The value and challenges of collegiality in practice

The ability to work optimally with colleagues is considered to be a valuable determinant of success, but collegiality is a challenge to assess. Could you be more collegial, and what might be the benefits and drawbacks for clinical practice? How could you be more collegial and foster more collegiality amongst those you work with? What is collegiality and what does it mean to be collegial? Collegiality can be defined as the relationship between individuals working towards a common purpose within an organisation. The concept has its origins in the roman practice of sharing responsibility equally between government officials of the same rank in order to prevent a single individual from gaining too much power. In contrast, managerialism does not provide opportunities for exploring democratic consensus because it promotes being responsive and obedient to implementing the wishes of authority (Dearlove, 1997, King, 2004). Collegiality emphasises trust, independent thinking and sharing between co-workers. This encourages both autonomy and mutual respect and can impact on organisational efficacy (Donohoo, 2017). In modern day practice, the focus is less on sharing responsibility between officials of the same rank and more on ensuring that all employees within an organisation are treated with equal respect as individual people (Lorenzen, 2006)

Denial at the top table: status attributions and implications for marketing

Senior marketing management is seldom represented on the Board of Directors nowadays, reflecting a deteriorating status of the marketing profession. We examine some of the key reasons for marketing’s demise, and discuss how the status of marketing may be restored by demonstrating the value of marketing to the business community. We attribute marketing’s demise to several related key factors: narrow typecasting, marginalisation and limited involvement in product development, questionable marketing curricula, insensitivity toward environmental change, questionable professional standards and roles, and marketing’s apparent lack of accountability to CEOs. Each of these leads to failure to communicate, create, or deliver value within marketing. We argue that a continued inability to deal with marketing’s crisis of representation will further erode the status of the discipline both academically and professionally

Endothelial Dysfunction and Specific Inflammation in Obesity Hypoventilation Syndrome

BACKGROUND: Obesity hypoventilation syndrome (OHS) is associated with increased cardiovascular morbidity. What moderate chronic hypoventilation adds to obesity on systemic inflammation and endothelial dysfunction remains unknown. QUESTION: To compare inflammatory status and endothelial function in OHS versus eucapnic obese patients. METHODOLOGY: 14 OHS and 39 eucapnic obese patients matched for BMI and age were compared. Diurnal blood gazes, overnight polysomnography and endothelial function, measured by reactive hyperemia peripheral arterial tonometry (RH-PAT), were assessed. Inflammatory (Leptin, RANTES, MCP-1, IL-6, IL-8, TNFalpha, Resistin) and anti-inflammatory (adiponectin, IL-1Ra) cytokines were measured by multiplex beads immunoassays. PRINCIPAL FINDINGS: OHS exhibited a higher PaCO(2), a lower forced vital capacity (FVC) and tended to have a lower PaO(2) than eucapnic obese patients. (HS)-CRP, RANTES levels and glycated haemoglobin (HbA1c) were significantly increased in OHS (respectively 11.1+/-10.9 vs. 5.7+/-5.5 mg x l(-1) for (HS)-CRP, 55.9+/-55.3 vs 23.3+/-15.8 ng/ml for RANTES and 7.3+/-4.3 vs 6.1+/-1.7 for HbA1c). Serum adiponectin was reduced in OHS (7606+/-2977 vs 13,660+/-7854 ng/ml). Endothelial function was significantly more impaired in OHS (RH-PAT index: 0.22+/-0.06 vs 0.51+/-0.11). CONCLUSIONS: Compared to eucapnic obesity, OHS is associated with a specific increase in the pro-atherosclerotic RANTES chemokine, a decrease in the anti-inflammatory adipokine adiponectin and impaired endothelial function. These three conditions are known to be strongly associated with an increased cardiovascular risk. TRIAL REGISTRATION: ClinicalTrials.gov NCT00603096

Delamination technique together with longitudinal incisions for treatment of Chiari I/syringomyelia complex: a prospective clinical study

<p>Abstract</p> <p>Background</p> <p>Treatment modalities in Chiari malformation type 1(CMI) accompanied by syringomyelia have not yet been standardized. Pathologies such as a small posterior fossa and thickened dura mater have been discussed previously. Various techniques have been explored to enlarge the foramen magnum and to expand the dura. The aim of this clinical study was to explore a new technique of excision of the external dura accompanied by widening the cisterna magna and making longitudinal incisions in the internal dura, without disturbing the arachnoid.</p> <p>Methods</p> <p>Ten patients with CMI and syringomyelia, operated between 2004 and 2006, formed this prospective series. All cases underwent foramen magnum decompression of 3 × 3 cm area with C1–C2 (partial) laminectomy, resection of foramen magnum fibrous band, excision of external dura, delamination and widening of internal dura with longitudinal incisions.</p> <p>Results</p> <p>Patients were aged between 25 and 58 years and occipital headache was the most common complaint. The mean duration of preoperative symptoms was 4 years and the follow-up time was 25 months. Clinical progression was halted for all patients; eight patients completely recovered and two reported no change. In one patient, there was a transient cerebrospinal fluid (CSF) fistula that was treated with tissue adhesive. While syringomyelia persisted radiologically with radiological stability in five patients; for three patients the syringomyelic cavity decreased in size, and for the remaining two it regressed completely.</p> <p>Conclusion</p> <p>Removal of the fibrous band and the outer dural layer, at level of foramen magnum, together with the incision of inner dural layer appears to be good technique in adult CMI patients. The advantages are short operation time, no need for duraplasty, sufficient posterior fossa decompression, absence of CSF fistulas as a result of extra arachnoidal surgery, and short duration of hospitalization. Hence this surgical technique has advantages compared to other techniques.</p

Measuring personal networks and their relationship with scientific production

The analysis of social networks has remained a crucial and yet understudied aspect of the efforts to measure Triple Helix linkages. The Triple Helix model aims to explain, among other aspects of knowledge-based societies, ¿the current research system in its social context. This paper develops a novel approach to study the research system from the perspective of the individual, through the analysis of the relationships among researchers, and between them and other social actors. We develop a new set of techniques and show how they can be applied to the study of a specific case (a group of academics within a university department). We analyse their informal social networks and show how a relationship exists between the characteristics of an individual¿s network of social links and his or her research output

Acute Cellular Alterations in the Hippocampus After Status Epilepticus

The critical, fundamental mechanisms that determine the emergence of status epilepticus from a single seizure and the prolonged duration of status epilepticus are uncertain. However, several general concepts of the pathophysiology of status epilepticus have emerged: (a) the hippocampus is consistently activated during status epilepticus; (b) loss of GABA-mediated inhibitory synaptic transmission in the hippocampus is critical for emergence of status epilepticus; and, finally (c) glutamatergic excitatory synaptic transmission is important in sustaining status epilepticus. This review focuses on the alteration of GABAergic inhibition in the hippocampus that occurs during the prolonged seizures of status epilepticus. If reduction in GABAergic inhibition leads to development of status epilepticus, enhancement of GABAergic inhibition would be expected to interrupt status epilepticus. Benzodiazepines and barbiturates are both used in the treatment of status epilepticus and both drugs enhance GABA A receptor-mediated inhibition. However, patients often become refractory to benzodiazepines when seizures are prolonged, and barbiturates are often then used for these refractory cases of status epilepticus. Recent evidence suggests the presence of multiple GABA A receptor isoforms in the hippocampus with different sensitivity to benzodiazepines but similar sensitivity to barbiturates, thus explaining why the two drug classes might have different clinical effects. In addition, rapid functional plasticity of GABA A receptors has been demonstrated to occur during status epilepticus in rats. During status epilepticus, there was a substantial reduction of diazepam potency for termination of the seizures. The loss of sensitivity of the animals to diazepam during status epilepticus was accompanied by an alteration in the functional properties of hippocampal dentate granule cell GABA A receptors. Dentate granule cell GABA A receptor currents from rats undergoing status epilepticus had reduced sensitivity to diazepam and zinc but normal sensitivity to GABA and pentobarbital. Therefore, the prolonged seizures of status epilepticus rapidly altered the functional properties of hippocampal dentate granule cell GABA A receptors, possibly explaining why benzodiazepines and barbiturates may not be equally effective during treatment of the prolonged seizures of status epilepticus. A comprehensive understanding of the cellular and molecular events leading to the development, maintenance, and cytotoxicity of status epilepticus should permit development of more effective treatment strategies and reduction in the mortality and morbidity of status epilepticus.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65664/1/j.1528-1157.1999.tb00873.x.pd

Integration and isolation in the global petrochemical industry: A multi-scalar corporate network analysis

The global petrochemical industry has long been characterized by stable patterns of Western corporate and geographic leadership, but since the early 2000s, the global playing field has changed significantly. China has overtaken the United States and Europe as the world’s largest petrochemical producer, and other emerging economies have emerged as global petrochemical players. Combining insights from scholarship on global corporate elites, world city networks, and relational economic geography, this article examines patterns in the corporate networks of leading petrochemical corporations. The research is based on a multi-scalar corporate network analysis, applying social network analysis to identify board interlocks, joint venture interlocks, and spatial interlocks between corporations. Through analyzing corporate networks across multiple scales, the research reveals patterns of both integration and isolation within the petrochemical industry. Isolation is evident in disconnected regional corporate elite networks, where the established North Atlantic corporate elite is interconnected through board interlocks, while corporate networks in Asia and other emerging economies remain disconnected. However, high levels of integration within the industry are also evident in an interconnected international company system formed through joint venture collaborations, and in overlapping subsidiary networks centered on petrochemical hubs around the world. The article argues that the results demonstrate a combination of resilience and change, or path dependence and contingency, in patterns of corporate power and collaboration. Western company networks still form the social and spatial backbone of the industry, but these have been challenged by emerging strategic centers and isolated elite networks in other parts of the world. This paper contributes to debates on industrial corporate elites, multiple globalizations, and the multipolar global economy

Improving training outcomes: the significance of motivation when learning about new shipboard technology

This paper reports on some of the findings from a study of new technology and training in shipping. It identifies the key significance of motivation in the learning process and identifies potential factors that motivate or demotivate seafarers when undertaking training about new equipment. It shows that seafarers’ motivation is likely to be impacted by confidence that training is good for the job as well as for promotion. It demonstrates that companies can facilitate and encourage individuals to initiate learning activities but that they may equally adopt strategies which discourage learning. Enabling factors include: establishing a positive learning environment; adopting clear policies; allowing seafarers to identify their own training needs and allowing seafarers to request support for specific courses. Conversely, companies may demotivate some seafarers in relation to training by shifting the burden of training ‘costs’, such as time and money, onto them