The prevailing theories of the firm acknowledge the importance of trust and loyalty but neglect such behaviour in the substance of their analyses. The present paper unravels this paradox by drawing ...on Niklas Luhmann's ground-breaking insight that the complexity-reducing function of social systems leads them to neglect their critical environmental dependencies, thereby compromising their own sustainability. If the firm is conceived as a social system, Luhmann's theory implies that the neglect of social behaviour by the predominant theories of the firm can be explained as reflecting the neglect of society by actual firms. This argument promises to not only furnish the theory of the firm with a concern for sustainability, but also render it more amenable to unconventional institutions, such as cooperatives and non–profit organisations, that help compensate for the damage inflicted by conventional firms on the social environment.
Objective This study aims to perform a systematic review evaluating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in improving depression resulting from cerebrovascular ...disease including vascular depression (VD) and poststroke depression (PSD). Methods A literature search of multiple scientific databases was conducted for English studies published from January 1980 to June 2016. Studies were included if the sample consisted of 50% or more adult humans with VD or PSD and had 3 or more subjects, the intervention applied was rTMS, and depression was assessed pre- and post intervention using a formal outcome measure. Randomized controlled trials (RCTs) were assessed for methodological quality using the Physiotherapy Evidence Database (PEDro) tool. A level of evidence was assigned to each study according to the modified Sackett Scale. Results Five studies met the inclusion criteria including 3 RCTs (level 1b; PEDro range: 6-8) and 2 uncontrolled pre–post studies (level 4). There were 186 participants with either PSD (n = 40) or VD (n = 146); the majority of the participants were female (52.7%) and had a mean age ranging from 51.9 to 67.9 years. There were no adverse effects reported by any of the studies. Using clinically accepted criteria for the response rate, all studies reported a benefit from rTMS for the treatment of depression. Three studies also demonstrated a benefit on remission rates as well. Conclusions rTMS was reported to be beneficial in treating depression among individuals with cerebrovascular disease over the short term. However, heterogeneous populations and variability in study design and protocol, as well as a limited number of studies to review, challenge the ability to form conclusions as to the effectiveness of rTMS.
To review institutional outcomes for patients treated with external-beam radiotherapy (EBRT) for orbital pseudotumor.
This is a single-institution retrospective review of 20 orbits in 16 patients ...diagnosed with orbital pseudotumor that received EBRT at the University of Oklahoma, Department of Radiation Oncology. Treated patients had a median follow-up of 16.5 months.
Fifteen patients (93.7%) were initially treated with corticosteroids. Eight had recurrence after steroid cessation, six were unable to taper corticosteroids completely or partially, and one experienced progression of symptoms despite corticosteroid therapy. Fourteen patients (87.5%) initially responded to radiotherapy indicated by clinical improvement of preradiation symptoms and/or tapering of corticosteroid dose. Mean EBRT dose was 20 Gy (range, 14-30 Gy). Thirteen patients (81.2%) continued to improve after radiation therapy. Patient outcomes were complete cessation of corticosteroid therapy in nine patients (56.3%) and reduced corticosteroid dose in four patients (25%). Radiotherapy did not achieve long-term control for three patients (18.7%), who still required preradiation corticosteroid dosages. Three patients received retreatment(s) of four orbits, of which two patients achieved long-term symptom control without corticosteroid dependence. One patient received retreatment to an orbit three times, achieving long-term control without corticosteroid dependence. No significant late effects have been observed in retreated patients.
Radiotherapy is an effective treatment for acute symptomatic improvement and long-term control of orbital pseudotumor. Orbital retreatment can be of clinical benefit, without apparent increase in morbidity, when initial irradiation fails to achieve complete response.
Abstract
Background:
Vaginal cancer is a rare malignancy that poses a challenge to treat and cure, as surgical excision requires life-changing procedures because of the proximity and involvement of ...rectum, bladder and anus. We report in this case study the successful delivery of stereotactic ablative radiotherapy (SABR) for a patient with vaginal cancer after previous radiotherapy.
Methods:
A 71-year-old white female who presented with dyspareunia and irritative urinary symptoms proven by biopsy was our candidate patient. Subsequent PET/CT revealed a hypermetabolic 3 cm lesion at the 12–1 o’clock position in the distal vagina involving the clitoris. The patient was initially treated with volumetric-modulated arc therapy (VMAT) with simultaneous integrated boost technique to the involved nodes, and later upon recurrence treated with SABR using 30 Gy in six fractions.
Findings:
To our knowledge, this is the first report of a vaginal cylinder used to physically distance organs at risk from the treatment target and also as a localising device with image guidance for the delivery of SABR using an external beam.
This article contends that, in their treatments of worker cooperatives, the predominant theories of the firm adhere to the logic of technological determinism, and can accordingly be evaluated using ...the ideas of Thorstein Veblen and Karl Marx. Invoking these patriarchs' respective distinctions between instrumental and ceremonial institutions and between the technical and social relations of production, the article argues that, contrary to contemporary theories of the firm, worker cooperatives possess an inherent but often latent advantage in implementing bureaucratic organizational structures, enjoying their instrumental/technical benefits for technology and coordination without incurring their ceremonial/social drawbacks for behavior and cooperation.
This paper argues that the predominant economic theories of the firm neglect the importance of cooperation based on trust and loyalty, and that as a result, their criticisms of worker cooperatives ...are incomplete. While competence-based theories tend to focus exclusively on coordination and thus fail to acknowledge that the development and application of productive knowledge also involves cooperation, contract-based theories cling to a rigid model of behaviour that does not account for the type of cooperation thus involved. Thus, although contract-based theories denigrate cooperatives for failing to achieve cooperation, cooperatives may in fact be more propitiously situated than conventional firms to achieve the cooperation involved in the development and application of productive knowledge. Meanwhile, although competence-based theories imply that cooperatives are incapable of achieving coordination, cooperatives may in fact be more propitiously situated than conventional firms to achieve coordination without incurring potentially adverse effects on cooperation. This ability, however, may be suppressed by a hostile institutional environment, which biases both the options available to individuals and the way they perceive those options against cooperatives. Although inter-cooperative associations can alleviate this institutional bias, they involve structural and cultural obstacles of their own.
Purpose
The economic theory of the firm apparently concurs with Niklas Luhmann’s theory of social systems with regard to the primary function of the firm to be complexity reduction, i.e. the ...alleviation of the cognitive burden on agents whose cognitive capacities are limited. At the same time, however, the theory of the firm ignores the attendant issues of societal sustainability emphasised by Luhmann. The paper aims to fill this gap.
Design/methodology/approach
Taking a theoretical approach, the paper builds on the conceptual construct of “the complexity-sustainability trade-off”, which combines two contrasting aspects of the relationship between a system and its environment, namely, the precariousness highlighted by Luhmann and the embeddedness highlighted by open systems theory. These themes are respectively reflected in the principles of complexity reduction and environmental dependence which constitute the trade-off.
Findings
Drawing inspiration from the classic Marshallian presentation of supply and demand in modern economics, the paper argues that the principles of complexity reduction and critical dependence translate into the demand for and supply of social systems. In the proposed systems-theoretic interpretation of the theory of the firm, demand and supply refer to the imperatives of achieving coordination and securing cooperation within the firm, respectively. Thus, in the theory of the firm, the complexity-sustainability trade-off manifests itself as a trade-off between coordination and cooperation.
Originality/value
The implicit focus of the theory of the firm on complexity reduction disregards the nature, importance and fragility of cooperation in real-world firms. In so doing, it impedes the authors’ understanding of unconventional types of business organisation, such as cooperatives. These defects can be corrected by reorienting the theory of the firm according to the proposed systems-theoretic approach, which holds that firms should not be governed or studied in isolation from their environment, as they too often are – and, accordingly, that apparently anomalous forms of organisation should be taken seriously, as they too often are not.
JCO
The purpose of this update was to determine differences in patient-reported chronic toxicity and disease outcomes with intensity-modulated radiation therapy (IMRT) compared with conventional ...pelvic radiation. Patients with cervical and endometrial cancers who received postoperative pelvic radiation were randomly assigned to conventional radiation therapy (CRT) or IMRT. Toxicity and quality of life were assessed using Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events, Expanded Prostate Cancer Index Composite (EPIC) bowel and urinary domains, and Functional Assessment of Cancer Therapy-General. Between 2012 and 2015, 279 eligible patients were enrolled to the study with a median follow-up of 37.8 months. There were no differences in overall survival (
= .53), disease-free survival (
= .21), or locoregional failure (
= .81). One year after RT, patients in the CRT arm experienced more high-level diarrhea frequency (5.8% IMRT
15.1% CRT,
= .042) and a greater number had to take antidiarrheal medication two or more times a day (1.2% IMRT
8.6% CRT,
= .036). At 3 years, women in the CRT arm reported a decline in urinary function, whereas the IMRT arm continued to improve (mean change in EPIC urinary score = 0.5, standard deviation = 13.0, IMRT
-6.0, standard deviation = 14.3, CRT,
= .005). In conclusion, IMRT reduces patient-reported chronic GI and urinary toxicity with no difference in treatment efficacy at 3 years.
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