone’s responsibility. However, if we are to be successful in promoting hygiene as part of public health, there are barriers which need to be overcome. A key issue is the need to balance evidence of the health benefits of hygiene against possible risks, such as environmental impacts and toxicity issues. Another issue is the role of microbes in human health and whether we have become “too clean”. Lack of a unified voice advocating for hygiene means these issues have tended to take precedence. Another barrier to change is public confusion about the need for hygiene and the difference between hygiene and cleanliness. To address this, we must work together to provide the public with a clear, consistent restatement of the importance of hygiene, and to change public perceptions about hygiene and good hygiene practice. This paper is unique because it examines these issues in an integrated manner and focuses on making achievable, constructive recommendations for developing an effective and sustainable approach. The paper lays out a risk management strategy for hygiene in home and everyday life which gives hygiene appropriate priority within the context of environmental and other health concerns. This “targeted hygiene” approach needs to be placed at the heart of a multimodal prevention strategy, alongside vaccination and other interventions. Based on the findings of this paper, we issue a call to action to national and international policy makers, health agencies and health professionals to recognize the need for an integrated, family-centredii approach to hygiene, and provide effective leadership to achieve this. This paper shows that many of the components of a behaviour change strategy are already in place, but need to be integrated rather than developed independently. We also issue a call to scientists, health professionals, environmental and regulatory agencies, immunologists, microbiomists, the private sector (hygiene appliance and product manufacturers) and the media to work together, through innovative research and communication policies. A collaborative effort is vital if we are to overcome barriers to change and action integrated behaviour change programmes that really work. The report represents the consensus views of an international, interdisciplinary group of experts in the field of infection prevention and hygiene. We recognise that this paper leaves many questions unanswered and would welcome further dialogue with stakeholders on how to develop policy. The aim of this paper is to provide a sound basis for such dialogue. At the 2016 launch of the European Human Biomonitoring Initiative, the EU commissioner for food safety said the followingiii which encapsulates the aim of this report. “We must collectively recognise that risk and uncertainty are part and parcel of every decision we take. We need to engage people in a serious and rational debate. But in this world of information overload – from old media and new – information, misinformation, opinions, prejudices, truths, half-truths and un-truths all compete for public attention. We need better communication of science so that people can be better informed about risk assessment and management decisions

The relationship between management accounting, profitability and operations in an uncertain world : evidence from literature and practice

At the heart of many core Management Accounting (MA) practices there is a potential mismatch between the assumption of a materially predictable future operating environment, and the reality of an uncertain and unpredictable world. Practices such as budgets, product costing, investment appraisal and financial projections, aimed at facilitating the achievement of profitability goals, are based on the assumption that the future is sufficiently stable and predictable to benefit from analytical calculation. However, we live in a world where the future can be uncertain, unstable and unpredictable. Does this mean that when operating conditions become unstable, unpredictable and uncertain many MA practices lose their core modus operandi? This thesis addresses this issue through an interwoven mix of a longitudinal case study and literature reviews spread over three projects. The case study was longitudinal and based on in depth participant observation. The firm involved was a £38m UK logistics company. The study benefited from totally unrestricted access to all strategic, financial and operational activities and data, because of the author’s senior role in the firm. The literature review was conducted using a targeted systematic review (Tranfield and Denyer, 2003) supported by additional narrative reviews. This synoptic paper provides a reflective synthesis of the findings and the contribution of the three projects which together constitute the research. Four core interlinked findings emerged from the study, based on the assumption that the achievement of profitability goals is the primary goal of the organisation. First, building on the proposals of (Otley, 1999) a framework showing the relationship between MA, profitability, operations and uncertainty is proposed. It demonstrates how MA financialises operations by creating a parallel financial space to the operational space; how profitability outcomes result from the financial consequences of operational actions; how the role of MA is to inform and control operational actions in a manner that achieves profitability goals; and how uncertainty has a critical impact on MA functionality. Second, the differing dimensions and implications of uncertainty are distinguished. The principal distinction is between external and internal uncertainty. External uncertainties arise from unanticipated changes from customers, suppliers and the market and thus affect the predictability of the future on which plans and targets are based. The data gathered during the course of this research suggests that external uncertainty tends to be typified by pockets of instability oscillating with periods of relative stability. Internal uncertainties occur in relation to management effectiveness, reporting validity and choice of appropriate accounting perspective (five are identified - Product, Customer, Throughout, Process, Financial Accounting). The external uncertainties magnify the impact of the internal uncertainties by potentially changing and thus de-stabilising the requirements of management, the validity of reporting and the appropriateness of the accounting perspective used. Third, Management Accounting Systems (MAS) respond to external uncertainties, and the aspirations of external financial stakeholders for increased profitability, by operating in two differing modes – the first is fixed/control (Fixed), the second is inform/flex (Flex). Fixed is the default mode and assumes conditions of relative certainty; the role is to control the achievement of agreed plans and targets. Flex is intermittently initiated when, signalled by feedback, the impact of external uncertainties or profit pressures trigger the need to change original plans and targets. Calculative analysis informs revised operational plans aimed at maintaining the achievement of profitability goals; targets are flexed to reflect the changes. The intent is to develop a revised position of relative stability in which the achievement of profitability plans and targets can be controlled via reverting back to Fixed. The process is therefore continual, but appears to be typified by an uneven series of oscillations between the two modes. Four, the Financial Accounting (FA) profitability measure, with the goal derived from external financial stakeholders, provides partial responses to the three internal uncertainties by introducing for each an element of certainty. For management effectiveness uncertainty, the profitability goal provides a relatively certain external referent which can be cascaded down the organisational structure, and against which performance can be evaluated. For reporting validity uncertainty, FA standards provide an authoritatively accepted definition of profitability, so that reported profitability is treated as if it were ‘true and fair’. For multiple accounting perspectives uncertainty, four perspectives (Product, Customer, Throughout, Process) make up a range of MA tools for developing actions to achieve target profitability levels, and the fifth (FA) provides the definition of profitability; all five are complementary and compatible as their differing aggregations are composed of the same underlying financial transactions. These responses, however, are only partial as the aspirations of external financial stakeholders are in themselves substantially self referential and liable to change, and the underlying uncertainty of FA reporting validity still exists, even if treated as if it does not. The study contributes to the further development of MA theory. It extends the Otley (1999) framework towards linking operations and profitability through parallel operational and financial spaces, and incorporating the central role of uncertainty. It adds to the debate in MA research on uncertainty by providing a classification of its dimensions, and its impact on triggering a requirement for differing MA modes. It highlights the central role of profitability in providing a stable certainty of purpose as a counterbalance to inherent internal and external uncertainties. It provides a clear identification of the differences and complementarities between MA and FA, FA defining the quantum of profitability achieved, MA facilitating the achievement of profitability goal. Finally the study inputs to a wide range of issues addressed by MA research which at their heart reflect the impact of uncertainty (Budgeting, Accounting Representation, Costing Perspectives). The study contributes to practice by proposing a set of ten tenets designed to provide guidelines for MAS development, implementation and evaluation. These are drawn from a cross sectional deconstruction of the four findings, viewed as a whole, aimed at identifying the specific factors that have direct implications for practice. The intent is that these tenets provide a bridge between theory and practice, based on the premise that, since MA theory was drawn from practice, the test of MA theory development is its applicability and relevance to practice.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

First documented case of Aeromonas veronii biovar sobria infection in northern Europe.

The first Scandinavian case of Aeromonas veronii biovar sobria infection, an episode of peritonitis in a patient suffering from a cirrhotic liver and an earlier unrecognized appendiceal cancer, is described

Haemophilus influenzae-induced acute otitis media. Aspects of virulence and protection in an animal model.

Acute otitis media (AOM) is the most common illness diagnosed during early childhood. One of the major etiologic agents is Haemophilus influenzae. Apart from AOM, this organism can cause a broad range of infectious diseases such as meningitis, epiglottitis, arthritis, and pneumonia. Despite the importance of H.influenzae, the mechanisms by which this heterogenous group of bacteria mediates the infectious process and how the host responds to them remain poorly defined. In this study an animal model of AOM induced by H.influenzae was established to investigate aspects of virulence and protection. The results showed that encapsulated and nontypeable (NTHi) strains yielded two different clinical courses in the rat. The most severe infections were, as in man, caused by strains that possessed the type b capsule, the most important virulence factor. In addition, there were differences in virulence between NTHi strains. In some strains these differences were possibly associated with the lipopolysaccharide. By developing a chromosomally mediated resistance to beta-lactams the bacterium could increase its power indirectly. Without any significant loss of virulence, the chromosomally altered NTHi could persist at the infectious site during antibiotic treatment and cause long-lasting structural changes in the middle ear. The host responses were dependent on whether the causative strain was encapsulated or not. A resolved H.influenzae type b (Hib) AOM induced a better protection against reinfections than an NTHi AOM, and the Hib infection conferred cross-protection against NTHi strains. A resolved pneumococcal AOM could also cross-protect but not subcutaneous whole cell immunizations, indicating that non-specific and local reactions may have been involved in the cross-protection. Finally, the commercially available conjugated Hib vaccine ACT-HIB® prevented experimental Hib AOM

The treatment of Haemophilus influenzae acute otitis media with amoxicillin protects against reinfection but not against structural changes

Acute otitis media (AOM) is the most common reason for outpatient antimicrobial therapy today. With increasing problems with antibiotic resistance, a more restrictive use of antibiotics has been advocated for both single and recurrent episodes. The arguments advanced have been immunological as well as ecological. To study the effects of a 5 day course of amoxicillin on recurrent AOM caused by non-typeable Haemophilus influenzae, Sprague-Dawley rats were used. Amoxicillin was introduced at the clinical peak of the first infection. One month later the animals were rechallenged. Local and systemic changes were monitored by otomicroscopy, bacterial cultures, and analyses of systemic IgG responses and histological changes. Antibiotic treatment accelerated the resolution of the primary infection. After resolution, only minor morphological changes were observed. The protective rate at rechallenge was 100% in the treatment group, compared with 80% in the untreated control group. Although the production of serum IgG antibodies was initially slightly impeded by the treatment, it was significantly higher in treated animals after rechallenge. Major structural changes could not be avoided at the second infection, however, and a significantly higher frequency of myringosclerosis was observed in treated animals. These experimental findings constitute support for further studies of antimicrobial drugs and recurrent AOM