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Introduction: In-situ simulation offers a realistic training environment with a higher level of fidelity compared to other simulation models. It is associated with enhanced knowledge retention and a higher level of composure during real clinical encounters. One common barrier to undertaking in-situ simulation is the concern that it contributes to a delay in providing patient care. In this study we gave patients in the waiting room seven hypothetical emergency medical scenarios, two of which were training simulation scenarios, and we asked them how long they would be willing to delay their care if the different scenarios were actually occurring in the emergency department (ED). Our objective was to investigate whether patients in the ED waiting room would be willing to delay their care if they knew that there were simulation training scenarios occurring. Methods: This was a prospective convenience sample of participants conducted at a Level 1 trauma centre. Participants completed a survey that presented seven hypothetical scenarios, including two in-situ simulation scenarios. They were then asked to indicate the amount of additional wait time they would deem acceptable for each scenario. Results: Responses to the two in-situ simulation scenarios indicated that 342 (40%) and 335 (40.5%) of the 827 study participants, respectively, were willing to wait > 40 minutes for these to occur. In contrast, and after controlling for age, sex, waiting time, and time of recruitment, subjects reported they would tolerate shorter wait times for simulation scenarios than for real patient-care scenarios. [Willingness to wait > 40 minutes for the five real scenarios ranged from 70.5–79.9%, P < .05). Conclusion: While patients demonstrated lower tolerance for simulation-related delays than for routine clinical care, our results showed that most were still willing to wait up to an additional hour to allow in-situ simulation to proceed. These findings indicate that in-situ simulation is broadly acceptable to patients and supports its continued use in clinical settings.

Background Most babies admitted to a Neonatal Intensive Care Unit (NICU) require a peripheral intravenous catheter (PIVC). PIVCs are secured using splints and adhesive dressings applied to the skin. Removing the dressings causes skin injury, pain, and risks infection. We designed the Pēpi Splint, which supports PIVCs without the application of adhesive dressings to the skin. We sought to determine the effectiveness and acceptability of the Pēpi Splint using a proof-of-concept design. Methods Eligible babies were > 1000 g and > 30 weeks’ corrected gestation admitted to Wellington Regional NICU and who required a PIVC. All babies received the same care as those not in the study, with the addition of the Pēpi Splint. Primary outcomes were the proportion of babies in which the Pēpi Splint secured the PIVC for the required time and proportion of babies who experience an adverse event. Secondary outcomes were the acceptability of the Pēpi Splint as reported by the parents. Results Thirty-eight babies, median (range) birth weight 2625 g (396—4970) and gestation 37wk (22—41). When the Pēpi was applied the postnatal weight was 2969 g (1145 – 4970) and gestation 37wk (29 – 41). The Pēpi Splint held the PIVC secure for 34/38 babies (89%), for a duration of 37 h (6 to 97). There were no adverse events. Of the four babies reported to have unsecure PIVCs, two were due to the securement two were displaced during feeding. Fifty-eight parents responded to a questionnaire (32 mothers, 26 fathers). Of these parents 52 (90%) would participate again and 52 (90%) would recommend participating to others. Overall, clinicians reported the Pēpi Splint was easy to use 33/38 (87%). Conclusion The Pēpi Splint safely secures PIVCs without adhesive dressings being applied to the skin and is acceptable to both parents and clinicians. Our findings provide support for a larger multicentred randomised controlled trial. Trial registration Registered with the Australian and New Zealand Clinical Trials Registry Reference ACTRN12620001335987 .

The oceans are warming, and marine heatwaves are increasing in frequency, extremity and duration. As ectotherms, fish that experience temperatures above their optimum suffer a host of physiological and demographic impacts, which result in a net negative effect on population biomass and productivity. However, temperatures generally decline with depth, which means that mesophotic ecosystems, found in the ‘twilight zone’ between approximately 30 and 150 m depth, have the potential to act as thermal refuges. While pelagic fishes have flexibility to deepen their distributions in the open ocean, reef fishes are dependent on benthic habitats for structural complexity and food. Mesophotic reefs may therefore be of particular importance as thermal refuges in coastal ecosystems. By analysing 27 years of model-derived temperature-depth data, we found that the intensity, duration and frequency of marine heatwaves were buffered at mesophotic versus euphotic depths at Tawhiti Rahi (the Poor Knights Islands) in Aotearoa, New Zealand. To explore and quantify the importance of this mesophotic thermal refuge we parameterised a temperature-dependent multispecies size-spectrum model for the Poor Knights Islands reef community and ran marine heatwave simulations in the presence and absence of mesophotic reef habitat. Almost all heatwave strengths resulted in biomass and productivity reductions for almost all modelled fish species, but the presence of a mesophotic thermal refuge often reduced or reversed these losses. For the biomass of fish species targeted by fisheries, negative impacts were reversed during a moderate heatwave (28% average difference compared to scenarios lacking a refuge), negated during a strong heatwave (24% difference), and mitigated during severe and extreme heatwaves (21% and 20% respectively). The productivity of fisheries targets was similar with or without a thermal refuge under moderate heatwave conditions, but under strong, severe and extreme heatwaves, refuges became valuable. Average productivity losses were almost negated during strong heatwaves (5% difference), negated during severe heatwaves (17% difference), and mitigated during extreme heatwaves (19% difference). By providing this first estimate of the value of mesophotic reefs as thermal refuges during marine heatwaves we hope to inform conservation and management decisions about the targeted protection of mesophotic reefs.

Background Continuous distribution of insecticide-treated nets (ITNs) has now been accepted as one way of sustaining ITN universal coverage. Community-based channels offer an interesting means of delivering ITNs to households to sustain universal ITN coverage. The objective of this study was to provide proof of concept for this channel. Methods A 9-month, community-based, distribution pilot was implemented beginning 1 year after a mass campaign in Lainya County, South Sudan from 2012 to 2013. Following social mobilization, community members could request an ITN from a net coupon holder. Eligibility criteria included having lost an ITN, giving birth outside of the health facility, or not having enough ITNs for all household members. After verification, households could exchange the coupon for an ITN at a distribution point. The evaluation was a pre/post design using representative household surveys with two-stage cluster sampling and a sample size of 600 households per survey. Results At endline, 78% of respondents were aware of the scheme and 89% of those also received an ITN through community-based distribution. Population access to ITNs nearly doubled, from 38% at baseline to 66% after the pilot. Household ownership of any ITN and enough ITNs (1 for 2 people) also increased significantly, from 66 to 82% and 19 to 46%, respectively. Community-based distribution was the only source of ITNs for 53.4% of households. The proportion of the population using an ITN last night increased from 22.7% at baseline to 53.9% at endline. A logistic regression model indicates that although behaviour change communication was positively associated with an increase in ITN use, access to enough nets was the greatest determinant of use. Conclusions ITN access and use improved significantly in the study area during the pilot, coming close to universal coverage targets. This pilot serves as proof of concept for the community-based distribution methodology implemented as a mechanism to sustain ITN universal coverage. Longer periods of implementation should be evaluated to determine whether community-based distribution can successfully maintain ITN coverage beyond the short term, and reach all wealth quintiles equitably.

The Sale and Supply of Alcohol Act 2012 came into force to promote the safe and responsible sale, supply, and consumption of alcohol in New Zealand. The Act was intended to minimise harm caused by excessive consumption of alcohol and reduce exposure to alcohol promotion. This study assessed supermarket adherence to sections 112–114 of the Act related to the display and advertisement of alcohol. It also assessed consumer exposure to alcohol marketing in these businesses. This paper reports on an audit of nine supermarkets in a major New Zealand city. Supermarkets exhibited high average adherence with the Act (86% adherence across audit fields); despite this, exposure to alcohol displays, promotions and advertisements remained an issue regardless of supermarket geographic location, size or chain affiliation. Supermarkets are an increasingly popular source of off‐licence alcohol sales. Exposure to alcohol marketing in these businesses will likely influence consumer purchasing behaviour. As an important public health challenge, based on this study, it would appear that supermarkets mostly meet the provisions of the Sale and Supply of Alcohol Act 2012, but not the intent. Additional work is required to strengthen their response to the Act.

Angiosperms are the cornerstone of most terrestrial ecosystems and human livelihoods 1,2 . A robust understanding of angiosperm evolution is required to explain their rise to ecological dominance. So far, the angiosperm tree of life has been determined primarily by means of analyses of the plastid genome 3,4 . Many studies have drawn on this foundational work, such as classification and first insights into angiosperm diversification since their Mesozoic origins 5–7 . However, the limited and biased sampling of both taxa and genomes undermines confidence in the tree and its implications. Here, we build the tree of life for almost 8,000 (about 60%) angiosperm genera using a standardized set of 353 nuclear genes 8 . This 15-fold increase in genus-level sampling relative to comparable nuclear studies 9 provides a critical test of earlier results and brings notable change to key groups, especially in rosids, while substantiating many previously predicted relationships. Scaling this tree to time using 200 fossils, we discovered that early angiosperm evolution was characterized by high gene tree conflict and explosive diversification, giving rise to more than 80% of extant angiosperm orders. Steady diversification ensued through the remaining Mesozoic Era until rates resurged in the Cenozoic Era, concurrent with decreasing global temperatures and tightly linked with gene tree conflict. Taken together, our extensive sampling combined with advanced phylogenomic methods shows the deep history and full complexity in the evolution of a megadiverse clade.

aim: We aimed to describe nurse practitioner (NP) workforce characteristics, clinical practice and enablers and barriers in Aotearoa New Zealand. methods: Five cross-sectional, self-reported online surveys were distributed biannually in collaboration with Nurse Practitioners New Zealand. Eligible participants were registered Aotearoa New Zealand NPs. Quantitative items covered demographics, practice activities and work environment; qualitative items captured priorities for change. Data were cleaned and reclassified to ensure comparability across survey rounds, and descriptive statistics were used to report findings. Ethics approval: Te Herenga Waka—Victoria University of Wellington, Human Ethics Committee, 2024/HE000107. results: Of the 1,004 valid responses (52–74% of the workforce per survey), most respondents were practicing clinically (>94%). By 2022, prescribing was near-universal (98%), with most ordering laboratory (92%) and radiology (70%) investigations. Employment was concentrated in district health boards/Health New Zealand – Te Whatu Ora, with increasing representation in primary health organisations, private practice, non-governmental organisations and self-employment. Respondents reported barriers to practicing at full-scope of practice, limited succession planning and challenges to workforce sustainability. conclusion: NPs are an established part of Aotearoa New Zealand’s health workforce. However, persistent structural barriers, limited succession planning and variable support for full-scope practice continue to constrain their contribution. Strengthening integration and sustainable policy support are essential to realise the full potential of the NP role.

Sponges are important components of marine systems globally, and while sponges have generally been shown to tolerate ocean acidification (OA), most earlier studies have focused on demosponges with siliceous skeletons. In contrast, little is known of how calcareous sponges, with calcite or aragonite skeletons, may react to OA conditions. Here we measured tissue necrosis and respiration rate of the temperate New Zealand calcareous sponge Grantia sp. to simulated OA. Our treatment conditions were based on the IPCC RCP8.5 (pCO2 1131.9 ± 113 μatm) scenario over a 28 day experiment, and responses were compared to current day control conditions (pCO2 512.59 ± 23 μatm). Sponge respiration rate was not significantly different between the control and treatment sponges and there was no evidence of tissue necrosis over the course of the experiment. Overall, our study is consistent with earlier studies on demosponges, showing calcareous sponges to be resilient to OA.

Little is known about the role of family characteristics in sleep disturbance for children with autism spectrum disorder (ASD). This study involved an exploratory analysis of the association between 17 child, parent, and socioeconomic characteristics and sleep disturbance using data from 203, 2–18-year-old children with ASD whose families participated in the Western Australian Autism Biological Registry. Results suggest that greater ASD symptom severity; child seizures; maternal autism traits, anxiety, and depression; lower paternal education; and lower family income were related to increased sleep disturbance. All these characteristics, aside from maternal depression, were significant predictors within a regression model, which accounted for 33% of the total variance. Thus, child characteristics alone may not adequately explain sleep disturbance in children with ASD.

In palynology and other laboratory-based disciplines, methodological literature often lags the development and adoption of new practices. Here we highlight the lack of literature on the application of heavy liquid density separation for pollen preparations, a technique that has become common practice in recent years. In a study of Holocene-age sediments from Lake Pupuke, northern New Zealand, we found that the density of the heavy liquid used to separate pollen from the minerogenic fraction, within the range of reported practice, affected pollen counts. When a relatively low density was used (2.0 g/cm3), buoyant pollen grains such as Prumnopitys taxifolia and Dacrydium cupressinum were overrepresented, whereas small, compact pollen grains such as Libocedrus and Metrosideros were underrepresented. This result raises wider concerns, as heavy liquid densities reported in the literature range from 1.88 to 2.40 g/cm3. We draw attention to this problem and recommend steps that palynologists can take to ensure that their enumerated pollen assemblages are representative and do not lead to spurious interpretations.