EP.TH.421A Systematic Review of Early versus Late Closure of Loop Ileostomy

Aim A Loop ileostomy is one of the most common techniques used in colorectal surgery, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis. However, it is a procedure that can cause a plethora of complications. Currently, there is no consensus regarding the optimal time for its reversal. Some studies suggested the early reversal of ileostomy procedure as a solution to reduce these complications. This study aims to review the available literature in order to ascertain the benefits behind early closure of loop ileostomy. Methods The literature was searched for all studies that included a comparison between the outcomes of early and late closure of loop ileostomy in terms of morbidity, mortality, or quality of life, where available. Early closure of loop ileostomy is defined as closure less than three months and late as more than three months, in accordance with conventional literature. The resultant articles were filtered using our inclusion and exclusion criteria. Finally, the remaining articles were assessed for quality and their results were compared to one another in order to draw our conclusions. Results The results were slightly inclined toward early closure of loop ileostomy, despite the limitations of the studies reviewed. Conclusion There were limitations of the studies reviewed, including the heterogenicity of studies, selection bias, lack of clear definition of measured outcomes, and small sample size. Taking that into consideration, the results of early closure of loop ileostomies in the selected patients were promising and require further investigation.

Medicolegal Considerations Regarding Steroid Use in Otolaryngology: A Review of the Literature

Objective: To review the literature on corticosteroid use and provide recommendations on patient counseling and/or consent to promote judicious prescribing and reduce the incidence of corticosteroid-related lawsuits. Method: A conventional literature search of PubMed on corticosteroid-related medicolegal cases was undertaken. Search terms included “medicolegal,” “otolaryngology,” and “adrenocorticosteroids.” A medical subjects headings search with the keywords “adrenal cortex hormones” and “jurisprudence” was also performed. Results: Corticosteroids have been reported as the third most frequent medication involved in malpractice claims, oftentimes leading to disproportionately costly payments. The most common specialties found to be involved in corticosteroid related medicolegal cases included dermatology (12%), primary care (10%), and neurologists or neurosurgeons (6%). The most common complications encountered were avascular necrosis (39%), changes in mood (16%), infection (14%), and vision changes (14%). Only a few cases corticosteroid-related litigation regarding otolaryngologists were identified. More frequent causes for otolaryngology claims were intraoperative complications, deficits in diagnoses, and failures or delays in treatment. Three medicolegal pitfalls regarding corticosteroid use were identified from this review included: (1) insufficient advising, (2) lack of or incomplete informed consent, and (3) the significance of the patient-physician relationship. Conclusion: Despite the scarcity of corticosteroid-related medicolegal literature pertaining to otolaryngologists, corticosteroids are one of the most widely prescribed medications in the field of otolaryngology and have been shown to have a high rate of medical malpractice claims in medicine. Counseling and consenting the patient, as well as developing a strong physician-patient relationship, are integral processes in addressing any adverse effects occurring during therapy, and may also help to decrease the incidence and success of litigation against otolaryngologists.

A New Generalized Variance Approach for Measuring Multidimensional Inequality and Poverty

The paper suggests a new generalized variance concept for measuring multidimensional inequality of a stratified society, based on multivariate statistical methods, where the members of society form a cloud in the oblique space of dimensions of inequality, such as income, expenditure and property. The cloud presents the multidimensional inequality capsulized in the cloud. The goal is to condense all the inequality information embodied by the cloud into a composite compact metric characterizing both the shape and the inner structure of the cloud. Contrary to the conventional literature that considers multidimensionality as a unidimensional weighted combination of the dimensions, our new composite index measures the inequality of the configuration of the points in the cloud. Our aim is twofold. First, we introduce the Inequality Covariance Matrix (ICM) assigned to the cloud, with elements measuring the correlations among dimensions. Having ICM, we propose the Generalized Variance (GV) of ICM to measure the composite Generalized Variance Inequality (GVI) level. Second, to evaluate the stratum-specific structure of the overall inequality, we suggest a new two-stage procedure. In the first stage, we divide the total GVI into between-groups and within-groups effects. Then, in the second stage the contributions of the strata to the within-groups inequality and, the contributions of the dimensions to the between-groups inequality are calculated. This GVI approach is sensitive to the correlation system, decomposable into stratum effects and, the number of dimensions is not limited. Moreover, including the log-dimensions in the analysis, GVI yields an Entropy Covariance Matrix giving a new Generalized Variance Entropy index. Finally, the GVI of censored poverty indicators means multidimensional poverty measurement. This special complex task is not yet solved in the traditional literature so far.

The U.S. Mexican immigrant family in a changing society: a critical overview

This article charts literature debates about the structural changes of the Mexican immigrant family in the United States. It presents, first, a critical overview of the conventional literature on the Mexican immigrant family, typically framed around assimilation models, their major themes, and shortcomings. Then, shifting frameworks, this paper shows how structural inequality and feminist models, as critical approaches to emerging immigrant family forms, help us to understand the transformational parallels between U.S. society and the Mexican immigrant family structure. It is argued in this article that the Mexican family is structurally diverse. In doing so, the discussion is placed in the larger context of the U.S., explaining how historical and present social forces associated with unequal access to economic, labor, and educational opportunities have perpetuated the marginality of the Mexican immigrant family vis-à-vis the mainstream family. The paper also outlines and discusses the ways feminist, intersectional, and postmodernism frameworks shape the current literature debates on immigrant families. Lastly, it discusses how diversity in terms of family structure and family life contributes to the general field of family study in the U.S. and globally.

Pyramidal Framework: Guidance for the Next Generation of GIS Spatial-Temporal Models

Over the last decade, innovative computer technologies and the multiplication of geospatial data acquisition solutions have transformed the geographic information systems (GIS) landscape and opened up new opportunities to close the gap between GIS and the dynamics of geographic phenomena. There is a demand to further develop spatio-temporal conceptual models to comprehensively represent the nature of the evolution of geographic objects. The latter involves a set of considerations like those related to managing changes and object identities, modeling possible causal relations, and integrating multiple interpretations. While conventional literature generally presents these concepts separately and rarely approaches them from a holistic perspective, they are in fact interrelated. Therefore, we believe that the semantics of modeling would be improved by considering these concepts jointly. In this work, we propose to represent these interrelationships in the form of a hierarchical pyramidal framework and to further explore this set of concepts. The objective of this framework is to provide a guideline to orient the design of future generations of GIS data models, enabling them to achieve a better representation of available spatio-temporal data. In addition, this framework aims at providing keys for a new interpretation and classification of spatio-temporal conceptual models. This work can be beneficial for researchers, students, and developers interested in advanced spatio-temporal modeling.

Why probability ambiguity in the many-worlds interpretation is blessing

The question of how to make sense of probability in the many-worlds interpretation is a controversial and difficult one. Conventional literature attempts to provide a correct way of assigning probability to each world in the universe of many worlds. Differing from these attempts, it is argued that probability ambiguity in the many-worlds interpretation is not a curse but a blessing, allowing us to study quantum phenomena in terms of conventional thermodynamics, connecting readily to black hole thermodynamics.

Measurement Development for Tourism Destination Business Environment and Competitive Advantages

This study attempts to develop a measurement model of competitiveness utilized in the tourism sector, which appears to be fundamentally different in nature from traditional goods and services. Tourism destination competitiveness reflecting the generic characteristics should be considered diversified to notice the distinctive perspective between the business environment and competitive advantages. Criticism of some prior conventional literature stems from the lack of a rigorous process to find the structure and attributes of the measurement items for a destination’s business environment and competitive advantages. The available theoretical framework and measures containing the destination business environment and competitive advantages warrant further investigation. The vital dimensions of the destination business environment (i.e., dynamism, hostility, turbulence, investment, information technology, and governance) and destination competitive advantages (i.e., defensiveness, local acceptance, accessibility, reasonability, uniqueness, supportiveness, and image sustainability) were successfully identified through quantitative and empirical analysis, which could provide a significant basis for managerial and policy decisions in the tourism industry.

On some alleged “problems” and alleged “solutions” in democratic firms

PurposeThis paper will discuss two problems that have plagued the literature on the Ward-Domar-Vanek labor-managed firm (LMF) model, the perverse supply response problem and the horizon problem. The paper also discusses the solution to the horizon problem and the alleged “solution” of a membership market.Design/methodology/approachThis is a conceptual paper so it analyzes the two problems and shows how they can be resolved. It also shows how one alleged “solution” (membership market) is based on several conceptual mistakes about the structure of rights in a democratic firm.FindingsThe perverse supply response is based on the assumption that the members of a democratic firm can expel for no cause some members when it would benefit the remaining members. It is shown that the same perverse behavior happens conceptually and historically in a conventional firm under the same assumptions. The horizon problem is resolved by the system of internal capital accounts (ICAs) that has been independently invented at least four times.Research limitations/implicationsThe idea of a democratic firm is quite often dismissed by conventional economists: “At first it seems like a good idea but unfortunately it is plagued by structural problems such as the perverse supply response and the horizon problem.” Hence it is important to see that the first is not a problem under ordinary assumptions and that the second is a solved problem.Practical implicationsThe perverse supply response problem can be reproduced in a conventional firm under similar assumptions, and the horizon problem is real problem for social or common ownership firms but is solved in the Mondragon-type worker cooperatives by the system of ICAs. This has been known and published since the early 1980s, but conventional economists ignore the solution and still cite it as an inherent structure problem of a democratic firm.Originality/valueIt has not been previously shown in the LMF literature that the perverse supply response can be reproduced in a conventional corporation under similar assumptions since the maximand for the conventional firm is not total market value but that value per current shareholder. The solution to the horizon problem using ICAs has long been “known” but never acknowledged in the conventional literature as if it was a necessary feature of workplace democracy. The idea of a membership market is analyzed and criticized.

A Systematic Review of Early versus Late Closure of Loop Ileostomy

Introduction. A Loop ileostomy is one of the most common techniques used in colorectal surgery to establish a reversible faecal diversion and bypass the large bowels, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis. However, it is a procedure that can cause a plethora of complications including long term ones such as the psychological effects. Currently, there is no consensus regarding the optimal time to perform closure of a loop ileostomy. Some studies suggested the early reversal of ileostomy procedure as a solution to reduce these complications. This study aims to review the available literature in order to ascertain the benefits behind early closure of loop ileostomy. Methods. The literature was searched for all studies that included a comparison between the outcomes of early and late closure of loop ileostomy in terms of morbidity, mortality, or quality of life, where available. Early closure of loop ileostomy is defined as closure less than three months and late as more than three months, in accordance with conventional literature. The resultant articles were filtered using our inclusion and exclusion criteria. Finally, the remaining articles were assessed for quality and their results were compared to one another in order to draw our conclusions. Results and Discussion. The results were slightly inclined toward early closure of loop ileostomy. However, there were limitations of the studies reviewed, including the heterogenicity of studies, selection bias, lack of clear definition of measured outcomes, and small sample size. Taking that into consideration, the results of early closure of loop ileostomies in the selected patients were promising and require further investigation.

BIM Application in Infrastructure Projects

Building Information Modelling (BIM) is becoming a common language for the construction of buildings and infrastructure sectors worldwide. This paper aims at providing a broad picture of published journal papers on BIM application in infrastructure projects. The review is based on bibliometric analysis of 239 papers. The bibliometric analysis technique is used as the analysis method, which when compared to conventional literature reviews allows for the reduction in the likelihood of subjective judgments. The paper presents the review of BIM applications in infrastructure projects analysed within a 10-year period; the analysis of most recent studies and trends of applying BIM methodology identifies the gaps of BIM applications in infrastructure projects and defines future areas of research. Detailed analyses of citation networks present the co-occurrence map of keywords, citation patterns of journals, articles and the most cited journals in the research area. Research shows that BIM applications in infrastructure projects have been continuously growing with a sudden increase after 2016. The study reveals that the research in this area conducted mainly in isolation comprised disjointed and fragmented research studies. Some of the sources are not available in scientific databases.