3,940 results for Modify

  • Repetitive Transcranial Magnetic Stimulation: A Call for Better Data

    Wilson, Marcus T.; St George, Lynley (2016)

    Journal article
    University of Waikato

    Repetitive Transcranial Magnetic Stimulation (rTMS) is increasingly used to treat stroke, Parkinson's disease and depression (Fregni et al., 2005; Loo and Mitchell, 2005; Hallet, 2007; O'Reardon et al., 2007; Ridding and Rothwell, 2007). rTMS uses bursts of magnetic pulses to change the excitability and connection strengths of cortical neurons. However, the evidence to inform clinical application is highly inconsistent (Thut and Pascual-Leone, 2010; Hamada et al., 2013) and substantially based on trial and error. Systematic theory is lacking. Typically, in rTMS research, measurements of motor-evoked potential (MEP) are made, often in terms of the strength of the MEP and the length of the cortical silent period that follows. However, the MEP is probably a poor and certainly an indirect measure of changes in the brain (Nicolo et al., 2015), clouding our understanding of rTMS mechanisms. In practice, therefore, particular amplitudes and timing of pulses in an rTMS sequence are selected because they show promise in small subsets of people. However, even basics such as the sign of any change in the outcome measure (e.g., does the MEP increase or decrease?) is debated. Many results show a wide spread in responses. It has become common to talk about “responders” and “non-responders” although evidence for a binary distinction in these two groups is lacking—in reality there is usually a continuum of response often including potentiation in some and depression in others (Nettekoven et al., 2015). Moreover, Héroux et al. (2015) provide evidence that the irreproducibility of results may be due to small sample sizes, unscientific screening of subjects and data, and selective reporting of results.

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  • The locus for an inherited cataract in sheep maps to ovine chromosome 6

    Wilson, Gareth R. S.; Morton, James D.; Palmer, David N.; McEwan, J. C.; Gately, Karl; Anderson, R. M.; Dodds, K. G.

    Journal article
    Lincoln University

    Purpose: Cataracts are an important cause of blindness in humans but there are few large animal models available. One of these animal models is Ovine Heritable Cataract, a bilateral cortical cataract which develops after birth. This cataract has been used as a model for human cataracts in drug trials, but the gene responsible for the cataract trait is unknown. A genetic test for cataract would improve the efficiency of the model by predicting which animals would develop cataracts. Identifying the genetic basis of the cataract would indicate its relevance to human cataract. Methods: A genome scan was performed on 20 sheep chromosomes, representing 86% of the genome, to determine the position of the cataract locus. Additional microsatellite markers were tested on chromosome 6 using a larger pedigree. Fine mapping was performed using a breakpoint panel of 36 animals and novel microsatellite markers taken from the bovine genome assembly. All exons of the candidate gene nudix (nucleoside diphosphate linked moiety X)-type motif 9 (NUDT9) were sequenced in normal and affected sheep. Results: Significant linkage was found between cataract status and markers on chromosome 6. Linkage analysis on the larger pedigree showed the most likely position of the cataract locus was between 112.3 and 132.9 cM from the centromere. During fine mapping, NUDT9 was considered as a positional candidate for the cataract gene because it was located within the linked interval and is expressed in the lens. The gene was ruled out as the cataract gene after extensive genotype analysis, but a single nucleotide polymorphism (SNP) inside it provided a useful restriction fragment length polymorphism (RFLP) marker for further fine mapping. Twelve new markers were found and used to map the cataract locus to between 131.1 and 131.8 cM from the centromere. Conclusions: A region of ovine chromosome 6 strongly linked to cataract has been identified, and a genetic test for cataract based on a SNP within this region has been developed. The best candidate gene within this region is AF4/FMR2 family, member 1 (AFF1), the mouse equivalent of which is associated with an inherited cataract.

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  • Pākehā Practice: Music and National Identity in Postcolonial Aotearoa/New Zealand

    Williams-Prince, Liam (2017)

    Masters thesis
    Victoria University of Wellington

    National discourses specific to Aotearoa/New Zealand — for example, biculturalism, which reimagines Māori-Pākehā relations as a partnership based on the Treaty of Waitangi — help to construct, express, and articulate connections between music and New Zealand identity. Yet unquestioned nationalisms — however benign or ‘official’ they seem — can marginalize some ways of being, knowing, organizing, and music-making, through their capacity to advance and reinforce undisclosed social values and political agendas. In this way, nationalism often disguises the consequences of those values and agendas. This thesis demonstrates how, by unproblematically invoking nationalisms for various purposes, significant New Zealand music-related institutions inadvertently reproduce Eurocentric national identity narratives which overlook the social, cultural, economic and political inequities of Aotearoa/NZ’s postcolonial present. Such narratives normalize conceptions of ‘New Zealand music’ dominated by historic and evolving cultural and economic connections between New Zealand society and the broader postcolonial Anglosphere. Consequently, identifications of ‘New Zealand’ culture and music often reflect dominant Pākehā norms, against which other musical traditions are contrasted. Several prominent ‘national’ institutions involved with music are examined through three cases studies. The first considers how state-supported music policies and agencies construct and legitimize economic, artistic and democratic ideologies as national values, and explores the consequences of a frequent failure to distinguish between a cultural identity, based on dominant Pākehā norms and values, and a culturally plural civic-based national identity. The second case study examines events during and surrounding two major music awards ceremonies, the Vodafone New Zealand Music Awards and the Silver Scroll Awards, showing how these ceremonies construct and reinforce a prestige hierarchy of ‘New Zealand music’ in which Anglo-American popular music styles are privileged over other musical expressions. The consequences for cultural representation in relation to New Zealand identity are considered. The final case study analyses the New Zealand popular music heritage presented at Auckland Museum’s exhibition, Volume: Making Music in Aotearoa. Volume’s displays and stories, contextualized and informed by Auckland Museum and prominent entities in New Zealand’s music industry, are shown to reinforce a dominant New Zealand music ‘Kiwiana’, neglecting divergent cultural perspectives and political positions. The thesis draws on comparative analyses of qualitative interviews conducted by the author, documents and reports, press media and journalism, audiovisual broadcasts and recordings, promotional material and museum visits. These primary materials are contextualized in wider literatures — particularly on nationalism, postcolonialism and music — to provide critical perspectives on historic social, political and cultural issues regarding New Zealand national identity and its relationship to music.

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  • Family language policy in refugee-background communities: Towards a model of language management and practices

    Revis, Melanie (2017)

    Journal article
    University of Canterbury Library

    As interest in the field of family language policy is burgeoning, an invitation has been issued to include more diverse families and language constellations. This article responds by presenting family language management data from Ethiopian and Colombian refugee families living in New Zealand. As part of the researcher’s ethnographic involvement in both communities, data was obtained through participant observations, interviews with parents and children, and recordings of naturally-occurring interactions between family members. Findings from both communities differ greatly: While many Ethiopian families used explicit management for their children to speak Amharic in the home, Colombian families tended to prefer laissez-faire policies as they did not direct their children’s language choice. Nevertheless, their children typically spoke Spanish, their heritage language. As a theoretical contribution, a model is developed to coherently present the caregivers' choice of language management and their children’s typical language practices. This model helps to uncover similarities and dissimilarities across families and communities. Since families typically moved through different management and practice constellations over time, the model also assists in identifying recurrent family language policy trajectories. The article concludes by drawing practical attention to the need and best timing for informing recent refugees about options and resources concerning intergenerational language transmission.

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  • Young Pacific Male Athletes and Positive Mental Wellbeing

    Marsters, Caleb (2017)

    Masters thesis
    The University of Auckland Library

    Background: Recent studies and increased media reporting across Australasia have linked young Pacific male elite athletes to depression, suicide, and other adverse mental health-related events. Despite these events, little is known about positive mental wellbeing and young Pacific male athletes. Aim: This research aimed to explore young Pacific male athletes??? perceptions of what contributes to positive mental wellbeing and peak performance at an elite level of sport. It is believed that this research will provide useful information to better support the mental health and wellbeing needs of young Pacific male athletes. Methodology: This qualitative study conducted in-depth face-to-face interviews with 20 young Pacific males (16-24 years) engaged in elite rugby league or rugby union programmes in Auckland. Interviews were semi-structured and underpinned by the Health Research Council of New Zealand???s (2014) Pacific Health Research Guidelines. A grounded theory approach was used for data analysis. Findings: Participants defined positive mental wellbeing as being holistic and emphasised the importance of family support and reciprocity, a well-balanced life, performing well, and personal development. Risk factors for athletes??? mental wellbeing included familial pressures, a lack of alternative activities and interests away from sports, difficulties transitioning to an elite level of sport, performance-related issues such as dips in form, injuries, alcohol misuse, and stigma around mental illness. Key protective factors for positive mental wellbeing for these athletes included family support, the support of their significant other, Christian faith and spirituality, the ???brotherhood???, a secure ???Pacific athlete??? identity, personal development, and supportive sports organisations. This study recognised that sports organisations, schools, Pacific families, and Pacific communities need to engage more actively with young Pacific males to reduce stigma around mental illness, increase awareness of mental health, and openly discuss issues around mental wellbeing. Conclusion: Recommendations from this study provide evidence-based strategies for promoting and supporting positive mental wellbeing among young Pacific male athletes. This research may be of benefit for elite sports organisations and their staff, schools, sports coaches, sport administrators, mental health professionals, health services, researchers, Pacific communities, and Pacific families to ensure the young Pacific males of this country thrive and flourish.

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  • Childhood food allergy in the New Zealand context: An exploration of trends, prevalence, risk factors, and the impact on quality of life

    McMilin, Colleen (2015)

    Doctoral thesis
    The University of Auckland Library

    Although food allergy has been extensively described, diagnosed, managed and researched, many questions still linger. For over 2000 years scientists have sought to understand the effects of food on the human body. Hippocrates, the Father of Medicine, had recognition that food can cause illnesses, disease and health concerns for some people. In 1906, Dr Clemens von Pirquet suggested the use of the word ???allergy??? to describe an inappropriate reaction to food or other substances not typically harmful or bothersome. Researchers are just beginning to recognise potential influences on the development and progression of food allergy. The prevalence and incidence rates of food allergies worldwide have been the subject of much debate in recent decades due to what many observe as a dramatic increase in childhood food allergies. A food allergy touches the life of not only the individual diagnosed but also their family, friends, health care providers, food producers, retailers, and schools. The epidemiology of food allergy in New Zealand has been incompletely described and there is minimal published data that allows for any estimation of the disease burden caused by food allergy in New Zealand. Aims Although New Zealand has a high prevalence of asthma, the epidemiology of other atopic disease has not been studied. Based on other studies completed around the world and the data available in New Zealand this thesis set out to better understand: (1) temporal trends in food allergy; (2) prevalence of peanut allergy and risk factors for peanut allergy; and (3) the impact of childhood food allergy on quality of life. Methods To meet the objectives of this thesis four projects made up of five studies were completed. Each project utilised a different data set to allow comparisons to be made of data from New Zealand with that which has been reported from other countries and to provide several perspectives on how food allergies are impacting New Zealand children. 1) To determine whether Emergency Department presentations can be used to describe temporal trends in food allergy presentations an audit was completed for all emergency department (ED) presentations from 1988 to 2011 of children (0 to 14 years old) to the public hospital ED in the Auckland District Health Board (ADHB) region, for which the ICD codes ???anaphylaxis, unspecified??? or ???allergy, unspecified???, were assigned. 2) The new knowledge learnt from project one was then applied to the National Minimum Dataset (NMDS), a national collection of public and private hospital discharge information, temporal trends in emergency department (ED) presentations for food-related acute allergic reactions from 1988 to 2011 of children (0 to 14 years old) were investigated. 3) Utilising data from the Growing Up in New Zealand cohort study the prevalence of peanut allergy and factors associated with the presence of peanut allergy at age two years were investigated. 4) The impact of food allergy on quality of life was investigated through the use of reflexive photography, photo elicitation, and the autodriven interview with food allergic children and their families. Results Understanding Administrative Coding of Emergency Department Visits for Unspecified Acute Allergic Reactions The aim of this project was to determine the proportion of ED visits coded as ???anaphylaxis, unspecified??? or ???allergy, unspecified??? that are food-related allergic reactions. Food-related acute allergic reactions account for 29% of hospital presentations that were assigned a discharge code for ???anaphylaxis, unspecified??? or ???allergy, unspecified in the ADHB. The ED presentation rate with food-related allergic reactions from 2004-2011 was almost twice as high as that which occurred from 1988-1995 (RR=1.98, 95%CI 1.10-3.72). By contrast, ED presentation rates for non-food-related allergic reactions did not change over these years. This apparent increase in New Zealand is consistent with observations using comparable data sources reported from Australia and the United States. Hospital Presentations Due to Acute Allergic Reactions Related to Food Between 1988 and 2011, 3,735 children 0 to 14 years old presented to a New Zealand hospital with an acute allergic reaction identified by ICD-9-CMA-II codes 692.5 (contact dermatitis and other eczema due to food in contact with), 693.1 (Dermatitis due to food taken internally), 995.0 (Anaphylactic reaction due to unspecified food), 995.3 (Allergy, unspecified), and 995.60-995.69 (Anaphylactic reaction due to food unspecified and specified). An average yearly increase of 8% in hospital presentations due to acute allergic reactions (p=<0.001). Peanut Allergy in the New Zealand Context Based on parental reported data collected from Growing Up in New Zealand, a contemporary longitudinal birth cohort study, 162 (2.1%) children were identified as peanut allergic. Within this cohort, factors associated with the development of a peanut allergy were categorized based on the measurement of child, family & wider influences on disease in early childhood as defined by: child characteristics, proximal social environments, distal social environments, and macro environmental factors. The odds of having parental reported peanut allergy at age two years were increased for boys, children diagnosed with eczema since 9 months, children whose mother had a history of atopic disease (eczema, hay fever, or food allergy), and mothers who identified as being of Asian ethnicity. The odds of having parental reported peanut allergy at age two years were decreased for children who had never tried nuts or peanuts, or whose mothers had no secondary qualifications or secondary school/NCEA 1-4. Impact of Food Allergy on New Zealand Families The impact a food allergy has on a family is influenced by environment and includes four levels home, school, community, and beyond the community. This is due, in part, to the amount of control a food allergic family has within these environments. The ability to control the environment gradually decreases as a food allergic family moves away from the home. Based on the impact a food allergy has on the food allergic family, three outcomes of living with a food allergy are evident responsibility, exclusion, and resilience. The lessons learned from these families can be used to guide other food allergic families through education and advocacy. Based on the family???s description of the impact of a food allergy on their quality of life and management strategies, there is a need for consistent national school policy focused on food allergies and the provision of education and training to hospitality workers. These changes could positively impact food allergic families at multiple environmental levels. Discussion Consistent with what has been reported from several other countries the prevalence of childhood food allergy appears to have increased in recent decades. The rate of parental self-report of peanut allergy in New Zealand is similar to other countries. In New Zealand, children of male gender or who have eczema are at increased, and those who have never tried nuts or peanuts by age two years were at decreased risk of parental reported peanut allergy. In New Zealand children of atopic mothers or mothers of Asian ethnicity are at increased risk and children of less educated mothers are at decreased risk of parental reported peanut allergy. A food allergy impacts all members of a food allergic family based on the level of control within various environments. Food allergy is a complex condition and this thesis provides insight into the current state of food allergy in New Zealand.

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  • Dimensions of ???Quality??? In The Case Of Foreign Degree Awarding Institutes of Sri Lanka: A Multiple Stakeholder Perspective

    Amugoda K Dona Wickramasinghe, MN (2015)

    Doctoral thesis
    The University of Auckland Library

    The provision of quality higher education is of critical importance for the economy of a developing country like Sri Lanka. This research considering the quality issues of the foreign degree awarding institutes of Sri Lanka investigates the dimensions of quality in relation to these institutes from a multiple stakeholder perspective. The central argument of this thesis is that it is necessary to understand what constitutes as quality in order to improve it. Thus, the study is aimed to identify various understandings of quality in relation to these institutes and their consequences to various stakeholders of these institutes. The study identifies key definitions, purposes and practices associated with the term quality. The students??? and the professionals??? perceptions of how these institutes implement and maintain the key quality criteria and the key issues arriving from the various understandings of quality are also investigated from the receiver country???s perspective. The study adopted a mix of vertical case study and mixed methods approach and worked within a pragmatic paradigm. A questionnaire survey, semi structured interviews and documentary data served as sources of data. The perceptions of students, lecturers and senior managers of five selected foreign degree awarding institutes of Sri Lanka and the officials of three government higher education organizations were sought to achieve the research objectives. The findings revealed a variety of definitions of quality and also various meanings to these definitions, indicating the elusive nature of quality. It was revealed that quality is shaped by external factors such as economy, culture, gender and social class. The different viewpoints of these stakeholders also created confusion, discrepancies and many challenges to quality in these institutes. The findings revealed that the quality of these institutes analysed are neither up to the standards of the government universities of Sri Lanka nor to the standards of their home universities. The way that some of these institutes studied, implemented and maintained quality did not resemble their claimed definitions, purposes and practices of quality, and these mismatches brought out several consequences to the stakeholder groups, while also making a negative impact on the higher education sector of Sri Lanka. The study provided recommendations to the key stakeholder groups to overcome these identified issues of quality.

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  • Datatecture: Creating a real home for a virtual identity

    Meekings, Scott (2017)

    Masters thesis
    Victoria University of Wellington

    It is increasingly common to live in continual flux between reality and virtuality – for architecture this means a dwindling focus on the built environment. For the architectural discipline to respond to these rapidly changing user-demands, a proactive relationship with our digital environment is required. It is proposed that a key occupation of the architectural discipline in the near future will be designing architecture that caters to our ‘real-world’ selves but takes advantage of the broad range of data available to us from the digital realm. This thesis proposes that within the big data stored about all those who engage with the digital environment, lies data that can influence and benefit the architectural discipline and allow us to respond convincingly to the increasing focus on digital and virtual engagement. As people increasingly ‘live online’ architects can now derive information about clients not only from meeting them in person but also by scraping data on their digital lives and constructing what is referred to in this thesis as a digital identity. The digital identity can include data about a myriad of architectural influences such as taste, activity and lifestyle. This thesis considers which data may become available over the next decade, how architectural designers can embrace it without specialist data-centric skill-sets and how it may help personalise architecture. A large amount of data is collected on the author from both ‘real-world’ scenarios and ‘virtual’ inhabitation of digital space. This data, along with other public sources of data are explored in terms of architectural potential, culminating in a vision for a new data-based and ultimately more efficient method for personalising and inhabiting architecture.

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  • Assessing the Vulnerability and Resilience of the Philippines to Disasters

    Yonson, Rio (2017)

    Doctoral thesis
    Victoria University of Wellington

    Some of the world’s most destructive disasters occurred in the Philippines, and a number of these happened in recent years. In 2011, 2012, and 2013, tropical cyclones Washi, Bopha, and Haiyan, respectively, left a staggering trail of over 8,000 deaths, as well as huge damages to assets and livelihoods. In 2009, tropical cyclones Ketsana and Pharma brought massive riverine floods, with a total damage and loss equivalent to 2.7% of the country’s GDP. This dissertation is an endeavour to measure disaster impacts and welfare risk, and to identify factors affecting vulnerability and resilience in different spatial scales in the Philippines. The first of four chapters is an extensive literature survey on the economic vulnerability and economic resilience to disasters. This serves as a prelude to the succeeding three empirical studies contained in Chapters 3 to 5. Chapter 3 aims to measure tropical cyclone-induced fatalities in the Philippine provinces, and identifies the factors that shape people’s vulnerability. It also quantifies the relative importance of hazard, exposure, and socioeconomic vulnerability in influencing fatalities. Chapter 4 is a household level study that quantitatively establishes the linkages between floods and diseases in the floodplains of a highly-urbanized city in the Philippines (Cagayan de Oro), and provides an estimate on the public finance implications of flood-induced diseases to the Philippine urban areas, and on the additional economic burden on affected households. Chapter 5 measures socioeconomic resilience and welfare risk from riverine flood disasters, and systematically quantifies the effectiveness of a menu of region-specific disaster risk reduction and management measures.

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  • Living in the 'liveable' city: Housing, Neighbourhood, and Transport Preferences in New Zealand cities

    Holmes, Frederick (2017)

    Masters thesis
    Victoria University of Wellington

    This thesis investigates preferences for housing, neighbourhoods, and transport in Auckland, New Zealand, supplemented by a comparison with similar research in Wellington and Hamilton. The topic is significant for New Zealand as there is an increasingly urban population, and the interconnected areas of urban form and transport can help the country reduce carbon emissions and provide a healthier, more enjoyable lifestyle for its people. The influence of residents’ preferences and their relationship with urban form on achieving compact city development is investigated. Historical and current planning rules and policies provide context for an analysis of how urban planning, preferences, and location and travel choices interact. Auckland’s housing and transport policies show a pattern of path dependency: decisions favouring greenfield development, sprawling low-density suburbs, and car-centred transport have driven subsequent investments and influenced the ease of using alternative transport modes. Such rules have also reduced the availability of housing in accessible, medium- to high-density neighbourhoods and may have contributed to the rising costs of this type of housing. A stated choice survey of 3,285 Auckland households was conducted to investigate the extent to which there is an unmet demand for compact development and alternatives to car travel. Using the survey results, a multinomial latent class model was developed to examine the preferences of households and the trade-offs they may be willing to make when choosing where to live. This type of model allows for identification of preference groups as a means of understanding the heterogeneity of preferences across the population. There was an unmet demand for accessible, medium-density housing, with some households willing to trade off dwelling size and neighbourhood type for higher accessibility or lower prices. The study also found that more people currently drive than would prefer to, with long journey times, safety concerns, unreliable services, and a lack of infrastructure acting as barriers to active and public transport. Households preferring low density are more likely to occupy their preferred dwelling type and be able to use their preferred transport mode. In contrast, those preferring high accessibility or driven by price are more likely to experience a mismatch between their preferred and current dwelling type, and are less likely to be able to use their preferred transport mode.

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  • Severe Cushing???s syndrome due to small cell prostate carcinoma: a case and review of literature

    Elston, Marianne; Crawford, VB; Swarbrick, M; Dray, Michael; Head, M; Conaglen, John (2017-06)

    Journal article
    The University of Auckland Library

    Cushing's syndrome (CS) due to ectopic adrenocorticotrophic hormone (ACTH) is associated with a variety of tumours most of which arise in the thorax or abdomen. Prostate carcinoma is a rare but important cause of rapidly progressive CS. To report a case of severe CS due to ACTH production from prostate neuroendocrine carcinoma and summarise previous published cases. A 71-year-old male presented with profound hypokalaemia, oedema and new onset hypertension. The patient reported two weeks of weight gain, muscle weakness, labile mood and insomnia. CS due to ectopic ACTH production was confirmed with failure to suppress cortisol levels following low- and high-dose dexamethasone suppression tests in the presence of a markedly elevated ACTH and a normal pituitary MRI. Computed tomography demonstrated an enlarged prostate with features of malignancy, confirmed by MRI. Subsequent prostatic biopsy confirmed neuroendocrine carcinoma of small cell type and conventional adenocarcinoma of the prostate. Adrenal steroidogenesis blockade was commenced using ketoconazole and metyrapone. Complete biochemical control of CS and evidence of disease regression on imaging occurred after four cycles of chemotherapy with carboplatin and etoposide. By the sixth cycle, the patient demonstrated radiological progression followed by recurrence of CS and died nine months after initial presentation. Prostate neuroendocrine carcinoma is a rare cause of CS that can be rapidly fatal, and early aggressive treatment of the CS is important. In CS where the cause of EAS is unable to be identified, a pelvic source should be considered and imaging of the pelvis carefully reviewed.

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  • Outcomes and Impact of Training and Development in Health Management and Leadership in Relation to Competence in Role: A Mixed-Methods Systematic Review Protocol

    Ayeleke, RO; North, Nicola; Wallis, Katharine; Liang, Z; Dunham, Annette (2016-12)

    Journal article
    The University of Auckland Library

    Background: The need for competence training and development in health management and leadership workforces has been emphasised. However, evidence of the outcomes and impact of such training and development has not been systematically assessed. The aim of this review is to synthesise the available evidence of the outcomes and impact of training and development in relation to the competence of health management and leadership workforces. This is with a view to enhancing the development of evidence-informed programmes to improve competence. Methods and Analysis: A systematic review will be undertaken using a mixed-methods research synthesis to identify, assess and synthesise relevant empirical studies. We will search relevant electronic databases and other sources for eligible studies. The eligibility of studies for inclusion will be assessed independently by two review authors. Similarly, the methodological quality of the included studies will be assessed independently by two review authors using appropriate validated instruments. Data from qualitative studies will be synthesised using thematic analysis. For quantitative studies, appropriate effect size estimate will be calculated for each of the interventions. Where studies are sufficiently similar, their findings will be combined in meta-analyses or meta-syntheses. Findings from quantitative syntheses will be converted into textual descriptions (qualitative themes) using Bayesian method. Textual descriptions and results of the initial qualitative syntheses that are mutually compatible will be combined in mixed methods syntheses. Discussion: The outcome of data collection and analysis will lead, first, to a descriptive account of training and development programmes used to improve the competence of health management and leadership workforces and the acceptability of such programmes to participants. Secondly, the outcomes and impact of such programmes in relation to participants??? competence as well as individual and organisational performance will be identified. If possible, the relationship between health contexts and the interventions required to improve management and leadership competence will be examined.

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  • Bronchiectasis exacerbation study on azithromycin and amoxycillin-clavulanate for respiratory exacerbations in children (BEST-2): Study protocol for a randomized controlled trial

    Chang, AB; Grimwood, K; Wilson, AC; van Asperen, PP; Byrnes, Catherine; O'Grady, K-AF; Sloots, TP; Robertson, CF; Torzillo, PJ; McCallum, GB; Masters, IB; Buntain, HM; Mackay, IM; Ungerer, J; Tuppin, J; Morris, PS (2013-02-20)

    Journal article
    The University of Auckland Library

    Background: Bronchiectasis unrelated to cystic fibrosis (CF) is being increasingly recognized in children and adults globally, both in resource-poor and in affluent countries. However, high-quality evidence to inform management is scarce. Oral amoxycillin-clavulanate is often the first antibiotic chosen for non-severe respiratory exacerbations, because of the antibiotic-susceptibility patterns detected in the respiratory pathogens commonly associated with bronchiectasis. Azithromycin has a prolonged half-life, and with its unique anti-bacterial, immunomodulatory, and anti-inflammatory properties, presents an attractive alternative. Our proposed study will test the hypothesis that oral azithromycin is non-inferior (within a 20% margin) to amoxycillin-clavulanate at achieving resolution of non-severe respiratory exacerbations by day 21 of treatment in children with non-CF bronchiectasis.Methods: This will be a multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel group trial involving six Australian and New Zealand centers. In total, 170 eligible children will be stratified by site and bronchiectasis etiology, and randomized (allocation concealed) to receive: 1) azithromycin (5 mg/kg daily) with placebo amoxycillin-clavulanate or 2) amoxycillin-clavulanate (22.5 mg/kg twice daily) with placebo azithromycin for 21 days as treatment for non-severe respiratory exacerbations. Clinical data and a parent-proxy cough-specific quality of life (PC-QOL) score will be obtained at baseline, at the start and resolution of exacerbations, and on day 21. In most children, blood and deep-nasal swabs will also be collected at the same time points. The primary outcome is the proportion of children whose exacerbations have resolved at day 21. The main secondary outcome is the PC-QOL score. Other outcomes are: time to next exacerbation; requirement for hospitalization; duration of exacerbation, and spirometry data. Descriptive viral and bacteriological data from nasal samples and blood inflammatory markers will be reported where available.Discussion: Currently, there are no published randomized controlled trials (RCT) to underpin effective, evidence-based management of acute respiratory exacerbations in children with non-CF bronchiectasis. To help address this information gap, we are conducting two RCTs. The first (bronchiectasis exacerbation study; BEST-1) evaluates the efficacy of azithromycin and amoxycillin-clavulanate compared with placebo, and the second RCT (BEST-2), described here, is designed to determine if azithromycin is non-inferior to amoxycillin-clavulanate in achieving symptom resolution by day 21 of treatment in children with acute respiratory exacerbations.Trial registration: Australia and New Zealand Clinical Trials Register (ANZCTR) number http://ACTRN12612000010897. http://www.anzctr.org.au/trial_view.aspx?id=347879. ?? 2013 Chang et al; licensee BioMed Central Ltd.

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  • Antibiotics for bronchiectasis exacerbations in children: rationale and study protocol for a randomised placebo-controlled trial

    Chang, AB; Grimwood, K; Robertson, CF; Wilson, AC; van Asperen, PP; O'Grady, K-AF; Sloots, TP; Torzillo, PJ; Bailey, EJ; McCallum, GB; Masters, IB; Byrnes, Catherine; Chatfield, MD; Buntain, HM; Mackay, IM; Morris, PS (2012-08-31)

    Journal article
    The University of Auckland Library

    Background: Despite bronchiectasis being increasingly recognised as an important cause of chronic respiratory morbidity in both indigenous and non-indigenous settings globally, high quality evidence to inform management is scarce. It is assumed that antibiotics are efficacious for all bronchiectasis exacerbations, but not all practitioners agree. Inadequately treated exacerbations may risk lung function deterioration. Our study tests the hypothesis that both oral azithromycin and amoxicillin-clavulanic acid are superior to placebo at improving resolution rates of respiratory exacerbations by day 14 in children with bronchiectasis unrelated to cystic fibrosis.Methods: We are conducting a bronchiectasis exacerbation study (BEST), which is a multicentre, randomised, double-blind, double-dummy, placebo-controlled, parallel group trial, in five centres (Brisbane, Perth, Darwin, Melbourne, Auckland). In the component of BEST presented here, 189 children fulfilling inclusion criteria are randomised (allocation-concealed) to receive amoxicillin-clavulanic acid (22.5 mg/kg twice daily) with placebo-azithromycin; azithromycin (5 mg/kg daily) with placebo-amoxicillin-clavulanic acid; or placebo-azithromycin with placebo-amoxicillin-clavulanic acid for 14 days. Clinical data and a paediatric cough-specific quality of life score are obtained at baseline, at the start and resolution of exacerbations, and at day 14. In most children, blood and deep nasal swabs are also collected at the same time points. The primary outcome is the proportion of children whose exacerbations have resolved at day 14. The main secondary outcome is the paediatric cough-specific quality of life score. Other outcomes are time to next exacerbation; requirement for hospitalisation; duration of exacerbation; and spirometry data. Descriptive viral and bacteriological data from nasal samples and blood markers will also be reported.Discussion: Effective, evidence-based management of exacerbations in people with bronchiectasis is clinically important. Yet, there are few randomised controlled trials (RCTs) in the neglected area of non-cystic fibrosis bronchiectasis. Indeed, no published RCTs addressing the treatment of bronchiectasis exacerbations in children exist. Our multicentre, double-blind RCT is designed to determine if azithromycin and amoxicillin-clavulanic acid, compared with placebo, improve symptom resolution on day 14 in children with acute respiratory exacerbations. Our planned assessment of the predictors of antibiotic response, the role of antibiotic-resistant respiratory pathogens, and whether early treatment with antibiotics affects duration and time to the next exacerbation, are also all novel.Trial registration: Australia and New Zealand Clinical Trials Register (ANZCTR) number ACTRN12612000011886.

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  • Molecular identification of the prey range of the invasive Asian paper wasp

    Ward, Darren; Ram??n-Laca, A (2013-11)

    Journal article
    The University of Auckland Library

    The prey range of the invasive Asian paper wasp, Polistes chinensis antennalis, was studied using molecular diagnostics. Nests of paper wasps were collected from urban residential and salt marsh habitats, larvae were removed and dissected, and DNA in the gut of the paper wasp larvae was amplified and sequenced with cytochrome c oxidase subunit I (COI). Seventy percent of samples (211/299) yielded medium-to high-quality sequences, and prey identification was achieved using BLAST searches in BOLD. A total of 42 taxa were identified from 211 samples. Lepidoptera were the majority of prey, with 39 taxa from 91% of samples. Diptera was a relatively small component of prey (three taxa, 19 samples). Conclusive species-level identification of prey was possible for 67% of samples, and genus-level identification, for another 12% of samples. The composition of prey taken was different between the two habitats, with 2.5?? more native prey species being taken in salt marsh compared with urban habitats. The results greatly extend the prey range of this invasive species. The technique is a more effective and efficient approach than relying on the collection of "prey balls", or morphological identification of prey, for the study of paper wasps.

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  • A discrete model to study reaction-diffusion-mechanics systems

    Weise, LD; Nash, Martyn; Panfilov, AV (2011-07-11)

    Journal article
    The University of Auckland Library

    This article introduces a discrete reaction-diffusion-mechanics (dRDM) model to study the effects of deformation on reaction-diffusion (RD) processes. The dRDM framework employs a FitzHugh-Nagumo type RD model coupled to a mass-lattice model, that undergoes finite deformations. The dRDM model describes a material whose elastic properties are described by a generalized Hooke's law for finite deformations (Seth material). Numerically, the dRDM approach combines a finite difference approach for the RD equations with a Verlet integration scheme for the equations of the mass-lattice system. Using this framework results were reproduced on self-organized pacemaking activity that have been previously found with a continuous RD mechanics model. Mechanisms that determine the period of pacemakers and its dependency on the medium size are identified. Finally it is shown how the drift direction of pacemakers in RDM systems is related to the spatial distribution of deformation and curvature effects.

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  • PREVIEW: PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World. Design, methods and baseline participant description of an adult cohort enrolled into a 3-year randomized clinical trial.

    Fogelholm, M; Larsen, T; Westerterp-Plantenga, M; Macdonald, I; Martinez, JA; Boyadjieva, N; Poppitt, Sally; Schlicht, W; Stratton, G; Sundvall, J; Lam, T; Jalo, E; Christensen, P; Drummen, M; Simpson, L; Navas-Carretero, S; Handjieva-Darlenska, T; Muirhead, R; Paulino Silvestre, Marta; Kahlert, D; Pastor-Sanz, L; Brand-Miller, J; Raben, A (2017-06-21)

    Journal article
    The University of Auckland Library

    Type-2 diabetes (T2D) is one of the fastest growing chronic diseases worldwide. The PREVIEW project has been initiated to find the most effective lifestyle (diet and physical activity) for the prevention of T2D, in overweight and obese participants with increased risk for T2D. The study is a three-year multi-centre, 2 ?? 2 factorial, randomised controlled trial. The impact of a high-protein, low-glycaemic index (GI) vs. moderate protein, moderate-GI diet in combination with moderate or high-intensity physical activity on the incidence of T2D and the related clinical end-points are investigated. The intervention started with a two-month weight reduction using a low-calorie diet, followed by a randomised 34-month weight maintenance phase comprising four treatment arms. Eight intervention centres are participating (Denmark, Finland, United Kingdom, The Netherlands, Spain, Bulgaria, Australia, and New Zealand). Data from blood specimens, urine, faeces, questionnaires, diaries, body composition assessments, and accelerometers are collected at months 0, 2, 6, 12, 18, 24, and 36. In total, 2326 adults were recruited. The mean age was 51.6 (SD 11.6) years, 67% were women. PREVIEW is, to date, the largest multinational trial to address the prevention of T2D in pre-diabetic adults through diet and exercise intervention. Participants will complete the final intervention in March, 2018.

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  • Cannabinoid CB1 and CB2 Receptor Signaling and Bias

    Ibsen, Mikkel; Connor, M; Glass, Michelle (2017-03-01)

    Journal article
    The University of Auckland Library

    An agonist that acts through a single receptor can activate numerous signaling pathways. Recent studies have suggested that different ligands can differentially activate these pathways by stabilizing a limited range of receptor conformations, which in turn preferentially drive different downstream signaling cascades. This concept, termed ???biased signaling??? represents an exciting therapeutic opportunity to target specific pathways that elicit only desired effects, while avoiding undesired effects mediated by different signaling cascades. The cannabinoid receptors CB1 and CB2 each activate multiple pathways, and evidence is emerging for bias within these pathways. This review will summarize the current evidence for biased signaling through cannabinoid receptor subtypes CB1 and CB2.

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  • Towards improving diagnosis of memory loss in general practice: TIMeLi diagnostic test accuracy study protocol

    Creavin, ST; Cullum, Sarah; Haworth, J; Wye, L; Bayer, A; Fish, M; Purdy, S; Ben-Shlomo, Y (2016-07)

    Journal article
    The University of Auckland Library

    People with cognitive problems, and their families, report distress and uncertainty whilst undergoing evaluation for dementia and perceive that traditional diagnostic evaluation in secondary care is insufficiently patient centred. The James Lind Alliance has prioritised research to investigate the role of primary care in supporting a more effective diagnostic pathway, and the topic is also of interest to health commissioners. However, there are very few studies that investigate the accuracy of diagnostic tests for dementia in primary care.We will conduct a prospective diagnostic test accuracy study to evaluate the accuracy of a range of simple tests for diagnosing all-cause-dementia in symptomatic people aged over 70??years who have consulted with their general practitioner (GP). We will invite eligible people to attend a research clinic where they will undergo a range of index tests that a GP could perform in the surgery and also be assessed by a specialist in memory disorders at the same appointment. Participating GPs will request neuroimaging and blood tests and otherwise manage patients in line with their usual clinical practice. The reference standard will be the consensus judgement of three experts (neurologist, psychiatrist and geriatrician) based on information from the specialist assessment, GP records and investigations, but not including items in the index test battery. The target condition will be all-cause dementia but we will also investigate diagnostic accuracy for sub-types where possible. We will use qualitative interviews with patients and focus groups with clinicians to help us understand the acceptability and feasibility of diagnosing dementia in primary care using the tests that we are investigating.Our results will help clinicians decide on which tests to perform in someone where there is concern about possible dementia and inform commissioning of diagnostic pathways.

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  • Can certified health professionals treat obesity in a community-based programme? A quasi-experimental study

    Miedema, B; Reading, Stacey; Hamilton, RA; Morrison, KS; Thompson, AE (2015-02)

    Journal article
    The University of Auckland Library

    To test the effectiveness of a non-pharmaceutical programme for obese participants in a rural Eastern Canadian Province using certified health professionals.A prospective quasi-experimental design with repeated premeasure and postmeasure.146 participants with obesity (body mass index >30???kg/m(2)) from rural and urban communities in an Eastern Canadian Province were divided into four groups.A 6-month intensive active community-based lifestyle intervention (InI) delivered by Certified Exercise Physiologists, Certified Personal Trainers and Registered Dietitians, followed by 6???months of self-management. A second intervention (InII) was nested in InI and consisted of group-mediated cognitive-behavioral intervention (GMCBI) delivered by an exercise psychologist to two of the four InI groups.(1) Improving health outcomes among the participants' preactive and postactive 6-month intervention and self-management period, (2) Documenting the impact of InII (GMCBI) and location of the intervention (urban vs rural).The 6-month active InI significantly improved cardiovascular health for participants who completed the intervention. InII (GMCBI) significantly lowered the attrition rate among the participants. The self-management period was challenging for the participants and they did not make further gains; however, most were able to maintain the gains achieved during the active intervention. The location of the intervention, urban or rural, had little impact on outcomes.A community-based programme utilising healthcare professionals other than physicians to treat obese patients was effective based on premeasure and postmeasure. During the self-management phase, the participants were able to maintain the gains. Psychological support is essential to participant retention.

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