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Notes how migrant Asian women reportedly have low levels of contraceptive use and high rates of abortion in NewZealand. Aims to: describe the contraceptive choices of Chinese women seeking abortion; to examine method choice in relation to demographic characteristics (including length of stay); and to determine whether Chinese women were over-represented among abortion clinic attendees. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Purpose: To explore the utility of phosphorus magnetic resonance spectroscopy ( 31 P MRS) in identifying anthracycline-induced cardiac toxicity in patients with breast cancer. Methods: Twenty patients with newly diagnosed breast cancer receiving anthracycline-based chemotherapy had cardiac magnetic resonance assessment of left ventricular ejection fraction (LVEF) and 31 P MRS to determine myocardial Phosphocreatine/Adenosine Triphosphate Ratio (PCr/ATP) at three time points: pre-, mid-, and end-chemotherapy. Plasma high sensitivity cardiac troponin-I (cTn-I) tests and electrocardiograms were also performed at these same time points. Results: Phosphocreatine/Adenosine Triphosphate did not change significantly between pre- and mid-chemo (2.16 ± 0.46 vs. 2.00 ± 0.56, p = 0.80) and pre- and end-chemo (2.16 ± 0.46 vs. 2.17 ± 0.86, p = 0.99). Mean LVEF reduced significantly by 5.1% between pre- and end-chemo (61.4 ± 4.4 vs. 56.3 ± 8.1 %, p = 0.02). Change in PCr/ATP ratios from pre- to end-chemo correlated inversely with changes in LVEF over the same period ( r = −0.65, p = 0.006). Plasma cTn-I increased progressively during chemotherapy from pre- to mid-chemo (1.35 ± 0.81 to 4.40 ± 2.64 ng/L; p = 0.01) and from mid- to end-chemo (4.40 ± 2.64 to 18.33 ± 13.23 ng/L; p = 0.001). Conclusions: In this small cohort pilot study, we did not observe a clear change in mean PCr/ATP values during chemotherapy despite evidence of increased plasma cardiac biomarkers and reduced LVEF. Future similar studies should be adequately powered to take account of patient drop-out and variable changes in PCr/ATP and could include T1 and T2 mapping.

This qualitative study explores the sexual decision making (SDM) of a group of young New Zealand women who had previously participated in casual sex without a condom. In doing so, it helps address a gap in the literature of first-hand accounts of the factors that have influenced SDM related to sexually transmitted infection (STI) risk in New Zealand. Eleven women were interviewed with the intention of gaining a greater understanding of their SDM before, and in, the ‘heat of the moment’. Four major themes related to SDM emerged from the data: 1) the importance of being in a relationship; 2) the influence of alcohol on SDM; 3) the power of societal expectations and the women's desire to be seen as “normal”; and 4) the sense of powerlessness many felt in negotiating condom use. The findings are discussed in relation to their relevance for sexual health promotion in the social context of New Zealand and in terms of research indicating that similar factors influence the SDM of young women in other Western countries.

Objectives To quantify brain microstructural changes in recently diagnosed relapsing-remitting multiple sclerosis (RRMS) using longitudinal T 1 measures, and determine their associations with clinical disability. Methods Seventy-nine people with recently diagnosed (< 6 months) RRMS were recruited from a single-centre cohort sub-study, and underwent baseline and 1-year brain MRI, including variable flip angle T 1 mapping. Median T 1 was measured in white matter lesions (WML), normal-appearing white matter (NAWM), cortical/deep grey matter (GM), thalami, basal ganglia and medial temporal regions. Prolonged T 1 (≥ 2.00 s) and supramedian T 1 (relative to cohort WML values) WML voxel counts were also measured. Longitudinal change was assessed with paired t -tests and compared with Bland-Altman limits of agreement from healthy control test-retest data. Regression analyses determined relationships with Expanded Disability Status Scale (EDSS) score and dichotomised EDSS outcomes (worsening or stable/improving). Results Sixty-two people with RRMS (mean age 37.2 ± 10.9 [standard deviation], 48 female) and 11 healthy controls (age 44 ± 11, 7 female) contributed data. Prolonged and supramedian T 1 WML components increased longitudinally (176 and 463 voxels, respectively; p  < .001), and were associated with EDSS score at baseline ( p  < .05) and follow-up (supramedian: p  < .01; prolonged: p  < .05). No cohort-wide median T 1 changes were found; however, increasing T 1 in WML, NAWM, cortical/deep GM, basal ganglia and thalami was positively associated with EDSS worsening ( p  < .05). Conclusion T 1 is sensitive to brain microstructure changes in early RRMS. Prolonged WML T 1 components and subtle changes in NAWM and GM structures are associated with disability. Clinical relevance statement MRI T 1 brain mapping quantifies disability-associated white matter lesion heterogeneity and subtle microstructural damage in normal-appearing brain parenchyma in recently diagnosed RRMS, and shows promise for early objective disease characterisation and stratification. Key Points • Quantitative T 1 mapping detects brain microstructural damage and lesion heterogeneity in recently diagnosed relapsing-remitting multiple sclerosis. • T 1 increases in lesions and normal-appearing parenchyma, indicating microstructural damage, are associated with worsening disability. • Brain T 1 measures are objective markers of disability-relevant pathology in early multiple sclerosis. Graphical abstract

BackgroundMathematical modelling of magnetic resonance (MR) perfusion imaging data allows myocardial blood flow (MBF) quantification and can potentially improve the diagnosis and prognostication of obstructive coronary artery disease (CAD). The diagnostic performance of distributed parameter (DP) modelling in detecting obstructive CAD has not yet been assessed. A model assessment in per vessel against per patient analysis has not been fully assessed yet in a single MR study. This work compares the diagnostic performance of DP modelling against the standard Fermi modelling, for the detection of obstructive CAD, in per vessel against per patient analysis.MethodsAfter informed consent, a pilot cohort of 28 subjects with known or suspected CAD underwent adenosine stress-rest magnetic resonance perfusion imaging at 3T. Data were analysed using Fermi and DP modelling against invasive coronary angiography and fractional flow reserve, acquired in all subjects. Obstructive CAD was defined as luminal stenosis of ≥70% alone, or luminal stenosis ≥50% and fractional flow reserve ≤0.80.ResultsOn ROC analysis, the diagnostic performance of all methods was improved in per patient analysis. DP modelling outperformed the standard Fermi model, in per vessel and per patient analysis. In per patient analysis, DP modelling-derived MBF at stress demonstrated the highest sensitivity and specificity (0.96, 0.92) in detecting obstructive CAD, against Fermi modelling (0.78, 0.88) and visual assessments (0.79, 0.88), respectively.ConclusionsDP modelling consistently outperformed Fermi modelling and showed that it may have merit for robustly stratifying patients with at least one vessel with obstructive CAD.

Mathematical modeling of perfusion cardiovascular magnetic resonance (CMR) data allows absolute quantification of myocardial blood flow and can potentially improve the diagnosis and prognostication of obstructive coronary artery disease (CAD), against the current clinical standard of visual assessments. This study compares the diagnostic performance of distributed parameter modeling (DP) against the standard Fermi model, for the detection of obstructive CAD, in per vessel against per patient analysis. A pilot cohort of 28 subjects (24 included in the final analysis) with known or suspected CAD underwent adenosine stress-rest perfusion CMR at 3T. Data were analysed using Fermi and DP modeling against invasive coronary angiography and fractional flow reserve, acquired in all subjects. Obstructive CAD was defined as luminal stenosis of ≥70 % alone, or luminal stenosis ≥50 % and fractional flow reserve ≤0.80. On ROC analysis, DP modeling outperformed the standard Fermi model, in per vessel and per patient analysis. In per patient analysis, DP modeling-derived myocardial blood flow at stress demonstrated the highest sensitivity and specificity (0.96, 0.92) in detecting obstructive CAD, against Fermi modeling (0.78, 0.88) and visual assessments (0.79, 0.88), respectively. DP modeling demonstrated consistently increased diagnostic performance against Fermi modeling and showed that it may have merit for stratifying patients with at least one vessel with obstructive CAD. Clinical Trial Registration: Clinicaltrials.gov NCT01368237 Registered 6 of June 2011. URL: https://clinicaltrials.gov/ct2/show/NCT01368237

The objective of this research is to support sustainable procurement of concrete pavements by linking materials-level global warming potential (GWP) to the project-level. Infrastructure owners require reliable environmental product declarations (EPDs) and methodologies for integrating GWP into the procurement process to ensure equitable decision-making. This work provides insights into current EPD reliability by assessing the sensitivity of concrete GWP to materials-level contributors to recommend a level of supply chain specificity needed to effectively communicate GWP. A benchmarking methodology was developed and implemented to establish reference values for procuring sustainable products. Having provided evidence towards EPD reliability, this work presents a framework that integrates GWP with pay items in project specifications. Linking incentives within infrastructure owner specifications to desired performance characteristics encourages all involved stakeholders to prioritize achievement of those performance characteristics. This same concept can be applied using GWP as the desired performance characteristics. A data collection protocol and life cycle information model (LCIM) for concrete pavement construction were developed to facilitate GWP integration into current project procurement practices. The LCIM methodology was developed and implemented to estimate the production and construction environmental impacts of six real-world concrete pavement construction projects. Applying the LCIM methodology allowed this work to map GWP to pay items and incentives in specifications and provide a pathway to extend a LCIM across the life cycle. The LCIM was further demonstrated on a real-world joint repair project, as well as for a concrete pavement reconstruction, demolition, and waste hauling. The culmination of this research demonstrated that the LCIM can be used to estimate the embodied environmental impacts of a concrete pavement across its life cycle and provided a framework for integrating environmental impacts into the procurement process, facilitating sustainable project procurement for infrastructure owners.

Proton magnetic resonance spectroscopy yields metabolic information and has proved to be a useful addition to structural imaging in neurological diseases. We applied short-echo time Spectroscopic Imaging in a cohort of 42 patients with secondary progressive multiple sclerosis (SPMS). Linear modelling with respect to brain tissue type yielded metabolite levels that were significantly different in white matter lesions compared with normal-appearing white matter, suggestive of higher myelin turnover (higher choline), higher metabolic rate (higher creatine) and increased glial activity (higher myo-inositol) within the lesions. These findings suggest that the lesions have ongoing cellular activity that is not consistent with the usual assumption of ‘chronic’ lesions in SPMS, and may represent a target for repair therapies.

To explore the utility of phosphorus magnetic resonance spectroscopy ( P MRS) in identifying anthracycline-induced cardiac toxicity in patients with breast cancer. Twenty patients with newly diagnosed breast cancer receiving anthracycline-based chemotherapy had cardiac magnetic resonance assessment of left ventricular ejection fraction (LVEF) and P MRS to determine myocardial Phosphocreatine/Adenosine Triphosphate Ratio (PCr/ATP) at three time points: pre-, mid-, and end-chemotherapy. Plasma high sensitivity cardiac troponin-I (cTn-I) tests and electrocardiograms were also performed at these same time points. Phosphocreatine/Adenosine Triphosphate did not change significantly between pre- and mid-chemo (2.16 ± 0.46 vs. 2.00 ± 0.56, = 0.80) and pre- and end-chemo (2.16 ± 0.46 vs. 2.17 ± 0.86, = 0.99). Mean LVEF reduced significantly by 5.1% between pre- and end-chemo (61.4 ± 4.4 vs. 56.3 ± 8.1 %, = 0.02). Change in PCr/ATP ratios from pre- to end-chemo correlated inversely with changes in LVEF over the same period ( = -0.65, = 0.006). Plasma cTn-I increased progressively during chemotherapy from pre- to mid-chemo (1.35 ± 0.81 to 4.40 ± 2.64 ng/L; = 0.01) and from mid- to end-chemo (4.40 ± 2.64 to 18.33 ± 13.23 ng/L; = 0.001). In this small cohort pilot study, we did not observe a clear change in mean PCr/ATP values during chemotherapy despite evidence of increased plasma cardiac biomarkers and reduced LVEF. Future similar studies should be adequately powered to take account of patient drop-out and variable changes in PCr/ATP and could include T1 and T2 mapping.