Knotted urethral catheter: a twist in the tail.

Inadvertent knotting of infant feeding tubes used for clean intermittent catheterisation (CIC) is a rare complication in paediatric patients. The small flexible tubes used in infants if advanced too far into the bladder may form a knot as the bladder empties. Surgical intervention is required especially if it is lodged in the urethra. We present a case of a baby boy aged 4 months on CIC with a 6 Fr feeding tube, which required a meatotomy for removal. Education while instituting CIC must emphasise the length of catheter insertion, the chance of knotted catheter and steps to take if it occurs. A dedicated urotherapy nurse would be ideal.

Integrating indigenous livelihood and lifestyle objectives in managing a natural resource.

Evaluating the success of natural resource management approaches requires methods to measure performance against biological, economic, social, and governance objectives. In fisheries, most research has focused on industrial sectors, with the contributions to global resource use by small-scale and indigenous hunters and fishers undervalued. Globally, the small-scale fisheries sector alone employs some 38 million people who share common challenges in balancing livelihood and lifestyle choices. We used as a case study a fishery with both traditional indigenous and commercial sectors to develop a framework to bridge the gap between quantitative bio-economic models and more qualitative social analyses. For many indigenous communities, communalism rather than capitalism underlies fishers' perspectives and aspirations, and we find there are complicated and often unanticipated trade-offs between economic and social objectives. Our results highlight that market-based management options might score highly in a capitalistic society, but have negative repercussions on community coherence and equity in societies with a strong communal ethic. There are complex trade-offs between economic indicators, such as profit, and social indicators, such as lifestyle preferences. Our approach makes explicit the "triple bottom line" sustainability objectives involving trade-offs between economic, social, and biological performance, and is thus directly applicable to most natural resource management decision-making situations.

Qualitative modelling of gold mine impacts on Lihir Island's socioeconomic system and reef-edge fish community.

Inhabitants of Lihir Island, Papua New Guinea, have traditionally relied on reef fishing and rotational farming of slash-burn forest plots for a subsistence diet. However, a new gold mine has introduced a cash economy to the island's socioeconomic system and impacted the fringing coral reef through sedimentation from the near-shore dumping of mine wastes. Studies of the Lihirian people have documented changes in population size, local customs, health, education, and land use; studies of the reef have documented impacts to fish populations in mine affected sites. Indirect effects from these impacts are complex and indecipherable when viewed only from isolated studies. Here, we use qualitative modelling to synthesize the social and biological research programs in order to understand the interaction of the human and ecological systems. Initial modelling results appear to be consistent with differences in fish and macroalgae populations in sites with and without coral degradation due to sedimentation. A greater cash flow from mine expansion is predicted to increase the human population, the intensity of the artisanal fishery, and the rate of sewage production and land clearing. Modelling results are being used to guide ongoing research projects, such as monitoring fish populations and artisanal catch and patterns and intensity of land clearing.