This is a timely publication examining the relationship between tourism and climate change. It is a detailed analysis and assessment offering both theoretical and practical approaches to the subject. ...It aims to bring together research on the implications of climate change on the tourism industry. The book provides a comprehensive discussion of the latest knowledge in the field of tourism and climate change. It is aimed at tourism practitioners and those with an academic interest in the fields of tourism management and climate change mitigation, adaptation and policy.
The contribution of tourism to climate change, and the likely consequences of climate change for key tourist destinations, has been well reported and discussed. Yet, there is a lack of evidence-based ...systematic practical advice as to how the tourism industry should respond to the challenge of climate change. Building on a sound conceptual understanding of the links between climate change and tourism, this book shows how the tourism sector might best respond. It not only focuses on the roles of supportive policies and institutions in ensuring a strong "enabling environment" for practical responses, but also on the practical responses themselves.
This practical approach is presented through a large number of case studies and examples which illustrate how policy and industry initiatives have been implemented in tourism, and if or why they were successful. The majority of examples come from places such as the Caribbean, Spain, the Maldives, Nepal, and the UK, as well as Australia, New Zealand and other parts of the Pacific. The examples are presented within an overall framework that facilitates the translation of adaptation and mitigation policies into practice.
This book offers the tourism industry, students and academics the opportunity to advance from the earlier, more conceptual texts on tourism and climate change by taking a much more practical approach. Its global coverage, through the use of international case studies, fosters a cross-fertilisation of ideas and initiatives. This text provides a detailed analysis of best practices in the face of climate change, across countries and geographically diverse tourist destinations and operations.
Even before the Civil War, American writers were imagining life after a massive global catastrophe. For many, the blank slate of the American continent was instead a wreckage-strewn wasteland, a new ...world in ruins. Bringing together epic and lyric poems, fictional tales, travel narratives, and scientific texts, Postapocalyptic Fantasies in Antebellum American Literature reveals that US authors who enthusiastically celebrated the myths of primeval wilderness and virgin land also frequently resorted to speculations about the annihilation of civilizations, past and future. By examining such postapocalyptic fantasies, this study recovers an antebellum rhetoric untethered to claims for historical exceptionalism - a patriotic rhetoric that celebrates America while denying the United States a unique position outside of world history. As the scientific field of natural history produced new theories regarding biological extinction, geological transformation, and environmental collapse, American writers responded with wild visions of the ancient past and the distant future.
The Meta-Analysis of Radiotherapy in squamous cell Carcinomas of Head and neck (MARCH) showed that altered fractionation radiotherapy is associated with improved overall and progression-free survival ...compared with conventional radiotherapy, with hyperfractionated radiotherapy showing the greatest benefit. This update aims to confirm and explain the superiority of hyperfractionated radiotherapy over other altered fractionation radiotherapy regimens and to assess the benefit of altered fractionation within the context of concomitant chemotherapy with the inclusion of new trials.
For this updated meta-analysis, we searched bibliography databases, trials registries, and meeting proceedings for published or unpublished randomised trials done between Jan 1, 2009, and July 15, 2015, comparing primary or postoperative conventional fractionation radiotherapy versus altered fractionation radiotherapy (comparison 1) or conventional fractionation radiotherapy plus concomitant chemotherapy versus altered fractionation radiotherapy alone (comparison 2). Eligible trials had to start randomisation on or after Jan 1, 1970, and completed accrual before Dec 31, 2010; had to have been randomised in a way that precluded prior knowledge of treatment assignment; and had to include patients with non-metastatic squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx undergoing first-line curative treatment. Trials including a non-conventional radiotherapy control group, investigating hypofractionated radiotherapy, or including mostly nasopharyngeal carcinomas were excluded. Trials were grouped in three types of altered fractionation: hyperfractionated, moderately accelerated, and very accelerated. Individual patient data were collected and combined with a fixed-effects model based on the intention-to-treat principle. The primary endpoint was overall survival.
Comparison 1 (conventional fractionation radiotherapy vs altered fractionation radiotherapy) included 33 trials and 11 423 patients. Altered fractionation radiotherapy was associated with a significant benefit on overall survival (hazard ratio HR 0·94, 95% CI 0·90–0·98; p=0·0033), with an absolute difference at 5 years of 3·1% (95% CI 1·3–4·9) and at 10 years of 1·2% (−0·8 to 3·2). We found a significant interaction (p=0·051) between type of fractionation and treatment effect, the overall survival benefit being restricted to the hyperfractionated group (HR 0·83, 0·74–0·92), with absolute differences at 5 years of 8·1% (3·4 to 12·8) and at 10 years of 3·9% (−0·6 to 8·4). Comparison 2 (conventional fractionation radiotherapy plus concomitant chemotherapy versus altered fractionation radiotherapy alone) included five trials and 986 patients. Overall survival was significantly worse with altered fractionation radiotherapy compared with concomitant chemoradiotherapy (HR 1·22, 1·05–1·42; p=0·0098), with absolute differences at 5 years of −5·8% (−11·9 to 0·3) and at 10 years of −5·1% (−13·0 to 2·8).
This update confirms, with more patients and a longer follow-up than the first version of MARCH, that hyperfractionated radiotherapy is, along with concomitant chemoradiotherapy, a standard of care for the treatment of locally advanced head and neck squamous cell cancers. The comparison between hyperfractionated radiotherapy and concomitant chemoradiotherapy remains to be specifically tested.
Institut National du Cancer; and Ligue Nationale Contre le Cancer.
Over two decades of vulnerability assessments have shown the Pacific Islands region to be one of the regions most at risk to the adverse consequences of climate change. Pacific Island countries have ...shown strong leadership in characterising the challenges of climate change, both nationally and for the region as a whole, and in identifying the most appropriate responses. This paper reviews the various Vulnerability, Risk and Adaptation (VRiA) Assessment Methods and Tools that have been used across the Pacific Islands region, with an emphasis on the past two decades. The aim is to identify the approaches that are best suited to the region, and to develop a common understanding and principles that may be relevant and useful to harmonising the assessment of vulnerability and risk, and of adaptation options across the region. Even though assessments undertaken in the Pacific Islands region tend to share the common objective of reducing vulnerabilities and risks, practitioners in the Pacific are using numerous approaches, methods and tools to assess vulnerabilities and identify possible adaptation interventions. No one approach will address all needs and accommodate all capacities. Rather, several successful approaches, methods and tools are identified. The paper also identifies and assesses the approaches, methods and tools that have merit for further use, without or with further improvements. Lessons learned as well as success stories and success factors are documented. These findings are reflected in principles designed to assist harmonisation of approaches to VRiA assessment. These principles, in turn, influence the development of a proposed higher-level framework and approach for VRiA assessments. It accommodates the various approaches, methods and tools commonly used with success in the Pacific.
Aim Children with developmental coordination disorder (DCD) are known to participate in active play less than typically developing children. However, it is not known whether the activity deficit ...between children with and without DCD widens or diminishes over time.
Method Data were obtained from a large, prospective cohort study of children (baseline n=2278, total n=2470). Motor coordination was assessed for 2083 students using the short form of the Bruininks–Oseretsky Test of Motor Proficiency. Participation in organized and free‐play activities was assessed using a participation questionnaire on five occasions over 3 years. Mixed‐effects modelling was used to examine differences in participation over time between children with probable DCD (pDCD, n=111, 46 males, 65 females) and their typically developing peers (n=1972, 1016 males, 956 females). The mean age for the whole sample was 9 years 11 months (SD 5mo) at assessment 1, 10 years 5 months (SD 5mo) at assessment 2, 10 years 11 months (SD 5mo) at assessment 3, 11 years 4 months (SD 4mo) at assessment 4, and 11 years 11 months (SD 4mo) at assessment 5.
Results Children with pDCD reported less participation in organized and free‐play activities than their typically developing peers, and these differences persisted over time. Among males, the gap in participation in free‐play activities between those with DCD and typically developing children diminished substantially over time; among females, it increased slightly.
Interpretation DCD is associated with a persistent activity deficit in children. Its effect on participation appears to be particularly serious among females but may diminish with time among males.
Several trials have studied the role of unconventional fractionated radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this ...meta-analysis was to assess whether this type of radiotherapy could improve survival.
Randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic HNSCC were identified and updated individual patient data were obtained. Overall survival was the main endpoint. Trials were grouped in three pre-specified categories: hyperfractionated, accelerated, and accelerated with total dose reduction.
15 trials with 6515 patients were included. The median follow-up was 6 years. Tumours sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III–IV disease (International Union Against Cancer, 1987). There was a significant survival benefit with altered fractionated radiotherapy, corresponding to an absolute benefit of 3·4% at 5 years (hazard ratio 0·92, 95% CI 0·86–0·97; p=0·003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at 5 years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1·7% with total dose reduction at 5 years, p=0·02). There was a benefit on locoregional control in favour of altered fractionation versus conventional radiotherapy (6·4% at 5 years; p<0·0001), which was particularly efficient in reducing local failure, whereas the benefit on nodal control was less pronounced. The benefit was significantly higher in the youngest patients (hazard ratio 0·78 0·65–0·94 for under 50 year olds, 0·95 0·83–1·09 for 51–60 year olds, 0·92 0·81–1·06 for 61–70 year olds, and 1·08 0·89–1·30 for over 70 year olds; test for trends p=0·007).
Altered fractionated radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation has the greatest benefit.
Background
Femoroacetabular impingement (FAI) has been recognized as a common cause of hip pain as well as a cause of hip arthritis, yet despite this, little is known about the etiology of the cam ...morphology or possible risk factors associated with its development.
Questions/purposes
The purposes of our study were to determine when the cam morphology associated with FAI developed in a cross-sectional cohort study of pediatric patients pre- and postphyseal closure using MRI and whether increased activity level during the period of physeal closure is associated with an increased likelihood that the cam deformity will develop.
Methods
Alpha angles were measured at the 3 o’clock (anterior head-neck junction) and 1:30 (anterosuperior head-neck junction) positions in both hips with a cam deformity defined as an alpha angle ≥ 50.5° at the 3 o’clock position. Forty-four volunteers (88 hips) were studied: 23 with open physes (12 females, mean age 9.7 years; 11 males, age 11.7 years) and 21 with closed physes (five females, age 15.2 years; 16 males, age 16.2 years). Daily activity level using the validated Habitual Activity Estimation Scale was compared for patients in whom cam morphology did and did not develop.
Results
None of the 23 (0%) patients prephyseal closure had cam morphology, whereas three of 21 (14%, p = 0.02; all males) postclosure had at least one hip with cam morphology. Daily activity level was higher (p = 0.02) for patients with the cam morphology (7.1 hours versus 2.9 hours). Mean alpha angles at the 3 o’clock head-neck position were 38° (95% confidence interval CI, 37.2°–39.1°) in the open physes group and 42° (95% CI, 40.16°–43.90°) in the closed physes group; at the 1:30 head-neck position, they were 45° (95% CI, 44.0°–46.4°) in the open physes group and 50° (47.9°–52.3°) in the closed physes group.
Conclusions
The fact that cam morphology was present exclusively in the closed physeal group strongly supports its development during the period of physeal closure with increased activity level as a possible risk factor.
Level of Evidence
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
This article advocates for a dynamic and comprehensive understanding of vulnerability to climate‐related environmental changes in order to feed the design of adaptation future pathways. It uses the ...trajectory of exposure and vulnerability (TEV) approach that it defines as ‘storylines of driving factors and processes that have influenced past and present territorial system exposure and vulnerability to impacts associated with climate variability and change.’ The study is based on the analysis of six peer‐reviewed Pacific island case studies covering various geographical settings (high islands vs low‐lying reef islands, urban vs rural) and hazards associated with climate variability and change; that addressed the interactions between natural and anthropogenic driving factors; and adopted multidecadal past‐to‐present approaches. The findings emphasize that most urban and rural reef and high islands have undergone increasing exposure and vulnerability as a result of major changes in settlement and demographic patterns, lifestyles and economies, natural resources availability, and environmental conditions. The article highlights three generic and successive periods of change in the studied islands’ TEV: from geopolitical and political over the colonization‐to‐political independence period; to demographic, socio‐economic, and cultural from the 1960s to the 1980s; culminating in the dominance of demographic, socio‐economic, cultural, and environmental drivers since the 1980s. Based on these empirical insights, the article emphasizes the existence of anthropogenic‐driven path‐dependency effects in TEV, thus arguing for the analysis of the temporal dimensions of exposure and vulnerability to be a prerequisite for science to be able to inform policy‐ and decision‐making processes toward robust adaptation pathways. WIREs Clim Change 2017, 8:e478. doi: 10.1002/wcc.478
This article is categorized under:
Climate and Development > Social Justice and the Politics of Development
South Tarawa atoll, Kiribati (credit: V.K.E. Duvat)
The South Tarawa Urban District (STUD), stretching 35 km on the southern rim of Tarawa Atoll in Kiribati (Central Pacific), experienced a dramatic increase in its Trajectory of Exposure and Vulnerability (TEV) to climate‐related hazards over the last decades to century, mainly due to the centralization of political power, key services and work opportunities, and to population growth, which have all together caused widespread environmental degradation. More generally, it illustrates the processes at work in Pacific atolls’ urban districts and islands. This article advocates for a temporal and comprehensive understanding of the main drivers of TEV to climate‐related environmental changes so as to capture latency phenomena in social systems and related path‐dependency effects. The paper then concludes for the TEV approach to be a pre‐requisite for science to be able to inform policy‐ and decision‐making processes towards robust adaptation pathways.
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