96,019 results

  • The Role of Dietary Histone Deacetylases (HDACs) Inhibitors in Health and Disease

    Bassett, S; Barnett, Matthew (2014-10-15)

    Journal article
    The University of Auckland Library

    Modification of the histone proteins associated with DNA is an important process in the epigenetic regulation of DNA structure and function. There are several known modifications to histones, including methylation, acetylation, and phosphorylation, and a range of factors influence each of these. Histone deacetylases (HDACs) remove the acetyl group from lysine residues within a range of proteins, including transcription factors and histones. Whilst this means that their influence on cellular processes is more complex and far-reaching than histone modifications alone, their predominant function appears to relate to histones; through deacetylation of lysine residues they can influence expression of genes encoded by DNA linked to the histone molecule. HDAC inhibitors in turn regulate the activity of HDACs, and have been widely used as therapeutics in psychiatry and neurology, in which a number of adverse outcomes are associated with aberrant HDAC function. More recently, dietary HDAC inhibitors have been shown to have a regulatory effect similar to that of pharmacological HDAC inhibitors without the possible side-effects. Here, we discuss a number of dietary HDAC inhibitors, and how they may have therapeutic potential in the context of a whole food.

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  • Changes in Composition of Caecal Microbiota Associated with Increased Colon Inflammation in Interleukin-10 Gene-Deficient Mice Inoculated with Enterococcus Species

    Bassett, S; Young, W; Barnett, Matthew; Cookson, A; McNabb, W; Roy, N (2015-03-11)

    Journal article
    The University of Auckland Library

    Human inflammatory bowel disease (IBD) is a chronic intestinal disease where the resident microbiota contributes to disease development, yet the specific mechanisms remain unclear. Interleukin-10 gene-deficient (Il10-/-) mice develop inflammation similar to IBD, due in part to an inappropriate response to commensal bacteria. We have previously reported changes in intestinal morphology and colonic gene expression in Il10-/- mice in response to oral bacterial inoculation. In this study, we aimed to identify specific changes in the caecal microbiota associated with colonic inflammation in these mice. The microbiota was evaluated using pyrotag sequencing, denaturing gradient gel electrophoresis (DGGE) and quantitative real-time PCR. Microbiota profiles were influenced by genotype of the mice and by bacterial inoculation, and a strong correlation was observed between the microbiota and colonic inflammation scores. Although un-inoculated Il10-/- and C57 mice had similar microbiota communities, bacterial inoculation resulted in different changes to the microbiota in Il10-/- and C57 mice. Inoculated Il10-/- mice had significantly less total bacteria than un-inoculated Il10-/- mice, with a strong negative correlation between total bacterial numbers, relative abundance of Escherichia/Shigella, microbiota diversity, and colonic inflammation score. Our results show a putative causative role for the microbiota in the development of IBD, with potentially key roles for Akkermansia, or for Bacteroides, Helicobacter, Parabacteroides, and Alistipes, depending on the composition of the bacterial inoculum. These data support the use of bacterially-inoculated Il10-/- mice as an appropriate model to investigate human IBD.

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  • Modulation of Genetic Associations with Serum Urate Levels by Body-Mass-Index in Humans

    Huffman, JE; Albrecht, E; Teumer, A; Mangino, M; Kapur, K; Johnson, T; Kutalik, Z; Pirastu, N; Pistis, G; Lopez, LM; Haller, T; Salo, P; Goel, A; Li, M; Tanaka, T; Dehghan, A; Ruggiero, D; Malerba, G; Smith, AV; Nolte, IM; Portas, L; Phipps-Green, A; Boteva, L; Navarro, P; Johansson, A; Hicks, AA; Polasek, O; Esko, T; Peden, JF; Harris, SE; Murgia, F; Wild, SH; Tenesa, A; Tin, A; Mihailov, E; Grotevendt, A; Gislason, GK; Coresh, J; D'Adamo, P; Ulivi, S; Vollenweider, P; Waeber, G; Campbell, S; Kolcic, I; Fisher, K; Viigimaa, M; Metter, JE; Masciullo, C; Trabetti, E; Bombieri, C; Sorice, R; D??ring, A; Reischl, E; Strauch, K; Hofman, A; Uitterlinden, AG; Waldenberger, M; Wichmann, HE; Davies, G; Gow, AJ; Dalbeth, Nicola; Stamp, L; Smit, JH; Kirin, M; Nagaraja, R; Nauck, M; Schurmann, C; Budde, K; Farrington, SM; Theodoratou, E; Jula, A; Salomaa, V; Sala, C; Hengstenberg, C; Burnier, M; M??gi, R; Klopp, N; Kloiber, S; Schipf, S; Ripatti, S; Cabras, S; Soranzo, N; Homuth, G; Nutile, T; Munroe, PB; Hastie, N; Campbell, H; Rudan, I; Cabrera, C; Haley, C; Franco, OH; Merriman, TR; Gudnason, V; Pirastu, M; Penninx, BW; Snieder, H; Metspalu, A; Ciullo, M; Pramstaller, PP; van Duijn, CM; Ferrucci, L; Gambaro, G; Deary, IJ; Dunlop, MG; Wilson, JF; Gasparini, P; Gyllensten, U; Spector, TD; Wright, AF; Hayward, C; Watkins, H; Perola, M; Bochud, M; Kao, WH; Caulfield, M; Toniolo, D; V??lzke, H; Gieger, C; K??ttgen, A; Vitart, V (2015)

    Journal article
    The University of Auckland Library

    We tested for interactions between body mass index (BMI) and common genetic variants affecting serum urate levels, genome-wide, in up to 42569 participants. Both stratified genome-wide association (GWAS) analyses, in lean, overweight and obese individuals, and regression-type analyses in a non BMI-stratified overall sample were performed. The former did not uncover any novel locus with a major main effect, but supported modulation of effects for some known and potentially new urate loci. The latter highlighted a SNP at RBFOX3 reaching genome-wide significant level (effect size 0.014, 95% CI 0.008-0.02, Pinter= 2.6 x 10-8). Two top loci in interaction term analyses, RBFOX3 and ERO1LB-EDARADD, also displayed suggestive differences in main effect size between the lean and obese strata. All top ranking loci for urate effect differences between BMI categories were novel and most had small magnitude but opposite direction effects between strata. They include the locus RBMS1-TANK (men, Pdifflean-overweight= 4.7 x 10-8), a region that has been associated with several obesity related traits, and TSPYL5 (men, Pdifflean-overweight= 9.1 x 10-8), regulating adipocytes-produced estradiol. The top-ranking known urate loci was ABCG2, the strongest known gout risk locus, with an effect halved in obese compared to lean men (Pdifflean-obese= 2 x 10-4). Finally, pathway analysis suggested a role for N-glycan biosynthesis as a prominent urate-associated pathway in the lean stratum. These results illustrate a potentially powerful way to monitor changes occurring in obesogenic environment.

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  • Estimating striae of Retzius periodicity nondestructively using partial counts of perikymata

    McFarlane, Gina; Littleton, Judith; Floyd, Bruce (2014-06)

    Journal article
    The University of Auckland Library

    Accurate age estimations for enamel formation and the timing of enamel hypoplasia have traditionally only been available through histological analyses of dental thin sections, which is a difficult and destructive process. However, an association between striae of Retzius periodicity, crucial for accurate aging, and the total number of striae in imbricational enamel has been reported in the literature. This means periodicity can be estimated nondestructively but is reliant on all perikymata being visible along the crown surface. Therefore, crowns with worn or damaged surfaces may not be able to be assessed, potentially limiting sample sizes. We tested this relationship in a modern New Zealand sample and investigated whether reliable associations might be identified using only partial perikymata counts from the cervical half of the crown. Using mandibular canines (n = 11), the distribution of perikymata per decile was recorded using high definition replica surfaces. Thin sections of the same crowns were used to assess periodicity histologically along with striae of Retzius distributions. A strong correlation between total striae numbers and periodicity was also identified in our sample. Furthermore, we report strong correlations that allow periodicity to be estimated from perikymata counts using only 10% of crown height when certain deciles are used. Based on these findings, we propose a simple matrix that can be developed for nondestructively estimating periodicity based on the range of perikymata counts in the sixth to ninth deciles. ?? 2014 Wiley Periodicals, Inc.

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  • Tuberous Sclerosis Australia: a case study of a maturing patient-driven organisation

    Stuart, CP (2016)

    Journal article
    The University of Auckland Library

    Purpose ??? Tuberous Sclerosis Australia (TSA) is a small rare disease organisation with a large scope. TSA was established in 1981 as a peer support organisation. Since then, its role has evolved to meet the needs of its members: individuals living with tuberous sclerosis complex (TSC), their families and health professionals. The paper aims to discuss these issues. Design/methodology/approach ??? This case study describes the diverse activities of TSA which include, but are not limited to: the provision of information and support services; sponsorship of research and fostering a network of TSC health professionals. The benefits of collaborations forged under the umbrella organisation TSC International are highlighted. Findings ??? The case study demonstrates some of the key challenges TSA faces, challenges shared by many similar health charities. These include: funding of health education and promotion activities; working with a large range of health professionals and the challenge of research fatigue. Originality/value ??? There is little research published describing the work of small disease specific organisations similar to TSA. This case study provides insight for those collaborating with similar organisations including health professionals and researchers.

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  • Bilateral priming accelerates recovery of upper limb function after stroke: A randomized controlled trial

    Stinear, Cathy; Petoe, MA; Anwar, S; Barber, Peter; Byblow, Winston (2014-01)

    Journal article
    The University of Auckland Library

    Background and Purpose???The ability to live independently after stroke depends on the recovery of upper limb function. We hypothesized that bilateral priming with active???passive movements before upper limb physiotherapy would promote rebalancing of corticomotor excitability and would accelerate upper limb recovery at the subacute stage. Methods???A single-center randomized controlled trial of bilateral priming was conducted with 57 patients randomized at the subacute stage after first-ever ischemic stroke. The PRIMED group made device-assisted mirror symmetrical bimanual movements before upper limb physiotherapy, every weekday for 4 weeks. The CONTROL group was given intermittent cutaneous electric stimulation of the paretic forearm before physiotherapy. Assessments were made at baseline, 6, 12, and 26 weeks. The primary end point was the proportion of patients who reached their plateau for upper limb function at 12 weeks, measured with the Action Research Arm Test. Results???Odds ratios indicated that PRIMED participants were 3?? more likely than controls to reach their recovery plateau by 12 weeks. Intention-to-treat and per-protocol analyses showed a greater proportion of PRIMED participants achieved their plateau by 12 weeks (intention to treat, ??2=4.25; P=0.039 and per protocol, ??2=3.99; P=0.046). ANOVA of per-protocol data showed PRIMED participants had greater rebalancing of corticomotor excitability than controls at 12 and 26 weeks and interhemispheric inhibition at 26 weeks (all P<0.05). Conclusions???Bilateral priming accelerated recovery of upper limb function in the initial weeks after stroke.

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  • Neither Ghettoed Nor Cosmopolitan - A Study of Western Women's Perceptions of Gender and Cultural Stereotyping in the UAE

    Hutchings, K; Michailova, Snejina; Harrison, EC (2013-04)

    Journal article
    The University of Auckland Library

    This research examined Western women in the United Arab Emirates (UAE) and whether they perceived there to have been gender and cultural stereotyping towards them, and if they exemplified a new breed of cosmopolitan expatriates or the more traditional experience of living within expatriate bubbles. The study was based on semi-structured interviews with 27 expatriate females from Australia, New Zealand, the United Kingdom and the United States working in the UAE. The female expatriates studied did not perceive gender and cultural stereotyping at work, but identified stereotyping as occurring in the non-work context; some of which resulted from the women engaging in auto-stereotyping. Additionally, the women neither lived within ghettoes in the UAE but nor could they be viewed as truly cosmopolitan; suggesting that expatriates' working and living experiences need to be understood as operating on a continuum. ?? 2012 Gabler Verlag.

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  • Genetic markers of repolarization and arrhythmic events after acute coronary syndromes

    Earle, Nicola; Poppe, Katrina; Pilbrow, AP; Cameron, VA; Troughton, RW; Skinner, JR; Love, Donald; Shelling, Andrew; Whalley, Gillian; Ellis, CJ; Richards, AM; Doughty, Robert (2015-04)

    Journal article
    The University of Auckland Library

    BACKGROUND: There is a genetic contribution to the risk of ventricular arrhythmias in survivors of acute coronary syndromes (ACS). We wished to explore the role of 33 candidate single nucleotide polymorphisms (SNPs) in prolonged repolarization and sudden death in patients surviving ACS. METHODS: A total of 2,139 patients (1680 white ethnicity) surviving an admission for ACS were enrolled in the prospective Coronary Disease Cohort Study. Extensive clinical, echocardiographic, and neurohormonal data were collected for 12 months, and clinical events were recorded for a median of 5 years. Each SNP was assessed for association with sudden cardiac death (SCD)/cardiac arrest (CA) and prolonged repolarization at 3 time-points: index admission, 1 month, and 12 months postdischarge. RESULTS: One hundred six SCD/CA events occurred during follow-up (6.3%). Three SNPs from 3 genes (rs17779747 [KCNJ2], rs876188 [C14orf64], rs3864180 [GPC5]) were significantly associated with SCD/CA in multivariable models (after correction for multiple testing); the minor allele of rs17779747 with a decreased risk (hazard ratio [HR] 0.68 per copy of the minor allele, 95% CI 0.50-0.92, P = .012), and rs876188 and rs386418 with an increased risk (HR 1.52 [95% CI 1.10-2.09, P = .011] and HR 1.34 [95% CI 1.04-1.82, P = .023], respectively). At 12 months postdischarge, rs10494366 and rs12143842 (NOS1AP) were significant predictors of prolonged repolarization (HR 1.32 [95% CI 1.04-1.67, P = .022] and HR 1.30 [95% CI 1.01-1.66, P = .038], respectively), but not at earlier time-points. CONCLUSION: Three SNPs were associated with SCD/CA. Repolarization time was associated with variation in the NOS1AP gene. This study demonstrates a possible role for SNPs in risk stratification for arrhythmic events after ACS.

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  • Pharmacology of Valinate and tert-Leucinate Synthetic Cannabinoids 5F-AMBICA, 5F-AMB, 5F-ADB, AMB-FUBINACA, MDMB-FUBINACA, MDMB-CHMICA, and Their Analogues

    Banister, SD; Longworth, M; Kevin, R; Sachdev, S; Santiago, M; Stuart, J; Mack, JB; Glass, Michelle; McGregor, IS; Connor, M; Kassiou, M (2016-09-21)

    Journal article
    The University of Auckland Library

    Indole and indazole synthetic cannabinoids (SCs) featuring l-valinate or l-tert-leucinate pendant group have recently emerged as prevalent recreational drugs, and their use has been associated with serious adverse health effects. Due to the limited pharmacological data available for these compounds, 5F-AMBICA, 5F-AMB, 5F-ADB, AMB-FUBINACA, MDMB-FUBINACA, MDMB-CHMICA, and their analogues were synthesized and assessed for cannabimimetic activity in vitro and in vivo. All SCs acted as potent, highly efficacious agonists at CB1 (EC50 = 0.45-36 nM) and CB2 (EC50 = 4.6-128 nM) receptors in a fluorometric assay of membrane potential, with a general preference for CB1 activation. The cannabimimetic properties of two prevalent compounds with confirmed toxicity in humans, 5F-AMB and MDMB-FUBINACA, were demonstrated in vivo using biotelemetry in rats. Bradycardia and hypothermia were induced by 5F-AMB and MDMB-FUBINACA doses of 0.1-1 mg/kg (and 3 mg/kg for 5F-AMB), with MDMB-FUBINACA showing the most dramatic hypothermic response recorded in our laboratory for any SC (>3 ??C at 0.3 mg/kg). Reversal of hypothermia by pretreatment with a CB1, but not CB2, antagonist was demonstrated for 5F-AMB and MDMB-FUBINACA, consistent with CB1-mediated effects in vivo. The in vitro and in vivo data indicate that these SCs act as highly efficacious CB receptor agonists with greater potency than ??(9)-THC and earlier generations of SCs.

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  • Complex formation equilibria of Cu2+ and Zn2+ with Irbesartan and Losartan

    Lachowicz, JI; Nurchi, VM; Crisponi, G; Jaraquemada-Pelaez, MDG; Caltagirone, C; Peana, M; Zoroddu, MA; Szewczuk, Z; Cooper, Garth (2017-01-15)

    Journal article
    The University of Auckland Library

    We conducted a thorough study of Cu2 + complex formation equilibria with Irbesartan and Losartan, the two primary drugs for the cure of cardiovascular diseases, with the aim of recognising if these drugs could exert a chelating action towards Cu2 +. We used different complementary techniques to gain a clear picture of the involved protonation and complexation equilibria. The low solubility in water of the ligands and of the formed metal complexes prevented the use of water as solvent, so we had to perform the measurements in mixed methanol-water solvents. Further, we studied the related equilibria with Zn2 + for evaluating a potential interference of this essential metal ion, largely present in biological fluids. Our study provided a strong evaluation of the formed complexes and of the relative stability constants. The binding of both metal ions takes place through the tetrazole moiety except for the Zn2 +-Irbesartan system. In this last case, NMR measurements gave evidence of a tautomeric equilibrium involving the imidazole ring and the aliphatic chain. The estimated complexation model, and the related stability constants, allowed a speciation study in human plasma, based on a number of simplifying assumptions, which remarked that both drugs, Losartan and Irbesartan, could exert a chelating action, scavenging non-negligible amounts of Cu2 + from the organism.

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  • Surgical control and margin status after robotic and open cystectomy in high-risk cases: Caution or equivalence?

    Sharma, P; Zargar Shoshtari, Kamran; Poch, MA; Pow-Sang, JM; Sexton, WJ; Spiess, PE; Gilbert, SM (2017-04)

    Journal article
    The University of Auckland Library

    The benefits of robotic-assisted radical cystectomy (RARC) are unclear, especially in patients with high-risk disease (pT3/T4). We evaluated pathological and postoperative outcomes of RARC versus open radical cystectomy (ORC) in these patients.We identified bladder cancer patients treated with RARC or ORC from January 2010-August 2014. Clinicodemographic factors were examined for potential confounding. Our primary outcome of interest was positive soft-tissue surgical margins (STSMs). Secondary outcomes included post-operative complications and length of stay (LOS). We used logistic regression to define the association between clinical factors with outcomes of interest, focusing on patients with locally advanced disease.We identified 472 patients treated with ORC (407, 86.2??%) or RARC (65, 13.8??%) of which 215 (45.6??%) were high-risk cases based on advanced pathologic stage (pT3/4). RARC patients were more commonly men (96.9 vs. 73.2??%, p???0.01), had better performance status (ECOG??0, 78.5 vs. 59.7??%, p??=??0.031), and received less neoadjuvant chemotherapy (21.5 vs. 39.3??%, p??=??0.006). Total (52.3 vs. 59.7??%, p??=??0.26) and high-grade complication rates (13.8 vs. 19.7??%, p??=??0.27) were similar, but median LOS was shorter after RARC (6 vs. 7??days, p???0.01). On multivariate analysis, prior pelvic radiation (OR: 4.78, 95??% CI: 2.16-10.57), and advanced tumor stage (OR: 3.06, 95??% CI: 1.56-6.03) were independently associated with positive STSMs in high-risk patients but robotic surgical approach was not (OR: 0.81, 95??% CI: 0.29-2.30; p??=??0.69).RARC had similar short-term postoperative outcomes compared to ORC and did not compromise oncological control in patients with extravesical disease.

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  • Primary prevention of suicide and suicidal behaviour for adolescents in school settings

    Macleod, E; Nada-Raja, S; Beautrais, A; Shave, R; Jordan-Cole, Vanessa (2015-12-03)

    Journal article
    The University of Auckland Library

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  • Impact of the Kaik??ura earthquake on the electrical power system infrastructure

    Liu, Yang; Nair, Nirmal-Kumar; Renton, A; Wilson, S (2017-06)

    Journal article
    The University of Auckland Library

    This paper summarizes the impact the 2016 Kaik??ura earthquakes have had on electrical transmission and distribution infrastructure performance. It also provides background context to the distribution network operator???s (i.e. MainPower???s) prior earthquake preparedness following the 2010 earthquakes in the region.

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  • Review of the book: Death and Dying in the Working Class, 1865???1920, by Michael K. Rosenow

    Taillon, Paul (2016-06-01)

    Unclassified
    The University of Auckland Library

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  • Is it time for airway management education to be mandatory?

    Baker, Paul; Feinleib, J; O'Sullivan, EP (2016-09)

    Journal article
    The University of Auckland Library

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  • Percutaneous emergency airway access; prevention, preparation, technique and training

    Kristensen, MS; Teoh, WHL; Baker, Paul (2015-03)

    Journal article
    The University of Auckland Library

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  • High-involvement work processes, work intensification and employee well-being: a study of New Zealand worker experiences

    Macky, K; Boxall, Peter (2008)

    Journal article
    The University of Auckland Library

    High-involvement work processes are at the heart of the current interest in high-performance work systems. A study of 775 New Zealand employees shows that greater experience of high-involvement processes is associated with higher job satisfaction. To a lesser extent, there are also better outcomes in terms of job-induced stress, fatigue and work???life imbalance. However, in situations where pressures to work longer hours are higher, where employees feel overloaded and where managers place stronger demands on personal time, employees are likely to experience greater dissatisfaction with their jobs, higher stress and fatigue, and greater work???life imbalance. Increasing the availability of work???life balance policies for employees was not found to ameliorate these relationships. The study implies that organizations that can foster smarter working without undue pressures to work harder are likely to enhance employee well-being.

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  • Evaluation of a crystalline nanosuspension: polymorphism, process induced transformation and in vivo studies.

    Sharma, P; Zujovic, ZD; Bowmaker, Graham; Marshall, Andrew; Denny, William; Garg, Sanjay (2011-04-15)

    Journal article
    The University of Auckland Library

    The aim of this work was to evaluate a crystalline nanosuspension of an investigational anticancer compound, SN 30191. Solid forms of SN 30191 were prepared and characterized by thermal analysis, infrared spectroscopy, ????C CP/MAS SSNMR spectroscopy, SEM and powder XRD. Wet milling was performed using a high pressure homogenizer and process induced transformations were studied as a function of time and pressure using infrared spectroscopy. Dose-toxicity and pharmacokinetics (PK) of the nanocrystal formulation were evaluated in mice after intravenous administration. SN 30191 was found to exist in two polymorphic forms (I and II) and a hydrate with an equilibrium solubility < 0.1 ??g/ml (pH 1.3-11.0, 37 ??C). Wet milling resulted in solid state transformation as a function of pressure. Form II was found to transform into form I at intermediate pressures. A further increase in pressure resulted in formation of a hydrate. The final nanosuspension consisted of SN 30191 as a hydrate. The dose-toxicity studies revealed higher tolerance (~4 times) for the nanosuspension (10 mg/kg) when compared with a solution formulation (2.5 mg/kg). Compared with solution formulation, the nanosuspension allowed the delivery of a higher dose and rendered possible the performance of PK and tissue distribution studies in animals.

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  • Battery energy storage systems: Assessment for small-scale renewable energy integration

    Nair, Nirmal-Kumar; Garimella, N (2010)

    Journal article
    The University of Auckland Library

    Concerns arising due to the variability and intermittency of renewable energy sources while integrating with the power grid can be mitigated to an extent by incorporating a storage element within the renewable energy harnessing system. Thus, battery energy storage systems (BESS) are likely to have a significant impact in the small-scale integration of renewable energy sources into commercial building and residential dwelling. These storage technologies not only enable improvements in consumption levels from renewable energy sources but also provide a range of technical and monetary benefits. This paper provides a modelling framework to be able to quantify the associated benefits of renewable resource integration followed by an overview of various small-scale energy storage technologies. A simple, practical and comprehensive assessment of battery energy storage technologies for small-scale renewable applications based on their technical merit and economic feasibility is presented. Software such as Simulink and HOMER provides the platforms for technical and economic assessments of the battery technologies respectively.

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  • A systematic review of skills transfer after surgical simulation training

    Sturn, LP; Windsor, John; Gosman, PH; Cregan, P; Hewett, PJ; Maddern, GJ (2008)

    Journal article
    The University of Auckland Library

    Objective: To determine whether skills acquired by simulationbased training transfer to the operative setting. Summary Background Data: The fundamental assumption of simulation- based training is that skills acquired in simulated settings are directly transferable to the operating room, yet little evidence has focused on correlating simulated performance with actual surgical performance. Methods: A systematic search strategy was used to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Only studies that reported on the use of simulationbased training for surgical skills training, and the transferability of these skills to the operative setting, were included. Results: Ten randomized controlled trials and 1 nonrandomized comparative study were included in this review. In most cases, simulation-based training was in addition to normal training programs. Only 1 study compared simulation-based training with patient- based training. For laparoscopic cholecystectomy and colonoscopy/ sigmoidoscopy, participants who received simulation-based training before undergoing patient-based assessment performed better than their counterparts who did not receive previous simulation training, but improvement was not demonstrated for all measured parameters.

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