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Malnutrition and frailty affect up to one-third of community-dwelling older adults in Australia and New Zealand (ANZ), burdening individuals, health systems and the economy. As these conditions are often under-recognised and untreated in the community, there is an urgent need for healthcare professionals (HCPs) from all disciplines to be able to identify and manage malnutrition and frailty in this setting. This paper describes the systematic and iterative process by which a practical guide for identifying and managing malnutrition and frailty in the community, tailored to the ANZ context, was developed. The development of the guide was underpinned by the Knowledge-to-Action Framework and included the following research activities: (1) a comprehensive literature review; (2) a survey of ANZ dietitians' current practices and perceptions around malnutrition and frailty; (3) interviews with ANZ dietitians; and (4) a multidisciplinary expert panel. This resulted in the development of a guide tailored to the ANZ context that provides recommendations around how to identify and manage malnutrition and frailty in the community. It is now freely available online and can be used by all HCPs across several settings. The approach used to develop this guide might be applicable to other conditions or settings, and our description of the process might be informative to others who are developing such tools to guide practice in their healthcare environment. Malnutrition and frailty are common in Australian and New Zealand communities, burdening individuals, health systems and the economy. This paper describes the process by which an evidence-informed guide for identifying and managing these conditions in the community was developed. The guide is now freely available online and can be used by all healthcare professionals across several settings, and our description of the process might be informative to others who are developing such tools to guide practice in their healthcare environment. [ABSTRACT FROM AUTHOR]

Context. The aim of farm-systems research is to test concepts in a holistic context that enables results to be as applicable as possible to commercial farmers. A downside of such research has been that it can take several seasons to be confident in the consistency of the outcomes and interpretation of the results. Scientists are often reluctant to communicate outcomes until they have clear conclusions, which conflicts with farmers' desire to see rapid answers and engage with research. Aims. This paper reviews a 3-year farm-systems research project investigating flexible milking strategies for New Zealand dairy farmers. The aims of this paper are to (1) examine the impact of real-time science communication in achieving farm system change, and (2) develop a framework for science communication and engagement in adaptive farm-systems research. Methods. The project involved farmer interviews, a farmlet experiment, a component experiment, partner farms, modelling, and a farmer reference group. We use data from sources such as e-newsletter engagement, webinar participation, web-page engagement, presentation attendance, and farmer feedback to collect insights on the impact of the project. Key results. The analysis highlighted that farmers do not always seek complete information and will follow a project as it evolves, particularly when it is highly topical. We propose a framework for delivering adaptive farm systems research and communication. The framework includes the critical aspects for real-time farm-systems research: credible evidence, rapid results, inclusion of farmer voices, meaningful outcomes, flexible communication channels, iterative feedback loops, and adaptable research design. Conclusion. Farm-systems research can be designed to communicate results to farmers as a project develops, while simultaneously using the engagement with farmers to refine the direction of the research. Implications. This framework can guide scientists leading multi-year farm systems projects to design, implement, and communicate the project outcomes to improve farmer engagement and adoption. [ABSTRACT FROM AUTHOR]

This perspective paper provides industry leaders, researchers and policy developers strategic approaches to ensure that the welfare of dairy cattle is protected at the same time as the industry increases its resilience to climate change. Farm systems and practices will evolve in response to the direct impacts of climate change and/or from responses to climate change, such as mitigation strategies to reduce dairy's greenhouse-gas (GHG) emissions. The five domains framework (nutrition, physical environment, health, behaviour, mental state) was used to assess the potential impacts on animal welfare and strategies to minimise these impacts are outlined. Given that the future climate cannot be certain these approaches can be applied under a range of emissions pathways to (1) ensure that the effects of GHG mitigations on animal welfare are considered during their development, (2) engage with end users and the public to ensure solutions to the effects of climate change and weather variability are accepted by consumers and communities, (3) identify and measure the areas where improved animal health can contribute to reducing GHG emissions from dairy production, (4) ensure those supporting farmers to develop and manage their farm systems understand what constitutes a good quality of life for dairy cattle, (5) ensure effective surveillance of animal disease and monitoring of welfare outcomes and farm-system performance in response to climate change and GHG mitigations. Overall, these strategies require a multidisciplinary co-development approach to ensure that the welfare of dairy cattle is protected at the same time as the industry increases its resilience to the wider impacts of a changing climate. [ABSTRACT FROM AUTHOR]

Context: Tagasaste (Cytisus proliferus), a fast-growing leguminous tree, has potential to supplement pasture production in steep-hill country and to increase pasture resilience. Aims: In the companion paper, we quantified tagasaste production characteristics. Here, we determine the effect of proximity of 10-year-old tagasaste trees on productivity of eight pasture species including grasses (perennial ryegrass, Lolium perenne ; cocksfoot, Dactylis glomerata ; prairie grass, Bromus willdenowii ; microlaena, Microlaena stipoides), perennial legumes (white clover, Trifolium repens ; red clover, T. pratense ; lotus, Lotus pedunculatus), and an annual legume (subterranean clover, T. subterraneum). Methods: A site was established in the East Coast region of the North Island of New Zealand on steep-hill country (>20° slope). Herbage production, nutritive value and survival of pasture species established as spaced transplants were measured over 3 years. Results: Cocksfoot had high survival, herbage production and metabolisable energy content but was negatively affected by proximity to tagasaste. Microlaena was not significantly affected by proximity to tagasaste; however, it was much less productive and had lower nutritive values than the other grasses. Only 40% of perennial ryegrass transplants survived 3 years, and survival of perennial legumes was negligible. Subterranean clover was able to set seed in the open and in shade. Conclusions: Cocksfoot was the most productive grass species, and microlaena was least affected by proximity to tagasaste. Given the poor persistence of perennial clovers, annual clovers may be better suited to a tagasaste silvopasture on steep, dry hillsides. Implications: Mixtures of cocksfoot and subterranean clover may be well suited to summer-dry hillsides, between and under trees in a tagasaste silvopasture. Microlaena may provide some forage and can maintain groundcover despite shade. Growth and survival of eight pasture species in proximity to the forage shrub tagasaste were quantified in drought-prone hill country. Cocksfoot and subterranean clover were highly productive only in lightly shaded areas, whereas microlaena, although less productive than other grasses, was not significantly affected by shade treatment, and perennial legumes showed negligible survival. Cocksfoot and subterranean clover could be established between trees in a tagasaste silvopasture, with naturalised microlaena maintained beneath the canopy to provide groundcover. [ABSTRACT FROM AUTHOR]

Soil habitat quality is an important indicator of environmental health. NewZealand soils are in critical condition because of various land-use practices, such as intensification of agriculture and urban growth, causing increased erosion and loss of fertile soil. Soil consists of organic (carbon-rich, microbe-laden detritus) and inorganic (weathered rock particles, minerals, water, air) components that are vital for sustaining flora and fauna, including humans. Soil in and of itself is alive with various forms of biota. Soil conservation takes an anthropocentric, utilitarian approach to policy and planning, whereas soil preservation takes an ecocentric or nature-centred approach. When the catchment boards of the earlier eras [governed by the Soil Conservation and Rivers Control Act 1941 (NZ)] were decommissioned to make way for regional councils around the time when the Resource Management Act 1991 (NZ) came into force, the soil scientific expertise was largely lost. At the same time, soil quality in New Zealand has been deteriorating ever since. In this paper, I argue for the establishment of community-based soil conservancies and conservancy officers and, ultimately, the legal endowment of personhood on soil in order for kaitiaki oneone (soil guardians) to be appointed. These measures will assist in the protection of soils, which will lead to better outcomes for the environment and generations to come. [ABSTRACT FROM AUTHOR]

Background: Early career medical professionals experience stress and burnout at higher levels than the wider community. Burnout can arise with competing demands of life and career, which is evident in early career development, where family planning can coincide with specialty training. General practice may be seen as a family friendly career option; however, few studies examine the experience of general practice trainees with stress and burnout and the impact that parenting has on their experience. This study aims to explore the experience of stress and burnout in general practice registrars and the exacerbating and protective factors, with a focus on the experiences of two groups of registrars, those that have children, and those that do not. Methods: A qualitative study was conducted with 14 participants, who were interviewed with questions exploring experiences of stress and burnout. Participants were grouped into those with children and those without children. The transcripts were thematically analysed. Results: Themes were identified as those that contributed to stress and burnout (such as time, financial concerns and isolation) and those factors that reduced stress and burnout (such as support from others and being respected and valued within the workplace). Parenting was identified as both a factor that could contribute to and reduce stress and burnout. Conclusions: Stress and burnout are important foci for future research and policy to ensure the sustainability of general practice. System based and individual focused policies, including individualising training to support parenting, are required to ensure that registrars are supported through their training years and beyond. General practice needs to work to increase recruitment of doctors, reduce early career burnout and to retain GPs in the long term. Early career medical professionals experience stress and burnout at higher levels than the wider community. General practice may have traditionally been seen as a family friendly career option, however, unfortunately it may be no longer. This paper examines the experience of GP trainees with stress and burnout and the impact that parenting has on their experience and looks at solutions to improve conditions for early to mid career GPs, and hopefully make general practice more attractive for future doctors. [ABSTRACT FROM AUTHOR]

Context: Tagasaste (Cytisus proliferus) has potential to supplement pasture production in steep-hill country and increase pasture resilience. Aims: To (1) quantify production of edible dry matter (EDM) of pruned 2-year-old tagasaste shrubs and branches from unpruned 10-year-old tagasaste trees, and (2) determine the effect of proximity of the 10-year-old tagasaste trees on selected pasture species established as spaced transplants. Methods: A site was established on the eastern coast of the North Island of New Zealand on steep-hill country (>20° slope). Tagasaste and pasture species production was measured over 3 years. Results: Tagasaste shrubs produced an average of 2.7 kg EDM shrub−1 year−1 and a tree branch produced 129 g EDM year−1. The metabolisable energy content of tagasaste branches averaged 10.0 MJ kg EDM−1, the crude protein content ranged from 18% to 27% and neutral detergent fibre content averaged 39%. Branch diameter and length were poor predictors of EDM branch−1. There was no effect of increasing proximity to tagasaste on DM production of the resident pasture. Effects of increasing proximity to tagasaste on the growth and survival of selected pasture species are reported in a companion paper. Conclusions: Edible-DM production was much greater from shrubs than tree branches and it was not possible to predict branch EDM from branch diameter or length. Implications: A tagasaste silvopasture is likely to be more productive if tagasaste is managed for grazing in situ than if using mature trees for harvesting of branches for browse. The production of edible dry matter (EDM) of 2-year-old tagasaste shrubs averaged 2.7 kg shrub−1 year−1 on one steep, north-facing hillside on the eastern coast of New Zealand. This equated to the production of 2.2 t EDM ha−1 year−1 at spacings of 3.5 m (816 shrubs ha−1), with a metabolisable energy content averaging 10.0 MJ kg EDM−1. In low-producing (<4 t DM ha−1 year−1) pastures on drought-prone, steep-hill country, inclusion of tagasaste could increase edible forage production by 50%. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the suitability and acceptability of virtual training post accreditation visits conducted online for medical specialist training in ophthalmology in Australia and New Zealand. Methods: A two-phase study (pilot and implementation) was conducted. In the pilot phase, an open-ended observation proforma was used by the authors to independently record their observations, which were later compared and discussed until consensus was achieved. All participants were asked to complete an online survey. A document analysis of accreditation documents was conducted. Observation data were broken down into themes and triangulated with online survey and document analysis results. In the implementation phase, the inspections were observed by one of the authors (SK) and the observation notes were discussed with other authors to obtain a contextual and consensual view. A document analysis of all accreditation-related documentation was undertaken. The documents included in the document analysis were planning and scheduling records, interview and inspection notes, training post inspection fact and document notices and accreditation reports. Finally, a post-inspection focus group of all inspectors was conducted. Results: The accreditation interviews adequately addressed all relevant issues with high levels of robustness and reliability. Participants found it more difficult to discuss complex issues virtually compared with onsite visits. The virtual accreditation reports were not any different to what would be expected if a face-to-face accreditation visit had been conducted; however, it was not possible using the virtual inspection to determine the appropriateness of facilities and clinic layout to support and facilitate trainee learning and supervision. Conclusions: Virtual accreditation of training posts in medical specialist training is viable in limited circumstances where there are no known complex training post-related issues and the site has not made substantial changes to clinic and theatre layout, equipment and facilities since the previous accreditation. What is known about the topic? All medical specialist colleges in Australia and New Zealand accredit the sites where training is delivered, usually by conducting periodic face‐to‐face visits. What does this paper add? This paper provides evidence that in limited circumstances, it is possible to accredit training posts virtually. What are the implications for practitioners? This paper provides an outline of issues to consider when planning virtual accreditation of training posts in medical specialist education. [ABSTRACT FROM AUTHOR]

Objective: To identify baseline factors associated with outcomes from an inpatient multidisciplinary pain management program (PMP) located in a bicultural area of Aotearoa New Zealand. Methods: A prospective cohort study was undertaken involving 164 people with chronic pain who attended the PMP. Demographic, clinical, and psychosocial measures were obtained at baseline, whereas clinical and psychosocial outcome measures were also obtained at program discharge and 3-month follow up (N = 100). Multivariate analyses were used to determine baseline demographic variables that were associated with outcomes at discharge and follow up. Results: Being male and working full-time were associated with poorer outcomes in select measures at discharge. At the 3-month follow up, Māori ethnicity, working full-time, being retired or unemployed, or having chronic widespread pain were associated with poorer outcomes for some measures, whereas those with rheumatoid arthritis had greater self-efficacy. Conclusions: Sex, ethnicity, employment status, and patient condition impact clinical outcomes from the program and in the time from discharge to follow up. Program content and/or delivery should be altered to promote more equitable outcomes for all patients in the long term. What is known about the topic? Multidisciplinary pain management programs (PMPs) are the best treatment for chronic pain, but not everyone benefits from such programs to the same extent. What does this paper add? Ethnicity, employment status, and pain condition are associated with PMP outcomes, but mainly in the long term. What are the implications for practitioners? Program content, delivery, and follow up should be adapted to facilitate equity in long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Non-traumatic lower limb amputation rates are rising worldwide, resulting in increased hospitalisations and use of rehabilitation services. This study aimed to identify key comorbidities associated with prolonged length of stay or decreased functional gain for episodes receiving inpatient rehabilitation following non-traumatic lower limb amputation. Methods: Prospectively collected data submitted to the Australasian Rehabilitation Outcomes Centre were analysed. The cohort comprised episodes for patients (aged ≥18 years) discharged from inpatient rehabilitation between 1 July 2013 and 30 June 2018 following a non-traumatic lower limb amputation. Results: The cohort included 5074 episodes with an average age of 66.3 years and the majority being male (71.7%). Comorbidities affecting the ability to participate in rehabilitation were reported for 65.4% of episodes, most commonly diabetes mellitus (50.3%), cardiac disease (33.5%), and respiratory disease (10.1%). These comorbidities were associated with a prolonged length of stay and reduced functional improvement. Conclusion: This study showed comorbidities contribute to prolonged length of stay and poorer functional outcomes among those undergoing inpatient rehabilitation following non-traumatic lower limb amputation. Future research should focus on strategies to address these comorbidities to help improve patient outcomes and reduce healthcare costs. What is known about the topic? It is known that the presence of comorbidities contributes to lower limb amputation; however, the effect that comorbidities have on inpatient rehabilitation outcomes is not well reported. What does this paper add? This study identified five comorbidities (diabetes mellitus, cardiac disease, respiratory disease, renal failure with dialysis, and mental health problems) associated with prolonged length of stay and decreased functional outcomes following inpatient rehabilitation for non-traumatic lower limb amputation. What are the implications for practitioners? Our findings suggest practitioners should focus on strategies to address these comorbidities to help improve functional outcomes, reduce length of stay, and reduce healthcare costs. [ABSTRACT FROM AUTHOR]

Statistical analyses of two morphological datasets, including 190 newly measured specimens, showed that individuals of Myosotis (Boraginaceae) from Te Waipounamu / South Island, Aotearoa, New Zealand, identified a priori with three different informal tag names, belong to the bracteate–prostrate group, are morphologically distinct from each other and from other species, and merit scientific description. Myosotis hikuwai Meudt, Prebble & G.M.Rogers is known from one location near Wānaka (Otago), has an unusual erect, spring annual habit, and is most similar to M. brevis and M. glauca , with which it is sympatric. Myosotis venticola Meudt & Prebble comprises plants that were sometimes previously identified as M. cheesemanii from certain ranges in Otago and southern Canterbury, but with retrorse trichomes present on the abaxial and adaxial side of the rosette leaves. Myosotis ultramafica Meudt, Prebble & Rance comprises individuals from ultramafic sites in certain ranges in Southland, and is most similar to M. cheesemanii and M. lyallii. We recommend that all three new species are listed as Threatened under the New Zealand Threat Classification System. In addition to descriptions and illustrations, the three new species are also included in a revised key to the nineteen species of southern hemisphere bracteate–prostrate Myosotis. Three new threatened species of forget-me-nots (Myosotis) endemic to the South Island of New Zealand are delimited and described on the basis of analyses of morphological data. Descriptions, maps and illustrations of the three new species, and a revised key to the nineteen species of bracteate–prostrate Myosotis , are provided. This paper is part of a taxonomic revision of all native species of southern hemisphere forget-me-nots. [ABSTRACT FROM AUTHOR]

Objective: Despite needs, people with advanced non-malignant respiratory disease are infrequently referred to palliative care services. Integrated models of palliative care and respiratory service delivery have been advocated to address this inequity of access. This study mapped current ambulatory palliative care service provision for patients with advanced non-malignant respiratory disease in Australia and New Zealand. Methods: An online survey was distributed to the palliative care physician membership of the Australian and New Zealand Society of Palliative Medicine. Information was sought regarding access to specific breathlessness and integrated respiratory and palliative care services, and their operation. Data were described using descriptive statistics. Results: In all, 133 respondents (93 from Australia, 40 from New Zealand; representing 55 Australian and 26 New Zealand discrete sites) with complete data were available for analysis. More than half the respondents reported seeing patients with advanced non-malignant respiratory disease frequently (56/97; 58%), and 18 of 81 services (22%) reported having breathlessness or integrated respiratory and palliative care services caring for this patient group. Such services were mostly staffed by respiratory and palliative care doctors and nurses and based in the clinic environment, with limited support available outside this setting. Of the 63 respondents without existing breathlessness or integrated services, 49 (78%) expressed interest in their establishment, with limited resources cited as the most common barrier. Conclusions: There is limited availability of integrated respiratory and palliative care or specialised breathlessness services in Australia and New Zealand despite widespread support by palliative care physicians. This study provides a snapshot to inform strategic service development. What is known about the topic?: People with advanced respiratory disease have very significant morbidity with complex needs equivalent to, and in many cases more intense than, people with end-stage lung cancer; they also have significant mortality. Yet, these people frequently do not access palliative care services. The establishment of integrated respiratory and palliative care services has been advocated as an effective means to overcome the barriers to palliative care access. Such services have demonstrated improved patient and family-reported outcomes, as well as service-level improvements. What does this paper add?: This paper maps the availability of integrated respiratory palliative care services in Australia and New Zealand. We reveal that although most palliative care physicians report seeing patients with advanced respiratory disease in practice, just one-fifth of services report having an integrated service approach. There was high interest and enthusiasm for such services (78%), but resources limited their establishment. What are the implications for practitioners?: Palliative care services recognise the needs of patients with advanced respiratory disease and the benefits of integrated respiratory and palliative care services to address these needs, but scarcity of resources limits the ability to respond accordingly. This study provides a snapshot of current service level to inform strategic development. [ABSTRACT FROM AUTHOR]

Galaxias maculatus is a declining amphidromous fish that supports New Zealand's culturally important whitebait fisheries targeting the migratory juvenile stage. Spawning ground protection and rehabilitation is required to reverse historical degradation and improve fisheries prospects alongside conservation goals. Although spawning habitat has been characterised in tidal rivers, there has been no previous study of spawning in non-tidal rivermouths that are open to the sea. We assessed seven non-tidal rivers over 4 months using census surveys to quantify spawning activity, identify environmental cues, and characterise fundamental aspects of the biogeography of spawning grounds. Results include the identification of compact spawning reaches near the rivermouths. Spawning events were triggered by periods of elevated water levels that were often of very short duration, suggesting that potential lunar cues were less important, and that rapid fish movements had likely occurred within the catchment prior to spawning events. Spawning grounds exhibited consistent vertical structuring above typical low-flow levels, with associated horizontal translation away from the river channel leading to increased exposure to anthropogenic stressors and associated management implications for protecting the areas concerned. These consistent patterns provide a sound basis for advancing protective management at non-tidal rivermouths. Attention to flood management, vegetation control, and bankside recreational activities is needed and may be assisted by elucidating the biogeography of spawning grounds. The identification of rapid responses to environmental cues deserves further research to assess floodplain connectivity aspects that enable fish movements in ephemeral flowpaths, and as a confounding factor in commonly used fish survey techniques. This paper provides a first assessment of the biogeography of Galaxias maculatus spawning grounds and amphidromous spawning behaviour at non-tidal rivermouths. Consistent patterns in catchment position, vertical structuring, and environmental cues were identified that provide a sound basis for protective management to assist the conservation of this culturally important fish, which is currently in decline. [ABSTRACT FROM AUTHOR]

This exploratory study examined general practitioners' (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs' life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility's end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs. This paper is on a topic of increasing policy importance. With the aging of the population, the pressure on our aged care facilities will become intense. This paper highlights how GPs, the main source of clinical supervision in residential aged care, do their job and what the issues are that facilitate and impede their participation. [ABSTRACT FROM AUTHOR]

In this paper, whānau Māori highlight how a Kaupapa Māori-centred intervention (the Harti Hauora Tamariki tool, hereafter Harti tool) has improved interactions with health services. The Harti tool is undergoing a randomised control trial (RCT) at Waikato Hospital in New Zealand. As part of the RCT, the authors engaged in a series of qualitative interviews with whānau members of tamariki Māori (children aged 0–5 years) admitted to Waikato Hospital's paediatric ward. Whānau who met at least one criteria for New Zealand's domains of deprivation were included. Using a Kaupapa Māori approach to the study, participants shared their views on barriers and facilitators to accessing health resources and primary care services. The interviews conducted highlight how the Harti tool, when administered in a culturally appropriate and respectful manner that prioritised relationship-building, enabled better connection to healthcare services. Prevalent in our analysis were connections to wider determinants of health and ways to reduce existing health inequities. To conclude the paper, how the Harti tool has enhanced feelings of being in control of health, with the potential to reduce the likelihood of a hospital readmission, is highlighted. [ABSTRACT FROM AUTHOR]

Assessment of the relative performance of white clover (Trifolium repens L.) cultivars, using multi-year and multi-location seasonal growth trials, is key to identification of material with specific and broad adaptation. This paper is based on a multi-year and multi-location study of 56 white clover entries comprising 14 commercial cultivars and 42 experimental synthetic lines evaluated for seasonal growth under rotational grazing across four locations in New Zealand over 4 years. The four locations (and animals grazing) were: Kerikeri (beef cattle), Aorangi (beef cattle), Ruakura (dairy cattle), Lincoln (sheep). Significant (P < 0.05) genotypic variation among the 56 entries, and genotype × year, genotype × location and genotype × season interactions, were estimated. We were able to identify cultivars and experimental synthetics with specific and broad adaptation to the three grazing management types. Cvv. AberDance, Apex, Demand, Prestige, Quartz and Riesling, with leaf size ranging from small to medium–large, showed highly above-average performance under sheep grazing. Synthetic lines 15 and 45 also had highly above-average performance under sheep grazing. Cvv. Legacy and Kopu II showed above-average performance under cattle and dairy grazing. Synthetics 15, 48, 49, 44, 22 and 18 and cv. Quartz had above-average performance under all three grazing managements. Synthetics 27, 33 and 38 had highly above-average performance across all three grazing managements and were superior to all 14 cultivars evaluated. Several of these superior synthetics are being tested across multiple grazing environments. Among the 14 cultivars evaluated, Legacy and Quartz showed superior seasonal growth performance across the three grazing managements. Quartz is being evaluated in several on-farm trials across temperate regions of the world. Fourteen white clover cultivars and 42 experimental synthetics were evaluated for seasonal growth under beef cattle, dairy cattle and sheep grazing across 4 years. Entries with specific and broad adaptation to the three grazing management types were identified. Cv. Legacy was more responsive to cattle and dairy grazing, and cv. Quartz to sheep grazing. Synthetics with specific and highly above-average performance across all three grazing managements, superior to the cultivars, were identified. [ABSTRACT FROM AUTHOR]

Macro-morphological data were analysed to assess the distinctiveness and revise the taxonomy of 14 species, varieties and tag-named taxa in five informal species groups of ebracteate-erect forget-me-nots endemic to New Zealand. The following nine species are recognised: Myosotis albosericea Hook.f., M. brockiei L.B.Moore & M.J.A.Simpson, M. capitata Hook.f., M. concinna Cheeseman, M. goyenii Petrie, M. laeta Cheeseman, M. monroi Cheeseman, M. rakiura L.B.Moore, and M. traversii Hook.f. Three species have two allopatric subspecies each in the South Island, distinguished by few, minor morphological characters, including Myosotis brockiei subsp. brockiei and M. brockiei subsp. dysis Courtney & Meudt subsp. nov., M. goyenii subsp. goyenii and M. goyenii subsp. infima Meudt & Heenan, and M. traversii subsp. cantabrica (L.B.Moore) Meudt comb. et stat. nov. and M. traversii subsp. traversii. Myosotis × cinerascens Petrie is hypothesised to be a rare natural hybrid involving M. traversii subsp. cantabrica and another species, possibly M. colensoi. Several vegetative and floral characteristics can distinguish the study taxa from one another and from other ebracteate-erect species. The nine species plus M. × cinerascens are included in the taxonomic treatment, and the key also includes other recently revised ebracteate-erect species. This paper uses morphology to revise the taxonomy of 10 species of forget-me-nots (Myosotis) endemic to New Zealand. New subspecies are described for two of the species. Myosotis is of high conservation priority because most of its species and subspecies are considered Threatened or At Risk. This study is part of a larger taxonomic research project of all southern hemisphere Myosotis , using morphology, genetics, pollen and other data. [ABSTRACT FROM AUTHOR]

Objective: The climate crisis necessitates urgent decarbonisation. The health sector must address its large carbon footprint. In the present study, we sought healthcare thought leaders' views about a future environmentally sustainable health system. Methods: The present study was a qualitative exploratory study consisting of semistructured, in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the US and New Zealand. Audio recordings of the interviews were transcribed and analysed by matrix display and thematic analysis. Results: Overall, healthcare thought leaders believe that to reduce the carbon footprint of healthcare we need to look beyond traditional 'green' initiatives towards a more fundamental and longer-term redesign. Five main themes and one 'key enabler' (information communication technology) were identified. In this paper we draw on other relevant findings, but chiefly focus on the fifth theme about reshaping the role of healthcare within society and using the size and influence of the health sector to leverage wider health, environmental and societal benefits. Conclusions: These ideas represent potentially low-carbon models of care. The next step would be to pilot and measure the outcomes (health, environmental, financial) of these models. What is known about the topic?: The health sector needs to reduce its large carbon footprint. Traditional 'green' initiatives, such as recycling and improving energy efficiency, are insufficient to achieve the scale of decarbonisation required. What does this paper add?: Healthcare thought leaders surveyed in the present study suggested that we also consider other, non-traditional ways to achieve environmental sustainability. In this paper we discuss their ideas about adopting an anticipatory approach to healthcare using predictive analytics, and using the size and influence of the health sector to effect wider health and environmental benefits. What are the implications for practitioners?: Achieving an environmentally sustainable healthcare system is likely to require broad and fundamental (i.e. transformational) change to the current service model. Health practitioners throughout the sector must be closely engaged in this process. [ABSTRACT FROM AUTHOR]

The aphid Aploneura lentisci is widespread in Australia and New Zealand, living all year round on roots of its secondary grass hosts. The fungal endophyte (Epichloë festucae var. lolii), strain AR37 in Lolium perenne is known to greatly reduce populations and was a likely reason for the superior growth and persistence of this association previously observed in the field. Aphid populations were quantified in a field trial near Ballarat, comparing yields of perennial ryegrass infected with eight different endophyte strains and an endophyte-free (Nil) control in a common ryegrass background (Grasslands Samson (G. Samson)). AR37 and another endophyte strain, AR5, had significantly fewer aphids than all other endophytes. These differences were significantly related to yield increases taken before and after sampling that persisted until the end of the trial. In a pot trial comparing commercially available ryegrass-endophyte combinations with equivalent Nil controls, aphid numbers were lower on G. Samson AR37 and Banquet II with AR5 (Endo®5) than on all other cultivar-endophyte combinations. Compared with Nil controls, the common toxic strain in G. Samson, and two strains in Trojan also reduced aphid numbers. The AR5 endophyte produces the alkaloid ergovaline but high concentrations of this in roots of potted plants could not account for differences in root aphid numbers. Root concentrations of epoxyjanthitrems, the only known alkaloids produced by AR37, were low and unlikely to be the cause of resistance to A. lentisci. An aphid, Aploneura lentisci , that feeds on grass roots is widespread in pastures in New Zealand and Australia. This paper reports data confirming that perennial ryegrass infected with a strain of Epichloë fungal endophyte, AR37, is highly resistant to this aphid and shows that another endophyte strain, AR5, gives the same level of control. Suppression of high aphid populations by these endophytes in the field at Ballarat resulted in a 37% increase in pasture production over endophyte-free ryegrass over a 5-month period. [ABSTRACT FROM AUTHOR]

Australia needs a new shared vision that the current trajectory of loss of natural heritage on its offshore islands is not acceptable and needs to change. This Special Issue brings together seven papers from leaders and practitioners with experience in offshore islands across the Australian and New Zealand context. The fundamentals for each paper are to suggest potential solutions or scenarios to move forward with island policy, and management. [ABSTRACT FROM AUTHOR]

Red deer (Cervus elaphus) are widely distributed throughout cold northern temperate latitudes, where they have evolved to cope within highly seasonal continental environments. Naturalisation of red deer to the more moderate seasonal (but variable climatic) environment of New Zealand has been spectacularly successful, and they are widely farmed in the country's pastoral environment for venison and antlers. The species is genetically programmed to exhibit photoperiodic control of voluntary feed intake, growth and reproduction, ensuring that energy demands are aligned with seasonally available resources and offspring are born in summer when climate is favourable for survival. However, despite genetic control of their endogenous seasonal cycles, there appears to be a strong ability for environmental factors such as nutrition to generate large phenotypic variation of seasonal traits. This may have contributed to their successful naturalisation to a wider range of seasonal environments than would be expected within their ancestral range. While precise timing of conception and duration of gestation length are the two fundamental mechanisms by which the strict seasonality of birth is maintained in seasonally breeding mammals, red deer exhibit considerable variation in both these traits. The present paper examines the outcomes of recent studies on farmed red deer on the impacts of lactation on conception date, the influence of nutrition during pregnancy on gestation length, and early life growth effects on the onset of female puberty. These studies have collectively demonstrated that while red deer are assumed to be under fairly rigorous genetic control of seasonality traits, they have a repertoire of phenotypic variation at various points of the reproductive cycle that may potentially allow a degree of adaptation to climatic variation that influences annual feed supply. This may explain the success of red deer in colonising a range of new environments that differ seasonally from their ancestral environment. Red deer (Cervus elaphus) exhibit annual seasonal cycles of reproduction largely mediated by genetically controlled responses to photoperiod. However, recent researches on farmed red deer in New Zealand have identified phenotypic variation in seasonal breeding under environmental control. These include impacts of female body condition during the mating and lactation periods on conception date, the influence of mid–late gestational feeding on gestation length and early life nutritional influences on body-mass set points for female entry into puberty. These non-genetic mechanisms may contribute to the species ability to naturalise to new environments that differ seasonally from ancestral environments. [ABSTRACT FROM AUTHOR]

Objectives: HealthPathways, pioneered in Canterbury, New Zealand, in 2008, is a web-based tool designed to promote health care integration and patient management in primary care and to reduce fragmentation in the delivery of health services. This cross-sectional study evaluated the utilisation and perceptions of this tool among health professionals in Australia and New Zealand. Methods: A cross-sectional survey was administered online through Research Electronic Data Capture (REDCap) to general practitioners (GPs), practice nurses and managers, nurse practitioners, specialist and community nurses, hospital clinicians, nurses, managers, and allied health professionals between April and September 2018. The frequency of HealthPathways use in the previous month was modelled as an ordered response using an ordered logistic regression model after adjusting for the possible effects of sex, age, years in clinical practice, location and time spent in practice. Results: Health professionals perceived HealthPathways to be useful in primary care management and referral, as well as in the prereferral treatment of patients. GPs in New Zealand, New South Wales and Victoria were 73%, 47% and 27% more likely to have used HealthPathways ≥10 times in the previous month respectively. Conclusion: The results suggest that HealthPathways is having a positive effect on healthcare systems in New Zealand and Australia. However, differences in uptake suggests the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. What is known about the topic?: Early evaluations suggest that HealthPathways is a useful tool for health professionals, although uptake and utilisation may be limited. However, there is no comparative evidence regarding uptake and implementation of the tool. What does the paper add?: This study is among the first to provide a comparative narrative of the literature assessing the implementation and uptake of HealthPathways across Australia and New Zealand. It is also among the first to compare the perceptions of allied health professionals in the use of HealthPathways across Australia and New Zealand. What are the implications for practitioners?: The results of this study suggest the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. [ABSTRACT FROM AUTHOR]

This paper addresses the systematics of the New Zealand spiders of the family Malkaridae. Malkarids are small araneoid spiders that live primarily in the leaf litter and mosses of temperate and tropical wet forests in Australia and New Zealand, with the exception of a single species in southern South America and another in New Caledonia. We treat the New Zealand species of Malkaridae that are not members of the subfamily Pararchaeinae, a monophyletic group of 11 new species that we classify in 2 new genera (Tingotingo , gen. nov. and Whakamoke , gen. nov.) and a new subfamily (Tingotinginae, subfam. nov.). We describe, diagnose, illustrate and map the distribution of specimen records of these 11 new species of New Zealand Malkaridae: Tingotingo porotiti , sp. nov., T. pouaru , sp. nov., T. tokorera , sp. nov., T. aho , sp. nov., Whakamoke orongorongo , sp. nov.; W. tarakina , sp. nov.; W. guacamole , sp. nov.; W. hunahuna , sp. nov.; W. paoka , sp. nov.; W. heru , sp. nov.; and W. rakiura , sp. nov. We also treat the phylogenetic relationships of Malkaridae and use the results of our previous work on the molecular phylogeny of Araneoidea as the bases for the classification of the family. Tingotingo , gen. nov. and Whakamoke , gen. nov. are sister clades. Tingotinginae, subfam. nov. is the sister group of the Malkarinae plus Pararchaeinae clade. We further hypothesise and discuss the morphological synapomorphies of Malkaridae, Tingotinginae, subfam. nov. and the two new genera. This study addresses the systematics of Malkaridae in New Zealand. We describe 2 new genera and 11 new species from New Zealand, and provide an overview of the systematics of the family. [ABSTRACT FROM AUTHOR]

The anadromous Geotria australis , one of only three lamprey species representing the early agnathan (jawless) stage of vertebrate evolution in Australia and New Zealand, is declining in abundance. Its adults were caught soon after they had entered rivers on their non-trophic upstream migration and maintained in laboratory tanks for 13–15 months through to spawning. As adult G. australis are susceptible to haemorrhagic septicaemia, they were treated prophylactically and maintained in 3-m3 aquaria supplied with a flow-through charcoal filtration system and UV steriliser. Air temperature and the light : dark regime were constantly adjusted to parallel those in the environment. Males developed the very large suctorial disc and gular pouch characteristic of maturity and both sexes matured at the same time as in the wild. While males frequently showed aggressive behaviour towards each other, the same male and female mated on several occasions. The male coiled around the female and, with his urogenital papilla close to the female's cloaca, twisted and vibrated, leading to egg release. These eggs formed coagulated clusters as in the wild, with many progressing through to the eight-cell stage. Remarkably, numerous G. australis were still alive 95–392 days after the end of the short spawning period, and one male after a further 119 days. Postspawning survival would be facilitated inter alia by extensive proteolysis, reflected in a shortening of the body. The data in this paper emphasise that G. australis is a highly atypical lamprey and provides invaluable information for conserving this declining species. The lamprey Geotria australis , when provided with appropriate conditions, can be maintained in laboratory tanks for many months from the commencement of the upstream migration through to spawning. Successful maintenance requires, however, the provision of conditions that overcome the potential for this species to succumb to haemorrhagic septicaemia. Spawning, which occurs at the same time as in their natural environment, is described. The prolonged period during which G. australis survive after spawning parallels that recorded for this species in its riverine environment and is unique among lampreys. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore whether a relationship exists between the number of disasters a jurisdiction has experienced and the presence of disaster-specific pharmacy legislation. Methods: Pharmacy legislation specific to disasters was reviewed for five countries: Australia, Canada, UK, US and New Zealand. A binary logistic regression test using a generalised estimating equation was used to examine the association between the number of disasters experienced by a state, province, territory or country and whether they had disaster-specific pharmacy legislation. Results: Three of six models were statistically significant, suggesting that the odds of a jurisdiction having disaster-specific pharmacy legislation increased as the number of disasters increased for the period 2007–17 and 2013–17. There was an association between the everyday emergency supply legislation and the presence of the extended disaster-specific emergency supply legislation AH19093_IE1.gif. Conclusions: It is evident from this review that there are inconsistencies as to the level of assistance pharmacists can provide during times of crisis depending on their jurisdiction and location of practice. It is not a question of whether pharmacists have the skills and capabilities to assist, but rather what legislative barriers are preventing them from being able to contribute further to the disaster healthcare team. What is known about the topic?: The contributing factors to disaster-specific pharmacy legislation has not previously been explored in Australia. It can be postulated that the number of disasters experienced by a jurisdiction increases the likelihood of governments introducing disaster-specific pharmacy legislation based on other countries. What does this paper add?: This study compared five countries and their pharmacy legislation specific to disasters. It identified that as the number of disasters increases, the odds of a jurisdiction having disaster-specific emergency supply or disaster relocation or mobile pharmacy legislation increases. However, this is likely to be only one of many factors affecting the political decisions of when and what legislation is passed in relation to pharmacists' roles in disasters. What are the implications for practitioners?: Pharmacists are well situated in the community to be of assistance during disasters. However, their ability to help patients with chronic disease management or providing necessary vaccinations in disasters is limited by the legislation in their jurisdiction. Releasing pharmacists' full potential in disasters could alleviate the burden of low-acuity patients on other healthcare services. This could subsequently free up other healthcare professionals to treat high-acuity patients and emergencies. [ABSTRACT FROM AUTHOR]

Objective: This study reports on the characteristics of individuals conducting health service research (HSR) in Australia and New Zealand, the perceived accessibility of resources for HSR, the self-reported impact of HSR projects and perceived barriers to conducting HSR. Methods: A sampling frame was compiled from funding announcements, trial registers and HSR organisation membership. Listed researchers were invited to complete online surveys. Close-ended survey items were analysed using basic descriptive statistics. Goodness of fit tests determined potential associations between researcher affiliation and access to resources for HSR. Open-ended survey items were analysed using thematic analysis. Results: In all, 424 researchers participated in the study (22% response rate). Respondents held roles as health service researchers (76%), educators (34%) and health professionals (19%). Most were employed by a university (64%), and 57% held a permanent contract. Although 63% reported network support for HSR, smaller proportions reported executive (48%) or financial (26%) support. The least accessible resources were economists (52%), consumers (49%) and practice change experts (34%); researchers affiliated with health services were less likely to report access to statisticians (P < 0.001), economists (P < 0.001), librarians (P = 0.02) and practice change experts (P = 0.02) than university-affiliated researchers. Common impacts included conference presentations (94%), publication of peer-reviewed articles (87%) and health professional benefits (77%). Qualitative data emphasised barriers such as embedding research culture within services and engaging with policy makers. Conclusions: The data highlight opportunities to sustain the HSR community through dedicated funding, improved access to methodological expertise and greater engagement with end-users. What is known about the topic?: HSR faces several challenges, such as inequitable funding allocation and difficulties in quantifying the effects of HSR on changing health policy or practice. What does this paper add?: Despite a vibrant and experienced HSR community, this study highlights some key barriers to realising a greater effect on the health and well-being of Australian and New Zealand communities through HSR. These barriers include limited financial resources, methodological expertise, organisational support and opportunities to engage with potential collaborators. What are the implications for practitioners?: Funding is required to develop HSR infrastructure, support collaboration between health services and universities and combine knowledge of the system with research experience and expertise. Formal training programs for health service staff and researchers, from short courses to PhD programs, will support broader interest and involvement in HSR. [ABSTRACT FROM AUTHOR]

Invasive animal species threaten global biodiversity. In New Zealand invasive species threaten iconic native species, and scientists are seeking approval to research new technologies that might be capable of eradicating these invasive species. The aim of this research was to understand what New Zealanders with an interest in pest control consider to be the main risks and benefits of introducing new technologies to manage invasive species. We invited key informants to participate in the focus groups, selecting people with knowledge and experience of pest control issues in New Zealand. Data were collected from seven focus groups held in three locations across New Zealand. A thematic analysis of the data was then conducted in which three key themes emerged: concern about the risk of unintended consequences, the benefits of landscape-scale technologies, and New Zealand being an early adopter of new technologies. The focus groups articulated a variety of benefits from introducing new technologies – such as replacing dangerous poisons with non-toxic alternatives – but it was the risks of the new technologies that dominated the discussions. Given these results, we recommend an education and communication strategy focussed on social learning, in conjunction with a codesigned decision-making process, to help establish social licence for the application of potentially controversial technologies. This paper examines attitudes on the risks and benefits of new technologies to manage invasive species in New Zealand. Three themes emerged from our research: the risks of unintended consequences, the benefits of landscape scale technologies, and the risks and benefits of being an early adopter of new technologies. [ABSTRACT FROM AUTHOR]

Context: Dairy farming will be increasingly scrutinised for its environmental impacts, in particular for its impacts on freshwater quality in New Zealand and elsewhere. Management and mitigation of high nitrate losses is one of the greatest water-quality challenges facing dairy farming in New Zealand and other countries. Management of critical flow pathways and nitrate-attenuation capacity could offer potential solutions to this problem and help maintain dairy-farming productivity, while reducing its water-quality impacts. Aims: The present paper reviewed the key water-quality issues faced by dairy farming and assessed potential of emerging edge-of-paddock technologies, and catchment-scale nutrient-attenuation practices, to reduce nitrate losses from dairy farming to receiving water bodies. Methods: We developed a conceptual catchment-scale modelling analysis assessing potential natural and built attenuation of nitrate losses from dairy farming in the Tararua and Rangitikei catchments (located in the lower part of the North Island, New Zealand). Key results: This exploratory analysis suggests that a reduction of greater than 25% in the river nitrate loads from dairy-farming areas could potentially be achieved by spatially aligning dairy land with areas of high subsurface nitrate-attenuation capacity, and by managing critical flow pathways using innovative edge-of-field technologies such as controlled drainage, drainage-water harvesting for supplemental irrigation, woodchip bioreactors, and constructed wetlands in the study catchments. Conclusions: The research findings highlighted the potential to better understand, map and effectively utilise existing natural and new built-in nitrate-attenuation capacity to significantly reduce water-quality impacts from dairy farming across environmentally sensitive agricultural catchments. This knowledge and tools could help farmers close the gap between what can be achieved with current, in-field mitigation practises and the nitrogen-loss allocation imposed by regulatory authorities. Implications: However, the research findings presented here are based on a coarse-scale, conceptual modelling analysis, and therefore further research is recommended to develop tools and practices to better understand, map and effectively utilise existing natural and new built-in nitrogen attenuation capacity at farm-scale to achieve productive and environmentally friendly pastoral dairy farming across agricultural landscapes. Water-quality impacts of dairy farming can be significantly reduced by developing tools and practices to design and manage dairy land use and drainage waters. This would include spatial alignment of intensive dairy lands with naturally high nitrogen-attenuation capacity pathways that reduce nitrate losses to sensitive water bodies. Likewise, the development of innovative edge-of-field technologies such as controlled drainage, drainage-water harvesting and re-use, woodchip bioreactors, and constructed wetlands enable the management of critical flow pathways from dairy farming on artificially drained lands. [ABSTRACT FROM AUTHOR]

Dairy feeding systems in Australia and New Zealand have seen an increase in the use of mixed rations to manage variability in climate and market conditions and enable a certain degree of resilience in the operating environment. In this review, resilience was defined as the ability of the farm system to respond to challenges, optimise productivity and profitability for a given set of circumstances, and persist over time. Specific attributes of a dairy system that contribute to resilience were considered as flexibility, consistency, adaptation, sustainability and profitability. A flexible forage base that uses water efficient forage species provides a consistent supply of nutrients from home-grown forages across the year and is a key driver of resilience. Consistent milk production from purchased concentrates adds value to the forage base and will ensure that the system is profitable in the long term. Appropriate investment in infrastructure and careful management of debt has a positive impact on technical and financial efficiency and improves overall economic performance and resilience of the system. Nutrients, feed wastage, cow comfort and welfare were also identified as key areas to focus on for improved sustainability. Future research investigating the interaction between forages and concentrates, and the subsequent milk production response will be important for the future resilience of mixed ration systems. Adaptive management at a tactical and strategic level across several technical areas will further underpin the resilience of a mixed ration dairy system, and minimise the impact of climate and price variability. This will have flow on benefits to animal welfare and resource sustainability, which will have a positive impact of the public perception of these systems within the Australian and New Zealand dairy industries. The use of mixed ration feeding systems in Australia and New Zealand has increased in the past decade in response to variable climate and market conditions and to enable dairy businesses to be more resilient. This paper reviews the attributes contributing to resilience, namely flexibility, consistency, adaptation, sustainability and profitability with a particular focus on the forage base, milk production responses, the production : cost base and resource management. Potential areas for future work to maintain the resilience of mixed ration systems are also considered. [ABSTRACT FROM AUTHOR]

The Australasian dairy industry is facing the dual challenges of increasing productivity, while also reducing its emissions of the greenhouse gases (GHG) methane and nitrous oxide. Following the COP21 Paris Agreement, all sectors of the economy will be expected to contribute to GHG abatement. Enteric methane is the major source of GHG emissions from dairy production systems (>70%), followed by nitrous oxide (13%) and methane (12%) from animal waste, with nitrogen (N)-fertiliser use contributing ~3.5% of total on-farm non-carbon dioxide equivalent (non-CO2e) emissions. Research on reducing methane emissions from dairy cattle has focussed on feeding dietary supplements (e.g. tannins, dietary oils and wheat), rumen modification (e.g. vaccine, inhibitors), breeding and animal management. Research on reducing nitrous oxide emissions has focussed on improving N fertiliser efficiency and reducing urinary N loss. Profitable options for significant abatement on farm are still limited, with the industry focusing instead on improving production efficiency, while reducing emission intensity (t CO2e/t product). Absolute emission reduction will become an imperative as the world moves towards carbon neutrality by 2050 and, thus, a priority for research. However, even with implementation of best-practice abatement, it is likely that some residual emissions will remain in the foreseeable future. The soil organic carbon content of dairy soils under well fertilised, high-rainfall or irrigated permanent pastures are already high, therefore limiting the potential for further soil carbon sequestration as an offset against these residual emissions. The Australasian dairy industry will, therefore, also need to consider how these residual emissions will be offset through carbon sequestration mainly in trees and, to a more limited extent, increasing soil organic carbon. The Australasian dairy industry is facing the challenge of increasing productivity while also reducing greenhouse gas (GHG) emissions. This paper reviews the most promising technologies, concluding that substantial GHG abatement is possible, but the industry will need to consider further offsets in trees to achieve carbon-neutral dairy farming in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

The incursion of the myrtle rust disease (Austropuccinia psidii) was officially confirmed on 3 May 2017 at a plant nursery located in Kerikeri, North Island, New Zealand. Since then the presence of myrtle rust has now been located throughout New Zealand, with additional outbreaks in Taranaki, Waikato and Bay of Plenty. It has been detected on a range of Myrtaceaea species including ramarama (Lophomyrtus bullata), pōhutukawa (Metrosideros excelsa), Monkey apple (Syzygium smithii), mānuka (Leptospermum scoparium), and Eucalyptus spp. (E. botryoides). Many of these species are iconic to the Indigenous Māori and have historical significance, being taonga (treasures). Since the incursions, Te Tira Whakamātaki (National Māori Biosecurity Network), have been informing Māori communities throughout New Zealand about the potential impacts of myrtle rust via a series of regional meetings (hui), email and social media that have included brief reports and recommendations. Feedback from these meetings and social media has strongly highlighted the desires of Māori communities to be active participants in decision-making and response plans for the management of myrtle rust as well as other pests and diseases. In this paper, we describe the journey of an Indigenous community approach to a modern biosecurity incursion. Myrtle rust was confirmed in May 2017 in New Zealand and has spread throughout the country. It has been detected on a range of Myrtle plant species with many of these iconic to Indigenous Māori. We describe the journey of an Indigenous community approach to a modern biosecurity incursion. [ABSTRACT FROM AUTHOR]

This paper highlights the importance of people as a central factor in improving health for Māori (Indigenous people of New Zealand). How whānau (family) relationships, connections, values and inspiration are integral to achieving Indigenous health goals is explained. Descriptions of how community researchers, healthcare staff, consumers and academics worked together to design interventions for two health services (in the Waikato and Bay of Plenty regions) is included. Through highlighting the experiences of health consumers, the potential for future interventions to reduce the advancement of pre-diabetes among whānau is described. Evidence from the study interviews reinforces the importance of whānau and whakapapa (heritage) as enabling factors for Indigenous people to improve health. Specifically, the positive effect of whānau enhancing activities that support peoples' aspirations of tino rangatiratanga (self-determination) in their lives when engaging with health care has been observed. This study highlights the many positives that have emerged, and offers an opportunity for taking primary health to the next level by placing whānau alongside Indigenous primary care providers at the centre of change strategies. [ABSTRACT FROM AUTHOR]

Critically reflecting on researcher–community partnerships is a key component in implementing chronic condition interventions in Indigenous communities. This paper draws on the results and learnings from a process evaluation that measures how well two research–community partnerships have followed the He Pikinga Waiora (HPW) Implementation Framework while co-designing chronic condition interventions in primary care. The HPW framework is centred on Indigenous self-determination and knowledge surrounded by community engagement, cultural centredness, systems thinking and integrated knowledge translation. The evaluation included in-depth interviews and online surveys with 10 team members. The findings demonstrate that the HPW framework was followed well, with strengths particularly in community engagement and relationship building. Areas for improvement included systems thinking and integrated knowledge translation to support sustainability of the interventions. The need for partnerships to use process evaluation results to support critical reflection is asserted, which helps build strong trust and synergy, power sharing and effective and sustainable implementation practices. It is concluded that the HPW framework is well suited to evaluating implementation of health interventions in primary care as it assists in the facilitation of better collaboration between researchers and Indigenous communities, and encourages the implementation team to reflect on power and privilege. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to evaluate the short-term outcomes of two health science academies established by a district health board in South Auckland, New Zealand, to create a health workforce pipeline for local Māori and Pasifika students. Methods: A mixed-methods approach was used, involving background discussions with key informants to generate an initial logic model of how the academies work, followed by secondary analysis of students' records relating to retention and academic achievement, a survey of senior academy students' interest in particular health careers and face-to-face interviews and focus groups with students, families and teachers. Results: Academy students are collectively achieving better academic results than their contemporaries, although selection decisions are likely to contribute to these results. Academies are retaining students, with over 70% of students transitioning from Year 11 to Years 12 and 13. Senior students are expressing long-term ambitions to work in the health sector. Conclusions: Health science academies show promise as an innovative approach to supporting Māori and Pasifika students prepare for a career in the health professions. Evaluating the long-term outcomes of the academies is required to determine their contribution to addressing inequities in the local health workforce. What is known about the topic?: Despite progress in health workforce participation for underrepresented indigenous and ethnic minority groups in New Zealand, significant disparities persist. Within this context, a workforce development pipeline that targets preparation of secondary school students is recommended to address identified barriers in the pursuit of health careers. What does this paper add?: We provide an evaluation of an innovative district health board initiative supporting high school students that is designed to ensure their future workforce is responsive to the needs of the local community. What are the implications for practitioners?: The findings have implications for decision makers in health workforce planning regarding the benefits of investing at an early stage of the workforce development pipeline in order to build an equitable and diverse health professions workforce. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact and cost associated with mental illness. Methods: A rapid review of the literature from Australia, New Zealand, UK and Canada was undertaken. The review included literature pertaining to the cost-of-illness and impact of mental illness as well as any modelling studies. Included studies were categorised according to impact on education, labour force engagement, earlier retirement or welfare dependency. The well-accepted Drummond 10-point economic appraisal checklist was used to assess the quality of the studies. Results: A total of 45 methodologically diverse studies were included. The studies highlight the significant burden mental illness places on all facets of society, including individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, a lower probability of gaining full-time employment and a reduced quality of life. Research from Canada suggests that the total economic costs associated with mental illness will increase six-fold over the next 30 years with costs likely to exceed A$2.8 trillion (based on 2015 Australian dollars). Conclusions: Mental illness is associated with a high economic burden. Further research is required to develop a better understanding of the trajectory and burden of mental illness so that resources can be directed towards cost-effective interventions. What is known about the topic?: Although mental illness continues to be one of the leading contributors to the burden of disease, there is limited information on the economic impact that mental illness imposes on individuals, families, workplaces and the wider economy. What does this paper add?: This review provides a summary of the economic impact and cost of mental illness. The included literature highlights the significant burden mental illness places on individuals, families, workplaces, society and the economy in general. The review identified several areas for improvement. For example, only limited information is available on the impact of attention deficit hyperactivity disorder, anxiety, cognitive function, conduct disorder, eating disorder and psychological distress. There was also a dearth of evidence on the intangible elements of pain and suffering of people and their families with depressive disorders. More research is required to better understand the full extent of the impact of mental illness and strategies that may be implemented to minimise this harm. What are the implications for practitioners?: Knowing the current and future impact of mental illness highlights the imperative to develop an effective policy response. [ABSTRACT FROM AUTHOR]

This paper analyses biogeography and ecology in the grass Simplicia , endemic to New Zealand, with respect to tectonic geology and to distributions in other groups of plants and animals. There are disjunctions and phylogenetic breaks at the Oparara basin (north-west Nelson), the Western Province–Eastern Province tectonic boundary, the Alpine fault and the Waihemo fault zone (Otago). Distribution boundaries at these localities recur in many other taxa and coincide spatially with important fault zones. General aspects of distribution and evolution in Simplicia are addressed, using a set of critical questions posed by McGlone (2015) as a conceptual framework. The biogeographic evidence suggests that the divergence of Simplicia and of its species took place by vicariance, and that this was mediated by tectonics. All individual plants of Simplicia have dispersed to their present locality, but there is no evidence that chance dispersal with founder speciation has occurred in the genus. Trends in these grasses, such as spikelet reduction, are global and have evolved in many different environments over tens of millions of years. This suggests that non-random mutation has been more important than environment and natural selection in directing the course of evolution. [ABSTRACT FROM AUTHOR]

This paper reviews the effect of a primary care financing scheme introduced in New Zealand as a component of the New Zealand Primary Health Care Strategy, a comprehensive reform of the way that primary healthcare was governed, financed and delivered. The population-based funding formulae incorporated an area-based measure of social deprivation and ethnicity in an explicit attempt to improve access to care for certain population groups and fund social interventions aimed at addressing conditions that lead to improved health outcomes. The New Zealand experience shows that introducing a nationwide, comprehensive program to improve access and reduce health disparities is possible. However, the effect of this effort on reducing health disparities is not entirely clear because success ultimately relies on local implementation of a complex set of interventions that need to be evaluated more rigorously. In addition, the partial subsidies for first contact care that came with the Strategy have been shown to improve access, but, the success of this approach relies on compliance by private-practising general practitioners with a fee reduction regimen, which is subject to local variation. [ABSTRACT FROM AUTHOR]

Objective. Suicide is a significant public health problem in New Zealand, with the youth suicide rate being one of the highest among developed countries. Increased suicide rates in recent years suggest that the evidence base and research priorities for New Zealand suicide prevention need to be reassessed. To inform policy development, the aim of the present study was to evaluate all peer-reviewed New Zealand published suicide research and major grant allocations from 2006 to 2016. Methods. The methodology duplicated a recent Australian review of suicide prevention research and funding. Publications and grant funding allocations were assessed independently. Key research databases were searched in April 2016 for all suicide-related publications. Identified papers were then classified by research type, population focus and type of self-injurious behaviour. Citation indices were obtained for each publication. Annual reports, newsletters and summary data from four major New Zealand funding bodies (the Health Research Council of New Zealand, Marsden Fund, Lottery Health Research and the Ministry of Health) were reviewed for funding allocations. Identified grants were coded for type of project, type of self-injurious behaviour and target population. Descriptive analyses were performed. Results. In all, 104 published articles and 27 grants met review criteria. Total funding was NZ$12 677 261.62. Most published articles were epidemiological in nature and the most common type of grant was for an intervention. Conclusions. In the past decade, a substantial number of articles has been published and significant funding was invested in New Zealand's suicide research. The present review suggests that future research investments should focus on effective translation of research findings into suicide prevention programs. Several pragmatic recommendations are proposed to help improve the evidence base and reduce New Zealand's suicide rates. [ABSTRACT FROM AUTHOR]

Objective. Patient navigation originated as an approach for reducing disparities in cancer care and consequent health outcomes. Over time navigator models have evolved and been used to address various health issues in differing contexts. This case study outlines the evolution, purpose and effects of a lay-led health navigator model in a deprived, sparsely populated, New Zealand rural setting, where primary care services are frequently understaffed and routinely overstretched. Methods. Routinely collected service utilisation data, survey results and health navigator interview data were utilised to illustrate the client group the service works with, why primary care refer to the service, as well as lessons learned from implementation to ongoing service provision. Results. Those referred to the navigator service generally represented the most vulnerable in the community. Survey respondents, overall, were highly satisfied with the service. Navigators identified barriers and facilitators to implementation, as well as ongoing obstacles and enablers to service provision. Conclusions. This lay-led navigator service provided support to a group of unwell individuals, with few resources and multiple barriers to negotiate, and has effectively engaged with health and social care services, while overcoming various barriers and obstacles to its establishment and ongoing operation. What is known about the topic? Patient navigation models of care were first employed in the 1990s, as a strategy to increase the uptake of cancer screening among disadvantaged women. They have since expanded across the cancer care continuum, but despite favourable findings, information regarding their potential in other settings is limited. What does this paper add? This paper provides a perspective on lay-led navigation services within a rural New Zealand primary care setting. The views of primary care professionals regarding the role and value of the service are provide, as is a summary of the key lessons learnt over the implementation, establishment and ongoing service delivery phases of the programme. What are the implications for practitioners? This case study proposes that lay-led navigation services can provide practical support to primary care; assisting it to meet the needs of patients living with multiple chronic conditions and social challenges. [ABSTRACT FROM AUTHOR]

This paper reviews current challenges in the Australian extension environment and provides a case for developing an adaptive extension platform for the dairy sector in Australia and New Zealand, to support evolving dairy farm systems. The variation in the public-sector engagement in extension, the diversity and number of extension providers and a relatively uncoordinated approach to define new extension roles, functions and professional requirements are current challenges for dairy extension across Australia. In the dairy sector, these challenges coincide with increasing demand for a responsive research, development, extension and education system in supporting the rapid evolution in dairy farming systems. Addressing these challenges is not an issue for extension alone; however, the required level of integration among research, development, extension and education in an environment where needs are changing and resources are scarce demands an engaged dairy-science profession. Drawing on international extension and agricultural innovation-system literature and earlier empirical research, the following three areas for development are proposed: (1) a professional development strategy that incorporates (i) an understanding of the new professional situations extension works within, (ii) leadership in cross-industry and cross-sector coordination concerning the nature of the changing client in research, development, extension and education system and (iii) clear priorities for extension; (2) a professional development plan that incorporates a workplace-learning approach; and (3) for extension specialists to be engaged in defining research priorities, the agenda for change and suitable pathways for change alongside other professional groups, including farming. This development agenda will, however, require an adaptive extension platform to advance these areas on behalf of farmers and public stakeholders. New thinking about the role of extension in supporting evolving dairy farm systems is required. This paper identifies significant changes and challenges impacting on the development of extension strategies in Australia and New Zealand. With increasing demand for a responsive research, development, extension and education system and declining resources, there is an imperative for dairy scientists to be active partners in addressing the challenges. [ABSTRACT FROM AUTHOR]

Changes in the farm operating and policy environments and a need to remain profitable under a cost-price squeeze have contributed to dairy systems in Australia and New Zealand becoming more intensive and complex in recent decades. Farm systems in both countries are now diverse, varying from being based predominantly on pasture with little purchased supplements, to those dependent on high levels of feed supplements and even having zero grazing. Dairy farm performance (defined in this paper as production or technical performance), return (return on assets or profit) and risk (variation in economic performance over time), and intensity of dairy systems was examined using farm survey data, case studies and existing published studies. The level of single technical performance measures, such as milk production, feed conversion efficiency and pasture consumption, prevailing in a business are not guides to the operating profit and return on assets of a business. In addition, when survey data of farm performance was grouped by return on assets, few farms were in the top 25% in successive years. Farms that performed consistently well were characterised by good, but not extreme, technical performance in a range of key areas, which translated to favourable business return (return on asset and profit). The knowledge and skills of farm managers are critical, and means that many different dairy systems can perform well physically and financially and successfully meet farmer goals. The relation between risk and the intensity of dairy systems was also investigated. Options that intensified systems generally resulted in higher net wealth for the farm owner, but almost always at increased risk. The best system for any farmer to operate is one which best meets their multifaceted preferences and goals, regardless of system type. A need to remain profitable under fluctuating operating and climatic conditions has increased the intensity of dairy systems in Australia and New Zealand. This paper examined if farm technical performance, profit and risk were related to farm system intensity and complexity. Single technical performance measures were poor guides of profit, with profitable businesses being more about the skills of the farm operator, and less about the system being run. [ABSTRACT FROM AUTHOR]

Family members continue to be used as interpreters in medical consultations despite the well-known risks. This paper examines participant perceptions of this practice in three New Zealand clinics chosen for their frequent use of interpreters and their skill in using them. It is based on a detailed study of 17 video-recorded interpreted consultations and 48 post-consultation interviews with participants (5 doctors, 16 patients and 12 interpreters, including 6 family members). All participants expressed satisfaction with the communication. Analysis of the interviews explored what participants liked or valued about family member interpreters (FMIs). Key themes were the FMIs' personal relationship and knowledge, patient comfort, trust, cultural norms, time efficiency and continued help outside the consultation. General practitioners (GPs) expressed awareness of potential risks and how to manage them, in contrast to patients and FMIs. Although the use of professional interpreters needs to be strongly promoted, a well-informed decision to use a family member is appropriate in some situations. GPs need to be well trained in how to assess and manage the risks. Rather than striving for 'best practice' (i.e. universal use of professional interpreters), it is better to aim for 'good practice' where a considered judgement is made about each situation on an individual basis. [ABSTRACT FROM AUTHOR]

G. L. McClymont developed a unique paradigm in which to consider the challenges that confront agriculture and it is based on an understanding of the interrelationships of plants, animals, soils and water within an economic and social framework. The major changes in our environment are the consequence of rapid population growth and the need to increase world food supplies. Within this context, this paper provides an overview of the link between agriculture, especially animal production and population health and how mycotoxins, fungal secondary metabolites, can perturb this link. Examples from New Zealand and Australian animal agriculture are described. The underlying premise of this paper is that agriculture is a major determinant of human health through the supply of food derived from both plant and animal sources. In other words, nutrition is the conduit between agriculture and human health. Against this backdrop the potential role of mycotoxins in determining food and feed supplies is discussed. Globally, mycotoxins have significant human and animal health, economic and international trade implications. [ABSTRACT FROM AUTHOR]

Family circumstances in infancy are persistent and powerful determinants of children's physical and mental health, influencing inequalities that trace from childhood through to adulthood. While the social factors that perpetuate patterns of inequality are more complex than can be addressed through single interventions, child and family health (CFH) services represent crucial sites where trajectories of inequality can be disrupted. In particular, approaches that foster opportunities for practitioner-parent engagement that challenge traditional hierarchical health care practice, such as the Family Partnership Model (FPM), are recommended as ways of addressing disadvantage. Little is known about how practitioners implement models of working in partnership with families and, consequently, there is a gap in understanding how best to develop and sustain these new CFH practices. This paper reports a research project that investigated the experiences of 25 health professionals working within a FPM framework with vulnerable families. Through discussion of four key themes - redefining expertise, changing practices, establishing new relationships with parents and the complexities of partnership practice - the paper offers first-hand accounts of reframing practices that recognise the needs, skills and expertise of parents and thus contribute to empowerment of families. [ABSTRACT FROM AUTHOR]

This paper assesses what health workforce 'sustainability' might mean for Australia and New Zealand, given the policy direction set out in the World Health Organization draft code on international recruitment of health workers. The governments in both countries have in the past made policy statements about the desirability of health workforce 'selfsufficiency', but OEC data show that both have a high level of dependence on internationally recruited health professionals relative to most other OEC countries. The paper argues that if a target of 'self-sufficiency' or sustainability were to be based on meeting health workforce requirements from home based training, both Australia and New Zealand fall far short of this measure, and continue to be active recruiters. The paper stresses that there is no common agreed definition of what health workforce 'self-sufficiency', or 'sustainability' is in practice, and that without an agreed definition it will be difficult for policy-makers to move the debate on to reaching agreement and possibly setting measurable targets or timelines for achievement. The paper concludes that any policy decisions related to health workforce sustainability will also have to taken in the context of a wider community debate on what is required of a health system and how is it to be funded. [ABSTRACT FROM AUTHOR]

The concept of commissioning is starting to gain traction in the Australian health system. Primary Care Networks began operations in July 2015 with a remit around commissioning health services. Despite the centrality of this concept, we know relatively little about commissioning in Australia. Other systems have experimented with it for some time, and this paper reviews the evidence and lessons inherent within the international literature. The study defines commissioning, and explores experiences of others who have adopted commissioning approaches and the evidence concerning the outcomes of these experiments. Commissioning is a difficult topic in many senses and its application to a complex area such as health reform can make it even more challenging. Ultimately, this evidence suggests that commissioning is more than simply a technical or operational process, but one that is value-based and relational. This is not to downplay the technical aspects, which in many jurisdictions have resulted in explicit and evidenced-based approaches to planning and priority setting. However, if new commissioning organisations, such as Primary Health Networks, are to have an impact, they need to balance the operational and relational elements of commissioning. [ABSTRACT FROM AUTHOR]

Introduction. In 2009, the Royal New Zealand College of General Practitioners commissioned the development of a framework to facilitate quality-improvement activity in primary care settings. This paper outlines the development of the framework, which integrates concepts of quality with the reality of practice-based clinical care, and discusses its value for primary care quality improvement. Method. Framework development involved: (1) literature review of theoretical approaches to healthcare quality; (2) field work utilising a mixed methods approach to obtain empirical data; and (3) model design. Results. Primary care practitioners are juggling competing priorities. Models and tools that promote quality-related activity at practice level need to take into account, and incorporate by design, day-to-day clinical and practice functions. Conclusions. The quality framework identifies the components of primary care practice and locates this model within the concepts and activities necessary for quality improvement. It may be used by primary care organisations and practices to facilitate focussed quality-improvement activity and self-directed process review. The framework was developed for, and within a New Zealand primary care setting, and is applicable internationally and within other healthcare settings. [ABSTRACT FROM AUTHOR]

This paper reports on the cost-effectiveness of pedometer-based versus time-based Green Prescriptions in improving physical activity and health-related quality of life (EQ-5D) in a randomised controlled trial of 330 low-active, community-based adults aged 65 years and over. Costs, measured in $NZ (NZ$1=A$0.83, December 2008), comprised public and private health care costs plus exercise-related personal expenditure. Based on intention-to-treat data at 12-month follow up, the pedometer group showed a greater increase in weekly leisure walking (50.6 versus 28.1min for the time-based group, adjusted means, P=0.03). There were no significant between-group differences in costs. The incremental cost-effectiveness ratios, for the pedometer-based versus time-based Green Prescription, per 30min of weekly leisure walking and per quality-adjusted life year were, (i) when including only community care costs, $115 and $3105, (ii) when including only exercise and community care costs, $130 and $3500, and (iii) for all costs, -$185 and -$4999, respectively. The cost-effectiveness acceptability curves showed that the pedometer-based compared with the time-based Green Prescription was statistically cost-effective, for the above cost categories, at the following quality-adjusted life year thresholds: (i) $30000; (ii) $30500; and (iii) $16500. The additional program cost of converting one sedentary adult to an active state over a 12-month period was $667. The outcomes suggest the pedometer-based Green Prescription may be cost-effective in increasing physical activity and health-related quality of life over 12 months in previously low-active older adults. [ABSTRACT FROM AUTHOR]

The Medical Schools Outcomes Database (MSOD) is an ongoing longitudinal tracking project of medical students from all medical schools in Australia and New Zealand. It was established in 2005 to track the career trajectories of medical students and will directly help develop models of workforce flow, particularly with respect to rural and remote shortages. This paper briefly outlines the MSOD project and reports on key methodological factors in tracking medical students. Finally, the potential impact of the MSOD on understanding changes in rural practice intentions is illustrated using data from the 2005 pilot cohort (n = 112). Rural placements were associated with a shift towards rural practice intentions, while those who intended to practice rurally at both the start and end of medical school tended to be older and interested in a generalist career. Continuing work will track these and future students as they progress through the workforce, as well as exploring issues such as the career trajectories of international fee-paying students, workforce succession planning, and the evaluation of medical education initiatives. [ABSTRACT FROM AUTHOR]

Objective. To ensure New Zealand's health workforce was fit for purpose, Health Workforce New Zealand (HWNZ) funded Workforce Service Reviews (WSRs) to develop visions for service reconfiguration and workforce for 2020. This paper describes what makes the WSR processes work, for whom, and in what circumstances. Method. Semi-structured interviews informed by a realist evaluation approach were conducted to obtain perceptions and experiences of WSR participants from four WSRs: eye health, palliative care, anaesthesia and aged care. Results. The WSR process was a successful means of bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. WSRs were constrained by: mixed signals about process and outcomes; being challenged not milestone focussed; lacking clarity about ownership of visions; and variable clarity about next steps. WSRs were optimised by having: a lead clinician with policy know-how, ability to inspire, bring people together, distil ideas into coherent frameworks; and a project manager with project enablement skill sets and expertise in complex systems, implementation, change management. Conclusions. Evidence now exists at a point in time about what makes the WSR processes work. Implications for HWNZ are presented using a capacity-building framework to inform future decision making regarding WSRs. What is known about the topic? More appropriate workforce planning is required to meet the challenges facing the health workforce, from both the demand and the workforce side. To ensure New Zealand's healthcare workforce was fit for purpose, HWNZ initiated an iterative WSR process in topic specific areas. The WSRs process was designed to develop a vision of the relevant health service and workforce for 2020, and models of care that were patient-centred and team-based. What does this paper add? The paper provides evidence that the WSR process was a successful means for bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. The paper presents key enablers of, and barriers to, the WSR iterative process. What are the implications for practitioners? The evaluation revealed that a multitude of factors can influence the capacity of the WSR process at the individual (workforce skills and abilities), organisational (leadership and interactions) and systems (infrastructure) levels. Implications for HWNZ on ways to build the capacity of the WSRs according to three capacity-building dimensions are presented to inform future decision making. [ABSTRACT FROM AUTHOR]