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Active Ingredient: Ondansetron

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Martin Cetron

Martin Cetron Publications
  1. Public health and ethical considerations in planning for quarantine

Martin Cetron
Center for Disease Control and Prevention, National Center for Infectious Diseases, Division of Global Migration and Quarantine, 1600 Clifton Road, Atlanta, GA 30333, USA
Yale J Biol Med 78:329-34. 2005

  • Battling 21st-century scourges with a 14th-century toolbox

    Martin Cetron
    Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
    Emerg Infect Dis 10:2053-4. 2004

    Detail Information Publications 2
    1. Public health and ethical considerations in planning for quarantine

    Martin Cetron
    Center for Disease Control and Prevention, National Center for Infectious Diseases, Division of Global Migration and Quarantine, 1600 Clifton Road, Atlanta, GA 30333, USA
    Yale J Biol Med 78:329-34. 2005

  • Battling 21st-century scourges with a 14th-century toolbox

    Martin Cetron
    Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
    Emerg Infect Dis 10:2053-4. 2004

    Labome.Org © 2015 All Rights Researved
    Princeton, New Jersey 08540, USA

  • Other articles

    Epidemiology and Infectious Diseases » Imported rickettsial diseases detected in Moscow among tourists from endemic foci

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    Imported rickettsial diseases detected in Moscow among tourists from endemic foci

    Tarasevich I.V. Saifullin M.A. Luchshev A.V. Pantyukhina A.N. Mazankova L.N. Dudina K.R. Makarova V.A. Shpynov S.N.

    1N.F Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia, Moscow; 2Infectious Diseases Hospital One, Moscow Healthcare Department; 3Branch One, A.A. Vishnevsky Central Military Clinical Hospital Three, Ministry of Defense of Russia, Moscow; 4Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow 5A.I. Evdokimov Moscow State University of Medicine and Dentistry

    The paper gives data on the epidemiology, clinical course, and diagnosis of imported rickettsial diseases detected in Moscow among the tourists returning from the endemic regions.

    Subscribe Literature About the Autors

    For correspondence:
    Prof. Tarasevich Irina Vladimirovna, BD; Acad. of the Russian Academy of Medical Sciences, Head, Laboratory of Rickettsial Environment, N.F. Gamaleya Research Institute of Epidemiology and Microbiology, Ministry of Health of Russia
    Address: 18, Gamaleya St. Moscow 123098
    Telephone: +7(499) 193-61-85
    E-mail: tarasevichirina@yandex.ru

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    Professor Baggoley chairs a number of national committees, including the Australian Health Protection Principal Committee, the Australian Therapeutic Goods Advisory Council and the National Cancer Expert Reference Group. Other current professional activities include membership of several Antimicrobial Resistance Committees, the National Health and Medical Research Council and the Australian Animal Health Laboratory Strategic Policy Group.

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    Vice-Chair Dr Theresa Tam, Branch Head, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Canada

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    Dr Martin Cetron, Director, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America

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    Professor Claudia Gonzalez is a psychologist and researcher at the Center of Epidemiology and Public Health Policy of the Universidad del Desarrollo in Santiago de Chile since 2011. At the Center she has conducted research on infectious diseases such as tuberculosis in prisons, risk factors for meningitis in the Chilean population and knowledge and attitudes about hantavirus.

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    Dr Paata Imnadze, Head of Scientific Board, National Center for Disease Control and Public Health, Tbilisi, Georgia

    Dr Paata Imnadze is head of the Scientific Board at the National Center for Disease Control and Public Health in Georgia.

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    Dr Fadzilah Kamaludin, Head, Office of Deputy Director General of Health (Public Health), and Director, Epidemic Intelligence Program (Field Epidemiology Training Program), Ministry of Health, Putrajaya, Malaysia

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    Dr Ziad Memish, Deputy Minister for Public Health, Riyadh, Kingdom of Saudi Arabia 1

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    Dr Marion Koopmans, Professor of Public Health Virology, Viroscience Department (head of department starting July 2014), Erasmus University of Rotterdam; and Chief, Virology Department, Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Kingdom of the Netherlands

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    Professor Malik Peiris, Director, School of Public Health and Chair in Virology; Co-Director, WHO H5 Reference Laboratory, The University of Hong Kong, Hong Kong SAR, China

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    Ms Karen Tan, Senior Director, Public Communication Division, Ministry of Communications and Information, Singapore

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    Prior to her current position, Ms Tan served at the Ministry of Health (Singapore) for 10 years. At the Ministry of Health, she had a dual capacity as the Director of Corporate Communications and as Press Secretary to the Minister for Health. During that time she was responsible for strategic communications planning, media relations, issue management, corporate publications, community relations and public consultations. She was responsible for all aspects of mass communications during the SARS epidemic in 2003 and the influenza A (H1N1) pandemic in 2009.

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    Dr Maria Van Kerkhove, Head, Outbreak Investigation Task Force, Center for Global Health, Institut Pasteur, Paris, France

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  • Drug-Resistant TB Patient in Isolation - Lung Conditions Center: Pulmonary and Respiratory Information

    Officials Seeking More than 600 Passengers on Patient's Flight; Patient Feeling Well in Hospital

    May 30, 2007 -- Health officials are reaching out to more than 600 people who flew on recent transatlantic flights with a man who has extensively drug-resistant tuberculosis (XDR TB).

    XDR TB is an infectious disease spread from person to person through the air. Unlike most tuberculosis cases, XDR TB resists the first and secondpreferred drug treatments.

    The man remains under a federal isolation order at an Atlanta hospital. He "continues to feel well" and shows no obvious signs of his tuberculosis, says Martin Cetron, MD, director of the CDC's Division of Global Migration and Quarantine.

    The man's tuberculosis doesn't appear to be highly contagious, Cetron notes, but about 80 people on both flights may be at the highest risk since they were sitting in his row or in the two rows in front of or behind his seat.

    Plans are under way to transport the man to Denver for treatment at the National Jewish Medical and Research Center. The CDC is helping with the logistics of those plans so as not to endanger other travelers, Cetron notes.

    Patient's Flights

    The CDC today provided more information on the man's transatlantic flights.

    On May 12, he flew from Atlanta to Paris on Air France flight 385. His exact seat on that flight isn't clear, but it may have been around row 51, Cetron notes. There were 433 passengers and 18 crew members on that flight. About 40-50 passengers were in the high-risk seats near the patient.

    On May 24, the man flew from Prague in the Czech Republic to Montreal on Czech Air flight 0104 in seat 12C. There were 191 passengers and nine crew members on that flight. About 30 passengers were in the high-risk seats near the man.

    So far, health authorities haven't reached passengers on those flights, but some have come forward after hearing about the situation. Passengers on those flights can call the CDC at (800) CDC-INFO for more information, says Cetron.

    The man also took several other flights: from France to Greece; from Greece to Italy; and from Italy to Prague. But because those flights are shorter than eight hours, they aren't considered as risky for tuberculosis transmission by World Health Organization standards.

    Patient's Story

    In an interview in today's Atlanta Journal-Constitution. the patient told a reporter that he and his wife left the U.S. for their honeymoon.

    The man reportedly said he knew he had tuberculosis that hadn't responded to drug treatments but felt healthy. He says that local officials never told him not to travel but said they "preferred" he not travel.

    The Atlanta Journal-Constitution says the man and his bride flew to Paris, then Athens, and then Rome. In Rome, he says the CDC called him and asked him to report for quarantine. Instead, he and his new wife left for Prague, flew to Montreal, and then drove into the U.S.

    The man told The Atlanta Journal-Constitution that he "didn't want to put anybody at risk" but feared unsuccessful treatment in Italy.

    CDC's Story

    In today's news conference, Cetron says it's the CDC's understanding that local health officials in Atlanta "clearly told him not to travel."

    "The patient had, from his own perspective, compelling reasons to travel, and there were no legal orders in place preventing his travel and no laws were broken," Cetron says, noting that the CDC was looking into options to isolate the man in Rome but that opportunity was missed when the man and his wife left Italy.

    Cetron says that when he learned the man and his wife had driven from Montreal into the U.S. he called the man on his cell phone with isolation instructions.

    "Since we issued our federal isolation order, he has been fully compliant. I believe that aspect of the past is not nearly as important as. moving forward," Cetron says.

    SOURCES: Martin Cetron, MD, director, Division of Global Migration and Quarantine, CDC. Ken Castro, MD, director, Division of Tuberculosis Elimination, CDC. WebMD Health News: "Fliers Warned About Tuberculosis." The Atlanta Journal-Constitution: "Atlantan Quarantined With Deadly TB Strain," May 30, 2007.

    © 2007 WebMD Inc. All rights reserved.

    CNN - CDC: Flu outbreak hits tourists in Alaska, Yukon - July 1, 1999

    CDC: Flu outbreak hits tourists in Alaska, Yukon

    July 1, 1999
    Web posted at: 5:32 PM EDT (2132 GMT)

    ATLANTA (Reuters) -- A flu outbreak has stricken at least 532 people in Alaska and Canada's Yukon Territory, most of them tourists on cruises to see the region's glaciers and other panoramic sights, U.S. health officials said Thursday.

    The Centers for Disease Control and Prevention (CDC) said 428 tourists and 104 tourism workers developed acute respiratory infection with cough and fever between May 22 and June 28. The CDC had previously reported 388 cases through June 21.

    The illnesses occurred among passengers on seven separate week-long cruises, the CDC said. Four tourists have been hospitalized, but there have been no deaths.

    "This looks like Influenza A virus," said Dr. Martin Cetron, chief of surveillance epidemiology in the Division of Quarantine of the CDC's National Center for Infectious Diseases.

    The CDC said that in many cases people became infected with influenza, a viral infection of the respiratory tract, during the land portion of their tours.

    "Last year there was a similar outbreak of Influenza A infection among tourism workers and tourists in the Alaska tourist region over four months or more, and (it) was fairly widespread," Cetron said.

    The CDC said about 40,000 tourists and tourism workers were affected by 1998's outbreak in Alaska and the Yukon Territory.

    Cetron said "anyone age 65 or older or anyone with an underlying chronic health problem" should consult a doctor before going to the region.

    "Talk to your doctor about the signs and symptoms of flu and the advisability of carrying antiviral medications with you should you develop symptoms," he said.

    Copyright 1999 Reuters. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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    Cetron diseases

    Title: Cepeda: An Epidemic's Allies Reside In The Schoolhouse
    September 29, 2012
    Lubbock Online

    Abstract : It’s been an alarming few days of obesity-related news. First, the Robert Wood Johnson Foundation released the results of its “F as in Fat” report, projecting half of U.S. adults will be obese by 2030 unless Americans make drastic dietary changes.

    Then The New York Times reported, according to data published by the University of Illinois at Chicago, white people lacking a high school diploma are experiencing sharp drops in life expectancy, reversing generations of progress to extend life spans. There are many possible reasons, including higher rates of smoking and a spike in prescription overdoses, but the skyrocketing rate of obesity is a known suspect.

    Tuesday marked the release of the most recent report from Mission: Readiness, an organization of about 300 retired generals, admirals and senior civilian military leaders who are trying to spread the word that obesity, and specifically childhood obesity, is a dire national security risk.

    The report, called “Still Too Fat to Fight,” takes on cheap junk foods readily available in our schools. According to Mission: Readiness, students in the U.S. consume almost 400 billion calories from junk food sold at schools each year.

    This will come as no surprise to anyone who has spent time in high schools — especially those in lower-income communities — where students routinely turn down their free or reduced-price breakfasts or lunches in favor of sacks of salty snacks and high-sugar beverages. And though grade-schoolers usually can’t get away with waiving their federal nutrition guideline-monitored meals, they often have a wide variety of cakes, cookies, candy and chips available to add to them — either in the cafeteria or from vending machines.

    The report features some cringe-worthy statistics: One in four young adults is unable to serve in the military because of excess body fat, and even many of the ones who do manage to enlist are at high risk of injury. The military’s health insurance system, according to Mission: Readiness, spends “well over $1 billion a year on treating weight-related diseases such as diabetes and heart disease” in addition to the cost of musculoskeletal injuries resulting from inadequate physical fitness and low levels of bone density that may be related to the plunge in dairy intake and a corresponding rise in childhood consumption of sodas and sugary drinks over the past 35 years.

    In the civilian population, studies recently named obesity the most expensive public health issue, costing the country more than $190 billion annually.

    During a teleconference the American Beverage Association held last May, President and CEO Susan Neely told reporters that over the course of the last three years ABA’s voluntary efforts to curb sugar in schools has resulted in a 97 percent decline in full-calorie soft drinks in schools, and marketing of soft drinks to children under 12 decreased 96 percent since 2004.

    She estimated a savings of approximately 1 trillion calories. In view of recent data establishing a strong causal link between limiting sugary drinks and a reduction in childhood obesity, this is a big step in the right direction.

    So there is reason to be optimistic. We can reduce childhood obesity, we just have to keep pressure on the makers of all the goodies that entice our children when they’re out of our reach.

    At least we’re not alone — if Uncle Sam says we’re all at risk when our kids have full access to junk at school, there’s a good chance more people will begin to demand that schools put a stop to it (Lubbock Online, 2012).

    Title: Doctors Have Mixed Feelings On School Vaccinations
    Date: October 3, 2012
    Source: Fox News

    Abstract : Colorado doctors mostly support local efforts to give kids their flu shots and other vaccines at school - but they also have misgivings, a new study shows.

    In particular, they threw more support to school flu shots, versus other vaccinations. They were also worried about how school vaccinations would affect their record-keeping and their bottom line.

    The study, reported in the journal Pediatrics, looked at doctors' feelings on so-called school-located vaccination - one-day "clinics" where local health officials and school districts offer kids flu shots or other vaccinations.

    The programs are seen as a potential way to bring more kids up-to-date with government-recommended vaccinations.

    Since 2010, the U.S. has advised nearly all Americans age six months and up to get an annual flu shot.

    Even though only a minority follow that advice - about 43 percent of Americans did during the 2010 flu season - that still translates to more than 100 million people clambering for the flu vaccine within the space of a few months.

    "To get all of those people into the doctor's office is impossible," said Dr. Judith Shlay of the Denver Public Health Department, the senior researcher on the new study.

    In Denver, a project funded by the Centers for Disease Control and Prevention has provided in-school flu shots, as well as vaccinations recommended for older kids and teenagers: the meningococcal meningitis vaccine, the human papilloma virus (HPV) vaccine and the "Tdap" vaccine against tetanus, diphtheria and pertussis (whooping cough).

    For the current study, Shlay's team wanted to know how pediatricians and family doctors felt about school vaccinations.

    Of the 584 doctors who responded to the survey, most supported in-school flu shots.

    About two-thirds were in favor of their privately insured patients getting the shot at school, while around three-quarters liked the idea for their patients on Medicaid.

    A financial consideration likely factors in there, since the federal government provides free vaccines for kids on Medicaid, but doctors may have a tough time being reimbursed for the administration costs. Shlay's team found less support for kids getting other vaccinations at school. Half of pediatricians and 59 percent of family doctors were for it when it came to patients with private insurance; 59 percent and 67 percent, respectively, supported it for Medicaid patients.

    One concern was that if older kids get all their vaccinations at school, they won't come in for routine check-ups. Many doctors were also worried they'd have a hard time keeping their patients' records straight.

    "If we give vaccinations in schools and the doctor doesn't know about it, then that's a concern," Shlay said.

    There is a way to address that, though. Colorado, and all other U.S. states, have computerized immunization registries that offer a consolidated record of children's vaccination histories.

    "That's a really important tool," Shlay said.

    But of the doctors in this survey, about one-third were not participating in Colorado's immunization registry.

    If more providers get involved in state registry systems, that could help ease worries over record-keeping, Shlay's team writes.

    Many doctors were also concerned about their bottom line. Most were at least somewhat worried that if an unpredictable number of patients got their vaccinations at school, their offices would have a tough time estimating how many vaccine doses to have in stock.

    Shlay said that's a legitimate concern, since the vaccines for older kids and teens are expensive. (The retail price of the HPV vaccine, for example, is about $130 per dose.)

    "If (doctors) end up with unused, expired vaccines, that's a problem," Shlay said. The potential waste, she added, is a concern not only for doctors, but for everyone who needs the vaccines.

    So that may mean doctors' offices will need to be more careful in terms of inventory, Shlay noted.

    But even if your child gets vaccinated at school, that's not a replacement for check-ups with the doctor.

    "There's more to health and healthcare than just vaccines," Shlay noted.

    It's important, she said, for doctors, public health officials and schools to all work together to make school vaccination programs effective - and, in the bigger picture, get all kids their appropriate vaccinations.

    A government study last year found that that goal is fairly far off: Only 49 percent of U.S. teens had received the first of three doses of the HPV vaccine, while 63 percent had gotten the meningitis vaccine and 69 percent the Tdap shot.

    "School-located vaccine programs are an important approach to augment vaccine delivery," Shlay said (Fox News, 2012).

    Title: Should Schools Close During Bad Flu Outbreaks?
    October 30, 2012
    Fox News

    Abstract : A new U.S. government study suggests that during a serious flu epidemic, closing schools can keep people - especially kids - out of the ER.

    Now, researchers say, the big questions include, When is it best to close schools? And what are the downsides?

    The study, reported in the journal Clinical Infectious Diseases, looked at what happened in two Texas communities during the H1N1 "swine" flu epidemic of 2009. In one community, schools were closed as a precaution; in the other, they weren't.

    It turned out that in the district where schools shut down, there were fewer ER visits for the flu.

    What's more, among kids age 6 and up, there was no increase in flu-related ER trips, while that rate doubled in the community where schools stayed open.

    "The effect was most dramatic among school-age children," said Dr. Martin S. Cetron, of the Centers for Disease Control and Prevention (CDC).

    There have been skeptics who've doubted that school closures could have much impact during a major flu outbreak, according to Cetron.

    "They've said, well, people will just congregate in malls or other public places," explained Cetron, who directs the CDC's division of global migration and quarantine, and worked on the study.

    But schools are different from malls, Cetron pointed out, with kids being in close contact with each other all day long.

    He said he thinks this study, along with others, "settles" the question of whether school closures are effective. "Should this be an arrow in our quiver? I think the answer is ‘yes,'" Cetron said.

    But lots of other questions remain.

    "Under what conditions could (school closures) be warranted?" Cetron said. "What level of severity is needed?"

    And if schools are closed, he noted, what are the downsides? Parents will have to stay home from work, or find child care. And kids and teachers will have to make up the lost school time somehow. So the expected benefits of school closings would need to be worth the troubles.

    Prediction is Difficult
    Every year, between five percent and 20 percent of Americans get the flu, contributing to some 36,000 deaths. The elderly and people with chronic medical conditions, like heart or lung disease, are among those most at risk.

    But the 2009 H1N1 flu epidemic was noteworthy in that it hit children and healthy young adults hard.

    The current study looked at two adjacent counties in Texas: Tarrant County, which closed its schools for eight days after a few kids were diagnosed with H1N1; and Dallas County, where schools did not shut down after a few cases were detected.

    Before Tarrant County's school closures, the flu accounted for about 3 percent of all ER visits to area hospitals; during the closures, that rate inched up to just over 4 percent. But the increase was bigger in Dallas County during the same time period: from 3 percent, to just over 6 percent.

    The impact was most clear among kids ages 6 to 18. In Tarrant County, there was no increase in the proportion of ER visits blamed on the flu. In Dallas County, the figure more than doubled, from about 5 percent to 11 percent.

    "It's important to point out that this was a pre-emptive school closure," Cetron said. "Usually, most closures we see are reactive."

    Predicting how a flu outbreak might affect a local area is far from easy. It's not like tracking a hurricane, for instance, Cetron pointed out.

    Decisions on school closures are made locally. For school districts to make wise decisions, Cetron said communication with local and state health agencies is key (Fox News, 2012).

    Title: Mumps Outbreak Traced To Face-To-Face Schooling, Study Suggests
    November 1, 2012
    Fox News

    Abstract : A face-to-face educational method used among Orthodox Jews apparently led to a U.S. outbreak of mumps in 2009 and 2010 even though most of those infected had been properly vaccinated, according to a U.S. study.

    The outbreak, detailed in the New England Journal of Medicine, indicates how close, repeated contact with an infected person can overwhelm the mumps vaccine, the researchers said.

    "The risk of infection with mumps may be higher when the exposure dose of virus is large or intensely transmitted," wrote lead author Albert Barskey, of the U.S. Centers for Disease Control and Prevention's (CDC) National Center for Immunization and Respirators Diseases, and colleagues.

    This may also explain why the mumps vaccine tends to be less effective among household contacts than among school or community contacts, they added.

    In the mumps outbreak, 3,502 cases were reported over a one-year period beginning in June 2009 in New Jersey, New York City and New York State's Orange and Rockland counties. A camp in the Catskill Mountains was the source.

    The researchers, from the involved state health departments and the CDC, studied 1,648 of those cases, nearly all of them Orthodox Jews. The researchers found that 89 percent had received the recommended two doses of mumps vaccine.

    Many attended a religious school known as a yeshiva, where boys receive intense training with a study partner known as a chavrusa, who sits across a narrow table. The teaching method often involves animated discussions and the partners are switched several times a day.

    The researchers wrote that "chavrusa study, with its prolonged, face-to-face contact," probably resulted in high exposures to the virus, and these "overcame vaccine-induced protection in individual students."

    The large families in Orthodox Jewish communities also contributed to the spread, Barskey told Reuters Health in a telephone interview.

    "As the outbreak went on, we started to see younger and older cases, and females as well. What that suggests is there was spread in the households. From family it would jump to a new school," he said.

    "The chavrusas played the biggest role. The households played a lesser role."

    The source of the outbreak was eventually traced to an 11-year-old boy, who had himself received two vaccine doses but nonetheless picked up the disease in the United Kingdom, where fears about vaccination had led to a large mumps outbreak.

    That child attended the camp, which had about 400 Orthodox Jewish boys (Fox News, 2012).

    Title: Virus Breaks Out At NYC School Being Used As Storm Shelter
    November 6, 2012
    NBC New York

    Abstract : A Brooklyn high school being used as a shelter for Sandy victims has to be shut down and sanitized after about a dozen storm refugees came down with a stomach virus.

    Mayor Bloomberg said John Jay High School will be closed Wednesday instead of opening for classes as scheduled.

    "The school will be thoroughly cleaned and then reopened," Bloomberg said.

    The mayor said none of the sickened storm victims was severely ill. The cleaning is being done as a precaution, he said.

    Thousands of city residents from low-lying areas stayed in shelters as Sandy smashed the tri-state.

    Bloomberg also said 10 schools that suffered storm damage or lost power will open Wednesday. The majority of city schools reopened on Monday.

    Another 47 schools still won't be open Wednesday. Bloomberg said parents should check www.nyc.gov to see where those students will need to report (NBC New York, 2012) .

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