Antimicrobial resistance: a biopsychosocial problem requiring innovative interdisciplinary and imaginative interventions

To date, antimicrobials have been understood through largely biomedical perspectives. There has been a tendency to focus upon the effectiveness of pharmaceuticals within individual bodies. However, the growing threat of antimicrobial resistance demands we reconsider how we think about antimicrobials and their effects. Rather than understanding them primarily within bodies, it is increasingly important to consider their effects between bodies, between species and across environments. We need to reduce the drivers of antimicrobial resistance (AMR) at a global level, focusing on the connections between prescribing in one country and resistance mechanisms in another. We need to engage with the ways antimicrobials within the food chain will impact upon human healthcare. Moreover, we need to realise what happens within the ward will impact upon the environment (through waste water). In the future, imaginative interventions will be required that must make the most of biomedicine but draw equally across a wider range of disciplines (e.g. engineering, ecologists) and include an ever-increasing set of professionals (e.g. nurses, veterinarians and farmers). Such collective action demands a shift to working in new interdisciplinary, inter-professional ways. Mutual respect and understanding is required to enable each perspective to be combined to yield synergistic effects

Trans­-Tasman Resources v Taranaki­ Whanganui Conservation Board [2021] NZSC 127: A New “High-Water Mark” for Seabed Mining

On 30 September 2021, the Supreme Court released its much-anticipated judgment unanimously dismissing the appeal by Trans-Tasman Resources (TTR) in the long-standing legal dispute surrounding its application for seabed mining consents under the Exclusive Economic (Environmental Effects) Act 2012 (EEZ Act). The proceedings have attracted considerable international and domestic interest from legal scholars and commentators, in addition to the concerns of environmental non-government organisations, affected iwi, and commercial fishing parties who opposed TTR’s application (opposing parties). The judgment has far-reaching implications for marine management in terms of state implementation of international law obligations and Indigenous rights, including the importance of tikanga Māori (Māori law and custom) in Aotearoa New Zealand. It provides valuable guidance and directions to decision-makers as to the scope and function of the EEZ Act, in line with New Zealand’s international obligations, and Crown obligations under Te Tiriti o Waitangi/the Treaty of Waitangi (the Treaty)

The Suprafroth (Superconducting Froth)

The structure and dynamics of froths have been subjects of intense interest due to the desire to understand the behaviour of complex systems where topological intricacy prohibits exact evaluation of the ground state. The dynamics of a traditional froth involves drainage and drying in the cell boundaries, thus it is irreversible. We report a new member to the froths family: suprafroth, in which the cell boundaries are superconducting and the cell interior is normal phase. Despite very different microscopic origin, topological analysis of the structure of the suprafroth shows that statistical von Neumann and Lewis laws apply. Furthermore, for the first time in the analysis of froths there is a global measurable property, the magnetic moment, which can be directly related to the suprafroth structure. We propose that this suprafroth is a new, model system for the analysis of the complex physics of two-dimensional froths

Broadening environmental governance ontologies to enhance ecosystem-based management in Aotearoa New Zealand

Ecosystem-based management (EBM) is a holistic approach to managing marine environments that can potentially reconcile cross-sectoral conflicts, scale mismatches, and fulfil sustainability objectives. In Aotearoa New Zealand (Aotearoa NZ), the operationalisation of EBM has been uneven; however, a set of principles to guide EBM in Aotearoa NZ provides a useful foundation to enable and enhance its uptake and to support governance approaches that attend to the rights, values, interests, and knowledges of Māori, the Indigenous peoples of Aotearoa. In acknowledging the need to give attention to the governance of marine environments, we apply insights from the ‘relational turn’ in social sciences and sustainability science to explore the ontological and epistemological broadening of ‘governance’ to identify opportunities for alternative forms of governance that accommodate Indigenous ways of knowing. We propose four pou (or enabling conditions) that generate alternatives to governance models underpinned by a ‘modernist’ (dualistic, technocratic) ontology: (i) enacting interactive administrative arrangements; (ii) diversifying knowledge production; (iii) prioritising equity, justice, and social difference; and (iv) recognising interconnections and interconnectedness. Our analysis of seven governance examples exposes evidence of radical and progressive transformations occurring within Aotearoa NZ regarding conceptions of the environment and the role of people in it that could support the wider uptake of EBM. Rather than advocating a ‘perfect model’ of governance for EBM, we find potential in EBM as a strategic approach to managing marine environments because of the synergies with Indigenous and relational ontologies, which lie in the emphasis on interconnectedness, inclusivity, diversity, and relationality

Designing law and policy for the health and resilience of marine and coastal ecosystems—Lessons from (and for) Aotearoa New Zealand

Ecosystem-based approaches to marine management, which integrate marine law and policy across sectors, communities, and scales, are increasingly advocated for in international policy debates and scholarly literature. We highlight critical and timely opportunities in Aotearoa New Zealand’s evolving legal context to support an ecosystem-based approach across fisheries regulation, biodiversity conservation, environmental effects management, and Indigenous or customary rights. Given the scale of proposed law reform affecting the ocean in Aotearoa New Zealand, there are important global lessons to be elucidated from (and for) the Aotearoa New Zealand experience, revealing the potential for law to center the health of ocean ecosystems and related people in integrated marine decision making

The Lancet Oral Health Series – implications for oral and dental research

No abstract available

How Does Blood-Retinal Barrier Breakdown Relate to Death and Disability in Pediatric Cerebral Malaria?

Background In cerebral malaria, the retina can be used to understand disease pathogenesis. The mechanisms linking sequestration, brain swelling and death remain poorly understood. We hypothesized that retinal vascular leakage would be associated with brain swelling. Methods We used retinal angiography to study blood-retinal barrier integrity. We analyzed retinal leakage, histopathology, brain MRI, and associations with death and neurological disability in prospective cohorts of Malawian children with cerebral malaria. Results Three types of retinal leakage were seen: Large focal leak (LFL), punctate leak (PL) and vessel leak. LFL and PL were associated with death (OR 13.20, 95%CI 5.21-33.78 and 8.58, 2.56-29.08 respectively), and brain swelling (p<0.05). Vessel leak and macular non-perfusion were associated with neurological disability (3.71, 1.26-11.02 and 9.06, 1.79-45.90). LFL was observed as an evolving retinal hemorrhage. A core of fibrinogen and monocytes was found in 39 (93%) white-centered hemorrhages. Conclusions Blood-retina barrier breakdown occurs in three patterns in cerebral malaria. Associations between LFL, brain swelling, and death suggest that the rapid accumulation of cerebral hemorrhages, with accompanying fluid egress, may cause fatal brain swelling. Vessel leak from barrier dysfunction, and non-perfusion were not associated with severe brain swelling, but with neurological deficits, suggesting hypoxic injury in survivors

Reduction in patient outcomes but implant-derived preservation of function following total knee arthroplasty: longitudinal follow-up of a randomized controlled trial

AimsThere are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes.MethodsA mid-term follow-up of the remaining 125 patients from a randomized cohort of total knee arthroplasty patients (initially comprising 212 recruited patients), comparing modern (Triathlon) and traditional (Kinemax) prostheses was undertaken. Functional outcomes were assessed with the Oxford Knee Score (OKS), knee range of movement, pain numerical rating scales, lower limb power output, timed functional assessment battery, and satisfaction survey. Data were linked to earlier assessment timepoints, and analyzed by repeated measures analysis of variance (ANOVA) mixed models, incorporating longitudinal change over all assessment timepoints.ResultsThe mean follow-up of the 125 patients was 8.12 years (7.3 to 9.4). There was a reduction in all assessment parameters relative to earlier assessments. Longitudinal models highlight changes over time in all parameters and demonstrate large effect sizes. Significant between-group differences were seen in measures of knee flexion (medium-effect size), lower limb power output (large-effect size), and report of worst daily pain experienced (large-effect size) favouring the Triathlon group. No longitudinal between-group differences were observed in mean OKS, average daily pain report, or timed performance test. Satisfaction with outcome in surviving patients at eight years was 90.5% (57/63) in the Triathlon group and 82.8% (48/58) in the Kinemax group, with no statistical difference between groups (p = 0.321).ConclusionAt a mean 8.12 years, this mid-term follow-up of a randomized controlled trial cohort highlights a general reduction in measures of patient function with patient age and follow-up duration, and a comparative preservation of function based on implant received at time of surgery

Prospective multicentre evaluation and refinement of an analysis tool for magnetic resonance spectroscopy of childhood cerebellar tumours

AbstractBackgroundA tool for diagnosing childhood cerebellar tumours using magnetic resonance (MR) spectroscopy peak height measurement has been developed based on retrospective analysis of single-centre data.ObjectiveTo determine the diagnostic accuracy of the peak height measurement tool in a multicentre prospective study, and optimise it by adding new prospective data to the original dataset.Materials and methodsMagnetic resonance imaging (MRI) and single-voxel MR spectroscopy were performed on children with cerebellar tumours at three centres. Spectra were processed using standard scanner software and peak heights for N-acetyl aspartate, creatine, total choline and myo-inositol were measured. The original diagnostic tool was used to classify 26 new tumours as pilocytic astrocytoma, medulloblastoma or ependymoma. These spectra were subsequently combined with the original dataset to develop an optimised scheme from 53 tumours in total.ResultsOf the pilocytic astrocytomas, medulloblastomas and ependymomas, 65.4% were correctly assigned using the original tool. An optimized scheme was produced from the combined dataset correctly assigning 90.6%. Rare tumour types showed distinctive MR spectroscopy features.ConclusionThe original diagnostic tool gave modest accuracy when tested prospectively on multicentre data. Increasing the dataset provided a diagnostic tool based on MR spectroscopy peak height measurement with high levels of accuracy for multicentre data