Context: Extracorporeal shockwave lithotripsy (SWL) is the first-line treatment for renal calculi in most cases. Recent technology has allowed lithotriptor machines to localize stones using fluoroscopy or ultrasound (US). Aim: The aim of this study is to compare stone free rates (SFR) using two techniques. Methods: This is a single center retrospective cohort study. We have studied 95 patients with renal calculi undergoing first SWL treatment with localization using US (48 pts) and fluoroscopy (47 pts). SFR was defined as fragments ≤2 m at 4 weeks post procedure on x-ray or US. Patient records were reviewed. Results: Stone size and location, age and body mass index were comparable between groups. Stones ≤7 mm had better SFR with US 86% (18/21) compared to fluoroscopy 59% (10/17) P= 0.08. Overall the US group had similar SFR to the fluoroscopy group for stones of all sizes and locations with 60% (29/48) compared to 45% (21/47)P= 0.18. Radiation exposure was the biggest difference between techniques with a mean radiation dose (mGy/cm²) in the US group of 103 (0–233) and 2113 (241–7821) in the fluoroscopy group. Radiation use in the US group was due to the use of a single shot pre- and post-procedure, this could be reduced to zero. Conclusions: Our data show equivalent outcomes using US compared to the traditional fluoroscopy localization technique. We would encourage departments to develop the use of US localization to reduce radiation exposure to patients.

For several years, international organisations including the Organisation for Economic Co-operation and Development (OECD), the World Bank, the World Customs Organization (WCO), the World Trade Organisation (WTO) and the European Union, have considered and provided recommendations on the use of information and communication technology (ICT) to enhance trade facilitation and to improve the processes of customs administrations. Now, governments, the business community and individuals are looking to improve their respective financial situation as a matter of absolute necessity during the current global economic downturn. Trade is a key ingredient to bolstering economic performance, and customs services are one component of a nation’s trading profile. Prudent management of ICT is a means to reap benefits that impact positively on the effectiveness of all customs operations, and hence the improvement of national finances. This paper provides some definitions of ICT and identifies the importance of its use in customs environments.

This paper is based on the findings of a research project that was designed to support the Australian government’s trade facilitation agenda by providing a trade stakeholder position on the development of an effective Australian single window for trade. Among other things, the Australian report examined the standards and best practices promulgated by recognised international authorities on this subject, including the World Trade Organization’s Trade Facilitation Agreement (TFA). As this was possibly the first study on single window driven by the private sector of a major developed trading country since implementation of the TFA, certain aspects of the study would seem to be relevant in the larger global context of that agreement and it is these aspects which are discussed in this paper. The paper concludes that all TFA signatories need to carefully consider their implementation priorities under the agreement. In doing so, it presents a series of conclusions from the original research that has relevance to all TFA signatory countries, regardless of their development status.

Aim: This study evaluated burden of illness in immunocompromised patients with systemic mycoses (SM) eligible for itraconazole treatment, specifically, histoplasmosis, blastomycosis and aspergillosis. Methods: A cross-sectional study used an electronic medical record network integrating information from 30 US hospitals, including >34 million patients, to evaluate burden and healthcare resource utilization over 6 months following initiation of antifungal therapy. Results: Symptomatic burden experienced by each of the otherwise healthy or age >65 or immunosuppressed cohorts receiving antifungal therapy for SM was comparable but significantly greater in cancer or HIV patients and transplant recipients. Across groups, there was substantially higher healthcare resource utilization in patients with SM versus matched controls without SM. Conclusion: The total impact of SM is particularly severe in high-risk or vulnerable populations.

The role of the World Customs Organization (WCO) in providing a mechanism for its 179 Member administrations to discuss matters of common interest and to seek solutions is outlined, including an overview of the WCO’s Integrity Program. Reference to the 1993 Arusha Declaration, and its later revised version, provides background to the WCO’s continuing efforts to combat corruption. Australian Customs and Border Protection Service’s (ACBPS) efforts to improve its corporate image through a concerted series of initiatives aimed at staff ethics, anti-corruption and other related factors are discussed. Examples are provided of the efforts being made at the international level by the WCO and at a national level by the ACBPS to divine a new and more effective approach. It is concluded that the price to be paid if integrity is to be maintained is eternal vigilance and the quest for new, more effective practices. Without integrity there can be no proper border management, no effective revenue collection and no public trust in customs agencies. The task is not simple but it remains essential for all agencies to adopt the kinds of measures outlined in this article if they are to maintain public trust.