Assemblage, place and globalisation

Funder: FP7 Ideas: European Research Council; Id: http://dx.doi.org/10.13039/100011199; Grant(s): 339567Relational perspectives have become pre‐eminent in geographical analysis of globalisation and its impacts in reshaping places, yet arguably leave unanswered questions about precisely how globalisation is reproduced through local places in practice. This paper seeks to extend and enhance the relational approach to globalisation and place by drawing on theoretical insights from assemblage thinking to articulate a methodological framework for empirical research. It draws on DeLanda's iteration of Deleuzoguattarian assemblage thinking to explore how the concepts of the exteriority of relations, territorialisation, coding, and multiplicity provide insights into the dynamics through which interactions between places and translocal assemblages affect changes in the properties and capacities of places and of their component parts, the internal adjustment of places to changes in components, and the possible future forms that a place may take following specific interactions. As such, the framework outlined advances relational analysis by permitting deeper analysis of the mechanics through which individual places endure and change in the context of globalisation and how these produce uneven geographies of globalisation. The discussion is illustrated by examples from empirical research on globalisation and rural localities

Ageing, serious leisure and the contribution of the grey economy 2016-2018

Interviews were conducted with 'older' (60+) volunteers working at a range of community organizations across mid Wales. Community organisations included a village community hub, the National Botanic Garden of Wales, Newtown Textile Museam and the Royal British Legion. This project investigated the benefits of ‘serious leisure’ in retirement, both for the individual and for the wider communities of which they are part. These interviews explore the participants involvement in serious leisure, the purpose of their engagements and value attached to their activities.This proposal is for a National Research Centre (WISERD/Civil Society) to undertake a five year programme of policy relevant research addressing Civil Society in Wales. Established in 2008, WISERD provides an 'All-Wales' focus for research and has had a major impact on the quantity and quality of social science research undertaken in Wales. As part of WISERD, WISERD/Civil Society will enable this work to be deepened and sustained through a focused research programme that further develops our research expertise, intensifies our policy impact and knowledge exchange work and strengthens our research capacity and career development activities. WISERD/Civil Society will therefore aim to develop key aspects of the multidisciplinary research initiated during the first phase of WISERD's work to produce new empirical evidence to inform our understanding of the changing nature of civil society in the context of devolved government and processes of profound social and economic change. There are many disagreements over what civil society is and how it may be changing. We do know that over the last forty years there have been unprecedented changes in the spheres of economy and industry, politics and governance, social relations and individual life courses. How individuals in local contexts are affected by and respond to dramatic institutional changes is not well understood. An important gap in our knowledge is in describing and explaining the impact of social change on local forms of civil society and civil society organisations and what this means for social cohesion and well-being. In addition how different forms of civil society are developing in the context of multi-level and devolved government is not well understood. Because of its size and devolved government, Wales offers a unique context for studying these issues. Viewing Wales as a 'laboratory for social science' the proposed centre will build on existing networks of researchers who have a wide range of expertise and skills. Large survey data sets will be exploited and analysed and new data collected on civil society in Wales, the UK and Europe. Inter-disciplinarity and multi-method approaches applied to longitudinal and comparative data will be a key feature and strength of the WISERD/Civil Society research programme. Our research will be underpinned by three principles: (i) to maximise research impact, (ii) to become a centre of excellence for comparative, longitudinal, and relational research methods and (iii) to contribute to the growth of research capacity in Wales. We will also extend our research out from Wales to undertake comparative studies at different regional, national and international levels. In this way WISERD will make substantive and novel contributions to the advancement of social theory applied to researching contemporary civil society and to methodological approaches to describing and explaining patterns of civic participation in the context of devolution and multi-level governance. Substantive research will be applied to real and timely research problems conducted under four inter-related themes: 1) Locality, Community and Civil Society 2) Individuals, Institutions and Governance 3) Economic Austerity, Social Enterprise and Inequality 4) Generation, Life Course and Social Participation. Our aim will be to produce a wide range of outputs accessible to a variety of different audiences, including: academic papers; books; working papers; seminars; web based material; video and e-learning materials; as well as disseminating our work through a diversity of activities. Public awareness will be raised through events; activities; and exhibitions, designed to foster interest and encourage discussion and debate. WISERD/Civil Society will have a strong management structure, substantial institutional support, and close links with relevant organisations, and will provide substantive career development for new and early-career researchers and PhD students.</p

Protocol for Compass: a randomised controlled trial of primary HPV testing versus cytology screening for cervical cancer in HPV-unvaccinated and vaccinated women aged 25-69 years living in Australia

INTRODUCTION: Australia's National Cervical Screening Program (NCSP) currently recommends 2-year cytology in women aged 18-69 years. Following a review of the NCSP prompted by the implementation of human papillomavirus (HPV) vaccination, the programme will transition in 2017 to 5-year primary HPV screening with partial genotyping for HPV16/18 in women aged 25-74 years. Compass is a sentinel experience for the renewed NCSP and the first prospectively randomised trial of primary HPV screening compared with cytology to be conducted in a population with high uptake of HPV vaccination. This protocol describes the main Compass trial, which commenced after a pilot study of ~5000 women completed recruitment. METHODS AND ANALYSIS: Women aged 25-69 years will be randomised at a 1:2 allocation to (1) 2.5-year image-read, liquid-based cytology (LBC) screening with HPV triage of low-grade smears (active control Arm A) or (2) 5-year HPV screening with partial genotyping and referral of HPV16/18-positive women to colposcopy (intervention Arm B). Women in Arm B positive for other oncogenic HPV (not 16/18) will undergo secondary randomisation at a 1:1 allocation to either LBC or dual-stained (p16INK4a and Ki-67) cytology testing (dual-stained cytology). The primary outcome is cumulative CIN3+ (CIN3, adenocarcinoma in situ and invasive cervical cancer) following a 5-year HPV exit testing round in both arms, in women randomised to the HPV arm versus women randomised to the LBC arm, based on an intention-to-treat analysis. The primary outcome will first be tested for non-inferiority and if declared, the primary outcome will be tested for superiority. A total of 36 300 women in birth cohorts not offered vaccination and 84 700 women in cohorts offered vaccination will be recruited, bringing the final sample size to 121 000. The trial is powered for the secondary outcome of cumulative CIN3+ in screen-negative women, adjusted for censoring after CIN2+ treatment and hysterectomy. ETHICS AND DISSEMINATION: Approved by the Bellberry Ethics Committee (2014-11-592). Findings will be reported in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER: NCT02328872; Pre-results

Protocol for Compass: a randomised controlled trial of primary HPV testing versus cytology screening for cervical cancer in HPV-unvaccinated and vaccinated women aged 25–69 years living in Australia

Introduction Australia’s National Cervical Screening Program (NCSP) currently recommends 2-year cytology in women aged 18–69 years. Following a review of the NCSP prompted by the implementation of human papillomavirus (HPV) vaccination, the programme will transition in 2017 to 5-year primary HPV screening with partial genotyping for HPV16/18 in women aged 25–74 years. Compass is a sentinel experience for the renewed NCSP and the first prospectively randomised trial of primary HPV screening compared with cytology to be conducted in a population with high uptake of HPV vaccination. This protocol describes the main Compass trial, which commenced after a pilot study of ~5000 women completed recruitment. Methods and analysis Women aged 25–69 years will be randomised at a 1:2 allocation to (1) 2.5-year image-read, liquid-based cytology (LBC) screening with HPV triage of low-grade smears (active control Arm A) or (2) 5-year HPV screening with partial genotyping and referral of HPV16/18-positive women to colposcopy (intervention Arm B). Women in Arm B positive for other oncogenic HPV (not 16/18) will undergo secondary randomisation at a 1:1 allocation to either LBC or dual-stained (p16INK4a and Ki-67) cytology testing (dual-stained cytology). The primary outcome is cumulative CIN3+ (CIN3, adenocarcinoma in situ and invasive cervical cancer) following a 5-year HPV exit testing round in both arms, in women randomised to the HPV arm versus women randomised to the LBC arm, based on an intention-to-treat analysis. The primary outcome will first be tested for non-inferiority and if declared, the primary outcome will be tested for superiority. A total of 36 300 women in birth cohorts not offered vaccination and 84 700 women in cohorts offered vaccination will be recruited, bringing the final sample size to 121 000. The trial is powered for the secondary outcome of cumulative CIN3+ in screen-negative women, adjusted for censoring after CIN2+ treatment and hysterectomy

Cervical screening with primary HPV testing or cytology in a population of women in which those aged 33 years or younger had previously been offered HPV vaccination: Results of the Compass pilot randomised trial

BACKGROUND: Using primary human papillomavirus (HPV) testing for cervical screening increases detection of high-grade cervical intraepithelial neoplastic lesions and invasive cancer (cervical intraepithelial neoplasia grade 2+ [CIN2+]) compared to cytology, but no evaluation has been conducted in a population previously offered HPV vaccination. We aimed to assess colposcopy referral and CIN2+ detection rates for HPV-screened versus cytology-screened women in Australia's HPV-vaccinated population (by 2014, resident women ≤33 years had been age-eligible for HPV vaccination, with 3-dose uptake across age cohorts being about 50%-77%). METHODS AND FINDINGS: Compass is an open-label randomised trial of 5-yearly HPV screening versus 2.5-yearly liquid-based cytology (LBC) screening. In the first phase, consenting women aged 25-64 years presenting for routine screening at 47 primary practices in Victoria, Australia, provided a cervical sample and were randomised at a central laboratory at a 1:2:2 allocation to (i) image-read LBC screening with HPV triage of low-grade cytology ('LBC screening'), (ii) HPV screening with those HPV16/18 positive referred to colposcopy and with LBC triage for other oncogenic (OHR) types ('HPV+LBC triage'), or (iii) HPV screening with those HPV16/18 positive referred to colposcopy and with dual-stained cytology triage for OHR types ('HPV+DS triage'). A total of 5,006 eligible women were recruited from 29 October 2013 to 7 November 2014 (recruitment rate 58%); of these, 22% were in the group age-eligible for vaccination. Data on 4,995 participants were analysed after 11 withdrawals; 998 were assigned to, and 995 analysed (99.7%) in, the LBC-screened group; 1,996 assigned to and 1,992 analysed (99.8%) in the HPV+LBC triage group; and 2,012 assigned to and 2,008 analysed (99.8%) in the HPV+DS triage group. No serious trial-related adverse events were reported. The main outcomes were colposcopy referral and detected CIN2+ rates at baseline screening, assessed on an intention-to-treat basis after follow-up of the subgroup of triage-negative women in each arm referred to 12 months of surveillance, and after a further 6 months of follow-up for histological outcomes (dataset closed 31 August 2016). Analysis was adjusted for whether women had been age-eligible for HPV vaccination or not. For the LBC-screened group, the overall referral and detected CIN2+ rates were 27/995 (2.7% [95% CI 1.8%-3.9%]) and 1/995 (0.1% [95% CI 0.0%-0.6%]), respectively; for HPV+LBC triage, these were 75/1,992 (3.8% [95% CI 3.0%-4.7%]) and 20/1,992 (1.0% [95% CI 0.6%-1.5%]); and for HPV+DS triage, these were 79/2,008 (3.9% [95% CI 3.1%-4.9%]) and 24/2,008 (1.2% [95% CI 0.8%-1.6%]) (p = 0.09 for difference in referral rate in LBC versus all HPV-screened women; p = 0.003 for difference in CIN2+ detection rate in LBC versus all HPV-screened women, with p = 0.62 between HPV screening groups). Limitations include that the study population involved a relatively low risk group in a previously well-screened and treated population, that individual women's vaccination status was unknown, and that long-term follow-up data on disease detection in screen-negative women are not yet available. CONCLUSIONS: In this study, primary HPV screening was associated with significantly increased detection of high-grade precancerous cervical lesions compared to cytology, in a population where high vaccine uptake was reported in women aged 33 years or younger who were offered vaccination. It had been predicted that increased disease detection might be associated with a transient increase in colposcopy referral rates in the first round of HPV screening, possibly dampened by HPV vaccine effect; in this study, although the point estimates for referral rates in women in each HPV-screened group were 41%-44% higher than in cytology-screened women, the difference in referral rate between cytology- and HPV-screened women was not significant. These findings provide initial support for the implementation of primary HPV screening in vaccinated populations. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613001207707