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Background: The extent to which type 2 diabetes (T2D) reduces life expectancy depends on the risk of complications. We aimed to characterise the relationship between risk factors for diabetes complications and life expectancy, in individuals with T2D, free from major chronic disease, in a regional database linked with national New Zealand health databases. Methods: A prospective cohort study design was employed, analysing data from individuals with T2D drawn from the comprehensive Diabetes Care Support Service database (1994–2018). Participants with known values for all five within-target risk factors (WTRF +) including blood pressure, glycaemia, and LDL cholesterol, alongside being non-smoking with normal renal function at baseline, were included. Life expectancy free from cardiovascular disease (CVD), cancer, and dementia at age 50 years was estimated using multistate life tables, adjusting for demographics and clinical metrics. Results: Women and men with no WTRF + at enrolment had a life expectancy free from CVD, cancer, or dementia of 13.1 (95% confidence interval: 9.1–19.0) and 11.2 (6.7–18.6) years, respectively. For the most socioeconomically deprived groups or Māori with no WTRF + at baseline, life expectancies were markedly lower. Life expectancies were 23.7 (18.9–29.7) years for women and 23.2 years (17.2–31.4) years for men with four or five WTRF + at baseline, respectively. While an increasing number of WTRF + at baseline was significantly associated with improved outcomes in men and certain subgroups (e.g. Other ethnicity group), this trend was not statistically significant for women overall or in most subgroups. Conclusions: Having multiple WTRF + at baseline is associated with a considerable increase in life expectancy free from major chronic disease among individuals with T2D. This highlights the importance of lifestyle and clinical interventions in the management of T2D and in the prevention and management of associated chronic conditions. [ABSTRACT FROM AUTHOR]

Simple Summary: Simple Summary: With the low demand for leather from sheepskin, New Zealand slaughterhouses dispose of most byproduct sheepskin from meat production as solid waste. This study aimed to develop a use for these sheepskins as a source of gelatin or collagen. Three extraction methods were evaluated. The extracted material was characterized for gelatin and collagen composition and structure. Sheepskin was found to be a useful alternative source of gelatin–collagen material. Abattoirs dispose of sheepskins as solid waste due to low price and poor demand for sheepskin leather. In principle, as an alternative to being disposed of in landfill, sheepskins can serve as a source of the protein collagen or the hydrolysis product, gelatin. In this research, sheepskins collected from abattoirs were used as a source of collagen. Three extraction methods were compared: acid extraction, acid with enzymes, and alkali extraction. The extracted material was characterized using scanning electron microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR), small angle X-ray scattering (SAXS), and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The collagen and gelatin extraction yield ranged from 3.1% to 4.8% with the product purity determined by hydroxyproline, ranging from 7.8% for the alkali process to 59% and 68% for the acid and acid-enzyme processes. SDS PAGE showed that the acid process produced fragments with molecular weights in the range 100 to >250 kDa, while acid–enzyme resulted in smaller fragments, below 30 kDa. The FTIR region of the amide I band at 1800–1550 cm−1, which was used as an indicator of the collagen and gelatin content, showed that the gelatin dominated in the acid extracts, and the alkaline extract contained a large portion of keratin. SAXS was found to be a sensitive method for showing the presence of intact collagen fibrils in materials from all of the extraction methods, albeit at low concentrations. Herein, sheepskin is shown to be a useful source for collagen–gelatin material of varying molecular weights. [ABSTRACT FROM AUTHOR]

Background: Health assessment tools developed using mainstream or Western concepts have been widely used in clinical practice worldwide. However, even culturally adapted or culturally based tools may not be relevant in other social contexts if they are grounded in Western beliefs and perspectives. The application of mainstream assessment tools, when used in Indigenous populations, can lead to the inappropriate application of normative data and inaccurate or biased diagnosis of conditions as Indigenous concepts of health differ from Western biomedical concepts of health. Thus, considering the need for culturally meaningful, sensitive, safe, and unbiased health assessment approaches and instruments over recent years, tools have been developed or adapted by and with Indigenous populations in Australia, Aotearoa/New Zealand, Canada, and the United States. However, there is no existing systematic or scoping review to identify the methods and approaches used in adapting or developing health assessment tools for use with the Indigenous population in Australia, Aotearoa/New Zealand, Canada, and the United States. Methods: In response to these gaps, we are working with a First Nations Community Advisory Group in Northern Ontario, Canada, to undertake a scoping review following the 2020 JBI methodology for scoping reviews. A systematic search will be conducted in PubMed, APA PsychINFO, CINAHL, MEDLINE, Web of Science, Bibliography of Native North Americans, Australian Indigenous Health info data set, and Indigenous Health Portal. Two reviewers will independently screen all abstracts and full-text articles for inclusion using criteria co-developed with an advisory group. We will chart the extracted information and summarize and synthesize the data. The summarized findings will be presented to a Community Advisory Group, including First Nations community partners, an Elder, and community members, and their feedback will be incorporated into the discussion section of the scoping review. Discussion: This scoping review involves iterative consultation with the Indigenous and non-Indigenous scholars, First Nations Community Advisory Group, and community partners throughout the research process. This review aims to summarize the evidence on standard ethical approaches and practices used in Indigenous research while adapting or developing health assessment tools. It will inform the larger study focused on developing an Indigenous Functional Assessment tool. Further, it will seek whether the Indigenous ways of knowing and equitable participation of Indigenous people and communities are incorporated in the Indigenous research process. Systematic review registration: Open Science Framework https://osf.io/yznwk. [ABSTRACT FROM AUTHOR]

Background: New Zealand (NZ) research into type 1 diabetes mellitus (T1DM) mortality can inform policy and future research. In this study we aimed to quantify the magnitude to which ethnicity and socioeconomic disparities influenced mortality at the population level among people with Type 1 diabetes (T1DM) in Auckland, New Zealand (NZ). Methods: The cohort data were derived from the primary care diabetes audit program the Diabetes Care Support Service (DCSS), and linked with national primary care, pharmaceutical claims, hospitalisation, and death registration databases. People with T1DM enrolled in DCSS between 1994–2018 were included. All-cause, premature, and cardiovascular mortalities were estimated by Poisson regression models with adjustment for population-level confounders. The mortality rates ratio (MRR) was standardized against the DCSS type 2 diabetes population. Mortality rates were compared by ethnic group (NZ European (NZE) and non-NZE) and socioeconomic deprivation quintile. The population attributable fraction (PAF) was estimated for ethnic and socioeconomic disparities by Cox regression adjusting for demographic, lifestyle, and clinical covariates. The adjusted slope index inequality (SII) and relative index of inequality (RII) were used to measure the socioeconomic disparity in mortalities. Results: Overall, 2395 people with T1DM (median age 34.6 years; 45% female; 69% NZE) were enrolled, among whom the all-cause, premature and CVD mortalities were 6.69 (95% confidence interval: 5.93–7.53), 3.30 (2.77–3.90) and 1.77 (1.39–2.23) per 1,000 person-years over 25 years. The overall MRR was 0.39 (0.34–0.45), 0.65 (0.52–0.80), and 0.31 (0.24–0.41) for all-cause, premature and CVD mortality, respectively. PAF attributable to ethnicity disparity was not significantly different for mortality. The adjusted PAF indicated that 25.74 (0.84–44.39)% of all-cause mortality, 25.88 (0.69–44.69)% of premature mortality, 55.89 (1.20–80.31)% of CVD mortality could be attributed to socioeconomic inequality. The SII was 8.04 (6.30–9.78), 4.81 (3.60–6.02), 2.70 (1.82–3.59) per 1,000 person-years and RII was 2.20 (1.94–2.46), 2.46 (2.09–2.82), and 2.53 (2.03–3.03) for all-cause, premature and CVD mortality, respectively. Conclusions: Our results suggest that socioeconomic disparities were responsible for a substantial proportion of all-cause, premature and CVD mortality in people with T1DM in Auckland, NZ. Reducing socioeconomic barriers to management and self-management would likely improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to examine socioeconomic inequality (SI) in cause-specific outcomes among adults with impaired glucose tolerance (IGT) and/or Impaired fasting glucose (IFG) in New Zealand (NZ) over 25 years.Patients and Methods: A population-based open cohort was derived from Diabetes Care Support Service in NZ with national databases linkage. Patients aged ≥ 18 years with IGT and/or IFG were enrolled between 01/01/1994 and 31/07/2018 and followed up until death or 31/12/2018. Incident outcomes (all-cause, premature, cardiovascular, and cancer death; cardiovascular, myocardial infarction, stroke, heart failure, and end-stage kidney disease hospitalization) by demographic, anthropometric, socioeconomic status, clinical measurements, enrol-time-periods, and IGT/IFG were evaluated. Adjusted incidence rate ratios, absolute risk difference, and SI measurements (slope and relative index of inequality) were estimated using Age-Period-Cohort models.Results: 29,894 patients (58.5 (SD 14.3) years mean age; 52.2% female) were enrolled with 5.6 (IQR: 4.4– 7.4) years of median follow-up. Mortality rates decreased, whereas hospitalization (except myocardial infarction) rates increased. SI was significant for each outcome. Higher mortality and hospitalization rates and worsened SI were common in men, older, the most deprived, and Māori patients, as well as patients with obesity, current smoking, with both IFG and IGT, and greater metabolic derangement (higher systolic blood pressure, lipids, and HbA1c, and lower level of mean arterial pressure).Conclusion: Enhanced management strategies are necessary for people with IGT and/or IFG to address persisting SI, especially for men, older people, current smokers, NZ European and Māori patients, patients with obesity, or with any abnormal metabolic measurements. [ABSTRACT FROM AUTHOR]

This paper provides a critique of academic experiences of neoliberal economic reform at a New Zealand (NZ) university. The authors engaged in a collaborative inquiry that was based upon a developing theoretical perspective of the reform process and how this affected their academic lives. We were keen to develop an understanding of liberal educational philosophy and how neoliberalism impacts on this. In this context we examined the nature of compliance and an academic's role in society. We conclude that universities in NZ are historically liberal and that there are limits to the neoliberal project due to the relationship that individuals have with knowledge and the pressures that come from being part of a worldwide academic community that aspires to excellence in research and teaching. However, new compliance measures, such as Performance-based Research Funding, have changed academic work and made a broader societal role for academics more difficult. In serving society universities are required to accept a role as critic and conscience of society. We suggest that academics must be both critic and conscience and that this responsibility can be fulfilled through our conduct, empowerment and speaking on behalf of others.

Background: This study aimed to examine the association between the incident onset of T2DM and 5- and 10-year risks of CVD and HF in people with IGT identified in primary care in South and West Auckland, New Zealand (NZ) between 1994 and 2019. Methods: We compared CVD and HF risks in patients with IGT and with/without T2D newly diagnosed within the exposure window (1–5 years). Tapered matching and landmark analysis (to account for immortal bias) were used to control for potential effects of known confounders. Results: Among 26,794 patients enrolled with IGT, 845 had T2D newly diagnosed within 5 years from enrolment (landmark date) and 15,452 did not have T2D diagnosed. Patients progressing to T2D (vs. those not progressing) had a similar 5-year risk for CVD (hazard ratio 1.19; 95% CI 0.61–2.32) but significantly higher 10-year risk of CVD (2.45(1.40–4.29)), 5-year risk of HF (1.94(1.20–3.12)) and 10-year risk of HF (2.84(1.83–4.39). The association between the onset of T2D and risk of 10-year risk of CVD, 5-year and 10-year risk of HF was more likely among men, the socioeconomically deprived, those currently smoking, patients with higher metabolic measures and/or those with lower renal function. Patients of NZ European ethnicity had a lower 10-year risk of CVD. Conclusions: The study suggests that the diagnosis of T2D mediates the risk of CVD and HF in people with IGT. The development of risk scores to identify and better manage individuals with IGT at high risk of T2D is warranted. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to examine the separate population-level contributions of the ethnic and socioeconomic disparities among people with type 2 diabetes mellitus (T2DM) and residence in New Zealand (NZ). Patients and Methods: A prospective cohort enrolled T2DM patients from 01/01/1994 into the Diabetes Care Support Service, a primary care audit program in Auckland, NZ. The cohort was linked to national registry databases (socioeconomic status, pharmaceutical claim, hospitalization, and death registration). Each cohort member was followed up till death or the study end time (31/12/2019), whichever came first. Incident clinical events (stroke, myocardial infarction (MI), heart failure (HF), end-stage renal disease (ESRD), and premature mortality (PM)) were used as outcomes. The attributable fractions (AFs) were estimated for the whole population and for specific population with NZ Europeans (NZE) and/or least deprived population as reference, both unadjusted and with adjustment for covariables by Cox Regression models. Results: Among 36,267 patients, adjusted population AFs indicated 6.6(− 30.8– 33.3)% of PM, 17.1(5.8– 27.0)% of MI, 35.3(22.6– 46.0)% of stroke, 14.3(3.2– 24.2)% of HF, and 15.9(6.7– 24.2)% of ESRD could be attributed to deprivation; while 14.3(3.3– 25.4)% of PM, − 3.3(− 8.3– 1.5)% of MI, − 0.5(− 6.7– 5.3)% of stroke, 4.7(0.3– 8.8)% of HF, 13.3(9.9– 16.6)% of ESRD could be attributed to ethnicity. Deprivation contributed a significant AF to stroke, while ethnicity was important for ESRD. Gradient of AF for deprivation indicated NZE and Asians were most affected by deprivation across outcomes. Conversely, Māori, with the highest AFs for ethnicity of PM and ESRD, were unaffected by deprivation. At same deprivations, the AFs of MI and stroke were greatest among NZE compared with other ethnic groups; the AF of ESRD was greatest among Māori and Pasifika. Conclusion: Both socioeconomic deprivation and ethnicity are strongly associated with outcomes in patients with T2DM in NZ, although the extent of the deprivation gradient is greatest among NZE and Asians, and least among Māori. [ABSTRACT FROM AUTHOR]

Introduction. The rural accelerated chest pain pathway (RACPP) has been shown to safely reduce the number of transfers to hospital for patients who present with chest pain to rural general practice. Aim. This study aimed to estimate the costs associated with assessing patients with low-risk chest pain using the RACPP in rural general practice compared with transporting such patients to a distant emergency department (ED). Methods. This was a retrospective cost minimisation analysis. All patients with low-risk chest pain that were assessed in New Zealand (NZ) rural general practice using the RACPP between 1 June 2018 and 31 December 2019 were asked to participate. The costs incurred by patients were determined by an online survey. Patients were also asked to estimate the costs if they would have been transferred to ED. System costs were obtained from the relevant healthcare organisations. The main outcome measure was the total cost for patients who present with low-risk chest pain. Results. In total, 15 patients (22.7% response rate) responded to the survey. Using the RACPP in general practice resulted in a median cost saving of NZ$1184 (95% CI: $1111 to $1468) compared with transferring the same patient to ED. Discussion. Although limited by low enrolment, this study suggests that there are significant savings if the RACPP is used to assess patients with low-risk chest pain in rural NZ general practice. [ABSTRACT FROM AUTHOR]

This paper investigates the potential of recycling waste copper chromium and arsenic (CCA)-treated timber for use as a reinforcement material in wood–plastic composites (WPCs) produced for use in construction, including an assessment of mechanical properties and the leaching of heavy metals. Wood flour was obtained through mechanical grinding, and fibres were obtained through alkaline digestion followed by bleaching. Composites produced with 40 wt.% bleached fibres showed increased tensile strength from 18.5 MPa for the polypropylene used as the matrix to 27.6 MPa. Likewise, the Young's modulus was increased from 0.84 to 2.33 GPa. The treatment of fibres was found to reduce arsenic concentration by up to 99.9%. Furthermore, the arsenic in the leachate from composites was found to decrease from 41.29 to 0.07 ppb when comparing CCA-treated wood flour composites to bleached fibre composites. The composites' material properties indicate that the use of end-of-life CCA-treated timber could be used to produce a composite material that could be used in New Zealand's building sector to meet the requirements of semi-structural applications. [ABSTRACT FROM AUTHOR]

Background: Peripheral neuropathy is a common complication of diabetes. The management of the associated neuropathic pain remains difficult to treat. Objective: This study explored the safety, tolerability and efficacy of a palmitoylethanolamide (PEA) formulation in treating diabetic-related peripheral neuropathic pain (PNP). Secondary outcomes included systemic inflammation, sleep and mood changes in patients diagnosed with type 1 and type 2 diabetes and PNP. Design: This study was a single-centre, quadruple-blinded, placebo-controlled trial with 70 participants receiving 600 mg of PEA or placebo daily, for 8 weeks, with a 94% rate of study participation completion. Primary outcomes were neuropathic pain and specific pain types (the BPI-DPN and NPSI). The secondary outcomes were sleep quality (MOS sleep scale), mood (DASS-21), glucose metabolism and inflammation. Results: There was a significant reduction (P ≤ 0.001) in BPI-DPN total pain and pain interference, NPSI total score and sub-scores, except for evoked pain (P = 0.09) in the PEA group compared with the placebo group. The MOS sleep problem index and sub-scores significantly improved (P ≤ 0.001). DASS-21 depression scores significantly reduced (P = 0.03), but not anxiety or stress scores. Interleukin-6 and elevated C-reactive protein levels significantly reduced in the PEA group (P = 0.05), with no differences in fibrinogen between groups (P = 0.78) at treatment completion. There were no changes in safety pathology parameters, and the treatment was well tolerated. Conclusions: The study demonstrated that the PEA formulation reduced diabetic peripheral neuropathic pain and inflammation along with improving mood and sleep. Further studies on the mechanistic effectiveness of PEA as an adjunct medicine and as a monotherapy pain analgesic are warranted. Clinical Trial Registration: Registry name: Australian New Zealand Clinical Trials Registry (ANZCTR), Registration number: ACTRN12620001302943, Registration link: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380826, Actual study start date: 20 November 2020. [ABSTRACT FROM AUTHOR]

Enteric methane emissions from ruminants account for ∼35% of New Zealand’s greenhouse gas emissions. This poses a significant threat to the pastoral sector. Breeding has been shown to successfully lower methane emissions, and genomic prediction for lowered methane emissions has been introduced at the national level. The long-term genetic impacts of including low methane in ruminant breeding programs, however, are unknown. The success of the New Zealand sheep industry is currently heavily reliant on the prolificacy, fecundity and survival of adult ewes. The objective of this study was to determine genetic and phenotypic correlations between adult maternal ewe traits (live weight, body condition score, number of lambs born, litter survival to weaning, pregnancy scanning and fleece weight), faecal and Nematodirus egg counts and measures of methane in respiration chambers. More than 9,000 records for methane from over 2,200 sheep measured in respiration chambers were collected over 10 years. Sheep were fed on a restricted diet calculated as approximately twice the maintenance. Methane measures were converted to absolute daily emissions of methane measured in g per day (CH4/day). Two measures of methane yield were recorded: the ratio of CH4 to dry matter intake (g CH4/kg DMI; CH4/DMI) and the ratio of CH4 to total gas emissions (CH4/(CH4 + CO2)). Ewes were maintained in the flocks for at least two parities. Non-methane trait data from over 8,000 female relatives were collated to estimate genetic correlations. Results suggest that breeding for low CH4/DMI is unlikely to negatively affect faecal egg counts, adult ewe fertility and litter survival traits, with no evidence for significant genetic correlations. Fleece weight was unfavourably (favourably) correlated with CH4/DMI (rg = −0.21 ± 0.09). Live weight (rg = 0.3 ± 0.1) and body condition score (rg = 0.2 ± 0.1) were positively correlated with methane yield. Comparing the two estimates of methane yield, CH4/DMI had lower heritability and repeatability. However, correlations of both measures with adult ewe traits were similar. This suggests that breeding is a suitable mitigation strategy for lowering methane yield, but wool, live weight and fat deposition traits may be affected over time and should be monitored. [ABSTRACT FROM AUTHOR]

Global agreements in place to reduce methane emissions in livestock are a potential threat to food security. Successful but independent breeding strategies for improved production and lower methane are in place. The unanswered questions are whether these strategies can be combined and how they impact one another, physically and economically. The New Zealand economy is largely dependent on pastoral agriculture from grazing ruminants. The sheep industry produces ~20 million lamb carcasses for export each year primarily from grass. Methane emitted from the fermentation of forage by grazing ruminants accounts for one-third of all New Zealand's greenhouse gas emissions. Here, we use sheep selection lines bred for divergent methane production and large numbers of their relatives to determine the genetic and phenotypic correlations between enteric methane emissions, carcass yield, and meat quality. The primary objectives were to determine whether previously shown physiological differences between methane selection lines (differing by ~12% in methane) result in a negative impact on meat production and quality by measuring close relatives. The results show no negative effects of breeding for lowered methane on meat and carcass quality. Gross methane emissions were highly correlated with liveweight and measures of carcass weight and negatively correlated with dressing-out percentage and fat yield (GR). Trends were similar but not significant for methane yield (g CH4/kg DMI). Preliminary evidence, to date, shows that breeding for low methane may result in animals with higher lean yields that are economically favorable even before carbon costs and environmental benefits are taken into account. These benefits were seen in animals measured for methane on fixed intakes and require validation on intakes that are allowed to vary. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study explored the genetic variability in the New Zealand sheep population for economically important skin traits. Skins were collected at slaughter from two progeny test flocks, resulting in 725 skins evaluated for grain strain, flatness, crust leather strength and overall suitability for shoe leather. DNA profiles collected from skins post‐slaughter were matched to individual animals using previously collected high‐density genotypes. RESULTS: Considerable phenotypic variation for skin traits was observed, with around 40% of the skins being identified as suitable for high‐value shoe leather production. Several key traits associated with leather production, including flatness, tear strength, grain strength and grain strain were found to be moderate to highly heritable (h2 = 0.28–0.82). There were no major significant genome‐wide association study (GWAS) peaks associated with many of the traits examined, however, one single‐nucleotide polymorphism (SNP) reached significance for the flatness of the skin over the hindquarters. CONCLUSION: This research confirms that suitable lamb skins can be bred for use as high‐value shoe leather. While moderately to highly heritable, skin traits in New Zealand lambs appear to be polygenic with no genes of major effect underlaying the traits of interest. Given the complex nature of these traits, the identification and selection of animals with higher‐value skins may be enabled by geomic selection. © 2022 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Background a Frailty Index (FI) calculated by the accumulation of deficits is often used to quantify the extent of frailty in individuals in specific settings. This study aimed to derive a FI that can be applied across three standardised international Residential Assessment Instrument assessments (interRAI), used at different stages of ageing and the corresponding increase in support needs. Methods deficit items common to the interRAI Contact Assessment (CA), Home Care (HC) or Long-Term Care Facilities assessment (LTCF) were identified and recoded to form a cumulative deficit FI. The index was validated using a large dataset of needs assessments of older people in New Zealand against mortality prediction using Kaplan Meier curves and logistic regression models. The index was further validated by comparing its performance with a previously validated index in the HC cohort. Results the index comprised 15 questions across seven domains. The assessment cohort and their mean frailty (SD) were: 89,506 CA with 0.26 (0.15), 151,270 HC with 0.36 (0.15) and 83,473 LTCF with 0.41 (0.17). The index predicted 1-year mortality for each of the CA, HC and LTCF, cohorts with area under the receiver operating characteristic curves (AUCs) of 0.741 (95% confidence interval, CI: 0.718–0.762), 0.687 (95%CI: 0.684–0.690) and 0.674 (95%CI: 0.670–0.678), respectively. Conclusions the results for this multi-instrument FI are congruent with the differences in frailty expected for people in the target settings for these instruments and appropriately associated with mortality at each stage of the journey of progressive ageing. [ABSTRACT FROM AUTHOR]

Background Little is known about the prevalence of frailty in indigenous populations. We developed a frailty index (FI) for older New Zealand Māori and Pasifika who require publicly funded support services. Methods An FI was developed for New Zealand adults aged 65 and older who had an interRAI Home Care assessment between June 1, 2012 and October 30, 2015. A frailty score for each participant was calculated by summing the number of deficits recorded and dividing by the total number of possible deficits. This created a FI with a potential range from 0 to 1. Linear regression models for FIs with ethnicity were adjusted for age and sex. Cox proportional hazards models were used to assess the association between the FI and mortality for Māori, Pasifika, and non-Māori/non-Pasifika. Results Of 54 345 participants, 3096 (5.7%) identified as Māori, 1846 (3.4%) were Pasifika, and 49 415 (86.7%) identified as neither Māori nor Pasifika. New Zealand Europeans (48 178, 97.5%) constituted most of the latter group. Within each sex, the mean FIs for Māori and Pasifika were greater than the mean FIs for non-Māori and non-Pasifika, with the difference being more pronounced in women. The FI was associated with mortality (Māori subhazard ratio [SHR] 2.53, 95% CI 1.63–3.95; Pasifika SHR 6.03, 95% CI 3.06–11.90; non-Māori and non-Pasifika SHR 2.86, 95% CI 2.53–3.25). Conclusions This study demonstrated differences in FI between the ethnicities in this select cohort. After adjustment for age and sex, increases in FI were associated with increased mortality. This suggests that FI is predictive of poor outcomes in these ethnic groups. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Accelerated diagnostic chest pain pathways are used widely in urban New Zealand hospitals. These pathways use laboratory-based troponin assays with good analytical precision. Widespread implementation has not occurred in many of New Zealand's rural hospitals and general practices as they are reliant on point-of-care troponin assays, which are less sensitive and precise. An accelerated chest pain pathway using point-of-care troponin has been adapted for use in rural settings. A pilot study in a low-risk rural population showed no major adverse cardiac events at 30 days. A larger study is required to be confident that the pathway is safe. AIMS: To assess the safety and effectiveness of an accelerated chest pain pathway adapted for rural settings and general practice using point-of-care troponin to identify low-risk patients and allow early discharge. METHODS: This is a prospective observational study of an accelerated chest pain pathway using point-of-care troponin in rural hospitals and general practices in New Zealand. A total of 1000 patients, of whom we estimate 400 will be low risk, will be enrolled in the study. OUTCOME MEASURES: The primary outcome is the proportion of patients identified by the pathway as low risk for a 30-day major adverse cardiac event. Secondary outcomes include the proportion of low-risk patients who were discharged directly from general practice or rural hospitals, the proportion of patients reclassified as having acute myocardial infarction by the pathway and the proportion of patients with low and intermediate risk safely managed in the rural hospital. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that polymorphisms within CYP1A2 impact inter-individual variation in the response to caffeine. The purpose of this study was to explore the acute effects of caffeine on resistance exercise, jumping, and sprinting performance in a sample of resistance-trained men, and to examine the influence of genetic variation of CYP1A2 (rs762551) on the individual variation in responses to caffeine ingestion. Methods: Twenty-two men were included as participants (AA homozygotes n = 13; C-allele carriers n = 9) and were tested after the ingestion of caffeine (3 mg/kg of body mass) and a placebo. Exercise performance was assessed with the following outcomes: (a) movement velocity and power output in the bench press exercise with loads of 25, 50, 75, and 90% of one-repetition maximum (1RM); (b) quality and quantity of performed repetitions in the bench press exercise performed to muscular failure with 85% 1RM; (c) vertical jump height in a countermovement jump test; and (d) power output in a Wingate test. Results: Compared to placebo, caffeine ingestion enhanced: (a) movement velocity and power output across all loads (effect size [ES]: 0.20–0.61; p < 0.05 for all); (b) the quality and quantity of performed repetitions with 85% of 1RM (ES: 0.27–0.85; p < 0.001 for all); (c) vertical jump height (ES: 0.15; p = 0.017); and (d) power output in the Wingate test (ES: 0.33–0.44; p < 0.05 for all). We did not find a significant genotype × caffeine interaction effect (p-values ranged from 0.094 to 0.994) in any of the analyzed performance outcomes. Conclusions: Resistance-trained men may experience acute improvements in resistance exercise, jumping, and sprinting performance following the ingestion of caffeine. The comparisons of the effects of caffeine on exercise performance between individuals with the AA genotype and AC/CC genotypes found no significant differences. Trial registration: Australian New Zealand Clinical Trials Registry. ID: ACTRN12619000885190. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Adolescents' uptake of long-acting reversible contraceptives (LARCs) in New Zealand is low. We created the concept of a proactive LARC provision programme to overcome barriers to LARC uptake. Previously, this concept was discussed with adolescents and positively received. Lack of provider awareness is a barrier to LARC use identified in previous research and by adolescents. AIM: We sought the views of general practitioners (GPs) to gauge whether LARCs and their proactive promotion for use in adolescents may be acceptable to GPs. METHODS: Nine New Zealand GPs were interviewed about their contraception provision to adolescents and were then asked to comment on the concept of a proactive LARC provision programme. The data collected were transcribed and analysed using a general inductive approach to identify common themes and ideas. We concurrently interviewed and analysed interviews and continued to recruit GPs until thematic saturation was reached. RESULTS: Six themes were identified from the interviews: (1) contraceptive decision making; (2) the GP role; (3) sexual activity; (4) social context; (5) gauging adolescent understanding; and (6) youth. When we proposed the concept of a proactive LARC provision programme, the GPs responded positively. DISCUSSION: The research demonstrates that LARC uptake is affected by limited provider awareness. These findings align with other research internationally that identifies barriers to adolescent contraceptive use. The findings of this study suggest that other GPs may support a proactive LARC provision programme in New Zealand. [ABSTRACT FROM AUTHOR]

In New Zealand, there are adolescents who are at risk of pregnancy and who do not want to become pregnant, but are not using contraception. Cost and other barriers limit access to contraception. To address the gap between contraceptive need and contraceptive access, this paper puts forward the concept of proactive contraception provision, where adolescents are offered contraceptives directly. To strengthen the case for proactive contraception provision, this paper addresses a series of potential objections. One is that such a programme would cause harm; another that such a programme would not have sufficient benefit. In rebutting these objections, the conclusion is reached that proactive contraception provision is a model worth pursuing as a means of meeting the needs of the New Zealand adolescent population and may be of interest more widely. [ABSTRACT FROM AUTHOR]

High adolescent pregnancy rates in New Zealand (NZ) are influenced by limited access to contraception. In this paper, we discuss using a proactive contraception provision (PCP) model to overcome barriers that prevent effective contraceptive uptake. After outlining steps taken to assess acceptability of PCP in NZ, we cover three issues to consider with PCP: the range of contraceptives that should be offered, the age range that should be approached, and finally whether to include adolescents without uteruses. We conclude that PCP is an approach worth considering in the NZ context and should be piloted to assess feasibility and effectiveness. [ABSTRACT FROM AUTHOR]

Similar to other livestock species, sheep are subject to a range of structural faults that contribute to lameness and involuntary culling. Recordkeeping in the sheep industry is generally sparse, particularly for structural traits; thus, the extent of the problem is ill-defined. Furthermore, the few studies centered on foot and leg structure have typically involved small numbers of animals measured only once. Consequently, estimates of heritability for pasterns, and for claw and hoof conformation scores in sheep are sparse in the literature, with little consideration of potential score changes across an animal's lifetime. Using a large dataset of repeatedly-measured scores, our objective was to reliably estimate the heritability and repeatability of several foot and leg traits indicative of structural soundness. Pedigree and performance data on 28,300 commercial crossbreed ewes were supplied by Focus Genetics, Ltd., New Zealand. The subjective foot and leg scores were recorded multiple times from first lambing to culling, with as many as 5 sets of records collected on individual ewes. The conformation traits evaluated were overall foot and leg conformation, rear pastern angles, front pastern angles, rear claw and hoof shapes, and front claw and hoof shapes. We fitted a repeatability model with fixed effects of recording age, age of dam, birth rank, rearing rank, heterosis (as a covariate), and contemporary group defined as the combination of birth year, birth flock, and recording mob. Random effects were direct additive, permanent environment, and residual. Heritability estimates ranged between 0.05 ± 0.01 for front claw and hoof shape score to 0.18 ± 0.01 for front pastern angle score. The corresponding repeatability estimates ranged from 0.13 ± 0.01 to 0.30 ± 0.01. The heritabilities estimated in our study were very similar to those obtained by Sheep Improvement Ltd., New Zealand; their estimates varied from 0.06 to 0.20 for the same traits. Based on the low heritability and moderate repeatability for these traits, culling animals based on their first recorded structural foot and leg scores may be risky. However, through their incorporation into a designed breeding program, genetic selection offers a viable approach to improve structural soundness in sheep. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Early discharge of patients with presentations triggering assessment for possible acute coronary syndrome (ACS) is safe when clinical assessment indicates low risk, biomarkers are negative, and electrocardiograms (ECGs) are nonischemic. We hypothesized that the Emergency Department Assessment of Chest Pain Score (EDACS) combined with a single measurement of high‐sensitivity cardiac troponin (hs‐cTn) could allow early discharge of a clinically meaningful proportion of patients. Methods: We pooled data from four patient cohorts from New Zealand and Australia presenting to an emergency department with symptoms suggestive of ACS. The primary outcome was major adverse cardiac events (MACE) within 30 days of presentation. In patients with a nonischemic ECG we evaluated the sensitivity for MACE and percentage low risk of every combination of high‐sensitivity cardiac troponin T (hs‐cTnT) concentration and high‐sensitivity cardiac troponin I (hs‐cTnI) concentration with EDACS. We used a standard smoothing technique on the probability density function for hs‐cTn and EDACS and applied bootstrapping to determine the optimal threshold combinations, namely, the combination that maximized the percentage low risk with ≥98.5% sensitivity for MACE. Results: From 2,536 patients, 2,258 presented without an ischemic ECG of whom 272 (12.1%) had a MACE within 30 days. The optimal threshold for hs‐cTnI was 7 ng/L combined with an EDACS threshold of 16 (36.8% patients low risk). The optimal thresholds for hs‐cTnT were 8 ng/L combined with an EDACS threshold of 15 (30.2% patients low risk). Conclusion: Single measurements of both hs‐cTnI and hs‐cTnT at presentation combined with EDACS to identify over 30% of patients as low risk and therefore eligible for safe early discharge after only one blood draw. [ABSTRACT FROM AUTHOR]

Background: Knowledge about the genetic diversity of a population is a crucial parameter for the implementation of successful genomic selection and conservation of genetic resources. The aim of this research was to establish the scientific basis for the implementation of genomic selection in a composite Terminal sheep breeding scheme by providing consolidated linkage disequilibrium (LD) measures across SNP markers, estimating consistency of gametic phase between breed-groups, and assessing genetic diversity measures, such as effective population size (Ne), and population structure parameters, using a large number of animals (n = 14,845) genotyped with a high density SNP chip (606,006 markers). Information generated in this research will be useful for optimizing molecular breeding values predictions and managing the available genetic resources. Results: Overall, as expected, levels of pairwise LD decreased with increasing distance between SNP pairs. The mean LD r2 between adjacent SNP was 0.26 ± 0.10. The most recent effective population size for all animals (687) and separately per breed-groups: Primera (974), Lamb Supreme (380), Texel (227) and Dual-Purpose (125) was quite variable. The genotyped animals were outbred or had an average low level of inbreeding. Consistency of gametic phase was higher than 0.94 for all breed pairs at the average distance between SNP on the chip (~4.74 kb). Moreover, there was not a clear separation between the breed-groups based on principal component analysis, suggesting that a mixed-breed training population for calculation of molecular breeding values would be beneficial. Conclusions: This study reports, for the first time, estimates of linkage disequilibrium, genetic diversity and population structure parameters from a genome-wide perspective in New Zealand Terminal Sire composite sheep breeds. The levels of linkage disequilibrium indicate that genomic selection could be implemented with the high density SNP panel. The moderate to high consistency of gametic phase between breed-groups and overlapping population structure support the pooling of the animals in a mixed training population for genomic predictions. In addition, the moderate to high Ne highlights the need to genotype and phenotype a large training population in order to capture most of the haplotype diversity and increase accuracies of genomic predictions. The results reported herein are a first step toward understanding the genomic architecture of a Terminal Sire composite sheep population and for the optimal implementation of genomic selection and genome-wide association studies in this sheep population. [ABSTRACT FROM AUTHOR]

Objective: International guidelines to rule-in acute myocardial infarction (AMI) in patients presenting with chest pain to the emergency department (ED) recommend an algorithm using high-sensitivity cardiac troponin (hs-cTn) sampling on presentation and 3 h following presentation. We tested the diagnostic accuracy of this algorithm by pooling data from five distinct cohorts from three countries of prospectively recruited patients with independently adjudicated outcomes.Method: We measured high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) on presentation (0 h) and 3 h post-presentation samples in adult patients attending an ED with possible AMI to validate the European Society of Cardiology (ESC) Working Group on Acute Cardiac Care rule-in algorithm (ESC-rule-in). Specifically, (i) in patients with a 0 h hs-cTn concentration ≤99th percentile and a 3 h hs-cTn >99th percentile, positive patients are those with an absolute change in troponin ≥50% of the 99th percentile, and (ii) in patients with a 0 and 3 h hs-cTn >99th percentile, positive patients are those with a relative change in troponin of ≥20%. We concurrently assessed the efficacy of the 0 and 3 h hs-cTn <99th percentile to rule-out AMI.Results: 1061 patients with hs-cTnI and 985 with hs-cTnT were included. The ESC-rule-in positive predictive value (PPV) was 83.5% (95% CI 74.9% to 90.1%) for hs-cTnI and 72.0% (95% CI 62.1% to 80.5%) for hs-cTnT. Forty-six AMIs (34.9%) were not ruled in using hs-cTnI and 62 (46.2%) using hs-cTnT. The sensitivity of the 99th percentile to rule-out AMI was 93.2% (95% CI 87.5% to 96.8%) for hs-cTnI and 94.8% (95% CI 89.5% to 97.9%) for hs-cTnT.Conclusions: The ESC-rule-in algorithm has good PPV with hs-cTnI and reasonable with hs-cTnT and can rule-in over 50% of AMIs. However, the sensitivity of the 99th percentile to rule-out AMI is too low for clinical use. [ABSTRACT FROM AUTHOR]

Objective: To validate the National Institute for Health and Care Excellence (NICE) recommended algorithms for high-sensitivity troponin (hsTn) assays in adults presenting with chest pain.Methods: International post hoc analysis of three prospective, observational studies from tertiary hospital emergency departments. The primary endpoint was cardiac death or acute myocardial infarction (AMI) within 24 hours of presentation, and the secondary endpoint was major adverse cardiac events (MACE) at 30 days.Results: 15% of patients were diagnosed with non-ST elevation myocardial infarction (MI) on admission. The hsTnI algorithm classified 2506/3128 (80.1%) of patients as 'ruled out' with 50 (2.0%) missed MI. 943/3128 (30.1%) of patients had a troponin I level below the limit of detection on admission with 2 (0.2%) missed MI. For the hsTnT algorithm, 1794/3374 (53.1%) of patients were 'ruled out' with 7 (0.4%) missed MI. 490/3374 (14.5%) of patients had a troponin T below the limit of blank on admission with no MI. MACE at 30 days occurred in 10.7% and 8.5% of patients 'ruled out' defined by the hsTnI and hsTnT algorithms, respectively.Conclusions: The NICE algorithms could identify patients with low probability of AMI within 2 hours; however, neither strategy performed as predicted by the NICE diagnostic guidance model. Additionally, the rate of MACE at 30 days was sufficiently high that the algorithms should only be used as one component of a more extensive model of risk stratification.Trial Registration Number: ACTRN12611001069943, NCT00470587; post-results. [ABSTRACT FROM AUTHOR]

Genetic and phenotypic parameters were estimated for production and disease traits (including dagginess) from about 2 million pedigree-recorded animals born between 1990 and 2008 in New Zealand dual-purpose ram breeding flocks. This is the most comprehensive study of genetic parameter estimates for the New Zealand sheep industry to date and includes estimates that have not previously been reported. Estimates of heritability were moderate for BW at 8 mo (LW8), fleece weight at 12 mo (FW12), dagginess score at 3 and 8 mo (DAG3, DAG8; 0.31 to 0.37), typical for weaning weight (WWT), fecal egg count in summer (FEC1) and autumn (FEC2), and analogous Nematodirus counts (NEM1, NEM2; 0.17 to 0.21), and low for number of lambs born to ewes (NLB; 0.09). The genetic correlations among production traits, WWT, LW8, and FW12, were positive and moderate to high. Correlations of DAG3 and DAG8 with production and disease traits were low and mostly negative. The NLB had low, but typically positive, correlations with other traits. Disease traits also had low, but positive, correlations with production traits (WWT, LW8, and FW12), and were highly correlated among themselves. In general, the heritability estimate for BW and dagginess were greater than what is currently used in the New Zealand genetic evaluation service (Sheep Improvement Limited), and the availability of accurate estimates for dagginess plus parasite resistance and their genetic correlations with production traits will enable more accurate breeding values to be estimated for New Zealand sheep. [ABSTRACT FROM AUTHOR]

The author discusses parallels between two 19th century immigrants to Australia and New Zealand and he compares their stories to the current immigration situation in both countries. William Ashton was originally from Yorkshire, England and was transported to Australia for "riot and sedition." After many travels, he eventually settled down in Australia. Henry Samuel Chapman was born in London, England and became a lawyer and was active in Great Britain's government.

The effects of poly[methylene (polyphenyl isocyanate)] (PMPPIC) and maleated polypropylene (MAPP) coupling agents, separately and combined, on the strength and Young's modulus of New Zealand radiata pine-reinforced polypropylene (PP) composites were assessed. A modest improvement compared to the unreinforced matrix strength of 4% and much greater improvement of 123%, substantially greater than reported elsewhere in the literature, were obtained using PMPPIC and MAPP respectively. Young's modulus improvements compared to the unreinforced matrix of 77 and 177% were obtained using PMPPIC and MAPP respectively. The MAPP coupling agents with the longest chain lengths and lower functionality gave the greatest benefit, supporting chain entanglement as the major mechanism for enhanced bonding with PP. Relatively high moulding temperatures and low injection pressures, bringing about enhancement of fiber orientation in the test direction, also appear to have contributed to such large improvements in composite properties in the current work. Combination of PMPPIC and MAPP coupling agents produced mixed results: benefits were obtained by combining PMPPIC and MAPP with the longest chain lengths which can be explained by PMPPIC bonding with hydroxyl groups not accessible to further coupling with MAPP once saturation is achieved. [ABSTRACT FROM AUTHOR]

Pyrenophora semeniperda (anamorph Drechslera campanulata) causes a minor leaf spot and seed infection of at least 36 genera of annual or perennial grasses and has been recorded on several dicotyledonous species. The fungus causes distinctive 'ring spot' leaf lesions, 1–4 mm in size with a light-coloured centre and dark-brown margin. It also produces prominent black stromata up to several centimetres long from germinating seeds. Thus, although it is a relatively uncommon fungus, it is unlikely to be overlooked. The current world distribution is in temperate grasslands and cereal growing areas of Argentina, Australia, Canada, Egypt, New Zealand, South Africa and the United States of America: there are no definite records from Europe or Asia. Reports of its epidemiology are reviewed to show that the fungus is unlikely to be more than a minor leaf and seed disease. It is readily seed-borne on a wide range of cereals and grasses that are traded internationally, so there have been many opportunities for it to spread beyond the limits of its natural distribution. There are no reports of economic losses associated with P. semeniperda. Although the pathogen produces highly toxic compounds, there have been no definitive reports of ill health in animals that have grazed pastures with natural levels of leaf infection of P.'semeniperda. [ABSTRACT FROM AUTHOR]

As a subject, market segmentation has a long, debated history in marketing literature. Its application to the wine industry seems to be in its infancy and needing careful assessment. This paper examines various approaches to market segmentation as applied in the wine industry. Also discussed is information on, and an assessment of, a behavioural segmentation study conducted on a sample of New Zealanders. The basis for this information is a mail survey of 1144 randomly selected potential respondents. Respondents were drawn from a national wine mailing list (n=640) and staff (n=304) and students (n=200) from a tertiary institute. No follow-up activity was undertaken and a 28% response rate was achieved. A range of behavioural and demographic information was collected. In particular, participants were asked to indicate on average how many bottles of wine they purchased per month. This information forms the basis of segmenting on volumes purchased and, together with other behavioural information, combines to form profiles of wine consumers. Significant differences were found between light, medium and heavy purchasers of wine for several characteristics. While the segmentation platform provides some useful information, its use highlights the absence of other pertinent information. It is concluded that underlying reasons or motivations contributing to group membership would enrich the behavioural segmentation platform. [ABSTRACT FROM AUTHOR]

Objectives: The Land Transport Act 1998 of New Zealand requires that medical practitioners must inform the Director of Land Transport if a patient they examine has a mental or physical condition that indicates that the patient should not be permitted to drive. The guidelines issued by the Land Transport Safety Authority (LTSA) for clinicians assessing a consumer's fitness to drive are under review. The current guidelines for such assessment are controversial. This paper aims to review the evidence for various factors that psychiatrists should consider when assessing a mental health consumer's fitness to drive. Conclusions: The assessment of fitness to drive should be based on clinical factors and not on diagnosis alone or the legal status of the consumer, as stipulated in the current guidelines. We offer several recommendations regarding the psychiatrist's role in the new guidelines. [ABSTRACT FROM AUTHOR]

Background Type 2 Diabetes (T2DM) affects different populations disproportionately including in New Zealand (NZ), where long-term temporal trends in cause-specific clinical outcomes between Māori, European and Pacific people remain unclear. Methods Data from patients with T2DM, aged 35-84 years enrolled 1994-2018 in a NZ primary care audit programme (the Diabetes Care Support Service) were linked with national death registration, hospitalisation, pharmaceutical claims and primary care databases. Cause-specific death and hospitalisation rates were adjusted for gender, age, smoking, obesity, social-economic status and time periods by age-period-cohort models. Results Overall, 79,912 (50.6% female, mean-age 56±15 years, median follow-up 9.7 years) patients with T2DM were enrolled. For Europeans vs Māori, adjusted incidence rates ratio (IRR) and absolute risk difference /1000 person-years were 1.96 (95% CI: 1.80- 2.14) and 22.85 (19.93-25.77) for all-cause mortality, 1.93 (1.63-2.29) and 6.97 (5.14-8.80) for cardiovascular (CVD) mortality, 1.64 (1.40-1.93) and 3.08 (2.25-3.92) for cancer mortality, 1.26 (1.25-1.28) and 42.70 (41.32-44.08) for CVD hospitalisation, 1.31 (1.28-1.34) and 44.76 (42.37-47.15) for cancer hospitalisation, 2.05 (1.96-2.14) and 31.44 (29.67-33.21) for end-stage renal disease (ESRD) hospitalisation. Pacific rates were significantly less than Māori, but higher than Europeans for ESRD (IRR:1.59 (1.52-1.67)) and CVD (1.09 (1.07-1.10)) hospitalisation. Conclusions Poorer health outcomes have persisted among Māori and Pacific people with T2DM for >20 years. New policies supporting more intensive management of T2DM are urgently needed. Differences in outcomes between Māori and Pacific people warrant further research. Key messages Outcome disparities have persisted among Māori and Pacific people with T2DM for >20 years. [ABSTRACT FROM AUTHOR]

The article discusses the widespread debate with respect to locally produced music that has taken place in New Zealand. They aim to bring together the various arguments for, and against, a music content radio quota and extend its purpose to consolidate the case in favor of quota legislation. They state that if locally produced popular music in New Zealand is to prosper, then a radio quota or some such measure is necessary, considering the importance of Kiwi music to the country's cultural identity.

Reports of comorbid eating disorders and Munchausen's syndrome are rare. As part of a follow-up study of the outcome of anorexia nervosa, medical records and direct structured psychiatric interview data were collected on all women treated for anorexia nervosa in Christchurch, New Zealand between 1981–1984. On interview, one participant received diagnoses of anorexia nervosa, bulimia nervosa, and factitious disorder (Munchausen's syndrome). The subject interwove symptoms of her eating disorders with factitious presentations on several occasions. This diagnosis had not been apparent prior to compilation of all medical records. [ABSTRACT FROM AUTHOR]

In 2003, Aotearoa New Zealand (NZ) passed the Prostitution Reform Act 2003 (PRA), which decriminalized sex work for NZ citizens and holders of permanent residency (PR) while excluding migrant sex workers (MSWs) from its protection. This is due to Section 19 (s19) of the PRA, added at the last minute against advice by the Aotearoa New Zealand Sex Workers' Collective (NZPC) as an anti-trafficking clause. Because of s19, migrants on temporary visas found to be working as sex workers are liable to deportation by Immigration New Zealand (INZ). Drawing on original ethnographic and interview data gathered over 24 months of fieldwork, our study finds that migrant sex workers in New Zealand are vulnerable to violence and exploitation, and are too afraid to report these to the police for fear of deportation, corroborating earlier studies and studies completed while we were collecting data. [ABSTRACT FROM AUTHOR]

The article focuses on the role of physicians in preserving medical knowledge and passing on the practice of medicine to the next general of physicians in New Zealand. The Medical Council of New Zealand (MCNZ), Royal New Zealand College of General Practitioners (RNZCGP) and New Zealand Medical Association (NZMA) emphasize this role in their documents and code of practice. Medical teachers are specifically assigned to impart knowledge to medical students and junior physicians.

A letter is presented which described a study that investigated the prevalence of gout in patients with diabetes. The clinical factors linked to gout in a large community-based group of patients with diabetes was likewise examined. Data analyzed was from the Diabetes Care Support Service (DCSS). The findings reportedly supported previous results that have illustrated an inverse relationship between serum urate and hemoglobin A1c (HbA1c) in the general population.

Otitis media (OM) is a major reason for antibiotic consumption and surgery in children. Nasopharyngeal carriage of otopathogens, Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi), is a prerequisite for development of OM, and increased nasopharyngeal otopathogen density correlates with disease onset. Vaccines can reduce or eliminate otopathogen carriage, as demonstrated for pneumococcal serotypes included in pneumococcal conjugate vaccines (PCV). The 10-valent PCV (PCV10) includes an NTHi carrier protein, and in 2011 superseded 7-valent PCV on the New Zealand Immunisation Program. Data are conflicting on whether PCV10 provides protection against NTHi carriage or disease. Assessing this in otitis-prone cohorts is important for OM prevention. We compared otopathogen density in the nasopharynx and middle ear of New Zealand PCV7-vaccinated and PCV10-vaccinated otitis-prone and non-otitis-prone children to determine PCV10 impact on NTHi and S. pneumoniae carriage. We applied qPCR to specimens collected from 217 PCV7-vaccinated children (147 otitis-prone and 70 non-otitis-prone) and 240 PCV10-vaccinated children (178 otitis-prone and 62 non-otitis-prone). After correcting for age and day-care attendance, no difference was observed between NTHi density in the nasopharynx of PCV7-vaccinated versus PCV10-vaccinated otitis-prone (p = 0.563) or non-otitis-prone (p = 0.513) children. In contrast, pneumococcal nasopharyngeal density was higher in PCV10-vaccinated otitis-prone children than PCV7-vaccinated otitis-prone children (p = 0.003). There was no difference in otopathogen density in middle ear effusion from PCV7-vaccinated versus PCV10-vaccinated otitis-prone children (NTHi p = 0.918; S. pneumoniae p = 0.415). When pneumococcal carriage was assessed by vaccine serotypes (VT) and non-vaccine serotypes (NVT), there was no difference in VT density (p = 0.546) or NVT density (p = 0.315) between all PCV7-vaccinated versus all PCV10-vaccinated children. In summary, PCV10 did not reduce NTHi density in the nasopharynx or middle ear, and was associated with increased pneumococcal nasopharyngeal density in otitis-prone children in New Zealand. Development of therapies that prevent or reduce otopathogen colonisation density in the nasopharynx are warranted to reduce the burden of OM. [ABSTRACT FROM AUTHOR]

The article discusses the problem tied to creatinine presence in acute kidney injury. Topics covered include the need for rapidly reducing creatinine concentration in a day to prevent patients from having cardiac arrest. Also mentioned is the increase in the mortality risk of patients associated with the increase in their creatinine level.

Background: Heart failure (HF) is the most common long-term complication of acute myocardial infarction (MI). Understanding plasma proteins associated with post-MI HF and their gene expression may identify new candidates for biomarker and drug target discovery.Methods: We used aptamer-based affinity-capture plasma proteomics to measure 1305 plasma proteins at 1 month post-MI in a New Zealand cohort (CDCS [Coronary Disease Cohort Study]) including 181 patients post-MI who were subsequently hospitalized for HF in comparison with 250 patients post-MI who remained event free over a median follow-up of 4.9 years. We then correlated plasma proteins with left ventricular ejection fraction measured at 4 months post-MI and identified proteins potentially coregulated in post-MI HF using weighted gene co-expression network analysis. A Singapore cohort (IMMACULATE [Improving Outcomes in Myocardial Infarction through Reversal of Cardiac Remodelling]) of 223 patients post-MI, of which 33 patients were hospitalized for HF (median follow-up, 2.0 years), was used for further candidate enrichment of plasma proteins by using Fisher meta-analysis, resampling-based statistical testing, and machine learning. We then cross-referenced differentially expressed proteins with their differentially expressed genes from single-cell transcriptomes of nonmyocyte cardiac cells isolated from a murine MI model, and single-cell and single-nucleus transcriptomes of cardiac myocytes from murine HF models and human patients with HF.Results: In the CDCS cohort, 212 differentially expressed plasma proteins were significantly associated with subsequent HF events. Of these, 96 correlated with left ventricular ejection fraction measured at 4 months post-MI. Weighted gene co-expression network analysis prioritized 63 of the 212 proteins that demonstrated significantly higher correlations among patients who developed post-MI HF in comparison with event-free controls (data set 1). Cross-cohort meta-analysis of the IMMACULATE cohort identified 36 plasma proteins associated with post-MI HF (data set 2), whereas single-cell transcriptomes identified 15 gene-protein candidates (data set 3). The majority of prioritized proteins were of matricellular origin. The 6 most highly enriched proteins that were common to all 3 data sets included well-established biomarkers of post-MI HF: N-terminal B-type natriuretic peptide and troponin T, and newly emergent biomarkers, angiopoietin-2, thrombospondin-2, latent transforming growth factor-β binding protein-4, and follistatin-related protein-3, as well.Conclusions: Large-scale human plasma proteomics, cross-referenced to unbiased cardiac transcriptomics at single-cell resolution, prioritized protein candidates associated with post-MI HF for further mechanistic and clinical validation. [ABSTRACT FROM AUTHOR]