New Zealand Pae Ora Healthcare Reforms 2022: Viable by Design? A Qualitative Study Using the Viable System Model.

BACKGROUND: The New Zealand (NZ) Pae Ora (Healthy Futures) health reforms came into effect in July 2022 with the establishment of Health New Zealand (HNZ) (Te Whatu Ora) and the Maori Health Authority (MHA) (Te Aka Whai Ora) - the organisations charged for healthcare provision and delivery. Given these changes represent major health system reform, we aimed to conduct an early evaluation of the design of the reforms to determine if they can deliver a viable and sustainable NZ health system going forward. METHODS: The evaluation was informed by Beer's viable system model (VSM). A qualitative exploratory design with semi-structured interviews and documents analysis using thematic analysis was used. We conducted 28 interviews with senior healthcare managers and reviewed over 300 official documents and news analyses. RESULTS: The VSM posits that for a system to be viable, all its five sub-systems (operations; co-ordination; operational control; development and governance) need to be strong. Our analysis suggests that the health reforms, despite their strengths, do not satisfy this requirement. The reforms do appreciate the complexity of the healthcare environment: multiple stakeholders, social inequalities, interdependencies. However, our analysis suggests a severe lack of detail regarding the implementation and operationalisation of the reforms. Furthermore, resourcing and coordination within the reformed system is also unclear. CONCLUSION: The health system reforms may not lead to a viable future NZ health system. Poor communication of the reform implementation and operationalisation will likely result in system failure and inhibit the ability of frontline health organisations to deliver care.

Effects of an industrial passive assistive exoskeleton on muscle activity, oxygen consumption and subjective responses during lifting tasks.

The purpose of this study was to evaluate the effects of an industrial passive assisted exoskeleton (IPAE) with simulated lifting tasks on muscle activity, oxygen consumption, perceived level of exertion, local perceived pressure, and systemic usability. Eight workers were required to complete two lifting tasks with and without the IPAE, that were single lifting tasks (repeated 5 times) and 15 min repeated lifting tasks respectively. Both of the tasks required subjects to remove a toolbox from the ground to the waist height. The test results showed that IPAE significantly reduced the muscle activity of the lumbar erector spinae, thoracic erector spinae, middle deltoid and labrum-biceps muscles; the reduction effect during the 15 min lifting task was reached 21%, 12%, 32% and 38% respectively. The exoskeleton did not cause significant differences in oxygen consumption and the perceived level of exertion, but local perceived pressure on the shoulders, thighs, wrists, and waist of the subjects could be produced. 50% of the subjects rated the usability of the equipment as acceptable. The results illustrate the good potential of the exoskeleton to reduce the muscle activity of the low back and upper arms. However, there is still a concern for the obvious contact pressure.

A rapid and facile preparation of APTS-labeled N-glycans by combination of ion pair-assisted extraction and HILIC-SPE for routine glycan analysis.

Glycoanalytical technology is required for a wide variety of scientific research, including basic glycobiological pharmaceutical, and biomarker research. Although several innovative analytical techniques have been developed for these purposes, quantitative glycan analysis based on electrophoretic separation, has often been impeded by the lack of cost-effective and facile sample preparation approaches. Here, we developed a rapid and facile sample preparation workflow for cost-effective glycan analysis and demonstrated its use with fully automated microchip electrophoresis (ME). Purification of 8-aminopyrene-1,3,6-trisulfonate (APTS)-labeled glycans was based on the combination of ion-pair assisted extraction (IPAE) with hydrophilic interaction chromatography-solid phase extraction (HILIC-SPE). Compared to commonly used sample preparation methods, the IPAE/HILIC-SPE method undergoes minimal nonspecific loss and undesirable degradation of N-glycans during the purification step. Furthermore, our method required only 10 min, and the entire workflow, including glycan release, labeling, and concentration processes was completed within 4 h. Although the present system should be improved to enable analysis of more complex mixtures, ME-based separation of APTS-labeled N-glycans offers a fully automated operation including conditioning, sample loading, separation, and can be analyzed with a sample-to-sample throughput of 120 s in parallel processes. The present workflow is easy to implement, does not require expensive reagents and instruments and may be useful for glycoscientists across disciplines.

Universal Screening for Prevention of Reading, Writing, and Math Disabilities in Spanish.

The purpose of this study was to describe a Spanish protocol that includes reading, writing, and math Curriculum-Based Measures (CBMs) aimed at early detection of students at risk of presenting learning disabilities (LD). Early identification of LD is a critical component of the Response to Intervention (RtI) model. In early grades, the screening of foundational skills mentioned above can provide a data-based guideline for identifying students requiring a more intensive response-based intervention before starting elementary school. We designed different CBMs based on indicators of basic early reading, writing, and math skills [Indicadores de Progreso de Aprendizaje en Lectura, Escritura y Matemáticas, IPAL, IPAE, and IPAM respectively] that aim to fulfill the twofold objective of universal screening and evaluation of the Spanish students' progress. For reading, IPAL includes alphabetic principle, phonological awareness, concepts about print, and riddles in kindergarten. In first and second grades, IPAL includes alphabetic principle, nonsense words fluency, maze sentences, and oral reading fluency. In addition, it includes phonemic segmentation for first grade and prosody for second grade. For writing, IPAE includes copying letters, writing allographs, dictated letters, dictated words with arbitrary spelling, dictated words with rule-based spelling, dictated nonsense words, dictated sentences, writing sentences, and writing a story for first-third grades. Finally, for math, IPAM includes number comparison, missing number, number identification, quantity array, and counting aloud for kindergarten, and number comparison, multi-digit computation, missing number, single-digit computation, and place value for first-third grades.

Cross-Plane Thermal Conductance of Phosphonate-Based Self-Assembled Monolayers and Self-Assembled Nanodielectrics.

Self-assembled nanodielectrics (SANDs) consist of alternating layers of polarized phosphonate-functionalized azastibazolium π-electron (PAE) and high-k dielectric metal oxide (ZrO2 or HfOx) films. SANDs are desirable gate dielectrics materials for thin-film transistor applications because of their excellent properties such as low-temperature fabrication, large dielectric strength, and large capacitance. In this paper, we investigate the cross-plane thermal boundary conductance of SANDs using the frequency domain thermoreflectance (FDTR) technique. First, we characterize the thermal conductance of PAE self-assembled monolayers (SAMs), inverted-PAE (IPAE) SAMs, and mixed PAE-IPAE SAMs, sandwiched between thin gold and silica (SiO2) films at the top and bottom surfaces. Next, we quantify the thermal conductance of SAND-n with different numbers (n) of PAE-ZrO2 layers and thicknesses ranging between 4.7 and 11.3 nm. From the FDTR measurements, we observe that the thermal boundary conductance of the SAMs can be tuned between 42.1 ± 4.6 MW/(m2 K) and 52.4 ± 2.5 MW/(m2 K), based on the relative density of the PAE and IPAE chromophores. In the SAND-n samples, we observe a monotonic decrease in the thermal conductance with increasing n. We use the measured thermal conductance data in a series resistance model to estimate a thermal interface conductance of 695 MW/(m2 K) for the contact between the PAE chromophore and the zirconium dioxide films, which is an order of magnitude larger than the SAMs. We attribute the improved thermal conductance to stronger adhesion between the PAE chromophore and the zirconium dioxide films, as compared to the weakly bonded SAMs to the gold and silicon dioxide films.

Participation and autonomy five years after stroke: A longitudinal observational study.

OBJECTIVE: Stroke is the second most common cause of disability in the world. The purpose of this study was to evaluate the participation and autonomy of persons with stroke, five years after a stroke, and to explore potential associations between factors and perceived restrictions in participation and autonomy. METHODS: This five-year follow-up survey study included individuals diagnosed with a first-time stroke during 2009-2010, in Gothenburg. The survey included the Impact of Participation and Autonomy-questionnaire (IPA-E), which comprised five domains: Autonomy Indoor, Family Role, Autonomy Outdoor, Work & Education, and Social Life & Relationships. Logistic regression analyses were used to analyze factors associated with participation restrictions. RESULTS: At 5 years after a stroke, 457 patients were alive; of these, 281 responded to the follow-up survey. Participation restrictions were most pronounced in the IPA-E domains of Autonomy Outdoors, Work/Education, and Social Life and Relationships. In contrast, restrictions were less pronounced in the IPA-E domains of Autonomy Indoors and Family Role. Severe stroke, older age, and female sex predicted participation restrictions at five years after a stroke. Participation restrictions were partly explained by feelings of depression at five years after stroke. Problems associated with participation restrictions were most frequently observed in the areas of mobility, leisure, and help/support from other people. CONCLUSION: This study showed that participation and autonomy were restricted among persons with stroke at five years after the stroke. The domains perceived as most restricted were those that required high levels of physical, social, and cognitive abilities.

Measuring Dipole Inversion in Self-Assembled Nano-Dielectric Molecular Layers.

A self-assembled nanodielectric (SAND) is an ultrathin film, typically with periodic layer pairs of high-k oxide and phosphonic-acid-based π-electron (PAE) molecular layers. IPAE, having a molecular structure similar to that of PAE but with an inverted dipole direction, has recently been developed for use in thin-film transistors. Here we report that replacing PAE with IPAE in SAND-based thin-film transistors induces sizable threshold and turn-on voltage shifts, indicating the flipping of the built-in SAND polarity. The bromide counteranion (Br-) associated with the cationic stilbazolium portion of PAE or IPAE is of great importance, because its relative position strongly affects the electric dipole moment of the organic layer. Hence, a set of X-ray synchrotron measurements were designed and performed to directly measure and compare the Br- distributions within the PAE and IPAE SANDs. Two trilayer SANDs, consisting of a PAE or IPAE layer sandwiched between an HfOx and a ZrOx layer, were deposited on the SiOx surface of Si substrates or periodic Si/Mo multilayer substrates for X-ray reflectivity and X-ray standing wave measurements, respectively. Along with complementary DFT simulations, the spacings, elemental (Hf, Br, and Zr) distributions, molecular orientations, and Mulliken charge distributions of the PAE and IPAE molecules within each of the SAND trilayers were determined and correlated with the dipole inversion.

Self-Perceived Participation and Autonomy at 1-Year Post Stroke: A Part of the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT Study).

BACKGROUND: Identifying factors predicting the long-term outcome of participation and autonomy after stroke is essential for developing individualized rehabilitation interventions. The aim was to describe self-assessed participation and autonomy and to explore factors associated with the same at 1 year post stroke. METHODS: Participants consisted of 79 persons (mean age = 67) with a first-time stroke at the 1-year follow-up. To investigate perceived participation and autonomy at 1 year, a self-assessment questionnaire, the Impact on Participation and Autonomy-English version (IPA-E) was used. Multivariate logistic regression models were performed using age, gender, stroke severity, and functional dependency at discharge as potential contributors to the perceived level of participation and autonomy. RESULTS: A high percentage (70%-88%) evaluated their functions as fair to very good within all domains of the IPA-E at 1 year post stroke. However, around a fifth experienced their Family role as poor to very poor. Participants' functional dependency at discharge significantly influenced the outcome for the domains of Family role (odds ratio [OR] = 5.66, P < .01), Social relations (OR = 3.23, P < .03), and Autonomy indoors (OR = 3.44, P < .04) at 1 year post stroke. CONCLUSION AND IMPLICATIONS: Aspects of the Family role domain deserve further attention in interventions aimed at improving participation and autonomy at 1 year post stroke. The results also indicate that supporting indoor autonomy and social relations of persons with stroke during the acute rehabilitation is important to enhance participation and autonomy at 1 year post stroke.

Clinical significance of serum hyaluronan in chronic fibrotic interstitial pneumonia.

BACKGROUND AND OBJECTIVE: Hyaluronan is an important constituent of the extracellular matrix in lungs, and growing evidence demonstrates its important biological properties in the lung. However, its role in interstitial pneumonia remains to be fully clarified. The goal of this study was to clarify the role of hyaluronan in interstitial pneumonia. METHODS: Hyaluronan in serum and bronchoalveolar lavage (BAL) fluid of chronic interstitial pneumonia (CIP) patients was measured, and the correlation with clinical parameters was determined. In addition, the correlation between hyaluronan in serum and clinical parameters was analysed in patients with acute exacerbation of interstitial pneumonia (IP-AE). RESULTS: When compared with healthy controls, serum hyaluronan was significantly greater in patients with CIP and was positively correlated with serum biomarkers of inflammation and fibrosis, such as C-reactive protein and surfactant protein-D. In BAL fluid, the amount of hyaluronan was positively correlated with the percentage of inflammatory cells and the amount of CXCL8. When compared with CIP patients, patients with IP-AE had significantly greater amounts of serum hyaluronan, and patients with the highest serum hyaluronan had the worst 60-day outcomes. CONCLUSIONS: This work suggests that serum hyaluronan may be a clinically useful biomarker of interstitial pneumonia and suggests the possibility that hyaluronan is involved in the pathogenesis of interstitial pneumonia by recruiting inflammatory cells into the lungs.

The privileged status of locality in consonant harmony.

While the vast majority of linguistic processes apply locally, consonant harmony appears to be an exception. In this phonological process, consonants share the same value of a phonological feature, such as secondary place of articulation. In sibilant harmony, [s] and [ʃ] ('sh') alternate such that if a word contains the sound [ʃ], all [s] sounds become [ʃ]. This can apply locally as a first-order or non-locally as a second-order pattern. In the first-order case, no consonants intervene between the two sibilants (e.g., [pisasu], [piʃaʃu]). In second-order case, a consonant may intervene (e.g., [sipasu], [ʃipaʃu]). The fact that there are languages that allow second-order non-local agreement of consonant features has led some to question whether locality constraints apply to consonant harmony. This paper presents the results from two artificial grammar learning experiments that demonstrate the privileged role of locality constraints, even in patterns that allow second-order non-local interactions. In Experiment 1, we show that learners do not extend first-order non-local relationships in consonant harmony to second-order nonlocal relationships. In Experiment 2, we show that learners will extend a consonant harmony pattern with second-order long distance relationships to a consonant harmony with first-order long distance relationships. Because second-order non-local application implies first-order non-local application, but first-order non-local application does not imply second-order non-local application, we establish that local constraints are privileged even in consonant harmony.

Comparative genome analysis provides insights into the evolution and adaptation of Pseudomonas syringae pv. aesculi on Aesculus hippocastanum.

A recently emerging bleeding canker disease, caused by Pseudomonas syringae pathovar aesculi (Pae), is threatening European horse chestnut in northwest Europe. Very little is known about the origin and biology of this new disease. We used the nucleotide sequences of seven commonly used marker genes to investigate the phylogeny of three strains isolated recently from bleeding stem cankers on European horse chestnut in Britain (E-Pae). On the basis of these sequences alone, the E-Pae strains were identical to the Pae type-strain (I-Pae), isolated from leaf spots on Indian horse chestnut in India in 1969. The phylogenetic analyses also showed that Pae belongs to a distinct clade of P. syringae pathovars adapted to woody hosts. We generated genome-wide Illumina sequence data from the three E-Pae strains and one strain of I-Pae. Comparative genomic analyses revealed pathovar-specific genomic regions in Pae potentially implicated in virulence on a tree host, including genes for the catabolism of plant-derived aromatic compounds and enterobactin synthesis. Several gene clusters displayed intra-pathovar variation, including those encoding type IV secretion, a novel fatty acid biosynthesis pathway and a sucrose uptake pathway. Rates of single nucleotide polymorphisms in the four Pae genomes indicate that the three E-Pae strains diverged from each other much more recently than they diverged from I-Pae. The very low genetic diversity among the three geographically distinct E-Pae strains suggests that they originate from a single, recent introduction into Britain, thus highlighting the serious environmental risks posed by the spread of an exotic plant pathogenic bacterium to a new geographic location. The genomic regions in Pae that are absent from other P. syringae pathovars that infect herbaceous hosts may represent candidate genetic adaptations to infection of the woody parts of the tree.

[Effect of direct hemoperfusion with a polymyxin B immobilized fiber column in acute exacerbation of interstitial pneumonia and serum indicators].

Acute exacerbation of interstitial pneumonia (IP-AE) can occasionally occur and has a poor prognosis. Direct hemoperfusion with a polymyxin B immobilized fiber column (PMX-DHP) has been shown to have a beneficial effect on acute respiratory distress syndrome, which has similar pathological features to that of IP-AE. This study was aimed to investigate the effects of PMX-DHP on IP-AE and serum indicators for epithelial damage. Nine patients with a clinical diagnosis of interstitial pneumonia, who developed acute exacerbation, were included in this study. Five patients had been given a diagnosis of idiopathic pulmonary fibrosis (IPF) and 3 cases were diagnosed as collagen vascular disease-associated interstitial pneumonia (CVD-IP). On days 30 and 60, 6 and 4 patients were surviving, respectively. On day 60, all 3 patients with CVD-IP were alive, while 4 of 5 patients with IPF had died. In 4 patients who survived for 60 days or longer, serum levels of LDH, CRP, and SP-D were significantly decreased after PMX-DHP, whereas KL-6 level was unchanged. In 5 patients, who died by day 60, no significant changes in the serum markers were observed. These data suggest that serum levels of LDH, CRP, and SP-D might be predictive of successful PMX-DHP treatment in cases of IP-AE.

The 'Impact on Participation and Autonomy': acceptability of the English version in a multiple sclerosis outpatient setting.

To elicit the opinion of multiple sclerosis (MS) patients about the acceptability of a newly designed participation questionnaire--the 'Impact on Participation and Autonomy' (IPA), 35 MS outpatients who had completed an English version of the IPA questionnaire (IPA-E) were interviewed. Patients were recruited consecutively from outpatients attending the MS clinic. They were invited to answer 15 short questions during a 20-minute interview after signing a consent form and completing the IPA-E questionnaire. Completion time of the IPA-E questionnaire was 19.3 +/- 4.7 minutes. Most respondents believed that the IPA-E items were easy or very easy to understand (83%), relevant (more than 74%), not embarrassing (more than 97%) and 94% considered that no items should be removed. Three additional topics were suggested: 'looking after children; 'the extent of information on current services'and information about 'treatment progress' Among the eight domains of the IPA, most respondents considered mobility to be the most important and education the least important. The IPA-E was found to be acceptable and relevant to a sample of MS outpatients, although it could have been enhanced by items on parental or family roles.

[Changes in platelet count and mean volume of platelet after administration of icosapentaenoic acid ethyl-ester, and factors that may affect those changes].

A total of 34 patients, aged 43 to 86 years old (mean 65), consisting of 26 males and 8 females, with thrombotic or arteriosclerotic diseases were orally given highly purified eicosapentaenoic acid ethyl-ester formulation (IPA-E) for 12 weeks without changing regular food intake. Changes in platelet count (PLT), mean platelet volume (MPV), platelet-crit (Pct) and change of distribution width of platelet size (PDW), and factors affecting the changes were studied administration, dose of IPA-E, age, sex, smoking habits, complications of diabetes mellitus and hyperlipidemia, and concomitant drugs such as calcium antagonists or diuretics. With daily administration of 1800 or 900 mg of IPA-E, PLT and Pct began to decrease after four weeks and decreased significantly after eight weeks until the completion of administration. After the 12th week, the MVP became smaller than the preadministration level, while PDW did not change significantly during the entire period of administration. The volume and rates of changes in PLT, MPV and Pct during administration for 12 weeks correlated negatively with those preadministration values. The PLT, MPV and Pct decreased significantly in both the 1800 and 900 mg groups compared to values before administration. There were no significant differences in changes between the two groups. The plasma IPA concentration in the 12th week of the 1800 mg group was significantly higher than that of the 900 mg group. The rate of changes in Pct had a significantly negative correlation with the achieved IPA concentration. The age, smoking habits, complications of diabetes mellitus, or concomitant drugs of calcium antagonists or diuretics did not affect the changes of platelet parameters significantly. The PLT and Pct in male patients decreased significantly, but no significant changes were observed in female patients. The PLT and Pct in patients with IIb and IV hyperlipidemia decreased significantly compared to those in normolipidemic or IIa hyperlipidemic subjects. The study demonstrated that IPA-E improved platelet parameters, suggesting IPA-E could prevent progression of thrombotic and arteriosclerotic diseases, IPA-E was particularly effective in male patients or patients with Type IIb or IV hyperlipidemia. Although a daily dose of 900 mg was effective, 1800 mg was even more effective.

[The effect on changes in serum lipids and factors that may affect those changes after administration of icosapentaenoic acid ethyl ester].

The effects of high-purity IPA-E administration on changes in serum lipids and factors that may affect those changes were investigated in 55 patients with arteriosclerotic disease (34 males and 21 females, aged 43-85) under a regular daily diet. Daily administration of 1800 mg or 900 mg IPA-E resulted in a significant decrease or tendency to decrease in serum TG, TC and LDL-C 4 weeks after the initial administration, which continued throughout the administration period. Apo-protein analysis revealed a significant increase in A-I and a significant decrease in B and E after the administration of IPA-E. Lipoprotein analysis disclosed decreasing tendency of VLDL, IDL, LDL and TG, where the changes in VLDL-C, VLDL-TG and TG were significant. The amount and rate of change in TG, TC and LDL-C after IPA-E administration had a significant negative correlation with their respective pre-administration values. The decrease from pre-administration values was significant for patients with abnormal values in both dosage groups. The average rate of decrease in TC and LDL-C were greater in the group receiving administration of 1800 mg/day than that receiving 900 mg/day, but the difference in the change was not significant between the 2 groups. Correlations between the amount or rate of decrease in TC or LDL-C and the baseline value, achieved value, or amount or rate of increase in plasma IPA concentration and IPA/AA ratio were not significant. However, the negative correlation between the rate of change in TG and achieved IPA concentration was significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of various factors on changes in the levels of unsaturated fatty acid in plasma and serum lipids after administration of icosapentaenoic acid ethyl ester].

We administered a highly purified icosapentaenoic acid ethyl ester (IPA-E) preparation orally for 12 weeks to 32 male and 22 female patients aged 43 to 85 (average 67 years) with arteriosclerosis to investigate the effects of various factors on changes in the levels of unsaturated fatty acid in plasma and serum lipids. On administration of 1800 mg/day of IPA-E, the plasma level of IPA increased significantly, while the plasma level of DHLA decreased significantly, but no significant changes were observed in plasma DHA and AA concentrations. There were significant inverse correlations between the pretreatment levels of plasma IPA and IPA/AA, and the volumes and ratios of changes in their plasma levels following administration of IPA-E. There was no significant correlation between patient age or concomitant administration of calcium antagonists and baseline plasma IPA level and IPA/AA value or changes in these parameters after administration of IPA-E. In male patients, the plasma IPA level before treatment was higher than that in female patients, while the increase in plasma IPA level after administration of IPA-E tended to be smaller than in female patients. In diabetic patients and those receiving diuretics concomitantly, plasma IPA/AA values before treatment with IPA-E were higher, while the increase in IPA/AA values after treatment tended to be smaller than other groups of patients. On analysis of covariance on modified baseline volume before treatment, the effect of age, sex, presence of diabetes mellitus and concurrent use of calcium antagonist or diuretics was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[The consumption of alcoholic drinks in adolescence]. / Consumo de bebidas alcohólicas en la adolescencia.

OBJECTIVE: To identify the factors involved in the use and abuse of alcoholic drinks among a group of adolescents attending school. DESIGN: A descriptive, crossover study. SITE. 23 schools in the city of Barcelona. PARTICIPANTS: Students doing the sixth and seventh grades of EGB (in general, between 11 and 13 years old). MAIN MEASUREMENTS AND RESULTS: An in-school questionnaire, which gathered data from 2,033 students (92.2% coverage), was carried out. The students' replies were used to construct one index of probable alcohol abuse (IPAA) and another of the penetration of alcohol in the environment (IPAE). 51.9% had consumed some alcoholic drink, with 9.5 as the average age for the first drink. 1.3% drank alcohol every day. 1.8% said they had been drunk two or more times during the previous six months. 3.1% had bought alcohol for their own use. 8% of the students had at least one point on the IPAA. The seventh-grade students scored higher on the IPAE. The alcohol abuse indicators increased if the parents consumed alcohol, but more so if their peers were also consumers (older siblings or friends). There is a link between alcohol and tobacco consumption. CONCLUSIONS: The data showed how the increased penetration of alcohol into schoolchildren's environment resulted in abusive consumption being more likely. The importance of preventing the abuse of alcoholic drinks among adolescents was confirmed.