Zealand Setting Research Articles

External validation of the CholeS conversion from laparoscopic to open cholecystectomy (CLOC) risk score in Aotearoa New Zealand: a validation study.

Conversion of laparoscopic cholecystectomy to open is uncommon, but is associated with longer hospital stay and recovery. Prognosticating conversion may aid service planning and provision. We therefore aimed to assess the external validity of the largest risk score for operative conversion. CHOLENZ was a multicentre, prospective, national cohort study of cholecystectomy for benign biliary disease conducted by STRATA, a trainee-led collaborative network. Data were collected from patients undergoing cholecystectomy in New Zealand hospitals between 1 August and 30 October 2021 with 30-day follow-up. The Conversion from Laparoscopic to Open Cholecystectomy (CLOC) score from the CholeS study was assessed for external validity by interrogating its accuracy and calibration in the CHOLENZ dataset. Of 1162 cholecystectomies started laparoscopically, 20 (1.7%) were converted to open in the CHOLENZ dataset. The CLOC score predicted 2.9% (IQR 1.3%-8.1%) would be converted. Area under the curve was 0.65 (95% 0.51-0.79) and calibration was acceptable with a Hosmer-Lemeshow p value of 0.45; with evidence of tendency to overestimate with interrogation of calibration across a continuous risk profile (intercept 1.27, slope 0.4). Sensitivity analysis with imputed data improved accuracy. Recalibration with the addition of body mass index, and preoperative bilirubin also improved accuracy to 0.86 (95% CI 0.78-0.95). The CLOC score in its original form is not generalisable to the Aotearoa New Zealand setting and is therefore not suitable for clinical use in our local setting.

Preoperative comprehensive geriatric assessment and multidisciplinary team input in older people undergoing elective orthopaedic surgery: A feasibility trial.

To determine the feasibility of preoperative comprehensive geriatric assessment (CGA) and multidisciplinary team (MDT) input for older people undergoing elective orthopaedic surgery in a tertiary New Zealand setting. This single-centre retrospective study included elective orthopaedic patients older than 65 years (and Māori/Pasifika aged greater than 55 years) with hyperpolypharmacy, frailty, neurocognitive disorders and poor functional status. Patients attended a preoperative clinic where they had a geriatrician-led CGA along with MDT input. The feasibility of this preoperative model was assessed using outcomes of acceptability, accessibility and adherence. A qualitative description of patient demographics along with clinic assessment and interventions further describes this pilot experience. Sixty patients met inclusion criteria. This group were vulnerable older people (median age 77 years), with a high incidence of hyperpolypharmacy (85%), frailty (80%) and neurocognitive disorders (30%). Acceptability was high (97%), along with CGA accessibility (100%); however, MDT accessibility varied (53-90%). Adherence to MDT intervention was low; with only 26% of patients completing physiotherapy sessions and only 29% adhering to dietary advice. Accurate recall was a significant factor contributing to poor adherence. Comprehensive geriatric assessment was demonstrated to be a broad and flexible intervention. CGA with MDT input is an acceptable and accessible intervention to be utilised as part of improved preoperative care for the older person undergoing elective orthopaedic surgery. Further consideration around methods to increase adherence in this patient group should be explored. Future research should focus on refining the intervention, and quantifying impact on patient outcomes.

ACPSEM position paper: pre-treatment patient specific plan checks and quality assurance in radiation oncology.

The Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) has not previously made recommendations outlining the requirements for physics plan checks in Australia and New Zealand. A recent workforce modelling exercise, undertaken by the ACPSEM, revealed that the workload of a clinical radiation oncology medical physicist can comprise of up to 50% patient specific quality assurance activities. Therefore, in 2022 the ACPSEM Radiation Oncology Specialty Group (ROSG) set up a working group to address this issue. This position paper authored by ROSG endorses the recommendations of the American Association of Physicists in Medicine (AAPM) Task Group 218, 219 and 275 reports with some contextualisation for the Australia and New Zealand settings. A few recommendations from other sources are also endorsed to complete the position.

Rapid Earthquake Rupture Characterization for New Zealand Using the FinDer Algorithm

ABSTRACT Immediately after a significant earthquake, rapid scientific information is critical for response decision-making and estimating secondary hazards, and is a key component of advisories and public communication. Characterization of the fault rupture extent is especially valuable because it strongly controls ground-motion estimates, or tsunami forecasts in offshore settings. The Finite-fault rupture Detector (FinDer) is designed to rapidly estimate location, extent, and orientation of earthquake fault rupture by matching spatial distributions of high-frequency seismic amplitudes with precomputed templates. Under a large public initiative to better prepare for and respond to natural disasters, FinDer is being implemented in New Zealand for rapid source characterization. Here, we report on implementation and performance, including offline and real-time testing using configurations modified for the New Zealand setting. Systematic testing is used to inform guidelines for real-time usage and interpretation. Analysis of rupture parameter recovery when using national network GeoNet stations demonstrates that for moderate (M 6+) onshore earthquakes FinDer can resolve magnitude and location well, and the rupture strike is also well determined for large (M 7+) onshore earthquakes. For near-offshore earthquakes (within 100 km), FinDer can provide reasonable magnitude estimates but cannot determine the location or strike. Real-time testing shows reliable detection for onshore earthquakes of M 4.5+, with reasonable location and magnitude accuracy. First detection times range between 7 and 65 s of earthquake origin, and stable solutions even for large (M 7+) magnitude events are delivered within 2 min. Although the GeoNet seismic network is not optimized for earthquake early warning, this provides a first exploration of network-based capability for New Zealand. Offline testing of significant M 7+ historic earthquakes demonstrates that FinDer’s rupture solutions can be used to improve rapid shaking predictions, and may be used to infer additional directivity and tsunami hazard even for complex events like the 2016 M 7.8 Kaikōura earthquake.

Painful ambivalence: A Marxist feminist analysis of moral anxiety and gendered class consciousness in “The Garden Party”

Through the utilization of Marxist feminist literary theory, the current article analyzes Catherine Mansfield's "The Garden Party" to examine the interconnected themes of class consciousness, gender, and social injustice. With a specific focus on the protagonist, Laura Sheridan, and her gradually evolving awareness of class, the article examines the narrative's suburban New Zealand setting and the social hierarchy between the affluent Sheridans and their less fortunate neighbors. The luxurious garden party serves as a poignant reminder of the upper class's disconnection from society and their condescending attitudes towards individuals of lower status. In addition to this, the article delves into gender and its effects on the characters' experiences and expectations. Its objective is to gain an understanding of the social realities of the time through the theoretical lens of Marxist feminism and address the pressing concerns of that era. Specifically, the article examines how Laura's representation of class consciousness reflects the societal power dynamics of the time, how the intersection of gender and class influences Laura's mixed feelings about the class system in her social environment, and how "The Garden Party" demonstrates the impact of class and gender on social hierarchies and power structures in the early twentieth century. The article draws attention to the pressing social concerns of the time. It demonstrates how the theoretical lens of Marxist feminism can aid in understanding the social realities of the past.

Gender-inclusive practice in pregnancy determination for transgender, gender diverse and non-binary patients in medical imaging.

In recent years, there has been an increased awareness and understanding of the varying gender identities within our society. Consequently, there has also been a need for healthcare providers to be cognizant of the unique needs of a gender-diverse population. Determining the pregnancy status of transgender, gender-diverse and non-binary patients in medical imaging settings has been poorly handled, and there is a lack of standardisation in the Australian and Aotearoa New Zealand setting. The potential risk of exposing a gender-diverse pregnant patient to ionising radiation increases the need for guidance to ensure potentially pregnant persons are not missed during screening questionnaires. This review article explores various approaches to pregnancy status determination for gender-diverse patients, recognising the complexities involved and emphasising the need for future work to establish a widely accepted solution.

Modelling Radicalisation: Applying Situational Action Theory to the Christchurch Attacks

The March 2019 Christchurch terror attacks were something of a turning point for both law enforcement agencies in New Zealand and for terrorism studies scholars. The growth of religious terrorism, the rise of right-wing extremism, and the imaginative use of the internet by violent extremists pose new security challenges today. This article examines the merits of a criminological radicalisation model for lone actors of terrorism specific to the New Zealand setting. The article examines the concept of radicalisation in the terrorism literature and argues for a clear distinction between the cognitive and behavioural stages of radicalisation. It analyses some of the unique domestic factors which affect radicalisation in New Zealand and provides a brief threat evaluation of extremism. The article proceeds to identify some of the reasons behind ‘why out of millions of people facing similar conditions, only the few become terrorists’ by applying the Situational Action Theory of Crime to the Christchurch terror attacks. Finally, the article recommends some specific interventions for law enforcement agencies to try and thwart future terrorists.

Boldly going… Introducing conflict management training to Starship Children's Hospital.

Conflict between health professionals and whānau (families) in paediatric hospitals is common and leads to significant distress for families and staff. The likelihood of challenges and conflict around communication and critical medical decision-making is increased where there are cultural and social complexities. Training staff to recognise and manage conflict as early as possible improves patient/whānau outcomes and staff well-being. This article describes an ongoing collaboration between Starship Children's Hospital in Auckland New Zealand (NZ) and the UK Medical Mediation Foundation (MMF) focused on educating staff in the early recognition and management of conflict using mediation skills. An evidence-based training programme and structured ongoing supervision of a small group of champions has enabled this training to be embedded into Starship clinical practice. The collaboration has included careful consideration of the New Zealand setting, ensuring that the content of the programme specifically addresses our unique cultural and social context. Mediation skills are an important step in ensuring that our patients and whānau feel heard, acknowledged, and respected, and contribute to the Starship Child Health's strategic priority of eliminating inequity and addressing institutional bias.

SARCOPENIA AS A PREDICTOR OF MORTALITY IN PATIENTS WITH METASTATIC TUMOURS IN THE SPINAL COLUMN

Sarcopenia has been observed to be a predictor of mortality in international studies of patients with metastatic disease of the spine. This study aimed to validate sarcopenia as a prognostic tool in a New Zealand setting. A secondary aim of this study was to assess the intra-observer reliability of measurements of psoas and vertebral body cross sectional areas on computed tomography imaging.A cohort of patients who had presented to Waikato Hospital with secondary neoplasia in the spinal column from 2014 to 2018 was selected. Cross sectional psoas and vertebral body areas were measured at the mid-pedicle L3 level, followed by calculation of the psoas to vertebral body cross sectional area ratio. Psoas to vertebral body cross sectional area ratio was compared with survivorship. The strength of the correlation between sarcopenia and survivorship was compared with the correlation between serum albumin and survivorship, as well as the correlation between the Metastatic Spine Risk Index (MSRI) and survivorship.A total of 110 patients who received operative (34) and non-operative (76) were included. The results demonstrate that psoas to vertebral body cross sectional area ratio is not statistically significantly correlated with survivorship (p=0.53). Serum albumin is significantly correlated with survivorship (p<0.0001), as was the MSRI. There is good intra-observer and inter-observer reliability for measurements of psoas to vertebral body cross sectional area.This study failed to demonstrate the utility for the psoas to vertebral body cross sectional area ratio that other studies have demonstrated in estimating survivorship. Serum albumin levels remain a useful prognostic indicator in patients with secondary tumours in the vertebral column.

Cover Image, Volume 52, Issue 1

On the cover: Grazing livestock in ryegrass pasture, Taranaki, New Zealand. Researchers in New Zealand set out to quantify the effect of bioavailable Cu on ammonia‐oxidizing bacteria and archaea, as well as nitrification rate in the context of research programs that are developing nitrification inhibitors for dairy pastoral systems. This research provides new insights into the relationship between Cu and ammonia nitrifiers in pastoral soils. See D.T. Matse et al., “Copper induces nitrification by ammonia‐oxidizing bacteria and archaea in pastoral soils,” https://doi.org/10.1002/jeq2.20440. Photo by Paramsothy Jeyakumar. image

Use of in-house internal audit functions in New Zealand

Purpose The purpose of this study is to examine which factors explain the use of an in-house internal audit function (IAF) in a voluntary setting. Design/methodology/approach Based on the foundations of agency and resource-based theory, this study examines a unique data set from the New Zealand setting, which combines information obtained from The Institute of Internal Auditors of New Zealand with empirical firm data collected from publicly available sources. Multivariate analysis is performed to test the prediction that in-house IAF use is associated with factors such as strong corporate governance, firm size, risk, complexity and firm ownership structure. Findings There is strong evidence that larger organisations are more likely to use an in-house IAF. The authors also find that listed firms and organisations that use a Big Four auditor are less likely to use in-house-based IAF. The authors learn that the IAF investment decision is dominantly influenced by a firm’s ability to fund an in-house IAF as compared to the IAF being used as a resource to improve firm performance to achieve sustained competitive advantage. This implies that IAFs need to ensure cost efficiency and eliminate unnecessary overheads and demonstrate and make visible the benefits the function offers to the host organisation. Originality/value The unique New Zealand setting, where the establishment and use of an IAF are voluntary, provides an environment to study factors that promote demand for internal audit services. Research implications are applicable to most parts of the world, including the UK, EU nations and the Asia-Pacific region, where IAF use is voluntary.

Establishing a community infusion service in Canterbury, New Zealand: strategies and lessons.

Background and context An increasing number of drugs and blood products need to be delivered by intravenous infusion. In the Canterbury region of New Zealand, these have historically been delivered at a hospital site; however, some infusions could be delivered in a community setting without compromising patient safety. Assessment of problem The Canterbury health system has a key strategic objective of delivering care close to patients' homes. In 2018, Canterbury district health board (DHB) put out a tender for a community infusion service that would deliver blood products and other intravenous drugs with appropriate medical oversight. Strategies for improvement Following an interview and selection process, a fee-for-service contract was developed with a group of general practices with partial common ownership. It was nurse-led with medical oversight available. In July 2018, a Community Infusion Service (CIS) was started in two urban sites in Canterbury. It later expanded to two more sites, one urban and one rural. Results From July 2018 to May 2021, over 3000 infusions and blood transfusions were delivered by the CIS across seven infusion types (blood; immunoglobulin; infliximab; natalizumab; pamidronate; toculizumab; zoledronic acid). Both general practice and hospital services referred patients to the CIS. No major incidents were reported. Patients reported satisfaction with the service. Lessons Infusions and blood products can be delivered safely nearer to patients' homes in primary care in a New Zealand setting. Medical input was rarely required; however, the transition was resource-intensive; it required both overall process and criteria negotiations, as well as individual patient discussions. In its initial stages, the CIS did not have adequate clinical governance and operational support, which affected the speed and scale of its development.

2021 Canadian Surgery Forum: Virtual, online Sept. 21-24, 2021.

# 01. Design and validation of a unique endoscopy simulator using a commercial video game {#article-title-2} Procedural simulation has been shown to enhance early endoscopy training. In this proof of concept study, we aimed to show that a first-person shooter (FPS) video game with a novel in-house

STEM Education in the New Zealand Setting: A Case-Study of STEM in a Year 7/8 Classroom

This article explains a case study undertaken for the purposes of answering the research questions: What does STEM education look like in a Year 7/8 New Zealand classroom? How do Year 7/8 students engage in the interdisciplinary approach of STEM education? Do/how do students value STEM learning in contrast to individual subject learning? This case study focused on a STEM unit of work with data collected through pre- and post-unit surveys, observations and student journals. Findings illustrate that students find STEM learning an engaging and interesting avenue for developing a deeper understanding when their learning is situated within a context they can connect with. The case study discussed in this article provides a rich example of STEM teaching and learning that will, hopefully, be informative for other teachers and researchers interested in exploring the integration of STEM education in the New Zealand setting.

They are not ‘Team New Zealand’ or the ‘New Zealand’ Warriors! An exploration of pseudo-nationalism in New Zealand sporting franchises

Often international sport can be viewed through a nationalistic lens, with sport allowing for nation-based team selections and competitions. Alternatively, we probe the notion of pseudo-nationalism in a New Zealand setting to examine two professional teams that, falsely, evoke familiar symbols and linkages to the nation. The first is ‘Team New Zealand’, which races in the global America’s Cup yachting series but overtly manufactures nationalistic links between the corporate sport, syndicate and nation. The second is the ‘New Zealand’ Warriors which operates as a professional franchise in the Australian-based National Rugby League competition against 15 other Australian clubs. Despite their corporate structures, as well as circulation in non-nation-based sporting contests, both teams exhibit forms of pseudo-nationalism by conflating, obfuscating and masquerading as nationally-representative sports teams. Collectively, both teams proffer a contested vision of pseudo-nationalism by mimicking other national sport teams while projecting, evoking and imploring an allegiance to ‘New Zealandness’.

Funds of identity

This paper provides an overview of the funds of identity (FoI) concept, theoretical framework, and applications, with a focus on its theoretical origins and application in education. Funds of identity (FoI) theory aims to complement the funds of knowledge (FoK) conceptual framework that draws attention to knowledge and competencies of minoritised students. Funds of identity theory is distinctive because of its focus on funds that are defined as significant by students themselves. Grounded in Vygotskian perspectives on identity, funds of identity scholarship offers a conceptual framework and concrete methods for the enactment of education that is personally meaningful. The paper concludes by exploring the relevance of FoI theory within the New Zealand setting, especially to support social justice for Māori learners.

Pandemic and the performing arts in New Zealand

Purpose This paper aims to document the narratives that emerged in favour of and against the austerity measures proposed by the Auckland Council, with specific reference to performing arts organisations (PAOs) in the aftermath of the pandemic 2020. Design/methodology/approach Written submissions from stakeholders received in response to austerity measures were analysed to identify the arguments presented to support/oppose funding cuts to PAOs. These narratives were thematically grouped into accounting, political, artistic and social categories to deliberate on the tensions that exist between these when funding PAOs. Findings This study identifies the arguments presented by grass-root PAOs on the rationale of their existence from a Pacific perspective. The analysis suggests that accounting, hitherto considered as a “sword” can also be used as a “shield” if PAOs direct their research accordingly and offers future research directions. Originality/value Prior studies concerning funding difficulties of PAOs have relied on opinions obtained ex-post from selected stakeholders. There are no known studies, which factor the opinions of grass-root PAOs, captured “during” funding deliberations. This study bridges this gap in the New Zealand setting by providing an analysis of grass-root opinions from the Pacific perspective, conducted during a funding deliberation.

Prostate cancer survivorship care: if not now, when?

Prostate cancer is the most common cancer diagnosed in Australian men (excluding non-melanoma skin cancer) and it is estimated that there are over 220,000 Australian men living with a diagnosis of prostate cancer [1]. Survival for men with prostate cancer is excellent in countries that have accessible screening and treatment services, and in Australia five-year relative survival is over 95% [1]. High incidence coupled with improving long term survival leads to a corresponding high prevalence rate and high community disease burden. Many men with prostate cancer experience long term decrements in their mental and physical quality of life, overall they have a greater suicide risk that their non-cancer peers, and unmet supportive care needs are pervasive [2].

Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children.

Children frequently present with head injuries to acute care settings. Although international paediatric clinical practice guidelines for head injuries exist, they do not address all considerations related to triage, imaging, observation versus admission, transfer, discharge and follow-up of mild to moderate head injuries relevant to the Australian and New Zealand context. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) set out to develop an evidence-based, locally applicable, practical clinical guideline for the care of children with mild to moderate head injuries presenting to acute care settings. A multidisciplinary Guideline Working Group (GWG) developed 33 questions in three key areas - triage, imaging and discharge of children with mild to moderate head injuries presenting to acute care settings. We identified existing high-quality guidelines and from these guidelines recommendations were mapped to clinical questions. Updated literature searches were undertaken, and key new evidence identified. Recommendations were created through either adoption, adaptation or development of de novo recommendations. The guideline was revised after a period of public consultation. The GWG developed 71 recommendations (evidence-informed = 35, consensus-based = 17, practice points = 19), relevant to the Australian and New Zealand setting. The guideline is presented as three documents: (i) a detailed Full Guideline summarising the evidence underlying each recommendation; (ii) a Guideline Summary; and (iii) a clinical Algorithm: Imaging and Observation Decision-making for Children with Head Injuries. The PREDICT Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children provides high-level evidence and practical guidance for front line clinicians.

Border Closures: Experiences of Ni‐Vanuatu Recognized Seasonal Employer Scheme Workers

Border Closures: Experiences of <scp>Ni‐Vanuatu</scp> Recognized Seasonal Employer Scheme Workers