Background Drug overdose is the leading cause of injury related fatality in the United States, and respiratory failure remains a major source of morbidity and mortality. Objectives We aimed to identify the incidence and risk factors for endotracheal intubation following acute drug overdose. Methods This secondary data analysis was performed on a 5-year prospective cohort at two urban tertiary-care hospitals. The present study analyzed adult patients with suspected acute drug overdose to derive independent clinical predictors of endotracheal intubation. Results We analyzed 2,497 patients with acute drug overdose, of whom 87 (3.5%) underwent endotracheal intubation. Independent clinical risk factors for endotracheal intubation were: younger age (OR 0.97, CI 0.96-0.98), and history of obstructive lung disease (OR 6.6, CI 3.5-12.3); however, heart failure had no association. Patients with obstructive lung disease had significantly more hypercapnea (mean difference 6.8mmHg, CI 2.3-11.3) and a higher degree of acidemia (mean pH difference 0.04, CI 0.01-0.07) than patients without obstructive lung disease. Lack of rapid sequence sedative/paralytic was associated with in-hospital fatality. Early complications of endotracheal intubation itself included desaturation (3.4%) and bradycardia (1%). Conclusions Endotracheal intubation was infrequently performed on patients with acute drug overdose, and complications were rare when performed. Risk factors associated with endotracheal intubation included younger age and prior obstructive lung disease.

The design procedure of Multi Nozzle Grid (MNG) has become possible with the viscous losses value obtained in a series of characterization testing. These tests were conducted using hybrid-liquid/solid motor configurations in which a single nozzle was replaced by a shorter MNG plate to improve the performance of the hybrid's flight configuration. A single nozzle that shares the same scaled nozzle contour and overall throat area as well as exit area is called an Equivalent Single Nozzle (ESN). The MNG configuration includes 85 nozzlettes all having the scaled-down contour as that of the ESN. Since the tests were static with no need for flight worthy hardware, the resulting ESN is quite heavy. Data from three MNG hot-firings tests were compared to data from a single hot-fire test of the ESN to quantify the viability and advantages of the MNG. The results show that viscous losses in the flow through the MNG drop the efficiency by 3% vs. that of the ESN. But when compared to a Conventional Single Nozzle (CSN) commonly used in air vehicles, the MNG system may improve performance by more than 11% due to length and mass saving.

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Based on the grid-nesting method proposed by the present author (1974), a Movable, multi-Nested Grid scheme (hereafter, MNG) is formulated to apply to a three-level primitive equation model in the a-coordinate system. The outermost grid size is 381 km at 6*N and the mesh ratio for each inner subdomain is one half. The interface condition between different nets is the so called "two-way" interaction. The Euler-backward scheme is adopted for the time integration. The heating due to cumulus ensemble is represented in the same way as the circular symmetric heating function proposed by Harrison (1973). Several preliminary tests have been carried out to examine the computational characteristics of the scheme and to see how the present MNG method works with real data (T7609, T7617, T7709 and T7711) produced by the JMA operational objective analysis system. The grid values of the finer grid net are calculated by a cubic interpolation formula step by step, and analyzed values on the innermost grid are modified as a results of the superposition of the symmetric model typhoon which is specified by the observed diameter of typhoon, the central surface pressure, the maximum surface wind and the temperature anomaly. The scheme has been tested with the 3-and 4-step MNG's. The predicted trajectories of the typhoon with these MNG's show the trend of improvement compared with those obtained by the JMA operational numerical weather prediction models. In addition, the three-dimensional structure simulated by the proposed 4-step MNG scheme is also discussed .