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Assembling the Healthopolis: Competitive city-regionalism and policy boosterism pushing Greater Manchester further, faster
No full textHealth and care policy is increasingly promoted within visions of the competitive city-region. This paper examines the importance of policy boosterism within the political construction of city-regions in the context of English devolution. Based on a two-year case study of health and social care devolution in Greater Manchester, England, we trace the relational and territorial geographies of policy across and through new ‘devolved’ city-regional arrangements. Contributing to geographical debates on policy assemblages and the geopolitics of competitive city-regionalism, we advance a conceptual framework linking crisis and opportunity; emulation and exceptionalism; and evidence and experimentation. In doing so, the paper makes two key contributions: First, we argue health and care policy is increasingly drawn towards the logic of global competitiveness, without being wholly defined by neoliberal political agendas. Second, we caution against positioning the city-region solely at the receiving end of devolutionary austerity. Rather, we show how the urgency of devolution was conditioned by crisis, yet concomitantly framed as a unique opportunity by entrepreneurial local state managers. As such, we illustrate how the local state harnessed policy boosterism to negotiate a more fluid politics of scale. The paper demonstrates how efforts to resolve the ‘local problem’ of governing health and care were rearticulated as a ‘global opportunity’ to forge new connections between place, health and economy. Consequently, we foreground the multiple tensions and contradictions accumulating through turning to health and care to push Greater Manchester further, faster. The paper concludes by asking what the present crisis might mean for city-regions in good health and turbulent times
Extracellular volume and global longitudinal strain both associate with outcomes but correlate minimally
No full textObjectives: We examined how extracellular volume (ECV) and global longitudinal strain (GLS) relate to each other and to outcomes.Background: Among myriad changes occurring in diseased myocardium, left ventricular imaging metrics of either: a) the interstitium—such as ECV , or b) contractile function—such as GLS, may consistently associate with adverse outcomes yet correlate minimally with each other, suggesting that ECV and GLS potentially represent distinct domains of cardiac vulnerability. Methods: In 1578 patients referred for cardiovascular magnetic resonance (CMR) without amyloidosis, we quantified how ECV associated with GLS in linear regression models. We then compared ECV and GLS in their associations with incident outcomes (death and hospitalization for heart failure (HHF)). Results: ECV and GLS correlated minimally (R2=0.04). Over a median follow-up of 5.6 years, 339 patients experienced adverse events (149 HHF, 253 deaths, 63 with both). GLS (univariable HR 2.07 per 5% increment, (95%CI 1.86-2.29) and ECV (univariable HR 1.66 per 4% increment, (95%CI 1.51-4.82) were principal variables associating with outcomes in univariable and multivariable Cox regression models. We observed similar results in several clinically important subgroups. In the whole cohort, ECV added prognostic value beyond GLS in univariable and multivariable Cox regression models.Conclusion: GLS and ECV may represent principal but distinct domains of cardiac vulnerability, perhaps reflecting their distinct cellular origins. Whether combining ECV and GLS may advance pathophysiologic understanding for a given patient, optimize risk stratification, and foster personalized medicine by targeted therapeutics requires further investigation. <br/
The double Compton process in astrophysical plasmas
No full textWe study the double Compton (DC) process for a wide range of particle energies, extending previous treatments well beyond the soft photon limit, employing both numerical and analytical methods. This allows us to investigate the physics of the DC process up to the highly relativistic regime relevant to electromagnetic particle cascades in the early Universe and photon-dominated astrophysical plasmas. Generalized exact analytic expressions for the DC emissivity in the soft photon limit are obtained. These are compared to existing approximations, for the first time studying the ultra-relativistic regime. We also numerically integrate the full DC collision term calculating the DC emissivity at general particle energies. A careful treatment of DC infrared divergences inside astrophysical plasmas, including subtle effects related to the presence of stimulated DC emission, is discussed. The obtained results can be efficiently represented using the code DC pack, which also allows one to compute average emissivities for general incoming electron and photon distributions. This puts the modelling of the DC process inside astrophysical plasmas on a solid footing and should find applications in particular for computations of the cosmological thermalization problem in the early Universe
UK-wide surveillance of neurological and neuropsychiatric complications of COVID-19: The first 153 patients
No full textBackgroundIncreasingly, concerns regarding potential neurological complications of COVID-19 are being reported, mostly in small series. Larger studies have been limited by both geography and specialty. Consequently, the breadth of complications is not represented. Comprehensive characterisation of clinical syndromes is critical to rationally select and evaluate potential therapies.MethodsDuring the exponential pandemic phase, we developed coordinated online portals for rapid notification across the spectrum of major UK neuroscience bodies, representing neurology, stroke, psychiatry, and intensive care. Evidence of infection and clinical case definitions were applied prospectively. Cases were compared to overall Government Public Health COVID-19 reporting.FindingsThe notification portals were live from 2nd April for ABN, 3rd April for BASP and 21st April for RCPsych, and data lock for this report was the 26th April 2020. During this period, 153 cases were notified, from across the UK and with an exponential growth in reported cases which correlated with the same period of exponential growth as overall COVID-19 Public Health report data. Median (range) age was 71 (23-94) years. Complete clinical data for Clinical Case Definitions were available for 125 patients. Of whom 77/125 (62%) had a cerebrovascular event, of whom 57/77 (74%) had ischemic strokes, nine (12%) intracerebral haemorrhages, and one clinical diagnosis of CNS vasculitis. The second most common group were 39/125 (31%) who had altered mental status, including nine/39 (23%) with encephalopathy and seven (18%) with encephalitis. The remaining 23/39 (59%) had a psychiatric diagnosis of whom 21/23 (92%) were new diagnoses. Of these psychiatric diagnoses, ten/23 (43%) were psychosis, six (26%) neurocognitive (dementialike) syndrome, and four (17%) an affective disorder. Of cases with altered mental status, 18 (49%) were under 60 and 19 (51%) were over 60; whereas 13 (18%) cases of cerebrovascular events were under 60 relative to 61 (82%) cases in those over 60 years old (p=0.001).InterpretationThis is the first nationwide, cross-specialty surveillance study of acute complications of COVID-19 in the nervous system. Alteration in mental status was common, reflecting encephalopathy/encephalitis and primary psychiatric diagnoses, often in young patients. These data provide valuable and timely information urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy throughout the areas of neurology and neuropsychiatr
An overview of treating people with co-morbid dementia: implications for cancer care
No full textWith increasing prevalence of both cancer and dementia in the United Kingdom, due to an ageing population, oncology healthcare professionals will experience higher numbers of people with both conditions. As dementia is highly heterogeneous and symptoms vary from individual to individual; it presents specific challenges for healthcare professionals, people with dementia and caregivers alike. This overview will describe current theories that explain the association between cancer and dementia, report prevalence rates and highlight the evidence on the impact of having a diagnosis of dementia on outcomes along the cancer pathway from cancer symptom detection to cancer treatment outcomes. It suggests that although prevalence rates of cancer and dementia are typically lower than other co-morbidities, people with cancer and dementia have poorer cancer-related outcomes. This includes later stage cancer diagnoses, fewer cancer treatment options and an increased risk of death compared to people with cancer alone or other co-morbid conditions. Considerations for cancer treatment decision making and management are proposed to improve patient experience for this patient group
Fully-Distributed Deloading Operation of DFIG-based Wind Farm for Load Sharing
No full textA system-level consensus-based deloading operation is proposed for DFIG-based wind farm (WF) participating in system active power regulation. Rotor overspeeding control (ROC) and pitch angle control (PAC) are coordinated for load sharing among each wind turbine (WT). For ROC, a novel fully-distributed consensus protocol is developed for fair load sharing control without the need to know the total active power capacity. Considering the influences of wind turbines’ individual differences and rotor speed limit, the amount of WTs involved in consensus protocol are dynamically adjusted according to their varying operating points. Further, a distributed optimization strategy is designed for active power setting-points allocation to curtail the utilization of WF’s pitch angle during PAC. As the result, the proposed strategy can fully and quickly extract the available rotor overspeeding margin for a high kinetic energy storage and a better dynamic performance in ROC stage, and further minimize the dependency on pitch angle when facing deeper deloading operation. Case studies demonstrate the effectiveness of the proposed scheme
COVID-19: a Catalyst for Change for UK Clinical Oncology
No full textThe United Kingdom (UK) has been severely affected by the Coronavirus Disease 2019 (COVID-19) pandemic. As the National Health Service (NHS) has urgently prioritised management of this outbreak, the UK clinical oncology community has had to adapt rapidly to maintain cancer services and training. These unprecedented times have altered countless aspects of cancer care, education and research, providing a legacy that will extend well beyond the pandemic which catalysed them. This editorial focuses on three key themes which distinguish the UK from many other countries
The COVID-19 pandemic and Dentistry: The Clinical, Legal and Economic consequences.:Part I: Clinical.
No full textSevere acute respiratory syndrome coronavirus 2, the virus which causes COVID-19, is highly contagious. Dentistry is a high-risk profession for occupational virus transmission because of the close proximity of the operator to the patient during treatment and the procedural generation of aerosols. The impact on the provision of dental care has been profound with routine care restricted or paused for a period around the world. There have been adverse consequences for dental education and clinical research. Emergency and urgent care provisions have generally proceeded. However, even when a patients’ condition is deemed urgent, access to the appropriate care may not have been possible due to lack of the recommended personal protective equipment. The common dental diseases of caries and periodontitis usually present with signs and symptoms after some advancement, hence the recommended regular dental examination so that these may be diagnosed early by a professional with suitable lighting, instruments and radiography. Conditions such as oral cancer similarly presents in its early stages without symptoms. Many countries introduced telephone and video consultations for patients with symptoms but much disease has gone undiagnosed and without management. It is difficult to ascertain the full effect of the disruption to dental services, education and research but it is likely to be substantial. The immediate future will focus on return to routine care provision with likely longer-term permanent changes.<br/
Implementing disruptive technological change in UK healthcare: Exploring development of a smart phone app for remote patient monitoring as a boundary object using qualitative methods
No full textPurpose: Developing technological innovations in healthcare is made complex and difficult due to effects upon the practices of professional, managerial and other stakeholders. Drawing upon the concept of boundary object, this paper explores the challenges of achieving effective collaboration in the development and use of a novel healthcare innovation in the English healthcare system. Design/methodology/approach: A case study is presented of the development and implementation of a smart phone application (app) for use by rheumatoid arthritis patients. Over a two-year period (2015–2017), qualitative data from recorded clinical consultations (n = 17), semi-structured interviews (n = 63) and two focus groups (n = 13) were obtained from participants involved in the app's development and use (clinicians, patients, researchers, practitioners, IT specialists and managers). Findings: The case focuses on the use of the app and its outputs as a system of inter-connected boundary objects. The analysis highlights the challenges overcome in the innovation's development and how knowledge sharing between patients and clinicians was enhanced, altering the nature of the clinical consultation. It also shows how conditions surrounding the innovation both enabled its development and inhibited its wider scale-up. Originality/value: By recognizing that technological artefacts can simultaneously enable and inhibit collaboration, this paper highlights the need to overcome tensions between the transformative capability of such healthcare innovations and the inhibiting effects simultaneously created on change at a wider system level.</p
Neuroimaging Manifestations in Children with SARS-CoV-2: A Multi-National Multi-Center Collaborative Study
No full textBackgroundThe manifestations of central nervous system (CNS) COVID-19 infection in children are primarily described in case reports that limit the ability to appreciate the full spectrum of disease in pediatric patients. The purpose of this study was to identify enough cases that could be evaluated in aggregate, in order to better understand the neuroimaging manifestations of COVID-19 in the pediatric population. MethodsAn international call for cases of children with encephalopathy related to SARS-CoV-2 infection and abnormal neuroimaging yielded 80 children with CNS abnormality on imaging. Clinical history and associated plasma/cerebrospinal fluid data was requested (Table 2, Webappendix page 1). This data was reviewed by a central neuroradiology panel, a child neurologist and a paediatric infectious diseases expert. The children were categorised on the basis of their time of likely exposure to SARS-CoV-2. In addition cases were excluded when a direct link to SARS-CoV-2 infection could not be established or an established alternate diagnostic cause could be hypothesized. The accepted referral centre imaging data, from ten countries, was remotely reviewed by a central panel of five paediatric neuroradiologists and a consensus opinion obtained on the imaging findings.FindingsIn total 38 children with neurological disease related to SARS-CoV-2 infection were identified. The cases represented contributions (number in parentheses) from France (13), United Kingdom (8), United States of America (5), Brazil (4), Argentina (4), India (2), Peru (1) and Saudi Arabia (1). Recurring patterns of disease were identified with neuroimaging abnormalities ranging from mild to severe. The most common imaging patterns encountered were post-infectious immune-mediated ADEM-like changes, myelitis or neural enhancement. We found that cranial nerve enhancement may occur in the absence of corresponding neurological symptoms. Splenial lesions and myositis were predominantly observed in patients with MIS-C. Unlike adults, cerebrovascular complications in children were less common. Significant pre-existing conditions were absent and the majority of children had a favorable outcome. However, this study also revealed development of fatal atypical CNS co-infections in 4 previously healthy children infected by SARS-CoV-2. InterpretationAcute and delayed-phase SARS-CoV-2-related CNS abnormalities are seen in children. Recurring patterns of disease and atypical neuroimaging manifestations can be found and should be recognized for SARS-CoV-2 infection as a potential underlying etiological factor. <br/