The influence of regional wind patterns on air quality during forest fires near Sydney, Australia.

Particulate pollution from forest fire smoke threatens the health of communities by increasing the occurrence of respiratory illnesses. Wind drives both fire behaviour and smoke dispersal. Understanding regional wind patterns would assist in effectively managing smoke risk. Sydney, Australia is prone to smoke pollution because it has a large population close to fire-prone eucalypt forests. Here we use the self-organising maps (SOM) technique to identify sixteen unique wind classes for the Sydney region from days with active fires, including identifying sea breeze occurrence. We explored differences in PM2.5 levels between classes and between hazard reduction burning (HRB) and wildfire days. For HRB days, classes with the highest PM2.5 mostly had a sea breeze, whereas better air quality days usually had winds aligned across the region (e.g. all westerly). The wind class with the most HRB days had low wind speeds and a sea breeze and was among the worst wind classes for air quality. For wildfire days, days with a sea breeze were also generally of poor air quality but many classes had at least some poor air quality days, most of which were during the 2019-2020 east coast wildfires in New South Wales. Some poor air quality days occurred in wind classes that sent strong plumes directly over air quality stations, spread smoke over a wide area or transported smoke from outside the region. The classes identified may be useful in scheduling HRBs, for example, identifying days with low pollution risk to conduct an HRB, or for assisting in understanding pollution risk and sending health warnings during HRBs and wildfires. Further development of the approach may allow the creation of multi-day classifications for fire managers to plan HRB ignitions over several days to ensure better smoke dispersal. Further research could incorporate other weather predictors or focus on other regions.

Increasing optimal coagulation factor dosing in the paediatric emergency department: A quality improvement study.

INTRODUCTION: Haemophilia is a disorder complicated by bleeding episodes that require emergent medical evaluation. Factor replacement dosing can present challenges for emergency department (ED) care. AIMS: We aimed to reduce out-of-range factor dosing in the ED. Specifically, we sought to increase the number of haemophilia ED patient visits between encounters where sub-optimal factor dosing was administered from a baseline of 4-15 encounters. METHODS: A chart review was completed on all patients with haemophilia A (HA) or B (HB) seen in the ED for injuries requiring factor concentrate from September 2015 to August 2016. Injuries were classified as minor-requiring a 50% factor correction or major-requiring a 100% factor correction. Optimal dosing range was defined as 90%-120% of the institutional guideline goal for the degree of injury. The predicted optimal dose range for each patient was compared to the actual dose administered. RESULTS: Baseline data demonstrated optimal dosing range in 70% of encounters. There was no difference between patients with HA or HB in frequency of out-of-range dosing (P = 0.15). There was no difference in frequency of out-of-range dosing between types of clotting factor concentrate used. After initiation of quality improvement (QI) interventions, we achieved 16 encounters between out-of-range dosing, exceeding our goal of 15. However, this success was not sustained. CONCLUSION: Optimal coagulation factor dosing is important for patient care and resource management. QI interventions promoted increased accuracy of factor dosing for patients with haemophilia seen in the ED.

Evaluation of Parenteral Nutrition Errors in an Era of Drug Shortages.

BACKGROUND: Ingredient shortages have forced many organizations to change practices or use unfamiliar ingredients, which creates potential for error. Parenteral nutrition (PN) has been significantly affected, as every ingredient in PN has been impacted in recent years. MATERIALS AND METHODS: Ingredient errors involving PN that were reported to the national anonymous MedMARx database between May 2009 and April 2011 were reviewed. Errors were categorized by ingredient, node, and severity. Categorization was validated by experts in medication safety and PN. A timeline of PN ingredient shortages was developed and compared with the PN errors to determine if events correlated with an ingredient shortage. This information was used to determine the prevalence and change in harmful PN errors during periods of shortage, elucidating whether a statistically significant difference exists in errors during shortage as compared with a control period (ie, no shortage). RESULTS: There were 1311 errors identified. Nineteen errors were associated with harm. Fat emulsions and electrolytes were the PN ingredients most frequently associated with error. Insulin was the ingredient most often associated with patient harm. On individual error review, PN shortages were described in 13 errors, most of which were associated with intravenous fat emulsions; none were associated with harm. There was no correlation of drug shortages with the frequency of PN errors. CONCLUSION: Despite the significant impact that shortages have had on the PN use system, no adverse impact on patient safety could be identified from these reported PN errors.