426 results for Undergraduate

  • Viral proteins as novel therapeutics in chronic horse wounds.

    Wakelin, Kirsty Anne (2015)

    Undergraduate thesis
    University of Otago

    This study examined the effects of two Orf virus-derived proteins, vIL-10 and VEGF-E, on chronic wounds in horses, to determine if they can improve vascularisation and re-epithelialisation while reducing scarring.

    View record details
  • Association of Interleukin-23 Receptor (IL-23R) gene variants with Gout and Rheumatic Heart Fever (RHF)

    Leaupepe, Keresoma (2015)

    Undergraduate thesis
    University of Otago

    Gout is an increasingly common form of inflammatory arthritis caused by the deposition of urate, leading to the formation of monosodium urate (MSU) crystals in joints and other body tissue. This results in subsequent recurrent acute inflammation attacks (1). Gout prevalence is increasing worldwide and has a particularly high prevalence in the Māori and Pacific populations of New Zealand (9.3 to 13.9% of Māori men and 14.9% of Pacific Island men) (2). Risk factors for gout development can be either genetic or environmental. The risk of gout is different between ancestral groups, suggesting that they have genetic differences (3). Rheumatic heart fever (RHF) is a systemic auto-inflammatory disease that is caused by infection of the upper respiratory tract (mainly the throat) by group A β-haemolytic streptococci (GABHS). RHF happens via antigen molecular mimicry and cross reactivity mechanisms between the host and bacteria. Cross reactivity of antibodies and/or T cells stimulates recognition between the S.pyrogenes peptides and the host protein and leads to inflammation and autoimmunity (4). RHF incidence and prevalence has steadily declined in developed countries since the early 1900s. However, it remains a leading cause of morbidity and mortality among young individuals (6 – 15 years) in developing countries. The risk of RHF can be familial or environmental e.g. as poor housing conditions, crowding, and poor health knowledge (5, 6). The IL23R gene codes for the interleukin 23 receptor. The receptor is located on the cell membrane of cells that are involved in the immune system, which provide defence mechanisms against infection and disease from foreign microbes. During the TH17 immune response, activation of IL23R from interaction with its subunit (IL23) initiates inflammation (7). Previous studies have shown that genetic variants derived from IL23R are associated with auto-inflammatory related diseases, such as rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease. A study by Liu et al (2015) showed that the IL23R SNP rs7517847 minor allele G confers an association with gout in Chinese Han male population. 4 Our aim was to test IL23R gene variants (rs11209026, rs7517847 and rs11465804) for association with gout and RHF in European and Polynesian populations using case-control sample sets recruited within New Zealand and (for gout) Europe. To test this hypothesis, SNPs were genotyped using Taqman assay and statistical analysis was carried out using R studio logistic regression to test for association of SNPs with gout and RHF. Common confounders including ancestry, sex and age were adjusted for in the regression analysis. Gout results revealed that rs11465804 and rs11209026 in both European and Polynesian were not significantly associated with gout. However, the rs7517847 minor allele (G) showed a significant association with gout in Polynesian (Polynesian OR = 0.85, P = 0.04) (European OR = 0.94, P = 0.53), which is consistent with the Lui et al (2015) findings. These data replicate the Liu et al (2015) findings and support the claim that IL23R has a causal role in gout in people with Polynesian ancestry. Hence, the IL23R pathway is a target for gout treatment in the Polynesian population. RHF results revealed that only SNP rs11209026 shows evidence of association with a protective effect for the minor allele (A) (OR = 0.07, P-value = 0.002) after adjustment. Therefore the rs11209026 major allele (G) is in a susceptible direction. This provides evidence that IL23R has a casual role in RHF development risk in Polynesian people.

    View record details
  • Modulation of colonic stem cell proliferation by bacterial components

    van Hout, Isabelle (2015)

    Undergraduate thesis
    University of Otago

    The intestine is home to a large number of commensal microbes, which are restricted to the intestinal lumen by the epithelial barrier. In the colon, which has the greatest number of commensal microbes, the epithelial barrier is maintained by turnover of the epithelium every 3-5 days by a small population of stem cells found at the base of the crypts. If bacteria are present in the lamina propria, it indicates a loss of barrier integrity so it is important for the epithelium to respond to this, to increase proliferation and repair the barrier to prevent inflammation. Previous research indicates that stimulating pattern recognition receptors, found on colonic stem cells, may be a mechanism by which epithelial proliferation can be altered. Here we have used human colonic organoids to determine if the colonic bacteria modulate the proliferation of the colonic stem cells and hence the properties of the colonic epithelium. Colonic organoids were grown from crypts isolated from healthy patients and suspended in Matrigel® overlaid with a specific stem cell growth media. Two distinct organoid types were seen in culture enteroids, which have a well-developed columnar epithelium and so appear to be representative of the native colonic epithelium, and spheroids, which have a poorly differentiated epithelium. The effect of the removal of the growth factor Wnt3A, removal of the inhibitors of the TGF-β pathway LY2157299 and SB202190, induction of differentiation by the addition of the γ-secretase inhibitor DAPT (10µm, [N-[N-(3,5-difluorophenacetyl)-l-alanyl]-S-phenylglycine t-butyl ester), or inclusion of bacterial components including lipopolysaccharide (LPS), lipoteichoic acid (LTA) flagellin and muramyl dipeptide (MDP) (all 20ng ml-1), in the growth media, on cell proliferation in enteroids was assessed by measurement of the expression of proliferation-associated genes (Cylcin D, p15, LTBP1, Ki67 LGR5, FOXM1 and MYC) by qPCR. In addition, the incorporation of EdU (5-ethynul-2’-deoxyuridine) into the nuclei of dividing cells was used to quantify proliferation in whole mounts of both spheroids and enteroids. Statistical significance was determined by a Kruskal Wallis test and a Dunns post test or a Mann-Whitney test. Few changes in proliferation-associated genes at the transcript level in enteroids were seen, indicating environmental changes do not alter enteroid proliferation. Consistent with the qPCR findings, direct quantification of cell proliferation in whole mounts of enteroids, also found no significant change in proliferation between control and experimentally treated enteroids. In contrast, spheroids had a significantly higher rate of proliferation than enteroids (p<0.01) for 10 days, compared to control spheroids. These results show that environmental changes can affect spheroid proliferation; hence spheroids may be a better model of the crypt base, which is the site of proliferation in the native epithelium. They also show there is a basal level of proliferation maintained in the cultures, despite environmental manipulations. Finally, these results show that the bacterial components LPS and flagellin, which signal through TLR4 and TLR5 respectively, decrease colonic proliferation, by directly interacting with the epithelium. A decrease in proliferation under the conditions tested here was unexpected, and may highlight that other components such as immune or mesenchymal cells, may be important in controlling colonic proliferation.

    View record details
  • A search for synthetic lethality between Polo-like Kinase 3 and E- Cadherin

    Gaastra, Joel Bertus Ross (2015)

    Undergraduate thesis
    University of Otago

    Hereditary diffuse gastric cancer (HDGC) is an autosomal dominant condition caused by a mutation in the tumour suppressor gene E-cadherin, (CDH1). It predisposes to a 70% likelihood of developing highly penetrant diffuse gastric cancer. Because HDGC is driven by the absence of a tumour suppressor, conventional therapeutic approaches targeting tumour-promoting oncogenes cannot be used. Synthetic lethality is an approach that circumvents this issue by targeting vulnerabilities in cells that lack the functional tumour suppressor. This project aimed to investigate a potential synthetic lethal relationship between CDH1 and polo-like kinase 3 (PLK3), a cytoskeletal and cell cycle regulator. Lentiviral delivery of two shRNA were successful in knocking down PLK3 expression in isogenic MCF10A cell lines, with and without CDH1 expression (MCF10A and CDH1-/-). Viability was measured and confirmed as synthetic lethal (mutations in combination cause cells to be less viable) if the CDH1-/- cells were less viable with a ratio of ≤0.85. Results from one shRNA knockdown trended towards synthetic lethality (p > 0.05). Another shRNA resulted with a considerable reverse synthetic lethal effect, but was not statistically significant. PLK antagonists poloxipan and wortmannin were used to inhibit PLK3. Poloxipan induced reverse synthetic lethality with reduced viability in MCF10A cells at low concentrations. High concentrations produced a marginal synthetic lethal phenotype. Wortmannin’s effect on MCF10A and CDH1-/- cells also varied from synthetic lethal and reverse synthetic lethal. As the viability of CDH1 deficient cells could not be significantly reduced via PLK3 knockdown or inhibition, this candidate is no longer considered to be a potential therapeutic target for the treatment of HDGC.

    View record details
  • Parents, siblings and pacifism : the Baxter family and others (World War One and World War Two)

    Cumming, Belinda C. (2007)

    Undergraduate thesis
    University of Otago

    Before she died, Millicent Baxter, wife of notorious New Zealand conscientious objector Archibald Baxter, wrote a letter confessing one of her final wishes: “I hope to live long enough to see the production of the documentary of my husband's book, We Will Not Cease ... I think it has a message for the young. The future of the world is in their hands …” Clearly pacifism was a shared commitment in her family, not just the passion of one individual member. This essay will seek to explore the importance of family in a pacifist stance. I will examine influences of, and effects on, various members of the family unit, and investigate the importance of familial support in aiding a conscientious objector to take the pacifist stance and cope with the consequent hardships confronted. My dissertation examines both the first and second World Wars. This focus on the family distinguishes my research from scholarship which precedes it.(…)While available scholarship provides a significant wealth of detail on conscientious objection in New Zealand, this narrow focus on administration has led to neglect of the families of the pacifists, the people who actually felt the affects of the policies formulated by politicians in Parliament and who witnessed the persecution and punishment of their loved ones. Attention has not been paid to the role of the family and I endeavour to remedy this neglect. I wish to explore how the family members in both wars were affected by the pacifist stance adopted by men in their families, and how they responded. (…) The stand of a conscientious objector is 'a protest against war and leads inevitably to conflict with the State.' 3 When a man elected to object to war and go against prevailing opinion at the time, he was putting himself forward to be ostracised, harassed and abused by the community, and be punished officially by the Government. This radical and life-changing decision to be a conscientious objector would likely have been a gradual process of thought and debate during the objector's life, not a spontaneous snap decision. I wish to explore the role that upbringing played in this decision-making process, and to investigate the influence that parents consciously or sub-consciously had over their children's views regarding peace and war. (…) By focusing on the family in research regarding conscientious objection in New Zealand over both Wars, this dissertation sheds light on hitherto neglected areas of investigation, and gives a voice to mothers, fathers, siblings and children who have until now often remained unheard. [extract from Introduction]

    View record details
  • Low country Liz : the making of a rural Southland woman

    Crawford, Jenny (1995)

    Undergraduate thesis
    University of Otago

    The wealth of archives and primary material left by Elvira Begg presents an exciting opportunity to examine as closely as possible the histories of rural Southland women. It was the discovery of these treasures that first inspired me to write about rural women's history. The focus of this work centres on the experiences of an educated city girl who met and married a young man with a farming background. Personal diaries, a collection of poems and an unpublished autobiography left by Mrs Begg form the basis of this study. Elvira's life will be traced chronologically, but the central focus will be on the transition from city to farm life, and how the experience affected this woman. The aim is to examine her life in Christchurch and the intellectual environment of Canterbury University, then look at the impact of the transition to an isolated sheep station in Eastern Southland. Christchurch during the 1930s provides the background to Elvira's life as an educated city girl. Chapter Two deals with her initial experiences and first impressions of rural New Zealand. In Chapter Three, entitled 'The Making of a Farmer's Wife', the focus is on the way Elvira adapted to the new environment over the years. Rural New Zealand between the 1940s and 1960s provides the historical context for her experiences in Southland. I will also examine Elvira's unique response to the challenges of rural life, in particular looking at her writings under the pseudonym 'Low Country Liz'. One woman's life also raises theoretical issues relating to women's biography. Questions of identity and constructions of 'self' are relevant in this context. […] This study does not aspire to make broad conclusions about the experiences of rural women. Rather it is hoped that an examination of this woman's life will help to illuminate aspects of life in rural Southland, whether by illustrating homogeneity or highlighting diversity. The intention is to expose the myth of the stereotypical 'Southland farmer's wife' and to show the diversity of backgrounds which have shaped the stereotype of Southland women. [extract from Introduction]

    View record details
  • Swaggers and society : a New Zealand experience

    Steven, Graeme D. (1979)

    Undergraduate thesis
    University of Otago

    The aims of this study are two-fold. First, to reach an understanding of the swagger, his lifestyle, and his outlook on life. And second, to investigate the relationships between the swagger and various groups in New Zealand society, in the late nineteenth and early twentieth centuries. The North Otago region was chosen as a base for the study because it has traditionally been regarded as one of the main swagger areas in New Zealand. The main town of Oamaru had a population of 4000 to 6000 in the 1890's, and was neither wholly urban or rural. As the service centre for the North Otago hinterland and a road, rail and sea centre, Oamaru had large numbers of itinerants, passing through the town. In the rural hinterland mixed cropping predominated, and this required large numbers of seasonal workers, which were drawn from outside the region. In Chapter One it is argued that rural itinerant workers were integrated into a rural structure that was both labour intensive and seasonal. Chapter Two discusses the characteristics which separate the swagger from other rural itinerants, which I have called, the "swag-carriers". In Chapter Three the conflict between the swagger and a developing bureaucracy, and middle class ideology in the late nineteenth century, is analysed. In Chapters Four and Five, the attitudes of rural and towns people towards the swagger are investigated. A model based on the value system of "reputation" and "respectability is used in Chapter Six to explain the ambivalence of attitudes towards the swagger, and to investigate an important aspect of the swagger psychology - his self esteem and his individuality.

    View record details
  • Suffering and the Dimensionality of Medical Knowledge: A Critique of Evidence Based Medicine

    McHugh, Hugh Marshall (2016)

    Undergraduate thesis
    University of Otago

    Evidence Based Medicine (EBM) is a recent philosophy that is highly influential in medicine. EBM is centred on the notion that medical practice should be supported by rigorous clinical research. This thesis explores a “dimensional” framework of knowledge and argues EBM results in the exclusion of certain non-scientific knowledge forms. Since these knowledge forms are essential to the realisation of medicine’s goals, EBM is holding medicine back. I frame the primary goal of medicine as to attend to suffering. There is a tendency to view the goal of medicine as the treatment of disease, but this fails to account for much of what occurs in practice. Suffering incorporates disease and also other humanistic aspects of medicine that may not be investigable in a scientific manner. Medical knowledge determines medical practice, so medicine must have knowledge of what suffering is to effectively attend to suffering. I propose a dimensional theory of knowledge that includes explicit, tacit, general and particular forms of knowledge. Explicated general knowledge includes the knowledge of science. Tacit knowledge is more readily enacted than articulated. Particular knowledge is knowledge that is applicable to specific circumstances and individuals. The existence of tacit and particular knowledge moderates the possibility and need for scientific justification and also means knowledge exists within the knower and not exclusively in abstracted forms. EBM’s philosophical framework excludes tacit and particular knowledge in its selective recognition of explicit-generalised “evidence”. This means that EBM’s conception of knowledge is incomplete and is philosophically inadequate. Though EBM makes useful contributions to clinical research appraisal, its normative assertions of “what counts as knowing” in medicine obscures human suffering and so might harm practice. This thesis presents the foundations for an alternative philosophy to EBM that would see “EBM” reframed as “clinical epidemiology” as a remedy for EBM’s normative restriction of medical knowledge.

    View record details
  • The Activity of the JAK-STAT Pathway in Infantile Haemangioma and the Haemogenic Potential of Infantile Haemangioma Explant Derived Cells

    Sulzberger, Lucy Isabelle (2017)

    Undergraduate thesis
    University of Otago

    Background: Stem cells have been identified within proliferating infantile haemangioma (IH), the most common tumour of infancy, and have been demonstrated to play a critical role in the rapid proliferation and gradual involution of this tumour. There is accumulating evidence showing that IH is caused by aberrant proliferation and differentiation of a haemogenic endothelium (HE). This HE possesses a functional capacity to undergo primitive erythropoiesis in vitro. Short chain fatty acid (SCFA) derivatives have been shown to stimulate cell proliferation and induce STAT-5 activation in various haematopoietic cell lines. Aims: The aims of this study were to investigate (1) the activity of the components of JAK-STAT pathway within the three phases of IH development; (2) the haematopoietic capacity of IH in vitro; and (3) the effects of SCFAs, butyric acid and propionic acid, to induce erythroid differentiation of explant-derived cells (IHEDCs) in culture. Methods: The presence of pSTAT proteins in proliferating, involuted and involuting IH were investigated using 3,3'-diaminobenzidine (DAB) and immunofluorescent (IF) immunohistochemical (IHC) staining, 1-DE Western Blotting, and NanoString analysis. Proliferating IH explants were cultured using an in vitro model and the IHEDCs emanating from the explants were harvested. Cell suspension of volume equivalent to 5x105 live cells was plated on Matrigel and incubated in 0.05-1mM butyric acid, RPMI and 0.05-1mM propionic acid, and 0.05M DMSO (positive control) in each of RPMI media only, RPMI enriched with iron and MCDB media. Media was changed daily and cells were extracted and quantified following 24-72 hours in culture. Differentiated IHEDCs were characterised by IF immunocytochemical (ICC) staining with glycophorin-A. Results: Protein and genomic data reveal the expression of STATs 1, 3 and 5 which are activated in IH, particularly in the proliferative phase, with expression tapering as the lesion involutes. pSTAT3 is expressed most abundantly with pSTAT5 the least abundant. Low concentrations of both butyric acid and propionic acid significantly increased proliferation and differentiation of IHEDCs into blast colonies and the production of bi-concave cells within 72 hours in culture. These enucleated bi-concave cells expressed the erythrocyte-specific marker, glycophorin-A. Conclusion: The findings of SCFAs promoting proliferation and differentiation of IHEDCs into blast colonies and differentiated erythrocytes reveal a novel role for SCFAs in human haematopoietic differentiation, possibly via pSTAT-5 signalling. IH offers a simple and novel in vitro model for generating haematopoietic precursors and production of human erythrocytes.

    View record details
  • Effectiveness and safety of vitamin D compounds in people with chronic kidney disease: A systematic review and meta-analysis

    Okamura-Kho, Amy (2016)

    Undergraduate thesis
    University of Otago

    Vitamin D therapy is commonly prescribed for people with chronic kidney disease to improve biochemical perturbations; however, evidence of effects on patient-centred outcomes such as mortality, cardiovascular events and fracture are uncertain. We updated a systematic review and meta-analysis of all available randomised controlled trials on vitamin D compounds in chronic kidney disease to determine its effects on clinical and biochemical outcomes as well as its optimum route of administration, frequency and dose. Searches of MEDLINE, EMBASE and Cochrane Renal Group specialised register databases identified 164 eligible studies that enrolled 10,333 participants. Based on low to very low quality evidence assessed using GRADE methodology, vitamin D had uncertain effects on all-cause mortality, fracture, parathyroidectomy, bone pain and progression to end-stage kidney disease. Compared to placebo, new vitamin D compounds may reduce major cardiovascular events by 18 to 58 people per 1000 people who have chronic kidney disease not receiving dialysis. Vitamin D reduced serum parathyroid hormone levels by 116 pg/ml (12.7 pmol/l) on average, while increasing serum calcium by 0.33 mg/dl (0.08 mmol/l) and phosphorus by 0.19 mg/dl (0.06 mmol/l) when compared to placebo. We are moderately confident that vitamin D therapy increases episodes of hypercalcaemia by 14 to 64 people per 1000 people treated. Effects of different vitamin D compounds, routes of administration, frequency and doses of vitamin D were not discernible from existing evidence. Additional trials are likely to change these estimated treatment effects and are needed to increase confidence in the evidence that informs clinical practice guidelines for vitamin D in people with chronic kidney disease.

    View record details
  • The University of Otago's Home Science Extension Service, 1929-1954

    Clarke, Katherine Mary (2003)

    Undergraduate thesis
    University of Otago

    The Home Science Extension Service (HSES) of the Otago University was established in 1929. The Service intended to remedy a lack in the educational facilities available for rural women. The HSES developed from the example of the rural educational work in the United States. The founders hoped that home science instruction could reduce many of the hardships and problems of rural domestic life. They wanted to improve health standards through dietary advice and educating women about cleanliness. They believed instruction about efficient homemaking techniques could reduce the toil of rural women. They also wanted to provide a source of enjoyment, by offering leisure activities and mental stimulation. The extension of home science teaching into the community needs to be seen in the wider context of two international movements, adult education and home science. New Zealand adult education largely developed from the British adult education system, while the American model of home economics inspired New Zealand's tradition of home science. The HSES fused these international themes in a New Zealand experiment into the possibilities for rural adult education. […] This investigation covers the founding of the HSES and its first twenty-five years of operation, from 1929 to 1954. The period ends in 1954 partly because this confines the study to the time before feminist movements began to openly challenge the belief that a woman's proper role was to be a homemaker. It is appropriate to study an organisation which helped women with homemaking during a period when many believed that this was to be their destiny. The twenty-five year period also encompasses three phases in the HSES's development: the 'Carnegie period'; the 'war years'; and the 'adult education era'. The changes within the HSES during these years provide insights into wider developments in New Zealand society. [extract from Introduction]

    View record details
  • Time to Safe Driving after Total Hip and Knee Replacement Surgery

    Meffan, Peter (2015)

    Undergraduate thesis
    University of Otago

    Introduction: Osteoarthritis is the most common form of arthritis in the western world. With its increasing prevalence, total joint replacement is in high demand. After total hip replacement (THR) and total knee replacement (TKR) a period of driving cessation is necessary. For many patients, a period of driving cessation creates financial stress and threatens independence. The current recommendation for driving cessation following THR or TKR surgery is 6 weeks, however the literature surrounding this is varied. Aims: To measure the average time it takes for a patient following either a THR or TKR to return to operating a motor vehicle safely; based on recovery of their pre-operative baseline transfer time to within 10%. Methods: The transfer time from accelerator to a brake force of 100N (transfer time) was measured on a custom built rig. Patients were tested pre-operatively, and 1, 2, 4, and 6 weeks post-operatively The time in weeks was measured to return to within 10% of their pre-operative transfer time. A quantitative questionnaire was used at each test to establish patient perception to the impediments to safe and confident driving. Results: The median time to return to baseline in THR was 2.0 weeks (95%CI 1.3-2.7) and in TKR 5.5 weeks (Log rank score 0.034). 14.3% of THR and 62.5% of TKR patients failed to reach baseline in the test period. The median time to return to baseline for all operation groups was 3.3 weeks in males (2.6 – 4.0) and 2.0 weeks in females (1.4 – 2.6) (Log rank 0.67). 18.2% of males and 45.5% of females failed to return to baseline in the test period. Males recorded faster transfer times at baseline than females (414ms and 573 respectively). Joint pain decreased markedly over the test period when scored by visual analogue score. TKR felt more joint pain at 1 week postoperative than THR (VAS 5.26 and 2.0 respectively). Perceived driving confidence had improved to baseline by 2 weeks postoperative. When asked, patients reported joint stiffness as the most troublesome symptoms in the postoperative period. Discussion: THR recovered to their baseline transfer time significantly quicker than TKR. This may be due to TKR experiencing more pain in the immediate post-operative period. Females recovered to baseline quicker than males, however this observation was not statistically significant. There was significant loss to follow up in this study, which particularly affected the TKR group. There were a significant number of TKR patients who did not reach baseline in the study period. Without data past 6 weeks follow up it is difficult to make recommendations for the TKR group. We suggest that THR are safe to return driving 3-4 weeks after their operation date. Due to the time limitations of the BMedSci (Hons) programme the study size was smaller than desired. Following completion of this thesis data collection will continue to strengthen the findings of this study.

    View record details
  • What’s the harm in waiting? Patient harms in the referral waiting gap

    Patel, Vimal (2016)

    Undergraduate thesis
    University of Otago

    Background Patient safety research seeks to improve the delivery of care, and ensure that patients’ risk of injury from healthcare itself is minimised. Referral between primary healthcare, specialist diagnostic agencies (such as community medical laboratories and radiological centres), and hospital based healthcare is common and important in primary care, yet patients have highly variable waiting times before receiving their care. However, there is almost no research exploring what happens to patients while they wait. Aims This study aims to investigate patient’s waiting periods between referral from their General Practitioner (GP) and receiving specialist healthcare. Specifically, this study aims to determine if patients come to any harm in this waiting gap, and if so, which patients are harmed and what types of harm happen. Methods I reviewed 5 years (2003-2007) of healthcare records of 201 general practice patient’s notes. Each consultation record was examined to identify the types of referral that were made and to find evidence of harms while the patient was waiting for referred healthcare. A subset of 101 of these patients also had the records reviewed for investigation types and evidence of harm while waiting for investigation. A broad definition of harm was used to capture a greater number of harms. Harms were categorised as related to referral for investigation, referral to medical specialty or referral to other non-medical specialty. Harms were also graded in severity (mild, moderate and severe) and were described under the following: ‘continued symptoms’, ‘delay in subsequent management’, ‘deterioration of condition’, ‘financial cost to patient’, ‘anxiety/mental harm’ or ‘other’. Comparisons were made between patients whose referrals had evidence of harm in the waiting gap with patients who did not. Comparisons included length of waiting gap, age, gender and specialty referred to and used t-tests or non-parametric tests, as appropriate. Results 5003 Consultation records were reviewed. A referral rate of 0.21 per person per year for medical and non-medical specialties was found, and a referral rate of 1.00 per person per year for investigations was found. 45 of 183 (25.5%) of referrals to medical or non-medical specialties had evidence of harm in the waiting gap, whereas 9 of 105 (1.8%) of referrals for investigation had harm in the waiting gap. Of the 58 total harms, 43 (74.1%) of harms were minor, 12 (20.5%) were moderate and 3 (5.2%) were severe. The largest broad classification of harm was “continued symptoms” with 38 harms (65.5%), followed by “delay in subsequent management” with 14 harms (24.1%) and “deterioration in condition” with 14 harms (24.1%). There were no statistically significant relationships between the age of patient nor sex of patient nor length of waiting time and the incidence of harm in the waiting gap. Conclusion This is the first study of harm in the referral waiting gap. The findings indicate that harm does happen while patients wait for referred care, and more research is needed to explore these harms. While the relatively small number of patients in this study limits the ability to draw robust implications for changed clinical practice, it is a strong starting point for larger, future research.

    View record details
  • Sympathetic hyperexcitation in obesity may be protective against pulmonary hypertension

    Diong, Crystal Theerin (2014)

    Undergraduate thesis
    University of Otago

    Pulmonary hypertension (PH) is a disease characterised by an elevation of mean pulmonary arterial pressure due to excessive vasoconstriction and pulmonary arterial remodelling. Despite the many negative health implications of obesity, epidemiological evidence suggests the presence of an ‘obesity paradox’ in PH, whereby obesity is associated with a lower mortality rate in patients with PH. The physiological mechanism underpinning this paradox is currently unknown. However, it is well established that pulmonary sympathetic nerve activity (pSNA) is an important modulator of pulmonary arterial pressure due to β-adrenergic mediated vasodilation of pulmonary vessels. Sympathetic hyperexcitation, or increased SNA in obesity has been shown to occur in some organ systems but has yet to be investigated in the lungs. Thus, this study aimed explore whether pSNA is increased in obesity and PH and if so, whether pSNA plays a greater role in vasodilating pulmonary vasculature in obesity with or without PH. Experiments were performed on four groups of anaesthetised male Zucker rats: lean control rats (lean-C), lean rats with PH (lean-PH), obese control rats (obese-C), and obese rats with PH (obese-PH). In vivo electrophysiology experiments directly recorded activity from the pulmonary sympathetic nerve in order to establish any differences in pSNA in obesity and PH. The pSNA in obese-C animals (2.4 ± 0.4 µV.s, mean ± SEM, n = 7) was significantly elevated compared to lean-C animals (0.5 ± 0.1 µV.s, P < 0.001, n = 7) while the pSNA in the obese-PH group (7.1 ± 2.5 µV.s, n = 4), was also significantly greater compared to their lean counterparts (lean-PH, 2.0 ± 2.5 µV.s, P < 0.01, n = 4). The development of PH was also associated with a 3-fold increase in pSNA in obese rats (P < 0.05). To determine the effect of differing pSNA on vessel diameter, synchrotron radiation microangiography was performed. This technique facilitated the visualisation of dynamic changes in vessel internal diameter during acute hypoxic pulmonary vasoconstriction (HPV, 8% O2 for 5 minutes), before β-adrenoceptor (β-AR) blockade, after β1-AR blockade (atenolol, 3 mg/kg) and after combined β1- and β2-AR blockade (propranolol, 2 mg/kg). Before β-AR blockade, the magnitudes of HPV were similar between all experimental groups. After β1-AR blockade, a greater magnitude of vasoconstriction was observed in the obese-C animals compared to lean-C. Upon combined β1- and β2-AR blockade, the magnitudes of HPV in obese animals both with and without PH (obese-PH, 33 ± 4% and obese-C, 24 ± 4%) were significantly exacerbated compared to their lean counterparts (lean-PH, 16 ± 3% and lean-C, 12 ± 3%, P < 0.05). These differences were primarily observed in resistance arterioles (< 300 µm), critical in modulating pulmonary arterial pressure. This study shows for the first time, differential sympathetic regulation of pulmonary vascular tone in obesity and PH. Sympathetic hyperexcitation in obese rats, both with and without PH plays a larger role in ‘protecting’ the pulmonary vasculature against constriction during HPV compared to lean counterparts, suggesting sympathetic hyperexcitation in obesity may be a potential mechanism underlying the obesity paradox in PH.

    View record details
  • Soil compaction : a direct consequence of dairy cattle treading

    Crawford, Diana J. (2004)

    Undergraduate thesis
    University of Otago

    84 leaves :illus., diagrs., (3 fold. in pocket), maps (1 fold. col. in pocket) ; 27 cm. Bibliography: p. 81-84. University of Otago department: Geography.

    View record details
  • Bryce v. Rusden : the vindication of a colony.

    Clendon, W. Ross (1973)

    Undergraduate thesis
    University of Otago

    PREFACE John Bryce was Minister of Native Affairs in New Zealand during the early 1880’s. Perhaps the first note-worthy point about him is his comparative obscurity, but when his name is recognised it is usually in connection with the leading role he played in the invasion of the Maori village of Parihaka in 1881. Later generations have come to regard that episode as cause for regret and even shame on the part of the Pakeha, and as evidence of the harshness and injustice which seems to have characterised so much of the colonists’ treatment of the Maoris. Some of Bryce’s contemporaries, especially those in England, also saw the Parihaka affair in this light, none more so than George William Rusden. His History of New Zealand, published in 1883, was a savage and lengthy indictment of the colony’s native policies over forty years, in particular of those policies pursued by John Bryce. Some of the aspersions made by Rusden against “the bully of Parihaka” were to result in the libel action of Bryce v. Rusden which was fought in London in 1886. When John Bryce sailed for England to vindicate his good name before a British judge and jury, he had behind him the moral support of his fellow colonists in New Zealand. They saw Bryce as being on a mission to defend not only his honour but also the honour of the colony as a whole; his cause was theirs also. This essay attempts to demonstrate the extent to which Bryce was regarded as a spokesman for all the colonists in New Zealand, and an effort has been made to determine just how successful he was in removing a stigma from the colony. It is also hoped that in the course of the essay some better understanding may be reached of John Bryce as a man and as a colonist and not merely as the plaintiff in the action. For, as both his detractors and his admirers would concede, John Bryce was a man who probably came closer than any of his political colleagues to typifying the ordinary colonist of his day. He was, in fact, the settler personified.

    View record details
  • Quality of Diabetic Foot Care in Oman

    Al-Busaidi, Ibrahim Saleh (2014)

    Undergraduate thesis
    University of Otago

    Background Diabetes mellitus is a common and increasingly important chronic disease worldwide. In Oman, the setting of this thesis, the prevalence of diabetes was 12.3% in 2008. Diabetes causes substantial morbidity and mortality, with diabetic foot disease (DFD) being one of the most serious and costly complications of diabetes. Good preventive foot care measures, patient and provider education and adherence to proper foot self-care practices can reduce the risk of developing DFD by up to 85.0%. No published study has investigated diabetic foot care in Oman. Objectives The aim of this study was to explore the quality of diabetic foot care provided by primary and secondary health care professionals in an area of Muscat, Oman. The specific objectives were: 1) To ascertain the level of foot self-care amongst people with diabetes; 2) To determine the level of foot care education for people with diabetes provided by primary and secondary health care professionals; 3) To determine the level of professional foot care services provided to people with diabetes; and 4) To examine the association between foot self-care practices and known risk factors for diabetes-related foot disease (DRFD). Methods The study setting was eight primary health care clinics and one polyclinic in Alseeb, Muscat, Oman. A convenience sample of 350 Omani patients with diabetes (310 from primary health care and 40 from the polyclinic) were invited to participate in the study. A questionnaire developed from two pre-existing questionnaires and pre-tested and translated into Arabic, was administered by author of this thesis and research assistants. The questionnaire included six domains including demographic details, patient-reported DRFD, foot self-care, foot care education, and professional foot care. Data were checked, entered into Excel spreadsheet, and analysed using STATA Statistical Software version 12.0 (2012). Proportions and means were calculated as appropriate for variables of interest. To examine the association between dependent and independent variables, a one-way analysis of variance was used for categorical variables and product-moment correlation test for continuous variables. Ethical approval was obtained from the Medical Research and Ethics Review Committee, Ministry of Health, Oman. Results Of the 350 participants, 62.3% were female and more than half of the patients were illiterate (52.9%). DRFD was found to be common in this population with more than 55.0% of the study population reported having at least one or more sensory peripheral neuropathy symptoms, and almost half (49.1%) complained of one or more peripheral vascular disease symptoms in the last month. In spite of this, patients often did not adopt all recommended behavioural foot care practices. For example, 54.7% did not look at the bottoms of their feet daily, 58.4% reported using moisturising creams or lotions between their toes daily, and 46.0% reported wearing traditional Omani sandals which do not offer protection from injuries. Fewer than half of the participants reported receiving advice or information on recommended foot care practices from their diabetes health care professionals. Professional diabetes foot care services were suboptimal. For example, 20.4% of participants reported never being asked about numbness in their feet and 21.7% reported having been seen by a podiatrist during the previous year. In the final model, a statistically significant association was found between foot self-care scores and level of formal education, diabetes treatment and professional foot care. Conclusions and recommendations Despite the presence of DRFD in this Omani population with diabetes, the overall quality of diabetic foot care was suboptimal. From the patient perspective there is a need for high quality diabetic foot care education to improve patients’ foot care awareness and self-management. Patient education requires good communication skills and an understanding of patients’ education levels, and the influence of cultural, social and religious practices. A multidisciplinary team approach and ongoing foot care education for health care professionals is needed in order to improve their diabetic foot care knowledge and skills. To better understand the context, barriers to regular recommended foot self-care practices needs to be explored further, and the reasons for non-adherence to the Omani diabetes foot care guidelines by health care professionals requires further clarification. Nevertheless, findings from this study will be useful for health care planners and policy makers in Oman and neighbouring countries with similar health systems for improving the overall quality of diabetes foot care.

    View record details
  • Immune suppression and cutaneous squamous cell carcinoma tumour biology

    Seddon, Annika (2013)

    Undergraduate thesis
    University of Otago

    Cutaneous squamous cell carcinoma is a non-melanoma skin cancer that is among the most common cancers capable of metastasis. The majority of cutaneous squamous cell carcinomas (cSCCs) are easily treated by simple surgical excision, but there exists a subset of cases (approximately five percent) that will become invasive and metastatic. Currently, there are no clinically relevant biomarkers to identify potentially aggressive cSCC, and the biological mechanisms remain unclear. Previous work by our laboratory found high levels of myeloid-derived suppressor cells (MDSCs), particularly the granulocytic subpopulation, in the circulating blood of renal transplant patients and patients with cSCC. MDSCs are a mixed group of immature immune cells (including a high proportion of immature granulocytes) that have been shown to inhibit anti-cancer immunosurveillance and hence facilitate tumour progression. This study analysed circulating and tumour infiltrating immunoregulatory cell populations (MDSCs, neutrophils and lymphocytes) in the blood and tumour samples from patients with cSCC who were not on immunosuppressive medications (non-immunosuppressed, n = 29) and immunosuppressed patients with cSCC (n = 18). The frequencies of MDSCs in the immunosuppressed group were significantly higher compared to the non-immunosuppressed group when analysed as a whole. When we split the non-immunosuppressed patient group by tumour stage (high-stage tumours (n =8) and low-stage tumours (n = 21)), we found that frequencies of total MDSCs and granulocytic MDSCs were significantly higher in the blood of both the high-stage tumour group and the immunosuppressed group compared to the low-stage tumour group. When the tumours of these patients were analysed, increased peritumoural and intratumoural levels of CD66b positive neutrophils as well as higher ratios of CD66b positive neutrophils to CD8 positive lymphocytes were observed as tumour stage increased. Moderate to strong correlations between levels of tumour-associated neutrophils and lymphocytes and levels of circulating MDSCs, were also observed. A clinical audit of cSCC patients treated in the Department of Plastic Surgery, Christchurch Hospital (2009 - 2011) was performed to investigate associations among immunoregulatory cell populations, high-risk tumour characteristics and survival in a larger cohort (n=168). Immunosuppressed patients (n = 39) had higher levels of circulating neutrophils and lower levels of lymphocytes in their blood compared to the non-immunosuppressed patients (n = 129). When the non-immunosuppressed patients were analysed independently, patients that had neutrophil counts of over 4.5 x 109/L, compared to those with lower neutrophil counts, had a significantly higher proportion of tumours that were greater than five millimetres in thickness (p = 0.03), a Clark level of five (p = 0.02) and had higher overall tumour stage (p = 0.04). Furthermore, a thickness of greater than five millimetres was the most significant predictor of overall survival in non-immunosuppressed patients, a characteristic that is given relatively little importance under the current staging system. None of the circulating immune cell populations investigated were associated with overall survival, however neutrophil levels in circulation showed some association with advanced tumour stage (p = 0.04). This is the first study to investigate MDSCs, neutrophils and lymphocytes with clinical information in patients with cSCC. Although patient numbers were small in the current study, and survival and recurrence data for this cohort is beyond the scope of this thesis, this work will be ongoing. As part of this ongoing research, the mechanisms by which neutrophils and granulocytic MDSCs might contribute to tumour progression should be explored. This research will lead to a greater understanding of the underlying pathology of aggressive cSCC, and may provide more informative biomarkers to help identify patients with high-risk cSCC.

    View record details
  • The Paediatric Outpatient Coding Pilot Study

    Kerr, Neal Alexander Moealia (2013)

    Undergraduate thesis
    University of Otago

    In New Zealand, recent literature would suggest that children with chronic health conditions and disabilities, and their families are in need of greater support. The primary aims of this thesis were to; determine whether the information currently available on these children was sufficient for service planning; explore the options for information collection; assess whether paediatric outpatient diagnostic coding could be used to inform planning and funding decisions for this group. These aims were addressed by examination of the national information sources on children with chronic health conditions and disabilities and assessing their ability to inform population Health Needs Assessment for service planning within District Health Boards. The data within the National Non-Admitted Patient Collection was then analysed in detail to determine whether it could yield findings on children with chronic health conditions and disabilities useful for service planning. Finally, a pilot study was undertaken to determine whether clinician based diagnostic coding of paediatric outpatient services comparing the use of ICD-10-AM and SNOMED-CT to yield data on these children is suitable for service planning and funding decisions. Review of the available information on children with chronic health conditions and disabilities in New Zealand confirmed that these children and their families are in need of greater support but that there are no sources currently in use which are suitable to inform service planning and funding decisions at the local District Health Board level (e.g. Timely, Comprehensive, Consistent, Regionally Specific, Diagnostically Defined and with associated Demographic Elements). The National Non-Admitted Patient Collection was shown to have many of the elements required to inform planning and funding decisions but lacked diagnostic information. Preliminary analysis of the Paediatric Outpatient Coding Pilot Study findings from the Southern District Health Board indicated that on average clinician based coding was faster with SNOMED-CT (1.1minutes) per visit than ICD-10-AM (1.6 minutes) or than Trained Clinical Coders using ICD-10-AM (3.1 minutes). Trained Clinical Coders using ICD-10-A M were able to assign diagnostic codes to the most common conditions more consistently than clinicians using ICD-10-AM or SNOMED-CT. Overall, 85 percent of participating clinicians either supported or strongly supported the national routine collection of paediatric outpatient diagnostic codes. A number of conclusions were evident from the research. The information currently available on children with chronic health conditions and disabilities is adequate to demonstrate that they need greater support. However, the information is not sufficient to inform local service planning to address this need. The preliminary findings of the Paediatric Outpatient Coding Pilot Study would suggest that, with further development in IT systems particularly, paediatric outpatient diagnostic coding combined with the National Non-Admitted Patient Collection, would constitute an ideal approach to capturing information on children with chronic health conditions and disabilities suitable to inform planning of local and national level health support services.

    View record details
  • Voluntary Tremor Suppression in Parkinson's Disease

    Ha, William Anthony (2013)

    Undergraduate thesis
    University of Otago

    Parkinson’s disease (PD) is a common degenerative neurological disorder, and resting tremor is one of the main symptoms of this disease. It has been observed that some patients with Parkinsonian rest tremor are able to suppress their tremor voluntarily with mental concentration or by focusing attention on the affected limb. This process is not well understood and this study aims to describe and assess voluntary tremor suppression in patients with PD, as well as to identify the critical cortical or subcortical regions activated during this process. Methods: Nine participants with tremor-dominant PD were recruited for this study. These patients had unilateral rest tremors of the upper limb and were able to consciously stop their tremor for a period of time. Each patient was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), movement tracking and functional imaging. Physical characteristics of the tremor such as amplitude and frequency were measured using a 3-D Polhemus Liberty electromagnetic movement tracking in the MoVELab. Functional imaging was undertaken using functional magnetic resonance imaging (fMRI) in a 3.0 Tesla scanner, with functional data collected with a standard T2 weighted MRI sequence along with T1 weighted 3-D anatomical data. Results: The extent of voluntary tremor suppression differed between the participants with some being able to suppress reliably for long periods of time, and others unable to do so consistently. Participants had slight to moderate tremors according to the UPDRS. The majority of participants described their method of suppression as concentrating on the affected limb and/or focusing on relaxing the limb. Movement tracking confirmed what was observed, with variation in tremor amplitude, and the extent of suppression. FMRI showed differing areas of activation involved in tremor suppression amongst the participants. Activated areas were generally contralateral to the tremor, and were widespread, including parts of the primary motor cortex, superior parietal lobule, supramarginal gyrus and middle frontal gyrus. Conclusion: This study was the first attempt at describing the process of voluntary tremor suppression in PD. The differing methods the participants used to suppress their tremor were recorded and described, and objective measures of the suppression taken. Functional imaging revealed a number of areas involved in tremor suppression.

    View record details