Letter, 1971 February 15, from Clifford J. Sager, M.D. to Eva Jessye

1 page, Jessye was involved in a writing project with Sager

Tacit Domains: The Transference of Practitioner Know‐How in Contemporary English Planning Practice

This article reflects upon ideas of tacit knowledge in order to examine the nature of planners’ expertise. It investigates the shifting knowledge and power dynamics between and within the public and private sectors, as a means of determining how tacit expertise is transferred and re‐appropriated in new domains and geographies of practice. Tacit understanding of what facilitates successful permissions and what impedes the approval process, helps planners navigate the plan‐led system and avoid inertia. Findings are two‐fold. Firstly, public sector planners transfer their own expert tacit knowledge to influence and direct local development planning. Secondly, the findings illustrate that public sector planners feel their tacit expertise is increasingly undervalued and traditional networks of knowledge transference have been dismantled due to the erosion of networks of peer support. This results in a disruptive counter narrative based in private planning practice where public sector experts are re‐emerging in commercial practice due to a range of factors, including: budgets cuts; demoralisation; and seeking greater job security in the private sector. This leads to new geographies of tacit knowledge, as local government planners transfer their knowledge into new professional environments. This can result in reconfigurations of locally embedded knowledge as expertise is repurposed and used to bolster the likelihood of development applications succeeding, often for profit motives rather than the broader public good. Furthermore, it can also lead to local knowledge being uprooted and spatially diffused across wider geographies as private sector planners frequently work across broader domains of practice than public sector counterparts. In conclusion, we outline gaps in our current understanding of the evolution of planning practice and outline future research opportunities

A study of home deaths in Japan from 1951 to 2002

BACKGROUND: Several surveys in Japan have indicated that most terminally ill Japanese patients would prefer to die at home or in a homelike setting. However, there is a great disparity between this stated preference and the reality, since most Japanese die in hospital. We report here national changes in home deaths in Japan over the last 5 decades. Using prefecture data, we also examined the factors in the medical service associated with home death in Japan. METHODS: Published data on place of death was obtained from the vital statistics compiled by the Ministry of Health, Labor and Welfare of Japan. We analyzed trends of home deaths from 1951 to 2002, and describe the changes in the proportion of home deaths by region, sex, age, and cause of death. Joinpoint regression analysis was used for trend analysis. Logistic regression analysis was performed to identify secular trends in home deaths, and the impact of age, sex, year of deaths and cause of deaths on home death. We also examined the association between home death and medical service factors by multiple regression analysis, using home death rate by prefectures in 2002 as a dependent variable. RESULTS: A significant decrease in the percentage of patients dying at home was observed in the results of joinpoint regression analysis. Older patients and males were more likely to die at home. Patients who died from cancer were less likely to die at home. The results of multiple regression analysis indicated that home death was related to the number of beds in hospital, ratio of daily occupied beds in general hospital, the number of families in which the elderly were living alone, and dwelling rooms. CONCLUSION: The pattern of the place of death has not only been determined by social and demographic characteristics of the decedent, but also associated with the medical service in the community

Amyloid and tau pathology associations with personality traits, neuropsychiatric symptoms, and cognitive lifestyle in the preclinical phases of sporadic and autosomal dominant Alzheimer’s disease

Background Major prevention trials for Alzheimer’s disease (AD) are now focusing on multidomain lifestyle interventions. However, the exact combination of behavioral factors related to AD pathology remains unclear. In 2 cohorts of cognitively unimpaired individuals at risk of AD, we examined which combinations of personality traits, neuropsychiatric symptoms, and cognitive lifestyle (years of education or lifetime cognitive activity) related to the pathological hallmarks of AD, amyloid-β, and tau deposits. Methods A total of 115 older adults with a parental or multiple-sibling family history of sporadic AD (PREVENT-AD [PRe-symptomatic EValuation of Experimental or Novel Treatments for AD] cohort) underwent amyloid and tau positron emission tomography and answered several questionnaires related to behavioral attributes. Separately, we studied 117 mutation carriers from the DIAN (Dominant Inherited Alzheimer Network) study group cohort with amyloid positron emission tomography and behavioral data. Using partial least squares analysis, we identified latent variables relating amyloid or tau pathology with combinations of personality traits, neuropsychiatric symptoms, and cognitive lifestyle. Results In PREVENT-AD, lower neuroticism, neuropsychiatric burden, and higher education were associated with less amyloid deposition (p = .014). Lower neuroticism and neuropsychiatric features, along with higher measures of openness and extraversion, were related to less tau deposition (p = .006). In DIAN, lower neuropsychiatric burden and higher education were also associated with less amyloid (p = .005). The combination of these factors accounted for up to 14% of AD pathology. Conclusions In the preclinical phase of both sporadic and autosomal dominant AD, multiple behavioral features were associated with AD pathology. These results may suggest potential pathways by which multidomain interventions might help delay AD onset or progression