Dissonance between posts of health agencies and public comments regarding COVID-19 and vaccination on Facebook in Northern California.

BACKGROUND: Public health crises, such as the COVID-19 pandemic, have prompted a need for health agencies to improve their disease preparedness strategies, informing their communities of new information and promoting preventive behaviors to help curb the spread of the virus. METHODS: We ran unsupervised machine learning and emotion analysis, validated with manual coding, on posts of health agencies (N = 1588) and their associated public comments (N = 7813) during a crucial initial period of the COVID-19 pandemic (January 2020 to February 2021) among nine different counties with a higher proportion of vaccine-hesitant communities in Northern California. In addition, we explored differences in concerns and expressed emotions by two key group-level factors, county-level COVID-19 death rate and political party affiliation. RESULTS: We consistently find that while health agencies primarily disseminated information about COVID-19 and the vaccine, they failed to address the concerns of their communities as expressed in public comment sections. Topics among public audiences focused on concerns with the COVID-19 vaccine safety and rollout, state mandates, flu vaccination, and frustration with politicians, and they expressed more positive and more negative emotions than health agencies. Further, there were several differences in primary topics and emotions expressed among public audiences by county-level COVID-19 death rate and political party affiliation. CONCLUSION: While this research serves as a case study, findings indicate how local health agencies, and their audiences, discuss their perceptions and concerns regarding the COVID-19 pandemic and may inform health communication researchers and practitioners on how to prepare and manage for emerging health crises.

Climatic regulation of the neurotoxin domoic acid.

Domoic acid is a potent neurotoxin produced by certain marine microalgae that can accumulate in the foodweb, posing a health threat to human seafood consumers and wildlife in coastal regions worldwide. Evidence of climatic regulation of domoic acid in shellfish over the past 20 y in the Northern California Current regime is shown. The timing of elevated domoic acid is strongly related to warm phases of the Pacific Decadal Oscillation and the Oceanic Niño Index, an indicator of El Niño events. Ocean conditions in the northeast Pacific that are associated with warm phases of these indices, including changes in prevailing currents and advection of anomalously warm water masses onto the continental shelf, are hypothesized to contribute to increases in this toxin. We present an applied domoic acid risk assessment model for the US West Coast based on combined climatic and local variables. Evidence of regional- to basin-scale controls on domoic acid has not previously been presented. Our findings have implications in coastal zones worldwide that are affected by this toxin and are particularly relevant given the increased frequency of anomalously warm ocean conditions.

Pelagic marine refugia and climatically sensitive areas in an eastern boundary current upwelling system.

Refugia are areas relatively buffered from contemporary climate change that enable the persistence of valued physical, ecological, or sociocultural resources. Spatially identifying refugia is important for conservation and applied management. Yet the concept of refugia has not been broadly extended to marine ecosystems. Here, we analyze data from a unique and long-term (1999-2015) standardized survey of pelagic marine and anadromous species off Oregon and Washington in the northern California Current to identify such refugia. We use quantitative approaches to assess locations with high species richness and community persistence relative to local and basin-scale environmental fluctuations. We have identified a potential climate change refugial zone along the continental shelf of Washington State in the Northeastern Pacific Ocean, characterized by a species-rich community with low interannual temporal community change. This region contrasts with adjacent areas to the south and offshore that have lower species richness, and higher temporal species community change. Also, using spatially variant generalized additive mixed models, we identify areas with species compositions that are more influenced by basin-scale climatic fluctuations than others. We propose that upwelling regions with retentive topographic features, such as wide continental shelves, can function as marine refugia for pelagic fauna, whereas offshore locations are potentially more climatically sensitive and experience high temporal change in species composition. Further identification of these marine refugia using in situ data for pelagic biodiversity and climatically sensitive areas can help guide management in the face of inevitable climatically driven change.

The impact of El Niño events on the pelagic food chain in the northern California Current.

The zooplankton of the northern California Current are typically characterized by an abundance of lipid-rich copepods that support rapid growth and survival of ecologically, commercially, and recreationally valued fish, birds, and mammals. Disruption of this food chain and reduced ecosystem productivity are often associated with climatic variability such as El Niño events. We examined the variability in timing, magnitude, and duration of positive temperature anomalies and changes in copepod species composition in the northern California Current in relation to 10 tropical El Niño events. Measurable impacts on mesozooplankton of the northern California Current were observed during seven of 10 of these events. The occurrence of anomalously warm water and the response of the copepod community was rapid (lag of zero to 2 months) following the initiation of canonical Eastern Pacific (EP) events, but delayed (lag of 2-8 months) following 'Modoki' Central Pacific (CP) events. The variable lags in the timing of a physical and biological response led to impacts in the northern California Current peaking in winter during EP events and in the spring during CP events. The magnitude and duration of the temperature and copepod anomalies were strongly and positively related to the magnitude and duration of El Niño events, but were also sensitive to the phase of the lower frequency Pacific Decadal Oscillation. When fisheries managers and biological oceanographers are faced with the prospect of a future El Niño event, prudent management and observation will require consideration of the background oceanographic conditions, the type of event, and both the magnitude and duration of the event when assessing the potential physical and biological impacts on the northern California Current.

Impact of endoscopic surveillance on mortality from Barrett's esophagus-associated esophageal adenocarcinomas.

BACKGROUND & AIMS: Although patients with Barrett's esophagus commonly undergo endoscopic surveillance, its effectiveness in reducing mortality from esophageal/gastroesophageal junction adenocarcinomas has not been evaluated rigorously. METHODS: We performed a case-control study in a community-based setting. Among 8272 members with Barrett's esophagus, we identified 351 esophageal adenocarcinoma: 70 in persons who had a prior diagnosis of Barrett's esophagus (who were eligible for surveillance); 51 of these patients died, 38 as a result of the cancers (cases). Surveillance histories were contrasted with a sample of 101 living persons with Barrett's esophagus (controls), matched for age, sex, and duration of follow-up evaluation. RESULTS: Surveillance within 3 years was not associated with a decreased risk of death from esophageal adenocarcinoma (adjusted odds ratio, 0.99; 95% confidence interval, 0.36-2.75). Fatal cases were nearly as likely to have received surveillance (55.3%) as were controls (60.4%). A Barrett's esophagus length longer than 3 cm and prior dysplasia each were associated with subsequent mortality, but adjustment for these did not change the main findings. Although all patients should be included in evaluations of effectiveness, excluding deaths related to cancer treatment and patients who failed to complete treatment, changed the magnitude, but not the significance, of the association (odds ratio, 0.46; 95% confidence interval, 0.13-1.64). CONCLUSIONS: Endoscopic surveillance of patients with Barrett's esophagus was not associated with a substantially decreased risk of death from esophageal adenocarcinoma. The results do not exclude a small to moderate benefit. However, if such a benefit exists, our findings indicate that it is substantially smaller than currently estimated. The effectiveness of surveillance was influenced partially by the acceptability of existing treatments and the occurrence of treatment-associated mortality.

Prevalence and neonatal factors associated with autism spectrum disorders in preterm infants.

OBJECTIVES: To determine the prevalence of autism spectrum disorders (ASD) across gestational age, examine the risk of ASD by gestational age controlling for other risk factors, and identify potential risk factors in the neonatal intensive care unit. STUDY DESIGN: A retrospective cohort of infants born at ≥ 24 weeks between January 1, 2000, and December 31, 2007 at 11 Kaiser Permanente Northern California hospitals (n = 195,021). ASD cases were defined by a diagnosis made at a Kaiser Permanente ASD evaluation center, by a clinical specialist, or by a pediatrician. Cox proportional hazards regression models were used to evaluate the association between gestational age and ASD as well as potential risk factors in the neonatal intensive care unit and ASD. RESULTS: The prevalence of ASD in infants <37 weeks was 1.78% compared with 1.22% in infants born ≥ 37 weeks (P < .001). Compared with term infants, infants born at 24-26 weeks had an adjusted hazard ratio (HR) for a diagnosis of ASD of 2.7 (95% CI 1.5-5.0). Infants born at 27-33 weeks (adjusted HR 1.4, 95% CI 1.1-1.8) and 34-36 weeks (adjusted HR 1.3, 95% CI 1.1-1.4) were also at increased risk. High frequency ventilation and intracranial hemorrhage were associated with ASD in infants < 34 weeks. CONCLUSIONS: ASD was ~ 3 times more prevalent in infants <27 weeks compared with term infants. Each week of shorter gestation was associated with an increased risk of ASD. High frequency ventilation and intracranial hemorrhage were associated with ASD among infants <34 weeks.

Hydrographic shipboard profile data collected within Olympic coast national marine sanctuary, 2005-2023.

Olympic Coast National Marine Sanctuary (OCNMS), which was established in 1994 and covers an area of 8257 km2, is located along Washington State's remote and rugged outer coast towards the northernmost extent of the California Current System (CCS). In this region, summertime equatorward winds drive seasonal upwelling of cold, nutrient rich waters onto the continental shelf. These waters help fuel a highly diverse and productive ecosystem that includes marine mammal and seabird communities as well as commercially and culturally important fisheries. The sanctuary is located within the boundaries of the legally defined Usual and Accustomed (U&A) fishing grounds of four Coastal Treaty Tribes, the Hoh Tribe, Makah Tribe, Quileute Tribe, and the Quinault Indian Nation, which hold treaty fishing rights and co-manage fisheries and other natural resources within the sanctuary through state, federal, and international partnerships and agreements. This data article describes shipboard hydrographic Conductivity-Temperature-Depth (CTD) and dissolved oxygen profile data that were collected within the sanctuary at fourteen locations during mooring deployment, recovery, and maintenance cruises between the months of May and October from 2005-2023. The 792 CTD profiles were acquired using Sea-Bird Scientific 19 SeaCAT or 19plus SeaCAT CTD profilers with associated SBE-43 (Sea-Bird Electronics) or Beckman or YSI-type (Yellow Springs Instruments) dissolved oxygen sensors. The data were processed using Sea-Bird Scientific's SBE Data Processing application. These data are needed for improving our understanding of subsurface oceanographic conditions - including marine heat waves, changes in timing of spring transition to upwelling, seasonal hypoxia, and ocean acidification - in this important but undersampled region, and can be used to help improve the management of marine resources regionally and within the sanctuary. The CTD cast data are available via Zenodo at https://doi.org/10.5281/zenodo.10466124.

Health benefits and cost-effectiveness of a hybrid screening strategy for colorectal cancer.

BACKGROUND & AIMS: Colorectal cancer (CRC) screening guidelines recommend screening schedules for each single type of test except for concurrent sigmoidoscopy and fecal occult blood test (FOBT). We investigated the cost-effectiveness of a hybrid screening strategy that was based on a fecal immunological test (FIT) and colonoscopy. METHODS: We conducted a cost-effectiveness analysis by using the Archimedes Model to evaluate the effects of different CRC screening strategies on health outcomes and costs related to CRC in a population that represents members of Kaiser Permanente Northern California. The Archimedes Model is a large-scale simulation of human physiology, diseases, interventions, and health care systems. The CRC submodel in the Archimedes Model was derived from public databases, published epidemiologic studies, and clinical trials. RESULTS: A hybrid screening strategy led to substantial reductions in CRC incidence and mortality, gains in quality-adjusted life years (QALYs), and reductions in costs, comparable with those of the best single-test strategies. Screening by annual FIT of patients 50-65 years old and then a single colonoscopy when they were 66 years old (FIT/COLOx1) reduced CRC incidence by 72% and gained 110 QALYs for every 1000 people during a period of 30 years, compared with no screening. Compared with annual FIT, FIT/COLOx1 gained 1400 QALYs/100,000 persons at an incremental cost of $9700/QALY gained and required 55% fewer FITs. Compared with FIT/COLOx1, colonoscopy at 10-year intervals gained 500 QALYs/100,000 at an incremental cost of $35,100/QALY gained but required 37% more colonoscopies. Over the ranges of parameters examined, the cost-effectiveness of hybrid screening strategies was slightly more sensitive to the adherence rate with colonoscopy than the adherence rate with yearly FIT. Uncertainties associated with estimates of FIT performance within a program setting and sensitivities for flat and right-sided lesions are expected to have significant impacts on the cost-effectiveness results. CONCLUSIONS: In our simulation model, a strategy of annual or biennial FIT, beginning when patients are 50 years old, with a single colonoscopy when they are 66 years old, delivers clinical and economic outcomes similar to those of CRC screening by single-modality strategies, with a favorable impact on resources demand.

Epidemiologic trends in pediatric tinea capitis: a population-based study from Kaiser Permanente Northern California.

BACKGROUND: Epidemic levels of tinea capitis (TC) have previously been reported in children. OBJECTIVE: We sought to determine new epidemiologic trends for TC among northern California children from 1998 through 2007. METHODS: Annual incidence of TC was based on diagnosis code or first-time antifungal prescriptions in all children up to age 15 years at Kaiser Permanente Northern California. RESULTS: An average of 672,373 children/y met the inclusion criteria. Trend analyses showed decreases in TC by diagnosis code and by prescriptions (73.7% and 23.7%, respectively). Girls had lower incidence rates than boys by diagnosis (111.9 vs 146.4, P < .001 for 1998, and 27.9 vs 39.9, P < .001 for 2007). African Americans had the highest incidence rates by diagnosis (447.3 in 1998 and 184.1 in 2007) compared with other ethnic groups. Trichophyton tonsurans was the predominant organism (89.4% of all positive fungal cultures in 1998 and 91.8% in 2007). Prescriptions for griseofulvin declined, whereas the prescriptions for other antifungals increased. LIMITATIONS: This was a retrospective study. CONCLUSIONS: In this cohort, there was a significant decrease in incidence of TC over the study period. Trichophyton tonsurans continued to be the predominant organism. These trends may be a result of improved education, recognition, diagnosis, and treatment of TC and increased use of new oral antifungals.

Psychosocial and diabetes risk factors among racially/ethnically diverse adults with prediabetes.

Psychosocial factors such as self-efficacy may be important in helping high-risk adults prevent diabetes. We aimed to describe psychosocial and diabetes risk factors in adults with prediabetes and evaluate if these varied by demographic characteristics. Cross-sectional data came from baseline surveys and electronic health records (2018-2021) of adults with prediabetes enrolled in a randomized study of peer support for diabetes prevention at Kaiser Permanente Northern California and Michigan Medicine. Linear regression was used to compare differences between racial/ethnic groups, adjusting for age, sex, and clinic. Of 336 participants in the study, 62% were female; median age was 57; 41% were White, 35% African American, 9% Hispanic. Mean autonomous motivation was 6.6 and self-efficacy to prevent diabetes was 6.0 (1-7 scale); mean perceived social support was 47 (12-72 scale). Hispanic adults reported higher autonomous motivation and African American adults reported higher self-efficacy compared to White adults. Hispanic and African American adults had more diabetes risk factors than White adults, including greater family history of diabetes, hypertension, sugar-sweetened beverage consumption, physical inactivity and food insecurity. In conclusion, participants reported high levels of autonomous motivation and self-efficacy at baseline, with Hispanic and African American adults reporting higher levels of some psychosocial factors related to behavior change, suggesting a significant opportunity to engage a diverse population of adults with prediabetes in diabetes prevention strategies. However, Hispanic and African American participants showed greater diabetes risk factors levels. Diabetes prevention efforts should address both to reduce diabetes incidence.

Understanding Human Papillomavirus Vaccine Promotions and Hesitancy in Northern California Through Examining Public Facebook Pages and Groups.

Human papillomavirus (HPV) vaccination coverage among adolescents is lower in rural regions and remains under the 80% coverage goal by Healthy People 2030. Through both sentiment analysis and topic modeling, this research examines how local health agencies and groups in nine Northern California counties promote HPV vaccines through Facebook and how target populations react to promotion posts in comments that elucidate their sentiments and hesitancy toward HPV vaccination. In January 2021, we identified 2,105 public Facebook pages and 1,065 groups related to health within the counties and collected a total of 212 posts and 505 comments related to the HPV vaccine. The posts were published between 2010 and 2021, with the majority (83%) published after 2017. There were large variations of Facebook activities across counties. We categorized four counties with HPV vaccination initiation rates below 40% as low-coverage counties and five counties with rates above 40% as high-coverage counties. In general, low-coverage counties had fewer Facebook activities in comparison to high coverage. Results showed that, on average, comments about the HPV vaccine exhibited more positive emotion, more negative emotion, and more anger than the posts. Overall, thematic topics that emerged from posts centered around awareness and screening of HPV and cervical cancer, STI testing services, information sources, and calls to action for health services. However, comment topics did not correspond to posts and were mostly related to vaccine hesitancy, discussing vaccine risks, safety concerns, and distrust in vaccine science, citing misinformation. When comparing high- versus low-coverage counties, posts expressed similar sentiments; however, comments within high-coverage counties expressed more anger than in low-coverage counties. Comments from both high- and low-coverage counties expressed concerns with vaccine safety, risks, and injury. It is important to note that commenters exchanged information sources and tried to address misinformation themselves. Our results suggest that the promotion of HPV vaccines from public Facebook pages and groups is limited in frequency and content diversity. This illustrates problems with generalized social media vaccination promotion without community tailoring and addressing specific hesitancy concerns. Public health agencies should listen to the thoughts of targeted audiences reflected through comments and design relevant messages to address these concerns for HPV vaccination promotion.

Predicting the Need for Phototherapy After Discharge.

BACKGROUND AND OBJECTIVES: Bilirubin screening before discharge is performed to identify neonates at risk for future hyperbilirubinemia. The American Academy of Pediatrics recommends using a graph of bilirubin levels by age (the Bhutani Nomogram) to guide follow-up and a different graph to determine phototherapy recommendations. Our objective was to evaluate predictive models that incorporate the difference between the last total serum bilirubin (TSB) before discharge and the American Academy of Pediatrics phototherapy threshold (Δ-TSB) to predict a postdischarge TSB above the phototherapy threshold by using a single graph. METHODS: We studied 148 162 infants born at ≥35 weeks' gestation at 11 Kaiser Permanente Northern California facilities from 2012 to 2017 whose TSB did not exceed phototherapy levels and who did not receive phototherapy during the birth hospitalization. We compared 3 logistic models (Δ-TSB; Δ-TSB-Plus, which included additional variables; and the Bhutani Nomogram) by using the area under the receiver operating characteristic curve (AUC) in a 20% validation subset. RESULTS: A total of 2623 infants (1.8%) exceeded the phototherapy threshold postdischarge. The predicted probability of exceeding the phototherapy threshold after discharge ranged from 56% for a predischarge Δ-TSB 0 to 1 mg/dL below the threshold to 0.008% for Δ-TSB >7 mg/dL below the threshold. Discrimination was better for the Δ-TSB model (AUC 0.93) and the Δ-TSB-Plus model (AUC 0.95) than for the Bhutani Nomogram (AUC 0.88). CONCLUSIONS: The use of Δ-TSB models had excellent ability to predict postdischarge TSB above phototherapy thresholds and may be simpler to use than the Bhutani Nomogram.

A study of type-specific HPV natural history and implications for contemporary cervical cancer screening programs.

BACKGROUND: HPV testing is replacing cytology for cervical cancer screening because of greater sensitivity and superior reassurance following negative tests for the dozen HPV genotypes that cause cervical cancer. Management of women testing positive is unresolved. The need for identification of individual HPV genotypes for clinical use is debated. Also, it is unclear how long to observe persistent infections when precancer is not initially found. METHODS: In the longitudinal NCI-Kaiser Permanente Northern California Persistence and Progression (PaP) Study, we observed the clinical outcomes (clearance, progression to CIN3+, or persistence without progression) of 11,573 HPV-positive women aged 30-65 yielding 14,158 type-specific infections. FINDINGS: Risks of CIN3+ progression differed substantially by type, with HPV16 conveying uniquely elevated risk (26% of infections with seven-year CIN3+ risk of 22%). The other carcinogenic HPV types fell into 3 distinct seven-year CIN3+ risk groups: HPV18, 45 (13% of infections, risks >5%, with known elevated cancer risk); HPV31, 33, 35, 52, 58 (39%, risks >5%); and HPV39, 51, 56, 59, 68 (23%, risks <5%). In the absence of progression, HPV clearance rates were similar by type, with 80% of infections no longer detected within three years; persistence to seven years without progression was uncommon. The predictive value of abnormal cytology was most evident for prevalent CIN3+, but less evident in follow-up. A woman's age did not modify risk; rather it was the duration of persistence that was important. INTERPRETATION: HPV type and persistence are the major predictors of progression to CIN3+; at a minimum, distinguishing HPV16 is clinically important. Dividing the other HPV types into three risk-groups is worth considering.

Regional processes are stronger determinants of rocky intertidal community dynamics than local biotic interactions.

Understanding the relative roles of species interactions and environmental factors in structuring communities has historically focused on local scales where manipulative experiments are possible. However, recent interest in predicting the effects of climate change and species invasions has spurred increasing attention to processes occurring at larger spatial and temporal scales. The "meta-ecosystem" approach is an ideal framework for integrating processes operating at multiple scales as it explicitly considers the influence of local biotic interactions and regional flows of energy, materials, and organisms on community structure. Using a comparative-experimental design, we asked (1) what is the relative importance of local biotic interactions and oceanic processes in determining rocky intertidal community structure in the low zone within the Northern California Current System, and (2) what factors are most important in regulating this structure and why? We focused on functional group interactions between macrophytes and sessile invertebrates and their consumers (grazers, predators), how these varied across spatial scales, and with ocean-driven conditions (upwelling, temperature) and ecological subsidies (nutrients, phytoplankton, sessile invertebrate recruits). Experiments were conducted at 13 sites divided across four capes in Oregon and northern California. Results showed that biotic interactions were variable in space and time but overall, sessile invertebrates had no effect on macrophytes while macrophytes had weakly negative effects on sessile invertebrates. Consumers, particularly predators, also had weakly negative effects on both functional groups. Overall, we found that 40-49% of the variance in community structure at the local scale was explained by external factors (e.g., spatial scale, time, upwelling, temperature, ecological subsidies) vs. 19-39% explained by functional group interactions. When individual functional group interaction strengths were used, only 2-3% of the variation was explained by any one functional group while 28-54% of the variation was explained by external factors. We conclude that community structure in the low intertidal zone is driven primarily by external factors at the regional scale with local biotic interactions playing a secondary role.

Comparison of four clinically validated testosterone LC-MS/MS assays: Harmonization is an attainable goal.

INTRODUCTION: Immunoassays and liquid chromatography-tandem mass spectrometry assays are commonly employed in clinical laboratories for measurement of total testosterone in serum. Results obtained from either of these methodologies compare poorly due to differences in calibration and/or inadvertent detection of interfering substances by the immunoassays. Standardization efforts are underway, but recent studies indicate that accuracy remains an issue. METHODS: This study compares the results from four independently developed and validated LC-MS/MS assays for total testosterone. The calibration for each assay was verified using National Institute of Standards and Technology Standard Reference Material 971. RESULTS: Initially, one of the four assays had a mean percent difference of +11.44%, compared to the All Method Mean, but following re-verification of all five non-zero calibrator concentrations with the NIST SRM 971, the mean percent difference decreased to -4.88%. Subsequently, the agreement between all four assays showed a mean bias of <5% across the range of all testosterone concentrations (0.13-38.10 nmol/L; 3.7-1098 ng/dL), including at low concentrations of <1 nmol/L (<29 ng/dL). CONCLUSIONS: Excellent agreement between four independently developed LC-MS/MS assays demonstrates that harmonization using standard reference material is attainable. However, as we found in this study, to ensure accurate calibration it is critical to validate the concentrations of new lots of calibrators.

Trend analysis of watershed-scale precipitation over Northern California by means of dynamically-downscaled CMIP5 future climate projections.

The impacts of climate change on watershed-scale precipitation through the 21st century were investigated over eight study watersheds in Northern California based on dynamically downscaled CMIP5 future climate projections from three GCMs (CCSM4, HadGEM2-ES, and MIROC5) under the RCP4.5 and RCP8.5 future climate scenarios. After evaluating the modeling capability of the WRF model, the six future climate projections were dynamically downscaled by means of the WRF model over Northern California at 9km grid resolution and hourly temporal resolution during a 94-year period (2006-2100). The biases in the model simulations were corrected, and basin-average precipitation over the eight study watersheds was calculated from the dynamically downscaled precipitation data. Based on the dynamically downscaled basin-average precipitation, trends in annual depth and annual peaks of basin-average precipitation during the 21st century were analyzed over the eight study watersheds. The analyses in this study indicate that there may be differences between trends of annual depths and annual peaks of watershed-scale precipitation during the 21st century. Furthermore, trends in watershed-scale precipitation under future climate conditions may be different for different watersheds depending on their location and topography even if they are in the same region.

CITIZEN SCIENTISTS MONITOR A DEADLY FUNGUS THREATENING AMPHIBIAN COMMUNITIES IN NORTHERN COASTAL CALIFORNIA, USA.

Ecoclub youth and supervising family members conducted citizen science to assess regional prevalence and distribution of Batrachochytrium dendrobatidis (Bd) among amphibians at Humboldt Bay National Wildlife Refuge (Refuge) and Redwood National and State Parks (Parks), Humboldt County, California, US, May 2013 through December 2014. Using quantitative real-time PCR, 26 (17%) of 155 samples were positive for Bd. Positive samples occurred in four frog and toad species: foothill yellow-legged frog ( Rana boylii ), northern red-legged frog ( Rana aurora ), Pacific chorus frog ( Pseudacris regilla ), and western toad (Anaxyrus [Bufo] boreas); no salamanders or anuran larvae were positive. Except for R. aurora , all infected anurans were first-time species reports for coastal northern California. At the Refuge, significantly fewer (6/71) postmetamorphic amphibians were positive compared to the Parks (20/69; P=0.0018). We assessed the association of being PCR-positive for Bd, season of sampling, and age of sampler (child, teen, or adult). The full model with season, species, and sampler age had the greatest support. Frogs tested in winter or spring were more likely to be positive than those tested in summer or fall; foothill yellow-legged frogs, northern red-legged frogs, and western toads were more likely to be positive than were Pacific chorus frogs; and the probability of being positive nearly doubled when a child (≤12 yr old) collected the sample compared to a teen or adult. Our results support other chytrid studies that found amphibians are more susceptible to Bd when temperatures are cool and that species differ in their susceptibility. The Ecoclub's findings provide new information important to conservation of northern California's coastal amphibians and demonstrate the value of involving children in citizen science.

Last chance therapies and managed care. Pluralism, fair procedures, and legitimacy.

How can health plans make fair determinations about when "experimental" (and costly) treatments such as high dose chemotherapy with autologous bone marrow transplantation should be covered despite lack of clear clinical consensus about their benefits? Different models for managing "last chance" therapies evolving in some health plans offer promising examples of how issues of fairness and legitimacy in decision-making can be addressed.

A systematic review of validated methods for identifying transverse myelitis using administrative or claims data.

PURPOSE: To identify and assess billing, procedural, or diagnostic code algorithms used to identify transverse myelitis in administrative databases. METHODS: We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to transverse myelitis. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics. RESULTS: Three studies met criteria for inclusion in this review. The only algorithm based solely on administrative claims data with a reported positive predictive value included five ICD-9 codes (codes 341.20, 341.21, 341.22, 323.8, 323.9). The positive predictive value for physician-diagnosed acute transverse myelitis was 62%. CONCLUSIONS: More research is needed to establish an accurate algorithm to identify transverse myelitis in large administrative databases using diagnosis and/or procedure codes. Use of standardized consensus definitions, clear description for algorithm selection, and reporting of validation procedure and results would be most beneficial.