The development of direct payments in the UK: implications for social justice

Direct payments have been heralded by the disability movement as an important means to achieving independent living and hence greater social justice for disabled people through enhanced recognition as well as financial redistribution. Drawing on data from the ESRC funded project Disabled People and Direct Payments: A UK Comparative Perspective, this paper presents an analysis of policy and official statistics on use of direct payments across the UK. It is argued that the potential of direct payments has only partly been realised as a result of very low and uneven uptake within and between different parts of the UK. This is accounted for in part by resistance from some Labour-controlled local authorities, which regard direct payments as a threat to public sector jobs. In addition, access to direct payments has been uneven across impairment groups. However, from a very low base there has been a rapid expansion in the use of direct payments over the past three years. The extent to which direct payments are able to facilitate the ultimate goal of independent living for disabled people requires careful monitoring

WHO criteria for measles elimination: A critique with reference to criteria for polio elimination

Smallpox was formally declared as eradicated in 1979. Smallpox is the only infectious disease of humans that has ever been eradicated. Poliomyelitis has been eliminated from three of the six World Health Organization (WHO) regions although not all countries within those regions always meet the elimination criteria. Elimination criteria for measles are being discussed. We use poliomyelitis and measles as examples to illustrate our assertion that the current approach to documenting measles elimination relies too heavily on criteria for surveillance quality, disadvantaging countries with long established and relatively inflexible surveillance systems. We propose an alternative approach to documenting measles elimination, with the two key criteria being molecular evidence to confirm the lack of a circulating endemic genotype for at least one year and maintenance of 95% coverage of one dose of measles-containing vaccine, with an opportunity for a second dose. Elimination status should be reviewed annually. We suggest four principles that should guide development of final criteria to document measles elimination: countries that have eliminated measles should be able to meet the elimination criteria; quality surveillance criteria are necessary but not sufficient to define elimination; quality surveillance criteria should be guided by elimination criteria, not the other way around; and elimination criteria should not differ between the WHO regions without good reason

Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background

Background: Pain, both from the surgical site, and from other sources such as musculoskeletal backache, can persist after caesarean section. In this study of a predominantly socially deprived population we have sought to prospectively examine the association between antenatal maternal anxiety and socioeconomic background and the development of persistent pain of all sources after caesarean section. Methods: Demographic details and an anxiety questionnaire were completed by 205 women before elective caesarean section. On the first postoperative day, pain scores were recorded, and at four months patients were asked to complete a Brief Pain Inventory and an Edinburgh Postnatal Depression Score. Results: Of 205 parturients recruited, 186 records were complete at the hospital admission phase and 98 (52.7%) were complete at the four-month follow-up phase. At recruitment, 15.1% reported pain. At four months 41.8% (95% CI 32.1 to 51.6%) reported pain, of whom pain was a new finding in 35.7% (95% CI 26.2 to 45.2%). Antenatal anxiety was not a significant predictor of severity of new pain at four months (P=0.43 for state anxiety, P=0.52 for trait anxiety). However, four-month pain severity did correlate with social deprivation (P=0.011), postnatal depression (P<0.001) and pain at 24 h (P=0.018). Conclusion: Persistent pain from a variety of sources after caesarean section is common. Our findings do not support the use of antenatal anxiety scoring to predict persistent pain in this setting, but suggest that persistent pain is influenced by acute pain, postnatal depression and socioeconomic deprivation

Semiclassical Treatment of Diffraction in Billiard Systems with a Flux Line

In billiard systems with a flux line semiclassical approximations for the density of states contain contributions from periodic orbits as well as from diffractive orbits that are scattered on the flux line. We derive a semiclassical approximation for diffractive orbits that are scattered once on a flux line. This approximation is uniformly valid for all scattering angles. The diffractive contributions are necessary in order that semiclassical approximations are continuous if the position of the flux line is changed.Comment: LaTeX, 17 pages, 4 figure

Clonal kinetics and single-cell transcriptional profiling of CAR-T cells in patients undergoing CD19 CAR-T immunotherapy

Chimeric antigen receptor (CAR) T-cell therapy has produced remarkable anti-tumor responses in patients with B-cell malignancies. However, clonal kinetics and transcriptional programs that regulate the fate of CAR-T cells after infusion remain poorly understood. Here we perform TCRB sequencing, integration site analysis, and single-cell RNA sequencing (scRNA-seq) to profile CD8+ CAR-T cells from infusion products (IPs) and blood of patients undergoing CD19 CAR-T immunotherapy. TCRB sequencing shows that clonal diversity of CAR-T cells is highest in the IPs and declines following infusion. We observe clones that display distinct patterns of clonal kinetics, making variable contributions to the CAR-T cell pool after infusion. Although integration site does not appear to be a key driver of clonal kinetics, scRNA-seq demonstrates that clones that expand after infusion mainly originate from infused clusters with higher expression of cytotoxicity and proliferation genes. Thus, we uncover transcriptional programs associated with CAR-T cell behavior after infusion.Published versio