Emergency Evacuation Route Planning Considering Human Behavior During Short- And No-notice Emergency Situations

Throughout United States and world history, disasters have caused not only significant loss of life, property but also enormous financial loss. The tsunami that occurred on December 26, 2004 is a telling example of the devastation that can occur unexpectedly. This unexpected natural event never happened before in this area. In addition, there was a lack of an emergency response plan for events of that magnitude. Therefore, this event resulted not only in a natural catastrophe for the people of South and Southeast Asia, but it is also considered one of the greatest natural disasters in world history. After the giant wave dissipated, there were more than 230,000 people dead and more than US$10 billion in property damage and loss. Another significant event was the terrorist incident on September 11, 2001 (commonly referred to as 9/11) in United States. This event was unexpected and an unnatural, i.e., man-made event. It resulted in approximately 3,000 lives lost and about US$21 billion in property damage. These and other unexpected (or unanticipated) events give emergency management officials short- or no-notice to prevent or respond to the situation. These and other facts motivate the need for better emergency evacuation route planning (EERP) approaches in order to minimize the loss of human lives and property in short- or no-notice emergency situations. This research considers aspects of evacuation routing that have received little attention in research and, more importantly, in practice. Previous EERP models only either consider unidirectional evacuee flow from the source of a hazard to destinations of safety or unidirectional emergency first responder flow to the hazard source. However, in real-life emergency situations, these heterogeneous, incompatible flows occur simultaneously over a bi-directional capacitated lane-based travel network, especially in short- and no-notice emergencies. After presenting a review of the work related to the multiple flow EERP problem, mathematical formulations are presented for the EERP problem where the objective for each problem is to identify an evacuation routing plan (i.e., a traffic flow schedule) that maximizes evacuee and responder flow and minimizes network clearance time of both types of flow. In addition, we integrate the general human response behavior flow pattern, where the cumulative flow behavior follows different degrees of an S-shaped curve depending upon the level of the evacuation order. We extend the analysis to consider potential traffic flow conflicts between the two types of flow under these conditions. A conflict occurs when flow of different types occupy a roadway segment at the same time. Further, with different degrees of flow movement flow for both evacuee and responder flow, the identification of points of flow congestion on the roadway segments that occur within the transportation network is investigated

Determined to die! Ability to act following multiple self-inflicted gunshot wounds to the head. The cook county office of medical examiner experience (2005-2012) and review of literature

Cases of multiple (considered 2+) self-inflicted gunshot wounds are a rarity and require careful examination of the scene of occurrence; thorough consideration of the decedent’s psychiatric, medical, and social histories; and accurate postmortem documentation of the gunshot wounds. We present a series of four cases of multiple self-inflicted gunshot wounds to the head from the Cook County Medical Examiner’s Office between 2005 and 2012 including the first case report of suicide involving eight gunshot wounds to the head. In addition, a review of the literature concerning multiple self-inflicted gunshot wounds to the head is performed. The majority of reported cases document two gunshot entrance wound defects. Temporal regions are the most common affected regions (especially the right and left temples). Determining the capability to act following a gunshot wound to the head is necessary in crime scene reconstruction and in differentiation between homicide and suicide

Gambling disorders, gambling type preferences, and psychiatric comorbidity among the Thai general population: Results of the 2013 National Mental Health Survey

Background and aims To estimate the prevalence of problem and pathological gambling, gender and age-group differences in gambling types, and comorbidities with other psychiatric disorders among the Thai general population. Methods Analysis was conducted on 4,727 participants of Thailand’s 2013 National Mental Health Survey, a multistage stratified cluster survey, using the Composite International Diagnostic Interview. Diagnoses of problem and pathological gambling and other psychiatric disorders were based on the DSM-IV-TR criteria with the following additional criteria for gamblers: more than 10 lifetime gambling episodes and a single year loss of at least 365 USD from gambling. Results The estimated lifetime prevalence rates of pathological and problem gambling were 0.90% [95% confidence interval (CI): 0.51–1.29] and 1.14% (95% CI: 0.58–1.70), respectively. The most popular type of gambling was playing lotteries [69.5%, standard error (SE) = 1.9], the prevalence of which was significantly higher among females and older age groups. The most common psychiatric disorders seen among pathological gamblers were alcohol abuse (57.4%), nicotine dependence (49.5%), and any drug use disorder (16.2%). Pathological gambling was highly prevalent among those who ever experienced major depressive episodes (5.5%), any drug dependence (5.1%), and intermittent explosive disorder (4.8%). The association between pathological gambling was strongest with a history of major depressive episode [adjusted odds ratio (AOR) = 10.4, 95% CI: 2.80–38.4]. Conclusion The study confirms the recognition of gambling disorders as a public health concern in Thailand and suggests a need for culturally specific preventive measures for pathological gamblers and those with a history of substance use disorders or major depression

Reliability and validity of the Thai version of the PHQ-9

<p>Abstract</p> <p>Background</p> <p>Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients.</p> <p>Methods</p> <p>The English language PHQ-9 was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, as well as final adjustments. The PHQ-9 was then administered among 1,000 patients in family practice clinic. Of these 1,000 patients, 300 were further assessed by the Thai version of the Mini International Neuropsychiatric Interview (MINI) and the Thai version of the Hamilton Rating Scale for Depression (HAM-D). These tools served as gold-standards for diagnosing depression and for assessing symptom severity, respectively. In the assessment, reliability and validity analyses, and receiver operating characteristic curve analysis were performed.</p> <p>Results</p> <p>Complete data were obtained from 924 participants and 279 interviewed respondents. The mean age of the participants was 45.0 years (SD = 14.3) and 73.7% of them were females. The mean PHQ-9 score was 4.93 (SD = 3.75). The Thai version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.79) and showed moderate convergent validity with the HAM-D (r = 0.56; P < 0.001). The categorical algorithm of the PHQ-9 had low sensitivity (0.53) but very high specificity (0.98) and positive likelihood ratio (27.37). Used as a continuous measure, the optimal cut-off score of PHQ-9 ≥ 9 revealed a sensitivity of 0.84, specificity of 0.77, positive predictive value (PPV) of 0.21, negative predictive value (NPV) of 0.99, and positive likelihood ratio of 3.71. The area under the curve (AUC) in this study was 0.89 (SD = 0.05, 95% CI 0.85 to 0.92).</p> <p>Conclusion</p> <p>The Thai version of the PHQ-9 has acceptable psychometric properties for screening for major depression in general practice with a recommended cut-off score of nine or greater.</p