Persistent Hiccups Following Stapedectomy

Objective: We report a case of a 37 year-old man who developed persistent hiccups after elective stapedectomy. Method and Results: The diagnostic approach is discussed as well as the non-pharmacologic and pharmacologic treatments and overall management. The aim is to stress that there is a variety of potential factors that can induce hiccups perioperatively and in cases like this a step by step approach must be taken. Conclusion: Persistent hiccups are very rare following stapedectomy, control of them is crucial for the successful outcome. The trigger may be more than one factors and the good response to treatment may be due to dealing successfully with more than one thing

Demosthenes: Orations XIII and XIV (On the Syntaxis, On the Symmories): Introduction and Commentary

The thesis on orations XIII and XIV of Demosthenes aspires: I. in the introduction, to provide a full account of the problems of chronology and authenticity, to elaborate and expand on individual issues that have not been dealt with sufficiently in the past or have proved to be controversial (particularly the symmories), and to reveal the political thought and argumentation presented in the orations II, in the commentary, to provide a literary, linguistic and historical study of the speeches As orations XIII and XIV are the first deliberative orations written by D. I felt 1 had to concentrate on the main issues he raised and study his argumentation in particular in order to understand his persuasive methods and even political alienation, if any, at this primary stage of his career. To this end the "Argumentation and Structure" chapters attempt to prove that for example XIII is a more cohesive oration than is currently thought, and that in XIV D. uses what I have named "blocks" of dense arguments, built symmetrically around concrete proposals The authenticity question applies really to XIII only and I have done my best to review the existing views, I have tried to reduce the problem not to whether the doublets could have been written by some other ancient writer with good imitation skills, nor how different they are from the other orations they appear in, but to whether the whole oration is a persuasive and cohesive piece of oratory. The historical aspect is prominent in the chapters dealing with date and authorship as well as in places where there was scope for presenting material regarding an individual problem that could not be found in any other scholarly work So in XIII 1 deal with the Athenian and the Megarian dispute over the Orgas and its relation to the 5th century incident, the burning of the opisthodomos at Athens, and the theoric fund 1 have also made an effort to clarify concepts that need to be reinforced or explored from scratch in order to explain certain aspects of the orations, in XIII the term ateleia (immunity from tax) and the subsequent honours granted to Menon and Perdikkas, and in XIV koinonika (property owned by religious associations) and klerouchika. A significant part of the introduction is devoted on producing a detailed account of the naval symmories problem, focusing on specific problems, formulating new hypotheses and providing some solutions to questions that scholars have been dealing with for some time. My main conclusion is that there were two systems based on symmories, the eisphora and the naval ones. In this process I have discussed all major points of view and in particular the most recent ones After an initial chapter on eisphora and symmories before 358/7 (the year of the establishment of the naval symmories) I tackle the liturgical class mainly because it was the main unit of the citizenry that carried the burden of taxation and it seemed relevant to examine the naval reforms with an eye to their behaviour. I examine: a. i. their number, and concluded that the number of liturgists was in the area Davies defined it, i.e. around 300, this is of great importance if we are to determine whether the 1200 were actually expected to be trierarchs as well as contributors, ii. whether the proeisphora was a liturgy carrying exemption, since if it did, it would require a larger number of liturgists, I concluded that it did not b. the evidence for anti-liturgic sentiments in unavoidably "aristocratic" sources and a possible swing of Athens to imperialism c. the changing attitude towards taxation, using l.G. II2 244 and 505 as evidence that the state had transformed an essentially irregular tax, the eisphora, to a yearly institution, a fact that in its turn showed that the state had revised its former negative attitude to "direct taxation" d. whether 5 or 6 trierarchs were actually ever assigned to a single ship in view of the confusion in the law of Periandros between trierarchs and contributors, this was disproved by the inscriptions that showed formal assignments of 2 or 3 In this way the inequity within the 1200 and the abuse of the law by the rich was clarified e. the new interpretation by Gabrielsen that exemptions were independent of any physical inability I found this interpretation unsubstantiated The next step was to examine the reform of Periandros taking into consideration the naval records of the period. 1 found that ships were allotted to symmories once they were established and that although in the beginning symmories were commissioned with the recovery of debts and repairs, this was not carried through later on I also argued that in I.G. II2 1622 there is the only record of individual members of symmories in an inscription, and I further concluded that certain members of a symmory were assigned the same ship year after year. Then 1 argued for the difference between a synteles (member of a symmory) and a trierarch describing the responsibilities each had and, finally, drew a distinction between the naval reforms of 358/7 and 340. After discussing possible ways of the appointment of the 1200, 1 examine at length the more or less intractable problem of whether the eisphora and naval symmories were identical. I constructively criticise all major approaches, concluding that there is no evidence that contradicts my opinion that there were two different systems

Trepanations in the ancient Greek colony of Akanthos: Skull surgery in the light of Hippocratic medicine

Objective: The study presents seven new cases of trepanations on four individuals from the ancient Greek colony of Akanthos (5th - 1st c. BC) and juxtaposes the paleopathological observations with the Hippocratic treatises. Materials: A meta-analysis of 42 published trepanations on 27 individuals from Greece. Methods: Trepanations from Akanthos were observed macroscopically, stereoscopically and by computer tomography. The meta-analysis considers the demographic, geographical and temporal distribution, the techniques, associated pathology, and survival rate. Results: Trepanations were observed on four females in Akanthos. Three trepanations were performed with scraping and four with drilling. Two individuals exhibited significant signs of healing, and two survived shortly after the operation. In two cases, trepanation was practiced for treating cranial injuries. In Greek antiquity trepanation was performed predominantly in males, principally as a surgical treatment of cranial injuries. The survival rate was 62.9 %. Scraping was the oldest, most frequent and successful technique. Conclusions: Trepanation performed systematically in Greece since the Bronze Age (ca. 2,000 BC). Hippocrates who rationally conceived medicine, codified the pre-existing empirical knowledge. The trepanations from Akanthos show technical similarities but also discrepancies from the Hippocratic recommendations, confirming the mental and technical readiness of the ancient surgeon. Significance: The synchronous to Hippocrates trepanations from Akanthos, provide the opportunity to compare physical evidence with the written sources. Limitations: The frequency of trepanations is affected by the representativeness and the state of the skeletal preservation. Suggestions for future research: Trepanations published in previous decades, need to be reassessed with new imaging modalities. A standard recording methodology is fundamental for data comparison. © 2021 Elsevier Inc

Identification and modeling of key logistics processes in the Agrifood Sector

As logistics become a substantial part of a firm's operations, the corresponding processes increases in importance. Identifying key logistics processes using a structured approach will align their outcomes to deliver the business goals, design appropriate measures and allocate sufficient resources for their improvement. This paper proposes a systematic methodology for the identification, categorization and prioritization of logistics processes, using a binary linear programming model. The identified key logistics processes are modeled by creating a number of UML diagrams and document them by the use of a pre-defined template. These processes include both inbound and supply chain - wide logistics activities and have a critical effect on the operational performance of an agrifood business entity. Companies can focus on these key logistics processes in order to optimize their critical aspects such as time and cost issues, resources planning and scheduling, as well as, queues and delay