Transport of an adult with severe respiratory failure on high-flow nasal prongs during a prolonged aeromedical evacuation: A case study.

This case describes the use of high-flow oxygen delivered via nasal prongs in the management of an adult patient with severe undifferentiated respiratory failure for the purposes of prolonged air medical transfer.

Infrared thermometers and infants: The device is hot the baby maybe not.

AIM: The risk of serious illness in febrile infants (<60 days old) is high, and so fever often warrants aggressive management. Infrared thermometers are unreliable in young infants despite their ubiquity. We aim to describe the: (i) frequency of infrared thermometer usage; (ii) progression to documented fever in the emergency department (ED) and (iii) rate of serious illness (meningitis, urinary tract infection and bacteremia). METHODS: In this single-centre retrospective chart review at The Royal Children's Hospital, Melbourne, we audited medical records of infants (<60 days old) presenting to the ED with pre-hospital fever on history over a 12-month period. We described the type of thermometer used at home (tympanic or forehead, 'infrared' vs. axillary or rectal, 'direct') correlated to peak temperature in ED, investigations, treatment and diagnosis. The primary outcome was subsequent fever in ED. RESULTS: Of 159 infants, two of three had infrared temperature measurement at home. Fifty-one (32.1%) developed fever in ED (direct 28/54, 52% vs. infrared 23/105, 22% RR 2.36 (95% CI 1.52-3.69)). Investigations (75%) and admission (60%) were common. Pre-hospital fever alone was less likely to be associated with serious illness, with fever in ED a much stronger predictor. CONCLUSIONS: In young infants, infrared thermometer use is common and less likely to predict subsequent fever. Twenty-two percent of infants with fever via infrared measurement had fever in ED. History of fever without confirmation is less likely to signal serious illness. Education to public and health-care providers is required to avoid usage of infrared devices in this population.

Feline Parvovirus Seroprevalence Is High in Domestic Cats from Disease Outbreak and Non-Outbreak Regions in Australia.

Multiple, epizootic outbreaks of feline panleukopenia (FPL) caused by feline parvovirus(FPV) occurred in eastern Australia between 2014 and 2018. Most affected cats were unvaccinated.We hypothesised that low population immunity was a major driver of re-emergent FPL. The aim ofthis study was to (i) determine the prevalence and predictors of seroprotective titres to FPV amongshelter-housed and owned cats, and (ii) compare the prevalence of seroprotection between a regionaffected and unaffected by FPL outbreaks. FPV antibodies were detected by haemagglutinationinhibition assay on sera from 523 cats and titres ≥1:40 were considered protective. Socioeconomicindices based on postcode and census data were included in the risk factor analysis. The prevalenceof protective FPV antibody titres was high overall (94.3%), even though only 42% of cats wereknown to be vaccinated, and was not significantly different between outbreak and non-outbreakregions. On multivariable logistic regression analysis vaccinated cats were 29.94 times more likelyto have protective FPV titres than cats not known to be vaccinated. Cats from postcodes of relativelyless socioeconomic disadvantage were 5.93 times more likely to have protective FPV titres. Thepredictors identified for FPV seroprotective titres indicate targeted vaccination strategies in regionsof socioeconomic disadvantage would be beneficial to increase population immunity. The criticallevel of vaccine coverage required to halt FPV transmission and prevent FPL outbreaks should bedetermined.

Quantitative analysis of the extent of heavy-metal contamination in soils near Picher, Oklahoma, within the Tar Creek Superfund Site.

The Tri-State Mining District of Missouri, Kansas and Oklahoma was the site of large-scale mining operations primarily for lead and zinc until the mid-1950s. Although mining across the area has ceased, high concentrations of heavy metals remain in the region's soil and water systems. The town of Picher, Ottawa County, OK, lies within this district and was included in the Tar Creek Superfund Site by the U.S. Environmental Protection Agency in 1980 due to extensive contamination. To elucidate the extent of heavy-metal contamination, a soil-chemistry survey of the town of Picher was conducted. Samples (n = 111) were collected from mine tailings, locally known as chat, in Picher and along cardinal-direction transects within an 8.05-km radius of the town in August 2015. Samples were analyzed for soil pH, moisture, and metal content. Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) analyses of 20 metals showed high concentrations of lead (>1000 ppm), cadmium (>40 ppm) and zinc (>4000 ppm) throughout the sampled region. Soil moisture content ranged from 0.30 to 35.9%, and pH values ranged from 5.14 to 7.42. MANOVA of metal profiles determined that soils collected from the north transect and chat were significantly different (p < 0.01) than other sampled directions. Lead, cadmium and zinc were correlated with one another. These data show an unequal distribution of contamination surrounding the Picher mining site. Mapping heavy-metal contamination in these soils represents the first step in understanding the distribution of these contaminants at the Picher mining site.