Medicine

Understanding the relationship between increased fat mass and risk of tendon disease

Supervisor

David Musson

Discipline

Medicine

Project code: MHS089

Tendons connect muscles to bones, and with over 4000 tendons in the human body, they are fundamental to our ability to move and function in a way we take for granted. Injuries to tendons severely affects our quality of life, reducing our ability to work and limiting our recreational activities.

Clinical observations suggest that increased fat mass is associated with an increased risk of tendon injury/disease. The increased load on the tendons could partly explain this association; however, tendon damage also occurs in non-weight bearing sites, such as upper limbs, suggesting that other factors are involved. The mechanisms that are driving the fat related increased risk of tendon injury/disease remain unknown.

Our current AMRF-funded project aims to examine the link between increased fat mass and increased risk of tendon injury/disease.

Specifically, as tendon injury/disease is characterised by structural and functional deterioration of the tendon, this summer studentship will use tendon biopsies obtained from orthopaedic surgeon colleagues to compare the structure and biomechanics of tendons from healthy-weight patients (BMI <25kg/m2), and those patients who are overweight or obese (BMI >28kg/m2.

Skills:
• Structural analysis of tendon using electron microscopy and atomic force microscopy
• Biomechanical analysis of tendon
• Communication skills

There is scope to follow this summer studentship with a lab-based Honours project, if interested.

Project withdrawn: Understanding tendon disease progression using a novel in vitro model

Project code: MHS090

This project has been withdrawn.

Are findings from reviews of calcium and vitamin D supplementation for the US Preventative Services Task Force (USPSTF) concordant with contemporaneous systematic reviews?

Supervisor

M Bolland

Discipline

Medicine

Project code: MHS102

Systematic reviews that include high-quality, adequately powered, randomised controlled trials are considered the highest level of evidence to inform clinical practice. The USPSTF is an independent government body that commissions systematic reviews that form the basis for their independent taskforce members without conflicts of interest to issue evidence-based recommendations and statements on clinical issues. Their recommendations are considered to be of very high quality and are very influential.

In the last 20 years the USPSTF has issued a number of statements and recommendations about the role of calcium supplements or vitamin D supplements or both for the prevention of falls, fractures, and non-skeletal conditions such as cardiovascular disease. We have previously commented in published letters on some USPSTF statements that the recommendations are based on only a small subset of relevant published randomised controlled trials. For example, the most recent 2018 USPSTF statement on calcium and vitamin D for fracture prevention included 11 trials, whereas we are aware of more than 60 published trials with fracture outcome data. Reviews that base recommendations on only a small subset of trials may lead to different conclusions from reviews based on all available trials. We previously have reported that conclusions of systematic reviews of calcium and vitamin D for falls and fractures published in high impact journals differ substantially, in part because they were based on different sets of trials.

The aim of this project is to systematically review the statements and recommendations from the USPSTF on calcium and vitamin D and the reviews on which they are based and compare their methods, results and conclusions with contemporaneous systematic reviews published in high impact journals and by the Cochrane collaboration.

The results will inform clinicians and researchers about the reliability of the USPSTF results and conclusions, and will be published in an international medical journal.

Skills:
The student will learn literature searching, interpretation and critical appraisal of publications, appreciation of the hidden details and differences behind guidelines and systematic reviews, levels of evidence, simple statistical analyses, and how to draft a manuscript for publication.

Project name

Supervisor

M Bolland

Discipline

Medicine

Project code: MHS103

Scientific misconduct appears to be a reasonably rare event. An episode of misconduct may be a one-off event, after which the individual does not have further opportunity to undertake scientific research (eg they are dismissed from their position) or they are “rehabilitated” and do not practice misconduct again. However, sometimes misconduct is not discovered for a long time, and the individual(s) involved may have repeatedly practiced misconduct in the interim.

Retraction of scientific papers may be due to scientific misconduct that affects the integrity of the paper. There are a number of examples where this misconduct is not a one-off event, and once the behaviour is uncovered, multiple retractions of scientific papers follow. There have been few systematic surveys of retracted papers. We wonder whether individuals who have practiced misconduct are successfully “rehabilitated” and subsequently publish papers free from concerns about misconduct after the misconduct has been identified and publicly recognised. We hypothesize that researchers found to have committed serial misconduct do not publish further scientific papers in the same field after the misconduct is publicly announced through retraction of a paper.

Retraction watch is a blog that catalogues episodes of misconduct and has an associated database of retractions. We propose to search the Retraction Watch database for individuals with at least 5 retracted papers. We will then identify the retracted papers and the date of retraction. We will then search literature databases to identify all publications from the identified individuals, and categorise each paper as being published before or after the initial retraction. We will therefore determine the publication trends for individuals with multiple retractions arising from serial misconduct.

The results will be of use to researchers, journal editors, and institutions who deal with issues related to scientific misconduct by providing evidence from existing cases as to whether untainted scientific publication has occurred previously for individuals known to have committed serial scientific misconduct.

Skills:
The student will learn literature searching, simple management of spreadsheets and databases, simple statistical analyses, and how to draft a manuscript for publication. It may be suited to someone with some experience of (or who enjoys) using Excel or similar spreadsheet software.

MENZACS- the Multi Ethnic New Zealand Study of Acute Coronary Syndromes- analysis of factors related to timing of presentation

Supervisor

Malcolm Legget
Rob Doughty

Discipline

Medicine

Project code: MHS091

The aim of this summer studentship will be to determine the factors and timing involved for patients presenting with acute coronary syndromes to access acute cardiac care, undergoing coronary angiography and intervention, and achieving revascularisation. This will be addressed in a substudy of the Multi Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS). Time to presentation to emergency care and the timing of both clinical and research blood samples that are taken for patients during hospitalisation with an acute coronary syndrome will be assessed. These factors will have an important influence on the level of certain biomarkers (for example troponin and N- terminal brain natriuretic peptide, NT-proBNP). Detailed understanding of the factors that influence biomarker levels will be important in future analyses looking at outcome following a heart attack, in a large contemporary New Zealand cohort. This has major significance to Maori and Pacific people, who are at greater risk of poor outcomes following an acute coronary event.

The student will require good data processing and analytical skills. The student will work as part of the Cardiovascular Research Group, Chair in Heart Health, and will also benefit from exposure to other cardiovascular research.

Decellularised animal tissue as a heart valve graft

Supervisor

Professor Jill Cornish
Dr David Musson

Discipline

Medicine

Project code: MHS154

This project aims to assess the potential application of decellularised animal tissue as a therapeutic product: a heart valve graft. Transplantation with animal tissue (xenotransplantation) has advantage over traditional human-tissue transplants (allotransplantation) as animal tissue is more readily available, and the demand for human donor organs hugely outweighs supply.
The project will entail:
• Decellularising porcine/bovine myocardium, heart valve, pericardium, and small intestine.
• Biocompatibility assessment of the decellularised product, including:
o Assessment of immunogenicity by exposing the decellularised product to macrophage cells, in vitro.
o Assessment of cytotoxicity by cell culture
o Assessment of mechanical properties
o Assessment of protein structure by histology

Impact of morbid obesity without bariatric surgery

Supervisor

Rinki Murphy

Discipline

Medicine

Project code: MHS002

Aims: The aim of our project is to measure the impact of morbid obesity on people's quality of life and general health in absence of bariatric surgery.

Methods: We have ethics approval to conduct a follow up of a cohort of patients who were previously identified as potential candidates for bariatric surgery, but did not proceed for various reasons.

Skills that will be taught:
• Contact and consent of patients to be included into the study
• Compiling data from various sources, including direct patient contact, electronic records and measuring individual parameters such as weight, heights etc.

Ideal for students keen to gain more patient contact as preparation for the hospital environment. This will also help familiarize you with the hospital electronic records system, particularly within the Auckland region.

Enriching rural medical career intentions of medical students

Supervisor

Phillippa Poole
Warwick Bagg, Boaz Shulruf, Branko Sijnja (Otago), Antonia
Verstappen, Tim Wilkinson (Otago)

Discipline

Medicine

Project code: MHS015

This builds on previous summer scholarships which found that NZ medical students from a rural background three times more likely than urban students to intend to work in a rural setting (1), yet a significant number of urban students switch to a rural career intention (2). At each school a subset of both urban and rural students has the opportunity to undertake a rural medical immersion programme (RMIP). International research suggests a RMIP adds to rural career intention (3)but this has not been quantified in NZ.

The New Zealand Medical Schools Outcomes Database and Longitudinal Tracking Project (the MSOD project) has collected sociodemographic data as well as career intentions of Auckland and Otago medical students for over a decade. This will be linked to details on whether or not a longitudinal rural immersion attachment was undertaken.

This particular study aims to:
(i) summarise characteristics of all students who have undertaken an RMIP in NZ;
(ii) understand to what extent an RMIP adds to rural career intention in NZ;
(iii) explore the interaction among background, other demographic or attitudinal characteristics, RMIP, and rural intention at entry and exit from medical school

The project has ethics approval, and would suit a student interested in medical career development who has some mathematical/ statistical skills.

Skills taught:
Literature searching and appraisal

Data handling and statistics
-data collection, data entry, data collation.
-use of large datasets
-linking data
-summary statistics, univariate and multivariate analysis, factor analysis

Writing for publication
-contribute significantly to a research paper

References:
1. Poole P, Stoner T, Verstappen A, Bagg W. Medical students: where have they come from; where are they going? NZ Med J 2016;129: 1435.
2. Kent M, Verstappen A, Wilkinson TJ, Poole P. Keeping them interested – a national study of factors that change medical student interest in working rurally (Submitted 2018).
3. Playford D, Ngo H, Gupta S, Puddey IB. Opting for rural practice: the influence of medical student origin, intention and immersion experience. Med J Aust. 2017 Aug 21;207(4):154-158.

Urine contamination and wasted resources – an audit

Supervisor

Sarah Clarke (NDHB)

Discipline

Medicine

Project code: MHS222

Come to sunny Kaitaia for your Summer Studentship! We need help to complete our audit cycle on urine sample collection and potential harm from inappropriate antibiotic prescription for contaminated specimens. Accommodation provided.

Audit of the first 100 urine samples processed in Kaitaia hospital laboratory starting from 01/09/2018. The data will be retrieved from the laboratory database, and NHI will be used on Concerto to find reported urine results and whether antibiotics are dispensed or not. The first cycle is complete so please come and join us to finish this off  We plan to publish our combined findings in a poster at the Rural Health Conference in 2018

Aim

To identify the current rate of contamination of urine samples to assess improvement in practice after instituting new initiatives in response to previous audit.

Study questions

  1. What proportion of urine samples processed by the laboratory are contaminated?
  2. How much resource is being wasted by processing contaminated samples in Kaitaia Hospital laboratory?
  3. How many patients are being dispensed antibiotics after the final urine report despite their urine sample being contaminated?
  4. Has there been any change since our previous audit?

Procedures

No procedures involving patients required. Audit using data available through NHI, Concerto and TestSafe. NHI will be removed from final report to anonymise patients and there will be no other identifying features of any patients.

Anticipated ethical risk

None