A Complex Adaptive Systems Perspective to Appreciative Inquiry

Appreciate Inquiry (AI) is utilized to facilitate organizational change by encouraging stakeholders to explore positives and generative capacities within their organization. In the literature, analysis of the effectiveness of AI is confined to psychological and managerial explanations such as highlighting the promotion of positive mindset and collective organizational planning. This paper will discuss a Complex Adaptive Systems (CAS) perspective and present a new model for understanding the functionality of AI. The emphasis of this paper is placed on exploring the effects of AI on the behavior and interactions of agents/employees related to how they cope with change. An analysis of AI’s functionality through the lens of CAS reveals two critical insights: a) AI enhances adaptability to change by strengthening communication among agents, which in turn fosters the emergence of effective team arrangements and a more rapid collective response to change and b) AI possesses the potential to generate a collective memory for social systems within an organization. Furthermore, a systematic analysis of AI indicates a close connection between this method and CAS-based styles of management. This paper concludes by suggesting that AI might represent a potential method with the capacity to place organizational teams in “the edge of chaos”.Keywords: appreciative inquiry, organizational change, management, complex adaptive systems, edge of chao

Comparison of Two Manual Therapy Techniques in Patients with Carpal Tunnel Syndrome: A Randomized Clinical Trial

Background: Manual therapy techniques are part of physiotherapy treatment of carpal tunnel syndrome (CTS) which are classified into two groups including nerve mobilization and mechanical interface mobilization. The aim of the study was to find which manual therapy method-technique directed to mechanical interface and nerve mobilization–has superior beneficial effects on clinical and electrophysiological findings in conservative management of patients with CTS. Methods: Thirty patients with CTS participated into two groups namely: mechanical interface and nerve mobilization in this randomized clinical trial. The intervention was performed three times weekly for 4 weeks. Mechanical interface mobilization was directed to structures around the median nerve at the forearm and wrist. Techniques of median nerve gliding and tension were used in the nerve mobilization group. The outcome measures included visual analogue scale (VAS), symptom severity scale (SSS), hand functional status scale (FSS) and motor and sensory distal latencies of median nerve. Paired t-test and ANCOVA were used for statistical analysis. Results: At the end of the 4th week of the treatment, the mean of VAS, SSS and FSS significantly improved in both groups (p<0.05), but the difference was not significant between the two groups (P>0.05). Although the mean of motor and sensory distal latencies of median nerve at the end of the treatment period only improved in the nerve mobilization group (p<0.05), the difference was not significant between the two groups (P>0.05). Conclusion: Mechanical interface mobilization and nerve mobilization techniques are not superior to each other in reducing pain and improving hand symptoms and functional status

Manual therapy in the treatment of carpal tunnel syndrome in diabetic patients: A randomized clinical trial

Background: Generally, conservative interventions including physiotherapy modalities and manual therapy have been recommended in the management of carpal tunnel syndrome (CTS), but this subject has not been studied in diabetic patients with CTS. Therefore the aim of this study was to investigate the effects of manual therapy on diabetic patients with CTS. Methods: Thirty diabetic patients with CTS were randomly divided into two equal groups: modality group and manual therapy group. Participants in the modality group received transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) and patients in the manual therapy group received manual techniques for the median nerve and its surrounding structures. Interventions were applied 3 times weekly for 4 weeks in both groups. Visual analogue scale (VAS), symptom severity scale (SSS), functional status scale (FSS) and median neurodynamic test (MNT) were evaluated before and after the interventions in both groups. Paired t-test and independent t-test were used for statistical analysis. Results: Paired t-test revealed that all of the outcome measures had a significant change in the manual therapy group, whereas only the VAS and SSS changed significantly in the modality group at the end of 4 weeks. Independent t-test showed that the variables of SSS, FSS and MNT in the manual therapy group improved significantly greater than the modality group. Conclusions: Manual therapy techniques applied to mechanical interface of the median nerve and nerve mobilization possess more appropriate and valuable effects on hand difficulties than modalities in diabetic patients with CTS

Comparison of the calcium-related factors in Parkinson's disease patients with healthy individuals

Background: Parkinson’s disease (PD) is one of the most common neurodegenerative diseases (ND). Studies have demonstrated that biochemical markers have an association with PD. We aimed to investigate an association of biochemical markers including calcium, vitamin D, alkaline phosphatase (ALP), parathormone (PTH), and phosphorous with PD. Methods: This study was conducted on 139 PD patients and 100 healthy individuals. Serum levels of calcium, phosphorous, ALP, PTH and vitamin D were evaluated. Furthermore, student’s t-test and logistic regression models were used by SPSS. Results: The mean levels of calcium (9.4±0.7 and 9.0±0.8 ) and vitamin D (29.7±22.1 and 25.8±23.7) were higher in PD patients as compared with healthy controls, which only status of calcium being significantly different in the two groups (P<0.001). Levels of ALP (202.4±96.7 and 242.9±142.4) and phosphorous (3.6±0.6 and 4.22±1.1) were significantly different comparing PD patients with healthy subjects (P<0.01, P<0.001, respectively). ALP and phosphorous were significantly different in the two groups (OR=0.996, CI 95%, 0.994-0.999, P <0.001, OR= 0.475, CI 95%, 0.325-0.694, P<0.001, respectively). Furthermore, increased levels of calcium resulted in an elevated risk of PD (OR= 2.175, CI 95% 1.377-3.435, P <0.001). Conclusion: Results show that mean levels of calcium are higher in PD patients relative to healthy controls. Thereby, higher levels of calcium may be associated with PD

Association of serum magnesium levels with risk factors, severity and prognosis in ischemic and hemorrhagic stroke patients

Background: Stroke is the third leading cause of mortality worldwide. One of the factors that affect the occurrence of stroke can be attributed to changes in the levels of trace elements. Accumulating evidence has been shown that magnesium, as an important element, is a new predictor of stroke. We aimed to determine the levels of Mg in ischemic stroke patients in comparison with those having the hemorrhagic type. Methods: This study was conducted on 447 stroke patients. Demographic characteristics of patients, stroke severity, and risk factors such as hypertension, ischemic heart disease, diabetes mellitus, and hyperlipidemia were recorded. Stroke was diagnosed based on the neurological examination and neuroimaging findings e.g. computed tomography (CT) or magnetic resonance imaging (MRI). The colorimetric technique was used to determine the concentration of Mg at 450 nm according to the commercial kit. Results: The mean of magnesium levels in ischemic patients was significantly higher than that in the hemorrhagic patients (P=0.001). Difference in magnesium status was associated with gender in thrombotic patients (P<0.05), while hyperlipidemia was associated with the status of magnesium in embolic patients (P=0.012). Furthermore, magnesium levels were correlated with ischemic heart disease in embolic (P=0.011) and sub-arachnoid hemorrhagic (SAH) patients (P=0.012), and with diabetes mellitus in thrombotic patients (P=0.012). Magnesium status was associated with the severity of ischemic stroke at the time of discharge in ischemic patients (P<0.001). Mg levels had the best area under curve (AUC) for the discrimination of ischemic patients from hemorrhagic ones. Conclusion: Magnesium levels were higher in ischemic patients compared to hemorrhagic ones, and these levels were associated with many risk factors contributing to a stroke. Magnesium may be used as a new predictor of stroke in ischemic patients as opposed to hemorrhagic ones. &#160

Muscle strength in diabetics compared to non-diabetic elderly subjects: A cross sectional and case-control study

Background: With the growing population of the elderly, the prevalence of disabilities and chronic diseases will also likely increase. Muscle weakness leads to low amounts of physical activity in elderly diabetic patients and makes them susceptible to falls. In this study, we aimed to compare the muscle strength between diabetic and non-diabetic elderly individuals. Methods: The present study is part of the the Amirkola Health and Ageing Project (AHAP) cohort performed on 1320 elderly individuals. Diabetic and non-diabetic subjects were considered as case and control groups, respectively. A diagnosis of diabetes was assigned to patients who were previously diagnosed and those with repeated fasting blood sugar FBS≥126mg/dl. Digi Hand Dynamometer device and manual muscle testing (MMT) grading systems were used to assess muscle force in the upper and lower extremities, respectively. Data were then analyzed and p<0.05 was considered significant. Results: 29.8 of the total participants (n=393) were diabetics. In the case group, 143 (36.4 of all diabetics) had weak upper extremity muscles. The number was 314 (33.9) among non-diabetics (P=0.38). We saw decreased lower extremity muscle force in 134 (34.1) diabetic individuals and 292 (31.5) non-diabetics (P=0.35). Statistical analysis showed no significant difference in any of the lower or upper extremity muscle forces between diabetics and non-diabetics (p>0.05). Conclusion: Our findings indicate that diabetes mellitus (DM) affects neither the upper nor the lower extremity muscle force in the elderly

Determination of plasma transcobalamin-II and zinc levels in newly-diagnosed and long-standing grand mal epileptic patients

Background: The changes of plasma transcobalamin-II (TCII) and Zinc (Zn) Levels in epileptic patients are not clearly understood. The aim of the current study was to evaluate the plasma contents of TCII and Zn levels in newly–diagnosed epileptic seizure patients, long-standing grand mal epileptic patients following treatment with sodium valproate and healthy control group. Methods: Thirty patients aged 36.76±12.91 years with newly–diagnosed and thirty long-standing grand mal epileptic patients aged 35.56 ±12.77 years were diagnosed based on the clinical symptoms. The control subjects were picked out from healthy individuals and matched to the patients, aged 36.30 ±12.80 years. Plasma Zn and TCN-2 was evaluated via spectrophotometry at 546 nm and 450 nm, respectively, using chimerical kits. Results: Plasma level of TCII in the newly–diagnosed epileptic seizures patients and long-standing grand mal epileptic patients were significantly increased, compared to the healthy controls 14.89 ±3.24 and 21.84± 2.73 vs. 9.55±1.24, (n=30), respectively. Plasma level of Zn was decreased in the newly–diagnosed epileptic seizure patients, while it was increased in long-standing grand mal epileptic patients compared to the control group 69.28± 6.41 and 80.56 ±6.12 and vs.75.80±1.59, (n=30), respectively. Conclusion: This study suggests that sodium valproate may disrupt the homeostatic balance of TCII and Zn, and cause abnormality of their serum level in newly–diagnosed epileptic seizure patients and long-standing grand mal epileptic patients. Further research is recommended to identify the underpinning for these changes. &#160

Evidence that Anti-Type VII Collagen Antibodies Are Pathogenic and Responsible for the Clinical, Histological, and Immunological Features of Epidermolysis Bullosa Acquisita

Epidermolysis bullosa acquisita (EBA) is an autoimmune blistering disease characterized by autoantibodies to type VII (anchoring fibril) collagen. Therefore, it is a prototypic autoimmune disease defined by a well-known autoantigen and autoantibody. In this study, we injected hairless immune competent mice with purified immunoglobulin G (IgG) fraction of serum from rabbits immunized with the non-collagenous amino-terminal domain (NC1) of human type VII collagen, the domain known to contain immunodominant epitopes. As a control, identical mice were injected with the IgG fraction of serum from non-immunized rabbits. Mice injected with immune IgG developed subepidermal skin blisters and erosions, IgG deposits at the epidermal-dermal junction of their skin, and circulating anti-NC1 antibodies in their serum-all features reminiscent of patients with EBA. Similar concentrations of control IgG purified from normal rabbits did not induce disease in the mice. These findings strongly suggest that autoantibodies that recognize human type VII collagen in EBA are pathogenic. This murine model, with features similar to the clinical, histological, and immunological features of EBA, will be useful for the fine dissection of immunopathogenic mechanisms in EBA and for the development of new therapeutic interventions

Epilepsy and Associated Factors in Elderly People of Amirkola, North of Iran (The Amirkola Health and Ageing Project)

Background: Knowledge about the associated factors with epilepsy in the elderly in Iran is limited. Therefore, this study aimed to determine the prevalence of epilepsy and associated factors in Amirkola elderly patients. Methods: This cross-sectional study is a part of a comprehensive and cohort research of "The Amirkola Health and Ageing Project". The Mini-mental State Examination was used for cognitive impairment, Geriatric Depression Scale for psychiatric diseases and the Physical Activity Scale for Elderly questionnaire for physical activity. Results: The prevalence of epilepsy was 35 from 1482 participants (24/1000). The significant association between Parkinson’s Disease (OR=6.25, 95CI=1.35-28.4, P=0.001), falls (OR= 3.81, 95CI=1.62-8.97, P=0.001), depression (P=0.001), hyperphosphatemia (P=0.039) and hypokalemia (P= 0.031) concluded with epilepsy. Past history of stroke (6 versus 2, OR= 2.8, 95CI, 0.97-8.27, P=0.07), increased serum level of triglyceride (OR= 1.96, 95CI= 0.99-3.88, P=0.06) and low-density lipoprotein (LDL) (P=0. 45) were seen in epileptic patients vs. non-epileptic patients. Conclusion: Parkinson's disease, frequency of falls and depression were the associated factors in epileptic patients and a correlation between past history of stroke, increased serum level of triglyceride and LDL with epilepsy were seen. Associated factors required screening, diagnosis and treatment

Examining the frequency of dysphagia and the predictive factors of dysphagia that require attention in patients with Parkinson's disease

Introduction. Due to the prevalence of dysphagia in patients with Parkinson's disease (PD) and its complications such as aspiration pneumonia, which is the main cause of death in these patients, PD-related disability can be prevented by early diagnosis and treatment of dysphagia. Objective. The present study was aimed at investigating the frequency of dysphagia in PD patients. Materials and methods. This cross-sectional study included 150 PD patients visiting a Neurology Clinic. The severity of PD was determined based on the Unified Parkinson Disease Rating Scale (UPDRS) and modified Hoen and Yahr (HYS) Scale. The Munich Dysphagia Test-Parkinson's disease (MDT-PD) questionnaire was used to assess dysphagia. Comparisons were made using generalized Fisher exact, Chi-square, ANOVA, and KruskalWallis tests. Predictive factors were analyzed using logistic regression. Statistical analyses were performed at significance level of 0.05. Results. Out of all 150 patients referred to the Clinic, the prevalence of dysphagia requiring attention was 25.3% (n = 38). The patients of the three groups according to the MDT-PD (no noticeable dysphagia, noticeable oropharyngeal, and dysphagia with aspiration risk) had a significant difference only in terms of the PD duration (p 0.001). In the predicting of dysphagia, the longer PD duration (p = 0.011) and homemaker occupation (p = 0.033) were protective factors, while female gender was a risk factor (p = 0.011). Conclusion. The prevalence of dysphagia requiring attention in the studied patients was 25.3%. It decreased with the longer duration of the disease, and its prevalence was lower in homemaker patients, while the odds of dysphagia was 5.8 times higher in women than in men