Reluctance of general practice staff to register patients without documentation: a qualitative study in North East London.

BACKGROUND: Lack of access to documentation is a key barrier to GP registration, despite NHS England guidance stating that documents are not required. Staff attitudes and practice regarding registration of those without documentation are under- researched. AIM: To understand the processes through which registration might be refused for those without documents, and the factors operating to influence this. DESIGN AND SETTING: Qualitative study conducted in general practice across three clinical commissioning groups in North East London. METHOD: In total, 33 participants (GP staff involved in registering new patients) were recruited through email invitation. Semi-structured interviews and focus groups were conducted. Data were analysed using Braun and Clarke's reflexive thematic analysis. Two social theories informed this analysis: Lipsky's street-level bureaucracy and Bourdieu's theory of practice. RESULTS: Despite good knowledge of guidance, most participants expressed reluctance to register those without documentation, often introducing additional hurdles or requirements in their everyday practice. Two explanatory themes were generated: that those without documents were perceived as burdensome, and/or that moral judgements were made about their deservedness to finite resources. Participants described a context of high workload and insufficient funding. Some felt that GP services should be restricted by immigration status, as is widespread in secondary care. CONCLUSION: Improving inclusive registration practice requires addressing staff concerns, supporting navigation of high workloads, tackling financial disincentives to registering transient groups, and challenging narratives that undocumented migrants represent a 'threat' to NHS resources. Furthermore, it is imperative to acknowledge and address upstream drivers, in this instance the Hostile Environment

Risk factors for feline infectious peritonitis in Australian cats

Objective: To determine whether patient signalment (age, breed, sex, and neuter status) are associated with naturally occurring feline infectious peritonitis (FIP) in cats in Australia. Design: A retrospective comparison of the signalment between cats with confirmed FIP and the general cat population. Results: The patient signalment of 382 FIP confirmed cases were compared with the Companion Animal Register of NSW and the general cat population of Sydney. Younger cats were significantly over-represented amongst FIP cases. Domestic crossbred, Persian, and Himalayan cats were significantly under-represented in the FIP cohort while several breeds were over-represented including British Shorthair, Devon Rex, and Abyssinian. A significantly higher proportion of male cats had FIP compared to female cats. Conclusion: This study provides further evidence that FIP is primarily a disease of young cats and that significant breed and sex predilections exist in Australia. This opens further avenues to investigate the role of genetic factors in FIP

Risk factors for feline infectious peritonitis in Australian cats

Objective: To determine whether patient signalment (age, breed, sex, and neuter status) are associated with naturally occurring feline infectious peritonitis (FIP) in cats in Australia. Design: A retrospective comparison of the signalment between cats with confirmed FIP and the general cat population. Results: The patient signalment of 382 FIP confirmed cases were compared with the Companion Animal Register of NSW and the general cat population of Sydney. Younger cats were significantly over-represented amongst FIP cases. Domestic crossbred, Persian, and Himalayan cats were significantly under-represented in the FIP cohort while several breeds were over-represented including British Shorthair, Devon Rex, and Abyssinian. A significantly higher proportion of male cats had FIP compared to female cats. Conclusion: This study provides further evidence that FIP is primarily a disease of young cats and that significant breed and sex predilections exist in Australia. This opens further avenues to investigate the role of genetic factors in FIP

Flat photonic bands in guided modes of textured metallic microcavities

M. G. Salt and William L. Barnes, Physical Review B, Vol. 61, pp. 11125-11135 (2000). "Copyright © 2000 by the American Physical Society."A detailed experimental study of how wavelength-scale periodic texture modifies the dispersion of the guided modes of λ/2 metal-clad microcavities is presented. We first examine the case of a solid-state microcavity textured with a single, periodic corrugation. We explore how the depth of the corrugation and the waveguide thickness affect the width of the band gap produced in the dispersion of the guided modes by Bragg scattering off the periodic structure. We demonstrate that the majority of the corrugation depths studied dramatically modify the dispersion of the lowest-order cavity mode to produce a series of substantially flat bands. From measurements of how the central frequency of the band gap varies with direction of propagation of the guided modes, we determine a suitable two-dimensional texture profile for the production of a complete band gap in all directions of propagation. We then experimentally examine band gaps produced in the guided modes of such a two-dimensionally textured microcavity and demonstrate the existence of a complete band gap for all directions of propagation of the lowest-order TE-polarized mode. We compare our experimental results with those from a theoretical model and find good agreement. Implications of these results for emissive microcavity devices such as light-emitting diodes are discussed

Vacuum Induced Coherences in Radiatively Coupled Multilevel Systems

We show that radiative coupling between two multilevel atoms having near-degenerate states can produce new interference effects in spontaneous emission. We explicitly demonstrate this possibility by considering two identical V systems each having a pair of transition dipole matrix elements which are orthogonal to each other. We discuss in detail the origin of the new interference terms and their consequences. Such terms lead to the evolution of certain coherences and excitations which would not occur otherwise. The special choice of the orientation of the transition dipole matrix elements enables us to illustrate the significance of vacuum induced coherence in multi-atom multilevel systems. These coherences can be significant in energy transfer studies.Comment: 13 pages including 8 figures in Revtex; submitted to PR

Molecular fluorescence above metallic gratings

P. Andrew and William L. Barnes, Physical Review B, Vol. 64, article 125405 (2001). "Copyright © 2001 by the American Physical Society."We present measurements of the fluorescence of emitters located in close proximity (d<λ) to metallic grating surfaces. By measuring both the spontaneous emission lifetime and angle-dependent radiation pattern of a monolayer of dye molecules as a function of their separation from planar and periodically corrugated mirrors of increasing modulation depth, we are able to examine the effect of varying the surface profile on the emission process. Both the distance dependence of the lifetime and the spatial distribution of the emitted light are significantly changed upon the introduction of a corrugation, quite apart from the appearance of the familiar Bragg-scattered bound-mode features. It is postulated that these perturbations arise from the interference of the grating scattered dipole fields with the usual upward propagating and reflected fields. In addition, the measurement of nonexponential decay transients for the deepest gratings examined provide evidence for the existence of optically dissimilar dipole positions above the grating surface

COVID-19 in Pregnant Women With Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance

OBJECTIVE: To describe coronavirus disease-2019 (COVID-19) and pregnancy outcomes in patients with rheumatic disease who were pregnant at the time of infection. METHODS: Since March 2020 the COVID-19 Global Rheumatology Alliance (GRA) has collected cases of patients with rheumatic disease with COVID-19. We report details of pregnant women at the time of COVID-19 infection, including obstetric details separately ascertained from providers. RESULTS: We report on 39 patients, including 22 with obstetric detail available. The mean and median age was 33 years, range 24-45 years. Rheumatic disease diagnoses included: rheumatoid arthritis (n=9), systemic lupus erythematosus (n=9), psoriatic/other inflammatory arthritides (n=8) and anti-phospholipid antibody syndrome (n=6). Most had a term birth (16/22), with 3 pre-term births, one termination, one miscarriage and one woman yet to deliver at time of report. A quarter (n=10/39) of pregnant women were hospitalised following COVID-19 diagnosis. Two of 39 (5%) required supplemental oxygen (both hospitalised); no patient died. The majority did not receive specific medication treatment for their COVID-19 (n=32/39, 82%), seven patients received some combination of anti-malarials, colchicine, anti-IL-1beta, azithromycin, glucocorticoids, and lopinavir/ritonavir. CONCLUSION: Women with rheumatic diseases who were pregnant at the time of COVID-19 had favourable outcomes. These data have limitations due to the small size and methodology, though they provide cautious optimism for pregnancy outcomes for women with rheumatic disease given the increased risk of poor outcomes that have been reported in other series of pregnant women with COVID-19