Ernst Toller : from Einheitsfront to Volksfront. The development of Toller's political ideology (1919-1939)

This thesis examines the development of the political outlook of the German author and revolutionary politician, Ernst Toller. It begins by looking at Toller's early years and explains how his experience as a front-line soldier during the First World war transformed his views, causing him to reject the conservative-nationalist ethos he had grown up with and to become, in his own description, a revolutionary pacifist. It then looks at his involvement in the revolutionary events which took place in Bavaria at the end of the First World War, the so-called Räterepublik, examines how they affected his understanding of social and political reality and traces their artistic reflection in the plays he wrote in the following period. A recurrent theme in Toller's political thinking throughout the years of the Weimar Republic was the idea of an Einheitsfront, a defence block of workers' organisations, which he advocated as the only means of halting the rise of National Socialism. Unfortunately, Toller's appeals to the main workers' parties to form such a block went unheard, yet they are significant all the same in that they reveal the acute political insight of a man whom many of his contemporaries dismissed as a hopeless utopian. Interestingly, and a point often missed in studies of his politics, Toller abandoned the Einheitsfront after he went into exile in 1933 and came to favour instead the creation of a Volksfront a broad, cross-party anti-fascist coalition which the Soviet Union vigorously promoted all through the 1930s until the signing of the Stalin-Hitler Pact in 1940. Toller's support for this idea, in part a corollary of his support for the Soviet Union itself, had a profound impact on his political outlook in exile, and caused him to close his eyes to the repression suffered by the opponents of the Stalin regime both inside and outside Russia, and, most significantly, led him to ignore the nascent socialist revolution which flourished in Spain after the defeat of Franco's coup d'etat in 1936. This study examines in some detail, therefore, Toller's involvement in the Volksfront, redefines his attitude towards Communist Russia and shows how his efforts to suppress his revolutionary beliefs and to become instead a mere anti-fascist affected his creative spirit during his years of exile

CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label,parallel-group, multicentre trial

Background The benefi t of CT coronary angiography (CTCA) in patients presenting with stable chest pain has not been systematically studied. We aimed to assess the eff ect of CTCA on the diagnosis, management, and outcome of patients referred to the cardiology clinic with suspected angina due to coronary heart disease. Methods In this prospective open-label, parallel-group, multicentre trial, we recruited patients aged 18–75 years referred for the assessment of suspected angina due to coronary heart disease from 12 cardiology chest pain clinics across Scotland. We randomly assigned (1:1) participants to standard care plus CTCA or standard care alone. Randomisation was done with a web-based service to ensure allocation concealment. The primary endpoint was certainty of the diagnosis of angina secondary to coronary heart disease at 6 weeks. All analyses were intention to treat, and patients were analysed in the group they were allocated to, irrespective of compliance with scanning. This study is registered with ClinicalTrials.gov, number NCT01149590. Findings Between Nov 18, 2010, and Sept 24, 2014, we randomly assigned 4146 (42%) of 9849 patients who had been referred for assessment of suspected angina due to coronary heart disease. 47% of participants had a baseline clinic diagnosis of coronary heart disease and 36% had angina due to coronary heart disease. At 6 weeks, CTCA reclassifi ed the diagnosis of coronary heart disease in 558 (27%) patients and the diagnosis of angina due to coronary heart disease in 481 (23%) patients (standard care 22 [1%] and 23 [1%]; p<0·0001). Although both the certainty (relative risk [RR] 2·56, 95% CI 2·33–2·79; p<0·0001) and frequency of coronary heart disease increased (1·09, 1·02–1·17; p=0·0172), the certainty increased (1·79, 1·62–1·96; p<0·0001) and frequency seemed to decrease (0·93, 0·85–1·02; p=0·1289) for the diagnosis of angina due to coronary heart disease. This changed planned investigations (15% vs 1%; p<0·0001) and treatments (23% vs 5%; p<0·0001) but did not aff ect 6-week symptom severity or subsequent admittances to hospital for chest pain. After 1·7 years, CTCA was associated with a 38% reduction in fatal and nonfatal myocardial infarction (26 vs 42, HR 0·62, 95% CI 0·38–1·01; p=0·0527), but this was not signifi cant. Interpretation In patients with suspected angina due to coronary heart disease, CTCA clarifi es the diagnosis, enables targeting of interventions, and might reduce the future risk of myocardial infarction. Funding The Chief Scientist Offi ce of the Scottish Government Health and Social Care Directorates funded the trial with supplementary awards from Edinburgh and Lothian’s Health Foundation Trust and the Heart Diseases Research Fund

Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic, The Scottish computed tomography of the heart (SCOT-HEART) trial:study protocol for randomized controlled trial

&lt;p&gt;Background: Rapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina. Despite this important service provision, coronary heart disease continues to be under-diagnosed and many patients are left untreated and at risk. Recent advances in imaging technology have now led to the widespread use of noninvasive computed tomography, which can be used to measure coronary artery calcium scores and perform coronary angiography in one examination. However, this technology has not been robustly evaluated in its application to the clinic.&lt;/p&gt; &lt;p&gt;Methods/design: The SCOT-HEART study is an open parallel group prospective multicentre randomized controlled trial of 4,138 patients attending the rapid access chest pain clinic for evaluation of suspected cardiac chest pain. Following clinical consultation, participants will be approached and randomized 1:1 to receive standard care or standard care plus ≥64-multidetector computed tomography coronary angiography and coronary calcium score. Randomization will be conducted using a web-based system to ensure allocation concealment and will incorporate minimization. The primary endpoint of the study will be the proportion of patients diagnosed with angina pectoris secondary to coronary heart disease at 6 weeks. Secondary endpoints will include the assessment of subsequent symptoms, diagnosis, investigation and treatment. In addition, long-term health outcomes, safety endpoints, such as radiation dose, and health economic endpoints will be assessed. Assuming a clinic rate of 27.0% for the diagnosis of angina pectoris due to coronary heart disease, we will need to recruit 2,069 patients per group to detect an absolute increase of 4.0% in the rate of diagnosis at 80% power and a two-sided P value of 0.05. The SCOT-HEART study is currently recruiting participants and expects to report in 2014.&lt;/p&gt; &lt;p&gt;Discussion: This is the first study to look at the implementation of computed tomography in the patient care pathway that is outcome focused. This study will have major implications for the management of patients with cardiovascular disease.&lt;/p&gt