The aim of this study was to describe the experience of 452 children and adults with a severe developmental disability who presented to a multidisciplinary clinic with swallowing, nutritional, and gastrointestinal problems. Data were obtained by chart review. Two hundred and ninety-four children (age range 7mo-19y, 173 males, 121 females) and 158 adults (age range 18-53y; 90 males, 68 females) were assessed over 5 years. One hundred and eighty-two children and 86 adults had cerebral palsy. Approximately 90% were wheelchair dependent and totally dependent on caregivers for feeding; 60% had epilepsy. Pulmonary aspiration was identified by oesophageal videofluoroscopy in 41% of 174 children and 47% of 34 adults. Chronic oesophagitis and Helicobacter pylori were found in 57% of 182 children and 76% of 66 adults undergoing endoscopy. Chronic suppurative lung disease was identified by computerized axial tomography in 94% of 62 children and all six adults studied. Most patients improved with simple interventions.

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Ten years after the Marine and Coastal Access Act 2009 that introduced marine planning to UK, this article investigates the progress and effectiveness of marine plans. It identifies that initial plans are still being produced in parts of the UK. Scotland has led the way with a National Marine Plan that has already been reviewed. England’s approach has been to produce a sequence of regional plans with two adopted. Wales adopted its National Marine Plan in November 2019 and Northern Ireland’s national marine plans are under preparation. The article examines the effectiveness of the plans through a framework informed by implementation theory assuming that plan-making indicates a ‘top-down’ approach to policy. The plans and their policies are assessed to draw reflections on the soundness of the documents. Marine licensing decisions are considered to assess the extent to which they reflect adopted policies. Limited evidence of the explicit influence of policies in those decisions was established. The findings were supplemented by interviews with key actors including applicants. This revealed a culture of conciliation and cooperation among decision-makers. Analysis and reflection led to positive and challenging conclusions for the future development of marine plan-making in the UK and elsewhere.

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Renewable energy and sustainable food production are high on the international agenda, as is the prospect of increasing activity northwards to Arctic waters. In this article, we review core elements of the marine governance systems for aquaculture facilities and offshore wind farms in Norway and Scotland. Management of these sectors through strategic planning, marine spatial planning and licensing systems furthers rule of law values such as stability and predictability, making investment less risky. The review illustrates how the governance systems also facilitates flexibility and adaptability, balancing predictability considerations against the need to adapt management to natural and economic changes and innovative technologies, or even effective multi-use. This article discusses how endeavours have been made to strike a balance between predictability and adaptability in these sectors in Norway and Scotland. The study of marine management regimes in the Arctic and northern parts of the Temperate Northern Atlantic, and the values underpinning these regimes, thus provides lessons for the future of the Arctic.