11319 research outputs found
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NZDep2018 analysis of census 2018 variables - DHB15: Wairarapa
No full textFor further information about data sources, interpretation of the graphs, and cautions, please see the separate Introduction Chapter
All data relating to the 2018 census is provided by Stats NZ, https://www.stats.govt.nz/
NZDep2018 analysis of census 2018 variables - TA16: Hamilton City
No full textFor further information about data sources, interpretation of the graphs, and cautions, please see the separate Introduction Chapter
All data relating to the 2018 census is provided by Stats NZ, https://www.stats.govt.nz/
NZDep2018 analysis of census 2018 variables - TA20: Waitomo District
No full textFor further information about data sources, interpretation of the graphs, and cautions, please see the separate Introduction Chapter
All data relating to the 2018 census is provided by Stats NZ, https://www.stats.govt.nz/
NZDep2018 analysis of census 2018 variables - TA25: Whakatane District
No full textFor further information about data sources, interpretation of the graphs, and cautions, please see the separate Introduction Chapter
All data relating to the 2018 census is provided by Stats NZ, https://www.stats.govt.nz/
Role of CaMKII and Alpha Stimulation in Heart Function
Get PDFCardiovascular disease is a major cause of morbidity and mortality in New Zealand. Elucidating its pathogenesis will help us better treat those who are affected by it. One protein that has been implicated in cardiovascular pathology is Calcium (Ca2+)/Calmodulin-dependent protein Kinase II (CaMKII). As its name suggests, it is activated by Ca2+-bound calmodulin. In a healthy heart, CaMKII plays a role in regulating Ca2+-handling proteins in the cardiomyocyte, such as Ryanodine Receptor and Phospholamban. CaMKII has the ability to become autonomously activated so that it can exert its effects even when the Ca2+ concentration decreases. However, if CaMKII is activated when it does not need to be, it can have pathological effects. It can be activated pathologically by hyperglycemia, oxidative stress and hyperadrenergic states, all of which are seen in cardiovascular pathology such as heart failure or diabetic cardiomyopathy. Alpha-adrenergic receptor signaling can also activate CaMKII, but little is known about the effects of alpha-adrenergic stimulation on the heart.
The aim of this project was the determine the functional effects of the alpha-adrenergic agonist Methoxamine on isolated wild-type mouse hearts, and in isolated CaMKII knockout mouse heart, in incremental doses to observe differences in the responses between the two groups to determine the role of CaMKII in the functional response to alpha-adrenergic stimulus in the heart.
The technique used to address these aims was the isolated heart set-up, which is also known as the Langendorff setup. The mouse hearts were surgically removed from the animal, with part of the aorta intact, and placed in an arresting buffer with a high potassium chloride concentration to ionically arrest the heart. The heart was then cannulated via the aorta, and perfused with a Krebs-Henseleit Buffer (KHB) that had all the necessary ions and nutrients to allow the heart to contract outside the body. The stability of the heart was determined via measurements such as coronary flow rate, perfusion pressure, and temperature. A fluid-filled balloon inserted into the ventricle allowed measurement of contractile and relaxation parameters. Increasing doses of alpha-adrenergic receptor agonist, Methoxamine, were added to the KHB perfusate. Three doses were used; 10-8, 10-6, and 10-4mmol/L.
I found that in response to alpha-adrenergic stimulation, there was a significant increase in the rate of contraction (1.384-fold increase; p= 0.0114) and the rate of relaxation (1.435-fold increase; p= 0.0066) in the healthy, wild-type mouse hearts, but not in the CaMKII knockout mouse hearts (rate of contraction- 1.167-fold change; p=0.5080; rate of relaxation- 1.156-fold change; p= 0.5862). There was a significant increase in the total developed pressure in the heart during systole in the healthy mouse hearts in response to alpha-adrenergic stimulation (1.407-fold increase; p= 0.0206), but this increase was not seen in the CaMKII knockout mice (1.099-fold change; p= 0.8750). There was also a significant reduction in the minimum pressure reached by the heart, and the end-diastolic pressure in the healthy wild-type mouse hearts in response to alpha-adrenergic stimulation. Again, this change was not seen in the CaMKII knockout mouse hearts.
The results show that CaMKII may be responsible for the regulation of some contractile and relaxation parameters in the heart. By phosphorylation of its target protein, Ryanodine Receptor, CaMKII can increase the amount and rate of Ca2+ release into the cytoplasm of the cardiomyocyte which would allow for faster and more robust contractions. Furthermore, by phosphorylating Phospholamban, CaMKII can increase the rate and amount of Ca2+ cleared from the cytoplasm of the cardiomyocyte which would allow for faster and better relaxation. The results also tell us that CaMKII may be party of the alpha-adrenergic signaling pathway.
Future research into the involvement of alpha-adrenergic signaling in cardiovascular pathology, and whether inhibiting CaMKII attenuates or completely ablates disease progression will allow us to target CaMKII or the alpha-adrenergic signaling pathway as a therapeutic for cardiovascular disease
Learning technologies: A medium for the transformation of medical education?
No full textContext
Learning technologies are ubiquitous in medical schools, implemented in anticipation of more effective, active and authentic learning and teaching. Such thinking appears to be an instance of solutionism. The evidence is that academics’ adoption of learning technologies is often limited in scale and scope and frequently fails to transform their teaching practices.
Purpose
This paper aims to provide a contextualised analysis of considerations pertinent to the adoption of learning technologies by teaching staff. We contextualise a framework for understanding adoption of learning technologies in higher education by medical education.
Conclusions
We identify multiple precursors that predict individual patterns of adoption, illuminating factors related to the technology, the individual staff member charged with adoption and the working environment. We offer conceptual clarity to the vexed issue of learning technology adoption and provide evidence explaining why, despite their widely promulgated potential, learning technologies do not offer an easy route to the transformation of medical education
Economic insecurity and income inequality in the wellbeing debate
Get PDFThis thesis explores two key measures of economic wellbeing - economic insecurity and income inequality. Chapters 2 and 3 present an Economic Security Index (ESI) for New Zealand, a new measure of economic wellbeing. An ESI is a measure of economic insecurity that identifies which subgroups of the population are susceptible to financial loss due to events such as an unanticipated rise in medical expenses or a fall in income. An ESI also measures if these subgroups have sufficient financial resources to act as a buffer when economic shocks occur. The main index is constructed in Chapter 2 using micro-level data from New Zealand’s Household Labour Force Survey (HLFS) and Household Economic Survey (HES). An alternative index is constructed in Chapter 3 using longitudinal data from the Survey of Family, Income and Employment (SoFIE) to test the robustness of the main index’s findings. After controlling for various demographic and socioeconomic factors, the findings of both versions of the ESI predict similar patterns. The main findings suggest that economic insecurity is highly cyclical, tracking closely to GDP growth and the unemployment rate. This result suggests that insecurity in New Zealand is largely an involuntary phenomenon. It is also observed that insecurity varies by subgroups of the population. Groups that are more likely to experience economic insecurity are ethnic minorities, young adults, people with no educational qualifications, single-adult households, persons whose relationships ended over the ESI year, high-income households and persons on temporary employment contracts.
In Chapter 4, both versions of the ESI and longitudinal health data from SoFIE are used to estimate the causal impact of economic insecurity on the mental wellbeing of New Zealanders. The study uses fixed effects models to test the hypothesis that being economically insecure increases the likelihood of poor mental wellbeing. To proxy for mental wellbeing, I use each respondent’s Kessler-10 (K10) score as well as the Short Form 36 (SF-36) health survey, two common indicators of mental disorders. For the SF-36 health survey, both the Mental and Physical Component Summary (MCS and PCS) Measures are used. To proxy for insecurity, the exogenously assigned ESI values from HLFS (‘predicted economic insecurity’) are used, as well as ESI values from SoFIE (representing ‘lived insecurity event’, such as if an individual loses their job or gets divorced). Consistent with the literature on this topic, the results suggest that both measures of insecurity lead to worse mental wellbeing; however, the results are not statistically significant. Further, the analysis produced mixed results when looking at the relationship between insecurity and physical health. Experiencing a ‘lived insecurity event’ is found to improve physical wellbeing, albeit the results are not statistically significant. ‘Predicted economic insecurity’ is found to have a strong, statistically significant negative relationship with each respondent’s standardised PCS scores, which suggests that insecurity worsens physical wellbeing. These associations remain after adjusting for several demographic and socioeconomic characteristics.
In Chapter 5, the theme shifts to income inequality. This chapter uses ordinary least squares (OLS) regression analysis to determine the deep determinants of income inequality, a topic that has received very little attention in the literature. Specifically, the study explores whether the deep determinants of comparative development - which explains differences across countries - are also important in explaining within-country income inequality. The three main hypotheses that explain comparative development are the geography, institutions and genetics/fractionalization hypotheses. The results of the preferred model show that there are some elements from each of the three hypotheses that contribute to explaining within-country income inequality. Whether a country is landlocked or not, distance from the technological frontier, birthplace diversity and the time that has elapsed since the Neolithic Revolution are all found to be deep determinants of income inequality. The results also show that the deep determinants of income inequality vary depending on a country’s level of economic development. Explanations for each finding are discussed
Investigating how pharmacists fit into the primary care non-medical prescribing landscape in New Zealand
Get PDFBackground
Increasing demand for health services and resource constraints have affected access to prescribing services in primary care. Some countries, including New Zealand (NZ), have introduced non-medical prescribing (NMP) to facilitate timely access to medicines. This shift in roles utilises the skills of health professionals including pharmacists to improve patients’ access to prescribing services. NMP in NZ is a relatively new health service, and little is known about the uptake, utilisation and perceptions of this service from both the public and pharmacists.
Aim
To investigate non-medical prescribing in New Zealand, and how pharmacists fit into this prescribing landscape in primary care.
Method
This thesis was conducted in five stages:
1. A literature review to establish an overview of NMP research conducted in NZ, and to identify knowledge gaps.
2. A review of data from a variety of NZ sources (NZ legislation, information from professional and regulatory organizations, policy documents, information from education providers, and grey literature) to provide an updated overview of NMP in NZ.
3. A pharmacoepidemiology study, utilising the NZ National healthcare collections to identify NMP trends in NZ primary care.
4. A discrete choice experiment to determine community pharmacists’ preferences for providing prescribing services in primary care in NZ.
5. A discrete choice experiment to determine the NZ publics’ preferences for utilising pharmacist prescribing services in primary care in NZ.
Main findings
1. There is a paucity of NZ research regarding non-medical prescribing. Little is known in NZ about the current state of NMP and how this service is being utilised. NZ research has yet to explore the place of pharmacist prescribers within primary care.
2. There is variation in the regulation, educational programmes and prescribing competencies used by the different prescribing health professionals involved in NMP in NZ.
3. NMP is not widely utilised in NZ, and nurse prescribers are the major NMP providers in primary care. Pharmacist prescribers are not well utilised and have the potential to contribute more to the NMP service in NZ.
4. NZ community pharmacists are willing to provide prescribing services in primary care in NZ using a variety of autonomous prescribing models in community pharmacies.
5. The NZ public are willing to use various models of pharmacist prescriber services in primary care if they are accessible when required, are open for longer hours, and cost less than a GP consultation.
Conclusion
Compared to the other countries, NMP in NZ is inconsistently implemented and underutilised. An overarching NMP policy should be developed to enable consistency in the various aspects of NMP. The DCEs signalled that NZ community pharmacists see themselves as part of the prescribing team, and that the NZ public are willing to utilise pharmacist prescribing services in primary care. As demand for healthcare in NZ increases, pharmacists have the potential to be part of the solution within the NMP framework in primary care. Policy makers and funders have the opportunity to utilise the outputs of this thesis to evolve the traditional role of pharmacists—to develop pharmacist prescribing services in NZ that enable equitable and timely access to prescribing for our communities
Does Size Matter? Using Osteology and Ancient DNA to Reconstruct Extinct Diversity in Duvaucel’s Gecko
No full textThe dynamic geology and climate of the New Zealand archipelago has had pronounced effects on the evolution of its endemic flora and fauna. However, contemporary biodiversity is depauperate, with previous studies revealing complex extinction-recolonization dynamics and cryptic extinctions following both Polynesian and European arrival. Hoplodactylus duvaucelii (Duvaucel’s gecko) is a large Diplodactylidae species, previously widespread throughout New Zealand (based on relative-size identification of Holocene subfossils), with extant populations restricted to predator-free offshore islands. This thesis uses integrated morphological and genetic approaches to reconstruct the taxonomic and phylogeographic diversity of New Zealand’s large geckos (‘H. cf. duvaucelii’) prior to Polynesian and European arrival. Geometric morphometrics (of three-dimensional micro-CT scans) was used to characterise and describe maxillae shape and size variation between extant genera (Dactylocnemis, Hoplodactylus, Mokopirirakau, Naultinus and Woodworthia), and to determine the taxonomic affinities of Holocene ‘H. cf. duvaucelii’ subfossils. All genera were morphologically distinct, with shape variation in the nasal and orbital margins primarily reflecting ecomorphological adaptation. However relative-size comparisons were only effective in distinguishing Hoplodactylus. Additionally, while some ‘H. cf. duvaucelii’ subfossils exhibited strong affinities towards H. duvaucelii, others possessed morphological variation not encompassed by extant representatives. Furthermore, ancient mitochondrial genomes recovered from Holocene ‘H. cf. duvaucelii’ subfossils using a minimally destructive DNA extraction method, were used to test for cryptic extinctions of large Holocene geckos, and to reconstruct phylogeographic structure in H. duvaucelii. All recovered ancient mitochondrial genomes were identified as H. duvaucelii, confirming their once widespread mainland distribution. Absence of large Holocene representatives outside Hoplodactylus implies gigantism evolved only once within the New Zealand Diplodactylidae radiation. Pronounced phylogeographic structure was identified within H. duvaucelii, with extant populations comprising two deeply divergent and morphologically distinct species: H. duvaucelii ‘North’ and H. duvaucelii ‘South’. This thesis provides the most comprehensive study of New Zealand’s Holocene subfossil geckos and highlights the applications of integrated geometric morphometric and ancient DNA analyses in taxonomy, biogeography and conservation of understudied fauna
Survival, not resilience: Young people's housing instability
Get PDFYoung people’s experiences of housing instability need to be recognised. The extant literature tends to equate young people’s experiences with that of adults and the limited literature that exclusively examines young people tends to take a narrow lens, with a focus on running away from home and living on the streets. What is missing is an in-depth examination of other forms of housing instability and inadequacy, and how these impact on young people. The current study looks at the experiences of young people, including experiences of eviction, unhealthy homes, overcrowding, frequent housing movements, and living in liminal spaces. To explore these experiences, a mixed methods approach was used. In the qualitative strand, a collaborative approach was undertaken using ethnography to give voice to the narratives of twelve girls in their youth who were surviving housing instability. As part of this approach, a novel method was used: friendship guided by whakawhanaugatanga. This method disrupted the traditional power imbalance between researcher and participant and therefore enabled knowledge to be co-created and the experiences of young people accessed. In the quantitative strand, a statistical analysis of data collected as part of the national Youth’12 questionnaire was undertaken. The mixed methods analysis of these data elucidated that a wider conceptualisation of housing instability that includes dimensions other than homelessness and eviction is justified. For young people, the impacts of all dimensions of housing instability are severe and work in intersecting ways to produce negative outcomes. Housing instability has a detrimental effect on their life chances and wellbeing, including disruption to education, fractured support networks, poor health outcomes, and trouble with the police. For young people, housing instability creates a climate of risk where they resort to perilous behaviour to survive, and this turbulent process discounts their sense of security. To borrow from Matthew Desmond, housing instability evicted these young people from their childhoods. Rather than a rosy view of resilience, these young people were simply surviving. This thesis concludes by suggesting policy recommendations specifically targeting young people’s housing needs. These are needed to support young people with their transition into adulthood and the ensuing responsibilities. These must be informed by data that captures all dimensions of housing instability and the unique needs of young people