Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares.

OBJECTIVES: To evaluate a strategy designed to optimise care and increase uptake of urate-lowering therapy (ULT) during hospitalisations for gout flares. METHODS: We conducted a prospective cohort study to evaluate a strategy that combined optimal in-hospital gout management with a nurse-led, follow-up appointment, followed by handover to primary care. Outcomes, including ULT initiation, urate target attainment, and re-hospitalisation rates, were compared between patients hospitalised for flares in the 12 months post-implementation and a retrospective cohort of hospitalised patients from 12 months pre-implementation. RESULTS: 119 and 108 patients, respectively, were hospitalised for gout flares in the 12 months pre- and post-implementation. For patients with 6-month follow-up data available (n = 94 and n = 97, respectively), the proportion newly initiated on ULT increased from 49.2% pre-implementation to 92.3% post-implementation (age/sex-adjusted odds ratio (aOR) 11.5; 95% confidence interval (CI) 4.36-30.5; p < 0.001). After implementation, more patients achieved a serum urate ≤360 micromol/L within 6 months of discharge (10.6% pre-implementation vs. 26.8% post-implementation; aOR 3.04; 95% CI 1.36-6.78; p = 0.007). The proportion of patients re-hospitalised for flares was 14.9% pre-implementation vs. 9.3% post-implementation (aOR 0.53, 95% CI 0.22 to 1.32; p = 0.18). CONCLUSION: Over 90% of patients were initiated on ULT after implementing a strategy to optimise hospital gout care. Despite increased initiation of ULT during flares, recurrent hospitalisations were not more frequent following implementation. Significant relative improvements in urate target attainment were observed post-implementation; however, for the majority of hospitalised gout patients to achieve urate targets, closer primary-secondary care integration is still needed

Hopes and Fears: Community cohesion and the ‘White working class’ in one of the ‘failed spaces’ of multiculturalism

Since 2001, community cohesion has been an English policy concern, with accompanying media discourse portraying a supposed failure by Muslims to integrate. Latterly, academia has foregrounded White majority attitudes towards ethnic diversity, particularly those of the ‘White working class’. Whilst questioning this categorisation, we present data on attitudes towards diversity from low income, mainly White areas within Dewsbury, West Yorkshire, a town portrayed in media discourse as one of the ‘failed spaces’ of multiculturalism. Drawing on mixed methods research, we present and discuss data that provide a complex message, seemingly confirming pessimistic analyses around ethnic diversity and predominantly White neighbourhoods but also highlighting an appetite within the same communities for greater and more productive inter-ethnic contact. Furthermore, anxieties about diversity and integration have largely failed to coalesce into broad support for organised anti-minority politics manifest in groups such as the English Defence League

Azithromycin versus standard care in patients with mild-to-moderate COVID-19 (ATOMIC2): an open-label, randomised trial

BACKGROUND: The antibacterial, anti-inflammatory, and antiviral properties of azithromycin suggest therapeutic potential against COVID-19. Randomised data in mild-to-moderate disease are not available. We assessed whether azithromycin is effective in reducing hospital admission in patients with mild-to-moderate COVID-19. METHODS: This prospective, open-label, randomised superiority trial was done at 19 hospitals in the UK. We enrolled adults aged at least 18 years presenting to hospitals with clinically diagnosed, highly probable or confirmed COVID-19 infection, with fewer than 14 days of symptoms, who were considered suitable for initial ambulatory management. Patients were randomly assigned (1:1) to azithromycin (500 mg once daily orally for 14 days) plus standard care or to standard care alone. The primary outcome was death or hospital admission from any cause over the 28 days from randomisation. The primary and safety outcomes were assessed according to the intention-to-treat principle. This trial is registered at ClinicalTrials.gov (NCT04381962) and recruitment is closed. FINDINGS: 298 participants were enrolled from June 3, 2020, to Jan 29, 2021. Three participants withdrew consent and requested removal of all data, and three further participants withdrew consent after randomisation, thus, the primary outcome was assessed in 292 participants (145 in the azithromycin group and 147 in the standard care group). The mean age of the participants was 45·9 years (SD 14·9). 15 (10%) participants in the azithromycin group and 17 (12%) in the standard care group were admitted to hospital or died during the study (adjusted OR 0·91 [95% CI 0·43-1·92], p=0·80). No serious adverse events were reported. INTERPRETATION: In patients with mild-to-moderate COVID-19 managed without hospital admission, adding azithromycin to standard care treatment did not reduce the risk of subsequent hospital admission or death. Our findings do not support the use of azithromycin in patients with mild-to-moderate COVID-19. FUNDING: National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and Pfizer

What lies beneath: exploring links between asylum policy and hate crime in the UK

This paper explores the link between increasing incidents of hate crime and the asylum policy of successive British governments with its central emphasis on deterrence. The constant problematisation of asylum seekers in the media and political discourse ensures that 'anti-immigrant' prejudice becomes mainstr earned as a common-sense response. The victims are not only the asylum seekers hoping for a better life but democratic society itself with its inherent values of pluralism and tolerance debased and destabilised

Super diversity and city branding: Rotterdam in perspective

As many other cities around the world, Rotterdam has been investing in improving its image to stimulate urban development and to attract visitors, residents and investors. In particular, during the last 15 years the municipality of Rotterdam has intensified its attempts to develop a ‘brand’ that fits the ‘new Rotterdam’, which was gradually rebuilt after destructive bombardments during the Second World War (Riezebos 2014). In 2014 Rotterdam was ranked 8th by ‘Rough Guide’ in the list of ‘Top 10 Cities to See’, whereas the ‘New York Times’ listed Rotterdam in the top 10 of 52 Places to Go. These rankings demonstrate Rotterdam’s success in repositioning itself, using the physical interior of the city as a key element in its branding strategy.</p

Youth, terrorism and education: Britain’s Prevent programme

Since the 7/7 bombings of July 2005, Britain has experienced a domestic terror threat posed by a small minority of young Muslims. In response, Britain has initiated ‘Prevent’, a preventative counter-terrorism programme. Building on previous, general critiques of Prevent, this article outlines and critically discusses the ways in which Prevent has approached young Muslims and their educational institutions. The article argues that, rather than trust in broader and non-stigmatising processes of anti-extremist education, the police-led Prevent has ‘engaged’ with and surveilled young Muslims. Within Prevent there is little evidence of educational processes that explicitly build youth resilience against extremism. Instead, Muslim youth are viewed as both ‘risky and at risk’ (Heath-Kelly, 2013), ‘at risk’ of catching the terrorist disease, with the contested model of ‘radicalisation’ and child protection concepts utilised to portray risks of exploitation by Islamist extremists that necessitate a deepening process of education-based surveillance. The article identifies non-stigmatising alternatives to the approach of Prevent, approaches of anti-extremism education that learn from previously problematic anti-racist educational efforts with white young people. This enables the article to advocate for enhanced human rights-based approaches of citizenship education (admittedly, in themselves contested) with all young people as the most effective way of building individual and collective youth resilience against terrorist ideologies

Azithromycin versus standard care in patients with mild-to-moderate COVID-19 (ATOMIC2): an open-label, randomised trial.

BACKGROUND: The antibacterial, anti-inflammatory, and antiviral properties of azithromycin suggest therapeutic potential against COVID-19. Randomised data in mild-to-moderate disease are not available. We assessed whether azithromycin is effective in reducing hospital admission in patients with mild-to-moderate COVID-19. METHODS: This prospective, open-label, randomised superiority trial was done at 19 hospitals in the UK. We enrolled adults aged at least 18 years presenting to hospitals with clinically diagnosed, highly probable or confirmed COVID-19 infection, with fewer than 14 days of symptoms, who were considered suitable for initial ambulatory management. Patients were randomly assigned (1:1) to azithromycin (500 mg once daily orally for 14 days) plus standard care or to standard care alone. The primary outcome was death or hospital admission from any cause over the 28 days from randomisation. The primary and safety outcomes were assessed according to the intention-to-treat principle. This trial is registered at ClinicalTrials.gov (NCT04381962) and recruitment is closed. FINDINGS: 298 participants were enrolled from June 3, 2020, to Jan 29, 2021. Three participants withdrew consent and requested removal of all data, and three further participants withdrew consent after randomisation, thus, the primary outcome was assessed in 292 participants (145 in the azithromycin group and 147 in the standard care group). The mean age of the participants was 45·9 years (SD 14·9). 15 (10%) participants in the azithromycin group and 17 (12%) in the standard care group were admitted to hospital or died during the study (adjusted OR 0·91 [95% CI 0·43-1·92], p=0·80). No serious adverse events were reported. INTERPRETATION: In patients with mild-to-moderate COVID-19 managed without hospital admission, adding azithromycin to standard care treatment did not reduce the risk of subsequent hospital admission or death. Our findings do not support the use of azithromycin in patients with mild-to-moderate COVID-19. FUNDING: National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and Pfizer