Objective assessment of functional and motor-cognitive outcomes among asymptomatic primary hyperparathyroidism patients undergoing parathyroidectomy using wearable technologies: a pilot study towards better informed clinical decision-making

For the past 40 years, most patients with Primary Hyperparathyroidism (PHPT) have presented with the asymptomatic form of PHPT. Despite the dominance of the asymptomatic PHPT phenotype, current National Institutes of Health (NIH) indications for parathyroidectomy fail to identify as many as 80% of patients afflicted with asymptomatic PHPT. To date, studies of the therapeutic benefits of parathyroidectomy among asymptomatic PHPT patients have relied on general health questionnaires and patient reports of their satisfaction with the surgery. The purpose of the present study was to implement objective, quantifiable metrics in assessing whether or not asymptomatic PHPT patients experience improvements in domains salient to them such as mobility and cognitive function following parathyroidectomy. This information may help set the foundation for more accurately identifying patients who would benefit from parathyroidectomy. We hypothesized that asymptomatic patients would exhibit improvement in motor-cognitive outcomes following successful parathyroidectomy. We performed a single-center prospective assessment of gait, frailty, and motor-cognitive function among patients diagnosed with PHPT. Demographics, medical history, and perioperative labs were recorded. Pre- and post-surgical measures included the Fried frailty criteria, the PROMIS 10 Global Health Scale, and gait analysis under habitual (ST), walking while performing working memory test (dual-task: DT), and fast-walking conditions, an upper extremity frailty (UEF) test, and an interactive trail-making task (iTMT) . Descriptive statistics, Chi-squared, 2-sample t tests, and repeated measures analysis of variance were applied where appropriate. 22 parathyroidectomy patients (male 7; 31.8%); median age of 54.9 (standard deviation=15.5) years participated. The prevalence of frailty/pre-frailty was 60% at baseline and reduced to 33% at 3 weeks post-op. PROMIS 10 physical health improved significantly by 3 months post-op (d=0.93, p=0.010). DT and fast walk velocities were significantly increased by 3 weeks post-op (p<0.050) with highest effect size observed during DT conditions (24%, Cohen's effect size d=1.30 , p=0.017). ST velocity increased but not significantly (17.5%, d=0.46, p=0.422). Results from UEF tests and iTMT did not achieve statistical significance at any visit date. Asymptomatic PHPT patients experience significant resolution of motor-cognitive symptoms as measured by DT gait and PROMIS 10 Global Health Scale following parathyroidectomy performed by a skilled surgeon

Green Housing = Improved Health: A Winning Combination

The case studies in this paper explore the relationship between housing and health. It explains how building affordable green housing provides health benefits to low-income residentsand it identifies the benefits of green housing for the environment and energy efficiency

The question of objectivity in Zola's Thérse Raquin : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in French at Massey University

Some French throughout.The first chapter examines the fascination the concept of objectivity held for certain French Realists including Emile Zola, acknowledged leader of the Naturalists who believed in the application of the scientific method to novel-writing. These writers sought to produce works of mimetic value and attached themselves to the tenets of objectivity in an attempt to achieve this. However it was recognized that their efforts at producing 'objective' novels were threatened by a requirement for artistry in published fiction. More recent thinking acknowledges that objectivity is not achievable, at least not in absolute terms. The problems inherent in various definitions of objectivity in fiction are examined and reveal general agreement that this kind of objectivity requires at least the appearance of detachment and neutrality by the author. In order to examine the question of the author's detachment, Chapter 2 ,makes a case for the distinctions of author, implied author and narrator to be blurred in Zola's Therese Raguin. Four distinct aspects of the narrating voice are examined. Examples are given of the various forms of commentary in the narrative which reveal the presence of the author-narrator. The author's preconceptions which threaten his neutrality are focused on in Chapter 3. The theory of determinism involving both causality and fatalism is seen as both abetting and threatening the author's attainment of a semblance of objectivity in the text. We examine the basis on which characters are presented and milieu is described in Therese Raquin. Zola is shown to be far from neutral

Brexit as constitutional "shock" and its threat to the devolution settlement: reform or bust

The devolution settlement was not designed to withstand such a major shock as Brexit and, furthermore, Brexit has demonstrated key weaknesses in the devolution design (an argument that is even more fundamental for Northern Ireland). This would point to a logical conclusion: to rectify these problems either the devolution design needs to be fundamentally redrawn post- Brexit allowing a distinct Scottish voice to be heard and given force or independence as a solution

Walking upright here : countering prevailing discourses through reflexivity and methodological pluralism : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University, Albany, New Zealand

Knowledge development takes place in the context of competing political, social and economic frameworks that often reflect dominant group values, practises and ideologies. Research scholarship needs to include and legitimate knowledge construction from different locations and epistemologies. Where research occurs with minority groups it is suggested that multiple research strategies are incorporated in order to prevent the reproduction of deficiency discourses. Such strategies could include self-reflexivity and the use of methodological pluralism, incorporating appropriate methodologies that can be used to expose and dismantle hegemonic discourses. A research exemplar is used that features the dual transition of migration and motherhood for women from Goa, India who are now living in New Zealand. This is done to illustrate the applicability of reflexivity and methodological pluralism in countering the hegemonic deficiency discourse associated with migrant women. The qualitative approach that was used privileges culture and locates the participants in their historical and cultural contexts. Goan women were interviewed about their migration history, their adjustment to living in New Zealand and experiences of childbirth and motherhood in a new country. The use of alternative creative and innovative conceptions of methodology that allow for the emergence of undetermined discursive spaces between different lines of inquiry, within which the authentic voices of participants might lodge and be heard is advocated. Without such strategies research that purports to represent the experiences of a particular group risks reproducing the processes of subordination that devalue certain groups while holding in place the needs and aspirations of a privileged few. The findings of the exemplar challenge monolithic essentialising representations of migrant women associated with discourses that position them as backward, passive and deficient. This thesis advances the discussion on what it means to construct knowledge of social practices within a multi-ethnic environment in order that the voice of the 'other' can be heard