Understanding Democratic Engagement at the Micro-Level: Communication, Participation and Representation

Theoretical and ‘real world’ research into democratic engagment concentrates on larger-scale contexts. There is an accompanying tendency to focus on participation, neglecting other aspects of engagement. The thesis rethinks the notion of democratic engagement by dividing it into three analytically distinct, but interwoven, aspects namely communication, participation and representation, and drawing attention to small-scale or micro-level contexts. Understanding the communicative, participative and representative aspects of engagment in micro-level settings favours a case study approach and a research strategy designed to capture the minutiae of experiences of engagement. ‘Mossbank’, a neighbourhood in a small-to-medium sized Scottish town, has been chosen as an appropriate case. Mossbank is undergoing a physical and social regeneration initiative that has created new sites of democratic activity centred on Mossbank-related issues. It is also a setting where democratic engagement is likely to be constrained. A flexible mixed methods approach to data collection has been adopted using questionnaires, interviews, documentary analysis and non-participative observation, enabling the generation of ‘rich’ and ‘thick’ data. A theoretically informed analytical framework is used to explore the different aspects of democratic engagement in Mossbank. Here, Iris Marion Young’s theorising on communication in deliberative settings has been particularly influential. Democratic engagement in Mossbank is dominated and constrained by formal, familiar and broadly conventional institutions, processes and roles ‘imported’ from established larger-scale democratic settings. Less visible, context-specific factors also have an influence. ‘Messy’ practices and asymmetry affect the ‘quality’ of communication. Participation in democratic processes has its own particular constraining characteristics related to individual motivations and abilities to ‘fit in’ and ‘succeed’ within pre-existing processes. Representation in Mossbank is distant and sporadic, culminating in the evolution of an increasingly brokered approach to the relationship, administered by an intermediary. The thesis contributes to ‘empirical’ debates relating to the scope and nature of democratic engagement. This is especially relevant given the continued growth and development of micro-level democratic institutions and processes in developed democracies. The thesis also contributes to debates concerning the nature and extent of the ‘dialogue’ between normative ideals of democracy and engagement, and research into ‘real world’ democratic engagement

Transformation in a changing climate: a research agenda

The concept of transformation in relation to climate and other global change is increasingly receiving attention. The concept provides important opportunities to help examine how rapid and fundamental change to address contemporary global challenges can be facilitated. This paper contributes to discussions about transformation by providing a social science, arts and humanities perspective to open up discussion and set out a research agenda about what it means to transform and the dimensions, limitations and possibilities for transformation. Key focal areas include: (1) change theories, (2) knowing whether transformation has occurred or is occurring; (3) knowledge production and use; (4), governance; (5) how dimensions of social justice inform transformation; (6) the limits of human nature; (7) the role of the utopian impulse; (8) working with the present to create new futures; and (9) human consciousness. In addition to presenting a set of research questions around these themes the paper highlights that much deeper engagement with complex social processes is required; that there are vast opportunities for social science, humanities and the arts to engage more directly with the climate challenge; that there is a need for a massive upscaling of efforts to understand and shape desired forms of change; and that, in addition to helping answer important questions about how to facilitate change, a key role of the social sciences, humanities and the arts in addressing climate change is to critique current societal patterns and to open up new thinking. Through such critique and by being more explicit about what is meant by transformation, greater opportunities will be provided for opening up a dialogue about change, possible futures and about what it means to re-shape the way in which people live

Electrospun collagen-based nanofibres: A sustainable material for improved antibiotic utilisation in tissue engineering applications

For the creation of scaffolds in tissue engineering applications, it is essential to control the physical morphology of fibres and to choose compositions which do not disturb normal physiological function. Collagen, the most abundant protein in the human body, is a well-established biopolymer used in electrospinning compositions. It shows high in-vivo stability and is able to maintain a high biomechanical strength over time. In this study, the effects of collagen type I in polylactic acid-drug electrospun scaffolds for tissue engineering applications are examined. The samples produced were subsequently characterised using a range of techniques. Scanning electron microscopy analysis shows that the fibre morphologies varied across PLA-drug and PLA-collagen-drug samples − the addition of collagen caused a decrease in average fibre diameter by nearly half, and produced nanofibres. Atomic force microscopy imaging revealed collagen-banding patterns which show the successful integration of collagen with PLA. Solid-state characterisation suggested a chemical interaction between PLA and drug compounds, irgasan and levofloxacin, and the collagen increased the amorphous regions within the samples. Surface energy analysis of drug powders showed a higher dispersive surface energy of levofloxacin compared with irgasan, and contact angle goniometry showed an increase in hydrophobicity in PLA-collagen-drug samples. The antibacterial studies showed a high efficacy of resistance against the growth of both E. coli and S. Aureus, except with PLA-collagen-LEVO which showed a regrowth of bacteria after 48 h. This can be attributed to the low drug release percentage incorporated into the nanofibre during the in vitro release study. However, the studies did show that collagen helped shift both drugs into sustained release behaviour. These ideal modifications to electrospun scaffolds may prove useful in further research regarding the acceptance of human tissue by inhibiting the potential for bacterial infection

Challenges and considerations of applying nature-based solutions in low- and middle-income countries in Southeast and East Asia

Low- and middle-income countries in Southeast and East Asia face a range of challenges related to the rapid pace of urbanisation in the region, the scale of pollution, climate change, loss of ecosystem services and associated difficulties for ecological restoration. Possible pathways towards a more sustainable future lie in the applications of nature-based solutions (NBS). However, there is relatively little literature on the application of NBS in the region, particularly Southeast Asia. In this paper we address this gap by assessing the socio-ecological challenges to the application of NBS in the region – one of the most globally biodiverse. We first provide an overview and background on NBS and its underpinnings in biodiversity and ecosystem services. We then present a typology describing five unique challenges for the application of NBS in the region: (1) Characteristics of urbanisation; (2) Biophysical environmental and climatic context; (3) Environmental risks and challenges for restoration; (4) Human nature relationships and conflicts; and (5) Policy and governance context. Exploiting the opportunities through South-South and North-South collaboration to address the challenges of NBS in Southeast and East Asia needs to be a priority for government, planners and academics.Peer reviewe

Past and future adaptation pathways

Adaptation pathways are increasingly being used as a foresight tool to help guide the implementation of climate change adaptation and deliberate transformation. This paper applies a pathways lens as a hindsight tool to provide new understanding about past change and adaptation relevant for improving future adaptation pathways approaches. Four case studies of past adaptations to change are examined: Solomon Islands Communities, Canadian forest-dependent communities, a Transylvanian village, and responses to climate adaptation policies in Australia. The results highlight that responses to change in these diverse case studies involve complex transitions that gradually create new conditions and trajectories; manifest as multiple but inter-related pathways of change and response at different social or spatial scales (e.g. different paths for different households or communities); have legacies and continuities across time that affect future pathways of change; are affected by power in complex ways; and can create further change and need for adaptation. Analyses also highlight that when working with prospective adaptation approaches as a response to climate change there is a need to consider: (1) underlying assumptions, values and principles associated with the future; (2) the existence of inter-connected multiple pathways and their implications for reinforcing existing social inequalities; and (3) how understanding past change provides inspiration for new and transformative futures. Overall, the paper concludes that shifts towards analyses for change rather than simply about change, such as adaptation pathways, will require more careful consideration of underlying ontological assumptions about the relationships between past, present and future

Co-designing transformation research : lessons learned from research on deliberate practices for transformation

Co-production of new knowledge can enhance open and integrative research processes across the social and natural sciences and across research/science, practice and policy interrelationships. Thus, co-production is important in the conduct of research about and for transformations to sustainability. While co-design is an integral part of co-production, it often receives limited attention in the conduct of co-produced research. This paper reports on lessons learned from an early stage of the co-design process to develop research on deliberate practices for transformative change. Key lessons learned are the need to: (1) ensure co-design processes are themselves carefully designed; (2) encourage emergence of new ways of thinking about problem formulation through co-design; (3) carefully balance risks for the participants involved while also enhancing opportunities for intellectual risk taking; (4) facilitate personal transformations in co-design as a way to stimulate and encourage further creativity; and (5) for funders to carefully and constructively align criteria or incentives through which a project or future proposal will be judged to the goals of the co-design, including for instrumental outcomes and objectives for creativity and imagination. Given that co-design necessarily involves a reflective practice to iteratively guide emergence of new thinking about the practices of change, co-design can itself be considered an important deliberate practice for transforming the conduct of research and the contribution of that research to social transformations

Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans.

BACKGROUND: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. METHODS: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. RESULTS: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. CONCLUSION: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease