Ben Smit

South Africa: Macroeconomic Challenges after a Decade of Success

More than halfway through the decade, the South African economy has done very well. This report asks whether such achievements provide grounds for complacency. In particular it discusses the current account challenge in light of the Accelerated and Shared Growth Initiative for South Africa (ASGI-SA) program. Our assessment is that a cautionary note on the need to reduce external imbalances is needed. We provide policy recommendations to minimize the negative impact of a possible sudden stop of capital inflows. On the consistency of ASGI-SA program, we note that, given South Africas recent employment and productivity performance a large investment program would be required to deliver the desired growth rates. In our view this imposes a large burden on public investment and on the current account itself.

Prospects for proton therapy in carcinoma of the cervix.

Carcinoma of the cervix remains a serious problem worldwide. The results of radiation therapy varies from institution to institution, with actuarial 5-year survival rates for Stage IIIB disease of between 28 and 60%. The inferior survival figures can be ascribed to poor local control due to inadequate dosage, partly due to the non-use of intracavitary therapy. Results from the literature were reviewed to assess the optimal dose required to sterilize the primary, para-metrial and nodal disease within the pelvis. The aim of this study is to assess whether the target volume could be reduced to allow an increased dose to be delivered. Protons, in view of their physical characteristics, would aid this objective. From CT scans the minimal target volume was determined, and treatment plans for a 200 MeV proton beam were evaluated. It appears that a volume reduction of up to 60% in the target volume may be achieved with proton therapy when compared to the usual target volume achievable with photon therapy, and thus a 20% dose increment may be reasonable. This increased dose may translate to a 40% improvement in the local control rate without an expected increase in complications. An improved local control rate may lead to improved survival. A compatible technique of well-fractionated high dose rate intracavitary therapy (ICT) based on an indwelling intra-uterine tube is offered that will allow up to 10 fractions of ICT with only a single anaesthetic, to be integrated with a similar number of fractions of proton therapy.

Fiscal and Monetary Policy in a Commodity-Based Economy

A rough description of macroeconomic policy in South Africa would be that monetary policy concentrates on building nominal credibility through focusing on inflation, while the brunt of the responsibility for output stabilization rests on fiscal policy. This aricle discusses the convenience of such a policy mix. First, we estimate the business cycle impact of fiscal and monetary policy to find that so far fiscal policy has been mostly pro-cyclical, whereas monetary policy has been, over the last couple of years, mildly counter-cyclical. We argue that fiscal policy should be made significantly more counter-cyclical than it has been - a strategy that would deliver more macroeconomic stability and potentially higher growth. Furthermore, we believe the Central Bank has earned the credibility to operate macro policy with a more decisive output stabilization objective, and we discuss several reinterpretations of the inflation targeting regime that provide the flexibility to do so without risking the strong anti-inflationary credibility of the SARB. On exchange rate policy we recommend that the authorities take a pragmatic approach to floating, mostly allowing the currency to move freely, but intervening to avoid overvaluation. We explain why and discuss how this objective could be achieved. Copyright (c) 2008 The Authors. Journal compilation (c) 2008 The European Bank for Reconstruction and Development.

Prolongation of segmental and pancreaticoduodenal allografts in the primate with total-lymphoid irradiation and cyclosporine

The prolongation of segmental and pancreaticoduodenal allografts (PDA) by total lymphoid irradiation (TLI) and in combination with cyclosporine (CsA) was assessed in a well established total pancreatectomy, diabetic, primate transplantation model. Pancreatic transplantation was performed in 119 pancreatectomized baboons (Papio ursinus). Of a total of 109 allografts performed, 71 were segmental allografts (open duct drainage) and 38 PDA. Of 119 graft recipients, 10 received segmental pancreatic autografts. TLI and CsA administered separately to segmental allograft recipients resulted in modest allograft survival and indefinite graft survival was not observed. 8 of 17 (47%) segmental allograft recipients that received TLI and CsA had graft survival beyond 100 days, indicating highly significant pancreatic allograft survival. All long-term segmental allograft recipients were rendered normoglycemic (plasma glucose less than 8 mmol/L) by this immunosuppressive regimen. In contrast, poor results were observed in PDA recipients treated with TLI and CsA. Mean survival in 18 treated PDA recipients was 23.8 days, 8 survived longer than 20 days (44.4%), and 1 greater than 100 days (5.5%). Despite treatment, early rejection of the duodenum in PDA recipients frequently resulted in necrosis and perforation and contributed to a high morbidity and mortality. This study indicates that, in contrast to the significant prolongation of segmental allografts by TLI and CsA, poor immunosuppression was achieved by this regimen in PDA recipients and was associated with a high morbidity and mortality caused by early rejection of the duodenum.