Tracking the Trends of the Self-Represented Litigant Phenomenon: Data from the National Self-Represented Litigants Project, 2019-2021

The last report covering data collected by the National Self-Represented Litigants Project (NSRLP) (information shared by self-represented litigants between January 1, 2018 and June 30, 2019) was published in January 2020, a mere two months before courts across Canada were left scrambling to adapt to a new reality: the COVID-19 pandemic. Nearly eighteen months later—after thousands of virtual hearings, new protocols, and public health challenges that both improved and destabilized access to justice in myriad different ways—the NSRLP is bringing forward its findings collected from SRLs from July 1, 2019 to June 30, 2021, from a total of 279 respondent

The Peaky Blinders: A Postmodern and Ideological Analysis of Class, Gender, and Nationalism

This paper focuses on the ideological and postmodern approaches to analyzing the popular television show from the British Broadcasting Corporation, Peaky Blinders. Utilizing a thematic approach for analysis, this paper highlights social class, gender, and nationalism throughout the show that best exemplifies the impact it has on challenging and subverting traditional narratives, as well as reflecting and upholding particular beliefs and values about the world. The analysis of the themes, and intersectionality of the themes, assesses the impact the television show has on audience viewpoints of social constructs, norms, and reality

A Qualitative Study Exploring the Perceptions and Experiences of Parents and Carers of People with Learning Disabilities When Accessing Healthcare

Historically people with learning disabilities (LD) have been subjected to discrimination, segregation, poor standards of care and even violence and abuse. Government policies have evolved with a changing society to incorporate people with LD into mainstream care with the most recent policies Valuing People (DoH, 2001) and Valuing People Now (DoH, 2009). Healthcare is of huge concern to people with LD and this has been accounted for in these policies. The healthcare of people with LD still, however, faces challenges. There is also a lack of assessment of the current policies and procedures, taking into account the views of those involved in the care of people with LD. This is a qualitative study exploring the views of parents and carers of people with LDs when accessing healthcare. A sample of seven participants, all carers or parents of people with LD, were interviewed. The transcripts of these interviews were analysed using the generic qualitative approach and three themes were identified: bad memories from the past, how things are now and hopes for the future. The results showed show consistencies with the literature reviewed regarding this subject, however, inconsistencies were also noted. The need for better nursing education regarding LD, for all branches, was identified and recommendations have been made for future nursing education, practice and research. The limitations of this study have been acknowledged and, even in light of these, it is hoped that this study contributes positively to research into healthcare for people with LD

A Qualitative Study Exploring the Perceptions and Experiences of Parents and Carers of People with Learning Disabilities When Accessing Healthcare

Historically people with learning disabilities (LD) have been subjected to discrimination, segregation, poor standards of care and even violence and abuse. Government policies have evolved with a changing society to incorporate people with LD into mainstream care with the most recent policies Valuing People (DoH, 2001) and Valuing People Now (DoH, 2009). Healthcare is of huge concern to people with LD and this has been accounted for in these policies. The healthcare of people with LD still, however, faces challenges. There is also a lack of assessment of the current policies and procedures, taking into account the views of those involved in the care of people with LD. This is a qualitative study exploring the views of parents and carers of people with LDs when accessing healthcare. A sample of seven participants, all carers or parents of people with LD, were interviewed. The transcripts of these interviews were analysed using the generic qualitative approach and three themes were identified: bad memories from the past, how things are now and hopes for the future. The results showed show consistencies with the literature reviewed regarding this subject, however, inconsistencies were also noted. The need for better nursing education regarding LD, for all branches, was identified and recommendations have been made for future nursing education, practice and research. The limitations of this study have been acknowledged and, even in light of these, it is hoped that this study contributes positively to research into healthcare for people with LD

Modelling palliative and end-of-life resource requirements during COVID-19:implications for quality care

OBJECTIVES: The WHO estimates that the COVID-19 pandemic has led to more than 1.3 million deaths (1 377 395) globally (as of November 2020). This surge in death necessitates identification of resource needs and relies on modelling resource and understanding anticipated surges in demand. Our aim was to develop a generic computer model that could estimate resources required for end-of-life (EoL) care delivery during the pandemic. SETTING: A discrete event simulation model was developed and used to estimate resourcing needs for a geographical area in the South West of England. While our analysis focused on the UK setting, the model is flexible to changes in demand and setting. PARTICIPANTS: We used the model to estimate resourcing needs for a population of around 1 million people. PRIMARY AND SECONDARY OUTCOME MEASURES: The model predicts the per-day 'staff' and 'stuff' resourcing required to meet a given level of incoming EoL care activity. RESULTS: A mean of 11.97 hours of additional community nurse time, up to 33 hours of care assistant time and up to 30 hours additional care from care assistant night sits will be required per day as a result of out of hospital COVID-19 deaths based on the model prediction. Specialist palliative care demand is predicted to increase up to 19 hours per day. An additional 286 anticipatory medicine bundles per month will be necessary to alleviate physical symptoms at the EoL care for patients with COVID-19: an average additional 10.21 bundles of anticipatory medication per day. An average additional 9.35 syringe pumps could be needed to be in use per day. CONCLUSIONS: The analysis for a large region in the South West of England shows the significant additional physical and human resource required to relieve suffering at the EoL as part of a pandemic response

Does visual perceptual testing correlate with caregiver and teacher reported functional visual skill difficulties in school-aged children? Considerations for practice

Purpose - As occupational therapists embrace evidence-informed and occupation-centred practice, the use of standardised visual perceptual tests remains a strong feature of typical paediatric practice. Yet, the research evidence for the use of such tools is inconclusive at best. This study compared the results of the Test of Visual Perceptual Skills (TVPS) with a checklist of reported functional difficulties in 30 children attending occupational therapy. The purpose of this paper was to determine the usefulness of visual perceptual testing in relation to occupation-centred practice. Design/methodology/approach - A descriptive correlational study design was used. Participants were 30 primary school-age children who were on a paediatric occupational therapy caseload. An additional 30 typically developing children participated in the development of the checklist. Findings - Correlations were found between reported functional visual skill difficulties and two subtests of the TVPS (visual memory and visual discrimination). No correlation was found between the reported functional difficulties and any of the other five subtests of the TVPS or the total score. Originality/value - Results highlight the weak relationship that existed in this study between standardised measures of visual perception, as measured by the TVPS, and functional difficulties. Therapists are cautioned to explore both the evidence base for continued use of standardised visual perceptual measures to inform occupation-centred practice and the need to embrace a more comprehensive person-centred approach to visual perceptual assessment

Association of Parental Obesity and Diabetes Mellitus With Circulating Adipokines in Nonobese Nondiabetic Offspring

BACKGROUND: Adipokines are implicated in the development of obesity-related traits. We hypothesized that nonobese participants without diabetes mellitus (DM) whose parents were obese or had DM would have altered circulating adipokines compared with those without parental history of these conditions. METHODS AND RESULTS: Participants in the community-based Framingham Third Generation cohort who were not obese (body mass index \u3c 30) and not diabetic with both parents in the Framingham Offspring cohort were included in this analysis (n=2034, mean age 40 years, 54% women). Circulating concentrations of fetuin A, RBP4 (retinol binding protein 4), FABP4 (fatty acid binding protein 4), leptin, LEP-R (leptin receptor), and adiponectin were assayed. Parental DM was defined as occurring before age 60 years, and obesity was defined as body mass index \u3e /=30 before age 60 years. General estimating equations were used to compare concentrations of adipokines among participants with 0, 1, or 2 parents affected by obesity or DM (separate analyses for each), adjusting for known correlates of adipokines. Overall, 44% had at least 1 parent who was obese and 15% had parents with DM. Parental obesity was associated with higher serum levels of FABP4 and LEP-R in their offspring (P=0.02 for both). Parental DM was associated with lower adiponectin but higher RBP4 concentrations in offspring (P \u3c /=0.02 for both). CONCLUSIONS: In our community-based sample, a parental history of DM or obesity was associated with an altered adipokine profile in nonobese nondiabetic offspring. Additional studies are warranted to evaluate whether such preclinical biomarker alterations presage future risk of disease

Where do UK clinicians find information at the point of care? A pragmatic, exploratory study

Funding: CSO Fellowship (MM).Aim To describe where clinical information is contemporarily and commonly found in UK primary care, what is favoured by clinicians, and whether this is (1) publicly funded (2) has commercial potential conflicts of interest. Design and setting A mixed methods study, consisting of (1) site visits to general practices in Scotland, (2) online questionnaire, focused on UK general practice (3) analysis of materials cited by professionals. Methods Data about sources of clinical information used was obtained verbally, visually and via search histories on computers from visits. This was used to inform a questionnaire in which primary care clinicians in the four nations of the UK were invited to participate. This obtained data about the information sources used and preferred by clinicians. This information was searched for data about funding and conflicts of interest. Results Over 2022, four practices were visited. 337 clinicians, 280 of whom were general practitioners completed an online questionnaire. 136 different resources were identified. These were mainly websites but sources of information included colleagues, either in practice or through online networks, apps, local guidelines, health charities, and learning resources aimed at GPs. Of these, 70 were not publicly funded, and were a mixture of membership organisations, charities, or sponsored venues. Conclusions Primary care clinicians obtain information for themselves and patients from a wide variety of sources. Funding is from a variety of sources and some contain advertising and/or sponsorship, risking commercial bias. Protocol Pre-published at https://osf.io/wrzqk.Peer reviewe

Human Inborn Errors of Immunity: 2019 Update on the Classification from the International Union of Immunological Societies Expert Committee.

We report the updated classification of Inborn Errors of Immunity/Primary Immunodeficiencies, compiled by the International Union of Immunological Societies Expert Committee. This report documents the key clinical and laboratory features of 430 inborn errors of immunity, including 64 gene defects that have either been discovered in the past 2 years since the previous update (published January 2018) or were characterized earlier but have since been confirmed or expanded upon in subsequent studies. The application of next-generation sequencing continues to expedite the rapid identification of novel gene defects, rare or common; broaden the immunological and clinical phenotypes of conditions arising from known gene defects and even known variants; and implement gene-specific therapies. These advances are contributing to greater understanding of the molecular, cellular, and immunological mechanisms of disease, thereby enhancing immunological knowledge while improving the management of patients and their families. This report serves as a valuable resource for the molecular diagnosis of individuals with heritable immunological disorders and also for the scientific dissection of cellular and molecular mechanisms underlying inborn errors of immunity and related human diseases