title: The utility of single nucleotide DNA variations as predictors of postoperative pain

authors: Jacobson, Gregory M.

subjects: OPRM1

abstract: Objectives: Genetic variation is an important contributor to postsurgical pain and thereby analgesia requirements. A description of the potential predictive power of genetic variants in pain should instruct improvements in pain management postoperatively. We set out to examine whether a set of genetic variants in pain related genes would show any association with actual pain outcomes in a typical surgical population. Methods: A candidate gene study was carried out in 135 surgical patients with 12 DNA variants (single nucleotide polymorphisms or ‘SNPs’) in known or putative pain pathway genes to detect associations with postoperative pain - measured by a verbal rating score (VRS) and patient-controlled analgesia (PCA) usage rate. Standard PCR based molecular biology approaches were used.
Results: At 20-24h after surgery, patients with the 1032G/1032G variant pair for the A1032G variant of the potassium channel KCNJ6 gene had a slightly higher median VRS than those with 1032A/1032A or 1032A/1032G pairs (p=0.04; dominant genetic model). This small difference was most apparent in the orthopaedic surgery patients where the 1032G/1032G pair associated with VRS (median(interquartile range)) of 5(4-6) vs. 3(0.5-4) in 1032A/1032A or 1032A/1032G groups. For PCA, patients with 3435C/3435C or 3435C/3435T pairs for ATPdependent efflux pump gene ABCB1 variant C3435T used PCA at a considerably higher rate of 0.89(0.07-1.66) mg.h-1 compared with just 0.11 (0-0.52) mg.h-1 for the 3435T/3435T pair (p=0.03; dominant model). A significantly higher usage rate was also detected for opioid receptor OPRM1 variant IVS2-691 with usage of 0.77(0.01-1.56) mg.h-1 for the IVS2C/IVS2C or IVS2C/IVS2G group vs. 0.24(0-1.26) mg.h-1 in the IVS2G/IVS2G group (p=0.04; recessive model).
Conclusion: While this study has identified some significant statistical associations the potential utility of the studied DNA variants in prediction of postoperative pain and patient-controlled opioid analgesia requirements appears to be quite limited at present.

text: The utility of single nucleotide DNA variations as predictors of postoperative pain Objectives: Genetic variation is an important contributor to postsurgical pain and thereby analgesia requirements. A description of the potential predictive power of genetic variants in pain should instruct improvements in pain management postoperatively. We set out to examine whether a set of genetic variants in pain related genes would show any association with actual pain outcomes in a typical surgical population. Methods: A candidate gene study was carried out in 135 surgical patients with 12 DNA variants (single nucleotide polymorphisms or ‘SNPs’) in known or putative pain pathway genes to detect associations with postoperative pain - measured by a verbal rating score (VRS) and patient-controlled analgesia (PCA) usage rate. Standard PCR based molecular biology approaches were used.
Results: At 20-24h after surgery, patients with the 1032G/1032G variant pair for the A1032G variant of the potassium channel KCNJ6 gene had a slightly higher median VRS than those with 1032A/1032A or 1032A/1032G pairs (p=0.04; dominant genetic model). This small difference was most apparent in the orthopaedic surgery patients where the 1032G/1032G pair associated with VRS (median(interquartile range)) of 5(4-6) vs. 3(0.5-4) in 1032A/1032A or 1032A/1032G groups. For PCA, patients with 3435C/3435C or 3435C/3435T pairs for ATPdependent efflux pump gene ABCB1 variant C3435T used PCA at a considerably higher rate of 0.89(0.07-1.66) mg.h-1 compared with just 0.11 (0-0.52) mg.h-1 for the 3435T/3435T pair (p=0.03; dominant model). A significantly higher usage rate was also detected for opioid receptor OPRM1 variant IVS2-691 with usage of 0.77(0.01-1.56) mg.h-1 for the IVS2C/IVS2C or IVS2C/IVS2G group vs. 0.24(0-1.26) mg.h-1 in the IVS2G/IVS2G group (p=0.04; recessive model).
Conclusion: While this study has identified some significant statistical associations the potential utility of the studied DNA variants in prediction of postoperative pain and patient-controlled opioid analgesia requirements appears to be quite limited at present.

year: 2014

title: Emotional Well-Being and Secondary Traumatic Stress In New Zealand Youth Workers

authors: Takhar-Stapleton, Amber

abstract: This study aimed to explore the relationship of STS and emotional well-being among New Zealand youth workers using a qualitative approach. Eleven participants were interviewed for the study using a semistructured interviewing technique. The purpose of this study was to fill a gap in the literature about the impact of working with traumatised youth and to identify if youth workers were at risk and vulnerable to the effects of trauma exposure. Three aims were incorporated in the study to answer the research question. The first aim was to explore ways in which youth work may be associated with decreased emotional well-being and STS with the second aim of identifying symptoms and causes of decreased emotional well-being and STS. Lastly, the third aim was to explore how decreased emotional well-being is associated with the development of STS. 
The findings suggest the majority of participants experienced moderate levels of decreased emotional well-being and displayed symptoms associated with the effects of secondary traumatic stress. The results confirmed the first aim of the study which identified youth work as being correlated with decreased emotional well-being and STS. The results suggested decreased emotional well-being increased vulnerability to developing STS and therefore, the third aim of the study was also confirmed. 
Several themes were found in the participants’ answers which revealed youth work is associated with emotional well-being and symptoms of STS. This included emotional detachment, suppression, and numbing, helplessness, burnout and lack of resources to cope, social withdrawal, difficulty sleeping and changes in appetite. Risk factors which appeared to increase vulnerability included personal trauma, PTSD, countertransference, and empathic engagement. Organisational stressors were also identified as increasing vulnerability which heavily influenced participants and contributed to extreme stress and exhaustion. 
Findings in this study contribute to the knowledge of secondary traumatic stress as well as increasing knowledge about the emotional effects of working with traumatised individuals. Furthermore, the study iii helps to educate helping professionals and increases knowledge of youth work.

text: Emotional Well-Being and Secondary Traumatic Stress In New Zealand Youth Workers This study aimed to explore the relationship of STS and emotional well-being among New Zealand youth workers using a qualitative approach. Eleven participants were interviewed for the study using a semistructured interviewing technique. The purpose of this study was to fill a gap in the literature about the impact of working with traumatised youth and to identify if youth workers were at risk and vulnerable to the effects of trauma exposure. Three aims were incorporated in the study to answer the research question. The first aim was to explore ways in which youth work may be associated with decreased emotional well-being and STS with the second aim of identifying symptoms and causes of decreased emotional well-being and STS. Lastly, the third aim was to explore how decreased emotional well-being is associated with the development of STS. 
The findings suggest the majority of participants experienced moderate levels of decreased emotional well-being and displayed symptoms associated with the effects of secondary traumatic stress. The results confirmed the first aim of the study which identified youth work as being correlated with decreased emotional well-being and STS. The results suggested decreased emotional well-being increased vulnerability to developing STS and therefore, the third aim of the study was also confirmed. 
Several themes were found in the participants’ answers which revealed youth work is associated with emotional well-being and symptoms of STS. This included emotional detachment, suppression, and numbing, helplessness, burnout and lack of resources to cope, social withdrawal, difficulty sleeping and changes in appetite. Risk factors which appeared to increase vulnerability included personal trauma, PTSD, countertransference, and empathic engagement. Organisational stressors were also identified as increasing vulnerability which heavily influenced participants and contributed to extreme stress and exhaustion. 
Findings in this study contribute to the knowledge of secondary traumatic stress as well as increasing knowledge about the emotional effects of working with traumatised individuals. Furthermore, the study iii helps to educate helping professionals and increases knowledge of youth work.

year: 2017

title: An interface of mātauranga Māori and archaeology to generate a whakapapa of pā tawhito

authors: McIvor, Isaac

subjects: Māori

abstract: Mātauranga Māori (Māori knowledge, epistemology) is foundational to iwi-Māori pasts and is essential to generating new knowledge about those pasts. Archaeology (the study of the physical remains of past human activity) is also an invaluable tool in understanding human history in Aotearoa New Zealand. Few studies have explored an interface between the two forms of knowledge, yet such an approach has great potential to develop new insights about the past that are relevant to descendants today. 

This thesis explores an interface between mātauranga Māori and archaeology to develop a whakapapa (relational genealogical framework) of the development of pā with a case study in Waikato. The word “pā” can refer to any tangata whenua (Indigenous people of the land, i.e., local Māori) settlement or village, but commonly refers to fortified forms, including villages, food stores and places of refuge. Many pā tawhito (historically occupied pā) have physical evidence that may simultaneously enhance descendant identity and well-being through ancestral connections and be a source of potential archaeological information. Researchers have recorded over seven thousand pā across the country (on the New Zealand Archaeological Association’s ArchSite database) at a much higher density than similar fortifications elsewhere in Oceania. Despite this proliferation, only limited and imprecise archaeological findings demonstrate when tangata whenua began constructing pā in their fortified form. We also do not sufficiently understand pā construction sequences through space and time.

This thesis is part of a broader Marsden-funded research project named ‘Rua Mātītī Rua Mātātā: A multidisciplinary investigation into the spatial-temporal role of pā in the development of Māori culture’. This project aimed to create a regional history of Waikato pā at the interface of archaeological science and mātauranga Māori. One side of the project included archaeological surveys and excavations in partnership with Waikato, Ngāti Apakura and Ngāti Maniapoto marae. This thesis focuses on the mātauranga Māori associated with pā in these areas and the broader Waikato region, and how tangata whenua and researchers may theoretically interface that information with archaeological knowledge.

The thesis has five research questions – each targeting a different facet of the whakapapa of pā in Waikato: (1) Why do kōrero (oral histories) include pā? (2) To what extent can we relate calendar years to whakapapa (tribal genealogies)? (3) When did warfare and pā construction develop in Waikato based on whakapapa? (4) Why did warfare and pā construction in Waikato develop at these times? (5) How do descendants relate to pā today?

Mixed methods included a thematic analysis of kōrero about pā and pakanga (warfare) from unpublished reo Māori (Māori language) manuscripts, Māori Land Court records, published sources and research interviews; the application of a Chronological Network Analysis (CNA) using ChronoLog software to relate whakapapa to calendar years; and a qualitative thematic analysis of research interviews with several Tainui descendants.

The review of textual information identified previously unrecognised primary reo Māori written texts for the vast majority of published twentieth-century Tainui kōrero authorities. Identifying these commonly uncited sources is a considerable contribution for future historians. Using a functionalist analysis of these sources, I argue that kōrero refer to pā as both real historical places and symbols of mana hapū (authority in collectives of extended families) in areas of land, their depth and breadth of occupation, socio-political changes and the strength of a community. Relating calendar years to whakapapa demands a historicisation of those structures, which is possible if one accepts the postmodern perspective that neither archaeology nor kōrero tuku iho (intergenerational oral histories) generate empirical or objectively true histories. Nonetheless, pursuing new and comprehensive understandings of the past is valuable.

A CNA model generated a 40-year median birthdate estimate span for over one thousand individuals born during the thirteenth to nineteenth centuries. Based on this whakapapa structure, kōrero pakanga (warfare histories) up until the battle of Mātakitaki in 1822 had five periods of higher frequency: 1420–1540, 1550–1580, 1600–1640, 1690–1730 and 1780–1822 CE. More conservative estimates combine the second and third periods, but the others are consistent. Smaller scale increases and decreases in the frequency of kōrero pakanaga were also present based on localised histories. The earliest kōrero pakanga correlate, if not slightly precede, the earliest known radiocarbon dates of pā fortification in approximately 1500 CE. Relative densities of kōrero pakanga and recorded archaeological pā also generally correlate by district.

Utu (rebalance) was the most common cause of warfare in kōrero across all periods. Meanwhile, conflict over mana rangatira (authority, influence, control) between related communities were more common in earlier kōrero pakanga. Warfare between more distantly related groups was more common from the 1600s and was commonly driven by utu and the occasional competition over whenua (land) and rawa taiao (resources). Contrary to anthropological literature, conflicts rarely resulted in conquest. Furthermore, there was a general increase in conflict size and political complexity in the later periods. The most recent layers of pā whakapapa are relationships held by living descendants who formed the qualitative interview group. I generated three themes based on interview responses: (1) pā (and wāhi tūpuna or ancestral places generally) are spaces of connection and identity affirmation; (2) colonising projects challenge those connections; and (3) descendants have kaitiakitanga (guardianship, through whakapapa) obligations to those places.

This thesis provides a whakapapa of pā, their origins, development, and importance to ngā kanohi ora (living descendants). It is only one among many potential interfaces between different ways to conceive and explain changes in time and space. The chosen method of exploring the interface treats it as multi-vocal, blurred, and complex. It exemplifies the potential avenues for fruitful knowledge generation between Western Science and Indigenous Knowledge Systems (in this case, mātauranga Māori). It also challenges the entrenchment of problematic terminology, such as “Prehistory” in Aotearoa New Zealand and demands space for, not only the protection of important wāhi tūpuna, but also the Crown’s development of resourcing, legislation, and policy to facilitate the exercise of kaitiakitanga. The results open potential ways in which archaeology may feedback into kōrero tuku iho in ways that are appropriate to the chronological whakapapa foundation of mātauranga ā-hapū.

text: An interface of mātauranga Māori and archaeology to generate a whakapapa of pā tawhito Mātauranga Māori (Māori knowledge, epistemology) is foundational to iwi-Māori pasts and is essential to generating new knowledge about those pasts. Archaeology (the study of the physical remains of past human activity) is also an invaluable tool in understanding human history in Aotearoa New Zealand. Few studies have explored an interface between the two forms of knowledge, yet such an approach has great potential to develop new insights about the past that are relevant to descendants today. 

This thesis explores an interface between mātauranga Māori and archaeology to develop a whakapapa (relational genealogical framework) of the development of pā with a case study in Waikato. The word “pā” can refer to any tangata whenua (Indigenous people of the land, i.e., local Māori) settlement or village, but commonly refers to fortified forms, including villages, food stores and places of refuge. Many pā tawhito (historically occupied pā) have physical evidence that may simultaneously enhance descendant identity and well-being through ancestral connections and be a source of potential archaeological information. Researchers have recorded over seven thousand pā across the country (on the New Zealand Archaeological Association’s ArchSite database) at a much higher density than similar fortifications elsewhere in Oceania. Despite this proliferation, only limited and imprecise archaeological findings demonstrate when tangata whenua began constructing pā in their fortified form. We also do not sufficiently understand pā construction sequences through space and time.

This thesis is part of a broader Marsden-funded research project named ‘Rua Mātītī Rua Mātātā: A multidisciplinary investigation into the spatial-temporal role of pā in the development of Māori culture’. This project aimed to create a regional history of Waikato pā at the interface of archaeological science and mātauranga Māori. One side of the project included archaeological surveys and excavations in partnership with Waikato, Ngāti Apakura and Ngāti Maniapoto marae. This thesis focuses on the mātauranga Māori associated with pā in these areas and the broader Waikato region, and how tangata whenua and researchers may theoretically interface that information with archaeological knowledge.

The thesis has five research questions – each targeting a different facet of the whakapapa of pā in Waikato: (1) Why do kōrero (oral histories) include pā? (2) To what extent can we relate calendar years to whakapapa (tribal genealogies)? (3) When did warfare and pā construction develop in Waikato based on whakapapa? (4) Why did warfare and pā construction in Waikato develop at these times? (5) How do descendants relate to pā today?

Mixed methods included a thematic analysis of kōrero about pā and pakanga (warfare) from unpublished reo Māori (Māori language) manuscripts, Māori Land Court records, published sources and research interviews; the application of a Chronological Network Analysis (CNA) using ChronoLog software to relate whakapapa to calendar years; and a qualitative thematic analysis of research interviews with several Tainui descendants.

The review of textual information identified previously unrecognised primary reo Māori written texts for the vast majority of published twentieth-century Tainui kōrero authorities. Identifying these commonly uncited sources is a considerable contribution for future historians. Using a functionalist analysis of these sources, I argue that kōrero refer to pā as both real historical places and symbols of mana hapū (authority in collectives of extended families) in areas of land, their depth and breadth of occupation, socio-political changes and the strength of a community. Relating calendar years to whakapapa demands a historicisation of those structures, which is possible if one accepts the postmodern perspective that neither archaeology nor kōrero tuku iho (intergenerational oral histories) generate empirical or objectively true histories. Nonetheless, pursuing new and comprehensive understandings of the past is valuable.

A CNA model generated a 40-year median birthdate estimate span for over one thousand individuals born during the thirteenth to nineteenth centuries. Based on this whakapapa structure, kōrero pakanga (warfare histories) up until the battle of Mātakitaki in 1822 had five periods of higher frequency: 1420–1540, 1550–1580, 1600–1640, 1690–1730 and 1780–1822 CE. More conservative estimates combine the second and third periods, but the others are consistent. Smaller scale increases and decreases in the frequency of kōrero pakanaga were also present based on localised histories. The earliest kōrero pakanga correlate, if not slightly precede, the earliest known radiocarbon dates of pā fortification in approximately 1500 CE. Relative densities of kōrero pakanga and recorded archaeological pā also generally correlate by district.

Utu (rebalance) was the most common cause of warfare in kōrero across all periods. Meanwhile, conflict over mana rangatira (authority, influence, control) between related communities were more common in earlier kōrero pakanga. Warfare between more distantly related groups was more common from the 1600s and was commonly driven by utu and the occasional competition over whenua (land) and rawa taiao (resources). Contrary to anthropological literature, conflicts rarely resulted in conquest. Furthermore, there was a general increase in conflict size and political complexity in the later periods. The most recent layers of pā whakapapa are relationships held by living descendants who formed the qualitative interview group. I generated three themes based on interview responses: (1) pā (and wāhi tūpuna or ancestral places generally) are spaces of connection and identity affirmation; (2) colonising projects challenge those connections; and (3) descendants have kaitiakitanga (guardianship, through whakapapa) obligations to those places.

This thesis provides a whakapapa of pā, their origins, development, and importance to ngā kanohi ora (living descendants). It is only one among many potential interfaces between different ways to conceive and explain changes in time and space. The chosen method of exploring the interface treats it as multi-vocal, blurred, and complex. It exemplifies the potential avenues for fruitful knowledge generation between Western Science and Indigenous Knowledge Systems (in this case, mātauranga Māori). It also challenges the entrenchment of problematic terminology, such as “Prehistory” in Aotearoa New Zealand and demands space for, not only the protection of important wāhi tūpuna, but also the Crown’s development of resourcing, legislation, and policy to facilitate the exercise of kaitiakitanga. The results open potential ways in which archaeology may feedback into kōrero tuku iho in ways that are appropriate to the chronological whakapapa foundation of mātauranga ā-hapū.

year: 2024-07