Staffing and Training Aspects of Hospital Management: Some Issues for Research

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68624/2/10.1177_107755878904600205.pd

Abdominal aortic aneurysm and hepatocellular carcinoma: A one-stage approach

Background: The operative management of abdominal aortic aneurysm (AAA) and co-existing intra-abdominal malignancy has been a long-standing controversy. It is unclear whether a single-stage or a two-stage approach is the more appropriate therapeutic option and also which lesion should be treated first. Case outline: An 82-year-old man with a 4×5-cm mass in the left liver (segment IV), suspected to be a hepatocellular carcinoma (HCC), had a concomitant 6-cm infrarenal AAA. At the same operation he underwent a left hepatectomy followed by repair of the aneurysm. He was discharged on the 17th postoperative day. To the best of our knowledge, this is the third report in the world literature of a patient who underwent a successful simultaneous resection of an AAA and HCC and the first in which the liver resection was performed first. Discussion: We recommend liver resection and AAA repair in a single-stage procedure, regardless of the time sequence of the procedures. This approach can be considered safe, and the theoretical risk of graft infection can be kept to a minimum

Abdominal aortic aneurysm and hepatocellular carcinoma: a one-stage approach

Backgroun

Bridging the representational gap in the dynamic systems approach to development

We describe the relationship between the dynamic systems approach to development and a recent approach to the dynamics of representational states - the dynamic field approach. Both approaches share an emphasis on the concepts of stability (attractor states), instability (especially bifurcations), soft-assembly and flexibility. But the dynamic field approach adds the concept of 'activation' to capture the strength with which behaviorally relevant information is specified. By explicitly linking these dynamic systems approaches, we allow for more direct comparisons between dynamic systems theory and connectionism. We note three current differences between these two approaches to development: (1) the notion of stability is central to how representational states are conceptualized in the dynamic field approach; (2) the dynamic field approach is more directly concerned with the sensorimotor origins of cognition; and (3) the dynamic approach is less advanced with regard to learning. We conclude that proponents of the two approaches can learn from the respective strengths of each approach. We suspect these differences will largely disappear in the next 20 years