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This presentation explores how claims for transformative adaptation toward more equitable and sustainable societies can be assessed. We build on a theoretical framework describing transformative adaptation as it manifests across four core elements of the public-sector adaptation lifecycle: vision, planning, institutional frameworks, and interventions. For each element, we identify characteristics that can help track adaptation as transformative. Our purpose is to identify how governance systems can constrain or support transformative choices and thus enable targeted interventions. We demonstrate and test the usefulness of the framework with reference to three case studies of nature-based solutions (NBS): river restoration (Germany), forest conservation (China), and landslide risk reduction (Italy). Building on a desktop study and open-ended interviews, our analysis adds evidence to the view that transformation is not an abrupt system change, but a dynamic complex process that evolves over time. While each of the NBS cases fails to fulfill all the transformation characteristics, there are important transformative elements in their visions, planning, and interventions. There is a deficit, however, in the transformation of institutional frameworks. The cases show institutional commonalities in multi-scale and cross- sectoral (polycentric) collaboration as well as innovative processes for inclusive stakeholder engagement; yet, these arrangements are ad hoc, short-term, dependent on local champions, and lacking the permanency needed for upscaling. For the public sector, this result highlights the potential for establishing cross-competing priorities among agencies, cross-sectoral formal mechanisms, new dedicated institutions, as well as programmatic and regulatory mainstreaming.

Analysis of salivary volatile organic compounds (VOCs) may offer a novel noninvasive modality for disease detection. This study aims to optimise saliva headspace VOC analysis and assess longitudinal variation of salivary VOCs. Whole saliva from healthy participants was acquired in order to assess four methodological parameters: saliva collection, volume, dilution, and acidification. Saliva VOCs were analysed using untargeted proton transfer reaction time-of-flight mass spectrometry. Using the optimised method, five saliva samples collected over 3 weeks assessed the longitudinal VOC variability and reproducibility with targeted selected ion flow tube-mass spectrometry analysis. The method of saliva collection influenced VOC detection and was a source of contamination. An amount of 500 µL of whole saliva by passive drool yielded optimal VOCs. Longitudinal variation was negligible with target short chain fatty acids and aldehydes. However, certain compounds showed variability suggesting the influence of potential exogenous factors. Overall, there was an acceptable range of inter- and intraindividual VOC variability. Standardisation with morning sampling after a 6 h fast is recommended demonstrating minimal intersubject variability. Future studies should seek to establish salivary VOC levels in healthy and diseased populations.

This chapter outlines a framework for multidimensional, holistic vulnerability assessment that is understood as part of risk evaluation and risk management in the context of Disaster Risk Management and Climate Change Adaptation. As a heuristic, the framework is a thinking tool to guide systematic assessments of vulnerability and to provide a basis for comparative indicators and criteria development to assess key factors and various dimensions of vulnerability, particularly in regions in Europe. However, it can also be applied in other world regions. The framework has been developed within the context of the research project MOVE (Methods for the Improvement of Vulnerability Assessment in Europe; www.move-fp7.eu) sponsored by the European Commission within the framework of the FP 7 program. &nbsp

Coastal floods are one of the most dangerous and harmful natural hazards affecting urban areas adjacent to shorelines. The present paper discusses the FP7-ENV-2013 EU funded PEARL (Preparing for Extreme And Rare events in coastaL regions) project which brings together world leading expertise in both the domain of hydro-engineering and risk reduction and management services to pool knowledge and practical experience in order to develop more sustainable risk management solutions for coastal communities focusing on present and projected extreme hydro-meteorological events. The PEARL approach draws upon the complexity theory and the use of complex adaptive system (CAS) models as tools to identify root causes of vulnerabilities and their multi-stressors and to analyze risk and the behavior of key actors.

international; International audience; Actions that range from incremental steps to transformational changes are essential for reducing risk from weather and climate extremes (high agreement, robust evidence). [8.6, 8.7] Incremental steps aim to improve efficiency within existing technological, governance, and value systems, whereas transformation may involve alterations of fundamental attributes of those systems. The balance between incremental and transformational approaches depends on evolving risk profiles and underlying social and ecological conditions. Disaster risk, climate change impacts, and capacity to cope and adapt are unevenly distributed. Vulnerability is often concentrated in poorer countries or groups, although the wealthy can also be vulnerable to extreme events. Where vulnerability is high and adaptive capacity relatively low, changes in extreme climate and weather events can make it difficult for systems to adapt sustainably without transformational changes. Such transformations, where they are required, are facilitated through increased emphasis on adaptive management, learning, innovation, and leadership. Evidence indicates that disaster risk management and adaptation policy can be integrated, reinforcing, and supportive - but this requires careful coordination that reaches across domains of policy and practice (high agreement, medium evidence). [8.2, 8.3, 8.5, 8.7] Including disaster risk management in resilient and sustainable development pathways is facilitated through integrated, systemic approaches that enhance capacity to cope with, adapt to, and shape unfolding processes of change, while taking into consideration multiple stressors, different prioritized values, and competing policy goals. Development planning and post-disaster recovery have often prioritized strategic economic sectors and infrastructure over livelihoods and well-being in poor and marginalized communities. This can generate missed opportunities for building local capacity and integrating local development visions into longer-term strategies for disaster risk reduction and adaptation to climate change (high agreement, robust evidence). [8.4.1, 8.5.2] A key constraint that limits pathways to post-disaster resilience is the time-bound nature of reconstruction funding. The degradation of ecosystems providing essential services also limits options for future risk management and adaptation actions locally. Learning processes are central in shaping the capacities and outcomes of resilience in disaster risk management, climate change adaptation, and sustainable development (high agreement, robust evidence). [8.6.3, 8.7] An iterative process of monitoring, research, evaluation, learning, and innovation can reduce disaster risks and promote adaptive management in the context of extremes. Technological innovation and access may help achieve resilience, especially when combined with capacity development anchored in local contexts. Progress toward resilient and sustainable development in the context of changing climate extremes can benefit from questioning assumptions and paradigms, and stimulating innovation to encourage new patterns of response (medium agreement, robust evidence). [8.2.5, 8.6.3, 8.7] Successfully addressing disaster risk, climate change, and other stressors often involves embracing broad participation in strategy development, the capacity to combine multiple perspectives, and contrasting ways of organizing social relations. Multi-hazard risk management approaches provide opportunities to reduce complex and compound hazards in rural and urban contexts (high agreement, robust evidence). [8.2.5, 8.5.2, 8.7] Considering multiple types of hazards reduces the likelihood that risk reduction efforts targeted at one type of hazard will increase exposure and vulnerability from other hazards, both in the present and future. Building adaptation into multi-hazard risk management involves consideration of current climate variability and projected changes in climate extremes, which pose different challenges to affected human and natural systems than changes in the means. Where changes in extremes cause greater stresses on human and natural systems, direct impacts may be more unpredictable, increasing associated adaptation challenges. The most effective adaptation and disaster risk reduction actions are those that offer development benefits in the relative near term, as well as reductions in vulnerability over the longer term (high agreement, medium evidence). [8.2.1, 8.3.1, 8.3.2, 8.5.1, 8.6.1] There are tradeoffs between current decisions and long-term goals linked to diverse values, interests, and priorities for the future. Short-term and long-term perspectives on both disaster risk management and adaptation to climate change thus can be difficult to reconcile. Such reconciliation involves overcoming the disconnect between local risk management practices and national institutional and legal frameworks, policy, and planning. Resilience thinking offers some tools for reconciling short- and long-term responses, including integrating different types of knowledge, an emphasis on inclusive governance, and principles of adaptive management. However, limits to resilience are faced when thresholds or tipping points associated with social and/or natural systems are exceeded. Building a strong foundation for integrating disaster risk management and adaptation to climate change includes making transparent the values and interests that underpin development, including who wins and loses from current policies and practices, and the implications for human security (high agreement, medium evidence). [8.2.3, 8.2.4, 8.4.2, 8.4.3, 8.6.1.2] Both disaster risk management and adaptation to climate change share challenges related to (1) reassessing and potentially transforming the goals, functions, and structure of institutions and governance arrangements; (2) creating synergies across temporal and spatial scales; and (3) increasing access to information, technology, resources, and capacity. These challenges are particularly demanding in countries and localities with the highest climate-related risks and weak capacities to manage those risks. Countries with significant capacity and strong risk management records also benefit from addressing these challenges. Social, economic, and environmental sustainability can be enhanced by disaster risk management and adaptation approaches. A prerequisite for sustainability is addressing the underlying causes of vulnerability, including the structural inequalities that create and sustain poverty and constrain access to resources (medium agreement, robust evidence). [8.6.2, 8.7] This involves integrating disaster risk management in other social and economic policy domains, as well as a long-term commitment to managing risk. The interactions among climate change mitigation, adaptation, and disaster risk management will have a major influence on resilient and sustainable pathways (high agreement, low evidence). [8.2.5, 8.5.2, 8.7] Interactions between the goals of mitigation and adaptation in particular will play out locally, but have global consequences. There are many approaches and pathways to a sustainable and resilient future. Multiple approaches and development pathways can increase resilience to climate extremes (medium agreement, medium evidence). [8.2.3, 8.4.1, 8.6.1, 8.7] Choices and outcomes for adaptive actions to climate extremes must reflect divergent capacities and resources and multiple interacting processes. Actions are framed by tradeoffs between competing prioritized values and objectives, and different visions of development that can change over time. Iterative, reflexive approaches allow development pathways to integrate risk management so that diverse policy solutions can be considered, as risk and its measurement, perception, and understanding evolve over time. Choices made today can reduce or exacerbate current or future vulnerability, and facilitate or constrain future responses. Available at : https://www.ipcc-wg1.unibe.ch/srex/downloads/SREX-Chap8_FINAL.pdf

Taking their inspiration from the work of Charles Webster, the essays in this volume consider the effect that demands for social and political reform have had on the theory and, above all, the practice of medicine and science, and on the ...

Many studies have reported the use of attenuation-corrected positron emission tomography with 18F-fluorodeoxyglucose (FDG PET) with full-ring tomographs to differentiate between benign and malignant pulmonary nodules. We sought to evaluate FDG PET using a partial-ring tomograph without attenuation correction.A retrospective review of PET images from 77 patients (range 38-84 years of age) with proven benign or malignant pulmonary nodules was undertaken. All images were obtained using a Siemens/CTI ECAT ART tomograph, without attenuation correction, after 185 MBq 18F-FDG was injected. Images were visually graded on a 5-point scale from "definitely malignant" to "definitely benign," and lesion-to-background (LB) ratios were calculated using region of interest analysis. Visual and semiquantitative analyses were compared using receiver operating characteristic analysis.Twenty lesions were benign and 57 were malignant. The mean LB ratio for benign lesions was 1.5 (range 1.0-5.7) and for malignant lesions 5.7 (range 1.2-14.1) (p0.001). The area under the ROC curve for LB ratio analysis was 0.95, and for visual analysis 0.91 (p = 0.39). The optimal cut-off ratio with LB ratio analysis was 1.8, giving a sensitivity of 95% and a specificity of 85%. For lesions thought to be "definitely malignant" on visual analysis, the sensitivity was 93% and the specificity 85%. Three proven infective lesions were rated as malignant by both techniques (LB ratio 2.6-5.7).FDG PET without attenuation correction is accurate for differentiating between benign and malignant lung nodules. Results using simple LB ratios without attenuation correction compare favourably with the published sensitivity and specificity for standard uptake ratios. Visual analysis is equally accurate.

This paper describes the structure and application of a multistate projection model that was developed by the Operational Research Service of the Department of Health and Social Security, UK. The model can be used to calculate the evolution of a multistate manpower or population distribution, with each state's stock classified either by length of time in a state or by age and subdivided into up to four noninteracting population subgroups (e.g., according to sex and country of origin). Both Markov ("push") and Renewal ("pull") flows can be simulated and a wide range of different network configurations can be modeled. Medical manpower planning problems are also discussed--in particular the issue of career planning for doctors in the presence of demand constraints--to exemplify the possible uses of the model. As background, the role of manpower planning in health care planning and the sorts of problems that arise in balancing the supply of, and demand for, any manpower group are outlined. The generality of the Department of Health and Social Security model is demonstrated by highlighting its structural similarity to the multistate models that have been the subject of study at IIASA in recent years. The model's uses in detecting both potential manpower supply instabilities in market-based manpower systems and planning in feasibilities in planned systems are pointed out. A model run is discussed, based on a hypothetical situation, in which growth rates of one grade in a manpower network lead to supply problems for the whole network. The Appendix contains sample input and output files.

The following report summarizes recent results of balloon-borne observations separately for the various disciplines: infrared astronomy, ultraviolet astronomy, X-ray astronomy, gamma-ray astronomy, cosmic rays, and atmospheric sciences. Bibliographies of the relevant publications are given for each discipline at the end of the corresponding section. Undoubtedly, the reader will find the great variety of significant research quite impressive. Nevertheless, we cannot hope to cover the field of scientific ballooning completely in this report. We may have overlooked or misrepresented some important investigations, and we wish to apologize for any such errors.

COVID-19 recovery is an opportunity to enhance life chances by Building Back Better, an objective promoted by the UN and deployed politically at national level. To help understand emergent and intentional opportunities to Build Back Better, we propose a research agenda drawing from geographical thinking on social contracts, assemblage theory and the politics of knowledge. This points research towards the ways in which everyday and professional knowledge cocreation constrains vision and action. Whose knowledge is legitimate, how legitimacy is ascribed and the place of science, the media and government in these processes become sites for progressive Building Back Better., ERC

Apothecaries formed a crucial part of early modern London's resources against the disorders and diseases that assailed its population, supplying medicines and a range of other goods and services - some medical, some not - to medical practitioners and patients alike. Despite their importance, this essential element in London's service economy has largely been neglected by historians. This thesis is a study of the regulation, lifecycle and work of apothecaries from the beginning of the seventeenth century to around 1670. It demonstrates the importance of the personal, political and commercial histories of seventeen-century apothecaries to an understanding of medicine and work in early modern London. The thesis begins with a consideration of the politics and policing of medicine in seventeenth century London. The apothecaries' guild, the Society of Apothecaries, was established in 1617. The process by which apothecaries came to be separated from the Grocers' Company is analysed in Chapter Two. The Society's fortunes over the next five decades, in resisting the efforts of the College of Physicians to increase its authority over apothecaries are considered in Chapter Three. Two aspects of the internal operation of the company are discussed next. Chapter Four examines the extensive - but moderate - control of the craft by the Society, influenced by legal norms and the difficulties of assessing the quality of medicines. Chapter Five focuses on apothecaries' individual and collective identities through their lifecycle, backgrounds, corporate careers, and, particularly, apprenticeships and apprentice-taking. Chapters Six to Eight explore several aspects of the trade of apothecaries and the economy of medicine in early modern London. The complex ways medicine were sourced, manufactured and supplied; the interactions of medical practitioners, as associates, partners or competitors; the customers of apothecaries; and the material culture of apothecaries' shops, and its relation to the problem of reassuring consumers about the medicines they purchased.

The thesis examines the relationship between reprobation fears and melancholic illness in puritan culture over a period of approximately ninety years. Reprobation formed part of the Calvinist doctrine of double predestination, by which God had chosen a few for salvation (the elect), and many for destruction (the reprobate). When a person came to believe that they were reprobate, this could give rise to symptoms of fear and despair similar to those associated with melancholy (an imbalance of black bile believed to affect the brain). The thesis shows how puritans used explanations based on melancholy in order to explain how otherwise godly people came to doubt their election. The first chapter shows how the Calvinist physician, Timothy Bright, incorporated ideas from medieval scholastic and medical texts into his Treatise of melancholie (1586), in order to explain how physiological causes could be at the root of reprobation fears. The second and third chapters examine the religious context in which Bright was writing. The second chapter shows puritan ambivalence about pronouncing a person to be reprobate through an examination of responses to the death of the apostate, Francesco Spiera. The third chapter shows how the Elizabethan puritan clergy developed a form of consolation for those suffering from despair of salvation based on the medieval idea that melancholy was the ‘devil’s bath’. The fourth and fifth chapters show the importance of physiological explanations for despair in defending the reputations of the dying. When a godly person despaired on their death-bed, or committed suicide, this was blamed on a combination of forces external to themselves – melancholy and the devil. The final chapter shows how Robert Burton’s Anatomy of Melancholy adapted puritan ideas about despair, to be more acceptable in the context of growing resistance to the preaching of double predestination in the 1620s and 30s.

This thesis examines attitudes toward infertility in early modern England and colonial New England from c.1620 to 1720 through infertility’s representation in contemporary medical, religious, and literary sources. This study uses an expanded definition of infertility, namely a 'spectrum of infertility', to capture the tensions that arose during periods of infertility and experiences of reproductive failure such as miscarriages, stillbirths, monstrous births, and false conceptions. A spectrum, more than a modern definition, more accurately represents the range of bodily conditions experienced by early modern women and men that indicated reproductive disorder in the body; by extension, the language of infertility expressed fears about disorder in times of social, religious, and political crisis in early modern society. The two societies' relationship was often described through reproductive language and the language of infertility appears in both societies when order - within the body, within marriages, or within and between communities - was threatened. This thesis contributes to a growing body of scholarship on infertility in early modern society by analysing its presence in communications within and between early modern England and colonial New England. It argues that understanding the English origins of the colonists' attitudes toward infertility is fundamental both to understanding the close connection between the two societies and to providing context for the colonists' perceptions about their encounters with new lands, bodies, environments, and reasons for emigration. As a result, this thesis seeks to break new ground in providing an overview of social, medical, and cultural reactions in both England and New England, demonstrating that similar language and tropes were used in both regions to communicate concerns about infertility. Exploring the interplay between the many sources addressing this health issue more accurately represents the complexity of early modern attitudes toward infertility, and the intimacy of the relationship between the fledgling New England colonies and their metaphorical Mother England.