Clinical Trials New Zealand

Multiple drivers of global change are causing rapid biodiversity loss worldwide. However, predicting species' trajectories remains challenging due to the dynamic and state-dependent nature of ecological responses in real-world ecosystems. Here, we leverage nonlinear time series analysis of a multi-decadal, high-resolution dataset encompassing climate, freshwater, and sediment variables, alongside estuarine macroinvertebrate abundance. Our analysis shows that key biological traits, including body size, mobility, and lifespan predict the mean and variability of the time-varying sensitivity of species to specific environmental drivers. Species with smaller body sizes or lower mobility exhibit consistently negative responses to warming. The temporal variability of species sensitivity, an aspect often overlooked in previous studies of species' environmental responses, is strongly associated with lifespan, with shorter-lived species showing greater fluctuations over time. These findings did not always align with results from controlled laboratory or short-term field experiments, highlighting the complex, state-dependent responses of species shaped by multiple drivers of global change. We introduce a framework that links biological traits to long-term environmental responses, providing a predictive basis for trait-sensitivity relationships.

Low-lying coastal estuaries, home for ~60% of the world’s population, are often dredged for navigation. Dredging deepens the estuary channel, hypothetically disturbing the hydro- and morpho-dynamics of an estuary. However, the impact of this activity on the morphological equilibrium state (i.e. balanced state between erosion and deposition) and flood propagation of the estuary leaves a substantial knowledge gap. As such, addressing this gap is fundamental to understanding the tendency of the estuary to bounce back to its morphological equilibrium state (i.e. which part severely needs more sediment), along with hydrodynamic impact on tidal and fluvial floods, especially under current sea-level rise (SLR) projections.Here, high-resolution bathymetric data from 2016 to 2025 are used to detect morphological changes and to run 2D hydrodynamic simulations under varying tidal and fluvial flood conditions, added with 2100 SLR projection in the Clyde estuary, United Kingdom. In tidal prism theory, scaling between the tidal prism (P) and cross section area (A) represents a dynamic equilibrium state of feedback between tidal channel morphology and hydrodynamics. It is used here to understand the current equilibrium state of the uppermost, anthropogenically constrained part and unconfined, downstream part of the estuary.In an equilibrium state, erosion and deposition in the system are in balance. Instead model shows that the Clyde estuary has been in a morphological disequilibrium state, during the entire study period. Dredging activity, type of flood, sea-level rise and channel confinement collectively affect the morphological equilibrium state of the Clyde estuary, with the channel confinement showing the most pronounced impact. Dredging and flood type have a minor impact on the downstream morphological equilibrium of the Clyde. In contrast, dredging significantly disrupts the equilibrium of the fully confined upstream section. Although net accretion occurs throughout the system—most strongly in the upstream region—the annual sedimentation rate decreases by approximately a factor of sixteen from 2016-2025. This is because the current disequilibrium state tends to make the system to erode itself. What is the impact of this on flooding? Increased accretion upstream restricts the upstream propagation of the tidal flood, thereby reducing the overall extent of tidal inundation. However, the associated reduction in upstream cross-sectional area increases the extent of fluvial flooding. Under the 2100 SLR projection, assuming the same levels of dredging and estuary shape as today, the estuary gets closer to its morphological equilibrium state. As the sea-level rise delivers more water into the estuary, it increases both the tidal prism volume and the cross-sectional area. Lastly, channel confinement by riverbanks to protect the infrastructure and people from flooding, impacts morphological disequilibrium the most. Channel confinement laterally reduces the cross-section area, making the space available for the flowing water laterally limited and consequently the system adjusts vertically, making it more erosive and increases flood risk. Here we show that tidal prism theory could aid us in understanding the morphological equilibrium state of a dredged estuary, providing us with a useful guideline on sustainable sediment management and flood mitigation under the projected sea-level rise.

Eczema is a chronic skin condition, characterised by inflammation, erythema, and pruritus. Usage of topical therapies containing botanical extracts is common, however evidence of efficacy is often lacking. This trial investigated the safety and efficacy of a mānuka-oil based cream, 2% ECMT-154, versus vehicle control (VC) for the topical treatment of eczema. This single-blind, parallel group randomised controlled trial was undertaken in 11 community pharmacies across New Zealand. Adults with moderate-to-severe eczema (Patient Oriented Eczema Measure [POEM] ≥ 8 to ≤ 24) were randomised 1:1 to topical 2% ECMT-154 or VC cream, applied twice daily for six weeks. The primary outcome was POEM at week six. 118 participants were recruited between 20th January 2022 and 22nd May 2023. Between baseline and week six mean POEM score (standard deviation) improved from 16.3 (4.2) to 8.8 (5.7) in the ECMT-154 group, and from 16.9 (3.8) to 8.8 (5.7) in the VC group, a between group difference of -0.38 (95% CI: -2.58 to 1.82, p = 0.74). No statistically significant differences were observed across all secondary outcome measures, and no serious adverse events were reported. Whilst symptoms of eczema improved in both treatment groups, there was no evidence of a difference in efficacy between ECMT-154 and VC cream in the treatment of eczema. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001096842, the study was registered on 18th of August 2021.

Intertidal estuarine habitats are inundated by seawater and uncovered with every tidal cycle, with potential exposure to both marine and atmospheric heatwaves. Little is known about the role of intertidal soft sediment ecosystems in the carbon cycle and how increasing extreme temperature events may affect carbon flux dynamics. Here we conducted a multi-day experiment simulating a low tide atmospheric heatwave at two estuary intertidal flats (sandy/muddy) to test the responses of macrobenthic biodiversity and fluxes of methane (CH4) and carbon dioxide (CO2). Results show heatwave simulation increases CO2 uptake at the sandy site and causes a switch from efflux (source) to influx (sink) of CO2 at the muddy site. Raw CH4 fluxes are unchanged by the temperature treatment but effect sizes relative to controls are greatest in muddy sediments. We provide evidence for cumulative effects of heatwave duration on macrobenthic biodiversity and greenhouse gas fluxes and show that increasing muddiness (often associated with degradation) and increasing duration of heatwave events may change the carbon source/sink status of estuaries.

Human rights frameworks have historically emphasised physical integrity, yet psychological integrity, the right to mental stability, identity, and emotional safety all remain neglected in health policy and law. This narrative review and commentary argues that psychological integrity is inseparable from ecological integrity, and that contemporary mental health crises are rooted in ruptured human–nature attachments. Drawing on Mother Nature Attachment Theory (MNAT) and supported by emerging empirical evidence, this review traces a trajectory from pre-attachment, through rupture via colonisation, displacement, and ecological collapse, to reconnection through cultural and ecological repair. Gaza exemplifies a contemporary site of deliberate ecological–psychological rupture, where environmental destruction compounds trauma and erodes cultural continuity. In contrast, Indigenous frameworks in Australasia, such as Te Whare Tapa Whā, provide culturally grounded models of reconnection that demonstrate how ecological repair and psychological restoration can proceed together. These contrasting cases illustrate MNAT’s trajectory and emphasise that safeguarding psychological integrity requires embedding ecological security into public health systems. The review concludes that planetary mental health depends on recognising healing of mind and Earth as an indivisible task. Healing mind and Earth must be understood as a single, urgent task within planetary public mental health.

No abstract available.

Pivotal clinical trials have assessed the efficacy and safety of fixed-dose upadacitinib 15 mg (UPA15) and 30 mg (UPA30) once daily in atopic dermatitis (AD). To assess the efficacy and safety of dose escalation to UPA30 and dose reduction to UPA15 based on a clinical response [90% reduction in Eczema Area and Severity Index (EASI 90)] after 12 weeks of treatment in adults with moderate-to-severe AD enrolled in a randomized blinded treat-to-target multicentre phase IIIb/IV study. A total of 461 patients were randomized in a 1 : 1 ratio to receive oral doses of UPA15 (n = 229) or UPA30 (n = 232) once daily during the 12-week double-blinded period. At week 12, patients on UPA15 not achieving EASI 90 were dose escalated to UPA30 (UPA15/30); patients achieving ≥ EASI 90 continued on UPA15 (UPA15/15). Patients on UPA30 not achieving EASI 90 at week 12 continued on UPA30 (UPA30/30); patients achieving ≥ EASI 90 received a reduced dose of UPA15 (UPA30/15) for 12 additional weeks. The primary efficacy endpoint was EASI 90 achievement at week 24. Results were reported descriptively as observed. Safety outcomes were assessed. At week 24, of patients who received dose escalation (UPA15/30), 48.1% [n = 64/133; 95% confidence interval (CI) 39.6-56.6] achieved EASI 90; of patients who received a dose reduction (UPA30/15), 68.5% (n = 89/130; 95% CI 60.5-76.4) maintained EASI 90. Of patients who continued on their initial dose, 29.3% (n = 24/82; 95% CI 19.4-39.1) on UPA30/30 achieved EASI 90 and 74.6% (n = 53/71; 95% CI 64.5-84.8) on UPA15/15 maintained EASI 90. At week 24, 32.5% (n = 27/83; 95% CI 22.5-42.6) and 38.0% (n = 38/100; 95% CI 28.5-47.5) of patients on UPA15/30 and UPA30/15, respectively, achieved a worst pruritus numerical rating scale score of 0 or 1 (WP-NRS 0/1), and 20.7% (n = 17/82; 95% CI 12.0-29.5) and 35.0% (n = 35/100; 95% CI 25.7-44.3), respectively, achieved combined EASI 90 and WP-NRS 0/1. At week 24, treatment emergent adverse events were reported in 43.1% (n = 31/72; UPA15/15), 54.2% (n = 78/144; UPA15/30), 61.5% (n = 56/91; UPA30/30) and 48.9% (n = 65/133; UPA30/15) of patients. No malignancies, adjudicated venous thromboembolic events or deaths were reported. Treatment of moderate-to-severe AD with UPA15 or UPA30, with dose escalation or dose reduction based on achievement of the optimal treatment target of EASI 90 at week 12, demonstrated that both approaches support the achievement and maintenance of EASI 90 at week 24. Overall safety findings were consistent with the known UPA safety profile, with no new safety signals identified.