A 54-year-old female presented with a 2-week history of increasing shortness of breath and fever. She had a history of a poorly differentiated sigmoid adenocarcinoma for which she underwent an anterior resection 6 months prior to admission, followed by 12 cycles of adjuvant FOLFOX chemotherapy. The patient was treated for a severe community-acquired pneumonia; however, she remained hypoxic. A chest CT revealed extensive right-sided fibrotic changes, tractional dilatation of the airways and ground glass density, which had developed since a staging CT scan performed 2 months previously. Although her symptoms improved with steroid therapy, repeat imaging revealed that right hydropneumothorax had developed, and this required the insertion of a chest drain. Following its successful removal, the patient continues to improve clinically and radiographically. The rapid onset and nature of these changes is consistent with a drug-induced fibrotic lung disease secondary to FOLFOX chemotherapy. The phenomenon is underreported and yet, it is relatively common: it occurs in approximately 10% of patients who are treated with antineoplastic agents, although information specifically relating to FOLFOX-induced pulmonary toxicity is limited. It is associated with significant morbidity and mortality, but is often hard to differentiate from other lung conditions, making the diagnosis a challenge. Pulmonary toxicity is an important complication associated with antineoplastic agents. It should be considered in any patient on a chemotherapeutic regimen who presents with dyspnoea and hypoxia in order to try to reduce the associated morbidity and mortality.

Early evaluation and study of the various criteria for the ORR clearly established the requirements for the fundamental safety and control instrumentation, and the instrumentation was well integrated into the design and construction of the plant. However, it was not designed for the optimum of maintenance convenience and minimum reactor down time in the event of instrument failure. This paper will attempt to describe the revisions and additions that have been made in the physical plant and maintenance which have resulted in a definite reduction of reactor down time due to instrument failure in both the reactor and in the experiments.

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Many U.S. transit agencies have been using planning support software to assist in daily planning, operation, and customer services. However, the literature is not clear about the extent to which transit agencies are using planning support software programs for daily activities. To determine the state of the practice in the use of planning support software in the U.S. transit agencies, a survey was conducted. The survey found that the use of planning support software confirms the general trend in the use of information technology: that is, its use is directly related to the size of the transit agencies. Larger transit agencies tend to use more planning support software, while small agencies do not use that much. Probably one of the most important findings is that many smaller transit agencies consider the purchase and use of planning support software in transit planning, operation, and marketing as unnecessary, especially given the difficulties in obtaining funding, training staff, and hiring and retaining technical support personnel. However, those difficulties are mainly caused by constraints in budgeting and technical staffing issues rather than the undesirability of or the unproved or unrealized benefits related to the use of planning support.