The Battle for City Hall: What Do We Fight Over?

An important dimension of contemporary American urban politics involves the redistributive role of local government. Activism at the local level has produced electoral movements that have succeeded in electing progressive local candidates and coalitions, yet on assuming office those officials face tremendous obstacles in meeting the expectations of those who put them in office. From 1991 to 1993 in Hartford, Connecticut, an attempt at progressive governance by a multiracial coalition was fraught with difficulties. Tensions among progressives and among leadership from impoverished communities of color, responses of downtown interests and the media, fiscal crises and the unrelenting needs of the population, served to complicate or stymie redistributive efforts and led to electoral defeat. However, new mechanisms for popular participation and several other reform measures were accomplished

Labor and neighborhood organizing in the context of economic restructuring : six organizations in Hartford, Connecticut

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 1991.Vita.Includes bibliographical references (v. 2, leaves 452-458).by Louise B. Simmons.Ph.D

Study of prognostic markers in advanced cancer

Background: Prognostication is a core skill fundamental to the clinical management of patients with advanced cancer. This skill is exercised to guide appropriate clinical decisions, plan supportive services and allocate resource utilisation. Prognostication by clinicians is often erroneous, optimistic, informal and subjective. Clinicians base survival predictions upon clinical experience, clinical intuition and knowledge of cancer trajectories. Prognostic factors have been identified and validated in patients with cancer. These can be clinical markers or biomarkers. Clinical markers including weight loss and Performance Status (PS), and biomarkers such as C-reactive protein (CRP), lactate dehydrogenase (LDH), White cell count (WCC) and albumin, all representative of systemic inflammation, have been shown to be predictive of survival. Several prognostic factors have been combined to develop prognostic tools to improve prognostication accuracy. The aims were to examine all these prognostic markers and the tools, to clarify which prognostic markers are most predictive of survival in advanced cancer. Methods: To meet these aims a systematic review, an analysis of a prospectively collected biobank of patients with lung cancer and finally a large de novo multi-centre (UK) observational cohort study (Inflammatory biomarkers in Prognosis in Advanced Cancer [IPAC] study), were undertaken. The latter examined prognostic factors and was informed by the systematic review and biobank analysis. The prognostic factors evaluated throughout included demographic factors, disease characteristics, clinical factors and biomarkers. Literature appraisal and synthesis, survival analysis and logistic regression methods were employed as appropriate. Results: The systematic review concluded that numerous prognostic tools predict survival in patients with advanced cancer; however comparison was difficult due to the heterogeneity of the tools and the methods used to determine their accuracy. Some tools incorporate prognostic factors that have been independently validated to be of prognostic significance in advanced cancer whilst other tools may include some factors which are not validated. The prognostic tools demonstrating greatest accuracy in determining survival are the Palliative Performance Scale (PPS), the Palliative Prognostic Score (PaP), the Palliative Prognostic Index (PPI), and the Glasgow Prognostic Score (GPS) including the modified variant (mGPS). These tools have all been externally validated in more than 2000 patients with advanced cancer and were independently associated with survival (p<0.001). The biobank analysis identified the markers (clinical and biomarkers) which are most predictive of survival in advanced lung cancer. The prognostic markers included in many of the prognostic tools with greatest survival prediction accuracy are PS and mGPS (p<0.001). A prospectively acquired biobank identified the markers (clinical and biomarkers) which are most predictive of survival in advanced incurable lung cancer. The prognostic markers which are included in many of the prognostic tools with greatest survival prediction accuracy are PS and mGPS. The prospective observational study demonstrated that CPS (Clinician Predicted Survival), mGPS, ECOG-PS (Eastern Cooperative Oncology Group - Performance Status), dyspnoea, Global Health, cognitive impairment, anorexia, weight loss, LDH, WCC and neutrophil count (NC) predicted survival at 30 days (univariate analysis). CPS, ECOG-PS, mGPS, dyspnoea, Global Health, cognitive impairment, anorexia, weight loss, LDH, WCC and NC, predicted survival at 3 months. On multivariate analysis, ECOG-PS, mGPS and neutrophil count predicted survival at 30 days while ECOG-PS, mGPS, weight loss, LDH and WCC predicted survival at 3 months. Conclusion: In patients with advanced cancer, the most accurate prognostic factors include clinical markers (Performance Status, weight loss) and biomarkers of the systemic inflammatory response (CRP and albumin [combined in the mGPS], NC, WCC). The next step in this work is assessing how these can be utilised in clinical practice

Sitka spruce and western hemlock regeneration after selective harvesting, Tongass National Forest, southeast Alaska

The objectives of this study were to determine the species composition and density of natural conifer regeneration following selective logging in southeast Alaska. Therefore, we quantified the density and size of new cohort spruce and hemlock and current seedling bank in 17 selectively logged stands. All stands were in mixed hemlock-spruce forests that were logged between 1900 and 1984, located at or near sea level, and not managed after this first logging. New cohorts included trees that germinated after logging plus advanced regeneration that was shorter than 1.4 in (standard height for diameter measurement - diameter at breast height, d.b.h.) at time of logging. With the exception of one tree, we found new cohort spruce only in plots that had been logged. New cohort hemlock were common in both logged and unlogged plots. New cohort spruce basal area ranged from 2 to 19 m2 / ha. Individuals were as large as 104 cm d.b.h. but generally ranged between 19 and 55 cm d.b.h. New cohort hemlock basal area ranged from less than 1 to 32 m2 / ha. The largest tree was 102 cm d.b.h. but most ranged from 11 to 51 cm d.b.h. The absence of new spruce in unlogged plots strongly suggests that disturbance favors spruce recruitment. The seedling bank included trees 0 to 3 m tall and less than 2.5 cm d.b.h. These seedlings became established after logging. The seedling bank density of both species was high; spruce ranged from 3,000 to 114,000 and hemlock ranged from 47,000 to 723,000 seedlings / ha. Rooting substrate (logs or undisturbed forest floor) was significant for both species (spruce p = 0.05, hemlock p = 0.0001). There were always more seedlings on logs than on undisturbed forest floor. By leaving spruce seed trees, judicious soil disturbance, planned entries to regulate overstory density and possibly planting spruce seedlings where the seed source is poor, we believe spruce can be regenerated in these systems. Pre-commercial thinning may be necessary to keep vigorously growing cohorts of spruce and hemlock in these stands, just as it is necessary in young stands regenerated after clearcutting

A farm transmission model for Salmonella in pigs, applicable to EU members states

The burden of Salmonella entering pig slaughterhouses across the European Union (EU) is considered a primary food safety concern. In order to assist EU Member States with the development of National Control Plans, we have developed a farm transmission model applicable to all Member States. It is an individual-based stochastic Susceptible-Infected model, that takes into account four different sources of infection of pigs (sows, feed, external contaminants such as rodents and new stock) and various management practices linked to Salmonella transmission/protection (housing, flooring, feed, All-In-All-Out production). A novel development within the model is the assessment of dynamic shedding rates. The results of the model, parameterized for two case study Member States (one high and one low prevalence) suggest that breeding herd prevalence is a strong indicator of slaughter pig prevalence. Until a Member States’ breeding herd prevalence is brought below 10% then the sow will be the dominant source of infection to pigs raised for meat production; below this level of breeding herd prevalence, feed becomes the dominant force of infection

Patient-centred care, health behaviours and cardiovascular risk factor levels in people with recently diagnosed type 2 diabetes: 5-year follow-up of the ADDITION-Plus trial cohort.

OBJECTIVE: To examine the association between the experience of patient-centred care (PCC), health behaviours and cardiovascular disease (CVD) risk factor levels among people with type 2 diabetes. DESIGN: Population-based prospective cohort study. SETTING: 34 general practices in East Anglia, UK, delivering organised diabetes care. PARTICIPANTS: 478 patients recently diagnosed with type 2 diabetes aged between 40 and 69 years enrolled in the ADDITION-Plus trial. MAIN OUTCOME MEASURES: Self-reported and objectively measured health behaviours (diet, physical activity, smoking status), CVD risk factor levels (blood pressure, lipid levels, glycated haemoglobin, body mass index, waist circumference) and modelled 10-year CVD risk. RESULTS: Better experiences of PCC early in the course of living with diabetes were not associated with meaningful differences in self-reported physical activity levels including total activity energy expenditure (β-coefficient: 0.080 MET h/day (95% CI 0.017 to 0.143; p=0.01)), moderate-to-vigorous physical activity (β-coefficient: 5.328 min/day (95% CI 0.796 to 9.859; p=0.01)) and reduced sedentary time (β-coefficient: -1.633 min/day (95% CI -2.897 to -0.368; p=0.01)). PCC was not associated with clinically meaningful differences in levels of high-density lipoprotein cholesterol (β-coefficient: 0.002 mmol/L (95% CI 0.001 to 0.004; p=0.03)), systolic blood pressure (β-coefficient: -0.561 mm Hg (95% CI -0.653 to -0.468; p=0.01)) or diastolic blood pressure (β-coefficient: -0.565 mm Hg (95% CI -0.654 to -0.476; p=0.01)). Over an extended follow-up of 5 years, we observed no clear evidence that PCC was associated with self-reported, clinical or biochemical outcomes, except for waist circumference (β-coefficient: 0.085 cm (95% CI 0.015 to 0.155; p=0.02)). CONCLUSIONS: We found little evidence that experience of PCC early in the course of diabetes was associated with clinically important changes in health-related behaviours or CVD risk factors. TRIAL REGISTRATION NUMBER: ISRCTN99175498; Post-results.The trial is supported by the Medical Research Council (grant reference no: G0001164 ), the Wellcome Trust (grant reference no: G061895 ),Diabetes UK and National Health Service R&D support funding . SJG is a member of the National Institute for Health Research (NIHR) School for Primary Care Research. The General Practice and Primary Care Research Unit was supported by NIHR Research funds. ATP is supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.This is the final version of the article. It was first available from BMJ via http://dx.doi.org/10.1136/bmjopen-2015-00893

Which behavior change techniques are associated with changes in physical activity, diet and BMI in people with recently diagnosed diabetes?

Peer reviewe

Are CT-derived muscle measurements prognostic, independent of systemic inflammation in good performance status patients with advanced cancer?

The present study examined the relationships between CT-derived muscle measurements, systemic inflammation, and survival in advanced cancer patients with good performance status (ECOG-PS 0/1). Data was collected prospectively from patients with advanced cancer undergoing anti-cancer therapy with palliative intent. The CT Sarcopenia score (CT-SS) was calculated by combining the CT-derived skeletal muscle index (SMI) and density (SMD). The systemic inflammatory status was determined using the modified Glasgow Prognostic Score (mGPS). The primary outcome of interest was overall survival (OS). Univariate and multivariate Cox regressions were used for survival analysis. Three hundred and seven patients met the inclusion criteria, out of which 62% (n = 109) were male and 47% (n = 144) were ≥65 years of age, while 38% (n = 118) were CT-SS ≥ 1 and 47% (n = 112) of patients with pre-study blood were inflamed (mGPS ≥ 1). The median survival from entry to the study was 11.1 months (1–68.1). On univariate analysis, cancer type (p &lt; 0.05) and mGPS (p &lt; 0.001) were significantly associated with OS. On multivariate analysis, only mGPS (p &lt; 0.001) remained significantly associated with OS. In patients who were ECOG-PS 0, mGPS was significantly associated with CT-SS (p &lt; 0.05). mGPS may dominate the prognostic value of CT-derived sarcopenia in good-performance-status patients with advanced cancer