A Civic Lantern to engage civic and civil society in goal-setting for sustainability in Cornwall: A research report

This is the final versionAcross Cornwall, there is an increasing appreciation of the importance of taking action to improve sustainability for future generations. Community organisations and leaders are already taking action to improve the social wellbeing and environmental health within their local areas. In 2020, the Cornwall Plan was published, outlining a vision for achieving a more sustainable Cornwall by 2050. The Cornwall Plan includes ambitious high-level plans to take Cornwall through six major transitions to become a greener and fairer place over the next generation. Action to achieve these transitions needs to take account of existing work conducted by wider civic and civil society organisations and individuals. Further, it should maximise on the knowledge and capacity that already exists. In January 2022, the Cornwall and Isles of Scilly Leadership Board (CIOSLB), agreed to support an experiment to engage civic and civil society organisations in determining two priority goals that would contribute to realising the vision of the Cornwall Plan over the next 12 months. In order to identify and prioritise these two goals, a workshop event called ‘The Civic Lantern’, was organised by University of Exeter researchers based at Penryn. The Civic Lantern was orchestrated as a space in which civic organisations, civil society groups and community leaders could shine a light on and share practical, community solutions to pressing issues of socio-ecological sustainability. Held on Thursday 9 June 2022, the workshop was hosted at Woodland Valley Farm, Ladock, with a professional facilitator and illustrator to help run and capture the event respectively. Overall, 42 participants ranging from grassroots activists, representatives from parish councils and environmental or social organisations attended. Through both a pre-event survey and in-person discussion, participants deliberated, sorted and then voted on which two socio-ecological goals should be supported by both the Leadership Board and the wider community. The event ended with a formal civic ceremony in which the two top goals were presented to representatives of the CIOS Leadership Board. The final two agreed goals for enhancing social and environmental sustainability were: Priority action 1: Give land and support to every community to have a sustainable growing scheme Priority action 2: Support communities to map under-utilised properties so that local people can be housed This report explains the context for the workshop, the structure of the event and its outcomes, and the next steps agreed upon to achieve these goals. Graphic illustrations of the event are included at the end of the report.Cornwall CouncilBritish Academ

Localising and democratising goal-based governance for sustainability

Data availability: The data that has been used is confidential.Accelerating social and environmental change raises pressing questions about how existing institutions can be reformed to mount a more effective response. In this context, goal-based governance has been widely adopted in order to mobilise existing bodies to agree shared goals and develop common purpose. Increasingly employed in sustainability governance at the international scale, goal-based governance concerns setting pan-organisational goals and mobilising to deliver them. There is growing recognition that this approach needs to be downscaled to the local level in ways that can increase democratic engagement in order to realise significant change. This paper examines the opportunities and challenges involved in doing this in Cornwall, UK. We draw on collaborative research with representatives from statutory organisations as well as civic and civil society to highlight: (1) the significance of institutional structures, culture and relationships; (2) the need to adopt innovative participatory methods to engage and enlist civic and civil society organisations in goal-setting; and (3) the importance of ensuring delivery. The paper explores the extent to which local institutions can engage in goal-based and collaborative governance to respond to the challenges of sustainability in ways that reflect specific geo-political and cultural contexts as well as responding to international demands for greater sustainability. The findings provide insights that have relevance for other contexts as local leaders experiment to better recognise, reflect and respond to the social, ecological and political challenges of our time.Cornwall CouncilBritish Academ

Localising and decentralising goal-based governance for sustainability in England: Policy Summary. A report for British Academy: Shared Understandings of a Sustainable Future

This is the final version.In the wake of COP26 held in Glasgow in November 2020, there is increased global urgency and momentum to create more sustainable futures. The transition to net-zero is central to these ambitions, yet existing national policies and strategies are often ineffective and poorly integrated with other aspects of sustainable development. One way to better support sustainability transitions is through broader approaches that mobilise diverse actors in collective deliberation and action to realise locally appropriate change. Our research explored the extent to which English local authorities can play a role in leading such goal-based governance at the sub-national scale. Existing research and action on goal-based governance has focused on the global scale, for example, in relation to mobilisation around the United Nations’ Sustainable Development Goals. However, there is growing recognition of the need for similar leadership and mobilisation at the sub-national scale. In England, local authorities are the only representative bodies with the political authority to lead concerted, place-based action on sustainability but to do this, they need to build broad coalitions for change. This represents a significant shift in the culture, role and practice of local authorities. In addition, civil society organisations are often wary of working with statutory bodies that are perceived to be risk-averse, bureaucratic, slow and top-down. Through a collaborative action research project in Cornwall, a county with strong ambitions to realise net-zero and foster sustainable development, we sought to examine the opportunities and challenges of localising goal-based governance for sustainability. Our project generated new knowledge and insights into the implementation and impact of localised goal-based governance, with important implications for policy and practice in other parts of the country.British Academ

Innovative models of care for the health facility of the future : a protocol for a mixed-methods study to elicit consumer and provider views

Introduction: To address the challenges of rapidly changing healthcare, governments and health services are increasingly emphasising healthcare delivery models that are flexible, person centred, cost-effective and integrate hospital services more closely with primary healthcare and social services. In addition, such models increasingly embed consumer codesign, integration of services, and leverage digital technologies such as telehealth and sophisticated medical records systems. Objectives: This paper provides a study protocol to describe a method to elicit consumer and healthcare provider needs and expectations for the development of innovative care models. Methods and analysis: A literature review identified six key models of care, supported by a common theme of consumer-focused care, along with the international evidence supporting the efficacy of these models. A mixed-methods study of the needs and expectations of consumer members and health providers who reside or work in the area of a new hospital catchment will be undertaken. They will complete a community-specific and provider-specific, short demographic questionnaire (delivered during the recruitment process) and be assigned to facilitator-coordinated online workshops comprising small focus groups. Follow-up interviews will be offered. Culturally and linguistically diverse members and Aboriginal and Torres Strait Islander Elders and their communities will also be consulted. Data will be analysed thematically (qualitative) and statistically (quantitative), and findings synthesised using a triangulated approach. Ethics and dissemination: The results will be actively disseminated through peer-reviewed journals, conference presentations and in a report to stakeholders. This study was reviewed and approved by the relevant Ethics Committee in New South Wales, Australia

The effect of long-term homocysteine-lowering on carotid intima-media thickness and flow-mediated vasodilation in stroke patients: a randomized controlled trial and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Experimental and epidemiological evidence suggests that homocysteine (tHcy) may be a causal risk factor for atherosclerosis. B-vitamin supplements reduce tHcy and improve endothelial function in short term trials, but the long-term effects of the treatment on vascular structure and function are unknown.</p> <p>Methods</p> <p>We conducted a sub-study of VITATOPS, a randomised, double-blind, placebo-controlled intervention trial designed to test the efficacy of long term B-vitamin supplementation (folic acid 2 mg, vitamin B₆25 mg and vitamin B₁₂0.5 mg) in the prevention of vascular events in patients with a history of stroke. We measured carotid intima-medial thickness (CIMT) and flow-mediated dilation (FMD) at least two years after randomisation in 162 VITATOPS participants. We also conducted a systematic review and meta-analysis of studies designed to test the effect of B-vitamin treatment on CIMT and FMD.</p> <p>Results</p> <p>After a mean treatment period of 3.9 ± 0.9 years, the vitamin-treated group had a significantly lower mean plasma homocysteine concentration than the placebo-treated group (7.9 μmol/L, 95% CI 7.5 to 8.4 versus 11.8 μmol/L, 95% CI 10.9 to 12.8, p < 0.001). Post-treatment CIMT (0.84 ± 0.17 mm vitamins versus 0.83 ± 0.18 mm placebo, p = 0.74) and FMD (median of 4.0%, IQR 0.9 to 7.2 vitamins versus 3.0%, IQR 0.6 to 6.6 placebo, p = 0.48) did not differ significantly between groups. A meta-analysis of published randomised data, including those from the current study, suggested that B-vitamin supplements should reduce CIMT (-0.10 mm, 95% CI -0.20 to -0.01 mm) and increase FMD (1.4%, 95% CI 0.7 to 2.1%). However, the improvement in endothelial function associated with homocysteine-lowering treatment was significant in short-term studies but not in longer trials.</p> <p>Conclusion</p> <p>Although short-term treatment with B-vitamins is associated with increased FMD, long-term homocysteine-lowering did not significantly improve FMD or CIMT in people with a history of stroke.</p> <p>Trial Registration</p> <p>Clinical Trial Registration URL: <url>http://www.actr.org.au/</url></p> <p>Trial Registration number: 12605000005651</p

Prdm5 Regulates Collagen Gene Transcription by Association with RNA Polymerase II in Developing Bone

PRDM family members are transcriptional regulators involved in tissue specific differentiation. PRDM5 has been reported to predominantly repress transcription, but a characterization of its molecular functions in a relevant biological context is lacking. We demonstrate here that Prdm5 is highly expressed in developing bones; and, by genome-wide mapping of Prdm5 occupancy in pre-osteoblastic cells, we uncover a novel and unique role for Prdm5 in targeting all mouse collagen genes as well as several SLRP proteoglycan genes. In particular, we show that Prdm5 controls both Collagen I transcription and fibrillogenesis by binding inside the Col1a1 gene body and maintaining RNA polymerase II occupancy. In vivo, Prdm5 loss results in delayed ossification involving a pronounced impairment in the assembly of fibrillar collagens. Collectively, our results define a novel role for Prdm5 in sustaining the transcriptional program necessary to the proper assembly of osteoblastic extracellular matrix

Carotid intima-medial thickness measured on multiple ultrasound frames: evaluation of a DICOM-based software system

United Kingdo

Do advertisements for antihypertensive drugs in Australia promote quality prescribing? A cross-sectional study

Background Antihypertensive medications are widely prescribed by doctors and heavily promoted by the pharmaceutical industry. Despite strong evidence of the effectiveness and cost-effectiveness of thiazide diuretics, trends in both promotion and prescription of antihypertensive drugs favour newer, less cost-effective agents. Observational evidence shows correlations between exposure to pharmaceutical promotion and less ideal prescribing. Our study therefore aimed to determine whether print advertisements for antihypertensive medications promote quality prescribing in hypertension. Methods We performed a cross-sectional study of 113 advertisements for antihypertensive drugs from 4 general practice-oriented Australian medical publications in 2004. Advertisements were evaluated using a quality checklist based on a review of hypertension management guidelines. Main outcome measures included: frequency with which antihypertensive classes were advertised, promotion of thiazide class drugs as first line agents, use of statistical claims in advertisements, mention of harms and prices in the advertisements, promotion of assessment and treatment of cardiovascular risk, promotion of lifestyle modification, and targeting of particular patient subgroups. Results Thiazides were the most frequently advertised drug class (48.7% of advertisements), but were largely promoted in combination preparations. The only thiazide advertised as a single agent was the most expensive, indapamide. No advertisement specifically promoted any thiazide as a better first-line drug. Statistics in the advertisements tended to be expressed in relative rather than absolute terms. Drug costs were often reported, but without cost comparisons between drugs. Adverse effects were usually reported but largely confined to the advertisements' small print. Other than mentioning drug interactions with alcohol and salt, no advertisements promoted lifestyle modification. Few advertisements (2.7%) promoted the assessment of cardiovascular risk. Conclusion Print advertisements for antihypertensive medications in Australia provide some, but not all, of the key messages required for guideline-concordant care. These results have implications for the regulation of drug advertising and the continuing education of doctors.Brett D Montgomery, Peter R Mansfield, Geoffrey K Spurling and Alison M War

Implementing large-system, value-based healthcare initiatives: a realist study protocol for seven natural experiments

IntroductionValue-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond ‘what works’ towards more nuanced understanding of ‘what tends to work for whom under which circumstances’. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts.Methods and analysisThis exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context–mechanism–outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed.Ethics and disseminationEthical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings.</jats:sec