bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards an Integrated Approach? Food Inspection Reforms in Canada and the European Union
Authors: Ugland Trygve , Veggeland Frode
Published: October 2008

Policy integration has become a fashionable concept among policy-makers at national and international levels over the last two decades, and both Canada and the European Union have adopted food safety policy integration as a central objective. This comparative study analyses how this objective has played out in the recent reforms of the Canadian and EU food inspection systems. The article argues that similar patterns of integration can be identified along the vertical dimension as a result of the development of stronger policy and program coordination capacities at the centre. In terms of horizontal integration, the EU food inspections system appears more consistent, interdependent, and structurally connected around the overriding food safety objective of protecting the health of the population.
The “Securitisation” of HIV/AIDS in Sub-Saharan Africa: A Critical Feminist Lens
Authors: O’Manique Colleen
Published: October 2008

This paper offers an account of how the HIV/AIDS pandemic in Sub-Saharan Africa (SSA) is understood as a threat to security, placing the various accounts of the securitisation of AIDS in the context of the human security situation in SSA. The first section examines in a very general way, the context of the “security crisis” of AIDS in Africa. The second part identifies the ways in which the HIV/AIDS pandemic is being “securitised”, and some of the potential implications of emerging security discourses for HIV/AIDS policy on the continent. It closes with an account of some of the more critical human security accounts on HIV/AIDS in SSA and finally, suggests how a critical feminist lens might broaden and deepen these perspectives.
Human Security as “Freedom from Want”: Inequities and Health in South Africa
Authors: MacLean Sandra J
Published: October 2008

It is frequently assumed that people’s health is determined primarily by their access to technically-based disease treatment, the standard of which is decided by national health policies that allocate health services. However, evidence suggests that population health is determined more by social status and gradients than by access to clinical care. Moreover, in the present era, there is concern that economic globalisation is exacerbating inequities within countries, thus contributing to greater human insecurity. This paper examines these issues in the context of South Africa since the end of apartheid. It argues that the ANC government’s attempts to reduce entrenched inequities in the health system and address the broad social determinants of health have been severely constrained by pressures of economic globalisation, which have induced the government to abandon the objectives of its socially-responsive Reconstruction and Development Programme (RDP) in favour of the neoliberal Growth, Employment and Redistribution Programme (GEAR).
Structuring Neoliberal Governance: The Nonprofit Sector, Emerging New Modes of Control and the Marketisation of Service Delivery
Authors: Evans Bryan , Richmond Ted , Shields John
Published: October 2008

Governments in the Anglo-American democracies have restructured their relationships with nonprofit organisations (NPOs). New modes of control have emerged which represent the paradox of centralised decentralisation. We examine the impacts on NPO financing, accountability and human resources. While the experience of Canadian NPOs is used to illustrate the impact of neoliberal induced restructuring, comparative evidence suggests that the Canadian experience is broadly representative. The imposition of neoliberal governance structures on nonprofit service providers serves to compromise their autonomy and advocacy function, while commercialising nonprofit operations and imposing burdens that have strained organisational capacity. The neoliberal model of market-based regulation has moved many nonprofit service organisations away from their community oriented focus and towards a “business model”. In various forms, the state has introduced quasi-markets or, at a minimum, required NPO’s to engage in more competitive practices with negative consequences for nonprofit mission, culture and labour-management practices. The result is a growing level of instability within the sector.
Indigenous Nationhood Claims and Contemporary Federalism in Canada and the United States
Authors: Steinman Erich
Published: October 2008

Vibrant indigenous communities have not only survived in both the United States and Canada but have recently been advancing a variety of renewed political claims. Central among them are claims to nationhood status and treatment as sovereign governments rather than as racial or ethnic minority groups. While initially following parallel trajectories, these respective efforts have produced surprising and divergent results to date. Although the acceptance of robust indigenous self-government is much more a feature of Canadian public discourse, and robust aboriginal self-government has been affirmed in a few unique but high-profile cases, federally-recognised tribal governments in the United States in general exercise more substantive governmental powers. This article addresses this puzzle and attempts to explain the observed respective changes in terms of both the political status of indigenous groups and federalist political structures. Utilising a comparative approach closely examining the two cases regarding a number of key factors, the analysis presented here identifies the source of the divergence in “Policy feedback” from three historical differences between the two post-colonial nations. Prior actions regarding recognition of inherent indigenous sovereignty, the forced breakup of tribal lands, and ties to the British Crown shaped the political channels through which tribal nationhood claims were promoted in the present. Contingently rather than deterministically, these political channels led to the distinctive outcomes in each nation.
Europeanisation and Environmental Policy Change
Authors: Ladi Stella
Published: October 2008

Environmental policy is one of the most regulated and one of the most Europeanised policy areas. This article analyses the concept of Europeanisation, discusses its mechanisms, the mediating factors that lead to change and its possible outcomes. It explores the relationship of specific mechanisms and mediating factors to policy convergence, inertia and divergence. The particularities of environmental policy are presented and a distinction between substantive and procedural policies is made. It is argued that a tendency to convergence of national environmental policies that goes beyond the borders of the EU and further than the “hard” mechanisms of Europeanisation can be observed.
A (Slow) Burning Issue: Convergence in National Regulation of Dioxins from Incineration
Authors: Weibust Inger
Published: October 2008

Since the 1980s, industrialised countries have shown substantial convergence in their regulation of dioxin from municipal solid waste incineration. Despite significant convergence in emissions limits, countries vary substantially in their timing, with some acting much sooner than others. What explains the observed convergence? New scientific information is an important permissive condition for convergence. The findings are most consistent with a mechanism of transnational communication, although independent problem solving cannot be ruled out. The actions of international NGOs do not appear to be significant in explaining the outcome. European Union directives and international agreements did not lead on this issue, although they have pushed the laggards to act. What explains the variation in timing across countries? Patterns of adoption are not explained by levels of dioxin exposure, as those countries with higher reliance on incineration and greater exposures tended to regulate later than others. Domestic political factors account for delayed responses in laggards.
Examining Influences of EU Policy on Instrument Choice: The Selection of a Green Certificate Trading Scheme in Sweden
Authors: Åstrand Kerstin
Published: October 2008

This paper explores the circumstances of the Swedish selection of an obligatory green certificate trading scheme over other policy instruments. The choice of policy instruments in the energy policy area is bound to the international context and in Europe to the European Union (EU). The aim of this paper is to examine the relative influences of European policies on the selection of certificate trading for stimulation of renewable electricity production. The paper turns to the ideas of Europeanisation to analyse influences from European policy on domestic instrument choice process. The empirical findings confirm the Europeanisation theories which suggest that European policies can affect domestic policy changes despite lack of prescribed measures. The study shows that the EU guidelines on state aid invoked a need to change support scheme, together with domestic factors: a programme coming to an end, a policy commitment to increase the share of new, renewable electricity production and budget restrictions. EU policies strengthened existing preferences for a market-based support scheme and influenced the dominant actors’ expectations about the future, providing additional justification of their instrument preferences. On the whole, this paper illustrates how the notion in economic theory to make use of the market for resource management has proliferated strongly in Swedish energy policy making.
How Should We Theorise Public Policy? Problem Solving and Problematicity
Authors: Turnbull Nick
Published: October 2008

The concept of policy problem informs the scholarly study of policymaking as well as policy practice. But the problem solving theory of policymaking has many conceptual shortcomings. The problem solving concept is flawed because it defines complex problems univocally, obscuring differences of opinion; focuses on problem solving at the expense of problem setting; and represents the policy process scientifically to disguise and/or suppress the contingent nature of political reasoning. The propositional basis of theories of the policy process excludes problematicity and produces a fragmented theory which misrepresents the political nature of policymaking. By building upon an epistemology of questioning we can address these shortcomings by revising and expanding the problem concept in policy theory. Such a conception implies that policy studies is not distinctive because it is applied and should therefore be integrated with political theory.
Metaphor, Catachresis and Equivalence: The Rhetoric of Freedom to Fly in the Struggle over Aviation Policy in the United Kingdom
Authors: Howarth David , Griggs Steven
Published: October 2008

This article investigates the dynamics of current aviation policy in Britain by examining the consultation process surrounding the New Labour government's 2003 strategic plan to expand airport capacity in the UK. It examines the way in which the Freedom to Fly coalition structured the terrain of public reasoning and debate so as to negate or at least contain those voices that challenged the Labour government's desire for expansion. The article draws upon recent developments in post-Marxist discourse theory to examine the rhetorical strategies and mechanisms by which organic intellectuals welded together a diverse range of pro-expansion interests, thus securing agreement that the demand for growth ought to be the overriding demand to be defended in the policy and public domains. In so doing, the article examines three rhetorical logics – those of rhetorical redescription, catachresis and equivalence – showing how these informed the new and successfuldiscourse of aviation expansion.
“Every Virus Tells a Story”: Toward a Narrative-Centred Approach to Health Policy
Authors: Orsini Michael , Scala Francesca
Published: October 2008

Combining insights from narrative inquiry and participatory policy analysis, this article analyses the “illness narratives” of people with hepatitis C, a blood-borne liver disease that affects millions of people around the world. In particular, we explore how a narrative-based approach to health politics and policy can illuminate our understanding of the social dimensions of health and illness. In incorporating the “experiential” knowledge of people living with this chronic condition, we seek to challenge the dominant approach of Evidence Based Medicine, in which randomised controlled trials operate as the Gold Standard against which all other forms of evidence are judged. Narrative approaches can be particularly useful, we argue, when examining newly emerging illnesses that are only beginning to receive public attention. Moreover, in the case of chronic illnesses such as hepatitis C, which can be relatively invisible in a public and media landscape dominated by diseases with dramatic, “punchy” storylines, rendering an illness “narratable” may be an important task of the policy analyst.
Techno-bureaucratic Doxa and Challenges for Deliberative Governance: The Case of Community Forestry Policy and Practice in Nepal
Authors: Ojha Hemant R
Published: October 2008

Despite repeated pleas for participatory and deliberative governance of environmental resources, there is still a predominance of technocratic values in environmental decision-making. This is especially true in the context of forest management in the Global South where centralised and technically-oriented colonial approaches of the past continue to be reproduced and exclude affected people to have their say and share in forest related decision-making and benefit distribution. Taking a case study from Nepal's Community Forestry Program, this paper shows that despite major shifts towards practices of participatory forestry, the technocratic domination of forest science in governance has taken new and more subtle forms (considered “doxa” – taken for granted forms – after Bourdieu) of control over forestry practices. In this paper, techno-bureaucratic doxa is problematised as a key challenge to deliberative governance, and specific ways are illustrated through which it constrains deliberation in forest governance. Emerging moments of crisis in this doxa are also identified to explore possibilities for greater citizen-public official deliberation in forest governance.
Social Economy Policies as Flanking for Neoliberalism: Transnational Policy Solutions, Emergent Contradictions, Local Alternatives
Authors: Graefe Peter
Published: October 2008

While early assessments of neoliberalism stressed its destructiveness, more recent analyses have begun to consider and assess how its consolidation has involved the creation of new institutions and governmentalities to stabilise emergent contradictions and instabilities. This article traces how the social economy has been positioned in the OECD's public policy discourse as a flanking mechanism, and especially the friction in these policy proposals between an “entrepreneurial” vision that attempts to extend market relations and the social capital/social cohesion vision of meeting unmet needs and promoting participation in voluntary organisations. The tension between the entrepreneurial and social capital visions is a recurrent theme in the national case studies canvassed here, with the former frequently crowding out the latter. The article concludes by looking at how the women's movement in Québec, Canada, has attempted to exploit this tension to push policies beyond neoliberalism.
Korupsi dan Disintegrasi in Indonesia since Suharto
Authors: King Peter
Published: October 2008

This article argues that Indonesia since reformasi remains subject to powerful tendencies for disintegrasi – both province-based “separatism” and general socio-political decay. These tendencies are greatly aggravated by the failure of democratically elected presidents and parliaments to effectively tackle endemic corruption or reform the armed forces, which continue to enjoy near-total immunity as a major practitioner, guarantor and enforcer of corrupt business practice and extortion. The article notes the activism of civil society and liberal media on the corruption issue and the commendable new array of anti-corruption institutions. But it argues that reform efforts have been virtually nullified by broad collusion of Indonesia's political, bureaucratic, military and business elites in sustaining – but also “democratising” and decentralising – the system of corruption inherited from Suharto. Change must await new social and political struggles initiated outside the parliamentary arena which itself has become a major source of KKN (Korupsi, Kolusi dan Nepotisme).
East Asia's Quest for a Regional Community
Authors: Kikuchi Tsutomu
Published: October 2008

This article analyses the processes of East Asian community-building, by incorporating competing interpretations on how to organise international relations in East Asia. It also examines the complicated diplomatic instruments adopted as a means of responding to the increasing uncertainties and anxieties caused by dramatic changes in the broader geopolitical and geoeconomic environment.
Ten Questions about East Timor for which we need Answers
Authors: Tanter Richard
Published: October 2008

Determining the social, political and economic basis of the outbreak of violence in Timor during early 2006 leads to questions about the nature and form of that conflict itself and its implications for Australian security policy. Until questions about the nature of recent political dynamics in East Timor and the intersection of patronage politics, foreign linkages and the possible manipulation of regional identity are determined, we cannot be sure of the kind of conflict the Timorese and those who would help them at risk of their lives are facing.
Discursive Contest between Liberal and Literal Islam in Southeast Asia
Authors: Zubaidah Rahim Lily
Published: October 2008

The paper focuses on the impact of global Islamic revivalism and state Islamisation initiatives on the cultural practices, institutions and laws in Southeast Asia's Muslim majority states of Malaysia and Indonesia. In particular, the assault on adat and the reconfiguration of legal and political structures with the intrusion of Wahabi-inspired literal Islam from West Asia are considered. As the discursive contest between literal and liberal or progressive Islam will have a major impact on the direction and outcome of the protracted War on Terror, it is imperative that the discursive advances of the former are countered by reinforcing democratic structures and institutions and addressing localised sociopolitical and economic grievances. In the long term, liberal Islam's inclusive and flexible worldview based on ijtihad and universal humanism are likely to prove more effective than the reliance on draconian security-orientated measures in the protracted War on Terror.
Contested Narratives, Ambiguous Impacts and Democratic Dilemmas: The Western News Media and the “War on Terror”
Authors: Tiffen Rodney
Published: October 2008

Because the essence of terrorism is to produce a psychological impact far greater than its physical impact, the relationship of contemporary international terrorism with the news media has often been called symbiotic, with publicity described as the oxygen on which terrorism lives. Although this view is in many respects true, it over-simplifies a more ambiguous, varied and complex reality, and in any case, the policy options open to Western democratic governments in limiting this ‘oxygen’ are very limited both normatively and pragmatically. Equally important, but attracting much less scholarly and popular attention, is the news media's role in the problematic politics of counterterrorism. Here the attraction of heroic narratives to both media and governments – for their own different reasons – creates coincidences of interest. Powerful metaphors such as the war on terror encourage strategies which may be substantially ineffective, perhaps even counter-productive, while politically benefiting the governments adopting them.
Imagining the Past: Memory Wars in Japan
Authors: Fujiwara Kiichi
Published: October 2008

This paper examines the ways in which Japanese nationalism is undergoing a shift from civic nationalism, based on separation of state and society, to a more organic statist nationalism, where state and society merge. It asserts that the “new nationalists” are engaged in a symbolic process of reconnecting the present to the past and by doing so, defending the nation's integrity
Caught in a Staples Vise: The Political Economy of Canadian Aquaculture
Authors: Rayner Jeremy , Howlett Michael
Published: October 2008

Aquaculture in Canada is a small, rapidly-growing high-technology resource sector “caught in a staples vise”. On the one hand it is an archetypal case of a new “post-staples” resource industry: combining high capital intensity and sophisticated technology to produce a new, post-staples, version of a classic staple resource – food fish. On the other, it perpetuates many of the same social and economic problems and issues that plagued traditional staples political economies: namely a hinterland location and heavy export reliance. And, as is the case with most intensively farmed technologically- intensive foodstuffs its rise and rivalry with the wild fishery is intense and conflictridden, with much distrust and debate a feature of contemporary aquacultural expansion. This article assesses these contradictory and sometimes conflicting developments in a resource industry for the most part situated in a very uneven transition towards a post-staples political economy.
A New Staples Industry? Complexity, Governance and Canada’s Diamond Mines
Authors: Fitzpatrick Patricia J
Published: October 2008

The discovery of indicator minerals in the Slave geological province began a staking and development rush that, in a little over a decade, saw Canada becoming one of the world’s largest producers of diamonds. An examination of the institutions surrounding the development of the first two diamond mines illustrates the complexities associated with mineral development. An emerging picture of a new approach to the northern staples-based economy reveals efforts to promote responsible economic development within a sound environmental framework. Furthermore, this approach necessarily involves the incorporation of a group of policy actors with agendas, needs, and requirements qualitatively different from those of traditional resource developers and producers. Thus the new diamond projects are proceeding in a way that is qualitatively different from historical practices that have governed staples based development in the mineral sector.
Offshore Petroleum Politics: A Changing Frontier in a Global System
Authors: Clancy Peter
Published: October 2008

Off-shore oil and gas development is often thought of as a classic mature staple sector, where hydrocarbons are extracted from a remote and physically challenging hinterland, by highly capitalised enterprise, to realise profit from sale and consumption in distant markets. There are, however, reasons to look more closely at this political economy of the offshore domain, particularly from the perspective of Hutton’s post-staples hypothesis. To begin, offshore oil and gas is a relative late-arrival to the staple trade. This means that its regulatory regimes have been infused with social policy concerns that were not present in the formative eras of terrestrial petroleum. Other features arise from the “offshore” location, where a thrust toward integrated oceans policy has emerged in recent decades and threatens to erode the sectoral autonomy of the petroleum domain. Offshore oil and gas developments are one of the new “unconventional” energy sources which have emerged in Canada over the last two decades as oil prices have risen and conventional domestic sources declined.
From Black Gold to Blue Gold: Lessons from the Petroleum Trade Regime for an Emerging Water Trade and Investment Regime
Authors: McDougall John
Published: October 2008

Water resources in Canada are “potential” or “quasi-staples”. That is, the exploitation of water resources has featured many of the aspects of a staples industry such as their large-scale, technologically influenced, rural-based, bulk-commodity characteristics, but lack others, especially a traditional staples export orientation. However, this situation is changing. In the electricity case, deregulation in both Canada and the US markets has resulted in the emergence of a new production regime in Canada, one that is approaching a typical “mature” staples industry, albeit with the new environmental regulations and conditions for participation of a much broader spectrum of “stakeholders” which bears some resemblance to a ‘post-staples” model. The same is true of water resources as a whole where, for almost two decades, one of the most controversial concerns raised by Canadian opponents of free trade with the United States was that it would lead to the large scale export of water from Canada. Should this come to pass, this commodity would become a “staple” and the water industry which would emerge in Canada would move from “potential” to “actual”
Is Foreign Aid Compatible with Good Governance?
Authors: Araral Eduardo
Published: October 2008

Is foreign aid compatible with good governance? Using the case of irrigation aid in the Philippines, I hypothesise that aid is embedded in a perverse set of incentives which could undermine the application of good governance principles espoused by donors. My findings suggest that the problems of “moral hazard” and aid fungibility are embedded in irrigation aid. Furthermore, these incentives also drive a vicious cycle in irrigation commonly found in many developing countries. These findings indeed suggest that incentives structured into the relationship between donors and irrigation agencies may undermine the application of some principles of good governance espoused by donors.
Health Reforms in Rajasthan: An Empirical Study on Agencification
Authors: Singh Avantika
Published: October 2008

Agencification, or the carving out of independent agencies from the government, is a New Public Management approach for restructuring government through separation of the policy formulation and policy implementation functions. This research is devoted to an empirical investigation of agencification in the public health system of the State of Rajasthan in India. The objective of this research is to make a meaningful contribution to the understanding of the rationale for agencification, composition of agencies, autonomy and control of agencies, and service delivery by agencies. This research employs organisation theory perspectives such as interorganisational relations to explicate mechanisms for achieving functional integration and coordination between agencies and parent departments.

Agencies studied in this research are legally independent bodies with not-for-profit status, which function within the policy framework provided by the parent ministry/department. However, there is no explicit performance contracting and accountability for results, and the idea of agencies is path dependent and linked to the reforms process. Because of resource dependence, agencies achieve functional integration with the parent ministry/department. Most of the agencies deliver services through a network of private providers and voluntary organisations, which establish coordination through the exchange of resources and information. Coordination is more formalised and dependent on Memorandums of Understanding (MoUs), contracts and paper-based reports than on trust, norms, reciprocity and informal communication.
Technocratic Solutions versus Political Realities: Implementing Governance Reforms in the Balochistan Province of Pakistan
Authors: Ahmad Raza , Akif Syed A A
Published: October 2008

Almost immediately after taking power in 1999, Pakistan’s fourth military regime articulated a seven point agenda that in large measure entailed governance policy shifts – the key being decentralization of powers and democratic local governance. Pakistan’s Poverty Reduction Strategy Paper (PRSP) articulated these goals in the pro-poor growth framework. The international aid community favoured this reform climate and the Asian Development Bank (ADB) took a lead in supporting public sector reforms especially by way of improving sub-national governance in a federal context. This paper focuses on the reform agenda articulated through ADB assisted Balochistan Public Resource Management and the complementary devolved social services programs. While it is still early to assess the impact of these policy shifts, we conclude that improved service delivery through better fiscal management is a long term goal. The ongoing reforms are located within and impacted by historically difficult federal-province relations and a highly contested political climate. There is an inherent danger of institutional reforms being appropriated by entrenched elites. In conclusion, subnational reforms cannot be isolated from the imperatives of federalism, local patrimonial structures i.e. the political economy context. Development agenda[s] should overtly address politics in designing and implementing governance reform programs.
The Ethics of Problem Representation: Widening the Scope of Ethical Debate
Authors: Bacchi Carol
Published: October 2008

This paper makes a case for extending the scope of ethical reflection and debate in public policy beyond the current tendency to confine ethical scrutiny to the behaviours of individual politicians or public servants, and/or to a restricted set of issues characterized as “moral” issues, decided by “conscience” (eg abortion, euthanasia, etc.). It argues that reflecting on the ways in which public policies construct or represent social “problems” provides a rationale for broadening ethical scrutiny to the basic purposes of government. This is because the ways in which policy “problems” are represented (problem representations) have a range of ethical implications for targeted groups and individuals and for the general population, in terms of people’s sense of self-worth, their participation in democratic decision-making, and their ability to live full and meaningful lives.
Ethics and Issues in Public Policy
Authors: Provis Chris
Published: October 2008

Several reasons can be identified which discourage issues from being defined as “ethical” issues in public policy making. One is the cost of resolving ethical issues, another is that it is harder to predict what the outcomes will be of argument and discussion about ethical issues, and a third is that identifying issues as ethical makes salient the prospect for allocating moral responsibility and blame. Efforts to increase the scope of market mechanisms are associated with avoidance of ethical issues, since markets offer routine, quasi-mechanical processes to resolve disagreement. However, to avoid definition of issues as ethical problems tends to push aside some concerns which it is important to address as part of human life.
The Ethics of Problem Representation in Public Education Policy: From Educational Disadvantage to Individual Deficits
Authors: McInerney Peter
Published: October 2008

This paper explores the ways in which notions of educational disadvantage have been reshaped and redefined in policy discourses during the ascendancy of neo-liberal governance in Australia. Over the past decade there has been a pronounced shift away from social democratic traditions of social justice towards more market-individualistic approaches that have called into question the ethical responsibilities of governments when it comes to challenging inequitable educational policies and practices. Commonwealth policy now leaves little place for socially produced disadvantage, as manifestations of disadvantage are typically described in educational terms and hence to be redressed by schools. What is most disturbing is that the problem is now being constructed around individual deficits, rather than structural inequalities. I conclude with a brief outline of ethical alternatives to current policies.
Endoscopic Removal of Foreign Bodies in Children
Authors: Lin Chien‐Heng , Chen An‐Chyi , Tsai Jeng‐Dau , Wei Sung‐Hsi , Hsueh Kai‐Chung , Lin Wei‐Ching
Published: October 2008

The ingestion of foreign bodies such as coins, fish bones, plastic toy parts, batteries, and needles is common in children. Although the majority of ingested foreign bodies pass through the gastrointestinal tract unaided, some children require either nonsurgical or surgical intervention. The medical records of children who presented to the pediatric emergency department of a single tertiary referral center between December 2001 and May 2006 were reviewed. A total of 87 patients underwent an endoscopic procedure because of suspected foreign body ingestion and foreign bodies were identified by endoscopy in 74 patients (85.1%). The mean age of these 74 patients was 3.4 years (range, 6 months to 13 years). The most common site of foreign body lodgment was the esophagus (n=38,51.4%); other sites included the stomach (n=33,44.6%) and duodenum (n=3, 4.0%). The types of foreign bodies included coins (n=42, 56.8%), button batteries (n = 16, 21.6%), sharp objects (n = 9, 12.2%), chicken bones (n = 2, 2.7%) and others (n=5, 6.7%). Only two foreign bodies (button batteries) in the duodenum could not be removed successfully by endoscopy. Instead, they were moved into the intestine and then eliminated spontaneously the following day. There were no major complications caused by foreign body ingestion or endoscopic procedures. The outcome of all patients was uneventful without morbidity or mortality. In our experience, endoscopic removal of foreign bodies under general anesthesia is an effective and safe method in children; the method also prevents erosion and perforation of the gastrointestinal tract.
Epidemiologic Study on Work‐related Eye Injuries in Kaohsiung, Taiwan
Authors: Ho Chi‐Kung , Yen Ya‐Lin , Chang Cheng‐Hsien , Chiang Hung‐Che , Shen Ying‐Ying , Chang Po‐Ya
Published: October 2008

To describe the epidemiologic features of work‐related eye injuries in Kaohsiung, a hospital‐based study was performed. Four hundred and eighty‐six patients who were treated at emergency service or were admitted to the ophthalmology ward over a 4‐year period were reviewed. Among these, 38.9% of eye injuries in the study were work‐related. Male workers had a 3.99 higher odds ratio (OR) than females to suffer from eye injuries (95% confidence interval [CI], 1.99‐8.04). Most of the work‐related eye injuries occurred in subjects who were 30‐49 years old (OR, 3.02, and 95% CI, 1.56‐5.82, when compared with those aged ≤29 years). The most common type of eye injury in the occupational exposure group was foreign body injury (31.2%), followed by blunt injuries (20.6%), chemical burn (19.6%), UV light radiation (12.7%), and corneal abrasions (11.6%). On the other hand, in the non‐occupational exposure group, the most common types of eye injury were blunt injuries (43.4%), corneal abrasions (28.3%), and foreign body injury (20.2%). Our study found that foreign body injury and blunt injuries were the two highest priority injuries for which prevention strategies should be developed in Kaohsiung city. Furthermore, after advanced examination of types of media that caused eye injuries, we found that being hit by wooden objects around the eye, by flying objects in the eye, and by welding flashes are important risk factors for workers to avoid. In conclusion, most of the occupational eye injuries occurred among male workers aged 30‐49 years. Due to the lack of an occupational eye injury surveillance system to monitor the incidence of eye injuries and to undertake risk assessment, preventable occupational eye injuries have not been properly controlled. We hope to provide information for further development of preventive strategies.
Exacerbation of Symptoms of Lumbar Disc Herniation Complicated by a Schwannoma: A Case Report
Authors: Liu Sen‐Yung , Lin Yueh‐Min , Wei Ta‐Sen , Lin Shan‐Ju , Liu Chen‐Chen , Chou Chii‐Wen
Published: October 2008

Herniation of the lumbar disc is a common cause of low back pain. Conservative management with physiotherapy, such as lumbar spine traction, is usually effective. Although a schwannoma of the lumbar spine is relatively uncommon, the clinical manifestations are similar to those of lumbar disc herniation, making the diagnosis difficult. This case report describes a 51‐year‐old male who had suffered from low back pain for 3 years and who was diagnosed with L2/L3 lumbar disc herniation. The low back pain was well‐controlled by conservative treatment and the symptoms improved progressively. Two months prior to our evaluation, however, the symptoms worsened acutely, and were accompanied by the onset of symptoms of cauda equina syndrome. A small tumor at the site of the L2/L3 disc herniation, observed incidentally during magnetic resonance imaging, was responsible for the symptoms of spinal stenosis at the lumbar region. The patient underwent laminectomy, tumor resection, and discectomy with near‐complete resolution of symptoms. In patients with lumbar disc herniation that improves with conservative treatment, the recurrence of symptoms should prompt a thorough review of the medical history, physical examination, and imaging studies to establish the diagnosis and prevent delay in treatment.
Effects of Verapamil and Procainamide on Acute Atrial Electrical Remodeling Induced by Short‐term Rapid Atrial Pacing in Humans
Authors: Chu Chih‐Sheng , Lee Kun‐Tai , Cheng Kai‐Hong , Lin Tsung‐Hsien , Lee Min‐Yi , Voon Wen‐Choi , Sheu Sheng‐Hsiung , Lai Wen‐Ter
Published: October 2008

Atrial electrical remodeling (ER) after spontaneous or pacing‐induced atrial fibrillation has been previously described in humans. We investigated atrial ER induced by a 5‐minute period of rapid atrial pacing and the pharmacologic effects of verapamil and procainamide on this atrial ER phenomenon. The atrial effective refractory periods (ERPs) at drive cycle lengths of 400 (ERP400) and 600 (ERP600) ms, at five representative atrial sites (high right atrium [HRA]; proximal, middle and distal coronary sinus; interarrial septum), were determined in 20 patients at baseline and immediately after cessation of a 5‐minute period of rapid pacing from the HRA at a rate of 150 bpm. The degrees of atrial ERP400 and ERP600 shortening after pacing were calculated as acute atrial ER. The same protocol was repeated in another 15 patients after intravenous administration of verapamil (0.15 mg/kg) and in another 15 patients after intravenous administration of procainamide (15 mg/kg). The results demonstrated that, in the control state acute atrial ER can be significantly demonstrated at each atrial representative site (p<0.001). The mean ERP400 and ERP600 shortenings were 9+4% and 8+4%, respectively. After procainamide infusion, but not after verapamil, baseline ERP400 and ERP600 values were significantly prolonged at the five representative atrial sites (p < 0.01). Acute atrial ER could still be demonstrated at each atrial site after procainamide or verapamil infusion (p < 0.001). In conclusion, acute atrial ER can be demonstrated after only a 5‐minute period of rapid atrial pacing in humans. Intravenous verapamil or procainamide does not abolish this ER process.
Minimally Invasive Total Hip Arthroplasty Using a Posterolateral Approach: Technique and Preliminary Results
Authors: Lin Yu‐Chuan , Chen Chung‐Hwan , Huang Hsuan‐Ti , Su Jiing‐Yuan , Fu Yin‐Chih , Chang Je‐Ken , Wang Gwo‐Jaw
Published: October 2008

Minimally invasive total hip arthroplasty (THA) has become popular over the past few years. The advantages of this technique include reduced soft tissue damage. On the other hand, there are new risks related to reduced visualization. The widespread introduction of minimally invasive THA is still controversial. Here, we present our experiences and early results with a posterolateral approach to minimally invasive THA. Between August 2005 and July 2006, 85 hips from 79 consecutive patients were operated on using posterolateral minimally invasive THA. The outcomes were assessed on the basis of clinical and radiographic parameters. The mean operative time was 55 minutes. The mean length of hospital stay was 5.3 days. Average postoperative Harris hip score was 92.0 at 3 months postoperatively Complications included only one (1.18%) intraoperative nondisplaced calcar split. There were no cases of dislocation, neurovascular injury or postoperative infection. Our study indicates an early result of low complication rate and good functional recovery following minimally invasive THA using a posterolateral approach. This minimally invasive THA technique provides short‐term safety and efficacy.
Lateral Rotation of the Lower Extremity Increases the Distance Between the Femoral Nerve and Femoral Artery: An Ultrasonographic Study
Authors: Hsu Hung‐Te , Lu I‐Chen , Chang Yin‐Lung , Wang Fu‐Yuan , Kuo Yi‐Wei , Chiu Shun‐Li , Chu Kuong‐Shing
Published: October 2008

Femoral nerve block (FNB) is by far the most useful lower extremity regional anesthetic technique for the anesthesiologist, and high‐resolution ulrrasonography is a useful tool with which to guide the performance of FNB. However, the relationships between the femoral nerve and the femoral artery in different lower extremity positions have rarely been discussed. The purpose of this study was to evaluate the relative positions of the femoral nerve and artery at different lateral rotational angles of the lower extremities using ultrasonographic imaging. We enrolled 41 healthy volunteers in this study Two‐dimensional ultrasonographic images of the femoral nerve were obtained using an ultrasound unit, in the inguinal crease, for four positions of the bilateral lower extremities: 0°, 15°, 30° and 45° lateral rotation of each extremity. The following assessments were made in each position: minimal skin‐to‐nerve distance (SN) and deviation of nerve‐to‐landmark (femoral artery pulsation) horizontal distance (NF). A trend towards lateral rotation of both lower extremities was identified. The Pearson correlation values between rotational degree to SN and rotational degree to NF were −0.216 and 0.430, with p values of 0.001 and less than 0.001, respectively. Body mass index had a good correlation (r=0.76‐0.78) with SN. The results of our ultrasound study revealed that the more lateral the rotation of both lower extremities, the closer the femoral nerve was to the skin and the farther away it was from the femoral artery. In order to increase the success rate and decrease the rate of complications, a suggested lateral 45° rotation of both lower extremities is strongly recommended when performing FNB using the peripheral nerve stimulator technique or the field block technique. In any situation, individual ultrasound guidance is recommended for FNB whenever possible.
Laparoscopic Partial Nephrectomy: The Effect of Preoperative Tumor Embolization
Authors: Li Ching‐Chia , Chou Yii‐Her , Wu Wen‐Jeng , Shih Ming‐Chen , Juan Yung‐Shun , Shen Jung‐Tsung , Liu Chia‐Chu , Huang Shu‐Pin , Huang Chun‐Hsiung
Published: October 2008

The purpose of this study was to describe our initial experience with preoperative tumor embolization for laparoscopic partial nephrectomy. Between September 2003 and August 2004, six patients with solid hypervascular renal rumors were treated with a combination of preoperative tumor embolization and laparoscopic partial nephrectomy. Ethanol (100%) was used to preoperatively embolize all major vessels supplying the tumor. The laparoscopic partial nephrectomy procedure was performed without clamping the renal vessels. The mean tumor size was 2.9 cm (range, 2.0‐4.0 cm). Mean estimated blood loss was 177 mL (range, 40‐410 mL). Mean laparoscopy time was 243 minutes (range, 160‐290 minutes). Histopathology demonstrated an infected cyst in one patient and a pTl renal cell carcinoma in five patients, including a specimen with a positive tumor margin. After a mean follow‐up period of 30 months (range, 25‐36 months), neither residual rumor nor recurrent tumor was identified by imaging studies in any of the six patients. Our initial experience suggests that preoperative embolization for the treatment of hypervascular renal rumors might reduce blood loss during subsequent laparoscopic partial nephrectomy, especially in procedures in which the renal vessels are not clamped. Preoperative tumor embolization may also help prevent the disastrous effect of incomplete tumor resection. A longer follow‐up will be necessary to confirm efficacy.
Acute Urinary Retention Due to Retrovesical Hematoma: A Case Report
Authors: Akgul Turgay , Polat Osman , Nuhoglu Baris , Ayyildiz Ali , Germiyanoglu Cankon
Published: October 2008

Acute urinary retention is a urologic emergency, which has a meaningful impact on patients' quality of life. The compression of retrovesical hematoma is a rare cause of urinary retention. We report the presentation and discuss the differential diagnosis of acute urinary retention due to retrovesical hematoma in a 57‐year‐old male patient.
Discordant Findings of Skeletal Metastasis Between Tc99m MDP Bone Scans and F18 FDG PET/CT Imaging for Advanced Breast and Lung Cancers—Two Case Reports and Literature Review
Authors: Chen Yu‐Wen , Huang Ming‐Yii , Hsieh Jan‐Sing , Hou Ming‐Fung , Chou Shah‐Hwa , Lin Chih‐Liang
Published: October 2008

Traditionally, Tc99m methyl diphosphate (MDP) bone scintigraphy provides high‐sensitivity detection of skeletal metastasis from breast and lung cancers in regular follow‐up. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), based on the glucose metabolism of malignant cells, plays a role in describing rumor growth, proliferation of neoplasm and the extent of metastasis. In general, concordant findings of skeletal metastasis are seen on both types of image, especially in cases of breast and lung cancer. However, there were extremely discordant findings of skeletal metastasis between bone scans and F18 FDG PET/CT imaging in two cases among 300 consecutive F18 FDG PET/CT follow‐up exams of patients with malignancies, during the past year, in our center. Both cases, one of breast cancer and one of lung cancer, had negative bone scintigraphic findings, but a diffusely high grade of F18 FDG avid marrow infiltration in the axial spine, leading to the diagnosis of stage IV disease in both cases. Owing to variant genetic aberrance of malignance, F18 FDG PET/CT reveals direct evidence of diffuse, rapid neoplasm metabolism in the bone marrow of the spine, but not of secondary osteoblastic reactions in vivo. F18 FDG PET/CT should always be employed in the follow‐up of patients with malignancies.
Mechanisms of Cough Syncope as Evaluated by the Valsalva Maneuver
Authors: Sharma Vijay K. , Chan Bernard P.L.
Published: October 2008

Transcranial Doppler is often employed for the assessment of cerebral hemodynamics. The study by Chao et al in the February 2007 issue of the journal raises some important issues regarding the understanding of the mechanisms involved in cough syncope. We suggest including some additional monitoring parameters, for example, end‐tidal or arterial carbon dioxide levels, transcranial Doppler waveform patterns and their characteristics in studies of patients with orthostatic hypotension. Vasomotor reactivity testing, especially in stenotic cerebral arteries, under controlled circumstances, may provide a quantitative assessment of cerebral autoregulation.