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Work integrated learning (WIL), particularly placement-based WIL (P-WIL), has gained momentum in Higher Education over the last decade as an educational strategy for enhancing student employability. However, there is very limited guidance on effective ways to embed and scaffold WIL assessments across courses (degree programs). We present the findings from an action-research study, purposed with building academic confidence to review and re-design existing assessments to have intentional and explicit employability foci. Key to the study was the sharing of existing WIL frameworks to build practitioner expertise. What arose was a notable intersection of similar, but unplanned assessments focused on career development learning, authentic assessment, and/or demonstrations of theory-to-practice performance during WIL activities. What was lacking was a means for designing an intentional holistic schema that tagged a suite of assessments dedicated to the development and demonstration of student employability across the course. An outcome was the creation of a novel meta-assessment WIL framework (WAM-F) that supported and purposefully integrated previously independent items: 1) career development learning; 2) transferable skills development; 3) reflections from professional practice theory-to-practice WIL experiences; and explicitly tethered these to the discipline orientation of the course. The overt tethering of discipline-specific learning outcomes to a range of WIL activities, via a course-wide approach, not only assures the regulatory requirement for all WIL experiences to contribute to, scaffold and develop the learning outcomes of a course, but also makes sense of emerging educational approaches for STEM teaching teams not always familiar or confident with how to embed fit-for-purpose employability learning.

Objectives To examine whether discharge destination is a useful predictor variable for the length of admission within psychiatric intensive care units (PICUs).Methods A clinician-led process separated PICU admissions by discharge destination into three types and suggested other possible variables associated with length of stay. Subsequently, a retrospective study gathered proposed predictor variable data from a total of 368 admissions from four PICUs. Bayesian models were developed and analysed.Results Clinical patient-type grouping by discharge destination displayed better intraclass correlation (0.37) than any other predictor variable (next highest was the specific PICU to which a patient was admitted (0.0585)). Patients who were transferred to further secure care had the longest PICU admission length. The best model included both patient type (discharge destination) and unit as well as an interaction between those variables.Discussion Patient typing based on clinical pathways shows better predictive ability of admission length than clinical diagnosis or a specific tool that was developed to identify patient needs. Modelling admission lengths in a Bayesian fashion could be expanded and be useful within service planning and monitoring for groups of patients.Conclusion Variables previously proposed to be associated with patient need did not predict PICU admission length. Of the proposed predictor variables, grouping patients by discharge destination contributed the most to length of stay in four different PICUs.

Abstract Background Accounting for the co-occurrence of multiple environmental influences is a more accurate reflection of population exposure than considering isolated influences, aiding in understanding the complex interactions between environments, behaviour and health. This study examines how environmental ‘goods’ such as green spaces and environmental ‘bads’ such as alcohol outlets co-occur to develop a nationwide area-level healthy location index (HLI) for New Zealand. Methods Nationwide data were collected, processed, and geocoded on a comprehensive range of environmental exposures. Health-constraining ‘bads’ were represented by: (i) fast-food outlets, (ii) takeaway outlets, (iii) dairy outlets and convenience stores, (iv) alcohol outlets, (v) and gaming venues. Health-promoting ‘goods’ were represented by: (i) green spaces, (ii) blue spaces, (iii) physical activity facilities, (iv) fruit and vegetable outlets, and (v) supermarkets. The HLI was developed based on ranked access to environmental domains. The HLI was then used to investigate socio-spatial patterning by area-level deprivation and rural/urban classification. Results Results showed environmental ‘goods’ and ‘bads’ co-occurred together and were patterned by area-level deprivation. The novel HLI shows that the most deprived areas of New Zealand often have the most environmental ‘bads’ and less access to environmental ‘goods’. Conclusions The index, that is now publicly available, is able to capture both inter-regional and local variations in accessibility to health-promoting and health-constraining environments and their combination. Results in this study further reinforce the need to embrace the multidimensional nature of neighbourhood and place not only when designing health-promoting places, but also when studying the effect of existing built environments on population health.

There is still much to learn about the predictors of therapeutic response in psychiatry, but progress is gradually being made and precision psychiatry is an exciting and emerging subspeciality in this field. This is critically important in the treatment of refractory psychotic disorders, where clozapine is the only evidence-based treatment but only about half the patients experience an adequate response. In this case report, we explore the possible biological mechanisms underlying treatment failure and discuss possible ways of improving clinical outcomes. Further work is required to fully understand why some patients fail to respond to the most effective treatment in refractory schizophrenia. Therapeutic drug monitoring together with early pharmacogenetic testing may offer a path for some patients with refractory psychotic symptoms unresponsive to clozapine treatment.

This paper describes a process of assessment reform designed to enhance Work Integrated Learning (WIL) approaches for two science courses at an Australian university. The project used a mixed-method approach involving online surveys, interviews, focus groups and workshops to gather student, industry and course team knowledge and understanding of WIL approaches to curricula. The investigation centred on the perceived value of collaborating with industry to facilitate enhancements in authentic assessment and on the barriers to, and challenges in, achieving successful outcomes. The action-research project, WIL-on-Campus (WoC), found that assessments oriented toward the inclusion of authentic tasks and processes, that contribute to the employability learning and job-readiness of students, is deemed important to students, industry and academics. However, reforms to assessment practice and process are required. For greatest impact, this study found that assessment reform processes require two critical interdependent factors: the socialisation of the shared institutional value of embedded WIL approaches to assessment, and the provision of top-down support to enable academic course teams to implement the ‘imposed’ changes. Further to this, while academics viewed the changes in approach to assessment design as challenging, they also noted that a shift is timely and believed that a course-wide WIL approach is possible and advantageous.

How do applications of emergent technologies contribute to the social legitimacy of finance? To address this question, we examine a set of technologies that have received increasing industry, media, and scholarly attention over the past decade: blockchains. Harnessing the concepts of ‘moral economy’ and ‘scandal’, we identify both possibilities and limits for blockchain applications to legitimate a range of monetary and investment activities. However, we also find that a persistent individualisation of responsibility for failures and shortcomings with ‘live’ blockchain experimentation has undermined the potentially legitimating aspects of this technology. Combining a reliance on technological fixes with a persistent individualist moral economy, we conclude, works against efforts to confront head-on the tensions underpinning the on-going legitimacy crises facing finance.

The role of accommodation-sharing platforms, such as Airbnb, is seen as a disruption to more conventional accommodation providers and rental markets in many cities and regions worldwide. This Regional Graphic focuses on New Zealand, showing a snapshot in time of the spatial distribution of the accommodation provided by Airbnb. What the map shows are patterns of statistically significant mildly positive clustering (Moran's I = 0.33, p ≤ 0.05) of the Airbnb locations. The ‘traditional’ tourism hotspots, mainly in the South Island of New Zealand, for example, Wanaka or Queenstown (Queenstown Hill, Lake Hayes South, Sunshine Bay), and the largest city, Auckland (Central West, East, Habourside and Waiheke Island), are shown. A few of the highest ranked places also feature a high intensity per usually resident person. For example, Queenstown Hill has 204 Airbnb listings per 1000 residents. The area with the highest number of Airbnbs is Wanaka, a smaller South Island tourist destination. A key issue for future research is how short-term rentals pose a challenge to local authorities who collect property taxes based on the value of the property, with some local authorities (e.g., Auckland) proposing or enacting specific by-laws in relation to Airbnb.

How can we understand the progressive, piecemeal emergence of global digital identity governance? Examining the activities of the Financial Action Task Force (FATF) - an intergovernmental organization at the center of global anti-money laundering and counter-the-financing of terrorism governance-this paper advances a two-fold argument. First, the FATF shapes how, where and who is involved in developing key standards of acceptability underpinning digital identity governance in blockchain activities. While not itself directly involved in the actual coding of blockchain protocols, the FATF influences the location and type of centralized modes of control over digital identity governance. Drawing on the notion of protocological control from media studies, we illustrate how centralized control emerging in global digital identity governance emanates from the global governance of financial flows long considered by international organizations like the FATF. Second, we suggest that governance by blockchains persistently shapes the ability of the FATF to stem illicit international financial flows. In highlighting both the influence of FATF on blockchain governance and blockchain governance on the FATF, we draw together two strands of literature that have been considered separately in an analysis of the formal, financial and fraught route to global digital identity governance.

Social and natural capital are fundamental to people’s wellbeing, often within the context of local community. Developing communities and linking people together provide benefits in terms of mental well-being, physical activity and other associated health outcomes. The research presented here was carried out in Christchurch - Ōtautahi, New Zealand, a city currently re-building, after a series of devastating earthquakes in 2010 and 2011. Poor mental health has been shown to be a significant post-earthquake problem, and social connection has been postulated as part of a solution. By curating a disparate set of community services, activities and facilities, organised into a Geographic Information Systems (GIS) database, we created i) an accessibility analysis of 11 health and well-being services, ii) a mobility scenario analysis focusing on 4 general well-being services and iii) a location-allocation model focusing on 3 primary health care and welfare location optimisation. Our results demonstrate that overall, the majority of neighbourhoods in Christchurch benefit from a high level of accessibility to almost all the services; but with an urban-rural gradient (the further away from the centre, the less services are available, as is expected). The noticeable exception to this trend, is that the more deprived eastern suburbs have poorer accessibility, suggesting social inequity in accessibility. The findings presented here show the potential of optimisation modelling and database curation for urban and community facility planning purposes.

Abstract Background There is no validated measure of positive mental well-being that is suitable for Deaf people who use a signed language such as British Sign Language (BSL). This impedes inclusion of this population in a range of research designed to evaluate effectiveness of interventions. The study aims were: (i) to translate the original English version of SWEMWBS into BSL and to test the SWEMWBS BSL with the Deaf population in the UK who use BSL; (ii) to examine its psychometric properties; and (iii) to establish the validity and reliability of the SWEMWBS BSL. Methods The SWEMWBS was translated into BSL following a six stage translation procedure and in consultation with the originators. The draft version was piloted with Deaf BSL users (n = 96) who also completed the CORE-OM BSL well-being subscale and the EQ-5D VAS BSL. Reliability was explored using Cronbach’s alpha for internal consistency and ICC for test-retest reliability. Validity was explored by using Kendall’s tau correction for convergent validity and an exploratory factor analysis for construct validity. Results The internal consistency for the reliability of the SWEMWBS BSL was found to be good and the test-retest one week apart showed an acceptable reliability. There was good convergent validity of the SWEMWBS BSL with the well-being subscale of the CORE-OM BSL and the EQ-5D VAS BSL. Conclusions The SWEMWBS BSL can be used with a Deaf population of BSL users. This is the first validated version of a BSL instrument that focuses solely on positively phrased questions for measuring mental well-being.

In response to government, industry, student and central University calls for initiatives to enhance graduate employability as a means for improved employment outcomes, a faculty within an Australian university formulated a five-year Work Integrated Learning (WIL) strategy (2015-2019). The Faculty goal was to re-new, develop, implement and evaluate scalable and sustainable intentional WIL-focused authentic curricula across every undergraduate Science, Technology, Engineering and Mathematics (STEM) course by the end of 2019. A ‘WIL Leadership Framework’ underpinned the whole-of-course team approach. This paper reports on the change-management processes and behaviours necessary to effect change from the bottom-up. Fostering academic staff capacity to build course-appropriate WIL curriculum has been slow and subtle and yet significant refinements to intentional and embedded WIL curriculum have occurred through a series of grounded research studies and curriculum renewal projects. WIL champions (the innovators), earmarked as change agents for enabling scalable curriculum transformation and renewal, were ‘hunted-out’ and nurtured. Their role was to influence teachers to enact context-specific and discipline-based WIL experiences into the curriculum. The main research findings to date reveal that STEM-specific WIL frameworks, concepts and assessment examples, presented as scholarly curriculum choices by WIL experts, and then actively and collegially discussed amongst the WIL champions and WIL early adopters, has been the most effective process to date for developing a WIL centred curriculum. The paper concludes by addressing the current operational goals predicated to have an impact on graduate employment for the Faculty.

Sustainably feeding the next generation is often described as one of the most pressing "grand challenges" facing the 21st century. Generally, scholars propose addressing this problem by increasing agricultural production, investing in technology to boost yields, changing diets, or reducing food waste. In this paper, we explore whether global food production is nutritionally balanced by comparing the diet that nutritionists recommend versus global agricultural production statistics. Results show that the global agricultural system currently overproduces grains, fats, and sugars while production of fruits and vegetables and protein is not sufficient to meet the nutritional needs of the current population. Correcting this imbalance could reduce the amount of arable land used by agriculture by 51 million ha globally but would increase total land used for agriculture by 407 million ha and increase greenhouse gas emissions. For a growing population, our calculations suggest that the only way to eat a nutritionally balanced diet, save land and reduce greenhouse gas emissions is to consume and produce more fruits and vegetables as well as transition to diets higher in plant-based protein. Such a move will help protect habitats and help meet the Sustainable Development Goals.

Background: Improving Access to Psychological Therapies (IAPT) is a National Institute for Health and Care Excellence-approved approach to intervention for depression and/or anxiety. This exploratory study sets the groundwork for comparing psychological therapies for Deaf sign language users experiencing anxiety and/or depression, delivered in British Sign Language (BSL) by a Deaf therapist with usual access through an interpreter within the IAPT national programme. Objectives: (1) To explore the following questions: (a) is BSL-IAPT more effective than standard IAPT for Deaf people with anxiety and/or depression? and (b) is any additional benefit from BSL-IAPT worth any additional cost to provide it? (2) To establish relevant BSL versions of assessment tools and methods to answer research questions (a) and (b). (3) To gauge the feasibility of a larger-scale definitive study and to inform its future design. Design: A mixed-methods exploratory study combing an economic model to synthesise data from multiple sources; a qualitative study of understanding and acceptability of randomisation and trial terminology; statistical determination of clinical cut-off points of standardised assessments in BSL; secondary data analysis of anonymised IAPT client records; realist inquiry incorporating interviews with service providers and survey results. Settings: IAPT service providers (NHS and private); the Deaf community. Participants: Deaf people who use BSL and who are clients of IAPT services (n = 502); healthy Deaf volunteers (n = 104); IAPT service providers (NHS and private) (n = 118). Interventions: IAPT at steps 2 and 3. Main outcome measures: Reliable recovery and reliable improvement defined by IAPT; Deaf community views on the acceptability of randomisation; BSL terminology for trial-related language; clinical cut-off measurements for the BSL versions of the Patient Health Questionnaire-9 items (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7); a valid BSL version of the EuroQol-5 Dimensions five-level version (EQ-5D-5L); costs, quality-adjusted life-years and incremental cost-effectiveness ratios. Data sources: IAPT service provider anonymised records of the characteristics and clinical outcomes of Deaf BSL users of BSL-IAPT and of standard IAPT; published literature. Results: Randomisation may be acceptable to Deaf people who use IAPT if linguistic and cultural requirements are addressed. Specifications for effective information in BSL for recruitment have been established. A valid EQ-5D-5L in BSL has been produced. The clinical cut-off point for the GAD-7 BSL is 6 and for the PHQ-9 BSL is 8. No significant difference in rates of reliable recovery and reliable improvement between Deaf users of standard IAPT or BSL-IAPT has been found. Whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain. Limitations: The small number of participating standard IAPT services who have seen Deaf clients means that there is statistical uncertainty in the comparable clinical outcome result. Clinical cut-off scores have not been verified through gold standard clinical interview methodology. Limited data availability means that whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain. Conclusions: There is a lack of evidence to definitively compare reliable recovery and reliable improvement between Deaf users of standard IAPT and BSL-IAPT. Instrumentation and prerequisites for a larger-scale study have been established. Future work: A prospective observational study for definitive results is justified. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

Abstract Objective: To detect spatial clusters of high infant mortality rates in New Zealand for Māori and non‐Māori populations and verify if these clusters are stable over a certain time period (1995–2008) and similar between the two populations. Method: We applied the Kulldorff's spatial scan statistics on data collected by New Zealand Ministry of Health (1995 to 2008) at the territorial local authorities (TLA) level. Kappa coefficient was used to assess the concordance between clusters obtained for Māori and non‐Māori populations. T‐test analyses were conducted to identify associations between spatial clusters and two predictors (population density and deprivation score). Results: There are some significant spatial clusters of infant mortality in New Zealand for both Māori and Non‐Māori. The concordance of the cluster locations between the two populations is strong (kappa=0.77). Unsurprisingly, infant mortality clusters for both Māori and Non‐Māori are associated with the deprivation score. The population density predictor is only significantly and positively associated with clusters obtained for the non‐Māori population. After controlling for deprivation the presence of spatial clusters is all but eliminated. Conclusions: Infant mortality patterns are geographically similar for both Māori and Non‐Māori. However, there are differences geographically between the two populations after accounting for deprivation. Implications: Health services that can affect infant mortality should be aware of the geographical differences across NZ. Deprivation is an important factor in explaining infant mortality rates and policies that ameliorate its effects should be pursued, as it is the major determinant of the geographical pattern of infant mortality in NZ.

Abstract Objective: To examine the association between hospitalisations for otitis media and area‐level measures of household crowding among children in New Zealand. Methods: Counts of hospital admissions for otitis media by census area unit were offset against population data from the 2006 national census. Area‐level household crowding, exposure to tobacco smoke in the home, equivalised income and individual‐level characteristics age and sex were adjusted for. To examine effect modification by ethnicity, three separate poisson models were examined for the total, Māori and non‐Māori populations. Results: Household crowding was significantly associated with hospital admissions for otitis media after adjustment in all three models. Neighbourhoods with the highest compared to the lowest proportion of crowded homes exhibited incidence rate ratios of 1.25 (95%CI 1.12–1.37) in the total population, 1.59 (95%CI 1.21–2.04) in the Māori restricted model and 1.17 (95%CI 1.06–1.32) in the non‐Māori restricted model. Conclusions: Otitis media hospitalisations are associated with area‐level measures of household crowding and other risk factors in this ecological study. The largest increase in otitis media incidence relative to neighbourhood rates of household crowding was exhibited among Māori cases of otitis media. Implications: This study adds weight to the growing body of literature linking infectious disease risk to overcrowding in the home.

This paper presents applied geographical research based on a spatial microsimulation model, SimAlba, aimed at estimating geographically sensitive health variables in Scotland. SimAlba has been developed in order to answer a variety of “what-if” policy questions pertaining to health policy in Scotland. Using the SimAlba model, it is possible to simulate the distributions of previously unknown variables at the small area level such as smoking, alcohol consumption, mental well-being, and obesity. The SimAlba microdataset has been created by combining Scottish Health Survey and Census data using a deterministic reweighting spatial microsimulation algorithm developed for this purpose. The paper presents SimAlba outputs for Scotland’s largest city, Glasgow, and examines the spatial distribution of the simulated variables for small geographical areas in Glasgow as well as the effects on individuals of different policy scenario outcomes. In simulating previously unknown spatial data, a wealth of new perspectives can be examined and explored. This paper explores a small set of those potential avenues of research and shows the power of spatial microsimulation modeling in an urban context.

Abstract Objective: To examine the association between geographic access to alcohol outlets and serious violent crime in New Zealand. Methods: A national study of alcohol outlet access and serious violent crime used a cross‐sectional ecological analysis. Serious violence offences recorded between 2005 and 2007 were aggregated for 286 police station areas. Using Geographical Information Systems (GIS), 9,320 licensed premises were geocoded and road travel distances to the closest alcohol outlet type/category were calculated for each area. Negative binomial regression models measured the association between the distance to the closest alcohol outlet and the number of serious violent offences in each police station area, controlling for area‐level measures of social deprivation, Māori population, young males 15–29 years and population density. Results: There were significant negative associations between distance (access) to licensed outlets and the incidence of serious violent offences with greater levels of violent offending recorded in areas with close access to any licensed premises compared to those areas with least access (IRR 1.5, 95% CI 1.10–2.03); with on‐licensed premises (IRR 1.6, 95% CI 1.16–2.08); and off‐licensed premises (IRR 1.4, 95% CI 1.05–1.93). Conclusion: Having greater geographic access to alcohol outlets was associated with increased levels of serious violent offending across study areas. Implications: Alcohol availability and access promoted under the current liberalised licensing regime are important contextual determinants of alcohol‐related harm within New Zealand communities.

Chronic Obstructive Pulmonary Disease is a progressive lung disease affecting the respiratory function of every sixth New Zealander and over 300 million people worldwide. In this paper, we explored how the combination of social, demographical and environmental conditions (represented by increased winter air pollution) affected hospital admissions due to COPD in an urban area of Christchurch (NZ). We juxtaposed the hospitalisation data with dynamic air pollution data and census data to investigate the spatiotemporal patterns of hospital admissions. Spatial analysis identified high-risk health hot spots both overall and season specific, exhibiting higher rates in winter months not solely due to air pollution, but rather as a result of its combination with other factors that initiate deterioration of breathing, increasing impairments and lead to the hospitalisation of COPD patients. From this we found that socioeconomic deprivation and air pollution, followed by the age and ethnicity structure contribute the most to the increased winter hospital admissions. This research shows the continued importance of including both individual (composition) and area level (composition) factors when examining and analysing disease patterns.

Objectives To investigate whether practices will be ready for the data reporting requirements for the new General Medical Services (GMS) contract, using coronary heart disease (CHD) as an example. Design Cross-sectional survey. Data sources Electronic general practitioner (GP) records of all CHD patients in five Scottish practices, validated by manual searches in 50 randomly selected patients in each practice. Main outcome measures Recording of family history, smoking status, blood pressure (BP), diabetes testing, aspirin therapy and cholesterol measurement. Results It is extremely easy for practices with completely electronic patient records to extract a disease register (mean 10 min, range 38 sec to 3 hr 6 min). Extraction of a complete dataset takes several days if it involves checking through paper records, whereas setting up and running a search from electronic records is possible in less than two hours. If practices use the same clinical system and identical data entry templates, the data can be directly compared. Some items that are easily recorded as part of routine clinical practice, such as prescribing of aspirin, are well recorded, but others, such as BP recording, are more of a problem. One hundred percent of the CHD patients sampled had a BP recording within the previous year, but some practices had these data in the paper records where they were not readily accessible. Conclusions We have shown that in Scotland there is a high level of testing and recording of all the important information regarding patients with recorded CHD, irrespective of whether practices have fully electronic records, paper-based records, or a mixture of the two. If practices have fully electronic patient records, the information can be extracted easily, but unless there is a standard template, the information can only be viewed in isolation and is of little value for comparative purposes.

Objective To describe the use of computing systems by primary care staff in Scotland. Participants Practice managers in Scotland on behalf of their practice teams. Methods A survey of computer use in Scottish general practices was carried out by the Scottish Clinical Information Management in Primary Care (SCIMP) group in April 2001. Every practice was sent an electronic copy of a questionnaire using NHSnet. Practices that did not respond to the electronic version were sent a paper version of the questionnaire. Main outcome measures Access to computers, use during consultations, links to laboratories, problems experienced by users. Results A total of 308 practices (30%) replied to the electronic questionnaire and 346 practices (33%) to a paper version, giving an overall response rate of 63% (654 practices). A total of 296 (29%) of practices could not receive the electronic version. It was reported that 94% of general practitioners and 74% of practice nurses frequently used a computer; 72% of practices used their computer for chronic disease management. There was great variability in links to laboratories for lab results (range 1_30% by region). Of responding practices, 16% had plans for a unified patient record, but access to a computer is still a major problem for community nurses. Satisfaction was expressed for all systems and many practices also use third-party programs. Conclusions Most Scottish doctors make frequent use of computers for a variety of clinical and practice management activities. Many other staff want to make greater use of computers, but are often unable to obtain access.

Many molecular biology and biochemistry instructors have altered their classroom behavior in favor of evidence-based, active learning instructional strategies. Overwhelming evidence confirms that lecture-only classrooms are detrimental to student learning outcomes, but we know less about the impact textbooks have on students outside the classroom. Two influential projects, the AP Biology redesign and Vision and Change, called for extensive restructuring of course content and hoped that textbooks would be restructured accordingly. This study evaluated all figures and tables from two introductory biology textbooks to quantify how well they implement recommendations from "Vision and Change" and AP Biology redesign. We documented significant differences among figures and tables when looking for experimental data, questions for students to answer, and quantitative interpretation. Using think-aloud interviews, we interrogated whether students engage differently with figures from the two textbooks. When figures provided take-home messages, students relied on written text rather than analyzing the graphical information for their understanding. Students frequently employed words from summaries within the figures to construct "inflated explanations" that mimicked comprehension.