title: Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study

authors: Blackmore, Tania Louise

subjects: Science & Technology

abstract: Background: New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals. 
Methods: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic). 
Results: Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family. 
Conclusions: The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.

text: Barriers and facilitators to colorectal cancer diagnosis in New Zealand: a qualitative study Background: New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals. 
Methods: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework (intervals: appraisal, help-seeking, diagnostic). 
Results: Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family. 
Conclusions: The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient.

year: 2020-10-01

title: Understanding Māori rights and interests in intellectual property arising from research and innovation

authors: Sterling, Rogena

abstract: In the era of big data, the significance of data as a raw material for production and a source of societal and economic value has grown immensely. Advances in data mining, analytics, computing power, and storage capacity have facilitated broader access and utilization of big data for corporate and governmental purposes. This surge aligns with the knowledge economy, emphasizing knowledge-intensive activities to drive economic growth, a focus underscored in the latest Government Strategy.

However, as the knowledge economy expands, concerns arise about equity, Treaty partnerships, and the need to address issues of Māori data sovereignty and Indigenous data sovereignty. Discussions around Māori data sovereignty emphasize the importance of Māori control over various forms of Māori data, such as Mātauranga Māori, taonga species, and administrative data. Organizations like Te Mana Raraunga have been instrumental in developing principles and audit tools to support Māori data sovereignty.

Amidst these developments, questions have surfaced about the protection of Māori intellectual property (IP) within Aotearoa New Zealand, particularly outlined in the WAI262 report. This report, funded by Genomics Aotearoa and the National Science Challenge Science for Technological Innovation, aims to address these concerns. The project includes a literature review examining national legislation and international agreements constituting New Zealand's Intellectual Property Rights regime. This review explores how these frameworks safeguard Māori IP rights concerning Māori data, genomic data, and Mātauranga Māori. The second component involves a survey targeting research institutions to assess the presence of IP policies protecting Māori data in research and innovation processes.

The report provides a concise summary of the literature review and survey findings, with the overarching goal of assisting institutions in developing policies that safeguard Māori rights over their knowledge and data. The objective is to ensure equitable benefit-sharing throughout the innovation processes and address the evolving landscape of data sovereignty.

text: Understanding Māori rights and interests in intellectual property arising from research and innovation In the era of big data, the significance of data as a raw material for production and a source of societal and economic value has grown immensely. Advances in data mining, analytics, computing power, and storage capacity have facilitated broader access and utilization of big data for corporate and governmental purposes. This surge aligns with the knowledge economy, emphasizing knowledge-intensive activities to drive economic growth, a focus underscored in the latest Government Strategy.

However, as the knowledge economy expands, concerns arise about equity, Treaty partnerships, and the need to address issues of Māori data sovereignty and Indigenous data sovereignty. Discussions around Māori data sovereignty emphasize the importance of Māori control over various forms of Māori data, such as Mātauranga Māori, taonga species, and administrative data. Organizations like Te Mana Raraunga have been instrumental in developing principles and audit tools to support Māori data sovereignty.

Amidst these developments, questions have surfaced about the protection of Māori intellectual property (IP) within Aotearoa New Zealand, particularly outlined in the WAI262 report. This report, funded by Genomics Aotearoa and the National Science Challenge Science for Technological Innovation, aims to address these concerns. The project includes a literature review examining national legislation and international agreements constituting New Zealand's Intellectual Property Rights regime. This review explores how these frameworks safeguard Māori IP rights concerning Māori data, genomic data, and Mātauranga Māori. The second component involves a survey targeting research institutions to assess the presence of IP policies protecting Māori data in research and innovation processes.

The report provides a concise summary of the literature review and survey findings, with the overarching goal of assisting institutions in developing policies that safeguard Māori rights over their knowledge and data. The objective is to ensure equitable benefit-sharing throughout the innovation processes and address the evolving landscape of data sovereignty.

year: 2021-05

title: A study of the digestion and metabolism of dairy cows differing in susceptibility to bloat

authors: Carruthers, Vicki Robin

abstract: The digestive characteristics of cows of high (HS) or low (LS) susceptibility to bloat were investigated. 

Sixteen HS and 16 LS cows were offered pasture or hay when pregnant but not lactating, and pasture or 75% pasture plus 25% hay when lactating. The susceptibility groups did not differ in voluntary intake or apparent digestibility of dry matter, organic matter, nitrogen or energy on either occasion. LS cows produced more milk of a lower protein content than HS cows but yields of fat, protein and lactose were similar for both susceptibility groups.

Subsequent experiments used 4 or 5 cows of each susceptibility group, each fitted with a fistula in the dorsal rumen and offered diets of hay or pasture.

On 3 of 8 diets offered, non-lactating LS cows had less digesta, measured by removal through the fistula, in the reticulo-rumen before feeding than did HS cows. Increasing or decreasing the quantity of digesta in the reticulo-rumen after feeding correspondingly increased or decreased both the quantity of digesta subsequently lost and the quantity remaining 21 hours after feeding, or before the next feeding, for both HS and LS cows. On all diets LS cows lost less fluid from the reticulo-rumen during feeding and more after feeding, than did HS cows. Altering the concentration of Na in rumen fluid by addition of water or electrolyte solutions did not affect the loss of fluid and DM from the reticulo-rumen of LS cows relative to that of HS cows. When offered 3 pastures differing in maturity, an increase in maturity of the pasture resulted in an increase in the quantity of digesta in the reticulo-rumen before feeding, but HS and LS cows did not differ in quantity of digesta on each of the 3 pastures. The quantity of digesta in the reticulo-rumen was greater in cows when offered a diet of low K:Na ratio than when offered a high ratio diet. On both diets, however, LS cows had less digesta in the reticulo-rumen, a lower concentration of K in plasma and excreted less K in their faeces than HS cows.

Lactating HS and LS cows offered pasture ad libitum did not differ in intakes of dry matter and water, in the quantities of fluid and dry matter in the reticulo-rumen or in the rate of digestion when estimated from the loss of dry matter from nylon bags incubated in the ventral sac of the rumen.

HS and LS cows did not differ in capacity of the reticule-rumen. The rumen fluid dilution rate, estimated using Cr EDTA, was similar for both susceptibility groups in 3 experiments and higher for LS than HS cows in one experiment.

Overall, these studies revealed few differences between HS and LS cows in the parameters measured, except that under some experimental conditions LS cows had less digesta in the reticulo-rumen than did HS cows.

text: A study of the digestion and metabolism of dairy cows differing in susceptibility to bloat The digestive characteristics of cows of high (HS) or low (LS) susceptibility to bloat were investigated. 

Sixteen HS and 16 LS cows were offered pasture or hay when pregnant but not lactating, and pasture or 75% pasture plus 25% hay when lactating. The susceptibility groups did not differ in voluntary intake or apparent digestibility of dry matter, organic matter, nitrogen or energy on either occasion. LS cows produced more milk of a lower protein content than HS cows but yields of fat, protein and lactose were similar for both susceptibility groups.

Subsequent experiments used 4 or 5 cows of each susceptibility group, each fitted with a fistula in the dorsal rumen and offered diets of hay or pasture.

On 3 of 8 diets offered, non-lactating LS cows had less digesta, measured by removal through the fistula, in the reticulo-rumen before feeding than did HS cows. Increasing or decreasing the quantity of digesta in the reticulo-rumen after feeding correspondingly increased or decreased both the quantity of digesta subsequently lost and the quantity remaining 21 hours after feeding, or before the next feeding, for both HS and LS cows. On all diets LS cows lost less fluid from the reticulo-rumen during feeding and more after feeding, than did HS cows. Altering the concentration of Na in rumen fluid by addition of water or electrolyte solutions did not affect the loss of fluid and DM from the reticulo-rumen of LS cows relative to that of HS cows. When offered 3 pastures differing in maturity, an increase in maturity of the pasture resulted in an increase in the quantity of digesta in the reticulo-rumen before feeding, but HS and LS cows did not differ in quantity of digesta on each of the 3 pastures. The quantity of digesta in the reticulo-rumen was greater in cows when offered a diet of low K:Na ratio than when offered a high ratio diet. On both diets, however, LS cows had less digesta in the reticulo-rumen, a lower concentration of K in plasma and excreted less K in their faeces than HS cows.

Lactating HS and LS cows offered pasture ad libitum did not differ in intakes of dry matter and water, in the quantities of fluid and dry matter in the reticulo-rumen or in the rate of digestion when estimated from the loss of dry matter from nylon bags incubated in the ventral sac of the rumen.

HS and LS cows did not differ in capacity of the reticule-rumen. The rumen fluid dilution rate, estimated using Cr EDTA, was similar for both susceptibility groups in 3 experiments and higher for LS than HS cows in one experiment.

Overall, these studies revealed few differences between HS and LS cows in the parameters measured, except that under some experimental conditions LS cows had less digesta in the reticulo-rumen than did HS cows.

year: 1986