Impact of the Covid-19 Pandemic on ALS Care in the UK

The Covid-19 pandemic has impacted healthcare. Our aim was to identify how amyotrophic lateral sclerosis (ALS) care in the UK has been affected by the pandemic by exploring the experiences of people living with ALS (plwALS), healthcare professionals (HCPs) working with plwALS, and ALS care centers. Three surveys were carried out to explore the experiences of plwALS, HCPs and ALS care centers during the pandemic. Quantitative data were analyzed using descriptive and inferential statistics and triangulated with the qualitative data which were analyzed thematically. Responses from 53 plwALS, 73 HCPs and 23 ALS care centers were analyzed. Five main themes were identified: keeping safe, losses, negative emotions, delivering care and alternative care delivery in a pandemic. PlwALS and HCPs felt that care was sub-optimal as a result of the pandemic. Changes to care included longer waiting times and face-to-face appointments being canceled or replaced by virtual consultations. While benefits of virtual consultations were reported, concerns were raised about incomplete clinical assessments and the disruption of provision of testing and interventions. ALS care has changed as a result of the pandemic. Patients have had a lack of face-to-face contact with HCPs and have experienced delays to investigations and treatments. PlwALS and HCPs were concerned about the impact of this change, but the long-term implications remain unclear. We propose recommendations for HCPs caring for plwALS, that will promote continuity of evidenced based care in the context of a pandemic

A risk society? Environmental hazards, risk and resilience in the later Middle Ages in Europe

Modern society is said to have restructured in reaction to contemporary hazards with the aim of improving its management of risk. This implies that pre-industrial societies were somehow fundamentally different. In this paper, we challenge that hypothesis by examining the ways in which risks associated with environmental hazards were managed and mitigated during the Middle Ages (defined here as the period from 1000 to 1550 AD). Beginning with a review of the many case studies of rapid onset disasters across Europe, we draw upon both historical and archaeological evidence and architectural assessments of structural damage for what is a pre-instrumental period. Building upon this, the second part of the paper explores individual outlooks on risk, emphasising the diversity of popular belief and the central importance of Christianity in framing attitudes. Despite their religious perspectives, we find that medieval communities were not helpless in the face of serious environmental hazards. We argue instead that the response of society to these threats was frequently complex, considered and, at times, surprisingly modern