96,661 results

  • In our own backyard: Investigating the health status of primary school children in Tonga

    Langridge, Fiona (2017)

    Doctoral thesis
    The University of Auckland Library

    Background Over the last two decades, much of the global child health focus has been on the reduction of the under-five mortality rate. Concurrently, children in low-resource regions with the largest populations have received most of the global attention. While this is justified, the plight of children in the primary school age group in smaller, low-resource regions such as the Pacific have been largely ignored. The aim of this thesis is to investigate the health needs of primary school children in Tonga using a culturally appropriate survey methodology. Methods This thesis includes two reviews of the literature, one retrospective and two prospective studies, and reflections on community engagement, cultural competence, and fieldwork in Tonga. a) Literature reviews: Studies of (i) primary school children???s health in low and lower middle-income countries; and then (ii) of children???s health in Tonga were identified and reviewed. b) (Study 1) Child morbidity in Tonga as described by hospital admissions for primary school aged children 2009-2013: Admissions for children aged 5-11 years to the main hospital in Tonga from Jan-2009 to Dec-2013 were described. c) (Study 2) Developing a survey for primary school children in Tonga: Using a Delphi technique and Pacific methodologies, 33 panel members reviewed two rounds of online questionnaires to determine what to include in a survey to describe the health of primary school aged children living in Tonga. d) (Study 3) Exploratory study investigating the health needs of primary school children in Tonga: From the results of Study 1 and Study 2, a survey approach was developed that included measurements of anthropometry, vision, ear health, and oral health, and questionnaires (translated into Tongan). This survey was administered to 256 children, 143 caregivers, and 20 teachers in three primary schools in Tonga. e) Community engagement and cultural competence: Pacific theory and methodologies underpin the entire process of this thesis from conception to completion, including the Fonofale model, Talanoa approach, and Kakala framework. In order to ensure this project was community led and owned, a philosophy of community engagement was followed that had service at its centre and the end goal of solidarity. The principles of humility, respect, empathy, and trust were the foundational pillars to achieve this outcome. Results Reviews: Forty studies from lower and lower middle-income countries of primary school aged children were identified and reviewed. The majority of the studies were from the African and South East Asian World Health Organization regions, with none from the Pacific. Only three studies covered the general health of children, with the remainder focussed on discrete diseases or health issues. None included non-physical aspects of health such as wellbeing, or social determinants of disease. Thirty-one published studies of child health in Tonga were identified. These studies covered single health issues including: immunisation, nutrition, rheumatic heart disease, respiratory disease and oral health. Study 1 - Child morbidity in Tonga as described by hospital admissions for primary school aged children 2009-2013: There were 1,816 admissions. The average annual admission rate was 20.2/1000 (95% CI 19.3-21.1). Hospital admission rates were higher in younger than older children (5-7 vs. 8-11 years, RR=1.28, 95% CI 1.18-1.41) and in boys than girls (RR=1.52, 95% CI 1.38-1.68). Injury and poisoning (28%), non-respiratory infectious diseases (19%), respiratory conditions (16%), abdominal/surgical conditions (13%) and dental (9%) were the most frequent admission reasons. A larger proportion of younger versus older children were hospitalised for dental (16% vs. 1%, P<0.001). Study 2 - Developing a survey for primary school children in Tonga: Panel consensus was met on a range of domains to be included in the survey method. The domains were: general demographics (80%), environment (80%), resilience and risk (88%), household economics (80%), psychological functioning (92%), social functioning (92%), physical functioning (88%), cognitive functioning (92%) and individual health conditions (84%). Of the subtopics within these domains particular importance was placed on including questions that described exposure of children to violence and abuse (93%), and on ensuring responses from the children were included. Study 3 - Exploratory study investigating the health needs of primary school children in Tonga: Four percent of the children failed vision testing, 36% failed audiology testing and 63% failed oral health screening. The prevalence of overweight was 19%. Caregivers reported respiratory symptoms (n=86, 65%), injury (n=59, 41%), pain (n=53, 40%), stomachache (n=48, 36%) and ear infection (n=39, 30%) as the most common ailments in their child. Mean health related quality of life scores were measured using the Child Health and Illness Profile-Child Edition. From the children???s reports boys had significantly lower scores for risk avoidance than girls (p = 0.0005). Children aged 5-7 versus 8-15 years had significantly lower scores for satisfaction (p = 0.0005), resilience (p = 0.016) and achievement (p = 0.002). From the caregivers??? report girls had significantly lower scores for academic performance than boys (p = 0.04). Boys had significantly lower scores for individual risk association compared to girls (p = 0.01). The children in Tonga experienced lower health related quality of life in comparison to children in the United States of America and Spain. Over 60% of caregiverss and teachers that responded felt that children are exposed to violence in Tonga and over 70% felt that neglect and abuse of children is a problem in Tonga. Five of 49 (10%) caregivers said that their child had been physically hurt by an adult in the last 12 months. Seventy-seven percent of caregiverss had smacked their child at least once in the last four weeks. Five main themes emerged regarding child maltreatment in Tonga: types of violence, parenting and discipline, causation and influences, effects and denial. Community engagement, cultural competence and reflections on field work: Within the process of engagement and field work, challenges were identified and countered. These included: participation fatigue, environmental constraints, resource constraints, health system limitations, translation of western paradigms, cultural barriers, language barriers, and experience. Successes were celebrated such as the use of technology, interdisciplinary and multidisciplinary approaches, community uptake, and cultural competence. Conclusion Tonga is a small nation in the Pacific. The health needs of its primary school aged children have not previously been an area of specific focus. The findings from this thesis outline a careful process developed to investigate the health of primary school aged children in Tonga. This thesis highlights the issues of overweight, ear/hearing health, oral health, health related quality of life and exposure to violence as important factors affecting the health and wellbeing of these children. In the Sustainable Development Goals era, there is a need to move away from just whether children survive, to how children survive. The focus on under-five mortality has been and continues to be essential. At the same time, the primary school age group is a critical time period for the development of behaviours that may put children at risk of morbidity throughout their life. It is also an accessible population due to their attendance of school and the ability to access them there. Measuring and defining health requires consideration of more than just the lack or existence of physical illness. Survival on its own is not a worthy aspiration if not partnered with a goal of thriving and being enabled to fulfil ones potential.

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  • Better Elective Waiting Times For The Surgical Outpatient Clinic

    Taneja, Ashish (2017)

    Doctoral thesis
    The University of Auckland Library

    Aim This thesis seeks to optimise the delivery of health care of patients referred to the General Surgical Outpatient Clinic with rectal bleeding. Method Patients referred to the General Surgical Outpatient Clinic at Counties Manukau Health with the presenting complaint of rectal bleeding (also regarded as minor anorectal conditions) represented a pressure point for the Department of General Surgery. The work described in this thesis is divided into three distinct sections. The first section takes a whole system approach in determining bottlenecks in the system and assessing some possible solutions. This was done, firstly by examining the trends of the current waiting list and also by performing a literature review of some of the strategies employed in other health care systems to help improve elective waiting times. This was followed by a systematic review into computer modelling systems as a means to analysing its use in the outpatient clinic setting. This provided a basis for the development of a generically constructed simulation model specific to the set-up of the outpatient clinic at CMH. The aim of the constructed simulation model was to test changes to the waiting list of outpatient clinic with hypothetical scenarios of increasing capacity through extra clinics, or through reducing unnecessary follow up appointments and of both strategies combined. The second section of the thesis investigated a patient initiated approach to follow up appointments and using General Practitioners with Specialty Interests (GPwSI). The findings from the modelling system and the systematic reviews were used to help create a clinical pathway for patients with Per Rectal (PR) bleeding. The pathway was evaluated in a quasi-randomised controlled study to look at outcomes of PR bleeding patients referred to the outpatient clinic compared to a historical cohort. The final section of the thesis investigated the validity of the generically constructed model by comparing its predictive value to real-time data. Results A literature review into strategies in health care designed to improve elective waiting times in public secondary care suggested that, while there was no onestop solution, a whole system approach was critical to any implemented strategy. The systematic review into modelling systems showed evidence of modelling system s use in improving access time via queuing theory. The prospectively constructed model analysed three hypothetical scenarios. It predicted that reducing follow up appointments would help improve waiting list at a similar rate to increasing capacity by means of an additional clinic. A systematic review into the strategy of patient initiated follow up, showed that there is merit in such a policy. However, a systematic review looking at the role of GPwSIs showed limited evidence of efficacy and raised question marks regarding their cost-effectiveness. A prospective study, implementing the concept of Patient Initiated Follow Up (PIFU)and streamlining a pathway for PR bleeding patients showed, that follow up rates for patients were much lower in the new clinic (6% vs. 45%, p<0.001). With reduced follow up appointments and the addition of a new clinic, the simulation model was tested against real data. Validity was high, for all the hypothesised scenarios, although the best match with the real data was when the model was simulated for the addition of the new clinic alone, as opposed to the combination of reduced follow up appointments and a new additional clinic. Conclusion Computer simulation modelling of a health system can help identify bottlenecks within a health system and this can be used to implement protocols and pathways that can not only streamline the delivery of care but also help optimise access to that care.

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  • Modelling peri-perceptual brain processes in a deep learning spiking neural network architecture

    Gholami Doborjeh, Zohreh; Kasabov, Nikola; Gholami Doborjeh, Maryam; Sumich, A

    Journal article
    Auckland University of Technology

    Familiarity of marketing stimuli may affect consumer behaviour at a peri-perceptual processing level. The current study introduces a method for deep learning of electroencephalogram (EEG) data using a spiking neural network (SNN) approach that reveals the complexity of peri-perceptual processes of familiarity. The method is applied to data from 20 participants viewing familiar and unfamiliar logos. The results support the potential of SNN models as novel tools in the exploration of peri-perceptual mechanisms that respond differentially to familiar and unfamiliar stimuli. Specifically, the activation pattern of the time-locked response identified by the proposed SNN model at approximately 200 milliseconds post-stimulus suggests greater connectivity and more widespread dynamic spatio-temporal patterns for familiar than unfamiliar logos. The proposed SNN approach can be applied to study other peri-perceptual or perceptual brain processes in cognitive and computational neuroscience.

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  • Operational analysis of dynamic line ratings

    Talpur, S; Lie, T; Zamora, R; Nair, NKC

    Conference item
    Auckland University of Technology

    Overhead line is an important asset for power industries. Rising demand in electricity, environmental concerns and cheaper electricity prices are some important factors behind operating the lines at their maximum potential. Replacing overhead lines and/or constructing new lines are not only expensive but also at the same time raise environmental concerns. However, rating overhead lines based on their natural capacity besides being cost effective is a technically feasible solution. In this project, the operational analysis of dynamic line ratings (DLR) is conducted to analyze potential of DLR when practically implemented across overhead line in a sub transmission network. It further guides system operators in fully utilizing the line capacity to its maximum potential. The project also investigates the impact of Flexible AC Transmission System (FACTS) device in the presence of DLR technique to control power flow from wind generators for stabilized and controlled transfer of electricity.

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  • Mitigation of residual flux for high-temperature superconductor (HTS) transformer by controlled switching of HTS breaker arc model

    Lie, T; Ullah, A; Gunawardane, K; Nair, NKC

    Conference item
    Auckland University of Technology

    AC circuit breaker's controlled switching is a popular method to reduce dielectric and thermal stresses during switching of transformers, transmission lines, reactor and shunt capacitors. The magnitude of inrush current often reaches five to nine times of rated magnetizing current and thus it affects the network stability. Particularly, it affects the superconductivity of HTS transformer. Moreover, a residual flux is developed in HTS transformer due to high inrush current. The amount of flux may increase to a very high value that has direct impact to have a very high transient inrush current. This paper presents inrush current mitigation phenomena in a single-phase HTS transformer by controlled switching of HTS breaker arc model. The inrush current phenomenon is modeled for a single-phase HTS transformer in this paper. The mitigation of inrush current is restrained to a lower level by the reclosing of a new type of arc model named HTS breaker arc model and the residual flux also minimized. The calculating method is established on the investigation of fast switching timing and characteristics of the HTS breaker arc model.

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  • Model-based mechanical ventilation: managing pulmonary disease using computation

    Chase JG; Dickson JL; Morton SE; Howe S; Kim KT; Kanangara O; Shaw GM (2017)

    Conference Contributions - Other
    University of Canterbury Library

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  • Diet composition and variability of wild Octopus vulgaris and Alloteuthis media (cephalopoda) paralarvae through a metagenomic lens

    Olmos-Pérez, L.; Roura, Á.; Pierce, G.J.; Boyer, Stephane; González, Á.F. (2018-01-23T13:30:06Z)

    Journal article
    Unitec

    The high mortality of cephalopod early stages is the main bottleneck to grow them from paralarvae to adults in culture conditions, probably because the inadequacy of the diet that results in malnutrition. Since visual analysis of digestive tract contents of paralarvae provides little evidence of diet composition, the use of molecular tools, particularly next generation sequencing (NGS) platforms, offers an alternative to understand prey preferences and nutrient requirements of wild paralarvae. In this work, we aimed to determine the diet of paralarvae of the loliginid squid Alloteuthis media and to enhance the knowledge of the diet of recently hatched Octopus vulgaris paralarvae collected in different areas and seasons in an upwelling area (NW Spain). DNA from the dissected digestive glands of 32 A. media and 64 O. vulgaris paralarvae was amplified with universal primers for the mitochondrial gene COI, and specific primers targeting the mitochondrial gene 16S gene of arthropods and the mitochondrial gene 16S of Chordata. Following high-throughput DNA sequencing with the MiSeq run (Illumina), up to 4,124,464 reads were obtained and 234,090 reads of prey were successfully identified in 96.87 and 81.25% of octopus and squid paralarvae, respectively. Overall, we identified 122 Molecular Taxonomic Units (MOTUs) belonging to several taxa of decapods, copepods, euphausiids, amphipods, echinoderms, molluscs, and hydroids. Redundancy analysis (RDA) showed seasonal and spatial variability in the diet of O. vulgaris and spatial variability in A. media diet. General Additive Models (GAM) of the most frequently detected prey families of O. vulgaris revealed seasonal variability of the presence of copepods (family Paracalanidae) and ophiuroids (family Euryalidae), spatial variability in presence of crabs (family Pilumnidae) and preference in small individual octopus paralarvae for cladocerans (family Sididae) and ophiuroids. No statistically significant variation in the occurrences of the most frequently identified families was revealed in A. media. Overall, these results provide new clues about dietary preferences of wild cephalopod paralarvae, thus opening up new scenarios for research on trophic ecology and digestive physiology under controlled conditions.

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  • A comparative study between different types of local flaps used for soft tissue reconstruction of volar thumb defect

    Thabet, W. N.; Aziz, Joseph (2018-01-16T13:30:02Z)

    Journal article
    Unitec

    Management of soft tissue defects of the thumb finger represents challenge for plastic surgeons regarding techniques, cosmetic and functional results. AIM OF STUDY: The present study was conducted to evaluate a comparison between three types of local flaps used for reconstructing soft tissue defects of the Volar aspect of the thumb, volar palmar advancement flap, heterodigital neurovascular island flap and first dorsal metacarpal artery flap. METHODS: 34 cases of soft tissue defects of the volar thumb finger were included in the study, divided into three groups, in each group a flap was used for reconstruction of soft tissue defects of the volar thumb. RESULTS: volar palmar advancement flap is performed with no donor site morbidity, is good in terms of sensation and cosmetic results, should not be used for defects more than 1.5 cm, heterodigital neurovascular flap is excelle

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  • African mothers’ experiences of raising ‘Afro-Kiwi kids’ in Aotearoa / New Zealand

    Connor, Helene; Ayallo, Irene; Elliott, Susan (2018-01-19T13:30:11Z)

    Journal article
    Unitec

    This article presents findings from qualitative research data gathered from a group of ten refugee-background and immigrant African mothers living in Auckland, Aotearoa/New Zealand. The research study—From Mama Africa to Papatūānuku: The experiences of a group of African Mothers living in Auckland—focused on the mothers’ narratives and their perceptions of their experiences of mothering within the cultural and social contexts of Aotearoa/New Zealand, and how they set about raising their ‘Afro-Kiwi kids’ (a term used by several of the women to describe their children’s dual identity) in their adopted country. Findings are specific to the cohort’s experiences and the Auckland community in which they have made new homes for themselves and their families. The role and place of African women migrants in resettlement and research into their mothering is limited, and this research was cognisant of addressing this gap in the literature. The study acknowledged the strong role women have within their families as guardians of culture and language, and an underlying rationale was to increase understanding of the ways mothers contribute to new migrant and refugee-background communities and to uncover some of the challenges they face. Identifying central themes from the narratives was a significant aspect of this research. Identifying and reporting on the themes provided an inherently flexible approach and enabled the researchers to work collaboratively with the women to make sense of and interpret the data. Themes identified included: integration, language, connections with Māori culture, cultural reproduction and mothering practices. He aroha whaerere, he potiki piri poho A mother’s love is the greatest treasure This proverb or whakatauki is a well-known saying in Māoridom and is often used to discuss the importance of mothering.

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  • Traversing the valley of glycemic control despair

    Chase JG; Dickson JL; Benyo B (2017)

    Conference Contributions - Other
    University of Canterbury Library

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  • School counselling as community work [Narrative community work in schools]

    Pizzini, Nigel; Gremillion, Helen (2018-01-12T13:30:08Z)

    Conference item
    Unitec

    This presentation explores narrative work in secondary schools as a vehicle for creating collective knowledge, and empowering young people to support one another. Narrative approaches de-privatise and deindividualise people’s experiences of difficulties, and reposition clients from “sufferer”’ of problems to “experts” on how to overcome them (White, 2007; White & Epston, 1990). Aspects of practice illustrated include “undercover” teams, which enlist a group of students to support culture change in a school (Winslade & Williams, 2012). A unique practice sitting at the intersection of narrative counselling and narrative community work will also be described, wherein helpful ideas from the counselling room about problems students experience are written into collaboratively-generated informational brochures that are made available to the school community as a whole. Via the facilitation of a school counsellor, students are thus able to share their insights and strategies (anonymously) in support of peers who may be experiencing similar problems.

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  • The life and times of Cakobau : the Bauan state to 1855

    Heasley, Murray (1983-05-24)

    Post-doctoral thesis
    University of Otago

    This thesis is divided into eleven chapters. The first of these, Sa Cadra Na Matanisiga: the acculturation of a Tui Kaba Chief, traces the major rites of passage which transformed Cakobau from a child to a Tui Kaba chief, in line to the title Vunivalu. The Second Chapter, The Origins of the Vunivalu: from Bulu to Ulunivuaka, is an investigation of the Bauan state from its mythical beginnings until the shift to Bau islet. It attempts to place Cakobau in the context of the Bauan historical experience. The Bauan Confederacy, it is argued, was built on the successful marriage of interests between the agriculturalist and the seafarer. The Third Chapter, The Epidemics: assault on the fertility cult, investigates the impact of two devastating epidemics. The writer believes that these diseases were a serious blow to Fijian perceptions of the reciprocal relationship of man and nature from which fertility flowed. Chapter Four, Inside the Confederacy: the pursuit of legitimacy, concentrates on internal Bauan politics, the difficulties encountered by any leadership to maintain a consensus and the need to engineer and survive the most complex political manoeuvres. Chapter Five, Legitimacy attained, further pursues Cakobau' s rise to power within the confederacy and his attainment of the title Vunivalu. He had become 'legitimate’ leader by ruthless methods and now had a position to secure. Chapters Six and Seven are confined to Bau's relations with the confederacies of Cakaudrove, Rewa and Verata, and the patterns of marriage and war evident to 1854. Chapter Eight, The Tongans: Bau’s mercenaries and Cakobau's nemesis, traces the careers of the Tongan brothers, Lasike and Tupou Toutai, loyal mercenaries of the Vunivalu. Their stance is compared with the more ambiguous role of their natural enemies, the Tongan King Taufa’ahau, and his supporters. Chapter Nine, The Foreigners: the observation and pursuit of Technology contrasts the activities of the traders with those of the British and American navies, and the Bauan reaction to them. Cakobau's exposure to foreign naval technology created a desire for these same tools and techniques in an attempt to consolidate and increase his power. Chapter Ten, The Lotu: new answers to old questions, focuses on the eventual decision of Cakobau to embrace Christianity, a decision which, after years of deliberation, constituted a major religious, social and political event. As duly installed Vunivalu he was in a position to redefine the moral order, a redefinition with ramifications that touched all aspects of Bauan culture. Chapter Eleven, 1855, draws together the themes developed in the preceding chapters. With Cakaudrove and Rewa neutralised as threats and with Cakobau's influence within the Bauan domain more extensive than it had ever been, his new authority apparently sanctioned by King George Taufa'ahau of Tonga and by Britain in the person of a naval captain, the Christian Vunivalu and Bau had, by September 1855, never seemed in a more powerful position. Ironically, the Americans accepted this position and in so doing posed a mortal threat to the Vunivalu and to the confederacy he represented.

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  • Creating a Modified Monopoly game for promoting students’ higher-order thinking skills and knowledge retention

    Tan Ming Kuang (2018)

    Doctoral thesis
    University of Otago

    While a deep understanding of basic accounting concepts is fundamental for students to fully comprehend the discipline, research has consistently found that students struggle with understanding accounting concepts and tend to achieve lower-order learning outcomes. New approaches are therefore needed to provide educational interventions that help students achieve learning outcomes that reflect a deep understanding of concepts and retention of them for a long period of time. Simulation games have been proven as an effective approach for promoting higher-order thinking and knowledge retention. To date, however, there has been no reliable evidence that the game approaches are effective at enhancing students’ higher-order thinking skills and knowledge retention in the accounting learning domain. The aim of this study is to modify a popular business simulation game, Monopoly™, to facilitate the acquisition of concept application skills and to investigate its effectiveness in the accounting domain. The ability to apply conceptual knowledge is classified as higher-order thinking in the revised Bloom’s taxonomy. This study uses situated learning theory, whereby a cognitive apprenticeship approach is utilised to develop a Modified Monopoly game that emphasizes 1) the use of accounting concepts in an authentic context, 2) the use of a variety of business contexts, and 3) the clarity of the game tasks. Additionally, the teacher’s role is to provide coaching, scaffolding, and fading support to students. These modifications and the active nature of the game’s activities are expected to facilitate the acquisition of concept application skills and the retention of the skills for a long period of time. To examine the effectiveness of the Modified Monopoly game developed by the author, this study involved a total of 200 accounting students from eight high schools in one of the largest cities in New Zealand. A quasi-experimental non-equivalent group design was employed, with a random assignment based on school/class and two control groups. These control groups, in which students learned the same accounting concepts, were defined as ‘the Extended Problem’ and ‘computer assisted instruction’ (CAI) groups. The Extended Problem group used a traditional paper-based approach in solving accounting scenarios, while the CAI group used computers for the given accounting scenarios. This study therefore employed three approaches: Modified Monopoly game, Extended Problem, and CAI. All the students were assessed for their cognitive ability to apply the accounting concepts at three stages. For the purposes of the assessment of conceptual knowledge, two assessment sets were developed. Each of the sets included 28 items with the same difficulty level. Prior to the application of the Modified Monopoly game, the Extended Problem, or the CAI, each student in each group was subjected to an assessment pre-test. Then a second set of assessment questions, a post-test, was given to the students in each group after they experienced learning through the three approaches. To capture the learning retention, all the students in each group were subjected to the second set of assessment questions again after a three- to six-month period (delayed post-test). The improvement scores (post-test – pre-test) and the deterioration scores (delayed post-test – post-test) were used to analyse the data of 144 students completing all the tests. The former assessed higher-order thinking skills, while the latter assessed knowledge retention. Additionally, a self-reported questionnaire asking students’ perception of the assigned approach was collected. Results showed that both the Modified Monopoly and the Extended Problem group, but not the CAI group, demonstrated significant improvement in higher-order thinking skills. The improvement scores of the Modified Monopoly group were significantly higher than the CAI group but lower than the Extended Problem group. However, students from the Modified Monopoly group did not demonstrate the level of knowledge deterioration compared with those from the Extended Problem group, suggesting that the game resulted in better knowledge retention than the Extended Problem approach. Additionally, the game groups demonstrated a significantly higher level of enjoyment and enthusiasm to continue the use of the Modified Monopoly approach than those using the Extended Problem. This study concludes that the Modified Monopoly approach is more effective for promoting higher-order thinking skills than the CAI approach and more effective than the Extended Problem for students’ knowledge retention.

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  • Antiplatelet and anticoagulant therapy in patients with acute coronary syndromes and atrial fibrillation

    Fake, Aimee Louise (2018)

    Doctoral thesis
    University of Otago

    Dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 receptor antagonist, is the standard of care following an acute coronary syndrome (ACS) presentation, and oral anticoagulation (OAC) is standard of care for stroke prevention in atrial fibrillation (AF) patients. In patients with AF who present with an ACS, it is not clear whether the combination of DAPT and OAC, known as triple therapy (TT), should be the preferred treatment strategy, or whether DAPT alone is optimal. The first two studies in this thesis examined contemporary antiplatelet/anticoagulant management in New Zealand. The first study examined management of 93 ACS patients with AF from a single-centre. We found DAPT was the preferred treatment regimen, and no TT use was observed. Decisions regarding therapy did not appear to be based on assessments of stroke or bleeding risk. In the second study, we utilised the national ANZACS-QI registry, and examined pharmacy prescription data for 610 ACS patients who underwent percutaneous coronary intervention (PCI) with a history of AF. In this cohort DAPT was again the most common discharge regimen followed by TT, and their use was not driven by stroke risk (CHA2DS2VASc scores). Rates of DAPT and TT declined markedly over the 12 months following the ACS event. On the basis of these two studies we concluded that no consistent treatment strategy was evident for the management of ACS patients with AF. A systematic literature review was then undertaken to identify optimal therapy. We selected papers describing treatment regimens and one-year outcomes for patients with AF and either ACS or PCI. The inclusion of stable PCI patients was necessary as the majority of literature featured mixed cohorts of ACS or stable coronary disease undergoing PCI. The identified literature was entirely observational in nature and the overall quality was poor. The largest studies reported that TT offered significant reductions in stroke over DAPT, and a consistent increase in bleeding associated with TT was reported. On the basis that the available literature did not offer clear guidance on when the benefits associated with stroke reduction with TT would be greater than the harm associated with excess bleeding, we constructed a decision analysis model. This model addressed likely thresholds at which TT stroke reduction may exceed harm from bleeding. Under most modelled scenarios TT was not preferred above DAPT at CHA2DS2VASc 2, and only outperformed DAPT when stroke risk was high in the CHA2DS2VASc 3-5 range. Given the importance of bleeding in determining the net clinical benefit of DAPT versus TT we examined how accurately bleeding events could be predicted in a cohort of 1000 acute myocardial infarction patients. We examined the ACS bleeding scores CRUSADE and ACTION as well as low platelet reactivity (LPR) to predict one-year TIMI major and minor bleeding. We found that neither score nor LPR accurately predicted one-year bleeding events. The clinical problem of optimal antiplatelet/anticoagulant therapy in ACS patients with AF remains significant. Our data suggests that at low stroke risks DAPT is probably the treatment of choice, with TT becoming more acceptable at higher stroke risk. Accurate classification of bleeding risk in this population is needed to minimise potential harms associated with TT.

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  • Martial Epigrammata, Book X : a commentary

    Francis, Charlotte Cecilia Macara (2007-04-19)

    Post-doctoral thesis
    University of Otago

    This thesis represents the first full-scale commentary on Book 10 of Martial's Epigrams. Jenkins' commentary on Book 10, a thesis from Cambridge in 1982, is the other detailed commentary on Book 10, but examines only 23 of the 104 epigrams from the book, selected according to significance or as being representative of broad categories and themes. My primary purpose is to present a literary analysis of the complete book, taking into account the literary tradition, and explaining the poems from a historical, social and political perspective. Most commentaries follow a traditional approach where the focus is investigation of the philological aspects of each epigram. These commentaries in their analysis of individual poems often fail to provide insight into Martial's literary intentions for a particular poem, and the book as a coherent whole is generally not taken into consideration. My commentary provides an exploration of programmatic and structural issues which contribute to the book's thematic continuity and unity. Aspects for consideration include the function and application of themes and motifs throughout the book, interrelationships of poems and their position within the book. Examination of these features is fundamental towards understanding Martial's literary objectives in Book 10.

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  • Modelling the New Zealand artist : Rita Angus & Colin McCahon

    Lummis, Richard Graeme (2004-12-11)

    Post-doctoral thesis
    University of Otago

    This thesis examines the problem of modelling, and the problematical models of, two New Zealand artists: Rita Angus and Colin McCahon. The primary concern is not the art but rather the cultural construction of these figures and their work - how they represented themselves and how they have been modelled by the shifting forces of history, ideology, and cultural authority. The discussion begins with a survey of the artwriting discourses that represent Angus's life and work during 1930s and 1940s, and it explores some of the factors that shape these texts and the problems they present. Then, by way of some new evidence, the dissertation unsettles the conventional narratives that generally appear in writings about the artist, her work, and her cultural milieu. Attention is also trained on the actions, verdicts and prescriptions of the writers, poets and intellectuals who became increasingly involved in the composition of art criticism in the late 1940s. These commentators attempted to discipline and refocus Angus's project, but she objected to their appraisals and aspirations, and even their interest in her work. Her protests had some remarkable effects on her career, and on the way in which others modelled her in the public domain. An analysis of her dissenting voice also offers much information about her own model of the artist. Finally, the discussion also examines two influential models of Angus as a symbolic painter, and suggests they are implausible. From the initial phase of his cultural invention onwards, McCahon has often been modelled as the New Zealand artist. A major concern is to establish how and why this artist became such a dominant figure. Because the construction ofMcCahon took place in the absence of a supportive artworld infrastructure, the text seeks to establish how such a fundamental impediment affected, conditioned and enabled his invention as a prominent public artist. The dissertation also examines the implications of his role as a curator and Deputy Director at the Auckland City Art Gallery, and argues that there are causal connections between this influential position and his growing stature as a painter. It will also become apparent that his experience as an artist informed his attempts to remodel the local artworld and its support systems through the Gallery's policies and programmes. Another powerful factor in the modelling of McCahon is the artist's representation of himself and his project. The text sets out to analyse the nature, complexity and effects of his autobiographical performances, and it will identify the historical and cultural conditions to which these writings respond.

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  • "The Southern World is My Home": The Working Life of Thomas Ferens 1848 - 1888

    Ferens-Green, Peita Kate (2018)

    Masters thesis
    University of Otago

    This thesis is a case study of Thomas Ferens, a Methodist lay preacher from England. Utilising personal testimony, it follows his life in New Zealand from 1848 – 1888, focussing upon his various occupational pursuits to explore how his sense of ‘self’ affected his migrant experience, analysing how he navigated life in the settlement, and how he was influenced by the world around him. Typically, migrant scholars using personal testimony focus on those of a (literate) middle to upper class status. A focus on Ferens, however, provides a working-class perspective. He similarly offers a perspective on Methodists in the Scottish Presbyterian Otago settlement. This work engages with studies of missionaries, religion in New Zealand, intercultural relations and constructs of self/other. It also addresses the impact of runholding and declaration of hundreds in North Otago and the need for personal mobility, both geographical and occupational, in this early period of settlement.

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  • Narrating transgressions in adolescence: a longitudinal study

    de Brelaz, Georgina (2018)

    Masters thesis
    University of Otago

    The relationship between parent-child elaborative reminiscing and children’s socioemotional development is well-established (see Salmon & Reese, 2016 for a review). In particular, a previous longitudinal study trained mothers to reminisce more elaboratively with their toddlers (Reese & Newcombe, 2007). This is a follow-up study of that sample which focused on 15-year-olds’ narratives of transgression events. It addressed three questions: 1) How are adolescents in New Zealand narrating their transgressions?; 2) To what extent do adolescents’ narratives of transgressions vary as a function of their mothers’ intervention condition and as a function of their own gender?; and 3) How do adolescents’ narratives of transgressions vary as a function of early childhood conversations about misbehaviours with mothers? Data were analysed both quantitatively and qualitatively. Overall, adolescents narrated ‘mild’ transgressions yet included a great deal of emotional detail. The coherence of their narratives was typical for their age. There were overall effects for both intervention and gender on adolescents’ narratives. Adolescents whose mothers were trained to reminisce more elaboratively told more coherent narratives and explained their emotions more than did adolescents in the control condition. There were also associations between gender and narrative coherence and emotion talk, with adolescent girls telling more coherent narratives and including more emotion talk in their narratives than boys. Significant associations were found between mother-child conversations about misbehaviour in early childhood and adolescents’ narratives of transgressions. When dyads talked more about emotions and explained their emotions more in early childhood, adolescents 12 years later talked more about emotions, explained emotions more and talked more positively about themselves and others. This pattern was stronger for participants in the intervention condition and particularly for boys. Emotion talk and narrative coherence are known to be linked to well-being, hence these findings and their clinical application are worthy of further investigation.

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  • Regulation of the human topoisomerase IIℓ: a thesis presented to Massey University in partial fulfilment of the requirements for the degree of Master of Science in Biochemistry

    Willingham, Melanie

    Thesis
    Massey University

    Eukaryotic DNA topoisomcrase II is a ubiquitous nuclear enzyme essential for maintaining the correct conformation of DNA. The enzyme acts to catalyse changes in the tertian structure of DNA. via the introduction of transient double-stranded breaks. Mammalian cells express two isoforms of type II topoisomerase. designated topoisomerase IIα and topoisomerase IIβ, which display differential expression and intracellular localisation. Levels of topoisomerase IIα gene expression are elevated in rapidly proliferating cells, whereas the β isoform is expressed at approximately equal levels throughout the cell cycle. Protein products of the two isoforms of topoisomerase II found in human cells are the primary intracellular targets of many common, effective chemotherapy drugs. The development of drug resistance, however, is a major clinical problem caused by both enzymes. The levels of topoisomerase IIα and topoisomerase IIβ are important determinants for the sensitivity of cells to the cytoxicity of drugs, with down-regulation of topoisomerase II thought to be a major factor involved in drug resistance. The rate of transcription is the main mechanism for controlling topoisomerase II expression and activity, and this is achieved by the binding of transcription factors to specific regulatory elements within the promoter sequence. Molecular mechanisms responsible for the regulation of expression of the topoisomerase II enzymes are thought to be associated with resistance to chemotherapy drugs, and therefore understanding these mechanisms is an important research focus. This study reports the cloning and characterisation of a 1.5 kb fragment of the 5'- flanking and untranslated region of the topoisomerase IIβ promoter (-1357 to +122). Analyses of 5'-serially and internally deleted lueiferase reporter constructs revealed a region upstream of the transcription start site (-1357 to -1228). which could have a negative regulatory role, and suggested 55% of topoisomerase IIβ promoter activity could be attributed to the region between -654 and -456. Mutational analysis of putative regulatory elements indicated that the two inverted CCAAT box (ICB1 and ICB2) within the latter region were important for regulation of topoisomerase IIβ promoter activity. Gel mobility shift assays indicated that both inverted CCAAT boxes in the promoter bound the transcription factor NF-Y. while ICB2 and a GC element were capable of binding transcription factors Sp1 and Sp3.

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  • Sharemarket performance and the New Zealand dollar : inside the relationships : a thesis presented in partial fulfilment of the requirements for the degree of a Master of Applied Economics, Massey University, Palmerston North, New Zealand

    Pech, Andrew

    Thesis
    Massey University

    New Zealand is often described as a small open economy with substantial foreign ownership of its assets. The economy is therefore sensitive to exchange rate movements and the sharemarket being the barometer of economic activities should be no exception. Further, exchange rates may also be endogenous to sharemarket fluctuations. This thesis analyses the relationship between the value of the New Zealand dollar vis a vis the currencies of its five largest trading partners and the New Zealand sharemarket performance between 1999 and mid-2005 using the vector autoregression (VAR) and vector error correction model (VECM) approaches. Findings from the research suggest the New Zealand sharemarket is robust to currency fluctuations in both the short- and long- term. The only exception to this is the New Zealand dollar-Australian dollar exchange rate (NZD/AUD), which has a negative short term effect on the sharemarket. The NZD/AUD is also the only exchange rate to depreciate following a positive shock to the sharemarket.

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