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.

The management of interdependence and the sharing of vision by micro-finance agencies for new and emerging SMEs

The purpose of this paper is to conceptualise a theoretical model that clarifies the variations in both processes for sharing vision and interdependence of the lender and the SME owner in micro-finance. Processes for sharing vision and interdependence are possible predictors of the effective tacit and explicit knowledge generation/utilization of a micro-finance agency – SME owner relationship. For new and emerging SMEs the micro-finance agency can provide a critical role in their development. Micro-finance agencies can provide a mechanism in economic development that enables SMEs to have greater speed to markets. The focus of this paper is on the relationship between the micro-finance lending officer and the SME owner. Specifically, the model developed in this paper informs understanding the nature of knowledge generation/utilization between micro-finance agencies and SMEs. Effective generation/utilization facilitates the assessment of the risk for investment. The model clarifies the variations between interdependence and the development of processes for sharing of vision. When you have high interdependence (characterised by good cooperation) and effective processes for sharing of vision, an environment of effective knowledge generation/utilization is likely to be created between the micro-finance agency and the SME owner. The model proposes that the effective management of both tacit and explicit knowledge between the micro-finance agency and SMEs supports them to reach their markets. Implications of this research for SMEs and micro-finance agencies include the increase of knowledge and understanding of SME processes.

OHS in the nursing workplace: accountability and the management of stress

There has been growing interest in occupational stress in the nursing context, both in New Zealand and internationally. This article takes a critical approach to the literature on nursing stress by examining the implications of a body of research largely informed by a theoretical approach which highlights the individual. In spite of evidence that the main sources of stress for nurses are related to workplace conditions, the focus is on the individual nurse and his/her personal response to stress. This approach encourages the development of interventions where the objectives are the individual management of stress, and thereby consolidates nurses' perceptions of powerlessness. Alternatives to these palliative measures, such as highlighting the legal obligations for employers to provide a safe workplace or collective industrial action for change, are glaringly absent in the literature. The importance of such an approach is supported by recent findings from the United States on the advantages of hospitals which promote nurses' autonomy and control.

The design and implementation of a repository for the management of spatial data integrity constraints

This paper reviews the key features of an environment to support domain users in spatial information system (SIS) development. It presents a full design and prototype implementation of a repository system for the storage and management of metadata, focusing on a subset of spatial data integrity constraint classes. The system is designed to support spatial system development and customization by users within the domain that the system will operate.

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.

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.

Operation of polymer electrolyte membrane fuel cells with dry feeds: Design and operating strategies

The operation of polymer electrolyte membrane fuel cells (PEMFCs) with dry feeds has been examined with different fuel cell flow channel designs as functions of pressure, temperature and flow rate. Auto-humidified (or self-humidifying) PEMFC operation is improved at higher pressures and low gas velocities where axial dispersion enhances back-mixing of the product water with the dry feed. We demonstrate auto-humidified operation of the channel-less, self-draining fuel cell, based on a stirred tank reactor; data is presented showing auto-humidified operation from 25 to 115 degrees C at 1 and 3 atm. Design and operating requirements are derived for the auto-humidified operation of the channel-less, self-draining fuel cell. The auto-humidified self-draining fuel cell outperforms a fully humidified serpentine flow channel fuel cell at high current densities. The new design offers substantial benefits for simplicity of operation and control including: the ability to self-drain reducing flooding, the ability to uniformly disperse water removing current gradients and the ability to operate on dry feeds eliminating the need for humidifiers. Additionally, the design lends itself well to a modular design concept. (c) 2005 Elsevier B.V. All rights reserved.