ALBERT

Description: Sustainability related challenges in mobility planning have been recognised at the international level, and the urgency for change has been widely discussed among scholars. However, there seems to be no general agreement on the best ways to pursue such change. To seek answers to the question of how to pursue change, this study analysed the development of the broad research fields of mobility, urban planning and transitions, and the overlap of these bodies of literature. Both academic and non-academic literatures were covered. By means of a systematic literature review, as well as bibliometric studies, several prominent research themes that address change from planning and transition perspectives were identified. Moreover, these themes describe different viewpoints and challenges in mobility planning. These include planning and policy for sustainable mobility and accessibility, backcasting and scenario planning, indicators in planning, modes of transport, decision-making, studies of global North and global South, as well as overarching themes of equity, equality and justice, roles of institutions, and co-production of knowledge. Strategies for staying up to date with these fields were also identified. In the literature covered, the temporal dimension in mobility planning was described in four different ways, but little was found about how accelerated transitions towards sustainable mobility can be achieved. Further knowledge gaps were identified in relation to behavioural change, policy development, institutionalisation of planning capacity, and social sustainability in mobility planning. This created an outline for possible future studies.

Description: Sustainability, Vol. 10, Pages 2542: Local Authority Responses to Climate Change in South Africa: The Challenges of Transboundary Governance Sustainability doi: 10.3390/su10072542 Authors: Hayley Leck David Simon Recent progress and innovation are testament to the willingness of municipal authorities to address climate change. However, urban regions worldwide exhibit an immense diversity of conditions, capabilities and responses to the challenges of changing climatic conditions. While separated by politico-administrative borders, adjacent municipalities within such regions are connected through biophysical, politico-economic, and social systems likely to be reconfigured under changing climatic/environmental conditions. Yet, to date, politico-administrative borders have largely determined the parameters of local government climate change adaptation strategies, with insufficient attention to the role of inter-municipal collaboration, especially between neighbouring rural, peri-urban and urban municipalities, for co-ordinating such policies and interventions. Within a multi-level governance framework, this paper considers the recent evolution of climate agendas in the eThekwini (formerly Durban City Council) metropolitan municipality and the adjacent Ugu (predominantly rural) district municipality on the south coast of KwaZulu-Natal province (KZN), South Africa, focusing particularly on cross-border collaboration within the greater city region. The challenges were investigated by means of 53 in-depth, semi-structured interviews with municipal, regional and local authority association staff in November 2009, March 2012, and August 2017. Our core argument is that weak inter-municipal collaboration, particularly between urban, peri-urban and rural areas within metropolitan and functional city regions, has been a significant impediment to realizing transformative adaptation within such regions. The experiences of these two contiguous yet contrasting municipalities represent a microcosm of the dramatic discontinuities and inequalities on all variables within adjacent urban metropolitan and rural contexts in South Africa and beyond. Despite promising recent signs, the challenges of inter-municipal collaborative action are therefore formidable.

Description: Scientists must have a say in the future of cities Nature 538, 7624 (2016). doi:10.1038/538165a Authors: Timon McPhearson, Susan Parnell, David Simon, Owen Gaffney, Thomas Elmqvist, Xuemei Bai, Debra Roberts & Aromar Revi A United Nations conference seeks urban sustainability. But the agenda will fail without input from researchers, warn Timon McPhearson and colleagues.

Description: Urban transformative potential in a changing climate Urban transformative potential in a changing climate, Published online: 30 August 2018; doi:10.1038/s41558-018-0264-0 The SDGs and CitiesIPCC offer an unprecedented opportunity for urban transformation, but bold, integrated action to address the constraints imposed by economic, cultural and political dynamics is needed. We move beyond a narrow, technocentric view and identify five key knowledge pathways to catalyse urban transformation.

Description: Background Though the majority of patients (pts) with newly diagnosed diffuse large B-cell lymphoma (DLBCL) are curable with R-CHOP chemotherapy, a significant proportion will relapse or have refractory disease. The most commonly used clinical tool is the international prognostic index (IPI), though this cannot fully capture the heterogeneity of cases seen in practice. In recent years biomarkers such as MYC are entering clinical use. Pts with lymphomas demonstrating dual abnormalities of MYC in association with BCL2 and/or BCL6-known as 'double-hit' lymphomas are consistently shown to have poorer disease free and overall survival. While Fluorescence in-situ hybridization (FISH) for MYC translocation is the gold-standard, immunohistochemistry (IHC) is faster and significantly cheaper. Studies in recent years have confirmed the prognostic significance of increased MYC expression by IHC. Due to significant inter-laboratory variability however, internal validation is required. Methods Tissue samples of pts treated at Royal North Shore Hospital in Sydney, Australia between 2003-2012 were retrospectively assessed. Pts were included if they were transplant eligible (age 70%. This was seen in 23% of samples. From the 13 cases with MYC FISH results, the positive and negative predictive values of positive MYC IHC were 50% and 92% respectively. There was no significant difference between the MYC positive and negative groups with respect to demographics or IPI score (Table 1). Significantly more patients with MYC positivity received intensive treatment (37% versus 16%, p=0.047). Despite this, 5 year OS was significantly poorer at 51% versus 87% at median follow-up of 40 months (P=0.0025, Figure 3). There was a trend towards worse EFS at 61% versus 75% though this did not reach statistical significance (P=0.242). On multivariate analysis, MYC IHC and IPI score were the only independent prognostic factors. Based on the relative odds ratio, a combined scoring system was designed, attributing 1 point for positive MYC IHC and/ or IPI intermediate-high risk, and 2 points for IPI high risk. This resulted in 4 risk groups with significantly different 5 year OS of 94%, 78%, 45% and 0% (P

Description: Introduction In recent decades, overall survival rates for children with acute lymphoblastic leukemia (ALL) have improved dramatically. Unfortunately, older patients have not experienced the same benefit. Recent years have seen investigation into the use of pediatric protocols for younger adults with ALL. Increased toxicity has often limited use to patients 40 years or younger. The Leukemia/Bone Marrow Transplant Program of BC is the referral center for adults with ALL in British Columbia. Approximately 20 patients are newly diagnosed with ALL each year. Until 2008, an adult protocol (known as ALL 89-1) was used in patients over 18 years. Since 2008, pediatric-based chemotherapy has been offered to patients 40 years or younger. We analyzed whether this change altered complete remission (CR), relapse and survival rates. We assessed whether the more intense protocol increased toxicity. Methods A retrospective analysis was performed on patients treated for ALL on a pediatric-based protocol. These protocols (ALL 08-01 and ALL 13-01) were modifications of the Donna Farber Cancer Institute 01-175 protocol. The format included induction with high dose methotrexate, followed by central nervous system (CNS) therapy including cranial irradiation. A single cycle of etoposide and high-dose cytarabine was given. Consolidation and continuation cycles included doxorubicin, asparaginase, vincristine and dexamethasone. Patients were included if they were aged 18-40 years and had standard risk, Philadelphia chromosome negative ALL. Between February 2008 and November 2014, 25 eligible patients were identified. These were compared with the 23 consecutive standard risk patients most recently treated with ALL 89-1. They had been diagnosed between February 2003 and July 2008. Exclusion criteria were age greater than 40 and non-standard risk ALL. Demographic and clinical data were collected on all patients from the Leukemia Program databases. Overall survival (OS) was calculated from time of diagnosis until death. Event free survival (EFS) was calculated from diagnosis until death, induction failure or relapse. Estimation of OS and EFS was performed using the Kaplan-Meier method. Patient characteristics were compared using Chi-squared test or Fisher's exact test. Ethics approval was obtained from the University of British Columbia ethics board. Results The median age of the combined patient group was 24.5 years. There were no statistically significant differences pre-treatment between groups. Combined median follow up was 28.7 months All 25 patients receiving a pediatric protocol achieved a CR, compared to 19 of 22 with the adult protocol. Despite the more intense chemotherapy dosing regimen in the pediatric protocol, there was no increase in hospitalizations, invasive fungal infections or deaths from treatment toxicity (Table 1). There was a trend towards increased thrombotic events in the pediatric-treated group, at 32% versus 9%. These included deep vein thrombosis in 4 patients, pulmonary emboli in 2, and cerebral sinus thrombosis in 2. Relapse occurred in 24% of the pediatric-treated patients and 45% of the adult-treated ones (p=0.215). Allogeneic stem cell transplantation was performed in 4 patients in the former group and 7 in the latter. Nine of these were carried out in CR2 or later, with two patients going into transplant with active disease. Overall survival following transplant was 44%. Two year event free survival was significantly improved in the group treated on the pediatric protocol (Figure 1), at 79% versus 36% (p=0.011). There was a trend towards improved overall survival in this small cohort, at 83% versus 49% (Figure 2). Conclusions A pediatric-based ALL treatment protocol was tolerated in patients up to the age of 40 years. In our centre, this is associated with an increase in EFS, and a trend towards increased OS, even considering the small cohort. We await with interest the results of larger studies investigating the ideal upfront therapy for young patients with ALL. Table 1. Results All Patients N=47 Adult N=22 Pediatric N=25 P Number % Number % Number % CR after induction 44 of 47 94 19 of 22 86 25 of 25 100 .095 Severe infection 20 of 47 43 9 of 22 41 11 of 25 44 .831 Thrombosis 10 of 47 21 2 of 22 9 8 of 25 32 .079 Pancreatitis 2 of 47 4 0 of 22 0 2 of 25 8 .491 Toxicity deaths 3 of 47 6 2 of 22 9 1 of 25 4 .593 Relapse 16 of 47 34 10 of 22 45 6 of 25 24 .215 AlloHSCT 11 of 47 23 7 of 22 32 4 of 25 16 .303 Disclosures No relevant conflicts of interest to declare.

Description: Background PET-CT has become an essential tool in the management of Lymphoma. PET-CT is utilized in both the initial staging of lymphoma as well as assessing treatment-response. High grade transformation of a low grade lymphoproliferative disorder (LPD) is associated with a poor prognosis. Patients (pts) are usually treated with standard of care for Diffuse Large B-Cell Lymphoma (DLBCL) with R-CHOP but generally have poorer outcomes and can experience relapse of either low or high grade disease. To our knowledge, PET-CT has not been evaluated as a prognostic tool for the subgroup of transformed DLBCL. Methods A retrospective audit was performed of patients treated at Royal North Shore Hospital in Sydney, Australia between 2003-2012. Pts were included if they were treated with Rituximab for DLBCL during the study period and if this occurred on a background of low-grade LPD. Clinical data including LPD type, initial staging, treatment and outcomes were also collected. Treatments were stratified into standard R-CHOP-like versus more intensive regimens including Hyper-CVAD and dose-adjusted R-EPOCH. PET-CT reports were reviewed at staging, interim and post-therapy time points and outcomes stratified to complete metabolic response (CR), partial metabolic response (PR) and progressive disease (PD),based on the nuclear medicine physician's report. Results 64 pts were identified in the study period with median follow up 4.4 yrs (range, 50d-11yrs)Male:female ratio was 1:1. Median age was 65 yrs (range 30-89). LPD diagnosis included Follicular Lymphoma (FL) (75%), Chronic Lymphocytic Leukemia (CLL) (6%) and others (19%) that included Mucosa Associated Lymphoid Tissue and Marginal Zone Lymphomas. 39 pts (61%) had PET-CT reports available for review. 45 pts (70%) were treated with R-CHOP with the remainder having more intensive regimes. 26% of pts received consolidation radiotherapy. 13 pts (20%) underwent autologous and 6 (9%) proceeded to an had an allogeneic transplant. 3 yr OS and EFS was 89% and 73% respectively. Univariate analysis demonstrated both interim and post therapy PET-CT to be significant for both OS and EFS (p