Hawke's Bay Regional Council

Climate change, fueled by greenhouse gas (GHG) emissions, is a major threat to human health and demands immediate and decisive action. The effects of climate change directly harm the health of patients cared for by pulmonary, sleep, and critical care health professionals while putting healthcare delivery at risk. Ironically, the healthcare sector itself contributes to GHG emissions. In 2024, an American Thoracic Society workshop convened an international work group of adult and pediatric pulmonologists, intensivists, nurses, researchers, educators, healthcare administrators, and healthcare advocates to identify strategies to decrease pulmonary, sleep, critical care, and research laboratory-related emissions; improve quality; and support sustainability. The workshop prioritized strategies with the highest probability of reducing healthcare sector emissions significantly and urgently while considering the short- and long-term impacts of mitigation strategies on safe healthcare delivery and unintended adverse effects on vulnerable populations. Interventions were identified on micro (individual provider), meso (healthcare organization), and macro (regulatory/government/policy) levels. As trusted voices, health professionals and their professional societies are uniquely positioned to advocate for systemic change, ensuring that healthcare not only adapts to the challenges of climate change but also actively contributes to solutions that promote a healthier, more sustainable future for all.

ABSTRACTMarine megafauna are important components of marine ecosystems and are of major significance to Indigenous communities, including Māori. Despite being recognised as a biodiversity hotspot for megafauna, most locations in Aotearoa New Zealand (NZ) do not have adequate information for the management of anthropogenic impacts on these taxa. Due to long‐standing relationships with Māori, there is a wealth of mātauranga Māori (Māori knowledge) on megafauna that may help fill key gaps. This study, Tere Tohorā Karanga Tāngata, aims to address information gaps on marine megafauna within Te Ākau/Bream Bay, on the north‐east of NZ's North Island. We utilise a wānanga (shared learning) approach alongside conventional visual and acoustic surveys to synthesise an accurate baseline of species occurrence, distribution, habitat use and site fidelity. Māori knowledge in a variety of forms was gathered and simultaneously integrated into the survey design across seven vessel‐based field surveys. We calculate seasonal sighting rates and use species distribution models (SDM) to determine the distribution of commonly occurring species and use photo‐identification to investigate site fidelity of marine mammals. Both knowledge systems confirmed the importance of Te Ākau/Bream Bay for marine megafauna, reporting high diversity and abundance of marine mammal (8 species) and seabird species (24 species) and high sighting rates of threatened taxa. While most species were encountered year‐round, sighting rates and predictions from SDMs highlight seasonal variability in the occurrence and distribution of most species. Māori knowledge aligned closely with results from conventional scientific approaches in confirming the most common species (common dolphin, Bryde's whale), seasonal habitat preferences, and, importantly, provided historical information on species that have been extirpated from the study area. Combined, the two knowledge systems have generated a robust baseline on marine megafauna that can be used to guide the management of these important species and showcase the advantages of utilising dual‐knowledge systems for characterising marine biodiversity.

Historically, settler states such as the USA, Canada, Australia and Aotearoa New Zealand (Aotearoa) have used government directives to entrench colonisation, producing long-lasting effects that marginalise Indigenous peoples. In Aotearoa, Māori (Indigenous peoples of New Zealand) have a sustained history of resisting colonisation, including pushing for change within the public sector. This article explores how Māori staff in a Crown agency navigate the complexities of working for the Crown. Drawing on narratives shared during a hui-a-kaupapa (open discussion), key themes emerged: the tension of working for the man , the centrality of cultural identity, experiences of turmoil and trauma, strategies for negotiating power dynamics and aspirations for tino rangatiratanga (self-determination). Despite shifting political landscapes, the imperative remains to uphold Te Tiriti o Waitangi and advance Māori aspirations. This requires centring Māori voices, embedding cultural competence and safety, and addressing systemic injustices to create a public sector that upholds Te Tiriti o Waitangi.

The reach of dialysis in toxicology is limited by two factors, high toxicant volume of distribution and low dialytic extraction of protein bound toxicants in blood. Therapeutic actions for lipid emulsion as antidote are thought involve a "lipid shuttle", whereby lipid droplets in the circulation "shuttle" lipophilic toxicants with "boarding" in well perfused heart and brain tissue with high toxicant concentrations and "exit" to biologically inert slower equilibrating sites such as muscle or adipose where toxicant concentrations are lower. Such a mechanism raises the conceptual possibility of an extracorporeal "exit" potentially mitigating toxicity through increased drug clearance. In experimental models drug binding nanoparticles in dialysate have been shown to mitigate the problem of blood proteins binding toxicant. We investigated whether the addition of intravenous lipid emulsion would increase extraction of amitriptyline into nanoparticle augmented peritoneal dialysate in rats orally dosed with amitriptyline for 1week. Rats were dosed with amitriptyline in drinking water for a week. On the day of the experiment, anaesthetised rats received either an initial bolus then infusion of lipid emulsion for one hour, or a bolus of saline at the initiation of the experiment equal to the total volume of lipid emulsion given. After a 50min equilibration period, a 10min pH gradient nanoparticle augmented peritoneal dialysis dwell was undertaken. Animals were humanely euthanised at the end of the experiment. Blood was sampled 0, 10, 45 and 60min and peritoneal dialysate was analysed for amitriptyline concentration. There were no significant differences in baseline physiology, initial amitriptyline blood concentration, nor pulse and blood pressure at any time between groups. Time weighted individual subject mean blood amitriptyline concentrations (median (IQR)); control 104 (87-125) nmol/l, lipid 219 (148-357) nmol/L, p = 0.03 and dialysate amitriptyline concentration; control 31(14-52) nmol/L, lipid 105 (62-185) nmol/L, p = 0.03 were greater in animals given intravenous lipid emulsion. These are the first data to our knowledge showing experimental support for the approach of simultaneously decreasing volume of distribution with an intravascular nanoparticle in conjunction with a drug binding particle in dialysate. Further work in this area is warranted.

Blunt cerebrovascular injury (BCVI) is a rare but potentially devastating injury that can lead to stroke and death without early diagnosis and treatment. Evidence-based practice guidelines recommend screening at-risk patients with neck computed tomographic angiography (CTA). We sought to evaluate the efficacy of such a screening protocol at a high-volume trauma centre in Aotearoa New Zealand. A retrospective chart review was conducted of adult blunt trauma patients who presented to our trauma centre from March to August 2023 who had injuries that met criteria for screening. Adherence to protocol as determined by capture of neck CTA within 6 hours of admission, incidence of BCVI, stroke and death were collected. Ninety-five patients met criteria to screen for BCVI; only 41 (43%) underwent screening CTA. BCVI incidence was 6/41 (14.6%). Of the 54 patients not screened, there was one BCVI that progressed to stroke. Overall BCVI rate is estimated at 2.4%; an additional seven BCVIs may have been present. BCVI is more common than previously recognised in blunt trauma patients. Increased awareness of BCVI screening protocols and systematic screening systems to facilitate early identification and treatment should be implemented to diminish the incidence of missed injury and devastating sequela.

Floral nectar composition beyond common sugars shows great diversity but contributing genetic factors are generally unknown. Mānuka (Leptospermum scoparium) is renowned for the antimicrobial compound methylglyoxal in its derived honey, which originates from the precursor, dihydroxyacetone (DHA), accumulating in the nectar. Although this nectar trait is highly variable, genetic contribution to the trait is unclear. Therefore, we investigated key gene(s) and genomic regions underpinning this trait. We used RNAseq analysis to identify nectary-associated genes differentially expressed between high and low nectar DHA genotypes. We also used a mānuka high-density linkage map and quantitative trait loci (QTL) mapping population, supported by an improved genome assembly, to reveal genetic regions associated with nectar DHA content. Expression and QTL analyses both pointed to the involvement of a phosphatase gene, LsSgpp2. The expression pattern of LsSgpp2 correlated with nectar DHA accumulation, and it co-located with a QTL on chromosome 4. The identification of three QTLs, some of the first reported for a plant nectar trait, indicates polygenic control of DHA content. We have established plant genetics as a key influence on DHA accumulation. The data suggest the hypothesis of LsSGPP2 releasing DHA from DHA-phosphate and variability in LsSgpp2 gene expression contributing to the trait variability.

ABSTRACT Freshwater policy is driven by interrelated challenges such as declining water quality, urban expansion, and agricultural intensification. But recent research indicates that implementation of policy is less successful than its development. Given recent innovations in New Zealand’s freshwater management and policy, this paper asks, What are the barriers to freshwater policy implementation in New Zealand? Data for this research were gathered through semi-structured interviews with key regional council and unitary authority employees. The research discovered several implementation barriers, such as low government and community capacity and difficulty aligning local policy with national policy. The paper argues that a closed loop between problem identification and responding to problems through planning slows the implementation of freshwater policy. In response, the paper offers a set of recommendations, designed for the New Zealand context, to enable more effective implementation of freshwater policy.