Te Aka Roa o Te Oranga, the far reaching vines of wellness: The development of a framework to evaluate alcohol and drug treatment for Māori

The impact of alcohol and other drug problems for Māori is well documented. Substance use has been implicated in a range of physical and mental health problems, and a variety of negative social statistics such as high rates of imprisonment. To date there has been little systematic documentation of treatment practices, and limited operationalisation of Māori health frameworks. The evaluation of the outcomes of alcohol and other drug treatments is an area in which there is a paucity of documentation, in terms of methods and frameworks for evaluation, and actual data. Te Aka Roa O Te Oranga (TAROTO) was developed from a range of projects undertaken by the National Addiction Centre. The TARATO evaluation framework embraces a holistic perspective: developed to examine the interaction between the client, whānau, practitioner, and service/organisation. The aim of the framework is to clarify the complex relationships and interactions between stakeholders within the context of treatment. It will also help to elucidate the strengths and weaknesses of individual services. Within this framework, a range of indicators and outcomes of “successful treatment” will be explored. The current project is the first phase of a broader project that will make a significant contribution to improvements in Māori health via further developing effective treatments of alcohol and other drug related problems

Does venous thromboembolism prophylaxis affect the risk of venous thromboembolism and adverse events following primary hip and knee replacement?:A retrospective cohort study

BACKGROUND: The optimum chemical venous thromboembolism (VTE) prophylactic agents following total hip and knee replacement (THR and TKR) remain unknown. NICE recommends multiple agents, including direct oral anticoagulants (DOACs), low-molecular weight heparin (LMWH), and aspirin. We assessed whether VTE prophylaxis affected the risk of VTE and adverse events following primary THR and TKR. MATERIALS AND METHODS: We reviewed 982 elective primary THRs (59%) and TKRs (41%) at a large tertiary centre during 2018. The primary outcome was any VTE (DVT and/or PE) within 90-days. Secondary outcomes were adverse events within 90-days (major bleeding and wound complications). The association between VTE prophylaxis and outcomes was assessed. RESULTS: The overall prevalence of VTE and adverse events were 2.7% (n = 27) and 15.2% (n = 136) respectively. The most common agents used were DOAC ± LMWH (50.7%, n = 498), followed by aspirin ± LMWH (35.5%, n = 349) and LMWH alone (4.7%, n = 46). The risk of VTE (aspirin ± LMWH = 3.7%, DOAC = 2.0%, LMWH = 2.2%) was not significantly different between agents (p = 0.294). The risk of any adverse event was significantly higher (p < 0.001) with aspirin ± LMWH (16.1%; n = 56) and LMWH (28.3%; n = 13) compared with DOACs ± LMWH (7.0%; n = 35) in TKRs only, there was no differences between agents for adverse events in THRs (p = 0.644). CONCLUSIONS: Choice of thromboprophylaxis did not influence the risk of VTE following primary THR and TKR. DOACs (+/− LMWH) were associated with the lowest risk of adverse events. Large multicentre trials are still needed to assess the efficacy and safety of these agents following THR and TKR

Psychosocial Determinants of Health in Recreational, Tactical, and Competitive Athletes: Implications for Physical Therapists

Neuromusculoskeletal (NMSK) injuries are ubiquitous in recreational, tactical, and competitive athletes. Many athletes who sustain a NMSK injury progress to develop chronic conditions that can limit physical activity and result in substantial long-term disability. Both social and psychological factors may drive care-seeking and treatment compliance following NMSK injury, as well as contribute to the chronification of injury. In turn, each of these factors could result in long-term cardiovascular consequences that contribute to morbidity and mortality over a lifetime. Physical therapists have a professional duty to work in communities, operational military units, and in competitive athletic programs to increase accessibility, foster care-seeking behaviors, and mitigate potential long-term consequences following NMSK injury. All practitioners should be aware that successful rehabilitation includes consideration of many complex biopsychosocial, technical, and operational factors. In this educational session, we will discuss the unique psychological and social determinants of health in recreational, tactical, and competitive athletes. This session will include specific suggestions about techniques physical therapists can employ to facilitate care-seeking following NMSK injury

Climate Science, Development Practice, and Policy Interactions in Dryland Agroecological Systems

The literature on drought, livelihoods, and poverty suggests that dryland residents are especially vulnerable to climate change. However, assessing this vulnerability and sharing lessons between dryland communities on how to reduce vulnerability has proven difficult because of multiple definitions of vulnerability, complexities in quantification, and the temporal and spatial variability inherent in dryland agroecological systems. In this closing editorial, we review how we have addressed these challenges through a series of structured, multiscale, and interdisciplinary vulnerability assessment case studies from drylands in West Africa, southern Africa, Mediterranean Europe, Asia, and Latin America. These case studies adopt a common vulnerability framework but employ different approaches to measuring and assessing vulnerability. By comparing methods and results across these cases, we draw out the following key lessons: (1) Our studies show the utility of using consistent conceptual frameworks for vulnerability assessments even when quite different methodological approaches are taken; (2) Utilizing narratives and scenarios to capture the dynamics of dryland agroecological systems shows that vulnerability to climate change may depend more on access to financial, political, and institutional assets than to exposure to environmental change; (3) Our analysis shows that although the results of quantitative models seem authoritative, they may be treated too literally as predictions of the future by policy makers looking for evidence to support different strategies. In conclusion, we acknowledge there is a healthy tension between bottom-up/ qualitative/place-based approaches and top-down/quantitative/generalizable approaches, and we encourage researchers from different disciplines with different disciplinary languages, to talk, collaborate, and engage effectively with each other and with stakeholders at all levels

Quantifying inhomogeneity in fractal sets

An inhomogeneous fractal set is one which exhibits different scaling behaviour at different points. The Assouad dimension of a set is a quantity which finds the ‘most difficult location and scale’ at which to cover the set and its difference from box dimension can be thought of as a first-level overall measure of how inhomogeneous the set is. For the next level of analysis, we develop a quantitative theory of inhomogeneity by considering the measure of the set of points around which the set exhibits a given level of inhomogeneity at a certain scale. For a set of examples, a family of ( ×m, ×n )-invariant subsets of the 2-torus, we show that this quantity satisfies a Large Deviations Principle. We compare members of this family, demonstrating how the rate function gives us a deeper understanding of their inhomogeneity.PostprintPeer reviewe

Supplementing Dairy Cows in Late Lactation With High Quality Silages

Agriculture on the Canterbury Plains of New Zealand is a mixture of integrated cropping and pastoral enterprises. Cropping farmers often provide supplementary feed for dairy farmers by growing forages for high quality silage. Such silages can improve milk production by increasing dry matter (DM) intake and/or by alleviating deficiencies of either soluble carbohydrate or protein in pasture (Woodward et al., 2002). Legumes and/or cereals have potential to make large quantities of high quality silage (de Ruiter et al., 2002). This trial aimed to determine milk production and composition differences between three silages fed during late lactation

Community cleavages: gay and bisexual men's perceptions of gay and mainstream community acceptance in the post-AIDS, post-rights era

Changes in gay and bisexual men's connectedness to the gay community are related to the declining public visibility of HIV/AIDS and greater acceptance for homosexuality and bisexuality in mainstream society. Little work, however, has focused on perceived acceptance for subgroups within the gay community or broader society. Using interviews (n = 20) and a survey (n = 202) of gay and bisexual men in a mid-sized Canadian city, we find perceived hierarchies of acceptance for the various subgroups as well as an age effect wherein middle-aged men perceive the least acceptance for all groups. These differences are linked with the uneven impact of social, political, and institutional changes relevant to gay and bisexual men in Canada