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Background/Aims Systemic lupus erythematosus, systemic vasculitis, inflammatory myositis, scleroderma and Sjogren’s syndrome are rare autoimmune rheumatic diseases (RAIRDs). A survey of people with RAIRDs found 61% were struggling, 45% had reduced/stopped work and 45% reported an impact on family life. A survey of NHS rheumatology departments found 80% do not offer access to self-management support to people with RAIRDs. Aims: To understand the patients’ experiences of their RAIRD and views on interventions to support self-management, including content and structure. Methods Online focus groups via Zoom using a topic guide developed with a multi-disciplinary team including patient partners with lived experience. Focus groups were advertised via patient charities’ social media platforms (Vasculitis UK, Scleroderma and Raynaud’s UK, Lupus UK, Myositis UK and the British Sjogren’s Syndrome Association). Sessions were audio-recorded, transcribed, organised using NVIVO, and analysed thematically. Results Twenty-six patients, 21 (80.76 %) female, median age 62 (range 34-82), participated in six focus groups. Diagnoses included systemic lupus erythematosus (4), inflammatory myositis (7), ANCA-associated vasculitis (5), mixed connective tissue disease (2), scleroderma (1), undifferentiated vasculitis (2), and primary or secondary Sjogren’s (16). Five patients (19%) were newly diagnosed ( Two related main themes capture the data:“I’m constantly doing medical admin along with surviving and fighting a disease.” A lack of joined-up healthcare (“I’ve got some great people but they’re not working as a team”), difficulty accessing specialists (“Everyone just passes you like the sort of parcel that no one wants to open”) and disease complexity (“she said you’re too complicated”) makes managing RAIRDs hard, resource-intensive work (“I’ve had to push so hard for all of it and I think that only happens with very rare conditions”).“Because you have very rare conditions it’s uniquely isolating.” The psychological impact of having complex autoimmune conditions can be exacerbated when they are poorly understood by family and friends (“I’ve encountered mental health problems having to manage family expectations of me”) and health professionals (“they’ve never seen a patient like me in their life”). Patients described strategies that could be beneficial at an individual level (“acceptance, mindfulness, meditation and to not beat myself up about things”) and the importance of addressing mental health (“you’ve got to build your self-esteem, so you don’t feel rubbish all the time”). Conclusion Patients with RAIRDs identified shared experiences to inform the development of a cross-condition self-management intervention. These include negotiating healthcare systems and managing the psychological impact of RAIRDs. Further work is needed with under-represented groups to identify whether their support needs are distinct. Disclosure E. Dures: None. C. Almeida: None. A. Hunt: None. P.C. Lanyon: None. N. Walsh: None. J.C. Robson: None.

The nature and breadth of protest movements in the 1960s continues to provoke debates. For years, scholars and participant-observers wrote largely top-down accounts of Students for a Democratic Society (SDS), suggesting the organization generated much of the protest of the era. This essay argues that recent trends in the field, particularly the works of younger historians such as David Farber and Alice Echols, represent important attempts to move beyond SDS-dominated sixties histories and focus on neglected constituencies of the period. Using Vietnam Veterans Against the War (VVAW) as an example, the essay shows that the scope of the sixties (and early seventies) protest was broader than previously assumed, and makes a plea to merge movement history with social history.

We used scanning electron microscopy to investigate autopsy tissue samples from 18 individuals who died at the time of the London smog event of 1952. Four lung tissue compartments were specifically targeted for analysis. The greatest diversity of particle types was found in the recent exposure compartment (aggregated in mucopurulent airway exudate). Metal-bearing particles were more common in the recent exposure compartment, while non-metal and Fecontaining particles were more abundant in the longer term retention compartments (lymph nodes and interstitial macrophages). Irrespective of location, these particles were usually associated with a matrix of carbon particles (∼100 nm in size). These data suggest that metal particles were an important part of the London aerosol at the time of the 1952 smog and that such particles are not necessarily preserved long-term in the lung. This lack of biopersistence may be a function of metal solubility and may have important toxicological implications.

The lungs act as a continuous sampler of respirable particulate matter in the environment. Quantitative analysis of the retained lung burden of particulate material provides important clues to exposures in individual cases as well as in epidemiological studies. Since 1980 we have developed and utilized microanalytical techniques to identify and quantify the inorganic particles retained in lungs. These results and the cumulative data in the database (initially described in 1991) have had far-ranging diagnostic and research applications. The database contains data from >900 non-fibrous particle analyses and >800 fibre analyses. In this report we summarize and highlight aspects of the database after 20 years.

The inhalation of respirable inorganic particles at low levels is a commonplace everyday occurrence. Typically, the types of particulates which are inhaled and variably retained in the lungs, are those commonly present in ambient aerosols. Much of the particulate matter is aeolian crustal material (deflationary soil) and anthropogenerated material (combustion emissions, construction products). This low or "background" level of exposure is usually orders of magnitude lower than the levels of exposure in occupational settings giving rise to lung disease. We have been studying the human lung burden of retained inorganic particulates for many years (Abraham and Burnett, 1983) and have developed an ever-expanding database (Abraham et al., 1991) of information on the lung burden in currently over 700 analyses of over 600 lungs. The database contains mostly data from persons with known or suspected aerosol particulate exposures of one kind or another; it also contains data from histologically normal lungs and lungs from persons with lung disease but not known occupational or environmental exposures. Previous studies have examined the relationship of concentrations of a few specific particles to pathologic reactions in patients with specific exposures and/or diseases, such as: sandblasters with silicosis; beryllium ceramics workers with and without chronic beryllium disease; cemented tungsten carbide workers with the unusual pathologic reaction; GIP (giant cell interstitial pneumonia); granulomatous and fibrotic lung disease in persons exposed to metals such as titanium, zirconium or aluminium; and welders. In addition, with the ongoing interest in the relationship of fine particulate aerosols in air pollution to health effects several studies have investigated the potential toxicity of various metals, especially the transition metals, Fe, Ni, V, Cu, Mn and Zn in materials such as residual oil fly ash (ROFA). The higher prevalence of such metals as V in ROFA than in particulates identified in, or recovered from lungs, is consistent with the importance of soluble metals from such particulates. Factors such as particle diameter, surface area, roughness and the presence of surface species are also likely to play critical roles. Metal particulate exposures are also of increasing interest in the etiology and pathogenesis of interstitial lung disease which might otherwise be termed "idiopathic" pulmonary fibrosis/"cryptogenic" fibrosing alveolitis (Kennedy and Chan-Yeung, 1996). Several years ago evidence of metal particulate exposure was

Alternately vilified as a publicity-seeking egoist and lauded as a rambunctious, fearless advocate, William Kunstler consistently embodied both of these qualities. Kunstler's unrelenting, radical critique of American racism and the legal system took shape as a result of his efforts to enlist the federal judicial system to support the civil rights movement. In the late 60s and the 70s, Kunstler, refocusing his attention on the Black Power and anti-war movement, garnered considerable public attention as defender of the Chicago Seven, and went on to represent such controversial figures as Leonard Peltier, the American Indian Movement leader charged with killing an FBI agent, and Jack Ruby, the killer of Lee Harvey Oswald. Later, Kunstler briefly represented Colin Ferguson, the Long Island Railroad mass murderer, outraging fans and detractors alike with his invocation of the infamous "black rage" defense. Defending those most loathed by mainstream, conventional America, William Kunstler delighted in taking on fiercely political cases, usually representing society's outcasts and pariahs free of charge and often achieving remarkable courtroom results in seemingly hopeless cases. Though Kunstler never gave up his revolutionary underpinnings, he gradually turned from defending clients whose political beliefs he personally supported to taking on apolitical clients, falling back on the broad rationale that his was a general struggle against an oppressive government. What ideological and tactical motives explain Kunstler's obsessive craving for media attention, his rhetorical flourishes in the courtroom and his instinctive and relentless drive for action? How did Kunstler migrate from a comfortable middle-class background to a life as a staunchly rebellious figure in social and legal history? David Langum's portrait gives depth to the already notorious breadth of William Kunstler's life.