Regional Business Cycles in New Zealand: Do they exist? What Might Drive Them?

We use National Bank of New Zealand Regional Economic Activity data, to identify and characterise classical business cycle turning points, for New Zealand’s 14 regions and aggregate New Zealand activity. Using Concordance statistic measures, logistic model and GMM estimation methods, meaningful regional business cycles have been identified and a number of significant associations established. All regions exhibit cyclical asymmetry for both durations and amplitudes, and synchronisations between aggregate NZ activity and each region are contemporaneous. The regional cycles rarely die of old age but are terminated by particular events. The regions most highly synchronised with the NZ activity cycle are Auckland, Canterbury, and Nelson-Marlborough; those least so are Gisborne and Southland. Noticeably strong co-movements are evident for certain regions. Geographical proximity matters, and unusually dry conditions can be associated with cyclical downturns in certain regions. There is no discernable evidence of association with net immigration movements, and no significant evidence of regional cycle movements being associated with real house price cycles. The agriculture-based nature of the New Zealand economy is highlighted by the strong influence of external economic shocks on rural economic performance. In particular, there is considerable evidence of certain regional cycles being associated with movements in New Zealand’s aggregate terms of trade, real prices of milksolids, real dairy land prices and total rural land prices. JEL Classification: C22, E32, R11, R12, R15 Keywords: Classical business cycle; Turning Points; Regional business cycles; Concordance statistics; New Zealan

Starting and Sustaining an Extracorporeal Membrane Oxygenation Program

The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly in all patient populations, especially adults for both acute lung or heart failure. ECMO is a complex, high risk, resource-intense, expensive modality that requires appropriate planning, training, and management for successful outcomes. This article provides an optimal approach and the basic framework for initiating a new ECMO program, which can be tailored to meet local needs. Setting up a new ECMO program and sustaining it requires institutional commitment, physician champions, multidisciplinary team involvement, ongoing training, and education of the ECMO team personnel and a robust quality assurance program to minimize complications and improve outcomes

Development and validation of metrics for assessment of ultrasound-guided fascial block skills

IntroductionLumbar disc surgery is painful. Few anaesthetists provide lumbar erector spinae block fordisc surgery and a need arises to provide training in order to conduct a randomisedcontrolled investigating pain relief after spinal surgery (NIHR153170).MethodsThe primary objective of the study was to measure the construct validity of a checklist forassessment of skills while performing lumbar and thoracic erector spinae fascial planeinjection in soft embalmed Thiel cadavers. Our secondary objectives were to assess the:construct validity of a global rating scale; construct validity of pectoral, serratus and fasciailiaca blocks in the same cadavers; correlation between the checklist and global rating scale;identify the most important checklist items and measure the variability of our observations.Twenty-four UK consultant regional anaesthetists completed two iterations of a Delphiquestionnaire. The final checklist consisted of 11 steps conducive to best practice. Thereafter,we validated the checklist by comparing the performance of 12 experts with 12 novices, eachperforming lumbar and thoracic ESP injections; fascia iliaca, serrato-pectoral (PEC II) andserratus injections, randomly allocated to the left and right sides of 6 soft embalmed Thielcadavers. Six expert, trained raters blinded to operator and site of block examined 120 videoseach.ResultsThe mean (95%CI:) internal consistency of the 11-item checklist for ESP injection was 0.72(0.63 – 0.79) and interclass correlation was 0.88 (0.82 – 0.93)The checklist showed construct validity for lumbar and thoracic erector spinae injection,experts vs novices (median (IQR [range]) 8.0 (7.0 to 10.0 [1 to 11]) vs 7.0 (5.0 to 9.0 [4 to 11]),difference 1.5 (1.0 to 2.5) P < 0.001). Global rating scales showed construct validity forlumbar and thoracic erector spinae injection, 28.0 (24.0 to 31.0 [7 to 35]) vs 21.0 (17.0 to24.0 [7 to 35]), difference 7.5 (6.0 to 8.5), P < 0.001.The most difficult items to perform were: identifying the needle tip before advancing theneedle and always visualising the needle tip. Instrument handling and flow of procedurewere the areas of greatest difficulty on the Global Rating Scale. Checklists and GRS scorescorrelated. There was homogeneity of regression slopes controlling for status, type ofinjection and rater. Generalizability analysis showed a high reliability using the checklist andGRS for all fascial plane blocks [(Rho (ρ2) 0.93-0.96): Phi (ϕ) (0.84 – 0.87)].ConclusionsWe showed construct validity of an 11-point checklist for fascial plane injection