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With the rapid development of artificial intelligence, work and leisure is expected to change, and human creative competence is expected to be increasingly important, partly for the workplace and the economy, but also for thriving and well-being. There is some interest in fostering creative competence in mathematics, where it is seen as relating largely to mathematical problem solving, when solutions are not matters of routine, at least for the student. Early studies, however, indicate little impact on teaching, which has tended to adhere to past practices without creative competence being an explicit goal or provision for achieving it. A belief that such a competence will grow undirected and unaided, or that it is only for the gifted student goes against current views of creative potential. Such beliefs could present obstacles to change, yet seem to have received little explicit exploration. This study aimed to identify some of the obstacles to fostering mathematics undergraduates’ creative thinking arising from tutors’ notions of mathematical creativity and its place in education. The views of twenty-two UK university mathematics tutors were collected and collated by phenomenographic analysis, a qualitative method designed to identify categories of belief. This showed latent potential problems arising from differences in the tutors’ beliefs about creativity (e.g. creativity being in the process or the product), and about its origin (e.g. creativity arising from nature or nurture). Adding these to students’ beliefs increases reservations about a readiness to foster students’ creative competences in mathematics. Ways of overcoming these obstacles are suggested. We felt it essential that mathematicians have a common understanding of mathematical creativity, and that certain myths about creative abilities are corrected. These understandings need to be shared with students, and provision made for fostering their creative thinking at a macro level (e.g. courses and workshops) and a micro level (e.g. rubrics to guide thinking). Collaborative creative thinking is also valued in the workplace. It would add to students’ assets if this provision included opportunities to practise it.

Tissue expansion of free flaps before transfer have been used to increase the size of the transferred tissue and to allow primary closure of the donor site. This is especially important in burns when there is a lack of healthy tissue, and in children when there is a relative lack of tissue. In this study the authors present their 17-year experience with tissue-expanded free flaps. Between 1985 and 2002, 14 cases of tissue expansion of free flaps before transfer were performed at the authors' institution. The indications for vascularized tissue were 9 facial defects (8 severe burns and 1 neurofibromatosis), 3 large lumbosacral ulcers resulting from spina bifida, 1 large vulvoperineal defect resulting from resection for Chron disease, and 1 large circumferential tissue defect at the lower extremity resulting from tumor extirpation. The flaps were 6 radial forearm, 4 parascapular, and 4 lateral arm free flaps. Tissue expanders were placed under the subcutaneous plane between the deep fascia and the muscle layer, preserving the pedicle architecture and integrity. The size of the tissue expander ranged from 250 to 700 mL and expansions were done either weekly or biweekly for a 10- to 20-week period. The patients were followed for 1 to 17 years. The outcome of the study was based on donor and recipient site morbidity, rate of complications, patient satisfaction, and long-term outcome of the donor and recipient sites. There was no failure in any of the transferred tissue at the recipient site and no tissue loss. Three patients had transient congestion of the free flaps, which resolved without any intervention. In all patients the donor area was closed primarily. One black patient had hypertrophic scar formation at the radial forearm donor site requiring reexpansion and primary closure. In other patients the scar was acceptable. One patient had an infection at the tissue expander site that was treated with removal of the implant and transfer of the free flap to the recipient defect the following day. In 4 patients with facial burns, posttransfer tissue expansion of the free flap at the recipient site was performed for minor revisions at later dates. All patients had good outcomes and were satisfied with the procedure. Preexpansion of free flaps is an effective but underused method. It is safe in terms of complications, results in a better appearing donor site scar, and allows transfer of larger amounts of tissue in patients with tissue deficiency.

The Grand Deception: Churchill and the Dardanelles. By Tom Curran, edited by Andrew Bonnell (Newport, NSW: Big Sky Publishing, 2015), pp.318. Fourteen illustrations and two maps. AU$34.99 (cloth).

In late November 1917, Lord Lansdowne, one of the most senior of British Unionist politicians, wrote a letter to the editor of the Daily Telegraph. The letter asked for the war aims of the Entente and the USA to be “coordinated” and suggested that a moderate revision of war aims might bring a negotiated peace nearer. The letter appeared to ally Lansdowne with the British Radicals, who had been close to President Wilson (until April 1917), and had argued for a negotiated peace to end the war since the autumn of 1916. The letter was ferociously denounced by the Northcliffe press, and by many of Lansdowne's Unionist colleagues. It was supposedly a “plea for surrender” and “a national misfortune”. Nevertheless, it touched off a series of new departures in the search for a negotiated settlement: House's visit to the inter Allied Conference in December, the Labour War Aims Memorandum, Lloyd George's Caxton Hall speech, Wilson's Fourteen Points Address, and the beginning of a public parley with the Central Powers in the replies of Hertling and Czernin in January 1918. The paper examines the possibilities for a negotiated peace during the winter of 1917–1918, that is, in the period between the publication of Lansdowne's famous letter and the sudden Versailles “Knockout Blow” Declaration of February 1918 which rejected out of hand any prospect of negotiation. The paper examines Wilson's ambiguous position in this debate, and in particular the evolution of moderate opinion inside Germany in reaction to these events. The paper suggests the unfortunate enfeeblement of moderate opinion in Germany in the face of the apparent triumph of “knockout blow” opinion in the Entente camp.

A medullary thyroid cancer (MTC)/multiple endocrine neoplasia syndrome was suspected in a patient having an metaiodobenzylguanidine (MIBG) scan while she was being investigated for pheochromocytoma. After surgery, this was confirmed histologically. Although MIBG scanning cannot be used as a screening tool for MTC because of its poor sensitivity for detection of MTC, this case report highlights that one should always scrutinize the thyroid gland while interpreting MIBG scans.

Cavernous angiomas although relatively common lesions rarely reach a large size. They have a well documented association with AVMs, capillary telangiectases and venous angiomas but are not specifically associated with intracerebral aneurysms. We present a case of what we believe to be the 4th largest reported giant cavernous angioma to present in adulthood. This cavernous angioma also happened to be associated with a large intracerebral aneurysm, an association not previously reported. The sometimes confusing nomenclature of cavernous angiomas and other similar vascular malformations is also discussed.

We describe an unusual case of sarcoidosis in which the patient presented with a discrete solitary parotid mass and no other manifestation of the disease. The diagnosis was based on the unexpected pathologic findings during examination of a superficial parotidectomy specimen. To the best of our knowledge, no such presentation has been previously reported in the English-language literature.

Bringing order to chaos The world presents us with a confusion of objects. We seem inclined to order these objects according to their similarities. So, for instance, we divide people into men and women; events into past, present and future; and cutlery into knives, forks and spoons. Organising the world like this reduces its complexity, enables a more parsimonious description of it, and reduces the burden of thought to what can be managed. Organising the world's objects may be something we are inclined to do, but objects can be organised in a variety of ways. Cutlery, for instance, can be sorted into plastic, metal and wooden items, long and short items, or knives, forks and spoons. Which is best? The answer, of course, depends on what you want to do. If you want to turn a hot coal, the first would be relevant; if you want to prise the lid from a can, the second would apply; if you want to eat dinner, the last would be appropriate. In other words, organisation and purpose go hand-in-hand (Bailey, 1994). An organisation that helps you do what you want is useful and can have survival value. Here, we are concerned with kinds of thinking and how they have been organised. A particular aim is to assess the potential of these organisations for supporting thought about thinking, especially amongst those who want students to develop some proficiency in thinking.

Overview This chapter reviews the potential contribution of the various frameworks, models and taxonomies presented in the book and summarises a number of issues which have arisen. It examines how various taxonomies can inform and support differing aspects and areas of education. It will summarise some problems inherent in classification and theoretical models of thinking. We highlight evidence from meta-analysis to show that thinking skills approaches can be very effective, especially those targeted at the skills of metacognition and self-regulation. Turning to matters of theory, we note a degree of rapprochement between cognitive, constructivist and some recent behaviourist formulations. However, we do not believe that it has been established that meaningful learning can take place only when there is a low level of teacher direction (Hattie, 2002). We point out that a great deal of educational practice is based on sets of widely accepted but usually untested beliefs, values and assumptions. Finally, we outline the value of a practical four-category framework (information gathering; building understanding; productive thinking; strategic management/reflective thinking) that has arisen from our work in this field. Thinking, learning and teaching Everyone who is involved in learning needs to have some understanding of its nature and purpose. A framework for understanding thinking and learning can be used at different levels; for example, as a general guide to the formulation of a mission statement or in formulating specific learning objectives and precise assessment items.

Introduction Every instructional design system is underpinned in some way or other by a theory of learning and a way of ‘knowing’ or ‘seeing’ the world. While learning theory describes and attempts to explain how people learn, the main aim of instructional design is to provide guidance on the practical task of designing learning experiences. Placing instructional design theorists on an epistemological continuum, behaviourist systems lie towards the positivist end of the scale and the post-modernist concern with critical theory at the opposite pole. Nearer the centre, but still on the positivist side, are the cognitivists, with their combination of positivism and interpretation. Close by, but nearer to the post-modern end of the scale, are the constructivists, with their orientation towards interpretation and criticism. While ‘behavioural objectivists’ see learning largely in terms of response strengthening, ‘cognitivists’ tend to explain it in terms of knowledge acquisition, and ‘constructivists’ construe learning in terms of the dialogic generation of ‘constructions’. It is interesting to note that it was the more behaviouristic branches of instructional design which held most immediate appeal for the early–mid twentieth-century industrialists and educational policy-makers. One of the most popular branches of this approach to instructional design became known as ‘programmed instruction’.

Although the radial arterial system is fairly consistent in structure, rare anomalies have been encountered. During the elevation of a radial forearm free flap for floor of mouth reconstruction, the authors have encountered an accessory branch of the radial artery arising from the main radial artery at the level of the mid forearm, extending laterally over the brachioradialis muscle, and descending into the dorsal wrist in the subcutaneous plane. This artery, named as the superficial radial artery, is a very rare vascular anomaly of the radial arterial system in the forearm. The reconstructive surgery literature is relatively silent about this particular variant. Knowledge of possible anatomic anomalies and careful identification of vessels are important to prevent damage to the arterial system and enable optimal flap harvest.

Thirty-three consecutive patients with plantar soft-tissue defects were managed by a single surgeon (EDN) with reconstruction by a medial plantar artery (MPA)-based flap. Foot defects resulted from a combination of abnormal weightbearing distribution and neuropathy secondary to diabetes mellitus in all patients. A retrospective study of diabetic patients from 1984 to 1997 with foot defects reconstructed with a MPA-based flap were reviewed. Thirty-three patients (age 55 ± 9) with an average tissue deficit of 13 ± 9 cm 2 had MPA reconstruction of the heel ( n = 8), midfoot ( n = 23), and forefoot ( n = 2). The mean follow-up was 19 months (range, 3 months–5 years). There were four minor complications, including marginal flap necrosis or localized infection, although all healed uneventfully. There were six major complications resulting in loss of the flap and proximal amputation. Out of seven patients, there were 12 rerotations of the previously rotated flap. Various techniques for reconstruction of plantar foot defects have been described in the literature. Utilizing glabrous skin for reconstruction of these defects is appealing for its unique shear and pressure-resisting properties. Surgical management of diabetic foot defects with the medial plantar artery flap is an effective means of soft tissue reconstruction.

UNLABELLED The electroencephalogram (EEG) and middle latency auditory evoked responses (MLAER) have been proposed for assessment of the depth of anesthesia. However, a reliable monitor of the adequacy of anesthesia has not yet been defined. In a multicenter study, we tested whether changes in the EEG and MLAER after a tetanic stimulus applied to the wrist could be used to predict subsequent movement in response to skin incision in patients anesthetized with 1 minimum alveolar anesthetic concentration (MAC) isoflurane in N2O. We also investigated whether the absolute values of any of these variables before skin incision was able to predict subsequent movement. After the induction of anesthesia with propofol and facilitation of tracheal intubation with succinylcholine, 82 patients received 1 MAC isoflurane (0.6%) in N2O 50% without an opioid or muscle relaxant. Spontaneous EEG and MLAER to auditory click-stimulation were recorded from a single frontoparietal electrode pair. MLAER were severely depressed at 1 MAC isoflurane. At least 20 min before skin incision, a 5-s tetanic stimulus was applied at the wrist, and the changes in EEG and MLAER were recorded. EEG and MLAER values were evaluated before and after skin incision for patients who did not move in response to tetanic stimulation. Twenty patients (24%) moved after tetanic stimulation. The changes in the EEG or MLAER variables were unable to predict which patients would move in response to skin incision. Preincision values were not different between patients who did and did not move in response to skin incision for any of the variables. MLAER amplitude increased after skin incision. We conclude that it is unlikely that linear EEG measures or MLAER variables can be of practical use in titrating isoflurane anesthesia to prevent movement in response to noxious stimulation. IMPLICATIONS Reliable estimation of anesthetic adequacy remains a challenge. Changes in spontaneous or auditory evoked brain activity after a brief electrical stimulus at the wrist could not be used to predict whether anesthetized patients would subsequently move at the time of surgical incision.

We describe an unusual case of sarcoidosis in which the patient presented with a discrete solitary parotid mass and no other manifestation of the disease. The diagnosis was based on the unexpected pathologic findings during examination of a superficial parotidectomy specimen. To the best of our knowledge, no such presentation has been previously reported in the English-language literature.

On Monday 3 August 1914, the government of Joseph Cook authorised a cable to London offering an expeditionary force. The leaders of the Labor Party voiced no criticism. This article explores the background to Labor's acquiescence. In the context of a looming federal election, a number of factors came into play. As the international crisis opened, Liberals alleged that Labor would jeopardise Australia's security. Labor had been prominent in supporting Irish Home Rule in 1914, inviting charges of disloyalty. Andrew Fisher had been hurt politically by such charges in the recent past. The Labor leaders Fisher and Pearce were also aware that they had authorised planning for an expeditionary force when in office, 1910-13. Since the Boer War, Labor had retreated from suggestions that Australia might shun an imperial war. Instead, in fear of Asia, Labor preached absolute loyalty to Britain and the internationalist spirit remained weak in Labor's ranks.

of Irian Jaya, the part of New Guinea belonging to Indonesia. Together the two provinces comprise about 30,000 square miles, forming an irregular right-angled triangle, with the coast of the Bismarck Sea as its hypotenuse. The triangle is bounded by low ranges of hills and mountains, which surround a huge, level alluvial plain across which winds, from the west to the east, the broad and sluggish Sepik River, fed by tributaries from both north and south. The population consists of about 300,000 people divided by their use of separate languages into more than two hundred groups, which vary in numbers from a few with 40,000 people to several with less than a hundred. In the Sepik Provinces (Figure 1)1 214 Papuan languages are spoken, while a few Austronesian languages are found on the coast. The people were once as culturally diverse-a certain amount of homogenization has taken place in recent years-but some cultural features were so widespread as to be practically universal. For one, the Sepik people were notably warlike. As might be expected of people with basically neolithic cultures, their weaponry was limited to the usual archaic modes of piercing, crushing, and defense; they used spears, spearthrowers, shields, bows and arrows, clubs, slingshots, and-the present subject-daggers made of human or cassowary bone. The cassowary deserves a special introduction at this point: it is a large ratite bird resembling an ostrich or emu, which inhabits some eastern Indonesian islands, New Guinea, northern Australia, and New Britain (Figure 2). There are three species: the one commonly found in the Sepik Provinces is the Single-wattled or Northern Cassowary (Casuarius unappendiculatus). It is the largest land creature of the area, standing nearly as tall as the average man. It is, besides, an imposing sight in its black, wispy plumage, with its garishly colored head crowned by a bony casque, and its long single wattle conceptualized by the natives as a female breast. (Natural facts notwithstanding, the cassowary is always considered female.) The cassowary, moreover, is in both mythology and real life a large, dangerous, and aggressive

A retrospective review of 36 cases of lymphoma presenting as a salivary gland mass was conducted over a 34-year period. A significant increase in the occurrence of lymphoma was noted in proportion to other salivary gland tumors (P less than 0.01, chi 2 analysis: 1954-1972, 11 of 714 (1.5%); 1973-1979, 9 of 201 (4.5%); 1980-1987, 16 of 265 (6.0%). The mean age was 61 years, sex distribution was equal, and 75% occurred in the parotid. Only 42% presented with signs or symptoms other than a painless mass. Glandular excision was done in early stages of the disease while biopsy was done at later stages. Frozen section analysis was accurate in all but one case and was useful in determining if biopsy were adequate. All patients were definitively treated with chemotherapy and/or radiotherapy. Several instructive points are apparent. Any patient presenting with an isolated salivary gland mass can have a lymphoma. There has, in fact, been a significantly increasing proportion of salivary gland lymphoma among the various salivary gland tumors in our patient population. In contrast to other salivary gland tumors, surgery is reserved for diagnosis and not for treatment. A lymph node biopsy may be sufficient to establish a diagnosis, in which case, glandular excision is unnecessary. Most of the patients presented with an asymptomatic isolated salivary gland mass. The presence of adjacent adenopathy, a rubbery feel to the mass, and the intraoperative appearance were the most suggestive signs of lymphoma. Frozen section analysis is helpful in determining the appropriate extent of surgery and is recommended.

From March, 1979 to March, 1983, 26 orthotopic liver transplantations and 1 retransplantation were performed in our center. Sixteen patients are alive, 5 beyond 2 years and 1 longer than 4 years after transplantation. The actuarial 1- and 2-year survival is 60%. Factors contributing to this result are patient selection and biliary anastomosis. In cirrhotic patients, the degree of deterioration of liver function correlated with survival; in patients with hepatocellular carcinoma, extrahepatic spread of tumor was the most frequent limiting factor. Choledochocholedochostomy with a widening plasty had a low complication rate providing that the arterial blood supply was undisturbed. Until now, HLA-matching has not contributed to the result of liver transplantation, although the effect for long-term survival is still unknown. The high survival rate and excellent quality of life of long-term survivors justify liver transplantation as treatment for otherwise noncurable liver diseases.

The Iwam are a tribe living on the banks of the Sepik River and of the May River, one of its southern tributaries, in north-east New Guinea. The Iwam language is part of Laycock's Upper Sepik Stock, which itself is part of his Upper Sepik Phylum: this includes languages at a considerable distance to the east, northeast and north which are all widely separated from each other by speakers of Toricelli Phylum languages (see map, Fig. 2). The May River Iwam were discoverd by the Behrmann expedition of 1912-19131 which seems to have failed to contact the Sepik Iwam, who were then living inland. They were briefly visitied by the Crane expedition of 1929,2 but apart from adventurous traders and labor recruiters met few other westerners until the establishment of the May River Patrol Post in 1956. There are now altogether about 2,300 Iwam. Those of the Sepik River live in four large and rather widely separated communities, and both the language and culture show slight differences from those of the May River Iwam, with their more numerous (about thirteen), much smaller and more closely spaced settlements. The material culture of the Iwam is not radically different from that of their riverine neighbours, give or take a few minor items. They were (and to some extent still are) prolific artisits, making large numbers of paintings on sago spathes for the decoration of ceremonial houses, carved shields3, carved canoe prows, engraved lime gourds, and weapons. The art styles of all these river groups show a basic reliance on a small range of forms: two-dimensional surfaces are covered with a limited number of standardized abstract designs in bilaterally or biaxially symmetrical compositions. The wealth of anthropomorphic and zoomorphic representations which is such a striking characteristic of middle Sepik River art-and to which, indeed, it largely owes its considerable fame-simply does not exist. Even the small proportion of representations of birds and human heads found among the Wogumas, to the east, seems absent from Iwam art. In the last few years, however, a number of large and small wood silhouette carvings of cassowaries (Figs. 3, 4) have been collected in both Sepik River and May River Iwam villages. These seem at first glance foreign to the Iwam context; unlike the rest of the art style they are lopsided and asymmetrical, even though they have surface decoration in typical designs. One's first impulse is to suspect that they are nontraditional; a feeling which is buttressed by the discovery that since the Iwam have started carving shields for the tourist trade,4 they have also (though perhaps only after 1970) been making similar cassowaries for sale as well. However, the earliest collection date of one of these, to my knowledge, is 1962, some time before any extensive commercialization of Iwam art began. Cults of any kind seemed to have played much less spectacular roles among the Iwam than in other Sepik River areas, but it is evident that the cassowary was involved in at least one, and that the carvings were cult objects. Iwam informants state that formerly they were kept in the men's ceremonial houses, inside small individual screened shrines, in which were also stored the painted skulls of victims of headhunting raids (Fig. 5). These skulls were the "guardians" of the carving. The maker or owner slept in the shrine. Boys were initiated to the sight of the figures, which were regularly presented with offerings of food. All this was done, say the Iwam, to insure the fertility of cassowaries for food. So far, so good. The large figures can be seen as the sacra of a fertility and hunting cult, and the small carvings as personal charms probably employed to the same end. There are counterparts to dual use of large and small versions of the same cult-object in other Sepik cultures, notably the well known hook-figures (yipwon) of the Karawari River.5 But why the relationship to skulls, and why are the skulls decorated? Schuster reports that the designs with which the enemy skulls were painted were also cut into the hair of young girls at their first menstruation; a coincidence which he relates to coneeptions of a connection between death and fertility found in other headhunting areas of the world.6 Cassowaryhead-fertility (both of human beings and cassowaries) thus form an interconnected series of ideas. To take a Freudian view, one might think of the heads as phallic symbols; a suggestion not at all contradicted by the fact that some of the actual heads involved are explicitly female. On the contrary, it would merely be still another example of the Sepik penchant for endowing one sex with the attributes of another which, common in mythology, appears in its most overt form in the ritual transvesticism of the middle Sepik River latmul tribe.7 If however the heads (skulls) are to be considered symbolically male, to complete the pattern the cassowary should be symbolized as female. In fact, it is; but before pursuing this it will be as well to review some ornithological facts as well as local conceptions about these interesting creatures.

(1962). Tibor Bodrogi, Art in North-East New Guinea. Art Journal: Vol. 22, No. 2, pp. 130-132.