Development of large radii half-wave plates for CMB satellite missions

The successful European Space Agency (ESA) Planck mission has mapped the Cosmic Microwave Background (CMB) temperature anisotropy with unprecedented accuracy. However, Planck was not designed to detect the polarised components of the CMB with comparable precision. The BICEP2 collaboration has recently reported the first detection of the B-mode polarisation. ESA is funding the development of critical enabling technologies associated with B-mode polarisation detection, one of these being large diameter half-wave plates. We compare different polarisation modulators and discuss their respective trade-offs in terms of manufacturing, RF performance and thermo-mechanical properties. We then select the most appropriate solution for future satellite missions, optimized for the detection of B-modes.Comment: 16 page

Evidence-based selection of environmental factors and datasets for measuring multiple environmental deprivation in epidemiological research

This Environment and Human Health project aims to develop a health-based summary measure of multiple physical environmental deprivation for the UK, akin to the measures of multiple socioeconomic deprivation that are widely used in epidemiology. Here we describe the first stage of the project, in which we aimed to identify health-relevant dimensions of physical environmental deprivation and acquire suitable environmental datasets to represent population exposure to these dimensions at the small-area level. We present the results of this process: an evidence-based list of environmental dimensions with population health relevance for the UK, and the spatial datasets we obtained and processed to represent these dimensions. This stage laid the foundations for the rest of the project, which will be reported elsewhere

Ten high-impact actions for integrated care success

Based on a case study from within Nottingham and Nottinghamshire. As the English NHS and social care system responds to current need and challenges, national policy remains that integrated care systems provide the best way forward to improved population health, reduced inequalities and per capita costs. Back in 2017 when Nottingham and Nottinghamshire was announced as an integrated care system (ICS) accelerator, with an early focus on Greater Nottingham and Rushcliffe, local leaders joined with Nottingham Business School in initiating a case study of the development. The predominant aim of the case study was to provide reflective insight and action learning to the local system

Sea Ice Dynamics: The Role Of Broken Ice In Multi-scale Deformation

Realistic models of Arctic Ocean behaviour should capture the influence of broken ice acting as a fault gouge between sliding floes. We performed double-direct shear friction tests on floating saline ice floes in the HSVA ARCTECLAB, Large Model Basin, Hamburg. We have focused these experiments on angularity and size to determine fault gouge characteristics. In our experiments the displacements and deformation of ice gouge were characterized during on-going frictional slip for the first time. Both stable sliding and stickslip behaviour were displayed. It appears that there are controls on behaviour according to gouge angularity. By measuring local stress, strain and acoustic emissions along the sliding interfacial fault we have captured the mechanics of the propagation of slip from slip initiation to dynamic propagation for the first time in the presence of broken ice

Ten high-impact actions for integrated care system success

As the English NHS and social care system responds to current need and challenges, national policy remains that integrated care systems provide the best way forward to improved population health, reduced inequalities and per capita costs. Back in 2017 when Nottingham and Nottinghamshire was announced as an integrated care system (ICS) accelerator, with an early focus on Greater Nottingham and Rushcliffe, local leaders joined with Nottingham Business School in initiating a case study of the development. The predominant aim of the case study was to provide reflective insight and action learning to the local system. This case study has drawn from workshops, roundtables, interviews, document reviews and analysis. Pre COVID-19, the over-arching finding centred on the NHS and social care system not being ready for comprehensive and systemic change, in the prevailing policy and operational environment. This finding was based on both local experience and national evidence since 2017

Primary vs. Secondary Antibody Deficiency: Clinical Features and Infection Outcomes of Immunoglobulin Replacement

<div><p>Secondary antibody deficiency can occur as a result of haematological malignancies or certain medications, but not much is known about the clinical and immunological features of this group of patients as a whole. Here we describe a cohort of 167 patients with primary or secondary antibody deficiencies on immunoglobulin (Ig)-replacement treatment. The demographics, causes of immunodeficiency, diagnostic delay, clinical and laboratory features, and infection frequency were analysed retrospectively. Chemotherapy for B cell lymphoma and the use of Rituximab, corticosteroids or immunosuppressive medications were the most common causes of secondary antibody deficiency in this cohort. There was no difference in diagnostic delay or bronchiectasis between primary and secondary antibody deficiency patients, and both groups experienced disorders associated with immune dysregulation. Secondary antibody deficiency patients had similar baseline levels of serum IgG, but higher IgM and IgA, and a higher frequency of switched memory B cells than primary antibody deficiency patients. Serious and non-serious infections before and after Ig-replacement were also compared in both groups. Although secondary antibody deficiency patients had more serious infections before initiation of Ig-replacement, treatment resulted in a significant reduction of serious and non-serious infections in both primary and secondary antibody deficiency patients. Patients with secondary antibody deficiency experience similar delays in diagnosis as primary antibody deficiency patients and can also benefit from immunoglobulin-replacement treatment.</p></div

Applying the ROBINS-I tool to natural experiments: an example from public health

Background: A new tool to assess Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) was published in Autumn 2016. ROBINS-I uses the Cochrane-approved risk of bias (RoB) approach and focusses on internal validity. As such, ROBINS-I represents an important development for those conducting systematic reviews which include non-randomised studies (NRS), including public health researchers. We aimed to establish the applicability of ROBINS-I using a group of NRS which have evaluated non-clinical public health natural experiments. Methods: Five researchers, all experienced in critical appraisal of non-randomised studies, used ROBINS-I to independently assess risk of bias in five studies which had assessed the health impacts of a domestic energy efficiency intervention. ROBINS-I assessments for each study were entered into a database and checked for consensus across the group. Group discussions were used to identify reasons underpinning lack of consensus for specific questions and bias domains. Results: ROBINS-I helped to systematically articulate sources of bias in NRS. However, the lack of consensus in assessments for all seven bias domains raised questions about ROBINS-I’s reliability and applicability for natural experiment studies. The two RoB domains with least consensus were selection (Domain 2) and performance (Domain 4). Underlying the lack of consensus were difficulties in applying an intention to treat or per protocol effect of interest to the studies. This was linked to difficulties in determining whether the intervention status was classified retrospectively at follow-up, i.e. post hoc. The overall risk of bias ranged from moderate to critical; this was most closely linked to the assessment of confounders. Conclusion: The ROBINS-I tool is a conceptually rigorous tool which focusses on risk of bias due to the counterfactual. Difficulties in applying ROBINS-I may be due to poor design and reporting of evaluations of natural experiments. While the quality of reporting may improve in the future, improved guidance on applying ROBINS-I is needed to enable existing evidence from natural experiments to be assessed appropriately and consistently. We hope future refinements to ROBINS-I will address some of the issues raised here to allow wider use of the tool

Of cattle, sand flies and men : a systematic review of risk factor analyses for South Asian visceral leishmaniasis and implications for elimination

Background: Studies performed over the past decade have identified fairly consistent epidemiological patterns of risk factors for visceral leishmaniasis (VL) in the Indian subcontinent. Methods and Principal Findings: To inform the current regional VL elimination effort and identify key gaps in knowledge, we performed a systematic review of the literature, with a special emphasis on data regarding the role of cattle because primary risk factor studies have yielded apparently contradictory results. Because humans form the sole infection reservoir, clustering of kala-azar cases is a prominent epidemiological feature, both at the household level and on a larger scale. Subclinical infection also tends to show clustering around kala-azar cases. Within villages, areas become saturated over a period of several years; kala-azar incidence then decreases while neighboring areas see increases. More recently, post kalaazar dermal leishmaniasis (PKDL) cases have followed kala-azar peaks. Mud walls, palpable dampness in houses, and peridomestic vegetation may increase infection risk through enhanced density and prolonged survival of the sand fly vector. Bed net use, sleeping on a cot and indoor residual spraying are generally associated with decreased risk. Poor micronutrient status increases the risk of progression to kala-azar. The presence of cattle is associated with increased risk in some studies and decreased risk in others, reflecting the complexity of the effect of bovines on sand fly abundance, aggregation, feeding behavior and leishmanial infection rates. Poverty is an overarching theme, interacting with individual risk factors on multiple levels. Conclusions: Carefully designed demonstration projects, taking into account the complex web of interconnected risk factors, are needed to provide direct proof of principle for elimination and to identify the most effective maintenance activities to prevent a rapid resurgence when interventions are scaled back. More effective, short-course treatment regimens for PKDL are urgently needed to enable the elimination initiative to succeed