bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic inflammatory response syndrome after percutaneous nephrolithotomy: An assessment of risk factors
Authors: Chen Liang , Xu Qing‐Quan , Li Jian‐Xing , Xiong Liu‐Lin , Wang Xiao‐Feng , Huang Xiao‐Bo
Published: October 2008

Objectives:  To analyze the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to quantitatively predict the probability of SIRS after PCNL.

Methods:  Medical records on 209 patients who underwent PCNL were retrospectively analyzed. The χ2 test, the t‐test and a logistic regression model were used to identify key risk factors of SIRS after PCNL. A predictive equation was then formulated to assess the risk of SIRS according to the results from the logistic model. Subsequently, the accuracy of the equation by calculating sensitivity, specificity, overall correct percentage, and positive and negative predictive values was tested.

Results:  The incidence of SIRS after PCNL was 23.4%. The key risk factors for SIRS following PCNL were: the number of tracts, receipt of a blood transfusion, stone size, and presence of pyelocaliectasis. Other factors added no independent risk to the development of SIRS. The calculated values for sensitivity, specificity, overall percentage correct, positive predictive value and negative predictive value were 44.9%, 95.0%, 83.3%, 73.3%, and 84.9%, respectively.

Conclusions:  Number of tracts, receipt of a blood transfusion, stone size and presence of pyelocaliectasis are identified as the key risk factors for SIRS after PCNL. The predictive equation allows for an individualized and quantitative assessment of the probability of SIRS after PCNL.
Postoperative pain control for primary cleft lip repair in infants: is there an advantage in performing peripheral nerve blocks?
Authors: SIMION CARMEN , CORCORAN JULIA , IYER ADITYA , SURESH SANTHANAM
Published: October 2008

Background:  Primary cleft lip repair is performed in infants under 1 year of age. The efficacy of an infraorbital nerve block vs intravenous fentanyl was compared in our prospective, randomized controlled trial.

Methods:  Forty‐six infants scheduled for primary cleft lip repair were prospectively randomized to one of two groups: group F that received 2 mcg·kg−1 of fentanyl intravenously and an infraorbital nerve block with 0.5 ml on each side of preservative‐free normal saline, and, group B that received bilateral infraorbital nerve blocks with 0.5 ml on each side of 0.25% bupivacaine and 2 ml of preservative‐free saline solution intravenously after induction of anesthesia but prior to surgical incision. Patients were observed by a blinded observer for (i) pain scores using neonatal infant pain score; (ii) need for rescue medication in the anesthesia care unit (PACU), in the short stay unit (SSU) and at home and (iii) feeding parameters including difficulty in feeding, time to first feeding and volume of feeds in the PACU, SSU and at home.

Results:  There were no significant differences in pain scores between the two groups over time (P = 0.98); there were no differences between groups in the number of rescue medications in the PACU, in the SSU as well as at home; however, the time to first rescue medication was greater in the block group compared with the fentanyl group (P = 0.07). There were no significant differences in feeding volumes between groups in the PACU (P = 0.46), SSU (P = 0.57) and at home (P = 0.15). There were no differences in time to initiate feeding between the two groups (P = 0.81). However, there was difficulty with feeding in the block groups compared with the fentanyl group (P = 0.01).

Conclusions:  The infraorbital nerve block can be effectively used for pain control in infants undergoing primary cleft lip repair. Although children undergoing a nerve block experienced minor difficulties in feeding, there were no differences in feeding volumes or other feeding parameters. This study has shed light into postoperative outcomes besides pain control on children undergoing cleft lip repairs.
The Callender modification of the Macintosh laryngoscope blade reduces the risk of tooth–blade contact in children
Authors: MIRESKANDARI SEYED‐MOHAMMAD , ASKARIZADEH NAHID , DARABI MOHAMMAD‐ESMAEEL , RAHIMI EIMAN , ATAEE HOSSEIN‐ALI , CHAMRAMI FARHAD , EGHTESADI‐ARAGHI PAYAM
Published: October 2008

Background:  Dental injury is well recognized as a potential complication of laryngoscopy and tracheal intubation. The flange of the Macintosh blade may contact teeth during laryngoscopy causing damage. The Callander modification of the Macintosh blade (Callander blade) with a shortened heel at the proximal end has been shown to increase the blade–tooth distance and reduce contact rates in adults.

Aim:  This study was designed to evaluate the effectiveness of the Callander blade on reducing dental contact in children.

Methods:  One hundred children, aged 4–14 years, scheduled for general anesthesia requiring endotracheal intubation were studied prospectively. The children were preoperatively evaluated for Mallampati score and dental defects, looseness, and avulsions. Following induction of anesthesia, laryngoscopy was performed twice on each child in succession, once with a standard Macintosh blade and once with a Callander blade of the same size in a random order. The blade–tooth distance and contact rate were compared between the two blades.

Results:  With the Callander blade, the blade–tooth distance was greater than with the Macintosh (1.78 ± 1.77 vs 0.28 ± 0.76 mm, P = 0.001). The frequency of direct contact was less with the Callander blade than it was with the Macintosh blade (33% vs 86%, respectively, P = 0.008). However, difficult laryngoscopy rate did not differ between the blades. Tracheal intubation was successful in all children and there was no dental injury.

Conclusion:  Our findings suggest that the Callander blade decreases the risk for dental injury and provides tracheal intubating conditions in children with normal airways similar to those obtained with a traditional Macintosh blade.
THIS ARTICLE HAS BEEN RETRACTED  Anatomic relationship between the internal jugular vein and the carotid artery in pre‐school children – an ultrasonographic study
Authors: ROTH BENJAMIN , MARCINIAK BRUNO , ENGELHARDT THOMAS , BISSONNETTE BRUNO
Published: October 2008

Background:  Central venous cannulation (CVC) in young children is technically difficult and may lead to potentially serious complications especially when performed blindly or using anatomical landmarks only. The aim of this study was to determine the anatomical relationship of the internal jugular vein (IJV) and the common carotid artery (CA) in preschool children using ultrasound.

Methods:  Forty‐five children aged 60 months and under were included prospectively and divided into three groups: Group 1: <6 months, Group 2: 7–18 months and Group 3: 19‐60 months. With the head in neutral position the location of the left and right IJV was noted as anterior, anterolateral (AL), lateral or medial in relation to the CA at the level of the cricoid cartilage. Depths of IJV and CA as well as time taken to locate the vessels were recorded.

Results:  The IJV was more commonly found in the AL position in all groups. The mean depth was 0.96 cm in Group 1, 0.95 cm in Group 2 and 3. Mean duration for localization of the vessels was 4.2 s in Group 1, 4 s in Group 2 and 4.3 s in Group 3. The differences between the groups were not significant.

Conclusion:  This study demonstrates that the IJV cover the CA in the majority of young children. Depth of the IJV is rarely more than 1 cm deep to the skin. Ultrasound location of the IJV and CA is easy and does not necessarily delay the procedure. The findings of this study support the use of ultrasound guidance for CVC in children.
Evaluation of the pediatric bonfils fiberscope for elective endotracheal intubation
Authors: BEIN BERTHOLD , WORTMANN FRANK , MEYBOHM PATRICK , STEINFATH MARKUS , SCHOLZ JENS , DÖRGES VOLKER
Published: October 2008

Background:  Difficult airway management in children is a particular challenge for anesthesiologists and pediatricians. This study was designed to evaluate the performance of the recently developed pediatric versions of the Bonfils fiberscope for elective endotracheal intubation during routine surgical procedures.

Methods:  After approval by the institutional review board and written informed consent, 55 children (age 6 ± 4 years) scheduled for elective minor surgical procedures were enrolled. Nineteen children received atropine before the intubation attempt, while in the remaining 36 children, no antisialogogue was used. For endotracheal tubes up to 3.5 mm internal diameter, a fiberscope with outer diameter (OD) 2 mm, and for larger endotracheal tubes, a fiberscope OD 3.5 mm was used. Time to intubation and failure rate were obtained.

Results:  In the 36 children without and the 19 children with atropine pretreatment, the success rate for tracheal intubation on the first attempt was 69%/78% (25/15 patients). 4/3 patients and 2/0 patients were intubated after two and three attempts, respectively, and in 5/1 patients (14%/5%) intubation failed even after three attempts. Time to intubation was median 58/60 s, 25th–75th percentile 35–100/32–110 s, and range 14–377/18–360 s. In both groups, failed intubations were because of the secretions contaminating the optic aperture.

Conclusions:  High failure rate and increased intubation times suggest that the pediatric Bonfils fiberscope has significant drawbacks when used for intubation of normal pediatric airways.
Anatomical dimensions of trachea, main bronchi, subcarinal and bronchial angles in fetuses measured ex vivo
Authors: HARJEET  , SAHNI DAISY , BATRA YATINDRA KUMAR , RAJEEV SUBRAMANYAM
Published: October 2008

Background:  The increasing opportunities to consider fetal intervention in selected cases of life‐threatening malformations have necessitated airway management of fetuses with low gestational age. This study is aimed to determine the anatomical dimensions of trachea, main bronchi, subcarinal and bronchial angles and their correlation to age and crown rump length (CRL) in fetuses.

Methods:  Measurements of tracheo‐bronchial dimensions including the subcarinal and bronchial angles with the vertical were taken in specimens obtained from 40 fetuses, varying in CRL from 61 to 270 mm. The incidence of different shapes at the upper end of trachea was studied. The subcarinal and angles of main bronchi with the vertical were measured radiographically with 20% barium sulfate, in another group of 21 fetuses varying in CRL from 63 to 129 mm.

Results:  Forty fetuses (22 males, 18 females) were analyzed for the dimensions based on CRL (61–130 mm; 131–200 mm; 201–270 mm – CRL 1, 2, and 3 respectively). The internal transverse diameter of trachea was found to increase steadily from 1.87 ± 0.56 to 2.67 ± 0.7 mm (P < 0.001) and 3.68 ± 0.39 mm (P < 0.001) with increasing CRL. Similarly the outer transverse and antero‐posterior diameter of the trachea increased steadily with age. Tracheal length was found to increase significantly to 17.48 ± 2.89 mm and 24.17 ± 2.3 from 12.72 ± 2.5 mm (P < 0.001). The length of paries membranaceous increased with gestational age. Although the length of bronchi increased significantly and linearly, subcarinal and bronchial angles did not show any significant changes with age. There was no sexual dimorphism in measurements in the fetuses of corresponding CRL. Oval shaped trachea was found in 60% and circular in 40% of fetuses. The measurements of subcarinal and bronchial angles performed by radiology were almost the same as those measured in trachea separated from fetuses.

Conclusion:  The internal transverse, outer transverse and antero‐posterior diameters, length of trachea and bronchi and circumference of trachea, relate in a linear fashion to CRL and age. However, subcarinal and bronchial angles remained constant.
Modified anchoring maneuver using pilot puncture needle to facilitate internal jugular vein puncture for small children
Authors: TRIPATHI MUKESH , PANDEY MAMTA
Published: October 2008

Objectives:  Internal jugular vein (IJV) cannulation in infants has been reported with varied success using surface landmark. The aim is to share authors experience of modified anchoring technique used in infants.

Methods:  Anchoring maneuver using pilot needle (PN) has been recently described in adults. We have found that if the PN is left in IJV and then i.v. cannula (22G or 24G) is passed just posterior to the puncture point of PN to track down the PN path at 10–20° angles from skin, a natural tumbling movement of the PN helped to anchor anterior wall of IJV and facilitated its puncture. The results of 128 punctures performed in infants (<1 years) were analyzed in two groups of <6 months (n = 52) and >6 months to 1 year (n = 76).

Results:  In infants weighing 3.5–14 kg, all cannulations were performed successfully. IJV puncture was detected at the entry of i.v. cannula more often in both the groups (81% in <6 months baby and 84% in >6 months baby) than withdrawing it. In 12 (10%) patients, the puncture site was changed to left IJV as carotid artery was punctured in three and failure to localize right IJV in nine patients by surface landmark.

Conclusions:  In authors experience, the described technique detected IJV cannulation at its entry in majority of infants and so the method is less prone to complications related to overshooting of the needle in lack of IJV puncture detection.
End‐of‐life decisions in pediatric intensive care. Recommendations of the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI)
Authors: GIANNINI ALBERTO , MESSERI ANDREA , APRILE ANNA , CASALONE CARLO , JANKOVIC MOMCILO , SCARANI ROBERTO , VIAFORA CORRADO ,   FOR THE SARNePI BIOETHICS STUDY GROUP
Published: October 2008

End‐of‐life decisions represent one of the most complex and challenging issues in pediatric intensive care. These recommendations aim to offer Italian pediatric intensive care unit (PICU) teams a framework for the end‐of‐life decision‐making process. The paper proposes a process based on the principle that the use of a diagnostic or therapeutic tool must comply with a ‘criterion of proportionality’. Appropriately informed parents, as natural interpreters and advocates of the best interests of their child, can contribute in assessing the burdensomeness of the treatment and determining its proportionality. The decision to limit, withdraw or withhold life‐sustaining treatments considered disproportionate represents a clinically and ethically correct choice. This decision should be made (a) collectively by PICU team and the other caregivers, (b) with the explicit involvement of parents, and (c) noting in the patient's clinical record the decisions taken and the reasons behind them. The withdrawing or withholding of life support can never entail the abandonment of the patient nor the withdrawal of any therapy aimed at treating any form of suffering. No action aimed at deliberately hastening the death of the patient is ever acceptable. These recommendations advocate a decision as far as possible shared by patient (whenever feasible), parents and caregivers. Ensuring that all involved are kept fully informed and that there is open and timely communication between them is the key to achieving this. It is the physician in charge of the patient's care and the head of the unit who bear the main responsibility for the final decision.
The hemodynamic effects of newborn caudal anesthesia assessed by transthoracic echocardiography: a randomized, double‐blind, controlled study
Authors: DENG MENG , WANG XUAN , WANG LiHONG , ZHENG SHAN
Published: October 2008

Background:  Caudal anesthesia has been increasingly used in abdominal, urinary tract, and lower extremity surgery of infants. However, little was known about the hemodynamic effects of caudal anesthesia in them, especially in neonates. The purpose of this prospective study was designed to investigate the hemodynamic alterations by transthoracic echocardiography in newborn baby after caudal anesthesia with plain Bupivacaine or with epinephrine added Bupivacaine.

Methods:  Thirty full‐term newborn infants scheduled for lower abdominal or urinary tract surgery were randomly allocated into three groups (n = 10 each) as follows: (i) GA group: general anesthesia with sevoflurane; (ii) GA+CP group: GA with sevoflurane, combined with caudal anesthesia of plain Bupivacaine (1.25 ml·kg−1 of 0.2%); (iii) GA+CA group: sevoflurane GA combined with caudal anesthesia of epinephrine‐added Bupivacaine (1.25 ml·kg−1 of 0.2% Bupivacaine plus 1/200 000 epinephrine). Cardiac output (CO), arterial blood pressure, and heart rate were measured before (T‐5) and 5(T5), 10(T10), 15(T15) min after performance of caudal anesthesia.

Results:  In GA group, no significant hemodynamic alteration was observed in comparison with T‐5, except HR, which decreased by 7% at T15; In GA+CP group, compared with T‐5, HR decreased significantly at T5, T10 and T15, respectively, by 6%, 7% and 10%. And also CO decreased significantly at T15 by 8% compared with T‐5; In GA+CA group, no significant hemodynamic alteration was observed expect diastolic arterial blood, which decreased significantly at T15 by 10% compared with T‐5; At T15, the larger decrease of systolic arterial blood in GA+CP group and GA+CA group vs (GA) group (P < 0.05).

Conclusions:  The study shows the stability of hemodynamic variables during caudal anesthesia with Bupivacaine and with epinephrine‐added Bupivacaine in newborn infants.
Solifenacin in the treatment of urgency and other symptoms of overactive bladder: results from a randomized, double‐blind, placebo‐controlled, rising‐dose trial
Authors: Cardozo Linda , Heßdörfer Elke , Milani Rodolfo , Arañó Pedro , Dewilde Luc , Slack Mark , Drogendijk Ted , Wright Mark , Bolodeoku John ,   for the SUNRISE Study Group (see )
Published: October 2008

OBJECTIVES

To examine the effects of the antimuscarinic agent solifenacin on urinary urgency, using a range of novel and established outcome measures, as urgency is the principal symptom of the overactive bladder syndrome (OAB).

PATIENTS AND METHODS

The study (SUNRISE, solifenacin in the treatment of urgency symptoms of OAB in a rising dose, randomized, placebo‐controlled, double‐blind, efficacy trial) was a randomized, double‐blind, 16‐week, placebo‐controlled, multicentre study of solifenacin 5/10 mg in 863 patients with symptoms of OAB for ≥3 months. The primary efficacy variable was the change from baseline to endpoint in the number of episodes of severe urgency with or without urgency incontinence per 24 h, as measured using the Patient Perception of Intensity of Urgency Scale, grade 3 + 4. Secondary efficacy variables included patient‐reported outcomes for bladder condition, urgency bother and treatment satisfaction. A 3‐day voiding diary was used to record micturition frequency and episodes of urgency and incontinence. A 7‐day diary was used to assess speed of onset of effect.

RESULTS

Solifenacin 5/10 mg was significantly more effective than placebo in reducing the mean number of episodes of severe urgency with or without incontinence per 24 h from baseline to endpoint (−2.6 vs −1.8, P < 0.001). There were also statistically significant differences in favour of solifenacin 5/10 mg over placebo for all secondary variables measured at endpoint, including patient‐reported outcomes. There was a significant improvement in urgency as early as day 3 of treatment. Treatment‐emergent adverse events with solifenacin 5/10 mg were mainly mild or moderate in severity, and only led to discontinuation in 3.6% of patients.

CONCLUSION

Solifenacin significantly reduced the number of urgency episodes and the extent of urgency bother, and was well tolerated; it was effective as early as day 3 of treatment.
Leydig cell tumour of the testis: presentation, therapy, long‐term follow‐up and the role of organ‐sparing surgery in a single‐institution experience
Authors: Suardi Nazareno , Strada Elena , Colombo Renzo , Freschi Massimo , Salonia Andrea , Lania Caterina , Cestari Andrea , Carmignani Luca , Guazzoni Giorgio , Rigatti Patrizio , Montorsi Francesco
Published: October 2008

OBJECTIVE

To report our single‐centre experience of patients with Leydig cell tumour (LCT) of the testis, which represents the most frequent interstitial neoplasm of the testis, and for which the natural history and therapy are debated.

PATIENTS AND METHODS

Between 1990 and 2006, 37 patients were treated for LCT of the testis. All patients had testicular markers assessed and 21 (57%) had their hormonal profile assessed (total testosterone, follicle‐stimulating hormone, luteinizing hormone and oestradiol). We analysed the symptoms at presentation, laboratory findings, organ‐sparing vs. radical surgery and oncological and symptomatic follow‐up data.

RESULTS

Medical referral was for a testicular mass in 32% of patients, gynaecomastia in 8%, testicular pain in 8%, infertility in 11%, and isosexual pseudo‐puberty in 5%. The mean (range) diameter of the tumour was 16.5  (6–68) mm. Before surgery testosterone levels exceeded the upper limit in a third of patients, while levels were hypogonadal in 19%. Oestradiol levels were increased in 29% of patients. At surgery, 29 patients (78%) had organ‐sparing surgery. The median (range) follow‐up was 4.6 (0.6–16.2)  years; no patient had disease relapse. Gynaecomastia was present in two of six patients at the follow‐up, despite pharmacological treatment. Four patients had a low testosterone level.

CONCLUSION

Patients diagnosed with LCT have a good prognosis; this study shows the safety of conservative surgery. Surgical removal of the tumour is not always associated with resolution of symptoms and abnormal laboratory values.
Robotic‐assisted laparoscopic partial nephrectomy: surgical technique and clinical outcomes at 1 year
Authors: Ho Henry , Schwentner Christian , Neururer Richard , Steiner Hannes , Bartsch Georg , Peschel Reinhard
Published: October 2008

OBJECTIVE

To report our surgical technique of robotic‐assisted laparoscopic partial nephrectomy (RLPN) for renal tumours of <7 cm and present their clinical outcomes, as minimally invasive PN is an increasingly viable option for small renal tumours.

PATIENTS AND METHODS

From July 2005 to December 2006, 20 consecutive patients (mean age 58.2 years, sd 7.9) had RLPN and a follow‐up of ≥1 year, all surgery being undertaken by one surgeon. All cases were elective except in one patient with a solitary kidney. We used the three‐arm da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA) in a four‐port, transperitoneal approach. Transient vascular occlusion was applied in all cases using a tourniquet technique. The tumour was excised with a 5‐mm margin using cold‐cut scissors, and the margins were assessed by frozen sections. The specimen was placed in an impervious bag for subsequent removal via the camera port. Under direct vision, we repaired all pelvicalyceal system entries with absorbable sutures. After the entire tumour bed surface was lined with FlosealTM (Baxter Healthcare, Deerfield, IL, ISA) the capsule/parenchyma was closed with running suture, reinforced by haemostatic clips.

RESULTS

The mean (sd) operative and warm ischaemia times were 82.7 (17.0) and 21.7 (2.4) min, respectively, and the mean estimated blood loss was 189 (32) mL. There were no intraoperative complications or conversion to open surgery. There was also no bleeding after surgery, perinephric haematoma or urinary leakage. The mean (sd) tumour size was 30.2 (2.4) mm, while margins were negative in all cases of malignancy. At the 1‐year follow‐up there was no local recurrence, renal functional deterioration or late surgical complications.

CONCLUSIONS

Our RLPN technique is a safe and feasible option for small renal tumours. Reproducible technique and good team co‐ordination are pivotal for obtaining good oncological and surgical outcomes.
Prevalence and incidence of Type 2 diabetes and its complications 1996–2003—estimates from a Swedish population‐based study
Authors: Ringborg A. , Lindgren P. , Martinell M. , Yin D. D. , Schön S. , Stålhammar J.
Published: October 2008

Aims  To determine the prevalence and incidence of Type 2 diabetes and its complications in Uppsala county, Sweden between 1996 and 2003.

Methods  Retrospective population‐based study of patients with Type 2 diabetes identified in computerized medical records at 26 county primary care centres. Prevalence and incidence of Type 2 diabetes were estimated in the population aged 30–39, 40–49, 50–59, 60–69, 70–79 and ≥ 80 years. Mortality, prevalence and incidence of complications in patients with Type 2 diabetes were determined through linkage to national inpatient, uraemia and cause‐of‐death registers.

Results  Crude prevalence of Type 2 diabetes increased from 2.2 to 3.5% between 1996 and 2003. In the population aged ≥ 30 years, the age‐ and sex‐adjusted period increase was 53%[odds ratio (OR) 1.53, 95% confidence interval (CI) 1.47–1.58]. Crude population incidence was approximately stable after 1997 (3.7 cases/1000 residents in 1997 compared with 3.8/1000 in 2003). Age‐ and sex‐adjusted mortality rates in Type 2 diabetic patients decreased by 4% per year (OR 0.96, 95% CI 0.94–0.97). Prevalence rates of cardiovascular disease in Type 2 diabetic patients were essentially stable, affecting 13.8% of females and 18.0% of males in 2003. No trend was detected for prevalence of renal failure or incidence of acute myocardial infarction, stroke and amputation.

Conclusions  Prevalence of Type 2 diabetes increased in Uppsala county between 1996 and 2003 as a consequence of approximately stable incidence since 1997 and declining mortality. Rates of diabetes‐related complications, notably cardiovascular disease, continued to impose a substantial burden.
The association of physical activity and depression in Type 2 diabetes
Authors: Lysy Z. , Da Costa D. , Dasgupta K.
Published: October 2008

Aims  Physical inactivity and depressed mood are both associated with a higher likelihood of diabetes‐related complications; the association between physical activity and depressed mood in Type 2 diabetes has not been reviewed previously. We have reviewed (i) the strength of this association and (ii) the impact of depression‐specific management and physical activity interventions on mood and activity levels in overweight adults with Type 2 diabetes.

Methods  Studies published between January 1996 and September 2007 were identified (Ovid‐medline, Psych‐Info and embase) using pertinent search terms (keyword/title).

Results  Of the 12 studies included (10 cross‐sectional, two trials), most employed a standardized questionnaire for depressed mood but only one item for physical activity. In adults with Type 2 diabetes, the inactive are 1.72 to 1.75 times more likely to be depressed than the more active; the depressed are 1.22 to 1.9 times more likely to be physically inactive than the non‐depressed. Two randomized trials demonstrated that a depression management programme improved mood, but only one demonstrated increased physical activity.

Conclusions  Studies to date suggest an association between depressed mood and physical inactivity in adults with Type 2 diabetes, although objective measures of physical activity have not been employed. Depression‐specific management may improve mood and possibly activity. A trial comparing the impact of depression‐specific management compared with exercise intervention on depressed mood and activity in Type 2 diabetes is justified.
Effect of weight‐reducing agents on glycaemic parameters and progression to Type 2 diabetes: a review
Authors: Lloret‐Linares C. , Greenfield J. R. , Czernichow S.
Published: October 2008

Weight loss is associated with improvements in glycaemic control and cardiovascular disease risk factors. However, in the diabetic population, weight management is more challenging, in part because of the weight‐promoting effects of the majority of glucose‐lowering therapies. This review summarizes evidence from 23 placebo‐controlled randomized trials, of at least 1 year duration, on the effects of drugs promoting weight loss (orlistat, sibutramine and rimonabant) on glycaemic variables, diabetes incidence and diabetes control. Fifteen studies of non‐diabetic subjects were found, eight of which included a longer treatment period. Eight studies in diabetic patients were reviewed. In non‐diabetic subjects, weight loss agents led to a significant improvement in fasting glucose, fasting insulin and insulin resistance. In the diabetic population, glycated haemoglobin decreased by 0.28–1.1% with orlistat and 0.6% with sibutramine and rimonabant. Orlistat reduces progression to diabetes in patients with glucose intolerance treated for 4 years (risk reduction of 45%). In summary, despite leading to only modest weight loss after 12 months, agents promoting weight loss have beneficial effects on glycaemic parameters, glycaemic control and progression to diabetes. These additional benefits of weight loss agents need to be highlighted in order to increase their judicious use in clinical practice, although this may be limited by their well‐known adverse side effects. The longer‐term safety of these agents beyond a few years is yet to be established.
Specific phenotype associated with diabetes mellitus secondary to chronic hepatitis C infection
Authors: Poussier A. , Lebouvier M. , Penfornis A. , Di Martino V. , Buffier P. , Verges B. , Hillon P. , Petit J. M.
Published: October 2008

Aim  A link between chronic hepatitis C virus (HCV) infection, Type 2 diabetes mellitus and insulin resistance has been suggested by several studies. However, HCV infection appears to be associated with insulin resistance but not with the metabolic syndrome. The aim of this study was to determine whether chronic HCV infection had an impact on the clinical characteristics of Type 2 diabetes.

Methods  We studied retrospectively a group of patients with diabetes mellitus associated with HCV infection (HCV‐DM) and compared them with patients with conventional Type 2 diabetes (DM).

Results  The HCV‐DM patients had a lower body mass index (P = 0.001) and systolic blood pressure (P = 0.04) compared with patients with DM diabetes. Ten patients (27.0%) in the HCV‐DM group and 35 (47.3%) in the DM group had microalbuminuria (P = 0.04). DM patients had significantly higher serum creatinine levels than HCV‐DM patients [87 (72–108) vs. 77 (64–86) µmol/l, P = 0.02; median (interquartile range)] but creatinine clearance (Cockroft Gault calculation) was similar. One HCV‐DM patient (2.7%) and 44 DM patients (59.4%) were treated with hypolipidaemic therapy (P = 0.0001). Even although nearly two‐thirds of the overall DM group were prescribed cholesterol‐lowering drugs, DM patients had significantly higher total cholesterol, high‐density lipoprotein cholesterol and triglyceride levels than HCV‐DM patients.

Conclusion  Our study provides further evidence that HCV‐DM patients have specific clinical characteristics in comparison with classical DM patients. These data suggest an association between HCV virus infection and the development of insulin resistance or diabetes mellitus without the typical features of the metabolic syndrome.
THE BENEFITS AND COSTS OF MONETARY UNION IN SOUTHERN AFRICA: A CRITICAL SURVEY OF THE LITERATURE
Authors: Tavlas George S.
Published: October 2008

Abstract With the 14 members of the Southern African Development Community (SADC) having set the objective of adopting a common currency for the year 2018, an expanding empirical literature has emerged evaluating the benefits and costs of a common‐currency area in Southern Africa. This paper reviews that literature, focusing on two categories of studies: (1) those that assume that a country's characteristics are invariant to the adoption of a common currency and (2) those that assume that a monetary union alters an economy's structure, resulting in trade creation and credibility gains. The literature reviewed suggests that a relatively small group of countries, typically including South Africa, satisfies the criteria necessary for monetary unification. The literature also suggests that, in a monetary union comprising all SADC countries and a regional central bank that sets monetary policy to reflect the average economic conditions (e.g. fiscal balances) in the region, the potential losses (i.e. higher inflation) from giving up an existing credible national central bank, a relevant consideration for South Africa, could outweigh any potential benefits of trade creation resulting from a common currency.
Generation of stable ‘low phytic acid’ transgenic rice through antisense repression of the 1d‐myo‐inositol 3‐phosphate synthase gene (RINO1) using the 18‐kDa oleosin promoter
Authors: Kuwano Mio , Mimura Tetsuro , Takaiwa Fumio , Yoshida Kaoru T.
Published: October 2008

Phytic acid acts as the major storage form of phosphorus in plant seeds and is poorly digested by monogastric animals. The degradation of phytic acid in animal diets is necessary to overcome both environmental and nutritional issues. The enzyme 1d‐myo‐inositol 3‐phosphate [Ins(3)P1] synthase (EC 5.5.1.4) catalyses the first step of myo‐inositol biosynthesis and directs phytic acid biosynthesis in seeds. The rice Ins(3)P1 synthase gene (RINO1) is highly expressed in developing seed embryos and in the aleurone layer, where phytic acid is synthesized and stored. In rice seeds, 18‐kDa oleosin (Ole18) is expressed in a seed‐specific manner, and its transcripts are restricted to the embryo and the aleurone layer. Therefore, to effectively suppress phytic acid biosynthesis, antisense RINO1 cDNA was expressed under the control of the Ole18 promoter, directing the same spatial pattern in seeds as RINO1 in transgenic rice plants. The generated transgenic rice plants showed strong ‘low phytic acid’ (lpa) phenotypes, in which seed phytic acid was reduced by 68% and free available phosphate was concomitantly increased. No negative effects on seed weight, germination or plant growth were observed. The available phosphate levels of the stable transgenic plants surpassed those of currently available rice lpa mutants.
Post‐conflict Statebuilding and State Legitimacy: From Negative to Positive Peace?
Authors: Roberts David
Published: October 2008

This article is concerned with the potential that statebuilding interventions have to institutionalize social justice, in addition to their more immediate ‘negative’ peace mandates, and the impact this might have, both on local state legitimacy and the character of the ‘peace’ that might follow. Much recent scholarship has stressed the legitimacy of a state's behaviour in relation to conformity to global governance norms or democratic ‘best practice’. Less evident is a discussion of the extent to which post‐conflict polities are able to engender the societal legitimacy central to political stability. As long as this level of legitimacy is absent (and it is hard to generate), civil society is likely to remain distant from the state, and peace and stability may remain elusive. A solution to this may be to apply existing international legislation centred in the UN and the ILO to compel international organizations and national states to deliver basic needs security through their institutions. This has the effect of stimulating local‐level state legitimacy while simultaneously formalizing social justice and positive peacebuilding.
Patronage or Participation? Community‐based Natural Resource Management Reform in Sub‐Saharan Africa
Authors: Nelson Fred , Agrawal Arun
Published: October 2008

This article examines the institutional factors that account for the outcome of efforts to decentralize control over natural resources to local communities. It focuses on the political nature of institutional processes associated with decentralization in sub‐Saharan Africa through a comparative analysis of wildlife management reforms in seven east and southern African countries. Institutional reforms are largely dependent on state authorities' patronage interests, which in turn are shaped by the relative economic value of wildlife, the degree of central control over commercial utilization, and the accountability of governance institutions. Our findings have a range of practical implications for the design of CBNRM initiatives and institutional reform strategies.
Challenging Orthodoxies: Understanding Poverty in Pastoral Areas of East Africa
Authors: Little Peter D. , McPeak John , Barrett Christopher B. , Kristjanson Patti
Published: October 2008

Understanding and alleviating poverty in Africa continues to receive considerable attention from a range of diverse actors, including politicians, international celebrities, academics, activists and practitioners. Despite the onslaught of interest, there is surprisingly little agreement on what constitutes poverty in rural Africa, how it should be assessed, and what should be done to alleviate it. Based on data from an interdisciplinary study of pastoralism in northern Kenya, this article examines issues of poverty among one of the continent's most vulnerable groups, pastoralists, and challenges the application of such orthodox proxies as incomes/expenditures, geographic remoteness, and market integration. It argues that current poverty debates ‘homogenize’ the concept of ‘pastoralist’ by failing to acknowledge the diverse livelihoods and wealth differentiation that fall under the term. The article concludes that what is not needed is another development label (stereotype) that equates pastoralism with poverty, thereby empowering outside interests to transform rather than strengthen pastoral livelihoods.
Women's Property, Women's Agency in China's ‘New Enclosure Movement’: Evidence from Zhejiang
Authors: Sargeson Sally
Published: October 2008

Who gets what, why and how, when Chinese villagers' land is enclosed? Focusing specifically on changes in women's property rights and drawing on data from Zhejiang province, this article shows that state, village and household institutions interact to produce significant gender disparities in both the compensation paid to expropriated villagers and the registration of ownership of household assets. Yet it would be incorrect to conclude that, dispossessed, women thereby lack agency. Analysis of women's responses to expropriation suggests that by selectively deploying laws, rules and norms in different settings, women are influencing not only compensation distribution, but also the terms under which the state compensates villagers for their expropriation and the gender relations in which property is embedded.
Negotiating Remote Borderland Access: Small‐Scale Trade on the Vietnam–China Border
Authors: Schoenberger Laura , Turner Sarah
Published: October 2008

This article explores the cross‐border trading networks and practices of highland residents in north‐west Vietnam. It reveals how such individuals, of highland minority and majority Kinh ethnicities, negotiate the political reality of an international border in highly pragmatic ways as they augment their livelihoods by trading commodities with inhabitants in south‐west China. We follow four particular commodities, traded across different political tiers of border crossing (each with specific rules, regulations and negotiations), by a diverse range of traders. In doing so we argue that border access is mediated by a complex and multifaceted set of social and structural components including not only state policy, but ethnically‐embedded social relations and specific geographic variables that, in turn, are engendering disparate economic opportunities.
Variance Reduction in Smoothing Splines
Authors: PAIGE ROBERT L. , SUN SHAN , WANG KEYI
Published: October 2008

Abstract. We develop a variance reduction method for smoothing splines. For a given point of estimation, we define a variance‐reduced spline estimate as a linear combination of classical spline estimates at three nearby points. We first develop a variance reduction method for spline estimators in univariate regression models. We then develop an analogous variance reduction method for spline estimators in clustered/longitudinal models. Simulation studies are performed which demonstrate the efficacy of our variance reduction methods in finite sample settings. Finally, a real data analysis with the motorcycle data set is performed. Here we consider variance estimation and generate 95% pointwise confidence intervals for the unknown regression function.
Parametric Estimation Procedures in Multivariate Generalized Pareto Models
Authors: MICHEL RENÉ
Published: October 2008

Abstract.  Modelling the tails of a multivariate distribution can be reasonably done by multivariate generalized Pareto distributions (GPDs). We present several methods of parametric estimation in these models, which use decompositions of the corresponding random vectors with the help of different versions of Pickands coordinates. The estimators are compared to each other with simulated data sets. To show the practical value of the methods, they are applied to a real hydrological data set.
Bayesian Goodness of Fit Testing with Mixtures of Triangular Distributions
Authors: McVINISH ROSS , ROUSSEAU JUDITH , MENGERSEN KERRIE
Published: October 2008

Abstract. We consider the consistency of the Bayes factor in goodness of fit testing for a parametric family of densities against a non‐parametric alternative. Sufficient conditions for consistency of the Bayes factor are determined and demonstrated with priors using certain mixtures of triangular densities.
UNEMPLOYMENT, LABOR MARKET TRANSITIONS, AND RESIDUAL WAGE DISPERSION
Authors: Fitzenberger Bernd , Garloff Alfred
Published: October 2008

It is commonplace in the debate on Germany's labor market problems to argue that low wage dispersion is a major reason for the high unemployment rate. This paper analyzes the relationship between unemployment and residual wage dispersion for individuals with comparable attributes. In the conventional neoclassical point of view, wages are determined by the marginal product of the workers. Accordingly, increases in union minimum wages result in a decline of residual wage dispersion and higher unemployment. A competing view regards wage dispersion as the outcome of search frictions and the associated monopsony power of the firms. Accordingly, an increase in search frictions causes both higher unemployment and higher wage dispersion. The empirical analysis attempts to discriminate between the two hypotheses for West Germany analyzing the relationship between wage dispersion and both the level of unemployment as well as the transition rates between different labor market states. The findings are not completely consistent with either theory. However, as predicted by search theory, one robust result is that unemployment by cells is not negatively correlated with the within‐cell wage dispersion.
SYNCHRONISING DEREGULATION IN PRODUCT AND LABOUR MARKETS
Authors: Seldeslachts Jo
Published: October 2008

Deregulation typically comes with redistribution of rents and thus with opposition from the losing interest groups. We show that, by exploiting complementarities, synchronising deregulation across markets makes this opposition lower. Indeed, a particular deregulation may reduce rents for one interest group, but may result in gains for another interest group. Synchronising reforms can therefore offer a way out of the ‘sclerosis’ of especially European markets. For this effect, we build a microeconomic model based on two assumptions: Cournot competitionà laVives in the product markets and firms hiring workers in accordance with an efficiency wage in the labour markets. As being particularly relevant for European economies, we focus on product market regulation that determines the degree of market integration and labour market regulation that determines the degree of employment protection.
‘BRAIN DRAIN’ OR ‘BRAIN CIRCULATION’: EVIDENCE FROM OECD'S INTERNATIONAL MIGRATION AND R&D SPILLOVERS
Authors: Le Thanh
Published: October 2008

This paper empirically investigates whether labour mobility can transfer technology across borders based on the panel cointegration method. Estimates of specifications on a cross‐section of 19 OECD countries during 1980–1990 lend strong support to this thesis. Data indicate that international labour movement may help transfer technology across borders in both directions: from donor countries to host countries and vice versa. This suggests that migration may more likely create a ‘brain circulation’ rather than a ‘brain drain’. In addition, human capital has a significant impact on the research and development (R&D) diffusion process as it enhances a country's capacity to learn from a foreign technology base.
ASSESSING THE ASSESSMENT OR, THE RAE AND THE OPTIMAL ORGANIZATION OF UNIVERSITY RESEARCH
Authors: La Manna Manfredi M. A.
Published: October 2008

The UK Research Assessment Exercise (RAE) is assessed as an incentive scheme affecting the allocation of research talent of varying ‘quality’ across departments. The ‘centres of excellence’ policy implicitly pursued through the RAE is an optimal allocation strategy only if all departments in all disciplines are of the generalist variety, i.e. each pursues a research path through all its stages. Conversely, the RAE‐induced research allocation minimizes efficiency if applied to specialist departments, when resources are concentrated on one specific research obstacle. It is argued that the RAE should not take the organization of University research as exogenous, but rather should encourage specialization. All results are obtained by applying to University research concepts and solutions borrowed from the mathematical theory of systems reliability.
INPUT QUALITY, RELATIONAL CONTRACTS AND INTERNATIONAL OUTSOURCING
Authors: Bond Eric W.
Published: October 2008

Abstract.  This paper presents a Ricardian trade model in which the quality of intermediate inputs affects the productivity of labour at the final production stage. The role of contracting frictions is shown by comparing the chain of comparative advantage obtained with full information with that resulting when the quality of inputs is affected by actions that are not verifiable in court. Conditions are derived under which parties can use the potential for repeat business (relational contracts) to sustain efficient production choices. These results yield predictions for how country and industry characteristics will affect the level of contracting frictions.
ADAPTIVE LEARNING AND MONETARY POLICY IN AN OPEN ECONOMY: LESSONS FROM JAPAN
Authors: Chen Yu‐chin , Kulthanavit Pisut
Published: October 2008

Abstract.  Motivated by Japan's economic experiences in recent decades, we incorporate adaptive learning into an open economy dynamic stochastic general equilibrium model to examine the volatility and welfare impact of alternative monetary policies. Comparing four Taylor‐styled policy rules that reflect Japan's monetary policy debates, we first show that imperfect knowledge and the associated learning process induce higher volatility in the economy and that explicit exchange rate stabilization is unwarranted. Moreover, contrary to results under the rational expectation paradigm, we find that while tight inflation controls raise output volatility, they can improve overall welfare under learning by smoothing inflation fluctuations.
MARKET REACTIONS TO THE PASSAGE OF THE FINANCIAL HOLDING COMPANY ACT IN TAIWAN
Authors: Wang Jane‐Sue , Chen Jing‐Twen , Chou Pin‐Huang
Published: October 2008

Abstract.  We examine how financial institutions react to various events surrounding the passage of Taiwan's Financial Holding Company Act in June 2001. Empirical results indicate that the financial system experiences significant abnormal returns along the legislative process. Smaller firms have significantly higher abnormal returns, thus lending no support for the hypothesis that larger firms benefit more from the Act. Further analysis shows that the significance of market value is replaced by a significant securities industry effect, thereby consistent with the observation that Taiwan's securities firms are generally smaller in market values and are potential target firms for financial holding companies.