Schwannomas of the Left Adrenal Gland and Posterior Mediastinum

Schwannoma is a rare tumor of neural crest cell origin. Most schwannomas occur in the head, neck, stomach or limbs, with a few cases occurring in the retroperitoneal space. A 30-year-old Taiwanese woman presented with a 1-week history of left anterior chest discomfort and left flank pain. The laboratory findings and endocrine studies were all within normal limits. Chest X-ray revealed masses in the posterior mediastinum. Chest computed tomography and magnetic resonance imaging showed several masses in the left paraspinal region and in the left adrenal region. The patient underwent total excision of the left paraspinal tumors and laparoscopic left adrenalectomy. Pathologic studies showed a picture of benign schwannoma. In conclusion, preoperative differentiation of benign schwannoma from malignant peripheral nerve sheath tumor or other tumors is important for good prognosis. Total excision of benign schwannoma is associated with favorable outcome in patients

Cannot Live without Facebook? An Expectation Confirmation Model with the Moderating Effects of Narcissism

Facebook provides an ideal channel for people to admire their own performance. People tend to show off themselves to others and confirming their feedback on Facebook. With behavior on Facebook, narcissism is now highlighted by many researchers. Hence, based on the expectation confirmation theory (ECT), our study looks into continuance Facebook usage behaviors. It explores the relationship between perceived feedback, confirmation, satisfaction, and continuance intentions, and most important of all, it examines the moderating effects of narcissistic traits on these relationships. Data are collected from 420 valid respondents through self-administered questionnaires. Results revealed that: (1) Continuance Facebook behavior intention is jointly influenced by perceived feedback and satisfaction, which in turn is determined by confirmation. Then, confirmation is influenced by perceived feedback; (2) Narcissism has the moderating effect on the relationships between feedback and confirmation as well as confirmation and satisfaction. Finally, interpretations and implication of these findings are discussed

Osteomyelitis of Multiple Lumbar Vertebrae Associated with Infected Aortic Aneurysm: A Case Report

A 73-year-old male patient presented with a pulsating abdominal mass and intractable low back pain for several days. Magnetic resonance imaging revealed an infected abdominal aortic aneurysm invading the second, third, and fourth lumbar vertebrae. He underwent radical debridement of the infected aneurysm with reconstruction using vascular bypass, partial corpectomy of the L2 to L4 vertebrae, anterior reconstruction with autogenous fibular shaft, and posterior instrumentation with posterolateral fusion. Culture of the necrotic tissues grew oxacillin-resistant Staphylococcus aureus. He received intravenous vancomycin infusion for 4 weeks and oral ciprofloxacin for 6 months postoperatively. After a 15-month follow-up, no apparent signs of further infection were noted. C-reactive protein and erythrocyte sedimentation rate returned to normal during follow-up. No neurologic symptoms other than mild low back soreness were noted. The stability of the lumbar spine was maintained using long segment reconstruction with autogenous fibula shaft and posterior instrumentation along with posterolateral fusion. Infected aortic aneurysm with vertebral osteomyelitis is a rare clinical entity. Prompt diagnosis and adequate treatment are essential

Risk Analysis of Cargos Damages for Aquatic Products of Refrigerated Containers: Shipping Operators’ Perspective in Taiwan

As the development of refrigerated container, transportation of aquatic products is growing rapidly in recent years. It is very important to avoid cargos damages for aquatic products of refrigerated containers, while the shipping operators are running this scope of business. Hence, the risk issue of adopting various improvement strategies would be important for the container shipping operators. In the light of this, the main purpose of this paper is to analyze the risks of cargos damages for aquatic products of refrigerated containers based on the container shipping operators’ perspective in Taiwan. We use four risk assessment procedures - risk identification, risk analysis and evaluation, risk strategies, and risk treatment - as the research method in this paper. The risk factors are generated from literature review and experts interviewing. Then, three dimensions with nineteen risk factors are preliminary identified. We used these risk factors to proceed with the empirical study via questionnaires. Three points of empirical results are presented. At first, the top factor of perceived risk as well as of risk severity is ‘container data setting errors.’ Secondly, the top factor of risk frequency is ‘lack of the goods’ pre-cooling themselves.’ Thirdly, three risk factors are classified into the low-risk area, whereas sixteen risk factors are placed on the medium-risk area. There is no risk factor fix on the high-risk area. Furthermore, three risk strategies - risk prevention, risk reduction, and risk transfer - are suggested to adopt by different risk factors

Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques

BACKGROUND: Few studies discuss the indicators used to assess the effect on cost containment in healthcare across hospitals in a single-payer national healthcare system with constrained medical resources. We present the intraclass correlation coefficient (ICC) to assess how well Taiwan constrained hospital-provided medical services in such a system. METHODS: A custom Excel-VBA routine to record the distances of standard deviations (SDs) from the central line (the mean over the previous 12 months) of a control chart was used to construct and scale annual medical expenditures sequentially from 2000 to 2009 for 421 hospitals in Taiwan to generate the ICC. The ICC was then used to evaluate Taiwan’s year-based convergent power to remain unchanged in hospital-provided constrained medical services. A bubble chart of SDs for a specific month was generated to present the effects of using control charts in a national healthcare system. RESULTS: ICCs were generated for Taiwan’s year-based convergent power to constrain its medical services from 2000 to 2009. All hospital groups showed a gradually well-controlled supply of services that decreased from 0.772 to 0.415. The bubble chart identified outlier hospitals that required investigation of possible excessive reimbursements in a specific time period. CONCLUSION: We recommend using the ICC to annually assess a nation’s year-based convergent power to constrain medical services across hospitals. Using sequential control charts to regularly monitor hospital reimbursements is required to achieve financial control in a single-payer nationwide healthcare system

Socioeconomic impacts of innovative dairy supply chain practices. The case of the Laiterie du Berger in the Senegalese Sahel

This study analyzes the Laiterie Du Berger (LDB)'s milk supply chain and its contribution to strengthening the food security and socioeconomic resources of Senegalese Sahelian pastoral households. Porter's value chain model is used to characterize the innovations introduced by the LDB dairy in its milk inbound logistics and supplier relationships. A socioeconomic food security index and qualitative data are used to assess the dairy's supply chain's contribution to strengthen smallholder households' livelihoods. Data for this research were obtained through individual surveys, focus groups and in-depth interviews of LDB managers and milk suppliers. Results show that milk income contributes significantly to household food security. Suppliers who stabilize their dairy income between rainy and dry seasons, diversify income sources and have larger herds are more likely to remain food secure. The LDB innovations contribute by helping herders access biophysical and economic resources, leading to better livestock feed and household food security. (Résumé d'auteur