Auckland District Health Board

Neonatal cardiac surgery (NCS) is associated with a risk of neurodevelopmental impairment. We reviewed outcomes of a national pre-school screen, the Before School Check (B4SC), of children who had NCS compared to the national cohort to determine whether NCS children had higher rates of abnormality and whether the B4SC could be useful to identify at-risk NCS children. B4SC results of children who had NCS between 2006 and 2014 were compared to controls. Sub-analyses were performed by cardiac subtype and timing of diagnosis. Outcome measures were the Parental Evaluation of Developmental Status (PEDS), vision and hearing screening, and the Strengths and Difficulties Questionnaire parent version (SDQ-P). Multivariable analysis adjusted for ethnicity, socio-economic positioning, and sex. Of 508 NCS children, 390 (76.8%) had B4SC outcomes completed. The 371 without a syndrome or chromosomal anomaly, were compared with controls (n = 543 971). NCS children were more likely to have abnormal PEDS (27.9% versus 19.8%, p < 0.001), vision (10.5% versus 5.6%, p < 0.001) and hearing (18.0% versus 9.0%, p < 0.001). There was no difference on SDQ-P. Adjusted for confounding variables, children with single ventricle (SV) had higher rates of abnormal PEDS (RR 1.9, CI 1.4-2.5), whilst SV and 2V with prenatal diagnosis had increased risk of an abnormal vision screen (RR 3.1, CI 1.8-5.5, and 2.2, CI 1.4-3.4). Abnormal hearing screen was increased in all NCS groups. NCS children have higher rates of abnormal PEDS, hearing and vision screening on the B4SC. The B4SC may help to identify at-risk NCS children who may benefit from intervention.

Changes to New Zealand's Oranga Tamariki Act in 2019, saw 17-year-olds moved from adult to youth jurisdiction. This study described mental distress experienced by 17-year-olds appearing in Youth Court compared to their high school peers. Seventeen-year-olds in the youth justice (YJ) system between 2019 and 2021 were compared to 17-year-olds in the Youth19 survey (Y19) by demographic characteristics, types, and prevalence of mental distress. YJ 17-year-olds experienced greater exposure to family violence, parental separation, and child protection compared to their Y19 peers. Depressive symptoms (OR 10.5, p < 0.0001), suicidality (OR 7.8, p < 0.0001), and cannabis use (OR 3.2, p < 0.001) were significantly more common when compared to Y19, with Māori males disproportionately affected. Seventeen-year-olds in YJ experience elevated levels of poverty, trauma, and mental health distress. Criminalizing trauma and mental distress is preventable. Forensic clinicians must facilitate evidence-based culturally safe mental health and addiction rehabilitation as part of a crime prevention strategy.

Artificial Intelligence (AI) is evolving at a rapid pace with impressive performance in many areas including health care. This study aimed to investigate the opportunities, challenges and barriers in implementing AI in patient monitoring using smart medical devices. This chapter provides a comprehensive analysis of the current state, potential applications, benefits, and challenges associated with the integration of AI into patient care settings. It could serve as a valuable resource for researchers, practitioners and policymakers interested in the transformative impact of AI on patient care. We reviewed studies that report on the opportunities and challenges in improving personalized patient care plans (PPCP) using AI. It is suggested that a holistic approach is required involving strategy, communications, integrations and collaboration between technology developers, healthcare professionals, regulatory bodies and end users including physicians and patients. Developing frameworks that prioritize ethical considerations, patient privacy, and model transparency is crucial for the responsible deployment of AI in healthcare. Balancing these opportunities and challenges requires collaboration between wider stakeholders to create a robust framework that maximizes the benefits of AI in healthcare while addressing the key challenges and barriers such as the explainability of the models, validation, regulation, and privacy integration with the existing clinical workflows.

Interventions to prevent aggression and reduce use of restrictive practices are essential for recovery-oriented mental health nursing care. This study explored how nurses can best enhance employment of a structured risk assessment instrument paired with an aggression prevention protocol. Fourteen nurses with responsibilities for reducing restrictive practices attended focus groups, and three consumer consultants working with mental health nursing staff participated in one-to-one interviews. The focus groups and interviews were designed to elicit recommendations to assist nurses use of the violence risk assessment instrument and apply the protocol interventions. Thematic analysis was used to analyse the data. Four themes were interpreted from the data. Theme one: The nurses are experiencing incredible difficulty talking about how they can be supported. Theme two: 'calming the farm': The need to self-regulate, with the subthemes: (1) some nurses may need support to 'calm the farm' and (2) if you can't 'calm the farm' another nurse may need to step in. Theme three was the need for robust training and education and the final theme was: The need for 'decompressing' before leaving the shift. Participants suggested while some nurses were very skilled at regulating their emotions while intervening to prevent violence, some had difficulty, or were not aware of their emotional state, and may need support from colleagues when intervening. Suggestions for enhancing the application of aggression prevention interventions include use of mental wellness check-in forms, engaging in clinical supervision and safety huddles at the end of the shift to assist nurses to decompress before leaving.

Abstract Purpose The aims of this study are (1) to derive a set of time series features to predict the total knee contact force during gait from two ankle-mounted inertial measurement units (IMUs); and (2) to explore the best combination of PROMs and IMU-derived, biomechanical measures for the prediction of postoperative quality of life (QoL) and reduce the inconsistency between biomechanical and PROMs. Methods Synced motion capture (optical and inertial) data were collected from four healthy participants to obtain a suitable time-series feature set that relates to knee contact forces (KCF). Then, using data from 28 patients during overground walking, we generated linear and random-forest regressor models for estimating QoL. These models were evaluated using temporal cross-validation. Results Overall, features from the IMUs could predict the total KCF (R 2 &gt; 0.90, RMSE = 0.14, %BW). A machine learning model was trained on the data obtained during the recovery (up to 1 year) to predict EQ-5D-5 L score (patient QoL). The models were able to predict within a margin of 1.81–4.40 units of the actual score 95% of the time. Conclusion The presented study derives surrogate measures of total knee contact force (KCF) using ankle-mount IMUs. We identified the best combination of PROMs and IMU-derived measures for postoperative QoL at four time-points. The optimal metrics varied for each time point: OKS only, knee kinematics with OKS, KCF with OKS, and KCF only. Further data collection will be required to compile a comprehensive dataset to generate a robust predictive model.

Phylum Annelida are ubiquitous metazoans found in almost every terrestrial and aquatic habitat on Earth. Historically, taxonomic studies on the phylum have been focused largely on its majorgroups, polychaetes, oligochaetes and leeches, so that while family-level keys for each group are available, no single-source identification guide exists to the world’s annelid families. Here, the first illustrated linear key to annelid families is provided and family-level descriptions and diagnoses that distinguish individuals of each family from those of other families in the phylum are updated. This information is generated from an annelid DELTA database of 334 characters and 166 mostly family-level taxa. A link is provided to downloadable software (ANNiKEY Interactive) allowing the same data to be interrogated using the open-source DELTA program Intkey, which enables both interactive identification and taxonomic query functionality. For each family-level taxon, a diagnosis, full description, links to taxonomic data at the World Register of Marine Species, illustrations of diagnostic features, and a summary of the recent literature, including a list of published keys to genera and species are provided.

ABSTRACT Solastalgia is the emotional response elicited by ecological degradation, originating from the concepts of solace, desolation, and pain. Climate change has profound societal and health impacts especially for marginalised communities who face food shortages, poverty and forced displacement. Indigenous peoples have deep relational ancestral connections with the land that are beyond connection to place, and experience unique intensified forms of distress resulting from environmental degradation. For Indigenous peoples, connections with land are disrupted through extractive politics such as colonisation and now climate emergency, legacies that leave deleterious effects on wellbeing. In collective Indigenous cultures, distress is embedded within wider contexts of community, history, and the earth itself. This paper critically reviews solastalgia from Māori and care ethics perspectives to demonstrate the power of adding relational, contextual, and embodied elements to the concept. This paper argues for the incorporation of Indigenous knowledge in the conceptualisation of climate-related distress. Māori notions of voice and place inform research approaches that are in solidarity with Indigenous voice to examine the impacts of climate degradation.

IntroductionInternational consensus guidelines support the initial administration of 30 mL/kg of intravenous fluids for haemodynamic resuscitation of newly diagnosed septic shock. Practice variation exists between the volume of fluids administered and timing of vasopressor commencement. The optimal approach in patients with septic shock is uncertain.Methods and analysisAustralasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In emergency Department Sepsis is a 1000-participant multicentre, randomised, open-label, parallel group clinical trial conducted in patients with septic shock presenting to the emergency department in participating sites in Australia, New Zealand and Ireland. Participants are randomised (1:1) to either restricted fluids and early vasopressors or a larger initial intravenous fluid volume and later vasopressors. The primary outcome is days alive and out of hospital at day 90 postrandomisation. Secondary outcomes are all-cause mortality at day 90, time from randomisation until death (to day 90), days alive and at home at day 90 and ventilator-free, vasopressor-free and renal replacement-free days to day 28 postrandomisation and death or disability at 6-month and 12-month postrandomisation. Health-related quality of life will be assessed at day 180 and 12 months following randomisation.Ethics and disseminationThe study was approved by Northern Sydney Local Health District Human Research Ethics Committee (HREC2020/ETH02874) on 21 January 2021. Patients will be enrolled under a waiver of prior consent. The patient or next-of-kin (or equivalent according to local jurisdiction) is approached at the first available opportunity and given a trial information sheet. According to local approvals, the patient or next-of-kin chooses to either continue in the trial or opt-out/decline continued participation. Results will be disseminated in peer-reviewed journals and presented at academic conferences.Trial registration numberNCT04569942