Parkinsonism refers to the clinical presentation of tremor at rest, rigidity, bradykinesia, loss of postural reflexes, flexed posture, and freezing. It is “definite” when tremor or rigidity is present with one other feature, “probable” when rest tremor or rigidity are present alone, and “possible” when two features other than rest tremor or rigidity are present. Traditionally,
Parkinsonian disorders have been classified Parkinson disease (PD), multisystem atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), wherein MSA encompasses the formally separate disorders of striatonigral degeneration (SND), sporadic olivopontocerebellar atrophy (SOPCA), and Shy-Drager Syndrome (SDS).
Clinical and pathologic studies suggest that these syndromes represent a spectrum of a single neurodegenerative disorder linked by common pathology. Hence MSA incorporates syndromes of MSA with predominant Parkinsonian features
A transaction is a set of one or more SQL
statements that are logically grouped together and that must be either
applied to the database in their entirety or not applied at all.
Consider the commonly cited example of a funds transfer from one
account to another. In its most simple form, this transfer will involve
two UPDATE statements: one to reduce
the account balance in the "from" account, and another to increase the
account balance in the "to" account. Suppose that the "from" account has
been updated, but then the change to the "to" account cannot be
completed. We must be sure to undo that first update, or the money that
was to be transferred will have, in effect, "disappeared."
We expect database transactions to conform to the
ACID principle, which means that transactions
The transaction is indivisibleeither all the statements in
the transaction are applied to the database, or none are.
The database remains in a consistent state before and after
Subqueries are a powerful tool that can be used in all four SQL data statements. This chapter will explore in great detail the many uses of the subquery.
A subquery is a query contained within another SQL statement (which I will refer to as the containing statement for the rest of this discussion). A subquery is always enclosed within parentheses, and it is usually executed prior to the containing statement. Like any query, a subquery returns a table that may consist of:
A single row with a single column
Multiple rows with a single column
Multiple rows and columns
The type of table returned by the subquery determines how it may be used and which operators may be used by the containing statement to interact with the table returned by the subquery. When the containing statement has finished executing, the tables returned by any subqueries
are discarded, making a subquery act like a temporary table with statement scope
(meaning that the server frees up any memory allocated to the subquery results after the SQL statement has finished execution).
Jane was a thirty-five-year-old Dutch woman with a background of drug abuse and chaotic relationships involving violence from men. For a brief period her three young children had been taken into care, but were now living with her again. She had managed to establish a more settled way of life, free of drugs, but was still troubled by traumatic events of the past during the time when she lived in a crime-ridden area of Amsterdam. She felt fearful much of the time, and showed continuing symptoms of PTSD. Her childhood had involved some sexual abuse by her brother. She had felt close to her mother, but perceived her as needy and neglectful. Her relationship with her father had been distant, and her parents had separated when she was aged fifteen. Jane had undergone counselling previously, with some benefit. We agreed to proceed with a few sessions of EMDR, focused initially on the sexual abuse by her brother.
Overall narrative revealed by EMDR
Although the ensuing narrative is not simple and linear, the overall story of Jane’s life emerges very clearly in these ten EMDR sessions. Thus, she felt neglected and unprotected as a child, desperately wanting her mother’s love, yet experiencing her mother as manipulative and “flighty”. She experienced her father as violent and frightening. Her brother sexually abused her. Further abuse and trauma occurred in sexual relationships in her teens. She became cynical and promiscuous. Her emotional pain and traumatic stress were blocked with extensive use of alcohol and drugs. Rage at her mother is a recurrent theme in the EMDR sessions. She also manages to report (more directly than she ever had before, apparently) specific episodes of abuse and trauma—experiencing relief as the emotions are abreacted through the eye movements. Her awareness of the defensive function of her drug and alcohol abuse becomes clearer as a result of the EMDR.
In organizations around the world, this is how change happens. You, the organization’s leader, identify a problem and hire an expert consulting organization to create the solution. The consultants bring in their legions and you get your answer. Next, you try to sell the plan to the rest of the organization. But instead of excitement, you’re met with indifference and resistance. Getting people on board becomes a full-time obsession. Your elegant solution, wrapped in a handsome binder, sits in silence on your bookshelf, an expensive reminder of what might have been.
“That still didn’t work. Let’s tweak the model.”
This cycle has repeated often. To deal with the apathy and resistance that accompanies many change processes, consultants developed a change management structure to ensure buy-in. This structure consists of a sponsor group, a steering committee, and design teams representing a cross section of the organization. This streamlined organization strives to reduce the barriers to change that exist within the wider organization. But these groups and teams often fall into the same trap that exists when consultants work solely with leaders. They go on to create the solution, and then, after making all of the key decisions, they seek to create buy-in from the rest of the organization.