Creativity, or, Holding on to aroha : exploring, exemplifying and encouraging creativity in adulthood : a thesis presented in partial fulfilment of the requirements for the degree of Master of Education (Adult), Massey University

"Creativity is the sixth sense, transporting us to dreamed of places which the other five cannot reach," to paraphrase the Prime Minister, the Right Honourable Helen Clark. It was the task of this thesis to 'catch' creativity, scrutinise it and make sense of it. Accordingly, it was necessary to: Define creativity as the catalyst for effective innovation Determine who manifests it; major and minor exemplars Discover where it occurs; personal and public sites Detect how it can be effectively encouraged Delve into reasons for esteeming it; philosophical and pragmatic Answers to the above alliterative list's demands, were found in three places: The first was a global location, specifically the international literature on creativity, with particular reference to that written over the past fifty years The second was a New Zealand venue for the encouragement of creativity, The Leaming Connexion, Wellington, evidenced in the story of its founder The third was in the personal perspective of five people who are convinced that creativity is central to shaping how they live. They agreed to be identified as a signature, witnessing the role that creativity has in their lives. Throughout, the theoretical and actual informed each other, as well as the thesis author. Soon universal evidence of creativity's relevance became apparent. On a poetic note, the study concluded that creativity is worth holding onto since it is at the heart of what makes us take nothing for granted. In so doing, its breath grants humanity meaning. More prosaically, the thesis ends with five practical recommendations as to how some of the insights gained might be implemented to help make living and learning more meaningful in an increasingly complex world

Mitral regurgitation in patients with severe aortic stenosis: Diagnosis and management

Severe aortic stenosis (AS) and mitral regurgitation (MR) frequently coexist. Although some observational studies have reported that moderate or severe MR is associated with higher mortality, the optimal management of such patients is still unclear. Simultaneous replacement of both aortic and mitral valves is linked to significantly higher morbidity and mortality. Recent advances in minimally invasive surgical or transcatheter therapies for MR allow for staged procedures in which surgical or transcatheter aortic valve replacement (SAVR/TAVR) is done first and MR severity re-evaluated afterwards. Current evidence suggests MR severity improves in some patients after SAVR or TAVR, depending on several factors (MR aetiology, type of valve used for TAVR, presence/absence of atrial fibrillation, residual aortic regurgitation, etc). However, as of today, the absence of randomised clinical trials does not allow for evidence-based recommendations about whether or not MR should be addressed at the time of SAVR or TAVR. A careful patient evaluation and clinical judgement are recommended to distinguish patients who might benefit from a double valve intervention from those in which MR should be left alone. The aim of this review is to report and critique the available data on this subject in order to help guide the clinical decision making in this challenging subset of patients

Towards a new method for coating heritage lead

Ethanolic solutions of long-chain carboxylic acids can be applied to lead metal substrates to form a coating of lead carboxylate which provides protection against atmospheric pollutants. In this paper we describe the optimal inhibitor concentration for the coating on lead. Electrochemical impedance data taken before and after immersion in media modelling oak emitted volatile organic compounds (VOCs) polluted atmospheres show that coating effectiveness decreases after exposure, but the effect is lessened if longer chain carboxylates are used

Further advances in lead carboxylate coatings : coating unprimed heritage lead

Further to the previously published work in this journal "Towards a new coating for heritage lead", a coating has been trialled with samples replicating aged lead artefacts. Lead was corroded in an oak environment to simulate storage or display in a wooden case then coated with ethanolic solutions of tetradecanoic and octadecanoic acid. X-ray diffraction and electrochemical impedance data suggests an better-quality coating is formed leading to improved corrosion resistance

Proportionate and Disproportionate Functional Mitral Regurgitation: A New Conceptual Framework That Reconciles the Results of the MITRA-FR and COAPT Trials

Traditional approaches to the characterization of secondary or functional mitral regurgitation (MR) have largely ignored the critical importance of the left ventricle (LV). We propose that patients with secondary MR represent a heterogenous group, which can be usefully subdivided based on understanding that the effective regurgitant orifice area (EROA) is dependent on left ventricular end-diastolic volume (LVEDV). According to the Gorlin hydraulic orifice equation, patients with heart failure, an LV ejection fraction of 30%, an LVEDV of 220 to 250 ml, and a regurgitant fraction of 50% would be expected to have an EROA of ≈0.3 cm2 independent of specific tethering abnormalities of the mitral valve leaflets. The MR in these patients is proportionate to the degree of LV dilatation and can respond to drugs and devices that reduce LVEDV. In contrast, patients with EROA of 0.3 to 0.4 cm2 but with LVEDV of only 160 to 200 ml exhibit degrees of MR that are disproportionately higher than predicted by LVEDV. These patients appear to preferentially benefit from interventions directed at the mitral valve. Our proposed conceptual framework explains the apparently discordant results from 2 recent randomized controlled trials of mitral valve repair. The MITRA-FR (Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation) trial enrolled patients who had MR that was proportionate to the degree of LV dilatation, and during long-term follow-up, the LVEDV and clinical outcomes of these patients did not differ from medically-treated control subjects. In comparison, the patients enrolled in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial had an EROA ≈30% higher but LV volumes that were ≈30% smaller, indicative of disproportionate MR. In these patients, transcatheter mitral valve repair reduced the risk of death and hospitalization for heart failure, and these benefits were paralleled by a meaningful decrease in LVEDV. Thus, characterization of MR as proportionate or disproportionate to LVEDV appears to be critical to the selection of an optimal treatment for patients with chronic heart failure and systolic dysfunction

Accuracy of dobutamine echocardiography for detection of myocardial viability in patients with an occluded left anterior descending coronary artery

Objectives.We studied the accuracy of dobutamine echocardiography for the detection of myocardial viability in patients with an occluded left anterior descending coronary artery and regional ventricular dysfunction.Background.Contractile reserve during dobutamine echocardiography is an accurate marker of myocardial viability in patients with coronary stenoses and ventricular dysfunction. However, its accuracy in patients with an occluded vessel has not been evaluated.Methods.We studied 41 patients with >50% stenosis of the left anterior descending coronary artery and regional ventricular dysfunction who underwent dobutamine echocardiography for detection of viable myocardium. Contractile reserve was defined as improvement in wall motion score of two or more contiguous septal or anterior segments during dobutamine echocardiography. Recovery of function was defined as improvement in rest wall motion score of two or more contiguous segments after revascularization.Results.Patients were classified into two groups according to the presence (n = 20) or absence (n = 21) of left anterior descending coronary artery occlusion. Contractile reserve was detected in 40% of patients with an occluded and 43% with a nonoccluded artery (p = 0.8). Of 41 patients, 27 underwent revascularization, 12 with and 15 without an occluded vessel. Recovery of function occurred in 6 (50%) of 12 patients in the occluded artery group and in 5 (33%) of 15 in the nonoccluded artery group (p = 0.4). Among patients with an occluded artery, the positive and negative predictive values of dobutamine echocardiography for recovery of function were 100% (95% confidence interval [CI] 48% to 100%) and 86% (95% CI 42% to 100%), respectively.Conclusions.Our results indicate that contractile reserve during dobutamine echocardiography can be detected in patients with an occluded vessel and may be useful for predicting recovery of function after revascularization

Spectroelectrochemical techniques for the conservation of metallic artefacts

The research presented in this thesis uses laboratory and synchrotron based structural techniques in combination with electrochemistry to test the durability of selected conservation methods. A new piece of portable spectroelectrochemical equipment (the peCell) is also described: the peCell was designed for the long-term monitoring of conservation treatments. Lead carboxylates were selected as the focal point of this research due to the interest in studying their deposition from ethanolic solution and the effectiveness of this type of coating on lead. Therefore the spectroscopic analysis, electrochemical testing in an electrolyte modelling atmospheric corrosion, short-term and longterm volatile organic compound (VOC) exposure, and museum testing of this inhibitor demonstrates an entire package of tests which might be used as a benchmark for testing conservation treatments prior to use on artefacts. In addition the contrasting effects of lead carboxylates in oil paintings and as conservation coatings are discussed. Alongside laboratory spectroelectrochemical data, the corrosion by oak VOCs of a conserved lead sample was studied, (a) using a state-of-the-art in situ timelapse technique on a synchrotron and (b) within a museum environment. Surface analysis by X-ray diffraction (XRD) was used to compare the growth of crystalline surface corrosion products over time: the extent of corrosion can be related to the effectiveness of the various conservation techniques. The peCell is a portable electrochemical or environmental cell which was invented in order to provide a way of tracking the chemical changes occurring in a conserved sample in situ over a long period of time. The cell is capable of holding three samples which can be monitored continuously using open circuit potential and sporadically (i.e. whenever a synchrotron beam line is accessible) using SR-XRD. Other environmental parameters within the cell can also be monitored, such as temperature. The prototype cell was successfully trialled at the XMaS beamline, ESRF using an alternative copper corrosion system