Determining the value of Māori nurses in Aotearoa : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Business Studies (Management), School of Management, Massey University, Palmerston North, New Zealand

This thesis examines the experiences of Māori Registered nurses within Aotearoa, New Zealand. This research offers an understanding of how Nursing discourse is embedded within legislation, regulatory bodies, and nursing practice and its direct impact on the health and well-being of Māori nurses. This discourse continues to marginalise and undervalue tikanga. As Māori nurse’s workplace expectations of cultural responsibilities are undertaken over and above standard nursing practices. Māori nurses often get allocated what was coined ‘difficult’ or complex Māori patient and their whānau. Māori nurses must ensure whānau are kept culturally safe while navigating and advocating for whānau in health care organisations where 1 in 2 Māori nurses face racism and discrimination. This thesis explored the experiences of Māori registered nurses using a kaupapa Māori, mixed-method approach. The survey was distributed during a two-week period during Covid-19. Five semi-structured interviews were completed, and responses were used to inform a survey of which there were 342 respondents. Once the data was cleaned, 333 valid responses were used to examine the perspective of Māori Registered nurses. Also identified were the experiences of Māori nurses and the impact on career advancement, use of tikanga in practice, cultural identity, professional development, and racism and discrimination within their work environment. This thesis’s findings validated the lack of leadership, opportunities, and responsive practices required to ensure Māori nurses are supported and valued not only within their profession but within their organisations honouring Te Tiriti o Waitangi requires creating real change for Māori nursing professionals to ensure they feel valued in their workplace, are fairly remunerated, and feel safe to identify and practice as Māori within their workplace

Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: An economic evaluation alongside a randomised controlled trial

Objective: To undertake an economic evaluation alongside the largest randomised controlled trial comparing Levonorgestrel-releasing intrauterine device ('LNG-IUS') and usual medical treatment for women with menorrhagia in primary care; and compare the cost-effectiveness findings using two alternative measures of quality of life. Methods: 571 women with menorrhagia from 63 UK centres were randomised between February 2005 and July 2009. Women were randomised to having a LNG-IUS fitted, or usual medical treatment, after discussing with their general practitioner their contraceptive needs or desire to avoid hormonal treatment. The treatment was specified prior to randomisation. For the economic evaluation we developed a state transition (Markov) model with a 24 month follow-up. The model structure was informed by the trial women's pathway and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per Quality Adjusted Life Year (QALY) estimated using both EQ-5D and SF-6D. Results: Using EQ-5D, LNG-IUS was the most cost-effective treatment for menorrhagia. LNG-IUS costs £100 more than usual medical treatment but generated 0.07 more QALYs. The incremental cost-effectiveness ratio for LNG-IUS compared to usual medical treatment was £1600 per additional QALY. Using SF-6D, usual medical treatment was the most cost-effective treatment. Usual medical treatment was both less costly (£100) and generated 0.002 more QALYs. Conclusion: Impact on quality of life is the primary indicator of treatment success in menorrhagia. However, the most costeffective treatment differs depending on the quality of life measure used to estimate the QALY. Under UK guidelines LNG-IUS would be the recommended treatment for menorrhagia. This study demonstrates that the appropriate valuation of outcomes in menorrhagia is crucial. Copyright: © 2014 Sanghera et al

Comparison of sequencing-based methods to profile DNA methylation and identification of monoallelic epigenetic modifications.

Analysis of DNA methylation patterns relies increasingly on sequencing-based profiling methods. The four most frequently used sequencing-based technologies are the bisulfite-based methods MethylC-seq and reduced representation bisulfite sequencing (RRBS), and the enrichment-based techniques methylated DNA immunoprecipitation sequencing (MeDIP-seq) and methylated DNA binding domain sequencing (MBD-seq). We applied all four methods to biological replicates of human embryonic stem cells to assess their genome-wide CpG coverage, resolution, cost, concordance and the influence of CpG density and genomic context. The methylation levels assessed by the two bisulfite methods were concordant (their difference did not exceed a given threshold) for 82% for CpGs and 99% of the non-CpG cytosines. Using binary methylation calls, the two enrichment methods were 99% concordant and regions assessed by all four methods were 97% concordant. We combined MeDIP-seq with methylation-sensitive restriction enzyme (MRE-seq) sequencing for comprehensive methylome coverage at lower cost. This, along with RNA-seq and ChIP-seq of the ES cells enabled us to detect regions with allele-specific epigenetic states, identifying most known imprinted regions and new loci with monoallelic epigenetic marks and monoallelic expression

A Cross-Sectional Characterization of Insulin Resistance by Phenotype and Insulin Clamp in East Asian Americans with Type 1 and Type 2 Diabetes

Classic features of type 1 and type 2 diabetes may not apply in Asian Americans, due to shared absence of common HLA DR-DQ genotype, low prevalence of positive anti-islet antibodies and low BMI in both types of diabetes. Our objective was to characterize diabetic phenotypes in Asian Americans by clamp and clinical features.This was a cross-sectional study conducted in a referral center. Thirty East young Asian American adult volunteers (27.6±5.5 years) with type 1, type 2 diabetes or controls underwent hyperinsulinemic euglycemic clamp to assess insulin resistance and DEXA to assess adiposity.Gender, BMI, waist/hip ratio, leptin, LDL, anti-GAD, anti-IA2 antibodies and C-reactive protein were similar among three groups. Serum C-peptide, adiponectin, free fatty acid, HDL concentrations and truncal fat by DEXA, were different between diabetic groups. Glucose disposal rate by clamp was lowest in type 2 diabetes, followed by type 1 diabetes and controls (5.43±2.70, 7.62±2.59, 8.61±2.37 mg/min/kg, respectively, p = 0.001). Free fatty acid concentration universally plummeted during steady state of the clamp procedure regardless of diabetes types in all three groups. Adipocyte fatty acid binding protein in the entire cohort (r = -0.625, p = 0.04) and controls (r = -0.869, p = 0.046) correlated best with insulin resistance, independent of BMI.Type 2 diabetes in Asian Americans was associated with insulin resistance despite having low BMI as type 1 diabetes, suggesting a potential role for targeting insulin resistance apart from weight loss. Adipocyte fatty acid binding protein, strongly associated with insulin resistance, independent of adiposity in the young Asian American population, may potentially serve as a biomarker to identify at-risk individuals. Larger studies are needed to confirm this finding

Pseudo-acetylation of multiple sites on human Tau proteins alters Tau phosphorylation and microtubule binding, and ameliorates amyloid beta toxicity

Tau is a microtubule-associated protein that is highly soluble and natively unfolded. Its dysfunction is involved in the pathogenesis of several neurodegenerative disorders including Alzheimer's disease (AD), where it aggregates within neurons. Deciphering the physiological and pathogenic roles of human Tau (hTau) is crucial to further understand the mechanisms leading to its dysfunction in vivo. We have used a knock-out/knock-in strategy in Drosophila to generate a strain with hTau inserted into the endogenous fly tau locus and expressed under the control of the endogenous fly tau promoter, thus avoiding potential toxicity due to genetic over-expression. hTau knock-in (KI) proteins were expressed at normal, endogenous levels, bound to fly microtubules and were post-translationally modified, hence displaying physiological properties. We used this new model to investigate the effects of acetylation on hTau toxicity in vivo. The simultaneous pseudo-acetylation of hTau at lysines 163, 280, 281 and 369 drastically decreased hTau phosphorylation and significantly reduced its binding to microtubules in vivo. These molecular alterations were associated with ameliorated amyloid beta toxicity. Our results indicate acetylation of hTau on multiple sites regulates its biology and ameliorates amyloid beta toxicity in vivo

An Approach to Enhance the Conservation-Compatibility of Solar Energy Development

The rapid pace of climate change poses a major threat to biodiversity. Utility-scale renewable energy development (>1 MW capacity) is a key strategy to reduce greenhouse gas emissions, but development of those facilities also can have adverse effects on biodiversity. Here, we examine the synergy between renewable energy generation goals and those for biodiversity conservation in the 13 M ha Mojave Desert of the southwestern USA. We integrated spatial data on biodiversity conservation value, solar energy potential, and land surface slope angle (a key determinant of development feasibility) and found there to be sufficient area to meet renewable energy goals without developing on lands of relatively high conservation value. Indeed, we found nearly 200,000 ha of lower conservation value land below the most restrictive slope angle (<1%); that area could meet the state of California’s current 33% renewable energy goal 1.8 times over. We found over 740,000 ha below the highest slope angle (<5%) – an area that can meet California’s renewable energy goal seven times over. Our analysis also suggests that the supply of high quality habitat on private land may be insufficient to mitigate impacts from future solar projects, so enhancing public land management may need to be considered among the options to offset such impacts. Using the approach presented here, planners could reduce development impacts on areas of higher conservation value, and so reduce trade-offs between converting to a green energy economy and conserving biodiversity

Silent, invisible and under-supported? : An autoethnographic journey through the valley of the shadow and youth mental health in Australia

This autoethnographic account of personal loss and consequent meaning-making aims to contribute to a unique understanding of young Australians facing both times of uncertainty and mental illness. As a qualitative study, it explores the lived experience of the researcher whose working life was spent in youth studies. This tacit knowledge seemed to fail as she tried to get help for her mentally ill son who died unexpectedly of a drug overdose. Using critical autoethnography and a highly reflexive approach, the researcher deploys three reflexive selves – mother-self, youth studies self, and autoethnographer/researcher-self – in order to answer the research question, How might a mother’s autoethnographic account of her son “falling through the cracks” help us to better understand and support Australian youth experiencing mental illness? The study contributes insights from a community perspective about the disjunction between policy promises and service delivery for young people with mental illness in Australia. The gap this thesis fills is methodological by nature, since the autoethnographic voice of a parent is rare in the multidisciplinary contexts of this research. Using youth studies as its theoretical framework, the literature review explores broad themes in youth studies as well as mental health, along with specific themes addressed throughout the thesis such as the experience of exclusion from decision-making, the issues of youth agency and mental illness, shame and stigma, suicidality and psychiatric treatment for mentally ill youth. The autoethnography itself is presented as two distinct chapters, the first tracing a narrative arc through migration, schooling, bullying, giftedness, existential angst, suicidality and mental illness, and the second continuing beyond the death of the researcher’s son, exploring the “broken dialogue” in mental health policy and service settings, laying bare a disjunction between the lay and professional views of mental illness. This thesis will be of interest and relevance for professionals who work with gifted youth as well as parents, teachers, policy-makers and others concerned with the mental health of Australian youth