To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Our food systems have performed well in the past, but they are failing us in the face of climate change and other challenges. This book tells the story of why food system transformation is needed, how it can be achieved and how research can be a catalyst for change. Written by a global interdisciplinary team of researchers, it brings together perspectives from multiple areas including climate, environment, agriculture, and the social sciences to describe how different tools and approaches can be used to tackle food system transformation. It provides practical, actionable insights for policymakers and advisors, demonstrating how science together with strong partnerships can enable real transformation on the ground. It also contributes to the academic debate on the transformation of food systems, and so will be an invaluable reference for researchers and students alike. This title is also available as Open Access on Cambridge Core.
Partnerships are crucial for fostering change in society, particularly in the solving of complex problems such as climate change. They are particularly important for researchers interested in societal change, given that research in the strictest sense is only about knowledge generation. Given partnerships are crucial for outcome-focused research, the selection of diverse strategic partners is key and must be guided by theories of change. Complementary visions are important but do not always need to be tightly structured. From farmers and producer groups to international agencies, multi-level partnerships help promote action at different levels. Collaborative arrangements are important but can be informal and flexible; many successful longer-term partnerships are deep and trustful at their core, often with informal relationships.
Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.
A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.
Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).
Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
The concept of climate-smart agriculture (CSA) was developed to tackle three of the greatest challenges of our time: food security, climate change adaptation and reducing emissions. Key research thrusts that need to be strengthened include (1) developing foresight and scenario building in terms of climate change and future development pathways; (2) producing and extending stress-tolerant breeds/varieties and practices, with low emissions; (3) improving and delivering seasonal forecasts and advisories; (4) building safety nets because of the inevitability of extreme events, e.g., index-based insurance and productive social safety nets, where assets are built to mitigate extreme events; (5) Devoting more attention to social differentiation and therefore better targeting of solutions; and (6) working on the barriers to technological uptake and policy change. We also argue that research itself needs to change in order to deliver rapid solutions, and we offer ten principles for effective Agricultural Research for Development (AR4D).
Large numbers of new medical devices and diagnostics are developed and health services need to identify which ones offer real advantages. The National Institute for Health and Care Excellence (NICE) has introduced a system for assessing technologies that are often notified by companies, based on claims made for their benefits to patients, the National Health Service, and the environment.
Detailed scrutiny of claims made for the benefits of products and the corresponding evidence, seeking associations between these and the selection of products for full evaluation to produce NICE guidance.
Between 2009 and 2015 a NICE committee considered 169 technologies, of which it selected 74 (44 percent) for full evaluation, based on the claims of benefit and the evidence available. An average of 7.5 claims were made per technology; the total number did not influence selection but presence of studies supporting all the claims (p < .001) or any of the claims (p < .05) had a positive influence, as did claims for quicker patient recovery (p < .001). A greater number of studies to support the claims made selection more likely (p < .001), as did cohort studies (p < .05) and surveys (p < .05) but, unexpectedly, not randomized trials. The Medical Device Directive class had no influence.
This study presents categories of claims that may be useful to those developing new products and to others engaged in health technology assessment. It illustrates the importance of relevant evidence and of having a clear vision of the place of new products in care pathways from an early stage.
In 1258, as baronial opposition to Henry III erupted and the government became locked in constitutional conflict, the country found itself in the grip of a serious food crisis. To blame was a run of bad weather and failed harvests. Thousands of famished famine refugees flocked to London in quest of food and charity, where many of them perished and were buried in mass graves. The multiple burials recently discovered and excavated in the cemetery of the hospital of St Mary Spital highlight the plight of the poor at this time of political turmoil. Was their fate part of a global catastrophe precipitated by the VEI7 explosion of Samalas Volcano, Indonesia, the previous year or was powerful solar forcing of global climates responsible for the unusually unstable weather? The answer depends in large measure upon establishing the precise chronology of how the crisis unfolded, drawing upon the surviving documentary record of prices and harvests, the comments of contemporary chroniclers and a range of high-resolution palaeo-climatic proxies. Reexamination of this episode illustrates the potential of environmental history to shed fresh light on familiar historical events and its capacity to place them in a global environmental context.
Weeds reduce the livestock production from pastures and impose control costs on producers and governments. Economic assessments of pasture weed problems are required on and beyond the farm for planning private and public weed control. This requirement has several dimensions that can be used to demonstrate the economic effect of weeds and encourage weed control by the private and public sectors. This paper discusses the economic problems of pasture weeds and the procedures for multi-level economic assessments with a major pasture weed in Australia as an example, and demonstrates the important private and social economic benefits from controlling this weed.
Objectives: The aim of this study was to review 5 years of activity from a new system devised by the National Institute for Health and Care Excellence (NICE), for assessing medical devices and diagnostics aimed at identifying and speeding adoption of technologies with clinical and cost advantages, compared with current practice in the United Kingdom healthcare system.
Methods: All eligible notified technologies were classified using the Food and Drug Administration and Global Medical Device Nomenclature nomenclatures. Decisions about selecting technologies for full assessment to produce NICE recommendations were reviewed, along with the reasons given to companies for not selecting products.
Results: Between 2009 and 2014, 186 technologies were notified (46 percent therapeutic and 54 percent diagnostic). Thirty-nine were judged ineligible (no regulatory approval), and 147 were considered by an independent committee. Of these, eighty (54 percent) were not selected for full assessment, most commonly because of insufficient evidence (86 percent): there were uncertainties specifically about benefits to the health service (54 percent), to patients (39 percent), and about cost (24 percent). The remaining 67 were selected and assessed for Medical Technology guidance (52 percent) (noninferior and/or lower cost consequences than current practice), for Diagnostics guidance (43 percent) or other NICE recommendations about adoption and use. Classifying technologies by two different systems showed no selection bias for any technology type or disease area.
Conclusions: Identifying new or under-used devices and diagnostics with potential benefits and promoting their adoption is important to health services in the United Kingdom and worldwide. This new system offers a means of fostering both uptake and further research. Lack of research data on new products is a major obstacle to evaluation.
The Tarija Formation of southern Bolivia, which is well known for its classic vertebrate faunas, is of prime importance in understanding of the chronology of the Ensenadan Land Mammal Age. This formation consists of well-exposed and relatively fossiliferous sections of clays, clayey silts, sands, gravels, and tuffs which were deposited in a predominately fluviatile regime in a Pleistocene structural basin. Four stratigraphic sections, each measuring 110 m or less, were studied to establish a magnetic polarity stratigraphy. Paleomagnetic samples were collected from the finer-grained sediments at 100 sites spaced at stratigraphic intervals of 5 m or less. All paleomagnetic specimens were demagnetized in alternating fields of least 250 oersteds (oe). Some specimens were also thermally demagnetized at 200°C or more. Of the 100 sites, 77 were ultimately used to determine the magnetic polarity zonation. Based on the four sections sampled, the Tarija Formation spans a time interval from about 1 my to about 0.7 my B.P. or perhaps younger. The lower half of the composite section is of reversed polarity punctuated by a short normal event. This sequence probably represents the late Matuyama chron with the Jaramillo subchron. The upper part of the section is of normal polarity and represents early Brunhes time. A tuffaceous unit 43 m above the Brunhes-Matuyama boundary yielded a fission track (zircon) age of 0.7 ± 0.2 by B.P. These data indicate that the classic Tarija fauna is middle Pleistocene Ensendan in age.
Background: The adoption of new medical devices and diagnostics is often hampered by lack of published evidence which makes conventional health technology assessment (HTA) difficult. We now have 5 years’ experience of the Medical Technologies Advisory Committee of the National Institute for Health and Care Excellence (NICE) in the United Kingdom, addressing this problem. This committee assesses devices and diagnostics against claims of advantage, to produce guidance on adoption for the health service.
Methods: We have reflected on the practical, technical, and intellectual processes we have used in developing guidance for the health service.
Results: When scientific and clinical evidence is sparse, promise and plausibility play an increased part in decision-making. Drivers of promise include a clear design and mechanism of action, the possibility of radical improvement in care and/or resource use, and improving health outcomes for large numbers of patients. Plausibility relates to judgements about the whether the promise is likely to be delivered in a “real world” setting. Promise and plausibility need to be balanced against the amount of evidence available. We examine the influence they may have on decision-making compared with other factors such as risk and cost.
Conclusions: Decisions about adoption of new devices and diagnostics with little evidence are influenced by judgements of their promise and the plausibility of claims that they will provide benefits in a real-world setting. This kind of decision making needs to be transparent and this article explains how these influences can be balanced against the use of more familiar criteria.