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The nine-banded armadillo (Dasypus novemcinctus) is currently considered an invasive species in parts of its range in the USA, and this range continues to expand to the north and east. Nine-banded armadillos are one of a handful of mammals known to contract leprosy (also known as Hansen's disease); range expansion thus leads to public health concerns about whether this might increase human exposure to infected animals. We collected blood samples from 61 road-killed armadillos over two summers (2021 and 2022) in Tennessee, a US state near the northern extreme of the species' current range, and screened them for exposure to Mycobacterium leprae, the causative agent of leprosy. All animals were seronegative, providing no evidence that range expansion is increasing the distribution of leprosy in the US., (© Wildlife Disease Association 2024.)

Objectives: Clinical trials studying Alzheimer's Disease (AD) face the challenge of recruiting participants with significant barriers to entering research studies. The objective of this study is to compare digital recruitment strategies' ability to recruit older adults with cognitive impairment (CI)., Methods: Older adults with CI were recruited for a clinical trial studying vestibular therapy in reducing falls and improving balance and cognition in older adults with CI. Potential participants were recruited via two different digital recruitment methods, a direct messaging campaign using established patient records and a social media campaign. Potential participants then filled out surveys to determine eligibility for the study., Results: The direct messaging campaign contacted 3060 potential participants and the social media campaign resulted in 8265 instances of unique engagement. Of the number of people reached, the direct messaging campaign had a higher percentage of people who submitted the survey compared to the social media campaign (8.3% vs. 1.2%, p < 0.001). There was no significant difference in age, race, ethnicity, education, household income, and insurance status between the recruitment groups (p > 0.05). Direct messaging recruitment proved more cost-effective at $21.74 per eligible participant compared to the social media campaign at $859.58 per eligible participant., Conclusion: This study found that direct messaging recruitment using established patient records was more cost-effective compared to social media recruitment for this clinical trial. In this sample size, similar demographics were reached by both recruitment methods. Future studies should continue to explore the use of social media and alternative methods to recruit representative participant populations for ongoing AD research., (© The Author(s) 2024.)

Objectives: To develop a novel remote head impulse test (rHIT), and to provide preliminary data validating the rHIT vestibular-ocular reflex (VOR) gains against the in-clinic vHIT., Methods: A convenience sample of 10 patients referred for vestibular assessment at our institution was recruited. In-clinic vHIT was used to quantify lateral VOR gains. Patients subsequently underwent an rHIT protocol, whereby patients performed active, lateral head rotations while their eyes and heads were recorded using a laptop camera and video-conferencing software. The vHIT and rHIT VOR gains were compared using paired t -tests, and a Pearson correlation coefficient between the gains was calculated. Absolute accuracy, sensitivity, and specificity of the rHIT were additionally calculated., Results: Of the 10 patients recruited, 4 were male, and the average ± standard deviation (SD) age was 61.4 ± 15.3 years. As determined by the vHIT, 2 patients had normal bilateral VOR gains, 6 with unilateral vestibular hypofunction, and 2 with bilateral vestibular hypofunction. The correlation between the rHIT and vHIT gains was 0.73 ( p  < .001). The rHIT exhibited an absolute accuracy of 75.0%, sensitivity of 70.0%, and specificity of 80.0%. When ears had a vHIT VOR gain less than 0.40, the rHIT exhibited 100.0% accuracy. Conversely, 60.0% of deficient ears with vHIT VOR gains greater than 0.40 were incorrectly categorized by the rHIT., Conclusion: The rHIT may be better suited for detecting more severe vestibular deficiencies. Future iterations of the rHIT should aim to increase the video frame-rate capabilities to detect subtler VOR impairments., Level of Evidence: 4., (© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background: Patients with vestibular loss have reduced wayfinding ability, but the association between vestibular loss and impaired steering spatial navigation is unclear., Objective: To evaluate whether vestibular loss is associated with reduced steering navigation performance in a virtual reality (VR) environment containing obstacles., Methods: 17 ambulatory adults with vestibular loss were age/sex-matched to healthy controls. Participants traversed a VR hallway with obstacles, and their navigation performance was compared using metrics such as collisions, time, total distance travelled, and speed in single and multivariate analysis., Results: In univariate analysis there was no significant difference in collisions between vestibular patients and controls (1.84 vs. 2.24, p = 0.974). However, vestibular patients took more time, longer routes, and had lower speeds to complete the task (56.9 vs. 43.9 seconds, p < 0.001; 23.1 vs. 22.0 meters, p = 0.0312; 0.417 vs. 0.544 m/s, p < 0.001). These results were confirmed in multivariate analysis., Conclusions: This study found that patients with vestibular loss displayed slower gait speeds and traveled longer distances, though did not make more collisions, during a VR steering navigation task. Beyond the known influence of vestibular function on gait speed, vestibular loss may also contribute to less efficient steering navigation through an obstacle-laden environment, through neural mechanisms that remain to be elucidated.

Recent advancements in understanding the biology of glioblastomas (GBM) and increasing adoption of genomic sequencing in oncology practice have led to the discovery of several targetable mutations in these cancers. Among them, the BRAF V600E mutation can be found in approximately 3% of GBM. Despite the aggressive nature of GBM, metastatic disease is rarely observed. While there are growing data utilizing BRAF-targeting strategies in patients with GBM, data examining their efficacy in cases of metastatic GBM are lacking. We present the case of a 46-year-old female with GBM, isocitrate dehydrogenase (IDH)-wildtype and O 6 -methylguanine-DNA methyltransferase promoter (MGMT) unmethylated, BRAF V600E-mutant, and MYC amplified with extra-central nervous system spread to the spine and lung. Four months after completion of treatment with standard chemoradiation and temozolomide, the patient developed severe back pain, leading to the eventual discovery of her metastatic disease. Based on the presence of the BRAF V600E mutation, the patient was treated with and achieved an intracranial and systemic response to combination BRAF-MEK targeted inhibition for 9 months before evidence of progression., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.)

Pain management is an important consideration for Head and Neck Cancer (HNC) patients as they are at an increased risk of developing chronic opioid use, which can negatively impact both quality of life and survival outcomes. This retrospective cohort study aimed to evaluate pain, opioid use and opioid prescriptions following HNC surgery. Participants included patients undergoing resection of a head and neck tumor from 2019-2020 at a single academic center with a length of admission (LOA) of at least 24 h. Exclusion criteria were a history of chronic pain, substance-use disorder, inability to tolerate multimodal analgesia or a significant post-operative complication. Subjects were compared by primary surgical site: Neck (neck dissection, thyroidectomy or parotidectomy), Mucosal (resection of tumor of upper aerodigestive tract, excluding oropharynx), Oropharyngeal (OP) and Free flap (FF). Average daily pain and total daily opioid consumption (as morphine milligram equivalents, MME) and quantity of opioids prescribed at discharge were compared. A total of 216 patients met criteria. Pain severity and daily opioid consumption were comparable across groups on post-operative day 1, but both metrics were significantly greater in the OP group on the day prior to discharge (DpDC) (5.6 (1.9-8.6), p < 0.05; 49 ± 44 MME/day, p < 0.01). The quantity of opioids prescribed at discharge was associated with opioid consumption on the DpDC only in the Mucosal and FF groups, which had longer LOA (6-7 days) than the Neck and OP groups (1 day, p < 0.001). Overall, 65% of patients required at least one dose of an opioid on the DpDC, yet 76% of patients received a prescription for an opioid medication at discharge. A longer LOA (aOR = 0.82, 95% CI: 0.63-0.98) and higher Charlson Comorbidity Index (aOR = 0.08, 95% CI: 0.01-0.48) were negatively associated with receiving an opioid prescription at the time of discharge despite no opioid use on the DpDC, respectively. HNC patients, particularly those with shorter LOA, may be prescribed opioids in excess of their post-operative needs, highlighting the need the for improved pain management algorithms in this patient population. Future work aims to use prospective surveys to better define post-operative and outpatient pain and opioid requirements following HNC surgery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Trakimas, Perez-Heydrich, Mandal, Tan, Gourin, Fakhry, Koch, Russell, Tufano, Eisele and Vosler.)

Primary central nervous system lymphomas (PCNSLs) are rare cancers of the central nervous system (CNS) and are predominantly diffuse large B-cell lymphomas of the activated B-cell (ABC) subtype. They typically present in the sixth and seventh decade of life, with the highest incidence among patients aged >75 years. Although many different regimens have demonstrated efficacy in newly diagnosed and relapsed or refractory PCNSL, there have been few randomized prospective trials, and most recommendations and treatment decisions are based on single-arm phase II trials or even retrospective studies. High-dose methotrexate (HD-MTX; 3-8 g/m2) is the backbone of preferred standard induction regimens. Various effective regimens with different toxicity profiles can be considered that combine other chemotherapies and/or rituximab with HD-MTX, but there is currently no consensus for a single preferred regimen. There is controversy about the role of various consolidation therapies for patients who respond to HD-MTX-based induction therapy. For patients with relapsed or refractory PCNSL who previously experienced response to HD-MTX, repeat treatment with HD-MTX-based therapy can be considered depending on the timing of recurrence. Other more novel and less toxic regimens have been developed that show efficacy in recurrent disease, including ibrutinib, or lenalidomide ± rituximab. There is uniform agreement to delay or avoid whole-brain radiation therapy due to concerns for significant neurotoxicity if a reasonable systemic treatment option exists. This article aims to provide a clinically practical approach to PCNSL, including special considerations for older patients and those with impaired renal function. The benefits and risks of HD-MTX or high-dose chemotherapy with autologous stem cell transplantation versus other, better tolerated strategies are also discussed. In all settings, the preferred treatment is always enrollment in a clinical trial if one is available.

Background: Approximately one-half of cervical cancer cases in the United States occur in underscreened or never-screened women. We examined predictors to completing Papanicolaou (Pap) testing and whether a positive human papillomavirus (HPV) self-collection result affects Pap testing adherence among underscreened women. Materials and Methods: Low-income women aged 30-65 years who reported no Pap testing in ≥4 years were recruited in North Carolina. Knowledge, attitudes, and barriers regarding cervical cancer and Pap testing were assessed by telephone questionnaires. We mailed self-collection kits for HPV testing and provided information regarding where to obtain affordable Pap testing. Participants received $45 for completing all activities. We used multivariable logistic regression to assess the predictors of longer reported time since last Pap (≥10 vs. 4-9 years) and of completion of Pap testing following study enrollment (follow-up Pap). Results: Participants ( n  = 230) were primarily black (55%), uninsured (64%), and with ≤high school education (59%). Cost and finding an affordable clinic were the most commonly reported barriers to screening. White women and those with ≤high school education reported longer intervals since last Pap test. Half of the participants reported completing a follow-up Pap test (55%). Women with a positive HPV self-collection were five times more likely to report completing a follow-up Pap test than those with negative self-collection (odds ratio = 5.1, 95% confidence interval 1.4-25.7). Conclusions: Improving awareness of resources for affordable screening could increase cervical cancer screening in underserved women. Home-based HPV self-collection represents an opportunity to re-engage infrequently screened women into preventive screening services.

Investigations focusing on host-ectoparasite interactions in animals have revealed asymptomatic to severe health and fitness consequences suggesting that species mobilize different interspecific response mechanisms. Fewer studies, however, have examined intraspecific responses to ectoparasitic burdens. In this study, we analyzed host health and fitness responses to increasing ectoparasite burdens along with the presence/absence of hemoparasites of free-ranging insular rock iguanas ( Cyclura cychlura ) in The Bahamas. Using hematology, plasma biochemistry, as well as body condition and growth rate comparisons, we failed to find significant associations of tick burdens with annual growth rate, corticosterone, packed cell volume, total white blood cell, and heterophil, monocyte, eosinophil or hemoglobin measures. We did, however, find mixed and significant associations of tick burdens with lymphocyte and basophil counts, heterophil-to-lymphocyte ratios, and body condition indices. These associations varied by sex, size, and hemoparasite infection status suggesting that different life stages of iguanas may invest differently in immune responses, and impacts may be modulated based on size and sex of hosts, and coinfection status., Competing Interests: None declared.

Background: Testing for high-risk human papillomavirus (HPV) infection using mailed, self-collected samples is a promising approach to increase screening in women who do not attend clinic screening at recommended intervals., Methods: To assess this intervention among high-risk women in the United States, 429 women without a Papanicolaou (Pap) test in 4 or more years (overdue by US guidelines) were recruited from the general population. Participants aged 30 to 65 years were mailed a kit to self-collect a cervicovaginal sample at home, return the sample by mail, and receive HPV results by telephone, with referral to follow-up cytological Pap testing at a local clinic. Cervicovaginal self-samples were collected with a Viba brush, stored in Scope mouthwash, and tested by Hybrid Capture 2. Data were collected in 2010 to 2011 and analyzed in 2017., Results: Two-thirds (64%) of participants returned a self-collected sample, of whom 15% tested HPV DNA positive. Human papillomavirus self-test-positive women reported higher rates of follow-up Pap tests (82%) than did those with self-test negative results (51%). No demographic differences were found in self-test return rate or HPV positivity. High acceptability was reported in participant surveys: most women (81%) had "mostly positive" overall thoughts about the self-test, and most reported being comfortable receiving the kit in the mail (99%), returning their self-collected sample by mail (82%), and receiving their test results by telephone (97%)., Conclusions: Conducting HPV self-testing through population-based recruitment, mailed kit delivery and return by mail, and results delivery by telephone has the potential to reach a broad segment of US underscreened women.

Interventions to mitigate household air pollution (HAP) from cooking with solid fuels often fail to take into account the role of access to freely available woodfuels in determining fuel choice and willingness to adopt clean cooking technologies, key factors in mitigating the burden of HAP. We use national-scale remote sensing data on land use land cover change, and population representative data from two waves of the Malawi Living Standards Measurement Survey to explore the relationship between land use change and the type of fuel households use, time spent collecting fuel, and expenditures on fuel, hypothesizing that land use dynamics influence household-level choice of primary cooking fuel. We find considerable heterogeneity with respect to regeneration and deforestation/degradation dynamics and evidence of spatial clustering. We find that regeneration of forests and woodlands increases the share of households that collect fuelwood, whereas deforestation and degradation lead households to purchase fuelwood. We also find that relatively large share of land under woody savannah or degraded forest (vs. fully stocked forest) increases fuel collection time. Areas with regeneration happening at broader scale experience increases in fuel expenditures. Our findings have implications for the spatial targeting of interventions designed to mitigate household air pollution.

We use Demographic and Health Survey (DHS) data to evaluate the impact of random spatial displacements on analyses that involve assigning covariate values from ancillary areal and point feature data. We introduce a method to determine the maximum probability covariate (MPC), and compare this to the naive covariate (NC) selection method with respect to obtaining the true covariate of interest. The MPC selection method outperforms the NC selection method by increasing the probability that the correct covariate is chosen. Proposed guidelines also address how characteristics of ancillary areal and point features contribute to uncertainty in covariate assignment.

The nine-banded armadillo ( Dasypus novemcinctus ) is the only known nonhuman reservoir of Mycobacterium leprae , the causative agent of Hansen's disease or leprosy. We conducted a 6-yr study on a wild population of armadillos in western Mississippi that was exposed to M. leprae to evaluate the importance of demographic and spatial risk factors on individual antibody status. We found that spatially derived covariates were not predictive of antibody status. Furthermore, analyses revealed no evidence of clustering by antibody-positive individuals. Lactating females and adult males had higher odds of being antibody positive than did nonlactating females. No juveniles or yearlings were antibody positive. Results of these analyses support the hypothesis that M. leprae infection patterns are spatially homogeneous within this armadillo population. Further research related to movement patterns, contact among individuals, antibody status, and environmental factors could help address hypotheses related to the role of environmental transmission on M. leprae infection and the mechanisms underlying the differential infection patterns among demographic groups.

We evaluate the impacts of random spatial displacements on analyses that involve distance measures from displaced Demographic and Health Survey (DHS) clusters to nearest ancillary point or line features, such as health resources or roads. We use simulation and case studies to address the effects of this introduced error, and propose use of regression calibration (RC) to reduce its impact. Results suggest that RC outperforms analyses involving naive distance-based covariate assignments by reducing the bias and MSE of the main estimator in most settings. Proposed guidelines also address the effect of the spatial density of destination features on observed bias.

With this paper we explore the sensitivity of study results to spatial displacements associated with Demographic and Health Survey (DHS) data in research that integrates ancillary raster data. Through simulation studies, we found that the impact of DHS point displacements on raster-based analyses can be moderated through the generation of covariates representing average values from neighborhood buffers. Additionally, raster surface characteristics (i.e., spatial smoothness) were found to affect the extent of bias introduced through point displacements. Although simple point extraction produced unbiased estimates in analyses involving smooth continuous surfaces, it is not recommended in analyses that involve categorical raster surfaces.

Interference occurs when the treatment of one person affects the outcome of another. For example, in infectious diseases, whether one individual is vaccinated may affect whether another individual becomes infected or develops disease. Quantifying such indirect (or spillover) effects of vaccination could have important public health or policy implications. In this article we use recently developed inverse-probability weighted (IPW) estimators of treatment effects in the presence of interference to analyze an individually-randomized, placebo-controlled trial of cholera vaccination that targeted 121,982 individuals in Matlab, Bangladesh. Because these IPW estimators have not been employed previously, a simulation study was also conducted to assess the empirical behavior of the estimators in settings similar to the cholera vaccine trial. Simulation study results demonstrate the IPW estimators can yield unbiased estimates of the direct, indirect, total, and overall effects of vaccination when there is interference provided the untestable no unmeasured confounders assumption holds and the group-level propensity score model is correctly specified. Application of the IPW estimators to the cholera vaccine trial indicates the presence of interference. For example, the IPW estimates suggest on average 5.29 fewer cases of cholera per 1000 person-years (95% confidence interval 2.61, 7.96) will occur among unvaccinated individuals within neighborhoods with 60% vaccine coverage compared to neighborhoods with 32% coverage. Our analysis also demonstrates how not accounting for interference can render misleading conclusions about the public health utility of vaccination., (© 2014, The International Biometric Society.)

We introduce a method for statistically identifying the optimal locations of deep tubewells (dtws) to be installed in Matlab, Bangladesh. Dtw installations serve to mitigate exposure to naturally occurring arsenic found at groundwater depths less than 200 meters, a serious environmental health threat for the population of Bangladesh. We introduce an objective function, which incorporates both arsenic level and nearest town population size, to identify optimal locations for dtw placement. Assuming complete knowledge of the arsenic surface, we then demonstrate how minimizing the objective function over a domain favors dtws placed in areas with high arsenic values and close to largely populated regions. Given only a partial realization of the arsenic surface over a domain, we use a Bayesian spatial statistical model to predict the full arsenic surface and estimate the optimal dtw locations. The uncertainty associated with these estimated locations is correctly characterized as well. The new method is applied to a dataset from a village in Matlab and the estimated optimal locations are analyzed along with their respective 95% credible regions.

Understanding why certain species can successfully colonize new areas while others do not is a central question in ecology. The nine-banded armadillo (Dasypus novemcinctus) is a conspicuous example of a successful invader, having colonized much of the southern United States in the last 200 years. We used 15 years (1992-2006) of capture-mark-recapture data from a population of armadillos in northern Florida in order to estimate, and examine relationships among, various demographic parameters that may have contributed to this ongoing range expansion. Modeling across a range of values for γ, the probability of juveniles surviving in the population until first capture, we found that population growth rates varied from 0.80 for γ = 0.1, to 1.03 for γ = 1.0. Growth rates approached 1.0 only when γ ≥ 0.80, a situation that might not occur commonly because of the high rate of disappearance of juveniles. Net reproductive rate increased linearly with γ, but life expectancy (estimated at 3 years) was independent of γ. We also found that growth rates were lower during a 3-year period of hardwood removal that removed preferred habitat than in the years preceding or following. Life-table response experiment (LTRE) analysis indicated the decrease in growth rate during logging was primarily due to changes in survival rates of adults. Likewise, elasticity analyses of both deterministic and stochastic population growth rates revealed that survival parameters were more influential on population growth than were those related to reproduction. Collectively, our results are consistent with recent theories regarding biological invasions which posit that populations no longer at the leading edge of range expansion do not exhibit strong positive growth rates, and that high reproductive output is less critical in predicting the likelihood of successful invasion than are life-history strategies that emphasize allocation of resources to future, as opposed to current, reproduction.

Objectives: We investigated whether deep tube wells installed to provide arsenic-free groundwater in rural Bangladesh have the added benefit of reducing childhood diarrheal disease incidence., Methods: We recorded cases of diarrhea in children younger than 5 years in 142 villages of Matlab, Bangladesh, during monthly community health surveys in 2005 and 2006. We surveyed the location and depth of 12,018 tube wells and integrated these data with diarrhea data and other data in a geographic information system. We fit a longitudinal logistic regression model to measure the relationship between childhood diarrhea and deep tube well use. We controlled for maternal education, family wealth, year, and distance to a deep tube well., Results: Household clusters assumed to be using deep tube wells were 48.7% (95% confidence interval = 27.8%, 63.5%) less likely to have a case of childhood diarrhea than were other household clusters., Conclusions: Increased access to deep tube wells may provide dual benefits to vulnerable populations in Matlab, Bangladesh, by reducing the risk of childhood diarrheal disease and decreasing exposure to naturally occurring arsenic in groundwater.

We develop novel methods for conceptualizing geographic space and social networks to evaluate their respective and combined contributions to childhood diarrheal incidence. After defining maternal networks according to direct familial linkages between females, and road networks using satellite imagery of the study area, we use a spatial econometrics model to evaluate the significance of correlation terms relating childhood diarrheal incidence to the incidence observed within respective networks. Disease was significantly clustered within road networks across time, but only inconsistently correlated within maternal networks. These methods could be widely applied to systems in which both social and spatial processes jointly influence health outcomes., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This study presents a case study of how social network and spatial analytical methods can be used simultaneously for disease transmission modeling. The paper first reviews strategies employed in previous studies and then offers the example of transmission of two bacterial diarrheal diseases in rural Bangladesh. The goal is to understand how diseases vary socially above and beyond the effects of the local neighborhood context. Patterns of cholera and shigellosis incidence are analyzed in space and within kinship-based social networks in Matlab, Bangladesh. Data include a spatially referenced longitudinal demographic database which consists of approximately 200,000 people and laboratory-confirmed cholera and shigellosis cases from 1983 to 2003. Matrices are created of kinship ties between households using a complete network design and distance matrices are also created to model spatial relationships. Moran's I statistics are calculated to measure clustering within both social and spatial matrices. Combined spatial effects-spatial disturbance models are built to simultaneously analyze spatial and social effects while controlling for local environmental context. Results indicate that cholera and shigellosis always clusters in space and only sometimes within social networks. This suggests that the local environment is most important for understanding transmission of both diseases however kinship-based social networks also influence their transmission. Simultaneous spatial and social network analysis can help us better understand disease transmission and this study has offered several strategies on how.

Upper respiratory tract disease (URTD) caused by Mycoplasma agassizii has been hypothesized to contribute to the decline of some wild populations of gopher tortoises (Gopherus polyphemus). However, the force of infection (FOI) and the effect of URTD on survival in free-ranging tortoise populations remain unknown. Using four years (2003-2006) of mark-recapture and epidemiological data collected from 10 populations of gopher tortoises in central Florida, USA, we estimated the FOI (probability per year of a susceptible tortoise becoming infected) and the effect of URTD (i.e., seropositivity to M. agassizii) on apparent survival rates. Sites with high (> or = 25%) seroprevalence had substantially higher FOI (0.22 +/- 0.03; mean +/- SE) than low (< 25%) seroprevalence sites (0.04 +/- 0.01). Our results provide the first quantitative evidence that the rate of transmission of M. agassizii is directly related to the seroprevalence of the population. Seropositive tortoises had higher apparent survival (0.99 +/- 0.0001) than seronegatives (0.88 +/- 0.03), possibly because seropositive tortoises represent individuals that survived the initial infection, developed chronic disease, and experienced lower mortality during the four-year span of our study. However, two lines of evidence suggested possible effects of mycoplasmal URTD on tortoise survival. First, one plausible model suggested that susceptible (seronegative) tortoises in high seroprevalence sites had lower apparent survival rates than did susceptible tortoises in low seroprevalence sites, indicating a possible acute effect of infection. Second, the number of dead tortoise remains detected during annual site surveys increased significantly with increasing site seroprevalence, from approximately 1 to approximately 5 shell remains per 100 individuals. If (as our results suggest) URTD in fact reduces adult survival, it could adversely influence the population dynamics and persistence of this late- maturing, long-lived species.