Small-scale farmer responses to the double exposure of climate change and market integration.

Anthropologists have long studied how small-scale societies manage climate variation. Here, we investigate how Yucatec Maya subsistence farmers respond to climate stress, and the ways in which market integration may enhance or disturb response stategies. Using information on harvest returns, climate perceptions, household economics and helping networks, modelling results show that as farmers rely more on market inputs (e.g. seed, tractors, fertilizer) for a successful yield, the reasons given for a bad harvest shift from climate variables to access to quality inputs. We also find that social and economic diversification is key to mediating a household's experience of climate and market shocks. The Maya are astute stewards of climate knowledge, and have effective social and economic means to mitigate potential fluctuations in food availability. In the transition from a subsistence to a market integrated economy, these traditional strategies become strained. Reliance on market inputs forges a more rigid food production system that conflicts with the diversity and flexibility on which traditional strategies depend to manage climate variation. Moving forward, the best policies would be those that facilitate maintaining an equal footing in both a subsistence maize economy, while incorporating new market opportunities. This article is part of the theme issue 'Climate change adaptation needs a science of culture'.

The ontogeny of fairness in seven societies.

A sense of fairness plays a critical role in supporting human cooperation. Adult norms of fair resource sharing vary widely across societies, suggesting that culture shapes the acquisition of fairness behaviour during childhood. Here we examine how fairness behaviour develops in children from seven diverse societies, testing children from 4 to 15 years of age (n = 866 pairs) in a standardized resource decision task. We measured two key aspects of fairness decisions: disadvantageous inequity aversion (peer receives more than self) and advantageous inequity aversion (self receives more than a peer). We show that disadvantageous inequity aversion emerged across all populations by middle childhood. By contrast, advantageous inequity aversion was more variable, emerging in three populations and only later in development. We discuss these findings in relation to questions about the universality and cultural specificity of human fairness.

[Orthopedics in the world wide web: university homepages of the G-7 states]. / Orthopädie im World Wide Web: Universitäts-Homepages der G7-Staaten.

QUESTIONS: By which criteria can a homepage be evaluated? How is the quality of homepages provided by universities in the field of orthopaedics/traumatology? METHODS: Based on 37 ranking instruments, an optimized list of criteria has been developed. Homepages of orthopaedic and traumatology departments of medical schools in the G7 Nations have been found with help of university homepages and search engines and afterwards were analysed according to previously defined criteria. RESULTS: A list of criteria containing 18 subject areas with 49 questions was developed. 136 homepages were evaluated from October 1998 to April 1999. 15 outstanding homepages were found. The best homepages are from medical schools in the USA and Germany. The most frequent subjects were structure of the department (contained in 85% of the homepages) and education/training (68%). 42 homepages provided medical information, 67% of those homepages provided references (attribution), and 26% provided information about authority and authorship. 46% of all hompages were not updated sufficiently. Out of 125 homepages with an e-mail address 36% responded to an inquiry. Multimedia features such as video, sound or animation were used by 6% of the homepages. CONCLUSION: Apart from few exceptions, homepages of orthopaedic-traumatologic departments of medical schools are still insufficient with regard to quality and quantity, especially regarding medical information for patients and professionals. The developed last of criteria should be helpful in installing a basic standard for homepage quality. The time and effort involved in setting up and servicing a homepage should not be underestimated.

Insulin replacement therapy in diabetic rats using an osmotic pump normalizes expression of enzymes key to hepatic carbohydrate metabolism.

Intensively treating type I diabetics with continuous subcutaneous insulin infusions or multiple daily insulin injections to normalize mean blood glucose concentrations significantly reduces the onset of secondary diabetic complications when compared to conventionally treated diabetics. Our studies focused on characterizing hepatic enzyme expression in intensively and conventionally treated diabetic rats. Alloxan-induced diabetic rats were conventionally treated with insulin injected twice daily or intensively treated with similar daily dosages of insulin administered via a surgically implanted osmotic pump. Our results demonstrate a significant difference in hepatic enzyme expression when these treatment regimes are compared. In conventionally treated diabetic rats, phosphoenolpyruvate carboxykinase (PEPCK) protein and mRNA levels remained slightly elevated when compared to normal animals, glycogen phosphorylase (GP) protein levels were still slightly decreased, and glycogen synthase (GS) protein and mRNA levels remained at the elevated levels observed in untreated diabetics. In contrast, the protein and mRNA levels of all three enzymes were normalized in the insulin pump-treated animals. These results suggest that intensive insulin therapy improves glycemia directly by normalizing hepatic gene expression while conventional insulin therapy normalizes plasma glucose concentrations indirectly.

[Documentation. A prerequisite for quality management]. / Dokumentation. Voraussetzung für Qualitätsmanagement.

For the judgment of the quality of medical services and for the progress of clinical medicine the comparison of data and informations of the diagnostic and therapeutic process is demanded. Therefore a systematic and concrete system of documentation should be implemented in every clinic, which consists of standard nomenclature, classification, instruments of outcome measure and documentation standards. There are a group of problems and barriers which stand in the way of this goal. It is useful to build a minimum basis data set which includes core criteria of clinical documentation in orthopedic surgery and include this in an information system so that all of these parts are considered and that a central and comparable data pool is offered for patient care, quality management and research.

[30 years of computer-based clinical documentation at the Heidelberg University Orthopedic Clinic. From basic documentation to medical controlling]. / 30 Jahre EDV-gestützte klinische Dokumentation an der Orthopädischen Universitätsklinik Heidelberg. Von der Basisdokumentation zum medizinischen Controlling.

An overview of the 30 years history and development of documentation and information systems in the Orthopedic University Hospital Heidelberg is presented. Since the foundation in 1967 four developmental phases can be described: first initiatives of medical doctors, establishment of a basic documentation system for scientific purposes, strategic information system planning and realisation of information systems with the possibility of controlling in medical areas and thereby steering of the services. Planning and realisation were accomplished within the framework of the masterplans and concepts of the university clinics of the state of Baden-Württemberg.

[From planning to realization of an electronic patient record]. / Von der Planung zur Realisierung einer elektronischen Patientenakte.

The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the necessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occurred during this process.

[Guidelines in orthopedics. Alliance of German Orthopedists. University Clinic of Orthopedics, Heidelberg]. / Leitlinien in der Orthopädie. Ein erster Schritt.

Guidelines are systematically developed statements of the actual knowledge in order to assist doctors and patients by the decision of appropriate health care. Since 1998 the DGOT has published 22 well structured guidelines, 20 guidelines are under construction. The AWMF as the coordinator of guideline constructing of all scientific medical societies has published 629 guidelines since 1995. The publication of guidelines of the DGOT and the BVO is the first step for dissemination, next steps should be implementation und evaluation. Then it will be evident whether change in medical practice will occur.

[Nomenclature and classification of complications. Standard procedure at the Heidelberg University Orthopedic Clinic]. / Nomenklatur und Klassifikation von Komplikationen. Leitfaden der Stiftung Orthopädische Universitätsklinik Heidelberg.

In order to get a better data management of complications in orthopedic surgery and in order to get comparable statistics a standardisation of nomenclature and classification of complications is demanded since 1.1.1997. The Orthopedic University Clinic of Heidelberg started with a register of all early complications of all inpatients. According to a standardized nomenclature all occurred complications the doctors put in the data of complications in a database. These data were controlled, complemented and classified by members of the quality management group. This guideline consists of five parts: catalogue of diagnoses, general and special definitions, classification and an allocation table of diagnoses to grades of severity.

Women's labor, fertility, and the introduction of modern technology in a rural Maya village.

PIP: The introduction of mechanized technology into a rural Maya agricultural community in the mid 1970s markedly increased the technology with which maize could be ground and water collected, which in turn introduced a possible savings in the time spent working. This study investigated the response of female fertility to the introduction of this labor-saving technology. Using two proximate determinants of female fertility, the association between the advent of modern technology and changes in the age at which women give birth to their first child and the length of mothers' birth intervals was examined. Analyses showed that women begin their reproductive careers at a younger age after the laborsaving technology was introduced. Estimate of the median age at first birth from the distribution function dropped from 21.2 years before the introduction to 19.5 years after the introduction of the technology. In addition, modeling results show that the probability of a woman giving birth to her first child doubles for any age after the introduction of laborsaving technology. However, changes in birth intervals are less conclusive since the differences of smoothed probability distributions are not significant. Moreover, findings indicate that women who initiate reproduction at a younger age can potentially have longer reproductive careers and larger families.^ieng

Documentation. Prerequisite for quality management.

For the judgment of the quality of medical services and for the progress of clinical medicine the comparison of data and informations of the diagnostic and therapeutic process is demanded. Therefore a systematic and concrete system of documentation should be implemented in every clinic, which consists of standard nomenclature, classification, instruments of outcome measure and documentation standards. There are a group of problems and barriers which stand in the way of this goal. It is useful to build a minimum basis data set which includes core criterias of clinical dokumentation in orthopedic surgery and include this in an information system so that all of these parts are considered and that a central and comparable data pool is offered for patient care, quality management and research.

Thirty years of computer-based clinical documentation at Heidelberg University Orthopaedic Clinic. From basic documentation to medical controlling.

An overview of the 30 years history and developement of documentation and information systems in the Orthopedic University Hospital Heidelberg is presented. Since the foundation in 1967 four developmental phases can be described: first initiatives of medical doctors, establishment of a basic documentation system for scientific purposes, strategic information system planning and realisation of information systems with the possibility of controlling in medical areas and thereby steering of the services. Planning and realisation were accomplished within the framework of the masterplans and concepts of the university clinics of the state of Baden-Württemberg.

From planning to realisation of an electronic patient record.

The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the neccessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occured during this process.

Guidelines in orthopaedic surgery. A first step.

Guidelines are systematically developed statements of the actual knowledge in order to assist doctors and patients by the decision of appropriate health care. Since 1998 the DGOT has published 22 well structured guidelines, 20 guidelines are under construction. The AWMF as the coordinator of guideline constructing of all scientific medical societies has published 629 guidelines since 1995. The publication of guidelines of the DGOT and the BVO is the first step for dissemination, nexts steps should be implementation und evaluation. Then it will be evident whether change in medical practice will occur.

Nomenclature and classification of complications. Standard procedure at Heidelberg University Orthopaedic Clinic.

In order to get a better data management of complications in orthopedic surgery and in order to get comparable statistics a standardisation of nomenclature and classification of complications is demanded since 1.1.1997. The Orthopedic University Clinic of Heidelberg started with a register of all early complications of all inpatients. According to a standardized nomenclature all occured complications the doctors put in the data of complications in a database. These data were controlled, complemented and classified by members of the quality menagement group. This guideline consists of five parts: catalogue of diagnoses, general and special definitions, classification and an allocation table of diagnoses to grades of severity.

Synovial fibroblasts as target cells for staphylococcal enterotoxin-induced T-cell cytotoxicity.

Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown aetiology. Recently, superantigens have been implied in the pathogenesis of RA. Superantigens activate a large fraction of T cells leading to the production of cytokines and proliferation. In addition, superantigens direct cellular cytotoxicity towards major histocompatibility complex (MHC) class II-expressing cells. There is now increasing evidence that cytotoxic T cells may be involved in the pathogenesis of RA. In the inflamed synovia class II-positive synovial fibroblasts (SFC) are found. In the present study it was tested whether MHC class II-positive SFC serve as target cells for superantigen-induced cellular cytotoxicity. SFC were stimulated with interferon-gamma to express class II antigens, then they were cultivated in the presence of CD4-positive T cells with or without staphylococcal enterotoxins (SE). Cytotoxicity of T cells was measured as release of lactate dehydrogenase from SFC. Specific cytotoxicity was only found in the presence of class II-positive SFC depending on the dose of SE. Maximum lysis was seen after 20 hr. T-cell cytotoxicity was inhibited by antibodies to MHC class II antigens. The data suggest that class II-positive SFC not only function as accessory cells for SE-mediated T-cell proliferation and interleukin-2 production but may also be the targets of superantigen-mediated cellular cytotoxicity.

How maya women respond to changing technology : The effect of helping behavior on initiating reproduction.

In the mid 1970s labor-saving technology was introduced into a Maya subsistence agricultural community that markedly increased the efficiency with which maize could be ground and water collected. This increased efficiency introduces a possible savings in the time that women allocate to work, which can be reapportioned to child care, food production, domestic work, or leisure. An earlier study suggested that this labor-saving technology had a positive effect in decreasing the age at which these Maya women begin their reproductive careers. Although there is a statistical association between the age at which women bear their first child and the introduction of modern technology, this association does not demonstrate that the decline in age at first birth is causally related to the presence of technology. This paper pursues two objectives to evaluate this potential causal relationship in greater detail. First, a theory relating technological change to the initiation of a reproductive career is briefly developed in order to make qualitative predictions about behavioral changes as a response to changing technology. Second, these predictions are then tested against time allocation data recently collected in this same Maya community.We suggest that both of the conditions necessary to initiate reproduction-fecundity and access to mates-fundamentally depend on the amount of help that a girl provides to her family. Further, the help that a girl provides can be affected by technological changes. Analyses show that when modern technology is available, unmarried young women do not change the time allocated to domestic tasks and child care, and allocate more time to low-energy leisure activities. This lack of perceived benefit to working more and a potential concomitant shift towards a positive energy balance may in part explain why Maya women leave home and initiate reproduction at a younger age after labor-saving technology is introduced.