2,132 research outputs found

    Methotrexate polyglutamates as a potential marker of adherence to long-term therapy in children with juvenile idiopathic arthritis and juvenile dermatomyositis:an observational, cross-sectional study

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    Introduction: Methotrexate (MTX) is a cornerstone of treatment in a wide variety of inflammatory conditions, including juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). However, owing to its narrow therapeutic index and the considerable interpatient variability in clinical response, monitoring of adherence to MTX is important. The present study demonstrates the feasibility of using methotrexate polyglutamates (MTXPGs) as a biomarker to measure adherence to MTX treatment in children with JIA and JDM. Methods: Data were collected prospectively from a cohort of 48 children (median age 11.5 years) who received oral or subcutaneous (SC) MTX therapy for JIA or JDM. Dried blood spot samples were obtained from children by finger pick at the clinic or via self- or parent-led sampling at home, and they were analysed to determine the variability in MTXPG concentrations and assess adherence to MTX therapy. Results: Wide fluctuations in MTXPG total concentrations (>2.0-fold variations) were found in 17 patients receiving stable weekly doses of MTX, which is indicative of nonadherence or partial adherence to MTX therapy. Age (P = 0.026) and route of administration (P = 0.005) were the most important predictors of nonadherence to MTX treatment. In addition, the study showed that MTX dose and route of administration were significantly associated with variations in the distribution of MTXPG subtypes. Higher doses and SC administration of MTX produced higher levels of total MTXPGs and selective accumulation of longer-chain MTXPGs (P < 0.001 and P < 0.0001, respectively). Conclusions: Nonadherence to MTX therapy is a significant problem in children with JIA and JDM. The present study suggests that patients with inadequate adherence and/or intolerance to oral MTX may benefit from SC administration of the drug. The clinical utility of MTXPG levels to monitor and optimise adherence to MTX in children has been demonstrated. Trial registration: ISRCTN Registry identifier: ISRCTN93945409. Registered 2 December 2011

    'You can't just put somebody in a situation with no armour'. An ethnographic exploration of the training and support needs of homecare workers caring for people living with dementia

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    BACKGROUND: Homecare workers carry out complex work with people living with dementia, while under-supported, undervalued and undertrained. In this ethnographic study, we explore the skills, training and support needs of homecare workers supporting people living with dementia. RESEARCH DESIGN AND METHODS: We conducted 82 interviews with people living with dementia (n = 11), family caregivers (n = 22), homecare staff (n = 30) and health and social care professionals (n = 19) and conducted 100-hours of participant observations with homecare workers (n = 16). We triangulated interview and observational findings and analysed data thematically. RESULTS: We developed four themes: 1) 'Navigating the homecare identity and role': describing challenges of moving between different role identities and managing associated expectations, 2) 'Developing and utilising relational and emotional skills': boundaries between caring and getting emotionally involved felt blurred and difficult to manage, 3) 'Managing clients who resist care': homecare workers experienced clients' reactions as challenging and felt "thrown to the wolves" without sufficient training, and 4) 'Drawing on agency and team support': homecare work could be isolating, with no shared workplace, busy schedules and limited opportunity for peer support. DISCUSSION AND IMPLICATIONS: It is important that training and support for homecare workers addresses the relational, emotional and rights-based aspects of the role. Where a flexible, responsive, person-centred service is required, corresponding training and support is needed, alongside organisational practices, taking account of the broader context of the homecare sector

    Assessment as the site of power:A Bourdieusian interrogation of service user and carer involvement in the assessments of social work students

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    The centrality of service user and carer involvement in social work education in England is now well established, both in policy and practice. However, research evidence suggests their involvement in student assessments is underdeveloped and under researched. This study focused on the positioning of service users and carers in relation to other stakeholders involved in the assessments of social work students in England. Using narrative research methodology, 21 participants, including service users, carers, social work students, social work employers and social work educators, were offered a semi-structured individual interview. Participants’ narratives revealed different power relations among those involved in social work students’ assessments and a lack of confidence among service users and carers in making failed assessment recommendations. The paper concludes by arguing the case for social work educators and service user organisations to provide joint training to support service users and carers in their role as assessors of social work students

    Revisiting Frederic Engel’s hypothesis: how The Lomas determine the distribution of preceramic archaeology on Peru’s southern coast

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    FrĂ©dĂ©ric Engel (1981:24), el pionero de los estudios del PrecerĂĄmico en el PerĂș, argumentĂł que la distribuciĂłn de los sitios arqueolĂłgicos durante el Holoceno temprano fue determinada por “la capacidad de las lomas” –oasis estacionales producidos por la humedad oceĂĄnica que estĂĄn presentes a lo largo de la costa del PerĂș– una proposiciĂłn que aĂșn se encuentra en debate. Nosotros evaluaremos las ideas de Engel basĂĄndonos en datos de sitios arqueolĂłgicos del PrecerĂĄmico Medio (hasta 4500 años cal AP) ubicados dentro y cerca de las lomas de la costa sur del PerĂș.The pioneer of Preceramic archaeology in Peru, FrĂ©dĂ©ric Engel (1981: 24), argued that archaeological site distribution during the Early Holocene, was defined by the ‘fog oasis situation’ of lomas –the seasonal oases sustained by ocean fogs that flourish along the arid Pacific coast of Peru– a proposition that remains much debated. Here we reassess Engel’s ideas using archaeological findings from Middle Preceramic archaeological sites (to c. 4500 cal BP) from alongside and within the lomas of the south coast of Peru.Sociedad Argentina de AntropologĂ­

    Measurement of the cross-section and charge asymmetry of WW bosons produced in proton-proton collisions at s=8\sqrt{s}=8 TeV with the ATLAS detector

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    This paper presents measurements of the W+→Ό+ÎœW^+ \rightarrow \mu^+\nu and W−→Ό−ΜW^- \rightarrow \mu^-\nu cross-sections and the associated charge asymmetry as a function of the absolute pseudorapidity of the decay muon. The data were collected in proton--proton collisions at a centre-of-mass energy of 8 TeV with the ATLAS experiment at the LHC and correspond to a total integrated luminosity of 20.2~\mbox{fb^{-1}}. The precision of the cross-section measurements varies between 0.8% to 1.5% as a function of the pseudorapidity, excluding the 1.9% uncertainty on the integrated luminosity. The charge asymmetry is measured with an uncertainty between 0.002 and 0.003. The results are compared with predictions based on next-to-next-to-leading-order calculations with various parton distribution functions and have the sensitivity to discriminate between them.Comment: 38 pages in total, author list starting page 22, 5 figures, 4 tables, submitted to EPJC. All figures including auxiliary figures are available at https://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/STDM-2017-13

    Search for new phenomena in final states with an energetic jet and large missing transverse momentum in pp collisions at √ s = 8 TeV with the ATLAS detector