Background 50% of antibiotic courses in long-term care facilities (LTCFs) are unnecessary, leading to increased risk of harm such as Clostridiodes difficile infection and antibiotic-resistant organisms. Antimicrobial Stewardship (AS) interventions plays an important role in optimizing antibiotic use. Most studies to improve antibiotic prescribing in LTCFs showed modest and unsustained results. We aimed to identify facilitators, barriers and strategies in implementing a urinary tract infection (UTI)-focused AS intervention at a LTCF with the secondary objective of exploring the pharmacist’s potential role(s) in this intervention. Methods A qualitative approach using conventional content analysis was used. Through purposeful sampling, we recruited different healthcare providers and administrators at Kensington Gardens. Interviewees attended focus groups or one-on-one interviews. Data were collected using a semi-structured interview guide. Data were analyzed inductively using a codebook modified in an iterative analytic process. Barrier and facilitator themes were identified from the transcripts and mapped using the COM-B (capability, opportunity, motivation and behaviour) model (Michie et al). Similarly, themes were identified from the transcripts regarding the pharmacist’s roles in this intervention. Results Sixteen participants were interviewed. Most barriers and facilitators mapped to the opportunities domain of the COM-B model. The main barrier themes were lack of access, lack of knowledge, ineffective communication, lack of resources and external factors while the main facilitator themes were education, effective collaboration, good communication, sufficient resources and access. For the pharmacist’s role, the barrier themes were ineffective collaboration and communication. Furthermore, the pharmacist can play a role in education and antibiotic selection. Conclusions A UTI-focused antimicrobial stewardship intervention in LTCF should consider strategies to improve access, knowledge, communication and collaboration in its design, having sufficient resources and addressing external factors in order to optimize the intervention’s success. Pharmacists can play a role in education and antibiotic selection. / Thesis / Master of Science (MSc) / Half of antibiotics prescribed in long-term care are not needed, leading to increased harm. It is unclear which strategies should be used to improve antibiotic prescribing. This project aims to identify facilitators, barriers and strategies in identifying and managing urinary tract infection in a long-term care facility as well as exploring the role of the pharmacist in this setting. We conducted focus groups and interviews to gather information and analyzed the transcripts to determine barrier and facilitator themes relating to urinary tract infection management and the role of the pharmacist. The main barrier themes were lack of access, lack of knowledge, ineffective communication, lack of resources and external factors while the main facilitator themes were education, effective collaboration, good communication, sufficient resources and access. For the pharmacist’s role, the barrier themes were ineffective collaboration and communication. In addition, the pharmacist can play a role in education and antibiotic selection.

The purpose of this study was to compare couples in different phases of marriage with the primary goal of contributing to our understanding of marital quality throughout the life span. Rusbult's investment theory (Rusbult, 1980, 1983; Rusbult & Buunk, 1993), which predicts specific outcomes concerning relationship satisfaction, commitment, and stability, served as the guiding theory behind this effort. Assumptions derived from the theory were tested with couples in three distinct phases of marriage selected from the first wave of the National Survey of Families and Households (Sweet, Bumpass, & Call, 1988). Short-term couples consisted of husbands and wives married between 4 and 6 years, intermediate couples consisted of those married between 20 and 25 years, and long-term couples consisted of those married 45 years or more. Couples were compared with regard to four specific aspects of their relationships: conflict frequency, conflict resolution, satisfaction, and perceptions of the quality of alternatives to their current marriages. Data generated from spouses' averaged scores were analyzed using a series of one-way ANOVAs and paired t-tests. Results from this sample of respondents clearly revealed that long-term couples engaged in less conflict, utilized different conflict resolution strategies, were more satisfied with their marriages, and perceived alternatives to their relationships as less favorable than younger couples. In addition, when husbands' and wives' scores on the above measures were compared, long-term couples exhibited fewer differences than younger couples. Findings from this study are discussed in light of existing research and theory. / Ph. D.

We propose a framework for managing changes in Long term Composed Services (LCSs). The key components of the proposed framework include a Web Service Change Management Language (SCML), change enactment, and change optimization. The SCML is a formal language to specify top-down changes. It is built upon a formal model which consists of a Web service ontology and a LCS schema. The Web service ontology gives a semantic description on the important features of a service, including functionality, quality, and context. The LCS schema gives a high-level overview of a LCS's key features. A top-down change is specified as the modification of a LCS schema in the first place. Change enactment is the process of reacting to a top-down change. It consists of two subcomponents, including change reaction and change verification. The change reaction component implements the proposed change operators by modifying a LCS schema and the membership of Web services. The change verification component ensures that the correctness of a LCS is maintained during the process of change reaction. We propose a set of algorithms for the processes of change reaction and verification. The change optimization component selects the Web services that participate in a LCS to ensure that the change has been reacted to in the best way. We propose a two-phase optimization process to select services using both service reputation and service quality. We present a change management system that implements the proposed approaches. We also conduct a set of simulations to assess the performance. / Ph. D.

Yes / Purpose: We develop new quantitative methods to estimate the level of speculation and long-term sustainability of Bitcoin and Blockchain. Design/Methodology/Approach: We explore the practical application of speculative bubble models to cryptocurrencies. We then show how the approach can be extended to provide estimated brand values using data from Google Trends. Findings: We confirm previous findings of speculative bubbles in cryptocurrency markets. Relatedly, Google searches for cryptocurrencies seem to be primarily driven by recent price rises. Overall results are sufficient to question the long-term sustainability of Bitcoin with the suggestion that Ethereum, Bitcoin Cash and Ripple may all enjoy technical advantages relative to Bitcoin. Our results also demonstrate that Blockchain has a distinct value and identity beyond cryptocurrencies - providing foundational support for the second generation of academic work on Blockchain. However, a relatively low estimated long-term growth rate suggests that the benefi ts of Blockchain may take a long time to be fully realised. Originality/value: We contribute to an emerging academic literature on Blockchain and to a more established literature exploring the use of Google data within business analytics. Our original contribution is to quantify the business value of Blockchain and related technologies using Google Trends.

An initial public offering (IPO) represents a significant event in a firm’s lifecycle, marking the transition from being a privately held company to a publicly traded entity by offering its shares to the public for the first time. Several previous studies have shown that, from an investor point of view, IPOs posits the opportunity to earn substantial return, and that they also tend to underperform long-term. In recent years, stock market volatility has fluctuated considerably due to factors such as the global pandemic and geopolitical conflicts. These factors have led to varying stock market returns, affecting individuals' savings. Additionally, the number of investors in Sweden has grown substantially over the past decade. This, combined with the relatively unexplored nature of market volatility in IPO research, has laid the foundation for this study's focus. Therefore, the purpose of this study is to assess the impact market volatility has on the initial return and the long-term risk-adjusted return of IPOs in Sweden.  To fulfill this purpose, analyses have been undertaken to investigate the relationship between IPO short- and long-term returns and market volatility between 2019 and 2022. This timeframe encapsulates two years experiencing low market volatility (2019 and 2021), and two years experiencing higher market volatility (2020 and 2022). The data sample consists of 165 firms when measuring short-term returns, and 162 firms when measuring long-term returns, who have all had their IPO within this timeframe and are all listed on the Swedish stock market. To further contribute to the literature, the study incorporates the Efficient Market Hypothesis (EMH), Prospect Theory, and the Winner´s Curse Theory. These are three well-established and contrasting theories within IPO research which are introduced to see how well their perspectives align with the study's findings.  The empirical results from the statistical analyses showed varied outcomes. While a statistically significant difference could be identified between certain years, the majority did not. Since the majority of the tests conducted could not find a significant difference in return between high and low volatile years, market volatility at the time of an IPO does not significantly influence the return. Consequently, the findings suggest that employing an investment strategy that involves investing in IPOs based on market volatility levels is not superior to other strategies. These findings give investors deeper insights into how IPOs and their timing are influenced by market conditions and can therefore aid them in making more informed decisions.

This theory-driven thesis explores the notably low levels of brand trust in Sweden through the lens of digitalization. Employing qualitative research methods, the authors conducted eight interviews with experienced experts in Sweden's marketing and communication sector. The study aims to provide an expert view on the current state of consumer trust and the factors contributing to mistrust. The study intends to identify effective strategies for building brand reliability and brand intentions, collectively fostering long-term brand trust, all from the digitalization perspective.  The results show that the rise of digitalization has contributed to lower trust in brands, identifying several reasons behind this mistrust, all connected to digitalization. Six strategies are identified as effective ways for brands to increase long-term brand trust. More specifically, email marketing, data privacy, and brand communities are shown to enhance brand reliability. Whereas trust recovery, ethical marketing, and influencer marketing enhance brand intentions. This is portrayed in a re-conceptualized framework based on an already established conceptual framework, showing how brand reliability and brand intentions collectively creates brand trust. This thesis contributes to the existing literature by offering a detailed analysis of the mistrust in brands and presents strategies to address this issue within the Swedish market by fostering long-term brand trust.

No / Within care organizations, “people with dementia” are often labeled as a homogenous group with little differentiating them from each other. This can mark them out as separate from and less capable than those without dementia. When individuals with dementia are described, understood, and related to in terms of their diagnosis, individuality may get lost. In this article, we seek to unsettle the socially constructed boundary between “people with dementia” and people without dementia. This is explored in the context of fieldwork we undertook as part of a Participatory Video project where we worked alongside people with a dementia diagnosis to co-create short films about their interests and concerns. In the process of this work, we found that alternative unities emerged between ourselves and people with dementia, as the dementia label faded into the and the person, with all his or her diverse interests and life experiences, came to the fore. We found ourselves building rapport and making connections with our research participants, a diverse group of individuals whose life experiences, outlooks, and experiences were simultaneously unique to them but also shared in many ways between themselves, and with us. As we spent time with participants in the communal lounge, in the adjoining day center, walking the hallways, out in the garden, or in individual apartments when invited, we found that people shared a wealth of information with us: about how they were feeling, things they liked, things they had done, instances of trauma, as well as some of their happiest times.

Yes / Film-making is an effective way of engaging people with dementia and improving their well-being. Andrea Capstick and colleagues explain how ‘participatory video’ gave one group an opportunity to tell their own story in film.

Yes / Aims To examine frontline staff acceptance of telehealth and identify barriers to and enablers of successful adoption of remote monitoring for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. The use of telehealth in the UK has not developed at the pace and scale anticipated by policy. Many existing studies report frontline staff acceptance as a key barrier, however data are limited and there is little evidence of the adoption of telehealth in routine practice. Design Case studies of four community health services in England that use telehealth to monitor patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods Thematic analysis of qualitative interviews with 84 nursing and other frontline staff; and 21 managers and key stakeholders; data collected May 2012–June 2013. Findings Staff attitudes ranged from resistance to enthusiasm, with varied opinions about the motives for investing in telehealth and the potential impact on nursing roles. Having reliable and flexible technology and dedicated resources for telehealth work were identified as essential in helping to overcome early barriers to acceptance, along with appropriate staff training and a partnership approach to implementation. Early successes were also important, encouraging staff to use telehealth and facilitating clinical learning and increased adoption. Conclusions The mainstreaming of telehealth hinges on clinical ‘buy-in’. Where barriers to successful implementation exist, clinicians can lose faith in using technology to perform tasks traditionally delivered in person. Addressing barriers is therefore crucial if clinicians are to adopt telehealth into routine practice. / Technology Strategy Board and the Economic and Social Research Council

Family and friends provide substantial daily assistance to older adults with disabilities, but little is known about how that caregiving impacts the health of older adults. Using survey data on a nationally-representative sample of older adults and their caregivers, matched with Medicare claims, I explored several aspects of the relationship between caregiving and the health of older adults receiving care. I relied largely on Andersen’s behavioral model, which describes health services use as a product of predisposing, enabling, and need characteristics. I found that 33%-37% of older adults with unmet care needs at one point in time still have them one year later. I also found frequent change in the composition of older adults’ networks of caregivers. Having a formal caregiver was associated with lower odds of unmet care needs for women; conversely, men receiving care from a spouse had three times lower odds of unmet care needs than those receiving care from a non-spousal caregiver. Some caregivers use services such as respite care, training, and support groups, but some caregivers lack access to desired services. I found that caregivers reporting unmet service need were more likely to be Black and Hispanic, while service use was higher among caregivers providing help on a regular schedule. Care-recipient health and function was associated with both service use and unmet service need, but available measures of local caregiver service supply were not. Older adults frequently seek care in emergency departments (EDs), but this care may not always be necessary or desirable. I hypothesized, but did not find, that caregiver service use was associated with care-recipient ED use. Instead, chronic health conditions and other need factors were the strongest predictors of ED use. I found that care-recipients of male caregivers had lower rates of ED utilization for reasons that were urgent and not preventable. I also found that care-recipients of adult children had lower rates of non-urgent ED utilization than care-recipients of more distantly-related or unrelated caregivers. These findings suggest that unmet care needs might be reduced by improving access to formal care for older women with functional limitations and monitoring unmarried older men. In addition, improving service access for Black and Hispanic caregivers, and for caregivers who provide unscheduled care, could reduce caregivers’ unmet service need. Finally, targeting training and support services to male spousal caregivers could improve access both to needed daily care and to emergency care. Future research should focus on replicating these analyses after more data become available and on developing alternate measures of caregiver service supply.