No abstract

American Three-toed Woodpeckers Picoides dorsalis are considered a sensitive species by the United States Bureau of Land Management and are on the United States Fish and Wildlife Service's Watch List. In Idaho, Oregon and Washington, they are of conservation concern due to low abundance and an apparent reliance on disturbed, old-growth forests. This species is strongly associated with Spruce Beetle Dendroctonous rufipennis epidemics, yet their occupancy relation with epidemic conditions have not been described. We studied Three-toed Woodpecker occupancy patterns in spruce-fir forests experiencing varying degrees of beetle infestation between 2013 and 2016. Accounting for detection probability, we found a strong positive relationship between occupancy and the density of currently infested trees. Estimated occupancy was 0.57 (Bayesian credible interval 0.49, 0.64) for 75-m-radius survey points with zero infested spruce trees vs. 0.99 (Bayesian credible interval 0.99, 1) for points with 235 recently infested stems per ha. In contrast, we found no relationships with density of trees infested at least 3 years prior to sampling, density of older snags (i.e. > 10 years dead) or quadratic mean diameter of healthy or recently infested trees. These results provide evidence of the importance of active Spruce Beetle infestation for Three-toed Woodpecker habitat. Conserving Spruce Beetle-infested trees for at least 3 years following the onset of a beetle epidemic would benefit Three-toed Woodpecker populations and other species that depend on woodpecker-excavated cavities. We suggest managers consider these results when planning logging activities aimed at Spruce Beetle mitigation.

Care coordination (CC) has shown positive outcomes among children with special health care needs (CSHCN); however, the association between CC and well-child care (WCC) visits is unknown. We hypothesize that CSHCN who receive CC are more likely to attend the recommended WCC visits. A retrospective cohort analysis was conducted of patients aged 15 months attending the Arizona Children’s Center clinic. Logistic regression models explored the association between children receiving CC and attending the recommended minimum WCC visits before 15 months of age. CC was associated with higher odds of proper WCC attendance (any CC service, adjusted odds ratio = 2.14, 95% confidence interval = 1.75-2.62; high level of CC, adjusted odds ratio = 2.61, 95% confidence interval = 1.73-3.94). Pediatric CC is associated with greater up-to-date status of the WCC schedule among CSHCN 15 months of age, and higher odds among children who receive higher levels of CC. Further research is needed to validate findings.

A 41-year-old woman was seen in no acute distress with an infected ventriculoperitoneal shunt. She underwent several revisions of the shunt but was readmitted to the hospital with nausea, vomiting, and neurologic sequelae. Results of spinal fluid analysis were white blood cells 68/mm3 (25% neutrophils), glucose less than 20 mg/dl, and protein 513 mg/dl. Cerebrospinal fluid, aerobic and anaerobic, and blood cultures were negative. Three weeks later the patient suffered a seizure and was prescribed antitubercular agents for a presumed diagnosis of tubercular meningitis. One week later, chest wound culture from her first visit suggested Mycobacterium tuberculosis, which was confirmed by DNA probe; cerebrospinal fluid culture eventually grew the organism. The patient fared well once she received antituberculosis agents. The time between first contact and treatment in the hospital delayed therapy.