Revista Jurídica Digital UANDES
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‘Reluctant to assess pain':A qualitative study of healthcare professionals’ beliefs about the role of pain in Juvenile Idiopathic Arthritis.
No full textObjectiveReducing pain is one of the main health priorities for children and young people with Juvenile Idiopathic Arthritis (JIA), however some studies indicate that pain is not routinely assessed in this patient group. The aim of this study was to explore healthcare professionals' (HCPs’) beliefs about the role of pain and the prioritisation of its assessment in children and young people with JIA. MethodsSemi-structured interviews were conducted with HCPs who manage children and young people (CYP) with JIA in the UK (including consultant and trainee paediatric rheumatologists, nurses, physiotherapists and occupational therapists). Data were analysed qualitatively following a framework analysis approach. ResultsTwenty-one HCPs participated. Analyses of the data identified six themes; lack of training and low confidence in pain assessment, reluctance to engage in pain discussions, low prioritisation of pain assessment, specific beliefs about the nature of pain in JIA, treatment of pain in JIA, and undervaluing pain reports. Assessment of pain symptoms was regarded as a low priority and some HCPs actively avoided conversations about pain. ConclusionThese findings indicate that the assessment of pain in CYP with JIA may be limited by knowledge, skills and attitudinal factors. HCPs' accounts of their beliefs about pain in JIA and their low prioritisation of pain in clinical practice suggest that a shift in perceptions about pain management may be helpful for professionals managing CYP with this condition.<br/
Immunogenicity in response to biologic agents
No full textImmunogenicity, or the formation of anti-drug antibodies (ADAbs), has been described in response to all biologic therapies licensed for rheumatoid arthritis (RA). In patients treated with monoclonal antibodies, immunogenicity may be associated with low serum drug levels, loss of therapeutic response, poor drug survival and/or adverse events such as infusion reactions. In this chapter we review the factors that may predispose to immunogenicity to biologics as well as mitigating factors in RA such as the effect of concomitant non-biologic DMARDs. The reported incidence of ADAbs varies greatly depending on techniques used for measurement. The interpretation of these is discussed followed by the effect of anti-drug antibodies and drug levels on drug efficacy and safety of biologics in RA. Finally we evaluate the evidence to date on the impact of biosimilar switching on immunogenicity and tolerising to ADAbs
Stakeholder engagement in construction: exploring corporate social responsibility (CSR), ethical behaviours and practices
No full textStakeholder engagement is an under theorized area of construction project management research. Often simplified as an act of corporate social responsibility, the complexity of the engagement concept, its` processes and consequences evades closer scrutiny and analysis. This paper provides an in-depth analysis of stakeholder engagement to reveal its` theoretical and practical complexity; two complimentary models of stakeholder engagement (Greenwood, 2007; Lane and Devin, 2018) being mobilized to empirical data from a hospital case study project. The result is a retheorization of stakeholder engagement as a complex, entwining process of responsibility, organizational action and work package requirements where stakeholder engagement and agency (i.e. ethical treatment of stakeholders) are understood as separate variables that result in shifts between responsible, paternalistic, neoclassic and strategic behaviours. The contribution lies in a more sophisticated understanding of stakeholder engagement being attained: shifts between stakeholder engagement and agency defining relations between parties in CSR terms; the ethical aspirations of AEC organizations being impacted by daily project activities; the unique characteristics of stakeholder engagement in construction (e.g. binding of party interests; effect of subcontractor entry; collective blame/praise) being brought into focus. Resulting recommendations include periodic review of engagement activity to ensure the CSR strategic objectives of organisations are aligned to stakeholder engagement work
Sexual dimorphism in the size and shape of the raptorial pedipalps of Giant Whip Spiders (Arachnida: Amblypygi)
No full textSexual dimorphism in the form of elaborate crests, horns and swellings can be a clear indicator of the differing evolutionary pressures to which males and females are subject. However, dimorphism can also be expressed in more subtle shape differences not outwardly obvious to the observer. Whip spiders (Amblypygi) possess a unique pair of spined pedipalps hypothesized to primarily function in prey capture, but also serving multiple other functions. Little is known regarding the intraspecific shape variation of these limbs and its potential causes. Because a role during courtship and male contest has also been hypothesized, sexual selection may contribute to shape differences. As such, we hypothesize that sexual dimorphism will be present in the size and shape of amblypygid pedipalps, with male contest selecting for longer and thicker pedipalps, and larger spines in males. This study aims to test this hypothesis, by quantifying the contribution of ontogeny and sexual dimorphism to shape within the raptorial pedipalps of Damon variegatus. Discriminant function analysis using GMM landmark data reveals statistically significant sexual shape dimorphism in both the tibia and femur of the pedipalp. Contrary to our hypothesis, males display a more gracile pedipalp morphology with reduced spination. Sex differences in the allometric slope and overall size were also found in a number of linear appendicular metrics using Type-II regression. Males have statistically longer pedipalp tibiae, whip femora, and leg two femora. We propose that males have evolved a longer pedipalps in the context of display contest rather than physical aggression. The elongation of structures used in display-based contest and courtship found herein further emphasizes the contribution of visual cues to the evolution of morphology more broadly.</p
How do they measure up? Differences in stakeholder perceptions of quality measures used in English community nursing
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Polarimetric Neutron Tomography of Magnetic Fields:Uniqueness of Solution and Reconstruction
No full textWe consider the problem of determination of a magnetic field from three dimensional polarimetric neutron tomography data. We see that this is an example of a non-Abelian ray transform and that the problem has a globally unique solution for smooth magnetic fields with compact support, and a locally unique solution for less smooth fields. We derive the linearization of the problem and note that the derivative is injective. We go on to show that the linearised problem about a zero magnetic field reduces to plane Radon transforms and suggest a modified Newton Kantarovich method (MNKM) type algorithm for the numerical solution of the non-linear problem, in which the forward problem is re-solved but the same derivative used each time. Numerical experiments demonstrate that MNKM works for small enough fields (or large enough velocities) and show an example where it fails to reconstruct a slice of the simulated data set. Lastly we show viewed as an optimization problem the inverse problem is non-convex so we expect gradient based methods may fail
Using quality indicators to predict inspection ratings:Cross-sectional study of general practices in England
No full textBackground The Care Quality Commission regulates, inspects, and rates general practice providers in England. Inspections are costly and infrequent, and are supplemented by a system of routine quality indicators, measuring patient satisfaction and the management of chronic conditions. These indicators can be used to prioritise or target inspections.Aim To determine whether this set of indicators can be used to predict the ratings awarded in subsequent inspections.Design and setting This cross-sectional study was conducted using a dataset of 6860 general practice providers in England.Method The indicators and first-inspection ratings were used to build ordered logistic regression models to predict inspection outcomes on the four-level rating system (‘outstanding’, ‘good’, ‘requires improvement’, and ‘inadequate’) for domain ratings and the ‘overall’ rating. Predictive accuracy was assessed using the percentage of correct predictions and a measure of agreement (weighted κ).Results The model correctly predicted 79.7% of the ‘overall’ practice ratings. However, 78.8% of all practices were rated ‘good’ on ‘overall’, and the weighted κ measure of agreement was very low (0.097); as such, predictions were little more than chance. This lack of predictive power was also found for each of the individual domain ratings.Conclusion The poor power of performance of these indicators to predict subsequent inspection ratings may call into question the validity and reliability of the indicators, inspection ratings, or both. A number of changes to the way data relating to performance indicators are collected and used are suggested to improve the predictive value of indicators. It is also recommended that assessments of predictive power be undertaken prospectively when sets of indicators are being designed and selected by regulators
Del Estado constitucional al Estado convencional de Derecho. Estudio Preliminar sobre el modelo del Estado Convencional de Derecho, en el contexto latinoamericano
No full textThis review presents a preliminary conceptual reference within a more extensive investigation about the constitutional tools for the integration of National Law and International Human Rights Law in the Latin American context. Thus, with an exploratory methodology, it establishes the initial elements of the Conventional Rule of Law, as a model for the understanding of Latin American developments connected with the new constitutionalism and the establishment of the control of conventionality in the Inter-American Human Rights System countries. Consequently, the paper will expose the mutation process suffered by the State of Law in its legal version to become the suggested model. To do so, the paper compiles comprehensive elements and developments of the doctrine that will help to understand this transformation.El presente artículo de revisión se encarga de construir un referente conceptual preliminar para efecto de una investigación amplia sobre las herramientas constitucionales de integración del derecho nacional e internacional de los derechos humanos en el contexto latinoamericano. En esta medida, con una metodología exploratoria, establece los elementos iniciales del Estado Convencional de Derecho, como modelo para el entendimiento de los desarrollos latinoamericanos vinculados, en términos generales, con el nuevo constitucionalismo y con el establecimiento del control de convencionalidad en los países pertenecientes al sistema interamericano de derechos humanos. De tal modo, el texto expondrá, desde una concepción estatal formalista y durante cuatro (04) acápites previos a las conclusiones, el proceso de mutación sufrido por el Estado de Derecho, en su devenir jurídico, hasta llegar al modelo sugerido, compilando presupuestos comprensivos y los desarrollos de la doctrina que ayudarán a entender esta transformación