Powering through the storm: estimating electric grid resilience using a power system cyclone impact model

Aim: Geographic variations in kidney transplant outcomes are well documented but poorly understood. This study aims to determine outcome variations among patients from three different states. Methods: A total of 917 renal transplant records were analyzed. Demographics and outcomes were retrospectively compared between the three states of New York (NY), New Jersey (NJ), and Pennsylvania (PA) from 2001 to 2012. The variables were compared with Chi-square test or Mann–Whitney test. We used Kaplan–Meier methodology to compare survival. Results: Higher waitlist times between NY and NJ recipients resulted in earlier transplantation when relisted in Philadelphia. PA recipients received a higher proportion of high-risk and hepatitis C virus (HCV) antibody-positive donors and were more likely to be HCV positive. PA recipients recorded the lowest rate of delayed graft function. Overall patient and graft survival rates at 1 and 3 years were not statistically different between the three states. However, by the end of the study, PA recipients exhibited the highest patient mortality and the highest retransplantation rates. Conclusion: One-year and 3-year patient and graft survival rates were not significantly different. This may be indicative of closer follow-up of PA recipients or longer wait times among NY and NJ candidates. Nevertheless, long-term outcomes were significantly worse in PA patients. Poor long-term outcome may be a manifestation of a sicker overall cohort. Medium-term transplantation results of those patients living in the favorable organ procurement organization are not negatively affected.

BackgroundOn April 17, 2020, the State of New York (NY) implemented an Executive Order that requires all people in NY to wear a face mask or covering in public settings where social distancing cannot be maintained. Although the Centers for Disease Control and Prevention recommended face mask use by the general public, there is a lack of evidence on the effect of face mask policies on the spread of COVID-19 at the state level.ObjectiveTo assess the impact of the Executive Order on face mask use on COVID-19 cases and mortality in NY.DesignA comparative interrupted time series analysis was used to assess the impact of the Executive Order in NY with Massachusetts (MA) as a comparison state.ParticipantsWe analyzed data on COVID-19 in NY and MA from March 25 to May 6, 2020.InterventionThe Executive Order on face mask use in NY.Main MeasuresDaily numbers of COVID-19 confirmed cases and deaths.Key ResultsThe average daily number of confirmed cases in NY decreased from 8549 to 5085 after the Executive Order took effect, with a trend change of 341 (95% CI, 187–496) cases per day. The average daily number of deaths decreased from 521 to 384 during the same two time periods, with a trend change of 52 (95% CI, 44–60) deaths per day. Compared to MA, the decreasing trend in NY was significantly greater for both daily numbers of confirmed cases (P = 0.003) and deaths (P < 0.001).ConclusionsThe Executive Order on face mask use in NY led to a significant decrease in both daily numbers of COVID-19 confirmed cases and deaths. Findings from this study provide important evidence to support state-level policies that require face mask use by the general public.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06476-9.

The host-feeding patterns of Anopheles quadrimaculatus Say and Anopheles punctipennis (Say) were examined in order to evaluate their potential contributions to the transmission of eastern equine encephalitis virus (EEEv) and other arboviruses in the northeastern U.S.A. Engorged mosquitoes of the two species were collected from EEEv foci in central New York (NY) and throughout New Jersey (NJ), and their bloodmeals were identified using a polymerase chain reaction (PCR)-based assay and sequencing portions of the mitochondrial cytochrome b gene. Analysis of 131 An. quadrimaculatus and 107 An. punctipennis from NY revealed that 97.7% and 97.2%, respectively, had acquired blood solely from mammalian hosts. Similarly, examination of 288 An. quadrimaculatus and 127 An. punctipennis from NJ showed 100% and 96.0%, respectively, contained mammalian-derived bloodmeals. Mosquitoes containing mixed bloodmeals from both avian and mammalian hosts were detected in 1.6% of An. quadrimaculatus from NY, and 2.8% and 4.0% of An. punctipennis from NY and NJ, respectively. White-tailed deer (Odocoileus virginianus) constituted the most common vertebrate host for these anopheline mosquitoes, accounting for 85.8-97.7% of all bloodmeals identified. The predominance of white-tailed deer as a source of bloodmeals supports enzootic amplification of deer-associated arboviruses in this region, including Jamestown Canyon, Cache Valley and Potosi viruses. One horse- and two human-derived bloodmeals were also detected in An. quadrimaculatus collected in NJ. Limited avian-derived bloodmeals were detected from mourning dove (Zenaida macroura), sharp-shinned hawk (Accipiter striatus) and house finch (Carpodacus mexicanus), mostly in mixed bloodmeals. Occasional feeding on avian hosts suggests that these mosquitoes may participate as epizootic-epidemic bridge vectors of EEEv from viraemic birds to mammalian hosts of concern, including horses and humans. An isolate of EEEv was recovered from the head and thorax of an An. punctipennis mosquito collected in NY.

Introduction. In March 2020, after the COVID-19 pandemic surged in New York City, higher education had to either halt or immediately convert to fully online education. Physical therapy program directors in New York (NY) State and New Jersey (NJ) immediately recognized a need to understand the new challenges facing students. Purpose. The purpose of this paper was to identify the challenges that students in physical therapist (PT)/physical therapist assistant (PTA) programs in NY and NJ were experiencing and how institutions could respond to those challenges. Subjects. Students enrolled in a PT or PTA program in NY or NJ; N = 934 (861 PT and 73 PTA). Methods. An online survey was distributed to PT/PTA programs in NY/NJ. The survey consisted of open-ended and closed-ended questions related to academic, financial, and nonacademic issues, transition to online learning, and how institutions could respond to student challenges. Descriptive statistics and thematic analysis were used. Results. The most important challenges that students identified were quality/quantity of hands-on experiences, lack of contact with classmates, personal physical and mental health/wellness, and affording tuition and fees. Some differences were found across geographical regions and graduating cohorts. Physical therapist and PTA student cohorts had the same top concerns. Five major themes emerged from open-ended questions: communication; safe return to campus for psychomotor skills; additional academic resources; recognition of students' financial, mental, and physical health concerns; and, financial support. Discussion and Conclusion. Students in physical therapy education in NY and NJ faced similar challenges because of COVID-19 as observed by other universities worldwide. Physical therapy education can be stressful, and these additional challenges made this time extremely difficult. The findings of this survey can be used to develop a crisis management plan for university emergencies that require program modifications.

Coastal communities in New Jersey (NJ), New York (NY), and Connecticut (CT) sustained huge structural loss during Sandy in 2012. We present a comprehensive science-based study to assess the role of coastal wetlands in buffering surge and wave in the tri-state by considering Sandy, a hypothetical Black Swan (BS) storm, and the 1% annual chance flood and wave event. Model simulations were conducted with and without existing coastal wetlands, using a dynamically coupled surge-wave model with two types of coastal wetlands. Simulated surge and wave for Sandy were verified with data at numerous stations. Structural loss estimated using real property data and latest damage functions agreed well with loss payout data. Results show that, on zip-code scale, the relative structural loss varies significantly with the percent wetland cover, the at-risk structural value, and the average wave crest height. Reduction in structural loss by coastal wetlands was low in Sandy, modest in the BS storm, and significant in the 1% annual chance flood and wave event. NJ wetlands helped to avoid 8%, 26%, 52% loss during Sandy, BS storm, and 1% event, respectively. This regression model can be used for wetland restoration planning to further reduce structural loss in coastal communities.

The aim of this study was to examine the effect of Medicaid expansion on non-traumatic dental condition (NTDC) emergency department visits in New York (NY) and New Jersey (NJ). The 2010-2014 State Emergency Department Databases for NY and NJ were analyzed. NTDCs were defined as ICD-9-CM codes 520.0-529.9. Primary payers for ED discharges and patient's race were considered. In NY, from 2010 to 2011, there was a 51 percent decrease in private insurance and a 91 percent increase in Medicaid for NTDCs. In NJ, with the 2014 expansion, NTDCs fell 35 percent for uninsured and rose 57 percent for Medicaid. Black individuals have by far the highest population rates of NTDC ED visits, particularly in NJ. The experiences in NY and NJ suggest that the timing of expansion had significant effects on payer distribution for NTDCs. Racial disparities continue exist with black individuals disproportionately accessing EDs for NTDCs.

Introduction. Faculty in U.S. physical therapy education programs made a rapid, reactive curricular modifications in response to the COVID-19 pandemic. The purpose of this study was to analyze the challenges and concerns of faculty in New York (NY) and New Jersey (NJ) during the pandemic, and their priorities for being adaptable, well-resourced programs moving forward. Review of Literature. The COVID-19 pandemic was a major program disruption for many physical therapy education programs. Historically, health profession programs making curricular transitions in response to unplanned disruptions realize benefits, but also challenges, limitations, and resource needs. Subjects. One hundred thirty-seven faculty across the 47 physical therapy education programs in NY and NJ participated in this study. Methods. A team of NY and NJ physical therapy education program directors and directors of clinical education generated an internet-based survey for analyzing the challenges and concerns NY and NJ faculty experienced during the COVID-19 pandemic in online teaching, personal challenges, academic issues, and campus activities. A mixed-methods approach was used to analyze the data from closed-end and open-ended questions. Statistical analysis was carried out on faculty demographics and ratings of challenges and concerns, and inductive thematic analysis of faculty responses to the open-ended questions. Results. Major faculty challenges were lack of contact, increased workload, and learning online technology. Major concerns were decreased quantity of hands-on laboratories, difficulty assessing student hands-on skills, delays in clinical education experiences, and student and faculty safety during on-campus activities. Six themes were identified: online education challenges, student and faculty safety, faculty personal needs, quality of student outcomes, communication, and administrative/institutional support. Discussion and Conclusion. An appreciation of faculty challenges and concerns during the COVID-19 pandemic and priorities for moving forward are important for programs making curricular transformations hybrid education to be better prepared for program disruptions.

There is growing recognition of disparities in chronic disease outcomes between Puerto Ricans on the island and those on the US mainland, yet comparative data are limited. We assessed the prevalence of key chronic conditions—Alzheimer’s disease and related dementias (ADRD), diabetes, and chronic kidney disease (CKD)—and total care costs for Medicare fee-for-service (FFS) beneficiaries in Puerto Rico (PR) compared to states with high older adult (65+) Puerto Rican populations [Florida (FL), New York (NY), Georgia (GA), New Jersey (NJ), California (CA)] from 2015 – 2020. We used data from the Mapping Medicare Disparities Tool from the Center for Medicare and Medicaid Services. Outcomes of interest included age-adjusted prevalence and risk-adjusted total costs per beneficiary. From 2015 – 2020, age-adjusted prevalence trends in PR showed decreases in ADRD by three percentage points (13% to 10%) and diabetes by six percentage points (46% to 40%). Conversely, CKD prevalence increased by 12 percentage points from 21% to 33%. Despite ADRD trends aligning with national averages, diabetes (PR: 40%, Nation: 26%, FL: 28%, NY: 27%, GA: 29%, NJ: 29%, CA: 24%) and CKD (PR: 33%, Nation: 25%, FL: 29%, NY: 24%, GA: 30%, NJ: 25%, CA: 23%) rates in Puerto Rico remain notably higher. Additionally, PR risk-adjusted average total spending per beneficiary in 2020 was below national averages for all assessed chronic conditions (ADRD: $13,037 vs. $20,678; diabetes: $11,363 vs. $15,525; CKD: $13,181 vs. $18,376). These disparities suggest potential impacts on access and quality of care and highlight the need for policy interventions.

The United States Army Corps of Engineers (USACE) New York District (NYD) has had a tremendous impact on an approximately $6 billion comprehensive coastal storm risk management program in the last 10 years since Hurricane Sandy caused significant damage in the New York (NY) and New Jersey (NJ) area. There was 2013- 2014 emergency repair and restoration to existing beach nourishment and navigation projects, but also USACE NYD accomplished the planning and design for multiple coastal storm risk management projects in the NY and NJ area. Of those projects, specific coastal risk reduction features are described for the Sea Bright to Manasquan, NJ; East Rockaway Inlet to Rockaway Inlet, NY; and Montauk Point Lighthouse Stabilization, NY. The planning and design for these projects exemplifies resilience principles and planned adaptability to withstand the challenges of the dynamic coastal environment. The USACE NYD is faced with numerous challenges such as environmental restrictions, politics, real estate, sea level change, etc.; the magnitude of coastal planning, design and construction that has occurred over these past 10 years for the NYD studies and projects demonstrates the fortitude of collaboration combined with current and innovative engineering principles.

<h3>Context:</h3> Currently, less than 5% of family medicine practices offer first-trimester abortion services, which means that most patients must seek services at specialty family planning facilities. Since abortion is often excluded from insurance coverage, patients pay up to $800 out-of-pocket. Medication abortion via telehealth is much cheaper ($150-$400). Still, many patients cannot afford this amount. To expand affordability, Aid Access – an asynchronous clinician-supported online abortion service - implemented a sliding-scale payment option that allows patients who ask for a discounted rate to choose a payment amount between $0 and $150 or use Medicaid if located in New York (NY). With the availability of telemedicine, more family medicine providers are starting to offer medication abortion services. It is important to understand the financial needs of patients seeking abortion so family physicians can implement payment options that increase access to these essential services. <h3>Objective:</h3> Analyze percent of patients who utilized sliding scale payment option including Medicaid in NY, along with how much was paid. <h3>Study Design:</h3> Retrospective chart review. <h3>Setting or Dataset:</h3> De-identified data from Aid Access patients served by family physicians in Washington (WA), New Jersey (NJ), and NY, including payment information. <h3>Population Studied:</h3> Patients who received mifepristone, misoprostol medication abortion through Aid Access in WA, NJ, and NY between April and November 2020 (n=504). <h3>Main and Secondary Outcome Measures:</h3> (1) Percent of patients who used the sliding scale payment option; (2) Percent of patients who paid $0, $1-$30, $31-$60, $61-90, and $91-$120, or used Medicaid. <h3>Results:</h3> Out of 504 patients, 24% (n=120) paid for their medication abortion use the sliding scale option and 3% (n=17) used Medicaid. Of the 120 patients using the sliding scale: 13% (n=16) paid $0, 11% (n=13) paid $1-$30, 28% (n=34) paid $31-$60, 28% (n=34) paid $61-$90, and 20% (n=24) paid $91-$120. <h3>Conclusions:</h3> Although most patients paid full price ($150) for their abortion, the sliding scale option including Medicaid was necessary for over 25% of patients. Of those who utilized the sliding scale, most patients paid less than half of the full price. In order to provide medication abortion services to those who need it, it is important to implement payment options such as the sliding-scale method.

Hurricane storm surge depends on the tidal stage, barometric pressure, Coriolis effect, wind stress, and wave forcing, as well as the local bathymetry. In the past, storm surge numerical models, such as Sea, Lake, and Overland Surges from Hurricanes (SLOSH), neglect wave forcing components to conserve computational efficiency. However, since hurricane wind, storm surge, and waves are coupled phenomena, numerous situations necessitate the inclusion of waves' effects to more correctly model hurricane storm surge. This paper describes the result of a collaborative effort by the National Institute of Standards and Technology (NIST), the National Oceanic and Atmospheric Administration (NOAA), and the University of Florida (UFl) to incorporate a wave model into the SLOSH model to extend its capability for storm surge simulation. A two-way coupling methodology was developed to incorporate two wave forcing components, that is, set-up from wave stresses and mass flux transport, into the SLOSH model. The aim was to better understand the relative contribution of each effect and their relationship to both storm strength and bathymetry. To this end, numerous simulations with different forcing variations (wind-stress only, wind and wave stresses, and wind and wave stresses with mass flux transport) were performed. The wind stresses used for the simulations were based on three hurricanes with different intensities, and the simulations were conducted for two basins with contrasting bathymetry in Florida (shallow and steep slopes). The results show that the impact of wave set-up and mass flux to storm surge levels varies between locations – even for the same storm in the same basin – proving that the interaction between the wind and wave forcing components is indeed complex. On average, however, the addition of the wave set-up and mass flux raised the maximum storm surge levels 10 to 30 percent, although isolated positions experience increased well above 100 percent.

: Maintaining economic viability in the rapidly developing global marketplace is a major priority of ports nationwide It is imperative that commercial ports, such as those in New York (NY) and New Jersey (NJ), evolve to remain competitive with developing global infrastructure. As a consequence, the U.S. Army Engineer District, New York, and the Port Authority of New York and New Jersey are going forward with plans to deepen existing channels for use by the newest generation of container ships. This will include the deepening of several waterways, most prominently the Kill van Kull (KVK), Arthur Kill (AK), and Port Jersey Channel, to a depth of 50 ft. A significant by-product of each deepening project will be large amounts of dredged material. In the case of the KVK and AK, the material will be composed predominantly of bedrock. As a result, the U.S. Army Corps of Engineers has commissioned a series of investigations into the viability of beneficially using dredged bedrock in the NY/NJ Harbor. This report outlines how numerous beneficial use opportunities can become feasible based on bedrock characteristics, case-specific constraints, and applicable regulatory concerns. Beneficial uses of bedrock are promoted by legislative acts. A few uses have been practiced routinely in this region. This report seeks to highlight considerations toward broader uses of bedrock commensurate with projected dredging volumes. This report does not seek to compare the relative merit or cost differential between viable beneficial use opportunities. Information regarding the method for determining the feasibility assessments is detailed.

PATIENTS WITH MEDICARE AS THE PRIMARY PAYER ARE LESS LIKELY TO UNDERGO NEPHRON SPARING SURGERY (NSS) FOR RENAL CELL CARCINOMA (RCC) THAN THEIR PRIVATELY INSURED COUNTERPARTS

DECREASING UTILIZATION OF LHRH-AGONISTS IN THE UNITED STATES IS INDEPENDENT OF REIMBURSEMENT CHANGES: A MEDICARE AND VETERANS HEALTH ADMINISTRATION CLAIMS ANALYSIS

This article describes a simple Susceptible Infected Recovered (SIR) model fitting with COVID-19 data for the month of March 2020 in New York (NY) state. The model is a classical SIR, but is non-autonomous; the rate of susceptible people becoming infected is adjusted over time in order to fit the available data. The death rate is also secondarily adjusted. Our fitting is made under the assumption that due to limiting number of tests, a large part of the infected population has not been tested positive. In the last part, we extend the model to take into account the daily fluxes between New Jersey (NJ) and NY states and fit the data for both states. Our simple model fits the available data, and illustrates typical dynamics of the disease: exponential increase, apex and decrease. The model highlights a decrease in the transmission rate over the period which gives a quantitative illustration about how lockdown policies reduce the spread of the pandemic. The coupled model with NY and NJ states shows a wave in NJ following the NY wave, illustrating the mechanism of spread from one attractive hot spot to its neighbor.