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After the collapse of Rome Europe was dominated by relatively small powers. Its development, therefore, was different from that of China or some of the powers of the Middle East. Lacking continuous existence and permanent facilities armies depended on native skills which recruits brought with them. The retinues of the powerful, who could train and buy equipment, were at an advantage. In time they became predominantly mounted warriors, the knights. Infantry were never a negligible force, but without training they lacked the coherence to make their mass effective. In the later Middle Ages standing armies in Europe grew out of rising prosperity, the improving structures of a few states and the demands of continuous warfare. By contrast Mamluk Egypt developed a standing army by about 1240, while China always had one. The Mongols, by virtue of their way of life with its ‘native skills’, constituted a permanent army. Although improved metallurgy increased the supply of better weapons and armour, and experience in stonework led to better fortifications, the technology of war changed little. War remained up close and personal, an affair of plundering and, when battle became necessary, close-order formations fighting at close-quarters. Gunpowder, therefore, was a major challenge whose impact on war before the mid 15th century was limited.
A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.
The social cohesion of multiethnic states is today at risk across the globe. African states have been facing that risk since their independence from colonial rule more than half a century ago. As elsewhere in the world, Africa’s histories of division and contest have sown seeds of political, social, and economic instability. However, Africa is not a place; it is a large continent. There are nearly 40 states south of the Sahara. A few are constantly wracked by instability, while the rest of the continent is experiencing considerable economic transformation. Ethnic conflict is not universal in Africa.
This chapter argues that ethnicity is a universal human characteristic; it is an identity whose moral economy of mutual social relations causes internal dispute more continuously than external contexts cause interethnic competition. Ethnicities are mixed, shared, and subject to constant change in their own self-awareness and their inter-relations with others. The last two centuries of Kenya’s history illustrate this point. In the stateless, precolonial, past, different ways of taming the varied regional environment were the greatest influence on the nature of “ecological ethnicities” that shared ideas, took in each others’ economic migrants, and engaged in little “inter-tribal war”. Under colonial rule, access to scriptural literacy and arguments about how best to resist subjection caused much a sharper, patriotic, ethnic self-awareness. Regional inequalities in development, especially the triumph of agriculture over pastoralism, made ethnicity more competitive – a condition greatly emphasised when independence gave some Africans a centralised coercive power over others. Kenya has only recently adopted a devolved constitution that may defuse this often lethal competition but it is as yet too early to say.
This chapter considers whether there is a trade-off between growth and equality, as economists sometimes assert, differentiating between vertical inequality (among individuals) and horizontal inequality (among groups). Most evidence challenges the supposed trade-off, suggesting greater equality increases growth, especially sustained growth. Inequality among individuals tends to limit human resources, while inequality among groups can lead to violent conflict, and both constrain growth. Greater equality also supports other desirable objectives, including better nutrition, less crime, and better health. The impact of growth on equality is analysed. This depends on how far earnings are spread via employment; and the redistributionary effects of tax and government expenditure. Labour-intensive activities tend to improve distribution, while capital-intensive ones, heavy reliance on minerals for exports and rising skill requirements tend to worsen it. For horizontal inequality, the impact of growth varies according to group location, economic specialization and policies, illustrated by the experience of Ghana, Peru, Malaysia and Northern Ireland. The chapter surveys policies likely to improve vertical and horizontal distribution, with examples drawn from many countries. Finally, the chapter considers the political conditions needed to support equalising policies.
This chapter suggests that social, political, institutional and demographic changes already observable in Africa hold out the possibility of national futures in which the manipulation of ethnic difference could cease to be the main route to political power. In the first of four sections it is argued that, although ethnic allegiances are powerful there are other, situational, identities round which human interests may gather. It is shown, secondly, that there is no single model or measure that can reliably relate ethnic diversity to economic development or the nature of governance. Since the early postcolonial years of “nation-building”, third, many civil society organisations have arisen in Africa, to promote not only ethnic interests but also such heterogeneous group identities as the urban poor in mega cities, women (often peacemakers), youth, and HIV/AIDS sufferers. While, finally, these organisations, including Pentecostal churches, may be led by “big men”, they nonetheless diversify and complicate the “big man” politics of ethnic difference that has rarely met such competition until now.
Today, the cohesion of multi-ethnic societies is at risk across the globe. Throughout history, to the present day, African countries have been facing this challenge. Historical inequalities and social division undermine cohesion and sow seeds of instability. How can Africa build a future where ethnic and other differences are a strength, a driver of growth and development, rather than sources of division and instability? Drawing together historians, economists and political scientists, each an authority on Africa, this book delivers a comprehensive study of that question through an exploration of the continent's divided histories, to understand where Africans stand now, and to reflect on how they might now work towards a more trusting society. Numerous case studies, statistical expositions and theoretical reflections bring conceptual clarity to the often poorly understood processes and contexts of social cohesion, not only in Africa, but across the developing and developed world.
The majority of self-management interventions are designed with a narrow focus on patient skills and fail to consider their potential as “catalysts” for improving care delivery. A project was undertaken to develop a patient self-management resource to support evidence-based, person-centered care for cancer pain and overcome barriers at the levels of the patient, provider, and health system.
The project used a mixed-method design with concurrent triangulation, including the following: a national online survey of current practice; two systematic reviews of cancer pain needs and education; a desktop review of online patient pain diaries and other related resources; consultation with stakeholders; and interviews with patients regarding acceptability and usefulness of a draft resource.
Findings suggested that an optimal self-management resource should encourage pain reporting, build patients’ sense of control, and support communication with providers and coordination between services. Each of these characteristics was identified as important in overcoming established barriers to cancer pain care. A pain self-management resource was developed to include: (1) a template for setting specific, measureable, achievable, relevant and time-bound goals of care, as well as identifying potential obstacles and ways to overcome these; and (2) a pain management plan detailing exacerbating and alleviating factors, current strategies for management, and contacts for support.
Significance of results
Self-management resources have the potential for addressing barriers not only at the patient level, but also at provider and health system levels. A cluster randomized controlled trial is under way to test effectiveness of the resource designed in this project in combination with pain screening, audit and feedback, and provider education. More research of this kind is needed to understand how interventions at different levels can be optimally combined to overcome barriers and improve care.
"The Journal of Medieval Military History continues to consolidate its now assured position as the leading academic vehicle for scholarly publication in the field of medieval warfare." Medieval Warfare