Perceptions and experiences of health care service use during the pandemic for children with uveitis: UNICORNS-C19 study

Purpose : COVID-19 has disrupted provision of and access to healthcare. Children newly diagnosed with uveitis are particularly vulnerable to these disruptions. We aimed to describe the impact of the pandemic on the experiences and perceptions of care use for families of children newly diagnosed with uveitis. Methods : UNICORNS-C19 is a cross-sectional study embedded within the Uveitis in Childhood National Prospective Cohort Study (UNICORNS), which is recruiting UK children with non-infectious uveitis in order to understand the sociodemographic, clinical and biological determinants of disease and treatment outcomes and quality of life. We distributed (postally and electronically) a modified Health Foundation / Ipsos Mori survey, which comprises 13 questions (closed and open) around health and social care. Quantitative data were analysed using descriptive statistics, free text responses were analysed using qualitative thematic analysis. A framework was developed to index and chart data into themes through an iterative process. Results : Response rate to date is 42 of the 95 UNICORNS families approached (44%). Of those who participated, 61% expressed concern over the impact of the pandemic on their health, with a third (31%) expressing difficulties in accessing essential medication, and 56% finding it harder to get basic food stuffs. Despite this, the majority expressed a positive experience with NHS services, with 72% being comfortable using their specialist hospital during the pandemic. Key themes identified in analysis included positive experiences of safety procedures and the adoption of digital health tools across different levels of care (primary to quaternary); negative experiences of poor co-ordination of care, or of delivery of synchronous telemedicine care of rare disease from primary / secondary health teams, and negative perceptions around the use of immunosuppression during the pandemic. Conclusions : The UNICORNS study is well placed to provide useful data on patient experience for those starting a rare, chronic childhood disease care pathway during a global pandemic. Our findings suggest that primary and secondary care teams require additional support in delivering / co-ordinating care for those with rare disease. UNICORN C-19 findings will inform recommendations for future service planning. This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually

Maser radiation from collisionless shocks

Funding: UK Engineering and Physical Sciences Research Council (grant Nos. EP/N014472/1, EP/R004773/1 and EP/N013298/1) and the Science and Technologies Facilities Council of the United Kingdom. F.C. and L.O.S. acknowledge support from the European Research Council (InPairs ERC-2015-AdG 695088) and FCT Portugal (grant No. PD/BD/114307/2016).This paper describes a model of electron energization and cyclotron-maser emission applicable to astrophysical magnetized collisionless shocks. It is motivated by the work of Begelman, Ergun and Rees [Astrophys. J. 625 , 51 (2005)] who argued that the cyclotron-maser instability occurs in localized magnetized collisionless shocks such as those expected in blazar jets. We report on recent research carried out to investigate electron acceleration at collisionless shocks and maser radiation associated with the accelerated electrons. We describe how electrons accelerated by lower-hybrid,waves at collisionless shocks generate cyclotron-maser radiation when the accelerated electrons move into regions of stronger magnetic fields. The electrons are accelerated along the magnetic field and magnetically compressed leading to the formation of an electron velocity distribution having a horseshoe shape due to conservation of the electron magnetic moment. Under certain conditions the horseshoe electron velocity distribution function is unstable to the cyclotron-maser instability [Bingham and Cairns, Phys. Plasmas 7, 3089 (2000); Melrose, Rev. Mod. Plasma Phys. 1 , 5 (2017)].Publisher PDFPeer reviewe

T2K ECAL Test–beam Proposal

The T2K experiment will search for the last unknown element of the neutrino mixing matrix. An crucial component of the near detector for this experiment is the electromagnetic calorimeter which is being built in the UK. Testbeam time is requested to test the full ECAL system, validate calibration techniques, and determine the hadronic and electromagnetic energy scale of the calorimeter

2. Pathways to detection of non-infectious childhood uveitis in the UK: findings from the UNICORN cohort study

Introduction Prompt detection of childhood uveitis is key to minimising negative impact. From an internationally unique inception cohort, we report pathways to disease detection. UNICORNS is a national childhood non-infectious uveitis study with longitudinal collection of a standardised clinical dataset and patient reported outcomes. Descriptive analysis of baseline characteristics are reported. Amongst 150 recruited children (51% female, 31% non-white ethnicity) age at detection ranged from 2–18yrs (median 10). In 69%, uveitis was diagnosed following onset of symptoms: time from first symptoms to uveitis detection ranged from 0-739days (median 7days), with longer time to detection for those presenting initially to their general practitioner. Non symptomatic children were detected through JIA/other disease surveillance (16%), routine optometry review (5%) or child visual health screening (1%). Commonest underlying diagnoses at uveitis detection were JIA (17%), TINU (9%, higher than pre-pandemic reported UK disease frequency) and sarcoid (1%). 60% had no known systemic disease at uveitis detection. At disease detection, in at least one eye: 34% had structural complications (associated with greater time to detection – 17 days versus 4 days for uncomplicated presentation). The larger relative proportions of children with non-JIA uveitis reported here increase the importance of improving awareness of childhood uveitis amongst the wider clinical communities. There is scope for improvement of pathways to detection. Forthcoming analysis on the full cohort (251 recruited to date across 33 hospitals and 4 nations) will provide nationally representative data on management and the determinants of visual and broader developmental/well-being outcomes

Autistic Development, Trauma and Personhood: Beyond the Frame of the Neoliberal Individual

This chapter critically explores notions of childhood development, particularly in regard to autism, reactions to traumatic events and the meaning of ‘personhood’. The construction of the neoliberal individual is contrasted with that of personhood as experienced by an autistic person. Person-centred methods of engagement as outlined in this chapter can give opportunities for opening up a respectful discursive space where autistic development is not framed from the outset as ‘disordered’

Global Increase in Climate-Related Disasters

Intense climate-related disasters - floods, storms, droughts, and heat waves - have been on the rise worldwide. At the same time and coupled with an increasing concentration of greenhouse gases in the atmosphere, temperatures, on average, have been rising, and are becoming more variable and more extreme. Rainfall has also been more variable and more extreme. Is there an ominous link between the global increase of these hydrometeorological and climatological events on the one side and anthropogenic climate change on the other? This paper considers three main disaster risk factors - rising population exposure, greater population vulnerability, and increasing climate-related hazards - behind the increased frequency of intense climate-related natural disasters. In a regression analysis within a model of disaster risk determination for 1971-2013, population exposure measured by population density and people's vulnerability measured by socioeconomic variables are positively linked to the frequency of these intense disasters. Importantly, the results show that precipitation deviations are positively related to hydrometeorological events, while temperature and precipitation deviations have a negative association with climatological events. Moreover, global climate change indicators show positive and highly significant effects. Along with the scientific association between greenhouse gases and the changes in the climate, the findings in this paper suggest a connection between the increasing number of natural disasters and man-made emissions of greenhouse gases in the atmosphere. The implication is that climate mitigation and climate adaptation should form part of actions for disaster risk reduction

The electromagnetic calorimeter for the T2K near detector ND280

The T2K experiment studies oscillations of an off-axis muon neutrino beam between the J-PARC accelerator complex and the Super-Kamiokande detector. Special emphasis is placed on measuring the mixing angle θ 13 by observing ν e appearance via the sub-dominant νμ ν e oscillation and searching for CP violation in the lepton sector. The experiment includes a sophisticated, off-axis, near detector, the ND280, situated 280 m downstream of the neutrino production target in order to measure the properties of the neutrino beam and to understand better neutrino interactions at the energy scale below a few GeV. The data collected with the ND280 are used to study charged- and neutral-current neutrino interaction rates and kinematics prior to oscillation, in order to reduce uncertainties in the oscillation measurements by the far detector. A key element of the near detector is the ND280 electromagnetic calorimeter (ECal), consisting of active scintillator bars sandwiched between lead sheets and read out with multi-pixel photon counters (MPPCs). The ECal is vital to the reconstruction of neutral particles, and the identification of charged particle species. The ECal surrounds the Pi-0 detector (PØD) and the tracking region of the ND280, and is enclosed in the former UA1/NOMAD dipole magnet. This paper describes the design, construction and assembly of the ECal, as well as the materials from which it is composed. The electronic and data acquisition (DAQ) systems are discussed, and performance of the ECal modules, as deduced from measurements with particle beams, cosmic rays, the calibration system, and T2K data, is described.© 2013 IOP Publishing Ltd and Sissa Medialab srl.The ECal detector has been built and is operated using funds provided by the Science and Technology Facilities Council U.K. Important support was also provided by the collaborating institutions. Individual researchers have been supported by the Royal Society and the European Research Council