This study aimed to explore patterns of attendance at classroom-based, taught education programmes for pre-registration house officers (PRHOs) and to identify reasons for non-attendance, and to consider implications for Foundation Programme curriculum delivery and suggest strategies for improving delivery. We analysed registers of attendance for education sessions for 3 local teaching hospitals in the Leicestershire, Northamptonshire and Rutland (LNR) Healthcare Workforce Deanery, along with PRHO exit questionnaire returns (from 2001 to 2005). Despite a trend for attendance to fall slightly over the course of a rotation, attendance rates have, in general, remained relatively stable at around two-thirds. However, during most 4-month posts, a fifth or more of PRHOs missed half or more of all sessions. Two types of barrier to attendance were identified: 'routine barriers', which relate to hospital working patterns, and 'contextual barriers', which refer to the particularities of each hospital post. There was no evidence that doctors' motivation and commitment towards the education programme is a main determinant of attendance. Contextual barriers to attendance, such as pressure being placed on PRHOs to remain on the ward, can be addressed. However, routine barriers to attendance, including on-call working patterns and annual leave, render it impossible to avoid significant numbers of education sessions being missed by PRHOs in each post during a rotation. En bloc teaching of basic generic skills prior to the start of the rotation plus greater use of online learning resources are examples of ways in which reliance on in-post, classroom-based programmes can be reduced.

In January 2003 the New Zealand government announced that it intended to redress the fragmentation of the state sector that was brought about by the radical state sector reforms of the late 1980s and early 1990s. Eschewing any “big bang” restructuring, over the next five years it proposes to enhance “coordination” among government agencies -- by means that may include the establishment of “circuit-breaker teams” and up to ten “super networks” to manage the proliferation of central government organizations. It proposes to reverse in some instances the policy/operational split that was imposed by the reforms, and seeks to achieve better integration between operational “outputs” and policy “outcomes.” This article discusses the suitability of these suggestions, in the light of a recent report by a government advisory group. This report examines what are, in fact, major flaws in the original reforms yet suggests remedies on the assumption that they are not. The case raises more general questions about the relationship between the theoretical bases of public sector reform, on the one hand, and practical experience on the other.

Practical Diabetes InternationalVolume 17, Issue 4 p. 104-108 Original ArticleFree Access Secular trend in birth weight in native White and immigrant South Asian populations in Leicester, UK: possible implications for incidence of type 2 diabetes in the future Subhankar Chowdhury DM, MRCP, Subhankar Chowdhury DM, MRCP Clinical Research Fellow Leicester General Hospital, Department of Diabetes, Leicester, UKSearch for more papers by this authorFawaz Ammari FRCP, Fawaz Ammari FRCP Clinical Research Fellow Leicester General Hospital, Department of Diabetes, Leicester, UKSearch for more papers by this authorAndrew C. Burden MD FRCP, Andrew C. Burden MD FRCP Consultant Physician and Honorary Senior Lecturer Leicester General Hospital, Department of Diabetes, Leicester, UKSearch for more papers by this authorRobert Gregory DM FRCP, Corresponding Author Robert Gregory DM FRCP Consultant Physician Leicester General Hospital, Department of Diabetes, Leicester, UKDiabetes Care, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UKSearch for more papers by this author Subhankar Chowdhury DM, MRCP, Subhankar Chowdhury DM, MRCP Clinical Research Fellow Leicester General Hospital, Department of Diabetes, Leicester, UKSearch for more papers by this authorFawaz Ammari FRCP, Fawaz Ammari FRCP Clinical Research Fellow Leicester General Hospital, Department of Diabetes, Leicester, UKSearch for more papers by this authorAndrew C. Burden MD FRCP, Andrew C. Burden MD FRCP Consultant Physician and Honorary Senior Lecturer Leicester General Hospital, Department of Diabetes, Leicester, UKSearch for more papers by this authorRobert Gregory DM FRCP, Corresponding Author Robert Gregory DM FRCP Consultant Physician Leicester General Hospital, Department of Diabetes, Leicester, UKDiabetes Care, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UKSearch for more papers by this author First published: 28 July 2000 https://doi.org/10.1002/1528-252X(200006)17:4<104::AID-PDI31>3.0.CO;2-WCitations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract The objective was to compare birth weights between local Whites and immigrant South Asian populations in Leicester and to look for temporal trends. This was a retrospective study of labour ward records at a teaching hospital in Leicester. We examined the records of all 1852 births in 1975 (28% South Asians) and an equal sized consecutive sample in 1988 (31% South Asians). Multiple linear regression was performed to estimate the effects of the available covariates (ethnicity, maternal age, parity, gestational age at delivery and sex of the baby) on birth weight. 40–50% of the variability in birth weight could be explained by the available demographic parameters. Mean birth weight showed a significant overall increase from 1975 to 1988 (mean (95% confidence interval)) 112 (95–148) g: p<0.0001). This trend was seen in both Whites (123 (80–166) g: p<0.0001) and South Asians (111 (53–180) g: p<0.0001). There was a concomitant drop in stillbirth rates in both the groups. South Asian babies were significantly lighter than Whites in 1975 (280 (225–336) g: p<0.0001) and remained so. The lack of 'catch up' by the South Asians is not easily explained, but may reflect genetic differences, or a requirement for environmental effects on birth weight to act for longer than 13 years to be expressed fully. If birth weight is important in the genesis of type 2 diabetes, coronary heart disease and renal disease, then the higher prevalence of these diseases in the South Asian population compared with the White population will continue. Copyright © 2000 John Wiley & Sons, Ltd. Introduction Low birth weight is an important determinant of perinatal mortality. It is now known to be predictive of future health risks as well being associated with higher probability of type 2 diabetes1, 2, essential hypertension3, coronary artery disease4, 5 and renal disease6 in later life. The immigrant South Asian population in the UK is known to give birth to lighter babies than the native Whites7, 8. Most studies in the UK have also shown higher perinatal mortality among South Asians compared to Whites9. The prevalence of type 2 diabetes10, 11, coronary artery disease prevalence12 and its mortality13 and the prevalence of chronic renal failure14 are also much higher among immigrant South Asians compared to Whites. It is a matter of debate whether the observed difference can be ascribed primarily to genetic or environmental influence. If the latter were true then South Asians living in the UK could hope to see improvement of their adverse health profile through a process of cultural adaptation over time. We would expect this to be preceded by a 'catching up' of birth weights by the immigrant South Asians. Studies on change of birth weights of babies born to second generation compared to first generation immigrant South Asians in the UK have shown a significant increase in one15 and a non-significant decrease in another16. However these studies did not address the issue of birth weight gap between South Asians and Whites and also did not examine temporal trends. The city of Leicester saw a major migration of South Asians (originally from the western Indian state of Gujarat) from East Africa in the early 1970s and they now comprise nearly 25% of its population. This makes Leicester a good place for a comparative study between Whites and South Asians. We therefore looked for change in birth weight of these two ethnic groups in Leicester between 1975 and 1988. Research design and methods This was a retrospective study of labour ward records for all births at the Leicester General Hospital, Leicester, in 1975, which was close to the time of the major South Asian migration to Leicester from East Africa. A significant proportion of these migrants was originally from the western Indian state of Gujarat. We compared this with an equal sized consecutive sample in 1988, a later year for which data was readily available. South Asians were identified by family name. A total of 1852 women gave birth at the Leicester General Hospital in 1975, of whom 517 (28%) were of South Asian origin. In 1988 574 of the 1852 births (31%) were South Asians. Apart from birth weight we also recorded available demographic data, which were maternal age, parity, gestational age at delivery and sex of the baby. Statistical methods Birth weight, maternal age and gestational age at delivery followed approximately normal distributions. Comparison of group means of these parameters was by the pooled variance t-test. The Mann–Whitney U-test was employed to test differences in parity and baby's gender, which were not normally distributed. Multiple linear regression was performed to estimate the effects of the available covariates (ethnicity, maternal age, parity, gestational age and sex of the baby) on birth weight. Data that were not normally distributed were logarithmically transformed before analysis. The statistical package used was UNISTAT version 4 for PC. p<0.05 was considered significant. Results There was an increase in mean overall birth weight by 112 g (95% CI 75–148 g, p<0.0001), from 3145 g (±560 g) in 1975 to 3257 g (±567 g) in 1988. Birth weight in both ethnic groups rose by a similar amount—by 123 g (95% CI 80–166 g, p<0.0001) among Whites and by 111 g (95% CI 53–180 g, p<0.0001) among South Asians (Table 1). Table 1. Birth weights of babies born at the Leicester General Hospital in 1975 and 1988 to White and South Asian mothers Year Overall births White South Asian p value 1975 3145±560 3223±546 2943±546 <0.0001 1988 3257±567 3346±564 3059±567 <0.0001 p value <0.0001 <0.0001 <0.0001 Mean±standard deviation (g). Concomitantly there was a drop in the proportion of 'very low birth weights' (<1500 g) as well as of 'moderately low birth weights' (1500–2500 g) in both ethnic groups—by 20% (from 1.0 to 0.8 per 100 births) and 24% (from 7.8 to 5.9 per 100 births) respectively among Whites and by 36% (from 1.4 to 0.9 per 100 births) and 40% (from 16.8 to 10.1 per 100 births) respectively among South Asians. The stillbirth rate also fell in both populations from 1975 to 1988—from 14.2 to 2.3 per 1000 White births and from 29 to 5.2 per 1000 South Asian births. In 1975 South Asians weighed 280 g less (95% CI 225–336 g, p<0.0001) at birth compared to Whites. The birth weight gap between the two populations was similar in 1988 (287 g, 95% CI 232–342 g, p<0.0001) (Table 1). The available covariates (ethnicity, maternal age, parity, gestational age at delivery and sex of the baby) accounted for 40–50% of the variation of birth weight (Table 2). White birth weight demonstrated a significant positive correlation with maternal age, gestational age and sex of the baby (heavier in males) both in 1975 and 1988; there was also significant correlation with parity in 1988, but not in 1975 (Table 2). Among South Asians birth weight showed significant positive correlation with parity, gestational age and sex of the baby (heavier in males) in both years; however it showed no significant correlation with maternal age (Table 2). Table 2. Results of multiple linear regression analysis on birth weights in the years 1975 and 1988 for the overall population, and for white and South Asian births separately Covariates Overall birth weights White birth weights South Asian birth weights 1975 1988 1975 1988 1975 1988 t-statistic p-value t-statistic p-value t-statistic p-value t-statistic p-value t-statistic p-value t-statistic p-value Ethnicity 9.3 <0.0001 10.7 <0.0001 Maternal age 3.6 <0.0005 3.0 <0.005 2.9 <0.005 2.4 <0.05 1.9 >0.05 1.6 >0.05 Parity 2.2 <0.05 5.7 <0.0001 1.4 >0.05 4.9 <0.0001 2.0 <0.05 2.9 <0.005 Gestational age at delivery 28.5 <0.0001 33.9 <0.0001 24.1 <0.0001 28.7 <0.0001 15.2 <0.0001 17.8 <0.0001 Sex of baby 5.7 <0.0001 6.7 <0.0001 5.0 <0.0001 5.7 <0.0001 2.6 <0.01 3.5 <0.001 R2* 0.5 0.5 0.4 0.5 0.4 0.5 * Values of R2 calculated for logarithmically transfomed data where these were not normally distributed. Maternal age increased significantly in both ethnic groups from 1975 to 1988—from 26.0±5.1 years to 27.3±5.3 years among Whites (p<0.0001) and from 25.3±4.8 years to 26.9±4.9 years among South Asians (p<0.0001). The proportion of male births increased significantly among South Asians, from 43.7% to 51.2% (p<0.05); the increase among Whites was not significant (from 50.1% to 53.9%, p=0.052). There was no change in gestational age at delivery in either group. Parity dropped significantly among Whites—from 1.1 (95% CI 1.0–1.1) in 1975 to 0.8 (95% CI 0.7–0.8) in 1988, p<0.0001, but showed no change among South Asians (Table 3). Table 3. Demographic profile of White and South Asian births in 1975 and 1988 Year Ethnic group Maternal age (years) mean±SD Parity Mean (95% CI) Gestational age (weeks) mean±SD Proportion of male babies (%) 1975 White 26.0±5.1 1.1 (1.0–1.1) 39.2±1.8 50.1 South Asian 25.3±4.8 1.2 (1.1–1.4) 38.9±2.2 43.7 1988 White 27.3±5.3 0.8 (0.7–0.8) 39.2±1.9 53.9 South Asian 26.9±4.9 1.1 (1.0–1.2) 38.8±1.9 51.2 Both in 1975 and in 1988 gestational age at delivery was significantly less in South Asians in comparison to Whites (38.9±2.2 weeks versus 39.2±1.8 weeks, p<0.005, in 1975 and 38.8±1.9 weeks versus 39.2±1.9 weeks, p<0.0001, in 1988). There was a significantly lower proportion of male births among South Asians compared to Whites in 1975 (43.7% versus 50.1%, p<0.05), but there was no difference in 1988 (51.2% versus 53.9%, p=0.283). In both years parity was significantly higher in South Asians (1.2±1.3 versus 1.1±1.3, p<0.01 in 1975 and 1.1±1.2 versus 0.8±1.0, p<0.0001 in 1988). In 1975 South Asian mothers were significantly younger than their White counterparts (25.3±4.8 years versus 26.0±5.1 years, p<0.0005), but this was no longer true in 1988 (26.9±4.9 years versus 27.3±5.3 years, p=0.1022) (Table 4). The differences in birth weight observed between Whites and South Asians could not be explained by these demographic variables. Table 4. Comparison of demographic parameters between White and South Asian births in 1975 and 1988 Demographic parameters 1975 1988 t/z-statistic* p-value t/z-statistic* p-value Maternal age 2.419 <0.05 1.514 0.1303 Parity 2.793 <0.01 6.237 <0.0001 Gestational age at delivery 3.19 <0.005 4.047 <0.0005 Sex of baby 2.471 <0.05 1.074 0.283 * t-statistic for maternal age and gestational age (pooled variance t-test); z-statistic for parity and sex of baby (Mann–Whitney U-test). Conclusions We observed a significant increase of 112 g in mean birth weights overall from 1975 to 1988 in Leicester. This was also reflected in the birth weight patterns of the two major sub-groups separately, namely the native Whites (123 g) and the immigrant South Asians (111 g). Secular increase in birth weight of populations has been demonstrated elsewhere17, 18. However other studies report no further increase and even a negative trend since the 1970s19. It has been shown that comparing birth weight distributions by their means can give the opposite result from that obtained by comparing the low weight extremes of the same distributions20. However, in our study the proportion of babies with moderately low (1500–2500 g) and very low (<1500 g) birth weights also showed a decline in both immigrant and native populations from 1975 to 1988. This was accompanied by a large drop in stillbirth rate in both the populations (by 82% among South Asians and 84% among Whites); however the stillbirth rate among South Asians remained double that among Whites. A 10 year (1976–1985) study of perinatal deaths in Leicestershire showed that while the rate fell steadily in the Whites, after an initial decline there was no further fall after 1980 in the South Asians9. Birth weight is determined by a complex interplay of several factors. These include fetal factors such as gender as well as maternal/obstetric factors such as age, weight, height, parity, gestational age at delivery, smoking habit in pregnancy21, 22 and the proportion of mothers with glucose intolerance during pregnancy. Some studies suggested an influence of the father's23 and even the maternal grandmother's height24. The latter two suggest genetic influence. However in a study on childbirths following ovum donation it was concluded that the environment provided by the mother was more important than her genetic contribution to birth weight25. In this retrospective study from labour ward records we were able to study the effects of only some of these factors, which could explain 40–50% of the variation in birth weight. However two important covariates, maternal weight and height, were not available. Among the available covariates, gestational age at delivery was the single most important determinant of birth weight, followed by the gender of the baby. Parity (or birth order) and maternal age showed more variable correlation with birth weight. The higher birth weight among the Whites could partially be explained in terms of greater gestational age at delivery (in both 1975 and 1988), higher proportion of male births (in 1975 only) and higher maternal age (in 1975 only). However the difference persisted even after controlling for these variables. Factors contributing to the increase in birth weight from 1975 to 1988 are an increase in the proportion of male births, and, among the Whites, in maternal age as well. Though mean birth weight among South Asians increased significantly, the concomitant increase in mean White birth weight meant that the birth weight gap (280 g in 1975 and 287 g in 1988) did not close over a period of 13 years. The increase in birth weight might result from improvements in socio-economic conditions and antenatal care. The persistent gap between the two ethnic groups appears to be genetic in origin. However, this presupposes optimum cultural integration of the migrant population with the Whites and also that the full environmental influence on birth weight is expressed within 13 years. Other studies have also concluded that genetic factors are more likely candidates to explain the smaller size at birth of Asian babies26. Low birth weight tends to predispose to type 2 diabetes, essential hypertension, coronary artery disease and renal disease in later life. This relationship seems to be confined to small-for-gestational-age babies rather than to the premature ones27. Moreover body proportion seems to be important, as insulin resistance in adult life is more closely related to thinness at birth (represented by a low ponderal index) than to low birth weight itself28. Length at birth is not a measurement that is routinely performed in most maternity units in the UK. Obesity in adult life is also independently associated with insulin resistance28. The relationship between weight at birth and future health risks is complex and the underlying mechanism(s) unclear. However if birth weights increased without an increase in adult obesity, a favourable impact on adult morbidity and mortality might be expected. Our study has shown an increase in birth weight over time in both ethnic groups. We may therefore hope to see a reduction in the incidence of type 2 diabetes, essential hypertension and coronary artery disease in these populations in the future. This may partially offset the current gloomiest predictions of epidemic rises in the incidence and prevalence of type 2 diabetes in Whites29 and South Asians in their country of origin30, 31, 32. Acknowledgements We thank Dr D. K. Bhattacharya, Lecturer in Econometrics, University of Leicester, for guidance on statistical analysis. References 1Barker DJP, Hales CN, Fall CHD, et al. Type 2 (non-insulin dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced foetal growth. Diabetologia 1993; 36: 62– 67. 2McCance DR, Pettit DJ, Hanson RL, et al. Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? Br Med J 1994; 308: 942– 945. 3Law CM, deSwiet M, Osmond C, et al. Initiation of hypertension in utero and its amplification throughout life. Br Med J 1993; 306: 24– 27. 4Osmond C, Barker DJP, Winter PD, et al. Early growth and death from cardiovascular disease in women. Br Med J 1993; 307: 1519– 1524. 5Vagero D, Leon D. Ischaemic heart disease and low birth weight: a test of the foetal origins hypothesis from the Swedish Twin Registry. Lancet 1994; 343: 260– 263. 6Brenner BM, Chertow GM. Congenital oligonephropathy and the etiology of adult hypertension and progressive renal injury. Am J Kidney Dis 1994; 23: 171– 175. 7Dawson I, Golder RY, Jonas EG. Birth weight by gestational age and its effect on perinatal mortality in White and in Punjabi birth: experience at a district general hospital in West London 1967–1975. Br J Obstet Gynaecol 1982; 89: 896– 899. 8Tuck SM, Cardozo LD, Studd JWW, et al. Obstetric characteristics of different racial groups. Br J Obstet Gynaecol 1983; 90: 92– 97. 9Clarke M, Clayton DG, Mason ES, et al. Asian mothers' risk factors for perinatal death—the same or different? A 10 year review of Leicestershire perinatal deaths. Br Med J 1988; 297: 384– 387. 10Mather HM, Keen H. The Southall diabetes survey: prevalence of known diabetes in Asians and Europeans. Br Med J 1985; 291: 1081– 1084. 11Samanta A, Burden AC, Fent B. Comparative prevalence of non-insulin dependent diabetes in Asian and white Caucasian adults. Diabetes Res Clin Pract 1987; 4: 1– 6. 12Donaldson LJ, Taylor JB. Patterns of Asian and non-Asian morbidity in hospitals. Br Med J 1983; 286: 949– 951. 13Mckeigue PM, Marmot MG. Mortality from coronary heart disease in Asian communities in London. Br Med J 1988; 297: 903 14Gujral JS, Burden AC, Iqbal J, et al. The prevalence of chronic renal failure in known diabetic and non-diabetic White Caucasians and South Asians. Pract Diabetes Int 1997; 14: 71– 74. 15Dhawan S. Birth weights of infants of first generation Asian women in Britain compared with second generation Asian women. Br Med J 1995; 311: 86– 88. 16Draper ES, Abrams KR, Clarke M. Fall in birth weight of third generation Asian infants. Br Med J 1995; 311: 876 17Chike-Obi U, David RJ, Coutinho R, et al. Birth weight has increased over a generation. Am J Epidemiol 1996; 144: 563– 569. 18Alberman E. Are our babies becoming bigger? J R Soc Med 1991; 84: 257– 260. 19Dubrova YE, Kurbatova OL, Kholod ON, et al. Secular growth trend in two generations of the Russian population. Hum Biol 1995; 67: 755– 767. 20Wilcox AJ, Russell IT. Birth weight and perinatal mortality. III. Towards a new method of analysis. Int J Epidemiol 1986; 15: 188– 196. 21Cogswell ME, Yip R. The influence of foetal and maternal factors on the distribution of birth weight. Semin Perinatol 1995; 19: 220– 240. 22Mathai M, Jacob S, Karthikeyan NG. Birth weight standards for South Indian babies. Ind Paed 1996; 33: 203– 209. 23Wilcox MA, Newton CS, Johnson IR. Paternal influences on birth weight. Acta Obstet Gynaecol Scand 1995; 74: 15– 18. 24Emanuel I, Filakti H, Alberman E, et al. Intergenerational studies of human birth weight from the 1958 birth cohort. I. Evidence for a multigenerational effect. Br J Obstet Gynaecol 1992; 99: 67– 74. 25Brooks AA, Johnson MR, Steer PJ, et al. Birth weight: nature or nurture? Early Hum Dev 1995; 42: 29– 35. 26Davies DP, Senior N, Cole G, et al. Size at birth of Asian and white Caucasian babies born in Leicester: implications for obstetric and paediatric practices. Early Hum Dev 1982; 6: 257– 263. 27Phipps K, Barker DJP, Hales CN, et al. Foetal growth and impaired glucose tolerance in men and women. Diabetologia 1993; 36: 225– 228. 28Phillips DIW, Barker DJP, Hales CN, et al. Thinness at birth and insulin resistance in adult life. Diabetologia 1994; 37: 150– 154. 29Ruwaard D, Gijsen R, Bartfelds AIM, et al. Is the incidence of diabetes increasing in all age groups in the Netherlands? Diabetes Care 1996; 19: 214– 216. 30King H, Rewers M. WHO Ad Hoc Diabetes Reporting Group: global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Care 1993; 16: 157– 177. 31Sayeed MA, Khan AR, Banu A, et al. Prevalence of diabetes and hypertension in a rural population of Bangladesh. Diabetes Care 1995; 18: 555– 558. 32Ramachandran A, Snehalatha C, Latha E, et al. Rising prevalence of NIDDM in an urban population in India. Diabetologia 1997; 40: 232– 237. Citing Literature Volume17, Issue4June 2000Pages 104-108 ReferencesRelatedInformation

We discuss below difference between the concepts of accountability and responsibility, in the context of government administration. We argue that New Zealand's public sector reforms, in particular have depended on an essentially mechanistic as distinct from an organic interpretation of public organisations. A mechanistic approach focuses disproportionately on notions of organisational accountability at the expense of responsibility, and as a consequence may prove counterproductive over the longer term in maintaining high standards of ethical probity. A concept of responsible accountability needs to be developed further as a means of countering this possibility. We speculate on whether the emphasis on contractualism has enhanced or undermined an integrity-based as opposed to a compliance-based ethics regime, and the possible implications of this for the maintenance of ethical standards.

Practical Diabetes InternationalVolume 15, Issue 3 p. 81-81 Book ReviewFree Access Diabetes and its Management. (5th edn.). Editors: Peter J Watkins, paul Drury, Simon L Howell. Publisher: Blackwell Science, Osney Road, Oxford OX2 0EL, UK. Year of issue: 1996. Pages: 308. Size: 138 × 213 mm. Cover: Softback. ISBN number: 0865428638. Price: £24.95 Robert Gregory DM MRCP, Robert Gregory DM MRCP Consultant Physician Leicester, UKSearch for more papers by this author Robert Gregory DM MRCP, Robert Gregory DM MRCP Consultant Physician Leicester, UKSearch for more papers by this author First published: 17 November 2005 https://doi.org/10.1002/pdi.1960150308AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume15, Issue3May 1998Pages 81-81 RelatedInformation

Major public sector changes in Australia and New Zealand over the past decade have produced significant shifts in the beliefs, training and outlook of public servants. Using data from surveys in 1986–87 and 1994–95, this article tracks key attitudinal changes. It finds more marked change in Wellington than in Canberra, perhaps reflecting the more radical public sector agenda on that side of the Tasman

The lasting impact of Charles E. Lindblom on public policy making theory flows from his insight into the nature of a collective, political, rationality. The term ‘incrementalism’, with which his name is commonly associated, obscures rather than enhances an appreciation of this enduring contribution. The debate between Lindblom and his main ‘rationalist’ critics has failed to demonstrate any necessary relationships between the scope of policy change and the role of formal analysis. It has also tended to reify public policy making, misleadingly representing ‘incrementalism’ as a chosen political strategy, or analytical technique, rather than as the inevitable form of collective political action.

The maple cambium miner, Phytobia setosa (Loew), attacks Acer spp., producing ray flecks which result in degrade in face veneer and furniture wood. Samples from infested sugar maple, Acer saccharum Marsh, trees demonstrated that while mines passed close to the vascular cambium the initial cells were not affected. Thus, although it is called a cambium miner it does not mine the cambium. Mines filled with parenchyma cells which proliferated from severed vascular rays. These cells, when mature, stored starch. In heavily infested trees the starch storage area in the xylem may thus be measurably increased. The zone of newly differentiating xylem provides the insect with the path of least resistance; variation in the condition of secondary xylem may account for the variability in host susceptibility.

One of the more troubling paradoxes of our time is the apparent positive correlation between human misery and the accumulation of knowledge and skills for the alleviation of that misery. Our increasing knowledge about human institutions is not accompanied by reduction in our failure to have meaningful social participation. Inner city violence, fundamental breakdown in family life, etc., suggest the extent of the failure of some of our most basic institutions. At the same time, there is increased participation in those institutions whose social function is to contain, repress, and remedy (correctional facilities, psychiatric hospitals, special classes, etc.). These trends are nowhere more apparent than in what is happening to our children. School drop-out rates, populations of juvenile correctional facilities, numbers of children seen in mental health clinics, special classes, admissions of children to psychiatric hospitals, etc., serve as reminders that all is not well. Both public and professional concerns call for reexamination of the knowledge we have accumulated, the relevance and utility of our formulations of the issues, the institutions which represent our formulations, the logistics of deployment of the professional cadre who dispense the services based on our knowledge, and the extent to which our professional practices with people are actually consistent with our best understand-

The problem of measuring a time interval using a crystal oscillator as a time base is discussed. A statistical analysis is made of the free-running oscillator and gated counter when the time interval to be measured is repetitive. Using the equivalent circuit of a quartz crystal, the difficulties involved in using a pulsed crystal oscillator as a time base are investigated. A method is described to...