Director independence: Going beyond misaligned incentives to resource dependence

Board director independence is critical to achieving and maintaining control to address the agency theory–based issue of interest misalignment between the principal (the organization) and the executives (agent). However, theoretical and empirical research and strategic risk considerations have brought into question the role or relevance that director independence plays in these control task and agency theory domains. We ask, using a quantitative survey method, whether board activity–based applications of independence may be associated with the service task of the board, namely its resource dependence mission. Our findings suggest that the resource dependence duty of the board may be positively associated with some autonomous activities, and yet other activities might be driven primarily by normative practices. Based on this, we suggest that a theoretical scope beyond and greater than agency theory may be needed when reassessing the role of director independence.JEL Classification: M1, O3</jats:p

Republished: Intracavitary ultrasound (ICARUS): a neuroendoscopic adaptation of intravascular ultrasound for intracerebral hemorrhage evacuation

Neurosurgeons performing intracerebral hemorrhage evacuation procedures have limited options for monitoring hematoma evacuation and assessing residual hematoma burden intraoperatively. Here, we report the successful neuroendoscopic adaptation of intravascular ultrasound, referred to here as intracavitary ultrasound (ICARUS), in two patients. Pre-evacuation ICARUS demonstrated dense hematomas in both patients. Post-evacuation ICARUS in patient 1 demonstrated significant reduction in clot burden and two focal hyperechoic regions consistent with pockets of hematoma not previously seen with the endoscope or burr hole ultrasound. These areas were directly targeted and resected with the endoscope and suction device. Post-evacuation ICARUS in patient 2 showed significant reduction of hematoma volume without indication of residual blood. ICARUS findings were confirmed on intraoperative DynaCT and postoperative CT 24 hours later. ICARUS is feasibly performed in a hematoma cavity both before and after hematoma aspiration. ICARUS may provide additional information to the operating surgeon and assist in maximizing hematoma removal.</jats:p

The Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation

BackgroundEndoscopic intracerebral hemorrhage (ICH) evacuation techniques have gained interest as a potential therapeutic option. However, the instrumentation and techniques employed are still being refined to optimize hemostasis and evacuation efficiency.ObjectiveWe describe the application of a specific endoscopic technique in the treatment of ICH called the Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique. It differs from previously described minimally invasive ICH interventions in that it combines two separate neuroendoscopic strategies in two phases, the first under dry-field conditions and the second using a wet-field strategy.MethodsAll patients who underwent endoscopic ICH evacuation with the SCUBA technique from December 2015 to September 2017 were included.ResultsThe SCUBA technique was performed in 47 patients. The average evacuation percentage was 88.2% (SD 20.8). Active bleeding identified to derive from a specific source was observed in 23 (48.9%) cases. Active bleeding was addressed with irrigation alone in five cases (10.6%) and required electrocautery in 18 cases (38.3%). Intraoperative bleeding occurred in 3 patients (6.4%) and postoperative bleeding occurred in a single case (2.1%).ConclusionsThe SCUBA technique provides surgeons with a defined strategy for true endoscopic hematoma evacuation. In particular, the fluid-filled cavity in SCUBA Phase 2 has the potential to provide several advantages over the traditional air-filled strategy, including clear identification and cauterization of bleeding vessels and visualization of residual clot burden. Further investigation is necessary to compare this technique to others that are currently used.</jats:sec

Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation

Background and purposePreclinical studies suggest that clot removal may mitigate primary and secondary brain injury following intracerebral hemorrhage (ICH). Although the MISTIE trial did not demonstrate an overall outcome benefit, it did demonstrate outcome benefit from effective reduction of clot burden. Minimally invasive endoscopic ICH evacuation may provide an alternative option for clot evacuation.MethodsPatients presenting to a single healthcare system from December 2015 to October 2018 with supratentorial spontaneous ICH were evaluated for minimally invasive endoscopic evacuation. Inclusion and exclusion criteria were prospectively established by a multidisciplinary group in the healthcare system. The prespecified primary analysis was the proportion of patients with modified Rankin Score (mRS) 0–3 at 6 months.ResultsOne hundred patients met the inclusion and exclusion criteria and underwent minimally invasive endoscopic ICH evacuation. The mean (SD) hematoma size was 49.7 (30.6) mL, the mean (SD) evacuation percentage was 88.2 (20.3)%, and 86% of patients had postoperative residual hematoma ≤15 mL. At 6 months the proportion of patients with an mRS of 0–3 was 46%.ConclusionsThis study suggests that minimally invasive endoscopic ICH evacuation may produce favorable long-term functional outcomes. Further evaluation of this technique in a randomized clinical trial is necessary.</jats:sec