SUMMER STUDENTSHIP PROGRAMME ...The Summer Studentship is open to any undergraduate student who is ... Dr. Max Berry 17-68 Effect of early life environment on maternal-pup interactions

2017/2018 SUMMER STUDENTSHIP PROGRAMME

PPPRRROOOJJJEEECCCTTT LLLIIISSSTTT These are the Projects available this year; some project adverts will have an early deadline. As projects are filled the online table and the pdf project listing will be updated accordingly - We recommend bookmarking this webpage and keep checking for updates.

Who can apply for the Summer Studentship programme?

The Summer Studentship is open to any undergraduate student who is currently enrolled at the University of Otago and at any NZ Universities.

The purpose of the studentship is to encourage undergraduate students into research careers and therefore is NOT designed for those with PhD's, Masters, who have already graduated or set to graduate later in the year.

How to apply for a summer project?

Students should select which project/s they are interested in applying for and send a brief one page CV to the contact email address of the supervisor listed on the project. If a supervisor has listed more than one project, it would be helpful to include the project reference #

Students are asked to provide the name of a referee (Supervisor or Dean of School) if they are not currently studying with the University of Otago.

You need to read the student handbook before applying NB: At this present time, the Research Office is in the process of securing funding for some projects. Once funding is secured and you have been selected, both the student and supervisor will be notified. As projects are filled, the online table will be updated immediately. (sometimes the online pdf version will take at least 48hours to be uploaded)

Students need to note that until funding is successfully secured there will be a possibility some projects will not go ahead.

The deadline for project funding and placement is 1st October.

List updated 14/08/2017 9:34 a.m.

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PROJECT TABLE

Primary Supervisor Project # Project Title

Dr. Rob Griffiths 17-45 Occupational Medicine Project

Dr. William Taylor 17-46 Recognition of work disability amongst patients attending hospital rheumatology clinics

Dr. Brian Corley 17-47 Chages in Resting Energy Expenditure with Different Schedules of Caloric Restriction: The CREEDS Study

Dr. Stephen Inns 17-49 The effect of the gastrointestinal microflora on diabetes

Prof. Sarah Romans 17-50 Bariatric surgery in the Seriously Mentally Ill

Dr. Patricia Whitfield 17-52 Preventing the Progression from Pre-Diabetes to Type 2 Diabetes in New Zealanders

Dr. Richard Carroll 17-54 Comparison of outcomes with differing follow up strategies in the management of Graves' disease: A retrospective observational study.

Dr. Richard Carroll 17-55 A pilot study to assess the feasibility of a regional familial endocrinopathy registry

Dr. Rosemary Hall 17-56 Management of osteoporosis with upper limb osteoporotic fractures

Dr. Rosemary Hall 17-57 Diabetes in pregnancy effects on subsequent generations

Dr. Carol Johnson 17-58 10 yr Audit of Adjuvant Vaginal Vault Brachytherapy

Dr. Mickey Fan 17-59 Cold exposure and energy expenditure

Dr. Mickey Fan 17-60 Cerebral blood flow regulation: understanding the role of pH balance and kidney function on cerebral perfusion

Dr. Nanette Schleich 17-62 Study into the preservation of mouse brains through plastination for use in micro-CT imaging

Prof. Michael Baker 17-63 Health hazards: Perception and reality

Dr. Tim Blackmore 17-64 Testing Patterns in Primary Care for the Diagnosis of Urinary Tract Infection

Dr. Lynn McBain 17-65 Early Learnings from Health Care Homes in CCDHB region

Prof. Mark Stringer 17-66 Heterotopic gastric mucosa in oesophageal atresia

Dr. Max Berry 17-67 Preserving life and limb: large animal models of critical care interventions

Dr. Max Berry 17-68 Effect of early life environment on maternal-pup interactions

Dr. Max Berry 17-69 Size matters: experimentally induced fetal growth restriction in guinea pigs

Prof. Sue Pullon 17-70 Dispelling common nutritional myths

Prof. Sue Pullon 17-71 Pick the winners – predicting lifestyle change success

Dr John Wyeth 17-73 Equity of access for exceptional circumstances (NPPA) applications

Dr. Lynn McBain 17-74 Evaluation of progress in Choosing Wisely in CCH DHB

Dr. Lynn McBain 17-75 Evaluation of progress in Choosing Wisely in Hutt Valley Health DHB

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project reference ###111777---444555***

Project Title:

17-45 Occupational Medicine Project

Primary Supervisor Dr. Rob Griffiths Email [email protected] Funding: Yes, Australia and NZ Society of Occupational Medicine Ethics Required, To be determined

Project Description:

AIM The successful student and supervisor will negotiate a project researching a current topic in

occupational medicine practice. The intention would be to survey a group of workers, employers or health professionals on an occupational medicine research question.

METHOD To email a survey using an employer or professional body intranet/or internet email system, following an appropriate structured review of the literature.

SIGNIFICANCE The research question should address a current concern, and will be approved by the Summer Studentship sponsor, the Australia and NZ Society of Occupational Medicine. The successful student will present the project at the 2018 ANZSOM NZ conference.

STUDENT ROLE The student will conduct the literature review, design the survey, analyse results, and discuss the findings.

EXPOSURE TO

SCIENTIFIC METHOD

Survey questionnaire design, and quantitative analysis

STUDENT

PREREQUISITES

Medical student

mailto:[email protected]

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project reference ###111777---444666

Project Title:

17-46 Recognition of work disability amongst patients attending hospital rheumatology clinics

Primary Supervisor Dr. William Taylor Email [email protected] Funding: The Research Office is still seeking funding opportunies for this project Ethics Ethics Required,to be determined once funding is secured


AIM The objective of this project is to determine the prevalence of work disability among consecutive

patients of working age attending the rheumatology clinics in the Wellington region, and to determine the knowledge of the rheumatology clinical staff regarding their patients’ occupation and work status.

METHOD Study design: A cohort study of patients of working age attending rheumatology clinics in the Wellington region. Patients: Consecutive patients attending any of the clinics operated by the Wellington Regional Rheumatology Unit between Jan 2017 to Mar 2017 (3 months) of working age (18 to 65 years) are eligible. The clinics include consultant, registrar and nurse clinics. There will be approximately 1500 patient appointments during this period among 7 consultants, 1 registrar and 4 nurses. It is not known what proportion of these patients are of working age. Data collection: eligible patients will receive a postal invitation to participate in a paper or web-based survey. The data to be collected from patient self-report includes identifying information in order to match patient responses with the health professional responses (see below). The questions consist of working status, occupation, current social benefit receipt and a global presenteeism question for patients in employment (item 5 of the Work Productivity and Activity Impairment questionnaire). A list of patients will be prepared for the most recently visited health professional, who will be asked to answer 3 questions about each of their patients – working status, occupation and whether receiving the Supported Living Payment. Reference to the healthcare record is allowed but directly asking the patient is not permitted. Demographic and disease details will be abstracted from the electronic health record. Analysis: the frequency of different categories of work status, benefit status, occupational category and the distribution of global presenteesim scores will be tabulated for each disease diagnostic group. The extent to which there is agreement between clinicians and patients assessment of occupation, work status and SLP receipt shall be calculated by absolute percentage agreement, and whether the agreement is different between different clinicians assessed using logistic regression.

SIGNIFICANCE Musculoskeletal disorders are the second most common reason for the Supported Living Payment (SLP, previously the Invalids’ Benefit) in New Zealand and historically, people with inflammatory arthritis have high rates of work disability. However, with better treatment regimes, it is possible that work disability has become less prevalent in this population. Anecdotally, most patients of working age attending rheumatology clinics in the Wellington region are in paid employment and requests for disability certification are uncommon. But it is not clear whether work disability is uncommon or merely under recognised by clinicians.

STUDENT ROLE Prepare study documents, perform patient survey, perform clinician survey, enter data, perform data analysis under supervision, prepare lay summary and inform patient participants of the results.

EXPOSURE TO

SCIENTIFIC METHOD

Survey methods, data management, simple statistical analysis.

STUDENT

PREREQUISITES

Any student


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Project Title:

17-47 Chages in Resting Energy Expenditure with Different Schedules of Caloric Restriction: The CREEDS Study

Primary Supervisor Dr. Brian Corley Email [email protected] Co-Supervisors Dr Rosemary Hall, Assoc Prof Jeremy Krebs Funding:

The Research Office is still seeking funding opportunies for this project

Ethics Ethics Required,to be determined once funding is secured


AIM To determine if the schedule of two calorie restricted diets, daily continuous restriction versus

intermittent very low calorie diet, influences the acute metabolic responses to a hypocaloric diet.

METHOD This is a prospective randomised controlled study of intermittent very low calorie diet in individuals exposed to an intermittent very low calorie diet (30%) 2 days per week compared with daily caloric restriction (80%) over a 6-week intervention period. The study will be conducted in a cohort of 36 non-smoking obese adult men in the Wellington region.

SIGNIFICANCE The prevalence of obesity and its complications have reached epidemic proportions in New Zealand. In 2015/2016, 31.6% of all individuals over the age of 15 years were obese, compared to 26.5% only 5 years previously, while 66.8% of all individuals were classed as either overweight or obese. Sadly, many efforts to induce & maintain weight loss have proved disappointing, reflecting our incomplete understanding of the physiology of weight loss in the obese. The CREEDS study will add to our understanding of what works to reverse established weight gain by continuing to refine our understanding of energy balance and weight loss interventions in the obese. In addition, the methods used for approaching energy expenditure analysis in this study are expected to have implications for other research domains that require accurate & novel analysis of resting energy expenditure measurements.

STUDENT ROLE The student will assist the primary researchers with measurements of energy expenditure using indirect calorimetry, phlebotomy, body composition scanning (observation due to licensing requirements), data entry, administration of validated questionnaires, data cleaning & data analysis, calibration of study devices. With the exception of DEXA scanning the student will be expected by the end of the studentship to be performing all measurements and procedures independently

EXPOSURE TO

SCIENTIFIC METHOD

The student will be involved in measurements of energy expenditure using indirect calorimetry, phlebotomy, body composition scanning (observation due to licensing requirements), data entry, administration of validated questionnaires, data cleaning & data analysis, calibration of study devices. The study is currently running but the summer studentship will coincide with the last few study visits and allow the students to be involved in conduct of the study visits as well as data analysis and interpretation. This will maximize the student’s exposure to different aspects of the scientific method in the context of a program that is already up and running.

STUDENT

PREREQUISITES

Medical Student or Science Student


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Project Title:

17-49 The effect of the gastrointestinal microflora on diabetes

Primary Supervisor Dr. Stephen Inns Email [email protected] Co-Supervisors Dr. Rosemary Hall Funding: The Research Office is still seeking funding opportunies for this project Ethics Ethics Required,to be determined once funding is secured


AIM The aims of this study are to: 1) estimate the proportion of patients with pre-diabetes and type

2 diabetes who have Helicobacter pylori and 2) measure the medication tolerability, gastrointestinal symptomatology and diabetes control in H. pylori infected vs. uninfected patients with pre-diabetes and T2DM.

METHOD This case control study will compare patients with known T2DM with age, gender and ethnicity matched control subjects for the presence of H pylori colonisation, gastrointestinal symptoms, and faecal microbiota. Subjects will complete questionnaires regarding past and current medical comorbidities, gastrointestinal symptomatology and, in the case group, complications of T2DM and its management. All subjects will supply blood and stool samples for diagnostic testing for T2DM and H pylori colonisation as well as T2DM control and faecal microbial composition.

SIGNIFICANCE Both T2DM and H. pylori are significant public health issues in New Zealand, particularly in Maori and Pacific people. Identifying an association between the presence of H. pylori and T2DM could inform public health strategies to identify and treat H. pylori in specific ethnic groups in New Zealand. Timely treatment of H. pylori may lead to improved diabetes control, with subsequent reductions in morbidity and financial cost of diabetes related complications. Moreover, clarifying this modifiable risk factor could lead to greater understanding of the disproportionately high rates of diabetes in Maori and Pacific people and identify methods to reduce inequalities. Overall the findings of this study will have significant public health implications and influence future service planning for patients with diabetes. This study is funded by the Health Research Council and would be appropriate for ongoing involvement for a student interested in continuing to Masters or BMedSci in 2018.

STUDENT ROLE The successful applicant would be responsible for all aspects of the study including patient recruitment, sample collection, processing and data collection. They will work with the direct support of the study research assistant and under the direct supervision of Drs Inns and Hall.

EXPOSURE TO

SCIENTIFIC METHOD

Patient recruitment Sample collection Sample processing Clinical questionnaire administration Data collection

STUDENT

PREREQUISITES

Medical student or other student interested and experienced in clinical research


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Project Title:

17-50 Bariatric surgery in the Seriously Mentally Ill

Primary Supervisor Prof. Sarah Romans Email [email protected] Co-Supervisors Dr. Susanna Every-Palmer, Dr. Mark Huthwaite Funding: The Research Office is still seeking funding opportunies for this project Ethics Ethics Required,to be determined once funding is secured


AIM To identify how many patients in an inpatient psychiatric hospital setting, identified as being

moderately to severely obese meet internationally accepted criteria for bariatric surgery (BS) and to enquire from a sub sample of this group what they know about BS and what their attitude to BS is?

METHOD This project will utilize a mixed methodology of qualitative and quantitative data collection, including a literature review, a retrospective audit of patient files, and a structured interview interviews of patients. A review of relevant literature and policy will be conducted to explore the evidence for the efficacy and acceptability of BS in patients with severe mental illness. The audit will be retrospective examination of the clinical records of people in a forensic and rehabilitation inpatient psychiatric service to identify those meeting the criteria for bariatric surgery. Semi structured interviews will be conducted with a sub group of these patients to find out their views on this form of intervention; interviews are neccessary as many have low literacy. A thematic analysis of these interviews will be conducted and key themes identified. Links will be made to relevant literature, and best practice both locally and internationally to develop recommendations for improving the health outcomes for people with severe mental illness who have the additional health burden of obesity.

SIGNIFICANCE Patients admitted to forensic and rehabilitation inpatient facilities are commonly those with the high mental health morbidity, many of whom carry the additional health burden of obesity. Obesity is causally associated with numerous disease states and premature mortality in people with psychiatric disorder. Dieting and exercise, the conventional approaches to weight loss have been shown to be of little value as an intervention for moderate to severe obesity. People with severe mental illness are a significantly disadvantaged group with low levels of health literacy, whose physical health needs are often overlooked or not advocated for. BS has been shown to be highly effective for patients without mental illness with moderate to severe obesity. The following criteria internationally regarded as eligibility criteria for surgery: a Body Mass Index (BMI) of above 40 kg/m2 or a BMI of 35 kg/m2 with comorbidities ( type 2 diabetes mellitus, hypertension, obstructive sleep apnoea and or knee osteoarthritis) and BS should not be overlooked in this often stigmatised and discriminated against group of people. Findings from this research will highlight a specific area of health need in patients with severe mental illness who are obese and will explore an important aspect of health literacy in patients carrying the additional health burden of obesity. Furthermore, it may identify areas for future research and policy development in this area. It builds on previous work carried about the the supervisors in the same clinical group.


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STUDENT ROLE S/he will: 1. search the literature on acceptibility and efficacy of this interviews for obesity in people

with serious mental illness and collate the findings 2. help construct a semistructured interview schedule to assess knowledge and attitudes to

bariatric surgery 3. conduct these interviews with 80-100 inpatients 4. undertake simple univariate statistics for frequencies and means of the variables

EXPOSURE TO

SCIENTIFIC METHOD

1. literature management skills 2. interview schedule construction 3. experience conducting semistructured interviews 4. data management (cleaning, recording, simple frequency statistical analyses

STUDENT

PREREQUISITES

Medical student with library search and interviewing skills preferred

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Project Title:

17-52 Preventing the Progression from Pre-Diabetes to Type 2 Diabetes in New Zealanders

Primary Supervisor Dr. Patricia Whitfield Email [email protected] Co-Supervisors AP Jeremy Krebs; Dr Rosemary Hall Funding:

The Research Office is still seeking funding opportunies for this project



AIM Why is it that Pacific, Maori and South Asian New Zealanders have similarly high rates of type 2

diabetes (T2DM), which are significantly higher than European New Zealanders, and yet have very different body composition? This research aims to explore whether there are fundamental physiological differences between people with different proportions of fat and lean mass at high risk of T2DM and whether they respond differently to interventions proven to reduce T2DM that specifically target either weight loss or increasing lean body mass.

METHOD This is a prospective cohort study of adult men with pre-diabetes or early Type 2 diabetes individuals with pre-diabetes or early Type 2 diabetes who identify as being NZ European, NZ Maori, Pacific or South Asian. After baseline physiological assessments of glucose metabolism (hyperinsulinaemic euglycaemic clamp; stable isotope dilution) body composition (DXA scanning) and energy expenditure (hood and room Calorimetry) participants will undergo a dietary weight loss intervention until 10% weight loss has been achieved. Participants will then repeat the measurements of glucose metabolism, body composition and energy expenditure. After follow-up testing, a subset of participants will undergo a gym-based exercise intervention as a feasibility assessment for future research.

SIGNIFICANCE Preventing the progression of pre-diabetes to T2DM has been listed as a major health priority for New Zealand. The proposed study aims to understand differences in glucose metabolism amongst individuals of different body composition, and different ethnicity, and aims to identify whether these individuals respond differently to a dietary intervention. Having a better ability to individualise treatment has the potential to enhance the wellbeing of those with prediabetes by reducing the risk of progressing to T2DM. Maori and Pacific people have disproportionately high rates of pre-diabetes (30.4% and 29.8% respectively) and T2DM (14.2% and 11.6% respectively). This research specifica lly recognises the disparities in rates of T2DM for Pacific, South Asian and Maori and seeks to not only understand the basis of this, but identify ways to individualise treatment for those with pre -diabetes to prevent them developing T2DM. Therefore we aim to improve health outcomes for these ethnic groups, directly reducing health inequalities. With 25% of NZs population having pre-diabetes, with many being identified through the successful cardiovascular risk assessment program in primary care, this research will directly inform the delivery of care to these individuals. Understanding who will best respond to dietary weight loss will enable primary care teams to be more targeted in their approach to diabetes prevention in their populations.


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STUDENT ROLE This is an active clinical diabetes research trial being run out of the University of Otago, Wellington Campus. The study is being led by a team of endocrinologist researchers. The role of the successful summer studentship applicant will be to be fully immersed in all aspects of this research trial, becoming one of the researchers. The student will be exposed to many aspects of clinical research and will be able to assist with qualitative and quantitative data collection (including during gold-standard diabetes research techniques); patient monitoring; practical skills (eg phlebotomy); laboratory skills and data management. They will also have the opportunity to analyse a component of the study data.

EXPOSURE TO

SCIENTIFIC METHOD

The successful applicant will be fully immersed in all aspects of the actively running clinical trial and will have exposure to data collection, management and analysis. They will be exposed to scientific method both through observation of the clinical researchers as well as through taking ownership over their own subset of the data. They will receive support and teaching in how to collect and analyse data appropriately. The specific scientific techniques involved in the research study will include physiological testing (hyperinsulinaemic euglycaemic clamp techniques; stable isotope dilution techniques) to assess hepatic and peripheral insulin resistance, as well as DXA scanning (to assess body composition) and indirect calorimetry (to assess energy expenditure).

STUDENT

PREREQUISITES

Medical student

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Project Title:

17-54 Comparison of outcomes with differing follow up strategies in the management of Graves' disease: A retrospective observational study.

Primary Supervisor Dr. Richard Carroll Email [email protected] Co-Supervisors Rosemary Hall, Jeremy Krebs, Alana Gould Funding: The Research Office is still seeking funding opportunies for this project


AIM To assess clinical outcomes using differing follow up strategies in the management of Graves'

disease (thyrotoxicosis).

METHOD All patients referred to the Endocrinology department, Wellington regional hospital, for the management of Graves' disease over a period of 2 years prior to this study will be identified. Records will be examined to collect information on presenting thyroid biochemistry, prescribed thyroid medications, the frequency of follow up blood testing and clinic visits. Patients will be stratified into those who received regular physical follow up within our department, those who maintained regular remote contact with our endocrine nurse, and those who were discharged rapidly back to their GP with advice regarding follow up. Outcomes with respect to time to resolution of thyrotoxicosis, adherence to recommended surveillance blood monitoring, and frequency of thyrotoxic relapse within the defined study will be compared between these groups.

SIGNIFICANCE At present there is no gold standard approach to the ongoing follow up of patients diagnosed with Graves' disease. In our department practice varies from regular clinic follow ups to early discharge to primary care with management advice, reflective of this. Evidence to support better clinical outcomes with one management approach would have a significant impact on clinical practice within ours and other endocrine departments.

STUDENT ROLE The student will be involved in all components of this project, including identification of appropriate patients, data collection, and data analysis. It is expected that the study results will be published or presented at an appropriate conference.

EXPOSURE TO

SCIENTIFIC METHOD

Identifying appropriate study participants, data collection and database entry. Basic quantitative analysis.

STUDENT

PREREQUISITES

Medical student preferably with an interest in endocrinology or internal medicine


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Project Title:

17-5 A pilot study to assess the feasibility of a regional familial endocrinopathy registry

Primary Supervisor Dr. Richard Carroll Email [email protected] Co-Supervisors Alana Gould (Endocrine Nurse Specialist) Funding: The Research Office is still seeking funding opportunies for this project Funding: The Research Office is still seeking funding opportunies for this project


AIM To assess the feasibility of a 3DHB/Central NZ region registry for patients and families with

famial endocrine tumour syndromes.

METHOD Increasingly, a predisposing germline mutation is suspected or identified in patients who develop an endocrine tumour. This mutation may predispose to tumours within one endocrine gland (isolated pituitary or parathyroid tumour syndromes, or more typically predispose to a syndrome of endocrine and none endocrine manifestations (MEN1-MEN4, Phaeochromocytoma-paraganglioma syndromes, etc). There are no data in New Zealand to indicate the frequency of these genetic mutations within our population, or the likelihood of any underlying germline mutation in those who present with established disease. The scope of this registry project is currently under discussion with interested parties and it is likely the project will evolve prior to the student commencing the summer studentship. Ethical approval for the agreed project will be sought in advance of the studentship. This project would establish the feasibility of a regional registry collecting data on patients and their families with confirmed germline mutations, along with data on those patients who are referred for genetic testing based on clinical suspicion. The project will assess practical aspects around the creation of such a registry with respect to identification of appropriate cases and collection of relevant data. Patients domiciled within the 3DHB or Central NZ region (depending on initial numbers identified) with confirmed or clinically diagnosed germline endocrine tumour syndromes will be identified. Relevant demographic, genetic, clinical, biochemical, radiological, and interventional data will be extracted from medical records.

SIGNIFICANCE If creation of a regional registry is feasible and practical, this will be extended to a national registry which would potentially have a number of significant implications for clinical management and research in this field:

As above, there are no data indicating the prevalence of germline endocrine tumour mutations in NZ. Work around this registry would therefore allow improved guidance on the appropriate use of genetics testing in those who present with established disease, and more appropriate resourcing of required management approaches.

Many syndromes display a specific genotype-phenotype relationship, and data on this in the NZ population would help to inform biochemical and radiological surveillance programs. Alternatively, the phenotype of some mutations known to be present within the NZ population is only poorly understood presently; increased knowledge would aid the development of appropriate surveillance programs.

The current management of patients and families with confirmed germline mutations differs significantly throughout NZ despite available clinical guidelines for many mutations. It is likely that a registry identifying these families will facilitate the standardization of clinical practice throughout NZ as has been observed with similar registries in other fields. Indeed this will be an active goal of the project.<br />• This registry would greatly facilitate research within the field. As an example, patients with MEN1 frequently develop pancreatic neuroendocrine tumours which are generally low grade and indolent. Those that are perceived to have a higher risk of malignancy are generally removed, although this may be associated with significant morbidity. Identification of additional factors that may help differentiate between tumours that are


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SIGNIFICANCE This registry would greatly facilitate research within the field. As an example, patients with MEN1 frequently develop pancreatic neuroendocrine tumours which are generally low grade and indolent. Those that are perceived to have a higher risk of malignancy are generally removed, although this may be associated with significant morbidity. Identification of additional factors that may help differentiate between tumours that are likely to be clinically significant and those that are unlikely to cause concern throughout life would greatly improve clinical management and establishment of this registry would greatly aid research like this.

STUDENT ROLE The student will be involved in all aspects of this initial phase of data collection. It is expected that the study could present outcomes of this project at relevant meetings, and would likely be invited to participate in the national Endocrine Society conference later in 2018 to present on this.

EXPOSURE TO

SCIENTIFIC METHOD

Data collection, registry management.

STUDENT

PREREQUISITES

Medical student with an interest in endocrinology, genetics, epidemiology, clinical research

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Project Title:

17-56 Management of osteoporosis with upper limb osteoporotic fractures

Primary Supervisor Dr. Rosemary Hall Email [email protected] Co-Supervisors Dr. John Wilson Funding: The Research Office is still seeking funding opportunies for this project


AIM To investigate the pre-fracture and post-fracture osteoporosis management of forearm and head of

humerous fractures at CCDHB.

METHOD Patients will be identified by searching Orthopaedic Fracture Clinic records. All forearm and humeral head fractures in patients greater than 50 years of age will be included. Patients will be excluded if fractures were part of a major trauma or pathological fractures from any cause. Data will be obtained by searching Concerto and Primary Care ‘Shared Care’ records. We plan to identify pre-fracture factors such as medical treatment (eg Vitamin D, Biphosphonates) previous fractures and previous bone density scan. Post-fracture factors investigated will include medical treatment (eg Vitamin D, Biphosphonates), subsequent bone density scan, hospital admission and length of stay, and independent living after a fracture. The primary outcome measure will be the proportion of patients commenced on an appropriate medical treatment regimen for their osteoporotic fracture (primarily bisphosphonates). Secondary outcomes will include analyses of post-fracture factors and pre-fracture factors as above.

SIGNIFICANCE Forearm and humeral head fractures are common osteoporotic fractures in the older population. Most do not require admission to hospital so subsequently knowledge about outcomes is scarce, particularly when compared to fractures such as hip fractures which always require a hospital admission. Forearm fractures may be the first osteoporotic fracture and an indicator for increased risk of future fractures. Timely and effective fracture prevention strategies are therefore essential, yet are often not implemented if the fracture is deemed to be minor. Complicating the management of osteoporotic fractures in the CCDHB region is the lack of publicly funded bone density scanning. As one of the few DHBs in New Zealand without this service there is the potential that osteoporosis diagnoses are not occurring in a timely manner and access to appropriate medication, which requires a Special Authority based on bone density criteria, is not available. Therefore we hope to obtain a comprehensive overview on the current management of an important and common fracture in our older population and identify areas for improvement. Additionally we wish to explore the appropriate role of bone density scanning in this population. We aim to present our findings at local and national meetings and submit our results for publication.

STUDENT ROLE The student will perform the audit, identify appropriate patients and search patient notes. The student will develop an appropriate database in which to enter the data and extract data for analysis. Statistical analysis will be performed with assistance from statisticians. The student will have the opportunity to be an author on any manuscript generated from this study and to present at local and national meetings.

EXPOSURE TO

SCIENTIFIC METHOD

The student will perform a literature review to identify current guidelines for managing these patients. The student will have the opportunity to develop and manage a database and perform statistical analysis on the data.

STUDENT

PREREQUISITES

Medical Student


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Project Title:

17-57 Diabetes in pregnancy effects on subsequent generations

Primary Supervisor Dr. Rosemary Hall Email [email protected] Funding: The Research Office is still seeking funding opportunies for this project Ethics Ethics Required,to be determined once funding is secured


AIM To identify the metabolic outcomes in women and their offspring up to 35 years after diabetes in

pregnancy.

METHOD Records will be searched for women who attended the diabetes in pregnancy clinics between 1981 and 2002. Healthcare records on Concerto, Wellington Southern Community Laboratories and Shared Care records in Primary Care will be used to identify whether women have developed diabetes or have died. If women have died we will attempt to find a cause of death. We will compare these data to rates of diabetes and mortality in women who did not have diabetes in pregnancy. Additionally we will explore the metabolic outcomes of the offspring of women who attended for formal assessments, and to identify the best strategies to engage families in assessments of metabolic risk.

SIGNIFICANCE Diabetes in pregnancy (DIP) is associated with adverse maternal and foetal outcomes and increasingly evidence suggests the intrauterine environment contributes to subsequent metabolic disease in the offspring. A multi-disciplinary diabetes in pregnancy clinic, established at Wellington hospital in the 1970’s, collected detailed data on 1080 women who attended between 1981 and 2002. We have recently been undertaking a feasibility study to contact women who were pregnant in the early 1980’s and 2002 and assess their metabolic risk and the risk of their offspring. In addition to a proportion of families attending for formal assessments, we have identified those women from the original database who have developed diabetes or who have died. In this smaller population the current rates of diabetes are much higher than suggested internationally, with potential significant implications for national rates of diabetes and disease burden later in life. We would like to explore in detail the whole group of 1080 women, specifically identifying outcomes for Maori and Pacific women, and compare these data to a group of women who delivered babies at Wellington Hospital during the same time period but did not have diabetes in pregnancy. Identification of better estimates of risk, particularly for Maori and Pacific women, will allow for targeted interventions to reduce the poor outcomes for those groups where disparity in healthcare exists.

STUDENT ROLE The student will search records of all women in the DIP database and in the control group and use as many strategies as necessary to identify outcomes in these women. Involvement in analysis and interpretation of data from the recent feasibility study will also occur. Statistical analysis will be performed with assistance from statisticians. The student will have the opportunity to be an author on any manuscript generated from this study and to present at local and national meetings.

EXPOSURE TO

SCIENTIFIC METHOD

The student will gain experience in searching medical records and interpreting laboratory results and coded medical diagnoses. The student will be involved in managing a relatively large data set and performing statistical analysis on these data to answer specific clinical questions.

STUDENT

PREREQUISITES

Medical Student


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Project Title:

17-58 10 yr Audit of Adjuvant Vaginal Vault Brachytherapy

Primary Supervisor Dr. Carol Johnson Email [email protected] Co-Supervisors Dr. Javier Stroud Funding: Waiting funding confirmation from the Cancer Society of New Zealand [Wellington Division]



AIM Wellington Hospital provides brachytherapy services to the lower half of the North Island. We have

over 10 years’ experience of treating patients with High Dose Rate brachytherapy (HDR) and have treated approximately 180 patients with vaginal vault brachytherapy. Some patients have been followed up locally with prospective data collection but many will have been followed up at other centres. The aim of this audit is to report on two cohorts – those treated with HDR as sole adjuvant therapy and those who have in addition had adjuvant external beam radiation. The audit will focus on local control and toxicity with other end-points including overall survival, cancer specific survival, disease free survival, patterns of relapse. A second component to the study will look at applicator choice - the dose deliverable by the 2 different types of applicators to the target and the stand-off to the vaginal mucosa.

METHOD A letter/audit form will be sent out to GPs/gynaecologists/relevant clinicians to collect data (prior to commencement of studentship) to supplement data held within CCDHB records. Tumour control and toxicity outcome data will be determined and reported against international benchmarks. The vaginal mucosa will be contoured and dose to surface calculated and absolute maximum stand-off measured. Those patients scanned with both applicator options will have comparative reports.

SIGNIFICANCE This will be the first audit of this service component. As a regional service we have a responsibility to our referring DHBs to report on the outcomes – always a balance of efficacy and toxicity – and to inform our patients referred to our service. There is a choice of applicators but the planning complexity is greater with one (ovoids) than the other (cylinder). The study will assess the difference in coverage achieved for those using the more complex applicator treatment (ovoids) and describe the frequency of applicators used for equipment replacement planning.

STUDENT ROLE The student will complete a database entering data from paper prospective data, clinical letters on Concerto and from retrospective audit forms. The student will determine the outcomes with respect to tumour control and toxicity. The student will identify the target vaginal mucosa (for the planner to calculate dose) and measure the stand-off from mucosa to applicator. The student will identify to what extent dose delivery is improved by using ovoids and determine the frequency ovoids may be selected over cylinders.

EXPOSURE TO

SCIENTIFIC METHOD

Retrospective audit.

Various end-points both tumour control and toxicity.

Use of both volumetric and single measurement comparisons.

STUDENT

PREREQUISITES

Preference given to medical student in clinical years. Must have ability to set up and query database.


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Project Title:

17-59 Cold exposure and energy expenditure

Primary Supervisor Dr. Mickey Fan Email [email protected] Funding: Waiting funding confirmation from the Surgical Research Trust Ethics Ethics Required,to be determined once funding is secured


AIM To determine the body’s metabolic response to environment cold

METHOD Using NZ’s only environmental and calorimetry suite at the Centre for Translational Physiology, we will assess the changes in metabolism during acute exposure to environmental cold. In an effort to replicate a standard day for office workers, metabolic rate will be assessed using whole-room calorimetry during an 8-hour mild cold exposure (17C).

SIGNIFICANCE Obesity is the result of a positive energy balance due to a mismatch between energy intake and expenditure. Despite efforts to improve our diet and lifestyle, obesity remains a worsening global problem. Elevating resting metabolism is an untapped avenue for combating the rising prevalence of obesity worldwide. By assessing dynamic metabolic changes during cold exposure, this study aims to identify the pathways responsible for elevating resting metabolism. Findings from this study could constitute novel targets for energy balance management.

STUDENT ROLE Successful candidate will be involved in participant recruitment and assist in experimental testing and data analysis.

EXPOSURE TO

SCIENTIFIC METHOD

The project will expose the student to a wide range of cutting edge experimental techniques used in integrative physiological research such as whole-room calorimetry and neuroimaging.

STUDENT

PREREQUISITES

Any student


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Project Title:

17-60 Cerebral blood flow regulation: understanding the role of pH balance and kidney function on cerebral perfusion

Primary Supervisor Dr. Mickey Fan Email [email protected] Funding: The successful student will work with the Research Office to complete the Neurological Foundation Summer

Studentship Scholarship application DUE 1 September 2017 Ethics Ethics Required,to be determined once funding is secured


AIM To determine the role of the pH regulation in cerebral blood flow regulation, and the

development of acute mountain sickness.

METHOD Our research utilizes integrative physiological approach to assess how the cerebral blood flow is maintained during prolonged exposure to environmental hypoxia. Using a diverse range of research techniques, we will examine how regulation of fluid and pH balance by the kidneys can alter perfusion to our brain, and how these changes might lead to the development of acute mountain sickness. In addition, we will assess how prolonged high altitude exposure affect oxygen levels in the brain, and how this might impair our cognitive functions.

SIGNIFICANCE Insights gained from this study will lay the foundation for novel diagnostic tools for assessing an individual’s susceptible to AMS. By gaining a better understanding of its development, we hope to develop new strategies for AMS prevention and management.

STUDENT ROLE Performing experimentation, data processing and analysis.

EXPOSURE TO

SCIENTIFIC METHOD

At the Centre for Translational Physiology in Wellington, we have built a unique environmental suite which allow us to manipulate the oxygen content, temperature and humidity in a laboratory setting. Using this state-of-the-art facility, we conduct several studies in the fields of environmental physiology, metabolism and sports science. As a part of our research team, you will gain invaluable insight and experience in human physiological research.

STUDENT

PREREQUISITES

Any student


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Project Title:

17-62 Study into the preservation of mouse brains through plastination for use in micro-CT imaging

Primary Supervisor Dr. Nanette Schleich Email [email protected] Co-Supervisors A/Prof Niels Hammer Funding:

The Research Office is still seeking funding opportunies for this project Ethics Ethics Required,to be determined once funding is secured


AIM This proposal aims at studying different tissue conservation methods (plastination) for their

suitability for mouse brain micro computed tomography (CT). The study is part of a larger research project on spectral CT and monoenergetic synchrotron CT imaging for pre-clinical research into brain cancer treatments. In particular, the aims for this summer student project are:

• to test (and modify if necessary) a custom-built sample holder for the SkyScan micro-CT scanner;

• to image existing plastinated samples with conventional micro-CT and analyse the results; • to plastinate several samples over the Christmas / New Year holiday period; • to image the newly plastinated samples with micro-CT, analyse the results and assess the

suitability of the plastination technique; • to evaluate the results in the context of existing spectral CT and synchrotron CT scans.

There may be an opportunity to also perform scans with spectral CT in Christchurch (TBD).

METHOD The plastination of tissues consists of several steps – fixation, dehydration, vacuum impregnation, and curing – which can be performed with different solvents and polymers. Preservation ideally retains the properties of the original sample, but depending on the choice and combination of plastination agents, the results will vary in properties such as deformability and solubility, and the original tissue may have undergone shrinkage. Of relevance for spectral and monoenergetic CT imaging are in particular the photon attenuation properties of the resulting plastinated tissues . The wider research project, of which this study is part of, investigates different combinations of fixation, dehydration and curing techniques. Each technique is tested on a small number of specimens, and the techniques providing the most satisfactory results is further optimised and repeated with the long-term aim to achieve several plastinated mice for the research into spectral and monoenergetic CT imaging of healthy mouse brain. Timeframes for the techniques vary between two weeks to two months for mouse brains and longer for whole mice. For this student project, plastination techniques that can be achieved within 2–3 weeks will be chosen and several specimens prepared in December, to be ready for imaging in January. Plastination work will be performed in the Department of Anatomy, UO Dunedin, with the help of the supervisors and a staff member who is an experienced plastinator. To assess the suitability of each technique, the plastinated specimens will undergo conventional micro-CT scans using a SkyScan 1172 scanner at the Anatomy Department. Previously prepared plastinated mice will be scanned and/or analysed for comparison. A custom-built sample holder for use with the SkyScan will be tested, and if necessary, modified. CT images will be analysed using SkyScan specific software as well as open source image processing software (e.g. ImageJ) and/or Matlab routines.

SIGNIFICANCE This is a study to test different tissue conservation methods (plastination) for their suitability for spectral CT and monoenergetic synchrotron CT imaging of healthy mouse brain. The study is part of a larger research project – Spectral CT and synchrotron CT for pre-clinical research into brain cancer treatments: PI Nanette Schleich – whose purpose is to develop spectral and monoenergetic CT to detect and monitor brain tumours in mice in-vivo non-invasively.


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SIGNIFICANCE Work performed previously using the MARS Spectral CT scanner located at the UO Christchurch campus and the Imaging and Medical Beamline (IMBL) at the Australian Sychrotron, Melbourne, included scans of healthy euthanized mice, either freshly culled or LN2-snap-frozen, to test different imaging protocols for mouse head scans and to develop and test different sample holder solutions to allow for scanning of frozen mice. Whilst imaging freshly euthanized mice has shown good results, and each freshly culled mouse can be used for several scans, this approach is not ideal. With frozen mice and cryogenic sample holders a number of technical difficulties have also been experienced (such as ice accumulation impacting on image quality). Even though new technical solution for keeping frozen mice cooled inside the MARS scanner or on the translation table of the IMBL have been developed, they will not easily allow for repeat scanning of samples with different modalities (not least as shipping of frozen animals between NZ and AU is fearfully expensive). We therefore have in 2016 started to test different plastination techniques for their suitability for monoenergetic and spectral CT imaging of healthy mouse brain, and imaged the first four plastinated mice with conventional micro-CT (Skyscan, Dunedin, Nov 2016), spectral CT (MARS, UOC, Nov/Dec 2016) and synchrotron CT (Beamtime IMBL M11305, Melbourne, Dec 2016, PI Nanette Schleich), respectively. Using plastinated mice will:

• avoid the need for euthanizing a new mouse for each scanning session; • avoid errors and uncertainties introduced into the comparison of scans with different settings

due to culling, mounting, inter-animal variations etc, and thus support more meaningful results;

• ensure direct comparability of scans with different scanner settings as they can be performed on the same plastinated specimen, even if scanned on different days.

The PI has current valid euthanasia approvals at UO Dunedin and UO Christchurch (2016–19). Materials and instrumentation required for this research (including plastination chemicals, mice, scanner time, phantoms, workshop time) are already available and/or have been funded through other grants.

STUDENT ROLE This Summer Studentship Project is expected to be completed within 10 weeks and will complement current research of the supervisors into plastination techniques suitable for spectral and synchrotron CT. The student will be supported throughout the project by the supervisors and staff at the Department of Anatomy (in particular the plastinator). The student will:

• review relevant plastination techniques and the basics of conventional CT versus monoenergetic and spectral CT imaging;

• review mouse plastinations performed to date within the wider project, imaging results and analyses;

EXPOSURE TO

SCIENTIFIC METHOD

The student will be exposed to scientific work including literature review, hypothesis and experimental design, and write-up. The student will learn/revise basics of medical imaging, in particular conventional and spectral/monoenergetic CT, and will be introduced to data reconstruction and analysis in the context of CT and image quality assessment. The student will gain experience with research in the novel field of plastinations and in micro-CT imaging, and undertake experimentation and preparation of research for publication.

STUDENT

PREREQUISITES

The student must be based on the Dunedin campus over summer. There may be an opportunity for a short research trip to use a different CT scanner. The student will ideally have a relevant science background (such as medical physics, bioengineering, physics, chemistry, medical sciences) or a background that includes a suitable science component.

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Project Title:

17-63 Health hazards: Perception and reality

Primary Supervisor Prof. Michael Baker Email [email protected] Co-Supervisors A/Prof Simon Hales Funding: Yes, Otago Research Committee

Ethics Ethics is Required


AIM 1. To describe how the media presents diverse human health hazards (the hazardscape*) to the

population of Wellington. 2. To describe in broad terms how this hazardscape is managed across sectors, along with important gaps, inconsistencies and potential improvements. * The term ‘Hazardscape’ describes “…the net result of both natural and human -made (anthropogenic) hazards and the cumulative risks that they pose across a given geographical area. This includes the interactions among nature, society, and technology at a variety of spatial scales, creating a mosaic of risks that affect places and the people who live there.” (Kelley and Covi. Environmental Health Insights 2013:7 67–69).

METHOD This project will include three stages: 1. The media hazardscape - Media coverage of hazards will be described by conducting a systematic text search of news media report sampled from a year of coverage (from sources such as the Dominion Post Newspaper and Stuff website). The project supervisors will work with the student to develop a standard way of extracting information about media reports of hazards. This will include fields such as the nature of the hazard, its setting, risk of health effects, seriously of these health effects, apparent importance of the hazard, potential for the public to protect themselves, and government agency responsible for managing that hazard. This information will be entered onto a database (Excel) and then analysed. 2. The health protection hazardscape - The student will describe the hazards managed by key agencies in Wellington (local, regional, national Government levels). This process will be based on:

• A search of the websites of the public agencies responsible for hazard management along with key documents and legislation to identify an inventory of the hazards they manage.

• A search of documents produced by these key agencies. • Interviews of key staff to identify their broad approach to assessing and managing

hazards. 3. Synthesis - The student will compare the hazardscape that is being presented to the public with the hazardscape that is being managed by key agencies. This will draw out key themes, as noted under significance (below).


PAGE 22

SIGNIFICANCE This project is testing two important hypotheses: • That the public is exposed, via the media, to a wide hazardscape that might threaten their

health and wellbeing, but without providing them with good ways of ranking the importance of these hazards and managing their risk.

• That the agencies that manage hazards across different sectors use quite diverse ways of

assessing, ranking, and managing hazards that may prevent resources being applied to the most important hazards, thus limiting effective interventions.

The information from this project will be used in two ways:

• To produce a paper that summarises the main findings and suggests ways of improving our management of the human hazardscape at a societal level (potential viewpoint article for NZ Medical Journal).

• As a contribution to the Health Protection paper being taught in the Department of Public Health.

STUDENT ROLE The student will be an active participant in all stages of this project, including: Literature review; Refinement of methods; Extraction of data from a sample of media reports, websites, and documents; Data analysis; and Preparation of a draft paper based on the findings.

EXPOSURE TO

SCIENTIFIC METHOD

This project will exposure the student to a wider set of public health and social science research skills including: Conceptualising a research study; Refining hypotheses; Study design; Design of data extraction tools; Data analysis; Scientific writing; and Preparing work for publication.

STUDENT

PREREQUISITES

Excellent analytical thinking and writing skills.

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Project Title:

17-64 Testing Patterns in Primary Care for the Diagnosis of Urinary Tract Infection

Primary Supervisor Dr. Tim Blackmore Email [email protected] Co-Supervisors Dr. Ayesha Verrall Funding: Yes, CCDHB Infectious Diseases Research Fund Ethics Ethics is Required


AIM To determine patterns of laboratory requests for culture from the community requestors, to

determine population rates across the country. To determine compliance with BPAC and other guidelines and whether the guideline remain appropriate.

METHOD The initial study will to use existing laboratory databases for the Wellington region, Otago and possibly Auckland, to determine patterns and whether there is national consistency. A follow-up questionnaire will be conducted of a random sample of requestors from general practice and long term care facilities to describe testing and treatment decisions.

SIGNIFICANCE Increasing rates of resistance may make current empiric guidelines inappropriate, but it is unclear whether current guidelines are being followed. It is not possible to determine whether the rates of resistance determined from laboratory databases are skewed towards resistant infections without understanding testing behaviour. Choosing Wisely approach EDs for testing and prescribing in UTI need better understanding of current practice.

STUDENT ROLE Student will need good spread-sheeting skills and data manipulation for the first phase. The second phase of determining requesting patterns will require the administration of the questionnaire to requestors. No direct questioning of patients is intended.

EXPOSURE TO

SCIENTIFIC METHOD

statistics, microbiology methods, choosing wisely principles, administering and analysing a survey

STUDENT

PREREQUISITES

medical student


PAGE 24


Project Title:

17-65 Early Learnings from Health Care Homes in CCDHB region

Primary Supervisor Dr. Lynn McBain Email [email protected] Co-Supervisors Mabli Jones - Compass Health Funding: Yes, Compass Health Wellington Funding

Ethics Ethics is Required


AIM To evaluate health care homes against the key aims for the HCH

METHOD Interviews of key stakeholders – practice staff and patients from health care home practices Qualitative data analysis Writing a report

SIGNIFICANCE Based in primary care / general practice Health Care Home is an innovative model of care centred on a patient’s needs. This model has been introduced into New Zealand in the Midlands (Waikato DHB) area and more recently to the CCDHB area. The HCH model has some key features: • Enables patients to access support from their Clinical Team in the most convenient way- same

day appointments, provides extended hours of access and allows patients to have virtual consultations with GPs via phone, or secure messaging. Patients wil l also have access to their clinical information through patient portals.

• Target extra capacity on those with greatest need to proactively plan care- involves multi-disciplinary teams which includes general practice teams, specialists and community nursing teams to support patients, making it a key component of integrated health that will enable DHBs and Primary Care to work in partnership to achieve the best possible outcomes for patients and the wider community.

• Address workforce challenges by developing and expanding the primary care workforce- developing new roles in primary care, Health Care Assistants, Clinical Pharmacists, full scope Nurse Practitioner’s

• Ensure care is integrated around patients and their families - the model results in a more comprehensive and cohesive system of health care that is: proactive, responsive and effective.

• Support business efficiency through the application of LEAN methodologies – enables practices to run at optimum capability.

In the CCDHB area this model stated in 2015 with 7 practices in the first tranche, another 9 practices (tranche 2) are starting the HCH journey from 2017. There has been no evaluation as yet and this project would serve to inform future more comprehensive evaluation including patient outcomes.

STUDENT ROLE Background reading on the HCH model. Assisting with preparation of Interview schedules. Interviews of stakeholders. Qualitative data analysis. Preparing a report.

EXPOSURE TO

SCIENTIFIC METHOD

Semi structured interview skills. Qualitative data analysis. Report writing.

STUDENT

PREREQUISITES

Interested in Primary health care Confident in interviewing Qualitative research skills an advantage – but could be developed Drivers licence and access to a car to be able to travel to interviews an advantage


PAGE 25


Project Title:

17-66 Heterotopic gastric mucosa in oesophageal atresia

Primary Supervisor Prof. Mark Stringer [Honorary Professor of Paediatric Surgery] Email [email protected] Funding: Waiting funding confirmation from Cure Kids


AIM (i) To establish what is known about a rare but potentially serious problem (the presence of

heterotopic gastric mucosa in the oesophagus) affecting patients with oesophageal atresia. (ii) To write a comprehensive literature review suitable for publication in a scientific peer -reviewed journal.

METHOD To retrieve and analyse the literature on heterotopic gastric mucosa in the oesophagus occurring in patients with oesophageal atresia. This will involve a comprehensive literature review and writing a clinical case report.

SIGNIFICANCE Publishing a comprehensive review of the existing literature would inform paediatric surgeons and other clinicians about this rare association with oesophageal atresia and help to guide the clinical management of affected patients.

STUDENT ROLE To undertake a comprehensive literature review on the topic (with guidance), understand the processes involved in a systematic literature review, and the elements of writing a case report. The student is expected, with guidance, to construct a case report with supporting literature review for publication.

EXPOSURE TO

SCIENTIFIC METHOD

Literature retrieval and analysis. Systematic review methodology and its limitations. Scientific writing.

STUDENT

PREREQUISITES

Ability to critically understand scientific literature. A medical student would be ideal but a detailed knowledge of oesophageal atresia is not required.


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Project Title:

17-67 Preserving life and limb: large animal models of critical care interventions

Primary Supervisor Dr. Max Berry Email [email protected] Co-Supervisors Dr Rebecca Dyson Funding: Waiting funding confirmation from the Surgical Research Trust Ethics Ethics Required,to be determined once funding is secured


AIM To review the literature around the use of large animal models to assist with development a nd

retention of surgical and critical care skills. The advantages, limitations and ethical considerations will be explored.

METHOD The student will comprehensively review the literature on the use of animal models in emergency care. In collaboration with the supervisory team, key areas of interest will be identified (e.g., critical airway management, cardiac injury) and developed further. The regulatory, ethical and resource implications of large animal training models will be explored. Their role as an adjunct to other training modalities such as augmented reality, simulation, and didactic clinical training will be explored.

SIGNIFICANCE The development and retention of skills necessary to preserve life and limb in the context of an unexpected acute event are difficult to teach and maintain in routine clinical practice. We have extensive experience of using anaesthetised large animals as a training model for acute care teams (pre-hospital, ED, anaesthesia) to refine these essential skills and develop improved care techniques. It would be very valuable to those working in the field to have an updated review paper describing the benefits / limitations and ethical issues around the use of animal models of this kind.

STUDENT ROLE The students primary role is the preparation of a review paper on the use of large animals as a model for critical care skills training, for which they will be an author. The student will work with clinical-academics, post doctoral researchers, the technical staff of the Biomedical Research Unit and clinicians from acute care disciplines. They will be able to participate in the on-going development and running of courses available to ED physicians and anaesthetists.

EXPOSURE TO

SCIENTIFIC METHOD

The student will be part of an interdisciplinary team that works co-operatively to develop critical care skills training. They will learn about the stringent requirements of biomedical research including the ‘3-Rs’ principals, the process of making an application to the animal ethics committee, and ethical care and treatment of research animals. They will be taught how to use search engines such as PubMed effectively to identify relevant publications and develop skills in literature review including the critical appraisal of medical and educat ional literature. They will be assisted in the preparation of a publication standard manuscript.

STUDENT

PREREQUISITES

Biomedical background


PAGE 27


Project Title:

17-68 Effect of early life environment on maternal-pup interactions

Primary Supervisor Dr. Max Berry Email [email protected] Co-Supervisors Dr Rebecca Dyson Funding: The Research Office is still seeking funding opportunies for this project Ethics Ethics Required,to be determined once funding is secured


AIM To develop the analysis techniques to assess maternal-pup interaction in guinea pigs following

changes in perinatal environment. METHOD Students will review high-definition videos of newborn maternal-pup interaction in guinea pigs

to develop a scoring matrix defining the frequency, type and quality of mother-pup behaviours including grooming, feeding and vocalisation. The differences in maternal-pup interactions between groups will be examined and the findings prepared for publication.

SIGNIFICANCE Events in early life are a major determinant of later health and wellbeing – the DOHaD (Developmental Origins of Health and Disease) paradigm. Mother-offspring interactions in the newborn period can have powerful and pervasive effects on physical (such as blood pressure) and psychological outcomes. We have a number of experimental models that reflect important, clinically relevant, early life perturbation including fetal exposure to maternal drug use, preterm birth and/or operative birth. Understanding how these early life experiences alter maternal-pup interaction is an important foundation step towards being able to improve physical and psychological health in affected offspring.

STUDENT ROLE Tools are already available to assess maternal-offspring interaction in older guinea pigs and in newborn rodents, but not in the newborn guinea pigs. The student will work with our interdisciplinary team of clinical-academics, post-doctoral scientists, animal technician and clinicians to (i) develop a scoring system for the assessment of maternal-pup interactions and (ii) see how they differ between experimental groups. In addition, the student will assist with the preparation of a manuscript describing the findings.

EXPOSURE TO

SCIENTIFIC METHOD

The student will be part of an interdisciplinary team that works co-operatively to understand the mechanisms underpinning the DOHaD phenomenon. They will learn about the stringent requirements of biomedical research including the ‘3-Rs’ principals and ethical care and treatment of research animals. They will be taught how develop and validate new assessment tools and to analyse the results using appropriate statistical software and will be assisted in the preparation of a publication standard manuscript.

STUDENT

PREREQUISITES



PAGE 28


Project Title:

17-69 Size matters: experimentally induced fetal growth restriction in guinea pigs

Primary Supervisor Dr. Max Berry Email [email protected] Co-Supervisors Dr Rebecca Dyson Funding: The Research Office is still seeking funding opportunies for this project Ethics Ethics Required,to be determined once funding is secured


AIM To assess the efficacy of gestation within a hypoxia chamber as a model for induced fetal

growth restriction in guinea pigs.

METHOD Pregnant time-mated guinea pig sows will be transitioned to a hypoxic chamber in early gestation and remain there until 3 days prior to delivery. The impact of maternal hypoxia on fetal and placental growth, pup number, birth weight and postnatal growth will be compared to that achieved in control animals maintained in normoxia.

SIGNIFICANCE Events in early life are a major determinant of later health and wellbeing – the DOHaD (Developmental Origins of Health and Disease) paradigm. Intrauterine growth restriction (IUGR) has profound adverse effects that persist into adult life; amongst others, increased rates of neurodevelopmental impairment, hypertension, diabetes and obesity. Before we can develop novel therapeutic interventions to address these issues we need to reliably induce experimental IUGR that mirrors the same pathophysiological characteristics seen in affected human infants. Maternal hypoxia has been used extensively in sheep and other rodents. However, guinea pigs are physiologically more closely aligned to humans and therefore this translational biomedical model will be a powerful tool for the development of novel, clinically important interventions.

STUDENT ROLE The student would be responsible for assisting with caring for sows exposed to a hypoxic environment. The student will work with our interdisciplinary team of clinical -academics, post-doctoral scientists, animal technicians and clinicians to (i) assess the wellbeing of sows maintained in the hypoxic chamber (ii) assess fetal and postnatal offspring characteristics (including ultrasound measures of fetal growth and wellbeing, DXA measured postnatal body composition, administration and analysis of glucose tolerance tests) and see how they differ between experimental groups. In addition, the student will assist with the preparation of a manuscript describing the findings.

EXPOSURE TO

SCIENTIFIC METHOD

The student will be part of an interdisciplinary team that works co-operatively to understand the mechanisms underpinning the DOHaD phenomenon. They will learn about the stringent requirements of biomedical research including the ‘3-Rs’ principals and ethical care and treatment of research animals. They will be taught how to work with an interdisciplinary team to develop a new biomedical model, to quantify and analyse the outcomes and will be assisted in the preparation of a publication standard manuscript.

STUDENT

PREREQUISITES



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Project Title:

17-70 Dispelling common nutritional myths

Primary Supervisor Information Primary Supervisor Prof. Sue Pullon Email [email protected] Co-Supervisors McHugh P, Smith M Funding: Waiting funding confirmation from RNZCGP (College of GPs)

Ethics Ethics Required


AIM The rising burden of chronic disease has thus far been largely under addressed in NZ and Western

countries, yet it threatens to cripple the health system. There has to be a better approach, and we are doing our part to help with one small piece of the puzzle. How do you dispel nutritional myths? Well, you find out what people believe first. This will involve a combination of qualitative methods and case based scenarios in order to address or dispel common myths held by members of the community, including health care practitioners

METHOD The project will involve a wide scope of learning, including literature review, data collection in the form of interviews with key stakeholders/community members, and data analysis, with emphasis on progressing towards publication. You will collect information from a range of sources on common nutritional advice / beliefs / myths surrounding a plant based diet, and review the evidence in a systematic way, including crafting case reports from available data and reviewing previous research on this.

SIGNIFICANCE In Tairawhiti we run a charitable trust which is delivering a community programme. Our previous research has focused on the use of a plant-based diet for various chronic diseases, mainly obesity. The local team, supported from the Dept PHC&GP at UOW, is composed of Nick Wright, Morgen Smith, Patrick McHugh and Bruce Duncan. You’ll work mostly with Nick and Morgen, but all of us will play a role in supervising you. We run a community programme during the year, and have collected data from this. People love a good story, and as long as this is crafted well, it will present a range of views that will inform the next stages of research by the local team and be very publishable.

STUDENT ROLE As the summer student you would be involved in a wide scope of learning, including li terature review and data analysis, with emphasis on progressing towards publication.You will be collecting the ‘myths’, collate these, research background around these, correct those who are wrong and confirm those who are right. You’ll be crafting the paper, but have a lot of input from the other people in the research team on this.

EXPOSURE TO

SCIENTIFIC METHOD

You’ll be working with a group of healthcare professionals who are working on research, familiar with what will work and what won’t, and how to go about the details. You’ll learn how to take a project from inception to publication - literature and other resources review, develop your interview skills, and undertake data collation and analysis, synthesis and writing the report. We’ll walk you through reviewing scientific evidence, you’ll be able to present your own ideas to us and we can review those, helping you to craft something of scientific rigour and give you more understanding of the science behind research.

STUDENT

PREREQUISITES

This project is open to health professional students. Preferentially, it will be available to students who come from the Tairawhiti region. We envision that the majority of the work will be undertaken in Tairawhiti, with the ability to spend 3-4 days in Wellington for training at the start of the studentship. A similar period may be required at the end of the period.


PAGE 30


Project Title:

17-71 Pick the winners – predicting lifestyle change success

Primary Supervisor Information Primary Supervisor Prof. Sue Pullon Email [email protected] Co-Supervisors Duncan B, Wright N, McHugh P Funding: Waiting funding confirmation from RNZCGP (College of GPs)


AIM If you told someone to change their diet, but they weren’t ready, then you’d have little chance

of success. The use of scarce resources necessitates that we use our public healthcare dollar wisely. So, is there a way to predict later success with a lifestyle change? We want you to begin to answer this big question: what are the factors that are associated with success in a dietary change? This could be anything from personality factors, to age, to financial situation.

METHOD You will undertake a literature (and other publicly available resources) review, including including information from our work to date, which will enable you to begin to collate points of interest. Who was successful, and under what circumstances? You'll get qualitative methods experience in analyzing written documents, synthesising the results and develop your skills in report and publication writing

SIGNIFICANCE The rising burden of chronic disease has thus far been largely under addressed in NZ and Western countries, yet it threatens to cripple the health system. There has to be a better approach, and we are doing our part to help with one small piece of the puzzle. In Tairawhiti, we run a charitable trust which is delivering a community programme. Our previous research has focused on the use of a plant-based diet for various chronic diseases, mainly obesity. This work will help support ongoing research in this important area, in Tairawhiti but also in NZ more generally.

STUDENT ROLE You’ll be working with a group of healthcare professionals who are working on research, familiar with what will work and what won’t, and how to go about the details. The local team, supported but the Dept of PHC&GP at UOW, is composed of Nick Wright, Morgen Smith, Patrick McHugh and Bruce Duncan. You’ll work mostly with Nick and Bruce, but all of us will play a role in supervising you. You’ll learn how to take a project from inception to publication.

EXPOSURE TO

SCIENTIFIC METHOD

You will undertake a literature (and other publicly available resources) review. You'll get qualitative methods experience in analyzing written documents, synthesising the results and develop your skills in report and publication writing.

STUDENT

PREREQUISITES

This project is open to health professional students. Preference will be given to students who come from the Tairawhiti region.The majority of the work will be undertaken in Tairawhiti, with the ability to spend 3-4 days in Wellington for training at the start of the studentship. A similar period may be required at the end of the period.


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Project Title:

17-73 Equity of access for exceptional circumstances (NPPA) applications

Primary Supervisor Information Primary Supervisor Dr John Wyeth Email [email protected] Co-Supervisors Dr Scott Metcalfe Funding:

YES, PHARMAC


AIM To describe and determine access to NPPA by socio-demographic characteristics.

METHOD Review of existing database with non-identifiable patient data of applications which contains information on disease, treatment and other factors. Compare findings to an earlier review of exceptional circumstances applications.

SIGNIFICANCE PHARMAC objective is to obtain best health outcome from available funding. If there is inequitable access to medicines this will compromise health outcomes achieved.

STUDENT ROLE The student will be part of the medical directorate at PHARMAC with support from other directorates in obtaining the data and in analysis.

EXPOSURE TO

SCIENTIFIC METHOD

The project will give experience in working with databases, use of simple statistics and review of published literature. The student will also have the opportunity of working within PHARMAC and learn about funding of pharmaceuticals, critical appraisal of papers, and health economics.

STUDENT

PREREQUISITES

medical student


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Project Title:

17-74 Evaluation of progress in Choosing Wisely in CCH DHB

Primary Supervisor Information Primary Supervisor Dr. Lynn McBain Email [email protected] Co-Supervisors Dr James Entwisle CCDHB Funding: Yes, Council of Medical Colleges


AIM An evaluation of Choosing Wisely initiatives and early information on successes

METHOD 1. Select (along with supervisors) one or two of the Choosing Wisely initiatives to examine in more depth.

2. Interviews with identified champions in the DHB, interview with other staff involved in the initiative.

3. Determining what data would be useful to collect for determining success, and if possible collection of data via clinical audit.

SIGNIFICANCE Choosing Wisely is a global initiative, recently launched in New Zealand. It encourages health professionals to talk with patients about unnecessary tests, treatments and procedures. It is about providing the best quality of care to the patient. Patients are being encouraged to ask four key questions: Do I really need to have this test?; What are the risks; Are there simpler, safer opti ons ? ; What happens if I do nothing? This campaign is being run by the Council of Medical Colleges, working with Consumer New Zealand. At CCDHB there are a number of initiatives underway at various stages in the cycle from initial discussion to established initiatives for change. here a number of projects that the student would be able to choose from that will help patients and clinicians choose wisely. These involve ensuring maximising limited resources including the novel use of IT, giving patient better information in personalised decision making including the use of traditional and novel communication/media

STUDENT ROLE • Background to the initiatives in the DHB - a brief stocktake • Along with supervisors select an initiative to examine in more depth • Interview those in the hospital services who are involved with Choosing Wisely. • Review the initiative and look for types of supporting data to evaluate . • Prepare a report that is able to be used to circulate/ publish to support other Choosing

Wisely programs

EXPOSURE TO

SCIENTIFIC METHOD

• Qualitative research methodology • Clinical audit • Exposure to quantitative data analysis

STUDENT

PREREQUISITES

Be able to undertake semi structured interviews primarily with clinicians, and health managers. Understand the basis of the evidence for various Choosing Wisely initiatives to be able to consider what quantitative data would be required Ability to undertake analysis of the clinical audit


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Project Title:

17-75 Evaluation of progress in Choosing Wisely in Hutt Valley Health DHB

Primary Supervisor Information Primary Supervisor Dr. Lynn McBain Email [email protected] Co-Supervisors Sisira Jayathissa , Greg Evans Hutt Valley DHB Funding:

Yes, Council of Medical Colleges


AIM An evaluation of Choosing Wisely initiatives and early information on successes

METHOD 1. Select (along with supervisors) one or two of the Choosing Wisely initiatives to examine in more depth

2. Interviews with identified champions in the DHB, interview with other staff involved in the initiative.

3. Determining what data would be useful to collect for determining success, and if possible collection of data via clinical audit

SIGNIFICANCE Choosing Wisely is a global initiative, recently launched in New Zealand. It encourages health professionals to talk with patients about unnecessary tests, treatments and procedures. It is about providing the best quality of care to the patient. Patients are being encouraged to ask four key questions: Do I really need to have this test ?; What are the risks; Are there simpler, safer options ? ; What happens if I do nothing ? This campaign is being run by the Council of Medical Colleges, working with Consumer New Zealand. At HV DHB there are a number of initiatives underway at various stages in the cycle from initial discussion to established initiatives for change.

STUDENT ROLE • Background to the initiatives in the DHB - a brief stocktake • Along with supervisors select an initiative to examine in more depth • Interview those in the hospital services who are involved with Choosing Wisely. • Review the initiative and look for types of supporting data to evaluate . • Prepare a report that is able to be used to circulate/ publish to support other Choosing

Wisely programs

EXPOSURE TO

SCIENTIFIC METHOD

• Qualitative research methodology • Clinical audit • Exposure to quantitative data analysis

STUDENT

PREREQUISITES

Be able to undertake semi structured interviews primarily with clinicians, and health managers. Understand the basis of the evidence for various Choosing Wisely initiatives to be able to consider what quantitative data would be required Ability to undertake analysis of the clinical audit data


Documents

SUMMER STUDENTSHIP PROGRAMME ...The Summer Studentship is open to any undergraduate student who is ... Dr. Max Berry 17-68 Effect of early life environment on maternal-pup interactions