Evaluation of the Hamilton City Council plants for Gullies programme

This evaluation found that the Hamilton City Council Plants for Gullies programme is successfully facilitating the restoration and enhancement of Hamilton City gullies by private gully owners. The mean number of native species in surveyed gullies was 2.1 in non-restored sites and 18.4 in restored sites. While the mean number of invasive species was 4.1 in non-restored sites to 2.6 in restored sites. This quantitative measure is a valuable indication of the ecosystem gains for Hamilton City. Hamilton gully owners are very satisfied with the Plants for Gullies programme; the mean satisfaction rating was 8.9 out of 10. These residents dedicate significant time and energy to restoring their gully sections; the mean time contribution of survey participants was 10.3 hours per month. Gully owners were found to be utilising knowledge acquired through participation in the programme to add valuable diversity to their gully ecosystems. This was repeatedly demonstrated by programme participants not only reintroducing the native plants supplied by the programme but also adding large quantities of privately-sourced plants. This investigation found that the Plants for Gullies and Gully Restoration programmes are effective in communicating key ecological restoration concepts. This was reflected by gully owner prioritisation of eco-sourcing, biodiversity and weed control as considerations in their restoration projects. The Gully Restoration Guide was found to be the most valuable component of the programme’s educational tools. However, it is recommended that this resource is updated to support the many gully owners who require information for advanced stages of ecological restoration. In summary, the Plants for Gullies programme is successfully delivering gully restoration assistance and advice to gully owners, which is resulting in significant improvements to Hamilton City’s gully systems. The programme is valued by all who are involved and could be recommended to other New Zealand cities as an effective model for environmental restoration and community engagement

Population Genetics and Autecology of the Endemic Shrub Epiphyte Pittosporum cornifolium

A comprehensive investigation of the population genetics and autecology of the endemic New Zealand shrub epiphyte Pittosporum cornifolium (Pittosporaceae) is presented. Pittosporum cornifolium has a wide geographic range and is well adapted to a variety of lifestyles namely terrestrial, rupestral, and more commonly, epiphytic. The primary habitats of P. cornifolium are lowland and coastal ecosystems which, in recent times (<200 years) have been subjected to widespread clearance and fragmentation resulting in major reductions to the species potential population range. The study focused on five populations in the North Island from Coromandel to Taranaki where habitat loss of lowland and coastal ecosystems has been significant. Population-level genetic analysis using Inter-Simple Sequence Repeat (ISSR) markers revealed that while P. cornifolium exhibited high genetic diversity at the species-level, genetic diversity was relatively low at the population-level. The outcrossing dioecious breeding system and unique evolutionary history of P. cornifolium are likely to be key factors influencing the observed high intra-specific diversity whereas reduced genetic diversity at population-level is probably due to geographic isolation caused by recent habitat fragmentation. Ecological parameters were investigated to determine the current ecological status of the five populations and results did not reveal any substantial ecological impediments to regeneration and dispersal modes. Ecological data were incorporated with information from national data sets to provide a more comprehensive overview of P. cornifolium autecology and to develop a predicted environmental distribution map. Key findings indicate P. cornifolium is typically affiliated with old growth forest systems and well drained low nutrient substrates, while low mean daily temperatures (<0.6°C) restrict environmental distribution. Both genetic and autecological research was applied to determine levels of intra-specific divergence in cultivated P. cornifolium individuals from the Poor Knights Islands (outer Hauraki Gulf), which are morphologically distinct from mainland forms. The Poor Knights Islands individuals were the most genetically distinct as revealed by ISSR analysis, having higher pairwise levels of genetic distance than iii mainland populations as well as more unique loci. A single mutation in the sequence of the Internal Transcribed Spacer (ITS) region was revealed in the Poor Knights Islands individuals, distinguishing them from mainland P. cornifolium and additional members of a monophyletic clade which have shared ITS sequences. Furthermore, P. cornifolium from the Poor Knights Islands have significant morphological and anatomical differences such as larger leaves and leaf tissue depths. Long term isolation on the offshore islands is likely to have had the most significant effect on this population divergence. The differences in the Poor Knights Islands individuals may warrant the delineation of a new subspecies or even species. However, a more comprehensive examination of the taxon across its mainland range, the Poor Knights Island group, and other northern offshore islands where the species is present is recommended to clarify current inferences. The results of this research have provided a framework for the development of species specific conservation and restoration strategies for P. cornifolium and reveal the importance of provenance and microhabitat (lifestyle) when sourcing seed for reintroduction projects

Are current ecological restoration practices capturing natural levels of genetic diversity? A New Zealand case study using AFLP and ISSR data from mahoe (Melicytus ramiflorus)

Sourcing plant species of local provenance (eco-sourcing) has become standard practice in plant community restoration projects. Along with established ecological restoration practices, knowledge of genetic variation in existing and restored forest fragments is important for ensuring the maintenance of natural levels of genetic variation and connectivity (gene flow) among populations. The application of restoration genetics often employs anonymous ‘fingerprinting’ markers in combination with limited sample sizes due to financial constraints. Here, we used two such marker systems, AFLPs and ISSRs, to estimate population-level genetic variation of a frequently used species in restoration projects in New Zealand, māhoe (Melicytus ramiflorus, Violaceae). We examined two rural and two urban forest fragments, as potential local source populations, to determine whether the māhoe population at the recently (re)constructed ecosystem at Waiwhakareke Natural Heritage Park (WNHP), Hamilton, New Zealand reflects the genetic variation observed in these four potential source populations. Both marker systems produced similar results and indicated, even with small population sizes, that levels of genetic variation at WNHP were comparable to in situ populations. However, the AFLPs did provide finer resolution of the population genetic structure than ISSRs. ISSRs, which are less expensive and technically less demanding to generate than AFLPs, may be sufficient for restoration projects where only a broad level of genotypic resolution is required. We recommend the use of AFLPs when species with a high conservation status are being used due to the greater resolution of this technique

Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) : a feasibility study

Fundings: This study is funded by the National Institute for Health Research (NIHR) Health Technology Assessment Program (project reference NIHR129230). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funding body has had no role in the design of the study and will have no role in the collection, analysis, and interpretation of the data and in the writing of any future manuscript. Acknowledgements The authors would like to thank all the patients, dentists and dental team members who are participating in the PIP Trial. We would also like to thank the members of the TSC and DMEC. We would like to acknowledge the funding for the project from the National Institute for Health Research Health Technology Assessment Programme (Project Number NIHR129230). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. Sponsor: University of Dundee Funder: National Institute for Health Research (NIHR), Health Technology Assessment (HTA) Programme, Project number: NIHR129230 The PIP study group consists of the co-chief investigators, grant holders, project management group and the Trial Management Committee as outlined as follows: Co-chief investigators: Jan E Clarkson (JC) and Craig R Ramsay (CR) Grant holders: Sondos Albradri (SA), Avijit Banerjee (AB), Katie Banister (KB), Dwayne Boyers (DB), David Conway (DC), Chris Deery (CD), Beatriz Goulao (BG), Ekta Gupta (EG), Fadi Jarad (FJ), Thomas Lamont (TL), Graeme MacLennan (GMacL), Francesco Mannocci (FM) Zoe Marshmann (ZM), Tina McGuff (TMcG), David Ricketts (DR), Douglas Robertson (DR) Marjon van der Pol (MvdP) and Linda Young (LY). Trial Management Committee: Sondos Albradri (SA), Avijit Banerjee (AB), Katie Banister (KB), Chris Deery (CD), Rosanne Bell (RB), David Conway (DC), Dwayne Boyers (DB), Lori Brown (LB), Pina Donaldson (PD), Anne Duncan (AD), Katharine Dunn (KD), Patrick Fee (PF), Mark Forrest (MF), Jill Gouick (JG), Beatriz Goulao (BG), Ekta Gupta (EG), Alice Hamilton (AH), Fadi Jarad (FJ), Jennifer Kettle (JK), Thomas Lamont (TL), Graeme MacLennan (GMacL), Lorna Macpherson (LM), Francesco Mannocci (FM), Zoe Marshmann (ZM), Fiona Mitchell (FM), Tina McGuff (TMcG), David Ricketts (DR), Douglas Robertson (DR), Marjon van der Pol (MvdP), Gabriella Wojewodka (GW) and Linda Young (LY)Peer reviewedPublisher PD

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Biological flora of New Zealand 13. Pittosporum cornifolium, tāwhiri karo, cornel-leaved pittosporum

A comprehensive review of the morphology, anatomy, taxonomy, chemistry and ecology of the endemic New Zealand facultative shrub epiphyte Pittosporum cornifolium (Pittosporaceae) is presented. Strong habitat specificity restricts this species to lowland forest and coastal habitats, which are widely yet discontinuously distributed north of latitude 42°15′S. Pittosporum cornifolium is typically associated with old growth forest systems and low nutrient substrates, with low mean daily temperatures in the coldest month (0.5 kPa) apparently restricting its distribution. Significant morphological variability is evident in leaves and flowers, especially with respect to plants from the Poor Knights Islands. Genetic analyses of five mainland populations and individuals representing Poor Knights Islands populations revealed relatively low genetic diversity at the population level which is likely to be the result of geographic isolation. Molecular phylogenetic studies suggest a New Caledonian origin for the species with close affinities to both P. pimeleoides subspecies. Several lines of evidence suggest recognition of the Poor Knights Islands entity as a new taxon. However, analysis of additional morphological, reproductive and molecular data across the full geographic range will be required to confirm current inferences. Although populations have declined, P. cornifolium is not currently threatened, however, it should be considered for reintroduction to sites in districts where its range has been severely reduced

REFLECT RCT: Prescribing High-dose Fluoride Toothpaste To High-risk Older Adults

Objectives: To evaluate the effectiveness and cost benefit of dentists prescribing of 5000ppm fluoride toothpaste compared to usual care in individuals 50+ years with high-risk of caries. Methods: A pragmatic, open-label, randomised controlled trial (CTIMP) that aims to recruit and follow-up for 3 years, 1200 participants from ~60 dental practices across the UK. Primary outcome: proportion of participants receiving dental treatment due to caries. Secondary outcomes: coronal and root caries increment, quality of life measures, and economic outcomes. Here we report recruitment rates and initial qualitative findings drawn from interviews with dentists concerning their experiences in participation and their views and behaviours concerning the prescribing of high dose fluoride toothpaste. Results: Recruitment started in February 2018, we have recruited 44 practices and 517 participants at a rate of 43 per month (target 91). Barriers of recruitment included acquiring necessary permissions in a timely fashion, funding for dentists, complex documentation needs of a CTIMP, identifying eligible participants and time-commitment required of patients. Dentists’ views and behaviour regarding high dose fluoride toothpaste prescription varied widely and could be influenced by their peers’ prescribing behaviour, where they were trained and their participation in the trial. Dentists’ views about patients also varied, some reported demands for continuous repeat prescriptions while some described reticence to use the toothpaste because of concerns of possible adverse effects of fluoride. Conclusions: The trial is important given the growing aging population and lack of evidence for the costs and effects of prescribing high dose fluoride toothpaste. Recruitment to practice-based trials is challenging and influenced by common factors and also factor that are unique to the context of each trial. This abstract is based on research that was funded entirely or partially by an outside source: UK NIHR Disclosure Statement: The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: Iain Pretty receives funding from the Colgate Palmolive company in the form of an academic grant