Towards intercultural engagement: building shared visions of neighbourhood and community in an era of new migration

Concerns about the consequences of new migration for good community relations have brought calls for bridge-building between apparently disconnected groups through greater social contact, intercultural dialogue and co-operation at the local scale. Although several initiatives have sought to build stronger relations between new and settled groups in the UK, we know relatively little about the impact of these encounters on those involved or their effectiveness in promoting good relations. In this paper, we explore the potential to erode perceived differences between diverse groups through dialogue around shared neighbourhood and community concerns. Drawing on interview and observational data in Bradford, our findings suggest that intercultural dialogue facilitates mutual learning and presents an opportunity to negotiate socially constructed group boundaries, unsettle racialised, gendered and class-based understandings of self' and other', and challenge emotions, myths and stereotypes that can underpin everyday animosities between new and settled residents. However, the capacity for co-operation around neighbourhood issues was found to differ within and between populations, reflecting complexities of identification, affiliation and belonging. Furthermore, bridge-building exercises between vulnerable new migrants and established groups with a stronger political voice and social rights may not be able to compensate for unfavourable dynamics of power between them

Acute Inflammatory Diseases of the Central Nervous System After SARS-CoV-2 Vaccination

BACKGROUND AND OBJECTIVES: Acute inflammatory CNS diseases include neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD). Both MOGAD and acute disseminated encephalomyelitis (ADEM) have been reported after vaccination. Consequently, the mass SARS-CoV-2 vaccination program could result in increased rates of these conditions. We described the features of patients presenting with new acute CNS demyelination resembling NMOSDs or MOGAD within 8 weeks of SARS-CoV-2 vaccination. METHODS: The study included a prospective case series of patients referred to highly specialized NMOSD services in the UK from the introduction of SARS-CoV-2 vaccination program up to May 2022. Twenty-five patients presented with new optic neuritis (ON) and/or transverse myelitis (TM) ± other CNS inflammation within 8 weeks of vaccination with either AstraZeneca (ChAdOx1S) or Pfizer (BNT162b2) vaccines. Their clinical records and paraclinical investigations including MRI scans were reviewed. Serologic testing for antibodies to myelin oligodendrocyte glycoprotein (MOG) and aquaporin 4 (AQP4) was performed using live cell–based assays. Patients' outcomes were graded good, moderate, or poor based on the last clinical assessment. RESULTS: Of 25 patients identified (median age 38 years, 14 female), 12 (48%) had MOG antibodies (MOGIgG+), 2 (8%) had aquaporin 4 antibodies (AQP4IgG+), and 11 (44%) had neither. Twelve of 14 (86%) antibody-positive patients received the ChAdOx1S vaccine. MOGIgG+ patients presented most commonly with TM (10/12, 83%), frequently in combination with ADEM-like brain/brainstem lesions (6/12, 50%). Transverse myelitis was longitudinally extensive in 7 of the 10 patients. A peak in new MOGAD cases in Spring 2021 was attributable to postvaccine cases. Both AQP4IgG+ patients presented with brain lesions and TM. Four of 6 (67%) seronegative ChAdOx1S recipients experienced longitudinally extensive TM (LETM) compared with 1 of 5 (20%) of the BNT162b2 group, and facial nerve inflammation was reported only in ChAdOx1S recipients (2/5, 40%). Guillain-Barre syndrome was confirmed in 1 seronegative ChAdOx1S recipient and suspected in another. DISCUSSION: ChAdOx1S was associated with 12/14 antibody-positive cases, the majority MOGAD. MOGAD patients presented atypically, only 2 with isolated ON (1 after BNT162b2 vaccine) but with frequent ADEM-like brain lesions and LETM. Within the seronegative group, phenotypic differences were observed between ChAdOx1S and BNT162b2 recipients. These observations might support a causative role of the ChAdOx1S vaccine in inflammatory CNS disease and particularly MOGAD. Further study of this cohort could provide insights into vaccine-associated immunopathology

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Wear‐Off of OnabotulinumtoxinA Effect Over the Treatment Interval in Chronic Migraine: A Retrospective Chart Review With Analysis of Headache Diaries

Objective: To quantify wear-off of the response to OnabotulinumtoxinA (OnabotA) treatment over the treatment cycle in chronic migraine at group and individual level. Background: OnabotA administered quarterly is an effective treatment for chronic migraine. However, some patients report that headache recurs before the scheduled follow-up injection. Methods In this retrospective chart review performed in 6 university outpatient centers or private practices specialized in headache treatment, 112 patients with a >= 30% response to OnabotA who completed headache diaries over 13 weeks after OnabotA treatment were included (age [mean +/- SD] 45 +/- 12 years, 82% female, headache days/month at baseline 24 +/- 6). Results Compared to weeks 5 to 8 after injection, headache days/week increased significantly in weeks 12 (+0.52 +/- 1.96, 95% CI [0.15, 0.88],P = 30% wear-off by weeks 12 and 13, and 28 patients (25%) showed >= 30% wear-off already by weeks 10 and 11. Age, gender, OnabotA dose or cycle number, or headache center did not predict individual wear-off. Conclusions: These data show that in clinical practice, on average the response of chronic migraine patients to OnabotA injection shows a clinically significant wear-off from week 12 after treatment. About 25% of the patients experience wear-off even by weeks 10 and 11. It must be noted that wear-off detected in a real-world study on OnabotA responders can be due to wear-off of a pharmacological OnabotA effect or a placebo effect, or to regression to the mean effects. This wear-off phenomenon may negatively affect quality of life of chronic migraine patients under OnabotA treatment. The best way to counteract wear-off remains to be determined