ABSTRACT Case history Two clusters of mortality among endangered tūturuatu/tchūriwat’/shore plover (Thinornis novaeseelandiae) have occurred at captive breeding facilities around New Zealand in recent years. In the first, four chicks died at Pūkaha National Wildlife Centre (Mount Bruce, NZ) in February 2016, and in the second five adult birds at the Cape Sanctuary (Cape Kidnappers, NZ) died in 2022. Clinical findings In 2016, four chicks were noted to become weak, have increased vocalisations and closed eyes prior to death. The remaining chicks were treated for 5 days with amoxycillin/clavulanate orally twice daily. Water containers and brooders were cleaned and disinfected with chlorhexidine. No further mortality was seen. In the 2022 cluster, three adult breeding birds died acutely and five others showed inappetence, weight loss and diarrhoea approximately 10 days after heavy rains flooded the local river. The five birds were treated with amoxycillin/clavulanate orally twice daily and oral fluids for 5 days. Two birds died and three survived. No breeding occurred in the aviaries in the following season. Pathological findings In 2016, the chicks showed pulmonary changes ranging from congestion and oedema to heterophilic inflammation consistent with septicaemia. In 2022, the adult birds showed proliferation of bacteria in the distal small intestine associated with mucosal ulceration and heterophilic infiltration. Acid-fast staining of the caecal contents in one bird showed organisms consistent with Cryptosporidium spp. Laboratory findings Aerobic bacterial cultures of the lung and liver of two affected chicks carried out in 2016 showed heavy growth of Plesiomonas shigelloides. The same organism was cultured from water trays and holding tanks containing water boatmen (Sigara arguta) on which the chicks were fed. In 2022, cultures from the livers of three dead birds each showed a mixed bacterial growth with differing dominant organisms (Aeromonas sobria, Hafnia alvei, Citrobacter freundii and an Enterococcus sp.). PCR and sequencing confirmed Cryptosporidium parvum in the caecum of one bird. Fresh faeces from 24 breeding birds from the captive breeding facilities were negative by PCR for Cryptosporidium spp. The captive breeding facilities obtain water for the aviaries and aquatic invertebrates to feed to the chicks from local freshwater sources. Water quality testing at the Cape Sanctuary revealed concentrations of faecal indicator bacteria in excess of safe drinking water guidelines, with peaks following heavy rainfall. Clinical relevance Fluctuations in water quality associated with mammalian faecal bacteria can adversely affect bird health and impact on captive rearing of endangered wildlife.

Psychosis is a severe mental disorder characterized by abnormal thoughts and perceptions (e.g., hallucinations) occurring quintessentially in schizophrenia and in several other neuropsychiatric disorders. Schizophrenia is widely considered as a neurodevelopmental disorder that onsets during teenage/early adulthood. A multiplex consanguineous Pakistani family was afflicted with severe psychosis and apparent autosomal recessive transmission. The first-cousin parents and five children were healthy, whereas two teenage daughters were severely affected. Structured interviews confirmed the diagnosis of DSM-V schizophrenia. Probands and father underwent next-generation sequencing. All available relatives were subjected to confirmatory Sanger sequencing. Homozygosity mapping and directed a priori filtering identified only one rare variant [MAF < 5(10)-5] at a residue conserved across vertebrates. The variant was a non-catalytic deubiquitinase, USP53 (p.Cys228Arg), predicted in silico as damaging. Genome sequencing did not identify any other potentially pathogenic single nucleotide variant or structural variant. Since the literature on USP53 lacked relevance to mental illness or CNS expression, studies were conducted which revealed USP53 localization in regions of the hippocampus (CA 1-3) and granular dentate. The staining pattern was like that seen with GRIA2/GluA2 and GRIP2 antibodies. All three proteins coimmunoprecipitated. These findings support the glutamate hypothesis of schizophrenia as part of the AMPA-R interactome. If confirmed, USP53 appears to be one of the few Mendelian variants potentially causal to a common-appearing mental disorder that is a rare genetic form of schizophrenia.

Real-time continuous glucose monitoring (rtCGM) has several advantages over intermittently scanned continuous glucose monitoring (isCGM) but generally comes at a higher cost. Do-it-yourself rtCGM (DIY-rtCGM) potentially has benefits similar to those of rtCGM. This study compared outcomes in adults with type 1 diabetes using DIY-rtCGM versus isCGM. In this crossover trial, adults with type 1 diabetes were randomized to use isCGM or DIY-rtCGM for eight weeks before crossover to use the other device for eight weeks, after a four-week washout period where participants reverted back to isCGM. The primary endpoint was time in range (TIR; 3.9-10 mmol/L). Secondary endpoints included other glycemic control measures, psychosocial outcomes, and sleep quality. Sixty participants were recruited, and 52 (87%) completed follow-up. Glucose outcomes were similar in the DIY-rtCGM and isCGM groups, including TIR (53.1% vs 51.3%; mean difference -1.7% P = .593), glycosylated hemoglobin (57.0 ± 17.8 vs 61.4 ± 12.2 mmol/L; P = .593), and time in hypoglycemia <3.9 mmol/L (3.9 ± 3.8% vs 3.8 ± 4.0%; P = .947). Hypoglycemia Fear Survey total score (1.17 ± 0.52 vs 0.97 ± 0.54; P = .02) and fear of hypoglycemia score (1.18 ± 0.64 vs 0.97 ± 0.45; P = .02) were significantly higher during DIY-rtCGM versus isCGM. Diabetes Treatment Satisfaction Questionnaire status (DTSQS) score was also higher with DIY-rtCGM versus isCGM (28.7 ± 5.8 vs 26.0 ± 5.8; P = .04), whereas diabetes-related quality of life was slightly lower (DAWN2 Impact of Diabetes score: 3.11 ± 0.4 vs 3.32 ± 0.51; P = .045); sleep quality did not differ between the two groups. Although the use of DIY-rtCGM did not improve glycemic outcomes compared with isCGM, it positively impacted several patient-reported psychosocial variables. DIY-rtCGM potentially provides an alternative, cost-effective rtCGM option.

Postoperative hypoparathyroidism may cause significant patient morbidity and even mortality. Emerging technologies centered on autofluorescent properties of parathyroid glands when exposed to near-infrared light hold promise to improve surgical parathyroid gland identification and preservation. Two systems (probe-based and camera-based) are commercially available currently; however, neither system alone provides indication of vascular viability or postoperative parathyroid gland function. The administration of indocyanine green, when combined with near-infrared fluorescence imaging, enables subjective assessment of parathyroid gland perfusion. Additional technologies to assess parathyroid gland perfusion are being developed. The impact of these nascent technologies on relevant clinical outcomes is an area of active investigation.

Hand-feel touch firmness is a sensory method reported to be used by the blueberry industry to characterise individual fruit firmness quality. A ‘soft’ blueberry may be considered unmarketable. However, firmness assessed by a hand touch is questionable due to being highly influenced by the assessor's subjective judgment. Objective instrumental methods are preferred to measure firmness and create a reliable and consistent dataset. This research aimed to study the relationship between sensory hand-feel touch firmness measured by a trained sensory panel and instrumental mechanical parameters of blueberry ‘Centurion’. To our knowledge, this is the first attempt to relate instrumental mechanical parameters to hand firmness using a sensory panel setting and reference samples to exemplify hand-feel intensity differences. Seven assessors were trained to evaluate hand touch firmness in a sensory panel setting. References samples resembling a blueberry were made of silicone and used to calibrate assessors’ performance by exemplifying four blueberry firmness scores (‘very soft’, ‘soft’, ‘firm’ and ‘very firm’). Six sensory sessions were conducted, where each session represented a harvest date and storage time combination (3 harvest dates X 2 storage times). Each sensory session considered blueberries exposed to five storage relative humidity (71 %, 88 %, 95 %, 97 % and 100 % RH). As a result, assessors were able to discriminate differences in hand touch firmness as influenced by storage relative humidity (water loss differences). In addition, mechanical parameters measured by the slope of force-deformation curve using a plate probe on a compression test (hardness slope) or a needle probe on a penetration test (skin break slope) were best related to sensory hand-feel firmness. Average hardness slope and skin break slope higher than 1.7 kN m−1 and 0.42 kN m−1, respectively, were associated with a very low (≤5 %) likelihood of observing unmarketable (‘soft’ + ‘very soft’) 'Centurion' blueberries in a batch. Our study provides a basis for the standardisation of mechanical methods that can be used to assess blueberry quality based on its ability to represent consumer sensation preferences of texture.

Poor prognostic factors in rheumatoid arthritis (RA) are associated with a more severe form of the disease. Nuclear medicine functional imaging has shown remarkable merit at identifying active disease in patients with RA and is increasingly being used in this regard. However, its prognostic value has not been evaluated thoroughly. We aimed to assess the prognostic value of technetium-99m ( 99m Tc-) glucosamine imaging in patients with RA. Twenty-two participants diagnosed by an experienced rheumatologist with RA were recruited for inclusion in the study. Blood samples were obtained from each participant for baseline C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody titer. On the same day, each participant was injected with 20-25 millicurie (mCi) of 99m Tc-glucosamine. Planar and single-photon emission computed tomography images of known disease sites were acquired up to 2 hours after radiopharmaceutical administration. Affected joints were qualitatively assessed and graded for 99m Tc-glucosamine uptake and compared with blood results. All participants affected joints had an increased uptake of the radiopharmaceutical, with 14 (63.6%) having elevated RF and anti-CCP antibody titers. Eight of the 14 patients with increased RF and anti-CCP antibodies had grade 3 uptake of 99m Tc-glucosamine. The remaining 6 had grade 2 uptake. A significant correlation between higher grade uptake and increased levels of RF and anti-CCP antibodies ( P = 0.031) was observed. We found a strong correlation between high-grade disease on imaging and the presence of RF and anti-CCP antibodies in patients with RA.

The New Zealand (NZ) Central Region Stroke Network, serving 1.17 million catchment population, changed to tenecteplase for stroke thrombolysis in 2020 but was forced to revert to Alteplase in 2021 due to a sudden cessation of drug supply. We used this unique opportunity to assess for potential before and after temporal trend confounding. In NZ all reperfused patients are entered prospectively into a national database for safety monitoring. We assessed Central Region patient outcomes and treatment metrics over three time periods: alteplase use (January 2018-January 2020); during switch to tenecteplase (February 2020-February 2021) and after reverting to alteplase (February 2021-December 2022) adjusting regression analyses for hospital, age, onset-to-needle, NIHSS, pre-morbid mRS and thrombectomy. Between January 2018 and December 2022, we treated 1121 patients with Alteplase and 286 with tenecteplase. Overall, patients treated with tenecteplase had greater odds of favorable outcome ordinal mRS [aOR = 1.43 (95% CI = 1.11-1.85)]; shorter door-to-needle (DTN) time [median 52 (IQR 47-83) vs 61 (45-84) minutes, p < 0.0001] and needle to groin (NTG) times [118 (74.5-218.5) vs 185 (118-255); p = 0.02)]. Symptomatic intracerebral hemorrhage (sICH) rate was lower in tenecteplase group [aOR 0.29 (0.09-0.95)]. Findings similarly favored tenecteplase when comparing tenecteplase to only the second alteplase phase. There was no inter-group difference when comparing the two alteplase phases. Our results suggest that previously reported benefits from tenecteplase in a real-world setting were not likely attributable to a temporal confounding.

Heart Failure (HF) patients often have limited exercise capacity due to dyspnoea and fatigue. Despite the availability of effective treatment, HF is associated with poor quality of life (QOL), high morbidity and mortality. Māori are twice as likely to die and four times as likely to be hospitalised for HF. Heart failure hospitalisations cost an estimated 2% to the New Zealand health system. Until the late 1980s, exercise was considered unsafe for HF; since then, considerable research evidence has suggested that exercise is safe and provides substantial physiological and psychological benefits. Whilst potential benefits are clear, there were no guidelines or resources available for HF patients in Hawkes Bay. With aim of improving functional capacity and QOL for HF patients and reduce readmissions, rehabilitation space was explored. Fiscal budgets and need of a multidisciplinary team were barriers to idealistic HF rehabilitation. The HF rehabilitation was integrated into pulmonary rehabilitation, with modification as per HF guidelines on exercise, content, and training of all staff regarding cardiology. The HF rehabilitation classes commenced in rural and urban regions (four regions in total). Patients were selected as per referral criteria and the first assessment was completed by the cardiologist/nurse practitioner/clinical nurse specialist and referred to an 8-week rehabilitation program. QOL tools were used to measure the before and after outcomes. More than 200 patients were referred and evaluated for results. Twenty-five HF patients were interviewed to understand enablers and barriers to rehabilitation. The HF patients who attended the program were almost 50% less likely to be readmitted, had reduced breathlessness, and improved fitness. Self-management skills and health literacy were also improved. Heart failure rehabilitation has proven to be a low-cost, high-value intervention, but is generally underused.

Halyomorpha halys, (brown marmorated stink bug, BMSB), is a high-concern invasive species causing severe damage to orchards in many countries outside its native Asian range. Management methods other than frequent sprays of broad-spectrum insecticides are needed to restore integrated pest management (IPM) practices in orchards. Chitin synthesis inhibitors are usually regarded as desirable options in IPM programs because of lower toxicity to beneficial insects and non-target organisms compared to neurotoxic insecticides. In this study, the activity of three chitin synthesis inhibitors (namely buprofezin, novaluron and triflumuron) was investigated on BMSB egg masses, 3rd instars and adults by means of laboratory bioassays. Novaluron and to a lesser extent triflumuron were detrimental to BMSB nymphs exposed to residues on potted peach plants. Novaluron caused high mortality among early instars emerged from sprayed egg masses. No significant differences were found between buprofezin and water control on eggs or 3rd instars. When sprayed on BMSB adults, none of the chitin synthesis inhibitors affected survival, fecundity or egg hatching. Given the activity on nymphs, but the lack of effects on adults, novaluron and triflumuron might be considered for field applications only as a tool in a wider management strategy along with other methods aimed at preventing the invasion of crops by BMSB adults. This article is protected by copyright. All rights reserved.

Ethnic differences in post-stroke outcomes have been largely attributed to biological and socioeconomic characteristics resulting in differential risk factor profiles and stroke sub-types, but evidence is mixed. This study assessed ethnic differences in stroke outcome and service access in New Zealand (NZ) and explored underlying causes in addition to traditional risk factors. This national cohort study used routinely collected health and social data to compare post-stroke outcomes between NZ Europeans, Māori, Pacific Peoples, and Asians, adjusting for differences in baseline characteristics, socioeconomic deprivation, and stroke characteristics. First and principal stroke public hospital admissions during November 2017-October 2018 were included (N=6,879). Post-stroke unfavourable outcome was defined as being dead, change in residence, or unemployed if working pre-stroke. In total, 5,394 NZ Europeans, 762 Māori, 369 Pacific Peoples and 354 Asians experienced a stroke during the study period. Median age was 65 years for Māori and Pacific Peoples, and 71 and 79 years for Asians and NZ Europeans, respectively. Compared with NZ Europeans, Māori were more likely to have an unfavourable outcome at all three time-points (OR=1.6 (95%CI=1.3-1.9); 1.4 (1.2-1.7); 1.4 (1.2-1.7), respectively). Māori also had increased odds of death at all time-points (1.7 (1.3-2.1); 1.5 (1.2-1.9); 1.7 (1.3-2.1)) and unemployment at twelve months (2.5 (1.2-5.2). There was evidence of differences in post-stroke secondary prevention medication by ethnicity. We found ethnic disparities in care and outcomes following stroke, independent of traditional risk factors raising concern for potential unconscious bias and institutional racism in stroke services.