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This article focuses on the steep fall in the international natural rubber price and investigates its impact on the socioeconomic situation of rubber smallholders in Southern Thailand, particularly diversification and community development. Based on surveys and semi-structured interviews, this article highlights the vulnerability of rubber smallholders in an upper middle-income country. Despite substantial diversification, volatility in the international rubber price still causes rural households to zigzag back and forth between the classes of near-poverty and accomplished middle class. Consistent diversification is hard to achieve, and there is a lack of local leadership. Current forces in the political economy of rubber are geared toward maintaining the status quo.

Although the main aim of clubfoot correction is to create a foot without limitations in daily activities and sport, studies on the walking capacity of children with corrected clubfeet are rare. In this cross-sectional study, the outcome of the six-minute walking test in 44 children with clubfeet (16 unilateral and 28 bilateral, mean age 8.57±2.45 years) was compared with the reference values of Geiger, clinical status measured with the Clubfoot Assessment Protocol (CAP), and regression analysis used to calculate which CAP subgroup predicts walking capacity. The mean walking capacity was decreased to 79 (P<0.001) and was not influenced by unilaterality or bilaterality (P=0.437). The subgroup CAP morphology was a significant predictor (R2=0.103; P=0.034). Knowing that walking capacity is only slightly decreased can help adjust expectations and set goals for training.

Although the average poverty level in Lao PDR has declined substantially since the beginning of economic reforms in 1986, sub-national dynamics give rise to a discussion of the trends and issues that determine and sustain provincial poverty and the variegated processes of rural transition. It appears that migration to core areas does not always generate better living standards, as migration to Vientiane Capital and Vientiane Province also results in a relocation of poverty from peripheral to core areas. This article sheds light on these problems and discusses the implications for the spatial dimensions of poverty in core provinces located on emerging Greater Mekong Subregion corridors and peripheral provinces. A case study of Savannakhet, located along the East West Economic Corridor, shows how rural households cope with the pressures arising from increasing market forces and regionalization. Based on in-depth fieldwork in the village of Ban Gnang Pho Sy, the results indicate that a shift occurred among the rural poor, in which their livelihoods changed from being based purely on subsistence agriculture to being focused increasingly upon pluriactive (commercial) farming, livelihood diversification and labour migration to Thailand. Provinces located along emerging corridors experience a complex mosaic of impacts of integration due to fragmented ethnic-linguistic geographies and the varying relevance of pull versus push factors: imports versus exports, inward versus outward investments, and in- versus out-migration. In sum, rather than the neoliberal promise of a flatter socioeconomic landscape, the human geography of the Greater Mekong Subregion remains rough, due to politicization of foreign direct investments, complex land dealings and landlessness, migration patterns and rising inequality.

Abstract:This research note proposes the entry of the emerging body of knowledge on Varieties of Asian Capitalism into Lao PDR, Cambodia and Vietnam. While geographers and economists have begun to study capitalist diversity in several Southeast Asian countries, former "Indo Chine" has so far been neglected. This seems to be an omission as economic reform in these three countries provides much scope for varieties of capitalism research. After an update on the latest theoretical insights this note introduces a research agenda focusing on capitalist institutions and its evolution in Lao PDR. Here, Savannakhet province in the southern part of the country is presented as a potential suitable research site, but it is hoped that both academics and policy-makers take up this agenda in order to increase our comparative knowledge of capitalist institutions and its potential to achieve poverty reduction in peripheral regions of Lao PDR, Cambodia and Vietnam.

Objectives.The objectives of this study were to determine the incidence density and the occurrence of horizontal spread of highly resistant gram-negative rods (HR-GNRs) in Dutch hospitals. The factors that influence these outcome measures were also investigated.Methods.All patients with HR-GNRs, as determined by sample testing, who were hospitalized in 1 of 18 hospitals during a 6-month period (April through October 2007) were included in this study. For all available isolates, the species was identified, susceptibility was determined (including the presence of extended-spectrum β-lactamases [ESBLs]), and molecular typing was performed. On the basis of a combination of species identification, molecular typing, and epidemiological data, the occurrence of nosocomial transmission was determined.Results.The mean incidence density of patients with HR-GNRs was 55 per 100,000 patient-days (cumulative incidence, 39 per 10,000 patients admitted). A facility being a university hospital was a statistically significant (P= .03) independent determinant of a higher incidence of patients with HR-GNRs. The majority of HR-GNR isolates were ESBL producers. The adjusted transmission index—the ratio between secondary and primary cases—in the participating hospitals ranged from 0.0 to 0.2. The overall adjusted transmission index of HR-GNRs was 0.07. No determinants for a higher transmission index were identified.Discussion.The nosocomial transmission rate of HR-GNRs was relatively low in all hospitals where well-established transmission-based precautions were used. The incidence density of patients with HR-GNRs was higher in university hospitals, probably due to the patient population and the complexity of the care provided.

ABSTRACTThe objectives of the present study were to determine the effects of multiple targeted interventions on the level of use of quinolones and the observed rates of resistance to quinolones in Escherichia coliisolates from hospitalized patients. A bundle consisting of four interventions to improve the use of quinolones was implemented. The outcome was measured from the monthly levels of use of intravenous (i.v.) and oral quinolones and the susceptibility patterns for E. coliisolates from hospitalized patients. Statistical analyses were performed using segmented regression analysis and segmented Poisson regression models. Before the bundle was implemented, the annual use of quinolones was 2.7 defined daily doses (DDDs)/100 patient days. After the interventions, in 2007, this was reduced to 1.7 DDDs/100 patient days. The first intervention, a switch from i.v. to oral medication, was associated with a stepwise reduction in i.v. quinolone use of 71 prescribed daily doses (PDDs) per month (95% confidence interval [CI] = 47 to 95 PDDs/month, P< 0.001). Intervention 2, introduction of a new antibiotic guideline and education program, was associated with a stepwise reduction in the overall use of quinolones (reduction, 107 PDDs/month [95% CI = 58 to 156 PDDs/month). Before the interventions the quinolone resistance rate was increasing, on average, by 4.6% (95% CI = 2.6 to 6.1%) per year. This increase leveled off, which was associated with intervention 2 and intervention 4, active monitoring of prescriptions and feedback. Trends in resistance to other antimicrobial agents did not change. This study showed that the hospital-wide use of quinolones can be significantly reduced by an active policy consisting of multiple interventions. There was also a stepwise reduction in the rate of quinolone resistance associated with the bundle of interventions.

Nosocomial pneumonia or hospital-acquired pneumonia (HAP) causes considerable morbidity and mortality. It is the second most common nosocomial infection and the leading cause of death from hospital-acquired infections. In 1996 the American Thoracic Society (ATS) published guidelines for empirical therapy of HAP. This review focuses on the literature that has appeared since the ATS statement. Early diagnosis of HAP and its etiology is crucial in guiding empirical therapy. Since 1996, it has become clear that differentiating mere colonization from etiologic pathogens infecting the lower respiratory tract is best achieved by employing bronchoalveolar lavage (BAL) or protected specimen brush (PSB) in combination with quantitative culture and detection of intracellular microorganisms. Endotracheal aspirate and non-bronchoscopic BAL/PSB in combination with quantitative culture provide a good alternative in patients suspected of ventilator-associated pneumonia. Since culture results take 2–3 days, initial therapy of HAP is by definition empirical. Epidemiologic studies have identified the most frequently involved pathogens: Enterobacteriaceae, Haemophilus influenzae, Streptococcus pneumoniaeand Staphylococcus aureus(‘core pathogens’). Empirical therapy covering only the ‘core pathogens’ will suffice in patients without risk factors for resistant microorganisms. Studies that have appeared since the ATS statement issued in 1996, demonstrate several new risk factors for HAP with multiresistant pathogens. In patients with risk factors, empirical therapy should consist of antibacterials with a broader spectrum. The most important risk factors for resistant microorganisms are late onset of HAP (≥5 days after admission), recent use of antibacterial therapy, and mechanical ventilation. Multiresistant bacteria of specific interest are methicillin-resistant S. aureus(MRSA), Pseudomonas aeruginosa, Acinetobacter calcoaceticus- baumannii, Stenotrophomonas maltophiliaand extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Each of these organisms has its specific susceptibility pattern, demanding appropriate antibacterial treatment. To further improve outcomes, specific therapeutic options for multiresistant pathogens and pharmacological factors are discussed. Antibacterials developed since 1996 or antibacterials with renewed interest (linezolid, quinupristin/dalfopristin, teicoplanin, meropenem, new fluoroquinolones, and fourth-generation cephalosporins) are discussed in the light of developing resistance.

The purpose of this study was to sonographically compare the early anatomical outcome of a group of clubfeet treated with the Ponseti method (group A, nine clubfeet) with a group treated with an adjustable plexidur splint, the Copenhagen method (group B, 19 feet). The clinical severity was assessed using the Diméglio–Bensahel classification. The need for complementary surgery was clinically assessed at the age of about 2 months. Ultrasound investigation was made in the neonatal period, after 2–3 months of non-surgical treatment and 1–2 months post-surgically. After 2 months of non-surgical treatment the correction obtained at the talo-navicular joint, expressed as the distance between the medial malleolus and the navicular (MM–N distance), was significantly greater in group A. After surgery, tenotomy of the Achilles tendon for all group A feet, and posterior or posteriomedial release for 13 feet in group B, the correction at the talo-navicular and calcaneo-cuboid joints was similar for the two groups. Anatomical correction of the displacement in these joints can be achieved without extensive interventional procedures. Ultrasound may be a valuable tool to assess the effects of different treatment protocols quantitatively.

INTRODUCTION: To reduce pouch related complications after restorative proctocolectomy, an alternative procedure was developed, the ileo neo-rectal anastomosis (INRA). This technique consists of rectal mucosa replacement by ileal mucosa and straight ileorectal anastomosis. Our study provides a detailed description of the functional results after INRA. PATIENTS AND METHODS: Eleven patients underwent an INRA procedure with a temporary ileostomy. Anorectal function tests were performed two months prior to and six and 12 months after closure of the ileostomy and comprised: anal manometry, ultrasound examination, rectal balloon distension, and transmucosal electrical nerve stimulation (TENS). Function was subsequently related to the histopathology of rectal biopsy samples. RESULTS: Median stool frequency decreased from 15/24 hours (10-25) to 6/24 hours (4-11) at one year. All patients reported full continence. Anal sensibility, and resting and squeeze pressures did not change after INRA. Rectal compliance decreased (2.1 (0.7-2.8) v 1.5 (0.4-2.2) and 1.4 (0.8-3.7) ml/mm Hg (p=0.03)) but the maximum tolerated volume increased (70 (50-118) v 96 (39-176) (NS) and 122 (56-185) ml (p=0.03)). Decreasing rectal sensitivity was found: the maximum tolerated pressure increased (14 (8-24) v 22 (8-34) (NS) and 26 (14-40) (p=0.02)) and the rectal threshold for TENS displayed a similar tendency. All patients displayed a low grade chronic inflammatory infiltrate in neorectal biopsy samples before closure of the ileostomy, with no change during follow up. CONCLUSIONS: The technique of INRA provides a safe alternative for restorative surgery. Stool frequency after INRA improves with time and seems to be related to decreasing sensitivity and not to histopathological changes in the neorectum. Furthermore, after the INRA procedure, all patients reported full continence.

The nucleotide sequence of the alcohol dehydrogenase gene Adh71k has been determined. The Adh71k allele encodes the thermostable and multifunctional ADH-71k allozyme of Drosophila melanogaster. Comparison with the sequences of AdhS, AdhF, and AdhFChD reveals differences in the coding and noncoding regions of the gene. Conceptual translation of the Adh71k sequence indicates that ADH-71k shares with ADH-F and ADH-FCHD an amino acid replacement at residue 192 and with ADH-FCHD an additional replacement of serine for proline at residue 214. Three unique differences were found in the nontranslated regions. It is proposed that a nucleotide deletion in the adult intron is related to the difference in expression level of the Adh71k allele, relative to the other alleles. An insertion of five nucleotides, additional to a single base deletion at that site, was detected in one of the larval enhancer regions in the 5' flanking region of the Adh71k allele, creating a palindromic structure in that area.

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