Tumor Necrosis Factor-Alpha Inhibitory Therapy for Non-Infectious Autoimmune Uveitis

Biologic agents represent a mainstay in the treatment of refractory non-infectious, immune-mediated uveitis. Tumor necrosis factor (TNF)-α inhibitors have demonstrated efficacy in inducing and sustaining disease remission in numerous systemic inflammatory disorders and their associated uveitic entities. In particular, studies have shown that infliximab and adalimumab can induce steroid-free disease remission in patients with Behçet’s disease and juvenile arthritis as treatments that are superior to conventional disease-modifying immunosuppressive agents. Patients receiving anti-TNF-α therapy may experience adverse events and should be closely monitored for the development of opportunistic infections, reactivation of tuberculosis and hepatitis, demyelinating disease and neuropathies, as well as malignancies

Anonymisation and visual images: issues of respect, 'voice' and protection

A central ethical issue confronting researchers using visual approaches is how to manage the use of identifiable images. Photographic and other visual materials can make the anonymisation of individuals problematic; at the same time many researchers as well as research participants view image manipulation and anonymisation as undesirable. There may be pressure from a range of stakeholders for images to be anonymised, particularly in relation to research with vulnerable groups, for example children. There are also a range of ethical concerns that need consideration in relation to the use of identifiable images; these include the contexts in which images were produced and may be consumed, the longevity of images in the public domain and the potential for future uses of images. This paper explores the ways in which researchers approach issues of anonymisation in visual research, drawing on a qualitative study of ethical issues in visual research. Focus group discussions and interviews with visual researchers revealed the ongoing challenge of identification and anonymisation. While decisions about visual identification are inevitably complex and situated, our data showed that there is an ongoing tension between, on the one hand, research participants’ rights and researchers’ desire for participants to be seen and heard and, on the other hand, researchers’ real and perceived responsibility to protect participants

第902回千葉医学会例会・第15回歯科口腔外科例会

Questionnaire to survey people with Parkinson’s choice of indoor and outdoor footwear, foot problems and fall history. (DOC 574 kb

Medial longitudinal arch development of school children : The College of Podiatry Annual Conference 2015: meeting abstracts

Background Foot structure is often classified into flat foot, neutral and high arch type based on the variability of the Medial Longitudinal Arch (MLA). To date, the literature provided contrasting evidence on the age when MLA development stabilises in children. The influence of footwear on MLA development is also unknown. Aim This study aims to (i) clarify whether the MLA is still changing in children from age 7 to 9 years old and (ii) explore the relationship between footwear usage and MLA development, using a longitudinal approach. Methods We evaluated the MLA of 111 healthy school children [age = 6.9 (0.3) years] using three parameters [arch index (AI), midfoot peak pressure (PP) and maximum force (MF: % of body weight)] extracted from dynamic foot loading measurements at baseline, 10-month and 22-month follow-up. Information on the type of footwear worn was collected using survey question. Linear mixed modelling was used to test for differences in the MLA over time. Results Insignificant changes in all MLA parameters were observed over time [AI: P = .15; PP: P = .84; MF: P = .91]. When gender was considered, the AI of boys decreased with age [P = .02]. Boys also displayed a flatter MLA than girls at age 6.9 years [AI: mean difference = 0.02 (0.01, 0.04); P = .02]. At baseline, subjects who wore close-toe shoes displayed the lowest MLA overall [AI/PP/MF: P < .05]. Subjects who used slippers when commencing footwear use experienced higher PP than those who wore sandals [mean difference = 31.60 (1.44, 61.75) kPa; post-hoc P = .04]. Discussion and conclusion Our findings suggested that the MLA of children remained stable from 7 to 9 years old, while gender and the type of footwear worn during childhood may influence MLA development. Clinicians may choose to commence therapy when a child presents with painful flexible flat foot at age 7 years, and may discourage younger children from wearing slippers when they commence using footwear

From contracts to service agreements: what can be learned from total purchasing?

Total purchasing is an experimental extension of GP fundholding through which GP practices can purchase community, secondary and tertiary services not included in standard fundholding budgets, for their registered patient populations. The paper presents selected findings from a study of contracting by TPPs during the first year of purchasing, concentrating on the perceived relationship between aspects of the contracting process and the achievement of TPPs’ strategic objectives. These findings are of relevance to the development of commissioning by primary care groups in light of the Government’s proposal that contracts be replaced by long‐term service agreements as competition within the NHS internal market is replaced by more collaborative arrangements between commissioners and providers. The paper identifies features of the contracting process which have been instrumental to the achievement of TPPs’ service development objectives and may need to be preserved to ensure effective commissioning within the context of the new service agreements.</jats:p

A design to investigate the feasibility and effects of partnered ballroom dancing on people with Parkinson disease: randomized controlled trial protocol

Background: self-help and physical leisure activities has become increasingly important in the maintenance of safe and functional mobility among an increasingly elderly population. Preventing the cycle of deterioration, falling, inactivity, dependency, and secondary complications in people with Parkinson disease (PD) is a priority. Research has shown that people with PD are interested in dance and although the few existing trials are small, initial proof of principle trials from the United States have demonstrated beneficial effects on balance control, gait, and activity levels. To our knowledge, there has been no research into long-term effects, cost effectiveness, the influence on spinal posture and turning, or the personal insights of dance participants.Objective: the purpose of this study was to determine the methodological feasibility of conducting a definitive phase III trial to evaluate the benefits of dance in people with PD. We will build on the proof of principle trials by addressing gaps in knowledge, focusing on areas of greatest methodological uncertainty; the choice of dances and intensity of the program; for the main trial, the availability of partners, the suitability of the currently envisaged primary outcomes, balance and spinal posture; and the key costs of delivering and participating in a dance program to inform economic evaluation.Methods: fifty participants (mild-to-moderate condition) will be randomized to the control (usual care) or experimental (dance plus usual care) groups at a ratio of 15:35. Dance will be taught by professional teachers in a dance center in the South of England. Each participant in the experimental group will dance with his or her spouse, a friend, or a partner from a bank of volunteers. A blinded assessor will complete clinical measures and self-reported ability at baseline, and at 3 and 6 months after randomization. A qualitative study of a subgroup of participants and partners will examine user’s views about the appropriateness and acceptability of the intervention, assessment protocol, and general trial procedures. Procedures for an economic evaluation of dance for health care will be developed for the main trial.Results: recruitment began in January 2013 and the last participant is expected to complete the trial follow-up in June 2014.Conclusions: findings from our study may provide novel insights into the way people with PD become involved in dance, their views and opinions, and the suitability of our primary and secondary outcome

The 'international dimension' in social work education: current developments in England

As our awareness of the impact of globalising trends has increased, so too has social work's interest in international issues grown. At the same time, concerns have been raised about what constitutes international social work, and how this 'international dimension' might be introduced to social work students as part of their preparation for practice. This paper reports on a recently completed study which explored the different ways in which international issues are being addressed in social work programmes leading to the newly established three-year degree in social work across the UK. Based on an email survey of accredited programmes in England, plus a small number of follow-up interviews, findings are presented on the different approaches and innovations adopted in the development of curriculum with an international perspective. Discussion focuses on possible factors promoting and/or inhibiting the development of an international dimension within the qualifying curriculum. The paper concludes with some observations on how the different understandings of 'international social work' can contribute to a greater appreciation of global problems and alternative ways of responding to social needs at local, national and international levels

Anonymisation and visual images: issues of respect, 'voice' and protection

A central ethical issue confronting researchers using visual methods is how to manage the use of identifiable images. Photographic and other visual materials can make the anonymisation of individuals problematic; at the same time many researchers, as well as research participants, view image manipulation as undesirable. Anonymisation is one of a range of ethical concerns that need consideration in relation to the use of identifiable images. Other concerns include the contexts in which images were produced and through which they may be consumed; the longevity of images in the public domain and the potential for future uses and secondary analysis of images. This paper explores some of the ways in which researchers specifically approach anonymisation in relation to visual methods, drawing on a qualitative study of ethical issues in visual research. Focus group discussions and interviews with researchers who use visual methods revealed the ongoing challenges of identification and anonymisation. While decisions about visual identification are inevitably complex and situated, our explorations revealed ongoing tensions between, on the one hand, research participants’ rights and researchers’ desire for participants to be seen as well as heard and, on the other hand, researchers’ real and perceived ethical responsibility to safeguard participants