Search

Summary Massive power failures are induced frequently by natural disasters. A fundamental challenge is how recovery can be resilient to the increasing severity of disruptions in a changing climate. We conduct a large-scale study on recovery from 169 failure events at two operational distribution grids in the states of New York and Massachusetts. Guided by unsupervised learning from non-stationary data, our analysis finds that under the widely adopted prioritization policy favoring large failures, recovery exhibits a scaling property where a majority ( ∼ 90%) of customers recovers in a small fraction ( ∼ 10%) of total downtime. However, recovery degrades with the severity of disruptions: large failures that cannot recover rapidly increase by ∼ 30% from the moderate to extreme events. Prolonged small failures dominate entire recovery processes. Further, our analysis demonstrates the promise of mitigating the degradation by enhancing recovery of a small fraction of large failures through distributed generation and storage.

As a contribution to recent discourse over the practice of natural science in Latin America’s liberal years, this paper examines Swiss-born botanist Moisés S. Bertoni’s place in Paraguay’s agricultural development following the Paraguayan War (1864-70). The war forced leaders in a devastated Paraguay to promote the immigration of European scientific experts and farmers, with the expectation that their knowledge of modern agricultural science and practice would revitalize the nation’s agriculture and lift Paraguay out of its poverty. From the late nineteenth century Bertoni’s work and knowledge of Paraguay’s tropical and semi-tropical climate and botany shaped much of Paraguayan agricultural policy and practice. And while his contributions were influential in understanding the nation’s environment and agriculture, what is unclear is how much his approach was the product of deliberate introduction of European agricultural science or the result of autochthonous experience and his own trial and error. Keywords: agricultural science; natural science; Paraguay; tropical climate

Coherence Imaging Spectroscopy (CIS) has emerged as a powerful tool for investigating complex ion phenomena in the boundary of magnetically confined plasma devices. The combination of Fourier-transform interferometry and high-resolution fast-framing cameras has made it possible to make sensitive velocity measurements that are also spatially resolved. However, this sensitivity makes the diagnostic vulnerable to environmental effects including thermal drifts, vibration, and magnetic fields that can influence the velocity measurement. Additionally, the ability to provide an absolute calibration for these geometries can be impacted by differences in the light-collection geometry between the plasma and reference light source, spectral impurities, and the presence of thin-films on in-vessel optics. This paper discusses the mitigation of these effects and demonstration that environmental effects result in less than 0.5 km/s error on the DIII-D CIS systems. A diagnostic comparison is used to demonstrate agreement between CIS and traditional spectroscopy once tomographic artifacts are accounted for.

It is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention (PCI) early after acute ST-segment elevation myocardial infarction (STEMI).Among 1892 patients with STEMI who presented within 3 hours after symptom onset and who were unable to undergo primary PCI within 1 hour, patients were randomly assigned to undergo either primary PCI or fibrinolytic therapy with bolus tenecteplase (amended to half dose in patients ≥75 years of age), clopidogrel, and enoxaparin before transport to a PCI-capable hospital. Emergency coronary angiography was performed if fibrinolysis failed; otherwise, angiography was performed 6 to 24 hours after randomization. The primary end point was a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary end point occurred in 116 of 939 patients (12.4%) in the fibrinolysis group and in 135 of 943 patients (14.3%) in the primary PCI group (relative risk in the fibrinolysis group, 0.86; 95% confidence interval, 0.68 to 1.09; P=0.21). Emergency angiography was required in 36.3% of patients in the fibrinolysis group, whereas the remainder of patients underwent angiography at a median of 17 hours after randomization. More intracranial hemorrhages occurred in the fibrinolysis group than in the primary PCI group (1.0% vs. 0.2%, P=0.04; after protocol amendment, 0.5% vs. 0.3%, P=0.45). The rates of nonintracranial bleeding were similar in the two groups.Prehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients with early STEMI who could not undergo primary PCI within 1 hour after the first medical contact. However, fibrinolysis was associated with a slightly increased risk of intracranial bleeding. (Funded by Boehringer Ingelheim; ClinicalTrials.gov number, NCT00623623.).

Severe weather events frequently result in large-scale power failures, affecting millions of people for extended durations. However, the lack of comprehensive, detailed failure and recovery data has impeded large-scale resilience studies. Here, we analyse data from four major service regions representing Upstate New York during Super Storm Sandy and daily operations. Using non-stationary spatiotemporal random processes that relate infrastructural failures to recoveries and cost, our data analysis shows that local power failures have a disproportionally large non-local impact on people (that is, the top 20% of failures interrupted 84% of services to customers). A large number (89%) of small failures, represented by the bottom 34% of customers and commonplace devices, resulted in 56% of the total cost of 28 million customer interruption hours. Our study shows that extreme weather does not cause, but rather exacerbates, existing vulnerabilities, which are obscured in daily operations. Power grids often fail during extreme weather events such as hurricanes, leaving millions of customers without electricity. A large-scale analysis of the operation of power grids in an extended geographical area now reveals that such events exacerbate vulnerabilities that are obscured during normal operation.

Nurses at the Well-Being Institute, a community-based nursing outreach clinic in Detroit, Michigan, located 75 women living with HIV, mental illness, and substance abuse who were lost to follow-up at their HIV medical clinic as part of a nursing research study. Women who had been scheduled for an appointment in the last 4 months but who had missed that appointment were considered "lost to follow-up" in the HIV clinic. The purpose of the research was to study factors related to health care access in women not participating in regular health care for their HIV infection. Women were randomly assigned to two study groups. Women assigned to "care as usual" study group (n = 37) received no additional services beyond study interviews for 1 year. Women assigned to the "nursing intervention" group (n = 38) were provided with nursing services designed to facilitate their return to and continued connection with their HIV clinic. Findings showed that factors related to the women's vulnerability, such as mental illness and drug use, were more related to their use of expensive health care services such as hospital emergency departments or hospital inpatient admissions than was assignment to either the "nursing intervention" or "care as usual" study groups. Two case studies describing the cost of care for 2 of the multiply diagnosed women in the study is presented. The women differed on whether they had stable housing and were accessing care for their mental illness.

Background— In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a pharmaco-invasive (PI) strategy was compared with primary percutaneous coronary intervention (pPCI) in ST—segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset but unable to undergo pPCI within 1 hour. At 30 days, the PI approach was associated with a nominally but nonstatistically significant lower incidence of the composite primary end point of death, shock, congestive heart failure, and reinfarction when compared with pPCI. The aim of the present study was to determine the effect of these strategies on 1-year mortality. Methods and Results— Vital status at 1 year was available in 936 of 944 (99.2%) and 941 of 948 (99.3%) patients in the PI and pPCI arm, respectively. At 1 year, all-cause mortality rates (6.7% versus 5.9%) were similar for PI and pPCI-treated patients ( P =0.49; risk ratio, 1.13; 95% confidence interval, 0.79–1.62). Cardiac mortality rates were similar as well (4.0% versus 4.1%, P =0.93; risk ratio, 0.98; 95% confidence interval, 0.62–1.54). Overall, only 34 patients died between day 30 and 1 year, 20 in the PI arm and 14 in the pPCI arm, of whom 20 died of noncardiac reasons (13 in the PI and 7 in the pPCI arm). There was no significant difference in 1-year all-cause mortality between the 2 groups among the prespecified key subgroups. Conclusions— At 1 year, mortality rates in the PI and pPCI arms were similar in ST—segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset and unable to undergo pPCI within 1 hour. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00623623.

One of the most important aspects of the recent mass migrations of Latin Americans into previously remote regions of the hemisphere is the impact these have had on areas cut by international boundaries. With the exception of the United States-Mexico border, however, historical examination of the process is still in its infancy. And few observers have developed a satisfactory theoretical basis explaining an admittedly complex process.One exception was Cuban historian Jorge Mañach, who spoke of “balanced” and “unbalanced” frontiers, largely in the context of the United States-Mexican boundary. He believed that power distribution between nations determined the degree to which their frontier interrelationships were equal or unequal. In Mañach's view, when a politically or economically weaker nation shares a boundary with one that is stronger, overall communication is sacrificed and the stronger power inevitably “spills over” into the neighboring region, economically and culturally.

Background: Primary percutaneous coronary intervention (PCI) has emerged as the preferred therapy for acute ST-elevation myocardial infarction (STEMI) provided it is performed in a timely fashion at an expert 24/7 facility. Fibrinolysis is a well-accepted alternative, especially in patients presenting early after symptom onset. The STREAM study will provide novel information on whether prompt fibrinolysis at first medical contact, followed by timely catheterization or rescue coronary intervention in STEMI patients presenting within 3 hours of symptom onset, represents an appropriate alternative strategy to primary PCI. Methods: Acute STEMI patients presenting early after symptom onset are eligible if PCI is not feasible within 60 minutes of first medical contact. This is an open-label, prospective, randomized, parallel, comparative, international multicenter trial. Patients are randomized to fibrinolysis combined with enoxaparin, clopidogrel, and aspirin, and cardiac catheterization within 6 to 24 hours or rescue coronary intervention if reperfusion fails within 90 minutes of fibrinolysis versus PCI performed according to local guidelines. Composite efficacy end points at 30 days include death, shock, heart failure, and reinfarction. Safety end points include ischemic stroke, intracranial hemorrhage, and major nonintracranial bleeding. Follow-up is extended to 1 year and includes all-cause mortality. Discussion: Continuing delays in achieving timely PCI remain a difficult issue. Many patients fail to achieve the desired reperfusion times of 90 to 120 minutes after first medical contact. The STREAM results will provide useful additional data on which to base informed therapeutic decisions. © 2010, Mosby, Inc. All rights reserved.

The high seizure susceptibility in epileptic chickens is due to an autosomal recessive mutation. In 3-day-old chicks homozygous for the epilepsy gene (epileptics), elevation of body temperature using microwave diathermy evoked an initial febrile seizure resembling the clonic seizures evoked in epileptic chicks by photic stimulation. After complete recovery, this was followed by a clonic-tonic seizure. In nonepileptic heterozygote hatchmates (carriers) of the same age, only the latter seizure pattern was observed. In 16- to 17-day-old chicks of either phenotype, both seizure patterns were observed during hyperthermia. In all cases, the temperature at which seizures occurred was significantly lower in epileptic than in nonepileptic chicks, indicating a lower threshold for febrile seizures when there is an inherited predisposition to convulse. The occurrence of seizures was dependent on the body temperature and not on the rate of rise of temperature. Elevation of the brain gamma-aminobutyric acid (GABA) concentrations by administration of the GABA transaminase inhibitor gamma-vinyl GABA reduced the incidence of the initial febrile seizures and increased the latency in those birds that were not fully protected.

With microwave diathermy, febrile seizures were produced in epileptic chicks aged 2-5 days. Drugs that enhance GABAergic activity (i.e., GABA, muscimol, and progabide), as well as valproic acid and gamma-hydroxybutyric acid, produced dose-dependent increases in latency to onset of seizures.

To gain insight into the surgical significance of acquired jejunal diverticula, we reviewed the experience at the teaching hospitals in our city during the past ten years. An antemortem diagnosis of jejunal diverticulosis was made in 27 men and 59 women with a mean age of 69.6 years. In 71 patients the diagnosis was made during upper gastrointestinal roentgenologic evaluation for abdominal symptoms, in three it was made during mesenteric arteriography or bleeding scan for massive rectal bleeding, in six it was made during exploratory laparotomy for acute abdominal signs and symptoms, and in the remaining six it was an incidental intraoperative finding. Surgical indications occurred in 13 patients (15%) and consisted of massive lower gastrointestinal bleeding in four patients, blind loop syndrome in three, small bowel obstruction in three, diverticular perforation in two, and chronic abdominal pain requiring jejunal resection in one. In three additional patients with melena and nine with chronic abdominal pain, jejunal diverticulosis was the only abnormality detected; none of these patients had operation. Although the majority of patients with jejunal diverticula do not require surgical treatment, it may be necessitated by complications such as bleeding, perforation, obstruction, blind loop syndrome, or intractable abdominal pain.

Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) restores epicardial patency in the infarct related artery but suboptimal microvascular perfusion occurs in up to 70% of patients. This microvascular obstruction (MVO) is associated with adverse left