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Objectives: Current policies for older patients do not adequately address the barriers to effective implementation of optimal care models in New Zealand, partly due to differences in patient definitions and the in-patient pathway they should follow through hospital. This research aims to: (a) synthesise a definition of a complex older patient; (b) identify and explore primary and secondary health measures; and (c) identify the primary components of a care model suitable for a tertiary hospital in the midland region of the North Island of New Zealand. Method: This mixed-methods study utilised a convergence model, in which qualitative and quantitative data were investigated separately and then combined for interpretation. Semi-structured interviews (n=11) were analysed using a general inductive method of enquiry to develop key codes, categories and themes. Univariate data analysis was employed using six years of routinely collected data of patients admitted to the emergency department and inpatient units (n=261,773) of the tertiary hospital. Results: A definition of a complex older patient was determined that incorporates chronic conditions, comorbidities and iatrogenic complications, functional decline, activities of daily living, case fatality, mortality, hospital length of stay, hospital costs, discharge destination, hospital readmission and emergency department revisit and age – not necessarily over 65 years old. Well-performing geriatric care models were found to include patient-centred care, frequent medical review, early rehabilitation, early discharge planning, a prepared environment and multidisciplinary teams. Conclusions: The findings of this New Zealand study increase understanding of acute geriatric care for complex older patients by filling a gap in policies and strategies, identifying potential components of an optimal care model and defining a complex geriatric patient. Implications for Public Health: The findings of this study present actionable opportunities for clinicians, managers, academics and policymakers to better understand a complex older patient in New Zealand, with significant relevance also for international geriatric care and to establish an effective acute geriatric care model that leads to beneficial health outcomes and provides safeguard mechanisms. [ABSTRACT FROM AUTHOR]

The Baby Care Questionnaire (BCQ) is an established ordinal measure of parenting beliefs about infant care, which includes structure and attunement scales. Rasch analysis is a powerful method to examine and improve psychometric properties of ordinal scales. This study aimed to evaluate the psychometric properties and improve precision of the structure and attunement scales of the BCQ using Rasch methodology. A Partial Credit Rasch model was applied to a sample of 450 mothers from the United Kingdom (n = 225) and New Zealand (n = 225) who completed the BCQ. Initial analyses indicated acceptable reliability of the structure and attunement scales of the BCQ, but some items showed misfit to the Rasch model associated with local dependency issues in both scales. After combining locally dependent items into testlets, both scales of the BCQ met expectations of the unidimensional Rasch model and demonstrated adequate and strong reliability and invariance across countries and person factors such as participants' age and their baby's sex. This permitted the generation of conversion algorithms to transform ordinal scores into interval data to enhance the precision of both scales of the BCQ. In conclusion, using Rasch methodology, this study demonstrated robust psychometric properties of the structure and attunement scales of the BCQ after minor modifications. The ordinal-to-interval conversion tables published here can be used to further enhance the precision of the structure and attunement scales of the BCQ without changing their original response format. These findings contribute to the enhancement of precision in measuring parenting beliefs about infant care. Highlights: The Baby Care Questionnaire (BCQ) assesses parenting beliefs on infant care through structure and attunement scales. Rasch methodology assessed BCQ's psychometric properties, refining structure and attunement scales for interval-level precision. By creating testlets, both BCQ scales demonstrated strong reliability and invariance across countries and person factors. Conversion algorithms converted ordinal scores to interval scores to enhance the precision of both scales of the BCQ. [ABSTRACT FROM AUTHOR]

Participation in evidence-based parenting programs benefits parents and children, but these programs have limited reach. This study utilized a mixed-method design to investigate the parenting concerns and parenting program needs of Chinese immigrant parents in New Zealand. Parents (n = 159) were surveyed about their perceived levels of child adjustment problems, parenting confidence, and parenting risk and protective factors. Parents' knowledge and experience with parenting programs, and their program preferences were also examined. Eight Chinese parenting practitioners were interviewed about parenting challenges, parental concerns, and barriers to program participation of Chinese immigrant parents. Survey results showed that parents who gave their child higher ratings on behavior problems reported less parental self-efficacy, and more parental adjustment, family relationship, teamwork, and parenting difficulties. Parents' knowledge and experience of available parenting programs was low. Barriers to program participation included time constraints, lack of program awareness, cultural and language barriers, and no childcare provision. Parents indicated a preference for a range of delivery options including group-based, seminar, and individually tailored programs. Program features most likely to influence attendance were content that addresses personally relevant issues and children's self-development (such as coping with failure, managing negative emotions, and increasing confidence), and convenient location of program. Practitioners indicated that managing difficult child behavior and maintaining positive parent-child relationships were key parenting challenges. These concerns were linked to cultural expectations about child obedience, academic performance, and parent/grandparent relationships. Findings highlight program preferences that could be offered to meet Chinese immigrant parenting support needs and increase program participation. Highlights: Parents and practitioners highlighted challenges, concerns, and needs of Chinese immigrant parents. Parents who gave higher child behavior problems ratings reported more parenting and family relationship difficulties. Identified parenting program, delivery, and content options that could meet Chinese immigrant parenting support needs. [ABSTRACT FROM AUTHOR]

There is growing interest in using comparative judgement to assess student work as an alternative to traditional marking. Comparative judgement requires no rubrics and is instead grounded in experts making pairwise judgements about the relative 'quality' of students' work according to a high level criterion. The resulting decision data are fitted to a statistical model to produce a score for each student. Cited benefits of comparative judgement over traditional methods include increased reliability, validity and efficiency of assessment processes. We investigated whether such claims apply to summative statistics and English assessments in New Zealand. Experts comparatively judged students' responses to two national assessment tasks, and the reliability and validity of the outcomes were explored using standard techniques. We present evidence that the comparative judgement process efficiently produced reliable and valid assessment outcomes. We consider the limitations of the study, and make suggestions for further research and potential applications. [ABSTRACT FROM AUTHOR]

Background: The prescribing of medications with anticholinergic and/or sedative properties is considered potentially inappropriate in older people (due to their side-effect profile), and the Drug Burden Index (DBI) is an evidence-based tool which measures exposure to these medications. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is an ongoing longitudinal study investigating the determinants of healthy ageing. Using data from LiLACS NZ, this study aimed to determine whether a higher DBI was associated with poorer outcomes (hospitalisation, falls, mortality and cognitive function and functional status) over 36 months follow-up. Methods: LiLACS NZ consists of two cohorts: Māori (the indigenous population of New Zealand) aged ≥ 80 years and non-Māori aged 85 years at the time of enrolment. Data relating to regularly prescribed medications at baseline, 12 months and 24 months were used in this study. Medications with anticholinergic and/or sedative properties (i.e. medications with a DBI > 0) were identified using the Monthly Index of Medical Specialities (MIMS) medication formulary, New Zealand. DBI was calculated for everyone enrolled at each time point. The association between DBI at baseline and outcomes was evaluated throughout a series of 12-month follow-ups using negative binomial (hospitalisations and falls), Cox (mortality) and linear (cognitive function and functional status) regression analyses (significance p < 0.05). Regression models were adjusted for age, gender, general practitioner (GP) visits, socioeconomic deprivation, number of medicines prescribed and one of the following: prior hospitalisation, history of falls, baseline cognitive function [Modified Mini-Mental State Examination (3MS)] or baseline functional status [Nottingham Extended Activities of Daily Living (NEADL)]. Results: Full demographic data were obtained for 671, 510 and 403 individuals at baseline, 12 months and 24 months, respectively. Overall, 31%, 30% and 34% of individuals were prescribed a medication with a DBI > 0 at baseline, 12 months and 24 months, respectively. At baseline and 12 months, non-Māori had a greater mean DBI (0.28 ± 0.5 and 0.27 ± 0.5, respectively) compared to Māori (0.16 ± 0.3 and 0.18 ± 0.5, respectively). At baseline, the most commonly prescribed medicines with a DBI > 0 were zopiclone, doxazosin, amitriptyline and codeine. In Māori, a higher DBI was significantly associated with a greater risk of mortality: at 36 months follow-up, adjusted hazard ratio [95% confidence interval (CI)] 1.89 (1.11–3.20), p = 0.02. In non-Māori, a higher DBI was significantly associated with a greater risk of mortality [at 12 months follow-up, adjusted hazard ratio (95% CIs) 2.26 (1.09–4.70), p = 0.03] and impaired cognitive function [at 24 months follow-up, adjusted mean difference in 3MS score (95% CIs) 0.89 (− 3.89 to − 0.41), p = 0.02). Conclusions: Using data from LiLACS NZ, a higher DBI was significantly associated with a greater risk of mortality (in Māori and non-Māori) and impaired cognitive function (in non-Māori). This highlights the importance of employing strategies to manage the prescribing of medications with a DBI > 0 in older adults. [ABSTRACT FROM AUTHOR]

Background: The impact of multiple medication exposure on health outcomes among older patients with end-stage kidney disease (ESKD) is unknown.Objective: The objective of this study was to identify the impact of medicine exposure on hospitalisation rates and mortality in a prospective longitudinal observational study of older dialysis patients.Methods: Patient demographics, medication use, hospitalisation, mortality and co-morbidity data were collected through the prospective longitudinal cohort study DOS65 + (Dialysis Outcomes in those aged ≥ 65 years Study) (n = 225). Medication exposure was measured by the total number of individual medications and the number of predetermined ‘medication groups’. Associations between medications prescribed at recruitment and health outcomes as measured by hospitalisation and mortality were assessed by univariate and multivariable regression analyses.Results: Older ESKD patients were exposed to a median of ten (0-20) medications and eight (0-15) medication groups. Multivariate analyses estimate each additional medication increased mortality risk by 8% (relative risk [RR] = 1.08; 95% confidence interval [CI] 1.07-1.09); each medication group increased mortality risk by 11% (RR = 1.11; 95% CI 1.09-1.12). Similar trends were observed for hospitalisation. Certain medication groups were associated with reduced hospitalisation rates, namely angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (RR = 0.62; 95% CI 0.53-0.72) and dihydropyridines (RR = 0.64; 95% CI 0.54-0.76). Warfarin, gastric acid suppressants, diuretics and β-blockers were associated with increased hospitalisation rates. Warfarin was associated with an increased mortality rate (RR = 1.40; 95% CI 1.19-1.65).Conclusions: Multiple medication exposure was prevalent in this older ESKD population, and was associated with an increased risk of mortality and hospitalisation. While this study is not able to determine the cause of these relationships, review of medication use is warranted in this population.Trial Registration: ACTRN12611000024943. [ABSTRACT FROM AUTHOR]

Background: Although generic medicines provide a safe and economical treatment for many illnesses, negative attitudes towards generics are common and branded innovator drugs are often preferred to generic drugs.Objective: The current study examined differences between individuals preferring branded innovator drugs compared with individuals preferring generic drugs or having no preference. We investigated differences in terms of demographics, perceived sensitivity to medicines, symptom burden, and other clinical variables.Methods: A representative general population sample (n = 1000) was recruited using random digit dialling. In a telephone interview, participants were asked about their preferences for and attitudes toward innovator versus generic drugs, perceived sensitivity to medicines, recent symptoms, and other clinical variables, such as the number of general practitioner (GP) visits, and medicine-related information-seeking behaviour.Results: Univariate logistic regression analyses showed that individuals preferring branded innovator medicines reported lower levels of education, more negative attitudes toward generic medicines, higher perceived sensitivity to medicines, a greater symptom burden and more frequent GP visits. There were no between-group differences in whether participants were currently prescribed drugs, or in participants’ medicine-related information-seeking behaviour. Entering all variables into a multivariate logistic regression model confirmed the findings of the univariate models, apart from perceived sensitivity of medicine and symptom burden. The multivariate analysis also confirmed non-European NZ ethnicity and having no current medication prescription to be significantly associated with a preference for branded medicines.Conclusions: Clinicians should be especially aware that the preference for a branded innovator medicine is higher in patients with lower education, higher perceived sensitivity to medicines, higher levels of symptom burden, higher levels of healthcare utilization and not currently taking any prescription medication. [ABSTRACT FROM AUTHOR]

We study aftershock sequences of six major earthquakes in New Zealand, including the 2016 M7.8 Kaikaoura and 2016 M7.1 North Island earthquakes. For Kaikaoura earthquake, we assess the expected number of long-delayed large aftershocks of M5+ and M5.5+ in two periods, 0.5 and 3 years after the main shocks, using 75 days of available data. We compare results with obtained for other sequences using same 75-days period. We estimate the errors by considering a set of magnitude thresholds and corresponding periods of data completeness and consistency. To avoid overestimation of the expected rates of large aftershocks, we presume a break of slope of the magnitude-frequency relation in the aftershock sequences, and compare two models, with and without the break of slope. Comparing estimations to the actual number of long-delayed large aftershocks, we observe, in general, a significant underestimation of their expected number. We can suppose that the long-delayed aftershocks may reflect larger-scale processes, including interaction of faults, that complement an isolated relaxation process. In the spirit of this hypothesis, we search for symptoms of the capacity of the aftershock zone to generate large events months after the major earthquake. We adapt an algorithm EAST, studying statistics of early aftershocks, to the case of secondary aftershocks within aftershock sequences of major earthquakes. In retrospective application to the considered cases, the algorithm demonstrates an ability to detect in advance long-delayed aftershocks both in time and space domains. Application of the EAST algorithm to the 2016 M7.8 Kaikoura earthquake zone indicates that the most likely area for a delayed aftershock of M5.5+ or M6+ is at the northern end of the zone in Cook Strait. [ABSTRACT FROM AUTHOR]

Parents' aspirations shape children's development. In this study, over 6700 pregnant women and over 4300 of their partners from the Growing Up in New Zealand cohort responded to a question about their hopes, dreams, and expectations for their unborn children. Responses were coded according to a Maslowian hierarchy of needs. Mothers and their partners predominantly mentioned self-actualization and physiological aspirations for their unborn children, but their responses varied as a function of parental ethnicity and level of educational achievement and less so as a function of socioeconomic status. Mothers of European ethnicity, and parents with higher levels of educational achievement, mentioned more aspirations for their children-especially for self-actualization and belonging-than mothers of non-European ethnicity and parents with lower levels of educational achievement. These findings are discussed with respect to Maslowian theory and cultural developmental theories, and in terms of understanding the aspirations of parents from diverse backgrounds. [ABSTRACT FROM AUTHOR]

Understanding the predictors of the onset and maintenance of substance use in adolescence is important because it is a recognized health risk. The present longitudinal study examined whether negative peer influence and peer connectedness predicted changes in adolescent alcohol, cigarette, marijuana, and other illegal drug use, and reciprocally whether substance use predicted changes in peer relationships. Adolescents (N = 1940; 52 % female; 52 % European New Zealanders, 30 % Maori, 12 % Pacific Islander) aged 10-15 years completed measures annually for 3 years. Cross-lagged panel models were used to examine bi-directional effects. Negative peer influence predicted increased use of all substances. In turn, alcohol, cigarette, and marijuana use predicted increased negative peer influence, but this effect was inconsistent over time. Peer connectedness, predicted to diminish the frequency of substance use, was found to be unrelated to it. Breaking the reciprocal cycle between peer coercion and substance use would seem to be useful for reducing substance use. [ABSTRACT FROM AUTHOR]

Purpose: To measure the iodine status and iodine intake of New Zealand adults 18-64 years of age following mandatory fortification of bread with iodine. Methods: A cross-sectional survey of NZ adults living in Dunedin and Wellington during February-November 2012. Three hundred and one men and women aged 18-64 years randomly selected from the New Zealand Electoral Roll completed a 24-h urine collection, a demographic and iodine-specific food frequency questionnaire (FFQ), and had height and weight measured. Urine collections were analysed for iodine and reported as median urinary iodine concentration (UIC) µg/L and median urinary iodine excretion (UIE) µg/day. The FFQ was used to estimate iodine intake with and without discretionary iodised salt use. Results: The median UIC for all adults was 73 µg/L, indicative of mild iodine deficiency. The mean urinary volume was 2.0 L. As an estimate of iodine intake, the median UIE was 127 µg/day. Estimated iodine intake, using the FFQ which included discretionary iodised salt use, was 132 µg/day. Iodine intakes were associated with UIC ( P = 0.040) and UIE ( P = 0.003), but not with bread iodine intake and iodised salt use. Conclusion: Using the WHO/UNICEF/ICCIDD target for iodine sufficiency (a UIC of >100 µg/L) based on school-aged children with a mean urinary volume of 1.0 L, the iodine status of NZ adults does not reach adequate levels (73 µg/L). A more realistic parameter in a population with a higher urinary volume excretion (2.0 L) is the UIE. A median UIE of 127 µg/day suggests that the iodine status of NZ adults is now likely to be adequate. [ABSTRACT FROM AUTHOR]

Background: Head impacts and resulting head accelerations cause concussive injuries. There is no standard for reporting head impact data in sports to enable comparison between studies. Objective: The aim was to outline methods for reporting head impact acceleration data in sport and the effect of the acceleration thresholds on the number of impacts reported. Methods: A systematic review of accelerometer systems utilised to report head impact data in sport was conducted. The effect of using different thresholds on a set of impact data from 38 amateur senior rugby players in New Zealand over a competition season was calculated. Results: Of the 52 studies identified, 42 % reported impacts using a >10- g threshold, where g is the acceleration of gravity. Studies reported descriptive statistics as mean ± standard deviation, median, 25th to 75th interquartile range, and 95th percentile. Application of the varied impact thresholds to the New Zealand data set resulted in 20,687 impacts of >10 g, 11,459 (45 % less) impacts of >15 g, and 4024 (81 % less) impacts of >30 g. Discussion: Linear and angular raw data were most frequently reported. Metrics combining raw data may be more useful; however, validity of the metrics has not been adequately addressed for sport. Differing data collection methods and descriptive statistics for reporting head impacts in sports limit inter-study comparisons. Consensus on data analysis methods for sports impact assessment is needed, including thresholds. Based on the available data, the 10- g threshold is the most commonly reported impact threshold and should be reported as the median with 25th and 75th interquartile ranges as the data are non-normally distributed. Validation studies are required to determine the best threshold and metrics for impact acceleration data collection in sport. Conclusion: Until in-field validation studies are completed, it is recommended that head impact data should be reported as median and interquartile ranges using the 10- g impact threshold. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between father involvement and their child's behaviour outcomes amongst a birth cohort of Pacific children and fathers in New Zealand. A birth cohort was established in 2000 from births at Middlemore Hospital in South Auckland where at least one parent was identified as being of Pacific ethnicity and a New Zealand permanent resident. This included 1,376 mothers, 825 fathers, and 1,398 children at baseline. At the 6-years measurement wave, father involvement was measured using the Inventory of Father Involvement, and child behaviour measured using the Child Behaviour Check-list. Internalising and externalising behaviour was related to father involvement in crude and adjusted logistic regression and generalised estimating equation models. 571 Pacific fathers participated at the 6-years measurement wave; most of Samoan (42.9 %) or Tongan (33.5 %) ethnic identification. Overall, 190 (32.1 %) children exhibited clinical or border-line internalising and externalising behaviour. Self-reported father involvement was generally high, but lower involvement was significantly related to increased odds of internalising [adjusted odds ratio (aOR) approximately 1.9, p < 0.001] and externalising (aOR approximately 4.0, p < 0.001) behaviour. Father involvement was significantly associated with child behaviour in Pacific families within New Zealand. Strategies that promote and enable increased father involvement may reduce negative child outcomes amongst Pacific families. [ABSTRACT FROM AUTHOR]

Objectives: To measure the postprandial plasma amino acid appearance in younger and older adults following a high protein mixed meal. Design: Cross-sectional study. Setting: Clinical research setting. Participants: Healthy men and women aged 60-75 (n=15) years, and young controls aged 20-25 years (n=15) matched for body mass index and insulin sensitivity based on the homeostatic model assessment of insulin resistance. Intervention: High protein mixed meal of complete food products. Measurements: Circulating amino acid concentrations were determined hourly before and for 5 hours after meal ingestion. Results: There was no difference between cohorts in postprandial appearance of non-essential amino acids, or area under the curve of any individual amino acid or amino acid class. However, older adults had higher baseline concentrations of aspartic acid, glutamic acid, glycine, ornithine, threonine and tyrosine and lower baseline concentrations of hydroxyproline, isoleucine, leucine, methionine and valine compared to younger adults. Younger adults showed peak essential (EAA) and branched-chain amino acid (BCAA) concentrations at 1 hour post meal while older adults' peak EAA and BCAA concentration was at 3 hours. Similarly, peak total amino acid concentrations were at 3 hours in older adults. Conclusion: Older adults digested and absorbed the protein within a mixed meal more slowly than younger adults. Delayed absorption of AA following a mixed meal of complete food products may suppress or delay protein synthesis in senescent muscle. [ABSTRACT FROM AUTHOR]

Peloruside A is a microtubule-stabilizing agent that is currently under investigation as a potential anticancer agent. Peloruside A binds to a site on β-tubulin that is distinct to that of the taxanes (paclitaxel and docetaxel) and the epothilones. An attractive clinical quality of microtubule-stabilizing agents is their ability to target multiple mechanisms of tumour growth. In addition to inducing tumour cell apoptosis by arresting cells in mitosis, microtubule-stabilizing agents also inhibit angiogenesis, a process needed by tumor cells for growth and metastasis. In this study, the effects of peloruside A on endothelial cell processes important for angiogenesis were assessed in comparison to docetaxel. Both peloruside A and docetaxel potently inhibited the proliferation of human umbilical vein endothelial cells, with IC values of 1.4 and 1.7 nM, respectively. Peloruside also potently blocked endothelial cell migration during wound closure and the three-dimensional organization of the endothelial cells into capillary-like tubes. In the wound scratch assay, peloruside A inhibited wound recovery with an IC of 6.3 nM after 18 h. Docetaxel was approximately 3-fold more potent than peloruside A. The number of capillary-like tubes that formed after 16 h culture in Matrigel™ was also inhibited in a dose-dependent manner with an IC of 4.5 nM. Docetaxel was about 2-fold more potent than peloruside A in preventing tube formation. This inhibition of endothelial cell function occurred at relatively non-cytotoxic concentrations over the 16-18 h incubations for both stabilizing agents, suggesting that anti-angiogenic effects are likely to occur before therapeutically relevant doses begin to inhibit tumor growth or adverse side effects develop. [ABSTRACT FROM AUTHOR]

Memantine is an uncompetitive N-methyl- d-aspartate (NMDA) receptor antagonist that is a well-established treatment option for moderate to severe dementia of the Alzheimer's type, either alone or in combination with cholinesterase inhibitors. The immediate-release (IR) formulations of memantine (tablets and oral solution) have been available in numerous countries, including the USA, for more than a decade and are administered orally twice daily at a maximum recommended total daily dosage of 20 mg/day. The memantine extended-release (ER) (Namenda XR) 28 mg once-daily capsule formulation was approved in the USA in 2010 and became available more recently. The potential advantages of memantine ER over the IR formulation include a more convenient dosage regimen and lower pill burden that may improve adherence to therapy; also, memantine ER capsules may be opened and the contents sprinkled on applesauce for patients who have difficulty swallowing. Memantine ER provides a higher total daily dosage than the recommended memantine IR regimen and pharmacokinetic data indicate greater exposure with the ER formulation, but the clinical implications of this are unclear, as the two formulations have not been assessed in a comparative clinical trial. The efficacy of memantine ER 28 mg once daily was demonstrated in a large, multinational, phase III trial, which showed that the addition of memantine ER to ongoing oral cholinesterase inhibitors improved key outcomes compared with cholinesterase inhibitor monotherapy, including measures of cognition and global status, which were the co-primary endpoints of the study. The most common adverse events were headache, diarrhoea and dizziness. [ABSTRACT FROM AUTHOR]

Background: Estimates of the variability that athletes show from competition to competition provide information about the relative contributions of environmental and other factors affecting competitive performance. Smallest and other important thresholds for assessing changes in performance in competitions and field or laboratory tests can also be derived from estimates of variability. Objectives: To systematically review estimates of within-athlete variability of competitive performance in various sports. Methods: We searched SPORTDiscus and Google Scholar for studies providing estimates of within-athlete variability between competitions. Estimates are reported here as coefficients of variation (CV) only for the best athletes. Some studies also combined within-athlete variability with between-athlete differences into a measure of predictability expressed as an intraclass correlation coefficient, reported here for the full field of competition. Results: Skeleton and 1,000-m speed-skating times have the lowest within-athlete variability (CV of 0.15 % and 0.4 %, respectively), apparently because of the effect of the initial phase of the race on race dynamics. Times in sprint and endurance sports also have relatively low variability (0.6-1.4 %), reflecting the predominant contribution of mean power output to performance. The power-velocity relationship tends to make CV for time smaller in sports performed against water or wind resistance, but this effect is offset by variability in the effects of wind and water on individual athletes. Sports requiring explosive power in a single effort, such as field events and weightlifting, have larger CVs for their performance measures (1.4-3.3 %), likely reflecting substantial contributions of skill. Sports with the greatest within-athlete variability (~50 %) were those with subjective scores (e.g. surfing). Predictability correlations ranged from 0.17 (half-pipe snowboarding) to 0.93 (cross-country skiing). There was little difference in variability or predictability between men and women. Application of power-velocity and power-duration relationships allows transformation of the estimates of within-athlete variability of competitive performance into thresholds for smallest and other important changes in performance in laboratory and field tests of power output. Conclusion: Understanding the contributions of race dynamics, power output, environment, skill, and subjective scoring to the variability of athletic performance should help identify and evaluate strategies for performance enhancement. [ABSTRACT FROM AUTHOR]

Purpose The Work-ability Support Scale (WSS) is a new tool designed to assess vocational ability and support needs following onset of acquired disability, to assist decision-making in vocational rehabilitation. In this article, we report an iterative process of development through evaluation of inter- and intra-rater reliability and scoring accuracy, using vignettes. The impact of different methodological approaches to analysis of reliability is highlighted. Methods Following preliminary evaluation using case-histories, six occupational therapists scored vignettes, first individually and then together in two teams. Scoring was repeated blind after 1 month. Scoring accuracy was tested against agreed 'reference standard' vignette scores using intraclass correlation coefficients (ICCs) for total scores and linear-weighted kappas (kw) for individual items. Item-by-item inter- and intra-rater reliability was evaluated for both individual and team scores, using two different statistical methods. Results ICCs for scoring accuracy ranged from 0.95 (95 % CI 0.78-0.98) to 0.96 (0.89-0.99) for Part A, and from 0.78 (95 % CI 0.67-0.85) to 0.84 (0.69-0.92) for Part B. Item by item analysis of scoring accuracy, inter- and intra-rater reliability all showed 'substantial' to 'almost perfect' agreement (kw ≥ 0.60) for all Part-A and 8/12 Part-B items, although multi-rater kappa (Fleiss) produced more conservative results (mK = 0.34-0.79). Team rating produced marginal improvements for Part-A but not Part-B. Four problematic contextual items were identified, leading to adjustment of the scoring manual. Conclusion This vignette-based study demonstrates generally acceptable levels of scoring accuracy and reliability for the WSS. Further testing in real-life situations is now warranted. [ABSTRACT FROM AUTHOR]

This paper analyses empirically the factors that influence the merger decision-making process of the New Zealand Commerce Commission using discrete-choice econometric modelling. Previous studies in various countries have typically modelled this process as involving a single step, even when a formal two-step process is actually used. We apply a new approach that treats merger decision-making as a two-step process, and compare the results with those from applications of the conventional one-step and ordered probit models. We expect the new approach to avoid biases inherent in the previous models, and therefore to produce statistically superior results. [ABSTRACT FROM AUTHOR]

The aim of this study was to develop a clinically valid and reliable audit tool that evaluates the assessment documentation of females presenting to the emergency department following an assault secondary to partner abuse. A 5-step process informed by a quality improvement approach was used to develop the tool and good inter-rater reliability was achieved. The tool developed has wide utility in services implementing family violence intervention in which nurses have a key role. [ABSTRACT FROM AUTHOR]

Objective: To determine the validity of the nutrition screening tool' Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II' (SCREEN II) among a purposive sample of octogenarians. Design: Cross-sectional validation study. Setting: Bay of Plenty, New Zealand. Participants: Forty-five community-living residents aged 85-86 years. Equal proportions of participants were recruited at low, medium and high nutrition risk based on their SCREEN II score 12 months prior. Measurements: Nutrition risk was assessed using SCREEN II. Demographic and health data were established. Using established criterion a dietitian's nutrition risk rating assessment ranked participants from low risk (score of 1) to high risk (score of 10). The assessment included a medical history, anthropometric measures and dietary intake. Dietary intake was established from three 24 hour multiple pass recalls (MPR). A Spearman's correlation determined the association between the SCREEN II score and the dietitian's risk score. Receiver operating characteristic (ROC) curves were completed to determine the sensitivity and specificity of the cut-off point for high nutrition risk. Results: The SCREEN II score was significantly correlated with the dietitian's risk rating (rs = −0.76 (p<0.01). A newly defined cut-off point <49 was established for high nutrition risk derived from ROC curves and AUC (0.87, p < 0.01); sensitivity 90% and specificity 86%. Conclusion: SCREEN II is a simple, easy to use, 14 item questionnaire and appears to be a valid tool for detection of nutrition risk people aged 85-86 years. [ABSTRACT FROM AUTHOR]

Permanent deformation is one of the most important types of distress in flexible pavement. Currently and based on the Australian Mechanistic-Empirical Pavement Design Procedure, the indirect tensile test (IDT) is conducted in New Zealand in order to determine the asphalt modulus. This test is carried out on a 100 mm diameter by 50 mm height specimen. However, the current Simple Performance Test (SPT) procedure requires the dynamic modulus to be obtained from the axial compression test performed on 100 mm diameter by 150 mm height specimen. One issue related to the axial compression test is that it is often impossible to obtain this size specimen from actual pavement since a typical asphalt layer thickness is less than 150 mm in New Zealand. Therefore, IDT becomes more appropriate for existing pavement evaluation due to its privilege of testing on cored size specimens. The objective of this research is to perform an experimental and analytical study on the dynamic modulus parameters derived from the aforementioned test methods to improve design accuracy. In this research, two common types of asphalt cement are tested at three different air void percentages. Graphical and statistical comparisons of results from the axial compression and IDT test methods are presented in order to assess their interrelationships. The findings show that, the dynamic modulus determined form IDT test is in good agreement with that form axial compression tests. Based on the statistical analysis, more than 90% of data showed complete similarity for the dynamic modulus calculated from these two tests. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether training and documentation led to improved assessment of female victims of assault due to domestic violence presenting to an emergency department. Eighty clinical records were audited using a valid and reliable audit tool over four time periods for variables including history, risk assessment, and examination. Documentation differed across the four groups ( p = 0.011). Between group analysis found there was a difference ( p = 0.055) between Groups 1 (before training) and 2 (after training), and Group 3 (with a specialist form in place), and there was a difference ( p = 0.009) between Groups 1 and 4 (8 years later). Training alone did not lead to change. Introducing specialist documentation with training was associated with an improvement in the standard of clinical assessment of female victims of assault due to domestic violence and this change increased over time. [ABSTRACT FROM AUTHOR]

As self efficacy beliefs help determine an individual's response to challenging situations, we explored the impact of the refugee experience on efficacy beliefs and their contribution to resettlement. General self efficacy (GSE) was assessed in 186 resettled Afghan and Kurdish refugees against a range of personal and temporal variables. Although no differences in GSE in relation to temporal factors were noted, significant relationships between self efficacy, lower psychological distress and higher subjective well being were evident. The findings suggest that GSE, because of its positive association with mental health and well being, is a variable worthy of further examination in refugees. In addition to ensuring a supportive environment for learning English, proactive employment strategies should be encouraged. Further research examining the use of successful refugee role models to promote self efficacy, enhance motivation for learning and ensure newly arrived refugees view resettlement as a challenge, rather than a threat, is recommended. [ABSTRACT FROM AUTHOR]

We sought to identify what services indigenous (Maori) and immigrant populations use pharmacies for, and how long pharmacy staff spend interacting with them, as longer interactions are associated with better quality care. We review literature on counseling in pharmacy, and interaction length as an indicator of counseling quality. 1,086 interactions were discretely observed in 36 pharmacies in 5 cities around New Zealand. Maori or Pacific people, along with men, were more likely to treat pharmacies as prescription 'depots', being less likely to buy over-the-counter or pharmacist only medicines (ORs: 0.25-0.72). However, the influence of demographic factors on interaction length was small (| B|s < 7.7 s). The weak effect of ethnicity on interaction length suggests that pharmacies are providing advice of relatively consistent quality to different population groups. Possible barriers to use of pharmacies for primary healthcare, including over-the-counter medicines in Maori and Pacific people are discussed. [ABSTRACT FROM AUTHOR]

Summary: This survey suggests that patients are prepared to accept higher absolute fracture risk than doctors, before considering pharmacological therapy to be justified. Patients require that drug treatments confer substantial fracture risk reductions in order to consider long-term therapy. Introduction: Absolute fracture risk estimates are now incorporated into osteoporosis treatment guidelines. At present, little is known about how patients regard fracture risk and its management. We set out to describe and compare the views of patients and doctors on the level of fracture risk at which drug treatment is justified. Methods: A cross-sectional survey was conducted on 114 patients referred for bone density measurement and 161 doctors whose practice includes management of osteoporosis. Participants were asked about fracture risk thresholds for pharmacological intervention. Results: The absolute risk of both major osteoporotic fracture and hip fracture at which drug treatment was considered by patients to be justifiable was higher than that reported by doctors [major osteoporotic fracture, median (interquartile range): patients, 50% (25 to 60); doctors, 10% (10 to 20); P < 0.0001; hip fracture: patients, 50% (25 to 60); doctors, 10% (5 to 20); P < 0.0001]. Patients required that a drug provide a median 50% reduction in relative risk of fracture in order to consider taking long-term therapy, irrespective of the treatment mode or dosing schedule. Among doctors, there was an inverse relationship between the number of osteoporosis consultations conducted each month and threshold of risk for recommending drug treatment ( r = −0.22 and r = −0.29 for major osteoporotic fracture and hip fracture, respectively, P < 0.01 for both) Conclusions: Patients are prepared to accept higher absolute fracture risk than doctors, before considering pharmacological therapy to be justified. Patients require that drug treatments confer substantial fracture risk reductions in order to consider long-term therapy. [ABSTRACT FROM AUTHOR]

Catumaxomab is a rat/murine hybrid, trifunctional, bispecific (anti-human epithelial cell adhesion molecule [EpCAM] x anti-CD3) monoclonal antibody. Compared with paracentesis alone, paracentesis followed by catumaxomab therapy was associated with significant prolongation of paracentesis- free survival and time to repeat paracentesis in a randomized, open-label, multicentre, pivotal phase II/III trial in patients with recurrent symptomatic malignant ascites due to EpCAM-positive tumours who were resistant to conventional chemotherapy. The benefits of catumaxomab were seen across a broad range of epithelial ovarian and nonovarian cancers, and irrespective of whether or not catumaxomab recipients developed human anti-mouse antibodies. Combining catumaxomab with paracentesis also resulted in more pronounced and prolonged reductions in ascites signs and symptoms and a delayed deterioration in health-related quality of life compared with paracentesis alone. Despite the study not being designed or powered to evaluate overall survival, significant differences favouring the addition of catumaxomab to paracentesis were seen in analyses of the safety population and the subpopulation of patients with gastric cancer. Catumaxomab was generally well tolerated in the pivotal phase II/III trial. The most frequent adverse events attributed to catumaxomab treatment included cytokine-release-related symptoms, which were mostly of mild to moderate severity and manageable with standard symptomatic treatment. [ABSTRACT FROM AUTHOR]

Recent studies have explored the organization of player movements in team sports using a range of statistical tools. However, the factors that best explain the performance of association football teams remain elusive. Arguably, this is due to the high-dimensional behavioural outputs that illustrate the complex, evolving configurations typical of team games. According to dynamical system analysts, movement patterns in team sports exhibit nonlinear self-organizing features. Nonlinear processing tools (i.e. Artificial Neural Networks; ANNs) are becoming increasingly popular to investigate the coordination of participants in sports competitions. ANNs are well suited to describing high-dimensional data sets with nonlinear attributes, however, limited information concerning the processes required to apply ANNs exists. This review investigates the relative value of various ANN learning approaches used in sports performance analysis of team sports focusing on potential applications for association football. Sixty-two research sources were summarized and reviewed from electronic literature search engines such as SPORTDiscus™, Google Scholar, IEEE Xplore, Scirus, ScienceDirect and Elsevier. Typical ANN learning algorithms can be adapted to perform pattern recognition and pattern classification. Particularly, dimensionality reduction by a Kohonen feature map (KFM) can compress chaotic high-dimensional datasets into low-dimensional relevant information. Such information would be useful for developing effective training drills that should enhance self-organizing coordination among players. We conclude that ANN-based qualitative analysis is a promising approach to understand the dynamical attributes of association football players. [ABSTRACT FROM AUTHOR]

Applying a grounded-theory approach to analyzing the Global Entrepreneurship Monitor (GEM) data, we attempt to explain why New Zealand exhibits only a moderate level of economic development despite its high level of entrepreneurship. By statistically analyzing why 34 other countries in the 2005 GEM dataset exhibit small deviations from the classical quadratic curvilinear relationship between entrepreneurship and economic development, we develop a better understanding of the entrepreneurial framework conditions underlying New Zealand's large deviation from this trend line. Based on our findings from the GEM data we make policy recommendations that could aid in moving New Zealand (and other countries) closer toward the trend line and thus promote economic development. [ABSTRACT FROM AUTHOR]

Summary: The association between socioeconomic status (SES) and bone health, specifically in men, is unclear. Based upon data from the large prospective Concord Health in Ageing Men Project (CHAMP) Study of community-dwelling men aged 70 years or over, we found that specific sub-characteristics of SES, namely, marital status, living circumstances, and acculturation, reflected bone health in older Australian men. Introduction: Previous studies reported conflicting results regarding the relationship between SES and bone health, specifically in men. The main objective of this study was to investigate associations of SES with bone health in community-dwelling men aged 70 years or over who participated in the baseline phase of the CHAMP Study in Sydney, Australia. Methods: The Australian Socioeconomic Index 2006 (AUSEI06) based on the Australian and New Zealand Standard Classification of Occupations was used to determine SES in 1,705 men. Bone mineral density and bone mineral content (BMC) were determined by dual-energy X-ray absorptiometry. Bone-related biochemical and hormonal parameters, including markers of bone turnover, parathyroid hormone, and vitamin D, were measured in all men. Results: General linear models adjusted for age, weight, height, and bone area revealed no significant differences across crude AUSEI06 score quintiles for BMC at any skeletal site or for any of the bone-related biochemical measures. However, multivariate regression models revealed that in Australian-born men, marital status was a predictor of higher lumbar BMC ( β = 0.07, p = 0.002), higher total body BMC ( β = 0.05, p = 0.03), and lower urinary NTX-I levels ( β=−0.08, p = 0.03), while living alone was associated with lower BMC at the lumbar spine ( β=−0.05, p = 0.04) and higher urinary NTX-I levels ( β=0.07, p = 0.04). Marital status was also a predictor of higher total body BMC ( β = 0.14, p = 0.003) in immigrants from Eastern and South Eastern Europe. However, in immigrants from Southern Europe, living alone and acculturation were predictors of higher femoral neck BMC ( β = 0.11, p = 0.03) and lumbar spine BMC ( β = 0.10, p = 0.008), respectively. Conclusions: Although crude occupation-based SES scores were not significantly associated with bone health in older Australian men, specific sub-characteristics of SES, namely, marital status, living circumstances, and acculturation, were predictors of bone health in both Australia-born men and European immigrants. [ABSTRACT FROM AUTHOR]

Objectives: To identify factors associated with nutrition risk among a purposive sample of those in advanced aged. Design: A cross sectional feasibility study. Setting: Three North Island locations in New Zealand. Participants: One hundred and eight community-living residents aged 75-85 years. Measurements: Nutrition risk was assessed using a validated questionnaire, Seniors in the Community: Risk Evaluation for Eating and Nutrition, Version II (SCREEN II). A Physical Activity Scale for the Elderly (PASE) was used to determine level of physical activity. Markers of body composition, grip strength and fasting blood samples were collected. Results: Fifty-two percent of participants were at high nutrition risk (SCREEN II score ≪50; range 29-58; out of maximum score 64). The mean score for SCREEN II was higher for older people who lived with others (50.3 ±5.1) compared to those who lived alone (46.4 ±5.8) p=0.001. The SCREEN II score was positively correlated with the total PASE score r= 0.20 (p=0.042), grip strength r=0.20 (p=0.041), and muscle mass percentage r=0.31 (p=0.004). Lower levels of haemoglobin, serum zinc and physical activity were associated with higher nutrition risk. Conclusion: Half the participants were at high nutrition risk. They tended to be widowed or live alone and had lower levels of haemoglobin and serum zinc. Those at lower nutrition risk had greater muscle mass and strength, lower body fat, consumed alcohol more frequently and engaged in more physical activity. Strategies which encourage older people to eat meals and be physically active with others may assist to improve their health. [ABSTRACT FROM AUTHOR]

In the region of Castilla-La Mancha (Spain), over half of the soils are under cropping. This vast agricultural activity, combined with other anthropological uses, has led to a deterioration of the soil quality and virtual degradation. Therefore, it was deemed to assess the quality of these soils, which was achieved by applying two different methods. Three soils, representative of typical conditions in this community, were sampled and diverse properties were analysed in order to apply two different approaches. The first soil evaluation was carried out by a traditional method developed by FAO using a productivity index, whereas the second method consisted of the application of a new method called SINDI, developed in New Zealand. Both approaches make an evaluation based on a number of indicators that differs in each case. These differences explain why each method ranked the soils studied in different order reaching diverse conclusions on their quality. [ABSTRACT FROM AUTHOR]

National surveys of gambling and problem gambling have recently been completed in New Zealand and Sweden. These studies are unique in that data collection was undertaken by official government statistical agencies, involved large, nationally representative samples, and attained high response rates. Comparison of the findings is facilitated by the use of similar procedures and instrumentation and is of interest in that both countries have similar per capita gambling expenditure and welfare states that have recently undergone major economic and social restructuring. Data on gambling participation, problem gambling prevalence and risk factors for problem gambling are presented and discussed. While there are a number of similarities and differences, the Swedish findings are more similar to those of an earlier national survey conducted in New Zealand during 1991. This suggests that risk factors are changing over time in relation to evolving patterns of gambling participation and attitudes towards gambling, a finding that has implications for future patterns of gambling and problem gambling in these and other countries. [ABSTRACT FROM AUTHOR]

Objectives: To assess the risks for adult-onset acute leukemia associated with employment in the New Zealand meat industry.Methods: A total of 110 incident leukemia cases identified from referrals to one of six treatment centers between 1989 and 1991 were compared with 199 general population controls. Detailed occupational exposure histories were obtained by interview.Results: There was an elevated risk associated with ever having worked in an abattoir (OR = 2.3, 95% CI 1.0-5.2), which appeared confined to those with over 2 years exposure (OR = 4.9, 95% CI 1.5-15.6). The excess risk was confined to abattoir workers having direct contact with animals or animal products (OR = 5.2 95% CI 1.2-22.2). Ever having worked as a butcher was associated with elevated risk (OR = 2.9, 95% CI 1.1-7.2), confined to those individuals who worked as a butcher in an abattoir (OR = 4.8) or who butchered livestock on farms (OR = 8.2). No increased risk was found for work as a retail/wholesale butcher or meatpacker (OR = 1.2).Conclusions: This study found increased leukemia risks associated with employment in the meat industry. These were confined to abattoir workers with over 2 years employment in the industry, and to persons whose jobs involved contact with animals or animal tissue, implying that biological exposures may be responsible. [ABSTRACT FROM AUTHOR]