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

The Biodiversity Forecasting Toolkit: Answering the ‘how much’, ‘what’, and ‘where’ of planning for biodiversity persistence

AbstractThis research reports on a new approach to conservation assessment that seeks to extend the target-based model traditionally underpinning systematic conservation planning. The Biodiversity Forecasting Tool (BFT) helps answer three important questions relating to regional biodiversity persistence: ‘how much’ biodiversity can persist for a given land-management scenario; ‘what’ habitats to focus conservation effort on; and ‘where’ in the landscape to undertake conservation action. The tool integrates fine-scaled variability in vegetation composition and structure with spatial context, which is critical for ensuring the viability of populations. Thus, a raster data framework is employed which deems each location or gridcell in a landscape as contributing to biodiversity benefits to various degrees. At its simplest, just two spatial inputs, vegetation community types and vegetation condition, are needed. Drawing on, as a case-study, a broad-scale biodiversity assessment for NSW, Australia, this paper reports on the successful application of the BFT tool for a variety of functions ranging from interactive scenario evaluation through to conservation benefits mapping

The Biodiversity Forecasting Toolkit: Answering the ‘how much’, ‘what’, and ‘where’ of planning for biodiversity persistence

AbstractThis research reports on a new approach to conservation assessment that seeks to extend the target-based model traditionally underpinning systematic conservation planning. The Biodiversity Forecasting Tool (BFT) helps answer three important questions relating to regional biodiversity persistence: ‘how much’ biodiversity can persist for a given land-management scenario; ‘what’ habitats to focus conservation effort on; and ‘where’ in the landscape to undertake conservation action. The tool integrates fine-scaled variability in vegetation composition and structure with spatial context, which is critical for ensuring the viability of populations. Thus, a raster data framework is employed which deems each location or gridcell in a landscape as contributing to biodiversity benefits to various degrees. At its simplest, just two spatial inputs, vegetation community types and vegetation condition, are needed. Drawing on, as a case-study, a broad-scale biodiversity assessment for NSW, Australia, this paper reports on the successful application of the BFT tool for a variety of functions ranging from interactive scenario evaluation through to conservation benefits mapping

Pressure-induced inclusion of neon in the crystal structure of a molecular Cu2(pacman) complex at 4.67 GPa

Crystals of a Cu complex of the macrocyclic Schiff-base calixpyrrole or 'Pacman' ligand, Cu2(L), do not contain any solvent-accessible void space at ambient pressure, but adsorb neon at 4.67 GPa, forming Cu2(L)·3.5Ne

Analysing Recent Socioeconomic Trends in Coronary Heart Disease Mortality in England, 2000–2007: A Population Modelling Study

A modeling study conducted by Madhavi Bajekal and colleagues estimates the extent to which specific risk factors and changes in uptake of treatment contributed to the declines in coronary heart disease mortality in England between 2000 and 2007, across and within socioeconomic groups

Methods to promote equity in health resource allocation in low- and middle-income countries : an overview

Unfair differences in healthcare access, utilisation, quality or health outcomes exist between and within countries around the world. Improving health equity is a stated objective for many governments and international organizations. We provide an overview of the major tools that have been developed to measure, evaluate and promote health equity, along with the data required to operationalise them. Methods are organised into four key policy questions facing decision-makers: (i) what is the current level of inequity in health; (ii) does government health expenditure benefit the worst-off; (iii) can government health expenditure more effectively promote equity; and (iv) which interventions provide the best value for money in reducing inequity. Benefit incidence analysis can be used to estimate the distribution of current public health sector expenditure, with geographical resource allocation formulae and health system reform being the main government policy levers for improving equity. Techniques from the economic evaluation literature, such as extended and distributional cost-effectiveness analysis can be used to identify ‘best buy’ interventions from a health equity perspective. A range of inequality metrics, from gap measures and slope indices to concentration indices and regression analysis, can be applied to these approaches to evaluate changes in equity. Methods from the economics literature can provide policymakers with a toolkit for addressing multiple aspects of health equity, from outcomes to financial protection, and can be adapted to accommodate data commonly available in low- and middle-income settings

Holographic Walking Technicolor and Stability of Techni-Branes

Techni-fermions are added as stacks of D7-anti-D7 techni-branes within the framework of a holographic technicolor model that has been proposed as a realization of walking technicolor. The stability of the embedding of these branes is determined. When a sufficiently low bulk cut-off is provided the fluctuations remain small. For a longer walking region, as would be required in any realistic model of electroweak symmetry breaking, a larger bulk cut-off is needed and in this case the oscillations destabilize.Comment: Latex, 25 pages, 10 figure

Improving quality through clinical governance in primary health care

Ensuring health care that is safe and of high quality is as much a priority for the primary care sector as it is for hospitals. The National Health and Hospital Reform Commission has made a number of recommendations which foreground the need for accountable services that have overarching quality improvement systems. However, attempts to integrate quality assurance and improvement programs into the everyday work of the Australian primary care sector must contend with the diversity of service types, the lack of systematised communication within and between these service types, and variation of managerial structures. This review explores clinical governance, a systematic and integrated approach to ensuring services are accountable for delivering quality services. Clinical governance as a policy framework was part of the National Health Service reforms of the early 1990s, but similar initiatives have also been developed in the US and Europe. The applicability of these initiatives to the diverse Australian primary care sector has not previously been studied.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy