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Introduction: Gamma‐hydroxybutyrate (GHB) use is associated with high risk of accidental overdose. This study examined the pre‐hospital circumstances, demographic characteristics and clinical outcomes of analytically confirmed GHB emergency department (ED) presentations in Western Australia (WA). Methods: This case series was conducted across three WA EDs involved in the Emerging Drugs Network of Australia, from April 2020 to July 2022. Patient demographics, pre‐hospital drug exposure circumstances and ED presentation and outcome characteristics were collected from ambulance and hospital medical records of GHB‐confirmed cases. Results: GHB was detected in 45 ED presentations. The median age was 34 years and 53.3% (n = 24) were female. Most patients arrived at the ED by ambulance (n = 37, 85.7%) and required immediate emergency care (Australasian Triage Score 1 or 2 = 97.8%). One‐third of patients were admitted to intensive care (n = 14, 31.1%). Methylamphetamine was co‐detected in 37 (82.2%) GHB‐confirmed cases. Reduced conscious state was indicated by first recorded Glasgow Coma Scale of ≤8 (n = 29, 64.4%) and observations of patients becoming, or being found, 'unresponsive' and 'unconscious' in various pre‐hospital settings (n = 28, 62.2%). 'Agitated' and/or 'erratic' mental state and behavioural observations were recorded in 20 (44.4%) cases. Discussion and Conclusions: Analytically verified data from ED presentations with acute toxicity provides an objective information source on drug use trends and emerging public health threats. In our study, patients presenting to WA EDs with GHB intoxication were acutely unwell, often requiring intensive care treatment. The unexpectedly high proportion of female GHB intoxications and methylamphetamine co‐ingestion warrants further exploration. [ABSTRACT FROM AUTHOR]

Introduction: Computed tomography (CT) imaging is one of the most commonly used diagnostic tools. Iodine‐based contrast media (IBCM) are frequently administered intravenously to improve soft tissue contrast in a wide range of CT scans. Supply chain disruptions triggered by the SARS‐CoV‐19 pandemic led to a global shortage of IBCM in mid‐2022. The purpose of this study was to explore the impact of this shortage on the delivery of healthcare in Western Australia. Methods: We performed a single‐centre retrospective analysis of the provision of CT studies, comparing historical patterns to the shortage period. We focussed our attention on the total number of CT scans (noncontrast CT [NCCT] and contrast‐enhanced CT [CECT]) and also specifically CT pulmonary angiogram (CTPA) and CT neck angiogram with or without inclusion of circle of Willis (CTNA) examinations. We also examined whether a decrease was compensated by increasing frequency of alternate examinations such as ventilation/perfusion (V/Q) scans, carotid Doppler ultrasound studies and Magnetic Resonance Angiograms (MRAs). Results: Since 2012, there has been an approximate linear increase in the frequency of CT examinations. During the period of contrast shortage, there was an abrupt drop‐off by approximately 50% in the CECT, CTPA and CTNA groups compared with the preceding 6 weeks (49%, 55% and 44%, respectively, with P < 0.001 in all cases). During the contrast shortage, the frequency of V/Q scans increased fivefold (from 13 to 65; P < 0.001). However, the provision of carotid Doppler ultrasound studies and MRAs remained approximately stable in frequency across recent time intervals. Conclusion: Our findings demonstrate that the IBCM shortage crisis had a very significant impact on the delivery of healthcare. While V/Q scans could (partially) substitute for CTPA studies in suspected pulmonary emboli, there appeared to be no valid alternative for CTNA studies in stroke calls. The unexpected and critical shortage of IBCM forced healthcare professionals to conserve resources, prioritise indications, triage patients based on risk, explore alternate imaging strategies and prepare for similar events recurring in the future. [ABSTRACT FROM AUTHOR]

The burden of acute illicit drug use in Australia is largely unknown. Establishing a prospective drug surveillance system in emergency departments using analytical confirmation may facilitate the early identification of emerging drugs. We describe demographic data and acute toxicity patterns, stratified by analytical confirmation of illicit drugs and novel psychoactive substances, to emergency departments in Western Australia. Patients presenting with severe and/or unusual clinical features consistent with recreational drug toxicity were identified across five Western Australian emergency departments participating in the Emerging Drugs Network of Australia between April 2020 and December 2021. Demographic and toxicology patterns in patients with and without analytically confirmed illicit drugs/novel psychoactive substances from blood samples were collected during the emergency department presentation. The cohort included 434 severe and/or unusual toxicology presentations; median age 33 years (first and third quartiles 25–40 years), 268 (61.8%) males. Any substance (illicit, novel psychoactive substance, pharmaceutical) was detected in 405 (93.3%) presentations. Illicit drugs/novel psychoactive substances were detected in 257 (59.2%) presentations, including 73 (28.3%) with more than one confirmed illicit drug/novel psychoactive substance. Frequent illicit drugs identified were metamfetamine (n = 201, 77.9%) and gamma-hydroxybutyrate (n = 30, 11.6%). Forty-eight novel psychoactive substances were detected within 43 (16.7%) presentations. Novel benzodiazepines were most frequently detected (n = 29, 60.4%). Frequent pharmaceuticals detected included diazepam (n = 100, 26.1%) and clonazepam (n = 40, 10.4%). One hundred and fifty-five (35.7%) presentations were discharged home and 56 (12.9%) were admitted to intensive care. Presentations with detected illicit drugs/novel psychoactive substances had a lower median intensive care length of stay compared to presentations without detected illicit drugs/novel psychoactive substances (32.6 h versus 50.8 h respectively, P < 0.001). Integration of clinical and analytic data in patients with severe and/or unusual toxicology presentations via the Emerging Drugs Network of Australia provides insight into illicit drug/novel psychoactive substance use responsible for acute harm across Western Australian emergency departments. [ABSTRACT FROM AUTHOR]

A survey was undertaken in the Great Sandy Desert, Western Australia, to document changes in total plant species richness and the richness of plants of significance to Aboriginal people, with time since fire. Species richness was highest in the early post-fire seral stages, then declined with time as 'fire ephemerals' completed their life cycle. Culturally significant plants, which comprised ~42% of all plants recorded, were found in all seral stages but were most abundant in the early stages post fire. A fine-scale mosaic of seral stages created by frequent patch burning provides a higher variety of plant resources per unit area, increasing harvesting efficiency of culturally important plants. Plant species richness, and the number of plant species of significance to Australian desert Aboriginal people, declined with time since fire. A fine-scale mosaic of post-fire seral stages created by regular anthropogenic patch burning enables more efficient harvesting of a greater variety of plant-based resources. [ABSTRACT FROM AUTHOR]

A risk-based framework for targeting investment in prescribed burning in Western Australia is presented. Bushfire risk is determined through a risk assessment and prioritisation process. The framework provides principles and a rationale for programming fuel management with indicators to demonstrate that bushfire risk has been reduced to an acceptable level. Indicators provide targets for fuel management that are applicable throughout the state and can be customised to meet local circumstances. The framework identifies eight bushfire risk management zones having broad consistency of land use, fire environment and management approach, which combine to create a characteristic risk profile. Thirteen fuel types based primarily on structural attributes of the vegetation that influence fire behaviour are recognised and used to assign models for fuel accumulation and fire behaviour prediction. Each bushfire risk management zone is divided into fire management areas, based on the management intent. These are areas where fuels will be managed primarily to minimise the likelihood of fire causing adverse impacts on human settlements or critical infrastructure, to reduce the risk of bushfire at the landscape scale or to achieve other land management outcomes. Indicators of acceptable bushfire risk are defined for each fire management area and are modified according to the distribution of assets and potential fire behaviour in the landscape. Risk criteria established in the framework can be converted to spatially represented targets for fuel management in each zone and can be reported against to measure the effectiveness of the fuel management program. In areas where the primary intent is to reduce the risk of bushfire at the landscape scale, managers have flexibility to apply prescribed fire in ways that maintain and enhance ecosystem services, nature conservation and landscape values through variation in the seasonality, intensity and scale of planned burning. A risk-based framework for targeting investment in prescribed burning in Western Australia is presented. The framework provides principles and a rationale for programming fuel management with indicators to demonstrate that bushfire risk has been reduced to an acceptable level. Bushfire risk is determined through a risk assessment and prioritisation process. [ABSTRACT FROM AUTHOR]

Flammable spinifex grasslands of arid Western Australia cover about 98 million hectares of the state, and large wildfires in this environment threaten biodiversity, life, property and cultural values. Understanding fire behaviour in spinifex grasslands informs prescribed burning and wildfire suppression activities. Unmanned aerial systems (UAS) are aiding in improving fire behaviour prediction by providing comprehensive and accurate measurements of vegetation cover, volume and height, the fuel characteristics of vegetation that influence fire behaviour. Classification of spinifex cover derived from UAS image capture has been compared to field transects. Data from UAS align better with Landsat satellite imagery than fuel cover measures from field transects. A good correlation was found between UAS-derived vegetation cover and Landsat imagery, which means satellite imagery can be used with confidence to estimate and map fuel cover at a range of temporal and spatial scales. UAS have also proven useful in the development of a spectral index describing spinifex cover. The rapid development of affordable UAS instruments and software has enabled the production of point clouds, which provide further vegetation structure information not available from previous image captures. These developments in UAS application together with satellite imagery will enable fire managers to more efficiently and accurately map fuel characteristics at a range of scales, greatly enhancing their ability to forecast fire danger and to predict fire behaviour without having to carry out costly ground-based field measurements. [ABSTRACT FROM AUTHOR]

Despite the importance of skeletal growth during adolescence, there is limited research reporting vitamin D status and its predictors in adolescents. Using prospective data from the Western Australian Pregnancy Cohort (Raine) Study, we investigated vitamin D status and predictors of serum 25-hydroxyvitamin D (25(OH)D) concentrations in adolescents. Serum 25(OH)D concentrations were measured in the same participants at 14 and 17 years (n 1045 at both time points). The percentage of adolescents with serum 25(OH)D concentrations < 50, 50–74·9 and ≥ 75 nmol/l was reported year-round and by month of blood collection. We examined the predictors of serum 25(OH)D concentrations, including sex, race, month of blood collection, physical activity, BMI, family income, and Ca and vitamin D intakes (n 919 at 14 years; n 570 at 17 years), using a general linear mixed model. At 14 years, 31 % of adolescents had serum 25(OH)D concentrations between 50 and 74·9 nmol/l and a further 4 % had concentrations < 50 nmol/l. At 17 years, 40 % of adolescents had serum 25(OH)D concentrations between 50 and 74·9 nmol/l and 12 % had concentrations < 50 nmol/l. Caucasian ethnicity, being sampled at the end of summer, exercising more, having a lower BMI, a higher Ca intake and a higher family income were significantly associated with higher serum 25(OH)D concentrations. The proportion of adolescents with serum 25(OH)D concentrations < 50 nmol/l was low in this Western Australian cohort. There is a need for international consensus on defining adequate vitamin D status in order to determine whether strategies to increase vitamin D status in adolescents are warranted. [ABSTRACT FROM PUBLISHER]

Introduction: Little is known about patient perceptions of the lethality of their overdose. Our aim was to compare patient perceptions with the risk assessment of clinical toxicologists. Methods: A prospective observational study of overdose patients presenting to a tertiary hospital. Eligible patients were surveyed once they were medically fit for psychiatric evaluation. Descriptive data were collected, including the Pierce Suicide Intent Scale (SIS). In response to 'how dangerous did you think this overdose was when you took the tablets?' patients marked a 10 cm VAS, with 0 = would be harmless, 10 = certain to cause death. A panel of clinical toxicologists independently made a risk assessment on a 10 cm VAS, with 0 = non-toxic ingestion and 10 = uniform lethality even with full medical intervention. Results: Of 202 patients enrolled, 118 (58.4%, 95% CI 51-65) were female; median age 33 years (interquartile range [IQR] 24-42). One hundred and three (51%, 95% CI 44-58) stated it was their intention to kill themselves and 44 (21.8%, 95% CI 16-28) wrote a suicide note. They most commonly used their own prescription medications (141, 69.8%, 95% CI 63-76). The median patient visual analog scale (VAS) was 5.8 (IQR 2.3-8.3) and median toxicology VAS was 1.4 (IQR 0.6-2.8); this difference was statistically significant ( P < 0.0001). The correlation between the patient visual analog scale (VAS) and Pierce SIS (median 8.5/25 [IQR 4-12]) was strong ( r= 0.73, P < 0.0001). Conclusions: Patient perceptions of the lethality of their overdose are correlated with their suicidal intent as measured on the Pierce SIS, with a significant mismatch between patient perceptions and the toxicological risk assessment. [ABSTRACT FROM AUTHOR]

Spinifex grasslands, characterised by the dominance of perennial hummock grasses of the genus Triodia, cover some 43% of Western Australia. The combination of the physical structure of the vegetation and the often extreme weather conditions makes spinifex grasslands highly flammable. Historically, lightning and burning by Aboriginal people maintained much of the grasslands as a fine- grained mosaic of vegetation at different seral stages providing diverse habitats. Where traditional Aboriginal burning has ceased, large summer wildfires have reduced habitat diversity. In many areas there is a need to reintroduce anthropogenic burning to re-establish habitat diversity at finer scales as well as to protect human life, property and cultural values. An understanding of fuel dynamics and fire behaviour is fundamental to managing fire in these landscapes. Spinifex grasslands have the potential to re-bum 5-7 years after fire, depending on rainfall, but can take 18-20 years to reach full maturity as a fuel. Because of the discontinuous nature of the vegetation, there are thresholds of combinations of fuel load, fuel moisture and wind speed that need to be exceeded before fire will spread. Once thresholds have been exceeded, fires have the potential to spread rapidly, especially under high wind speeds. In this paper we present a revised empirical model for predicting threshold fuel and weather conditions for fire initiation and subsequent rate of spread over a broad range of fuel and weather conditions. [ABSTRACT FROM AUTHOR]

Objective: To investigate the level and perceived quality of health promotion advice received from rural pharmacists. Design: Self-administered written survey on access to and quality of pharmacy services in rural Western Australia completed by rural residents. Setting: Rural pharmacy. Participants: Four hundred and eighty-three respondents who regularly used a pharmacy. Outcome measures: Items in the survey included frequency of receiving prevention advice and satisfaction ratings on health and pharmacy services. Results: Eighty-eight per cent of respondents had never discussed exercise or diet with their pharmacist and 65% had never discussed preventing health problems. Receiving good prevention advice predicted satisfaction with health services in general but not satisfaction with pharmacy services. Conclusion: Pharmacies are being underutilised with respect to their capacity to deliver heath prevention advice and ways to capitalise on this potential need to be investigated. [ABSTRACT FROM AUTHOR]

The article discusses the risk of heat-related injury to children in Western Australia. It highlights data on heat-related injury from the Princess Margaret Hospital for Children, including information about severity, type, date, time and place of injury of the patient. The statistical significant link between hot weather and injuries suggests that heatwave forecasts in Perth can predict an increased risk of heat-related injuries.

Indigenous Australians used fire in spinifex deserts for millennia. These practices mostly ceased following European colonisation, but many contemporary Indigenous groups seek to restore 'right-way fire' practices, to meet inter-related social, economic, cultural and biodiversity objectives. However, measuring and reporting on the fire pattern outcomes of management is challenging, because the spatio-temporal patterns of right-way fire are not clearly defined, and because spatio-temporal variability in rainfall makes fire occurrence highly variable in these desert environments. We present an approach for measuring and reporting on fire management outcomes to account for spatio-temporal rainfall variability. The purpose is to support Indigenous groups to assess performance against their management targets, and lay the groundwork for developing an accredited method for valuing combined social, cultural and biodiversity outcomes. We reviewed fire management plans of desert Indigenous groups to identify spatial fire pattern indicators for right-way fire in spinifex deserts. We integrated annual rainfall surfaces with time-since fire mapping (using Landsat imagery) to create a new spatial dataset of accumulated rainfall-since-last-fire, that better represents post-fire vegetation recovery as categorised by local Indigenous people. The fire pattern indicators were merged into a single score using an environmental accounting approach. To strengthen interpretation, we developed an approach for identifying a control area with matching vegetation and fire history, up to the point of management. We applied these methods to a 125,000 ha case study area: Durba Hills, managed by the Martu people of Western Australia. Using a 20-year time series, we show that since right-way fire management at Durba Hills was re-introduced (2009), the fire pattern indicators have improved compared to those in the matched control area, and the composite result is closer to the fine-scaled mosaic of right-way fire pattern targets. Our approach could be used by Indigenous groups to track performance, and inform annual fire management planning. As the indicators are standardised for rainfall variation, results from multiple sites can be aggregated to track changes in performance at larger scales. Finally, our approach could be adapted for other fire-prone areas, both in Australia and internationally with high spatio-temporal rainfall variability, to improve management planning and evaluation. • Measuring changes in fire patterns in areas with variable rainfall is challenging. • Integrating rainfall with fire history data improves estimates of spatial patterns. • Fire pattern indicators were combined using an environmental accounting framework. • We tested the approach in a desert area managed by Indigenous Australians. • Fire management over 10 years is pushing fire towards a pre-colonisation pattern. [ABSTRACT FROM AUTHOR]

Background Activation of the hypothalamic-pituitary-adrenal (HPA) axis has been associated with higher levels of cardiovascular (CVD) risk factors in adults. This study aimed to assess the relation between measures of HPA axis activity under resting conditions and CVD risk factors in a general population of adolescents at 17 years. Methods A total of 1134 adolescents from the Western Australian Pregnancy Cohort (Raine) Study had phenotypic and socio-demographic data. The associations between HPA axis measures (plasma ACTH, total cortisol, calculated free cortisol, corticosteroid binding globulin (CBG), and salivary cortisol) and a range of cardiovascular risk factors were examined using multivariable linear regression models, with adjustment for gender, adiposity, birth weight, gestational age, and socio-behavioural factors. Results Plasma total cortisol was positively associated with systolic blood pressure (SBP) ( p = 0.011), total cholesterol, HDL-cholesterol, and triglycerides (all p < 0.001), and hs-CRP ( p = 0.047). Salivary cortisol was associated positively with HDL-C ( p = 0.033) and negatively with LDL-cholesterol ( p = 0.016); plasma calculated free cortisol was positively associated with triglycerides ( p = 0.006); plasma CBG was positively associated with total cholesterol and HDL-cholesterol (both p < 0.001), LDL-cholesterol ( p = 0.022), and hs-CRP ( p = 0.001). After correction for multiple comparisons, significant associations remained for total cortisol with total cholesterol, HDL-C, and triglycerides; for calculated free cortisol with triglycerides; and for CBG with HDL-C, total cholesterol, and hs-CRP. Plasma ACTH was not associated with any cardiovascular risk factor. There was no association between BMI and any measure of HPA axis activity. Conclusion In an adolescent population, HPA axis measures under resting conditions are associated with a range of CVD risk factors. Clarification of the mechanisms underlying these associations in adolescence would be an important step in understanding the evolution of adult CVD. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of cyclosporin in controlling the clinical signs associated with atopic dermatitis in dogs under Australian field conditions., Design: A multicentre prospective clinical investigation of the use of cyclosporin in 41 dogs with atopic dermatitis., Procedure: Dogs were treated with cyclosporin (5 mg/kg orally once daily with food) for 6 weeks. Four clinical parameters of severity of atopic dermatitis were measured on Day 0 and on Day 42 using a 0 to 4 scoring system. Individual variables were then combined to form a Global Score. Both client and clinician observed pruritus scores were combined to form a Pruritus Score. Pre- and post-treatment scores were statistically analysed. The difference in results between the two investigators was also recorded and analysed., Results: All dogs showed a marked reduction in pruritus and erythema during the 6-week treatment period. All dogs showed a significant (P < 0.001) improvement in clinical lesion scores and Global Score (P < 0.001). The mean percentage improvement in Global Score from Day 0 to Day 42 was 83.9%. The mean percentage improvement in Pruritus Score from Day 0 to Day 42 was 83%. The medication was well tolerated. Side effects such as vomiting, diarrhoea and soft stools were observed in four dogs. Another four dogs developed bacterial pyoderma during the trial period. There was no significant difference in results between the two centres., Conclusion: Cyclosporin was well tolerated and efficacious in the symptomatic treatment of atopic dermatitis in dogs attending two veterinary dermatology referral centres in Australia, under Australian field conditions, when administered at 5 mg/kg/day for 6 weeks.