90,065 results

  • Functional activation of glutamate ionotropic receptors in the developing mouse retina

    Acosta Etchebarne, Monica; Chua, J; Kalloniatis, M (2007-02)

    Journal article
    The University of Auckland Library

    Ionotropic glutamate receptors have been associated with early development of the visual process by regulating cell differentiation, cell motility, and synaptic contacts. We determined the expression of functional ionotropic glutamate receptors during development of the mouse retina by assessing 1-amino-4-guanidobutane (agmatine; AGB) immunolabelling after application of a range of glutamate analogs. Colocalization of AGB with calretinin and islet-1 allowed the identification of functional receptors in neurochemically defined neurons. Activation with kainate (KA), ??-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), and N-methyl-D-aspartate (NMDA) resulted in AGB entry into neurons consistent with that found previous receptor subunit localization studies in the developing retina. Temporal analysis revealed that application of 50 ??M KA activated receptors as early as embryonic day 18 in the ventricular zone and in the ganglion cell layer, whereas 30 ??M AMPA activated cells predominantly in the ganglion cell layer. Cholinergic amacrine cells showed functional KA and AMPA receptors upon their insertion into the conventional amacrine cell layer from postnatal day 1 (P1). OFF cone bipolar cells showed functional KA receptors from P6, at a developmental age when they are known to make contact with ganglion cells. NMDA activation led to diffuse AGB labeling at birth among cells in the ganglion cell layer, whereas, at P1, regularly spaced cholinergic amacrine cells in the conventional amacrine cell layer started to be responsive to NMDA. Non-NMDA receptors were first to show functional activation in the developing retina, and cholinergic amacrine cells displayed functional ionotropic glutamate receptors after reaching their final destination.

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  • The rotating spot method of timing subjective events

    Pockett, Susan; Miller, Arden (2007)

    Journal article
    The University of Auckland Library

    The rotating spot method of timing subjective events involves the subject???s watching a rotating spot on a computer and reporting the position of the spot at the instant when the subjective event of interest occurs. We conducted an experiment to investigate factors that may impact on the results produced by this method, using the subject???s perception of when they made a simple finger movement as the subjective event to be timed. Seven aspects of the rotating spot method were investigated, using a factorial experiment. Four of these aspects altered the physical characteristics of the computer generated spot or clock face and the remaining three altered the instructions given to the participant. We found compelling evidence that one factor, whether the subject was instructed to report the instant when the finger movement was initiated or the instant when it was completed, resulted in a systematic shift in the response. Evidence that three other factors affect the observed variability in the response was also found. In addition, we observed that there are substantial systematic differences in the responses made by different subjects. We discuss the implications of our findings and make recommendations about the optimal way of conducting future experiments using the rotating spot method. Our overall conclusion is that our results strongly validate the rotating spot method of timing at least the studied variety of subjective event.

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  • Identification and inversion of converted shear waves: case studies from the European North Atlantic continental margins

    Eccles, Jennifer; White, RS; Christie, PAF (2009-10)

    Journal article
    The University of Auckland Library

    SUMMARY Wide-angle shear wave arrivals, converted from compressional to shear waves at crustal interfaces, enable crustal Vp/Vs ratios to be determined which provide valuable constraint on geological interpretations. Analysis of the converted shear wave phases represents the next logical step in characterizing the crustal structure and composition following multichannel seismic structural imaging and tomographic inversion of the wide-angle compressional wave phases. In this offshore study across two passive margins extending from stretched continental to fully oceanic crust, the high-data density (2???10 km ocean bottom seismometer, OBS, spacing) and a consistent, efficient conversion interface produced shear wave data sets suitable for traveltime inversion. The shear waves were recorded by three orthogonal geophones in each OBS. Arrival phases, visible to 180 km offset, were identified using their arrival times, moveout velocities and particle motions. Across the North Atlantic volcanic rifted continental margins studied, breakup was accompanied by the eruption of large volumes of basalts of the North Atlantic Igneous Province. The interface between post-volcanic sediments and the top of the basalts provides the dominant conversion boundary across the oceanic crust and the continent???ocean transition. However, the shear wave data quality was significantly diminished at the continental ends of the profiles where the thick basalt flows and hence this conversion interface feathers out and crustal attenuation increases. Initial modelling of the converted shear wave phases was carried out using a layer-based approach with arrivals converted on the way up used to constrain the Vp/Vs ratio of the post-volcanic sedimentary sequence beneath each OBS. To produce a model with continuous crustal S-wave velocities, the compressional wave velocities beneath the sediment-top basalt interface were transformed into starting shear wave velocities using a constant value of Vp/Vs and the inversion carried out by specifying the appropriate ray path. Once the data set had been fully interpreted, correction of the traveltimes to effective symmetric ray paths enabled us to apply a regularized grid inversion. Such inversions are less subjective than the layer-based approach and yield more robust minimum structure results with quantifiable errors, except in the vicinity of a known subbasalt low-velocity zone encountered on the Faroes margin. Monte Carlo analyses were performed for this approach; the average model from multiple inversions using randomized starting models and traveltimes shows the structure required by the traveltimes and the model standard deviation gives an estimate of uncertainty. Model and inversion parametrizations were fully tested and optimum parameters chosen for compressional and shear wave inversions. This allows, after appropriate model smoothing, an estimate to be made of the spatial variation of the Vp/Vs ratio within the crust. There are marked gradients in Vp, Vs and Vp/Vs ratio across the continent???ocean transition, which may result from intrusion of high magnesium mafic igneous material into the crystalline continental crust. The Vp/Vs ratio, used in conjunction with Vp, also provides constraints on the subbasalt lithologies forming the low-velocity zone. We conclude from such an analysis that this zone is unlikely to be composed entirely of igneous hyaloclastite material; some proportion of clastic sedimentary rocks is likely to be present. The Vp/Vs and Vp properties of the units underlying the low-velocity zone are inconsistent with crystalline continental basement and this unit is likely to represent a sill-intruded Mesozoic sedimentary sequence from a pre-breakup sedimentary basin.

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  • Should measurement of vitamin D and treatment of vitamin D insufficiency be routine in New Zealand?

    Bolland, Mark; Grey, Andrew; Davidson, JS; Cundy, Timothy; Reid, Ian (2012-02)

    Journal article
    The University of Auckland Library

    Epidemiological studies have reported associations between lower vitamin D levels and a great variety of diseases, prompting calls for widespread treatment of individuals with low vitamin D levels. Most of New Zealand's population have vitamin D levels for at least part of the year that are considered insufficient (25-hydroxyvitamin D <25 nmol/L), such as the frail elderly, and those with specific clinical indications. Treatment for such individuals does not require vitamin D measurements. Requests for vitamin D measurements in Auckland have nearly quadrupled in the past decade, from 8500 in the year 2000 to 32,800 in 2010, with substantial increases in cost. Vitamin D measurement is often inaccurate and imprecise, and the vast majority of tests performed currently do not reveal vitamin D deficiency. Therefore, a move away from routine vitamin D measurements seems sensible, though they are still indicated when investigating suspected metabolic bone disease or hypocalcaemia.

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  • Antisense Hypoxia-Inducible Factor-1 alpha Augments Transcatheter Arterial Embolization in the Treatment of Hepatocellular Carcinomas in Rats

    Sun, Xueying; Jiang, Hongchi; Jiang, Xian; Tan, Hongtao; Meng, Qinghui; Sun, Bei; Xu, Ruian; Krissansen, Geoffrey (2009-04-01)

    Journal article
    The University of Auckland Library

    Transcatheter arterial embolization (TAE) is a standard treatment for unresectable hepatic malignancies. It blocks the arterial blood supply to the tumor, but blockade of the blood supply can be short-lived as collateral blood vessels develop, leading to the failure of TAE. Here we report that intraportal delivery of adeno-associated viral (AAV) vectors expressing antisense hypoxia-inducible factor-1 alpha (HIF-1 alpha) (AAV-ASHIF) augments TAE to combat hepatocellular carcinoma (HCC). Intraportal delivery of AAV-ASHIF led to long-term localized expression of transgenic ASHIF in rat liver, and suppressed the growth of CBRH7919 HCC tumors established in rat liver by inhibiting the formation of neovessels and tumor cell proliferation. TAE therapy caused the necrosis and shrinkage of liver tumors; however, neovessels quickly formed and the residual tumors underwent rapid expansion. TAE enhanced tumor and liver hypoxia, which in turn upregulated expression of HIF-1a, vascular endothelial growth factor, glucose transporter-1, lactate dehydrogenase A, and proliferating cell nuclear antigen. Intraportal injection of AAV-ASHIF augmented the therapeutic effects of TAE and diminished its undesirable effects, resulting in extensive tumor cell death and suppression of the growth of liver tumors. In conclusion, this study has revealed that HIF-1 impedes the response of liver tumors to TAE. Antisense HIF-1a therapy is warranted as an approach for enhancing the efficacy of TAE to treat unresectable liver cancers.

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  • Towards a climate event stratigraphy for New Zealand over the past 30 000 years (NZ-INTIMATE project)

    Alloway, Brent; Lowe, DJ; Barrell, DJ; Newnham, RM; Almond, PC; Augustinus, Paul; Bertler, NA; Carter, L; Litchfield, NJ; McGlone, MS; Shulmeister, J; Vandergoes, MJ; Williams, PW (2007)

    Journal article
    The University of Auckland Library

    It is widely recognised that the acquisition of high-resolution palaeoclimate records from southern mid-latitude sites is essential for establishing a coherent picture of inter-hemispheric climate change and for better understanding of the role of Antarctic climate dynamics in the global climate system. New Zealand is considered to be a sensitive monitor of climate change because it is one of a few sizeable landmasses in the Southern Hemisphere westerly circulation zone, a critical transition zone between subtropical and Antarctic in???uences. New Zealand has mountainous axial ranges that amplify the climate signals and, consequently, the environmental gradients are highly sensitive to subtle changes in atmospheric and oceanic conditions. Since 1995, INTIMATE has, through a series of international workshops, sought ways to improve procedures for establishing the precise ages of climate events, and to correlate them with high precision, for the last 30 000 calendar years. The NZ-INTIMATE project commenced in late 2003, and has involved virtually the entire New Zealand palaeoclimate community. Its aim is to develop an event stratigraphy for the New Zealand region over the past 30 000 years, and to reconcile these events against the established climatostratigraphy of the last glacial cycle which has largely been developed from Northern Hemisphere records (e.g. Last Glacial Maximum (LGM), Termination I, Younger Dryas). An initial outcome of NZ-INTIMATE has been the identi???cation of a series of well-dated, high-resolution onshore and offshore proxy records from a variety of latitudes and elevations on a common calendar timescale from 30 000 cal. yr BP to the present day. High-resolution records for the last glacial coldest period (LGCP) (including the LGM sensu stricto) and last glacial???interglacial transition (LGIT) from Auckland maars, Kaipo and Otamangakau wetlands on eastern and central North Island, marine core MD97-2121 east of southern North Island, speleothems on northwest South Island, Okarito wetland on southwestern South Island, are presented. Discontinuous (fragmentary) records comprising compilations of glacial sequences, ???uvial sequences, loess accumulation, and aeolian quartz accumulation in an andesitic terrain are described. Comparisons with ice-core records from Antarctica (EPICA Dome C) and Greenland (GISP2) are discussed. A major advantage immediately evident from these records apart from the speleothem record, is that they are linked precisely by one or more tephra layers. Based on these New Zealand terrestrial and marine records, a reasonably coherent, regionally applicable, sequence of climatically linked stratigraphic events over the past 30 000 cal. yr is emerging. Three major climate events are recognised: (1) LGCP beginning at ca. 28 000 cal. yr BP, ending at Termination I, ca. 18 000 cal. yr BP, and including a warmer and more variable phase between ca. 27 000 and 21 000 cal. yr BP, (2) LGIT between ca. 18 000 and 11 600 cal. yr BP, including a Lateglacial warm period from ca. 14 800 to 13 500 cal. yr BP and a Lateglacial climate reversal between ca. 13 500 and 11 600 cal. yr BP, and (3) Holocene interglacial conditions, with two phases of greatest warmth between ca. 11 600 and 10 800 cal. yr BP and from ca. 6 800 to 6 500 cal. yr BP. Some key boundaries coincide with volcanic tephras.

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  • Theorising power relationships in multi-owned residential developments: unpacking the bundle of rights

    Blandy, S; Dixon, Jennifer; Dupuis, A (2006)

    Journal article
    The University of Auckland Library

    This article foregrounds the complex connections between property and law in the multi-owned residential sites which are becoming increasingly common in many countries. Empirical research into intensive housing developments in New Zealand and gated communities in England found that, despite differences in legal structures, individual owners often expressed frustration at their lack of control over the on-going management of such developments. This article suggests an analytical framework for considering and explaining issues of power and control amongst developers, residents and managing agents of these sites. We use the concept of the ???bundle of rights??? approach to property interests and ownership to explore the importance of the right to manage. Drawing on the work of Foucault, Bourdieu, Clegg and Callon, the article tracks the transfer of power and legal rights through the critical legal events identi???ed as taking place in the process of development and sale of multi-owned residential sites. It is suggested that these analytical tools might be useful in illuminating power relationships and legal arrangements in other urban property con???gurations.

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  • Differential selection pressure exerted on HIV by CTL targeting identical epitopes but restricted by distinct HLA alleles from the same HLA supertype.

    Leslie, A; Price, DA; Mkhize, P; Bishop, Karen; Rathod, A; Day, C; Crawford, H; Honeyborne, I; Asher, T; Luzzi, G; Edwards, A; Rousseau, C; Mullins, J; Tudor-Williams, G; Novelli, V; Brander, C; Douek, D; Kiepiela, P; Walker, BD; Goulder, PJR (2006)

    Journal article
    The University of Auckland Library

    HLA diversity is seen as a major challenge to CTL vaccines against HIV. One current approach focuses on ???promiscuous??? epitopes, presented by multiple HLA alleles from within the same HLA supertype. However, the effectiveness of such supertype vaccines depends upon the functional equivalence of CTL targeting a particular epitope, irrespective of the restricting HLA. In this study, we describe the promiscuous HIV-speci???c CTL epitopes presented by alleles within the B7 supertype. Substantial differences were observed in the ability of CTL to select for escape mutation when targeting the same epitope but restricted by different HLA. This observation was common to all six promiscuous B7 epitopes identi???ed. Moreover, with one exception, there were no signi???cant differences in the frequency, magnitude, or immunodominance of the CTL responses restricted by different HLA alleles to explain these discrepancies. This suggests that the unique peptide/MHC complexes generated by even closely related HLA induce CTL responses that are qualitatively different. This hypothesis is supported by additional differences observed between CTL targeting identical epitopes but restricted by different HLA: ???rst, the occurrence of distinct, HLA-speci???c escape mutation; second, the recruitment of distinct TCR repertoires by particular peptide/MHC complexes; and, third, signi???cant differences in the functional avidity of CTL. Taken together, these data indicate that signi???cant functional differences exist between CTL targeting identical epitopes but restricted by different, albeit closely related HLA. These ???ndings are of relevance to vaccine approaches that seek to exploit HLA supertypes to overcome the problem of HLA diversity.

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  • The Effects of Treating Male Hypogonadism on Couples' Sexual Desire and Function

    Conaglen, John; Conaglen, Helen (2009-02-01)

    Journal article
    The University of Auckland Library

    Hypogonadism is a common endocrine condition characterized by low levels of testosterone (T) and marked by numerous symptoms, one of which is low sexual desire. Studies comparing T delivery systems have suggested that hypogonadal men's partners may be at risk from exposure to T gels. Little other mention is found of the impact of hypogonadism and its treatment on a man's partner and the couple's sexual function.To assess sexual desire and sexual function in hypogonadal men and their woman partners before and after treatment with T replacement therapy.Twenty-one hypogonadal men and 18 partners were recruited from a tertiary endocrine clinic, and were compared with a control group of 20 eugonadal age-matched men and their partners. All men had baseline blood tests to confirm their status as hypogonadal or eugonadal, and hypogonadal men repeated tests at 3-month intervals. All participants completed the Sexual Desire Inventory (SDI) and sexual function questionnaires at baseline and at 3-month intervals until the hypogonadal men attained normal T levels.Pre- and post-treatment SDI and sexual function questionnaires were compared once T normalization was achieved. Between- and within-group comparisons were carried out.Pretreatment hypogonadal men recorded lower levels of sexual desire and function than controls, but significantly improved once hypogonadism was corrected. Eugonadal controls recorded no significant changes in either sexual desire or function during the study. Partners of the hypogonadal men reported no changes on the SDI, but significant improvements in sexual function as their partners recovered.SDI and sexual function measures reflect sexual changes that accompany rising serum T levels during correction of male hypogonadism. Women partners reported more satisfaction, less pain, and improved sexual function following the men's treatment. Treatments affecting one partner potentially have important effects on the other. Conaglen JV, and Conaglen HM. The effects of treating male hypogonadism on couples' sexual desire and function. J Sex Med 2009;6:456-463.

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  • NNZ-2591, a novel diketopiperazine, prevented scopolamine-induced acute memory impairment in the adult rat

    Guan, Jian; Zhang, R; Dale-Gandar, L; Hodgkinson, S; Vickers, Mark (2010-07-11)

    Journal article
    The University of Auckland Library

    In rats, cyclo-L-glycyl-L-2-allylproline (NNZ-2591), a diketopiperazine, is neuroprotective after ischemic brain injury and also improves motor function in a rat model of Parkinson's disease. Given nootropic actions of diketopiperazines, we investigated the effects of and potential role for acetylcholine neurotransmission in NNZ-2591 on spatial memory after scopolamine-induced amnesia in rats. Adult male Wistar rats were assigned to four groups: saline/water; saline/NNZ-2591; scopolamine/water and scopolamine/NNZ-2591. Morris Water Maze (MWM) tasks were used to determine spatial learning and memory. Thirty minutes prior to each of four daily acquisition trials, rats were intraperitoneally injected with either scopolamine (0.5 mg/kg) or saline. Either NNZ-2591 (30 mg/kg) or water was administered orally (gavages) 10 min after the injection. Immediately after completion of the day 4 acquisition trial a spatial probe trial was performed. The brains were then collected for immunohistochemical analysis. Scopolamine impaired spatial learning and memory compared to saline treated group, particularly in the day 1 acquisition trial. NNZ-2591 did not reverse this deficit, however it significantly improved memory retention by showing more time spent in the correct quadrant. NNZ-2591 also counteracted the scopolamine-induced up-regulation of choline-acetyltransferase positive neurons in the striatum and similarly counteracted the increased synaptophysin density in the hippocampus. Furthermore, a scopolamine-independent antagonistic effect on muscarinic M2 acetylcholine receptors was found after NNZ-2591 treatment, supporting its modulation of acetylcholine neurotransmission. The data suggest that NNZ-2591 prevents scopolamine-induced acute impairment in memory and modulation of acetylcholine neurotransmission may be the mode of action underlying the memory improvement.

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  • Influenza vaccine for patients with chronic obstructive pulmonary disease

    Poole, Phillippa; Chacko, Emme; Wood-Baker, R; Cates, C (2006-06)

    Journal article
    The University of Auckland Library

    Background In???uenza vaccinations are currently recommended in the care of people with COPD, but these recommendations are based largely on evidence from observational studies with very few randomised controlled trials (RCTs) reported. In???uenza infection causes excess morbidity and mortality in COPD patients but there is also the potential for in???uenza vaccination to cause adverse effects or not to be cost effective. Objectives To evaluate the evidence from RCTs for a treatment effect of in???uenza vaccination in COPD subjects. Outcomes of interest were exacerbation rates, hospitalisations, mortality, lung function and adverse effects. Search methods We searched the Cochrane Airways Group Specialised Register of trials, and reference lists of articles. References were also provided by a number of drug companies we contacted. The latest search was carried out in May 2010. Selection criteria RCTs that compared live or inactivated virus vaccines with placebo, either alone or with another vaccine in persons with COPD. Studies of people with asthma were excluded. Data collection and analysis Two reviewers extracted data. All entries were double checked. Study authors and drug companies were contacted for missing information. Main results Eleven trials were included but only six of these were speci???cally performed in COPD patients. The others were conducted on elderly and high-risk individuals, some of whom had chronic lung disease. Inactivated vaccine in COPD patients resulted in a signi???cant reduction in the total number of exacerbations per vaccinated subject compared with those who received placebo (weighted mean difference (WMD) -0.37, 95% con???dence interval -0.64 to -0.11, P = 0.006). This was due to the reduction in ???late??? exacerbations occurring after three or four weeks (WMD -0.39, 95% CI -0.61 to -0.18, P = 0.0004). In Howells 1961, the number of patients experiencing late exacerbations was also signi???cantly less (odds ratio 0.13, 95% CI 0.04 to 0.45, P = 0.002). Both Howells 1961 and Wongsurakiat 2004 found that inactivated in???uenza vaccination reduced in???uenza -related respiratory infections (WMD 0.19, 95% CI 0.07 to 0.48, P = 0.0005). In both COPD patient and in elderly patients (only a minority of whom had COPD), there was a signi???cant increase in the occurrence of local adverse reactions in vaccinees, but the effects were generally mild and transient. There was no evidence of an effect of intranasal live attenuated virus when this was added to inactivated intramuscular vaccination. The studies are too small to have detected any effect on mortality. An updated search conducted in September 2001did not yield any further studies. A search in 2003 yielded two further reports of the same eligible study Gorse 2003. A search in 2004 yielded two reports of the another eligible study Wongsurakiat 2004. The author informed us of another report of the same study Wongsurakiat 2004/2. An update search in May 2010 did not identify any new studies for consideration.

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  • Stepwise reactions of acetylenes with iridium thiocarbonyl complexes to produce isolable iridacyclobutadienes and conversion of these to either cyclopentadieneyl-iridium or tethered iridabenzene complexes

    Clark, GR; Lu, Guo-Liang; Roper, WR; Wright, Leonard (2007)

    Journal article
    The University of Auckland Library

    Treatment of IrCl(CS)(PPh3)2 with an excess of KI gives orange IrI(CS)(PPh3)2 (1). IrI(CS)(PPh3)2 (1) reacts reversibly with dioxygen to form the brown dioxygen complex Ir(O2)I(CS)(PPh3)2 (2). Reaction between IrI(CS)(PPh3)2 (1) and 2 equiv of ethyne produces the green-brown tethered iridacyclobutadiene complex Ir[C3H2(CHdCHS-1)]I(PPh3)2 (3), one ethyne combining in a cycloaddition reaction with the IrC multiple bond to the CS ligand to form the four-membered IrC3 ring and the second ethyne alkylating the sulfur atom to give the vinylthio substituent at the 1-position of the metallacyclic ring, which is tethered to the iridium through an Ir-C bond. In reactions related to those with ethyne, phenylacetylene reacts with IrCl(CS)(PPh3)2 to give as the major product the tethered iridacyclobutadiene Ir[C3H(CHd C{Ph}S-1)(Ph-3)]Cl(PPh3)2 (4), with the phenyl substituent adjacent to the iridium, and as the minor product the isomeric tethered iridacyclobutadiene Ir[C3H(CHdC{Ph}S-1)(Ph-2)]Cl(PPh3)2 (5). A thermal reaction of Ir[C3H(CHdC{Ph}S-1)(Ph-3)]Cl(PPh3)2 (4) with further phenylacetylene produces the tethered, substituted cyclopentadienyliridium complex Ir[?? 5 -C5H2(SCPhdCH-1)(Ph-3)(Ph-5)]Cl(PPh3) (6), which retains the iridium-carbon bond to the vinylthio substituent. Methyl propiolate reacts with IrI(CS)- (PPh3)2 (1) to form exclusively the tethered iridacyclobutadiene Ir[C3H(CHdC{CO2Me}S-1)(CO2Me- 2)]I(PPh3)2 (7). Treatment of this iridacyclobutadiene, 7, with silver triflate allows introduction of a third methyl propiolate, which brings about ring expansion of the iridacyclobutadiene to form the stable tethered iridabenzene Ir[C5H2(CHdC{CO2Me}S-1)(CO2Me-2)(CO2Me-4)]Cl(PPh3)2 (8). Complex 8 retains the same vinylthio tethering group as found in 7. The structures of 2-8 have been confirmed by X-ray crystal structure determinations. Both NMR spectroscopic and structural data for 8 support the formulation of this compound as a tethered metallaaromatic molecule.

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  • The Impact of Stroke on Unpaid Caregivers: Results from the Auckland Regional Community Stroke Study, 2002-2003

    Parag, Varsha; Hackett, Maree; Yapa, Chaturangi; Kerse, Ngaire; McNaughton, Harry; Feigin, VL; Anderson, CS (2008)

    Journal article
    The University of Auckland Library

    ackground: Few studies have assessed the longitudinal impact of providing unpaid care for stroke survivors. We aimed to describe the positive and negative impact of providing unpaid care and to identify independent predictors of poor carer outcome. Methods: The Auckland Regional Community Stroke study was a prospective population-based stroke incidence study conducted in Auckland, New Zealand, over a 12-month period in 2002???2003. Stroke survivors and their unpaid carers were assessed at 6 and 18 months after stroke onset using the Short Form 36 questionnaire and the Bakas Caregiving Outcomes Scale. Results: Data were available from 167 stroke survivor???carer pairs at 6 months and 62 pairs at 18 months. Unpaid carers reported lower health-related quality of life at 6 months after stroke than their age- and sex-matched counterparts in the New Zealand population. The impact of providing care was predominantly negative; however, approximately one third of the carers had improved relationships with the stroke survivor. No reliable predictors of carer burden were identified. Conclusions: This study re-emphasises the heavy burden of stroke on unpaid carers but was unable to identify factors that predicted carers at the greatest risk of experiencing a poor outcome. Effective strategies are needed to reduce the burden of providing unpaid care.

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  • Appropriate prescribing in the elderly: An investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland

    Ryan, C; O'Mahony, D; Kennedy, Julia; Weedle, P; Barry, P; Gallagher, P; Byrne, S (2009)

    Journal article
    The University of Auckland Library

    Background: Elderly patients are particularly vulnerable to inappropriate prescribing, with increased risk of adverse drug reactions and consequently higher rates of morbidity and mortality. A large proportion of inappropriate prescribing is preventable by adherence to prescribing guidelines, suitable monitoring and regular medication review. As a result, screening tools have been developed to help clinicians improve their prescribing. Objectives: To compare identi???cation rates of inappropriate prescribing in elderly patients in primary care using two validated screening tools: Beers??? criteria and improved prescribing in the elderly tool (IPET); to calculate the net ingredient cost (NIC) per month (???) of the potentially inappropriate medicines in this population of patients. Method: A consecutive cohort of 500 patients 65 years of age and over were recruited prospectively from primary care over a 6 month period in a provincial town in Ireland. Patients??? medical records (electronic and paper) were screened and all relevant information concerning current illnesses and medications was recorded on a standardized data collection form to which Beers??? criteria [considering diagnosis (CD) and independent of diagnosis (ID)] and IPET tools were applied. The NIC was calculated from an edition of the Irish monthly index of medical specialities published concurrently with the data collection. Results: Beers??? criteria identi???ed a total of 69 medicines that were prescribed inappropriately (eight CD and 61 ID) in 65 patients (13%), costing ???824??88 per month while IPET identi???ed 63 potentially inappropriate medicines in 52 (10??4%) patients costing ???381??28 per month. Conclusions: Potentially inappropriate medications are prescribed in a signi???cant proportion of elderly people in primary care, with signi???cant economic implications.

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  • Correction of refractive error and presbyopia in Timor-Leste

    Ramke, Jacqueline; du Toit, R; Palagyi, A; Brian, G; Naduvilath, T (2007-07)

    Journal article
    The University of Auckland Library

    Aim: To investigate the aspects of spectacle correction of vision-impairing refractive error and presbyopia in those aged >40 years in Timor-Leste. Method: A population-based cross-sectional survey with cluster random sampling was used to select 50 clusters of 30 people. Those who had uncorrected or undercorrected refractive error (presenting acuity worse than 6/18, but at least 6/18 with pinhole), uncorrected or undercorrected presbyopia (near vision worse than N8), and/or who were using or had used spectacles were identified. Dispensing history, willingness to wear and willingness to pay for spectacles were elicited. Results: Of 1470 people enumerated, 1414 were examined (96.2%). The ??????met refractive error need?????? in the sample was 2.2%, and the ??????unmet refractive error need?????? was 11.7%. The ??????refractive error correction coverage?????? was 15.7%. The ??????met presbyopic need?????? was 11.5%, and the ??????unmet presbyopic need?????? was 32.3%. The ??????presbyopia correction coverage?????? was 26.2%. Lower correction coverage was associated with rural domicile, illiteracy and farming. Of the sample, 96.0% were willing to wear spectacles correcting impaired vision. Of these, 17.0% were willing to pay US$3 (??1.52, J2.24) for spectacles, whereas 50.2% were unwilling to pay US$1 (??0.51, J0.75). Women and rural dwellers were less likely to be willing to pay at least US$1 for spectacles. Conclusion: Refractive error and presbyopia correction coverage rates are low in Timor-Leste. There is a large need for spectacles, especially for elderly and illiterate people, farmers and rural dwellers: those least able to pay for them. An equitable cross-subsidisation spectacle system should be possible.

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  • Practitioners, patients, and their visits: a description of accident and medical (A&M) clinics in New Zealand, 2001/2.

    Hider, P; Lay Yee, Roy; Davis, Peter (2007)

    Journal article
    The University of Auckland Library

    Aims The National Primary Medical Care survey was undertaken to describe primary health care in New Zealand, including the characteristics of accident and medical (A&M) clinic providers, their practices, the patients they see, the problems presented, and the management offered. Methods Data were collected from a 50% random sample of all A&M clinics in New Zealand as part of the National Primary Medical Care survey carried out in 2001/2. Results Data were obtained from 12 A&M clinics throughout New Zealand between usual hours (Monday???Friday 8am???6pm) and at other times. A&M clinics were staffed by an average of 2.7 full-time equivalent (FTE) A&M practitioners . Most clinics operated as a limited liability company. The majority of A&M practitioners were male and aged between 35???44 years. On average, A&M doctors had been in practice for over 10 years and had been in the sampled practice for only 2.9 years. More than a third of doctors had not trained in New Zealand. The doctors worked, on average, 6.3 half days and saw nearly 90 patients per week. The findings suggest that young patients and a diverse ethnic range attend A&M practices. Community Services Card holders were not usual patients. Few patients had an ongoing relationship with the practices. Most visits related to a single, new, and short-term problem that was often an injury or a respiratory illness. About a fifth of visits were associated with an order for an investigation or an X-ray, fewer investigations were arranged outside usual hours. About half the visits resulted in a prescription but more visits outside normal hours received pharmacological treatment and the number of items was higher. The most frequently prescribed items were antibiotics and analgesics. Follow-up was arranged for between a third to a half of visits, depending on the time of day. Referrals were often made to non-medical destinations. While patient and visit characteristics were generally similar regardless of whether the visit occurred during usual working hours or at other times, some differences were apparent in the type of problems that were presented out of hours and their management. Conclusions The main impression is that the medical A&M clinics provide episodic treatment for relatively young patients mainly related to a new, short-term problem, particularly an injury or a respiratory illness. This picture is consistent with previous research and the role of similar clinics overseas. Further work is needed to compare A&M clinics with established general practice in relation to the services that are provided as well as the acceptability and quality of these services.

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  • Accounting for medical variation: The case of prescribing activity in a New Zealand general practice sample

    Davis, Peter; Lay Yee, Roy; Millar, J (1994)

    Journal article
    The University of Auckland Library

    Medical practice variation is extensive and well documented, particularly for surgical interventions, and raises important questions for health policy. To date, however, little work has been carried out on interpractitioner variation in prescribing activity in the primary care setting. An analytical model of medical variation is derived from the literature and relevant indicators are identified from a study of New Zealand general practice. The data are based on nearly 9,500 completed patient encounter records drawn from over a hundred practitioners in the Waikato region of the North Island, New Zealand. The data set represents a 1% sample of all weekday general practice office encounters in the Hamilton Health District recorded over a 12-month period. Overall levels of prescribing, and the distribution of drug mentions across diagnostic groupings, are broadly comparable to results drawn from international benchmark data. A multivariate analysis is carried out on seven measures of activity in the areas of prescribing volume, script detail, and therapeutic choice. The analysis indicates that patient, practitioner and practice attributes exert little systematic influence on the prescribing task. The principal influences are diagnosis, followed by practitioner identity. The pattern of findings suggests also that the prescribing task cannot be viewed as an undifferentiated activity. It is more usefully considered as a process of decision-making in which 'core' judgements--such as the decision to prescribe and the choice of drug--are highly predictable and strongly influenced by diagnosis, while 'peripheral' features of the task--such as choosing a combination drug or prescribing generically--are less determinate and more subject to the exercise of clinical discretion.(ABSTRACT TRUNCATED AT 250 WORDS)

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  • Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes

    Young, Robert; Hopkins, Raewyn; Eaton, TE (2007-10-01)

    Journal article
    The University of Auckland Library

    The clinical utility of spirometric screening of asymptomatic smokers for early signs of air flow limitation has recently come under review. The current authors propose that reduced forced expiratory volume in one second (FEV1) is more than a measure of airflow limitation, but a marker of premature death with broad utility in assessing baseline risk of chronic obstructive pulmonary disease (COPD), lung cancer, coronary artery disease and stroke, collectively accounting for 70-80% of premature death in smokers.Reduced FEV1 identifies undiagnosed COPD, has comparable utility to that of serum cholesterol in assessing cardiovascular risk and defines those smokers at greatest risk of lung cancer. As such, reduced FEV1 should be considered a marker that identifies smokers at greatest need of medical intervention.Smoking cessation has been shown to attenuate FEV1 decline and, if achieved before the age of 45-50 yrs, may not only preserve FEV1 within normal values but substantially reduce cardiorespiratory complications of smoking.Recent findings suggest inhaled drugs (bronchodilators and corticosteroids), and possibly statins, may be effective in reducing morbidity and mortality in patients with chronic obstructive pulmonary disease. The current authors propose that spirometry has broad utility in identifying smokers who are at greatest risk of cardiorespiratory complications and greatest benefit from targeted preventive strategies, such as smoking cessation, prioritised screening and effective pharmacotherapy.

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  • Mapping of mitral regurgitant defects by cardiovascular magnetic resonance in moderate or severe mitral regurgitation secondary to mitral valve prolapse

    Gabriel, Hapuaratchige; Kerr, Andrew J; Raffel, Owen C; Stewart, Ralph A; Cowan, Brett; Occleshaw, Christopher J (2008-04-09)

    Journal article
    The University of Auckland Library

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  • Thyrotropin-releasing hormone added to corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease (Review)

    Crowther, Caroline; Alfirevic, Z; Han, S; Haslam, RR (2010)

    Journal article
    The University of Auckland Library

    Background Thyrotropin-releasing hormones (TRH) added to prenatal corticosteroids had been suggested as a way to further reduce breathing problems and neonatal lung disease in infants born preterm. Objectives To assess the effect of giving prenatal TRH in addition to corticosteroids to women at risk of very preterm birth for the prevention of neonatal respiratory disease. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2), MEDLINE (1965 to July 2009), EMBASE (1988 to July 2009) and reference lists. We also contacted trial authors. Selection criteria Randomised controlled trials in women at sufficient risk of preterm birth to warrant the use of prenatal corticosteroids to promote lung maturity. TRH and corticosteroids were compared with corticosteroids with or without placebo. The main outcomes considered were fetal and infant mortality, infant morbidity, childhood development and maternal morbidity. Data collection and analysis All assessments of trial eligibility, risk of bias and data extractions were done by at least two review authors independently. Main results Over 4600 women were recruited into the 13 included trials. The five trials had a low risk of bias in the five risk of bias domains. Overall, prenatal TRH, in addition to corticosteroids, did not reduce the risk of neonatal respiratory disease or chronic oxygen dependence, and did not improve any of the fetal, neonatal or childhood outcomes assessed by intention-to-treat analyses. Indeed, the data showed prenatal TRH to have adverse effects for women and their infants. All side-effects monitored were more likely to occur in women receiving TRH. In the infants, prenatal TRH increased the risk of needing ventilation (risk ratio (RR) 1.16, 95% confidence interval (CI) 1.03 to 1.29, three trials, 1969 infants), having a low Apgar score at five minutes (RR 1.48, 95% CI 1.14 to 1.92, three trials, 1969 infants) and, for the two trials providing data, was associated with poorer outcomes at childhood follow up. Sensitivity analyses by trial quality, or subgroups with differing times from entry to birth, or different dose regimens of TRH, did not change these findings. Authors' conclusions Prenatal TRH, in addition to corticosteroids, given to women at risk of very preterm birth do not improve infant outcomes and can cause maternal side-effects.

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