Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation

Objective: To evaluate contractile reserve (CR) determined by exercise echocardiography in predicting clinical outcome and left ventricular (LV) function in asymptomatic severe mitral regurgitation (MR). Design: Cohort study. Setting: Regional cardiac centre. Patients and outcome measures: LV volumes and ejection fraction (EF) were measured at rest and after stress in 71 patients with isolated MR. During follow up (mean (SD) 3 (1) years), EF and functional capacity were serially assessed and cardiac events ( cardiac death, heart failure, and new atrial fibrillation) were documented. Results: CR was present in 45 patients (CR+) and absent in 26 patients (CR-). Age, resting LV dimensions, EF, and MR severity were similar in both groups. Mitral surgery was performed in 19 of 45 (42%) CR+ patients and 22 of 26 (85%) CR2 patients. In patients undergoing surgery, CR was an independent predictor of follow up EF (p = 0.006) and postoperative LV dysfunction (EF < 50%) persisted in five patients, all in the CR2 group. Event-free survival was lower in surgically treated patients without CR (p = 0.03). In medically treated patients, follow up EF was preserved in those with intact CR but progressively deteriorated in patients without CR, in whom functional capacity also deteriorated. Conclusions: Evaluation of CR by exercise echocardiography may be useful for risk stratification and may help to optimise the timing of surgery in asymptomatic severe MR.

Nervous and muscle system development in Phascolion strombus (Sipuncula)

Recent interpretations of developmental gene expression patterns propose that the last common metazoan ancestor was segmented, although most animal phyla show no obvious signs of segmentation. Developmental studies of non-model system trochozoan taxa may shed light on this hypothesis by assessing possible cryptic segmentation patterns. In this paper, we present the first immunocytochemical data on the ontogeny of the nervous system and the musculature in the sipunculan Phascolion strombus. Myogenesis of the first anlagen of the body wall ring muscles occurs synchronously and not subsequently from anterior to posterior as in segmented spiralian taxa (i.e. annelids). The number of ring muscles remains constant during the initial stages of body axis elongation. In the anterior-posteriorly elongated larva, newly formed ring muscles originate along the entire body axis between existing myocytes, indicating that repeated muscle bands do not form from a posterior growth zone. During neurogenesis, the Phascolion larva expresses a non-metameric, paired, ventral nerve cord that fuses in the mid-body region in the late-stage elongated larva. Contrary to other trochozoans, Phascolion lacks any larval serotonergic structures. However, two to three FMRFamide-positive cells are found in the apical organ. In addition, late larvae show commissure-like neurones interconnecting the two ventral nerve cords, while early juveniles exhibit a third, medially placed FMRFamidergic ventral nerve. Although we did not find any indications for cryptic segmentation, certain neuro-developmental traits in Phascolion resemble the conditions found in polychaetes (including echiurans) and myzostomids and support a close relationship of Sipuncula and Annelida.

Export processing zones and growth triangle development: The case of the BIMP-EAGA, Southeast Asia

Exorts processing zones (EPZs) and growth triangles have been two common Asian initiatives to increase wealth and regional competitiveness in the world economy. Since they are seldom analysed jointly, this paper investigates their mutuality in the development process. Taking the problematic case of the Brunei-Indonesia-Malaysia-Philippines East ASEAN Growth Area (BIMP-EAGA) triangle, we explore the role of EPZs in enhancing regional collaboration, competitiveness, and domestic linkages. Despite the triangle's weak economic complementarities, its processing zones are found capable of advancing development by furthering opportunities in regionalisation/localisation of production. Latterly, trade and investment liberalisation within ASEAN raises broad questions about the rationale of EPZs and growth triangles. Zone-triangle nexuses will require rethinking as, under different regulatory conditions, the zones compete more directly across ASEAN and also with global rivals. Copyright © 2005 John Wiley & Sons, Ltd.

The Bali bombs and the tourism development cycle

This paper analyses the impact of the Bali bombings on international visitor arrivals in Bali and compares this crisis with previous crises with reference to Butler’s hypothetical tourism area life cycle. The paper demonstrates that the Bali bombings had by far the greatest impact on international tourism visitation than any other crisis in the island’s history. Such was the severity of the decline in Bali that both national and local measures were taken to restore confidence. Important though these measures were, they do not fully account for the strong resurgence in international arrivals, suggesting that the destination has not yet reached consolidation in accordance with Butler’s hypothesis and that the strength of the resurgence owes much to the underlying trend of the development phase associated with the general picture proposed by Butler.

Performance comparisons between greedy and lagrange algorithms in adaptive MIMO MC-CDMA systems

This paper describes two algorithms for adaptive power and bit allocations in a multiple input multiple output multiple-carrier code division multiple access (MIMO MC-CDMA) system. The first is the greedy algorithm, which has already been presented in the literature. The other one, which is proposed by the authors, is based on the use of the Lagrange multiplier method. The performances of the two algorithms are compared via Monte Carlo simulations. At present stage, the simulations are restricted to a single user MIMO MC-CDMA system, which is equivalent to a MIMO OFDM system. It is assumed that the system operates in a frequency selective fading environment. The transmitter has a partial knowledge of the channel whose properties are measured at the receiver. The use of the two algorithms results in similar system performances. The advantage of the Lagrange algorithm is that is much faster than the greedy algorithm. ©2005 IEEE

Water, Communities and Mineral Resource Development: Understanding the Risks and Opportunities

Issues around water – its quality, use, availability and environmental value – can be a major point of tension between mineral projects and local communities. Failure to manage these issues appropriately can jeopardise the obtaining of regulatory approvals for new projects and place at risk the ‘social licence to operate’ of existing operations. Conversely, there may also be significant opportunities for companies to engage constructively with communities over water issues and to make a positive contribution to the sustainable development of these communities. Using case studies, this paper will explore the various types of social risks and opportunities associated with water and mineral resource development and identify key learnings relating to the management of these issues.