Voting on sustainable transport: communication and governance challenges in Greater Manchester's ‘congestion charge’ referendum

In December 2008, the Greater Manchester electorate voted to reject a £3 billion package of transport measures that would have included investment in the conurbation's bus, tram and rail networks and walking and cycling infrastructure, together with, and partially funded by, the introduction of a congestion charge. The proposals followed a successful bid to the UK Government Transport Innovation Fund (TIF). High levels of car use present challenges to cities, and the TIF bid can be seen as an attempt to address these by promoting and facilitating a modal shift. The paper reflects on the debates surrounding the proposals, which led to a referendum. In particular, it explores the challenges of communicating complex, controversial plans in a fragmented and contested political arena

A METHOD OF TESTING IMPLANTED CARDIAC PACEMAKERS

In some patients with complete heart block electrical pacing has become an accepted form of treatment, and this has been well reviewed (Chardack, Gage, and Greatbatch, 1960; Chardack 1964; Zoli et al., 1961; Portal et al., 1962). The quoted battery life of pacemakers available co-mercially is from 2 to 5 years. However, experience with our first 10 cases has shown that earlier replacement of the units is sometimes necessary because of premature battery failure and either gradual or sudden failure of another component. These failures cause changes in one or more of the following output characteristics of the pacemaker: rate, amplitude, and pulse width. Measure-ment of these characteristics is easily made with the pacemaker outside the body, but after the unit is implanted this presents some difficulty. Pulse rate of the unit can be obtained from the electro-cardiogram, but output voltage and pulse width are more difficult to measure. One commercial model * provides two subcutaneous testing electrodes to which needles can be attached under local anmsthetic, but it is possible for these wires to break while the unit is functioning correctly (Par-sonnet et al., 1963). The standard electrocardiogram from a patient with an implanted pacemaker shows the stimu-lating pulses (Fig. 1), but their wave form is not accurately reproduced because of the limited fre