Prolonged Loss Research Articles

Changes to Intestinal Transport Physiology and Carbonate Production at Various CO2 Levels in a Marine Teleost, the Gulf Toadfish (Opsanus beta).

Most marine teleosts defend blood pH during high CO2 exposure by sustaining elevated levels of HCO3(-) in body fluids. In contrast to the gill, where measures are taken to achieve net base retention, elevated CO2 leads to base loss in the intestine of marine teleosts studied to date. This loss is thought to occur through transport pathways previously demonstrated to be involved with routine osmoregulation in marine teleosts. The main objective of this study was to characterize the intestinal transport physiology of the gulf toadfish (Opsanus beta) when exposed to varied levels of CO2: control, 5,000, 10,000, and 20,000 μatm CO2 (0.04, 0.5, 1, and 2 kPa, respectively). Results of this study suggest that intestinal apical anion exchange is highly responsive to hypercarbia, evidenced by a dose-dependent increase in intestinal luminal HCO3(-) (mmol L(-1)) that was mirrored by a reduction in Cl(-) (mmol L(-1)). Despite activation of HCO3(-) transport pathways typically used during osmoregulation, fractional fluid absorption was only significantly lower at the highest level of CO2. Although increased HCO3(-) excretion could provide more substrate for intestinally produced carbonates, carbonate production was not significantly increased during hypercarbia at the levels tested. This study is among the first to thoroughly characterize how compensation for elevated CO2 affects transport physiology and carbonate production in the marine fish intestine. This deeper understanding may be particularly relevant when considering the impacts of future predicted ocean acidification, where prolonged base loss may alter the energetic cost of acid-base balance or osmoregulation in marine fish.

The effect of progressive hearing loss on the morphology of endbulbs of Held and bushy cells

Studies of congenital and early-onset deafness have demonstrated that an absence of peripheral sound-evoked activity in the auditory nerve causes pathological changes in central auditory structures. The aim of this study was to establish whether progressive acquired hearing loss could lead to similar brain changes that would degrade the precision of signal transmission. We used complementary physiologic hearing tests and microscopic techniques to study the combined effect of both magnitude and duration of hearing loss on one of the first auditory synapses in the brain, the endbulb of Held (EB), along with its bushy cell (BC) target in the anteroventral cochlear nucleus. We compared two hearing mouse strains (CBA/Ca and heterozygous shaker-2+/−) against a model of early-onset progressive hearing loss (DBA/2) and a model of congenital deafness (homozygous shaker-2−/−), examining each strain at 1, 3, and 6 months of age. Furthermore, we employed a frequency model of the mouse cochlear nucleus to constrain our analyses to regions most likely to exhibit graded changes in hearing function with time. No significant differences in the gross morphology of EB or BC structure were observed in 1-month-old animals, indicating uninterrupted development. However, in animals with hearing loss, both EBs and BCs exhibited a graded reduction in size that paralleled the hearing loss, with the most severe pathology seen in deaf 6-month-old shaker-2−/− mice. Ultrastructural pathologies associated with hearing loss were less dramatic: minor changes were observed in terminal size but mitochondrial fraction and postsynaptic densities remained relatively stable. These results indicate that acquired progressive hearing loss can have consequences on auditory brain structure, with prolonged loss leading to greater pathologies. Our findings suggest a role for early intervention with assistive devices in order to mitigate long-term pathology and loss of function.

Risk Factors and Outcome Analysis in Children with Carbon Monoxide Poisoning

Carbon monoxide (CO) poisoning is one of the common causes of poisoning in patients and can result in significant morbidity and mortality. However, few studies have focused on the pediatric group. We retrospectively reviewed children (age<18years) with CO poisoning from nonfire accidents at a tertiary medical center in Taiwan from 2002 to 2010. We analyzed the patients' characteristics, management, and outcome; compared the data of patients who received hyperbaric oxygen (HBO) to those who received normobaric oxygen (NBO) therapy; and identified the ri0sk factors for patients who developed delayed neurological sequelae (DNS) or permanent neurological sequelae (PNS). A total of 81 children were enrolled. The annual case number increased from five cases in 2002 to 20 in 2010, particularly during the cold months (December to February). The most common source of exposure was an indoor heating system (54.3%). The most common presenting symptoms were vomiting (32.1%) and consciousness changes (30.9%). HBO treatment tended to be administered to patients with a higher initial COHb (%) (p<0.001), an initial Glasgow coma scale change (p<0.001), and admission to the hospital (p=0.002). After multivariate analysis, treatment in the intensive care unit because of prolonged loss of consciousness (p=0.002) was the only independent risk factor for patients with DNS; only rescue by a ventilator (p<0.001) was an independent risk factor for patients with PNS. In comparison to the NBO therapy, HBO treatment did not show benefit or harm to patients according to the incidence of inducing DNS or PNS after multivariate analysis. For those with treatment in the intensive care unit because of prolonged loss of consciousness and rescue by a ventilator, special attention should be given and follow-up should be performed to determine whether DNS or PNS occurs, particularly epilepsy and cognitive deficits.

Which individuals become fatter when they practice exercise?

Summary Introduction It is well established that high volumes (15–20 h/week) of physical activity at intensities > 60% VO 2max , as well as low volumes (2–3 hrs/wk) of low intensity exercise targeted in the zone of the LIPOXmax (around 40% VO 2max ) allow a significant and prolonged loss of fat mass. By contrast it is not uncommon to observe patients whose fat mass increases when they practice low volumes of activity at intensity around or above 60% VO 2max . This paradoxical situation has surprisingly retained little attention. This study aimed at characterizing these patients. Methods Over 2 years we observed and investigated 26 patients (5 men and 13 women) aged 21 to 69 who gained weight when they began to engage in physical activity. They weighed 62 to 144 kg. These patients achieved an exercise calorimetry and segmental impedance and we compared to 15 matched subjects (2 men and 13 women) who gradually lose weight with a protocol of physical activity at low to moderate intensity. Results There are no differences in body composition. Exercise calorimetry evidences that the ability of these subjects to oxidize lipid was both significantly lower (8.10 ± 0.49 vs 10.8 ± 1.04 mg/min/kg of muscle, P P = 0.05). The level where there is no longer lipid oxidation and an exclusive use of carbohydrates also occurs in these subjects at a lower intensity (61.7 ± 3.1% vs 75.18 ± 5.90% VO 2max , P Conclusion Therefore, paradoxical weight gain due to low volume of exercise at > 60% VO 2max is not uncommon, although it seems a priori illogical and is thus largely ignored. It seems to be primarily determined by a targeting above the area of lipid oxidation, resulting into orexigenic falls in blood glucose, mostly in subjects that are low fat oxidizers. The glucose lowering effect of exercise performed in water may also favor this mechanism.

The impact of a standardized program on short and long-term outcomes in bariatric surgery.

Analysis of the OBN registry data was performed by fiscal year between April 2010 and March 2015. Three-month overall postoperative complication rates and 30day postoperative mortality were calculated. The mean percentage of weight loss at 1, 2, and 3years postoperative, and regression of obesity-related diseases were calculated. The analysis of continuous and nominal data was performed using ANOVA, Chi-square, and McNemar's testing. A multiple logistic regression analysis was performed for factors affecting postoperative complication rate. Eight thousand and forty-three patients were included in the bariatric registry between April 2010 and March 2015. Thirty-day mortality was rare (<0.075%) and showed no significant difference between years. Three-month overall postoperative complication rates significantly decreased with standardization (p<0.001), as did intra-operative complication rates (p<-0.001). Regression analysis demonstrated increasing standardization to be a predictor of 3month complication rate OR of 0.59 (95%CI 0.41-0.85, p=0.00385). The mean percentage of weight loss at 1, 2, and 3years postoperative showed stability at 33.2% (9.0 SD), 34.1% (10.1 SD), and 32.7% (10.1 SD), respectively. Sustained regression in obesity-related comorbidities was demonstrated at 1, 2, and 3years postoperative. Evidence indicates the implementation of a standardized system of bariatric care has contributed to improvements in complication rates and supported prolonged weight loss and regression of obesity-related diseases in patients undergoing bariatric surgery in Ontario.

Histoplasma capsulatumInfection with Extensive Lytic Bone Lesions Mimicking LCH

Multiple lytic bone lesions in a child can be a manifestation of various diseases like Langerhans cell histiocytosis, metastatic neuroblastoma, leukemia, hyperparathyroidism, multifocal osteomyelitis and histoplasmosis. Disseminated histoplasmosis caused by Histoplasma capsulatum var. duboisii is well known to present with multiple osteolytic lesions in immunocompromised adults and is mostly restricted to the African subcontinent. Histoplasmosis seen in American and Asian countries is caused by Histoplasma capsulatum var. capsulatum, which presents with pulmonary and systemic manifestations and rarely bone involvement. We report a case of histoplasmosis, caused by H. capsulatum var. capsulatum with extensive lytic bone lesions in a 13 year old immunocompetent boy who presented with prolonged fever, weight loss and multiple boggy swellings. He responded to amphotericin and is currently on Itraconazole. This case is unique for extensive osteolytic lesions with H. capsulatum var. capsulatum infection in an immunocompetent child.

Large Scale Experiments Simulating Hydrogen Distribution in a Spent Fuel Pool Building During a Hypothetical Fuel Uncovery Accident Scenario

Abstract Following the Fukushima accident and its extended station blackout, attention was brought to the importance of the spent fuel pools' (SFPs) behavior in case of a prolonged loss of the cooling system. Since then, many analytical works have been performed to estimate the timing of hypothetical fuel uncovery for various SFP types. Experimentally, however, little was done to investigate issues related to the formation of a flammable gas mixture, distribution, and stratification in the SFP building itself and to some extent assess the capability for the code to correctly predict it. This paper presents the main outcomes of the Experiments on Spent Fuel Pool (ESFP) project carried out under the auspices of Swissnuclear (Framework 2012–2013) in the PANDA facility at the Paul Scherrer Institut in Switzerland. It consists of an experimental investigation focused on hydrogen concentration build-up into a SFP building during a predefined scaled scenario for different venting positions. Tests follow a two-phase scenario. Initially steam is released to mimic the boiling of the pool followed by a helium/steam mixture release to simulate the deterioration of the oxidizing spent fuel. Results shows that while the SFP building would mainly be inerted by the presence of a high concentration of steam, the volume located below the level of the pool in adjacent rooms would maintain a high air content. The interface of the two-gas mixture presents the highest risk of flammability. Additionally, it was observed that the gas mixture could become stagnant leading locally to high hydrogen concentration while steam condenses. Overall, the experiments provide relevant information for the potentially hazardous gas distribution formed in the SFP building and hints on accident management and on eventual retrofitting measures to be implemented in the SFP building.

N-Methyl-D-Aspartate Receptors, Ketamine, and Rett Syndrome: Something Special on the Road to Treatments?

N-Methyl-D-Aspartate Receptors, Ketamine, and Rett Syndrome: Something Special on the Road to Treatments?

Potential Mechanisms for Prolonged Loss of Ambulation with Deflazacort in Duchenne Muscular Dystrophy - Tolerability Profile and Effects on Growth (P5.059)

Potential Mechanisms for Prolonged Loss of Ambulation with Deflazacort in Duchenne Muscular Dystrophy - Tolerability Profile and Effects on Growth (P5.059)

Return to work after specialised burn care: A two-year prospective follow-up study of the prevalence, predictors and related costs

BackgroundBurn injuries may cause long-term disability and work absence, and therefore result in high healthcare and productivity costs. Up to now, detailed information on return to work (RTW) and productivity costs after burns is lacking. AimsThe aim of this study was to accurately assess RTW after burn injuries, to identify predictors of absenteeism and to calculate healthcare and productivity costs from a societal perspective. MethodsA prospective cohort study was conducted in the burn centre of Rotterdam, the Netherlands, including all admitted working-age patients from 1 August 2011 to 31 July 2012. At 3, 12 and 24 months post-burn, patients were sent a questionnaire: including the Work and Medical Consumption questionnaire for the assessment of work absence and medical consumption and the EQ-5D-3L plus a cognitive dimension to assess post-burn and pre-burn quality of life (QOL).Cost analyses were from a societal perspective according the micro-costing method and the friction cost method was applied for the calculation of productivity loss.Univariate logistic regression was used to identify predictors of absenteeism at three months. ResultsA total of 104 patients were included in the study with a mean total body surface area (TBSA) burned of 8% (median 4%). 66 respondents were pre-employed, at 3 months 70% was back at work, at 12 months 92% and 8% had not returned to work at time of final follow-up at 24 months. Predictors of absenteeism at 3 months were: TBSA, length of stay, ICU-admission and surgery. Mean costs related to loss in productivity were €11.916 [95% CI 8.930–14.902] and accounted for 30% of total costs in pre-employed respondents in the first two years. ConclusionThis two-year follow-up study demonstrates that burn injuries cause substantial and prolonged productivity loss amongst burn survivors with mixed burn severity. This absenteeism contributes to already high societal costs of burn injuries. Predictors of absenteeism found in this study were primarily fixed patient and treatment related factors, future studies should focus on modifiable factors, in order to improve RTW outcomes. Also, more attention in the rehabilitation trajectory is needed to optimally support RTW in burn survivors.

Increases in M-wave latency of biceps brachii after elbow flexor eccentric contractions in women

Eccentric contractions (ECCs) induce muscle damage that is indicated by prolonged loss of muscle function and delayed onset muscle soreness. It is possible that ECCs affect motor nerves, and this may contribute to the prolonged decreases in force generating capability. The present study investigated the hypothesis that M-wave latency of biceps brachii would be increased after maximal elbow flexor ECCs resulting in prolonged loss of muscle strength. Fifteen women performed exercise consisting of 60 maximal ECCs of the elbow flexors using their non-dominant arm. M-wave latency was assessed by the time taken from electrical stimulation applied to the Erb's point to the onset of M-wave of the biceps brachii before, immediately after, and 1-4days after exercise. Maximal voluntaryisometric contraction (MVC) torque, range of motion (ROM) and muscle soreness using a numerical rating scale were also assessed before and after exercise. Prolonged decreases in MVC torque (1-4days post-exercise: -54 to -15%) and ROM (1-2days: -32 to -22%), and increased muscle soreness (peak: 4.2 out of 10) were evident after exercise (p<0.05). The M-wave latency increased (p<0.01) from 5.8±1.0ms before exercise to 6.5±1.7ms at 1day and 7.2±1.5ms at 2days after exercise for the exercised arm only. No significant changes in M-wave amplitude were evident after exercise. The increased M-wave latency did not fully explain the prolonged decreases in MVC torque after eccentric exercise, but may indicate reversible motor nerve impairment.

Learning and sleep-dependent consolidation of spatial and procedural memories are unaltered in young men under a fixed short sleep schedule

ObjectiveTo investigate if a fixed short sleep schedule impairs one of the main functions of sleep, which is to consolidate newly learned memories. MethodsSixteen young men participated in two experimental conditions, each of which lasted for 3 consecutive days and nights in our laboratory: a short sleep schedule (4.25-h sleep opportunity per night) versus a normal sleep schedule (8.5h per night). In the evening after two experimental nights, participants learned locations of 15 card pairs (spatial memory task) and a procedural finger tapping sequence task. Post-sleep retrieval of both memory tasks was tested the next morning. ResultsThe short sleep schedule, compared with the normal sleep schedule, considerably altered sleep characteristics, e.g. the proportion of time in slow-wave sleep increased across the three experimental nights. In contrast, neither learning in the evening of day 2, nor subsequent overnight memory consolidation (i.e. concerning the change in memory performance between pre-sleep learning on day 2 and post-sleep retrieval on day 3) differed between the normal and short sleep schedule conditions. ConclusionsOur findings suggest that learning in the evening and subsequent sleep-dependent consolidation of procedural and spatial memories are unaltered in young men living under a fixed short sleep schedule. Future studies are warranted to validate our findings in other groups (e.g. adolescents and older subjects) and after more prolonged chronic sleep loss paradigms.

Characterizing the molecular interaction of perfluorocarbons with carbamazepine and benzodiazepine using photo-acoustic studies

Lennox–Gastaut syndrome (LGS) is commonly characterized by a triad of features including multiple seizure types, intellectual disability or regression. LGS type of seizures is epilepsy which is due to abnormal vibrations occurring in seizures. During the time of such abnormal vibrations, both the seizures and the lungs suffer a lack in oxygen content to a considerable extent. These result in prolonged vibrations and loss of nervous control. Perfluorodecalin C10F18 (PFD) and perfluorohexane C6F14 (PFH) which are excellent oxygen carriers are made as an interfacial solution with anti-epileptic drugs (AEDs) such as carbamazepine and benzodiazepine with dimethylformamide (DMF) as common solvent. The interfacial solutions were subjected to ultrasonic-laser diffraction (photo-acoustical method). The experimentally measured data were plugged in classical mathematical models to analyze the complete molecular interactions. The estimated structure factor S(Q) and the L-J potential parameter φ (r) reveals that both PFD and PFH co-exist along with AEDs and support the purpose of this study, which is a neuro-lung protective strategy.

A Core Design Study for a Small Modular Boiling Water Reactor with Long-Life Core

This paper presents the core design and performance characteristics of the Novel Modular Reactor (NMR-50), a 50-MW(electric) small modular reactor. NMR-50 is a boiling water reactor with natural-circulation cooling and two layers of passive safety systems that enable the reactor to withstand prolonged station blackout and loss of ultimate heat sink accidents. The main goal in the core design is to achieve a long-life core (~10 years) without refueling for deployment in remote sites. Through assembly design studies with the CASMO-4 lattice code and coupled neutronics and thermal-hydraulic core analyses with the PARCS and RELAP5 codes, a preliminary NMR-50 core design has been developed to meet the 10-year cycle length with an average fuel enrichment of 4.75 wt% and a maximum enrichment of 5.0 wt%. The calculated fuel temperature coefficient and coolant void coefficient provide adequate negative reactivity feedbacks. The maximum fuel linear power density throughout the 10-year burn cycle is 18.7 kW/m, and the minimum critical power ratio is 2.07, both of which meet the selected design limits with significant margins. Preliminary safety analyses using the RELAP5 code show that the core will remain covered during the entire transient procedure of two design-basis loss-of-coolant accidents. These results indicate that the targeted 10-year cycle length is achievable while satisfying the operation and safety-related design criteria with sufficient margins.

Preserved retinotopic brain connectivity in macular degeneration.

The eye disease macular degeneration (MD) is a leading cause of blindness worldwide. There is no cure for MD, but several promising treatments aimed at restoring vision at the level of the retina are currently under investigation. These treatments assume that the patient's brain can still process appropriately the retinal input once it is restored, but whether this assumption is correct has yet to be determined. We used functional magnetic resonance imaging (fMRI) and connective field modelling to determine whether the functional connectivity between the input-deprived portions of primary visual cortex (V1) and early extrastriate areas (V2/3) is still retinotopically organised. Specifically, in both patients with juvenile macular degeneration and age-matched controls with simulated retinal lesions, we assessed the extent to which the V1-referred connective fields of extrastriate voxels, as estimated on the basis of spontaneous fMRI signal fluctuations, adhered to retinotopic organisation. We found that functional connectivity between the input-deprived portions of visual areas V1 and extrastriate cortex is still largely retinotopically organised in MD, although on average less so than in controls. Patients with stable fixation exhibited normal retinotopic connectivity, however, suggesting that for the patients with unstable fixation, eye-movements resulted in spurious, homogeneous signal modulations across the entire input-deprived cortex, which would have hampered our ability to assess their spatial structure of connectivity. Despite the prolonged loss of visual input due to MD, the cortico-cortical connections of input-deprived visual cortex remain largely intact. This suggests that the restoration of sight in macular degeneration can rely on a largely unchanged retinotopic representation in early visual cortex following loss of central retinal function.

English

A 45 year old man with malignant pleural mesothelioma had symptoms of prolonged cough, heamoptysis, breathlessness, weight loss and low grade persistent fever. The high prevalence of pulmonary tuberculosis in this environment, coupled with paucity of radiologists in rural areas to competently review his chest radiograph, resulted in making the wrong diagnosis of pulmonary tuberculosis (PTB) as against malignant pleural mesothelioma. He was also wrongly treated for PTB for a period of nine months before referral to a Teaching Hospital. The correct diagnosis was made in a university teaching hospital where adequate specialized manpower was available. Distant metastasis to the liver was already observed at presentation. He was treated with six courses of chemotherapy (Peclitaxel and Cisplastin) and he did well before he was lost to follow-up. Key words: Malignant pleural mesothelioma, PTB, liver metastasis.

Serious Adverse Reactions Caused by Counterfeit Drugs. A Clinical Case of Transient Global Amnesia Caused by Dietary Supplement Containing a High Dose of Sildenafil

On 25/11/2014 the patient VHG arrives at emergency department of Cardarelli Hospital in Naples following prolonged confusional state and total loss of memory in the last 24 hours. The episode is diagnosed as transient global amnesia (TSA). During the hospitalization the patient receives specialist visits that don't reveal any abnormalities. The patient reports that he assumed, a few hours before the onset of amnesia, a dietary supplement. The product named Sex Bull, purchased online, it’s indicated for the improvement of sexual performance both in men than in women and, in according to label, it doesn't contain any pharmacological active ingredient. Poison Control Centre of Cardarelli Hospital provides to send a sample of tablets of Sex Bull to Superior Institute of Health (Rome) for a qualitative and quantitative determination of components. The analyses show the presence of Paracetamol, vitamin C, sugar and at the dosage of 100 ± 1.5 mg is a drug used in clinical practice for the treatment of erectile dysfunction and the sale of pharmaceutical products containing the active substance Sildenafil is subject to medical prescription. In literature, are published several case-reports and a review reporting cases of TGA following a first administration of Sildenafil. In this case report, it’s difficult to establish the causal link between the adverse drug reaction (ADR) and the consumption of the active substance Sildenafil, because Sex Bull” it is a counterfeit drug. The production and distribution of counterfeit drugs is not done according to Good Manufacturing Practice and Good Distribution Practice so the quality of pharmacological active ingredients isn't guaranteed. Because of these reasons it is not possible establishing any form of interaction between counterfeit products and other pharmaceutical therapies in progress or the ability of these drugs to induce serious ADR or aggravate a pre-existing medical condition.

Abstract A181: Dissecting the spatiotemporal functions of WAVE complex during chemotaxis using CRISPR and optogenetics

Abstract Neutrophils comprise a crucial component of the innate immune system and rely on chemotaxis to track down, engulf, and destroy pathogens. However, neutrophils also migrate to sites of developing tumors where they may promote angiogenesis and set the stage for metastasis to occur. The WAVE regulatory complex (WRC) serves a central role in mediating chemotaxis, as it links the actin dynamics powering cell movement to the signaling cascade which responds to environmental stimuli. Actively migrating neutrophils must respond quickly (within seconds) to changes in their environment; unfortunately, traditional methods one may use to alter WRC activity (e.g, RNAi and gene deletion) require hours/days to take effect. Consequently, while we know that WRC is generally required for efficient chemotaxis, its specific functions during each temporal phase, such as establishment and maintenance of a chemotactic response, remain unknown. Furthermore, the roles of WRC in this process are convoluted by additional actin assembly and assembly-promoting factors that act alongside WRC to drive neutrophil movement: Cells may compensate for prolonged loss of WRC through altering the activities of one or more of these factors. Here, I employed CRISPR to knockout the HEM1 subunit of WRC in neutrophil-like HL60 cells. Lacking functional WRC, these cells exhibit impaired chemotaxis, similar to cells where HEM1 expression is knocked-down. Unexpectedly however, the knockout neutrophils display additional defects in morphology and actin organization that are never observed in knockdown cells, despite knockdown cells containing less than 10% of normal Hem1 levels. I have also, in parallel, generated and validated optogenetic tools that can be used to rapidly and reversibly recruit WRC to different subcellular locations. When expressed in neutrophils lacking HEM1, these tools will open up the possibility of acutely ‘activating’ or ‘inactivating’ WRC during different temporal stages of chemotaxis (e.g., polarity establishment or maintenance). Ultimately, a more nuanced understanding of neutrophil chemotaxis should lead to the identification of new drug targets that may be used to block the accumulation of neutrophils at sites of tumor growth. Citation Format: Brian R. Graziano, Orion D. Weiner. Dissecting the spatiotemporal functions of WAVE complex during chemotaxis using CRISPR and optogenetics. [abstract]. In: Proceedings of the CRI-CIMT-EATI-AACR Inaugural International Cancer Immunotherapy Conference: Translating Science into Survival; September 16-19, 2015; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(1 Suppl):Abstract nr A181.

On the Impacts of Power Outages during Hurricane Sandy—A Resilience‐Based Analysis

ABSTRACTThe dependence on continuous availability of power for day‐to‐day functioning and sustenance of life is more critical today than ever before. A prolonged loss of power is no longer just an inconvenience, but brings normal life to a standstill. When Hurricane Sandy hit the U.S East Coast in October 2012, many lost their homes and properties due to the flooding and severe winds. However, a significant impact was the power outages to over 8 million customers across 21 states, for days and even weeks. This paper takes a systems view of these power outages from supply and demand sides, from a quantitative resilience perspective. The focus of this study is on the resilience action that enables restoration of the disrupted system. Generic resilience framework and metrics are used as the basis for the resilience analysis; the observations, lessons learnt, and recommendations based on this analysis are expected to improve recovery from large‐scale power outages resulting from any disruptive event in future.

Rates of Hospitalization for Dehydration Following Hurricane Sandy in New Jersey.

Hurricane Sandy, one of the most destructive natural disasters in New Jersey history, made landfall on October 29, 2012. Prolonged loss of electrical power and extensive infrastructure damage restricted access for many to food and water. We examined the rate of dehydration in New Jersey residents after Hurricane Sandy. We obtained data from 2008 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records from nonfederal New Jersey hospitals (N=517,355). Patients with dehydration had ICD-9-CM discharge diagnosis codes for dehydration, volume depletion, and/or hypovolemia. We used log-linear modeling to estimate the change in in-patient hospitalizations for dehydration comparing 2 weeks after Sandy with the same period in the previous 4 years (2008-2011). In-patient hospitalizations for dehydration were 66% higher after Sandy than in 2008-2011 (rate ratio [RR]: 1.66; 95% confidence interval [CI]: 1.50, 1.84). Hospitalizations for dehydration in patients over 65 years of age increased by nearly 80% after Sandy compared with 2008-2011 (RR: 1.79; 95% CI: 1.58, 2.02). Sandy was associated with a marked increase in hospitalizations for dehydration. Reducing the rate of dehydration following extreme weather events is an important public health concern that needs to be addressed, especially in those over 65 years of age.