New Echocardiography Reference Ranges for Aotearoa (NewERA) Study: the application of international echocardiographic reference values to linear measurements of the hearts of healthy, young Maori and Pacific adults may not detect cardiac enlargement.

AIMS: To develop ethnic-specific echocardiography reference ranges for Aotearoa, and to investigate the impact of indexation to body surface area (BSA). Current reference international ranges are derived from people of mostly NZ European ethnicity and may not be appropriate for Maori and New Zealanders of Pacific ethnicity, who both experience high rates of cardiovascular disease. METHODS: Echocardiography was performed in a cross-sectional study of 263 healthy adults (18-50 years): Maori (N=71, 43 female), Pacific (N=53, 28 female), European (N=139, 74 female). Linear measurements of the left heart are reported and indexed to BSA. The upper/lower limit of normal (ULN/LLN) by ethnicity and sex were derived (quantile regression). Ethnic- and sex-specific differences were examined using ANOVA. RESULTS: The ULN was higher for all un-indexed dimensions in men compared to women, and for most indices the ULN was smallest in NZ Europeans and largest in Maori and Pacific peoples. Indexation reversed these relationships: NZ Europeans had higher ULN for many measurements. CONCLUSIONS: Indexing to BSA introduced bias that preferences the NZ European ethnicity by creating an upper limit reference threshold that far exceeds this sample's upper range. As a result, this may lead to under-recognition of cardiac enlargement in Maori and Pacific patients, and in particular for women. Unique reference ranges for all ethnic groups and sexes are required to optimally detect and manage cardiovascular diseases (CVD) in Aotearoa.

Beyond competencies - describing work ready plus graduates for the New Zealand medical imaging workforce.

INTRODUCTION: Medical imaging is a profession where technology and practice is moving forward at a fast pace, while also being situated within rapidly evolving models of healthcare delivery. This requires capabilities in our graduates beyond the competencies to undertake the role. This study used an existing Professional Capability Framework as the foundation for the development of a survey tool to identify those capabilities most valued by the health services that provide placement opportunities for students. METHODS: A prospective survey, conducted online, was used to gather the data from senior medical imaging staff who work regularly with students and new graduates. RESULTS: The results identified the top capabilities within each of three domains of personal, interpersonal, and cognitive capabilities. The results from the personal domain show that remaining calm under pressure or when things take an unexpected turn; understanding personal strengths and limitations; being willing to face and learn from errors; wanting to do as good a job as possible and having energy, passion and enthusiasm for the profession and role are most valued by the profession. We have identified links between the most desired interpersonal capabilities and attributes of well-functioning interprofessional teams and the cognitive capabilities align to those required for critical thinking and clinical reasoning. CONCLUSIONS: These results have allowed the curriculum development team to review the graduate profile of medical imaging technology graduates. The curriculum development team has begun a process to incorporate learning strategies that will encourage the development of these capabilities in our graduates.

Nonlinear dynamics of the observed HIV-positive population size in Fiji.

In this paper, the reported numbers of HIV-positive individuals in Fiji between and including the years 1989 and 2002 have been used to study the dynamics of the observed HIV-positive population size. The Fiji data showed a pattern that appears to begin to approximate the "S" shaped growth pattern. It is well-known in the mathematics literature that this nonlinear pattern is a natural growth phenomenon and that there are suitable mathematical equations--from the classical Verhulst equation to the recent Tsoularis equation--that can be used to study it. These equations generate two-dimensional curves, the uses of which are case-dependent. In this paper, the curves used are the Logistic Curve and the Gompertz Curve, which are known to be relatively accurate in predicting the short-term behaviour of the observed HIV-positive population size at the initial stages of growth. This study showed that the curves, based on the 1989-2002 data, gave the scenarios in which new reported cases could stabilize by 2005 or 2013. Based on the 1989-2001 data, both curves gave the worst-case scenario of continuous increase till the year 2020 when the numbers could begin to stabilize.