bluuebunny/crossref_metadata_2025 huggingface dataset:
Probabilistic method for reliability assessment of metal oxide varistors under lightning stress
Authors: Luca Amicucci Giovanni , Mazzetti Carlo
Published: April 2004

Surge protective devices are used to limit the maximum voltage on protected circuits. In the last decade, metal oxide varistors (MOVs) have been the most used protective devices. Since many of the outages experienced on sensitive circuits are due to overvoltages originated by the effects of direct and nearby lightning flashes, it is important to evaluate the reliability of such protective devices under lightning stress. Actually, MOVs are affected by ageing, essentially due to the number and amplitude of stresses, and also other factors such as overheating, pollution and humidity. The aim of this paper is to present a method, based on probabilistic arguments, to evaluate the ageing process of MOVs. The expected life, so obtained, can be used to decide when the MOV must be changed before its failure occurs (reliability assessment), since the main standards do not give definitive indications about such features. The estimated expected life can be used in the design of logistic/maintenance procedures.
The extraordinary Gordon Pask
Authors: Cook Peter
Published: April 2004

This is a short tribute statement about that extraordinary man, Gordon Pask, and his stimulating influence on architecture.
The cybernetics of architecture: a tribute to the contribution of Gordon Pask
Authors: Hamilton Frazer John
Published: April 2004

Discusses the relation between cybernetics and architecture and pays tribute to Gordon Pask’s role and influence. Indicates Pask’s contribution to an increasingly environmentally responsive architectural theory that may lead to a more humane and ecologically conscious environment.
Memories of Gordon
Authors: Gregory Richard L.
Published: April 2004

Presents some memories of my friend Gordon Pask, noting especially his early contributions to what is now called artificial intelligence and the occasion of the NPL Symposium on The Mechanisation of Thought Processes.
Appropriate length of extended day care
Authors: Panis Lambert J.G.G. , Verheggen Frank W.S.M. , Pop Peter , Prins Martin H.
Published: April 2004

Extended day care (EDC) is a one‐day admission spending one night in hospital. Many EDC patients do not need hospital care over night, so probably they could be transferred to a day surgery setting, resulting in decreased costs and increased efficiency. The objectives of the study were to assess the appropriate length of extended day care (ALED) and a possible transfer to day surgery. ALED was defined as the time between the start of the surgical procedure and the final moment appropriate hospital care was provided. About 80 per cent of the patients could possibly have been treated in day surgery. The other patients could not be transferred, because of a prolonged ALED. With the implementation of new policies on admission to and discharge from the hospital and the use of altered types of operation room scheduling or patient logistics the transfer of most EDC patients to day surgery would be possible.
Values underlying continuous improvement
Authors: Jabnoun Naceur
Published: April 2004

Increased global competition, where high quality and low cost are at premium, led to increased interest in continuous improvement. The success of continuous improvement initiatives is dependent on many factors that include leadership, structure and shared organizational values. This paper identifies two sets of values that underlie continuous improvement. The first set is composed of driving values while the second set includes the enabling values. The paper also presents a few measures for infusing these values.
National culture and total quality management: empirical assessment of a theoretical model
Authors: Noronha Carlos
Published: April 2004

Using a sample of total quality management (TQM) companies operating in mainland China, Hong Kong, and Taiwan, a structural equation model explaining the influence of Chinese cultural values on TQM was tested. Results indicated that the proposed model demonstrated satisfactory goodness of fit. The underlying Chinese values of abasement, adaptiveness, harmony with people, harmony with the universe, interdependence, and respect for authority were found to have important influences on four quality dimensions, namely climate, processes, methods, and results.
Total quality management (TQM) practices in Turkish manufacturing organizations
Authors: Bayazit Ozden
Published: April 2004

Total quality management (TQM) is one of the most popular modern management concepts. It refers to a quality emphasis that encompasses the entire organization, from supplier to customer. In this paper, the TQM practices in the Turkish manufacturing industry are analyzed, based on a survey conducted among 100 large companies. This paper presents results of a survey of Turkish manufacturing companies. The key finding from the research is that a growing number of companies in Turkey are willing to implement TQM to generate competitive advantage. It was also found that important factors for a successful implementation process are upper management support, employee involvement and commitment, customer focus, quality education and training, teamwork, and use of statistical techniques.
Introduction: Education, ethics, and the “cult of efficiency”: implications for values and leadership
Authors: Begley Paul T. , Stefkovich Jacqueline A.
Published: April 2004

In 1962, historian Raymond E. Callahan argued that American educators had allowed themselves to become overly enchanted by Taylorite notions of scientific management and had adopted the techniques of the business‐industrial world, to the detriment of the nation's students. Callahan's Education and the Cult of Efficiency not only offered a new and bold interpretation of the history of education in the twentieth century, but it also coined a phrase that continues to represent the constant struggle faced by educators as they seek to balance high‐quality instructional practices with external calls for accountability that often come from corporate and public leaders. This special issue of the Journal of Educational Administration (JEA) presents a set of articles which explore the theme of “Education, Ethics, and the Cult of Efficiency.” The articles that make up this issue began as papers delivered at the 8th Annual Values and Educational Leadership Conference held at Pennsylvania State University in October 2003. The essence of our message in this: The traditional parameters of managerialism and efficiency focused responses to administrative situations must now be augmented with more creative, sophisticated and morally defensible approaches to leadership.
Are education and efficiency antithetical?
Authors: Lowe Boyd William
Published: April 2004

Are education and efficiency antithetical? Does the pursuit of efficiency in education inevitably lead to misguided practices and measurement attempts that distort the character and purposes of education? Despite legitimate fears about misguided efforts at efficiency, history shows that efficiency and enlightened educational leadership can be combined beneficially. Indeed, if we want to use educational resources as wisely and effectively as possible, to benefit as many students as possible, we must evaluate the efficiency of alternative policies and practices. This article explores the issues involved, and steps required, for a balanced and appropriate pursuit of efficiency that preserves educational values and avoids the dangers of the “cult of efficiency.”
Trust formation in cross‐cultural business‐to‐business relationships
Authors: Heffernan Troy
Published: April 2004

Given the increase in the globalisation of the world's economies, the importance of building successful cross‐cultural business to business partnerships is emerging as a critical strategy for organisations to consider. For these forms of relationships trust has been identified as an essential component of success. However, little is known about the development and formation of trust in cross‐cultural business to business relationships. Consequently, triangulating two qualitative techniques, this paper examines the development of trust through the initial three stages of the relationship lifecycle. Findings suggest that trust develops in markedly different forms dependent on the lifecycle stage of the relationships.
The magic matrix of clinical governance
Authors: Lewis S.A. , Saunders N. , Fenton K.
Published: April 2004

The implementation of effective frameworks which support the clinical governance agenda is proving to be a significant challenge for management teams across the NHS. Since there is no recognised ideal model or gold standard for such frameworks, it is not surprising that many organisations remain in a state of “trial and error” with their clinical governance arrangements. This article provides an insight into the ongoing developments of the clinical governance “infrastructure” at Southampton University Hospitals NHS Trust. A model of delivery for clinical governance within a large acute teaching hospital is proposed and it is hoped that it may prove useful to colleagues across the country, who may well be facing difficulties in their structural arrangements to deliver the clinical governance agenda.
Lipid lowering after myocardial infarction in hospital practice
Authors: Dutta D. , Ogunnaike B.
Published: April 2004

There is strong evidence for the use of HMG Co‐A reductase inhibitors (statins) for secondary prevention after myocardial infarction. Previous surveys suggest sub‐optimal use of such secondary prevention measures. The national service framework (NSF) for coronary heart disease (CHD) has now set new standards for preventing and treating CHD. In our audit of 182 survivors of myocardial infarction in 1999, 86.2 per cent had cholesterols measured on admission, but only 39 per cent had statins prescribed on discharge. Our data provide information about base‐line practice for the year immediately preceding the publication of the NSF and indicate that the average district general hospital may have a long way to go to meet the target set by the NSF.
The increasing relevance of Pask’s work to modern information seeking and use
Authors: Ford Nigel
Published: April 2004

A series of seven empirical studies conducted in Sheffield lend support to the notion that learners do spontaneously display styles of information processing behaviour originally identified by Pask and Scott, that even versatile postgraduate students are susceptible to the effects of matching and mismatching of teaching and learning styles, and that the arena in which these learning styles may be observed extends beyond learning to information seeking activity including database searching. Much research is still to be done to resolve the enigma of learning styles. However, arguably Pask’s time has come in the sense that current computing software and educational infrastructure now allow with relative ease the testing of the potential of Pask’s constructs using large samples of students, and the realisation of this potential in the development and delivery of mainstream teaching and learning resources.
The limits of social conversation
Authors: Navarro Pablo
Published: April 2004

Approaches Pask’s conversation theory from a sociological perspective. Pask’s vision of conversation as a self‐organising process can help our understanding of the emergence of social order out of social interaction. Through conversation, human beings would be able to construct a shared reality which would be the common setting of their social life. But modern societies are only partially based on conversational interaction. Many of their structural traits are not a result of conversational agreements, but of the unintended consequences of conscious (inter)actions. In these societies, the main source of social order at the macro level is not intentional action, but the dissipation of intentional action. This phenomenon generates the dissipative structures that represent the objective frame of social life. The main purpose of this paper is to review the theoretical work of Gordon Pask from a sociological point of view, in order to appraise its potential as an instrument adequate for social analysis.
Just‐in‐time implementation in the public sector
Authors: Yasin Mahmoud M. , Wafa Marwan A. , Small Michael H.
Published: April 2004

The effective implementation of just‐in‐time (JIT) in the US public sector is examined in this empirical study. Specifically, the relationships between organizational modification efforts prior to JIT implementation, problems encountered during implementation and JIT success are investigated using a sample of 86 public sector organizations. The results of this research seem to support the notion that JIT, as a form of “managerialism”, has the potential to increase the operational efficiency, service quality and organizational effectiveness of public sector organizations. However, for this potential to be achieved, public sector organizations, like their private sector counterparts, must be willing to modify their procedures and operations. The potential benefits of JIT to public sector organizations are not in doubt. However, the art of designing the right JIT implementation strategy for such organizations is debatable. Therefore, issues related to these concerns are worthy of future research. This study is a modest contribution toward that end.
Behind the mind of the strategist
Authors: Pellegrino Kimberly C. , Carbo Jerry A.
Published: April 2004

Delves into the mind of the strategic thinker. The aim of this examination is to establish the conceptual foundations for a new theory of strategic thinking that looks at this process from an individual perspective. This will be accomplished by merging two separate strains of strategy research into a single strategic thinking philosophy. The two strains of strategy research that will be utilized include cognitive simplification tools and personal cognitive style. This foundational work opens the door to a new perspective on how strategic thinking is conducted and creates avenues for future empirical investigation into the mind of the strategist.
Perception of export barriers to Mercosur by Brazilian firms
Authors: Azzi da Silva Paulo , da Rocha Angela
Published: April 2004

This study analyzes the perceptions of export obstacles to the Mercosur by top executives of Brazilian companies located in the state of Riode Janeiro. Differences in perceptions were studied in order to determine to what extent they were associated with industry type, firmsize, export experience and geographic scope of export activities. Self‐administered questionnaires were sent to top executives of Rio de Janeiro companies that had recently exported to Mercosur countries. A total of 69 companies returned the questionnaire, representing a total response rate of 50.36 per cent. Data were analyzed using factor analysis and stepwise linear discriminant analysis. Results confirmed the hypothesized relationships.
The impact of an automated storage and retrieval system on public services
Authors: Shirato Linda , Cogan Sarah , Yee Sandra
Published: April 2004

In June 1998, the Bruce T. Halle Library opened on Eastern Michigan University’s campus and began using an automated storage and retrieval system for low‐use books and periodicals. Approximately one third of the library’s total collection was placed into this storage system, freeing floor space for many new activities in the library. This system, linked to the library’s online catalog, could retrieve items requested by a patron in less than ten minutes. While the Automated storage/retrieval systems (AS/RS) performed well, other start‐up problems of a new building and public perceptions of the AS/RS made its introduction a challenge. Planning, implementation, and public reaction and acceptance are discussed.
Living in the Moment: Lags, Leads, and the Link Between Legislative Agendas and Interest Advocacy*
Authors: Lowery David , Gray Virginia , Fellowes Matthew , Anderson Jennifer
Published: April 2004

Objectives. Based on sharply divergent interpretations about the nature of the politics of organized interests, three competing perspectives imply that organized interests variously lead, lag, or are contemporaneous with legislative agendas.

Methods. We contribute to this debate by presenting data using a short‐term timeframe to assess the sequence of the relationship between legislative agendas and lobbying activity; we examine the lags and leads in the relationship between legislative agendas in 1995, 1997, and 1999 and the density of state lobbying communities in 1997 using Gray and Lowery's (1996) energy, stability, area (ESA) model of interest system density.

Results. The analysis provides little support for the lagging and leading hypotheses and strong support for the contemporaneous hypothesis.

Conclusions. Although this analysis will not end all debates over the sequential relationship between legislative agendas and lobbying activity, it suggests that legislative agenda and interest system density are largely governed by within‐session dynamics.
Intrapopulation variation in reproduction by female eastern kingbirds Tyrannus tyrannus: the impacts of age, individual performance, and breeding site
Authors: Murphy Michael T.
Published: April 2004

I used data from a 13‐year study of eastern kingbirds Tyrannus tyrannus from central New York, USA, to evaluate the relative impact of female age and body size on reproduction. I also calculated repeatabilities of reproductive traits for both females and the sites where they bred in an attempt to evaluate the relative contribution of each to intrapopulation variation in reproduction. Female age had a strong influence on timing of breeding (breeding date advanced by one day for each year of life), but was not a significant source of variation for clutch size, egg mass, number of young to hatch or fledge, or total seasonal production. Repeatabilities of breeding date for females and sites were both significant (0.284 and 0.181, respectively), but the only other significant repeatabilities were for female clutch size (0.282) and female egg mass (0.746). Among‐year repeatabilities of breeding date for females who bred at two or more sites over their lifetime were as high as those for females that were site faithful. Thus, breeding date was probably affected independently by the female and site. No measure of productivity exhibited a repeatable pattern in comparisons made among females or sites. All reproductive traits were entered as dependent variables in a series of stepwise multiple regression analyses in an attempt to identify female properties (size, lifespan and condition) that might be linked proximately to differences in breeding statistics. I found that (a) large birds tended to breed the earliest, (b) clutch size was independent of female size, condition and lifespan, (c) female body size and egg size were correlated positively, but (d) production of young was independent of all measured female properties. Reproduction appears to be linked more closely to the female than to the site. Body size accounts for a portion of the repeatable portion of breeding date and egg mass, but most of the intrapopulation variation in these and other traits remained unexplained.
Avian molecular systematics on the rebound: a fresh look at modern shorebird phylogenetic relationships
Authors: Van Tuinen Marcel , Waterhouse David , J. Dyke Gareth
Published: April 2004

The study of avian molecular systematics currently lags behind that of mammals in several ways. Little phylogenetic resolution is observed among orders and phylogenetic studies below the ordinal level largely remain based on fast evolving mitochondrial sequences. New papers by Paton et al., Ericson et al., and Thomas et al. provide avian molecular systematics with a badly needed boost. These studies indicate that sampling more taxa and slower evolving nuclear genes yields strong phylogenetic resolution among the major shorebird (order Charadriiformes) families. The new data show surprising overall consensus and converge on certain novel clades. If correct, this newly obtained phylogenetic framework has tremendous implications for our understanding of the evolution of shorebird morphology, ecology and behaviour.
Endovanilloids
Authors: van der Stelt Mario , Di Marzo Vincenzo
Published: April 2004

Endovanilloids are defined as endogenous ligands of the transient receptor potential vanilloid type 1 (TRPV1) protein, a nonselective cation channel that belongs to the large family of TRP ion channels, and is activated by the pungent ingredient of hot chilli peppers, capsaicin. TRPV1 is expressed in some nociceptor efferent neurons, where it acts as a molecular sensor of noxious heat and low pH. However, the presence of these channels in various regions of the central nervous system, where they are not likely to be targeted by these noxious stimuli, suggests the existence of endovanilloids. Three different classes of endogenous lipids have been found recently that can activate TRPV1, i.e. unsaturated N‐acyldopamines, lipoxygenase products of arachidonic acid and the endocannabinoid anandamide with some of its congeners. To classify a molecule as an endovanilloid, the compound should be formed or released in an activity‐dependent manner in sufficient amounts to evoke a TRPV1‐mediated response by direct activation of the channel. To control TRPV1 signaling, endovanilloids should be inactivated within a short time‐span. In this review, we will discuss, for each of the proposed endogenous ligands of TRPV1, their ability to act as endovanilloids in light of the criteria mentioned above.
Biochemical pharmacology of the vanilloid receptor TRPV1
Authors: Cortright Daniel N. , Szallasi Arpad
Published: April 2004

There is mounting evidence that the vanilloid (capsaicin) receptor; transient receptor potential channel, vanilloid subfamily member 1 (TRPV1), is subjected to multiple interacting levels of control. The first level is by reversible phosphorylation catalyzed by intrinsic kinases (e.g. protein kinase A and C) and phosphatases (e.g. calcineurin), which plays a pivotal role in receptor sensitization vs. tachyphylaxis. In addition, this mechanism links TRPV1 to intracellular signaling by various important endogenous as well as exogenous substances such as bradykinin, ethanol, nicotin and insulin. It is not clear, however, whether phosphorylation per se is sufficient to liberate TRPV1 under the inhibitory control of phosphatydylinositol‐4,5‐bisphosphate. The second level of control is by forming TRPV1 heteromers and their association with putative regulatory proteins. The next level of regulation is by subcellular compartmentalization. The membrane form of TRPV1 functions as a nonselective cation channel. On the endoplasmic reticulum, TRPV1 is present in two differentially regulated forms, one of which is inositol triphosphate‐dependent whereas the other is not. These three TRPV1 compartments provide a versatile regulation of intracellular Ca2+ levels. Last, there is a complex and poorly understood regulation of TRPV1 activity via control of gene expression. Factors that downregulate TRPV1 expression include vanilloid treatment and growth factor (notably, nerve growth factor) deprivation. By contrast, TRPV1 appears to be upregulated during inflammatory conditions. Interestingly, following experimental nerve injury and in animal models of diabetic neuropathy TRPV1 is present on neurons that do not normally express TRPV1. Combined, these findings imply an important role for aberrant TRPV1 expression in the development of neuropathic pain and hyperalgesia. In humans, disease‐related changes in TRPV1 expression have already been described (e.g. inflammatory bowel disease and irritable bowel syndrome). The mechanisms that regulate TRPV1 gene expression under pathological conditions are unknown but a better understanding of these pathways has obvious implications for rational drug development.
Molecular architecture of the vanilloid receptor
Authors: Ferrer‐Montiel Antonio , García‐Martínez Carolina , Morenilla‐Palao Cruz , García‐Sanz Nuria , Fernández‐Carvajal Asia , Fernández‐Ballester Gregorio , Planells‐Cases Rosa
Published: April 2004

The transient receptor potential channel vanilloid receptor subunit 1 (TRPV1) is a molecular integrator of physical and chemical stimuli in the peripheral nociceptor terminals. TRPV1 is an ionotropic channel that plays a critical role in both thermal nociception and inflammatory hyperalgesia. Structure–function relationships are providing fundamental insights of the modular architecture of this neuronal receptor. As a result, the molecular determinants that endow TRPV1 with its physiological properties, namely activation by heat, potentiation by extracellular acidic pH, and interaction with vanilloid‐like compounds, as well as its permeation properties are being unveiled. This information can now be used to build up molecular models for the protein which, upon experimental validation, could be used as tools to thrust the target‐oriented design of druggable TRPV1 ligands.
Unraveling DNA helicases
Authors: Tuteja Narendra , Tuteja Renu
Published: April 2004

DNA helicases are molecular ‘motor’ enzymes that use the energy of NTP hydrolysis to separate transiently energetically stable duplex DNA into single strands. They are therefore essential in nearly all DNA metabolic transactions. They act as essential molecular tools for the cellular machinery. Since the discovery of the first DNA helicase in Escherichia coli in 1976, several have been isolated from both prokaryotic and eukaryotic systems. DNA helicases generally bind to ssDNA or ssDNA/dsDNA junctions and translocate mainly unidirectionally along the bound strand and disrupt the hydrogen bonds between the duplexes. Most helicases contain conserved motifs which act as an engine to drive DNA unwinding. Crystal structures have revealed an underlying common structural fold for their function. These structures suggest the role of the helicase motifs in catalytic function and offer clues as to how these proteins can translocate and unwind DNA. The genes containing helicase motifs may have evolved from a common ancestor. In this review we cover the conserved motifs, structural information, mechanism of DNA unwinding and translocation, and functional aspects of DNA helicases.
Actin‐binding domain of mouse plectin
Authors: Ševčík Jozef , Urbániková L'ubica , Košt'an Július , Janda Lubomír , Wiche Gerhard
Published: April 2004

Plectin, a large and widely expressed cytolinker protein, is composed of several subdomains that harbor binding sites for a variety of different interaction partners. A canonical actin‐binding domain (ABD) comprising two calponin homology domains (CH1 and CH2) is located in proximity to its amino terminus. However, the ABD of plectin is unique among actin‐binding proteins as it is expressed in the form of distinct, plectin isoform‐specific versions. We have determined the three‐dimensional structure of two distinct crystalline forms of one of its ABD versions (pleABD/2α) from mouse, to a resolution of 1.95 and 2.0 Å. Comparison of pleABD/2α with the ABDs of fimbrin and utrophin revealed structural similarity between plectin and fimbrin, although the proteins share only low sequence identity. In fact, pleABD/2α has been found to have the same compact fold as the human plectin ABD and the fimbrin ABD, differing from the open conformation described for the ABDs of utrophin and dystrophin. Plectin harbors a specific binding site for intermediate filaments of various types within its carboxy‐terminal R5 repeat domain. Our experiments revealed an additional vimentin‐binding site of plectin, residing within the CH1 subdomain of its ABD. We show that vimentin binds to this site via the amino‐terminal part of its rod domain. This additional amino‐terminal intermediate filament protein binding site of plectin may have a function in intermediate filament dynamics and assembly, rather than in linking and stabilizing intermediate filament networks.
Functional transitions of F0F1‐ATPase mediated by the inhibitory peptide IF1 in yeast coupled submitochondrial particles
Authors: Galkin Mikhail , Venard Renée , Vaillier Jacques , Velours Jean , Haraux Francis
Published: April 2004

The mechanism of inhibition of yeast F0F1‐ATPase by its naturally occurring protein inhibitor (IF1) was investigated in submitochondrial particles by studying the IF1‐mediated ATPase inhibition in the presence and absence of a protonmotive force. In the presence of protonmotive force, IF1 added during net NTP hydrolysis almost completely inhibited NTPase activity. At moderate IF1 concentration, subsequent uncoupler addition unexpectedly caused a burst of NTP hydrolysis. We propose that the protonmotive force induces the conversion of IF1‐inhibited F0F1‐ATPase into a new form having a lower affinity for IF1. This form remains inactive for ATP hydrolysis after IF1 release. Uncoupling simultaneously releases ATP hydrolysis and converts the latent form of IF1‐free F0F1‐ATPase back to the active form. The relationship between the different steps of the catalytic cycle, the mechanism of inhibition by IF1 and the interconversion process is discussed.
Functioning parathyroid cyst on Sestamibi scan
Authors: Choi Chi‐Yee , Chow Tam‐Lin
Published: April 2004

Functioning parathyroid cyst is a rare cause of primary hyperparathyroidism. Surgeons can experience difficultly in diagnosing this condition during cervical exploration as it mimics a thyroid cyst. Preoperative localization by Sestamibi scan is limited by the volume of functioning parathyroid tissue in the cyst wall. Therefore, a high index of suspicion is required in order not to miss the abnormal parathyroid tissue. The diagnosis can be confirmed by intraoperative needle aspiration of the cyst fluid for parathyroid hormone and histological examination. A case of functioning parathyroid cyst localized by Sestamibi scan is presented.
Changing concepts of surgical treatment for haemorrhoids: From excision to reduction fixation
Authors: Cheung Hester Yui Shan , Chung Chi‐Chiu , Li Michael Ka‐Wah
Published: April 2004

A diversity of surgical procedures has been described for treating haemorrhoidal disease. The current article attempts to give an account of these procedures, based on different concepts about pathogenesis and aetiology of haemorrhoids. Surgical excision, that is, haemorrhoidectomy, has stood the challenge of time and currently remains to be the most definitive way for treating the disorder. More recently, stapled haemorrhoidopexy has emerged as a potential less painful alternative. Different from conventional excision, this is basically a mucosal reduction procedure rather similar to the Délorme's operation. The concept is exciting and initial results from different studies look promising. However, the published trials so far are limited in the following aspects – insufficient data on fourth‐degree and thrombosed haemorrhoids, complete lack of data on external haemorrhoids, unknown long‐term recurrence rate, as well as insufficient information on feasibility as a day‐case procedure. Further studies with longer follow‐up should be conducted in order to determine whether stapled haemorrhoidopexy will become the ultimate procedure in treating haemorrhoidal disease in the nearest future.
A controlled trial comparing emergency hemorrhoidectomy versus conservative treatment for acutely thrombosed hemorrhoid
Authors: LAM C.Y.W. , LAM D.T.Y. , CHOI C.Y. , CHIU P.W.Y. , LAM S.C.W. , KWOK S.P.Y.
Published: April 2004

Aim: Acutely thrombosed hemorrhoid is either treated conservatively or with emergency hemorrhoidectomy. The treatments have not been compared in a randomized controlled trial. We aim to investigate the relative effectiveness and safety of the two modes of treatment.

Methods: We performed a randomized controlled trial at the United Christian Hospital. Patients with acutely thrombosed hemorrhoids were randomized to either conservative management or emergency hemorrhoidectomy. The primary outcome was the number of days to halve the visual analog pain score (VAS). Secondary outcomes included VAS on follow‐up, early and late functional status, total analgesic requirment, days off work and complication rate.

Results: Forty‐six patients entered the trial between June 2000 and October 2001. Twenty‐three were randomized to each group. Demographic variables were similar for both groups, so was VAS on admission. The number of days taken to halve the VAS was significantly shorter after emergency hemorrhoidectomy (2.5 vs 4.2 days, P=0.001). VAS at days 14, 21, 28 were similar between the groups. The functional status (mobilization and sitting, defecatory pain) at days 3, 6, 14, 21 and 28 were also similar. Analgesic requirements and days off work were similar. There was no complication after emergency hemorrhoidectomy. After resolution, nine patients (45%) of the conservative group required hemorrhoidectomy for persistent symptoms.

Conclusion: Emergency hemorrhoidectomy relieves pain faster than conservative management. It is safe and has similar functional results as conservative management. Emergency hemorrhoidectomy is therefore the treatment of choice.
A Prospective Comparative Study Between Targeted Parathyroidectomy Under Local Anaesthesia And Conventional Parathyroidectomy In Primary Hyperparathyroidism
Authors: FUNG T.M.K. , AHUJA A.T. , LAM Y.H. , YUEN H.Y. , WONG K.T. , LAU J.Y.W.
Published: April 2004

Introduction: Minimal invasive parathyroidectomy (MIP) has evolved as a popular method in the treatment of primary hyperparathyroidism. Our study aimed to examine how effective is MIP compared to conventional parathyroidectomy.

Methods: All patients with primary hyperparathyroidism received a triage ultrasound scan. In patients who had their parathyroid glands localized by the ultrasound, parathyroidectomy was performed under local anaesthesia (LA‐MIP) via a 3‐cm incision using the lateral approach. In patients with negative imaging, they underwent conventional parathyroidectomy under general anaesthesia (GA). Cure is defined as remaining normocalcemic on follow up. The cure rate, complication rate, hospital stay and number of frozen sections utilized were compared.

Results: Forty‐four patients were treated by LA‐MIP and 37 patients were treated by GA since 1999–2003. The positive predictive value of USG localization was 97%. After a median follow up of 24 months, there were no difference in the cure rate (41/44 in LA‐MIP versus 35/37 in GA, P > 0.05) and complication rate (2/44 in LA‐MIP vs 2/37 in GA, P > 0.05). However, the LA group was found to have shorter hosptial stay (median = 1 vs 2 in GA, P < 0.05) and utilized less frozen‐sections (median = 1 vs 2 in GA, P < 0.05).

Conclusions: Ultrasound‐guided minimal invasive parathyroidectomy under local anaesthesia is as effective as conventional parathyroidectomy in the treatment of primary hyperparathyroidism. An estimated cost‐reduction of HK $14 432 was found in each case treated by LA‐MIP through utilizing less frozen‐sections, less general anaesthesia and shorter hosiptal stay.
Retrospective review on laparoscopic cholecystectomy in patients with acute cholecystitis in a community hospital
Authors: HUI S.K. , CHEUNG K.F. , FAN N. , NG W.T.
Published: April 2004

Aim: Since the first audit of laparoscopic cholecystectomy (LC) in patients suffering from acute cholecystitis in 1999–2000, the policy of early laparoscopic cholecystectomy was launched in Yan Chai Hospital. The present study aims to look at the conversion rate, complication and hospital stay.

Methods: Retrospective review of laparoscopic cholecystectomies was done for patients presented with acute cholecystitis from January 2001 to June 2003. Only patients with both clinical and histopathological diagnosis of acute cholecystitis were included. Patients presented with acute cholangitis and pancreatitis were excluded. Predictive factors including age, sex, fever, WBC, duration of symptoms, timing of surgery were analysed. Chi‐Square test and Mann–Whitney test were used for statistical analysis with significance level set at 5%.

Results: Total 141 patients with acute cholecystitis were operated with initial laparoscopic approach. Mean age was 60.1 years old. 70.9% of operation performed within 48 h after admission. The overall conversion rate was 33%. Significant predictive factors for conversion were: older patient (mean age for LC group was 58.2 years old [95%CI 54.5–61.8] and for conversion group was 64.5 years old [95% CI 60.1–68.9], P=0.046), delayed presentation (P=0.001), fever before operation (P=0.039), operation performed after 72 h after admission (P=0.026). Conversion rate for operation performed within first 24 h after admission was 26.2%. Conversion rate increased to 68% for operation performed 74 h after admission. For patients with body temperature ≥38°C before operation, conversion rate was significant higher (i.e. 50 vs 26%) (P=0.012). Conversion rates for patients with 1 day symptom and for patients with 3 days or longer symptom were 18.8% and 51%, respectively. Sex, ASA and WBC count were not significant predictive factors. The mean operation time for successful laparoscopic group was 101 min and 102 min for conversion group. Complications occurred in 14.8% of cases including chest infection (3), AMI (2), wound infection (6), CBD injury (1). Mean hospital stay was 6.6 day for successful LC group and was longer for conversion group (10.7 day).

Conclusion: Older patient, delayed presentation and fever on presentation were associated with higher conversion rate. Earlier operation was associated with successful LC. Conversion rate was similar to previous study done in 1999–2000. In coming future, efforts should be made (i.e. 24 h liver function test, radiological support) to achieve an earlier diagnosis of acute cholecystitis and hence better operative outcome.**Multiple regression analysis in progress, data will be submitted as soon as possible.
Laparoscopic repair for perforated duodenal ulcer: graham patch technique
Authors: LAM P.W.F. , LAM C.S. , HUI E.K.L. , SUN Y.W. , MOK F.P.T.
Published: April 2004

Aim: This article described the technique to avoid suture entanglement during laparoscopic Graham patch repair (LGPR) and the feasibility of the technique.

Methods: Twenty‐four patients with perforated duodenal ulcer from January 2000 to February 2004 were subjected to LGPR. The same principle of open Graham patch repair was exercised.

Result: LGPR was performed successfully in 23 males and one female, median age of 44.5. No conversion to open surgery. Median perforation size was 5 mm, range 3–10 mm. Median operative time was 80 min Median for ambulation was postoperative day 2, and postoperative stay was 4 days. Median analgesic requirement was: one dose of pethidine (50 mg imi injection) and zero tablet of dologesic. Complications included one pelvic collection treated by antibiotics, one urinary retention and one pyloric stenosis. No leakage and no wound infection.

Conclusion: LGPR was a feasible alternative for laparoscopic repair of perforated duodenal ulcer, and might be particularly suitable for larger perforation.
Management of postoperative urinary retention: a randomized trial of in‐out versus overnight catheterization
Authors: LAU H. , LAM B. , PATIL N.G.
Published: April 2004

Background: There has been no consensus on the best catheterization strategy for the management of postoperative urinary retention. A prospective randomized trial was undertaken to establish the best practice guidelines for the management of postoperative urinary retention. We also evaluated the contemporary incidence of urinary retention following different categories of general surgery and examined risk factors associated with its occurrence.

Methods: All patients who underwent elective inpatient surgery between January 2002 and June 2003 were recruited in the study. Patients who developed postoperative urinary retention were randomized to either having in‐out catheterization or placement of an indwelling catheter for 24 h after surgery.

Results: A total of 1448 patients were recruited. The overall incidence of urinary retention was 4.1% (n=60). Significant risk factors associated with postoperative urinary retention included old age, anorectal procedures and use of spinal anaesthesia. Comparison of re‐catheterization and urinary tract infection rates between patients who were treated with in‐out versus overnight catheterization showed no significant differences.

Conclusions: Postoperative urinary retention should be managed by in‐out catheterization. Indwelling catheterization for 24 h appeared to bestow no additional benefits. The incidence of urinary retention increased with age, anorectal procedures and the use of spinal anaesthesia.
Sedation with oral midazolam in adults undergoing upper gastrointestinal endoscopy: a double‐blind placebo‐controlled randomized trial
Authors: MUI L.M. , TEOH A.Y.B. , NG E.K.W. , YEUNG A.C.M. AU , CHUNG S.C.S. , LAU J.Y.W.
Published: April 2004

Aim: To investigate the effectiveness of oral midazolam as premedication in undergoing upper endoscopy (OGD).

Methods: One hundred and thirty patients were randomized to receive either 7.5 mg oral midazolam (n=65) or placebo (n=65) as premedication. Outcomes measures included anxiety score in visual analogue scale during OGD, overall tolerance, extent of amnesia, overall satisfaction, patient's willingness to repeat procedure, recovery time and haemodynamic changes after medication.

Results: The median (interquartile range [IQR]) anxiety score in midazolam group was significantly lower than in control group (2.0 IQR [0–4.9] vs 3.8 IQR [2.1–7.95]; P < 0.001). A significant greater number of patients in midazolam group graded overall tolerance as ‘excellent or good’ (P=0.002) and reported a partial or complete amnesia response (P=0.03) when compared to control group. Although there were no statistically significant differences in satisfaction score between groups, more patients in midazolam group were willing to repeat procedure if necessary (89.2 vs 69.2%; P=0.005). The median recovery time was significantly longer in midazolam group than in control group (5minutes IQR [5–15] vs 5 min IQR [5–10]; P=0.014). There were no statistically significant differences in haemodynamic changes between groups after medication.

Conclusion: Premedication with oral midazolam is a safe and effective sedation method that significantly reduces anxiety and improves overall tolerance during OGD.
A randomized controlled trial to compare the efficacy of xylocaine spray and amethocaine lozenge in preparing patients for oesophago‐gastro‐ duodenoscopy (OGD)
Authors: WONG K.F. , LEUNG S.K. , LAU K.W.
Published: April 2004

Xylocaine spray and amethocaine lozenge are used as local anaesthetic to prepare patients for OGD. Xylocaine is more widely used while the cost of amethocaine is half that of xylocaine for the use per patient. We conducted a prospective randomized controlled trial to compare their efficacy in terms of patient discomfort (patient satisfaction score) and the ease of the procedure (endoscopist score). A total of 127 patients undergoing elective OGD were recruited (from 1/9/03 to 5/1/04). They were randomly assigned by the use of random number to use either xylocaine or amethocaine as the local anaesthetic agent. There were 55 males and 75 females. 70 patients were randomized to the ‘xylocaine’ group while 57 patients were randomized to the ‘amethocaine’ group. There was no significant difference between the demographic data of the two groups. OGD was performed by a single endoscopist, who was blinded to the type of local anaesthetic used. After OGD, an independent endoscopy nurse asked the patient for the satisfaction score. There was no statistically significant difference between the two groups in terms of satisfaction scores and the ease of procedure. Both drugs were well tolerated. No complication related to drug or procedure occurred. We conclude that xylocaine and amethocaine are equally effective in preparing patients for OGD. The cost of amethocaine lozenge is lower.
Surgical complications of patient undergoing renal transplantation in China
Authors: YUNG Y.P. , MAH I.S.F. , CHAN W.H. , AU W.H. , MAN C.W.
Published: April 2004

Introduction: Owing to the severe shortage of organ donation in our locality, large number of end‐stage renal failure (ESRF) patients have to consider the option of renal transplant in mainland China. The objective of this study is to assess the complication rate of patients having renal transplantation done in China.

Patients and Method: Medical record of 119 patients with renal transplant done in China since 1/1/1990 were reviewed with particular attention to surgically related complications. Results were compared with some oversea series.

Results: 109 out of 119 patients who had received renal transplant in China are being followed up at the time of review (nine died and one dropped out for unknown reason). The mean follow time was 32 months (1–123). Surgical complications occurred in 32 patients (26%). Four graft lost due to rupture arterial anastomosis, arterial thrombosis, venous thrombosis and anastomotic pseudoaneurysm. Ten patients(8%) had renal artery stenosis requiring angioplasty. nine patients (7.5%) had wound related problems (three gapped wound, four wound infection and two incisional hernia). Two patients (1.6%) with urinary leakage. Three patients (2.5%) with ureteric stricture. six patients (5%) had perinephric collection. One patient with wound haematoma in early postop period requiring clot evacuation.

Discussion: The complications rate in our group is similar to oversea series. Renal transplantarion is the most cost‐effective treatment of ESRF. More and more patient had transplantation done in China. Patients frequently ask about the safety and results of having operation in China. Our result provide an insight into this question though more solid conclusion is required by gathering more results from other hospitals.
Two new potent and convenient predictors of mortality in older nursing home residents in Japan
Authors: Tajima Orie , Nagura Eiichi , Ishikawa‐Takata Kazuko , Ohta Toshiki
Published: April 2004

Background:  Malnourishment is closely connected with poor health outcomes in frail elderly. However, the relative importance of specific nutritional predictors of mortality remains unclear in the Japanese population. We investigated the potent nutritional factors associated with mortality from nutritional assessments of three parameters in Japanese frail elderly.

Methods:  Ninety residents in a nursing home in Japan, aged 65 and over (18 men, 72 women; mean age 82.2 ± 8.0 years) were enrolled in a 38‐month follow‐up study. The eligibility condition for analysis was having lived at the nursing home for more than 30 days, so three participants were excluded. Three nutritional parameters, which included: anthropometric measurements (body mass index, mid‐arm circumference, triceps skinfold thickness and calf circumference); serum markers (albumin, total protein, prealbumin, retinol binding protein and total cholesterol); and food intake, were assessed. After categorizing each putative factor according to tertile distribution, risk of mortality was analyzed using Cox proportional hazard models.

Results:  At the end of the 38‐month follow‐up period, 29 participants had died. After adjustment for gender, age, clinical status, and functional status, three indicators (i.e. mid‐arm circumference, triceps skinfold thickness and lipid intake) showed a significant relationship with mortality. When all of the putative factors were included in a stepwise procedure, mid‐arm circumference and lipid intake were significantly associated with adjusted mortality.

Conclusion:  Among institutionalized Japanese frail elderly, lower levels of mid‐arm circumference and lipid intake could potently predict an increased risk of mortality. These two indicators may be useful for many kinds of assessments and intervention for the improvement of health conditions in Japanese frail elderly.