The effect of repeated hurricanes on the age of organic carbon in humid tropical forest soil.

Increasing hurricane frequency and intensity with climate change is likely to affect soil organic carbon (C) stocks in tropical forests. We examined the cycling of C between soil pools and with depth at the Luquillo Experimental Forest in Puerto Rico in soils over a 30-year period that spanned repeated hurricanes. We used a nonlinear matrix model of soil C pools and fluxes ("soilR") and constrained the parameters with soil and litter survey data. Soil chemistry and stable and radiocarbon isotopes were measured from three soil depths across a topographic gradient in 1988 and 2018. Our results suggest that pulses and subsequent reduction of inputs caused by severe hurricanes in 1989, 1998, and two in 2017 led to faster mean transit times of soil C in 0-10 cm and 35-60 cm depths relative to a modeled control soil with constant inputs over the 30-year period. Between 1988 and 2018, the occluded C stock increased and δ13C in all pools decreased, while changes in particulate and mineral-associated C were undetectable. The differences between 1988 and 2018 suggest that hurricane disturbance results in a dilution of the occluded light C pool with an influx of young, debris-deposited C, and possible microbial scavenging of old and young C in the particulate and mineral-associated pools. These effects led to a younger total soil C pool with faster mean transit times. Our results suggest that the increasing frequency of intense hurricanes will speed up rates of C cycling in tropical forests, making soil C more sensitive to future tropical forest stressors.

The impact of cultural stress on family functioning among Puerto Rican displaced families and the effect on mental health.

Hurricane María caused significant devastation on the island of Puerto Rico, impacting thousands of lives. Puerto Rican crisis migrant families faced stress related to displacement and relocation (cultural stress), often exhibited mental health symptoms, and experienced distress at the family level. Although cultural stress has been examined as an individual experience, little work has focused on the experience as a family. To address this gap, we conducted a mixed-methods study designed to examine the predictive effects of cultural stress on family conflict and its mental health implications among Puerto Rican Hurricane María parent and child dyads living on the U.S. mainland. In the quantitative phase of the study, 110 parent-child dyads completed an online survey assessing cultural stress, family dynamics, and mental health. As part of our primary analysis, we estimated a structural equation path model. Findings from the quantitative phase showed a significant positive relationship between family cultural stress and family conflict, as well as individual parent and child mental health symptoms. In the qualitative phase of the study, 35 parent-child dyads participated in individual interviews. Findings from the interviews revealed variations in difficulties related to language, discrimination, and financial burdens, with some participants adapting more quickly and experiencing fewer stressors. Findings also highlight the impact on mental health for both parents and youth, emphasizing the family-level nature of cultural stress, while noting a potential discrepancy between qualitative and quantitative findings in the discussion of family conflict.

The interplay of drought and hurricanes on tree recovery: insights from dynamic and weak functional responses.

Identifying the functional traits that enable recovery after extreme events is necessary for assessing forest persistence and functioning. However, the variability of traits mediating responses to disturbances presents a significant limitation, as these relationships may be contingent on the type of disturbance and change over time. This study investigates the effects of traits on tree growth-for short and longer terms-in response to two vastly different extreme climatic events (droughts and hurricanes) in a Puerto Rican forest. I found that trees display a dynamic functional response to extreme climatic events. Leaf traits associated with efficient photosynthesis mediated faster tree growth after hurricanes, while trees with low wood density and high water use efficiency displayed faster growth after drought. In the longer term, over both drought and hurricanes, tree size was the only significant predictor of growth, with faster growth for smaller trees. However, despite finding significant trait-growth relationships, the predictive power of traits was overall low. As the frequency of extreme events increases due to climate change, understanding the dynamic relationships between traits and tree growth is necessary for identifying strategies for recovery.

Technology-based communication among Hurricane Maria survivors in the United States: a trans-territorial lens.

PURPOSE: Rooted in a trans-territorial framework, the present study was designed to provide new evidence regarding the patterns of communication among Hurricane Maria survivors who migrated to the U.S. in the aftermath of the storm. METHODS: A total of 319 Hurricane Maria survivor adults ages 18 and older were recruited into the Adelante Boricua study between August 2020 and October 2021. Most participants had relocated to the U.S. between 2017 and 2018. We used latent profile analysis and multinomial regression to examine the relationship of technology-based communication with depressive symptoms, well-being, cultural connection, and migration stress. RESULTS: We identified a five-class solution, consisting of (1) moderate communication (32%), (2) disengaged (24%), (3) no social media (18%), (4) daily with family in Puerto Rico (6%), and (5) daily trans-territorial (13%) typologies. Participants in the disengaged class were more likely to report elevated depressive symptoms and limited English proficiency, lower prosocial behaviors, lower levels of religiosity, lower attendance at religious services in the U.S., and less engagement in social activities, compared to participants in the Moderate Communication class. CONCLUSION: Roughly one in four individuals in our sample reported very limited technology-based communication with friends/family in their sending and new-receiving communities. As technology and smartphones continue to become integrated into 21st-century life, it is vital that researchers explore how the tremendous potential for connectedness relates to trans-territorial crisis migrants' well-being and adaptation.

Quantifying the dynamics of migration after Hurricane Maria in Puerto Rico.

Population displacement may occur after natural disasters, permanently altering the demographic composition of the affected regions. Measuring this displacement is vital for both optimal postdisaster resource allocation and calculation of measures of public health interest such as mortality estimates. Here, we analyzed data generated by mobile phones and social media to estimate the weekly island-wide population at risk and within-island geographic heterogeneity of migration in Puerto Rico after Hurricane Maria. We compared these two data sources with population estimates derived from air travel records and census data. We observed a loss of population across all data sources throughout the study period; however, the magnitude and dynamics differ by the data source. Census data predict a population loss of just over 129,000 from July 2017 to July 2018, a 4% decrease; air travel data predict a population loss of 168,295 for the same period, a 5% decrease; mobile phone-based estimates predict a loss of 235,375 from July 2017 to May 2018, an 8% decrease; and social media-based estimates predict a loss of 476,779 from August 2017 to August 2018, a 17% decrease. On average, municipalities with a smaller population size lost a bigger proportion of their population. Moreover, we infer that these municipalities experienced greater infrastructure damage as measured by the proportion of unknown locations stemming from these regions. Finally, our analysis measures a general shift of population from rural to urban centers within the island. Passively collected data provide a promising supplement to current at-risk population estimation procedures; however, each data source has its own biases and limitations.

"I don't want to die": a qualitative study of coping strategies to prevent fentanyl-related overdose deaths among people who inject drugs and its implications for harm reduction policies.

BACKGROUND: Fentanyl and fentanyl-related analogues are the main drivers of overdose death in the USA, particularly among people who inject drugs (PWID). Despite the fact that non-Hispanic whites exhibit higher population rates of synthetic opioid mortality, overdose deaths have increased among African American and Latinos in urban areas. Yet little attention has been paid to the introduction of fentanyl among rural PWID in Puerto Rico. METHODS: We conducted N = 38 in-depth interviews with PWID in rural Puerto Rico to document participants' experiences of injection drug use after the arrival of fentanyl and the strategies they implemented to manage overdose death risks. RESULTS: Participants suggest that the arrival of fentanyl in large scale happened after Hurricane Maria in 2017; this coincided with a dramatic increase in overdose episodes and deaths. Fear of overdose deaths motivated some participants to substitute intravenous drug use for other forms of substance use or to seek MOUD. PWID that continued injection use resorted to conducting "hit tests," avoiding injecting alone, using naloxone, and employing fentanyl testing strips. CONCLUSIONS: While overdose deaths would have been higher without participants' willingness to adopt harm-reduction strategies, this paper illustrates the limits of these policies to address the current epidemic of fentanyl-related overdose deaths among this population. More studies are needed to understand how health disparities shape overdose risks for minority populations. However, major policy changes, in particular the revision of the harmful role of the War on Drugs and the termination of failed neoliberal economic policies that contribute to deaths of despair, should be addressed if we are to make a dent in this epidemic.

Association between adverse experiences during Hurricane María and mental and emotional distress among adults in Puerto Rico.

OBJECTIVES: To evaluate the association between adverse experiences during Hurricane María and mental and emotional distress in Puerto Rico. METHODS: This cross-sectional study used baseline data from adult (30-75 years) participants of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT). Enrolled individuals prior to COVID-19 who completed a 33-item questionnaire on Hurricane María-related experiences (sub-categorized as personal, service, or property losses), depression symptomatology, post-traumatic stress disorder (PTSD), and anxiety were included for analysis (n = 456). RESULTS: Most participants experienced fear for their family's safety, damage to their home and personal items, communication outages, and water shortages. Each additional stressor was significantly associated with higher odds of depression symptoms, PTSD, and anxiety. Personal losses were significantly associated with higher likelihood of all outcomes, while services losses were associated with depression symptoms and anxiety; property loss was not significantly associated with any outcome. CONCLUSIONS: Adverse experiences during a major natural disaster are associated with mental and emotional distress. Strategies to minimize hardships during natural disasters, especially personal and service losses, are essential to preserve mental health. Post-disaster psychological support to individuals is crucial.

Substance use, injection risk behaviors, and fentanyl-related overdose risk among a sample of PWID post-Hurricane Maria.

BACKGROUND: While natural disasters like hurricanes are increasingly common, their long-term effects on people who inject drugs are not well understood. Although brief in duration, natural disasters can radically transform risk environments, increasing substance use and drug-related harms. METHODS: Based on a study of people who inject drugs (PWID) and injection risk behaviors in rural Puerto Rico, the present study uses data from two different phases of the parent study. Data for 110 participants were collected from December 2015 to January 2017, soon before Hurricane Maria landed in September 2017; the 2019 phase, in the aftermath of the hurricane, included a total of 103 participants. The present study's main analyses used data from 66 PWID who participated in both the pre-Maria and post-Maria interviews (66 individuals measured at two time points, for a total of 132 observations), using mixed-effects binomial logistic regression to examine recent overdose experiences pre- and post-Maria. A separate descriptive analysis included all 103 participants from the 2019 interview. RESULTS: After Hurricane Maria, some declines in injection frequency were observed (the percentage of people reporting injecting monthly or less increased from 3.0% before Hurricane Maria to 22.7% after Hurricane Maria). However, fewer PWID reported using a new needle for most or all injections. In the pre-Maria interview, 10.6% of participants indicated they had experienced an overdose during the year of the interview and/or the calendar year prior, and this figure increased to 24.2% in the post-Maria interview. In the regression analysis, the odds of reporting an overdose during the interview year and/or calendar year prior were three times as high post-Maria, relative to pre-Maria (odds ratio 3.25, 95% confidence interval 1.06-9.97). CONCLUSION: Substance use patterns, injection risk behaviors, and overdose episodes and deaths differed after Hurricane Maria, relative to before the hurricane, yet it is unclear to what extent these changes also reflect the simultaneous arrival of fentanyl. In preparation for future natural disasters, it is imperative to strengthen the health infrastructure by enhancing access and curbing barriers to syringe services programs and medications for opioid use disorder, particularly in rural or underserved locations.

Returning to normal? 'Building back better' in the Dominican education system after Tropical Storm Erika and Hurricane Maria.

Child-centred disaster risk reduction aims to reduce child vulnerability and increase resilience to disasters. The 2015 Comprehensive School Safety Framework (CSSF) sought to decrease hazard risks to education. Between 2015 and 2017, Dominica was struck by Tropical Storm Erika and Hurricane Maria, which significantly affected the education system at the local and national scales. Since Maria, a couple of national initiatives (Safer Schools and Smart Schools) have been introduced to increase resilience and meet the CSSF's objectives. This paper assesses progress made through a qualitative analysis of interviews with 29 school leaders, government officials, and disaster risk reduction stakeholders. Implementation of the climate resilience programme in 2018 resulted in nationwide teacher training and production of school disaster plans. Limited successes have improved social resilience, but short-term implementation due to COVID-19 and a lack of a teacher knowledge base have presented challenges to the scheme's long-term sustainability and the implementation of the CSSF's goals.

The influence of government negligence on the way people experienced the essential services of hospitals, clinics, and pharmacies after Hurricane Maria.

Hurricane María had a profound impact on the way essential health services were given during the emergency period that followed its landfall on Puerto Rico. The main objective of this research was to find out what people with health conditions in need of essentials services from hospitals, clinics, and pharmacies did during the emergency period. Furthermore, we wanted to know people's view about the government's response to the aftermath of the hurricane. By conducting a series of interviews with different health specialists, students at the University of Puerto Rico-Cayey, and citizens of the community of Jájome Alto in Cayey, Puerto Rico, we were able to better understand aspects of the physical and social impact caused by Hurricane Maria. Interviews made at Casa Pueblo in Adjuntas, Puerto Rico, served as an inspiration for how we can prepare better for future natural disasters.

Psychological effects before, during and after Hurricane Maria.

Since vulnerability is not recognized, the issue of mental health in Puerto Rico is something that is invisible on the island. The objective of this research is to recognize the negative psychological effects caused by the passage of Hurricane Maria in Puerto Rico. The data collection was carried out through nine semi-structured interviews, with Puerto Ricans between the ages of twenty to seventy-five years of age, the majority being college students. The experiences of each of the interviewees regarding their life before, during and after Hurricane Maria were investigated. The results of this research showed that the greatest impact, in terms of mental health, was during the months after the hurricane. As mentioned by most of the participants, the despair of seeing that nothing returned to normal and that necessities-drinking water, electricity, food, etc.-were scarce, created a mass hysteria and great trauma. Puerto Ricans have not yet overcome the adversities that Hurricane Maria brought. During the investigation, we were able to observe how there are still people who have not recovered mentally or psychologically after this natural disaster. According to our observations, there are many people in need of professional psychological help, which is not recognized, as seeking such help is taboo. Therefore, it is time to act and start working on this situation.

The effects of ceftriaxone by intravenous push on adverse drug reactions in the emergency department.

OBJECTIVE: At our hospital, a shortage of sterile saline bags led to changing ceftriaxone from intravenous infusion to intravenous push. We examined if this change led to an increase in adverse reactions. METHODS: We conducted a retrospective chart analysis on patients 18 and older that were administered ceftriaxone in the ED between January to March 2018. Research assistants recorded information about possible adverse reactions. Adverse reactions were defined as any noxious or unintended response to a drug given at therapeutic doses. Potential adverse reactions were independently reviewed by three EM clinicians and confirmed by an adverse drug reaction probability scale. The primary outcome was the rate of adverse reactions for IVP administration of ceftriaxone. RESULTS: 831 encounters were identified, 77 were excluded due to erroneous or missing data, and a total of 753 were included. Study demographics include an average age of 52.8, a female majority (54.2%) and predominantly black patient population (41.5%). A total of 24 cases were potential adverse reactions. After independent review, only one of the 24 cases was determined to be an adverse reaction to ceftriaxone from IVP. The total adverse event rate observed was 1/753 or 0.13%. CONCLUSIONS: Our study demonstrates that the rate of adverse reactions for IVP is lower than previously reported. Given the demonstrated safety of IVP administration, future studies are warranted to determine the implications for ED efficiency and cost benefits from this change in drug delivery.

"Y no quedó nada, nada de la casa, todo salió volando" (And there was nothing left, nothing of the house, everything flew away): a critical medical ecological perspective on the lived experience of hurricane María in Puerto Rico.

BACKGROUND: Ecological disasters create dramatic changes as man-made and natural ecosystems adapt to their effects. In 2017, Hurricanes Irma and María devastated Puerto Rico. Public focus after such traumatic ecological events often neglects pre-existing community dynamics, heterogeneity of lived experience, and complexity of decision-making in the disaster context. We intended to better understand the lived experience of this ecological trauma in communities across ecosystems in Puerto Rico and among those displaced to Florida. METHOD: We used the Critical Medical Ecological (CME) framework to assess the relative contribution of ecological dimensions on lived experience across community levels and time. We used qualitative methods with emic coding and etic mapping of salient constructs to the ecological model. In total, 96 people participated in 23 discussion encounters. Two people coded interviews in Spanish using Dedoose. We identified common themes in sequential order mapped to elements of the CME to approximate the participants' temporal experience. RESULTS: Codes applied to the period of the hurricane's landfall, traverse, and exit were markedly distinct from the other two periods (before and after) examined in this study: the experience of the hurricane's strike was highly personal and, at this level, reflected a mix of sociocultural, biological, and abiotic factors. After the hurricanes, social and community factors re-emerged while new risks and conditions arose that were biological (e.g., leptospirosis, no food or water) or abiotic (e.g., unusable roads/bridges, structures destroyed), but created ongoing stressors and social needs for communities. As we found, the dynamics of the social and household landscape sometimes involved the decision to leave Puerto Rico altogether, or forced people to continually face and adapt to the ongoing collapse in basic services that were only slowly and differentially restored. CONCLUSION: Lived experience across each stage of the hurricanes differed substantially from one another. Communities disrupted by ecological disaster are also frequently entangled within global economic and political histories and dependencies that could preclude recovery. Island nations are especially vulnerable to both climate-induced ecological change and political-economic exploitation. The ongoing health effect of the hurricane remains palpable in many communities of Puerto Rico and among the diaspora in Florida.

Early warning systems and evacuation: rare and extreme versus frequent and small-scale tropical cyclones in the Philippines and Dominica.

Survey questionnaires were administered among populations affected by Super Typhoon Yolanda in the Philippines in 2013 and Hurricane Maria in Dominica in 2017 to test the efficacy of early warning systems in prompting residents to take appropriate action ahead of severe hazards. Both events were rare and extreme but occurred in locations that regularly experience less severe tropical cyclones. The research assessed if, how, and when residents received warnings, what instructions were given, and where and when people decided to seek safety. In both of the cases under review, residents were aware of the approaching storms, but critical information on their severity and potential impacts was either not received in time or not understood fully, resulting in low levels of evacuation and safety-seeking behaviour. This paper suggests that planning and public communication need to focus on the uncertainty surrounding the severity and multifaceted nature of tropical cyclones and accompanying hazards and their consequences.

Conducting an immersive community-based assessment of post-hurricane experience among Puerto Ricans: lived experience of medical ecology in an environmental disaster and migration.

BACKGROUND: Two devastating sequential hurricanes impacted Puerto Rico during September of 2017. The hurricanes were traumatic and created social and ecological upheaval throughout Puerto Rico, and subsequently in communities of Central Florida where affected Puerto Ricans migrated. The 2017 hurricane season exposed and exacerbated previous long-standing socio-political, economic, environmental, and health crises, generating a humanitarian emergency in the country. The consequences of these human-ecological disasters destroyed much of Puerto Rico's residential and environmental infrastructure, displacing thousands of people and resulting in an unprecedented migration to the United States. We report on the lived experience of the investigator team and partnership in conducting community-based formative research subsequent to this disaster, research that aimed to identify salient issues relating to the impact of Hurricanes Irma and María on Puerto Rican communities both in Puerto Rico and in Central Florida. DISCUSSION: The challenges faced during the conduct of this research include but are not limited to (1) emotional distress of participants and team members, (2) access to affected populations, and (3) precarious environmental factors, such as unstable infrastructure. To address these challenges, the researchers applied a Critical Medical Ecological paradigm along with qualitative methods to assist constructing explanatory models while obtaining internally-valid (from the community perspective), cathartic narrative accounts of the lived experience of hurricane survivors. The experience of the research team may help inform other investigators conducting applied research during a humanitarian crisis. CONCLUSION: Lessons learned in this research included: (1) usefulness of applying the Critical Medical Ecological model in the development of the project, (2) incorporating participation and methods that prioritize authenticity, (3) understanding the trauma experience and using study methods sensitive to it, and (4) innovating with best approaches to conduct the study given the challenges in post-hurricane Puerto Rico. These lessons could provide new insights on how to conduct in-depth participatory health research with community members who have been traumatized and - often - displaced. This research also demonstrates the value of pre-existing partnerships, critical consciousness in the field team, and medical ecological modeling as experiential for organizing complex, inter-related, multi-level variables that explain community and individual impact of environmental disasters.

Decoloniality and community-psychology practice in Puerto Rico: autonomous organising (autogestión) and self-determination.

Psychology, as a diverse social practice, must take a stance regarding the colonial world-system that legitimises the hegemonic production of knowledge. Decolonising community psychology requires the transformation of its practices to face cultural and institutional systems that reproduce inequality in colonial contexts as well as the validating of indigenous knowledge. Reflecting on an intervention in response to the devastation of Hurricane Maria in Puerto Rico, this paper highlights the importance of a community psychological practice that promotes the search for self-determination and autonomous organising or autogestión. Following the notion that community psychologists should be social change agents whose professional activity constitutes a political act, our proposal is to stress decoloniality as a pedagogical practice, incorporating its principles to everyday interactions with diverse people, groups, organisations and communities. Self-determination refers to the ability for people, groups, neighbourhoods and communities to recognise the demands of their contexts and respond in ways that potentiate control over their own lives simultaneously with the search and action for collective well-being. Autonomous organising aims at individual and collective empowerment, to demand from official institutions and agents what their rights are, when they need it, by organising contestant responses to the systematic injustices and the abandonment of colonial instances.

Challenges and Lessons Learned After Hurricane Maria: Learning Points for the Medical Student Community.

On September 20 of 2017, Hurricane Maria made landfall in Puerto Rico as a strong category 4 hurricane with destructive winds and flooding. Everyone suffered in the aftermath of the hurricane due to overwhelming destruction and lack of available resources. For medical students, these conditions were intensified due to their duty as first responders, academic responsibilities from medical school, personal losses, and financial difficulties. Despite the hardships, these students learned lessons and found solutions to overcome their challenges. The objective of this article is to portray the situations that medical students confronted and offer suggestions on how medical students and academic institutions can prepare for future natural disasters.

Smoke Alarms and Carbon Monoxide Alarms in Households With Children, Puerto Rico, 2010.

In 2017, Puerto Rico sustained extensive damage from Hurricane Maria, increasing the risk of fires and carbon monoxide (CO) poisonings. Using a population-based, in-person survey of households with children less than 6 years old in Puerto Rico, we collected data in 2010 concerning the presence of smoke alarms and CO alarms in these households. We generated national estimates by extrapolating the number of households in each stratum using data from the 2010 Census. We determined which household characteristics predicted the presence of these alarms. Of 355 households analyzed, 31% had functional smoke alarms, or an estimated 109,773 households territory wide. The presence of smoke alarms was associated with living in multifamily housing and no child in the household receiving government medical insurance. Public housing or publicly subsidized housing, as compared to owner-occupied housing and unsubsidized rental housing, was associated with having a functional smoke alarm in households with children aged less than 6 years. Based on only six houses having CO alarms, we estimated only 7685 (2%) households had CO alarms. The low prevalence of functional smoke or CO alarms 7 years before Hurricane Maria is unfortunate and should be remedied by ensuring that such alarms are widely installed in current rebuilding activities.

Investigating the impact of Hurricane Maria on an ongoing birth cohort in Puerto Rico.

Prior to Hurricane Maria, Puerto Rico already had 200+ hazardous waste sites, significant contamination of water resources, and among the highest rates of preterm birth in the US. To address these issues, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Center was formed in 2010 to investigate prenatal environmental exposures, particularly phthalates, and adverse birth outcomes. Recent work from the PROTECT study confirms that in utero exposure to certain phthalates is associated with shorter gestation and increased risk of preterm birth. However, previous research also suggests that pregnant women who experience a natural disaster such as Hurricane Maria are at higher risk of adverse birth outcomes, but it is unknown whether this is due to stress, hazardous exposures, or a combination of factors. Thus, the aim of this analysis was to characterize hurricane-related changes in phthalate exposures and experiences within the PROTECT cohort. Among 176 participants who were pregnant during or within 5 months after Maria, 122 completed a questionnaire on hurricane-related experiences. Questionnaire results and biomarkers of exposure suggest that participants did not have regular access to fresh foods and water during hurricane recovery, and almost half reported structural damage to their home. In addition, biomarker concentrations of phthalates commonly used in food packaging were higher among participants post-hurricane, while phthalates commonly used in personal care products were lower compared to pre-hurricane levels. Hurricane-related increases in phthalate exposure, as well as widespread structural damage, food and water shortages, and long-term absence of electricity and cell phone service, likely increased the risk of adverse birth outcomes among this already vulnerable population.

Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017.

We report 2 cases of melioidosis in women with diabetes admitted to an emergency department in the US Virgin Islands during October 2017. These cases emerged after Hurricanes Irma and Maria and did not have a definitively identified source. Poor outcomes were observed when septicemia and pulmonary involvement were present.