Does cardiovascular therapy affect the onset and recurrence of preretinal and vitreous haemorrhage in diabetic eye disease?

Aims To review the role of cardiovascular disease and therapy in the onset and recurrence of preretinal/vitreous haemorrhage in diabetic patients. Methods Retrospective case note analysis of diabetic patients with vitreous haemorrhage from the Diabetic Eye Clinic at Birmingham Heartlands Hospital. Results In total, 54 patients (mean age 57.1, 37 males, 20 type I vs34 type II diabetic patients) were included. The mean (SD) duration of diagnosed diabetes at first vitreous haemorrhage was significantly longer, 21.9 (7.6) years for type I and 14.8 (9.3) years for type II diabetic patients (P<0.01, unpaired t-test, two-tailed). Aspirin administration was not associated with a significantly later onset of vitreous haemorrhage. Four episodes were associated with ACE-inhibitor cough. There was a trend towards HMGCoA reductase inhibitor (statin) use being associated with a delayed onset of vitreous haemorrhage: 21.4 years until vitreous haemorrhage (treatment group) vs 16.2 years (nontreatment group) (P=0.09, two-tailed, unpaired t-test, not statistically significant). During follow-up 56 recurrences occurred, making a total of 110 episodes of vitreous haemorrhage in 79 eyes of 54 patients. The mean (range) follow-up post haemorrhage was 1067 (77–3842) days, with an average of 1.02 recurrences. Age, gender, diabetes type (I or II) or control, presence of hypertension or hypercholesterolaemia, and macrovascular complications were not associated with a significant effect on the 1-year recurrence rate. Aspirin (and other antiplatelet or anticoagulant agents) and ACE- inhibitors appeared to neither increase nor decrease the 1-year recurrence rate. However, statin use was significantly associated with a reduction in recurrence (Fisher exact P<0.05; two-tailed) with an odds ratio (95% CI) of 0.25 (0.1–0.95). Conclusion In this retrospective analysis, the onset of preretinal/vitreous haemorrhage was not found to be accelerated by gender, hypertension, hypercholesterolaemia, evidence of macrovascular disease, or HbA1c. Neither aspirin nor ACE-inhibitor administration accelerated the onset or recurrence of first vitreous haemorrhage. Statins may have a protective role, both delaying and reducing the recurrence of haemorrhage.

Purchasing green transport and logistics services:implications from the environmental sustainability attitude of 3PLs

Environmental sustainability is an area of increasing importance for third party logistics (3PL) companies. As the design and implementation of services requires interaction between buyer and 3PL, the 3PLs are in a critical position to support the efforts towards greening operations of different supply chain participants. However the literature in this field reflects a gap between the perspectives of buyers and 3PLs. This chapter attempts to fill this void through an explorative case study analysis on the environmental attitude of 3PLs in order to derive implications for buyers’ behavior. The results indicate that the buyer’s role is critical in different ways in the development of green initiatives among 3PLs. An increased orientation towards longer-term contracts and joint development would likely enhance the level of green initiatives. Indirectly, the buyer has the opportunity to influence its 3PLs through interaction with employees on different levels in the company, including top management.

A KM perspective on implementing an electronic patient record within an NHS hospital

The Electronic Patient Record (EPR) is being developed by many hospitals in the UK and across the globe. We class an EPR system as a type of Knowledge Management System (KMS), in that it is a technological tool developed to support the process of knowledge management (KM). Healthcare organisations aim to use these systems to provide a vehicle for more informed and improved clinical decision making thereby delivering reduced errors and risks, enhanced quality and consequently offering enhanced patient safety. Finding an effective way for a healthcare organisation to practically implement these systems is essential. In this study we use the concept of the business process approach to KM as a theoretical lens to analyse and explore how a large NHS teaching hospital developed, executed and practically implemented an EPR system. This theory advocates the importance of taking into account all organizational activities - the business processes - in considering any KM initiatives. Approaching KM through business processes allows for a more holistic view of the requirements across a process: emphasis is placed on how particular activities are performed, how they are structured and what knowledge demanded and not just supplied across each process. This falls in line with the increased emphasis in healthcare on patient-centred approaches to care delivery. We have found in previous research that hospitals are happy with the delivery of patient care being referred to as their 'business'. A qualitative study was conducted over a two and half year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non- participant observation of meetings and documentary data. We believe that the inclusion of patients within the study may well be the first time this has been done in examining the implementation of a KMS. The theoretical propositions strategy was used as the overarching approach for data analysis. Here Initial theoretical research themes and propositions were used to help shape and organise the case study analysis. This paper will present preliminary findings about the hospital's business strategy and its links to the KMS strategy and process.

Purchasing green transport and logistics services:implications from the environmental sustainability attitude of 3PLs

Environmental sustainability is an area of increasing importance for third party logistics (3PL) companies. As the design and implementation of services requires interaction between buyer and 3PL, the 3PLs are in a critical position to support the efforts towards greening operations of different supply chain participants. However the literature in this field reflects a gap between the perspectives of buyers and 3PLs. This chapter attempts to fill this void through an explorative case study analysis on the environmental attitude of 3PLs in order to derive implications for buyers’ behavior. The results indicate that the buyer’s role is critical in different ways in the development of green initiatives among 3PLs. An increased orientation towards longer-term contracts and joint development would likely enhance the level of green initiatives. Indirectly, the buyer has the opportunity to influence its 3PLs through interaction with employees on different levels in the company, including top management.

One-year outcome of bevacizumab therapy for chronic macular edema in central and branch retinal vein occlusions in real-world clinical practice in the UK

Background: The purpose of this study was to investigate the 12-month outcome of macular edema secondary to both chronic and new central and branch retinal vein occlusions treated with intravitreal bevacizumab in the real-life clinical setting in the UK. Methods: Retrospective case notes analysis of consecutive patients with retinal vein occlusions treated with bevacizumab in 2010 to 2012. Outcome measures were visual acuity (measured with Snellen, converted into logMAR [logarithm of the minimum angle of resolution] for statistical calculation) and central retinal thickness at baseline, 4 weeks post-loading phase, and at 1 year. Results: There were 56 and 100 patients with central and branch retinal vein occlusions, respectively, of whom 62% had chronic edema and received prior therapies and another 32% required additional laser treatments post-baseline bevacizumab. Baseline median visual acuity was 0.78 (interquartile range [IQR] 0.48–1.22) in the central group and 0.6 (IQR 0.3–0.78) in the branch group. In both groups, visual improvement was statistically significant from baseline compared to post-loading (P,0.001 and P=0.03, respectively), but was not significant by month 12 (P=0.058 and P=0.166, respectively); 30% improved by at least three lines and 44% improved by at least one line by month 12. Baseline median central retinal thickness was 449 μm (IQR 388–553) in the central group and 441 µm (IQR 357–501) in the branch group. However, the mean reduction in thickness was statistically significant at post-loading (P,0.001) and at the 12-month time point (P,0.001) for both groups. The average number of injections in 1 year was 4.2 in the central group and 3.3 in the branch group. Conclusion: Our large real-world cohort results indicate that bevacizumab introduced to patients with either new or chronic edema due to retinal vein occlusion can result in resolution of edema and stabilization of vision in the first year.

The politics of professional sports facility subsidies in Florida

Political leaders in urban settings regularly confront difficult decisions over how to distribute public funds. Those decisions may be even more controversial when they involve public subsidies of professional sports facilities. Yet, state and local governments in the United States have granted billions of dollars in financial and land-based subsidies for professional sports facilities over the past two decades, raising questions about how these types of corporate welfare decisions are made by local leaders. Scholarship on urban politics and community power suggests a number of theories to explain political influence. They include elitism, pluralism, political economy and growth machines, urban regimes, coalition theory, and minority empowerment. My hypothesis is that coalition theory, a theory that argues that public policy decisions are made by shifting, ad hoc alliances within a community, best describes these subsidy decisions. ^ To test this hypothesis I employ a public policy process model and develop a framework of variables that is used to methodically examine four sports facilities funding decisions in two Florida counties between 1977 and 1998: Joe Robbie Stadium and the American Airlines Arena in Miami-Dade, and the Ice Palace Arena and the Raymond James Stadium in Hillsborough County. The framework includes six variables that permit a rigorous examination of the actors involved in the decision, their interactions, and the political environment within which they operate. The variables are formal political structure, informal sector, subsidy proponents, subsidy opponents, public policy options, and public opinion. ^ This research rests on qualitative data gathered from interviews of public and private officials involved in subsidy decisions, public records, and media reports Employing a case study analysis, I offer a rich description of the decision making process to publicly fund sports stadiums and arenas in Florida. My findings confirm that the best theory to explain decisions to subsidize sports facilities is one in which short-term, temporary coalitions are formed to accomplish policy goals. ^

Gender, identity, and the security state: The politics of international drug trafficking

This dissertation examined how United States illicit drug control policy, often commonly referred to as the "war on drugs," contributes to the reproduction of gendered and racialized social relations. Specifically, it analyzed the identity producing practices of United States illicit drug control policy as it relates to the construction of U.S. identities. ^ Drawing on the theoretical contributions of feminist postpositivists, three cases of illicit drug policy practice were discussed. In the first case, discourse analysis was employed to examine recent debates (1986-2005) in U.S. Congressional Hearings about the proper understanding of the illicit drug "threat." The analysis showed how competing policy positions are tied to differing understandings of proper masculinity and the role of policymakers as protectors of the national interest. Utilizing critical visual methodologies, the second case examined a public service media campaign circulated by the Office of National Drug Control Policy that tied the "war on drugs" with another security concern in the U.S., the "war on terror." This case demonstrated how the media campaign uses messages about race, masculinity, and femininity to produce privileged notions of state identity and proper citizenship. The third case examined the gendered politics of drug interdiction at the U.S. border. Using qualitative research methodologies including semi-structured interviews and participant observation, it examined how gender is produced through drug interdiction at border sites like Miami International Airport. By paying attention to the discourse that circulates about women drug couriers, it showed how gender is normalized in a national security setting. ^ What this dissertation found is that illicit drug control policy takes the form it does because of the politics of gender and racial identity and that, as a result, illicit drug policy is implicated in the reproduction of gender and racial inequities. It concluded that a more socially conscious and successful illicit drug policy requires an awareness of the gendered and racialized assumptions that inform and shape policy practices.^

The influence of HOPE VI public housing on public schools

In the United States, public school enrollment is typically organized by neighborhood boundaries. This dissertation examines whether the federally funded HOPE VI program influenced performance in neighborhood public schools. In effect since 1992, HOPE VI has sought to revitalize distressed public housing using the New Urbanism model of mixed income communities. There are 165 such HOPE VI projects nationwide. Despite nearly two decades of the program's implementation, the literature on its connection to public school performance is thin. My dissertation aims to narrow this research gap. There are three principal research questions: (1) Following HOPE VI, was there a change in socioeconomic status (SES) in the neighborhood public school? The hypothesis is that low SES (measured as the proportion of students qualifying for the Free and Reduced Lunch Program) would reduce. (2) Following HOPE VI, did the performance of neighborhood public schools change? The hypothesis is that the school performance, measured by the proportion of 5th grade students proficient in state wide math and reading tests, would increase. (3) What factors relate to the performance of public schools in HOPE VI communities? The focus is on non-school, neighborhood factors that influence the public school performance. For answering the first two questions, I used t-tests and regression models to test the hypotheses. The analysis shows that there is no statistically significant change in SES following HOPE VI. However, there are statistically significant increases in performance for reading and math proficiency. The results are interesting in indicating that HOPE VI neighborhood improvement may have some relationship with improving school performance. To answer the third question, I conducted a case study analysis of two HOPE VI neighborhood public schools, one which improved significantly (in Philadelphia) and one which declined the most (in Washington DC). The analysis revealed three insights into neighborhood factors for improved school performance: (i) a strong local community organization; (ii) local community's commitment (including the middle income families) to send children to the public school; and (iii) ties between housing and education officials to implement the federal housing program. In essence, the study reveals how housing policy is de facto education policy.

Imunoexpressão das proteínas APE-1 e XRCC-1 em carcinoma epidermoide de língua oral

DNA repair systems play a critical role in protecting the human genome from damage caused by carcinogens present in the environment. Mutations in DNA repair genes may be responsible for tumor development and resistance of malignant cells to chemotherapeutic agents. The major pathway for oxidative DNA damage repair is the base excision repair pathway. The objective of this study was to investigate the immunoexpression of APE-1 and XRCC-1, which are proteins involved in DNA base excision repair and its association with clinical and histopathological parameters in oral tongue squamous cell carcinoma (OTSCC), in order to investigate a possible prognostic value for those proteins. The expression of APE-1 and XRCC-1 was evaluated semi-quantitatively by immunohistochemistry in 50 OTSCC cases. Clinical data was collected from patients’ medical charts and histopathological grading was performed for each case. Statistical analysis (Chi-square and Fisher’s exact tests; significance of 5%) was performed to determine the association between protein expressions and clinico-pathological characteristics. APE-1 was highly expressed in nucleus and cytoplasm in 56% of cases. XRCC-1 showed overexpression only in nucleus in 60% of cases. High expression of XRCC-1 was significantly associated to clinical stages I and II (P=0.02). Both proteins were not associated to other clinical parameters or histopathological grading. Our findings demonstrate that DNA base excision repair proteins APE-1 and XRCC-1 are upregulated in OTSCC, however, they are not related to clinical and histologic parameters, except for XRCC-1 association to better clinical staging. Our results indicate that the immunohistochemical expression of these proteins has no association with prognostic parameters in this tumor.

Imunoexpressão das proteínas APE-1 e XRCC-1 em carcinoma epidermoide de língua oral

DNA repair systems play a critical role in protecting the human genome from damage caused by carcinogens present in the environment. Mutations in DNA repair genes may be responsible for tumor development and resistance of malignant cells to chemotherapeutic agents. The major pathway for oxidative DNA damage repair is the base excision repair pathway. The objective of this study was to investigate the immunoexpression of APE-1 and XRCC-1, which are proteins involved in DNA base excision repair and its association with clinical and histopathological parameters in oral tongue squamous cell carcinoma (OTSCC), in order to investigate a possible prognostic value for those proteins. The expression of APE-1 and XRCC-1 was evaluated semi-quantitatively by immunohistochemistry in 50 OTSCC cases. Clinical data was collected from patients’ medical charts and histopathological grading was performed for each case. Statistical analysis (Chi-square and Fisher’s exact tests; significance of 5%) was performed to determine the association between protein expressions and clinico-pathological characteristics. APE-1 was highly expressed in nucleus and cytoplasm in 56% of cases. XRCC-1 showed overexpression only in nucleus in 60% of cases. High expression of XRCC-1 was significantly associated to clinical stages I and II (P=0.02). Both proteins were not associated to other clinical parameters or histopathological grading. Our findings demonstrate that DNA base excision repair proteins APE-1 and XRCC-1 are upregulated in OTSCC, however, they are not related to clinical and histologic parameters, except for XRCC-1 association to better clinical staging. Our results indicate that the immunohistochemical expression of these proteins has no association with prognostic parameters in this tumor.

Managing supply chain knowledge-based linkages for improving operational performance

Purpose: This paper aims to explore the role of internal and external knowledgebased linkages across the supply chain in achieving better operational performance. It investigates how knowledge is accumulated, shared, and applied to create organization-specific knowledge resources that increase and sustain the organization's competitive advantage. Design/methodology/approach: This paper uses a single case study with multiple, embedded units of analysis, and the social network analysis (SNA) to demonstrate the impact of internal and external knowledge-based linkages across multiple tiers in the supply chain on the organizational operational performance. The focal company of the case study is an Italian manufacturer supplying rubber components to European automotive enterprises. Findings: With the aid of the SNA, the internal knowledge-based linkages can be mapped and visualized. We found that the most central nodes having the most connections with other nodes in the linkages are the most crucial members in terms of knowledge exploration and exploitation within the organization. We also revealed that the effective management of external knowledge-based linkages, such as buyer company, competitors, university, suppliers, and subcontractors, can help improve the operational performance. Research limitations/implications: First, our hypothesis was tested on a single case. The analysis of multiple case studies using SNA would provide a deeper understanding of the relationship between the knowledge-based linkages at all levels of the supply chain and the integration of knowledge. Second, the static nature of knowledge flows was studied in this research. Future research could also consider ongoing monitoring of dynamic linkages and the dynamic characteristic of knowledge flows. Originality/value: To the best of our knowledge, the phrase 'knowledge-based linkages' has not been used in the literature and there is lack of investigation on the relationship between the management of internal and external knowledge-based linkages and the operational performance. To bridge the knowledge gap, this paper will show the importance of understanding the composition and characteristics of knowledge-based linkages and their knowledge nodes. In addition, this paper will show that effective management of knowledge-based linkages leads to the creation of new knowledge and improves organizations' operational performance.

The contradictions and complementarities of combining ERP systems with enterprise 2.0 supported informal systems

The chapter discusses both the complementary factors and contradictions of adopting ERP based systems with enterprise 2.0. ERP is characterized as achieving efficient business performance by enabling a standardized business process design, but at a cost of flexibility in operations. It is claimed that enterprise 2.0 can support flexible business process management and so incorporate informal and less structured interactions. A traditional view however is that efficiency and flexibility objectives are incompatible as they are different business objectives which are pursued separately in different organizational environments. Thus an ERP system with a primary objective of improving efficiency and an enterprise 2.0 system with a primary aim of improving flexibility may represent a contradiction and lead to a high risk of failure if adopted simultaneously. This chapter will use case study analysis to investigate the use of a combination of ERP and enterprise 2.0 in a single enterprise with the aim of improving both efficiency and flexibility in operations. The chapter provides an in-depth analysis of the combination of ERP with enterprise 2.0 based on social-technical information systems management theory. The chapter also provides a summary of the benefits of the combination of ERP systems and enterprise 2.0 and how they could contribute to the development of a new generation of business management that combines both formal and informal mechanisms. For example, the multiple-sites or informal communities of an enterprise could collaborate efficiently with a common platform with a certain level of standardization but also have the flexibility in order to provide an agile reaction to internal and external events.

Essays on State-Building and Sectarian Violence

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This dissertation seeks to explain the role of governmental and non-governmental actors in increasing/reducing the emergence of intergroup conflict after war, when group differences have been a salient aspect of group mobilization. This question emerges from several interrelated branches of scholarship on self-enforcing institutions and power-sharing arrangements, group fragmentation and demographic change, collective mobilization for collectively-targeted violence, and conflict termination and the post-conflict quality of peace. This question is investigated through quantitative analyses performed at the sub-national, national, and cross-national level on the effect of elite competition on the likelihood of violence committed on the basis of group difference after war. These quantitative analyses are each accompanied by qualitative, case study analyses drawn from the American Reconstruction South, Iraq, and Cote d'Ivoire that illustrate and clarify the mechanisms evaluated through quantitative analysis.

Shared findings suggest the correlation of reduced political competition with the increased likelihood of violence committed on the basis of group difference. Separate findings shed light on how covariates related to control over rent extraction and armed forces, decentralization, and citizenship can lead to a reduction in violence. However, these same quantitative analyses and case study analysis suggest that the control of the state can be perceived as a threat after the end of conflict. Further, together these findings suggest the political nature of violence committed on the basis of group difference as opposed to ethnic identity or resource scarcity alone.

Together, these combined analyses shed light on how and why political identities are formed and mobilized for the purpose of committing political violence after war. In this sense, they shed light on the factors that constrain post-conflict violence in deeply divided societies, and contribute to relevant academic, policy, and normative questions.

La liquidación de las instituciones corporativas coloniales en tiempos de la independencia : la Reducción de San Ignacio de los Tobas, Jujuy

Este trabajo estudia el impacto de las nuevas concepciones económicas sobre las estructuras agrarias corporativas introducidas en el Río de la Plata desde la revolución. El caso a analizar es la Reducción indígena de San Ignacio de los Tobas en la frontera oriental con el Chaco, que experimentó un proceso de liquidación de tierras entre 1816 y 1821. En ese proceso se enfrentaron dos discursos en torno al destino de este tipo de instituciones corporativas: uno que proponía su desmantelamiento como entidades jurídicas y la venta de sus tierras a particulares, el otro que sostenía el restablecimiento de su pleno funcionamiento, aunque dentro de un marco republicano que terminó horadando la legitimidad de origen de la Reducción indígena.

La liquidación de las instituciones corporativas coloniales en tiempos de la independencia : la Reducción de San Ignacio de los Tobas, Jujuy

Este trabajo estudia el impacto de las nuevas concepciones económicas sobre las estructuras agrarias corporativas introducidas en el Río de la Plata desde la revolución. El caso a analizar es la Reducción indígena de San Ignacio de los Tobas en la frontera oriental con el Chaco, que experimentó un proceso de liquidación de tierras entre 1816 y 1821. En ese proceso se enfrentaron dos discursos en torno al destino de este tipo de instituciones corporativas: uno que proponía su desmantelamiento como entidades jurídicas y la venta de sus tierras a particulares, el otro que sostenía el restablecimiento de su pleno funcionamiento, aunque dentro de un marco republicano que terminó horadando la legitimidad de origen de la Reducción indígena.