Search

The electric grid plays a crucial role in the functioning of American households, schools, businesses, and health facilities, as well as national security. Action is needed to address the vulnerability of the grid to natural disasters, which are increasing in frequency and intensity due to climate change. States that are particularly under threat include those in the Southeast, such as Louisiana, Mississippi, and Florida, where hurricanes and severe storms can be especially destructive. States in this region also typically rely on natural gas as a primary source of energy, which upholds a centralized grid structure that is more susceptible to widespread power outages than a distributed structure. Power outages, which disproportionately impact low-income communities, can be detrimental to health and safety during a natural disaster by severing access to communication and necessary medical equipment. Using Louisiana as a case study, we recommend one policy through which the state can transition to a more distributed structure; the Louisiana Public Service Commission should revise the 2019 legislation that financially disincentivizes customers to install solar panels, and instead expand the benefits for these customers. This change will increase the proliferation of solar energy, which can serve as power sources in a distributed grid. Solar panels, coupled with battery storage, can reduce the likelihood of power outages during extreme weather events. Expanding the use of renewable energy in Louisiana could encourage other states in the region to also make this shift, serving as a model for stronger climate adaptation across the country.

To assess the efficacy of ramelteon in preventing delirium, an acute neuropsychiatric condition associated with increased morbidity and mortality, in the perioperative, ICU setting.Parallel-arm, randomized, double-blinded, placebo-controlled trial.Academic medical center in La Jolla, California.Patients greater than or equal to 18 years undergoing elective pulmonary thromboendarterectomy.Ramelteon 8 mg or matching placebo starting the night prior to surgery and for a maximum of six nights while in the ICU.Incident delirium was measured twice daily using the Confusion Assessment Method-ICU. The safety outcome was coma-free days assessed by the Richmond Agitation-Sedation Scale. One-hundred twenty participants were enrolled and analysis completed in 117. Delirium occurred in 22 of 58 patients allocated to placebo versus 19 of 59 allocated to ramelteon (relative risk, 0.8; 95% CI, 0.5-1.4; p = 0.516). Delirium duration, as assessed by the number of delirium-free days was also similar in both groups (placebo median 2 d [interquartile range, 2-3 d] vs ramelteon 3 d [2-5 d]; p = 0.181). Coma-free days was also similar between groups (placebo median 2 d [interquartile range, 1-3 d] vs ramelteon 3 d [2-4 d]; p = 0.210). We found no difference in ICU length of stay (median 4 d [interquartile range, 3-5 d] vs 4 d [3-6 d]; p = 0.349), or in-hospital mortality (four vs three deaths; relative risk ratio, 0.7; 95% CI, 0.2-3.2; p = 0.717), all placebo versus ramelteon, respectively.Ramelteon 8 mg did not prevent postoperative delirium in patients admitted for elective cardiac surgery.