Individuals with spinal cord injury (SCI) have altered neurophysiology and present with symptoms that must be interpreted in the context of their specific neurologic injury. This is a case of a 16‐year‐old female adolescent with C5 American Spinal Injury Association Impairment Scale A SCI who presented with intractable nausea. Multiple etiologies for her nausea, including medication effect, metabolic and gastrointestinal disorders, autonomic dysreflexia, and mood disorder, were systematically ruled out. Due to the persistence of the patient's symptoms and suboptimal progression in her rehabilitation, a central nervous system etiology was investigated. Ultimately, atlantoaxial instability with odontoid compression on the medulla was identified and her refractory nausea resolved following an occiput to C2 fusion. To our knowledge, this is the first reported case of atlantoaxial instability causing intractable nausea due to brain stem compression in a patient with SCI.
Level of Evidence: V
PurposeMultinational enterprises (MNEs) face twin pressures of maintaining a globally integrated brand while remaining responsive to local demands. Previous research has shown that misunderstandings may surface from the way subsidiary employees read corporate messages, particularly if institutional and social distances between corporate headquarters (HQs) and subsidiaries are wide. Employer branding is sometimes used to help resolve such tensions if HQs are sensitive to signals from their subsidiaries in the policy development process. Thus, this paper addresses the question: to what extent does institutional proximity facilitates the creation and maintenance of socially legitimate employer brands in MNE subsidiaries.Design/methodology/approachThe paper uses an interpretive approach in analysing two cases of multinational subsidiaries operating in Pakistan but with divergent HQ institutional distances (Northern Europe and Middle East). A qualitative approach to data collection was taken and ten semi-structured interviews with senior and middle managers and two focus groups of six lower level employees in each case organization were conducted.FindingsThe findings suggest that institutional proximity played a secondary role in establishing a legitimate employer brand whereas a receptive and responsive signalling process was of greater importance. The authenticity of the employer brand was stronger in the organization that was more receptive to the incoming signals from local employees compared to the firm that was rather institutionally closer due to shared customs and culture.Practical implicationsFindings point to the significance of the character and intensity of the employment relationship at a micro level as the honesty and credibility of organizational messages and interpreted and re-interpreted at a localized level, thereby bearing serious implications for both global and local managers.Originality/valueThese findings contribute to the IHRM literature on the integration-responsiveness problem, to the debate over institutional proximity, and to the influence of religion on people management.
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