Novel pre-copulatory behavior in basking sharks observed by drone.

Basking sharks (Cetorhinus maximus) seasonally aggregate in coastal surface waters of the North Atlantic, providing opportunities for visual observation. While putative courtship displays have been observed, actual copulation has not been documented. Here we examine video collected by an unmanned aerial vehicle ("drone") of novel behavioral interactions between basking sharks in Cape Cod Bay, Massachusetts in May 2021. The behaviors, including close following and tight concentric circling, are consistent with pre-copulatory behavior observed in other shark species. These observations provide new insights into the pre-copulatory behavior of basking sharks.

Return to Activity After SARS-CoV-2 Infection: Cardiac Clearance for Children and Adolescents.

CONTEXT: Sedentary behavior and inability to participate in organized physical activity has negatively affected the physical and mental health of children and adolescents; however, cardiac injury and associated risk for sudden cardiac death with return to activity remains a major concern. Guidelines have been proposed for return to activities; however, these fail to address the needs of younger children and those participating in more casual activities. Guidance is needed for primary care providers to facilitate safe return to everyday activity and sports and to help direct appropriate laboratory, electrocardiographic, and anatomical assessment. EVIDENCE ACQUISITION: Review of computerized databases of available literature on SARS-CoV-2 infection in children and postinfection sequelae, risk factors for sudden cardiac death, and previous return to play recommendations. STUDY DESIGN: Clinical guidelines based on available evidence and expert consensus. LEVEL OF EVIDENCE: Level 4. RESULTS: In this report, we review the literature on return to activity after SARS-CoV-2 infection and propose recommendations for cardiac clearance for children and adolescents. Though severe disease and cardiac injury is less common in children than in adults, it can occur. Several diagnostic modalities such as electrocardiography, echocardiography, cardiac magnetic resonance imaging, and serologic testing may be useful in the cardiac evaluation of children after SARS-CoV-2 infection. CONCLUSION: Gradual return to activity is possible in most children and adolescents after SARS-CoV-2 infection and many of these patients can be cleared by their primary care providers. Providing education on surveillance for cardiopulmonary symptoms with return to sports can avoid unnecessary testing and delays in clearance.

Iatrogenic medication errors reported to the Victorian Poisons Information Centre.

BACKGROUND: Iatrogenic medication errors are a cause of medical morbidity and mortality. They result in significant cost to the Australian healthcare system each year. There is limited Australian evidence describing the iatrogenic errors occurring within the hospital system. AIMS: To examine and describe iatrogenic medication errors occurring in Victorian healthcare settings through the analysis of referrals to a state Poisons Information Centre (PIC). METHODS: A retrospective review of iatrogenic medication errors reported to the Victorian PIC (VPIC) from community and hospital healthcare settings from January 2015 to December 2019. RESULTS: Over a 5-year period, 357 iatrogenic errors were identified, 63% (n = 224) of which occurred in a hospital setting. The remaining errors occurred in a community healthcare setting. One in five patients were symptomatic from the medication error at the time of the call to the VPIC, and a change in management was required in 45% (n = 165) of all cases. Five percent (n = 17) of patients developed moderate to severe clinical toxicity as determined by the recorded poisoning severity score, and 88% (n = 18) of these required critical care management. Incorrect medication dosing accounted for 62% (n = 221) of errors. Common medication dosing errors included: double dose (51%, n = 114), incorrect medication administered (14%, n = 49), incorrect route (9%, n = 31), incorrect patient (6%, n = 22) and adult dose given to a child (4%, n = 15). CONCLUSIONS: Iatrogenic errors are occurring in the Victorian health care system. These errors can result in serious morbidity. Identification of causative factors and investment in preventative strategies will likely reduce associated morbidity and healthcare costs.

Health care cost savings from Australian Poisons Information Centre advice for low risk exposure calls: SNAPSHOT 2.

Introduction: To estimate cost savings from the Australian Poisons Information Centres (PIC) through reductions in unnecessary health resources following unintentional low toxicity poisonings.Methods: Two telephone surveys were conducted. The first to PIC callers over a one-week period about unintentional exposures where the callers' alternate course of action in the hypothetical situation in which the PIC did not exist was questioned. The second survey to determine the proportion of callers followed PIC advice. We estimated cost savings associated with instances where individuals acted on advice not to present to hospital, when they indicated they would have otherwise as well as savings from preventing unnecessarily utilisation of medical resources. Database records of unintentional poisonings from all Australian PICs for 2017 were used.Results: A total of 958 consecutive callers were surveyed. PIC advised 91% of callers to stay at home, remaining callers were referred to hospital (5%), to their GP (3%) or given other recommended management advice (1%). PIC advice was followed by 97.6% of callers. In PIC absence, 22% of callers who were advised to stay home would have presented to hospital (3% via ambulance), 8% would visit their General Practitioner (GP) and only 9% would stay at home. In 2017, PICs were called about 94,913 unintentional poisonings; and PICs generated at least $10.1 million in annual savings.Conclusion: In 2017, PICs provided at least a three-fold return on investment for every dollar invested, demonstrating that PICs are a highly cost effective service.

Depth-graded Mo/Si multilayer coatings for hard x-rays.

This manuscript presents the first systematic study of non-periodic, broadband Mo/Si multilayer coatings with and without B 4C interface barrier layers for hard x-ray applications with large field of view. The photon energy of operation in this work is 17.4 keV, the Mo Kα emission line. The coatings involve layers with varying thicknesses in the nanometer scale and the behavior at the layer interfaces plays a crucial role in their performance. Reflectivity measurements and modeling at 8.05 keV and 17.4 keV, Transmission Electron Microscopy (TEM), as well as thin film stress measurements, are employed to examine and optimize the reflective performance of these coatings and the physics of their constituent layers and interfaces. Mo/Si with B 4C barrier layers on the Mo-on-Si interface is shown to produce the highest reflectivity among all design configurations considered in this work.

Trends in self-poisoning and psychotropic drug use in people aged 5-19 years: a population-based retrospective cohort study in Australia.

OBJECTIVES: To characterise trends in self-poisoning and psychotropic medicine use in young Australians. DESIGN: Population-based retrospective cohort study. SETTING: Calls taken by the New South Wales and Victorian Poisons Information Centres (2006-2016, accounting for 70% of Australian poisoning calls); medicine dispensings in the 10% sample of Australian Pharmaceutical Benefits Scheme data (July 2012 to June 2016). PARTICIPANTS: People aged 5-19 years. MAIN OUTCOME MEASURES: Yearly trends in intentional poisoning exposure calls, substances taken in intentional poisonings, a prevalence of psychotropic use (dispensing of antidepressants, antipsychotics, benzodiazepines and medicines for attention deficit hyperactivity disorder (ADHD)). RESULTS: There were 33 501 intentional poisonings in people aged 5-19 years, with an increase of 8.39% per year (95% CI 6.08% to 10.74%, p<0.0001), with a 98% increase overall, 2006-2016. This effect was driven by increased poisonings in those born after 1997, suggesting a birth cohort effect. Females outnumbered males 3:1. Substances most commonly taken in self-poisonings were paracetamol, ibuprofen, fluoxetine, ethanol, quetiapine, paracetamol/opioid combinations, sertraline and escitalopram. Psychotropic dispensing also increased, with selective serotonin reuptake inhibitors (SSRIs) increasing 40% and 35% July 2012 to June 2016 in those aged 5-14 and 15-19, respectively. Fluoxetine was the most dispensed SSRI. Antipsychotics increased by 13% and 10%, while ADHD medication dispensing increased by 16% and 10%, in those aged 5-14 and 15-19, respectively. Conversely, dispensing of benzodiazepines to these age groups decreased by 4% and 5%, respectively. CONCLUSIONS: Our results signal a generation that is increasingly engaging in self-harm and is increasingly prescribed psychotropic medications. These findings indicate growing mental distress in this cohort. Since people who self-harm are at increased risk of suicide later in life, these results may foretell future increases in suicide rates in Australia.

Button battery exposures in Australian children: a prospective observational study highlighting the role of poisons information centres.

CONTEXT: Button battery ingestion is a worldwide problem, with evidence of increasing harms and deaths in recent decades. Australian Poisons Information Centre (PIC) experience includes cases of treatment delay due to lack of healthcare professional recognition of risks, and/or lack of local resources. This study aims to characterise Australian button battery exposures, focusing on exposure circumstances, and preventable health system shortcomings. METHODS: A prospective observational study of button battery exposure calls to New South Wales PIC, November 2015-May 2017, using a follow-up survey to obtain outcome data and additional details. Survey data was combined with nationwide PIC data over the same period. RESULTS: Australian PICs were consulted on 578 exposures over the 19-month study period, including 506 paediatric cases. The median (IQR) age for the paediatric cases was 23 months (14-36 months). Where the source was identified, batteries came from toys in 26% of cases, with hearing aids, watches, and remote controls being other common sources. Children in outer regional, remote and very remote areas were overrepresented, and 15 cases were referred to a different hospital due to X-ray facilities being unavailable at their nearest hospital. We identified inconsistent triage from a range of first responders, and knowledge gaps regarding button battery dangers amongst some healthcare professionals. DISCUSSION: Button battery exposures are a common call to Australian PICs. This study highlights a potential role of education campaigns, professional guidelines, and child-resistant battery compartments in toys and household devices. PICs calling ahead to ensure X-ray availability/diversion to a different hospital likely reduced delays for this time-critical exposure. CONCLUSIONS: Button battery exposures continue to be a problem in Australia. Data collected by PICs can provide useful information for public health and product safety initiatives. A PIC-led protocol to direct initial medical management of button battery exposures could reduce delays and improve outcomes.

Patterns of poisoning exposure at different ages: the 2015 annual report of the Australian Poisons Information Centres.

OBJECTIVES: To characterise the types of calls received by Australian Poisons Information Centres (PICs) in Australia, and to analyse poisoning exposures by age group, circumstances of exposure, and the types of substances involved. Design, setting: Retrospective analysis of call records from all four Australian PICs (national coverage). MAIN OUTCOME MEASURES: Basic demographic information; exposure circumstances, substance types involved in each age group; recommendations for management (eg, stay at home, go to hospital). RESULTS: There were 204 906 calls to Australian PICs in 2015, 69.0% from the general public, 27.9% from health professionals; 16.2% of calls originated from hospitals. 170 469 calls (including re-calls about an exposure) related to 164 363 poison exposure events; 64.4% were unintentional, 18.1% were the consequences of medication error, and 10.7% involved deliberate self-poisoning. Most exposures were of 20-74-year-old adults (40.1%) or 1-4-year-old toddlers (36.0%). The PICs advised callers to stay at home for 67.4% of exposures, and to present to hospital for 10.9%. The most common substances involved in exposures overall were household cleaners (10.2%) and paracetamol-containing analgesics (7.3%). Exposures of infants and toddlers were most frequently to household cleaning substances (17.8%, 15.3% respectively) and personal care items (6.6%, 7.3%); callers were usually advised to stay at home (88.5%, 86.4%). Deliberate self-poisoning (49.1%) and hospital referral (23.9%) were most frequent for adolescents. Exposures of adults (20-74 years) frequently involved psychotropic pharmaceuticals (17.8%) or painkillers (15.1%). Exposures in adults over 74 were typically medication errors involving cardiovascular (23.6%), anticoagulant (4.6%), or antidiabetic (4.1%) medications. CONCLUSIONS: Poisoning is a significant public health problem throughout life, but the nature of the hazards differs markedly between age groups. PIC data could inform strategic public health interventions that target age-specific poisoning hazards.

Increasing rates of quetiapine overdose, misuse, and mortality in Victoria, Australia.

BACKGROUND: Quetiapine is misused due to its anxiolytic and hedonic effects and has been associated with deliberate self-harm. This study analyzed quetiapine-related calls to the Victorian Poisons Information Centre (VPIC), coronial data from Victorian Institute of Forensic Medicine (VIFM) and prescribed data from the Pharmaceutical Benefits Scheme (PBS) to determine current trends in overdose, misuse and mortality. METHODS: This was a retrospective review of multiple databases. Calls to VPIC and coronial data from the VIFM were reviewed from 2006 to 2016. PBS prescription data from 2000 to 2015 was obtained from the Australian Statistics on Medicines website. RESULTS: VPIC data indicated a 6-fold increase in the number of quetiapine-related calls over the 11-year period of which most were overdose-related (77%). Overdose and misuse calls increased by 6-fold and 6.6-fold, respectively. Coronial data also indicated a rise in quetiapine-related harm; a 7.4-fold increase in quetiapine-related deaths was recorded for the same period. Similarly, Australian PBS data showed that quetiapine prescriptions increased 285-fold since 2000. There was a significant positive correlation between the increase in prescribing and overdose (r = 0.75, p < 0.001), and prescribing and mortality (r = 0.82, p < 0.01). CONCLUSIONS: This study revealed an increasing trend of misuse, non-fatal and fatal overdoses in Victoria over the last decade. The increasing rates of prescriptions in Australia and thus increased quetiapine availability are likely to have contributed to increased poisoning and mortality. Further research is warranted to explore the reasons behind increased prescribing, including off-label use.

Aperiodic Mo/Si multilayers for hard x-rays.

In this work we have developed aperiodic Molybdenum/Silicon (Mo/Si) multilayers (MLs) to reflect 16.25 keV photons at a grazing angle of incidence of 0.6° ± 0.05°. To the best of our knowledge this is the first time this material system has been used to fabricate aperiodic MLs for hard x-rays. At these energies new hurdles arise. First of all a large number of bilayers is required to reach saturation. This poses a challenge from the manufacturing point of view, as thickness control of each ML period becomes paramount. The latter is not well defined a priori, due to the thickness of the interfacial silicide layers which has been observed to vary as a function of Mo and Si thickness. Additionally an amorphous-to-crystalline transition for Mo must be avoided in order maintain reasonably low roughness at the interfaces. This transition is well within the range of thicknesses pertinent to this study. Despite these difficulties our data demonstrates that we achieved reasonably flat ML response across the angular acceptance of ± 0.05°, with an experimentally confirmed average reflectivity of 28%. Such a ML prescription is well suited for applications in the field of hard x-ray imaging of highly diverging sources.

A decade of Australian methotrexate dosing errors.

OBJECTIVE: Accidental daily dosing of methotrexate can result in life-threatening toxicity. We investigated methotrexate dosing errors reported to the National Coronial Information System (NCIS), the Therapeutic Goods Administration Database of Adverse Event Notifications (TGA DAEN) and Australian Poisons Information Centres (PICs). DESIGN AND SETTING: A retrospective review of coronial cases in the NCIS (2000-2014), and of reports to the TGA DAEN (2004-2014) and Australian PICs (2004-2015). Cases were included if dosing errors were accidental, with evidence of daily dosing on at least 3 consecutive days. MAIN OUTCOME MEASURES: Events per year, dose, consecutive days of methotrexate administration, reasons for the error, clinical features. RESULTS: Twenty-two deaths linked with methotrexate were identified in the NCIS, including seven cases in which erroneous daily dosing was documented. Methotrexate medication error was listed in ten cases in the DAEN, including two deaths. Australian PIC databases contained 92 cases, with a worrying increase seen during 2014-2015. Reasons for the errors included patient misunderstanding and incorrect packaging of dosette packs by pharmacists. The recorded clinical effects of daily dosage were consistent with those previously reported for methotrexate toxicity. CONCLUSION: Dosing errors with methotrexate can be lethal and continue to occur despite a number of safety initiatives in the past decade. Further strategies to reduce these preventable harms need to be implemented and evaluated. Recent suggestions include further changes in packet size, mandatory weekly dosing labelling on packaging, improving education, and including alerts in prescribing and dispensing software.

Oxycodone/naloxone preparation can cause acute withdrawal symptoms when misused parenterally or taken orally.

CONTEXT: Oral oxycodone/naloxone preparations are designed to reduce the incidence of constipation associated with oxycodone use. The low oral bioavailability (< 2%) of naloxone makes the precipitation of the acute opioid withdrawal symptoms unlikely following oral oxycodone/naloxone exposure. The incidence of acute opioid withdrawal symptoms following both oral and intravenous administration of oxycodone/naloxone preparations has not been described. OBJECTIVE: The aim of the study was to investigate the incidence and circumstances associated with oxycodone/naloxone-induced acute opioid withdrawal. METHODS: An observational case series of acute opioid withdrawal following oxycodone/naloxone administration were selected from all calls received by the Victoria Poisons Information Centre from January 2012 to December 2014. Data collected included patient demographics, reported symptoms, type of caller, intentional or accidental exposure and advice given. RESULTS: There were 107 reported exposures to oxycodone/naloxone preparations. Route of exposure was oral in 92 (86%) and intravenous injection of crushed tablets in 14 (14%) of cases, respectively. Nine callers had a history of long-standing opioid treatment and developed withdrawal symptoms with oral oxycodone/naloxone. Temporal relationship between first dose, increased dose and chewing tablets was described. There were 14 exposures to crushed oxycodone/naloxone tablets injected intravenously; all precipitated an acute withdrawal state. DISCUSSION: The development of opioid withdrawal symptoms with intravenous injection of oxycodone/naloxone is likely a result of bypassing first-pass metabolism. Withdrawal symptoms after ingesting increased dose, first dose or chewing oxycodone/naloxone suggests that there is a systemic absorption of naloxone in opioid-dependent callers. CONCLUSION: Oxycodone with naloxone tablets can lead to acute opioid withdrawal symptoms if crushed and injected parentally. First dose, increased dose and chewing of these opioid-naloxone combination tablets in opioid-dependent people can also result in acute opioid withdrawal symptoms or diminished pain relief.

Triple-wavelength, narrowband Mg/SiC multilayers with corrosion barriers and high peak reflectance in the 25-80 nm wavelength region.

We have developed new, Mg/SiC multilayer coatings with corrosion barriers which can be used to efficiently and simultaneously reflect extreme ultraviolet (EUV) radiation in single or multiple narrow bands centered at wavelengths in the spectral region from 25 to 80 nm. Corrosion mitigation was attempted through the use of Al-Mg or Al thin layers. Three different multilayer design concepts were developed and deposited by magnetron sputtering and the reflectance was measured at near-normal incidence in a broad spectral range. Standard Mg/SiC multilayers were also deposited and measured for comparison. They were shown to efficiently reflect radiation at a wavelength of 76.9 nm with a peak reflectance of 40.6% at near-normal incidence, the highest experimental reflectance reported at this wavelength for a narrowband coating. The demonstration of multilayer coatings with corrosion resistance and multiple-wavelength EUV performance is of great interest in the development of mirrors for space-borne solar physics telescopes and other applications requiring long-lasting coatings with narrowband response in multiple emission lines across the EUV range.

Development and calibration of mirrors and gratings for the soft x-ray materials science beamline at the Linac Coherent Light Source free-electron laser.

This work discusses the development and calibration of the x-ray reflective and diffractive elements for the Soft X-ray Materials Science (SXR) beamline of the Linac Coherent Light Source (LCLS) free-electron laser (FEL), designed for operation in the 500 to 2000 eV region. The surface topography of three Si mirror substrates and two Si diffraction grating substrates was examined by atomic force microscopy (AFM) and optical profilometry. The figure of the mirror substrates was also verified via surface slope measurements with a long trace profiler. A boron carbide (B4C) coating especially optimized for the LCLS FEL conditions was deposited on all SXR mirrors and gratings. Coating thickness uniformity of 0.14 nm root mean square (rms) across clear apertures extending to 205 mm length was demonstrated for all elements, as required to preserve the coherent wavefront of the LCLS source. The reflective performance of the mirrors and the diffraction efficiency of the gratings were calibrated at beamline 6.3.2 at the Advanced Light Source synchrotron. To verify the integrity of the nanometer-scale grating structure, the grating topography was examined by AFM before and after coating. This is to our knowledge the first time B4C-coated diffraction gratings are demonstrated for operation in the soft x-ray region.

Metal fume fever - a case review of calls made to the Victorian Poisons Information Centre.

OBJECTIVE: To determine the epidemiology of metal fume fever over an extended period in Victoria, Australia. METHODS: A retrospective case review of all metal fume fever related calls to the Victorian Poisons Information Centre. Specific defined criteria were used to identify cases of metal fume fever and a set of data points extracted for each. RESULTS: Eighty-four (99%) of the cases involved adults. Fifty-three percent of exposures occurred in the workplace. The most frequent day of symptom manifestation was Monday (24%). All of the calls concerned people involved in welding metal with subsequent inhalation of fumes. DISCUSSION: Calls were most common at the beginning of the week, reflecting the previously described phenomena of increased symptoms occurring after a period on nonexposure (loss of tolerance). Workplace safety and education is key to prevention of metal fume fever. Medical profession education may help prevent occurrences of metal fume fever at home, at school and in the workplace.

Hydrofluoric acid poisoning: data from the Victorian Poisons Information Centre.

OBJECTIVE: To determine the epidemiology of hydrofluoric acid (HF) exposures, over an extended time period, in Victoria, Australia. METHODS: Retrospective case review of all HF exposures from calls to the Victorian Poisons Information Centre (VPIC) from June 2005 to February 2011. RESULTS: The VPIC received calls regarding 75 separate HF exposures (approximately 12 per year). The majority 68 (91%) of calls related to male patients. Sixty-nine (92%) calls related to adults, six (8%) to children (<12 years) and none to the elderly (>65 years age). Fifty-three per cent of exposures occurred at the workplace. Dermal exposures comprised 54 (72%). Forty-six (85%) of these resulted from hand contact, six (11%) arm and two (4%) legs. The second most common exposure was ocular 11 (15%). More than half of exposures involved HF concentrations of 10% or less. Of the dermal exposures treated in EDs, 16% required calcium treatment in a form other than gel. Overall poisoning severity was mild (79% of cases Poisoning Severity Score of 0 or 1). Health professionals were the most frequent callers (53% of all cases). CONCLUSIONS: Calls to the VPIC regarding HF are relatively rare, but almost all calls regarding HF taken by the VPIC required hospital evaluation. The majority of exposures were accidental occupational dermal exposures in male adults and most of these were minor, requiring topical calcium gel only. Small exposures with higher concentrated HF can be fatal; however, there were no cases of severe toxicity in the present study.