John William Jagger and the South African railways, 1921-1924

The Major problems facing me during both the research and the writing of this essay were the material available and the nature of the subject. Initially, both the necessary material and Jagger's character and role as Minister of Railways seemed remarkably elusive. The nature of the material available tended to enforce a reliance on Jagger's actions in parliament and the crises which he faced on that somewhat isolated stage, and on the gleanings from an almost exclusively partisan press. Jagger himself was a humourless, dry and lonely man whose private life remained his own business. His public career was the common story of the "boy with brains" who "did well in the Colonies". Another problem arises out of the fact that Jagger was appointed Minister of Railways and Harbours, a portfolio as dry as his personality. These factors go a long way towards explaining the generally uncontroversial nature of the material presented in this essay. Any dullness and related deficiencies are, of course, entirely the fault of the writer. It could be asked of what possible significance grain elevators, harbour extensions and railway deficits are. It is unlikely that any of these features will ever be considered to be of major significance to the history of South Africa in the twentieth century. In fact it could never really be said that J.W.Jagger was of major significance to South African history. What is presented here, however, be it dry statistics or seemingly absurd scandals about grain elevators or harbour extensions, is what Jagger himself found compelling. These aspects of South African life, the economic aspects, are where Jagger found fulfilment. To many this may seem incomprehensible, but this was Jagger's life. Life, after all, is at the core of history and it is only by immersing ourselves in the past, as historians, that we can hope to understand the present. Thus Jagger's life - albeit a dry and humourless life - is history; it lives; it is the "stuff of which dreams are made". Statistics and ways and means of economising comprise the essence of both Jagger's term of office as Minister of Railways and Harbours, and in fact of his entire life. The making of money, the best ways of saving it, and the best ways of spending it for the good of the nation comprise the essence of his career

Protecting Boat People: Reply to David Matas

Reply to David Mata

Evaluating geostatistical modeling of exceedance probability as the first step in disease cluster investigations: very low birth weights near toxic Texas sites

Background The first step in evaluating potential geographic clusters of disease calls for an evaluation of the disease risk comparing the risk in a defined location to the risk in neighboring locations. Environmental exposures, however, represent continuous exposure levels across space not an exposure with a distinct boundary. The objectives of the current study were to adapt, apply and evaluate a geostatistical approach for identifying disease clusters. Methods The exceedance probability for very low birth weight (VLBW; < 1.5 kg) infants was mapped using an Intrinsic Conditional Autoregressive model. The data were applied to a 20 by 20 grid of 1 km2 pixels centered on each of the 13 National Priority List Superfund Sites in Harris County, Texas. Results Large clusters of VLBW were identified in close proximity to four of the 13 Superfund Sites. Three of the Superfund Sites, associated with disease clusters, were located close together in central Houston and these sites may have been surrounded by a single, confluent disease cluster. Conclusions Geostatistical modeling of the exceedance probability for very low birth weights identified disease clusters of varying size, shape and statistical certainty near Superfund Sites in Harris County, Texas. The approach offers considerable potential as the first step for investigating potential disease clusters.The open access fee for this work was funded through the Texas A&M University Open Access to Knowledge (OAK) Fund

Impact of phytoplankton community size on a linked global ocean optical and ecosystem model

Author Posting. © The Author(s), 2011. This is the author's version of the work. It is posted here by permission of Elsevier for personal use, not for redistribution. The definitive version was published in Journal of Marine Systems 89 (2012): 61-75, doi:10.1016/j.jmarsys.2011.08.002.We isolated the effect phytoplankton cell size has on varying remote sensing reflectance spectra (Rrs(λ)) in the presence of optically active constituents by using optical and radiative transfer models linked in an offline diagnostic calculation to a global biogeochemical/ecosystem/circulation model with explicit phytoplankton size classes. Two case studies were carried out, each with several scenarios to isolate the effects of chlorophyll concentration, phytoplankton cell size, and size-varying phytoplankton absorption on Rrs(λ). The goal of the study was to determine the relative contribution of phytoplankton cell size and chlorophyll to overall Rrs(λ) and to understand where a standard band ratio algorithm (OC4) may under/overestimate chlorophyll due to Rrs(λ) being significantly affected by phytoplankton size. Phytoplankton cell size was found to contribute secondarily to Rrs(λ) variability and to amplify or dampen the seasonal cycle in Rrs(λ), driven by chlorophyll. Size and chlorophyll were found to change in phase at low to mid-latitudes, but were anti-correlated or poorly correlated at high latitudes. Phytoplankton size effects increased model calculated Rrs(443) in the subtropical ocean during local spring through early fall months in both hemispheres and decreased Rrs(443) in the Northern Hemisphere high latitude regions during local summer to fall months. This study attempts to tease apart when/where variability about the OC4 relationship may be associated with cell size variability. The OC4 algorithm may underestimate [Chl] when the fraction of microplankton is elevated, which occurs in the model simulations during local spring/summer months at high latitudes in both hemispheres.Funding for this study came from a NASA Earth and Space Science Fellowship and University of Rhode Island Graduate School Oceanography Alumni Fellowship, both awarded to C. Mouw. The CCSM-3 BEC simulations were generated with support from NASA Ocean Biology and Biogeochemistry Program (NNX07AL80G) and the NSF Center for Microbial Oceanography Research and Education (C-MORE, EF-0424599)

Isolated Meningeal Recurrence of Transitional Cell Carcinoma of the Bladder

Meningeal carcinomatosis occurs in 1–18% of patients with solid tumours, most commonly carcinomas of the breast and lung or melanomas. There are relatively few reports of meningeal carcinomatosis in transitional cell carcinoma of the bladder. Isolated meningeal recurrence is particularly uncommon, and we present an unusual case of this in a 58-year-old man. The case was further complicated by the somewhat atypical presentation with a confirmed ischaemic stroke. The patient died one month after presentation

Is the early identification and referral of suspected head and neck cancers by community pharmacists feasible?:A qualitative interview study exploring the views of patients in North East England

INTRODUCTION Head and neck cancer (HNC) is the eighth most common cancer in the United Kingdom. Survival rates improve when the cancer is diagnosed at an early stage, highlighting a key need to identify at-risk patients. This study aimed to explore opportunistic HNC identification and referral by community pharmacists (CPs) using a symptom-based risk assessment calculator, from the perspective of patients with a diagnosis of HNC. METHODS Purposive sampling was used to recruit patients from the HNC pathway in three large teaching hospitals in Northern England. Qualitative methodology was used to collect data through an iterative series of semistructured telephone interviews. Framework analysis was utilised to identify key themes. RESULTS Four main themes were constructed through the analytic process: (1) HNC presentation and seeking help; (2) the role of the CP; (3) public perception of HNC and (4) the role of a symptom-based risk calculator. Participants agreed that CPs could play a role in the identification and referral of suspected HNCs, but there were concerns about access as patients frequently only encounter the medicine counter assistant when they visit the pharmacy. HNC symptoms are frequently attributed to common or minor conditions initially and therefore considered not urgent, leading to delays in seeking help. While there is public promotion for some cancers, there is little known about HNC. Early presentation of HNC can be quite variable, therefore raising awareness would help. The use of a symptom-based risk calculator was considered beneficial if it enabled earlier referral and diagnosis. Participants suggested that it would also be useful if the public were made aware of it and could self-assess their symptoms. CONCLUSION In principle, CPs could play a role in the identification and referral of HNC, but there was uncertainty as to how the intervention would work. Future research is needed to develop an intervention that would facilitate earlier identification and referral of HNC while not disrupting CP work and that would promote HNC and the risk calculator more widely. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement and engagement (PPIE) was integrated throughout the project. Initially, the proposal was discussed during a Cancer Head and Neck Group Experience (CHANGE) PPIE meeting. CHANGE was set up to support HNC research in 2018. The group is composed of seven members (four female, three male) with an age range of 50-71 years, who were diagnosed at Sunderland Royal Hospital. A patient representative from the University of Sunderland PPIE group and a trustee of the Northern HNC Charity were recruited as co-applicants. They attended project management group meetings and reviewed patient-facing documentation

Personalized Genetic Risk Counseling to Motivate Diabetes Prevention: A randomized trial

OBJECTIVE To examine whether diabetes genetic risk testing and counseling can improve diabetes prevention behaviors. RESEARCH DESIGN AND METHODS We conducted a randomized trial of diabetes genetic risk counseling among overweight patients at increased phenotypic risk for type 2 diabetes. Participants were randomly allocated to genetic testing versus no testing. Genetic risk was calculated by summing 36 single nucleotide polymorphisms associated with type 2 diabetes. Participants in the top and bottom score quartiles received individual genetic counseling before being enrolled with untested control participants in a 12-week, validated, diabetes prevention program. Middle-risk quartile participants were not studied further. We examined the effect of this genetic counseling intervention on patient self-reported attitudes, program attendance, and weight loss, separately comparing higher-risk and lower-risk result recipients with control participants. RESULTS The 108 participants enrolled in the diabetes prevention program included 42 participants at higher diabetes genetic risk, 32 at lower diabetes genetic risk, and 34 untested control subjects. Mean age was 57.9 ± 10.6 years, 61% were men, and average BMI was 34.8 kg/m2, with no differences among randomization groups. Participants attended 6.8 ± 4.3 group sessions and lost 8.5 ± 10.1 pounds, with 33 of 108 (30.6%) losing ≥5% body weight. There were few statistically significant differences in self-reported motivation, program attendance, or mean weight loss when higher-risk recipients and lower-risk recipients were compared with control subjects (P > 0.05 for all but one comparison). CONCLUSIONS Diabetes genetic risk counseling with currently available variants does not significantly alter self-reported motivation or prevention program adherence for overweight individuals at risk for diabetes