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Labour’s choices: the political economy of Keir Starmer’s party
Get PDFThis article explores the dilemmas at the heart of the economic strategy of Keir Starmer’s government by tracking developments in British (centre-)left political economy since the Global Financial Crisis of 2008. It first traces the emergence of a shared narrative of political economy circulating among the UK and transatlantic centre-left, as well as some further left and right, over the 2010s and into the early 2020s. Identifying the core diagnoses and prescriptions contained within this narrative, this article situates them in economic, ideological, and political developments since 2008. It then traces the fragmentation of this economic imaginary from 2022. In combination with an unhappy transition to office, this fragmentation has generated a deeply confused and internally contradictory economic strategy in the UK Labour government. This paper then explains this process by placing ideological and political developments in their material and external contexts. A worsening macroeconomic and geopolitical context actively decomposed the constituent parts of the narrative and challenged some of its assumptions; in turn, this revived submerged disagreements within the governing party. The paper consequently argues that while these tensions can be explained partly by ideological closure, they derive to a significant and probably greater extent from institutional and material factors, especially questions of statecraft and the UK’s misfiring growth regime in an increasingly gloomy global context. The paper ends, however, by cautioning against an overbearing determinism. It indicates the remaining arenas for political agency open to the government, should it prove able and willing to act
Testing a screening algorithm for the identification of growth-disorders for use in UK children
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Plasma vascular endothelial growth factor levels are a potential therapy-response biomarker for pancreatic cancer
Get PDFTrajectory, healthcare utilisation and recovery in 3590 individuals with long covid: a 4-year prospective cohort analysis.
Get PDFOBJECTIVE: To characterise long-term trajectory of recovery in individuals with long covid. DESIGN: Prospective cohort. SETTING: Single-centre, specialist post-COVID service (London, UK). PARTICIPANTS: Individuals aged ≥18 years with long covid (hospitalised and non-hospitalised) from April 2020 to March 2024. MAIN OUTCOME MEASURES: Routine, prospectively collected data on symptoms, quality of life (including Fatigue Assessment Scale (FAS) and EuroQol 5 Dimensions (EQ-5D), return to work status and healthcare utilisation (investigations, outpatient and emergency attendances). The primary outcome was recovery by self-reported >75% of 'best health' (EQ-5D Visual Analogue Scale) and was assessed using Cox proportional hazards regression models over 4 years. Linked National Health Service England registry data provided secondary care healthcare utilisation and expenditure. RESULTS: We included 3590 individuals (63.3% female, 73.5% non-hospitalised, median age 50.0 years, 71.9% with ≥2 doses of COVID-19 vaccination), who were followed up for a median of 136 (0-346) days since first assessment and 502 (251-825) days since symptom onset. At first assessment, 33.2% of employed individuals were unable to work. Dominant symptoms were fatigue (78.7%), breathlessness (68.1%) and brain fog (53.5%). 33.4% of individuals recovered to >75% of best health prior to clinic discharge (recovery occurred median 202 (94-468) days from symptom onset). Vaccinated individuals were more likely to recover faster (pre: HR 2.93 (2.00-4.28) and post: HR 1.34 (1.05-1.71) COVID-19 infection), whereas recovery hazard was inversely associated with FAS (HR 0.37 (0.33-0.42)), myalgia (HR 0.59 (0.45-0.76)) and dysautonomic symptoms (HR 0.46 (0.34-0.62)). There was high secondary care healthcare utilisation (both emergency and outpatient care). Annual inpatient and outpatient expenditure was significantly lower in hospitalised individuals while under the service. When compared with the prereferral period, emergency department attendances were reduced in non-hospitalised patients with long covid, but outpatient costs increased. CONCLUSIONS: In the largest long covid cohort from a single specialist post-COVID service to date, only one-third of individuals under follow-up achieved satisfactory recovery. Fatigue severity and COVID-19 vaccination at presentation, even after initial COVID-19 infection, was associated with long covid recovery. Ongoing service provision for this and other post-viral conditions is necessary to support care, progress treatment options and provide capacity for future pandemic preparedness. Research and clinical services should emphasise these factors as the strongest predictors of non-recovery
Health service access for ethnically underrepresented communities: A scoping review of complex interventions.
Get PDFBACKGROUND: The aim of this scoping review is to systematically map the existing evidence of complex interventions used to improve access and/or engagement of ethnically underrepresented communities with healthcare services in the UK, and explore equity factors of the evidence. METHODS: The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist. Six databases were searched. Analysis was completed using reflexive and thematic content analysis. Interventions were mapped against the five domains of the Patient-centred access framework and the PROGRESS-Plus equity framework. RESULTS: A total of 35 studies met the inclusion criteria. Of these studies 63% were completed in primary care, 31% in mental health, 3% in maternity services and 3% in dental care. Several communities were represented, including Gypsy, Roma and Travellers, African Caribbeans, Jewish communities, as well as broader groups such as South Asians, migrants and Muslims. Complex interventions were spread across the five domains of the patient centred access framework and included strategies such as outreach workers, using community settings such as places of worship, cultural adaptations and cultural training for healthcare staff. Effectiveness of interventions was assessed in a third of studies. PROGRESS-Plus analysis identified exclusion criteria including age groups (e.g., below 18 years), ethnic groups (e.g., not first-generation migrants), disabilities (e.g., severe mental health problems) and plus (e.g., language proficiency). CONCLUSIONS: All domains of the patient centred access framework were represented with approachability and acceptability being the most common. Effectiveness assessment was not included in two thirds of studies however, complex interventions show promise to improve equity in ethnically underrepresented communities. Future research should endeavour to assess effectiveness and the translation of interventions in healthcare contexts outside of primary care and mental health. Future policy and research should consider how to increase transparency of power and build strong collaborations with underrepresented communities
Deep learning models to map osteocyte networks from confocal microscopy can successfully distinguish between young and aged bone.
Get PDFOsteocytes, the most abundant and mechanosensitive cells in bone tissue, play a pivotal role in bone homeostasis and mechano-responsiveness, orchestrating the delicate balance between bone formation and resorption under daily activity. Studying osteocyte connectivity and understanding their intricate arrangement within the lacunar canalicular network is essential for unravelling bone physiology, which is significantly disrupted during ageing. Much work has been carried out to investigate this relationship, often involving high resolution microscopy of discrete fragments of this network, alongside advanced computational modelling of individual cells. However, traditional methods of segmenting and measuring osteocyte connectomics are time-consuming and labour-intensive, often hindered by human subjectivity and limited throughput. In this study, we explored the application of deep learning and computer vision techniques to automate the segmentation and measurement of osteocyte connectomics, enabling more efficient and accurate analysis. For this specific application, once trained, the analysis was completed within 10 seconds, compared to manual segmentation time of 130 hours. We compared a number of state-of-the-art computer vision models (U-Nets and Vision Transformers) to successfully segment the osteocyte network, finding that an Attention U-Net model can accurately segment and measure 81.8% of osteocytes and 42.1% of dendritic processes, when compared to manual labelling. While further development is required, we demonstrated that this degree of accuracy is already sufficient to distinguish between bones of young (2-month-old) and aged (36-month-old) mice, as well as partially capturing the degeneration induced by genetic modification of osteocytes. Comparison of the model predictions with manual measurements showed no significant difference, indicating that, with additional training, such deep learning algorithms could be trained to human-level accuracy when measuring the osteocyte network. By harnessing the power of these advanced technologies, further developments will likely shed light on the complexities of osteocyte networks with ever-increasing efficiency
What Is Centrism?
Get PDFCentrism, an ambiguous political term, requires greater analytical scrutiny. After summarising conceptualisations of centrism – and of a centre in politics – that can be derived from existing literature, this article is focused on centrism as a purported set of ideas: a centre beyond left and right. As a case study for this outlook, the centrist project of French president Emmanuel Macron is analysed. A new theory of centrism is then presented – centrism as a structure for political action – which recognises both the lack of political concepts within centrism and the inclusion of a political strategy which makes it an observable phenomenon: a politics which oscillates between left and right. Within liberal democracies, centrism offers a strategy for action, derived from a critique of left and right political establishments. Yet it does so in an ideational context largely shaped by existing ideologies of left and right, moderate and extreme. While oscillation may ease political decision-making, as a strategy, it does not inscribe specifically centrist political ideas. A distinct centrism which transcends left and right remains elusive
