bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation for cognitive impairments after cerebral malaria in African children: strategies and limitations
Authors: Bangirana Paul , Idro Richard , John Chandy C. , Boivin Michael J.
Published: August 2006

Cerebral malaria results in short‐ to long‐term cognitive impairments in many of its child survivors. Although some of the risk factors for impairments have been identified, no attempts have been made to address the plight of those who develop cognitive impairments. This paper discusses the burden of cognitive impairment caused by cerebral malaria and suggests some rehabilitation strategies based on brain injury and cognitive rehabilitation studies. Potential cognitive rehabilitation solutions such as cognitive exercises, environmental enrichment, nutritional supplementation, physical therapy and speech therapy are highlighted. The limitations of implementing these interventions and solutions are discussed in light of the limited human resources and infrastructure of the developing countries that are malaria endemic.
Sharing the burden of TB/HIV? Costs and financing of public–private partnerships for tuberculosis treatment in South Africa
Authors: Sinanovic Edina , Kumaranayake Lilani
Published: August 2006

Objective  To explore the economic costs and sources of financing for different public–private partnership (PPP) arrangements to tuberculosis (TB) provision involving both workplace and non‐profit private providers in South Africa. The financing required for the different models from the perspective of the provincial TB programme, provider, and the patient are considered.

Method  Two models of TB provider partnerships were evaluated, relative to sole public provision: public–private workplace (PWP) and public–private non‐government (PNP). The cost analysis was undertaken from a societal perspective. Costs were collected retrospectively to consider both the financial and economic costs. Patient costs were estimated using a retrospective structured patient interview.

Results  Expansion of PPPs could potentially lead to reduced government sector financing requirements for new patients: government financing would require $609–690 per new patient treated in the purely public model, in contrast to PNP sites which would only need to $130–139 per patient and $36–46 with the PWP model. Moreover, there are no patient costs associated with the treatment in the employer‐based facilities and the cost to the patient supervised in the community is, on average, three times lower than in public sector facilities.

Conclusions  The results suggest that there is a strong economic case for expanding PPP involvement in TB treatment in the process of scaling up. The cost to the government per new patient treated could be reduced by enhanced partnership between the private and public sectors.
Follow‐up of a low cost latrine promotion programme in one district of Amhara, Ethiopia: characteristics of early adopters and non‐adopters
Authors: O'Loughlin Rosalyn , Fentie Gashu , Flannery Brendan , Emerson Paul M.
Published: August 2006

Objectives  To verify reported construction of 22 385 household latrines in 2004, after community mobilization, as part of a trachoma control programme in one district of Amhara, Ethiopia, and to explore characteristics of early latrine adopters and non‐adopters.

Methods  We used a two‐stage cluster sample survey design to randomly select eight sub‐districts and 160 households listed as having built a latrine, and visited them to verify presence and use. Household heads were interviewed to determine latrine cost and knowledge, attitude and practice regarding latrines. Non‐latrine adopting neighbours were interviewed for comparison. We estimated district latrine ownership and calculated adjusted odds ratios for factors associated with latrine use.

Results  Latrines were present in 87% (95% CI 77–97) of listed households; 90% (81–99) were in use. Among all district residents we estimated ownership as 50.2% (44–56) and use as 45.2% (36–55). Of latrine owners who had built in 2004, 69% (53/77) had spent nothing on their latrine, those who paid spent an average of US$4.0 [standard deviation (SD) US$3.6]; overall the median cost was US$0 and the mean US$0.80 (SD US$1.7). Household heads adopting latrines were 1.9 times (95% CI 1.3–2.8) more likely to have any education and 1.5 times (95% CI 1.1–2.0) more likely to have a larger family than non‐adopting neighbours. Cleanliness (48%, 56/116) and health benefits (42%, 49/116) were the most frequently reported advantages of latrines.

Conclusion  The latrine promotion programme dramatically increased latrine access and use at very low cost. The method of community mobilization used could be an effective way of reaching millennium development sanitation targets.
Detection and subtyping of dengue 1–4 and yellow fever viruses by means of a multiplex RT‐nested‐PCR using degenerated primers
Authors: Sánchez‐Seco M. P. , Rosario D. , Hernández L. , Domingo C. , Valdés K. , Guzmán M. G. , Tenorio A.
Published: August 2006

Objective  Differential diagnosis of infections that cause similar diseases and may be active simultaneously in the same geographical areas is greatly needed. Dengue and yellow fever viruses (DENV and YFV) are transmitted by the same species of mosquito and both can cause haemorrhagic fever symptoms. These viruses are active mainly in regions where expensive and sophisticated technologies are not available. Our objective was to develop a simple, reliable and easy‐to‐perform method to detect and identify these viruses.

Methods  We slightly modified a generic RT‐PCR able to detect the mentioned viruses and other members of this genus: specific primers for each one of these viruses were designed and included in the nested reaction instead of one of the generic ones. The reaction was optimized and viruses are amplified giving rise to bands of different sizes distinguishable in agarose gels.

Results  This test is able to detect and identify the four DENVs and YFV to a high level of sensitivity and specificity and can be used with clinical samples. This simple, reliable and easy‐to‐perform method able to detect and identify dengue 1–4 and YFV can be used in poor endemic countries.
Plica polonica in association with pediculosis capitis and scabies – a case report
Authors: Gnanaraj Pushpa , Venugopal V. , Pandurangan C. N.
Published: August 2006

Plica polonica is a rare disorder of hair in which groups of hair shafts become irreversibly entangled, forming a matted, malodorous and encrusted, sticky, moist mass. Various predisposing factors are known to cause this condition. We report one such case associated with pediculosis capitis and scabies.
Preliminary testing of a just‐in‐time, user‐defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions
Authors: Jibaja‐Weiss Maria L. , Volk Robert J. , Friedman Lois C. , Granchi Thomas S. , Neff Nancy E. , Spann Stephen J. , Robinson Emily K. , Aoki Noriaki , Robert Beck J.
Published: August 2006

Objective  To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision.

Design  Pre‐post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit.

Sample  Fifty‐one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals.

Intervention  A computerized decision aid that combines entertainment‐education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others.

Outcomes  Patients’ use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS).

Results  Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made.

Conclusions  A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients.
Who uses decision aids? Subgroup analyses from a randomized controlled effectiveness trial of two prostate cancer screening decision support interventions
Authors: Partin Melissa R. , Nelson David , Flood Ann Barry , Friedemann‐Sánchez Greta , Wilt Timothy J.
Published: August 2006

Objective  To examine who reported using unsolicited prostate cancer screening decision aids distributed as part of a randomized controlled trial, whether reported use varied by type of aid (video or pamphlet), and what affect reported use had on study outcomes.

Methods  A total of 1152 men aged 50 and older from four medical facilities in the United States were randomly assigned to pamphlet, video or usual care (control). Materials were mailed 2 weeks prior to clinic appointments in general internal medicine. Outcomes were assessed by phone survey 1 week after appointments. Analyses examined the reported use of materials by study group, the association between patient characteristics and reported use, and the impact of reported use (adjusting for patient characteristics) on a 10‐item knowledge index.

Results  Fifty‐six per cent of those randomized to receive the video and 50% of those randomized to receive the pamphlet reported using the materials. Reported use of the video was higher for patients who had greater than a high school education (OR 1.73), were married (OR 2.20), and reported no prior abnormal prostate cancer screening test results (OR 3.39). Reported use of the pamphlet did not vary by patient characteristics. In intent‐to‐treat analyses (ignoring reported use), individuals randomized to the video and pamphlet groups had significantly higher knowledge scores relative to the control group (7.44, 7.26 and 6.90 respectively). Adjusting for reported use modestly increased the estimated differences across treatment groups but did not substantially change conclusions about the relative effects of these aids on knowledge.

Conclusions  Only half of men receiving unsolicited prostate cancer screening decision aids before a visit reported using the aids, and who reported using them varied by type of aid. Efforts to broadly implement decision aids may need to offer a variety of approaches, and incorporate creative strategies to enhance reaching all population subgroups.
Quantitative investigation on the distribution of Malassezia species on healthy human skin in Korea
Authors: Lee Y. W. , Yim S. M. , Lim S. H. , Choe Y. B. , Ahn K. J.
Published: August 2006

This study concerns a culture research based on the data gathered from Korean subjects to examine distribution of Malassezia yeast. Malassezia yeast were cultivated out of samples from scalp, forehead, chest, arm and thigh. Malassezia restricta was recovered more frequently in the teens and young adults, while M. globosa was the predominant species in subjects older than 50 years of age. The population density of Malassezia yeast was significantly higher in the age group (AG) of 21–30 years compared with other AGs (P < 0.05). It was also significantly higher in the chest compared with the forehead, arm and thigh (P < 0.05). The key is to recognise the existence of a difference in the amount and type of Malassezia species in different AGs as well as body areas, which reflects differing skin lipid levels in various AGs and different body areas.
Candida species in stool, symptoms and complaints in general practice – a cross‐sectional study of 308 outpatients
Authors: Jobst Detmar , Kraft Karin
Published: August 2006

Patients with unspecific symptoms were sometimes tested for Candida. In case of findings of this yeast‐like fungus in their stools they often were labelled with the diagnosis of a ‘Candida‐syndrome’. This comprises headache, weakness, flatulence, ravenous appetite for sweets, itching skin and several more unspecific symptoms. All 500 randomly sampled patients in 12 mainly naturopathic practices were asked to take part. In case of participation, they received stool‐tubes and questionnaires to be answered during the waiting‐time by the patients themselves. We asked for details of lifestyle, diseases and a number of unspecific symptoms. The stool‐tubes were sent to a microbiological lab within 24 h after being filled. About one‐third of all 308 participants carried Candida albicans in their stools. This finding is regarded as normal. Smoking habits were highly associated to Candida: 45 of the 78 smokers (58%), but only 68 of the 230 (29%) non‐smokers were Candida positive, P < 0.0001. Three more results were associated with Candida‐positive stools: Candida‐vaginitis, allergies against food and allergies in general. Hints of a Candida‐syndrome could not be found. The relation with smoking cigarettes is a new result. Associations to Candida‐vaginitis and allergies were described before.
Tinea incognito in Italy: a 15‐year survey
Authors: Romano C. , Maritati E. , Gianni C.
Published: August 2006

Tinea incognito or steroid modified tinea is a dermatophytic infection in which topical or systemic steroids, administered as a result of dermatological misdiagnosis or preexisting pathologies, have modified the clinical appearance of the fungal infection, transforming the typical ringworm and mimicking other skin diseases. This is a retrospective study of the agents, clinical aspects, sources of infection of 200 cases (98 males, 102 females, mean age 42 years) of tinea incognito, observed in Siena and Milan, Italy, in the period 1987–2002. In order of decreasing frequency, Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis, Microsporum gypseum, Trichophyton violaceum and Trichophyton erinacei were isolated. The clinical appearance of the infection was lupus erythematosus discoid‐like, eczema‐like, rosacea‐like, especially on the face, impetigo‐like and eczema‐like on trunk and limbs. Less often the dermatophytosis resembled psoriasis, purpura, seborrhoic dermatitis and lichen planus. There was folliculitis in 9% of cases and dermatophytid in 3% of cases. Antimycotic therapy brought about clinical and mycological recovery in all patients except one, who had iatrogenic immunodepression.
Cell proliferation and p53 expression in pseudoepitheliomatous hyperplasia of oral paracoccidioidomycosis
Authors: Kaminagakura E. , Bonan P. R. F. , Lopes M. A. , Almeida O. P.
Published: August 2006

Paracoccidioidomycosis (PCMycosis) is a systemic mycosis frequently found in many regions of Latin America. Microscopically, it is characterised by granulomatous inflammation and pseudoepitheliomatous hyperplasia (PEH). This work describes the proliferation index and p53 expression by immunohistochemistry in PEH of PCMycosis, normal oral mucosa (NOM) and mild oral epithelial dysplasia (ED). Ki67 positive cells were present in the basal and parabasal layers in NOM and PEH, while in ED it was also observed in the spinous layer. Percentage of ki67 positive cells was 7.7, 28.2 and 46.0 in NOM, PEH and ED respectively. p53 was negative in NOM and in PEH it was expressed by few cells in the basal layer of only three cases. However, it was expressed in all cases of ED, in basal and parabasal layers. Although histologically PEH mimics well‐differentiated squamous cell carcinoma, its proliferative pattern and p53 expression are more similar to NOM than to dysplasia. These findings, confirm PEH as a reactive process probably associated with the underlying chronic inflammation.
Trichophyton mentagrophytes of rabbit origin causing family incidence of kerion: an environmental study
Authors: Van Rooij P. , Detandt M. , Nolard N.
Published: August 2006

Our laboratory was contacted by a family living directly above a rabbit farm. Both their children had developed a kerion, in consequence of a misdiagnosed superficial mycosis. This study was designed to demonstrate a link between the two kerion cases and the environmental contamination. The degree of contamination was estimated and factors favourising the spread of infection were determined. Dermatophytes were isolated from various environmental sites using Rodac plates. For direct sampling of scalp and fur the brushing technique was used. The farm and home environment initially showed a severe contamination by Trichophyton mentagrophytes. At the farm, cages and surfaces covered with rabbit hair were strongly contaminated. As for the home environment, the dog's basket and clothes from the mother carried a large number of spores. Trichophyton mentagrophytes was identified as responsible agent for the children's kerions and the lesions of the rabbits. Mother, eldest child and dog seemed to be excellent carriers. Cleaning and disinfection measures resulted in a reduction of the overall contamination. The home environment was no longer a source of contamination. Nevertheless, on the farm a fair number of dermatophytes could still be isolated from the wire meshes and roof beams covered with fluff.
Onychomycosis in primary school children: association with socioeconomic conditions
Authors: Gunduz Turan , Metin Dilek Yesim , Sacar Tuncer , Hilmioglu Süleyha , Baydur Hakan , Inci Ramazan , Tümbay Emel
Published: August 2006

Onychomycosis in childhood is reported to be unusual. The aim of this study was to determine the prevalence of onychomycosis in primary school children and to make comparison between different socioeconomic status in the rural and urban areas of the city. Hand and foot nails of 23235 children aged 7–14 were examined. Onychomycosis was suspected and nail scrapings for mycological examination were taken in 116 of them. Hyphae or spores were seen in 41 (0.18%) by direct microscopic examination, and mycological cultures were positive in 24 (0.1%) of them. Toenails were affected in all of the fungal culture positive cases. Trichosporon spp, Trichophyton rubrum, Candida albicans and Candida glabrata grew in 11, 6, 5 and 2 of the cultures repectively. Onychomycosis prevalence was significantly higher in the children living in the rural areas (p = 0.016) [Odds ratio = 3.43 (%95 CI 1.11<OR<11.84)], and onychomycosis was more frequent in boys than girls (p = 0.001) [(Odds ratio = 5.85 (1.66<OR<24.61)].
An Ultrasonographic Method to Study Reproductive Seasonality in Ewes Isolated from Rams
Authors: Kaulfuss K‐H , Giucci E , Süss R , Wójtowski J
Published: August 2006

Contents

In studies concerning the seasonality in sheep, the effect of the teaser‐ram, which can by itself induce oestrus as well as the development of ovary function bodies, has not been considered. In this study, a method is developed to determine ovarian activity during the year while excluding a possible influence of the ram. The study was carried out on 10 German Blackhead Mutton ewes (GBM) and 10 German Mutton Merino ewes (GMM) and lasted for 14 months. The ewes were kept without contact with any ram, and once a week a transrectal ultrasonography was conducted to determine ovary function bodies (corpora lutea, follicles) and a blood sample was taken to analyse progesterone (P4) concentration. In both breeds, the number of ovulating ewes, the ovulation rate (OR), the size of the corpora lutea (CL) and P4‐concentrations showed significant seasonal fluctuations. During the main breeding period (September–February), the OR was higher (2.0 ± 0.4) than during the rest of the year (1.6 ± 0.5). Outside the main breeding season (March–August), approximately 40% GBM ewes and only approximately 15% GMM ewes produced CL. The cycle and the related seasonal changes in the P4‐concentration coincide with different ultrasonically diagnosed CL (developing or regressing, insufficient, no CL). Between the volume of fully developed CL and P4‐concentration, correlations of 0.57 (GMM) and 0.45 (GBM), respectively, were found. On average, P4‐concentration in September to February was by approximately 1.60–1.66 nmol/l in the GMM and by approximately 1.80–1.86 nmol/l in the GBM higher than in spring and summer. Considering the OR, the P4‐values corresponded with the CL volumes, i.e. in the months from August to February the CL values were significantly larger than in the months March to August. The ultrasonic ovarian diagnosis is a useful method to determine the ram‐uninfluenced seasonality of reproduction in sheep.
Influence of the Freezing Technique (Nitrogen Liquid vs Ultrafreezer of −152°C) and Male‐to‐Male Variation Over the Semen Quality in Canarian Mastiff Breed Dogs
Authors: Batista M , Alamo D , González F , Cruz MG , Gracia A
Published: August 2006

Contents

This study was carried out to assess the in vitro quality of canine semen frozen in an ultrafreezer at −152°C and to evaluate the male‐to‐male variation of frozen semen in five male dogs of the Canarian Mastiff breed. Four ejaculates of each dog were processed individually (5% glycerol and 0.5% Equex) to reach a final concentration of 100 × 106 spermatozoa/ml. Then, two freezing techniques were tested to assess the seminal quality (sperm motility, live spermatozoa and abnormal sperm cell percentages) at 1, 30, 60, 120 and 360 days after freezing: (i) semen was frozen and stored in liquid nitrogen; (ii) semen was frozen and stored in the ultrafreezer at −152°C. After freezing–thawing, both freezing protocols showed no significant differences in sperm motility and the percentages of live and abnormal spermatozoa. On the other hand, the microscopic characteristics of spermatozoa in fresh semen were practically similar among males; however, after the semen processing and freezing, significant differences were observed (p < 0.05) among males, especially as regards sperm motility. This inter‐individual variability was detected in both freezing protocols, showing that the male‐to‐male variation in the seminal quality post‐freezing was independent of the freezing technique used. The in vitro results obtained in the Canarian Mastiff breed confirmed that the use of ultra‐freezers at −152°C is a potential alternative to liquid nitrogen for storing canine semen for long periods of time.
YMDD motif variants in inactive hepatitis B carriers detected by Inno‐Lipa HBV DR assay
Authors: Akarsu Mesut , Sengonul Aylin , Tankurt Ethem , Sayiner Ayca Arzu , Topalak Omer , Akpinar Hale , Abacioglu Yusuf Hakan
Published: August 2006

Introduction:  Mutations of hepatitis B virus (HBV) polymerase, especially occurring at the highly conserved YMDD region, are related to resistance to lamivudine. Although these mutations are frequently secondary to lamivudine use, they can also occur naturally. The aim of the present study was to determine the prevalence of YMDD variants that exist naturally in patients who are inactive HBV carriers.

Methods:  Seventy‐one adult inactive HBV carriers were studied. All of the patients were confirmed to have maintained normal alanine aminotransferase (ALT) values for one or more years by monitoring serum ALT levels at 3‐monthly intervals. None of the patients received interferon or antiviral agents. YMDD variants were analyzed by the HBV Drug Resistance Line Probe assay (Inno‐Lipa HBV‐DR).

Results:  YMDD variants were detected in 13 (18.3%) of the 71 anti‐HBe positive inactive HBV carriers. Of the 13 patients, 10 (76.9%) also had accompanying L180M mutation. The combination of wild type and YMDD variant HBV was present in 11 of 13 patients. In two patients, only YIDD and/or YVDD variants plus L180M were detected without the presence of wild YMDD motif.

Conclusion:  Naturally occurring YMDD motif variants were detected at a high rate in a group of lamivudine‐untreated inactive HBV carriers.
Transmission of hepatitis C virus by needle‐stick injury in community settings
Authors: Haber Paul S , Young Margaret M , Dorrington Lloyd , Jones Andrew , Kaldor John , De Kanzow Sophie , Rawlinson William D
Published: August 2006

Background:  Hepatitis C virus (HCV) is predominantly transmitted by blood‐to‐blood contact, typically by sharing of needles by injecting drug users. Discarded needles could act as a vector for transmission of this infection.

Methods:  Two cases of HCV seroconversion following a needle‐stick injury in a community setting were identified. The effects of specimen processing and storage conditions on detection of HCV RNA were assessed to provide information about the likelihood of discarded needles containing infectious HCV.

Results:  Consistent with a role for discarded needles in viral transmission, in vitro studies demonstrated that viral load declined by less than one log following storage for 24 h.

Conclusion:  All needle‐stick injuries should be promptly investigated by serology and HCV‐PCR.
Role of AST to platelet ratio index in the detection of liver fibrosis in patients with recurrent hepatitis C after liver transplantation
Authors: Toniutto Pierluigi , Fabris Carlo , Bitetto Davide , Falleti Edmondo , Avellini Claudio , Rossi Elisabetta , Smirne Carlo , Minisini Rosalba , Pirisi Mario
Published: August 2006

Background and Aim:  Per protocol annual liver biopsy represents the gold standard in the assessment of graft fibrosis progression due to recurrent hepatitis C after liver transplantation. Non‐invasive liver fibrosis tests have been proposed as surrogate markers of liver fibrosis in hepatitis C virus (HCV)‐positive immune‐competent patients. No data are available in the literature on the usefulness of non‐invasive liver fibrosis tests in liver transplanted patients with recurrent HCV infection.

Methods:  A total of 102 annual per protocol liver biopsies performed in 51 consecutive HCV‐positive recipients (31 men), with a follow‐up period lasting up to 5 years, were included and evaluated in this study. At each time point, the following non‐invasive liver fibrosis tests were calculated: aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio, age–platelet index, AST to platelet ratio index (APRI), Forns’ fibrosis index and Bonacini’s discriminant score.

Results:  In discriminating patients with histological fibrosis score >2, APRI provided the best area under the receiver operating characteristic curves (AUROC) (0.801), in comparison to the other four non‐invasive liver fibrosis tests. The AUROC of APRI was better in female (0.871) than in male (0.753) recipients. Among female recipients, an APRI value >1.4 was 91% sensitive and 75% specific in detecting a staging score >2. The corresponding values among male recipients were 60% and 77%, respectively.

Conclusions:  Among non‐invasive liver fibrosis tests, APRI has the highest diagnostic value in discriminating liver transplanted patients with progression to significant liver fibrosis, although its accuracy is influenced by recipient sex.
Surgical treatment of haemorrhoidal disease with CO2 laser and Milligan–Morgan cold scalpel technique
Authors: Pandini L. C. , Nahas S. C. , Nahas C. S. R. , Marques C. F. S. , Sobrado C. W. , Kiss D. R.
Published: August 2006

Objective  To prospectively compare immediate postoperative results of the surgical treatment of haemorrhoidal disease (HD) by Milligan–Morgan technique using either the CO2 laser or cold scalpel.

Methods  Forty patients with grade III/IV HD were prospectively randomized to undergo surgical treatment (Milligan–Morgan) using either the CO2 laser (group A) or the cold scalpel method (group B). Data were compared regarding postoperative pain, complications, healing time, return to normal activity and patient satisfaction. Patients were blinded to treatment method until the completion of the study. Postoperative outcomes were assessed by patient questionnaire and outpatient follow‐up visits. Pain was assessed by Visual Analogue Scale and analgesic consumption.

Results  Twenty patients were randomized into each group and were comparable relative to mean age, gender and grade of HD. There were no statistically significant differences regarding postoperative pain measured (P =0.17) or consumption of oral (P = 0.741) and parenteral analgesics (P = 0.18) between the two groups. Mean pain score at the first bowel movement was significantly higher in group A (P = 0.035), although the use of analgesics was similar in both the groups. There were no differences regarding complications, mean healing time, return to normal activities and patient satisfaction.

Conclusion  There were no differences in the immediate results after Milligan–Morgan haemorrhoidectomy using either the CO2 laser or cold scalpel regarding postoperative pain, complications, healing time, return to normal activities or patient satisfaction.
Surgical manipulation of the large intestine increases bacterial translocation in patients undergoing elective colorectal surgery
Authors: Reddy B. S. , Gatt M. , Sowdi R. , MacFie J.
Published: August 2006

Objective  Several animal studies have suggested that surgical manipulation of the intestine alters the barrier function and promotes bacterial translocation (BT). Whether this occurs in humans has never been investigated. The aim of this study was to determine the effect of surgical manipulation of the intestine on the prevalence of BT in patients undergoing elective colorectal surgery.

Method  This was a prospective observational study of 50 consecutive elective surgical patients in whom a sample of mesenteric lymph node (MLN) was harvested after mobilization of the colon, prior to ligation of the vascular pedicle. These results were compared with 472 historical controls, who had a sample of MLN taken before the mobilization of colon during laparotomy. A positive culture of MLN confirmed BT.

Results  BT was identified in 39/49 (79.6%) patients in the study group compared with 54/472 (11.4%) patients in the control group. This difference was statistically significant (P < 0.001, χ2 test).

Conclusion  Surgical manipulation of the bowel does increase the prevalence of BT and therefore is associated with changes in gut barrier function in elective surgical patients.
A prospective comparison between clinical outcome and open‐configuration magnetic resonance defecography findings before and after surgery for symptomatic rectocele
Authors: Hübner M. , Hetzer F. , Weishaupt D. , Hahnloser D. , Clavien P.‐A. , Demartines N.
Published: August 2006

Background  The correlation between clinical symptoms and anatomical findings by conventional imaging is poor in patients with rectoceles. The aim of this prospective study was to assess and to correlate symptomatic changes after anterior levatorplasty with morphologic changes visualized by magnetic resonance defecography (MRD).

Method  Fourteen women with a median age of 57 (range 37–83) accepted to participate. Seven of 14 had previous hysterectomy. Patients underwent MRD before surgery and again 6 months postsurgery. Pre‐ and postoperative symptoms and quality of life (QoL) (Eypasch) were assessed. Faecal and urinary incontinence were graded (Wexner‐ / Hanley‐score).

Results  The median Eypasch‐score improved from 90 (range 38–106) to 106 (range 29–133) after surgery (P = 0.016). Similarly, the Wexner‐score ameliorated from 8 (range 0–20) to 4.5 (range 0–18; P = 0.02). Seven patients described new dyspareunia postoperatively. The median follow up was 16.5 months (range 9–45). The median rectocele size decreased from 37 mm (range 30–48) preoperatively to 12 mm (range 0–42) postoperatively (P = 0.004). Furthermore, enteroceles were corrected and pelvic floor descent was significantly reduced after surgery. Only the clinical symptom of incomplete evacuation strongly correlated with the respective radiological finding of contrast dye trapping (Rho = 0.822; P = 0.001).

Conclusion  Anterior levatorplasty improved QoL in patients with symptomatic rectocele. Postsurgical correction of rectocele is accurately documented by MRD. Only moderate correlation between morphologic and clinical improvements was observed.
Crohn's‐like colitis, enterocolitis and perianal disease in Hermansky–Pudlak syndrome
Authors: Hazzan D. , Seward S. , Stock H. , Zisman S. , Gabriel K. , Harpaz N. , Bauer J. J.
Published: August 2006

Hermansky–Pudlak syndrome (HPS) is a rare autosomal recessively inherited disorder consisting of the triad of oculocutaneous tyrosinase‐positive albinism, prolonged bleeding time secondary to platelet storage pool defect and ceroid depositions within the reticuloendothelial system. Some patients also reportedly have gastrointestinal (GI) complications related to chronic granulomatous colitis, enterocolitis and extensive granulomatous perianal disease, the later previously unreported in the literature. These observations suggest that the GI complications of HPS are due to the development of classical Crohn's disease. The implications for disease pathogenesis and surgical management are discussed.
Environmental social controls and capital investments: Australian evidence
Authors: Wood Dorothy , Ross Donald G.
Published: August 2006

Environmental social controls (ESCs) such as mandatory disclosure, regulations, subsidies, and stakeholder opinion are intended to improve firm environmental performance. This paper reports ESC importance to Australian financial managers in making capital investment decisions. A decision‐making experiment showed managers to be most responsive to stakeholder opinion (42 per cent), followed by subsidization (26 per cent) and regulatory cost (22 per cent). Mandatory disclosure has very little influence (10 per cent). ESC interaction effects are limited so coordination of ESC policy is not a primary concern. High degrees of managerial self‐insight suggest policy changes would be enhanced by close consultations with the managers involved.
Ranking of United Kingdom Law Journals: An Analysis of the Research Assessment Exercise 2001 Submissions and Results
Authors: Campbell Kevin , Goodacre Alan , Little Gavin
Published: August 2006

Notwithstanding the Chancellor of the Exchequer's announcement in the 2006 Budget that, after the 2008 Research Assessment Exercise (‘RAE 2008’), it is the government's firm presumption that the system for assessing research quality and allocating quality‐related funding to United Kingdom universities will be mainly metrics based, RAE 2008 is vitually certain to proceed and to have considerable significance for legal research in the United Kingdom. In this rapidly developing and controversial context, this paper uses statistical analysis of the data from RAE 2001 to construct a series of metrics‐based rankings which, when taken together, provide a reliable and coherent ranking of leading United Kingdom law journals.
Regulation and Social Solidarity
Authors: Prosser Tony
Published: August 2006

Justifications for regulation are commonly based on the identification of market failures. This is however inadequate to account for much regulation, and sees regulation as inherently second best to market allocations. This article argues that, although some regulation will be based on market failure, other justifications can be found in the protection of rights and in the maintenance of social solidarity. Theoretical support for this last rationale can be found in the work of Durkheim and Duguit and the concept of public service. To accept this rationale for regulation has important implications both for regulatory policies and regulatory instruments.
Waiting for Enron: The Unstable Equilibrium of Auditor Independence Regulation
Authors: Kershaw David
Published: August 2006

A primary function of auditor independence regulation is to ensure that any financial incentives auditors may have to approve misleading or inaccurate accounting are outweighed by market and regulatory deterrents to compromising an auditor's independence. This article is an inquiry into the current state of this incentive equilibrium in the United Kingdom: the possible costs and benefits that may be incurred by auditors if they elect to acquiesce to management's demands to accept problematic accounting. It argues that the equilibrium position currently incentivizes a rational auditor to acquiesce. On the one hand, the article demonstrates that the recent evolution of audit firm revenue streams has provided auditors with a substantial incentive to compromise their independence and provided management with credible sanctions to pressurize them to do so. On the other hand, the article shows that regulatory and market costs of acquiescence do not counterbalance the benefits of acquiescence.
The Deep Colonizing Practices of the Australian Royal Commission into Aboriginal Deaths in Custody
Authors: Marchetti Elena
Published: August 2006

This paper demonstrates how legal processes utilized by institutions established to reverse the effects of colonization, can continue the colonizing agenda. The processes reflect ‘deep’ rather than ‘de‐’colonizing practices. The Australian Royal Commission into Aboriginal Deaths in Custody (RCIADIC), which tabled its National Report over a decade ago and which was heralded as the inquiry which would transform race politics for Indigenous Australians, is used as an example of a ‘decolonizing’ institution that inadvertently adopted deep colonizing practices. Using data from interviews with 48 Indigenous and non‐Indigenous people who were associated with the RCIADIC, this paper expands Deborah Bird Rose's theoretical construct of ‘deep colonizing practices’ and illustrates how difficult it is to shift hegemonic legal processes and beliefs, despite intentions to empower and embrace Indigenous views.
Unbalanced Growth and the Sustainability of the Current Account Deficit
Authors: Bonatti Luigi
Published: August 2006

In an endogenous growth framework, a two‐country economy is modeled with an integrated product and asset markets. The countries differ with respect to the share of their GDP that is redistributed through the fiscal system, and the country where this share is smaller tends to grow faster. This high‐growth country finances a portion of its investment expenditures by attracting funds from the low‐growth country, whose growth rate is depressed by this outflow. The high‐growth country runs ever‐increasing current account deficits and its negative net international investment position rises without bounds. This notwithstanding, sustainability is guaranteed.
Speculative Attacks and Informational Structure: an Experimental Study
Authors: Cornand Camille
Published: August 2006

This paper addresses the question of whether public information destabilizes the economy in the context of signals of a different nature. We present an experimental evaluation of the speculative attack game of Morris and Shin (1998). Our objective is two‐fold: to evaluate whether public information destabilizes the economy within a context of signals of different nature and to enlarge upon the results of Heinemann, Nagel, and Ockenfels (2004) (HNO). Our evidence suggests that in sessions with both private and common signals, the fact that the common signal plays a focal role enhances the central bank’s welfare: it reduces the probability of crisis and increases its predictability. Therefore, we raise doubts about the policy implications of HNO’s findings. The new policy lesson is that the central bank has more control over the beliefs of traders if it discloses one clear signal when agents also get private information from other sources.
The Production Possibility Frontier as a Maximum Value Function: Concavity and Non‐increasing Returns to Scale
Authors: Dalal Ardeshir J.
Published: August 2006

This paper makes both a methodological as well as a substantive contribution to the literature on the concavity of the production possibility frontier (PPF). Rather than using the standard, calculus‐based techniques, the method here relies on the fact that the PPF is a maximum value function. The consequent simplification in analysis makes it possible to demonstrate that the conditions which are sufficient to guarantee global concavity of the PPF are considerably less stringent than those stated in the literature. Existing analyses have assumed that production functions are (a) concave and homothetic, or (b) display non‐increasing returns to scale (NIRS) and homogeneity. This paper shows that concavity without homotheticity, or NIRS and quasiconcavity without homogeneity (or even homotheticity) are sufficient, thus greatly increasing the generality of existing results. The analysis can be extended to include situations in which the input set includes industry‐specific factors.
INTERNATIONAL RELOCATION OF PRODUCTION: WHERE DO FIRMS GO?
Authors: Sleuwaegen Leo , Pennings Enrico
Published: August 2006

The flexible relocation of capacity across countries by multinational enterprises has become an important source of concern. Using a unique sample of relocating firms in Belgium, we find that wages and market potential of host regions are important determinants for the location choice. Considering firm characteristics, we show that large firms have a higher propensity to relocate to remote countries. Public aid only plays a decisive role in the investment decision for relocations to adjacent countries, suggesting a potential harmful role in distorting competition. More proactive policies in line with changing comparative location advantages should be implemented to accommodate relocations.
GROWTH, R&D AND WELFARE: THE ROLE OF PUBLIC POLICY
Authors: Minniti Antonio
Published: August 2006

This paper analyzes the normative side of an R&D growth model in which market structure and growth are jointly determined in the equilibrium of a one‐sector economy under monopolistic competition. We find that a distortion in the allocation of R&D, namely the presence of technological spillovers between firms, generates two market failures: insufficient growth and excessive entry of firms. We show that this result is driven by the interplay between market structure and growth. A simple tax/subsidy scheme to support the efficient solution is proposed.
The Marginal Costs and Benefits of Redistributing Income and the Willingness to Pay for Status
Authors: ALLGOOD SAM
Published: August 2006

The effect of status on aggregate welfare is ambiguous for marginal reforms that redistribute income. If average consumption falls, the change in relative consumption increases household utility but reinforces the decrease in household labor supply, raising welfare cost. For parameterizations of the model developed here, reforms which lower average consumption increase aggregate welfare. Numerical calculations show that status increases marginal welfare cost and marginal net benefit for a demogrant reform. Redistributing to high income households may increase aggregate welfare depending on the definition of average consumption and if the willingness to pay for status increases with income.
Budget Balancedness and Optimal Income Taxation
Authors: BERLIANT MARCUS , PAGE FRANK H.
Published: August 2006

We make two contributions to the theory of optimal income taxation. First, assuming conditions sufficient for existence of a Pareto optimal income tax and public goods mechanism, we show that if agents' preferences satisfy an extended notion of single crossing called capacity constrained single crossing, then there exists a Pareto optimal income tax and public goods mechanism that is budget balancing. Second, we show that, even without capacity constrained single crossing, existence of a budget balancing Pareto optimal income tax and public goods mechanism is guaranteed if the set of agent types contains no atoms.
Human Fallibility, Complementarity, and Fiscal Decentralization
Authors: NISHIMURA YUKIHIRO
Published: August 2006

This paper examines economic growth properties under alternative fiscal organizations when a bureau's decisions are fallible. A country consists of J jurisdictions, which need a public service. In a centralized government, one authority decides on services in every jurisdiction. In a decentralized government, J authorities are in charge of each public service. An authority can have high ability or low ability, and an authority with high ability draws a good project with higher probability. We first show that the decentralized government provides the same average quality of public services, with lower variance, than does the centralized government. We then apply this result to an economic growth model where the value of the Solow residual is a constant elasticity of substitution (CES) function of public services. We show that there is a critical value of the degree of complementarity below which fiscal decentralization is more desirable than fiscal centralization for an expected economic growth, and the decentralized government has a lower variance of GDP growth.
Promotion Rules and Skill Acquisition: An Experimental Study
Authors: OOSTERBEEK HESSEL , SLOOF RANDOLPH , SONNEMANS JOEP
Published: August 2006

Standard economic theory identifies a trade‐off between up‐or‐stay and up‐or‐out promotion rules. Up‐or‐stay never wastes the skills of those not promoted but may provide insufficient incentives to invest in skills. Up‐or‐out can always induce investment in skill acquisition but may waste the skills of those not promoted. The paper reports an experiment designed to study this trade‐off. Under up‐or‐out, parties behave almost exactly as theory predicts. But under up‐or‐stay (and stay‐or‐stay), results differ markedly from theoretical predictions. In that case workers invest rather frequently, although the prediction is that they would not. These deviations can be explained by various reciprocity mechanisms.
Income Tax Evasion and the Fear of Ruin
Authors: CHANDER PARKASH
Published: August 2006

This paper characterizes the optimal income tax function when the agent is risk averse and the objective of the principal is to maximize a social welfare function. We show that the optimal tax function is generally non‐decreasing and concave if the principal's objective is maximin and the agent's utility function satisfies a reasonable condition which we call ‘repetitive risk aversion’. It is shown further that in many cases the optimal tax function is similarly concave when the social welfare function is utilitarian.
Decreased brain damage and curtailed inflammation in transcription factor CCAAT/enhancer binding protein β knockout mice following transient focal cerebral ischemia
Authors: Kapadia Ramya , Tureyen Kudret , Bowen Kellie K. , Kalluri Haviryaji , Johnson Peter F. , Vemuganti Raghu
Published: August 2006

CCAAT/enhancer binding protein β (C/EBPβ) is a leucine‐zipper transcription factor that regulates cell growth and differentiation in mammals. Expression of many pro‐inflammatory genes including the cytokine interleukin‐6 is known to be controlled by C/EBPβ. We report that focal cerebral ischemia induced by transient middle cerebral artery occlusion (MCAO) significantly increases C/EBPβ gene expression in mouse brain at between 6 and 72 h of reperfusion. To understand the functional significance of C/EBPβ in postischemic inflammation and brain damage, we induced transient MCAO in cohorts of adult C/EBPβ null mice and their wild‐type littermates. At 3 days of reperfusion following transient MCAO, C/EBPβ null mice showed significantly smaller infarcts, reduced neurological deficits, decreased terminal deoxynucleotidyl transferase‐mediated dUTP nick‐end labeling‐positive cells, decreased intercellular adhesion molecule 1 (ICAM1) immunopositive vessels, decreased extravasated neutrophils and fewer activated microglia/macrophages, compared with their wild‐type littermates. Furthermore, GeneChip analysis showed that postischemic induction of many transcripts known to promote inflammation and neuronal damage was less pronounced in the brains of C/EBPβ–/– mice compared with C/EBPβ+/+ mice. These results suggest a significant role for C/EBPβ in postischemic inflammation and brain damage.