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This study examined six- and 12-month levels of adherence to physical activity, functional changes, and psychosocial determinants of physical activity in 176 older adults who participated in the “Get Fit for Active Living (GFAL)” pilot program. Functional and psychosocial measures were conducted in person at six months; psychosocial measures and physical activity participation were assessed by telephone interview at 12 months. Ninety-five per cent were retained in the study at the six-month follow-up, and 88 per cent at 12 months. The self-reported adherence rate to exercise at 12 months was 66 per cent. The main reason for continued exercise participation was to maintain health (45%). Reasons for nonadherence were illness (38%) and lack of motivation (32%). Results identify factors associated with positive behaviour change that health promoters can utilize when targeting the older adult population. The GFAL project results can serve as a model for sustainable, community-based older-adult exercise programs.
Few countries routinely collect comprehensive encephalitis data, yet understanding the epidemiology of this condition has value for clinical management, detecting novel and emerging pathogens, and guiding timely public health interventions. When this study was conducted there was no standardized diagnostic algorithm to aid identification of encephalitis or systematic surveillance for adult encephalitis. In July 2012 we tested three pragmatic surveillance options aimed at identifying possible adult encephalitis cases admitted to a major Australian hospital: hospital admissions searches, clinician notifications and laboratory test alerts (CSF herpes simplex virus requests). Eligible cases underwent structured laboratory investigation and a specialist panel arbitrated on the final diagnosis. One hundred and thirteen patients were initially recruited into the 10-month study; 20/113 (18%) met the study case definition, seven were diagnosed with infectious or immune-mediated encephalitis and the remainder were assigned alternative diagnoses. The laboratory alert identified 90% (102/113) of recruited cases including six of the seven cases of confirmed encephalitis suggesting that this may be a practical data source for case ascertainment. The application of a standardized diagnostic algorithm and specialist review by an expert clinical panel aided diagnosis of patients with encephalitis.
The paper is an investigation into the withdrawal rates of seven Scottish Offices and covers the years 1972-76 with an appendix giving the results for 1977.
The rates were basically analysed by class and duration with further investigations mainly on the 1976 data by age at entry, sex, size of sum assured, premium paying term, premium payment frequency and by type of agent introducing the business. Comparisons were made of the level of withdrawal rates among the various Offices and also the variations from year to year separately. A graduation of the combined data for 1975 and 1976 for each of the five main classes was carried out.
The aim of this paper is to use a model office to examine the potential impact of AIDS on non-linked life assurance business in the UK.
The subject of AIDS continues to stimulate a large amount of research. The UK actuarial profession has been kept informed by the regular Bulletins [1-5] from the Institute of Actuaries AIDS Working Party (the “IAWP”). Using a model developed by A. D. Wilkie , the IAWP examined the possible spread of the infection amongst male homosexuals and produced tables of additional mortality. The most recent Bulletin (No. 4), published in March 1989, updated these projections in the light of new data, and we have based our investigations principally upon these more recent projections.
This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.
One thing should already be clear from the preceding chapters: transnational climate governance is qualitatively different from the standard multilateral model that has characterised the last two decades of climate change governance. The multilateral model is a hierarchical one; it functions through the generally accepted legitimate authority of nation-states to act on issues that transcend borders. In the multilateral process, a legally binding global treaty engages all nation-states in a common (and hopefully enforceable) purpose. In theory, there is an assumption of smooth vertical development of policy that draws on the legitimate, traditional authority of nation-states, both in constructing the international treaty and formulating national regulations. International law translates to national regulation, which directs domestic actions at more local levels. Alternatives to the authority and legitimacy of the multilateral process are rarely considered quite simply because the global system has functioned through this process for over a century (Denemark & Hoffmann 2008) despite criticisms about the interests served by this system and whose order it seeks to preserve (Cox 1987; Murphy 1994; Cox & Sinclair 1996). The emergence and functioning of TCCG asks us to question and engage questions of authority and legitimacy with a more critical eye, to understand how, in Hajer’s (2003) words, we can have policy without a polity, or how, as Rosenau asks, a range of actors can govern without the legal authority to do so (Rosenau & Czempiel 1992).
Our intention at the outset of this project was to move beyond the focus on individual cases or particular segments of the world of TCCG in order to examine what we might be able to discover collectively about this phenomenon. In this final chapter, we return to this overarching theme and identify the ways in which our analysis of TCCG contributes to ongoing debates in the field.
Underpinning this contribution, we suggest, are two novel aspects of our work. First, the book provides the first analysis of transnational governance that includes both an extensive database of a large number and a diverse array of particular case-studies. Existing research in the field of transnational governance has been mostly based on either individual examples or a small number of cases; whereas these can provide rich and nuanced analyses, there is nevertheless a significant value added in attempting to say something about this phenomenon as a whole. While we have not been able to survey the entire universe of cases in the transnational climate governance arena, a task that would be difficult to undertake given that much of this activity is relatively unknown, we have devised a strategy to maximise the diversity of cases we explore. In the sense that the approach we have developed includes the full variety of forms of TCCG, we thus suggest that it can be regarded as representative of the phenomenon as a whole. The database approach has enabled us to see patterns in the types of initiatives that predominate in TCCG, in terms of the types of actors, the issues upon which they focus, the forms of institutionalisation, the practices of governance, the claims to legitimacy and the geographical reach of TCCG initiatives.
This chapter examines the political dynamics underpinning the emergence of TCCG. In the first section of the chapter, we undertake a temporal analysis of the growth of TCCG, focusing on its parallel evolution with the international climate change regime and the broader political-economic shifts outlined in the previous chapter. In the second section of the chapter, our analysis turns to consider the patterns and drivers of private, hybrid and public transnational initiatives over time and to consider the governance functions that are being pursued in these different forms of TCCG. Through this analysis, we seek to capture the process through which climate politics has pluralised by describing and offering explanations for the growth of institutional diversity over time.
In doing so, the three theoretical lenses discussed in Chapter 3 serve as guides for our analysis. The agency-centred perspective is particularly helpful for highlighting the interests of the actors that populate climate politics, their sources of influence and factors underpinning the demand and supply of new forms of transnational governance. The social and system dynamics perspective helps to explain the diffusion of common practices and governance techniques through communities of environmental practitioners and policymakers. Finally, the critical political theory perspective sheds light on the marketisation of a substantial cluster of TCCG initiatives, the ideological underpinnings of these initiatives and the particular constellations of public and private forces that animate them. We use the TCCG database and illustrative case-studies to interrogate these issues illuminating the relationship between the agency of different actors, market logics, functional imperatives and normative contexts.
Our knowledge of transnational governance has been fundamentally shaped by the theoretical perspectives and methodological approaches that have been used to study it (O’Neill et al. 2013, 444). Primarily using a case-study approach revolving around a few high-profile examples, research on transnational governance has focused on the ways in which actors have sought to engage with different forms of transnational governance, the various functions that such arrangements seek to perform and their potential consequences in terms of legitimacy and effectiveness. Such approaches have yielded significant insights into these aspects of transnational governance but cannot, by their very nature, achieve a more comprehensive or systematic view. As O’Neill et al. (2013) suggest, such approaches may be ill-equipped to deal with the challenges of ‘complexity and uncertainty, vertical linkages across multiple scales, horizontal linkages across issue areas, and (often rapidly) evolving problem sets and institutional initiatives’ that beset global environmental governance research, such that new methodological approaches are required. If we regard transnational governance initiatives as having something in common – in terms of what they are seeking to accomplish, or in terms of the ways in which they are organised and constituted – we suggest that methodological innovations capable of creating a more comprehensive account of the overall phenomenon are required.
In order to develop such a broader understanding of the extent and nature of transnational governance in the climate change domain, our approach extends beyond small n case-studies or surveys of one particular type of transnational arrangement through the construction and analysis of a database of sixty transnational climate governance initiatives. This approach enables an analysis of the contours of transnational climate governance in a way that has not been possible within existing methodological approaches, allowing for a more thorough description of who and what are involved, where it is taking place, and how and why it is being pursued.
The world of climate politics is increasingly no longer confined to the activities of national governments and international negotiations. Critical to this transformation of the politics of climate change has been the emergence of new forms of transnational governance that cut across traditional state-based jurisdictions and operate across public and private divides. This book provides the first comprehensive, cutting-edge account of the world of transnational climate change governance. Co-authored by a team of the world's leading experts in the field and based on a survey of sixty case studies, the book traces the emergence, nature and consequences of this phenomenon, and assesses the implications for the field of global environmental politics. It will prove invaluable for researchers, graduate students and policy makers in climate change, political science, international relations, human geography, sociology and ecological economics.
Throughout the course of this book, we have undertaken analysis that delineates the emergence and functioning of TCCG and examines the new authority dynamics and sources of legitimacy that such initiatives draw upon and create. From this analysis, it is clear that there is a great deal of climate governance activity going on outside the halls of multilateral treaty negotiations. This governance activity is institutionally innovative, operating across multiple scales and engaging a wide range of actors in the global response to climate change. Yet perhaps the most important question has yet to be addressed: what does it all add up to? In other words, so what?
Chronicling and analysing the world of transnational climate governance initiatives is not the same as demonstrating that they are having a significant impact on the global response to climate change. For many commentators, such activity is merely a distraction from the hard work of addressing the climate crisis, either because it does not impact upon the real power politics of the issue or because the momentum for change comes from below (Soroos 2001; Bond 2012). We are optimistic that TCCG cannot merely be dismissed as an irrelevance, though we are cognizant that our grounds for optimism stem as much from the understanding of the potential for TCCG as they do from concrete evidence of accomplishments of TCCG initiatives to date. As we explore further in this chapter, establishing both the basis upon which such accomplishments might be measured and accruing substantial evidence in this regard remain challenging and relatively unexplored research tasks. We also note that the plurality of TCCG this book has revealed implies that some initiatives may represent useful societal responses to climate change, while others may not. To begin to address the question of how TCCG is having an effect on responses to climate change, and the effectiveness of such endeavours, in this chapter we explore if and how TCCG is reshaping the architecture of global climate governance. We scrutinise whether and how it is having an impact upon the climate change problem, and we discuss the pathways through which these initiatives might advance the goals of transitioning to a low-carbon future.
TCCG is concerned with a range of issues (see Chapter 2), from the familiar agendas of promoting renewable energy technologies and the creation of carbon markets to issues of investment risk, food security and water services with which mainstream climate change governance has had limited involvement. Despite this diversity, we find four predominant sets of issues with which the majority of initiatives are concerned: (1) energy; (2) carbon markets and finance; (3) carbon sequestration and forests; and (4) infrastructure (transport, waste and water projects and systems) (Chapter 2, Figure 2.4).
This chapter explores how and why TCCG focuses on these issues and their potential consequences for understanding climate governance more broadly. First, we examine the nature of the four sets of issues that have come to provide the focus for TCCG activity, and we ask why they have become the focus of activity. While such TCCG patterns are in common with (or connected to) other areas of climate governance, they also have features distinct to both the character of TCCG itself and the nature of the particular issue areas. The second section of the chapter explores how transnational activity around these issues is organised – which types of TCCG arrangement are engaged in which issue areas – and how such areas combine in interesting and sometimes counterintuitive ways. Using a cluster analysis technique to group initiatives, the resulting combinations show no intuitive or natural patterns of TCCG. Rather, TCCG initiatives are put together in much messier ways by particular sorts of actors pursuing particular agendas, combining pre-existing policy and institutional fields with climate change to produce distinct clusters of activity in the TCCG arena.