Corneal Confocal Microscopy: A novel noninvasive test to diagnose and stratify the severity of human diabetic neuropathy

OBJECTIVE: The accurate quantification of human diabetic neuropathy is important to define at-risk patients, anticipate deterioration, and assess new therapies. ---------- RESEARCH DESIGN AND METHODS: A total of 101 diabetic patients and 17 age-matched control subjects underwent neurological evaluation, neurophysiology tests, quantitative sensory testing, and evaluation of corneal sensation and corneal nerve morphology using corneal confocal microscopy (CCM). ---------- RESULTS: Corneal sensation decreased significantly (P = 0.0001) with increasing neuropathic severity and correlated with the neuropathy disability score (NDS) (r = 0.441, P 3) defined an NFD of 6) defined a NFD cutoff of <20.8/mm2 with a sensitivity of 0.71 (0.42–0.92) and specificity of 0.64 (0.54–0.74). ---------- CONCLUSIONS: CCM is a noninvasive clinical technique that may be used to detect early nerve damage and stratify diabetic patients with increasing neuropathic severity. Established diabetic neuropathy leads to pain and foot ulceration. Detecting neuropathy early may allow intervention with treatments to slow or reverse this condition (1). Recent studies suggested that small unmyelinated C-fibers are damaged early in diabetic neuropathy (2–4) but can only be detected using invasive procedures such as sural nerve biopsy (4,5) or skin-punch biopsy (6–8). Our studies have shown that corneal confocal microscopy (CCM) can identify early small nerve fiber damage and accurately quantify the severity of diabetic neuropathy (9–11). We have also shown that CCM relates to intraepidermal nerve fiber loss (12) and a reduction in corneal sensitivity (13) and detects early nerve fiber regeneration after pancreas transplantation (14). Recently we have also shown that CCM detects nerve fiber damage in patients with Fabry disease (15) and idiopathic small fiber neuropathy (16) when results of electrophysiology tests and quantitative sensory testing (QST) are normal. In this study we assessed corneal sensitivity and corneal nerve morphology using CCM in diabetic patients stratified for the severity of diabetic neuropathy using neurological evaluation, electrophysiology tests, and QST. This enabled us to compare CCM and corneal esthesiometry with established tests of diabetic neuropathy and define their sensitivity and specificity to detect diabetic patients with early neuropathy and those at risk of foot ulceration

Secondary user relations in emerging mobile computing environments

Mobile technologies are enabling access to information in diverse environ.ments, and are exposing a wider group of individuals to said technology. Therefore, this paper proposes that a wider view of user relations than is usually considered in information systems research is required. Specifically, we examine the potential effects of emerging mobile technologies on end-­‐user relations with a focus on the ‘secondary user’, those who are not intended to interact directly with the technology but are intended consumers of the technology’s output. For illustration, we draw on a study of a U.K. regional Fire and Rescue Service and deconstruct mobile technology use at Fire Service incidents. Our findings provide insights, which suggest that, because of the nature of mobile technologies and their context of use, secondary user relations in such emerging mobile environments are important and need further exploration

Managing digital coordination of design: emerging hybrid practices in an institutionalized project setting

What happens when digital coordination practices are introduced into the institutionalized setting of an engineering project? This question is addressed through an interpretive study that examines how a shared digital model becomes used in the late design stages of a major station refurbishment project. The paper contributes by mobilizing the idea of ‘hybrid practices’ to understand the diverse patterns of activity that emerge to manage digital coordination of design. It articulates how engineering and architecture professions develop different relationships with the shared model; the design team negotiates paper-based practices across organizational boundaries; and diverse practitioners probe the potential and limitations of the digital infrastructure. While different software packages and tools have become linked together into an integrated digital infrastructure, these emerging hybrid practices contrast with the interactions anticipated in practice and policy guidance and presenting new opportunities and challenges for managing project delivery. The study has implications for researchers working in the growing field of empirical work on engineering project organizations as it shows the importance of considering, and suggests new ways to theorise, the introduction of digital coordination practices into these institutionalized settings

Agency and institutions in organization studies

textabstractAgency and institutions are essential concepts within institutional theory. In this Perspectives issue, we draw on a select group of Organization Studies articles to provide an overview of the topic of agency and institutions. We first consider different ways of defining agency and institutions and examine their implications for institutional theory. We then analyse the relationship of actors and institutions through four lenses – the wilful actor, collective intentionality, patchwork institutions and modular individuals. Our analysis leads us to dissociate agency from individuals and view it as a capacity or quality that stems from resources, rights and obligations tied to the roles and social positions actors occupy. Roles and social positions are institutionally engineered. It is social actors qua occupants of roles and positions (not individuals) that enter the social ‘stage’ and exercise agency

Computing the everyday: social media as data platforms

We conceive social media platforms as sociotechnical entities that variously shape user platform involvement and participation. Such shaping develops along three fundamental data operations that we subsume under the terms of encoding, aggregation, and computation. Encoding entails the engineering of user platform participation along narrow and standardized activity types (e.g., tagging, liking, sharing, following). This heavily scripted platform participation serves as the basis for the procurement of discrete and calculable data tokens that are possible to aggregate and, subsequently, compute in a variety of ways. We expose these operations by investigating a social media platform for shopping. We contribute to the current debate on social media and digital platforms by describing social media as posttransactional spaces that are predominantly concerned with charting and profiling the online predispositions, habits, and opinions of their user base. Such an orientation sets social media platforms apart from other forms of mediating online interaction. In social media, we claim, platform participation is driven toward an endless online conversation that delivers the data footprint through which a computed sociality is made the source of value creation and monetization

Speaking with things: Encoded researchers, social data, and other posthuman concoctions

We apply our heuristics for &lsquo;interviewing&rsquo; nonhuman research participants (Adams and Thompson 2011) to the digital things of qualitative research itself: recording devices, data analysis software, and other sociomaterial concoctions recruited at different stages of contemporary research projects. We suggest that these &lsquo;inorganic organized&rsquo; entities participate as co-researchers that inevitably extend but also disrupt research practice and knowledge construction, introducing new tensions and contradictions. Counterpointing phenomenology and Actor Network Theory, we usher some of the hidden and coded materialities of research practice into view, and glimpse unexpected realities co-enacted. Such immersive entanglements raise ethical questions about the posthumanist fluencies now demanded in social science research practice and we outline several considerations

New games, new rules: big data and the changing context of strategy

Big data and the mechanisms by which it is produced and disseminated introduce important changes in the ways information is generated and made relevant for organizations. Big data often represents miscellaneous records of the whereabouts of large and shifting online crowds. It is frequently agnostic, in the sense of being produced for generic purposes or purposes different from those sought by big data crunching. It is based on varying formats and modes of communication (e.g., texts, image and sound), raising severe problems of semiotic translation and meaning compatibility. Crucially, the usefulness of big data rests on their steady updatability, a condition that reduces the time span within which this data is useful or relevant. Jointly, these attributes challenge established rules of strategy making as these are manifested in the canons of procuring structured information of lasting value that addresses specific and long-term organizational objectives. The developments underlying big data thus seem to carry important implications for strategy making, and the data and information practices with which strategy has been associated. We conclude by placing the understanding of these changes within the wider social and institutional context of longstanding data practices and the significance they carry for management and organizations

Clinicians’ role in the adoption of an Oncology Decision Support App in Europe and its implications for organizational practices: A Qualitative Case Study

Background: Despite the existence of adequate technological infrastructure and clearer policies, there are situations where users, mainly physicians, resist mobile health (mHealth) solutions. This is of particular concern, bearing in mind that several studies, both in developed and developing countries, showed that clinicians’ adoption is the most influential factor in such solutions’ success. Objective: This research focuses on understanding clinicians’ roles in the adoption of an Oncology Decision Support App, the factors impacting this adoption, and its implications for organizational and social practices. Methods: A qualitative case study of a decision support app in Oncology, called ONCOassist. The data were collected through 17 in-depth interviews with clinicians and nurses in the UK, Ireland, France, Italy, Spain and Portugal. Results: This case demonstrates the affordances and constraints of mHealth technology at the workplace, their implications for the organization of work, and clinicians’ role in their constant development and adoption. The research findings confirmed that factors such as app operation and stability, ease of use, usefulness, cost, and portability play a major role in the adoption process; however, other social factors such as endorsement, neutrality of the content, attitude towards technology, existing workload and internal organizational politics are also perceived as key determinants of clinicians’ adoption. Interoperability and cultural views of mobile usage at work are the key workflow disadvantages; while higher efficiency and performance, sharpened practice and location flexibility are the main workflow advantages. Conclusions: Several organizational implications emerged, suggesting the need for some actions such as fostering a work culture that embraces new technologies, and the creation of new digital roles for clinicians both on the hospitals/clinics and on the development sides but also more collaboration between healthcare organizations and Digital Health providers to enable Electronic Medical Record (EMR) integration and solve any interoperability issues. From a theoretical perspective, we also suggest the addition of a fourth step to Leonardi’s (2018) methodological guidance to account for user engagement; embedding the users in the continuous design and development processes ensures the understanding of user-specific affordances that can then be made more obvious to other users and increase the potential of such tools to go beyond their technological features and have a higher impact on workflow and the organizing process