Alan N. Martin

Agent chameleons: agent minds and bodies

Agent design has to date concerned itself with the issues pertaining to a single body embedded in a single environment, whether virtual or real. This paper discusses the notion of an agent capable of migrating between information spaces (physical worlds, virtual reality, and digital information spaces). An architecture is presented that facilitates agent migration and mutation within such environments. This will in turn support agent evolution the ultimate in agent adaptivity.

PCR ribotype prevalence and molecular basis of macrolide–lincosamide–streptogramin B (MLSB) and fluoroquinolone resistance in Irish clinical Clostridium difficile isolates

BACKGROUND Antimicrobial use is recognized as a risk factor for Clostridium difficile infection (CDI) and outbreaks. We studied the relationship between PCR ribotype, antimicrobial susceptibility and the genetic basis of resistance in response to exposure to antimicrobial agents. METHODS C. difficile isolates were cultured from 133 CDI patients for whom recent antimicrobial drug exposure had been recorded. Isolates were ribotyped by PCR and assessed for their susceptibility to the macrolide-lincosamide-streptogramin B (MLS(B)) group of compounds (erythromycin and clindamycin) and fluoroquinolone antimicrobials (ciprofloxacin, levofloxacin and moxifloxacin). Where relevant, the genetic basis of resistance was determined. RESULTS Prevalent ribotypes (including 027, 001 and 106) exhibited significantly greater antimicrobial resistance compared with ribotypes 078 and 014, among others. Clindamycin-resistant ribotype 078 was detected for the first time. Ribotypes 027 and 001 were more likely to exhibit MLS(B) resistance, a feature that was associated with the erm(B) gene. Exposure to MLS(B) or fluoroquinolone antimicrobial compounds in the 8 weeks prior to the onset of infection was not associated with specific genetic markers of resistance. Single amino acid substitutions in the A and B subunits of DNA gyrase were noted and were ribotype specific and linked to resistance to moxifloxacin. CONCLUSIONS Resistance to MLS(B) and fluoroquinolone antimicrobial compounds is common among prevalent ribotypes of C. difficile. The genetic basis for antimicrobial resistance appears to be ribotype specific and conserved in the absence of recent antimicrobial selection pressure.

Bus catcher: a context sensitive prototype system for public transportation users

In this paper we describe the architectural andfunctional characteristics of Bus Catcher, a contextsensitive prototype system for public transportation users.Bus Catcher assists mobile users in planning their busrides by providing timely and accurate information aboutcurrent bus locations and estimated arrival times. Acomplete report on the implementation together with apreliminary evaluation of the system is provided in thispaper.

Maintaining the identity of dynamically embodied agents

Virtual agents are traditionally constrained in their embodiment, as they are restricted to one form of body. We propose allowing them to change their embodiment in order to expand their capabilities. This presents users with a number of difficulties in maintaining the identity of the agents, but these can be overcome by using identity cues, certain features that remain constant across embodiment forms. This paper outlines an experiment that examines these identity cues, and shows that they can be used to help address this identity problem.

Agent Chameleons: Virtual Agents Real Intelligence

Agent Chameleons provides virtual agents powered by real intelligence, delivering next generation autonomic entities that can seamlessly migrate, mutate and evolve on their journey between and within physical and digital information spaces.

An Investigation of the Subtype Diversity of Clinical Isolates of Irish Clostridium Difficile Ribotypes 027 and 078 by Repetitive-Extragenic Palindromic PCR

A repetitive-extragenic palindromic PCR (rep-PCR) subtyping method (DiversiLab) in conjunction with ribotyping, toxinotyping and antimicrobial-susceptibility testing was used to detect subtypes within Clostridium difficile ribotypes 027 and 078. Clinical isolates of ribotypes 027 (toxinotype III) (n = 30) and 078 (toxinotype V) (n = 23) were provided by health-care facilities across the Republic of Ireland over 2 months in 2006 and 1 month in 2009. Ribotype 027 isolates were significantly more related to each other (9 different subtype profiles) when compared to ribotype 078 isolates (14 different profiles) (P = 0.001; cut-off >90 % similarity). Almost half of ribotype 078 isolates (45.5 %) showed no relationship to each other. The clonality of ribotype 027 isolates suggests effective adaptation to the human niche, whereas the considerable genetic diversity within ribotype 078 isolates suggests that they may have originated from a variety of sources. Subtyping correlated well with antimicrobial susceptibility, in particular clindamycin susceptibility for ribotype 027, but diverse antimicrobial-susceptibility profiles were seen in ribotype 078 isolates, even within a single health-care facility. Between 2006 and 2009, a change in the predominant subtype of ribotype 027 was seen, with the recent clone representing half of all ribotype 027 isolates studied. This strain exhibited 89 % similarity to a rep-PCR profile of the North American NAP-1 strain.

Future reasoning machines: mind and body

Purpose – In investing energy in developing reasoning machines of the future, one must abstract away from the specific solutions to specific problems and ask what are the fundamental research questions that should be addressed. This paper aims to revisit some fundamental perspectives and promote new approaches to reasoning machines and their associated form and function.Design/methodology/approach – Core aspects are discussed, namely the one‐mind‐many‐bodies metaphor as introduced in the agent Chameleon work. Within this metaphor the agents embodiment form may take many guises with the artificial mind or agent potentially exhibiting a nomadic existence opportunistically migrating between a myriad of instantiated embodiments. The paper animates these concepts with reference to two case studies.Findings – The two case studies illustrate how a machine can have fundamentally different capabilities than a human which allows us to exploit, rather than be constrained, by these important differences.Originality/...

294Working Differently to Greatly Improve Care for Frail Patients Attending the Emergency Department

Background: Recognising the often complex medical, functional and social care needs of frail older patients presenting to the Emergency Department provided the impetus to improve the care model at the front door. In line with best practice, the principles of A) early identification of need and B) early initiation of treatment were adopted by establishing the Frail Intervention Therapy (FIT) Team in the Emergency Department (ED). The team comprises Physiotherapy, Occupational Therapy, Medical Social Work, Speech & Language Therapy, Dietetics and Pharmacy. Following an interdisciplinary approach to care, within one hour of presentation to the ED, the team assesses all patients over 75 years to determine their treatment needs and the appropriate care pathway. Methods: The team developed a common screening tool to identify the appropriate care pathway i.e. admission or discharge. Working with medical and nursing colleagues, patients deemed suitable for admission are fast-tracked to the Specialist Geriatric Ward or alternatively, those appropriate for discharge are offered follow-up home therapy. Results: Patients suitable for admission receive therapy from the FIT team on their day of presentation. Once admitted, handover is provided to the in-patient Health and Social Care Professional team, thereby avoiding delays thus leading to better outcomes, including reduced readmissions, reduced long term care and lower costs. Encouragingly, in 2016, early initiation of treatment led to a 33% increase in patients being discharged home rather than converting to long-term care. Furthermore, during a five month period in 2016, 6% of patients (55 patients) were successfully discharged and maintained at home (at 30 days), saving over 800 bed days. Conclusions: This successful model has been replicated nationally in 2017. Furthermore, the outreach model has been instrumental in informing the design of the National Integrated Care Teams due for establishment this year supported by the Integrated Older Persons’ Clinical Care Programme.

078A Study of the Prevalence and Appropriateness of Proton Pump Inhibitor Prescriptions in an Irish Nursing Home Cohort

Background: Proton pump inhibitors (PPIs) are effective treatments for gastrointestinal symptoms and diseases. Evidence suggests PPIs are often prescribed inappropriately. Recent pharmacoepidemiological research has associated PPI use with an increased risk of dementia. A large-scale study of PPI use in nursing homes reported 27% of residents were taking a PPI. 49% of these prescriptions did not have an evidence based indication [1]. Our aim was to investigate the prevalence and appropriateness of PPI prescriptions in an Irish nursing home cohort. Methods: The data for this nested cohort study was collected as part of research into bowel colonisation with clinically significant bacteria in nursing home patients. The patients’ medical record and drug chart were reviewed. Prescriptions for PPIs were recorded with the name, dose and regimen. An indication for the PPI therapy in line with the drugs summary of product characteristics was sought and recorded. Results: 86 nursing home residents were included in the data collection representing 87% of the resident population. The average age was 84 years old. 57% of patients were prescribed a proton pump inhibitor with lansoprazole being the most commonly prescribed. 59% of these did not have an identifiable indication. The most common indications were treatment of peptic ulcer disease (PUD) and gastro-oesophageal reflux disease (35% each). Conclusion: While more than half of the nursing home patients in this study were prescribed a PPI, the majority did not have a recognised indication. A brief assessment of each resident’s requirement for a PPI would enable more accurate PPI prescribing, possibly avoiding unnecessary adverse effects. Reference 1. Rane P et al. Prevalence and predictors of non-evidence based proton pump inhibitor use among elderly nursing home residents in the US. Research in Social and Administrative Pharmacy 2016; 13: 358–363.