Cultural innovation and megafauna interaction in the early settlement of arid Australia.

Elucidating the material culture of early people in arid Australia and the nature of their environmental interactions is essential for understanding the adaptability of populations and the potential causes of megafaunal extinctions 50-40 thousand years ago (ka). Humans colonized the continent by 50 ka, but an apparent lack of cultural innovations compared to people in Europe and Africa has been deemed a barrier to early settlement in the extensive arid zone. Here we present evidence from Warratyi rock shelter in the southern interior that shows that humans occupied arid Australia by around 49 ka, 10 thousand years (kyr) earlier than previously reported. The site preserves the only reliably dated, stratified evidence of extinct Australian megafauna, including the giant marsupial Diprotodon optatum, alongside artefacts more than 46 kyr old. We also report on the earliest-known use of ochre in Australia and Southeast Asia (at or before 49-46 ka), gypsum pigment (40-33 ka), bone tools (40-38 ka), hafted tools (38-35 ka), and backed artefacts (30-24 ka), each up to 10 kyr older than any other known occurrence. Thus, our evidence shows that people not only settled in the arid interior within a few millennia of entering the continent, but also developed key technologies much earlier than previously recorded for Australia and Southeast Asia.

Thoracic manifestations of inhalational injury caused by the Whakaari/White Island eruption.

INTRODUCTION: Thoracic imaging of people who have survived exposure to a volcanic pyroclastic flow has not been described. In December 2019, an active volcano in New Zealand erupted with loss of life and severe burns to groups of people who were within one kilometre of a new fissure. Our aim was to describe the range of pulmonary abnormality in patients admitted to the Burns unit at Middlemore Hospital. METHODS: We describe the initial radiographic and computed tomography (CT) appearance of lung injuries in 14 people close to this fissure who were transported to our national burns centre in Middlemore hospital. We compared these appearances with bronchoscopy findings and A-a gradients as a measure of oxygen utilisation. RESULTS: All patients had chest radiographs and eight had CT scans within two days after admission. Nine had bronchoscopies within the first week. Two were repatriated to Australia, one of whom did not survive. Two died within 3 days after admission, and the remaining ten patients survived the first week. Eight patients required ongoing ventilation, seven of whom had abnormal CXRs or CT scans on admission. Two of these patients developed an ARDS pattern of oedema reflecting lung injury from the toxic surge but they recovered. In the five patients who survived the first week with relatively minor evidence of lung injury, bibasal atelectasis was the most common finding. CONCLUSION: Pyroclastic flow effect caused a variety of lung abnormalities most likely due to toxic gas emissions. Upper airway burns were seen at bronchoscopy in only 5 patients. An ARDS response in the lungs of two patients improved within three months.

Fat Embolism Syndrome: The Ambiguity of Diagnosis in the Postarthroplasty Patient: A Case Report.

CASE: We present the case of an otherwise healthy, 74-year-old woman, who underwent bilateral hip arthroplasty and subsequently presented with decreased level of consciousness, mimicking a severe postoperative delirium. After several days and investigations, the diagnosis of fat embolism syndrome (FES) was reached, and appropriate management was given. CONCLUSION: Orthopedic surgeons and their teams should consider FES as a differential diagnosis of prolonged post-operative delirium. With supportive management these patients can make a full recovery without lasting neurological symptoms. Our patient has shown no subsequent sequelae after 10-month follow-up.