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Background Māori have been found to experience marked health inequities compared to non-Māori, including for injury. Accessing healthcare services post-injury can improve outcomes; however, longer-term experiences of healthcare access for injured Māori are unknown. This paper reports on data from the longitudinal Prospective Outcomes of Injury Study – 10 year follow up (POIS-10) Māori study in Aotearoa/New Zealand (NZ), to qualitatively understand Māori experiences of accessing injury-related healthcare services long-term. Methods Follow-up telephone interviews were conducted with 305 POIS-10 Māori participants, who were injured and recruited 12-years earlier, experiencing a range of injury types and severities. Free text responses about trouble accessing injury-related health services were thematically analysed. Results Sixty-one participants (20%) reported trouble accessing injury-related health services and provided free text responses. Three related themes describing participants’ experiences were connected by the overarching concept that participants were engaging with a system that was not operating in a way it was intended to work: 1) Competing responsibilities and commitments encapsulates practical barriers to accessing services, such as a lack of time and having to prioritise other responsibilities such as work or whānau (family); 2) D isrupted mana refers to the feelings of personal disempowerment through, for example, receiving limited support, care or information tailored to participants’ circumstances and is a consequence of patients contending with the practical barriers to accessing services; and 3) Systemic abdication highlights systemic barriers including conflicting information regarding diagnoses and treatment plans, and healthcare provider distrust of participants. Conclusions Twelve years post-injury, a considerable proportion of Māori reported experiencing barriers to accessing healthcare services. To restore a sense of manaakitanga and improve Māori access to healthcare, Māori-specific supports are required and systemic barriers must be addressed and removed.

Individuals that combine features of both genders-gender blends-are sometimes appealing and sometimes not. Heretofore, this difference was explained entirely in terms of sexual selection. In contrast, we propose that part of individuals' preference for gender blends is due to the cognitive effort required to classify them, and that such effort depends on the context in which a blend is judged. In two studies, participants judged the attractiveness of male-female morphs. Participants did so after classifying each face in terms of its gender, which was selectively more effortful for gender blends, or classifying faces on a gender-irrelevant dimension, which was equally effortful for gender blends. In both studies, gender blends were disliked when, and only when, the faces were first classified by gender, despite an overall preference for feminine features in all conditions. Critically, the preferences were mediated by the effort of stimulus classification. The results suggest that the variation in attractiveness of gender-ambiguous faces may derive from context-dependent requirements to determine gender membership. More generally, the results show that the difficulty of resolving social category membership-not just attitudes toward a social category-feed into perceivers' overall evaluations toward category members.

BackgroundThe ‘Prospective Outcomes of Injury Study–10 years on’ (POIS-10) aims to contribute to improving long-term disability, health and well-being outcomes for injured New Zealanders. This brief report describes recruitment, characteristics and key outcomes to 12 years post-injury.MethodsBetween 2007 and 2009, the study recruited 2856 people, including 566 Māori, from New Zealand’s Accident Compensation Corporation’s entitlement claims register. People experienced a range of injury types, causes and settings; 25% had been hospitalised for their injury. POIS-10 data were primarily collected via interviewer-administered structured questionnaires.ResultsOf the original participants, 2068 (92%) were eligible for follow-up in POIS-10. Of these, 1543 (75%) people participated between March 2020 and July 2021, including 240 Māori. Half of the participants (n=757; 50%) reported ongoing problems attributed to their injury 12 years earlier. Most reported difficulties with items assessing disability (WHO Disability Assessment Schedule II). For health-related quality of life (HRQoL), measured using the EQ-5D-5L, the prevalence of problems was higher 12 years post-injury compared with 12 months post-injury for four of five dimensions. Importantly, the prevalence of problems did not reduce to pre-injury levels for any HRQoL dimension.DiscussionPOIS-10 highlights the importance of early post-injury interventions to improve health, disability and well-being outcomes of injured New Zealanders.

Aim/Purpose: We aimed to investigate the circumstances under which Kahoot! (a Game-based Student Response System (GSRS)) increases junior and senior Information Science university students’ learning and knowledge retention beyond that of traditional teaching methods. We also explored whether the positive learning impacts of Kahoot! vary as a function of student subject knowledge (i.e., junior vs senior students). Background: The effectiveness of game-based student response systems (GSRSs) as learning tools in the classroom remains unclear, given inconsistent findings across educational research. Kahoot! enhances secondary and tertiary students’ attention and motivation during class, but its effectiveness on learning and retention of course knowledge may vary depending on situational and individual factors. In New Zealand universities, students spend three years studying towards a Bachelor’s degree, majoring in subject(s) of their choice. By the end of their third year of study, students are eligible to graduate with a sound knowledge of their chosen major. Thus, first-year students (referred to as “junior students”) and third-year students (“senior students”) may differ in terms of their learning styles and their ability and willingness to integrate Kahoot! use into their course work and revision. It is hypothesised that differences in subject knowledge between junior versus senior students will influence the perceived effectiveness of Kahoot!. Methodology: Thirteen first-year (junior) and fourteen third-year (senior) Information Science students (total n = 27), who used Kahoot! in seven lectures (for 30 minutes per lecture) were interviewed about their perception of Kahoot!’s effectiveness. We conducted a mixed-methods case study of students’ interview transcripts, demographic records and student scores, where thematic (content) analysis was used to analyse interview responses. Then, we quantified themes for a one-way ANCOVA, with student subject knowledge predicting Kahoot!’s effectiveness, when controlling for students’ duration of tertiary study and study habits (i.e., hours dedicated to course work per week) as potential confounders. Contribution: This study addresses the conflict in existing literature around whether GSRSs improve student learning beyond traditional teaching methods. To our knowledge, this is the first study that shows GSRSs (namely Kahoot!) use improves, or at least, supplements tertiary students’ learning and knowledge retention of lecture content. This study also reveals how student characteristics (i.e., accumulated tertiary experience) and their subject knowledge influence the effectiveness of Kahoot! as a learning tool. Findings: Kahoot!’s use increased students’ learning and knowledge retention, among other positive impacts (e.g., attention and engagement). However, the perceived learning impact of Kahoot! was greater for senior students. Senior students found Kahoot! more useful for learning new knowledge and revising previously acquired knowledge. On the other hand, while junior students also experienced positive learning impacts using Kahoot!, they reported concerns regarding limited and shallow content coverage, and the time-consuming and distracting nature of the platform. Recommendations for Practitioners: Educators should take care to ensure GSRSs are appropriately implemented to support rather than replace traditional teaching methods (e.g., “chalk and talk” style presentations, PowerPoint use). In addition, lecturers using GSRSs should clearly inform students about the examinable content and their expectations for performance in formal assessments. Recommendation for Researchers: The positive impact of Kahoot! use on students’ learning and knowledge retention may be due to stronger interactions and engagement during class. Researchers should more closely explore how student-lecturer interactions and in-depth discussions following GSRS use influence learning. Thus, there is a need to re-evaluate Malone’s (1980) intrinsic motivation theory in relation to the “interactive” or “enjoyability” components experienced during Kahoot! use. Impact on Society: The positive impacts of Kahoot! use on student learning vary for junior and senior students. However, our findings indicate that both cohorts of students benefit from 15-minute Kahoot! sessions at the end of a lecture or course unit, allowing them to test their knowledge and revise* previously taught material. Kahoot! provides a comfortable platform that allows students to ask and answer questions without embarrassment. More experienced students can also evaluate their learning by creating their own Kahoot! quizzes and providing feedback to the lecturers. Overall, Kahoot! use could have a positive impact on teaching and learning globally. Future Research: Beyond the recommendation for researchers above, future research should explore how differences in lecturers’ teaching styles and students’ self-regulation of learning impact Kahoot!’s effectiveness as a learning tool.

PurposePatient-reported outcome measures (PROMs) are useful for trauma registries interested in monitoring patient outcomes and trauma care quality. PROMs had not previously been collected by the New Zealand Trauma Registry (NZTR). More than 2500 New Zealanders are admitted to hospital for major trauma annually. The Trauma Outcomes Project (TOP) collected PROMs postinjury from three of New Zealand’s (NZ’s) major trauma regions. This cohort profile paper aims to provide a thorough description of preinjury and 6 month postinjury characteristics of the TOP cohort, including specifically for Māori (Indigenous population in Aotearoa me Te Waipounamu/NZ).ParticipantsBetween July 2019 and June 2020, 2533 NZ trauma patients were admitted to one of 22 hospitals nationwide for major trauma and included on the NZTR. TOP invited trauma patients (aged ≥16 years) to be interviewed from three regions; one region (Midlands) declined to participate. Interviews included questions about health-related quality of life, disability, injury recovery, healthcare access and household income adequacy.Findings to dateTOP recruited 870 participants, including 119 Māori. At 6 months postinjury, most (85%) reported that the injury still affected them, 88% reported problems with≥1 of five EQ-5D-5L dimensions (eg, 75% reported problems with pain or discomfort, 71% reported problems with usual activities and 52% reported problems with mobility). Considerable disability (World Health Organization Disability Assessment Schedule, WHODAS II, score ≥10) was reported by 45% of participants. The prevalence of disability among Māori participants was 53%; for non-Māori it was 44%. Over a quarter of participants (28%) reported trouble accessing healthcare services for their injury. Participation in paid work decreased from 63% preinjury to 45% 6 months postinjury.Future plansThe 12 and 24 month postinjury data collection has recently been completed; analyses of 12 month outcomes are underway. There is potential for longer-term follow-up interviews with the existing cohort in future. TOP findings are intended to inform the National Trauma Network’s quality improvement processes. TOP will identify key aspects that aid in improving postinjury outcomes for people experiencing serious injury, including importantly for Māori.

Summary Neutrophils contribute to the pathological processes of a number of inflammatory disorders, including rheumatoid arthritis, sepsis and cystic fibrosis. Neutrophils also play prominent roles in schistosomiasis japonica liver fibrosis, being central mediators of inflammation following granuloma formation. In this study, we investigated the interaction between Schistosoma japonicum eggs and neutrophils, and the effect of eggs on the inflammatory phenotype of neutrophils. Our results showed significant upregulated expression of pro‐inflammatory cytokines (IL‐1α, IL‐1β and IL‐8) and chemokines (CCL3, CCL4 and CXCL2) in neutrophils after 4 h in vitro stimulation with S. japonicum eggs. Furthermore, mitochondrial DNA was released by stimulated neutrophils, and induced the production of matrix metalloproteinase 9 (MMP‐9), a protease involved in inflammation and associated tissue destruction. We also found that intact live eggs and isolated soluble egg antigen (SEA) triggered the release of neutrophil extracellular traps (NETs), but, unlike those reported in bacterial or fungal infection, NETs did not kill schistosome eggs in vitro. Together these show that S. japonicum eggs can induce the inflammatory phenotype of neutrophils, and further our understanding of the host–parasite interplay that takes place within the in vivo microenvironment of schistosome‐induced granuloma. These findings represent novel findings in a metazoan parasite, and confirm characteristics of NETs that have until now, only been observed in response to protozoan pathogens.

Background Injuries can have detrimental impacts on mental health, even after physical recovery. In our Prospective Outcomes of Injury Study (POIS), 25% of participants experienced psychological distress (assessed using the Kessler 6) three months after a sentinel injury event (SIE), declining to 16% at 24 months post-SIE. Internationally, studies of hospitalised patients found distress persisted beyond 24 months post-injury and remained higher than the general population. However, most studies only assessed distress at one timepoint, relied on long-term recall, or were limited to small samples or specific injury types. Therefore, we aim to describe the prevalence of psychological distress 12 years post-SIE and to investigate pre-injury, injury-related and early post-injury characteristics associated with long-term distress. Methods POIS is a longitudinal cohort study of 2856 New Zealanders injured between 2007 and 2009, who were on the national injury insurer, Accident Compensation Corporation entitlement claims’ register. Of these, 2068 POIS participants completed an interview at 24 months and agreed to further contact. They were invited to a follow-up interview 12 years post-SIE which included the Kessler-6 (K6), the psychological distress outcome of interest. Data about a range of pre-injury, injury-related and early (3 months) post-injury characteristics were collected via earlier interviews or administrative data sources (e.g. hospital discharge data). Results Twelve years post-SIE, 1543 (75%) people were re-interviewed and 1526 completed the K6; n  = 177 (12%) reported psychological distress. Multivariable modified Poisson regression models found pre-injury characteristics were associated with an increased risk of clinically relevant distress at 12 years, i.e. having inadequate income, identifying as Māori, Pacific or Asian and having one mental health condition. Early post-injury psychological distress and dissatisfaction with social relationships also increased risk. However, being older was associated with a reduced risk of distress. Conclusion Clinically relevant distress persists long-term post-injury among adults with varying injury severity, types and causes, and at higher prevalence than in the general population. Early identification of injured people at risk of long-term psychological distress provides opportunities for timely interventions to reduce psychological distress.

Koala retrovirus (KoRV) displays features of both an endogenous and exogenous virus and is linked to neoplasia and immunosuppression in koalas. This study explores the apparent differences in the nature and impact of KoRV infection between geographically and genetically separated “northern” and “southern” koala populations, by investigating the disease status, completeness of the KoRV genome and the proviral (DNA) and viral (RNA) loads of 71 northern and 97 southern koalas. All northern animals were positive for all KoRV genes ( gag , pro-pol and env ) in both DNA and RNA forms, whereas many southern animals were missing one or more KoRV genes. There was a significant relationship between the completeness of the KoRV genome and clinical status in this population. The proviral and viral loads of the northern population were significantly higher than those of the southern population (P < 0.0001), and many provirus-positive southern animals failed to express any detectable KoRV RNA. Across both populations there was a positive association between proviral load and neoplasia (P = 0.009). Potential reasons for the differences in the nature of KoRV infection between the two populations are discussed.

Blastocystis is an ubiquitous, enteric protozoan of humans and many other species. Human infection has been associated with gastrointestinal disease such as irritable bowel syndrome, however, this remains unproven. A relevant animal model is needed to investigate the pathogenesis/pathogenicity of Blastocystis. We concluded previously that pigs are likely natural hosts of Blastocystis with a potentially zoonotic, host-adapted subtype (ST), ST5, and may make suitable animal models. In this study, we aimed to characterise the host-agent interaction of Blastocystis and the pig, including localising Blastocystis in porcine intestine using microscopy, PCR and histopathological examination of tissues. Intestines from pigs in three different management systems, i.e., a commercial piggery, a small family farm and a research herd (where the animals were immunosuppressed) were examined. This design was used to determine if environment or immune status influences intestinal colonisation of Blastocystis as immunocompromised individuals may potentially be more susceptible to blastocystosis and development of associated clinical signs. Intestines from all 28 pigs were positive for Blastocystis with all pigs harbouring ST5. In addition, the farm pigs had mixed infections with STs 1 and/or 3. Blastocystis organisms/DNA were predominantly found in the large intestine but were also detected in the small intestine of the immunosuppressed and some of the farm pigs, suggesting that immunosuppression and/or husbandry factors may influence Blastocystis colonisation of the small intestine. No obvious pathology was observed in the histological sections. Blastocystis was present as vacuolar/granular forms and these were found within luminal material or in close proximity to epithelial cells, with no evidence of attachment or invasion. These results concur with most human studies, in which Blastocystis is predominantly found in the large intestine in the absence of significant organic pathology. Our findings also support the use of pigs as animal models and may have implications for blastocystosis diagnosis/treatment.