From the Land to Sea and Back Again? Using Terrestrial Planning to Understand the Process of Marine Spatial Planning

Over the last 5–10 years, marine spatial planning (MSP) has emerged as a new management regime for national and international waters and has already attracted a substantial body of multi-disciplinary research on its goals and policy processes. This paper argues that this literature has generally lacked deeper reflexive engagement with the emerging system of governance for our seas that has meant that many of MSP’s core concepts, assumptions and institutional arrangements have not been subject rigorous intellectual debate. In an attempt to initiate such an approach, this article explores the relationship between MSP and its land-based cousin, terrestrial spatial planning (TSP). While it is recognized that there are inherent limitations to a comparison of these two systems, it is argued that the tradition of social science debate over the purpose and processes of TSP can be used as a useful stimulus for a more rigorous reflection of such issues as they relate to MSP. The article therefore explores some of the parallels between MSP and TSP and then discusses some of the key intellectual traditions that have shaped TSP and the implications these may have for future marine planning practice. The article concludes with a number of potentially useful new avenues that may form the basis of a critical research agenda for MSP.

The impact of peer review on the radiotherapy treatment planning process in the treatment of lung cancer

Background:
Advanced radiotherapy techniques permit accurate delivery of radiotherapy to lung tumours. Improved accuracy increases the possibility of radiotherapy field geographic miss of the tumour. One source of error is the accuracy of target volume (TV) delineation by the clinical oncologist. Colleague peer review of all curative intent lung cancer plans has been mandatory in our institution since May 2013. At least 2 clinical oncologists review plans checking treatment paradigm, TV delineated, dose to tumour and dose to critical organs. We report the impact of peer review on the radiotherapy planning process for lung cancer.

Methods:
The radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly peer review meetings after their TVs volumes were provisionally signed off by the treating consultant or post-fellowship registrar. All cases and any resultant change to the treatment plan were recorded in our prospective peer review database. We present the summary of changes agreed following the peer review process for a 6 month period.

Results:
Fifteen peer review sessions, including 46 patients (36 NSCLC, 10 SCLC) were analysed. An average of 3 cases were discussed per meeting (range 1 5). 24% of treatment courses were changed. In 4% there was a complete change in paradigm
of treatment (1 patient proceeded to induction chemotherapy, 1 patient had high dose palliative radiotherapy). In 16% there was a change in TV delineated and in 9% a change in dose (2 dose reductions and 2 alterations to post-operative dose fractionations).

Conclusions:
Consultant led peer review resulted in a change in a component of the treatment plan for 28% of patients that would not otherwise have taken place. Given this impact, consultant led peer review should be considered as an essential component in the radiotherapy planning process for all patients treated with curative radiotherapy.

Consideration of coastal risk in the Irish spatial planning process

The vulnerability of coastal areas to associated hazards is increasing due to population growth, development pressure and climate change. It is incumbent on coastal governance regimes to address the vulnerability of coastal inhabitants to these hazards. This is especially so at the local level where development planning and control has a direct impact on the vulnerability of coastal communities. To reduce the vulnerability of coastal populations, risk mitigation and adaptation strategies need to be built into local spatial planning processes. Local government, however, operates within a complex hierarchal governance framework which may promote or limit particular actions. It is important, therefore, to understand how local coastal planning practices are shaped by national and supranational entities. Local governments also have to respond to the demands of local populations. Consequently, it is important to understand local populations’ perceptions of coastal risk and its management. Adopting an in-depth study of coastal planning in County Mayo, Ireland, this paper evaluates: (a) how European and national policies and legislation shape coastal risk management at local level; (b) the incorporation of risk management strategies into local plans; and (c) local perception of coastal risks and risk management. Despite a strong steer from supranational and national legislation and policy, statutory local plans are found to be lacking in appropriate risk mitigation or adaptation strategies. Local residents appear to be lulled into a sense of complacency towards these risks because of the low level of attention afforded to them by the local planning authorities. To avoid potentially disastrous consequences for local residents and businesses, it is imperative that this situation is redressed urgently. Based on our analysis, we recommend: the development and implementation of a national ICZM strategy, supported by detailed local ICZM plans; and obliging local government to address known risks in their plans rather than defer them to project level decision making.

The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer

AIMS: Modern radiotherapy uses techniques to reliably identify tumour and reduce target volume margins. However, this can potentially lead to an increased risk of geographic miss. One source of error is the accuracy of target volume delineation (TVD). Colleague peer review (CPR) of all curative-intent lung cancer plans has been mandatory in our institution since May 2013. At least two clinical oncologists review plans, checking treatment paradigm, TVD, prescription dose tumour and critical organ tolerances. We report the impact of CPR in our institution.

MATERIALS AND METHODS: Radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly CPR meetings after their target volumes were reviewed and signed off by the treating consultant. All cases and any resultant change to TVD (including organs at risk) or treatment intent were recorded in our prospective CPR database. The impact of CPR over a 13 month period from May 2013 to June 2014 is reported.

RESULTS: One hundred and twenty-two patients (63% non-small cell lung carcinoma, 17% small cell lung carcinoma and 20% 'clinical diagnosis') were analysed. On average, 3.2 cases were discussed per meeting (range 1-8). CPR resulted in a change in treatment paradigm in 3% (one patient proceeded to induction chemotherapy, two patients had high-dose palliative radiotherapy). Twenty-one (17%) had a change in TVD and one (1%) patient had a change in dose prescription. In total, 6% of patients had plan adjustment after review of dose volume histogram.

CONCLUSION: The introduction of CPR in our centre has resulted in a change in a component of the treatment plan for 27% of patients receiving curative-intent lung radiotherapy. We recommend CPR as a mandatory quality assurance step in the planning process of all radical lung plans.

Review of the area planning process (a)

The area planning process continues and formal recommendations arising from it are now being brought forward as development proposals to amalgamate or close schools. At this point in the process the Education Committee requested some comment on five different aspects of the process: the impact of Area Planning to date; the validity of the surplus school vacancy calculation methodology; the Annual Area Profile information; the Needs Model (including as appropriate the implications of the Drumragh judgement); possible enhancements to the consultation and communication process;the facilitation of alternative cross-sectoral or cross-border solutions. This paper offers high level comment on each of these issues. In addition, the Education Committee facilitated a stakeholder consultation meeting in Parliament Buildings on 4 February, 2015. The broad themes that emerged in that discussion will also be mentioned in this paper.

Review of the area planning process (b)

This paper offers a commentary on the area planning reports form primary schools published by each of the Education and Library Boards (ELB) in June 2014. The format of the reports are broadly similar for each ELB, although there are some differences amongst them. All provide an overview on the policy context for the area planning process, a statistical picture of the schools in the ELB and detail on the issues considered for sets of schools within the ELB.

Policing and planning child and adolescent neuropsychiatry : the reform process in Bologna 2009-2014

Desde a aprovação do plano de saúde mental regional em Itália ... o Departamento Local de Saúde Mental e Perturbações aditivas em Bolonha, tem desenvolvido um projeto de reforma cujo objectivo é inovar o sistema de saúde mental local. ...ABSTRACT: Since the Regional mental health plan 2009-2011 was approved in Italy the Department of Mental Health and addictions of the Bologna local health trust developed as a laboratory aimed at innovating the mental health systen locally. ...

Sustainable urban planning: parameters to the operational process

In modern society, energy consumption and respect for the environment have become essential aspects of urban planning. The rising demand for alternative sources of energy, coupled with the decline in the construction sector and material usage, gives the idea that the thinking on modern cities, where attention is given to reduced energy consumption, savings, waste recycling and respect for the surrounding environment, is being put into practice. If we examine development of the city over recent centuries, by means of the theories of the most famous and influential urban planners, it is possible to identify the major problems caused by this type of planning. For this reason, in recent urban planning the use of systems of indicators that evaluate and certify land environmentally and energetically guides the master plan toward a more efficient city model. In addition the indicators are targeted on key factors determined by the commissioner or the opportunities the territory itself provides. Due the complexity of the environmental mechanics, the process of design and urban planning has become a challenging issue. The introduction of the indicators system has made it possible to register the life of the process, with a spiral route that allows the design itself to be refined. The aim of this study, built around the creation of a system of urban sustainability indicators that will evaluate highly eco-friendly cities, is to develop a certification system for cities or portions of them. The system will be upgradeable and objective, will employ real data and will be concerned with energy production and consumption.

Decision making and planning of children in the reproductive process of males

Reproduction is not restricted to the biological; it is also a complex and dynamic social process. The objective of this paper is to analyze the decision and planning of children as part of the reproductive process in men. Methodologically, a qualitative research was made. The analysis includes in-depth interviews with 30 parents between 20 and 45 years, of medium socio-economic level in México. The results show that the reproductive process incorporates family formation negotiated with their couple the marriage until they had economic potential. In some cases, their decision hastened because the couple was pregnant. The planning was not contemplated but when getting the news, they accept it and get involved in the process, while others see it as a conflict.

EnvironalPlanning: an analytical network process model for environmentally conscious construction planning

Although the construction pollution index has been put forward and proved to be an efficient approach to reducing or mitigating pollution level during the construction planning stage, the problem of how to select the best construction plan based on distinguishing the degree of its potential adverse environmental impacts is still a research task. This paper first reviews environmental issues and their characteristics in construction, which are critical factors in evaluating potential adverse impacts of a construction plan. These environmental characteristics are then used to structure two decision models for environmental-conscious construction planning by using an analytic network process (ANP), including a complicated model and a simplified model. The two ANP models are combined and called the EnvironalPlanning system, which is applied to evaluate potential adverse environmental impacts of alternative construction plans.

How do critical care nurses define the discharge planning process?

Background: Professional, political and organisational factors have focused attention on the discharge planning process in the Victorian health care sector. Discharge planning for patients, as part of continuity of care, is seen as a key concept in the delivery of nursing care. However, there is no question that discharge planning has emerged as a complex area of practice, and is, perhaps, most complex in the critical care area.

Aim: The study reported here is part of a larger thesis exploring critical care nurses’ perceptions and understanding of the discharge planning process in the health care system in the state of Victoria, Australia. As part of the survey participants were asked to define discharge planning as it related to the critical care environment in which they worked.

Methods: Utilising an exploratory descriptive approach, 502 Victorian critical care nurses were approached to take part in the study. The resultant net total of 218 participants completed the survey, which represented a net response rate of 43.4%. The data were analysed using quantitative and qualitative methodologies.

Findings: Three common themes emerged. A significant number of participants did not believe that discharge planning occurred in critical care, and therefore, thought that they could not provide a definition. There was uncertainty as to what the discharge planning process actually referred to in terms of discharge from critical care to the general ward or discharge from the hospital. There was an emphasis on movement of the patient to the general ward, which was considered in three main ways by first, getting the patient ready for transfer; second, ensuring a smooth transition to the ward and third, transfer of the patient to the ward often occurred because the critical care bed was needed for another patient.

Conclusion: The findings presented here suggest at a nursing level, the discharge planning process is not well understood and some degree of mutual exclusivity still remains. There is a need for further education of critical care nurses with regard to the underlying principles of the discharge planning process.