New Zealand Research Articles

Acceptability of teledentistry use among residents and staff in aged residential care facilities in the Otago region of New Zealand.

To assess ARC residents' and staff perceptions of the benefits of, and comfort with, teledentistry use in ARC facilities in the Otago region of NZ, and identify end-user-level factors associated with its use. Difficulty in accessing oral healthcare services is a key barrier to aged residential care (ARC) residents' oral health and well-being. Teledentistry offers a possible solution, yet studies on its acceptability in ARCs are sparse, especially in New Zealand (NZ). This study assessed ARC residents' and staff perceptions of the benefits of, and comfort with, teledentistry use in ARC facilities in the Otago region of NZ and identified end-user-level factors associated with its use. Rest home-level residents and care staff in ARC facilities in the Otago region of NZ were surveyed to assess their awareness of teledentistry, perceptions of benefit and comfort using teledentistry, and end-user-level factors associated with the feasibility of using it in ARCs. One hundred residents and 77 care staff from 14 facilities participated. Three-quarters of resident participants thought that teledentistry was beneficial. Three in five resident participants were comfortable receiving remote dental consultations and care advice through teledentistry. Acceptability, as measured by perceived benefits and comfort, was lower among older participants. Staff participants were receptive to teledentistry use for residents and were comfortable facilitating remote dental consultations and care through teledentistry. No staff participants disagreed with the potential benefits of teledentistry for ARC residents. Teledentistry would likely be acceptable to residents and staff in ARC facilities in NZ, contributing to residents' improved access to oral health care and improved oral health and well-being.

Tree contributions to climate change adaptation through reduced cattle heat stress and benefits to milk and beef production.

Cattle heat stress causes billions of dollars' worth of losses to meat and milk production globally, and is projected to become more severe in the future due to climate change. Tree establishment in pastoral livestock systems holds potential to reduce cattle heat stress and thus provide nature-based adaptation. We developed a general model for the impact of trees on cattle heat stress, which can project milk and meat production under future climate scenarios at varying spatial scales. The model incorporates the key microclimate mechanisms influenced by trees, including shade, air temperature, humidity, and wind speed. We conducted sensitivity analyses to demonstrate the relative influence of different mechanisms through which trees can impact cattle heat stress, and how tree impacts are influenced by climatic context globally. Trees hold the greatest potential to reduce cattle heat stress in higher latitudes and altitudes, with minor benefits in the lowland tropics. We projected the future contributions of current trees in mitigating climate change impacts on the dairy and beef herds of Aotearoa-New Zealand (A-NZ) in 2070-2080. Trees were simulated to contribute to A-NZ milk yields by over 491 million liters (lower CI = 112 million liters, upper CI = 850 million liters), and meat yields by over 8316 tonnes (lower CI = 2431 tonnes, upper CI = 13,668 tonnes) annually. The total economic contribution of existing trees in mitigating future cattle heat stress was valued at $US 244 million (lower CI = $US 58 million, upper CI = $US 419 million). Our findings demonstrate the importance of existing trees in pastoral landscapes and suggest that strategic tree establishment can be a valuable adaptation option for reducing cattle heat stress under climate change. Tree establishment in the next few years is critical to provide adaptation capacity and economic benefit in future decades.

Integrating management systems in the energy sector: the case of the electricity industry in New Zealand

The New Zealand Electricity Engineers Association (EEA) asked for advice about development of a guide for a public safety management system (PSMS) for electricity distribution networks based on ISO45001 Occupational health and safety management systems. This would help eliminate overlap between legislation and standards while maintaining compliance with legal requirements. At Victoria University of Wellington we have been working on such an integrated approach and this article reports on the project and suggests how the results can be extended to include other areas of management while retaining the ability for appropriate elements to be audited and certified in accordance with systems required by legislation. The project reviewed an earlier report and literature review on PSMS for the Electricity Networks Association. Development of the legal requirements for a PSMS were reviewed and use of the International Standards Organization (ISO) framework for all management system standards proposed to encompass ISO45001 and similar standards. Relevant management content was incorporated in the high-level structure and key stakeholders contributed technical content. Use of the ISO Annex SL as a template enabled development of an integrated management system incorporating other management system standards, that would still support legal compliance while enabling elimination of duplication and clutter, and waste of resources at a time of technology change. The work was carried out in New Zealand (NZ) and may not apply in other countries with different legal requirements. Auditors may resist integrated management systems although this may not be a limitation if documentation is appropriately written. The electricity networks businesses in NZ may move to implementation of the PSMS guide but this will be an internal decision and results may take some years to declutter documentation and reduce overlapping audits under management system standards. Over the next decade the context of the New Zealand electricity industry will undergo major shifts with the need to adapt to increasing expectations for occupational health and safety and public safety, adaptation to climate change and accelerated implementation of new technologies. The electricity industry will need to apply its resources to those changes while avoiding duplicated efforts to implement multiple management systems. Developing an integrated management system that incorporates several management systems and public safety may aid protection of non-workers who cannot otherwise be “controlled” by a business.

Whakaari/White Island disaster. An analysis informed by sociological theories of risk

On December 9, 2019, the volcano on Whakaari/White Island, a popular New Zealand (NZ) tourist destination, erupted. Twenty-two people died. Drawing on sociological theories of risk, most particularly on systems-thinking, this qualitative analysis describes the origins of the disaster, formulates questions for the authorities and suggests actions to reduce the chances of a repeat. It is concluded that the safety culture of NZ’s adventure tourism (AT) industry requires attention. It is also concluded that bureaucratic devices such as the adventure tourism insurance cover provided by NZ’s Accident Compensation Corporation (ACC) may have encouraged, through a risk-compensation dynamic, greater risk-taking. It is suggested that improved oversight will deliver a safer adventure tourism industry. It is recommended that the authorities investigate to what extent insurance cover influences business practices.

Ngā Matatiki Mātauranga: Tikanga, Policies and Libraries

ABSTRACT There is trauma in how Indigenous knowledge collections in libraries are managed. This paper seeks to understand the tikanga Māori context of Indigenous knowledges management in library collection policies. A review of selected library policies from five major AotearoaNew Zealand libraries regarding collection development, tikanga Māori integration and specifically Māori collection content will be explored using a modified Mead’s Tikanga Test (of 2003). From this analysis will be inferred the ways in which the various library policies negate or affirm tikanga Māori. This will be followed by a brief introduction to the model Ngā Matatiki Mātauranga for culturally safe management of Indigenous collections to be integrated into collection policies. This paper will draw from a Māori perspective, in Aotearoa-New Zealand. The testing of library policies from five major libraries will drive the findings to represent the state of Indigenous collection policy in Aotearoa and how best for Māori to distinguish our futures in libraries.

Donor ethnicity, sex, and age impact chondrogenic re-differentiation capacity: a multi-demographic study of human articular chondrocytes in vitro

ABSTRACT To unravel causes of disparities in osteoarthritis (OA) prevalence and to improve cell-based cartilage repair treatments, there is need to investigate the multifactorial impact of patient demographics on a biophysiological level. In this study, we systematically analyse single- and multi-demographic impact on in vitro chondrogenic re-differentiation capacity of human articular chondrocytes (hACs), specifically of an Aotearoa-New Zealand (NZ) patient cohort which displays unique demographic diversity. HACs were isolated from 14 NZ donors with distinct demographics (ethnicity: indigenous Māori vs European descendant Pākehā; sex; age 18–24 vs 25–30 yrs). In vitro chondrogenic re-differentiation capacity of donor chondrocytes was assessed through quantifications of cartilage matrix deposition (GAG, DNA, GAG/DNA) and by histological visualisation. Isolated chondrocytes ranged from low chondrogenic re-differentiation capacity, characterised by fibrocartilage tissue deposition, to high re-differentiation capacity to deposit GAG-rich tissue. Age-related reduction in GAG/DNA content was detected while no impact of ethnicity or sex was observed. Multi-demographic analysis revealed reduced GAG deposition in Māori male (compared to Māori female), and Māori (18–24 yrs) compared to Māori (25–30 yrs) and Pākehā (18–24 yrs) within our cohort. Multi-demographic analysis is a promising strategy to understand disparities in OA prevalence in patient cohorts and can help guide development of cell-based strategies for diverse patient populations.

Status epilepticus in Auckland, New Zealand: Treatment patterns and determinants of outcome in a prospective population-based cohort.

Determination of the real-world performance of a health care system in the treatment of status epilepticus (SE). Prospective, multicenter population-based study of SE in Auckland, New Zealand (NZ) over 1 year, with data recorded in the EpiNet database. Focus on treatment patterns and determinants of SE duration and 30-day mortality. The incidence, etiology, ethnic discrepancies, and seizure characteristics of this cohort have been published previously. A total of 365 patients were included in this treatment cohort; 326 patients (89.3%) were brought to hospital because of SE, whereas 39 patients (10.7%) developed SE during a hospital admission for another reason. Overall, 190 (52.1%) had a known history of epilepsy and 254 (70.0%) presented with SE with prominent motor activity. The mean Status Epilepticus Severity Score (STESS) was 2.15 and the mean SE duration of all patients was 44 min. SE self-terminated without any treatment in 84 patients (22.7%). Earlier administration of appropriately dosed benzodiazepine in the pre-hospital setting was a major determinant of SE duration. Univariate analysis demonstrated that mortality was significantly higher in older patients, patients with longer durations of SE, higher STESS, and patients who developed SE in hospital, but these did not maintain significance with multivariate analysis. There was no difference in the performance of the health care system in the treatment of SE across ethnic groups. When SE was defined as 10 continuous minutes of seizure, overall mortality was lower than expected and many patients had self-limited presentations for which no treatment was required. Although there were disparities in the incidence of SE across ethnic groups there was no difference in treatment or outcome. The finding highlights the benefit of a health care system designed to deliver universal health care.

Use of empirical medical therapies for idiopathic male infertility in Australia and New Zealand.

Idiopathic male infertility is common, yet there is no approved treatment. This study aimed to understand practice patterns towards empirical medical therapy (EMT) for idiopathic male infertility in Australia and New Zealand (NZ). Clinical members of the Endocrine Society of Australia, Fertility Society of Australia & NZ, and Urological Society of Australia & NZ were invited to complete a survey. Questions included demographics, EMT practice habits, and thoughts regarding infertility case scenarios. Unadjusted group differences between specialists, those with and without additional training in male infertility, and frequency of managing it were evaluated. Overall, 147 of 2340 members participated (6.3%); majority were endocrinologists and gynaecologists. Participants were experienced; 35% had completed additional training in male infertility and 36.2% reported they frequently manage male infertility. Gynaecologists were more likely to manage male infertility and attend education courses than endocrinologists and urologists. Beliefs about the effect of EMT on sperm concentration and pregnancy did not differ between speciality types. Many respondents considered all patient scenarios suitable for EMT. Of medications, hCG and clomiphene were selected most. Two respondents indicated they would use testosterone to treat male infertility. This study demonstrates common use of EMT in Australia and NZ for idiopathic male infertility. The breadth of responses reflects a lack of consensus within the current literature, highlighting the need for further research to clarify their role in the management of idiopathic male infertility.

Partnering Early to Provide for Infants At Risk of Cerebral Palsy (PĒPI ARC): protocol for a feasibility study of a regional hub for early detection of cerebral palsy in Aotearoa New Zealand.

Cerebral palsy (CP) can now be diagnosed in infants with identified CP risk factors as early as three months of age; however, many barriers prevent equitable access to early detection pathways. The "Partnering Early to Provide for Infants At Risk of Cerebral Palsy" feasibility study (PĒPI ARC) seeks to trial a new approach to decrease inequitable health service in Aotearoa New Zealand for high-risk infants and their families. PĒPI ARC incorporates face-to-face clinics, an in-person and virtual Hub, and the use of telehealth to enable flexible access to CP assessments and support for health professionals in early CP detection. A non-randomised feasibility study was conducted from a tertiary Neonatal Intensive Care Unit (NICU) in Wellington and included seven regional referral centres, servicing nearly 30% of the total population in New Zealand (NZ). The families of infants with a high risk of neurodevelopmental impairment and health professionals interacting with the Hub were invited to participate. Mixed methods were used to evaluate the (i) equitable implementation of an early detection pathway, (ii) acceptability, (iii) demand among families and health professionals, (iv) efficacy in relation to reducing the age of receipt of CP diagnosis, and (v) the experiences around communication and information sharing. The NZ Health and Disability Ethics Committee approved this study (HDEC: 2022 FULL 13434). The findings will be disseminated in peer-reviewed journals, in conference presentations, and via professional networks. Australian New Zealand Clinical Trials Registry: ACTRN12623000600640.

Using CHROMagar™ STEC medium exclusively does not recover all clinically relevant Shiga toxin-producing Escherichia coli in Aotearoa, New Zealand.

Diagnostic laboratories in Aotearoa, New Zealand (NZ) refer cultures from faecal samples positive for Shiga toxin genes to the national Enteric Reference Laboratory for isolation of Shiga toxin-producing Escherichia coli (STEC) for epidemiological typing. As there was variation in the culture media being referred, a panel of 75 clinical isolates of STEC, representing 28 different serotypes, was used to assess six commercially available media and provide guidance to clinical laboratories. Recommendations were subsequently tested for a 3-month period, where STEC isolations and confirmations were assessed by whole genome sequencing analysis against the culture media referred. CHROMagar™ STEC (CH-STEC; CHROMagar Microbiology, Paris, France) or CH-STEC plus cefixime-tellurite sorbitol MacConkey agar was confirmed inferior to CH-STEC plus blood agar with vancomycin, cefsulodin, and cefixime (BVCC). The former resulted in fewer STEC types (n=18) being confirmed compared to those from a combination of CH-STEC and BVCC (n=42). A significant (P<.05) association with an STEC's ability to grow on CH-STEC and the presence of the ter gene cluster, and eae was observed. Culturing screen positive STEC samples onto both CH-STEC and BVCC ensures a consistently higher recovery of STEC from all clinical samples in NZ than CH-STEC alone.

Using interRAI Assessment for Research: Developing a National Research Agenda in Aotearoa New Zealand

interRAI provides a suite of standardized, validated instruments used to assess health and psychosocial well-being, and to inform person-centered care planning. Data obtained from these standardized tools can also be used at a population level for research and to inform policy, and interRAI is currently used in more than 40 countries globally. We present a brief overview of the use of interRAI internationally within research and policy settings, and then introduce how interRAI is used within the universal public health system in Aotearoa New Zealand (NZ), including considerations relating to Māori, the Indigenous people of NZ. In NZ, improvement in interRAI data utilization for research purposes was called for from aged care, health providers, and researchers, to better use these data for quality improvement and health advancement for New Zealanders. A national research network has been established, providing a medium for researchers to form relationships and collaborate on interRAI research with a goal of translating routinely collected interRAI data to improve clinical care, patient experience, service development, and quality improvement. In 2023, the network members met (hybrid: in-person and online) and identified research priorities. These were collated and developed into a national interRAI research agenda by the NZ interRAI Research Network Working Group. Research priorities included reviewing the interRAI assessment processes, improving methods for data linkage to national data sets, exploring how Indigenous Data Sovereignty can be upheld, as well as a variety of clinically focused research topics. Implications for Practice, Policy, and Research: This appears to be the first time national interRAI research priorities have been formally identified. Priorities identified have the potential to inform quality and clinical improvement activities and are likely of international relevance. The methodology described to cocreate the research priorities will also be of wider significance for those looking to do so in other countries.

A conceptual cost estimation model for the pre-design stage of road projects using multiple regression analysis

Purpose The current estimation practice in construction projects greatly needs upgrading, as there has been no improvement in the cost overrun issue over the past 70 years. The purpose of this research was to develop a new multiple regression analysis (MRA)-based model to forecast the final cost of road projects at the pre-design stage using data from 43 projects in New Zealand (NZ). Design/methodology/approach The research used the case study of 43 completed road projects in NZ. Document analysis was conducted to collect data, and statistical tests were used for model development and analysis. Findings Eight models were developed, and all models achieved the required F statistics and met the regression assumptions. The models’ mean absolute percentage error (MAPE) was between 21.25% and 22.77%. The model with the lowest MAPE comprised the road length and width, number of bridges, pavement area, cut and fill area, preliminary cost and cost indices change. Research limitations/implications The model is based on road projects in NZ. However, it was designed to be able to adapt to other contexts. The findings suggest that the model can be used to improve traditional conceptual estimating methods. Past project data is often stored by the project team but rarely used for analysing and forecasting purposes. This research emphasises that past data can be effectively used to predict the project cost at the pre-design stage with limited information. Originality/value No research was conducted to adopt cost modelling techniques into the conceptual estimation practice in the NZ construction industry.

Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort.

Strongyloides stercoralis is not endemic in Aotearoa New Zealand (AoNZ). However, approximately one third of Auckland residents are born in endemic countries. This study aimed to describe the epidemiology and management of strongyloidiasis in Auckland, with a focus on migrants from Pacific Island Countries and Territories. This study retrospectively reviewed clinical, laboratory and pharmacy records data for all people diagnosed with strongyloidiasis in the Auckland region between July 2012 and June 2022. People with negative Strongyloides serology were included to estimate seropositivity rate by country of birth. Over ten years, 691 people were diagnosed with strongyloidiasis. Most diagnoses were made by serology alone (441, 64%). The median age was 63 years (range 15-92), 500 (72%) were male, and the majority were born in Polynesia (350, 51%), Fiji (130, 19%) or were of Pasifika ethnicity (7%). Twelve participants (1.7%) had severe strongyloidiasis at diagnosis. The total proportion treated with ivermectin was only 70% (484/691), with no differences between immunocompromised and immunocompetent participants, nor by ethnicity. The outcome of treatment (based on a combination of serology and/or eosinophilia and/or stool microscopy) could only be determined in 50% of the treated cohort. One participant failed treatment with ivermectin, experiencing recurrent strongyloidiasis, and another participant died in association with severe strongyloidiasis. The rate of 'positive' Strongyloides serology was highest among participants born in Samoa (48%), Fiji (39%), and Southeast Asian countries (34%). Strongyloidiasis was common and under-treated in Auckland during the study period. Clinicians should have a low threshold for considering strongyloidiasis in migrants from endemic countries, including Polynesia and Fiji.

Characterising the decay of organic metal complexes in speleothem-forming cave waters

Organic metal complexes (OMCs) transport trace metals (e.g., Co, Ni, Cu) from surface soils, via the unsaturated zone, to sites of cave carbonate (speleothem) formation. OMCs clearly imprint on speleothem trace element chemistry, but the role of kinetic factors in the signal transfer process has yet to be elucidated. We investigated whether OMCs may viably link metal concentrations in stalagmites and local hydrology (i.e., drip rate), via their time-sensitive dissociation (or ‘decay’) in the speleothem water thin-film. We performed competitive ligand exchange experiments using water and soil samples from eight geographically diverse Aotearoa New Zealand caves, providing a first comparative characterisation of speleothem-specific OMC kinetics. Critically, this approach corroborated that NOM ligands limit transition metal availability at the dripwater-speleothem interface, exhibiting stabilities on the order Cu ≈ Co > Ni, whereas organic complexation of the alkaline earth metals Mg and Sr was virtually absent. Systematic variations of OMC stability with natural organic matter characteristics were not observed amongst water samples, whilst enhanced complexation was clearly evident in the comparably organic-rich soil extracts. Our results imply that the supply of transition metals to speleothems is inversely related to drip rate, increasing with drip interval via the decay of OMCs. This process appears most sensitive on time-scales relevant to typical speleothem-forming settings (<0 to ca. 40 drips min−1, corresponding to ca. <5.6 mL min−1), and therefore provides a general, mechanistic link to a quantitative proxy of palaeoclimatic cave drip rates.

Immune system modulation & virus transmission during parasitism identified by multi-species transcriptomics of a declining insect biocontrol system

BackgroundThe Argentine stem weevil (ASW, Listronotus bonariensis) is a significant pasture pest in Aotearoa New Zealand, primarily controlled by the parasitoid biocontrol agent Microctonus hyperodae. Despite providing effective control of ASW soon after release, M. hyperodae parasitism rates have since declined significantly, with ASW hypothesised to have evolved resistance to its biocontrol agent. While the parasitism arsenal of M. hyperodae has previously been investigated, revealing many venom components and an exogenous novel DNA virus Microctonus hyperodae filamentous virus (MhFV), the effects of said arsenal on gene expression in ASW during parasitism have not been examined. In this study, we performed a multi-species transcriptomic analysis to investigate the biology of ASW parasitism by M. hyperodae, as well as the decline in efficacy of this biocontrol system.ResultsThe transcriptomic response of ASW to parasitism by M. hyperodae involves modulation of the weevil’s innate immune system, flight muscle components, and lipid and glucose metabolism. The multispecies approach also revealed continued expression of venom components in parasitised ASW, as well as the transmission of MhFV to weevils during parasitism and some interrupted parasitism attempts. Transcriptomics did not detect a clear indication of parasitoid avoidance or other mechanisms to explain biocontrol decline.ConclusionsThis study has expanded our understanding of interactions between M. hyperodae and ASW in a biocontrol system of critical importance to Aotearoa-New Zealand’s agricultural economy. Transmission of MhFV to ASW during successful and interrupted parasitism attempts may link to a premature mortality phenomenon in ASW, hypothesised to be a result of a toxin-antitoxin system. Further research into MhFV and its potential role in ASW premature mortality is required to explore whether manipulation of this viral infection has the potential to increase biocontrol efficacy in future.

Sizing Up General Practice Environments for Big-Bodied Patients: An Environmental Assessment of Three Facilities in Aotearoa New Zealand.

This research describes the physical environments of and equipment in Aotearoa New Zealand (NZ) general practices in relation to available standards for big-bodied people (BBP) seeking healthcare. The prevalence of BBP both in NZ and globally has increased over the last 30 years and is expected to increase further. As the first and most utilized point of contact for patients in NZ and many countries, it is essential that general practices provide suitable environments to cater for and meet the needs of big-bodied patients seeking healthcare. An exploratory study utilizing an environmental investigation was undertaken in three diverse general practices. Data collection consisted of direct observation and physical measurements of practice layout and equipment. Findings were compared to the existing guidelines or standards for the healthcare of BBP. The analysis identified most environmental facets and equipment in all three general practices did not meet published guidelines for the care of BBP. In the global context of increasing and sustained prevalence of BBP, this exploratory study highlights it is crucial that general practices and similar community-based facilities review their physical environments and equipment and consider modifications to improve accessibility, inclusivity, and comfort for BBP.

Persistent Opioid Use After Hospital Admission From Surgery in New Zealand: A Population-Based Study.

Persistent opioid use (POU) is common after surgery and is associated with an increased risk of mortality and morbidity. There have been no population-based studies exploring POU in opioid-naïve surgical patients in New Zealand (NZ). This study aimed to determine the incidence and risk factors for POU in opioid-naïve patients undergoing surgery in all NZ hospitals. We included all opioid-naïve patients who underwent surgery without a concomitant trauma diagnosis and received opioids after discharge from any NZ hospital between January 2007 and December 2019. Patients were considered opioid naïve if no opioids had been dispensed to them or if they did not have a prior diagnosis of an opioid-use disorder up to 365 days preceding the index date. The primary outcome was the incidence of POU, defined a priori as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify risk factors for POU. We identified 1789,407 patients undergoing surgery with no concomitant diagnosis of trauma; 377,144 (21.1%) were dispensed opioids and 260,726 patients were eligible and included in the analysis. Of those included in the final sample, 23,656 (9.1%; 95% confidence interval [CI], 9.0%-9.2%) developed POU. Risk factors related to how opioids were prescribed included: changing to different opioid(s) after discharge (adjusted odds ratio [aOR], 3.21; 95% CI, 3.04-3.38), receiving multiple opioids on discharge (aOR, 1.37; 95% CI, 1.29-1.45), and higher total oral morphine equivalents (>400 mg) (aOR, 1.23; 95% CI, 1.23-1.45). Conversely, patients who were coprescribed nonopioid analgesics on discharge had lower odds of POU (aOR, 0.91; 95% CI, 0.87-0.95). Only small differences were observed between different ethnicities. Other risk factors associated with increased risk of POU included undergoing neurosurgery (aOR, 2.02; 95% CI, 1.83-2.24), higher comorbidity burden (aOR, 1.90; 95% CI, 1.75-2.07), preoperative nonopioid analgesic use (aOR, 1.65; 95% CI, 1.60-1.71), smoking (aOR, 1.44; 95% CI, 1.35-1.54), and preoperative hypnotics use (aOR, 1.35; 95% CI, 1.28-1.42). Approximately 1 in 11 opioid-naïve patients who were dispensed opioids on surgical discharge, developed POU. Potentially modifiable risk factors for POU, related to how opioids were prescribed included changing opioids after discharge, receiving multiple opioids, and higher total dose of opioids given on discharge. Clinicians should discuss the possibility of developing POU with patients before and after surgery and consider potentially modifiable risk factors for POU when prescribing analgesia on discharge after surgery.

Measuring and reporting environmental impacts of dairy farming

Purpose This study aims to explore farmers’ perceptions of environmental impacts of dairying and their practices towards implementing environmental management accounting (EMA) techniques. Design/methodology/approach Semi-structured interviews were held with five dairy farmers in the South Island of New Zealand (NZ). Findings Dairy farmers perceive environmental sustainability in dairying as being able to feed people while protecting the environment so that future generations can also enjoy the natural world. Recognising the need to alter their practices to reduce environmental damage they have produced, dairy farmers use some EMA techniques, but the primary motivation is compliance with government regulations. Other motivations for using EMA techniques are high economic returns, maintaining their reputation and self-satisfaction. Barriers to implementing EMA techniques are primarily due to lack of clarity and feasibility of regulations, coercion and inadequate communication by regulators and high compliance costs. Originality/value The findings contribute to the current EMA literature by providing a better understanding of EMA practices of dairy farmers in NZ, barriers to implementing EMA and how those barriers could be reduced. It may also help NZ central and local government in developing environmental strategies and policies. Furthermore, this research is expected to help people in the dairy industry to find ways to educate farmers about how the measures that are required can help them to reduce both the environmental impacts and the costs of dairying, thus contributing to sustainable development globally.

Student-centred curriculum integration in primary schools: nurturing democratic citizenship in Aotearoa New Zealand

AbstractThis article investigates how James A. Beane’s model of student-centred curriculum integration (CI) enhances students’ learning experiences in the classroom by meeting diverse learning needs and fostering democratic citizenship. It discusses the theory of Beane’s model of CI with respect to John Dewey’s underpinning philosophy of democratic education and explores the practice of Beane’s model via the narratives of two of the authors who implemented the model in primary schools in Aotearoa/ New Zealand (NZ). The findings show that implementing student-centred CI in contexts that are meaningful and relevant to students has the capacity to enhance the value and impact of students’ learning experiences. In the process, the democratic design of Beane’s model allows issues of social justice, inclusion and multiculturalism to be tackled by giving students agency and enabling them to ‘make a difference’ within their communities.

Examining the impact of COVID-19 on Māori:non-Māori health inequities in Aotearoa, New Zealand: an observational study protocol

IntroductionThe COVID-19 pandemic has had both direct and indirect impacts on the health of populations worldwide. While racial/ethnic health inequities in COVID-19 infection are now well known (and ongoing), knowledge...