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Quasilinear theories have been shown to well describe a range of transport phenomena in magnetospheric, space, astrophysical and laboratory plasma “weak turbulence” scenarios. It is well known that the resonant diffusion quasilinear theory for the case of a uniform background field may formally describe particle dynamics when the electromagnetic wave amplitude and growth rates are sufficiently “small”, and the bandwidth is sufficiently “large”. However, it is important to note that for a given wave spectrum that would be expected to give rise to quasilinear transport, the quasilinear theory may indeed apply for given range of resonant pitch-angles and energies, but may not apply for some smaller, or larger, values of resonant pitch-angle and energy. That is to say that the applicability of the quasilinear theory can be pitch-angle dependent, even in the case of a uniform background magnetic field. If indeed the quasilinear theory does apply, the motion of particles with different pitch-angles are still characterised by different timescales. Using a high-performance test-particle code, we present a detailed analysis of the applicability of quasilinear theory to a range of different wave spectra that would otherwise “appear quasilinear” if presented by e.g., satellite survey-mode data. We present these analyses as a function of wave amplitude, wave coherence and resonant particle velocities (energies and pitch-angles), and contextualise the results using theory of resonant overlap and small amplitude criteria. In doing so, we identify and classify five different transport regimes that are a function of particle pitch-angle. The results in our paper demonstrate that there can be a significant variety of particle responses (as a function of pitch-angle) for very similar looking survey-mode electromagnetic wave products, even if they appear to satisfy all appropriate quasilinear criteria. In recent years there have been a sequence of very interesting and important result

Background The Outcome Measures in Rheumatology (OMERACT) Glucocorticoid (GC) Impact Working Group has been working to develop a core domain set to measure the impact of GCs on patients living with rheumatic and musculoskeletal diseases. The mandatory domains previously identified for inclusion in all clinical trials measuring the GC effects include infection, bone fragility, mood disturbance, hypertension, diabetes, weight, fatigue, and mortality. Before progressing to instrument selection, the Working Group sought to establish precise definitions of all mandatory domains within the core domain set. Methods OMERACT methodology was applied with the use of evidence and consensus-based decision making of all stakeholder groups (patient research partners, health care professionals, clinician researchers, industry members and methodologists) to develop detailed definitions for the broad domain, target domain and domain components, taking into consideration sources of variability that could affect measurement of the domain. The working group synthesized prior qualitative studies, quantitative work, and results from Delphi rounds, to develop a rich definition of ‘what’ is to be measured. Results Between 2021 and 2023, the OMERACT Working Group on GC Impact conducted virtual meetings to establish domain definitions. First, we mapped each domain onto an OMERACT Core Area. All domains were primarily represented within the Pathophysiological Manifestations Core Area, except from Fatigue which was primarily Life Impact and Weight which spanned both Core Areas. Sources of variability included cultural factors, age, gender, education level, socioeconomic status, personal experiences, emotional state, and language barriers. The domain definitions will form the foundation for instrument selection and the initial step of domain / concept match and content validity in the OMERACT pillar of ‘truth’ before moving on to feasibility and discrimination., Background: The Outcome Measures in Rheumatology (OMERACT) Glucocorticoid (GC) Impact Working Group has been working to develop a core domain set to measure the impact of GCs on patients living with rheumatic and musculoskeletal diseases. The mandatory domains previously identified for inclusion in all clinical trials measuring the GC effects include infection, bone fragility, mood disturbance, hypertension, diabetes, weight, fatigue, and mortality. Before progressing to instrument selection, the Working Group sought to establish precise definitions of all mandatory domains within the core domain set. Methods: OMERACT methodology was applied with the use of evidence and consensus-based decision making of all stakeholder groups (patient research partners, health care professionals, clinician researchers, industry members and methodologists) to develop detailed definitions for the broad domain, target domain and domain components, taking into consideration sources of variability that could affect measurement of the domain. The working group synthesized prior qualitative studies, quantitative work, and results from Delphi rounds, to develop a rich definition of ‘what’ is to be measured. Results: Between 2021 and 2023, the OMERACT Working Group on GC Impact conducted virtual meetings to establish domain definitions. First, we mapped each domain onto an OMERACT Core Area. All domains were primarily represented within the Pathophysiological Manifestations Core Area, except from Fatigue which was primarily Life Impact and Weight which spanned both Core Areas. Sources of variability included cultural factors, age, gender, education level, socioeconomic status, personal experiences, emotional state, and language barriers. The domain definitions will form the foundation for instrument selection and the initial step of domain / concept match and content validity in the OMERACT pillar of ‘truth’ before moving on to feasibility and discrimination. Conclusion: The OMERACT GC I

Elizabeth Hoon,1 Carlee Ruediger,2,3 Tiffany K Gill,2 Rachel J Black,2,4 Catherine L Hill2–41School of Public Health, University of Adelaide, Adelaide, SA 5000, Australia; 2Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia; 3Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia; 4Rheumatology Unit, The Royal Adelaide Hospital, Adelaide, SA 5000, AustraliaCorrespondence: Catherine L HillAdelaide Medical School, University of Adelaide, Level 7, SAHMRI, North Tc, Adelaide, SA 5000, AustraliaEmail Catherine.Hill@sa.gov.auObjective: To determine patient experiences of glucocorticoid (GC) therapy in polymyalgia rheumatica (PMR) and giant cell arteritis (GCA).Methods: Patients with a diagnosis of PMR or GCA were invited to participate in this qualitative study that used focus groups to explore: symptoms onset, process of diagnosis, treatment, adverse effects (AEs), and ongoing condition/s management. Data were transcribed verbatim and a “framework” approach was used for analysis and interpretation.Results: Fourteen patients participated. Weight gain, changes in face and neck shape, and bruising were commonly reported and impacts of these AEs on quality of life were highlighted. Dealing with uncertainties associated with long-term experiences of the condition/s and cycles of GC treatment were raised as were workload demands for patients in managing both the condition and other people’s expectations and recommendations related to GC therapy.Conclusion: These findings demonstrate that the patient experience of GC use is poorly captured by usual physician monitoring for GC AEs. These findings suggest that development of a patient-reported outcome instrument for inflammatory conditions treated with GCs is required.Keywords: patient experience, polymyalgia rheumatica, giant cell arteritis, adverse effects, glucocorticoid therapy

OBJECTIVE: To inform development of a core domain set for outcome measures for clinical trials in polymyalgia rheumatica (PMR), we conducted patient consultations, a systematic review, a Delphi study, and 2 qualitative studies. METHODS: Domains identified by 70% or more of physicians and/or patients in the Delphi study were selected. The conceptual framework derived from the 2 qualitative research studies helped inform the meaning of each domain and its relationship to the others. The draft core domain set was refined by further discussion with patients and physicians who had participated in the Delphi study. At the Outcome Measures in Rheumatology (OMERACT) 2016, the domains were discussed and prioritized by 8 breakout groups. Formal voting took place at the end of the workshop and in the final plenary. RESULTS: Ninety-three percent of voters in the final plenary agreed that the inner core of domains considered mandatory for clinical trials of PMR should consist the following: laboratory markers of systemic inflammation, pain, stiffness, and physical function. Patients global and fatigue were considered important but not mandatory (outer core). The research agenda included psychological impact, weakness, physical activity, participation, sleep, imaging, and health-related quality of life. CONCLUSION: This core domain set was considered sufficiently well-defined that the next step will be to apply the OMERACT Filter 2.0 Instrument Selection Algorithm to select candidate instruments for a subsequent deeper dive into the data. This will allow instruments to be mapped onto each of our core domains to derive a core outcome set for PMR.

Giant cell arteritis (GCA) is one of the commonest forms of vasculitis in the elderly, and may result in blindness and stroke. The pathogenesis of GCA is not understood, although environmental, infectious and genetic risk factors are implicated. One gene of interest is PTPN22, encoding lymphoid protein tyrosine phosphatase (Lyp), expressed exclusively in immune cells, which is proposed to be an 'archetypal non-HLA autoimmunity gene'. The minor allele of a functional PTPN22 single nucleotide polymorphism (rs2476601, R620W), which disrupts an interaction motif in the protein, was originally reported to be associated with biopsy-proven GCA in Spanish patients, with supporting data from three replicate Northern European studies. Recently, this observation was extended with additional patients and controls, and studies encompassing European, Scandinavian, UK and American patients. The aim of our study was to determine the association between PTPN22 rs2476601 (R620W) and biopsy-proven GCA in an Australian case cohort.

An overview of the electromagnetic (EM) physics of the Geant4 toolkit is presented Two sets of EM models are available: the 'Standard' initially focused on high energy physics (HEP) while the 'Low-energy' was developed for medical, space and other applications The 'Standard' models provide a faster computation but are less accurate for keV energies, the 'Low-energy' models are more CPU time consuming A common interface to EM physics models has been developed allowing a natural combination of ultra-relativistic, relativistic and low-energy models for the same run providing both precision and CPU performance Due to this migration additional capabilities become available The new developments include relativistic models for bremsstrahlung and e+e- pair production, models of multiple and single scattering, hadron/ion ionization, microdosimetry for very low energies and also improvements in existing Geant4 models In parallel, validation suites and benchmarks have been intensively developed (author)

Over recent years there have been several political imperatives in the UK directed toward children's palliative care and ensuring that services are high-quality, coordinated, family-centred, and able to meet the needs of children with complex disabilities. In addition, in 2010 the health and social care regulation authority in England-the Care Quality Commission (CQC)-aligned hospices with regulation and inspection requirements. This context has acted as a driver for the creation of effective education and training to ensure a skilled and expert workforce. Against this backdrop, this paper describes a project to develop a learning and development strategy for Children's Hospices across London (CHaL). CHaL educators worked with a research team to develop a unified strategy that was based on evidence of good practice, embedded in required CQC outcomes, and validated with a wider audience. The resultant strategy contains a set of four key leaming and development principles that are applicable and transferable across different hospices.

Kent New Opportunities to Work (Kent NOW) has been developed by Kent County Council (KCC) to deliver the Second Local Public Service Agreement (LPSA2) target 8.2, to return 250 long-term Incapacity Benefit (IB) claimants to sustained (13+ weeks) employment. This report presents a qualitative evaluation of the programme, comprising interviews with service providers at three intervention sites, service users and others working with the same client group. The evaluation aims: ? To provide a rich description of the interventions deployed in Folkestone, Maidstone and North Kent; ? To reveal the experiences of the service users and staff who use or provide these interventions; ? To uncover possible explanations for the limited success of the interventions in achieving the LPSA2 target; ? In light of the above, to discover alternative perceptions of ‘success’; ? To identify which aspects of each programme are performing most effectively and why; and ? To provide recommendations regarding the future direction of future interventions with this client group. An overwhelming message from this evaluation is that Kent NOW is working within a very difficult environment, considering: the client group; the lack of prior knowledge of the client group, not just within Kent NOW, but throughout government, in light of the novelty of policy and action in this area; strategic and managerial difficulties; and the political environment. These factors have been shown to have impacted upon the ability of the interventions to achieve their goals to an extent that should not be underestimated. Lessons learnt from the Kent NOW programme can be taken forward and applied in future interventions with this client group. In this sense, the authors consider the Kent NOW programme to be successful, exposing the many barriers to returning long-term IB claimants to work. This evaluation has, in turn, highlighted the ways in which future interventions may overcome these barriers, increasing the likelihoo

Aim To develop a model of change during and following professional treatment for drinking problems, grounded in clients' accounts. Participants Subsets of consecutively selected clients of the UK Alcohol Treatment Trial (UKATT), followed-up at 3 months (n = 211) and 12 months (n = 198) after randomization. Location Five statutory and non-statutory alcohol problems treatment agencies in three areas of England and Wales. Data Open-ended interviews conducted according to a brief interview guide, leading to 4002013800-word post-interview reports used for analysis (tape-recordings used for auditing purposes). Analysis Reports analysed by a team according to grounded theory principles, involving an iterative process with successive refinement of interviewing and analysis with each successive batch of data. Findings A model of change from the clients' perspective was developed. Treatment was seen by clients as facilitating various changes in ways of thinking and/or increased support of various kinds from family and friends, along with new ways of acting in relation to drinking or more generally. For many those changes had led to an appreciation of the benefits accruing to them. Treatment was seen as part of a broader treatment system which included pretreatment assessment, forms of help additional to the trial treatment, plus an element of self-directed change during and following treatment. Taken with awareness of worsening alcohol-related harms, triggering events and external influence to seek treatment (the catalyst system), to which clients continued to refer following treatment, the change process is depicted as a complex, ongoing set of systems in which a trial treatment is embedded.Conclusions Models of change should be broadened so that treatment is seen as a complex system of parts, facilitating a nexus of cognitive, social and behavioural changes, embedded within a broader system of events and processes catalysing change. Such a model helps explain t

Quasilinear theories have been shown to well describe a range of transport phenomena in magnetospheric, space, astrophysical and laboratory plasma “weak turbulence” scenarios. It is well known that the resonant diffusion quasilinear theory for the case of a uniform background field may formally describe particle dynamics when the electromagnetic wave amplitude and growth rates are sufficiently “small”, and the bandwidth is sufficiently “large”. However, it is important to note that for a given wave spectrum that would be expected to give rise to quasilinear transport, the quasilinear theory may indeed apply for given range of resonant pitch-angles and energies, but may not apply for some smaller, or larger, values of resonant pitch-angle and energy. That is to say that the applicability of the quasilinear theory can be pitch-angle dependent, even in the case of a uniform background magnetic field. If indeed the quasilinear theory does apply, the motion of particles with different pitch-angles are still characterised by different timescales. Using a high-performance test-particle code, we present a detailed analysis of the applicability of quasilinear theory to a range of different wave spectra that would otherwise “appear quasilinear” if presented by e.g., satellite survey-mode data. We present these analyses as a function of wave amplitude, wave coherence and resonant particle velocities (energies and pitch-angles), and contextualise the results using theory of resonant overlap and small amplitude criteria. In doing so, we identify and classify five different transport regimes that are a function of particle pitch-angle. The results in our paper demonstrate that there can be a significant variety of particle responses (as a function of pitch-angle) for very similar looking survey-mode electromagnetic wave products, even if they appear to satisfy all appropriate quasilinear criteria. In recent years there have been a sequence of very interesting and important result