bluuebunny/crossref_metadata_2025 huggingface dataset:
Pricing and Implementation of Longevity Bonds in Taiwan
Authors: Wang Jennifer L. , Yang Sharon S.
Published: February 2010

As the population ages and the deterioration of pension funds continue, hedging longevity risk is becoming increasingly important in Taiwan. This article analyzes the potential market for issuing longevity bonds to hedge against the longevity risk in Taiwan. Many recent studies have suggested that longevity bond can serve as an effective risk management tool to mitigate the longevity risks. Following the design of the longevity bond proposed by Denuit, Devolder and Godernaiaux (2007), we make an illustration of pricing longevity bond using Lee-Carter model on the basis of the mortality experience in Taiwan. Our results show that the risk premium for issuing a longevity bond in Taiwan is lower than that in the United State. However, in order to measure the longevity risk more precisely and to overcome the potential problems of issuing longevity bonds in Taiwan, the quality of mortality data should be improved and more regulations need to be amended in the near future.
The Volatility of Mortality
Authors: Bauer Daniel , Börger Matthias , Ruß Jochen , Zwiesler Hans-Joachim
Published: February 2010

The use of forward models for the future development of mortality has been proposed by several authors. In this article, we specify adequate volatility structures for such models. We derive a Heath-Jarrow-Morton drift condition under different measures. Based on demographic and epidemiological insights, we then propose two different models with a Gaussian and a non-Gaussian volatility structure, respectively. We present a Maximum Likelihood approach for the calibration of the Gaussian model and develop a Monte Carlo Pseudo Maximum Likelihood approach that can be used in the non-Gaussian case. We calibrate our models to historic mortality data and analyze and value certain longevity-dependent payoffs within the models.
A Bayesian Comparison of Models for Changing Mortalities toward Evaluating Longevity Risk in Japan
Authors: Kogure Atsuyuki , Kitsukawa Kenji , Kurachi Yoshiyuki
Published: February 2010

We present a Bayesian approach to compare models for forecasting mortality rates under the framework of the Lee-Carter methodology. We consider the original normal log-bilinear formulation of the methodology as well as the recently proposed Poisson log-bilinear formulation. For each formulation, we compare three models: the deterministic trend model, the stochastic trend model and the stationary (no trend) model, each of which represents a different future scenario for changing mortalities. Markov-chain Monte Carlo methods are used to sample the predictive distributions from each model and to calculate the marginal likelihoods for the model selection. The approach is applied to Japanese male mortality rates from 1970 to 2003. The results show that the stochastic trend model is most appropriate for forecasting mortality rates both for the normal and the Poisson formulation. We then use the selected model to evaluate longevity risk in Japan by calculating the posterior predictive distributions of the life annuities for the population at age 65.
Valuing Surrender Options in Korean Interest Indexed Annuities
Authors: Kim Changki
Published: February 2010

We present surrender rate models with explanatory variables such as the difference between reference rates and crediting rates, policy age since issue, unemployment rates, and economy growth rates, using a logit model. We calculate the values of the surrender options in Korean interest-indexed annuities. It is interesting to note that the values of the surrender options subject to a surrender charge show negative values despite the fact that the surrender options are the right given to policyholders. We then attempt to find the fair surrender charges for the insurance company and its policyholders.
Estimation of Capital Beta and Cost of Capital: A Focus on Japanese Property-liability Insurance Companies and Lines of Business
Authors: Shirasu Yoko , Komoribayashi Katsuya , Moridaira Soichiro
Published: February 2010

In this paper we estimate the equity beta and cost of capital of Japanese property liability insurance companies. For this, we obtain the overall equity beta and cost of capital for each company and then estimate the equity beta and cost of capital by the business lines. To obtain a companys overall equity beta, we use the one-factor capital asset pricing model (CAPM) and the three-factor Fama-French (FF) model. To estimate each business lines equity beta, we use the full-information industry beta (FIB) methodology. Econometric analysis reveals that the CAPM and FF models are well suited to estimating Japanese property-liability insurance companies the equity beta and cost of capital. Furthermore, by using the FIB methodology, we find that each the equity beta of each business line is different.
A Comparison of Corporate Bankruptcy Models in Australia: The Merton vs. Accounting-based Models
Authors: Tanthanongsakkun Suparatana , Pitt David , Treepongkaruna Sirimon
Published: February 2010

Actuaries have long employed logistic type regression models in their analysis of renewal rates for property and casualty insurance products. This paper introduces an application of such methodology to the prediction of corporate bankruptcy. This is an example of a widerfield area of endeavor where actuaries have the potential to add real value. The results presented in the paper have implications for levels of risk-based capital to be held by insurers and other financial organizations. This paper examines how effectively the default likelihood indicator (DLI) estimated from the Merton model can predict corporate bankruptcy in Australia during 1990-2003. In addition, the performance of the Merton model and the three most popular bankruptcy models, i.e., Altman (1968), Zmijewski (1984), and Shumway (2001) are also compared. Our findings suggest that the Merton model is the most informative model in explaining corporate bankruptcy, followed by the Shumway model. Among accounting and market-based variables in bankruptcy models, only two variables, namely the ratio of total liabilities to total assets (TL/TA) and the idiosyncratic standard deviation of stock returns are most significant in predicting corporate bankruptcy. Finally, the results from our comparative study of bankruptcy prediction models suggest developing a multivariable logistic regression model which includes both financial ratios and Mertons default likelihood indicator as predictors. We assess the predictive ability of this model by comparing 95% confidence intervals for the predicted probability of default for firms that default and firms that are not observed to default.
The Effects of Economies of Scale and Diversification on the Cost Structure of the Malaysian Non-life Insurance Industry
Authors: Yin Choo Yap
Published: February 2010

Using a sample of Malaysian non-life insurers over the period 2000-2007, I develop and test a model that explains the expense ratio as a function of output level, line-of-business diversification and other variables. Using various proxies for scale and line-of-business diversification, the empirical results show the existence of an interactive and non-linear relationship with cost. The findings suggest that there is no single minimum efficient scale level for all insurers; rather, it is contingent on the insurer's degree of line-of-business diversification and vice versa. I also find that costs for newly consolidated insurers and motor insurance are relatively higher and fail to find evidence that foreign-owned insurers or foreign joint venture insurers are more cost efficient.
Comparison between Financial Theory and Cooperative Game Theory in Risk Capital Allocation
Authors: Seog S. Hun , Shin Sungwhee
Published: February 2010

We compare two prominent approaches to capital allocation in insurance firms. The financial theory approach includes Merton and Perold (1993) and Myers and Read (2001). The cooperative game theory approach utilizes concepts such as the Shapley value and the Aumann-Shapley value. We argue that, when an entire division is added or when the effect of a decision is discrete, the Shapley value approach provides an improvement over the Merton and Perold approach in that it properly accounts for the order in which divisions are added, and resoles the unallocated capital problem. When the effect of a decision is continuous, we show that the Auman-Shapley value approach not only provides game theoretic support for, but also conceptually extends, the Myers and Read approach.
The Cost of Delay in a Mortgage/Credit Loan Portfolio
Authors: Jang Jiwook
Published: February 2010

Using an actuarial model, we examine the cost of delay in mortgage/credit loan payments. It is assumed that the default arrival process follows the Poisson process and the loss sizes are assumed to be independent and an identical truncated exponential. We also assume that the delay between default occurrence and partially (or fully) recovered payment is an independent identical truncated exponential random variable. For the recovery rate random variable, we simply use its expectation. Using the relationship between the shot noise process and accumulated/discounted aggregate losses process and applying the piecewise deterministic Markov processes theory, we obtain the explicit expressions for the expected value of losses and the expected value of part (or whole) of the loan recovered with the delay. Based on these moments, we define and predict the cost of delay in a mortgage/credit loan portfolio and their numerical examples are provided.
Effects of Disability-Based Underwriting Prohibitions on the Labor Market
Authors: Wang Ping
Published: February 2010

In the U.S., a majority of the non-elderly population obtains health insurance coverage through an employer. State governments enacted regulations that prohibit the use of a variety of underwriting criteria, ostensibly to make insurance more affordable to those who would have otherwise been denied coverage or charged higher rates. This study tests whether regulations that restrict the use of disability status as an underwriting criterion for small businesses have unintended consequences in the labor market. The findings suggest that in states where disability is prohibited as an underwriting criterion, both disabled and able-bodied workers of small firms earn more than their counterparts not subject to such restrictions, albeit due to different causes.
Labor conditions of university teachers on Belgrade University: The problem of evaluation
Authors: Jankovic Ana , Jaric Isidora
Published: February 2010

Current process of the reform of higher education system in Serbia emphasize the issue of standardization of different aspects of teachers' work. Bologna reform introduces certain innovations in the process of evaluation of teachers work - obligatory self-evaluation and student evaluations. First reactions on these innovations stressing the question of ambiguity in interpretations of the results of this kind of evaluations. The empirical analysis of the collected interviews on five faculties of Belgrade University chart some of the symbolic points of resistance, as well as the points of symbolic identification and acceptance related to the process of evaluation. Careful analysis of the ways in which interviewees construct their narratives about the idea of evaluation of their own teaching skills and practices shows numerous defects of current evaluation procedures, as well as the concrete possibilities for their improvements and adjustments to the changed requirements of teaching process in higher education institutions.
Diagramme et agencement chez Gilles Deleuze: L'élaboration du concept de diagramme au contact de Foucault
Authors: Krtolica Igor
Published: February 2010

(francuski) Pendant les ann?es 1970, Gilles Deleuze ?labore avec F?lix Guattari et Claire Parnet les concepts d'agencement et de diagramme: au moins jusqu'? Mille plateaux (1980), agencement et diagramme - rebaptis?s machine concr?te et machine abstraite -, constitueront le soubassement th?orique de l'ensemble du travail de Deleuze. Or, l'id?e de diagramme doit beaucoup au Foucault de Surveiller et punir avec lequel Deleuze m?ne un dialogue th?orique ininterrompu pendant ces ann?es-l?: elle cristallise pour lui un enjeu de taille, celui de penser la mutation des structures historiques hors des sch?mas dominants du structuralisme et du marxisme. Deleuze, penseur du devenir, se confrontant ? Foucault, historien-g?n?alogiste des transformations: au coeur de cette confrontation sur le diagramme, surgissent deux conceptions distinctes de la mutation que Deleuze s'efforce de concilier dans son livre sur Foucault.
Walter Kaufmann and the future of the humanities
Authors: Pickus David
Published: February 2010

Walter Kaufmann (1921-1980) is best remembered for his work on Nietzsche However, from 1950 to the end of his life he produced a wing-raging and provocative body of philosophical criticism. At the heart of Kaufmann's efforts was a concern for the humanities and its role in modern intellectual life. Kaufmann's central meditation on this subject, The Future of the Humanities (1970) deserves more attention that it has received so far. It finds a way to blend two fundamental goals of contemporary theory, a quest of authenticity and the desire to foster a critical spirit. The way Kaufmann achieved these goals, testifying to his ongoing relevance for those who care about the humanities, is the subject of this essay.
Searle's conception of institutional reality
Authors: Mladenovic Ivan
Published: February 2010

This paper aims to present Searle's conception of institutional reality as an important contribution to contemporary political philosophy and social theory. Its importance notwithstanding, the two objections will be raised concerning the central notion of collective intentionality. Searle thinks of this notion as crucial for explaining human cooperation and social reality. The first objection is that Searle missed to take into account the rationality assumption in his explanation of cooperation and human interaction. The second objection is related to the previous one. Additionally, Serle missed to investigate the role of autonomous moral agent in the procedure of constructing social reality. Given this shortcoming there is no possibility for addressing the question of justice within Serle's theory of institutional reality.
Ethnomusicologists researching towns they live in: Theoretical and methodological queries for a renewed discipline
Authors: Arauzo Samuel
Published: February 2010

This article focuses on theoretical and methodological implications of the 20th-century epistemic turn in the humanities towards a more self-critical and politicized approach to the production of knowledge in academia. It examines in particular their general impact on ethnography-based disciplines such as ethnomusicology, arguing that this is felt even more intensely in work being done in the cities the researchers live in, where their home institutions are based. The article then addresses methodological alternatives for ethnomusicology in the rather conflicting 21st century context, such as participatory action strategies eliciting new grounds for collaboration between academic and extra-academic perspectives, based on ongoing initiatives undertaken by an academic research collective in Rio de Janeiro, Brazil, which integrate political and academic dimensions in new disciplinary ways.
The light of the word in Ljubica Maric's music
Authors: Makevic Zorica
Published: February 2010

Ljubica Maric's music provides manifold encouragements for consideration in the light of the Logos, according to the teaching exposed in the prologue of the Gospel by St. John. It speaks of the essential inconceivability of time and life, which have their cause in God and His Logos. Seeing through and praising 'the logos of things' guide all its aspects: the tone reveals itself as a vibration, as the energy of lasting and existing, as the beginning of every time and motion; the sonority of different instrumental media is freely expressed and mutually determined in co-action with specific musical and contextual moments; the rhythm evades every regularity and mechanicalness, by which both single duration's and the whole metro-rhythmic course gain a vivid expression. The entire shape of the work is also taken from the reality of psychological and historical time, from its unreductable dynamics, being always in a vivid connection with the space, origin and tradition. The respect for 'the truth of things', the awe before the mystery of time and existence, which call upon the very principle of life in the divine Logos are obvious in everything. Designation of man as a being of light and reason created in the image of God to be the likeness of His being, is expressed in Ljubica Maric's music by the measure of human pulse taken as the basic tempo of her entire opus. Ljubica Maric expressed her consciousness of the reason as a special gift to the man by extremely careful treatment of the words - its meanings, melodies, rhythms, which she always considered the very source of music. The relation between the word and the voice - its sonorous body - is shown in the cantata Songs of Space (1956) as a mystery of the encounter of the Logos and the matter. In relation to her earlier works, this one is a marked breakthrough of the composer's authentic 'voice', which will find its full identity only after receiving the divine Word, symbolized by the melodies of the Serbian Octoechos in the cycle Musica Octoicha (1958-1963). Thus, Ljubica Maric's music has entered its 'New Testament' time and become a specific story of the Logos and His presence in the world and history. In the opaque and dramatic course of that related musical time, the melodics of chanting is experienced as the manifestation of the light, meaning, reason freedom, awe. These graceful effects bring into the work a certain beyond-time dynamics - inverse perspective of time - and, like a Byzantine church dome, they bear witness to the divine condescension. Ljubica Maric's music is steeped in the mystery of the beginning and the end, which meet in eternity, in the One who is Alpha and Omega; in its one tone and in its entire course, it grasps the whole of time and existence - through the divine Word itself by which it has also been made.
Al niente: The last opus of Vasilije Mokranjac: After a quarter of a century
Authors: Radovic Branka
Published: February 2010

This year we mark the 25th anniversary of the death of one of the most distinguished Serbian composers, Vasilije Mokranjac, whose diversified opus of predominantly symphonic and piano music, greatly influenced on composers of his and subsequent generations. The last opus by this author is his Preludium for clarinet solo written a few months before the tragic death of the artist, who, in this as well as in his entire opus, expressed his anxiety over life and death, his wonder at the sense and absurdity of the things man does, the things he longs for and what he is preoccupied with. Written in a simple and clear form, the work carries traces of excitement, expressionism and neoromantic dualism which is the basic characteristics of Mokranjac's composing handwriting.
'Up there is a foggy mountain': An ethnomusicological-filological contribution on a traditional song from the Kopaonik region
Authors: Jovanovic Jelena , Radic Prvoslav
Published: February 2010

A comparative ethnomusicological and philological analysis was made of the narrative song (ballad) field recording Tamo gore maglita planina, from the village of Mrca, Kopaonik mountain region, South Serbia. The song was sung by Sultana Savic (b. in 1903) whose birthplace is the nearby village of Stava. Philological analysis revealed that the features of the song's language belong primarily to the Kosovo-Resava dialect type, with occasional influences from Prizren-Timok speech. The song's content shows its connection to old Balkan beliefs, partly personified by the shepherd mythological couple of Radoje (Vlasic Radule) and Janja. Ethnomusicological analysis provides numerous arguments (rudimentary monothematic form, refrain pause, tone row consisting of trichord, repetitiveness) to support the assumption that the song is a part of the archaic Balkan, Serbian and South Slavic ritual vocal tradition, formed, most probably, under the predominant influence of Dinaric rural vocal culture. These findings are also complementary to Jovan Cvijic's anthropogeographical remarks about the region where the song originates from.
Violence against women in Nepal: Role of health care workers
Authors: Joshi SK
Published: February 2010

DOI: 10.3126/kumj.v7i2.2695Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 89-90
Clinical profiling and use of loop-mediated isothermal amplification assay for rapid detection of Mycobacterium tuberculosis from sputum
Authors: Poudel A , Pandey BD , Lekhak B , Rijal B , Sapkota BR , Suzuki Y
Published: February 2010

Background: Tuberculosis is a global health problem and the situation is worsening with newer incidences of drug resistance and HIV association. Diagnosis of tuberculosis can be done by many methods and test, culture of sputum being the ideal one. Nucleic acid amplification (NAA) assay are more time efficient one, that amplify and detect specific nucleic acid sequences allows rapid, sensitive and specific detection of M. tuberculosis in sputum samples. Objectives: The present study intends to compile the clinical presentations of the pulmonary tuberculosis (PTB) patients and to evaluate the efficacy of in-house loop-mediated isothermal amplification (LAMP) in detecting Mycobacterium tuberculosis in sputum samples by comparing with microscopy and culture. Materials and methods: Two hundred two sputum samples were collected from 202 patients at National Tuberculosis Center, Bhaktapur, Nepal. Complete clinical profiling, epidemiological data and record on BCG vaccination were noted and the samples were subjected for microscopy, culture and in-house LAMP with six primers specific for 16S RNA gene of Mycobacterium tuberculosis. Result: Of the 176 cases of clinical profiling, productive cough was most common symptom in 147 (83.52%), followed by chest pain 136 (77.27%), fever 133 (75.56%) and haemoptysis 61 (34.66%). There was a statistically significant association between BCG vaccination and development of TB (Χ2=5.33, P=0.02). Of 202 cases, 115 (56.93%) were chest X-ray positive, 101(50%) were direct smear-positive and 100 (49.51%) were culture positive. LAMP had a sensitivity of 97% and specificity of 94.12% while comparing with culture. In addition, its sensitivity and specificity were 91.09% and 89.11% respectively with reference to microscopy. Conclusion: As in our previous study, overall, the result of present study further confirms that the in-house LAMP is a simple, rapid, sensitive and specific DNA amplification technique for PTB diagnosis. Because of rapidity of microscopy and specificity of culture, in-house LAMP assay can be used as a very powerful and useful supplementary tool with complete clinical profiling of the patients for rapid diagnosis of TB in both AFB-positive and negative cases who are suspected as PTB in disease endemic country like Nepal. Key words: clinical profiling; Sputum; DNA; LAMP; M. tuberculosis; Nepal DOI: 10.3126/kumj.v7i2.2701 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 109-114
Study of Helicobacter hepaticus in gallbladders with cholelithiasis and its sensitivity pattern
Authors: Pradhan SB
Published: February 2010

Background: Cholelithiasis is one of the most common digestive surgical disorders. The natural history of gallstone development is unknown. Bacteria are found in high concentration in bile and stone. It is difficult to ascertain whether bacterial infection of the bile arose before stone formation or vice versa. Materials & methods: Prospective study was carried out in 30 cholecystectomy specimens of patients with cholelithiasis collected from 15th January 2005 to 24th July 2005 in Department of Pathology, Kathmandu Medical College Teaching Hospital. The samples were collected in a sterile vial containing 0.5% saline. A small piece of gallbladder was taken in Blood agar and Chocolate agar media for micro anaerobic culture at 370C. The growth of the organism was observed after 48 hours of incubation. Gram stain and various biochemical tests were performed for the confirmation of Helicobacter hepaticus and its sensitivity pattern was studied. Histologically Helicobacter hepaticus was demonstrated in formalin fixed tissue sections using Warthin Starry Silver stain. Results: A total of 76.66% cases showed growth positivity. Nitrofurantoin was found to be the most sensitive drug (95.7%) for Helicobacter hepaticus followed by Ciprofloxacin (91.3%), Cephalaxin (91.3%), Certriaxone (91.3%), Ofloxacin (82.6%), Amikacin (65.2%) and Norfloxacin (60.9%). Helicobacter hepaticus was least sensitive to Amoxycillin (57%). Conclusion: From this study, it is quite apparent that Helicobacter hepaticus infection is commonly associated (76.66%) with cholelithiasis. If the patients are treated with the sensitive antibiotics regularly and the infection, that is the number one cause for the precipitation of bile leading to the formation of gallstones, can be controlled, the incidence of cholelithiasis can be reduced so that the health care expenditure related to gallbladder disease can be reduced markedly. Key words: Cholelithiasis Helicobacter hepaticus; WSS stain DOI: 10.3126/kumj.v7i2.2704 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 125-128
Placenta accreta
Authors: Nizami DJ , Awasthi RT , Dash S , Verghese J
Published: February 2010

Total placenta accreta is a rare condition. Its management is a dilemma. Attempted separation of the placenta in placenta accreta can cause torrential blood loss. Therefore an antenatal diagnosis of placenta accreta permits advance planning of delivery. Two alternatives are caesarean section through the fundus with subsequent immediate hysterectomy, which has traditionally been the treatment of choice or if the patient wishes more children, leaving the placenta in place and managing conservatively1. We present a 38 year old lady who was diagnosed to have placenta accreta while performing a caesarean section for a breech presentation. We had to proceed with a total hysterectomy. DOI: 10.3126/kumj.v7i2.2710 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 149-151
Varenicline: For smoking cessation
Authors: Rao J , Shankar PK
Published: February 2010

Varenicline, a partial agonist of α4β2 nicotinic acetylcholine receptor (nAChR), is the most recently approved drug for smoking cessation. Despite the availability of effective treatments for smoking cessation, such as nicotine replacement therapy and Bupropion sustained-release, abstinence rates remain less than optimal. As a nAChR partial agonist, Varenicline attenuates the craving and withdrawal symptoms that occur with abstinence from nicotine and also reduces the rewarding effects of nicotine obtained from smoking in patients who lapse. Clinical trials have demonstrated superior efficacy of this drug over Bupropion-SR for achieving abstinence from smoking, and Varenicline has also been shown to significantly delay smoking relapse. As the latest agent approved for smoking cessation, the mechanism of action, efficacy, and safety of Varenicline has been reviewed in this paper. Key words: α4β2 nicotinic acetylcholine receptor; Varenicline; smoking cessation; partial agonist. DOI: 10.3126/kumj.v7i2.2714 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 162-164
Management of foreign body aspiration or ingestion in dentistry
Authors: Parolia A , Kamath M , Kundubala M , Manuel TS , Mohan M
Published: February 2010

Foreign body aspiration or ingestion can be a potential complication during routine dental treatment. The handling of dental objects requires particular care, especially where the patient is supine or semi-recumbent. Dentist must be able to manage emergency situations in which patients accidentally swallow dental instruments or materials during treatment and procedures. This article reviews the complications, management and prevention of aspiration or ingestion of foreign bodies. Key words: Foreign bodies; Aspiration/ Ingestion; Management; Prevention DOI: 10.3126/kumj.v7i2.2715 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 165-171
Comparative attitude and plans of the medical students and young Nepalese doctors
Authors: Lakhey M , Lakhey S , Niraula SR , Jha D , Pant R
Published: February 2010

Introduction: Many doctors are leaving Nepal to work abroad. To understand this problem better, we decided to study the attitude and plans of young doctors and medical students. Materials and methods: This cross-sectional study was conducted at Kathmandu Medical College involving 65 firstyear medical students, 100 interns and 100 house officers. The data collected was entered in Microsoft excel and analysed by SPSS (Statistical Package for Social Sciences) programme. Chi-square test was used to compare two proportions. Significance level was set at 5%. Results: Only 2% house officers said that their job prospects were excellent as compared to 22.4% of students, whereas 20% house officers as compared to 9% students thought job prospects in Nepal were poor (p= 0.003). Eighty two percent of students thought that a doctor's service to his country was very important as compared to 51% of interns (p=‹ 0.001) and 58% of house officers. Forty percent of students, 58% of interns and 48% of house officers (no statistical significance between the three groups) planned to migrate to a developed country after graduation. Eighty eight percent of students, 89% interns and 74% of house officers (no statistical significant differences between the three groups) were of the opinion that improving career opportunities or working environment of the doctor could make the profession more attractive. Conclusion: Although majority of students, interns and house officers were of the opinion that a doctor's service to his community/country was very important, almost half of them still planned to migrate to a developed country after graduation. Improving the chances of professional advancement and professional working environment can make the profession more attractive, and therefore, may decrease this tendency for brain drain from our country. Key words: Attitude; medical students; migration; young doctors; statistical significance. DOI: 10.3126/kumj.v7i2.2717 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 177-182
Darwinism in a medical school
Authors: Sthapit B , Dhungana V
Published: February 2010

DOI: 10.3126/kumj.v7i2.2718 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26, 183-184
Early pregnancy termination with a simplified mifepristone: Medical abortion outpatient regimen
Authors: Chuni N , Chandrashekhar TS
Published: February 2010

Background: An estimated 30 million abortions are performed worldwide every year. Many women do not have access to abortion and die of complications after illegal abortions. Medical abortion could provide greater access to safe abortion services; availability of the procedure is, therefore, of global public health importance. Aim: The aim was to study the efficacy of lowered dose of Mifepristone in medical abortion. Materials and methods: One hundred and twelve cases with a pregnancy of 63 days duration or less were enrolled in a prospective study using a lowered dose of 200mg Mifepristone followed, 48 hours later, by home administration of 400μg Misoprostol orally. At the second visit, on day 15, outcome and adverse effects were analysed. Women who failed to undergo a complete abortion were further managed by surgical evacuation of uterus. Results: The mean gestational age was 50.6 days. The rates of complete abortion were 92.8%, 83 % and 80 % in the ≤49 days group, 50 to 56 days and 57 to 63 days group respectively. Vaginal bleeding emerged as the biggest reason for medically indicated termination. Nulliparous women had a greater frequency of side effects, though values did not reach statistical signifi cance. Conclusion: This regimen of a lower dose of 200mg Mifepristone, followed by home administration of 400μg oral Misoprostol 48 hours later is safe and highly effective especially in pregnancies of up to 49 days duration. Key words: Mifepristone; Medical termination of pregnancy (MTP) DOI: 10.3126/kumj.v7i3.2725 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 209-212
A comparative study on adult mortality of Nepal
Authors: Aryal UR , Lohani SP , Upadhaya S , Sinha RC
Published: February 2010

Background: Adult mortality (15-49 years) is one of the major public health issues which remains neglected in many developing counties like Nepal. Only limited data are available which is insufficient to identify the cause and level of mortality among adults. Objectives: The aim of the study is to explore and compare the adult mortality rate of Nepal between 1996, 2001 and 2006 surveys. Materials and methods: This is comparative study conducted by using secondary data extracted from Nepal Family Health Survey (NFHS, 1996), National Census Report 2001 and Nepal Demographic and Health Survey (NDHS, 2006). Statistical analysis was done using Microsoft excel soft ware. The adjusted mortality rates were computed using 2001 census population as standard population. Result: This studied showed there was statistical evidence of declining age specific mortality rate between 1996 and 2006 survey for both men and women respectively (p<0.05). Annually adult men mortality rate and adult women mortality rate was found to be declining by 1% and 3.2% respectively. Women mortality rate declined by 2.26 times as compared to men mortality rate over ten year's period. Conclusion: There is a need of in-depth analysis of adult mortality in the developing countries like Nepal. Key words: Adult mortality; Nepal DOI: 10.3126/kumj.v7i3.2732 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 246-251
Health problems among the street children of Dharan municipality
Authors: Thapa K , Ghatane S , Rimal SP
Published: February 2010

Background: The street children, a marginalised and vulnerable population to poor health, have grown all over the world and also in our country. The continuous exposure to harsh environment and nature of their life style threatens their mental, physical, social and spiritual well being. With the increasing number the problem is also growing at an alarming proportion. It is therefore important to have baseline data on their health problems. Objectives: This study was conducted to identify the physical health problems among the street children of Dharan Municipality, Nepal. Materials and methods: This is a cross sectional descriptive study. Forty eight subjects were included in the study. Research instruments included an interview schedule, physical health examination performa and lab investigations (i.e. blood for haemoglobin, urine routine examination/microscopic examination, stool routine examination/ microscopic examination). Results: Study results showed that 68.8% of the street children were between 11-15 years of age, 95.8% were males. Out of the total subjects 81.2% were found to be rag pickers. Research findings reveal that 100% of the subjects had at least one or more health problems. The study revealed that majority 87.5% had the habit of cigarette smoking, 50% had habit of consuming alcohol and 72.9% had the habit of taking drug. Dendrite (glue sniffing) was the only drug used by the respondents in this study. The most common health problems were head lice infestation (81.2%), headache (66.7%), cut injury (60.4%), common cold (52.1%), dental caries (52%), burning micturation (47.9%), cough (47.9%), underweight (43.8%), abdominal pain (39.6%), tinnitus (37.55%), gum bleeding (33.3%), joint pain (31.2%), eye infl ammation (25%), leg cramps (25%), palpable lymph nodes (25%), chest pain (18.8%), skin lesions (16.7%), abnormal vision (8.3%). Conclusion: Most of the diseases were due to poor health habits. It was found that the nature of work, their life styles and the different types of behaviour they adapt finally lead them to many health problems. The health problem can be prevented, if an integrated program that involves all the issues are developed and implemented. Key words: Street children; health problems; Dharan. DOI: 10.3126/kumj.v7i3.2737 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 272-279
Cardiac arrest during laparoscopic cholecystectomy under general anaesthesia: A study into four cases
Authors: Gautam B , Shrestha BR
Published: February 2010

Laparoscopic cholecystectomy (LapChole) has virtually superseded the more conventional open abdomen approach for the surgical treatment of symptomatic cholelithiasis. LapChole is however not a risk free procedure and serious, potentially fatal intra-operative complications can occur. Here we present case reports of four patients who suffered from intra-operative cardiac arrest during LapChole. All four recovered without residual morbidity and three of them underwent successful surgery in the same setting. No definite cause could be identified in any of the patients. We outline several possible mechanisms that could have been involved and discuss these events in face of published reports describing similar incidences. We infer that the creation of carbon-dioxide (CO2) pneumoperitoneum was involved in the causation of the cardiac arrest because all four incidences occurred within minutes thereafter. Although rare, such complications can be fatal and are thus demanding to the anaesthesiologist. Key words: Anaesthetic complications; carbon-dioxide pneumoperitoneum (CP); cardiac arrest; general anaesthesia; laparoscopic cholecystectomy DOI: 10.3126/kumj.v7i3.2738 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 280-288
Three rooted, four canalled mandibular first molar (Radix Entomolaris)
Authors: Parolia A , Kundabala M , Thomas MS , Mohan M , Joshi N
Published: February 2010

A mandibular first molar with two distal roots is an interesting example of anatomic variation. This paper describes case reports of mandibular first molar with three roots (one mesial and two distal) and four canals (two in mesial and one in each distobuccal and distolingual root). The canals were shaped with protaper rotary files and irrigated with 5.25% sodium hyochlorite, 0.2 %w/v of chlorhexidine gluconate and normal saline as the final irrigant. The canals were then obturated with gutta- percha and AH plus sealer. These case reports show an anatomic variation of internal morphology of the tooth and points out the importance of searching for additional canals. Key words: Mandibular first molar; two distal roots; four canals DOI: 10.3126/kumj.v7i3.2739 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 289-292
The retreatment of a mandibular second premolar with unusual canal anatomy
Authors: Pai AEV , Gautam S , Kundabala M
Published: February 2010

Mandibular premolars usually have a single root and canal. Complex root canal system with atypical variations is a common finding among them. Failure to identify such a one can affect the prognosis of endodontic treatment. Apart from knowledge and sophisticated instruments, a good clinical expertise is required in identifying, tracing and treating such a root canal system. This case report is on the retreatment of a left mandibular second premolar (44) having a Vertucci's Type III canal configuration. Inability to identify this canal configuration led to a missed canal, faulty obturation and post treatment apical periodontitis. DOI: 10.3126/kumj.v7i3.2741 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 298-300
Incidence of end stage renal disease on renal replacement therapy in Nepal
Authors: Hada R , Khakurel S , Agrawal RK , Kafle RK , Bajracharya SB , Raut KB
Published: February 2010

Background: End stage renal disease patients are treated with dialysis in Nepal. But there is no renal registry to indicate the burden of disease in the country. Objectives: The objective of this study is to find out the incidence of ESRD on renal replacement therapy and their out come. Materials and methods: It is a retrospective analysis (audit) of all ESRD patients who had received dialysis inside Nepal and had under gone transplantation from 1990 to 1999. The haemodialysis (HD) registry, HD patients file, intermittent peritoneal dialysis (IPD) registry of Bir Hospital, Shree Birendra Hospital, Tribhuwan University Teaching hospital and National Kidney Center were reviewed. Acute renal failure and acute on chronic renal failure were excluded and the demographic profile, dialysis session, dialysis duration and outcome of all ESRD patients were computed. One patient was counted only once in spite of attending more than one center for dialysis. SPSS package was used for analysis. Results: Total number of 1393 ESRD patients received renal replacement therapy (RRT) in the decade. Mean age of patients were 46.7 ± 16.7 with 70% of ESRD were between 20-60 years age with male: female ratio of 1.8:1. Initial mode of RRT was IPD in 58.2%, HD in 41.7% and pre-emptive transplantation in 0.1% patients. Records of 189 patients could not be found and out of remaining 1208 patients, 85.8% received dialysis for < 3 months, 6% received dialysis for more than a year and 9.5% had undergone kidney transplantation. The incidence of ESRD had increased gradually with 3.4 per million populations (pmp) in 1990 to 11.89 pmp in 1999 with an average annual incidence of 6 pmp and only 0.31% of expected ESRD patients received RRT. Conclusion: The incidence of ESRD is increasing but majority discontinue or die within 3 months. Dialysis centers needs to be expanded to different parts of country and prospective studies have to be carried out to find out of cause of ESRD and to institute preventive measures.Key words: End stage renal disease; Renal replacement therapy; Haemodialysis; Intermittent peritoneal dialysis; Incidence of end stage renal disease; Nepal. DOI: 10.3126/kumj.v7i3.2742 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 302-305
Tetanus
Authors: Poudel P , Budhathoki S , Manandhar S
Published: February 2010

Tetanus is now a rare disease in developed world. However it remains an important cause of death worldwide and is associated with a high case fatality, particularly in the developing world. Tetanus is caused by contamination of wound by spores of Clostridium tetani. Neonatal tetanus results from contamination of the umbilical stump at or following delivery of a child born to a mother who did not possess sufficient circulatory antitoxin to protect the infant passively by transplacental transfer. It produces its clinical effects via a powerful exotoxin, tetanospasmin, which leads to uncontrolled disinhibited efferent discharges from motor neurons in the spinal cord and brainstem, causing intense muscular rigidity and spasm. Shorter incubation and onset times are associated with more severe disease and poorer prognosis. Four clinical forms of tetanus are recognised. They are generalised, localised, cephalic and neonatal tetanus. Tetanus is associated with several complications like respiratory failure, cardiovascular instability, renal failure and autonomic dysfunctions. Recovery from tetanus takes a long time. Diagnosis is established clinically. Symptomatic management, early recognition of complications, careful monitoring for dysautonomia and respiratory assistance are the anchors for successful outcome of patients. Tetanus is preventable through vaccination. Vaccination is highly safe and efficacious. Active immunisation should be instituted in all partially immunised, unimmunised persons and those recovering from tetanus. Passive immunisation is given as treatment of a case as well as prevention following high risk injury. Nepal has achieved neonatal tetanus elimination status on 2005 and is running different programs to sustain the status. Key words: Tetanus; neonatal tetanus; spasm; treatment; immunisation. DOI: 10.3126/kumj.v7i3.2744 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 315-322
Modern trends in medical education: A critical appraisal
Authors: Bapat SK
Published: February 2010

DOI: 10.3126/kumj.v7i3.2748 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 330-333
Bioterrorism Knowledge and Educational Participation of Nurses in Missouri
Authors: Rebmann Terri , Mohr Lisa Buettner
Published: February 2010

Background:

Nurses are integral to bioterrorism preparedness, but nurses' bioterrorism preparedness knowledge has not been evaluated well.

Methods:

Missouri Nurses Association members (1,528) were studied in the summer of 2006 to assess their bioterrorism knowledge and the perceived benefits of education as well as barriers to education.

Results:

The response rate was 31%. Most respondents (60%,n= 284) received no bioterrorism education. Nurses who were nurse practitioners (t= −2.42,p< .05), were male (t= −2.99,p< .01), or were on a planning committee (t= −1.96,p= .05) had received more education than other nurses. The most commonly cited barrier to education (46.6%,n= 221) was not knowing where to obtain training. One third of respondents (31.2%) reported no interest in receiving bio-terrorism education in the future. Nurses' average score on the knowledge test was 73%. The most commonly missed questions pertained to infection control and decontamination procedures.

Conclusion:

Bioterrorism preparedness training should be offered through continuing education and nursing school curricula.

J Contin Educ Nurs2010;41(2):67–76.
The Importance of Tobacco Cessation Training for Nurses in Serbia
Authors: Merrill Ray M. , Gagon Heather , Harmon Tanner , Milovic Ivan
Published: February 2010

Background:

This study assessed smoking prevalence, attitudes, and perceived patient counseling responsibilities among practicing nurses in Serbia. The need for nurses to receive tobacco cessation training is explored.

Methods:

Data were collected through a cross-sectional survey of 230 nurses at public institutions in Belgrade, a health care center in Belgrade, and public health care facilities throughout Serbia.

Results:

The smoking prevalence was 52% for male nurses and 47% for female nurses. Nurses had the greatest mean level of agreement with statements about controlling smoking through policy, followed by statements about being role models. Only 15% (
n
= 35) of nurses regularly counseled their patients about smoking, and only 16% of nurses (45% of males vs. 12% of females,
p
< .0001) had received training in counseling patients about smoking. Nurses' training in counseling patients about smoking was positively associated with the nurses' belief that their counseling could help patients stop smoking or never start smoking. In addition, nurses with training in counseling patients about smoking considered themselves significantly better prepared to assist patients to quit smoking. Nurses who smoked were significantly less likely to believe that their counseling about smoking could be effective. They also felt significantly less well prepared to assist patients to quit smoking.

Conclusion:

These findings show that nurses' training in tobacco cessation counseling results in greater self-perceived confidence and frequency of regular tobacco cessation counseling in Serbia.

J Contin Educ Nurs
2010;41(2):89–96.
Microskills in Office Teaching
Authors: Angela M. Allevi , J. Lindsey Lane
Published: February 2010

CME EDUCATIONAL OBJECTIVES

1.

Determine the factors that contribute to a learner's development as a reflective practitioner.

2.

List steps an outpatient preceptor can take to maximize student and/or resident learning.

3.

Discuss precepting techniques that can be used to improve performance of patient-centered skills.