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Sputum induction is widely used in clinical settings for collection of biological samples from the lower airways. However, in recent years sputum induction has been associated with serious adverse events and even death. This position statement was commissioned by the Thoracic Society of Australia and New Zealand to address major adverse events of two deaths associated with sputum induction that have occurred in Australia in 2021, and outlines best practice for the safe use of sputum induction. The statement resulted from systematic literature searches by a multi‐disciplinary group including respiratory physicians, nurses and physiotherapists (paediatric and adults focused). Consumers had input to an advanced draft of the position statement. The position statement covers indications for sputum induction, informed consent, scope of practice of personnel administering the procedure, infection control considerations, details about the sputum induction procedure, safety considerations and risk assessment in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Up to 30% of female infertility can be attributed to tubal abnormalities. Assessment of fallopian tube patency forms a component of the basic assessment of infertility. Tubal patency can be checked through hysterosalpingogram (HSG) under radiologic guidance with oil‐ or water‐based contrast medium (OBCM or WBCM), or hystero‐salpingo contrast sonography (HyCoSy) under ultrasound guidance with WBCM. Tubal flushing with OBCM has been shown to improve fertility rates. Objectives: To study the feasibility and tolerability of performing Lipiodol (ethiodised oil) flush concurrently with HyCoSy. To examine the in vivo sonographic visibility of Lipiodol vs normal saline. Materials and Methods: Retrospective observational study of patients with subfertility referred for Lipiodol flushing under ultrasound guidance between August 2017–September 2020 at six private ultrasound practices in Sydney, Australia. Results: There were 412 patients who were referred for Lipiodol flushing. Of these, 86 patients did not have concurrent Lipiodol flush at HyCoSy performed due to strict exclusion criteria. Of the 326 patients who proceeded with Lipiodol flushing at HyCoSy, all cases were successful, with no cases of extravasation. There were no major complications. In vivo sonographic visualisation of Lipiodol was similar to that of the commonly used agitated 0.9% saline (n = 20; mean visibility score 4.3 ± 0.9 vs 4.0 ± 1.2). Conclusion: Our study has shown that Lipiodol flushing at time of HyCoSy as a single procedure is feasible and tolerable to patients. Flushing with Lipioidol during HyCoSy is likely as sonographically visible as 0.9% saline. [ABSTRACT FROM AUTHOR]

Summary: Objective: Measurement of hypertonic saline‐stimulated copeptin has recently been described for the differentiation of polyuria‐polydipsia syndrome. This study aims to determine the copeptin response to intravenous 3% hypertonic saline, including evaluation of adverse effects, in a local cohort of healthy adults >18 years in Australia. Design: Prospective clinical study. Methods: Twenty healthy volunteers (10 males and 10 females) were recruited. Participants underwent infusion of 3% hypertonic saline via a previously described standardized protocol, until the plasma sodium was ≥150 mmol/L, with measurement of plasma copeptin. Results: Mean peak sodium was 152 mmol/L ± SD 1.4 with osmolality 315 mmol/kg ± SD 3.9. Median volume of hypertonic saline infused to reach target sodium ≥ 150 mmol/L was 1536 mL (IQR 1362, 1992). Mean rate of plasma sodium rise was 5.9 mmol/L/hour ± SD 1.5. Hypertonic saline‐stimulated copeptin had non‐parametrical distribution with median of 33.8 pmol/L (IQR 27.6, 63.6). Overall median symptom burden was 6/10 (range 3/10‐9/10). Copeptin was significantly higher for those who experienced nausea and/or vomiting (n = 13) (median 39.0 pmol/L; IQR 32.5, 90), compared to those participants who did not experience either (median 20.0 pmol/L; IQR 13.0, 31.0) (P = 0.003). There were no serious adverse events. Conclusion: Hypertonic saline‐stimulated copeptin measurements were similar in our population compared with previously reported reference intervals in healthy volunteers. There is a wide range of stimulated copeptin measurements in the healthy population. Nausea and vomiting are common adverse effects which enhance the copeptin response. [ABSTRACT FROM AUTHOR]

The optimal osmotic agent to treat intracranial hypertension in patients with severe traumatic brain injury (TBI) remains uncertain. We aimed to test whether the choice of mannitol or hypertonic saline (HTS) as early (first 96 h) osmotherapy in these patients might be associated with a difference in mortality. We retrospectively analyzed data from 2015 from 14 tertiary intensive care units (ICUs) in Australia, UK, and Europe treating severe TBI patients with intracranial pressure (ICP) monitoring and compared mortality in those who received mannitol only versus HTS only. We performed multi-variable analysis adjusting for site and illness severity (Injury Severity Score, extended IMPACT score, and mean ICP over the first 96 h) using Cox proportional hazards regression. We collected data on 262 patients and compared patients who received early osmotherapy with mannitol alone (n = 46) with those who received HTS alone (n = 46). Mannitol patients were older (median age, 49.2 (19.2) vs. 40.5 (16.8) years; p = 0.02), with higher Injury Severity Scores (42 (15.9) vs. 32.1 [11.3]; p = 0.001), and IMPACT-TBI predicted 6-month mortality (34.5% [23–46] vs. 25% [13–38]; p = 0.02), but had similar APACHE-II scores, and mean and maximum ICPs over the first 96 h. The unadjusted hazard ratio for in-hospital mortality in patients receiving only mannitol was 3.35 (95% confidence interval [CI], 1.60–7.03; p = 0.001). After adjustment for key mortality predictors, the hazard ratio for in-hospital mortality in patients receiving only mannitol was 2.64 (95% CI, 0.96–7.30; p = 0.06). The choice of early osmotherapy in severe TBI patients may affect survival, or simply reflect clinician beliefs about their different roles, and warrants controlled investigation. [ABSTRACT FROM AUTHOR]

Background: There are no medications known that improve the outcome of infants with bronchiolitis. Studies have shown the management of bronchiolitis to be varied. Objectives: To describe medication use at the seven study hospitals from a recent multi-centre randomised controlled trial on hydration in bronchiolitis (comparative rehydration in bronchiolitis [CRIB]). Methods: A retrospective analysis of extant data of infants between 2 months (corrected for prematurity) and 12 months of age admitted with bronchiolitis identified through the CRIB trial. CRIB study records, medical records, pathology and radiology databases were used to collect data using a standardised form and entered in a single site database. Medications investigated included salbutamol, adrenaline, steroids, ipratropium bromide, normal saline, hypertonic saline, steroids and antibiotics. Results: There were 3456 infants available for analysis, of which 42.0% received at least one medication during hospitalisation. Medication use varied by site between 27.0 and 48.7%. The most frequently used medication was salbutamol (25.5%). Medication use in general, and salbutamol use in particular, increased by 8.2 and 9.3%, respectively, per month after 4 months of age; from 22.9 and 3.6% at 4 months to 81.4 and 68.8% at 11 months. In infants admitted to the intensive care unit (ICU) compared with those not admitted to ICU 81.6 and 39.5%, respectively, received medication at one point during the hospital stay. Conclusions: Medication was used for infants with bronchiolitis frequently and variably in Australia and New Zealand. Medication use increased with age. Better strategies for translating evidence into practice are needed. [ABSTRACT FROM AUTHOR]

We evaluated the implementation of a cystic fibrosis annual review process in a tertiary paediatric hospital. After implementation, there was demonstrated improvement in an important outcome measure-the use of inhaled mucolytic agents. [ABSTRACT FROM AUTHOR]

We analyse the potential impacts of sea-level rise on the management of saline coastal wetlands in the Hunter River estuary, NSW, Australia. We model two management options: leaving all floodgates open, facilitating retreat of mangrove and saltmarsh into low-lying coastal lands; and leaving floodgates closed. For both management options we modelled the potential extent of saline coastal wetland to 2100 under a low sea-level rise scenario (based on 5 % minima of SRES B1 emissions scenario) and a high sea-level rise scenario (based on 95 % maxima of SRES A1FI emissions scenario). In both instances we quantified the carbon burial benefits associated with those actions. Using a dynamic elevation model, which factored in the accretion and vertical elevation responses of mangrove and saltmarsh to rising sea levels, we projected the distribution of saline coastal wetlands, and estimated the volume of sediment and carbon burial across the estuary under each scenario. We found that the management of floodgates is the primary determinant of potential saline coastal wetland extent to 2100, with only 33 % of the potential wetland area remaining under the high sea-level rise scenario, with floodgates closed, and with a 127 % expansion of potential wetland extent with floodgates open and levees breached. Carbon burial was an additional benefit of accommodating landward retreat of wetlands, with an additional 280,000 tonnes of carbon buried under the high sea-level rise scenario with floodgates open (775,075 tonnes with floodgates open and 490,280 tonnes with floodgates closed). Nearly all of the Hunter Wetlands National Park, a Ramsar wetland, will be lost under the high sea-level rise scenario, while there is potential for expansion of the wetland area by 35 % under the low sea-level rise scenario, regardless of floodgate management. We recommend that National Parks, Reserves, Ramsar sites and other static conservation mechanisms employed to protect significant coastal wetlands must begin to employ dynamic buffers to accommodate sea-level rise change impacts, which will likely require land purchase or other agreements with private landholders. The costs of facilitating adaptation may be offset by carbon sequestration gains. [ABSTRACT FROM AUTHOR]

Abstract: The dissolution rate of illite, a common clay mineral in Australian soils, was studied in saline–acidic solutions under far from equilibrium conditions. The clay fraction of Na-saturated Silver Hill illite (K1.38Na0.05)(Al2.87Mg0.46Fe3+ 0.39Fe2+ 0.28Ti0.07)[Si7.02Al0.98]O20(OH)4 was used for this study. The dissolution rates were measured using flow-through reactors at 25±1°C, solution pH range of 1.0–4.25 (H2SO4) and at two ionic strengths (0.01 and 0.25M) maintained using NaCl solution. Illite dissolution rates were calculated from the steady state release rates of Al and Si. The dissolution stoichiometry was determined from Al/Si, K/Si, Mg/Si and Fe/Si ratios. The release rates of cations were highly incongruent during the initial stage of experiments, with a preferential release of Al and K over Si in majority of the experiments. An Al/Si ratio >1 was observed at pH 2 and 3 while a ratio close to the stoichiometric composition was observed at pH 1 and 4 at the higher ionic strength. A relatively higher K+ release rate was observed at I =0.25 in 2–4 pH range than at I =0.01, possibly due to ion exchange reaction between Na+ from the solution and K+ from interlayer sites of illite. The steady state release rates of K, Fe and Mg were higher than Si over the entire pH range investigated in the study. From the point of view of the dominant structural cations (Si and Al), stoichiometric dissolution of illite occurred at pH 1–4 in the higher ionic strength experiments and at pH ⩽3 for the lower ionic strength experiments. The experiment at pH 4.25 and at the lower ionic strength exhibited lower RAl (dissolution rate calculated from steady state Al release) than RSi (dissolution rate calculated from steady state Si release), possibly due to the adsorption of dissolved Al as the output solutions were undersaturated with respect to gibbsite. The dissolution of illite appears to proceed with the removal of interlayer K followed by the dissolution of octahedral cations (Fe, Mg and Al), the dissolution of Si is the limiting step in the illite dissolution process. A dissolution rate law showing the dependence of illite dissolution rate on proton concentration in the acid-sulfate solutions was derived from the steady state dissolution rates and can be used in predicting the impact of illite dissolution in saline acid-sulfate environments. The fractional reaction orders of 0.32 (I =0.25) and 0.36 (I =0.01) obtained in the study for illite dissolution are similar to the values reported for smectite. The dissolution rate of illite is mainly controlled by solution pH and no effect of ionic strength was observed on the dissolution rates. [Copyright &y& Elsevier]

Solutes in saline groundwater (total dissolved solids up to 37 000 mg/L) in the Lake Cooper region in the southern margin of the Riverine Province of the Murray Basin are derived by evapotranspiration of rainfall with minor silicate, carbonate and halite dissolution. The distribution of hydraulic heads, salinity, percentage modern carbon (pmc) contents, and Cl/Br ratios imply that the groundwater system is complex with vertical flow superimposed on lateral flow away from the basin margins. Similarities in major ion composition, stable (O, H, and C) isotope, and 87Sr/86Sr ratios between groundwater from the shallower Shepparton Formation and the deeper Calivil - Renmark aquifer also imply that these aquifers are hydraulically interconnected. Groundwater in the deeper Calivil - Renmark aquifer in the Lake Cooper region has residence times of up to 25 000 years, implying that pre-land-clearing recharge rates were <1 mm/y. As in other regions of the Murray Basin, the low recharge rates account for the occurrence of high-salinity groundwater. Shallow (<20 m) groundwater yields exclusively modern 14C ages and shows a greater influence of evaporation over transpiration. Both these observations reflect the rise of the regional water-table following land clearing over the last 200 years and a subsequent increase in recharge to 10 - 20 mm/y. The rise of the regional water-table also has increased vertical and horizontal hydraulic gradients that may ultimately lead to the export of salt from the Lake Cooper embayment into the adjacent fresher groundwater resources. [ABSTRACT FROM AUTHOR]

Presents the results of the Saline versus Albumin Fluid Evaluation study conducted in intensive care units in Australia and New Zealand. Organizations that supported the study; Information on albumin; Number of patients involved in the study.