Artykuły w czasopismach na temat „St. Thomas of Acon's hospital (London, England)”

Summary Leonard Craske (1878–1950), born and raised in London, England, spent two years as a medical student at St Thomas’ Hospital Medical School. Following this, he worked as an actor and studied drawing and sculpting. After emigrating to the USA and settling in Boston, he became an accomplished sculptor, creating the well-known Fishermen's Memorial in Gloucester, Massachusetts, the work for which he is best remembered.

Clinical specialist physiotherapists from the five severe respiratory failure centres in England where respiratory extracorporeal membrane oxygenation (ECMO) is practiced have established this consensus agreement for physiotherapy best practice. The severe respiratory failure centres are Wythenshawe Hospital, Manchester; Glenfield Hospital, Leicester; Papworth Hospital, Cambridge; Guy’s and St Thomas’ Hospital, London and The Royal Brompton Hospital, London. Although research into physiotherapy and ECMO is increasing, there is not a sufficient amount to write evidence-based guidelines; hence the development of a consensus document, using knowledge and experience of the specialist physiotherapists working with patients receiving ECMO. The document outlines safety aspects, practicalities and additional treatment considerations for physiotherapists conducting respiratory care and physical rehabilitation.

SummaryWe report a marked increase in the rate of notifications of tuberculosis in young adults in the London Borough of Lambeth. Analysis of notifications made to the Proper Officer over a 10-year period showed that the age specific notification rate in the cohort aged 20–44 years increased from 30/100000 in 1983 to 51/100000 in 1992. Analysis of St. Thomas' Hospital laboratory records of patients seen between 1984 and 1991 from whom Mycobacterium tuberculosis was isolated showed an increase in the number of patients of African origin from five in the first half of the study period (1984–7) to 25 in the second half (1988–91): 21 of these 25 had immigrated into England within 4 years of their illness. This finding is being further investigated in a prospective study of ethnicity, travel history and date of immigration of Lambeth residents notified with tuberculosis.

Objective: To assess the distribution of deep vein thrombosis in the calf by phlebography. Setting: Department of Vascular Radiology, St. Thomas' Hospital, London, England. Patients: Seventy patients with suspected deep vein thrombosis or pulmonary embolism were examined. Interventions: Bilateral ascending contrast phlebography was performed in all patients. Main Outcome Measures: The sites of any thrombus in the stem or muscle veins of the calf below the popliteal vein were recorded. Results: One hundred legs contained thrombus. In fifty-three legs thrombus was present solely in the calf veins below the popliteal vein. Isolated thrombus in either one or more of the three paired stem veins or the muscle veins was present in twenty-two calves. Conclusions: Because of the difficulty in visualising some calf veins by duplex ultrasound it is suggested that a detailed knowledge of the distribution of thrombus may assist ultrasonographers.

Abstract Acute Chest Syndrome (ACS) is the second most common cause of hospitalisation in patients with Sickle Cell Disease (SCD) and up to 25% of those admitted will require intensive care management. ACS is a leading cause of death in SCD. It may also play a role in the development of chronic lung disease in SCD patients and the prevalence of Asthma in SCD patients is high. The pathogenesis of ACS is complex. Previous work has suggested a relationship between asthma and higher risk of ACS in children with SCD. Data in the UK is limited. Our aim therefore was to describe the presentation, course and outcome of ACS in our local SCD pediatric population, compared with those children who had ACS with SCD and physician diagnosed Asthma (Asthma). Methods: The data collection took place at The Evelina Children’s Hospital, which is part of St Thomas’ Hospital, a large teaching hospital in Central London, England. There are over 400 children with SCD registered, and around 30 new SCD births per year. A retrospective analysis of patient hospital electronic and paper records was performed of 63 ACS presentations over a three year period from 2003 to 2006. Inclusion in the study required a new infiltrate on chest radiograph plus acute respiratory symptoms in a patient with SCD under the age of 16 years. The group included 16 (25%) presentations in children with SCD and Asthma. Results: No Known Asthma 47 Presentations; Mean age 6.2 yrs (range 1–15yrs); HbSS 87%, HbSC13%; Previous ACS 26% (n=12); Mean length of stay 5.4 days (range 1–27); Mortality 0; Mean C-Reactive protein (CRP) on admission 70 (normal <5); Mean oxygen saturations on presentation 92% in air (40% of patients presented with saturations <92% in air) Physician Diagnosed Asthma 16 Presentations; Mean age 4.6 (range 1–15yrs); HbSS 94%, HbSC 6%; Previous ACS 63% (n=10); Mean length of stay 5.4 (range 2–14); Mortality 0; Mean CRP on admission 41; Mean oxygen saturations on presentation 92% in air (50% of patients presented with saturations <92% in air) DISCUSSION: Demographics: Comparable in terms of age and haemoglobin genotype. Presentation: Patients with asthma were more likely to have had previous ACS. Children with asthma presented with a lower CRP. Treatment: The treatment in both groups including the use of blood transfusion, and need for transfer to intensive care were comparable. However there was an observed difference in the use of inhaled bronchodilators (non asthma 21% v asthma 50%). Steroids were rarely used (4%) to treat the patients who did not have a pre-existing diagnosis of asthma, however were used to treat most (94%) of those patients with asthma. Outcome: Length of stay was comparable, no deaths in either group. CONCLUSION: Although patients in our study group with asthma had a higher frequency of previous ACS episodes, we did not demonstrate that patients with asthma suffer a more severe course of illness.

AimIn March 2020, COVID-19 triggered an NHS directive to reduce face-to-face consultations and adapt to virtual clinics.1 Hospital pharmacies, each with their own model of care, quickly innovated to ensure patients received their medication safely.The aim of this study was to evaluate the provision of medications optimisation for paediatric patients following virtual outpatient consultations (VOC) and explore potential improvements for future implementations.MethodThis was a mixed method study using quantitative data; which reviewed medications sent to patients in red, amber, and green categories2 and qualitative data; using patient feedback, to evaluate the processes in three London hospitals. Pathway mapping (PM) sessions, with multidisciplinary team involvement, were conducted across these hospitals to identify areas for improvement and analyse gaps in services. Virtual PM sessions were attended by 30 representatives across the multidisciplinary team including: pharmacists, nurses, consultants, pharmacy technicians, post room attendants; and general, operational, and project managers.Semi-structured questionnaires were used to conduct one to one telephone interviews with patients’ families. A separate topic guide was used to interview General practitioners (GP) and primary care network (PCN) pharmacists. The audio recordings were transcribed as ‘intelligent verbatim’ and analysed using Nvivo. Braun and Clarke’s six phases approach was used to conduct an inductive thematic analysis.3 To improve the rigorousness of the study, more than 50% of the transcript were double coded.4As this was a service evaluation, ethics approval was not necessary. The project was registered with each hospital’s clinical audit department.ResultsThe three process maps were analysed and potential improvements for the medicines optimisation pathway were assessed by a paediatric pharmacy subgroup using ease-impact matrix. Potential improvements include: exploration and use of Electronic Prescription Service by secondary and tertiary care, improving communication through Information Technology systems between prescribers and hospital pharmacists, and the creation of a transparent standard operating procedure regarding medication supply following VOC.Seventy-one patients’ families across the sites were interviewed between January-May 2021 to reflect on their experience of receiving medications following a VOC. Four GPs and one PCN pharmacist were interviewed in May 2021 to assess on the impact of VOC on primary care.Key reflections from themes generated include the convenience of receiving medications from hospital pharmacies following VOC, satisfaction of the current process, including medicines packaging and medicines information provided to patients and their families.Other reflections included limitations of the current process and its implication on patient safety. Medicines information helplines and education provided by pharmacists were regarded by patients’ families and GPs as a valuable attribute.ConclusionPatients’ families appreciated the current model of care, however patients’ families and primary care healthcare professionals have identified both challenges and suggestions for improvement in delivering the current model. Future research should focus on a mixed mode of integrated care with green and amber medications2 prescribed directly to community pharmacies with clinical screening and counselling conducted by hospital pharmacists.ReferencesStevens S and Pritchard A. Important and urgent – next steps on NHS response to Covid-19. NHS England [Online]. 17 March 2020: Available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/urgent-next-steps-on-nhs-response-to-covid-19-letter-simon-stevens.pdfGuy’s and St Thomas’ NHS Foundation Trust, Kings College Hospital NHS Foundation Trust, Lewisham and Greenwich NHS Trust. South East London Joint Medicines Formulary. netFormulary. [Online]. 2020: Available at: http://www.selondonjointmedicinesformulary.nhs.uk/Braun V and Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3:77-101.Maher C, Hadfield M, Hutchings M, et al. Ensuring rigor in qualitative data analysis: a design research approach to coding combining NVivo with traditional material methods. International Journal of Qualitative Methods 2018;17:1-13.

The author, Derek Beatty, was diagnosed with T1D Diabetes 45 years ago when living in High Wycombe, Buckinghamshire, England. Symptoms of thirst, tiredness, difficulty in reading small print, led to GP doctor consultation with fasting blood glucose Biochemistry tests. Possible Genetic Inheritance may have contributed to reduced Immunogenic resistance to infection possibly triggered from business travel to several African Countries including Kenya, Zambia, Nigeria, Sudan, Egypt, South Africa. Add the trauma as witness to a fatal car crash in Bricket Wood, St Albans, when a driver of a Rolls Royce crashed into the rear of a lorry in the dark on an October afternoon. With a natural Adrenalin trigger to help in an emergency and First Aid training when in a Scout Group in Edinburgh, to stop and assist, comfort the car driver, shout for an ambulance when others appeared. An ambulance arrived promptly (before the era of Mobile Phones), Paramedics took over with hospital transfer. This frightening event has left a vivid memory flashback scar along with near fatal Hypoglycaemia with Neuroglycopenia scars. The Police called 3 days later and requested a witness statement. There was no hesitation to be able to help. When asked about the car driver welfare the answer was that he had suffered severe neurological injury and sadly died. What followed was a correct Fatal Accident Inquiry before a Coroner identifying Accidental Death. With courage the wife and family spoke after to thank me for doing my best to help save the driver, but sadly he had passed. We hope and pray he rests in peace. This tragic experience has left a strong sense of courage and determination in the belief that prevention is better than cure. When, and if tragedy occurs, what might have been the cause always helps in learning and education and often offers future opportunity to enable prevention. We can learn from tragedy and take steps to forensically identify cause and seek to prevent recurrence. The experience of near fatal Diabetes Hypoglycaemia and Neuroglycopenia caused by ignorance and failure to educate a family what to do in a diabetes hypoglycaemia emergency involving the Hormone Insulin with NHS GP mismanagement and Gross Negligence in Public Office cover up, when combined with an Addisonian Adrenalin Crisis, both with Neuroglycopenia and Simultaneous, has led to 30 years forensic research of the event cause with identified errors in Law justifying disclosure and loss recovery from those responsible for legal errors. Today with global interest and helpful personal clinical support from an excellent Diabetes Endocrinology Team of Clinicians and Nurses in Edinburgh and recognition with interest from many clinicians and nurses worldwide of the importance of this work has enhanced personal positivity to succeed and Win in Insulin Chicanes when at the same time treating an incurable long term health condition requiring daily injections of the hormone Insulin platformed with dose adjustment to target normoglycaemia and accommodate lifestyle while addressing insulin dose and type; exercise; diet; differences in carbohydrate and fat content in foods; interest in Keto style diet; fruit; vegetables; food sugar content; adverse stress: happiness; family and friendship encouragement and support; education of damage of excess alcohol; smoking; recreational drugs; and the link to the medical mystery. Summary review of Virological attack associated with Obesity, Overeating, Alcohol, risk of Foetal Alcohol Spectrum Disorder, Smoking, triggers for Parkinson’s Disease, Dyslexia, certain Ophthalmic conditions with possible links e.g., Nystagmus linked to Dyslexic, Genetically Inherited Addison’s Disease possibly from India after discovery by Thomas Addison in 1860 and add the Insulin Journey from discovery Banting, Best, Macleod, Collip, 1922, and the World’s First Hypoglycaemia Event with Neuroglycopenia experienced as a Clinical Event by Dr Jim Gilchrist and in L:aw recognised as Such by Banting, Best, Macleod, Collip, and Toronto Police, Canada at the time. Yes, Insulin can be used as a Poison, but it is a lifesaving Hormone for which today in 2024 all T1D Diabetes patients are exceedingly grateful for the research of over 100 years ago. One must never describe in Law Insulin as a Poison without good cause and reason. Insulin is a Hormone. This is important especially in tragic cases in pregnancy when Gestational Diabetes can occur leading to neonate and young baby infection and on occasion fatality. In 2023 I have experienced Blue Toe Syndrome associated with negative test Long COVID caused by vascular disturbance at toe extremity and Quinsi, very rare in long term Diabetes, sometimes in Tonsilitis during teenage and early adult life, but likely identified as Virological infection caused by Long COVID. Was prevention of Hypoglycaemia Unawareness in 1987–1994 possible? How do we discover? We need to research. We need social recognition and understanding in 2024 as we use this experience to better understand Clinical Hypoglycaemia and Neuroglycopenia in Law. 2023 published awareness of Hypoglycaemia, IDF INTERNATIONAL DIABETES FEDERATION with Immunogenic Issues in Diabetes and Addison’s Disease, has identified implications for COVID-19 Public Health Inquiry Investigation in Scotland. Forensic Aspects of Hypoglycaemia 4, now explores CPS Crown Prosecution Service and Court Reference Redacted in St Albans, Hertfordshire, England, to Correct Errors in Law identified from 1989 when a Law Society registered solicitor in Knutsford, Cheshire, who on the balance of probability, was aware that the Law Society in England at the time had allocated £500,000 in Public Funds to assess whether a case existed to identify Marketing and Safety adverse experience of Hypoglycaemia Unawareness? Investigation led to instances of personal injury and cases of unexplained death in bed syndrome to address a claim for damage experience against the Pharmaceutical Industry. A licence to market BHI Insulin on 26 August 1982 was given after close forensic safety consideration by application to the MHRA at the Department of Health, London. The Licence was granted with provisions that prescribing GP General Practitioner doctors reduced the Insulin dose by up to 20% when prescribed to T1D diabetes patients treated with Porcine or Beef Insulin, prescribed BG Blood Glucose monitoring medical devices to the patient, and provide clear education to the Patient and family members living with the Diabetes Patient, providing care for the patient, and knowing exactly what to do in a Diabetes Hypoglycaemia Emergency, and by default an Endocrine Red Alert Adrenalin Addisonian Crisis. On all counts the GP Practice in St Albans and Bricket Wood, Hertfordshire, failed miserably. When consulted in 1989 by the patient’s wife and sister-in-law the Knutsford solicitor firm failed to disclose known Law Society Investigation update involving Hypoglycaemia and education to the solicitor clients, the patient’s Wife and Sister-in-Law, and instead sent a libelous letter to the patient in 1989 with redisclosure in 1994. Character defamation of the patient in 1989 and 1994 is forensically identified in 2024 as clinical behavioural temporary mental health when in a state of hypoglycaemia unawareness and can be demonstrated in the animal rat model showing inferior quality Purkinje Cell Environmental Enrichment with insulin overdose or underdose leading to hyperglycaemia which when under corrected can lead to diagnose of T2D Type 2 Diabetes often associated with diet, lack of exercise, poor keto diet experience, alcohol abuse leading to obesity. In 2000, a request to the Court for medical notes disclosure was described as a ‘Fishing Trip’. Again in 2005 an Insurance Broker completely ignorant of Diabetes and Hypoglycaemia misled the court. Disclosure December 2020 by a Transaction Director, London, of the Firm EY, is identified as failure to identify and seek NHS help to address likely Genetically Inherited Addison’s Disease in an NHS patient, first suspected in 1994 when the GP Practice failed to act, then in March 1996 when the Official Solicitor was invited to investigate with referral failure. 2024 Forensic Analysis has identified opportunities to act and correct errors in law, nothing was done, why? In 2024 we investigate the cause of Suicide on 11 October 2020 in Alban Manor Nursing Home, St Albans, during COVID-19 Pandemic of Addison’s Disease Patient. Despite aged 79 her life could have been saved but alleged negligence in breach of the Mental Health Act 1983 caused the death with failure to take into account warnings from the Banting Lecture 1994 Hypoglycaemia, Real or Unreal, Lawful or Unlawful with Addison’s Disease Suicide. Under European Human Rights Law, The Human Rights Act 1998, and European Convention on Human Rights, a Public Immunity Argument exists to publish to learn from experience to prevent reoccurrence with implications to assist COVID-19 Public Health Inquiry Investigation.

Abstract Background: Secondary CNS involvement (SCNS) is a detrimental complication seen in ~5% of patients with diffuse large B-cell lymphoma (DLBCL) treated with modern immunochemotherapy. Data from older series report short survival following SCNS, typically <6 months. However, data in patients that develop SCNS following primary therapy that contains a rituximab-based-regimen as well as the impact of more intensified treatment for SCNS are limited. Aims: The aims of this study were to i) describe the natural history of SCNS in a large cohort of patients treated with immunochemotherapy, and ii) determine prognostic factors after SCNS. Patients and methods: We performed a retrospective study of patients diagnosed with SCNS during or after frontline immunochemotherapy (R-CHOP or equivalently effective regimens). SCNS was defined as new involvement of the CNS (parenchymal, leptomeningeal, and/or eye) in patients without known CNS involvement at the time of first pathologic diagnosis of DLBCL. Patients were identified from local databases and/or regional/national registries in Denmark, Canada (British Columbia), Australia, Israel, US (University of Iowa/Mayo Clinic SPORE), and England (Guy's and St. Thomas' Hospital, London). Clinico-pathologic and treatment characteristics at the time of SCNS were collected from medical records. Results: In total, 281 patients with SCNS diagnosed between 2001 and 2016 were included. Median age at SCNS was 64 (range 20-93) years and male:female ratio was 1.3. SCNS occurred as part of first relapse in 244 (87%) patients and 112 (40%) had documented concurrent systemic disease at the time of SCNS. The median time from initial DLBCL diagnosis to SCNS was 9 months, which was similar for patients treated with (N=76, 27%) or without upfront CNS prophylaxis (N=205, 73%) (10 vs 9 Mo; P=0.3). The median post-SCNS OS was 4 months (interquartile range 2-13) and the 2yr survival rate was 20% (95% CI 15-25) for the entire cohort. Associations between clinicopathologic features, management strategy, and post-SCNS survival are shown in Table 1, which excludes patients who did not receive any treatment against SCNS, patients treated with steroids alone, and a patient with unavailable treatment information (n=43, 15%). In multivariable analysis, performance status >1, concurrent leptomeningeal and parenchymal involvement, SCNS developing before completion of 1st line treatment, and combined systemic and CNS involvement by DLBCL were associated with inferior outcomes. Upfront CNS prophylaxis did not influence post-SCNS OS. High-dose methotrexate (HDMTX) and/or platinum based treatment regimens (i.e. ICE, DHAP, or GDP [+/- IT treatment and/or radiotherapy], N=163) for SCNS were associated with reduced risk of death (HR 0.45 [0.32-0.62, P<0.01]). The 2yr post-SCNS survival for patients treated with HDMTX and/or platinum-based regimens (N=163) was 29% (95% CI 22-37). For patients with isolated parenchymal SCNS, single modality treatment with radiotherapy resulted in 2-yr OS of 19% (95% CI 8-35). For the subgroup of 49 patients treated with HDMTX- and/or platinum-based regimens for isolated SCNS after 1st line DLBCL treatment and with performance status 0 or 1, the 2yr post-SCNS survival was 46% (95% CI 31-59). Overall, 9% of the patients received HDT with ASCT as part of salvage therapy at the time of SCNS. Amongst 36 SCNS patients without systemic involvement and in CR following intensive treatment (HDMTX and/or platinum-based treatments), 11 patients consolidated with HDT had similar outcomes to 25 patients treated without consolidating HDT (P=0.9, Fig 1) Conclusions: Outcomes for patients with SCNS remain poor in this large international cohort of patients from the immunochemotherapy era. Combined parenchymal and leptomeningeal disease, presence of systemic disease concurrent with SCNS, performance status >1, and SCNS developing during first line treatment were independently associated with inferior OS. However, a significant fraction of patients with isolated SCNS after first line DLBCL treatment and with good performance status may achieve long-term remissions after intensive regimens for SCNS. Disclosures El-Galaly: Roche: Consultancy, Other: travel funding. Cheah:Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Gilead Sciences: Membership on an entity's Board of Directors or advisory committees; Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees, Other: Speaker's Bureau. Kansara:Celgene: Honoraria. Connors:Bristol Myers Squib: Research Funding; NanoString Technologies: Research Funding; F Hoffmann-La Roche: Research Funding; Millennium Takeda: Research Funding; Seattle Genetics: Research Funding. Sehn:roche/genentech: Consultancy, Honoraria; amgen: Consultancy, Honoraria; seattle genetics: Consultancy, Honoraria; abbvie: Consultancy, Honoraria; TG therapeutics: Consultancy, Honoraria; celgene: Consultancy, Honoraria; lundbeck: Consultancy, Honoraria; janssen: Consultancy, Honoraria. Opat:Roche: Consultancy, Honoraria, Other: Provision of subsidised drugs, Research Funding. Seymour:Genentech: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie Inc.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Villa:Celgene: Honoraria; Lundbeck: Honoraria; Roche: Honoraria, Research Funding.

William Attree (1780–1846) came from a prominent family in Brighton, England. He studied medicine at St Thomas’ Hospital, London, and there was unwell for nearly 6 months with severe ‘spasms’ of the hand/arm/chest (1801–1802). Attree qualified Member of the Royal College of Surgeons in 1803 and served as dresser to Sir Astley Paston Cooper (1768–1841). In 1806 Attree is recorded as ‘Surgeon and Apothecary’ of Prince's street, Westminster. In 1806 Attree's wife died in childbirth and the following year he underwent emergency amputation of the foot in Brighton following a road traffic accident. Attree served as surgeon in the Royal Horse Artillery at Hastings, presumably in a regimental or garrison hospital. He went onto become surgeon to the Sussex County Hospital, Brighton, and Surgeon Extraordinary to two Kings: George IV and William IV. In 1843 Attree was appointed as one of the original 300 Fellows of the Royal College of Surgeons. He died in Sudbury, near Harrow. His son William Hooper Attree (1817–1875) was surgeon to Don Miguel de Braganza, the former King of Portugal. The medical literature appears to lack a history of nineteenth century doctors (especially military surgeons) with physical disability. Attree's biography goes a small way towards developing this field of enquiry.

The translations and cross-cultural adaptation of the Scoliosis Research Society Revised (SRS-22r) into Urdu Ahmed ATR *1,2, Rye C 1,3, Rand S 1, Simmonds JV 1 1.Great Ormond Street Institute of Child Health, University College London. 2. West London NHS Healthcare Trust. 3. Great Ormond Street Hospital NHS Foundation Trust ___________________________ Development of an evidence-based pathway of care for children presenting with Toe-Walking gait to the Royal National Orthopaedic Hospital. Christine Douglas *1,2, Jane Simmonds 2, Jonathan Wright 1 1 Royal National Orthopaedic Hospital (RNOH), Stanmore UK 2 Great Ormond Street Institute for Child Health, UCL, UK __________________________ Trends in notification of cases to the Northern Ireland Cerebral Palsy Register Claire Kerr*, Oliver Perra, Róisín Keenan, Karen McConnell ____________________________ Moving towards a better understanding of well-being for children with complex disabilities who use a robotic device, the Innowalk ©Made for Movement (This research is supported by an APCP bursary 2022-2023) Dr Dawn Pickering, Cardiff University __________________________ Translation and cross-cultural adaptation of Indian (Hindi) version of the Paediatric Motor Activity Log Scale-Revised (PMAL-R). Surve ER *1,2, Coomer A 1,3,4, Rand S 1, Simmonds JV 1 1.Great Ormond Street Institute of Child Health, University College London. 2. West London NHS Healthcare Trust. 3. St Mary’s Hospital, Imperial Healthcare Trust. 4. St Georges, University of London __________________________ The Paediatric Physiotherapy Curricula Landscape: A Survey of United Kingdom Entry-Level Programs. Jennifer Chesterton, Faculty of Health Science and Wellbeing. University of Sunderland. Paul Chesterton, School of Health and Life Sciences, Teesside University __________________________ Physiotherapy and Occupational Therapy Hip Hop Collaboration Jenny Thomas, Advanced Physiotherapist, Sheffield Children’s Hospital * __________________________ Community-based gym exercise for non-ambulant adults with childhood onset disability Karen McConnell *1, Claire McFeeters2, Joanne Marley2, Alix Crawford3, Katy Pedlow2 1. School of Nursing and Midwifery, Queen’s University Belfast, 2. School of Health Sciences, Ulster University, 3. Mae Murray Foundation __________________________ Burden or Blessing? Evaluating parental satisfaction of a parent-mediated approach to a pilot interdisciplinary therapy Early Intervention Programme. Brimlow K*., McKenzie A., Philips A. Scottish Centre for Children with Motor Impairments, Cumbernauld, United Kingdom __________________________ Walk tall and look the world right in the eye: A service evaluation of a 4-week trial to assess if the Innowalk Pros could provide physical activity for children with complex neuro-disabilities within a Special School Kath Brimlow*, Jenni Coulter, Aida de La Torre Romero, Georgina Farquhar Scottish Centre for Children with Motor Impairments __________________________ ‘FUNdamentals in Athletics’ Lynsey Cunningham and Clare Gardiner* (South Eastern H&SC Trust) Lee Campbell (Athletics Coach) __________________________ A call to action: gasping for attention Naomi Winfield*, University College London, Milton Keynes University Hospital Madeline Pilbury, Stockport NHS Foundation Trust Carolyn Aitken Arbuckle, NHS Lothian Jason Kettle, Lincolnshire Community Health Services NHS Trust Samantha Grace, St George’s Hospital London Laura Lowndes, Cambridge University Hospitals NHS Trust. __________________________ The translation and cultural adaptation of the Paediatric Balance Scale to Hindi Nikita Dcruz*, Cambridgeshire Community Services NHS Trust Professor Jane Simmonds, University College London Naomi Winfield, University College London, Milton Keynes University Hospital __________________________ Re-SPLASH - Re-Starting Physiotherapy Led Aquatic Therapy Services in Hospital Sarah Brown*, Susan Leiper, Barry Johnstone __________________________ Breathe-Easy: a pilot study to examine the acceptability and feasibility of a novel postural management night-time intervention to improve respiratory health of children with complex neuro-disability. Crombie S*, Sellers D, Kapur A, Hillman G, Baskerville J, Morris C, Bremner S, Lundin J. __________________________ Validation of the Spider, a multisystemic symptom impact tool for symptomatic hypermobility. Busby, V 1,2, Ewer, E,1,3 Simmonds, J.V.1,4 1.UCL Great Ormond Street Institute of Child Health, 2. Buckinghamshire Healthcare NHS Trust, 3. Hounslow and Richmond Community Healthcare NHS Trust, 4. London Hypermobility Unit, Central Health Physiotherapy __________________________ The heROIC trial: Does the use of a Robotic rehabilitation trainer change Quality Of Life, range of movement and function In children with Cerebral Palsy? Clare Grodon (Whittington Health NHS Trust) Harriet Shannon (UCL Great Ormond Street Institute of Child Health) Paul Bassett (Statsconsultancy Ltd) __________________________ Making sense of ‘sport as a therapy choice’ for paediatric physiotherapists working with young people who have disabilities. Susan Booth* (studying at University of Salford) Lecturer in Paediatric Physiotherapy, University of Bolton Professor Garry Crawford (University of Salford) Dr Nicky Spence (University of Salford) __________________________ Effectiveness of integrated hip care pathways for pain, function and quality of life in children with Cerebral Palsy: A systematic literature review. Tanya M. McGrath*, Senior Lecturer, University of the West of England, Bristol, England (UK) Shea T. Palmer, Professor of Physiotherapy, Cardiff University, Wales (UK) __________________________ The differences between skeletal muscle in children with Cerebral Palsy and children who are typically developing. Rebekah Moynihan, Physiotherapist, Leckey __________________________ A focus group of experienced paediatric physiotherapists sharing their perspectives on physiotherapy management of Patellar Dislocation Holly Heighway* - MSc Paediatric Physiotherapy, University College London Daniel Armitage – Lecturer (Teaching), University College London Sarah Rand – Lecturer (Teaching), University College London Dr Louise Kedroff - Lecturer (Teaching), University College London __________________________ Ankle plantarflexor volume appears reduced in some Idiopathic toe walkers. A service evaluation. McNee AE1*, Noble J2, Evans S1, Zeigler K1, Ng Man Sun S1, Hulme A1, Fry NR2, Shortland AP2. 1Paediatric Orthopaedic Team, Chelsea and Westminster Hospital, London 2One Small Step Gait Laboratory, Evelina Children’s Hospital, London __________________________ Children and Young People (CYP) with acute finger injuries do not need referral to Physiotherapy. Nikki Thorpe, Royal Free NHS Trust, Barnet Hospital Children and Young People’s Musculoskeletal outpatient service. __________________________ Barriers and Facilitators for families of children with neurodisability participating in research: implications for physiotherapy research design and delivery. Candiss Argent*1, Claire Ingleby1, Elizabeth Thompson1, Malabika Ghosh1, Sarah Edney1,2 1.Lancashire Teaching Hospitals NHS Foundation Trust, UK, 2. Newcastle University, UK __________________________ “It kind of hurts …I still do it because it’s my physio’: Children’s experiences of physiotherapy within a feasibility RCT Rachel Rapson*, Bernie Carter, Jos M. Latour, Wendy Ingram, Jonathan Marsden. __________________________ A feasibility randomised controlled trial of an interactive exercise-training device for children with cerebral palsy. Rachel Rapson*, Bernie Carter, Jos M. Latour, Wendy Ingram, Jonathan Marsden.

Background: Little is known about motivation for weight loss and barriers to weight loss among patients with idiopathic intracranial hypertension (IIH). Such information is crucial for developing tailored weight management recommendations and novel interventions. Methods: We administered a survey to patients with IIH presenting to neuro-ophthalmology clinics at The University of Michigan Kellogg Eye Center (Michigan, USA) and St. Thomas' Hospital (London, England). Participants rated importance and motivation to lose weight (1–10 scale; 10 = extremely important/motivated). Facilitators and barriers to weight loss were assessed using open-ended survey questions informed by motivational interviewing methodology. Open-ended responses were coded by 2 team members independently using a modified grounded theory approach. Demographic data were extracted from medical records. Descriptive statistics were used to analyze quantitative responses. Results: Of the 221 (43 Michigan and 178 London) patients with IIH (Table 1), most were female (n = 40 [93.0%] Michigan and n = 167 [94.9%] London). The majority of patients in the United States were White (n = 35 [81.4%] Michigan), and the plurality were Black in the United Kingdom (n = 67 [37.6%] London]) with a mean (SD) BMI of 38.9 kg/m2 (10.6 kg/m2) Michigan and 37.5 kg/m2 (7.7 kg/m2) London. Participants' mean (SD) level of importance to lose weight was 8.5 (2.2) (8.1 [2.3] Michigan and 8.8 [2.1] London), but their mean (SD) level of motivation to lose weight was 7.2 (2.2) (6.8 [2.4] Michigan and 7.4 [2.1] London). Nine themes emerged from the 992 open-ended coded survey responses grouped into 3 actionable categories: self-efficacy, professional resources (weight loss tools, diet, physical activity level, mental health, and physical health), and external factors (physical/environmental conditions, social influences, and time constraints). Most responses (55.6%; n = 551) were about barriers to weight loss. Lack of self-efficacy was the most discussed single barrier (N = 126; 22.9% total, 28.9% Michigan, and 20.4% London) and facilitator (N = 77; 17.5% total, 15.9% Michigan, and 18.7% London) to weight loss. Other common barriers were related to physical activity level (N = 79; 14.3% total, 13.2% Michigan, and 14.8% London) and diet (N = 79; 14.3% total, 9.4% Michigan, and 16.3% London). Commonly reported facilitators included improvements in physical activity level (N = 73; 16.6% total, 18.5% Michigan, and 15.1% London) and dietary changes (N = 76; 17.2% total, 16.4% Michigan, and 17.9% London). Conclusions: Patients with IIH believe weight loss is important. Self-efficacy was the single most mentioned important patient-identified barrier or facilitator of weight loss, but professional resource needs and external factors vary widely at the individual level. These factors should be assessed to guide selection of weight loss interventions that are tailored to individual patients with IIH.

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(Bettina Braun, Mainz) Grochowina, Nicole, Reformation (Seminar Geschichte), Berlin / Boston 2020, de Gruyter Oldenbourg, X u. 220 S. / Abb., € 24,95. (Tobias Jammerthal, Neuendettelsau) Behringer, Wolfgang / Wolfgang Kraus / Roland Marti (Hrsg.), Die Reformation zwischen Revolution und Renaissance. Reflexionen zum Reformationsjubiläum (Kulturelle Grundlagen Europas, 6), Berlin 2019, Lit, 350 S. / Abb., € 39,90. (Martina Fuchs, Wien) Greiling, Werner / Thomas T. Müller / Uwe Schirmer (Hrsg.), Reformation und Bauernkrieg (Quellen und Forschungen zu Thüringen im Zeitalter der Reformation, 12), Wien / Köln / Weimar 2019, Böhlau, 474 S. / Abb., € 55,00. (Ulrich Bubenheimer, Reutlingen) Werz, Joachim, Predigtmodi im frühneuzeitlichen Katholizismus. Die volkssprachliche Verkündigung von Leonhard Haller und Georg Scherer in Zeiten von Bedrohungen (1500 – 1605) (Reformationsgeschichtliche Studien und Texte, 175), Münster 2020, Aschendorff, X u. 606 S. / graph. Darst., € 77,00. 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This essay combines life writing with meditations on the significance of walking as integral to the ritual practice of pilgrimage, where the individual improves her soul or health through the act of walking to a shrine containing healing relics of a saint. Braiding together insights from medieval literature, contemporary ecocriticism, and memory studies, I reflect on my own pilgrimage practice as it impacts the land itself. Canterbury, England serves as the central shrine for four pilgrimages over decades: 1966, 1994, 1997, and 2003.The act of memory was not invented in the Anthropocene. Rather, the nonhuman world has taught humans how to remember. From ice-core samples retaining the history of Europe’s weather to rocks embedded with fossilized extinct species, nonhuman actors literally petrifying or freezing the past—from geologic sites to frozen water—become exposed through the process of anthropocentric discovery and human interference. The very act of human uncovery and analysis threatens to eliminate the nonhuman actor which has hospitably shared its own experience. How can humans script nonhuman memory?As for the history of memory studies itself, a new phase is arguably beginning, shifting from “the transnational, transcultural, or global to the planetary; from recorded to deep history; from the human to the nonhuman” (Craps et al. 3). Memory studies for the Anthropocene can “focus on the terrestrialized significance of (the historicized) forms of remembrance but also on the positioning of who is remembering and, ultimately, which ‘Anthropocene’ is remembered” (Craps et al. 5). In this era of the “self-conscious Anthropocene” (Craps et al. 6), narrative itself can focus on “the place of nonhuman beings in human stories of origins, identity, and futures point to a possible opening for the methods of memory studies” (Craps et al. 8). The nonhuman on the paths of this essay range from the dirt on the path to the rock used to build the sacred shrine, the ultimate goal. How they intersect with human actors reveals how the “human subject is no longer the one forming the world, but does indeed constitute itself through its relation to and dependence on the object world” (Marcussen 14, qtd. in Rodriguez 378). Incorporating “nonhuman species as objects, if not subjects, of memory [...] memory critics could begin by extending their objects to include the memory of nonhuman species,” linking both humans and nonhumans in “an expanded multispecies frame of remembrance” (Craps et al. 9). My narrative—from diaries recording sacred journey to a novel structured by pilgrimage—propels motion, but also secures in memory events from the past, including memories of those nonhuman beings I interact with.Childhood PilgrimageThe little girl with brown curls sat crying softly, whimpering, by the side of the road in lush grass. The mother with her soft brown bangs and an underflip to her hair told the story of a little girl, sitting by the side of the road in lush grass.The story book girl had forgotten her Black Watch plaid raincoat at the picnic spot where she had lunched with her parents and two older brothers. Ponchos spread out, the family had eaten their fresh yeasty rolls, hard cheese, apples, and macaroons. The tin clink of the canteen hit their teeth as they gulped metallic water, still icy cold from the taps of the ancient inn that morning. The father cut slices of Edam with his Swiss army knife, parsing them out to each child to make his or her own little sandwich. The father then lay back for his daily nap, while the boys played chess. The portable wooden chess set had inlaid squares, each piece no taller than a fingernail paring. The girl read a Junior Puffin book, while the mother silently perused Agatha Christie. The boy who lost at chess had to play his younger sister, a fitting punishment for the less able player. She cheerfully played with either brother. Once the father awakened, they packed up their gear into their rucksacks, and continued the pilgrimage to Canterbury.Only the little Black Watch plaid raincoat was left behind.The real mother told the real girl that the story book family continued to walk, forgetting the raincoat until it began to rain. The men pulled on their ponchos and the mother her raincoat, when the little girl discovered her raincoat missing. The story book men walked two miles back while the story book mother and girl sat under the dripping canopy of leaves provided by a welcoming tree.And there, the real mother continued, the storybook girl cried and whimpered, until a magic taxi cab in which the father and boys sat suddenly appeared out of the mist to drive the little girl and her mother to their hotel.The real girl’s eyes shone. “Did that actually happen?” she asked, perking up in expectation.“Oh, yes,” said the real mother, kissing her on the brow. The girl’s tears dried. Only the plops of rain made her face moist. The little girl, now filled with hope, cuddled with her mother as they huddled together.Without warning, out of the mist, drove up a real magic taxi cab in which the real men sat. For magic taxi cabs really exist, even in the tangible world—especially in England. At the very least, in the England of little Susie’s imagination.Narrative and PilgrimageMy mother’s tale suggests how this story echoes in yet another pilgrimage story, maintaining a long tradition of pilgrimage stories embedded within frame tales as far back as the Middle Ages.The Christian pilgrim’s walk parallels Christ’s own pilgrimage to Emmaus. The blisters we suffer echo faintly the lash Christ endured. The social relations of the pilgrim are “diachronic” (Alworth 98), linking figures (Christ) from the past to the now (us, or, during the Middle Ages, William Langland’s Piers Plowman or Chaucer’s band who set out from Southwark). We embody the frame of the vera icon, the true image, thus “conjur[ing] a site of simultaneity or a plane of immanence where the actors of the past [...] meet those of the future” (Alworth 99). Our quotidian walk frames the true essence or meaning of our ambulatory travail.In 1966, my parents took my two older brothers and me on the Pilgrims’ Way—not the route from London to Canterbury that Chaucer’s pilgrims would have taken starting south of London in Southwark, rather the ancient trek from Winchester to Canterbury, famously chronicled in The Old Road by Hilaire Belloc. The route follows along the south side of the Downs, where the muddy path was dried by what sun there was. My parents first undertook the walk in the early 1950s. Slides from that pilgrimage depict my mother, voluptuous in her cashmere twinset and tweed skirt, as my father crosses a stile. My parents, inspired by Chaucer’s Canterbury Tales, decided to walk along the traditional Pilgrims’ Way to Canterbury. Story intersects with material traversal over earth on dirt-laden paths.By the time we children came along, the memories of that earlier pilgrimage resonated with my parents, inspiring them to take us on the same journey. We all carried our own rucksacks and walked five or six miles a day. Concerning our pilgrimage when I was seven, my mother wrote in her diary:As good pilgrims should, we’ve been telling tales along the way. Yesterday Jimmy told the whole (detailed) story of That Darn Cat, a Disney movie. Today I told about Stevenson’s Travels with a Donkey, which first inspired me to think of walking trips and everyone noted the resemblance between Stevenson’s lovable, but balky, donkey and our sweet Sue. (We hadn’t planned to tell tales, but they just happened along the way.)I don’t know how sweet I was; perhaps I was “balky” because the road was so hard. Landscape certainly shaped my experience.As I wrote about the pilgrimage in my diary then, “We went to another Hotel and walked. We went and had lunch at the Boggly [booglie] place. We went to a nother hotel called The Swan with fether Quits [quilts]. We went to the Queens head. We went to the Gest house. We went to aother Hotle called Srping wells and my tooth came out. We saw some taekeys [turkeys].” The repetition suggests how pilgrimage combines various aspects of life, from the emotional to the physical, the quotidian (walking and especially resting—in hotels with quilts) with the extraordinary (newly sprung tooth or the appearance of turkeys). “[W]ayfaring abilities depend on an emotional connection to the environment” (Easterlin 261), whether that environment is modified by humans or even manmade, inhabited by human or nonhuman actors. How can one model an “ecological relationship between humans and nonhumans” in narrative (Rodriguez 368)? Rodriguez proposes a “model of reading as encounter [...] encountering fictional story worlds as potential models” (Rodriguez 368), just as my mother did with the Magic Taxi Cab story.Taxis proliferate in my childhood pilgrimage. My mother writes in 1966 in her diary of journeying along the Pilgrims’ Way to St. Martha’s on the Hill. “Susie was moaning and groaning under her pack and at one desperate uphill moment gasped out, ‘Let’s take a taxi!’ – our highborn lady as we call her. But we finally made it.” “Martha’s”, as I later learned, is a corruption of “Martyrs”, a natural linguistic decay that developed over the medieval period. Just as the vernacular textures pilgrimage poems in the fourteeth century, the common tongue in all its glorious variety seeps into even the quotidian modern pilgrim’s journey.Part of the delight of pilgrimage lies in the characters one meets and the languages they speak. In 1994, the only time my husband and I cheated on a strictly ambulatory sacred journey occurred when we opted to ride a bus for ten miles where walking would have been dangerous. When I ask the bus driver if a stop were ours, he replied, “I'll give you a shout, love.” As though in a P. G. Wodehouse novel, when our stop finally came, he cried out, “Cheerio, love” to me and “Cheerio, mate” to Jim.Language changes. Which is a good thing. If it didn’t, it would be dead, like those martyrs of old. Like Latin itself. Disentangling pilgrimage from language proves impossible. The healthy ecopoetics of languages meshes with the sustainable vibrancy of the land we traverse.“Nettles of remorse…”: Derek Walcott, The Bounty Once my father had to carry me past a particularly tough patch of nettles. As my mother tells it, we “went through orchards and along narrow woodland path with face-high nettles. Susie put a scarf over her face and I wore a poncho though it was sunny and we survived almost unscathed.” Certain moments get preserved by the camera. At age seven in a field outside of Wye, I am captured in my father’s slides surrounded by grain. At age thirty-five, I am captured in film by my husband in the same spot, in the identical pose, though now quite a bit taller than the grain. Three years later, as a mother, I in turn snap him with a backpack containing baby Sarah, grumpily gazing off over the fields.When I was seven, we took off from Detling. My mother writes, “set off along old Pilgrims’ Way. Road is paved now, but much the same as fifteen years ago. Saw sheep, lambs, and enjoyed lovely scenery. Sudden shower sent us all to a lunch spot under trees near Thurnham Court, where we huddled under ponchos and ate happily, watching the weather move across the valley. When the sun came to us, we continued on our way which was lovely, past sheep, etc., but all on hard paved road, alas. Susie was a good little walker, but moaned from time to time.”I seem to whimper and groan a lot on pilgrimage. One thing is clear: the physical aspects of walking for days affected my phenomenological response to our pilgrimage which we’d undertaken both as historical ritual, touristic nature hike, and what Wendell Berry calls a “secular pilgrimage” (402), where the walker seeks “the world of the Creation” (403) in a “return to the wilderness in order to be restored” (416). The materiality of my experience was key to how I perceived this journey as a spiritual, somatic, and emotional event. The link between pilgrimage and memory, between pilgrimage poetics and memorial methods, occupies my thoughts on pilgrimage. As Nancy Easterlin’s work on “cognitive ecocriticism” (“Cognitive” 257) contends, environmental knowledge is intimately tied in with memory (“Cognitive” 260). She writes: “The advantage of extensive environmental knowledge most surely precipitates the evolution of memory, necessary to sustain vast knowledge” (“Cognitive” 260). Even today I can recall snatches of moments from that trip when I was a child, including the telling of tales.Landscape not only changes the writer, but writing transforms the landscape and our interaction with it. As Valerie Allen suggests, “If the subject acts upon the environment, so does the environment upon the subject” (“When Things Break” 82). Indeed, we can understand the “road as a strategic point of interaction between human and environment” (Allen and Evans 26; see also Oram)—even, or especially, when that interaction causes pain and inflames blisters. My relationship with moleskin on my blasted and blistered toes made me intimately conscious of my body with every step taken on the pilgrimage route.As an adult, my boots on the way from Winchester to Canterbury pinched and squeezed, packed dirt acting upon them and, in turn, my feet. After taking the train home and upon arrival in London, we walked through Bloomsbury to our flat on Russell Square, passing by what I saw as a new, less religious, but no less beckoning shrine: The London Foot Hospital at Fitzroy Square.Now, sadly, it is closed. Where do pilgrims go for sole—and soul—care?Slow Walking as WayfindingAll pilgrimages come to an end, just as, in 1966, my mother writes of our our arrival at last in Canterbury:On into Canterbury past nice grassy cricket field, where we sat and ate chocolate bars while we watched white-flannelled cricketers at play. Past town gates to our Queen’s Head Inn, where we have the smallest, slantingest room in the world. Everything is askew and we’re planning to use our extra pillows to brace our feet so we won’t slide out of bed. Children have nice big room with 3 beds and are busy playing store with pounds and shillings [that’s very hard mathematics!]. After dinner, walked over to cathedral, where evensong was just ending. Walked back to hotel and into bed where we are now.Up to early breakfast, dashed to cathedral and looked up, up, up. After our sins were forgiven, we picked up our rucksacks and headed into London by train.This experience in 1966 varies slightly from the one in 1994. Jim and I walk through a long walkway of tall, slim trees arching over us, a green, lush and silent cloister, finally gaining our first view of Canterbury with me in a similar photo to one taken almost thirty years before. We make our way into the city through the West Gate, first passing by St. Dunstan’s Church where Henry II had put on penitential garb and later Sir Thomas More’s head was buried. Canterbury is like Coney Island in the Middle Ages and still is: men with dreadlocks and slinky didjeridoos, fire tossers, mobs of people, tourists. We go to Mercery Lane as all good pilgrims should and under the gate festooned with the green statue of Christ, arriving just in time for evensong.Imagining a medieval woman arriving here and listening to the service, I pray to God my gratefulness for us having arrived safely. I can understand the fifteenth-century pilgrim, Margery Kempe, screaming emotionally—maybe her feet hurt like mine. I’m on the verge of tears during the ceremony: so glad to be here safe, finally got here, my favorite service, my beloved husband. After the service, we pass on through the Quire to the spot where St. Thomas’s relic sanctuary was. People stare at a lit candle commemorating it. Tears well up in my eyes.I suppose some things have changed since the Middle Ages. One Friday in Canterbury with my children in 2003 has some parallels with earlier iterations. Seven-year-old Sarah and I go to evensong at the Cathedral. I tell her she has to be absolutely quiet or the Archbishop will chop off her head.She still has her head.Though the road has been paved, the view has remained virtually unaltered. Some aspects seem eternal—sheep, lambs, and stiles dotting the landscape. The grinding down of the pilgrimage path, reflecting the “slowness of flat ontology” (Yates 207), occurs over vast expanses of time. Similarly, Easterlin reflects on human and more than human vitalism: “Although an understanding of humans as wayfinders suggests a complex and dynamic interest on the part of humans in the environment, the surround itself is complex and dynamic and is frequently in a state of change as the individual or group moves through it” (Easterlin “Cognitive” 261). An image of my mother in the 1970s by a shady tree along the Pilgrims’ Way in England shows that the path is lower by 6 inches than the neighboring verge (Bright 4). We don’t see dirt evolving, because its changes occur so slowly. Only big time allows us to see transformative change.Memorial PilgrimageOddly, the erasure of self through duplication with a precursor occurred for me while reading W.G. Sebald’s pilgrimage novel, The Rings of Saturn. I had experienced my own pilgrimage to many of these same locations he immortalizes. I, too, had gone to Somerleyton Hall with my elderly mother, husband, and two children. My memories, sacred shrines pooling in familial history, are infused with synchronic reflection, medieval to contemporary—my parents’ periodic sojourns in Suffolk for years, leading me to love the very landscape Sebald treks across; sadness at my parents’ decline; hope in my children’s coming to add on to their memory palimpsest a layer devoted to this land, to this history, to this family.Then, the oddest coincidence from my reading pilgrimage. After visiting Dunwich Heath, Sebald comes to his friend, Michael, whose wife Anne relays a story about a local man hired as a pallbearer by the local undertaker in Westleton. This man, whose memory was famously bad, nevertheless reveled in the few lines allotted him in an outdoor performance of King Lear. After her relating this story, Sebald asks for a taxi (Sebald 188-9).This might all seem unremarkable to the average reader. Yet, “human wayfinders are richly aware of and responsive to environment, meaning both physical places and living beings, often at a level below consciousness” (Easterlin “Cognitive” 265). For me, with a connection to this area, I startled with recollection emerging from my subconscience. The pallbearer’s name in Sebald’s story was Mr Squirrel, the very same name of the taxi driver my parents—and we—had driven with many times. The same Mr Squirrel? How many Mr Squirrels can there be in this small part of Suffolk? Surely it must be the same family, related in a genetic encoding of memory. I run to my archives. And there, in my mother’s address book—itself a palimpsest of time with names and addressed scored through; pasted-in cards, names, and numbers; and looseleaf memoranda—there, on the first page under “S”, “Mr. Squirrel” in my mother’s unmistakable scribble. She also had inscribed his phone number and the village Saxmundum, seven miles from Westleton. His name had been crossed out. Had he died? Retired? I don’t know. Yet quick look online tells me Squirrell’s Taxis still exists, as it does in my memory.Making KinAfter accompanying a class on a bucolic section of England’s Pilgrims’ Way, seven miles from Wye to Charing, we ended up at a pub drinking a pint, with which all good pilgrimages should conclude. There, students asked me why I became a medievalist who studies pilgrimage. Only after the publication of my first book on women pilgrims did I realize that the origin of my scholarly, long fascination with pilgrimage, blossoming into my professional career, began when I was seven years old along the way to Canterbury. The seeds of that pilgrimage when I was so young bore fruit and flowers decades later.One story illustrates Michel Serres’s point that we should not aim to appropriate the world, but merely act as temporary tenants (Serres 72-3). On pilgrimage in 1966 as a child, I had a penchant for ant spiders. That was not the only insect who took my heart. My mother shares how “Susie found a beetle up on the hill today and put him in the cheese box. Jimmy put holes in the top for him. She named him Alexander Beetle and really became very fond of him. After supper, we set him free in the garden here, with appropriate ceremony and a few over-dramatic tears of farewell.” He clearly made a great impression on me. I yearn for him today, that beetle in the cheese box. Though I tried to smuggle nature as contraband, I ultimately had to set him free.Passing through cities, landscape, forests, over seas and on roads, wandering by fields and vegetable patches, under a sky lit both by sun and moon, the pilgrim—even when in a group of fellow pilgrims—in her lonesome exercise endeavors to realize Serres’ ideal of the tenant inhabitant of earth. Nevertheless, we, as physical pilgrims, inevitably leave our traces through photos immortalizing the journey, trash left by the wayside, even excretions discretely deposited behind a convenient bush. Or a beetle who can tell the story of his adventure—or terror—at being ensconced for a time in a cheese box.On one notorious day of painful feet, my husband and I arrived in Otford, only to find the pub was still closed. Finally, it became time for dinner. We sat outside, me with feet ensconced in shoes blessedly inert and unmoving, as the server brought out our salads. The salad cream, white and viscous, was presented in an elegantly curved silver dish. Then Jim began to pick at the salad cream with his fork. Patiently, tenderly, he endeavored to assist a little bug who had gotten trapped in the gooey sauce. Every attempt seemed doomed to failure. The tiny creature kept falling back into the gloppy substance. Undaunted, Jim compassionately ministered to our companion. Finally, the little insect flew off, free to continue its own pilgrimage, which had intersected with ours in a tiny moment of affinity. Such moments of “making kin” work, according to Donna Haraway, as “life-saving strateg[ies] for the Anthropocene” (Oppermann 3, qtd. in Haraway 160).How can narrative avoid the anthropocentric centre of writing, which is inevitable given the human generator of such a piece? While words are a human invention, nonhuman entities vitally enact memory. The very Downs we walked along were created in the Cretaceous period at least seventy million years ago. The petrol propelling the magic taxi cab was distilled from organic bodies dating back millions of years. Jurassic limestone from the Bathonian Age almost two hundred million years ago constitutes the Caen stone quarried for building Canterbury Cathedral, while its Purbeck marble from Dorset dates from the Cretaceous period. Walking on pilgrimage propels me through a past millions—billions—of eons into the past, dwarfing my speck of existence. Yet, “if we wish to cross the darkness which separates us from [the past] we must lay down a little plank of words and step delicately over it” (Barfield 23). Elias Amidon asks us to consider how “the ground we dig into and walk upon is sacred. It is sacred because it makes us neighbors to each other, whether we like it or not. Tell this story” (Amidon 42). And, so, I have.We are winding down. Time has passed since that first pilgrimage of mine at seven years old. Yet now, here, I still put on my red plaid wollen jumper and jacket, crisp white button-up shirt, grey knee socks, and stout red walking shoes. Slinging on my rucksack, I take my mother’s hand.I’m ready to take my first step.We continue our pilgrimage, together.ReferencesAllen, Valerie. “When Things Break: Mending Rroads, Being Social.” Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. Manchester: Manchester UP, 2016.———, and Ruth Evans. Introduction. Roadworks: Medieval Britain, Medieval Roads. Eds. Valerie Allen and Ruth Evans. Manchester: Manchester UP, 2016.Alworth, David J. Site Reading: Fiction, Art, Social Form. Princeton: Princeton UP, 2016.Amidon, Elias. “Digging In.” Dirt: A Love Story. Ed. Barbara Richardson. Lebanon, NH: ForeEdge, 2015.Barfield, Owen. History in English Words. Grand Rapids: William B. 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