Promotion or protection : the management of tourist visitation to New Zealand's Antarctic and sub-Antarctic territories New Zealand as a case study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Business Studies in Management Systems at Massey University

Antarctica and the sub-Antarctic islands are among the last regions on earth that are still relatively unspoilt from human activity. At the same time, they are also among the last tourism frontiers in the world. The forms of tourism, trends, impacts and the current management mechanisms are described and assessed. New Zealand is offered as a case-study because it is experiencing increased visitation to its Antarctic and sub-Antarctic territories. As claimant to a section of Antarctica and signatory to the Antarctic Treaty, New Zealand has a vested interest in preserving this unique area. As the operator of Antarctic bases, it is probable that the New Zealand government may be called upon to provide assistance to tourist expeditions in the Antarctic. New Zealand companies are involved in tourist visits to the sub-Antarctic islands. Attention is drawn to areas of concern, and the various policies New Zealand applies to Antarctic and sub-Antarctic ecotourism are analysed. The need for a sustainable tourist management regime is examined, in order to balance the paradox between preservation and visitation. The varying aspects of international and national management regimes to manage Antarctic and sub-Antarctic tourism are discussed. Antarctica is managed by an international system, whereas the sub-Antarctic islands are subject to national legislation. This has implications for tourism management in these regions. It is questioned whether the present tourist regulations are adequate to protect the sub-Antarctic and Antarctic environments from the impacts of tourism. It is suggested that the current mechanisms are not sufficient, and the establishment of an International Convention on Antarctic and sub-Antarctic Tourism is proposed

Fit for the future : Physical fitness of children and adolescents with intellectual disabilities

Children and adolescents with an intellectual disability (ID) are more vulnerable for health problems than typically developing peers. Good physical fitness is therefore important. This prevents health risk now and in the future. This thesis describes the study on physical fitness of children and adolescents with ID. It starts with a systematic literature review and pilot study on appropriate fitness tests for children and adolescents with moderate to severe ID. In the next step, the physical fitness and physical activity was measured in 128 participants. Using retrospective data, the maximal heart rates of children and adolescents with ID were studied as well. The results indicate that the physical fitness of children and adolescents with moderate to severe ID is very low. Secondly, more than half of the participants were not active enough according to the physical activity guidelines. Thirdly, children and adolescents with ID are shown to have lower maximal heart rates than typically developing peers. This thesis ends with recommendations to increase the physical fitness of children and adolescents with ID in clinical practice

Physical activity levels of children and adolescents with moderate-to-severe intellectual disability

Background: Regular participation of children and adolescents with intellectual disabilites in physical activity is important to maintain good health and to acquire motor skills. The aim of this study was to investigate the habitual physical activity in these children. Methods: Sixty-eight children and adolescents (2–18 years) with a moderate-tosevere intellectual disability were included in the analyses. They wore an accelerometer on eight consecutive days. Data was analysed by use of descriptive statistics and multiple linear regression analyses. Results: The participants took on average 6,677 ± 2,600 steps per day, with intensity of 1,040 ± 431 counts per minute. In total, 47% of the participants were meeting physical activity recommendations. Low motor development was associated with low physical activity. Conclusions: As more than half of the participants were not meeting the recommendations, family and caregivers of these children should focus on supporting and motivating them to explore and expand their physical activities

Game-based learning has good chemistry with chemistry education: A three-level meta-analysis

Game-based learning (GBL) may address the unique characteristics of a single subject such as chemistry. Previous systematic reviews on the effects of GBL have yielded contradictory results concerning cognitive and motivational outcomes. This meta-analysis aims to: (a) estimate the overall effect size of GBL in chemistry education on cognitive, motivational, and emotional outcomes compared with non-GBL (i.e., media comparison); (b) examine possible moderators of the effects; and (c) identify the more effective game design and instructional design features (i.e., value-added comparison). We screened 842 articles and included 34 studies. This study is the first GBL meta-analysis that employed a three-level random-effects model for the overall effects. Moderator analysis used a mixed-effects meta-regression model. Results from the media comparison suggest chemistry GBL was more effective for cognition (g = 0.70, k = 30, N = 4155), retention (g = 0.59, k = 20, N = 2860), and motivation (g = 0.35, k = 7, N = 974) than non-GBL and the substantial heterogeneity (I2 = 86%) for cognitive outcomes. No study reported emotional outcomes, and studies considering value-added comparisons of GBL with versus without specific design features (k = 3) were too few to perform a meta-analysis. Moderator analyses implied that except for publication source and sample size, no other moderator was related to effect sizes. There may be the small-study effects, particularly publication bias. Although we conclude that GBL enhances chemistry learning more than non-GBL, the results also make clear that additional high-quality value-added research is needed to identify design guidelines that may further improve chemistry GBL. More GBL meta-analyses on subjects other than chemistry are also needed. As the first GBL meta-analysis that emphasizes emotion, we call for more research on emotion and on relationships between cognition, motivation, and emotion in GBL

Sugar Matters: Improving In Vivo Clearance Rate of Highly Glycosylated Recombinant Plasma Proteins for Therapeutic Use.

Correct glycosylation of proteins is essential for production of therapeutic proteins as glycosylation is important for protein solubility, stability, half-life and immunogenicity. The heavily glycosylated plasma protein C1-inhibitor (C1-INH) is used in treatment of hereditary angioedema attacks. In this study, we used C1-INH as a model protein to propose an approach to develop recombinant glycoproteins with the desired glycosylation. We produced fully functional recombinant C1-INH in Chinese hamster ovary (CHO) cells. In vivo we observed a biphasic clearance, indicating different glycosylation forms. N-glycan analysis with mass spectrometry indeed demonstrated heterogeneous glycosylation for recombinant C1-INH containing terminal galactose and terminal sialic acid. Using a Ricinus Communis Agglutinin I (RCA120) column, we could reduce the relative abundance of terminal galactose and increase the relative abundance of terminal sialic acid. This resulted in a fully active protein with a similar in vivo clearance rate to plasmaderived C1-INH. In summary, we describe the development of a recombinant human glycoprotein using simple screening tools to obtain a product that is similar in function and in vivo clearance rate to its plasma-derived counterpart. The approach used here is of potential use in the development of other therapeutic recombinant human glycoproteins

Quality Improvement of Pancreatic Surgery by Centralization in the Western Part of the Netherlands

BACKGROUND: Centralization of pancreatic surgery in high-volume hospitals is under debate in many countries. In the western part of the Netherlands, the professional network of surgical oncologists agreed to centralize all pancreatic surgery from 2006 in two high-volume hospitals. Our aim is to evaluate whether centralization of pancreatic surgery has improved clinical outcomes and has changed referral patterns. MATERIALS AND METHODS: Data of the Comprehensive Cancer Centre West (CCCW) of all 249 patients who had a resection for suspected pancreatic cancer between 1996 and 2008 in the western part of the Netherlands were analyzed. Multivariable modeling was used to evaluate survival for 3 time periods; 1996–2000, 2001–2005 (introduction of quality standards), and 2006–2008 (after centralization). In addition, the differences in referral pattern were analyzed. RESULTS: From 2006, all pancreatic surgery was centralized in 2 hospitals. The 2-year survival rate increased after centralization from 39% to 55% (P = .09) for all patients who had a pancreatic resection for pancreatic cancer. After adjustment for age, tumor location, stage, histology, and adjuvant treatment, the latter period was significantly associated with improved survival (hazard ratio [HR] 0.50; 95% confidence interval [95% CI] 0.34–0.73). CONCLUSIONS: Centralization of pancreatic surgery was successful and has resulted in improved clinical outcomes in the western part of the Netherlands, demonstrating the effectiveness of centralization

Data verification of nationwide clinical quality registries

Background Clinical auditing is an emerging instrument for quality assessment and improvement. Moreover, clinical registries facilitate medical research as they provide ‘real world’ data. It is important that entered data are robust and reliable. The aim of this study was to describe the evolving procedure and results of data verification within the Dutch Institute for Clinical Auditing (DICA). Methods Data verification performed on several (disease‐specific) clinical registries between 2013 and 2015 was evaluated. Sign‐up, sample size and process of verification were described. For each procedure, hospitals were visited by external data managers to verify registered data. Outcomes of data verification were completeness and accuracy. An assessment of the quality of data was given p

Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

Background: Previous studies have shown that opioids can reduce chronic breathlessness in advanced disease. However, physicians remain reluctant to prescribe opioids for these patients, commonly due to fear of respiratory adverse effects. Aim: To systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness. Methods: Pubmed, Embase, Cochrane central register of controlled trials, CINAHL, ClinicalTrials.gov and the reference lists of relevant systematic reviews were searched. Two independent researchers screened against predefined inclusion criteria and extracted data. Meta-analysis was conducted where possible. Results: We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in partial pressure of carbon dioxide (0.27 kPa; 95% CI 0.08 to 0.45) and no significant change in partial pressure of oxygen and oxygen saturation (both p>0.05). Non-serious respiratory depression (definition variable/not stated) was described in 4/1064 patients. One cancer patient pre-treated with morphine for pain needed temporary respiratory support following nebulized morphine for breathlessness (single case study). Conclusions: We found no evidence of significant or clinically relevant respiratory adverse effects of opioids for chronic breathlessness. Heterogeneity of design and study population, and low study quality are limitations. Larger studies designed to detect respiratory adverse effects are needed