bluuebunny/crossref_metadata_2025 huggingface dataset:
Taxing the Poor: The Politics of Income Taxation in Ireland
Authors: Hardiman Niamh
Published: July 2005

Income tax is the largest single means of generating revenue in modern states, and its impact is felt by virtually all members of society. How it is levied is therefore a matter of the highest political significance. Yet countries vary greatly in the manner in which they allocate the burden of paying income tax. In Ireland, the profile of income tax has changed dramatically throughout the course of economic modernization, since about 1960. By 1980 it was generally agreed that employees were carrying too much of the burden, especially those on fairly low incomes. Steady growth in recent years has enabled governments to cut tax rates while still bringing in rising revenue. But shifting the distribution of tax has proved very difficult, and tax reform has tended to favor the wealthy most. This article draws on comparative political science literature to highlight the political and institutional variables relevant to explaining these trends.

“The Chancellor of the Exchequer is a man whose duties make him more or less of a taxing machine. He is entrusted with a certain amount of misery which it is his duty to distribute as fairly as he can” (Robert Lowe, Viscount Sherbrooke, (Liberal), Hansard, 1870, April 11, col. 1639).
Book Notes
Authors: Perkins William B.
Published: July 2005

R. Douglas Arnold, Michael J. Graetz, and Alicia H. Munnell (Eds.), Framing the Social Security Debate: Values, Politics, and Economics.

Eugene Bardach, Getting Agencies to Work Together: The Practice and Theory of Managerial Craftsmanship.

J. Patrick Dobel, Public Integrity.

Milton Fisk, Toward a Healthy Society: The Morality and Politics of American Health Care Reform.

Marie Gottschalk, The Shadow Welfare State: Labor, Business, and the Politics of Health Care in the United States.

Graeme A. Hodge, Privatization: An International Review of Performance.

Donald F. Kettl, The Global Public Management Revolution: A Report on the Transformation of Governance.

Steven G. Koven, Public Budgeting in the United States: The Cultural and Ideological Setting.

George A. Krause, A Two‐way Street: The Institutional Dynamics of the Modern Administrative State.

Michael T. McGuire and William H. Anderson, The U.S. Healthcare Dilemma: Mirrors and Chains.

Kenneth J. Meier and Jeff Gill, What Works: A New Approach to Program and Policy Analysis.

Karen Mossberger, The Politics of Ideas and the Spread of Enterprise Zones.

Kate O'Neill, Waste Trading among Rich Nations: Building a New Theory of Environmental Regulation.

William Simonsen and Mark D. Robbins, Citizen Participation in Resource Allocation.

John D. Wirth, Smelter Smoke in North America: The Politics of Transborder Pollution.
The Demographics of Gubernatorial Appointees: Toward an Explanation of Variation
Authors: Riccucci Norma M. , Saidel Judith R.
Published: July 2005

This study examines the various factors that could potentially predict or explain demographic diversity in high‐level gubernatorial appointments in state government. In particular, it identifies and analyzes a set of variables that could help answer the question: Under what conditions are governors more likely to appoint higher proportions of women and people of color to top‐ranking executive branch positions? This question, not yet addressed by researchers, is particularly salient in the current climate of accelerated devolution. Decisionmakers in state governments play a greater role in determining policy across an increasingly wide range of areas than at any time in recent history. From the standpoint of representativeness, the demographic background of state policymakers increases the stakes of those who participate, particularly in terms of policy outcomes. Thus, it is especially important to identify the participants in state‐level policy arenas and the factors that could predict their appointments.
The Electoral Foundations of Japan's Banking Regulation
Authors: Rosenbluth Frances , Thies Michael F.
Published: July 2005

This article locates Japan's financial policies in the context of electoral incentives. The collapse of Japan's economic bubble in 1990 exposed the rot in the banking system, hidden for decades by a Liberal Democratic Party (LDP) government intent on maintaining favor with local support groups and protecting inefficient small banks. In a move wholly uncharacteristic of Japan's postwar politics, the LDP ultimately forced the banks to absorb huge losses rather than require taxpayers to bail out their mortgage‐lending subsidiaries (jusen). We compare the government's subsequent bank bailout scheme with past government action and find that the government's objectives have shifted from boosting bank profits to ensuring their prudential regulation. We conclude on an optimistic note about the prospects for more public goods‐oriented politics in Japan.
The Fate of National Health Insurance in Canada and the United States: A Multiple Streams Explanation
Authors: Blankenau Joe
Published: July 2005

This article uses the multiple streams lens to describe why Canada eventually adopted national health insurance in the 1960s, compared with the most recent attempt at adopting national health insurance in the United States. The analysis strengthens the lens by paying close attention to the impact of differing institutional frameworks on the streams. It is found that the lens provides a useful description of the complexity of policymaking, pointing out critical elements in the process that are often overlooked.
Influencing Environmental Policy in Rural Communities: The Environmental Opposition at Work
Authors: Switzer Jacqueline Vaughn
Published: July 2005

Environmental opposition groups have often formed in rural communities as a response to sweeping environmental regulations. They do not match the stereotypes of nongovernmental organizations funded by extractive resource industries, but have a solid grass‐roots membership that is stalling, if not altogether thwarting, the momentum of the environmental movement.
Locating Critical Components of Regional Human Capital
Authors: Farmer Michael C. , Kingsley Gordon
Published: July 2005

Enormous attention has been devoted recently to the contributions of human capital in the strategic and competitive success of different regions. These advances by macroeconomists and trade theorists have important implications for understanding the influence of economic development programs in a rural environment. Drawing upon this research we argue that human capital concepts may offer a more effective basis for assessment of strategic resource needs and use within a rural setting. An approach using direct elicitation methods is outlined for developing human capital measures. One significant advantage of a human capital approach is the potential for creating indicators that bridge the interests of economic development and environmental programs.
Tracing Issue Definition and Policy Change: An Analysis of Disability Issue Images and Policy Response
Authors: Jeon Yongjoo , Haider‐Markel Donald P.
Published: July 2005

We examine the role of issue definition in disability policy change. Based on qualitative and quantitative evidence from media coverage and congressional hearings, we conclude that policy change was influenced by the redefinition of disability issues from medical and economic definitions to a new sociopolitical perspective. Specifically, we find evidence that media attention and tone influenced the number of congressional hearings and the tone of these hearings. The change in the congressional definition subsequently contributed to the passage of key legislation based on the sociopolitical/civil rights definition of disability. Importantly, our research supports previous studies that suggest problem definition helps to explain significant policy change.
Microcredit as a Grass‐Roots Policy for International Development
Authors: Waller Gary M. , Woodworth Warner
Published: July 2005

The failure of top‐down development policies in the Third World has given rise to a variety of grass‐roots, or bottom‐up, development strategies to combat the severe poverty that continues to plague developing countries. Among these grass‐roots approaches, microcredit has grown rapidly in popularity, scope, and impact over the last two decades. Microcredit provides financial capital for poor entrepreneurs who toil in the informal, poverty sectors in developing country economies. In addition to the thousands of predominantly nongovernmental organizations that offer microcredit programs, many national governments in the Third World are now seeking to integrate microcredit strategies into their development policy and planning. Accordingly, this article examines the microcredit movement, including its rationale and underlying premises, its impact on the poor, and its role in development policy.
Development and the Role of Microcredit
Authors: Snow Douglas R. , Buss Terry F.
Published: July 2005

Microcredit is a concept that has gained widespread acceptance by international development agencies and major donors. It is viewed as a way to correct both governmental and market failure in Sub‐Saharan Africa. Many view microcredit as a method for linking the formal and informal sectors of African economies to increase the reach of the formal sector. Extending the reach of the formal economy through microcredit is possible, and desirable, depending on macroeconomic reforms, respect for traditional financing relationships, and local control of institutions. However, very little has been done to determine the extent to which microcredit programs actually increase economic well‐being. The model program, Grameen Bank of Bangladesh, has been studied and evaluated, but replications may not be inherently successful. The literature accepts that microcredit will increase economic well‐being, if programs are correctly designed. Program design issues cannot be resolved, however, until economic well‐being is measured and associated with specific designs.
The Politics of Connectivity: The Role of Big Business in UK Education Technology Policy
Authors: Selwyn Neil , Fitz John
Published: July 2005

Since 1997, the United Kingdom (UK) government has embarked upon a series of education policy initiatives based around the increased role of private interests in both policy formulation and implementation. This article takes a detailed look at private sector involvement in education policymaking and implementation using the current “National Grid for Learning” (NGfL) technology policy drive as a contemporary form. Based on a series of in‐depth interviews with key public and private actors in the NGfL the article covers the role of business in the origins, policy formation, and eventual implementation of the initiative. It concludes by discussing the function big business can be said to be playing in UK education policy and the bearing this may have on the long‐term sustainability and effectiveness of such policies.
Issue Definition, Conflict Expansion, and Tort Reform: Lessons from the American General Aviation Industry
Authors: Tarry Scott E.
Published: July 2005

This article examines the concepts of issue definition and conflict expansion through an analysis of the debate over tort reform in the general aviation industry. More specifically, the article studies the efforts of the general aviation manufacturers to define the issue of tort reform in ways that strengthened their unlikely coalition with important consumer groups and minimized opposition from organized labor, which typically sides with the plaintiffs bar in the tort reform debate. The case is intriguing because it provides more than just a snapshot of the industry's efforts. The analysis begins by examining some of the manufacturers’ less successful strategies and traces the evolution of their campaign, which culminates in the rather clever use of issue definition and conflict expansion strategies for which the trial lawyers were unprepared to match. In the end, effective use of these strategies overcame what appeared to most observers to he a classic political mismatch.
Undue Hardship and Reasonable Accommodation: The View From the Court
Authors: Rioux Marcia H. , Crawford Cameron , Anweiler Jane
Published: July 2005

Title I of the Americans With Disabilities Act prohibits employment discrimination against disabled people. This article provides an overview of how the courts have interpreted the duty to accommodate an individual with a disability, focusing on the concepts of “reasonable accommodation” and “undue hardship.”
Local Government Implementation of the Americans With Disabilities Act: Factors Affecting Statutory Compliance
Authors: Switzer Jacqueline Vaughn
Published: July 2005

One of the questions raised after the signing of the 1990 Americans With Disabilities Act is how local governments would implement the statute. This qualitative study examines 20 cities in two states, categorizing implementation efforts and identifying factors that affect local government compliance with the law.
The Americans With Disabilities Act and Medical Providers: Ten Years After Passage of the Act
Authors: Grabois Ellen W. , Nosek Margaret A.
Published: July 2005

This article discusses the impact of the Americans With Disabilities Act (ADA) on health care providers in the last decade. Even though some ADA training has been provided for health care providers, more education will help to improve access to their offices, improve health care practices for their patients with disabilities, and be an incentive for the providers to help raise the consciousness of the rest of the community about the ADA.
The Americans With Disabilities Act as Engine of Social Change: Models of Disability and the Potential of a Civil Rights Approach
Authors: Batavia Andrew I. , Schriner Kay
Published: July 2005

The Americans With Disabilities Act, based on the civil rights/minority group and independent living models of disability, may enhance access to health care, personal assistance, employment, the electoral process, and smoke‐free environments for people with disabilities. However, this essential law cannot resolve these key issues. Supplemental theoretical and policy approaches will be necessary to promote fundamental change.
Immigration and Net Migration in New York City 1980–90
Authors: Hempstead Katherine
Published: July 2005

The relationship between immigration and the net migration of the native‐born is an important component of the overall impact of immigration. Prior analyses of cross‐sectional state and Metropolitan Statistical Area data suggest that a negative relationship exists, particularly among those with relatively little education. At the national level, much attention has been paid to the potential ethnic segregation of the population as primarily non‐White immigrants displace primarily White native‐born residents from certain areas, but there are important state and local policy issues as well, as this population shift has potentially significant implications for demand for municipal services and school enrollment. Yet until now, there has been no attempt to examine this relationship for a particular metro area. This article provides some preliminary estimates of the relationship between immigration and the migration of the native‐born in New York City between 1980 and 1990 using a census survival methodology and zip code‐level data. Initial results suggest a statistically significant negative relationship between immigration and net migration of the native‐born. The policy implications of this phenomenon are discussed briefly.
Big City Labor Markets and Immigrant Economic Performance
Authors: James Franklin J. , Romine Jeff , Resnick Terry Phyllis
Published: July 2005

Franklin J. James spent much of his career working to understand and improve our metropolitan communities. His interests were varied, ranging from impacts of fiscal and economic distress on urban areas to understanding socioeconomic forces reviving our central cities. During the last several years, Professor James had turned his attention to examining the positive economic impacts immigrants and ethnic communities have for reinvigorating our central cities‐and beginning to investigate how non‐native American's will impact America's suburbs in metropolitan settings

This preliminary exploration examines destination choices of immigrants, the characteristics of immigrant labor markets, and the determinants of immigrant earnings. The article begins to explore indirect evidence on the economic efficiency with which immigrants and native workers distribute themselves within and among labor markets as well as the assimilation process facing new immigrants. Evidence is presented to explain how the earnings of recent immigrants are affected by their human capital characteristics, their race, and ethnicity, and other factors. We reject the hypothesis that immigrants participate in a tertiary sector of urban labor markets and conclude that the determinants of immigrant earnings are similar enough to those of U.S. natives that it makes sense to assume that they work in the same primary labor market in which most native White Americans work. We find that urban labor markets for immigrants are surprisingly efficient, thus enabling immigrants to take advantage of economic opportunities. A major exception concerns what appears to be a powerful effect of discrimination on the economic progress of Black immigrants.
The European Merger Regime
Authors: Cini Michelle
Published: July 2005

Even though the European Union's merger regime has been warmly received, three distinct critiques of European policy in this field are identified. In acknowledging these critiques, this article reviews EU merger policy and suggests ways in which it might be reformed in the future. However, in order to understand the particular form that the policy now takes, emphasis must be placed on the context within which the European model of merger control has evolved. Three factors are considered: the rationale underpinning the policy; the origins of the policy as a hard‐fought compromise among the (then) 12 members of the Union; and the role played by supranational actors in the implementation and enforcement of the policy. These three European characteristics of the policy help to explain the distinctiveness of the EU model.
The Competition Criterion in British Merger Control Policy
Authors: Kryda Georgine M.
Published: July 2005

The 1984 Tebbit Doctrine formalized competition as the watchword in British merger control, a highly discretionary system that encourages negotiation between firms and the government. The government has rarely invoked the full extent of its review powers over corporate mergers, even after the 1989 European Merger Control Regulation ceded some authority to Brussels. Is competition really a criterion influencing British merger control, or do institutional and personal biases direct the decision? This article reviews the rationale for merger control, outlines the structure of the British system, and analyzes merger activity and regulators' decisions from 1984–2000.
The Politics of an Emergent Global Regime for Controlling Tax Competition
Authors: Thomas Kenneth P.
Published: July 2005

This article probes what I call the emergent global regime for controlling tax competition. Since at least the early 1990s, states have perceived that competition for investment, whether through direct subsidies or tax incentives, threatens to undermine the fiscal underpinnings of the modern state, particularly in terms of its provision of social welfare programs. As states have provided financial or fiscal subsidies to capital (especially mobile capital), they have had to compensate through some combination of imposing higher levels of taxation on other actors, running higher deficits, and cutting spending. Each has shown itself to have substantial problems, and the response of states has now come full circle: to reconsider the competition for investment that causes the fiscal problems in the first place.
Enforcing Emissions Trading Programs
Authors: Stranlund John K. , Chavez Carlos A. , Field Barry C.
Published: July 2005

Combining an analysis of the compliance incentives faced by firms in an emissions trading program, a comprehensive review of the enforcement strategies employed in Sulfur Dioxide Allowance and the Regional Clean Air Incentives Market (RECLAIM) programs, and a review of the compliance performance of these programs thus far, we are able to propose several practical guidelines for enforcing emissions trading programs. We stress the importance of prevailing market prices for emissions permits in determining compliance incentives, the importance of accurately measuring firms' emissions, and the importance of implementing enforcement strategies that remove the incentives firms may have to falsify emissions reports.
Setting an Agenda for Local Action
Authors: Silver Diana , Weitzman Beth , Brecher Charles
Published: July 2005

Many social programs, funded by government or philanthropy, begin with efforts to improve local conditions with strategic planning. Mandated by funders, these processes aim to include the views of community residents and those with technical expertise. Program leaders are left to reconcile public and expert opinions in determining how to shape their programs. The experience of the Robert Wood Johnson Foundation's Urban Health Initiative suggests that although consultation with experts and the public failed to reveal a clear assessment of the community's problems or their solutions, it did assist in engaging diverse groups. Despite this engagement, however, core leaders wielded substantial power in selecting the agenda.
Stem Cell Policies in the United States and in Germany
Authors: Gottweis Herbert
Published: July 2005

The article compares policymaking in the field of human embryonic stem cell research in the United States and in Germany. Although experimental research with human stem cells is controversial in both countries, restrictions on research are much more strict in Germany than in the United States. In order to explain the contrast between the United States and Germany in dealing with human embryonic stem cell research and to predict possible future developments, we need to look carefully at a number of important differences in the interpretations and discourses of embryonic stem cell research and their consequences for the strategies of institutions and actors in the political‐regulatory realm.
A Multiple Streams Model of U.S. Foreign Aid Policy
Authors: Travis Rick , Zahariadis Nikolaos
Published: July 2005

This study builds an interactive, quantitative model to explain U.S. foreign aid allocations. We develop an explanation based on Kingdon's multiple streams model to argue that aid decisions are the result of trade ties, socialist orientation, human needs, and the political ideologies of the administration and the senate interacting with adjustments to baseline funding. We find that there are significant conditional relationships between economic and security‐related assistance and our external and domestic variables with external variables generally being more important. The findings have implications for the study of public policy, the future of the foreign aid program, and theoretical attempts to develop more generalizable explanations of policy that encompass foreign and domestic issues.
Discrepancies between self‐ratings of and satisfaction with oral health in two older adult populations
Authors: Locker David , Gibson Barry
Published: July 2005

Abstract –

Objectives:  General health perceptions, usually measured by means of single‐item indicators, are commonly included in health and oral health surveys. The aim of the study reported here was to assess the relationship between self‐rated oral health and satisfaction with oral health in two studies of older adult populations.

Methods:  Participants in Study 1 were aged 50 years and over, the majority of whom had multiple chronic medical conditions and disabilities and lived within a multi‐level geriatric care setting. They were recruited when attending a clinic in that setting for their annual dental screening. Participants in Study 2 were somewhat healthier community dwelling individuals, also aged 50 years and older, who took part. They were originally recruited by means of a telephone survey based on random‐digit dialling. For Study 1, data were collected by means of personal interviews and a review of dental clinic charts, while for Study 2 personal interviews, clinical examination and self‐completed questionnaires were used. Measures included self‐rated oral health, satisfaction with oral health, oral health‐related quality of life (OHRQoL) and tooth loss.

Results:  Data were obtained from 225 persons in Study 1 and 541 in Study 2. In both studies there was a significant association between self‐ratings of oral health and satisfaction with oral health. However, also in both studies there was a discrepancy between the measures: approximately 10% of those with favourable oral health ratings were dissatisfied while approximately half of those with unfavourable ratings were satisfied. Those with apparently discordant responses had significantly higher scores on OHRQoL measures such as the GOHAI and the OHIP‐14 than those with concordant responses. In Study 2, a similar discrepancy between self‐rated general health and satisfaction with general health was also observed.

Conclusions:  There is degree of discordance between self‐ratings of and satisfaction with both oral and general health status in the older adult populations studied here. This may be because of the expectations concerning health in later life. More needs to be known about the frames of reference people use in constructing their responses to questions designed to assess health perceptions.
Concepts of risk in dental public health
Authors: Burt Brian A.
Published: July 2005

Abstract –  The purpose of this paper is to review the concepts of risk as we use them today in dental public health practice, and to suggest that we should broaden our view of risk. Use of terms like risk factor in the literature can be quite vague, and it is recommended that a clear definition of that and related terms be adhered to. A broader view of risk in dental research would take in the concepts of social determinants of health and population health. While some progress has been made in our understanding of these issues, better knowledge would give the public health administrator more readily available information to use in program planning. The skewed distribution of caries in the high‐income countries has led to the emergence of targeted prevention programs toward those considered to be at high risk. In public health programs, targeting at the individual level is not practical: the risk assessment methods are not yet sufficiently precise, and even when individuals are identified there are practical problems with schools and with the children themselves. (For private practice, however, high‐risk child patients can be identified as those with at least one approximal lesion in permanent teeth.) For public health purposes, an argument is made for geographic targeting, i.e. identification of areas of social deprivation where whole schools or school districts can be targeted. Geographic targeting is something between individual targeting and whole‐population approaches. Ideally, geographic targeting would supplement population measures like water fluoridation and dental health education. Examples of geographic targeting from Ohio and New York are presented as illustrations.
Caries risk assessment: methods available to clinicians for caries detection
Authors: Tranæus Sofia , Shi Xie‐Qi , Angmar‐Månsson Birgit
Published: July 2005

Abstract –  It is hypothesized that occlusal lesions are initiated on the fissure walls and can therefore be obscured by sound superficial tissue. Additionally, there is evidence that one effect of regular use of fluorides is greater opacity of enamel, which may obscure underlying lesions in dentin, the so‐called ‘hidden lesions’. Dental radiographs are inadequate for detecting decay in the occlusal surfaces until the lesion is well advanced through the enamel and into the dentin. The clinician relies on visual observation of texture and discoloration, clinical judgment based upon experience, and on tactile sense by probing with an explorer. An objective detection method to complement the traditional visual assessment is used by the clinician for arriving at clinical decisions on the management of the carious lesion: whether invasive therapy or a more conservative, noninvasive approach. Objective and reliable longitudinal monitoring of the lesion's response to preventive measures allow the selection of an appropriate therapy before the lesion progresses to the stage where invasive treatment is required. This paper discusses the problem of the lack of appropriate clinical methods for the detection and quantification of carious lesions. A few commercially available methods are described (the quantitative light‐induced fluorescence method, the DIAGNOdent device, and electrical caries monitor) and some new techniques mentioned.
Acute intestinal obstruction due to intramural haemorrhage in small intestine in a patient with severe haemophilia A and inhibitor
Authors: Ramadan Khaled M. A. , Lowry John P. , Wilkinson Alan , McNulty Orla , McMullin Mary F. , Jones Francis G. C.
Published: July 2005

Abstract:  Patients with severe haemophilia A usually present with joint, gastrointestinal and urinary tract haemorrhage. Bleeding elsewhere is often precipitated by pre‐existing pathology or trauma. We report a patient with severe haemophilia A, who presented with symptoms of acute intestinal obstruction. He has a factor VIII inhibitor and receives recombinant factor VIIa on demand at home. The CT scan of abdomen showed dilated small intestine with fluid filled loops and a long segment in the jejunum with marked transmural thickening. There was no other pathology in the small intestine. These appearances were consistent with intramural haemorrhage in the small intestine as the cause of acute obstruction. He was managed conservatively with recombinant factor VIIa and this resulted in resolution of his symptoms. This case highlights an unusual presentation of bleeding in a haemophilia patient. Intestinal obstruction due to haemorrhage in the small intestinal wall is extremely rare and only previously reported in a few haemophilia patients. It also highlights the effectiveness of conservative management with recombinant factor VIIa as opposed to immediate exploratory surgery.
Oxidative stress as a multiple effector in Fanconi anaemia clinical phenotype
Authors: Pagano Giovanni , Degan Paolo , D'Ischia Marco , Kelly Frank J. , Nobili Bruno , Pallardó Federico V. , Youssoufian Hagop , Zatterale Adriana
Published: July 2005

Abstract: Fanconi anaemia (FA) is a genetic disease characterised by bone marrow failure with excess risk of myelogenous leukaemia and solid tumours. A widely accepted notion in FA research invokes a deficiency of response to DNA damage as the fundamental basis of the ‘crosslinker sensitivity’ observed in this disorder. However, such an isolated defect cannot readily account for the full cellular and clinical phenotype, which includes a number of other abnormalities, such as malformations, endocrinopathies, and typical skin spots. An extensive body of evidence pointing toward an involvement of oxidative stress in the FA phenotype includes the following: (i)In vitroandex vivoabnormalities in a number of redox status endpoints; (ii) the functions of several FA proteins in protecting cells from oxidative stress; (iii) redox‐related toxicity mechanisms of the xenobiotics evoking excess toxicity in FA cells. The clinical features in FA and thein vivoabnormalities of redox parameters are here reconsidered in view of the pleiotropic clinical phenotype and known biochemical and molecular links to anin vivoprooxidant state, which causes oxidative damage to biomolecules, resulting in an excessive number of acquired abnormalities that may overwhelm the cellular repair capacity rather than a primary deficiency in DNA repair. FA may thus represent a unique model disease in testing the integration between the acquisition of macromolecular damage as a result of oxidative stress and the ability of the mammalian cell to respond effectively to such damage.
Laparoscopic partial hepatectomy
Authors: D’Angelica Michael
Published: July 2005

Objective:  To review the literature that addresses carrying out laparoscopic partial hepatectomy

Methodology:  A review and analysis of the English‐speaking literature addressing laparoscopic partial hepatectomy.

Results:  Laparoscopic partial hepatectomy is carried out in limited numbers and mostly on small tumours requiring wedge or segmental resections. No prospective trials have been carried out comparing laparoscopic techniques to open surgery, but case control comparisons suggest that this technique is safe and associated with shortened hospital stay and decreased incisional pain. Major hepatectomies have been carried out laparoscopically, but in very limited numbers and published experience is not sufficient to formally address this operation.

Conclusions:  Laparoscopic minor partial hepatectomy appears to be safe and of some benefit to patients if carried out by surgeons experienced in both laparoscopic and hepatic surgery. The ultimate utility of this novel surgical technique will have to be determined by future randomized prospective trials.
Role of radiofrequency ablation for liver malignancies
Authors: Ng Kelvin Kwok‐Chiu , Poon Ronnie Tung‐Ping
Published: July 2005

Radiofrequency ablation (RFA) is commonly used to treat unresectable malignant liver tumours. It can achieve effective local tumour control and the maximal normal liver parenchyma can be preserved. In recent years, there has been a tremendous expansion in the application of RFA for patients with malignant liver tumours. However, the therapeutic effect of this local ablation treatment needs to be balanced against its risks and possible local failure. The present review focuses on the role of RFA for liver malignancies, with special attention to the indication, approaches, complications, survival benefits, combination therapies and comparison with other treatment modalities. Despite favourable results of most clinical studies of RFA, the associated risks and tumour recurrence of this treatment modality should not be underestimated. Careful patient selection, meticulous RFA techniques, and prompt treatment of residual and recurrent tumours are necessary to ensure a better outcome after RFA. Until recently, there has been no strong evidence showing that RFA can replace any other treatment modalities in the management of liver tumours. Nonetheless, more convincing evidence by randomized trials is required for the establishment of a treatment protocol of RFA for patients with liver malignancies.
Pituitary adenomas: Trans‐sphenoidal experience of 300 cases
Authors: Golwa Habila Filimon , Lei Ting , Su Kai
Published: July 2005

Objective:  The main aim of the present study was to examine the effectiveness and complication rate of the 1 cm right‐sided unilateral sublabial trans‐sphenoidal surgery for patients with pituitary adenoma equal to or greater than 5 mm in diameter.

Method:  A total of 350 patients were surgically treated for pituitary adenomas between December 1999 and December 2003 in an academic neurosurgical unit in China. Three hundred patients (86%) were treated with the 1‐cm right‐sided unilateral sublabial trans‐sphenoidal approach. The mean age of patients was 43 years (range 10–78 years) and female patients accounted for 59% of the total. One hundred and ninety‐six (64%) patients had functioning endocrine tumours and 104 (36%) patients had non‐functioning tumours or macroadenomas. Tumours which were outside this simple and basic classification were excluded from the study.

Results:  There were no operative mortalities. One patient developed hypopituitarism and 16 (5%) developed transient diabetes insipidus that required pituitrin treatment. The remission rate for macroadenoma was 85% and that for microadenoma was 98.5% during a medium term follow‐up of 1–5 years. One hundred and fifteen patients had prolactin secreting tumours and 90.4% achieved endocrine remission. Fifty‐six patients had growth hormone secreting tumours and 75.4% achieved endocrine remission. Preoperatively, one hundred and fifty‐one patients presented with visual impairment and 148 (98%) achieved a documented improvement in visual acuity. The mean duration of hospital stay was 4 days (range 3–7 days).

Conclusion:  This minimally invasive trans‐sphenoidal surgery for pituitary adenomas could be used as the primary treatment for small pituitary tumours. The effectiveness of the tumour removal and low morbidity rate compare favourably with the conventional sublabial approach as well as the more recently developed endoscopic endonasal approaches.
Evaluation of PCR for Diagnosis of Indian Kala-Azar and Assessment of Cure
Authors: Maurya R. , Singh R. K. , Kumar B. , Salotra P. , Rai M. , Sundar S.
Published: July 2005

This study was done to evaluate PCR with Ld1 primers for the diagnosis of Indian visceral leishmaniasis (VL) and to assess its role in prediction of the disease outcome. The PCR assay was performed with DNA isolated from the peripheral blood of parasitologically confirmed cases of VL before the initiation of treatment, just after the end of treatment, and at 3 and 6 months of follow-up. The pretreatment PCR result was positive for 100 of 101 patients (sensitivity, 99%; confidence interval [CI], 94 to 100%). None of the 150 negative controls tested were PCR positive (specificity, 100%; CI, 96.8 to 100%). Of 60 patients who were treated at our center, 51 (85%; CI, 73 to 93%) became negative immediately after treatment and continued to be negative at 3 and 6 months of follow-up. At the 3-month follow-up, two of the remaining nine patients were PCR positive, making 58 (96.7%; CI, 87 to 100%) patients PCR negative. At the 6-month follow-up, all patients became PCR negative. One patient who was PCR negative immediately after the end of treatment relapsed 11 months later. This limited prospective study with VL patients suggests that the PCR assay is a highly sensitive and specific (99% and 100%, respectively) tool for the diagnosis of VL. In the majority of patients, it can identify a successful disease outcome; however, its translation into the field setting remains a major challenge.
Molecular Detection and Quantitative Analysis of the Entire Spectrum of Human Adenoviruses by a Two-Reaction Real-Time PCR Assay
Authors: Ebner K. , Suda M. , Watzinger F. , Lion T.
Published: July 2005

Adenoviruses (AdV) can cause life-threatening infections in immunosuppressed patients. Reliable diagnostic tests are therefore of paramount importance. Apparently, any of the six AdV species (A to F), currently comprising 51 different serotypes, can play a clinically important role in patients with impaired immune response. It is imperative therefore that diagnostic assays cover the entire spectrum of these viruses. We have sequenced presumably conserved regions of the adenoviral genome in all AdV serotypes. Based on the complete sequence information of the hexon gene, we were able to develop a two-reaction real-time PCR assay covering all human adenoviruses with equally high specificity and sensitivity. The detection systems were tested using reference strains for all 51 serotypes and >1,000 clinical samples derived from peripheral blood and stool specimens from pediatric patients after allogeneic stem cell transplantation. The two-reaction assay presented permits highly specific detection and quantification of adenoviral DNA of any serotype. From the perspective of routine clinical diagnosis, the assay represents an important improvement over existing approaches by providing a sensitive and economic technique for early detection and monitoring of adenoviral infections.
Comparison of Multiple-Locus Variable-Number Tandem-Repeat Analysis with Pulsed-Field Gel Electrophoresis,
spa
Typing, and Multilocus Sequence Typing for Clonal Characterization of
Staphylococcus aureus
Isolates
Authors: Malachowa Natalia , Sabat Artur , Gniadkowski Marek , Krzyszton-Russjan Jolanta , Empel Joanna , Miedzobrodzki Jacek , Kosowska-Shick Klaudia , Appelbaum Peter C. , Hryniewicz Waleria
Published: July 2005

Multiple-locus variable-number tandem-repeat analysis (MLVA), a new PCR-based method of typing
Staphylococcus aureus
, was compared to pulsed-field gel electrophoresis (PFGE),
spa
typing, and multilocus sequence typing (MLST) on a group of 59
S. aureus
(mostly methicillin-resistant) clinical isolates. The aim of the study was to establish possible criteria of clustering MLVA patterns and to check concordance levels between the results produced by MLVA and the three other typing methods. As in our earlier study, MLVA turned out to have discriminatory power similar to that of PFGE. Comparison of data obtained by the two approaches allowed us to propose a 70% or ca. 80% cutoff value of the similarity between two MLVA patterns, depending on a cutoff level applied to interpret the PFGE results, 75% or ca. 90%, respectively. The cutoff values corresponded to the difference of up to six or four bands, respectively, among maximum 14 bands in total produced by two isolates in the analysis. The MLVA clusters matched well those obtained by PFGE, and they were also consistent in general with clusters generated by
spa
typing and MLST, these latter methods characterized lower resolution. Our results suggest that MLVA may be reliable in shorter-term
S. aureus
epidemiological studies, including analyses of outbreaks and hospital-to-hospital strain transmission events. Well-known advantages of typing methods based on PCR (low cost, short time, and easiness of performance) make MLVA a method that may be useful in a variety of laboratories, including those performing routine microbiological analyses within medical centers.
Development of a Quantitative Real-Time PCR Assay for Detection of
Mycoplasma genitalium
Authors: Svenstrup Helle Friis , Jensen Jørgen Skov , Björnelius Eva , Lidbrink Peter , Birkelund Svend , Christiansen Gunna
Published: July 2005

Mycoplasma genitalium
is known to cause nonchlamydial, nongonococcal urethritis in men and to be associated with pelvic inflammatory disease in women. Specific and sensitive PCR methods are needed for diagnosis of this bacterium because it is very difficult to culture from patient samples. To determine the bacterial load in patients' specimens, a quantitative real-time LightCycler PCR was developed. The housekeeping gene
gap
encoding glyceraldehyde-3-phosphate dehydrogenase was chosen as the target gene. The assay could consistently detect five genome copies per reaction. To evaluate the PCR, we tested 246 selected urethral swab samples from men attending a clinic for sexually transmitted diseases. Eighty-two of the samples were found positive for
M. genitalium
by a conventional 16S rRNA gene PCR assay, whereas 164 samples were randomly chosen among those tested negative. Of the positive samples, 78 (95.1%) were found positive, whereas 6 (3.7%) of the negatives were found positive by the LightCycler assay. The patient samples were also tested with a quantitative TaqMan assay, and the bacterial load was compared to the LightCycler results. A good linear correlation between the LightCycler and the TaqMan assays was found with a correlation coefficient of 0.89 and a slope of 0.99. Significantly more
M. genitalium
-positive men had urethritis, discharge, and dysuria than had
M. genitalium
-negative men. The
M. genitalium
DNA load in samples from patients with urethritis was significantly higher than in samples from those without (61 and 2.9 copies/μl, respectively [
P
= 0.0005]). This assay may prove useful in the monitoring of treatment and for optimizing sample preparation methods.
Detection of
Pseudomonas aeruginosa
Producing Metallo-β-Lactamases in a Large Centralized Laboratory
Authors: Pitout Johann D. D. , Gregson Daniel B. , Poirel Laurent , McClure Jo-Ann , Le Phillip , Church Deirdre L.
Published: July 2005

Metallo-β-lactamases (MBLs) have been increasingly recognized from clinical isolates worldwide, but the laboratory detection of these strains is not well defined. We report a study that developed an EDTA disk screen test and a molecular diagnostic assay for the detection of MBL-producing
Pseudomonas aeruginosa
. Using NCCLS disk methodology, inhibition zone diameters were determined in tests with imipenem (IPM) and meropenem (MEM) disks alone and in combination with 930 μg of EDTA. This test was compared with the MBL Etest. The duplex PCR assay showed 100% sensitivity and specificity for detecting MBL-producing control strains. Of the 241 clinical strains of IPM-nonsusceptible
P. aeruginosa
from the Calgary Health Region isolated from 2002 to 2004, 110/241 (46%) were MBL positive using phenotypic methods while 107/241 (45%) were PCR positive for MBL genes: 103/241 (43%) for
bla
VIM
and 4/241 (2%) for
bla
IMP
. The EDTA disk screen test using MEM showed 100% sensitivity and 97% specificity for detecting MBLs in control and clinical strains. The EDTA disk screen test is simple to perform and to interpret and can easily be introduced into the workflow of a clinical laboratory. We recommend that all IPM-nonsusceptible
P. aeruginosa
isolates be routinely screened for MBL production using the EDTA disk screen test and that PCR confirmation be performed at a regional laboratory.
Real-Time Nucleic Acid Sequence-Based Amplification Using Molecular Beacons for Detection of Enterovirus RNA in Clinical Specimens
Authors: Landry Marie L. , Garner Robin , Ferguson David
Published: July 2005

Real-time nucleic acid sequence-based amplification (NASBA) using molecular beacon technology (NASBA-beacon) was compared to standard NASBA with postamplification hybridization using electrochemiluminescently labeled probes (NASBA-ECL) for detection of enteroviruses (EV) in 133 cerebrospinal fluid and 27 stool samples. NASBA-ECL and NASBA-beacon were similar in sensitivity, detecting 55 (100%) and 52 (94.5%) EV-positive samples, respectively. There were no false positives. Both NASBA assays were significantly more sensitive than culture. Real-time NASBA-beacon reagents and equipment rental were more expensive than those for NASBA-ECL; however, time to result was shortened by 1.5 h, hands-on time was reduced by 25 min, and the assay was much simpler for technologists to learn and perform.
Applicability of Oral Fluid Collected onto Filter Paper for Detection and Genetic Characterization of Measles Virus Strains
Authors: Chibo Doris , Riddell Michaela A. , Catton Mike G. , Birch Chris J.
Published: July 2005

Expansion of measles molecular surveillance to developing countries where measles is endemic will help facilitate measles control. Limited infrastructure in these areas is a barrier to referral of specimens suitable for measles virus (MV) genotyping. In this study, we demonstrate that oral fluid dried onto filter paper can be used for the detection and characterization of MV strains. Using this approach, an MV-positive sample by reverse transcriptase PCR could be obtained from 67% of serologically confirmed acute measles cases. Mimicking certain environmental conditions and duration of transportation established that MV RNA remained detectable and suitable for nucleic acid sequencing in oral fluid spots for at least 1 week. In the context of a measles outbreak in a remote region of the world where infrastructure is poor, oral fluid samples dried onto filter paper and sent to a specialized laboratory for testing will aid in the identification and characterization of the causative MV strain.