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River catchments are dynamic networks that contain multiple levels of spatial and temporal complexity. Benthic macroinvertebrates are key indicator taxa throughout catchments, and beta diversity has been used as a metric to explore determinants of community composition at the catchment scale. Although factors influencing spatial beta diversity have been explored, the determinants of temporal beta diversity have been understudied. In this study, we aimed to understand how shifts in benthic macroinvertebrate community composition over multiple years are related to local and regional variables. We used beta regression with a large, publicly available biomonitoring dataset from river networks in California, USA, to model the effects of local environmental variables, flow variability, and spatial network context on benthic macroinvertebrate temporal beta diversity. The spatial variables channel slope, drainage density, and upstream catchment area had the strongest relationships with macroinvertebrate beta diversity. Channel slope was negatively related to temporal beta diversity, whereas drainage density and upstream catchment area were positively related to temporal beta diversity. Temporal beta diversity was also higher when the rate and magnitude of rises and falls in flow were higher in the hydrograph, as well as when the number of zero-flow days and the duration of flow rises and falls were higher. Overall, our results indicate that temporal beta diversity of freshwater benthic macroinvertebrates is shaped by both long-term hydrological context and spatial context and that these factors may serve as better predictors of long-term community variability than variability in point estimates of environmental measurements. Our study supports the need for biomonitoring efforts at long spatial and temporal timescales and highlights the need to consider metacommunity change in the management of freshwater systems. [ABSTRACT FROM AUTHOR]

The decline in amphibian populations is one of the starkest examples of the biodiversity crisis. For stream breeding amphibians, alterations to natural flow regimes by dams, water diversions, and climate change have been implicated in declines and extirpations. Identifying drivers of amphibian declines requires long time series of abundance data because amphibian populations can exhibit high natural variability. Multiple population viability analysis (MPVA) models integrate abundance data and share information from different populations to estimate how environmental factors influence population growth. Flow alteration has been linked to declines and extirpations in the Foothill Yellow‐legged Frog (Rana boylii), a stream breeding amphibian native to California and Oregon. To date, no study has jointly analyzed abundance data from populations throughout the range of R. boylii in an MPVA model. We compiled time series of egg mass counts (an index of adult female abundance) from R. boylii populations in 36 focal streams and fit an MPVA model to quantify how streamflow metrics, stream temperature, and surrounding land cover affect population growth. We found population growth was positively related to stream temperature and was higher in the years following a wet year with high total annual streamflow. Density dependence was weakest (i.e., carrying capacity was highest) for streams with high seasonality of streamflow and intermediate rates of change in streamflow during spring. Our results highlight how altered streamflow can further increase the risk of decline for R. boylii populations. Managing stream conditions to better match natural flow and thermal regimes would benefit the conservation of R. boylii populations. [ABSTRACT FROM AUTHOR]

Natural resource managers need information about the risks associated with climate change to provide guidance on where to implement various management practices on natural lands. The spatial variation of projected impacts within a vegetation type can be used to target climate‐adaptive management actions because different locations will be exposed to different levels of climatic stress. Vegetation refugia are areas that retain non‐stressful climate conditions under future climates. Consensus vegetation refugia – areas retaining suitable climates under both wetter and drier future projections – represent only 14.6% of California's natural vegetation. One state and one federal government agency have incorporated vegetation refugia maps into conservation planning for 522 vertebrate species and for post‐wildfire reforestation. Monitoring how vegetation responds to management actions at sites within vegetation refugia can improve the conservation of plants subjected to a changing climate. [ABSTRACT FROM AUTHOR]

PrEP's potential benefit for men who have sex with men (MSM) who use stimulants may be limited by adherence or prescriber willingness to recommend PrEP due to concerns of non-compliance. Using data from PATH-PrEP, a 48-week study evaluating PrEP for MSM in Los Angeles, we modeled an interaction between stimulant use and condomless sex with multiple partners (CAS-MP) on prevention-effective dried blood spot tenofovir-diphosphate concentrations. At week 4, participants reporting stimulant use and CAS-MP had a decreased odds of prevention-effective adherence compared to non-stimulant use and non-CAS-MP (AOR 0.15, 95% CI 0.04–0.57). From week 4–48, participants reporting stimulant use and CAS-MP had increased odds of prevention-effective adherence (AOR 1.06 per week, 95%CI 1.01–1.12). Participants reporting CAS-MP without stimulant use had no significant change in prevention-effective adherence (AOR 0.99 per week, 95%CI 0.96–1.02). Stimulant use moderated the association of CAS-MP on prevention-effective PrEP adherence over time. [ABSTRACT FROM AUTHOR]

To examine insurance-based disparities in provider-related barriers to care among children in California in the wake of changes to the insurance market resulting from the Affordable Care Act. Our sample included 6514 children (ages 0 to 11 years) from the 2014–2016 California Health Interview Survey. We examined parent reports in the past year of 1) having trouble finding a general provider for the child, 2) the child not being accepted by a provider as a new patient, 3) the child's health insurance not being accepted by a provider, or 4) any of the above. Multivariable models estimated the associations of insurance type—Medi-Cal (Medicaid), employer-sponsored insurance, or privately purchased coverage—and parent reports of these problems. Approximately 8% of parents had encountered at least one of these problems. Compared with parents of children with employer-sponsored insurance, parents of children with Medi-Cal or privately purchased coverage had over twice the odds of experiencing at least one of the barriers. Parents of children with Medi-Cal had over twice the odds of being told a provider would not accept their children's coverage or having trouble finding a general provider and 3times the odds of being told a provider would not accept their children as new patients. Parents of children with privately purchased coverage had over 3times the odds of being told a provider would not accept their children's coverage. Our study found significant disparities in provider-related barriers by insurance type among children in California. [ABSTRACT FROM AUTHOR]

We examined changes in health insurance coverage and access to and use of health care among adult (ages 18-64) Latinos in the US before (2007-13) and after (2014-16) implementation of the main provisions of the Affordable Care Act. Data from the California Health Interview Survey were used to compare respondents in the two periods. We used multivariable and decomposition regression analyses to investigate the role of documentation status in access disparities between Mexicans and other Latinos in California. Our findings show that after the implementation of these provisions in California, insurance coverage increased for US- and foreign-bom Latinos, including undocumented Latinos. Our decomposition analyses show that after implementation, disparities between Mexicans and other Latinos declined with respect to having coverage and a usual source of care. Without the implementation of these provisions in 2014, these disparities would have been 5.76 percent and 0.31 percent larger, respectively. In contrast, legal documentation status was positively associated with disparities between Mexicans and other Latinos in having coverage and physician visits. If Mexican Latinos had had the same share of undocumented immigrants as other Latinos, disparities in health insurance coverage would have declined by 24.17 percent. [ABSTRACT FROM AUTHOR]

Human-facilitated introductions of nonnative taxa have changed species' geographic ranges and increased the prevalence of secondary contact and the potential for hybridization, with a host of effects on ecological systems. Land managers increasingly face these complex situations, tasked with developing strategies to preserve biodiversity in the face of such changes. We conducted a management-relevant experiment to inform the development of strategies for management of wild populations. We examined the fitness consequences of genetic admixture in a hybrid swarm between native California tiger salamanders and nonnative barred tiger salamanders. Variation in hydroperiod within the hybrid zone has previously been observed to affect landscape patterns of genetic introgression, with modified permanent ponds harboring salamanders with a greater proportion of nonnative genes. Our study experimentally examines the relationship between hydroperiod and fitness of three classes of salamanders: native, nonnative and hybrid. Using experimental pond mesocosms, we implemented three pond drying regimes and recorded survival and secondary determinants of salamander fitness. Our results indicate native-genotype advantages in rapidly drying mesocosms relative to other genetic classes. Furthermore, our results indicate that management of aquatic habitat to minimize the success of hybrid individuals may be a viable strategy to reduce the spread of nonnative genotypes. Overall, our approach demonstrates how controlled experiments can be designed to provide meaningful information for the development of real-world conservation strategies. [ABSTRACT FROM AUTHOR]

The Dynamic Continuous-Area Space-Time (DYCAST) system is a biologically based spatiotemporal model that uses public reports of dead birds to identify areas at high risk for West Nile virus (WNV) transmission to humans. In 2005, during a statewide epidemic of WNV (880 cases), the California Department of Public Health prospectively implemented DYCAST over 32,517 km2 in California. Daily risk maps were made available online and used by local agencies to target public education campaigns, surveillance, and mosquito control. DYCAST had 80.8% sensitivity and 90.6% specificity for predicting human cases, and . analysis indicated moderate strength of chance-adjusted agreement for >4 weeks. High-risk grid cells (populations) were identified an average of 37.2 days before onset of human illness; relative risk for disease was >39x higher than for low-risk cells. Although prediction rates declined in subsequent years, results indicate DYCAST was a timely and effective early warning system during the severe 2005 epidemic. [ABSTRACT FROM AUTHOR]

The article discusses the question whether insider trading liability extends to those who trade on nonpublic information subject only to a confidentiality agreement in California. The background of the insider trading doctrine and misappropriation theory to determine the applicability of the law is outlined. Also recommended is the proper imposition of liability that should be limited to those who hold a fiduciary duty or those refrain from self-dealing in the confidential information.

The article discusses the legal and environmental challenges faced by the U.S. maritime administration in disposing of the Suisun Bay non-retention fleet. It outlines the procedural history of the case against the maritime administration which was found to be in violation of the (CWA) California Water Quality Board. It explores the major legal impediments to non-retention vessel disposal including National Invasive Species Act (NISA), in-water growth removal issues, and anti-degradation.

Epidemic transmission of West Nile virus (WNV) in Sacramento County, California, in 2005 prompted aerial application of pyrethrin, a mosquito adulticide, over a large urban area. Statistical analyses of geographic information system datasets indicated that adulticiding reduced the number of human WNV cases within 2 treated areas compared with the untreated area of the county. When we adjusted for maximum incubation period of the virus from infection to onset of symptoms, no new cases were reported in either of the treated areas after adulticiding; 18 new cases were reported in the untreated area of Sacramento County during this time. Results indicated that the odds of infection after spraying were ≈6x higher in the untreated area than in treated areas, and that the treatments successfully disrupted the WNV transmission cycle. Our results provide direct evidence that aerial mosquito adulticiding is effective in reducing human illness and potential death from WNV infection. [ABSTRACT FROM AUTHOR]

Conservation and land management decisions may be misguided by inaccurate or misinterpreted knowledge of biodiversity. Non-systematists often lack taxonomic expertise necessary for an accurate assessment of biodiversity. Additionally, there are far too few taxonomists to contribute significantly to the task of identifying species for specimens collected in biodiversity studies. While species level identification is desirable for making informed management decisions concerning biodiversity, little progress has been made to reduce this taxonomic deficiency. Involvement of non-systematists in the identification process could hasten species identification. Incorporation of DNA sequence data has been recognized as one way to enhance biodiversity assessment and species identification. DNA data are now technologically and economically feasible for most scientists to apply in biodiversity studies. However, its use is not widespread and means of its application has not been extensively addressed. This paper illustrates how such data can be used to hasten biodiversity assessment of species using a little-known group of edaphic beetles. Partial mitochondrial cytochrome oxidase I was sequenced for 171 individuals of feather-wing beetles (Coleoptera: Ptiliidae) from the Klamath ecoregion, which is part of a biodiversity hotspot, the California Floristic Province. A phylogram of these data was reconstructed via parsimony and the strict consensus of 28,000 equally parsimonious trees was well resolved except for peripheral nodes. Forty-two voucher specimens were selected for further identification from clades that were associated with many synonymous and non-synonymous nucleotide changes. A ptiliid taxonomic expert identified nine species that corresponded to monophyletic groups. These results allowed for a more accurate assessment of ptiliid species diversity in the Klamath ecoregion. In addition, we found that the number of amino acid changes or percentage nucleotide difference did not associate with species limits. This study demonstrates that the complementary use of taxonomic expertise and molecular data can improve both the speed and the accuracy of species-level biodiversity assessment. We believe this represents a means for non-systematists to collaborate directly with taxonomists in species identification and represents an improvement over methods that rely solely on parataxonomy or sequence data. [ABSTRACT FROM AUTHOR]

The city of Palm Springs gained fame as an exclusive resort in the 1920s. Thereafter, the city elite became consumed with maintaining its reputation. Because public policies in Palm Springs increasingly reflected the interests of local business, real estate, and village elites, social engineering and control over land use became the driving forces behind the city's political economy. Collaborating with local businessmen and attorneys, Palm Springs civic leaders persecuted their lower-income constituents who resided on the local Native American reservation. Attempting to dispossess the Indians of their tribal lands and erase any blighted neighborhoods that might degrade "the city beautiful," Palm Springs officials successfully removed the city's people of color and restructured the race and class configuration of the city. [ABSTRACT FROM AUTHOR]

Influenza virus is a global health concern due to its unpredictable pandemic potential. This potential threat was realized in 2009 when an H1N1 virus emerged that resembled the 1918 virus in antigenicity but fortunately was not nearly as deadly. 5J8 is a human antibody that potently neutralizes a broad spectrum of H1N1 viruses, including the 1918 and 2009 pandemic viruses. Here, we present the crystal structure of 5 J8 Fab in complex with a bacterially expressed and refolded globular head domain from the hemagglutinin (HA) of the A/California/07/2009 (H1N1) pandemic virus. 5J8 recognizes a conserved epitope in and around the receptor binding site (RBS), and its HCDR3 closely mimics interactions of the sialic acid receptor. Electron microscopy (EM) reconstructions of 5J8 Fab in complex with an HA trimer from a 1986 H1 strain and with an engineered stabilized HA trimer from the 2009 H1 pandemic virus showed a similar mode of binding. As for other characterized RBS-targeted antibodies, 5J8 uses avidity to extend its breadth and affinity against divergent H1 strains. 5J8 selectively interacts with HA insertion residue 133a, which is conserved in pandemic H1 strains and has precluded binding of other RBS-targeted antibodies. Thus, the RBS of divergent HAs is targeted by 5J8 and adds to the growing arsenal of common recognition motifs for design of therapeutics and vaccines. Moreover, consistent with previous studies, the bacterially expressed H1 HA properly refolds, retaining its antigenic structure, and presents a low-cost and rapid alternative for engineering and manufacturing candidate flu vaccines. [ABSTRACT FROM AUTHOR]

We studied summer use of high elevation lakes by American Dippers (Cinclus mexicanus) in the Trinity Alps Wilderness, California by conducting repeated point count surveys at 16 study lakes coupled with a 5-year detailed survey of all available aquatic habitats in a single basin. We observed American Dippers during 36% of the point-count surveys and found birds at 10 of 16 study lakes. Over 90% of the American Dipper sightings were in lentic habitats in Deep Creek Basin. Bird presence at a lake was positively correlated with steep rocky littoral zones and high densities of caddisfly (Trichoptera) larvae. We also observed numerous successful foraging bouts oil juvenile life stages of lentic-breeding amphibians. We did not find any nests at the lakes but did observe juvenile dippers. American Dippers art" highly adapted to flowing waters, and our findings coupled with incidental observations from the literature and other researchers suggests that high elevation lentic waterbodies have been largely overlooked as a seasonal niche for migrant dippers. [ABSTRACT FROM AUTHOR]

Climate change in California is expected to alter future water availability, impacting water supplies needed to support future housing growth and agriculture demand. In groundwater-dependent regions like California's Central Coast, new land-use related water demand and decreasing recharge is already stressing depleted groundwater basins. We developed a spatially explicit state-and-transition simulation model that integrates climate, land-use change, water demand, and groundwater gain-loss to examine the impact of future climate and land use change on groundwater balance and water demand in five counties along the Central Coast from 2010 to 2060. The model incorporated downscaled groundwater recharge projections based on a Warm/Wet and a Hot/Dry climate future from a spatially explicit hydrological process-based model. Two urbanization projections from a parcel-based, regional urban growth model representing 1) recent historical and 2) state-mandated housing growth projections were used as alternative spatial targets for future urban growth. Agricultural projections were based on recent historical trends from remote sensing data. Annual projected changes in groundwater balance were calculated as the difference between land-use related water demand, based on historical estimates, and climate-driven recharge plus agriculture return flows. Results indicate that future changes in climate-driven groundwater recharge, coupled with cumulative increases in agricultural water demand, result in overall declines in future groundwater balance, with a Hot/Dry future resulting in cumulative groundwater decline in all but Santa Cruz County. Cumulative declines by 2060 are especially prominent in San Luis Obispo (-2.9 to -5.1 Bm 3 ) and Monterey counties (-6.5 to -8.7 Bm 3 ), despite limited changes in agricultural water demand over the model period. These two counties show declining groundwater reserves in a Warm/Wet future as well, while San Benito and Santa Barbara County barely reach equilibrium. These results suggest future groundwater supplies may not be able to keep pace with regional demand and declining climate-driven recharge, resulting in a potential reduction in water security in the region. However, our county-scale projections showed new housing and associated water demand does not conflict with California's groundwater sustainability goals. Rather, future climate coupled with increasing agricultural groundwater demand may reduce water security in some counties, potentially limiting available groundwater supplies for new housing., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Tamara Wilson reports financial support was provided by California Strategic Growth Council. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Positive response bias is common under the high demand conditions of personnel selection. This study investigated positive response bias on the California Psychological Inventory (CPI)-434 by police officer applicants as scored by the CPI-434-Police and Public Safety Report. Police officer applicants completed the CPI-434 under high and then again under low demand conditions. The high demand condition was represented by the CPI administration as part of the preemployment psychological evaluation. The low demand condition was represented by a CPI administration with no contingencies approximately 4 months later during the police academy. Demand effects were illustrated by comparing applicant scores (within-subject) under high versus low demand conditions on CPI-Police and Public Safety Report (CPI-PPSR) prediction equations and CPI scales. Significant demand effects were observed on 23 of 46 comparisons. Modest support for the construct validity of the Good Impression (Gi) scale and somewhat less for the Fake Good Index as measures of positive response bias were observed. Response bias potential impact on police officer performance predictions was discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Competing Interests: The authors have declared that no competing interests exist.

New American Joint Committee on Cancer eighth edition staging parameters have removed mitotic rate as a stage T1 category criterion, but it remains embedded in the synopsis of primary cutaneous melanoma (CM). A paucity of data is available, characterizing atypical mitotic forms in CM. In this study, we classify the various morphologic forms of atypical mitoses, characterize mitotic figure density, and examine the correlation between atypical mitotic figures and Breslow depth. We performed a retrospective study of 185 thick (>0.8 mm) and thin (<0.8 mm) CM specimens. Metaphase mitotic figures represented the highest percentage of total mitotic figures in cases of thick melanoma (40%) and were the second most common in thin melanoma (18%). The average Breslow depth for melanoma harboring starburst mitoses was 2.85 mm, compared with the average Breslow depth of all thick melanoma cases, 1.88 mm. The average thickness of melanoma cases containing tripolar mitoses was 2.28 mm. Breslow depth correlated with the number of atypical mitotic figures in both thick and thin melanomas (the Pearson correlation test, r = +0.18, P < 0.01). Metaphase and prophase mitoses are a common finding in both thick and thin melanomas. Although atypical mitoses were indiscriminate, starburst and tripolar (ie, multipolar) mitoses were only inherent to cases of thick melanoma (stage T3). In sum, our study reveals a parallel relationship between the density of atypical mitotic figures and Breslow depth.

Background: This paper provides statewide estimates on health care access and utilization patterns and physical and behavioral health by citizenship and documentation status among Latinos in California., Methods: This study used data from the 2011-2015 California Health Interview Survey to examine health care access and utilization and physical and behavioral health among a representative sample of all nonelderly Latino and US-born non-Latino white adults (N=51,386). Multivariable regressions estimated the associations between the dependent measures and citizenship/documentation status among Latinos (US-born, naturalized citizen, green card holder, and undocumented)., Results: Adjusted results from multivariable analyses observed worse access and utilization patterns among immigrant Latinos compared with US-born Latinos, with undocumented immigrants using significantly less health care. Undocumented Latinos had lower odds of self-reporting excellent/very good health status compared with US-born Latinos, despite them having lower odds of having several physical and behavioral health outcomes (overweight/obesity, physician-diagnosed hypertension, asthma, self-reported psychological distress, and need for behavioral health services). Among those reporting a need for behavioral health services, access was also worse for undocumented Latinos when compared with US-born Latinos., Conclusions: Patterns of poor health care access and utilization and better physical and behavioral health are observed across the continuum of documentation status, with undocumented immigrants having the worst access and utilization patterns and less disease. Despite fewer reported diagnoses and better mental health, undocumented Latinos reported poorer health status than their US-born counterparts.

We examined changes in health insurance coverage and access to and use of health care among adult (ages 18-64) Latinos in the US before (2007-13) and after (2014-16) implementation of the main provisions of the Affordable Care Act. Data from the California Health Interview Survey were used to compare respondents in the two periods. We used multivariable and decomposition regression analyses to investigate the role of documentation status in access disparities between Mexicans and other Latinos in California. Our findings show that after the implementation of these provisions in California, insurance coverage increased for US- and foreign-born Latinos, including undocumented Latinos. Our decomposition analyses show that after implementation, disparities between Mexicans and other Latinos declined with respect to having coverage and a usual source of care. Without the implementation of these provisions in 2014, these disparities would have been 5.76 percent and 0.31 percent larger, respectively. In contrast, legal documentation status was positively associated with disparities between Mexicans and other Latinos in having coverage and physician visits. If Mexican Latinos had had the same share of undocumented immigrants as other Latinos, disparities in health insurance coverage would have declined by 24.17 percent.

Objective: To assess differences in health care access, utilization, and experiences among Latino children in California according to parental citizenship status and language use., Methods: Data are from the 2011 and 2012 California Health Interview Survey public use child files. A total of 2841 interviews of parents of Latino children younger than the age of 12 years were conducted. Analyses were conducted to determine the associations between access (usual of source of care, delay in receiving needed care, health insurance), utilization (physician visits in past year, emergency department visits), and experiences (doctor listens, doctor explains instructions clearly, communication via telephone or e-mail) according to parental citizenship status and household language use after adjusting for confounders., Results: In multivariate analyses, there were no significant differences in access to care according to parental citizenship status. Children with 2 noncitizen parents had fewer doctor visits and were less likely to go to the emergency department in the past year than those with 2 citizen parents. Among children with 1 or 2 noncitizen parents, their parents reported worse experiences in care than those with 2 citizen parents. Similar results were observed for language use. Parents of children in bilingual and Spanish-only households were less likely to report that their children's doctors explained things clearly, and parents in Spanish-only households were less likely to communicate via telephone or e-mail than those in English-only households., Conclusions: Health policy should focus on provider-parent communication to ensure health care equity for Latino children whose parents are not citizens or do not speak English., (Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the effect of clinical pharmacists embedded in primary care at a military facility by reviewing laboratory assessments following pharmacist management of referred patients with diabetes and hyperlipidemia., Methods: Electronic medical records of patients who were referred to clinical pharmacists for control of diabetes and/or hyperlipidemia were reviewed for those with at least two encounters during a 6-month period with baseline and follow-up laboratory assessments. As appropriate to patient diagnoses, glycosylated hemoglobin (A1C), low density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and body mass index (BMI) were included in assessments. Paired t tests were used to determine the statistical significance of mean changes between the beginning and end of the 6-month period., Results: In the cohort of patients with diabetes (n = 46), mean A1C decrease over 6 months was 0.9 points (P = 0.004). In the cohort of patients with hyperlipidemia (n = 15), mean LDL-C decrease was 20 mg/dL (P = 0.004). Changes in mean LDL-C, TGs, and BMIs were observed in each group but were not statistically significant., Conclusion: Although small sample sizes limited statistical power in this analysis, results suggest that referral of ambulatory patients to a clinical pharmacist in a military medical home for diabetes and/or hyperlipidemia improved care management.

Purpose: The research sought to ascertain the types and quantity of research evidence accessed by health personnel through PubMed and UpToDate in a university medical center over the course of a year in order to better estimate the impact that increasing levels of open access to biomedical research can be expected to have on clinical practice in the years ahead., Methods: Web log data were gathered from the 5,042 health personnel working in the Stanford University Hospitals (SUH) during 2011. Data were analyzed for access to the primary literature (abstracts and full-text) through PubMed and UpToDate and to the secondary literature, represented by UpToDate (research summaries), to establish the frequency and nature of literature consulted., Results: In 2011, SUH health personnel accessed 81,851 primary literature articles and visited UpToDate 110,336 times. Almost a third of the articles (24,529) accessed were reviews. Twenty percent (16,187) of the articles viewed were published in 2011., Conclusion: When it is available, health personnel in a clinical care setting frequently access the primary literature. While further studies are needed, this preliminary finding speaks to the value of the National Institutes of Health public access policy and the need for medical librarians and educators to prepare health personnel for increasing public access to medical research.