The Role of Ethics and Targets in Environmental Governance and the Enduring Importance of New Public Management

This article examines the importance of new public management in environmental governance. In order to explain what makes new public management such a robust framework for environmental governance, the article draws on the key themes of individual and collective responsibility in responding to climate change, examining the role of new public management in response to ecological and environmental change, resource scarcity, focus on global energy sources and politics. The article discusses the role of three aspects of environmental governance in turn: the theoretical understandings relating to individuals and society in response to climate change, the politics of these responses and governance arrangements, and how these are formed by the hastening paucity of certain energy resources. The article then moves on to examine these themes in the context of new public management, arguing that the responses we see to climate change in environmental governance are driven by measurement and targets, as these can be universally set and communicated. This shows the enduring nature of new public management in political and policy responses to the challenges of climate change

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

The Thames Gateway and the Social City : a comparative study of governance of Brownfield regeneration in the United Kingdom and Germany

The thesis examines governance of two Brownfield (previously developed land) regeneration initiatives, in the Thames Gateway in the UK and the Social City in Germany. The thesis explores the effect of institutional design, modes of governance, relevant stakeholders, the norms and knowledge of underpinning policy processes, and evaluates policy outputs, outcomes, and best practice across the cases. Within these categories, it examines the role of communities, the effect of unitary and federal structures, and the relations between actors in governance, drawing upon the policy networks framework. In the case study areas of Barking and Thurrock in the Thames Gateway and Marzahn and Potsdam in the Social City, both regeneration initiatives ascribe important roles for communities in the governance process, and share goals such as improving housing, communal areas of land and educational facilities. The thesis uses the policy networks model to compare and contrast governance models of regeneration in the cases, arguing that despite the range of partners and agencies involved in delivery of regeneration projects in the UK and Germany, the projects and governance of each regeneration initiative was essentially driven by the centre, with resources distributed to only a select key actors and made for an asymmetrical power relationship between the centre and the network, with the centre able to intervene in these governance models and projects.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The impact of the EU-UK Free Trade Agreement on the UK economy

The end of the Brexit transition period and the implementation of the EU-UK Free Trade and Cooperation Agreement has added to the UK heightened economic uncertainty caused by the pandemic lockdowns. The structural changes brought about by the agreement involve new regulations governing trade between the UK and the EU-27 based on zero tariffs and quotas in goods but with significant non-trade barriers such as extra administrative burdens caused by certifying rules of origin. Quite tellingly financial services are hardly covered in the agreement. The implementation hurdles to date point to a steep learning curve for both sides, as there is need for constant observance and surveillance of its practical applications and implications. Tensions from the implementation of the Northern Irish Protocol and demarcation of fishery territories for example are ongoing and have the potential to derail some of the agreement’s key principles

Understanding renewed Public Service Ethos (PSE) in public management: policy, purpose, and pedagogy

Public service ethos (PSE) is traditionally associated with public administration, bureaucracy, and frontline response. Thinkers such as Aristotle and Weber embedded ideas of public virtue and vocation, yet new managerialism, as well as changes to public services management challenge traditional notions of PSE. Recent events such as the Covid – 19 pandemic, counter terrorism, and government austerity agendas have put PSE back into the public eye. In this chapter we examine the context for a renewed PSE as a crucial aspect of resilience for workers in public services and public management. We focus on three areas that we feel are important for PSE: policy, purpose and pedagogy., and how a renewed PSE can inform pedagogy in the discipline, renewing ideas of vocation in public administration training