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In UK energy policy, community-led energy initiatives are increasingly being imbued with transformative power to facilitate low carbon transitions. The ways that such expectations for communities are manifesting in practice remains, however, relatively poorly understood. In particular, key conceptual developments in unpacking what constitutes ‘community’ that highlight the significance of ‘place’ along with important characteristics, such as shared visions, collective social action, and resilience, have yet to be comprehensively explored in the context of community-led energy initiatives. This paper uses an interpretive stance to engage with these conceptual ideas about community and provides insights into the nature of community and its meaning for developing energy-related initiatives and realising the wider goals of energy policy. The paper draws on data from in-depth qualitative, longitudinal interviews undertaken in two residential communities and one purely workplace-based community, which are engaged in community energy initiatives. We argue that there are difficulties and ambiguities in creating shared visions, achieving social action, and developing resilience that are related to the specificities of community in place, but that all three characteristics are likely to be important for the making of sustainable places. [ABSTRACT FROM AUTHOR]

The genetic basis of type 2 diabetes (T2D) is poorly understood, with only three common gene variants confirmed. As part of the Wellcome Trust Case Control Consortium we have genotyped 500,568 single-nucleotide polymorphisms (SNPs) in 1954 type 2 diabetic patients and 2922 population controls. In a preliminary analysis, and after stringent quality control (including > 98% genotype success rate, HWE P > 0.01 in cases and controls), we analyzed ∼309,000 SNPs with minor allele frequencies of >5% that cover 62% of common variation in the human genome. Replication analyses were performed on 10 of the top signals using an additional 3073 UK cases and 3879 UK controls. SNPs showing the strongest associations included a cluster in the FTO gene on chromosome 16 (e.g. rs9939609; MAF=0.4; odds ratio (OR)=1.26 [95% CI 1.16-1.37], P = 3 x 10[sup -8]) that reached genome wide significance. This result was replicated (OR = 1.19 [95% CI 1.11 - 1.28], P = 2 x 10[sup -8]) in the additional cases and controls, giving a combined OR = 1.22 [95% CI 1.16-1.29], P = 5 x 10[sup -13]. Linkage disequilibrium around associated SNPs extended 47kb within FTO (r² > 0.2). Known type 2 diabetes risk alleles in the TCF7L2, PPARG and KCNJ11 genes occurred at ranks 1,264 and 790 respectively. The P 12A variant in PPARG and a SNP that tags the E23K variant (r² = 0.9) in KCNJ11, did not reach genome wide levels of significance (OR = 1.26 [95% CI 1.11 - 1.44], P=0.0004) and OR = 1.15 [95% CI 1.05 - 1.24], P = 0.0016) respectively, but effect sizes were consistent with previous large studies and meta-analyses. In conclusion, the first UK genome wide association study has identified FTO, which is widely expressed in early development as a gene contributing to T2D risk. Results in known T2D SNPs show that further large replication studies are needed to confirm potential novel genes. [ABSTRACT FROM AUTHOR]

Doctor Montagu Lomax was a retired General Practioner, whose service in English lunatic asylums during the First World War inspired him to write The experiences of an asylum doctor: with suggestions for asylum and lunacy law reform . Published in 1921, the book acted as a catalyst for lunacy reform and stimulated improvements in the mental health services in the United Kingdom. Lomax spent the remainder of his retirement campaigning for lunacy reform. He suffered financial and personal hardship following the publication of the book and was castigated by his own profession. On the centenary of the publication of Experiences , this article explores the background and motivation of a remarkable man.

Perioperative medicine is an emerging specialty aimed at improving outcomes in the high-risk surgical population. The authors set out to characterize the demographics and determine the motivation of 'early adopters' of this specialty by retrospectively reviewing the application forms of students enrolled on the UCL Perioperative Medicine Masters Programme. A total of 139 applications were reviewed. The median age of applicants was 35 years; 81% were UK based, with the remainder from a worldwide distribution. Seventeen per cent were consultant anaesthetists and 64% anaesthetic trainees, with the remainder including doctors from other specialties (17%) and nurses (2%). Qualitative analysis using grounded theory methodology revealed common motivational themes: the belief that perioperative medicine would lead to better patient care, that it represents the future working practice for anaesthetists, a desire to be able to better lead local developments, and personal fulfilment and benefit. The responses provided insight into the motivation of an international cohort of professionals. Perioperative medicine was perceived as a developing multidisciplinary specialty that will lead to better patient care. Applicants understood the importance of perioperative care extending beyond the operating theatre which may explain the growing demand for training in perioperative medicine.

Purpose of the Study: Statins and ezetimibe reduce low-density lipoprotein cholesterol (LDL-c) and cardiovascular disease (CVD) risk. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors lower LDL-c by 50%-70% and might be useful in refractory patients. The National Institute for Health and Care Excellence (NICE) technology appraisal guidance (TAG) recommends use of these drugs in secondary prevention and familial hypercholesterolaemia (FH) at differing LDL-c thresholds. We have estimated the proportion of patients in whom this third-line drug might be useful., Study Design: We used data from a lipid-lowering audit programme to study 72 with FH and/or CVD of 271 patients referred over 12 months who failed to achieve target total cholesterol (TC) and LDL-c levels. All 72 patients were treated with ezetimibe, and 69 cases also received statins. We used LDL-c thresholds 1.5-5.5 mmol/L to estimate how many of these refractory patients could benefit from PCSK9 inhibitors., Results: In 72 patients, TC and LDL-c targets were not met by 64 and 53 patients, respectively. We judged using the NICE TAG that only one patient (1.4% ezetimibe requiring and 0.4% total referrals) required a PCSK9 inhibitor., Conclusions: We determined that the proportion of patients eligible for a PCSK9 inhibitor at various TC and LDL-c levels is modest. This may reflect the use of all available statins in UK lipid clinics often at non-daily frequency. We suggest that cost-effective use of PCSK9 inhibitors requires prescribing being restricted to clinicians working in specialised lipid clinics., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Improved molecular understanding of the pathogenesis of type 2 diabetes is essential if current therapeutic and preventative options are to be extended. To identify diabetes-susceptibility genes, we have completed a primary (418-marker, 9-cM) autosomal-genome scan of 743 sib pairs (573 pedigrees) with type 2 diabetes who are from the Diabetes UK Warren 2 repository. Nonparametric linkage analysis of the entire data set identified seven regions showing evidence for linkage, with allele-sharing LOD scores > or =1.18 (P< or =.01). The strongest evidence was seen on chromosomes 8p21-22 (near D8S258 [LOD score 2.55]) and 10q23.3 (near D10S1765 [LOD score 1.99]), both coinciding with regions identified in previous scans in European subjects. This was also true of two lesser regions identified, on chromosomes 5q13 (D5S647 [LOD score 1.22] and 5q32 (D5S436 [LOD score 1.22]). Loci on 7p15.3 (LOD score 1.31) and 8q24.2 (LOD score 1.41) are novel. The final region showing evidence for linkage, on chromosome 1q24-25 (near D1S218 [LOD score 1.50]), colocalizes with evidence for linkage to diabetes found in Utah, French, and Pima families and in the GK rat. After dense-map genotyping (mean marker spacing 4.4 cM), evidence for linkage to this region increased to a LOD score of 1.98. Conditional analyses revealed nominally significant interactions between this locus and the regions on chromosomes 10q23.3 (P=.01) and 5q32 (P=.02). These data, derived from one of the largest genome scans undertaken in this condition, confirm that individual susceptibility-gene effects for type 2 diabetes are likely to be modest in size. Taken with genome scans in other populations, they provide both replication of previous evidence indicating the presence of a diabetes-susceptibility locus on chromosome 1q24-25 and support for the existence of additional loci on chromosomes 5, 8, and 10. These data should accelerate positional cloning efforts in these regions of interest.