Showing papers by "Center for Global Development published in 1998"

Estimating Wealth Effects without Expenditure Data or Tears: With an Application to Educational Enrollments in States of India

Abstract: The relationship between household wealth and educational enrollment of children can be estimated without expenditure data. A method for doing so - which uses an index based on household asset ownership indicators - is proposed and defended in this paper. In India, children from the wealthiest households are over 30 percentage points more likely to be in school than those from the poorest households, although this gap varies considerably across states. To estimate the relationship between household wealth and the probability that a child (aged 6 to 14) is enrolled in school, Filmer and Pritchett use National Family Health Survey (NFHS) data collected in Indian states in 1992 and 1993. In developing their estimate Filmer and Pritchett had to overcome a methodological difficulty: The NFHS, modeled closely on the Demographic and Health Surveys, measures neither household income nor consumption expenditures. As a proxy for long-run household wealth, they constructed a linear asset index from a set of asset indicators, using principal components analysis to derive the weights. This asset index is robust, produces internally coherent results, and provides a close correspondence with data on state domestic product and on state level poverty rates. They validate the asset index using data on consumption spending and asset ownership from Indonesia, Nepal, and Pakistan. The asset index has reasonable coherence with current consumption expenditures and, more importantly, works as well as - or better than - traditional expenditure-based measures in predicting enrollment status. The authors find that on average a child from a wealthy household (in the top 20 percent on the asset index developed for this analysis) is 31 percent more likely to be enrolled in school than a child from a poor household (in the bottom 40 percent). This paper - a product of Poverty and Human Resources, Development Research Group - is part of a larger effort in the group to inform educational policy. The study was funded by the Bank`s Research Support Budget under the research project Educational Enrollment and Dropout (RPO 682-11).

Clinical Pharmacokinetics of Mycophenolate Mofetil

Abstract: The pharmacokinetics of the immunosuppressant mycophenolate mofetil have been investigated in healthy volunteers and mainly in recipients of renal allografts. Following oral administration, mycophenolate mofetil was rapidly and completely absorbed, and underwent extensive presystemic de-esterification. Systemic plasma clearance of intravenous mycophenolate mofetil was around 10 L/min in healthy individuals, and plasma mycophenolate mofetil concentrations fell below the quantitation limit (0.4 mg/L) within 10 minutes of the cessation of infusion. Similar plasma mycophenolate mofetil concentrations were seen after intravenous administration in patients with severe renal or hepatic impairment, implying that the de-esterification process had not been substantially affected. Mycophenolic acid, the active immunosuppressant species, is glucuronidated to a stable phenolic glucuronide (MPAG) which is not pharmacologically active. Over 90% of the administered dose is eventually excreted in the urine, mostly as MPAG. The magnitude of the MPAG renal clearance indicates that active tubular secretion of MPAG must occur. At clinically relevant concentrations, mycophenolic acid and MPAG are about 97% and 82% bound to albumin, respectively. MPAG at high (but clinically realisable) concentrations reduced the plasma binding of mycophenolic acid. The mean maximum plasma mycophenolic acid concentration (Cmax) after a mycophenolate mofetil 1 g dose in healthy individuals was around 25 mg/L, occurred at 0.8 hours postdose, decayed with a mean apparent half-life (t1/2) of around 16 hours, and generated a mean total area under the plasma concentration-time curve (AUC infinity) of around 64 mg.h/L. Intra- and interindividual coefficients of variation for the AUC infinity of the drug were estimated to be 25% and 10%, respectively. Intravenous and oral administration of mycophenolate mofetil showed statistically equivalent MPA AUC infinity values in healthy individuals. Compared with mycophenolic acid, MPAG showed a roughly similar Cmax about 1 hour after mycophenolic acid Cmax, with a similar t1/2 and an AUC infinity about 5-fold larger than that for mycophenolic acid. Secondary mycophenolic acid peaks represent a significant enterohepatic cycling process. Since MPAG was the sole material excreted in bile, entrohepatic cycling must involve colonic bacterial deconjugation of MPAG. An oral cholestyramine interaction study showed that the mean contribution of entrohepatic cycling to the AUC infinity of mycophenolic acid was around 40% with a range of 10 to 60%. The pharmacokinetics of patients with renal transplants (after 3 months or more) compared with those of healthy individuals were similar after oral mycophenolate mofetil. Immediately post-transplant, the mean Cmax and AUC infinity of mycophenolic acid were 30 to 50% of those in the 3-month post-transplant patients. These parameters rose slowly over the 3-month interval. Slow metabolic changes, rather than poor absorption, seem responsible for this nonstationarity, since intravenous and oral administration of mycophenolate mofetil in the immediate post-transplant period generated comparable MPA AUC infinity values. Renal impairment had no major effect on the pharmacokinetic of mycophenolic acid after single doses of mycophenolate mofetil, but there was a progressive decrease in MPAG clearance as glomerular filtration rate (GFR) declined. Compared to individuals with a normal GFR, patients with severe renal impairment (GFR 1.5 L/h/1.73m2) showed 3-to 6-fold higher MPAG AUC values. In rental transplant recipients during acute renal impairment in the early post-transplant period, the plasma MPA concentrations were comparable to those in patients without renal failure, whereas plasma MPAG concentrations were 2- to 3-fold higher. Haemodialysis had no major effect on plasma mycophenolic acid or MPAG. Dosage adjustments appear to not be necessary either in renal impairment or during dialysis. (ABSTRACT TRUN

Early Changes in Biochemical Markers of Bone Turnover Predict the Long-Term Response to Alendronate Therapy in Representative Elderly Women: A Randomized Clinical Trial

Abstract: Although the antiresorptive agent alendronate has been shown to increase bone mineral density (BMD) at the hip and spine and decrease the incidence of osteoporotic fractures in older women, few data are available regarding early prediction of long-term response to therapy, particularly with regard to increases in hip BMD. Examining short-term changes in biochemical markers incorporates physiologic response with therapeutic compliance and should provide useful prognostic information for patients. The objective of this study was to examine whether early changes in biochemical markers of bone turnover predict long-term changes in hip BMD in elderly women. The study was a double-blind, placebo-controlled, randomized clinical trial which took place in a community-based academic hospital. One hundred and twenty community-dwelling, ambulatory women 65 years of age and older participated in the study. Intervention consisted of alendronate versus placebo for 2.5 years. All patients received appropriate calcium and vitamin D supplementation. The principal outcome measures included BMD of the hip (total hip, femoral neck, trochanter, and intertrochanter), spine (posteroanterior [PA] and lateral), total body, and radius. Biochemical markers of bone resorption included urinary N-telopeptide cross-linked collagen type I and free deoxypyridinoline; markers of bone formation included serum osteocalcin and bone-specific alkaline phosphatase. Long-term alendronate therapy was associated with increased BMD at the total hip (4.0%), femoral neck (3.1%), trochanter (5.5%), intertrochanter (3.8%), PA spine (7.8%), lateral spine (10.6%), total body (2.2%), and one-third distal radius (1.3%) in elderly women (all p < 0.01). In the placebo group, bone density increased 1.9-2.1% at the spine (p < 0.05) and remained stable at all other sites. At 6 months, there were significant decreases in all markers of bone turnover (-10% to -53%, p < 0.01) in women on alendronate. The changes in urinary cross-linked collagen at 6 months correlated with long-term bone density changes at the hip (r = -0.35, p < 0.01), trochanter (r = -0.36, p < 0.01), PA spine (r = -0.41, p < 0.01), and total body (r = -0.34, p < 0.05). At 6 months, patients with the greatest drop in urinary cross-linked collagen (65% or more) demonstrated the greatest gains in total hip, trochanteric, and vertebral bone density (all p < 0.05). A 30% decrease in urinary cross-linked collagen at 6 months predicted a bone density increase of 2.8-4.1% for the hip regions and 5.8-6.9% for the spine views at the 2.5-year time point (p < 0.05). There were no substantive associations between changes in biochemical markers and bone density in the placebo group. Alendronate therapy was associated with significant long-term gains in BMD at all clinically relevant sites, including the hip, in elderly women. Moreover, these improvements were associated with early decreases in biochemical markers of bone turnover. Early dynamic decreases in urinary cross-linked collagen can be used to monitor and predict long-term response to bisphosphonate therapy in elderly women. Future studies are needed to determine if early assessment improves long-term patient compliance or uncovers poor compliance, thereby aiding the physician in maximizing the benefits of therapy.

Beyond the New Public Management: Changing Ideas and Practices in Governance

Abstract: Beyond the New Public Management provides an analysis of current conceptual debates in public management and governance. It critically reviews attempts made over the last two decades to apply the 'new public management' model in developed and developing countries.

Patterns of economic growth : hills, plateaus, mountains, and plains

Abstract: The recent growth literature has underestimated the importance - and ignored the implications - of the instability and volatility of growth rates. In particular, the use of panel data to investigate the effects of long-term growth in developing countries - especially with fixed effects estimates - is potentially more problematic than helpful. Except during the Great Depression, the historical path for per capita GDP in the United States has been reasonably stable exponential trend growth, with modest cyclical deviation. Graphically, growth in the United States displays as a modestly sloping, only slightly bumpy, hill. But almost nothing that is true about per capita GDP for the United States (or for other OECD countries) is true for developing countries. First, per capita GDP in most developing countries does not follow a single time trend: For a given country, there is great instability in growth rates over time, relative to both average level of growth and to cross-sectional variance. These shifts in growth rates lead to distinct patterns. Some countries have had steady growth (hills and steep hills); others have had rapid growth followed by stagnation (plateaus); others have had rapid growth followed by declines (mountains) or even catastrophic declines (cliffs); still others have experienced continuous stagnation (plains) or even steady decline (valleys). Second, volatility - however measured - is much greater in developing than in industrial countries. These stylized observations about growth rates, Pritchett concludes, suggest that it may be useless to use panel data to investigate long-term growth rates in developing countries. Perhaps more can be learned about developing countries by investigating what initiates (or halts) episodes of growth. There is something of a professional split in growth literature, Pritchett observes. Macroeconomists studying industrial countries discuss steady-state growth and ponder whether all countries in the convergence club will reach the same happy level in the end. Development economists, on the other hand, are the pathologists of economics, having discovered that developing countries are most emphatically not all alike. Developing countries have found ways to be ecstatic but they have also discovered many different ways to be unhappy. This paper - a product of the Development Research Group - is part of a larger effort in the group to understand the determinants of economic growth.

Intergenerational Schooling Mobility and Macro Conditions and Schooling Policies in Latin America

Abstract: The effects of market and policy reforms on poverty and inequality in Latin America have been of considerable concern. The region continues to have relatively great income inequalities. Two different societies with the same income distribution may have different levels of social welfare because they have different degrees of social mobility. To date little attention has been paid to measuring social mobility in the region. Schooling is thought to be a major mechanism through which intergenerational social mobility is affected. This paper explores the strength of the association of family background with child schooling and whether the strength of this association is related to some major macro and aggregate school policy variables.

Patterns of economic growth: hills, plateaus, mountains, and plains

Abstract: Except during the Great Depression, the historical path for per capita Gross Domestic Product (GDP) in the United Stateshas been reasonably stable exponential trend growth, with modest cyclical deviation. Graphically, growth in the United States displays as a modestly sloping, only slightly bumpy, hill. But almost nothing that is true about per capita Gross Domestic Product (GDP) for the United States (or for other member countries of the Organization for Economic Cooperation and Development (OECD)) is true for developing countries. First, per capita Gross Domestic Product (GDP) in most developing countries does not follow a single time trend: For a given country, there is great instability in growth rates over time, relative to both average level of growth and to cross-sectional variance. These shifts in growth rates lead to distinct patterns. Some countries have had steady growth (hills and steep hills); others have had rapid growth followed by stagnation (plateaus); others have had rapid growth followed by declines (mountains) or even catastrophic declines (cliffs): still others have experienced continuous stagnation (plains) or even steady decline (valleys). Second, volatility--however measures--is much greater in developing than in industrial countries. These stylized observations about growth rates, the author concludes, suggest that it may be useless to use"panel data"to investigate long-term growth rates in developing countries. Perhaps more can be learned about developing countries by investigating what initiates (or halts) episodes of growth. There is something of a professional split in"growth"literature, the author observes. Macroeconomists studying industrial countries discuss steady-state growth and ponder whether all countries in the convergence club will reach the same happy level in the end. Development economists, on the other hand, are the pathologists of economics, having discovered that developing countries are most emphatically not all alike. Developing countries have found ways to be ecstatic but they have also discovered many different ways to be unhappy.

Pharmacokinetics of oral ganciclovir alone and in combination with zidovudine, didanosine, and probenecid in HIV-infected subjects.

Abstract: The aim of this study was to determine whether oral ganciclovir interacted pharmacokinetically with zidovudine (AZT), didanosine (ddI), or probenecid. A multicenter, open-label, randomized, crossover pharmacokinetic study with four phases was undertaken at an outpatient private research center and at university research clinics. Twenty-six HIV-infected adults (23 men, 3 women) with cytomegalovirus (CMV) seropositivity and CD4+ T-lymphocyte count > or =100 cells/microl were studied. Patients had to be stable on antiretroviral therapy for at least 4 weeks. Patients with a history of opportunistic infection or gastrointestinal symptoms were excluded. Measurements included serial blood and urine samples during the dosing intervals at steady state. The steady-state pharmacokinetics of ganciclovir were determined after the participants had stabilized and were tolerating AZT or ddI therapy. When a 1000-mg dose of oral ganciclovir was taken every 8 hours, there was a significant mean increase in Cmax and dosing interval area under the serum concentration time curve over a dosing interval (AUC) for the two antiretroviral drugs: for AZT, 61.6% and 19.5%, respectively; for ddI when administered sequentially (2 hours before ganciclovir), 116.0% and 114.6%; and for ddI administered simultaneously with ganciclovir, 107.9% and 107.1%, respectively. There was no significant change in renal clearance for either antiretroviral drug, suggesting that the interaction did not occur through a renal mechanism. There was no significant change in mean ganciclovir Cmax and AUC(0-8) when coadministered with AZT. Mean increases in Cmax and AUC(0-8) of oral ganciclovir averaged 40.1% and 52.5%, respectively, when coadministered with probenecid, but decreased by 22.1% and 22.7%, respectively, when oral ganciclovir was administered 2 hours after ddI. There was no change in the mean ganciclovir Cmax or AUC(0-8) when administered simultaneously with ddI. The mean renal clearance of oral ganciclovir was not affected by AZT or ddI coadministration intake, but there was a mean decrease of 19% when coadministered with probenecid. We conclude the increased serum concentration and reduced renal clearance of ganciclovir suggests competition with probenecid for secretion at the renal tubule. The mechanism of the interaction of oral ganciclovir with either AZT or ddI remains to be determined. The magnitude of the effect of oral ganciclovir on ddI pharmacokinetics may result in an increase in ddI concentration-related toxicities. Similarly, the small but significant decrease in ganciclovir concentration with sequential combination ddl therapy may impair the efficacy of oral ganciclovir. For HIV-infected patients receiving ganciclovir and ddI, clinicians should recommend administering the two drugs simultaneously, and patients should be monitored closely for ddI-associated toxicities.

Oral ganciclovir dosing in transplant recipients and dialysis patients based on renal function

Abstract: Background. An oral formulation of ganciclovir (GCV) was recently approved for the prevention of cytomegalovirus disease in solid organ transplant recipients. This study was designed to determine the bioavailability of GCV and to test a dosing algorithm in transplant and dialysis patients with different levels of renal function. Methods. Pharmacokinetic studies were carried out in 23 patients who were either a recipient of an organ transplant or on hemodialysis. Drug dosing was established by the following algorithm based on calculated creatinine clearance (CrCl): CrCl = (140-age) x body weight / 72 x Cr x.85 for women that is, CrCl >50 ml/min, 1000 mg every 8 hr; CrCl of 25-50 ml/min, 1000 mg every 24 hr; CrCl of 10-24 ml/ min, 500 mg every day; CrCl <10 ml/min (or on dialysis), 500 mg every other day after dialysis. GCV was taken within 30 min after a meal. The patients received oral GCV for between 12 days and 14 weeks. Serum specimens (or plasma from patients on hemodialysis) obtained at steady state were analyzed for GCV concentrations by high-performance liquid chromatography. In nine of the transplant recipients, absolute bioavailability was determined by comparing GCV levels after single oral and intravenous doses of GCV. Results. The following GCV concentrations (mean ± SD) were determined: with CrCl of ≥70 ml/min, the minimum steady-state concentration (C min ) and maximum concentration (C max ) were 0.78±0.46 μg/ml and 1.42±0.37 μg/ml, respectively, with a 24-hr area under the concentration time curve (AUC 0-24 ) of 24.7<7.8 μg.hr/ml; with CrCl of 50-69 ml/min, the C min and C max were 1.93±0.48 and 2.57±0.39 μg/ml, respectively, with an AUC 0-24 of 52.1±10.1 μg.hr/ml; with CrCl of 25-50 ml/min, the C min and C max were 0.41±0.27 and 1.17<0.32 μg/ml, respectively, with an AUC 0-24 of 14.6±7.4 μg.hr/ml. For one patient with a CrCl of 23.8 ml/min, the C min and C max were 0.32 and 0.7 μg/ml, respectively, with an AUC 0-24 of 10.7 μg.hr/ml. With CrCl of <10 ml/min, the mean C min and C max were 0.75<0.42 and 1.59<0.55 μg/ml, respectively, with a mean AUC 0-24 of 64.6±18.8 μg.hr/ml. Absolute bioavailability, for the nine patients so analyzed, was 7.2±2.4%. For those patients with end-stage renal failure, GCV concentrations fell during dialysis from a mean of 1.47±0.48 μg/ml before dialysis to 0.69±0.38 μg/ml after dialysis. Conclusions. The bioavailability of oral GCV in transplant patients was similar to that observed in human immunodeficiency virus-infected patients. However, levels between 0.5 and 1 μg/ml (within the IC 50 of most cytomegalovirus isolates) could be achieved with tolerable oral doses. The proposed dosing algorithm resulted in adequate levels for patients with CrCl greater than 50 ml/min and for patients on dialysis. For patients with CrCl between 10 and 50 ml/min, the levels achieved were low and these patients would likely benefit from increased doses.

Sustaining the Andes?: Social capital and policies for rural regeneration in Bolivia

Abstract: This paper extends debates about social capital to an analysis of the role of local institutions in establishing environmentally-sustainable development in the Bolivian Andes. Currently, neo-liberal orthodoxies assume an Andean environmental crisis without acknowledging that local adaptation by local inhabitants may reduce exposure to risk, and also enhance economic performance. Conversely alternative development orthodoxy refuses to accept that some regions may indeed be in irreversible decline. The paper questions each of these "orthodoxies". It begins by outlining a framework linking environmental and rural economic regeneration to social capital formation, and then illustrates this in relation to case studies from the departments of Potosi and La Paz. Evidence suggests that local organizations have helped localities negotiate more effectively with state, market, and other civil society actors, as well as provide access to new, cleaner technology, financial resources, and new markets. However, the impact of local institutions in reversing processes of rural decline varies among locations, and for some areas progressive decline and out-migration seem likely. Rural regeneration is only likely to occur in these areas through concerted policy commitment to highland small farm production. This is unlikely in the absence of effective social mobilization at a national level. RESUME Priservation des Andes? Capital social et politiques de reconstruction en Bolivie. Cet exposee largit le debat sur le capital social 'a une analyse du rble des institutions locales dans la mise en place d'un developpement des Andes boliviennes viable sur le plan de l'environnement. Actuellement, Les orthodoxies neolibr inversement, I'orthodoxie alternative de dv umgekehrt weigert sich die alternative Entwicklungsorthodoxie anzuerkennen, daB sich manche Regionen tatsichlich in einem irreversiblen Niedergang befinden. Der Text stelltjede dieser ,,Orthodoxien" in Frage. Er beginnt damit, einen Rahmen zu umreiBen, in dem eine Regeneration der Umwelt und der l~ndlichen Wirtschaft mit der Bildung sozialen Kapitals in Verbindung gebracht wird und veranschaulicht dies an Hand von Fallstudien aus den Bezirken Potosi und La Paz. Die Fakten lassen darauf schlieBen, daB lokale Organisationen dazu beigetragen haben, daB man in solchen Gegenden effektiver mit dem Staat, dem Markt und anderen Akteuren der biirgerlichen Gesellschaft umgeht und somit ein Zugriff auf neue, sauberere Technologien, Geldquellen und neue M.rkte m6glich wird. Der EinfluB, den lokale Institutionen darauf haben, den Niedergang lIndlicher Regionen riickgiingig zu machen, istjedoch von Gebiet zu Gebiet unterschiedlich, und in manchen Regionen ist ein Fortschreiten dieses Niederganges und ein Abwandern wahrscheinlich. Eine Regeneration ist in solchen Gebieten nur durch eine konzertierte Hinwendung zur Produktion in Kleinbetrieben des Hochlands zu erwarten. Eine solche Entwicklung ist in Abwesenheit einer effektiven sozialen Mobilmachung auf nationaler Ebene jedoch unwahrscheinlich.

Industrial Transformation in Eastern Europe in the Light of the East Asian Experience

Abstract: List of Tables - Preface - Notes on the Editors and Contributors - PART ONE: INTRODUCTION - On Appropriate Models for Transformation in Eastern Europe J.Henderson - PART TWO: TRANSFORMATION IN COMPARATIVE PERSPECTIVE - Social and Political Dimensions of Economic Transformation: Eastern Europe and Pacific Asia J.Henderson & R.Whitley - Industrial Transformation in East-Central Europe and East Asia: Should the State Whither Away? W.Andreff - Privatization and the State: Russia, Eastern Europe, East Asia N.Harris & D.Lockwood - The Starting Point of Liberalization: China and the Former USSR on the Eve of Reform P.Nolan - Institutional Change and Economic Development in East-Central Europe and China: Contrasts in the Light of the 'East Asian Model' D.Lo & H.Radice - PART THREE: NATIONAL SPECIFICITIES - Institutional Foundations of Robust Economic Performance: Public Sector Industrial Growth in China V.Nee & S.Su - The Developmental Alliance for Industrialization in East Asia: State and Business in South Korea and Taiwan E.M.Kim - Enterprise Strategies and Labour Relations in Central and Eastern Europe S.Vickerstaff, J.Thirkell & R.Scase - Ideologies, Economic Policies and Social Change: the Cyclical Nature of Hungary's Transformation L.Czaban - Index

Privatisation, Enterprise Development and Economic Reform: Experiences of Developing and Transitional Economies

Abstract: Part 1 Introduction: privatization, enterprise development and economic reform experiences of developing and transitional economies, Paul Cook et al. Part 2 Enterprise reform and private sector development - theory, policy and experience: the dual risks of market exchange and the transition process, Mo Yamin transnational corporations as agents for the transmission of business culture to host countries, Hafiz Mirza the response of Ghana's manufacturing sector to structural adjustment, Isaac Acheampong and Michael Tribe private investment, bank credit and structural adjustment in Ghana, Martin Brownbridge open economy adjustment and transition in Vietnam, John Weeks financial and legal reform and enterprise restructuring - evidence from Poland, John S. Henley enterprise restructuring in Central and Eastern Europe (CEE) and the former Soviet Union - the role of technical assistance, George B. Assaf joint ventures in China and their relation to the local economy, Le-Yin Zhang and John T. Thoburn foreign trade reform and China's state export-import enterprises, Alasdair I. MacBean. Part 3 Small and medium enterprise development: small-firm formation in transitional economies - a case study of Egypt, Amr A. Elleithy and Fred Nixson dynamics of small enterprise development - state versus market in the Asian newly industrializing economies, Philippe Regnier social and cultural influences on the growth of small firms, S.A. Hussain. Part 4 Social impact of enterprise restructuring: privatization, employment and social protection, Paul Cook and Colin Kirkpatrick the effect on labour of the restructuring of coal production, Jonathan Winterton and Ruth Winterton coal in Vorkuta - subsidies and the social safety net, Paul G. Hare.

Effect of high-dose oral ganciclovir on didanosine disposition in human immunodeficiency virus (HIV)-positive patients.

Abstract: This study was designed to investigate the interaction between high-dose oral ganciclovir (6,000 mg/day) and didanosine at steady state in patients who were seropositive for human immunodeficiency virus (HIV) and cytomegalovirus (CMV) infection. The study was conducted as an open-label, randomized, three-period crossover study. Patients received (in random order) multiple oral doses of didanosine 200 mg every 12 hours alone, ganciclovir 2,000 mg every 8 hours alone, and ganciclovir 2,000 mg every 8 hours in combination with didanosine 200 mg every 12 hours. Blood and urine samples for determinations of drug concentrations were obtained on day 3 of each dose regimen. When ganciclovir was administered either before or 2 hours after didanosine, the mean increases in maximum concentration (Cmax), area under the concentration-time curve (AUC0-12), and percent excreted in urine of didanosine were 58.6% and 87.3%, 87.3% and 124%, and 100% and 153%, respectively. There were no statistically significant effects of didanosine on the steady-state pharmacokinetics of ganciclovir in the presence of didanosine, irrespective of sequence of administration. There were no significant changes in renal clearance of didanosine, suggesting that the mechanism for the interaction does not involve competition for active renal tubular secretion. The mechanism responsible for increased didanosine concentrations and percent excreted in urine during concurrent ganciclovir therapy may be a result of increased bioavailability of didanosine. However, the mechanism appears to be saturated at oral ganciclovir doses of 3 g/day.

Indigenous irrigation organizations and the formation of social capital in northern Highland Ecuador

Abstract: Recent debates on the role of social capital in develop ment are of relevance to nature-society analysis within geography because they highlight the ways in which forms of social organization can increase the effectiveness, equity and efficiency of natural resource management strategies Through a case study of irrigation management organizations in the Northern Andes of Ecuador, this paper addresses the ways in which this form of social capital has been created as a result of both relatively recent development interventions and longer term political economic processes The study also discusses the impacts that this has had on natural resources and rural livelihoods The paper suggests possible indicators for assessing social capital formation, and draws conclusions regarding the conditions under which social capital is most likely to be created and most likely to have positive impacts_

Golbalization, institutional legacies and industrial transformation in Eastern Europ

Abstract: Companies are integrated into the world economy in a number of ways. This article, starting from a sympathetic, though critical engagement with the global commodity chains (GCC) perspective, explores the extent to whcih this perspective is relevant to the analysis of the international firm networks that have developed in Estern Europe. In so doing the article examines the wayus the institutional legacies of the state socialist past and inherited macro-and micro-economic structures influence the integration of the region's companies into global production networks. While the authors do not deny the existence of inter-firm relations similar to the ones described by the GCC perspective, they point out that the situation in Eastern Europe is much more complex than in the developing world, and its complexity is a product of the very different historical backgrounds and modes of incorporation in the world economy that Eastern European countries have experienced. Drawing on a number of case studies from the auto...

How Much Do Teachers Earn

Abstract: In the continuing debate over how to improve education systems, many people argue that teachers' salaries need to be increased. Nevertheless, there is very little reliable information on how much teachers actually earn, how well they fare relative to the labor market and the general distribution of income, and how the pay structure affects the recruitment, retention and motivation of teachers. This paper seeks to establish a reliable method for analyzing how much teachers earn using standard and accepted methods of labor market analysis, and applying them to the case of Bolivia. We break the question of "How much do teachers earn?" into three distinct parts. The first part shows that teachers' monthly incomes are less on average than the rest of the labor market, but that their hourly earnings are higher. An econometric analysis of household survey data shows that, after controlling for personal characteristics, teachers hourly earnings are still higher than they would earn in the private sector, but lower than they would earn in other unionized public sector jobs. Non-salary benefits are shown to provide teachers with further advantages over the private sector labor market. Next, we show that teachers are relatively well off in the overall distribution of income after incorporating other sources of income and life choices (i.e., second jobs, hours worked, second wage earners). We demonstrate that teachers are not apparently "forced" to take second jobs since they are less likely than other workers to take second jobs, and when they do, the hourly earnings in those jobs is higher than their teaching jobs. The final section of the paper discusses the implications of these findings for policies to improve recruitment, retention, and motivation of high quality teachers.

Networking and rural development through sustainable forest management: frameworks for pluralistic approaches

Abstract: The sustainability of rural development initiatives (including forestry) depends greatly on the capacities of the institutions involved, the relationships among them and their relative power. Therefore a strategy to foster pluralistic approaches to rural development should focus on building the capacities of those who have typically been marginalized by development strategies and discussions as well as on developing relationships that allow more effective, efficient and equal interactions and greater accountability among all participants. This article develops this argument by first drawing lessons from research into the nature of inter-institutional relationships among nongovernmental organizations (NGOs), governments and rural peoples' organizations (RPOs). It then links some of those findings to recent discussions of the role of networks, associations and relationships of trust (or what has been termed "social capital") in sustainable development, and suggests that these discussions provide useful frameworks for thinking about pluralistic strategies. The article then considers two experiences in building institutional capacities and relationships: one is a longer-standing case from Bolivia; the other a more recent initiative in Colombia. In the Bolivian example, the initiative has come from civil society, whereas in Colombia the initiative has come from government. The overall conclusion reached is that synergistic relationships can indeed be built. While some of the examples come from agriculture, their institutional lessons are equally applicable to the case of forestry.

Steady-state relative bioavailability of three oral ganciclovir dosage regimens delivering 6,000 mg/day in patients with human immunodeficiency virus.

Abstract: This study was designed to determine the steady-state relative bioavailability of ganciclovir after three dosage regimens designed to deliver 6,000 mg/day. The study design was an open-label, randomized, three-treatment crossover design in which 22 human immunodeficiency virus (HIV) and cytomegalovirus (CMV) seropositive patients received in random order multiple oral doses of ganciclovir 1,000 mg six times a day, 1,500 mg four times a day, and 2,000 mg three times a day. Blood samples were obtained on day 3 of each oral regimen over a 24-hour time interval. Mean steady-state average serum concentrations of ganciclovir were greater than 1.0 microgram/mL, which exceeds the median in vitro inhibitory concentration (IC50) of most CMV isolates (0.5-1.0 microgram/mL). All three regimens resulted in values for area under the concentration-time curve from 0 to 24 hours (AUC0-24) that were comparable to those seen after maintenance ganciclovir intravenous infusions of 5 mg/kg/day. The 1,000 mg six times daily regimen resulted in an AUC0-24 that was significantly higher than that of the 1,500 mg four times daily or the 2,000 mg three times daily regimens, although the differences were less than 12.5%.

Absolute Bioavailability and Dose Proportionality of Oral Ganciclovir after Ascending Multiple Doses in Human Immunodeficiency Virus (HIV)-Positive Patients

Abstract: This study was designed to determine the bioavailability and dose linearity and proportionality of ganciclovir after multiple oral administrations of 3,000 mg to 6,000 mg per day. In an open-label, randomized, four-treatment crossover design, 24 patients seropositive for human immunodeficiency virus (HIV) and cytomegalovirus (CMV) received in random order multiple oral doses of ganciclovir 1,000 mg every 3 hours (six times a day), 1,000 mg four times a day, and 1,000 mg three times a day and a single 5-mg/kg intravenous infusion (over 1 hour) of ganciclovir. Blood samples for pharmacokinetic determinations were obtained on day 3 of each oral regimen and on the day of the intravenous infusion over a 24-hour time interval. Mean steady-state average serum concentrations of ganciclovir were 0.54, 0.79, and 0.99 microgram/mL, respectively, with the 3, 4, and 6 g/day oral regimens. The steady-state area under the concentration-time curve (AUC0-24) for the 6,000 mg/day oral regimen approached that of the single-dose intravenous regimen. There was a proportional increase in AUC0-24 between the 3 and 4 g/day dosage regimens, but not between the 4 and 6 g/day regimens. This suggests nonlinear absorption of ganciclovir at higher dosages, although the departure from proportionality was less than 11%.

Technological change among peasants in Central Argentina

Abstract: Drawing on a case-study from Central Argentina, this article suggests that researchers can be too cautious about introducing technologies of which farmers have no previous experience. In particular, it challenges the notion that the only technology appropriate to peasant conditions is that which is rooted in traditional ideas and culture. Under certain circumstances, externally supplied technologies may also be appropriate. Rather than focusing solely on the technology, it is necessary to look at the socio-economic and historical context in which the technology will be used.