Estimating Risk to California Energy Infrastructure from Projected Climate Change

This report outlines the results of a study of the impact of climate change on the energy infrastructure of California and the San Francisco Bay region, including impacts on power plant generation; transmission line and substation capacity during heat spells; wildfires near transmission lines; sea level encroachment upon power plants, substations, and natural gas facilities; and peak electrical demand. The following end-of-century impacts were projected: Expected warming will decrease gas-fired generator efficiency. The maximum statewide coincident loss is projected at 10.3 gigawatts (with current power plant infrastructure and population), an increase of 6.2 percent over current temperature-induced losses. By the end of the century, electricity demand for almost all summer days is expected to exceed the current ninetieth percentile per-capita peak load. As much as 21 percent growth is expected in ninetieth percentile peak demand (percapita, exclusive of population growth). When generator losses are included in the demand, the ninetieth percentile peaks may increase up to 25 percent. As the climate warms, California’s peak supply capacity will need to grow faster than the population. Substation capacity is projected to decrease an average of 2.7 percent. A 5º Celsius (9º Fahrenheit) air temperature increase (the average increase predicted for hot days in August) will diminish the capacity of a fully loaded transmission line by an average of 7.5 percent. The potential exposure of transmission lines to wildfire is expected to increase with time. This study identified some lines whose probability of exposure to fire are expected to increase by as much as 40 percent. Up to 25 coastal power plants and 86 substations are at risk of flooding (or partial flooding) due to sea level rise

Cairns Mental Health Co‐Responder Project: essential elements and challenges to programme implementation

In Australia and internationally, co‐responder models are becoming an increasingly common intervention to respond to police callouts where there is an assumed mental health‐related component or crisis. This type of model involves a collaborative approach where trained police officers team with mental health clinicians to provide specialized responses in order to improve outcomes for persons with mental illness. However, there is limited understanding as to major elements required for implementation of the model. This study aims to identify the essential elements and challenges in implementation of the Mental Health Co‐Responder Project in Cairns, Australia, where the team consists of a mental health nurse with demonstrated competencies in crisis intervention and a specially trained police officer. In 2016, 39 participants completed semi‐structured interviews regarding knowledge and experience of the Cairns co‐responder model. The participants represented first responders and community‐based service providers who work with and support persons living with mental illness. Using a thematic analysis approach, key elements identified as essential to successful project implementation were as follows: -co‐responder team characteristics, -senior and project executive level support -collaborative project governance, and -co‐location of the team within a mental health setting. The main perceived challenges to project implementation included the following: initial concerns regarding client confidentiality, lack of an evaluation plan, and adequate project resourcing. Governance through a vigorous joint agency operation committee and adequate resourcing is imperative to the sustainability of this model

Cardiorespiratory Responses to Physical Work During and Following 17 Days of Bed Rest and Spaceflight

To determine the influence of a 17-day exposure to real and simulated spaceflight (SF) on cardiorespiratory function during exercise, four male crewmembers of the STS-78 space shuttle flight and eight male volunteers were studied before, during, and after the 17-day mission and 17 days of -6° head-down-tilt bed rest (BR), respectively. Measurements of oxygen uptake, pulmonary ventilation, and heart rate were made during submaximal cycling 60, 30, and 15 days before the SF liftoff and 12 and 7 days before BR; on SF days 2, 8, and 13 and on BR days 2, 8, and 13; and on days 1, 4, 5, and 8 after return to Earth and on days 3 and 7 after BR. During 15 days before liftoff, day 4 after return, and day 8 after return and all BR testing, each subject completed a continuous exercise test to volitional exhaustion on a semirecumbent (SF) or supine (BR) cycle ergometer to determine the submaximal and maximal cardiorespiratory responses to exercise. The remaining days of the SF testing were limited to a workload corresponding to 85% of the peak pre-SF peak oxygen uptake (VO2 peak) workload. Exposure to and recovery from SF and BR induced similar responses to submaximal exercise at 150 W. VO2 peak decreased by 10.4% from pre-SF (15 days before liftoff) to day 4 after return and 6.6% from pre-BR to day 3 after return, which was partially (SF: -5.2%) or fully (BR) restored within 1 wk of recovery. Workload corresponding to 85% of the peak pre-SF VO2 peak showed a rapid and continued decline throughout the flight (SF day 2, 6.2%; SF day 8, 9.0%), reaching a nadir of 11.3% during testing on SF day 13. During BR, VO2 peak also showed a decline from pre-BR (BR day 2, -7.3%; BR day 8, -7.1%; BR day 13, -9.0%). These results suggest that the onset of and recovery from real and simulated microgravity-induced cardiorespiratory deconditioning is relatively rapid, and head-down-tilt BR appears to be an appropriate model of this effect, both during and after SF

Comparison of a space shuttle flight (STS-78) and bed rest on human muscle function

Effets et comparaison sur les caractéristisques musculaires (longueur, composition des fibres musculaires et les caractéristiques contractiles in vivo du muscle du mollet) de 4 hommes ayant séjournés dans une station orbitale pendant 17 jours et de 8 hommes ayant subi volontairement une immobilisation en position couchée de 17 jours

Comparison of a space shuttle flight (STS-78) and bed rest on human muscle function

Effets et comparaison sur les caractéristisques musculaires (longueur, composition des fibres musculaires et les caractéristiques contractiles in vivo du muscle du mollet) de 4 hommes ayant séjournés dans une station orbitale pendant 17 jours et de 8 hommes ayant subi volontairement une immobilisation en position couchée de 17 jours

Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee

Background and Objectives To review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians. Methods A multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine–compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. Results Initial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety