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The COVID-19 pandemic forced surprised governments worldwide to act fast and decisively, often revealing lack of preparation for this kind of situation. However, such crises are expected to occur far more frequently than ever before. To keep societies prospering, governments, administrations, and civil servants will have to adapt quickly and effectively—and hence need to develop the required capabilities (e.g., appropriate policies, strategies, knowledge, skills). To deepen our understanding of appropriate action in face of crises, resulting consequences for stability and required, demanded or enforced behavior of people, we propose the concept of resilience. Resilience, we argue by way of five propositions, helps articulating the underlying dynamics in society and its administrative systems in order to allow for a sustainable incorporation of the long-term perspective in the short-term strategy, particularly in times of disturbances and temporary perturbations.

textabstractWe set out to develop a method and research technique that could unite both modelling and case-based observations in order to analyse collective decision-making processes. Following Abbott’s (2001) recommendation regarding social processes, we have defined collective decision-making as an uninterrupted and non-directional process that is structured in sequences or lineages of events. To structure these processes, we re-modelled the basic components of Kauffman’s (1993) NK-model. We converted N to ‘problem and solution definitions’ (PSDs) and K to ‘connectedness’ between actors (c_score). An important modification is that we consider NK to be a dependent configuration; i.e., K entails both content and process. Fitness is defined as the probability of an actor achieving (elements of) its PSD as a result of its adaptive moves in relation to the adaptive moves of others. The model is put to the test in four different studies: (1) 20 years of decision-making in planning, building and servicing HSL-Zuid high-speed railways in the Netherlands; (2) the strategic search process of villages and cantons in the Gotthard region of Switzerland; (3) the redevelopment of a football stadium and the surrounding area in south Rotterdam, the Netherlands; and (4) the rise and fall of the Airport RailLink in Bangkok, Thailand. From these studies, we derived six archetypes in collection decision-making, subdivided into actor archetypes and interaction archetypes. For the actor archetypes, behavioural consistency is not just a trait for the actor but also affects the space of possibilities and/or behaviours of other actors. The interactions of individual actors combine to produce self-propagating dynamics that drive the further evolution of the collective decision-making process. The fitness field model enables researchers to investigate the various dimensions of the collective decision-making process – ranging from individual strategies and actions to variation, selection and retention of contents, from interactions to fitness gains and losses, and back again.

While essentially heteronormative, the world of Her’s male protagonist, Theodore Twombly, is complicated by the operating systems, sexual surrogates, blind dates, images, and phone sex aficionados he attempts to be intimate with, to which can be added his estranged wife and the romcom ideal in plain sight, Amy. This chapter explores Theodore’s interactions with seven of the film’s women: his wife, Catherine; ‘Samantha’; ‘SexyKitten’; Amy; his blind date; Samantha’s surrogate, Isabella; and a sexy pregnant TV star he glimpses briefly on a screen, and then incorporates into a phone sex session that turns from fantasy to horror. It investigates the complicated relationship between intimacy and authenticity in a future we are already beginning to inhabit.

In the United Kingdom, genetic counsellors work together with clinical geneticists and clinical scientist colleagues within specialist genetics services, but they also often work in multidisciplinary teams (MDTs) outside of such services. There, they contribute genetic knowledge together with expert understanding of how to communicate genetic information effectively. They can offer education and support to the MDT, while providing management advice for both affected patients and the extended at-risk family members. As genomic technologies are implemented across many disciplines within healthcare, genetic counsellors are playing a key role in enabling non-genetic health professionals learn, understand and integrate genomic data into their practice. They are also involved in curriculum development, workforce planning, research, regulation and policy creation - all with the aim of ensuring a robust evidence base from which to practise, together with clear guidelines on what constitutes competence and good practice. The Association of Genetic Nurses and Counsellors (AGNC) in The United Kingdom (UK) and Republic of Ireland is committed to supporting genetic counsellors, across all sectors of healthcare and research, as they help deliver genomic medicine for the patient, family and world-class health services.European Journal of Human Genetics advance online publication, 22 March 2017; doi:10.1038/ejhg.2017.28.

Summary Background Germline pathogenic variants in the E-cadherin gene ( CDH1 ) are strongly associated with the development of hereditary diffuse gastric cancer. There is a paucity of data to guide risk assessment and management of families with hereditary diffuse gastric cancer that do not carry a CDH1 pathogenic variant, making it difficult to make informed decisions about surveillance and risk-reducing surgery. We aimed to identify new candidate genes associated with predisposition to hereditary diffuse gastric cancer in affected families without pathogenic CDH1 variants. Methods We did whole-exome sequencing on DNA extracted from the blood of 39 individuals (28 individuals diagnosed with hereditary diffuse gastric cancer and 11 unaffected first-degree relatives) in 22 families without pathogenic CDH1 variants. Genes with loss-of-function variants were prioritised using gene-interaction analysis to identify clusters of genes that could be involved in predisposition to hereditary diffuse gastric cancer. Findings Protein-affecting germline variants were identified in probands from six families with hereditary diffuse gastric cancer; variants were found in genes known to predispose to cancer and in lesser-studied DNA repair genes. A frameshift deletion in PALB2 was found in one member of a family with a history of gastric and breast cancer. Two different MSH2 variants were identified in two unrelated affected individuals, including one frameshift insertion and one previously described start-codon loss. One family had a unique combination of variants in the DNA repair genes ATR and NBN . Two variants in the DNA repair gene RECQL5 were identified in two unrelated families: one missense variant and a splice-acceptor variant. Interpretation The results of this study suggest a role for the known cancer predisposition gene PALB2 in families with hereditary diffuse gastric cancer and no detected pathogenic CDH1 variants. We also identified new candidate genes associated with disease risk in these families. Funding UK Medical Research Council (Sackler programme), European Research Council under the European Union's Seventh Framework Programme (2007–13), National Institute for Health Research Cambridge Biomedical Research Centre, Experimental Cancer Medicine Centres, and Cancer Research UK.

The pace of societal change and the development of societal challenges have speeded up considerably during the last couple of decades, with substantial impact on different levels, i.e. ranging from global to local, or from business to government. When focusing on the public domain, these changes and challenges have had a major impact on public professionals, who face different and frequently changing questions. Mid-career programs in Public Administration (MPA) have the mission to support enrolled professionals in dealing with these changes and challenges. This article is about the development of such MPAs. Both substantive and didactic development is needed. To counter institutional inertia it seems vital to institutionalize a regular rethinking and adaptation of curricula and didactic strategies. This article identified some important points of attention and some options to deal with these in order to continuously improve the contribution of MPA programs to relevant and effective professional development and ongoing professional learning.

Research and teaching are the main substantive activities of university staff members. How are both areas connected to each other? What is the role of research in teaching? How can research be used to improve the quality and impact of teaching? This is exactly what this special issue of Teaching Public Administration is about. Everybody will agree that one of the core tasks of teaching staff at the public administration departments of universities consists of conducting and publishing research, as well as teaching students about the discipline. However, research and teaching do not always seem to match. Life inside the classroom seems to be becoming increasingly detached from the research that is being undertaken by the teachers themselves. However, students could greatly benefit from a stronger connection between research and teaching. First of all, a connection between or the integration of research and teaching may help students to become research-minded and to perform actual research more adequately. Methods courses and dedicated research assignments are, of course, essential, but more inclusive integration of research into teaching may help students to gain a better feeling for which methods could or should be used when, and for how data may be interpreted. Secondly, a research orientation in teaching may help students to become more critical and reflexive. On an academic level, ‘knowledge’ should not be taken for granted, but its base, presuppositions and meaning, should be subject to debate. Students should socialize in a culture in which such debate, and their creative participation in it, is self-evident. The purpose of this special issue is to bring together contributions that deal with issues on incorporating research into teaching programs. [...]

Following the 1953 flood, the Dutch delta has been shut off from the sea by a series of dams and dykes. This closing-off transformed the delta from a constantly changing estuarine environment into a freshwater body. A different way of thinking about ‘nature’ in the period 1970–1980 led to the policy proposal to transform the Haringvliet, one of the shut-off water bodies, back to its natural state. The intended first step was a minor change in the sluice control of the dam that separates the Haringvliet from the sea. However minor, this step was never taken and it is still an ongoing policy debate whether the sluice should be slightly opened or not. This paper presents a coevolutionary analysis of why such a seemingly small change could take so much time and effort to become actualized. We demonstrate that the course of the policy process is determined through patterns of reciprocity between the physical and societal systems. Effects of measures are unpredictable, and the desired state of this water basin greatly varies between actors and over time. It is a combination of these factors that explains why the sluice control has not been changed yet.

There are no national recommendations for routine screening for sickle cell trait, nor is there guidance on whether or how to notify donors that they might be tested or identified as having sickle cell trait. As a result, the organizations that collect blood have implemented variable policies about whether and how to inform prospective donors of the possible screening and discovery of this noncommunicable condition. The question of what they should do is related to the broader question of how to handle incidental and secondary findings. In a recent report, the Presidential Commission for the Study of Bioethical Issues outline a framework for handling such findings in the clinical, research, and direct-to-consumer contexts. While the commission's report did not directly address incidental and secondary findings in the public health context of blood donation, it made several overarching recommendations that apply in all contexts where such findings might arise. This essay outlines the special issues raised by discovering sickle cell trait in blood donation and considers the implications of the commission's framework for that problem.

Most definitions of nonalcoholic fatty liver disease (NAFLD) allow some intake of alcohol but little attention has been paid to the possible contribution of alcohol-derived calories in the overall daily intake. The aim of the present study was to determine whether, in a group of 144 patients referred to liver outpatients with NAFLD, a more structured questioning of dietary habits and alcohol consumption would provide better information on alcohol-derived and dietary-derived calorie intake and the relationship with the BMI.Both food intake and calories resulting from alcohol ingestion were frequently underestimated as was the percentage of patients who were drinking excessively (30 U a week), which was surprisingly high at 40%. The substantial calorie intake resulting from alcohol consumption in this group was associated with a reduction in dietary calorie intake, so that the total daily calorie intake remained similar to those with low-to-moderate or no alcohol consumption. The findings also showed that the BMI, although still elevated, was significantly reduced in those drinking heavily compared with low and nondrinkers.Patients with NAFLD can have substantially higher levels of alcohol consumption than usually recognized. The additional calorie intake resulting from this is to some extent balanced by a reduction in dietary calorie intake with less elevation in BMI, and a clear distinction from an alcohol-induced steatosis may be difficult.

This article focuses on the nodal orientation of the Dutch police, which is an innovative and controversial target of Dutch policing. This target states that the police should focus on flows and on places where the various flows coincide. The Dutch interpretation of the nodal orientation combines a perspective on policing in infrastructural networks with one that considers the police as a player in (social) security networks. Nodal policing in the Netherlands has been introduced as a ‘sensitizing’ and evolving concept. This article describes a selection of evolving nodal policing practices and discusses the strategic and normative implications for Dutch policing that arise from these practices.

Background Experience with miniaturized coronary artery bypass (CAB) systems in coronary artery bypass graft (CABG) surgery on the beating heart is limited. We used a relatively new miniaturized cardiopulmonary bypass (CPB) system, which we termed assisted CAB (ACAB), to perform CABG on the beating heart in 110 patients, and we analyzed clinical outcomes in this patient group. Methods Between January 2004 and September 2006, we used ACAB to perform CABG on the beating heart in 110 patients. The mean patient age was 73 +/- 8.1 years. The ACAB system uses a small prime volume of only 500 mL, and the circuit is shorter than that used in conventional CPB. In addition, the tubing and oxygenator systems were surface-coated with phosphorylcholine. The initial heparin dose was 150 IU/kg, with a target activated clotting time of >250 seconds. With this management, none of the patients experienced system thrombosis. We did not use cardioplegia or aortic crossclamping and did not routinely retransfuse cardiotomy blood. Observational data for the 110 patients were analyzed. Results The mean number of anastomoses performed was 2.67. The rate of perioperative infarction was 1.8% (2 patients). Perioperative mortality was 7% (8 patients). The mean EuroSCORE for all patients was 6.4 +/- 4, whereas it was 13.75 +/- 6.18 for the patients who died. Mean CPB time was 64.96 +/- 16.66 minutes. Conclusion In our experience, beating heart CABG supported by a miniaturized CPB is a safe procedure with acceptable perioperative results.

What can KM do for corporate memory, management thinking, and IS responsibility, as well as for overall business performance?

This chapter describes the introduction of intervention teams that were set up to tackle problems of public safety, order and social problems. This innovative coordination practice originated in the city of Rotterdam in the Netherlands. Since 2001, local intervention teams have been operating in the city in order to strengthen public safety and social cohesion and to provide services to citizens. The assumption is that public safety problems can sometimes be better tackled if the private situations of people that have trouble organizing their lives or cause nuisance are taken into account. A typical strategy to tackle such problems is through house calls (Istha, 2009). During such house calls several aspects are investigated in an integrated approach. Besides checking on the situation, care is also offered when necessary. This means that law enforcement and care are practiced in combination. The intervention teams are part of the so-called Collaborative Approach Enforcement Property & Person (CAE), which gathers several services of Rotterdam: Public Affairs, Social Welfare, City Development, Customs, City Surveillance and the Safety Directorate.

Aims: To test the hypothesis that regional variations in the prevalence of alcoholic liver disease are contributed to by regional variations in ‘softness’ of drinking water, i.e. its mineral content. Methods: Annual hospital admission rates for alcoholic liver disease per 100,000 population in the 28 Strategic Health Authorities (SHAs) existing in England over the period 2003–2006 were compared with regional measures of water hardness, alcohol consumption and social deprivation. As corroborative evidence, the same relations were examined for hospital admission rates for osteoporosis, a disorder with an already established link with calcium deficiency in drinking water (as well as with heavy drinking). Results: Hospital admissions rates for alcoholic liver disease were higher in predominant-soft-water SHAs than with hard water SHAs. These areas, with one exception, were also associated with high alcohol consumption, but not with greater social deprivation. Hospital admission rates for osteoporosis were found to vary in a way similar to that for alcoholic liver disease, with significant correlations with soft water and alcohol consumption. Conclusion: Given experimental evidence that magnesium deficiency can aggravate liver damage from alcohol, soft water with its low magnesium concentration may be a factor additional to alcohol consumption in the development of liver damage. The parallel findings with osteoporosis admissions, explainable by low calcium and magnesium levels present in soft water, along with the known effect of heavy drinking on bone metabolism, provide corollary support for the hypothesis linking soft water with the pathogenesis of these two diseases.

markdownabstract__Abstract__ 1977 was an important year for the Dutch police as it was then that a seminal strategy document called ‘A Changing Police was published that would set the course for the next three decades. The writers of the report felt that for the police to bridge the growing gap between them and the society they serve, they would have to be innovative, and think outside of their usual security paradigms. They found their solution in community policing and the strategy document laid out the framework for Community Policing (COP) in the Netherlands. This document was widely considered a milestone in the development of Dutch policing (see Cachet et al. 1998). However, by 2005, the Dutch Board of Chief Commissioners felt it necessary to publish a new strategy document to once again map out the future of Dutch Policing. After nearly three decades, the Dutch police was again in need of a shared philosophy that would serve as a foundation for their mandate. This new document was titled ‘The Police in Evolution’ (PIE) but it stayed true to the values of COP by once again focusing on the local community and stressing community policing. In this paper we explore the establishment and development of Dutch COP. We look at several distinct phases in the long term development of Dutch COP, and examine the factors that explain the shifts that have taken place in the way Dutch COP is carried out. We ask also about the prospects of Dutch COP in the future. The paper will consist of four sections. In the first Section, we examine the historical roots and the development of Dutch COP since its inception in 1977. In Section 2, we look at the current state of affairs for COP in the Netherlands. In the third section, we put forward several explanations for the significant shifts that have taken place over the course of the COP’s 30-year history. In the fourth section, we discuss the prospects for Dutch COP in the coming years. Section 5 presents our conclusions.

textabstractWe connect the idea of 'levers for change' with 'governance capacity' and propose 'adaptive networks' as an ideal type embedded in, and leveraging change in, governance systems. Discourses connect practices of citizens and companies with that governance system. Aware of interdependencies, individuals may act in the interest of the whole system and self-organize into adaptive networks, and influence discourses to a common end. Their effectiveness depends on second-orderedness: adaptive networks in niches outside the governance system may influence it through levers. The motivation and competence to build creative tension helps adaptive networks emerge and coevolve with power networks, improving governance capacity.

OBJECTIVE: One of the major and devastating complications of the coronary artery bypass grafting (CABG) is the stroke. Avoiding cardiopulmonary bypass (CPB) may reduce this neurological complication. In the past years there was an increased interest in the off-pump coronary artery grafting (OPCAB). The benefit of this method of revascularization in term of stroke and mortality is controversially discussed. METHODS: A retrospective analysis of collected data from 252 patients were operated without cardiopulmonary bypass out of 1516 CABG procedures from January 2004 through May 2006. The mean age of the patient population was 70±11years, within a range of 27-88 years. Forty-eight (19%) patients were older than 80 years and there were 172 (69%) males. Mean graft per patient was 1.78±0.79. The internal mammary artery (IMA) graft was used in 95% of the patients. For eight (3.17%) patients this was the second procedure. RESULTS: Hospital mortality was 3.17%; Mean EuroSCORE in these patients was 10.36±6.67. No neurological complications occurred, six (2.38%) patients had temporary psycho syndrome. Postoperative myocardial infarction occurred in three (1.19%) patients. Two patients required rethoracotomy as a result of bleeding. Thirty-eight (15%) patients needed postoperative therapy for atrial fibrillation. CONCLUSION: CABG with OPCAB technique has the benefit of low mortality and morbidity in terms of stroke. The advantages of this technique depends on the patient's general condition at the time of the operation, the sufficiency of pump function and coronary morphology, as well as on the surgeon's experience. OBJETIVO: Uma das principais e devastadoras complicações da revascularização do miocárdio é o acidente cerebrovascular. Evitar a circulação extracorpórea (CEC) pode reduzir essa complicação neurológica. No passado, houve um interesse crescente na cirurgia de revascularização do miocárdio sem circulação extracorpórea. O benefício deste método de revascularização com relação ao acidente cerebrovascular e à mortalidade ainda é discutido de forma controversa. MÉTODOS: Uma análise retrospectiva dos dados coletados de 1.516 pacientes submetidos à cirurgia de revascularização do miocárdio, de janeiro de 2004 a maio de 2006, dos quais 252 pacientes que foram operados sem circulação extracorpórea. A média de idade da população da amostra foi de 70±11 anos, variando de 27 a 88 anos. Quarenta e oito pacientes (19%) tinham mais de 80 anos e 172 pacientes (69%) eram homens. O número médio de transplante por paciente foi de 1,78±0,79. A artéria torácica interna (ATI) foi usada em 95% dos pacientes, enquanto que para oito pacientes a ATI foi o segunda procedimento. RESULTADOS: A mortalidade hospitalar foi de 3,17%; o EuroScore médio nesses pacientes foi de 10,36±6,67. Não ocorreram complicações neurológicas, porém, seis pacientes (2,38%) tiveram psicossíndrome temporária. Infarto do miocárdio ocorreu em três pacientes (1,19%) após a cirurgia. Dois pacientes precisaram fazer uma nova toracotomia por motivo de sangramento e 38 (15%) de tratamento para fibrilação atrial após a cirurgia. CONCLUSÃO: A cirurgia de revascularização do miocárdio sem circulação extracorpórea apresenta o benefício da baixa mortalidade e morbidade com relação ao acidente cerebrovascular. As vantagens dessa técnica dependem da condição geral do paciente na época da cirurgia, da suficiência da função da bomba e da morfologia coronária, bem como da experiência do cirurgião.

This report has been modified from one presented to the Wellington City Council and sets out observations and conclusions gained from a visit to San Francisco and the area affected by the Loma Prieta Earthquake which struck the San Francisco Bay area on 17 October 1989. I visited the area from 29 November to 8 December 1989. The earthquake occurred at 5.04pm local time and was measured at 7.1 on the Richter scale. It was located 16km NE of Santa Cruz and 30km south of San Jose in the Santa Cruz mountains, 100 km south of San Francisco City. Sixty two people were killed, 994 homes destroyed with 18,000 not occupiable immediately after the earthquake. 155 businesses were destroyed and 2,500 businesses closed temporarily. Cost of damage is estimated at between 6.5 and 10 billion US dollars. San Francisco City suffered a major visitor decline after the earthquake. I attended as one of three members of the New Zealand National Society for Earthquake Engineering "Follow Up" Reconnaissance team for the purpose of establishing what damage had occurred to sewer and stormwater systems, water supply systems and gas utilities. My visit was funded by the Wellington City Council and was mostly devoted to study of sewer and stormwater systems.

Background Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK. Administration of chemoprophylaxis to close contacts reduces the risk of a secondary case. However, unnecessary chemoprophylaxis may be associated with adverse reactions, increased antibiotic resistance and removal of organisms, such as Neisseria lactamica, which help to protect against meningococcal disease. Limited evidence exists to suggest that overuse of chemoprophylaxis may occur. This study aimed to evaluate prescribing of chemoprophylaxis for contacts of meningococcal disease by general practitioners and hospital staff. Methods Retrospective case note review of cases of meningococcal disease was conducted in one health district from 1st September 1997 to 31st August 1999. Routine hospital and general practitioner prescribing data was searched for chemoprophylactic prescriptions of rifampicin and ciprofloxacin. A questionnaire of general practitioners was undertaken to obtain more detailed information. Results Prescribing by hospital doctors was in line with recommendations by the Consultant for Communicable Disease Control. General practitioners prescribed 118% more chemoprophylaxis than was recommended. Size of practice and training status did not affect the level of additional prescribing, but there were significant differences by geographical area. The highest levels of prescribing occurred in areas with high disease rates and associated publicity. However, some true close contacts did not appear to receive prophylaxis. Conclusions Receipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions. High publicity appears to increase demand for prophylaxis. Some true contacts do not receive appropriate chemoprophylaxis and are left at an unnecessarily increased risk.

Mr Thakore and colleagues (March 2002 JRSM1) conclude that 55% of calls for emergency ambulances did not merit an immediate response. As they acknowledge, the design of the study was not ideal. The initial reason for the request was determined from ambulance crew and accident and emergency (A&E) data after the patient had been seen. This will almost inevitably introduce bias when applying the triage criteria, and the assessment should have been blinded. Also, it is much easier to make such determinations in hindsight, with additional time and clinical information, than when faced with a real call when one has to consider the consequences of the decision reached. It is surprising that this paper makes no reference to priority-based dispatch systems, such as the Advanced Medical Priority Dispatch System (AMPDS), as these are currently used by most ambulance services in the UK. These systems have been shown to have a low risk of serious under-prioritization of life-threatening episodes2. However, work that we have undertaken in Nottingham suggests that they may not be very effective in predicting low-priority 999 calls3. The NHS Executive has stressed the importance of developing telephone prioritization systems that will free ambulance services from having to respond to ‘patients who dialled 999 but who do not need emergency care’4. We believe this may be difficult to achieve. Appropriate and effective telephone triage on non-emergency 999 calls requires a greater understanding of the relationship between the initial telephone assessment by ambulance control and the subsequent outcome of the individual call. Without these data we will not be able to ensure that such a system could operate safely and we endorse the authors' views that prospective studies are essential to assess the feasibility of accurately identifying lower priority calls.

George Orwell has attained something akin to the status of a cultural icon, ironic given the myth of him as an iconoclast. While Animal Farm and Nineteen Eighty-Four account for much of this acclaim, Orwell's essays also contribute significantly, and the writer enjoys an honored place in the pantheon of essayists. Seen by some, though not all, as a clear-eyed teller of unpleasant truths, Orwell could also write endearing, perceptive, and unselfconscious pieces about postcards, tea-making, and toads. His essays are used frequently as mortar to support blocks of biographical or psychological speculation, the result of a supposed difficulty in separating the writer and his writings. The very title of Orwell's essay "Why I Write" seems to cry out for such treatment, and the cry has often been answered. In this foregrounding the writer, however, the periodical context in which and for which Orwell wrote his essays often has been ignored. Yet where Orwell wrote is scarcely less important than why he wrote. An indication of the periodical's importance comes from Orwell himself. "The mentality of the English left-wing intelligentsia can be studied in half a dozen weekly and monthly papers," he claims in his 1941 essay "The Lion and the Unicorn" (74).(1) Given that a year earlier his "Boys' Weeklies" had mapped out the terrain for a survey of boys' magazines, the comment signals an abiding interest in the periodical press. In the later essay, however, Orwell comes not to praise the weeklies and monthlies but to bury them - or, at least, to rough them up a little. He declares, "The immediately striking thing about all these papers is their generally negative, querulous attitude, their complete lack at all times of any constructive suggestion" (74). Orwell names no names (thus damning all), but a paragraph later suggests some suspects, lashing the New Statesman and Nation and the News Chronicle for colluding in the "intellectual sabotage from the Left" of English morale. The accusation carries serious implications, Orwell charging that as a result of this sabotage "Fascist nations judged that [the English people! were 'decadent' and that it was safe to plunge into war" (75). Inflammatory stuff, certainly, but there remains an intriguing and telling twist. In the same month in which Orwell was writing "The Lion and the Unicorn," his short, appreciative study of the Victorian novelist Charles Reade appeared. What surprises is not the subject of this essay but the site of publication: the allegedly negative, querulous, unconstructive New Statesman and Nation. Clearly, Orwell was not frightened to bite the hand that fed him (admittedly, the New Statesman and Nation provided only occasional sustenance) but more productive insights can be drawn. First, Orwell acknowledges the centrality of periodicals and papers to the thinking of the English left-wing intelligentsia in the 1930s and 1940s. Young readers of Magnet and Gem were not the only group affected by the periodical press. Second, and more important, he uses those same organs to broadcast his own ideas. The significance of the periodical to the development and transmission of his opinions, however, has largely gone unrecognized. This despite the fact that Orwell's association with periodicals can be traced back to the very beginnings of his writing career. Indeed, periodicals provided that start. For nearly two years before the publication in 1933 of his first book, Down and Out in Paris and London, his writing (reviews, articles, and essays) appeared only in journals and weeklies. Reviewing the second number of the periodical New Writing in 1936, Robert Waller notes that Orwell, who had contributed "Shooting an Elephant," "is an Adelphi discovery" (188). Since Waller was writing in The Adelphi, this claim to a promising young author lacks a certain impartiality. Nevertheless, the boast contains a sizable element of truth, Orwell's (then Eric A. Blair's) sketch "The Spike" having been published in The Adelphi in 1931. …

Granular cell myoblastoma is an uncommon tumor in the respiratory tract. It usually occurs in the tongue, skin, breast, or subcutaneous tissue. When it occurs in the respiratory tract, it is usually located in the bronchus or larynx. Primary tracheal location is rare with only nine such cases reported in the literature. This report describes a 26-year-old woman with granular cell myoblastoma of the trachea. She presented with a four-year history of bronchial asthma. The tumor was surgically excised by tracheal resection and reconstruction. The patient has remained well and free of obstructive airway symptoms, without recurrence of the tumor for more than one year.

Ten patients with acromegaly, six with active acromegaly and four with inactive acromegaly were studied with regard to the possible relationship between aldosterone metabolism and hypertension. It was noted that tetrahydroaldosterone-3-glucuronide levels were highest in those cases which exhibited the highest prolactin levels. It was in these cases that hypertension was present and they were active as judged by clinical and biochemical parameters. On administration of bromocryptine there was a reduction of tetrahydroaldosterone-3-glucuronide, prolactin and also a significant reduction of blood pressure. The significance of these results is discussed.

Ten patients with hypertension and obesity were studied during a program of weight loss on an unrestricted sodium diet. The study showed that weight loss during the ten month period was accompanied by a significant decrease in urinary aldosterone, tetrahydroaldosterone -3-glucuronide and plasma renin activity values. It was also demonstrated that successful reduction in body weight was associated with a reduction in blood pressure. It is postulated that blood pressure reduction in obese patients during weight reduction may depend on decreases in aldosterone and plasma renin activity. The reduction in levels of tetrahydroal-dosterone-3-glucuronide is due to an energy related depression of the glucuronidation process caused by carbohydrate deficiency. It is postulated that the lowered rate of metabolism of aldosterone as measured by the diminished formation of the metabolite tetrahydroaldosterone-3-glucuronide is an important determinant of blood pressure status during weight reduction.

SummaryThis paper investigates the recalculation from its base date of theFinancial TimesIndex of Industrial Ordinary Shares (hereafter called theFTIndex) using the ordinary arithmetic mean of the values of its constituents, rather than the geometric mean that is actually used in its calculation. The value of this arithmetic version of theFTIndex represents that of a portfolio invested equally in each of the original constituents at the base date. The behaviour of the recalculated index may therefore be described in portfolio terms.The arithmeticized index has been calculated at each end-year since the base date of theFTIndex (1 July 1935). By the end of 1970 its value was 38% higher than that of the (geometric)FTIndex. The percentage by which the new index exceeded the original was found to have increased approximately linearly with time; a least-squares linear fit over the whole period indicated that the percentage excess of the arithmetic version over the original index had increased on average by 0·8% a year. A separate fit for the period from end-1960 onwards shows that this rate had increased to 2·7% per year, and even over the period since 1950, it has been 1·1% per year. Use of these relationships gives a rough adjustment of theFTIndex for portfolio comparison purposes.We also calculated a series of arithmetic indices with base dates at the end of each year since the original base date of theFTIndex. In the majority of calendar years since its foundation, theFTIndex has not fallen far behind the corresponding arithmetic version over the twelve month period. However, over periods of more than a year, the geometric and arithmetic indices can show dramatically different results, particularly if the percentage change in the index value is considered. It is clear that longer-term changes in the value of theFTIndex cannot be interpreted as the changes that would have occurred in the value of a portfolio equally invested in the thirty constituent shares at the beginning of the period.None of these findings affects the usefulness of theFTIndex for its original purpose, as a sensitive daily indicator of changes in the industrial ordinary share market. It is purely its long-run use as a portfolio standard that is misleading. For this purpose the more recently instituted arithmetic indices are likely to be useful in the future. Meanwhile, our arithmeticizedFTIndex values may be useful to correct the downward drift imposed on theFTIndex by its geometric construction.

Summary Two cases are described who developed epileptic seizures whilst taking maprotiline hydrochloride in therapeutic dosage. In both cases the electroencephalogram was normal and the fits stopped on withdrawal of the drug.

Summary Two cases of severe thyrotoxicosis are described. They both exhibited choreo-athetoid movements which were abolished by successful treatment of the thyrotoxicosis. It is suggested that the tremor of mild thyrotoxicosis is one end of a spectrum at which choreo-athetosis is at the most severe end. A tentative explanation of this hypothesis is given in the discussion.

Marks, P. (1974). Thorax , 29 , 248-251. Multiple thoracotomy for metastatic pulmonary neoplasm. Surgical excision of solitary, metastatic, malignant lesions of the lung is reported as of benefit in certain cases in which the primary tumour apparently has been completely removed and in which there is no evidence of further metastatic spread. It has been shown that in a few instances survival for many years may be expected to follow such a procedure, while at other times the degree of palliation of pulmonary symptoms makes the operation worthwhile. Two patients who had metastatic lung deposits successfully removed are described. Further pulmonary metastases, without evidence of metastases elsewhere or recurrence of the original lesion, were resected. In both cases remarkable palliation of symptoms was afforded and both are alive at the time of writing (1 November 1973).

A system is described for the recording and measurement of human body shape by a series of circular ultrasound scans. Computer manipulation of the echo data provides a graphic display of body contour, and a measurement of total body surface area and volume. The theoretical resolution for distance measurements using this device is 2.5 mm, a figure achieved in practical calibration experiments using a metal test object. Measurements from the body surface, although less precise, are sufficiently accurate and reproducible to enable useful clinical information to be obtained, particularly in recording the morphological changes associated with obesity and malnutrition.

Out of 102 patients with cardiac infarction admitted to the coronary care unit at this hospital and not treated with anticoagulants 30 (29%) developed isotopic evidence of deep vein thrombosis. Of the 65 smokers only 7 (11%) developed a deep vein thrombosis, whereas of the 37 non-smokers 23 (62%) developed a deep vein thrombosis. This difference is highly significant (P < 0·00001).

Purpose One ambition of most mid-career MPA programmes is to combine the attainment of an academic master degree with a qualitative leap in professional skills and functioning. This ambition requires that academic insights and methods be sensibly linked to real-life professional contexts and challenges. This chapter develops a rationale to enhance conditions and mechanisms that help to produce such linking, based on insights in professional learning. Design/methodology/approach Two methods used in the mid-career MPA programme at Erasmus University Rotterdam to help students to establish such links will be discussed. The first method involves an evolving personal learning agenda and the second method involves peer-to-peer coaching. Both methods will also be used to evaluate the added value of the programme for the professional functioning of the students. Findings The MPA programme makes students link theory to their own real-life practice and changes their perspective on analysis and professional intervention. Often, however, these new perspectives are quite general in nature, not taking much account of the specific context. Thorough lecturer feedback and training in peer consultation may help students to become more reflexive and to develop better situation-specific strategies. Practical implications The findings point to the need for further development of didactical strategies. Originality/value The chapter analyses professional added value of an academic programme.

Ten patients with severe myxœdema were treated with regular increments of thyroxine. The urine aldosterone excretion rate and plasma-aldosterone level increased with each increasing dose of thyroxine. Two patients in whom the serum-aldosterone rose to abnormally high levels had cardiac failure which resolved when the thyroxine dose was reduced.

A case of aspiration pneumonia due to incoordination of swallowing is described. Its aetiology lies in the myopathy of thyrotoxicosis and a tentative hypothesis as to its causation is suggested.