bluuebunny/crossref_metadata_2025 huggingface dataset:
Philosophical Organization Theory
Authors: Tsoukas Haridimos
Published: January 2019

When it comes to the field of organization and management theory, a philosophical perspective enables us to conduct organizational research imbued with the attitude of “wonder”; it helps researchers question dominant images of thought underlying mainstream thinking, and provides fresh distinctions that enable the development of new theory. In bringing together a collection of key essays by Haridimos Tsoukas, this volume explores fundamental concepts, such as organizational routines, that have gained currency in the field, as well as revisiting traditional concepts such as change, strategy, and organization. It discusses organizational knowledge, judgment, and reflection-in-action, and, at the meta-theoretical level, suggests complex forms of theorizing that seek to reflect the complexity of organizations. The conceptual attention throughout is on process and practice, underlain by performative phenomenology and an emphasis on agents’ lived experience. This provides us with the language to appreciate the dynamic character of organizational behaviour, the embeddedness of action, and the complexity of organizational life. The theoretical claims presented in this volume have important implications for scholarly practice, insofar as they help retrain our attention: from seeing structures and individuals, we can now appreciate processes, experiences, and practices. A phenomenological attitude makes organization theory more open, more creative, and more reflexive, and this book will be essential reading for researchers and students in the field of organization studies.
What is Reflection-in-Action?
Authors: Tsoukas Haridimos
Published: January 2019

How does an administrator, manager, or other practitioner know how to do what she does while she does it? Building on the work of Donald Schön, this chapter proposes a phenomenological theory of practice and of reflection-in-the-course-of-practice that transcends what is seen as Schön’s cognitive orientation, as well as some other limitations in his theorizing. The theory includes: an appreciation for the evaluative dimensions built into competent practice that encourage, if not require, reflecting; a further theorizing of the character of surprise; and a fuller delineation of the character of improvisation in relation to practice and its surprises. Schön’s arguments are reframed in phenomenological, especially Heideggerian, terms, and these discussions are illustrated with vignettes from the world of practice drawn from field research.
The Power of the Particular
Authors: Tsoukas Haridimos
Published: January 2019

This chapter elaborates on how singularities (unique, first-time/once-occurrent events) may be thought of in organization science, and how an organization science of singularities may be possible. Organizations are designed to generate regularities. Historically oriented towards capturing regularities, organization science has treated organizations as abstract systems, devoid of the idiosyncrasies of human agency. However, while organizations categorize and generalize, insofar as people in organizations act, they inevitably create and encounter differences. Difference indicates uniqueness implicit in the particularity of things, and the repetitiveness of regularities in organizations does not indicate the reproduction of sameness, since repetition is an occasion for generating difference. An organization science of singularities is concerned with bringing to attention the unique features of organizational life that create new possibilities. Such a science is performative, seeking to provide action-oriented accounts of organizational life from within.
Precarious Homes: Encounters with the Benefit System
Authors: Koch Insa Lee
Published: January 2019

Chapter 3 looks at how so-called ‘single mothers’ engage the benefit system in their daily attempts to build and maintain family homes. In both policy terms and popular language, the ‘single mother’ is typically portrayed as a woman who corrupts both the immaculate trust of a mother to her child and the civic trust of a citizen to the public by bearing children in order to access public resources. By contrast, this chapter takes as its point of departure women’s own daily pursuits of family homes and the social relations that matter within them. It argues that the rules and logic of the benefit system come into conflict with women’s own expectations of what makes a good family home. By portraying women as needy individuals defined by their lack, means-tested benefits not only expose women to bureaucratic complexity but more substantively, penalize their reliance on fluid household arrangements that encompass friends, partners, grown-up children, and extended kin. While some women learn to ‘play the system’, their attempts to personalize the state also place them in an awkward and sometimes altogether illegal relationship with the law.
Sovereign Debt and Human Rights
Authors: Lumina Cephas
Published: January 2019

The ability of States to fulfil their international human rights obligations depends, to a large extent, on the availability and allocation of sufficient resources to essential investments in human, social and physical infrastructure that provide the foundation for sustainable and equitable development, as well as the full realisation of human rights. In many cases, however, excessive sovereign debt burdens and the ensuing costs of servicing or repaying the debt often reduce the amount of resources available to governments for the realisation of human rights. Furthermore, the policy conditions that are typically linked to loans and debt relief provided by international financial institutions often limit investment in and undermine the provision of accessible public services. This chapter seeks to establish the connection between sovereign debt and human rights through a broad discussion of the impact of sovereign debt and related policy conditionalities on the realisation of all human rights.
The Educational Traveller
Authors: Corens Liesbeth
Published: January 2019

This chapter foregrounds the diversity and dynamics of the expatriate community and writes the history of expatriate English Catholics into a much older tradition of educational travel. Recognizing that continuity alerts us to read the expatriate houses neither as a purely new phenomenon, nor as exclusively defined by flight from repression. Rather, without prioritization, it integrates retreat from persecution and preparation for the future, but still recognizing the two-way interaction. Children and youngsters were sent to colleges on the Continent to ensure that they were safe from Protestant influence and to prepare them for an active apostolate. Highlighting these dynamics helps to move beyond a static understanding of expatriates which limits the understanding of movement to the moment of migration, and instead discloses an expatriate life that was much more dynamic and in flux than these images suggest. Going abroad was a transformative experience.
The Intercessor
Authors: Corens Liesbeth
Published: January 2019

This chapter explores questions about assimilation and integration of Catholics in a universal Church through the lens of expatriates’ devotional lives. Their English identity was not a merely abstract idea but was, like all early modern belonging, constituted through bonds and reciprocal relations. The formative role of charity in fostering and maintaining communal bonds explains some of the driving motivations behind expatriate English Catholics’ preserving their own English community distinct from that of their hosts. They needed to perpetuate the commemoration of their ancestors to ensure their salvation, and intended to return England to the Catholic fold for the salvation of their compatriots. Yet this chapter also questions the assumption that migrants belonged either to their home society or their host society, and that there is a linear way to map their steady integration into the new host culture. Identification with and participation in one community did not preclude membership of other communities.
Philosophical Poetry
Authors: Cummings Brian
Published: January 2019

Fulke Greville is well known as the author of philosophical treatises in verse, but what does it mean to be a philosophical poet? This chapter considers the idea of philosophical poetry in Greville, not by assessing philosophical ideas in his poetry, but by understanding how poetry for him is a specific and creative way of doing philosophy. To do this, the chapter considers the unusual metrical device of the ‘feminine ending’, usually defined as a line with a hypermetric extra foot. Sidney theorizes about this as well as practising it, and several Elizabethan poets, including Shakespeare as well as Greville, specialize in it. The chapter concludes by discussing how the ‘feminine ending’ is associated especially with expressing mental doubt, qualification, or scepticism.
Full Steam Ahead or Dead in the Water? European Union Environmental Policy after the Economic Crisis
Authors: Gravey Viviane , Moore Brendan
Published: January 2019

For the EU, environmental policy has been posited as both a source of legitimacy and an opportunity for international leadership. However, concerns have been raised that the 2007–8 economic crisis and its consequences have negatively affected the EU’s environmental ambition. This chapter addresses this issue by comparing the pre-crisis and post-crisis policy intensity of three EU environmental policy subsectors (environment–industry, climate and energy, and air-quality policy) using the Index of Policy Activity (IPA). The results suggest that average policy intensity has increased in these subsectors since the economic crisis. The pre-crisis policy intensity in the climate and energy subsector was significantly lower than environment–industry or air-quality policy, but a rapid increase has led to a post-crisis convergence.
Irish Environmental Policy after the Economic Crisis
Authors: Flynn Brendan
Published: January 2019

This chapter employs qualitative analysis to apply the Index of Policy Activity (IPA) to environmental policy in Ireland between 1995 and 2016. It develops the IPA by deploying the new indicator of ‘provenance’, which enables the lack of environmental policy innovation in Ireland to be demonstrated, finding the state to be a ‘policy-taker’ from the European Union. The chapter shows that, while Ireland was hugely affected by the economic crisis of 2007–8 and became the subject of a complex bailout from the Troika, the impact upon environmental policy has been limited. Ireland was a relative laggard prior to the crisis, and possessed a Green coalition government, so there have been few demands or scope for reversals and deregulation. Ironically, the chapter finds that crisis has been good for environmental policy outcomes and that a return to growth may pose the biggest challenge for the future of the Irish environment.
Environmental Policy in Times of Crisis
Authors: Davidescu Simona
Published: January 2019

This chapter employs qualitative analysis to apply the Index of Policy Activity (IPA) to a relative newcomer to the European Union, Romania. The chapter analyses renewable energy legislation, and finds that the unexpected success of Romania in this policy area is actually a case of ‘reluctant and accidental compliance’ over the period 2008–17. The chapter reveals a case of active, high visibility dismantling from 2013 onwards, which domestic politicians consistently linked to the global financial crisis of 2007–8. However, the analysis suggests that past legacies, sloppy and vague policy formulation, and lack of learning were actually the real drivers of policy failure in Romania and therefore of policy dismantling.
The Restoration of Biodiversity in France
Authors: Berny Nathalie
Published: January 2019

This chapter employs qualitative analysis to apply the Index of Policy Activity (IPA) to nature protection and biodiversity policy in France over a twenty-year period. It extends the application of the IPA to include consideration of two critical aspects of implementation that can shape policy ambition: the support of the policy actors and administrative capacity. The chapter reveals that biodiversity policy has been subject to extensive reforms, which have overlapped with a devolution agenda, leading to increased regionalization of this policy sector. One outcome of this process is that under-resourced regional administrations must shoulder the burden of implementing policy. These findings suggest that France may be engaging in dismantling by arena shifting.
Lagrange Numbers Less Than Three
Authors: Reutenauer Christophe
Published: January 2019

This chapter reflects the technical heart ofMarkoff’s theory. Themain theoremis that if the Lagrange number of a sequence is smaller than 3, then this sequence is the image under the substitution a->11, b->22 of a sequence satisfying theMarkoff property outlined inChapter 4. The proof goes through several technical lemmas: except for a finite number of terms, the sequence has only 1 and 2s; 121 and 212 are forbidden factors; the factors 1122 and 2211 are preceded and followed bywordswith a special lexicographical property; more forbidden factors; 1 and 2’s appear in pairs. The similar theorem for bi-infinite sequences is deduced.
Markoff’s Theorem for Quadratic Forms
Authors: Reutenauer Christophe
Published: January 2019

In this chapter, Markoff’s theorem for quadratic forms is proved. These forms are real, binary, and indefinite. The two first sections are concerned with results which are reminiscent of the work of Gauss: each form is equivalent, under the action of GL2(Z), to a form having a root larger than 1, the other being between − 1 and 0. For such a form, onemay define a bi-infinite chain of forms, using the expansion into continued fractions of both roots; then the infimum of the form is equal to the infimum of the first coefficients of all these forms. In the last section,Markoff’s theoremis deduced: if three times the infimum of a formis larger than the square root of its discriminant, then the formmust be equivalent to aMarkoff form.
Palindromes and Periods
Authors: Reutenauer Christophe
Published: January 2019

The geometrical definition of Christoffel words shows that such a word is of the form amb for some palindrome m. These palindromes are special palindromes on a two-letter alphabet,withmany surprising characterizations; they are called centralwords. In particular, they may be computed by iterated palindromization, as follows from a theorem of Aldo de Luca. This operation may be simulated by a formula of Justin. Central words are characterized also by the existence of two relatively prime periods, p and q, and length equal to p + q − 2 (Mignosi and de Luca). Moreover, Christoffel words are products of two palindromes (Chuan).
Agricultural Neglect and Retarded Structural Change in Sub-Saharan Africa
Authors: Auty Richard M. , Furlonge Haydn I.
Published: January 2019

Sub-Saharan Africa has followed a singular pattern of structural change that lags global trends and traps a large proportion of the workforce in low-productivity agriculture through a process of agricultural involution. This chapter focuses on the small land-rich crop-driven economies, which comprised the vast majority of sub-Saharan countries at independence. Baldwin’s yeoman farm model suggests that the diffuse linkages of such economies are advantageous for development, but his model neglects the need for resilient institutions and sound policy, which most countries lacked. The elite in sub-Saharan Africa abused crop marketing boards to extract rents from small farmers, converting the linkages from favourably diffuse to concentrated and theft-prone. Most economies traced staple trap trajectories and experienced growth collapses that, contrary to staple trap theory, failed to motivate the elite to promote diversified economic growth, with the exception of Mauritius. This chapter traces this policy failure to the prioritization of industrialization and associated persistent neglect of the potential development stimulus of agriculture.
The Evolving Role of Manufacturing in Economic Development
Authors: Auty Richard M. , Furlonge Haydn I.
Published: January 2019

Differences in industrial policy explain why Latin America lost its head start in economic development to East Asia. Latin America persisted with industrialization by import substitution under soft budget constraints, which failed to mature and generate adequate foreign exchange and government revenues. In contrast, East Asia abandoned import substitution early to pursue competitive industrialization under hard budget constraints that incentivized rapid sector maturation. East Asia is closing the productivity gap with the US, but Taiwan’s cautious competitive industrialization is more welfare-enhancing than South Korea’s aggressive big push. Chile pioneered Latin American reform in line with its comparative advantage in commodity-driven growth and successfully managed its mineral rent to become best practice. However, diversification remains constrained and economic growth has slowed. Brazilian reforms have been less effective than Chile in managing rents to minimize Dutch disease and curb growth-sapping rent-seeking. However, contrary to Rodrik, this chapter argues that Latin American structural change reflects realignment with comparative advantage and not premature deindustrialization.
The Principal Findings and some Policy Implications
Authors: Auty Richard M. , Furlonge Haydn I.
Published: January 2019

The resource curse is part of a broader rent curse linked to geopolitical rent, regulatory rent, and labour rent, as well as natural resource rent. Variation in the intensity of rent curse effects reflects major shifts in policy fashion. It declined with the post-1980s dismantling of industrialization by import substitution. Previously, low rent incentivized the pursuit of policies promoting efficient economic growth under hard budget constraints in East Asia and Mauritius (and now in Bangladesh, Vietnam, and the Philippines). High rent in Latin America and sub-Saharan Africa led to staple trap trajectories associated with protracted growth collapses. However, labour surplus South Asia and the Gulf states can learn from policy errors to, respectively, pursue labour-intensive growth and merge dualistic labour markets as part of a package of sector neutral policies, macroeconomic stability, and an enabling environment.
Conclusions
Authors: Goldman Alan H.
Published: January 2019

This concluding chapter gives a brief summary of the conclusions of each chapter, and an indication of what the reader should take away from this book.
The Decadent Imagination
Authors: Eastlake Laura
Published: January 2019

This chapter examines how aesthetes and decadents staked a competing claim to those Roman narratives of corruption and contagion outlined in Chapter 7. Beginning with a detailed analysis of Marius the Epicurean (1885), it shows how Walter Pater and his contemporaries sought to delink aestheticism from Gibbonian narratives of decline and fall, and to reclaim aesthetic masculinity from associations of moral and masculine deviance. The second part examines decadent authors such as Oscar Wilde, Villiers de L’Isle Adam, and George Moore, who adopted an equally recuperative, though more controversial approach to the ancient Roman past. Revelling in the more illicit and disturbing aspects of Roman history with a playfully self-parodic humour which is typical of the movement as a whole, and frequently voicing their affinity with the most notorious of Roman emperors—Nero—decadent writers appear be invested in a very genuine attempt to disassociate decadent ideologies from Gibbonian models of degeneration and decline.
Conclusion
Authors: Eastlake Laura
Published: January 2019

This final chapter examines the cultural implications of a new century and the outbreak of the Great War for notions of masculinity. It considers the writings of commentators like Robert Baden Powell and A. C. Benson to show that questions of how best to prepare Britain’s youth to face the ‘vast energies and problems’ of the modern world were also, inevitably, questions about the role and relevance of a classical education in that process. The final section glances forward to examine the processes by which receptions of Ancient Rome persist, and are remade during the Great War and a new modern era of total war. Far from attempting to ‘finish’ the meaning of Rome or to homogenize its uses as part of a single theory of what Rome meant to the Victorian male, this chapter emphasizes the ongoing pluralities and complexities inherent in the Roman parallel.
Shaping Policy in India
Authors: Chakrabarti Rajesh , Sanyal Kaushiki
Published: January 2019

How effective is the Indian polity in making laws and policies to address changing ground realities? How do its gears work? Which stakeholder groups are more successful in bringing about policy change, through what methods, and in what contexts? Seeking to answer these questions, Shaping Policy in India takes a close look at nine landmark Indian laws and legislative attempts to reveal the socio-political process of policy formulation in the world’s largest democracy. Offering in-depth accounts of the evolution of these nine major legislations, this book interrogates the suitability of existing political theories to explain the policy development process in an emerging economy like India. It covers recent events in the 1999–2014 period that have underlined the role of non-government players in law-making in India, as well as long-standing movements like right to information, right to education, and food security. Case studies have been used to assess the complexity against the relief of existing political theories, invariably developed in the West and to identify gaps in current political theory in understanding the nature of issue-based political movements, advocacy, and activism. The book then takes a few initial steps towards suggesting a paradigm based on complexity theory that may better serve to illuminate this critical part of the political process.
Muslim Mahākāvyas
Authors: Obrock Luther
Published: January 2019

In his essay on Muslim mahākāvyas, Luther Obrock studies exchanges between the cosmopolitan idioms of Sanskrit and Persian at pre-Mughal Sultanate courts. He introduces three remarkable texts: Udayaraja’s Rājavinoda, an encomium that praises the Muzaffarid Sultan Mahmud Begada of Gujarat using terms adapted from idealized representations of Hindu kingship; Kalyana Malla’s Sulamaccarita, a retelling of both the Biblical narrative of David and Bathsheba and the story of the jinn and the fisherman that appears in the Thousand and One Nights; and finally Shrivara’s Kathākautuka, a translation of Jami’s Yūsuf wa Zulaykhā that effectively transforms the Persian, Sufi-influenced masnavī into a Sanskrit kāvya of Shaivite devotion. These works can be understood as sites of cultural and literary encounter where poets and intellectuals experimented creatively to secure Sanskrit’s continuing relevance in the changing literary ecology of the regional sultanates.
Legal Directives and Practical Reasons
Authors: Gur Noam
Published: January 2019

This book investigates law’s interaction with practical reasons. What difference can legal requirements—be they traffic rules, tax laws, work safety regulations, or others—make to normative reasons relevant to our action? The book critically examines some of the existing answers to that question and puts forward an alternative account. At the outset, two competing positions are pitted against each other: first, the view taken by Joseph Raz, that when the law satisfies certain conditions that endow it with legitimate authority, it acquires pre-emptive force, namely it constitutes reasons for action that exclude and take the place of some other reasons; second, an antithetical position, according to which legal requirements cannot exclude otherwise applicable reasons, but can at most provide us with reasons that operate, and compete with opposing reasons, in terms of their weight. These positions are examined from several perspectives, such as justified disobedience cases, law’s conduct-guiding function, and the phenomenology associated with authority. It is found that, although each of the above positions offers insight into the relation between law and practical reasons, they both suffer from significant flaws. These observations lay the basis on which, in the final part of the book, an alternative position is put forward and defended. On this position, the existence and operation of a reasonably just and well-functioning legal system constitutes some reasons that are neither ordinary reasons for action nor pre-emptive ones, but rather reasons to adopt an (overridable) disposition that inclines its possessor towards compliance with the system’s requirements.
Outcomes of Ambulatory Upper Extremity Surgery Patients Discharged Home with Perineural Catheters from a Veterans Health Administration Medical Center
Authors: King Roderick , Mariano Edward R , Yajnik Meghana , Kou Alex , Kim T Edward , Hunter Oluwatobi O , Howard Steven K , Mudumbai Seshadri C
Published: January 2019

Objective

The feasibility and safety of managing ambulatory continuous peripheral nerve blocks (CPNB) in Veterans Health Administration (VHA) patients are currently unknown. We aimed to characterize the outcomes of a large VHA cohort of ambulatory upper extremity surgery patients discharged with CPNB and identify differences, if any, between catheter types.

Methods

With institutional review board approval, we reviewed data for consecutive patients from a single VHA hospital who had received ambulatory CPNB for upper extremity surgery from March 2011 to May 2017. The composite primary outcome was the occurrence of any catheter-related issue or additional all-cause health care intervention after discharge. Our secondary outcome was the ability to achieve regular daily telephone contact.

Results

Five hundred one patients formed the final sample. The incidence of any issue or health care intervention was 104/274 (38%) for infraclavicular, 58/185 (31%) for interscalene, and 14/42 (33%) for supraclavicular; these rates did not differ between groups. Higher ASA status was associated with greater odds of having any issue, whereas increasing age was slightly protective. Distance was associated with an increase in catheter-related issues (P < 0.01) but not additional health care interventions (P = 0.51). Only interscalene catheter patients (3%) reported breathing difficulty. Infraclavicular catheter patients had the most emergency room visits but rarely for CPNB issues. Consistent daily telephone contact was not achieved.

Conclusions

For VHA ambulatory CPNB patients, the combined incidence of a catheter-related issue or additional health care intervention was approximately one in three patients and did not differ by brachial plexus catheter type. Serious adverse events were generally uncommon.
The American Public Health Association's Annual Meeting
Authors: McSpedon Corinne
Published: January 2019

Fostering dialogue and action on health equity.
Metastases to the nose from clear cell renal cell carcinoma
Authors: Cui Pengfei , Cong Xiaofeng , Yin Jiaxin , Liu Miaomiao , Wang Xinhui , Yang Lei , Qu Limei , Liu Ziling
Published: January 2019

Rationale:

Patients with nasal metastases are seldom seen among clear cell renal cell carcinoma (CCRCC). We report a rare case presenting as a solitary nasal cutaneous nodule, and summarize the therapeutic experience of tyrosine kinase inhibitors (TKIs).

Patient concerns:

A 86-year-old man with a chief complaint of continuous back pain for 3 months and discovery of a cutaneous nodule on the nose for a month visited the oncology department of our hospital. Maxillofacial computed tomography (CT) scans demonstrated a 1.5 × 0.9 cm and ovoid soft tissue density shade at dorsum of the nose. CT of abdomen revealed a 3.5 × 2.7 cm mass in right kidney and presenting an obvious heterogeneous enhancement.

Diagnoses:

The pathological examination of nasal excision biopsy confirmed the diagnosis of nasal clear cell carcinoma. Immunohistochemical analysis indicated that the nasal metastatic tumor had a renal origin.

Interventions:

Sunitinib at a dose of 50 mg/day was administered initially, while the serious cutaneous toxicities, especially hand-foot syndrome, occurred to the patient. Subsequently, axitinib at a dose of 5 mg twice daily was accepted as second-line treatment.

Outcomes:

The nasal mass shrinked significantly after 8-week treatment of axitinib, and the primary tumor has been stable till now.

Lessons:

Axitinib successfully controlled the nasal cutaneous metastasis with mild adverse reactions, and did not aggravate the cutaneous toxicities resulting from sunitinib. The incidence of cutaneous adverse events were low which had been reported by previous studies; however, it is difficult to say that axitinib is a more effective treatment modality for RCC with nasal metastases, which requires further studies.
Application of intrapulmonary wire combined with intrapleural fibrin glue in preoperative localization of small pulmonary nodules
Authors: Zhang Wen-Hua , Bai Yan-Yan , Guo Wei , Li Ming , Chang Gui-Xia , Liu Wei , Mao Yu
Published: January 2019

Objective:

This study aims to investigate the accuracy of the preoperative localization of small nodules by computerized tomography (CT)-guided placing wire and intrapleural fibrin glue near the nodules at 3 days before the operation.

Methods:

From October 2015 to December 2017, a total of 79 patients, who received preoperative localization of small pulmonary nodules and surgical treatment in the Department of Thoracic Surgery of Hohhot First Hospital, were enrolled into this study. These patients were randomly divided into 2 groups: methylene blue localization group (n = 47), and modified localization group (n = 32), where the patients received preoperative localization of the small nodules by CT-guided placing wire and intrapleural fibrin glue near the nodule at 3 days before the operation. Localization accuracy, operation time and difficulty in postoperative seeking for pathological specimens were compared between these 2 groups.

Results:

In the methylene blue localization group, 3 patients had localization failure due to the intrathoracic diffusion of methylene blue, and the success rate was 93.61%. In the modified localization group, all 32 patients succeeded in the localization, and the success rate was 100%. Operation time and difficulty of finding the specimen was significantly lower in the modified localization group than in the methylene blue localization group (P < .05).

Conclusion:

The application of preoperative localization of small nodules by placing wire and intrapleural fibrin glue improves the success rate of resection, reduces operation time and the risk of the operation, and lowers the difficulty of finding pathological specimens after the operation. Hence this operative procedure is worthy of popularization.
Mandibular width as a novel anthropometric measure for assessing obstructive sleep apnea risk
Authors: Maresky Hillel S. , Klar Miriam M. , Tepper Jaron , Gavriel Haim , Ziv Baran Tomer , Shapiro Colin M. , Tal Sigal
Published: January 2019

Craniofacial abnormalities are a known obstructive sleep apnea (OSA) risk factor, but still need to be better characterized. This study investigates the relationship between mandibular width and the risk of developing OSA.

We retrospectively analyzed 3D reconstructions of head and neck computed tomography (CT) scans at our institution for mandibular width, neck circumference, neck fat volume (NFV), airway volume (AWV), and NFV:AWV ratio. Age, gender, and BMI were also documented. Patients were contacted to complete a STOP-BANG survey to assess OSA risk. Only patients with reconstructable scans and completed STOP-BANG questionnaires were included in the study. Survey results were analyzed to assess the correlation between mandible width and STOP-BANG. Mandible association was also compared to the associations of the other known risk factors.

The final analysis included 427 patients with a mean age of 58.98 years (standard deviation = 16.77), 56% of whom were male. Mandibular width was found to positively correlate with STOP-BANG score (r = .416, P < .001). Statistically significant differences between mandible size for each risk group was seen (P < .001). After controlling for age and sex, mandible size was significantly different only for the low risk vs. high risk groups (odds ratio = 1.11; 95% confidence interval = 1.03–1.20; P = .007). Furthermore, when stratified according to mandible size, the small mandible group (<77.50 mm) predominantly consisted of low risk patients; the medium size mandible group (77.50–84.40 mm) was predominated by intermediate risk patients, and large mandible (>84.40 mm) was predominantly seen in high risk patients. Mandible width expressed a stronger association than NFV:AWV ratio, but neck circumference and NFV had stronger associations than did mandible width.

In addition to previously documented OSA risk factors, mandibular width is positively correlated with OSA as an independent risk factor. Observation of a wide mandible (jaw) should raise awareness of OSA risk and increase screening methods when appropriate.
Efficacy of infantile hepatic hemangioma with propranolol treatment
Authors: Tsai Mu-Chieh , Liu Hsi-Che , Yeung Chun-Yan
Published: January 2019

Rationale:

Hepatic hemangioma is rarely discovered during the infantile period. Although most of the cases are asymptomatic, some of them may suffer life-threatening situations. In this regard, early detection is mandatory for preventing the ominous consequences that might be culminated from the disease.

Patient concerns:

A 2-month-14-day-old female infant was found incidentally to have multiple hepatic lesions during a newborn ultrasound screen. She was born smoothly at term after a non-eventful pregnancy course. Physical examination was completely normal and postnatal vital signs were stable.

Diagnosis:

Infantile multiple hepatic hemangiomas.

Intervention:

High-resolution ultrasound and abdominal computer tomogram were conducted to confirm the diagnosis. Propranolol was started at the age of 3 months and 7 days old with an initial dosage of 1.5 mg/kg per day and increased gradually to 2.5 mg/kg per day. No obvious adverse effects were noted during the treatment course. Rapid clinical improvement with decreasing size was observed by ultrasound 10 days after the treatment. Eventually, hepatic lesions totally disappeared 4.5 months later. Propranolol in dosage of 2.5 mg/kg per day was continued until 6 months after the initial prescription.

Outcomes:

A period of 11-month follow-up revealed no evidence of recurrence of hemangiomas.

Lessons:

Early diagnosis and intervention are mandatory for infantile hepatic hemangiomas to prevent possible ominous consequences. Though the propranolol therapy protocol for the disease is still under developing, the current report strengthens the recommendation to use propranolol as the first-line medication for treating infantile hepatic hemangiomas.
Linear and nonlinear analyses of heart rate variability following orthostatism in subclinical hypothyroidism
Authors: Hoshi Rosangela A. , Andreão Rodrigo V. , Santos Itamar S. , Dantas Eduardo M. , Mill José Geraldo , Lotufo Paulo A. , Bensenor Isabela M.
Published: January 2019

Subclinical hypothyroidism (SCHypo) is associated with autonomic disturbances that can interfere in physiological responses. This study was designed to evaluate linear and nonlinear variables of heart rate variability (HRV) following postural change, comparing subjects with SCHypo to euthyroid subjects.

HRV analyses were performed in 5-minute time series collected in the supine and standing positions from a subsample of 855 participants of the ELSA-Brasil study. The cardiac autonomic nervous function was evaluated by linear time and frequency domain analyses (SDNN, RMSSD, LFms2, HFms2, and LF/HF ratio) as well as by nonlinear symbolic dynamics (0, 1, and 2 V).

After exclusions, 509 (92.0%) euthyroid and 44 (8.0%) SCHypo participants were eligible for analyses. At the baseline supine rest measurement, the 0 V symbolic pattern was higher (27.7 vs 25.4, P = .02) and 2 V was lower (18.0 vs 22.9, P = .02) than in the euthyroid group. Comparing the variation between positions, the 0 V pattern showed a lower delta in SCHypo than in Euthyroid subjects (8.0 vs 10.8%, P = .04).

SCHypo presented lower sympathetic and parasympathetic tonus at rest and a blunted sympathetic response to active postural change, marked by reduced variation in the 0 V of symbolic analysis (SA). Additionally, it is suggested that SA of HR dynamics is an alternative and, possibly, a more sensitive method for cardiac autonomic assessment following orthostatism in this population.
Efficacy of acupotomy for cerebral palsy
Authors: Kwon Chan-Young , Lee Boram , Chang Gyu Tae , Yoon Sang-Hoon
Published: January 2019

Background:

In children, cerebral palsy (CP) is one of the most common causes of irreversible neurological sequelae. Acupotomy, a modernized acupuncture form combining the effects of microsurgery and conventional acupuncture, may show specific benefits in the treatment of CP, especially with respect to spasticity. The aim of this review was to evaluate the efficacy of acupotomy for CP.

Methods:

Eleven databases were comprehensively searched from their inception dates to November 27, 2018. Randomized controlled trials (RCTs) or quasi-RCTs evaluating acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment for CP were included. The methodological quality of included studies was assessed using the risk of bias tool. The quality of evidence for each main outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analysis was performed, and the pooled data were presented as mean difference (MD) with 95% confidence interval (CI) for continuous outcomes and as risk ratio (RR) with 95% CI for dichotomous outcomes.

Results:

Eight studies involving 530 participants were included. In 1 study, acupotomy was associated with significantly higher total effective rate (TER) compared with Bobath (P < .01). Acupotomy combined with rehabilitation was associated with significantly higher TER (RR 1.24, 95% CI 1.01–1.52,I2 = 77%) and gross motor function measure score (MD 12.62, 95% CI 11.75–13.49,I2 = 54%), and significantly lower muscle tone of gastrocnemius measured by the Ashworth scale or the modified Ashworth scale (MD −0.97, 95% CI −1.07 to −0.88,I2 = 0%) compared with rehabilitation alone. No studies reported the incidence of adverse events. The methodological quality of the included studies and quality of evidence for the main finding were generally low.

Conclusion:

Current evidence shows that acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment might have benefits in the treatment of CP. However, due to the small number of studies included, the lack of sample size, poor methodological qualities, and low quality of evidence, the findings of this review should be interpreted with caution. Larger and more rigorous, high-quality RCTs should be performed on this topic.

PROSPERO registration number:

CRD42018105891.
Liver heterotopia associated with congenital diaphragmatic hernia
Authors: Mito Kumiko , Amano Yusuke , Oshiro Hisashi , Matsubara Daisuke , Fukushima Noriyoshi , Ono Shigeru
Published: January 2019

Rationale:

Liver heterotopia associated with congenital diaphragmatic hernia (CDH) is a rare condition; to the best of our knowledge, only 17 cases have been reported to date. The histogenesis and clinicopathological features are largely unknown. We herein report 2 cases of liver heterotopia associated with CDH along with 17 cases described in the literature to shed light on their clinicopathological characteristics.

Patient concerns:

Case 1 was a vaginally delivered male newborn who presented with respiratory distress immediately after birth. Case 2 was a female fetus who was found to have left-sided CDH during gestation.

Diagnosis:

In case 1, a chest X-ray revealed left-sided CDH. In case 2, magnetic resonance imaging performed at 33 weeks of gestation revealed left-sided CDH.

Interventions:

Case 1 underwent diaphragmatic patch repair surgery 3 days after birth. Histopathological examination following surgery in case 1 revealed the presence of ectopic liver tissue in the hernia sac. Case 2 was delivered by Cesarean section, and diaphragmatic patch surgery was performed 3 days after birth. During surgery, an isolated nodule was identified on the peritoneal side of the border of the defective foramen of the diaphragm. Histopathological examination following surgery in case 2 confirmed the presence of an epidermal cyst in the hernia sac. In addition, the isolated nodule was histopathologically found to be ectopic liver tissue.

Outcomes:

In Case 1, CDH recurred at 6 months after surgery, and a second patch repair surgery was performed. The surgically removed hernia sac was found to contain microscopic ectopic liver tissue on histopathology. Case 1 recovered well after surgery, and there was no critical change during the 10-month postoperative period. Case 2 recovered well after surgery, and there was no critical change during the 20-month postoperative period.

Lessons:

There were no secondary pathological conditions associated with the presence of ectopic liver in CDH, such as torsion, infarction, rupture, intra-abdominal bleeding, or tumorization. Our observations suggest that liver heterotopia is a rare but asymptomatic condition in patients with CDH.
Clinical treatment of diabetic foot ulcer combined with Budd-Chiari syndrome
Authors: Fan Lei , Luo Huan , Liu Bing , Fa Xianen , Liu Tao , Ma Chao
Published: January 2019

Rationale:

Diabetic foot ulcer is a severe complication of diabetes, and most patients with diabetic foot ulcer require amputation. The incidence of Budd-Chiari syndrome is low; it is relatively rare. Diabetic foot ulcer combined with Budd-Chiari syndrome has not been reported so far.

Patient concerns:

A 52-year-old man presented with uncontrolled high body temperature, continued expansion of the lower leg and foot ulcer with increasing malodor.

Diagnosis:

The patient was diagnosed with Wagner grade 4 diabetic foot ulcer combined with Budd-Chiari syndrome.

Interventions:

Critical treatment was performed immediately after his admission to the hospital. After the patient's condition was stable, we performed an interventional procedure to relieve the inferior vena cava obstruction. Debridement was then performed on the diabetic foot ulcer. Finally, skin grafting was performed due to condition of the wound. We completed moist healing and vacuum sealing drainage throughout the treatment process.

Outcomes:

The patient was hospitalized for 56 days, and all his right lower extremity ulcers eventually healed.

Lessons:

In the treatment of diabetic foot ulcer combined with Budd-Chiari syndrome, it is necessary to develop a unified treatment plan that includes the timely treatment of Budd-Chiari syndrome upon admission, the strategic use of debridement, and the application of moist healing and vacuum sealing drainage.
Does nifedipine improve outcomes of embryo transfer?
Authors: Ng Kelvin Kwok Lap , Rozen Genia , Stewart Tanya , Agresta Franca , Polyakov Alex
Published: January 2019

Background:

Implantation failure is the main factor affecting the success rate of in vitro fertilization (IVF) procedures. Studies have reported that uterine contractions (UC) at the time of embryo transfer (ET) were inversely related to implantation and pregnancy rate, hence reducing the success of IVF treatments. Various pharmacological agents, with the exception of calcium channel blockers, have been investigated to improve ET outcomes by reducing UC. Thus, a double-blinded randomized, placebo-controlled trial was conducted to determine whether nifedipine, a calcium channel blocker with potent smooth muscle relaxing activity and an excellent safety profile, can improve the outcome of patients undergoing ET treatments.

Methods:

Ninety-three infertile women were recruited into 1 of 2 groups: placebo (n = 47) or nifedipine 20 mg (n = 46). Study participants were admitted 30 minutes prior to ET and given either tablet after their baseline vital signs were recorded. They then underwent ET and were observed for adverse events for another 30 minutes post-ET. Follow up of the participants’ outcomes was conducted via electronic medical records. The primary outcomes are implantation and clinical pregnancy rates. Secondary outcomes include any maternal or fetal adverse events, miscarriage, pregnancy, live births, and neonatal outcomes. Resulting data were then analyzed using t test, Pearson chi-square test, and Fisher exact test to compare outcomes between the 2 groups.

Results:

No statistical differences in the implantation rate (42.6% vs 39.1%, P = .737, rate ratio 0.868, 95% confidence interval [CI]: 0.379–1.986) and the clinical pregnancy rate (23.4% vs 26.1%, P = .764, rate ratio 1.155, 95% CI: 0.450–2.966) were detected between the placebo and the treatment groups. In addition, no statistical significance between the placebo and the treatment groups for any secondary outcomes were detected.

Conclusions:

This double blinded, randomized, and placebo-controlled trial demonstrated that the single use of 20 mg nifedipine given 30 minutes before embryo transfer did not improve the implantation rate or the clinical pregnancy rate of the infertility treatment. Further studies are required to demonstrate the clinical benefits and risks of nifedipine usage in embryo transfer.
Rhegmatogenous retinal detachment with a giant tear located in the intermediate periphery
Authors: Kohmoto Ryohsuke , Fukumoto Masanori , Sato Takaki , Oosuka Shou , Kobayashi Takatoshi , Kida Teruyo , Suzuki Hiroyuki , Ikeda Tsunehiko
Published: January 2019

Rationale:

We experienced 2 cases of retinal detachment (RD) with giant tears located in the intermediate periphery of the fundus. In this case report, we investigated the clinical characteristics in these 2 cases.

Patient concerns and diagnoses:

Case 1 involved a 63-year-old male, who became aware of metamorphopsia and decreased visual acuity (VA) in his left eye. Upon examination, he was diagnosed with a giant tear at the margin of the intermediate peripheral lattice degeneration. Case 2 involved a 54-year-old male, who became aware of decreased VA in his right eye. Upon examination, he was diagnosed with vitreous hemorrhage and a giant tear located in the upper intermediate periphery. In these 2 cases, there was no obvious previous or familial history.

Interventions:

In both cases, reattachment was achieved by performing vitrectomies.

Outcomes:

These 2 cases were characterized by the refraction being close to emmetropia due to the flat corneal curvature, even though there was a long axial length and the eyeballs were spherically large. In both cases, the postoperative clinical course outcome was favorable and no complication occurred

Lessons:

Our findings indicate that intermediate peripheral giant tears may occur in spherically large eyeballs, and that vitreous surgery is effective in such cases. Since the risk of the onset of RD in the fellow eye is thought to be high, strict postoperative follow-up is necessary.