title: Patient-reported diagnostic intervals to colorectal cancer diagnosis in the Midland region of New Zealand: a prospective cohort study

authors: Blackmore, Tania Louise

subjects: Science & Technology

abstract: Background and objectives
New Zealand (NZ) has high rates of colorectal cancer (CRC) but low rates of early detection. The majority of CRC is diagnosed through general practice, where lengthy diagnostic intervals are common. We investigated factors contributing to diagnostic delay in a cohort of patients newly diagnosed with CRC.

Methods
Patients were recruited from the Midland region and interviewed about their diagnostic experience using a questionnaire based on a modified Model of Pathways to Treatment framework and SYMPTOM questionnaire. Descriptive statistics were used to describe the population characteristics. Chi-square analysis and logistic regression were used to analyse factors influencing diagnostic intervals.

Results
Data from 176 patients were analysed, of which 65 (36.9%) experienced a general practitioner (GP) diagnostic interval of >120 days and 96 (54.5%) experienced a total diagnostic interval (TDI) > 120 days. Patients reporting rectal bleeding were less likely to experience a long TDI (odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.14–0.78) and appraisal/help-seeking interval (OR, 0.19, 95% CI: 0.06–0.59). Patients <60 were more likely to report a longer appraisal/help-seeking interval (OR, 3.32, 95% CI: 1.17–9.46). Female (OR, 2.19, 95% CI: 1.08–4.44) and Māori patients (OR, 3.18, 95% CI: 1.04–9.78) were more likely to experience a long GP diagnostic interval.

Conclusion
NZ patients with CRC can experience long diagnostic intervals, attributed to patient and health system factors. Young patients, Māori, females, and patients experiencing change of bowel habit may be at particular risk. We need to increase symptom awareness of CRC for patients and GPs. Concentrated efforts are needed to ensure equity for Māori in access to screening, diagnostics, and treatment.

text: Patient-reported diagnostic intervals to colorectal cancer diagnosis in the Midland region of New Zealand: a prospective cohort study Background and objectives
New Zealand (NZ) has high rates of colorectal cancer (CRC) but low rates of early detection. The majority of CRC is diagnosed through general practice, where lengthy diagnostic intervals are common. We investigated factors contributing to diagnostic delay in a cohort of patients newly diagnosed with CRC.

Methods
Patients were recruited from the Midland region and interviewed about their diagnostic experience using a questionnaire based on a modified Model of Pathways to Treatment framework and SYMPTOM questionnaire. Descriptive statistics were used to describe the population characteristics. Chi-square analysis and logistic regression were used to analyse factors influencing diagnostic intervals.

Results
Data from 176 patients were analysed, of which 65 (36.9%) experienced a general practitioner (GP) diagnostic interval of >120 days and 96 (54.5%) experienced a total diagnostic interval (TDI) > 120 days. Patients reporting rectal bleeding were less likely to experience a long TDI (odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.14–0.78) and appraisal/help-seeking interval (OR, 0.19, 95% CI: 0.06–0.59). Patients <60 were more likely to report a longer appraisal/help-seeking interval (OR, 3.32, 95% CI: 1.17–9.46). Female (OR, 2.19, 95% CI: 1.08–4.44) and Māori patients (OR, 3.18, 95% CI: 1.04–9.78) were more likely to experience a long GP diagnostic interval.

Conclusion
NZ patients with CRC can experience long diagnostic intervals, attributed to patient and health system factors. Young patients, Māori, females, and patients experiencing change of bowel habit may be at particular risk. We need to increase symptom awareness of CRC for patients and GPs. Concentrated efforts are needed to ensure equity for Māori in access to screening, diagnostics, and treatment.

year: 2021

title: The Māori female - her body, spirituality, sacredness and mana : a space within spaces

authors: August, Wikitoria

subjects: Body image in women

abstract: This thesis is an exploration of bodily rituals, practices and cultural spaces of the female Māori body. Critical social theories and Kaupapa Māori research paradigms are combined to disrupt and challenge hegemonic Western knowledges. Qualitative methods - interviews, focus groups and autobiographical experience - are used to understand bodily practices that pertain to being Māori and female. There are three points to my discussion. I argue first, that the embodied relationship between Māori women and urupā and food gathering spaces rests on notions of Papatūānuku and female reproduction. During menstruation or pregnancy most women are restricted from urupā. Many participants, however, view this tikanga positively and describe it as making them feel special. Second, I examine the ways in which Māori female bodies are colonised and positioned between Western patriarchal and traditional ways of being. Due to various reasons surrounding colonisation, there are gaps in younger generations' Māori knowledge and this has led to tensions about which space to occupy. Finally, I discuss mana and conclude by asserting that the Māori female body has not lost individual mana, despite the efforts of colonisation to take mana away from Māori women. Throughout this research I offer cultural perspectives in order to prompt new ways of thinking about the Māori female body. 

The views expressed in this thesis are not the views of all Māori. Practices, tikanga and knowledges vary between different iwi, hapū and rohe.

text: The Māori female - her body, spirituality, sacredness and mana : a space within spaces This thesis is an exploration of bodily rituals, practices and cultural spaces of the female Māori body. Critical social theories and Kaupapa Māori research paradigms are combined to disrupt and challenge hegemonic Western knowledges. Qualitative methods - interviews, focus groups and autobiographical experience - are used to understand bodily practices that pertain to being Māori and female. There are three points to my discussion. I argue first, that the embodied relationship between Māori women and urupā and food gathering spaces rests on notions of Papatūānuku and female reproduction. During menstruation or pregnancy most women are restricted from urupā. Many participants, however, view this tikanga positively and describe it as making them feel special. Second, I examine the ways in which Māori female bodies are colonised and positioned between Western patriarchal and traditional ways of being. Due to various reasons surrounding colonisation, there are gaps in younger generations' Māori knowledge and this has led to tensions about which space to occupy. Finally, I discuss mana and conclude by asserting that the Māori female body has not lost individual mana, despite the efforts of colonisation to take mana away from Māori women. Throughout this research I offer cultural perspectives in order to prompt new ways of thinking about the Māori female body. 

The views expressed in this thesis are not the views of all Māori. Practices, tikanga and knowledges vary between different iwi, hapū and rohe.

year: 2004

title: Variations to the Groundwater Seepage Face on Meso-tidal Dissipative Beaches

authors: Emami, Amir

subjects: Seepage face

abstract: Groundwater seeping from the beachface can induce erosion and so may play a role in controlling the development of beach morphology. This research answers some fundamental questions about the processes that control the groundwater seepage line position on a dissipative beach. For instance: What is the relationship between the observed groundwater seepage line and the intertidal beachface volume? What is the best statistical model, which can describe the importance of the groundwater seepage line and surfzone morphology in changing the beachface volume? How well can video images be used for extracting groundwater seepage lines and shorelines at a dissipative meso-tidal beach? How does the groundwater seepage line on a dissipative meso-tidal beach change over the tidal cycle? What are the main parameters controlling the groundwater seepage line on a dissipative, meso-tidal beach and which driver is the most important in explaining changes to the seepage line? Can numerical models (both linear and non-linear) accurately predict the tidal groundwater changes across the beachface and determine the position of the groundwater exit point?
     The processes that are explored are rip currents, characterized by the observed variations in the surfzone morphology, as well as beach slope, hydraulic conductivity, wave set-up, tidal variations and water table variations. Specifically, changes to the alongshore variation and decoupling of the seepage line from the shoreline are studied along two gently-sloping beaches in the west cost of New Zealand using video images, field measurements and a 2D non-linear Boussinesq model. Finally the advantages and disadvantages of applying the linear versus the non-linear Boussinesq equations to beach groundwater modelling are discussed. The thesis also demonstrates the accuracy of using video images for extracting the seepage line and shoreline.
     The statistical study conducted using video imagery and surveys of the seepage line at Muriwai Beach showed that the variation of the beach volume can be related to the seepage line and surfzone morphology, (which was measured using the pixel intensity extracted from the time-averaged video images). My results showed that in most regions of the beach, there is a clear correlation between the beachface volume and the seepage line, with an elevated seepage line causing a reduction of volume. This inverse correlation occurred in all datasets. The seasonal analysis showed that the seepage line in winter is more correlated with volume than summer. The field results also indicated that the beachface volume is more correlated with the seepage line at low tide rather than high tide. Hence, the seepage line has a greater effect lower on the beach, and beachface volume reduction is more influenced by the low tide seepage line. This study also showed that the seepage line was less clearly related to changes in the surfzone morphology.
     One of the shortcomings of the study at Muriwai Beach was the lack of survey data and the inability to use the video imagery more effectively because of the lack of ground truthing. Therefore images collected at Ngarunui Beach, where cameras were still operating, were used to study the application of the time-averaged images in extracting the seepage line and variance images in detecting the shoreline. The comparison between the extracted shoreline and beach survey data showed that the difference between the surveyed data and video based data in upper intertidal beach is much lower than lower part of the beach indicating that the video extracting algorithm works better at the high tide rather than the low tide. On the other hand, both seepage line and shoreline showed the decoupling process very well in both incoming and outgoing tides. During the rising tide, the infiltration from the tidal wave causes the water table rise, although beach groundwater level increases much more quickly than rising tide. An hourly comparison of the decoupling process showed that the seepage line decouples from the shoreline more quickly on the lower part (less steep intertidal beachface) rather than the steeper upper part of the beach profile. This decoupling process showed that Ngarunui Beach fills more rapidly than the tide rises, and drains more slowly than tide falls. This finding was tested using my field data collected using Solinst piezometers -Solinst is the brand name of the piezometers which were used at Ngarunui Beach- and manual water detectors at the beach. The decoupling between the seepage line and the shoreline extracted from video images also showed that the seepage face width is much greater in north and middle of the beach rather than south part. The rip current in south of the beach may have an effect on lowering the groundwater exit point elevation and shortening the seepage face width. Although according to the data from the current meters deployed in the beach, it seems that the rips may have a small effect on changing the groundwater seepage line rather than sediment properties and beach topography.
     Modelling using a 2D non-linear Boussinesq model, which I developed during the research, showed that the seepage line calculated by my model is compatible with the surveyed seepage line. The non-linearity effect of the hydraulic conductivity and the groundwater depth may play an important role in accuracy of the results. The non-linear model also showed the same pattern of the decoupling between the seepage line and the shoreline as the video images showed. Similar to the result of my 1D numerical model at Muriwai beach, the numerical model results at Ngarunui beach also showed that the seepage line elevation decreases with increasing the hydraulic conductivity and intertidal beachface slope. The model successfully replicated the wider seepage face in middle and north of the beach rather the south (also shown in the video image analysis).

text: Variations to the Groundwater Seepage Face on Meso-tidal Dissipative Beaches Groundwater seeping from the beachface can induce erosion and so may play a role in controlling the development of beach morphology. This research answers some fundamental questions about the processes that control the groundwater seepage line position on a dissipative beach. For instance: What is the relationship between the observed groundwater seepage line and the intertidal beachface volume? What is the best statistical model, which can describe the importance of the groundwater seepage line and surfzone morphology in changing the beachface volume? How well can video images be used for extracting groundwater seepage lines and shorelines at a dissipative meso-tidal beach? How does the groundwater seepage line on a dissipative meso-tidal beach change over the tidal cycle? What are the main parameters controlling the groundwater seepage line on a dissipative, meso-tidal beach and which driver is the most important in explaining changes to the seepage line? Can numerical models (both linear and non-linear) accurately predict the tidal groundwater changes across the beachface and determine the position of the groundwater exit point?
     The processes that are explored are rip currents, characterized by the observed variations in the surfzone morphology, as well as beach slope, hydraulic conductivity, wave set-up, tidal variations and water table variations. Specifically, changes to the alongshore variation and decoupling of the seepage line from the shoreline are studied along two gently-sloping beaches in the west cost of New Zealand using video images, field measurements and a 2D non-linear Boussinesq model. Finally the advantages and disadvantages of applying the linear versus the non-linear Boussinesq equations to beach groundwater modelling are discussed. The thesis also demonstrates the accuracy of using video images for extracting the seepage line and shoreline.
     The statistical study conducted using video imagery and surveys of the seepage line at Muriwai Beach showed that the variation of the beach volume can be related to the seepage line and surfzone morphology, (which was measured using the pixel intensity extracted from the time-averaged video images). My results showed that in most regions of the beach, there is a clear correlation between the beachface volume and the seepage line, with an elevated seepage line causing a reduction of volume. This inverse correlation occurred in all datasets. The seasonal analysis showed that the seepage line in winter is more correlated with volume than summer. The field results also indicated that the beachface volume is more correlated with the seepage line at low tide rather than high tide. Hence, the seepage line has a greater effect lower on the beach, and beachface volume reduction is more influenced by the low tide seepage line. This study also showed that the seepage line was less clearly related to changes in the surfzone morphology.
     One of the shortcomings of the study at Muriwai Beach was the lack of survey data and the inability to use the video imagery more effectively because of the lack of ground truthing. Therefore images collected at Ngarunui Beach, where cameras were still operating, were used to study the application of the time-averaged images in extracting the seepage line and variance images in detecting the shoreline. The comparison between the extracted shoreline and beach survey data showed that the difference between the surveyed data and video based data in upper intertidal beach is much lower than lower part of the beach indicating that the video extracting algorithm works better at the high tide rather than the low tide. On the other hand, both seepage line and shoreline showed the decoupling process very well in both incoming and outgoing tides. During the rising tide, the infiltration from the tidal wave causes the water table rise, although beach groundwater level increases much more quickly than rising tide. An hourly comparison of the decoupling process showed that the seepage line decouples from the shoreline more quickly on the lower part (less steep intertidal beachface) rather than the steeper upper part of the beach profile. This decoupling process showed that Ngarunui Beach fills more rapidly than the tide rises, and drains more slowly than tide falls. This finding was tested using my field data collected using Solinst piezometers -Solinst is the brand name of the piezometers which were used at Ngarunui Beach- and manual water detectors at the beach. The decoupling between the seepage line and the shoreline extracted from video images also showed that the seepage face width is much greater in north and middle of the beach rather than south part. The rip current in south of the beach may have an effect on lowering the groundwater exit point elevation and shortening the seepage face width. Although according to the data from the current meters deployed in the beach, it seems that the rips may have a small effect on changing the groundwater seepage line rather than sediment properties and beach topography.
     Modelling using a 2D non-linear Boussinesq model, which I developed during the research, showed that the seepage line calculated by my model is compatible with the surveyed seepage line. The non-linearity effect of the hydraulic conductivity and the groundwater depth may play an important role in accuracy of the results. The non-linear model also showed the same pattern of the decoupling between the seepage line and the shoreline as the video images showed. Similar to the result of my 1D numerical model at Muriwai beach, the numerical model results at Ngarunui beach also showed that the seepage line elevation decreases with increasing the hydraulic conductivity and intertidal beachface slope. The model successfully replicated the wider seepage face in middle and north of the beach rather the south (also shown in the video image analysis).

year: 2016