The rescaling of sub-national planning: Can localism resolve England’s spatial planning conundrum?

This paper analyses the recent reorganisation of sub-national planning in England. The abrupt termination in 2010 of regional spatial strategies (RSSs) left England as the only major country in north-western Europe without effective sub-national governance structures (outside London) for spatial planning. Drawing on in-depth interviews with public-sector planners and other research material, this paper analyses the impacts of the demise of regional planning for ‘larger-than-local’ policy coordination in England. The paper seeks to question whether localism can succeed where regionalism is perceived to have failed in dealing effectively with the strategic spatial dilemmas integral to planning. It concludes by assessing whether the evolving decentralised forms of sub-national governance (combined authorities and local enterprise partnerships (LEPs)) emerging through the government’s ‘devolution revolution’ can develop to fill the current strategic planning void and resurrect some form of spatial planning throughout England

A eukaryote assemblage intercalated with Marinoan glacial deposits in South Australia

Video of digital X-ray tomographs (µCT) in longitudinal plane through cylinder of siltstone, maximum diameter seen (left to right when viewing movie) is 5.4m

Breeding site fidelity, and breeding pair infidelity in the endangered Carnaby’s Cockatoo Calyptorhynchus latirostris

The ecology and behaviour of the endangered Carnaby’s Cockatoo Calyptorhynchus latirostris have been studied in detail at Coomallo Creek in the northern wheatbelt of Western Australia from 1969 until the present. Results of research on this breeding population conducted on individually marked birds from 1970 to 1990 were compared with results from analyses of DNA taken from nestlings in the study area from 2003, 2005, and each year from 2009 to 2013. Analyses of DNA confirmed earlier findings about the stability of adult breeding pairs, and that females used the same breeding hollow they used previously, provided the hollow was not occupied when they returned to breed. When moving to another hollow, they chose a hollow in the same vicinity of the previous hollow. Analyses in 22 cases where DNA was obtained from both nestlings of a breeding attempt revealed that in six (27.3%) cases, the second egg was fertilised by a male not paired with the female. These extra-pair copulations were not suspected during the earlier study based on observations of individually marked birds

LATE DEVONIAN-TOURNAISIAN CONODONTS FROM THE EASTERN KHYBER REGION, NORTH-WEST PAKISTAN

Conodonts (62 species and subspecies) from acid-leaching of 226 samples from four sections through the Ali Masjid Formation west of Misri Khel in the former South Khyber Agency, north-west Pakistan, are documented by illustrations and distributional data. These indicate that most of this unit, at least in that area, spans the interval Middle crepida Zone (low in the Famennian) to at least Early crenulata Zone (mid-Tournaisian), though a fauna from low in one of the sections produced conodonts indicative of the Late falsiovalis Zone (early Frasnian). Two major hiatuses are inferred: between the Late falsiovalis and Middle crepida zones, and between the Late expansa and Early duplicata zones. Coherence of the conodont biostratigraphy accords with lithologic alignments between the sections. &nbsp

The interaction between transpolar arcs and cusp spots

Transpolar arcs and cusp spots are both auroral phenomena which occur when the interplanetary magnetic field is northward. Transpolar arcs are associated with magnetic reconnection in the magnetotail, which closes magnetic flux and results in a "wedge" of closed flux which remains trapped, embedded in the magnetotail lobe. The cusp spot is an indicator of lobe reconnection at the high-latitude magnetopause; in its simplest case, lobe reconnection redistributes open flux without resulting in any net change in the open flux content of the magnetosphere. We present observations of the two phenomena interacting--i.e., a transpolar arc intersecting a cusp spot during part of its lifetime. The significance of this observation is that lobe reconnection can have the effect of opening closed magnetotail flux. We argue that such events should not be rare

Service Design in Chronic Health

Every day we interact with services. From checking our mobile phone to taking the bus to work, from ordering shopping online to taking money out of the ATM. Most if not all of these services will have been designed, and we have a sense of which of these services are good or bad, and we can change providers based on this experience. Now consider health. The majority of the UK’s health provision is delivered as a service; in fact, the clue is in the title. The National Health Service (NHS) is the biggest provider of healthcare in the world. In 2014 the NHS employed 150,273 doctors, 377,191 qualified nursing staff, 155,960 qualified scientific, therapeutic and technical staff and 37,078 managers. It comprises 156 acute trusts, it’s planned expenditure for 2014/15 is £113.035bn and the NHS deals with over 1 million patients every 36 hours. Service design is an emergent discipline of design and as such, to date, has had little to do with the development of services in health. This chapter is going to reflect on the challenges changing societal needs will have on the way that health care is provided, and how by applying the theory, methods and practice of participatory service design, health services are able to respond and deliver services that ‘work’ for both patients, carers and health service providers. The chapter will set out a key challenge to today and tomorrow’s healthcare provision, in that the key resource to engage is now those individuals living with chronic conditions. Service design has particular strengths in involving a diverse range of stakeholders to co-design solutions that work for all

Capillary pressure may predict preclinical changes in the eye

This is the final version. Available on open access from Springer Verlag via the DOI in this recordAIMS/HYPOTHESIS: Microvascular dysfunction is associated with end-organ damage. Macular oedema is an important component of diabetic retinopathy. Macular thickness can be accurately quantified by optical coherence tomography (OCT), enabling accurate assessment of the macular prior to clinically apparent abnormalities. We investigated whether macular (fovea) thickness in non-diabetic individuals is related to the microvascular variables controlling fluid filtration across a blood vessel wall, in particular capillary pressure and the microvascular filtration capacity (Kf). METHODS: We recruited 50 non-diabetic individuals (25 men, 25 women; age range: 26-78 years; BMI range: 20-46 kg/m(2)). Fovea thickness was assessed by OCT. Microvascular assessments included: finger nailfold capillary pressure; Kf; microvascular structural assessments, i.e. skin vasodilatory capacity, minimum vascular resistance (MVR) and microvascular distensibility; and endothelial function. RESULTS: At 214.6 (19.9) microm (mean [SD]), fovea thickness was within normal range. Capillary pressure, adjusted for BMI, was associated with fovea thickness (standardised beta 0.573, p = 0.006, linear regression). Fovea thickness was not associated with Kf, microvascular structural assessments or endothelial function. Capillary pressure was still associated with fovea thickness when adjusted for microvascular variables (Kf, vasodilatory capacity, MVR, microvascular distensibility or endothelial function), or for risk factors for diabetes (systemic blood pressure, insulin sensitivity, inflammation, glycaemic status and lipids) and age. CONCLUSIONS/INTERPRETATION: Capillary pressure, a key determinant of movement of fluid across a blood vessel wall, is associated with fovea thickness in non-diabetic individuals. This suggests that with regard to potential preventative or therapeutic targets, attention should be directed at the mechanisms determining retinal microvascular pressure.Diabetes UKNational Institute for Health Research (NIHR

Is it feasible to conduct a randomised controlled trial of pretransplant exercise (prehabilitation) for patients with multiple myeloma awaiting autologous haematopoietic stem cell transplantation? Protocol for the PREeMPT study

Introduction While myeloma is an incurable malignancy, developments in disease management have led to increased life expectancy in recent years. Treatment typically involves stem-cell transplantation. Increased survival rates equate to more patients living with the burden of both the disease and its treatment for increasing number of years, rendering myeloma a long-term condition. Evidence exists to demonstrate the benefits of exercise for patients recovering from stem-cell transplantation, and prehabilitation—exercise before treatment—has been shown to be effective in other disease areas. To date there has been no research into prehabilitation in patients with myeloma awaiting transplantation treatment. Our objective is to determine whether it is feasible to conduct a randomised controlled trial into pretransplant exercise for patients with multiple myeloma who are awaiting autologous stem-cell transplantation. Methods and analysis This mixed methods study identifies patients with diagnosis of multiple myeloma who have been assigned to the autologous transplantation list and invites them to participate in six weekly sessions of individualised, supervised exercise while awaiting transplantation. Quantitative data to determine feasibility targets include rates of recruitment, adherence and adverse events, and outcome measures including 6 min walking distance test and quality of life. Qualitative interviews are undertaken with a purposive sample of patients to capture their experiences of the study and the intervention

Weight change and sulfonylurea therapy are related to 3 year change in microvascular function in people with type 2 diabetes

Aims/hypothesis: Although cardiovascular disease is the biggest cause of death in people with diabetes, microvascular complications have a significant impact on quality of life and financial burden of the disease. Little is known about the progression of microvascular dysfunction in the early stages of type 2 diabetes before the occurrence of clinically apparent complications. We aimed to explore the determinants of endothelial-dependent and -independent microvascular function progression over a 3 year period, in people with and without both diabetes and few clinical microvascular complications. Methods: Demographics were collected in 154 participants with type 2 diabetes and in a further 99 participants without type 2 diabetes. Skin microvascular endothelium-dependent response to iontophoresis of acetylcholine and endothelium-independent responses to sodium nitroprusside were measured using laser Doppler fluximetry. All assessments were repeated 3 years later. Results: People with type 2 diabetes had impaired endothelial-dependent microvascular response compared with those without (AUC 93.9 [95% CI 88.1, 99.4] vs 111.9 [102.3, 121.4] arbitrary units [AU] × min, p < 0.001, for those with vs without diabetes, respectively). Similarly, endothelial-independent responses were attenuated in those with diabetes (63.2 [59.2, 67.2] vs 75.1 [67.8, 82.4] AU × min, respectively, p = 0.002). Mean microvascular function declined over 3 years in both groups to a similar degree (pinteraction 0.74 for response to acetylcholine and 0.69 for response to sodium nitroprusside). In those with diabetes, use of sulfonylurea was associated with greater decline (p = 0.022 after adjustment for co-prescriptions, change in HbA1c and weight), whereas improving glycaemic control was associated with less decline of endothelial-dependent microvascular function (p = 0.03). Otherwise, the determinants of microvascular decline were similar in those with and without diabetes. The principal determinant of change in microvascular function in the whole population was weight change over 3 years, such that those that lost ≥5% weight had very little decline in either endothelial-dependent or -independent function compared with those that were weight stable, whereas those who gained weight had a greater decline in function (change in endothelial-dependent function was 1.2 [95% CI -13.2, 15.7] AU × min in those who lost weight; -15.8 [-10.5, -21.0] AU × min in those with stable weight; and -37.8 [-19.4, -56.2] AU × min in those with weight gain; ptrend < 0.001). This association of weight change with change in endothelial function was driven by people with diabetes; in people without diabetes, the relationship was nonsignificant. Conclusions/interpretation: Over 3 years, physiological change in weight was the greatest predictor of change in microvascular function.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.This work was supported by the Innovative Medicines Initiative (the SUMMIT consortium, IMI-2008/115006).published version, accepted version (12 month embargo