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Our objective was to calculate the time in the sun necessary to maintain existing 25‐hydroxyvitamin D (25(OH)D) concentration at locations across Australia and New Zealand. We used a microsimulation model to estimate changes in monthly 25(OH)D concentration using data on standard erythemal dose, solar zenith angle, and climatological ozone. We estimated the number of standard vitamin D doses per 10‐min interval and used a dose‐response equation to determine the average time in the sun to maintain existing 25(OH)D concentration according to month and time of day. Across all locations in summer, 5–10 min outdoors between 8 a.m. and 4 p.m. on most days of the week, with 35% of the body surface area exposed, is sufficient to maintain existing 25(OH)D concentration. In winter, at mid‐to‐high latitudes, time outdoors during the middle of the day is required. In winter, with 10% of the body surface area exposed, greater than 45 min in the middle of the day is required in most locations to maintain existing 25(OH)D concentration. These data can be used to inform guidelines regarding maintaining vitamin D via sun exposure and may help health practitioners identify patients who may be vitamin D deficient. [ABSTRACT FROM AUTHOR]

Genotype-phenotype associations between the bovine genome and grazing behaviours measured over time and across contexts have been reported in the past decade, with these suggesting the potential for genetic control over grazing personalities in beef cattle. From the large array of metrics used to describe grazing personality behaviours (GP-behaviours), it is still unclear which ones are linked to specific genes. Our prior observational study has reported associations and trends towards associations between genotypes of the glutamate metabotropic receptor 5 gene (GRM5) and four GP-behaviours, yet the unbalanced representation of GRM5 genotypes occurring in observational studies may have limited the ability to detect associations. Here, we applied a subsampling technique to create a genotypically-balanced dataset in a quasi-manipulative experiment with free ranging cows grazing in steep and rugged terrain of New Zealand's South Island. Using quadratic discriminant analysis, two combinations of eleven GP-behaviours (and a total of fifteen behaviours) were selected to build an exploration model and an elevation model, respectively. Both models achieved ∼ 86% accuracy in correctly discriminating cows' GRM5 genotypes with the training dataset, and the exploration model achieved 85% correct genotype prediction of cows from a testing dataset. Our study suggests a potential pleiotropic effect, with GRM5 controlling multiple grazing behaviours, and with implications for the grazing of steep and rugged grasslands. The study highlights the importance of grazing behavioural genetics in cattle and the potential use of GRM5 markers to select individuals with desired grazing personalities and built herds that collectively utilize steep and rugged rangelands sustainably. [ABSTRACT FROM AUTHOR]

Background: Despite its introduction into the diagnostic nomenclature over four decades ago, there remain large knowledge gaps about disordered gambling. The primary aims of the present study were to document the long-term course, childhood precursors, and adult life outcomes associated with disordered gambling. Methods: Participants enrolled in the population-representative Dunedin Study were prospectively followed from birth through age 45. Disordered gambling was assessed six times from age 18; composite measures of childhood social class, general intelligence, and low self-control were based on assessments obtained from birth through age 15; adult socioeconomic, financial, and legal outcomes were obtained through age 45. Lifetime disordered gambling was predicted from the three childhood precursors and the adult outcomes were predicted from lifetime disordered gambling. Results: Past-year disordered gambling usually occurred at only a single time point and recurrence was relatively uncommon. Lower childhood social class, general intelligence, and self-control significantly predicted lifetime disordered gambling in adulthood. In turn, lifetime disordered gambling in adulthood significantly predicted occupational, educational, and financial problems in adulthood (ds = 0.23–0.41). These associations were markedly reduced and sometimes rendered nonsignificant after adjusting for childhood precursors (ds = 0.04–0.32). Conclusions: Socioeconomic, financial, and legal outcomes in adulthood are not merely consequences of disordered gambling, but also are predicted from childhood precursors. Deflecting the trajectories of young people at risk for developing disordered gambling may help to ameliorate not just the development of later disordered gambling, but also other associated adverse outcomes. [ABSTRACT FROM AUTHOR]

The creation of more sustainable land use strategies is paramount to designing multifunctional agricultural landscapes that allow grasslands to continually deliver multiple ecosystem services. A mapping modelling approach would provide us with a tool for system diagnosis to better assess the value of a landscape and define place-based practices for designing more context-adjusted systems that are in synergy with the complexity of grasslands. To assess the potential capability of a high-country pastoral livestock production system in New Zealand in delivering ecosystem services, this work uses a geospatial model as a decision support tool to identify management practices that enhance grassland health. The model uses national, climatic, soil, and landcover data to assess the agricultural productivity, flood mitigation, C sequestration, erosion, and sediment delivery capacity of a case study high-country station in New Zealand. Model outcomes suggest that the station has the potential for increased agricultural productivity although varying spatially, a high flood mitigation capacity, a high capacity for C sequestration, a moderate risk of erosion, a capacity to reduce sediment delivery to streams, and overall, a low to moderate nitrogen and phosphorus accumulation. Output maps display a spatial visualisation of ecosystem services associated with the landscape topography, soil, and vegetation patterns that allow the identification of neglected areas and planning of best place-based management practices strategies to enhance the health of grasslands. [ABSTRACT FROM AUTHOR]

Background: The evidence for the clinical utility of pharmacogenomic (PGx) testing is growing, and guidelines exist for the use of PGx testing to inform prescribing of 13 antidepressants. Although previous randomised controlled trials of PGx testing for antidepressant prescribing have shown an association with remission of depression in clinical psychiatric settings, few trials have focused on the primary care setting, where most antidepressant prescribing occurs. Methods: The PRESIDE Trial is a stratified double-blinded randomised controlled superiority trial that aims to evaluate the impact of a PGx-informed antidepressant prescribing report (compared with standard prescribing using the Australian Therapeutic Guidelines) on depressive symptoms after 12 weeks, when delivered in primary care. Six hundred seventy-two patients aged 18–65 years of general practitioners (GPs) in Victoria with moderate to severe depressive symptoms, measured using the Patient Health Questionnaire-9 (PHQ-9), will be randomly allocated 1:1 to each arm using a computer-generated sequence. Participants and GPs will be blinded to the study arm. The primary outcome is a difference between arms in the change of depressive symptoms, measured using the PHQ-9 after 12 weeks. Secondary outcomes include a difference between the arms in change in PHQ-9 score at 4, 8 and 26 weeks, proportion in remission at 12 weeks, a change in side effect profile of antidepressant medications, adherence to antidepressant medications, change in quality of life and cost-effectiveness of the intervention. Discussion: This trial will provide evidence as to whether PGx-informed antidepressant prescribing is clinically efficacious and cost-effective. It will inform national and international policy and guidelines about the use of PGx to select antidepressants for people with moderate to severe depressive symptoms presenting in primary care. Trial registration: Australian and New Zealand Clinical Trial Registry ACTRN12621000181808. Registered on 22 February 2021. [ABSTRACT FROM AUTHOR]

Background: Experimental work using pot trials and mesocosm studies has indicated that species combinations are more effective than single species mitigating the soil nutrient constraints that limit pasture productivity in New Zealand's hill country, but there is little field evidence to support this. Aim: We question whether coexistence of species provides an opportunity to facilitate enhanced uptake and improved procurement of key soil nutrients in these mid-altitude grasslands. Methods: Native and exotic legumes and co-occurring plant species were sampled according to whether they were growing together in close proximity or in single species patches. Foliar concentrations of nutrients were compared. Results: Nutrient concentrations in a native broom, Carmichaelia petriei, were higher when it was growing in combination with native tussock grasses. Higher concentrations of eight nutrients were recorded in foliage of an exotic legume, Lotus pedunculatus, when it was growing with native grasses or within the acuminate foliage of Aciphylla aurea (golden spaniard). Foliar concentrations of only P and Mn were elevated in white clover (Trifolium repens) foliage when it was growing in combination with grasses. Conclusions: These findings point to mutual facilitation of nutrient uptake by combinations of species growing together. Some species that are less desirable from an agricultural perspective improve acquisition of soil nutrients by the plant community. Novel native species assemblages represent a potential opportunity to refine pasture management, facilitating optimal exploitation of nutrients. This could reduce fertiliser requirements and enhance and protect native biodiversity in pastoral grasslands. [ABSTRACT FROM AUTHOR]

In this paper we follow a hypothetical mathematician who is working on a problem that is eventually solved. We treat this problem as if it were difficult for the mathematician. In following the mathematician's work, we note both what she does and what she doesn't do in the process. By the latter, we consider the times when progress is not being made and how this lack of progress is resolved. The purpose here is to give some idea of how a research mathematician might approach a research level problem. We also propose that the problem under discussion is one of many problems that tertiary students can valuably tackle using a discovery-based approach as a means of using their mathematical content knowledge as well as learning to be creative. [ABSTRACT FROM AUTHOR]

Background: The grazing behaviour of herbivores and their grazing personalities might in part be determined genetically, but there are few studies in beef cattle illustrating this. In this study, we investigated for first time the genetic variation within a candidate 'grazing gene', the glutamate metabotropic receptor 5 gene (GRM5), and tested associations between variation in that gene and variation in grazing personality behaviours (GP-behaviours) displayed by free-ranging cows during winter grazing in the steep and rugged rangelands of New Zealand. Mature beef cows (n = 303, from 3 to 10 years of age) were tracked with global positioning system (GPS) and, with 5-minutes (min) relocation frequency, various GP-behaviours were calculated. These included horizontal and vertical distances travelled, mean elevation, elevation range, elevation gain, slope, home range and movement tortuosity, variously calculated using daily relocation trajectories with repeated measurements (i.e., 7 to 24 days (d)) and satellite-derived digital elevation models (DEM). The different GP-behaviours were fitted into mixed models to ascertain their associations with variant sequences and genotypes of GRM5. Results: We discovered three GRM5 variants (A, B and C) and identified the six possible genotypes in the cattle studied. The mixed models revealed that A was significantly associated with elevation range, home range and movement tortuosity. Similarly, GRM5 genotypes were associated (P < 0.05) to home range and movement tortuosity, while trends suggesting association (P < 0.1) were also revealed for elevation range and horizontal distance travelled. Most GP-behaviour models were improved by correcting for cow age-class as a fixed factor. The analysis of GP-behaviours averaged per cow age-class suggests that grazing personality is fully established as beef cows reached 4 years of age. Home range and movement tortuosity were not only associated with GRM5 variation, but also negatively correlated with each other (r = − 0.27, P < 0.001). Conclusions: There seems to be a genetically determined trade-off between home range and movement tortuosity that may be useful in beef cattle breeding programmes aiming to improve the grazing distribution and utilisation of steep and rugged rangelands. [ABSTRACT FROM AUTHOR]

Background: Combinations of grasses and nitrogen-fixing legumes are ubiquitous in most natural and derived pastoral grasslands. This was not formerly the case in New Zealand's unique indigenous grasslands that are now frequently impacted by exotic pasture grasses and legumes. Understanding the co-existence of native and exotic plants is the broad focus of this research. Aims: Spillover of nitrogen (N) from clovers to grasses in diverse pasture is well known. We question whether grasses provide reciprocal nutritional benefits to legumes. Does the mutual exploitation of soil biogeochemistry by legumes and grasses help to explain their coexistence and, if so, does this have implications for biodiversity in NZ's novel native grassland communities? Methods: Combinations of grasses and legumes, including a native tussock grass, were grown in a nutrient-poor (low P, S, Ca, Mg, Mn, and B) high country soil in a pot experiment, quantifying the foliar acquisition of nutrients from soil. Field data were obtained by sampling foliage of clover in single- and mixed-species patches in a more fertile lowland pasture. Results: Benefits of legume and grass growing together were reflected in enhanced productivity and higher uptake of a range of key nutrients. This was most evident but not restricted to a combination of two exotic species: cocksfoot and white clover. In the nutrient-poor soil, legumes grew better in combination with different species of introduced grasses. Uptake of key elements from soil to plants significantly differed with combinations of legumes and grasses compared to individual species. Elevated concentrations of P, K and S were recorded in clover when growing with grasses, although Ca uptake was lower. Expected reciprocal reduction of clover N or enhanced grass N were not recorded. Mass balance data (total extraction of key nutrients from the soil pool) showed that combination of grasses and legumes exploit soil nutrients (particularly P, Zn, Mn and Mo) more effectively than single species alone. In grasses, only tissue concentrations of K, S and Zn significantly increased when growing with legumes, but native tussock grass procured less nutrients when growing with the exotic legumes. Field sampling of clover from the more fertile lowland soil showed significantly higher foliar concentrations of K, Mn, Cu and B, but less Ca. Conclusions: The findings are indicative of a mutualistic relationship: legumes derive nutritional benefits from growing with grasses. Native tussock grass contained less N when growing with the exotic legumes, suggesting less compatibility and a lack of adaptation to coexistence. [ABSTRACT FROM AUTHOR]

Auckland Volcanic Field (AVF) is a basaltic intraplate volcanic field in North Island, New Zealand, upon which >1.6 million people live. Seismic velocity tomography and geochemistry suggest a primary mantle source region at a depth of 70–90 km. Geochemical analysis indicates a range of magma compositions, and that melts ascend with little crustal interaction. Eruptions generally began with a phreatomagmatic phase forming maar and tuff rings with tephra fall, base surges, and ballistic projectiles as the main hazards. Subsequent magmatic phases formed scoria cones, and sometimes produced lava flows. Ages of 47 of the 53 volcanic centres reveal that the AVF first erupted ∼193 ka, and last erupted ∼500 yrs. BP. These geochronological constraints indicate repose periods ≤0.1–13 kyr, which have decreased since ∼60 ka. From known geological and exposure information, and using an interdisciplinary approach, eight future eruption scenarios have been developed for planning processes. Outstanding questions for the AVF concern the cause of mantle melting, the structure of the underlying lithosphere, magma ascent rates, controls on repose periods and eruptive volumes. Answering these questions may improve our understanding of warning periods, monitoring strategies, spatiotemporal risk profiles, and socio-economic impacts of volcanism on New Zealand's largest city. [ABSTRACT FROM AUTHOR]

Many regions around the world have farms surrounding potentially active volcanoes that have been dormant for decades to centuries. Without any recent experience, a new major eruption and tephra fall would present an unfamiliar soil and pasture remediation challenge. We interviewed 23 farmers from the volcanic North Island of New Zealand in order to gain insight into the current understanding of tephra fall risk and associated production recovery strategies needed for the pastoral agricultural sector. Of the interviewees, 26% had experienced past minor tephra falls on their farms while 70% believed they were at risk of experiencing future tephra fall. Around half of all interviewed farmers (48%), including one who had previously experienced tephra fall, provided suggestions for possible remediation techniques. The remaining half (52%) did not know what to do if tephra were to fall on their farm. The farmer-suggested remediation strategies are: 1) waiting for rainfall to wash away the tephra (for thin falls), 2) cultivation, 3) re-grassing, 4) ploughing, 5) using fertilizers, 6) flipping the upper 0.5 metres of tephra and soil, and 7) physical removal. A key barrier to effective recovery is lack of rapid access to appropriate knowledge during and following a tephra fall. These findings provide potentially useful treatment strategies for heavy tephra fall on pasture and a key reference amongst the farming community when considering farm system preparedness for (and recovery from) tephra fall. [ABSTRACT FROM AUTHOR]

Breeding cows for improved production and production efficiency may have led to indirect selection for behavioural traits including grazing and urination behavioural patterns. This study investigated the relationship between genetic merit (breeding worth; BW) and grazing and urination behaviour in Holstein-Friesian × Jersey lactating dairy cows. Two groups of 12 cows were assigned into high BW (HBW; NZ$146 ± 12.8) or low BW (LBW; NZ$40 ± 11.8) groups. Cows were observed for grazing (grazing, ruminating, idling and bite rate) and urinating (frequency and duration of urination events) behaviour during the first grazing session of the day (5 h; between milking 0900–1400 h). Based on the whole grazing and urination behaviour data matrix, MANOVA and PCA procedures suggested no difference in the grazing and urination behaviour of HBW and LBW cows. Further work measuring additional traits (e.g. intake rate, bite mass, diurnal urination patterns) may be required to differentiate cows of divergent BW based on behavioural patterns. [ABSTRACT FROM AUTHOR]

Tsunamis can have severe impacts on society. In addition to casualties and damage to buildings, they can also damage and disrupt critical infrastructure. To support effective risk management, it is important to understand the possible extent, severity and duration of these impacts. While impacts on buildings and casualty estimations are relatively well developed for tsunamis, critical infrastructure impact models are either not available or lack accurate vulnerability information. This paper addresses these issues by reviewing global tsunami impacts to critical infrastructure to develop a semi-quantitative tsunami damage matrix for critical infrastructure components and systems. One potential application of the damage matrix is demonstrated within an impact assessment process for Christchurch, New Zealand. The impact assessment determines asset damage likelihood for energy, water, telecommunication and transportation assets from a large tsunami inundation scenario. Consistent with observations from previous international tsunamis, above-ground assets and buried storm water pipe networks in Christchurch were found to perform poorly, while buried potable and waste water pipe networks were less impacted. This process provides a simple, but widely applicable, impact assessment approach which further studies can build on. Future research should focus on developing quantitative probabilistic tsunami vulnerability models for critical infrastructure that implement multiple asset standards and hazard intensity measures, and better account for uncertainty. [ABSTRACT FROM AUTHOR]

What is known and objective Interventions intended to slow the emergence and spread of antibacterial resistance through enhanced antimicrobial stewardship will be more effective if informed by an accurate knowledge of current patterns of antibacterial consumption. For example, knowledge of the relative magnitude of community antibacterial consumption in relation to hospital antibacterial consumption within each nation or region should help guide decisions about the relative importance of community and hospital antimicrobial stewardship programmes. It is commonly stated that community antibacterial consumption comprises approximately 80% of total national antibacterial consumption. We aimed to determine this proportion across a large range of nations. Methods We measured community and hospital antibacterial consumption in New Zealand during 2015, from both reimbursement and purchase data, and compared the New Zealand data with those reported from a large range of other nations during similar time periods. Results and discussion Community antibacterial consumption comprised approximately 85%-95% of total antibacterial consumption in all nations for which data were available, and in New Zealand comprised a higher proportion than in any other nation. The proportion of total antibacterial consumption comprised by community consumption was significantly higher in countries with relatively high levels of total antibacterial consumption than in countries with relatively low levels of total antibacterial consumption. What is new and conclusion The high proportion of total antibacterial consumption comprised by community antibacterial consumption suggests devoting particular attention to improved community antimicrobial stewardship. These results suggest that improving antimicrobial stewardship in the community may provide greater overall benefits in combating antibacterial resistance than improving antimicrobial stewardship in hospitals. [ABSTRACT FROM AUTHOR]

The M7.8 Kaikōura Earthquake in 2016 presented a number of challenges to science agencies and institutions throughout New Zealand. The earthquake was complex, with 21 faults rupturing throughout the North Canterbury and Marlborough landscape, generating a localised seven metre tsunami and triggering thousands of landslides. With many areas isolated as a result, it presented science teams with logistical challenges as well as the need to coordinate efforts across institutional and disciplinary boundaries. Many research disciplines, from engineering and geophysics to social science, were heavily involved in the response. Coordinating these disciplines and institutions required significant effort to assist New Zealand during its most complex earthquake yet recorded. This paper explores that effort and acknowledges the successes and lessons learned by the teams involved. [ABSTRACT FROM AUTHOR]

Coseismic landsliding presents a major hazard to infrastructure in mountains during large earthquakes. This is particularly true for road networks, as historically coseismic landsliding has resulted in road losses larger than those due to ground shaking. Assessing the exposure of current and planned highway links to coseismic landsliding for future earthquake scenarios is therefore vital for disaster risk reduction. This study presents a method to evaluate the exposure of critical infrastructure to landsliding from scenario earthquakes from an underlying quantitative landslide hazard assessment. The method is applied to a proposed new highway link in South Island, New Zealand, for a scenario Alpine Fault earthquake and compared to the current network. Exposure (the likelihood of a network being affected by one or more landslides) is evaluated from a regional-scale coseismic landslide hazard model and assessed on a relative basis from 0 to 1. The results show that the proposed Haast-Hollyford Highway (HHH) would be highly exposed to coseismic landsliding with at least 30–40 km likely to be badly affected (the Simonin Pass route being the worse affected of the two routes). In the current South Island State Highway network, the HHH would be the link most exposed to landsliding and would increase the total network exposure by 50–70% despite increasing the total road length by just 3%. The present work is intended to provide an effective method to assess coseismic landslide hazard of infrastructure in mountains with seismic hazard, and potentially identify mitigation options and critical network segments. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to determine the clinical characteristics on arrival and the subsequent clinical outcome of HIV-infected UN quota refugees who settled in New Zealand during the last 11 years and to estimate their rate of HIV transmission. Methods: A population study was conducted. Data were provided by the Mangere Refugee Resettlement Centre, the infectious disease physicians caring for the subjects, the New Zealand AIDS Epidemiology Group and laboratories carrying out HIV viral load assays. Results: One hundred of 7732 (1.3%) UN quota refugees were HIV positive; mean age 30 years, 56% were men, median initial CD4 count was 320 (range 20–1358). HIV infection was most commonly acquired by heterosexual intercourse (74%). The median follow up was 5.0 years (range 1 month to 9.7 years). Five died and 15 subjects had 16 AIDS-defining illnesses, most commonly tuberculosis ( n = 10). Sixty subjects commenced highly active antiretroviral therapy of whom 36/59 (61%) had an undetectable HIV viral load after 1 year of treatment. None of the six children born to HIV-infected women in New Zealand were infected. There were two known cases of horizontal transmission of HIV infection. Conclusion: Although HIV-infected quota refugees often have to overcome severe social, cultural and financial handicaps, their clinical outcome is generally very good, with response rates to highly active antiretroviral therapy that are similar to other patient groups. Furthermore, they have not been a significant source of transmission of HIV infection after resettlement in New Zealand. [ABSTRACT FROM AUTHOR]

Previous studies have shown that functional appliances can enhance mandibular growth when applied during the active growth period. However, besides patient compliance problems with bulky appliances and prolonged treatment demands, there is contradictory evidence that functional appliances have a significant long-term effect. Is there a method to enhance the growth response and improve the long-term success of functional appliances? Previous studies have also found that therapeutic ultrasound (US) can stimulate cartilage and bone growth. The objective of this study was to evaluate the effect of therapeutic US on condylar and mandibular growth in the rabbit model. Eight growing New Zealand male rabbits were chosen for this study. They received therapeutic US on one side of the mandible for 20 minutes/day for four weeks. Anthropometrical and histological evaluations revealed that US enhances mandibular growth by condylar endochondreal bone growth and consequently mandibular ramus growth. The significant results of this study support conducting a long-term study to evaluate the ultimate stability of the results obtained. Also, they suggest an extended research with a larger sample size and investigating the molecular basis of this stimulatory effect, together with forward posturing splints for optimal macroscopic and microscopic responses. [ABSTRACT FROM AUTHOR]

Flood damage assessments provide critical information for flood hazard mitigation under changing climate conditions. Recent efforts to improve and systemise damage assessments have focused primarily on urban environments with few examples for primary industries such as dairy. This paper explores the adverse consequences of flooding on dairy farms in the Bay of Plenty region, New Zealand. Ex-tropical Cyclone Debbie in April 2017 caused prolonged riverine and surface water flooding on over 3500 hectares of dairy farmland. The event provided an opportunity to develop and apply a participatory approach for collecting information about on-farm flood damage, and both response and recovery actions implemented by dairy farmers. Semi-structured interviews and transect walks with farmers revealed a range of direct and indirect damages to production and capital assets, influenced by duration of inundation, silt deposition and seasonality. Results highlight the need to identify on-farm and off-farm asset interdependencies of dairy farm systems to estimate long-term socio-economic consequences at farm-level. Enhancing dairy farm flood resilience in a changing climate will rely on farm-level response and recovery plans, proactively supported by emergency management agencies, farm service suppliers and support agencies. [ABSTRACT FROM AUTHOR]

Understanding future eruptions and their potential consequences is an important component of volcanic disaster risk reduction. Suites of scenarios are a useful compromise between fully probabilistic and fully deterministic (single scenario) approaches. In this paper, we present an interdisciplinary approach that combines stakeholder (volcanologists, disaster risk researchers, policy advisors, infrastructure managers, and emergency managers) requirements with fundamental science to produce multi-hazard eruption scenarios for a high-risk volcano. We apply this approach to the Auckland Volcanic Field (AVF) to develop a suite of scenarios (' DEVORA Scenarios ') that cover the wide spectrum of credible expected eruption activity. Demand was driven by a desire from stakeholders for scenarios that are scientifically credible and relevant for disaster risk management purposes, including evacuation, welfare, recovery, and critical infrastructure disruption planning. Stakeholders were embedded throughout the scenario development process, most importantly at the scoping and design stage, and through multiple formal and informal review cycles. Balancing scientific credibility whilst ensuring the scenarios is relevant to stakeholders was a challenge that required considerable time by all parties. Importantly, the process of scenario development was just as useful as the final product: it facilitated open discourse on major scientific uncertainties and information gaps on AVF volcanism, hazards, and risk. This served two important ends: 1) it allowed scientists to communicate areas of uncertainty to other stakeholders such as emergency managers, and 2) it identified potential future research avenues with an obvious and tangible societal benefit. It is anticipated that the DEVORA Scenarios will serve as a foundation for studies exploring the societal ramifications of a future AVF eruption. The process we outline here can be followed to develop credible and relevant suites of eruption scenarios for disaster risk management purposes in other environments. • Suite of multi-hazard eruption scenarios were developed for the Auckland Volcanic Field, New Zealand. • Strong interest from variety of stakeholders for useful scenarios for disaster risk reduction purposes. • Multi-hazard scenario development involved integration of multiple methodologies and disciplines. • The scenario process facilitated discussions between stakeholders to identify critical scenario requirements. [ABSTRACT FROM AUTHOR]

This study investigates the effects of disruptions to different community environments, community resilience and cumulated felt earthquake intensities on yearly mood and anxiety symptom treatments from the New Zealand Ministry of Health's administrative databases between September 2009 and August 2012. The sample includes 172,284 long-term residents from different Christchurch communities. Living in a better physical environment was associated with lower mood and anxiety treatment rates after the beginning of the Canterbury earthquake sequence whereas an inverse effect could be found for social community environment and community resilience. These results may be confounded by pre-existing patterns, as well as intensified treatment-seeking behaviour and intervention programmes in severely affected areas. Nevertheless, the findings indicate that adverse mental health outcomes can be found in communities with worse physical but stronger social environments or community resilience post-disaster. Also, they do not necessarily follow felt intensities since cumulative earthquake intensity did not show a significant effect. [ABSTRACT FROM AUTHOR]

In this longitudinal study, we compare the effects of different types of relocation and level of affectedness on the incidence and relapse of mood and anxiety symptom treatments identified by publicly funded care or treatment one year before and one and two years after the ‘2011 Christchurch earthquake’ in New Zealand. Based on a subset of Christchurch residents from differently affected areas of the city identified by area-wide geotechnical land assessments (no to severe land damage) ‘stayers’, ‘within-city movers’, ‘out-of-city movers’ and ‘returners’ were identified to assess the interaction effect of different levels of affectedness and relocation on the incidence and relapse of mood and anxiety symptom treatments over time. Health and sample information were drawn from the New Zealand Ministry of Health's administrative databases allowing us to do a comparison of the pre-/post-disaster treatment status and follow-up on a large study sample. Moving within the city and returning have been identified as general risk factors for receiving care or treatment for mood or anxiety symptoms. In the context of the 2011 Christchurch earthquake, moving within the city showed a protective effect over time, whereas returning was a significant risk factor in the first post-disaster year. Additionally, out-of-city movers from minor, moderately or severely damaged Christchurch's plain areas were identified as especially vulnerable two years post-disaster. Generally, no dose-response relationship between level of affectedness and mood or anxiety symptom treatments was identified, but the finding that similarly affected groups from the city's plain areas and the more affluent Port Hills showed different temporal treatment trends highlights the importance of including socio-economic status in exposure assessment. High-risk groups included females, older adults and those with a pre-existing mental illness. Consequently, mental health intervention programs should target these vulnerable groups, as well as out-of-city movers from affected areas in the long run. [ABSTRACT FROM AUTHOR]

Decision making in complex contexts such as disaster risk management requires collaborative approaches to knowledge production. Evidence-based disaster risk management and pre-event planning relies on robust and relevant disaster risk knowledge. We report on a case study of Project AF8, a "cocreation" collaboration involving local- and central-government disaster risk management agencies and groups, critical infrastructure organizations, and scientists from six universities and Crown Research Institutes. Participant observation and interview data are used to document and analyze the processes used to generate, share, and apply multidisciplinary disaster risk knowledge. Project AF8 was conceived as a cross-jurisdictional and multiagency initiative to plan and prepare for a coordinated response across the South Island following a large magnitude earthquake along the Alpine Fault, one of New Zealand's major natural hazard risks. Findings show that (1) practitioners at all levels operate in highly uncertain environments and therefore have specific knowledge needs at different times and for different purposes, (2) disaster risk knowledge was perceived to be most effective when scientifically credible and focused on identifying likely impacts on the capacity of communities to function, and (3) disaster risk knowledge outputs and the processes used to cocreate them were perceived to be equally important. Using cocreation to combine researcher credibility with practitioner relevancy enhanced the legitimacy of Project AF8 processes, the collective disaster risk knowledge they facilitated, and the wider project. In hindsight, a greater focus at the outset on developing a formal coproduction structure may have increased the pace of cocreation, particularly in the early phases. Future interdisciplinary disaster risk management initiatives could benefit by adopting contextually relevant aspects of this example to strengthen the science-practice interface for more effective pre-event planning and decision making. [ABSTRACT FROM AUTHOR]

Understanding future volcanic eruptions and their potential impact is a critical component of disaster risk reduction, and necessitates the production of salient, robust hazard information for decision-makers and end-users. Volcanic eruptions are inherently multi-phase, multi-hazard events, and the uncertainty and complexity surrounding potential future hazard behaviour is exceedingly hard to communicate to decision-makers. Volcanic eruption scenarios are recognised to be an effective knowledge-sharing mechanism between scientists and practitioners, and recent hybrid scenario suites partially address the limitations surrounding the traditional deterministic scenario approach. Despite advances in scenario suite development, there is still a gap in the international knowledge base concerning the synthesis of multi-phase, multi-hazard volcano science and end-user needs. In this study we present a new modular framework for the development of complex, long-duration, multi-phase, multi-hazard volcanic eruption scenario suites. The framework was developed in collaboration with volcanic risk management agencies and researchers in Aotearoa-New Zealand, and is applied to Taranaki Mounga volcano, an area of high volcanic risk. This collaborative process aimed to meet end-user requirements, as well as the need for scientific rigour. This new scenario framework development process could be applied at other volcanic settings to produce robust, credible and relevant scenario suites that are demonstrative of the complex, varying-duration and multi-hazard nature of volcanic eruptions. In addressing this gap, the value of volcanic scenario development is enhanced by advancing multi-hazard assessment capabilities and cross-sector collaboration between scientists and practitioners for disaster risk reduction planning. • Pairing statistical models with end-user input gives credible and relevant outputs. • Modular eruption scenario framework allows flexibility for a range of end-user needs. • Frameworks delivers dynamic spatio-temporal outputs disaster risk applications. • Co-creative volcanic hazard assessment leads to relevant and credible outputs. [ABSTRACT FROM AUTHOR]

Invasive Haemophilus influenzae infection during pregnancy can cause preterm birth and fetal loss, but the mechanism is unclear. We investigated 54 cases of pregnancy-associated invasive H. influenzae disease in 52 unique pregnancies in the Auckland region of New Zealand during October 1, 2008‒September 30, 2018. Intraamniotic infection was identified in 36 (66.7%) of 54 cases. Outcome data were available for 48 pregnancies. Adverse pregnancy outcomes, defined as fetal loss, preterm birth, or the birth of an infant requiring intensive/special care unit admission, occurred in 45 (93.8%) of 48 (pregnancies. Fetal loss occurred in 17 (35.4%) of 48 pregnancies, before 24 weeks' gestation in 13 cases, and at >24 weeks' gestation in 4 cases. The overall incidence of pregnancy-associated invasive H. influenzae disease was 19.9 cases/100,000 births, which exceeded the reported incidence of pregnancy-associated listeriosis in New Zealand. We also observed higher rates in younger women and women of Māori ethnicity.

Australia and Aotearoa New Zealand have the highest incidence of melanoma and KC in the world. We undertook a cost-of-illness analysis using Markov decision-analytic models separately for melanoma and keratinocyte skin cancer (KC) for each country. Using clinical pathways, the probabilities and unit costs of each health service and medicine for skin cancer management were applied. We estimated mean costs and 95% uncertainty intervals (95% UI) using Monte Carlo simulation. In Australia, the mean first-year costs of melanoma per patient ranged from AU$644 (95%UI: $642, $647) for melanoma in situ to AU$100,725 (95%UI: $84,288, $119,070) for unresectable stage III/IV disease. Australian-wide direct costs to the Government for newly diagnosed patients with melanoma were AU$397.9 m and AU$426.2 m for KCs, a total of AU$824.0 m. The mean costs per patient for melanoma ranged from NZ$1450 (95%UI: $1445, $1456) for melanoma in situ to NZ$77,828 (95%UI $62,525, $94,718) for unresectable stage III/IV disease. The estimated total cost to New Zealand in 2021 for new patients with melanoma was NZ$51.2 m, and for KCs, was NZ$129.4 m, with a total combined cost of NZ$180.5 m. These up-to-date national healthcare costs of melanoma and KC in Australia and New Zealand accentuate the savings potential of successful prevention strategies for skin cancer.

Aims: The overall rate of community antibiotic dispensing in New Zealand in recent decades has been high when compared with many other nations, but since 2015 has consistently declined each year. We aimed to determine whether the magnitude of reductions in community antibiotic dispensing in New Zealand between 2015 and 2018 differed in relation either to the patient's demographic features or in relation to the primary health organisation of the patient's registered general practitioner., Methods: Demographic data on all patients registered with a general practice in New Zealand, and on all community pharmacy antibiotic dispensing for these patients during 2013-2018 were obtained from national healthcare databases. The rates of dispensing for patients registered with a general practitioner were measured as antibiotic courses dispensed per 1,000 population per day, and as defined daily doses per 1,000 population per day., Results: Total community antibiotic dispensing in New Zealand, measured as defined daily doses per 1,000 inhabitants per day, decreased by 13.8% during 2015-2018, an average annual reduction of 4.6% per year, with especially large reductions in dispensing of amoxicillin/clavulanate, fluoroquinolones and macrolides. The reductions in dispensing were greatest in children aged 0-4 years old, but lesser reductions were seen in all age groups. Antibiotic dispensing declined regardless of patient ethnicity or level of socioeconomic deprivation. There were marked differences between primary health organisations in the size of the reductions in antibiotic dispensing during 2015-2018, which ranged between 4.8% for the Te Tai Tokerau PHO to 21.5% for the Ngati Porou Hauora Charitable Trust PHO., Conclusions: Total community antibiotic dispensing has reduced significantly in New Zealand between 2015 and 2018, with large disparities between primary health organisations in the size of the reductions. The overall rates of antibiotic dispensing remain high for non-Māori and non-Pacific people, and prescribers should aim to further reduce inappropriate antibiotic prescribing for these populations. However, the overall rate of antibiotic dispensing for Māori and Pacific people may now approximate an optimal level. Prescribers should aim to further reduce inappropriate antibiotic prescribing, but also to increase appropriate antibiotic prescribing for these populations., Competing Interests: Nil.

Competing Interests: Dr Hamilton reports non-financial support from High Performance Sport NZ during the conduct of the study; Dr Gerrard is the Chair of the Therapeutic Use Exemption Committee (TUEC) Drug-Free Sport New Zealand; Chair, World Anti-Doping Agency (WADA) TUE Expert Group; Chair, TUEC, World Rugby; Vice-Chair, Sports Medicine Committee, International Swimming Federation (FINA); Dr Fulcher reports personal fees from New Zealand Football during the conduct of the study; medical director for New Zealand Football; member of the FIFA Medical Committee; Dr Exeter is a contractor to High Performance Sport NZ; Dr Coleman is a contractor for medical services.

Background: Genetic factors contribute to anorexia nervosa (AN); and the first genome-wide significant locus has been identified. We describe methods and procedures for the Anorexia Nervosa Genetics Initiative (ANGI), an international collaboration designed to rapidly recruit 13,000 individuals with AN and ancestrally matched controls. We present sample characteristics and the utility of an online eating disorder diagnostic questionnaire suitable for large-scale genetic and population research., Methods: ANGI recruited from the United States (US), Australia/New Zealand (ANZ), Sweden (SE), and Denmark (DK). Recruitment was via national registers (SE, DK); treatment centers (US, ANZ, SE, DK); and social and traditional media (US, ANZ, SE). All cases had a lifetime AN diagnosis based on DSM-IV or ICD-10 criteria (excluding amenorrhea). Recruited controls had no lifetime history of disordered eating behaviors. To assess the positive and negative predictive validity of the online eating disorder questionnaire (ED100K-v1), 109 women also completed the Structured Clinical Interview for DSM-IV (SCID), Module H., Results: Blood samples and clinical information were collected from 13,363 individuals with lifetime AN and from controls. Online diagnostic phenotyping was effective and efficient; the validity of the questionnaire was acceptable., Conclusions: Our multi-pronged recruitment approach was highly effective for rapid recruitment and can be used as a model for efforts by other groups. High online presence of individuals with AN rendered the Internet/social media a remarkably effective recruitment tool in some countries. ANGI has substantially augmented Psychiatric Genomics Consortium AN sample collection. ANGI is a registered clinical trial: clinicaltrials.govNCT01916538; https://clinicaltrials.gov/ct2/show/NCT01916538?cond=Anorexia+Nervosa&draw=1&rank=3., (Copyright © 2018. Published by Elsevier Inc.)

Aims: There are significant ethnic disparities in the incidence of various infectious diseases in New Zealand. Antimicrobial stewardship interventions which ignore these disparities may have negative effects on the health of some ethnic groups. We aimed to determine the relationship between ethnicity and community antimicrobial dispensing in New Zealand, to inform the development of antimicrobial stewardship interventions in New Zealand., Methods: Demographic data on all patients registered with a general practice in New Zealand and on all community pharmacy antibacterial dispensings during 2015 were obtained from national healthcare databases. The rates of dispensing were measured as the number of dispensings per 1,000 population per day and as defined daily doses per 1,000 population per day., Results: The rate of community antibacterial dispensing for the total population surveyed was 3.01 dispensings per 1,000 population per day, and was 3.49 for Pacific, 3.23 for Māori, 3.02 for European, 2.70 for Middle Eastern, Latin American and African, and 2.35 for Asian people. In all ethnic groups the rate of community antibacterial dispensing increased with increasing socioeconomic deprivation. Seasonal variation in antibacterial dispensing ranged between 34% in Asian people and 24% in European people., Conclusions: The ethnic disparities in the rates of antibacterial dispensing in New Zealand are consistent with, but less marked than, the ethnic disparities in the incidence of infectious diseases in New Zealand. Improved community-wide understanding of both the benefits and the harms of antibacterial medicines is necessary to support improved antibacterial use in New Zealand in the future., Competing Interests: Nil.

Background: The relentless emergence and spread of strains of Neisseria gonorrhoeae that are resistant to many antimicrobial agents has led to frequent changes in treatment guidelines, with a consequent risk that prescribers may not be aware of current guidelines., Aim: To determine the proportion of patients with gonorrhoea who were treated with a regimen consistent with the New Zealand Sexual Health Society (NZSHS) guidelines., Methods: We audited the treatment given to adult patients with laboratory-proven gonorrhoea in Auckland, New Zealand, during the first 6 months of 2015., Results: Treatment compliant with the current NZSHS guidelines was administered in only 65% (458/706) episodes overall. Guideline-compliant treatment was much more likely to be prescribed for patients who presented to a sexual health clinic (89%) than for patients who presented to either a general practice or other community clinic (52%) or to a hospital (56%) (P < 0.0001). Overall, 52 of 706 (7%) episodes were not treated with any antimicrobial regimen by the service that diagnosed the patients' gonorrhoea, 13 of 62 (21%) episodes in patients who presented to a hospital, 34 of 403 (8%) episodes in patients who presented to a general practice or other community clinic and 5 of 241 (2%) episodes in patients who presented to a sexual health clinic (P < 0.0001)., Conclusion: Low levels of compliance with treatment guidelines increase the risk that antibiotic-resistant strains of N. gonorrhoeae will spread within the Auckland region. Improved compliance with treatment guidelines, particularly in patients who present either to general practice or to hospitals, is necessary to maintain the efficacy of current treatment regimens., (© 2017 Royal Australasian College of Physicians.)

Background: Current guidelines recommend that women with HIV infection receive annual cervical smears., Methods: We evaluated the uptake of annual cervical smears by women with HIV infection under the care of the Infectious Disease Service at Auckland City Hospital. In an attempt to identify potential barriers to regularly receiving an annual cervical smear, we invited the women to complete a questionnaire. The responses from women who had regularly received an annual cervical smear were compared with those who had not., Results: The proportion of women who had received a cervical smear increased from 44% in 2001, to 73% in 2010 (p=0.001). Ninety-three women (76%) completed the study questionnaire. No statistically significant differences were found in the questionnaire responses between the women who had regularly received an annual cervical smear and those who had not., Conclusion: The proportion of women in this cohort who received a cervical smear in 2010 is comparable with other studies of women with HIV infection in New Zealand and overseas. We have not been able to identify barriers that prevent women with HIV infection in Auckland regularly receiving an annual cervical smear. We plan to encourage women who have not received a cervical smear in the previous 2-year period to have a cervical smear performed when they attend the Infectious Disease Clinic, and will continue to notify the National Cervical Screening Programme that all women who are newly diagnosed with HIV infection should have an annual recall code attached to future cervical smear reports. We expect that these interventions will further increase the proportion of women with HIV infection in Auckland who receive an annual cervical smear.

Aim: New Zealand has low rates of disease caused by to Mycobacterium tuberculosis (TB) and Human Immunodeficiency Virus (HIV). This study is the first to describe a New Zealand cohort of patients with HIV-associated TB., Method: We retrospectively reviewed the clinical records, laboratory data and chest radiographs of all patients who were diagnosed with HIV-associated TB and who commenced treatment for TB disease at Auckland City Hospital between January 1997 and July 2009., Results: During the 12-and-a-half year study period, 40 patients were diagnosed with HIV-associated TB. The median age was 37 years and the median CD4 count was 130 cells/mm3. Only 2 patients were New Zealand born. Twenty-four (60%) patients had known HIV infection prior to their diagnosis of TB disease. Two patients with known HIV infection and positive tuberculin skin tests had not received treatment for latent tuberculosis infection (LTBI). Twenty-three (58%) patients received antiretroviral treatment during their TB treatment. There were 21 episodes of treatment interruption or immune reconstitution inflammatory syndrome. Three (8%) patients died., Conclusions: New Zealand continues to have a low incidence of HIV-associated TB. Early HIV diagnosis with universal screening and the treatment of LTBI in persons living with HIV infection is key to minimising the disease burden.

Our aim was to describe the epidemiology and incidence of community-onset invasive S. aureus disease in children presenting to our hospital, and to compare the clonal complexes and virulence genes of S. aureus strains causing invasive and non-invasive disease. The virulence gene repertoire of invasive disease isolates was characterized using DNA microarray and compared with the virulence gene repertoire of non-invasive S. aureus isolates. Over the study period, 163 children had an invasive S. aureus infection. There was no difference in the distribution of clonal complexes or in the prevalence of genes encoding virulence factors between invasive and non-invasive isolates. Future research should include a strong focus on identifying the host and environmental factors that, along with organism virulence factors, are contributing to the patterns of invasive S. aureus disease observed in New Zealand.

Background & Aims: Central venous access device (CVAD)-related complications such as catheter-related sepsis, occlusion and breakage contribute to both mortality and morbidity in home parenteral nutrition (HPN) patients. Prospectively collected data in these patients are scarce., Methods: Data on all CVAD-related complications in four tertiary referral centres in Australia and New Zealand were prospectively collected between 01/01/2009 and 31/12/2009 together with costs of each episode that required admission., Results: Of 53 patients (42 adults and 11 children), 27 suffered a total of 49 episodes of CVAD-associated complications (line infection 36, catheter blockage 5, line fracture 1, line migration 7), giving an incidence of 3.6 per 1000 CVAD days (11.6 per 1000 in patients with a multi-use CVAD). Thirty seven episodes resulted in hospital admission for a median duration of 8 days (range 1-29). Responsible microbes were mainly enteric with klebsiella being the most commonly isolated organism (10 episodes). The average cost of care per episode of CVAD-associated complication requiring inpatient admission was $A9,710 (€6480 approximately)., Conclusion: CVAD complications, in particular line infection are still a major source of potentially avoidable HPN morbidity and mortality with a high cost to the healthcare system. The predominance of enteric organisms in our series raises the possibility of bacterial translocation as a significant component of the pathogenesis of line sepsis in HPN patients., (Copyright © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Mortality and serious long-term sequelae still occur in about 50% of patients with tuberculous meningitis. The frequency and the clinical features of neurological and systemic complications were determined in a retrospective review of 104 patients with tuberculous meningitis. Complications occurred in 81 patients (78%). The most common complications were: hyponatraemia 49%, hydrocephalus 42%, stroke 33%, cranial nerve palsies 29%, epileptic seizures 28%, diabetes insipidus 6%, tuberculoma 3%, myeloradiculopathy 3% and hypothalamic syndrome 3%. The most common iatrogenic complication was hepatotoxicity related to anti-tuberculosis treatment in seven patients. Twenty-three patients (22%) died. At last follow-up one patient (1%) remained in a persistent vegetative state, 14 patients (13%) had severe disability and 12 patients (12%) were moderately disabled. The most common complications in the 81 long-term survivors were cognitive impairment (12%) and epilepsy (11%). Neurological and systemic complications of tuberculous meningitis were common and were important causes of mortality and long-term morbidity., (Copyright 2010 Elsevier Ltd. All rights reserved.)

The clinical features, investigations, treatment and outcome were studied in 104 patients with definite or probable tuberculous meningitis. The diagnosis of definite tuberculous meningitis required the growth of Mycobacterium tuberculosis from cultures, or a positive polymerase chain reaction (PCR) assay for M. tuberculosis. In probable tuberculous meningitis, cultures and the PCR assay were negative, but other causes of meningitis were excluded and there was a response to anti-tuberculosis treatment. Of the 104 patients, 36% had a poor outcome (severe disability, persistent vegetative state or death), 12% moderate disability and 52% good recovery. A diagnosis of definite tuberculous meningitis, the severity of the symptoms at presentation and the occurrence of a stroke were significant predictors of a poor outcome. The most common reasons for a delayed diagnosis were presentation with mild symptoms wrongly attributed to a systemic infection, incorrectly attributing CSF abnormalities to non-tuberculous bacterial meningitis and failure to diagnose extraneural tuberculosis associated with meningitis. Recognition of the difficulties in making a diagnosis of tuberculous meningitis may facilitate earlier diagnosis in the future., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objective: New Zealand's organ donation rates are among the lowest in the OECD. In a bid to increase organ availability, the New Zealand Human Tissue Act 2008 introduces new consent arrangements for deceased donor organ procurement. This article assesses these new arrangements and presents the case for further reform., Approach: Our assessment and arguments are based on philosophical analysis informed by empirical data on the effectiveness of alternative consent systems. We: 1) Identify widely held ethical judgments about policies and practices relevant to organ donation (e.g. those relating to coronial post-mortems), 2) Assess the implications of these judgments for the Human Tissue Act and the assumptions that underpin it, and 3) Derive policy recommendations that are consistent with the judgments., Conclusion: The Human Tissue Act 2008 retains a strong consent requirement for organ procurement: organs may not be transplanted unless either the deceased or the family consents. We argue that organ availability could and should be increased by shifting from a model that requires consent to one that requires the absence of significant dissent., Implications: We recommend that New Zealand adopt either 1) an organ donation system similar to the existing system for ordering coronial post-mortems, or 2) a variant of the 'opt-out' system already in place in several other countries.

Aim: To estimate the prevalence of hookworm, ascaris, and trichuris infection; as well as anaemia, growth retardation, scabies, and impetigo; in schoolchildren of Taveuni Island, Fiji., Methods: Schoolchildren from five villages on Taveuni Island were examined and had their haemoglobin concentration measured on a finger-prick blood sample. In addition, they had a faecal sample examined for the presence of helminth ova., Results: 258 children aged 5-15 years were surveyed. The overall prevalence of infection was: hookworm 14%, ascaris 33%, trichuris 17%, scabies 32%, and impetigo 2%. Eight percent of children were anaemic, while 8% and 6% of children were on or below the third centile for weight and height respectively., Conclusions: The relatively low overall prevalence of hookworm infection and of anaemia suggests that regular anthelminthic treatment of schoolchildren would only provide modest health benefits. Further study is needed to identify the reasons why Taveuni Island schoolchildren weigh less than expected for their age.