Earthquakes, today’s and tomorrow’s

I slept through it.  Did you feel it?  At 5:25 am today (Friday) there was a moderate earthquake in the Puget Sound area, centered near Poulsbo, WA on the Kitsap peninsula.  The USGS says it was a magnitude 4.5.

In my personal, Keith Seinfeld metrics, having lived for nine years in California, that qualifies as big enough to feel, and maybe enough to unnerve you.  But, otherwise, pretty minor.  Officially, it’s a “light” but “notable earthquake,” and the biggest we’ve had since a similar one on October 7th, 2006 (which was centered near Buckley, WA).

If you felt it, you can share your report here with the USGS (and see where the shaking was felt most strongly).

Coincidentally, the seismology team at the U.W. reported new details this week on “slow earthquakes” and “deep tremors.”

Burying a seismometer on Washingtons Olympic Peninsula

Seismologist Mario La Rocca and U.W. grad student Wendy McCausland placing a seismometer near Sequim in 2004. (La Rocca is an Italian geologist who works closely with the U.W.)

As I explained in my radio story, these are imperceptible quakes which recur on a fairly predictable cycle — every 15 months.  The next one is due this summer, under the Olympic Peninsula.

The deep tremors and slow quakes are explained in this week’s journal Science.  It appears they’re related to the Juan de Fuca plate subducting under the North American plate.  Each slow quake adds a little more stress and strain to the major fault along the Washington coast.  Every 500 years, roughly, that fault releases in a mega-thrust earthquake.  Ken Creager at the U.W. says it seems possible or even likely that the next mega-quake will happen during one of the slow earthquakes.

Unfortunately, he can only test the theory after the Big One happens.

Vaccine subsidies may end

My story on KPLU about a proposal to end state subsidies of childhood vaccines only brushed over the impact on pediatricians and family doctors.  It was a short story, written for a newscast.  This is not the most important budget cut pending in Olympia, or the one that will impact the most people.  But, it’s an example of a good program that probably is in trouble in this economy.

I traded messages with the president of the Washington chapter of the American Academy of Pediatricians.  Dr. Neil Kaneshiro wrote an eloquent explanation of what it might mean:

The burden on the pediatrician depends on how they respond to the change. As you have found out, it is a dramatic shift in policy. In the “old days” before Universal Purchase, pediatricians used to see kids for their checkups and then send them to the health dept for their vaccines. Not a very good system as some of those parents didn’t bother or weren’t able to take the kids in to a separate facility on a different day possibly missing work again just to get their vaccines. Now the vast majority of immunizations for kids are delivered in the pediatrician/family practitioner office because the immunization program makes it a seamless process. The benefits for kids were easy to see. No hassles and no barriers to immunizations. Immunization rates improved. (Many will say that Universal Purchase does not correlate with high immunization rates. That is true, but it definitely helps the rate by removing all financial barriers to immunizations so that any parent who wants one for their child can get it. The problem with immunization rates in Washington State is primarily with the strong anti-immunization sentiment fueled by celebrities like Jenny McCarthy. We have the highest proportion of families who opt out of school mandated vaccines in the nation.)

There are significant costs associated with provision of immunization services. Ordering, inventory, refrigeration/freezer capacity, needles, syringes, nurse/medical assistant time, physician counseling of patients.
Those are the costs with the current Universal Purchase program. When that is taken away, several other things come into play.
1. Acquisition cost. I estimate we have $150,000-200,000 worth of vaccine in our refrigerator and go through that monthly.
2. We would need vigilant monitoring of insurance reimbursement because doctors in other parts of the country have lost significant amounts of money because insurers were not reimbursing less than the actual cost of vaccine.
3. We would need to set up an entirely separate ordering and inventory system and institute failsafe measures to prevent vaccine from moving from VFC stock to Commercial stock and vice versa. Lots of potential fraud issues arise if VFC vaccine is used for someone with Blue Cross insurance. And potential bankruptcy issues arise if purchased vaccine is given to Medicaid kids.

Medicaid reimburses essentially nothing for the above services. Commercial insurance reimburses for the administration, but sometimes not the ordering, inventory refrigeration, insurance/overhead costs. The unspoken deal with the state was that physicians would move immunization services for Medicaid into the medical home since they were providing vaccines for everyone. In turn the state would be able to reduce the immunization infrastructure in the public health system as the primary care providers were taking care of it.

Depending on individual pediatricians vaccine purchasing power and negotiating position with insurers, buying and selling vaccine could be either profitable or not. Pediatricians are unfortunately not known for their business savvy and this will cause some practices to go under or stop doing immunizations.

I think that since pediatricians lose money every time they give a vaccine to a Medicaid child, it is possible that the financial strain will force some to revert back to the old system of referring kids to the health department for immunization services. Unfortunately much of that public health infrastructure has been dismantled and is unlikely to be rebuilt under the current budget situation.

The bottom line is that this will introduce barriers to immunization for kids that are not there now and our immunization rates will fall.

Mr. Gates, Rotarians, and polio

The Gates Foundation (do we still have to refer to it by its full, formal name?) is giving a whopping $255 million to help eradicate polio from Earth.  Bill made the announcement to a Rotary International conference today (1/21/09), because the Rotarians have been leading the push for polio eradication (raising money, volunteering, and using their local branches in places like India and Nigeria to push for political support).

Polio remains present in just four countries — India, Nigeria, Afghanistan, and Pakistan.   You can imagine the political/warfare challenges to delivering vaccine to remote villages in the “-stans.”  In India, the pockets of disease are also in remote areas (mostly in Uttar Pradesh).  And Nigeria has had a host of troubles, including a rumor five years ago that the vaccines were a plot against Muslim girls.  That caused a huge setback and a resurgence of the disease.

Some additional challenges today have to do with how polio behaves in the presence of other endemic diseases.  In those cases, it’s harder for the vaccine to provoke immunity, and more doses are required (sometimes 10 doses!).

There’s been a lot of debate over whether it’s worth the huge cost (billions of dollars) to wipe out the last few cases of one disease, when so many other diseases are causing more harm.  There are now fewer than 2,000 cases of polio a year.  But global health leaders say the resurgence we saw in Africa after the Nigerian troubles shows that you can’t permanently contain this highly contagious disease.  (It’s spread by a virus, either in contaminated water or by people who are carriers.)

Gates gave quite an inspirational speech to the Rotarians in San Diego.  I didn’t get a chance to hear it, but I was sent a transcript.  It turns out his wife Melinda has an aunt who was afflicted with polio, and has been in braces most of her life.

If the campaign succeeds, polio would be the second disease eradicated, after smallpox (officially gone as of 1980, according to the World Health Organization).

Movie theaters find second life, as third place

Digital technology (the savior or nemesis off all types of media) has a new role in movie theaters.  At least that’s the spin I got from the CEO of a small chain, called Galaxy Theatres, based in Sherman Oaks, CA.

Cinemas used to be limited to whatever films they had on-hand during any given week.  By going “digital,” they can play video from many potential sources — anything you can send via the internet or a satellite.  In addition to playing movies, they could show big-screen Monday Night Football in 3-D.  Or, host a giant viewing party for the Presidential Inauguration.  Or, rent the theater out for a myriad of possible personalized showings.

“Take the words ‘Movie Theater’ off the building.  What do you have?” asks Frank Rimkus, CEO of Galaxy.  I didn’t have much of an answer, so (surprise!) he had his own ready.  He calls it a state-of-the-art presentation facility, with a screen that’s two stories tall.  “If you’ve got that kind of building, what else can you do with it? That’s the question.”

In other words, maybe you’re proud of your 48-inch screen and surround sound at home.  But Galaxy boasts a 900-inch screen.  For extroverts: You could watch with 200 of your closest friends. And, as movie theaters experiment with restaurant-style food, you can imagine a near future where “going to the theater” is a little bit like going to a sports pub.  Voila – a new type of “third place” (a term coined by Ray Oldenburg to refer to social gathering spots).

Galaxy is trying to establish itself as a community gathering spot.  Tomorrow (Wednesday, 1/21/09), in Gig Harbor, WA, it’s playing middleman between the public schools and NASA.  A thousand public school students from the Peninsula School District will have a live satellite connection from the theater to the International Space Station.

The live 20-minute Q-and-A with two astronauts couldn’t happen at one of those old movie theaters using film.   (It’s free and open to the public, by the way, with doors opening at 9:30 am.)

So far, Rimkus says only about 10% of America’s cinemas have upgraded to digital projection.  The Cinerama in Seattle was one of the first.   But he predicts a massive changeover in the next five years.  “The industry is basically taking old propeller airplanes and replacing them with jets,” he says.

Hey, maybe Starbucks, promoter of the Third Place concept, could get into this … bring your laptop, have a latte, and watch a giant screen.

Smart dummies, spreading

Simulation is becoming a trendy buzzword in medicine.  Technology has advanced to the point where a lot of medical procedures can be practiced on high-tech mannequins, or via computer simulations.  A few studies have shown better outcomes for doctors who trained first on simulators, although the evidence is still somewhat preliminary. I have a story airing tomorrow (Thursday) on KPLU about the mannequins.  (Update 1/15 – story now posted here.)

I didn’t have room to mention in the story some of the expansion that’s in the works locally.  The University of Washington’s main simulation center, called ISIS, is not only in new digs at the surgery pavilion.  They’re getting ready to add a much bigger simulation center at Harborview hospital, possibly by the end of 2009, and another one after that at Seattle Children’s Hospital.  Then, there are plans to offer continuing medical education courses using the U.W. simulators.

That should keep the U.W. as one of the national leaders in medical simulation (the top spot is generally considered to be Stanford’s sim center).

The U.W. will be competing locally with Swedish Medical Center, which just opened its own simulation center, and expects to rent it out to train teams from other local hospitals.

The mannequins have come a long way from the old Resusci-Annie, used for CPR training.  They are still clearly dolls, so, as hospitals around the country start buying into simulation, expect to see a lot more innovations.  (Good news for the Norwegian company Laerdal, which invented the Resusci-Annie, and still makes the most popular mannequins.)

Laerdal's SimNewB

Laerdal's SimNewB

Also, for a nice overview of the use of simulation to make better medical teams, see Tom Paulson’s recent story in the P-I.

Understanding an avalanche

Our newsroom has been consumed just keeping up with fresh information about the flooding and storm impacts.  No time this week for a deeper look at anything.  But, this would have been a good topic:  Mark Moore of the Northwest Avalanche Center grabbed my attention during a news conference about the weather on New Year’s Eve.

He declared that the avalanche danger had become  “extreme.”  He explained, with a series of slides, how it’s not just having a large snowfall that makes for an avalanche.  It’s the type of snow and the temperatures during each successive snow-storm that make for a big hazard.  We saw this come true on the mountain passes last week, and especially this week.

This landslide/avalanche near Snoqualmie Pass took out not only all the layers of snow, but several  inches deep of soil as well — and a ski lift.  (I haven’t done any deeper research on this, but I’m pretty sure it has the same fundamental cause as the all-snow avalanches.)

Avalanche and landslide at Hyak (Snoqualmie Summit East)

Avalanche and landslide at Hyak (Snoqualmie Summit East) (WSDOT)

Check out the full gallery of photos posted by WSDOT.

And for a nice info-graphic explaining the underlying science, plus a profile of the scientists, see Tom Paulson’s story in the P-I (published just before the Hyak slide came rumbling down).