Emergency department surge capacity : Recommendations of the Australasian surge strategy working group

Background For more than a decade emergency medicine organizations have produced guidelines, training and leadership for disaster management. However to date, there have been limited guidelines for emergency physicians needing to provide a rapid response to a surge in demand. The aim of this study is to identify strategies which may guide surge management in the Emergency Department. Method A working group of individuals experienced in disaster medicine from the Australasian College for Emergency Medicine Disaster Medicine Subcommittee (the Australasian Surge Strategy Working Group) was established to undertake this work. The Working Group used a modified Delphi technique to examine response actions in surge situations. The Working Group identified underlying assumptions from epidemiological and empirical understanding and then identified remedial strategies from literature and from personal experience and collated these within domains of space, staff, supplies, and system operation. Findings These recommendations detail 22 potential actions available to an emergency physician working in the context of surge. The Working Group also provides detailed guidance on surge recognition, triage, patient flow through the emergency department and clinical goals and practices. Discussion These strategies provide guidance to emergency physicians confronting the challenges of a surge in demand. The paper also identifies areas that merit future research including the measurement of surge capacity, constraints to strategy implementation, validation of surge strategies and measurement of strategy impacts on throughput, cost, and quality of care.

Prior storm experience moderates water surge perception and risk

Background How accurately do people perceive extreme water speeds and how does their perception affect perceived risk? Prior research has focused on the characteristics of moving water that can reduce human stability or balance. The current research presents the first experiment on people's perceptions of risk and moving water at different speeds and depths. Methods Using a randomized within-person 2 (water depth: 0.45, 0.90 m) ×3 (water speed: 0.4, 0.8, 1.2 m/s) experiment, we immersed 76 people in moving water and asked them to estimate water speed and the risk they felt. Results Multilevel modeling showed that people increasingly overestimated water speeds as actual water speeds increased or as water depth increased. Water speed perceptions mediated the direct positive relationship between actual water speeds and perceptions of risk; the faster the moving water, the greater the perceived risk. Participants' prior experience with rip currents and tropical cyclones moderated the strength of the actual–perceived water speed relationship; consequently, mediation was stronger for people who had experienced no rip currents or fewer storms. Conclusions These findings provide a clearer understanding of water speed and risk perception, which may help communicate the risks associated with anticipated floods and tropical cyclones.

A role for nocturnal serum testosterone surge in regulating spermatogenesis in the adult non-human primate

Adult male bonnet monkeys exhibit nychthemeral rhythms in testosterone (T) secretion but the precise role of this heightened level of T secretion in regulating spermatogenesis is not known. Intranasal administration of microdoses (500 mu g or 250 mu g/day) of Norethisterone (IN-NET) to adult monkeys (n = 6) at 1600 h each day selectively and completely suppressed the nocturnal surge levels of serum T. Concomitant with this was a significant reduction (P<0.01) in serum LH but not FSH levels. DNA flow cytometric analysis of testicular biopsy tissue showed by week 10 of IN-NET treatment an arrest in meiotic transformation of primary spermatocytes (4C) to round/elongate (1C/HC) spermatids and by week 20 there was a complete absence of 4C, 1C and HC cells (with a relative accumulation in 2C cells). The accumulated meiotic (4C) cells at week 10 showed an increase (>80%, P<0.01) in coefficient of variation and a decrease in intensity of DNA-bound ethidium bromide fluorescence, parameters characteristic of degenerating 'apoptotic' subpopulation of germ cells. While two monkeys exhibited acute oligozoospermia 4 became azoospermic by 20 weeks of IN-NET treatment. A complete, qualitative reversal in the regressive changes in spermatogenesis and near-normal sperm output were apparent at the end of a 20-week recovery phase. These data demonstrate that prolonged, selective suppression of nocturnal surge levels of serum T secretion exerts a primary effect on meiosis in spermatogenesis leading to oligo/azoospermic status in adult bonnet monkeys.

Role of prolactin(prl) in regulation of the nocturnal surge of testosterone (t) in the bonnet monkey (macaca radiata)

Earlier studies from this lebordory have shown thet adult male bonnet monkeys exhibit nychthemrel rhythmicity la the secretion of serum 'T' the levele reehlng peek by 22OOhr. Of the gonedotropine cnelyeed only serum PRL showed a concommitent increme with T(Biol.of Reprod. 24,814, 1981). In the present study mMinietretion of l rgobromocryptin (EBC) either by i.v.route(2mg)or by naeel l pr~(100~)reeulted in blockade of nocturnal increase of both PRL end T(Controle T-18.6ng/ml: PRL 130=29ng/ml: EBC treated T-2.2&1.2ng/ml; PRL n.d.to 15nng/ml). Adminietretion of N oPRL could not reverse the effect of EBC. Although, increaeed serum PRL induced by injection of Chlorprommine did not result in increase in serum 'T' during the dey time, the nocturnel 'T' surge could not be obeeerved. EBC treeted monkeys, however, showed normal testosterone response to exogenous hCG. These IeSUlte a0 SwgeStive of high levels of PRL me&in6 reeponeiveneee of testes to tonic levels of serum IX. (Aided by grant8 from ICMR, Kew Delhi, WHO, Geneva eld FPF, India).

On the roles of the northeast cold surge, the Borneo vortex, the Madden-Julian Oscillation, and the Indian Ocean Dipole during the extreme 2006/2007 flood in southern Peninsular Malaysia

The mid-December 2006 to late January 2007 flood in southern Peninsular Malaysia was the worst flood in a century and was caused by three extreme precipitation episodes. These extreme precipitation events were mainly associated with strong northeasterly winds over the South China Sea. In all cases, the northeasterlies penetrated anomalously far south and followed almost a straight trajectory. The elevated terrain over Sumatra and southern Peninsular Malaysia caused low-level convergence. The strong easterly winds near Java associated with the Rossby wave-type response to Madden-Julian Oscillation (MJO) inhibited the counter-clockwise turning of the northeasterlies and the formation of the Borneo vortex, which, in turn, enhanced the low-level convergence over the region. The abrupt termination of the Indian Ocean Dipole (IOD) in December 2006 played a secondary role as warmer equatorial Indian Ocean helped in the MJO formation.

Determination of surge-diverter voltage/current characteristic

A mathematical model has been proposed to determine the voltage/current characteristic of the surge diverter for a wide range of currents of short duration of 8/20 and 4/10ÿs waveshapes. Experimental data agree well with the proposed model.

Determination of the follow current in surge diverters

Using a suitable mathematical model, computations of power/follow current in surge diverters (lightning arresters) have been made from the known short-circuit capacity of the power-frequency source and the nonlinear resistor characteristics. Also the effect of the initiation angle is studied. Typical verifications with the available data have been carried out. The influence of arc drop in the surge-diverter spark gap is neglected.

Influence of surge impedance of the connecting lead in response time measurement of u.h.v. damped capacitive voltage dividers

In the determination of the response time of u.h.v. damped capacitive impulse voltage dividers using the CIGRE IMR-1MS group (1) method and the arrangement suggested by the International Electrotechnical Commission (the I EC square loop),the surge impedance of the connecting lead has been found to influence the accuracy of determination. To avoid this difficulty,a new graphical procedure is proposed. As this method uses only those data points which can be determined with good accuracy, errors in response-time area evaluation do not influence the result.

Hill Instability Analysis Of Tlp Tether Subjected To Combined Platform Surge And Heave Motions

This paper presents the Hill instability analysis of Tension Leg Platform (TLP) tether it, deep sea. The 2-D nonlinear beam model which is Undergoing Coupled axial and transverse vibrations, is applied. The governing equations are reduced to nonlinear Hill equation by use of the Galerkin's method and the modes superposition principle. The Hill instability charted Lip to large parameters is obtained. An important parameter M is defined and can he expressed as the functions of tether length, the platform surge and heave motion amplitudes. Some example studies are performed for various environmental conditions. The results demonstrate that the nonlinear coupling between the axial and transverse vibrations has a significant effect on the response of structure.. It needs to be considered for the accurate dynamic analysis of long TLP tether subjected to the combined platform surge and heave motions.