Alex Harvey

HARVEY, A. McGEHEE; SHULMAN, LAWRENCE E.; TUMULTY, PHILIP A.; CONLEY, C. LOCKARD; SCHOENRICH, EDYTH H. Author Information

With weakening prospects of prompt mitigation, it is increasingly likely that the world will experience 4°C and more of global warming. In such a world, adaptation decisions that have long lead times or that have implications playing out over many decades become more uncertain and complex. Adapting to global warming of 4°C cannot be seen as a mere extrapolation of adaptation to 2°C; it will be a more substantial, continuous and transformative process. However, a variety of psychological, social and institutional barriers to adaptation are exacerbated by uncertainty and long timeframes, with the danger of immobilizing decision-makers. In this paper, we show how complexity and uncertainty can be reduced by a systematic approach to categorizing the interactions between decision lifetime, the type of uncertainty in the relevant drivers of change and the nature of adaptation response options. We synthesize a number of issues previously raised in the literature to link the categories of interactions to a variety of risk-management strategies and tactics. Such application could help to break down some barriers to adaptation and both simplify and better target adaptation decision-making. The approach needs to be tested and adopted rapidly.

Many observers have, commented on the frequency of abnormalities of the thymus in patients with myasthenia gravis. Approximately one half of the reports of autopsies on patients with myasthenia gravis have contained descriptions of benign tumors, hyperplasia or persistence of the thymus. It is true, of course, that the autopsies on patients with myasthenia gravis are more apt to be reported if there is present some abnormality such as a tumor of the thymic region. On the other hand, it is likely that many small tumors or other abnormalities of the thymus have been overlooked at necropsy in a number of patients with myasthenia gravis. Norris 1 expressed the opinion that pathologic changes may be found in the thymus in cases of myasthenia gravis in direct ratio to the care with which they are sought. The literature contains the descriptions of only a few attempts to influence the course of

The world literature covering the coincidence of Addison's disease and either diabetes mellitus and/or thyroid aberration has been reviewed. In addition, ten new patients, eight with idiopathic and two with tuberculous Addison's disease, thyroid dysfunction and diabetes mellitus were studied. Five of the eight patients with idiopathic Addison's disease showed significant titers ofantiadrenal antibody and six of these eight showed significant titers of thyroid antibodies. However, neither of the two patients with tuberculous Addison's disease showed evidence of antiadrenal antibody, but one exhibited thyroid antibodies. Patients with idiopathic rather than tuberculous Addison's disease showed a higher coincidence of diabetes mellitus and/or thyroid dysfunction.