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This study establishes an optical inversion scheme for deriving the absorption coefficient of colored (or chromophoric, depending on the literature) dissolved organic material (CDOM) at the 440 nm wavelength, which can be applied to global water masses with near-equal efficacy. The approach uses a ratio of diffuse attenuation coefficient spectral end members, i.e., a short and long wavelength pair. The global perspective is established by sampling "extremely" clear water plus a generalized extent in turbidity and optical properties that each span three decades of dynamic range. A unique data set was collected in oceanic, coastal, and inland waters (as shallow as 0.6 m) from the North Pacific Ocean, the Arctic Ocean, Hawaii, Japan, Puerto Rico, and the east and west coasts of the United States. The data were partitioned using subjective categorizations to define a validation quality subset of conservative water masses, i.e., the inflow and outflow of properties constrain the range in the gradient of a constituent, plus 15 subcategories of water masses that were not evolving conservatively. The dependence on subcategories was confirmed with an objective methodology based on cluster analysis techniques. The latter defined five distinct classes with validation quality data present in all classes, but which also decreased in percent composition as a function of increasing class number and optical complexity. Four different algorithms based on different validation quality end members were validated with accuracies of 1.-6.2 %, wherein pairs with the largest spectral span were most accurate. Although algorithm accuracy decreased with the inclusion of more subcategories containing non-conservative water masses, changes to the algorithm fit were small when a preponderance of subcategories were included. The high accuracy for all end-member algorithms was the result of data acquisition and data processing improvements, e.g., increased vertical sampling resolution to less than 1mm and a boundary constraint to mitigate wave focusing effects, respectively. An independent evaluation with a historical database confirmed the consistency of the algorithmic approach and its application to quality assurance, e.g., to flag data outside expected ranges, identify suspect spectra, and objectively determine the in-water extrapolation interval by converging agreement for all applicable end-member algorithms. The legacy data exhibit degraded performance (as 44 % uncertainty) due to a lack of high-quality near-surface observations, especially for clear waters wherein wave-focusing effects are problematic. The novel optical approach allows the in situ estimation of an in-water constituent in keeping with the accuracy obtained in the laboratory. [ABSTRACT FROM AUTHOR]

Abstract: Spatial and temporal decorrelation scales in phytoplankton bloom magnitudes are reviewed with the goal of informing the design of efficient and informative observing networks for monitoring of potentially harmful algal blooms (HABs) along the U.S. West Coast. Our analysis of historic MODIS Fluorescent Line Height data shows that, unlike several previous studies, seasonal timing of phytoplankton blooms off the U.S. West Coast propagates from South to North. In situ data show that temporal decorrelation scales are shortest off Northern California (∼4 days) and longest in the Southern California Bight (∼17 days). In a cross-shore direction, we find that variability in the near-shore biomass is decoupled from biomass further offshore (∼2–4km). Our review of the cloud cover gap statistics suggests that satellite data provide reasonably inexpensive information about bloom events, particularly at seasonal to inter-annual scales, but is insufficient to capture many event-scale blooms. Absent adequate satellite data, in situ monitoring becomes essential. Existing networks of automated monitoring sites from piers and moorings off the California coast is insufficient to describe regional variability in blooms, but is likely informative of bloom magnitudes in the immediate proximity of observation stations. We suggest that a more effective network will have a combination of shore-based stations and a few (5–10) offshore moorings. Shore-based stations should be located in proximity to sensitive HAB targets. This would provide monitoring of existing conditions and guide decision-making about beach closures and aquaculture management practices. Offshore stations can serve as proxy for regional conditions and can be used to issue early warnings of potential HAB conditions developing in a specific region. [Copyright &y& Elsevier]

The article focuses on several issues related with surge capacity in the emergency medical services (EMS) systems in the U.S. It defines the meaning of surge capacity, its impact on the society, and its importance during large-scale disasters. It presents ways on how to plan and develop a successful surge capacity in the EMS systems. It notes that developing surge capacity is a community issue that involves an important commitment of money, time, public support, and political buy-in.

The article presents views of several emergency medical personnel regarding emergency medical services (EMS). Among the medical personnel included in the article are Gregg Moriguchi, from Federal Fire Department in Aiea, Hawaii, Timothy J. Perkins from Virginia Department of Health Office of EMS in Richmond, Virginia, and John Studnek from National Registry of Emergency Medical Technicians in Columbus, Ohio. Philosphies and challenges regarding their experiences as EMS leaders are provided.

The article presents a tribute to the founding fathers of modern-day emergency medical services (EMS) in the U.S. Karl William Edmark invented the defilbrillator, which is considered to be an important tool in prehospital emergency cardiac care. However, David Boyd developed the framework and guidelines for implementing EMS systems throughout the U.S. Nancy Caroline wrote the original paramedic textbook "Emergency Care in the Streets."

Abstract: The NSF-sponsored Coastal Ocean Processes Wind Events and Shelf Transport (WEST) experiment investigates the interplay between wind-driven transport and shelf productivity; while eastern boundary shelves are characterized by high productivity due to upward fluxes of nutrients into the euphotic zone, wind forcing also represents negative physical and biological controls via offshore transport and deep (light-limiting) mixing of primary producers. Although this interaction has been well documented for eastern boundary systems generally and for California specifically, one of the primary goals of WEST was to characterize more fully the interplay between positive and negative effects of wind stress, which result in the consistently elevated biological productivity in these shelf regions. During 3 month-long summer cruises (2000–2002) we observed extremes in upwelling/relaxation, using both in situ instrumentation and remotely sensed data. Relationships between optical and physical properties were examined, with emphasis on biogeochemical implications. During 2000, the WEST region was optically dominated by phytoplankton and covarying constituents. During 2001 and 2002, periods of more intense upwelling favorable winds, we observed a transition to optical properties dominated by detrital and inorganic materials. In all years, the continental shelf break provided a natural boundary between optically distinct shelf and open ocean waters. During 2002, we obtained discrete trace-metal measurements of particulate iron and aluminum; we develop a bio-optical proxy for acetic-acid leachable iron from backscatter and fluorescence, and demonstrate that particulate iron is not well correlated to traditional upwelling proxies such as macronutrients, temperature, and salinity. We conclude that the shelf break between ca. 100 and 200m water depth serves as a natural break point between coastal and oceanic water masses in this region, and that the elevated biomass and productivity associated with this eastern boundary current regime is dominated by these iron rich, shallow shelf waters. [Copyright &y& Elsevier]

Provides information on a study which estimated primary production using phytoplankton utilization of nitrate for the Monterey Bay, California region. Model description; Results and discussion.

Reports on a study on coronary heart disease (CHD) in the United States, with emphasis on the risk factor value in healthy Afro-American and white siblings from premature CHD families, as compared to national age, sex and race population reference norms. Reference to family history as a potent indicator of premature CHD; Similarities of the levels of high-density lipoprotien cholesterol between siblings; Availability of guidelines to decrease risk factors.

Background: The Demand Control Support Questionnaire (DCSQ) is an established self-reported tool to measure a stressful work environment. Validated German and English versions are however currently missing. The aim of this study was therefore to evaluate the psychometric properties of German and English versions of the DCSQ among white-collar employees in Switzerland and the US. Methods: This cross-sectional study was carried out on 499 employees in Switzerland and 411 in the US, respectively. The 17-item DCSQ with three scales assessed psychosocial stress at work (psychological demands, decision latitude, and social support at work). Depressive symptoms were measured by the 2-item Patient Health Questionnaire. Cronbach’s α and item-total correlations tested the scale reliability (internal consistency). Construct validity of the questionnaire was examined using exploratory factor analysis (EFA). Logistic regressions estimated associations of each scale and job strain with depressive symptoms (criterion validity). Results: In both samples, all DCSQ scales presented satisfactory internal consistency (Cronbach’s α ≥ 0.72; item-total correlations ≥ 0.33), and EFA showed the 17 items loading on three factors, which is in line with the theoretically assumed structure of the DCSQ construct. Moreover, all three scales as well as high job strain were significantly associated with depressive symptoms. The associations were stronger in the US sample. Conclusions: The German and the English versions of the DCSQ seem to be reliable and valid instruments to measure psychosocial stress based on the job demand-control-support model in the workplace of white-collar employees in Switzerland and the US. [ABSTRACT FROM AUTHOR]

An interview with Gary Wingrove, director of government relations and strategic affairs for the Mayo Clinic's nonprofit air and ground transportation company, is presented. When asked about major issues affecting the rural emergency medical services (EMS) systems in the U.S., Wingrove refers to reimbursement, recruitment and retention. He discusses the health initiatives being undertaken by the state EMS and rural health offices of Nebraska, Minnesota and Montana. Wingrove recognizes the gaps within the U.S. public health care system.

An interview with Colonel Patricia R. Hastings, the director of the U.S. Army's Emergency Medical Services division, is presented. When asked about military medicine, she explains that it is a kind of medicine that covers humanitarian and disaster response, serious medical and trauma care, with routine care of soldiers and their family. She cites the lessons learned from previous disaster responses and offers insights on the treatment methods and equipment used in the military.

An interview with Les R. Beckner, retired career paramedic, is presented. When asked about his philosophy regarding the training of emergency drivers in emergency medical services (EMS), he explains that they are just one piece of the safety puzzle. He added that the idea of having the U.S. National Transportation Safety Board (NTSB) investigate ambulance accidents is very useful.

Abstract: Coastal waters of the United States (U.S.) are subject to many of the major harmful algal bloom (HAB) poisoning syndromes and impacts. These include paralytic shellfish poisoning (PSP), neurotoxic shellfish poisoning (NSP), amnesic shellfish poisoning (ASP), ciguatera fish poisoning (CFP) and various other HAB phenomena such as fish kills, loss of submerged vegetation, shellfish mortalities, and widespread marine mammal mortalities. Here, the occurrences of selected HABs in a selected set of regions are described in terms of their relationship to eutrophication, illustrating a range of responses. Evidence suggestive of changes in the frequency, extent or magnitude of HABs in these areas is explored in the context of the nutrient sources underlying those blooms, both natural and anthropogenic. In some regions of the U.S., the linkages between HABs and eutrophication are clear and well documented, whereas in others, information is limited, thereby highlighting important areas for further research. [Copyright &y& Elsevier]

Objective: Despite a decrease in teenage pregnancy rates in the United States in the past decades, teen pregnancy continues to be a considerable health issue. In this paper, we outline the development of our novel peer-based intervention, Get It?, that aims to increase awareness of and self-efficacy to use long-active reversible contraceptives (LARCs) among teenagers., Methods: Peer narrative videos were created from audio recording semi-structured, one-on-one interviews with teenage LARC users. Focus groups of young women 19 years old and younger were conducted to choose the most audience-appropriate videos to be included in the final intervention. Using a thematic content analysis approach, transcripts of the audio recorded focus groups were reviewed and manually coded., Results: The final layout of Get It? included 4 videos that were chosen by participants of the focus groups, as well as supplemental activities that included a basic description of the LARC devices, the ability to anonymously post personal stories about LARCs that can be shared with others, and the opportunity to email the primary investigator questions about LARCs. Thematic analysis of the focus group discussions revealed that when it came to narrative videos, participants desired (1) an authentic narrator, (2) more information on the narrator, and (3) narrators displaying ample emotions., Conclusion: Peer narratives play a vital role in influencing a teenager's perspective on their health status; therefore, understanding what constitutes reliable narration from an online format was critical in the development of a peer-based electronic intervention that informs teenagers of the most effective contraceptive available to them., Competing Interests: Conflicts of Interest The research reported in this publication was supported by the NICHD of the National Institutes of Health, which awarded the primary investigator with 75% salary support. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: The National Institutes of Health's policy for the inclusion of females in clinical research was a pivotal step towards the consideration of sex as a biological variable, which is of particular importance in oncology, given differential incidence and outcomes of cancer between the sexes, and known pharmacodynamic, pharmacokinetic, and immunological differences. Therefore, we aim to investigate if such biological sex-based differences translate to clinically meaningful outcome differences from recently approved systemic oncology therapies., Methods: A systematic review of randomized control trials (RCTs) cited in Food and Drug Administration, European Medicines Agency, and Health Canada approvals was conducted. Chemotherapy, targeted agents, and immunotherapy RCTs reporting sex-based sub-group analyses for overall/progression-free survival (OS/PFS) were considered. Hazard ratios (HRs) and 95% confidence intervals (CIs) were utilized. Sensitivity analyses for survival endpoints, drug type, and cancer site were conducted., Results: Ninety-nine RCTs were included, representing 62,384 patients (23,574 (38%) female). Pooled OS HRs [95% CIs] were 0.77 [0.72-0.81] and 0.76 [0.72-0.79] for females and males, respectively (P = 0.73), and 0.51 [0.47-0.56] and 0.57 [0.53-0.61] (P = 0.08) for PFS. Sensitivity analyses yielded similar results. No RCTs reported sex-based toxicity or quality-of-life (QOL) data., Conclusion: Female and male patients appear to derive comparable benefits from recently approved systemic oncology therapies. Future RCTs are encouraged to report sex-based toxicity and QOL data., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

As harmful algal blooms (HABs) increase in magnitude and duration worldwide, they are becoming an expanding threat to marine wildlife. Over the past decade, blooms of algae that produce the neurotoxins domoic acid (DA) and saxitoxin (STX) and documented concurrent seabird mortality events have increased bicoastally in the United States. We conducted a retrospective analysis of HAB related mortality events in California, Washington, and Rhode Island between 2007 and 2018 involving 12 species of seabirds, to document the levels, ranges, and patterns of DA and STX in eight sample types (kidney, liver, stomach, intestinal, cloacal, cecal contents, bile, blood) collected from birds during these events. Samples (n = 182) from 83 birds were examined for DA (n = 135) or STX (n = 17) or both toxins simultaneously (n = 30), using ELISA or LCMS at the National Oceanographic and Atmospheric Administration, National Marine Fisheries Service (NOAA-NMFS) Wildlife Algal-toxin Research and Response Network (WARRN-West) or the University of California, Santa Cruz (UCSC). DA or STX was detected in seven of the sample types with STX below the minimum detection limit in blood for the three samples tested. DA was found in 70% and STX was found in 23% of all tested samples. The ranges of detectable levels of DA and STX in all samples were 0.65-681,190.00 ng g -1 and 2.00-20.95 ng g -1 , respectively. Cloacal contents from a Pacific loon (Gavia pacifica) collected in 2017 from Ventura County, California, had the highest maximum level of DA for all samples and species tested in this study. The highest level of STX for all samples and species was detected in the bile of a northern fulmar (Fulmarus glacialis) collected in 2018 from San Luis Obispo County, California. DA detections were consistently found in gastrointestinal samples, liver, bile, and kidney, whereas STX detections were most frequently seen in liver and bile samples. Co-occurring HAB toxins (DA and STX) were detected in white-winged scoters (Melanitta deglandi) in 2009, a Brandt's cormorant (Phalacrocorax penicillatus) in 2015, and a northern fulmar and common murre (Uria aalge) in 2018. This article provides DA and STX tissue concentrations and patterns in avian samples and shows the utility of various sample types for the detection of HAB toxins. Future research to understand the pharmacodynamics of these toxins in avian species and to establish lethal doses in various bird species would be beneficial., (Copyright © 2021. Published by Elsevier B.V.)

Background: The misdiagnosis of appendiceal cancer as inflammatory appendicitis is becoming of greater clinical concern because of the rise of nonoperative management especially in the elder population. To quantify this rate of misdiagnosis, we retrospectively reviewed SEER-Medicare data., Methods: The SEER-Medicare database was reviewed from 2000 to 2014. We identified patients older than 65 years old who were diagnosed with appendiceal cancer and then cross-referenced them for a diagnosis of inflammatory appendicitis. Demographic data and oncologic stage were collected., Results: Our results showed that 28.6% of appendiceal cancer patients received an incorrect initial diagnosis of inflammatory appendicitis. Patients older than 75 years of age were more likely to be misdiagnosed than those between ages 65 and 75 (risk ratio [RR]: 0.81; 95% confidence interval: 0.70-0.93; P = .003). We found that 42% of patients within the misdiagnosis group presented with an earlier stage of disease (stage 1 or 2) compared to 26% of those primarily diagnosed with appendiceal cancer (P < .001)., Conclusion: A significant proportion of patients older than 65 years old with appendiceal cancer were initially misdiagnosed with acute appendicitis. We suggest caution when considering a nonoperative approach for appendicitis in the elderly and follow-up imaging or an interval appendectomy should be part of the treatment plan., (© 2019 Wiley Periodicals, Inc.)

Background: We sought to identify patterns of care for patients with appendiceal cancer and identify clinical factors associated with patient selection for multimodality treatment, including cytoreductive surgery and perioperative intraperitoneal chemotherapy (CRS/PIC)., Materials and Methods: National Cancer Database (NCDB) data from 2004 to 2014 of all diagnoses of appendiceal cancers were examined. We examined treatment modalities, as well as demographic, tumor-specific, and survival data. A multivariate logistic regression analysis was performed to determine the patient cohort most likely to receive CRS/PIC. Kaplan-Meier was used to estimate survival for all treatment groups. Significance was evaluated at P ≤ 0.05., Results: We analyzed data on 18,055 patients. Nine thousand nine hundred ninety-two (55.3%) were treated with surgery only, 5848 (32.4%) received surgery and systemic chemotherapy, 1393 (7.71%) received CRS/PIC, 520 (2.88%) received chemotherapy alone, and 302 (1.67%) received neither surgery nor chemotherapy. Significant predictors of receiving CRS/PIC included male sex (OR 1.33, 95% CI: 1.11-1.59), white race (OR 2.00, 95% CI 1.40-2.86), non-Hispanic ethnicity (OR 1.92, 95% CI 1.21-3.05), private insurance (OR 1.52, 95% CI 1.26-1.84), and well-differentiated tumors (OR 4.25, CI: 3.39-5.32) (P < 0.05). Treatment with CRS/PIC was associated with a higher 5-year survival for mucinous malignancies, when compared to surgery alone (65.6% versus 62.4%, P < 0.01). Treatment with CRS/PIC was also associated with higher 5-year survival for well-differentiated malignancies, when compared to all other treatment modalities (74.9% versus 65.4%, P < 0.01)., Conclusions: Patients were more likely to undergo CRS/PIC if they were male, white, privately insured, and with well-differentiated tumors. CRS/PIC was associated with improved survival in patients with mucinous and low-grade tumors., (Copyright © 2019 Elsevier Inc. All rights reserved.)

We explored the influence of morphology on geographic differences in 5-year survival for non-Hodgkin lymphoma (NHL) diagnosed in 1990-1994 and followed for 5years: 16,955 cases from 27 EUROCARE-3 cancer registries, and 22,713 cases from 9 US SEER registries. Overall 5-year relative survival was 56.1% in EUROCARE west, 47.1% in EUROCARE east and 56.3% in SEER. Relative excess risk (RER) of death was 1.05 (95% confidence interval (CI) 1.01-1.10) in EUROCARE west, 1.52 (95% CI 1.44-1.60) in EUROCARE east (SEER reference). Excess risk of death was significantly above reference (diffuse B lymphoma) for Burkitt's and NOS lymphoma; not different for lymphoblastic and other T-cell; significantly below reference (in the order of decreasing relative excess risk) for NHL NOS, mantle cell/centrocytic, lymphoplasmacytic, follicular, small lymphocytic/chronic lymphocytic leukaemia, other specified NHL and cutaneous morphologies. Interpretation of marked variation in survival with morphology is complicated by classification inconsistencies. The completeness and standardisation of cancer registry morphology data needs to be improved.