Urban planning after the Black Death: townscape transformations in later-medieval England (1350-1530)

This article offers a reconsideration of planning and development in
English towns and cities after the Black Death (1348). Conventional historical
accounts have stressed the occurrence of urban ‘decay’ in the later fourteenth and fifteenth centuries. Here, instead, a case is made that after 1350 urban planning continued to influence towns and cities in England through the transformation of their townscapes. Using the conceptual approaches of urban morphologists in particular, the article demonstrates that not only did the foundation of new towns and creation of new suburbs characterize the period 1350–1530, but so too did the redevelopment of existing urban landscapes through civic improvements and public works. These reveal evidence for the particular ‘agents of change’ involved in the planning and development process, such as surveyors, officials, patrons and architects, and also the role played by maps and drawn surveys. In this reappraisal, England’s urban experiences can be seen to have been closely connected with those instances of urban planning after the Black Death occurring elsewhere in contemporary continental Europe.

A New Concept of Interprofessional Education in Planning Programmes: Reflections on Healthy Urban Planning Project

Although widely debated, some of the defining professional characteristics of planners appear to be competencies in co-ordination, mediation and multidisciplinary working. Despite this, there is little pedagogical reflection on how interprofessional skills are promoted in planning programmes. This paper reflects on the experience of bringing together undergraduate students from medicine and planning to explore the concept of Healthy Urban Planning in a real life context of an urban motorway extension. This reveals a number of unexpected outcomes of such collaboration and points to the value of promoting interprofessional education, both as a way of increasing interest in some of the key challenges now facing society and in order to induce greater professional reflection amongst our students.

A New Concept of Interprofessional Education in Planning Programmes: Reflections on a Healthy Urban Planning Project

Although widely debated, some of the defining professional characteristics of planners appear to be competencies in co-ordination, mediation and multidisciplinary working. Despite this, there is little pedagogical reflection on how interprofessional skills are promoted in planning programmes. This paper reflects on the experience of bringing together undergraduate students from medicine and planning to explore the concept of Healthy Urban Planning in a real life context of an urban motorway extension. This reveals a number of unexpected outcomes of such collaboration and points to the value of promoting interprofessional education, both as a way of increasing interest in some of the key challenges now facing society and in order to induce greater professional reflection amongst students.

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.