Monograph no. 13: Scoping the potential uses of systems thinking in developing policy on illicit drugs.

This monograph (No. 13) summarises pilot work to scope the potential uses of systems thinking for developing illicit drug policy. Systems approaches have the potential to offer much to drug policy analysis through their use of participatory methods, capacity to deal with multiple simultaneous policy options, and appreciation of the complexity, interconnectedness and dynamic feedback loops associated with policy decisions. The monograph outlines six systems approaches used by the New Zealand team in exploring illicit drug policy. The results of in-depth interviews with five experienced policy makers and a demonstration project around a policy issue are described. The potential utility of systems approaches in illicit drug policy are demonstrated

Toward a transformed system to address child abuse and family violence in New Zealand

Executive Summary Introduction The Glenn Inquiry (TGI) has contracted Institute of Environmental Science and Research Limited (ESR) to bring together the relevant experience and expertise to collaboratively model a transformed system to address child abuse and neglect (CAN) and family violence (FV) in New Zealand. Our approach We have treated the task of reducing FV and CAN as a ‘wicked problem’1; that is, reducing FV and CAN is a problem that cannot be solved once and for all, and is not a matter of simply applying expert knowledge. The methods used in this project have been chosen because they are appropriate for working with wicked problems: stakeholder engagement, systems thinking and inter-disciplinary analysis. In this report, we refer to both CAN and FV. We recognise that, for some purposes, dealing with CAN requires particular strategies and treatment; however, the purpose of this report is to develop a transformed system that will reduce both CAN and other forms of FV. While the underlying causes of CAN and other FV may be considered independently, and some responses to each form of abuse will need to be particular, this report proposes a wider system of responses that will enable targeted interventions for each form of abuse. We use the term ‘family violence’ in this report in the sense it has come to be understood in Aotearoa, and is used in Te Rito: New Zealand Family Violence Prevention Strategy. In this use, FV includes intimate partner violence, child abuse and neglect, elder abuse, inter-sibling abuse and parental abuse. The project consisted of four work-streams: A review of the international and national literature on what would constitute a high performing system to address CAN and FV, including a review of New Zealand’s current approach with a focus on government legalisation, policies and initiatives; Qualitative modelling of the system dynamics associated with the existing way in which New Zealand has responded to CAN and FV; A secondary (sociological) analysis of suggestions for system improvement from the People’s Report; and, Developing a systemic model of a transformed system through collaborative workshops with sector experts

Genes required for free phage production are essential for pseudomonas aeruginosa chronic lung infections

The opportunistic pathogen Pseudomonas aeruginosa causes chronic lung infection in patients with cystic fibrosis. The Liverpool Epidemic Strain LESB58 is highly resistant to antibiotics, transmissible, and associated with increased morbidity and mortality. Its genome contains 6 prophages and 5 genomic islands. We constructed a polymerase chain reaction (PCR)-based signature-tagged mutagenesis library of 9216 LESB58 mutants and screened the mutants in a rat model of chronic lung infection. A total of 162 mutants were identified as defective for in vivo maintenance, with 11 signature-tagged mutagenesis mutants having insertions in prophage and genomic island genes. Many of these mutants showed both diminished virulence and reduced phage production. Transcription profiling by quantitative PCR and RNA-Seq suggested that disruption of these prophages had a widespread trans-acting effect on the transcriptome. This study demonstrates that temperate phages play a pivotal role in the establishment of infection through modulation of bacterial host gene expression

A Fully Integrated Real-Time Detection, Diagnosis, and Control of Community Diarrheal Disease Clusters and Outbreaks (the INTEGRATE Project):Protocol for an Enhanced Surveillance System

BACKGROUND:Diarrheal disease, which affects 1 in 4 people in the United Kingdom annually, is the most common cause of outbreaks in community and health care settings. Traditional surveillance methods tend to detect point-source outbreaks of diarrhea and vomiting; they are less effective at identifying low-level and intermittent food supply contamination. Furthermore, it can take up to 9 weeks for infections to be confirmed, reducing slow-burn outbreak recognition, potentially impacting hundreds or thousands of people over wide geographical areas. There is a need to address fundamental problems in traditional diarrheal disease surveillance because of underreporting and subsequent unconfirmed infection by patients and general practitioners (GPs); varying submission practices and selective testing of samples in laboratories; limitations in traditional microbiological diagnostics, meaning that the timeliness of sample testing and etiology of most cases remains unknown; and poorly integrated human and animal surveillance systems, meaning that identification of zoonoses is delayed or missed. OBJECTIVE:This study aims to detect anomalous patterns in the incidence of gastrointestinal disease in the (human) community; to target sampling; to test traditional diagnostic methods against rapid, modern, and sensitive molecular and genomic microbiology methods that identify and characterize responsible pathogens rapidly and more completely; and to determine the cost-effectiveness of rapid, modern, sensitive molecular and genomic microbiology methods. METHODS:Syndromic surveillance will be used to aid identification of anomalous patterns in microbiological events based on temporal associations, demographic similarities among patients and animals, and changes in trends in acute gastroenteritis cases using a point process statistical model. Stool samples will be obtained from patients' consulting GPs, to improve the timeliness of cluster detection and characterize the pathogens responsible, allowing health protection professionals to investigate and control outbreaks quickly, limiting their size and impact. The cost-effectiveness of the proposed system will be examined using formal cost-utility analysis to inform decisions on national implementation. RESULTS:The project commenced on April 1, 2013. Favorable approval was obtained from the Research Ethics Committee on June 15, 2015, and the first patient was recruited on October 13, 2015, with 1407 patients recruited and samples processed using traditional laboratory techniques as of March 2017. CONCLUSIONS:The overall aim of this study is to create a new One Health paradigm for detecting and investigating diarrhea and vomiting in the community in near-real time, shifting from passive human surveillance and management of laboratory-confirmed infection toward an integrated, interdisciplinary enhanced surveillance system including management of people with symptoms. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/13941

Housing, home and women's identity.

There are two central arguments around which this thesis is constructed. The first is that we cannot understand everyday life without exploring the ways in which space and social interaction are mutually constituted. This argument is explored in relation to women's experiences of the house and home. Women's identity formation, I argue, is tied up with the form of the built environment and cultural concepts of 'home.' Part one explores the theoretical and methodological context of this project and the reasons for using different approaches. These range from an interweaving of N.Z fiction and housing policy over time, socio-semiotic analysis of house and home advertising, to qualitative research involving individual and focus group interviews, all of which are underpinned by a feminist perspective. The two historically based chapters on fiction and policy, and advertising, demonstrate how the category 'woman' and women have been aligned with the house and home within the context of heterosexual relations. This relationship, I argue, is subject to contestation and change as women challenge roles associated with constructions of femininity and a spatially gendered division of labour. Part two draws on the interview material with chapters organised around the narratives emerging from individual and focus group material, Woman/Women Alone, The Good-Enough-Mother and Transitions. Within the context of this material I explore Iris Marion Young's concept of home as a critical value and the relevance of emotion theory. In conclusion, I assess the extent to which the diversity of theory, methodology and interview material address the central claims which underpin this project

Scoping the potential uses of systems thinking in developing policy on illicit drugs

This monograph (No. 13) summarises pilot work to scope the potential uses of systems thinking for developing illicit drug policy. Systems approaches have the potential to offer much to drug policy analysis through their use of participatory methods, capacity to deal with multiple simultaneous policy options, and appreciation of the complexity, interconnectedness and dynamic feedback loops associated with policy decisions. The monograph outlines six systems approaches used by the New Zealand team in exploring illicit drug policy. The results of in-depth interviews with five experienced policy makers and a demonstration project around a policy issue are described. The potential utility of systems approaches in illicit drug policy are demonstrated

Practitioner identity in systemic intervention: Reflections on the promotion of environmental health through Maori community development

In systemic intervention, boundary critique is important. This means explicitly exploring the inclusion, exclusion and marginalization of both people and issues. Most of the practitioner's attention in boundary critique is usually focused on relationships between stakeholders (i.e. the participants in the intervention and those who might be affected by it). A significant focus is also the remit of the intervention: those things that need to be directly addressed or bracketed out in order to make a difference that is meaningful to a broad range of stakeholders. What is often less visible during boundary critique is the personal and/or professional identity of the practitioner, and the impact this may have on both relationships with others and the construction of people's understanding of the issues they are grappling with. This paper reflects on a project promoting environmental health through Māori community development that reveals the importance of personal and professional identity to systemic intervention. It is argued that it is impossible for practitioners to set aside their identities and become 'neutral' modellers or process facilitators. When this appears to happen it is because the practitioner's identity has been (often invisibly) constructed to legitimate his or her activities, and these activities do not transgress the expectations of participants that flow from their understanding of the practitioner's identity and role. Nevertheless, even though practitioner identities inevitably impact on the trajectory of interventions, at least some of their implications can be explicitly acknowledged and managed as part of systemic intervention. Some examples of management strategies are provided