Working Together: Exploring the Factors that Influence Interorganizational Cooperation

Administrative and policy failures increasingly occur because of the inability of organizations to facilitate collective action in the absence of a central, hierarchical authority. I explore how organizations achieve (or fail to achieve) voluntary, self-organizing collective action that is not a direct result of external control, presenting a polycentric system of governance within a set of public, nonprofit, and for-profit agencies operating in the policy domain of emergency management. Using a complex adaptive systems framework (Axelrod and Cohen 1999), I identify the patterns of variation, interaction, and the choices made among agencies that determine whether organizations work together. I develop a model of an integrated, interdependent system of emergency management facilitated by a knowledge commons, as opposed to the established sequential cycle of disaster response. The research problem addressed, collective action without hierarchy, is fundamentally an issue of decision making. The ability of decision makers to recognize key situations in their environments and develop strategies for action, i.e. cognition, is critical. Analysis of network data and semi-structured interviews finds that urgent need, proximity, and professional capital, a concept developed in this dissertation, promote and sustain cooperation. I show how these factors increase the capacity of heterogeneous networks to accomplish shared goals. Even if the conditions of urgent need and proximity are satisfied, situations exist where agencies fail to cooperate. Key standards of professional performance—appearance, levels of staffing, past performance, response time, and the quality of equipment—influence the decisions of emergency managers to work together. I present the concept of professional capital to describe how these recognized standards of professional performance demonstrate competence and justify the decisions of managers to interact. Professional capital transcends jurisdictional and disciplinary boundaries, influencing the confidence of decision makers and shaping judgments based on expectations of performance. This concept adds a missing component to social capital theory, which currently focuses on the roles of pre-established trust and norms of reciprocity in promoting collective action

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

The Orthopaedic Section of the American Physical Therapy Association presents this sixth set of clinical practice guidelines on Achilles pain, stiffness, and muscle power deficits that are characteristic of Achilles Tendinitis. These clinical practice guidelines are linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders

Network Features and Processes as Determinants of Organizational Interaction during Extreme Events

Despite the widely acknowledged importance of collaboration among participants in governance networks, a limited number of studies have attempted to statistically model the processes by which those networks form. In this article, we explore a range of network features and processes and measure their influence on network formation. We examine the case of Hurricane Katrina and employ exponential random graph models to identify the drivers of network formation in extreme events. We find that both the attributes of individual organizations and endogenous network processes affect organizational collaboration. Understanding these factors is important because the structure of the response network influences information flow, resource exchange, and performance

Removal of a below knee plaster cast worn for 28 months: a case report

<p>Abstract</p> <p>Introduction</p> <p>An unusual situation in which a below knee cast was removed after 28 months is reported. To the best of our knowledge no similar cases have been reported in the literature.</p> <p>Case presentation</p> <p>The cast was removed from the leg of a 45-year-old Caucasian woman. Significant muscle atrophy and dense skin scales were present but the underlying skin surface was relatively healthy with only small pitted 1-2 mm ulcers. No pathogenic organisms were cultured from this environment.</p> <p>Conclusion</p> <p>It seems likely that skin can tolerate cast immobilization for prolonged duration.</p

Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly

Hip fracture, a moderate musculoskeletal trauma, is associated with a high postoperative mortality. Most patients are elderly, with comorbid conditions and often with heart disease. The objective of this study was to find out if clinical parameters and analyses of specific muscle enzymes could predict three month postoperative mortality. A total of 302 patients above 75 years of age with hip fracture were consecutively enrolled. Baseline information on age, sex and comorbidity assessed with the American Society of Anesthesiologists (ASA) score was obtained before surgery. Creatine kinase (CK), myocardium-specific creatine kinase (CK-MB) and troponin T (TnT) were analysed from venous blood, collected the day before surgery (−1) and postoperatively, within 24 hours (0) and on days one (+1) and four (+4). The overall three month mortality was 19.5%. Multivariate analyses showed that age, male sex and comorbidity (ASA) correlated with mortality (p = 0.027, p = 0.002, p < 0.001, respectively). Surgery induced a two- to threefold increase of CK and CK-MB but without any correlation with mortality. However, high TnT levels >0.04 μg/l correlated significantly with death (days −1, +1 and +4, p = 0.003, p = 0.005 and p = 0.003, respectively). Multivariate analyses, adjusted for age, sex and ASA category, confirmed this correlation (day +4, p = 0.008). Thus, in elderly patients with comorbidities undergoing hip fracture surgery information on sex, age, ASA category and postoperative laboratory analyses on TnT provide the clinicians with useful information on patients at risk of fatal outcome

5 year retrospective follow-up of new cases of Charcot neuroarthropathy - A single centre experience

Background: Few data describe the natural history of Charcot neuroarthropathy treated with a total contact plaster cast (TCC). Methods: A 5 year retrospective analysis of 50 patients presenting with an acute CN, Assessing time to clinical resolution into appropriate footwear and assessing if initial immobilisation device influenced resolution time. Results: During the study period 42 patients (84%) of patients went into remission, 2 died during their treatment, 4 had major amputations, in 2 patients treatment was ongoing. 36 patients were treated with combination offloading devices, 6 were treated with one modality only. Median time to resolution for patients initially treated with a TCC was not significantly shorter than for those treated with a removable below knee boot. 34.9% required re-casting due to clinical deterioration in the removable device. Conclusions: More precise measures of resolution of CN are needed to assess the impact of initial treatment modality on time to resolution

Recurrence of Diabetic Pedal Ulcerations Following Tendo-Achilles Lengthening

Foot and ankle surgeons are frequently challenged by the devastating systemic consequences of diabetes mellitus manifested through neuropathy, integumentary and joint breakdown, delayed healing, decreased ability to fight infection, and fragile tendon/ligaments. Diabetic neuropathic pedal ulcerations lead to amputations at an alarming rate and also carry a high mortality rate. This article will discuss causes of diabetic pedal ulcerations that persist or recur after tendo-Achilles lengthening and will highlight areas that need to be addressed by the practitioner such as infection, vascular and nutritional status, glucose control, off-loading, biomechanics, and patient compliance

The charcot foot in diabetes.

The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity