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Aim: The aim of this study was to assess whether obese patients undergoing primary total hip replacement (THR) via a posterior approach had superior revision rates and Oxford Hip Scores (OHS) compared to those via a lateral approach. Patients and methods: This is a retrospective cohort study using prospective data from the New Zealand Joint Registry applying STROBE and RECORD guidelines. Patients undergoing THR since 2010 were stratified by body mass index (BMI) into obese (BMI 30–39 kg/m2), and morbidly obese (BMI ⩾40 kg/m2) groups. All-cause revision rates, and 6-month OHS post-surgery were compared between groups. Multivariate analysis was performed. Results: 12,109 unilateral THRs in obese patients were identified. The mean follow-up was 2.8 years (range 0.01–6.95 years). Univariate analysis in the BMI ⩾ 40 group showed the posterior approach had a significantly lower all-cause revision rate (0.99/100 observed component years (ocys); 95% CI, 0.65–1.44/100 ocys) than the lateral approach (1.71/100 ocys (95% CI, 0.98–2.77/100 ocys), p < 0.05). There was no significant difference in dislocation rates between the surgical approaches. OHS was statistically higher in the posterior approach group in BMI 30–39 patients (p < 0.001) but not clinically significant. Multivariate analysis showed femoral head size significantly influenced all-cause revision rates and mitigated against the increased risk associated with the surgical approach. Conclusion: The choice of surgical approach in obese patients conveys no advantage in overall revision rates in the short-term. Choosing an appropriate size of femoral head may be of greater importance than choice of surgical approach for obese patients in primary THR. [ABSTRACT FROM AUTHOR]

Background: While high-quality meta-analyses have confirmed the effectiveness of aphasia therapy after stroke, there is limited evidence for the comparative effectiveness of different aphasia interventions. Two commonly used interventions, Constraint-induced Aphasia Therapy Plus (CIAT Plus) and Multi-modality Aphasia Therapy (M-MAT), are hypothesised to rely on diverse underlying neural mechanisms for recovery and may be differentially responsive to aphasia severity. COMPARE is a prospective randomised open-blinded end-point trial designed to determine whether, in people with chronic post-stroke aphasia living in the community, CIAT Plus and M-MAT provide greater therapeutic benefit compared to usual care, are differentially effective according to aphasia severity, and are cost-effective. This paper details the statistical analysis plan for the COMPARE trial developed prior to data analysis.Methods: Participants (n = 216) are randomised to one of three arms, CIAT Plus, M-MAT or usual care, and undertake therapy with a study trained speech pathologist in groups of three participants stratified by aphasia severity. Therapy occurs for 3 h blocks per day for 10 days across 2 weeks. The primary clinical outcome is aphasia severity as measured by the Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ) immediately post intervention. Secondary outcomes include WAB-R-AQ at 12-week follow-up, and functional communication, discourse efficiency, multimodal communication, and health-related quality of life immediately post intervention and at 12-week follow-up.Results: Linear mixed models (LMMs) will be used to analyse differences between M-MAT and UC, and CIAT-Plus and UC on each outcome measure immediately and at 12 weeks post-intervention. The LMM for WAB-R-AQ will assess the differences in efficacy between M-MAT and CIAT-Plus. All analyses will control for baseline aphasia severity (fixed effect) and for the clustering effect of treatment groups (random effect).Discussion: This trial will provide relative effectiveness data for two common interventions for people with chronic post-stroke aphasia, and highlight possible differential effects based on aphasia severity. Together with the health economic analysis data, the results will enable more informed personalised prescription for aphasia therapy after stroke.Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN 12615000618550 . Registered on 15 June 2016. [ABSTRACT FROM AUTHOR]

Summary: This article introduces a special issue of the Australian and New Zealand Journal of Statistics, being a Festschrift for Adrian Baddeley on the occasion of his 65th birthday. [ABSTRACT FROM AUTHOR]

Background: Data from clinical registries may be linked to gain additional insights into disease processes, risk factors and outcomes. Identifying information varies from full names, addresses and unique identification codes to statistical linkage keys to no direct identifying information at all. A number of databases in Australia contain the statistical linkage key 581 (SLK-581). Our aim was to investigate the ability to link data using SLK-581 between two national databases, and to compare this linkage to that achieved with direct identifiers or other non-identifying variables.Methods: The Australian and New Zealand Society of Cardiothoracic Surgeons database (ANZSCTS-CSD) contains fully identified data. The Australian and New Zealand Intensive Care Society database (ANZICS-APD) contains non-identified data together with SLK-581. Identifying data is removed at participating hospitals prior to central collation and storage. We used the local hospital ANZICS-APD data at a large single tertiary centre prior to deidentification and linked this to ANZSCTS-CSD data. We compared linkage using SLK-581 to linkage using non-identifying variables (dates of admission and discharge, age and sex) and linkage using a complete set of unique identifiers. We compared the rate of match, rate of mismatch and clinical characteristics between unmatched patients using the different methods.Results: There were 1283 patients eligible for matching in the ANZSCTS-CSD. 1242 were matched using unique identifiers. Using non-identifying variables 1151/1242 (92.6%) patients were matched. Using SLK-581, 1202/1242 (96.7%) patients were matched. The addition of non-identifying data to SLK-581 provided few additional patients (1211/1242, 97.5%). Patients who did not match were younger, had a higher mortality risk and more non-standard procedures vs matched patients. The differences between unmatched patients using different matching strategies were small.Conclusion: All strategies provided an acceptable linkage. SLK-581 improved the linkage compared to non-identifying variables, but was not as successful as direct identifiers. SLK-581 may be used to improve linkage between national registries where identifying information is not available or cannot be released. [ABSTRACT FROM AUTHOR]

Background: Adverse pregnancy outcomes are more common in women with hyperglycaemia. Many women have suboptimal uptake of HbA1c testing postdelivery. Aims: To compare pregnancy outcomes among multi‐ethnic women with different degrees of hyperglycaemia during pregnancy, and their association with postnatal HbA1c uptake after the introduction of email reminders. Materials and Methods: A retrospective and prospective single‐centre study was conducted in South Auckland in 2639 women with early gestational diabetes mellitus (GDM) (diagnosed < 20 weeks), late GDM (diagnosed ≥ 20 weeks), overt diabetes in pregnancy, or known type 2 diabetes (T2DM) during pregnancy. Automated email reminders were sent to general practitioners to increase postnatal HbA1c screening. Results: HbA1c during pregnancy increased across the late GDM (n = 1425), early GDM (n = 148), overt diabetes (n = 573) and T2DM (n = 493) groups (P < 0.001). Stillbirth was least common in the late GDM group (0, 0.7, 0.5, and 1.9%, respectively, P < 0.001), as were caesarean delivery (32.7, 45.1, 39.4, and 53.5%, respectively, P < 0.001), large for gestational age (LGA) (14.7, 18.2, 22.3, and 30.5%, respectively, P < 0.001), small for gestational age (8.8, 16.7, 11.0, and 11.1%, respectively, P = 0.02), and preeclampsia/eclampsia (7.7, 9.2, 13.0, and 14.8%, respectively, P < 0.001). LGA and preeclampsia/eclampsia were more common among Pacific and Māori women than European women (LGA, 30.1, 22.7, 10.3%, respectively, P < 0.001; preeclampsia/eclampsia, 13.5, 14.0, and 8.1%, respectively, P < 0.001). Postpartum HbA1c screening increased among women with GDM/overt diabetes after the introduction of the reminder emails (39.6% vs 34.0%, P = 0.03). Conclusions: Women with late GDM are least likely to experience adverse outcomes. Email reminders to improve postpartum HbA1c screening warrant further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Acute kidney injury after cardiopulmonary bypass surgery is associated with morbidity and mortality. This study aims to evaluate the role of low perfusion flow and pressure in the development of cardiopulmonary bypass–associated acute kidney injury, stroke and death, using multicentre registry data. Methods: We identified patients from the Australian and New Zealand Collaborative Perfusion Registry who underwent coronary artery bypass grafting and/or valvular surgery between 2008 and 2018. Primary predictor variables were the length of time the perfusion flow was <1.6 L/min/m2 and the length of time perfusion pressure was < 50mmHg. The primary outcome was new postoperative acute kidney injury defined by the risk-injury-failure-loss-end stage criteria. Secondary outcomes were stroke and in-hospital death. The influence of perfusion flow and pressure during cardiopulmonary bypass on the primary and secondary outcomes was estimated using separate multivariate models. Results: A total of 16,356 patients were included. The mean age was 66 years and 75% were male. Acute kidney injury was observed in 1,844 patients (11%), stroke in 204 (1.3%) and in-hospital death in 286 (1.8%). Neither the duration of the time spent for perfusion flow (<1.6 L/minute/m2) nor the duration of the time spent for perfusion pressure (<50 mmHg) was associated with postoperative acute kidney injury, stroke or death in adjusted models. Conclusions: Neither low perfusion pressure nor low perfusion flow during cardiopulmonary bypass were predictive of postoperative acute kidney injury, stroke or death. [ABSTRACT FROM AUTHOR]

In this study, we present an empirical comparison of statistical models and machine learning models for daily electricity price forecasting in the New Zealand electricity market. We demonstrate the effectiveness of GARCH and SV models and their t -distribution variants when paired with feature selection techniques, including LASSO, mutual information, and recursive feature elimination. A key aspect of our study is the inclusion of a diverse set of explanatory variables in all models. We compare these models against a range of popular machine learning models, including LSTM, GRU, XGBoost, LEAR, and a four-layer DNN, where the latter two are considered benchmarks. Our results reveal that GARCH and SV models, particularly their t variants, perform exceptionally well when paired with feature selection techniques and explanatory variables. In most scenarios considered, these models outperform machine learning models when coupled with LASSO feature selection. This contribution provides a comprehensive evaluation of the performance of different models and feature selection techniques for electricity price forecasting in the New Zealand electricity market. Our best-performing model improves the symmetric mean absolute percentage error (sMAPE) and mean absolute scaled error (MASE) by 2% to 3% over the LEAR benchmark model, highlighting the practical relevance of our findings. • Statistical and machine learning models to forecast New Zealand electricity prices are compared. • GARCH and SV models with t distribution excel with explanatory variables and feature selection. • LASSO feature selection outperforms base models in most cases. • GARCH and SV models with LASSO outperform the benchmark LEAR and DNN models. [ABSTRACT FROM AUTHOR]

Social media has changed the way we live. It is now so integral to daily life that it is one of the top activities that people spend their time on each day. Given its ubiquity, it is important to understand what kinds of personality traits draw people toward social media and whether social media changes personality. The present study utilizes a longitudinal design with a large nationally representative sample (N = 11,629) to examine the bidirectional relationship between personality and social media use (SMU). First, cross-lagged analyses revealed a bidirectional relationship between SMU and neuroticism such that neuroticism predicted increased SMU, but SMU also predicted increased neuroticism. However, while increased SMU predicted reduced honesty/humility, honesty/humility did not predict SMU. No other relationships emerged between personality and SMU. This study is the first to examine the extent to which personality both predicts SMU, and is in turn reciprocally shaped by social media exposure in a large-scale national probability panel study. [ABSTRACT FROM AUTHOR]

In New Zealand, as in other industrialised societies, an ageing population has led to an increased need for palliative care services. A cross‐sectional postal survey of bereaved carers was conducted in order to describe both bereaved carer experience of existing services in the last 3 months of life, and to identify factors associated with overall satisfaction with care. A self‐complete questionnaire, using a modified version of the Views of Informal Carers – Evaluation of Services (VOICES) instrument was sent to 4,778 bereaved carers for registered deceased adult (>18yrs) patients in one district health board (DHB) for the period between November 2015 and December 2016. Eight hundred and twenty‐six completed questionnaires were returned (response rate = 21%). The majority of respondents (83.8%) rated their overall satisfaction with care (taking all care during the last 3 months into account), as high. However, satisfaction varied by care setting. Overall satisfaction with care in hospice was significantly higher compared to other settings. Additionally, patients who died in hospice were more likely to be diagnosed with cancer and under 65 years of age. The factors associated with overall satisfaction with care in the last 2 days of life were: caregiver perceptions of treatment with dignity and respect; adequate privacy; sufficient pain relief and decisions in line with the patient's wishes. A more in‐depth exploration is required to understand the quality of, and satisfaction with, care in different settings as well as the factors that contribute to high/low satisfaction with care at the end‐of‐life. [ABSTRACT FROM AUTHOR]

Workplace wellness programmes have increased over the past years, but as yet has not been investigated in food and grocery organizations in New Zealand (NZ). The study aim was to explore the commitment of NZ Food and Grocery Council (FGC) companies in altering the workplace environment for employee health and the efficacy of the current wellness policies. Using a mixed-methods approach, FGC companies (n = 22) completed a workplace environment audit (WEA) survey. Three focus groups were held, consisting of employees (n = 20) from four of the FGC companies that completed the WEA survey. Two sets of data were then compared via methodological triangulation. The mean WEA score was 46% (p = 0.00), indicating an 'average' commitment by the FGC to health-promotion in their own workplaces. Significantly more initiatives related to improving nutrition were offered (p = 0.00) and larger food companies scored higher than smaller companies (p = 0.063). During the focus groups, employees revealed they felt workplace wellness programmes increased productivity, improved their physical health, allowed work–life balance, promoted social interaction and provided health-related education. Barriers to participating in wellness activities were identified as lack of time, working in a blue-collar position and working externally to the main office. The results of this study have large implications for companies and employers in NZ for future planning, implementation and monitoring of health initiatives in the workplace. [ABSTRACT FROM AUTHOR]

Construct: The MUSIC® Inventory measures the construct of academic motivation across five factors: empowerment, usefulness, success, interest, and caring. The factors are defined in terms of the degree the student perceives that they have control over their environment, that the coursework is useful to their future, that they can succeed in the course, that the course and instructional methods are interesting, and that the teacher cares about their wellbeing and their success respectively. Background: A valid measure of medical students' academic motivation would provide medical teachers with a method for evaluating the motivational aspect of their course and provide focus for changes in teaching and learning to improve medical student engagement. While the MUSIC® Inventory structure has been validated in the tertiary setting and with several professional programs, it has not been validated with medical students. The aim of this study was to use both classical test theory and Rasch modeling to assess the reliability and confirm the structure of the five-factor model of the MUSIC® Inventory with medical students. Approach: One-hundred-fifty-two medical students completed the 26-item inventory. Descriptive statistics, internal consistency, correlations between factors, confirmatory factor analysis, and Rasch analysis using the rating scale model were performed to determine reliability and validity. Findings: The five factors showed good internal consistency (Cronbach's alpha.87 –.92). Correlations between factors were moderate to high (r =.38 –.89). Confirmatory factor analysis highlighted inconsistencies in factor loadings of three of the items hypothesized to measure interest. Rasch analysis using the rating scale model showed that all items for each factor had good item fit (0.65 – 1.37). Person separation (2.28 – 2.85) and reliability (.84 –.91) scores indicated that the scales were able to differentiate different levels of respondents. Item separation (2.25 – 6.97) and reliability scores (.83 –.98) indicated that the items of the scales were being differentiated by the respondents. Conclusions: Rasch analysis indicates that the five factors of academic motivation measured by the MUSIC® Inventory account for the response patterns in data from medical students. However, while the factors of empowerment, usefulness, success, and caring showed expected reliability and validity using classical analysis, three of the interest items cross-loaded on to the usefulness factor. Possible reasons may include ambiguity of language for the items or medical students' conception of usefulness and interest. Future research will explore medical students' understanding of the language used to measure these factors in further detail. [ABSTRACT FROM AUTHOR]

Purpose: The current study was designed to investigate the differences in language input related to family factors (maternal level of education [MLE] and socioeconomic level of deprivation [SLD]) and their association with language outcomes in preschoolers. Method: This study used New Zealand SLD and MLE classification systems to examine differences in language input related to these factors among 20 typically developing preschool children aged 2-5 years. The quantity of children's language input (adult words [AWs], conversational turns [CTs]) was calculated using the Language ENvironment Analysis audiotaping technology for two typical weekend days. Four 5-min Language ENvironment Analysis recording segments were transcribed and coded, and parental language strategies were classified as optimal language strategy, moderate language strategy, or sub-optimal language strategy (S-OLS) for child language outcomes. The receptive and expressive language of each child was assessed using the Preschool Language Scales-Fifth Edition. Results: Mann-Whitney U tests showed significant differences between the quantity of language input (AWs/hr, CTs/hr) for high and low MLE and high and low SLD groups. Consistent with the literature, the use of S-OLSs was significantly lower for families with high MLE (Mdn = .25, IQR = .14) and low SLD (Mdn = .22, IQR = .13) than for families with low MLE (Mdn = .41, IQR = .24) and high SLD (Mdn = .41, IQR = .26). Spearman correlation coefficients indicated significant associations between language input (AWs/hr, CTs/hr, S-OLSs) and language outcomes. Conclusions: Reduced language input and the frequent use of S-OLSs associated with low maternal education and high deprivation and low language outcomes for these children highlight the importance for all parents/families to learn optimal language strategies to support the development of strong language skills in their children in young age. [ABSTRACT FROM AUTHOR]

This study investigated the response to class-wide phonological awareness and oral language teaching for 40 children who entered school with speech and language difficulties. A stepped wedge research design was adopted to compare the immediate impact of the 10-week teacher-led instruction. The progress of the children with speech and language difficulties was monitored over the first school year and compared with 110 children with language difficulties alone and 95 children with typical development. Children with speech and language needs showed a strong intervention response in phoneme awareness and vocabulary learning but needed more support to transfer skills to word decoding and spelling. Implementing the approach earlier in the school year resulted in stronger literacy performance at the year-end for all three groups. The importance of positive speech–language pathologist and teacher collaborations to support a systematic approach to evidence-based foundational literacy teaching is discussed. [ABSTRACT FROM AUTHOR]

The aim of this study was to ascertain whether a high carbohydrate diet in the days before movement patterns simulating a squash match would increase carbohydrate oxidation during the match, and alter physical performance. Nine New Zealand level squash players were recruited to complete a simulated squash match on two occasions: 1) following a 48-hr high carbohydrate (11.1g·kg-1); and 2) following a calorie-matched low carbohydrate (2.1 g·kg-1) diet. The interventions were assigned in a randomized, single-blind, cross-over design. The match simulation was designed to mimic a five-game match lasting approximately 1 hr. Performance was measured as time to complete each game. Expired respiratory gases and heart rate were continuously collected throughout the trial using a portable gas analysis system. Capillary blood glucose and lactate samples were obtained during a 90 s rest period between each game. Rating of perceived exertion was also recorded after each set. Respiratory exchange ratio was significantly higher during exercise following the high CHO diet (0.80 vs. 0.76) p < .001) and this was associated with significantly faster time to complete the games (2340 ± 189 s vs. 2416 ± 128 s, p = .036). Blood glucose and lactate concentrations were also significantly higher in the high carbohydrate condition (p = .038 and p = .021 respectively). These results suggest that ingestion of a diet high in carbohydrate (>10 g/kg body weight) preceding simulated competitive squash produces increased rates of carbohydrate oxidation and maintains higher blood glucose concentrations. These metabolic effects were associated with improved physical performance. [ABSTRACT FROM AUTHOR]

This study aimed to examine the normative data for the SARTS rugby tests in elite and schoolboy rugby players. A second aim was to examine differences between level of sport and position of play in the SARTS rugby tests. Elite (N = 57) and Schoolboy (N = 63) rugby players performed the SARTS tests relevant to rugby players each for 1 min, with 1–2 min rest between each test. A 2×2 factorial ANOVA was used to assess for the main effect of player position and player level of play. Results showed that elite players performed more Ball Abduction External Rotation (BABER) (dominant and non-dominant), Side Hold Rotations (dominant and non-dominant), Ball Taps (dominant and non-dominant), and Overhead Snatch than schoolboy players. Heavier players performed fewer Push-up Claps. Injured rugby players should perform at least the mean value of the repetitions of the SARTS tests before returning to contact training after an injury. [ABSTRACT FROM AUTHOR]

Purpose: In healthy speakers, the more frequent and probable a word is in its context, the shorter the word tends to be. This study investigated whether these probabilistic effects were similarly sized for speakers with dysarthria of different severities. Method: Fifty-six speakers of New Zealand English (42 speakers with dysarthria and 14 healthy speakers) were recorded reading the Grandfather Passage. Measurements of word duration, frequency, and transitional word probability were taken. Results: As hypothesized, words with a higher frequency and probability tended to be shorter in duration. There was also a significant interaction between word frequency and speech severity. This indicated that the more severe the dysarthria, the smaller the effects of word frequency on speakers’ word durations. Transitional word probability also interacted with speech severity, but did not account for significant unique variance in the full model. Conclusions: These results suggest that, as the severity of dysarthria increases, the duration of words is less affected by probabilistic variables. These findings may be due to reductions in the control and execution of muscle movement exhibited by speakers with dysarthria. [ABSTRACT FROM AUTHOR]

We test the hypothesis that ocean seafloor pressures impart stresses that alter the initiation or termination of transient slow slip events (SSEs) on shallow submarine and near‐coastal faults, using simulated seafloor pressures and a new catalog of SSEs in the Hikurangi subduction zone. We show that seafloor pressures may be represented by an average time history over the ~100‐km dimensions of the study area. We account for SSE uncertainties and the multiplicity of processes that affect SSEs statistically by estimating the probabilities of rejecting the null hypothesis that SSE initiation or termination pressures are those to be expected by chance sampling of known (modeled) seafloor pressures, with low probabilities indicating some causal connection. No impact of ocean pressure changes on SSE initiation is detectable, but a correlation with their terminations is suggested. SSE slip that weakens the fault and makes it more sensitive to small stress changes may explain results. Plain Language Summary: The ocean waters may impart stresses that change how shallow submarine and near‐coastal faults start or stop slipping, particularly when they slip slowly over days to months (in episodes called slow slip events or SSEs). We can now assess this possibility using new simulated seafloor pressures and a catalog of SSEs in the Hikurangi subduction zone, encompassing the onshore and offshore region of northeastern New Zealand. We only ask how probable this causal connection is because SSEs are difficult to measure precisely and many physical processes may change their behaviors. Our statistical analyses do not reveal any impact of ocean pressure changes on how or when SSEs start, but do indicate they may affect when SSEs end. One explanation of this result is that the slow slippage actually causes the fault to become weaker, making it more sensitive to the small stress changes imparted by the ocean. Key Points: Ocean water column changes may affect how and when Hikurangi shallow slow slip events end, but have no detectable impact on their startsTransient slow slip events may weaken faults, making them more sensitive to small stress changes (

Background: We are performing a combined randomised and observational study comparing internal fixation to non-surgical management for common wrist fractures in older patients. This paper describes the statistical analysis plan.Methods/design: A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE) is a randomised controlled trial comparing two types of usual care for treating wrist fractures in older patients, surgical fixation using volar locking plates and non-surgical treatment using closed reduction and plaster immobilisation. The primary aim of this comparative-effectiveness study is to determine whether surgery is superior to non-surgical treatment with respect to patient-reported wrist function at 12 months post treatment. The secondary outcomes include radiographic outcomes, complication rates and patient-reported outcomes including quality of life, pain, treatment success and cosmesis. Primary analysis will use a two-sample t test and an intention-to-treat analysis using the randomised arm of the study. Statistical analyses will be two-tailed and significance will be determined by p < 0.05. Sensitivity analyses will be conducted to assess for differences in intention-to-treat, per-protocol and as-treated analyses. Sensitivity analyses will also be conducted to assess selection bias by evaluating differences in participants between the randomised and observational study arms, and for bias relating to any missing data. An economic analysis will be conducted separately if surgery is shown to provide superior outcomes to a level of clinical significance.Discussion: This statistical analysis plan describes the analysis of the CROSSFIRE study which aims to provide evidence to aid clinical decision-making in the treatment of distal radius fractures in older patients.Trial Registration: CROSSFIRE was approved by The Hunter New England Human Research Ethics Committee (HNEHREC Reference No: 16/02/17/3.04). Registered on 22 July 2016 with The Australian and New Zealand Clinical Trials Registry (ANZCTR Number; ACTRN12616000969460 ). This manuscript is based on v.11 of the statistical analysis plan. A copy of v.11, signed by the chief investigator and the senior statistician is kept at the administering institution. [ABSTRACT FROM AUTHOR]

Purpose: Our objective was to explore the intersection between mild traumatic brain injury (MTBI) recovery experiences and injury understandings, using both quantitative and qualitative methods. Materials and Methods: The quantitative component was a descriptive case–control study comparing participants (n = 76) who had recovered or not recovered after an MTBI, across demographic and psychological variables. A subset of participants (n = 10) participated in a semi-structured interview to explore experiences of recovery in more detail. We followed threads across the datasets to integrate findings from component methods. Results: The quantitative analyses revealed differences between the two groups in terms of injury recovery understandings and expectations. The qualitative analyses suggested that achieving consistency across information sources was important. By tracing threads back and forth between the component datasets, we identified a super-ordinate meta-theme that captured participants' experiences of wrestling with uncertainty about their recovery and the impacts in terms of heightened anxiety, confusion, and feelings of invalidation. Conclusion: The effectiveness of psychoeducation and reassurance after MTBI may be optimized when content is tailored to the individual. Clinicians are urged to attend both to the subjective interpretations patients make of information gained from formal and informal, internal and external sources, and where information across these sources conflicts and creates uncertainty. Effectiveness of psychoeducation and reassurance after injury may be optimized when content is tailored to the individual rather than being generic. Effectiveness of such interventions may also be optimized by understanding the subjective interpretations individuals make of injury knowledge gleaned from formal and informal, internal and external sources. Conflicting information from such multiple sources may create uncertainty with associated increased distress as an individual negotiates their recovery from injury. Attending to this uncertainty may be a helpful target for treatment. [ABSTRACT FROM AUTHOR]

Background: The Melanoma Genomics Managing Your Risk Study is a randomised controlled trial that aims to evaluate the efficacy of providing information on personal genomic risk of melanoma in reducing ultraviolet radiation (UV) exposure, stratified by traditional risk group (low or high phenotypic risk) in the general population. The primary outcome is objectively measured total daily Standard Erythemal Doses at 12 months. Secondary outcomes include UV exposure at specific time periods, self-reported sun protection and skin-examination behaviours, psychosocial outcomes, and ethical considerations surrounding offering genomic testing at a population level. A within-trial and modelled economic evaluation will be undertaken from an Australian health system perspective to assess the cost-effectiveness of the intervention.Objective: To publish the pre-determined statistical analysis plan (SAP) before database lock and the start of analysis.Methods: This SAP describes the data synthesis, analysis principles and statistical procedures for analysing the outcomes from this trial. The SAP was approved after closure of recruitment and before completion of patient follow-up. It outlines the planned primary analyses and a range of subgroup and sensitivity analyses. Health economic outcomes are not included in this plan but will be analysed separately. The SAP will be adhered to for the final data analysis of this trial to avoid potential analysis bias that may arise from knowledge of the outcome data.Results: This SAP is consistent with best practice and should enable transparent reporting.Conclusion: This SAP has been developed for the Melanoma Genomics Managing Your Risk Study and will be followed to ensure high-quality standards of internal validity and to minimise analysis bias.Trial Registration: Prospectively registered with the Australian New Zealand Clinical Trials Registry, ID: ACTR N12617000691347 . Registered on 15 May 2017. [ABSTRACT FROM AUTHOR]

Background: The investigational medicinal product GKT137831 is a selective inhibitor of NOX 1 and 4 isoforms of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase family of enzymes, which has the potential to ameliorate diabetic kidney disease. An investigator-initiated, double-blind, randomised, placebo-controlled, multicentre phase 2 clinical trial started recruitment in December 2017, with the aim of evaluating the efficacy and safety of GKT13783, in adults with type 1 diabetes mellitus and persistently elevated urinary albumin excretion over a period of 48 weeks.Methods/design: The trial is currently recruiting in Australia and New Zealand, with recruitment expected to end on 30 June 2020. The primary outcome measure of the trial is the urinary albumin excretion level measured at 48 weeks of treatment. This statistical analysis plan presents an update to the published trial protocol and provides a comprehensive description of the statistical methods that will be used for the analysis of the data from this trial. In doing so, we follow the "Guidelines for the content of statistical analysis plans in clinical trials" to support transparency and reproducibility of the trial findings.Discussion: With the use of this prior statistical analysis plan, we aim to minimise bias in the reporting of the findings of this trial, which evaluates the investigational medicinal product GKT137831. The results of the trial are expected to be published in 2022.Trial Registration: ANZCTR registry: ACTRN12617001187336. Registered on 14 July 2017. Universal Trial Number: U1111-1187-2609; Protocol number: T1DGKT137831; Genkyotex trial number: GSN000241. [ABSTRACT FROM AUTHOR]

Automatic lidars and ceilometers provide valuable information on cloud and aerosols, but have not been used systematically in the evaluation of GCMs and NWP models. Obstacles associated with the diversity of instruments, a lack of standardisation of data products and open processing tools mean that the value of the large ALC networks worldwide is not being realised. We discuss a tool, called the Automatic Lidar and Ceilometer Framework (ALCF), that overcomes these problems and also includes a ground-based lidar simulator, which calculates the radiative transfer of laser radiation, and allows one-to-one comparison with models. Our ground-based lidar simulator is based on the Cloud Feedback Model Intercomparison Project (CFMIP) Observation Simulator Package (COSP) which has been used extensively for spaceborne lidar intercomparisons. The ALCF implements all steps needed to transform and calibrate raw ALC data and create simulated backscatter profiles for one-to-one comparison and complete statistical analysis of cloud. The framework supports multiple common commercial ALCs (Vaisala CL31, CL51, Lufft CHM 15k and Sigma Space MiniMPL), reanalyses (JRA-55, ERA5 and MERRA-2) and models (AMPS and the Unified Model). To demonstrate its capabilities, we present case studies evaluating cloud in the supported reanalyses and models using CL31, CL51, CHM 15k and MiniMPL observations at three sites in New Zealand. We show that the reanalyses and models generally underestimate cloud fraction and overestimate cloud albedo, the common too few too bright problem. If sufficiently high temporal resolution model output is available (better than 6 hourly), a direct comparison of individual clouds is also possible. We demonstrate that the ALCF can be used as a generic evaluation tool to examine cloud occurrence and cloud properties in reanalyses, NWP models and GCMs, potentially utilising the large amounts of ALC data already available. This tool is likely to be particularly useful for the analysis and improvement of low-level cloud simulations which are not well monitored from space. This has previously been identified as a critical deficiency in contemporary models, limiting the accuracy of weather forecasts and future climate projections. [ABSTRACT FROM AUTHOR]

To understand facilitators and barriers to engagement in a multidisciplinary assessment and intervention program for children and adolescents with obesity, particularly for Māori, the Indigenous people of New Zealand. Whānau Pakari participants and caregivers (n = 71, 21% response rate) referred to the family-based healthy lifestyles program in Taranaki, New Zealand, were asked to participate in a confidential survey, which collected self-reported attendance levels and agreement with statements around service accessibility and appropriateness and open-text comments identifying barriers and facilitators to attendance. Self-reported attendance levels were higher when respondents reported sessions to be conveniently located (P =.03) and lower when respondents considered other priorities as more important for their family (P =.02). Māori more frequently reported that past experiences of health care influenced their decision to attend (P =.03). Facilitators included perceived convenience of the program, parental motivation to improve child health, and ongoing support from the program. Program convenience and parental and/or self-motivation to improve health were facilitators of attendance. Further research is required to understand the relationship between past experiences with health care and subsequent engagement with services. [ABSTRACT FROM AUTHOR]

The prolonged existence of COVID-19 will provide national statistical offices with the greatest challenges that they might ever expect. The paper foreshadows the range of influences on the planning of official statistical offices and international organisations. The paper draws on experiences in New Zealand and focuses on aspects which have general applicability in other countries. This paper was finalised on April 25, 2020, and some examples cited will not be relevant given the dynamic situations in most countries, and how knowledge about COVID-19 evolves. The central thrust of the paper is that national statistical offices need to be thinking now about the huge medium- and long-term influences that will shape what they need to do. The screening and surveillance options available need to be relevant for each stage of easing of restrictions initiated to prevent contact. Teams which bring together all the relevant scientific expertise are needed to assess testing strategies at each step. The methodological, technological, and operational challenges will require high levels of public trust in the gathering of information, and confidence in the resulting statistics. This paper provides views on what those challenges might be, at this early stage of living with COVID-19. The fiscal pressures placed on governments will not only make existing programmes vulnerable but may prevent initiatives that might now be critical. [ABSTRACT FROM AUTHOR]

Aim: In New Zealand, there are few adequate food frequency questionnaires for assessing dietary intake. This study aimed to develop and assess the relative validity of a multi‐nutrient, culturally appropriate, semi‐quantitative food frequency questionnaire for use in young adult New Zealand women (the New Zealand Women's Food Frequency Questionnaire (NZWFFQ)). Methods: Women (n = 110) aged 16–45 years of Māori, Pacific or European ethnicity completed a NZWFFQ assessing dietary intake over the previous month, and a 4‐day weighed food record. Relative validity was evaluated by comparing nutrient intakes from the NZWFFQ with the food record using Spearman's rank correlation coefficients, cross‐classification, the weighted kappa statistic and Bland–Altman analysis. Results: Nutrient intake was higher from the NZWFFQ compared with the food record for all nutrients (range: 1%–64% difference) except alcohol (−16% difference). Energy‐adjusted correlations ranged from 0.23 to 0.67 (average 0.48). Correct classification into same and adjacent quartiles was over 70% for all nutrients except folate and vitamin D. Gross misclassification into opposite quartiles ranged from 1% (monounsaturated fat, magnesium, calcium) to 10% (iron). The weighted kappa showed poor agreement for vitamin D and folate, fair agreement for most nutrients, and moderate agreement for fibre, vitamin E, magnesium, calcium and phosphorus. Conclusions: The NZWFFQ overestimated intake of nearly all nutrients. While not suitable for assessing absolute intake, the NZWFFQ is suitable for ranking individuals based on nutrient intake demonstrating reasonable relative validity for this purpose. [ABSTRACT FROM AUTHOR]

Background: Chronic full-thickness rotator cuff tears (FTRCTs) represent a major clinical concern because they show highly compromised healing capacity. Purpose: To evaluate the efficacy of using a 3-dimensional (3D) bioprinted scaffold with human umbilical cord blood (hUCB)–mesenchymal stem cells (MSCs) for regeneration of chronic FTRCTs in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 32 rabbits were randomly assigned to 4 treatment groups (n = 8 per group) at 6 weeks after a 5-mm FTRCT was created on the supraspinatus tendon. Group 1 (G1-SAL) was transplanted with normal saline. Group 2 (G2-MSC) was transplanted with hUCB-MSCs (0.2 mL, 1 × 106) into FTRCTs. Group 3 (G3-3D) was transplanted with a 3D bioprinted construct without MSCs, and group 4 (G4-3D+MSC) was transplanted with a 3D bioprinted construct containing hUCB-MSCs (0.2 mL, 1 × 106 cells) into FTRCTs. All 32 rabbits were euthanized at 4 weeks after treatment. Examination of gross morphologic changes and histologic results was performed on all rabbits after sacrifice. Motion analysis was also performed before and after treatment. Results: In G4-3D+MSC, newly regenerated collagen type 1 fibers, walking distance, fast walking time, and mean walking speed were greater than those in G2-MSC based on histochemical and motion analyses. In addition, when compared with G3-3D, G4-3D+MSC showed more prominent regenerated tendon fibers and better parameters of motion analysis. However, there was no significant difference in gross tear size among G2-MSC, G3-3D, and G4-3D+MSC, although these groups showed significant decreases in tear size as compared with the control group (G1-SAL). Conclusion: Findings of this study show that a tissue engineering strategy based on a 3D bioprinted scaffold filled with hUCB-MSCs can improve the microenvironment for regenerative processes of FTRCT without any surgical repair. Clinical Relevance: In the case of rotator cuff tear, the cell loss of the external MSCs can be increased by exposure to synovial fluid. Therefore, a 3D bioprinted scaffold in combination with MSCs without surgical repair may be effective in increasing cell retention in FTRCT. [ABSTRACT FROM AUTHOR]

Background: Microfracture or bone marrow stimulation (BMS) is often the first choice for clinical treatment of cartilage injuries; however, fibrocartilage, not pure hyaline cartilage, has been reported because of the development of fibrosis in the repair tissue. Transforming growth factor β1 (TGF-β1), which can promote fibrosis, can be inhibited by losartan and potentially be used to reduce fibrocartilage. Hypothesis: Blocking TGF-β1 would improve cartilage healing in a rabbit knee BMS model via decreasing the amount of fibrocartilage and increasing hyaline-like cartilage formation. Study Design: Controlled laboratory study. Methods: An osteochondral defect was made in the patellar groove of 48 New Zealand White rabbits. The rabbits were divided into 3 groups: a defect group (defect only), a BMS group (osteochondral defect + BMS), and a BMS + losartan group (osteochondral defect + BMS + losartan). For the rabbits in the BMS + losartan group, losartan was administrated orally from the day after surgery through the day of euthanasia. Rabbits were sacrificed 6 or 12 weeks postoperatively. Macroscopic appearance, microcomputed tomography, histological assessment, and TGF-β1 signaling pathway were evaluated at 6 and 12 weeks postoperatively. Results: The macroscopic assessment of the repair revealed that the BMS + losartan group was superior to the other groups tested. Microcomputed tomography showed superior healing of the bony defect in the BMS + losartan group in comparison with the other groups. Histologically, fibrosis in the repair tissue of the BMS + losartan group was significantly reduced when compared with the other groups. Results obtained with the modified O'Driscoll International Cartilage Repair Society grading system yielded significantly superior scores in the BMS + losartan group as compared with both the defect group and the BMS group (F value: 15.8, P <.001, P =.012, respectively). TGF-β1 signaling and TGF-β-activated kinase 1 of the BMS + losartan group were significantly suppressed in the synovial tissues. Conclusion: By blocking TGF-β1 with losartan, the repair cartilage tissue after BMS was superior to the other groups and consisted primarily of hyaline cartilage. These results should be easily translated to the clinic because losartan is a Food and Drug Administration–approved drug and it can be combined with the BMS technique for optimal repair of chondral defects. Clinical Relevance: Biologically regulated marrow stimulation by blocking TGF-β1 (oral intake of losartan) provides superior repair via decreasing fibrocartilage formation and resulting in hyaline-like cartilage as compared with outcomes from BMS only. [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: Tracheostomy management is considered an area of advanced practice for speech–language therapists (SLTs) internationally. Infrequent exposure and limited access to specialist SLTs are barriers to competency development. Aims: To evaluate the benefits of postgraduate tracheostomy education programme for SLTs working with children and adults. Methods & Procedures: A total of 35 SLTs participated in the programme, which included a 1‐day tracheostomy simulation‐based workshop. Before the workshop, SLTs took an online knowledge quiz and then completed a theory package. The workshop consisted of part‐task skill learning and simulated scenarios. Scenarios were video recorded for delayed independent appraisal of participant performance. Manual skills were judged as (1) completed successfully, (2) completed inadequately/needed assistance or (3) lost opportunity. Core non‐medical skills required when managing a crisis situation and overall performance were scored using an adapted Ottawa Global Rating Scale (GRS). Feedback from participants was collected and self‐perceived confidence rated prior, immediately post and 4 months post‐workshop. Outcomes & Results: SLTs successfully performed 94% of manual tasks. Most SLTs (29 of 35) scored > 5 of 7 on all elements of the adapted Ottawa GRS. Workshop feedback was positive with significant increases in confidence ratings post‐workshop and maintained at 4 months. Conclusions & Implications: Postgraduate tracheostomy education, using a flipped‐classroom approach and low‐ and high‐fidelity simulation, is an effective way to increase knowledge, confidence and manual skill performance in SLTs across patient populations. Simulation is a well‐received method of learning. [ABSTRACT FROM AUTHOR]

Background: The patellar tendon is often considered the "gold standard" graft for reducing the risk of graft rupture after anterior cruciate ligament (ACL) reconstruction. However, its use may also be associated with an increased risk of injury to the contralateral ACL. Purpose: To clarify the association between graft choice and the risk of revision and contralateral ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Prospective data captured by the New Zealand ACL Registry between April 2014 and December 2018 were reviewed. All primary ACL reconstructions performed using either a hamstring tendon or patellar tendon autograft were included. Cox regression survival analysis adjusting for patient factors was performed to compare the risk of revision and contralateral ACL reconstruction between the hamstring tendon graft and the patellar tendon graft. Results: A total of 7155 primary ACL reconstructions were reviewed, of which 5563 (77.7%) were performed using a hamstring tendon graft and 1592 (22.3%) were performed using a patellar tendon graft. Patients with a hamstring tendon graft had a revision rate of 2.7% compared with 1.3% in patients with a patellar tendon graft (adjusted hazard ratio [HR], 2.51; 95% CI, 1.55-4.06; P <.001). The patellar tendon graft was associated with an increased risk of contralateral ACL reconstruction compared with the hamstring tendon graft (adjusted HR, 1.91; 95% CI, 1.15-3.16; P =.012). The number needed to treat (NNT) with a patellar tendon graft to prevent 1 revision was 73.6. However, the NNT with a hamstring tendon graft to prevent 1 contralateral reconstruction was 116.3. Conclusion: Use of a patellar tendon graft reduced the risk of graft rupture but was associated with an increased risk of injury to the contralateral ACL. Adequate rehabilitation and informed decision making on return to activity and injury prevention measures may be important in preventing subsequent injury to the healthy knee. [ABSTRACT FROM AUTHOR]

Introduction: The Australia New Zealand Trauma Registry enables the collection and analysis of standardised data about trauma patients and their care for quality improvement, injury prevention and benchmarking. Little is known, however, about the needs of providers and clinicians in relation to these data, or their views on trauma quality improvement priorities. As clinical experts, trauma clinicians should have input to these as ultimately their practice may be influenced by report findings. This paper presents the perspectives of multidisciplinary trauma care professionals in Australia and New Zealand about the use of the Australia New Zealand Trauma Registry data and trauma quality improvement priorities.Methods: An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted using the Snowballing Method between September 2018 and February 2019. Participants were recruited via a non-random sampling technique to complete an online survey. Descriptive statistical and content analyses were conducted.Results: The data use priorities identified by 102 trauma professionals from a range of locations participated were clinical improvement and system/process improvement (86.3%). Participants reported that access to trauma data should primarily be for clinicians (93.1%) and researchers (87.3%). Having a standardised approach to review trauma cases across hospitals was a priority in trauma quality improvement.Conclusion: Trauma registry data are under-utilised and their use to drive clinical improvement and system/process improvement is fundamental to trauma quality improvement in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Primary care physicians in the US, like their colleagues in several other high-income countries, are increasingly tasked with coordinating services delivered not just by specialists and hospitals but also by home care professionals and social service agencies. To inform efforts to improve care coordination, the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians queried primary care physicians in eleven high-income countries about their ability to coordinate patients' medical care with specialists, across settings of care, and with social service providers. Compared to physicians in other countries, substantial proportions of US physicians did not routinely receive timely notification or the information needed for managing ongoing care from specialists, after-hours care centers, emergency departments, or hospitals. Primary care practices in a handful of countries, including the US, are not routinely exchanging information electronically outside the practice. Top-performing countries demonstrate the feasibility of improving two-way communication between primary care and other sites of care. The surveyed countries share the challenge of coordinating with social service providers, and the results call for solutions to support primary care physicians. [ABSTRACT FROM AUTHOR]

A lucky chance encounter for statistical science in NZ. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates whether an acute bout of whole body vibration (WBV): (i) improves measures of central hemodynamics and (ii) can be completed without inducing orthostatic intolerance in frail older adults. Methods: Nine rest home residents participated in a cross-over design incorporating WBV and non-vibrational control conditions (CON) on 2 separate testing days. The order of the two testing conditions was randomized. Participants completed 10 sets of 60 seconds of WBV training or CON with an inter-set rest period of 60 seconds. Results: During training, no interaction or between-condition effects were observed for any variable. Following training, there was an interaction effect reported for augmentation index (AIx) (P < 0.019) and a significant large increase in AIx for WBV (P = 0.020, Eta = 0.202). Three participants exhibited one-off notable decreases in either central systolic or diastolic blood pressure. Conclusion: An acute bout of WBV is a safe training method for frail older adults. [ABSTRACT FROM AUTHOR]

This study explored the viability of preventive treatment services for individuals with sexual interest in children, in jurisdictions without mandatory reporting but where risk-related disclosures to authorities are permitted at therapists' discretion. Health professionals (N = 112) were surveyed regarding their comfort, confidence, knowledge of relevant legal provisions, and personal disclosure thresholds, in relation to a hypothetical scenario of a client confiding pedophilic interest to seek help. Findings were mixed regarding implications for prevention service viability. Despite the complexities of the legal and ethical context of the study setting (New Zealand), predictions regarding professionals' uncertainty in relation to their legal and ethical duties, and displaying a bias toward disclosing information to authorities when permitted, were not fully borne out, although pervasive knowledge inaccuracies and associated training needs were revealed. Instead, general tendencies among respondents were toward comfort, confidence, and the inclination toward maintaining client confidentiality. Yet, widespread variance within the sample, and individuals' thresholds appearing rather unpredictable on the basis of demographic or professional variables, highlights likely barriers for potential clients in feeling safe enough to come forward. Given that preventive treatment viability in this context relies on self-referral, it is suggested that a purpose-designed preventive treatment service, with clear accessible confidentiality and reporting policies that are well within the law, could be the best way forward for viable preventive treatment in discretionary reporting contexts. [ABSTRACT FROM AUTHOR]

Fatigue resulting from shift work and extended hours can compromise patient care and the safety and health of nurses, as well as increasing nursing turnover and health care costs. This research aimed to identify aspects of nurses' work patterns associated with increased risk of reporting fatigue-related outcomes. A national survey of work patterns and fatigue-related outcomes in 6 practice areas expected to have high fatigue risk (child health including neonatology, cardiac care/intensive care, emergency and trauma, in-patient mental health, medical, and surgical nursing). The 5-page online questionnaire included questions addressing: demographics, usual work patterns, work in the previous two weeks, choice about shifts, and four fatigue-related outcomes – having a sleep problem for at least 6 months, sleepiness (Epworth Sleepiness Scale), recalling a fatigue-related error in clinical practice in the last 6 months, and feeling close to falling asleep at the wheel in the last 12 months. The target population was all registered and enrolled nurses employed to work in public hospitals at least 30 h/week in one of the 6 practice areas. Participation was voluntary and anonymous. Respondents (n = 3133) were 89.8% women and 8% Māori (indigenous New Zealanders), median age 40 years, range 21–71 years (response rate 42.6%). Nurses were more likely than New Zealand adults in general to report chronic sleep problems (37.73% vs 25.09%, p < 0.0001) and excessive sleepiness (33.75% vs 14.9%, p < 0.0001). Fatigue-related error(s) in the last 6 months were recalled by 30.80% and 64.50% reported having felt sleepy at the wheel in the last 12 months. Logistic regression analyses indicated that fatigue-related outcomes were most consistently associated with shift timing and sleep. Risk increased with more night shifts and decreased with more nights with sleep between 11 p.m. and 7 a.m. and on which nurses had enough sleep to feel fully rested. Risk also increased with roster changes and more shift extensions greater than 30 min and decreased with more choice about shifts. Comparisons between intensive care/cardiac care and in-patient mental health nursing highlight that fatigue has different causes and consequences in different practice areas. Findings confirm the need for a more comprehensive and adaptable approach to managing fatigue. We advocate an approach that integrates safety management and scientific principles with nursing and management expertise. It should be data-driven, risk-focused, adaptable, and resilient in the face of changes in the services required, the resources available, and the overall goals of the healthcare system. [ABSTRACT FROM AUTHOR]

Several treatment approaches are available for adults who stutter, including speech treatment, cognitive behaviour therapy (CBT) treatment for anxiety, and a combination of both. It is useful to determine whether any differences exist between adults who stutter enrolled in different types of treatment. Therefore, the purpose of this study was to compare demographic, speech, and psychological characteristics of adults who stutter enrolled in speech, psychological, and combined treatment programs. Participants were 288 adults who stuttered (18–80 years) enrolled in one of three different treatment programs: Speech Treatment for stuttering (n = 134), Anxiety Treatment for anxiety about stuttering (n = 70), or Speech Treatment for Stuttering With or Without Anxiety Treatment (n = 84). Participants completed a range of demographic, speech, and psychological measures prior to the start of treatment. A significantly higher proportion of participants in the Anxiety Treatment group were in a personal relationship than the other treatment groups. The Anxiety Treatment group had higher average age than the other treatment groups. The Speech Treatment group also demonstrated significantly higher self-rated stuttering severity than the Anxiety Treatment group, even though there were no significant difference between groups for clinician-rated percentage of syllables stuttered. Although most characteristics of adults who stuttered did not vary by treatment type, the present findings suggest that adults who stutter enrolled in speech treatment perceived their stuttering as more severe, which may have prompted treatment seeking. Further research is needed regarding the supportive influence of personal relationship for those with the disorder. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate whether a web-based exercise programming system improves adherence to a home exercise program for people with musculoskeletal conditions. Design : Eligible patients with a musculoskeletal condition presenting to a physical therapist in private practice were randomized to the following: (a) control (home exercise prescribed by therapist's usual methods) or (b) intervention (home exercise prescribed using a web-based exercise programming system). The primary outcome was self-rated exercise adherence measured at week 3 via 11-point Numeric Rating Scales. Secondary outcomes were satisfaction with exercise delivery and confidence in ability to undertake prescribed exercise. Process measures were also included. Results : We enrolled 305 participants, with loss to follow-up of 14.5% (22/152) and 13.7% (21/153) in intervention and control groups, respectively. Compared with controls, the intervention group reported higher exercise adherence (mean difference Numeric Rating Scale units (95% confidence intervals): adherence overall -1.0 [-1.6 to -0.3] and regarding number of exercises in session -0.7 [-1.3 to -0.1], number of repetitions -0.8 [-1.4 to -0.2], and number of sessions -1.0 [-1.6 to -0.3]). The intervention group showed greater confidence to exercise than control, with no difference in satisfaction. Conclusions: A web-based exercise programming system improved home exercise adherence and confidence in ability to undertake exercise, although the clinical relevance of the results needs to be established. [ABSTRACT FROM AUTHOR]

Introduction: Measuring the diameter of the inferior vena cava (IVC) or the height of the jugular venous pressure (JVP) with point-of-care ultrasound (POCUS) is a practical alternative method for estimating a patient's intravascular volume in the rural setting. This study aims to determine whether or not POCUS of the IVC or JVP generates additional useful clinical information over and above routine physical examination in this context. Methods: Twenty generalist physicians, working in five New Zealand rural hospitals, recorded their estimation of a patient's intravascular volume based on physical examination and then again after performing POCUS of the IVC or JVP, using a visual scale from 1 to 11. Results: Data were available for 150 assessments. There was an only moderate agreement between the pre- and post-test findings (Spearman's correlation coefficient = 0.46). In 28% (42/150) of cases, the difference was four or more points on the scale, and therefore, had the potential to be clinically significant. Conclusion: In the rural context, POCUS provides new information that frequently alters the clinician's estimation of a patient's intravascular volume. [ABSTRACT FROM AUTHOR]

Background: The number of vaginal breech and twin deliveries may be insufficient for adequate training. Objective: To determine whether advanced trainees and new Fellows in obstetrics are gaining adequate experience and confidence in vaginal breech and twin deliveries. Methods: An online survey was emailed to registered Royal Australia and New Zealand College of Obstetrics and Gynaecology (RANZCOG) advanced trainees and new Fellows (Years 1–5). This survey asked about their experience, confidence and whether they intend to perform vaginal breech and twin deliveries as specialists. Results: The survey was sent to 703 advanced trainees (162) and Fellows (541) and answered by 217 (31.7%). Experience and confidence in vaginal breech and twin deliveries increased with the number of procedures performed (P < 0.001) in both groups and were significantly higher among Fellows. Despite the level of experience, 100% of respondents felt confident in managing vaginal twin deliveries with or without supervision, whereas 14.9% of respondents did not feel confident in managing vaginal breech deliveries. Intention to offer these procedures in their practice depended on confidence levels, and there was a significant difference between twins and breech. Overall, 87.3% of respondents intended to offer vaginal twin deliveries in their practice, while only 32.7% intended to offer vaginal breech deliveries. Conclusion: Confidence in complex vaginal deliveries increases with increasing number of procedures performed and a significant proportion of trainees and Fellows consider they do not have sufficient experience. The association between confidence and intention to offer these procedures is stronger in twins than in breech deliveries. [ABSTRACT FROM AUTHOR]

Aims This exploratory study aims to model the impact of sex and age on the percentage of pre-drinking in 27 countries, presenting a single model of pre-drinking behaviour for all countries and then comparing the role of sex and age on pre-drinking behaviour between countries. Methods Using data from the Global Drug Survey, the percentages of pre-drinkers were estimated for 27 countries from 64,485 respondents. Bivariate and multivariate multilevel models were used to investigate and compare the percentage of pre-drinking by sex (male and female) and age (16–35 years) between countries. Results The estimated percentage of pre-drinkers per country ranged from 17.8% (Greece) to 85.6% (Ireland). The influence of sex and age on pre-drinking showed large variation between the 27 countries. With the exception of Canada and Denmark, higher percentages of males engaged in pre-drinking compared to females, at all ages. While we noted a decline in pre-drinking probability among respondents in all countries after 21 years of age, after the age of 30 this probability remained constant in some countries, or even increased in Brazil, Canada, England, Ireland, New Zealand and the United States. Conclusions Pre-drinking is a worldwide phenomenon, but varies substantially by sex and age between countries. These variations suggest that policy-makers would benefit from increased understanding of the particularities of pre-drinking in their own country to efficiently target harmful pre-drinking behaviours. [ABSTRACT FROM AUTHOR]

Rasch analysis was conducted to enhance the precision of the widely used 10-item Perceived Stress Scale using two datasets (n = 450 each) randomly selected from samples of the New Zealand general population (n = 1102), New Zealand university students (n = 479) and US university students (n = 396). The best Rasch model fit (χ 2(27) = 29.92, p =.36), good person separation reliability (.80) and coverage (98%) of the sample by the scale items were achieved when locally dependent items were combined into subtests. These findings support reliability and internal structural validity of the 10-item Perceived Stress Scale. The instrument precision can be further improved using the ordinal-to-linear conversion tables published here. [ABSTRACT FROM AUTHOR]

Aims This exploratory study aims to model the impact of sex and age on the percentage of pre-drinking in 27 countries, presenting a single model of pre-drinking behaviour for all countries and then comparing the role of sex and age on pre-drinking behaviour between countries. Methods Using data from the Global Drug Survey, the percentages of pre-drinkers were estimated for 27 countries from 64,485 respondents. Bivariate and multivariate multilevel models were used to investigate and compare the percentage of pre-drinking by sex (male and female) and age (16–35 years) between countries. Results The estimated percentage of pre-drinkers per country ranged from 17.8% (Greece) to 85.6% (Ireland). The influence of sex and age on pre-drinking showed large variation between the 27 countries. With the exception of Canada and Denmark, higher percentages of males engaged in pre-drinking compared to females, at all ages. While we noted a decline in pre-drinking probability among respondents in all countries after 21 years of age, after the age of 30 this probability remained constant in some countries, or even increased in Brazil, Canada, England, Ireland, New Zealand and the United States. Conclusions Pre-drinking is a worldwide phenomenon, but varies substantially by sex and age between countries. These variations suggest that policy-makers would benefit from increased understanding of the particularities of pre-drinking in their own country to efficiently target harmful pre-drinking behaviours. [ABSTRACT FROM AUTHOR]

Background: DriveSafe measures awareness of the driving environment. It is one subtest of DriveSafe DriveAware, a cognitive fitness‐to‐drive screening instrument. We converted DriveSafe to a touchscreen format for ease of administration; this necessitated the development of an automatic data collection and scoring system to reflect the decision that would otherwise have been made by an expert rater. We applied a structured process to determine what constituted 'correct' scores. We then examined the resulting scoring parameters to determine if these discriminated at‐risk drivers from a comparison sample. Methods: Thirty at‐risk older drivers and 30 younger drivers took touchscreen DriveSafe. Following presentation of images containing between one and four objects/hazards for 4 seconds, participants indicated their recall of object/hazard characteristics (type, location and direction of movement) by touching the screen. We analysed responses via descriptive statistics to compare spread, accuracy and consistency; and via a Fisher's exact test to determine whether the set scoring parameters could discriminate between at‐risk and comparison drivers. Results: Fisher's exact test results indicated 24 of 28 location zones and 18 of 28 direction ranges discriminated at‐risk drivers from the comparison group (P < 0.05). Frequency of missed or incorrectly identified hazards was much higher for the at‐risk group for all variables. At‐risk drivers missed or misidentified significantly (P < 0.00) more object types (34%), directions (47%), and locations (36%) than the comparison group (≤4% for each variable). At‐risk drivers entered 31 additional responses for objects/hazards not displayed; the comparison group entered no additional responses. Conclusion: The automatic variable data collection and scoring system reflected decisions that would have been made by an expert rater. This systematic process provided automated scoring decisions that enabled us to discriminate at‐risk drivers from a comparison group. Psychometric evaluation of data gathered with touchscreen DriveSafe is required prior to use in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Germline BRCA1/2 mutations account for approximately 15% of invasive ovarian carcinomas. Referral of all women with non‐mucinous epithelial tubo‐ovarian and peritoneal cancer, especially high‐grade serous carcinoma (HGSC) to genetic services for genetic counselling and subsequent BRCA testing, has become standard of care in many countries. Publicly funded BRCA testing was restricted to women ≤70 years old with HGSC in New Zealand for most of our study period. Referral rates of women with HGSC for BRCA mutation testing in New Zealand have not previously been reported. Aims: To determine the proportion of eligible patients with tubo‐ovarian or peritoneal HGSC referred to Auckland Gynaecologic Oncology Centre who were referred for genetic counselling. To determine the number of patients who underwent BRCA1/2 genetic testing and the rate of germline BRCA mutations. Methods: Eligible cases were identified from Auckland Gynaecologic Oncology multidisciplinary meetings database from 1 January 2012 to 31 December 2014. Genetic referrals sent were checked against the genetic services database to ensure that referrals were received. Genetic counselling clinic attendance, uptake and results of genetic testing were also collected. Results: One hundred and four eligible patients were identified with 58 patients referred. Referral rates increased from 37.5% in 2012 to 64.3% in 2014. Of the 58 patients referred, 53 attended genetic counselling, and 49 underwent BRCA mutation testing, of whom 10 (20.4%) tested positive for a germline BRCA mutation. Conclusion: Overall, 55.8% of eligible patients were referred for genetic testing; however, referral rates increased with time. This BRCA mutation‐positive rate is comparable with current international data. [ABSTRACT FROM AUTHOR]

Aim: Total gastrectomy and Ivor Lewis oesophagectomy procedures are the mainstay of upper gastrointestinal cancer management. Maintenance of adequate nutritional intake is essential for positive patient outcomes. Although numerous nutritional support options exist, clear evidence‐based guidelines on the optimal means and duration of nutritional support are lacking. The aim of this study is to establish preliminary data on the current perioperative nutritional practices of upper gastrointestinal surgeons performing these procedures across Australia and New Zealand. It is hoped this will help provide the platform for future research towards establishing evidence‐based guidelines in upper gastrointestinal surgery. Methods: A questionnaire exploring the nutritional practices and considerations of surgeons was developed and emailed to the members of the Australia & New Zealand Gastric & Oesophageal Surgery Association. Results: A total of 27.4% of Australia & New Zealand Gastric & Oesophageal Surgery Association members completed the questionnaire. Surgeons reported inserting a jejunostomy feeding tube intraoperatively in Ivor Lewis oesophagectomy procedures 80–100% of the time, compared to only 20–39% of the time in total gastrectomy procedures. For both procedures, surgeons often refer their patients to a dietitian preoperatively, and always postoperatively. Preoperative immune‐enhancing nutrition is rarely administered. Patient age and BMI are deemed to be of low importance when determining the means of nutritional support. Conclusions: This study has demonstrated the current nutritional practices employed in Australia and New Zealand for patients undergoing major upper gastrointestinal surgery. Questions remain regarding the noted differences between procedures as well as the optimal means and duration of perioperative nutritional support. [ABSTRACT FROM AUTHOR]

Greater rates of genetic gain can be achieved by selecting animals born to younger parents. However, little is known about the lifetime performance of dual purpose ewes (Ovis aries) that are born to primiparous ewe lambs (8 to 9 months old at breeding). This experiment investigated the effect of being born from either a ewe lamb or mixed age dam as either a single or twin on the lifetime performance of ewe progeny. Lifetime performance was measured in terms of the life time live weights of the ewes, the weight and number of lambs born and weaned, the efficiency of production (kilograms of lamb weaned / predicted pasture intake (kgDM) of the ewes), and ewe survival. The study followed the lifetime production of 17 single and 41 twin female lambs born to mature ewes (M1 and M2, respectively), and 28 single and 29 twin lambs born to ewe lambs (L1 and L2, respectively). Over their lifetime L2 ewes were lighter (P<0.05) but had similar body condition scores to the other three ewe groups. There was no difference in average progeny weaning weight or total progeny litter weaning weights between groups. The M1 ewes had the greatest longevity (P<0.05) of the four groups. Even though L2 ewes were lighter than the other three groups, this was insufficient to increase their lifetime efficiency of production (kg lamb weaned/predicted pasture consumption), relative to the other groups. These results suggest farmers could select replacements born to ewe lambs without sacrificing animal production. [ABSTRACT FROM AUTHOR]

How computers in schools impact on children's learning has been studied through research that explores student achievement at one point in time or by comparing different classroom contexts with differing results. The introduction of an optional netbook purchasing scheme for children in a low socio‐economic community provided an opportunity to compare the academic improvement for those who joined the scheme with those who did not with both groups learning within the same context with the same teachers. Using nationally calibrated assessment tools that test reading, writing, and mathematical skill progression, the student achievement data from six schools across a 2‐year period were analysed using chi‐square testing, regression analysis, propensity score matching, and cumulative logit modelling. The results identified few significant differences between the students in most aspects of achievement and no significant difference in academic improvement between the two groups. Lay Description: What is currently known about the subject matter: Whole class use of netbooks can improve achievement in reading, writing and mathematics.Children in low socio‐economic contexts have limited access to the Internet or netbooks for learning. What this paper adds to this: The use of netbooks alone has an insignificant effect on achievement in standardized assessments.Academic progress of children in the same context is similar whether using netbooks or not. Implication of study findings for practitioners: Introduction of netbook schemes should enable all students to have dedicated access. [ABSTRACT FROM AUTHOR]

Aim: Fruit and vegetables are strongly promoted because of the nutrients they provide; many processed products contain added sugar and sodium. The present study aims to quantify the sugar and sodium content of pre‐packaged fruit and vegetable‐based products that are available in New Zealand supermarkets. Methods: Nutrition Information Panel data were collected from non‐frozen, processed fruit and vegetable products in New Zealand supermarkets (including soups, sauces, jams and spreads, pickles, chutneys and dips, and canned/bottled fruit and vegetables) where fruit and/or vegetables were the majority ingredient(s). Results: With the exception of canned/bottled vegetables, more than 60% of products contained added sugar. Per serve, the median sugar content was highest in canned/bottled fruit (17.8 g). More than 75% of soups, vegetable‐based sauces, pickles/chutneys and canned/bottled vegetables contained added sodium, with soups (722 mg) recording the highest median values per serve. Conclusions: Consumers need to be aware that although they are encouraged to eat a diet high in fruit and vegetables, there may be large quantities of added sugar and sodium in manufactured fruit and vegetable products that can have significant negative impacts on their health. Government health promotion campaigns encouraging the consumption of fruit and vegetables should be careful to target fresh, frozen and home‐prepared foods, and work on educating the public about the lower nutritional quality associated with most processed fruit and vegetable products. [ABSTRACT FROM AUTHOR]

Abstract Aims Triple-negative breast cancer (TNBC) has inferior outcomes to other subtypes of breast cancer. We studied the demographics and baseline breast cancer characteristics of patients in New Zealand with TNBC and assessed survival outcomes and prognostic/predictive factors. Materials and methods We searched the New Zealand breast cancer registry database and identified patients with TNBC without distant metastatic disease. We retrieved demographic, tumour characteristic and treatment information. Locoregional recurrence-free survival, breast cancer-specific survival (BSS), metastasis-free survival (MRFS) and overall survival were determined. Predefined univariate and multivariate analyses were carried out investigating the association of survival outcomes with treatment and tumour characteristics. Results In total, 1390 patients were identified, with a median follow-up of 3.5 years. The median age was 55 years. Thirty-eight per cent were node positive and 79% were grade III. Mastectomy was carried out in 53%, adjuvant radiation delivered in 66% and chemotherapy in 69%. The significant predictive factors for overall survival, BSS and MRFS were radiotherapy, chemotherapy and neoadjuvant chemotherapy. The significant prognostic indicators were lymphovascular invasion, nodal status and tumour size. On Kaplan–Meier analysis, the 5 year overall survival was 72%. The median time to death for those who died was 3.55 years with 92% of deaths within 5 years. Seventy-four per cent of patients had distant metastasis as a first recurrence and isolated local recurrences occurred in only 4.5%. Metastatic disease occurred in lung (55.9%) and was in multiple sites in 51%. Conclusion We report a large population-based series of TBNC without distant metastatic disease at diagnosis highlighting the unique behavioural characteristics of TNBC. Traditional therapies are positively associated with survival outcomes, and yet, particularly in the setting of recurrent disease, prognosis remains poor. Increased research into more effective systemic agents and the most effective timing of delivery of these may result in improved outcomes. Highlights • Triple-negative breast cancer (TNBC) has unique tumour characteristics and outcomes. • 5 year overall survival is 72%, inferior to other subtypes of breast cancer. • Metastatic disease was common and associated with an aggressive course. • Effective use of current chemotherapy agents may improve outcomes. • Specific trials (with molecular guidance) are required for TNBC. [ABSTRACT FROM AUTHOR]