An evaluation of Te Rau Puawai workforce 100: Stakeholder perspectives

To evaluate the Te Rau Puawai programme, the Ministry of Health commissioned the Maori and Psychology Research Unit of the University of Waikato in July 2001. The overall aim of the evaluation was to provide the Ministry with a clearer understanding of the programme including: the perceived critical success factors, the barriers if any regarding Te Rau Puawai, the impact of the programme, the extent to which the programme may be transferable, gaps in the programme, and suggested improvements. There are a number of stakeholders who do not have a direct role in the provision of Te Rau Puawai. These people are not involved in the day to day running of Te Rau Puawai (as do, for example, the coordinator, support team or academic mentors), nevertheless they play an important role, contributing in a variety of ways to the programme

Controlled clinical trial of canine therapy versus usual care to reduce patient anxiety in the emergency department

Objective Test if therapy dogs reduce anxiety in emergency department (ED) patients. Methods In this controlled clinical trial (NCT03471429), medically stable, adult patients were approached if the physician believed that the patient had “moderate or greater anxiety.” Patients were allocated on a 1:1 ratio to either 15 min exposure to a certified therapy dog and handler (dog), or usual care (control). Patient reported anxiety, pain and depression were assessed using a 0–10 scale (10 = worst). Primary outcome was change in anxiety from baseline (T0) to 30 min and 90 min after exposure to dog or control (T1 and T2 respectively); secondary outcomes were pain, depression and frequency of pain medication. Results Among 93 patients willing to participate in research, 7 had aversions to dogs, leaving 86 (92%) were willing to see a dog six others met exclusion criteria, leaving 40 patients allocated to each group (dog or control). Median and mean baseline anxiety, pain and depression scores were similar between groups. With dog exposure, median anxiety decreased significantly from T0 to T1: 6 (IQR 4–9.75) to T1: 2 (0–6) compared with 6 (4–8) to 6 (2.5–8) in controls (P<0.001, for T1, Mann-Whitney U and unpaired t-test). Dog exposure was associated with significantly lower anxiety at T2 and a significant overall treatment effect on two-way repeated measures ANOVA for anxiety, pain and depression. After exposure, 1/40 in the dog group needed pain medication, versus 7/40 in controls (P = 0.056, Fisher’s exact test). Conclusions Exposure to therapy dogs plus handlers significantly reduced anxiety in ED patients

Fracture in Mode I using a Conserved Phase-Field Model

We present a continuum phase-field model of crack propagation. It includes a phase-field that is proportional to the mass density and a displacement field that is governed by linear elastic theory. Generic macroscopic crack growth laws emerge naturally from this model. In contrast to classical continuum fracture mechanics simulations, our model avoids numerical front tracking. The added phase-field smoothes the sharp interface, enabling us to use equations of motion for the material (grounded in basic physical principles) rather than for the interface (which often are deduced from complicated theories or empirical observations). The interface dynamics thus emerges naturally. In this paper, we look at stationary solutions of the model, mode I fracture, and also discuss numerical issues. We find that the Griffith's threshold underestimates the critical value at which our system fractures due to long wavelength modes excited by the fracture process.Comment: 10 pages, 5 figures (eps). Added 2 figures and some text. Removed one section (and a figure). To be published in PR

Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations

© 2019 The Authors Objective: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. Methods: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. Results: While most ACCHOs had delivered post-release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. Conclusion: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs’ role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur

Emergence: Key physical issues for deeper philosophical inquiries

A sketch of three senses of emergence and a suggestive view on the emergence of time and the direction of time is presented. After trying to identify which issues philosophers interested in emergent phenomena in physics view as important I make several observations pertaining to the concepts, methodology and mechanisms required to understand emergence and describe a platform for its investigation. I then identify some key physical issues which I feel need be better appreciated by the philosophers in this pursuit. I end with some comments on one of these issues, that of coarse-graining and persistent structures.Comment: 16 pages. Invited Talk at the Heinz von Foerster Centenary International Conference on Self-Organization and Emergence: Emergent Quantum Mechanics (EmerQuM11). Nov. 10-13, 2011, Vienna, Austria. Proceedings to appear in J. Phys. (Conf. Series

Emergence: Key physical issues for deeper philosophical inquiries

A sketch of three senses of emergence and a suggestive view on the emergence of time and the direction of time is presented. After trying to identify which issues philosophers interested in emergent phenomena in physics view as important I make several observations pertaining to the concepts, methodology and mechanisms required to understand emergence and describe a platform for its investigation. I then identify some key physical issues which I feel need be better appreciated by the philosophers in this pursuit. I end with some comments on one of these issues, that of coarse-graining and persistent structures.Comment: 16 pages. Invited Talk at the Heinz von Foerster Centenary International Conference on Self-Organization and Emergence: Emergent Quantum Mechanics (EmerQuM11). Nov. 10-13, 2011, Vienna, Austria. Proceedings to appear in J. Phys. (Conf. Series

Inflammation-driven bone formation in a mouse model of ankylosing spondylitis: sequential not parallel processes

Background\ud \ud Ankylosing spondylitis (AS) is an immune-mediated arthritis particularly targeting the spine and pelvis and is characterised by inflammation, osteoproliferation and frequently ankylosis. Current treatments that predominately target inflammatory pathways have disappointing efficacy in slowing disease progression. Thus, a better understanding of the causal association and pathological progression from inflammation to bone formation, particularly whether inflammation directly initiates osteoproliferation, is required.\ud \ud Methods\ud \ud The proteoglycan-induced spondylitis (PGISp) mouse model of AS was used to histopathologically map the progressive axial disease events, assess molecular changes during disease progression and define disease progression using unbiased clustering of semi-quantitative histology. PGISp mice were followed over a 24-week time course. Spinal disease was assessed using a novel semi-quantitative histological scoring system that independently evaluated the breadth of pathological features associated with PGISp axial disease, including inflammation, joint destruction and excessive tissue formation (osteoproliferation). Matrix components were identified using immunohistochemistry.\ud \ud Results\ud \ud Disease initiated with inflammation at the periphery of the intervertebral disc (IVD) adjacent to the longitudinal ligament, reminiscent of enthesitis, and was associated with upregulated tumor necrosis factor and metalloproteinases. After a lag phase, established inflammation was temporospatially associated with destruction of IVDs, cartilage and bone. At later time points, advanced disease was characterised by substantially reduced inflammation, excessive tissue formation and ectopic chondrocyte expansion. These distinct features differentiated affected mice into early, intermediate and advanced disease stages. Excessive tissue formation was observed in vertebral joints only if the IVD was destroyed as a consequence of the early inflammation. Ectopic excessive tissue was predominantly chondroidal with chondrocyte-like cells embedded within collagen type II- and X-rich matrix. This corresponded with upregulation of mRNA for cartilage markers Col2a1, sox9 and Comp. Osteophytes, though infrequent, were more prevalent in later disease.\ud \ud Conclusions\ud \ud The inflammation-driven IVD destruction was shown to be a prerequisite for axial disease progression to osteoproliferation in the PGISp mouse. Osteoproliferation led to vertebral body deformity and fusion but was never seen concurrent with persistent inflammation, suggesting a sequential process. The findings support that early intervention with anti-inflammatory therapies will be needed to limit destructive processes and consequently prevent progression of AS