Governing energy in organisations: Energy management professionals, marginalised practices, and the limits to change

Organisations and institutions of many kinds play important roles in maintaining and transforming energy systems, not least through their direct contributions to energy demand. Major service‐providing institutions such as universities and hospitals have especially large and complex demands. Facing pressures to reduce environmental impacts and costs, many of these organisations are trying to reduce their energy consumption—with varying degrees of success. The responsibility for pursuing this goal in practice often lies with practitioners here referred to as Energy Management Professionals (EMPs). However, there has been little systematic investigation of EMPs' practices and their energy implications. Using qualitative evidence from English universities and hospitals, we argue that three types of work are marginalised in EMPs' practices, namely: (a) change‐focused work, and within that; (b) work engaging with people and what they do, and within that; (c) work engaging with institutional policy‐making. We argue that these marginalisations limit the scale and scope of demand reduction efforts, and also show how they arise from interacting dynamics of national policies and priorities, institutional structures and professional practices, and the influence of neoliberal governance, among other things. Finally, we discuss how rethinking institutional energy governance could help reduce energy demand and reflect on wider lessons for research and policy on organisational sustainability

Modelling energy demand from higher education institutions: A case study of the UK

Among the various sustainability goals of higher education institutions (HEIs), reducing energy use and carbon emissions are particularly important. However, not much is known about energy demand from the higher education sector – especially since there is a lack of robust models of energy demand in this sector. This paper, the first to utilize a panel dataset and advanced panel econometric techniques in order to model energy use in higher education, investigates variations in energy use between HEIs (cross-sectional analysis), and also changes in energy use over time (temporal analysis), using the UK as a case study. We argue that panel dataset and methods are more useful for understanding growth (and reduction) in energy use within the HE sector than the methods used within previous cross-sectional studies. Results show that, over time and also across the sector, energy consumption in the HEIs increases with increases in income and floor space, but at a slower rate. As HEIs grow overall (in terms of income, floor space, student and staff number) over time, they become more 'energy efficient' (using less energy per unit of area, population or income), indicating economies of scale in the temporal dimension. Results also show that after controlling for income and size, research intensive HEIs consume more energy. We also find a small but statistically significant effect of energy prices on energy consumption, as might be expected. Simulation using the model parameters for an example scenario suggests that energy consumption will continue to increase unless there is a significant change in the policies driving income growth and spatial expansion in the HE sector in the UK

From exports to exercise: how non-energy policies affect energy systems

Because of existing policy silos, energy policy tends to be addressed from a narrowly energy-centric basis; yet energy systems are clearly also affected by a wide range of policies emanating from other sectors. This article explores the impacts of policies associated with various ‘non-energy sectors’ on energy supply and demand, using a systematic and wide-ranging review of academic, policy and grey literatures. We discuss six policy sectors where these impacts are, in our assessment, not sufficiently recognised by policymakers or researchers but have significant energy implications. Overall, we find that there is little acknowledgement or analysis of this issue, especially of the full causal chain from ‘non-energy policies’ through to energy system impacts; for whatever reason, consideration of the reverse links (e.g. of the health impacts of energy policies) is far more common. The upshot is that non-energy policy impacts on energy systems are not sufficiently visible within either research or policy. We argue that this serves as a barrier to change, and that increasing the visibility of these complex and multi-faceted connections is thus a vital task for researchers and policymakers alike

Can people talk about their past practices? Challenges, opportunities, and practical applications of biographic inquiry for geographic research on consumption

Within human geography, there is increasing interest in the application of theories of practice for understanding resource consumption and for pursuing sustainability goals. In stressing the routine, performative, and contextual dimensions of action, research on geographies of practice is faced with particular methodological challenges. A lively debate concerns the utility of talk-based methods for investigating routine practices, such as those relating to everyday consumption. While it has been compellingly argued that people can talk individually or in groups about their practice, as of yet, these methodological debates have not been extended to the question of whether people can talk about past practices over the life course. This is despite the fact that attending to practice dynamics at the life-course scale can reveal important insights into the intersections of structure, agency, time, and space in consumption practices. Seeking to address this gap, this methodology-focused paper explores biographic inquiry as an empirical strategy for research on geographies of practice and consumption. After identifying significant challenges in representation associated with researching routine action in general, and past practices in particular, it outlines key learnings garnered during a biographic study on domestic consumption in Ireland. Central methodological features supporting talk-elicitation include zooming-in-and-out of temporal registers, multi-modality, and phased implementation. The paper concludes that people can talk about past practices in often very detailed, intricate ways and that retrospective talk is a valuable tool for understanding practice dynamics at the life-course scale

Masters of the machinery: The politics of economic modelling within European Union energy policy

Economic modelling plays a major role in the development, justification and evaluation of energy policies. However, there has been little investigation of how political dynamics systematically influence these models' development and outputs, or the implications for energy strategies, targets and interventions. Using in-depth interviews with 24 European modellers and policyworkers, we illuminate the politics of economic modelling within European Union (EU) energy policymaking, focusing on dynamics of contestation, differentiated influence and power relations within models' a) framing of questions and problems; b) framing of scenarios and solutions; c) structural assumptions and d) definition of quantitative data inputs. We then consider deeper questions of e) access and exclusion, showing how modelling is used to silence critical voices and reinforce incumbent interests. We argue that understanding this politics of modelling is crucial to the implementation of sustainable energy transitions. We conclude with recommendations for researchers and policyworkers seeking to promote the use of alternative/innovative models in energy policy (within and beyond the EU), centring on reflexivity; recognition; and relationship-building. Developing multi-sectoral ‘communities of practice’ around innovative modelling approaches is vital in challenging a vicious circle of evidence and policy that legitimises business-as-usual in a dangerously warming world

Utility of repeat cytological assessment of thyroid nodules initially classified as benign: clinical insights from multidisciplinary care in an Irish tertiary referral centre.

BACKGROUND: Fine needle aspiration biopsy (FNAB) is the tool of choice for evaluating thyroid nodules with the majority classified as benign following initial assessment. However, concern remains about false negative results and some guidelines have recommended routine repeat aspirates. We aimed to assess the utility of routine repeat FNAB for nodules classified as benign on initial biopsy and to examine the impact of establishing a multidisciplinary team for the care of these patients. METHODS: We performed a retrospective review of 400 consecutive patients (413 nodules) who underwent FNAB of a thyroid nodule at our hospital between July 2008 and July 2011. Data recorded included demographic, clinical, histological and radiological variables. RESULTS: Three hundred and fifty seven patients (89 %) were female. Median follow-up was 5.5 years. Two hundred and fifty eight (63 %) nodules were diagnosed as benign. The rate of routine repeat biopsy increased significantly over the time course of the study (p for trend = 0.012). Nine Thy 2 nodules were classified differently on the basis of routine repeat biopsy; one patient was classified as malignant on repeat biopsy and was diagnosed with papillary thyroid carcinoma. Eight were classified as a follicular lesions on repeat biopsy-six diagnosed as benign following lobectomy; two declined lobectomy and were followed radiologically with no nodule size increase. CONCLUSIONS: The false negative rate of an initial benign cytology result, from a thyroid nodule aspirate, is low. In the setting of an experienced multidisciplinary thyroid team, routine repeat aspiration is not justified

Associations of vitamin D pathway genes with circulating 25-hydroxyvitamin-D, 1,25-dihydroxyvitamin-D, and prostate cancer:a nested case-control study

Vitamin D pathway single nucleotide polymorphisms (SNPs) are potentially useful proxies for investigating whether circulating vitamin D metabolites [total 25-hydroxyvitamin-D, 25(OH)D; 1,25-dihydroxyvitamin, 1,25(OH)2D] are causally related to prostate cancer. We investigated associations of sixteen SNPs across seven genes with prostate-specific antigen-detected prostate cancer

Cancer stem cell markers in breast cancer: pathological, clinical and prognostic significance

INTRODUCTION: The cancer stem cell (CSC) hypothesis states that tumours consist of a cellular hierarchy with CSCs at the apex driving tumour recurrence and metastasis. Hence, CSCs are potentially of profound clinical importance. We set out to establish the clinical relevance of breast CSC markers by profiling a large cohort of breast tumours in tissue microarrays (TMAs) using immunohistochemistry (IHC). METHODS: We included 4, 125 patients enrolled in the SEARCH population-based study with tumours represented in TMAs and classified into molecular subtype according to a validated IHC-based five-marker scheme. IHC was used to detect CD44/CD24, ALDH1A1, aldehyde dehydrogenase family 1 member A3 (ALDH1A3) and integrin alpha-6 (ITGA6). A 'Total CSC' score representing expression of all four CSC markers was also investigated. Association with breast cancer specific survival (BCSS) at 10 years was assessed using a Cox proportional-hazards model. This study was complied with REMARK criteria. RESULTS: In ER negative cases, multivariate analysis showed that ITGA6 was an independent prognostic factor with a time-dependent effect restricted to the first two years of follow-up (hazard ratio (HR) for 0 to 2 years follow-up, 2.4; 95% confidence interval (95% CI), 1.2 to 4.8; P = 0.009). The composite 'Total CSC' score carried independent prognostic significance in ER negative cases for the first four years of follow-up (HR for 0 to 4 years follow-up, 1.3; 95% CI, 1.1 to 1.6; P = 0.006). CONCLUSIONS: Breast CSC markers do not identify identical subpopulations in primary tumours. Both ITGA6 and a composite Total CSC score show independent prognostic significance in ER negative disease. The use of multiple markers to identify tumours enriched for CSCs has the greatest prognostic value. In the absence of more specific markers, we propose that the effective translation of the CSC hypothesis into patient benefit will necessitate the use of a panel of markers to robustly identify tumours enriched for CSCs

Relationship between bacterial strain type, host biomarkers, and mortality in clostridium difficile infection

Background: Despite substantial interest in biomarkers, their impact on clinical outcomes and variation with bacterial strain has rarely been explored using integrated databases. Methods: From September 2006 to May 2011, strains isolated from Clostridium difficile toxin enzyme immunoassay (EIA)-positive fecal samples from Oxfordshire, United Kingdom (approximately 600 000 people) underwent multilocus sequence typing. Fourteen-day mortality and levels of 15 baseline biomarkers were compared between consecutive C. difficile infections (CDIs) from different clades/sequence types (STs) and EIA-negative controls using Cox and normal regression adjusted for demographic/clinical factors. Results: Fourteen-day mortality was 13% in 2222 adults with 2745 EIA-positive samples (median, 78 years) vs 5% in 20 722 adults with 27 550 EIA-negative samples (median, 74 years) (absolute attributable mortality, 7.7%; 95% CI, 6.4%-9.0%). Mortality was highest in clade 5 CDIs (25% [16 of 63]; polymerase chain reaction (PCR) ribotype 078/ST 11), then clade 2 (20% [111 of 560]; 99% PCR ribotype 027/ST 1) versus clade 1 (12% [137 of 1168]; adjusted P <. 0001). Within clade 1, 14-day mortality was only 4% (3 of 84) in ST 44 (PCR ribotype 015) (adjusted P =. 05 vs other clade 1). Mean baseline neutrophil counts also varied significantly by genotype: 12.4, 11.6, and 9.5 × 109 neutrophils/L for clades 5, 2 and 1, respectively, vs 7.0 × 109 neutrophils/L in EIA-negative controls (P <. 0001) and 7.9 × 109 neutrophils/L in ST 44 (P =. 08). There were strong associations between C. difficile-type-specific effects on mortality and neutrophil/white cell counts (rho = 0.48), C-reactive-protein (rho = 0.43), eosinophil counts (rho =-0.45), and serum albumin (rho =-0.47). Biomarkers predicted 30%-40% of clade-specific mortality differences. Conclusions: C. difficile genotype predicts mortality, and excess mortality correlates with genotype-specific changes in biomarkers, strongly implicating inflammatory pathways as a major influence on poor outcome after CDI. PCR ribotype 078/ST 11 (clade 5) leads to severe CDI; thus ongoing surveillance remains essential