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All doctors are highly experienced at passing exams during medical school and in postgraduate training. However, for a number of trainees, notably those who have had a period out of programme to undertake research or for parental leave, the European Examination in General Cardiology (EEGC) is the first exam they will have sat in more than 4 years. In addition, the challenging and busy nature of cardiology training, annual review of competence progression and advanced modular training allocation process can allow little time or energy for revision. Finally, personal circumstances and responsibilities change as we get older, and this can pose additional difficulties, and at times conflict, when preparing for the exam. The British Cardiovascular Society (BCS) emails all cardiology trainees about the EEGC in November of their fifth Specialty Training year (ST5)—if you are in ST5 and don’t receive this email, you should contact the BCS and inform your training programme director. It is important that trainees understand the structure of the exam and the topics covered. This information is covered in detail in Behind the Scenes of the European Exam in General Cardiology, Heart 2019 and on the BCS, European Society of Cardiology (ESC) and theUnion of European Medical Specialists (UEMS) websites. ### Preparing the knowledge required to pass the exam Adult …

The European Examination in General Cardiology (EEGC) is a joint venture between the European Union of Medical Specialists, the European Society of Cardiology (ESC) and the participating National Cardiac Societies, including the British Cardiovascular Society (BCS). It provides a high-quality test of knowledge for cardiology trainees from 14 countries where it is used to support training. In the UK, the EEGC is taken in specialty training (ST)5, and can be retaken in ST6 and ST7 if necessary, and is approved by the GMC as a requirement for CCT. Development of the exam (figure 1) starts at the ESC Congress in August with a question writing meeting (a). Each question has a clinical scenario, a single question and five possible answers shown in alphabetical order. The questions are written and edited by groups of cardiologists from a range of countries and subspecialties. The knowledge tested is mapped to the curriculum …

Process is a central category in institutionalist economics. Conceptions of process, often bound up with ideas of historical time and circular or cumulative causation, are regularly used to distinguish institutionalism from mainstream theorising and to highlight similarities or complementarities with other heterodox positions. Discussions of institutionalist ideas of process, however, have tended to concentrate on the contributions of Thorstein Veblen to the exclusion of those of other major institutionalists. In contrast, this article considers two other important contributors to institutionalist thought: John Commons and Clarence Ayres. The differences between these authors’ works are often thought to articulate some kind of a fault line in institutionalist thought, highlighting very different and indeed incompatible positions. I argue that although their overall projects are clearly very different, if attention is focussed on the general ontological presuppositions of each author, there exists a good measure of common ground between them. This is especially the case if comparisons are made, in line with the focus of this special issue, between their conceptions of process and order. From an ontological perspective, moreover, those aspects of their accounts that at first appear at odds, are rather shown to be quite compatible and even usefully complementary.

Ontology is usually defined very broadly as the study of being or as the study of the kinds of things that exist. But we all know something about ontology and use it on a daily basis. To use a simple example, a stick may be a useful tool to clean a carpet, but it would not be a very good tool for cleaning a window. We know this because we understand something about the natures, the being, of windows, carpets and sticks. Ontology, has enjoyed something of a resurgence in recent years. However, it continues to elicit very different, often polarised, attitudes in social theory. Some view ontology as either irrelevant, a ‘fifth-wheel’ that generates no practical implications or concerns, or (if it does have implications) as an undesirable form of essentialism, most likely betraying some unreconstructed form of ‘modernism’. For others, myself included, ontology is viewed as essential and non-optional in the sense that all social theorising presupposes some kind of ontology, and it is better to be explicit about this than to remain wedded to an implicit ontology that may well be fraught with important problems and inconsistencies. It is fair to say that amongst those currently concerned with the study of technology, it is the former view that tends to dominate. The main task of this chapter is to argue for a particular conception of ontology that can be useful for the study of technology whilst avoiding the usual criticisms levelled at it. More specifically, this chapter first provides some of the context to these differing views concerning ontology's significance. It then lays out a broad conception of ontology that, it is hoped, might meet the concerns of even those who tend to be suspicious or critical of ontology. In so doing, this chapter also introduces and develops a series of ontological arguments, concepts and distinctions that will be drawn upon throughout the remaining chapters. Contextualising Ontology The term ‘ontology’ dates back to at least the late scholastic writers of the seventeenth century. The traditional understanding of the term is the science or study of being, deriving from the Greek ‘onto’ (being) and ‘logos’ (study or science). Defined in this way, of course, ontology might involve the study of just about anything, and those who dismiss ontology as irrelevant often make just this point.

It is uncontentious to suggest that those with autism tend to have some kind of special relationship with technology. An abundance of reports from parents and clinicians take it largely for granted that children with autism are attracted or drawn to various kinds of technological devices (Colby, 1973). More formal evidence for such a relationship has come from research into the use of assistive technologies (Wainer and Ingersoll, 2011, Goldsmith and LeBlanc, 2004). Elsewhere, support comes from research into the profiles of autistic children, where a disproportionate number of those with autism are male and offspring of engineers and mathematicians (Wheelwright and Baron-Cohen, 2001). Support is also found in claims that there are dramatic increases in the prevalence of autism in high-technology regions such as Silicon Valley (Silberman, 2000). A central feature of these reports is the idea that technology presents a more comfortable or more manageable interface between those with autism and aspects of a social world that are often experienced as mysterious and unsettling. Whilst a few studies exist that focus upon implications that follow from such a relationship for our understanding of autism, as far as I know there are none that ask if such a relationship might tell us something about the nature of technology. This is the general motivation of this chapter. More specifically, this chapter summarises the main features of autism as it is currently understood along with a discussion of prominent theories used to explain it. An account of these broad features is then given in terms of the conception of technology developed in preceding chapters, focusing upon the nature of the relationship between those with autism and technology. A central focus is upon the different kinds of isolatability that exist in reality and that are particularly relevant to an understanding of technology. My main argument is then that difficulties in coping with inherently unisolatable phenomena both prompt an attraction to technological devices and encourage particular kinds of relations to it. Finally, some implications are considered.

In this chapter I want to develop the idea, introduced in Chapter 6, that recombination plays an important role in explaining some of the special characteristics or properties that are often associated with technology. That recombination plays an important role in our understanding of technology is a suggestion that has gained prominence in recent years within some strands of mainstream economics. However it is not a new idea, and can be traced back at least to contributions to the sociology of invention literature of the 1920s and 30s. Moreover, as noted above, a focus on recombination was also central to the work of Clarence Ayres. The aim of this chapter is to review the different conceptions of recombination that emerge in these different literatures and highlight their strengths and weaknesses. I argue that some conception of recombination marks a positive development in all these traditions. However, I also argue, drawing upon ideas from earlier chapters, that for a conception of recombination to be of much use it must both be given a more ontological formulation and be combined with a more complex conception of technology. The advantages of this reformulation are illustrated by briefly considering the contention that modern societies can be understood to be speeding up or accelerating. From Production Functions to Recombination As noted above, a common criticism of standard mainstream economics is that it pays little attention to the study of technology, or more precisely there is little concern with the nature of technology. Within mainstream accounts, technology's presence is felt via the stipulation of different relationships between inputs and outputs. At most, technology is conceptualised as some kind of ‘menu’ that is intended to capture constraints placed on human action in relation to production (Metcalfe, 2010). These constraints are left unexplained, in the sense that their explanation is thought to lie outside the purview of economics proper. Given these constraints, however, economists are concerned with what can be said about the relations of inputs and outputs, information typically summarised in terms of the shapes and properties of production functions. In this case, questions about technology reduce to questions about the efficiency with which inputs generate outputs, the relative proportions in which the inputs are employed and the ease of substituting one input for another. None of these issues requires much consideration of what technology might be.

Andrew Feenberg’s work continues critical theory’s concern with the way in which capitalism appears, or is experienced, as beyond criticism or challenge. Why or how the social practices involved appear this way is explained in terms of their apparent rationality. While Feenberg does more than most critical theorists to elaborate the conception of rationality involved, the account he gives, in terms of particular resemblances to science, seems at best ad hoc and at worst seems to cede science to positivism. I argue, however, that Feenberg’s account of rationality can easily be given an alternative, more ontological, grounding. Some implications of this alternative account are then drawn out, especially in relation to Feenberg’s theory of technology.

Mainstream economists tend to take a positive view of the role that markets play in solving environmental problems. For them, environmental problems arise because of ‘missing markets’ and require the generation of new markets, internalising externalities and allowing agents’ preferences to be registered ‘properly’ in, or through, the market. This paper provides an illustration of how misguided this basic approach to environmental problems can be. Specifically, the focus of the paper is upon the problem of aviation emissions and the policy solution most prominently advocated to mitigate them, emissions trading. Adopting this focus shows the limitations of a pivotal, though largely unacknowledged, assumption of mainstream perspectives on environmental problems, namely, that all emissions (and indeed costs) are assumed to be equivalent. In other words, it does not matter how particular emissions come about or what the long-term structural conditions are that are faced by any particular emitter. However, once a focus upon dynamic interdependencies and trajectories of systems is adopted, rather than the usual preoccupation with short-term maximisation behaviour, it becomes clear that, in the case of aviation at least, emissions trading is most likely to exacerbate an already worrying problem. Copyright , Oxford University Press.

There is a tension in many discussions of technology concerning the distinctionbetween technical objects and other artefacts. On the one hand, a variety ofartefacts, such as paintings, sculptures, jewellery, food, toys, passports, etc., tendnot to be considered as technical objects. Such artefacts do not enter into accountsof technical change or technological trajectories and are not referred to in orderto illustrate major theories of technology—for example, it is hard to image atheory of technological determinism having emerged from a concern with suchartefacts as paintings or jewellery. On the other hand, general discussion oftechnology tends to shift between the word technology and undifferentiatedreference to material artefacts or even simply artefacts. That is, specific talk ofparticular “acceptably technical” objects, such as computers or hammers, whengeneralised, quickly take the form of discussions of artefacts or material thingswith no clearly or explicitly distinguished technical characteristics. No doubtmuch of this tension arises for the simple reason that it is not easy to establish whatit is about certain artefacts that make them unambiguously technical in nature.Various attempts have been made to use some conception of “function” or“means” to mark the difference. But such attempts quickly unravel. Is art or foodwithout function? Are not most actions or productions a means to some otheraction or production?The main argument of this paper is that a defining aspect of technology is therole that it plays in extending human capabilities. Moreover, drawing attention tothis aspect of technology, I suggest, serves not only to help distinguish technologyfrom other material artefacts but also goes some way to explaining the peculiarposition technology occupies in modern societies, or at the very least provides auseful framework for posing important questions about technology.These arguments, however, require a fair amount of elaboration. First, a varietyof definitional issues are raised. For example, can a role be a defining aspect of a

Ontology tends to be held in deep suspicion by many currently engaged in the study of technology. The aim of this paper is to suggest an ontology of technology that will be both acceptable to ontology’s critics and useful for those engaged with technology. By drawing upon recent developments in social ontology and extending these into the technological realm it is possible to sustain a conception of technology that is not only irreducibly social but able to give due weight to those features that distinguish technical objects from other artefacts. These distinctions, however, require talk of different kinds of causal powers and different types of activity aimed at harnessing such powers. Such discussions are largely absent in recent technological debates, but turn out to be significant both for ongoing technology research and for the recasting of some more traditional debates within the philosophy of technology

This paper explores the interplay of factors that produce specific local patterns of interaction between firms and universities, using survey evidence from a comparative study of two e´lite locations, the Oxford and Cambridge regions. It uses these examples to examine why innovating firms have external links, why they have them with universities, which spatial mechanisms are significant in the place-specific technology transfer links universities have with firms in their immediate hinterlands, and what kinds of institutional factors influence the form links take.

KEEBLE D., LAWSON C., MOORE B. and WILKINSON F. (1999) Collective learning processes, networking and ‘institutional thickness' in the Cambridge region, Reg. Studies 33 , 319-332 . The paper investigates the nature and extent of regional collective learning processes and networking by innovative, technology based, small and medium sized enterprises(SMEs)in the Cambridge region. It highlights the importance of socio-cultural preconditions for learning involving the University of Cambridge, and documents the significance of firm spin-offs, inter-firm and organization networking, and local scientific and managerial recruitment, as dynamic collective learning processes. It also, however, identifies the complementary importance of wider national and global networks for SME innovation inputs, research collaboration and professional staff recruitment. Finally, it assesses the relevance of the concept of ‘institutional thickness' in evaluating firms' experience of regional support structures and services. KEEBLE D...

This paper argues the case for extending the competence theory of the firm, or more generally the competence perspective, to analysis of the region. The relevance of the perspective follows from the characterisation of productive systems such as firms and regions as ensembles of competences that emerge from, but are not reducible to, social interaction. Attention is drawn to an identifiable (although unacknowledged) convergence of ideas in the recent regional literature, arguing that these ideas are best re-conceptualised in terms of regional competences. The cluster of hightechnology firms in the Cambridge region of the UK is briefly referred to in order to illustrate the main ideas of the paper.

The paper argues that technology-intensive small firms often need to internationalise their activities, and especially sales, at a very early stage of their development because of the limited and global nature of the technological market niche which they have been set up to exploit. From a survey of 100 such firms in the Cambridge and Oxford regions, it demonstrates that many technology-based smaller firms are engaged in a range of international networks and internationalisation processes, including internationalisation of markets, research collaboration, labour recruitment, ownership and facilities location. Technology-intensive firms reporting high levels of internationalisation also differ significantly from those which are more nationally-oriented, for example in terms of size, age, research intensity, university links, and innovativeness. There are also differences with respect to recent growth rates. Finally, the paper demonstrates that far from substituting international for local networks, technology-intensive firms which have achieved high levels of internationalisation in fact also exhibit above-average levels of local networking with respect to research collaboration and intra-industry links. Internationalisation therefore appears to be grounded or embedded in successful local networking and research and technology collaboration.

1. Introduction - Ontology, Philosophy and the Social Science Part 1 Ontology and Social Theory 2. The Ontological Status of Subjectivity 3. Technology, Technological Determinism and the Transformational Model of Technical Activity 4. Ontological Theorising and the Assumptions Issue in Economics 5. Wittgenstein and the Ontology of the Social: Some Kripkean Reflections on Bourdieu's 'Theory of Practice' 6. Deducing Natural Necessity from Purposive Activity: The Scientific Realist Logic of Habermas's Theory of Communicative Action and Luhmann's Systems Theory 7. Underlabouring for Ethics: Lukacs's Critical Ontology Part 2 - Ontology and Philosophy 8. Quine and the Ontological Turn in Economics 9. Tracking Down the Transcendental Argument and the Synthetic a priori Chasing Fairies or Serious Ontological Business 10. Re-Examining Bhaskar's Three Ontological Domains: the Lessons from Emergence 11. Real, Invented or Applied? Some Reflections on Scientific Objectivity and Social Ontology 12. Theorising Ontology Part 3 - Ontology and Applied Research 13. Freedom, Possibility and Ontology - Rethinking the Problem of 'Competitive Ascent' in the Caribbean 14. On the Ontology of International Norm Diffusion 15. Realist Social Theorising and the Emergence of State Educational Systems 16. The Educational Limits of Critical Realism? Emancipation and Rational Agency in the Compulsory Years of Schooling 17. Economics and Autism: Why the Drive Towards Closure? 18. Applying Critical Realism: Re-conceptualising the Emergent Early Music Performer Labour Market

Recent years have witnessed a considerable resurgence of interest in institutional economics, much of which has been generated by contributions going under the heading of "new institutional economics."1 Although it is difficult to impose any precise programmatic unity upon these contributions [Coates 1986; Maki 1987], it is certainly possible to discern various important commonalities. Most significantly, as other commentators have already pointed out [e.g., Hodgson 1989; Rutherford 1989, 1994], new institutionalist writers share an adherence to some form of individualism. That being the case, however, it warrants emphasis that the precise form of the individualism at work in new institutionalist contributions is rarely spelled out. Rather, the usual strategy is to distinguish and criticize positions understood to be alternatives to individualism such as holism and collectivism. Of particular interest here is the fact that when examples of such supposedly untenable alternatives to individualism are cited, the work of J. R. Commons is frequently referred to. Commons's work is referred to because it is held to exemplify certain errors that are to be transcended. Thus, although new institutionalists often incorporate or express sympathy toward some of Commons's specific ideas (an obvious example being Williamson's [1975; 1985] use of the "transaction" as the basic unit of analysis), their main objective is to define their own general methods and concerns as being in direct opposition to those of Commons. The purpose of this paper is basically twofold. First, I want to argue that the new institutionalist contributions misrepresent Commons's actual writings. That is, they tend to set up a "straw-person" interpretation of Commons.2 Second, I wish to offer some explanation of the identified misrepresentations. More specifically, in the

Despite recent advances, economic methodology has found it difficult to transcend certain positivist premisses and concerns. We argue that developments in philosophy and social theory under the heading of critical realism are particularly significant with respect to overcoming these problems. To illustrate, we focus upon various themes that arise in a recent collection concerned with economic methodology and institutionalist economics, relating these themes to relevant aspects of this realist position. In so doing, we argue that an economic methodology restricted to description and an institutionalism committed to some form of methodological individualism are not only unnecessary but problematic.

The work of J.R. Commons, I want to argue, bears a close relationship to, is clarified by and informs, recent developments in social theory. Specifically, recent developments in social theory, elaborated under the heading of critical realism, serve to organize or systematize Commons' work in such a way as to defend it against the commonly made criticisms of incoherence and irrelevance to more general or theoretical concerns. On the other hand Commons' work, based as it is upon practical case study and intervention, serves both to extend or ‘deepen’ existing critical realist accounts and demonstrate their relevance for political economy.

This volume investigates the relationship between globalization, inequality and social capital, and reveals that although strongly related, these ideas are also highly contested. The authors elucidate the interactions between these concepts, looking in detail at the conflicts and competitiveness which can arise at both the national and organizational level.

LAWSON C. and LORENZ E. (1999) Collective learning, tacit knowledge and regional innovative capacity, Reg. Studies 33 , 305‐317 . The paper reviews key ideas in the firm capabilities literature and shows how they can be usefully extended to develop a conception of collective learning among regionally clustered enterprises. The paper also explores the relationship between codifiable and tacit knowledge in the innovation process, and investigates the claim that tacit knowledge, because it is difficult to transfer in the absence of labour mobility, may constitute a basis for sustained regional competitive advantage. The closing section uses case study material based on Minneapolis and Cambridge to illustrate the importance for innovation of a regional capability for combining and integrating diverse knowledge, and of the sources of such capabilities as pre-conditions for successful high technology regions. LAWSON C. et LORENZ E. (1999) L'apprentissage collectif, la connaissance implicite et la capacite regio...

Theorizing in economics is often associated with some form of individualism. This paper considers the nature of this association in the work of Carl Menger. I adopt this focus not only because of continuing interest in Menger's work, but because recent developments in social theory facilitate a fruitful reevaluation of his general position. I argue that a convincing link between theory and individualism is absent in Menger's work. Moreover, I argue that the various criticisms often made of his work actually relate to the ideas which underlie his individualism rather than, as is usually supposed, those arising from an adherence to a form of Aristotelianism.

This opening epigraph by Cooke and Morgan encapsulates recent thinking on regional innovation systems. While national regulatory frameworks in their broadest sense provide the overall operating context, the regional or local environment is where firms live and learn. This is also the geographical scale at which the nexus of actions by individuals, business intermediaries, universities, and society can make a difference to the evolution of economic development. Thus the world is composed of a’ hierarchical mosaic of densely-developed regional economies with specific resource endowments, assets, institutions, co-ordination mechanism, know-how, rules of conduct and cognitive frameworks’ (Asheim and Dunford 1997,451). The specific characteristics of regions arise from the interaction of geo-historical events, and increasingly by ‘the elaboration of new forms of globalization in the organisation of industrial activity’ (Amin 1993, 447).

Simon Andrew William Samuel Biggart attended Epsom College before studying medicine at Charing Cross and Westminster Medical School. Known to his medical school friends as “SAWS,” he threw himself into student life with vigour and developed lifelong interests in sailing, golf, skiing, and foreign travel. After taking a BSc in …

A 42 year old man was referred for investigation of an abnormal chest x ray that showed profound widening of the mediastinum suggestive of a large thoracic aneurysm. At the age of 35 …

This volume investigates the relationship between globalization, inequality and social capital, and reveals that although strongly related, these ideas are also highly contested. The authors elucidate the interactions between these concepts, looking in detail at the conflicts and competitiveness which can arise at both the national and organizational level.