Adaptation knowledge for New Zealand’s primary industries: Known, not known and needed

Climate sensitive primary industries including pastoral farming, high-value horticulture and viticulture are central to Aotearoa-New Zealand’s economy. While advances have been made in understanding the impacts and implications of climate change critical knowledge gaps remain, particularly for adaptation. This study develops and applies a novel methodology to identify and characterise adaptation knowledge for primary industries. The basis for the review is ten years’ of research and action under the Sustainable Land Management and Climate Change (SLMACC) program, supplemented with a systematic review of the published literature. Reports (n = 32) and literature (n = 22) are reviewed and assessed using the Adaptation Knowledge Cycle to characterise analytical and empirical foci. The detailed assessment of knowledge for Impacts, Implications, Decisions or Actions enables a robust and rigorous assessment of existing knowledge, identifies critical research gaps and emerging needs. Results show research to date has focused almost exclusively on understanding the impact of climate variability and extremes on land management. There are significant empirical (e.g. location and sector) and methodological (e.g. integrated assessments, scenarios, and vulnerability assessment) gaps, for at risk regions and sectors, and limited understanding of the decisions and actions necessary to enable successful adaptation. To inform future adaptation planning, additional work is required to better understand the implications, decision-making processes and obstacles to action. More detailed understanding of location-, season-, time- and sector-specific responses to climate change is also necessary. Findings advance our understanding of adaptation knowledge and reflect on diversity of information necessary to enable and sustain resilient rural futures and provide a conceptual and methodological basis for similar assessments elsewhere

Principles and process for developing participatory adaptation pathways in the primary industries

Adaptation pathways is an approach to identify, assess, and sequence climate change adaptation options over time, linking decisions to critical signals and triggers derived from scenarios of future conditions. However, conceptual differences in their development can hinder methodological advance and create a disconnect between those applying pathways approaches and the wider community of practitioners undertaking vulnerability, impacts, and adaptation assessments. Here, we contribute to close these gaps, advancing principles, and processes that may be used to guide the trajectory for adaptation pathways, without having to rely on data-rich or resource-intensive methods. To achieve this, concepts and practices from the broad pathways literature is combined with our own experience in developing adaptation pathways for primary industries facing the combined impacts of climate change and other, nonclimatic stressors. Each stage is guided by a goal and tools to facilitate discussions and produce feasible pathways. We illustrate the process with a case study from Hawke’s Bay, New Zealand, involving multiple data sources and methods in two catchments. Resulting guidelines and empirical examples are consistent with principles of adaptive management and planning and can provide a template for developing local-, regional- or issue-specific pathways elsewhere and enrich the diversity of vulnerability, impacts, and adaptation assessment practice

Development and validation of a physical activity monitor for use on a wheelchair

Study design: Keeping physically active is important for people who mobilize using a wheelchair. However, current tools to measure physical activity in the wheelchair are either not validated or limited in their application. The purpose of this study was to develop and validate a monitoring system to measure wheelchair movement.<p></p> Methods: The system developed consisted of a tri-axial accelerometer placed on the wheel of a wheelchair and an analysis algorithm to interpret the acceleration signals. The two accelerometer outputs in the plane of the wheel were used to calculate the angle of the wheel. From this, outcome measures of wheel revolutions, absolute angle and duration of movement were derived and the direction of movement (forwards or backwards) could be distinguished. Concurrent validity was assessed in comparison with video analysis in 14 people with spinal cord injury using their wheelchair on an indoor track and outdoor wheelchair skills course. Validity was assessed using intraclass correlation coefficients (ICC(2,1)) and Bland–Altman plots.<p></p> Results: The monitoring system demonstrated excellent validity for wheel revolutions, absolute angle and duration of movement (ICC(2,1)>0.999, 0.999, 0.981, respectively) in both manual and powered wheelchairs, when the wheelchair was propelled forwards and backwards, and for movements of various durations.<p></p> Conclusion: This study has found this monitoring system to be an accurate and objective tool for measuring detailed information on wheelchair movement and manoeuvring regardless of the propulsion technique, direction and speed

Impact of mental health problems on case fatality in male cancer patients

Background: Although mortality rates are elevated in psychiatric patients relative to their healthy counterparts, little is known about the impact of mental health on survival in people with cancer. / Methods and results: Among 16 498 Swedish men with cancer, survival was worse in those with a history of psychiatric hospital admissions: multiply-adjusted hazard ratio (95% confidence interval) comparing cancer mortality in men with and without psychiatric admissions: 1.59 (1.39, 1.83). / Conclusion: Survival in cancer patients is worse among those with a history of psychiatric disease. The mechanisms underlying this association should be further explored

A multilevel examination of gender differences in the association between features of the school environment and physical activity among a sample of grades 9 to 12 students in Ontario, Canada

<p>Abstract</p> <p>Background</p> <p>Creating school environments that support student physical activity (PA) is a key recommendation of policy-makers to increase youth PA. Given males are more active than females at all ages, it has been suggested that investigating gender differences in the features of the environment that associate with PA may help to inform gender-focused PA interventions and reduce the gender disparity in PA. The purpose of this cross-sectional study was to explore gender differences in the association between factors of the school environment and students' time spent in PA.</p> <p>Methods</p> <p>Among a sample of 10781 female and 10973 male students in grades 9 to 12 from 76 secondary schools in Ontario, Canada, student- and school-level survey PA data were collected and supplemented with GIS-derived measures of the built environment within 1-km buffers of the 76 schools.</p> <p>Results</p> <p>Findings from the present study revealed significant differences in the time male and female students spent in PA as well as in some of the school- and student-level factors associated with PA. Results of the gender-specific multilevel analyses indicate schools should consider providing an alternate room for PA, especially for providing flexibility activities directed at female students. Schools should also consider offering daily physical education programming to male students in senior grades and providing PA promotion initiatives targeting obese male students.</p> <p>Conclusions</p> <p>Although most variation in male and female students' time spent in PA lies between students within schools, there is sufficient between-school variation to be of interest to practitioners and policy-makers. More research investigating gender differentials in environment factors associated with youth PA are warranted.</p

Quality and correlates of medical record documentation in the ambulatory care setting

BACKGROUND: Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. METHODS: We reviewed electronic medical records from 834 patients receiving care from 167 physicians (117 internists and 50 pediatricians) at 14 sites of a multi-specialty medical group in Massachusetts. We abstracted information for five measures of medical record documentation quality: smoking history, medications, drug allergies, compliance with screening guidelines, and immunizations. From other sources we determined physicians' specialty, gender, year of medical school graduation, and self-reported time spent teaching and in patient care. RESULTS: Among internists, unadjusted rates of documentation were 96.2% for immunizations, 91.6% for medications, 88% for compliance with screening guidelines, 61.6% for drug allergies, 37.8% for smoking history. Among pediatricians, rates were 100% for immunizations, 84.8% for medications, 90.8% for compliance with screening guidelines, 50.4% for drug allergies, and 20.4% for smoking history. While certain physician and patient characteristics correlated with some measures of documentation quality, documentation varied depending on the measure. For example, female internists were more likely than male internists to document smoking history (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.27 – 2.83) but were less likely to document drug allergies (OR, 0.51; 95% CI, 0.35 – 0.75). CONCLUSIONS: Medical record documentation varied depending on the measure, with room for improvement in most domains. A variety of characteristics correlated with medical record documentation, but no pattern emerged. Further study could lead to targeted interventions to improve documentation

The face of equipoise - delivering a structured education programme within a randomized controlled trial: qualitative study

Background: In trials of behavioural interventions, the individuals who deliver the intervention are in a position of key influence on the success of the trial. Their fidelity to the intervention is crucial. Yet little is understood about the experiences of this group of trial personnel. This study aimed to investigate the views and experiences of educators who delivered a structured education intervention to people with type 2 diabetes, which incorporated training in self-monitoring of either blood glucose (SMBG) or urine glucose (SMUG) as part of a randomized controlled trial (RCT). Methods: Educators’ views were explored through focus groups before and after training (N = 18) and approximately 1 year into the trial (N = 14), and semi-structured telephone interviews at approximately 2 years (N = 7). Analysis was based on the constant comparative method. Results: Educators held preferences regarding the intervention variants; thus, they were not in individual equipoise. Training raised awareness of preferences and their potential to impact on delivery. Educators were confident in their unbiased delivery, but acknowledged the challenges involved. Concealing their preferences was helped by a sense of professionalism, the patient-centred nature of the intervention, and concessions in the trial protocol (enabling participants to swap monitoring methods if needed). Commitment to unbiased delivery was explained through a desire for evidence-based knowledge in the contentious area of SMBG. Conclusions: The findings provide insight into a previously unexplored group of trial personnel - intervention deliverers in trials of behavioural interventions - which will be useful to those designing and running similar trials. Rather than individual equipoise, it is intervention deliverers’ awareness of personal preferences and their potential impact on the trial outcome that facilitates unbiased delivery. Further, awareness of community equipoise, the need for evidence, and relevance to the individual enhance commitment to the RCT

Climate change adaptation through an integrative lens in Aotearoa New Zealand

Climate change is being felt across all human and natural systems in Aotearoa New Zealand and is projected to worsen this decade as impacts compound and cascade through natural system and sectoral dependencies. The effectiveness of adaptation is constrained by how fast greenhouse gas emissions are reduced globally, the pace of change, the frequency and progression of impacts, and the capacity of our natural, societal and political systems to respond. We explore how these systems and sectors interact with existing and projected climate change stressors by categorising climate change impacts (Trends and Events) and consequential thresholds (Thresholds), and by grouping systems and sectors by types (Typologies). This approach has identified commonalities and differences between the typologies which are illustrated with examples. Critical constraints and opportunities for adaptation have been identified to guide sector adaptation decision-making and for ongoing adaptation progress and effectiveness monitoring. Constraints are found across all sectors, and opportunities exist to address them through modelling and projections, monitoring frameworks, decision tools and measures, governance coordination and integration of the Māori worldview of the relationship between humans and nature. However, limits to adaptation exist and will increase over time unless all sectors and all nations urgently reduce their emissions

Australasia

Observed changes and impacts Ongoing climate trends have exacerbated many extreme events (very high confidence). The Australian trends include further warming and sea level rise sea level rise (SLR), with more hot days and heatwaves, less snow, more rainfall in the north, less April–October rainfall in the southwest and southeast and more extreme fire weather days in the south and east. The New Zealand trends include further warming and sea level rise (SLR), more hot days and heatwaves, less snow, more rainfall in the south, less rainfall in the north and more extreme fire weather in the east. There have been fewer tropical cyclones and cold days in the region. Extreme events include Australia’s hottest and driest year in 2019 with a record-breaking number of days over 39°C, New Zealand’s hottest year in 2016, three widespread marine heatwaves during 2016–2020, Category 4 Cyclone Debbie in 2017, seven major hailstorms over eastern Australia and two over New Zealand from 2014–2020, three major floods in eastern Australia and three over New Zealand during 2019–2021 and major fires in southern and eastern Australia during 2019–2020

Does self monitoring of blood glucose as opposed to urinalysis provide additional benefit in patients newly diagnosed with type 2 diabetes receiving structured education? The DESMOND SMBG randomised controlled trial protocol

BackgroundThe benefit of self-monitoring of blood glucose (SMBG) in people with type 2 diabetes on diet or oral agents other than sulphonylureas remains uncertain. Trials of interventions incorporating education about self-monitoring of blood glucose have reported mixed results. A recent systematic review concluded that SMBG was not cost-effective. However, what was unclear was whether a cheaper method of self-monitoring (such as urine glucose monitoring) could produce comparable benefit and patient acceptability for less cost.Methods/DesignThe DESMOND SMBG trial is comparing two monitoring strategies (blood glucose monitoring and urine testing) over 18 months when incorporated into a comprehensive self-management structured education programme. It is a multi-site cluster randomised controlled trial, conducted across 8 sites (7 primary care trusts) in England, UK involving individuals with newly diagnosed Type 2 diabetes.The trial has 80% power to demonstrate equivalence in mean HbA1c (the primary end-point) at 18 months of within &plusmn; 0.5% assuming 20% drop out and 20% non-consent. Secondary end-points include blood pressure, lipids, body weight and psychosocial measures as well as a qualitative sub-study.Practices were randomised to one of two arms: participants attend a DESMOND programme incorporating a module on self-monitoring of either urine or blood glucose. The programme is delivered by accredited educators who received specific training about equipoise. Biomedical data are collected and psychosocial scales completed at baseline, and 6, 12, and 18 months post programme. Qualitative research with participants and educators will explore views and experiences of the trial and preferences for methods of monitoring.DiscussionThe DESMOND SMBG trial is designed to provide evidence to inform the debate about the value of self-monitoring of blood glucose in people with newly diagnosed type 2 diabetes. Strengths include a setting in primary care, a cluster design, a health economic analysis, a comparison of different methods of monitoring while controlling for other components of training within the context of a quality assured structured education programme and a qualitative sub-study