Central London Research Articles

Effectiveness of a new 3D printed simulator for mitral transcatheter edge-to-edge repair in enhancing the confidence and procedural skills of the operator

Background. Mitral transcatheter edge-to-edge repair (m-TEER) is a minimally invasive procedure for treating mitral regurgitation (MR). m-TEER is a highly technical procedure, and a steep learning curve needs to be overcome for operators to ensure optimal patient outcomes and minimise procedural complications. Training via online simulation and observation of procedures is not sufficient to establish operator confidence; thus, advanced hands-on training modalities need to be explored and developed.Methods. In this study, a novel anatomical simulator for m-TEER training was evaluated in comparison to a standard model. The proposed simulator resembled the anatomical features of the right and left atrium, left ventricle and mitral valve apparatus. Participants in the questionnaire (n = 18) were recruited across 4 centres in London with (n = 8) and without (n = 10) prior experience in m-TEER. Participants were asked to simulate procedures on both an idealised, routinely used simulator and the newly proposed anatomical model. The questionnaire was designed to assess (i) participants’ confidence before and after training and (ii) the realism of the model in the context of the m-TEER procedure. The results of the questionnaires were collected, and statistical analysis (t-test) was performed.Results. Both models were equally beneficial in increasing operator confidence before and after the simulation of the intervention (P = 0.43). However, increased confidence after training with the anatomical model was recorded (P = 0.02). Participants with prior experience with m-TEER therapy were significantly more confident about the procedure after training with the anatomical model than participants who had no prior experience (P = 0.002). On average, all participants thought that the anatomical model was effective as a training simulator (P = 0.013) and should be integrated into routine training (P = 0.015)). Participants with experience thought that the anatomical model was more effective at reproducing the m-TEER procedure than the idealised model (P = 0.03).Conclusions. This study showed how a more realistic simulator can be used to improve the effectiveness of m-TEER procedural training. Such pilot results suggest planning future and large investigations to evaluate improvements in clinical practice.

Situational awareness and situational heroism: a close reading of testimonies from the London Bridge terror attack 2019

ABSTRACT Based on an-in depth analysis of two testimonies, this article explores how ordinary people can become ‘situational heroes’. On 29 November 2019, Darryn Frost and Steve Gallant were caught up in a terrorist attack in central London. In that situation, Frost and Gallant demonstrated a high degree of situational awareness and took bold and swift action to stop the attacker. Using the literary method of close reading, I analyse their testimonies with a particular eye towards two questions: how did the two men perceive the dangerous situation? Can and should they be seen as heroes? As a convicted murderer and long-serving prisoner, Gallant was certainly no hero in the conventional sense. Yet, in 2023 he received The Queen’s Gallantry Medal for ‘for acts of exemplary bravery’ alongside with Frost and a few others. This, I argue, is symptomatic of a broader shift towards situational awareness and towards what I call situational heroism. As it is less about being a hero and more aboutacting heroically in particular situations, situational heroism is less elitist and more inclusive than many historical forms of heroism. However, it also raises new ethical questions.

Prevalence of stricturing, penetrating complications and extraintestinal manifestations in inflammatory bowel disease detected on cross-sectional imaging in a tertiary care setting.

Stricturing, penetrating complications and extraintestinal manifestations (EIMs) are frequent in patients with inflammatory bowel disease (IBD). There is limited data on the prevalence of these complications in patients with IBD. Therefore, we aimed to assess the burden of these complications detected incidentally on cross-sectional imaging. A retrospective study conducted at two tertiary care centers in London, Ontario. Patients (≥18years) with a confirmed diagnosis of IBD who underwent CT enterography (CTE) or MR enterography (MRE) between 1 Jan 2010 and 31 Dec 2018 were included. Categorical variables were reported as proportions and the mean and standard deviations were reported for continuous variables. A total of 615 imaging tests (MRE: 67.3% [414/615]) were performed in 557 IBD patients (CD: 91.4% [509/557], UC: 8.6% [48/557]). 38.2% (213/557) of patients were male, with mean age of 45.6years (±15.8), and median disease duration of 11.0years (±12.5). Among patients with CD, 33.2% (169/509) had strictures, with 7.8% having two or more strictures and 66.3% considered inflammatory. A fistula was reported in 10.6% (54/509), the most common being perianal fistula (27.8% [15/54]), followed by enterocutaneous fistula (16.8% [9/54]), and enteroenteric fistula (16.8% [9/54]). Additionally, 7.4% (41/557) of patients with IBD were found to have an EIM on cross-sectional imaging, with the most prevalent EIM being cholelithiasis (63.4% [26/41]), followed by sacroiliitis (24.4% [10/41]), primary sclerosing cholangitis (4.8% [2/41]) and nephrolithiasis (4.8% [2/41]). Approximately 40% of patients with CD undergoing cross-sectional imaging had evidence of a stricture or fistulizing disease, with 7% of patients with IBD having a detectable EIM. These results highlight the burden of disease and the need for specific therapies for these disease phenotypes.

A Cross-Sectional Evaluation of the Virtual Outpatient Management of People With Mpox.

To report on the implementation and outcomes of a virtual ward established for the management of mpox during the 2022 outbreak, we conducted a 2-center, observational, cross-sectional study over a 3-month period. All patients aged ≥17 years with laboratory polymerase chain reaction-confirmed monkeypox virus managed between 14 May and 15 August 2022, at the Hospital for Tropical Diseases at University College London Hospitals National Health Service (NHS) Foundation Trust and sexual health services at Central North and West London NHS Foundation Trust, were included. Main outcomes included the proportion of patients managed exclusively on the virtual ward, proportion of patients requiring inpatient admission, proportion of patients with human immunodeficiency virus, and duration of lesion reepithelialization. Among confirmed cases (N = 221), 86% (191/221) were managed exclusively on the virtual ward, while 14% (30/221) required admission. Treatment for concomitant sexually transmitted infections was provided to 25% (55/221) of patients, antibiotics for other infective complications to 16% (35/221), and symptomatic relief to 27% (60/221). The median time from onset to complete lesion reepithelialization and de-isolation was 18 days (range, 8-56 days). Eleven percent (24/221) of individuals disengaged from services within 4 days of testing. The virtual ward model facilitated safe and holistic outpatient management of mpox, while minimizing admissions. This approach could serve as a model for future outbreak responses.

The value of direct child observation in a therapeutic parent-toddler group, for students of psychoanalysis

ABSTRACT Starting in Vienna in the 1920s, Anna Freud’s first tentative attempts at observing children became a crucial component of the ‘double approach’ which integrated direct child observation with psychoanalytic reconstruction. This approach enabled the detailed study of unfolding developmental processes and the construction of a theory of normative as well as pathological child development. Direct child observation was an integral component in the curriculum of the Psychoanalytic Master’s degree at Anna Freud’s Hampstead Clinic (later, the Anna Freud Centre) in London. The process, experience and value of observation for students of psychoanalysis is described, focussing on observers in a therapeutic parent-toddler group. The experience of observing or being observed is discussed from the perspective of staff facilitating the group, students, parents and children.

Longitudinal assessment of physical function in adults with X-linked hypophosphatemia following initiation of burosumab therapy.

X-linked hypophosphatemia (XLH) is a rare genetic disorder of phosphate metabolism. Burosumab is a monoclonal antibody treatment shown to improve phosphate homeostasis and improve symptoms as well as fracture healing when used as a therapy for XLH in adults. However, little is known about its effects on the large deficits in multiple components of physical function previously reported in XLH. Ten adults (6 females, age 41.1 ± 15.7 y) were recruited from specialist centres in London and Bristol. During clinical visits for initial burosumab treatment and at 6-month and 12-month follow-up, physical function, and physical activity (PA) assessments were performed. In detail, lower limb power was assessed by mechanography via a countermovement jump, mobility by short physical performance battery (SPPB), functional capacity by 6-min walk test (6MWT), upper limb strength by hand grip dynamometry, and PA via an International Physical Activity Questionnaire (IPAQ). Differences between baseline and 6-month follow-up, and in a subset of 5 patients between 6- and 12-month follow-up, were assessed. Lower limb power increased by 9% (P = 0.049) from baseline to 6 months, as did SPPB score (+ 1.2 points, P = 0.033) and total PA (+ 65%, P = 0.046) although hand grip and 6MWT did not differ. Only for hand grip was a significant improvement (+ 10%, P = 0.023) seen between 6 and 12 months. Burosumab treatment is associated with improved lower limb function and mobility at 6 months, with improvement in hand grip strength at 12 months. Future studies should explore the underlying mechanisms and describe on function and other patient outcomes.

Using virtual reality for occupational safety and health in a UK tunnelling megaproject

Recent advancements into key technological developments (KTDs) are leading to a paradigm shift in the way that occupational safety and health (OSH) is managed in the architecture, engineering, construction and operation sector. This paper reports on a pilot case study where building information modelling and virtual reality were used for OSH training purposes related to the operation of a tunnel-boring machine. The aim of the research was to identify the benefits, barriers and challenges associated with the implementation of these KTDs in a joint venture organisation delivering part of a complex megaproject in Central London, UK, the Thames Tideway Tunnel project (thereafter, ‘Tideway’). The reported benefits included better safety in design and improved hazard perception. Tideway estimates that the project could potentially see a 20% reduction in training time and a 10% reduction in accidents. The key lessons learned include the need to keep costs down, the necessity for system portability and ease of access. The results of the study will assist organisations that are interested in the adoption of these KTDs and provide valuable insights to the wider construction industry. This will in turn enable companies to improve how OSH is managed and promote the uptake of KTDs for OSH.

617 Patient Harm Is Underreported Due to an Inadequate Reporting System for Serious Incidents

Abstract Aim The Royal Free London Skin Cancer Service (RFL-SCS) is the largest referral centre in London, having received 26,114 two-week-wait referrals since January 2022. Patients are filtered through a complex Skin Cancer Pathway (SCP) involving multiple disciplines (dermatology, plastic surgery, oncology). This root cause analysis of Serious Incidents (SIs) attempts to pinpoint their underlying causes and identify key themes for the re-design of the SCP to ensure patient safety. Method A retrospective analysis of SIs recorded by the RFL-SCS between January 2022 and September 2023 was conducted. Incidents were attributed to various stages in the SCP, which was mapped out in detail. Related information was gathered by interviewing staff at significant points in the pathway and reviewing relevant procedures. A survey of practitioners was conducted to understand if SI reporting through the Datix system was accurate. Results From 26,114 referrals, 1326 needed treatment. 657 of these patients breached the two-week-referral target, with 10 SIs identified. 83% of practitioners surveyed felt that this was an underestimation. Major event types involved no follow-up appointments being booked after: MDT (3); surgery (2); scans (5); patient lost to follow up (1); and poor communication with patients (2). Conclusions System-wide changes must be implemented to prevent SIs from reoccurring. The Datix reporting system was described as convoluted and inadequate, leading to under-reporting of patient harm. More research needs to be conducted in designing an automated tracking system to flag-up and action MDT outcomes for patients with completed excisions, histology, and scans. This will prospectively avoid delays in onward referrals.

The impact of continuous lenalidomide maintenance treatment on people living with multiple myeloma—a single-centre, qualitative service evaluation study

PurposeContinuous lenalidomide maintenance treatment after autologous stem cell transplantation delivers improvement in progression free and overall survival among newly diagnosed multiple myeloma patients and has been the standard of care in the UK since March 2021. However, there is scant information about its impact on patients’ day-to-day lives. This service evaluation aimed to qualitatively assess patients receiving lenalidomide treatment at a cancer centre in London, in order that the service might better align with needs and expectations of patients.MethodsWe conducted 20 semi-structured interviews among myeloma patients who were on continuous lenalidomide maintenance treatment at a specialist cancer centre in London. Members of the clinical team identified potentially eligible participants to take part, and convenience sampling was used to select 10 male and 10 female patients, median age of 58 (range, 45–71). The median treatment duration was 11 months (range, 1–60 months). Participants were qualitatively interviewed following the same semi-structured interview guide, which was designed to explore patient experience and insights of lenalidomide. Reflexive thematic analysis was used for data analysis.ResultsFour overarching themes were as follows: (i) lenalidomide: understanding its role and rationale; (ii) reframing the loss of a treatment-free period to a return to normal life; (iii) the reality of being on lenalidomide: balancing hopes with hurdles; (iv) gratitude and grievances: exploring mixed perceptions of care and communication. Results will be used to enhance clinical services by tailoring communication to better meet patients’ preferences when making treatment decisions.ConclusionThis study highlights that most patients feel gratitude for being offered continuous lenalidomide and perceive it as alleviating some fears concerning relapse. It reveals variations in side effects in different age groups; younger patients reported no/negligible side effects, whilst several older patients with comorbidities described significant symptom burden, occasionally leading to treatment discontinuation which caused distress at the perceived loss of prolonged remission. Future research should prioritise understanding the unique needs of younger patients living with multiple myeloma.

Resurgence of influenza with increased genetic diversity of circulating viruses during the 2022-2023 season.

Introduction. After two seasons of absence and low circulation, influenza activity increased significantly in the winter of 2022-2023. This study aims to characterize virological and epidemiological aspects of influenza infection in Bulgaria during the 2022-2023 season and perform a phylogenetic/molecular analysis of the hemagglutinin (HA) and neuraminidase (NA) sequences of representative influenza strains.Hypothesis/Gap Statement. Influenza A and B viruses generate new genetic groups/clades each season, replacing previously circulating variants. This results in increased antigenic distances from current vaccine strains. Strengthening existing influenza surveillance is essential to meet the challenges posed by the co-circulation of influenza and SARS-CoV-2.Methodology. We tested 2713 clinical samples from patients with acute respiratory illnesses using a multiplex real-time RT-PCR kit (FluSC2) to detect influenza A/B and Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) simultaneously. Representative Bulgarian influenza strains were sequenced at the WHO Collaborating Centres in London, UK, and Atlanta, USA.Results. Influenza virus was detected in 694 (25.6 %) patients. Of these, 364 (52.4 %), 213 (30.7 %) and 117 (16.9 %) were positive for influenza A(H1N1)pdm09, A(H3N2) and B/Victoria lineage virus, respectively. HA genes of the 47 influenza A(H1N1)pdm09 viruses fell into clades 5a.2. and 5a.2a.1 within the 6B.5A.1A.5a.2 group. Twenty-seven A(H3N2) viruses belonging to subclades 2b, 2a.1, 2a.1b and 2a.3a.1 within the 3C.2a1b.2a.2 group were analysed. All 23 sequenced B/Victoria lineage viruses were classified into the V1A.3a.2 group. We identified amino acid substitutions in HA and NA compared with the vaccine strains, including several substitutions in the HA antigenic sites.Conclusion. The study's findings showed genetic diversity among the influenza A viruses and, to a lesser extent, among B viruses, circulating in the first season after the lifting of anti-COVID-19 measures.

Opportunistic offering of self-sampling to non-attenders within the English cervical screening programme: a pragmatic, multicentre, implementation feasibility trial with randomly allocated cluster intervention start dates (YouScreen)

Self-sampling has game-changing potential to tackle the declining participation and inequities seen in many organised cervical screening programmes. Wide variation in uptake between settings and mode of kit offer highlight the importance of local piloting. Furthermore, harnessing the benefits of self-sampling in real-world settings has been surprisingly challenging. The YouScreen study estimated the impact of offering self-sampling to non-attenders within the English Programme and evaluated large-scale opportunistic offering of self-sampling in primary care. A pragmatic modified stepped-wedge implementation feasibility trial with randomly-allocated cluster intervention start dates at primary care practices in England (133 participating, 62 non-participating). Eligible women were aged 25-64 years and ≥6 months overdue for screening ("non-attenders"). Between January 13, 2021 and 30 November, 2021 self-sampling kits were distributed to non-attenders via an opportunistic offer in primary care when they consulted for any reason and direct mailout to those unscreened 15-months after routine invitation. Primary outcomes were the proportion of non-attenders screened each month; change in coverage; and uptake (90 days). YouScreen is registered with ISRCTN:12759467. 8338 women provided self-samples following recruitment between January 13, 2021 and 30 November, 2021. Self-samples were returned from 65.5% (6061/9248) who accepted an opportunistically offered kit and 12.9% (2777/17,604) directly-mailed kits. Responders were representative of the ethnically diverse and deprived underlying non-attendee population (64% ethnic minority groups, 60% from the two most deprived national quintiles). The self-sampling intervention resulted in a 22% (95% CI 18-26) increase in non-attenders screened per month (per-protocol analysis) and 12% (95% CI 9-15) (intention-to-treat analysis). Change in coverage at participating (mean intervention duration 7.5 months) vs non-participating practices was 1.6% (95% CI 0.4-2.8). Adverse effects were not formally collected. Opportunistically offering self-sampling to under-screened women in primary care could increase coverage in England and potentially reach underserved populations. North Central London and North East London Cancer Alliance.

The Needs of Women Using Homelessness Services: The Results of Collaborative Research in London

This paper explores the results of a study conducted in collaboration with the homelessness sector in central London and an academic team. Data were collected on 134 women who used homelessness services in an area of central London during a nine-day window. In addition, fully anonymised service history records, covering an average period of 85 months, were reviewed with the consent of another 59 women with lived experience of homelessness. Nine women also agreed to in-depth interviews. Five key stakeholders in policy and practice were also interviewed. The research supports the findings of earlier research into the gender dynamics of homelessness. The results highlight the presence of a high-cost, high-risk population of women who are characterised by sustained and recurrent experience of homelessness, housing exclusion, and deprivation and who make repeated and sustained use of homelessness and other services without escaping homelessness. Strong associations between domestic abuse and women’s homelessness are evident in the results of the research, again echoing the results of earlier work. The possibilities of developing new strategic responses to women’s homelessness, including specialised forms of Housing First, are considered.

Continuous non-invasive measurement of cardiac output in neonatal intensive care using regional impedance cardiography: a prospective observational study

ObjectivesTo compare agreement between echocardiography and regional impedance cardiography (RIC)-derived cardiac output (CO), and to construct indicative normative ranges of CO for gestational age groups.Design, setting and participantsProspective cohort observational...

An age-related nomogram for antral follicle count: an observational study of 3821 women

Research questionTo investigate the relationship between antral follicle count (AFC) and chronological age and establish expected values for AFC. DesignThis is a retrospective cohort study at a specialist gynaecological ultrasound centre in London. Women presenting to a gynaecology diagnostic unit for investigation of symptoms or routine check-up, and undergoing transvaginal ultrasound examinations, between the 1st of January 2017 and 22nd of September 2022. ResultsWe analysed 8821 data entries from 7573 women. We estimated the relationship between AFC and age to develop an AFC nomogram independent of the stage in the menstrual cycle. The AFC corresponding to the 10th, 25th, 50th, 75th and 90th centiles for each patient and age group have been calculated. Both nomogram and condition specific populations displayed a gaussian relationship between AFC and age. For the nomogram population, a peak median AFC of 30, was observed between the age groups of 21 -23. The AFC distribution of the previous cystectomy group was found to be statistically different in comparison to the nomogram population(P<0.0001). However, the same did not hold true for those on hormonal contraception (P=0.43). ConclusionsWe provide an AFC nomogram reporting median and interquartile values for AFC by chronological age across the reproductive years. This is a useful tool for providing counselling for those undergoing ovarian reserve assessments taken any time in the menstrual cycle including for those on hormonal contraceptives or previous cystectomy.

Fetal Scoliosis: Natural History and Outcomes.

Scoliosis can be detected on prenatal ultrasonography and may be associated with structural and syndromic abnormalities. Associations and pregnancy outcomes related to the prenatal diagnosis of scoliosis are poorly understood. A retrospective cohort study was undertaken at a tertiary referral center in London. Referred cases with spinal deformities between 1997 and 2021 were identified from the prenatal ultrasonography database. Outcomes were ascertained from the database and electronic notes. One hundred twenty-three cases of fetal spinal deformities (scoliosis, kyphosis, or kyphoscoliosis) were identified from a referral population of 660,000 pregnancies, giving an incidence of approximately 0.2 per 1000 fetuses. Fifty-eight live births (47.2%) and 65 cases (52.8%) of fetal or neonatal demise or termination were observed. Most live births were isolated spinal deformities with a good postnatal outcome (n = 35, 60.3%). The commonest syndromic diagnosis in this group was VACTERL association (n = 7, 12.1%). Most cases of fetal loss were associated with severe malformations, most commonly spina bifida, body stalk anomaly and amniotic band sequence, or chromosomal abnormalities, except in 2 cases (3.1%). This is the largest reported cases series to date of prenatally diagnosed fetal spinal deformity. This confirms that fetal scoliosis and associated vertebral abnormalities are underdiagnosed prenatally, with the reported incidence (0.2 per 1000) lower than the recognized incidence of congenital scoliosis (1 in 1,000). The concurrent finding of severe malformations was strongly associated with fetal loss. When an isolated finding, most fetal spinal deformities had a good postnatal outcome, while 1:8 live births were diagnosed with VACTERL association.

Are patients with hypertrophic cardiomyopathy given appropriate advice on exercise at a central London inherited cardiac conditions outpatient service?

Are patients with hypertrophic cardiomyopathy given appropriate advice on exercise at a central London inherited cardiac conditions outpatient service?

The experience of surgical cancer patients during the COVID-19 pandemic at a large cancer centre in London.

The COVID-19 pandemic has had an enormous impact on the experiences of patients across all health disciplines, especially those of cancer patients. The study aimed to understand the experiences of cancer patients who underwent surgery during the first two waves of the pandemic at Guy's Cancer Centre, which is a large tertiary cancer centre in London. A mixed-methods approach was adopted for this study. Firstly, a survey was co-designed by the research team and a patient study group. Patients who underwent surgery during the COVID-19 pandemic were invited to take part in this survey. Results were analysed descriptively. Three discussion groups were then conducted to focus on the main themes from the survey findings: communication, COVID-19 risk management and overall experience. These discussion groups were transcribed verbatim and underwent a thematic analysis using the NVivo software package. Out of 1657 patients invited, a total of 250 (15%) participants took part in the survey with a mean age of 66 (SD 12.8) and 52% females. The sample was representative of a wide range of tumour sites and was reflective of those invited to take part. Overall, the experience of the cancer patients was positive. They felt that the safety protocols implemented at the hospital were effective. Communication was considered key, and patients were receptive to a change in the mode of communication from in-person to virtual. Despite the immense challenges faced by our Cancer Centre, patients undergoing surgery during the first two waves of the COVID-19 pandemic had a generally positive experience with minimal disruptions to their planned surgery and ongoing care. Together with the COVID-19 safety precautions, effective communication between the clinical teams and the patients helped the overall patient experience during their surgical treatment.

The Impact of COVID-19 on Bicycle-Related Injuries Managed at a Level 1 Major Trauma Center in London, United Kingdom.

Introduction The COVID-19 pandemic changed peoples' travel behaviors; an uptake in cycling was observed in the United Kingdom. The aim of this study was to assess the cycling-related orthopedic injuries presented to a major trauma center (MTC) before and during the COVID-19 pandemic. Method This retrospective observational single-center study analyzed referrals to the orthopedic department during a matched two-month period in 2019 and 2020. Data were collated on cycling-related injuries including demographic variables, mechanism of injury, anatomical area of injury, and the management of injury. The data were compared and statistical analysis was performed using the Pearson Chi-squared test to assess for significance. Results A total of 2409 patients were referred to the orthopedic department with injuries. A 35.6% decrease in total referrals was made during the COVID-19 pandemic. Analysis of cycling-specific injuries demonstrated a statistically significant increase in referrals to the orthopedic department during the COVID-19 pandemic. A statistically significant difference in upper limb trauma was also observed during the COVID-19 pandemic. Patterns of management, namely operative vs. non-operative management, did not demonstrate a difference in the two time periods. Discussion This study highlights that during the COVID-19 pandemic, cycling behavior changed with more patients suffering orthopedic injuries as a result. Orthopedic departments may need to plan for this change in behaviors with more capacity being created to manage the demand. Conclusion Cycling-related injuries referred to the orthopedic department increased during the pandemic.

CSR perceptions and practices in small hotels in urban cities

PurposeThis study aims to examine the perception and practices related to Corporate Social Responsibility (CSR) implemented in Small and Medium-sized Enterprises (SMEs), focussing on small hotels in London.Design/methodology/approachA qualitative research design comprising detailed semi-structured interviews was employed with 12 small hotel owner-managers in central London and its outskirts. The study adopts a social constructionist approach to explore CSR perspectives and practices, along with a social capital framework to investigate how CSR is perceived at the individual level and consequently manifested into CSR practices.FindingsThe findings indicate that a small hotel’s implementation of CSR is influenced by long-term versus short-term considerations, as well as socio-economic and socio-political conditions. Individual-level factors, like hoteliers’ CSR conceptualisation and personal and business values, affect CSR adoption in small hotels. Lastly, institutional-level factors, such as ineffective institutional participation and the hotelier’s cultural background against the cosmopolitan context of a big city, have contributed to a muted response to socially responsible issues.Research limitations/implicationsThis study was conducted with a limited sample of 12 participants from small hotels in London and its outskirts, which may limit the generalisability of the findings. Future research could enhance these findings by involving a larger and more diverse group of participants from various urban areas, potentially employing a quantitative research approach for broader applicability. This study’s insights can guide policymakers in educating small business owners on CSR benefits and implementation. It also proposes how governments could encourage sustainable practices among small hotels seeking to enhance their reputation. Moreover, these findings enable small businesses to develop their stakeholder strategies for greater CSR initiatives.Originality/valueThis study integrates social capital theory into investigating CSR in small hotels in London, broadening the literature on CSR perception and integration, particularly in SMEs and the hospitality sector.

Creating Lasting Love: An Ethnographic Study of Sexual Pleasure, Intimacy and Contraception

Sexual pleasure and intimacy are key reasons why people have sex, yet it remains underexamined in our understanding of how people make decisions about contraception. This paper draws on ethnographic research of the intersections between sexual pleasure, intimacy and contraception among women using specialist contraceptive services in central London. I describe how contraceptive use and choices are intertwined with how women assess intimacy in their sexual relationship, and not solely a desire to avoid pregnancy. How and when women use contraceptives relays their concerns about creating and maintaining pleasure and intimacy in their sexual relationships. Moreover, this ethnographic account illustrates how women draw on various contraceptive methods in their decision making and use them to increase communication and trust, distinguish relationships and potentially enhance sexual pleasure, which is indexical and necessary for enduring intimate connections. Considering intimacy alongside sexual pleasure also allows us to consider the relational dimensions of contraceptive choice and how these are far from static, one-off decisions. These empirical insights into intimacy illustrate that contraceptive choice is both a reflection of the perceived intimacy in a relationship and is also a “practice of intimacy”, particularly when people are navigating the various forms of intimacies available.