bluuebunny/crossref_metadata_2025 huggingface dataset:
Shelterin: the protein complex that shapes and safeguards human telomeres
Authors: de Lange Titia
Published: September 2005

Added by telomerase, arrays of TTAGGG repeats specify the ends of human chromosomes. A complex formed by six telomere-specific proteins associates with this sequence and protects chromosome ends. By analogy to other chromosomal protein complexes such as condensin and cohesin, I will refer to this complex as shelterin. Three shelterin subunits, TRF1, TRF2, and POT1 directly recognize TTAGGG repeats. They are interconnected by three additional shelterin proteins, TIN2, TPP1, and Rap1, forming a complex that allows cells to distinguish telomeres from sites of DNA damage. Without the protective activity of shelterin, telomeres are no longer hidden from the DNA damage surveillance and chromosome ends are inappropriately processed by DNA repair pathways. How does shelterin avert these events? The current data argue that shelterin is not a static structural component of the telomere. Instead, shelterin is emerging as a protein complex with DNA remodeling activity that acts together with several associated DNA repair factors to change the structure of the telomeric DNA, thereby protecting chromosome ends.

Six shelterin subunits: TRF1, TRF2, TIN2, Rap1, TPP1, and POT1
A comparative study of the safety of 0.25% levobupivacaine and 0.25% racemic bupivacaine for paracervical block in the first stage of labor
Authors: Palomäki Outi , Huhtala Heini , Kirkinen Pertti
Published: September 2005

Background.  The objective of the study was to evaluate and compare the safety of levobupivacaine and racemic bupivacaine for paracervical block (PCB) in the first stage of labor after uncomplicated pregnancy.

Methods.  Forty women in an open pilot study and 397 women in a double‐blind randomized study received PCB for pain relief in the first stage of labor, either with 25 mg of levobupivacaine or with 25 mg of racemic bupivacaine. The incidence of cardiotocographic pathology was compared between the groups using Fisher's exact test. The 95% confidence intervals for the between‐group difference were calculated by Newcombe's method.

Results.  In the randomized double‐blind study, the incidence of any pathological result in cardiotocography (CTG) was 10.4% in the levobupivacaine group and 12.8% in the racemic bupivacaine group. The incidence of fetal bradycardia in the groups was 2.6 and 3.8%, respectively. All the cardiotocographic changes were transient, and no operative intervention was indicated because of CTG. No difference in the analgesic effect between the drugs was found. Most of the parturients in the levobupivacaine group (97%) and in the racemic bupivacaine group (96%) had spontaneous vaginal delivery. Neonatal outcome was good in both groups.

Conclusions.  No difference in cardiotocographic pathology was found between PCB with levobupivacaine compared with PCB with racemic bupivacaine. The incidence of bradycardia was low. PCB was found to be a safe pain‐relief method for low‐risk parturients.
What determines the analgesic effect of paracervical block?
Authors: Palomäki Outi , Huhtala Heini , Kirkinen Pertti
Published: September 2005

Background.  The objective of the study was to evaluate the analgesic effect of paracervical block (PCB) in labor pain relief and to discover the determinants associated with good analgesia.

Methods.  In a prospective trial, 341 women received PCB for pain relief in the first stage of labor, with 10 ml of 0.25% levobupivacaine or racemic bupivacaine. All these pregnancies were uncomplicated and the progress of labor was normal. The analgesic effect of PCB was measured by using a visual analog scale (VAS). The factors associated with good pain relief (>50% decrease in the VAS score within 30 min) were analyzed statistically by Student's t‐test or the Mann–Whitney test (continuous variables), Fisher's exact test (categorial variables) and after univariate analysis by logistic regression analysis. For pairwise comparisons, Wilcoxon's signed ranks test was used.

Results.  Good pain relief was achieved in 47.2% of the cases. 12.3% of the parturients needed subsequent epidural or spinal analgesia. In logistic regression analysis, primiparity, a high pain score before PCB, and PCB given by a specialized obstetrician were found to affect the level of pain relief 30 min after PCB.

Conclusions.  The best pain relief after PCB was achieved among primiparas. Good pain relief was connected with a high pain score before PCB and an experienced obstetrician.
Repair of recurrent vaginal vault prolapse using sacrospinous ligament fixation with mesh interposition and reinforcement
Authors: Lo Tsia‐Shu , Horng Shang‐Gwo , Huang Huei‐Jean , Lee Shu‐Jane , Liang Ching‐Chung
Published: September 2005

Objective.  Our goal was to study the efficacy of performing the repeated sacrospinous ligament fixation with mesh interposition and reinforcement in women with recurrent vaginal vault prolapse.

Materials and methods.  Fifteen consecutive patients with symptomatic severe vaginal vault or uterus prolapse after previous sacrospinous ligament fixation were enrolled. The sacrospinous ligament fixation was performed with a mesh interposition between sacrospinous ligament complex and vaginal apex. The mesh was extended to anterior and posterior vaginal wall for the repair of concurrent cystocele and rectocele, if indicated. The surgical results and complications were evaluated. The prolapse evaluation was performed according to International Continence Society (ICS) ordinal stages of pelvic organ prolapse.

Results.  The mean age was 55 years. The mean follow‐up was 2.9 years (range 1.0–5.5 years). Repeated sacrospinous ligament fixation was performed for all patients. Eleven were performed unilaterally to the right and four to the left. The average time for sacrospinous fixation was 20 min. The average blood loss for sacrospinous fixation was 75 ml. No major complication except one accidental rectotomy was observed. It was repaired intraoperatively without sequel. The concurrent pelvic surgeries included vaginal total hysterectomies, anterior colporrhaphies, posterior colporrhaphies, and tension‐free vaginal tape procedures. No recurrence of apical prolapse was observed. However, two patients developed stage I prolapse on anterior vaginal wall (cystocele) and required no further repair. Minor postoperative complications were observed.

Conclusion.  Repeated sacrospinous ligament fixation with mesh interposition and reinforcement is a safe and effective procedure for the correction of recurrent vault prolapse. The extended implanted mesh can be used for the repair of concurrent cystorectocele effectively. A long‐term follow‐up is necessary to detect any late complication.
Sympathetic denervation accelerates wound contraction but delays reepithelialization in rats
Authors: Souza Bruna R. , Cardoso Juliana F. , Amadeu Thaís P. , Desmoulière Alexis , Costa Andréa M. A.
Published: September 2005

Participation of the peripheral nervous system in wound healing is not well understood. The aim of this study was to investigate the effects of sympathetic denervation on rat excisional cutaneous wound healing. Male rats were chemically denervated with intraperitoneal administration of 6‐hydroxydopamine (6‐OHDA) in 1% ascorbic acid. 6‐OHDA or vehicle was administered twice a week until euthanasia, beginning 7 days before wounding. A full‐thickness excisional lesion was performed and the lesion area measured to evaluate wound contraction. After euthanasia, the lesion and adjacent normal skin were formalin‐fixed and paraffin‐embedded. Sections were stained with hematoxylin and eosin or toluidine blue, or immunostained for α‐smooth muscle actin. Animals treated with 6‐OHDA showed acceleration in wound contraction, increase in myofibroblastic differentiation, reduction in mast cell migration, and a delay in reepithelialization. To investigate the effects of neurogenic inflammation, a group of animals was treated with 6‐OHDA only after the acute inflammatory phase, and these animals showed delayed wound contraction 3 and 7 days after wounding when compared to those treated before the lesion. In conclusion, the present study shows that sympathetic denervation affects cutaneous wound healing, probably by a decrease in neurogenic inflammation during the initial phase of healing and the absence of catecholamines throughout the final phase.
Smoking cessation intervention in parents of young children: a randomised controlled trial
Authors: Abdullah Abu Saleh M. , Mak Yim W. , Loke Alice Y. , Lam Tai‐Hing
Published: September 2005

Objective  To examine whether telephone counselling based on the stages of change component of Transtheoretical model of behaviour change together with educational materials could help non‐motivated smoking parents of young children to cease.

Design  Randomised controlled trial.

Setting  Hong Kong Special Administrative Region, PR China.

Participants  952 smoker fathers and mothers of Chinese children aged 5 years.

Intervention  Participants were randomly allocated into two groups: the intervention group received printed self‐help materials and three‐session telephone‐based smoking cessation counselling delivered by trained counsellors; the control group received printed self‐help materials only. A structured questionnaire was used for data collection at baseline and at 1, 3 and 6 month follow up.

Main outcome measures  The main outcome is 7 day point prevalence quit rate at 6 months (defined as not smoking during the 7 days preceding the 6 month follow up) determined by self reports. Other secondary outcomes were self reported 24 h point prevalence quit rate and self‐reported continuous quit rate and bio‐chemically validated quit rate at 6 months.

Results  A total of 952 smoker fathers and mothers were randomized to the intervention (n = 467) and control (n = 485) groups. Most were daily smokers (92.4%) and the mean number of cigarettes smoked per day was 14.5 (SD = 8.9). By using intention‐to‐treat analysis, the 7 day point prevalence quit rate at 6 month follow up was significantly greater in the intervention group (15.3%; 68/444) than the control group (7.4%; 34/459) (P < 0.001). The absolute risk reduction was 7.9% (95% confidence interval: 3.78% to 12.01%). The number needed to treat to get one additional smoker to quit was 13 (95% CI: 8–26). The crude odds ratio of quitting was 2.3(95% CI: 1.5–3.5). The adjusted odds ratio was 2.1 (95% CI: 1.4–3.4) (adjusted for age, number of years smoked, and alcohol dependency).

Conclusion  Proactive telephone counselling is an effective aid to promote smoking cessation among parents of young children.
Three cases of acquired von Willebrand disease associated with systemic lupus erythematosus
Authors: Viallard J.‐F. , Pellegrin J. L. , Vergnes C. , Borel‐Derlon A. , Clofent‐Sanchez G. , Nurden A. T. , Leng B. , Nurden P.
Published: September 2005

Acquired von Willebrand disease associated with systemic lupus erythematosus (SLE) has been detected in three middle‐aged women. In each case the first clinical manifestation was a bleeding syndrome. Plasma levels of von Willebrand factor (VWF) and ristocetin‐induced platelet agglutination were as found in type 1 von Willebrand disease for the first patient, type 3 for the second patient, and type 2 for the third patient. Intraplatelet levels of VWF were normal for all three patients. In all cases a mixture of patient's plasma with normal plasma resulted in inhibition of ristocetin‐induced binding of VWF to normal platelets. Intravenous immunoglobulin given to patients 2 and 3 corrected the plasma VWF level of the second patient but not that of the third. Therapy with corticosteroids was partially beneficial for patient 3 and patient 2. For patient 2, the severity of the cutaneous lesions also led to the use of cyclophosphamide, and this therapy resulted in total correction of VWF levels. Our observations confirm previous reports of acquired von Willebrand syndrome associated with SLE and show heterogeneity both in the phenotypic form and in the response to treatment.
The effect of a natural antioxidant on the stability of heat‐treated paprika
Authors: Ladrón de Guevara Ricardo Gómez , Bernabeu Rodolfo , Picazo Marta Isabel , González Manuel , Varón Ramón
Published: September 2005

The colour loss occurring in a paprika made from the dehydrated fruits of pepper, Capsicum annuum L. var. Ocal (control), was compared with the colour lost by a similar paprika submitted to an industrial sanitation process involving water vapour. The heat treatment resulted in a considerable greater loss of colour when the paprika was stored at 25 °C in different relative humidities (0, 23, 57 and 75%) compared with the control paprika. The study also analysed the effect of adding a natural antioxidant (rosemary extract at 1%) to the heat‐treated product. In this case, colour stability increased significantly in all the conditions assayed; the lower the humidity, the greater the increase in stability.
Psychiatric nurses’ response to suicidal psychiatric inpatients: struggling with self and sufferer
Authors: GILJE F. , TALSETH A. G. , NORBERG A.
Published: September 2005

Research on nurses’ responses to suicidal patients is sparse. The purpose of this secondary analysis of qualitative data from interviews with 19 nurses employed in Norway was to describe nurses’ responses to suicidal psychiatric inpatients. Thematic analyses revealed four themes: ‘struggling with discernment of self and sufferer’; ‘reconciling inner dialogue’; ‘opening up while envisioning self from sufferer’; and ‘revisioning the meaning of life revealed over time’. The main theme was ‘struggling with self and sufferer’. While these findings reveal existential issues and self reflections of psychiatric nurses’ struggle with the suffering of suicidal patients, they also contribute to a methodological debate. Further research is needed to examine nurses’ responses to suicidal patients in various settings and to develop secondary analysis of qualitative data.
Engulfment‐regulated proteolysis of SpoIIQ: evidence that dual checkpoints control σK activity
Authors: Jiang Xin , Rubio Aileen , Chiba Shinobu , Pogliano Kit
Published: September 2005

During Bacillus subtilis sporulation, the engulfment checkpoint is thought to directly regulate late forespore transcription but to indirectly regulate late mother cell transcription, via the σG‐produced protease SpoIVB. We here demonstrate that SpoIIQ is subject to σG‐independent, but engulfment‐dependent, proteolysis that depends on SpoIVB. Thus, SpoIVB produced before engulfment supports some SpoIVB‐dependent events, suggesting that its activity or access to substrates must be regulated by engulfment. Furthermore, a mutation (bofA) that allows σK to be active without σG does not allow σK activity in engulfment mutants, although the pro‐σK processing enzyme (SpoIVFB) is localized to the septum in engulfment mutants, suggesting that engulfment comprises a second checkpoint for σK Finally, we find that SpoIIQ and another protein required for σG activity (SpoIIIAH), which directly interact and assemble helical structures around the forespore, recruit the σK‐processing enzyme SpoIVFB to the forespore and these structures. We suggest that these foci serve a synapse‐like role, allowing engulfment to simultaneously control both σG and σK, and integrating multiple checkpoints and signalling pathways.
Diurnal variation of the δ13C of pine needle respired CO2 evolved in darkness
Authors: PRATER JAMES L. , MORTAZAVI BEHZAD , CHANTON JEFFREY P.
Published: September 2005

The δ13C of pine needle CO2 evolved in darkness (δ13Cr) for slash pine trees (Pinus elliottii) was determined by placing recently collected pine needles in darkness and collecting respired CO2 over a short time period (< 15 min). δ13Cr measurements were made over several 24 h periods to test the hypothesis that significant variation in δ13Cr would be observed during a diurnal cycle. The δ13Cr measurements from the 24 h time series trials showed a consistent midday 13C‐enrichment (5–10‰) relative to bulk biomass. The δ13Cr values became more 13C‐depleted at night and following shading, and approached bulk‐biomass δ13C values by dawn. The effect of night‐time respired 13C‐enriched CO2 on the δ13C value of the remaining assimilate is shown to be minimal (13C depleted by 0.22‰) under field conditions for P. elliottii needles.
The Power of Networks: Integration and Financial Cooperative Performance
Authors: Desrochers Martin , Fischer Klaus P.
Published: September 2005

Abstract**:  The purpose of this paper is to perform a cross‐country survey of the level of integration of systems of financial cooperatives (FC) and its effect on measures of performance. We develop a classification scheme based on a theoretical framework that builds on published work using transaction cost economics (TCE) to explain integration of large numbers of financial cooperatives into networks. We identify three critical levels of increasing integration we call respectively atomized systems, consensual networks and strategic networks. Further, we test some of the propositions that result from the theoretical framework on an international sample of financial cooperative systems. Based on this analysis we can conclude that: (i) Integration is less (more) important in developing (more developed) countries and for very small (large) financial cooperatives as a determinant of efficiency. However, integration tends to reduce volatility of efficiency and performance regardless of development. (ii) Integration appears to help control measure of managers’ expense preferences that tend to affect performance of FC. (iii) Despite high costs of running hub‐like organizations in highly integrated system, these systems economize in bounded rationality and operate at lower costs than less integrated systems.
Why do Agricultural Credit Cooperatives Merge? The Portuguese Experience
Authors: Cabo Paula , Rebelo João
Published: September 2005

Abstract**:  Over the last decade, increasing financial problems in the Portuguese Agricultural Credit Cooperatives (ACCs), mainly difficulty in gathering equity, have forced them to pursue an intensive merger activity. This paper describes the economic reasons that have led the ACCs to merge, and analyses the ex post merger impact on their economic performance. The results show that: (a) incorporating ACCs are larger, more profitable and hold a better credit management; (b) incorporated ACCs are smaller, face difficulties in reaching a minimum efficient scale and have weaker credit management as well as leverage problems; and (c) merged ACCs have a heavy administrative cost structure and also face profitability problems. Regarding the mergers’ ex post impact on the ACCs performance, we find no positive influence on cost reduction, credit management and solvency ratio.
Membrane‐coating Granules and the Intercellular Cementing Substance (Membrane‐coating Material) in the Epidermis in Different Regions of the Equine Hoof
Authors: Anthauer K. , Mülling C. , Budras K.‐D.
Published: September 2005

This study aimed to carry out a comprehensive morphological examination of the structure and ultrastructure of the membrane‐coating granules (MCG) and membrane‐coating material (MCM) common to all hoof segments as well as segment‐specific features in the MCG and MCM regarding their synthesis, structure and biochemical composition. Tissue samples from the hooves of the left front and right hind limb of 20 adult riding horses were used. Samples were preserved and embedded for histological routine methods as well as for histochemical techniques and tracer techniques for light and electron microscopy. The MCM shows a segment‐specific structure, biochemical composition and function, which were demonstrated for the different parts of the hoof. The MCM and its properties are related to the segment‐specific horn quality. Besides intercellular structural factors the MCM is of major importance for the structural integrity and the biomechanical properties of the hoof horn. The physiological structure and composition of MCM provides explanation for the existence of clinically well‐known sites of predilection for hoof disorders such as the White Line Disease. Alterations of the MCM play a role in dysfunction and diseases of the hoof epidermis; they are particularly involved in the pathogenesis of infectious diseases of the hoof.
Oral health workforce in rural and remote Western Australia: Practice perceptions
Authors: Kruger Estie , Tennant Mark
Published: September 2005

Objective:  In this study an analysis was undertaken to determine: (i) the major factors that influence oral health professionals to practise in rural areas and determine practice location; (ii) what assists the professional oral health workforce to remain in rural practice; and (iii) what the main reasons are for leaving rural practice.

Design:  A postal survey was undertaken among all registered oral health professionals in Western Australia.

Setting:  Rural and remote Western Australia.

Participants:  Registered dental therapists, dental hygienists and dentists in rural and remote Western Australia.

Results:  Results indicated that there are various factors that attract people to rural and remote areas, other than financial incentives. Incentives to remain in rural practice include the need for professional development. The most common reason for leaving rural practice was to access children's educational facilities.

Conclusions:  This study emphasises that many factors contribute to recruitment and retention of dental professionals in rural practice. A broad integrated retention strategy is needed to address oral health workforce shortage issues in rural and remote Western Australia.
Intracytoplasmic sperm injection: a review of risks and complications
Authors: Woldringh Gwendolyn H. , Kremer Jan A.M. , Braat Didi D.M. , Meuleman Eric J.H.
Published: September 2005

In the mini‐review section this month, there are four reviews on different subjects: intracytoplasmic sperm injection, photodynamic therapy in prostate cancer, and the roles of re‐TUR and intravesical chemotherapy in superficial bladder cancer.

There is a fifth paper in the section which is not a mini‐review, but rather a short appreciation of Terence Millin, a pioneer in urological surgery, and a great surgical innovator.
Efficacy of nilutamide as secondary hormonal therapy in androgen‐independent prostate cancer
Authors: Nakabayashi Mari , Regan Meredith M. , Lifsey Deborah , Kantoff Philip W. , Taplin Mary‐Ellen , Sartor Oliver , Oh William K.
Published: September 2005

OBJECTIVE

To evaluate the activity of nilutamide as secondary hormonal therapy in patients with androgen‐independent prostate cancer (AIPC), as treatment options are limited for these patients and secondary hormonal therapy with antiandrogens has advantages, including low toxicity, oral administration and high patient acceptance.

PATIENTS AND METHODS

We retrospectively identified 45 patients with AIPC who were treated with nilutamide as secondary hormonal therapy in two institutions. The decrease in prostate‐specific antigen (PSA) levels, side‐effects of treatment, and the relationship between baseline characteristics, type and duration of previous therapy and response to nilutamide were assessed. Most patients received oral nilutamide at 150 mg/day.

RESULTS

Eighteen of 45 evaluable patients (40%) had a PSA level decrease of ≥ 50%. Responders (PSA decline ≥ 50%) had a median (range) time to progression of 4.4 (0.31–44.7) months. There were responses to nilutamide whether used as the second to fifth line of hormonal therapy. There were no differences in response to nilutamide based on clinical stage, type of local therapy, PSA level at diagnosis or initiation of nilutamide, or type of previous antiandrogen therapy. Responders were more likely to have received monotherapy with luteinizing hormone‐releasing hormone analogues or orchidectomy as first‐line hormonal treatment (P = 0.02). The most common reversible adverse effects were mild to moderate visual adaptation effects, reported in 20% of patients.

CONCLUSIONS

Nilutamide appears to be an effective secondary hormonal therapy in patients with AIPC and is associated with a mild toxicity profile.
Secondary‐care treatment patterns in the UK for women with urinary incontinence
Authors: Wagg Adrian , Gupta Roben Das , Assassa Philip , Shaw Christine , Mayne Chris , Martin Mona
Published: September 2005

OBJECTIVES

To describe the treatment trends for women with urinary incontinence (UI) after their referral from primary to secondary care, as despite the high prevalence of UI within the female population, relatively few women actively seek treatment for their UI and fewer reach secondary care.

PATIENTS AND METHODS

We retrospectively reviewed the notes of patients attending in two randomly selected months in five hospital sites in the UK. Records were identified through outpatient clinic lists, surgery lists, nursing and physiotherapy lists. Data were collated and analysed for trends

RESULTS

In all, 412 women (mean age 54.6 years, sd 12.6) covering 1406 visits to secondary care were covered by the study. Most women had a symptomatic diagnosis of mixed UI and mild to moderate UI, as defined by their physician. Most women had conservative therapies by either continence nurses or physiotherapists, regardless of the severity of their condition; 73% had cystometry and 39% were recommended for surgical intervention.

CONCLUSIONS

Women largely undergo similar procedures in secondary care. Most present with mixed UI. The perceived severity of disease did not preclude a trial of conservative therapies.
Familial multiple endocrine neoplasia type I: the urologist is first on the scene
Authors: Christopoulos Constantinos , Antoniou Nikos , Thempeyioti Anastasia , Calender Alain , Economopoulos Panagiotis
Published: September 2005

OBJECTIVE

To study the urological manifestations of familial multiple endocrine neoplasia type 1 (MEN‐1).

PATIENTS AND METHODS

The study included 26 adults (median age 38.5 years, range 18–80) from two unrelated MEN‐1 pedigrees. In 15 of the patients the diagnosis was confirmed by genetic analysis, while in the rest the diagnosis was based on clinical criteria combined with genealogy data.

RESULTS

Urolithiasis associated with primary hyperparathyroidism was present in 65% of MEN‐1 patients and in 77% of those who were symptomatic. In 68% of patients complications of urolithiasis (renal/ureteric colic, urinary tract infection) were the presenting clinical manifestations of MEN‐1, whereas in 50% they constituted the only clinical manifestation of the syndrome. The mean time from the onset of symptoms of urolithiasis to the diagnosis of the polyendocrinopathy was 17.2 years. Initial failure to recognize the presence of MEN‐1 in patients with primary hyperparathyroidism led to conservative parathyroid surgery, with subsequent relapse of the hyperparathyroidism, requiring re‐operation. Serious renal morbidity included one case of pyonephrosis necessitating nephrectomy. While urolithiasis was a cardinal clinical manifestation of MEN‐1, there was otherwise considerable phenotypic polymorphism, even among patients bearing the same MEN1 gene mutation.

CONCLUSION

In patients with familial MEN‐1 the complications of urolithiasis are the commonest presenting clinical manifestations and the cause of significant morbidity. In the presence of a family history of renal stones, appropriate investigations may lead to the timely diagnosis of this important, albeit rare, disorder.
Assessing the size and stage of testicular germ cell tumours: 1984–2003
Authors: Bhardwa Jeetesh M. , Powles Tom , Berney Dan , Baithun Suhail , Nargund Vinod H. , Oliver R. Tim D.
Published: September 2005

OBJECTIVE

To assess the size and stage of testicular tumours on presentation in the period 1984–2002.

PATIENTS AND METHODS

Demographic details and information on staging on 550 patients treated at St. Bartholomew's and the Royal London Hospital in the period 1984–2002 were collected prospectively in the departmental database. Information on testicular size was obtained by reviewing the histopathology records, and the maximum dimension of the tumour as measured in the gross specimen was taken as the size of the testicular tumour.

RESULTS

The period 1984–2002 was divided into three intervals, i.e. 1984–95, 1996–98 and 1999–2002. The mean testicular tumour size in the three intervals decreased from 4 cm (162 tumours) to 3.2 cm (85) and 2.5 cm (72; P = 0.002, Student's t‐test). The proportion of tumours of <2 cm on presentation also increased, from 11% to 14% and 23% in the three intervals, respectively, while the proportion of patients with stage 1 disease increased from 57%, to 63% and 77%, respectively.

CONCLUSIONS

The size of testicular tumours on presentation has shown a consistent decline in the last two decades, the mean size now being 2.5 cm. That 23% are now <2 cm raises the possibility of testis‐preserving surgery in this young group of patients, who have an excellent prognosis, and therefore in the long‐term issues such as psychological morbidity and natural fertility assume greater importance. There is a need for a randomized controlled trial to evaluate these issues.
Percutaneous nephrolithotomy with ultrasonography‐guided renal access: experience from over 300 cases
Authors: Osman Mahmoud , Wendt‐Nordahl Gunnar , Heger Katrin , Michel Maurice S. , Alken Peter , Knoll Thomas
Published: September 2005

OBJECTIVE

To report our experience with over 300 patients treated with percutaneous nephrolithotomy (PNL), for although PNL was established as a treatment in the 1970s, its use diminished with the introduction of extracorporeal shockwave lithotripsy (ESWL); clinical experience with ESWL showed its limitations, and the role of PNL for treating urolithiasis was redefined, which with improvements in instruments and lithotripsy technology has expanded the capability of percutaneous stone disintegration.

PATIENTS AND METHODS

The study included 315 patients (156 males, 159 females, aged 13–85 years) treated with PNL in our department between 1987 and 2002. The mean (range) stone diameter was 27 (7–52) mm. The kidney was punctured under ultrasonography guidance via a lower‐pole calyx whenever possible. The working channel was dilated using an Alken dilator under X‐ray control. If necessary, a flexible renoscope was used. Ultrasonic, pneumatic and laser probes were used for lithotripsy.

RESULTS

Four weeks after treatment the total stone‐free rate was 96.5%; 45.7% of all patients were primarily stone‐free, 21.3% had clinically insignificant residual stones that passed spontaneously within 4 weeks after PNL, and 33% of the patients needed auxiliary measures (a second PNL, ESWL, ureterorenoscopy). Overall, the early complication rate was 50.8%, the most common complications being transient fever (27.6%), clinically insignificant bleeding (7.6%) or both (3.2%); 3.5% of the patients developed urinary tract infections (with no signs of urosepsis), 3.2% had renal colic and 2.9% upper urinary tract obstruction. One patient (0.3%) developed acute pancreatitis after PNL; one died from urosepsis and one needed selective angiographic embolization of the punctured kidney due to bleeding. No patient required transfusions and there were no injuries to neighbouring organs.

CONCLUSIONS

These results show that PNL causes no significant blood loss or major complications in almost all patients. Two aspects may especially reduce the potential complications: ultrasonography‐guided renal puncture and using PNL in an experienced centre. PNL is a highly efficient procedure that provides fast and safe stone removal.
The Four Little Dragons: An Enthusiast's Reading Guide
Authors: Hicks George
Published: September 2005

This article surveys literature which attempts to explain the success of east Asia's four little dragons ‐ Korea, Taiwan, Hong Kong and Singapore. The approach is chronological, with the period 1960–88 divided into phases marked by shifts in economic thought.

In general, the explanations of economists have lagged years behind events, with predictive exercises usually proving spectacular failures. On the whole, the neo‐classical economists have had the best of the arguments, as they have been able to show that good policies are of crucial importance.
Exchange Rate Regimes in the Asian‐Pacific Region
Authors: Garnaut Ross
Published: September 2005

This survey is designed to complemenl Treadgold's on Macroeconomic Manugement (APEL March 1990) by reviewing the literature on exchange rate regimes with reference to the Asian‐Pacific region. After a brief typology of exchange rate regimes, the article discusses the choice between currency system, the relationship between choice of regime and policy objectives, constraints on choice of regimes, the distinction between ‘traded’ and ‘non‐traded’ goods, the ‘booming’ export sector case and finally the relevance of regulatory distortions and the related question of transition from one regime to amiher.
Urbanization Issues in the Asian‐Pacific Region
Authors: Jones Gavin W
Published: September 2005

Various aspects of urbanization – including the rapid growth of urban, especially metropolitan populations, increasing levels of urban primacy, rural‐urban migration and the infrastructure needs generated by these trends – have exercised the minds of Asian‐Pacific planners for decades. The policy responses have varied, but, apart from a lack of unanimity on appropriate policy goals, there has been a general failure to recognize that broad macro‐economic or sectoral policies may have greater spatial impact than measures, often rather feeble, adopted for their direct spatial effects.

The paper reviews urbanization trends in the Asian‐Pacific region, and discusses the causes of urbanization. It then briefly reviews the public policy responses recommended in the literature or actually practised in the region. A series of issues in urban policy and planning are then discussed.
Pacific Economic Co‐operation:
Authors: Elek Andrew
Published: September 2005

The rapid growth of East Asian exports in the 1980s led to rising trade tensions. Trading partners, especially in the USA and Europe, tended to overlook the substantial growth of East Asia's imports (especially raw materials and capital equipment), focusing only on its capture of market shares in products for which US and EC manufacturers no longer held a comparative advantage. There is considerable interest in economic regionalism, raising concern about the division of the world economy into discriminatory trade blocs.

In most economies around the Pacific, there is wide appreciation of the region's overwhelming interest in the maintenance of an open world trading system based on the non‐discrimination principle of the GATT. Among initiatives for bilateral and regional trade liberalization in recent years, the Asia Pacific Economic Co‐operation (APEC) forum offers perhaps the best prospect of co‐operative promotion of these objectives. APEC, established in 1989, already includes fifteen economies from both sides of the Pacific accounting for over half of world production. APEC's guiding principles stipulate that co‐operation should be outward‐looking, building consensus on a gradually broader range of economic issues.

This paper proposes four pragmatic options in areas for useful co‐operation:

Improving market access by reducing barriers to trade, such as the heavy protection of some parts of Northeast Asian agriculture, and of textiles and some other manufactures in major OECD countries.

Reducing uncertainty about future market access: for example, agreement to streamline dispute settlement procedures could reduce resort to arbitrary or discriminatory measures to deal with trade tensions.

Reducing physical bottlenecks, such as shortfalls in infrastructure, ranging from harbours to telecommunications, which impede trade in goods and also in services such as tourism.

Harmonizing domestic legislation and rules, such as those relating to safety, quality and environmental standards.

It will not be easy to realize the economic gains from nondiscriminatory trade liberalization. But progress should be possible in some sectors where complementarity among APEC economies is obvious, as in mineral processing, where original reasons for protection have been weakened by changing circumstances, and where natural resource endowments and transport costs limit effective competition from outside the region. Regional initiatives will need to be non‐discriminatory in order to avoid creating needless divisions in the world trading system.

Preferential or discriminatory trading arrangements that fragment the multilateral world trading system constitute a threat to the Pacific region's economic prosperity. In contrast, this paper recommends an evolutionary approach: seeks early consensus on less contentious issues in order to build the sense of trust required for more effective future co‐operation among economies on both sides of the Pacific, without discrimination against economies outside the region.
Air Transport in the Asian–Pacific Region
Authors: Findlay Christopher , Forsyth Peter
Published: September 2005

Air transport in the Asian–Pacific region is growing faster than anywhere else. Asian airlines (other than Japanese) are the lowest cost operators in the world. But like all airlines, they operate in a tightly regulated framework. Some 2000 bilateral air service agreements among 160 countries specify which airline flies on a route, what capacity it offers and how much capacity third–country airlines are allowed. The regulatory system is now coming under various pressures: from the growth of a tourist industry demanding lower fares, from increased competition with the emergence of a new generation of low–cost airlines, and from the US ‘mega carriers’ and their alliances. The airlines of the region have the opportunity to benefit from these changes in the regulatory environment. But this will require a more trade–oriented approach to aviation than some countries of the region now have.

A number of guiding principles for civil aviation policy in the 1990s suggest themselves

More liberal arrangements for the allocation of traffic rights would benefit the regional economies

Such liberalization is possible within the current bilateral system, but faster progress would be achieved through regional negotiations

Such regional negotiations are likely to make greater progress if conducted jointly with other trade issues

There remains a role for GATS (General Agreement on Trade in Services) type arrangements, especially in relation to so–called ‘soft rights’, and in laying down ground rules for regional negotiations.
Food Price Policy in East Asia
Authors: Anderson Kym
Published: September 2005

The primary objective of this survey is to examine the extent to which the available empirical literature suggests that economies of East Asia are following the policy trend of earlier industrialising economies in gradually changing from taxing to assisting food producers in the course of their economic development. More specifically, the survey attempts (a) to summarise the trends in agricultural incentives in East Asia; (b) to examine briefly the literature on motivations for those policy trends; and (c) to mention some of the future trade and policy implications.
The Information Revolution in the Asian‐Pacific Region
Authors: Lamberton Don
Published: September 2005

In this paper, an attempt is made to survey literature dealing with these developments in the Asian‐Pacific region. Section I explores the information sector. Section II focuses on telecommunications, the leading edge of the information infrastructure. Section III reviews writing about ‘IT‐led development’, the view of information technology as a powerful tool for the promotion of socioeconomic development. Section IV looks at the role of the World Bank, the largest single hard‐currency source of finance for telecommunications in developing countries. Section V reports on some aspects of IT trade and internationalisation. Section VI provides summary country case studies. Section VII raises some questions about the link between telecommunications and economic development.
Intellectual Property Rights in the Asian‐Pacific Region: problems, patterns, and policy
Authors: Konan Denise Eby , La Croix Sumner J. , Roumasset James A. , Heinrich Jeffery
Published: September 2005

This paper explores recent theory and evidence regarding increased protection of intellectual property rights (ZPRs) in Asia. Knowledge has significant public good aspects making optimal provision a problem of trading off universal access against adequate incentives for R&D. Given the ease of evasion of IPR relative to tariffs, attempts to push low and middleincome countries to higher levels of protection may be against their national interests. The Uruguay Round may encounter less than enthusiastic enforcement. Further efforts to refine IPR protection might usefully be focused on flexibility instead of harmonisation.
Water Resources in the Asia‐Pacific Region: Managing Scarcity
Authors: Rosegrant Mark W. , Meinzen‐Dick Ruth S.
Published: September 2005

Irrigation, together with improved crop varieties and substantial growth in fertiliser use in the late 1960s through the early 1980s, was a key factor in stimulating strong agricultural growth in much of the Asia‐Pacific region. New sources of water are increasingly expensive to exploit, but irrigation continues to be a major catalyst for agricultural growth. In the face of increasing degradation, the maintenance of the water resource base must be a high priority policy objective. This paper reviews the management of water resources in the Asia‐Pacific region, for countries with significant irrigated area: Cambodia, China, Indonesia, Korea‐DPR, Republic of Korea, Laos, Malaysia, Mongolia, Myanmar, Philippines, Thailand and Vietnam.
Rural‐to‐Urban Migration in China*
Authors: Wu Harry X. , Zhou Li
Published: September 2005

One consequence of economic reform in China has been the greatly accelerated migration of labour from rural areas to cities. Estimates suggest an annual migrant labour flow of around 50‐60 million people, of whom 10–15 million have settled permanently in cities. This article surveys the information that has become available from a number of population and labour surveys. It covers the volume, spatial and temporal dimension of rural‐to‐urban migration, the characteristics of migrant labourers, the determinants of migration and the impact of migration on China's rural and urban economy.
Diversity and Identity in the Non‐profit Sector: Lessons from LGBT Organizing in Toronto
Authors: Smith Miriam
Published: September 2005

The objective of this paper is to explore the ways in which diversity is taken into account in the conceptualization, definition and role of the voluntary sector as well as policy debates around the recasting of relations between the state and the voluntary sectors. The paper is based on a study of voluntary sector organizing among lesbian, gay, bisexual and transgender (LGBT) citizens in the city of Toronto. It presents an overview of LGBT voluntary sector organizing in the city, demonstrating the rich network of non‐profit organizations that serve the LGBT community in the city of Toronto, Canada's largest city. The paper argues that the dominant cross‐national and cross‐time definitions of the voluntary sector do not account for some of the specific features of LGBT organizing and result in the marginalization of such organizing from the very concept of the voluntary sector. The paper discusses the implications of this mapping for policy discussions of the state–voluntary sector relationship. Drawing on the Canadian experience of government consultation with voluntary sector organizations, the paper demonstrates that such initiatives define certain forms of diversity in voluntary sector organizing out of the policy‐making process. Traditional policy‐making around voluntary sector issues is organized in ways that exclude urban and local identity‐based organizing.
Health Policy and the Politics of Evidence
Authors: Milewa Timothy , Barry Christine
Published: September 2005

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence‐based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre‐eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision‐making in the National Institute for Health and Clinical Excellence (NICE)—an organization established by the British government in 1999 to decide whether selected health technologies should be made available throughout the National Health Service in England and Wales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal—founded on a discursive appropriation of the idea of the “common good”—goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision‐making.
SPIRITUALITY AS A NATURAL PHENOMENON: BRINGING BIOLOGICAL AND PSYCHOLOGICAL PERSPECTIVES TOGETHER
Authors: Hay David , Socha Pawel M.
Published: September 2005

Abstract. Working in Britain and in Poland, the authors independently arrived at an interpretation of spirituality as a natural phenomenon. From the point of view of the British author, spirituality is based on a biological predisposition that has been selected for in the process of evolution because it has survival value. In several important ways this approach is in harmony with the psychological perspective of the Polish author that sees spirituality as a socioculturally structured and determined attempt to cope with the existential human situation. Thus interpreted, spirituality is a human universal appearing in many secular as well as religious forms, although its most typical manifestations have been in religious experience. In this essay we discuss research data in support of this theoretical point of view and highlight some of the issues in bringing the two theoretical perspectives together.
COGNITIVE SCIENCE AND HATHAYOGA
Authors: Goldberg Ellen
Published: September 2005

Abstract. Cognitive science and hathayoga both make emphatic claims about the relationship between the body and the mind. To examine this complementary relationship I draw upon the five main approaches currently being used by cognitive science and then consider their implications within the context of three specific points of contact with hathayoga theory: the rejection of dualism, the nature of consciousness, and the role of the nervous and circulatory systems in religious experience. This type of comparative analysis can provide additional information about the nature of consciousness and the potential practices that heighten our awareness or knowledge of it. Consequently, cognitive science offers a new and provocative way to dialogue with Indian yoga traditions in terms of the methods and theories of modernity.