Community perspectives on the appropriateness and importance of support goals for young autistic children.

LAY ABSTRACT: Researchers do not know much about what autistic adults, parents and professionals think about support goals for young autistic children. People's views of support goals might also be influenced by their beliefs about early support more generally. This survey involved 87 autistic adults, 159 parents of autistic children and 80 clinical professionals living in New Zealand and Australia. We asked participants questions about themselves and what they thought about early support for young autistic children in general. We then asked participants to rate whether different support goals were appropriate for young autistic children and, if they were appropriate, to rate their level of priority. We found that autistic adults, parents and professionals all rated goals about the adult changing to better support the child, reducing and replacing harmful behaviours and improving the child's quality of life as the highest priorities. They all rated goals about autism characteristics, play skills and academic skills as the lowest priorities. Compared to parents and/or professionals, autistic adults gave lower priority ratings for play skills, autism characteristics and participation goals. Autistic adults were also more likely to rate goals related to play skills and autism characteristics as inappropriate. While these three participant groups generally agreed on the order of priority of early support goals for young autistic children, autistic adults found goals related to autism characteristics, play and/or participation to be an even lower priority and less appropriate than parents and professionals.

Marine heatwave conditions drive carryover effects in a temperate sponge microbiome and developmental performance.

Marine heatwaves are increasingly subjecting organisms to unprecedented stressful conditions, but the biological consequences of these events are still poorly understood. Here we experimentally tested the presence of carryover effects of heatwave conditions on the larval microbiome, settlers growth rate and metamorphosis duration of the temperate sponge Crella incrustans. The microbial community of adult sponges changed significantly after ten days at 21°C. There was a relative decrease in symbiotic bacteria, and an increase in stress-associated bacteria. Sponge larvae derived from control sponges were mainly characterised by a few bacterial taxa also abundant in adults, confirming the occurrence of vertical transmission. The microbial community of sponge larvae derived from heatwave-exposed sponges showed significant increase in the endosymbiotic bacteria Rubritalea marina. Settlers derived from heatwave-exposed sponges had a greater growth rate under prolonged heatwave conditions (20 days at 21°C) compared to settlers derived from control sponges exposed to the same conditions. Moreover, settler metamorphosis was significantly delayed at 21°C. These results show, for the first time, the occurrence of heatwave-induced carryover effects across life-stages in sponges and highlight the potential role of selective vertical transmission of microbes in sponge resilience to extreme thermal events.

Parent reported barriers and facilitators to support services for autistic children in Aotearoa New Zealand.

LAY ABSTRACT: Parents might have problems in getting support services for their autistic child due to certain barriers. However, there might also be things that can ease or facilitate parents' access to support services. In this study, New Zealand parents were asked about their experiences in getting support services for their autistic child. We also looked at differences in reported barriers and facilitators based on several demographic factors with a focus on family level of financial resourcing. A total of 173 parents completed a survey. The results suggested that parents experienced several barriers, particularly related to service pathways. Facilitators were also experienced, predominantly related to providers. Financial resourcing predicted the number of parent-reported barriers. Both lower level of family financial resourcing and having a non-binary child predicted parents' rating of the extent of barriers. Child age and level of speech were predictors for reports of experiencing a higher number of facilitators, with parents of younger children or of non-speaking autistic children reporting a greater number of facilitators. We discuss how these results may be useful to support service delivery and identify areas for future research.

Securing peripheral intravenous catheters in babies without applying adhesive dressings to the skin: a proof-of-concept study.

BACKGROUND: Most babies admitted to a Neonatal Intensive Care Unit (NICU) require a peripheral intravenous catheter (PIVC). PIVCs are secured using splints and adhesive dressings applied to the skin. Removing the dressings causes skin injury, pain, and risks infection. We designed the Pepi Splint, which supports PIVCs without the application of adhesive dressings to the skin. We sought to determine the effectiveness and acceptability of the Pepi Splint using a proof-of-concept design. METHODS: Eligible babies were > 1000 g and > 30 weeks' corrected gestation admitted to Wellington Regional NICU and who required a PIVC. All babies received the same care as those not in the study, with the addition of the Pepi Splint. Primary outcomes were the proportion of babies in which the Pepi Splint secured the PIVC for the required time and proportion of babies who experience an adverse event. Secondary outcomes were the acceptability of the Pepi Splint as reported by the parents. RESULTS: Thirty-eight babies, median (range) birth weight 2625 g (396-4970) and gestation 37wk (22-41). When the Pepi was applied the postnatal weight was 2969 g (1145 - 4970) and gestation 37wk (29 - 41). The Pepi Splint held the PIVC secure for 34/38 babies (89%), for a duration of 37 h (6 to 97). There were no adverse events. Of the four babies reported to have unsecure PIVCs, two were due to the securement two were displaced during feeding. Fifty-eight parents responded to a questionnaire (32 mothers, 26 fathers). Of these parents 52 (90%) would participate again and 52 (90%) would recommend participating to others. Overall, clinicians reported the Pepi Splint was easy to use 33/38 (87%). CONCLUSION: The Pepi Splint safely secures PIVCs without adhesive dressings being applied to the skin and is acceptable to both parents and clinicians. Our findings provide support for a larger multicentred randomised controlled trial. TRIAL REGISTRATION: Registered with the Australian and New Zealand Clinical Trials Registry Reference ACTRN12620001335987 .

Mixed gender accommodation: prevalence, trend over time and vulnerability of older adults.

Admitting male and female patients to the same room compromises the safety of female patients and violates the rights of all patients. We demonstrate that mixed bedding is common (47.22% of admissions), increasing and disproportionately affects vulnerable older patients in a large New Zealand hospital from 2011 to 2019 (n = 160 048). Eliminating mixed bedding should be a priority for our hospital system.

Near-future extreme temperatures affect physiology, morphology and recruitment of the temperate sponge Crella incrustans.

Current rates of greenhouse gas emissions are leading to a rapid increase in global temperatures and a greater occurrence of extreme climatic events such as marine heatwaves. In this study, we assessed the effects of thermal conditions predicted to occur within the next 40 years (SSP3-7.0 scenario of IPCC, 2021) on the respiration rate, buoyant weight, morphology and recruitment of the temperate model sponge Crella incrustans. Under predicted average temperatures (+ 2.5 °C, over the local mean), C. incrustans did not show any physiological and morphological changes compared to current conditions. However, when exposed to a simulated marine heatwave (16 days duration and a thermal peak at 22 °C), there was a large increase in sponge respiration rate, significant weight loss resulting from tissue regression, and sponge mortality. The simulated marine heatwave resulted also in a shorter period of recruitment, lower recruitment rate and higher mortality of settlers. Despite the tissue regression, the majority of sponges that survived the extreme temperatures showed respiration rates similar to controls 13 days after the thermal peak, indicating some resilience of C. incrustans to extreme thermal events. Our study shows that marine heatwaves will significantly impact the physiology, morphology, and recruitment of temperate sponges under near-future conditions, but that these sponges are likely to persist in warmer oceans.

A cross-sectional study of the relationship between recreational sporting activity and calcaneal bone density in adolescents and young adults.

OBJECTIVE: Childhood and adolescence are critical periods of bone development. Sporting activity is thought to impact peak bone mass acquisition, but most studies have used dual-energy X-ray absorptiometry (DXA) to assess bone health and reported associations between bone mass and elite sporting activity. The objective of this study was instead to assess the relationship between recreational sporting activity (RSA) and another bone assessment, calcaneal quantitative ultrasound (cQUS), in adolescents and young adults. METHODS: We related recreational sporting activity, assessed through a lifestyle questionnaire, to heel ultrasound bone parameters in a cohort of New Zealand students aged 16-35 years. Complete datasets with data on all relevant confounders (body mass index (BMI), pubertal timing, smoking status, and alcohol consumption) were available for 452 participants. cQUS was performed using a Lunar Achilles EX II machine to obtain bone parameters, broadband ultrasound attenuation (BUA), and speed of sound (SOS); stiffness index (SI) was derived from these measures. All descriptive statistics and statistical analyses were carried out using SPSS Statistics for Macintosh, Version 23.0 (IBM Corp., Armonk, NY, USA). Results are presented as p-values and 95% CI. RESULTS: Reported lifetime sport participation declined after an individual's mid-teens. Bone cQUS parameters (SI and BUA and T-score) were all positively associated with BMI, and current physical activity (SI, SOS, BUA, T-score, and Z-score) with SI and SOS measures most strongly associated with current high impact and past recreational sporting activity (all p < 0.05). CONCLUSION: Calcaneal heel ultrasound bone parameters were associated with physical activity, with SI and SOS rather than BUA more strongly related to current and past recreational sporting activity in young New Zealand adults.

Adaptive strategies of sponges to deoxygenated oceans.

Ocean deoxygenation is one of the major consequences of climate change. In coastal waters, this process can be exacerbated by eutrophication, which is contributing to an alarming increase in the so-called 'dead zones' globally. Despite its severity, the effect of reduced dissolved oxygen has only been studied for a very limited number of organisms, compared to other climate change impacts such as ocean acidification and warming. Here, we experimentally assessed the response of sponges to moderate and severe simulated hypoxic events. We ran three laboratory experiments on four species from two different temperate oceans (NE Atlantic and SW Pacific). Sponges were exposed to a total of five hypoxic treatments, with increasing severity (3.3, 1.6, 0.5, 0.4 and 0.13 mg O2  L-1 , over 7-12-days). We found that sponges are generally very tolerant of hypoxia. All the sponges survived in the experimental conditions, except Polymastia crocea, which showed significant mortality at the lowest oxygen concentration (0.13 mg O2  L-1 , lethal median time: 286 h). In all species except Suberites carnosus, hypoxic conditions do not significantly affect respiration rate down to 0.4 mg O2  L-1 , showing that sponges can uptake oxygen at very low concentrations in the surrounding environment. Importantly, sponges displayed species-specific phenotypic modifications in response to the hypoxic treatments, including physiological, morphological and behavioural changes. This phenotypic plasticity likely represents an adaptive strategy to live in reduced or low oxygen water. Our results also show that a single sponge species (i.e., Suberites australiensis) can display different strategies at different oxygen concentrations. Compared to other sessile organisms, sponges generally showed higher tolerance to hypoxia, suggesting that sponges could be favoured and survive in future deoxygenated oceans.

A multidisciplinary perioperative medicine clinic to improve high-risk patient outcomes: A service evaluation audit.

Various perioperative interventions have been demonstrated to improve outcomes for high-risk patients undergoing surgery. This audit assessed the impact of introducing a multidisciplinary perioperative medicine clinic on postoperative outcomes and resource usage amongst high-risk patients.Between January 2019 and March 2020, our institution piloted a Comprehensive High-Risk Surgical Patient Clinic. Surgical patients were eligible for referral when exhibiting criteria known to increase perioperative risk. The patient's decision whether to proceed with surgery was recorded; for those proceeding with surgery, perioperative outcomes and bed occupancy were recorded and compared against a similar surgical population identified as high-risk at our institution in 2017.Of 23 Comprehensive High-Risk Surgical Patient Clinic referrals, 11 did not proceed with the original planned surgery. Comprehensive High-Risk Surgical patients undergoing original planned surgery, as compared to high-risk patients from 2017, experienced reduced unplanned intensive care unit admission (8% versus 19%, respectively), 30-day mortality (0% versus 13%) and 30-day re-admission to hospital (0% versus 20%); had shorter postoperative lengths of stay (median (range) 8 (7-14) days versus 10.5 (5-28)) and spent more days alive outside of hospital at 30 days (median (range) 18 (0-25) versus 21 (16-23)). Cumulatively, the Comprehensive High-Risk Surgical patient cohort compared to the 2017 cohort (both n=23) occupied fewer postoperative intensive care (total 13 versus 24) and hospital bed-days (total 106 versus 212).The results of our Comprehensive High-Risk Surgical Patient pilot project audit suggest improved individual outcomes for high-risk patients proceeding with surgery. In addition, the results support potential resource savings through more appropriate patient selection.

Relapse patterns after low-dose-rate prostate brachytherapy.

PURPOSE: When biochemical failure (BF) develops after low-dose-rate prostate brachytherapy, the relapse site is frequently not found. We set out to find whether prostate-specific membrane antigen positron emission tomography -CT (PSMA PET-CT) scanning has improved knowledge of relapse patterns. METHODS AND MATERIALS: A database was analyzed, which contained information and long-term followup on 903 men who had an iodine-125 seed implant as monotherapy for early-stage prostate cancer. There was a total of 68 BFs. RESULT: In 38 men developing BF before PSMA PET-CT scanning was available, the site of relapse was local in six, distant in twelve, and unknown in twenty. In 30 men developing BF more recently who had a PSMA PET-CT scan, the relapse site was demonstrated in all cases, and 19 (63%) men had relapsed at the prostate base. Radiation dosimetry of base relapses and paired controls demonstrated that implants routinely delivered a lower radiation dose to the base than to the rest of the prostate. Eight of seventeen cases found to have prostate relapse only underwent salvage prostatectomy. CONCLUSION: PSMA PET-CT scanning is highly effective in demonstrating the relapse site(s) when BF develops after low-dose-rate prostate brachytherapy. Knowledge of the relapse site increases management options for men developing BF.

Short-term responses of tropical lagoon sponges to elevated temperature and nitrate.

Sponges are often important components of coastal lagoons, however their responses to anthropogenic stressors remain poorly understood. Here, we tested the responses of three lagoon sponges, Neopetrosia exigua, Amphimedon navalis and Spheciospongia vagabunda from Mauritius (Western Indian Ocean), to nine temperature and nitrate combinations for 14 days. We found that elevated seawater temperature resulted in significant physiological responses in all species, but there was generally little negative effect of elevated nitrate. At the end of the experiment, the buoyant weight of all three species were significantly reduced, while for the two chlorophyll a-containing species, N. exigua and S. vagabunda, effective quantum yield (ΔF/Fm') of photosystem (PS) II, photosynthetic pigment concentrations, gross photosynthetic rate and gross photosynthesis to respiration (P:R) ratio were also reduced. Dark respiration rates were higher in all three species at elevated temperature. While these lagoon sponges appeared to be impacted by elevated temperature, here, we demonstrate that these species are physiologically tolerant to excess nitrate concentrations.

Child and Family Characteristics Associated with Sleep Disturbance in Children with Autism Spectrum Disorder.

Little is known about the role of family characteristics in sleep disturbance for children with autism spectrum disorder (ASD). This study involved an exploratory analysis of the association between 17 child, parent, and socioeconomic characteristics and sleep disturbance using data from 203, 2-18-year-old children with ASD whose families participated in the Western Australian Autism Biological Registry. Results suggest that greater ASD symptom severity; child seizures; maternal autism traits, anxiety, and depression; lower paternal education; and lower family income were related to increased sleep disturbance. All these characteristics, aside from maternal depression, were significant predictors within a regression model, which accounted for 33% of the total variance. Thus, child characteristics alone may not adequately explain sleep disturbance in children with ASD.

Consumer alcohol exposure in supermarkets: legislatively adherent, but a societal problem.

OBJECTIVE: The Sale and Supply of Alcohol Act 2012 came into force to promote the safe and responsible sale, supply, and consumption of alcohol in New Zealand. The Act was intended to minimise harm caused by excessive consumption of alcohol and reduce exposure to alcohol promotion. This study assessed supermarket adherence to sections 112-114 of the Act related to the display and advertisement of alcohol. It also assessed consumer exposure to alcohol marketing in these businesses. METHODS: This paper reports on an audit of nine supermarkets in a major New Zealand city. RESULTS: Supermarkets exhibited high average adherence with the Act (86% adherence across audit fields); despite this, exposure to alcohol displays, promotions and advertisements remained an issue regardless of supermarket geographic location, size or chain affiliation. CONCLUSIONS: Supermarkets are an increasingly popular source of off-licence alcohol sales. Exposure to alcohol marketing in these businesses will likely influence consumer purchasing behaviour. Implications for public health: As an important public health challenge, based on this study, it would appear that supermarkets mostly meet the provisions of the Sale and Supply of Alcohol Act 2012, but not the intent. Additional work is required to strengthen their response to the Act.

Author Correction: Growth and longevity in giant barrel sponges: Redwoods of the reef or Pines in the Indo-Pacific?

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Keratoconus Prevalence Among High School Students in New Zealand.

PURPOSE: To determine the prevalence of keratoconus among high school students in Wellington, New Zealand. METHOD: The Wellington Keratoconus Study was a population-based prospective cross-sectional study of 2 cohorts in Wellington: cohort 1 (year 9 students, mean age 13.9 years) and cohort 2 (year 11 students, mean age 15.5 years). RESULTS: A total of 1916 students with a mean age of 14.6 years participated from 20 schools in the region. Keratoconus was found in 1:191 (0.52%) participants overall and in 1:45 (2.25%) Maori participants. Pentacam mean Kmax of 48.7 diopters (D) (cohort 1, 45.5 D; cohort 2, 49.9 D), thinnest pachymetry of 494.05 µm (cohort 1, 479.0 µm; cohort 2, 499.5 µm), posterior elevation at the thinnest point of 23.4 (cohort 1, 15.2; cohort 2, 26.6), Belin/Ambrosio enhanced ectasia display overall D value of 4.30 (cohort 1, 3.2; cohort 2, 4.7) were noted in participants with keratoconus. In those with keratoconus, 8 of 10 had visual impairment of 0.2 Logarithm of the Minimum Angle of Resolution (LogMAR) or worse in the better eye; 7 of 10 did not use visual aids; 7 of 10 had atopy; and 6 of 10 were from a low school decile. In those without keratoconus, 43.8% had atopy. CONCLUSIONS: Keratoconus may affect up to 1 in 191 New Zealand adolescents and 1 in 45 Maori adolescents. Keratoconus appeared to be associated with Maori ethnicity, atopy, lower school decile, visual impairment, and the underutilization of visual aids. Nationwide screening programs may have a role in reducing the burden of disease associated with keratoconus.

Modified Sequential Organ Failure Assessment sepsis score in an emergency department setting: Retrospective assessment of prognostic value.

OBJECTIVE: Use of the Sequential Organ Failure Assessment (SOFA) score has been proposed by the Third International Consensus Definitions for Sepsis and Septic Shock. The utility in the ED is not yet well established. We retrospectively studied the application of a modified SOFA (mSOFA) score, to assess its ability to predict mortality. METHODS: At our urban tertiary teaching hospital staff recorded patients with probable sepsis in the ED Information System (EDIS). Data was analysed for the year of July 2015 to June 2016. For a sample of the suspected sepsis patients, ED and inpatient clinical records were manually reviewed to ascribe an mSOFA score and assess its performance in predicting mortality, with a primary outcome of death by 30 days. RESULTS: There were 474 patients recorded over the 1 year with probable sepsis, of whom 228 were manually reviewed. The mSOFA was a significant predictor of mortality at all the time points tested. The 30 day mortality was 22/88 (25%) for those with a positive mSOFA score and 3 out of 140 (2.1%) of those with a negative mSOFA score (OR 15.2, 95% CI [4.4, 52.7]; P < 0.001). This equated to a negative predictive value of 97.9% (95% exact CI 93.9-99.6%). CONCLUSION: For ED patients thought likely to have sepsis, the mSOFA score distinguished those with a high or low mortality risk. The high negative predictive value could be practically useful. Prospective study of the mSOFA score used in ED will be needed to validate these observations.

A prospective audit of the 10-year outcomes from low dose-rate brachytherapy for early stage prostate cancer.

AIM: New Zealand men diagnosed with early stage prostate cancer need to know what outcomes to expect from management options. METHODS: Between 2001 and 2016, 951 men were treated with low dose-rate brachytherapy (permanent iodine-125 seed implantation) by the Wellington Prostate Brachytherapy Group based at Southern Cross Hospital, Wellington. At follow up after treatment, men had their PSA measured and were scored for urinary, bowel and sexual side effects. RESULTS: Median follow-up of men was 7.9 years (range 2.0-16.3 years). Ten-year PSA control was 95% for the 551 men with low-risk prostate cancer and 82% for the 400 men with intermediate-risk prostate cancer. Adverse effects were generally minor and short-term only. Temporary urinary obstruction developed soon after the implant in 2.6% men, and the 10-year cumulative risk of urethral stricture was 2.6%. Erectile dysfunction developed in 29% men, two-thirds of whom had a good response to a PDE5 inhibitor. Most men returned to a normal routine within four days of the implant. CONCLUSION: LDR brachytherapy is a highly effective low-impact treatment option for New Zealand men with early stage prostate cancer.

Growth and longevity in giant barrel sponges: Redwoods of the reef or Pines in the Indo-Pacific?

Describing life history dynamics of functionally important species is critical for successful management. Barrel sponges (Xestospongia spp.) fill ecologically important roles on coral reefs due to their large size and water column interactions. Studies of Caribbean X. muta suggest they may be up to 1000 s of years old. However, nothing is known of barrel sponge growth rates outside the Caribbean. We assessed Indo-Pacific barrel sponge demography with a focus on specific growth rate (SGR), density, and mean volume across four sites of varying habitat quality. Four growth models were compared using Akaike's Information Criterion using a multi-model inference approach. Age was extrapolated and validated based on sponge size on a shipwreck of known age. Sponges from different sites showed differences in density, volume gained, and mean volume, but not growth rates. Interestingly, SGRs were slightly slower than that of X. muta, yet growth models supported rapid growth; Indo-Pacific sponges were over twice as old as published estimates of comparably sized X. muta (53-55 as compared to 23 years of age, respectively), although extrapolation errors are likely to increase with sponge size. This suggests that barrel sponge growth rates in the Indo-Pacific might be more comparable to Pines rather than Redwoods.

Healthcare-seeking behaviour of people with sexually transmitted infection symptoms attending a Sexual Health Clinic in New Zealand.

AIMS: Untreated sexually transmitted infections (STIs) can lead to serious health complications and may be transmitted to uninfected individuals. Therefore, the early detection and subsequent management of STIs is crucial to control efforts. Time to presentation for STI symptoms and risk of transmission in this period has not been assessed in New Zealand to date. METHODS: All new clients presenting to an urban sexual health clinic (SHC) were invited to complete a questionnaire, which included demographic information, sexual health history, and details about the clinic visit. RESULTS: Of 331 people approached, 243 (73.4%) agreed to complete the questionnaire. Four incomplete questionnaires were excluded, leaving 239 participants (47.3% female and 52.7% male, 43.8% under the age of 25). The most common reason for seeking healthcare was experiencing symptoms (39.4%) and 41.7% of people with symptoms waited more than seven days to seek healthcare. Around a third (30.6%) of people with symptoms had sex after they first thought they may need to seek healthcare. Infrequent condom use was reported more often by people who had sex with existing partners (84.6%) than by people who had sex with new partners (10.0%). CONCLUSIONS: This is the first study to quantify healthcare-seeking behaviour for STI in New Zealand. Delayed healthcare-seeking (defined as waiting more than seven days) was common and almost a third of people reported engaging in sex while symptomatic. Enabling prompt healthcare-seeking is crucial to minimise transmission risk. Structural barriers such as the financial cost of STI tests must be removed and education around symptom recognition and healthcare system navigation should be provided.