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The concluding chapter begins by summarizing the main findings of how politicians balance pressures arising from the economy, national politics, and supranational politics when they design and implement the economic policy of the European Union. With different emphasis, these pressures resurface across time and cut across the entire policy cycle, from the formation of preferences to the negotiations over legislative and executive measures, the timing and direction of reforms, and the patterns of compliance. The chapter then draws some tentative, yet interesting, insights about the effectiveness, fairness, and responsiveness of the policy. The record of effectiveness is mixed. Long-term trends appear reasonably reassuring, but these dynamics hide large cross-country differences, which, rather worryingly, characterize mainly the euro area. There are, however, no glaring indications of unfairness. Concerns about negative externalities have trumped the influence of raw economic power in implementation. Moreover, the policy is not insensitive to changes in public opinion and governmental positions. The chapter concludes by highlighting the usefulness of this theoretical framework.
The second part of the book investigates the implementation of the policy. As far as preventive surveillance is concerned, at its core lay the country-specific recommendations on the macroeconomic policies of the member states. These recommendations are the object of intense negotiations between the Commission and the Council. Why are they a matter of bargaining? What shapes the Council’s propensity to modify the Commission’s proposals and what affects their strengthening or weakening? This chapter employs bargaining and compliance theories to address these questions. Analyzing the recommendations issued between 1999 and 2019, it shows that the Council is rather active in modifying the Commission’s assessments and strengthens four-fifths of the recommending provisions that it decides to modify. Economic and supranational factors dominate this process. Governments balance the pressures originating from the bargaining dynamic within the Council with the need to preserve policy credibility and effectiveness in the face of noncompliance and worsening economic conditions.
The introduction explains the book’s argument that individuals impacted by the repercussions of interstate disputes dealt with by the Court should and can be further integrated into its procedure and considered in its legal reasoning. Through the lens of social idealism, it explains how the Court’s effectiveness and legitimacy may be compromised due to its reluctant approach towards individuals. It also clarifies the method, methodology, scope, and structure of the book.
This chapter concludes the monograph, summarizing the main reflections offered throughout and reflecting on the future of the relationship between the individual and the International Court of Justice.
In the post-World War II era, international lawyers have occupied the front seat in the study of international organisations (IOs). During the past decade, this disciplinary hierarchy has grown to feel increasingly unsatisfying. This chapter offers an anthropological take on the study of IOs building both on the past decade of anthropological work and my ethnography at the UN Human Rights Committee. IOs are frequently accused of ineffectiveness embedded in endless paper-pushing techniques. In this chapter, I engage with these criticisms and ask: can we find another perspective from which to assess effectiveness? What happens if we stop investing our analytical attention in what we think IO operations and their desired ‘impacts’ should be and instead engage in non-normative inquiries into what IOs actually do? I explore what can we learn about IOs’ visions for world improvement by focusing on the legal technicalities and material forms that define their operations. I propose that, instead of a hindrance or distraction, these forms embody ‘standards for a better world’ that are an essential component of IOs’ civilising mission.
Exposure and response prevention (ERP) is the first-line psychological treatment for obsessive compulsive disorder (OCD). Recent research shows that the Bergen 4-day Treatment (B4DT), which is a concentrated ERP program, can be very effective. However, this intensive format has not been widely implemented, and it is unclear whether positive outcomes are unique to B4DT, or whether a similar intensive ERP program (not based on B4DT) is equally effective. We examined short- and long-term outcomes of the Melbourne Intensive Treatment-OCD (MIT-O) program, an out-patient intensive ERP program for OCD involving an intensive phase of four full-day sessions conducted over two weeks, and a supportive 21-day phase involving self-directed tasks and twice-a-week check-in calls with the therapy team. Participants were 21 individuals with OCD. The severity of OCD, depression, anxiety, stress, obsessive beliefs, and emotion regulation difficulties were assessed at four time points (pre-treatment, post-treatment, 6-month, and 12-month follow-up). Results showed a large and significant decrease in OCD and obsessive beliefs at post-treatment. These improvements were maintained at 12-month follow-up. Using international consensus criteria for treatment response, almost all participants (90.5%) showed at least partial treatment response and one-third were in remission at the final assessment. These results showed that the MIT-O program was effective, but post-treatment and 12-month remission rates were somewhat less favourable than previously published results from the B4DT program. Nevertheless, the MIT-O post-treatment outcomes were comparable to other CBT programs for OCD and should be considered when other longer term treatment formats such as in-patient treatments are not feasible.
Key learning aims
(1) To evaluate the effectiveness of an intensive exposure and response prevention program in reducing obsessive compulsive disorder (OCD) symptoms.
(2) To examine the long-term maintenance of treatment gains at 6-month and 12-month follow-up assessments.
(3) To report the treatment response rate and remission outcomes achieved through the intensive format.
(4) To consider the broader implementation of intensive exposure and response prevention programs as an alternative format for OCD treatment.
People with non-communicable diseases (NCDs) have a higher prevalence of comorbid depression than the general population. While previous research has shown that behavioural activation is effective for general depression, its efficacy and safety in treating depression associated with NCDs remains unclear.
Aims
To compare the efficacy and safety of behavioural activation against comparators in reducing depression symptoms in people with NCDs.
Method
We searched six databases from inception until 30 March 2023 (updated 23 September 2024) for randomised controlled trials (RCTs) comparing behavioural activation with comparators for depression in people with NCDs. Risk of bias was assessed using the Cochrane Collaboration’s ‘risk-of-bias 2 tool’. We calculated a random-effects, inverse-variance weighting meta-analysis.
Results
Of the 21 386 initial studies, 12 RCTs (with 2144 patients) comparing behavioural activation with any comparator on treatment outcomes for depression with comorbid NCD met the inclusion criteria. Six studies rated as low risk of bias. For short-term follow-ups (up to 6 months), meta-analysis showed behavioural activation had little effect on depression symptom improvement in people with NCDs (Hedges’ g = −0.24; 95% CI, −0.62 to 0.15), compared to comparators, with high heterogeneity (I2 = 91.91%). Of the 12 included studies, three RCTs provided data on adverse events occurring during the trial.
Conclusions
Evidence from this systematic review is not sufficient to draw clear conclusions about the efficacy and safety of behavioural activation for reducing depression symptoms in people with NCDs. Future reviews need to include more high-quality, well-designed RCTs to better understand the potential benefits of behavioural activation for comorbid depression.
Public acceptability is crucial for the effectiveness of policy implementation. The carbon trading market is widely adopted by many countries and regions to achieve carbon neutrality and mitigate climate change. Our paper utilizes China's carbon trading market as a quasi-natural experiment, drawing on microdata from the China Residential Energy Consumption Survey to analyze the policy's impact on public acceptance of carbon pricing. We find that the carbon trading market significantly reduces the acceptability of carbon prices among households working in carbon-related industries in the pilot areas. This conclusion is still valid after a series of robustness checks. Regarding the mechanism of influence, the carbon trading market raises households' perceived costs, mainly reflected in the negative impact of rising product prices and increasing living costs. Finally, enhancing public perception of carbon, improving the distribution effect and decreasing the information asymmetry of the policy implementation can improve public acceptability of carbon prices.
Since the 1950s, the United Nations (UN) has designated days (e.g., World Wetland Day), years (e.g., Year of the Gorilla) and decades (e.g., Decade on Biodiversity) with a commonly stated goal to raise awareness and funding for conservation-oriented initiatives, and these Days, Years and Decades of ‘…’ (hereafter ‘DYDOs’) continue. However, the effectiveness of these initiatives to achieve their stated objectives and to contribute to positive conservation outcomes is unclear. Here we used a binary analysis change model to evaluate the effectiveness of UN conservation-oriented DYDOs observed between 1974 and 2020. We also examined four case studies to understand the different strategies employed to meet specified conservation goals. We found that DYDOs apparently contributed to positive conservation outcomes when they were tied to social media campaigns and/or when they were strategically situated in current events or global discourse. Although the outcomes of DYDOs were varied, those with longer timescales and those that engaged local communities were more likely to be successful. We suggest that DYDO organizers should identify all possible paths of action through the lens of the change model outlined in this paper to strengthen the value and effectiveness of these initiatives in the future. Using this approach could help ensure that resources are used efficiently and effectively, and that initiatives yield positive conservation outcomes that benefit people and nature.
This book provides a comprehensive analysis of biases inherent in contemporary clinical research, challenging traditional methodologies and assumptions. Aimed at students, professionals, and science enthusiasts, the book delves into fundamental principles, research tools, and ethics. It is organized in three sections: The first section covers fundamentals including framing clinical research questions, core research tools, and clinical research ethics. The second section discusses topics relevant to clinical research, organized according to their relevance in the development of a clinical study. Chapters within this section examine the strengths and limitations of traditional and alternative methods, ethical issues, and patient-centered consequences. The third section presents four in-depth case examples, illustrating issues across diverse health conditions and treatments: gastroesophageal reflux disease, hypercholesterolemia, screening for breast cancer, and depression. This examination encourages readers to critically evaluate the methodologies and assumptions underlying clinical research, promoting a nuanced understanding of evidence production in the health sciences.
This chapter discusses policy implications that flow from comprehensive deterrence theory (CDT). The account points to many implications. Perhaps foremost is the conclusion that there simply is insufficient research to ground deterrence-based policies. There are, though, other equally important implications. The chapter argues that, based on CDT, many deterrence-based policies are likely to be ineffective and may increase rather than decrease crime. At the same time, it is likely that deterrence-based policies can be effective, but only under certain conditions. We extend this reasoning to argue that CDT can be used to inform deterrence-based policies in jails and prisons as well as schools.
Chapter 2 presents the current institutional framework, with a special focus on the exercise of the legislative function. After a brief presentation of the most relevant institutional principles, notably those of effectiveness, institutional balance, and sincere cooperation, the chapter turns to the Parliament, the Council, and the Commission and explains their prerogatives and internal structures in the light of the concept of “executive federalism.” The chapter shows that the legislative institutions of the EU, in line with the principles of autonomy and internal differentiation, allocate important preparatory tasks to different internal bodies (that is, parliamentary committees, Coreper, and GRI) and analyzes the role of those bodies in the adoption of legislation.
International organizations have issued recommendations and prescriptions on constitution-making and reform, especially since 1989. However, such constitution-shaping activities by European and universal organizations, notably the UN, have for the most part not led to a better operation of the rule of law on the ground. Besides these problems of effectiveness, normative concerns against constitutional assistance and advice by international organizations have been raised. It is suggested that, in order to become more legitimate (which might then also improve effectiveness), constitution-shaping by international organizations needs to absorb postcolonial concerns. This includes respect for local rule-of-law cultures flowing from non-European constitutional thought and the inclusion of a much deeper social agenda with a global ambition. Thus revamped, international organizations’ constitution-shaping role could be reinvigorated so as to sustain the rule of law on the domestic level, thereby contributing to transnational ordering and global constitutionalism.
Talent Management: Selecting and Preparing Leaders for Global Assignments examines how organizations select and prepare global leaders for effective assignments. An effective mobility program allows development of global leaders. The chapter identifies the personal characteristics for an international assignee and conditions necessary for an effective international assignment. Family responsibilities as well as a spouse’s/partner’s career and employment issues continue to be reasons candidates turn down assignments. To increase flexibility, multinationals have increased the use of “flexpatriates” in nonstandard international assignments. Effectiveness is the ability to live and work effectively in the cultural setting of an assignment. Effectiveness is a function of Professional expertise, Adaptation, Intercultural interaction, and Situational readiness and is reflected in a formula: E = f (PAIS). The international assignment of female executives has become an important consideration as more women have graduated from business schools and are in line for senior management and international careers. Training should be a function of the degree of cultural exposure that will be experienced. Culture shock, acculturative stress, can be a reason for failure to adapt to the host country. Duty of Care and an organization’s responsibilities to employees are discussed.
Whilst behavioural activation (BA) is an empirically supported treatment for depression, some patients do not benefit. The aim of this study was to evaluate the effectiveness of two treatment augmentations to an extant manualized 8-session group version of BA. The two treatment augmentations were (a) dose–response psychoeducation to improve attendance and (b) implementation intentions to improve clinical outcomes. A cohort comparison design in routine practice comparing standard group BA (n=31, drawn from a sample of n=161, from 22 BA groups) with treatment-augmented group BA (n=31 from 3 BA+ groups). There was no effect of the two treatment augmentations on attendance or in overall mean reductions to depression (mean improvement difference=2.2), anxiety (mean improvement difference=1.9) or impaired functioning (mean improvement difference=1.5). Rates of reliable improvement in depression were significantly higher for augmented BA (odds ratio=3.21 for BA+ compared with BA). Efforts should be made to still improve outcomes for empirically supported interventions, with any treatment augmentations tested in well-controlled studies.
Key learning aims
(1) To learn about the utility of adapting existing treatments as opposed to developing new treatments.
(2) To learn about the potential of propensity score matching in the analysis of routinely collected datasets.
(3) To learn about delivery of behavioural activation in groups.
(4) To better understand how to enhance and evaluate treatment protocols using theoretically informed and low-cost treatment augmentations.
To assess the effectiveness of the ‘Weet wat je eet’ (‘Know what you eat’) school-based nutrition education programme on behavioural determinants and behaviour among students aged 12–15 years. A quasi-experimental study design was used, collecting data at baseline and after implementing the programme in both an intervention and control group (in total 611 students) across the Netherlands. Students from eighteen Dutch secondary education schools completed two consecutive questionnaires, assessing knowledge, self-efficacy, attitude, subjective norm, intention, and behaviours related to healthy, safe, and sustainable nutrition. Multilevel regression analyses were conducted corrected for gender, grade, education level, and school location. The intervention group showed a significant higher increase in self-efficacy, attitude, intention to drink water (all three P < 0.01), and a significant higher decrease in the consumption of sugary drinks, snacks, and meat (all P < 0.05) than the control group. Both the groups scored significantly higher on knowledge during the post-test (both P < 0.05), although the intervention group not significantly higher than the control group (P = 0.14). No significant effects were observed for subjective norm, intention, and fruit, vegetable, and whole grain bread consumption. The results of this study showed positive effects of the ‘Weet wat je eet’ school-based nutrition education programme on self-efficacy and attitude towards healthy, safe and sustainable nutrition, intention to drink more water, and various healthy eating behaviours among secondary school students. Further research is necessary to assess the long-term sustainability of these results.
In this chapter, we describe the most important policy evaluation criteria that can be used to choose the appropriate mix of energy and climate policy instruments. We give space to economic efficiency, effectiveness, macroeconomic effects, equity, acceptability, enforceability, and administrative practicability. In the second part of the chapter, we present a simple overview of the most important economic models that can be used to estimate the impact of the introduction of energy and climate policy measures, such as applied general equilibrium models and integrated assessment models. Further, we provide a short introduction to some policy evaluation methods such as randomised controlled trials, difference-in-difference, and regression discontinuity designs that can be used to evaluate policy effectiveness.
This chapter advanced the analytical framework of the book, which revolves around the role of the state in governing large-scale decarbonization through collaborative climate governance with interactions of non-state and sub-state actors, networks and multi-stakeholder partnerships in the various governance relations. We provide a coherent framework rooted in theoretical and conceptual debates on the multitude of relations between the state and non-state actors in the governance of climate change. By connecting these governance relations to three evaluative themes of the politics of decarbonization (justice, effectiveness, and legitimacy), we theorize how the state shapes decarbonization processes in a landscape of non-state and sub-state climate action. The chapter situates the book’s contributions to the wider scholarship and highlights the theoretical debates that the empirical chapters will revisit.
Healthcare is inextricably bound to productivity, efficiency, and economic development. Although many methods for analyzing productivity and efficiency have been extensively covered, relatively little focus has been placed on how those methods can be applied to health care in a coherent and comprehensive manner. The Cambridge Handbook of Healthcare outlines current foundations and states of the art on which future research can build. It brings together experts in this growing field to cover three key sources and aspects of human welfare – productivity, efficiency, and healthcare. Beginning with academic focused chapters, this book bridges and provides outreach to the practice and regulation of the health care industry and includes academic and regulatory perspectives, including overviews of major evidence from international empirical applications. Each chapter is dedicated to a particular topic and delivered by international experts on that topic.
Though it is derived from individual thriving, community thriving cannot be reduced to the aggregate of individual experiences. Rather, community thriving is defined as the function of a community’s sustainability and its effectiveness at producing well-being outcomes. An overview of community concepts related to thriving, thus defined, is offered, and the implications of well-being, fairness, and worthiness in a community context are detailed. The chapter concludes with specific historical illustrations and steps readers can take to enhance the thriving of their own communities.