Postpartum onset and subsequent relapse of eosinophilic granulomatosis with polyangitis

Eosinophilic granulomatosis with polyangiitis (EGPA) can affect women of childbearing age. However, reports of the disease in the postpartum period are limited. We present a case of postpartum-onset EGPA that went into clinical remission before relapsing in the subsequent postpartum period. Our patient presented with dyspnoea, arthralgia and rash, shown to be eosinophilic vasculitis, 3?days following the birth of her second child. CT of the thorax showed alveolar shadowing and mediastinal lymphadenopathy. She was treated successfully for EGPA with glucocorticoid therapy. She declined maintenance treatment during remission. Off treatment, she remained disease free throughout her next pregnancy. In the postpartum period she relapsed in an almost identical manner, requiring prolonged glucocorticoid therapy, cyclophosphamide and rituximab. This case highlights the importance of maintenance therapy around pregnancy in individuals with EGPA, and the need for careful monitoring of women with a history of EGPA in the postpartum period

High-power laser production of PET isotopes

Recent experiments have demonstrated that laser-solid interactions at intensities greater than 1019 W/cm2 can produce fast electron beams of several hundred MeV [1], tens of MeV γ-rays [2, 3], up to 58MeV proton beams [4, 5], and heavier ions [6] of up to 7MeV/nucleon. One of the potential applications of the high-energy proton beams is the production of radioactive isotopes for positron emission tomography (PET). PET is a form of medical imaging requiring the production of short-lived positron emitting isotopes 11C, 13N, 15O, and 18F, by proton irradiation of natural/enriched targets using cyclotrons. PET development has been limited because of the size and shielding requirements of the nuclear installations. Recent results have shown when an intense laser beam interacts with solid targets, tens of MeV protons capable of producing PET isotopes are generated [7, 8, 9]

A vision for laser induced particle acceleration and applications

High intensity lasers interacting with solid and gas targets can produce energetic beams of electrons, protons, heavy ions, photons and neutrons. There is the potential for producing "table top" sources of radiation for many different applications

Achievement of NICE Quality Standards for patients with new presentation of inflammatory arthritis: observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

Objectives. A national audit was performed assessing the early management of suspected inflammatory arthritis by English and Welsh rheumatology units. The aim of this audit was to measure the performance of rheumatology services against National Institute for Health and Care Excellence (NICE) quality standards (QSs) for the management of early inflammatory arthritis benchmarked to regional and national comparators for the first time in the UK. Methods. All individuals >16 years of age presenting to rheumatology services in England and Wales with suspected new-onset inflammatory arthritis were included in the audit. Information was collected against six NICE QSs that pertain to early inflammatory arthritis management. Results. We present national data for the 6354 patients recruited from 1 February 2014 to 31 January 2015; 97% of trusts and health boards in England and Wales participated in this audit. Only 17% of patients were referred by their general practitioner within 3 days of first presentation. Specialist rheumatology assessment occurred within 3 weeks of referral in 38% of patients. The target of DMARD initiation within 6 weeks of referral was achieved in 53% of RA patients; 36% were treated with combination DMARDs and 82% with steroids within the first 3 months of specialist care. Fifty-nine per cent of patients received structured education on their arthritis within 1 month of diagnosis. In total, 91% of patients had a treatment target set; the agreed target was achieved within 3 months of specialist review in only 27% of patients. Access to urgent advice via a telephone helpline was reported to be available in 96% of trusts. Conclusion. The audit has highlighted gaps between NICE standards and delivery of care, as well as substantial geographic variability

Patient- and clinician-reported outcomes for patients with new presentation of inflammatory arthritis: observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

Objectives. Our aim was to conduct a national audit assessing the impact and experience of early management of inflammatory arthritis by English and Welsh rheumatology units. The audit enables rheumatology services to measure for the first time their performance, patient outcomes and experience, benchmarked to regional and national comparators. Methods. All individuals >16 years of age presenting to English and Welsh rheumatology services with suspected new-onset inflammatory arthritis were included in the audit. Clinician- and patient-derived outcome and patient-reported experience measures were collected. Results. Data are presented for the 6354 patients recruited from 1 February 2014 to 31 January 2015. Ninety-seven per cent of English and Welsh trusts participated. At the first specialist assessment, the 28-joint DAS (DAS28) was calculated for 2659 (91%) RA patients [mean DAS28 was 5.0 and mean Rheumatoid Arthritis Impact of Disease (RAID) score was 5.6]. After 3 months of specialist care, the mean DAS28 was 3.5 and slightly >60% achieved a meaningful DAS28 reduction. The average RAID score and reduction in RAID score were 3.6 and 2.4, respectively. Of the working patients ages 16–65 years providing data, 7, 5, 16 and 37% reported that they were unable to work, needed frequent time off work, occasionally and rarely needed time off work due to their arthritis, respectively; only 42% reported being asked about their work. Seventy-eight per cent of RA patients providing data agreed with the statement ‘Overall in the last 3 months I have had a good experience of care for my arthritis’; <2% disagreed. Conclusion. This audit demonstrates that most RA patients have severe disease at the time of presentation to rheumatology services and that a significant number continue to have high disease activity after 3 months of specialist care. There is a clear need for the National Health Service to develop better systems for capturing, coding and integrating information from outpatient clinics, including measures of patient experience and outcome and measures of ability to work

CMOS driven micro-pixel LEDs integrated with single photon avalanche diodes for time resolved fluorescence measurements

We describe a single chip approach to time resolved fluorescence measurements based on time correlated single photon counting. Using a single complementary metal oxide silicon (CMOS) chip, bump bonded to a 4 × 16 array of AlInGaN UV micro-pixellated light-emitting diodes, a prototype integrated microsystem has been built that demonstrates fluorescence excitation and detection on a nanosecond time scale. Demonstrator on-chip measurements of lifetimes of fluorescence colloidal quantum dot samples are presented