Leamington Spa Hospital

ABSTRACTBackgroundApproximately 4.4 million people in England (8% of the total population) are living with a long‐term neurological condition. Within this group of vulnerable individuals, there will be individuals living with severe spasticity that requires regular outpatient treatment with botulinum toxin injection. The closure of outpatient spasticity services during the pandemic impacted individuals who required spasticity treatment and their carers, as well as the specialist clinicians responsible for service delivery.ObjectivesWe aimed to gain insight into the experiences of individuals living with spasticity, their carers and a clinical spasticity service lead during the pandemic, and to reflect on potential learning for the future.MethodsA qualitative study was designed using semi‐structured interviews conducted by telephone. Participants comprised patients living with a long‐term neurological condition who attended outpatient spasticity clinics before the start of the pandemic in England, primary carers who accompanied patients attending these clinics and a clinical spasticity service lead. Data were audio recorded, transcribed, anonymised and coded. Data analysis utilised the One Sheet of Paper thematic approach to identify themes, which were discussed and analysed by the interdisciplinary research team and two patient and carer participants.ResultsOut of the 11 participants recruited, aged 36–77 years, seven comprised people living with spasticity related to a long‐term neurological condition, three were carers and one was a clinical spasticity service lead. Six participants were male and five were female. Among the participants, four were stroke survivors, two were living with spinal cord injury and one was living with multiple sclerosis. Analysis revealed six major themes: experience of living with spasticity during the pandemic; impact of the pandemic on patient, carer and clinician health; access to and experience of outpatient clinic appointments; coping strategies during the pandemic; system improvements; and learning from the pandemic period.ConclusionThese findings contribute research knowledge to a very limited research knowledge base and suggest that there is scope for improving system and service delivery through the allocation of research funding to senior clinicians working in this specialist area.

People with neuroendocrine neoplasms (NENs) face a multitude of challenges, including delayed diagnosis, low awareness of the cancer among healthcare professionals and limited access to multidisciplinary care and expert centres. We have developed the first patient care pathway for people living with NENs in England to guide disease management and help overcome these barriers. The pathway was developed in two phases. First, a pragmatic review of the literature was conducted, which was used to develop a draft patient care pathway. Second, the draft pathway was then updated following semi-structured interviews with carefully selected expert stakeholders. After each phase, the pathway was discussed among a multidisciplinary, expert advisory group (which comprised the authors and the Deputy Chief Operating Officer, West Suffolk NHS Foundation Trust), who reached a consensus on the ideal care pathway. This article presents the outputs of this research. The pathway identified key barriers to care and highlighted how these may be addressed, with many of the findings relevant to the rest of the UK and international audiences. NENs are increasing in incidence and prevalence in England, compounding pre-existing inequities in diagnosis and disease management. Effective integration of this pathway within NHS England will help achieve optimal, equitable care provision for all people with NENs, and should be feasible within the existing expert multidisciplinary teams across the country.

The study of law as a social process should combine an analysis of structures from a political economy perspective with a sociological focus on the practices of lawyering in mediating social relations and conflicts through the formulation and interpretation of legal texts. This approach is applied here to software, which has become the oxygen of the world economy, powering the digitalisation that has transformed economic activities and social life. The forms this has taken have been moulded by lawyers, battling over intellectual property rights in computer programs, enshrining them in national law and international standards, as well as devising the international tax avoidance strategies that have helped propel the giant digital-tech transnational corporations to global dominance. These contests have taken place through processes of formulation and interpretation of the legal concepts that both reflect and shape social struggles over economic and political power, mediated by law, in contemporary corporate capitalism.

Phoresy is an association between two species in which one transports another. Burying beetles (Nicrophorus spp), also known as carrion beetles, carry mites. There are about 20 phoretic mites on this Nicrophorus beetle, seen in the Great Lakes–St Lawrence forest near Gravenhurst, Canada, and these mites will remain attached until they arrive at the beetle's next carcass. Male Nicrophorus beetles first locate the carcasses of small mammals or birds, and then prepare them by stripping off the fur or feathers. After locating a suitable male and mating, the female lays her eggs inside the prepared carrion. Males and females then bury the carcass in a ~20-cm-deep grave (which will become the beetle's brood chamber) by gradually excavating soil beneath it and covering it with antimicrobial secretions. Burying beetles are unusual in that both males and females take part in raising their young. The American burying beetle (Nicrophorus americanus) historically inhabited 35 states and three Canadian provinces but is now found in only five states and one province. In 1989, the US Fish and Wildlife Service listed it as endangered.