Tag Archives: Research

Younger Women’s Wellness after Cancer Program improves quality of life for women in New Zealand

Preliminary results from the culturally adapted Kōwhai Study in New Zealand are showing positive signs that the Younger Women’s Wellness after Cancer Program has the potential to improve the quality of life of women after cancer treatment.

We spoke to the Kōwhai Study Manager and long-time Women’s Wellness collaborator, Janine Porter-Steele, about the latest results from the study, as well as future plans for implementation across Australia, New Zealand and Hong Kong.

How are lifestyle intervention programs proving to improve the quality of life for women after a cancer diagnosis?

Younger women, under the age of 50, treated for breast cancer in Australia and New Zealand (NZ) are a large and growing population and while advances in diagnosis, treatment and management have significantly improved survival rates, the medium, long-term and late side effects reflect a significant burden to young women. Side effects include physical, psychosocial and psychosexual issues, like early menopause and associated risks, fatigue, obesity, sleep disturbances, higher incidence of diabetes, and cardiac and bone health concerns.  Social aspects might include disruption to family, relationships and work-life as well as fitting in with peers. Psychosexual side effects of treatment include sexual dysfunction, fertility and body image issues.

Studies have demonstrated that women believe they lack information and confidence in ways to not only reduce their risk of recurrence of cancer and other chronic disease but also to manage the long-term effects that cancer has on their lives.

There is also evidence that lifestyle interventions can mitigate chronic disease risk and many of the side effects associated as well as improve quality of life for this group of patients.

This is why we developed the The Women’s Wellness after Cancer Program (WWACP), which is a twelve-week Program designed to address common treatment after-effects in women after cancer. This program was subsequently adapted to focus on the different needs of younger women (Younger Women’s Wellness after Cancer (YWWACP). It has been trialled as a feasibility study in New Zealand (NZ) (The Kōwhai Study), in Australia (The Emerald Study), and in Hong- Kong. As part of the NZ study, a separate and discreet sub-study offering a culturally adapted program was undertaken with a cohort of Māori women.

Can you tell us a bit more about the Kōwhai Study, which was recently completed in New Zealand?

The Kōwhai Study recruited women aged 18- 50 years who had completed intensive treatment (surgery, chemotherapy / targeted therapies and radiotherapy) for breast cancer in the preceding 24 months.

The participants were randomised into a control (usual care) group or to an intervention group. The participants allocated to the control group received general information from their usual health care professionals during their routine clinic visits. The intervention group received a journal, fact sheets, access to a website and 3-5 consultations over the twelve-week duration of the program with an experienced cancer care nurse.

Apart from assessing the usability, acceptability and accessibility of the Kōwhai Study, improving quality of life was equally important, as our aim with the Younger Women’s Wellness after Cancer programs is to improve late and long term side effects and reduce distressing ongoing symptomology.  Secondary endpoints include comparison of waist circumference measurements from commencement to completion of the study and changes in menopausal symptoms, body image, sexual function, sleep, physical activity and nutrition.

Despite launching the Study during the Covid pandemic, we received a rapid intake of participants, which demonstrated an enormous desire for this type of lifestyle intervention in New Zealand.

What were some of the outcomes of the Study?

 While we are still collating and analysing some of the data from the Study, the Kōwhai Study is showing promising signs of improving late and long-term side effects of cancer treatment and improving quality of life for participants, from a physical, psychosocial and psychosexual perspective.

Participants are reporting reduced levels of distress, improved emotional status and a downward trend in waist circumference.

What’s next for the Younger Women’s Wellness after Cancer Program?

We have now completed feasibility studies in New Zealand (Kōwhai Study), Australia (Emerald Study) and Hong Kong (YWWACPHK), with all three studies receiving high interest and uptake from local participants and positive feedback. This proves to us that the program is feasible and accepted and that, if rolled out more widely, could be very successful and have a great influence on improving the quality of life for younger women after cancer.

We are now pooling the results from these three studies and will be looking to secure a larger partnership grant, in the near future, to conduct a larger study and roll the program out more widely.

For more information about the Kōwhai Study, click here.

For more information about the Emerald Study, click here.

For more information about the Younger Women’s Wellness after Cancer Program in Hong Kong, click here.

Women in Hong Kong pilot Younger Women’s Wellness after Cancer Program

A team of researchers at the Chinese University of Hong Kong have recently completed the pilot study of a culturally-adapted Younger Women’s Wellness After Cancer Program for Women in Hong Kong (YWWACPHK).

We sat down with Assistant Professor Dorothy Chan from the Faculty of Medicine at the University to discuss the program pilot and plans to conduct a full-scale study in the coming months.

What was the driver for developing a culturally-appropriate program for younger women after cancer in Hong Kong?

Breast cancer is the most common cancer among Hong Kong Chinese women, and its incidence rate has continued to rise in recent years. In 2020, 4,956 new cases of breast cancer were reported in Hong Kong. Of these, 1,314 patients were aged below 50 years, representing 26.5% of the total breast cancer cases.

The number of breast cancer cases diagnosed at age 50 or below in Hong Kong is increasing. Around 70% of Chinese women in this age group are married and participate in the work force. Younger Chinese women with breast cancer are therefore expected to return to work after their cancer diagnoses and treatment. Current health promotion programmes for women with breast cancer in Hong Kong do not specifically target the younger age group. Most require the women to physically attend during office hours, and thus many working women may not be able to participate. The availability of a flexible and Internet-based programme that overcomes the problems of time constraint and geographical location can offer a new channel through which women can receive health information, advice and care from healthcare professionals. Nearly 99% of Hong Kong citizens use their smartphones to connect to the Internet, and approximately 71% use desktop computers. The Internet-based YWWACP, aimed at providing a whole-lifestyle intervention to help younger women managing their health, can therefore represent a suitable approach, which meets younger women’s needs and facilitates the delivery of information and support.

How has the program been adapted for Chinese women in Hong Kong?

The programme was culturally adapted, and modifications made where necessary. The text of the electronic original YWWACP programme book was translated into traditional Chinese. Then, to enhance the cultural relevance, some modifications were made, for example, in relation to the diet (types of food), the types of physical activities commonly performed by Hong Kong Chinese women and the places where relaxation activities took place. The body mass index was modified with reference to the recommendation made by World Health Organisation for Asian adults. Information about alcohol after cancer was removed as alcohol intake is not common among Hong Kong women. Furthermore, instead of presenting the content in the form of an electronic book, the contents were presented on the website and scheduled on a daily and weekly basis (over a 12-week period). In addition, some health information, such as local cancer statistics and screening measures, and the official websites of health departments providing information on healthy eating and physical activities, were added.

To illustrate the steps to perform stretching and muscle strengthening exercises, graphics of young Chinese women were used. A voice plugin function was added so that the participants could click and listen to the content. Consultations with a cancer nurse were conducted either using telephone or text messaging with a cancer nurse at Weeks 6 and 12 as per the preference of Hong Kong Chinese women made during the virtual consultation at the beginning of the programme. The discussion board was removed as suggested by previous WWACP studies as it was rarely used by participants.

What are you hoping to achieve from conducting a full-scale study later in the year?

In our pilot study which was conducted during the COVID-19 pandemic, at 12 weeks after intervention completion, the intervention group showed a significant increase in the pain subscale scores of sexual function, and more improvement in the level of physical activity than the control group. Nineteen intervention group participants reported that they were satisfied with the programme and suggestions for improvement were provided. We hope that in our future full-scale study, not only could we see the changes in their level of physical activity and sexual function, but also we hope to see changes in other aspects, such as sleep quality, dietary intake and quality of life.

What are your long-term ambitions for the YWWACPHK?

In the long term, we hope that this programme will be incorporated into the routine health services offered to breast cancer patients or have the website of the programme made available to all cancer patients who would like to search and obtain information.

For more information about the Younger Women’s Wellness after Cancer Program for Women in Hong Kong, you can visit ywwacp.nur.cuhk.edu.hk/

Tele-exercise to boost recovery for regional cancer patients

Women in rural and regional areas recovering from gynaecological cancer and treatment will now have access to a University of Queensland rehabilitation program through telehealth.

Professor Sandie McCarthy from UQ’s School of Nursing, Midwifery and Social Work, and co-lead of Mater Research’s Health Care Delivery and Innovation program, said additional  funding from Wesley Medical Research is expanding the ACUMEN program to help regional Queensland women access support previously unavailable to them.

“More than one third of women living with reproductive cancers in Queensland are from regional and rural areas and unfortunately, many can’t access the same post-operative support as their city peers,” Professor McCarthy said.

“The new funding from Wesley Medical Research expands the current ACUMEN program by providing this group of women with the support they need through telehealth.

“ACUMEN brings together a group of health providers to deliver key recovery tools that will enhance quality of life, and now we can do that through videoconferencing.”

Approximately 20,000 Australian women are living with treatment-induced chronic disease after their cancer diagnosis.

The project’s Chief Investigator Dr Janine Porter-Steele, from Wesley Medical Research, Wesley Choices Cancer Support and UQ’s School of Nursing, Midwifery and Social Work, said it was important to get regional and rural women involved in the program.

“Most women with reproductive cancers are insufficiently active and it comes down to the lack of support and education provided,” Dr Porter-Steele said.

“Despite the known benefits of exercise after treatment, only 30 per cent of women met physical activity guidelines.

“ACUMEN is addressing an unmet need for a large group of women who are at a heightened risk of chronic conditions including diabetes, fatigue, and psychological distress.”

Rural and regional participants will receive basic equipment, assessment tools and a Fitbit for activity tracking.

Supervised exercise sessions will be delivered via a videoconferencing platform.

The first phase of the ACUMEN program has delivered face-to-face sessions for almost 50 women in south-east Queensland over the past year.

Program participant Kerry Henry said self-confidence is replaced with fear and loss of control after a cancer diagnosis.

“The program gave me a chance to take control of my fitness, and with the support of great exercise physiologists it improved my strength and balance and I feel so much better within myself.”

Queensland women living in regional and rural areas can join the program by emailing the research team at acumen@uq.edu.au.

The University of Queensland, Wesley Medical Research and The Wesley Hospital, Mater Research and Metro North Health work together to deliver the ACUMEN program, with new funding from Wesley Medical Research enabling regional and rural women to access the program via telehealth.

This article first appeared in the UQ News.

Why women need to talk about type 2 diabetes

We recently spoke with Professor Jackie Sturt from Kings College London on the Women’s Wellness podcast about why women need to talk about type 2 diabetes and how the Women’s Wellness with Type 2 Diabetes program is helping women feel supported on their journey to wellness.

More than 200 million women across the globe are living with type 2 diabetes, which is a deficiency in insulin. Professor Sturt says the reason for the lack of insulin is often because the cells in our body have become resistant to the insulin circulating, which is necessary for glucose to get into our cells.

“Our body needs this glucose to function, but in type 2 diabetes there’s a problem between the lock and the key,” she says.

“The glucose is not getting from the circulating blood system into the cells that need it. So, there’s too much glucose circulating the body, which is what causes the problems.”

Professor Sturt says that type 2 diabetes now affects more than 60 million younger women, between the ages of 18 and 39, across the globe.

“There are genetic factors that affect your likelihood of developing type 2 diabetes, however, globally we’re living in this obesogenic environment, which is promoting sedentary behaviour and higher calory intake,” she says.

“These factors lead to weight gain and this can play a part in switching on those genes that trigger diabetes, so type 2 diabetes is certainly linked to lifestyle factors.”

Professor Sturt says women’s experiences of living with chronic health conditions differ from those of men so women need tailored support programs to suit their specific needs and concerns.

“Women have a reproductive stage of life, which can span between the age of 14 to 65, and this stage is very much impacted by living with a chronic condition like type 2 diabetes,” she says.

“Not only are women having to manage this complex metabolic condition, but they’re also having to manage their menstrual cycle, hormonal fluctuations, pregnancy and contraception and then the depletion of hormones and heading into menopause and the weight gain associated with this stage.

“All of these factors make it very difficult for women to focus on their diabetes, so they need extra support and special focus to help them feel like they’re in control and they’ve got some sense of management of these twin health experiences.”

Listen to the full episode on the Women’s Wellness podcast here or read more about the Women’s Wellness with Type 2 Diabetes program here.

 

WWAGBP program

Grant recognises need to develop wellness program for Vietnamese women after giving birth

A team of researchers from VinUniversity in Vietnam and the University of Technology Sydney in Australia have been awarded a grant to develop a 12-week wellness program for Vietnamese women after giving birth. We spoke to Dr. Nguyen Thi Thanh Huong, Assistant Professor, Senior Lecturer at College of Health Sciences, VinUniversity – Principal Investigator of this project, about what this program will mean for women in Vietnam.

Q. What was the impetus for developing a women’s wellness after giving birth program for Vietnamese women?

The transition to parenthood is a potentially vulnerable time for mothers’ mental health. Baby blues are expected to happen during the first couple of weeks. However, for approximately 20% of Vietnamese mothers, it goes beyond that, resulting in postpartum depression in the first year after birth. Complications of this condition involve both the mothers – lower life quality, or even suicidal/self-harming behaviours; and their children – impaired physical as well as mental development.

Vulnerable groups of women in less socio-economically developed areas with economic constraints, lack of family support, and/or insufficient access to information regarding mental wellness are less likely to seek mental health services and even if they do reach out, mothers tend to seek help from fortune-tellers or “word-of-mouth” medicine rather than modern and evidence-based methods.

Q. How will the Program be developed?

The VinUniversity women research team, in collaboration with the University of Technology Sydney research team led by Professor Debra Anderson, aims to explore the current situation of mental wellness of Vietnamese women after birth and associated factors. After that, a Vietnamese version of the Women’s Wellness Program (WWP), named Women’s Wellness After Giving Birth Program (WWAGBP), with a package of booklets, a website, and delivery guidelines will be adapted and piloted to confirm the degree to which the package adequately reflects the Vietnamese cultural context and effectively promotes Vietnamese women’s wellness after giving birth.

Q. How long do you anticipate it will take to develop and launch the Program?

The Program is anticipated to take nine months to develop before being piloted. In this phase, a baseline survey will be conducted to explore the prevalence of postpartum depression among women after giving birth and associated factors. Then, the WWAGBP will be culturally adapted from the WWP and be confirmed on its validity and reliability by health experts in related areas and by key stakeholders.

We hope to launch the program to the first round of participants in mid-2023.

Q. What will the Program look like for Vietnamese women?

Women who have delivered their babies within one year (or even pregnant women willing to join) will be invited to participate in a 12-week wellness program that will help mothers handle the special changes or prepare them to be ready for women’s issues after giving birth. The topics that might be included in the wellness program include; nutrition, sleep, stress and relaxation and psychosocial support.

Two milestone evaluations will be set for weeks 1, 6 and 12 week and 12. A wrap-up workshop with experts from WWP international network (Australia, New Zealand, United Kingdom, China, Hong Kong, and Vietnam) will be organised to review the outcomes of the WWAGBP in the pilot and develop an action plan for future implementation of the WWAGBP in a larger-scale project.

Q. What do you hope to achieve with the development of this Program?

We hope the WWAGBP will be an innovation that uniquely contributes to current efforts to support Vietnamese women after giving birth as a non-pharmacologically virtual support for women’s wellness, a culturally adapted WWP aligning with the Vietnamese context, and a pioneering and novel program for women after giving birth.

This program will contribute to the body of knowledge in Vietnam and the world about postpartum depression, mental wellness for women after giving birth, and effective coping strategies delivered with an e-health intervention package.

For more information about the Women’s Wellness after Giving Birth Program in Vietnam, please contact:

Dr. Nguyen Thi Thanh Huong – Principal Investigator
College of Health Sciences, VinUniversity, Hanoi 100000, Vietnam
Email: huong.ntt@vinuni.edu.vn

Ms. Hoang Phuong Anh – Project Coordinator
College of Health Sciences, VinUniversity, Hanoi 100000, Vietnam
Email: anh.hp@vinuni.edu.vn

One program doesn’t suit all – translating the WWACP in New Zealand and Hong Kong

Following the success of the Women’s Wellness after Cancer Program (WWACP) trials in Australia, Professor Sandie McCarthy had the opportunity to take Women’s Wellness outside of Australia when she took up a position at the University of Auckland back in 2017. We talked to Professor McCarthy about why there was a need for Women’s Wellness programs overseas and how the programs have been translated to be culturally appropriate and successful in different countries and regions.

What was the impetus for translating the programs for different cultures?

In 2017 I took up the role as Head of the School of Nursing at the University of Auckland. Given my background as a chemotherapy nurse in Australia and many years in research developing the Women’s Wellness after Cancer Program, it soon became very clear that there was no cancer research happening in supportive care in New Zealand.

The system was similar in terms of acute cancer treatment but, like Australia, it lacked the aftercare that women were crying out for. And the more I embedded myself in the system and heard from clinicians and patients, the more I realised the critical need for a program like the Women’s Wellness after Cancer Program in New Zealand.

How did you adapt the program for New Zealand and, in particular, Māori women?

I started talking to Cancer Trials NZ, who traditionally dealt with acute treatment, but who were very interested in exploring the development of a supportive cancer recovery program for women in New Zealand. At the same time, we identified that Hong Kong women were also hungry for a program. We successfully secured a grant to support New Zealand and Hong Kong to work together to build up the Women’s Wellness after Cancer Programs to be culturally appropriate and address specific needs in each country.

We worked with community leaders, health practitioners and academics to tailor the programs. In New Zealand, the program we run looks very different to the one we run in Australia. For example, in New Zealand our sessions are run in a Māori cultural space in groups, rather than individual sessions, to recognise that illness is shared by the whole family rather than just tackled by the individual who is unwell.

In Hong Kong, where alcohol is not really a health concern, we stripped that out of the program and the approach we’ve taken is much more direct to suit the learning culture. The Hong Kong program also focuses mainly on gynecological cancer with a strong emphasis on sexuality.

And what’s next?

The trials in New Zealand and Hong Kong have been hugely successful and we’ve since secured two grants to develop Hong Kong and Cantonese versions of the program. We also secured a grant from the Health Research Council of New Zealand to develop a culturally appropriate program for younger women in New Zealand with breast cancer. This trial has just been completed and was a huge success, finishing 12 months earlier than expected, even though it started 9 months late.

We are also really excited to announce that we will be implementing our Women’s Wellness after Cancer Program across a major health service in Queensland and will start to train more than 200 clinicians across their public and private services.

For more information about the Women’s Wellness Programs, visit www.dawncomplete.org.au

Life after cancer treatment – bridging the wellness gap

With the launch of the Women’s Wellness podcast, we spoke to Professor Sandie McCarthy from the University of Queensland about the Women’s Wellness after Cancer Program; its origins, its purpose and how lifestyle interventions can improve post-treatment experiences.

Why do we need a program for Women’s Wellness after Cancer?

The catalyst for the Women’s Wellness after Cancer program happened when I was working as a chemotherapy nurse many years ago. I would provide care for women over an intensive period of time and then never see them again and would often wonder what happened to these women after their cancer treatment. One day I ran into a lady I had helped treat and she looked really unwell. I asked how she was doing and she said that while the cancer was gone, she was left with heart failure. And this was many years before we fully understood the many side effects cancer treatments have.

So from that moment on, I started researching what happened to these women and was quite devastated as a clinician as to the after effects, and long term side effects, of the treatments that I had been administering. In those days these weren’t really well recognised – they are now.

Today we also understand that if we implement certain lifestyle changes, both during and after treatment, we can often prevent those side effects from happening or moderate their effects. And this was ultimately the impetus for the development of the Women’s Wellness after Cancer Program.

What sort of lifestyle modifications can women put in place if they are undergoing cancer treatment or completed treatment?

There’s a raft of different lifestyle changes and modifications women can make after cancer treatment but what ultimately underpins success for women’s wellness is good psycho-social support. We’ve got to wrap these women in a support blanket, because essentially when they’ve left cancer treatment, they’re left to recover on their own – they are considered well. Many women don’t know what lifestyle changes or strategies to use to change their treatment outcomes and post treatment experience.

What we’re really focused on with the Women’s Wellness after Cancer Program is quality of life and function for these women, and how lifestyle modifications can enhance that. This includes things like lots of movement, minimising alcohol wherever possible, eating a really healthy diet, getting enough sleep, minimising the effects of early onset menopause that is brought on by many breast and gynecological cancer treatments and minimising psycho-social distress.

So what can women expect from the Women’s Wellness after Cancer Program?

The Women’s Wellness after Cancer Program is a 12-week, very supportive, lifestyle management intervention program, where we give a lot of clinical and psycho-social support to women. Throughout the 12-weeks we guide them through the lifestyle changes that they need to make in a very evidence-based way. So things like, what’s the best way to get your body moving, particularly when you’ve got pain or neuropathy; what’s the best diet to have – women who have undergone breast cancer treatment, for example, often come out of the treatment weighing a lot more than when they went in due to the nature of the drugs, so we support women to lose weight in the best and safest way. We also help women work through how best to manage the hot flushes and the sleeplessness that is a result of treatment-induced menopause and how to manage lymphedema, which is the swelling of limbs that can occur after some surgeries.

These are just some of the ways we support women during the 12-week program and we’ve had a great deal of success with the program. Since then, we’ve moved onto younger women with the Younger Women’s Wellness after Cancer Program because they have very specific issues around sexual function, fertility, social support and how to bring up young children in the context of this condition, for example.

What’s next for Women’s Wellness?

We’ve expanded the Younger Women’s Wellness after Cancer Program into New Zealand and Hong Kong and next year we’ll be developing a whole new program with Canteen for younger women and young men between the ages of 15 and 24. We’re developing a lifestyle intervention for them, which will be totally delivered by telehealth and designed by the participants – they’ve even designed the logos for the program.

We’ll also be moving into addressing issues like body image in our Programs, because a lot of cancer surgeries, chemotherapy and radiotherapy result in a lot of bodily alteration that can be quite difficult to deal with, from the removal of breasts, lymphedema and stomas on the outside of your stomach rather than normal bowel function, for example. So we’re considering how to support women to develop a ‘normal’ lifestyle in the context of bodily alterations that come as a result of cancer treatments.

For more information about the Women’s Wellness after Cancer Program and other wellness programs, visit www.dawncomplete.org.au 

Helping young people rebuild their lives after cancer

A digital program to support young people adjusting to life after cancer has been awarded $1.37 million from the National Health and Medical Research Council.

WWRC collaborator Professor Sandie McCarthy, from the University of Queensland’s (UQ) School of Nursing, Midwifery and Social Work is leading the project BALANCE, which will be developed by UQ in partnership with cancer support organisation Canteen.

Professor McCarthy said the aim of the digital program was to enhance the physical and mental wellbeing of young people treated for cancer by giving them the knowledge and skills to sustain a healthy lifestyle.

“Surviving cancer does not necessarily mean younger people can return to their former state of health – they must work at it,” Professor McCarthy said.

“Young people need mental health strategies to manage the distress associated with their cancer experience.

“As the program is driven by the needs of young people, it will be designed and delivered in consultation with them.”

For more information about BALANCE, contact Professor McCarthy at s.mccarthy@uq.edu.au

Video courtesy of Channel 10 News, airing 8 October 2021

The BALANCE program is supported by:

Supporting women’s wellness

Researchers, health practitioners and educators from across the globe gathered virtually to launch the Women’s Wellness Research Collaborative – an international research organisation dedicated to supporting women across every stage of life.

Founder and Director, Professor Debra Anderson, said the launch marked a milestone for the organisation and for herself, personally.

“I have been developing the Women’s Wellness Research Collaborative for more than 10 years, bringing together the best minds in the field from across the globe,” Professor Anderson said.

“The launch of this Collaborative signifies a shift in how we view and talk about women’s wellness, with a stronger focus on evidence-based research that supports women with practical, research-based solutions to manage ongoing health concerns.

“Our research covers all the elements that contribute to women’s wellbeing, including exercise and diet, managing stress and anxiety, sleeping well and implementing positive lifestyle changes that reduce the risk of developing preventable conditions,” she said.

“We’ve translated some of this research into a number of evidence-based wellness programs – Dawn Complete Health and Wellbeing – to address specific health needs for women, including wellness after cancer and managing type 2 diabetes, which we are delivering alongside a number of clinical partners across the Asia Pacific region and in the UK.”

The Collaborate has several projects currently underway and recruiting participants across Australia and New Zealand, including the Entwine project – a screening tool for women with gynaecological cancer and the Kōwhai Study – looking at promoting younger women’s wellness after breast cancer treatment, particularly in women of New Zealand and European origin.

Professor Anderson said the Collaborative, only in its infancy, is set to make a huge impact on how we talk about women’s wellness, bringing more evidence to the discussion to fully support women throughout their lives.

“Our vision is to continue to work with leading clinical partners and educators to influence the wellness conversation, drive meaningful programs and support women to get the best out of life, at every stage of life,” she said.

The Collaborative is supported by several research partners, including the University of Technology Sydney, The Menzies Health Institute Queensland and Griffith University, the University of Queensland and the University of Auckland.