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Indigenous academics are often faced with a balancing act between the danger and risk of critiquing the institutions within which they reside, and the duty or obligation they feel to do so. As Indigenous Maori academics located within three different business schools across Aotearoa New Zealand, our work in both research and teaching is often highly critical of the institution, which can leave us exposed, vulnerable and grasping to hold onto a fragile sense of identity in the academy. We use the conceptual framework of parrhesia as a critical response to the institutional landscape of business schools and higher education in general. Parrhesia can be described as free speech directly critiquing hegemonic norms and practices. In this article, we share our experiences as episodes of parrhesia, as voice and action derived from our Indigenous worldview, to illustrate the utility of Indigenous parrhesiastes. Finally, we suggest that parrhesia offers us as Indigenous academics mode and mechanism with which we can challenge institutional power structures in different ways to effect change through the advance of safe and purposeful inclusion of Indigenous epistemologies, identities and pedagogies in the academy.

Despite increased attention being given to Indigenous rights, decolonization, and reconciliation in a broader business setting, the engagement of business, marketing, and consumer studies with Indigenous cultures and peoples is negligible. Although Indigenous and First Nations peoples have a significant position in the social sciences, there is no specific body of marketing or consumer knowledge that is dedicated to Indigenous knowledge and practices, even though there is a growing interest in more inclusive and transformative marketing. This paper reports on current research on Indigenous worldviews and marketing, with a continuum of Indigenous research being presented which is particularly informed by Māori experiences in Aotearoa New Zealand. Several appropriate research methods for advancing Indigenous knowledge are presented. The paper concludes by noting the potential contributions that Indigenous knowledge may provide and some of the challenges faced. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to identify the rate and risk factors for a reoperation for arthrofibrosis following primary anterior cruciate ligament (ACL) reconstruction. Methods: Prospective data recorded in the New Zealand ACL Registry were cross‐referenced with data from the Accident Compensation Corporation (ACC). Primary ACL reconstructions performed between April 2014 and May 2021 were analysed. The ACC database was used to identify patients who underwent a reoperation for a diagnosis of arthrofibrosis. Multivariable survival analysis was performed to compute adjusted hazard ratios (aHR) and 95% confidence intervals. Results: A total of 12,296 primary ACL reconstructions were analysed, of which 230 underwent a reoperation for arthrofibrosis (1.9%) at a mean follow‐up of 3.6 years. A higher risk of arthrofibrosis was observed in females (aHR = 1.76, p = 0.001), patients with a history of previous knee surgery (aHR = 1.82, p = 0.04) and when a transtibial drilling technique was used (aHR = 1.53, p = 0.03). ACL reconstruction >6 months after injury had the lowest rate of arthrofibrosis (1.3%, aHR = 0.45, p = 0.01). There was no difference in risk between early surgery within 6 weeks versus delayed surgery between 6 weeks and 6 months after injury (2.9% versus 2.1%, aHR = 0.78, not significant). Conclusion: Female sex, previous knee surgery and a transtibial drilling technique increased the risk of reoperation for arthrofibrosis. Early surgery within 6 weeks of injury was not associated with an increased risk when compared with surgery between 6 weeks and 6 months after injury. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Corporatisation of universities has drawn parallels between contemporary universities and business corporations, and extended analysis of corporate social responsibility to universities. This article reports on a case study of university-community engagement with schools and school communities through youth engagement programmes to enhance democratic principles in student leadership and raise aspirations for university education for students from disadvantaged backgrounds. Data from over 1200 respondents suggest that university-community engagement produced positive outcomes for individual student participants, schools and school communities and also benefited the university in terms of brand recognition and good standing in the community. This raises questions about the social responsibility of universities as agents of change to entrench society's fundamental values of democratic participation and social justice.

Background: The bone–patellar tendon–bone (BTB) autograft is associated with difficulty with kneeling after anterior cruciate ligament (ACL) reconstruction; however, it is unclear whether it results in a more painful or symptomatic knee compared with the hamstring tendon autograft. Purpose: To identify the rate and risk factors for knee pain and difficulty with kneeling after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Primary ACL reconstruction procedures prospectively recorded in the New Zealand ACL Registry from April 2014 to May 2021 were analyzed. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to identify patients reporting consequential knee pain (CKP), defined as a KOOS Pain subscore of ≤72 points, and severe kneeling difficulty (SKD), defined as a self-report of "severe" or "extreme" difficulty with kneeling. Absolute values of the KOOS Pain and Symptoms subscales were also compared. Results: A total of 10,999 patients were analyzed. At 2-year follow-up, 9.3% (420/4492) reported CKP, and 12.0% (537/4471) reported SKD. The most important predictor of CKP at 2-year follow-up was having significant pain before surgery (adjusted odds ratio, 4.10; P <.001). The most important predictor of SKD at 2-year follow-up was the use of a BTB autograft rather than a hamstring tendon autograft (21.3% vs 9.4%, respectively; adjusted odds ratio, 3.12; P <.001). There was no difference between the BTB and hamstring tendon grafts in terms of CKP (9.9% vs 9.2%, respectively; P =.494) or in absolute values of the KOOS Pain (mean, 88.7 vs 89.0, respectively; P =.37) and KOOS Symptoms (mean, 82.5 vs 82.1, respectively; P =.49) subscales. Conclusion: At 2-year follow-up after primary ACL reconstruction, 9.3% of patients reported CKP, and 12.0% reported SKD. The BTB autograft was associated with difficulty with kneeling, but it did not result in a more painful or symptomatic knee compared with the hamstring tendon autograft. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify the risk factors for meniscal repair failure following concurrent primary anterior cruciate ligament (ACL) reconstruction. Methods: Prospective data recorded by the New Zealand ACL Registry and the Accident Compensation Corporation were reviewed. Meniscal repairs performed during concurrent primary ACL reconstruction were included. Repair failure was defined as a subsequent reoperation involving meniscectomy of the repaired meniscus. Multivariate survival analysis was performed to identify the risk factors for failure. Results: A total of 3,024 meniscal repairs were analysed with an overall failure rate of 6.6% (n = 201) at a mean follow-up of 2.9 years (SD 1.5). The risk of medial meniscal repair failure was higher with hamstring tendon autografts (adjusted HR [aHR] = 2.20, 95% CI 1.36–3.56, p = 0.001), patients aged 21–30 years (aHR = 1.60, 95% CI 1.30–2.48, p = 0.037) and in patients with cartilage injury in the medial compartment (aHR = 1.75, 95% CI 1.23–2.48, p = 0.002). The risk of lateral meniscal repair failure was higher in patients aged ≤ 20 years (aHR = 2.79, 95% CI 1.17–6.67, p = 0.021), when the procedure was performed by a low case volume surgeon (aHR = 1.84, 95% CI 1.08–3.13, p = 0.026) and when a transtibial technique was used to drill the femoral graft tunnel (aHR = 2.30, 95% CI 1.03–5.15, p = 0.042). Conclusion: The use of a hamstring tendon autograft, younger age and the presence of medial compartment cartilage injury are risk factors for medial meniscal repair failure, whereas younger age, low surgeon volume and a transtibial drilling technique are risk factors for lateral meniscal repair failure. Level of evidence: Level II. [ABSTRACT FROM AUTHOR]

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. Methods: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. Results: The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. Conclusions: Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care. [ABSTRACT FROM AUTHOR]

Past studies found that large‐amplitude geomagnetically induced current (GIC) related to magnetospheric Ultra Low Frequency (ULF) waves tend to be associated with periods >120 s at magnetic latitudes >60°, with comparatively (a) smaller GIC amplitudes at lower latitudes and shorter wave periods and (b) fewer reports of waves associated with GIC at lower latitudes. ULF wave periods generally decrease with decreasing latitude; thus, we examine whether these trends might be due, in part, to the undersampling of ULF wave fields in commonly available measurements with 60 s sampling intervals. We use geomagnetic field (B), geoelectric field (E), and GIC measurements with 0.5–10 s sampling intervals during the 29–31 October 2003 geomagnetic storm to show that waves with periods <∼120 s were present during times with the largest amplitude E and GIC variations. These waves contributed to roughly half the maximum E and GIC values, including during times with the maximum GIC values reported over a 14‐year monitoring interval in New Zealand. The undersampling of wave periods <120 s in 60 s measurements can preclude identification of the cause of the GIC during some time intervals. These results indicate (a) ULF waves with periods ≤120 s are an important contributor to large amplitude GIC variations, (b) the use of 0.1–1.0 Hz sampling rates reveals their contributions to B, E, and GIC, and (c) these waves' contributions are likely strongest at magnetic latitudes <60° where ULF waves often have periods <120 s. Plain Language Summary: Geomagnetic field variation can induce geoelectric fields in the Earth that interfere with the operation of grounded electric power transmission systems. There are many sources of geomagnetic field variation, including plasma waves in the near‐Earth space environment. Past studies have found that wave periods between 120 and 600 s in high latitude regions led to the largest electrical currents in power systems. The waves responsible for driving these electrical currents have periods that decrease with decreasing latitude. We examine whether these trends may be partly due to the wide use of measurements with sampling rates that cannot resolve wave periods below 120 s. We use measurements sampled every 0.5–10 s during a major geomagnetic storm to show that wave periods shorter than 120 s can drive large amplitude geoelectric field and electrical current variations. These results suggest (a) waves with periods <120 s are an important contributor to electrical currents in power systems, (b) the use of sampling intervals of 1–10 s reveals their contributions, and (c) these waves' contributions are likely strongest at middle and low latitude regions where wave periods are often <120 s. Key Points: Waves with periods <∼2 min occur at magnetic latitudes <60° throughout the 29–31 October 2003 stormThe waves drive or contribute significantly to geomagnetically induced currents that are comparable to 14‐year peak values0.1–1.0 Hz sampling rates are required to determine wave contributions to currents at magnetic latitudes <60° [ABSTRACT FROM AUTHOR]

The establishment of a culturally diverse surgical workforce, largely on the basis of gender, has been highly promoted in Australasia in the last decade. Despite this, discussions of gender diversity in surgery have largely excluded Indigenous women. This study presents the experiences of wāhine Māori and Pasifika doctors in Aotearoa, who formed a surgical sisterhood to support them towards applying for advanced surgical training. Utilising mana wāhine and Masi methodologies, semi-structured interpersonal interviews were undertaken with five wāhine who formed the surgical sisterhood. Following transcription and analysis of all interviews, four key themes were identified. These were mana wāhine, unity, our why and change on the horizon. These themes illustrate the complex and varied experiences of wāhine Māori and Pasifika and how they have navigated their surgical pathways amidst multiple layers of discrimination towards being in a position to apply for advanced surgical training. [ABSTRACT FROM AUTHOR]

Research of clinical patients with a pre-existing psychological disorder involved in a disaster is limited. This study investigated relationships between preand post-earthquake psychopathology (i.e., anxiety, depression, and posttraumatic stress), peritraumatic distress, work and social impairment, perceived support post-earthquake, and personality dimensions in an outpatient, anxiety disorder population. Thirty-seven patients with pre-existing anxiety disorders completed standard clinical assessments pre-earthquake. They then completed a second set of questionnaires 3 months after exposure to the 2010 Christchurch, Aotearoa New Zealand, earthquake. Bivariate correlations on the variables determined what relationships were present, and paired samples t-tests assessed differences in pre- and post-earthquake anxiety, depression, and alcohol and drug consumption as well as relationships with peritraumatic distress, posttraumatic stress, and personality variables. Significant relationships were found between pre-earthquake psychopathology, peritraumatic distress, post-earthquake psychopathology, and impairment. Paired samples t-tests demonstrated anxiety and depression scores were significantly lower post-earthquake. However, prior anxiety and depression, as well as peritraumatic distress, were significantly associated with post-earthquake psychopathology, including posttraumatic stress and impaired work and social functioning. There were no differences between pre- and post-event alcohol and drug consumption. The personality dimensions of harm avoidance, self-directedness, and persistence significantly associated with post-disaster anxiety and depression. Promisingly, post-earthquake perceived support was significantly negatively correlated with depression and posttraumatic stress. [ABSTRACT FROM AUTHOR]

Background: The hamstring tendon is frequently used to reconstruct the anterior cruciate ligament (ACL), but there is a lack of consensus on the optimal method of fixation. Registry studies have shown that the type of femoral fixation device can influence the risk of revision ACL reconstruction (ACLR), but it is unclear whether the type of tibial fixation has an effect. In New Zealand, over 95% of hamstring tendon grafts are fixed with an adjustable loop suspensory device on the femoral side, with variable usage between suspensory and interference devices, with or without a sheath, on the tibial side. Purpose: To investigate the association between the type of tibial fixation device and the risk of revision ACLR. Study Design: Cohort Study; Level of evidence, 2. Methods: Prospective data recorded in the New Zealand ACL Registry were analyzed. Only primary ACLRs performed with a hamstring tendon autograft fixed with a suspensory device on the femoral side were included. A Cox regression survival analysis with adjustment for patient factors was performed to analyze the effects of the type of tibial fixation device, the number of graft strands, and graft diameter on the risk of revision. Results: A total of 6145 primary ACLRs performed between 2014 and 2019 were analyzed. A total of 59.6% of hamstring tendon autografts were fixed with a suspensory device on the tibial side (n = 3662), 17.6% with an interference screw with a sheath (n = 1079), and 22.8% with an interference screw without a sheath (n = 1404). When compared with suspensory devices, a higher revision risk was observed when using an interference screw with a sheath (adjusted hazard ratio [HR], 2.05; P =.009) and without a sheath (adjusted HR, 1.81; P =.044). The number of graft strands and a graft diameter of ≥8 mm were associated with the rate of revision on the univariate analysis; however, after adjusting for confounding variables on the multivariate analysis, they did not significantly influence the risk of revision. Conclusion: In this study of hamstring tendon autografts fixed with an adjustable loop suspensory device on the femoral side during primary ACLR, the use of an interference screw, with or without a sheath, on the tibial side resulted in a higher revision rate when compared with a suspensory device. [ABSTRACT FROM AUTHOR]

Introduction: Promoting healthy eating and active play in early life is critical, however few interventions have been delivered or sustained at scale. The evaluation of interventions at scale is a crucial, yet under-researched aspect of modifying population-level health behaviours. INFANT is an evidence-based early childhood healthy lifestyle intervention that aims to improve parents' knowledge and skills around promoting optimal energy balance-related behaviours that, in turn, influence children's diet, activity and adiposity. It consists of: 1) Four group sessions delivered via first time parent groups across the first 12 months of life; 2) access to the My Baby Now app from birth to 18 months of age. This research aims to assess real-world implementation, effectiveness and cost-effectiveness of INFANT when delivered at scale across Victoria, Australia. Methods and Analysis: A hybrid type II implementation-effectiveness trial applying a mixed methods design will be conducted. INFANT will be implemented in collaboration with practice and policy partners including maternal and child health services, population health and Aboriginal health, targeting all local government areas (n=79) in Victoria, Australia. Evaluation is based on criteria from the 'Outcomes for Implementation Research' and 'RE-AIM' frameworks. Implementation outcomes will be assessed using descriptive quantitative surveys and qualitative interviews with those involved in implementation, and include intervention reach, organisational acceptability, adoption, appropriateness, cost, feasibility, penetration and sustainability. Process measures include organizational readiness, fidelity, and adaptation. Effectiveness outcomes will be assessed using a sample of INFANT participants and a non-randomized comparison group receiving usual care (1,500 infants in each group), recruited within the same communities. Eligible participants will be first time primary caregivers of an infant aged 0-3 months, owning a personal mobile phone and able to communicate in English. Effectiveness outcomes include infant lifestyle behaviours and BMIz at 12 and 18 months of age. Impact: This is the first known study to evaluate the scale up of an evidence based early childhood obesity prevention intervention under real world conditions. This study has the potential to provide generalisable implementation, effectiveness and cost-effectiveness evidence to inform the future scale up of public health interventions both in Australia and internationally. Clinical Trial Registration: Australian and New Zealand Clinical Trial Registry https://www.anzctr.org.au/ , identifier ACTRN12620000670976. [ABSTRACT FROM AUTHOR]

Background: In primary anterior cruciate ligament (ACL) reconstruction, a bone–patellar tendon–bone (BTB) autograft is associated with lower ipsilateral failure rates. BTB autografts are associated with a higher rate of contralateral ACL injuries, which some clinicians view as a marker of success of the BTB autograft. However, there is a lack of evidence on whether BTB autografts improve the rate of return to activity and sport. Purpose: To compare the rate of return to preinjury activity levels in high-activity patients after ACL reconstruction with BTB autograft or hamstring tendon autograft. Study Design: Cohort study; Level of evidence, 3. Methods: In a high-activity cohort of patients recorded between 2014 and 2018 in the New Zealand ACL Registry, prospectively collected data on preinjury and postoperative Marx activity scores were analyzed. The proportion of patients who returned to their preinjury activity levels at 1- and 2-year follow-up was compared between graft types. Results: Overall, 11.3% (208/1844) of patients returned to their preinjury activity levels at 1-year follow-up, and 15.5% (184/1190) returned at 2-year follow-up. At 1-year follow-up, 17.2% of patients with a BTB autograft returned to their preinjury activity levels compared with 9.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.59 [95% CI, 1.16-2.17]; P =.004). At 2-year follow-up, 23.3% of patients with a BTB autograft had returned to their preinjury activity levels compared with 13.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.63 [95% CI, 1.14-2.34]; P =.008). Male sex and younger age were associated with a higher rate of return to activity at both follow-up time points. Conclusion: The use of BTB autografts increased the odds of returning to preinjury activity levels at early follow-up. A higher rate of return to activity is a possible explanation for the higher rate of contralateral ACL injuries with the use of BTB autografts. [ABSTRACT FROM AUTHOR]

These revised guidelines for contemporary endodontic education in Australia and New Zealand (version 2021) propose the minimum criteria for the training of dentistry students. The document contains a definition of endodontics and a description of the scope of endodontics. It proposes a general outline for education programmes in endodontics as part of general dental practice. [ABSTRACT FROM AUTHOR]

The Cenozoic Pelagornithidae, or pseudotoothed birds, are characterized by unique bony projections along the cutting edges of the beak. These birds were previously known from late Paleocene to Pliocene fossil sites and some species reached wingspans up to 6.4 m. Here we describe a partial skeleton of a small‐sized pelagornithid from the early Paleocene of New Zealand. Protodontopteryx ruthae gen. et sp. nov. is the oldest record of the clade, the smallest known species, and the first pre‐Eocene pelagornithid from the Southern Hemisphere. The skull of the new species exhibits the characteristic pelagornithid morphology, but the postcranial skeleton distinctly differs from other pelagornithids, and various plesiomorphic features indicate that it is the earliest‐diverging representative of the Pelagornithidae. The much stouter humerus suggests that the new species was less adapted to sustained soaring than previously known pelagornithids. Pseudoteeth therefore evolved before pelagornithids became highly specialized gliders. Unlike the giant Neogene pelagornithid species, which presumably were skimmers, early Paleocene pelagornithids are likely to have targeted selected prey items and may have been predominantly piscivorous. The new species furthermore suggests that pelagornithids evolved in the Southern Hemisphere and documents a very early radiation of neornithine seabirds, which may have been triggered by changes in marine ecosystems around the K–Pg boundary. [ABSTRACT FROM AUTHOR]

These revised guidelines developed by the Australian Society of Endodontology Inc. and the Australian and New Zealand Academy of Endodontists for educational requirements for specialisation in endodontics in Australia and New Zealand (version 2020) propose minimum criteria for training specialists in our field. The document contains a definition of endodontics and a description of the scope of endodontics. It proposes criteria for selection of the students and describes the proposed main features and a general outline of the education programme. [ABSTRACT FROM AUTHOR]

Purpose: The use of an accessory anteromedial portal to drill the femoral graft tunnel in primary anterior cruciate ligament (ACL) reconstruction was introduced in the 2000s in an effort to achieve a more anatomic femoral tunnel position. However, some early studies reported an increase in revision ACL reconstruction compared to the traditional transtibial technique. The aim of this study was to analyse recent data recorded by the New Zealand ACL Registry to compare outcomes of ACL reconstruction performed using the anteromedial portal and transtibial techniques. Methods: Analysis was performed on primary isolated single-bundle ACL reconstructions recorded between 2014 and 2018 by the New Zealand ACL Registry. Patients were categorised into two groups according to whether an anteromedial portal or transtibial technique was used to drill the femoral graft tunnel. The primary outcome was revision ACL reconstruction and was compared between both groups through univariate and multivariate survival analyses. The secondary outcomes that were analysed included subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Marx activity score. Results: Six thousand one hundred and eighty-eight primary single-bundle ACL reconstructions were performed using either the anteromedial portal or transtibial drilling techniques. The mean time of follow-up was 23.3 (SD ± 14.0) months. Similar patient characteristics such as mean age (29 years, SD ± 11), sex (males = 58% versus 57%) and time to surgery (median 4 months, IQR 5) were observed between both groups. The rate of revision ACL reconstruction was 2.6% in the anteromedial portal group and 2.2% in the transtibial group (n.s.). The adjusted risk of revision ACL reconstruction was 1.07 (95% CI 0.62–1.84, n.s.). Patients in the anteromedial portal group reported improved scores for subscales of the KOOS and higher Marx activity scores at 1-year post-reconstruction. Conclusion: There was no difference in the risk of revision ACL reconstruction between the two femoral tunnel drilling techniques at short-term follow-up. We observed minor differences in patient-reported outcomes at 1-year follow-up favouring the anteromedial portal technique, which may not be clinically relevant. Surgeons can achieve good clinical outcomes with either drilling technique. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is a major cause of death in New Zealand. In recent years, targeted therapies have improved outcomes. Aim: To determine the uptake of anaplastic lymphoma kinase (ALK) testing, and the prevalence, demographic profile and outcomes of ALK‐positive non‐small‐cell lung cancer (NSCLC), in New Zealand, where no national ALK‐testing guidelines or subsidised ALK tyrosine kinase inhibitor (TKI) therapies are available. Methods: A population‐based observational study reviewed databases to identify patients presenting with non‐squamous NSCLC over 6.5 years in northern New Zealand. We report the proportion tested for ALK gene rearrangements and the results. NSCLC samples tested by fluorescence in situ hybridisation were retested by next generation sequencing and ALK immunohistochemistry. A survival analysis compared ALK‐positive patients treated or not treated with ALK TKI therapy. Results: From a total of 3130 patients diagnosed with non‐squamous NSCLC, 407 (13%) were tested for ALK gene rearrangements, and patient selection was variable and inequitable. Among those tested, 34 (8.4%) had ALK‐positive NSCLC. ALK‐positive disease was more prevalent in younger versus older patients, non‐smokers versus smokers and in Māori, Pacific or Asian ethnic groups than in New Zealand Europeans. Fluorescence in situ hybridisation, ALK immunohistochemistry and next generation sequencing showed broad concordance for detecting ALK–positive disease under local testing conditions. Among patients with ALK‐positive metastatic NSCLC, those treated with ALK TKI survived markedly longer than those not treated with ALK TKI (median overall survival 5.12 vs 0.55 years). Conclusion: Lung cancer outcomes in New Zealand may be improved by providing national guidelines and funding policy for ALK testing and access to subsidised ALK TKI therapy. [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]

Molecular diagnostic laboratories screen for mutations in disease-causing genes in order to confirm a clinical diagnosis. The classification of DNA variants as ‘pathogenic’ or ‘likely pathogenic’ mutations creates a workflow bottleneck, which becomes increasingly challenging as greater number of genes are screened. The classification challenge is also acute if there are conflicting reports regarding pathogenicity and differing classification criteria between laboratories. This study aimed to compare two procedures for the classification of variants in the breast cancer (BRCA)1 gene. Methods: This bioinformatic study was conducted at LabPLUS, Auckland, New Zealand, from February to June 2017. DNA was extracted from peripheral blood samples of 30 patients and gene library construction was carried out using a commercially available targeted panel for the BRCA1 and BRCA2 genes. The genes were subsequently sequenced and the sequence data analysed. The guidelines published by the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/ AMP) provides a comprehensive framework for the interpretation of variants in genes that are associated with Mendelian disorders. The use of these guidelines were compared to the variant classifications that were achieved by reference to those reported in the BRCA Exchange database. Results: The results showed concordance between the two classification protocols for a panel of 30 BRCA1 gene variants, although the transparency in following the ACMG/AMP guidelines provides a diagnostic laboratory with a generalisable approach that allows laboratorydirected revisions to be undertaken in light of new information. Conclusion: The ACMG/AMP-based guidelines were applied to a cohort of patients with BRCA1 gene variants. The use of these guidelines provides a system which creates consistency in variant interpretation and supports subsequent clinical management. [ABSTRACT FROM AUTHOR]

This article explores projects by the Alexander Turnbull Library to collect social media materials that reflect contemporary New Zealand culture and life. The article focuses on projects to harvest Twitter content relating to the 2016 Kaikōura earthquake and the 2017 New Zealand General election, and the ATL100 Facebook Archive project, which piloted collecting personal Facebook account archives relating to Aotearoa New Zealand and the Pacific from the general public. [ABSTRACT FROM AUTHOR]

Worldwide, indigenous communities experience diminished health status and poorer health outcomes in comparison to the dominant non-indigenous population. This novel survey demonstrates that both OHNS supervisors and trainees largely understand and acknowledge the importance of providing culturally appropriate health services for Maori but are less familiar with the importance of appraising personal and institutional attitudes towards culture. In conjunction with the New Zealand based surgical training committees, the Maori Health Advisory Group is developing a formalized cultural safety teaching and assessment programme to meet this need and which will form part of a broader RACS strategy to address Maori health equity. [Extracted from the article]

Background: To review long QT syndrome molecular autopsy results in sudden unexplained death in young (SUDY) between 2006 and 2013 in New Zealand. Methods: Audit of the LQTS molecular autopsy results, cardiac investigations and family screening data from gene-positive families. Results: During the study period, 365 SUDY cases were referred for molecular autopsy. 128 cases (35%) underwent LQTS genetic testing. 31 likely pathogenic variants were identified in 27 cases (21%); SCN5A (14/31, 45%), KCNH2 (7/31, 22%), KCNQ1 (4/31, 13%), KCNE2 (3/31, 10%), KCNE1 (2/31, 7%), KCNJ2 (1/31, 3%). Thirteen variants (13/128, 10%) were ultimately classified as pathogenic. Most deaths (63%) occurred during sleep. Gene variant carriage was more likely with a positive medical history (mostly seizures, 63% vs 36%, p = 0.01), amongst females (36% vs 12%, p = 0.001) and whites more than Maori (31% vs 0, p = 0.0009). Children 1–12 years were more likely to be gene-positive (33% vs 14%, p = 0.02). Family screening identified 42 gene-positive relatives, 18 with definitive phenotypic expression of LQTS/Brugada. 76% of the variants were maternally inherited (p = 0.007). Further family investigations and research now support pathogenicity of the variant in 13/27 (48%) of gene-positive cases. Conclusion: In New Zealand, variants in SCN5A and KCNH2, with maternal inheritance, predominate. A rare variant in LQTS genes is more likely in whites rather than Maori, females, children 1–12 years and those with a positive personal and family history of seizures, syncope or SUDY. Family screening supported the diagnosis in a third of the cases. The changing classification of variants creates a significant challenge. [ABSTRACT FROM AUTHOR]

Aim: To describe the existing usage of oral health care protocols and of oral health care routines carried out in New Zealand Rest Homes and Long Term Care (RH/LTC) facilities. Methods: A two-part structured questionnaire was sent to 425 randomly selected facilities. It recorded the number of residents, staff and location of the facilities. It then examined whether the facility had written Oral Health Care (OHC) policies, whether they were drafted with the assistance of a dental professional, and whether the staff had problems with adhering to the policies. Results: Written policies for oral care were in place in 139 facilities (35.9%). Of those with policies, 15.4% had had a dental professional assist in drafting it (5.5% overall). Only 14.0% of facilities had ever had a dental professional in to give a demonstration in oral care, and 90.2% of facilities felt that a demonstration in oral care would be beneficial. Most facility management teams were satisfied with the way in which they dealt with basic oral care for their residents, and the way in which they manage dental emergencies (72.6% and 77.9% respectively). Baseline oral examinations were a low priority for facilities; only one in nine reported providing them for residents on entry. Conclusions: Written oral health policies are not used extensively in New Zealand LTC facilities. The provision of baseline oral examinations to document the oral health of residents at admission is uncommon. The sector recognised a need for improvement, but they were generally satisfied with the level of care they were able to provide for residents, given existing economic and time constraints. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to critically examine the concept of social responsibility within two community-based not-for-profit organisations in New Zealand, and to test the hypothesis that having a social agenda necessarily means being socially responsible. We adopted the methodologies of phenomenology and appreciative inquiry, and found that not-for-profit organisations believe social responsibility is embedded in their mission and activities, although they may not clearly state this in their public statements. We also found that not-for-profits consider financial accountability to be a central aspect of their social responsibility because of the trust they enjoy to use funds from the public to address society's ills. The challenge for not-for-profits is to develop evaluative frameworks that measure social responsibility. The findings of this study underpin the importance of the not-for-profit sector developing measures of social responsibility to help guide and progress its own good practice. The rhetoric of mission statements alone does not constitute social responsibility. How organisations share power, how they dialogue with and empower clients and communities, the environmental consequences of their activities, and their human rights, ethical and employment practices are important elements of not-for-profit social responsibility. Our study makes two key contributions. Firstly, we move the discourse about social responsibility beyond whether not-for-profits should be required to be socially responsible, to a critique of their activities and functions in order to ascertain the levels of social responsibility and how best they can fulfil their mandates in a socially responsible way. Secondly, by focusing on community-based organisations, this study seeks to build a better understanding of the concept of social responsibility by not-for-profits at the community level, where their impact is felt the most; it thus extends the discourse on social responsibility of not-for-profits, which has tended to focus primarily on large international organisations. [ABSTRACT FROM AUTHOR]