You Are Not Alone. Supporting Health Professionals Following a Clinical Error. Understanding the Psychological Impact That Clinical Error Has on Health Professionals and if Organisational Culture Influences the Experience of the Health Professional

Background: Despite significant advancements in patient safety over the past two decades, everyday patients continue to be harmed. In the context of the escalating pressures of increasing workloads, staff shortages, burnout, low morale and high staff turnover faced by healthcare organisations, the negative impact these pressures have on patient care is evident. Well-trained staff with years of experience can make errors. These individuals who make an error are recognised as the ‘second victims’ (Wu, 2000). Becoming a second victim can have severe negative effects that are often long-lasting on a health professional’s psychological and physical well-being, and in turn can negatively impact patient care. Organisational support and a positive safety culture play a critical role in lessening the effects of the second victim phenomenon. This research offers a unique insight into the current situation within New Zealand and contributes to the international literature relating to clinical error and the second victim phenomenon. The aims of this research were, to answer the following questions: I. What psychological impact does involvement with clinical error have on New Zealand health professionals? II. What impact does organisational culture have on the recovery of health professionals following a clinical error? III. What support do health professionals want following a clinical error? Method: This research adopted a mixed-method embedded convergent parallel design; the study was largely quantitative and included qualitative data to enhance the quantitative results. The quantitative data was collected using a self-reporting survey tool with a Likert scale. The tool was developed by combining selected questions taken from three existing tools, The Second Victim Experience and Support Tool, The Safety Attitudes Questionnaire and The Safety Climate Survey, with the inclusion of two open ended questions. The study included a final sample of 41 participants, all registered New-Zealand-based health professionals, including doctors, nurses, medical imaging technologists and clinical pharmacists. Findings: There were several significant findings, many of which were consistent with other published studies. Overall, participants experienced greater psychological distress than physical distress. The most reported psychological symptom was the ‘fear of embarrassment.’ Female participants experienced more severe psychological and physical effects (p=0.045) than males, whilst medical imaging technologists reported more severe psychological effects than nurses or doctors. The most desired support following involvement with a clinical error was colleague support. The difference between gender was statistically significant (p=0.002), and females reported a stronger desire for support than males (p=0.037). Conclusion: This research has identified that the second victim phenomenon is real and is not well managed. There are several nuances that this study has observed across the different professional groups. These major findings provide a unique insight into the experience of New Zealand health professionals and has contributed to the existing second victim and safety culture research, including a new understanding of the impact clinical errors have on medical imaging technologists. Furthermore, this research has several implications for future research and practice in New Zealand and internationally and provides an opportunity for expanding this research to a wider population

Fieldworking. Fieldwork in Landscape Architecture as a Diffractive Methodology Understood Through the Lens of Agential Realism

Our understanding of landscapes and how humans work through and engage with them as physical and cultural entities has changed in recent years. Landscapes such as coastal areas have come to heightened attention due to increased pressures from the climate crisis and ecological emergency. Tāmaki Makaurau Auckland in Aotearoa New Zealand is under coastal influence and will inevitably experience a significant change in the future—through natural events and human development. Concepts such as the Anthropocene and the recent quantum revolution fundamentally changed and disrupted this conceptualisation. However, methods and methodologies in the various domains of landscape architecture (such as research, education, practice, and planning) and related spatial studies have not undergone the same pace of change. This is predominantly noticeable in the methodological approaches, applied methods, techniques, and tools, where the disciplines lack a unique approach. In this thesis, I investigate fieldwork methods (best practice approaches) known in landscape architecture by applying them to a coastal area in Tāmaki Makaurau Auckland. As a result of my probing, as well as through a diffractive reading of the literature and the application of Karen Barad’s concept of agential realism, I propose a re-definition of fieldwork as a material-discursive process of iterative intra-action. Fieldwork as a diffractive methodology has the potential to facilitate the observed paradigm shifts in the conception of landscapes and promote a more humble and holistic human engagement with landscapes. This hypothesis critiques the prevalent positivist, solutionist, and predominantly Western framing of spatial studies tasked with decision-making practices (i.e., spatial planning and land use considerations) that determine landscapes’ physical and cognitive future, past, and present—to meet landscapes with more humility and care

Exploring New Zealand Honeydew Honey, Yacon Concentrate, and their Novel Food and Health Applications

In order to understand the physical and functional properties of food products, it is essential to obtain physicochemical and sensory information. Without this information, it would be impossible to establish market opportunities, as manufacturers and researchers would be unable to predict consumer acceptance. In this thesis, physicochemical principles were used to understand the properties of New Zealand honeydew honey (NZHDH) and New Zealand yacon concentrate (NZYC). Subsequently, NZHDH and NZYC were incorporated into a novel food product (low alcohol beer), which was analysed using both physicochemical principles and sensory evaluations. Finally, alternative applications of NZHDH and NZYC were investigated, including their inhibitory effects on the formation of acrylamide, their anti-diabetic and anti-obesity properties, and their anti-microbial properties. In Chapter 3, the physicochemical properties of NZHDH such as proximate composition, mineral, sugar, phenolic, and amino acid profiles, and antioxidant activity, were determined. Results indicated the major mineral in NZHDH was potassium, with significant amounts of phosphorus, magnesium, and sodium. The major sugars were fructose and glucose, while sugars unique to NZHDH such as palatinose, turanose, erlose, and melezitose were also detected, with erlose dominating over melezitose. The major phenolic compounds were pinocembrin, abscisic acid, and pinobanksin, with this being the first comprehensive phenolic profiling of NZHDH conducted to the author’s knowledge. Proline was the major amino acid; L-aspartic acid, L-glutamic acid, L-alanine, and L-phenylalanine were the next most abundant, with this being the first profiling of the amino acid content of NZHDH to the author’s knowledge. The antioxidant activity of NZHDH was comparable to literature values for Mānuka honey, considered to be the “gold standard” for antioxidant activity. Overall, NZHDH was comparable to other more well-described varieties of HDH in the literature, suggesting it would have similar health-promoting benefits. In Chapter 4, the physicochemical properties of NZYC such as proximate composition, mineral, sugar, phenolic, amino acid, and organic acid profiles, antioxidant activity, and glycaemic index (GI), were determined. Results indicated that the major mineral in NZYC was potassium, with significant amounts of phosphorus, calcium, and magnesium also identified. Fructose was the major sugar; NZYC was also found to have high total content of fructooligosaccharides (FOS) and inulins (non-digestible prebiotic carbohydrates) which have been associated with numerous health benefits including gut health and weight loss, among others. Chlorogenic acid and caffeic acid were the major phenolic compounds; L-arginine, L-glutamic acid, L-proline, L-aspartic acid, and asparagine were the major amino acids; citric acid was the major organic acid. The antioxidant activity of NZYC was found to be several times higher than Mānuka honey, and NZYC was determined to be a low-GI food. Overall, these results indicate that NZYC may have excellent health-promoting benefits, particularly in the areas of gut health, weight loss, and antioxidative effects. In Chapter 5, five novel flavoured low alcohol beers (LABs) (and one control beer) incorporating NZHDH and/or NZYC were developed. The physicochemical properties of these LABs such as ethanol content, fructooligosaccharide and inulin presence, volatile profile, colour, and amino acid profile were determined. All six LABs had sufficiently low ethanol content to be classified as LABs in New Zealand. Beers that were flavoured with NZYC were found to contain fructooligosaccharides and/or inulins, while beers which were not flavoured with NZYC were not. The LABs could not be differentiated in terms of their volatile profile; however, crude NZHDH was found to differ from crude NZYC, particularly due to the presence of compounds associated with “earthy” flavours. Significant differences were not consistently identified across all LAB samples in terms of colour; however, samples containing NZYC tended to have darker colour than samples which did not. The LABs could not be differentiated in terms of their amino acid profiles. Sensory evaluation of the LABs was also conducted using unstructured line scales, just-about-right (JAR) scales, and check-all-that-apply (CATA) questions. Fifty-three participants completed the sensory evaluation (thirty-one male and twenty-two female). For unstructured line scales, the LAB samples could not be differentiated but were overall somewhat liked by the participants. For JAR, three attributes were evaluated and a high proportion of participants indicated that sweetness, hoppiness, and bitterness were too low in the six LAB samples. Twenty-six terms were used for CATA, and seven of these terms reached statistical significance between the LAB samples. Results from physicochemical analysis supported the incorporation of NZYC into a functional LAB beverage; however, both physicochemical and sensory results suggest that reformulation would be required to achieve greater differentiation between the samples and increased overall liking. In Chapter 6, the potential health benefits of NZHDH and NZYC were investigated with respect to inhibition of the formation of acrylamide in the Maillard reaction, anti-diabetic and anti-obesity activity, and anti-bacterial activity. Results suggest that NZHDH, NZYC, and phenolic compounds found in NZHDH and NZYC are unable to significantly reduce the formation of acrylamide at the tested concentrations. Phenolic extracts of NZHDH and NZYC were found to exhibit anti-diabetic activity, which was in agreement with literature concerning the major phenolic compounds identified in Chapters 3 and 4. Crude NZYC was found to exhibit anti-obesity activity, which was in agreement with literature concerning the major phenolic compounds identified in Chapter 4, while crude NZHDH exhibited negligible anti-obesity activity. Phenolic extracts of NZHDH and NZYC were unable to inhibit the growth of Escherichia coli, Pseudomonas aeruginosa, or Saccharomyces cerevisiae. Overall, this thesis provides insightful information regarding (a) physicochemical information on NZHDH, NZYC, and novel LAB beverages formulated containing NZHDH and/or NZYC, (b) sensory information on the novel LAB beverages, and (c) some potential health benefits of NZHDH and NZYC. In terms of the practicality of the research, manufacturers and researchers now have basic physicochemical information about NZHDH and NZYC, some of which was not previously available in the literature, while NZYC has been highlighted due to its high FOS content and notable anti-obesity effects. Further experimentation should be considered such as reformulation of the LABs to improve functional properties, sample differentiation, and overall liking

Critique of Hart’s Concept of Law in Samoa

Hart’s “Concept of Law” has gained widespread recognition in legal philosophy by proposing that a legal system is best understood as a combination of primary rules that impose obligations and secondary rules that grant the authority to create, modify, and interpret those primary rules. One aspect in Hart’s concept concerns the prelegal or primitive system, consisting of a society governed solely by primary rules of conduct without secondary rules. Thus, it proceeds to assert that such a system exists in a small, stable community bound by shared beliefs and kinship. This article illustrates that upon closer scrutiny within legally intricate and bijural contexts – such as the case of Samoa, where both primary and secondary rules co-exist – the argument proves to be fundamentally flawed. Moreover, this critique highlights the limitations in the standard application of Hart’s Concept of Law in other post-colonial contexts, including Aotearoa New Zealand and South Africa. The article further argues that more critical and nuanced perspectives are needed to examine the legal reality of Hart’s theory in modern post- colonial contexts

“Mudalalis” in Business and Society: A Critical Examination of Sri Lankan Entrepreneurs

We live in a world where we formulate different social identities and get evaluated by different social groups and societal stakeholders. In such a socially embedded world, stigma and legitimacy play important roles in business and privately. Stigma and legitimacy are complex, multi-level social constructs where social norms, beliefs, and values play a major role in their formation. In business contexts, they also influence the success and failure of entrepreneurs and their ventures in powerful ways by providing the foundation for the level of trust and acceptance between entrepreneurs and the other major stakeholders, like investors, customers, suppliers, and government regulators. Trust becomes crucial in overcoming the liabilities of newness, gaining access to limited resources, securing a reputation in the market, creating strategic partnerships, and ensuring long-term business viability. Despite their importance, management scholars observe an interesting paradox in the stigma-legitimacy relationship and their interplay. One group of management scholars posits that stigma and legitimacy exist on a single continuum – with legitimacy corresponding to a lack of stigma and the existence of illegitimacy. The other group suggests that stigma and legitimacy occupy two independent continuums. The single-continuum view suggests that both cannot coexist; if actors increase one, the other decreases. The view of two different continua, however, posits that stigma and legitimacy can coexist in an interdependent way, based on the audience or context. This theoretical tension and the highly socially embedded and contested nature of entrepreneurship in Sri Lanka represent the focal point of my PhD research. As I am Sri Lankan, I have decided to conduct my study in the emerging South Asian context of Sri Lanka, where entrepreneurs are typically referred to as Mudalalis. The indigenous term Mudalali carries a negative connotation, implying a ‘money lover’ and contributing to the stigmatization of Sri Lankan entrepreneurs, which is not a desired career path in Sri Lanka, contrary to many other emerging markets. Such stigmatization significantly impacts the actions and behaviours of Sri Lankan entrepreneurs as a mainstream social group (not a marginalized minority group), posing challenges to their long-term survival in the market. However, the situation also creates a unique space for entrepreneurship researchers to explore the intersection of stigma and legitimacy against the backdrop of religion and colonial history. Since the legitimization of stigmatized mainstream groups has not been widely studied in the entrepreneurship literature, my study has particular theoretical significance. Positioned within the interpretive paradigm, I have employed a qualitative thematic analysis to understand the sources and types of Sri Lankan entrepreneurs’ stigma, their stigma mitigation strategies, ways in which they seek to legitimize themselves in the eyes of the general public and on specific legitimacy-building mechanisms Sri Lankan entrepreneurs employ as individual, for their ventures, and collectively as a social group. Employing elite informant interviews, I have collected data from 30 Sri Lankan entrepreneurs. I present my findings in two empirical papers, one focusing on the relationship between stigma and legitimacy (i.e., Paper 1) and the other focusing on legitimacy and the micro-macro translation of legitimacy-as-perception (i.e., Paper 2). The study in Paper 1 employs an abductive qualitative approach. The findings draw on stigma sources and mitigation strategies proposed by Zhang et al. (2021), exploring both the relational nature of stigma and its multiple levels (Aranda et al., 2023). The findings reveal novel insights into the social identity stigmatization of mainstream entrepreneurs, highlighting various sources (i.e., moral, associational and tribal stigma) and characteristics of stigma (i.e., centrality, disruptiveness and malleability). My findings also point to specific strategies Sri Lankan entrepreneurs use to mitigate the stigma associated with their social identity. These strategies include strategies, like, boundary management, dilution, reconstruction, and emotional work – collectively reflecting the complex and multi-level nature of entrepreneurial stigma where social cognition plays an important role against the backdrop of specific institutional logics (i.e., religion, profession and the market) and colonial history. The second empirical paper explores the multi-level nature of the entrepreneurial legitimacy of Sri Lankan entrepreneurs. Employing the less studied legitimacy-as-perception perspective introduced by Suddaby et al. (2017), the paper examines the multi-level nature of entrepreneurial legitimacy, and the cross-level effects of their associational stigma linked to Mudalalis. The qualitative thematic analysis of in-depth interviews with 30 Sri Lankan entrepreneurs reveals novel insights into the entrepreneurial legitimation processes at the individual, firm, and collective levels. Perhaps most importantly, it shows how Sri Lankan entrepreneurs use their ventures as vehicles for external social legitimation, not just internal self-identity and self-esteem. Furthermore, my findings also point to an agent-object duality within the process of entrepreneurial legitimation at individual, firm and collective levels, again driven by multi-level socio-cognitive mechanisms. In pursuing social legitimacy, Sri Lankan entrepreneurs engage in three important legitimacy-building mechanisms across all three levels, namely, differentiation, symbolism and distancing. While being stigmatized through their association with Mudalalis, Sri Lankan entrepreneurs also at the same time also perpetuate the stigma against the Mudalalis, thus acting as both victims and perpetrators of the social stigma of the Mudalalis

A Cross-Lagged Panel Analysis of Cortisol Levels and Internalizing Behaviors in Children Born Very Preterm Across Early Childhood: Associations Differ for Boys and Girls at Age 1.5 Years

Children born very preterm (≤32 weeks’ gestation) are exposed to considerable stress in the neonatal period that, in turn, is associated long-term with altered physiological stress reactivity and regulation, as well as increased internalizing (anxiety and depressive) behaviors. Whether cortisol levels are related to evolving internalizing behaviors in this population has not been evaluated to our knowledge. The present study investigated the association between cortisol reactivity to a cognitive assessment in a novel clinic environment and parent-reported internalizing behaviors both concurrently and across ages in children born very preterm and examined whether relationships differed by biological sex at birth. Total cortisol output (AUCg) and reactivity (AUCi) were calculated from saliva assayed across age-appropriate cognitive tasks, and parents reported on their child's behavior at ages 1.5, 3, and 4.5 years. Valid cortisol data at one or more assessment points were available from 174 participants. Random-intercept cross-lagged panel models showed no longitudinal relationships between internalizing behaviors and cortisol output (AUCg, AUCi). Follow-up multilevel models revealed that the relationship between cortisol AUCg and internalizing behaviors was specific to girls at age 1.5 years. Findings highlight the importance of examining sex differences in biobehavioral relationships across development. Future research should consider factors that may attenuate these relationships across development

The Potential of Spiking Neural Networks in Predicting Earthquakes in New Zealand

This study investigates the use of Spiking Neural Networks (SNNs) in earthquake prediction, focusing on New Zealand, a seismically active region. Traditional earthquake prediction methods struggle with accuracy and real-time warning capabilities. SNNs, inspired by the brain’s biological processes, excel at handling dynamic time-series data, making them a promising tool for tasks involving spatio-temporal patterns such as seismic waveforms. Utilizing the NeuCube platform([1]), we processed seismic data from 56 stations across New Zealand in 2022. Our model achieved an accuracy increase from 38% to 70% as the seismic event approached, highlighting its potential for real-time earthquake monitoring. Although further optimization is required, this research demonstrates SNNs' potential in improving early earthquake warning systems. Future work will focus on refining the model's architecture and incorporating multimodal data to enhance prediction accuracy and applicability

A Critical Reading of Solastalgia Through Indigenous and Care Ethics Lenses

Solastalgia is the emotional response elicited by ecological degradation, originating from the concepts of solace, desolation, and pain. Climate change has profound societal and health impacts especially for marginalised communities who face food shortages, poverty and forced displacement. Indigenous peoples have deep relational ancestral connections with the land that are beyond connection to place, and experience unique intensified forms of distress resulting from environmental degradation. For Indigenous peoples, connections with land are disrupted through extractive politics such as colonisation and now climate emergency, legacies that leave deleterious effects on wellbeing. In collective Indigenous cultures, distress is embedded within wider contexts of community, history, and the earth itself. This paper critically reviews solastalgia from Māori and care ethics perspectives to demonstrate the power of adding relational, contextual, and embodied elements to the concept. This paper argues for the incorporation of Indigenous knowledge in the conceptualisation of climate-related distress. Māori notions of voice and place inform research approaches that are in solidarity with Indigenous voice to examine the impacts of climate degradation

Leveraging Machine Learning Approaches to Decode Hive Sounds for Stress Prediction

Beekeeping plays a vital role in preserving ecosystems through pollination and increasing biodiversity. Effective monitoring of honeybee health and hive conditions is essential to balance bee populations and their environment. This study addresses the challenges of data scarcity and generalization in beehive health monitoring by introducing a semi-supervised learning model that employs a Transformer-based encoder-classifier for acoustic analysis of hive sounds. This research demonstrates the application of a Transformer-based architecture specifically tailored for bee bioacoustics and stress detection, integrating advanced feature extraction and fine-tuning techniques for this application. The main objective is to identify stress-related indicators from audio data collected via smart beehives. The proposed method utilizes a dataset of 5,336 labelled audio clips from diverse sources, including the NU-hive project and YouTube audio, to aid the learning process and enhance the classification accuracy for both labeled and unlabeled data. The audio features used in the analysis include Mel-frequency cepstral coefficients (MFCCs) and their delta and delta-delta variants, root mean square (RMS) energy, spectral centroid, and dominant frequency from Short-Time Fourier Transform (STFT). The Transformer-based encoder-classifier is implemented to classify bee behaviour within the hive as Normal, NoQueen, or Swarm, and to distinguish stressed from not stressed states. Evaluations indicate that the semi-supervised Transformer encoder-classifier achieves 99% accuracy on labeled data, with precision and recall values of 0.99 or higher for the Normal and NoQueen classes, and 0.96 for the Swarm class. Cluster validation produced a silhouette score of 0.47 and a Davies-Bouldin index of 0.57, indicating moderate cluster separability and compactness. The modelwas able to pseudo-label 94.7% of unlabeled data, validated against the nearest labelled neighbours. These results show the effectiveness of AI-driven beehive monitoring in supporting sustainable beekeeping practices and ecosystem conservation efforts