Assessment of human immediate response capability related to tsunami threats in Indonesia at a sub-national scale

Human immediate response is contextualized into different time compartments reflecting the tsunami early warning chain. Based on the different time compartments the available response time and evacuation time is quantified. The latter incorporates accessibility of safe areas determined by a hazard assessment, as well as environmental and demographic impacts on evacuation speed properties assessed using a Cost Distance Weighting GIS approach. Approximately 4.35 million Indonesians live in tsunami endangered areas on the southern coasts of Sumatra, Java and Bali and have between 20 and 150 min to reach a tsunami-safe area. Most endangered areas feature longer estimated-evacuation times and hence the population possesses a weak immediate response capability leaving them more vulnerable to being directly impacted by a tsunami. At a sub-national scale these hotspots were identified and include: the Mentawai islands off the Sumatra coast, various sub-districts on Sumatra and west and east Java. Based on the presented approach a temporal dynamic estimation of casualties and displacements as a function of available response time is obtained for the entire coastal area. As an example, a worst case tsunami scenario for Kuta (Bali) results in casualties of 25 000 with an optimal response time (direct evacuation when receiving a tsunami warning) and 120 000 for minimal response time (no evacuation). The estimated casualties correspond well to observed/reported values and overall model uncertainty is low with a standard error of 5%. The results obtained allow for prioritization of intervention measures such as early warning chain, evacuation and contingency planning, awareness and preparedness strategies down to a sub-district level and can be used in tsunami early warning decision support

Acupuncture in Seasonal Allergic Rhinitis (ACUSAR) - Design and Protocol of a Randomised Controlled Multi-Centre Trial

Background: We report on the study design and protocol of a randomised controlled trial (Acupuncture in Seasonal Allergic Rhinitis, ACUSAR) that investigates the efficacy of acupuncture in the treatment of seasonal allergic rhinitis (SAR). Objective: To investigate whether acupuncture is non-inferior or superior to (a) penetrating sham acupuncture and (b) rescue medication in the treatment of SAR. Design: 3-armed, randomised controlled multi-centre trial with a total follow-up time of 16 weeks in the 1st year and 8 weeks in the 2nd year. Setting: 41 physicians in 37 out-patient units in Germany specialised in acupuncture treatment. Patients: 400 seasonal allergic rhinitis patients with clinical symptoms and test-positive (skin-prick test and/or specific IgE) to both birch and grass pollen. Interventions: Patients will be randomised in a 2:1:1 ratio to one of three groups: (a) semi-standardised acupuncture plus rescue medication (cetirizine); (b) penetrating sham acupuncture at non-acupuncture points plus rescue medication; or (c) rescue medication alone for 8 weeks (standard treatment group). Acupuncture and sham acupuncture will consist of 12 treatments per patient over 8 weeks. Main Outcome Measures: Average means of the Rhinitis Quality of Life Questionnaire (RQLQ) overall score and the Rescue Medication Score (RMS) between weeks 6 and 8 in the first year, adjusted for baseline values. Outlook: The results of this trial available in 2011 will have a major impact on the decision of whether acupuncture should be considered as a therapeutic option in the treatment of SAR

Efficacy of Injections with Disci/Rhus Toxicodendron Compositum for Chronic Low Back Pain – A Randomized Placebo-Controlled Trial

The effectiveness of injection therapy for low-back pain is still debatable. We compared the efficacy of local injections of the homeopathic preparation Disci/Rhus toxicodendron compositum (verum) with placebo injections and with no treatment in patients with chronic low back pain.In a randomized controlled partly double blind multicenter trial patients with chronic low back pain from 9 German outpatient clinics were enrolled and randomly allocated in a 1∶1∶1 ratio to receive subcutaneous injections (verum or placebo) into painful sites on the lower back over 12 treatment sessions within eight weeks, or no treatment (rescue pain medication with paracetamol or NSAIDs). All trial personnel and participants were masked to treatment allocation. The primary outcome measure was the average pain intensity over the last seven days on a visual analogue scale (0-100 mm, 0 = no pain, 100 = worst imaginable pain) after eight weeks. Follow-up was 26 weeks. Primary analysis was by intention to treat. Between August 2007 and June 2008, 150 patients were randomly allocated to three groups (51 verum, 48 placebo and 51 no treatment). The mean baseline-adjusted low back pain intensity at week eight was: verum group 37.0 mm (97.5% CI 25.3;48.8), no treatment group 53.0 (41.8;64.2), and placebo group 41.8 (30.1;53.6). The verum was significantly superior to no treatment (P = 0.001), but not to placebo (P = 0.350). No significant side effects were reported.The homeopathic preparation was not superior to placebo. Compared to no treatment injections resulted in significant and clinical relevant chronic back pain relief.ClinicalTrials.gov NCT00567736

Current achievements to reduce deforestation in Kalimantan

Indonesia has developed its forest reference emission level (FREL), using a historical reference period of 1990-2012. Based on official Ministry of Environment and Forestry (MoEF) data, this paper analyses gross deforestation rates and emissions from deforestation in the five provinces of the island of Kalimantan which occurred in the time after 2012, i.e. 2013 until 2015, and puts them in relation to the average annual deforestation and emission rates of each province in the reference period. Even though the overall linear trend of deforestation and emission rates in Kalimantan from 1990 until 2015 goes down, this trend is not reflected in all of the five provinces equally. West and North Kalimantan’s rates even seem to be on the rise. The potentials to achieve emission reduction targets thus remain unequal for each province in Kalimantan Island

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Spatio-Temporal Population Distribution and Evacuation Modeling for Improving Tsunami Risk Assessment in the Lisbon Metropolitan Area

Lisbon, Portugal, is subject to significant risk of tsunami, and was hit by a very destructive earthquake-triggered tsunami during daytime in 1755. The Regional Plan for Territorial Management for the Lisbon Metropolitan Area (PROT), under discussion, includes a tsunami hazard map, showing that significant urbanized areas may be at risk of inundation. In order to consider the time dependence of population exposure to tsunami threats, we map and analyze the spatio-temporal population distribution in the daily cycle in the Lisbon Metropolitan Area. High-resolution day- and nighttime population distribution maps are developed using ‘intelligent dasymetric mapping’, i.e. using areal interpolation to combine best-available census data and statistics with land use and land cover data. Mobility statistics are considered for mapping daytime distribution, and empirical parameters used for interpolation are obtained from a previous modeling effort of part of the study area. In combination with the tsunami hazard map, information on infrastructure, land use and terrain slope, the modeled population distribution is used to assess people’s evacuation times, applying a GIS-based evacuation modeling approach to the city of Lisbon. The detailed spatio-temporal population exposure assessment allows producing both day- and nighttime evacuation time maps, which provide valuable input for evacuation planning and management. Results show that a significant amount of population is potentially at risk, and its numbers increase dramatically from nighttime to daytime, especially in the zones of high susceptibility. Also, full evacuation can be problematic in the daytime period, even if initiated immediately after a major earthquake. The presented approach is considered to greatly improve risk mapping and assessment and can benefit all phases of the disaster management process

On the importance of risk knowledge for an end-to-end tsunami early warning system

Warning systems commonly use information provided by networks of sensors able to monitor and detect impending disasters, aggregate and condense these information to provide reliable information to a decision maker whether to warn or not, disseminates the warning message and provide this information to people at risk. Ultimate aim is to enable those in danger to make decisions (e.g. initiate protective actions for buildings) and to take action to safe their lives. This involves very complex issues when considering all four elements of early warning systems (UNISDR-PPEW), namely (1) risk knowledge, (2) monitoring and warning service, (3) dissemination and communication, (4) response capability with the ultimate aim to gain as much time as possible to empower individuals and communities to act in an appropriate manner to reduce injury, loss of life, damage to property and the environment and loss of livelihoods. Commonly most warning systems feature strengths and main attention on the technical/structural dimension (monitoring & warning service, dissemination tools) with weaknesses and less attention on social/cultural dimension (e.g. human response capabilities, defined warning chain to and knowing what to do by the people). Also, the use of risk knowledge in early warning most often is treated in a theoretical manner (knowing that it is somehow important), yet less in an operational, practical sense. Risk assessments and risk maps help to motivate people, prioritise early warning system needs and guide preparations for response and disaster prevention activities. Beyond this risk knowledge can be seen as a tie between national level early warning and community level reaction schemes. This presentation focuses on results, key findings and lessons-learnt related to tsunami risk assessment in the context of early warning within the GITEWS (German-Indonesian Tsunami Early Warning) project. Here a novel methodology reflecting risk information needs in the early warning context has been worked out. The generated results contribute significantly in the fields of (1) warning decision and warning levels, (2) warning dissemination and warning message content, (3) early warning chain planning, (4) increasing response capabilities and protective systems, (5) emergency relief and (6) enhancing communities’ awareness and preparedness towards tsunami threats. Additionally examples will be given on the potentials of an operational use of risk information in early warning systems as first experiences exist for the tsunami early warning center in Jakarta, Indonesia. Beside this the importance of linking national level early warning information with tsunami risk information available at the local level (e.g. linking warning message information on expected intensity with respective tsunami hazard zone maps at community level for effective evacuation) will be demonstrated through experiences gained in three pilot areas in Indonesia. The presentation seeks to provide new insights on benefits using risk information in early warning and will provide further evidence that practical use of risk information is an important and indispensable component of end-to-end early warning