Assessing development and climate variability impacts on water resources in the Zambezi River basin: Initial model calibration, uncertainty issues and performance.

STUDY REGION: : The Zambezi River basin, one of the most important water resources in sub-Saharan Africa from both a water supply and hydro-power generation perspective. STUDY FOCUS: : Calibration of two hydrological models (Pitman and WEAP) that have been established for 76 sub-basins covering the total basin area of about 1 350 000 km2. The longer-term purpose of establishing the models is to facilitate scenario analyses of future conditions related to changes in water use and management as well as climate change. NEW HYDROLOGICAL INSIGHTS FOR THE REGION: : While there are many (inevitable) uncertainties in the data used, as well as the models and calibrated parameter sets themselves, the results suggest that the models are generally fit for purpose in terms of evaluating future changes. There are, however, some parts of the basin where the reduction of identified uncertainties would lead to improved models and greater confidence in their future use. One of sources of uncertainty relates to the existence of several large wetland areas that have impacts on downstream flows, but are difficult to simulate due to the relatively poor existing understanding of the dynamics of water exchange between the river channels and the wetland storage areas.

[Tumors in the gallbladder: a possible differentiation between malignant and benign tumours]. / Tumoren in de galblaas; een moeilijke differentiatie tussen maligniteit en goedaardige tumor.

In a 59-year-old woman with pain in the right upper abdomen, echography and CT-scan revealed adenomatosis of the gallbladder. Her symptoms did not disappear after cholecystectomy, even though echography showed no further abnormality. In a 46-year-old man with fever and weight loss, echography revealed two polyps in the gallbladder. Following cholecystectomy, histopathology revealed cholesterol polyps and an infection with Entamoeba coli. In a 63-year-old man with systemic symptoms, a biopsy of the echographically diagnosed tumour of the gallbladder revealed that he had actually had cholecystitis. The management was wait-and-see and the patient recovered completely. In a 68-year-old woman with jaundice and attacks of abdominal pain, a CT-scan revealed gallstones. The symptoms recurred following an ERCP. Following cholecystectomy, an adenocarcinoma of the gallbladder was found. One year later, a contact metastasis developed forwhich she received radiotherapy. After 4 years she was in good condition. Patients with a tumour in the gallbladder are often diagnosed with gallbladder cancer, which has a poor prognosis. Other diseases should also be considered, since the treatment and prognosis differ greatly. It is important to differentiate at an early stage. Ultrasound, CT and MRI have improved the possibility of differentiating and choosing the correct treatment.

Twenty-five years' experience with the arterial switch operation.

OBJECTIVE: The arterial switch operation was introduced in 1976 to correct transposition of the great arteries and has since replaced atrial palliation. This study examines the long-term outcomes of the arterial switch operation. METHODS: Included in the study were 195 patients who underwent the arterial switch operation from 1977 through June 2000. Patients were evaluated for functional class, pulmonary stenosis, left ventricular function, arrhythmias, aortic sequelae, and coronary disease. RESULTS: Overall perioperative mortality was 15%, but rates dropped in the last 5 years to 4% for complex transposition and 0% for simple transposition. Of 151 survivors, 2 died late; 1 died of persisting pulmonary hypertension and 1 died of ventricular fibrillation after coronary pathologic changes. At last follow-up, a total of 145 patients were in New York Heart Association functional class I and 4 patients were in class II. The most frequent complication was pulmonary stenosis, necessitating 45 reinterventions in 26 patients. Left ventricular dysfunction was noted in 5 patients. Arrhythmias were seen in 5 patients: 2 patients had ventricular fibrillation (1 died and 1 required a defibrillator implantation), 1 had sick sinus syndrome, 1 had atrial flutter, and 1 had a single attack of supraventricular tachycardia. Aortic valve incompetence was absent or trivial in 146 patients, 3 had mild incompetence, 1 had moderate incompetence, and 1 had severe incompetence. Coronary sequelae were found in 5 of the 61 patients who underwent angiography. CONCLUSION: Long-term clinical outcome of the arterial switch operation is good, and perioperative mortality is now low. Morbidity is dominated by pulmonary stenosis and coronary artery disease, with the potential for lethal arrhythmias.

A comparison of the practices used for distribution of controlled substances in Massachusetts hospitals with those reported nationally.

A survey questionnaire concerning the procedures used to distribute controlled substances was mailed to 100 randomly selected Massachusetts hospital pharmacies. The tabulated results were compared to a similar study surveying 285 short-term medical and surgical hospitals nationwide. Of the 58 responding hospitals, 47 (81%) reported controlling either all or some Schedule III Controlled Substances in a manner similar to that used for the distribution and accountability of Schedule II drugs. A total of 42 (72%) reported maintaining the same systems for Schedule IV agents. In contrast, only 24 (42%) of those respondents reported controlling Schedule V drugs in a manner similar to Schedule II Controlled Substances. Similar to the findings of a nationwide study, many of the responding Massachusetts hospitals reported selective inclusion of those Schedule III, IV, and V drugs possessing an increased risk of illicit diversion into a more controlled distribution system. In conclusion, many Massachusetts hospitals distribute and account for controlled substances in a manner similar to that used nationwide.

Physical examinations in psychiatric practice in Ohio.

In 1974 members of the Ohio Psychiatric Association were surveyed to determine the extent to which psychiatrists performed physical examinations and their attitudes toward conducting such examinations. Responses from 222 psychiatrists showed that most believed psychiatric patients should have a physical examination, but that it should be conducted by a physician other than a psychiatrist. Those who felt more confident in their diagnostic skills tended to perform examinations more frequently than psychiatrists who were unsure of their skills. Regardless of whether they performed examinations, the respondents were almost universal in the belief that their medical training and experience added an important dimension to their skills.