A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study

Background: Patients with chest pain contribute substantially to emergency department attendances, lengthy hospital stay, and inpatient admissions. A reliable, reproducible, and fast process to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event is needed to facilitate early discharge. We aimed to prospectively validate the safety of a predefined 2-h accelerated diagnostic protocol (ADP) to assess patients presenting to the emergency department with chest pain symptoms suggestive of acute coronary syndrome. Methods: This observational study was undertaken in 14 emergency departments in nine countries in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The ADP included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction [TIMI] score), electrocardiograph, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. The primary endpoint was major adverse cardiac events within 30 days after initial presentation (including initial hospital attendance). This trial is registered with the Australia-New Zealand Clinical Trials Registry, number ACTRN12609000283279. Findings: 3582 consecutive patients were recruited and completed 30-day follow-up. 421 (11•8%) patients had a major adverse cardiac event. The ADP classified 352 (9•8%) patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in three (0•9%) of these patients, giving the ADP a sensitivity of 99•3% (95% CI 97•9–99•8), a negative predictive value of 99•1% (97•3–99•8), and a specificity of 11•0% (10•0–12•2). Interpretation: This novel ADP identifies patients at very low risk of a short-term major adverse cardiac event who might be suitable for early discharge. Such an approach could be used to decrease the overall observation periods and admissions for chest pain. The components needed for the implementation of this strategy are widely available. The ADP has the potential to affect health-service delivery worldwide.

Enterprise systems curricula for Asia-Pacific region : a vision for 2020

Enterprise Systems (ES) have emerged as possibly the most important and challenging development in the corporate use of information technology in the last decade. Organizations have invested heavily in these large, integrated application software suites expecting improvments in; business processes, management of expenditure, customer service, and more generally, competitiveness, improved access to better information/knowledge (i.e., business intelligence and analytics). Forrester survey data consistently shows that investment in ES and enterprise applications in general remains the top IT spending priority, with the ES market estimated at $38 billion and predicted to grow at a steady rate of 6.9%, reaching $50 billion by 2012 (Wang & Hamerman, 2008). Yet, organizations have failed to realize all the anticipated benefits. One of the key reasons is the inability of employees to properly utilize the capabilities of the enterprise systems to complete the work and extract information critical to decision making. In response, universities (tertiary institutes) have developed academic programs aimed at addressing the skill gaps. In parallel with the proliferation of ES, there has been growing recognition of the importance of Teaching Enterprise Systems at tertiary education institutes. Many academic papers have discused the important role of Enterprise System curricula at tertiary education institutes (Ask, 2008; Hawking, 2004; Stewart, 2001), where the teaching philosophises, teaching approaches and challenges in Enterprise Systems education were discussed. Following the global trends, tertiary institutes in the Pacific-Asian region commenced introducing Enterprise System curricula in late 1990s with a range of subjects (a subject represents a single unit, rather than a collection of units; which we refer to as a course) in faculties / schools / departments of Information Technology, Business and in some cases in Engineering. Many tertiary educations commenced their initial subject offers around four salient concepts of Enterprise Systems: (1) Enterprise Systems implementations, (2) Introductions to core modules of Enterprise Systems, (3) Application customization using a programming language (e.g. ABAP) and (4) Systems Administration. While universities have come a long way in developing curricula in the enterprise system area, many obstacles remain: high cost of technology, qualified faculty to teach, lack of teaching materials, etc.

Democratization and Violence: European and International Perspectives

It is a startling fact that when in the mid-80s a ‘third wave’ of democracy took hold in Latin America and Eastern Europe, both democracy and violence were simultaneously on the rise worldwide. Almost by definition democracies represent an institutionalized framework and a way of life that ensures non-violent means to share power between communities of people with widely differing values and beliefs. As Keane (2004) points out, ‘violence is anathema to [democracy’s] spirit and substance’ (p. 1). Accordingly, the process of democratization was accompanied by expectations that violence would generally decrease, and that these countries would embark on a process of reducing levels of violence as Western European countries had done earlier in the 19th and 20th century.

Education and training of medical physicists in south East Asia: Accomplishments and challenges

John Cameron has made significant contributions to the field of Medical Physics. His contributions encompassed research and development, technical developments and education. He had a particular interest in the education of medical physicists in developing countries. Structured clinical training is also an essential component of the professional development of a medical physicist. This paper considers aspects of the clinical training and education of medical physicists in South-East Asia and the challenges facing the profession in the region if it is to keep pace with the rapid increase in the amount and technical complexity of medical physics infrastructure in the region.

Population structure of Bactrocera dorsalis s.s., B. papayae and B. philippinensis (Diptera: Tephritidae) in southeast Asia: evidence for a single species hypothesis using mitochondrial DNA and wingshape data

Background Bactrocera dorsalis s.s. is a pestiferous tephritid fruit fly distributed from Pakistan to the Pacific, with the Thai/Malay peninsula its southern limit. Sister pest taxa, B. papayae and B. philippinensis, occur in the southeast Asian archipelago and the Philippines, respectively. The relationship among these species is unclear due to their high molecular and morphological similarity. This study analysed population structure of these three species within a southeast Asian biogeographical context to assess potential dispersal patterns and the validity of their current taxonomic status. Results Geometric morphometric results generated from 15 landmarks for wings of 169 flies revealed significant differences in wing shape between almost all sites following canonical variate analysis. For the combined data set there was a greater isolation-by-distance (IBD) effect under a ‘non-Euclidean’ scenario which used geographical distances within a biogeographical ‘Sundaland context’ (r2 = 0.772, P < 0.0001) as compared to a ‘Euclidean’ scenario for which direct geographic distances between sample sites was used (r2 = 0.217, P < 0.01). COI sequence data were obtained for 156 individuals and yielded 83 unique haplotypes with no correlation to current taxonomic designations via a minimum spanning network. BEAST analysis provided a root age and location of 540kya in northern Thailand, with migration of B. dorsalis s.l. into Malaysia 470kya and Sumatra 270kya. Two migration events into the Philippines are inferred. Sequence data revealed a weak but significant IBD effect under the ‘non-Euclidean’ scenario (r2 = 0.110, P < 0.05), with no historical migration evident between Taiwan and the Philippines. Results are consistent with those expected at the intra-specific level. Conclusions Bactrocera dorsalis s.s., B. papayae and B. philippinensis likely represent one species structured around the South China Sea, having migrated from northern Thailand into the southeast Asian archipelago and across into the Philippines. No migration is apparent between the Philippines and Taiwan. This information has implications for quarantine, trade and pest management.

Leadership [2nd Asia-Pacific ed.]

This second edition of Leadership continues to offer a balanced approach to the study of leadership, drawing on Australasian practices and international theory. It looks at the characteristics of leaders in a wide variety of Australasian settings - organisations in the private, public, and not-for-profit sectors, as well as in politics and in our community. Traditional content such as charismatic, transformational, contingency, and situational theories of leadership are covered in detail, along with the power, influence, motivation, coaching, communication, and team building aspects of leadership. The text also introduces contemporary issues, such as entrepreneurship, knowledge management, leadership in international contexts, and the importance of ethics and social responsibility.

Sustainable urban infrastructure development in South East Asia : evidence from Hong Kong, Kuala Lumpur and Singapore

Many South East Asian cities have experienced substantial physical, economic and social transformations during the past several decades. The rapid pace of globalization and economic restructuring has resulted in these cities receiving the full impact of urbanization pressures. In an attempt to ease these pressures, cities such as Singapore, Hong Kong and Kuala Lumpur have advocated growth management approaches focusing especially on urban infrastructure sustainability. These approaches aim to achieve triple bottom line sustainability by balancing economic and social development, and environmental protection. This chapter evaluates three Asia-Pacific city cases, Singapore, Hong Kong and Kuala Lumpur, and assesses their experiences in managing their urban forms and infrastructure whilst promoting sustainable patterns of urban development.