A Tale of Two Sandys

Responses to Hurricane Sandy consistently cluster into two types according to how the issues have been defined and understood. On one hand, the crisis was seen as an extreme weather event that created physical and economic damage, and temporarily moved New York City away from its status quo. On the other hand, Hurricane Sandy exacerbated crises which existed before the storm, including poverty, lack of affordable housing, precarious or low employment, and unequal access to resources generally. A Tale of Two Sandys describes these two understandings of disaster and discuss their implications for response, recovery, and justice in New York City. The white paper is based on 74 interviews with policymakers, environmental groups, volunteer first responders, and residents affected by the storm; ethnographic observation; analysis of public reports from government, community-based organizations, and other groups; qualitative analysis of canvassing forms and data; and a review of the academic literature on disaster response. As a framing document, A Tale of Two Sandys selects certain case studies for their exemplary nature, including how different groups identified vulnerable populations, timelines for aid and recovery, a case study of housing and rebuilding, and finally, urban climate change politics. The primary purpose of A Take of Two Sandys is to propose a sophisticated, accurate, and useful way of understanding the inequalities entwined with Sandy’s aftermath and to enable ways to address them

Discourse, Disaster, and the Urban Hazardscape: The political ecology of climate and disasters after Hurricane Sandy

This dissertation examines how the phenomenon of climate change is changing the public conception of natural disasters, and vice versa. Using the aftermath of Hurricane Sandy in New York City as a case study, this project draws on a year of in-depth fieldwork triangulated with media coverage, public reports, and city-level quantitative data to illustrate how popular misconceptions about how disasters happen were at work in the public response to the catastrophe. In particular, my research develops a conceptualframework using discourse analysis, to identify two false doctrines or tropes which underlie many of these misconceptions. The first, the doctrine of natural disaster, asserts that environmental disasters are fundamentally physiological rather than social in origin. The second, the doctrine of disaster exceptionalism, asserts that so-called natural disasters are rare and unpredictable events. The results of this project indicate that while climatechange has the potential to disrupt these two false doctrines, this is not yet occurring in the public response to disaster. This dissertation also extends earlier work on the intersection of climate policy and environmental justice, known as the “climate gap”, and extends it to adaptation, proposing an “adaptation gap” is also at work. Finally, this dissertation proposes a new test for delineating different types of climate change adaptation, further developing work on what constitutes transformational adaptation

Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa.

Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO).We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO.The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO.Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care

Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa.

Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO).We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO.The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO.Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care

Genomic characterization of 99 viruses from the bunyavirus families Nairoviridae, Peribunyaviridae, and Phenuiviridae, including 35 previously unsequenced viruses.

Bunyaviruses (Negarnaviricota: Bunyavirales) are a large and diverse group of viruses that include important human, veterinary, and plant pathogens. The rapid characterization of known and new emerging pathogens depends on the availability of comprehensive reference sequence databases that can be used to match unknowns, infer evolutionary relationships and pathogenic potential, and make response decisions in an evidence-based manner. In this study, we determined the coding-complete genome sequences of 99 bunyaviruses in the Centers for Disease Control and Prevention's Arbovirus Reference Collection, focusing on orthonairoviruses (family Nairoviridae), orthobunyaviruses (Peribunyaviridae), and phleboviruses (Phenuiviridae) that either completely or partially lacked genome sequences. These viruses had been collected over 66 years from 27 countries from vertebrates and arthropods representing 37 genera. Many of the viruses had been characterized serologically and through experimental infection of animals but were isolated in the pre-sequencing era. We took advantage of our unusually large sample size to systematically evaluate genomic characteristics of these viruses, including reassortment, and co-infection. We corroborated our findings using several independent molecular and virologic approaches, including Sanger sequencing of 197 genome segments, and plaque isolation of viruses from putative co-infected virus stocks. This study contributes to the described genetic diversity of bunyaviruses and will enhance the capacity to characterize emerging human pathogenic bunyaviruses