Refinements in stress echocardiographic techniques improve inter-institutional agreement in interpretation of dobutamine stress echocardiograms

Aims To determine the degree of inter-institutional agreement in the assessment of dobutamine stress echocardiograms using modern stress echo cardiographic technology in combination with standardized data acquisition and assessment criteria. Method and Results Among six experienced institutions, 150 dobutamine stress echocardiograms (dobutamine up to 40 mug.kg(-1) min(-1) and atropine up to I mg) were performed on patients with suspected coronary artery disease using fundamental and harmonic imaging following a consistent digital acquisition protocol. Each dobutamine stress echocardiogram was assessed at every institution regarding endocardial visibility and left ventricular wall motion without knowledge of any other data using standardized reading criteria. No patients were excluded due to poor image quality or inadequate stress level. Coronary angiography was performed within 4 weeks. Coronary angiography demonstrated significant coronary artery disease (less than or equal to50% diameter stenosis) in 87 patients. Using harmonic imaging an average of 5.2+/-0.9 institutions agreed on dobutamine stress echocardiogram results as being normal or abnormal (mean kappa 0.55; 95% CI 0.50-0.60). Agreement was higher in patients with no (equal assessment of dobutamine stress echocardiogram results by 5.5 +/- 0.8 institutions) or three-vessel coronary artery disease (5.4 +/- 0.8 institutions) and lower in one- or two- vessel disease (5.0 +/- 0.9 and 5.2 +/- 1.0 institutions, respectively-, P=0.041). Disagreement on test results was greater in only minor wall motion abnormalities. Agreement on dobutamine stress echocardiogram results was lower using fundamental imaging (mean kappa 0.49; 95% CI 0.44-0.54; P

Estimation of total body water from bioelectrical impedance analysis in patients with pancreatic cancer - agreement between three methods of prediction

Introduction Bioelectrical impedance analysis (BIA) is a useful field measure to estimate total body water (TBW). No prediction formulae have been developed or validated against a reference method in patients with pancreatic cancer. The aim of this study was to assess the agreement between three prediction equations for the estimation of TBW in cachectic patients with pancreatic cancer. Methods Resistance was measured at frequencies of 50 and 200 kHz in 18 outpatients (10 males and eight females, age 70.2 +/- 11.8 years) with pancreatic cancer from two tertiary Australian hospitals. Three published prediction formulae were used to calculate TBW - TBWs developed in surgical patients, TBWca-uw and TBWca-nw developed in underweight and normal weight patients with end-stage cancer. Results There was no significant difference in the TBW estimated by the three prediction equations - TBWs 32.9 +/- 8.3 L, TBWca-nw 36.3 +/- 7.4 L, TBWca-uw 34.6 +/- 7.6 L. At a population level, there is agreement between prediction of TBW in patients with pancreatic cancer estimated from the three equations. The best combination of low bias and narrow limits of agreement was observed when TBW was estimated from the equation developed in the underweight cancer patients relative to the normal weight cancer patients. When no established BIA prediction equation exists, practitioners should utilize an equation developed in a population with similar critical characteristics such as diagnosis, weight loss, body mass index and/or age. Conclusions Further research is required to determine the accuracy of the BIA prediction technique against a reference method in patients with pancreatic cancer.

The distribution and morphological characteristics of catecholaminergic cells in the brain of monotremes as revealed by tyrosine hydroxylase immunohistochemistry

The present study describes the distribution and cellular morphology of catecholaminergic neurons in the CNS of two species of monotreme, the platypus (Ornithorhynchus anatinus) and the short-beaked echidna (Tachyglossus aculeatus). Tyrosine hydroxylase immunohistochemistry was used to visualize these neurons. The standard A1-A17, C1-C3 nomenclature was used for expediency, but the neuroanatomical names of the various nuclei have also been given. Monotremes exhibit catecholaminergic neurons in the diencephalon (All, A12, A13, A14, A15), midbrain (A8, A9, A10), rostral rhombencephalon (A5, A6, A7), and medulla (A1, A2, C1, C2). The subdivisions of these neurons are in general agreement with those of other mammals, and indeed other amniotes. Apart from minor differences, those being a lack of A4, A3, and C3 groups, the catecholaminergic system of monotremes is very similar to that of other mammals. Catecholaminergic neurons outside these nuclei, such as those reported for other mammals, were not numerous with occasional cells observed in the striatum. It seems unlikely that differences in the sleep phenomenology of monotremes, as compared to other mammals, can be explained by these differences. The similarity of this system across mammalian and amniote species underlines the evolutionary conservatism of the catecholaminergic system. Copyright (C) 2002 S. Karger AG, Basel.

Further evidence for the agreement between patients with stroke and their proxies on the Frenchay Activities Index

Objective: To determine item, subscale and total score agreement on the Frenchay Activities Index (FAI) between stroke patients and proxies six months after discharge from rehabilitation. Design: Prospective study design. Setting/subjects: Fifty patient-proxy pairs, interviewed separately, in the patient's residence. Main outcome measures: Modified FAI using 13 items. Individual FAI items, subscales and total score agreement as measured by weighted kappa and intraclass correlation coefficients (ICC). Results: Excellent agreement was found for the total FAI (ICC 0.87, 95% confidence interval (CI) 0.78-0.93), and domestic (ICC 0.85, 95% CI 0.73-0.91) and outdoor (ICC 0.87, 95% CI 0.78-0.95) subscales, with moderate agreement found for the work/leisure subscale (ICC 0.63, 95% CI 0.34-0.78). For the individual FAI items, good, moderate, fair and poor agreement was found for five, three, four and one item, respectively. The best agreement was for objective items of preparing meals, washing-up, washing clothes, shopping and driving. The poorest agreement was for participation in hobbies, social outings and heavy housework. Scoring biases associated with patient or proxy demographic characteristics were found. Female proxies, and those who were spouses, scored patients lower on domestic activities; male patients, and those who were younger, scored themselves higher on outdoor activities and higher patient FIM scores were positively correlated with higher FAI scores. Conclusions: While total and subscale agreement on the FAI was high, individual item agreement varied. Proxy scores should be used with caution due to bias.

Factores determinantes do nível de divulgação sobre instrumentos derivados de acordo com as recomendações do Basel Committee on Banking Supervision e da Organisation of Securities Commissions - evidência empírica no sector bancário português

Este estudo analisa o nível de divulgação sobre instrumentos derivados e seus factores determinantes nas entidades bancárias portuguesas. Para o efeito, foi utilizado um índice de divulgação, baseado nas recomendações emitidas pelo Basel Committee on Banking Supervision e pela Organisation of Securities Commissions, e analisados os Relatórios & Contas anuais, individuais, relativos a 2009. Conclui-se que o número de empresas que apresenta informação sobre a utilização de instrumentos derivados é bastante elevado, mas o valor médio de divulgação apresentado é bastante reduzido. Identificam-se, como factores determinantes do nível de divulgação, o tamanho da empresa, a qualidade do auditor externo e o facto de a empresa ter procedido a um aumento de capital durante o exercício económico em análise.

Grau de cumprimento com as recomendações do Basel Committee on Banking Supervision e da Organisation of Securities Commissions, sobre divulgação de informação relacionada com instrumentos derivados - evidência empírica no sector bancário português

This study analyzes the level of disclosure on derivatives, in accordance with the recommendations issued by the Basel Committee on Banking Supervision and the Organization of Securities Commission, by Portuguese banks. We have analyzed individual annual reports related to 2009, using a disclosure index based on those recommendations. We concluded that the number of companies that provides information about derivative instruments is quite high, but the average value of disclosure is very low. The information disclosed more frequently is that related to general aspects, followed by information related to accounting and valuation methods.

Estudo do grau de cumprimento com as recomendações do Basel Committee on Banking Supervision e da Organisation of Securities Commissions, sobre divulgação de informação relacionada com instrumentos derivados, pelas entidades portuguesas pertencentes ao sector bancário

Este estudo analisa o nível de divulgação sobre instrumentos derivados, de acordo com as recomendações emitidas pelo Basel Committee on Banking Supervision e pela Organisation of Securities Commissions, pelas entidades bancárias portuguesas. Para o efeito, foi utilizado um índice de divulgação e analisados os Relatórios & Contas anuais, individuais, relativos a 2009. Conclui-se que o número de empresas que apresenta informação sobre a utilização de instrumentos derivados é bastante elevado, mas o valor médio de divulgação apresentado é bastante reduzido. A informação mais divulgada é a relativa a informações gerais, seguida da informação relacionada com contabilidade e métodos de avaliação.

Pre-operative tractography of the facial nerve in vestibular schwannomas: inter-observer agreement with surgical findings

Pre-operative diffusion tensor (DT) tractography is currently employed in our institutions. We use it to predict the course of the facial nerve (FN) in the vicinity of vestibular schwannomas (VS) of the cerebellopontine angle (CPA). In this study we were interested to assess the inter-observer reproducibility of this method. Two Neuroradiologists (PMGP and TT) determined independently the location of the FN by tractography and compared the results with in-vivo findings of microsurgery of VS.

Agreement between data obtained from repeated interviews with a six-years interval

The objective of the study was to compare information collected through face-to-face interviews at first time and six years later in a city of Southeastern Brazil. In 1998, 32 mothers (N=32) of children aged 20 to 30 months answered a face-to-face interview with structured questions regarding their children's brushing habits. Six years later this same interview was repeated with the same mothers. Both interviews were compared for overall agreement, kappa and weighted kappa. Overall agreement between both interviews varied from 41 to 96%. Kappa values ranged from 0.00 to 0.65 (very bad to good) without any significant differences. The results showed lack of agreement when the same interview is conducted six years later, showing that the recall bias can be a methodological problem of interviews.

O impacto da implementação do Basel III no capital dos bancos portugueses

Este trabalho é uma análise dos efeitos da implementação das últimas recomendações do Basel Committee on Banking Supervision (BCBS) também conhecidas como o Basel III de 2010 que deverão ser faseadamente implementadas desde 1 de Janeiro de 2013 até 1 de Janeiro de 2019, no capital próprio dos bancos Portugueses. Neste trabalho assume-se que os ativos pesados pelo risco de 2012 mantêm-se constantes e o capital terá de ser aumentado segundo as recomendações ano após ano até ao fim de 2018. Com esta análise, pretende-se entender o nível de robustez do capital próprio dos bancos Portugueses e se os mesmos têm capital e reservas suficientes para satisfazer as recomendações de capital mínimo sugeridas pelo BCBS ou caso contrário, se necessitarão de novas injeções de capital ou terão de reduzir a sua atividade económica. O Basel III ainda não foi implementado em Portugal, pois a União Europeia está no processo de desenvolvimento e implementação do Credit Requirement Directive IV (CRD IV) que é uma recomendação que todos os bancos centrais dos países da zona Euro deverão impor aos respetivos bancos. Esta diretiva da União Europeia é baseada totalmente nas recomendações do Basel III e deverá ser implementada em 2014 ou nos anos seguintes. Até agora, os bancos Portugueses seguem um sistema com base no aviso 6/2010 do Banco de Portugal que recomenda o cálculo dos rácios core tier 1, tier 1 e tier 2 usando o método notações internas (IRB) de avaliação da exposição do banco aos riscos de crédito, operacional, etc. e onde os ativos ponderados pelo risco são calculados como 12,5 vezes o valor dos requisitos totais de fundos calculados pelo banco. Este método é baseado nas recomendações do Basel II que serão substituídas pelo Basel III. Dado que um dos principais motivos para a crise económica e financeira que assolou o mundo em 2007 foi a acumulação de alavancagem excessiva e gradual erosão da qualidade da base do capital próprio dos bancos, é importante analisar a posição dos bancos Portugueses, que embora não sejam muito grandes a nível global, controlam a economia do país. Espera-se que com a implementação das recomendações do Basel III não haja no futuro uma repetição dos choques sistémicos de 2007. Os resultados deste estudo usando o método padrão recomendado pelo BCBS mostram que de catorze bancos Portugueses incluídos neste estudo, apenas seis (BES, Montepio, Finantia, BIG, Invest e BIC) conseguem enquadrar nas recomendações mínimas do Basel III até 1-1- 2019 e alguns outros estão marginalmente abaixo dos rácios mínimos (CGD, Itaú e Crédito Agrícola).

Towards network-on-chip agreement protocols

Demands for functionality enhancements, cost reductions and power savings clearly suggest the introduction of multiand many-core platforms in real-time embedded systems. However, when compared to uni-core platforms, the manycores experience additional problems, namely the lack of scalable coherence mechanisms and the necessity to perform migrations. These problems have to be addressed before such systems can be considered for integration into the realtime embedded domain. We have devised several agreement protocols which solve some of the aforementioned issues. The protocols allow the applications to plan and organise their future executions both temporally and spatially (i.e. when and where the next job will be executed). Decisions can be driven by several factors, e.g. load balancing, energy savings and thermal issues. All presented protocols are analytically described, with the particular emphasis on their respective real-time behaviours and worst-case performance. The underlying assumptions are based on the multi-kernel model and the message-passing paradigm, which constitutes the communication between the interacting instances.