Examining Professional Identity: The Views of New Zealand Chartered Accountants

The purpose of this thesis was to examine the professional identity of New Zealand chartered accountants. A perusal of prior literature indicated that professional identity is integral to a profession, yet the concept has not been well defined. This study attempts to gain a greater understanding of this term. Specifically, semi structured interviews were conducted with 60 New Zealand chartered accountants. These participants were categorised by both their areas of employment and level of experience. The areas of employment included: top tier, midtier, rural, industrial, and academic categories, while their level of experience was segmented into 0-2, 3-5, 6-10 and 10+ years of experience. These interviews were transcribed and run through Leximancer 4.0, a computer textual analysis program. This software produced conceptual maps, key themes, and concepts which were used in the data analysis process. The findings of this thesis were specific to the New Zealand accounting body: NZICA. Consistent with prior studies, this paper found that the term “professional identity” was not well understood. Indeed, terms such as stereotypes, traits, characteristics, attributes, and branding were used interchangeably for the term. Furthermore, there was a misalignment between the professional identity portrayed by NZICA and the interpretation of its members. Members identified a weak relationship between themselves and their institute. This was a consistent finding across the entirety of the sampled population. This study has practical implications for future research. NZICA passed a vote as recently as October 2013 to become “One New Institute”, thus it is currently undertaking a rebranding process. This study identifies weaknesses in current branding that may, in future, be able to be remedied. Furthermore, this study is replicable and can provide other institutes with an opportunity to gain insight into their respective organisations. As no prior accounting literature has undertaken to define professional identity, this investigation also provides an insight into the term. As a result, this insight can be applied to wider academic literature

A methodology for thorough text preparation of German Lieder

The impetus behind this study is the suspicion that singers beginning their training are either unaware of the vast amount of preparation that needs to occur when performing any work or they are aware but have no idea where to start. The understanding of text and an emotional connection with its meaning are vital to a successful Lied performance. This dissertation aims to create a method of preparing the text (of a Lied) that encourages detailed observation and creative thought, and which enables a musician with limited understanding of the German language to comfortably acquaint themselves with the repertoire. This thesis is based on the idea that text should always come first when preparing a song for performance. By looking at various resources one can find the best ways to analyse and understand texts of all languages. From this a 3 step method has been formed. Step 1; observation, step 2; analysis, and step 3; performance. The method has been put into the form of a two-page worksheet detailing the procedure. It also includes a definition of terms, a recommended resources list and a German International Phonetic Alphabet guide. The method is then put into practice using two pieces from Robert Schumann\u27s song cycle, Frauenliebe und Leben and conclusions presented at the end

The Experiences of Occupational Therapists Working on Interprofessional Primary Health Care Teams: A Case Study.

The aim of this research was to provide evidence on the integration of occupational therapy (OT) intervention in primary care from the perspective of OTs. Typical services provided, experience with team members, and the identified value of OT in primary health care was explored. OT possesses the expertise and skill set to address the most common chronic conditions that primary care providers treat by entry level educational preparation. OT services are based upon a holistic view of individuals creating an affective skill set to participate in and coordinate health care delivery for the client. Currently limited evidence is available to support OT in primary care. A need exists for the development of defined roles for OT in the interprofessional primary care team. The changing reimbursement model for health care delivery and associated funding also adds to the paucity of information available in this emerging practice area. Qualitative methods were used in this case study research. Semi-structured interviews were transcribed, coded, and analyzed for emergent themes. Findings of this study include main themes of facility characteristics, assessment and intervention strategies, interprofessional communication, barriers including space and time, and future needs for the education of OTs. Conclusions from this study present how integration into primary care will require OTs to advocate for their place in this setting as valued and beneficial members to the primary care team. OTs found that the greatest impact was made through focusing interventions on habits and routines, managing chronic conditions and co-morbidities, and prevention

The effects of protoporphyrin IX-induced photodynamic therapy with and without iron chelation on human squamous carcinoma cells cultured under normoxic, hypoxic and hyperoxic conditions.

BACKGROUND: Photodynamic therapy requires the combined interaction of a photosensitiser, light and oxygen to ablate target tissue. In this study we examined the effect of iron chelation and oxygen environment manipulation on the accumulation of the clinically useful photosensitiser protoporphyrin IX (PpIX) within human squamous epithelial carcinoma cells and the subsequent ablation of these cells on irradiation. METHODS: Cells were incubated at concentrations of 5%, 20% or 40% oxygen for 24h prior to and for 3h following the administration of the PpIX precursors aminolevulinic acid (ALA), methyl aminolevulinate (MAL) or hexylaminolevulinate (HAL) with or without the iron chelator 1,2-diethyl-3-hydroxypyridin-4-one hydrochloride (CP94). PpIX accumulation was monitored using a fluorescence plate reader, cells were irradiated with 37 J/cm(2) red light and cell viability measured using the neutral red uptake assay. RESULTS: Manipulation of the oxygen environment and/or co-administration of CP94 with PpIX precursors resulted in significant changes in both PpIX accumulation and photobleaching. Incubation with 5% or 40% oxygen produced the greatest levels of PpIX and photobleaching in cells incubated with ALA/MAL. Incorporation of CP94 also resulted in significant decreases in cell viability following administration of ALA/MAL/HAL, with oxygen concentration predominantly having a significant effect in cells incubated with HAL. CONCLUSIONS: Experimentation with human squamous epithelial carcinoma cells has indicated that the iron chelator CP94 significantly increased PpIX accumulation induced by each PpIX congener investigated (ALA/MAL/HAL) at all oxygen concentrations employed (5%/20%/40%) resulting in increased levels of photobleaching and reduced cell viability on irradiation. Further detailed investigation of the complex relationship of PDT cytotoxicity at various oxygen concentrations is required. It is therefore concluded that iron chelation with CP94 is a simple protocol modification with which it may be much easier to enhance clinical PDT efficacy than the complex and less well understood process of oxygen manipulation

An in vitro comparison of the effects of the iron-chelating agents, CP94 and dexrazoxane, on protoporphyrin IX accumulation for photodynamic therapy and/or fluorescence guided resection.

Comparative StudyJournal Article"This is the peer reviewed version of the following article:Photochemistry and Photobiology, Volume 87, Issue 6, pages 1419–1426, November/December 2011, which has been published in final form at http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1751-1097.2011.00985.x/full. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."Photodynamic therapy (PDT) utilizes the combined interaction of a photosensitizer, light and molecular oxygen to ablate tumor tissue. Maximizing the accumulation of the photosensitizer protoporphyrin IX (PpIX) within different cell types would be clinically useful. Dermatological PpIX-induced PDT regimes produce good clinical outcomes but this currently only applies when the lesion remains superficial. Also, as an adjuvant therapy for the treatment of primary brain tumors, fluorescence guided resection (FGR) and PDT can be used to highlight and destroy tumor cells unreachable by surgical resection. By employing iron chelators PpIX accumulation can be enhanced. Two iron-chelating agents, 1,2-diethyl-3-hydroxypyridin-4-one hydrochloride (CP94) and dexrazoxane, were individually combined with the porphyrin precursors aminolevulinic acid (ALA), methyl aminolevulinate (MAL) and hexyl aminolevulinate (HAL). Efficacies of the iron-chelating agents were compared by recording the PpIX fluorescence in human squamous epithelial carcinoma cells (A431) and human glioma cells (U-87 MG) every hour for up to 6 h. Coincubation of ALA/MAL/HAL with CP94 resulted in a greater accumulation of PpIX compared to that produced by coincubation of these congeners with dexrazoxane. Therefore the clinical employment of iron chelation, particularly with CP94 could potentially increase and/or accelerate the accumulation of ALA/MAL/HAL-induced PpIX for PDT or FGR

Objective and subjective comprehension of jury instructions in criminal trials

It would seem important that jury instructions are clear and comprehensible to jurors if they are to effectively carry out their responsibility in criminal trials. Research suggests, however, that jurors may not fully understand instructions despite reporting high levels of comprehension. The current study (N = 33) surveyed jurors who had recently served on a jury to assess their level of comprehension and the factors that contributed to their decisions. It was found that a substantial proportion of jurors were mistaken about directions relating to beyond reasonable doubt and burden of proof. It also was found that higher levels of self-reported comprehension were associated with self-reported reliance on additional factors to arrive at a decision, and a more positive evaluation of the prosecutions' case. Overall, although jurors report that they understand directions, they do not appear to use those directions in arriving at a decision. Subjective comprehension appears to be an important factor in understanding the effect of directions on jurors

Investigating the Epigenetic Mechanism Behind Transgenerational Inheritance in Mice with Abnormal Folate Metabolism

Exposure to environmental stressors can impact our health and that of future generations even when they are not similarly exposed. How disease risk is inherited is unclear. My thesis focuses on a mouse model of transgenerational inheritance in which folate metabolism is disrupted by a mutation in Methionine synthase reductase ($\it{Mtrr^gt}$). Remarkably, $\it{Mtrr^+/gt}$ heterozygosity leads to an increased likelihood of a wide spectrum of congenital malformations in their wildtype offspring for at least four generations. Folate metabolism is required for DNA synthesis and cellular methylation. Folate and its metabolism have also been linked to spermatogenesis and male fertility. My thesis aims to explore three possible mechanisms for the transgenerational inheritance of congenital malformations in the $\it{Mtrr^gt}$ model: germ cell morphology and function abnormalities, genetic instability and altered germ cell epigenetic patterns. We first considered if the $\it{Mtrr^gt}$ mutation affected testes morphology, spermatogenesis or sperm parameters. These were largely normal in $\it{Mtrr^gt}$ males. Next, we performed whole genome DNA sequencing of \mtrr embryos to determine whether abnormal folate metabolism affects genetic stability. Importantly, the frequency of structural variants and single nucleotide polymorphisms (SNPs) were similar in C57Bl/6 control and $\it{Mtrr^gt/gt}$ embryos indicating that the $\it{Mtrr^gt}$ mutant genome is relatively stability. We did however identify an increase in SNP and SV frequency at the $\it{Mtrr}$ locus, linked to the generation of the $\it{Mtrr^gt}$ mice in a 129/P2 genetic background prior to backcrossing into the C57Bl/6 background. Subsequently, we identified a large number of differentially methylated regions (DMRs) in sperm DNA of $\it{Mtrr^+/+}$, $\it{Mtrr^+/gt}$, and $\it{Mtrr^gt/gt}$ males compared to C57Bl/6 control sperm. Few DMRs were associated with underlying SNPs or SVs. However, no sperm DMRs identified in $\it{Mtrr^+/gt}$ males persisted in embryonic or adult tissues of the wildtype F1 or F2 generations. Despite this, we identified two genes, $\it{Hira}$ and $\it{Rn45s}$, that were adjacent to DMRs and were misexpressed in the F2 and F3 generation embryos. This suggested that abnormal DNA methylation in sperm may influence gene expression two generations later despite reprogramming events. Additionally, we identified a number of differentially expressed small non-coding RNAs in $\it{Mtrr^+/gt}$ and $\it{Mtrr^gt/gt}$ sperm compared to C57Bl/6 control sperm. Overall, a complete understanding of the mechanisms behind transgenerational inheritance of phenotypes in the $\it{Mtrr^gt}$ model remains elusive. Unravelling the mechanisms of transgenerational epigenetic inheritance could have important implications for the future prediction and prevention of human diseases.Wellcome Trust 4-year PhD studentship in Developmental Mechanisms. Additional funding from St John's college and the Cambridge Philosophical Society

Effect of an oxygen pressure injection (OPI) device on the oxygen saturation of patients during dermatological methyl aminolevulinate photodynamic therapy

Journal Article“The final publication is available at Springer via http://dx.doi.org/10.1007/s10103-012-1188-y"Methyl aminolevulinate photodynamic therapy (MAL-PDT) (a topical treatment used for a number of precancerous skin conditions) utilizes the combined interaction of a photosensitizer (protoporphyrin IX (PpIX)), light of the appropriate wavelength, and molecular oxygen to produce singlet oxygen and other reactive oxygen species which induce cell death. During treatment, localized oxygen depletion occurs and is thought to contribute to decreased efficacy. The aim of this study was to investigate whether an oxygen pressure injection (OPI) device had an effect on localized oxygen saturation levels and/or PpIX fluorescence of skin lesions during MAL-PDT. This study employed an OPI device to apply oxygen under pressure to the skin lesions of patients undergoing standard MAL-PDT. Optical reflectance spectrometry and fluorescence imaging were used to noninvasively monitor the localized oxygen saturation and PpIX fluorescence of the treatment area, respectively. No significant changes in oxygen saturation were observed when these data were combined for the group with OPI and compared to the group that received standard MAL-PDT without OPI. Additionally, no significant difference in PpIX photobleaching or clinical outcome at 3 months between the groups of patients was observed, although the group that received standard MAL-PDT demonstrated a significant increase (p < 0.05) in PpIX fluorescence initially and both groups produced a significant decrease (p < 0.05) after light irradiation. In conclusion, with this sample size, this OPI device was not found to be an effective method with which to improve tissue oxygenation during MAL-PDT. Further investigation is therefore required to find a more effective method of MAL-PDT enhancement. © 2012 Springer-Verlag London Ltd

Vancomycin-Associated Acute Kidney Injury in Critically Ill Adolescent and Young Adult Patients

Background: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. Objective: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. Methods: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit. Acute kidney injury in this population was defined as an increase in serum creatinine by 0.5 mg/dL or 50% from baseline. Patients who developed AKI were evaluated for specific risk factors compared to those who did not develop AKI. Results: A total of 50 patients (20 developed AKI) were included in the study. There was no difference in vancomycin daily dose or duration of vancomycin therapy. Maximum vancomycin trough (31.15 mg/dL vs 12.5 mg/dL, P = .006), percentage of patients with concurrent nephrotoxic medication (95% vs 60%, P = .012) and concurrent vasopressor (55% vs 23%, P = .029) were higher in those who developed AKI. Percentage of patients who underwent a procedure while on vancomycin (35% vs 6.7%, P = .021) was also higher within the AKI group. Conclusions: Vancomycin-associated AKI occurred in 40% of critically ill adolescent and young adult patients. These patients may be more likely to develop vancomycin-associated AKI if they had undergone a procedure, as well as in the presence of high vancomycin trough levels, concurrent nephrotoxic agents, and concurrent vasopressor therapy

The time-dependent accumulation of protoporphyrin IX fluorescence in nodular basal cell carcinoma following application of methyl aminolevulinate with an oxygen pressure injection device

Clinical TrialJournal ArticleAuthor's post-print is subject to a Creative Commons Attribution Non-Commercial No Derivatives LicenseTopical protoporphyrin (PpIX)-induced photodynamic therapy (PDT) relies on the penetration of the prodrug into the skin lesion and subsequent accumulation of the photosensitizer. Methyl aminolevulinate (MAL)-PDT is an established treatment for thinner and superficial non-melanoma skin cancers (NMSCs) but for the treatment of the thicker nodular basal cell carcinoma (nBCC) enhanced penetration of the prodrug is required. This study employed a new higher pressure, oxygen pressure injection (OPI) device, at the time of Metvix® application with a view to enhancing the penetration of MAL into the tumors. Each patient had Metvix® applied to a single nBCC followed by application of a higher pressure OPI device. Following different time intervals (0, 30, 60, 120 or 180 min) the tumors were excised. The maximum depth and area of MAL penetration achieved in each lesion was measured using PpIX fluorescence microscopy. As expected, an increase in the depth of MAL-induced PpIX accumulation and area of tumor sensitized was observed over time; when the Metvix® cream was applied for 0, 30, 60, 120 and 180 min the median depth of PpIX fluorescence was 0%, 21%, 26.5%, 75.5% and 90%, respectively and the median area of tumor sensitized was 0%, 4%, 6%, 19% and 60%, respectively. As the investigation presented here did not include a control arm, the relative depths of fluorescence observed in this study were statistically compared (using the non-parametric Mann Whitney U test) with the results of our previous study where patients had Metvix® cream applied either with or without the standard pressure OPI device. When the higher pressure OPI device was employed compared to without OPI this increase was observed to be greater following 30, 120, and 180 min although overall not significantly (p=0.835). In addition, no significant difference between the higher pressure OPI device employed here and the previously investigated standard pressure OPI device was observed (p=0.403). However, when the results for both OPI devices were combined and compared to the standard treatment (no OPI employed) group, although the difference did not reach significance (p=0.531) a consistent and substantial increase in the depth of PpIX fluorescence was observed, therefore employment of an OPI device during topical MAL-PDT protocols warrants further investigation as a technique for enhancing MAL penetration