Rules, Prudence and Public Value: Public Servants and Social Media in Comparative Perspective

The reach of social media is prodigious. Its ubiquitous nature has reshaped the ways in which government agencies can communicate with citizens. But amidst the rush to embrace the opportunities of Twitter, Facebook and other platforms, governments have had to lay down rules to govern how and when public service departments should use social media. This article undertakes a comparative analysis of the formal rules and guidelines in place across four Westminster jurisdictions – Australia, New Zealand, Canada and the UK – to identify the types of behaviours and activities that are seen as desirable when public servants are reaching out to the wider public through social media. The article argues that the horizontal communication patterns associated with social media are fundamentally at odds with the hierarchical structures of the Westminster system of government.</jats:p

Sticky words? Towards a theory of rhetorical path dependency

Speech matters. Political actors are defined by what they say as much as by what they do but, with each rhetorical choice, they also narrow the range of rhetorical options open to them for the future. This paper examines the idea of path dependency, a well-established concept in the field of policy studies, and applies it to the study of political rhetoric. It argues that words are sticky, leaving political leaders caught between the desire to utilise fresh and engaging rhetoric to explain new policy choices and the reality that they cannot shake off the wording of their previous promises. In advancing a theory of rhetorical path dependency, the paper builds on the insights of both discursive institutionalism and rhetorical political analysis to suggest that whilst ideas are indeed vital to the shaping of institutions, the arguments that give those ideas shape can themselves be constrained by earlier choices

CIVIL SERVANTS, POLITICAL HISTORY, AND THE INTERPRETATION OF TRADITIONS

ABSTRACTA renewed interest in aspects of high politics among historians who subscribe to the ‘new political history’ has coincided with the embrace by some political scientists of interpretivism as a method for understanding how beliefs and traditions impact on British political life. In order to examine the potential synergies between these two developments, this article utilizes a form of ‘historical interpretivism’ to study the beliefs and actions of senior civil servants. In 1980, the British government released a Memorandum of Guidance for Officials Appearing before Select Committees – known ever since as the ‘Osmotherly’ rules – to help civil servants navigate the stresses of appearing before parliamentary committees. This article analyses the civil service files in the decade leading up to the publication of the Osmotherly rules to reveal how senior civil servants sought to reconcile their interpretations of Westminster tradition with the need to respond to the demands of the ‘open government’ agenda. The article argues that studying the narratives which guide the beliefs of individual civil servants and their political masters can help political historians and political scientists alike analyse the power of tradition in shaping political action.</jats:p

Continuous Complete Remission in Two Patients with Acute Lymphoblastic Leukemia and Severe Fungal Infection Following Short-Term, Dose-Reduced Chemotherapy

Spontaneous remission in acute lymphoblastic leukemia (ALL) is a rare phenomenon, which typically involves a pattern of feverish or septic disease followed by quick but mostly transient remission. We report on two male patients (46-year-old (pt. 1) and 19-year-old (pt. 2)) with CD20 positive, BCR-ABL negative common B-ALL. Patient 1 had received dexamethasone and cyclophosphamide (1.2 g) as a prephase therapy, followed by rituximab and a cumulative dose of 200 mg daunorubicin combined with 2 mg vincristine as an induction therapy. Patient 2 was treated with a reduced therapy regimen (Vincristine 1 mg, dexamethasone and 80 mg daunorubicin, 12-month mercaptopurine maintenance) due to (alcohol-related) toxic liver failure and pontine myelinolysis. Both patients developed severe septic disease just few days into induction treatment. Patient 1 suffered from pulmonary mycosis, which had to be resected eventually. Histological work-up revealed invasive mucor mycosis. Patient 2 presented with elevated serum aspergillus antigen and radiographic pulmonary lesions, indicative of pulmonary mycosis. In both patients, chemotherapy had to be interrupted and could not be resumed. Both patients recovered under broad antimicrobial, antifungal and prophylactic antiviral therapy and achieved molecular complete remission. At data cut-off remissions had been on-going for 34 months (pt. 1) and 8 years (pt. 2). Short-term, reduced intensity induction chemotherapy accompanied by severe fungal infections was followed by long-lasting continuous complete remissions in ALL. Thus, we hypothesize that infection-associated immunogenic responses may not only prevent early relapse of ALL but could also eradicate minimal residual disease. The effects of combined cytotoxic therapy and severe infection may also be mimicked by biomodulatory treatment strategies aiming at reorganizing pathologically altered cellular signaling networks. This could reduce toxicity and comorbidity in adult patients requiring leukemia treatment. Therefore, these two cases should encourage systematic studies on how leukemia stroma interaction can be harnessed to achieve long lasting control of ALL

Biomodulatory Treatment Regimen, MEPED, Rescues Relapsed and Refractory Classic Hodgkin’s Disease

Introduction: Current combined intensive chemotherapy and radiation regimens yield excellent survival rates in advanced classic Hodgkin’s lymphoma (cHL). However, acute toxicity in elderly, comorbid patients can be challenging and long-term survival in refractory patients remains poor. Patients and Methods: We report on six patients with r/r HL, three patients with long-term follow-up, three newly treated, after biomodulatory therapy. All patients received MEPED (treosulfan 250 mg p.o. daily, everolimus 15 mg p.o. daily to achieve serum trough levels of 15 ng/ml, pioglitazone 45 mg p.o. daily, etoricoxib 60 mg p.o. daily and dexamethasone 0.5 mg p.o. daily). Patients had either received every at that time approved systemic treatment or were ineligible for standard treatment, including immune checkpoint inhibition (ICPi) due to prior demyelinating autoimmune polyneuropathy, myasthenia gravis and previous allogeneic hematopoietic-stem-cell transplant (alloHSCT). Medication was administered continuously from day 1. One patient with relapse after alloHSCT received trofosfamide 50 mg daily instead of treosulfan to avoid risk of increased myelotoxicity. The patients were treated in individual healing attempts outside a clinical trial after institutional review board approval. 18F-fluoro-2-deoxy-d-glucose positron emission tomography combined with computed tomography scan (FDG-PET/CT) was performed to monitor treatment and follow-up. Results: In the three newly treated patients, CT scans showed partial remissions after 2–5 months on MEPED treatment. Two patients had achieved PET Deauville score 2 and 3, while the third remained positive at Deauville score 5. One patient achieving PR became eligible for alloHSCT, while the other two patients continued treatment with MEPED. All patients eventually achieved continuous complete remission (cCR), one after consecutive alloHSCT, one after discontinuing MEPED consolidation for >1 year and one on on-going MEPED consolidation, respectively. Only one patient experienced Grade 3 toxicity (bacterial pneumonia) requiring temporary discontinuation of MEPED for 10 days. All three previously published patients received allo HSCT for consolidation and have achieved cCR. Conclusions: MEPED is well tolerated with low toxicity and highly efficacious in relapsed/refractory cHL, including severely comorbid patients. Due to its immunomodulatory components, MEPED might also have a synergistic potential when combined with ICPi but requires further evaluation within a clinical trial