aheadinall

Josephine Pryde

2012-03-15T06:40:00.000-07:00

Josephine Pryde

REENA SPAULINGS FINE ART

For all the vigilance with which Josephine Pryde 's art guards meaning, it does reveal some of the ways in which its maker is alert to the complexities and mundanities of being a working artist. She has written for Texte Zur Kunst about stealing time on the job through daydreaming. For her show at Richard Telles Fine Art last year, she presented photographs of a toddler and delivered an opening-night performance of L�o Ferr�'s "La Vie d'Artiste," a song whose lyrics relay a biting narrative of an artist's submission to economic reality. The juxtaposition suggested the complications both in the spheres of finance and individual …

Tutu says situation in Gaza Strip has become 'scary'

2012-03-15T04:14:00.000-07:00

Archbishop Desmond Tutu says he is shocked by conditions in the Gaza Strip after months of Israeli sanctions.

The Nobel peace laureate says the coastal strip has become "desolate and scary" as a result of shortages of fuel and other basic goods. He says Israel should ease the blockade.

Israel imposed the sanctions last year after the Hamas militant group seized control of …

'Scared' a glorious coming-of-age story

2012-03-15T01:53:00.000-07:00

I'm Not Scared

(Io Non Ho Paura)(STAR)(STAR)(STAR)1/2

Michele Giuseppe Cristiano

Anna Aitana Sanchez-Gijon

Pino Dino Abbrescia

Felice Giorgio Careccia

Filippo Mattia Di Pierro

Sergio Diego Abatantuono

Filippo's mother Susy Sanchez

Miramax Films presents a film directed by Gabriele Salvatores.Written by Niccolo Ammaniti (based on his novel) and FrancescaMarciano. In Italian with English subtitles. Running time: 108minutes. Rated R (for disturbing images and language). Opening todayat Landmark Century.

Michele is a 10-year-old boy whose summer is unfolding as oneperfect day after another. He lives in a …

Defining the Physical Gate of a Mechanosensitive Channel, MscL, by Engineering Metal-Binding Sites

2012-03-14T23:30:00.000-07:00

ABSTRACT

The mechanosensitive channel of large conductance, MscL, of Escherichia coli is one of the best-studied mechanosensitive proteins. Although the structure of the closed or "nearly-closed" state of the Mycobacterium tuberculosis ortholog has been solved and mechanisms of gating have been proposed, the transition from the closed to the open states remains controversial. Here, we probe the relative position of specific residues predicted to line the pore of MscL in either the closed state or during the closed-to-open transition by engineering single-site histidine substitutions and assessing the ability of Ni^sup 2+^, Cd^sup 2+^ or Zn^sup 2+^ ions to affect channel activity. …

Reporter lives Broadway fantasy in 'Mary Poppins'

2012-03-14T21:09:00.000-07:00

NEW YORK (AP) — For weeks, I dreamed of my Broadway debut in "Mary Poppins."

There was the excitement of costume fittings, the hard work of rehearsals and the anticipation of being on stage at a premier New York theater. I woke up each morning, counting down the days; I could hardly wait for the moment.

It was over in a blink.

My time in the spotlight as a chimney sweeper in the Disney musical ended just as quickly as it had begun.

For its fifth anniversary, "Mary Poppins" invited me to be a chimney sweep for a day to experience the inner workings of the production at the New Amsterdam Theatre.

I knew it would be fun, but what I thought would be an easy task …

Greek PM hopes to reform economy

2012-03-14T18:49:00.000-07:00

Greece's prime minister is hoping his trip to Washington will boost efforts to get his country out of a financial crisis. But Secretary of State Hillary Clinton said Monday that Greece is not asking for any specific help from Washington.

Greek Prime Minister George Papandreou, after meeting with Clinton at the State Department, told reporters that Greece is exploring ways within the European Union of improving Greece's borrowing prospects.

Clinton said, "Neither the prime minister nor Greece has asked the United States for anything."

Both officials said they discussed the need for major economies to make financial reforms and clamp down on …

Leading by example Dwayne Missouri's work ethic provides valuable inspiration for Northwestern teammates

2012-03-14T16:28:00.000-07:00

Northwestern coach Randy Walker would much rather let his veteranplayers' actions do his talking when it comes to coaching his youngerplayers.

"I can talk and talk and talk about what great ones look like,"Walker said. "It's a whole lot easier to go, `Watch him. Watch D-Mo.' "

D-Mo is Dwayne Missouri, Northwestern's left defensive end and theheart and soul of its defense. He led the Wildcats last season with20 tackles for losses, the second-most in school history. When theWildcats were able to stay in games, it was usually because of theirdefense, and Missouri was a huge part of it. He was a second-team All-Big Ten pick by both the coaches and the media, the only …

Protesters lift blockage of big Peru gold mine

2012-03-14T14:08:00.000-07:00

LIMA, Peru (AP) — Protesters in Peru lifted their road blockade of Latin America's biggest gold mine late Tuesday in order to begin government-backed talks with the mine's owners, the mayor of the affected district said.

Yanacocha's owners had called the four-day-old protests "illegal and violent" and said they had cut back production after the access road was blocked and local peasants set ablaze back hoes, dump trucks and a bulldozer.

"We have suspended the blockade to open a dialogue on Thursday with directors of Yanacocha mine on a proposal made by the government," La Encanada Mayor Jorge Vasquez told The Associated Press.

He said that if an agreement isn't reached …

IAAF Diamond League, DN Galan Results

2012-03-14T11:47:00.000-07:00

STOCKHOLM (AP) — Results Friday from the DN Galan, a Diamond League athletics event at the Stockholm Olympic Stadium (distances in meters):

Men

200_1, Usain Bolt, Jamaica, 20.03. 2, Alonso Edward, Panama, 20.47. 3, Ainsley Waugh, Jamaica, 20.56. 4, Jaysuma Saidy Ndure, Norway, 20.67. 5, Richard Thompson, Trinidad and Tobago, 20.85. 6, Trell Kimmons, United States, 20.94. 7, Jeremy Dodson, United States, 21.32, Marvin Anderson, Jamaica, DQ.

400_1, Jermaine Gonzales, Jamaica, 44.69. 2, LaShawn Merritt, United States, 44.74. 3, Christopher Brown, Bahamas, 44.79. 4, Angelo Taylor, United States, 44.82. 5, Rondell Bartholomew, …

Bright future: Southwick-based Comark is poised to capitalize on digital TV

2012-03-14T09:27:00.000-07:00

There are about 1,900 television stations in the United States, and all of them have a problem of sorts. With the advent of Digital Television (DTV), they will all require new transmitters or extensive modifications to existing models, as well as a good deal of technical support to make the complex conversion from analog to digital broadcasting.

All this bodes extremely well for Southwick-based Comark Communications Corp, one of the nation's Dm pioneers, which looks to grab at least a third of a market that will easily exceed $1 billion.

Tuned In

Comark, currently marking its 25th anniversary in business, is positioned to celebrate in style. It has already gained a …

Kings Beat Heat

2012-03-14T07:07:00.000-07:00

Ron Artest scored 32 points, Kevin Martin added 29 and the Sacramento Kings overcame a …

Castro Marques scores 31 as Dream beat Sky 93-86

2012-03-14T04:46:00.000-07:00

Iziane Castro Marques scored 16 of her 31 points in the fourth quarter, leading the Atlanta Dream to a 93-86 victory over the Chicago Sky on Tuesday night.

Erika DeSouza had 17 points and 13 rebounds, Sancho Lyttle scored 15 points and Angel McCoughtry and Shalee Lehning added 10 each for the Eastern Conference-leading Dream (9-3). Atlanta, which opened the season 6-0, has won three of its last four.

Chicago got off to a fast start, taking a 10 point lead midway through the first quarter. The Dream rallied and took a lead midway through the second quarter, but the Sky went back ahead by six after a jumper by Dominique Canty early in the third.

…

Judge reduces trust fund for Leona Helmsley's dog

2012-03-14T02:03:00.000-07:00

Leona Helmsley's dog isn't quite as well-heeled as she used to be. Manhattan Surrogate Judge Renee Roth has reduced the trust fund for the little dog, named Trouble, from $12 million to $2 million.

The remaining $10 million now goes to Helmsley's charitable foundation.

The 9-year-old Maltese lives in Florida with the general manager of the Helmsley Sandcastle Hotel. Helmsley died last August.

The court decision, made April 30, became public Monday.

Fraudster stole cash for drugs ; A Cleaner stole cheques from two of her employers then cashed hundreds of pounds for herself.

2012-03-13T23:12:00.000-07:00

A Cleaner stole cheques from two of her employers then cashedhundreds of pounds for herself.

Sarah Webster, 25, took the cheques from homes she cleaned inCults and Aberdeen.

The mum-of-two then wrote cheques to herself and stole nearlypounds400, but was caught when a bank worker questioned asignature.

Webster, pictured, admitted fraud and theft when she appeared atAberdeen Sheriff Court.

Fiscal depute Carol Cameron said Webster had worked in homesbelonging to Michael Unger and David MacKerrill.

The first man went on holiday leaving Webster the key to hishouse. His cheque book was on his desk.

A teller at a bank in Albyn Place saw the account holder'ssignature was wrong when Webster went in with a pounds489 cheque.

The court heard Mr Unger sacked her on March 5.

Miss Cameron said: "On that date he picked up a message from thebank and was advised that the accused had attempted to cash a chequefrom him."

Mr Unger said he did not write the cheque or another forpounds200 that was cashed.

Mr MacKerrill also realised a cheque for nearly pounds200 hadbeen cashed on his account.

The court heard former heroin and cocaine addict Webster usedthe cash to buy drugs.

Webster, of 44 Dalnain Road, Aberdeen, admitted stealing fourcheques from addresses in Ashgrove Road West and Westerton Place,between February 9 and March 2 this year.

She also admitted obtaining pounds200 by fraud at GreenfernRoad's Clydesdale Bank on February 12 and pounds197.50 from the samebank on May 28 this year.

Webster also admitted trying to get pounds489.30 from the RoyalBank of Scotland, Albyn Place, on March 2 this year. She wasordered to do 150 hours community service.

Honda to sell new gas-electric hybrid next year, outlines strategy for plant cost cuts

2012-03-13T20:20:00.000-07:00

Honda will sell a new, improved and affordable gas-electric hybrid in the U.S., Japan and Europe starting in early 2009, underlining the Japanese automaker's commitment to "green" technology, the company president said Wednesday.

The new model _ to be sold solely as a hybrid, and not as a traditional, gasoline-powered car _ is a key part of Honda Motor Co.'s strategy for the next three years that President Takeo Fukui outlined at Tokyo headquarters.

The plan also included production innovations and expansion in Japan to cut costs so Honda can stay competitive amid soaring material and energy costs, he said.

In addition to the new hybrid, Honda will introduce several other hybrids: a Civic, a new sporty model based on the CR-Z and a Fit subcompact, sold as the Jazz in Europe, Fukui said.

"Hybrids have drawn attention for their image, but time has come to go to the next step," he said, stressing that Honda was serious about selling hybrids in numbers.

Fukui refused to give the price for the new vehicle, which would be offered solely as a hybrid.

But he said the difference between hybrids and their comparable standard models should be kept within 200,000 yen (US$1,900; euro1,200), although such price gaps can now reach as much as 500,000 yen (US$4,800; euro3,000).

"The 200,000 yen difference is a must," said Fukui.

The new hybrid's name was not yet disclosed. It will be a five-door sedan seating five passengers, and feature new technology that reduced the size and weight of the hybrid system to increase fuel efficiency, according to Honda, Japan's second-biggest automaker.

Although Honda already has developed hybrids, it has fallen behind Japanese rival Toyota Motor Corp. in this segment.

Last year, Honda discontinued the gas-and-electric version of its Accord sedan _ sold only in North American _ which sold just 25,000 units since going on sale in 2004. In 2006, it pulled the plug on the slow-selling Insight hybrid.

Over the past decade, Toyota has sold more than a million Prius gas-electric hybrid cars worldwide. When including other hybrid models, cumulative overall sales of gas-electric vehicles total 1.46 million, according to Toyota, which also makes the Camry sedan and Lexus luxury cars.

Honda has sold nearly 262,000 hybrid vehicles worldwide since it started selling them in 1999. Hybrids deliver a cleaner, more efficient ride by switching between a gas engine and an electric motor at different speeds, and by recycling the energy the car produces as it moves.

Honda said Wednesday that it plans to sell 500,000 hybrids a year sometime after 2010, half the number that Toyota has already announced it seeks to sell a year by the same time period.

Fukui said he didn't consider that as a defeat to Toyota. But he acknowledged the Prius was a smart success, partly because it's only offered as a hybrid.

"It's very clear to see the Prius is a hybrid," he said.

At the end of this year, the production line for the hybrid motor will be raised to 250,000 units annual capacity from the current 70,000, Honda said.

Honda said it's also pushing its fuel-cell technology to ease environmental concerns.

A fuel cell vehicle has no emissions because it runs on the power created when hydrogen, stored as fuel in the vehicle, combines with oxygen in the air to emit water.

Honda said it expects to lease several dozen of its new fuel cell vehicle, FCX Clarity, a year, mostly in California, reaching 200 vehicles in the first three years. The leasing is set to start in July 2008 in the U.S., and a few months later in Japan.

Under the plans for production cost cuts, Fukui said a new car plant will reduce energy needs by 30 percent compared with an existing Honda plant. A new engine plant will have flexible lines that can produce different engines, including diesels.

Honda will invest 158 billion yen (US$1.5 billion; euro960 million) for the two "next-generation plants," which will be able to trace components for better quality control, it said.

Fukui said such production finesse will be expanded to Honda's global operations but must first begin at home in Japan.

"The power of Japan is needed," he said.

Its booming motorcycle business is a key strength that helps makes Honda unique among the world's major automakers, the company said.

Honda motorcycles are hugely popular in developing economies such as Vietnam and Thailand, and Honda is beefing up its motorcycle production methods so that it can withstand a potential drop in the dollar to 90 yen levels.

A weak dollar, now trading at about 103 yen, down about 10 percent from the previous year, hurts the earnings of Japanese automakers by eroding their overseas income when converted to yen.

Needlescopic versus laparoscopic appendectomy: a systematic review

2012-03-13T17:27:00.000-07:00

Background: Needlescopic appendectomies (NA) have been performed since the 1990s. We sought to systematically analyze trials comparing NA with laparoscopic appendectomies (LA) in the management of appendicitis.

Methods: We performed a systematic review of the literature. We compared and analyzed clinical trials on NA and LA to generate summative data expressed as standardized mean differences (SMD).

Results: Of 5 retrieved trials from the electronic database 2 trials involving 412 patients met our inclusion criteria. In the fixed-effects models, NA took longer than LA, and this time difference was statistically significant: SMD 0.20 min, 95% confidence interval 0.01-0.40, p = 0.030, z^sub 1^ = 2.09. In both fixed- and random-effects models, the difference in total hospital stay and in perioperative complications between the NA and LA groups were nonsignificant. Furthermore, in both fixed- and random-effects models, NA was associated with a higher conversion rate to open appendectomy than LA. There was no heterogeneity between the trials (Q = 0.34, p = 0.55).

Conclusion: Needlescopic appendectomy can be a safe and effective procedure for the management of appendicitis. It is comparable to LA in terms of hospital stay and perioperative complications. However, NA is associated with a longer duration of surgery and a higher conversion rate, indicating technical challenges of the procedure. Before recommending routine use of the needlescopic technique for appendectomy, a major multicentre randomized controlled trial is necessary.

Contexte : On effectue des appendicectomies au trocart optique (needlescope) depuis les ann�es 1990. Nous avons voulu analyser de mani�re syst�matique les �tudes qui ont compar� les appendicectomies au trocart optique aux appendicectomies laparoscopiques dans la prise en charge de l'appendicite.

M�thodes : Nous avons proc�d� � une revue syst�matique de la litt�rature. Nous avons compar� et analys� les �tudes cliniques ayant port� sur les appendicectomies au trocart optique et les appendicectomies laparoscopiques afin de g�n�rer des donn�es sommatives exprim�es sous forme de diff�rence moyenne standardis�e (DMS).

R�sultats : Sur 5 �tudes recens�es � partir de bases de donn�es �lectroniques, 2 regroupant 412 patients r�pondaient � nos crit�res d'inclusion. Selon les mod�les � effets fixes, l'appendicectomie au trocart optique a pris plus de temps que l'appendicectomie laparoscopique et cette diff�rence de temps s'est r�v�l�e statistiquement significative (DMS 0,20 minute; intervalle de confiance � 95 %, 0,01-0,40; p = 0,030; z^sub l^ = 2,09). Dans les mod�les, tant � effets fixes qu'al�atoires, les diff�rences de dur�e totale de l'hospitalisation et de complications p�riop�ratoires entre les groupes soumis � l'appendicectomie au trocart optique et � l'appendicectomie laparoscopique n'ont pas �t� significatives. De plus, dans les mod�les � effets fixes et al�atoires, l'appendicectomie au trocart optique a �t� associ�e � un taux de conversion plus �lev� � l'appendicectomie ouverte, comparativement � l'appendicectomie laparoscopique. On n'a not� aucune h�t�rog�n�it� entre les �tudes (Q = 0,34; p = 0,55).

Conclusion : L'appendicectomie au trocart optique peut �tre une technique s�curitaire et efficace pour la prise en charge de l'appendicite. Elle est comparable � l'appendicectomie laparoscopique pour ce qui est de la dur�e du s�jour hospitalier et des complications p�riop�ratoires. Toutefois, l'appendicectomie au trocart optique demande plus de temps et est associ�e � un taux de conversion plus �lev�, ce qui t�moigne des d�fis techniques de l'intervention. Avant de recommander l'utilisation d'embl�e d'une technique au trocart optique pour l'appendicectomie, il faudra proc�der � une grande �tude multicentrique contr�l�e et randomis�e sur ce type d'intervention.

Open appendectomy performed through a grid iron incision in the right lower quadrant was first introduced in the 19th century1,2 and remained mainly unchallenged until the introduction of laparoscopic appendectomy (LA) in 1983 by Semm,3,4 a gynecologist. This was an important change in the management of appendicitis owing to advantages like improved wound-healing,5 shorter hospital stay,6 markedly reduced postoperative pain7 and good cosmetic results,8 all all of which lead to an early return to normal daily activities.9,10 The launch of needlescopic instruments, defined as those 3-mm or less in diameter, sparked further excitement in the 1990s.11 The first successful needlescopic appendectomy (NA) was reported in 1994.12 In theory, NA is beneficial to patients because of the smaller trocar wounds and hence less tissue trauma associated with this minimally invasive approach. It was therefore intriguing to evaluate NA further. Studies comparing NA and LA have been reported, but their conclusions have been limited by study design, study type or study sample.

We sought to use meta-analysis as a tool to compare the outcomes of LA and NA with respect to duration of surgery, total hospital stay, conversion rate and perioperative complications. The specific questions we sought to answer are as follows:

* Does NA significantly reduce the duration of surgery?

* What is the difference in total hospital stay associated with these techniques?

* What is the conversion rate in NA?

* Does NA reduce the incidence of perioperative complications?

METHODS

We identified relevant studies on NA versus LA published between January 1997 and January 2007 in the MEDLINE, EMBASE, CINAHL, Cochrane library and PubMed databases. We used the terms "trials on needlescopic appendectomy/appendicectomy," "minimally invasive appendectomy/appendicectomy" and "key hole surgery for appendicitis" in combination with the medical subject headings "needlescopic versus conventional laparoscopic appendicectomy" and "minimal versus conventional laparoscopic appendectomy/appendicectomy." We also obtained relevant articles referenced in these studies. We used the "related article" function to widen our search criteria, and we reviewed all abstracts, comparative studies, nonrandomized trials and citations scanned.

We reviewed each article to assess eligibility for inclusion in this systematic review. Our inclusion criteria are listed in Box 1. We analyzed randomized controlled trials comparing NA and LA. We analyzed 4 outcome variables: duration of surgery, hospital stay, conversion rate and perioperative complications. Two of us (M.M.S. and M.A.K.) extracted the data independently, with complete agreement. We defined complication as a condition that developed due to surgery and required either repeat surgery or further medical treatment or prolonged the length of stay in hospital. Our data included the following complications: wound infection (with evidence of cellulites and positive culture), wound abscess (which required incision and drainage), intra-abdominal abscess (which required either surgical or radiological drainage), urinary tract infection (where urine culture was positive), chest infection (confirmed on chest radiography), prolonged ileus (no bowel sounds after 72 hours), relaparotomy for any reason and intraoperative or postoperative destabilizing hemorrhage. The criteria to define NA and LA are described in Box 2.

A senior statistician (E.C.) performed statistical analyses using Excel 2003 for Windows XP (Microsoft). For continuous data (e.g., duration of surgery, hospital stay), we used the Hedges g statistic to calculate standardized mean differences (SMDs). We combined the SMDs using inverse variance weights in the fixed-effects model and the DerSimonian-Laird method in the random-effects model.12 We summarized binary data (e.g., complications, recurrence) as risk ratios (RR) and combined them using the Mantel-Haenszel method under the fixed-effects model and the DerSimonian-Laird method under the random-effects model. In each case, we performed a heterogeneity test to determine whether the fixed-effects model was appropriate. When standard deviations (SDs) were not reported in the studies, we estimated SDs either from ranges or p values.13 We used forest plots for the graphical display of results from this review. Subgroup and sensitivity analyses were not feasible owing to the limited number of studies included in our review. Publication bias was also difficult to assess for the same reason.

RESULTS

Figure 1 depicts our search results. We retrieved 5 trials comparing NA and LA involving a total of 1098 patients from the electronic databases. Two randomized controlled trials14,15 involving 412 patients met our inclusion criteria (Box 1). We excluded 3 trials9,16,17 owing to the reasons mentioned in Table 1. Characteristics of each trial are provided in Table 2. There were a total of 200 patients in the needlescopic group and 212 patients in the laparoscopic group. The outcome variables extracted from these trials are shown in Table 3.

Methodological quality of included studies

The methodological quality of included trials is explained comprehensively in Table 4. We used the Mantel- Haenszel fixed-effects model to compute robustness and susceptibility to any outliers among these trials. The allocation concealment and blinding of investigators or assessors were not clearly reported in the studies; consequently, we considered the methodological quality of the trials to be inadequate, and the results of our review may be considered biased.

Duration of surgery

In the fixed-effects models, NA lasted longer than LA, and this time difference was statistically significant: fixedeffects model SMD 0.20 minutes, 95% confidence interval (CI) 0.01-0.40, p = 0.030, z^sub 1^ = 2.09. However, in the random-effects model, statistically there was no difference between the 2 approaches: SMD 0.13 minutes, 95% CI -0.23 to 0.50, p = 0.48, z^sub 1^ = 0.70 (Fig. 2). There was no heterogeneity between the trials (Q = 1.86, p = 0.17).

Hospital stay

In both fixed- and random-effects models, the difference in total hospital stay between the NA and LA groups was statistically nonsignificant: fixed-effects model SMD -0.03 d, 95% CI -0.20 to 0.16, p = 0.74, z^sub 1^ = -0.32 and random-effects model SMD -0.007 d, 95% CI -0.09 to 0.7, p = 0.87, z^sub 1^ = -0.16 (Fig. 3). There was no heterogeneity between the trials (Q = 0.80, p = 0.36).

Perioperative complications

In both fixed- and random-effects models, the difference in the perioperative complication rate between the NA and LA groups was statistically nonsignificant: fixedeffects model RR 0.80, 95% CI 0.44-1.48, p = 0.49, z^sub 1^ = -0.68 and random-effects model RR 0.85, 95% CI 0.47-1.53, p = 0.59, z^sub 1^ = -0.53 (Fig. 4). There was no heterogeneity between the trials (Q = 2.99, p = 0.08).

Conversion rate

In both fixed and random-effects models, NA was associated with a higher conversion rate to open appendectomy than LA, which was statistically significant: fixed-effects model RR 2.80, 95% CI 1.50-5.23, p = 0.001, z^sub 1^ = 3.25 and random-effects model RR 2.80, 95% CI 1.51-5.21, p = 0.001, z^sub 1^ = 3.26 (Fig. 5). There was no heterogeneity between the trials (Q = 0.34, p = 0.55).

DISCUSSION

Needlescopic appendectomy is an evolving technique. General surgeons are practising it with great caution owing to lack of level-I evidence. Our systematic review attempts to provide some evidence on this issue. It is the hope of those pioneering this field that it will extend the benefits already proven for LA versus open appendectomy. 18 For example, the use of smaller 2- to 3-mm ports, rather than 5- or 10-mm ports, will further hasten recovery and reduce postoperative pain and length of hospital stay.19 In experienced hands, NA is a feasible procedure and can be performed safely in select patients, especially in young girls, for the treatment of acute appendicitis. It is less invasive and cosmetically superior to LA.20 We observed no difference in perioperative complications between the 2 techniques or in the resulting length of stay in hospital. The higher conversion rate to open appendectomy observed in the NA group is indicative of the initial technical difficulties surgeons have to face using finer instruments. However, with current instrumentation and the skill level of general surgeons, NA understandably will take longer than the more traditional laparoscopic procedures, and after a learning curve, improved and highquality results may be achieved.

Advocates of NA believe that an element of surgical trauma is due to the skin wound and tissue handling. If we can operate with a smaller skin wound and more gentle tissue handling without compromising access, a better outcome is anticipated. Thus, surgeons must strike a balance between trauma secondary to surgery and adequate access. Our systematic review may pave the way for NA, a less invasive procedure for acute appendicitis, but further exploration and investigation are required. Our study shows that NA has some statistically significant benefits over LA, and after achieving the necessary technical experience, surgeons can consider performing this procedure in patients with acute appendicitis.

To our knowledge, our systematic review is the only comprehensive review of NA to date. It highlights the need for a major multicentre double-blind prospective randomized controlled trial on NA because in this review only 2 randomized controlled trials involving a small number of patients with various stages of appendicitis were retained for analysis. In the meantime, NA may be considered an alternate option for removal of the appendix.

Competing interests: None declared.

Contributors: Drs. Sajid and Baig designed the study. Drs. Sajid and Khan acquired the data, which Drs. Sajid, Khan and Cheek analyzed. Drs. Sajid and Baig wrote the article, which Drs. Khan and Cheek reviewed. All authors approved the final version for publication.

[Sidebar]

Box 1. Inclusion criteria

* Prospective randomized controlled trials on needlescopic versus conventional laparoscopic appendectomy in all languages

* Trials on patients of any age and sex

Box 2. Minimally invasive approaches for appendectomy

Needlescopic appendectomy

* Use of 2 or 3 ports

* One port of 5 mm and 2 ports of 2 or 3 mm/3 ports of 3 mm/3 ports of 2 mm

* Cumulative port size 9-14 mm

* Laparoscope 2-5 mm in size and 0�/30� angle of vision

Conventional laparoscopic appendectomy

* Use of 3 ports

* One port of 10-12 mm and 2 ports of 5 mm

* Cumulative port size 16-27 mm

* Laparoscope 5-10 mm in size and 30� angle of vision

[Reference]

References

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2. McBurney C. The incision made in the abdominal wall in cases of appendicitis. Ann Surg 1894;20:38-43. Available: www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1493708 (accessed 2009 Feb. 25).

3. Semm K. Endoscopic appendectomy. Endoscopy 1983;15:59-64.

4. Berry J Jr, Malt RA. Appendicitis near its centenary. Ann Surg 1984;200:567-75.

5. Ortega AE, Hunter JG, Peters JH, et al. A prospective randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group. Am J Surg 1995;2:208-12.

6. Tang E, Ortega AE, Anthone GJ. Intraabdominal abscess following laparoscopic and open appendectomies. Surg Endosc 1996;10:327-8.

7. Chung RS, Rowland DY, Li P. A meta-analysisof randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg 1999;177:250-6.

8. Azaro EM, Amaral PC, Ettinger JE. Laparoscopic versus open appendectomy: a comparative study. JSLS 1999;3:279-83.

9. Croce E, Olmi S, Azzola M, et al. Laparoscopic appendectomy and minilaparoscopic approach; a retrospective review after 8 years' experience. JSLS 1999;3:285-92.

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12. Cochrane RA, Hay DJ. A microlap appendectomy: case report. Minim Invasive Ther Allied Technol 1997;6:168-9.

13. Egger M, Smith GD, Altman DG. Systematic reviews in healthcare. London: BMJ Publishing; 2006.

14. Huang M, Wei P, Wu C, et al. Needlescopic, laparoscopic and open appendectomy: a comparative study. Surg Laparosc Endosc Percutan Tech 2001;11:306-12.

15. Lau DHW, Yau KK, Chung CC, et al. Comparison of needlescopic appendectomy versus conventional laparoscopic appendectomy. A randomized controlled trial. Surg Laparosc Endosc Percutan Tech 2005;15:75-9.

16. Mostafa G, Matthews BD, Sing RF, et al. Mini-laparoscopic versus laparoscopic approach to appendectomy. BMC Surg 2001;1:4.

17. Chock A, Seslar S, Stoopen E, et al. Needlescopic appendectomy. Surg Endosc 2003;17:1451-3.

18. Bennett J, Boddy A, Rhodes M. Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutan Tech 2007;17:245-55.

19. Matthews BD, Mostafa G, Harold KL, et al. Minilaparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 2001;11:351-5.

20. Schier F. Laparoscopic appendectomy with 1.7 mm instruments. Pediatr Surg Int 1998;14:142-3.

[Author Affiliation]

Muhammad Shafique Sajid, MBA, MSc, MD*

Munir Ahmad Khan, MRCS*

Elizabeth Cheek, PhD[dagger]

Mirza Khurrum Baig, MD*

From the *Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex and the [dagger]Department Computing Mathematical and Information Science, University of Brighton, Brighton, UK

Accepted for publication

Dec. 11, 2007

Correspondence to:

Dr. M.S. Sajid

SpR General Surgery

Worthing & Southlands Hospitals

NHS Trust

Worthing, West Sussex BN11 2DH

United Kingdom

fax 01903 285 052

surgeon1wrh@hotmail.com

Recrafting Federalism in Russia and Canada: Power, Budgets, and Indigenous Governance

2012-03-13T14:35:00.000-07:00

Peter H. Solomon, Jr. Recrafting Federalism in Russia and Canada: Power, Budgets, and Indigenous Governance. Toronto: Centre for Russian and East European Studies, University of Toronto, 2005. ix, 124p.

In this rather short, but nonetheless extremely interesting and informative book, scholars from Russia and North America provide us with some novel insights and very useful data on Russian and Canadian federalism. The chapters are all drawn from the workshop, "Governance in Federations: Law, Regional Development, and Aboriginal Communities in Russia and Canada," which was held in Toronto in December 2004. This, the third of a series of such workshops devoted to federalism in Russia and Canada, focuses on taxation, budgets and tlnancial transfers and also the place of aboriginals in federal systems.

After a short introduction and a report on the papers delivered at the workshop by Alexei Trochev, there follows six chapters. The first three chapters are devoted to federalism in the Russian Federation. A major strength of these chapters is that they are all written by scholars who have a detailed knowledge of both theory and practice.

Vladimir Leskin, who is a section head at the Institute of Systems Analysis of the Russian Academy of Sciences, provides an excellent overview of federalism in his chapter on Federal Statehood and Conflict Resolution. Here, I found it particularly useful to have a comprehensive list of the key laws on federalism which have been adopted in the postcommunist period, and his ten theses on Russian Federalism provide an excellent breakdown of the key developments in Russia from Yeltsin to Putin.

Irina Podporina, Dean of the Faculty of Economics at the Moscow State Medical Dental University, provides us with a short but extremely useful account of fiscal federalism and budgetary relations. In her analysis we are presented with excellent data which show that regional variations in economic development are still very high and that programmes to ameliorate such inequalities have failed to provide "all citizens with equal access to basic services and social guarantees" (p. 62). She also gives us an excellent account of the centralization of the budgetary process and the failure of fiscal federalism to stimulate regional economic development.

Leonid Polishchuk takes a very novel approach in his discussion of the presidential appointment of governors, which he links to questions of economic development. He also provides a very illuminating account of the costs and benefits of political decentralization.

The final three chapters discuss the rights of aboriginals within the Canadian and Russian federal systems. Mikhail Todyshev (Vice-President of the Russian Association of Indigenous Peoples of the North) shows how the rights of indigenous communities have been eroded particularly with the adoption of the Federal Law No 122-FZ of August 2004 which is known as the "social benefits reform" law.

Gary N. Wilson, in his fine chapter, discusses the concept of nested federalism in Russia and Canada, and finally Natalia Loukacheva concludes with a short but interesting study of the unique status of the Nunavut territory in the Candian North.

In conclusion, Peter Solomon has brought together a very interesting and informative collection of essays, which I would highly recommend.

[Author Affiliation]

Cameron Ross, University of Dundee

Wholesale inventories and sales both increase

2012-03-13T11:35:00.000-07:00

WASHINGTON (AP) — U.S. wholesale companies added to their stockpiles in April for a 16th straight month, a sign that businesses were confident in future sales gains. However, fresh data since then has shown the economy has weakened, suggesting supply levels could shrink in the months to come.

Inventories rose 0.8 percent in April to $447.2 billion, the highest level since October 2008, the Commerce Department reported Thursday. Sales increased 0.3 percent to $395.5 billion, marking the ninth sales gain in the past 10 months.

Companies boosted their stockpiles of furniture, machinery, paper, clothing and chemicals. Stockpiles of autos, lumber and computer equipment declined.

Wholesale inventories have increased 16.6 percent since hitting a low in September 2009. U.S. manufacturing has been one of the strongest sectors of the economy since the recession ended two years ago.

But a report from the Institute for Supply Management showed that factory activity cooled in May, expanding at the slowest pace in 20 months. Supply disruptions stemming from the Japan crises have led to shortages of auto and electronics parts. High gas prices are also hurting consumer spending, which makes up 70 percent of economic activity.

Economists said they expect manufacturing to continue growing, but they cautioned that gains in coming months may be smaller.

Magic routs division rival Hawks

2012-03-13T08:26:00.000-07:00

The Orlando Magic asserted its dominance over NBA Southeast Division rival Atlanta by thumping the Hawks 113-81 on Saturday.

J.J. Redick scored 17 points in place of an injured Vince Carter as Orlando ended a four-game losing streak and pushed its divisional lead over the Hawks back out to 1-1/2 games.

Matt Barnes finished with 18 points to help the Magic build a 38-point lead at one point.

Atlanta was led by Al Horford's 14 points.

Jazz 111, Mavericks 93

In Dallas, Deron Williams had 20 points and 9 assists in his return to the lineup as Utah downed Dallas.

Carlos Boozer added 15 points for the Jazz, who made up for blowing a winning chance in their previous meeting, never allowing its lead to fall below 13 points in the game's final 21 minutes.

Dirk Nowitzki scored 29 points for Southwest Division-leading Dallas.

Kings 102, Nuggets 100

In Sacramento, California, Tyreke Evans made the tiebreaking jump shot in the final second as Sacramento snapped a season-worst five-game losing skid in style against Denver.

Evans, who finished with 27 points, sank a 10-footer to cap a wild fourth quarter where the lead changed hands frequently. J.R. Smith missed a desperation 3-point attempt at the buzzer.

Chauncey Billups had 27 points for Denver and made a 3-pointer from 25 feet to level it at 100-100 with 11 seconds remaining.

The Nuggets played a fifth straight game without injured star Carmelo Anthony because of a knee injury. The NBA's second-leading scorer is expected to play Tuesday.

Rockets 105, Knicks 96

In Houston, Luis Scola matched a season high with 23 points as Houston downed New York to win its first game in four.

Aaron Brooks added 20 for the Rockets.

David Lee had 26 points and 12 rebounds for the Knicks.

Bobcats 89, Grizzlies 87

In Charlotte, North Carolina, Gerald Wallace tipped in Raymond Felton's missed shot at the buzzer to give Charlotte a tight win over Memphis.

Felton scored 19 points and Wallace had 18 points and eight rebounds for the Bobcats, who improved to 13-4 at home.

O.J. Mayo scored 25 points for the Grizzlies, who fell to an 0-8 record when playing on the second night of back-to-back games.

Thunder 108, Pacers 102

In Oklahoma City, Kevin Durant matched his season high with 40 points as Oklahoma City downed Indiana.

Russell Westbrook added 18 points, nine rebounds and six assists for the Thunder (20-16), who are already just three wins shy of matching their total from last season.

Danny Granger scored 25 points to lead Indiana, which has lost nine straight road games.

Bulls 110, Timberwolves 96

In Chicago, the hosts won their first game in four by defeating Minnesota.

Joakim Noah had 20 points and nine rebounds, and Kirk Hinrich had 20 points and seven assists for the Bulls.

Ryan Gomes led Minnesota with 15 points.

76ers 104, Pistons 94

In Auburn Hills, Michigan, Detroit was beaten by Philadelphia, falling to its 12th straight loss.

The losing skid is the Pistons' worst since 1993-94.

Elton Brand matched a season high with 25 points for the 76ers, and Ben Gordon had 20 points, including the 10 millionth point in NBA history.

Charlie Villanueva's 19 points led the Pistons.

Tri-State racetrack hosting 3 job fairs: ; Gaming facility is looking to hire full-time and part-time workers and about 300 dealers

2012-03-13T04:31:00.000-07:00

Tri-State Racing and Gaming Center is having three job fairs thisweek.

On Monday afternoon, Ron LaDuca, director of table games at Tri-State, said about 40 people had applied for various positions. Alongwith dealers, the facility was looking for security/surveillance,food/beverage and money room positions, he said.

The facility is hiring full-time and part-time workers, he said,including about 300 dealers.

For dealer positions, job seekers must take a multiple-weekcourse before starting work. Classes will begin at West VirginiaState Community and Technical College the first week of June. Poker,roulette and blackjack classes are $490 for a seven-week course. The11-week craps course costs $770.

In August 2007, Kanawha County voters approved poker and othercasino games at Tri-State. In October, the racetrack hosted a jobfair, with dozens of people paying $350 to pre-register for dealerclasses, which would have begun in November or December 2007.

Officials had hoped to have the table games up and running by thebeginning of 2008.

However, delays in the election, getting equipment and findingcertified instructors pushed back the classes.

Now, dealer-training classes are scheduled to end in July, LaDucasaid. Following the classes, potential dealers have to obtainlicensing, which will take an additional one to two weeks, he said.

Tri-State is also sponsoring a fair at the Big Sandy SuperstoreArea in Huntington today and at the Beckley-Raleigh CountyConvention Center in Beckley on Thursday. Both fairs run from 11a.m. to 7 p.m.

Hal Darnold, 67, of Charleston has wanted to be a blackjackdealer since Tri-State Racing and Gaming Center's table games wereapproved. He signed up for the dealer classes once before, butsetbacks at the track delayed the start of classes.

On Monday, he was back, testing and registering for classesduring one of three job fairs Tri-State is holding this week.

"I love to watch people gamble," Darnold said while beginning apre-test. "A lot of money [from the table games] is going to helppeople in the area. Where's the bad story?

There isn't one."

Joe Workman, 26, of Nitro was filling out an application for asecurity position at Tri-State. He just got out of the Army in Apriland has military police and law enforcement experience.

He's glad the racetrack has expanded its operations.

"I think it's great," he said. "It will add a lot more jobs inthe area."

Charles Haverty, 67, of Chloe came to the job fair for an obviousreason.

"I need a job. ... I need something to subsidize my income," hesaid, adding that he is retired and collects Social Security.

He's worked in a casino before, spending four or five monthsworking as a cook. "I like the atmosphere [of a casino]," he said

Now, he wants to be out on the floor, dealing poker.

"When they said they were going to open this up, I just smiled.It's great in every way. ... And I need something to cut down on myown poker playing," he said, with a little laugh."

ATP Rankings

2012-03-13T01:20:00.000-07:00

Through Aug. 9

Singles

1. Rafael Nadal, Spain, 10,745 points.

2. Novak Djokovic, Serbia, 6,905.

3. Roger Federer, Switzerland, 6,795.

4. Andy Murray, Britain, 5,305.

5. Robin Soderling, Sweden, 4,740.

6. Nikolay Davydenko, Russia, 4,285.

7. Tomas Berdych, Czech Republic, 3,780.

8. Juan Martin del Potro, Argentina, 3,770.

9. Fernando Verdasco, Spain, 3,475.

10. Jo-Wilfried Tsonga, France, 3,455.

11. Andy Roddick, United States, 3,235.

12. David Ferrer, Spain, 3,100.

13. Marin Cilic, Croatia, 2,890.

14. Mikhail Youzhny, Russia, 2,725.

15. Jurgen Melzer, Austria, 2,470.

16. Nicolas Almagro, Spain, 2,210.

17. Ivan Ljubicic, Croatia, 2,200.

18. Gael Monfils, France, 2,025.

19. John Isner, United States, 1,850.

20. Marcos Baghdatis, Cyprus, 1,790.

Council's new bank

2012-03-12T22:22:00.000-07:00

Somerton town council has changed its bank to reduce the costburden on ratepayers.

The town council currently faces an annual bank charge of Pounds445 a year from NatWest to hold its account.

The bank also charges the council Pounds 6 a month for managementcosts and Pounds 3 a month for administering the payment ofsalaries.

The town council has now agreed to transfer the account to LloydsTSB as there is no charge to hold the bank account while the monthlyfees cost the same.

Council chairman Michael Fraser- Hopewell said it would savearound Pounds 460.

Cash to aid heart attack victims

2012-03-12T19:31:00.000-07:00

LIFE-saving equipment is being extended across Southmead andFrenchay Hospitals thanks to a GBP250,000 project.

North Bristol NHS Trust, which runs both hospitals, has pledgedthat every hospital department will be within three minutes' reach ofnew defibrillators.

The resuscitation department at the trust is currently trainingstaff how to use the latest technology, which will vastly improve apatient's survival rate in the event of a cardiac arrest.

For each minute that a shock is delayed, the chances of survivalare reduced by between five and ten per cent.

The trust now hopes to provide continuous cover across all siteswith a nurse on every shift trained in defibrillation.

Resuscitation officer Carol Coles said: "We hope to be able toprovide a defibrillator to a collapsed patient within three minute inany area of our hospitals.

"Staff who are trained in defibrillation will requirefamiliarisation sessions for the new machines, but their improvedaccessibility means this process will be fairly straightforward."

A total of 58 new defibrillators are being provided by theCritical Care directorate, consisting of eight automatic externaldefibrillators at almost GBP2,600 each and 50 semiautomated models atGBP5,000 each.

These will support and replace some of the existing 70 oldermachines which previously had to be shared between severaldepartments and wards.

New Business: MulchWorx Inc.

2012-03-12T15:25:00.000-07:00

Owner(s):

Eric Holsworth

Address:

1128 E. Cook Road Fort Wayne, IN 46825

Telephone:

(260) 490-9838

(260) 615-0325

Web site:

mulchworx.com

Type of business:

Installation and/or blowing of landscape materials like mulch, soil, compost and other organics directly into landscape beds or difficult-to-reach areas.

Owner's education/background:

Holsworth has 13-plus years of experience in the landscape industry. He earned a bachelor's degree from Indiana Wesleyan University, where he graduated with high honors.

Competitive advantage:

"MulchWorx uses a high-tech blower truck to apply and install all varieties of mulches and other organics in almost any area or terrain quickly and cost-effectively. Mulch can be installed up to 10 times faster than by traditional, manual methods. Because of the process, uniform and precise application of the mulch is possible, reducing need by up to 35 percent. Mulch is installed directly from the truck into beds, eliminating piles of mulch, physical labor, and staining of driveways."

First-year goals:

"To target and attain residential and commercial clients while maintaining great relationships with landscape contractors who utilize MulchWorx services."

Five-year goals:

"To continue to grow our customer base; to have a fleet of high-tech trucks to further service our growing customer base; to have a staff of well-educated, friendly, customer-oriented employees whose main goal is to strengthen MulchWorx commitment to its customers; and to add additional services such as blowing soil, terraseeding, erosion control, lawn installation, topdressing and rock blowing."

Poland's PM: US election extend defense talks

2012-03-12T11:51:00.000-07:00

Prime Minister Donald Tusk of Poland says that talks over accepting a U.S. missile defense base "could take some more time" because of the upcoming American presidential election.

Warsaw has rejected as "unsatisfactory" the security guarantees that Washington offered in return for possibly placing 10 interceptors in northern Poland.

Tusk said Friday that talks continue but that the U.S. is focused on the November election.

Tusk tells TVP Info television that U.S. presidential elections are a "sort of a breakthrough and for that reason we can assume that these talks could take some more time."

He says provisions that would free Poland from legal and financial responsibility if the interceptors are used remain a sticking point.