Supplementary education and the coronavirus pandemic: Economic vitality, business spatiality and societal value in the private tuition industry during the first wave of Covid-19 in England.

This paper challenges geographers to examine the lucrative, but vastly understudied, global supplementary education sector (e.g. private tuition; learning centres; cram schools). It marks a break from research in Geographies of Education on locational, socio-cultural and political-economy issues, by concentrating directly on the economic geography of this metaphorically monikered 'shadow education' sector. Centred on the first wave of the coronavirus pandemic, the paper's aim is to investigate the impact of COVID-19 on the economic vitality, business spatiality and societal value of private tuition in England. Methodologically, it utilises in-depth interviews with tutors providing one-to-one instruction in English, maths or science in the regionally-differentiated tuition market. The findings demonstrate business vitality was impacted: COVID-19 related disruption to schooling produced a profound economic shock for the tuition industry, though new opportunities also emerged from the crisis. Business spatiality was fundamentally rewritten, not only in terms of delivery but also as local markets became national ones. The social value of the industry was drawn into question, as the service was both vital and regressive in its distribution. In conclusion, the paper argues geographers of education must: (i) Embrace research on supplementary education in its own right and as it articulates with state education provision; (ii) Pursue economic analyses which consider both how markets work to produce unequal outcomes for potential consumers, and how they emerge as a space of educational entrepreneurship for those seeking to make a living; and (iii) Urgently examine how the coronavirus pandemic is rewriting processes across the education system.

A Randomised Controlled Trial Comparing Three Different Radiofrequency Technologies: Short-Term Results of the 3-RF Trial.

OBJECTIVE: To date there has been no comparison of outcomes of endovenous radiofrequency (RF) devices. The 3-RF trial is the first randomised controlled trial of three commercially available RF ablation technologies. METHODS: Patients were recruited [182/302 patients with great saphenous vein (GSV) incompetence] into a prospective double blind randomised trial of Venefit, radiofrequency induced thermal therapy (RFITT), and endovenous radiofrequency (EVRF). The primary outcome measure was GSV closure (total/partial/failed) at six months. Secondary outcome measures included ablation times, complications, pain scores, analgesia requirements, and quality of life (QoL) scores to 12 months. RESULTS: Patients treated [180: Venefit (57), RFITT (64), EVRF (59)] were matched for age, sex, and vein characteristics. At six months, complete GSV closure was significantly better after Venefit and RFITT treatment (100% and 98%, respectively) compared with EVRF treatment (79%, p < .001). Mean treatment time was significantly faster for RFITT than for Venefit and EVRF (p < .0001). Euroqol 5D (EQ5D) visual analogue score (VAS) did not differ between groups at any time point. The only difference between groups in EQ5D domain scores was for the pain/discomfort domain at two weeks when significantly fewer EVRF patients reported no problems compared with Venefit and RFITT. This difference had disappeared at six and 12 months. The Aberdeen Varicose Vein Questionnaire (AVVQ) improved for all groups at six and 12 months compared with pre-treatment levels; however, there was no significant difference between groups. CONCLUSION: Compared with Venefit and RFITT, EVRF was associated with significant failure of truncal ablation at six months; however, clinical outcomes did not differ significantly at 12 months. clinicaltrials.gov identifier: NCT02441881, NHS Health Research Authority (Hampstead Research Ethics Committee) number: 14/LO/1232.

Efficacy and Safety of Valproic Acid for Spinal Muscular Atrophy: A Systematic Review and Meta-Analysis.

BACKGROUND: Spinal muscular atrophy (SMA) is a neuromuscular disorder classified into four types based on the age of onset of the disease. Early onset is correlated with a higher mortality rate, mainly due to respiratory complications. Valproic acid (VPA) is a histone deacetylase (HDAC) inhibitor that has shown positive results on SMA both in experimental and cohort studies. OBJECTIVES: This systematic review and meta-analysis aimed to investigate the efficacy and safety of VPA in patients with SMA. METHODS: Eleven databases were systematically searched on 30 May 2017 for clinical trials that reported the efficacy and safety of VPA in SMA patients. The primary outcome was the efficacy of VPA in terms of gross motor function and expression of both full-length spinal motor neuron (SMN) gene (FL-SMN) and exon 7-lacking SMN. The secondary outcome was the safety of VPA in terms of reported adverse effects. The protocol was registered at PROSPERO (CRD42017067203). RESULTS: Five of the ten included studies were used in the meta-analysis (n = 126). The overall effect estimate, comparing pre- and post-VPA treatment, regardless of carnitine co-administration and design of the studies, showed significant improvement in gross motor function (standard mean difference [SMD] = 0.302, 95% confidence interval [CI] 0.048-0.556, P = 0.02) using the Hammersmith Functional Motor Scale (HFMS), Modified Hammersmith Functional Motor Scale (MHFMS), and MHFMS-Extend, with no significant heterogeneity. Similarly, in non-randomized controlled studies, the results indicated that there was a significant improvement detected (SMD = 0.335, 95% CI 0.041-0.628, P = 0.025), with no significant heterogeneity. Meanwhile, our results suggest that there was no significant improvement in treatment with co-administered carnitine (SMD = 0.28, 95% CI - 0.02 to 0.581, P = 0.067). No significant differences were found between pre- and post-VPA treatment co-administered with carnitine, in terms of the change in FL-SMN and exon 7-lacking SMN. Qualitative synthesis showed that other motor functions were not improved, while respiratory function test results were contradictory. Regarding the safety of the treatment, a double-blind, randomized, placebo-controlled trial reported no statistically significant differences for adverse events (AEs) between groups. Moreover, most of the included studies reported no serious AEs related to VPA use, although weight gain, gastrointestinal symptoms and respiratory symptoms were notable problems. CONCLUSIONS: Our study suggests that VPA treatment results in an improvement in gross motor functions for SMA patients, but not in other assessments of motor function or, possibly, in respiratory function. Furthermore, VPA appears to be a relatively safe drug, although treatment may be associated with a wide range of AEs (including body weight increase, fatigue, fever, flu-like symptoms, irritability, and pain). Double-blind, randomized, controlled trials are required to confirm these findings.

Generational patterns of alcohol consumption: Continuity and change.

In most contemporary western societies there is growing concern about rising levels of alcohol consumption, particularly by young people, even in countries, such as France, which have previously been assumed to have 'sensible' drinking cultures. Recent popular and policy debates about British drinking cultures have hinted at a shift in generational attitudes towards alcohol, as well as patterns of consumption. Previous intergenerational studies of work and care have found that in particular historical periods different normativities develop, reflecting both social and economic conditions. In this paper, we draw on a research project about alcohol consumption conducted in an urban and rural area - including intergenerational interviews with case study families - to identify the different normativities in terms of attitudes towards and consumption of alcohol experienced by three cohort generations in their youth. The paper then goes on to explore the patterns of both change and continuity that are evident in the interviewees' experiences. The conclusion reflects on drivers of intergenerational change and associated health policy implications.