Improving detection of familial hypercholesterolaemia in primary care using electronic audit and nurse-led clinics

RATIONALE, AIMS AND OBJECTIVES: In the UK fewer than 15% of familial hypercholesterolemia (FH) cases are diagnosed, representing a major gap in coronary heart disease prevention. We wished to support primary care doctors within the Medway Clinical Commissioning Group (CCG) to implement NICE guidance (CG71) and consider the possibility of FH in adults who have raised total cholesterol concentrations, thereby improving the detection of people with FH. METHODS: Utilizing clinical decision support software (Audit+) we developed an FH Audit Tool and implemented a systematic audit of electronic medical records within GP practices, first identifying all patients diagnosed with FH or possible FH and next electronically flagging patients with a recorded total cholesterol of >7.5 mmol L(-1) or LDL-C > 4.9 mmol L(-1) (in adults), for further assessment. After a 2-year period, a nurse-led clinic was introduced to screen more intensely for new FH index cases. We evaluated if these interventions increased the prevalence of FH closer to the expected prevalence from epidemiological studies. RESULTS: The baseline prevalence of FH within Medway CCG was 0.13% (1 in 750 persons). After 2 years, the recorded prevalence of diagnosed FH increased by 0.09% to 0.22% (1 in 450 persons). The nurse advisor programme ran for 9 months (October 2013-July 2014) and during this time, the recorded prevalence of patients diagnosed with FH increased to 0.28% (1 in 357 persons) and the prevalence of patients 'at risk and unscreened' reduced from 0.58% to 0.14%. CONCLUSIONS: Our study shows that two simple interventions increased the detection of FH. This systematic yet simple electronic case-finding programme with nurse-led review allowed the identification of new index cases, more than doubling the recorded prevalence of detected disease to 1 in 357 (0.28%). This study shows that primary care has an important role in identifying patients with this condition

Telling the Story of a Street: Micro-Retail Change in Manchester from the 1960s

This paper investigates locational change in one street - King Street in Manchester, England – in an attempt to analyse broader retail trends and evaluate their implications. Analysis of Goad plans dating from the mid-1960s reveal King Street to be a microcosm of locational trends in retailing, such as the increasing prevalence of the multiple retailer in urban centres. Also highlighted is the micro-spatial impact of store (re-)location decisions within a city centre by retailers. A focus on such issues at the level of the individual street highlights the complex specificity and nuanced nature of such trends

What's in a name? Place branding and toponymic commodification

If places are increasingly regarded as brands in both the practice of place marketing and its associated theory, then the study of place names (toponymy) arguably overlaps with theories and concepts involving brand naming within the marketing literature. This paper synthesises the diverse literature streams surrounding critical toponymy and brand naming through an exploration of place branding activities. The paper develops the concept of place name commodification, beyond the limited attention it has received within existing critical toponymy research, before examining the issues of endogenous and exogenous contestation that surround it. The paper concludes by discussing how the commodifying effects of places as brand names, with their associated brand values and imagery, can potentially suppress the alternative place perceptions of users, and in doing so stifle the natural potential for cocreation of the place ‘product’ and its related value

Back to basics in the marketing of place: the impact of litter upon place attitudes

YesAttempts to apply marketing theory and principles to place have become a legitimate area of academic and 'real world' practice. However, place marketing does not typically incorporate all elements of the traditional 7 Ps, focusing far too often on just one of these - promotion. Besides this rather myopic approach, place marketing suffers from an overly strategic view of the world that ignores the meaning and lived experience of places to individuals, especially residents. The purpose of this article is twofold - first, we investigate the impact of litter on place attitudes. Litter is a common, but negative, element of place, which is intimately connected to the lived experience of a place but typically far removed from the positive promotional activity favoured by place marketing efforts and the study thereof. In this sense, the article reframes place marketing from a strategic to a micro-marketing endeavour. We found that exposing respondents to litter significantly lowers their place attitudes. Our second contribution is to demonstrate the relevance of classic marketing research approaches, such as attitudinal measures, to investigate litter and its impact on place evaluations, through quasi-experimental design (with 662 respondents). Through this, we extend the range of theory and method applied in place marketing - away from controllable promotional endeavours investigated through case-studies to a more holistic and robust interpretation of place marketing, which has a measurable impact upon the places where people live and visit

Maps, Memories and Manchester: The Cartographic Imagination of the Hidden Networks of the Hydraulic City

The largely unseen channelling, culverting and controlling of water into, through and out of cities is the focus of our cartographic interpretation. This paper draws on empirical material depicting hydraulic infrastructure underlying the growth of Manchester in mapped form. Focusing, in particular, on the 19th century burst of large-scale hydraulic engineering, which supplied vastly increased amounts of clean drinking water, controlled unruly rivers to eliminate flooding, and safely removed sewage, this paper explores the contribution of mapping to the making of a more sanitary city, and towards bold civic minded urban intervention. These extensive infrastructures planned and engineered during Victorian and Edwardian Manchester are now taken-for-granted but remain essential for urban life. The maps, plans and diagrams of hydraulic Manchester fixed particular forms of elite knowledge (around planning foresight, topographical precision, civil engineering and sanitary science) but also facilitated and freed flows of water throughout the city. The survival of these maps and plans in libraries, technical books and obscure reports allows the changing cultural work of water to be explored and evokes a range of socially specific memories of a hidden city. Our aetiology of hydraulic cartographics is conducted using ideas from science and technology studies, semiology, and critical cartography with the goal of revealing how they work as virtual witnesses to an 1 unseen city, dramatizing engineering prowess and envisioning complex and messy materiality into a logical, holistic and fluid network underpinning the urban machine. 1

Scalar tensions in urban toponymic inscription: The corporate (re)naming of football stadia

This article examines issues of scale in urban toponymic inscription. The specific focus of inquiry is toponymic commodification, whereby corporate brand names of international scope are imposed on English football stadia and their locally embedded fan communities. We employ primary data relating to three football clubs in the Greater Manchester conurbation, all of which have sold their stadium naming rights to corporate entities. Drawing on fans’ perspectives, our findings initially surface the scalar tensions arising from such occurrences. We explore how football club authorities attempt to manage these tensions; first through efforts to embed corporate names into the fabric of urban communities, and second by using commemoration to valorize notions of the ‘local’ for their fan base. The article concludes by discussing how our findings deepen understanding of critical toponymies, particularly in terms of theorizing scale and shedding light on the workings of neoliberal agendas for controlling urban space

Is Malaysia’s banded langur, Presbytis femoralis femoralis, actually Presbytis neglectus neglectus? Taxonomic revision with new insights on the radiation history of the Presbytis species group in Southeast Asia

The disjunct distribution of Presbytis femoralis subspecies across Sumatra (P. f. percura), southern (P. f. femoralis) and northern (P. f. robinsoni) Peninsular Malaysia marks the unique vicariance events in the Sunda Shelf. However, the taxonomic positions and evolutionary history of P. f. femoralis are unresolved after decades of research. To elucidate this evolutionary history, we analyzed 501 base pairs of the mitochondrial HVSI gene from 25 individuals representing Malaysia’s banded langur, with the addition of 29 sequences of Asian Presbytis from Genbank. Our results revealed closer affinity of P. f. femoralis to P. m. mitrata and P. m. sumatrana while maintaining the monophyletic state of P. f. femoralis as compared to P. f. robinsoni. Two central theses were inferred from the results; (1) P. f. femoralis does not belong in the same species classification as P. f. robinsoni, and (2) P. f. femoralis is the basal lineage of the Presbytis in Peninsular Malaysia. Proving the first hypothesis through genetic analysis, we reassigned P. f. femoralis of Malaysia to Presbytis neglectus (Schlegel’s banded langur) (Schlegel in Revue Methodique, Museum d’Histoire Naturelle des Pays-Bas 7:1, 1876) following the International Code of Zoological Nomenclature (article 23.3). The ancestors of P. neglectus are hypothesized to have reached southern Peninsular Malaysia during the Pleistocene and survived in refugium along the western coast. Consequently, they radiated upward, forming P. f. robinsoni and P. siamensis resulting in the highly allopatric distribution in Peninsular Malaysia. This study has successfully resolved the taxonomic position of P. neglectus in Peninsular Malaysia while providing an alternative biogeographic theory for the Asian Presbytis