Sydney Area Research Articles

Self-limiting non-medical pharmaceutical opioid use among young people in Sydney, Australia: An exploratory study.

Indicators suggest an escalation in opioid use globally, with recent HIV outbreaks linked to non-medical pharmaceutical opioid (NMPO) use. Little is known about how young Australians engage in NMPO use. During 2015, we conducted qualitative interviews with young people (16-29 years) who reported oral NMPO use at least twice in the past 90 days. The study included a sample of injecting (n = 14) and oral (n = 22) users. This paper focuses on the oral user group. Most participants grew up in affluent areas of Sydney, reported few health problems, rarely accessed health or welfare services and had limited contact with police. NMPO use was part of a repertoire of drug use involving: (i) use to come down from stimulants; (ii) use in conjunction with cannabis and alcohol; and (iii) use by itself. Participants reported limiting their use in order to avoid stigma and dependence. Results suggest culture of self-limiting NMPO use characterised by stable housing, disposable income and intimate friendship networks. Despite the adverse health outcomes observed in other settings, our data suggest that the patterns and meanings of NMPO use observed in this small sample may help explain the limited nature of problematic use among young Australians to date. Findings indicate a need for epidemiological data, including longitudinal data, to assess possible demographic shifts in NMPO use in Australia, and to address risk factors for dependence and transitions to injecting and heroin use in this population. [Dertadian GC, Dixon TC, Iversen J, Maher L. Self-limiting non-medical pharmaceutical opioid use among young people in Sydney, Australia: An exploratory study. Drug Alcohol Rev 2017;00:000-000].

Coal Mine Water Pollution and Ecological Impairment of One of Australia’s Most ‘Protected’ High Conservation-Value Rivers

The environmental regulation of a coal mine in the greater Sydney area has failed to recognise the importance of and protect a high conservation-value river located in a World Heritage listed area. This study measured the water quality and ecological health (using macroinvertebrates) of the Wollangambe River and its tributaries near the point of the waste water discharge of a coal mine and assessed the longitudinal impact for 22 km downstream. The investigation revealed two important aspects. The first is the significant impact of the waste water discharge when compared to the otherwise near-pristine condition of the high conservation-value river system. The second is the spatial extent of the pollution from the mine that extends at least 22 km downstream from the outflow of coal mine wastes. The resulting water pollution is causing major impairment of the aquatic ecosystem, with reduced abundance, taxonomic richness and loss of pollution-sensitive macroinvertebrate groups. Water pollution from the mine includes thermal pollution, increased salinity and increased concentrations of zinc and nickel. The mine’s waste discharge also strongly modified the river’s ionic composition. The study also highlights the failure of the regulatory and governance systems that enable the mine to operate in a manner that causes major environmental impacts.

Post-occupancy Energy Consumption of BASIX Affected Dwellings in the Sydney Metropolitan Area

Australian residential sector contributes approximately 13 per cent of the total greenhouse gas (GHG) emissions. The New South Wales (NSW) government in Australia has introduced mandatory energy efficiency/ GHG emissions reduction target through the Building Sustainability Index (BASIX) assessment tool, which estimates the operational energy consumption and GHG emissions from new residential developments based on information available at the building design stage. However, post-occupancy energy consumption can be different from the estimated figures at the design stage. This research aims to disentangle the relationships between various attributes that influence energy consumption at the dwelling scale through a post-occupancy residential energy performance analysis model. The model combines multidimensional attributes which include building design features, construction quality, possession of household appliances and their usage, demographic and homeowners’ energy use behaviour. The model allows comparing the estimated energy consumption/ GHG emissions from BASIX assessment with actual energy consumption/ GHG emissions in the real household environment. Data for this study has been collected from a sample of 48 BASIX affected dwellings located in the greater Sydney area which includes energy bill data, real-time monitoring of electricity consumption and indoor environment (temperature and humidity) data. This paper reports findings based on the data collected from late 2015 to mid-2016 from 16 dwellings. The initial results demonstrate discrepancies in energy consumption (therefore GHG emissions), household occupancy and breakdown of energy consumption for various services between BASIX estimates and the collected data. Given that BASIX assessment is based on information available at the design stage, the reported discrepancies are expected. More importantly, the initial results show that BASIX assessments under-estimated energy consumption for active cooling and over-estimated consumption for lighting and ventilation and other household plug loads.

An early evaluation of an integrated, recovery orientated approach to severe and persisting mental health problems

Introduction: Partners in Recovery (PIR) is a national program run in 48 Australian local areas from 2012 until 2016. PIR aims to better support people with severe and persistent mental illness who have chronic and complex needs, through integrating health and other services in a recovery orientated approach aimed to be embedded in future practice through systems change. Recovery orientated practice recognises the strengths of service users and empowers them within the mental health system, emphasising shared decision making and respecting the self-determined goals of the consumer.We undertook a multiple methods evaluation of the early implementation of this program in an area to the west of Sydney. We worked with a Reference Group to develop a Program Logic Model (PLM) and assigned indictors. Using a combination of document review, surveys and interviews with consumers, carers and service providers and managers, we measured success in achieving the agreed indicators.Short description of practice change implementedWith funding from the Australian government, the Nepean Blue Mountains Medicare Local (a primary health care organisation west of Sydney) joined in a collaboration with partner organisations as well as consumers with severe and persisting mental health problems and their carers. PIR aims to improve outcomes through better coordination and integration of health and other services. A key longer term aim of the program is enduring systems change, both in terms of promoting recovery focussed care and improved and lasting collaborations across organisations to better achieve the consumers’ goals for recovery.Memoranda of Understanding and inter-organisational agreements assisted in aligning goals and priorities between the different agencies and regular meetings facilitated planning and review of activities across partner organisations. Care Facilitators were employed to assist consumers to access the required support available through the various participating organisations. Training was provided for staff of all partner organisations.Key findings: At the time of our evaluation PIR had been in operation for two years. Organisational structures had been developed and staff were employed according to the needs identified. Enrolment in the program initially occurred more rapidly than anticipated as consumers responded to promotional activities. Many of those enrolled reported improved access to services, although transport, housing, social opportunities and access to some specialist mental health services were noted particularly by staff, to remain challenges for some. Certain population groups in the area, including those living at a greater distance from urban centres, the homeless, those with drug and alcohol as well as mental health diagnoses and culturally diverse groups including Aboriginal and Torres Strait islander peoples appeared to be less well served by PIR.Highlights: This approach to integration of services for those with severe and persisting mental health problems was facilitated by the strong leadership provided by the Primary Care Organisation and the alignment of vision between most of the partner organisations. Challenges occurred where partner organisations were less familiar with and committed to a recovery approach to care. Though training was provided, organisational culture made change difficult in some organisations. Support Facilitators from one organisation will be placed in another organisation in an attempt to influence culture and understandings of participating organisations. Consumers and carers reported improved access to services and were keen to participate in leadership and peer support roles in the future. Staff and management of partner organisations reported improved access to services for their clients as a result of enhanced referral pathways and establishment of collaborative partnerships. However PIR was said to be a “work in progress” and many expressed concern about the short term nature of the current program.Conclusion: PIR in the Nepean Blue Mountains area of Sydney has provided an integrated client-centered service which has relevance in other settings. The PLM approach provided a useful framework for describing the program as well as for conducting an early evaluation of the program and indicating potential opportunities for further development. Our evaluation continues to inform program development.

The effect of liquor licensing restrictions on assault: a quasi-experimental study in Sydney, Australia.

To determine whether restrictions on the availability of alcohol in two inner-city entertainment areas in Sydney, Australia (1) reduced the incidence of assault in those areas, (2) increased the incidence of assault in nearby areas (where the restrictions did not apply), (3) resulted in a net reduction in overall levels of assault (4) and/or whether the reductions in assault were most pronounced during the daily time-periods when liquor trading restrictions were in operation. Structural time-series modelling was used to estimate and compare trends in assault in areas/times affected by the new restrictions on alcohol availability with trends in assault in areas unaffected by the new restrictions. Sydney, Australia. The primary outcome measure was the police-recorded monthly incidence of non-domestic assault in the 78months between January 2009 and June 2015. Following the reforms, we found reductions in assaults of 45% [beta = -0.599, 95% confidence interval (CI)=-1.107, -0.091] and 22% (beta =0.260, 95% CI=-0.397, -0.123), respectively, in the Kings Cross and Sydney CBD Entertainment Precincts. In the Kings Cross Entertainment Precinct, reductions in assault were observed in all three daily time-periods. In the Sydney CBD Entertainment Precinct reductions in assault were observed only in the second and third daily time-periods. Assaults did not increase in entertainment areas adjacent to or within easy reach of the target areas. Restrictions on the availability of alcohol appear to reduce the incidence of assault.

Validation of the Child Sexual Abuse Knowledge Questionnaire

ABSTRACTA validation study of the Child Sexual Abuse Knowledge Questionnaire (CSA-KQ) was conducted on a sample of 1712 non-empanelled jurors in the greater Sydney area, Australia. The CSA-KQ contains nine items derived from empirical findings on common misconceptions about typical features of abuse offences, children’s responses to child sexual abuse, and their ability to give reliable evidence. Study 1 tested the factor structure of the questionnaire in a sample of 843 non-empanelled jurors. The best model indicated by exploratory factor analysis had two factors: the Impact of Sexual Abuse on Children and Contextual Influences on the Report. Study 2 cross-validated the findings and tested the predictive validity of the CSA-KQ in a realistic simulated trial in which an 11-year-old complainant alleged abuse by her grandfather. Confirmatory factor analysis replicated the findings of Study 1, showing strong reliability for each of the factors (ρy = 0.70 to ρy = 0.80) and for the CSA-KQ (ρy = 0.76). CSA-KQ scores were significantly correlated with the perceived credibility of the complainant (r = 0.23). Moreover, the CSA-KQ scores predicted verdict: jurors with greater knowledge about CSA were more likely to convict the defendant than jurors who knew less about CSA.

Microgeographic factors and patterns of aeroallergen sensitisation.

To examine patterns of airborne allergen (aeroallergen) sensitisation in the Greater Sydney area (Sydney), and their relationships with climate, coastal proximity and environment (urban v regional). Retrospective cross-sectional study of patients who underwent aeroallergen skin prick testing at three Sydney allergy clinics, January 2001 - October 2014. Proportions of patients sensitised to specific aeroallergen types; relationships between sensitisation patterns and climate and geography. Of 1421 patients who met the selection criteria (mean age, 28.3 years [SD, 21.3]; 53.3% were female), 1092 (76.8%) were sensitised to at least one aeroallergen. Those living less than 15 km from the coast were less commonly sensitised to cockroach (<15 km, 15.1%; 15-30 km, 40.0%; >30 km, 39.7%; P <0.001) and grass aeroallergens (<15 km, 36.5%; 15-30 km, 52.2%; >30 km, 58.1%; P <0.001) than patients further inland; the same applied to mould, weed and tree aeroallergens. Subtropical grass sensitisation was more common in temperate/warm summer climates (about 50%) than in temperate/hot summer (27.1%) or subtropical climates (15%) (P <0.001), and less common in urban (36.7%) than in regional areas (54%; P = 0.014). 72.4% of grass-sensitised patients were co-sensitised to both temperate and subtropical grasses. A selected ten-aeroallergen skin prick test panel identified 98.5% of atopic patients in this Sydney sample. Environmental and geographic factors are associated with different patterns of allergic sensitisation in Sydney. Extensive co-sensitisation to subtropical and temperate grasses has implications for immunotherapy in Australia, where most currently available therapies are based on formulations directed at temperate grasses only.

Design intervention in architecture and planning: practical explorations and applied outcomes

ABSTRACTWithin architecture and planning, the elements and outcomes of design can be difficult to conceptualize and manage. The problem lies not simply in the range of stakeholders differentially interpreting the functionality and aesthetics of a building, but also in the effect of structures’ scaling up from the site, through precinct to the metropolitan level. Incremental assembly of the built environment can promote dislocation of form and dissociation of function without any necessary legibility, integration, or harmony. This article explores the concept of visual appropriateness within frameworks of design intervention constructed by public planning authorities. Having scoped the problem, it searches over 2000 architecture, urban design, and planning references for ‘theoretical’ intervention measures, extended to include ‘empirical’ ones derived from selected planning schemes. Sorted into 3 thematic groups and 47 individual themes, they are then arranged into two evaluation dimensions within a multi-criteria analysis directed to the case of residential development in seven local government areas in Sydney, Australia. Results confirm that stronger design intervention will characterize areas with denser and more aggressive development activity and potential. The project demonstrates what is involved in contextualizing and translating just one of the several constituents of urban design.

Management of critical illness with non-invasive ventilation by an Australian HEMS

BackgroundNon-invasive ventilation (NIV) therapy is widely used for the management of acute respiratory failure. The objective of this study was to investigate the current use of NIV during interhospital retrievals...

Review of therapeutic agents employed by an Australian aeromedical prehospital and retrieval service.

There is little current evidence regarding which therapeutic agents are actually used within existing aeromedical services. The Greater Sydney Area Helicopter Emergency Medical Service operates a large, physician-staffed, multimodal, prehospital and interhospital retrieval service. The aim of the present study was to identify the range and frequency of drug, fluid and blood product use within our service. This was a retrospective cross-sectional study. Case sheets relating to a 12 month period were inspected to identify the therapeutic agents used by retrieval teams during each mission. Corresponding case notes, demographic data (age, sex) and case data (prehospital vs interhospital, trauma vs medical) were extracted from an electronic database. Of 2566 missions, 848 were prehospital, 1662 interhospital and 56 mixed. Prehospital missions were associated with fewer agents per case (median, 2 vs 3) and a narrower range of agents overall (45 vs 117) compared to interhospital missions. In both mission types, the most frequently used agents included morphine, fentanyl, Hartmann's solution, ketamine, rocuronium, ondansetron and midazolam. Noradrenaline, propofol and metaraminol were used frequently in interhospital missions only. A number of stocked and unstocked agents were used less commonly, or not at all, over the study period. The results of the present study form a practical guide to aid prehospital and retrieval services in establishing or reviewing their medical agent formularies. Key practice points illuminated by the data provide insights into current practice in critical care. There remains a clear need for similar studies from other services worldwide.

A new pupillarial scale insect (Hemiptera: Coccoidea: Eriococcidae) from Angophora in coastal New South Wales, Australia.

A new scale insect, Aolacoccus angophorae gen. nov. and sp. nov. (Eriococcidae), is described from the bark of Angophora (Myrtaceae) growing in the Sydney area of New South Wales, Australia. These insects do not produce honeydew, are not ant-tended and probably feed on cortical parenchyma. The adult female is pupillarial as it is retained within the cuticle of the penultimate (second) instar. The crawlers (mobile first-instar nymphs) emerge via a flap or operculum at the posterior end of the abdomen of the second-instar exuviae. The adult and second-instar females, second-instar male and first-instar nymph, as well as salient features of the apterous adult male, are described and illustrated. The adult female of this new taxon has some morphological similarities to females of the non-pupillarial palm scale Phoenicococcus marlatti Cockerell (Phoenicococcidae), the pupillarial palm scales (Halimococcidae) and some pupillarial genera of armoured scales (Diaspididae), but is related to other Australian Myrtaceae-feeding eriococcids.

Desiccation survival time for eggs of a widespread and invasive Australian mosquito species, Aedes (Finlaya) notoscriptus (Skuse).

The Australian native mosquito Aedes (Finlaya) notoscriptus (Skuse) is closely associated with natural and artificial water holding receptacles. Eggs are laid in habitats where they are exposed to drying conditions as water levels fluctuate. Withstanding desiccation enables survival in challenging environments and increases the potential for establishment in non-native habitats. Until now, the desiccation resistance of Ae. notoscriptus eggs has been unknown despite the historical invasive success of this important dog heartworm and arbovirus vector. Viability and mean survival times of eggs from two Ae. notoscriptus populations (metropolitan areas of Sydney, NSW and Adelaide, SA) were evaluated, with eggs stored under three dryness conditions for up to 367 days. Our results revealed that Ae. notoscriptus eggs can withstand desiccation for extended periods, under a variety of conditions, with approximately 9-13% egg viability recorded after one year. This prolonged egg survival reflects the widespread distribution of this mosquito in Australia and its history of incursions and subsequent establishment in non-native habitats. Differences in mean egg volume were recorded in addition to significantly different egg length to width ratios for the two populations, which may reflect adaptation to biotope of origin and an associated likelihood of drought and drying conditions. The results of this study suggest that the desiccation resistant eggs of Ae. notoscriptus make this species highly adaptable, increasing the risk of movement to non-endemic regions of the world.

Deconstructing injecting risk of hepatitis C virus transmission: Using strategic positioning to understand “higher risk” practices

Aims: Currently, efforts to prevent hepatitis C virus (HCV) focus on the message that all sharing of injecting equipment is risky. This obscures the strategies undertaken by people who inject drugs (PWID) to reduce risk of transmission to themselves and others. Methods: Self-complete survey of clients of Needle and Syringe Programs (NSPs) in a metropolitan area of Sydney, Australia. Among those who reported sharing injecting equipment, two categories of risk were constructed based on self-perceived HCV status and self-reported distributive and receptive sharing of injecting equipment. The “higher risk” category contained participants who reported being either HCV-positive and distributive sharing or HCV-negative and receptive sharing. The “lower risk” category contained participants who reported being either HCV-positive and receptive sharing or HCV-negative and distributive sharing. Findings: Around a third of the total sample were categorised as “higher risk”. In multivariate analysis, being in the higher risk category was associated with perceived difficultly in managing drug use (adjusted odds ratio (AOR) = 2.37; 95% CI 1.34–4.18; p = 0.003) and having less trust in drug and alcohol workers (AOR = 0.68; 95% CI 0.52–0.90; p = 0.007). Conclusions: This exploratory study highlights gaps in the way that the HCV prevention sector understands and addresses risk. Further research is required to guide prevention efforts that are meaningful and relate to the strategies that PWID undertake to reduce HCV risk.

Urban carbon transformations: unravelling spatial and inter-sectoral linkages for key city industries based on multi-region input–output analysis

With around 80% of global greenhouse gas emissions directly or indirectly attributed to cities, attempts to mitigate climate change impacts must seriously consider urban carbon transformations. Two challenges are currently constraining urban planning decisions around decarbonisation. Firstly, a lack of detailed knowledge about city-induced emissions occurring outside of the city boundary hampers the design of mitigation strategies that involves the city's ‘hinterland’. Secondly, the complexity of interconnections between industries and regions located upstream or downstream the supply chain of urban economic activity makes it difficult to implement specific, effective and efficient decarbonisation policies. In this study, a multi-scale, multi-region input–output model with nested regions at city, state, nation and world level is employed to study the carbon footprints and the inter-sectoral linkages in terms of embodied carbon emissions of the two largest metropolitan areas of Australia, Melbourne and Sydney. The results show that imported emissions make up more than 50% of the city carbon footprints, with most of them attributable to goods (excluding food) and services (excluding electricity). This highlights the importance of promoting mitigation measures both within and outside of the city. The energy, mining and agriculture sectors – usually located outside of city boundaries – all have significant carbon linkage multipliers associated with city demand, indicating the need of pursuing carbon mitigation measures in these sectors. The linkage analysis pinpoints to crucial sectors that need to be targeted in future investments towards urban decarbonisation to minimise emissions and to maximise positive economic effects for urban and regional economies. The study also provides an improved understanding of the differences and similarities between Australia's two main cities. It is envisaged that this type of analysis will become increasingly relevant to other cities as the spatial resolution of multi-region input–output databases continues to improve.

MP35-17 UNDERACTIVE BLADDER (UAB) SYMPTOMS AND VOIDING PARAMETERS IN ELDERLY COMMUNITY-DWELLING MALES WITH 5 YEAR FOLLOWUP

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common in older men and there is increasing awareness of the impact of the underactive bladder (UAB) in the elderly. We assessed symptoms suggestive of UAB and voiding parameters in a group of community-dwelling elderly men over a period of 5 years. METHODS: Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects are re-assessed after two years and five years with repeat survey and clinical assessment. UAB symptoms were assessed based on the IPSS-voiding subscore (IPSSV) and correlated with voiding parameters at baseline and five year follow-up. RESULTS: 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had deceased). 275 men with prostate cancer and 302 men with previous surgical treatment for BPH were omitted from analyses. Men with significant overactive bladder symptoms (IPSSstorage subscore >5) were excluded leaving 870 men for analysis. 93% had low IPSS-V scores (0-6),6% intermediate IPSS-V (7-13) and 1% high IPSS-V(14-20). Mean peak flow rates at baseline for men with low, intermediate and high IPSS-V scores were 13.3 mls/sec, 10.9mls/ sec and 10.1mls/sec respectively (P<0.001) but there was no significant change at 5 years (12.5mls/s, 10.6mls/s, 10.8mls/s). Mean post void residual volume for men with low, intermediate and high IPSS-V scores at baseline were 66.9mls, 78.4mls and 92.6mls respectively (P1⁄40.001) and there was no significant change at 5 years. Increased total IPSS-V correlated with reduced peak flow and increased post void residual (P<0.001), but not with age. Only 18 (2%) men had surgery for LUTS between baseline and 5 years. The risk of undergoing surgery correlated with intermediate/high IPSS-V scores (P1⁄40.014). CONCLUSIONS: Both UAB symptoms and voiding parameters of uroflowmetry and post void residual volume remain relatively stable over a five year period in elderly, community-dwelling men. UAB symptoms correlated with elevated postvoid residual urine and reduced urinary flow rates although the number of men requiring surgical intervention was low.

MP35-18 NOT A VOLUME BUT A STRUCTURAL VARIATION OF THE PROSTATIC URETHRA WITHIN THE PROSTATE PREDICT THE DEGREE OF OBSTRUCTIVE SYMPTOM: A PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common in older men and there is increasing awareness of the impact of the underactive bladder (UAB) in the elderly. We assessed symptoms suggestive of UAB and voiding parameters in a group of community-dwelling elderly men over a period of 5 years. METHODS: Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects are re-assessed after two years and five years with repeat survey and clinical assessment. UAB symptoms were assessed based on the IPSS-voiding subscore (IPSSV) and correlated with voiding parameters at baseline and five year follow-up. RESULTS: 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had deceased). 275 men with prostate cancer and 302 men with previous surgical treatment for BPH were omitted from analyses. Men with significant overactive bladder symptoms (IPSSstorage subscore >5) were excluded leaving 870 men for analysis. 93% had low IPSS-V scores (0-6),6% intermediate IPSS-V (7-13) and 1% high IPSS-V(14-20). Mean peak flow rates at baseline for men with low, intermediate and high IPSS-V scores were 13.3 mls/sec, 10.9mls/ sec and 10.1mls/sec respectively (P<0.001) but there was no significant change at 5 years (12.5mls/s, 10.6mls/s, 10.8mls/s). Mean post void residual volume for men with low, intermediate and high IPSS-V scores at baseline were 66.9mls, 78.4mls and 92.6mls respectively (P1⁄40.001) and there was no significant change at 5 years. Increased total IPSS-V correlated with reduced peak flow and increased post void residual (P<0.001), but not with age. Only 18 (2%) men had surgery for LUTS between baseline and 5 years. The risk of undergoing surgery correlated with intermediate/high IPSS-V scores (P1⁄40.014). CONCLUSIONS: Both UAB symptoms and voiding parameters of uroflowmetry and post void residual volume remain relatively stable over a five year period in elderly, community-dwelling men. UAB symptoms correlated with elevated postvoid residual urine and reduced urinary flow rates although the number of men requiring surgical intervention was low.

Spatial analysis of pediatric burns shows geographical clustering of burns and ‘hotspots’ of risk factors in New South Wales, Australia

ObjectivePediatric burns are a significant cause of morbidity and mortality, and it is estimated that more than 80% are preventable. Studies among adults have shown that burns risk are geographically clustered, and higher in socioeconomically-disadvantaged areas. Few studies among children have examined whether burns are geographically clustered, and if burn prevention programs are best targeted to high-risk areas. MethodRetrospective analyses examined the 2005-to-2014 NSW Severe Burns Injury Service data. Geospatial imaging software was used to map the relative-risk and clustering of burns by postcodes in Greater Sydney Area (GSA). Cluster analyses were conducted using Getis-Ord and Global Moran's I statistics. High- and low-risk populations and areas were examined to ascertain differences by sociodemographic characteristics, etiology and the extent of the burn. ResultsScalds were the most common types of burns and boys were at greater risk than girls. There was significant clustering of burns by postcode area, with a higher relative risk of burns in western and north-western areas of Sydney. The high-risk clusters were associated with socioeconomic disadvantage, and areas of low burns risk were associated with socioeconomic advantage. In both high- and low-risk areas burns occurred more frequently in the 12–24 months and the 24–36 months age groups. The implication of this study is that pediatric burns risk clustering occurs in specific geographic regions that are associated with socioeconomic disadvantage. The results of this study provide greater insight into how pediatric populations can be targeted when devising intervention strategies, and suggest that an area-targeted approach in socioeconomically-disadvantaged areas may reduce burns risk.

Planning for Peri-urban Agriculture: a geographically-specific, evidence-based approach from Sydney

ABSTRACTAgriculture on the fringes of cities across the Global North is increasingly perceived as making an important contribution to urban sustainability. As Australian cities continue to expand and encroach on their peri-urban peripheries, there is rising concern about loss of farmland to housing. Such concerns are especially urgent in the Sydney Basin, due to population growth, and topographical and land-use constraints. Accounting for the Basin's farmlands, however, remains opaque, not unrelated to difficulties in acquiring reliable data on the area and value of Sydney's agricultural industries. The problem is not simply that there are no data available but rather that the nature of existing data is (often hotly) contested. Critical questions for urban planners therefore remain unanswered, including: is peri-urban agriculture as important as advocates suggest? Are metropolitan food supplies under threat? If peri-urban farmland is important, what should be done to preserve it? In collating and analysing existing Australian Bureau of Statistics (ABS) and non-ABS data on Sydney agriculture between 1992 and 2011, we outline the need for more reliable and consistent longitudinal data to enable better planning for Sydney's farmland into the future. Notwithstanding limitations of available data sources, our findings reveal trends in Sydney Basin agriculture that invite debate on many assumptions about the nature of peri-urban agriculture. These findings emphasise the importance of geographically specific, evidence-based analysis as a basis for planning for peri-urban agriculture.

Impact of the New South Wales fires during October 2013 on regional air quality in eastern Australia

Smoke plumes from fires contain atmospheric pollutants that can be transported to populated areas and effect regional air quality. In this paper, the characteristics and impact of the fire plumes from a major fire event that occurred in October 2013 (17–26) in the New South Wales (NSW) in Australia, near the populated areas of Sydney and Wollongong, are studied. Measurements from the Fourier Transform InfraRed (FTIR) spectrometer located at the University of Wollongong allowed a calculation of specific emission factors (EFs) in terms of grams per kilogram of dry fuel burned: 1640 g kg−1 of carbon dioxide; 107 g kg−1 of carbon monoxide; 7.8 g kg−1 of methane; and 0.16 g kg−1 of nitrous oxide. These EFs have then been used to calculate daily fire emissions for the NSW fire event using the APIFLAME emissions' model, leading to an increase of 54% of CO emitted compared to calculations with EFs from Akagi et al. (2011), widely used in the literature.Simulations have been conducted for this event using the regional chemistry-transport model (CTM) CHIMERE, allowing the first evaluation of its regional impact. Fire emissions are assumed well mixed into the boundary layer. The model simulations have been evaluated compared to measurements at the NSW air quality stations. The mean correlation coefficients (R) are 0.44 for PM10, 0.60 for PM2.5 and 0.79 for CO, with a negative bias for CO (−14%) and a positive bias for PM2.5 (64%). The model shows higher performance for lower boundary layer heights and wind speeds. According to the observations, 7 days show concentrations exceeding the air quality Australian national standards for PM10, 8 days for PM2.5. In the simulations, 5 days are correctly simulated for PM10, 8 days for PM2.5. For PM10, the model predicts 1 additional day of exceedance (one false detection). During this fire episode, inner Sydney is affected during 5 days by PM exceedances, that are mainly attributed to organic carbon in the model simulations.To evaluate the influence of the diurnal variability and the injection heights of fire emissions, two additional simulations were performed: one with all fire emissions injected below 1 km (CHIM_1 km), since satellite observations suggest low injection for this fire case, and one with a diurnal profile (CHIM_diu) adjusted to best match surface observations closest to the fires. CHIM_1 km displays less bias and root mean square error, and CHIM_diu presents a good agreement for hourly statistics for stations where peaks of PM are well captured, but enhances the differences when a peak is overestimated by the model. This sensitivity analysis highlights significant uncertainties related to these two key fire parameters (which add up to uncertainties on emissions), resulting in variations on concentrations of PM and CO.

Natural history of non-neurogenic overactive bladder and urinary incontinence over 5 years in community-dwelling older men: The concord health and aging in men project.

To describe the natural history of non-neurogenic overactive bladder (OAB) and urgency incontinence in community-dwelling older men. A representative sample of 1,705 community-dwelling men aged 70 and older in a defined geographic area of Sydney, Australia, had their urinary symptoms assessed using the International Prostate Symptom Scores (IPSS) and the International Consultation of Incontinence Questionnaire (ICIQ) at baseline, 2-year follow-up, and 5-year follow-up. Four hundred and eighty-eight men without neurological diseases or prostate cancer during follow-up, or history of urological treatment at baseline were included in the analysis. Urgency incontinence was defined as leakage of urine occurring more than weekly in the above-defined population. OAB was defined as either urgency or urgency incontinence according to 2002 International Continence Society consensus. Of the men with OAB at baseline, 29% received treatment for OAB or benign prostatic enlargement over 5 years. Of the remaining men, 33% had sustained remission at 2-year and 5-year follow-ups without treatment. Of the men with OAB at 2-year follow-up, remission rate at 5-year follow-up was 53% in men without OAB at baseline and 27% in men with OAB at baseline (P = 0.23). No statistically significant difference was found in baseline characteristics between men with sustained remission and men with persistent symptoms. One in three older men with non-neurogenic OAB had sustained remission of symptoms without medical or surgical interventions. No significant predictor of sustained remission was identified. Neurourol. Urodynam. 36:443-448, 2017. © 2016 Wiley Periodicals, Inc.