Review of California Wildfire Evacuations from 2017 to 2019

Between 2017 and 2019, California experienced a series of devastating wildfires that together led over one million people to be ordered to evacuate. Due to the speed of many of these wildfires, residents across California found themselves in challenging evacuation situations, often at night and with little time to escape. These evacuations placed considerable stress on public resources and infrastructure for both transportation and sheltering. In the face of these clear challenges, transportation and emergency management agencies across California have widely varying levels of preparedness for major disasters, and nearly all agencies do not have the public resources to adequately and swiftly evacuate all populations in danger. To holistically address these challenges and bolster current disaster and evacuation planning, preparedness, and response in California, we summarize the evacuations of eleven major wildfires in California between 2017 and 2019 and offer a cross-comparison to highlight key similarities and differences. We present results of new empirical data we collected via an online survey of individuals impacted by: 1) the 2017 October Northern California Wildfires (n=79), 2) the 2017 December Southern California Wildfires (n=226), and 3) the 2018 Carr Wildfire (n=284). These data reveal the decision-making of individuals in these wildfires including choices related to evacuating or staying, departure timing, route, sheltering, destination, transportation mode, and reentry timing. We also present results related to communication and messaging, non-evacuee behavior, and opinion of government response. Using the summarized case studies and empirical evidence, we present a series of recommendations for agencies to prepare for, respond to, and recover from wildfires

Towards understanding the clinical significance of QT peak prolongation: a novel marker of myocardial ischemia independently demonstrated in two prospective studies

Background: QT peak prolongation identified patients at risk of death or non-fatal MI. We tested the hypothesis that QT peak prolongation might be associated with significant myocardial ischaemia in two separate cohorts to see how widely applicable the concept was. Methods and Results: In the first study, 134 stroke survivors were prospectively recruited and had 12-lead ECGs and Nuclear myocardial perfusion scanning. QT peak was measured in lead I of a 12-lead ECG and heart rate corrected by Bazett’s formula (QTpc). QTpc prolongation to 360ms or more was 92% specific at diagnosing severe myocardial ischaemia. This hypothesis-generating study led us to perform a second prospective study in a different cohort of patients who were referred for dobutamine stress echocardiography. 13 of 102 patients had significant myocardial ischaemia. Significant myocardial ischaemia was associated with QT peak prolongation at rest (mean 354ms, 95% CI 341-367ms, compared with mean 332ms, 95% CI 327-337ms in those without significant ischaemia; p=0.002). QT peak prolongation to 360ms or more was 88% specific at diagnosing significant myocardial ischaemia in the stress echocardiography study. QT peak prolongation to 360ms or more was associated with over 4-fold increase odds ratio of significant myocardial ischaemia. The Mantel- Haenszel Common Odds Ratio Estimate=4.4, 95% CI=1.2-16.0, p=0.023. Conclusion: QT peak (QTpc) prolongation to 360ms or more should make us suspect the presence of significant myocardial ischaemia. Such patients merit further investigations for potentially treatable ischaemic heart disease to reduce their risk of subsequent death or non-fatal MI

Custom-molded foot-orthosis intervention and multi-segment medial foot kinematics during walking

Context: Foot-orthosis (FO) intervention to prevent and treat numerous lower extremity injuries is widely accepted clinically. However, the results of quantitative gait analyses have been equivocal. The foot models used, participants receiving intervention, and orthoses used might contribute to the variability. Objective: To investigate the effect of a custom-molded FO intervention on multisegment medial foot kinematics during walking in participants with low-mobile foot posture. Design: Crossover study. Setting: University biomechanics and ergonomics laboratory. Patients or Other Participants: Sixteen participants with low-mobile foot posture (7 men, 9 women) were assigned randomly to 1 of 2 FO groups. Intervention(s): After a 2-week period to break in the FOs, individuals participated in a gait analysis that consisted of 5 successful walking trials (1.3 to 1.4 m/s) during no-FO and FO conditions. Main Outcome Measure(s): Three-dimensional displacements during 4 subphases of stance (loading response, mid- stance, terminal stance, preswing) were computed for each multisegment foot model articulation. Results: Repeated-measures analyses of variance (ANO- VAs) revealed that rearfoot complex dorsiflexion displacement during midstance was greater in the FO than the no-FO condition (F114 = 5.24, P=.O4, partial r|2 = 0.27). Terminal stance repeated-measures ANOVA results revealed insert-by-insert condition interactions for the first metatarsophalangeal ¡oint complex (F114=7.87, P=.O1, partial if = 0.36). However, additional follow-up analysis did not reveal differences between the no-FO and FO conditions for the balanced traditional ortho- sis (F, 14 = 4.32, P = .O8, partial if = 0.38) or full-contact orthosis (F1i14 = 4.10, P=.O8, partial if = 0.37). Conclusions: Greater rearfoot complex dorsiflexion during midstance associated with FO intervention may represent improved foot kinematics in people with low-mobile foot postures. Furthermore, FO intervention might partially correct dysfunctional kinematic patterns associated with low-mobile foot postures.