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A substantial minority of US children were identified as having an existing special health care need using national survey data. Children with existing special health care needs are disproportionately poor and socially disadvantaged. Moreover, many of these children face significant barriers to health care.

Wind-driven coastal ocean upwelling supplies nutrients to the euphotic zone near the coast. Nutrients fuel the growth of phytoplankton, the base of a very productive coastal marine ecosystem [Pauly D, Christensen V (1995) Nature 374:255-257]. Because nutrient supply and phytoplankton biomass in shelf waters are highly sensitive to variation in upwelling-driven circulation, shifts in the timing and strength of upwelling may alter basic nutrient and carbon fluxes through marine food webs. We show how a 1-month delay in the 2005 spring transition to upwelling-favorable wind stress in the northern California Current Large Marine Ecosystem resulted in numerous anomalies: warm water, low nutrient levels, low primary productivity, and an unprecedented low recruitment of rocky intertidal organisms. The delay was associated with 20-to 40-day wind oscillations accompanying a southward shift of the jet stream. Early in the upwelling season (May-July) off Oregon, the cumulative upwelling-favorable wind stress was the lowest in 20 years, nearshore surface waters averaged 2°C warmer than normal, surf-zone chlorophyll-a and nutrients were 50% and 30% less than normal, respectively, and densities of recruits of mussels and barnacles were reduced by 83% and 66%, respectively. Delayed early-season upwelling and stronger late-season upwelling are consistent with predictions of the influence of global warming on coastal upwelling regions.climate variability ͉ coastal marine ecosystems ͉ coastal ocean upwelling ͉ marine ecology E quatorward winds along the eastern boundaries of the world's oceans drive offshore surface Ekman transport and the upwelling of cold, nutrient-rich water into the euphotic zone near the coast. These nutrient pulses stimulate high phytoplankton production, which, in turn, supports a rich coastal marine ecosystem and productive fisheries (1). Examples of such dynamics include the California Current, the Humboldt Current, the Benguela Current, and the Canary Current (2).The strength and extent of the seasonal cycle in upwellingfavorable winds varies along the U.S. west coast. In the northern California Current Large Marine Ecosystem (CCLME), there is a strong seasonal cycle with upwelling-favorable winds, the appearance of cold, saline, nutrient-rich water near the coast, and equatorward currents over the shelf occurring after a spring transition (3). Alongshore winds in the northern CCLME are more variable than those farther south because they are more frequently influenced by eastward-traveling Gulf of Alaska low-pressure systems. The intermittent cessation of upwelling-favorable winds is called relaxation and plays an important role in coastal circulation and the recruitment of marine organisms † † . The timing of the spring transition and the total amount of upwelling-favorable winds during the spring-summer upwelling season have a considerable impact on coastal ecosystem responses. Farther south in the CCLME, winds are more persistently upwelling-favorable and the transition to a more productive spring-su...

Phytoplankton production drives marine ecosystem trophic-structure and global fisheries yields. Phytoplankton biomass is particularly influential near coral reef islands and atolls that span the oligotrophic tropical oceans. The paradoxical enhancement in phytoplankton near an island-reef ecosystem—Island Mass Effect (IME)—was first documented 60 years ago, yet much remains unknown about the prevalence and drivers of this ecologically important phenomenon. Here we provide the first basin-scale investigation of IME. We show that IME is a near-ubiquitous feature among a majority (91%) of coral reef ecosystems surveyed, creating near-island ‘hotspots' of phytoplankton biomass throughout the upper water column. Variations in IME strength are governed by geomorphic type (atoll vs island), bathymetric slope, reef area and local human impacts (for example, human-derived nutrient input). These ocean oases increase nearshore phytoplankton biomass by up to 86% over oceanic conditions, providing basal energetic resources to higher trophic levels that support subsistence-based human populations.

The near-term progression of ocean acidification (OA) is projected to bring about sharp changes in the chemistry of coastal upwelling ecosystems. The distribution of OA exposure across these early-impact systems, however, is highly uncertain and limits our understanding of whether and how spatial management actions can be deployed to ameliorate future impacts. Through a novel coastal OA observing network, we have uncovered a remarkably persistent spatial mosaic in the penetration of acidified waters into ecologically-important nearshore habitats across 1,000 km of the California Current Large Marine Ecosystem. In the most severe exposure hotspots, suboptimal conditions for calcifying organisms encompassed up to 56% of the summer season, and were accompanied by some of the lowest and most variable pH environments known for the surface ocean. Persistent refuge areas were also found, highlighting new opportunities for local adaptation to address the global challenge of OA in productive coastal systems.

WHAT'S KNOWN ON THIS SUBJECT:The importance of transition from pediatric to adult health care for youth with special health care needs has gained increasing attention over the past decade, but fewer than half of this population received needed transition preparation in [2005][2006]. abstract OBJECTIVE: To examine current US performance on transition from pediatric to adult health care and discuss strategies for improvement. WHAT THIS STUDY ADDS: METHODS: The 2009-2010 National Survey of Children with SpecialHealth Care Needs is a nationally representative sample with 17 114 parent respondents who have youth with special health care needs (YSHCN) ages 12 and 18. They are asked about transition to an adult provider, changing health care needs, increasing responsibility for health care needs, and maintaining insurance coverage. We analyzed the association of selected characteristics with successful transition preparation. RESULTS:Overall, 40% of YSHCN meet the national transition core outcome. Several factors are associated with transition preparation, including female gender; younger age; white race; non-Hispanic ethnicity; income $400% of poverty; little or no impact of condition on activities; having a condition other than an emotional, behavioral, or developmental condition; having a medical home; and being privately insured.CONCLUSIONS: Most YSHCN are not receiving needed transition preparation. Although most providers are encouraging YSHCN to assume responsibility for their own health, far fewer are discussing transfer to an adult provider and insurance continuity. Although changes in sample design limit trend analysis, there have been no discernible improvements since this transition outcome was measured in the 2005

This study illustrates the importance of health insurance for children with special health care needs. Continued efforts are needed to ensure that all children with special health care needs have insurance and that remaining access and utilization barriers for currently insured children with special health care needs are also addressed.

The biological and physical processes contributing to planktonic thin layer dynamics were examined in a multidisciplinary study conducted in East Sound, Washington, USA between June 10 and June 25, 1998. The temporal and spatial scales characteristic of thin layers were determined using a nested sampling strategy utilizing 4 major types of platforms: (1) an array of 3 moored acoustical instrument packages and 2 moored optical instrument packages that recorded distributions and intensities of thin layers; (2) additional stationary instrumentation deployed outside the array comprised of meteorological stations, wave-tide gauges, and thermistor chains; (3) a research vessel anchored 150 m outside the western edge of the array; (4) 2 mobile vessels performing basin-wide surveys to define the spatial extent of thin layers and the physical hydrography of the Sound. We observed numerous occurrences of thin layers that contained locally enhanced concentrations of material; many of the layers persisted for intervals of several hours to a few days. More than one persistent thin layer may be present at any one time, and these spatially distinct thin layers often contain distinct plankton assemblages. The results suggest that the species or populations comprising each distinct thin layer have responded to different sets of biological and/or physical processes. The existence and persistence of planktonic thin layers generates extensive biological heterogeneity in the water column and may be important in maintaining species diversity and overall community structure.