Improved diagnosis and management of sepsis and bloodstream infection

Sepsis is a severe organ dysfunction triggered by infections, and a leading cause of hospitalization and death. Concurrent bloodstream infection (BSI) is common and around one third of sepsis patients have positive blood cultures. Prompt diagnosis and treatment is crucial, but there is a trade-off between the negative effects of over diagnosis and failure to recognize sepsis in time. The emerging crisis of antimicrobial resistance has made bacterial infections more difficult to treat, especially gram-negative pathogens such as Pseudomonas aeruginosa. The overall aim with this thesis was to improve diagnosis, assess the influence of time to antimicrobial treatment and explore prognostic bacterial virulence markers in sepsis and BSI. The papers are based on observational data from 7 cohorts of more than 100 000 hospital episodes. In addition, whole genome sequencing has been performed on approximately 800 invasive P. aeruginosa isolates collected from centers in Europe and Australia. Paper I showed that automated surveillance of sepsis incidence using the Sepsis-3 criteria is feasible in the non-ICU setting, with examples of how implementing this model generates continuous epidemiological data down to the ward level. This information can be used for directing resources and evaluating quality-of-care interventions. In Paper II, evidence is provided for using peripheral oxygen saturation (SpO2) to diagnose respiratory dysfunction in sepsis, proposing the novel thresholds 94% and 90% to get 1 and 2 SOFA points, respectively. This has important implications for improving sepsis diagnosis, especially when conventional arterial blood gas measurements are unavailable. Paper III verified that sepsis surveillance data can be utilized to develop machine learning screening tools to improve early identification of sepsis. A Bayesian network algorithm trained on routine electronic health record data predicted sepsis onset within 48 hours with better discrimination and earlier than conventional NEWS2 outside the ICU. The results suggested that screening may primarily be suited for the early admission period, which have broader implications also for other sepsis screening tools. Paper IV demonstrated that delays in antimicrobial treatment with in vitro pathogen coverage in BSI were associated with increased mortality after 12 hours from blood culture collection, but not at 1, 3, and 6 hours. This indicates a time window where clinicians should focus on the diagnostic workup, and proposes a target for rapid diagnostics of blood cultures. Finally, Paper V showed that the virulence genotype had some influence on mortality and septic shock in P. aeruginosa BSI, however, it was not a major prognostic determinant. Together these studies contribute to better understanding of the sepsis and BSI populations, and provide several suggestions to improve diagnosis and timing of treatment, with implications for clinical practice. Future works should focus on the implementation of sepsis surveillance, clinical trials of time to antimicrobial treatment and evaluating the prognostic importance of bacterial genotype data in larger populations from diverse infection sources and pathogens

Microsatellite primers for red drum (Sciaenops ocellatus)

In this note, we document polymerase-chain-reaction (PCR) primer pairs for 101 nuclear-encoded microsatellites designed and developed from a genomic library for red drum (Sciaenops ocellatus). Details of the genomic library construction, the sequencing of positive clones, primer design, and PCR protocols may be found in Karlsson et al. (2008). The 101 microsatellites (GENBA NK Accession Numbers EU015882-EU015982) were amplified successfully and used to genotype 24 red drum obtained from Galveston Bay, Texas (Table 1). A total of 69 of the microsatellites had an uninterrupted (perfect) dinucleotide motif, and 30 had an imperfect dinucleotide motif; one microsatellite had an imperfect tetranucleotide motif, and one had an imperfect and compound motif (Table 1 ). Sizes of the cloned alleles ranged from 84 to 252 base pairs. A ‘blast’ search of the GENBANK database indicated that all of the primers and the cloned alleles were unique (i.e., not duplicated)

Exploring Value Potential in a Function-Focused Industry

ABSTRACT Key words: Axiology, Value of Exchange, Blue Ocean Strategy, Docking Equipment, Key Value Factor, Value Co-Creation, The STACC Value Model Issue of Study: In a typical red ocean - an industry with shrinking margins, overcapacity and decreasing demand - Crawford Solutions has the ambition to become what they call a solution provider. The question arises whether there is a potential for value-oriented efforts and whether customers will perceive such a value offer. There are many stakeholders involved in acquiring docking equipment but it is uncertain who the customers really are as well as who the real customer is. It is also highly uncertain whether, where and how there is a potential for value creation in this highly function focused industry. Purpose: To explore the potential for value creation and delivery in a function-focused industry. To identify factors that generate value and, in doing so, present an aqueduct leading from the current red ocean to a blue ocean. Conclusion: The term Value of Exchange is developed to fill the gap between the Value in Exchange and the Value in Use. By utilizing the Buyer Utility Map, the installation is identified as a blue ocean where Value of Exchange can be generated. Through a case study, we have found fifteen Key Value Factors that lead to the creation of Value of Exchange. We want to add Value of Exchange to the traditional two value concepts, Value in Exchange and Value in Use in order to give a clearer meaning to service dominant offers, like delivery, not labeling them as necessary evils but great contextual contributors for Value Co-Creation. The presented STACC Value Model provides an updated view on customer interdependencies and the nature of value creation in processes involving intermediaries

Breeding sheep for worm resistance

Sheep production os one of Western Australia\u27s most important agricultural industries. However, it is faced with the serious threat of sheep worm populations becoming increasingly resistant to the available drenches. Although it\u27s not a \u27quick fix\u27 solution, part of the long term answer may be selection for sheep with greater resistance to worms

Hälsa på (o)jämlika villkor : en analys av statens offentliga utredning – Vård efter behov och på lika villkor – en mänsklig rättighet

This papers topic is the right to health for undocumented migrants in Sweden. In the year of 2010, the government of Sweden appointed an investigation after receiving cri-tique from both domestic and international voices and organizations. The investigation concludes that the healthcare system is not in conformity with Sweden’s human rights obligations and ambitions and a change in the national legislation was needed. With the theoretical perspective of Hannah Arendt and Peter Nyers accident theory, combined with the research on health and equality presented in the book The Spirit Lev-el, this paper concludes that the new national legislation presented by the investigation is not enough to fulfill the right to health. Although it would be a big step in order to fulfill the right to health for undocumented people living in Sweden, this paper con-cludes that there is a problem in fulfilling the right to health for persons who lack citi-zenship and discusses whether it is possible in Sweden

Inbyggd risk och Frontex ansvar för irreguljära migranter i medelhavet

Frontex plays a central role in the development of EU border control. Since Frontex inception, the primary target of joint coordinated operations has been irregular migration. The system created to analyze and prevent irregular migration is the primary focus in this essay. The theoretical approach is the accident theory. Through a qualitative content analysis of Frontex official documents and annual risk analysis, this paper seeks to address the accidents produced in the system, and the conse-quences it has at the external border. With focus on the outcome of the joint operations on a specific border zone, this essay will argue that the rise of migrants need saving at sea is partly because of the system developed by Frontex. By highlighting the accident created, I then seek to assign respon-sibilities, using David Millers connection theory. The accident needs to be understood as inherent in the system, which gives us better understanding of what the system does create, both intentionally and unintentionally.Frontex spelar en central roll inom utvecklingen av EU:s externa gränskon-troll. Sedan starten har irreguljär migration varit det primära målet i Frontex samordnade operationer med medlemsstaterna. Det system som utvecklats för att analysera och förhindra irreguljär migration är fokus i denna studie. Teorin om Accidents är den teoretiska utgångspunkten för studien. Ge-nom en kvalitativ innehållsanalys av Frontex officiella dokument och årliga riskanalyser, har denna studie som syfte att lyfta fram de accidents som Frontex system producerar. Med fokus på konsekvenserna av en specifik samordnad operation vid en specifik del av den externa gränsen, kommer denna studie argumentera att ökningen av migranter i medelhavet delvis kan förklaras av en accidents producerad av Frontex system. Genom att lyfta fram denna accident, kan ansvar fördelas utifrån David Millers connection theory. Accidents behöver utifrån teorin förstås som inbyggda i systemet, vilket ger en helhetsförståelse i hur systemet fungerar, med och utan avsikt