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To examine associations between extended medical graduates’ rural clinical school (RCS) experience and geographic origins with practising in rural communities five and eight years after graduation. Cohort study of 2011 domestic medical graduates from ten Australian medical schools with rural clinical or regional medical schools. Practice location types eight years after graduation (2019/2020) as recorded by the Australian Health Practitioner Regulation Agency, classified as rural or metropolitan according to the 2015 Modified Monash Model; changes in practice location type between postgraduate years 5 (2016/2017) and 8 (2019/2020). Data were available for 1321 graduates from ten universities; 696 were women (52.7%), 259 had rural backgrounds (19.6%), and 413 had extended RCS experience (31.3%). Eight years after graduation, rural origin graduates with extended RCS experience were more likely than metropolitan origin graduates without this experience to practise in regional (relative risk [RR], 3.6; 95% CI, 1.8–7.1) or rural communities (RR, 4.8; 95% CI, 3.1–7.5). Concordance of location type five and eight years after graduation was 92.6% for metropolitan practice (84 of 1136 graduates had moved to regional/rural practice, 7.4%), 26% for regional practice (56 of 95 had moved to metropolitan practice, 59%), and 73% for rural practice (20 of 100 had moved to metropolitan practice, 20%). Metropolitan origin graduates with extended RCS experience were more likely than those without it to remain in rural practice (RR, 2.0; 95% CI, 1.3–2.9) or to move to rural practice (RR, 1.9; 95% CI, 1.2–3.1). The distribution of graduates by practice location type was similar five and eight years after graduation. Recruitment to and retention in rural practice were higher among graduates with extended RCS experience. Our findings reinforce the importance of longitudinal rural and regional training pathways, and the role of RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.

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Pp. xiv, 274. $26.50(US), paper. Reviewed by David S. FoglesongNICOLA COOPER. France in Indochina: Colonial Encounters.Oxford and New York: Berg, 2001 Pp ix, 240. $19.50 (US), paper.Reviewed by Nola CookeMARGARET CRITCHLOW RODMAN. Houses Far from Home: British Colonial Space in the New Hebrides.Honolulu: University of Hawaii Press, 2001. Pp. xiv, 247. $24.95 (US), paper Reviewed by Paul D'ArcyJONATHAN M. HOUSE. Combined Arms: Warfare in the Twentieth Century.Lawrence: University Press of Kansas, 2001. Pp. xvii, 364. $19.95 (US), paper Reviewed by Roger BeaumontSTEPHEN A. SCHUKER, ed. with collaboration from ELISABETH MÜLLER-LUCKNER. Deutschland und Frankreich: Vom Konflikt zur Aussöhnung: Die Gestaltung der westeuropäischen Sicherheit, 1914–1963.Munich: R. Oldenbourg Verlag, 2000. Pp. xix, 280. €49.80. Reviewed by Andrew J. CrozierCHARLES W. KOBURGER,JR. The Central Powers in the Adriatic, 1914–1918: War in a Narrow Sea.Westport: Praeger, 2001. Pp. xxi, 145. $65.00 (US). 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Atherosclerotic renovascular disease (ARVD) commonly causes renal failure and hypertension and is accompanied by high cardiovascular comorbidity and mortality. Interrelationships between these factors remain poorly understood. Patients with ARVD presenting to a single center between 1995 and 1999 were followed up, with prospective collection of clinical and biochemical data. Fifty men and 48 women were identified. Mean age at entry was 68.7 ± 8.3 (SD) years, and baseline creatinine clearance (CrCl) was 35.5 ± 20.7 mL/min. During follow-up (27.7 ± 18.7 months), 10 patients required dialysis therapy, 11 patients underwent revascularization, and 35 patients (36%) died. Patients in whom renal function deteriorated during follow-up (n = 61) had similar ages, baseline CrCls, blood pressures, and comorbidities compared to patients with stable function. Mortality (55.7% versus 27.0%; P< 0.01) and proteinuria (protein, 1.3 ± 1.6 versus 0.3 ± 0.4 g/24 h; P< 0.001) were greater in patients with declining function. Baseline renal function was not significantly related to blood pressure, proteinuria, or change in renal function during follow-up (change in CrCl), but patients with a lower CrCl had increased mortality. There was no increase in cardiovascular comorbidity in groups with lower renal function. Patients with the most severe anatomic ARVD had worse hypertension and increased mortality, but severity of ARVD was unrelated to extent of renal dysfunction and proteinuria at baseline. Lack of correlation between renal artery anatomy and baseline renal function or functional outcome and correlation between renal functional outcome and proteinuria suggest that renal parenchymal damage is a major determinant of renal dysfunction and outcome in ARVD. © 2002 by the National Kidney Foundation, Inc.

Background. Atherosclerotic renovascular disease (ARVD) is commonly associated with renal failure. It is now recognized that intrarenal damage, (ischaemic or atherosclerotic nephropathy) is a major contributor to the renal impairment in these patients. In this study the impact of histological changes upon renal functional outcome was investigated in patients with atherosclerotic nephropathy.Methods. The Hope Hospital renal biopsy database (1985–1998) was interrogated for patients with histology compatible with atherosclerotic nephropathy. Case‐note review enabled the assessment of several clinical parameters and outcomes, including change in creatinine clearance per year (ΔCrCl (ml/min/year)), blood pressure control, dialysis need, and death. Renal parenchymal damage was analysed by morphometric analysis (of interstitial fibrosis and glomerulosclerosis) and a semi‐quantitative chronic damage score (score 0–3 (normal–severe) for each of glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriolar hyalinosis; maximum=12). Patients were stratified into two groups who had either deteriorating (group 1) or stable (group 2) renal function during follow‐up.Results. Twenty‐five patients (age 64.7±10.5, range 43–83 years; 17 male, eight female) were identified. Sixteen patients had undergone angiography; two had significant (>50%) renal artery stenosis. Mean follow‐up was 25.6±14.8 (range 5–50) months. Group 1 patients had ΔCrCl −7.4±6.8 ml/min/year, n=14 and group 2 patients had ΔCrCl 4.8±7.0 ml/min/year, n=11. Four patients in group 1 developed end‐stage renal disease and five patients died (three in group 1 and two in group 2). At study entry, group 1 patients had worse renal function (CrCl 27.6±17.6 vs 36.0±33.9, NS), greater proteinuria (1.2 vs 0.5 g/24 h, NS), and higher systolic blood pressure (167.1±30.8 mmHg vs 150.6±37.8, NS) compared with group 2 patients. Group 1 patients showed more glomerulosclerosis (51.6 vs 24.9%, P<0.01), greater proportional interstitial volume (44.9 vs 33.9%, P<0.02), and higher overall chronic damage score (P<0.05) than those in group 2. There was a significant correlation between renal functional outcome and chronic damage score, glomerulosclerosis and proportional interstitial volume for the entire patient cohort.Conclusion. In patients with atherosclerotic nephropathy the severity of histopathological damage is an important determinant and predictor of renal functional outcome.

This paper tests the rational expectations theory of the term structure using recent daily, weekly, and monthly observations on New Zealand interest rates. We find that for many maturities we cannot reject the expectations hypothesis using both short and long versions of the theory. These results are interpreted as further evidence that the failure of the expectations hypothesis in the United States is due to the specific interest rate smoothing behaviour of the Federal Reserve.

This paper addresses the issue of whether New Zealand's public debt obligations should be denominated in domestic or foreign currency. Using the tax‐smoothing approach of Bohn (1990), we estimate optimal debt portfolios. We find that, contrary to recent Government policy and the results from a simple mean‐variance analysis, the welfare‐maximising policy requires that all public debt be denominated in foreign currency.

Given the stock of public debt, a decision must be made about what proportion will be denominated in foreign rather than domestic currency. This note uses the Kydland-Prescott and Barro-Gordon time consistency framework to analyse that decision from the different viewpoints of the New Zealand Debt Management Office (in the Treasury) and of the Reserve Bank of New Zealand. It is shown why the former might choose a higher proportion of domestic debt than the Reserve Bank, and that the socially optimal choice lies between the two.