title: A case study of using the He Pikinga Waiora Implementation Framework: Challenges and successes in implementing a twelve-week lifestyle intervention to reduce weight in Māori men at risk of diabetes, cardiovascular disease and obesity

authors: Oetzel, John G.

subjects: Science & Technology

abstract: BACKGROUND: Māori men have stark health inequities around non-communicable diseases. This study describes the case of a partnership attempting to develop and implement a culturally centred intervention through a collaborative partnership to potentially address the inequities. In particular, the partnership followed a participatory, co-design approach using the He Pikinga Waiora (HPW) Implementation Framework; the study presents lessons learnt in addressing health inequities following this framework. METHODS: The partnership involved a university research team and a Māori community health provider. They engaged with other stakeholders and several cohorts of Māori men through a co-design process to adapt a 12-week lifestyle intervention. The co-design process was documented through meeting notes and interviews with partners. Two cohorts participated in separate single group pre-intervention/post-intervention designs with multi-method data collection. Key outcome measures included weight loss, self-reported health, physical activity, and nutrition. Post-intervention data collection included qualitative data. RESULTS: The co-design process resulted in a strong and engaged partnership between the university team and the provider. There were significant challenges in implementing the intervention including having two additional partner organisations dropping out of the partnership just after the initial implementation phase. However, a flexible and adaptable partnership resulted in developing two distinct lifestyle interventions run with 32 Māori men (in two different cohorts of 8 and 24). All but one in the first cohort completed the programme. The first cohort had a modest although statistically insignificant improvement in weight loss (d = 1.04) and body mass index (BMI; d = 1.08). The second cohort had a significant reduction in weight loss (d = 1.16) and BMI (d = 1.15). They also had a significant increase in health-related quality of life (d = 1.7) and self-rated health (d = 2.0). CONCLUSION: The HPW Framework appears to be well suited to advance implementation science for Indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design interventions for chronic disease prevention in Indigenous communities. Despite this promise, there are structural challenges in developing and implementing interventions to address health inequities. TRIAL REGISTRATION: Retrospectively registered, Australia New Zealand Clinical Trials Registry, ACTRN12619001783112.

text: A case study of using the He Pikinga Waiora Implementation Framework: Challenges and successes in implementing a twelve-week lifestyle intervention to reduce weight in Māori men at risk of diabetes, cardiovascular disease and obesity BACKGROUND: Māori men have stark health inequities around non-communicable diseases. This study describes the case of a partnership attempting to develop and implement a culturally centred intervention through a collaborative partnership to potentially address the inequities. In particular, the partnership followed a participatory, co-design approach using the He Pikinga Waiora (HPW) Implementation Framework; the study presents lessons learnt in addressing health inequities following this framework. METHODS: The partnership involved a university research team and a Māori community health provider. They engaged with other stakeholders and several cohorts of Māori men through a co-design process to adapt a 12-week lifestyle intervention. The co-design process was documented through meeting notes and interviews with partners. Two cohorts participated in separate single group pre-intervention/post-intervention designs with multi-method data collection. Key outcome measures included weight loss, self-reported health, physical activity, and nutrition. Post-intervention data collection included qualitative data. RESULTS: The co-design process resulted in a strong and engaged partnership between the university team and the provider. There were significant challenges in implementing the intervention including having two additional partner organisations dropping out of the partnership just after the initial implementation phase. However, a flexible and adaptable partnership resulted in developing two distinct lifestyle interventions run with 32 Māori men (in two different cohorts of 8 and 24). All but one in the first cohort completed the programme. The first cohort had a modest although statistically insignificant improvement in weight loss (d = 1.04) and body mass index (BMI; d = 1.08). The second cohort had a significant reduction in weight loss (d = 1.16) and BMI (d = 1.15). They also had a significant increase in health-related quality of life (d = 1.7) and self-rated health (d = 2.0). CONCLUSION: The HPW Framework appears to be well suited to advance implementation science for Indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design interventions for chronic disease prevention in Indigenous communities. Despite this promise, there are structural challenges in developing and implementing interventions to address health inequities. TRIAL REGISTRATION: Retrospectively registered, Australia New Zealand Clinical Trials Registry, ACTRN12619001783112.

year: 2020

title: The Rangatahi court

authors: Dickson, Matiu

abstract: It has become popular to use the marae setting as an alternative to the mainstream courts in dealing with young Māori offenders. The rationale is that taking young Māori offenders back to the marae to be dealt with in the youth justice system, encourages them to face up to their responsibilities and aids their rehabilitation back into the community. The expectation is that whānau will be present to support the young person and to help resolve his or her offending and bad behaviour. I supported this innovation when it was introduced but now I have second thoughts having seen that a marae that piloted this scheme was vandalised with graffiti painted on the marae buildings. In my view, when this happened the scheme to use marae should have ceased and an opportunity taken to rethink their use in this way. For a Māori the vandalism of their marae is like a physical assault on the person of their tupuna. This paper looks at the traditional role of marae in the Māori community and questions the use of marae as judicial settings. It suggests what needs to be done first to make this setting tika or appropriate.

text: The Rangatahi court It has become popular to use the marae setting as an alternative to the mainstream courts in dealing with young Māori offenders. The rationale is that taking young Māori offenders back to the marae to be dealt with in the youth justice system, encourages them to face up to their responsibilities and aids their rehabilitation back into the community. The expectation is that whānau will be present to support the young person and to help resolve his or her offending and bad behaviour. I supported this innovation when it was introduced but now I have second thoughts having seen that a marae that piloted this scheme was vandalised with graffiti painted on the marae buildings. In my view, when this happened the scheme to use marae should have ceased and an opportunity taken to rethink their use in this way. For a Māori the vandalism of their marae is like a physical assault on the person of their tupuna. This paper looks at the traditional role of marae in the Māori community and questions the use of marae as judicial settings. It suggests what needs to be done first to make this setting tika or appropriate.

year: 2011

title: Computational Nanobiosensing – Drawing Analogies Between Optimisation and Nanobiosensing for Smart Tumour Targeting

authors: Zhang, Lisa

abstract: Nanotechnology has been rapidly developing for early diagnosis and treatment of cancer, with nanoparticles being a large focus. However, traditional drug delivery mechanisms are passive and inefficient, with only 0.7% of nanoparticles reaching the tumour through blood vasculature. In vivo computation, also known as computational nanobiosensing (CONA), replaces nanoparticles with swarms of externally manipulable nanorobots whose movement is controlled by an external actuating system. The biological problem of smart tumour targeting is viewed from the computational perspective as an optimisation problem: nanorobot swarms (computational agents) explore the blood vasculature of high-risk tissue (search space) to locate the tumour (global optimum). Tumour biological gradient fields (BGF) create a fitness landscape, which can be analysed with fitness landscape analysis (FLA) to select and tune appropriate search algorithms for in vivo computation.

Key limitations of previous work for in vivo computation are a lack of realistic BGFs that reflect the tumour microenvironment to test search algorithms on; and for FLA, no available measures that consider physical constraints of the in vivo environment.

Two realistic tumour BGF models were created using COMSOL Multiphysics software (CFD Module), one highly vascularised, the other less vascularised. The vascular architecture was based on in vivo blood vessel networks in healthy and tumour regions, and blood velocity was used as a BGF. Blood velocity was found to be lowest in the tumour region, not exceeding 100 µm/s, confirming its applicability as a BGF for search algorithm testing.

Three new FLA measures were created and validated with numerical simulations on two possible tumour vascular landscapes. These measures addressed the physical constraints of discrete search space, unidirectional blood flow, and nanorobot steering imperfections when using a uniform magnetic field. The less vascularized landscape was found to be more discrete, more heterogeneous, and contain a smaller countercurrent frequency of search direction. This indicated it would be more challenging to solve for than the highly vascularised landscape.

These advancements of the CONA framework allow the in vivo search environment to be better visualised and understood for algorithmic development, as well as provide realistic BGFs to test these search algorithms on.

text: Computational Nanobiosensing – Drawing Analogies Between Optimisation and Nanobiosensing for Smart Tumour Targeting Nanotechnology has been rapidly developing for early diagnosis and treatment of cancer, with nanoparticles being a large focus. However, traditional drug delivery mechanisms are passive and inefficient, with only 0.7% of nanoparticles reaching the tumour through blood vasculature. In vivo computation, also known as computational nanobiosensing (CONA), replaces nanoparticles with swarms of externally manipulable nanorobots whose movement is controlled by an external actuating system. The biological problem of smart tumour targeting is viewed from the computational perspective as an optimisation problem: nanorobot swarms (computational agents) explore the blood vasculature of high-risk tissue (search space) to locate the tumour (global optimum). Tumour biological gradient fields (BGF) create a fitness landscape, which can be analysed with fitness landscape analysis (FLA) to select and tune appropriate search algorithms for in vivo computation.

Key limitations of previous work for in vivo computation are a lack of realistic BGFs that reflect the tumour microenvironment to test search algorithms on; and for FLA, no available measures that consider physical constraints of the in vivo environment.

Two realistic tumour BGF models were created using COMSOL Multiphysics software (CFD Module), one highly vascularised, the other less vascularised. The vascular architecture was based on in vivo blood vessel networks in healthy and tumour regions, and blood velocity was used as a BGF. Blood velocity was found to be lowest in the tumour region, not exceeding 100 µm/s, confirming its applicability as a BGF for search algorithm testing.

Three new FLA measures were created and validated with numerical simulations on two possible tumour vascular landscapes. These measures addressed the physical constraints of discrete search space, unidirectional blood flow, and nanorobot steering imperfections when using a uniform magnetic field. The less vascularized landscape was found to be more discrete, more heterogeneous, and contain a smaller countercurrent frequency of search direction. This indicated it would be more challenging to solve for than the highly vascularised landscape.

These advancements of the CONA framework allow the in vivo search environment to be better visualised and understood for algorithmic development, as well as provide realistic BGFs to test these search algorithms on.

year: 2024