Enabling sustainable urban water management through governance experimentation.

A shift towards sustainable urban water management is widely advocated but poorly understood. There is a growing body of literature claiming that social learning is of high importance in restructuring conventional systems. In particular, governance experimentation, which explicitly aims for social learning, has been suggested as an approach for enabling the translation of sustainability ideas into practice. This type of experimentation requires a very different dynamic within societal relations and necessitates a changed role for professionals engaged in such a process. This empirically focused paper investigates a contemporary governance experiment, the Cooks River Sustainability Initiative, and determines its outcome in terms of enabling social learning for attaining sustainable water practice in an urban catchment. Drawing on the qualitative insights of the actors directly involved in this novel process, this paper provides evidence of changes in individual and collective understanding generated through diverse forms of social interaction. Furthermore, the research reveals perceived key-factors that foster and/or hamper the execution of this new form of experimentation, including project complexity, resource intensity and leadership. Overall, this paper highlights that, while implementation of governance experimentation in a conventional setting can be highly challenging, it can also be highly rewarding in terms of learning.

Realising sustainable urban water management: can social theory help?

It has been acknowledged, in Australia and beyond, that existing urban water systems and management lead to unsustainable outcomes. Therefore, our current socio-technical systems, consisting of institutions, structures and rules, which guide traditional urban water practices, need to change. If a change towards sustainable urban water management (SUWM) practices is to occur, a transformation of our established social-technical configuration that shapes the behaviour and decision making of actors is needed. While some constructive innovations that support this transformation have occurred, most innovations remain of a technical nature. These innovative projects do not manage to achieve the widespread social and institutional change needed for further diffusion and uptake of SUWM practices. Social theory, and its research, is increasingly being recognised as important in responding to the challenges associated with evolving to a more sustainable form of urban water management. This paper integrates three areas of social theories around change in order to provide a conceptual framework that can assist with socio-technical system change. This framework can be utilised by urban water practitioners in the design of interventions to stimulate transitions towards SUWM.

Diameter of the bony lacrimal canal: normal values and values related to nasolacrimal duct obstruction: assessment with CT.

BACKGROUND AND PURPOSE: Epiphora, or tearing due to primary acquired nasolacrimal duct obstruction (PANDO), is increasingly being treated with balloon dilatation. The cause of PANDO is unknown, but a small diameter of the bony nasolacrimal canal might be one of the etiologic factors. The purpose of this study was to determine the normal distribution of diameters of the bony canal and to ascertain whether there is an association between the diameter of the bony canal and primary nasolacrimal duct obstruction. METHODS: Using axial CT, we measured the minimum diameter of the bony nasolacrimal canal in a control group of 50 men and 50 women and in 19 patients with PANDO. RESULTS: The mean minimum diameter in the control group was 3.5 mm, which was smaller than expected on the basis of published data. The difference between the mean minimum diameter in men (3.70 mm) and that in women (3.35 mm) was significant. The mean minimum diameter in the patient group was 3.0 mm, which was significantly smaller than that in the control group. There was, however, considerable overlap. CONCLUSION: A small diameter of the bony canal appears to be one of the etiologic factors in PANDO.

Abscess of the lacrimal sac due to chronic or subacute dacryocystitis: treatment with temporary stent placement in the nasolacrimal duct.

Stents were placed temporarily in 10 obstructed lacrimal systems in patients with a chronic or subacute lacrimal abscess that did not respond to conventional antibiotic therapy. In all 10 cases, the abscess was treated successfully. Long-term patency of the lacrimal system was restored in five cases. Temporary stent placement appears to be a promising method to treat a chronic or subacute lacrimal abscess.

Obstructed nasolacrimal duct system in epiphora: long-term results of dacryocystoplasty by means of balloon dilation.

PURPOSE: To evaluate the long-term results of balloon dacryocystoplasty in the treatment of epiphora due to obstruction of the nasolacrimal ducts. MATERIALS AND METHODS: One hundred eyes in 84 patients with complete or incomplete obstruction of the lacrimal sac and duct were selected for dacryocystoplasty. A catheter with a balloon diameter of 3 mm was used. Follow-up was 5-48 months. No stents were placed. A Kaplan-Meier analysis was used to evaluate patency. RESULTS: The long-term primary patency rate was 70% +/- 7 (+/- standard error). Repeat dacryocystoplasty was successful in 10 of the 11 cases with initial failure or reobstruction during follow-up, which yielded a long-term secondary patency rate of 81% +/- 7. There was no association between the length of the obstruction or the duration of symptoms before dacryocystoplasty and the initial and long-term success. Initial and long-term success was statistically significantly higher in dacryocystoplasty for an incomplete obstruction rather than for a complete obstruction. CONCLUSION: The long-term results of dacryocystoplasty, followed if necessary by repeat dacryocystoplasty, are good. Dacryocystoplasty is a safe and simple procedure and could become the treatment of choice for epiphora due to obstruction of the nasolacrimal ducts. Dacryocystorhinostomy is indicated when dacryocystoplasty or repeat dacryocystoplasty fails or when dacryocystoplasty is contraindicated (e.g., in anatomic malformations in the lacrimal duct or bony canal).

Use of a collagen hemostatic closure device to achieve hemostasis after arterial puncture: a cost-effectiveness analysis.

PURPOSE: To evaluate whether a collagen hemostatic closure device is a safe, cost-effective alternative to manual compression for achieving hemostasis at arterial puncture sites. MATERIALS AND METHODS: A cost-effectiveness analysis, based on a meta-analysis of published data, was performed from the perspective of the health-care system. The gain in effectiveness was expressed as the decrease in rate of puncture-site complications that required treatment. Costs associated with achieving hemostasis and treating complications were included. RESULTS: Use of a collagen closure device decreased the number of puncture-site complications from 31:1,000 to 16:1,000. The average cost of using the device was $177 per patient compared with $42 per patient for manual compression. The incremental cost of averting one complication exceeded $9,000. CONCLUSION: Use of a collagen closure device to achieve hemostasis after an arterial puncture may reduce the complication rate, but the additional cost per complication averted is very high.

Digital signatures and the electronic health records: providing legal and security guarantees.

This contribution deals with legal issues which arise in the application of electronic health records. Especially the issues with regard to ensuring both the authenticity of data and their originators are discussed.

Triage of patients to angiography for detection of aortic rupture after blunt chest trauma: cost-effectiveness analysis of using CT.

OBJECTIVE: The purpose of this study was to evaluate the cost-effectiveness of dynamic chest CT, compared with plain chest radiography and immediate angiography, in deciding when angiography should be performed in hemodynamically stable patients with suspected aortic rupture after blunt chest trauma. The use of CT was evaluated in relation to the prior probability of aortic rupture. MATERIALS AND METHODS: A cost-effectiveness analysis comparing six diagnostic strategies combining chest radiography, CT, and angiography in various sequences was performed. Effectiveness was expressed as survival to hospital discharge, and costs were those incurred to society. Estimates for the variables in the analysis were derived from published reports. The model was evaluated for two cohorts of patients: those undergoing and those not undergoing CT for the evaluation of other injuries. Sensitivity analysis was performed for all variables in the model with emphasis on the prior probability of aortic rupture. RESULTS: Selecting patients for triage to angiography based on the CT findings yielded higher effectiveness at a lower cost-effectiveness ratio than doing so based on the chest radiograph, and the incremental cost-effectiveness ratio was less than $500,000 per life saved. For the cohort undergoing CT for the evaluation of other injuries, triage to angiography based on the CT findings yielded equivalent survival chances compared with immediate angiography and cost less ($1468 per patient evaluated compared with $2508). For the cohort not undergoing CT for other injuries, immediate angiography yielded the highest survival chances but was expensive, with an incremental cost-effectiveness ratio of $2 million per life saved compared with triage based on CT. In the latter cohort, immediate angiography yielded higher survival chances and had a cost-effectiveness ratio of less than $500,000 compared with the triage by CT if the prior probability of aortic rupture was 5% or more. CONCLUSION: Selecting hemodynamically stable patients after blunt chest trauma with suspected aortic rupture for angiography on the basis of CT findings is more effective than doing so based on the findings on chest radiography and is cost-effective compared with other accepted health care programs. Immediate angiography has a high incremental cost-effectiveness ratio compared with triage by CT and is warranted only in patients not undergoing CT for the evaluation of other injuries who have a prior probability of aortic rupture of 5% or more.