Detection of right-to-left Atrial communication using agitated saline contrast imaging : experience with 1162 patients and recommendations for echocardiography

Background: Right-to-left shunting via a patent foramen ovale (PFO) has a recognized association with embolic events in younger patients. The use of agitated saline contrast imaging (ASCi) for detecting atrial shunting is well documented, however optimal technique is not well described. The purpose of this study is to assess the efficacy and safety of ASCi via TTE for assessment of right-to-left atrial communication in a large cohort of patients. Method: A retrospective review was undertaken of 1162 consecutive transthoracic (TTE) ASCi studies, of which 195 had also undergone clinically indicated transesophageal (TEE) echo. ASCi shunt results were compared with color flow imaging (CFI) and the role of provocative maneuvers (PM) assessed. Results: 403 TTE studies (35%) had paradoxical shunting seen during ASCi. Of these, 48% were positive with PM only. There was strong agreement between TTE ASCi and reported TEE findings (99% sensitivity, 85% specificity), with six false positive and two false negative results. In hindsight, the latter were likely due to suboptimal right atrial opacification, and the former due to transpulmonary shunting. TTE CFI was found to be insensitive (22%) for the detection of a PFO compared with TTE ASCi. Conclusions: TTE ASCi is minimally invasive and highly accurate for the detection of right-to-left atrial communication when PM are used. TTE CFI was found to be insensitive for PFO screening. It is recommended that TTE ASCi should be considered the initial diagnostic tool for the detection of PFO in clinical practice. A dedicated protocol should be followed to ensure adequate agitated saline contrast delivery and performance of provocative maneuvers.

Identity verification in conveyancing : the failure of current legislative and regulatory measures, and recommendations for change

"Defrauding land titles systems impacts upon us all. Those who deal in land include ordinary citizens, big business, small business, governments, not-for-profit organisation, deceased estates...Fraud here touches almost everybody." the thesis presented in this paper is that the current and disparate steps taken by jurisdictions to alleviate land fraud associated with identity-based crimes are inadequate. The centrepiece of the analysis is the consideration of two scenarios that have recently occurred. One is the typical scenario where a spouse forges the partner's signature to obtain a mortgage from a financial institution. The second is atypical. It involves a sophisticated overseas fraud duping many stakeholders involved in the conveyancing process. After outlining these scenarios, we will examine how identity verification requirements of the United Kingdom, Ontario, the Australian states, and New Zealand would have been applied to these two frauds. Our conclusion is that even though some jurisdictions may have prevented the frauds from occurring, the current requirements are inadequate. We use the lessons learnt to propose what we consider core principles for identity verification in land transactions.

Review of refugee mental health interventions following resettlement : best practice and recommendations

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.

Commercial vehicle pre-clearance programs : current issues and recommendations for potential implementation

The regulation of overweight trucks is of increasing importance. Quickly growing heavy vehicle volumes over-proportionally contribute to roadway damage. Raising maintenance costs and compromised road safety are also becoming a major concern to managing agencies. Minimizing pavement wear is done by regulating overloaded trucks on major highways at weigh stations. However, due to lengthy inspections and insufficient capacities, weigh stations tend to be inefficient. New practices, using Radio Frequency Identification (RFID) transponders and weigh-in-motion technologies, called preclearance programs, have been set up in a number of countries. The primary aim of this study is to investigate the current issues with regard to the implementation and operation of the preclearance program. The State of Queensland, Australia, is used as a case study. The investigation focuses on three aspects; the first emphasizes on identifying the need for improvement of the current regulation programs in Queensland. Second, the operators of existing preclearance programs are interviewed for their lessons-learned and the marketing strategies used for promoting their programs. The trucking companies in Queensland are interviewed for their experiences with the current weighing practices and attitudes toward the potential preclearance system. Finally, the estimated benefit of the preclearance program deployment in Queensland is analyzed. The penultimate part brings the former four parts together and provides the study findings and recommendations. The framework and study findings could be valuable inputs for other roadway agencies considering a similar preclearance program or looking to promote their existing ones.

Building essential BPM capabilities to assist successful ICT deployment in the developing context : observations and recommendations from Sri Lanka

The role of Information and Communications Technology (ICT) has been identified as an important factor by the United Nations in achieving the millennium development goals (UNAPCICT, 2012)1. The potential for ICT has been identified as a means to reducing poverty, creating global communities by providing access to the internet and mobile networks to rural communities, improving education services, medical services, and information availability. As of today, significant amounts of funds have been invested by the governments and donor organizations in ‘Information and Communication Technologies for Development (ICT4D)’projects by establishing telecenters, e-villages, e-health, electronic and mobile banking, and egovernment systems for citizens in general, and more specifically, rural communities to bridge the digital divide (Heeks & Molla, 2009).

Plasmodium falciparum parasites lacking histidine-rich protein 2 and 3 : a review and recommendations for accurate reporting

Malaria rapid diagnostic tests (RDTs) play a critical role in malaria case management, surveillance and case investigations. Test performance is largely determined by design and quality characteristics, such as detection sensitivity, specificity, and thermal stability. However, parasite characteristics such as variable or absent expression of antigens targeted by RDTs can also affect RDT performance. Plasmodium falciparum parasites lacking the PfHRP2 protein, the most common target antigen for detection of P. falciparum, have been reported in some regions. Therefore, accurately mapping the presence and prevalence of P. falciparum parasites lacking pfhrp2 would be an important step so that RDTs targeting alternative antigens, or microscopy, can be preferentially selected for use in such regions. Herein the available evidence and molecular basis for identifying malaria parasites lacking PfHRP2 is reviewed, and a set of recommended procedures to apply for future investigations for parasites lacking PfHRP2, is proposed.

Reproducibility of subjective appetite ratings and ad libitum test meal energy intake in overweight and obese males

Background To determine whether changes in appetite and energy intake (EI) can be detected and play a role in the effectiveness of interventions, it is necessary to identify their variability under normal conditions. We assessed the reproducibility of subjective appetite ratings and ad libitum test meal EI after a standardised pre-load in overweight and obese males. Methods Fifteen overweight and obese males (BMI 30.3 ± 4.9 kg/m2, aged 34.9 ± 10.6 years) completed two identical test days, 7 days apart. Participants were provided with a standardised fixed breakfast (1676 kJ) and 5 h later an ad libitum pasta lunch. An electronic appetite rating system was used to assess subjective ratings before and after the fixed breakfast, and periodically during the postprandial period. EI was assessed at the ad libitum lunch meal. Sample size estimates for paired design studies were calculated. Results Appetite ratings demonstrated a consistent oscillating pattern between test days, and were more reproducible for mean postprandial than fasting ratings. The correlation between ad libitum EI on the two test days was r = 0.78 (P < 0.01). Using a paired design and a power of 0.8, a minimum of 12 participants would be needed to detect a 10 mm change in 5 h postprandial mean ratings and 17 to detect a 500 kJ difference in ad libitum EI. Conclusion Intra-individual variability of appetite and ad libitum test meal EI in overweight and obese males is comparable to previous reports in normal weight adults. Sample size requirements for studies vary depending on the parameter of interest and sensitivity needed.

Sustainable grazing management for temporal and spatial variability in north Australian rangelands – a synthesis of the latest evidence and recommendations

Rainfall variability is a major challenge to sustainable grazing management in northern Australia, with management often complicated further by large, spatially-heterogeneous paddocks. This paper presents the latest grazing research and associated bio-economic modelling from northern Australia and assesses the extent to which current recommendations to manage for these issues are supported. Overall, stocking around the safe long-term carrying capacity will maintain land condition and maximise long-term profitability. However, stocking rates should be varied in a risk-averse manner as pasture availability varies between years. Periodic wet-season spelling is also essential to maintain pasture condition and allow recovery of overgrazed areas. Uneven grazing distributions can be partially managed through fencing, providing additional water-points and in some cases patch-burning, although the economics of infrastructure development are extremely context-dependent. Overall, complex multi-paddock grazing systems do not appear justified in northern Australia. Provided the key management principles outlined above are applied in an active, adaptive manner, acceptable economic and environmental outcomes will be achieved irrespective of the grazing system applied.

Drink driving among Indigenous Australians in outer regional and remote communities and development of a drink driving program: A summary of findings and recommendations

Drink driving is a leading cause of criminal justice system contact for Indigenous Australians. National and state strategies recommend Indigenous road safety initiatives are warranted. However, there is sparse evidence to inform drink driving-related preventive and treatment measures. Using quantitative and qualitative methods, the study examines the profile of Queensland’s Indigenous drink drivers using court convictions and identifies the contributing psycho-social, cultural and contextual factors through qualitative interviews.

Essays on Financial Analyst Forecasts and Recommendations

The trade of the financial analyst is currently a much-debated issue in today’s media. As a large part of the investment analysis is conducted under the broker firms’ regime, the incentives of the financial analyst and the investor do not always align. The broker firm’s commercial incentives may be to maximise its commission from securities trading and underwriting fees. The purpose of this thesis is to extend our understanding of the work of a financial analyst, the incentives he faces and how these affect his actions. The first essay investigates how the economic significance of the coverage of a particular firm impacts the analysts’ accuracy of estimation. The hypothesis is that analysts put more effort in analysing firms with a relatively higher trading volume, as these firms usually yield higher commissions. The second essay investigates how analysts interpret new financial statement information. The essay shows that analysts underreact or overreact to prior reported earnings, depending on the short-term pattern in reported earnings. The third essay investigates the possible investment value in Finnish stock recommendations, issued by sell side analysts. It is established that consensus recommendations issued on Finnish stocks contain investment value. Further, the investment value in consensus recommendations improves significantly through the exclusion of recommendations issued by banks. The fourth essay investigates investors’ behaviour prior to financial analysts’ earnings forecast revisions. Lately, the financial press have reported cases were financial analysts warn their preferred clients of possible earnings forecast revisions. However, in the light of the empirical results, it appears that the problem of analysts leaking information to some selected customers does not appear systematically on the Finnish stock market.

Impact of dust on solar photovoltaic (PV) performance: Research status, challenges and recommendations

The peaking of most oil reserves and impending climate change are critically driving the adoption of solar photovoltaic's (PV) as a sustainable renewable and eco-friendly alternative. Ongoing material research has yet to find a breakthrough in significantly raising the conversion efficiency of commercial PV modules. The installation of PV systems for optimum yield is primarily dictated by its geographic location (latitude and available solar insolation) and installation design (tilt, orientation and altitude) to maximize solar exposure. However, once these parameters have been addressed appropriately, there are other depending factors that arise in determining the system performance (efficiency and output). Dust is the lesser acknowledged factor that significantly influences the performance of the PV installations. This paper provides an appraisal on the current status of research in studying the impact of dust on PV system performance and identifies challenges to further pertinent research. A framework to understand the various factors that govern the settling/assimilation of dust and likely mitigation measures have been discussed in this paper. (C) 2010 Elsevier Ltd. All rights reserved.

South and South-East Asian coastal fisheries: their status and directions for improved management: conference synopsis and recommendations

As a step to address the problems of coastal fisheries in Asia, the WorldFish Center joined forces with fisheries agencies from eight developing Asian countries (Bangladesh, India, Indonesia, Malaysia, The Philippines, Sri Lanka, Thailand and Vietnam) and the Asian Development Bank, to implement a project entitled “Sustainable Management of Coastal Fish Stocks in Asia” (also known as the “TrawlBase” project). The project was implemented between 1998 and 2001. The main achievements of this partnership were: (a) Development of a database called “Fisheries Resource Information System and Tools” (FiRST), which contains trawl research survey data and socioeconomic information for selected fisheries, and facilitates its analysis; (b) Evaluation of the extent of resource decline and over-fishing, both biological and economic, in the region; (c) Identification of the measures needed to manage coastal fisheries in the participating countries, resulting in draft strategies and action plans; and (d) Strengthening of national capacity in coastal fisheries assessment, planning and management.