Towards optimal care in inflammatory bowel disease:Thiopurines, tofacitinib and impact on working life

In this thesis, we aimed for further optimization of IBD care by evaluating efficacy and safety of ‘old’ and ‘new’ oral immunomodulators (thiopurines and tofacitinib) and by focusing on the disease impact on working life. Optimized mercaptopurine treatment based on therapeutic drug monitoring (TDM) is superior to placebo to achieve combined clinical remission and endoscopic improvement in ulcerative colitis (UC) patients after one year. TDM did not prevent drug-related adverse events or drug withdrawal. Thiopurine methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15) gene polymorphisms and high levels of 6-thioguanine nucleotides (6-TGN) and 6-methylmercaptopurine (6-MMP) are associated with development of thiopurine-induced leukopenia. In a ‘real-world’ cohort, tofacitinib leads to corticosteroid-free clinical remission and endoscopic improvement in 39% of UC patients after one year. The tofacitinib safety profile is acceptable given its efficacy in this refractory population. In the majority of UC patients, tofacitinib reduces histological inflammation and induces a substantial decline of total STAT1, STAT3 and STAT5 expression in colonic mucosa. Low STAT1 expression after treatment is associated with tofacitinib response and presumably reflects the degree of histological inflammation. High JAK2 baseline expression seem associated with tofacitinib non-response.Over half of the IBD patients report work productivity loss, predominantly caused by ‘on-the-job’ productivity loss (presenteeism). Fatigue is the most frequently reported reason for work productivity loss by IBD patients. Reduced health-related quality of life (HRQL) and fatigue lead to increased work productivity loss and considerable indirect healthcare costs. IBD-related problems negatively influence quality of working life (QWL). Fatigue, reduced HRQL and work productivity loss are associated with declined QWL

The sound of violets: the ethnographic potency of poetry?

This paper takes the form of a dialogue between the two authors, and is in two halves, the first half discursive and propositional, and the second half exemplifying the rhetorical, epistemological and metaphysical affordances of poetry in critically scrutinising the rhetoric, epistemology and metaphysics of educational management discourse. Phipps and Saunders explore, through ideas and poems, how poetry can interrupt and/or illuminate dominant values in education and in educational research methods, such as: • alternatives to the military metaphors – targets, strategies and the like – that dominate the soundscape of education; • the kinds and qualities of the cognitive and feeling spaces that might be opened up by the shifting of methodological boundaries; • the considerable work done in ethnography on the use of the poetic: anthropologists have long used poetry as a medium for expressing their sense of empathic connection to their field and their subjects, particularly in considering the creativity and meaning-making that characterise all human societies in different ways; • the particular rhetorical affordances of poetry, as a discipline, as a practice, as an art, as patterned breath; its capacity to shift phonemic, and therewith methodological, authority; its offering of redress to linear and reductive attempts at scripting social life, as always already given and without alternative

“Savages Who Speak French”: Folklore, Primitivism and Morals in Robert Hertz

Hertz's analysis of the Alpine cult of Saint Besse apparently marks a break from his studies of death, sin and the left to folkloric studies. This analysis helps one to understand the personality of Robert Hertz. His sociological curiosity about folklore reveals his ambiguous position in social sciences at the beginning of the twentieth century. His text appears to be a variation from the Durkheimian norm, but another reading could suggest that Hertz continued and went beyond Durkheimian thought to something between sociology of the modern world and engaged socialism. Through this study, Hertz linked his political ideals, his work in ethnology and his desire for social involvement. The cult of Saint Besse perpetuated as much religious tradition as local identity. The Alpine people were presented in the text as wilful perpetuators of an ideal social order, whose loss for his contemporary city dwellers Hertz feared. The alpine Other, marked by a material and moral backwardness, represented for activist and socialist Hertz one of the paths of balanced social organization that stabilized the identity of a group across time if it fit rather well into the folkloric stereotypes of the beginning of the twentieth century. Finally, by linking events in Herz's life (e.g., the accidental Alpine death of his father), this article suggests that the legend of Saint Besse embodied several recurring motifs in Hertz' career: the accidental deaths of saint and father by falls, the military role of the saint and of Hertz himself

From paradox to pattern shift: Conceptualising liminal hotspots and their affective dynamics

This article introduces the concept of liminal hotspots as a specifically psychosocial and sociopsychological type of wicked problem, best addressed in a process-theoretical framework. A liminal hotspot is defined as an occasion characterised by the experience of being trapped in the interstitial dimension between different forms-of-process. The paper has two main aims. First, to articulate a nexus of concepts associated with liminal hotspots that together provide general analytic purchase on a wide range of problems concerning “troubled” becoming. Second, to provide concrete illustrations through examples drawn from the health domain. In the conclusion, we briefly indicate the sense in which liminal hotspots are part of broader and deeper historical processes associated with changing modes for the management and navigation of liminality

Stigma narratives: LGBT transitions and identities in Malta

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 A B Academic Publishers.This article considers narratives of transition experiences of a group of Lesbian, Gay, Bisexual and Transgender (LGBT) young people in Malta. The article draws on Goffman's concept of stigma and uses this to explore transitions in a society that retains some traditional characteristics, particularly the code of honour and shame, although mediated by aspects of modernity. Interviews were undertaken with 15 young people with the goal of producing narratives. The article analyses the experience of stigma, its effects and how young people manage its consequences. It concludes by drawing attention to the pervasive nature of stigma and the importance of structure, agency and reflexivity in youth transitions. In particular stigma remains an important feature of societies in which hetero-normative sexuality remains dominant

Using liminality to understand mothers’ experiences of long-term breastfeeding: ‘Betwixt and between’, and ‘matter out of place’

© 2015, © The Author(s) 2015. Breastmilk is widely considered as the optimum nutrition source for babies and an important factor in both improving public health and reducing health inequalities. Current international/national policy supports long-term breastfeeding. UK breastfeeding initiation rates are high but rapidly decline, and the numbers breastfeeding in the second year and beyond are unknown. This study used the concept of liminality to explore the experiences of a group of women breastfeeding long-term in the United Kingdom, building on Mahon-Daly and Andrews. Over 80 breastfeeding women were included within the study, which used micro-ethnographic methods (participant observation in breastfeeding support groups, face-to-face interviews and online asynchronous interviews via email). Findings about women’s experiences are congruent with the existing literature, although it is mostly dated and from outside the United Kingdom. Liminality was found to be useful in providing insight into women’s experiences of long-term breastfeeding in relation to both time and place. Understanding women’s experience of breastfeeding beyond current usual norms can be used to inform work with breastfeeding mothers and to encourage more women to breastfeed for longer

Learning at the Interstices; Locating Practical Philosophies for Understanding Physical/virtual Inter-spaces

Virtual worlds are relatively recent developments, and so it is tempting to believe that they need to be understood through newly developed theories and philosophies. However, humans have long thought about the nature of reality and what it means to be “real.” This paper examines the three persistent philosophical concepts of Metaxis, Liminality and Space that have evolved across more than 2000 years of meditation, contemplation and reflection. Our particular focus here is on the nature of the interface between the virtual and the physical: at the interstices, and how the nature of transactions and transitions across those interfaces may impact upon learning. This may, at first, appear to be an esoteric pursuit, but we ground our arguments in primary and secondary data from research studies in higher education

Liminal Roles as a Source of Creative Agency in Management: The Case of Knowledge-Sharing Communities

Studies suggest that the experience of liminality – of being in an ambiguous, ‘betwixt and between’ position – has creative potential for organizations. We contribute to theory on the link between liminality and creative agency through a study of the coordinators of ‘knowledge-sharing communities’; one of the latest examples of a ‘neo-bureaucratic’ practice that seeks to elicit innovative responses from employees while intensifying control by the organization. Through a role-centred perspective, our study found that both the structural and interpretive aspects of coordinators’ role enactments promoted a degree of creative agency. ‘Front-stage’ and ‘back-stage’ activities were developed to meet the divergent expectations posed by senior management and community members, and the ambiguity of their roles prompted an array of different role interpretations. Our findings contribute to theory by showing how the link between liminality and creative agency is not confined to roles and spaces (consultancy work, professional expertise) that are positioned across organizational boundaries, or free from norms and expectations, but may also apply to roles that are ambiguously situated within organizational contexts and which are subject to divergent expectations. This shows how neo-bureaucratic forms may be both reproduced and renewed through the creative responses of individual managers

Liminal entrepreneuring : the creative practices of nascent necessity entrepreneurs

This paper contributes to creative entrepreneurship studies through exploring ‘liminal entrepreneuring’, i.e., the organization-creation entrepreneurial practices and narratives of individuals living in precarious conditions. Drawing on a processual approach to entrepreneurship and Turner’s liminality concept, we study the transition from un(der)employment to entrepreneurship of 50 nascent necessity entrepreneurs (NNEs) in Spain, the United Kingdom, and Ireland. The paper asks how these agents develop creative entrepreneuring practices in their efforts to overcome their condition of ‘necessity’. The analysis shows how, in their everyday liminal entrepreneuring, NNEs disassemble their identities and social positions, experiment with new relationships and alternative visions of themselves, and (re)connect with entrepreneuring ideas and practices in a new way, using imagination and organization-creation practices to reconstruct both self and context in the process. The results question and expand the notion of entrepreneuring in times of socioeconomic stress