Successful management of lymphangiomatosis and chylothorax in a 7-month-old infant

A 7-month old infant presented with an effusion and multiple lesions in his spleen. A diagnosis of lymphangiomatosis was made based on chylous effusion and an MRI demonstrating numerous enhancing lesions within the spleen on T2-weighed images. Conservative measures, including the withdrawal of feeds and octreotide, did not significantly reduce the rate of chyle production and increasing requirement for respiratory support. Resection of the patient's spleen and partial pleurectomy were associated with a dramatic improvement in his condition. At 27 months the patient was well with no evidence of further lymphangiomas or a recurrence of his chylothoraces.

Successful mental health aging: Results from a longitudinal study of older Australian men

Objective: The authors investigated the associations of medical and lifestyle factors with the mental health of men in their 80s. Methods: This was a prospective study of a community-representative cohort of older men. Successful mental health aging was defined as reaching age 80 years with Mini-Mental State Examination score (MMSE) of 24 or more and Geriatric Depression Scale-15 items (GDS-15) score of 5 or less. Results: Of 601 men followed for 4.8 years, 76.0% enjoyed successful mental health aging. Successful mental health aging was inversely associated with age (hazard ratio [HR] = 0.87; 95% confidence interval [CI]: 0.81 - 0.94), non-English-speaking background (HR = 0.42; 95% CI: 0.21 - 0.85), and the consumption of full-cream milk (HR = 0.63; 95% CI: 0.45 - 0.89), and directly associated with high school or university education (HR = 1.92; 95% CI: 1.34 - 2.75) and vigorous (HR = 1.89; 95% CI: 1.17 - 3.05) and nonvigorous physical activity (HR = 1.50; 95% CI: 1.05 - 2.14). Marital status, smoking and alcohol use, weekly consumption of meat or fish, and a medical history of hypercholesterolemia, hypertension, diabetes, myocardial infarction, and stroke were not associated with mental health outcomes in men aged 80 years or over. Conclusion: Three in four men who reach age 80 years undergo successful mental health aging. Factors associated with successful mental health aging include education and lifestyle behaviors such as physical activity. Lifestyle modification by means of increasing physical activity and reducing saturated fat intake may prove to be a safe, inexpensive, and readily available strategy to help maximize the successful mental health aging of the population.

Teaching medical students using role play: Twelve tips for successful role plays

Engaging students in role play promotes active learning. Planned and structured role plays can be used to deliver components of the curriculum in clinical rotations of a medical programme. Role plays are most effective if learning objectives are defined, and the cases are challenging. All students should be involved and ground rules should be set. Allow adequate time for the role play, feedback and reflection. Let the students enjoy themselves. This paper provides 12 tips to create a meaningful learning experience for students using role play.

Successful use of recombinant factor VII in massive hemoptysis due to community-acquired pneumonia

Recombinant activated factor VII (rFVIIa) is a powerful hemostatic agent developed for use in hemophilia. It has been used increasingly in life-threatening hemorrhage in a variety of other settings in which conventional medical or surgical therapy is unsuccessful. This report describes the successful use of rFVIIa for pulmonary hemorrhage due to a focal bleeding source in a regional hospital where bronchial artery embolization or surgery were not available. rFVIIa may be a useful temporizing measure in the unstable patient with pulmonary hemorrhage without coagulopathic bleeding when conventional treatment. is not immediately available.

Perspectives on quality of life by people with aphasia and their family: Suggestions for successful living

Understanding the client's perspective is essential for good practitioner care in rehabilitation after stroke, and nothing is more relevant than enquiring directly about our clients' quality of life to inform our management. Relatively little is known about how older people with aphasia consider the quality of their current lives, and this article seeks to explore this issue. Four women's accounts of their life quality are presented, as well as their husbands' or daughter's accounts of their lives. Their stories share some common elements. Who you love or share your life with; where you live; feeling independent and/or in control; and engaging in satisfying activities mattered to these women's life quality. The impact of aphasia varies across the cases, and the need to accept change for successful living is illustrated in all accounts.

Successful treatment of post-influenza pseudomembranous necrotising bronchial aspergillosis with liposomal amphotericin, inhaled amphotericin B, gamma interferon and GM-CSF

A case of aspergillus tracheobronchitis following influenza A infection in an immunocompetent 35 year old woman is described that required prolonged mechanical ventilation for airways obstruction. Treatment included liposomal amphotericin, inhaled amphotericin, gamma interferon and GM-CSF. Liposomal amphotericin therapy was associated with reversible hepatosplenomegaly. Inhaled corticosteroids with continued antifungal therapy were used for the management of severe recurrent airway obstruction. After a prolonged course of treatment she survived with fixed airways obstruction unresponsive to corticosteroids.

The role of management incentives in successful information systems development and implementation

Because organizations are making large investments in Information systems (IS), efficient IS project management has been found critical to success. This study examines how the use of incentives can improve the project success. Agency theory is used to: identify motivational factors of project success, help the IS owners to understand to what extent management incentives can improve IS development and implementation (ISD/I). The outcomes will help practitioners and researchers to build on theoretical model of project management elements which lead to project success. Given the principal-agent nature of most significant scale of IS development, insights that will allow for greater alignment of the agent’s goals with those of the principal through incentive contracts, will serve to make ISD/I both more efficient and more effective, leading to more successful IS projects.

Successful artificial insemination (AI) in the koala using neat and extended semen collected by electroejaculation (EE)

Presently AI in the koala has been based on the insemination of fresh undiluted semen collected with an artificial vagina (1). While this approach has been extremely successful, further refinement and implementation of AI for use with cryopreserved semen will require protocols that incorporate diluted semen collected by EE. Recent studies have shown that koala semen is likely to have an "ovulation factor" such that over-dilution may result in ovulation failure (2). The current study determined whether AI of EEed neat and/or diluted semen was capable of inducing a luteal phase and/or resulted in the production of pouch young. All koalas were inseminated in the breeding season between day 2 and 5 of oestrus and subsequently monitored for evidence of parturition (day 35) and return of oestrus. Successful induction of a luteal phase was based on evidence of an elevated progesterone concentration 28 days after insemination (2). All semen samples were collected by EE and seminal characteristics recorded (3). The diluent used for semen extension was Tris-citrate glucose (TCG) which contained antibiotics but no egg yolk (4). AI was conducted on conscious koalas using a "Cook koala insemination catheter" and a glass rod used to mimic penile thrusting (1). Three insemination treatments were used; (A) 1mL of undiluted semen (n = 9); (B) 2mL of 1:1 diluted semen (n = 9); and (C) 1 mL of 1:1 diluted semen (n = 9). The results of the AI trial are shown in Table 1. This study has shown that it is possible to use both neat and diluted semen (1:1; 1 or 2 mL) to successfully produce koala offspring at conception rates similar to those achieved following natural mating. Interestingly, dilution of semen had no apparent detrimental effect on induction of a luteal phase following AI.

Pattern-based reuse of successful designs: usability ofsafety-critical systems

Users of safety-critical systems are expected to effectively control or monitor complex systems, with errors potentially leading to catastrophe. For such systems, safety is of paramount importance and must be designed into the human-machine interface. While many case studies show how inadequate design practice led to poor safety and usability, concrete guidance on good design practices is scarce. The paper argues that the pattern language paradigm, widely used in the software design community, is a suitable means of documenting appropriate design strategies. We discuss how typical usability-related properties (e.g., flexibility) need some adjustment to be used for assessing safety-critical systems, and document a pattern language, based on corresponding "safety-usability" principles