End-user informed demographic projections for Hamilton up to 2041

This report provides a set of projections of the population of Hamilton City and the larger Hamilton Zone. The projections have been calculated by means of the cohort component model. The projections can be considered alongside official Statistics New Zealand projections, but differ from the latter in terms of assumptions made about net migration. These assumptions constitute a number of scenarios that were informed by the Hamilton City Council and local consultations. These scenarios are linked to the potential impact of a number of economic development activities. The report also contains projections of the number of households, the labour force and two ethnic groups: Māori and New Zealand Europeans. In addition, a dwellings-based methodology is used to produce small area (Census Area Unit) projections. Across the scenarios, Hamilton City’s projected population growth over the next two decades ranges from 13.8 percent to 36.0 percent. This is between 1.5 to 12.2 percentage points higher than the corresponding projected national growth

The Waikato Region: Major tourism issues and opportunities to facilitate tourism development: Public summary

A regional tourism project was commissioned by Katolyst, the Waikato Economic Development Agency, to assess the following: What is meant by regional tourism; the current views of industry stakeholders within the tourism and hospitality sectors; major issues, drivers, and obstacles facing tourism and pathways to address them, including industry capabilities and new opportunities for industry growth. The purpose of this research was to record the voice of tourism operators and stakeholders at the grass roots, to identify the specific issues facing the Waikato. Visitors do not focus on geographical or political boundaries, but rather are seeking an experience that transcends these boundaries. The region is generally ignorant of the significant economic impacts of the tourism sector, and education and advocacy is urgently needed. Tourism should not be seen in isolation to other key economic generators for the region, and there is potential for cross sector regional initiatives between tourism and other major sectors within the Waikato that could lead to cross sector strategic growth. The Waikato is a significant player in international visitor expenditure (7th out of 30 tourism regions), although the forecasted growth to 2012 for the Waikato is less than the national average. Although the Australian visitor market is significant for Hamilton International Airport, it comprises just 2% of all Australian visitors to New Zealand. Domestic visitors are the major driver of visitor expenditure in the region, with domestic visitor expenditure in the Waikato the third highest among the 30 tourism regions in New Zealand. Events are a driver, yet there is a perception that there is a lack of coordination and regional linkages. i-SITEs are inadequately funded and can rely on non-visitor revenue streams. There is a need to improve tourism expertise and knowledge to facilitate product development, especially getting current and potential tourism product export ready and to understand the distribution channels for domestic and international marketing. Most operators in the region are small owner operated firms with a few medium sized firms. A number are lacking tourism sector knowledge and business capabilities

Cycling on the Verge? Exploring the Place of Utility Cycling in Contemporary New Zealand Transport Policy

Efforts to increase cycling as a mode of transport (utility cycling) occur at central, regional and local levels of government through a range of supportive strategies, research, and guidelines. Despite these efforts, utility cycling levels in New Zealand have remained persistently low. This thesis examines the apparent disparity between policy intent and policy result, using a discourse analytical approach. It examines how cycling is positioned in contemporary New Zealand transport policy documents, and explores whose priorities are shaping transport policy with what implications for utility cycling. This study uses a critical discourse analysis (CDA) approach to analyse the land transport documents from across the institutions of government. The CDA approach, grounded in the work of van Dijk and Fairclough, draws on ideas from the interpretive tradition of discourse analysis, inspired by Foucault’s concepts of knowledge and power. This approach reveals the position of utility cycling by exposing the framing, dominant discourses, and discursive strategies that privilege certain transport objectives and activities over others. The findings show transport is promoted almost exclusively by central government as an activity to facilitate economic growth and efficiency, despite its potential (and actual) impacts on health and well-being, social justice, and environmental sustainability. The discursive practices of the government privilege private motor vehicle use, helping to both legitimate and maintain that privilege at all levels of government, while positioning utility cycling as a marginalised mode of transport. This thesis contributes to scholarship on utility cycling and land transport policy in New Zealand by identifying how the discursive strategies of government control the position of utility cycling in New Zealand. This study underscores the need for a central government-led, long-term strategic vision for a genuinely integrated, multi-modal transport system, in order for the benefits of utility cycling to be fully maximised

Wise City Governing: Bridging the sustainability aspiration-action divide in the New Zealand mid-sized city Authority

Perhaps expecting a pragmatically emerged local government to embed the concept of sustainability as its guiding principle in 2002, may have been too big-an-ask, yet the modern city complexity demands that a greater shift toward this approach be purposively pursued in Aotearoa/New Zealand (NZ). This study searches below the symptomatic concerns of the mid-sized NZ city context, in order to explore and understand the causal features, conditions, factors and elements that currently appear to be inhibiting local integrated sustainable development success. Through this exploration, this research also strives to identify a ‘wise city governing’ model that may assist in bridging the apparent phenomenon of the sustainability aspiration-action divide. Within the background to this exploration, the study additionally considers whether the Local Government Act 2002 ‘better local government’ 2012 reforms may work to resolve this deeper problématique of local governing in NZ. This research, seated within a whole systems/social constructionist frame, utilises a broad literature review, the five city survey (offering an institutional capital perspective) and a more detailed case study of one selected city (offering a social capital perspective) to explore this context and phenomenon. From the initial literature sweep, it was found that previous research on NZ local government has tended toward seeking out the political, peak body and senior public administrative viewpoints, or been representative of the larger NZ city voices, while the every-day perspectives of mid-sized Cities and their Authorities have been under-researched to date. The survey findings evidenced that the aspiration-action divide exists across the five surveyed cities, while the presence of serious systemic weaknesses within the case study Authority are also revealed. From a whole system viewpoint, the results of this study find that the current NZ corporatised mid-sized city Authority model is hamstrung in its capacity to wisely transform its governing system. The Authority system therefore remains blind to realising the urgency presented by the critical natural and human ecological cues. Additionally, it continues to be limited in its ability to authentically engage with its full community in order to co-create flexible, innovative and adaptive solutions to meet the real city demands. The consequence of perpetuating a tokenistic but essentially unsustainable state, where the fiscal sphere persists in dominating decision-making, is an amplified risk of continuity interruption, failure or ultimate collapse. The full study results, support the research histories of Stoker’s local governing review and through the comparative literature of Naschold, Norton, Scott et al. and others, finds that the NZ transformational model is at least 20 years behind its international counterparts. Furthermore, the differences between the approaches of the overseas ecological and New Zealand’s corporatised modernisation models are accentuated. Additionally, this research bears out the concerns expressed in the Jacobs/Taylor discourse around the dangers of hybrid government manipulations, and this was found to be even more critical when a low civil engagement within a corporatise-government hybrid is present. This understanding links with Evans et al. 2006 DISCUS study, whereby an equally high institutional and social capital capacity was evidenced as being a prerequisite for attaining a greater level of localised sustainable development success – as originally expressed within Agenda 21 and Local Agenda 21. Overall it is unlikely that the current ‘better local government’ legislative changes will produce the contextual shift up the ‘wise local govern-ing’ ladder, bridging the sustainability aspiration-action divide in order to deliver ‘better’ short and long term sustainable development value

Supportive Environments for Active Living?: A Case Study of Local Government Discourses of the Built and Social Environments and Physical Activity

Lack of physical activity among New Zealanders is typically regarded as a serious public health concern. Surveys indicate that a considerable proportion of the population fail to engage in even modest amounts. As well as conferring health benefits, leading an active life can help to build social capital, achieve manual tasks, enhance enjoyment, and reduce traffic congestion and pollution. The research of physical activity in New Zealand is, therefore, important. Many factors influence physical activity behaviour, but traditionally there has been a focus on individual-level behaviour-change approaches. In recent years research has started to focus more on characteristics of physical and social environments, such as provision of cycle paths and development of community social cohesion. Concerned by what I observed to be an over-emphasis by New Zealand agencies on encouraging individual behaviour change, I set out to examine the factors that contributed to the shaping of built and social environments, and their effects on population physical activity. Identifying a gap in the research, I examined these factors via a case study of the Hamilton City Council (HCC). My study employed Foucauldian 'tools' to examine selected HCC documents and interview transcripts with a view to identifying the discourses underpinning local government action with regard to built and social environments and physical activity. In this process I interviewed seven HCC staff members from six relevant departments, including Parks and Gardens, Community Development, and Roading and Transportation. Data was gathered from the staff members using semi-structured interviews, based on pre-prepared guidelines, developed following a review of relevant literature. Relevant HCC strategy and planning documents were selected only after interviews were completed and included their urban design, transportation, creativity and identity and social well-being strategies. I adopted a Foucauldian perspective to analyse the data because I wanted to examine the phenomena of increased physical inactivity by questioning particular 'ways of knowing' and 'truths'. Such an examination, at the level of local government, could help reveal why some cities are more conducive to active living than others. This theoretical approach helped reveal a number of underpinning discourses, including discourses of economic rationality; the council as nurturer; safety and surveillance; participative government; and work efficiency. Key discourses of economic rationality and participative government were pervasive in both the interviews and documents, highlighting the degree to which economic considerations and consultative practices dominate local government actions. My four main findings were that HCC is shaped by and shapes certain discourses; HCC activities are contingent upon many factors outside their control; the creation of supportive environments for active living is a complex task; and, that dominating discourses can silence or obscure other equally valid discourses. These findings gave rise to discursive effects. Firstly, local authority planning, strategizing and action can promote population behaviour control by facilitating resident self-regulation. Secondly, factors outside the control of local authorities can impact on their ability to realise active living goals. Lastly, valid but silenced 'ways of knowing' about physical activity, health, and governance can constrain population physical activity participation. I found that HCC actions were reflective of the discourses identified, illustrating wider societal concerns regarding physical inactivity, obesity, citizenship, economic success, 'democratic' practices, and efficiency. This study contributes to population physical activity research by recognising the value of environmental approaches, but underscoring the need to consider the sources, mechanisms of maintenance, and effects of discourses circulating in local government using appropriate theoretical approaches

Obstacles on the path: An exposition of the experience of car-free living

The contemporary focus by local and central government on the promotion of sustainable transport options has highlighted the need for commuting to move away from the current dependence on private cars to more public and active (walking and cycling) modes of transport. Given the prominence of the motor car in personal transport options however, choosing to live car-free in this car dependent culture appears at first glance to be an irrational choice. This research explores the lived experiences of a group of Hamilton residents who have made such a choice. Using a grounded theory approach, the thesis presents the results of interviews with nine car-free Hamilton residents who shared their personal transport stories, which include their childhood experiences, but focus on their current everyday practices and experiences. Through semi-structured interviews, the costs and benefits of a car-free lifestyle are articulated and analysed. Their motivations for choosing to forgo cars and their solutions for overcoming potential barriers to car-free living are also reported and explored. The collected data generated a range of themes which are presented in three chapters, each covering a specific aspect of the participants’ stories. The first group of themes relate to the public sphere, the second to the private realm and the final group emanates from specific elements of car-free living that the thesis sought to clarify through the participants’ stories. The key finding is that living car-free within Hamilton City is viewed by the participants as a well reasoned and eminently sensible choice, which produces multiple benefits. In addition to their reduced environmental footprints, the participants value the social interaction associated with active and public transport. Their consensus is that they are healthier, wealthier and more involved members of the community. The most problematic areas of living without a car were associated with recreational and social activities, which often do not coincide with public transport schedules or involve distances too great for active transport. The benefits far outweigh any disadvantages however, and ultimately, this thesis concludes that a motor car is not necessary for the everyday activities of urban living in Hamilton and any associated inconveniences are not as insurmountable as generally imagined

Biomarkers and overall survival in patients with advanced hepatocellular carcinoma treated with TGF-βRI inhibitor galunisertib.

BackgroundTransforming growth factor beta (TGF-β) signalling is involved in the development of hepatocellular carcinoma (HCC). We followed changes in biomarkers during treatment of patients with HCC with the TGF-βRI/ALK5 inhibitor galunisertib.MethodsThis phase 2 study (NCT01246986) enrolled second-line patients with advanced HCC into one of two cohorts of baseline serum alpha-fetoprotein (AFP): Part A (AFP ≥1.5x ULN) or Part B (AFP <1.5x ULN). Baseline and postbaseline levels of AFP, TGF-β1, E-cadherin, selected miRNAs, and other plasma proteins were monitored.ResultsThe study enrolled 149 patients (Part A, 109; Part B, 40). Median OS was 7.3 months in Part A and 16.8 months in Part B. Baseline AFP, TGF-β1, E-cadherin, and an additional 16 plasma proteins (such as M-CSF, IL-6, ErbB3, ANG-2, neuropilin-1, MIP-3 alpha, KIM-1, uPA, IL-8, TIMP-1, ICAM-1, Apo A-1, CA-125, osteopontin, tetranectin, and IGFBP-1) were found to correlate with OS. In addition, a range of miRs were found to be associated with OS. In AFP responders (21% of patients in Part A with decrease of >20% from baseline) versus non-responders, median OS was 21.5 months versus 6.8 months (p = 0.0015). In TGF-β1 responders (51% of all patients) versus non-responders, median OS was 11.2 months versus 5.3 months (p = 0.0036).ConclusionsConsistent with previous findings, both baseline levels and changes from baseline of circulating AFP and TGF-β1 function as prognostic indicators of survival. Future trials are needed to confirm and extend these results

Somatostatin receptor expression, tumour response, and quality of life in patients with advanced hepatocellular carcinoma treated with long-acting octreotide

Octreotide may extend survival in hepatocellular carcinoma (HCC). Forty-one per cent of HCCs have high-affinity somatostatin receptors. We aimed to determine the feasibility, safety, and activity of long-acting octreotide in advanced HCC; to identify the best method for assessing somatostatin receptor expression; to relate receptor expression to clinical outcomes; and to evaluate toxicity. Sixty-three patients with advanced HCC received intramuscular long-acting octreotide 20 mg monthly until progression or toxicity. Median age was 67 years (range 28–81 years), male 81%, Child–Pugh A 83%, and B 17%. The aetiologies of chronic liver disease were alcohol (22%), viral hepatitis (44%), and haemochromatosis (6%). Prior treatments for HCC included surgery (8%), chemotherapy (2%), local ablation (11%), and chemoembolisation (6%). One patient had an objective partial tumour response (2%, 95% CI 0–9%). Serum alpha-fetoprotein levels decreased more than 50% in four (6%). Median survival was 8 months. Thirty four of 61 patients (56%) had receptor expression detected by scintigraphy; no clear relationship with clinical outcomes was identified. There were few grade 3 or 4 toxicities: hyperglycaemia (8%), hypoglycaemia (2%), diarrhoea (5%), and anorexia (2%). Patients reported improvements in some symptoms, but no major changes in quality of life were detected. Long-acting octreotide is safe in advanced HCC. We found little evidence of anticancer activity. A definitive randomised trial would identify whether patients benefit from this treatment in other ways

Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia

Background. A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV) fluid therapy was central to this plan. Methods. Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 μg/mL at 0.1 mL/kg/hr) or intrathecal morphine (n = 50; 300 μg in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively) was compared. Results. The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, P = .06), less postoperative IV fluids (median 1200 mL versus 4300 mL, P = .03) than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, P = .05) and had shorter hospital stays than those managed with epidural infusions (4.7 ± 0.9 days versus 6.8 ± 1.2 days, P = .02). Conclusions. Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection

Reinvigorating and redesigning early intervention in psychosis services for young people in Auckland

RESUMO: Auckland tem sido pioneira na implementação de modelos de Intervenção Precoce em Psicose. No entanto, esta organização do serviço não mudou nos últimos 19 anos. Segundo os dados obtidos da utilização do serviço, no período de 1996 -2012 foram atendidos 997 doentes, que tinham um número médio de 89 contactos (IQR: 36-184), com uma duração média de 62 horas de contactos (IQR: 24-136). Estes doentes passaram um número médio de 338 dias (IQR: 93-757) em contacto com o programa. 517 doentes (52%) não necessitaram de internamento no hospital, e os que foram internados, ficaram uma mediana de 124 dias no hospital (IQR: 40-380). Os doentes asiáticos tiveram um aumento de 50% de probabilidade de serem internados no hospital. Este relatório inclui 15 recomendações para orientar as reformas para o serviço e, nomeadamente, delinear a importância de uma visão organizacional e dos seus componentes-chave. As recomendações incluem o reforço da gestão e da liderança numa estrutura de equipe mais integrada, com recursos dedicados a melhorar a consciencialização da comunidade, a educação e deteção precoce, bem como a capacidade de receber referenciações diretas. Os Indicadores Chave de Desempenho devem ser estabelecidos, mas os Exames de Estado Mental em risco, devem ser removidos. Auckland deve manter a faixa etária alvo atual. A duração do serviço deve ser aumentada para um mínimo de três anos, com a opção de aumentá-la para cinco anos. A proporção de gestor de cuidados para os doentes deve ser preconizada em 1:15, enquanto o pessoal de apoio não-clínico deve ser aumentado. Os psiquiatras devem ter uma carga de trabalho de cerca de 80 doentes por equivalente de tempo completo. Um serviço local de prestação de cuidados deve ser desenvolvido com, nomeadamente, intervenções culturais para responder às necessidades da população multicultural de Auckland. A capacidade de investigação deve ser incorporada no Serviço de Intervenção Precoce em Psicoses. Qualquer alteração deverá envolver contacto com todas as partes interessadas, e a Administração Regional de Saúde deve comprometer-se em tempo, recursos humanos e políticos para apoiar e facilitar a mudança do sistema, investindo de forma significativa para melhor servir a comunidade Auckland.----------------------------------- ABSTRACT: Auckland has been pioneering in the adoption of Early Intervention in Psychosis models but the design of the service has not changed in 19 years. In service utilisation data from 997 patients seen from 1996 -2012, patients had a median number of 89 contacts (IQR: 36-184), with a median duration of 62 hours of contact (IQR: 24-136). Patients spent a median number of 338 days (IQR: 93-757) in contact with the program. 517 patients (52%) did not require admission to hospital, and those who did spent a median of 124 days in hospital (IQR: 40-380). Asian patients had a 50% increased chance of being admitted to hospital. This report includes 15 recommendations to guide reforms to the service, including outlining the importance of vision and key components. It recommends strengthened managerial leadership and a more integrated team structure with dedicated resources for improved community awareness, education and early detection as well as the capacity to take direct referrals. Key Performance Indicators (KPIs) should be established but At Risk Mental States should be excluded. Auckland should maintain the current target age range. The duration of service should be increased to a minimum of three years, with the option to extend this to five years. The ratio of care co-ordinator to patients should be capped at 1:15 whilst non-clinical supporting staff should be increased. Psychiatrists should have a caseload of about 80 per FTE. A local Service Delivery framework should be developed, as should cultural interventions to meet the needs of the multicultural population of Auckland. Research capacity should be incorporated into the fabric of Early Intervention in Psychosis Services. Any changes should involve consultation with all stakeholders, and the DHB should commit to investing time, human and political resources to support and facilitate meaningful system change to best serve the Auckland community