The 2017-19 activity at Mount Agung in Bali (Indonesia): Intense unrest, monitoring, crisis response, evacuation, and eruption.

After 53 years of quiescence, Mount Agung awoke in August 2017, with intense seismicity, measurable ground deformation, and thermal anomalies in the summit crater. Although the seismic unrest peaked in late September and early October, the volcano did not start erupting until 21 November. The most intense explosive eruptions with accompanying rapid lava effusion occurred between 25 and 29 November. Smaller infrequent explosions and extrusions continue through the present (June 2019). The delay between intense unrest and eruption caused considerable challenges to emergency responders, local and national governmental agencies, and the population of Bali near the volcano, including over 140,000 evacuees. This paper provides an overview of the volcanic activity at Mount Agung from the viewpoint of the volcano observatory and other scientists responding to the volcanic crisis. We discuss the volcanic activity as well as key data streams used to track it. We provide evidence that magma intruded into the mid-crust in early 2017, and again in August of that year, prior to intrusion of an inferred dike between Mount Agung and Batur Caldera that initiated an earthquake swarm in late September. We summarize efforts to forecast the behavior of the volcano, to quantify exclusion zones for evacuations, and to work with emergency responders and other government agencies to make decisions during a complex and tense volcanic crisis.

Costing nursing services using RVUs.

Keeping track of nursing resources consumed by each hospital inpatient does not have to be a cumbersome process. The authors present an inexpensive, straightforward approach to generate management information on nursing acuity by DRG, payor, hospital service, or physician.

Comparing acuity among hospitals. Who has the sickest patients?

A method by which nursing managers can determine the acuity level of their hospitals' patients, relative to other hospitals, is proposed. Without this information, it is difficult to justify higher staffing needs based on a sicker patient population than other hospitals.

Nurse staffing studies: no need to reinvent the wheel.

The authors estimate that hospitals spend $15,000,000 yearly on nurse staffing studies. Unfortunately, much of this annual investment is used to reinvent the wheel. Therefore, this article recommends standardizing the terminology and some of the basic principles for patient classification (the basis of nurse staffing systems) so that directors of nursing can better assess their organizations and make meaningful comparisons with other institutions. This article is adapted from a presentation at the annual meeting of the Hospital Management Systems Society, Tucson, Arizona, February 15, 1979.

Motor cycle helmets and facial injuries.

The design of motor cycle helmets has been changing over the years and at the present time there are two basic types in popular use: "full-face" and "jet" helmets. Both helmet types give good protection to the brain, but, one would think, different degrees of facial protection. A special study of traffic crashes has indicated that full-face helmets provide significantly greater protection against facial injury than do jet helmets. The study also indicated that the wearers of full-face helmets have no greater risk of involvement in road traffic crashes than do the wearers of jet helemts. It is suggested that the use of full-face helmets should be encouraged and consideration given to the revision of helmet standards to require the provision of facial protection.