The feminisation of British neurology: implications for workforce planning.

As in other hospital specialties, an increasing proportion of neurology trainees are female. To predict the workforce implications it is necessary to determine what life choices future neurologists will make. A questionnaire survey of life choices was administered to neurology consultants and trainees, general medical senior house officers, and medical students. Of the 344 respondents, 3% of specialist registrars (SpRs) and 4.6% of consultants work part time. Eighty-seven per cent of female and 22% of male junior doctors plan to work part time for, on average, 7.5 and 1.5 years respectively. Thirty percent of consultants also plan to work part time. A number of SpRs (14.3%) and consultants (6%) have taken a career break while 37.5% of SpRs and 18.2% of consultants are planning a career break. The changing demands of both sexes will have a greater impact on the neurology workforce than the increasing proportion of women alone. Increased part-time working will require additional trainees to ensure service requirements are met

Feminist composite narratives of Chinese women: the interrelationship of work, family and community in forced labour situations

This contribution builds on the work Lewis has engaged in around women’s decision-making processes on work and care. Gender has been an important consideration across her work and this has been explored in familial and organisational settings. The personal is undoubtedly political and a feminist lens privileges this. Previous research (including Lewis) has marked a shift from work-life balance to work personal life integration. This implies agency and perhaps a particular kind of woman able to make choices. In contrast, this paper focuses on Chinese migrant women working in vulnerable situations. Drawing on data gathered from a forced labour project, we present some composite narratives from women as daughters, mothers and wives. These highlight the role of the core economy in decisions about migration for work. Inevitably work decisions are bound up with and situated in wider care and familial networks. These insights around emotional and practical labour are feminist concerns. We present the complex decisions made by women around precarious work, present and distant ‘families’ and care. We suggest that future work-life research should heed Lewis’ call for more nuanced understandings of the multi-layered context of people’s experiences, workplace practices and relevant national policies, but go beyond this, to pay attention to the globalised forces underpinning ever greater inequity in work, in families and in communities

Participation in community arts: lessons from the inner-city

In this paper, we critically reflect, through the lens of liberation psychology, on our experiences of using participative community arts in work with young people and intergenerational groups in inner-city Manchester, UK. We used mixed methods to examine the impact of and engagement with community arts in two projects. One study was quasi experimental in design and used questionnaires developed by the researchers to compare Higher Education aspirations with levels of self-esteem and self-efficacy, as a result of participating in creative music sessions. The other study was a multi-media action research project, using qualitative methods to explore participant experience and the impact of the activities. Our methods included observations, interviews, the creative products and the creative processes. Through our critical reflections, we examine the role of power and powerlessness in participative arts, as well as ways in which participation had the potential to enable ‘conscientisation', which in turn had the potential to lead to self-empowerment and motivation for action. Both projects demonstrated the importance of forming ‘communities of practice’ with a diverse range of stakeholders in order to gain maximum impact from the projects and move towards a position of collaborative governance. We found that this approach was a useful starting point for facilitating ‘collaborative governance’ for wider social and political change

'I'm not a therapist you know...I'm an artist': Facilitating well-being and basic psychological needs satisfaction through community arts participation

The role of the artist is crucial to the success of arts for health initiatives yet remains under-explored in the research literature. This article examines the practice of arts facilitation through the lens of self-determination theory (SDT). Fourteen interviews with artists leading projects for older adults across three settings were subject to a secondary thematic analysis. A hybrid approach was adopted with themes developed inductively and deductively. Artists were found to satisfy participants’ basic psychological needs in diverse ways. Autonomy: artists spoke of valuing the expression of individual differences and identities, encouraging participants to assume ownership of projects. Competence: developing participants’ aptitudes and skills and repairing negative self-beliefs emerged as common goals. Relatedness: artists sought to cultivate social interaction within groups and forge relationships with participants themselves. Self-determination theory provides a well-validated framework to conceptualize the psycho-social processes mediating arts project outcomes relating to psychological well-being

Dis/ability and austerity: Beyond work and slow death

The forthcoming book Dis/ability Studies: Theorising Disablism and Ableism argues that we are living in an historical epoch which might be described as neoliberal-ableism, in which we are all subjected to slow death, increased precarity and growing debility. In this paper we apply this analysis to a consideration of austerity with further reference to disability studies and politics

The evidence for switching dibenzazepines in people with epilepsy

This is the author accepted manuscript. The final version is available on open access from Wiley via the DOI in this recordThe dibenzazepines particularly carbamazepine are associated with known adverse effects (AEs) and drug to drug interactions. Eslicarbazepine acetate (ESL) is structurally distinct from other members of the dibenzazepine family and has the advantage of once daily dosing. Observational and trial data report successful switching from older dibenzazepines to ESL. The evidence base for doing so is unclear and not standardised. This is a literature review following the PRISMA scoping guidelines identifying the evidence of switching dibenzazepines. Transition methods, ratios, tolerance to change, adverse effects and retention post change were evaluated. Study quality was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. Seven studies investigated the outcome of transition between carbamazepine and or oxcarbazepine to ESL, with specific data on the transition dose ratio and scheduling. The available data suggest that the overnight transition between oxcarbazepine and ESL in a 1:1 ratio (most common) is generally well tolerated with high retention rates. The transition showed improvement in adverse events associated with oxcarbazepine across a variety of domains. Almost 60% transitioned because of adverse events experienced no further symptoms at 12 months. There is less data on the transition from carbamazepine to ESL. The evidence available suggests an overnight transition in the ratio of 1:1.3-1.5. The retention rate following transition from carbamazepine to ESL was 69% (follow up of four months) with almost half of those transitioned because of adverse events experiencing no further symptoms. There is Grade C evidence available to help guide clinicians in the transition

Partnership working as liberation psychology: Forced labor among UK Chinese migrant workers

© 2017 Taylor & Francis. In this article we seek to reflect critically on some recent research we have carried out, in collaboration with a Chinese welfare NGO, on the experience of forced labor among Chinese migrant workers in the UK. We will (a) locate briefly the wider political context of migrant work (both regular and irregular) in the UK; (b) explore how and why the actual research methods and process of the research deviated in practice from those that were planned; and (c) show the extent to which aspects of the research process reflected a liberation psychology perspective

Trace.space: a psychogeographical community project with members of an arts and health organisation

In this paper we theorise a situationist psychogeographical community group work project, conducted with members of an arts and health organization. Using creative ways to improve the mental health and well-being of individuals, we draw on the concepts of trace and spaces both to map relationships between researchers and group members and project implications. This project was driven by three aims which were: to do community group-work in order to produce contributions both inside and outside of the University; to use a psychogeographical approach to playfully critique everyday life in consumer capitalist society and finally, to consider the extent to which wider personal and political changes could be enabled. To realise these aims, we put into practice a range of architectural, critical community psychological and psychogeographical methods including photo-elicitation, dice walking and site specific investigations. We also facilitated participatory workshops via the creation of artistic and reflective maps and writing poems and stories. Reflections from all the stakeholders, conclusions and implications of this work are considered in terms of individual, group and societal changes. We argue for more psychogeographically inspired work

Work, Parenting and Gender: The care-work negotiations of three couple relationships in the UK

Changes globally mean that there are now record numbers of mothers in paid employment and a reported prevalence of involved fathering. This poses challenges to mothers and fathers as they negotiate care-work practices within their relationships. Focusing on interviews with three heterosexual couples (taken from a wider UK qualitative project on working parents), the paper considers care-work negotiations of three couples, against a backdrop of debates about intensive mothering and involved fathering. It aims to consider different configurations of work and care within three different couple relationships. We found that power within the relationships was negotiated along differential axis of gender and working status (full or part time paid work) . We present qualitatively rich insights into these negotiations. Framed by a critical discursive psychological approach, we call on other researchers to think critically about dominant discourses and practices of working, caring and parenting, pointedly how couples situated around the world operationalise these discourses in talking about themselves as worker and carers

Forecasting stroke-like episodes and outcomes in mitochondrial disease

In this retrospective, multicentre, observational cohort study, we sought to determine the clinical, radiological, EEG, genetics and neuropathological characteristics of mitochondrial stroke-like episodes and to identify associated risk predictors. Between January 1998 and June 2018, we identified 111 patients with genetically-determined mitochondrial disease who developed stroke-like episodes. Post-mortem cases of mitochondrial disease (n = 26) were identified from Newcastle Brain Tissue Resource. The primary outcome was to interrogate the clinic-radio-pathological correlates and prognostic indicators of stroke-like episode in patients with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes syndrome. The secondary objective was to develop a multivariable prediction model to forecast stroke-like episode risk. The most common genetic cause of stroke-like episodes was the m.3243A>G variant in MT-TL1 (n = 66), followed by recessive pathogenic POLG variants (n = 22), and 11 other rarer pathogenic mitochondrial DNA (mtDNA) variants (n = 23). The age of first stroke-like episode was available for 105 patients (mean [SD] age: 31.8 [16.1]); a total of 35 patients (32%) presented with their first stroke-like episode ≥40 years of age. The median interval (interquartile range) between first and second stroke-like episodes was 1.33 (2.86) years; 43% of patients developed recurrent stroke-like episodes within 12 months. Clinico-radiological, electrophysiological and neuropathological findings of stroke-like episodes were consistent with the hallmarks of medically refractory epilepsy. Patients with POLG-related stroke-like episodes demonstrated more fulminant disease trajectories than cases of m.3243A>G and other mtDNA pathogenic variants, in terms of the frequency of refractory status epilepticus, rapidity of progression and overall mortality. In multivariate analysis, baseline factors of body mass index, age-adjusted blood m.3243A>G heteroplasmy, sensorineural hearing loss and serum lactate were significantly associated with risk of stroke-like episodes in patients with the m.3243A>G variant. These factors informed the development of a prediction model to assess the risk of developing stroke-like episodes that demonstrated good overall discrimination (area under the curve = 0.87, 95% CI 0.82-0.93; c-statistic = 0.89). Significant radiological and pathological features of neurodegeneration was more evident in patients harbouring pathogenic mtDNA variants compared with POLG: brain atrophy on cranial MRI (90% vs 44%, p G variant can help inform more tailored genetic counselling and prognostication in routine clinical practice