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Metabolic dysfunction and excess accumulation of adipose tissue are detrimental side effects from breast cancer treatment. Diet and physical activity are important treatments for metabolic abnormalities, yet patient compliance can be challenging during chemotherapy treatment. Time-restricted eating (TRE) is a feasible dietary pattern where eating is restricted to 8 hours/day with water-only fasting for the remaining 16 hours. The objective of this study is to evaluate the effect of a multimodal intervention consisting of TRE, healthy eating, and reduced sedentary time during chemotherapy treatment for early-stage (I-III) breast cancer on accumulation of visceral fat (primary outcome), other fat deposition locations, metabolic syndrome, and CVD risk (secondary outcomes) compared to usual care. The study will be a two-site, two-arm, parallel-group superiority randomized control trial enrolling 130 women scheduled for chemotherapy for early-stage breast cancer. The intervention will be delivered by telephone including 30-60-minute calls with a registered dietitian who will provide instructions on TRE, education and counselling on healthy eating, and goal setting for reducing sedentary time. The comparison group will receive usual cancer and supportive care including a single group-based nutrition class, and healthy eating and physical activity guidelines. Magnetic resonance imaging, blood draws, and assessment of blood pressure will be performed at baseline, after chemotherapy (primary end-point), and 2-year follow-up. If our intervention is successful in attenuating the effect of chemotherapy on visceral fat accumulation and cardiometabolic dysfunction, it has the potential to reduce risk of cardiometabolic disease and related mortality among breast cancer survivors.
Many older adults experience memory changes that can have a meaningful impact on their everyday lives, such as restrictions to lifestyle activities and negative emotions. Older adults also report a variety of positive coping responses that help them manage these changes. The purpose of this study was to determine how objective cognitive performance and self-reported memory are related to the everyday impact of memory change.
We examined these associations in a sample of 94 older adults (age 60–89, 52% female) along a cognitive ability continuum from normal cognition to mild cognitive impairment.
Correlational analyses revealed that greater restrictions to lifestyle activities (|rs| = .36–.66), more negative emotion associated with memory change (|rs| = .27–.76), and an overall greater burden of memory change on everyday living (|rs| = .28–.61) were associated with poorer objective memory performance and lower self-reported memory ability and satisfaction. Performance on objective measures of executive attention was unrelated to the impact of memory change. Self-reported strategy use was positively related to positive coping with memory change (|r| = .26), but self-reported strategy use was associated with more negative emotions regarding memory change (|r| = .23).
Given the prevalence of memory complaints among older adults, it is important to understand the experience of memory change and its impact on everyday functioning in order to develop services that target the specific needs of this population.
Studies that reveal detailed information about trilobite growth, particularly early developmental stages, are crucial for improving our understanding of the phylogenetic relationships within this iconic group of fossil arthropods. Here we document an essentially complete ontogeny of the trilobite Redlichia cf. versabunda from the Cambrian Series 2 (late Stage 4) Ramsay Limestone of Yorke Peninsula in South Australia, including some of the best-preserved protaspides (the earliest biomineralized trilobite larval stage) known for any Cambrian trilobite. These protaspid stages exhibit similar morphological characteristics to many other taxa within the Suborder Redlichiina, especially to closely related species such as Metaredlichia cylindrica from the early Cambrian period of China. Morphological patterns observed across early developmental stages of different groups within the Order Redlichiida are discussed. Although redlichiine protaspides exhibit similar overall morphologies, certain ontogenetic characters within this suborder have potential phylogenetic signal, with different superfamilies characterized by unique trait combinations in these early growth stages.
The deviation from thermodynamic equilibrium of the ion velocity distribution functions (VDFs), as measured by the Magnetospheric Multiscale (MMS) mission in the Earth’s turbulent magnetosheath, is quantitatively investigated. Making use of the unprecedented high-resolution MMS ion data, and together with Vlasov–Maxwell simulations, this analysis aims at investigating the relationship between deviation from Maxwellian equilibrium and typical plasma parameters. Correlations of the non-Maxwellian features with plasma quantities such as electric fields, ion temperature, current density and ion vorticity are found to be similar in magnetosheath data and numerical experiments, with a poor correlation between distortions of ion VDFs and current density, evidence that questions the occurrence of VDF departure from Maxwellian at the current density peaks. Moreover, strong correlation has been observed with the magnitude of the electric field in the turbulent magnetosheath, while a certain degree of correlation has been found in the numerical simulations and during a magnetopause crossing by MMS. This work could help shed light on the influence of electrostatic waves on the distortion of the ion VDFs in space turbulent plasmas.
Innovation Concept: The fairness of the Canadian Residency Matching Service (CaRMS) selection process has been called into question by rising rates of unmatched medical students and reports of bias and subjectivity. We outline how the University of Saskatchewan Royal College emergency medicine program evaluates CaRMS applications in a standardized, rigorous, equitable and defensible manner. Methods: Our CaRMS applicant evaluation methods were first utilized in the 2017 CaRMS cycle, based on published Best Practices, and have been refined yearly to ensure validity, standardization, defensibility, rigour, and to improve the speed and flow of data processing. To determine the reliability of the total application scores for each rater, single measures intraclass correlation coefficients (ICCs) were calculated using a random effects model in 2017 and 2018. Curriculum, Tool or Material: A secure, online spreadsheet was created that includes applicant names, reviewer assignments, data entry boxes, and formulas. Each file reviewer entered data in a dedicated sheet within the document. Each application was reviewed by two staff physicians and two to four residents. File reviewers used a standardized, criterion-based scoring rubric for each application component. The file score for each reviewer-applicant pair was converted into a z-score based on each reviewer's distribution of scores. Z-scores of all reviewers for a single applicant were then combined by weighted average, with the group of staff and group of residents each being weighted to represent half of the final file score. The ICC for the total raw scores improved from 0.38 (poor) in 2017 to 0.52 (moderate) in 2018. The data from each reviewer was amalgamated into a master sheet where applicants were sorted by final file score and heat-mapped to offer a visual aid regarding differences in ratings. Conclusion: Our innovation uses heat-mapped and formula-populated spreadsheets, scoring rubrics, and z-scores to normalize variation in scoring trends between reviewers. We believe this approach provides a rigorous, defensible, and reproducible process by which Canadian residency programs can appraise applicants and create a rank order list.
Innovation Concept: Competence by Design (CBD) was implemented nationally for Emergency Medicine (EM) residents beginning training in 2018. One challenge is the need to introduce residents to Entrustable Professional Activities (EPAs) that are assessed across numerous clinical rotations. The Royal College's resources detail these requirements, but do not map them to specific rotations or present them in a succinct format. This is problematic as trainees are less likely to succeed when expectations are unclear. We identified a need to create practical resources that residents can use at the bedside. Methods: We followed an intervention mapping framework to design two practical, user-friendly, low-cost, aesthetically pleasing resources that could be used by residents and observers at the bedside to facilitate competency-based assessment. Curriculum, Tool or Material: First, we designed a set of rotation- and stage-specific EPA reference cards for the use of residents and observers at the bedside. These cards list EPAs and clinical presentations likely to be encountered during various stages of training and on certain rotations. Second, we developed a curriculum board to organize the EPA reference cards by stage based upon our program's curriculum map. The curriculum board allows residents to view the program's curriculum map and the EPAs associated with each clinical rotation at a glance. It also contains hooks to hang and store extra cards in an organized manner. Conclusion: We believe that these practical and inexpensive tools facilitated our residency program's transition to competency-based EPA assessments. Anecdotally, the residents are using the cards and completing the suggested rotation-specific EPAs. We hope that the reference cards and curriculum board will be successfully incorporated into other residency programs to facilitate the introduction of their EPA-based CBD assessment system.
Sodium bismuth titanate (NBT) and its solid solutions with other ABO3 perovskites are of great interest for lead-free ferroelectric and piezoelectric applications. In this article, we provide an introduction to the complex structure of NBT, including atomic displacements and nanoscale defects. We also review poling effects and properties as well as NBT-ABO3 phase equilibria. The interesting relaxor properties, frequency dispersion in dielectric permittivity, and field-induced structural phase transitions of these systems are discussed. Finally, we describe other functional, mechanical, and electrical properties of NBT.
To achieve their conservation goals individuals, communities and organizations need to acquire a diversity of skills, knowledge and information (i.e. capacity). Despite current efforts to build and maintain appropriate levels of conservation capacity, it has been recognized that there will need to be a significant scaling-up of these activities in sub-Saharan Africa. This is because of the rapid increase in the number and extent of environmental problems in the region. We present a range of socio-economic contexts relevant to four key areas of African conservation capacity building: protected area management, community engagement, effective leadership, and professional e-learning. Under these core themes, 39 specific recommendations are presented. These were derived from multi-stakeholder workshop discussions at an international conference held in Nairobi, Kenya, in 2015. At the meeting 185 delegates (practitioners, scientists, community groups and government agencies) represented 105 organizations from 24 African nations and eight non-African nations. The 39 recommendations constituted six broad types of suggested action: (1) the development of new methods, (2) the provision of capacity building resources (e.g. information or data), (3) the communication of ideas or examples of successful initiatives, (4) the implementation of new research or gap analyses, (5) the establishment of new structures within and between organizations, and (6) the development of new partnerships. A number of cross-cutting issues also emerged from the discussions: the need for a greater sense of urgency in developing capacity building activities; the need to develop novel capacity building methodologies; and the need to move away from one-size-fits-all approaches.
Seabird bycatch is widely regarded as the greatest threat globally to procellariiform seabirds. Although measures to reduce seabird–fishery interactions have been in existence for many years, uptake in fleets with high risk profiles remains variable. We recorded seabird bycatch and other interactions in the Namibian demersal longline fishery. Interaction rates were estimated for seasonal and spatial strata and scaled up to fishing effort data. Bycatch rates were 0.77 (95% CI 0.24–1.39) and 0.37 (95% CI 0.11–0.72) birds per 1,000 hooks in winter and summer, respectively. Scaling up to 2010, the most recent year for which complete data are available, suggests 20,567 (95% CI 6,328–37,935) birds were killed in this fishery that year. We compared bycatch rates to those from experimental fishing sets using mitigation measures (one or two bird-scaring lines and the replacement of standard concrete weights with 5 kg steel weights). All mitigation measures significantly reduced the bycatch rate. This study confirms the Namibian longline fishery has some of the highest known impacts on seabirds globally, but implementing simple measures could rapidly reduce those impacts. In November 2015 the Ministry of Fisheries and Marine Resources introduced regulations requiring the use of bird-scaring lines, line weighting and night setting in this fishery. A collaborative approach between NGOs, industry and government was important in achieving wide understanding and acceptance of the proposed mitigation measures in the lead up to the introduction of new fishery regulations.
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.
Whose responsibility is it to tackle climate change? ‘Everyone’s and no one’s’, we might glibly reply. Responsibility is diffused across scales, social groups, sectors, countries and generations. The causes of climate change are implicated in everyday acts of production and consumption and relate to the ways in which societies organise their transportation, housing, energy, water and food systems. Recognising the complex and diffuse agencies and authorities that address climate change, the world of climate politics is no longer limited to the activities of national governments, international organisations and interstate bargaining between states. Increasingly, subnational governments, non-governmental organisations, businesses and individuals are taking responsibility into their own hands, experimenting with bold new approaches to the governance of climate change (Betsill & Bulkeley 2004; Andonova, Betsill & Bulkeley 2009; Selin & VanDeveer 2009b; Bulkeley & Newell 2010; Hoffmann 2011; Bulkeley et al. 2013). The governance of climate change now takes a seemingly bewildering array of forms: carbon markets, certification standards, voluntary workplace schemes, emissions registries, carbon labelling, urban planning codes and so on. 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, operate across public-private divides and seek to develop new approaches and techniques through which responses are developed. What sets these initiatives apart from other forms of transnational relations is how they not only influence others, but also how they directly intervene in the governing of global affairs in ways that defy conventional understandings of international relations.
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.
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.