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Physical therapy and glucocorticoid injections are initial treatment options for knee osteoarthritis, but available data indicate that most patients receive one or the other, suggesting they may be competing interventions. The initial cost difference for treatment can be substantial, with physical therapy often being more expensive at the outset, and cost-effectiveness analysis can aid patients and clinicians in making decisions.To investigate the incremental cost-effectiveness between physical therapy and intra-articular glucocorticoid injection as initial treatment strategies for knee osteoarthritis.This economic evaluation is a secondary analysis of a randomized clinical trial performed from October 1, 2012, to May 4, 2017. Health economists were blinded to study outcomes and treatment allocation. A randomized sample of patients seen in primary care and physical therapy clinics with a radiographically confirmed diagnosis of knee osteoarthritis were evaluated from the clinical trial with 96.2% follow-up at 1 year.Physical therapy or glucocorticoid injection.The main outcome was incremental cost-effectiveness between 2 alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICERs) were used to identify the proportion of ICERs under the specific willingness-to-pay level ($50 000-$100 000). Health care system costs (total and knee related) and health-related quality-of-life based on quality-adjusted life-years (QALYs) were obtained.A total of 156 participants (mean [SD] age, 56.1 [8.7] years; 81 [51.9%] male) were randomized 1:1 and followed up for 1 year. Mean (SD) 1-year knee-related medical costs were $2113 ($4224) in the glucocorticoid injection group and $2131 ($1015) in the physical therapy group. The mean difference in QALY significantly favored physical therapy at 1 year (0.076; 95% CI, 0.02-0.126; P = .003). Physical therapy was the more cost-effective intervention, with an ICER of $8103 for knee-related medical costs, with a 99.2% probability that results fall below the willingness-to-pay threshold of $100 000.A course of physical therapy was cost-effective compared with a course of glucocorticoid injections for patients with knee osteoarthritis. These results suggest that, although the initial cost of delivering physical therapy may be higher than an initial course of glucocorticoid injections, 1-year total knee-related costs are equivalent, and greater improvement in QALYs may justify the initial higher costs.ClinicalTrials.gov Identifier: NCT01427153. more...

The bull trout Salvelinus confluentus is an apex predator in native fish communities in the western USA and is listed as threatened under the U.S. Endangered Species Act (ESA). Restoration of this species has raised concerns over its potential predatory impacts on native fish fauna. We held a five-person expert panel to help determine potential impacts of reintroducing bull trout into the Clackamas River, northwest Oregon, on the viability of four anadromous salmonid populations that are listed as threatened under the ESA: spring and fall Chinook salmon Oncorhynchus tshawytscha, coho salmon O. kisutch, and winter steelhead O. mykiss. The panel session was rigorously structured and used a modified Delphi process with structured expert elicitation, disclosure, discussion, and brainstorming. Each panelist distributed 100 score points among seven categories of potential bull trout impact (from no impact to very high impact) on extinction probabilities for the anadromous salmonids. Results were provid... more...

Translocations to recover native fishes have resulted in mixed success. One reason for the failure of these actions is inadequate assessments of their feasibility prior to implementation. Here, we provide a framework developed to assess the feasibility of one type of translocation—reintroduction. The framework was founded on two simple components of feasibility: the potential for recipient habitats to support a reintroduction and the potential of available donor populations to support a reintroduction. Within each component, we developed a series of key questions. The final assessment was based on a scoring system that incorporated consideration of uncertainty in available information. The result was a simple yet transparent system for assessing reintroduction feasibility that can be rapidly applied in practice. We applied this assessment framework to the potential reintroduction of threatened bull trout Salvelinus confluentus into the Clackamas River, Oregon. In this case, the assessment suggest... more...

Foskett Spring is a small isolated desert spring in the Warner Basin of Oregon containing an undescribed subspecies of speckled dace protected under the US Endangered Species Act. Uncertainty regarding the taxonomic status of Foskett dace has raised questions about their evolutionary relationship to other more abundant populations in the Warner Basin. To address these questions, we sequenced 1,982 base pairs (bp) of the ND2 and cyt-b genes of mitochondrial DNA (mtDNA) for 85 fish from Foskett Spring, the surrounding Warner Basin, and the adjacent Goose Lake Basin. We observed 58 unique mtDNA haplotypes defined by 96 bp substitutions in both genes. MtDNA sequences were highly divergent and reciprocally monophyletic between dace from the Warner and Goose Lake Basins, with sequence divergences (5 and 3% at ND2 and cyt-b, respectively) in the range usually observed between fish species. In contrast, mean sequence divergence between Foskett dace and other Warner Basin populations was less than 1%, with no evidence of reciprocal monophyly among mtDNA lineages. These results indicate that Foskett dace and other populations in the Warner Basin are approximately equally diverged from one another evolutionarily, suggesting similar times of divergence since the late Pleistocene. We believe further studies are needed to determine if rapid evolution of novel traits have occurred in dace inhabiting the unique ecological setting of Foskett Spring during the past 10,000 years. more...