Signs and symptoms in children with a serious infection: a qualitative study

BACKGROUND: Early diagnosis of serious infections in children is difficult in general practice, as incidence is low, patients present themselves at an early stage of the disease and diagnostic tools are limited to signs and symptoms from observation, clinical history and physical examination. Little is known which signs and symptoms are important in general practice. With this qualitative study, we aimed to identify possible new important diagnostic variables. METHODS: Semi-structured interviews with parents and physicians of children with a serious infection. We investigated all signs and symptoms that were related to or preceded the diagnosis. The analysis was done according to the grounded theory approach. Participants were recruited in general practice and at the hospital. RESULTS: 18 children who were hospitalised because of a serious infection were included. On average, parents and paediatricians were interviewed 3 days after admittance of the child to hospital, general practitioners between 5 and 8 days after the initial contact. The most prominent diagnostic signs in seriously ill children were changed behaviour, crying characteristics and the parents' opinion. Children either behaved drowsy or irritable and cried differently, either moaning or an inconsolable, loud crying. The parents found this illness different from previous illnesses, because of the seriousness or duration of the symptoms, or the occurrence of a critical incident. Classical signs, like high fever, petechiae or abnormalities at auscultation were helpful for the diagnosis when they were present, but not helpful when they were absent. CONCLUSION: behavioural signs and symptoms were very prominent in children with a serious infection. They will be further assessed for diagnostic accuracy in a subsequent, quantitative diagnostic study

Defining a Primary Market and Estimating Demand for Major Bicycle-Sharing Program in Philadelphia, Pennsylvania.

Public bicycle-sharing (bike share) programs have become increasingly popular in recent years, particularly in Europe, with a number of cities recently implementing systems and high levels of usage. North American efforts have been more limited to date, with high-profile recent examples including a small program in Washington, D.C., and a substantial seasonal program in Montreal, Canada. Because there are no established large-scale programs in the United States, planners exploring potential system designs and feasibilities are faced with an unusual degree of uncertainty about who would ride, where they might ride, and how often they might ride. A large-scale bike share system is under consideration in Philadelphia, Pennsylvania. This paper discusses the methods and findings of a two-phase project that (a) used a raster-based geographic information system analysis to identify a primary geographic market area for a bike share program and (b) applied bike share trip diversion rates observed in peer European cities to estimate daily bike share trips in the primary market area. This analysis resulted in estimates for daily usage in Philadelphia that ranged from roughly 6,000 to 23,000 for two scales of market area and three demand scenarios (low, middle, and high). As bike share systems continue to proliferate in different settings, new data can refine the methods used here to provide increasing levels of certainty in the future

Strategieprozesse in Familienunternehmen: Strategische Implikationen einer dynamischen Umwelt

Das Schweizer Medizintechnik-Unternehmen Ypsomed hat die Nachfolge von der ersten in die zweite Generation erfolgreich realisiert. Der Gründer, ein innovativer Unternehmer, hat das Unternehmen vor allem durch die weltweit erste Insulinpumpe geprägt und vorangetrieben. Der Markt der Medizintechnik gerät immer stärker unter Druck. Die Digitalisierung verändert die Kundenanforderungen auch im Bereich des Gesundheitswesens. Der Familien-CEO steht vor der Entscheidung, wie sich das Unternehmen zukünftig aufstellen muss, um am Markt bestehen zu können und vor allem die Innovationsführerschaft nicht zu verlieren. Das unternehmerische Erbe des Gründers soll genauso erhalten bleiben wie die Innovations- und Erneuerungskraft des Unternehmens. Die Innovationsstrategie des Unternehmens soll offen für neue Ideen und Impulse sein, aber auch strukturierten Prozessen folgen. Da das Unternehmen an der Schweizer Börse gelistet ist, müssen auch die Shareholder, welche eine Internationalisierungsstrategie bevorzugen, berücksichtigt werden. Welche Maßnahmen des strategischen Managements genutzt werden können, um dieses Ziel zu erreichen, beschäftigt den Unternehmer und erfordert entsprechende Entscheidungen

Family firm heterogeneity and CEO compensation in Continental Europe

CEO compensation in family firms is affected by certain corporate governance characteristics, such as the generational stage of the firm (founder or descendant-controlled firms), the level of family involvement on the board of directors (lone or multiple family members sitting on the board) and the family status of the CEO (family or professional CEO). In this paper, we argue that moderating effects arise among these dimensions of heterogeneity. The results show that in firms owned by descendants, the presence of multiple family members is beneficial in lowering family CEO compensation, while the opposite is true in the presence of the founder. Moreover, within founder and descendant firms, the number of family representatives on the board exerts a strong influence on the compensation of family CEOs, whereas it does not affect the compensation of professional CEOs. The results also show that in certain family clusters, CEO compensation is higher than in nonfamily firms, thereby emphasizing that when comparing CEO compensation in family and nonfamily firms, it is important to consider the intersections among the heterogeneity dimensions of the governance of family firms. The findings of the paper contribute to the literature on the governance of family firms by showing that certain family firm types are more effective than others in keeping CEO compensation under control