Seasonal characteristics of flood regimes across the Alpine-Carpathian range.

The aim of this paper is to analyse the differences in the long-term regimes of extreme precipitation and floods across the Alpine-Carpathian range using seasonality indices and atmospheric circulation patterns to understand the main flood-producing processes. This is supported by cluster analyses to identify areas of similar flood processes, both in terms of precipitation forcing and catchment processes. The results allow to isolate regions of similar flood generation processes including southerly versus westerly circulation patterns, effects of soil moisture seasonality due to evaporation and effects of soil moisture seasonality due to snow melt. In many regions of the Alpine-Carpathian range, there is a distinct shift in flood generating processes with flood magnitude as evidenced by a shift from summer to autumn floods. It is argued that the synoptic approach proposed here is valuable in both flood analysis and flood estimation.

Prospective analysis of mental status progression in ethanol-intoxicated patients.

Distinguishing patients with uncomplicated ethanol intoxication from intoxicated patients with other causes of mental status depression is a common clinical dilemma. The authors serially tested mental status in a group of ethanol-intoxicated patients to determine the interval over which mental status changes could be attributed to uncomplicated intoxication. Study patients were identified by (1) admission breath ethanol greater than or equal to 100 mg/dL; (2) ethanol-related impairment necessitating further observation or treatment; and (3) not critically ill or exhibiting focal neurologic signs. Mental status scores (sums of specific indices of alertness, orientation, and agitation) were determined initially, 1 hour after arrival, then every 2 hours. Causes of mental status depression other than acute intoxication were diagnosed in 16 patients, while another 18 failed to completely normalize mental status by the time of emergency department discharge or hospital admission. The remaining 71 with uncomplicated ethanol intoxication required (mean +/- SD) 3.2 +/- 3.6 hours to normalize mental status scores. A large proportion, however, took considerably longer to normalize mental status: 15 (21%) took 7 or more hours, and three (4%) took as long as 11 hours. Although patients with ethanol-associated depression of mental status lasting 3 hours after emergency department admission should be carefully evaluated for other causes of mental status abnormalities, the authors' observations indicate considerable individual variation in the duration of mental status depression caused by uncomplicated ethanol intoxication.

The John Doe syndrome: diagnosis and outcome of patients unidentified at the time of emergency department admission.

Patients unidentified at the time of admission to urban emergency departments are a group about whom little is known. To determine the medical diagnoses and outcomes of these "John" and "Mary Does", we reviewed emergency department charts for these patients admitted from January 1 to December 31, 1988. During this period there were 344 initially unidentifiable patients, for 0.44% of all visits. Age was 36.9 +/- 15.6 years (mean +/- SD); 71% were male. All patients had one or more of the following diagnoses, with mortality highest for cardiopulmonary arrest (n = 42, mortality = 100%), followed by major trauma (163, 68%), drug overdose (27, 41%), miscellaneous medical conditions (11, 18%), neuropsychiatric disorders (59, 12%), acute alcohol intoxication (62, 0%), and seizures (13, 0%). Overall mortality was 47%. Identification was made prior to hospital discharge in 92% of cases. In this group, the most common sources of information were the patient (38%), family (19%), or documents eventually found on the person or in belongings (4%). Survivors were much more likely to be identified than those who died (99% versus 84%, P less than .0001). These observations describe a John Doe syndrome in patients whose identity is obscured by critical illness, the effects of drugs or alcohol, or neuropsychiatric disease. Economic privation is a major underlying risk factor.