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In 1992 and 1995, Bartlett and Youd introduced empirical equations for the prediction of lateral spread displacement; these equations have gained wide use in engineering practice. The equations were developed from the multilinear regression (MLR) of a large case history database. This study corrects and updates the original analysis. Corrections and modifications include: (1) Bartlett and Youd erroneously overestimated measured displacements for lateral spreads generated by the 1983 Nihonkai-Chubu, Japan earthquake; those errors are corrected herein. (2) Several sites were deleted where boundary shear impeded free lateral displacement. (3) Data were added from three additional earthquakes. (4) The functional form of the mean-grain-size term was modified from (D5015) to log(D5015+0.1mm) to produce improved prediction of displacements for coarse-grained granular sites. (5) The functional form of the model was changed from log(R) to log(R*), where R* is a function of the magnitude of the earthquake, to preve...

A 44-year-old woman presented to our Emergency Department with a 4-day history of severe, sharp left upper quadrant abdominal pain associated with nausea and vomiting. She had been seen 3 days prior at another Emergency Department, and had a negative work-up including a normal non-contrast computed tomography (CT) scan of the abdomen/pelvis for possible kidney stone. Vital signs were: temperature 36.3°C (97.3°F), pulse 100 beats/min, respiratory rate 18 breaths/min, and blood pressure 141/80 mm Hg. Physical examination was remarkable for marked tenderness in the left upper and middle quadrants and voluntary guarding. Bowel sounds were normal. Although laboratory studies were normal, a CT scan of the abdomen/pelvis with intravenous contrast suggested a superior mesenteric artery dissection. This was confirmed with arteriography. The clinical presentation, diagnostic evaluation, and management of superior mesenteric artery dissection are reviewed.

Objectives On September 18, 2003, Hurricane Isabel made landfall as a category 2 hurricane over the mid-Atlantic region, generating record conditions for the region's 27 years of monitoring. The purpose of this study was to investigate the impact of the hurricane on the number and type of emergency department (ED) patient visits and its impact on hospital admission rate from the day of landfall to day 5 postlandfall. Comparisons were made with a control group, which comprised average daily ED census during the six-month period preceding landfall and the average daily admission rates for the preceding six months. Methods Designed as an observational cohort study, daily ED patient visits and admissions through the ED were tracked from the day of landfall to day 5 postlandfall. The study population included all ED patient visits at a six-hospital urban health care system, including a Level 1 trauma center in the coastal southeastern region of Virginia, with an aggregate annual ED volume of 261,000. Daily patient volumes, complaint categories, and admission rates were measured during the study period and compared with a control population that included average daily patient volumes, complaint categories, and admission rates at the same facilities for six months before landfall. During a 30-day postlandfall period, 63 emergency physicians on staff at the study hospitals were sent an ad hoc survey and asked to report their experiences if they worked during the study period. The survey included requests for future preparedness recommendations based on their experiences and are reported. Results During the six-month period preceding Hurricane Isabel, the average number of aggregate ED visits per day was 670. The average daily number of patient visits by complaint category included six major traumas, 483 medical complaints, 169 minor traumas, and 13 psychiatric complaints. On the day of landfall, the total aggregate ED volume was 359 (-46%), which included two (-66%) major traumas, 263 (-46%) medical complaints, 88 (-48%) minor traumas, and six (-54%) psychiatric complaints. During the subsequent four days postlandfall, there was a significant increase in average daily aggregate ED census of 840 (+25%) patient visits, which included three (-50%) major traumas, 564 (+17%) medical complaints, 263 (+57%) minor traumas, and ten (-23%) psychiatric complaints. The largest single-day increase in ED visits was day 1 postlandfall, with a 35% increase in daily volume (905 patient visits). The percentage of admissions from the ED to an inpatient unit on the day of landfall also demonstrated a significant increase (19%) compared with the control group (13%). Admission rates through the ED had appeared to normalize on day 1 postlandfall (12%). Response rate to the ad hoc physician survey by those who worked during the study period was 31.2% (10 of 32). The most common problem areas reported included communication failures, access to on-call personnel, and provider and nursing understaffing during the immediate postlandfall period. Conclusions A significant overall reduction in ED visits by almost half the typical average volume was noted on the day of landfall (-46%). During the four days immediately following landfall, however, there was a marked increase in the overall ED census, with a particularly high increase on day 1 postlandfall. The largest complaint category increase was minor trauma (+57%). Hospital admission rates were highest on the day of landfall and seemed to return to baseline on day 1 postlandfall. These data may be useful for structuring ED personnel and hospital resource allocation to better serve its community during hurricane preparedness planning.

Objective To discuss the various symptoms and causes of objective tinnitus in children. Study design Retrospective case review. Patients Five children who had audible signals emanating from their ears caused by audible spontaneous otoacoustic emissions, palatal myoclonus, arteriovenous malformation, and acoustic trauma. Main outcome measure The tinnitus reported by the patients was linked to acoustic signals that could be measured objectively or heard by the examiner. Results Four of the five children had essentially normal hearing. The one child who demonstrated a hearing loss audiometrically was thought to have normal hearing sensitivity, but his intense roaring objective tinnitus appeared to mask his low-frequency thresholds. All five patients had measurable acoustic signals in the ear canal that matched the patients' descriptions of their tinnitus. Conclusion The cases illustrate how the objective tinnitus was diagnosed and measured, how a treatment algorithm was applied, and the expected results of treatment. In addition, the cases provide support for the use of psychologic counseling throughout the examination and treatment of objective tinnitus in children.

We report Dysgonic Fermenter-type 2 septicaemia presenting in two previously healthy individuals, and review 52 cases of infection with Dysgonic Fermenter-type 2 reported in the English language literature. This zoonosis is usually acquired through contact with dogs and cats. Infection often presents with little warning to patient or physician and carries a high mortality. The immunosuppressed patient, those without a spleen, alcoholics and those with chronic disease appear to be most susceptible, although the healthy individual is also prone to infection. The infection is probably underdiagnosed due to difficulties in isolating Dysgonic Fermenter-type 2 by conventional blood culture techniques. Clinical and microbiological awareness is of prime importance in the early diagnosis of this potentially lethal infection.

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