What price advice?

"Ever time you brush our teeth; every time you fill our petrol tank; every time you shop at the supermarket virtually every time that you spend money - somebody is making money. Why not share in the profits they make off you?" That sentence was the injection of my passion for equities 40 years ago.peer-reviewe

Assessment and modelling of chiropractic and allied healthcare in Australia: Background and need for a formal investigation

There is need for a detailed investigation on the availability and impact of chiropractic and allied healthcare services, on healthcare choice and healthcare costs, as well as the delivery and spatial distribution of chiropractors in Australia. The goal of this paper is to discuss the background and to propose our intent to conduct an interdisciplinary assessment and modelling of the determinant factors of adoption of healthcare choices in Australia. Due to the highly complex nature of selecting a healthcare choice amongst available alternatives in today's world, it has been decided to design a research project using a new and innovative approach to the study of knowledge and knowledge systems in a social group. It was determined that the theory base of social interpretation of knowledge and knowledge implementation and change will drive this study. the study design will entail mixed methods including surveys, extensive document review, and a series of interviews of key stakeholders in the allied health professions within Australia. Studies such as this have potential to guide the planning process for federal and state governance bodies in chiropractic, in facilitating consumer choice between alternatives in healthcare. the knowledge gained through this study can drive healthcare change into the 21st century with chiropractic as a potential change agent

Demographic characteristics and perceptions of supply and demand of chiropractic services in Australia: Results from stage 1 of the work force study survey

Objectives: The aim of this report is to describe the demographic characteristics including the age profile, gender differences, income and perceptions of supply and demand of the chiropractic profession in Australia. This workforce study (WFS) was divided into three components, Australian Chiropractors (Stage 1), their patients (Stage 2), and members of the general public (Stage 3). Methods: A web-based, 64-item, cross-sectional survey questionnaire was issued to registered chiropractors (CAA and non-CAA members) throughout Australia in 2010. At the time of the survey there were 3,892 registered chiropractors. Survey invitations were sent to those who were registered chiropractors, and had provided email addresses (n=1,917). Results: Demographic Characteristics: There is evidence to suggest that the profession may be becoming increasingly female over time. Income exclusively from chiropractic care included 27.9% who reported an annual pre-tax net income of $115,000 or less and 32.3$115,000. Of the latter group, 12% indicated that they were earning more than $215,000. Income was not related to the hours worked per week particularly for males. Supply and Demand: When considering their home state and their local region, more chiropractors thought that there was undersupply in their state, but an adequate supply in their local region. A large proportion (40%) of the sample felt that universities in Australia were graduating the correct number of chiropractors per year, and 32% reported that too many were being produced in Australia. Very few reported that the Universities were not graduating enough chiropractors. Conclusion: This paper reflects some of the findings from Stage 1 of the three stage Workforce study, showing a profession heading towards a more even gender balance and characterised by a higher than average annual income. Future research should include the impact on supply and demand of the possibility of an increasingly female profession. In addition to this, although there is a perception that there is under-utilisation of chiropractic services in inland, rural and remote areas, the extent of which should be further explored. Information from this study will assist with strategic decision making and planning. A strategic framework for the profession should not only consider the findings from this study but also explore other factors that may have an impact on supply and demand, for example general trends in health and aging from local and national government reports

Chronic recurrent ankle sprain: A randomized clinical trial studying the impact of two treatment protocols

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Failure Under Stress: The Effect of the Exotic Herbivore \u3cem\u3eAdelges tsugae\u3c/em\u3e on Biomechanics of \u3cem\u3eTsuga canadensis\u3c/em\u3e

Background and Aims Exotic herbivores that lack a coevolutionary history with their host plants can benefit from poorly adapted host defences, potentially leading to rapid population growth of the herbivore and severe damage to its plant hosts. The hemlock woolly adelgid (Adelges tsugae) is an exotic hemipteran that feeds on the long-lived conifer eastern hemlock (Tsuga canadensis), causing rapid mortality of infested trees. While the mechanism of this mortality is unknown, evidence indicates that A. tsugae feeding causes a hypersensitive response and alters wood anatomy. This study investigated the effect of A. tsugae feeding on biomechanical properties at different spatial scales: needles, twigs and branches. Methods Uninfested and A. tsugae-infested samples were collected from a common garden experiment as well as from naturally infested urban and rural field sites. Tension and flexure mechanical tests were used to quantify biomechanical properties of the different tissues. In tissues that showed a significant effect of herbivory, the potential contributions of lignin and tissue density on the results were quantified. Key Results Adelges tsugae infestation decreased the abscission strength, but not flexibility, of needles. A. tsugae feeding also decreased mechanical strength and flexibility in currently attacked twigs, but this effect disappeared in older, previously attacked branches. Lignin and twig tissue density contributed to differences in mechanical strength but were not affected by insect treatment. Conclusions Decreased strength and flexibility in twigs, along with decreased needle strength, suggest that infested trees experience resource stress. Altered growth patterns and cell wall chemistry probably contribute to these mechanical effects. Consistent site effects emphasize the role of environmental variation in mechanical traits. The mechanical changes measured here may increase susceptibility to abiotic physical stressors in hemlocks colonized by A. tsugae. Thus, the interaction between herbivore and physical stresses is probably accelerating the decline of eastern hemlock, as HWA continues to expand its range

Systemic inflammation in COPD is not influenced by pulmonary rehabilitation

Purpose: Pulmonary rehabilitation is known to lead to improvements in exercise tolerance, health-related quality of life and help reduce symptoms. Exercise, one of the largest components of such an intervention, although of great benefit, can increase the inflammatory response related to chronic obstructive pulmonary disease, depending on intensity and duration. Through this study, the effects of a 12week, high-intensity PR programme on COPD inflammatory-related markers were investigated. Materials and methods: This study is a longitudinal, observational type of study. Sixty COPD patients were enrolled, 49 of which completed the programme. A 2-h high-intensity PR programme was delivered, twice weekly for 12 weeks. The following markers were assessed at baseline, 4, 8 and 12 weeks through rehabilitation – C-reactive protein, erythrocyte sedimentation rate, neutrophil, eosinophil counts, complete blood count, six-minute walk test and St. George’s Respiratory Questionnaire. Serum amyloid A levels were assessed at baseline, week 8 and 12 and exhaled NO at baseline and upon completion of the programme. Results: This 12-week PR programme resulted in no changes in the inflammatory markers but resulted in significant improvements in both the 6MW distance and health quality of life. Conclusions: Beneficial effects on functional and HRQoL measures resulted, which, however, appear unrelated to changes in the systemic inflammatory markers.peer-reviewe

Right atrial area and right ventricular outflow tract akinetic length predict sustained tachyarrhythmia in repaired tetralogy of Fallot

AIMS: Repaired tetralogy of Fallot (rtoF) patients are at risk of atrial or ventricular tachyarrhythmia and sudden cardiac death. Risk stratification for arrhythmia remains difficult. We investigated whether cardiac anatomy and function predict arrhythmia. METHODS: One-hundred-and-fifty-four adults with rtoF, median age 30.8 (21.9–40.2) years, were studied with a standardised protocol including cardiovascular magnetic resonance (CMR) and prospectively followed up over median 5.6 (4.6–7.0) years for the pre-specified endpoints of new-onset atrial or ventricular tachyarrhythmia (sustained ventricular tachycardia/ventricular fibrillation). RESULTS: Atrial tachyarrhythmia (n = 11) was predicted by maximal right atrial area indexed to body surface area (RAAi) on four-chamber cine-CMR (Hazard ratio 1.17, 95% Confidence Interval 1.07–1.28 per cm(2)/m(2); p = 0.0005, survival receiver operating curve; ROC analysis, area under curve; AUC 0.74 [0.66–0.81]; cut-off value 16 cm(2)/m(2)). Atrial arrhythmia-free survival was reduced in patients with RAAi ≥ 16 cm(2)/m(2) (logrank p = 0.0001). Right ventricular (RV) restrictive physiology on echocardiography (n = 38) related to higher RAAi (p = 0.02) and had similar RV dilatation compared with remaining patients. Ventricular arrhythmia (n = 9) was predicted by CMR RV outflow tract (RVOT) akinetic area length (Hazard ratio 1.05, 95% Confidence Interval 1.01–1.09 per mm; p = 0.003, survival ROC analysis, AUC 0.77 [0.83–0.61]; cut-off value 30 mm) and decreased RV ejection fraction (Hazard ratio 0.93, 95% Confidence Interval 0.87–0.99 per %; p = 0.03). Ventricular arrhythmia-free survival was reduced in patients with RVOT akinetic region length > 30 mm (logrank p = 0.02). CONCLUSION: RAAi predicts atrial arrhythmia and RVOT akinetic region length predicts ventricular arrhythmia in late follow-up of rtoF. These are simple, feasible measurements for inclusion in serial surveillance and risk stratification of rtoF patients

TCRγ-Chain Gene Rearrangement by PCR-Based GeneScan: Diagnostic Accuracy Improvement and Clonal Heterogeneity Analysis in Multiple Cutaneous T-Cell Lymphoma Samples

Cutaneous T-cell lymphomas are a heterogeneous group of lymphomas where the tumor population emerges within a multiple subclone pattern (“clonal heterogeneity”). PCR analysis has been shown to be useful in the diagnosis of mycosis fungoides (MF) and Sézary Syndrome (SS). Focusing the attention on clonal heterogeneity, the efficacy of the multiplex/heteroduplex (HD) PCR and the GeneScan (GS) capillary electrophoresis analysis was compared in the early diagnosis of MF/SS, using a multiple sample approach. Indeed, GS demonstrated TCRγ gene rearrangement (GR) in all the 57 SS (100%) and in 123/146 (84%) of the MF samples, whereas the multiplex/HD PCR was less sensitive. An increase in clonality was observed in connection with both a worsening of the cutaneous disease (79% T1/T2; 100% T3/T4) and an increase in the histopathological score (HS<5, 76%; HS≥5, 94%). Clonal heterogeneity with adjunctive reproducible skin TCRγ-GRs was also observed. “Clonal instability,” with different GRs, was present in a small percentage of patients. Therefore, it can be concluded that GS analysis in TCRγ-GR is able to improve diagnosis in MF/SS patients and the multiple sample approach is helpful for a correct interpretation of clonal patterns in skin lesions, especially in early-stage MF and in SS skin/blood samples

Empowering Responsible Online Gambling by Real-time Persuasive Information Systems

Online gambling, unlike other mediums of problem- atic and addictive behaviours, such as tobacco and alcohol, offers unprecedented opportunities for building information systems that are able to monitor and understand a user’s behaviour in real-time and adapt persuasive messages and interactions that would fit their personal profile and usage context. Online gambling industry usually provides Application Programming Interfaces (APIs) meant mainly to enable third-party applications to network with their gambling services and enhance a user’s gambling experience. In this industrial practice and experience paper, we advocate that such API’s can also be used to retrieve gamblers’ online data, such as browsing and betting history, promotions and available offers and use it to build more intel- ligent and proactive responsible gambling information systems. We report on our industrial experience in this field and make the argument that data available for persuasive marketing and usability should, under specific usage conditions, also be made available for responsible gambling information systems. This principle would provide equal opportunities for both directions. We discuss the psychological foundations of our proposed solution and the risks and challenges typically found when building such a software-assisted intervention, persuasion and emotion regulation technology. We also shed light on its potential implications from the perspectives of social corporate responsibility and data protection. We finally propose a conceptual architecture to demonstrate our vision and explain how it can be implemented. In the wider context, the paper is meant to provide insights on building behavioural awareness and regulation information systems in relation to problematic digital media usage

High platelet reactivity in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Randomised controlled trial comparing prasugrel and clopidogrel

Background: Prasugrel is more effective than clopidogrel in reducing platelet aggregation in acute coronary syndromes. Data available on prasugrel reloading in clopidogrel treated patients with high residual platelet reactivity (HRPR) i.e. poor responders, is limited. Objectives: To determine the effects of prasugrel loading on platelet function in patients on clopidogrel and high platelet reactivity undergoing percutaneous coronary intervention for acute coronary syndrome (ACS). Patients: Patients with ACS on clopidogrel who were scheduled for PCI found to have a platelet reactivity ≥40 AUC with the Multiplate Analyzer, i.e. “poor responders” were randomised to prasugrel (60 mg loading and 10 mg maintenance dose) or clopidogrel (600 mg reloading and 150 mg maintenance dose). The primary outcome measure was proportion of patients with platelet reactivity <40 AUC 4 hours after loading with study medication, and also at one hour (secondary outcome). 44 patients were enrolled and the study was terminated early as clopidogrel use decreased sharply due to introduction of newer P2Y12 inhibitors. Results: At 4 hours after study medication 100% of patients treated with prasugrel compared to 91% of those treated with clopidogrel had platelet reactivity <40 AUC (p = 0.49), while at 1 hour the proportions were 95% and 64% respectively (p = 0.02). Mean platelet reactivity at 4 and 1 hours after study medication in prasugrel and clopidogrel groups respectively were 12 versus 22 (p = 0.005) and 19 versus 34 (p = 0.01) respectively. Conclusions: Routine platelet function testing identifies patients with high residual platelet reactivity (“poor responders”) on clopidogrel. A strategy of prasugrel rather than clopidogrel reloading results in earlier and more sustained suppression of platelet reactivity. Future trials need to identify if this translates into clinical benefit