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Recent marine heatwaves have had pervasive effects on marine ecosystems, from declines in primary production to die-offs of top predators. Seabird mortalities are often observed in association with heatwaves, but population impacts are not well understood. In this work, we report the rapid mortality of approximately half of Alaska's common murre ( Uria aalge ) population in response to an extreme marine heatwave. Between the 7-year period before (2008-2014) and after (2016-2022) the heatwave, murre numbers plummeted 52 to 78% at 13 colonies across two large marine ecosystems. We calculated a loss of 4.00 million common murres, the largest documented wildlife mortality event in the modern era. No evidence of recovery has yet been observed, suggesting that these ecosystems may no longer support historic numbers of seabird top predators.

Background: Completing high school enables access to educational and employment opportunities associated with better physical and mental health and improved quality of life. Identifying modifiable factors that promote optimal educational trajectories for youth experiencing disadvantage is an important research focus. Social inclusion has been theorised to play a role in promoting better educational outcomes for this priority population, however limited research has examined this relationship., Method: This study used three waves of data from the state-representative Australian arm of the International Youth Development Study (IYDS) (youngest cohort, N = 733; 54% female, 95% Australian born) to examine the extent to which vulnerability in primary school (Grade 5; M age  = 10.97, SD = 0.38) and social inclusion in mid-adolescence (Year 10; M age  = 15.50, SD = 0.53), were associated with school completion in young adulthood (post-secondary; M age  = 19.02, SD = 0.43)., Results: Regression models identified an interaction between social inclusion and vulnerability (OR = 1.37, 95% CI [1.06, 1.77], p = .016), indicating that the association between vulnerability and school completion varied as a student's level of social inclusion increased. Higher social inclusion was beneficial for youth with lower levels of vulnerability but did not appear to influence school completion for the most vulnerable students., Conclusions: For many young people, promoting social inclusion may support engagement in education and play a protective role. However, further research is needed to better understand the role of social inclusion for highly vulnerable youth, particularly the mechanisms via which social inclusion may have differential effects on school completion., (© 2024 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Although consensual sending of sexts between adolescents is considered developmentally appropriate, it may also entail a range of negative consequences. Current sexting research lacks a comprehensive theoretical framework identifying a range of risk and protective factors underpinning adolescent consensual sending of sexts across individual, interpersonal, and distal levels. Further, there is a lack of systematic evaluation of how the importance of these factors may vary across adolescent age. This study investigated the utility of the Social Development Model to predict a range of risk and protective factors across individual, family, peer, school, and community-level factors. The sample included 1302 teenagers from Victoria, Australia (M age  = 14.54, SD = 1.14, 50.8% girls). Results indicated that 146 (11.7%) participants sent a sext (76 boys and 70 girls). Logistic regression analyses revealed that the Social Development Model accounted for 45.8% of variance in sexting, with greater likelihood of sending sexts being associated with older age, prior sexual activity, school sector, physical activity, lifetime substance use, greater depressive symptoms, sensation seeking, and perceived substance availability in the community. Multigroup analyses revealed that lifetime substance use was associated with a greater likelihood of sending sexts among younger teens. Among older adolescents, adaptive coping was associated with reduced engagement in sexting, while higher parental overcontrol and family conflict increased the odds of sending sexts. Overall, sexting is associated with a range of modifiable factors potentially amenable to intervention., (© 2023. The Author(s).)

Enhancing social inclusion in young people could increase engagement in education, yet few longitudinal studies have examined this relationship. This study aimed to identify whether social inclusion in an Australian adolescent sample predicted high school completion three years later. Using state-representative data from the International Youth Development Study, two waves of the youngest cohort (51.6% female and 94.6% Australian born) during mid-adolescence (n = 825, M age  = 15.99, SD = 0.39) and post-secondary school (n = 809, M age  = 19.03, SD = 0.44) were analyzed. Factor analysis identified a 4-factor structure that represented an overarching social inclusion construct: (1) Citizenship, (2) Connectedness to Community, (3) Connectedness to Family, and (4) Connectedness to and Participation in School. Multivariate regression analyses indicated higher social inclusion levels in mid-adolescence predicted an increased likelihood of high school completion three years later. The implementation of strategies that incorporate the enhancement of social inclusion may improve educational outcomes for young people., (© 2023. The Author(s).)

Knowledge of non-breeding distributions is a crucial component to seabird conservation, as conditions during the non-breeding period can play an important role in regulating seabird populations. Specifically, if seabirds from different colonies share the same wintering grounds, conditions in that shared region could have a widespread impact on multiple breeding populations. Red-legged kittiwakes (Rissa brevirostris) are endemic to the Bering Sea and may be especially susceptible to effects of climate change due to a restricted breeding range, small population size, and specialized diet. To examine whether red-legged kittiwakes from different breeding colonies overlapped in winter distribution and activity patterns, we used geolocation loggers to simultaneously track individuals from the two largest red-legged kittiwake breeding colonies in Alaska (separated by over 1000 km) during two consecutive non-breeding periods. We found that non-breeding activity patterns were generally similar between birds originating from the two colonies, but birds employed different migratory strategies during the early winter. Kittiwakes from Buldir Island in the western Aleutian Islands left the colony in September and immediately headed west, spending October through December around the Sea of Okhotsk and the Kuril Islands. In contrast, birds from St. George Island in the Pribilof Islands remained in the eastern Bering Sea or around the eastern Aleutian Islands for a couple months before traveling farther west. During late winter however, from January through March, birds from both colonies converged south of Kamchatka and east of the Kuril Islands over the Kuril-Kamchatka Trench and in the Western Subarctic Gyre before returning to their respective colonies in the spring. This late winter overlap in distributions along the Kuril-Kamchatka Trench suggests the region is a winter hotspot for red-legged kittiwakes and highlights the importance of this region for the global kittiwake population., Competing Interests: The authors have read the journal’s policy and the authors of this manuscript have the following competing interests: Abram Fleishman is employed by the commercial company Conservation Metrics, Inc. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Objective: To design a value-based payment model to incentivize pharmacists for increased administration of influenza, herpes zoster, pertussis-containing, and pneumococcal vaccines to adults at community pharmacies., Design: A modified delphi technique was used to create a concept for a value-based payment model through consensus of expert opinion., Setting: and participants: Experts were recruited from a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution to participate in 4 electronic surveys and 1 in-person meeting., Outcome Measures: Consensus on model design by means of a modified delphi technique., Results: A panel of 11 experts participated in a series of electronic surveys and 1 in-person meeting. The final value-based payment model addressed how and when pharmacists would receive an incentive for meeting specific vaccination goals. The final value-based payment model also addressed the following concepts: estimated cost avoidance, vaccine effectiveness, and community protection. A 3-tiered incentive model was agreed on by the participants to tie increased vaccination rates with increased payment. Vaccination goals for each tier were defined as the percent increase in vaccination rates from the year immediately preceding. Incentives were defined as a percentage of estimated direct medical costs avoided to be shared between the payer and pharmacy., Conclusion: A conceptual value-based payment model to incentivize pharmacists for increased delivery of adult vaccinations at community pharmacies was designed and agreed on by experts representing a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution. Consensus was achieved by aligning the interests of both payers and pharmacies. The final model included 3 tiers of bundled incentives to reward percent increases in adult vaccination from historical baselines. This model may be used as an example for community pharmacies and health care payers to design future value-based immunization programs., (Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

About 62,000 dead or dying common murres (Uria aalge), the trophically dominant fish-eating seabird of the North Pacific, washed ashore between summer 2015 and spring 2016 on beaches from California to Alaska. Most birds were severely emaciated and, so far, no evidence for anything other than starvation was found to explain this mass mortality. Three-quarters of murres were found in the Gulf of Alaska and the remainder along the West Coast. Studies show that only a fraction of birds that die at sea typically wash ashore, and we estimate that total mortality approached 1 million birds. About two-thirds of murres killed were adults, a substantial blow to breeding populations. Additionally, 22 complete reproductive failures were observed at multiple colonies region-wide during (2015) and after (2016-2017) the mass mortality event. Die-offs and breeding failures occur sporadically in murres, but the magnitude, duration and spatial extent of this die-off, associated with multi-colony and multi-year reproductive failures, is unprecedented and astonishing. These events co-occurred with the most powerful marine heatwave on record that persisted through 2014-2016 and created an enormous volume of ocean water (the "Blob") from California to Alaska with temperatures that exceeded average by 2-3 standard deviations. Other studies indicate that this prolonged heatwave reduced phytoplankton biomass and restructured zooplankton communities in favor of lower-calorie species, while it simultaneously increased metabolically driven food demands of ectothermic forage fish. In response, forage fish quality and quantity diminished. Similarly, large ectothermic groundfish were thought to have increased their demand for forage fish, resulting in greater top-predator demands for diminished forage fish resources. We hypothesize that these bottom-up and top-down forces created an "ectothermic vise" on forage species leading to their system-wide scarcity and resulting in mass mortality of murres and many other fish, bird and mammal species in the region during 2014-2017., Competing Interests: The authors have declared that no competing interests exist.

Recently available downscaled ocean climate models for the Bering Sea and Aleutian Arc offer the opportunity to assess climate vulnerability for upper trophic level consumers such as marine birds. We analyzed seasonal and annual spatial projections from three climate models for two physical climate variables (seawater temperature and sea ice) and three forage variables (large copepods, euphausiids, and benthic infauna), comparing projected conditions from a recent time period (2003-2012) to a future time period (2030-2039). We focused the analyses on core areas within globally significant Important Bird Areas, and developed indices of the magnitude of projected change and vulnerability agreement among models. All three climate models indicated a high degree of change for seawater temperature warming (highest in the central and eastern Aleutian Islands) and ice loss (most significant in the eastern Bering Sea) across scales, and we found those changes to be significant for every species and virtually every core area assessed. There was low model agreement for the forage variables; while the majority of core areas were identified as climate vulnerable by one or more models (72% for large copepods, 73% for euphausiids, and 94% for benthic infauna), very few were agreed upon by all three models (only 6% of euphausiid-forager core areas). Based on the magnitude-agreement score, euphausiid biomass decline affected core areas for fulmars, gulls, and auklets, especially along the outer shelf and Aleutian Islands. Benthic biomass decline affected eiders along the inner shelf, and large copepod decline was significant for storm-petrels and auklets in the western Aleutians. Overall, 12% of core areas indicated climate vulnerability for all variables assessed. Modeling and interpreting biological parameters to project future dynamics remains complex; the strong signal for projected physical changes raised concerns about lagged responses such as distribution shifts, breeding failures, mortality events, and population declines., Competing Interests: One or more of the authors are employed by a commercial company: Axiom Data Science. (W.C. Koeppen) This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objective: To develop prescriber-specific infographics containing community pharmacy prescription dispensing data and share them with targeted prescribers to determine their utility in facilitating initial collaborative conversations regarding the care of mutual patients., Methods: Prescription dispensing data from an independent community pharmacy in western Pennsylvania was collected to generate highly visual infographics for the most frequent prescribers to the pharmacy. Infographics were individualized for prescribers, and they included information on mutual patients between the pharmacy and the prescriber. Infographics were then shared with prescribers during semistructured, audio-recorded interviews. Interview questions elicited feedback on prescriber medication-related needs, quality and performance measures, infographic format and utility, and prescriber-pharmacist collaboration. Interviews were transcribed and coded by 2 independent investigators using qualitative analysis software. Coding discrepancies were resolved. A thematic analysis of the interview data was conducted., Results: Eight interviews were conducted with prescribers. The following themes emerged: (1) the infographic prompted prescribers to recognize potential collaborative opportunities with community pharmacists; (2) the infographic stimulated discussion on prescribing patterns and mutual patient populations; (3) prescribers value discussing the infographic data in a face-to-face meeting; (4) prescribers want to hear from pharmacists when mutual patients have medication-related problems; and (5) the infographic helped prescribers identify quality measures that they were not currently meeting., Conclusion: Infographics containing prescription dispensing data for mutual patients may be a useful tool when shared by community pharmacists to facilitate collaborative discussions with prescribers., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

The Statin Use in Persons with Diabetes (SUPD) measure has been adopted by the Centers for Medicare and Medicaid Services as a display measure for Medicare Part C and Part D plan sponsors and is slated for inclusion within the primary star rating measure set. As such, the measure has become a focal point for quality improvement efforts by many health plans. Current pharmacy-based interventions reported in the literature involve pharmacists recommending that a patient's provider issue a prescription for a statin; studies to date have not shown that this intervention has been effective for the majority of patients with diabetes. One innovative option is pharmacist prescriptive authority of statins for patients with diabetes. In such a model, a pharmacist identifies a patient with diabetes who is not on a statin, assesses the patient for contraindications and appropriateness of therapy, and works directly with the patient to close the gap in care. This solution could lead to earlier initiation of statin therapy and reduce the burdens associated with multiple communications with the patient's primary care provider. In 2018, Idaho became the first state to allow pharmacist prescribing to close the SUPD measure, with certain regulatory safeguards in place. DISCLOSURES: No funding supported the writing of this article. The authors have nothing to disclose.

Global warming is a nonlinear process, and temperature may increase in a stepwise manner. Periods of abrupt warming can trigger persistent changes in the state of ecosystems, also called regime shifts. The responses of organisms to abrupt warming and associated regime shifts can be unlike responses to periods of slow or moderate change. Understanding of nonlinearity in the biological responses to climate warming is needed to assess the consequences of ongoing climate change. Here, we demonstrate that the population dynamics of a long-lived, wide-ranging marine predator are associated with changes in the rate of ocean warming. Data from 556 colonies of black-legged kittiwakes Rissa tridactyla distributed throughout its breeding range revealed that an abrupt warming of sea-surface temperature in the 1990s coincided with steep kittiwake population decline. Periods of moderate warming in sea temperatures did not seem to affect kittiwake dynamics. The rapid warming observed in the 1990s may have driven large-scale, circumpolar marine ecosystem shifts that strongly affected kittiwakes through bottom-up effects. Our study sheds light on the nonlinear response of a circumpolar seabird to large-scale changes in oceanographic conditions and indicates that marine top predators may be more sensitive to the rate of ocean warming rather than to warming itself., (© 2017 John Wiley & Sons Ltd.)

Objective: To assess the effect of a community pharmacist-led intervention on the proportion of patients with diabetes placed on statin therapy., Design: The Pharmacy Quality Alliance endorsed a performance measure, Statin Use in Persons with Diabetes, which evaluates the percentage of patients aged 40-75 years who were dispensed a medication for diabetes and also received a statin medication., Setting: This new measure has been implemented within the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) dashboard., Participants: In this randomized controlled study, eligible patients identified in EQuIPP are those who received medications from a large chain community pharmacy in North Carolina, are 40-75 years, had ≥2 prescription fills of a diabetes medication, and were not receiving statin therapy., Intervention: The control group received no intervention. Primary care prescribers of patients in the intervention group were contacted by phone and fax to obtain a prescription for an appropriate statin., Main Outcome Measures: The primary outcome was the proportion of patients in each group who were dispensed a statin, calculated using Fisher exact test. Sub-analyses were performed to control for patient age, sex, and insurance type., Results: The number of statins prescribed was statistically significant between intervention group (n = 221) versus control group (n = 199) with 46 statins versus 17 statins, respectively (P <0.001). The number of statins dispensed was also statistically significant between groups with 34 statins in the intervention group versus 15 statins in the control group (P = 0.015). The fourth most common (9.2%) reason prescribers rejected statin therapy initiation was "Patient has normal cholesterol" and this caused the greatest amount of discussion between pharmacist and prescriber., Conclusion: Through a brief pharmacist-to-provider intervention, a significant gap closure in statin therapy was seen in patients with diabetes. There is an opportunity for pharmacies, health plans, and prescribers to utilize the community pharmacist in achieving quality, evidence-based patient care., (Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Power analyses are essential when developing a long-term monitoring program for a target species whose observation is logistically challenging and expensive. These analyses can be complicated when the observations have a complex variance structure reflecting many factors. Crevice-nesting seabirds such as least and crested auklets Aethia pusilla and Aethia cristatella illustrate both this need and these challenges. They are ecosystem indicators for the Bering Sea, a system expected to undergo large changes. Unfortunately, they are difficult to monitor as colonies occur on remote, hard to access islands in the Aleutians and Bering Sea, and nests occur in crevices underground, preventing direct observation. Current monitoring consists of breeding-season counts of auklets standing on the surface of sample plots in the colony; logically, a substantial decline in nesting population guarantees an eventual substantial decline in surface attendants. Yet, it remains debatable whether these highly variable counts can be used to statistically detect biologically relevant declines in the attending population let alone the nesting population. Subsequently, existing monitoring programs vary widely in survey design, effort levels, and daily summary statistics. The power of different survey designs was assessed by simulating observations from a state model developed from 11 years of observations using mixed-effects models and zero-inflated Poisson-lognormal regression. The analyses illustrate the process required for any monitoring program whose observations are described inadequately by standard statistical models. State model development revealed survey design refinements that reduce sampling variation. For least auklets, current sampling efforts provided 90% power to detect annual declines of 11% ("Critically Endangered" using IUCN Red List criteria), 4.5% ("Endangered"), or 2.4% ("Vulnerable") in two, four, or six generations, respectively; crested auklets took a few years longer. Power was more sensitive to number of days than number of plots. Results appear robust across a range of bird densities, providing guidance for monitoring other colonies or crevice-nesting species with similar life history strategies. Research should now focus on illuminating the relationship between the attending and nesting populations. Given the frequency of complicated variance structures and zero counts in ecological data, the general statistical models used here should prove widely applicable.