The Ottawa ankle rules for the use of diagnostic X-ray in after hours medical centres in New Zealand

Aims: The aims of this study were to measure baseline use of Ottawa ankle rules (OAR), validate the OAR and, if appropriate, explore the impact of implementing the Rules on X-ray rates in a primary care, after hours medical centre setting. Methods: General practitioners (GPs) were surveyed to find their awareness of ankle injury guidelines. Data concerning diagnosis and X-ray utilisation were collected prospectively for patients presenting with ankle injuries to two after hours medical centres. The OAR were applied retrospectively, and the sensitivity and specificity of the OAR were compared with GPs’ clinical judgement in ordering X-rays. The outcome measures were X-ray utilisation and diagnosis of fracture. Results: Awareness of the OAR was low. The sensitivity of the OAR for diagnosis of fractures was 100% (95% CI: 75.3 – 100) and the specificity was 47% (95% CI: 40.5 – 54.5). The sensitivity of GPs’ clinical judgement was 100% (95% CI: 75.3 – 100) and the specificity was 37% (95% CI: 30.2 – 44.2). Implementing the OAR would reduce X-ray utilisation by 16% (95% CI: approx 10.8 – 21.3). Conclusions: The OAR are valid in a New Zealand primary care setting. Further implementation of the rules would result in some reduction of X-rays ordered for ankle injuries, but less than the reduction found in previous studies.Accident Compensation Corporation of New ZealandOtago Universit

When you ask the fish: Child wellbeing through the eyes of Samoan children

Child wellbeing is the subject of substantial academic and policy interest globally and in New Zealand. Notably however, the voices of children are largely missing in much of the extended literature. In addition, and largely due to an assumption that wellbeing is a universally held construct, the influence of cultural values and beliefs on the perceptions and experiences of wellbeing of children, such as the Samoan children in this study, have not warranted in-depth attention. This study explores the influence of culture on how 8-year old Samoan children living in Wellington, NZ, conceptualise their wellbeing (Dunlop-Bennett, 2019). Part I of this article details the research approach developed for this study. Guided by Talanoa ile i’a (Faleolo, 2009) or ‘Talking to the Fish’, this study positioned children as experts on their wellbeing and through the use of talanoa and photos successfully created the reflective discussion space for 11 Samoan children to share their knowledge. The findings, outlined in Part II, show that when given the opportunity, these Samoan children offered critical and realistic insights into their experiences and aspirations. One model of wellbeing shared by these children used the analogy of a seesaw, where wellbeing was achieved when the “good bits and the bad bits” are balanced. The influence of context of wellbeing was a second key finding. These Samoan children’s experiences of wellbeing indicated a subtle interplay and balancing of their fa’asamoa (the Samoan way) and New Zealand life experiences. While this ethnic-specific study does not purport to represent the diversity of the Samoan diaspora, it presents a model that can be adapted by the Samoan diaspora living in other parts of New Zealand as well as other Pasifika and minority groups, as appropriate

Discovery of Novel Adenosine Receptor Agonists That Exhibit Subtype Selectivity.

A series of N(6)-bicyclic and N(6)-(2-hydroxy)cyclopentyl derivatives of adenosine were synthesized as novel A1R agonists and their A1R/A2R selectivity assessed using a simple yeast screening platform. We observed that the most selective, high potency ligands were achieved through N(6)-adamantyl substitution in combination with 5'-N-ethylcarboxamido or 5'-hydroxymethyl groups. In addition, we determined that 5'-(2-fluoro)thiophenyl derivatives all failed to generate a signaling response despite showing an interaction with the A1R. Some selected compounds were also tested on A1R and A3R in mammalian cells revealing that four of them are entirely A1R-selective agonists. By using in silico homology modeling and ligand docking, we provide insight into their mechanisms of recognition and activation of the A1R. We believe that given the broad tissue distribution, but contrasting signaling profiles, of adenosine receptor subtypes, these compounds might have therapeutic potential.This study was supported by the Swiss National Science Foundation (SNSF professorship PP00P2_123536 and PP00P2_146321 to M.L.), the BBSRC (G.L., BB/G01227X/1 and BB/M00015X/1), an MRC Doctoral Training Partnership (I.W. MR/J003964/1), and the EPSRC (A.K., EP/G500045/1).This is the author accepted manuscript. The final version is available from the American Chemical Society via http://dx.doi.org/10.1021/acs.jmedchem.5b0140

Recognition of physical and psychological symptoms: no influence of GP demographic factors

AIM: To describe the relationship between general practitioner demographic factors and the recognition of psychological and physical symptoms in consultation. METHODS: A survey of a random sample of 70 GPs and their patients (n=3414) from the lower North Island of New Zealand. RESULTS: No relationship was found between GP personal and practice demographic characteristics and GP identification of psychological and physical symptoms. Patients were more likely not to present psychological symptoms (62%) than not present physical symptoms (5%) in consultation. Thirteen percent of GPs wanted more formal psychiatric training, 45% wanted more contact time in consultation, and 72% thought that cost was a barrier to patients attending. No significant relationship was found between these factors and GP detection of significant psychological symptoms in consultation. DISCUSSION: Personal and practice demographics of GPs may not predict their ability to detect physical and psychological symptoms. More research is needed to explore these findings which contradict previous work

SWCam: the short wavelength camera for the CCAT Observatory

We describe the Short Wavelength Camera (SWCam) for the CCAT observatory including the primary science drivers, the coupling of the science drivers to the instrument requirements, the resulting implementation of the design, and its performance expectations at first light. CCAT is a 25 m submillimeter telescope planned to operate at 5600 meters, near the summit of Cerro Chajnantor in the Atacama Desert in northern Chile. CCAT is designed to give a total wave front error of 12.5 μm rms, so that combined with its high and exceptionally dry site, the facility will provide unsurpassed point source sensitivity deep into the short submillimeter bands to wavelengths as short as the 200 μm telluric window. The SWCam system consists of 7 sub-cameras that address 4 different telluric windows: 4 subcameras at 350 μm, 1 at 450 μm, 1 at 850 μm, and 1 at 2 mm wavelength. Each sub-camera has a 6’ diameter field of view, so that the total instantaneous field of view for SWCam is equivalent to a 16’ diameter circle. Each focal plane is populated with near unit filling factor arrays of Lumped Element Kinetic Inductance Detectors (LEKIDs) with pixels scaled to subtend an solid angle of (λ/D)2 on the sky. The total pixel count is 57,160. We expect background limited performance at each wavelength, and to be able to map < 35(°)2 of sky to 5 σ on the confusion noise at each wavelength per year with this first light instrument. Our primary science goal is to resolve the Cosmic Far-IR Background (CIRB) in our four colors so that we may explore the star and galaxy formation history of the Universe extending to within 500 million years of the Big Bang. CCAT's large and high-accuracy aperture, its fast slewing speed, use of instruments with large format arrays, and being located at a superb site enables mapping speeds of up to three orders of magnitude larger than contemporary or near future facilities and makes it uniquely sensitive, especially in the short submm bands

Detailed modelling of a large sample of Herschel sources in the Lockman Hole: identification of cold dust and of lensing candidates through their anomalous SEDs

We have studied in detail a sample of 967 SPIRE sources with 5σ detections at 350 and 500 μm and associations with Spitzer-SWIRE 24 μm galaxies in the HerMES-Lockman survey area, fitting theirmid- and far-infrared, and submillimetre, spectral energy distributions (SEDs) in an automatic search with a set of six infrared templates. For almost 300 galaxies,we havemodelled their SEDs individually to ensure the physicality of the fits. We confirm the need for the new cool and cold cirrus templates, and also of the young starburst template, introduced in earlier work. We also identify 109 lensing candidates via their anomalous SEDs and provide a set of colour–redshift constraints which allow lensing candidates to be identified from combined Herschel and Spitzer data. The picture that emerges of the submillimetre galaxy population is complex, comprising ultraluminous and hyperluminous starbursts, lower luminosity galaxies dominated by interstellar dust emission, lensed galaxies and galaxies with surprisingly cold (10–13 K) dust. 11 per cent of 500 μm selected sources are lensing candidates. 70 per cent of the unlensed sources are ultraluminous infrared galaxies and 26 per cent are hyperluminous. 34 per cent are dominated by optically thin interstellar dust (‘cirrus’) emission, but most of these are due to cooler dust than is characteristic of our Galaxy. At the highest infrared luminosities we see SEDs dominated by M82, Arp 220 and young starburst types, in roughly equal proportions