We analysed the influence of weather, time since fire (TSF) and topography on the occurrence of crown fire, as mapped from satellite imagery, in 23 of the largest wildfires in dry sclerophyll forests in eastern Australia from 2002 to 2013. Fires were analysed both individually and as groups. Fire weather was the most important predictor of crown consumption. TSF (a surrogate for fuel accumulation) had complex nonlinear effects that varied among fires. Crown fire likelihood was low up to 4 years post-fire, peaked at ~10 years post-fire and then declined. There was no clear indication that recent burning became more or less effective as fire weather became more severe. Steeper slope reduced crown fire likelihood, contrary to the assumptions of common fire behaviour equations. More exposed areas (ridges and plains) had higher crown fire likelihood. Our results suggest prescribed burning to maintain an average of 10 years’ TSF may actually increase crown fire likelihood, but burning much more frequently can be effective for risk reduction. Our results also suggest the effects of weather, TSF and slope are not adequately represented in the underlying equations of most fire behaviour models, potentially leading to poor prediction of fire spread and risk.

Purpose:Comprehensive review of gene replacement therapy with guidance and expert opinion on handling and administration for pharmacists.Summary:There are currently ∼2600 gene therapy clinical trials worldwide and 4 Food and Drug Administration (FDA)-approved gene therapy products available in the United States. Gene therapy and its handling are different from other drugs; however, there is a lack of guidance from the National Institutes of Health (NIH), FDA, Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and professional associations regarding their pharmaceutical application. Although the NIH stratifies the backbone biologicals of viral vectors in gene therapies into risk groups, incomplete information regarding minimization of exposure and reduction of risk exists. In the absence of defined guidance, individual institutions develop their own policies and procedures, which often differ and are often outdated. This review provides expert opinion on the role of pharmacists in institutional preparedness, as well as gene therapy handling and administration. A suggested infrastructural model for gene replacement therapy handling is described, including requisite equipment acquisition and standard operating procedure development. Personnel, patient, and caregiver education and training are discussed.Conclusion:Pharmacists have a key role in the proper handling and general management of gene replacement therapies, identifying risk level, establishing infrastructure, and developing adequate policies and protocols, particularly in the absence of consensus guidelines for the handling and transport of gene replacement therapies.

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.

We analysed the influence of wildfire area, topography, fuel, surface weather and upper-level weather conditions on long-distance spotting during wildfires. The analysis was based on a large dataset of 338 observations, from aircraft-acquired optical line scans, of spotting wildfires in south-east Australia between 2002 and 2018. Source fire area (a measure of fire activity) was the most important predictor of maximum spotting distance and the number of long-distance spot fires produced (i.e. >500m from a source fire). Weather (surface and upper-level), vegetation and topographic variables had important secondary effects. Spotting distance and number of long-distance spot fires increased strongly with increasing source fire area, particularly under strong winds and in areas containing dense forest and steep slopes. General vegetation descriptors better predicted spotting compared with bark hazard and presence variables, suggesting systems that measure and map bark spotting potential need improvement. The results from this study have important implications for the development of predictive spotting and wildfire behaviour models.

Spotting during wildfires can significantly influence the way wildfires spread and reduce the chances of successful containment by fire crews. However, there is little published empirical evidence of the phenomenon. In this study, we have analysed spotting patterns observed from 251 wildfires from a database of over 8000 aerial line scan images capturing active wildfire across mainland southeast Australia between 2002 and 2018. The images were used to measure spot fire numbers, number of “long-distance” spot fires (> 500 m), and maximum spotting distance. We describe three types of spotting distance distributions, compare patterns among different regions of southeast Australia, and associate these with broad measures of rainfall, elevation, and fuel type. We found a relatively high correlation between spotting distance and numbers; however, there were also several cases of wildfires with low spot fire numbers producing very long-distance spot fires. Most long-distance spotting was associated with a “multi-modal” distribution type, where high numbers of spot fires ignite close to the source fire and isolated or small clumps of spot fires ignite at longer distances. The multi-modal distribution suggests that current models of spotting distance, which typically follow an exponential-shaped distribution, could underestimate long-distance spotting. We also found considerable regional variation in spotting phenomena that may be associated with significant variation in rainfall, topographic ruggedness, and fuel descriptors. East Victoria was the most spot-fire-prone of the regions, particularly in terms of long-distance spotting.

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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.

Relapsed high-risk neuroblastoma has few effective therapies currently available or in development. Cabozantinib is an Food and Drug Administration approved multitargeted tyrosine kinase inhibitor for select adult malignancies with preclinical data suggesting efficacy against neuroblastoma. A safe and tolerable dose has been identified for children, but its efficacy remains unknown.We describe four children with relapsed metastatic neuroblastoma treated with cabozantinib. All four patients had extended disease control (two complete responsesfor >12 months, 2 stable disease >6 months) with manageable predictable toxicities requiring dose reduction in two patients.We discuss the potential for the use of cabozantinib in neuroblastoma. K E Y W O R D Scancer biology, chemotherapy, CNS relapse, CNS tumors, molecular biology of neuroblastoma, neuroblastoma, neuroblastoma biology, new agents, oncology (general), pediatric oncology, phase 2 clinical trial agents