Study: Severe Weather-Related Power Outages Pose Increasing Threat to Patients Who Rely on Electronic Medical Equipment.

This Medical News article discusses how the frequency and distribution of US power outages affects patients who use electronic medical equipment.

Improvement of DBR routing protocol in underwater wireless sensor networks using fuzzy logic and bloom filter.

Routing protocols for underwater wireless sensor networks (UWSN) and underwater Internet of Things (IoT_UWSN) networks have expanded significantly. DBR routing protocol is one of the most critical routing protocols in UWSNs. In this routing protocol, the energy consumption of the nodes, the rate of loss of sent packets, and the rate of drop of routing packets due to node shutdown have created significant challenges. For this purpose, in a new scenario called FB-DBR, clustering is performed, and fuzzy logic and bloom filter are used in each cluster's new routing protocol in underwater wireless sensor networks. Due to the fuzzy nature of the parameters used in DBR, better results are obtained and bloom filters are used in routing tables to compensate for the deceleration. as the average number of accesses to routing table entries, dead nodes, Number of Packets Sent to Base Station (BS), Number of Packets Received at BS, Packet Dropped, and Remaining Energy has improved significantly.

Power Outages and Community Health: a Narrative Review.

PURPOSE OF REVIEW: Power outages, a common and underappreciated consequence of natural disasters, are increasing in number and severity due to climate change and aging electricity grids. This narrative review synthesizes the literature on power outages and health in communities. RECENT FINDINGS: We searched Google Scholar and PubMed for English language studies with titles or abstracts containing "power outage" or "blackout." We limited papers to those that explicitly mentioned power outages or blackouts as the exposure of interest for health outcomes among individuals living in the community. We also used the reference list of these studies to identify additional studies. The final sample included 50 articles published between 2004 and 2020, with 17 (34%) appearing between 2016 and 2020. Exposure assessment remains basic and inconsistent, with 43 (86%) of studies evaluating single, large-scale power outages. Few studies used spatial and temporal control groups to assess changes in health outcomes attributable to power outages. Recent research linked data from electricity providers on power outages in space and time and included factors such as number of customers affected and duration to estimate exposure. The existing literature suggests that power outages have important health consequences ranging from carbon monoxide poisoning, temperature-related illness, gastrointestinal illness, and mortality to all-cause, cardiovascular, respiratory, and renal disease hospitalizations, especially for individuals relying on electricity-dependent medical equipment. Nonetheless the studies are limited, and more work is needed to better define and capture the relevant exposures and outcomes. Studies should consider modifying factors such as socioeconomic and other vulnerabilities as well as how community resiliency can minimize the adverse impacts of widespread major power outages.

Health care during electricity failure: The hidden costs.

BACKGROUND: Surgery risks increase when electricity is accessible but unreliable. During unreliable electricity events and without data on increased risk to patients, medical professionals base their decisions on anecdotal experience. Decisions should be made based on a cost-benefit analysis, but no methodology exists to quantify these risks, the associated hidden costs, nor risk charts to compare alternatives. METHODS: Two methodologies were created to quantify these hidden costs. In the first methodology through research literature and/or measurements, the authors obtained and analyzed a year's worth of hour-by-hour energy failures for four energy healthcare system (EHS) types in four regions (SolarPV in Iraq, Hydroelectric in Ghana, SolarPV+Wind in Bangladesh, and Grid+Diesel in Uganda). In the second methodology, additional patient risks were calculated according to time and duration of electricity failure and medical procedure impact type. Combining these methodologies, the cost from the Value of Statistical Lives lost divided by Energy shortage ($/kWh) is calculated for EHS type and region specifically. The authors define hidden costs due to electricity failure as VSL/E ($/kWh) and compare this to traditional electricity costs (always defined in $/kWh units), including Levelized Cost of Electricity (LCOE also in $/kWh). This is quantified into a fundamentally new energy healthcare system risk chart (EHS-Risk Chart) based on severity of event (probability of deaths) and likelihood of event (probability of electricity failure). RESULTS: VSL/E costs were found to be 10 to 10,000 times traditional electricity costs (electric utility or LCOE based). The single power source EHS types have higher risks than hybridized EHS types (especially as power loads increase over time), but all EHS types have additional risks to patients due to electricity failure (between 3 to 105 deaths per 1,000 patients). CONCLUSIONS: These electricity failure risks and hidden healthcare costs can now be calculated and charted to make medical decisions based on a risk chart instead of anecdotal experience. This risk chart connects public health and electricity failure using this adaptable, scalable, and verifiable model.

Optimization of solar-driven systems for off-grid water nanofiltration and electrification.

The work described is motivated by an inability to extend central infrastructure for power and water to low-population-density areas of the Navajo Nation and elsewhere. It is estimated that 35% of the Navajo population haul water for household use, frequently from unregulated sources of poor initial quality. The proposed household-scale, solar-driven nanofiltration (NF) system designs are economically optimized to satisfy point-of-use water purification objectives. The systems also provide electrical energy for a degree of nighttime household illumination. Results support rational design of multiple-component purification systems consisting of solar panels, a high-pressure pump, NF membranes, battery storage and an electrical control unit subject to constraints on daily water treatment and excess energy generation. The results presented are conditional (based on initial water quality, membrane characteristics and geography) but can be adapted to satisfy alternative treatment objectives in alternate geographic, etc. settings. The unit costs of water and energy from an optimized system that provides 100 gpd (1 gallon is 3.78 L) and 2 kWh/day of excess electrical energy are estimated at $0.16 per 100 gallons of water treated and $0.26 per kWh of nighttime electrical energy delivered. Methods can be used to inform dispersed infrastructure design subject to alternate constraint sets in similarly remote areas.

Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia.

INTRODUCTION: Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals. METHODS: Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using 'top-down' and 'bottom-up' thematic coding. RESULTS: Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision. CONCLUSION: This supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes.

Newborn Service Readiness of Primary Level Health Facilities of Eastern Mountain Region of Nepal.

BACKGROUND: Newborn service readiness is facility's observed capacity to provide newborn services and a pre-requisite for quality. Newborn services are priority program of government and efforts are focused on infrastructure and supplies at peripheral health facilities. Study describes health facility readiness for newborn services in four domains of general requirements, equipment, medicines and commodities, and staffing and guidelines. METHODS: Convergent parallel mixed method using concurrent triangulation was done in public health facilities providing institutional deliveries of two randomly selected districts- Taplejung and Solukhumbu of Eastern Mountain Region of Nepal. Face to face interview and observation of facilities were done using structured questionnaire and checklist; in-depth interviews were done using interview guideline from November 2016 to January 2017. Ethical clearance was taken. Descriptive analysis and deductive thematic analysis were done. RESULTS: Mean score of newborn service readiness was 68.7±7.1 with range from 53.3 to 81.4 out of 100. Domains of general requirement, equipment, medicine and commodity, supervision, staffing and guideline were assessed. The gaps identified in general requirements were availability of uninterrupted power supply, means of communication and referral vehicle. Clean wrappers and heater for room temperature maintenance were identified during interviews to be part of the readiness. All health facilities had trained staff while retention of skill was of concern. There was felt need of enforcing adequate training coverage to suffice the need of human resources in remote. CONCLUSIONS: Efforts of improving transportation, heater for room temperature maintenance, trainings with skill retention strategy, utilization of guidelines, availability of skilled birth attendance could result increased and improved newborn service readiness.

Self-Powered Intracellular Drug Delivery by a Biomechanical Energy-Driven Triboelectric Nanogenerator.

Nondestructive, high-efficiency, and on-demand intracellular drug/biomacromolecule delivery for therapeutic purposes remains a great challenge. Herein, a biomechanical-energy-powered triboelectric nanogenerator (TENG)-driven electroporation system is developed for intracellular drug delivery with high efficiency and minimal cell damage in vitro and in vivo. In the integrated system, a self-powered TENG as a stable voltage pulse source triggers the increase of plasma membrane potential and membrane permeability. Cooperatively, the silicon nanoneedle-array electrode minimizes cellular damage during electroporation via enhancing the localized electrical field at the nanoneedle-cell interface and also decreases plasma membrane fluidity for the enhancement of molecular influx. The integrated system achieves efficient delivery of exogenous materials (small molecules, macromolecules, and siRNA) into different types of cells, including hard-to-transfect primary cells, with delivery efficiency up to 90% and cell viability over 94%. Through simple finger friction or hand slapping of the wearable TENGs, it successfully realizes a transdermal biomolecule delivery with an over threefold depth enhancement in mice. This integrated and self-powered system for active electroporation drug delivery shows great prospect for self-tuning drug delivery and wearable medicine.

Degradation of carbamazepine by vacuum-UV oxidation process: Kinetics modeling and energy efficiency.

Vaccum-ultraviolet (VUV) is effective for elimination of organic contaminants in aqueous environment and degradation of carbamazepine (CBZ) by VUV irradiation was systematically investigated in this study. A dynamic kinetic model was developed to simulate the destruction of CBZ that is mainly initiated by hydroxyl radicals (HO). The second-order rate constant of the reaction between CBZ and HO was determined to be 1.4 × 109 M-1 s-1. Effect of initial CBZ concentration, VUV irradiation intensity and natural organic matter (NOM) were further investigated in several batch experiments. The predicted CBZ removal rates increased with the increasing VUV intensity, while decreased with the increasing initial CBZ and NOM concentrations. Based on the electrical energy per order (EE/O) calculation, the optimal VUV intensity was determined to be 7.5 × 10-8 Einstein s-1. Meanwhile, several intermediates/products were identified and their time-dependent evolution profiles were determined, and finally a plausible degradation pathway of CBZ was proposed. Ecotoxicity assessment indicated that the potential toxicity of CBZ and its oxidation products should be paid more attention in the VUV process.

Community Pharmacy Response in the Aftermath of Natural Disasters: Time-Sensitive Opportunity for Research and Evaluation.

One year ago, Hurricane Maria passed over the archipelago of Puerto Rico, leaving widespread disruption of nearly all human services, including the health care sector. In the aftermath of the hurricane, limited access to medical care and prescription medications presented a serious challenge to maintaining control of preexisting chronic diseases. Many patients did not have access to refrigeration for heat-sensitive medications. Significant dietary changes due to the limited availability of shelf-stable foods further exacerbated chronic conditions such as heart failure and diabetes. The role of community pharmacists following a natural disaster has previously been documented, and may include the triage of evacuees, assessment of immunization needs, and provision of prescription medications under a collaborative practice agreement. However, our experience in Puerto Rico demonstrated a variety of barriers limited pharmacists' ability to adequately respond to the magnitude of this disaster. These included medication shortages, extended loss of power, and limited telecommunications for contacting prescribers, disaster relief agencies, and third-party payers. Ultimately, the lack of preexisting emergency protocols made overcoming such barriers difficult. As the first and sometimes only accessible health care provider to many patients following a natural disaster, we must build a solid evidence base and better understanding of the individual, interpersonal, and environmental factors that contribute to the community pharmacist response. To date, however, a paucity of data exists on both the pharmacist and patient factors, which may contribute to an effective immediate response to patient needs at the community pharmacy following a natural disaster. Future research must focus on these multi-level factors to better inform public policy and effective disaster planning. Ultimately, such research and planning will lead to increased resiliency in our primary health care systems in the face of future disasters.

Three-electrode Coin Cell Preparation and Electrodeposition Analytics for Lithium-ion Batteries.

As lithium-ion batteries find use in high energy and power applications, such as in electric and hybrid-electric vehicles, monitoring the degradation and subsequent safety issues becomes increasingly important. In a Li-ion cell setup, the voltage measurement across the positive and negative terminals inherently includes the effect of the cathode and anode which are coupled and sum to the total cell performance. Accordingly, the ability to monitor the degradation aspects associated with a specific electrode is extremely difficult because the electrodes are fundamentally coupled. A three-electrode setup can overcome this problem. By introducing a third (reference) electrode, the influence of each electrode can be decoupled, and the electrochemical properties can be measured independently. The reference electrode (RE) must have a stable potential that can then be calibrated against a known reference, for example, lithium metal. The three-electrode cell can be used to run electrochemical tests such as cycling, cyclic voltammetry, and electrochemical impedance spectroscopy (EIS). Three-electrode cell EIS measurements can elucidate the contribution of individual electrode impedance to the full cell. In addition, monitoring the anode potential allows the detection of electrodeposition due to lithium plating, which can cause safety concerns. This is especially important for the fast charging of Li-ion batteries in electric vehicles. In order to monitor and characterize the safety and degradation aspects of an electrochemical cell, a three-electrode setup can prove invaluable. This paper aims to provide a guide to constructing a three-electrode coin cell setup using the 2032-coin cell architecture, which is easy to produce, reliable, and cost-effective.

Modeling of Electric Demand for Sustainable Energy and Management in India Using Spatio-Temporal DMSP-OLS Night-Time Data.

Changes in the pattern of electric power consumption in India have influenced energy utilization processes and socio-economic development to greater extent during the last few decades. Assessment of spatial distribution of electricity consumption is, thus, essential for projecting availability of energy resource and planning its infrastructure. This paper makes an attempt to model the future electricity demand for sustainable energy and its management in India. The nighttime light database provides a good approximation of availability of energy. We utilized defense meteorological satellite program-operational line-scan system (DMSP-OLS) nighttime satellite data, electricity consumption (1993-2013), gross domestic product (GDP) and population growth to construct the model. We also attempted to examine the sensitiveness of electricity consumption to GDP and population growth. The results revealed that the calibrated DMSP and model has provided realistic information on the electric demand with respect to GDP and population, with a better accuracy of r 2 = 0.91. The electric demand was found to be more sensitive to GDP (r = 0.96) than population growth (r = 0.76) as envisaged through correlation analysis. Hence, the model proved to be useful tool in predicting electric demand for its sustainable use and management.

A Low-Pressure Oxygen Storage System for Oxygen Supply in Low-Resource Settings.

BACKGROUND: Widespread access to medical oxygen would reduce global pneumonia mortality. Oxygen concentrators are one proposed solution, but they have limitations, in particular vulnerability to electricity fluctuations and failure during blackouts. The low-pressure oxygen storage system addresses these limitations in low-resource settings. This study reports testing of the system in Melbourne, Australia, and nonclinical field testing in Mbarara, Uganda. METHODS: The system included a power-conditioning unit, a standard oxygen concentrator, and an oxygen store. In Melbourne, pressure and flows were monitored during cycles of filling/emptying, with forced voltage fluctuations. The bladders were tested by increasing pressure until they ruptured. In Mbarara, the system was tested by accelerated cycles of filling/emptying and then run on grid power for 30 d. RESULTS: The low-pressure oxygen storage system performed well, including sustaining a pressure approximately twice the standard working pressure before rupture of the outer bag. Flow of 1.2 L/min was continuously maintained to a simulated patient during 30 d on grid power, despite power failures totaling 2.9% of the total time, with durations of 1-176 min (mean 36.2, median 18.5). CONCLUSIONS: The low-pressure oxygen storage system was robust and durable, with accelerated testing equivalent to at least 2 y of operation revealing no visible signs of imminent failure. Despite power cuts, the system continuously provided oxygen, equivalent to the treatment of one child, for 30 d under typical power conditions for sub-Saharan Africa. The low-pressure oxygen storage system is ready for clinical field trials.

Index extraction for electromagnetic field evaluation of high power wireless charging system.

This paper presents the precise dosimetry for highly resonant wireless power transfer (HR-WPT) system using an anatomically realistic human voxel model. The dosimetry for the HR-WPT system designed to operate at 13.56 MHz frequency, which one of the ISM band frequency band, is conducted in the various distances between the human model and the system, and in the condition of alignment and misalignment between transmitting and receiving circuits. The specific absorption rates in the human body are computed by the two-step approach; in the first step, the field generated by the HR-WPT system is calculated and in the second step the specific absorption rates are computed with the scattered field finite-difference time-domain method regarding the fields obtained in the first step as the incident fields. The safety compliance for non-uniform field exposure from the HR-WPT system is discussed with the international safety guidelines. Furthermore, the coupling factor concept is employed to relax the maximum allowable transmitting power. Coupling factors derived from the dosimetry results are presented. In this calculation, the external magnetic field from the HR-WPT system can be relaxed by approximately four times using coupling factor in the worst exposure scenario.

Solar powered oxygen systems in remote health centers in Papua New Guinea: a large scale implementation effectiveness trial.

BACKGROUND: Pneumonia is the largest cause of child deaths in Papua New Guinea (PNG), and hypoxaemia is the major complication causing death in childhood pneumonia, and hypoxaemia is a major factor in deaths from many other common conditions, including bronchiolitis, asthma, sepsis, malaria, trauma, perinatal problems, and obstetric emergencies. A reliable source of oxygen therapy can reduce mortality from pneumonia by up to 35%. However, in low and middle income countries throughout the world, improved oxygen systems have not been implemented at large scale in remote, difficult to access health care settings, and oxygen is often unavailable at smaller rural hospitals or district health centers which serve as the first point of referral for childhood illnesses. These hospitals are hampered by lack of reliable power, staff training and other basic services. METHODS: We report the methodology of a large implementation effectiveness trial involving sustainable and renewable oxygen and power systems in 36 health facilities in remote rural areas of PNG. The methodology is a before-and after evaluation involving continuous quality improvement, and a health systems approach. We describe this model of implementation as the considerations and steps involved have wider implications in health systems in other countries. RESULTS: The implementation steps include: defining the criteria for where such an intervention is appropriate, assessment of power supplies and power requirements, the optimal design of a solar power system, specifications for oxygen concentrators and other oxygen equipment that will function in remote environments, installation logistics in remote settings, the role of oxygen analyzers in monitoring oxygen concentrator performance, the engineering capacity required to sustain a program at scale, clinical guidelines and training on oxygen equipment and the treatment of children with severe respiratory infection and other critical illnesses, program costs, and measurement of processes and outcomes to support continuous quality improvement. CONCLUSIONS: This study will evaluate the feasibility and sustainability issues in improving oxygen systems and providing reliable power on a large scale in remote rural settings in PNG, and the impact of this on child mortality from pneumonia over 3 years post-intervention. Taking a continuous quality improvement approach can be transformational for remote health services.

Earthquakes, Fuel Crisis, Power Outages, and Health Care in Nepal: Implications for the Future.

Earthquakes are a major natural calamity with pervasive effects on human life and nature. Similar effects are mimicked by man-made disasters such as fuel crises and power outages in developing countries. Natural and man-made disasters can cause intangible human suffering and often leave scars of lifelong psychosocial damage. Lessons from these disasters are frequently not implemented. The main objective of this study was to review the effects of the 2015 earthquakes, fuel crisis, and power outages on the health services of Nepal and formulate recommendations for the future. The impacts of earthquakes on health can be divided into immediate, intermediate, and long-term effects. Power outages and fuel crises have health hazards at all stages. It is imperative to understand the temporal effects of earthquakes, because the major needs soon after the earthquake (emergency care) are vastly different from long-term needs such as rehabilitation and psychosocial support. In Nepal, the inadequate and nearly nonexistent specialized health care at the peripheral level claimed many lives during the earthquakes and left many people disproportionately injured. Preemptive strategies such as mobile critical care units at primary health centers, intensive care training for health workers, and alternative plans for emergency care must be prioritized. Similarly, infrastructural damage led to poor sanitation, and alternative plans for temporary settlements (water supply, food, settlements logistics, space for temporary settlements) must be in place where the danger of disease outbreak is imminent. While much of these strategies are implementable and are often set as priorities, long-term effects of earthquakes such as physical and psychosocial supports are often overlooked. The burden of psychosocial stresses, including depression and physical disabilities, needs to be prioritized by facilitating human resources for mental health care and rehabilitation. In addition, inclusion of mental health and rehabilitation facilities in government health care services of Nepal needs to be prioritized. Similarly, power outages and fuel crises affect health care disproportionately. In the current context where permanent solutions may not be possible, mitigating health hazards, especially cold chain maintenance for essential medicines and continuation of life-saving procedures, are mandatory and policies to regulate all health care services must be undertaken. (Disaster Med Public Health Preparedness. 2017;11:625-632).

What Happened to Our Environment and Mental Health as a Result of Hurricane Sandy?

OBJECTIVES: This study describes findings of the impacts of Hurricane Sandy on environmental factors including power outages, air quality, water quality, and weather factors and how these affected mental health during the hurricane. METHODS: An ecological study was conducted at the county level to describe changes in environmental factors-especially power outages-and their relationships to emergency department (ED) visits for mental health problems by use of a Poisson regression model. RESULTS: We found that many environmental hazards occurred as co-exposures during Hurricane Sandy in addition to flooding. Mental health ED visits corresponded with the peak of maximum daily power blackouts, with a 3-day lag, and were positively associated with power blackouts in Bronx (prevalence ratio [PR]: 8.82, 95% confidence interval [CI]: 1.27-61.42) and Queens (PR: 2.47, 95% CI: 1.05-5.82) counties. A possible dose-response relationship was found between the quantile of maximum blackout percentage and the risk of mental health in the Bronx. CONCLUSION: We found that multiple co-environmental hazards occurred during Hurricane Sandy, especially power blackouts that mediated this disaster's impacts. The effects of power outage on mental health had large geographic variations and were substantial, especially in communities with low sociodemographic status. These findings may provide new insights for future disaster response and preparedness efforts. (Disaster Med Public Health Preparedness. 2016;10:314-319).

War is the Enemy of Health. Pulmonary, Critical Care, and Sleep Medicine in War-Torn Syria.

The Syrian crisis, now in its fifth year, has created an unprecedented strain on health services and systems due to the protracted nature of the warfare, the targeting of medics and health care infrastructure, the exodus of physicians and nurses, the shortage of medical supplies and medications, and the disruption of medical education and training. Within a few short years, the life expectancy of resident Syrians has declined by 20 years. Over the first 4 years of the conflict, more than 75,000 civilians died from injuries incurred in the violence. More than twice as many civilians, including many women and children, have died prematurely of infectious and noninfectious chronic diseases for want of adequate health care. Doctors, local administrators, and nongovernmental organizations are struggling to manage the consequences of the conflict under substandard conditions, often using unorthodox methods of health care delivery in field hospitals and remotely by telehealth communication. Much-needed medical supplies are channeled through dangerous routes across the borders from Lebanon, Jordan, and Turkey. Physicians in the United States and other western nations have helped Syrian physicians make the most of the situation by providing training on introducing innovations in technology and treatment. Portable ultrasound machines have been introduced and are being used extensively in the management of trauma and shock. This report, prepared by members of the Syrian American Medical Society, documents current needs for health care relief within Syria, focusing on pulmonary, critical care, and sleep medicine, and some of the efforts currently underway to meet those needs.