In some instances, an employer's refusal to modify a workplace policy, such as a leave or attendance policy, could constitute disparate treatment as well as a failure to provide a reasonable accommodation. For example, an employer may have a policy requiring employees to notify supervisors before 9:00 a.m. if they are unable to report to work. If an employer would excuse an employee from complying with this policy because of emergency hospitalization due to a car accident, then the employer must do the same thing when the emergency hospitalization is due to a disability.(74)
The Shirk Report Volume 504
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However, there is a relatively small volume of research contained in the overlap between decision-making, supply chains and ethics, plus CSR, plus sustainability; and there is a clear link between ethics, CSR and sustainability, so these are treated as analogous here. This helps create an interdisciplinary frame of reference regarding decision-making that is missing from reviews such as Seuring (2013), and a broader more holistic frame regarding sustainability that is missing from OR papers that address only a single environmental metric, such as carbon emissions, alongside conventional economic optimisation. Ethical decision-making has its own set of distinct associations and a rich discourse independent of DT, notably in marketing, psychology, corporate governance and leadership studies. However, this is also excluded from the scope of this study.
Massive ovarian edema is a rare gynecological entityresembling a solid ovarian tumor due to the accumulation ofedematous fluid within the ovarian stroma, first described byKalstone et al in 1969(1) anddefined by the World Health Organization as an accumulation ofedematous fluid within the ovarian stroma separating normalfollicular structures. Massive edema of the ovary is a rarecondition affecting mainly young women (mean age, 20 years);however, premenarcheal (2) ormenopausal women (3) have beenreported to be affected as well. Massive ovarian edema ischaracterized by a build-up of interstitial fluid withoutneoplastic changes, and it is mainly considered to be theconsequence of torsion of the ovary, despite the fact that thereare several reported cases without torsion observed during surgery(4-7).However, this condition can be easily mistaken for a neoplasm,resulting in overtreatment by the removal of the whole affectedovary. Conservative treatment is recommended for this entity,particularly when preservation of fertility is important.Therefore, the accuracy of preoperative diagnosis should beimproved by taking massive ovarian edema into consideration whensolid enlargement of the ovary is detected.
There are two types of massive ovarian edema,depending on the presence or absence of concomitant pathologicalfindings predisposing to the partial torsion of the mesovarium.Primary massive ovarian edema is an entity without a concomitantpathology, whereas secondary massive ovarian edema is an entitysuperimposed on already diseased ovaries (16). The most favored hypothesis for theetiology is obstructed venous and lymphatic circulation, but notarterial blood flow, due to the complete or partial torsion of theovary, leading to the development of a massive ovarian edema(13). As a result, stromal cellluteinization is induced, due to the response of the edematousovary to torsion and subsequent ischemia, which causes hormoneproduction (17). There are estrogenand progesterone receptors in stromal cells, and mechanicalstimulation due to stretching of the stroma by the edematous fluidmay lead to hormone-related symptoms (13,14,18).Another explanation for the hormone-related changes is thederegulated expression of a local paracrine factor, such asepidermal growth factor, insulin-like growth factor or cytokines(18). Secondary massive ovarianedema occurs in diseased ovaries, such as those with an ovarianmass or cyst-like ovarian capillary hemangioma (19), serous and mucinous cyst adenomas(6), mature cystic teratoma(20), ovarian fibrothecoma(21), polycystic ovary syndrome(22) and Meigs syndrome (23), and may also occur as a consequence ofdrug treatment for ovulation induction (24) and in some malignancies (25,26).Malignancies reported to cause ovarian lymphatic vessel obstructionby metastatic carcinoma cells include gastric carcinoma (26), uterine cervical cancer (25) and lymphangitis carcinomatosa(27).
Although there are no diagnostic imaging criteria,ultrasonography and MRI have been reported to be the most usefulmodalities for diagnosing this entity. Umesaki et al(28) reported that a solid ovariantumor with multiple peripheral ovarian follicles onultrasonographic examination may indicate a possible preoperativediagnosis of massive ovarian edema. Furthermore, another report byUmesaki et al (29) using MRIdemonstrated that the main indicator of massive ovarian edema is anenlarged ovary with edematous stroma exhibiting high intensity onT2-weighted images, with multiple ovarian follicles pressed towardsthe peripheral cortical area of the ovary by the edematous fluidaccumulated within the ovarian stroma. Similarly, Hall et al(30) also reported that thepresence of multiple ovarian follicles situated around theperiphery of the cortex of the enlarged ovary on MRI is a crucialsign that indicates massive ovarian edema. Therefore, the findingof multiple ovarian follicles located at the peripheral cortex ofan enlarged ovary is considered to be a crucial diagnostic evidenceof massive ovarian edema.
Histologically, the ovarian architecture ispreserved, but with an edematous and hypocellular ovarian stroma,and a thickened and fibrotic outer cortex. In cases with endocrinesymptoms, a cluster of luteinized stromal cells is occasionallyobserved (31). There is diffuseedema confined to the medullary stroma and the spared cortex. Smallsubcortical follicular cysts, and uniformly dilated blood andlymphatic vessels are observed (15). Necrosis and hemorrhage are unusual,as the torsion commonly causes venous and lymphatic obstruction,but not arterial occlusion (31).Focal stromal luteinization has been noted in some of the studiedcases, and it is considered to be a mechanical stimulation ofproliferation and luteinization of stromal cells induced bystretching of the stroma due to lymphedema (14). Nogales et al (15) reported no histopathological evidenceof a proliferative process, such as fibromatosis, and concludedthat massive edema of the ovary is a reactive, non-proliferativestate of specific stromal cells due to torsion of the ovary.
The rather bulky, but surprisingly lightweight (for its size and power) M-508 is a true dual-mono design, consisting essentially of two completely separate amplifiers on a single chassis. That it is not designed for outstandingly high current capability is evident both from the modest size of its power transformer and the gauge of its AC cord. The M-508, however, does feature Onkyo's \"Real-Phase\" power supply, where a series transformer between the rectifier bridge and the reservoir capacitors couples the positive charging currents to the negative, improving the rejection of common-mode power-supply noise. Incidentally, the 0.003% distortion rating at \"rated output\" is questionable. \"Rated output\" is supposed to be that point where an amp starts to go into overload; 0.003% is obviously nowhere near overload. Either the THD figure is too low, or the amp overloads above 200W.The M-508 is an impressive-looking piece of hardware, with good, clean metalwork finished in flat black on all sides, and two unusually large (6!9 wide), black front-panel meters. Their calibrations and indicator needles are edge-lit in what might be described as rain-forest green, making for quite a sexy appearance. The meters are described as \"high-speed\" types, and are optimistically calibrated up to 500W and +4dB—the latter relative to a 200W 0dB level.The amp has two sets of inputs, marked Direct and Variable, the latter feeding through a pair of small input-level knobs on the front. Four pushbuttons select Normal or +10dB meter sensitivity, or turn the meters on and off. In the +10 position, meter sensitivity is increased 10 times, so you can still get meaningful readings at reduced volume levels. Another switch selects the Direct or Variable inputs, and can be used to select either of two sets of permanent input connections. This means that, for instance, you could leave your CD player plugged into the power amp, and select it with the push of a button, using either its own or the M-508's level controls for volume adjustment.There are also two sets of loudspeaker connections, and two more front-panel buttons select either or both sets of speakers. One depressed speaker button does not, however, automatically pop out if you press the other, which means it is easy to shut off both speakers at once. As there is no headphone output on the amp, I cannot see the advantage of being able to kill both sets of speakers, but I can see it causing some consternation when a user accidentally punches the one button that is already on, and is suddenly faced with a Dead System. (Even the meters are deactivated when both speakers are Off.)Although the power-supply rails are internally fused, there is no loudspeaker overload fusing; fast-acting, long-holding relays in the speaker output lines are claimed by Onkyo to provide all the speaker protection necessary. They're probably right with regard to woofer overload, but I do not believe any relay is capable of responding fast enough to protect a typical tweeter from a hard clipping overload (footnote 1). A tweeter with plenty of thermal inertia (as from ferrofluid damping) would probably be OK, but something like a ribbon could vaporize before the relay opened up. The saving grace here is that the amplifier has enough power and headroom (claimed to be 265W for up to 200ms) that HF overload due to clipping—the usual ca