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Closed stranger adoption has not commonly been recognised as a tool of Indigenous oppression in Aotearoa New Zealand, yet it was a colonial practice that caused great harm to Māori. This article narrates some of the ways in which adoptees who identify as Māori demonstrate resilience and resistance to the pernicious effects of closed stranger adoption. Using a mana (strengths-based values) enhancing approach, meaning we champion respect and understanding, this research elucidates how Māori adoptees navigate complex social relationships in courageous and creative ways, including when seeking birth kinship, maintaining those relationships, and making broader efforts to (re)connect with things Māori. Māori adoptees want their experiences to be recognised by Māori and non-Māori alike, so that the ongoing harms of closed stranger adoption can be redressed, and the next generations do not continue to live the negative impacts.

In Aotearoa New Zealand, the precariat is populated by at least one in six New Zealanders, with Māori (Indigenous peoples) being over-represented within this emerging social class. For Māori, this socio-economic positioning reflects a colonial legacy spanning 150 years of economic and cultural subjugation, and intergenerational experiences of material, cultural and psychological insecurities. Relating our Kaupapa Māori approach (Māori cultural values and principles underlining research initiatives) to the precariat, this article also draws insights from existing scholarship on social class in psychology and Assemblage Theory in the social sciences to extend present conceptualizations of the Māori precariat. In keeping with the praxis orientation central to our approach, we consider three exemplars of how our research into Māori precarity is mobilized in efforts to inform public deliberations and government policies regarding poverty reduction, humanizing the welfare system and promoting decent work. Note: Aotearoa New Zealand has been popularized within the everyday lexicon of New Zealanders as a political statement of Indigenous rights for Māori.

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Knowledge from past disasters can inform and support recovery, yet these insights are not always readily accessible to recovery practitioners. To bridge this gap, effective collaboration is needed to produce practical, evidence-based resources. This was the focus of the Recovery Capitals (ReCap) project, a collaboration between researchers and practitioners across Australia and Aotearoa New Zealand.

Accessing healthcare during a disaster matters for the well-being of people and communities. This article explores healthcare messaging about General Practitioner (GP) services for non-COVID-19 health concerns during the Level 4 lockdown in Te Papaioea (Palmerston North), Aotearoa New Zealand. Messaging from Government, media and local GP clinics were analysed to understand how people were advised to seek care for non-COVID-19 health concerns. We found inconsistencies in these communications, ranging from messages to not attend healthcare services because of possible COVID-19 surges, to messages with vague, or lack of, information. Government messages did include advice for seeking general healthcare, but this was largely rendered invisible due to the focus on ‘staying home, saving lives’. Media messaging was similarly influenced by these Government directives. Few GP clinics had websites, and few provided information about accessing general healthcare services. Clinics also lacked up-to-date telephone messages about seeking healthcare for non-COVID-19 symptoms and illnesses. All three sources neglected the cultural, social and contextual diversity of the local audience. We recommend that communication during disasters should be clear, concise and consistent. Further, GPs should be supported to have websites and telecommunication platforms. All communications should be inclusive and aim to reach diverse audiences.

Growing homelessness in Aotearoa New Zealand stems primarily from rising inequalities and poverty. Drawing from scholarship on relational ethics, principled practice and Māori cultural concepts, this paper offers our reflections on nearly two decades of collective work to document and address homelessness. Central to the approach outlined are enduring community partnerships, the cultivation of reciprocal relations, and time spent with homeless people and those trying to work with them. We present exemplars for how we draw on everyday interactions with homeless people and agency staff to enhance local service and broader systemic responses to homelessness.

Environmental data require fit-for-purpose data management systems and related spatial applications to be used effectively for management. Geographic Information Systems (GIS) have become a key tool to analyse and visualise spatial data with their increasing volume and variety. Well-designed data centres that combine a data management system with GIS, reduce costs and improve efficiency for spatial planning processes. Small or remote territories and islands such as the South Atlantic UK Overseas Territories (SAUKOT), with limited financial resources and capacity, face many challenges to develop such centres. In 2013 an island-based Information Management System (IMS)-GIS Data Centre was established in the SAUKOT. Until then, governments did not have the ability to use spatial planning effectively to manage their environments. The IMS-GIS Data Centre has been operating as: 1) repository of high-quality reference datasets to support decision making, 2) interactive data visualisation to share maps and information with stakeholders and 3) data portals to assist data discovery and sharing. This paper describes i) how the SAUKOT have built their own IMS-GIS Data Centres ii), how these Data Centres have provided effective and manageable solutions to support terrestrial and marine spatial planning processes and iii) the challenges the Data Centres are still facing. Thanks to relatively simple data management concepts and the use of open-source programs, the IMS-GIS Data Centre is transferable to other contexts sharing similar challenges to those faced by the SAUKOT Os dados ambientais exigem uma adequação dos sistemas de gestão de dados e respetivas aplicações geográficas para que sejam utilizados eficazmente na gestão. Os Sistemas de Informação Geográfica (SIG) tornaram-se uma ferramenta essencial para analisar e visualizar dados espaciais com seu volume e variedade crescentes. Os Data centers bem projetados, que combinam um sistema de gestão de dados com SIG, reduzem custos e melhoram a eficiência dos processos de planeamento espacial. Os territórios e ilhas pequenas ou remotas, como os Territórios Ultramarinos do Atlântico Sul do Reino Unido (SAUKOT), com recursos e capacidade financeira limitados, enfrentam muitos desafios para desenvolver esses centros. Em 2013, um centro de dados do Sistema de Gestão de Informações em Ilhas (IMS) foi estabelecido no SAUKOT. Até então, os governos não tinham a capacidade de usar o planeamento espacial efetivamente para gerir os seus ambientes. O IMS-GIS Data Center opera como: 1) repositório de conjuntos de dados de referência de alta qualidade para apoiar a tomada de decisão, 2) visualização interativa de dados para compartilhar mapas e informações com as partes interessadas e 3) portais de dados para auxiliar na descoberta e compartilhamento de dados. Este artigo descreve i) como os SAUKOT construíram os seus próprios Data Centers IMS-GIS; ii) como esses Data Centers forneceram soluções eficazes e geríveis para apoiar os processos de planeamento espacial terrestre e marinho; e iii) os desafios que os Data Centers ainda enfrentam. Graças a conceitos de gestão de dados relativamente simples e o uso de programas de código aberto, o IMS-GIS Data Center é transferível para outros contextos que compartilham desafios semelhantes aos enfrentados pelo SAUKOT. Fundação para a Ciência e Tecnologia - FCT info:eu-repo/semantics/publishedVersion

The Antarctic is considered to be a pristine environment relative to other regions of the Earth, but it is increasingly vulnerable to invasions by marine, freshwater and terrestrial non‐native species. The Antarctic Peninsula region (APR), which encompasses the Antarctic Peninsula, South Shetland Islands and South Orkney Islands, is by far the most invaded part of the Antarctica continent. The risk of introduction of invasive non‐native species to the APR is likely to increase with predicted increases in the intensity, diversity and distribution of human activities. Parties that are signatories to the Antarctic Treaty have called for regional assessments of non‐native species risk. In response, taxonomic and Antarctic experts undertook a horizon scanning exercise using expert opinion and consensus approaches to identify the species that are likely to present the highest risk to biodiversity and ecosystems within the APR over the next 10 years. One hundred and three species, currently absent in the APR, were identified as relevant for review, with 13 species identified as presenting a high risk of invading the APR. Marine invertebrates dominated the list of highest risk species, with flowering plants and terrestrial invertebrates also represented; however, vertebrate species were thought unlikely to establish in the APR within the 10 year timeframe. We recommend (a) the further development and application of biosecurity measures by all stakeholders active in the APR, including surveillance for species such as those identified during this horizon scanning exercise, and (b) use of this methodology across the other regions of Antarctica. Without the application of appropriate biosecurity measures, rates of introductions and invasions within the APR are likely to increase, resulting in negative consequences for the biodiversity of the whole continent, as introduced species establish and spread further due to climate change and increasing human activity., The Antarctic Peninsula region (APR) is increasingly vulnerable to biological introductions and invasions, caused by increases in the intensity, diversity and distribution of human activities. This study identified 103 species that are likely to present a risk to biodiversity and ecosystems within the APR over the next 10 years; marine invertebrates dominated the list of highest risk species, but vertebrate species were thought unlikely to establish within the 10 year timeframe. We recommend the further development and application of biosecurity measures in the APR, and further studies to identify potential biological invaders in other regions of Antarctica. See also the Commentary by https://doi.org/10.1111/gcb.15013

This research explores the ways in which safety and emotion were drivers of evacuation for people residing in high-density inner-city housing in the Central Business District of Te Whanganui-a-Tara (Wellington) following the 2016 Kaikωura earthquake. Drawing predominantly on qualitative free-response answers from a survey of 803 people approximately one year after the Kaikωura earthquake, the study argues that ontological insecurity was a key driver of people's actions. Key themes identified in relation to ontological insecurity and emotional responses were the severity of the shaking and how it was experienced, the building damage, official warnings, the ongoing earthquake aftershocks, and the social actions of others. This work argues that with the ongoing growth in high-density inner-city living, disaster risk and emergency management should encompass preparedness, response, and recovery strategies that include emotional responses and social processes while valuing the specificity of inner-city living.

Death by assisted dying has long received media attention and remains a current socio-political health topic today. For many, understanding assisted dying is derived from media representations that...

Objective: To explore how health emergency management (HEM) personnel make sense of professional development, such as education and training, in their everyday roles and responsibilities within an increasingly complex emergency management and disaster field.Design: This in-depth qualitative study comprised of semistructured interviews with 10 Aotearoa New Zealand HEM personnel from a range of healthcare professions, including emergency managers, nurses, clinical support, and paramedics. The thematic, data-driven approach was exploratory. The research identified inductively significant thematic concepts relating to professional development from the health emergency personnel’s talk about their roles and responsibilities.Results: The authors identified four themes relating to professional development in the participants’ talk: test yourself under pressure; selling what we do; under the pump; and real stuff that actually makes a difference. These themes represent shared sense-making about how the participants negotiated their professional development needs and the needs of others while performing their everyday roles and responsibilities. Conclusions: Our findings support the production of local and contextually driven knowledge that highlights how HEM personnel discuss professional development as strengths, tensions, challenges, and knowledge gaps. These insights contribute to a broader understanding of what needs to be taken into account when developing competencies, skill sets, and training programs to promote professional development in an increasingly complex emergency management and disaster field.

© The Author(s) 2017. Effective preparedness messages increase human capacity to prepare, respond and minimise harm during an emergency. The purpose of this study was to highlight the development of a pictorial infographic resource for earthquake and other emergencies for older people, people with mobility issues and people with literacy concerns in Aotearoa/New Zealand. A case study methodology was used to enable an in-depth description of the processes involved in designing, developing and disseminating the infographic. Case studies provide a medium to represent communitysituated knowledge and expertise. They value context, specificity and lived experience. The second two authors drove the initiative, and project managed the production of the infographic. The first author conducted a semi-structured interview with the other two authors to garner details of the process. This interview was transcribed and the case study outline was crafted. The authors went on to produce this paper collectively. The outcomes of this case study include recommending that a multidisciplinary approach be used to engage a range of stakeholders, to produce suitable preparedness messages for a range of audiences. Designing preparedness resources necessitates an iterative method and collective decision-making by relevant stakeholders. International best-practice guidelines provide evidence to ensure suitable resources are produced and gaps in knowledge identified, so that emergency preparedness is accessible for all.

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Medical misdiagnosis for women continues to be a significant problem, leading to disparate health outcomes. To understand how women make sense of experiences of medical misdiagnosis, eight women from Aotearoa/ New Zealand were interviewed about misdiagnosis of conditions that equally affect female and male bodies. This work was guided by feminist principles and used narrative analysis to develop the following three themes: (1) Contradictory dialogues: doctor as expert or not? (2) Self-advocacy in the misdiagnosis experience; and (3) Not taken seriously in healthcare settings: it’s all in your head. Supported by previous work, our findings assert that women are treated poorly in healthcare settings with detrimental outcomes for them and their wider community. Reasons for this include female bodies being excluded from medical research, so that little is known about how illnesses present in female bodies, or how they affect women. Problematically, knowledge founded on male bodies is used to diagnose conditions in women. These biases perpetuate gender stereotypes and preconceived beliefs about women. Unexplained symptoms are considered ‘made up’ or are blamed on women’s mental well- being. Women are therefore not always considered credible symptom reporters and may be dismissed and ignored by healthcare professionals.

The New Zealand Prostitutes’ Collective (NZPC) is an organisation founded on the rights, welfare, health, and safety of sex workers in Aotearoa New Zealand and globally. The collective is committed to ensuring the agency of sex workers in all aspects of life. After years of lobbying by the NZPC to overturn an archaic law founded on double standards, whereby sex workers and third parties were prosecuted for acts such as soliciting and brothel keeping, the Prostitution Reform Act 2003 saw the decriminalisation of commercial sex activities and allowed for third parties to operate brothels. Aotearoa New Zealand remains the only country to decriminalise most commercial sex work and endorse the rights of sex workers. Dame Catherine Healy has been with the NZPC since its inception in 1987. As the national coordinator she is a vocal lead activist and advocate for sex workers’ rights. She also publishes extensively on sex workers’ rights. In 2018, Catherine was presented with a Dame Campion to the New Zealand Order of Merit in acknowledgment for working for the rights of sex workers. Dr Denise Blake is an academic and the chair of the NZPC Board. Denise has been involved in the sex industry in a variety of roles for a number of years, and also advocates strongly for the rights of sex workers. In this interview, Catherine talks to Denise and Amanda Thomas about her work and the history of the NZPC.

In Aotearoa New Zealand, disaster risk management (DRM) aspires to protect the lives and livelihoods of people and places. It does this by encouraging people and communities to be disaster ready, while ensuring reduction of potential and actual harm from a disaster, responding immediately and directly following a disaster, and recovering so that there is ongoing regeneration and resiliency for the people and communities impacted by a disaster.

Developing multi-stakeholder networks to transfer response and recovery related knowledge between government agencies and flood-prone communities has become an important component of contemporary d...

n 1955, the Aotearoa/New Zealand government legislated the closed stranger adoption period. Approximately 80,000 children were constructed as a legal fiction when deemed as if born to a legally married couple. Birth family information was permanently sealed. Yet being raised in a fictional subject position and being denied access to any family of origin has consequences for all involved. After ten years of lobbying, the Adult Adoption Information Act (1985) came into effect. The power of that legislation was to overturn the strategies that suppressed adoptees’ rights to know details of their birth. Adult adoptees over the age of 20 years could access their original birth certificates, which provided a birth mother’s name. With this identifying information, reunions became possible. Birth family reunions involve a diverse range of experiences, reflecting the ways in which adoptees are contextually and historically produced. This paper reconsiders the identity implications of reunion stories using the theoretical concept of hybrid identity. The complexities of reunions are multiple, and adoptees negotiate their identities through being both born to and born as if and yet neither identity is safe. In the production of this hybrid story, it was possible to see the political and moral trajectories that enable and constrain a sense of self through the complexities of a legal context that produces binary subject positions.

Being prepared for a disaster is an important strategy for reducing physical, social, psychological and cultural harm. Preparedness practices mitigate the immediate impacts of a disaster while also enabling people to respond to and cope with any ongoing consequences. However, not all people have the ability to prepare. This paper queries how preparedness discourses impact on people without financial means, capacity or support to prepare. The work situates preparedness within a neoliberal system that is preoccupied with risk management as an economic cost reducing exercise. It highlights that without the ability to feel safe and achieve ontological security in a disaster, people can experience instability and mental health is compromised. It questions disaster preparedness texts that produce a form of structural violence, preventing the ability to have needs meet, while privileging agency to some and denying it to others. Government documents and preparedness websites from Aotearoa/New Zealand are outlined to highlight the frequently ignored preparedness needs of vulnerable groups. The role of research in preparedness activities is also discussed. People working in the emergency management space should contest the socio-political conditions that produce increased risk for disadvantaged groups.

© 2020 This work explores the ways in which stigma influences how people engage with disaster risk reduction. It specifically addresses the experiences and perceptions of stigma for people who receive Opioid Substitution Treatment (OST), a successful harm reduction strategy that reduces illicit drug use, risk of overdose and criminal activity. Unfortunately, while receiving OST people endure stigma because of their perceived or assumed history of drug use, which positions them as socially deviant and unacceptable. During a disaster or emergency, forms of social stigma from health and emergency management personnel have implications for access to treatment such as OST. Drawing on semi-structured interviews with 21 people receiving OST from services in four major cities in Aotearoa New Zealand, an interpretive analysis was applied to better understand how stigma matters to their lived experience. Four key themes, namely “Experiences of stigma”, “Discrimination from health professionals”, and “Disasters and emergency management” and “Support within disaster contexts” were identified in their talk. We conclude that it is vital that medications and other necessary treatments are made accessible to those who need them to maintain health and wellbeing. It is important to be aware that stigmatising beliefs manifest in disaster-response settings which have consequences for people who are already more vulnerable than others. Therefore we suggest that appropriate education and training be provided.

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PurposeThe purpose of this research is to highlight the role of not-for-profit (NFP) organisations in enhancing disaster preparedness. The authors set out to understand their perspectives and practices in regard to disaster preparedness activities to support people who live precarious lives, especially those who live as single parents who are the least prepared for disasters.Design/methodology/approachThe research draws on in-depth, semi-structured interviews with 12 staff members, either in a group setting or individually, from seven NFP organisations, who were located in Ōtautahi (Christchurch) and Kaiapoi in Aotearoa New Zealand. These participants were interviewed eight years after the 2011 Christchurch earthquake.FindingsFour key narrative tropes or elements were drawn from across the interviews and were used to structure the research results. These included: “essential” support services for people living precarious lives; assisting people to be prepared; potential to support preparedness with the right materials and relationships; resourcing to supply emergency goods.Originality/valueThis research contributes to disaster risk reduction practices by advocating for ongoing resourcing of NFP groups due to their ability to build a sense of community and trust while working with precarious communities, such as single parents.

A discursive approach to knowledge contends that language is the constitutive force of experience and lived reality. Meaning is created through language use within relationships, while discourses function as the statements that produce knowledge, power and truth claims. We cannot step outside of the discourses through which our knowledge of experience is produced, though their complexity always allows us to resist particular identities that are discursively available to us. Based on interviews with 12 adoptees constituted within the ‘closed’ adoption period between 1955 and 1985, this narrative analysis represents the way in which the adoptive body matters to participants’ experiences of adoption and their resistances to the discourses that produce knowledge of adoption: Embodiment needed to be incorporated into this discursive work. Knowing, accessing and being- in-the-world are achieved through our senses in everyday life. We engage and shape cultural norms that enable and constrain corporeality. The adoptive experience is lived and felt through bodies that struggle to articulate their corporeality through discourse. Without discourses fit for purpose, speaking embodiment in and through adoption is precarious and adoptees attempt to articulate subjectivities beyond those allowed. This paper discusses the strategies used to materialise body matters in researching adoption.

© 2016 by the authors. Opioid Substitution Treatment (OST) is a harm reduction strategy enabling opiate consumers to avoid withdrawal symptoms and maintain health and wellbeing. Some research shows that within a disaster context service disruptions and infrastructure damage affect OST services, including problems with accessibility, dosing, and scripts. Currently little is known about planning for OST in the reduction and response phases of a disaster. This study aimed to identify the views of three professional groups working in Aotearoa/New Zealand about OST provision following a disaster. In-depth, semi-structured interviews were conducted with 17 service workers, health professionals, and emergency managers in OST and disaster planning fields. Thematic analysis of transcripts identified three key themes, namely “health and wellbeing”, “developing an emergency management plan”, and “stock, dose verification, and scripts” which led to an overarching concept of “service continuity in OST preparedness planning”. Participants viewed service continuity as essential for reducing physical and psychological distress for OST clients, their families, and wider communities. Alcohol and drug and OST health professionals understood the specific needs of clients, while emergency managers discussed the need for sufficient preparedness planning to minimise harm. It is concluded that OST preparedness planning must be multidisciplinary, flexible, and inclusive.

As Marine Spatial Planning (MSP) is taking off world-wide as a holistic approach to marine management, there has been a growing need for the inclusion of socio-economic factors in this process. Yet, producing spatial data for cultural values, in particular, remain a challenge because these values are abstract and difficult to extract and quantify. Here, we demonstrate a simple repeatable manual technique for mapping cultural coastal values using in-person interviews and Public Participation GIS (PPGIS) techniques. With 47 participants in the Falkland Islands labelling 745areas of cultural coastal value, this technique gave rise to the identification of cultural coastal value hotspots across the islands in four categories: Natural Beauty, Recreation, Sense of Place and Cultural History. The locations of values were not affected by their distance to a settlement, nor were participants particularly likely to select areas close to their home. The resulting maps of coastal cultural values have been incorporated in the MSP framework and webGIS for the Falkland Islands, allowing for the integration of these social factors in the decision making processes.

In the Falkland Islands, the South American fur seal and South American sea lion spatially overlap and interact with bottom-trawling fisheries. Until 2015, interactions of these species with the Patagonian bottom trawl squid fishery were uncommon. During the second fishing season 2017 a dramatic increase in seal interactions was observed, with a corresponding increase in incidental mortalities. Various mitigation measures were applied, seal exclusion devices (SEDs) fitted inside a net extension inserted between the trawl net and cod-end being the most efficient. The SEDs became mandatory in the fishery in September 2017. Since then, the number of seal mortalities remains negligible. SED efficiency is monitored by 100 % observer coverage. To the best of our knowledge, the Falkland Islands Patagonian squid fishery is currently the only trawl fishery in the Southwest Atlantic with full observer coverage and SED usage. It is hoped in the near future similar mitigation measures extend to other coastal countries whose fisheries also interact with these otariids.

The Aotearoa/New Zealand Adoption Act 1955 legislated and governed adoption practices from 1955 to 1985. Through an exploration of the historical, cultural and social assumptions underlying the Adoption Act 1955, this article questions how the social power relations complicit with adoption legislation and policy produce and reproduce subject positions for adoptees. In-depth narrative interviews were conducted with 12 adoptees from throughout Aotearoa/New Zealand. The researchers found the legal constitution of adoptees produces them as legitimate; however, they remain ‘other’ through dominant discourses of heteronormative blood kinship that reiterates their illegitimacy. The legal fiction of their legitimacy as if born to failed to secure them space within normative narratives of kinship and compromised adoptees' ability to take up responsibility as neoliberal citizens. Current New Zealand debate on adoption fails to take account of the experience of adoptees, focusing instead on the rights of married couples, including same-sex couples, to continue practices of adoption. Our analysis informs the critical importance of listening to how adoptees experience repeated exclusions and enduring loss represented by the metaphor of no-man's land. Copyright © 2015 John Wiley & Sons, Ltd.

Review of Elizabeth Stanley, The Road to Hell.

Many commercial weight loss programs offer meals as a key component of their plan, which may lead consumers to believe that these meals confer unique weight loss benefits. Consumers may not be awar...

Context. Imatinib mesylate (GlivecÒ, GleevecÒ, Novartis) has made a dramatic impact on the treatment available for both chronic myeloid leukaemia (CML) and gastrointestinal stromal tumours (GISTs). Both are rare diseases that have possibly been unfamiliar to many pharmacists until now. Objective. To provide readers with a structured overview of CML and GISTs and the trial data available to support the role imatinib is playing in the treatment of these diseases. Data sources. Published reviews and primary trial results were sourced via Medline to prepare the review. Articles published up to and including August 2002 were considered. Additionally, pertinent books were used to prepare the text and Novartis kindly supplied information currently only available on file at the company. As imatinib has only been available for a short time, all types and sizes of trials were considered for inclusion. The authors made the final decision as to the relevance and therefore subsequent inclusion of data. Conclusions. Imatinib is a new molecularly targeted therapy for the treatment of CML and GISTs. It has provided an efficacious alternative therapy choice for physicians managing the care of patients suffering from these diseases. In the future there is the possibility that imatinib may demonstrate activity in other disease states characterized by the genetic changes targeted by imatinib. The results of randomized controlled trials in new and existing indications are awaited.

Background: The main toxicity of irinotecan in advanced colorectal cancer (CRC) is delayed diarrhoea. Intestinal SN-38, released by deconjugation of the parent glucuronide excreted into the bile or produced in situ by intestinal carboxylesterase, is toxic to the intestinal epithelium. The canalicular transport of irinotecan and SN-38G is mediated by ABCC2 (MRP2) and ABCB1 (MDR1) which are both inhibited by ciclosporin. We tested whether irinotecan and ciclosporin was non-inferior for anti-cancer efficacy and superior for toxicity compared with single-agent irinotecan. Methods: Six hundred and seventy-two patients with advanced, measurable CRC following prior fluoropyrimidine-containing chemotherapy were randomised to either irinotecan 3-weekly 350 mg/m(2) (or 300 mg/m(2) if age >70 or performance status (PS) = 2) or 3-weekly irinotecan at 140 mg/m(2) (120 mg/m(2) if age >70 or PS = 2) with ciclosporin 3 mg/kg t.d.s. for three days by mouth starting on the morning before irinotecan. The primary end-point was the proportion of patients alive and progression-free at 12 weeks. The key secondary end-point was the incidence of grade >= 3 diarrhoea within 12 weeks of randomisation. Results: The proportion of patients progression-free at 12 weeks with irinotecan was 53.4% compared to 47.2% with irinotecan plus ciclosporin (difference = -6.3%, 95% confidence interval (CI) [-13.8%, 1.3%]). Since the lower limit of the 95% CI crossed the pre-specified non-inferiority margin of -10.6%, non-inferiority of irinotecan plus ciclosporin compared to irinotecan alone was not statistically demonstrated. 15.0% patients developed severe diarrhoea on irinotecan compared to 13.8% on irinotecan plus ciclosporin, a non-significant difference. Interpretation: The pharmacokinetic biomodulation of irinotecan using oral ciclosporin does not improve the therapeutic index of irinotecan in advanced CRC. Funding: The trial was funded by Cancer Research UK and supported by Amgen Pharma. (C) 2013 Elsevier Ltd. All rights reserved.

Summary.-The replacing of items correctly recalled during paired-associate learning gave no advantage to Ss over Ss who received completely new items on each trial. Superficially, this result appeared to support all-or-none theory, but item analyses show item difficulty to be a confounding factor. The failure of the drop-out paradigms to provide criucal tests of all-or-none predicdons is discussed. Rock (1957) revived the continuity-discontinuity of learning argument when he proposed an all-or-none theory of paired-associate learning. His experimental paradigm involved the replacement of incorrect items in a paired-associate list, and he found that Ss so treated took no more trials to criterion than Ss who repeated an unchanging list. He argued that learning of individual items in a list must take place on a single exposure of that item, that is, learning for separate items is all-or-none. Contrariwise, incremental theories claimed that the associative bonds between members of the S-R pairs build up gradually over repeated exposures until some sort of threshold for correct response is passed. Kristofferson (1961) gave Rock's original experiment a new twist when he had Ss learn lists of decreasing length though the dropping-out of items correctly recalled on the previous trial. His controls received entirely new lists of length equal to the number of items incorrectly recalled on the previous rrial. Incremental theory would predict better performance from Ss repeating items already seen, whereas all-or-none theory (and the null hypothesis) would predict no difference between groups. Experimentals were significantly better than controls. Rock and Steinfeld ( 1963) countered by not having Ss spell out responses as Kristofferson demanded and found no differences becween conditions, thereby claiming support for their all-or-none view. Rock and Steinfeld conceded that Kristofferson's study permitted valid tests of the theoretical dispute, but rhey had reservations about his design-"by discarding correct items after every trial, the list becomes increasingly short. This may change the nature of the task for the subject. Towards the end the list will contain only a few items which perhaps can be retained in immediate memory." The present experiment is designed to take account of Rock and Sceinfeld's criticism of the Kristofferson design. In this study one group (Repeats) receive new items substituted for those correctly recalled on the previous trial; items missed on a previous trial are retained so that lists remain the same length. A second group (Replacers) receive a completely new list on each trial. The number of trials to a criterion of errorless responding, or other common measures of performance cannot be taken here since neither experimental condition has the usual logical endpoint. Ss could be tested ad infiniturn as long as suitable S-R pairs were available. Instead, performance was assessed by errors