Patient experiences of serious adverse drug reactions and their attitudes to medicines:a qualitative study of survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK

Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality and account for around 6.5% of hospital admissions. Patient experiences of serious ADRs and their long-term impact on patients' lives, including their influence on current attitudes towards medicines, have not been previously explored. Objective: The aim of the study was to explore the experiences, beliefs, and attitudes of survivors of serious ADRs, using drug-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as a paradigm. Methods: A retrospective, qualitative study was undertaken using detailed semi-structured interviews. Fourteen adult survivors of SJS and TEN, admitted to two teaching hospitals in the UK, one the location of a tertiary burns centre, were interviewed. Interview transcripts were independently analysed by three different researchers and themes emerging from the text identified. Results: All 14 patients were aware that their condition was drug induced, and all but one knew the specific drug(s) implicated. Several expressed surprise at the perceived lack of awareness of the ADR amongst healthcare professionals, and described how the ADR was mistaken for another condition. Survivors believed that causes of the ADR included (i) being given too high a dose of the drug; (ii) medical staff ignoring existing allergies; and (iii) failure to monitor blood tests. Only two believed that the reaction was unavoidable. Those who believed that the condition could have been avoided had less trust in healthcare professionals. The ADR had a persisting impact on their current lives physically and psychologically. Many now avoided medicines altogether and were fearful of becoming ill enough to need them. © 2011 Adis Data Information BV. All rights reserved. Conclusions: Life-threatening ADRs continued to affect patients’ lives long after the event. Patients’ beliefs regarding the cause of the ADR differed, and may have influenced their trust in healthcare professionals and medicines. We propose that clear communication during the acute phase of a serious ADR may therefore be important.

The influence of culture and market orientation on services brands:insights from Irish banking and retail firms

Purpose: This paper aims to examine the influence of the culture of the service firm on its interpretation of the role of the brand and on the development and implementation of its brand values. Design/methodology/approach: A grounded theory approach was used. Interviews were conducted with 20 managers within two leading banking firms in Ireland and two leading grocery retailers in Ireland. Findings: The development of the brand, and its role within the firm, is closely related to the firm's culture. The research shows obstacles and opportunities created by the cultural context of firms wishing to disseminate and embed a set of brand values. The paper presents an "involvement model" of brand values implementation and outlines changes required to implement brand values. Research limitations/implications: The study was bound by access to firms, and managers' availability. The authors sought an insight into the relationship between each firm's culture and its brands. They advocate quantitative research to further investigate the findings within these service sectors and to test proposed antecedents (transformational leadership, employee involvement) and outcomes (employee-based brand equity and consumer-based brand equity) of values adoption. Practical implications: The paper identifies aspects of retail and banking cultures which support or detract from brand development. In particular, it presents the learnings from successful brand values implementation in a clan culture, aspects of which are applicable across other cultures. Originality/value: The paper provides valuable insights into the role of the brand within the service firm and the positive and negative influence of context on brand values and their development and implementation. © Emerald Group Publishing Limited.

Medicines optimisation for young people with juvenile arthritis and other long-term conditions:system-level barriers to engagement

To explore the views of pharmacy and rheumatology stakeholders about system-related barriers to medicines optimisation activities with young people with long-term conditions. A three-phase consensus-building study comprising (1) focus groups with community and hospital pharmacists; (2) semi-structured telephone interviews with lay and professional adolescent rheumatology stakeholders and pharmacy policymakers, and (3) multidisciplinary discussion groups with community and hospital pharmacists and rheumatology staff. Qualitative verbatim transcripts from phases 1 and 2 were subjected to framework analysis. Themes from phase 1 underpinned a briefing for phase 2 interviewees. Themes from phases 1 and 2 generated elements of good pharmacy practice and current/future pharmacy roles for ranking in phase 3. Results from phase 3 prioritisation and ranking exercises were captured on self-completion data collection forms, entered into an Excel spreadsheet and subjected to descriptive statistical analysis. Institutional ethical approval was given by Aston University Health and Life Sciences Research Ethics Committee. Four focus groups were conducted with 18 pharmacists across England, Scotland and Wales (7 hospital, 10 community and 1 community/public health). Fifteen stakeholders took part in telephone interviews (3 pharmacist commissioners; 2 pharmacist policymakers; 2 pharmacy staff members (1 community and 1 hospital); 4 rheumatologists; 1 specialist nurse, and 3 lay juvenile arthritis advocates). Twenty-five participants took part in three discussion groups in adolescent rheumatology centres across England and Scotland (9 community pharmacists; 4 hospital pharmacists; 6 rheumatologists; 5 specialist nurses, and 1 physiotherapist). In all phases of the study, system-level issues were acknowledged as barriers to more engagement with young people and families. Community pharmacists in the focus groups reported that opportunities for engaging with young people were low if parents collected prescriptions alone, which was agreed by other stakeholders. Moreover, institutional/company prescription collection policies – an activity largely disallowed for a young person under 16 without an accompanying parent - were identified by hospital and community pharmacists as barriers to open discussion and engagement. Few community pharmacists reported using Medicines Use Review (England/Wales) or Chronic Medication Service (Scotland) as a medicines optimisation activity with young people; many were unsure about consent procedures. Despite these limitations, rheumatology stakeholders ranked highly the potential of pharmacists empowering young people with general health care skills, such as repeat prescription ordering. The pharmacy profession lacks vision for its role in the care of young people with long-term conditions. Pharmacists and rheumatology stakeholders identified system-level barriers to more engagement with young people who take medicines regularly. We acknowledge that the modest number of participants may have had a specific interest and thus bias for the topic, but this underscores their frank admission of the challenges. Professional guidance and policy, practice frameworks and institutional/company policies must promote flexibility for pharmacy staff to recognise and empower young people who are able to give consent and take responsibility for medicines activities. This will increase mutual confidence and trust, and foster pharmacy’s role in teaching general health care skills. In this way, pharmacists will be able to build long-term relationships with young people and families.

The impact of family forms on interpersonal influence between single parent and full families

The relationship between individual thoughts and the social environment has been widely studied in sociology (Weber, 1968), psychology (Lewin, 1951) and social psychology. The influence of reference groups on individual behaviour is often manifested in the decisions made by consumers while members of these reference groups are often the individual’s friends and acquaintances. Their decisions, their values and norms serve as an example for the individual. In this study the influences of reference groups are examined within the context of the family form in Hungary. The paper focuses on the nature of peer influence in single parent households and full families, to analyse the normative and informational dimensions of peer pressure and communication patterns within the family.

A marketingeszközök alkalmazásának hatása a versenyképességre = The Impact of Marketing Tools on Competitiveness

A tanulmány a marketing szerteágazó területei és a vállalatok versenyképessége közötti összefüggéseket kereste és hasonlította össze az öt évvel ezelőtti felmérés eredményeivel. Az elemzés így kitért arra, hogy a vezetők hogyan észlelik a marketing szerepét a vállalati eredményesség szempontjából, hogyan hatnak a teljesítményre a termék- és márkázási döntések, a szolgáltatások menedzselése, valamint a reklámtevékenység. A kutatás érinti a marketing szervezeti megjelenését és a többi vállalati funkciókkal megfigyelhető kapcsolatát, majd az erőforrás-elmélet megközelítését felhasználva elemezte a marketing eszközök és képességek versenyképességre gyakorolt hatását. Az eredmények alapján azt állapíthatjuk meg, hogy a marketing gyakorlata számos ponton kapcsolódik a vállalati teljesítményhez, azonban előtérbe kerülnek azok a marketing jellegű képességek, amely a vállalat marketing rendszerének működtetéséhez, nyomon követéséhez és megújításához szükségesek. ____ The study aimed to reveal the association between the widespread functions of marketing and corporate competitiveness and it compared the results to the ones of the similar survey research conducted five years before. The analysis concerns the perceived role of marketing in the success companies and how product and brand decisions, the management of services or advertising practices can influence the performance of companies. The organisational representation of marketing and the relationship with other corporate functions were also investigated. Finally, the study implemented the approach of resource-based theory to determine the effects of marketing assets and capabilities on competitiveness. Based on the results we can conclude that several connections can be determined between marketing and corporate performance but the role of marketing related capabilities that are necessary for managing, tracing and developing marketing systems is increasing.

Influence of parameters of drying on laser induced diffuse reflectance of banana discs

Banana discs of 1 cm thickness were immersed into different antioxidant solutions to slow down potentially disturbing discoloration during drying. Samples were randomly split into 8 groups according to the 2^p experimental design. Two antioxidant solutions with 1.66% and 4.59% ascorbic acid, two levels of drying temperature with 50°C and 80°C, two levels of drying time with 6h and 8h were used or adjusted. Laser diodes of seven wavelengths (532, 635, 650, 780, 808, 850 and 1064 nm) were selected to illuminate the surface and light penetration pattern was evaluated on the basis of radial profiles. Profiles acquired at three wavelengths (532, 635 and 650 nm) were found to respond sensitively to adjusted parameters. As a result of drying, intensity decay was observed to move closer to incident point. Significant effect (p<0.01) of temperature, drying time and their interaction was found on extracted descriptive attributes of intensity profiles: full width at half maximum (FWHM), distance of inflection point (DIP) and slope of logarithmic decay (SLD). Beyond their presence, antioxidant concentration was neutral factor without significant contribution to the model. Results were in agreement with reference spectroscopic measurements, especially with NDVI index. Promising results suggest that evaluated method might be suitable for monitoring purposes during drying of fruits.

A marketingeszközök és –tevékenységek részvényesi értékre gyakorolt hatása (The effect of marketing assets and activities on shareholder value)

A vállalati marketing pénzügyi teljesítményre, különösen részvényesi értékre gyakorolt hatásának kimutatása mind fontosabbá válik a marketingráfordítások nagyságának növekedésével, valamint annak felismerésével, hogy a részvényesek számára vevői érték nélkül nem lehet hosszú távon értéket biztosítani, azonban kedvező piaci eredményekkel sem feltétlenül valósul meg a pénzügyi teljesítmény növekedése. A szerzők tanulmányukban a marketingeszközök és -tevékenységek részvényesi értékre gyakorolt hatását vizsgálják, rámutatnak arra, hogy milyen módon befolyásolhatják a részvényeseket megillető szabad pénzáramot, a tulajdonosi megtérülést, a stratégiai tervezési időhorizontot és a végértéket. A marketing néhány lehetséges negatív hatását is kiemelik. Ezt követően felvázolják a marketingjellegű beruházások reálopciós karakterisztikáit, valamint játékelméleti összefüggéseit dinamikusan változó környezetben. ________ Proving the effect of corporate marketing on financial performance, especially on shareholder value, becomes more and more important as marketing expenditures increase. Furthermore by the recognition that for shareholders without customer value it is not possible to provide value in the long run, however, neither good market results can assure the growth of financial performance. In this paper the authors examine the effect of marketing assets and activities on shareholder value, they point out how these can influence free cash flow to equity, shareholder return, strategic planning time period and terminal value. They emphasize also some possible negative effects of marketing. The authors outline the real optional characteristics of marketing investments and their game theoretical relations in dynamic environment.

The Influence of Phosphorus on Periphyton Mats from the Everglades and Three Tropical Karstic Wetlands

The distinctive karstic, freshwater wetlands of the northern Caribbean and Central American region support the prolific growth of calcite-rich periphyton mats. Aside from the Everglades, very little research has been conducted in these karstic wetlands, which are increasingly threatened by eutrophication. This study sought to (i) test the hypothesis that water depth and periphyton total phosphorus (TP) content are both drivers of periphyton biomass in karstic wetland habitats in Belize, Mexico and Jamaica, (ii) provide a taxonomic inventory of the periphytic diatom species in these wetlands and (iii) examine the relationship between periphyton mat TP concentration and diatom assemblage at Everglades and Caribbean locations. ^ Periphyton biomass, nutrient and diatom assemblage data were generated from periphyton mat samples collected from shallow, marl-based wetlands in Belize, Mexico and Jamaica. These data were compared to a larger dataset collected from comparable sites within Everglades National Park. A diatom taxonomic inventory was conducted on the Caribbean samples and a combination of ordination and weighted-averaging modeling techniques were used to compare relationships between periphyton TP concentration, periphyton biomass and diatom assemblage composition among the locations. ^ Within the Everglades, periphyton biomass showed a negative correlation with water depth and mat TP, while periphyton mat percent organic content was positively correlated with these two variables. These patterns were also exhibited within the Belize, Mexico and Jamaica locations, suggesting that water depth and periphyton TP content are both drivers of periphyton biomass in karstic wetland systems within the northern Caribbean region. ^ A total of 146 diatom species representing 39 genera were recorded from the three Caribbean locations, including a distinct core group of species that may be endemic to this habitat type. Weighted averaging models were produced that effectively predicted mat TP concentration from diatom assemblages for both Everglades (R2=0.56) and Caribbean (R2=0.85) locations. There were, however, significant differences among Everglades and Caribbean locations with respect to species TP optima and indicator species. This suggests that although diatoms are effective indicators of water quality in these wetlands, differences in species response to water quality changes can reduce the predictive power of these indices when applied across systems. ^

The Influence of Servicescape and Local Food Attributes on Pleasure and Revisit Intention in an Upscale-Casual Dining Restaurant

The current study looks at the relationship between servicescape, emotional product involvement, perceived quality of local foods, the positive emotion of pleasure, and revisit intention in an upscale buffet style restaurant on a university campus in the Southeastern U.S. Test results show positive relationships between all of the constructs in the proposed conceptual model. The study also gives practitioners and academics insights into practices that can help to market the use of local foods through the restaurant environment in order to engage emotionally involved customers. This marketing can illicit pleasurable feelings and increase perceived product quality of local foods with the purpose of getting customers to revisit the restaurant. Suggestions for further research on the subject are proposed.

Mining the online social network data: Influence, summarization, and organization

Online Social Network (OSN) services provided by Internet companies bring people together to chat, share the information, and enjoy the information. Meanwhile, huge amounts of data are generated by those services (they can be regarded as the social media ) every day, every hour, even every minute, and every second. Currently, researchers are interested in analyzing the OSN data, extracting interesting patterns from it, and applying those patterns to real-world applications. However, due to the large-scale property of the OSN data, it is difficult to effectively analyze it. This dissertation focuses on applying data mining and information retrieval techniques to mine two key components in the social media data — users and user-generated contents. Specifically, it aims at addressing three problems related to the social media users and contents: (1) how does one organize the users and the contents? (2) how does one summarize the textual contents so that users do not have to go over every post to capture the general idea? (3) how does one identify the influential users in the social media to benefit other applications, e.g., Marketing Campaign? The contribution of this dissertation is briefly summarized as follows. (1) It provides a comprehensive and versatile data mining framework to analyze the users and user-generated contents from the social media. (2) It designs a hierarchical co-clustering algorithm to organize the users and contents. (3) It proposes multi-document summarization methods to extract core information from the social network contents. (4) It introduces three important dimensions of social influence, and a dynamic influence model for identifying influential users.

Physical oceanography, nutrients, and d18O measured on water bottle samples during POLARSTERN cruise ARK-XXII/2

Extremely low summer sea-ice coverage in the Arctic Ocean in 2007 allowed extensive sampling and a wide quasi-synoptic hydrographic and d18O dataset could be collected in the Eurasian Basin and the Makarov Basin up to the Alpha Ridge and the East Siberian continental margin. With the aim of determining the origin of freshwater in the halocline, fractions of river water and sea-ice meltwater in the upper 150 m were quantified by a combination of salinity and d18O in the Eurasian Basin. Two methods, applying the preformed phosphate concentration (PO*) and the nitrate-to-phosphate ratio (N/P), were compared to further differentiate the marine fraction into Atlantic and Pacific-derived contributions. While PO*-based assessments systematically underestimate the contribution of Pacific-derived waters, N/P-based calculations overestimate Pacific-derived waters within the Transpolar Drift due to denitrification in bottom sediments at the Laptev Sea continental margin. Within the Eurasian Basin a west to east oriented front between net melting and production of sea-ice is observed. Outside the Atlantic regime dominated by net sea-ice melting, a pronounced layer influenced by brines released during sea-ice formation is present at about 30 to 50 m water depth with a maximum over the Lomonosov Ridge. The geographically distinct definition of this maximum demonstrates the rapid release and transport of signals from the shelf regions in discrete pulses within the Transpolar Drift. The ratio of sea-ice derived brine influence and river water is roughly constant within each layer of the Arctic Ocean halocline. The correlation between brine influence and river water reveals two clusters that can be assigned to the two main mechanisms of sea-ice formation within the Arctic Ocean. Over the open ocean or in polynyas at the continental slope where relatively small amounts of river water are found, sea-ice formation results in a linear correlation between brine influence and river water at salinities of about 32 to 34. In coastal polynyas in the shallow regions of the Laptev Sea and southern Kara Sea, sea-ice formation transports river water into the shelf's bottom layer due to the close proximity to the river mouths. This process therefore results in waters that form a second linear correlation between brine influence and river water at salinities of about 30 to 32. Our study indicates which layers of the Arctic Ocean halocline are primarily influenced by sea-ice formation in coastal polynyas and which layers are primarily influenced by sea-ice formation over the open ocean. Accordingly we use the ratio of sea-ice derived brine influence and river water to link the maximum in brine influence within the Transpolar Drift with a pulse of shelf waters from the Laptev Sea that was likely released in summer 2005.

Dimethylsulphide (DMS), dimethylsulphonioproionate (DMSP) and halocarbon concentrations taken from 25m integrated samples during the 2011 SOPRAN Bergen Raunefjord Mesocosm experiment, Norway

The human-induced rise in atmospheric carbon dioxide since the industrial revolution has led to increasing oceanic carbon uptake and changes in seawater carbonate chemistry, resulting in lowering of surface water pH. In this study we investigated the effect of increasing CO2 partial pressure (pCO2) on concentrations of volatile biogenic dimethylsulfide (DMS) and its precursor dimethylsulfoniopropionate (DMSP), through monoculture studies and community pCO2 perturbation. DMS is a climatically important gas produced by many marine algae: it transfers sulfur into the atmosphere and is a major influence on biogeochemical climate regulation through breakdown to sulfate and formation of subsequent cloud condensation nuclei (CCN). Overall, production of DMS and DMSP by the coccolithophore Emiliania huxleyi strain RCC1229 was unaffected by growth at 900 µatm pCO2, but DMSP production normalised to cell volume was 12 % lower at the higher pCO2 treatment. These cultures were compared with community DMS and DMSP production during an elevated pCO2 mesocosm experiment with the aim of studying E. huxleyi in the natural environment. Results contrasted with the culture experiments and showed reductions in community DMS and DMSP concentrations of up to 60 and 32 % respectively at pCO2 up to 3000 µatm, with changes attributed to poorer growth of DMSP-producing nanophytoplankton species, including E. huxleyi, and potentially increased microbial consumption of DMS and dissolved DMSP at higher pCO2. DMS and DMSP production differences between culture and community likely arise from pH affecting the inter-species responses between microbial producers and consumers.

Castles in the air: the life, times and influence of the Reverend Moses Harvey (1820-1901).

The period from 1874 to 1901 was a time of significant transition in the economic and political life of Newfoundland. Twenty years into responsible government and with Confederation on the backburner, the colony’s politicians turned their attention to economic diversification, landward development and carving out the island’s place in the British Empire. The period saw both economic prosperity and retrenchment; the construction of a trans-insular railway; the adoption of policies to foster agriculture, forestry, manufacturing and mining; and diplomatic efforts to resolve France’s outstanding claims on the northwest coast of the island. At the same time, the government made an attempt to intervene directly in its primary industry, the fisheries. It created a Fisheries Commission in 1889 that recommended conservation measures and artificial propagation as ways to restore the health of some of the island’s fish stocks. They also proposed new methods of curing, packaging and marketing Newfoundland’s cod, as well as a complete overhaul of the truck system. A major player in both the public and private debates surrounding all of these subjects was the Reverend Moses Harvey. Along with being minister of the Free Church of Scotland in St. John’s, Harvey was one of Newfoundland’s most active promoters in the late nineteenth century. He served as the media mouthpiece for both Prime Minister William Whiteway and Prime Minister Robert Thorburn; editing the Evening Mercury – the official organ of the Liberal Party and then the Reform Party – from 1882 to 1883 and 1885 until 1890. As well, Harvey wrote regular columns on Newfoundland issues for newspapers in London, New York, Boston, Montreal, Toronto, and Halifax. He also produced numerous books, articles, encyclopedia entries, and travel guides outlining the island’s attractions and its vast economic potential. In short, Harvey made a significant contribution in shaping the way residents and the outside world viewed Newfoundland during this period. This thesis examines late nineteenth-century Newfoundland through the writing of Moses Harvey. The biographical approach offers a fuller, more nuanced account of some of the major historical themes of the period including the politics of progress, opening up the interior, railway construction and attitudes toward the fisheries. It also provides an insider’s prospective on what led to some of the major political decisions, policy positions or compromises taken by the Whiteway and Thorburn governments. Finally, a more detailed review of Harvey’s work exposes the practical and political differences that he had with people like D.W. Prowse and Bishop Michael Howley. While these so-called “boomers” in Newfoundland’s historiography agreed on broad themes, they parted ways over what should be done with the fisheries and how best to channel the colony’s growing sense of nationalism.

Morphometrics of seagrasses at species level, Moreton Bay, Australia determined from core samples collected in 2012-2013

Seagrass meadows are important marine carbon sinks, yet they are threatened and declining worldwide. Seagrass management and conservation requires adequate understanding of the physical and biological factors determining carbon content in seagrass sediments. Here, we identified key factors that influence carbon content in seagrass meadows across several environmental gradients in Moreton Bay, SE Queensland. Sampling was conducted in two regions: (1) Canopy Complexity, 98 sites on the Eastern Banks, where seagrass canopy structure and species composition varied while turbidity was consistently low; and (2) Turbidity Gradient, 11 locations across the entire bay, where turbidity varied among sampling locations. Sediment organic carbon content and seagrass structural complexity (shoot density, leaf area, and species specific characteristics) were measured from shallow sediment and seagrass biomass cores at each location, respectively. Environmental data were obtained from empirical measurements (water quality) and models (wave height). The key factors influencing carbon content in seagrass sediments were seagrass structural complexity, turbidity, water depth, and wave height. In the Canopy Complexity region, carbon content was higher for shallower sites and those with higher seagrass structural complexity. When turbidity varied along the Turbidity Gradient, carbon content was higher at sites with high turbidity. In both regions carbon content was consistently higher in sheltered areas with lower wave height. Seagrass canopy structure, water depth, turbidity, and hydrodynamic setting of seagrass meadows should therefore be considered in conservation and management strategies that aim to maximize sediment carbon content.