An evaluation of the ecology and riparian management of the south branch of the Whareroa Stream, Paekakariki : a thesis presented in partial fulfilment of the requirements for the degree of Master of Applied Science in Natural Resource Management at Massey University

Whareroa Farm, Mackays Crossing, Paekakariki, was bought by the Department of Conservation in 2005. The goal was to effect the restoration of a corridor for flora and fauna from the Akatarawa Forest in the east to Queen Elizabeth Park and the sea in the west. The south branch of the Whareroa Stream, which arises as a series of tributaries from a ridge 272m above sea level, traverses Whareroa Farm and the adjacent Queen Elizabeth Park. It was thought likely that the stream had been severely affected ecologically during a century of cattle and sheep farming, though the degree to which the ecological degradation had occurred was unknown. Obvious deforestation and land use changes suggested that, in concert with many other New Zealand hill country farms, the ecological changes would be significant. To establish and quantify the degree of degradation, the Auckland Regional Council (ARC) Stream Environment Valuation (SEV) protocol was applied to the Whareroa Stream and its tributaries. Five sites were selected for valuation, varying from open pasture to bush covered and open parkland. The resulting SEV scores showed losses of ecological value ranging from 32% to 46% across the sites. The Macroinvertebrate Community Index (MCI) and the fish Index of Biological Integrity (IBI) were measured at each site. Results indicated that aquatic habitats were unable to sustain adequate assemblages at four of the five sites. The valuations of the riparian zones at each site used the River Environment Classification (REC) and Riparian Management Classification (RMC) protocols. The results indicated that current riparian characteristics showed poor to absent effective riparian zones from the headwaters to the sea at all sites. Riparian zones are pivotal to the provision of stream ecological integrity and are responsible for maintaining the longitudinal, lateral and vertical connectivity between a stream, its network and its surrounding land. The loss of in-stream organic matter from lack of riparian vegetation together with the loss of effective temperature control from lack of shade, impacts negatively on the habitats for macroinvertebrates and fish. This was highlighted in the Whareroa Stream network. While the SEV and RMC evaluations showed that, with best practice management plans, there was great potential for improvement of the Whareroa Stream ecology, any riparian restoration would require sympathetic and improved fencing, withdrawal of stock from stream access and the retirement of headwater land from pastoral use. The loss of ecological integrity that occurs as a result of prolonged land use changes from forest to agriculture is well illustrated by the situation in the south branch of the Whareroa Stream and its tributaries

Sustainable ecological systems and urban development in New Zealand : a wetlands case study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Ecology at Massey University, New Zealand

The destiny of urban wetlands lies largely in the hands of the urban planners. The results of this study suggest that planners are underestimating the importance of the urban wetland with irreversible consequences. The ecological integrity of natural systems like wetlands is inevitably compromised when they occur in urban environments. The Resource Management Act 1991 altered the approach to urban development from being entirely anthropocentric to one of consideration of the environment in which such developments were planned. Supposedly, adherence to the Act has resulted in a more focused approach to environmental outcomes in district and regional plans. However, this research into the effects of urban development on urban wetland riparian areas identifies a lack of appreciation of their structure and function. Eight palustrine wetlands were assessed for health and riparian function. They comprised two non-urban wetlands that provided the best-available ecological data on wetland health and six urban wetlands. Ecological indicators and urbanisation data were incorporated into a multi-metric model (named the Urban Wetland Health Index) to evaluate the biological health of urban wetlands. A key finding of this research is that the urban wetlands have poor ecological health and functioning indicated by excessive nutrients and algal blooms. Other key findings included the inadequate structure and function of the wetland riparian areas; the loss of riparian habitat associated with a lack of indigenous vegetation; the minimal cultural values given to the urban wetlands; and the negative impacts of urban imperviousness and inadequate stormwater infrastructure on wetland health. Notably, older residential areas that had poor stormwater connections to appropriate drainage also had the least healthy urban wetlands. The role of stormwater runoff in compromising the health of the urban wetlands was not addressed in the 2010 Kapiti Coast District Plan Review documents regarding Landscape and Biodiversity. These documents guide the development of the ‘second generation’ district plan. The Urban Wetland Health Index was found to be robust and reliable with this research. It was designed to address a gap in the tools available to planners, ecologists and other professionals seeking to assess the impacts of urban development on urban wetland ecosystem health. This Index is an important tool for use by councils in reviewing their district plans and undertaking plan changes. The incorporation of ecosystem services science into their policies and plans, and the understanding of the value of urban wetland ecosystem services, is needed to foster urban sustainability

Follow-on rifaximin for the prevention of recurrence following standard treatment of infection with clostridium fifficile (RAPID): a randomised placebo controlled trial

©2018 The Authors. Published by BMJ. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: http://dx.doi.org/10.1136/gutjnl-2018-316794Background Clostridium difficile infection (CDI) recurs after initial treatment in approximately one in four patients. A single-centre pilot study suggested that this could be reduced using ’follow-on’ rifaximin treatment. We aimed to assess the efficacy of rifaximin treatment in preventing recurrence. Methods A multisite, parallel group, randomised, placebo controlled trial recruiting patients aged ≥18 years immediately after resolution of CDI through treatment with metronidazole or vancomycin. Participants received either rifaximin 400mg three times a day for 2weeks, reduced to 200mg three times a day for a further 2weeks or identical placebo. The primary endpoint was recurrence of CDI within 12 weeks of trial entry. Results Between December 2012 and March 2016, 151 participants were randomised to either rifaximin or placebo. Primary outcome data were available on 130. Mean age was 71.9 years (SD 15.3). Recurrence within 12 weeks was 29.5% (18/61) among participants allocated to placebo compared with 15.9% (11/69) among those allocated to rifaximin, a difference between groups of 13.7% (95% CI −28.1% to 0.7%, p=0.06). The risk ratio was 0.54 (95% CI 0.28 to 1.05, p=0.07). During 6-month safety follow-up, nine participants died in each group (12%). Adverse event rates were similar between groups. Conclusion While ’follow-on’ rifaximin after CDI appeared to halve recurrence rate, we failed to reach our recruitment target in this group of frail elderly patients, so the estimated effect of rifaximin lacks precision. A meta-analysis including a previous trial suggests that rifaximin may be effective; however, further, larger confirmatory studies are needed.The trial was sponsored by the University of Nottingham, was coordinated from the Nottingham Clinical Trials Unit and was supported by the National Institute for Health Research Clinical Research Network

Cognitive and psychiatric symptom trajectories 2–3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK

Background: COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning. Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2–3 years, and whether symptoms at 2–3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2–3 years were associated with occupation change. People with lived experience were involved in the study. Findings: 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2–3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16–1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2–3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2–3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0–48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0–17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2–3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6–31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04–2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21–1·98] for every point increase in CCI-20). Interpretation: Psychiatric and cognitive symptoms appear to increase over the first 2–3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19. Funding: National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research.</p