Citizen engagement in spatial planning, shaping places together

This paper explores the roles and practices of collective citizen engagement in spatial planning. Drawing on a selection of core articles in planning scholarship, it investigates how citizens (re-)shape urban places by responding to perceived flaws in how spatial planning addresses societal challenges. Formal planning interventions are often spatially and socially selective, ineffective, or even non-existent due to a lack of institutional capacities and resources. Consequently, citizens take on roles that they consider as missing, underperformed or ineffective. The paper shows that this results in a variety of practices complementary to, independent from, or opposing formal planning actors and interventions. Five dilemmas citizens face are identified, highlighting the tensions that surface on exclusion, participation, and governmental responsibilities when citizens claim their role in urban governance

Exploring transitions in the peri-urban area

Spatial planners and policy makers currently struggle to understand the peri-urban area, with its mixture of land uses and its transitional status between the urban and the rural. This paper presents the concept of transition, derived from complexity science, to allow planners to analyse peri-urban development in terms of a number of interacting processes, some induced, some evolving autonomously. Drawing on four case studies of European urban regions, the research finds that many of the dynamic processes underlying peri-urban development are not susceptible to the influence of planning agencies. This should enable planners to develop a more adaptive approach in the future, identifying areas where productive and case-specific interventions can be made

Planning and complexity: Engaging with temporal dynamics, uncertainty and complex adaptive systems

The nature of complex systems as a transdisciplinary collection of concepts from physics and economics to sociology and ecology provides an evolving field of inquiry (Laszlo and Krippner, 1998) for urban planning and urban design. As a result, planning theory has assimilated multiple concepts from the complexity sciences over the past decades. The seemingly chaotic or non-linear urban phenomena resulting from the combination of hard and soft systems (Checkland, 1989) or physical and environmental aspects of the city with human intervention, motivation and perception have been of particular interest in the context of increasing criticism of top-down approaches. Processes such as self- organisation, temporal dynamics and transition, previously ignored or assumed problematic within equilibrium-centred conceptualisations or mechanistic theories, have found their way back into planning through complexity theories of cities (CTC) (Allen, 1997; Batty, 2007; de Roo and Silva, 2010; Marshall, 2012; Portugali, 2011b). While there is an overlap with Structuralist-Marxist and humanistic perspectives (Portugali, 2011c) and a continuity from an older science of cities (Batty, 2013), it is interesting to observe the engagement with bottom-up phenomena, structural and functional co-evolution and resultant adaptable and self-organisational systems within complexity planning. It has taken time for planning to adopt complexity thinking beyond metaphor or common usage of the term, but we now appear to be at a tipping point where complexity planning is exploring methods of engagement and cognition, rather than the question of whether cities are complex

Percutaneous Preoperative Biliary Drainage for Resectable Perihilar Cholangiocarcinoma: No Association with Survival and No Increase in Seeding Metastases

Background. Endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) are both used to resolve jaundice before surgery for perihilar cholangiocarcinoma (PHC). PTBD has been associated with seeding metastases. The aim of this study was to compare overall survival (OS) and the incidence of initial seeding metastases that potentially influence survival in patients with preoperative PTBD versus EBD. Methods. Between 1991 and 2012, a total of 278 patients underwent preoperative biliary drainage and resection of PHC at 2 institutions in the Netherlands and the United States. Of these, 33 patients were excluded for postoperative mortality. Among the 245 included patients, 88 patients who underwent preoperative PTBD (with or without previous EBD) were compared to 157 patients who underwent EBD only. Survival analysis was done with Kaplan-Meier and Cox regression with propensity score adjustment. Results. Unadjusted median OS was comparable between the PTBD group (35 months) and EBD-only group (41 months; P = 0.26). After adjustment for propensity score, OS between the PTBD group and EBD-only group was similar (hazard ratio, 1.05; 95 % confidence interval, 0.74-1.49; P = 0.80). Seeding metastases in the laparotomy scar occurred as initial recurrence in 7 patients, including 3 patients (3.4 %) in the PTBD group and 4 patients (2.7 %) in the EBD-only group (P = 0.71). No patient had an initial recurrence in percutaneous catheter tracts. Conclusions. The present study found no effect of PTBD on survival compared to patients with EBD and no increase in seeding metastases that developed as initial recurrence. These data suggest that PTBD can safely be used in preoperative management of PHC

Helicobacter pylori infection: approach of primary care physicians in a developing country

<p>Abstract</p> <p>Background</p> <p>The aim of the study was to assess the knowledge and practices of primary care physicians in diagnosis and management of <it>Helicobacter pylori (H. pylori) </it>infection in developing country.</p> <p>Methods</p> <p>This convenient sample based, cross sectional study was conducted in primary care physicians of Karachi, Pakistan from March 2008 to August 2008 through a pretested self-designed questionnaire, which contained 11 items pertaining to <it>H. pylori </it>route of transmission, diagnosis, indication for testing, treatment options, follow up and source of information.</p> <p>Results</p> <p>Out of 509 primary care physicians, 451 consented to participate with the response rate of 88.6%. Responses of 426 primary care physicians were analyzed after excluding 19 physicians. 78% of the physicians thought that contaminated water was the source of spread of infection, dyspepsia was the most frequent indication for investigating <it>H. pylori </it>infection (67% of the physicians), while 43% physicians were of the view that serology was the most appropriate test to diagnose active <it>H. pylori </it>infection. 77% of physicians thought that gastric ulcer was the most compelling indication for treatment, 61% physicians preferred Clarithromycin based triple therapy for 7–14 days. 57% of the physicians would confirm <it>H. pylori </it>eradication after treatment in selected patients and 47% physicians preferred serological testing for follow-up. In case of treatment failure, only 36% of the physicians were in favor of gastroenterologist referral.</p> <p>Conclusion</p> <p>The primary care physicians in this study lacked in knowledge regarding management of <it>H. pylori </it>infection. Internationally published guidelines and World gastroenterology organization (WGO) practice guideline on <it>H. pylori </it>for developing countries have little impact on current practices of primary care physicians. We recommend more teaching programs, continuous medical education activities regarding <it>H. pylori </it>infection.</p

Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis The ESCAPE Randomized Clinical Trial:The ESCAPE Randomized Clinical Trial

IMPORTANCE For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function. OBJECTIVE To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for INTERVENTIONS There were 44 patients randomized to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 patients randomized to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if needed. MAIN OUTCOMES AND MEASURES The primary outcome was pain, measured on the Izbicki pain score and integrated over 18 months (range, 0-100 [increasing score indicates more pain severity]). Secondary outcomes were pain relief at the end of follow-up; number of interventions, complications, hospital admissions; pancreatic function; quality of life (measured on the 36-Item Short Form Health Survey [SF-36]); and mortality. RESULTS Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, -12 points [95% CI, -22 to -2]; P = .02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P = .10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P <.001). Treatment complications (27% vs 25%), mortality (0% vs 0%), hospital admissions, pancreatic function, and quality of life were not significantly different between early surgery and the endoscopy-first approach. CONCLUSIONS AND RELEVANCE Among patients with chronic pancreatitis, early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months. However, further research is needed to assess persistence of differences over time and to replicate the study findings

Opera and poison : a secret and enjoyable approach to teaching and learning chemistry

The storyline of operas, with historical or fictional characters, often include potions and poisons. This has prompted a study of the chemistry behind some operatic plots. The results were originally presented as a lecture given at the University of Minho in Portugal, within the context of the International Year of Chemistry. The same lecture was subsequently repeated at other universities as an invited lecture for science students and in public theaters for wider audiences. The lecture included a multimedia and interactive content that allowed the audience to listen to arias and to watch video clips with selected scenes extracted from operas. The present article, based on the lecture, demonstrates how chemistry and opera can be related and may also serve as a source of motivation and inspiration for chemistry teachers looking for alternative pedagogical approaches. Moreover, the lecture constitutes a vehicle that transports chemistry knowledge to wider audiences through examples of everyday molecules, with particular emphasis on natural products.The author is pleased to express his gratitude to Jorge Calado and Michael John Smith for useful discussions. The author also thanks the reviewers of the manuscript for their helpful comments and suggestions. Thanks are due to the Foundation for Science and Technology (FCT,Portugal), QREN and FEDER/EU for financial support through the research centers, CQ/UM PEst-C/QUI/UI0686/2011. Ciencia Viva, Portugal, is also acknowledged for financial support of the activities organized by the University of Minho during the International Year of Chemistry. The author also expresses his gratitude to Ana Paula Ferreira and Andre Cunha Leal from RTP Antena 2 who contributed immensely to the popularization of the lecture on which this paper is based on

Percutaneous Preoperative Biliary Drainage for Resectable Perihilar Cholangiocarcinoma: No Association with Survival and No Increase in Seeding Metastases

Background: Endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) are both used to resolve jaundice before surgery for perihilar cholangiocarcinoma (PHC). PTBD has been associated with seeding metastases. The aim of this study was to compare overall survival (OS) and the incidence of initial seeding metastases that potentially influence survival in patients with preoperative PTBD versus EBD. Methods: Between 1991 and 2012, a total of 278 patients underwent preoperative biliary drainage and resection of PHC at 2 institutions in the Netherlands and the United States. Of these, 33 patients were excluded for postoperative mortality. Among the 245 included patients, 88 patients who underwent preoperative PTBD (with or without previous EBD) were compared to 157 patients who underwent EBD only. Survival analysis was done with Kaplan–Meier and Cox regression with propensity score adjustment. Results: Unadjusted median OS was comparable between the PTBD group (35 months) and EBD-only group (41 months; P = 0.26). After adjustment for propensity score, OS between the PTBD group and EBD-only group was similar (hazard ratio, 1.05; 95 % confidence interval, 0.74–1.49; P = 0.80). Seeding metastases in the laparotomy scar occurred as initial recurrence in 7 patients, including 3 patients (3.4 %) in the PTBD group and 4 patients (2.7 %) in the EBD-only group (P = 0.71). No patient had an initial recurrence in percutaneous catheter tracts. Conclusions: The present study found no effect of PTBD on survival compared to patients with EBD and no increase in seeding metastases that developed as initial recurrence. These data suggest that PTBD can safely be used in preoperative management of PHC