Clinical Trial Tabex News NZ 2015

Natural plant-based product outperforms
nicotine replacement therapy in NZ trial
By Suzy Botica
A New Zealand study recently published in the New England Medical Journal has shown that
a low-cost product found in plants such as Golden Rain is more effective at helping people quit
smoking than the more expensive and widely used nicotine replacement therapy.
Dr Natalie Walker from the University
of Auckland led the HRC-funded
study into cytisine, a naturally
occurring plant alkaloid sourced from
Bulgaria that has been sold in Eastern
Europe as an inexpensive smoking-
cessation aid since the 1960s, but is
unavailable – and relatively unknown
– elsewhere. This is the first trial
in the world to have compared the
effectiveness of cytisine with nicotine
replacement therapy (NRT).
The study team recruited 1310 adult
daily smokers from New Zealand
who were motivated to quit and had
called the national Quitline. The
participants were randomly assigned
to either receive cytisine for 25 days
or NRT (in the form of patches and/
or gum or lozenges) for eight weeks.
Participants in both groups also
received telephone-based Quitline
behavioural support.
The proportion of study participants
who managed to continuously abstain
from smoking over a one-month
period was higher for those in the
cytisine group (40 per cent) than for
those in the NRT group (31 per cent).
Cytisine also remained more effective
than NRT at keeping participants
smoke-free at the two-month and six-
month follow ups.
The effects of cytisine appear to be
longer-lasting than NRT as well.
Participants in the cytisine group who
didn’t succeed in quitting smoking,
took much longer to resume smoking
again after the trial’s designated ‘quit
day’ than those in the NRT group: 53
days for the cytisine group compared
to just 11 days for the NRT group.
Dr Walker says that cytisine looks a
bit like nicotine to the brain, which is
how it works to reduce the severity of
smokers’ nicotine cravings.
“During treatment we found that
participants in the cytisine group
reported fewer symptoms of tobacco
withdrawal, found smoking less
rewarding, and reduced the number
of cigarettes they smoked each day,”
says Dr Walker.
Cytisine wasn’t without its drawbacks.
Participants taking cytisine reported
more side effects than those in the
NRT group, most commonly nausea,
vomiting, and sleep disorders.
However, the side effects were similar
to those observed in patients taking
varenicline – the most effective
smoking cessation treatment available
on the market.
HRCnews Issue No. 83 March 2015
INSIDE
Potential vaccines for
cancer and asthma
Dr Natalie Walker
(Continued on page 7)
In the HRC 2010 annual funding
round, Dr Natalie Walker was
awarded over $1 million for
her project to investigate a new
low-cost intervention for smoking
cessation.
Expressions of Interest for Projects
for the HRC’s 2016 funding round
open on 15 June 2015. For more
information go to www.hrc.
govt.nz/funding-opportunities/
researcher-initiated-proposals.
Find out what these vaccines have in
common on pages 18 and 19.

2
HRC News March 2015
Health Research Council of New Zealand
Te Kaunihera Rangahau Hauora o Aotearoa
Chief Executive’s message
2014 was a big year of change for the Health Research Council
of New Zealand. As the new Chief Executive (in post for about
three weeks as I write this) I will sorely miss the input of Lex
Davidson. I am one of many researchers who has benefited from
his flexibility and understanding of the need for the ‘occasional’
no-cost extension and related contract amendment. I had
imagined that I would be able to seek his wise counsel during my
first year in post, but sadly that was not to be. You can tell from
this issue that he is greatly missed here – and I have heard from
many research offices and researchers around the country that
they too will miss him enormously. Our thoughts are with his
family at this time.
I have spent my first few weeks getting to know staff, and kick-
starting the process of meeting with/talking to key stakeholders
around New Zealand. Gaining an understanding of the ‘whole
of HRC’ business, and its place in the ‘whole of health research’
context is something I am really enjoying. Part of this process is
being augmented by projects we have underway exploring better
ways to evaluate the impact of the research that we support. I
look forward to sharing some of the information we are collating
and synthesising as and when it is available.
How best to evaluate the impact of health research is inherently
complex and problematic, but demonstrating ‘value add’ is
crucial and something we are committed to doing. Knowledge
about impact is much aided by the information you provide in
annual and final reports about publications, spin-off projects
that build on the HRC-funded work, and of course the changes
your work brings about in practice, policy and education. Our
intention is that it will become far simpler for researchers to
do that with revisions to HEARD (the HRC’s online reporting
system), and its integration into HRC Gateway. But, if you have
stories about the impact of your work, don’t wait for your report
- talk to us! The stories in this issue are just some of the examples
that exist – we would welcome you letting us know more.
At the end of January 2015, I had the opportunity to meet
with officials from the Ministry for Business, Innovation
and Employment and European funders about the Joint
Programming Initiative on Healthy Diet, Health Living (JPI-
HDHL) and the Global Alliances for Chronic Diseases (GACD)
and Infectious Disease Preparedness (GLOPID). One of the
things that really came across in all of these meetings is the
IN THIS ISSUE
A tribute to Lex Davidson (1947–2014) 3
Reflection of Lex 5
Tribute message from Sir Robert
Stewart, KNZM
6
Strategic refresh of the HRC announced 7
Study identifies ways to make cycling
safer on NZ roads
8
PubMed Commons: A forum for
scientific discourse
9
Harnessing wireless power for artificial
heart pumps
10
E-therapy for youth depression in
primary care
11
Unique study to explore NZ’s ‘puzzling’
testicular cancer rates
12
Virus hunters’ make new discovery
while studying unsolved gastro
outbreaks
14
Rotavirus vaccine trial a success 15
Shaping palliative care for Māori 17
Asthma and cancer vaccine research
crossover
18
Right dose – right result 20
HRC Chief Executive, Dr Kathryn McPherson
Follow the
HRC on Twitter
If you’d like an easy way to keep
up with the latest HRC news,
you can follow us on Twitter:
@HRCNewZealand.

3
HRC News March 2015
positive regard with which New Zealand health research
and researchers are held. Part of our mandate is to
contribute to ensuring that regard is maintained and indeed
grows. This is no mean feat and yet it is what attracted me
to this position.
We are now well and truly into the assessment process
for the annual contestable funding round (see www.hrc.
govt.nz/news-and-publications for rebuttal submission
dates). This will be the first year I will not be dealing with
reviews of my own grants (always a mixed blessing I find
with around 160 of you having a similar sense I suspect
in the weeks to come). However, those reviews, and the
associated rebuttals, contribute to thoughtful discussion
and informed decisions in our assessing committees. What
I am seeing first-hand is just how many reviewers the
HRC engages with to meet our objective of three to four
independent reviews for each grant. A rough estimate is
that we are in contact with about 1600 academics nationally
and internationally during this time frame. It’s a mammoth
undertaking as you can imagine so – next time you are
asked to review – if it’s within your area of expertise, please
consider saying yes!
Finally – congratulations to Professor Anne Kelso who
takes over from Professor Warwick Anderson as the
new Chief Executive of the National Health and Medical
Research Council in Australia in April, and enormous
thanks to the staff and board of the HRC for making me
welcome and for teaching me so much. Here’s to 2015 being
a really good year for the contribution that the HRC, and
health research, makes for New Zealanders.
Dr Kathryn McPherson, Chief Executive, Health Research Council of
New Zealand
A tribute to Lex Davidson
(1947–2014)
By Dr Bruce A Scoggins, PhD
(HRC Chief Executive from 1991 to 2006)
Lex was appointed Manager Finance and Corporate Services at the HRC in January 1991
immediately following the transition of the Medical Research Council to the Health Research
Council of New Zealand. I joined the staff in October 1991 and Lex and I worked closely
together for the next 15 years to ensure that the council’s financial accounts, accountability
statement and performance measures met the requirements of the Government, the HRC
Board, and Audit New Zealand.
Balancing
income from the
Government with
a range of research
funding initiatives
of different duration
required Lex to
develop an approach which ensured
funds were being used effectively
– not sitting unused in either in
the HRC’s or a host institution’s
bank account. Development of an
appropriate strategy was skillfully
managed by Lex through engagement
with the HRC’s Board and the staff
administering research funds at the
various host institutions.
It was never easy matching the
research community’s and the HRC’s
Research Committees’ desire for
increased funding to support more
research with the Government’s
budget allocation.
Together with the Board, Lex
often had the dual challenges of
tempering expectations for increased
health research funding from the
HRC’s Research Committees and
stakeholders, and dealing with the
fiscal realities of the Government’s
budget allocation, which was often
not negotiated on the three-yearly
cycle required by the HRC Act.
The transition, over four years, to full
cost funding of research conducted
at the same time (1997/98) as the
transfer of the HRC’s funding from
Vote Health to Vote Research, Science
Lex Davidson
Dr Bruce Scoggins

4
HRC News March 2015
Upcoming closing dates
For an up-to-date list of all application registration,
opening and closing dates please go to the HRC
website: www.hrc.govt.nz.
Ngā Kanohi Kitea Full Project Grant
Full applications close 8 April 2015 (1pm)
Hard copies of full applications due at the HRC by
10 April 2015 (5pm)
Full applications:
Clinical Practitioner Research Fellowship
The Sir Charles Hercus Health Research Fellowship
Clinical Research Training Fellowship
Foxley Fellowship
Online submissions open 4 June 2015 (8am)
Online submissions close 1 July 2015 (12pm, noon)
Hard copies due at the HRC by 3 July 2015 (5pm)
Projects – Expression of Interest
Online submissions open 15 June 2015 (8am)
Online submissions close 15 July 2015 (12pm, noon)
Hard copies due at the HRC by 17 July 2015 (5pm)
Projects – Full application (Invitation only)
Online submissions open 6 October 2015 (8am)
Online submissions close 18 November 2015 (12pm,
noon)
Hard copies due at the HRC by 20 November 2015
(5pm)
Programmes – Full application
Online submissions open 10 August 2015 (8am)
Online submissions close 14 October 2015 (12pm,
noon)
Hard copies due at the HRC by 16 October 2015 (5pm)
Full applications:
Emerging Researcher First Grant
Feasibility Studies
Online submissions open 10 August 2015 (8am)
Online submissions close 4 September 2015 (12pm,
noon)
Hard copies due at the HRC by 8 September 2015
(5pm)
Explorer Grants – Full application
Online submissions open 1 October 2015 (8am)
Online submissions close 4 November 2015 (12pm,
noon)
Hard copies due at the HRC by 6 November 2015
(5pm)
and Technology was well managed
by Lex and the Secretariat Executive
Management team. Since the transition
of its funding the HRC has been
accountable to two ministries1
, which is
uncommon for a Crown entity.
Both the transition of the HRC’s
funding and the move to full-cost
funding fully utilised Lex’s skills.
Of particular importance was his
validation of the overhead rates to
be used by host institutions on fully
costed contracts.
Lex also played a significant role in
the financial planning of the HRC’s
joint funding initiatives with other
agencies and the HRC’s Partnership
Programme. The latter was developed
by Drs Patricia Anderson and
Michelle Sullivan, with my assistance.
As the manager of Corporate Services,
Lex, together with the administration
managers ensured that the Secretariat
staff had a great working environment,
originally in Symonds Street, but since
2002, in Stanley Street in Auckland.
In his 24 years at the HRC, Lex
worked with seven HRC Board Chairs
and two Chief Executives. He was also
Acting Chief Executive on a number
of occasions, including before and
after Dr Robin Olds’ tenure.
The HRC’s annual report to Parliament
was prepared to a significant extent by
Lex and his team. Over the years this
has become a significant task with the
inclusion of a substantive number of
performance measures.
Lex was ably supported in the
accounts office by a hardworking
and loyal finance team, led by Sandra
Burge. He was also a great support to
me in my 15 years as Chief Executive
of the HRC.
This year is the 25th anniversary of
the establishment of the HRC, and
although Lex will not be with us,
we will all be thinking of him as we
celebrate the achievements of the
organisation.
His enthusiasm, commitment and
loyalty will be greatly missed!
1
Health and Research, Science and Technology
(Continued from page 3)

5
HRC News March 2015
Reflection of Lex
When I asked my colleagues at work about Lex
Can you give me one word that first comes to your head?
I got naughty and cheeky, a jokester, a clown
Humorous, generous, mischievous man-about town
Yes there’s no denying, it must be said
He’s a comic, a prankster, he’d mess with your head!
One day he said “Burgie I’ll help you to your car”
How nice I thought, geez Lex you’re a star
But I did not know, he’d been up to his tricks
He’d been down to my car and something he’d fixed
To my door handle, I let out a scream
A weta just sat there, as if in a dream.
I remember one morning I sat down at my desk
I reached for my mouse, what was there was grotesque!
Yes Lex he had been up to his tricks – oh once more
The sod – and this time I let out a roar
Instead of my small metal handheld device
Lay a mouse, it really was not very nice.
Now there’s one more word that I got – it stood out
“Foodie” he’s that, oh yes – there’s no doubt
Yes we all know that our Lex – he liked to cook
He even wrote his own “Good Gobbles” cook book
And when someone was sick, you could always rely
On Lex, to bake something to help you get by.
Some days he’d come into the office with food
And he’d jiggle and dance about, sometimes quite rude
“What is it? he’d say “go on and guess”
And the side of his mouth would slide up in jest
He’d swear it was possum or rabbit or eel
He could make anything into a meal!
We’d look at it, sniff at it, poke it and think
Is this food something we really can eat?
It was often weird stuff he’d bought back from his travels
We wondered if eating would make us unravel
And Lex, he would hover, and watch us with glee
As we ate some strange critter from trips overseas.
I remember one day we both heard a loud bang
And to his window we quickly both ran
Down on the ground a wood pigeon lay
That poor bird, could not fly up and away
I swear I could see a glint in Lex’s eye
He was thinking of making a yummy bird pie!
At work we often have team building days
Dress up for the occasion our invite would say
When he was put in a team called “Colour Blue”
He quickly made all of their food, turn this hue
And I think that he had a fetish for tights
The costumes he came in were such a delight!
Lex was Robin Hood, Blackbeard and Santa Claus too
There was simply nothing this man would not do
One year we had a Mexican theme
And that year I have to say – Lex was supreme
He came in his hat and white mafia suit
He did sneaky dealings, made funds to boot!
I’ve worked a few places around town in my time
And had a few bosses, who’ve kept me in line
But there’s one who stands out, atop of the rest
There’s no doubt about it, Lex is the “Best of the Best!”
By Sandra “Burgie” Burge
HRC Finance Administrator,
and colleague of Lex Davidson for 24 years
Lex Davidson at the 2009 New Zealand Science Honours Dinner
(Photo courtesy of the Royal Society of New Zealand)

6
HRC News March 2015
Secretariat staff news
The HRC Board Chair, Board members and Secretariat
were delighted to welcome Dr Kathryn McPherson to
the HRC in January as the HRC’s new Chief Executive.
Dr McPherson is an experienced public health researcher
and has worked in the research field for over 16 years to
improve the health of people with disabling conditions.
Dr McPherson is author or co-author of more than 150
peer-reviewed journal articles. She has already had some
experience working with the HRC, having served two
terms on the HRC’s Public Health Research Committee.
Dr McPherson holds a PhD from the University of
Edinburgh. She has clinical experience in nursing
midwifery and community health, and an academic
background in psychology and rehabilitation. In
addition to having held appointments at AUT University,
University of Otago, the University of Auckland, and
Victoria University, Dr McPherson is Visiting Professor
at a number of international universities.
HRC Board Chair Sir Robert Stewart, KNZM, says the
board is thrilled to have someone of Dr McPherson’s
standing in the research community lead the HRC into
the future, and the HRC Board and Secretariat look
forward to working with her.
Dr McPherson is looking forward to working with the
sector to achieve HRC’s mission, and to that end will
meet with a range of stakeholders and researchers from
around New Zealand over the coming months, including
those from universities, government departments,
district health boards, and non-governmental
organisations. Details about Dr McPherson’s plans to
meet with HRC stakeholders will be publicised in future
issues of HRC News and HRC Update.
Welcome back to Rebecca Luther who has returned to
the Research Policy, Strategy and Evaluation team from
parental leave. Rebecca has resumed her role as Senior
Policy Analyst working three days a week (Wednesday,
Thursday and Friday). Many thanks to Pauline Curtis
who filled in during Rebecca’s parental leave and who has
since moved on to a new role at AUT University. We wish
Pauline all the very best.
It’s also welcome back to Senior Evaluations Analyst
Megan Biles, who is working three days a week (Monday,
Wednesday and Friday) as part of the Research Policy,
Strategy and Evaluation team.
We’re pleased to announce that Grant Barnett has been
appointed as the HRC’s new Finance Manager. Grant
comes to the HRC from the Auckland District Health
Board and he will take on many of the responsibilities
previously held by the HRC’s Chief Financial Officer, Lex
Davidson, who sadly passed away in December 2014.
Grant joins the HRC this month and we look forward to
working with him.
The HRC’s former Chief Executive, Dr Bruce Scoggins,
has written a special tribute to Lex Davidson, which can
be found on page 3 of this issue of HRC News.
In November 2014 Stacey Pene’s fixed-term contract role
with the HRC’s Maori Health Research team ended. The
HRC would like to thank Stacey for the contribution he
has made to the HRC during his time here, and wish him
all the best for his future career.
Tribute message from Sir Robert Stewart, KNZM
Lex Davidson, the HRC’s Chief Financial Officer was a man I really admired. He had
many great qualities, but one feature that was outstanding, in my opinion, was that he was
scrupulously honest.
Lex had worked for the HRC for over 24 years, and he will be greatly missed by the HRC Board
and staff of the Secretariat, and many others who had had the pleasure to work with him.Sir Robert Stewart,
KNZM, HRC Board Chair

7
HRC News March 2015
Dr Walker says one of the most compelling reasons to
make cytisine more widely available is the cost. Cytisine is
commercially produced in Bulgaria and Poland, and doesn’t
have a patent attached to it. As a result, it is significantly
cheaper than NRT and varenicline (cytisine: US$20 to
$30 for 25 days; NRT: US$112 to $685 for 8 to 10 weeks;
varenicline: US$474 to $501 for 12 weeks).
“More affordable smoking cessation treatments are urgently
needed,” says Dr Walker. “In New Zealand both NRT and
varenicline are heavily subsidised by the government. This
trial has shown that cytisine is more effective than NRT
and considerably cheaper than both NRT and varenicline,
so big cost savings are possible if cytisine was licensed and
marketed outside of Eastern Europe.”
Following on from this study, Dr Walker hopes to secure
funding to carry out a head-to-head trial to see if cytisine is
as good as varenicline for helping people quit smoking.
Information: Dr Natalie Walker
National Institute for Health Innovation, the University of
Auckland
✆ +64 9 923 9884
n.walker@nihi.auckland.ac.nz
Strategic refresh of the HRC announced
The HRC Board Chair, Sir Robert Stewart, KNZM, recently received a letter from the Science
and Innovation Minister, Hon Steve Joyce and Health Minister, Hon Jonathan Coleman
outlining their intent to undertake a strategic refresh of the Health Research Council of New
Zealand (HRC). The ministerial press release about the nature and purpose of the refresh can be
found at www.beehive.govt.nz/release/health-research-council-review-underway. The HRC is
pleased to be involved in disseminating information about the refresh to key stakeholders.
Why undertake a refresh? The
Government has called for the refresh
to examine how HRC’s contribution
fits with the Government’s broad
health and economic goals. Ministers
have expressed support for our role
in supporting what is recognised
internationally as New Zealand’s
high performing health research
sector. They see the refresh as an
opportunity to facilitate HRC’s role
and contribution, and to capture our
relevance, efficiency, effectiveness and
impact within New Zealand’s Science
and Innovation System.
What will be involved? The process
will involve officials from the
Ministry of Business, Innovation
and Employment and Ministry of
Health jointly conducting the refresh
exercise. They will work closely with
the HRC to collect information, and
consult with the health research
sector and end-users to develop
their advice. Feedback will be sought
from a range of stakeholders such as
researchers and universities, district
health boards, clinicians, medical
technology firms, Māori and Pacific
stakeholders and other funding
agencies. The timeframe for the
refresh is over the next few months
with ministers expecting to receive
the findings in June.
Our expectations? We have been
advised that the word ‘refresh’ has
intentionally been chosen rather than
‘review’ or ‘restructure’. The process is
aimed at enhancing our contribution,
and the intent is that it will be an
open and engaged process. We will be
providing input into, and commenting
on, the advice that will go forward
and officials from the ministries will
be keeping the HRC fully informed as
the refresh progresses.
As the new Chief Executive of the
HRC, I welcome the strategic refresh
as a real opportunity to identify what
the HRC does well, and be responsive
to areas where we could do better. I
look forward to hearing your views
and feedback and receiving the
synthesised findings of the review in
due course. I am keen, as those of you
who have already met me know, to
engage with you and the ministries
on the best way for us to achieve our
mission and our goals.
The HRC takes very seriously the
need to demonstrate our ‘value add’
to New Zealand. To that end we have
initiated a number of activities in
the last year or so that will assist in
producing data to meet the refresh
objectives. For example, interim
findings from our bibliometric survey
provide evidence that HRC-funded
research is more highly cited than
other New Zealand health research.
This is of course just one measure,
but it does indicate the work
produced is of the highest quality and
utility to other researchers. There
are many ways that New Zealand in
2015 is different because of the work
the HRC has supported over the past
25 years. The refresh will inform how
we do this as we move ahead to the
next 25.
Dr Kathryn McPherson
HRC Chief Executive

8
HRC News March 2015
Study identifies ways to make cycling safer
on NZ roads
By Suzy Botica
Cyclists in Auckland have a higher risk of being involved in a crash with a motor vehicle than
cyclists from other parts of the country. This is despite – and possibly because of – the region
having the lowest level of bicycle use relative to car use. Identifying factors that can help
improve the conditions cyclists’ face and overcome barriers to active travel nationally was a key
focus of the recently completed Taupo Bicycle Study.
In 2009, University of Auckland
researcher Dr Sandar Tin Tin began
a HRC-funded project to investigate
the injury risks and cycling behaviour
of a large group of cyclists recruited
from the Taupo Cycle Challenge,
New Zealand’s largest mass cycling
event, in 2006. The 2590 cyclists who
participated in this baseline Taupo
Bicycle Study came from throughout
New Zealand, although most were
from the North Island.
With the support of her supervisors,
Professors Shanthi Ameratunga and
Alistair Woodward, Dr Tin Tin set
about following up with participants
from the baseline Taupo Bicycle Study,
resurveying them through a web
questionnaire. Participants’ data were
then linked to data from four national
databases, including police reports, the
Accident Compensation Corporation
(ACC) claims database, hospital
discharges, and mortality records.
To date, 13 papers based on this
exploratory research have been
published in international peer-
reviewed journals. One of the latest
papers, published last year in the
European Journal of Public Health1
,
examines the role of conspicuity
(i.e. visibility) in preventing bicycle
crashes involving a motor vehicle in
New Zealand.
Dr Tin Tin says they found that aids
designed to increase cyclists’ physical
conspicuity – such as fluorescent
clothing, lights, and reflective
materials – were not sufficient to
prevent bicycle crashes involving
a motor vehicle, particularly in
Auckland where bicycle use is low
compared to car use. More important
for cyclists’ safety on the road was
the visibility of cyclists based on
motor vehicle drivers’ interests and
experience or ‘attention conspicuity’.
“We may be able to improve attention
conspicuity by creating a more
balanced transport mix,” says Dr Tin
Tin. “The ‘safety in numbers’ effect
suggests that if more people cycle
and less drive, cyclists will be safer as
drivers are more likely to pay attention
to the presence of cyclists.”
Although Dr Tin Tin points out that
the Auckland study participants had
different cycle characteristics than
those cyclists from other regions (e.g.
the Auckland cyclists were less likely
to cycle off-road, but more likely to
cycle in the dark and in a bunch), she
says these factors only explain half
of their higher crash risk. The other
half is likely to be due to the car-
dominated transport environment.
“Our findings suggest that New
Zealand has been caught in a vicious
circle in the past two decades, where
a lower proportion of cyclists on the
road decreases their conspicuity and
poses them a higher crash risk, which
in turn discourages bicycle use,” says
Dr Tin Tin.
“Turning this vicious circle to a
virtuous one requires cooperative and
multidisciplinary efforts to promote
cyclists’ safety and encourage cycling
on New Zealand roads.”
Curiously, although cyclists may feel
more visible, and hence safer, riding in
a bunch, the study found that bunch
riding may actually be associated with
a higher crash risk.
“Our study couldn’t determine if the
crash happened during bunch riding,
just that those who engage in bunch
riding are more likely to have had a
crash. Perhaps this is because cyclists
are more likely to take risks in a bunch
and less likely to notice road hazards.”
The Taupo Bicycle Study
project received funding worth
over $600,000 in the HRC’s 2009
annual funding round. Dr Sandar
Tin Tin has recently completed
this five-year long project using
participants’ data linked to four
national databases.
Dr Sandar Tin Tin

9
HRC News March 2015
Other on-road injury risk factors
identified included being over 35 years
old, living in urban areas or in the
Auckland region, using a road bike,
and having had a history of a crash.
Over the study follow-up period, the
Taupo Bicycle Study participants had
116 crashes that came to the attention
of medical personnel or police per
1000 people per year, of which 66
occurred on the road and 10 involved
a collision with a motor vehicle2
.
This correlates to 240 crashes and
38 collisions per million hours spent
cycling on the road – similar to figures
from Australia and the US, but much
higher than European countries.
“Although the latest census shows that
there has been a 16 per cent increase
in bicycle commuting from 2006,
bicycling still only makes up a small
fraction of all trips in New Zealand.
I hope that the outcomes from this
study will help shape strategies to
promote travel-related physical
activity and improve road safety in
New Zealand,” says Dr Tin Tin.
Information: Dr Sandar Tin Tin
School of Population Health, the
University of Auckland
✆ +64 9 373 7999 ext 87034
s.tintin@auckland.ac.nz
Taupo Bicycle Study cyclists
Of the 2590 participants in the Taupo Bicycle Study, 35.5
per cent lived in Auckland, 20.6 per cent in Wellington,
and 42.5 per cent in other regions.
On average, the participants cycled five hours a week on
the road, of which 20 per cent involved riding in a bunch.
About 29.3 per cent reported always wearing fluorescent
colours when cycling.
Of the 1731 participants who cycled in the dark, 83.8 per
cent always used functioning front lights, 89.9 per cent
always used functioning back lights, and 49.1 per cent
always used reflective materials.
The participants identified adverse weather and the
danger of a car-dominated transport environment as the
most important barriers to bicycle travel. More bike lanes
and paths, better bicycle security in public places, and
shower facilities at work would encourage them to cycle
more often.
1
Tin Tin, S, Woodward, A, Ameratunga, S. (2014).
The role of conspicuity in preventing bicycle crashes
involving a motor vehicle. The European Journal of
Public Health.
2
Tin Tin, S, Woodward, A, Ameratunga, S. (2013).
Incidence, risk, and protective factors of bicycle
crashes: Findings from a prospective cohort study in
New Zealand. Preventive Medicine 57, 152–161.
PubMed Commons: A forum for scientific discourse
PubMed Commons provides a forum for sharing information and perspectives about
biomedical publications in the biomedical literature database, PubMed. This project was
developed in response to interest from the scientific community and has been operating as an
open pilot since December 2013.
PubMed Commons enables authors of
PubMed-indexed publications to post
relevant comments to any PubMed
record. Anyone can view comments,
which appear below abstracts.
Comments are posted immediately
but are regularly monitored for
adherence to guidelines. They are
contributed under a worldwide,
royalty-free, non-exclusive, perpetual
Creative Commons license that
permits sharing and reuse.
The quality of the comments is high,
but the use of the Commons is low.
There are currently around 8,500
members, with over 2,700 comments
live on publications. Moderation
occurs after comments are made, and
there is a computational approach
to use ratings and other information
to increase or decrease prominence.
This infrastructure has been able to
minimise the potentially harmful use
of the forum to date.
There is a joining wizard with email
addresses from PubMed authors to
enable self-joining. The PubMed
Commons team provides a personal
alerting service to authors of articles
receiving comments (about 10 per
cent respond to comments).
National Center for Biotechnology
Information
U.S. National Library of Medicine,
National Institutes of Health
Go to PubMed Commons at www.
ncbi.nlm.nih.gov/pubmedcommons
for more information.

10
HRC News March 2015
Harnessing wireless power for artificial
heart pumps
By Suzy Botica
Although artificial heart pumps have revolutionised the treatment of patients with heart failure,
they do have one significant limitation: all of them currently have a bulky cable passing through
the skin to power the pump, which is a major source of infection. In fact, about 60 per cent of
people with heart pumps get a serious infection that requires hospitalisation.
In 2010, University of Auckland physiologist and bioengineer Professor Simon Malpas began
a HRC-funded project designed to circumvent this problem by developing a way to wirelessly
power artificial heart pumps. With the project now complete, we catch up with Professor
Malpas to find out if he and his team at the university’s Auckland Bioengineering Institute have
succeeded in their quest.
Q: What are some of the major
challenges you’ve had to overcome
to develop your system of wireless
power for artificial heart pumps?
A: In industrial or commercial
applications that use wireless power,
such as your electric toothbrush, the
alignment of the transmitter and
receiver coils is known and fixed.
However, it’s different for biological
applications. We humans aren’t fixed;
we have fat, muscle, and tissue, which
makes us squishy – and we move.
We’ve developed a system of power
transfer that allows for two things:
firstly, it allows for the coil on the
inside of the body and the coil on
the outside of the body to move in
relation to each other so that they
align. Secondly, we’ve designed
compact coils that can deliver up
to 10W of power without causing
excessive heating. That’s really
important because if you cause
heating of about 40 to 43 degrees,
this can result in long-term cellular
damage to the patient.
Q: Does your system have a backup
if something goes wrong?
A: Yes, our system includes a
rechargeable backup battery that can
supply 5W for about 30 minutes.
This battery allows the patient to be
tether free so that they can carry out
activities such as showering without
worrying about the power transfer
system. The battery also ensures
there’s constant power in case the
system is accidently disengaged.
Q: How has this new technology that
you’ve developed been received in
the medical devices industry?
A: Our main target opportunity for
this technology was artificial hearts,
and there’s no doubt that remains the
area with a pressing need. Everyone
in the industry recognises the
problem and sees that the solution is
to have wireless power. The market
for artificial hearts is not an area for
the fainthearted though. Companies
need a huge amount of capital for
their development. We’re currently
in discussions with two companies
working in different areas about
the application of our technology,
and we’re going to submit a funding
application with them early this
year. Any company we team up with
has to be at the right phase of their
development cycle – and these two
are – so we’re hopeful successful
partnerships will come about.
Q: Last year you were awarded a
HRC grant of nearly $1.2 million
to develop an implantable device
to improve the management of
patients with fluid on the brain
(hydrocephalus). What’s the main
problem you’re looking to solve here
with the aid of wireless power?
A: Hydrocephalus is one of the most
Professor Simon Malpas was
awarded over $1 million in the
HRC 2010 annual funding round,
for his project to develop wireless
power for an implantable heart
pump.
Professor Simon Malpas

11
HRC News March 2015
common neurological disorders
among children. It’s associated with
increased pressure on the brain due
to excess fluid and/or a failure to
drain this fluid – and it’s fatal unless
a shunt is inserted. While lifesaving,
unfortunately 50 per cent of these
shunts will fail within two years.
Currently, there are no systems that
enable you to monitor a shunt’s
performance. If the pressure is going
up in the skull and the shunt needs to
be replaced or reprogrammed to allow
for more or less flow out, there’s no
means of assessing that.
The symptoms of early shunt failure
are also often very similar to a simple
headache or non-related infection,
which necessitates many costly CT
or MRI scans to resolve. We want to
remove that stress, reduce cost and
radiation exposure, and the likelihood
of missing shunt malfunction by
developing a tiny implant that will
allow clinicians to wirelessly monitor
the intracranial pressure, brain
temperature, and fluid flow of patients
with water on the brain.
Q: How will this implant work?
A: We’re working on developing a
very small implant that would be
placed under the skull. A wand waved
across the implant would then send
intracranial pressure signals remotely
to an external reader. One of the
major parts of this grant is to develop
pressure sensing capability and
stability over a long period of time.
Q: What do you hope to achieve by
the end of this HRC grant?
A: Our aim in this grant is to remain
focused on developing and proving the
technology, and then carrying out the
first animal trials. If we can get through
all of those phases by the end of it then
we’ll be in a good space to seek out
private investment from venture capital
funds or other sources for the next
round of research required.
There are three classes of medical
devices. Class three devices are for
chronic conditions and include
pacemakers and artificial hearts. Our
implant would be a class 3 device,
which means it will be subject to
the most stringent evaluation and
approval processes for safety and
efficacy. I don’t know of anyone else in
New Zealand who has designed and
produced a class 3 medical device, so
it would be unique if we can do it.
Information: Professor Simon
Malpas
The University of Auckland
✆ +64 9 923 6922
s.malpas@auckland.ac.nz
E-therapy for youth depression in primary care
Depression is serious problem affecting more than 50,000 young New Zealanders each year.
There are effective psychological therapies, such as cognitive behavioural therapy, but more
than three-quarters of adolescents with depression never receive treatment.
A research team at the University
of Auckland, led by Professor Sally
Merry, have developed an effective
e-therapy for young people to cope
with feeling down, worried or
stressed, called SPARX. SPARX takes
the form of an innovative fantasy
game that lets young people learn
skills in a virtual world and apply
them in real settings.
With funding from the HRC’s
Research Partnerships for New
Zealand Health Delivery initiative,
Professor Merry, in partnership with
Kapiti Youth Support, undertook
a research project that expanded
SPARX to an online format and
created an e-monitor to link young
people electronically with primary
care clinicians who ‘prescribe’ SPARX,
and who in turn could monitor young
people’s progress.
The research showed that an online
intervention can be delivered
successfully within the context of
a youth health service, with high
levels of satisfaction reported by the
young people who used the resource
and with a significant improvement
in symptoms of depression. It was
identified that feedback can be
provided directly to young people
using SPARX and that this can be
delivered via an e-monitor and web-
based dashboard to clinicians.
SPARX was officially launched at the
University of Auckland by the Prime
Minister on 28 April, 2014.
The findings from Professor Merry’s
research have been used to support
In 2012, Professor Sally Merry
was awarded nearly $200,000 for
her project ‘E-monitoring and
e-therapy for youth depression
in primary care’. Funding was
awarded through the HRC
Research Partnerships for
New Zealand Health Delivery
initiative.
Professor Sally Merry

12
HRC News March 2015
Unique study to explore NZ’s ‘puzzling’
testicular cancer rates
By Suzy Botica
In 2010 a paper published in the International Journal of Cancer showed that Māori have the
highest rate of testicular cancer in New Zealand1
. Intrigued by the paper’s findings, Dr Jason
Gurney is embarking on a programme of research to find out why Māori are the only non-white
population in the world to have the highest rates of this cancer.
Dr Gurney (Ngāpuhi, Ngati Hine) was
awarded a 2014 HRC Eru Pōmare
Research Fellowship in Māori Health
to carry out his study of testicular
cancer at the University of Otago,
Wellington. His supervisor and
mentor for this study is Associate
Professor Diana Sarfati, lead author of
the 2010 paper which first sparked his
interest in testicular cancer.
“It was one of the first papers I read
when I started working with Diana at
the University of Otago, Wellington’s
Department of Public Health. The
paper showed that Māori have 50 per
cent higher rates of testicular cancer
than European New Zealanders. This
is in stark contrast to other countries
where European males suffer up to
five times the rates of testicular cancer
compared to other ethnic groups.
That’s what makes this New Zealand
finding so puzzling,” says Dr Gurney.
Perhaps even more perplexing though
was the finding that Pacific men in
New Zealand have very low rates
of testicular cancer. Māori men are
about three times more likely to have
testicular cancer than Pacific New
Zealanders. Dr Gurney refers to this
as the ‘Polynesian paradox’, where
“two Polynesian populations residing
in the same country experience a
vastly different burden of disease”.
“This is one of the very rare occasions
where Māori and Pacific peoples
don’t move in parallel with respect
to the incidence of a given cancer or
One of the HRC’s major Career
Development Awards – the
HRC Eru Pōmare Postdoctoral
Fellowship – was awarded to
Dr Jason Gurney last year. Dr
Gurney will use his funding to
research why Māori men have
significantly higher rates of
testicular cancer than non-Māori
men. You can read about the
other Māori Health Research
Postdoctoral Fellowships that the
HRC offers at www.hrc.govt.nz/
funding-opportunities/maori-
development.
Dr Jason Gurney and Associate Professor Diana Sarfati (Photo courtesy of the University of Otago, Wellington)

13
HRC News March 2015
disease. It may well be the lynchpin
in this whole mystery, because if we
can explain why Māori have such high
rates of testicular cancer and Pacific
peoples such low rates, then we have
a good chance of explaining what’s
causing testicular cancer – and that
would be ground-breaking.”
Dr Gurney’s fellowship will involve
piloting the first case-control study
of testicular cancer to be performed
in New Zealand. It will also draw on
his lead-authored paper published in
The Journal of Urology2
which found
that ethnic patterns of undescended
testes, where the testes fail to reach
the normal position in the scrotum,
mirrored those observed for
testicular cancer.
“Undescended testes is one of the
few known risk factors for testicular
cancer. We found that Māori had
higher rates of undescended testes
than all other ethnic groups, with
Pacific and Asian groups having
the lowest rates. Since the main risk
factors for undescended testes occur
in the womb, this suggests that the
ethnic patterning of testicular cancer
is at least partly due to prenatal risk
factors.”
Dr Gurney and his research team are
currently in the process of developing
the design for the case-control study,
which he says will require about 1000
participants. Maternal smoking, low
birth weight and short gestational
duration, as well as pre- and post-
natal exposure to cannabis, are just
a few of the potential risk factors
his group will be exploring. Study
participants will also undergo blood
tests to account for any possible
genetic risk factors.
“It’s a bit like looking for a needle
in a haystack, as there are so many
exposures that have been linked to
testicular cancer,” says Dr Gurney.
“As soon as we can pinpoint which
risk factors are more important than
others, then we can start to look at
prevention. We can’t prevent a disease
if we don’t know what causes it.”
Dr Gurney says his HRC-funded
fellowship – which will allow their
group to pilot the case-control study,
before seeking additional funding to
complete it – is a unique opportunity
to not only explain why Māori have
the highest rates of testicular cancer
in New Zealand, but also to help
pinpoint what causes testicular cancer
in general, something which has
eluded the global research community
to date.
“Ultimately, this is all about
preventing testicular cancer. If we
can point to certain things, like
cannabis use, then that’s a highly
modifiable risk factor. I want to
explore every avenue that we can in
terms of retrospective and prospective
research.”
Although advances in treatment have
led to very high survivorship among
testicular cancer patients, Dr Gurney
says that this high survival masks the
impact of other significant outcomes.
“This is a disease with a very long
shadow, as it occurs in young men
with a median age of about 35. A
number of survivors will be left
infertile or suffer some other sexual
dysfunction after treatment. It’s an
enormous quality of life issue not just
for the young men, but also for their
whānau.”
Information: Dr Jason Gurney
University of Otago, Wellington,
✆ +64 4 918 6182
jason.gurney@otago.ac.nz
1
Sarfati D, Shaw S, Blakely T, Atkinson J, Stanley J.
(2010) Ethnic and socioeconomic trends in testicular
cancer incidence in New Zealand. International Journal
of Cancer: 128, 1683–1691.
2
Gurney J, Sarfati D, Stanley J, Studd R. (2013) Do
ethnic patterns of cryptorchidism reflect those found
in testicular cancer? The Journal of Urology, Vol. 190,
1852–1857.
national implementation of SPARX
through the Prime Minister’s
Youth Mental Health Project, in
collaboration with the National
Institute of Health Innovation (NIHI)
at the University of Auckland and the
Ministry of Health. The research team
are continuing to work with NIHI and
the Ministry of Health to implement
and monitor SPARX online, with
the Ministry funding the ongoing
implementation and maintenance of
SPARX.
SPARX is actively being promoted in
many settings, including functions
attended by general practitioners,
school nurses, school guidance
counsellors, psychiatrists and others.
The implementation team at NIHI,
with support from the research team,
have ensured active engagement in
public meetings and community
events designed to reach out to
members of the public (parents,
whānau, community organisations
tasked with youth health), and are
exploring ways in which social media
can be used to maximise the reach to
young people.
For more information, go to
www.sparx.org.nz.
Subscribing to
HRC News
Current and past issues of HRC
News can be viewed on the
HRC website: www.hrc.govt.nz.
If you would like to subscribe to
HRC News, please email: info@
hrc.govt.nz, and put ‘Subscribe
HRC News’ in the header.
Please include your name and
postal address details. You can
also use this email address to
advise us if you no longer wish
to receive HRC News.

14
HRC News March 2015
‘Virus hunters’ make new discovery while
studying unsolved gastro outbreaks
By Suzy Botica
Institute of Environmental Science and Research (ESR) scientist Dr Richard Hall has confirmed
what is believed to be New Zealand’s first reported case of the sometimes nasty virus known as
human parechovirus 3 (HPeV3).
The ESR team, dubbed the ‘virus hunters’,
made the discovery as part of an HRC-
funded study delving into unsolved
outbreaks of human gastroenteritis
(vomiting and diarrhoea).
Each year more than 25 per cent of
gastro outbreaks in New Zealand go
unsolved.
HPeV3 was first discovered in Japan
in 2004, but up until very recently
it has only been reported once in
Bolivia. Last year it caused a significant
outbreak of sepsis (infection of the
blood) in babies in Australia.
Dr Hall says the virus, which mainly
infects babies and young children,
may often cause no symptoms, but
is also known to cause more severe
diseases which can be fatal, including
blood infections in newborn babies,
acute inflammation of the brain, and
even paralysis.
The faecal sample that tested positive
for HPeV3 came from a 2-year-
old child who was part of a gastro
outbreak that occurred in a childcare
facility over the course of 17 days in
2012. It is not clear if it was the cause
of the outbreak, but the Ministry
of Health and the medical officer
of health from the district health
board where the patient resided were
notified about the finding.
“The HPeV3 virus survives in the
body for only a short time, maybe
a few weeks, and is thought to be
spread through the faecal-oral route.
It can affect different tissue types in
the body, such as the membranes
surrounding the brain, but there’s still
a lot that we don’t know about it.”
Dr Hall says the reason why the HPeV3
virus hasn’t been found in Australasia
up until now isn’t because it’s
uncommon. Instead, it’s because people
haven’t thought to look for it before.
“Due to the serious illnesses
associated with HPeV3 infection,
we’d like to make clinicians and
public health authorities aware of its
presence, and suggest they consider
Dr Richard Hall received an
Emerging Research First Grant
worth $150,000 in the HRC’s
2011 annual funding round.
These grants support emerging
researchers who are seeking to
establish independent careers
in health research. For more
details go to www.hrc.govt.nz/
funding-opportunities/researcher-
initiated-proposals.
Dr Richard Hall

15
HRC News March 2015
Rotavirus vaccine trial a success
By Mark Wright
A vaccine that can be safely given to newborns to protect them from rotavirus and the severe
gastroenteritis it can cause, has come a step closer following a successful HRC-funded efficacy
trial in Dunedin.
Although the new vaccine has been
developed by the RV3 Rotavirus
Vaccine Programme at the Murdoch
Children’s Research Institute in
Melbourne, it has strong links to the
University of Otago, through the
involvement of a former paediatrics
senior lecturer, Professor Graeme
Barnes, who moved to Melbourne
in the 1970s and played a key role in
rotavirus research.
University of Otago principal
investigator Dr Pam Jackson says
RV3 was developed from a strain of
rotavirus – identified by Professor
Barnes – where newborns that had it
exhibited no symptoms. Babies who
had it didn’t go on to get rotavirus
later, so that apparent natural
protection made the strain an ideal
basis for a vaccine.
“Also, this strain has come from
human newborns, as opposed to the
other vaccines, which have come from
cow or monkey rotavirus strains.”
To put its importance in perspective,
Professor Barry Taylor, co-principal
investigator and Dean of the Dunedin
School of Medicine and Head of
Paediatrics and Child Health, says
rotavirus kills an estimated 600,000
children every year, mainly in the
third world.
“In New Zealand it would probably
cause one or two deaths per year, but it
does result in a lot of days in hospital.
“It is most dangerous in the first
month or two. The other rotavirus
immunisations that have been
developed by commercial companies
are actually given later and they don’t
protect in that early period.”
Dr Jackson says one of the reasons
Dunedin was chosen for the RV3 trial
is that New Zealand had yet to add
any of the other rotavirus vaccines to
its schedule at that time.
“When you are developing vaccines
you need to start by looking at efficacy
and immunogenicity. What that means
is you have to do a small study to see
if the vaccine produces measurable
protection in the child, and then you
need to broaden it out to other areas.”
A larger scale efficacy study is also
being done in Indonesia because
previous studies have shown that
while current vaccines have good
efficacy in developed countries, in
developing countries efficacy has been
poor, even though that is where such
vaccines are most needed.
Eventually it will be manufactured in
Indonesia using proven oral vaccine
production facilities used for the
production of a vaccine for polio,
which has been largely eradicated.
A robust randomised control trial
used three different groups: one
where they were given a placebo, and
the second where they were given
their first dose as an infant, at about
six weeks, then 16 and 24 weeks.
Those in the third arm were given
their first dose within the first five
days of life, with follow-up doses at
eight and 16 weeks.
“This was a world first. This is the first
time that we’ve had an oral vaccine
given to neonates,” explains Dr Jackson.
“Being able to give the vaccine
early has a number of benefits. In
developing countries, where there is
the highest burden of rotavirus and
the highest burden of deaths, many
people may only see a birth attendant,
or perhaps a midwife. If you can
deliver an oral vaccine at that time
when they are at greatest risk of death
then you will prevent more deaths.”
Giving an oral vaccine early also
negates the risk of intussusception, a
complication seen with some rotavirus
vaccines where the bowel telescopes
into itself.
Dr Jackson says the trial results were
better than expected with the vaccine
providing a strong immune response
in more than 90 per cent of those in
both the newborn and infant group,
which she describes as extraordinary
figures. The vaccine was also well
tolerated without any major problems
or side effects.
A HRC International
Investment Opportunity Fund
grant worth over $450,000 was
awarded to Professor Barry
Taylor and his team in 2008 for
their project looking at a human
neonatal rotavirus vaccine for the
global community.
Professor Barry Taylor

16
HRC News March 2015
According to Professor Taylor,
countries that have already brought in
a rotavirus vaccine have had a 60 per
cent reduction in hospital admissions
for rotavirus after just one year.
One of the existing vaccines was
introduced in New Zealand last year.
However, it’s hoped that once this new
oral vaccine is through its phase III
trials that New Zealand will switch
to using it, because it will be cheaper
and will protect that first month to six
weeks of life.
“The Government, through the HRC,
have put some money into developing
this, so there is a case for using it,” he
says. “It might be another four or five
years before it becomes a commercial
product, but the aim is to produce it
cheaply for third world countries.”
Both Professor Taylor and Dr Jackson
are especially grateful for the support
they have had from the Dunedin
community, saying it takes an altruistic
mother to allow a new vaccine to be
trialed on her baby, especially when
it involves three to four blood tests
afterwards to see if it works.
“Dunedin families are remarkably
altruistic and participate in research
more than any other city in New
Zealand,” says Professor Taylor.
“It’s partly because the university
has always been here and there is a
reasonable amount of trust. We try and
maintain that trust by ensuring things
don’t go wrong and that people are
treated well.”
Professor Taylor says the trial also
had tremendous support from
Emeritus Professor Don Roberton,
Otago’s former Health Sciences
Pro Vice Chancellor, who is an
immunologist.
“We also had an excellent study
coordinator in Amanda Muloch and
some great nursing staff.”
The study is already spawning new
lines of research, including Dr Mee-
Yew Chen’s MD thesis on the vaccine
and the role of maternal antibodies
– the antibodies babies get from their
mother – and whether they interfere
with or even promote the oral vaccine.
“That research hasn’t been done before
so it’s really exciting.”
Information: Dr Pamela Jackson
Dunedin School of Medicine,
University of Otago
✆ +64 3 474 0999 ext 8181
pam.jackson@otago.ac.nz
Professor Barry Taylor
Dunedin School of Medicine,
University of Otago
✆ +64 3 474 7874
barry.taylor@otago.ac.nz
testing for HPeV3 as is carried out in
the US, Japan, and Europe, and more
recently in Australia, especially for
rare cases of severe disease that can’t
be explained,” says Dr Hall.
The development of any future
diagnostic tests would be put together
by ESR, the Ministry of Health, and
DHB labs.
The study team used the latest
high-throughput DNA sequencing
technology offered by New Zealand
Genomics Limited to test the
anonymous faecal samples. The
techniques used were able to capture
any known virus listed in the
GenBank database at the National
Center for Biotechnology Information
in the US. The list of DNA sequences
generated was huge – enough to fill up
34,140 volumes of Pride and Prejudice.
In addition to HPeV3, the data
analysis also revealed a spectrum
of other viruses and parasites that
may have caused the previously
unsolved outbreaks. Two viruses were
identified that are already known to
cause such outbreaks – sapovirus
and rotavirus. Dr Hall says these
viruses must have escaped detection
during routine laboratory testing. The
new information collated from this
study has been used to refine current
laboratory testing methods, allowing
for more outbreaks to be resolved.
“Viruses cause a huge percentage
of the 4.5 million cases of vomiting
and diarrhoea that happen in New
Zealand every year. They are usually
very contagious and can quickly be
passed on and affect a vast number
of people. These viruses are like the
$2 coins in your wallet: they are very
common and change hands a lot. If
you’ve had something like norovirus,
you can be shedding viral particles for
up to three weeks.”
The full results of this study have been
published in the top international
Journal of Clinical Microbiology1
.
Information: Dr Richard Hall
Institute of Environmental Science
and Research (ESR)
✆ +64 4 529 0605
richard.hall@esr.cri.nz
1
Moore N E, Wang J, Hewitt J, Croucher D, Williamson
D A, Paine S, Yen S, Greening G E, Hall R J (2015).
Metagenomic analysis of viruses in feces from unsolved
outbreaks of gastroenteritis in humans. Journal of
Clinical Microbiology, 53:15–21.
About HRC News
HRC News can be viewed on the HRC
website: www.hrc.govt.nz
Editor: Kristine Scherp
Writers: Suzy Botica
Mark Wright
Email: sbotica@hrc.govt.nz
Postal: PO Box 5541, Wellesley Street
Auckland, 1141, New Zealand
Phone: (09) 303 5200
Fax: (09) 377 9988
Contributions are welcome. All articles in
HRC News may be reprinted, provided the
writer and the source are acknowledged.
ISSN 1178-9565 (Print)
ISSN 1178-9557 (Online)

17
HRC News March 2015
Shaping palliative care for Māori
By Mark Wright
Research carried out as part of an HRC partnership project with the Ministry of Health has
provided valuable information to develop more appropriate palliative care for Māori.
Lead researcher Dr Lesley Batten,
from the Research Centre for Māori
Health and Development at Massey
University, says at the time the
Request for Proposals was released
they were already working on clinical
issues around Māori end of life care
with Arohanui Hospice in Palmerston
North.
“When the Liverpool Care Pathway
(LCP) – which was the gold standard
end of life pathway for the last 24
to 48 hours of life – was introduced
to New Zealand, Arohanui Hospice
was one of the key organisations that
introduced and evaluated it.”
Dr Batten says Māori have not been
accessing hospice care in the same
numbers as other groups, and they
have been identified as a population
with special needs in the New Zealand
Palliative Care Strategy.
A multiphase study was launched,
beginning with a stocktake of the LCP,
to examine cultural goals and how
those operated in practice.
The researchers also interviewed
stakeholders to get their perspectives
about cultural care.
Dr Maureen Holdaway, the Associate
Director of the Research Centre
at Massey, says they interviewed
patients, whānau, Māori health
providers, and community support
people – including kaumatua, kuia,
and health workers – to find out what
they felt Māori end of life care should
involve.
“One of the key things to come
out of this was that some of the
issues whānau had around cultural
understanding, communication,
information and support services
hadn’t improved greatly over a long
period of time.
“But there were also some very good
examples of how well some support
services, especially aged care facilities,
accommodated whānau and whānau
needs. Simple things like being able
to have co-care and sing waiata, and
accommodating the family without
them feeling like they were an
imposition on staff,” she says.
“Other positive things included
providing special foods and enabling
whānau to be part of the process by
doing some of the basic care and
attending to cultural needs to ensure
their whānau member had a good
journey.
Dr Maureen Holdaway and Dr Lesley Batten (Photo courtesy of Massey University)
Dr Maureen Holdaway and
her team were awarded $803,763
for a project, which commenced
in March 2011, to research
culturally appropriate end of life
care for Māori. This project was a
joint venture funded through the
HRC’s Partnership Programme
initiative, in conjunction with
the Ministry of Health. For more
information about the HRC’s
Partnership Programme, go
to www.hrc.govt.nz/about-us/
PartnershipProgramme.

18
HRC News March 2015
Asthma and cancer vaccine research
crossover
By Mark Wright
New technology developed by Malaghan Institute researchers as part of HRC-funded
research into cancer vaccines, is also feeding into early stage HRC-funded research into a
vaccine for asthma.
“It’s one of these serendipitous
crossovers between the two diseases
that we are looking at,” explains
Deputy Director of Research at
the Malaghan Institute of Medical
Research, Associate Professor Ian
Hermans.
“We have been working on a synthetic
anti-cancer vaccine that simulates
particular T-cells in the tumour
setting. The idea is that you elicit a
T-cell response that can identify and
kill tumour tissue.”
Meanwhile, Malaghan Institute
Senior Researcher Professor Franca
Ronchese is particularly interested in
the way immune responses, like an
asthmatic response, involve important
immunostimulatory cells called
dendritic cells.
These sentinel cells are distributed
throughout the body and take in
molecules that are present in the
local environment. While they are
particularly attune to pathogens or
tissue under distress, they sometimes
react to inhaled allergens, triggering
an inappropriate immune response in
the form of asthma.
Because the dendritic cell is at the
heart of that process, Professor
Ronchese wants to examine whether
killing dendritic cells that have
acquired allergens can effectively shut
down that inappropriate immune
response. She is particularly interested
in the possibility of harnessing the
In the HRC 2011 annual
funding round, Professor
France Ronchese and her team
were awarded over $1 million
for a project to research the
immunotherapy of allergic
disease.
Professor Franca Ronchese and Associate Professor Ian Hermans (Photo courtesy of the Malaghan
Institute of Medical Research)

19
HRC News March 2015
immune system to do the job.
Associate Professor Hermans says the
vaccines they have been developing
are designed to generate a particular
phenotype of T-cell that has the ability
to select cells and kill them.
“What we’ve done with our vaccine in
asthma is to push their activity into
killing anything that has acquired an
allergen, so effectively these T-cells
could kill dendritic cells.”
“That is where the two paths cross:
around this ability to stimulate killer
T-cells to a defined product. In this
case, it’s an allergen, and in the case of
a tumour, it’s to a tumour-associated
protein.”
The vaccine design has already
proved effective in an animal model
of asthma, and is also looking very
promising in cancer models.
One of the key components of the new
vaccine technology is an adjuvant,
which was developed in collaboration
with synthetic chemist Dr Gavin
Painter from the Ferrier Research
Institute at Victoria University of
Wellington.
Associate Professor Hermans says the
adjuvant is attached to the vaccine to
strengthen the immune response. The
aim is to generate a large population
of T-cells which are specific to an
allergen, if you want to treat asthma,
or to a tumour protein, if you want to
treat cancer.
“We’ve been focusing on a very
unusual adjuvant that brings a third
immune cell type called an NKT cell
into the equation, which actually helps
the killer T-cell response develop.”
These NKT cells recognise glycolipids
rather than proteins, or peptide
fragments from the proteins. The
researchers chemically link glycolipids
to the vaccine in such a way that
the vaccine remains inactive until
delivered to speciallised cells within
the body that drive killer T-cell
responses. The components are then
separated by intracellular enzymes
and go their separate ways. They end
up on the cell’s surface in the right
orientation to stimulate NKT cells,
and push the killer T-cells to divide.
In the case of the asthma vaccine, the
aim is to encourage killer T-cells that
are specific to the allergen to divide
rapidly over the next few days, so that
millions of cells can then circulate to
the lungs and surrounding lymphoid
tissues that drain from the lung, and
kill off any dendritic cells involved in
causing asthma.
The new vaccine technology also
raises the possibility of looking at this
model for other allergic diseases later
down the track.
Information: Associate Professor Ian
Hermans
Malaghan Institute of Medical
Research
✆ +64 4 903 3043
ihermans@malaghan.org.nz
“Death and dying was just one stage
in the journey. For whānau it was
also important to have the time to
think and talk about what was going
to happen after, and for providers to
accommodate some of the things that
they wanted.”
Dr Batten says one of the key things to
emerge from the findings of that part of
the project was that cultural care wasn’t
just about someone’s ethnicity. Rather,
it was about all of the care being
integrated so that there was respect for
communication and coordinated care.
“It wasn’t a case of the hospice or
health service taking over the cultural
matters. If the health services had
their work sorted, the whānau could
get on and do their work – and the
two of those together made culturally
appropriate care.”
The third phase of the study was
translational: taking what was learned
from the first two phases and working
with the providers to set up pilot
projects.
One project involved providing
specific education for undergraduate
nurses, while another ran an intensive
integrated toolkit programme in an
aged residential care organisation. This
included an audit and staff education
and a number of other activities.
Another part of the study involved
making changes to the LCP document
that is being used in New Zealand
to standardise things like ethnicity
documentation to meet national
standards. This included doing
simple things like creating space
for both a next of kin and a whānau
spokesperson, and allowing for a
tohunga or Māori spiritual advisor,
alongside religious support.
Dr Batten feels that they now have the
framework for something that could be
rolled out.
“This research was developed from the
beginning as translational research.
That meant there was always the
expectation that the people in positions
of influence in clinical situations would
have something to work with at the
end of it, and we have developed some
clinical tools that could be used in
clinical practice.”
Information: Dr Maureen Holdaway
Research Centre for Māori Health &
Development
Massey University
✆ +64 9 414 0800 ext 85092
m.a.holdaway@massey.ac.nz

HRC News March 2015
Right dose – right result
By Mark Wright
“It’s about the right dose, of the right drug, for the right time, in the right patient, which leads to
the right result.”
“It’s about the right dose, of the right
drug, for the right time, in the right
patient, which leads to the right result.”
It is a simple and succinct explanation,
but Dr Paul Chin, from the University
of Otago, Christchurch says it neatly
sums up the aim of his pharmacology
research undertaken after he was
awarded the 2012 HRC Clinical
Research Training Fellowship.
“The overall thrust was to work out
better ways to dose patients with
various medications. With all drugs
you have to balance the risk of side
effects against the potential benefits.”
During his two-year fellowship Dr
Chin focused on two medications:
the antibiotic gentamicin, which has
been around for about 50 years, and
a relatively new blood thinner called
dabigatran.
Dr Chin says that although gentamicin
is used widely, it has side effects such as
deafness and kidney damage.
“Despite the potential for those
complications, it has been a really
good antibiotic and is still used today.”
Dabigatran, like the warfarin it
replaces, can cause bleeding.
“It’s about trying to dose those things
better and try and find tools that
prescribers can use to help with the
dosing and ensure patients are not
getting too much or too little.”
Both drugs are eliminated through
the kidneys and while tools, such as
kidney markers for measuring kidney
function, are being refined all the
time, they also need better equations
to evaluate those measurements.
Dr Chin says he has investigated new
equations that are better at working
out what sort of dose the patient
should be on – particularly in relation
to gentamicin – so that the chances of
kidney damage can be reduced.
They found dabigatran had some
added levels of complexity in terms of
what happens to it in the body.
“Even using the best equation for kidney
function, the prescriber can really only
account for about 40 per cent or so of
the information they would need to get
a good handle on what sort of dose the
patient requires. There is still a large
amount of variability to explain and I
wanted to see if there was a better way
of doing it.”
Dr Chin says they looked to blood
markers, comparing those to
clotting tests on blood samples, then
successfully correlated those with
dabigatran levels to work out what the
levels should be.
“One of the original selling points
of dabigatran is that you don’t have
to subject the patient to regular
blood tests; you can prescribe the pill
and walk away. With warfarin, the
medicine it is meant to replace, we
usually do regular blood tests to see if
the blood is thin enough or too thin.
“We’ve shown that about 20 per cent
of patients using dabigatran are going
to have blood that is either too thick
or too thin. Being able to identify
those patients would be quite helpful
in terms of trying to reduce their risks
of clots or bleeds.”
Dr Chin says that having a test to
measure dabigatran levels can tell you
whether they are getting too much
medication or whether there is some
other medicine the patient is taking
that is affecting it.
As a result, they have been able to
provide an optimum range of levels
for prescribers to target to avoid both
over-treatment and under-treatment.
“The next step is to work out whether
targeting those levels actually
improves outcomes,” he says.
“In New Zealand we already have
15,000 patients on dabigatran, even
though it is new, so it is an extremely
important medicine for us to get a
good handle on.”
Information: Dr Paul Chin
Department of Clinical Pharmacology
University of Otago, Christchurch
✆ +64 3 364 0640
paulchinnz@gmail.com
Dr Paul Chin
Dr Paul Chin was awarded a
HRC Career Development Award
– a Clinical Research Training
Fellowship – worth over $150,000
in 2012.
Clinical Research Training
Fellowships for the HRC’s 2016
funding round open on 4 June
2015. Go to www.hrc.govt.nz/
funding-opportunities/career-
development for more details.

Clinical Trial Tabex News NZ 2015

Recommended

Recommended

More Related Content

Viewers also liked

Viewers also liked (19)

Similar to Clinical Trial Tabex News NZ 2015

Similar to Clinical Trial Tabex News NZ 2015 (20)

More from Georgi Daskalov

More from Georgi Daskalov (20)

Recently uploaded

Recently uploaded (20)

Clinical Trial Tabex News NZ 2015