The prevalence of glaucoma among 45-year-old New Zealanders.

AIM: We aimed to estimate the prevalence of glaucoma in New Zealand using a population-based birth cohort of 45-year-olds. METHODS: Study members of the Dunedin Multidisciplinary Health & Development Study participated (n=938 out of 1037 births (91%)). The data collected included visual acuity, visual field (VF), refraction, central corneal thickness, intraocular pressure (IOP), axial length, spectral domain optical coherence tomography (OCT), and non-mydriatic fundus photographs. Two ophthalmologists reviewed data independently to generate a consensus glaucoma status: "Normal" if no suspicion of glaucoma; "Ocular hypertension" if IOP >21 mmHg; "Glaucoma suspect" if optic disc photograph was suspicious for glaucoma with no more than borderline or non-corresponding VF or OCT abnormalities; and "Glaucoma" if optic disc photograph was suspicious for glaucoma and there were corresponding abnormalities of the OCT or VF. RESULTS: Of 891 participants with sufficient data to assign a glaucoma status, 804 were "Normal" (90.2% [CI 88.3-92.2]), 15 were "Ocular hypertension" (1.68% [95% confidence interval (CI) 0.84-2.5]), 65 were "Glaucoma suspect" (7.30% [95% CI 5.6-9.0]), and 7 were classified as "Glaucoma" (0.79% [95% CI 0.21-1.4]). An additional 73 participants (8.2%, [95% CI 6.3%-10%]) had abnormalities on the OCT scan but were not deemed to be glaucoma suspects. CONCLUSION: The prevalence of glaucoma in New Zealand is between 0.2% and 1.4%, consistent with other population-based studies in the same age group. The study highlights the sensitivity of OCT and the potential for misinterpretation and over-investigation.

Doctors' travel in the Anthropocene.

The health sector is uniquely placed as both a significant contributor to greenhouse gas emissions and a first responder to the impacts of climate change. The breadth and complexity of the health sector mean that decarbonisation will be a substantial challenge to current practice. Doctors are leaders in the health system and in their communities, and there are multiple imperatives for doctors to lead on decarbonisation. Here we specifically examine the impact of travel undertaken by hospital-based senior doctors for the purpose of continuing medical education. Where quantified, doctors' travel is a significant source of greenhouse gas emissions for district health boards, although there is significant uncertainty about the estimates. This travel occurs within a system that encourages and enables it through educational, financial, regulatory and cultural mechanisms, and is for many doctors an important component of their job satisfaction. This system needs to be redesigned to optimise education, job satisfaction, collaboration and wellbeing in the decarbonised health sector of the future.

Why heel spurs are traction spurs after all.

It is unclear whether plantar and posterior heel spurs are truly pathological findings and whether they are stimulated by traction or compression forces. Previous histological investigations focused on either one of the two spur locations, thereby potentially overlooking common features that refer to a uniform developmental mechanism. In this study, 19 feet from 16 cadavers were X-ray scanned to preselect calcanei with either plantar or posterior spurs. Subsequently, seven plantar and posterior spurs were histologically assessed. Five spur-free Achilles tendon and three plantar fascia entheses served as controls. Plantar spurs were located either intra- or supra-fascial whereas all Achilles spurs were intra-fascial. Both spur types consistently presented a trabecular architecture without a particular pattern, fibrocartilage at the tendinous entheses and the orientation of the spur tips was in line with the course of the attached soft tissues. Spurs of both entities revealed tapered areas close to their bases with bulky tips. Achilles and plantar heel spurs seem to be non-pathological calcaneal exostoses, which are likely results of traction forces. Both spur types revealed commonalities such as their trabecular architecture or the tip direction in relation to the attached soft tissues. Morphologically, heel spurs seem poorly adapted to compressive loads.

Audit of NZ COVID Tracer QR poster display and use in Dunedin.

AIMS: To assess how well the NZ COVID Tracer QR (Quick Response) code poster is displayed by Dunedin businesses and other venues in which groups of people gather indoors, and to calculate the proportions of visitors to those venues who scan the QR code poster. METHODS: We randomly selected 10 cafes, 10 restaurants, 10 bars, five churches, and five supermarkets and visited them at their busiest times. We evaluated the display of QR code posters using a six-item assessment tool that was based on guidance provided to businesses and services by the Ministry of Health, and we counted the number of people who entered each venue during a one-hour period and the number who scanned the QR code poster. RESULTS: All six criteria for displaying QR code posters were met at half of the hospitality venues, four of five churches, and all supermarkets. Scanning proportions were low at all venues (median 10.2%), and at 12 (30%) no visitors scanned; eight of these venues were bars. CONCLUSION: This audit provides a snapshot of the display and scanning of QR code posters in a city with no managed isolation and quarantine facilities and where no COVID-19 cases have been detected for 10 months.

On the use of a new monocular-indirect ophthalmoscope for retinal photography in a primary care setting.

AIM: There is consensus among general practitioners regarding the difficulty of direct ophthalmoscopy. Hence, there is increasing interest in smartphone-based ophthalmoscopes; the New Zealand-made oDocs Nun ophthalmoscope is one such device, released in November 2018. This study aims to subjectively assess the quality of the images captured with it in order to determine the feasibility of its use in a primary care setting. METHOD: Twenty-eight general practitioners (GPs) from different practices throughout New Zealand agreed to participate in this prospective observational study and were sent an oDocs Nun ophthalmoscope. Using the device, clinicians took retinal photographs of patients who presented with visual complaints and uploaded one image per eye onto a database. Three hundred and fifty-seven photographs were collated and rated by four professionals (two ophthalmologists and two optometrists) on the basis of image quality and the anatomical features visible. RESULTS: On a Likert scale from 1 (poor quality) to 4 (very good quality), the median and mode values for each professional's rating of all photographs were both 2. On average, 94.5% of the photographs were deemed to have visible optic discs and 50.0% to have visible maculae adequate for detecting an abnormality. Pairwise comparison showed 93.7% agreement among the four professionals for optic disc visibility, and 74.2% agreement for macula visibility. CONCLUSION: The oDocs Nun is a promising tool which GPs could use to circumvent the challenges associated with direct ophthalmoscopy. With appropriate training to ensure proficiency, it may have a valuable role in telemedicine and tele-referral.

On the influence of surface coating on tissue biomechanics - effects on rat bones under routine conditions with implications for image-based deformation detection.

BACKGROUND: Biomechanical testing using image-based deformation detection techniques such as digital image correlation (DIC) offer optical contactless methods for strain and displacement measurements of biological tissues. However, given the need of most samples to be speckled for image correlation using sprays, chemical alterations with impact on tissue mechanicals may result. The aim of this study was to assess the impact of such surface coating on the mechanical properties of rat bones, under routine laboratory conditions including multiple freeze-thaw cycles. METHODS: Two groups of rat bones, highly-uniform and mixed-effects, were assigned to six subgroups consisting of three types of surface coating (uncoated, commercially-available water- and solvent-based sprays) and two types of bone conditions (periosteum attached and removed). The mixed-effects group had undergone an additional freeze-thaw cycle at - 20 degrees. All bones underwent a three-point bending test ranging until material failure. RESULTS: Coating resulted in similar and non-significantly different mechanical properties of rat bones, indicated by elastic moduli, maximum force and bending stress. Scanning electron microscopy showed more pronounced mechanical alterations related to the additional freeze-thaw cycle, with fewer cracks being present in a bone from the highly-uniform group. CONCLUSIONS: This study has concluded that surface coating with water- or solvent-based sprays for enhancing image correlation for DIC and having an additional freeze-thaw cycle do not significantly alter mechanical properties of rat bones. Therefore, this method may be recommended as an effective way of obtaining a speckled pattern.

Utilization of 3D printing technology to facilitate and standardize soft tissue testing.

Three-dimensional (3D) printing has become broadly available and can be utilized to customize clamping mechanisms in biomechanical experiments. This report will describe our experience using 3D printed clamps to mount soft tissues from different anatomical regions. The feasibility and potential limitations of the technology will be discussed. Tissues were sourced in a fresh condition, including human skin, ligaments and tendons. Standardized clamps and fixtures were 3D printed and used to mount specimens. In quasi-static tensile tests combined with digital image correlation and fatigue trials we characterized the applicability of the clamping technique. Scanning electron microscopy was utilized to evaluate the specimens to assess the integrity of the extracellular matrix following the mechanical tests. 3D printed clamps showed no signs of clamping-related failure during the quasi-static tests, and intact extracellular matrix was found in the clamping area, at the transition clamping area and the central area from where the strain data was obtained. In the fatigue tests, material slippage was low, allowing for cyclic tests beyond 105 cycles. Comparison to other clamping techniques yields that 3D printed clamps ease and expedite specimen handling, are highly adaptable to specimen geometries and ideal for high-standardization and high-throughput experiments in soft tissue biomechanics.