bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving cellular function through modulation of energy metabolism
Authors: Maes D. , Collins D. , Declercq L. , Foyouzi‐Yousseffi R. , Gan D. , Mammone T. , Pelle E. , Marenus K. , Gedeon H.
Published: September 2004

The ambivalent consequences of mitochondrial stimulation on cellular activity have been well established. Mitochondria supply the cell with energy through a process of oxidative phosphorylation but thereby generate free radicals, resulting in the accumulation of hydrogen peroxide in the cytoplasm. We have investigated the impact of cellular senescence as well as UV irradiation, on the balance between these two activities.

The adenosine triphosphate (ATP) level, DNA and protein synthesis in fibroblasts obtained from donors between 30 and 90 years of age appeared to be significantly influenced by the aging process. Both DNA and protein synthesis could be stimulated by increasing intracellular ATP levels. In‐vitro senescent fibroblasts showed a reduction in the level of ATP as well as a shift in mitochondrial membrane potential. At the same time, there was an increase in intracellular hydrogen peroxide with increasing population doubling, indicating a clear dysfunction of the metabolic machinery in the mitochondria of senescent cells. To counteract this degradation of the energy pool, we treated cells with creatine, which is known to restore the pool of phosphocreatine in the mitochondria. Creatine treatment significantly increased cell survival after UV exposure, stimulated the repair of UVB‐induced DNA damage in keratinocytes and caused a significant reduction in the number of sunburn cells in a UVB‐exposed reconstituted skin model. These results clearly indicate that restoration of the energy pool in mitochondria increased cellular self‐defense mechanism. These data show the important role played by the mitochondrial energy metabolism on the aging process, and indicate a possible therapy that can be used to counteract this negative effect. Treatment with creatine seems to provide the necessary boost to the cellular metabolism, which leads to an induction of a significant amount of protection and repair to human skin cells.
Evaluation of fatigue caused to human body by solar exposure by measuring brain function performance
Authors: Horikoshi T. , Matsue K. , Takahashi T. , Ishii H. , Yamada K. , Hayashi S. , Yabune M. , Murakami M. , Kajimoto O.
Published: September 2004

Following direct exposure to sunlight while pursuing leisure activities, many have noticed a strong sense of fatigue in the evening. In this regard, our results of a survey of awareness showed that the development of fatigue from solar exposure of the body was generally recognized. On the other hand, a tool for objective and quantitative determination of mental fatigue has recently been reported. Known as the Advanced Trail Making Test (ATMT), it is a method of evaluating brain function. In the present study, we attempted to determine fatigue development caused by exposure of the human body to solar radiation using ATMT results. For 3 days in the summer season, 15 male subjects (26–41 years old) received exposure to the sun equivalent to 100 kJ cm−2 of ultraviolet radiation three to four times each day. During the periods of exposure, the subjects wore short‐sleeved shirts and short pants, and covered their heads with a towel. Following the 3‐day period, they were divided into two groups based on their subjective evaluation of a sense of tiredness, fatigued (n = 10) and non‐fatigued (n = 5). In the fatigued group, a significant increase in the subjective score for fatigue sense was observed in the evening of all 3 days following sun exposure, as well as in the morning of the third day, as compared with those in the non‐fatigued group. Further, a significant increase in average ATMT value was also observed in the fatigued group in the evening of the first and second days following sun exposure, as well as in the morning of the third day. These results indicate that ATMT may be a useful evaluation tool for quantitative and objective measurement of mental fatigue caused by exposure to sunlight.
The structure of consciousness and the physiological characteristics of the skin regarding skin transparency: comparison between the young and middle‐aged and elderly women
Authors: Seiya T. , Nomura M. , Hayashi S. , Hasegawa T.
Published: September 2004

Transparency of the skin is an important keyword that is frequently used in questionnaires related to the female skin condition and skin consciousness, as well as an index for ‘before and after’ comparisons of the effect of cosmetics. However, the concept of ‘transparency’ has not been concretely defined. In the present study, we investigated the importance of ‘transparent skin’ and the relationship between transparency and other expressions for skin condition comparing the young with middle‐aged and elderly women. Furthermore, we also analyzed the correlation between the subjective assessment score of transparency of panels made by evaluators and the skin physiological parameters of those panels, and compared the difference of their relationship when the young and middle‐aged and elderly women were employed as evaluators. Regarding the consciousness of the young women, the importance of ‘transparent skin’ was ranked in the top position while ‘skin roughness’ was the chief worry of the middle‐aged and elderly women. On the other hand, both age groups indicated that transparent skin is a complex concept composed of skin texture, color, and moisture. Analysis of the relationship between the subjective assessment and the skin physiological parameters showed that the uneven dispersion of b in the skin color (standard deviation), the water content of stratum corneum, and the skin surface configuration (depth of furrows, amount of furrows) closely correlated with the judgment of skin transparency in the young group, in contrast to the uneven dispersion of L and a in the skin color (standard deviation) in the middle‐aged and elderly women. These results suggest that there may be no differences between the different age groups in the linguistic concept of transparency, while there may be differences in the physiological characteristics of skin that are utilized in making the judgment of transparency.
Facial distribution of subcutaneous fat in women
Authors: Satoh M. , Mori S. , Yoshizuka N. , Takema Y.
Published: September 2004

There is great interest in the cosmetic field in improving the shape of the face, which is determined by the amount of bone, muscle and subcutaneous fat. We examined the amount of facial subcutaneous fat in healthy women by magnetic resonance imaging (MRI), and investigated the distribution of fat in relation to the body shape. A total of 38 healthy women; 10 lean, 18 normal and 10 obese subjects, were examined by cephalometric MRI to obtain T1‐weighted images, by which fat regions can be clearly observed. The area of subcutaneous fat was greater in obese subjects than in normal subjects, and was decreased in lean subjects. At 45 measured points, the thickness of subcutaneous fat was greater in the cheek near the nose independently of the body shape, and the surface of the masseter muscle and lower jaw increased according to the body mass index (BMI). This research suggested that there are two types of regions, one type maintains fat mass and the other type increases with BMI.
Influence of cleansing on stratum corneum tryptic enzyme in human skin
Authors: Schepky A. G. , Holtzmann U. , Siegner R. , Zirpins S. , Schmucker R. , Wenck H. , Wittern K. P. , Biel S. S.
Published: September 2004

Synopsis

Desquamation in human skin is a well‐balanced process of de novo production of corneocytes and their shedding from the skin surface. The proteolysis of corneodesmosomes is an important step in the final desquamation process. In the degradation of these adhesion molecules, the stratum corneum tryptic enzyme (SCTE) plays a key role. In initial studies with extracts of porcine epidermis, SCTE was shown to be inactivated by low concentrations of sodium lauryl ether sulphate (SLES). These in vitro findings were supported by in situ results obtained by measuring the release of fluorescent dyes coupled to trypsin‐specific substrates incubated on human skin cross‐sections. Moreover, in further studies, it could be demonstrated that the SCTE activity in the human horny layer decreases after in vivo application of cleansing products containing SLES. After repeated washing of human volunteers with tap water, a standard market cleansing product (SLES/betaine system) or a new improved cleansing product (SLES/betaine/disodium cocoyl glutamate system), the specific SCTE activity was determined in extracts from the uppermost layers of the stratum corneum. It could be shown that after application of the new formula the remaining SCTE activity was significantly higher than after use of the standard market formula. This ex vivo approach has proven to be very helpful for measuring surfactant effects on human skin enzymes. Using this assay, we developed an improved shower gel formula, which leads to a significantly higher skin enzyme activity after application, compared to a standard market formula.
Vitamin A palmitate photostability and stability over time
Authors: Carlotti M. E. , Rossatto V. , Gallarate M. , Trotta M. , Debernardi F.
Published: September 2004

Vitamin A palmitate photostability in relation to ultravoilet A (UVA) and ultravoilet B (UVB) was tested in hydroxy ethyl cellulose hydrogels at pH 4.0, 5.6, 7.0, and 8.0, alone and with the addition of sunscreens (3,4‐methylbenzilidencamphor or butyl methoxy dibenzoylmethane) or an antioxidant (butylated hydroxy toluene). The photostability of vitamin A palmitate was also tested in encapsulated systems (Tagravit_A1 microcapsules, Lipotec_liposomes, phosphatidylcholine liposomes, and Lipotec_nanocapsules) dispersed in gels at pH 5.6 and 7.0. The stability of retinyl palmitate over time in hydroxy ethyl cellulose hydrogels at pH 5.6 and 7.0 (stored 1 month at 25 or 40 °C), alone or with butylated hydroxy toluene, was also tested. The stability of retinyl palmitate over time in encapsulated systems, dispersed in gels at pH 5.6 and 7.0, was also studied. O/W emulsions were also prepared to compare the stability of vitamin A palmitate introduced in a lipophilic/hydrophilic medium (O/W emulsions) and a hydrophilic medium (hydrogels). HPLC analysis showed that encapsulated systems such as Lipotec_nanocapsules, Tagravit_A1 microcapsules, phosphatidylcholine liposomes, and Lipotec_liposomes protect the vitamin A ester over time from hydrolysis and from oxidation to retinaldeide and retinoic acid, and that Lipotec_nanocapsules and phosphatidylcholine liposomes also improve the vitamin's photostability. A change in pH (5.6–7.0) of the gels did not influence the vitamin ester's stability. pH levels of 4.0 and 8.0 determined a decrease in the stability of retinyl palmitate in the gels. A high concentration of sunscreens improved the photostability of retinyl palmitate in the gels at pH 5.6 and 7.0. Butylated hydroxy toluene protected retinyl palmitate from degradation induced by light at all the pH levels studied and by heat at pH 5.6 and 7.0, as can be seen from the study of the photostability of vitamin A palmitate under UVB and UVA and of stability over time. Rheological studies showed a slight decrease in the viscosity of the gels after UVB–UVA irradiation and a higher decrease in the viscosity of the gels and the emulsions after storage at 25 and 40°C. This decrease can be attributed to a partial degradation of hydroxy ethyl cellulose and of emulsifier, as can be seen from the decrease in shear stress versus shear rate values under these conditions of storage, denoting a depolymerization of the rheological modifier.
Use of the synthetic superoxide dismutase/catalase mimetic EUK‐134 to compensate for seasonal antioxidant deficiency by reducing pre‐existing lipid peroxides at the human skin surface
Authors: Declercq L. , Sente I. , Hellemans L. , Corstjens H. , Maes D.
Published: September 2004

Synopsis

The generation of reactive oxygen species (ROS) in UV‐exposed skin is believed to contribute to the photoaging process. The stratum corneum (SC) contains a variety of enzymatic and non‐enzymatic antioxidants to protect against various environmental sources of free radicals. We have previously shown a seasonal variation in SC catalase activity with strong deactivation in sun‐exposed skin in the summer, whereas SC superoxide dismutase (SOD) activity remained intact in those conditions. This potentially leads to the local overproduction of H2O2. The oxidized lipid squalene hydroperoxide accumulates at the surface of sun‐exposed skin in the summer and upon exposure to ultravoilet A (UVA) doses as low as 0.1 J cm−2 and adequate protection against excessive lipid peroxidation at times of UV exposure should be aimed for. We have been using the induction of lipid hydroperoxides at the skin surface by a single dose of UVA (1 J cm−2) as a model system to evaluate the protective effect of antioxidants in vivo. Topical treatment with the synthetic SOD/catalase mimetic molecule (EUK‐134) 1 h before UVA exposure reduced the level of lipid peroxides at the surface of UVA‐exposed skin but also baseline peroxide levels on non‐irradiated skin were reduced in a dose‐dependent fashion. In contrast to alpha‐tocopherol, EUK‐134 even reduced the level of lipid peroxides at the surface of UVA‐exposed skin when it was applied after irradiation. We confirmed that this salen–manganese complex was able to reduce squalene hydroperoxide levels in vitro, suggesting peroxidase‐like activity towards organic peroxides. These data support the concept that the synthetic SOD/catalase mimetic EUK‐134 might be able to compensate for seasonal deficiencies in antioxidant defense capacity at the skin surface, thereby contributing to an optimal protection of the skin against the accumulation of oxidative damage.
A New Approach to Modelling Gnp Functions: an Application of Two‐Stage Technologies and Modifying Function Framework
Authors: Gary Wong K.K.
Published: September 2004

This paper first demonstrates that two‐stage technologies together with Lewbel's modifying function framework can provide a general procedure for combining profit functions and nominal value‐added functions to obtain new specifications of GNP functions suitable for empirical trade analysis. Next, it illustrates the usefulness of this procedure by proposing a new parametric form of a GNP function in which the derived import demand and output supply systems can be easily constrained to be regular, and the functional structure is parsimonious in the number of additional parameters. We also compare our estimates with those obtained using the familiar Translog flexible form. Results indicate that the proposed procedure is feasible and promising as a tool for generating regular and realistic import demand and output supply equations.
Technical Efficiency in Australian Textile and Clothing Firms: Evidence From the Business Longitudinal Survey
Authors: Mokhtarul Wadud I.K.M.
Published: September 2004

This paper estimates technical efficiency of Australian textile and clothing firms based on the data obtained from the Business Longitudinal Survey (BLS) conducted by the Australian Bureau of Statistics (ABS). Using a Cobb Douglas stochastic production frontier the paper examines firm level technical efficiency in the time varying inefficiency effect model with technical inefficiency effects assumed as an independently distributed truncated normal variable. Estimates of the production frontier revealed significant but small elasticities of labour and capital for textile and clothing firms, respectively, and a negative (but insignificant) Hicks neutral technical change for both. Estimated coefficients of the explanatory variables for inefficiency effects indicated that technical efficiency varied significantly according to firms’ age, size, capital intensity, proportion of non‐production to total workers and type of legal status. Predicted firm specific efficiency varied from 16 per cent to 95 per cent and mean efficiency ranged between 30 to 70 per cent. In view of these results policies have been suggested to improve technical efficiency of the firms as well as productivity growth of the sub sectors.
Economic development and Indigenous Australia: contestations over property, institutions and ideology*
Authors: Altman Jon C.
Published: September 2004

Economic development for remote Indigenous communities cannot be understood unless the relative importance of customary activity, potentially enhanced by native title legal rights in resources, is recognised. The present article uses a three‐sector hybrid economy framework, rather than the usual two‐sector private (or market) and public (or state) model to more accurately depict the Indigenous economy. Examples are provided of the actual and potential significance of the customary sector of the hybrid economy. Focusing on the concepts of property and institutions, it is demonstrated that significant local, regional, and national benefits are generated by the Indigenous hybrid economy. A role is foreshadowed for resource economists and the New Institutional Economics in quantifying these benefits, including positive externalities, so that they might be more actively supported by the state.
Estimating society's willingness to pay to maintain viable rural communities*
Authors: Bennett Jeff , Van Bueren Martin , Whitten Stuart
Published: September 2004

Declining populations in rural and regional areas have become a high political priority in Australia. Calls for measures to support rural communities have been prompted by substantial population declines in some country areas. In Europe and the USA, similar political pressures to halt population losses in rural and regional areas are also apparent; often as a component of the multifunctionality of agriculture. The question addressed in the present paper is whether or not the Australian tax‐paying public would be willing to pay to avoid losses of people from rural and regional areas that may result from environmental protection measures. As an integral component of two recent non‐market, environmental valuation exercises using Choice Modelling, the value of the benefits associated with the maintenance of rural populations has been estimated. The results demonstrate that a positive existence value is held primarily by urban dwellers for rural population levels.
Effectively communicating economics to policy makers*
Authors: Pannell David J.
Published: September 2004

Many economists are concerned with communicating the results of economic analysis or the implications of economic theory to policy makers. Our effectiveness in doing this varies widely for different individuals and different issues. The present paper is an attempt to provide practical advice to enhance this effectiveness. It considers policy adoption in the light of published literature about the adoption of innovations by small business managers. A small survey of policy makers and policy advisors was conducted, providing a number of practical tips and insights.
Donning Coase‐coloured glasses: a property rights view of natural resource economics*
Authors: Anderson Terry L.
Published: September 2004

Economic analysis of natural resource and environmental issues inappropriately places too much emphasis on Pigouvian externalities and too little on Coasean property rights and transaction costs. The crucial questions are who has what property rights and what are the transaction costs associated with these property rights. Asserting an externality implicitly assumes a set of property rights and hence a distribution of the social costs, but it is precisely a lack of property rights that allows decision makers to ignore social costs. By viewing natural resource and environmental problems through a Coasean lens, we better focus our attention on how property rights evolve, how they influence transaction costs, and how those transaction costs affect the potential for bargaining to minimise social costs.
Anarchism, Internationalism and Nationalism in Europe, 1860–1939
Authors: Levy Carl
Published: September 2004

This article is part of a broader project on the social history or histories of anarchism. The standard accounts of anarchism (Nettlau, Joll, Woodcock, Marshall etc.) have been combinations of the histories of ideas and political/social movements. A larger project I am engaged in uses another methodology and is reliant upon the vast outpouring of published and unpublished academic writing on social history that has been produced since the 1960s. I will cover only several interconnected themes here: anarchism, internationalism and nationalism in Europe. This article will give a synoptic overview of the internationalism of the European anarchist and syndicalist movements during the “classical” period of anarchism (1860–1939). It focuses on the First and Second Internationals and the birth of the Third. It examines the ideology and culture of Internationalism, which was the nursery of the modern anarchist movement. The linkage between federalist and regionalist republicanism is stressed and the legacy of the Paris Commune of 1871 is highlighted. The desire to secure a global level playing field in labour markets promoted labour internationalism during the First International and a revival of this strategy by anarchists and syndicalists during the era of the Second International. The mismatch of industrial development and union density between industrialised Britain or Germany and artisanal and industrialising France and southern Europe limited internationalism in the 1860s and the 1900s. Equally the patriotic legacy of the Commune of Paris undermined the internationalism of anarchists and syndicalists when war broke out in 1914. In 1917–1918 anarchist and syndicalist internationalism seemed to be revived as Europe entered a period of revolutionary discontent. But very quickly the Bolsheviks and the Soviet Union channelled this wave into the Third International and ultimately the interests of the newly born Soviet State. Anarchist and syndicalist internationalism had little effect on the fortunes of the anarchists in the Spanish Civil War in a world of nation‐states and state‐centric political parties and movements.
The Rescue of Jews in Nazi‐Occupied Belgium, France and the Netherlands
Authors: Moore Bob
Published: September 2004

The question of why and how gentiles rescued Jews during the Nazi period has been a consistent element in the wider historiography of the Holocaust ever since 1945, not least after the creation of Yad Vashem and the identification and recognition of non‐Jews as “Righteous among the Nations”. Research on the Holocaust has identified, and continues to identify, individuals who meet the criteria laid down for the award, and the shelves of books devoted to memoirs bear witness to its continued popularity with the book‐buying public. However, study of the topic to date has been very narrowly defined, either as sociological enquiry into the nature of altruism, or as the history of a relatively small number of dedicated individuals. This paper attempts to outline the importance of a wider context for the study of rescue under three headings. Firstly, it focuses on the linkages between rescue activities and other forms of resistance during the occupation period. Secondly, it demonstrates the importance of a regional rather than a national approach to the topic. Finally it examines how “rescue” can be seen as having a tradition; for example in the case of Belgium from the experiences of occupation in the First World War, and in the Netherlands from longer‐standing rural social traditions of helping those in need.
The “Sin of Omission”? Radio Vatican and the anti‐Nazi Struggle, 1940–1942
Authors: Adler Jacques
Published: September 2004

Studies and articles have recently appeared condemning Pius XII and Vatican policy during World War II. Pius XII and the Vatican are charged with having committed “crimes of omission”. The papacy is accused of having remained silent during the mass killings of the Jews and of passivity when no order was given to the national Churches to act in the Jews' defence. An examination of broadcasts from Vatican radio challenges such conclusions. These broadcasts show that Vatican radio exposed Nazi persecution of the Church and opposed collaboration with Nazism. Furthermore, Vatican radio also appealed to Christians to remain true to their faith's injunctions: to defend the sanctity of life and the unity of humankind. In so doing the Vatican pursued a policy of spiritual resistance to Nazi ideology and racism.
An Australian “Historikerstreit”? Review Article
Authors: Bonnell Andrew G. , Crotty Martin
Published: September 2004

Frontier Conflict. The Australian Experience. Edited by Bain Attwood and S.G. Foster

Historical Records of Australia Series III Despatches and Papers Relating to the History of Tasmania, Vol. VIII, Tasmania, January‐December 1829. Edited by Peter Chapman

The History Wars. By Stuart Macintyre and Anna Clark

Whitewash. On Keith Windschuttle's Fabrication of Aboriginal History. Edited by Robert Manne

The Fabrication of Aboriginal History. By Keith Windschuttle
How do nonhuman animals perceptually integrate figural fragments?1
Authors: FUJITA KAZUO
Published: September 2004

Abstract:  Visual information available from the environment is often fragmented in time and space. Integrating such fragmentary information is essential for animals to recognize meaningful objects surrounding them. It has been well‐documented that humans perceptually organize visual inputs. In nonhumans, on the other hand, little has been known about their process of perceptual organization. This paper focuses amodal completion in nonhuman species as one of such processes. So far, several nonhuman species including primates, rodents, and birds have been tested for amodal completion of a variety of stimuli. Positive results have been obtained in most of the species tested. In particular, nonhuman primates have been suggested to share many characteristics of this process with humans; a notable exception is pigeons. They have been shown to fail to complete with a variety of stimuli in a variety of procedures. However, this may be understood as a nature of this species adapted to their ecology. Surprising differences in perception in species that share many cognitive characteristics such as memory, concept formation, figure recognition, and so on, advises us to pay more attention to the correlation of perceptual systems and the way the species live in.
Perceptual organization of motions in pigeons (Columba livia)1
Authors: USHITANI TOMOKAZU , FUJITA KAZUO , SATO AKIRA
Published: September 2004

Abstract:  We investigated whether pigeons perceived relative motion of more than one object. We trained pigeons to match a white target dot moving vertically at a constant speed to one color and the same dot moving diagonally to another. In Experiment 1, we presented an additional yellow dot (accompanying dot) moving horizontally near the target. We hypothesized that the pigeons would match the diagonal motion to the color for “vertical motion” and vice versa if they perceived relative motion of the target and the accompanying dot. We reduced the size and the speed of the stimuli by half in Experiment 2 and changed the movement pattern of the target to a sine‐function in Experiment 3. In Experiment 4, we presented two accompanying dots. However, the results of Experiments 1 to 4 showed no evidence that pigeons perceived relative motion. In Experiment 5, we substituted a moving frame for accompanying dots. The pigeons tended to respond to the color corresponding to the relative motion. These results suggest that pigeons may organize a set of moving objects as one object moving relative to the other in some stimulus displays in which the second object constitutes an explicit reference frame.
Gaze‐following and joint visual attention in nonhuman animals
Authors: ITAKURA SHOJI
Published: September 2004

Abstract:   In this paper, studies of gaze‐following and joint visual attention in nonhuman animals are reviewed from the theoretical perspective of Emery (2000). There are many studies of gaze‐following and joint visual attention in nonhuman primates. The reports concern not only adult individuals but also the development of these abilities. Studies to date suggest that monkeys and apes are able to follow the gaze of others, but only apes can understand the seeing‐knowing relationship with regards to conspecifics in competitive situations. Also, there have recently been some reports of ability to follow the gaze of humans in domestic animals, such as dogs or horses, interacting with humans. These domestic animals are considered to have acquired this ability during their long history of selective breeding by humans. However, we need to clarify social gaze parameters in various species to improve our knowledge of the evolution of how we process others’ gazing, attention, and mental states.
Spontaneous construction of “Chinese boxes” by Degus (Octodon degu): A rudiment of recursive intelligence?1
Authors: TOKIMOTO NAOKO , OKANOYA KAZUO
Published: September 2004

Abstract:  The ability to hierarchically combine multiple objects to construct a self‐embedded structure is assumed to be unique to primates and parrots. However, we observed that Degus, a species of rodents, spontaneously constructed this structure while they were being trained for an unrelated vocal operant task. With a large dust‐bath bowl, a medium sized food cup, and a small toy ball, they built a triplet “Chinese boxes.” The strategy by Degus in constructing this structure was similar with that by primates: first they mainly constructed pairs of the objects and then proceeded to triplets. The relation between the evolutionary emergence of hierarchical construction and language acquisition is discussed.
Use of experimenter‐given directional cues by a young white‐handed gibbon (Hylobates lar)1
Authors: INOUE YOICHI , INOUE ETSUKO , ITAKURA SHOJI
Published: September 2004

Abstract:  A three‐year‐old white‐handed gibbon (Hylobates lar) was tested in terms of her ability to follow experimenter‐given directional cues in an object‐choice task. Four conditions were run: the experimenter baited one of two cups and then gave one of the following four directional cues: (a) pointing at the baited cup from a short distance (5 cm); (b) pointing at the target from a long distance (20 cm); (c) orienting body, head, and eyes toward the baited cup; and (d) orienting eyes only toward the baited cup. A young gibbon was able to use all of the experimenter‐given cues to obtain hidden food rewards. Several possible reasons for the gibbon's superior performance in comparison to other primates reported in the existing literature were discussed.
Rectal analgesia for the relief of perineal pain after childbirth: a randomised controlled trial of diclofenac suppositories
Authors: Dodd Jodie M. , Hedayati Hedyeh , Pearce Elizabeth , Hotham Neil , Crowther Caroline A.
Published: September 2004

Objective  To evaluate rectal diclofenac in the relief of perineal pain after trauma during childbirth.

Design  A randomised, double‐blind trial.

Setting  Delivery Suite, Women's and Children's Hospital, South Australia.

Population  Women with a second‐degree (or greater) perineal tear or episiotomy.

Methods  Women were randomly allocated to either diclofenac or placebo suppositories (Anusol), using a computer‐generated randomisation schedule with stratification for parity and mode of birth. Treatment packs contained two × 100 mg diclofenac or two placebo suppositories, the first being inserted when suturing was complete, and the second 12–24 hours after birth. Women were asked to complete questionnaires at 24 and 48 hours after birth relating to their degree of perineal pain using the validated Short Form McGill Pain Questionnaire.

Main outcome measures  Pain scores at 24 and 48 hours after birth.

Results  A total of 133 women were recruited, with 67 randomised to diclofenac suppositories and 66 to placebo. Women in the diclofenac group were significantly less likely to experience pain at 24 hours while walking (RR 0.8; 95% CI 0.6 to 1.0), sitting (RR 0.8; 95% CI 0.6 to 1.0), passing urine (RR 0.6; 95% CI 0.4 to 1.0) and on opening their bowels (RR 0.6; 95% CI 0.2 to 0.9) compared with those women who received placebo. These differences were not sustained 48 hours after birth.

Conclusions  The use of rectal non‐steroidal anti‐inflammatory drug suppositories is a simple, effective and safe method of reducing the pain experienced by women following perineal trauma within the first 24 hours after childbirth.
Pre‐myomectomy uterine artery embolisation minimises operative blood loss
Authors: Ngeh Nicholas , Belli Anna‐Maria , Morgan Robert , Manyonda Isaac
Published: September 2004

Women with massive fibroids (extending beyond the level of the umbilicus) are conventionally offered a hysterectomy, rather than myomectomy, which is considered too technically challenging, with risks of excessive haemorrhage. Some women desire fertility, or may simply wish to preserve their uterus. Uterine artery embolisation is a relatively new treatment for fibroids, and complication rates are thought to be high with massive fibroids. We have performed uterine artery embolisation immediately prior to myomectomy, and found a reduction in blood loss. Uterine artery embolisation may be a useful adjunct to surgery in women with massive fibroids or for whom uterine artery embolisation alone is considered inadequate primary treatment, those with previous myomectomy where surgery might be complicated by extensive adhesions, in Jehovah's Witnesses and in other women who refuse blood transfusion.
Informed consent for elective and emergency surgery: questionnaire study
Authors: Akkad Andrea , Jackson Clare , Kenyon Sara , Dixon‐Woods Mary , Taub Nick , Habiba Marwan
Published: September 2004

Objectives  To evaluate women's experience of giving consent to obstetric and gynaecological surgery and to examine differences between those undergoing elective and emergency procedures.

Design  A prospective questionnaire study.

Setting  A large teaching hospital.

Population  1006 consecutive patients undergoing elective or emergency surgery in obstetrics and gynaecology.

Methods  Questionnaires were administered to women who had given consent to surgery following the introduction of national guidelines and consent form. Differences in responses between elective and emergency patients were assessed using frequencies, single and multivariable analyses.

Main outcome measures  Patients' experience and recall of the consent process, their overall satisfaction and their views on what is important for adequate consent.

Results  There were significant differences between patients undergoing elective or emergency surgery. Patients undergoing emergency surgery were less likely to have read (OR 0.22) or understood (OR 0.40) the consent form, and were more likely to report feeling frightened by signing it (OR 2.52). They were more likely to report they felt they had no choice about signing the consent form (OR 2.11), and that they would have signed regardless of its content (OR 3.14). Overall, significantly more patients undergoing elective (80%) or emergency (63%) surgery reported satisfaction with the consent process. Patients were more likely to report satisfaction if they read (OR 1.80) and agreed with (OR 3.49) the consent form, and if someone checked that they understood (OR 3.09).

Conclusion  Patients' needs may not be adequately addressed by current guidelines for consent to treatment, particularly in emergency circumstances. The introduction of more complex forms and procedures appears to conflict with patients' need for personal communication and advocacy. The implications on the ethical and legal standing of consent are considerable.
Hysterectomy improves quality of life and decreases psychiatric symptoms: a prospective and randomised comparison of total versus subtotal hysterectomy
Authors: Thakar Ranee , Ayers Susan , Georgakapolou Alexandra , Clarkson Peter , Stanton Stuart , Manyonda Isaac
Published: September 2004

Objective  To conduct a prospective and concurrent evaluation of changes in health status and quality of life and psychological outcome measures over one year in women randomised to total or subtotal abdominal hysterectomy. The concurrent evaluation was the impact of total versus subtotal hysterectomy on bladder, bowel and sexual function.

Design  Prospective, randomised, double‐blind study.

Setting  A large UK Teaching Hospital (St George's Hospital, London) and a large District General Hospital (Mayday University Hospital, Croydon).

Methods 

Sample  Two hundred and seventy‐nine women undergoing hysterectomy for benign disease were randomly allocated to total hysterectomy (n= 146) or subtotal hysterectomy (n= 133).

Main outcome measures  Quality of life assessment using the Short‐Form‐36 health survey (SF‐36) and psychological outcome measures using the General Health Questionnaire‐28 (GHQ‐28) before the operation and 6 and 12 months after.

Results  Quality of life and psychological symptoms were similar in the two groups at baseline. Following surgery, quality of life improved in six of the eight domains, with no significant difference between the groups, with the exception of emotions which showed a greater improvement in subtotal hysterectomy women between baseline and 12 months. When this difference was examined further by looking at change in the GHQ subscales, there were no significant differences between total and subtotal hysterectomy women in the amount of change in anxiety, depression, somatic symptoms or social dysfunction, between baseline and post‐operative measurements. All women showed an improvement in psychological symptoms following both operations.

Conclusion  Hysterectomy, whether total or subtotal, may improve quality of life and psychological outcome.
Higher order repeat caesarean sections: how safe are five or more?
Authors: Rashid Mumtaz , Rashid Rabia S.
Published: September 2004

Objective  To determine the maternal morbidity and mortality associated with multiple repeat caesarean sections.

Design  Retrospective study.

Setting  Security Forces Hospital serving Ministry of Interior and Security Forces personnel in Riyadh, Kingdom of Saudi Arabia.

Population  Three hundred and eight case records undergoing between fifth and ninth caesarean section (mean 7) were studied and compared with a control group of 306 patients undergoing third or fourth caesarean section during the period January 1994–December 2002.

Main outcome measure  Operative and post‐operative complications and difficulties.

Results  Five or more caesarean sections were associated with a longer operating time as well as an increased rate of severe adhesions. Blood transfusion rate was similar in the two groups but a drop of pre‐operative to post‐operative haemoglobin was significantly higher in the study group compared with the controls. There was no significant difference in the Apgar score of the baby, neonatal admission rate, incidence of caesarean hysterectomy, uterine scar rupture, placenta praevia, placenta accreta, bladder injury, incidence of postpartum pyrexia, wound infection and urinary tract infection between the two groups. There was no maternal death in the study group but one mother died in the control group.

Conclusion  The higher order (5–9) repeat caesarean sections carry no specific additional risk for the mother or the baby when compared with the lower order (3 or 4) repeat caesarean sections.
A cost–utility analysis of microwave and thermal balloon endometrial ablation techniques for the treatment of heavy menstrual bleeding
Authors: Garside Ruth , Stein Ken , Wyatt Katrina , Round Ali , Pitt Martin
Published: September 2004

Objective  To assess the cost effectiveness of the second‐generation surgical treatments for heavy menstrual bleeding (microwave and thermal balloon endometrial ablation) compared with existing endometrial ablation techniques (transcervical resection and rollerball, alone or in combination) and hysterectomy.

Design  A state transition (Markov) cost–utility economic model.

Population   Women with heavy menstrual bleeding.

Methods  A Markov model was developed using spreadsheet software. Transition probabilities, costs and quality of life data were obtained from a systematic review of effectiveness undertaken by the authors, from published sources, and expert opinion. Cost data were obtained from the literature and from a NHS trust hospital. Indirect comparison of thermal balloon endometrial ablation versus microwave endometrial ablation or either second‐generation endometrial ablation method versus hysterectomy, and comparison of second‐generation versus first‐generation techniques were carried out from the perspective of health service payers. The effects of uncertainty were explored through extensive one‐way sensitivity analyses and Monte Carlo simulation.

Main outcome measures  Incremental cost effectiveness ratios based on cost per quality adjusted life year (QALY) gained, and cost effectiveness acceptability curves.

Results  Compared with first‐generation techniques, both microwave and thermal balloon endometrial ablation cost less and accrued more QALYs. Hysterectomy was more expensive, but accrued more QALYs than all endometrial ablation methods. Baseline results showed that differences between microwave endometrial ablation and thermal balloon endometrial ablation were slight. Sensitivity analyses showed that small changes in values may have a marked effect on cost effectiveness. Probabilistic simulation highlighted the uncertainty in comparisons between different endometrial ablation options, particularly between second‐generation techniques.

Conclusions  Despite limitations in available data, the analysis suggests that second‐generation techniques are likely to be more cost effective than first‐generation techniques in most cases. Hysterectomy, where a woman finds this option acceptable, continues to be a very cost effective procedure compared with all endometrial ablation methods.
Planned caesarean section decreases the risk of adverse perinatal outcome due to both labour and delivery complications in the Term Breech Trial
Authors: Su Min , Hannah Walter J. , Willan Andrew , Ross Susan , Hannah Mary E.
Published: September 2004

Objective  To determine if the decreased risk of adverse perinatal outcome, with a policy of planned caesarean, in the Term Breech Trial, was due to a reduction of problems of labour, problems of delivery or unrelated problems.

Design  Secondary analysis of data from the Term Breech Trial, a randomised controlled trial of planned caesarean versus planned vaginal birth for the singleton fetus in frank or complete breech presentation at term.

Setting  Women were recruited from 121 centres in 26 countries.

Population  Women who were enrolled in the Term Breech Trial.

Methods  Adverse perinatal outcome was classified as due to labour, due to delivery, due to neither labour nor delivery or unexplained by an experienced obstetrician who was masked to allocation group. The risk of an adverse outcome in each category was compared according to intention to treat and also by actual method of delivery.

Main outcome measures  Adverse perinatal outcome (excluding lethal congenital anomalies) that was due to labour, due to delivery, due to neither labour nor delivery or unexplained.

Results  Planned caesarean was associated with a lower risk of adverse outcome due to both labour (RR 0.14, 95% CI 0.04–0.45, P < 0.001) and delivery (RR 0.37, 95% CI 0.16–0.87, P= 0.03), compared with planned vaginal birth. Prelabour caesarean and caesarean during early labour were associated with the lowest risk and vaginal birth was associated with the highest risk of adverse outcome due to both labour (0%, 0.4% and 2.2%, respectively) and delivery (0.2%, 0% and 3.1%, respectively).

Conclusions  Planned caesarean decreases the risk of adverse perinatal outcome due to both problems of labour and problems of delivery for the singleton fetus in breech presentation at term, compared with planned vaginal birth.
A randomised double‐blind comparison of epidural fentanyl versus fentanyl and bupivicaine for pain relief in the second stage of labour
Authors: Lindow S.W. , Dhillon A.R. , Husaini S.W. , Russell I.F.
Published: September 2004

Objectives  To compare the effectiveness of two different methods for epidural analgesia in the second stage of labour—fentanyl alone versus the usual mixture of bupivicaine and fentanyl.

Design  A double‐blind, randomised, controlled trial.

Setting  An English maternity hospital.

Sample  Eighty nulliparous women in the second stage of labour.

Methods  After successful institution of epidural analgesia with a continuous infusion of bupivicaine/fentanyl mixture in the first stage of labour, the patients were randomised at full dilatation to receive either continuation of the same solution or a change to a fentanyl‐only solution given at the same rate.

Main outcome measures  Mode of delivery, duration of the second stage and quality of analgesia.

Results  There was no difference in the number of instrumental deliveries (30%vs 27.5%) or the duration of the second stage (141 vs 147 minutes) between the bupivicaine/fentanyl and fentanyl groups, respectively. The bupivicaine/fentanyl group demonstrated a lower need for rescue epidural analgesia (1 vs 6, RR 0.2, 95% CI 0.02–1.3) and significantly fewer high pain scores (11 vs 20, RR 0.6, 95% CI 0.3–1.0).

Conclusion  Second stage epidural analgesia with fentanyl did not alter delivery outcomes or labour duration but resulted in poorer analgesia.
Domestic violence: prevalence and association with gynaecological symptoms
Authors: John R. , Johnson J.K. , Kukreja S. , Found M. , Lindow S.W.
Published: September 2004

Objective  To determine the prevalence of domestic violence in a population of women attending a gynaecology outpatient clinic in the United Kingdom and also to investigate whether women who reported domestic violence were more likely to complain of certain gynaecological symptoms.

Design  Questionnaire survey.

Setting  A gynaecology outpatient clinic in a North of England Hospital.

Sample  Nine hundred and twenty consecutive clinic attenders.

Methods  Anonymous confidential questionnaire given to women.

Main outcome measures  Disclosure of a past history of domestic violence and gynaecological complaints.

Results  Nine hundred and twenty consecutive women were included and 825 questionnaires were returned (90% response rate). The prevalence of physical abuse was 21% (171/825). Thirty‐four (4%) had experienced violence in the past year. Domestic violence is three times less common in women over 50 years old. Ex‐husbands (32%) and ex‐boyfriends (29%) were the main perpetrators. Forty‐eight percent women who had experienced physical violence also had forced sexual activity. Of the 15 presenting symptoms reported by the women, lower abdominal pain, dysmenorrhoea, dyspareunia, smear abnormalities, cancer worries and bowel symptoms were significantly more common complaints in the group who reported domestic violence. The women with domestic violence also had significantly more consultations; however, the duration of their symptoms was not significantly different.

Conclusion  The prevalence of domestic violence in a cohort of women who attended the gynaecology outpatient clinic in a North of England Hospital was 21%. Women who are subjected to domestic violence tend to have more consultations and are more likely to complain of certain symptoms.