Tunbridge Wells Research Articles

2300 A survey on the underlying knowledge of doctors’ in conducting polypharmacy review and medication optimisation in older adults.

Abstract Introduction Polypharmacy is common among older adults and could result in adverse outcomes if not reviewed and optimised regularly (Davies et al, 2020). The aim of this survey is to assess and report on the variation in doctors’ understanding of medication reviews at Maidstone and Tunbridge Wells hospitals (MTW). Method A short, anonymised, online questionnaire was circulated to all current doctors at MTW via email and WhatsApp groups. Results 38 doctors of different grades (Foundation Year One-Consultant) from a variety of medical and surgical specialties responded. Of these, 41% could correctly define appropriate polypharmacy, but only 6% could define problematic polypharmacy. Most respondents (59.5%) had not received any training on structured medication reviews (SMR). 51.4% were not aware of any tools used in medication optimisation. 43% said they ‘always carry out’ medication reviews in clinical practice and 8.3% said that they never do. Less than half (38%) felt confident in completing SMR. The main barriers to routine implementation of SMR identified by the respondents were: lack of confidence (27%), time pressures (26%), senior clinicians not giving importance to SMR (16%), 3% felt it was not the doctor’s responsibility. Most respondents (91.7%) said that they would benefit from further training in SMR. Conclusions The results show that there is a wide variation in the respondents’ understanding and practice of medication reviews. Also, that there is a clear and well- founded demand for training. Once training has been formulated and delivered a follow up survey of those attending should be used to help gauge its effectiveness. The small sample size is a limitation of this study affecting its generalisability as is the fact that it was a self-selected group completing the survey.

Management of Ocular Surface Inflammation with Persistent Epithelial Defects Using a Sutureless Human Amniotic Membrane Dehydrated Matrix: A Prospective Study Utilizing a Digital Ocular Surface Assessment Tool.

To report the outcomes of using a sutureless human amniotic membrane dehydrated matrix (HAMDM) in the management of a range of ocular surface conditions utilizing a digital ocular surface disease assessment tool. Two UK NHS Trusts - Queen Victoria Hospital Foundation Trust (East Grinstead and Maidstone) and Tunbridge Wells Trust (Kent) - prospectively treated patients with ocular surface disease with sutureless HAMDM. The patient cohort was assessed for resolution of epithelial defects, ocular surface inflammation, and best-corrected visual acuity pre- and posttreatment. Measurements of ocular surface inflammation and epithelial defect size were assessed using AOS digital imaging software, a validated tool for objective grading of bulbar conjunctival redness and measurement of corneal epithelial defects. A total of 47 applications of sutureless HAMDM on 46 eyes of 46 patients (25 male, 21 female, age 9-94 years) were assessed across various etiologies for an average of 24.0±14.1 days. Patients with limbal stem-cell deficiency (n=17), persistent epithelial defects (n=16), neurotrophic corneal disease (n=7), filamentary keratitis (n=2), corneal erosion (n=1), corneal thinning (n=1), ocular surface inflammation (n=1), and traumatic corneal laceration (n=1) were included in the study. Across all patents, 63% of eyes showed complete healing of epithelial defects and 32.6% of eyes showed partial resolution. The average rate of healing (wound closure) was 0.36 mm2 per day across the overall patient cohort, and the rate of healing in cases with complete resolution of epithelial defects was 0.41 mm2 per day. Inflammation across all four quadrants of the ocular surface remained stable. Visual acuity across the patient cohort remained stable (61%) and improved in 26% of patients (0.06±0.51 logMAR). Sutureless HAMDM application can be accomplished in just a few minutes and effectively treat a range of ocular surface disease in a clinical, nonsurgical setting. The AOS imaging software offered a quantitative methodology for measuring epithelial defect size and inflammation state.

Keith Reader (1945–2022)

The death of Keith Reader in July 2022 is a sad loss for French studies in the UK. Keith was a wonderfully rich and insightful scholar who contributed prolifically to the discipline across an astonishingly diverse range of subjects. He was exceptionally erudite; even more importantly, he was an intellectual in every sense of the word, although he would have been quick to deprecate the application of the term to himself. Keith was himself possessed of an acutely probing mind; moreover, he was keenly convinced both of the value of intellectual enquiry in itself and the importance of the broader social contribution it can make. Born in Tunbridge Wells, Keith grew up in Crawley before going to Cambridge in 1964 to study for a BA in French. However, it was an experience there outside the halls of academia that proved a real watershed in his life. The syllabus that awaited him at university was wholly devoted to language and literature, in line with most modern languages programmes at the time; while he found it somewhat narrow and dreary, albeit less for its content than for how it was taught, the discovery of film in the three independent cinemas then existing in Cambridge was to prove the beginning of a passion that would last throughout his life. That early hunger that drove him to supplement his studies with a field manifestly of relevance to his chosen academic discipline, although with little institutional recognition (let alone legitimation) of the connections between them, found a parallel in his next experience as a student, when he enthusiastically embraced whatever little—mainly anglophone—theory was on offer in the context of the graduate course in General and Comparative Literature in which he enrolled at Oxford. That enthusiasm heralded the determination with which he used the years he spent as a lecteur in Caen and then in Paris to engage with the French variety of theory, becoming one of the very first UK scholars to explore the world peopled by Barthes, Lacan, Foucault, Derrida, and Althusser, this last still a very visible presence in the École normale supérieure during Keith’s period there.

Percutaneous Cholecystostomy in Severe Acute Cholecystitis: An Observational Study From a Single Institute.

Background Although percutaneous cholecystostomy (PC) is generally accepted as a bridge to definitive therapy for acute cholecystitis (AC), which remains cholecystectomy, some patients did not undergo cholecystectomy, mainly due to contraindications to surgery. Here, we aimed to investigate the predictors of recurrence and the outcome after PC. Methods This is a retrospective study from a single general hospital at Tunbridge Wells, United Kingdom. One hundred twenty-six patients who presented with AC grade 3 and were initially managed with PC were included. In addition, the proportion of patients who did not undergo subsequent laparoscopic cholecystectomy (LC) and their characteristics were analyzed. Results The mean age of the study cohort was 72 (36-98) years, and the median length of drain insertion was 39.5 days. The majority (52%) presented with severe AC grade 3 with failed medical treatment to control the disease, while 7% had an emphysematous gallbladder. Eighty percent of patients did not develop any further attacks of AC after PC removal. The most common comorbidity was hypertension (35%). The mean age-adjusted Charlson comorbidity score was 3.72. Thirty-six percent (45/126) of the study cohort underwent LC, while the remaining patients did not receive any surgical intervention. Nine percent were deemed unfit for surgery. Forty-one patients (33%) were managed conservatively as they did not have a further attack of cholecystitis after PC removal or had a mild attack managed with antibiotics. In addition, 22% experienced procedural complications, including a blocked stent, pain, and cellulitis around the tube. The 30-day mortality rate of patients who did not undergo LC was 5%. Predictors of interval cholecystectomy were younger age, calculus cholecystitis, low Charslson index score, and uncomplicated and shorter length of hospital stay with PC. Conclusion Most severe AC patients treated initially with PC did not undergo subsequent LC. Therefore, PC in high-surgical-risk patients with AC could be a definitive treatment.

British Enlightenment Theatre: Dramatizing Difference

British Enlightenment Theatre: Dramatizing Difference

Irish Literature in Transition, 1700-1780, ed. Moyra Haslett

<i>Irish Literature in Transition, 1700-1780</i>, ed. Moyra Haslett

Evaluation of Alvarado score and appendicitis inflammatory response score as diagnostic tools for acute appendicitis

Background: The study aims to evaluate the diagnostic accuracy of AIR and Alvarado scores for acute appendicitis cases.Methods: We conducted a retrospective study with 73 patients to compare the efficacy of the appendicitis inflammatory response (AIR) score with the Alvarado score in the diagnosis of acute appendicitis from January 2021 to March 2021. The study included all consecutive patients referred with suspected appendicitis or acute RIF pain, to the surgical unit at Tunbridge Wells Hospital. Results: Based on histopathology findings of 73 patients, 59 (80.8%) patients had acute appendicitis. Using the AIR score, 5 (8.5%) patients scored high, 41 (69.5%) scored moderate, and 13 (22.0%) scored low in the histologically-positive group. In the histology-negative group, none (0.0%) scored high, 2 (14.3%) scored moderate, and 12 (85.7%) scored low, with only 2 patients being false positives. The correlation between the AIR score and histopathology results was thus highly significant (p value=0.000). Using the Alvarado score, in the histology-positive group, 33 (55.9%) scored high, 17 (28.8%) moderate and 9 (15.3%) low. In the histology-negative group, 2 (14.3%) patients scored high, 6 (42.9%) scored moderate, and 6 (42.9%) patients scored low. 8 patients were false positives. We found a significant correlation between the Alvarado score and histopathology results (p value=0.011). The sensitivity of the AIR and Alvarado scores were 77.97% and 67.80% respectively and the specificity was 85.71% and 78.57% respectively.Conclusions: The AIR score had higher specificity, sensitivity, positive predictive value, and a lower rate of false positives.

P-038 Comparison of three methods of semen analysis: A novel at-home sperm test kit, a computer-assisted assessment and an embryologist

Study questionHow does computer-assisted semen analysis (CASA) (Lenshooke, LOGIXX) and at-home sperm testing (ExSeed) compare with manual methodology assessment of male fertility based on WHO criteria (5thEdition); a three-method comparison study.Summary answerAll methods showed good agreement for concentration and limited agreement for motility highlighting the need for further development of alternatives to manual assessment.What is known alreadySeveral studies have shown good correlation between CASA systems and laboratory-based manual semen analysis, but only a few have carried out a three-way comparison study. One of which showed positive correlation with motility and concentration between a smartphone-based semen analysis and laboratory-based CASA system and positive correlation between concentration and motility between the smartphone-based CASA system and microscopic-based results. The at-home sperm test kit may play a role in motivating infertile males to visit clinics for early diagnosis and also reducing the need for multiple visits to the fertility clinic for repeat semen analyses.Study design, size, durationFifty patients (between 29 and 56 years) attending a fertility clinic were included in the study between September 2021 to December 2021. Semen samples were split into 3 aliquots and evaluated using manual semen assessment (MSA) according to the WHO 5th Edition (2010) guidelines, the ExSeed Home Sperm Test (HST) and the LensHooke® X1 PRO Semen Quality Analyzer (CASA).Participants/materials, setting, methodsThe semen samples were collected from fifty participants at CARE Fertility Tunbridge Wells. The samples were placed in an incubator at 37°C for 30 minutes to liquefy. After liquefaction, sperm concentration, total motility, total motile sperm count (TMSC) and normal morphology were evaluated. Spearman’s Rank correlations (>0.7) and Chi-squared tests were used and the p-value < 0.05 was considered as statistically significant.Main results and the role of chanceAll variables were highly significantly (p < 0.0002) positively correlated between all 3 methods.The greatest correlations were obtained for sperm concentration (CASA/HST: r = 0.826; MSA/HST: r = 0.870; MSA/CASA: r = 0.871) and TMSC (MSA/CASA: p = 0.792; CASA/HST: r = 0.800; MSA/HST: r = 0.854). Correlations for motility were markedly lower (MSA/HST: r = 0.611; CASA/HST: r = 0.717; MSA/LCASA: r = 0.750). The lowest correlation was found for morphology (MSA/CASA: r = 0.500). The HST device does not determine morphology.As compared to MSA, using the HST device agreement for normal or low sperm concentration (≥15 × 106/mL or < 15 × 106/mL respectively) was identified in 84.3% of the cases, whereas 94.0% with CASA. The agreement between CASA and HST was 82.0%. For total motility ≥ or < 40%, the agreements were 68.0% (CASA/HST), 56.9% (MSA/HST) and 82.0% (MSA/CASA), respectively.For the identification of patients with normal morphology >4%, the agreement between MSA and CASA was 30%.Limitations, reasons for cautionThe small sample size was 50 cases. The home testing device does not assess morphology. Furthermore, it is difficult to ascertain whether a consumer would carry out the analysis with this device with the same accuracy as an embryologist.Wider implications of the findingsThe need for repeated semen analyses, the effect of the COVID-19 pandemic and the discomfort some patients feel in a clinical setting, necessitate the need for evaluation of novel semen analysis approaches. These emerging technologies have potential to be more patient friendly, convenient and efficient than standard semen assessment methods.Trial registration numbernot applicable

Clay mineral formation and transformation in non-marine environments and implications for Early Cretaceous palaeoclimatic evolution: The Weald Basin, Southeast England

Analyses of clay minerals within the Early Cretaceous Weald Basin, Southeast England reveal kaolinite, illite and chlorite as the main detrital clay minerals while glauconite and smectite are subordinates. A kaolinite-rich assemblage which characterized the sand-dominated Ashdown and Tunbridge Wells Sand formations and an illite-dominated assemblage associated mostly with the Wadhurst Clay and Weald Clay formations are recognized. Kaolinite was enriched in the Ashdown and Tunbridge Wells Sand formations during warm and humid climate with high precipitation that encouraged chemical weathering and leaching, while cold and dry conditions favoured the concentration of illite in the Wadhurst Clay and Weald Clay formations. Rainfall patterns associated with warm climate were drastically reduced during the drier climatic conditions. Most clay minerals are detrital in origin, with chlorite being more prominent than previously recognized. Contrary to previous studies and assumptions, this study revealed that authigenic clay minerals are present in the Hastings Beds, with vermiform and mica-replacive kaolinite being the most common, consistent with humid depositional environments. Isolated authigenic illite is also present, along with a chloritized grain, providing evidence for mesodiagenesis. The absence of dickite and occurrence of kaolinite, suggest that authigenic illite formed in relatively shallow burial conditions, indicating a maximum burial depth of 2500 m–3000 m, about 1000 m deeper than previous estimates of 1500 m–2000 m. Authigenic clay minerals are absent in the Weald Clay Formation possibly because of hindered flow of meteoric water and limited growth space for authigenic minerals. This study is significant in: 1) reinforcing multiple methods to facilitate a robust and balanced knowledge of formation and transformation of clay minerals; 2) investigating detrital and authigenic clay mineral assemblages when assessing the palaeoenvironments of sedimentary basins.

Queens at the Spa: Catherine of Braganza, Mary of Modena and the Politics of Display at Bath and Tunbridge Wells

Stuart consorts Catherine of Braganza and Mary of Modena joined a line of English and European queens repairing to spa waters to assist fertility. Following the Restoration of the English monarchy in 1660, Catherine and Mary assumed substantial responsibility to provide heirs for the reinstated Stuart dynasty. Both women faced prolonged difficulties conceiving and giving birth, yet they asserted their commitment to childbearing and the possibility that they would bear children through their appearance in the spa towns of Bath and Tunbridge Wells. The queen’s presence at the waters was appropriated in public discourse and memory, transforming spas from medical and social locations into political spaces, and asserting the political nature of the queen’s fertility.

Recent Articles

Recent Articles

Kent Shoulder Pain Survey: Understanding the prevalence of shoulder pain amongst Kent's National Health Service employees

Purpose: (1) The Primary purpose was to identify the prevalence of shoulder problem among the 5 NHS Trusts: Maidstone & Tunbridge Wells NHS Trust, East Kent Hospitals University Foundation NHS Trust, Medway NHS Foundation Trust, Dartford & Gravesham NHS Trust and Kent Community Health NHS Foundation Trust.

Sphaerosiderites as sensitive recorders of non‐marine depositional and diagenetic history: Insights from the Lower Cretaceous Wealden Supergroup

AbstractWaterlogged, reducing soils in modern and ancient wetlands feature distinctive syndepositional to early diagenetic spherical iron carbonate concretions, known as sphaerosiderites. Sphaerosiderites are thought to record pore water elemental chemistry and local palaeoenvironmental conditions, and are widely used in palaeohydrological reconstructions throughout the Phanerozoic. The Lower Cretaceous non‐marine Wealden Supergroup of Southern England, deposited in fluvio‐lacustrine settings, contains abundant well‐preserved sphaerosiderites offering an ideal archive for unravelling the geochemistry of ancient non‐marine environments. Sphaerosiderites were characterised via multiple microanalytical techniques (SEM‐EDS, EPMA, XRD, SIMS), and show morphological and compositional heterogeneity (e.g. concentric zones of variably enriched Mn, Ca or Mg, elemental differences between cores and rims) in well‐preserved sphaerosiderites from the Ashdown and Tunbridge Wells Sand formations. The preservation of primary fabrics, lack of post‐burial cements or extensive alteration suggests these sphaerosiderites record primary palaeoenvironmental conditions. By contrast, in the Wadhurst Clay Formation, sphaerosiderites are recrystallised, potentially reflecting wide scale palaeoenvironmental changes (e.g. marine incursions). New experimental constraints on elemental uptake during siderite growth suggests that rather than reflecting pore water elemental chemistry, the elemental heterogeneity in the Wealden sphaerosiderites reflects complex parameters; variations in pH, cation concentrations, DIC, growth rate and siderite saturation state in groundwaters. At a larger scale, morphological and compositional differences between sphaerosiderites from distinct palaeosol horizons record spatial and temporal variability in local hydrogeochemistry. This suggests that the Weald Basin wetlands of the Lower Cretaceous featured a dynamic and periodically fluctuating groundwater table, where sphaerosiderites growing close to the soil surface responded rapidly to variability in physiochemical conditions, consistent with wet and warm conditions suggested by sedimentological evidence and climate model simulations. Similar morphological and compositional variability noted in other Phanerozoic sphaerosiderites suggests analogous processes operated in ancient wetlands, and that sphaerosiderites could provide a crucial tool to understand wetland dynamics in deep time.

Joseph Edward Briffa

Joseph Edward Briffa (“Joe”), latterly a consultant anaesthetist at the Kent and Sussex Hospital in Tunbridge Wells, Kent, died surrounded by his family at his home …

PO-1462 Metastatic spinal compression referral patterns during pandemic lockdowns in Kent region UK

Purpose or Objective: Metastatic spinal cord compression (MSCC) is an oncological emergency with a potential for catastrophic neurological deficit. Once diagnosed, MSCC requires urgent treatment to avoid neurological disability. We looked at health-seeking behavioural changes in lockdown 1(L1) (March 23-June 24 2020) compared to the lockdown 2(L2) (Oct 25-Dec 2 2020) in England, UK. This study posited that incidence of MSCC in 2020 especially during L1, would increase due to: (i)reduced access to NHS resources due to the pandemic (ii) change in health-seeking behaviour due to perceived risk of COVID-19. (iii) changes to previously accepted practice with regards to systemic and radiotherapy treatment. Modelling studies have shown these factors led to a delay in diagnoses with increased late-stage presentations and cancer-related death. Following the national campaign that ensued due to decline in cancer diagnosis in L1, we hypothesized a reduction in MSCC presentations in L2, due to increased public health awareness and continued availability of cancer services, despite lockdown. Materials and Methods: A retrospective, multicentre analyses of MSCC cases across Kent was undertaken for year 2020. Year 2019 served as control. Study included all MSCC cases across the following NHS trusts (i) Maidstone and Tunbridge Wells (ii) Dartford and Gravesham (iii) East Kent University Hospital and (iv) Medway. Shapiro-Wilk was used to assess normality and unpaired T-test to compare referral numbers between 2019 vs 2020 and between L1 vs L2. p ≤0.05 was considered significant. Results: There were 134 MSCC cases in 2019 vs 193 in 2020. An average of 12 patients per month were treated in 2019 vs 17 in 2020, p=0.002 (fig 1). During L1, the average number of patients was 16 per month vs 11 in 2019 in the same period, p=0.08. For L2, it was 19 vs 11 respectively, p=0.10 (fig 2). More patients were offered single 8Gy fraction treatment in 2020 [77% (n=149) vs 66% (n=89)] (fig 2). (Figure Presented) Conclusion: There was an increase in the total number of MSCC in 2020 and in the average cases per month during lockdowns. This was expected given recent data showing delay in cancer diagnoses with an increase in late presentations. Though the number of MSCC was higher in L2 vs L1, there was a downward trend towards the end of L2. This may signify the positive impact of the national cancer campaign. Unfortunately, Kent region was badly hit with the new Covid 19 strain (B117) and most of the services were affected due to staff redeployment, sickness and isolation. Many patients with existing comorbidities are still anxious utilising hospital services due to perceived infection risk. Further work will be needed to reverse health-seeking behaviours to pre-pandemic levels. Focused cancer public health campaign may be required to allay patient fears and ensure safety, during use of vital health services. More single 8Gy fractions were delivered in 2020 compared to any previous years, indicating MSCC patients may now be scanned, planned and treated in one visit.

Development of the ground model in an area of significant faulting and periglacial legacy: case study from Royal Tunbridge Wells, Kent

This case study describes a proposed commercial redevelopment at Royal Tunbridge Wells, Kent. The site, located on the Tunbridge Wells Sand and Wadhurst Clay formations, has been affected by major structural faulting as well as by periglacial conditions during the Quaternary. A key aspect of the project was the development of a geological model to inform the engineering design. This study presents the ground model development process, starting with an appreciation of the macro geological setting, understanding the Quaternary landsystem, to focusing on the data from the intrusive ground investigation. The understanding of the primary sedimentary depositional system is critical to the development of a site geological conceptual model. Sediments from highly variable environments of deposition, such as were present in the Early Cretaceous, will present geotechnical and geohazard challenges to a site's development and this first-principles understanding is important in this process. The link from these fundamental geological principles to engineering design, communicated through the ground model, as demonstrated in this paper, is the requirement of the engineering geological appraisal. Locally complex geology demanded a phased site investigation approach, responding to an evolving design and to construction demands, and to meet defined programme requirements for a second-stage tender, to ultimately de-risk key areas with regard to the dynamic ground and groundwater conditions. Thematic collection: This article is part of the Ground models in engineering geology and hydrogeology collection available at: https://www.lyellcollection.org/cc/Ground-models-in-engineering-geology-and-hydrogeology

Commentary on: The Use of DCE-MRI to Evaluate the Blood Supply to the Nipple-Areola Complex: A Study in 245 Asian Women.

Commentary on: The Use of DCE-MRI to Evaluate the Blood Supply to the Nipple-Areola Complex: A Study in 245 Asian Women Marc D Pacifico, MD, FRCS (Plast) Marc D Pacifico, MD, FRCS (Plast) Corresponding Author: Dr Marc D. Pacifico, Purity Bridge, Tunbridge Wells, TN4 8AE, UK. E-mail: marc@pacifico.co.uk Search for other works by this author on: Oxford Academic PubMed Google Scholar Aesthetic Surgery Journal, Volume 41, Issue 6, June 2021, Pages NP355–NP356, https://doi.org/10.1093/asj/sjaa359 Published: 27 February 2021 Article history Editorial decision: 08 December 2020 Corrected and typeset: 27 February 2021 Published: 27 February 2021

Management of Metastatic Spinal Cord Compression in Secondary Care: A Practice Reflection from Medway Maritime Hospital, Kent, UK.

Introduction: Malignant spinal cord compression (MSCC) is one of the most devastating complications of cancer. This event requires rapid decision-making on the part of several specialists, given the risk of permanent spinal cord injury or death. The goals of treatment in spinal metastases are pain control and improvement of neurological function. There can be challenges in delivering prompt diagnosis and treatment in a secondary care setting. We have reflected on the experience of managing MSCC in a district general setting. Aim: Our retrospective audit identified 53 patients with suspected MSCC who entered the relevant pathway from April 2017 to March 2018 at Medway, United Kingdom (UK). Our audit standards were set out by Medway Maritime Hospital and Maidstone and Tunbridge Wells NHS Trust MSCC working group members, using a combination of published evidence and best practice. Results: The patients with suspected MSCC were 53 and 29 of them (54.7%) had confirmed MSCC. The most common malignancies within the confirmed MSCC were lung (11 patients, 37.9%), breast (5 patients 17.2%), and renal (3 patients, 10.3%), followed by prostate, myeloma and carcinoma of unknown primary (2 patients (6.9%) each), as well as pancreatic, colorectal, lymphoma and, bladder (1 patient (3.4%) each). A magnetic resonance imaging (MRI) scan was performed in 48 patients (90.5%); the majority (31 patients, 64.6%) underwent the MRI within the first 24 h, whereas 3 patients had the investigation between 24 and 72 h from the admission. Among the 29 patients with confirmed MSCC, 6 (20.6%) were treated with surgical decompression, while 20 (69%) received radiotherapy (RT) and 3 (10.3%) best supportive care, respectively. Median time to surgery was 5 days (ranged between 2 and 8 days), whereas for RT 44.4 h (ranged between 24 and 72 h). Finally, all 3 patients that decided on symptom control were referred to a palliative care team within the first 24 h following the MRI scan. Conclusions: MSCC is frequently presented outside tertiary care. This may cause subsequent delays in investigation, diagnosis, and treatment, which can be improved by following a fast track referral pathway.

Social Polarisation at the Local Level: A Four-Town Comparative Study on the Challenges of Politicising Inequality in Britain

This article examines how intensifying inequality in the UK plays out at a local level, in order to bring out the varied ways polarisation takes place ‘on the ground’. It brings a community analysis buttressed by quantitative framing to the study of economic, spatial and relational polarisation in four towns in the UK. We distinguish differing dynamics of ‘elite-based’ polarisation (in Oxford and Tunbridge Wells) and ‘poverty-based’ polarisation (in Margate and Oldham). Yet there are also common features. Across the towns, marginalised communities express a sense of local belonging. But tensions between social groups also remain strong and all towns are marked by a weak or ‘squeezed middle’. We argue that the weakness of intermediary institutions, including but not limited to the ‘missing middle’, and capable of bridging gaps between various social groups, provides a major insight into both the obstacles to, and potential solutions for, re-politicising inequality today.

91 - Audit of stage III non-small cell lung cancer (NSCLC) management at Maidstone and Tunbridge Wells NHS Trust (MTW)

91 - Audit of stage III non-small cell lung cancer (NSCLC) management at Maidstone and Tunbridge Wells NHS Trust (MTW)