Natural history of idiopathic erythrocytosis - A retrospective case series review

Idiopathic Erythrocytosis (IE) is a diagnosis given to patients who have an absolute erythrocytosis (red cell mass more than 25% above their mean normal predicted value) but who do not have a known form of primary or secondary erythrocytosis (BCSH guideline, 2005). We report here the results of a follow-up study of 80 patients (44 male and 36 female) diagnosed with IE from the United Kingdom and the Republic of Ireland over a 10 year period. Baseline information was initially collected when investigating for molecular causes of erythrocytosis in this group. The diagnosis of IE was made on the basis of a raised red cell mass >25% above mean normal predicted value, absence of Polycythaemia Vera (PV) based on the criteria of Pearson and Messinezy (1996), and the exclusion of secondary erythrocytosis (oxygen saturation >92% on pulse oximetry, no history of sleep apnoea, no renal or hepatic pathology, and a normal oxygen dissociation curve (if indicated). The average age at diagnosis of erythrocytosis was 34.5 (2–74 years). Erythropoietin levels were available for 77/80 of the patients and were low in 18 (23%) and normal or high in 59 (74%). Ultrasound imaging was carried out in 67 patients (84%) at time of diagnosis and no significant abnormalities found. Fourteen patients had a family history of erythrocytosis. These patients have now been followed up for an average of 9.4 years (range 1–39). Out of 80 patients 56 patients can still be classified as having IE, of whom 52 are living (cause of death in the other 4 - lung cancer, RTA, sepsis, unknown). Thirty-five of these patients are regularly venesected, 3 take hydroxyurea (one also venesected), 11 receive no treatment while treatment is unknown in 2. Twenty take aspirin, 1 warfarin and 31 no thromboprophylaxis. Four of these patients had suffered thromboembolic complications (3 with CVA/TIAs and 1 with recurrent DVT) at or before their original diagnosis. Since diagnosis 8 patients have had 9 thrombotic events of which 7 were arterial (1 CVA, 3 TIAs, 1 MI, 2 PVD) and 2 venous (DVT/PE). Twenty take aspirin, 1 dipyridamole, 1 warfarin and 30 take no thromboprophylaxis. Out of the 24 patients who now have a diagnosis other than IE, 8 have been diagnosed with myelo-proliferative disease. Thirteen patients have a molecular abnormality which is likely to account for their erythrocytosis (11 VHL, 1 PHD-2, 1 EPO-receptor mutations). Three patients have secondary erythrocytosis. Older case studies identified a heterogenous group of patients, some of whom probably had apparent erythrocytosis and some who had either primary polycythaemia or secondary causes later identified (Modan and Modan, Najean et al). More recent reviews have identified a more homogenous group with low rates of transformation to myelofibrosis/acute leukaemia and low rates of thrombosis of around 1% patient-year. Follow up of our initial patient group does indeed reveal a heterogeneous group of patients with 10% now diagnosed with an MPD, although when analysis is confined to those patients who continue to fulfil the criteria for IE, the clinical course has been more stable. There has been no progression to MDS or leukaemia in this group (one patient with PV progressed to AML). The rate of thrombosis is 1.6% patient-years which is lower than the rate seen in PV and is consistent with the rate identified in other series. Molecular defects continue to be identified in this group and future investigation is likely to reveal further abnormalities.

A Question of Legitimacy? A Dynamic Perspective on Multinational Firm Control

The control and coordination of a network of geographically and culturally dispersed subsidiaries is one of the most prominent challenges in international management. However, many empirical findings on the effectiveness of various control mechanisms and combinations thereof are still counterintuitive. This study uses longitudinal case studies and cross-sectional interview data to extend control theory by examining why, how, and in what sequence large multinational firms (MNCs) implement controls in their networks of foreign subsidiaries. Our analysis draws from literature on institutional theory, embeddedness, and organizational power to demonstrate that MNC headquarters need to overcome institutional duality when implementing their controls abroad. We find that headquarters do so by using social controls, primarily as a way of legitimizing and institutionalizing their process and output controls that are implemented subsequently.

Mapping public sector organizations:An agenda for future research

This article summarizes the key findings from the five mapping case studies presented in this special issue and relates them back to the conceptual, definitional, and theoretical issues presented in the opening article (MacCarthaigh & Roness, 2012). In so doing, the article considers the alternative ways in which organizational change can best be captured, mapped, and explained and the key issues to be considered when conducting such exercises. As well as identifying how the case studies have advanced the possibilities for mapping public sector organizational change over time in a cross-national context and the benefits this offers for other aspects of public administration research, the article identifies some impediments to future research and collaboration in the field and suggests ways to overcome them. © Taylor & Francis Group, LLC.

Analyzing longitudinal continuity and change in public sector organizations

This article provides the introduction to a special edition that presents for the first time a series of detailed country case studies concerned with the matter of organizational life cycles. Building on some recent scholarship, it begins by surveying the development of the field, before setting out some of the key methodological and theoretical issues and challenges involved in adopting a longitudinal perspective to the study of organizational change. It proposes that by capturing the variety of ways in which public sector organizations emerge, survive, and terminate, new perspectives on how administrative systems evolve can be presented and compared. © Taylor & Francis Group, LLC.

The Oxford Handbook of Conflict Management in Organizations

New ways of managing conflict are increasingly important features of work and employment in organizations. In the book the world's leading scholars in the field examine a range of innovative alternative dispute resolution (ADR) practices, drawing on international research and scholarship and covering both case studies of major exemplars and developments in countries in different parts of the global economy. Developments in the management of individual and collective conflict at work are addressed, as are innovations in both unionized and non-union organizations and in the private and public sectors.

New practices for managing conflict in organizations are set in the context of trends in workplace conflict and perspectives on how conflict should be understood and addressed. Part 1 examines the changing context of conflict management by addressing the main frameworks for understanding conflict management, the trend in conflict at work, developments in employment rights, and the influence of HRM on conflict management. Part 2 covers the main approaches to conflict management in organizations, addressing both conventional and alternative approaches to conflict resolution. Conventional grievance handling and third-party processes in conflict resolution are examined as well as the main ADR practices, including conflict management in non-union firms, the role of the organizational ombudsman, mediation, interest-based bargaining, line and supervisory management, and the concept of conflict management systems. Part 3 presents case studies of exemplars and innovators in the field, covering mediation in the US postal service, interest-based bargaining at Kaiser-Permanente, 'med-arb' in the New Zealand Police, and judicial mediation in UK employment tribunals. Part 4 covers international developments in conflict management in Germany, Japan, The United States, Australia, New Zealand, the United Kingdom and China.

This Handbook gives a comprehensive overview of this growing field, which has seen an huge increase in programmes of study in university business and law schools and in executive education programmes.

Tool life and hole surface integrity studies for hole-making of Ti6Al4V Alloy

With a significant growth in the use of titanium alloys in the aviation manufacturing industry, the key challenge of making high-quality holes in the aircraft assembly process needs to be addressed. In this work, case studies deploying traditional drilling and helical milling technologies are carried out to investigate the tool life and hole surface integrity for hole-making of titanium alloy. Results show that the helical milling process leads to much longer tool life, generally lower hole surface roughness, and higher hole subsurface microhardness. In addition, no plastically deformed layer or white layer has been observed in holes produced by helical milling. In contrast, a slightly softened region was always present on the drilled surface. The residual stress distributions within the hole surface, including compressive and tensile residual stress, have also been investigated in detail.