Applying a perceptions and practicalities approach to understanding nonadherence to antiepileptic drugs

Summary Objective Nonadherence to antiepileptic drugs (AEDs) is a common cause of poor seizure control. This study examines whether reported adherence to AEDs is related to variables identified in the National Institute for Health and Clinical Excellence (NICE) Medicines Adherence Guidelines as being important to adherence: perceptual factors (AED necessity beliefs and concerns), practical factors (limitations in capability and resources), and perceptions of involvement in treatment decisions. Methods This was a cross-sectional study of people with epilepsy receiving AEDs. Participants completed an online survey hosted by the Epilepsy Society (n = 1,010), or as an audit during inpatient admission (n = 118). Validated questionnaires, adapted for epilepsy, assessed reported adherence to AEDs (Medication Adherence Report Scale [MARS]), perceptions of AEDs (Beliefs about Medicines Questionnaire [BMQ]), and patient perceptions of involvement in treatment decisions (Treatment Empowerment Scale [TES]). Results Low adherence was related to AED beliefs (doubts about necessity: t(577) = 3.90, p < 0.001; and concerns: t(995) = 3.45, p = 0.001), reported limitations in capability and resources (t(589) = 7.78, p < 0.001), and to perceptions of a lack of involvement in treatment decisions (t(623) = 4.48, p < 0.001). In multiple logistic regression analyses, these factors significantly (p < 0.001) increased variance in reported adherence, above that which could be explained by age and clinical variables (seizure frequency, type, epilepsy duration, number of AEDs prescribed). Significance Variables identified in the NICE Medicines Adherence Guidelines as potentially important factors for adherence were found to be related to adherence to AEDs. These factors are potentially modifiable. Interventions to support optimal adherence to AEDs should be tailored to address doubts about AED necessity and concerns about harm, and to overcome practical difficulties, while engaging patients in treatment decisions

Labour market experiences of young UK Bangladeshi men: Identity, inclusion and exclusion in inner-city London

Detailed qualitative data are used to explore the processes perpetuatinglabour market disadvantage among young UK-Bangladeshi men living in central London. Strong forces of inclusion within the Bangladeshi community are found to interact with forces of exclusion from ‘mainstream’ society to constrain aspirations and limit opportunities. Though diverse forms of young Bangladeshi masculinity are found, a common pattern is heavy dependency on intra-ethnic networks. Negative experiences of and isolation from ‘mainstream’ society further reinforce reliance on ‘our own people’. However, acute ambivalence towards belonging to a dense Bangladeshi community exists, exemplified in the widespread denigration of the restaurant trade. Many respondents express the desire to ‘break out’ and access new experiences. The findings support current policy emphasis on ‘connecting people to work’ but highlight the more fundamental need to connect people across ethnic boundaries. The paper urges researchers to ‘unpack’ ethnicity to consider carefully what ethnic identity implies in terms of access to resources and opportunities for different individuals in different contexts in order better to understand the diversity of labour market outcomes and the persistence of disadvantage

Global unions: chasing the dream or building the reality?

This article takes as its theme the global restructuring of capital and its impact on worker organization. It argues for a reassertion of class in any analysis of global solidarity, and assesses the opportunities and barriers to effective global unionization. Rooted in the UK experience, the article analyzes the impact of the European social dimension on trade unions, before taking the discussion into a global dimension. It concludes by suggesting that there are reasons for cautious optimism in terms of solidarity building, despite difficult historical legacies and the common replacement of action with rhetoric

Stereotactic ablative body radiotherapy for the treatment of spinal oligometastases

Abstract not availableJ.H. Chang, S. Gandhidasan, R. Finnigan, D. Whalley, R. Nair, A. Herschtal, T. Eade, A. Kneebone, J. Ruben, M. Foote, S. Siv

Dose reconstruction including dynamic six-degree of freedom motion during prostate radiotherapy

© Published under licence by IOP Publishing Ltd. An in-house developed program for real-time reconstruction of motion-induced dose errors, DoseTracker, was extended to handle rotational target motion in addition to the previously implemented translational motion, and applied offline for prostate VMAT treatments. For translational motion, the motion-induced errors of DoseTracker were in good agreement with ground truth dose reconstructions performed in a commercial treatment planning system. For rotational motion, no ground truth was available, but DoseTracker showed that the VMAT dose is highly robust against static interfractional rotations but quite sensitive to dynamic intrafraction rotations due to interplay effects between target motion and machine motion

Luminous infrared galaxies as possible sources of the UHE cosmic rays

Ultra High Energy (UHE) particles coming from discrete extragalactic sources are potential candidates for EAS events above a few tens of EeV. In particular, galaxies with huge infrared luminosity triggered by collision and merging processes are possible sites of UHECR acceleration. Using the PSCz catalogue of IR galaxies we calculate a large scale anisotropy of UHE protons originating in the population of the luminous infrared galaxies (LIRGs). Small angle particle scattering in weak irregular extragalactic magnetic fields as well as deflection by regular Galactic field are taken into account. We give analytical formulae for deflection angles with included energy losses on cosmic microwave background (CMB). The hypotheses of the anisotropic and isotropic distributions of the experimental data above 40 EeV from AGASA are checked, using various statistical tests. We show that on the basis of the small scale clustering analysis there is a much better correlation of the UHECRs data below GZK cut-off with the predictions of the LIRG origin than with those of isotropy. We derive analytical formulae for a probability of a given number of doublets, triplets and quadruplets for any density distribution of independent events on the sky. The famous AGASA UHE triple event is found to be very well correlated on the sky with the brightest extragalactic infrared source within 70 Mpc - merger galaxies Arp 299 (NGC 3690 + IC 694).Comment: 17 pages, 10 figures, accepted for publ: Journal of Physics

Co-designing drug alerts for health and community workers for an emerging early warning system in Victoria, Australia

Background: Alerts about changes in unregulated drug markets may be useful for supporting health and community workers to anticipate, prevent, and respond to unexpected adverse drug events. This study aimed to establish factors influencing the successful design and implementation of drug alerts for use in clinical and community service settings in Victoria, Australia. Methods: An iterative mixed methods design was used to co-produce drug alert prototypes with practitioners and managers working across various alcohol and other drug services and emergency medicine settings. A quantitative needs-analysis survey (n = 184) informed five qualitative co-design workshops (n = 31). Alert prototypes were drafted based on findings and tested for utility and acceptability. Applicable constructs from the Consolidated Framework for Implementation Research helped to conceptualise factors that impact successful alert system design. Results: Timely and reliable alerts about unexpected drug market changes were important to nearly all workers (98%) yet many reported insufficient access to this kind of information (64%). Workers considered themselves ‘conduits’ for information-sharing and valued alerts for increasing exposure to drug market intelligence; facilitating communication about potential threats and trends; and improving capacity for effective responding to drug-related harm. Alerts should be ‘shareable’ across a range of clinical and community settings and audiences. To maximise engagement and impact, alerts must command attention, be easily recognisable, be available on multiple platforms (electronic and printable formats) in varying levels of detail, and be disseminated via appropriate notification mechanisms to meet the needs of diverse stakeholder groups. Three drug alert prototypes (SMS prompt, summary flyer, and a detailed poster) were endorsed by workers as useful for supporting their work responding to unexpected drug-related harms. Discussion: Alerts informed by coordinated early warning networks that offer close to real-time detection of unexpected substances can provide rapid, evidence-based drug market intelligence to inform preventive and responsive action to drug-related harm. The success of alert systems requires adequate planning and resourcing to support design, implementation, and evaluation, which includes consultation with all relevant audiences to understand how to maximise engagement with information, recommendations, and advice. Our findings about factors impacting successful alert design have utility to inform the development of local early warning systems

Automated parametric neutronics analysis of the Helium Cooled Pebble Bed breeder blanket with Be₁₂Ti

The Helium Cooled Pebble Bed (HCPB) breeder blanket is being developed as part of the European Fusion Programme. Part of the programme is to investigate blanket designs relevant for future demonstration fusion power plants. This paper presents neutronics analyses of the HCPB with an alternative neutron multiplier, Be12Ti which is incorporated into the design, replacing the current Be multiplier. A parameter study was performed for a range of geometries to identify the optimal heights of the lithium ceramic and neutron multiplier pebble beds. Automated creation of CAD models followed by conversion to constructive solid geometry (CSG) and unstructured mesh (UM) geometry allows the models to be useful for both neutronics simulations and engineering simulations. In this neutronics study simulations were performed using MCNP 6.1 to find the tritium breeding ratio, energy multiplication and the volumetric heat loads of different blanket designs. Combinations of geometry parameters and material choices that resulted in adequate TBR values were identified and will be further investigated with automated engineering simulations. This paper provides insight, supported by neutronics analysis, on the validity of the design and comments on some of the potential advantages and disadvantages of using Be12Ti in the Helium Cooled Pebble Bed (HCPB) breeder blanket. Blankets with Be12Ti neutron multiplier were found to produce less tritium but higher energy multiplication when compared to blankets with Be neutron multiplier

Exploring attitudes to edgy urban destinations: the case of Deptford, London

The role of tourists and tourism in urban development is not fully understood. Research has focused on tourism districts within city centres, but less is known about tourism in peripheral, less affluent urban districts. These areas can appeal to visitors as edgy alternatives to mainstream destinations. This study establishes who is interested in visiting and why, and it explores the underlying rationale for negative attitudes. The aims are addressed by an in-depth analysis of Deptford in South East London. This area is a relatively deprived part of a world city, albeit one that has long been earmarked as London's next cool district. The study uses a mix of different sources to analyse the case. Responses to a New York Times article on Deptford are analysed and the attitudes of actual visitors and key stakeholders are explored. The discussion includes an examination of different interpretations and attitudes towards the notion of edginess. Edginess is deemed attractive by certain audiences; something linked to a reverence for working-class life in the arts. The study concludes that, whilst edginess is a noted characteristic, what people appreciate about Deptford is its ‘distinctive ordinariness’ – its contrast with more polished and contrived urban districts

Social relations in crowds: recognition, validation and solidarity

Social identity research on crowds demonstrates how cognitive self-definition as a crowd member results in conformity to identity-relevant norms. Less research addresses the social-relational changes within a crowd and how these impact collective experience positively. The present study investigates these processes at a month-long mass gathering in India. Analysis of 37 interviews with participants attending the annual Magh Mela pilgrimage evidences the concept of shared identity as underpinning their understanding of this mass gathering. Moreover, a theoretically-derived thematic analysis of these interviews shows the value of the analytic concepts of recognition, validation, and solidarity in illuminating the ways in which social relations in the crowd were experienced and contributed to the experience of the event. Through exploring the multi-dimensional nature of relational connectedness in crowds we contribute to an understanding of crowd experience and group processes