The surgical management of consecutive exotropia

Purpose: To review the results and techniques of surgical treatment of consecutive exotropia. Methods: We performed a retrospective chart review of all patients who underwent surgery for consecutive exotropia in a pediatric ophthalmology practice between 1992 and 2001. Patients were excluded if follow-up lasted < 6 weeks or if exotropia was caused by other ocular disorders such as previous trauma or congenital cataracts. Results: Fifty-nine patients were identified. The procedure performed in the majority of cases was unilateral lateral rectus recession and medial rectus advancement to the original insertion. Seven patients underwent bilateral lateral rectus recession, and 6 underwent lateral rectus recession combined with medial rectus resection. The mean interval between original surgery and surgery for consecutive exotropia was 14.1 years (range 4 months to 47.5 years). The mean preoperative distance exodeviation was 31.7 prism diopters (PD). Satisfactory alignment lie, within 10 PD of orthophoria) was achieved in 36 patients (61%) at week 1 and 42 patients (71%) at final follow-up. Mean follow up was 16.0 months. Thirty-nine patients (66%) demonstrated an exodrift after surgery (mean 7.6 PD). Conclusion: Consecutive exotropia may occur many years, even decades, after esotropia surgery. Lateral rectus recession with advancement of the previously recessed medial rectus is an effective treatment. An exotropic drift occurs after consecutive exotropia surgery, usually within the first 6 weeks. A suitable ocular alignment immediately after surgery for consecutive exotropia is a small-angle esotropia of 5 to 10 PD.

Growth performance and management of a mixed rainforest tree plantation

Monoculture plantations of Pinus, Eucalyptus and Acacia have been established oil rainforest lands throughout the world. However, this type of reforestation generally supplies low quality timber and contributes to landscape simplification. Alternatives to exotic monoculture plantations are now beginning to gain momentum with farmers and landholders attempting to establish a variety of rainforest trees in small plantations. When compared to the well studied commercial species, knowledge concerning the growth and management of many of these rainforest species is in its infancy. To help expand this limited knowledge base an experimental plantation of 16 rainforest tree species in a randomised design was established near Mt. Mee, in south-eastern Queensland, Australia. Changes in growth, form (based on stem straightness, branch size and branchiness), crown diameters and leaf area of each species were examined over 5 years. Patterns of height growth were also measured monthly for 31 months. Species in this trial could be separated into three groups based on their overall growth after 5 years and their growth patterns. Early successional status, low timber density, high maximum photosynthetic rates and large total leaf areas were generally correlated to rapid height growth. Several species (including Araucaria cunninghamii, Elaeocarpus grandis, Flindersia brayleyana, Grevillea robusta and Khaya nyasica) had above average form and growth, while all species in the trial had considerable potential to have increased productivity through tree selection. As canopy closure occurred at the site between years four and five, growth increments declined. To reduce stand competition a number of different thinning techniques could be employed. However, simple geometric or productivity based thinnings appear to be inappropriate management techniques for this mixed species stand as they would either remove many of the best performing trees or nearly half the species in the trial. Alternatively, a form based thinning would maintain the site's diversity, increase the average form of the plantation and provide some productivity benefits.

Sustainable Management of the Great Artesian Basin: An Analysis Based on Law and Environmental Economics

Current policy issues surrounding management of the Great Artesian Basin - historical development of existing legislation and institutions - hydrological and historical background information - development of concerns over unsustainable use of resources and possible adverse environmental impacts - recent developments associated with the general reforms to water law and policy initiated by the Council of Australian Governments (COAG) - comparison of issues surrounding the Murray-Darling Basin and the Great Artesian Basin.

A framework of lessons learned from community-based marine reserves and its effectiveness in guiding a new coastal management initiative in the Philippines

Community-based coastal resource management has been widely applied within the Philippines. However, small-scale community-based reserves are often inefficient owing to management inadequacies arising because of a lack of local support or enforcement or poor design. Because there are many potential pitfalls during the establishment of even small community-based reserves, it is important for coastal managers, communities, and facilitating institutions to have access to a summary of the key factors for success. Reviewing relevant literature, we present a framework of lessons learned during the establishment of protected areas, mainly in the Philippines. The framework contains summary guidance on the importance of (1) an island location, (2) small community population size, (3) minimal effect of land-based development, (4) application of a bottom-up approach, (5) an external facilitating institution, (6) acquisition of title, (7) use of a scientific information database, (8) stakeholder involvement, (9) the establishment of legislation, (10) community empowerment, (11) alternative livelihood schemes, (12) surveillance, (13) tangible management results, (14) continued involvement of external groups after reserve establishment, and (15) small-scale project expansion. These framework components guided the establishment of a community-based protected area at Danjugan Island, Negros Occidental, Philippines. This case study showed that the framework was a useful guide that led to establishing and implementing a community-based marine reserve. Evaluation of the reserve using standard criteria developed for the Philippines shows that the Danjugan Island protected area can be considered successful and sustainable. At Danjugan Island, all of the lessons synthesized in the framework were important and should be considered elsewhere, even for relatively small projects. As shown in previous projects in the Philippines, local involvement and stewardship of the protected area appeared particularly important for its successful implementation. The involvement of external organizations also seemed to have a key role in the success of the Danjugan Island project by guiding local decision-makers in the sociobiological principles of establishing protected areas. However, the relative importance of each component of the framework will vary between coastal management initiatives both within the Philippines and across the wider Asian region.

Mapping and characterising subtropical estuarine landscapes using aerial photography and GIS for potential application in wildlife conservation and management

Coarse-resolution thematic maps derived from remotely sensed data and implemented in GIS play an important role in coastal and marine conservation, research and management. Here, we describe an approach for fine-resolution mapping of land-cover types using aerial photography and ancillary GIs and ground data in a large (100 x 35 km) subtropical estuarine system (Moreton Bay, Queensland, Australia). We have developed and implemented a classification scheme representing 24 coastal (subtidal, intertidal. mangrove, supratidal and terrestrial) cover types relevant to the ecology of estuarine animals, nekton and shorebirds. The accuracy of classifications of the intertidal and subtidal cover types, as indicated by the agreement between the mapped (predicted) and reference (ground) data, was 77-88%, depending on the zone and level of generalization required. The variability and spatial distribution of habitat mosaics (landscape types) across the mapped environment were assessed using K-means clustering and validated with Classification and Regression Tree models. Seven broad landscape types could be distinguished and ways of incorporating the information on landscape composition into site-specific conservation and field research are discussed. This research illustrates the importance and potential applications of fine-resolution mapping for conservation and management of estuarine habitats and their terrestrial and aquatic wildlife. (c) 2005 Elsevier Ltd. All rights reserved.

Idiopathic necrotizing dermatitis: Current management

Objectives: To identify and demonstrate necrotizing dermatitis in infancy; an uncommon, puzzling syndrome, in which anecdotal reporting and personal experience indicates that one third of cases may require skin grafting. Much informed discussion about the pathogenesis of this distressing syndrome centres on the role of spider envenomation; and in particular on the speculative role of the Australian White-tailed spider, Lampona cylindrata. Methods: We present here six cases of necrotizing dermatitis treated surgically at the Royal Children's Hospital and Mater Children's Hospital in Brisbane over the period from 1991 to 1999. Clinical history, surgical details and pathological investigations were reviewed in each case. Microbiological investigation of necrotic ulcers included standard aerobic and anaerobic culture. Result: Nocardia and Staphylococcus were cultured in two cases, but no positive bites were witnessed and no spiders were identified by either the children or their parents. All cases were treated with silver sulphadiazine creme. Two of the infants required general anaesthesia, excision debridement and split skin grafting. The White-tailed spider, Lampona cylindrata, does not occur in Queensland, but Lampona murina does; neither species has necrotizing components in its venom. Circumstantial evidence is consistent with this syndrome being due to invertebrate envenomation, possibly following arachnid bites. Conclusion: In our experience there is insufficient evidence to impute a specific genus as the cause, at this stage of scientific knowledge. If the offending creature is a spider, we calculate that the syndrome of necrotizing dermatitis occurs in less than 1 in 5000 spider bites.

Consensus statement on the management of the GH-treated adolescent in the transition to adult care

The European Society for Paediatric Endocrinology held a consensus workshop in Manchester, UK in December 2003 to discuss issues relating to the care of GH-treated patients in the transition from paediatric to adult life. Clinicians experienced in the care of paediatric and adult patients on GH treatment, from a wide range of countries, as well as medical representatives from the pharmaceutical manufacturers of GH participated.

Factors affecting student attitudes toward flexible online learning in management education

In response to recent technological advances and the trend toward flexible learning in education, the authors examined the factors affecting student satisfaction with flexible online learning. The authors identified 2 key student attributes of student satisfaction: (a) positive perceptions of technology in terms of ease of access and use of online flexible learning material and (b) autonomous and innovative learning styles. The authors derived measures of perceptions of technology from research on the Technology Acceptance Model and used locus of control and innovative attitude as indicators of an autonomous and innovative learning mode. First-year students undertaking an introductory management course completed surveys at the beginning (n = 248) and at the end (n = 256) of course work. The authors analyzed the data by using structural equation modeling. Results suggest that student satisfaction is influenced by positive perceptions toward technology and an autonomous learning mode.

The use of cusum analysis in the early detection and management of hospital bed occupancy crises

Objective: To assess the value of cusum analysis in hospital bed management. Design: Comparative analysis of medical patient flows, bed occupancy, and emergency department admission rates and access block over 2 years. Setting: Internal Medicine Services and Emergency Department in a teaching hospital. Interventions: Improvements in bed use and changes in the level of available beds. Main outcome measures: Average length of stay; percentage occupancy of available beds; number of patients waiting more than 8 hours for admission (access block); number of medical patients occupying beds in non-medical wards; and number of elective surgical admissions. Results: Cusum analysis provided a simple means of revealing important trends in patient flows that were not obvious in conventional time-series data. This prompted improvements in bed use that resulted in a decrease of 9500 occupied bed-days over a year. Unfortunately and unexpectedly, after some initial improvement, the levels of access block, medical ward congestion and elective surgical admissions all then deteriorated significantly. This was probably caused by excessive bed closures in response to the initial improvement in bed use. Conclusion: Cusum analysis is a useful technique for the early detection of significant changes in patient flows and bed use, and in determining the appropriate number of beds required for a given rate of patient flow.

Positioning terrorism in management and marketing: Research propositions

Terrorism poses both direct and indirect threats to the operations of the firm. It represents a market imperfection that increases transaction costs and creates barriers to the free flow of goods, affecting potential gains that would occur in the presence of unhindered exchange. Terrorism reflects the risk or actual encounter of violent acts, whose goal is to engender fear, coercion, or intimidation. We investigate terrorism and its association with marketing strategy and operations. Key concepts on terrorism are reviewed and a collection of propositions is offered. We highlight the pivotal roles of sourcing, production, distribution, pricing, communications, and general business strategy as functions influenced by, or capable of influencing, terrorism. Lastly, we offer managerial implications, as well as directions and guidelines for future research.