bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Zr doping on the magnetic properties and FORC diagrams of (Nd0.8Ce0.2)1.6Fe12Co2B alloys
Authors: Pan M. X. , Xu H. , Li Z. , Tan X. H. , Hou X. L. , Gu Y. , Zhang P. Y.
Published: November 2018

The microstructure and room temperature magnetic properties for (Nd0.8Ce0.2)1.6Fe12Co2BZrx (x = 0-5) nanocomposite alloys prepared by melt-spinning method and subsequent thermal annealing have been investigated. Zr addition has proved to result in relevant improvements in the microstructure and magnetic properties. The enhanced coercivity Hcj of 6.02 kOe and maximum energy products (BH)max of 15.2 MGOe have been obtained at the optimum temperature Ta with the Zr content at x = 2 and x = 3, respectively. The results of X-ray diffraction (XRD) and transmission electron microscope (TEM) indicate that a small amount of Zr addition can refine the grain size and cause a uniform distribution of soft magnetic α-Fe phase. A first-order-reversal curve (FORC) analysis is performed for the Zr-free (x = 0) sample and the Zr-doped (x = 3) sample. The FORC diagrams suggest the Zr-doped sample with a higher maximum ρ of the major peak and the flat surface is responsible for the better magnetic performance. The results of Kronmüller plot show that nucleation model is the dominating mechanism for the magnetization reversal in the Zr-free and Zr-doped alloys and give the evidence for the increase in microstructural parameter αex resulting in a drastic increase of coercivity in the Zr-doped alloy.
Global elucidation of broken symmetry solutions to the independent particle model through a Lie algebraic approach
Authors: Thompson Lee M.
Published: November 2018

Broken symmetry solutions—solutions to the independent particle model that do not obey all symmetries required by the Hamiltonian—have attracted significant interest for capturing multireference properties with mean-field scaling. However, identification and optimization of broken-symmetry solutions is difficult owing to the non-linear nature of the self-consistent field (SCF) equations, particularly for solutions belonging to low-symmetry subgroups and where multiple broken symmetry solutions are sought. Linearization of SCF solution space results in the Lie algebra, which this work utilizes as a framework for elucidation of the set of solutions that exist at the desired symmetry. To demonstrate that searches constructed in the Lie algebra yield the set of broken symmetry solutions, a grid-based search of real-restricted, real-unrestricted, complex-restricted, paired-unrestricted, and real-general solutions of the C2v (nearly D4h) H4 molecule is performed.
Non-adiabatic mass correction to the rovibrational states of molecules: Numerical application for the H2+ molecular ion
Authors: Mátyus Edit
Published: November 2018

General transformation expressions of the second-order non-adiabatic Hamiltonian of the atomic nuclei, including the kinetic-energy correction terms, are derived upon the change from laboratory-fixed Cartesian coordinates to general curvilinear coordinate systems commonly used in rovibrational computations. The kinetic-energy or so-called “mass-correction” tensor elements are computed with the stochastic variational method and floating explicitly correlated Gaussian functions for the H2+ molecular ion in its ground electronic state. {Further numerical applications for the 4He2+ molecular ion are presented in the forthcoming paper, Paper II [E. Mátyus, J. Chem. Phys. 149, 194112 (2018)]}. The general, curvilinear non-adiabatic kinetic energy operator expressions are used in the examples, and non-adiabatic rovibrational energies and corrections are determined by solving the rovibrational Schrödinger equation including the diagonal Born–Oppenheimer as well as the mass-tensor corrections.
Damage characteristics of elastic material through a thin membrane using high-intensity focused ultrasound (HIFU)
Authors: Liu N. N. , Cui Y. D. , Khoo B. C. , Zhang A. M.
Published: November 2018

High-intensity focused ultrasound (HIFU) is a non-invasive technique and widely used in medical and dental treatment for reaching and affecting deep seated tissues within the body, such as the removal of fat tissues under the skin, destruction of malignant tumour cells or target volume for the purpose of tissue debulking. This study aims to explore the damage characteristics of elastic material (regarded as soft tissue) by HIFU separated by a thin membrane all immersed in a water medium, in which the latter is used to mimic the human skin in medical treatments. Measurements of acoustic pressure along the vertical central line of HIFU transducer with and without this membrane were conducted and effects of membrane on the focal region were investigated. Results showed that the existence of the membrane serves primarily to reflect partial energy of incident ultrasound wave, and has no effect on phases of wave propagating in water. Next, Polydimethylsiloxane (PDMS) was selected as the elastic material for the experiments. The process of PDMS damage through the membrane by HIFU were recorded and the distribution of temperature around and within the ‘destroyed’ PDMS block was captured by an infrared camera. The very high temperature measured within the PDMS leading to the formations of cavity and crack within the PDMS block, can be attributed to the accumulation of the energy from the ultrasound source. Finally, the effects of PDMS with different elasticity on their damage characteristics are discussed.
Unsteady shock interactions on V-shaped blunt leading edges
Authors: Wang Dexin , Li Zhufei , Zhang Zhiyu , Liu Nan-Sheng , Yang Jiming , Lu Xi-Yun
Published: November 2018

The unsteady dynamics of shock interactions on the crotch of two typical V-shaped blunt leading edges have been investigated numerically and experimentally with a freestream Mach number 6 for different ratios (R), defined as the rounding radius at the crotch to the blunt radius at the leading edge. The primary flow features observed in the shock tunnel experiments are reproduced by the large-eddy simulations. The time-averaged flow structures in the crotch are clearly shown as counterrotating vortices originating from the collision of jets near the stagnation point. These jets and vortices undergo unsteady motions coupled with the dynamics of shock interactions. Of great interest, two typical global oscillations, i.e., swing oscillation and arch-recover oscillation corresponding to the two values of R, are identified. The coherent structures of the oscillations are analyzed using the proper orthogonal decomposition technique. It is demonstrated that the swing oscillation and arch-recover oscillation are characterized by an antisymmetric pattern and a symmetrical pattern, respectively. These two oscillations are also characterized by the energetic middle-frequency components of the broadband wall pressure spectra. Two feedback models are proposed for the prediction of such middle-frequency components. The results show that the swing oscillation causes much more severe pressure load, and the local impingement of the transmitted shock on the crotch is responsible for the peak value of the pressure fluctuation. This study illustrates that the geometry of R has a key impact on the unsteady shock interactions and, therefore, should be considered critically in practical applications, such as the cowl lip of a hypersonic inward-turning inlet.
Implementation of the foil-on-hohlraum technique for the magnetic recoil spectrometer for time-resolved neutron measurements at the National Ignition Facility
Authors: Parker C. E. , Frenje J. A. , Johnson M. Gatu , Schlossberg D. J. , Reynolds H. G. , Hopkins L. Berzak , Bionta R. , Casey D. T. , Felker S. J. , Hilsabeck T. J. , Kilkenny J. D. , Li C. K. , Mackinnon A. J. , Robey H. , Schoff M. E. , Séguin F. H. , Wink C. W. , Petrasso R. D.
Published: November 2018

The next-generation Magnetic Recoil Spectrometer, called MRSt, will provide time-resolved measurements of the deuterium-tritium-neutron spectrum from inertial confinement fusion implosions at the National Ignition Facility. These measurements will provide critical information about the time evolution of the fuel assembly, hot-spot formation, and nuclear burn. The absolute neutron spectrum in the energy range of 12-16 MeV will be measured with high accuracy (∼5%), unprecedented energy resolution (∼100 keV) and, for the first time ever, time resolution (∼20 ps). Crucial to the design of the system is a CD conversion foil for the production of recoil deuterons positioned as close to the implosion as possible. The foil-on-hohlraum technique has been demonstrated by placing a 1-mm-diameter, 40-μm-thick CD foil on the hohlraum diagnostic band along the line-of-sight of the current time-integrated MRS system, which measured the recoil deuterons. In addition to providing validation of the foil-on-hohlraum technique for the MRSt design, substantial improvement of the MRS energy resolution has been demonstrated.
A numerical study for dielectric constant profile of aqueous solvent in ionic solution radiated by high-intensity electric pulses
Authors: Bo Wenfei , Tang Jingchao , Yang Yang , Ma Jialu , Huang Qi , Guo Lianghao , Wang Zhanliang , Wu Zhe , Zeng Baoqing , Gong Yubin
Published: November 2018

In this paper, a mathematical physics model is set up to study dielectric constant profile of aqueous solvent in ionic solution, to revise Brownian dynamics simulation in ionic solution by considering time-variant dielectric constant profile with change in ion positions, and to study the effect of high-intensity electric pulses on the profile. The validation of the model is confirmed with verification calculations. By means of the proposed model, dielectric constant profiles in calcium chloride and sodium chloride solutions and their response to pulses are simulated. Based on numerical results, dielectric constants of aqueous solvent spatially vary instead of being the same value in ionic solutions. And the profiles are variant with time due to ion motion in solutions. From the profiles, overall dielectric constant in calcium chloride solution is lower than that in sodium chloride solution. And overall dielectric constant decreases with increment of solution concentration. In addition, the results show that influence on the profiles depends on solution concentration and field intensity of the pulse. The profile in solutions with low concentration is more vulnerable to the pulse than that with high concentration. And overall dielectric constant decreases dramatically as field intensity increases. Those understandings provide basis for application of pulses in biomedical engineering at the molecular level. Meanwhile, pulse radiation provides a potential way to constrain water molecules at room temperature reflected by significantly reducing dielectric constant, and to lower absorption loss of electromagnetic field in millimeter and far infrared band.
Variational reduced density matrix method in the doubly occupied configuration interaction space using three-particle N-representability conditions
Authors: Alcoba Diego R. , Capuzzi Pablo , Rubio-García Alvaro , Dukelsky Jorge , Massaccesi Gustavo E. , Oña Ofelia B. , Torre Alicia , Lain Luis
Published: November 2018

Ground-state energies and two-particle reduced density matrices (2-RDMs) corresponding to N-particle systems are computed variationally within the doubly occupied configuration interaction (DOCI) space by constraining the 2-RDM to satisfy a complete set of three-particle N-representability conditions known as three-positivity conditions. These conditions are derived and implemented in the variational calculation of the 2-RDM with standard semidefinite programming algorithms. Ground state energies and 2-RDMs are computed for N2, CO, CN−, and NO+ molecules at both equilibrium and nonequilibrium geometries as well as for pairing models at different repulsive interaction strengths. The results from the full three-positivity conditions are compared with those from the exact DOCI method and with approximated 2-RDM variational ones obtained within two-positivity and two-positivity plus a subset of three-positivity conditions, as recently reported [D. R. Alcoba et al., J. Chem. Phys. 148, 024105 (2018) and A. Rubio-García et al., J. Chem. Theory Comput. 14, 4183 (2018)]. The accuracy of these numerical determinations and their low computational cost demonstrate the usefulness of the three-particle variational constraints within the DOCI framework.
Analysis of ethanol as plug removal agent in near borehole zones for coal bed methane
Authors: Guo Hongyu , Zhao Guojun , Ma Kai , Xia Daping , Chen Shanlai , Luo Yuan
Published: November 2018

As coal bed methane (CBM) gas production can be reduced by reservoir pollution within near borehole zones, the feasibility of the use of ethanol as a plug removal agent and its impact on gas production are discussed in this paper. Four representative samples of Yima, Datong, Shaqu, and Yangquan coals were selected across a range of different ranks and were soaked with ethanol for experiments, and their change characteristics before and after treatment were compared using optical microscopy, mercury intrusion, and isothermal adsorption techniques. The results of this analysis revealed that the pore volume and porosity of coal samples increased following ethanol treatment, while the affinity for methane was significantly reduced. The use of ethanol was also advantageous because it reduced water lock and damage. This research showed that the use of ethanol as a plug removal agent in CBM near borehole zones has significant potential engineering applications.
Prevalence of depression among Maori patients in Auckland general
practice
Authors: Arroll Bruce , Goodyear-Smith Felicity , Kerse Ngaire , Hwang Melanie , Crengle Susan , Gunn Jane , Fishman Tana , Hatcher Simon , Pradhan Sanat , Sidhu Karishma
Published: November 2018

INTRODUCTION: There has been concern over high rates of mental illness in Maori. Previous studies in general practice have had small sample sizes. AIM: To determine the prevalence of major depression among Maori patients in Auckland general practice using the CIDI and the PHQ as measurement tools. METHODS: This prevalence study is part of a larger randomised trial. The patients were recruited from 77 general practitioners from around Auckland who could provide a private room for interviewing. The patients were invited to participate in the waiting room and all consecutive patients were approached. For this study all patients received a computerised CIDI examination and one third received a PHQ assessment prior to getting the CIDI. The interviewer was blind to the questionnaire results when the patient did the CIDI. RESULTS: There were 7994 patients approached from whom there were data on 7432. The prevalence of Maori in the study was 9.7%. The overall 12-month prevalence of major depression based on the CIDI was 10.1% 95%CI (8.8 to 11.4). For Maori the prevalence was 11.5% 95%CI (8.8 to 14.2) and for non-Maori 10.1% 95%CI (8.6 to 11.3). For Maori men and Maori women the prevalence was 8.5% and 13.4% and for non-Maori men and non-Maori women it was 8.3% and 11.1%. The prevalence of depression over at least the previous two weeks on the PHQ =9 for all participants was 12.9% 95%CI (11.2 to 14.5). DISCUSSION: The prevalence of depression among Maori is high, but not as high as earlier studies. This may be due to the bigger sample size of this study. KEYWORDS: Maori, prevalence, depression, primary care, general practice, New Zealand
Cardiovascular risk assessment: Audit findings from a nurse clinic  a quality improvement initiative
Authors: Waldron Sarah , Horsburgh Margaret
Published: November 2018

BACKGROUND AND CONTEXT: Evidence has shown the effectiveness of risk factor management in reducing mortality and morbidity from cardiovascular disease (CVD). An audit of a nurse CVD risk assessment programme undertaken between November 2005 and December 2008 in a Northland general practice. METHOD : A retrospective audit of CVD risk assessment with data for the first entry of 621 patients collected exclusively from PREDICT-CVDTM, along with subsequent data collected from 320 of these patients who had a subsequent assessment recorded at an interval ranging from six months to three years (18 month average). RESULTS: Of the eligible population (71%) with an initial CVD risk assessment, 430 (69.2%) had a five year absolute risk less than 15%, with 84 (13.5%) having a risk greater than 15% and having not had a cardiovascular event. Of the patients with a follow-up CVD risk assessment, 34 showed improvement. Medication prescribing for patients with absolute CVD risk greater than 15% increased from 71% to 86% for anti-platelet medication and for lipid lowering medication from 65% to 72% in the audit period. STRATEGIES FOR IMPROVEMENT: The recently available heart health trajectory tool will help patients become more aware of risks that are modifiable, together with community support to engage more patients in the nurse CVD prevention programme. Further medication audits to monitor prescribing trends. LESSONS: Patients who showed an improvement in CVD risk had an improvement in one or more modifiable risk factors and became actively involved in making changes to their health. KEYWORDS: Cardiovascular disease risk assessment; nurse clinics; audit
Aspirin for primary prevention: yes or no?
Authors: Selak Vanessa , Raina Elley C , Wells Sue , Rodgers Anthony , Sharpe Norman
Published: November 2018

AIM: To assess benefit versus harm of aspirin for cardiovascular disease (CVD) primary prevention by age group, gender and risk category and to interpret these results in light of current New Zealand CVD risk assessment and management guidelines. METHODS: Rates of benefit (avoided vascular events) and harm (additional major extracranial bleeds) for each gender and age group were calculated from data from the six randomised controlled trials included in the Anti-Thrombotic Trialists’ (ATT) Collaboration meta-analysis. These rates were applied to CVD risk categories to calculate the net benefit or net harm likely to occur from the use of aspirin in primary prevention of CVD as monotherapy and when added to lipid and blood pressure–lowering therapies. RESULTS: Benefits of aspirin monotherapy outweigh the harms for both men and women aged up to 80 years with calculated five-year CVD risk >15% in primary prevention. Harm may outweigh benefit for primary prevention for those over 80 years. For men 70–79 years the benefit of aspirin in primary prevention is marginal when added to lipid and blood pressure–lowering therapies. DISCUSSION: The recent ATT Collaboration meta-analysis has raised doubts about the relative safety of aspirin in primary prevention of CVD. However, modelling by risk category and age group suggests that current guidelines are justified in recommending aspirin for primary prevention of CVD in those with five-year CVD risk ≥15% up to the age of 80 years. For men 70–79, consider lipid and blood pressure - lowering therapies first then reassess whether aspirin adds additional net benefit. KEYWORDS: Aspirin; primary prevention; cardiovascular disease; cardiovascular risk
Providing and receiving self-management support for chronic illness: Patients and health practitioners' assessments
Authors: Carryer Jenny , Budge Claire , Hansen Chiquita , Gibbs Katherine
Published: November 2018

INTRODUCTION: Providing care for people with chronic illness is a major issue for health practitioners around the world, especially as populations age. Encouraging self-management is beneficial in terms of relieving the burden on the health system and promoting better health and adherence to medication and advice amongst this group. AIM: To measure the level of self-management support being provided to and received by people living with chronic illness in a District Health Board (DHB) region. METHODS: Self-report questionnaires (PACIC) were completed by 341 people living with chronic illness to measure the self-management support they receive from general practitioners and nurses. A modified version of the PACIC was used with 12 GPs and 77 primary health nurses in the same region to assess the provision of self-management support. RESULTS: Patients’ assessments suggest that they are receiving intermittent self-management support for their chronic illness. A comparison of ratings of different health practitioners revealed that nurses were reported to be providing support more consistently than GPs. The health practitioners rated themselves as providing self-management support more often than the patients reported receiving it. Many clinicians also suggested that not all forms of support are appropriate for everyone, suggesting the need to tailor support to the individual. DISCUSSION: Chronic illness support needs to be considered within the context of the individual and to be embedded in an ongoing relationship between the person and the provider. Findings highlight the benefits of a multidisciplinary team approach to self-management support and education in chronic illness care. KEYWORDS: Chronic disease; self care; primary health care; primary nursing care; physicians, family
Relationship between decile score of secondary school, the size of town of origin and career intentions of New Zealand medical students
Authors: Mitchell Clinton , Shulruf Boaz , Poole Phillippa
Published: November 2018

INTRODUCTION: New Zealand is facing a general practice workforce crisis, especially in rural communities. Medical school entrants from low decile schools or rural locations may be more likely to choose rural general practice as their career path. AIM: To determine whether a relationship exists between secondary school decile rating, the size of the town of origin of medical students and their subsequent medical career intentions. METHODS: University of Auckland medical students from 2006 to 2008 completed an entry questionnaire on a range of variables thought important in workforce determination. Analyses were performed on data from the 346 students who had attended a high school in New Zealand. RESULTS: There was a close relationship between size of town of origin and decile of secondary school. Most students expressed interests in a wide range of careers, with students from outside major cities making slightly fewer choices on average. DISCUSSION: There is no strong signal from these data that career speciality choices will be determined by decile of secondary school or size of town of origin. An increase in the proportion of rural students in medical programmes may increase the number of students from lower decile schools, without adding another affirmative action pathway. KEYWORDS: Education, medical; social class; career choice
Appetite for life: an evaluation of a primary care lifestyle programme
Authors: Cutler Liz , King Bronwen , McCarthy Nicky , Hamilton Greg , Cook Lynley
Published: November 2018

INTRODUCTION: Appetite for Life is a six-week primary carebased programme for women who are overweight, and aims to achieve long-term health gain through establishing healthy eating and physical activity patterns and a healthier weight. AIM: To evaluate the outcomes of Appetite for Life, a primary carebased healthy lifestyle programme for women who are overweight. METHODS: Two hundred and sixty-one women enrolled and consented to take part in the six-week Appetite for Life programme via general practice and were followed for 12 months. Eating behaviours and physical activity levels were measured at baseline, six weeks, six months and 12 months. Anthropometric and biomedical data was collected at visits to the participants general practitioners at baseline and 12 months. RESULTS: Positive lifestyle changes were reported that were sustained for the duration of the 12-month follow-up period. Participants reported an increase in intake of fruit and vegetables, dairy products, healthy fats and an increased level of physical activity. There was also an increase in reported enjoyment and participation in exercise. Mean weight was maintained over this time period. There was a reduction in mean LDL and total plasma cholesterol. DISCUSSION: A healthy lifestyle programme offered through primary care that is based on a non-dieting approach may help overweight women develop and sustain positive lifestyle changes. KEYWORDS: Health promotion; health status; obesity; weight loss, physical activity
The feasibility of assessing the Flinders Programme of Patient Self-Management in New Zealand primary care settings
Authors: Horsburgh Margaret , Bycroft Janine , Mahony Faith , Roy Dianne , Miller Denise , Goodyear-Smith Felicity , Donnell Erin
Published: November 2018

INTRODUCTION: The Flinders ProgramTM has been adopted in New Zealand as a useful and appropriate approach for self-management with primary care clients who have chronic conditions. The Flinders ProgramTM has not been evaluated in New Zealand settings. AIM: To assess the feasibility of undertaking a substantive long-term trial to gauge the effectiveness of primary care nurses using the Flinders ProgramTM to improve health outcomes for New Zealand populations. METHODS: A pilot study was undertaken considering four components of feasibility of conducting a long-term trial: practice recruitment, participant recruitment, delivery of the intervention and outcome measures. This included comparing 27 intervention and 30 control patients with long-term health conditions with respect to change in self-management capacityPartners in Health (PIH) scalequality of care using the Patient Assessment of Chronic Illness Care (PACIC) scale and self-efficacy across six months. Intervention participants received care planning with practice nurses using the Flinders ProgramTM in general practices, while control participants received usual care in comparable practices. RESULTS: General practice and participant recruitment was challenging, together with a lack of organisational capacity and resources in general practice for the Flinders ProgramTM. The measures of self-management capacity (PIH), quality of care (PACIC) and self-efficacy were useful and valuable primary outcome measures. DISCUSSION: The overall findings do not support a substantive trial of the Flinders ProgramTM in primary care. Difficulties associated with participant recruitment and ability of practice nurses to undertake the Flinders ProgramTM within general practice need to be resolved. KEYWORDS: Self-management; long-term conditions; chronic conditions; chronic illness; primary care; nurses
Does Your Heart Forecast help practitioner understanding and confidence with cardiovascular disease risk communication?
Authors: Wells Sue , Kerr Andrew , Broadbent Elizabeth , MacKenzie Craig , Cole Karl , McLachlan Andy
Published: November 2018

INTRODUCTION: Explaining what cardiovascular disease (CVD) risk means and engaging in shared decision-making regarding risk factor modification is challenging. An electronic CVD risk visualisation tool containing multiple risk communication strategies (Your Heart Forecast) was designed in 2009. AIM: To assess whether this tool facilitated explaining CVD risk to primary care patients. METHODS: Health professionals who accessed a Primary Health Organisation website or who attended educational peer groups over a three-month period were invited to complete questionnaires before and after viewing a four-minute video about the tool. Respondents were asked to make an informed guess of the CVD risk of a 35-year-old patient (actual CVD risk 5%) and rate the following sentence as being true or false: If there were 100 people like Mr Andrews, five would go on to have a cardiac event in the next five years. They also were asked to rank their understanding of CVD risk and confidence in explaining the concept to patients. RESULTS: Fifty health professionals (37 GPs, 12 practice nurses, one other) completed before and after questionnaires. Respondents CVD risk estimates pre-video ranged from <5% to 25% and nine rated the sentence as being false. After the video, all respondents answered these questions correctly. Personal rankings from zero to 10 about understanding CVD risk and confidence in explaining risk reduced in range and shifted towards greater efficacy. Discussion: Whether this tool facilitates discussions of CVD risk with patients and improves patient understanding and lifestyle behaviour needs to be evaluated in a randomised trial. KEYWORDS: Cardiovascular disease; risk communication.
In the eyes of the Dunedin public, what constitutes professionalism in medicine?
Authors: Hutchinson Maria , Reid Jim
Published: November 2018

INTRODUCTION: There has been much debate over the last two decades about professionalism in medicine. Opinions are diverse but, problematically, most are from the academic and medical viewpoints. There is substantially less discourse from the public perspective. AIM: To explore the Dunedin publics perspective of important professional qualities in the medical profession. METHODS: Customers in pharmacies around Dunedin rated 18 different professional qualities on a five-point scale of importance in a self-administered anonymous survey. They also ranked their top five qualities, including their own ideas. RESULTS: Participants rated professional qualities categorised as patient autonomy (mean 4.6) and patient welfare (mean 4.7) of higher importance than qualities categorised as social justice (mean 3.9) and appearance (mean 3.7). Honesty was the top ranked professional quality overall (10.6% of respondents had it in their top five) and the next two top ranked were both concerning patient autonomy (listens carefully and treats you with respect). The most significant difference found between demographic groups and choices was that 53% of people with a highest educational qualification of secondary school or below rated accepts a leadership role in the community as a very important or important quality, compared with 29.4% of people with a post-secondary school qualification (p-value <0.001). DISCUSSION: This has implications for the current move to make doctors take on more social responsibility within the health care system. It is imperative to have both society and the medical profession aiming for common goals and the challenge of this decade will be striking the balance. KEYWORDS: New Zealand; professionalism; public; social justice; patient autonomy; patient welfare
Rural nurse to nurse practitioner: an ad hoc process
Authors: Carryer Jenny , Boddy Julie , Budge Claire
Published: November 2018

INTRODUCTION: Despite a 10-year history of nurse practitioner (NP) development in New Zealand (NZ) there is no formalised or universal process for ensuring the transition of willing nurses to NP status. This unmet need is of particular interest in the rural context where workforce issues are paramount. The aim of this study was to explore the transition from rural nurse to NP in NZ. METHOD: A qualitative descriptive survey was sent to all NZ nurses with a rural address. Ninety-two questionnaires were returned, of which 21 respondents were working in a rural location and aiming to become an NP. Data analysis included description of demographic data and thematic analysis of open-ended question responses. FINDINGS: Four themes encompassed the experiences of the 21 potential NP candidates: uncertainty about opportunities for employment as an NP and legislative and funding barriers for NP practice; support or resistance from GPs and nurse colleagues, self-doubt, and the importance of mentoring; difficulties with the NP authorisation process; and meeting the NP competencies within the challenges imposed by rural location. CONCLUSION: At the systems level of workforce design, stronger linkages between policy development, investment, employment creation, funding streams, professional regulation and overall communication require attention. KEYWORDS: Rural health; nurse practitioners; workforce; health policy
Charms & Harms: Hawthorn
Authors: Rasmussen Phil
Published: November 2018

SUMMARY MESSAGE: Some evidence exists for hawthorn extracts having beneficial effects when taken concurrently with optimal medication for the treatment of mild chronic heart failure, although further long-term studies involving large numbers of patients are needed. Evidence is less convincing for its efficacy in hypertension, angina, coronary artery disease, arrhythmias and other cardiac conditions. As with all herbal medicines, different hawthorn products vary in their pharmaceutical quality, and the implications of this for dosage, efficacy and safety should be considered.
Guidelines Summary: Clinical guidelines for weight management in New Zealand adults, children and young people
Authors: Jull Andrew , Lawes Carlene , Eyles Helen , Maddison Ralph , Gorton Delvina , Arcus Kim , Chee Nigel , Taylor Barry , Mann on behalf of the guideline development team Jim
Published: November 2018

This paper summarises the treatment algorithms (Figures 1 and 2) and key messages from the Clinical Guidelines for Weight Management in New Zealand Adults, Children and Young People prepared for the Ministry of Health. The guidelines aim to provide support to weight management providers in primary care and the community. The full guidelines and methods can be downloaded from the Ministry website (http://www.moh.govt.nz).
Factors influencing cigarette access behaviour among 1415-year-olds in New Zealand: a cross-sectional study
Authors: Nelson Rupert , Paynter Janine , Arroll Bruce
Published: November 2018

INTRODUCTION: Young people access tobacco from both retail and social sources such as family or friends. Both social influences and density of tobacco retail outlets may be associated with frequency of youth smoking. AIM: To update New Zealand data on demographic factors and social influences associated with retail access and social sources. METHODS: The sample consisted of 1415-year-old New Zealand youth who self-reported as current smokers. Outcome measures were participants reporting of three different methods of cigarette access. Descriptive data was presented and multiple logistic regressions were used to examine associations between demographic and social influence factors and cigarette sources. RESULTS: Current smoking habits was found to be the strongest predictor of cigarette source, with daily smokers much more likely to report retail purchase than less than monthly smokers (adjusted OR 11.23, 95% CI 10.1012.47). The second strongest predictor was parental smoking habitsstudents with both parents smoking being much more likely to obtain from family than students with neither parent (adjusted OR 2.10, 95% CI 1.952.26). Socioeconomic status and living in highly populated areas were also factors significantly associated with particular sources of tobacco. DISCUSSION: Though this study is cross-sectional, many potential confounders were controlled for, and results are consistent with the notion that financial means and urban proximity to tobacco retailers are enabling some students to use retailers as a cigarette source. Increased taxation and persuading adult family members to quit and to be more possessive about their cigarettes will help protect youth from smoking. KEYWORDS: Smoking; youth; adolescent; supply; availability; nicotine; social; retail
Making sense of chronic illness  a therapeutic approach
Authors: Jacobi Sue , MacLeod Rod
Published: November 2018

INTRODUCTION: A diagnosis of any chronic progressive illness can be a traumatic experience. People wonder how they will be able to cope and health care professionals wonder how they can help those so affected. The aim of the study was to discover how people find meaning when they are diagnosed with chronic illness. The research question asked is: How do people make sense of living with chronic progressive illness? METHOD: This is a qualitative study using a phenomenological approach to apply what is learned to developing therapeutic strategies in order to help those so diagnosed to find the meaning they need in order to live with resilience. Semi-structured interviews with seven people were held in order to determine how they cope with living with chronic progressive illness. The results were then used to develop some suggestions for health professionals as they seek to assist people with chronic progressive illness. FINDINGS: All participants displayed much resilience and determination which was found to emerge from three main themes: memory, hope and meaning. Memory was seen to be the link between all the themes. These are described and, arising out of the results of this study, some suggestions are made in order to assist in management. CONCLUSION: It is possible for health care professionals to assist patients to make sense of chronic illness by helping them to view their illness as part of life, and therefore a challenge to be faced rather than seeing life as dominated by illness. KEYWORDS: Chronic disease; resilience, psychological; narration; psychology, existential
Educational needs of practice nurses in mental health
Authors: Prince Anne , Nelson Katherine
Published: November 2018

INTRODUCTION: Large numbers of patients see practice nurses (PNs) daily for their health care. Many of these patients will have a mental health need. International research suggests that practice nurses are undertaking mental health assessment and interventions without the requisite skills and knowledge. AIM: To describe the needs of PNs in mental health education and to explore any involvement with patients with mental health concerns. METHODS: Postal survey of PNs in Hawkes Bay and Tairawhiti regions. Analysis was by descriptive, correlation and inferential statistics and content analysis for open questions. RESULTS: Fifty-two respondents completed the survey (response rate 36%) and the results demonstrate that these PNs are caring for patients with an extensive range of mental health concerns daily. Most common are people with depression and anxiety. The nurses perform a variety of mental health interventions such as counselling and advice on medication and have minimal confidence in their skill level. Their expressed learning needs included education on many mental health conditions including suicidal ideation, all types of depression and bipolar disorder, and of therapies such as cognitive behavioural therapy and family therapy. DISCUSSION: PNs require education and support specifically designed to meet their identified needs in mental health to help improve care to patients. This will require collaboration between secondary mental health services, primary mental health nurses and tertiary institutions. With targeted education these nurses should become more confident and competent in their dealings with people who present to their practice with a mental health concern. KEYWORDS: Education; mental health; practice nurse; survey; primary health care
Patient Dashboard: the use of a colour-coded computerised clinical reminder in Whanganui regional general practices
Authors: McMenamin John , Nicholson Rick , Leech Ken
Published: November 2018

INTRODUCTION: Clinical reminders have been shown to help general practice achieve an increase in some preventive care items, especially if they identify a patient’s eligibility for the target item, prompt clinicians at the right time, provide a fast link to management tools and facilitate clinical recording. WRPHO has introduced the Patient Dashboard clinical reminder and monitored its impact on health targets. Aim: This paper reports the impact of a computerised colour-coded clinical reminder on achieving agreed health targets in Whanganui regional practices. METHODS: Patient Dashboard was developed from previous versions in Auckland and Northland and provided to Whanganui regional practices with Primary Health Organisation (PHO) support. The Dashboard was linked with existing and new clinical management tools which automatically updated clinical records. Data from practices was pooled by Whanganui Regional Primary Health Organisation and target achievement rates reported over 15 months. RESULTS: Over the initial 15 months of Patient Dashboard use, recording of smoking status increased from 74% to 82% and of alcohol use from 15% to 47%. Screening for diabetes increased from 62% to 74%, cardiovascular risk assessment from 20% to 43%, cervical screening from 71% to 79%, and breast screening from 60% to 80%. DISCUSSION: Patient Dashboard was associated with increased performance indicators both for those targets which were part of a PHO programme and for targets without additional support. KEYWORDS: Reminder systems; quality indicators, health care; preventive health services; mass screening
Validation of the GAD-7 (Malay version) among women attending a primary care clinic in Malaysia
Authors: Mohd Sidik Sherina , Arroll Bruce , Goodyear-Smith Felicity
Published: November 2018

INTRODUCTION: Anxiety is a common mental health disorder in primary care, with a higher prevalence among women compared to men. AIM: This is the first study to validate the Generalised Anxiety Disorder-7 questionnaire (GAD-7) as a case-finding instrument for anxiety in a primary care setting in Malaysia. The objective was to determine the diagnostic accuracy of the Malay version of the GAD-7 in detecting anxiety among women. METHODS: This cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive women participants attending the clinic during data collection were given self-administered questionnaires including the GAD-7 (Malay version). Participants then were selected using systematic weighted random sampling for Composite International Diagnostic Interviews (CIDI). The GAD-7 was validated against the CIDI reference standard. RESULTS: The response rate was 87.5% for the questionnaire completion (895/1023), and 96.8% for diagnostic interviews (151/156). The prevalence of anxiety was 7.8%. The GAD-7 had a sensitivity of 76% (95% CI 61%87%), a specificity of 94% (88%97%), positive LR 13.7 (6.230.5) and negative LR 0.25 (0.140.45). DISCUSSION: The Malay version of the GAD-7 was found to be valid and reliable in case-finding for anxiety in this study. Due to its brevity, it is a suitable case-finding instrument for detecting anxiety in primary care settings in Malaysia. KEYWORDS: Validation; anxiety; primary care; women; Malaysia
Why are there gaps in our management of those with high cardiovascular risk?
Authors: Doolan-Noble Fiona , Tracey Jocelyn , Mann Stewart
Published: November 2018

INTRODUCTION: Multiple New Zealand and other international studies have identified gaps in the management of those identified at high risk of a future cardiovascular (CV) event. This study sought to explore the views of health professionals about the barriers and facilitators present within the current primary health care system to the optimal management of those at high CV risk. METHODS: This qualitative study utilised a focus group methodology to examine the barriers and facilitators within primary health care (PHC), and employed a general inductive approach to analyse the text data. FINDINGS: The analysis of text data resulted in the emergence of interrelated themes, underpinned by subthemes. The patient, their circumstances and their characteristics and perceptions provided the first key theme and subthemes. The next key theme was primary health care providers, with subthemes of communication and values and beliefs. The general practice was the third theme and included multiple subthemes: implementation planning and pathway development, time and workload and roles and responsibilities. The final main theme was the health system with the subthemes linking to funding and leadership. CONCLUSION: This study determined the factors that act as barriers and facilitators to the effective management of those at high CV risk within the New Zealand PHC sector. General practice has a pivotal role in preventive health care, but to succeed there needs to be a refocusing of the PHC sector, requiring support from policy makers, District Health Boards and Primary Health Organisations, as well as those working in the sector. KEYWORDS: Primary health care; high cardiovascular risk management; general practitioners; practice nurses; barriers; facilitators
Reasons for non-attendance: audit findings from a nurse-led clinic
Authors: Wilkinson Jill , Daly Mary
Published: November 2018

BACKGROUND AND CONTEXT: Evidence has shown that non-attendance at clinics occurs for a variety of reasons and impacts negatively on client outcomes and effective use of clinic resources. This paper reports an audit of non-attendance at Care Plus and diabetes clinics undertaken between October 2007 and October 2008, in a large general practice in the Wellington region. ASSESSMENT OF PROBLEM: A retrospective and prospective audit of the non-attendance rate at nurse-led wellness clinics was completed using the Query Builder function in Medtech32, collecting data from 142 people who did not attend a scheduled appointment. RESULTS: Thirty-three people were unable to be contacted about their reason for not attending. Of those contacted, 68 did not attend because they were unaware of the appointment, confused regarding the appointment time, or simply forgot. Eighty-four people were aged between 18 and 65 years, yet of those contacted, only four cited work had prevented their attendance at the clinic. Difficulty with transport was reported by only two people. STRATEGIES FOR IMPROVEMENT: The audit highlighted the importance of administration processes for scheduling routine appointments and reminding patients about appointments. It provided evidence that administrative support for nurse-led clinics is necessary. LESSONS: Involvement in clinical audit was a new experience for many of the staff and the usefulness of the findings led to more positive views about how audit can be used. The importance of appropriate administrative support was highlighted. Lessons learned for future audits included the importance of a complete data set and consistent use of codes for data entry. KEYWORDS: Audit; primary care; non-attendance
Does a clinical guideline change chlamydia testing? Report from the Waikato Chlamydia Project
Authors: Morgan Jane , Donnell Andre , Bell Anita
Published: November 2018

BACKGROUND AND CONTEXT: Waikato District Health Board was one of three districts chosen to implement a national chlamydia management guideline, with the aim of optimising testing and treatment. Previous New Zealand studies suggest any test increases associated with such an intervention may be short-lived. ASSESSMENT OF PROBLEM: District-wide chlamydia test volumes were compared for three periods, before (JuneNov 2008), during (JuneNov 2009) and after (JuneNov 2010) guideline implementation by age, gender and ethnicity. Crude estimates of population test uptake were calculated. Azithromycin pharmacy claim volumes were assessed as a measure of treatment. RESULTS: Chlamydia test uptake for women was already high, with 23% of 15- to 24-year-old women tested during the period from June to November 2008. Although tests from under-25-year-olds increased during implementation in 2009, the change was not significant and was not sustained in 2010, p=0.06. Similarly, there were no significant sustained changes by gender or ethnicity following implementation. STRATEGIES FOR IMPROVEMENT: This includes a continued emphasis on optimal chlamydia case finding and treatment by focusing on those at greater risk of infection. Efforts to improve partner notification should be instigated which may in turn better engage men around sexual health. LESSONS: Local data should be used to identify local issues. There is a need to determine whether <25 years is the optimal age threshold for targeted chlamydia testing in New Zealand and to ensure appropriate resources, training and support are in place for primary care nurses who play a pivotal role in sexual health care delivery. Keywords: Chlamydia trachomatis; mass screening; practice guidelines; primary health care; contact tracing