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Identification of clinical predictors for recovery from shoulder pain following ultrasound guided corticosteroid injection into the subacromial- subdeltoid bursa
INTRODUCTION TO THE THESIS
The study reported in this thesis investigates predictors of success following a corticosteroid injection (CSI) into the subacromial-subdeltoid (SASD) bursa of the glenohumeral (GH) joint. Anecdotally, there is a lack of knowledge regarding how patients will respond to a CSI into the SASD bursa, as well as what attributes may suggest whether a patient will or will not recover well following a bursal injection. This thesis therefore aimed to collate outcome measures and investigate if they can predict changes following a SASD bursal CSI. The study is presented as a Manuscript, which is preceded by a Literature Review discussing research pertinent to the area of study undertaken.
Research into the impact of shoulder pain is presented in the following Literature Review presented in Chapter I. The epidemiology and economic impact of shoulder pain is explored first, demonstrating a global lack of current research in this field, and the rise in national costs associated with shoulder pain recovery. The next section titled ‘Why Shoulder Pain?’ explains causes of shoulder pain, integrating anatomical, functional, and biomechanical considerations and theories of pain to provide a comprehensive review of shoulder pain. Subacromial impingement syndrome (SIS) is reported to be one of the most common shoulder pathologies causing shoulder pain and therefore will be discussed in depth in the section titled ‘What is Shoulder Pain’. This will provide background information regarding the likely cause of SIS related shoulder pain, followed by the treatment options that may be used prior to a CSI being considered. The section will introduce SIS as a condition, followed by discussion of the process of diagnosis, treatment options, and prognosis.
Given the study investigates corticosteroid injections into the SASD bursa, and whether a response could be predicted following an injection, corticosteroids and their use will be discussed in some depth. The section titled ‘Corticosteroid Injections’ introduces the corticosteroid agents used for musculoskeletal (MSK) pathologies, and the methods used to facilitate accuracy of the injection. This is important to discuss because this study observed ultrasound guided CSIs, and there is debate regarding the effectiveness of guided versus non- guided injections. In this same section evidence pertaining to the effectiveness of a CSI will be discussed, presenting data on short-term versus long-term prognosis following an injection, as well as an outline of reported side effects of CSIs.
Predictors and outcome measures related to shoulder rehabilitation will be introduced and discussed in the final section of the Literature Review. This discussion may appear tangential to shoulder pain and CSIs, however, because this pertains to the prediction of outcomes of shoulder pain, it is important to present information regarding such predictors and their use in research and clinical practice. Within the ‘Predictor’ section of the Literature Review, the initial stages of development of a clinical prediction rule (CPR) will be described. Although it was not an aim, nor a product, of this thesis to develop a CPR, it is important to demonstrate the steps necessary to create a successful prediction study. The use of predictors in healthcare will be discussed, as well as common predictors of shoulder pain and disability. Additionally, although this is a prediction study, it is important to introduce outcome measures, as some patient reported outcome measures (PROMs) can be used to assess a patient’s current status and predict future outcomes. The PROM subsection begins with a broad discussion on subjective versus objective measurement, followed by a paragraph on common PROMs used for shoulder pain and disability. A more substantial review on the development, validation and use of outcome measures in healthcare and research completes this section.
Finally, a Summary of Chapter I highlights the reasoning behind investigating individual predictors and outcome measures that can predict shoulder pain following a CSI into the SASD bursa. Following this, a Methodology section will present how shoulder pain in the context of this thesis should be researched. The study proper will be presented as a Manuscript in Chapter II, reporting the main findings, as well as the appendices for the manuscript which provide additional information relating to the study. The thesis appendices are located in Chapter III, containing information not reported in the manuscript, such as ethics approval, consent forms, participant information and questionnaires
Culturally inclusive pedagogies of care : a narrative inquiry
This paper is a reflection on culturally relevant pedagogies of care to achieve more equitable outcomes for diverse cultures within early childhood. The authors are academics at a tertiary institute in Auckland, New Zealand. Our aim is to share our experiences as teachers in a diverse and multi-ethnic city in New Zealand. Authors draw on narrative methodology to deconstruct our experiences and share how we position ourselves in teaching and learning. The paper emphasises an enactment of pedagogy that recognises diverse cultural knowledge and other ways of knowin
Collaboration in the New Zealand commercial construction sector : a case study of a medium sized construction company
The New Zealand commercial construction sector is experiencing a significant economic boom. During this boom many companies are struggling to operate efficiently, resulting in failures to meet project expectations, clients being un-happy with results, and financial stress causing, in some cases, companies to become insolvent. Many of these issues relate back to the competitive nature of the industry. In an effort to become more effective, the NZ construction industry is discussing strategies for addressing the problems it faces. One strategy receiving increasing interest is how the industry could work more collaboratively across the supply-chain to improve performance.
The research seeks to answer ‘is collaboration occurring in the New Zealand commercial construction sector’?
An investigation of a medium sized construction company was undertaken to assess at what stages it was working collaboratively, and whether there was an untapped opportunity for the company to be more collaborative. Findings have shown that participants are demonstrating high levels of cooperation and teamwork on-site, with a willingness to work collaboratively. However, much of this behaviour is confined to the on-site team, with limited evidence it extended beyond the construction site. Barriers to collaboration included communication problems, different mind-sets, and the diversity of understanding regarding collaborative work practice. Participants felt that a more formalized structure would be beneficial, and could provide them with the means to develop and maintain a collaborative culture. The research recommended that there needs to be greater input by leadership for facilitating effective collaborative practice in the workplace
A hybrid intelligent intrusion detection system for advanced persistent threats
RESEARCH MOTIVATION:
The objective of this research is to investigate how to increase the detection rate and increase the tracking rate of APT and TA in their early attack phases within an environment of distributed networks.
ABSTRACT:
Today's world has networks without clear frontiers, where employees can and do work outside the company protection systems. Furthermore, they use two or more devices providing many possible entry points for attackers. Large scale attacks are often unknowingly initiated by these users.
Large scale Targeted Attacks (TA) are slow, fragmented, distributed, seemingly unrelated, and very sophisticated attacks targeting high-value organisations, and these attacks are often executed over long periods. When nations or states back these attacks, they are known as Advanced Persistent Threat (APT).
This research focuses on developing a methodology capable of detecting an APT in its early stages combining an Artificial Immune System (AIS) methodology known as Dendritic Cell Algorithm (DCA) with Genetic Algorithm (GA) and Support Vector Machine (SVM) classifiers. This Hybrid Model uses GA for feature extraction and SVM for DCA Signal Selection during the pre-processing stage, and DCA is the classifier for the Traffic Processing and Decision Modules during the processing phase. The Signal Selection process applies a cumulative distribution function of the Pareto distribution model to the results obtained with SVM to produce the DCA Safe and Danger signals. The Traffic Processing stage presents two linear equations and their weights for implementation on different types of datasets. Finally, the Decision Module calculates the Anomaly Threshold required for the dataset classification by obtaining the intersection of the distribution of the training normal and abnormal scores
Profile of Generation Z and work engagement levels of Generation Z and Generation Y in Auckland
RESEARCH QUESTIONS:
As per the identified aim and objectives of this research study, the following research questions are formulated:
What is the profile of Generation Z based on an Auckland, New Zealand sample population?
What is the level of work engagement of Generation Z and Generation Y based on an Auckland, New Zealand sample population?
What is the level of vigor, dedication and absorption of Generation Z and Generation Y based on an Auckland, New Zealand sample population?
Are some of the known profile characteristics of Generation Z true or false in an Auckland, New Zealand context?
ABSTRACT:
A new workforce (Generation Z born between 1995 and after) has started to enter the workforce which is going to increase their presence in the workplace with each passing year. There is a need to know what this generation prefers, needs and expects from their workplace. Their outlook towards the work-related aspects is also very important. An individual’s characteristics can influence his/her approach towards his/her work and the workplace. This can get reflected in their levels of work engagement. Though it is not always possible to delve deeper into the characteristics of each employee in the workplace on a regular basis, a need is to at least determine these aspects at the generational cohort level. This can help organizations and HR practitioners in formulating new workplace policies and in reviewing the current ones.
This research study is attempting to identify the profile characteristics of Generation Z and their work engagement levels in Auckland, New Zealand. Though this research study is predominantly focusing on Generation Z, it is considered to compare work engagement of Generation Z (new generation) with work engagement of Generation Y (previous generation born between 1980 and 1994) as the latter is going to be in the workplace for many more years, they are relatively experienced and are not very far away from Generation Z in terms of age gap.
A quantitative methodology approach is adopted to embark on a scientific enquiry. Both parametric and non-parametric statistical methods are used in understanding the data and for the hypothesis testing. Help is taken from descriptive and inferential statistical methods to analyse the data. Two separate questionnaires are used for the data collection. One questionnaire is used to determine the profile of Generation Z in Auckland and the other one i.e. Utrecht Work Engagement Scale (UWES) is used to determine the levels of work engagement of both generations. The data is collected by using self-reported questionnaires.
The effect sizes and the confidence interval levels have also been computed to obtain practical relevance of the findings. Further, the analysis is extended to the gender level to find any significant statistical difference between the gender groups of both generations. The result findings allowed a deeper discussion by reviewing these findings in light of the literature. This
deeper investigation and discussion further provided an opportunity to make far-reaching recommendations which can help organizations, HR practitioners, managers, the community, individuals and the government. It is recommended that job security, autonomy, person-job fit and situational leadership style or path-goal leadership theory be adopted as availability of
these can help in improving employee motivation, competence, commitment and satisfaction levels and thereby employee’s work engagement levels. In addition to matching of an individual’s skills, knowledge and abilities, matching an individual’s values with the values of a job is very important. Match development levels (competence and commitment) of employees and corresponding style of leadership behaviour (directive and/or supportive). Alternatively, select directive, supportive, participative and achievement oriented leadership behaviours that are best suited to employees’ needs, characteristics and the work setting.
This research study highlighted Generation Z characteristics and work engagement levels of Generation Z and Generation Y and thereby assists organizations and managers to favourably adjust to the changing age structure of the workforce
On-chip peripheral control of ultra-compact spectrometer
Spectrometers are found in applications where substances are classified through analysis of relative light reflection, transmission or fluorescence, commonly used in food, medicine and lighting applications.
The Hamamatsu C12880MA offers low cost and high sensitivity in a small robust package. This project successfully employs hardware features of the NXP MK20DX256 microcontroller to interface with the sensor.
The sensor specifies a relatively high clock rate of 0.2 - 5.0MHz for gating spectral (video) output. Video pixels are captured with a synchronised analogue to digital converter (ADC). A start pulse initiates this process while also determining the integration time. Any jitter or relative variation between these timings will reduce the accuracy of the measurement.
Interfacing at even minimum specified clock rate with low-cost microcontrollers, such as those found in popular Arduino based evaluation boards, can prove challenging. Online examples typically operate at only a fraction of the specified rate, often with little or no regard for jitter or relative timing.
Making use of available on-chip peripherals, the MK20DX256 microcontroller generates accurate control signals with very little CPU intervention. The ADC conversion is triggered by these same events which in turn initiate direct memory access (DMA) for acquired data. This is currently operating at stable clock speeds of 0.2Mhz and integration times from 0.27 to 10mS, this range could be expanded with additional programming if required.
As a proof of concept this project is now ready for further development into a prototype and application to related activities within the research group
ExCo Member Update: New Zealand
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National Energy strategy
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IEA Hydrogen Task – NZ Engagement
FCV Infrastructur
One every 55 minutes
RESEARCH QUESTION:
How might Architecture help address the poor mental health of many students in India by looking to the historical tradition of an Ashram as a holistic space of self-reflection and healing?
ABSTRACT:
Mental health is a growing issue worldwide, with India having the highest suicide rate within the South East Asia region. Mental health is seen as a stigma in India, which is one of the main reasons as to why this issue is not discussed openly. Students are taking their lives due to the overwhelming pressure and stress, caused by their studies and, unfortunately, family expectations. There is a serious lack of trained psychiatrists in India which makes the problem worse.
Practices such as meditation and yoga are holistic approaches which aid in reducing stress and anxiety. Ashrams, historic centres of spiritual practice in India, are proposed as an architectural model for the relief of mental health problems amongst Indian students.
Located in Mumbai city at The University of Mumbai, the project proposes a facility that will enable university students to practice yoga and meditation in a residential setting. The organisation of the spaces takes clues from the traditional Vastu Shastra layout which looks at the science of directions that combine the 5 elements of nature and balance them with man and material. This will look at how private, semi-private and public spaces, connectivity, light, and blue and green spaces (landscape and water) can enhance an individual’s mental health
Integration
RESEARCH QUESTION:
How can intensification within a suburban centre enhance the existing urban fabric and rejuvenate a sense of community?
ABSTRACT:
Auckland is making a determined push towards higher density living. Development plans look at creating nodes of density within major transit suburbs, and Auckland is set to change in unprecedented ways. Large schemes built to meet regulations and to maximise economic objectives are beginning to taint our existing urban fabric. The culture of our suburban lifestyle and the character of our suburban centres is rapidly disappearing.
Onehunga is a critical suburb within this change and a prime example of this damaging process. A historic suburb essential in settlement of Tamaki Makaurau, Onehunga was a key trading point between Maori and Europeans and featured New Zealand’s oldest port. This study investigates ways in which Onehunga can be developed to preserve its character and contextually respect the existing urban fabric. It examines the critical strategies to creating sustainable communities in this process of necessary urban change, acknowledging plans such as Auckland Council’s Panuku Development and the Masterplan 2050, but critical of their approach, and their results.
Through its history, and by its present condition, Onehunga has the potential to rival other older suburbs – Ponsonby, Parnell – as urban identities in Auckland. Integration will create a mixed-use higher-density scheme which aims to turn the currently run-down core into a revitalised, intensified and vibrant suburban centre, with the identity of a “go-to” destination.
This design study will be the catalyst.
Site: Waipu Lane, Onehung