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Community Pharmacists' Perception of their Roles in Primary Mental Health Care
Full text linkIntroduction: Mental illness is the leading contributor to disability, globally. The economic, social and individual cost of mental illness is high, being an indiscriminate health condition affecting all walks of life, gender, race and age. People with mild to moderate mental health conditions are generally cared for in primary health care with their drug treatment available from the community pharmacy. This gives the community pharmacist the ideal opportunity to interact with people with mild to moderate mental health conditions and play an important role in their care. To date, community pharmacists’ views on their roles and contribution to primary mental health care in New Zealand have not been investigated.
Aim: To explore community pharmacists’ perceptions of their role in primary mental health care.
Methodology: A qualitative study was undertaken. Fifteen face-to-face semi-structured interviews took place with registered community pharmacists from across New Zealand. Participants discussed current primary mental health services delivered by community pharmacists as well as facilitators and barriers to service provision. Interviews were audio-taped and transcribed verbatim. Data obtained were then coded and common themes were identified using a thematic analysis approach.
Results: Four main themes were identified. These themes showed that participants all believed they had an important role to play in primary mental health care. The level of interaction varied from the basic dispensing role, to dispensing plus patient counselling with provision of education and advice, through to broader patient centred primary mental health care. Community pharmacists could provide a continuum of primary mental health services which included multidisciplinary team care, patient support and patient advocacy. Factors identified that impacted on the ability to provide primary mental health care services included stigma, privacy and confidentiality issues, staffing levels, availability of time and funding, community pharmacists’ education and their perceptions of patient’s needs.
Conclusion: As part of the primary health care team, community pharmacists are increasing their contribution to the provision of primary mental health care. This coincides with an increased emphasis within policy and practice by government and pharmacy and medicine stakeholder organisations to support pharmacists to increase their face-to-face work in primary mental health care
The nature and influence of the hidden curriculum impacting SGM health learning in health professional education – A scoping review protocol
No full textThis document outlines the justification and process for a scoping review of current knowledge on the hidden curriculum relating to Sexual and Gender Minority health in health professional education. It includes a brief synopsis of the background literature, the aims, research questions, and methods of the planned scoping review. The purpose of this scoping review is to map the current literature relating to the nature and influence of the hidden curriculum on SGM health learning with a particular focus on undergraduate HPE
Systems-practice framework: An integrated approach for foodservice management
Full text linkThere is increasing pressure on foodservice organisations to improve the sustainability of their operations and to do so practitioners must be equipped with appropriate tools. In this paper, a tool to guide management strategies for pro-environmental behaviour change is introduced. The tool is based on a new framework that combines two existing models: the widely used foodservice ‘systems model’ and a model from sociology proven to be effective for understanding sustainable practices, the ‘social practice model’. This new hybrid ‘systems-practice’ framework is applied to an ethnographic case study, using document analyses, observations, focus groups and interviews, to investigate food waste in hospital kitchens. The present case study illustrates the practical implications of employing this approach and enhances the external validity of the proposed framework. The present study showed how the social practice model added to the existing systems model emphasised the role of foodservice personnel for generating pro-environmental practices, and thus offered a more people-based approach to foodservice management. The case study data provided evidence for the efficacy of a systems-practice approach to foodser-vice. This is especially relevant for encouraging a more environmentally aware behavioural orientation within food service systems. Based on easy-to-follow steps presented in the adjoined ‘application of the systems-practice guide’, practitioners can use the framework to either understand practices that already exist in their operations, with the purpose being to ensure further systemisation of positive practices, or to effect change by creating new sustainable practices and phasing out existing unsustainable practices
Identifying Transition Capacity for Agri-food Regimes: Application of the Multi-level Perspective for Strategic Mapping
Full text linkIn this paper, agri-food systems are discussed in the context of a set of socio-technical transitions principles, with a focus on energy, materials and practice elements that have the potential to promote sustainable outcomes across the system. This paper aims to develop an integrated approach for regime analysis, informed by emerging knowledge on socio-technical transitions. The application of the multi-level perspective (MLP) as a heuristic framework to structure descriptions of the multi-dimensional transition contexts of contemporary agri-food regimes is explored. To do this, the paper aims to elaborate the MLP by proposing an integrated means through which complex transition dynamics can be mapped across: (a) energy and material flows and (b) social practices which shape, direct and determine these energy and material flows. This approach is labelled strategic regime mapping (SRM). The paper forwards insights from the development of SRM and discusses the role of strategic mapping of key points across the regime. By combining insight on the conceptualization of dynamic and globally interconnected socio-technical systems with specific observations on contemporary agri-food systems, the paper provides insight into the mapping of transition capacity across agri-food systems, as well as highlighting the significant challenges associated with such an undertaking
Development of nanofibres for local delivery of neuroactive drugs to the brain
Full text linkIntroduction: Drug delivery to the brain to treat neurological disorders is a challenge due to the blood-brain barrier, which physically and actively restricts the transport of molecules into the brain. Implantable drug delivery systems (e.g. hydrogels and nano/micro-particles) have been developed to overcome the blood-brain barrier issues. However, limitations such as excessive swelling or disintegration of the hydrogel, retaining the particles at the site of action, low loading efficiency and burst release of the drug can occur. Therefore, the overarching aim of this thesis was to develop and characterise implantable nanofibres (NF) for drug delivery to treat neurological disorders using low toxic solvent systems.
Methods: NFs were prepared using the technique of electrospinning using biodegradable polymers. For the first time, a new, low toxicity solvent system consisting of acetone (ACE) and ethyl acetate (EtAc) (Class III solvents) was used to prepare poly-(lactic-coglycolic acid) (PLGA) NFs. The electrospun PLGA NFs were characterised based on morphology, solid-state characteristics, tensile strength and hydrophobicity and compared to NFs electrospun using more toxic solvent systems of dichloromethane (DCM) and dimethylformamide (DMF) (Class II solvents). The incorporation and release kinetics of drugs with different molecular weights (paracetamol 151.17 g/mol, ampicillin 349.41 g/mol and tetracycline 480.90 g/mol) were investigated.
Poly-(caprolactone) (PCL) was also investigated as a NF drug delivery system and was co-electrospun with chitosan (CH), gelatine (GEL) or poly-(ethylene oxide) (PEO). The NFs were compared to determine if the blended polymers improved the chemical and physical properties of PCL NFs. In vitro degradation studies were conducted and the drug release kinetics of L-655,708 from PCL and the PCL/blend NFs was investigated. Further release studies from PCL/CH NFs were undertaken, with a comparison between the neuroactive-drug L-655,708 and indomethacin. The in vitro cytotoxicity and immune response assays were conducted to investigate the biocompatibility of the NFs.
Results: Compared to PLGA NFs produced using the conventional solvents DCM and DMF, the new ACE:EtAc solvent system resulted in NFs with a decrease in fibre diameter uniformity and an increased hydrophobic surface as determined by field emission scanning electron microscopy (FE-SEM) and water contact angle measurements, respectively. NFs made using both solvent systems were amorphous, however, the residual solvent could be detected by thermogravimetric analysis. Attenuated total reflectance-Fourier transform infrared spectroscopy analysis showed there was no change in PLGA chemical composition after electrospinning. Tensile strength studies showed that NFs prepared using the less toxic ACE:EtAc solvent system was lower in tensile strength and underwent a different mechanical deformation process compared with DCM:DMF NFs.
The solid-state analysis confirmed the incorporation of the drug in the PLGA NFs, with FE-SEM and hot stage microscopy identifying drug on the surface of the NFs. The drug release kinetics of tetracycline and paracetamol were similar from both NFs with an initial burst release, followed by a gradual release over 504 h. Assessment, however, of the release profile for ampicillin revealed a smaller initial bolus release with the release from PLGA ACE:EtAc being slower than PLGA DCM:DMF. The release kinetics indicated that the molecular weight of the incorporated drug, nor fibre diameter influenced drug release.
FE-SEM analysis of PCL and PCL/blend NFs showed smooth, bead-free NFs with average fibre diameter in the order of PCL/CH < PCL < PCL/PEO < PCL/GEL. The polymers incorporated into the NFs were chemically unchanged by the electrospinning process and the NFs did not appear to have residual solvent present. The PCL component of PCL/CH and PCL/GEL NFs had reduced crystallinity, while PCL/PEO NF was the most thermally stable and had the highest mechanical strength. The hydrophobic surface properties of the PCL NF were decreased when blended with PEO and GEL.
An in vitro degradation study revealed a reduction in mass of 44% and 38% from PCL/PEO and PCL/GEL, with negligible loss over the 4-weeks from PCL and PCL/CH. With polymer degradation said to influence drug release, it was interesting to observe that the degradation study did not translate into the faster release of L-655,708 from PCL/PEO or PCL/GEL, as PCL/CH showed the fastest release with 100% release after 24 h. The drug release from PCL/CH was further investigated as a charge interaction was postulated to be the mechanism of release, however, the release of the neutral drug indomethacin was similar to the release of L-655,708. Two theories were put forward to explain the release kinetics from the PCL/CH NF; 1) phase separation of the polymers occurred during electrospinning, forming two distinct fibres with the hydrophobic drugs favouring the lesser hydrophobic interaction with CH resulting in drug diffusion out of the CH NF. Alternatively, a core/sheath NF occurred where the drug was located in the CH sheath around a PCL core resulting in drug distributed at the surface of the NF. 2) During the electrospinning process, nano-pores were created on the surface of the NF that facilitated the diffusion of the drugs from the NF. In vitro cell culture studies showed PCL/GEL had the greatest cell proliferation over 24 h and the highest cell viability over 3 days. NFs with fibroblast cells cultured on the surface did not elicit an immune response, however further studies need to be conducted to confirm biocompatibility.
Conclusion: This thesis demonstrates the development of a drug delivery system using the electrospinning process that utilises less toxic solvent systems. Drug release was sustained over 21 days and supports the use of a NF as a promising candidate for the local delivery to treat neurological disorders
The lost kelp forest: a multi-disciplinary approach to understand change of Macrocystis pyrifera habitat in Otago, New Zealand
Full text linkMacrocystis pyrifera (M. pyrifera) is an ecosystem engineer. It modifies the environment providing the foundation, food, resources, and habitat provisions for many other organisms. Globally, kelp forests have been declining due to multiple-stressor impacts. Anecdotally, M. pyrifera has declined in Otago, New Zealand however no research has yet assessed this. The aim of this study was to determine changes in extent of M. pyrifera along coastal Otago to understand if there has been a change in living memory of local knowledge holders. The research then aimed to validate evidence given by interviewees and investigate what habitat remains for the potential of future regeneration of the kelp forests in this area. During 19 semi-structured interviews, local knowledge holders reported a complete loss of M. pyrifera forests along the southern coastline north of Taieri Island that occurred between approximately 1970’s – 1980’s. This stretch of coastline is still referred to as “The Kelp”, even by interviewees who never observed M. pyrifera here. The area indicated by interviewees at the entrance of the Taieri River was investigated further. A multibeam survey located the presence of two reef structures (0.2 km2 and 0.9 km2) in the location indicated by interviewees. The two reef structures appeared to have hard substrate in a depth range (9 – 21 m) that could support M. pyrifera, if other environmental conditions were congruent. A drop camera survey of the two reef structures was done to investigate the substrate and biological compositions of the reef structures. This was compared to a previous survey that had been completed in the East Otago Taiāpure where it is known that there is still M. pyrifera. The camera analysis supported the multibeam survey, that there was sufficient hard substrate to support M. pyrifera. Assessment of the algal composition showed a homogenous mix of coralline, C. brownii and mixed red algae when compared to the heterogeneous canopy and understory composition of the East Otago Taiāpure. Along both the northern and southern coastlines there was an agreement amongst interviewees that runoff from the land, in particular sedimentation, was a key driver behind the changes observed. This fits both with the increases in fine sediment from land use observed around Otago as well as the presence of sediment resilient species of algae. To further understand the implications of the loss of kelp forests along this coastline it would be essential to quantify the stressors that have caused the loss of kelp along this coastline and if these stressors are still present in this environment. In a changing global environment, it is important to understand the changes that have, and will continue to occur in order to do valuable ecosystem-based management
The effects of hydrothermal processing on legumes: Volatile profile and digestibility aspects
No full textLegumes are cultivated and consumed all over the world as a staple food. Legumes are an economical source of protein, slow-release starch, fibre, (un)saturated fatty acids, vitamins and minerals. In the face of a growing world population, which demands an economical and nutritious food source, legumes are an important crop. So far, legumes have not yet been exploited to their fullest potential. Legumes have a volatile profile that can result in overall undesirable odours. Legumes, even undergoing prolonged processing, can have a relatively lower starch and protein digestibility (compared to other crops and meat). Compounding the issue is the presence of deleterious antinutrients in legumes, such as enzyme inhibitors, lectins, tannins, and phytate, which must be inactivated and/or removed by processing prior to consumption. Thus, processing is very important in the utilisation of legumes, both for minimising undesirable volatile compounds, as well as increasing starch and protein digestibility. As such, this thesis aims to fill the gap in the literature of a thorough investigation into the effects of hydrothermal processing.
To do so, this thesis characterised eleven types of commercially available legumes in New Zealand according to their volatile and fatty acid profiles through headspace solid phase microextraction gas chromatography mass spectrometry and gas chromatography flame ionisation detection, respectively. Thereafter, cowpeas, chickpeas and kidney beans were selected to be processed using boiling, a commonly used hydrothermal processing technique. Changes in headspace volatile and fatty acid profile were analysed after the above-mentioned processing technique. Both open system and closed system approaches were conducted to investigate the changes in legume’s volatile profile after boiling of legumes in an open system and processing of legumes in a sealed container. Finally, starch and protein digestibility of legumes processed for varying durations were determined through in vitro oral-gastro-intestinal digestion.
Results showed that integrating volatile fingerprinting and fatty acid analysis is effective in characterising the volatile and fatty acid profiles of dried legumes, with discriminant volatile compounds identified for each legume. The detected volatile profile consisted of aldehydes, alcohols, ketones, terpenes, esters and lactones, furans and hydrocarbons. The lipid profiles comprised of five major fractions consisting of palmitic, stearic, oleic, linoleic and α-linolenic acids. Hydrothermal processing (boiling) was shown to be suitable for the reduction of undesirable volatile compounds, mostly in the aldehyde and alcohol chemical groups, hypothesised to be through the inactivation of endogenous enzymes such as lipoxygenase. Fatty acid profiles changed very little during hydrothermal processing. Simultaneously, an inverse relationship between decreasing legume texture and increasing rate of starch and protein digestion was observed with increasing hydrothermal processing time in cowpeas, chickpeas and kidney beans. Prolonged processing duration (≥60 min) increased the extent of starch digestion but decreased the extent of protein digestion. This could be partially due to the degradation of amino acids (arising from protein) participating in Maillard reactions and thermal degradation; the presence of products such as furans, pyridines and sulphur-containing compounds detected at prolonged processing durations supported this hypothesis. A closed system approach (complementary to the open system approach) provided additional evidence towards the confirmation of the aforementioned hypothesis, as the most volatile compounds (e.g., sulphur-containing compounds) were able to be captured because they were not lost into the environment during processing.
The knowledge gained in this thesis has extended the fundamental understanding of the legumes processing using conventional hydrothermal technique. The knowledge gained in this thesis creates a foundation for future research and can be used to advise consumers and the industry on how to select processing intensity to maximise legume’s utilisation and benefits
Network-oriented public transport planning in medium and small New Zealand cities
Full text linkTransport planning has traditionally used a reactive “predict and provide” model in which the main role of public transport (PT) is to move rush-hour commuters to and from the CBDs of large, dense cities. Beyond this, PT is only needed as a “lifeline” service for those unable to access private travel. Contrary to these assumptions, network-oriented planning argues that high-quality, connective PT networks can leverage network effects to serve diverse travel needs and compete with the private car.
In New Zealand, free-market thinking has made network-oriented approaches difficult to implement, but a series of reforms in the last 10–20 years have encouraged networkoriented planning. These reforms were driven by the needs of Auckland and Wellington, but the experiences of other cities under these reforms have drawn little attention. This thesis utilises qualitative methods to investigate changes to PT, often involving elements of network-oriented planning, in small and medium New Zealand cities. This centres on eight key informant interviews and the case study of Dunedin, whose bus network has been reformed along network-oriented lines.
Findings are focused on the future of PT in New Zealand, especially outside of the largest three cities. Reforms at a national level are regarded as successful despite some controversy over elements of the Public Transport Operating Model (PTOM). Although some commentators have called for responsibilities for PT to be moved from regional councils to city councils, this is not supported due to the importance of achieving economies of scale, especially around efficient use of limited professional expertise. The importance of economies of scale is demonstrated by a positive trend in recent years of increased collaboration between councils around the country. This is not to say the current governance arrangements are satisfactory; there may be a place for some PT functions to be centralised, and/or more specialised regional transport bodies. For small and medium cities especially, the challenges of serving schoolchildren with PT proves to be a complex issue; it is important that a network-oriented framework is not used too dogmatically to prevent solutions that are sensitive to actual local needs, which vary heavily from place to place.
Although factors such as the size of a city, its urban form, or market forces have an impact, this thesis argues that the success or failure of PT in a city is ultimately within the control of decision-makers. Given this, network-oriented planning is a key element of the joined-up, integrated thinking needed to turn good intentions into results
People and processes during decision-making in open source software communities: A case study of Python
No full textOpen Source Software Development (OSSD) communities are often able to produce high quality software comparable to proprietary software. The success of an OSSD community is often attributed to the underlying governance model, and a key component of these models is the decision-making stage. Most studies on OSSD communities, particularly those that focus on decision-making involving people and processes, have adopted a qualitative lens to study decision-making, rather than undertaking a data-driven, empirical study. This work aims to bridge this gap by pursuing a large-scale quantitative study based on data available in Python development email archives.
There are two parts to this study: people and processes. The first part of this thesis investigates members’ involvement during different stages of decision-making and the participant patterns for different types of proposals. It also uses Social Network Analysis (SNA) to identify the core decision-makers in Python. Amongst these core contributors, this thesis also identifies those decision-makers who contribute in multiple ways (i.e. perform multiple roles) and thus form the boundary spanners in OSSD. Based on this, we propose an approach to identify a replacement administrator that can take charge of the community if the current leader is no longer able to contribute.
The second part of this thesis addresses the need to make hidden decision-making processes more explicit. Even when such processes are publicly documented, the rationale for the various steps in a decision-process often remain hidden. To address these gaps, this thesis presents the Decision-Making Process (DeMaP) miner framework that employs NLP techniques and a data-driven, bottom-up approach to extract the decision-making process from email discussions. This thesis also presents a mechanism that can be used to infer the rationale behind how OSS enhancement decisions were reached (e.g. based on developer consensus or administrator pronouncement).
The thesis makes two main contributions. First, it makes a knowledge contribution by a) highlighting the involvement patterns of members during decision-making in different types of proposals and different states within these proposals, b) identifying key decision makers and boundary spanners in the Python OSSD community, c) extracting the Python decision-making process, and d) determining the rationale behind specific decisions. Second, it makes a methodological contribution in the form of a framework (DeMaP miner) that can be used to mine the decision-making processes and the rationale behind decisions (Rationale miner), both in the Python community and in other similar OSSD communities
Rapid Point-of-Care Testing for Hepatitis C – Assessment of Feasibility, Knowledge of Participants and Outcomes.
Full text linkIn New Zealand, approximately 50,000 people or more are infected with hepatitis C(HCV), and only 50% or less are currently diagnosed. HCV infection(and related complications) is presently the single most common diagnosis leading to liver transplantation in New Zealand. With current treatments, HCV infection has a high cure rate and the foremost hurdle to eradication is the identification of those infected. A blood test to detect HCV antibodies is currently used as the initial test. Trained personnel, expensive equipment and repeated appointments are required in the current HCV care cascade which increases the number of patients lost to follow-up.
A point-of-care test is a swift testing method that allows individuals to be tested, informed of the results and further management started during the same visit. The OraQuick HCV point-of-care test has high sensitivity and specificity and is validated against traditional EIA testing methods. This test detects HCV antibodies and confirmation of active infection is needed with an RNA test after a positive antibody test. The study assessed the feasibility of point-of-care HCV testing in a general practice setting and at a sexual health clinic in Dunedin, New Zealand and aimed to gain insights into participants’ knowledge and experience with the test.
HCV point-of-care tests were offered to patients aged 45 to 65 years as well as anyone at least 18 years old with a risk factor for hepatitis C. Mouth swab testing(n=111;50.9%) was used in the initial phase and finger-prick testing(n=107;49.1%) later. Volunteers with known hepatitis C were tested as well using both testing methods and the tests were positive. Data collected included demographics, risk factors for HCV infection and participant experience with the testing method. A questionnaire was used to assess knowledge regarding viral hepatitis. Data variables have been analysed with significance defined at p < 0.05.
A total of 218 participants were recruited for the study. The median age was 29 years(IQR 22 to 46). Fifty six percent(n = 122) of the participants were female. All the test via the finger prick method were negative. Fourteen mouth swab tests were false positive. One person was detected to have an active HCV infection and managed and cured as per guidelines. On knowledge-based questions the study population scored a median of 58.3% (IQR 50 to 75). There were no statistically significant differences in percentage of correct answers between participants with different levels of education, F(4, 213) = 0.857, p =0.491. A majority of study participants (93.6%) reported that they preferred to get their results on the same day and that the point-of-care test caused less anxiety(74.8%) compared to a usual blood test. There were no complications of administering the rapid point-of-care test.
Point-of-care testing for HCV is feasible and preferred by participants. Only one person with active HCV infection was detected. Future studies should take into consideration the number of false positives via the mouth swab method of testing in this study. Knowledge regarding hepatitis C was low among participants. This study has also provided valuable insights into the viability and participants’ experience of offering point-of-care testing for HCV in New Zealand. The results form the basis for a larger trial with multiple sites across the country and a higher number of participants