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OBJECTIVE To determine whether a stainless steel implant sterilized with a novel cold atmospheric plasma sterilization (CAPS) device adversely affects local tissues in rabbits and whether CAPS was as effective as steam sterilization with an autoclave to inactivate Pasteure//a multocida. ANIMALS 31 healthy New Zealand White rabbits. PROCEDURES Steam-autoclaved stainless steel implants inoculated with P multocida underwent a second steam autoclave sterilization (AIA) or CAPS (AICAPS). One AIA implant and 3 AICAPS implants were randomly placed subcutaneously at 4 sites in 21 rabbits (84 implants). These rabbits were monitored daily for 5 days for evidence of systemic illness and local tissue reactions at the implantation sites and then euthanized. Samples were taken from each implant site for bacterial culture and histologic examination. RESULTS Cultures of samples obtained from all sites were negative for bacterial growth. No significant difference was observed in mean skin thickness or erythema between AIA and AICAPS implant sites on any observed day. Also, individual histologic grades for the epidermis. dermis, subcutis. and muscle and total histologic grade were not significantly different between AIA and AICAPS implant sites. CONCLUSIONS AND CLINICAL RELEVANCE Cold atmospheric plasma sterilization was noninferior to steam sterilization of P mu/tocida-contaminated stainless steel implants in the rabbits in the present study, However, studics of the efficacy nf CAPS for inactivation of other important bacteria are needed. [ABSTRACT FROM AUTHOR]

Child to parent violence (CPV) involves continual and cumulative abusive actions perpetrated by children and adolescents towards their parents or caregivers. This abuse produces short-term distress and ongoing long-term harmful consequences for parents and their families. Practitioners, researchers and policy-makers are increasingly challenged to identify, conceptualize and respond to this form of family violence. A major challenge is that parents and caregivers under-report this abuse so there is a lack of awareness and understanding of their psychological experiences in relation to CPV. This research adopts an interpretative phenomenological approach to explore the psychological experience of CPV. Interviews were conducted with six New Zealand mothers and two grandmothers who all experienced CPV. This abuse was experienced as an 'emotional bloody roller coaster' of unconditional love through to hatred; as 'judgement' - self-blame and others' blame of their parenting skills; and the 'absent father' in their adolescents' lives was drawn on as an explanation for the abuse. Taken together, these psychological experiences identify the silencing of CPV is related to parents' conflicting emotions towards their children, their thoughts and feelings about themselves and how other people view them, and the impact of an absent father figure in their children's everyday lives. [ABSTRACT FROM AUTHOR]

Objectives. Bone erosion has been linked with tophus deposition in gout but the roles of osteitis (MRI bone oedema) and synovitis remain uncertain. Our aims in this prospective 3 T MRI study were to investigate the frequency of these features in gout and determine their relation to one another.Methods. 3 T MRI scans of the wrist were obtained in 40 gout patients. Scans were scored independently by two radiologists for bone oedema, erosions, tophi and synovitis. Dual-energy CT (DECT) scans were scored for tophi in a subgroup of 10 patients.Results. Interreader reliability was high for erosions and tophi [intraclass correlation coefficients (ICCs) 0.77 (95% CI 0.71, 0.87) and 0.71 (95% CI 0.52, 0.83)] and moderate for bone oedema [ICC = 0.60 (95% CI 0.36, 0.77)]. Compared with DECT, MRI had a specificity of 0.98 (95% CI 0.93, 0.99) and sensitivity of 0.63 (95% CI 0.48, 0.76) for tophi. Erosions were detected in 63% of patients and were strongly associated with tophi [odds ratio (OR) = 13.0 (95% CI 1.5, 113)]. In contrast, no association was found between erosions and bone oedema. Using concordant data, bone oedema was scored at 6/548 (1%) sites in 5/40 patients (12.5%) and was very mild (median carpal score = 1, maximum = 45). In logistic regression analysis across all joints nested within individuals, tophus, but not synovitis, was independently associated with erosion [OR = 156.5 (21.2, >999.9), P < 0.0001].Conclusion. Erosions were strongly associated with tophi but not bone oedema or synovitis. MRI bone oedema was relatively uncommon and low grade. These findings highlight the unique nature of the osteopathology of gout. [ABSTRACT FROM PUBLISHER]

Background: The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines., Methods: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed., Results: Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed., Conclusions: The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.

Aims: To evaluate costs associated with a diagnosis of spondyloarthritis (SpA) in an Aotearoa/New Zealand cohort., Methods: Patients with SpA attending specialist SpA clinics in Auckland and Hamilton completed a series of questionnaires on costs associated with ankylosing spondylitis, disease parameters (BASDAI), work productivity (WPAI, WLQ) and quality of life measures (EQ-5D, ASAS-HI)., Results: Eighty-one patients (median age 43 years) completed the study. All fulfilled the ASAS criteria for axial spondyloarthritis and 44 (58%) fulfilled the Modified New York Criteria for ankylosing spondylitis. The mean (SD) score on the EQ-VAS was 69mm (24.1). More than half reported difficulties with usual activities and more than 80% had moderate pain or discomfort despite current treatment. Sixty-six (82%) were in the workforce, and the mean work productivity loss was 4.8%. The mean (SD) annual cost was NZ$15,677 (NZ$11,269) with NZ$12,189 direct cost and NZ$3,488 productivity loss. The largest cost driver was use of biologic medications, which were used by 48% patients., Conclusions: This study has quantified the direct and indirect costs of spondyloarthritis (SpA) in Aotearoa/New Zealand, and demonstrates meaningful reduction in quality of life and work productivity in patients with SpA. The major driver of direct costs in SpA are biologic medications., Competing Interests: Douglas White reports speaker fees for Abbvie outside the submitted work and has been an investigator on several clinical trials sponsored by Abbvie. Nicola Dalbeth reports speaker fees from Abbvie and Janssen, outside the submitted work.

Background: Rabies is a fatal infection and immunisation is important to consider in those travellers going to rabies endemic areas. In those at high risk, a course of three immunisations may be given by the intramuscular (IM) or intradermal (ID) route, both of which are approved by the World Health Organization (WHO) and the Centers for Disease Control (CDC). Little is known in the New Zealand context regarding the effectiveness of pre-exposure ID rabies immunisation., Methods: The data was collected prospectively on all travellers requiring the immunisation from July 2001 to September 2003 in Auckland. The standard WHO rabies immunisation protocol was used with three ID injections of 0.1 ml, given on days 0, 7, and 21 or 28 with a booster after 12 months. The vaccine used was the Pasteur Merieux human diploid cell vaccine (HDCV) or the Rabipur Purified chick embryo cell (PCEC) vaccine. Both vaccines are approved by the WHO and the CDC, and are interchangeable. Serology was performed approximately 2 weeks after completion of the primary immunisation course or after a booster, wherever possible. Antibody levels were measured using EIA, and levels of >0.5 IU/ml were considered protective., Results: Of the 263 travellers assessed in this study, 125 were males and 138 were females. The mean age of the cohort was 34.8 years (SD=11.7). There were not found to be any statistically significant correlations between age and antibody levels neither was there any significant association between gender and antibody levels. In addition to the sample group, a further 12 travellers had rabies serology performed but were excluded from the study because they had IM vaccines as part of their primary course. Whilst rabies serology ranged from 0.2 to 27.9 IU/ml in the study cohort, the mean antibody level for the group was 4.7 IU/ml (SD=4.1 IU/ml). The mean antibody level for males was 4.3 IU/ml (SD=3.3), and for females, 5.2 IU/ml (SD=4.6). Of the 263 travellers, all had some level of detectable antibodies. The overall seroconversion rate was 95.1%., Conclusions: ID rabies immunisation appears effective, when given according to the standard WHO protocol, in New Zealand. ID rabies immunisation is also more affordable for travellers, especially those on a restrictive budget. ID rabies immunisation can continue to be recommended, particularly where follow-up serology can be done before travel and where there are staff who are experienced in ID immunisation.

Objective: To describe illnesses of returned travellers presenting at GeoSentinel sites in New Zealand., Methods: Record data for all patients presenting for travel-related illnesses seen at two GeoSentinel sites, operating as commercial travel clinics, in Auckland and Hamilton, NZ, were extracted for the period November 1997 to December 2001., Results: 205 patients were identified with 262 diagnoses. Just over half were females (54.21%) and nearly half were in the 25-35 years age group (47.3%). About two-fifths of patients reported a pre-travel health consultation (41.0%). The commonest diseases diagnosed were diarrhoeal illnesses (23%), dermatological diagnoses (16%, excluding animal bites), animal bites (10%), and non-specific viral illnesses (8%), many of which manifest as respiratory infections. Tropical diseases, such as schistosomiasis (4%) malaria (2%) and dengue fever (0.5%), were not common., Conclusions: Information on travel-related illnesses, when reported through a global reporting system, can be useful for the travel health adviser in identifying issues of current concern. Although the frequency of tropical disease is low, it remains important to prevent these potentially fatal diseases., Implications: GeoSentinel makes a global contribution to the surveillance of emerging and re-emerging infectious diseases through a network of individual sites in various countries including New Zealand. This information can be used to help provide preventive advice for travellers as well as help in assessing illness in post-travel patients and potentially assist in preventing the secondary spread of some diseases acquired abroad following return.